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ABSTRACT: Hypertrophic cardiomyopathy is a genetic heart condition occurring in up to 1 in 200 patients in the United States, many of whom are young and otherwise healthy. This condition puts those affected at increased risk for adverse cardiac outcomes, including sudden cardiac arrest and death, with particular concern for this to occur during exercise and other forms of exertion. Recent studies aimed at evaluating the risk of exercise in hypertrophic cardiomyopathy patients have suggested that moderate and even vigorous exercise may be safe for certain patients. Clinical guidelines are changing to reflect this recent information and to encourage a shared decision-making approach, which can allow more hypertrophic cardiomyopathy patients to participate in health-promoting exercise activities.

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Branched-chain amino acids (BCAA) are used as a recovery method after exercise-induced muscle damage (EIMD). Although data suggest that BCAA may alleviate the delayed-onset muscle soreness (DOMS) evoked by EIMD, there is no consensus about the most effective supplementation protocol. To investigate the effects of BCAA on DOMS after a single exercise session that caused EIMD, a systematic review and meta-analysis were conducted on the effectiveness of BCAA supplementation to reduce DOMS symptoms in healthy subjects after a single session of EIMD. Randomized clinical trials (RCT) were searched in Medline, Cochrane Library, Science Direct, SciELO, LILACS, SciVerse Scopus, Springer Link journals, Wiley Online Library, and Scholar Google, until May 2021. Ten RCTs were included in the systematic review and nine in the meta-analysis. Seven studies demonstrated that BCAA reduced DOMS after 24 to 72 h. BCAA doses of up to 255 mg/kg/day, or in trained subjects, for mild to moderate EIMD, could blunt DOMS symptoms. However, high variability between studies due to training status, different doses, time of treatment, and severity of EIMD do not allow us to conclude whether BCAA supplementation is efficient in untrained subjects, applied acutely or during a period of pre to post days of EIMD, and at higher doses (> 255 mg/kg/day). The overall effects of BCAA on DOMS after a single session of exercise were considered useful for improving muscle recovery by reducing DOMS in trained subjects, at low doses, in mild to moderate EIMD, and should not be administered only after the EIMD protocol.

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Physical exercise has acute and chronic effects on inflammatory balance, metabolic regulation, and redox status. Exercise-induced adaptations are mediated by enhanced 70-kDa heat shock protein (HSP70) levels and an improved heat shock response (HSR). Therefore, exercise could be useful against disease conditions [obesity, diabetes mellitus (DM), and exposure to atmospheric pollutants] marked by an impaired HSR. However, exercise performed by obese or diabetic subjects under pollution conditions might also be dangerous at certain intensities. Intensity correlates with an increase in HSP70 levels during physical exercise until a critical point at which the effort becomes harmful and impairs the HSR. Establishing a unique biomarker able to indicate the exercise intensity on metabolism and cellular fatigue is essential to ensure adequate and safe exercise recommendations for individuals with obesity or DM who require exercise to improve their metabolic status and live in polluted regions. In this review, we examined the available evidence supporting our hypothesis that HSP70 could serve as a biomarker for determining the optimal exercise intensity for subjects with obesity or diabetes when exposed to air pollution and establishing the fine threshold between anti-inflammatory and pro-inflammatory exercise effects.

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Infrared thermography (IRT) has gained popularity in sports medicine for determining whether changes in skin temperature relate to pain and muscle damage. Such a relationship would support IRT as a non-invasive method to monitor these physiological responses. However, the literature remains controversial. Here, we determine the relationship between exercise-induced muscle soreness (DOMS), pain, and skin temperature in men and women before and after exercise. Twenty-two physically active adults (10 men and 12 women) completed a squat exercise protocol to induce muscle damage. Skin temperature, DOMS, and pressure pain threshold (PPT) were assessed in the quadriceps pre, post-exercise, and 48 h post-exercise. DOMS increased similarly in men and women post-exercise and 48 h post-exercise. PPT was lower in women compared to men. PPT decreased 48 h post-exercise for men but did not differ between the moments for women. Skin temperature responses were sex-dependent. Mean and maximum temperatures increased post-exercise for men, and maximum temperature reduced 48 h post-exercise. In women, the minimum temperature increased 48 h post-exercise. DOMS was not predicted by skin temperature but showed a direct association between pre and 48 h post-exercise variation of maximum skin temperature and PPT. We conclude that there is a sex-dependent effect in analyzing skin temperature changes in response to exercise, something that seems to not have been addressed in previous studies. To date, inferences are generally assumed as similar for both men and women, which we show may not be the case.

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To evaluate the availability and characteristics of exercise training during hemodialysis in Brazil and to identify the reported barriers to exercise program implementation and maintenance. All dialysis units were assessed for eligibility using the database of the Brazilian Society of Nephrology. Each dialysis unit was contacted by telephone and the questions were administered. In dialysis units with exercise training, questions related to personnel involved, exercise components, and program delivery were included. Additionally, the barriers to exercise program implementation and maintenance were evaluated. This study included 261 dialysis units that responded to the survey. Forty-one dialysis units reported exercise training during hemodialysis in Brazil (prevalence of 15.7%). We identified 66 physiotherapists and 10 exercise physiologists in dialysis units with exercise training. Resistance training was the most common program component (92.7%). Hypotension (90.5%) and muscle cramps (85.7%) were the most common adverse events reported. In dialysis units with exercise training, poor patients' adherence to exercise was the most commonly reported barrier. The most prevalent barrier in dialysis units that tried or never tried to implement the exercise programs was a lack of resources. The number of dialysis units that have exercise training during hemodialysis in Brazil is low, and the most common program component is resistance training. A lack of resources was the most prevalent barrier in dialysis units that tried or never tried to implement the exercise programs.

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En un estudio abierto, prospectivo a corto plazo se incluyeron 25 pacientes de uno u otro sexo, con edades comprendidas entre 16 a 60 años y con rigidez por cocntractura muscular consecutiva a traumatismo o ejercicio. A cada paceinte se le administró un nuevo mioespasmolítico: tizanidina por vía oral a dosis de 4 mg cada 8 horas durante 5 días. Se valoró en todos los casos, al inicio del estudio y a los 3 y 5 días de tratamiento el dolor espontáneo, el dolor a la palpación, la tensión muscular y la incapacidad funcional. También se valoraron los efectos seccundarios que se presentaron durante la administración de la tizanidina. Se notó una importante mejoría en los cuatro parámetros estudiados desde el tercer día de tratamiento, misma que se mantuvo hasta el final del estudio. El medicamento fue bien tolerado a dosis de 12 mg ya que el 68% de los pacientes no presentaron ningún efecto secundario. Se concluye que la tizanidina es una buena alternativa para el tratamiento de las contracturas musculares postraumáticas y por ejercicio

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