Introduction:MicroRNAs (miRNAs) are key post-transcriptional regulators that also take part in immune responses and recovery processes following exercise. While both gut microbiota composition and peripheral blood mononuclear cell (PBMC)-derived miRNAs are known to be influenced by endurance training, potential correlations between these two systems in athletes remain largely unexplored. Objective:This study aimed to investigate correlations between gut microbiota composition and PBMC miRNA expression following a maximal exercise stress test in endurance athletes. Methods:Fifty-eight participants (22 runners, 18 cyclists, and 18 controls) underwent maximal exercise testing, with blood samples collected pre- and post-maximal exercise stress test for small RNA sequencing of PBMCs. Baseline fecal samples were analyzed via 16S rRNA gene sequencing to characterize gut microbiota. Expression data of PBMC miRNAs and microbial taxonomic profiles were integrated to assess potential correlations. Results:Thirteen significant correlations (|r| = 0.41-0.51, p < 0.005) were identified between gut bacterial taxa known to produce short-chain fatty acids (SCFAs)-including Veillonella, Blautia, Coprococcus, Butyrivibrio, Propionibacterium, and Parabacteroides-and the expression of PBMC miRNAs following a maximal exercise test. The significantly expressed PBMC microRNAs included hsa-miR-545-3p, hsa-miR-126-3p, hsa-miR-1292-3p, hsa-miR-6805-5p, hsa-miR-3668, hsa-miR-196b-5p, hsa-miR-602, hsa-miR-324-5p, and hsa-miR-365a-3p, some of which are known to modulate inflammatory pathways and immune cell signaling. Conclusion:This is the first study demonstrating an association between resting gut microbiota composition and PBMC miRNA expression following maximal exercise stress test in endurance athletes. These findings raise the possibility of a complex association between gut microbial composition and PBMC miRNA expression in response to exercise. While causality cannot be inferred, the observed correlations suggest a candidate microbiota-miRNA that warrants further investigation in the context of exercise-induced immune regulation and recovery in athletes.

INTRODUCTION:The present position paper focuses on screening individuals from the general population who are interested in engaging in leisure time physical activities. This document, which relies on the expert perspective of the Sports Cardiology Forum of the Israeli Heart Society, was created to equip attending physicians with essential tools for addressing such inquiries. Given that sudden death resulting from ischemic heart disease is the leading cause of mortality among individuals over 35 years old who participate in high-intensity sports, screening within this demographic aims to detect coronary disease and its risk factors. Regular physical activity is a crucial component of healthy living, with its benefits outweighing potential risks. Asymptomatic individuals planning to undertake light to moderate physical activity, even if they are at high risk for atherosclerotic disease, do not necessitate preparticipation evaluation.

IntroductionStudying microRNAs in the immune cells of athletes offers a novel perspective on the molecular regulation of immune function and recovery, potentially uncovering strategies to enhance performance and resilience to physical stress. However, PBMC microRNA expression in endurance athletes, such as runners and cyclists, remains underexplored, especially with regard to sex differences.Aims(i) Assess sport- and sex-specific differences in PBMC microRNA expression induced by acute maximal and sub-maximal aerobic exercise in runners and cyclists and (ii) examine correlations between PBMC microRNAs and exercise performance. Methods: A total of 58 healthy athletes were included: 22 runners (9 females), 18 cyclists (9 females), and 18 active controls (9 females). Participants underwent VO2max and time-to-exhaustion tests, with blood samples collected pre- and post-exercise to analyze PBMC microRNA levels.ResultsRunners exhibited a higher microRNA response than cyclists or controls, with significant sex-based differences. After VO2max test, 279 microRNAs (255 upregulated) were altered in runners, compared to only seven microRNAs (none upregulated) in cyclists. Exercise intensity and duration had sport-specific effects on microRNA expression. Time-to-exhaustion in runners and weekly training volume in both groups were significantly associated with changes in PBMC microRNA profiles.ConclusionThis study reveals that PBMC microRNA expression in response to maximal and sub-maximal exercise tests are sport- and sex-specific, providing new insights into the molecular adaptations of endurance athletes and their relationship to athletic performance.

There is still a pressing need for further investigation to bridge the gap in understanding the differences in gut microbiota composition between female runners and their male counterparts. We aimed to determine the gut microbiota composition in competitive non-professional female and male runners and to correlate the gut bacteria to performance. Our study included 40 subjects, of which 22 were runners (13 males and 9 females) and 18 control subjects (9 males and 9 females, representing the general population who perform light physical activity with a weekly running volume of ≤5 km per week). Fecal specimens were collected and analyzed for taxonomic profiling to compare species’ relative abundances between males and females based on the results of 16SrRNA analysis. Bacterial alpha and beta diversity were assessed to determine the differences in microbial composition between runners and controls, and between sexes. Each participant underwent a maximal oxygen consumption test and a time-to-exhaustion test at 85% of the measured VO2max. Blood lactate was collected every 5 min during the tests. Bacterial alpha diversity showed a significant difference (p = 0.04) between runners and controls. Taxonomic analysis of gut microbiota composition showed a lower Enterobacteriaceae abundance and a higher Methanosphaera abundance in runners compared with the control group. Ten different bacteria (Methanosphaera, Mitsuokella, Prevotellaceae, Megamonas, Rothia, Oscillospira, Bacteroides, Odoribacter, Blautia massiliensis, Butyricicoccus_pullicaecorum) were positively correlated with exercise (VO2max, lactate blood levels, time to exhaustion, and weekly training volume). We found no significant differences in the gut microbiota composition between male and female runners. Gut microbiota composition positively correlates with sports performance in competitive non-professional female and male runners, and female runners show similar gut microbiome diversity to male runners.

We recently have shown that the gut microbiota composition in female and male runners positively correlates with sports, and female runners show similar gut microbiome diversity to male runners. However, gut microbiota composition has not yet been fully investigated in other endurance athletes, such as cyclists. Therefore, in the current study, we investigated the gut microbiome profiles in competitive, non-professional female and male cyclists compared to what we have shown in runners. We aim to understand (1) whether the gut microbiome signature is sport-specific; (2) whether there is a microbiome difference between female and male cyclists and runners; and (3) whether the gut bacteria expressed in cyclists and runners correlates with exercise performance. Our study included 58 subjects: 18 cyclists (9 males), 22 runners (13 males), and 18 control subjects (9 males). Fecal samples were obtained and subjected to taxonomic analysis to assess the relative abundances of species across subjects based on 16S rRNA sequencing results. Both alpha and beta diversity of the bacterial communities were evaluated to identify compositional variations between the groups. Each participant completed a maximal oxygen consumption test and a time-to-exhaustion test at 85% of the measured VO2max. Cyclists performed the test on an SRM ergometer, while runners used a motorized treadmill. Blood lactate levels were measured at 5 min intervals throughout the time-to-exhaustion trials. Alpha diversity demonstrated a significant difference (p-adj < 0.001) between cyclists and runners. Male cyclists showed significantly lower alpha diversity than runners (p-adj < 0.001). The taxonomic analysis of gut microbiota composition between cyclists, runners, and controls showed a lower or higher abundance of fifteen different bacteria. In cyclists, there was a significant positive correlation between six bacteria, and in runners, there was a significant positive correlation between eight bacteria, with weekly training volume, time-to-exhaustion, VO2max, and blood lactate levels. This study suggests potential sport-specific characteristics in long-distance cyclists’ and runners’ gut microbiome signatures. These findings emphasize the differences in gut microbiota between cyclists and runners, probably due to the difference in physiological and biomechanical conditions related to the activity mode during each sport.

PURPOSE:Cardiorespiratory fitness (CRF) declines with age, and greater declines increase the risk for adverse health outcomes. Understanding factors that attenuate age-related decreases in CRF can help extend healthy life. We sought to determine the longitudinal associations of aerobic physical activity, muscle-strengthening activity (MSA), and adiposity with CRF. METHODS:Study participants were enrolled in the Cooper Center Longitudinal Study and had three or more preventive medical examinations at the Cooper Clinic (Dallas, Texas) during 1987-2019. Aerobic activity and MSA were self-reported, and three measures of adiposity were clinically assessed: body mass index (BMI), body fat percentage, and waist circumference. CRF, expressed as metabolic equivalents (METs), was estimated by a maximal treadmill test. The longitudinal associations of aerobic activity, MSA, and adiposity with CRF were estimated using multivariable mixed linear regression models. RESULTS:The study included 6105 participants who were followed for a median of 7.1 yr. Most participants were men (83.6%), and their average age at baseline was 47.0 (SD = 8.7) yr. Mean CRF at baseline was 12.2 (SD = 2.3) METs. Increasing aerobic activity (per 500 MET·min·wk -1 , β = 0.069, 95% confidence interval = 0.064-0.074 METs) or MSA (per days per week, β = 0.066, 95% confidence interval = 0.058-0.073 METs) was associated with increased CRF over time. Increasing BMI, body fat percentage, or waist circumference were each associated with decreased CRF over time. CONCLUSIONS:These data offer longitudinal evidence on how changes in aerobic activity, MSA, and various measures of adiposity (beyond BMI) independently correlate with CRF over time. Healthy lifestyle behaviors that include increasing aerobic and MSA and limiting adiposity may positively influence the retention of fitness with age and improve downstream health outcomes.

The use of wearable sensors for real-time monitoring of exercise-related measures has been extensively studied in recent years (e.g., performance enhancement, optimizing athlete's training, and preventing injuries). Surface electromyography (sEMG), which measures muscle activity, is a widely researched technology in exercise monitoring. However, due to their cumbersome nature, traditional sEMG electrodes are limited. In particular, facial EMG (fEMG) studies in physical training have been limited, with some scarce evidence suggesting that fEMG may be used to monitor exercise-related measurements. Altogether, sEMG recordings from facial muscles in the context of exercise have been examined relatively inadequately. In this feasibility study, we assessed the ability of a new wearable sEMG technology to measure facial muscle activity during exercise. Six young, healthy, and recreationally active participants (5 females), performed an incremental cycling exercise test until exhaustion, while facial sEMG and vastus lateralis (VL) EMG were measured. Facial sEMG signals from both natural expressions and voluntary smiles were successfully recorded. Stable recordings and high-resolution facial muscle activity mapping were achieved during different exercise intensities until exhaustion. Strong correlations were found between VL and multiple facial muscles' activity during voluntary smiles during exercise, with statistically significant coefficients ranging from 0.80 to 0.95 (p<0.05). This study demonstrates the feasibility of monitoring facial muscle activity during exercise, with potential implications for sports medicine and exercise physiology, particularly in monitoring exercise intensity and fatigue.

(1) Background: Cardiac rehabilitation often emphasizes aerobic capacity while overlooking the importance of muscle strength. This study evaluated the impact of an enhanced remote strength training program (RCR-ST) on cardiac rehabilitation. (2) Methods: In this randomized prospective study (RCT registration number SMC-9080-22), 50 patients starting cardiac rehabilitation were assessed for muscle strength, aerobic capacity, and self-reported outcomes at baseline and after 16 weeks. Participants were divided into two groups: the RCR-ST group received a targeted resistance training program via a mobile app and smartwatch, while the control group received standard care with general resistance training advice. (3) Results: The RCR-ST group demonstrated significant improvements in muscle endurance, notably in leg extension and chest press exercises, with increases of 92% compared to 25% and 92% compared to 13% in the control group, respectively. Functional assessments (5-STS and TUG tests) also showed marked improvements in agility, coordination, and balance. Both groups improved in cardiorespiratory fitness, similarly. The RCR-ST group reported enhanced physical health and showed increased engagement, as evidenced by more frequent use of the mobile app and longer participation in the rehabilitation program (p < 0.05). (4) Conclusions: Incorporating a focused strength training regimen in remote cardiac rehabilitation significantly improves muscle endurance and patient engagement. The RCR-ST program presents a promising approach for optimizing patient outcomes by addressing a crucial gap in traditional rehabilitation protocols that primarily focus on aerobic training.

Myocardial blood flow (MBF) assessment can provide incremental diagnostic and prognostic information and thus the validation of dynamic SPECT is of high importance. We recently developed a novel cardiac phantom for dynamic SPECT validation and compared its performance against the GE Discovery NM 530c. We now report its use for validation of a new hybrid SPECT/CT System featuring advanced cadmium zinc telluride (CZT) technology in a ring array detector design (StarGuide™, GE HealthCare). Our recently developed cardiac phantom with injected technetium-99m radiotracer was used to create physiological time activity curves (TACs) for the left ventricular (LV) cavity and the myocardium. The TACs allow the calculation of uptake rate (K1) and MBF. The StarGuide system was used to acquire and process the TACs, and these were compared to the TACs produced by the phantom and its mathematical model. Fifteen (15) experiments with different doses representing various MBF values were conducted, and a standard statistic tool was applied for significance. The TACs produced by the StarGuide system had a significant correlation (p < 0.001) with the reference TACs generated by the phantom both for the LV (r = 0.94) and for the myocardium (r = 0.89). The calculated MBF difference between the system and the phantom was 0.14 ± 0.16 ml/min/g and the average relative absolute difference was 13.2 ± 8.1

Current studies report thermographic changes following aerobic or resistance exercise but not short, vigorous anaerobic exercise. Therefore, we investigated body surface temperature changes using thermal imaging following a short session of anaerobic exercise. We studied three different regions of interest (ROIs): the legs, chest, and forehead. Thermal imaging for each participant was performed before and immediately after completing a Wingate anaerobic test and every minute during a 15 min recovery period. Immediately after the test, the maximum temperature was significantly higher in all ROIs (legs, p = 0.0323; chest, p = 0.0455; forehead, p = 0.0444) compared to pre-test values. During the recovery period, both legs showed a significant and continuous temperature increase (right leg, p = 0.0272; left leg, p = 0.0382), whereas a non-significant drop was noted in the chest and forehead temperatures. Additionally, participants with a lower anaerobic capacity exhibited a higher delta increase in surface leg temperature than participants with higher anaerobic capacities, with a minimal change in surface leg temperature. This is the first study to demonstrate body surface temperature changes following the Wingate anaerobic test. This temperature increase is attributed to the high anaerobic mechanical power outputs achieved by the leg muscles and the time taken for temperature reduction post-exercise.

Aims Cardiac rehabilitation is an essential component of secondary prevention consistently unexploited by most eligible patients. Accordingly, the remote cardiac rehabilitation program (RCRP) was developed to create optimal conditions for remote instruction and supervision for patients to enable successful completion of the program. Methods This study comprised 306 patients with established coronary heart disease who underwent a 6-month RCRP. RCRP involves regular exercise, monitored by a smartwatch that relays data to the operations center and a mobile application on the patient's smartphone. A stress test was performed immediately before the RCRP and repeated after 3 months. The aims were to determine the effectiveness of the RCRP in improving aerobic capacity, and correlating the program goals and first-month activity, with attaining program goals during the last month. Results Participants were mostly male (81.5%), aged 58 ± 11, enrolled in the main after a myocardial infarction or coronary interventions. Patients exercised aerobically for 183 min each week, 101 min (55% of total exercise) at the target heart rate. There was a significant improvement in exercise capacity, assessed by stress tests, metabolic equivalents which increased from 9.5 ± 3 to 11.4 ± 7(p < 0.001). Independent predictors of RCRP goals were older age and more minutes of aerobic exercise during the first program month (p < 0.05). Conclusion Participants succeeded in performing guideline recommendations, resulting in a significant improvement in exercise capacity. Older age and increased volume of first month of exercise were significant factors associated with a greater likelihood to attain program goals.

Background: There is no agreement on the best strategy for interpreting/ analyzing cardiopulmonary exercise test (CPET) results. Aims: This study aims to evaluate the feasibility of using computer-aided algorithms to evaluate CPET data to identify the exercise limitation/ intolerance level. Methods: This study used 206 retrospective CPET files from the Pulmonary Institute and the Cardiology Rehabilitation Center at the Sheba Medical Center and 50 from the exercise physiology laboratory at the Washington-Hill College, both in Israel. Eighty patients with confirmed primary cardiovascular-related exercise limitation, seventy-six with ventilatory-related exercise limitation, and fifty healthy (none or very mild exercise restraints) subjects comprised the pool of examined CPET data. Support Vector Machine (SVM) Learning was performed on 150 (50 in each group) of the 206 CPETs, while model validation was performed on the remaining 56 CPET files. By applying the K-means clustering method, distribution analysis was used to compare the SVM interpretive module's performance to that of senior cardiologists, pulmonologists, and expert exercise physiologists. Results: Overall, the proposed interpretive model has a predictive power of between 78% and 100%, as shown by its ability to correctly classify the degree of exercise limitation. Conclusions: The proposed machine-learning CPET interpretive module was highly sensitive and specific in identifying patients with mild, moderate, or severe cardiovascular- or ventilatory-related exercise limitations/ intolerance. Comparable modules may be applied to additional (kinds of exercise limitations) and larger populations, making this tool powerful and clinically applicable.

Purpose: Asynchronous home-based cardiac rehabilitation (HBCR) is a viable alternative to center-based cardiac rehabilitation (CBCR). However, to achieve significant functional improvement, a high level of adherence and activity must be achieved. The effectiveness of HBCR among patients who actively avoid CBCR has not been effectively investigated. This study aimed to investigate the effectiveness of the HBCR program among patients unwilling to participate in CBCR. Methods: A randomized prospective study enrolled 45 participants to a 6-mo HBCR program and the remaining 24 were allocated to regular care. Both groups were digitally monitored for physical activity (PA) and self-reported outcomes. Change in peak oxygen uptake (VO 2peak ), the primary study outcome, was measured by the cardiopulmonary exercise test, immediately before program start and 4 mo thereafter. Results: The study included 69 patients, 81% men, aged 55.9 ±12 yr, enrolled in a 6-mo HBCR program to follow a myocardial infarction (25.4%) or coronary interventions (41.3%), heart failure hospitalization (29%), or heart transplantation (10%). Weekly aerobic exercise totaled a median of 193.2 (110.2-251.5) min (129% of set exercise goal), of which 112 (70-150) min was in the heart rate zone recommended by the exercise physiologist. After 4 mo, VO 2peak improved by 10.2% in the intervention group versus −2.7% in the control group (+2.46 ± 2.67 vs −0.72 ± 3.02 mL/kg/min; P < .001). Conclusion: The monthly PA of patients in the HBCR versus conventional CBCR group were well within guideline recommendations, showing a significant improvement in cardiorespiratory fitness. Risk level, age, and lack of motivation at the beginning of the program did not prevent achieving goals and maintaining adherence.

We previously were able to predict the anaerobic mechanical power outputs using features taken from a maximal incremental cardiopulmonary exercise stress test (CPET). Since a standard aerobic exercise stress test (with electrocardiogram and blood pressure measurements) has no gas exchange measurement and is more popular than CPET, our goal, in the current paper, was to investigate whether features taken from a clinical exercise stress test (GXT), either submaximal or maximal, can predict the anaerobic mechanical power outputs to the same level as we found with CPET variables. We have used data taken from young healthy subjects undergoing CPET aerobic test and the Wingate anaerobic test, and developed a computational predictive algorithm, based on greedy heuristic multiple linear regression, which enabled the prediction of the anaerobic mechanical power outputs from a corresponding GXT measures (exercise test time, treadmill speed and slope). We found that for submaximal GXT of 85% age predicted HRmax, a combination of 3 and 4 variables produced a correlation of r = 0.93 and r = 0.92 with % error equal to 15 ± 3 and 16 ± 3 on the validation set between real and predicted values of the peak and mean anaerobic mechanical power outputs (p < 0.001), respectively. For maximal GXT (100% of age predicted HRmax), a combination of 4 and 2 variables produced a correlation of r = 0.92 and r = 0.94 with % error equal to 12 ± 2 and 14 ± 3 on the validation set between real and predicted values of the peak and mean anaerobic mechanical power outputs (p < 0.001), respectively. The newly developed model allows to accurately predict the anaerobic mechanical power outputs from a standard, submaximal and maximal GXT. Nevertheless, in the current study the subjects were healthy, normal individuals and therefore the assessment of additional subjects is desirable for the development of a test applicable to other populations.

BACKGROUND:To evaluate chorda tympani nerve function as measured by unilateral increases of gustatory thresholds in the presence of ipsilateral acute otitis media.METHODS:Prospective clinical study comparing electrogustometric measurements was conducted to evaluate the taste thresholds of each side of the tongue in a patient during an acute episode of unilateral acute otitis media. Included were patients aged 12-40 who presented to the emergency department and outpatient ear, nose, and throat clinic of a university-affiliate tertiary medical center with unilateral acute otitis media between January 2019 and January 2020 and consented to the study.RESULTS:Eleven patients were initially recruited into the study, and 10 patients aged (mean ± standard deviation) 26.1 ± 11.2 years comprised the final study group. Taste thresholds were significantly elevated on the side ipsilateral to the ear affected by acute otitis media (P < .05).CONCLUSION:Chorda tympani nerve conductance is impaired during the acute stage of acute otitis media. This may have implications in the understanding of peripheral neural properties during acute middle ear inflammatory conditions and on the diagnosis of acute otitis media.

BACKGROUND:Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. METHODS:We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. RESULTS:The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved. CONCLUSION:Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.