BACKGROUND:The efficacy of prehabilitation through preoperative strength training for individuals undergoing total knee arthroplasty (TKA) remains inconclusive. OBJECTIVE:The present study aimed to evaluate the effects of maximal strength training (MST) before operation on muscle strength and physical function 3 weeks following TKA. METHODS:48 individuals scheduled for fast-track unilateral primary TKA were randomized to MST (n = 24), performing 4 sets at 4 repetition maximum in seated leg press 3 times per week for 8 weeks, or control usual care (CON, n = 24). The primary outcome was bilateral leg press maximal strength. Secondary outcomes were performance-based physical function, including 10-step stair climbing, 30 s sit-to-stand, 40 m fast-paced walking, and unipedal stance tests, and self-reported physical function as knee injury and osteoarthritis outcome score-physical function short form (KOOS-PS), European quality of life 5 dimension, 5 Level, and forgotten joint score. RESULTS:MST improved bilateral leg press 1RM relative to body weight after intervention (mean change 0.45, P < 0.0001), and there were between-group differences in the delta changes from baseline to preoperation (mean difference 0.43, P < 0.0001) and postoperation (mean difference 0.27, P < 0.001), favoring MST. MST also led to better maintenance of postoperative stair climbing (mean difference -3.38 s, P = 0.0013). Although the MST group experienced a significant preoperative improvement in sit-to-stand (mean change 2 repetitions, P = 0.0019), walking ability (mean change -2.28 s, P < 0.001), and KOOS-PS (mean change 8, P < 0.0001), these effects did not extend to postoperative outcomes. CONCLUSIONS:The findings indicate that preoperative MST is safe and effective in improving muscle strength and preserving stair-climbing ability for individuals undergoing TKA, positioning MST as a pragmatic prehabilitation strategy. CLINICAL TRIAL REGISTRATION:NCT05892133.

Changes in the nervous system with age are largely responsible for decreased force generating capacity (FGC), i.e., maximal strength and rate of force development. Emphasizing studies applying near-maximal/maximal contraction and stimulation intensity during testing, and training intensity above 60 % maximal strength, this review uncovered that efferent neural drive, comprising motor unit recruitment and firing frequency, consistently appeared to be a main contributing factor for the decline and subsequent improvement in FGC with age. However, identifying single steps along the efferent neural drive pathway is challenging. Structural changes in the brain and corticospinal excitability alterations may be partly responsible for the reduced FGC, although these are seldom investigated in relation to FGC. Further, methodological constraints associated with measurements of corticospinal excitability challenge firm conclusions. Conduction velocity in the corticospinal tract is slower with age and intracortical inhibition increases, the latter may be improved following strength training. Peripheral factors - loss of spinal α-motoneurons, reduced spinal α-motoneuron excitability, and reduced conduction velocity - also contribute, albeit without considerable improvements following strength training. Despite methodological constraints associated with corticospinal measurements, we conclude that the efferent neural drive enhancement observed following strength training is likely a result of central nervous system adaptations, as peripheral adaptations appear to be negligible. It therefore seems essential to apply training that specifically targets efferent neural drive enhancement with older age. Heavy loads are imperative for efferent neural drive improvements and should be recommended to maintain or improve efferent neural drive and maximal FGC in older adults.

OBJECTIVE:Preoperative physiotherapy in patients receiving primary total knee arthroplasty (TKA) aims to relieve pain, delay surgery, and improve postoperative recovery. This study investigates the change in PROMs and pain after primary TKA between patients who received preoperative physiotherapy (P) and those who did not (NP). DESIGN:Registry-based cohort study with data from an institutional registry. PATIENTS:1,688 patients followed a standardized fast-track clinical pathway between August 2017 and January 2024 and were grouped in P or NP. METHODS:Primary outcome was KOOS-PS at 2 months and 1 year postoperatively. Secondary outcomes included pain, the Forgotten Joint Score, and EQ-5d-5L. Two anchor questions related to self-perceived knee function and willingness to have the surgery again at 12 months' follow-up were also evaluated. RESULTS:The model estimate demonstrated no significant between-group difference in KOOS-PS at 2 months (1.12 points; p = 0.079) or 1-year follow-up (1.25 points; p = 0.097). Visual inspection of descriptive plots showed that NP patients had higher KOOS-PS, less pain, and better joint score and quality of life at all time points. At 12 months' follow-up, both groups had similar responses to the anchor questions. CONCLUSION:After adjustment for baseline differences, no between-group differences in postoperative self-reported physical function were observed; consistently lower scores in the physiotherapy group may reflect systematic preoperative differences between groups.

Skeletal muscle strength of the lower limbs is negatively impacted in advanced knee osteoarthritis. However, its role in predicting physical function of these patients remains unclear. Therefore, we aimed to evaluate hierarchical linear regression associations between lower limbs' maximal muscle strength, rate of force development and physical function in 50 patients (age: 65 ± 8 years; 22 males and 28 females; and BMI: 31 ± 5 kg/m2) with advanced knee osteoarthritis. Results revealed that leg press maximal strength and leg extension maximum voluntary contraction were associated with sit-to-stand and stair climbing performance (all p < 0.001) and accounted for variances of 29 % and 38 % in 30-s sit-to-stand and 37 % and 24 % in stair climbing performance, respectively. Leg press maximal strength and leg extension maximum voluntary contraction were also associated with Knee Injury and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS) (both p = 0.041), each accounting for 7 % of the variance. Similarly, rate of force development was associated with 30-s sit-to-stand (p < 0.001) and stair climbing performance (p = 0.05), explaining 22 % and 6 % of additional variances, respectively. No association was observed between measures of muscle strength and 40 m fast-paced walking. The present study highlights maximal muscle strength, and in part rate of force development, as powerful predictors of physical function in patients with advanced knee osteoarthritis and may be used as simple, valuable measures when evaluating patients' physical function.

Older adults typically exhibit reductions in skeletal muscle maximal strength and the ability to produce force rapidly. These reductions are often augmented by concomitant acute and chronic diseases, resulting in attenuated physical performance and higher propensity of falls and injuries. With the proportion of older adults in the population increasing, there is an alarming need for cost-effective strategies to improve physical performance and combat a multitude of age-related diseases. Surprisingly, despite convincing evidence emerging over three decades that strength training can substantially improve maximal strength (1RM), rate of force development (RFD) and power, contributing to improved health, physical performance and fall prevention, it appears that it has not fully arrived at the older adults' doorsteps. The aim of the current narrative review is to accentuate the convincing benefits of strength training in healthy and diseased older adults. As intensity appears to play a key role for improvements in 1RM, RFD and power, this review will emphasize training performed with heavy (80%-84% of 1RM) and very heavy loads (≥ 85% of 1RM), where the latter is often referred to as maximal strength training (MST). MST uses loads of ~90% of 1RM, which can only be performed a maximum of 3-5 times, 3-5 sets and maximal intentional concentric velocity. Strength training performed with loads in the heavy to very heavy domain of the spectrum may, because of the large increases in muscle strength, focuses on neural adaptations and relatively low risk, provides additional benefits for older adults and contrasts current guidelines which recommend low-to-moderate intensity (60%-70% of 1RM) and slow-moderate concentric velocity. This review also provides information on practical application of MST aimed at practitioners who are involved with preventive and/or rehabilitative health care for older adults.

Although many studies have investigated whether aerobic training in hypoxia (IHT) could bring advantages to maximal oxygen uptake (V̇O2max) and sea-level performance when compared to analogous normoxic training (NT), the literature results are inconsistent. This variability may come from differences in population, training protocols, hypoxic methods, and potential bias. Therefore, a comprehensive meta-analysis with strict inclusion criteria is needed to assess the effects of aerobic IHT on V̇O2max and performance. This study aims to review previous meta-analyses and analyze all parallel-design studies examining the effect of aerobic IHT compared to NT on V̇O2max and sea-level aerobic performance. Systematic research was conducted following PRISMA guidelines regarding the effects of aerobic IHT on sea-level V̇O2max and performance outcomes. The analysis accounted for characteristics of the population, training protocol, hypoxic environment, and publication details. A total of 35 studies involving 524 participants were included. The analysis showed that IHT, compared to NT, did not significantly improve V̇O2max (p = 0.333), peak power output (p = 0.159), and time to exhaustion (p = 0.410). Subgroup analyses identified no significant differences based on fitness level (p = 0.690) and exercise modality (p = 0.900); however, a publication bias was found (p = 0.004). These results suggest that, despite some enthusiastic findings in the literature, possibly influenced by publication-related biases, aerobic IHT does not offer superior improvement in V̇O2max and performance compared with NT. Therefore, adding hypoxia to aerobic exercise does not enhance training adaptations.

Background: Mechanical net efficiency ( η net) has proven to be mainly dependent on skeletal muscle mitochondria density. Due to the difficulty of estimating energy expenditure for high-intensity exercise, ηnet was only evaluated for intensities below the lactate (La - ) threshold. Therefore, the aim of this study was to estimate ηnet at high-intensity exercise, to find its main determinants and to compare them to those of moderate-intensity ηnet. Considering the relevance of oxygen delivery and extraction during near-maximal effort, we hypothesized that stroke volume (SV), cardiac output (Q) and net oxidative phosphorylation could be the three main factors influencing the η net for high-intensity exercise. Methodology: On the first day, 14 healthy participants (9 males, 5 females; age 24 ± 3 years) performed an incremental exercise test on a semi-recumbent ergometer to determine the peak oxygen uptake (VO 2max ) and power output (PPO). On the second day, the subjects performed a sub-maximal graded exercise test on the same ergometer with two 6-minute steps at 25% (moderate intensity) and 75% (high intensity) of the PPO. VO 2 and heart rate (HR) were monitored continuously and La - was collected at the end of each step. SV was assessed using cardiac ultrasound during exercise and Q was derived from SV and HR. We considered the last 30 s of each step. η net was calculated as the ratio of mechanical work (converted to kcal·min −1 ) to energy expenditure above the resting metabolism (also converted to kcal·min −1 ). Net expenditure was calculated from the VO2 values. For each step with more than 4.0 mmol·L −1 of La - , the glycolytic contribution was added to aerobic metabolism and estimated considering 3.0 mL·kg −1 of VO 2 for each 1 mmol·L −1 of La - accumulation. On the last day, the subject underwent a muscle biopsy of vastus lateralis to measure the net oxidative phosphorylation capacity (P-L net OX ). Summary of Results: The subject reached a mean PPO of 291±71 W and a VO 2max of 3.65±0.95L·min −1 . η net 25 was 21.7±5.3%, while η net 75 was 17.9±2.9%. HR 25 and SV 25 were 103.8±15.0bpm and 97.1±21.6mL, while HR 75 and SV 75 were 173.2±9.2bpm and 116.4±45.9mL, with the resulting Q 25 and Q 75 of 10.1±2.0 and 22.0±5.1L·min −1 , respectively. P-L net OX was 75.8±22.8pmol·s -1 ·mg -1 . The analyses do not show a correlation between central hemodynamics parameters and η net for either 25% (SV 25 : r = 0.224 and Q 25 : r = 0.220) and 75% of PPO (SV 75 : r = -0.280 and Q 75 : r = 0.390), despite the HR is lower for higher efficiency at 25% of PPO (HR 25 : r =-0.630, p=0.016*; HR 75 : r=-0.280). Conversely, P-L net OX correlates positively with η net 75 (r=0.600; p=0.023*), but not with η net 25 (r=-0.130). Conclusions: Contrary to our hypothesis, these results indicate that central hemodynamics parameters do not influence η net at high exercise intensity. However, mitochondria oxidative capacity positively correlates with high intensity η net. Therefore, high intensity η net is likely a product of peripheral factors related to mitochondria oxidative capacity rather than a consequence of central hemodynamic response. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Regular physical activity and endurance exercise training prevent age-related vascular endothelial dysfunction in the arm in men. However, the effects of physical activity and/or endurance exercise training in the legs, which have a greater predisposition for vascular disease, have not been completely elucidated. This study sought to examine the impact of aging, physical activity, and endurance exercise training on leg vascular function in men. Flow-mediated dilation (FMD) of the superficial femoral and popliteal arteries (SFA and PA, respectively) was assessed in a total of 39 men, comprised of 10 young sedentary (Y; 23 ± 2 yr), 8 older sedentary (OS; 76 ± 8 yr), 9 older physically active (OA; 71 ± 8 yr), and 12 older endurance exercise trained (OT) subjects with exceptional aerobic exercise capacity (V̇o2max) for their age (70 ± 3 yr, V̇o2max = 53 ± 6 mL·kg-1·min-1). FMD was lower in the OS group compared with the Y in the SFA (Y: 4.3 ± 2.1%, OS: 1.7 ± 1.0%, P = 0.005) and PA (Y: 5.8 ± 2.4%, OS: 1.9 ± 1.1%, P < 0.05). SFA and PA FMD were not different from OS in the OA group (SFA: 2.8 ± 1.5%; PA: 1.6 ± 1.0%) but were higher than OS in the OT group (SFA: 3.4 ± 2.3%, P = 0.043; PA: 4.2 ± 3.0%, P = 0.025) and not different from Y. There was evidence of a moderate-strong correlation between SFA (r = 0.32, P = 0.052) and PA (0.36, P = 0.037) FMD and V̇o2max but not physical activity levels. These findings suggest that habitual physical activity in general, and endurance exercise training in particular, diminishes the detrimental effect of aging on lower limb vascular function in men, and this may be linked to an augmented V̇o2max.NEW & NOTEWORTHY In the current study, we provide evidence of a relation between high levels of physical activity associated with lifelong endurance exercise training and protection from age-related declines in vascular endothelial function in the lower limb in men. Moreover, our findings suggest that aerobic fitness, in particular, may confer the benefits of endurance exercise training in maintaining lower limb endothelial function with advancing age.

PURPOSE:The effect of exercise on serum concentration of vitamin D metabolites remains inconclusive, with studies reporting deviating results. This study evaluated the acute effect of a single session of two specific exercise forms; strength training (ST) and high-intensity interval training (HIIT), on circulating 25-hydroxyvitamin D (25(OH)D), free 25(OH)D and 1,25-dihydroxyvitamin D (1,25(OH) 2 D), and skeletal muscle vitamin D receptor (VDR) gene expression, in healthy adults. METHODS:Thirty-nine participants (19 women and 20 men, aged 21-30 yr) completed a single bout of ST and HIIT exercise, separated by 2 weeks. Serum concentration of total 25(OH)D, free 25(OH)D and 1,25(OH) 2 D were assessed before exercise, immediately after, and 3 and 24 h after each session. Muscle biopsies were obtained at rest (first visit), and at 3 and 24 h post ST and HIIT, and analyzed for VDR gene expression. Repeated-measures ANOVA was used to assess serum concentration across time, whereas a one-way ANOVA was used for muscle VDR gene expression analyses. RESULTS:Serum concentration of 25(OH)D or free 25(OH)D did not change after either exercise mode when correcting for plasma volume alterations. 1,25(OH) 2 D was reduced by 13.1 ± 18.3 pmol·L -1 and 7.1 ± 9.6 pmol·L -1 immediately after ST and HIIT, respectively ( P < 0.001). Muscle VDR mRNA expression increased after ST by 3.1 ± 1.8 (3 h) and 2.2 ± 1.7 (24 h) fold change ( P < 0.05). CONCLUSIONS:One single session of ST or HIIT did not alter serum concentration of 25(OH)D and free 25(OH)D when correcting for plasma volume changes. Both exercise modes caused a transient reduction in 1,25(OH) 2 D suggesting utilization of 1,25(OH) 2 D by muscle cells after exercise. Elevated VDR gene expression after ST suggests a functional role of VDR in fast-twitch muscle fibers.

Improving peak oxygen uptake (V̇O2peak) and maximal strength are key objectives of rehabilitation for patients with unspecific musculoskeletal disorders (MSDs). Although high-intensity training yield superior outcomes for these factors, patients with MSDs may not tolerate high-intensity due to pain and fear. Therefore, we examined the effect and feasibility of incorporating aerobic high-intensity intervals (HIITs) and maximal strength training (MST) in a standard clinical rehabilitation program for patients with unspecific MSDs. 73 patients (45 ± 10 years) with MSDs partaking in a standard, public, and 4-week rehabilitation program were randomized to high-intensity training (HG: 4 × 4 minutes intervals at ∼90% of maximal heart rate; HRmax, and 4 × 4 repetitions leg press at ∼90% of 1 repetition maximum; 1RM, with maximal intended velocity) or keep todays treatment of low-to moderate-intensity training (MG: various cycling, walking, and/or running activities at ∼70%-80% of HRmax and 3 × 8 - 10 repetitions leg press at ∼75% of 1RM without maximal intended velocity). HG improved V̇O2peak (12 ± 7%) and leg press 1RM (43 ± 34%) more than moderate-intensity group (V̇O2peak; 5 ± 6%, 1RM; 19 ± 18%, both p < 0.001). We observed that no adverse events and no between-group differences in dropout rate or self-reported quality of life (both p > 0.05). There were positive correlations between improved V̇O2peak and improved physical (p = 0.024) and emotional (0.016) role functioning. We conclude that both high-intensity interval training and MST are feasible and improve V̇O2peak and maximal strength more than standard low-to moderate-intensity treatment of patients with unspecific MSDs. Our findings suggest that high-intensity training should be implemented as a part of standard clinical care of this patient population.

Background Patients with schizophrenia suffer from physical health conditions, culminating in reduced physical functioning with enormous costs for patients and society. Although aerobic endurance and skeletal muscle strength, typically reduced in this population, relate to cognition and function, no study has explored their respective contributions to performance of functional skills and everyday tasks. Methods In a cross-sectional study, 48 outpatients (28/20 men/women; 35 +/- 11(SD) years) with schizophrenia spectrum disorders (ICD-10; F20-25) were administered the UCSD Performance-based Skills Assessment-Brief (UPSA-B; functional skills), Specific Level of Functioning (SLOF; functional performance) and the Positive and Negative Syndrome (PANSS) scale. Peak oxygen uptake (VO2peak) was assessed along with leg press maximal muscle strength (1RM) and mechanical power. Results UPSA-B performance was associated with VO2peak (r = 0.28,p < 0.05), accounting for 8 % (p < 0.05) of shared variance, but was unrelated to 1RM and mechanical power. The SLOF physical functioning domain was associated with VO2peak (r = 0.30,p < 0.05) and 1RM (r = 0.24,p < 0.05), while SLOF personal care (r = 0.27,p < 0.05) and activities (r = 0.30,p < 0.05) were related only to VO2peak. Hierarchical regression analyses revealed that while VO2peak and age combined to account for 20 % (p < 0.05) of the variance in physical functioning, the contribution of 1RM was eliminated after adjusting for age. VO2peak and negative symptoms combined predicted 24 % and 35 % of the variance in personal care and activities, respectively. UPSA-B scores did not add to the prediction of SLOF scores. Conclusions Although VO2peak and 1RM both relate to functional outcomes, the combination of VO2peak, age, and negative symptoms exert the greatest detrimental influence on functional performance beyond skills deficits.

Although exercise is medicine for outpatients with schizophrenia, it is unclear if one-year adherence-supported exercise leads to a "tipping point", at which the exercise becomes a routine manifested as life-long training in the patient group. METHODS:Forty-eight outpatients (28 men/20 women: 35 ± 11 (mean ± SD) years) with schizophrenia (ICD-10: F20-29) were randomised to: 1) collaborative care group (TG), performing aerobic interval (AIT; 4 × 4-min treadmill walking/running at ∼90 % peak heart rate) and leg press maximal strength training (MST; 4 × 4 repetitions at ∼90 % maximal strength [1RM]) 2d·wk.-1 for 1-year, supported by transportation and training supervision; or 2) control group (CG). Peak oxygen uptake (V̇O2peak) and walking work efficiency were measured directly along with scaled 1RM/power, anthropometry, blood pressure, and blood samples at inclusion, 1-year, and 5-years post-intervention. RESULTS:The TG increased V̇O2peak (11 %, p < .01), scaled 1RM (40 %, p < .001), and power (26 %, p < .001) compared to CG after 1-year. At follow-up, no intergroup differences in these factors were observed (all p > .05). Both groups improved walking work efficiency (TG: 11 %; CG: 18 %; both p < .05) after 1-year (no intergroup difference, p > .05), but not at follow-up (both p > .05). At follow-up, HDL (high-density lipoprotein)-cholesterol (-15 %, p < .01) and glucose (26 %, p < .01) decreased/increased(respectively) more in the TG than CG. No other intergroup differences were observed in anthropometry or blood samples. CONCLUSION:1-year adherence-supported high-intensity training improves V̇O2peak, 1RM, and power in outpatients with schizophrenia. However, the improvements in these factors key to longevity are not maintained after 5 years. These findings highlight the importance of long-lasting cost-efficient adherence support, ultimately affecting the population's prognosis.

SARS-CoV-2 may result in the development of new symptoms, known as long COVID, a few months after the original infection. It is elusive to what extent physical capacity in patients diagnosed with long COVID is impacted. We compared maximal oxygen uptake (V̇O2max), one of the single most important factors for cardiovascular health and mortality, expired lung volumes and air flow, oxygen cost of walking and 6-min-walking-test (6MWT), in 20 patients diagnosed with long COVID (11 males and 9 females; 44 ± 16 years (SD); 26.7 ± 3.8BMI, duration of acute phase 1.7 ± 1.2 weeks, tested 4 ± 3 months after long COVID diagnosis) with 20 healthy age and sex matched controls (11 males and 9 females; 44 ± 16 years; 25.9 ± 4.0BMI). Long COVID patients had a V̇O2max of 41.4 ± 16.2 mL∙kg−1∙min−1(men) and 38.2 ± 7.5 (women) and this was not different from controls. Similarly, mean spirometry measures in the patient group (VC; FVC; FEV1; FEV1/FVC) were also not different (85–106

Prolonged moderate-intensity exercise leads to a progressive upward drift in heart rate (HR) that may compromise stroke volume (SV). Alternatively, the HR drift may be related to abated SV due to impaired ventricular function. The aim of this study was to examine the effects of cardiovascular drift on left ventricular volumes and in turn SV. Thirteen healthy young males completed two 60-min cycling bouts on a semirecumbent cycle ergometer at 57% maximal oxygen consumption (V̇o2max) either under placebo condition (CON) or after ingesting a small dose of β1-blockers (BB). Measurements of HR, end-diastolic volume (EDV), and end-systolic volume were obtained by echocardiography and used to calculate SV. Other variables such as ear temperature, skin temperature, blood pressure, and blood volume were measured to assess potential changes in thermoregulatory needs and loading conditions. HR drift was successfully prevented when using BB from min 10 to min 60 (128 ± 9 to 126 ± 8 beats/min, P = 0.29) but not in CON (134 ± 10 to 148 ± 10 beats/min, P < 0.01). Conversely, during the same time, SV increased by 13% when using BB (103 ± 9 to 116 ± 7 mL, P < 0.01), whereas it was unchanged in CON (99 ± 7 to 101 ± 9 mL, P = 0.37). The SV behavior was mediated by a 4% increase in EDV in the BB condition (164 ± 18 to 170 ± 18 mL, P < 0.01), whereas no change was observed in the CON condition (162 ± 18 to 160 ± 18 mL, P = 0.23). In conclusion, blocking HR drift enhances EDV and SV during prolonged exercise. These findings suggest that SV behavior is tightly related to filling time and loading conditions of the left ventricle.

Abstract The existence of spot reduction, exercise‐induced local body fat reduction, has been debated for half a century. Although the evidence is equivocal, no study has applied aerobic endurance training closely matching interventions for energy expenditure. Sixteen overweight (BMI: 29.8 ± 3.3(SD) kg m−2) males (43 ± 9 years) were randomized to: (1) abdominal endurance exercise (AG), combining treadmill running at 70% HRmax (27 min) with 4 × 4 min (30%–40% maximal strength, 1RM) of torso rotation and abdominal crunches (57 min), 4 days⋅week−1 for 10 weeks; or (2) control group (CG) performing only treadmill running (45 min) at 70% HRmax. Local fat mass was measured by dual‐energy x‐ray absorptiometry (DEXA), along with 1RM, and pulmonary oxygen uptake (to control energy expenditure during training). Trunk fat mass decreased more (697 g, 3%, p < 0.05) in AG (1170 ± 1093 g, 7%; p < 0.05) than in CG (no change). Total fat mass (AG: 1705 ± 1179 g, 6%; CG: 1134 ± 731 g, 5%; both p < 0.01) and body weight (AG: 1.2 ± 1.2 kg, 1%, p < 0.05; CG: 2.3 ± 0.9 kg, 3%, p < 0.01) decreased similarly in AG/CG. Torso rotation (AG: 32 ± 16 kg, 39%, p < 0.01; CG: no change) and abdominal crunch 1RM (AG: 35 ± 16 kg, 36%, p < 0.01; CG: 13 ± 12 kg, 17%, p < 0.05) increased more (p < 0.05/0.01) in AG than CG. Abdominal endurance exercise utilized more local fat than treadmill running, indicating that spot reduction exists in adult males.

Maximal oxygen uptake and exercise performance typically decline with age. However, there are indications of preserved vascu-lar function and blood flow regulation during arm exercise. Yet, it is unknown if this potential physiological preservation with age is mirrored in peripheral metabolic capacity and V_O2/W ratio. Thus, to investigate the effects of aging in the arms, we measured metabolic and vascular responses to 6-min bouts of dynamic handgrip exercise at 40% and 80% of maximal work rate (WRmax) in 11 young (26 +/- 2 yr) and 12 old (80 +/- 6 yr) males, applying Doppler-ultrasound combined with blood samples from a deep fore-arm vein. At baseline, the old had a larger arterial diameter compared with young (P < 0.001). During exercise, the two groups reached the same WRmax. V_O2, blood flow, and oxygen supply were higher (40%WRmax; 80%WRmax, all P < 0.01), and arteriove-nous oxygen difference was lower (80%WRmax, P < 0.02), in old compared with young. Old also had a higher oxygen excess at 80%WRmax (P < 0.01) than young, whereas no difference in muscle diffusion or oxygen extraction was detected. Only young exhibited an increase in intensity-induced arterial dilation (P < 0.05), and they had a lower mean arterial pressure than old at 80%WRmax (P < 0.001). V_O2/W (40%WRmax; 80%WRmax) was reduced in old compared with young (both P < 0.05). In conclusion, in old and young males with a similar handgrip WRmax, old had a higher V_O2 during 80%WRmax intensity, achieved by an increased blood flow. This may be a result of the available cardiac output reserve, compensating for reduced work efficiency and attenuated vascular response observed in old.NEW & NOTEWORTHY Contrasting the typically observed decline in V_O2max with age, the current study reveals an age-related increase in forearm metabolic capacity during handgrip exercise in old, mediated by an increased forearm blood flow. Exercise with a small muscle mass in arms, where central components of the oxygen transport are not limiting, allows old to attain a simi-lar maximal work rate as young despite their increased V_O2/W ratio.

Maximal oxygen uptake (V̇O2max) may be the single most important factor for long‐distance running performance. Interval training, enabling high intensity, is forwarded as the format that yields the largest increase in V̇O2max. However, it is uncertain if an optimal outcome on V̇O2max, anaerobic capacity, and running performance is provided by training with a high aerobic intensity or high overall intensity. Thus, we randomized 48 aerobically well‐trained men (23 ± 3 years) to three commonly applied interval protocols, one with high aerobic intensity (HIIT) and two with high absolute intensity (sprint interval training; SIT), 3× week for 8 weeks: (1) HIIT: 4 × 4 min at ~95% maximal aerobic speed (MAS) with 3 min active breaks. (2) SIT: 8 × 20 s at ~150% MAS with 10 s passive breaks. (3) SIT: 10 × 30 s at ~175% MAS with 3.5 min active breaks. V̇O2max increased more (p < 0.001) following HIIT, 4 × 4 min (6.5 ± 2.4%, p < 0.001) than SIT, 8 × 20 s (3.3 ± 2.4%, p < 0.001) and SIT, 10 × 30 s (n.s.). This was accompanied by a larger (p < 0.05) increase in stroke volume (O2‐pulse) following HIIT, 4 × 4 min (8.1 ± 4.1%, p < 0.001) compared with SIT, 8 × 20 s (3.8 ± 4.2%, p < 0.01) and SIT, 10 × 30 (n.s.). Anaerobic capacity (maximal accumulated oxygen deficit) increased following SIT, 8 × 20 s (p < 0.05), but not after HIIT, 4 × 4 min, nor SIT, 10 × 30 s. Long‐distance (3000‐m) endurance performance increased (p < 0.05–p < 0.001) in all groups (HIIT, 4 × 4 min: 5.9 ± 3.2%; SIT, 8 × 20 s: 4.1 ± 3.7%; SIT, 10 × 30 s: 2.2 ± 2.2%), with HIIT increasing more than SIT, 10 × 30 s (p < 0.05). Sprint (300‐m) performance exhibited within‐group increases in SIT, 8 × 20 s (4.4 ± 2.0%) and SIT, 10 × 30 s (3.3 ± 2.8%). In conclusion, HIIT improves V̇O2max more than SIT. Given the importance of V̇O2max for most endurance performance scenarios, HIIT should typically be the chosen interval format.

Objective Protein–energy malnutrition and the subsequent muscle wasting (sarcopenia) are common ageing complications. It is knowing to be also associated with dementia. Our programme will test the cytoprotective functions of vitamin E combined with the cortisol-lowering effect of chocolate polyphenols (PP), in combination with muscle anabolic effect of adequate dietary protein intake and physical exercise to prevent the age-dependent decline of muscle mass and its key underpinning mechanisms including mitochondrial function, and nutrient metabolism in muscle in the elderly.Methods and analysis In 2020, a 6-month double-blind randomised controlled trial in 75 predementia older people was launched to prevent muscle mass loss, in respond to the ‘Joint Programming Initiative A healthy diet for a healthy life’. In the run-in phase, participants will be stabilised on a protein-rich diet (0.9–1.0 g protein/kg ideal body weight/day) and physical exercise programme (high-intensity interval training specifically developed for these subjects). Subsequently, they will be randomised into three groups (1:1:1). The study arms will have a similar isocaloric diet and follow a similar physical exercise programme. Control group (n=25) will maintain the baseline diet; intervention groups will consume either 30 g/day of dark chocolate containing 500 mg total PP (corresponding to 60 mg epicatechin) and 100 mg vitamin E (as RRR-alpha-tocopherol) (n=25); or the high polyphenol chocolate without additional vitamin E (n=25). Muscle mass will be the primary endpoint. Other outcomes are neurocognitive status and previously identified biomolecular indices of frailty in predementia patients. Muscle biopsies will be collected to assess myocyte contraction and mitochondrial metabolism. Blood and plasma samples will be analysed for laboratory endpoints including nutrition metabolism and omics.Ethics and dissemination All the ethical and regulatory approvals have been obtained by the ethical committees of the Azienda Ospedaliera Universitaria Integrata of Verona with respect to scientific content and compliance with applicable research and human subjects’ regulation. Given the broader interest of the society toward undernutrition in the elderly, we identify four main target audiences for our research activity: national and local health systems, both internal and external to the project; targeted population (the elderly); general public; and academia. These activities include scientific workshops, public health awareness campaigns, project dedicated website and publication is scientific peer-review journals.Trial registration number NCT05343611.

Maximal oxygen uptake (V̇O2max) is a pivotal factor for aerobic endurance performance. Recently, aerobic high‐intensity interval training (HIIT) was documented to be superior to sprint interval training (SIT) in improving V̇O2max in well‐trained males. However, as mounting evidence suggests that physiological responses to training are sex‐dependent, examining the effects of HIIT versus SIT on V̇O2max, anaerobic capacity, and endurance performance in females is warranted.

Introduction: Skeletal muscle strength is reduced in patients with schizophrenia, contributing to their impaired physical health, functional performance, and potentially mental health challenges. Although short-term training programs have shown promising results, improving muscle strength and functional performance, it is unknown how exercise can be successfully integrated into the long-term clinical care of outpatients with schizophrenia. Objective: To investigate effects of strength training with adherence support in a collaborative care model.Methods: We randomized 28 men and 20 women (mean +/- SD, 35 +/- 11 years) to leg press maximal strength training (MST) with 4 sets at 90 % of one repetition maximum (1RM) 2 x week, facilitated by municipal service and professional supervision (TG), or a control group (CG).Results: The TG increased scaled leg press 1RM (0-3 months: 19 %; 0-6 months: 31 %, 0-12 months: 40 %, all p < .001, and 3-12 months: 18 %, p < .05) and power (0-3 months, 11 %; 0-6 months: 22 %, 0-12 months: 26 %, all p < .001, and 3-12 months: 13 %, p < .05) throughout the 1-year period compared to the CG. The increased muscle strength was accompanied by improved sit-to-stand performance (20 %) after 12 months (p < .001). Both groups also exhibited within-group improvements in walking work efficiency after 6 months (TG: 13 %; CG: 23 %) and 1 year (TG: 11 %; CG: 21 %, p < .01-0.05), but with no evident differences between the groups. Stair climbing performance remained unchanged.Conclusion: Our results reveal that strength training can successfully be integrated as a part of long-term clinical care of outpatients with schizophrenia, contributing to improved functional performance.