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      Effect of Ischemic Preconditioning on Endurance Performance Does Not Surpass Placebo.

      Medicine and Science in Sports and Exercise
      Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          Recent studies have reported ischemic preconditioning (IPC) can acutely improve endurance exercise performance in athletes. However, placebo and nocebo effects have not been sufficiently controlled, and the effect on aerobic metabolism parameters that determine endurance performance (e.g., oxygen cost of running, lactate threshold, and maximal oxygen uptake [V˙O2max]) has been equivocal. Thus, we circumvented limitations from previous studies to test the effect of IPC on aerobic metabolism parameters and endurance performance in well-trained runners.

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          Mental fatigue impairs physical performance in humans.

          Mental fatigue is a psychobiological state caused by prolonged periods of demanding cognitive activity. Although the impact of mental fatigue on cognitive and skilled performance is well known, its effect on physical performance has not been thoroughly investigated. In this randomized crossover study, 16 subjects cycled to exhaustion at 80% of their peak power output after 90 min of a demanding cognitive task (mental fatigue) or 90 min of watching emotionally neutral documentaries (control). After experimental treatment, a mood questionnaire revealed a state of mental fatigue (P = 0.005) that significantly reduced time to exhaustion (640 +/- 316 s) compared with the control condition (754 +/- 339 s) (P = 0.003). This negative effect was not mediated by cardiorespiratory and musculoenergetic factors as physiological responses to intense exercise remained largely unaffected. Self-reported success and intrinsic motivation related to the physical task were also unaffected by prior cognitive activity. However, mentally fatigued subjects rated perception of effort during exercise to be significantly higher compared with the control condition (P = 0.007). As ratings of perceived exertion increased similarly over time in both conditions (P < 0.001), mentally fatigued subjects reached their maximal level of perceived exertion and disengaged from the physical task earlier than in the control condition. In conclusion, our study provides experimental evidence that mental fatigue limits exercise tolerance in humans through higher perception of effort rather than cardiorespiratory and musculoenergetic mechanisms. Future research in this area should investigate the common neurocognitive resources shared by physical and mental activity.
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            Placebo and the new physiology of the doctor-patient relationship.

            Modern medicine has progressed in parallel with the advancement of biochemistry, anatomy, and physiology. By using the tools of modern medicine, the physician today can treat and prevent a number of diseases through pharmacology, genetics, and physical interventions. Besides this materia medica, the patient's mind, cognitions, and emotions play a central part as well in any therapeutic outcome, as investigated by disciplines such as psychoneuroendocrinoimmunology. This review describes recent findings that give scientific evidence to the old tenet that patients must be both cured and cared for. In fact, we are today in a good position to investigate complex psychological factors, like placebo effects and the doctor-patient relationship, by using a physiological and neuroscientific approach. These intricate psychological factors can be approached through biochemistry, anatomy, and physiology, thus eliminating the old dichotomy between biology and psychology. This is both a biomedical and a philosophical enterprise that is changing the way we approach and interpret medicine and human biology. In the first case, curing the disease only is not sufficient, and care of the patient is of tantamount importance. In the second case, the philosophical debate about the mind-body interaction can find some important answers in the study of placebo effects. Therefore, maybe paradoxically, the placebo effect and the doctor-patient relationship can be approached by using the same biochemical, cellular and physiological tools of the materia medica, which represents an epochal transition from general concepts such as suggestibility and power of mind to a true physiology of the doctor-patient interaction.
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              Validity of criteria for establishing maximal O2 uptake during ramp exercise tests.

              The incremental or ramp exercise test to the limit of tolerance has become a popular test for determination of maximal O(2) uptake (VO(2max)). However, many subjects do not evidence a definitive plateau of the VO(2) -work rate relationship on this test and secondary criteria based upon respiratory exchange ratio (RER), maximal heart rate (HR(max)) or blood [lactate] have been adopted to provide confidence in the measured VO(2max). We hypothesized that verification of VO(2max) using these variables is fundamentally flawed in that their use could either allow underestimation of VO(2max) (if, for any reason, a test were ended at a sub-maximal [Formula: see text]), or alternatively preclude subjects from recording a valid VO(2max). Eight healthy male subjects completed a ramp exercise test (at 20 W/min) to the limit of tolerance on an electrically braked cycle ergometer during which pulmonary gas exchange was measured breath-by-breath and blood [lactate] was determined every 90 s. Using the most widely used criterion values of RER (1.10 and 1.15), VO(2max) as determined during the ramp test (4.03 +/- 0.10 l/min) could be undermeasured by 27% (2.97 +/- 0.24 l/min) and 16% (3.41 +/- 0.15 l/min), respectively (both P or = 8 mM) were untenable because they resulted in rejection of 3/8 and 6/8 of the subjects, most of whom (5/8) had demonstrated a plateau of VO(2max) at VO(2max). These findings provide a clear mandate for rejecting these secondary criteria as a means of validating VO(2max) on ramp exercise tests.
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                Author and article information

                Journal
                27580156
                10.1249/MSS.0000000000001088

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