Purpose: Lactate is an established prognosticator in critical care. However, there still is insufficient evidence about its role in predicting outcome in COVID-19. This is of particular concern in older patients who have been mostly affected during the initial surge in 2020. Methods: This prospective international observation study (The COVIP study) recruited patients aged 70 years or older (ClinicalTrials.gov ID: NCT04321265) admitted to an intensive care unit (ICU) with COVID-19 disease from March 2020 to February 2021. In addition to serial lactate values (arterial blood gas analysis), we recorded several parameters, including SOFA score, ICU procedures, limitation of care, ICU- and 3-month mortality. A lactate concentration ≥ 2.0 mmol/L on the day of ICU admission (baseline) was defined as abnormal. The primary outcome was ICU-mortality. The secondary outcomes 30-day and 3-month mortality. Results: In total, data from 2860 patients were analyzed. In most patients (68%), serum lactate was lower than 2 mmol/L. Elevated baseline serum lactate was associated with significantly higher ICU- and 3-month mortality (53% vs. 43%, and 71% vs. 57%, respectively, p < 0.001). In the multivariable analysis, the maximum lactate concentration on day 1 was independently associated with ICU mortality (aOR 1.06 95% CI 1.02–1.11; p = 0.007), 30-day mortality (aOR 1.07 95% CI 1.02–1.13; p = 0.005) and 3-month mortality (aOR 1.15 95% CI 1.08–1.24; p < 0.001) after adjustment for age, gender, SOFA score, and frailty. In 826 patients with baseline lactate ≥ 2 mmol/L sufficient data to calculate the difference between maximal levels on days 1 and 2 (∆ serum lactate) were available. A decreasing lactate concentration over time was inversely associated with ICU mortality after multivariate adjustment for SOFA score, age, Clinical Frailty Scale, and gender (aOR 0.60 95% CI 0.42–0.85; p = 0.004). Conclusion: In critically ill old intensive care patients suffering from COVID-19, lactate and its kinetics are valuable tools for outcome prediction. Trial registration number: NCT04321265.
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Purpose: In long-track speed skating, drafting is a commonly used phenomenon in training; however, it is not allowed in time-trial races. In speed skating, limited research is available on the physical and psychological impact of drafting. The aim of this study was to determine the influence of “skating alone,” “leading,” or “drafting” on physical intensity (heart rate and blood lactate) and perceived intensity (perceived exertion) of speed skaters. Methods: Twenty-two national-level long-track speed skaters with a mean age of 19.3 (2.6) years skated 5 laps, with similar external intensity in 3 different conditions: skating alone, leading, or drafting. Repeated-measures analysis of variance showed differences between the 3 conditions, heart rate (F2,36 = 10.546, P < .001), lactate (F2,36 = 12.711, P < .001), and rating of perceived exertion (F2,36 = 5.759, P < .01). Results: Heart rate and lactate concentration were significantly lower (P < .001) when drafting compared with leading (heart rate Δ = 7 [8] beats·min–1, 4.0% [4.7%]; lactate Δ = 2.3 [2.3] mmol/L, 28.2% [29.9%]) or skating alone (heart rate Δ = 8 [7.1] beats·min–1, 4.6% [3.9%]; lactate Δ = 2.8 [2.5] mmol/L, 33.6% [23.6%]). Rating of perceived exertion was significantly lower (P < .01) when drafting (Δ = 0.8 [1.0], 16.5% [20.9%]) or leading (Δ = 0.5 [0.9], 7.7% [20.5%]) versus skating alone. Conclusions: With similar external intensity, physical intensity, as well as perceived intensity, is reduced when drafting in comparison with skating alone. A key finding of this study is the psychological effect: Skating alone was shown to be more demanding than leading, whereas leading and drafting were perceived to be similar in terms of perceived exertion. Knowledge about the reduction of internal intensity for a drafting skater compared with leading or skating alone can be used by coaches and trainers to optimize training conditions.
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The results of this study indicate that whole body metabolic and cardiovascular responses to 140 min of either steady state or variable intensity exercise at the same average intensity are similar, despite differences in skeletal muscle carbohydrate metabolism and recruitment
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Using stable isotope techniques, this study shows that plasma free fatty acid oxidation is not impaired during exercise in non-obese type II diabetic patients.
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This paper descibes a study that shows that glycogen-lowering exercise, performed the evening before an exercise bout in combination with glycogen restriction leads to a reduction of the oxidation rate of ingested glucose during moderate-intensity exercise
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This research article shows that a high intensity exercise program compared to a low intensity exercise program of the same session duration and frequency, increases insulin sensitivity to a larger extend in healthy subjects. It also shows that the short insulin tolerance test can be used to detect differences in insulin sensitivity in intervention studies.
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Background Wheelchair tennis, a globally popular sport, features a professional tour spanning 40 countries and over 160 tournaments. Despite its widespread appeal, information about the physical demands of wheelchair tennis is scattered across various studies, necessitating a comprehensive systematic review to synthesise available data. Objective The aim was to provide a detailed synthesis of the physical demands associated with wheelchair tennis, encompassing diverse factors such as court surfaces, performance levels, sport classes, and sexes. Methods We conducted comprehensive searches in the PubMed, Embase, CINAHL, and SPORTDiscus databases, covering articles from inception to March 1, 2023. Forward and backward citation tracking from the included articles was carried out using Scopus, and we established eligibility criteria following the Population, Exposure, Comparison, Outcome, and Study design (PECOS) framework. Our study focused on wheelchair tennis players participating at regional, national, or international levels, including both juniors and adults, and open and quad players. We analysed singles and doubles matches and considered sex (male, female), sport class (open, quad), and court surface type (hard, clay, grass) as key comparative points. The outcomes of interest encompassed play duration, on-court movement, stroke performance, and physiological match variables. The selected study designs included observational cross-sectional, longitudinal, and intervention studies (baseline data only). We calculated pooled means or mean differences with 95% confidence intervals (CIs) and employed a random-effects meta-analysis with robust variance estimation. We assessed heterogeneity using Cochrane Q and 95% prediction intervals. Results Our literature search retrieved 643 records, with 24 articles meeting our inclusion criteria. Most available information focused on international male wheelchair tennis players in the open division, primarily competing in singles on hard courts. Key findings (mean [95% CI]) for these players on hard courts were match duration 65.9 min [55.0–78.8], set duration 35.0 min [28.2–43.5], game duration 4.6 min [0.92–23.3], rally duration 6.1 s [3.7–10.2], effective playing time 19.8% [18.9–20.7], and work-to-rest ratio 1:4.1 [1:3.7–1:4.4]. Insufficient data were available to analyse play duration for female players. However, for the available data on hard court matches, the average set duration was 34.8 min [32.5–37.2]. International male players on hard court covered an average distance per match of 3859 m [1917–7768], with mean and peak average forward speeds of 1.06 m/s [0.85–1.32] and 3.55 m/s [2.92–4.31], respectively. These players executed an average of 365.9 [317.2–422.1] strokes per match, 200.6 [134.7–299.0] per set, 25.4 [16.7–38.7] per game, and 3.4 [2.6–4.6] per rally. Insufficient data were available for a meta-analysis of female players’ on-court movement and stroke performance. The average and peak heart rates of international male players on hard court were 134.3 [124.2–145.1] and 166.0 [132.7–207.6] beats per minute, and the average match heart rate expressed as a percentage of peak heart rate was 74.7% [46.4–100]. We found no studies concerning regional players or juniors, and only one study on doubles match play. Conclusions While we present a comprehensive overview of the physical demands of wheelchair tennis, our understanding predominantly centres around international male players competing on hard courts in the open division. To attain a more comprehensive insight into the sport’s physical requirements, future research should prioritise the inclusion of data on female and quad players, juniors, doubles, and matches played on clay and grass court surfaces. Such endeavours will facilitate the development of more tailored and effective training programmes for wheelchair tennis players and coaches.
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Talloze studies tonen aan dat een fysiek actieve leefstijl bloeddruk, cholesterol en gewicht verlaagt, botten en spieren versterkt en het risico van hart- en vaatziekten, darmkanker en diabetes type II vermindert. Bewegen kan dus worden gezien als een medicijn wat voor iedereen toegankelijk is.
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Pitch size varies in official soccer matches and differently sized pitches are adopted for tactical purposes in small-sided training games. Since interactive team behaviour emerges under constraints, the authors evaluate the effect of pitch size (task) manipulations on interactive team behaviour in small-sided soccer games. Four 4-a-side (plus goalkeepers) small-sided games were played: a reference game (30×20 m), length manipulation (24×20 m), width manipulation (30×16 m), and a combination (24×16 m). Using position data (100Hz), three measures quantifying the teams' interaction were calculated: longitudinal inter-team distance, lateral inter-team distance, and surface area difference. Means and standard deviations, correlations and coupling values were calculated. Running correlations were calculated over a 3-s window to evaluate interaction patterns. As expected, a shorter pitch results in smaller longitudinal inter-team distance, lateral inter-team distance decreased for narrow pitches, and smaller total playing area resulted in decreased surface area. Unanticipated, a crossover effect was present; length and width manipulations also triggered changes in lateral and longitudinal direction respectively. Inter-team distances and surface area difference differed significantly across conditions. Interaction patterns differed across conditions for all measures. So, highly tactically relevant, soccer teams seem to adapt their interactive behaviour according to pitch size in small-sided games. © 2013 Institute of Systems Science, Academy of Mathematics and Systems Science, CAS and Springer-Verlag Berlin Heidelberg.
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To prepare medical students appropriately for the management of toxicological emergencies, we have developed a simulation-based medical education (SBME) training in acute clinical toxicology. Our aim is to report on the feasibility, evaluation and lessons learned of this training. Since 2019, each year approximately 180 fifth-year medical students are invited to participate in the SBME training. The training consists of an interactive lecture and two SBME stations. For each station, a team of students had to perform the primary assessment and management of an intoxicated patient. After the training, the students completed a questionnaire about their experiences and confidence in clinical toxicology. Overall, the vast majority of students agreed that the training provided a fun, interactive and stimulating way to teach about clinical toxicology. Additionally, they felt more confident regarding their skills in this area. Our pilot study shows that SBME training was well-evaluated and feasible over a longer period.
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