https://caltcm.memberclicks.net/assets/documents/acc_aha_chf_2013_guidelines.pdf

2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)62167-9.pdf

Frailty in elderly people

SUMMARYACSM Position Stand on The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Adults. Med. Sci. Sports Exerc., Vol. 30, No. 6, pp. 975-991, 1998. The combination of frequency, intensity, and duration of chr

http://myweb.facstaff.wwu.edu/chalmers/pdfs/acsm position stand - quantity and quality of exercise.pdf

ACSM Position Stand: The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults

The purpose of this report is to provide revised standards and guidelines for the exercise testing and training of individuals who are free from clinical manifestations of cardiovascular disease and those with known cardiovascular disease. These guidelines are intended for physicians, nurses, exercise physiologists, specialists, technologists, and other healthcare professionals involved in exercise testing and training of these populations. This report is in accord with the “Statement on Exercise” published by the American Heart Association (AHA).1

These guidelines are a revision of the 1995 standards of the AHA that addressed the issues of exercise testing and training.2 An update of background, scientific rationale, and selected references is provided, and current issues of practical importance in the clinical use of these standards are considered. These guidelines are in accord with the American College of Cardiology (ACC)/AHA Guidelines for Exercise Testing.3

### The Cardiovascular Response to Exercise

Exercise, a common physiological stress, can elicit cardiovascular abnormalities that are not present at rest, and it can be used to determine the adequacy of cardiac function. Because exercise is only one of many stresses to which humans can be exposed, it is more appropriate to call an exercise test exactly that and not a “stress test.” This is particularly relevant considering the increased use of nonexercise stress tests.

### Types of Exercise

Three types of muscular contraction or exercise can be applied as a stress to the cardiovascular system: isometric (static), isotonic (dynamic or locomotory), and resistance (a combination of isometric and isotonic).4,5 Isotonic exercise, which is defined as a muscular contraction resulting in movement, primarily provides a volume load to the left ventricle, and the response is proportional to the size of the working muscle mass and the intensity of exercise. Isometric exercise is defined as a muscular contraction without movement (eg, handgrip) and imposes greater pressure than volume …

Exercise Standards for Testing and Training A Scientific Statement From the American Heart Association

The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.

Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

The aims of this study were to identify the time course of change of salivary testosterone (sT), cortisol (sC), and IgA (SIgA); mood state; and performance capacity during a 2-week taper in judo athletes and to examine the diurnal variation in these salivary markers. Eleven male judo athletes completed 5 weeks of training: 1 week of normal training (NORM), 2 weeks of intensified training (INT), and 2 weeks of exponential tapering (TAPER). Once per week subjects completed vertical and horizontal countermovement jump tests, a grip strength test, a Special Judo Fitness Test, a multistage aerobic fitness test, a 3 × 300-m run test, and anthropometric measurement. Subjects also completed questionnaires to assess mood state and muscle soreness. Two daily saliva samples (at 0700 and 1900) were collected at the end of each week during NORM and INT and every day during TAPER. Increased morning sT, decreased evening sC, lower muscle soreness, and enhanced mood state (p < 0.05) were evident by the early phases of TAPER. A significant 7.0% improvement in 3 × 300-m performance time, a 6.9% improvement in the vertical jump (p < 0.05), and increased morning and evening SIgA secretion rate (p < 0.01) were observed during the middle-late phases of TAPER. The higher values of salivary variables were observed in the morning. This study indicates that salivary hormones display diurnal variation. Furthermore, changes in hormonal responses, mood state, and muscle soreness precede enhancements in performance and mucosal immunity, suggesting that judo athletes taper for at least a week before competition.

Salivary hormones, IgA, and performance during intense training and tapering in judo athletes.

Recent studies have shown that neutrophils can utilize glutamine and that glutamine supplementation can improve neutrophil function in postoperative and burn patients. The present study investigated the influence of oral glutamine supplementation on stimulated neutrophil degranulation and oxidative burst activity following prolonged exercise. Subjects, 7 well-trained men, reported to the laboratory following an overnight fast and cycled for 2 hrs at 60% VO2max on two occasions a week apart. They were randomly assigned to either a glutamine or placebo treatment. For both trials, subjects consumed a sugar-free lemon drink at 15-min intervals until 90 minutes, then a lemon flavored glutamine drink (GLN) or sugar-free lemon drink (PLA) was consumed at 15-min intervals for the remaining exercise and the 2-hr recovery period. Venous blood samples were taken pre-, during, and postexercise. Glutamine supplementation had no effect on the magnitude of postexercise leukocytosis, the plasma elastase concentration following exercise (which increased in both trials), or the plasma elastase release in response to bacterial stimulation (which fell in both trials). Neutrophil function assessed by oxidative burst activity of isolated cells did not change following exercise in either trial. These findings therefore suggest that the fall in plasma glutamine concentration does not account for the decrease in neutrophil function (degranulation response) following prolonged exercise.

Effect of Oral Glutamine Supplementation on Human Neutrophil Lipopolysaccharide-Stimulated Degranulation Following Prolonged Exercise

PREFACE INTRODUCTION: THE BIOCHEMICAL BASIS OF EXERCISE AND SPORT THE WEIGHTLIFTER THE SPRINTER MIDDLE DISTANCE EVENTS THE ENDURANCE ATHLETE THE GAMES PLAYER SPORTING TALENT: THE GENETIC BASIS OF ATHLETIC CAPABILITY ADAPTATIONS TO TRAINING APPENDICES INDEX

The Biochemical Basis of Sports Performance

There are many factors in mucosal secretions that contribute to innate immunity and the 'first line of defence' at mucosal surfaces. Few studies, however, have investigated the effects of exercise on many of these 'defence' factors. The aim of the present study was to determine the acute effects of prolonged exercise on salivary levels of selected antimicrobial peptides (AMP) that have not yet been studied in response to exercise (HNP1-3 and LL-37) in addition to immunoglobulin A (IgA). A secondary objective was to assess the effects of exercise on saliva antibacterial capacity. Twelve active men exercised on a cycle ergometer for 2.5 h at approximately 60% of maximal oxygen uptake. Unstimulated whole saliva samples were obtained before and after exercise. There was a significant decrease (P < 0.05) in salivary IgA:osmolality ratio, following exercise, but IgA concentration and secretion rate were unaltered. Salivary HNP1-3 and LL-37 concentrations (P < 0.01 and P < 0.05, respectively), concentration:osmolality ratios (P < 0.01) and secretion rates (P < 0.01) all increased following exercise. Salivary antibacterial capacity (against E. coli) did not change. The increased concentration of AMPs in saliva may confer some benefit to the 'first line of defence' and could result from synergistic compensation within the mucosal immune system and/or airway inflammation and epithelial damage. Further study is required to determine the significance of such changes on the overall 'defence' capacity of saliva and how this influences the overall risk for infection.

Salivary antimicrobial peptides (LL-37 and alpha-defensins HNP1-3), antimicrobial and IgA responses to prolonged exercise

Some athletes can have quite high intakes of branched-chain amino acids (BCAAs) because of their high energy and protein intakes and also because they consume protein supplements, solutions of protein hydrolysates, and free amino acids. The requirement for protein may actually be higher in endurance athletes than in sedentary individuals because some amino acids, including the BCAAs, are oxidized in increased amounts during exercise compared with rest, and they must therefore be replenished by the diet. In the late 1970s, BCAAs were suggested to be the third fuel for skeletal muscle after carbohydrate and fat. However, the majority of later studies, using various exercise and treatment designs and several forms of administration of BCAAs (infusion, oral, and with and without carbohydrates), have failed to find a performance-enhancing effect. No valid scientific evidence supports the commercial claims that orally ingested BCAAs have an anticatabolic effect during and after exercise in humans or that BCAA supplements may accelerate the repair of muscle damage after exercise. The recommended protein intakes for athletes (1.2 to 1.8 g . kg body mass(-1) . d(-1)) do not seem to be harmful. Acute intakes of BCAA supplements of about 10-30 g/d seem to be without ill effect. However, the suggested reasons for taking such supplements have not received much support from well-controlled scientific studies.

/pdf/interrelationship-between-physical-activity-and-branched-117ro92xzw.pdf

Michael Gleeson

Papers

Salivary hormones, IgA, and performance during intense training and tapering in judo athletes.

Effect of Oral Glutamine Supplementation on Human Neutrophil Lipopolysaccharide-Stimulated Degranulation Following Prolonged Exercise

The Biochemical Basis of Sports Performance

Salivary antimicrobial peptides (LL-37 and alpha-defensins HNP1-3), antimicrobial and IgA responses to prolonged exercise

Interrelationship between Physical Activity and Branched-Chain Amino Acids