Abstract

To determine the efficacy and potential protective mechanism of canagliflozin combined with aerobic exercise in treating chronic heart failure (CHF). Isoproterenol was injected into rats to create CHF models. The rats were then subsequently divided into saline, canagliflozin (3 mg/kg/d), aerobic exercise training, and canagliflozin combined with aerobic exercise training. Compared to the CHF group, the canagliflozin combined with the aerobic exercise group had superior ventricular remodeling and cardiac function. In rats treated with canagliflozin combined with aerobic exercise, the expression of cytochrome P450 (CYP) 4A3, CYP4A8, COL1A1, COL3A1, and FN1 was reduced, while the expression of CYP26B1, ALDH1A2, and CYP1A1 increased significantly. Additionally, canagliflozin combined with aerobic exercise decreased the phosphorylation of AKT and ERK1/2. Canagliflozin combined with aerobic exercise has a positive effect on the development of CHF via the regulation of retinol metabolism and the AKT/ERK signaling pathway.

Introduction

Chronic heart failure (CHF), the most prevalent form of cardiovascular illness, is a global health issue with a high death and morbidity rate.1 The disease affects about 2% of the adult population worldwide, and the 5-year mortality rate is estimated to be between 45 and 60%.2 CHF is a complex condition characterized by a cardiac muscle’s inability to maintain blood supply to peripheral tissues, resulting in decreased systemic energy metabolism.3 Multiple studies have demonstrated that regulating cardiac energy metabolism is critical for treatment.4,5 The β-oxidation of fatty acids in the mitochondria satisfies the heart’s high energy requirements. Oliveros et al. observed previously observed that a vitamin A deficit paired antioxidant defenses, promoted lipid peroxidation in the adult rat heart, and altered aortic lipid metabolism.6 The peroxisome proliferator-activated receptor (PPAR) is a ligand-activated nuclear transcription factor.7 PPAR modulates fatty acid oxidation (FAO) and mitochondrial bioenergetics, suppresses myocardial remodeling and fibrosis, and improves HF.8 Consequently, we must investigate new techniques for enhancing cardiac function by ameliorating abnormalities of cardiac energy metabolism, preventing cardiac remodeling and fibrosis, and thereby preventing or postponing the advancement of heart failure.

Canagliflozin, an inhibitor of sodium-glucose cotransporter 2 (SGLT-2), has been demonstrated to benefit HF with a lower ejection fraction.9 SGLT-2 inhibitors (canagliflozin, and so forth) for patients with CHF, improve the quality of life, and reduce mortality, morbidity, and readmission rates.10 In diabetic and nondiabetic subjects, canagliflozin treatment significantly reduced the risk of cardiovascular death, myocardial infarction, and hospitalization for hypertension.11 In addition, SGLT-2 inhibitors can improve fatty acid metabolism and utilize ketone bodies to create mitochondrial energy, so enhancing the aerobic metabolism of skeletal muscle, inhibiting anaerobic metabolism, and enhancing aerobic exercise capacity.12 Canagliflozin has been demonstrated to decrease myocardial glucose metabolism, enhance myocardial fatty acid metabolism, and increase the circulation of ketone bodies,13 thereby ameliorating heart failure via modifying myocardial energy metabolism and oxidative stress.14

Results

Canagliflozin combined with aerobic exercise improved isoproterenol-induced cardiac dysfunction
To investigate the effect of canagliflozin combined with aerobic exercise on CHF, cardiac function was assessed using echocardiography. After 10 days of ISO administration, the levels of LVEF (p < 0.001) and LVFS (p < 0.001) in the ISO group were significantly lower than in the control group, indicating that the CHF rat model was successfully established. LVEF and LVFS levels were significantly higher in the ISO+CA group (LVEF, p < 0.05; LVFS, p < 0.05), the ISO+AE group (LVEF, p < 0.05; LVFS, p < 0.05), and the ISO+AE+CA group (LVEF, p < 0.01; LVFS, p < 0.01). Moreover, compared to the ISO group, the levels of LVIDs (p < 0.05) and LVESV (p < 0.05) were significantly reduced in the ISO+AE+CA group but not in the ISO+CA group (LVIDs, p = 0.21; LVESV, p = 0.21). (Figures 1A and 1B, Table 1).

Objective
To investigate the influence of aerobic exercise on myocardial injury, NF-B expression, glucolipid metabolism and inflammatory factors in rats with Coronary Heart Disease (CHD) and explore the possible causative role.

Methods
45 Sprague Dawley® rats were randomized into model, control and experimental groups. A high-fat diet was adopted for generating a rat CHD model, and the experimental group was given a 4-week aerobic exercise intervention. ECG was utilized to evaluate the cardiac function of the rats; HE staining to evaluate the damage of myocardial tissue; TUNEL staining to evaluate cardiomyocyte apoptosis level; ELISA to assay the contents of inflammatory factors and glucolipid metabolism in cardiomyocytes; qPCR to assay IB- and NF-B mRNA expression; Western-blot to assay the apoptosis-related proteins and NF-B signaling pathway-related proteins expressions in myocardial tissue.

Results
In contrast to the model group, aerobic exercise strongly improved the rat’s cardiac function and glucolipid metabolism (p < 0.01), enhanced IL-10 content, Bcl-2/Bax level as well as IB- protein and mRNA expression (p < 0.01), and reduced myocardial injury and cardiomyocyte apoptosis, the contents of IL-6, IL-1 and TNF-, Caspase 3 level, NF-B mRNA and protein expression and p-p38 and p-STAT3 expressions (p < 0.01).

Conclusion
Aerobic exercise can not only effectively reduce myocardial injury, the release of inflammatory factors and NF-B expression in CHD rats, but also improve cardiac function and glucolipid metabolism. Its mechanism is likely to be related to the inhibition of the NF-B signaling pathway.

Introduction

Coronary Heart Disease (CHD) refers to coronary artery lumen stenosis or even blockage caused by atherosclerosis, which causes myocardial ischemia, hypoxia and even necrosis, and is also known as ischemic heart disease. 1 , 2 Physiological, genetic and environmental factors that cause aberrant glucolipid metabolism and inflammatory response disorders are the dominating incentives that induce atherosclerosis and the primary pathophysiological basis of CHD. 3 , 4 With the improvement in living standards, the incidence of CHD is increasing year by year, posing a huge economic burden on families and countries. Reducing the mortality and extending the survival time of CHD patients is a major challenge that cardiovascular disease researchers and clinicians urgently need to solve.

Considerable evidence shows that vascular endothelial injury will raise the adhesion and permeability of vascular endothelium, and then multiple inflammatory factors will gather and produce an inflammatory fiber proliferation reaction, which eventually gives rise to atherosclerosis. 7 , 8 , 9 Nuclear Factor Kappa B (NF-B) takes part in not only the occurrence but also the development of inflammatory response. NF-B inhibitor protein IB- can accelerate the dissociation of NF-B. The dissociated NF-B can be rapidly transferred to the nucleus, modulating the transcription and translation processes of diverse inflammatory factors and adhesion factors, and is an important cytokine that modulates the activation and cascade amplification of inflammatory factors. 10 , 11 Schiffmann et al. 12 have demonstrated that CHD patients will have apparent glucolipid metabolism disorder. Over-nutrition and sedentary behaviors will strikingly accelerate the accumulation of fat and glucose in the body, which in turn will aggravate the vascular endothelial damage of patients. Substantial evidence indicates that aerobic exercise can efficaciously regulate glucolipid metabolism in the body, reduce the activity of lipoprotein lipase, lower blood lipid and blood sugar levels, and reduce body weight. 13 , 14 Ornish et al. 15 demonstrated that long-term aerobic exercise can apparently reduce blood lipid levels and reduce vascular endothelial damage in patients with cardiovascular disease. At present, there are few studies on the impact of aerobic exercise on myocardial damage, glucolipid metabolism, and inflammation in CHD. This investigation aimed to build a rat CHD model to study the influence of aerobic exercise on myocardial damage, NF-B expression, glucolipid metabolism and inflammatory responses in CHD rats, as well as to further explore its possible causative role.

Abstract

     Recent advances in wearable sensing and machine learning have created ample opportunities for “in the wild” movement analysis in sports, since the combination of both enables real-time feedback to be provided to athletes and coaches, as well as long-term monitoring of movements. The potential for real-time feedback is useful for performance enhancement or technique analysis, and can be achieved by training efficient models and implementing them on dedicated hardware. Long-term monitoring of movement can be used for injury prevention, among others. Such applications are often enabled by training a machine learned model from large datasets that have been collected using wearable sensors. Therefore, in this perspective paper, we provide an overview of approaches for studies that aim to analyze sports movement “in the wild” using wearable sensors and machine learning. First, we discuss how a measurement protocol can be set up by answering six questions. Then, we discuss the benefits and pitfalls and provide recommendations for effective training of machine learning models from movement data, focusing on data pre-processing, feature calculation, and model selection and tuning. Finally, we highlight two application domains where “in the wild” data recording was combined with machine learning for injury prevention and technique analysis, respectively.

Introduction

     Measuring sports movement during training and competition allows monitoring athletes’ performance and their risk of injury (Camomilla et al., 2018, Cust et al., 2019). Performance monitoring is relevant to assess motor capacity and physical demand, as well as to analyze technique and how technique impacts performance (Camomilla et al., 2018). In the complementary perspective of sport-related injuries, monitoring can be oriented to preventing, assessing, and informing the recovery from injuries (Preatoni et al., 2022).

     The state-of-the-art approach to measure movement is to perform a biomechanical analysis from data recorded in a lab environment using optical motion capture (OMC) systems and force plates. Such an analysis includes calculating spatio-temporal variables, as well as joint angles, joint moments, and ground reaction forces. Musculoskeletal models can provide additional insights into muscle forces and activations, which cannot be measured directly. However, these state-of-the-art measurement techniques can only be used in a laboratory environment and are limited by high costs, a stationary setup, and a short duration.

Conclusion

     In this perspective paper, we have discussed different opportunities and challenges regarding analysis of “in the wild” movement data using machine learning. We have highlighted the importance of careful data recordings. This is important when recording movement in general, to collect the correct data at the correct point in time, but becomes even more important when machine learning is used for processing, to ensure that the trained model works for the data it should be analyzing, and that the correct analysis is performed. We have discussed several considerations regarding both data recording in general and specific to training of machine learning models, to ensure that in future researchers can properly address these in experiments. Furthermore, we highlighted how “in the wild” movement data can be used in two application domains, specifically monitoring injury risk and technique analysis.

     By combining machine learning with “in the wild” recordings, the main advantages are the potential for real-time feedback, while analyses can also be performed on large datasets. The real-time potential can be used to enhance the performance of athletes during training and competition. Its advantages for large datasets can be exploited when performing long-term monitoring to forecast injuries, especially by developing personalized models, while statistical features could be found that provide more insight than traditional parameters as well. The combination of real-time feedback with analysis on large datasets allows for computationally efficient calculation of many variables, e.g. joint angles of a kinematic model, which can then be used to create avatars of athlete’s movements to provide actionable insights. In conclusion, this perspective paper provides researchers with guidance and directions for future development of machine learning models for movement analysis “in the wild”.

Abstract

     The aim of this study is to examine whether students of a sport management undergraduate course can gain knowledge in the management of a professional soccer club, by participating in a commercial serious game. Serious is considered the cyber game that its purpose exceeds entertainment. For this case study, the serious sport club management game was “Top Eleven”. The theoretical model that this study was based on, is Misfeldt’s “scenarios based learning” for the transformation of a serious game into an educational means. It includes dimensions that cover part of the sport management class content in the National and Kapodistrian University of Athens, School of Physical Education and Sport Science. The transformation consisted of educational scenarios vested to the serious game, in order to add educational parameters to its basic elements with the purpose to relate further to the sport management class. The application showed that Top Eleven covers adequately Misfeldt’s model dimensions; therefore it can be used as an educational tool. Furthermore, an evaluation of the class gamification was conducted by the participating students (n = 62). The data collected showed that the majority of the students (f = 61, 98.4%) agreed that the participation in the serious game was “helpful” to their sport management class education process. They further agreed that they gained “very” or “very much” knowledge related to the management of a professional soccer club (f = 41, 66.1%) and that 59.7% (f = 37) of them would choose to work in a position of “sport club manager” as a result of the experience they gained by participating in the serious game.

Introduction

     Technology dominates modern times. Smart devices and internet are present in everyday life. Part of it is virtual reality, used to imitate the human activity in many areas, with a way increasingly like physical life. This allows using technology for fun, but also for gaining experiences that would not otherwise be possible, especially when it involves risk; economic, social, or physical. Therefore, such technology has also been entered the feld of education to better train learners (Baalsrud et al., 2013; Boskic & Hu, 2015). The main reason is that due to students’ inexperience, they cannot address work problems or make decisions that would jeopardize an organization’s relationship with its customers, investors, suppliers, or governmental agencies. Consequently, in education, especially in higher education, digital programs in form of simulators and/or serious games run as virtual work environments with complex conditions, very close to reality. As a result, learners can see, almost immediately, the efects of their work decisions as they apply the knowledge they have acquired during their professional education. Another reason for using serious games in higher education is the cost for obtaining the very expensive stimulators (Carvalho, 2017; Aldrich, 2009).

Conclusion

     The purpose and the original contribution of this study compared to current research already published is that it investigated the feasibility of converting a commercial, online, popular, and free to use serious sports club management game, into a simulator for providing the students with relevant awareness/knowledge using a game environment, The innovative approach to this was that we extended the original concept of the game by vesting educational assignments that students need to complete by using data and situations extracted from the game. It also provides lengthy sport management education scenarios, which ft to vest the serious game Top Eleven in order this popular, user-friendly, no cost game, applies as an auxiliary educational means, for an introductory class of sport management. On that, the students who participated in the study, admitted that they acquired knowledge on what it means to manage a soccer club and therefore based on their simulating job experience can now express their opinion on whether they would like to pursue this career path. It further presents one of the most attractive and no cost simulators, for teaching an introduction to sport management, which is missing from the current relevant bibliography.

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Methods

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Methods

Isokinetic Evaluation

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References

Purpose: To evaluate the effect of the coracoclavicular distance widening in athletes after arthroscopic acromioclavicular (AC) stabilization using a suspensory button fixation device in terms of function, athletic performance, or isokinetic assessment. Methods: Sixty-eight athletes with a minimum 6-month follow-up after AC stabilization using suspensory button fixation were allocated in 2 groups, the widening group and non-widening group, according to the measured coracoclavicular distance after 6 months from the operation. The assessment was done every 6 months by Subjective Patient Outcome for Return to Sports (SPORTS) score, Athletic Shoulder Outcome Scoring System (ASOSS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, ConstanteMurley score (CMS), and the coracoclavicular distance. Isokinetic testing was performed at 24 months postoperatively to evaluate shoulder abduction and external rotation strength. Results: No statistically significant differences were found between the 2 groups in terms of the DASH, ASOSS, SPORTS, and the CMS, in addition to the isokinetic testing (P > .05). A statistically significant improvement in both groups over the follow-up stage was identified in the DASH, ASOSS, SPORTS, and the CMS (P < .05). Conclusions: Coracoclavicular distance widening following arthroscopic suspensory button fixation for AC joint dislocation did not affect function, athletic performance, or isokinetic evaluation in athletes. Level of Evidence: III; nonrandomized, comparative trial.

Acromioclavicular (AC) joint dislocations are a common injury that account for almost 50% of sports-related shoulder injuries.1,  2,  3 The Rockwood classification is the most commonly used classification system. Conservative management is widely used for type I and II dislocations, whereas surgical treatment the intervention of choice for type IV to VI dislocations.1,4,  5,  6

Many surgical options have been reported in the literature, all of which aim for full recovery with the return to the preinjury level of activity and sport participation.6,  7,  8 The suspensory button fixation was reported initially for the fixation of syndesmotic ankle injuries. The use of these devices in the treatment of AC dislocations has been described in open and arthroscopic techniques.7,9,  10,  11

The loss of AC joint reduction, as evident by coracoclavicular (CC) distance widening, is commonly reported after AC stabilization using suspensory button fixation devices. The effect of such findings on the athletic performance of patients is not yet fully understood.7,9,11,  12,  13,  14,  15 The purpose of this study is to evaluate the effect of CC distance widening in athletes after arthroscopic AC joint stabilization using a suspensory bottom fixation device in terms of function, athletic performance, and/or isokinetic assessment. We hypothesized that the CC distance rewidening after AC joint stabilization using a suspensory button fixation might affect the function and athletic performance of the shoulder joint.