Daniele A. Cardinale

Cerebral palsy (CP) is an early-onset neurodevelopmental condition associated with metabolic impairment and an increased risk of non-communicable diseases across the lifespan. However, the basis of these changes remains largely unknown. This study provides a comprehensive cardiometabolic and physical function profile of 23 adults with CP relative to 33 typically developing (TD) adolescents and 61 TD adults. Compared to TD individuals, adults with CP exhibited reduced cardiorespiratory fitness, smaller cardiac dimensions, and lower muscle mass. Circulating metabolomic and proteomic profiling identified a distinct molecular signature in CP, including altered tricarboxylic acid (TCA) cycle metabolites, and elevated myostatin, matrix-related proteins and pro-inflammatory cytokines. We further tested the capacity for physiological and molecular adaptation using an acute bout of endurance exercise. In response to exercise, individuals with CP exhibited an attenuated response compared to TD groups, characterized by a blunted lactate response and lower venous oxygen levels. TD participants also increased canonical exercise-responsive factors, including NADK, IL-8, ANGPTL1 and GDF15, whereas these responses were attenuated in CP. These novel findings define a distinct cardiometabolic profile in adults with CP at rest and reveal an attenuated molecular response to exercise. These data carry implications for targeted interventions and prevention strategies across the lifespan.

Aim: To explore the integrated cardiopulmonary, metabolic, and muscular response to incremental exercise in individuals with cerebral palsy (CP) compared with typically developing participants. Method: This was a prospective cross‐sectional study. Sixteen (seven male) individuals with CP (classified in Gross Motor Function Classification System levels II–V) and 30 (15 male) typically developing participants performed a treadmill‐based incremental submaximal test and an exercise test to task failure. Participants used running frames (CP) or performed traditional running (typically developing participants). Metabolic and cardiopulmonary parameters were measured during both tests. Electromyography of the vastus lateralis and gastrocnemius medialis was recorded during the test to task failure. Results: Compared with typically developing participants, individuals with CP showed decreased minute ventilation ( p < 0.05), increased respiratory frequency at a comparable exercise intensity ( p < 0.05), and an altered metabolic response, on the basis of the partial pressure of carbon dioxide ( p < 0.05) and lactate levels ( p < 0.001), during both tests. In addition, participants with CP exhibited a lower ventilatory efficiency during the test to task failure ( p < 0.01). Electromyography analysis suggested peripheral skeletal muscle fatigue in the lower limbs ( p < 0.05) in individuals with CP compared with typically developing participants. Interpretation: Individuals with CP have a disproportional ventilatory response to incremental exercise, not driven by metabolic perturbations. The increased breathing frequency resulted in high rate of perceived exertion and signs of peripheral muscle fatigue compared with typically developing participants. Our findings stress the importance of interventions focused on ventilatory function in individuals with CP.

Altitude training enhances haematological adaptations and endurance at sea level, typically requiring exposure to ∼2500 m altitude for 3–4 weeks. Emerging evidence suggests that low‐dose carbon monoxide (CO) inhalation might mimic hypoxia and might be used by elite athletes. In this study, we examine whether periodic low‐dose CO exposure can replicate the live‐high, train‐low model in well‐trained individuals, focusing primarily on haematological and performance effects of CO exposure, with haematological markers commonly used to interpret haemoglobin mass changes discussed as exploratory. Eight well‐trained individuals (four males and four females) participated in a randomized crossover study. They completed two training blocks of 4 weeks at sea level: one with CO inhalation (INCO) to simulate live‐high, train‐low and one with ambient air as a control (AIR), separated by a 6 month washout. Haematological variables, in vivo muscle oxidative capacity and performance metrics were assessed before and after each intervention. After INCO, haemoglobin mass ( p = 0.018; +53.6 ± 10.8 g. vs. +0.8 ± 11.8 g), red blood cell volume ( p = 0.032; +156.6 ± 66.7 mL vs. −65.1 ± 50.7 mL) and blood volume ( p = 0.036; +240.4 ± 120.5 mL vs. −208.3 ± 167.5 mL) increased significantly compared with AIR. INCO significantly reduced immature reticulocytes ( p = 0.04), but muscle oxidative capacity and performance metrics remained unchanged. These findings suggest that daily low‐dose CO exposure at sea level over 4 weeks enhanced haematological adaptations more than standard training but did not affect muscle oxidative capacity or performance.

Aim: This study aimed to investigate the determinants of running performance in a cross-country running race and examine whether running economy and biomechanics are affected. Moreover, we analyzed whether the magnitude of change in running economy (RE) is related to changes in biomechanics, performance, and fitness measures.Method: Thirteen runners (12 male and 1 female), with an average 10 km personal best time of 36:46 ± 3:17 (min:s), participated in the 30 km cross-country race, Lidingöloppet. Assessments of submaximal and maximal running physiology, biomechanics, and anthropometry were conducted before and immediately after the race. A multiple linear regression model was applied to explain performance variance. Pearson’s correlation analyses examined the relationships between performance and pre-test variables, and between changes in running economy and both pre-test fitness measures and changes in biomechanics. Paired Student’s t-tests were used to compare pre- and post-race values.Results: Performance was best explained using a model including oxygen uptake at lactate threshold (LT), fat utilization, and allometrically scaled running economy (R² = 0.918, adjusted R² = 0.887, F = 29.7, p < 0.01). Race performance also correlated with maximal oxygen uptake (VO₂max, r = −0.776, p = 0.003), fat mass (r = 0.646, p = 0.032), and velocity at VO₂max (vVO₂max, r = −0.853, p < 0.01). The oxygen cost of running increased (201.8 ± 14 vs. 208.4 ± 9.3 mL kg⁻¹·km⁻¹; p = 0.041), whereas respiratory exchange ratio (0.91 ± 0.04 vs. 0.85 ± 0.05; p < 0.01) and body mass (69.2 ± 7.5 vs. 67.6 ± 7.7 kg; p < 0.01) decreased post-race. Energetic cost of running (0.997 ± 0.076 vs. 1.015 ± 0.052 kcal kg⁻¹·km⁻¹; p = 0.192) and all biomechanical measurements, including cadence, contact time, overstride, vertical displacement, and vertical force, were unaffected by the race. The magnitude of change in running economy was related only to pre-test running economy (r = −0.749; p = 0.003) but not to performance (r = −0.440; p = 0.132), other pre-test fitness measures, or any changes in biomechanics.Conclusion: The best performance prediction model included oxygen uptake at estimated lactate threshold, fat utilization during submaximal running, and allometrically scaled running economy. Oxygen cost of running increased post-race, likely due to increased fat oxidation, despite decreased body mass. No changes in biomechanics were observed, and changes in running economy could not be explained by changes in biomechanics. Aerobic fitness, anthropometry, and performance were not associated with changes in running economy. Given the small and relatively homogeneous sample, findings should be considered exploratory, although they suggest that practitioners may benefit from targeting fat oxidation, oxygen uptake at the estimated lactate threshold, and running economy in training.

Physiological characteristics such as VO_2max, running economy (RE), maximal aerobic speed (MAS), maximal sprinting speed (MSS), anaerobic speed reserve (ASR), and player profiling (based on MSS and MAS) have been proven to be important for training prescriptions in football. However, previous studies on player profiling have neglected the absolute values of MSS and MAS. The objectives of this study were to compare the aforementioned physiological variables among player roles, create benchmarks, and provide normative data to help coaches categorize players, ultimately proposing a new player profiling method. We analyzed 195 male professional football players (50 forwards, 59 midfielders, 44 full-backs, and 42 center-backs). Multivariate analysis of variance with Tukey’s post hoc tests revealed positional differences. Center-backs exhibited lower VO_2max than midfielders and full-backs. Both center-backs and forwards showed poorer RE and MAS compared to midfielders and full-backs. Full-backs achieved higher MSS than midfielders and center-backs, and forwards outperformed center-backs. Finally, midfielders demonstrated lower ASR than all other positions. Benchmarks based on T-scores for all variables were provided. Finally, in the new profiling method proposed—also based on T-scores—players were classified as “speed”, “endurance”, or “hybrid” if their MAS and/or MSS T-score exceeded 60, “in development” if both were below 45, and “average” if both scores were between 45 and 60 without any value above 60. The normative data provided can assist coaches in identifying specific areas for improvement in players’ physical conditioning—particularly valuable for youth athletes or those returning from injury. Additionally, the new profiling method offers insights into individual player characteristics, enabling more tailored and effective training interventions.

This study aimed to evaluate in vivo oxidative capacity and relative resistance to O ₂ diffusion using near‐infrared spectroscopy (NIRS) in the m. triceps brachii of recreational to world class swimmers and evaluate their relationships with swimming performance. Twenty‐eight swimmers were enrolled and assigned into three subgroups according to their level: ‘recreational/trained’ (Tier 1/2; n  = 8), ‘national’ (Tier 3; n =  12) and ‘international/world class’ (Tier 4/5; n = 8). Performance was evaluated by 100 m freestyle trials. Training volume was measured by self‐reported distance (km/week). The recovery k of m. triceps brachii was non‐invasively estimated by NIRS through repeated intermittent occlusions under two conditions: well‐oxygenated ( k _HIGH ) and low O ₂ availability ( k _LOW ). The difference between k _HIGH and k _LOW (Δ k ) was calculated as an index of relative resistance to O ₂ diffusion. FINA points and 100 m performance differed among all groups. Training volume was greater in Tier 4/5 (34.0 ± 5.5 km week ⁻¹ ) and Tier 3 (35.5 ± 11.6 km week ⁻¹ ) than in Tier 1/2 (6.4 ± 1.8 km week ⁻¹ ). k _HIGH was greater in Tier 4/5 and Tier 3 (3.18 ± 0.41 and 2.79 ± 0.40 min ⁻¹ ) versus Tier 1/2 (2.10 ± 0.36 min ⁻¹ ; all P  < 0.002). k _HIGH correlated with FINA points, 100 m performance and training volume. ∆ k was not different among tiers and was not associated with training volume or performance. M. triceps brachii oxidative capacity ( k _HIGH ) was positively associated with performance and training volume in swimmers. ∆ k , which reflects relative resistance to O ₂ diffusion, was not different among athletes. These data suggest that m. triceps brachii oxidative capacity is associated with swimming performance and that muscle O ₂ diffusing capacity exerts a similar relative resistance to O ₂ diffusive flow across swimmers.

Three weeks of training at moderate altitude with exposure to low doses of CO can significantly enhance hematological adaptations in elite cyclists compared to moderate-altitude training alone. Cycling performance determinants improved more with CO inhalation at moderate altitude compared to sea-level training, whereas there were no differences in submaximal and maximal performance measures compared to moderate-altitude training alone. This study highlights the potential of CO supplementation as an effective adjunct to altitude training regimens.

Purpose: Altitude training is a common strategy used with the intent to increase hemoglobin mass (Hb_mass) in athletes. However, if the Hb_mass is increased during altitude camps, it seems to decline rapidly upon returning to sea level. This study aimed to examine the efficacy of three weekly heat training sessions over a 3.5-wk period after a 3-wk altitude camp on the maintenance of Hb_mass in elite cyclists. Methods: Eighteen male cyclists (maximal oxygen consumption: 76 ± 5 mL·min⁻¹·kg⁻¹) underwent a 3-wk altitude training camp at ~2100 m above sea level. After the camp, participants were divided into one group performing three weekly heat sessions that were subtracted from their usual training (HEAT) while the other continuing usual training (CON). Training characteristics were recorded during the intervention, whereas hematological measurements were recorded before the camp as well as 2 d and 3.5 wk after the altitude camp. Results: The 3-wk altitude camp led to an overall increase in total Hb_mass of 4.1%. Afterward, HEAT maintained Hb_mass (0.2%, P = 0.738), whereas CON group experienced a significant reduction (−3.3%, P < 0.001) (ΔHEAT vs ΔCON, P < 0.001). Moreover, HEAT increased plasma volume (PV) by 11.6% (P = 0.007) and blood volume (BV) by 5.8% (P = 0.007), whereas CON only showed an increase in PV (5.5%, P = 0.041). Exercise intensity and training load were not different between groups during the maintenance period. Conclusions: This study suggests that incorporating three weekly heat training sessions into the usual training routine preserves a moderately increased Hb_mass in elite cyclists after an altitude camp.

Classifying athletes based on estimates of biological maturation (i.e., bio-banding) as a supplement to traditional age grouping has been shown to be a potential tool for enriching player development in team sports; however, bio-banding has not yet been evaluated in ice hockey. The primary aim was to investigate player experiences and coaches’ selection preferences in bio-banding versus age-banding in a group of 12-13-year-old (early growth spurt) male elite players (n = 69). We also examined the relationship between somatic maturity, expressed as a % predicted adult height (%PAH), and fitness performance. Bio-banding was assessed using a questionnaire and 29 coaches selected their top players in each game based on age or bio-bands. %PAH correlated with grip strength (r = .57, p>0.001) and jumping power (r = .63, p<0.001), but not with vertical jump height, sprint time or endurance. Players who played against more mature players in bio-bands than in age groups experienced higher demands, while players who played against less mature players were able to utilize their skills to a greater extent. Coaches generally favored later-than-average maturing players who performed better on performance tests and chronologically older players in bio-banding. We conclude that bio-banding in youth ice hockey has some promising effects and warrants further evaluation.