Long-Term Combined Effects of Citrulline and Nitrate-Rich Beetroot Extract Supplementation on Recovery Status in Trained Male Triathletes: A Randomized, Double-Blind, Placebo-Controlled Trial

Citrulline (CIT) and nitrate-rich beetroot extract (BR) are widely studied ergogenic aids. Nevertheless, both supplements have been studied in short-term trials and separately. To the best of the authors’ knowledge, the effects of combining CIT and BR supplementation on recovery status observed by distance covered in the Cooper test, exercise-induced muscle damage (EIMD) and anabolic/catabolic hormone status have not been investigated to date. Therefore, the main purpose of this research was to assess the effect of the long-term (9 weeks) mixture of 3 g/day of CIT plus 2.1 g/day of BR (300 mg/day of nitrates (NO3−)) supplementation on recovery by distance covered in the Cooper test, EIMD markers (urea, creatinine, AST, ALT, GGT, LDH and CK) and anabolic/catabolic hormones (testosterone, cortisol and testosterone/cortisol ratio (T/C)) in male trained triathletes. Thirty-two triathletes were randomized into four different groups of eight triathletes in this double-blind, placebo-controlled trial: placebo group (PLG), CIT group (CITG; 3 g/day of CIT), BR group (BRG; 2.1 g/day of BR (300 mg/day of NO3−)) and CIT-BR group (CIT-BRG; 3 g/day of CIT plus 2.1 g/day of BR (300 mg/day of NO3−)). Distance covered in the Cooper test and blood samples were collected from all participants at baseline (T1) and after 9 weeks of supplementation (T2). There were no significant differences in the interaction between group and time in EIMD markers (urea, creatinine, AST, ALT, GGT, LDH and CK) (p > 0.05). However, significant differences were observed in the group-by-time interaction in distance covered in the Cooper test (p = 0.002; η2p = 0.418), cortisol (p = 0.044; η2p = 0.247) and T/C (p = 0.005; η²p = 0.359). Concretely, significant differences were observed in distance covered in the Cooper test percentage of change (p = 0.002; η²p = 0.418) between CIT-BRG and PLG and CITG, in cortisol percentage change (p = 0.049; η2p = 0.257) and in T/C percentage change (p = 0.018; η2p = 0.297) between CIT-BRG and PLG. In conclusion, the combination of 3 g/day of CIT plus 2.1 g/day of BR (300 mg/day of NO3−) supplementation for 9 weeks did not present any benefit for EIMD. However, CIT + BR improved recovery status by preventing an increase in cortisol and showing an increase in distance covered in the Cooper test and T/C.

Recovery From COVID-19 in Multiple Sclerosis

Background and ObjectivesTo understand the course of recovery from coronavirus disease 2019 (COVID-19) among patients with multiple sclerosis (MS) and to determine its predictors, including patients' pre–COVID-19 physical and mental health status.MethodsThis prospective and longitudinal cohort study recruited patients with MS who reported COVID-19 from March 17, 2020, to March 19, 2021, as part of the United Kingdom MS Register (UKMSR) COVID-19 study. Participants used online questionnaires to regularly update their COVID-19 symptoms, recovery status, and duration of symptoms for those who fully recovered. Questionnaires were date stamped for estimation of COVID-19 symptom duration for those who had not recovered at their last follow-up. The UKMSR holds demographic and up-to-date clinical data on participants as well as their web-based Expanded Disability Status Scale (web-EDSS) and Hospital Anxiety and Depression Scale (HADS) scores. The association between these factors and recovery from COVID-19 was assessed using multivariable Cox regression analysis.ResultsOf the 7,977 patients with MS who participated in the UKMSR COVID-19 study, 599 reported COVID-19 and prospectively updated their recovery status. Twenty-eight hospitalized participants were excluded. At least 165 participants (29.7%) had long-standing COVID-19 symptoms for ≥4 weeks and 69 (12.4%) for ≥12 weeks. Participants with pre–COVID-19 web-EDSS scores ≥7, participants with probable anxiety and/or depression (HADS scores ≥11) before COVID-19 onset, and women were less likely to report recovery from COVID-19.DiscussionPatients with MS are affected by postacute sequelae of COVID-19. Preexisting severe neurologic impairment or mental health problems appear to increase this risk. These findings can have implications in tailoring their post–COVID-19 rehabilitation.

ESA recovery metrics v1

The U.S. Endangered Species Act (ESA) protects over 2,000 species, but no concise, standardized metrics exist for assessing changes in species recovery status. Tracking these changes is crucial to understanding species status, adjusting conservation strategies, and assessing the performance of the ESA. We helped develop and test novel metrics that track changes in recovery status using six components. ESA 5-year status reviews provided all of the information used to apply the recovery metrics. When we analyzed the reviews, we observed several key challenges to species recovery. First, the reviews lack a standardized format and clear documentation. Second, despite having been listed for decades, many species still lack basic information about their biology and threats. Third, many species have continued to decline after listing. Fourth, many species currently have no path to recovery. Applying the recovery metrics allowed us to gain these and other insights about ESA implementation. We urge the U.S. Fish and Wildlife Service to adopt the metrics as part of future status reviews in order to inform public discourse on improving conservation policy and to systematically track the recovery progress of all ESA species.

Pre-existing anxiety, depression, and neurological disability are associated with long COVID: A prospective and longitudinal cohort study of the United Kingdom Multiple Sclerosis Register

Objectives: To assess the prevalence of and factors associated with developing long COVID among patients with multiple sclerosis (MS), a condition which shares the neurological and psychological symptomatology of long COVID Design: Community-based prospective and longitudinal observational study Setting: The United Kingdom (UK) MS Register (UKMSR) COVID-19 study Participants: A national cohort of MS patients with COVID-19 Main outcome measures: Participants used the online questionnaire-based platform of the UKMSR to update their COVID-19 symptoms and recovery status. Questionnaires were date-stamped for estimation of COVID-19 symptom duration. The UKMSR also holds demographic and up-to-date clinical data on participants including comorbidities, MS type, date of MS diagnosis, disease-modifying therapies, web-based Expanded Disability Status Scale scores (a measure of physical disability in MS), and Hospital Anxiety and Depression Scale. The association between these factors and recovery from COVID-19 was assessed using multivariable Cox regression analysis. Results: Out of 7,977 MS patients who participated in the UKMSR COVID-19 study, 599 had COVID-19 and updated their recovery status prospectively. At least 181 participants (31.1%) had long-standing COVID-19 symptoms for ≥4 weeks and 76 (13.1 %) for ≥12 weeks. Participants with higher levels of pre-COVID-19 physical disability, participants with anxiety and/or depression prior to COVID-19 onset, and women were less likely to recover from COVID-19. Conclusions: Long COVID appears to affect patients with a pre-existing chronic condition, especially those with physical disabilities or mental health problems disproportionately when compared to reports in the general population. Long COVID research and the development of post-COVID-19 rehabilitation services need to be inclusive of these at-risk populations. Trial Registration: ClinicalTrials.gov: NCT04354519

Supercompensation in Elite Water Polo: Heart Rate Variability and Perceived Recovery

We examined the association of heart rate variability assessed with the logarithm of the root mean square of successive differences (LnRMSSD) and perceived recovery status of nine elite water polo players with the fluctuations of the internal training load (ITL). ITL, post-wakening LnRMSSD, and measures of perceived recovery were obtained across one regeneration week, during two mesocycles of intensified preseason training (PR1, PR2) and during two mesocycles of in-season training (IN1, IN2). ITL at PR1 and PR2 was increased by 60–70% compared to regeneration week (p<0.01) and was reduced by 30% at IN1 and IN2 compared to PR1 and PR2 (p<0.01). Weekly averaged LnRMSSD (LnRMSSDmean) was higher in IN2 compared to regeneration week and PR2 (p<0.01 and p<0.05, respectively). Perceived recovery was higher at IN1 and IN2 compared to PR2 (p=0.01 and p<0.001, respectively). ITL correlated with LnRMSSD in the preseason (r=–0.26, p=0.03). Nonetheless, similar association was not apparent during the in-season period (r=0.02, p=0.88). Cardiac autonomic perturbations may not occur when an increment of internal training load is less than 60–70%. However, the reduction of training load in season by 30% improves both LnRMSSDmean and perceived recovery status, implying that training periodization may lead players in supercompensation.

Quantifying Sub-Elite Youth Football Weekly Training Load and Recovery Variation

Monitoring the training load in football is an important strategy to improve athletic performance and an effective training periodization. The aim of this study was two-fold: (1) to quantify the weekly training load and recovery status variations performed by under-15, under-17 and under-19 sub-elite young football players; and (2) to analyze the influence of age, training day, weekly microcycle, training and playing position on the training load and recovery status. Twenty under-15, twenty under-17 and twenty under-19 players were monitored over a 2-week period during the first month of the 2019–2020 competitive season. Global positioning system technology (GPS) was used to collect external training loads: total distance covered, average speed, maximal running speed, relative high-speed running distance, high metabolic load distance, sprinting distance, dynamic stress load, accelerations and decelerations. Internal training load was monitored using ratings of perceived exertion (RPE) and session rating of perceived exertion (sRPE). Recovery status was obtained using the total quality recovery (TQR) scale. The results show an age-related influence for external training load (p ≤ 0.001; d = 0.29–0.86; moderate to strong effect), internal training load (p ≤ 0.001, d = 0.12–0.69; minimum to strong effect) and recovery status (p ≤ 0.001, d = 0.59; strong effect). The external training load presented differences between training days (p < 0.05, d = 0.26–0.95; moderate to strong effect). The playing position had a minimum effect on the weekly training load (p < 0.05; d = 0.06–0.18). The weekly microcycle had a moderate effect in the TD (p < 0.05, d = 0.39), RPE (p < 0.05; d = 0.35) and sRPE (p < 0.05, d = 0.35). Interaction effects were found between the four factors analyzed for deceleration (F = 2.819, p = 0.017) and between inter-day, inter-week and age for total covered distance (F = 8.342, p = 0.008). This study provided specific insights about sub-elite youth football training load and recovery status to monitor training environments and load variations. Future research should include a longer monitoring period to assess training load and recovery variations across different season phases.

Blood indices, in-hospital outcome and short-term prognosis in patients with COVID-19 pneumonia

The predictive role of blood indices in coronavirus disease 2019 (COVID-19) related in-hospital adverse outcomes and post-recovery status is not fully defined. The main aim was to assess the association of complete blood indices measured at baseline with COVID-19 related in-hospital clinical outcomes, including length of hospital and intensive care unit (ICU) stay, receiving mechanical ventilation, degree of lung injury and in-hospital death, and post-recovery status. This retrospective study included patients with newly diagnosed COVID-19 infection from August 20, to September 25, 2020. The initial study cohort included 127 patients with newly diagnosed COVID-19. Of whom 26 patients were excluded, leaving 101 patients for final analysis. low lymphocytes % [Odds ratio and confidence intervals = OR (CI)] [0.2(0.0-0.2, p=0.03] increased the odds of ICU stay length while high platelet mean volume (PMV) [0.9 (1.1-5, p<0.00], high platelet distribution width (PDW) [0.3(0.4-1.9), p<0.00], and low lymphocytes % [0.2 (0.0-0.2), p=0.02] increased the odds of length of hospital stay. Decreased lymphocytes % showed significant independent association with increased risk for mechanical ventilation use [0.9 (0.9-1), p=0.04], extensive degree of lung injury [0.2 (0.1-0.7), p<0.00], and in-hospital death [0.5 (0.3-0.8), p=0.01]. High lymphocytes %[0.9 (0.9-1), p<0.00] and high PMV [0.3 (0.3-0.8), p=0.02] were significantly associated with complete recovery while increased neutrophil % [1 (1-1.1), p=0.04] was associated with increased risk for post recovery fatigue. In conclusion, low lymphocytes % and high neutrophil % are useful markers for predicting adverse in-hospital outcome and post-recovery persistent fatigue, respectively. High PMV and lymphocyte % showed significant association with favorable short-term prognosis.