Department of Sport, Exercise and Health

Krafttraining kann nicht nur die Muskelmasse und Muskelkraft erhöhen, sondern kann auch einen Einfluss auf die Wahrnehmung von Schmerzreizen haben. Dies bedeutet, dass ein identischer Schmerzreiz nach einer Einheit an Krafttraining weniger schmerzhaft wahrgenommen wird.

In dem vorliegenden Projekt untersuchen wir den Einfluss eines spezielles Krafttrainings auf die Schmerzwahrnehmung. Hierfür wird während des Krafttraining eine Blutdruckmanschette proximal am trainierten Bein angelegt. Diese Blutdruckmanschette wird während des Trainings unterschiedlich stark aufgeblasen. Die Manschette bewirkt, dass die Blutzufuhr zu dem trainierten Bein eingeschränkt wird und kein venöser Rückstrom aus dem trainierten Bein mehr möglich ist. Diese Einschränkung der Blutflusses führt dazu, dass selbst durch Krafttraining mit kleinen Gewichten eine sehr hohe Ansammlung an Metaboliten im trainierten Bein erfolgt, was zu einer erhöhten Ermüdung führt.

In dem vorliegenden Forschungsprojekt wird der Einfluss dieses niedrig-intensiven Krafttraining mit simultaner Blutflussrestriktion auf die Schmerzwahrnehmung untersucht. Im Fokus stehen dabei unterschiedliche Manschettendrücke sowie Zusammenhänge zur peripheren und zentralen Ermüdung.

Premature birth, defined as the delivery of babies before the 37th week of pregnancy, presents an increasing challenge. Since the 1980s, medical advances such as specialized medication and ventilation techniques have significantly improved the survival rates of premature infants. Globally, approximately 11% of all births are premature, with Switzerland reporting about 5700 premature newborns each year.

Prematurity increases the risk of cardiovascular disease. Research indicates that very premature babies face a notably higher risk of heart problems. These infants often exhibit different heart shapes and functions, along with elevated blood pressure, beginning in infancy and potentially persisting into adulthood. This is partly because their blood vessels tend to be less elastic.

In addition to cardiovascular issues, premature babies frequently encounter challenges with certain cognitive tasks. Traditionally, the cardiovascular and brain functions of premature infants have been studied separately, despite the known close link between these systems in adults. Therefore, the EXCELSIOR study is exploring the impact of exercise on the small blood vessels in the eye, which can be examined through retinal vessel imaging. The objective is to determine if positive changes in these blood vessels correlate with improved cognitive performance.

Overnutrition, reduced energy expenditure and chronic inflammation stimulate triglyceride storage. Once the triglyceride stores are saturated, lipids in excess are redirected to form sphingolipids. However, sphingolipid accumulation drives complex molecular alterations, which promote peripheral insulin resistance and atherosclerosis. Failure to manage this sphingolipid overload eventually results in diabetes mellitus and coronary artery diseases. In the last decade, these pathophysiological findings found resonance in milestone clinical studies. In primary prevention, a score combining the blood level of four sphingolipids outperformed the 2019 SCORE of the European Society of Cardiology in terms of cardiovascular risk prediction. The same score predicted cardiovascular mortality beyond low-density lipoprotein cholesterol in secondary prevention. Remarkably, sphingolipids are not limited to cardiovascular risk prediction, as they were shown to predict diabetes mellitus onset ten years before the disease was diagnosed. While the utility of sphingolipid profiling to stratify cardiometabolic risk is well-established, little is known about therapeutic modalities to lower sphingolipid levels. If circulating sphingolipids are to be measured in clinical practice, providing patients with evidence-based sphingolipid-lowering interventions is essential. As exercise is a powerful means to prevent and treat cardiometabolic diseases, exercise interventions are ideal candidates for mitigating sphingolipid levels in a cost-effective, safe, and patient-empowering manner. This 2-arm, monocentric, randomised controlled trial explores whether and to what extent an 8-week fitness-enhancing training programme can lower serum sphingolipid levels of middle-aged adults at elevated cardiometabolic risk (n= 98, 50% females). The exercise intervention will consist of supervised high-intensity interval training (three sessions weekly), while the control group will receive physical activity counselling based on current guidelines. Maximal cardiopulmonary exercise tests will be performed before and after the 8-week programme to verify patients' fitness has improved. Blood will be sampled early in the morning in a fasted state before and after the 8-week programme. Participants will be provided with individualised, pre-packaged meals for the two days preceding blood sampling to minimise potential confounding. An 'omic-scale sphingolipid profiling, using high-coverage reversed-phase liquid chromatography coupled to tandem mass spectrometry, will be applied to capture the circulating sphingolipidome. Classical biomarkers of cardiometabolic health (total cholesterol, low- and high-density density lipoprotein cholesterol, triglycerides, glycated haemoglobin, and the homeostatic model assessment for insulin resistance) and retinal vessel diameters, a novel surrogate of microvascular health, will also be assessed pre-and post-intervention. This study will inform clinicians whether and to what extent exercise can be used as an evidence-based treatment to lower circulating sphingolipid levels.

Background and rationale.

Mental health disorders are the leading cause of disability in adolescents worldwide. 70 to 80% of individuals with mental disorders experience sleep disturbances. Preliminary evidence from adult studies suggest that treating sleep disturbances in these patients can improve mental health outcomes. Moreover, regular physical activity (PA) is increasingly promoted as a remedy for sleep and other mental health problems. Thus, combining sleep therapy and PA counseling may synergistically improve mental health outcomes in adolescent psychiatric patients. Guidance on how to address sleep disturbances and PA counselling among this population in routine clinical care has the potential to improve clinical and psychosocial outcomes.

Overall objectives.

To improve psychopathology in adolescent psychiatric outpatients with comorbid sleep disturbances by testing a novel behavioral intervention (SLEEPAC) that improves both sleep and PA levels. This multi-component intervention combines CBT-I, circadian treatment, and PA counseling and will be compared against treatment as usual (TAU).

Specific aims.

With the prospect of further developing and fine-tuning transdiagnostic treatment protocols for young psychiatric patients with comorbid sleep disturbances, the objectives of the proposed study are twofold: (1) To test the efficacy of a novel transdiagnostic blended care e-health sleep (CBT-I + circadian treatment) and PA therapy and to test its efficacy against TAU. The primary endpoint is severity reduction of psychopathology. Improvements of sleep health and regular PA levels will be investigated as secondary outcomes. (2) To evaluate the prognostic value of sleep neurophysiological biomarkers (high-density sleep-EEG) on intervention efficiency, thereby advancing current approaches in precision psychiatry.

Methods.

The proposed study will recruit 140 psychiatric outpatients with comorbid sleep problems from our partner clinics in Basel and Bern (KJP-UPD Bern, UKBB Basel). Inclusion criteria: aged 13-18 years, presence of sleep problems in addition to a psychiatric diagnosis. Adolescents will be serially randomized over 1,5 years into one of 2 intervention arms: (a) SLEEPAC; or (b) TAU. The intervention will be delivered in 6 sessions over 12 weeks. Data will be collected at 3 time points: Baseline, post-intervention, and 6-months follow-up. Psychopathological load will be assessed via Symptom Checklist-90-Revised. The composite sleep health score is based on self-reported sleep quality, -quantity, and timing, complemented by 7-day sleep tracker (Oura Ring Gen3). PA will be assessed objectively via the same device (Oura Ring was selected due to prior compliance issues among this population with Actigraph). Primary biomarkers are the micro-architectural features of sleep assessed by a high-density sleep-EEG, such as sleep spindles, slow wave activity, and REM-latency. Secondary biomarkers include heart rate variability, and fitness.

Expected results.

The proposed study aims to further develop and fine-tune transdiagnostic treatment protocols (i.e. for multiple psychiatric disorders) in adolescent psychiatric outpatients with sleep disturbances. Testing the potential of sleep treatments for improving psychopathology in young psychiatric patients is a promising and highly novel approach. Thus, it is expected that both SLEEPAC and TAU will improve psychopathology in youth, with SLEEPAC resulting in superior effects than TAU alone.

Impact. The onset of mental health disorders is often during adolescence, requiring countermeasures at an early developmental stage. Since sleep disturbances are a diagnostic feature for many psychiatric disorders, treating sleep problems transdiagnostically may positively impact other health outcomes. PA counseling may complement the benefits of the sleep intervention, working in concert to improve mental health outcomes.

Background

There is growing evidence that even low-intensity physical activity (e.g., walking at a “normal” pace) produces substantial health benefits. Walking is “universally accessible”, even for mobility-limited and chronically ill older people. To date, little consideration has been given to the environment and individual preferences of older people when promoting walking. A personalized approach based on geographic information systems (GIS) could help address the problem of low long-term adherence to walking programs.

Objective

MOBITEC-Routes aims to investigate the effects of an individualized GIS-based intervention on walking, physical activity, physical function, life space, participation in social activities, and quality of life.

Methods

In the target group of chronically ill, mobility limited older people (aged 65 years and older), the experimental intervention will be compared with a control intervention in a randomized controlled trial.

Outlook

If successful, the personalized GIS-based approach can be easily implemented in preventive health promotion.

Growing scientific evidence shows that specific sphingolipids, known as ceramides, predict cardiovascular risk beyond traditionally used biomarkers such as lipoproteins and triglycerides. Mechanistically, ceramides have been shown to promote foam cell formation, vascular inflammation, peripheral insulin resistance, and ultimately atherosclerosis. Currently, however, it remains unclear if and how physical activity, a simple, low-cost, and patient-empowering mean to optimise cardiometabolic health, can mitigate sphingolipid levels. The SphingoHIIT study aims to assess how certain circulating sphingolipid species respond to a single session of high-intensity interval training (HIIT). We hypothesise that circulating sphingolipid levels will be temporarily increased following a single HIIT session. This risk category A study will last 11 days and include 32 healthy participants aged between 20 and 29 years (50% of females). Participants will be randomly allocated either to the intervention group (n= 16) or the control group (n= 16). Blocked randomisation will be used to reduce bias and achieve balance in the allocation of participants to both groups, as commonly done when the sample size is small. Following an assessment of inclusion and exclusion criteria, a maximal cardiopulmonary exercise testing will be performed to determine peak oxygen uptake and peak heart rate. A washout period of five days will then be carried out before participants start to self-sample fasted dried blood spots to determine baseline levels of sphingolipids. After three days of sampling, participants will undergo a single HIIT session. Dried blood spots will be collected at five additional fixed time points (2min, 15min, 30min, 60min, and 24h) following the HIIT session. To minimise the dietary influence, participants will be asked to solely consume the provided individualised, pre-packaged meals starting one day before the first dried blood sampling.

Additionally, for the duration of the whole study, participants will wear a wrist accelerometer to track their physical activity. The SphingoHIIT study is expected to provide novel knowledge regarding the effect of an acute bout of physical exercise on sphingolipid levels. The results of this study will be published in a peer-reviewed journal and will be presented at scientific conferences.