ORCID Profile
0000-0002-9298-4347
Current Organisations
Philip Morris International (Switzerland)
,
Weifang University of Science and Technology
,
Radboudumc
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Publications
Supplementation with Whey Protein, but Not Pea Protein, Reduces Muscle Damage Following Long-Distance Walking in Older Adults
Publisher: MDPI AG
Date: 10-01-2023
DOI: 10.3390/NU15020342
Abstract: Background: Adequate animal-based protein intake can attenuate exercise induced-muscle damage (EIMD) in young adults. We examined the effects of 13 days plant-based (pea) protein supplementation compared to whey protein and placebo on EIMD in active older adults. Methods: 47 Physically active older adults (60+ years) were randomly allocated to the following groups: (I) whey protein (25 g/day), (II) pea protein (25 g/day) or (III) iso-caloric placebo. Blood concentrations of creatine kinase (CK) and lactate dehydrogenase (LDH), and skeletal muscle mass, muscle strength and muscle soreness were measured prior to and 24 h, 48 h and 72 h after a long-distance walking bout (20–30 km). Results: Participants walked 20–30 km and 2 dropped out, leaving n = 15 per subgroup. The whey group showed a significant attenuation of the increase in EIMD at 24 h post-exercise compared to the pea and placebo group (CK concentration: 175 ± 90 versus 300 ± 309 versus 330 ± 165, p = p 0.001). No differences in LDH levels, muscle strength, skeletal muscle mass and muscle soreness were observed across groups (all p-values 0.05). Conclusions: Thirteen days of pea protein supplementation (25 g/day) does not attenuate EIMD in older adults following a single bout of prolonged walking exercise, whereas the whey protein supplementation group showed significantly lower post-exercise CK concentrations.
Cooling during exercise in temperate conditions: impact on performance and thermoregulation.
Publisher: Georg Thieme Verlag KG
Date: 25-04-2014
Abstract: Exercise-induced increase in core body temperature may lead to the development of hyperthermia (>40.0°C) and/or decreased performance levels. This study examined the effects of wearing a cooling vest during a 5-km time trial on thermoregulatory responses and performance. 10 male masters athletes (42±10 years) performed a 5-km time trial on a motorized treadmill in a climate chamber (25°C, 55% relative humidity) with and without a cooling vest. Split times, heart rate, core-, skin- and cooling vest temperature were measured every 500 m. Subjects also rated thermal comfort and level of perceived exertion. The cooling vest significantly decreased heart rate (p<0.05), decreased skin temperature (p<0.001) and improved thermal comfort (p<0.005) during the time trial. Time to finish the 5-km time trial and pacing strategy did not differ between the control (1 246±96 s) and cooling vest condition (1 254±98 s, p=0.85). Additionally, thermoregulatory responses, maximum core body temperature and level of perceived exertion were not different across conditions (p=0.85, p=0.49, p=0.11, respectively). In conclusion, we demonstrated that wearing a cooling vest during exercise improves thermal comfort but does not enhance performance or decrease core body temperature in male masters athletes under temperate ambient conditions.
Red Blood Cell Aging as a Homeostatic Response to Exercise-Induced Stress
Publisher: MDPI AG
Date: 11-11-2019
DOI: 10.3390/APP9224827
Abstract: Our knowledge on the molecular mechanisms of red blood cell aging is mostly derived from in vitro studies. The Four Days Marches of Nijmegen in the Netherlands, the world’s largest yearly walking event, constitutes a unique possibility to study the effect of mechanical and biochemical stressors occurring during moderate-intensity exercise on red blood cell aging in vivo. Therefore, longitudinal measurements were performed of biophysical, immunological, and functional red blood cell characteristics that are known to change during aging. Our data show that moderate-intensity exercise induces the generation of a functionally improved red blood cell population with a higher deformability and a decreased tendency to aggregate. This is likely to be associated with an early removal of the oldest red blood cells from the circulation, as deduced from the (dis)appearance of removal signals. Thus, the physiological red blood cell aging process maintains homeostasis in times of moderate-intensity exercise-induced stress, probably by accelerated aging and subsequent removal of the oldest, most vulnerable red blood cells.
Impact of thermal sensation on exercise performance in the heat: a Thermo Tokyo sub-study.
Publisher: Springer Science and Business Media LLC
Date: 19-11-2022
DOI: 10.1007/S00421-021-04845-8
Abstract: Thermal perception, including thermal sensation (TS), influences exercise performance in the heat. TS is a widely used measure and we examined the impact of initial TS (iTS) on performance loss during exercise in simulated Tokyo environmental conditions among elite athletes. 105 Elite outdoor athletes (endurance, skill, power and mixed trained) participated in this crossover study. Participants performed a standardized exercise test in control (15.8 ± 1.2 °C, 55 ± 6% relative humidity (RH)) and simulated Tokyo (31.6 ± 1.0 °C, 74 ± 5% RH) conditions to determine performance loss. TS was assessed ± 5 min prior to exercise (iTS) and every 5 min during the incremental exercise test (TS). Based on iTS in the Tokyo condition, participants were allocated to a neutral (iTS = 0, n = 11), slightly warm (iTS = 1, n = 50), or warm-to-hot (iTS = 2/3, n = 44) subgroup. For the whole cohort iTS was 1 [1-2] and TS increased to 3 [3-3] at the end of exercise in the Tokyo condition. Average performance loss was 26.0 ± 10.7% in the Tokyo versus control condition. The slightly warm subgroup had less performance loss (22.3 ± 11.3%) compared to the warm-to-hot subgroup (29.4 ± 8.5%, p = 0.003), whereas the neutral subgroup did not respond different (28.8 ± 11.0%, p = 0.18) from the slightly warm subgroup. iTS impacted the magnitude of performance loss among elite athletes exercising in hot and humid conditions. Athletes with a warm-to-hot iTS had more performance loss compared to counterparts with a slightly warm iTS, indicating that pre-cooling strategies and/or heat acclimation may be of additional importance for athletes in the warm-to-hot iTS group to mitigate the impact of heat stress.
Increasing Nitrate-Rich Vegetable Intake Lowers Ambulatory Blood Pressure in (pre)Hypertensive Middle-Aged and Older Adults: A 12-Wk Randomized Controlled Trial
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1093/JN/NXAB157
Abstract: Emerging evidence suggests that increasing dietary nitrate intake may be an effective approach to improve cardiovascular health. However, the effects of a prolonged elevation of nitrate intake through an increase in vegetable consumption are understudied. Our primary aim was to determine the impact of 12 wk of increased daily consumption of nitrate-rich vegetables or nitrate supplementation on blood pressure (BP) in (pre)hypertensive middle-aged and older adults. In a 12-wk randomized, controlled study (Nijmegen, The Netherlands), 77 (pre)hypertensive participants (BP: 144 ± 13/87 ± 7 mmHg, age: 65 ± 10 y) either received an intervention with personalized monitoring and feedback aiming to consume ∼250-300 g nitrate-rich vegetables/d (∼350-400 mg nitrate/d n = 25), beetroot juice supplementation (400 mg nitrate/d n = 26), or no intervention (control n = 26). Before and after intervention, 24-h ambulatory BP was measured. Data were analyzed using repeated measures ANOVA (time × treatment), followed by within-group (paired t-test) and between-group analyses (1-factor ANOVA) where appropriate. The 24-h systolic BP (SBP) (primary outcome) changed significantly (P-interaction time × treatment = 0.017) with an increase in the control group (131 ± 8 compared with 135 ± 10 mmHg P = 0.036) a strong tendency for a decline in the nitrate-rich vegetable group (129 ± 10 compared with 126 ± 9 mmHg P = 0.051) which was different from control (P = 0.020) but no change in the beetroot juice group (133 ± 11 compared with 132 ± 12 mmHg P = 0.56). A significant time × treatment interaction was also found for daytime SBP (secondary outcome, P = 0.011), with a significant decline in the nitrate-rich vegetable group (134 ± 10 compared with 129 ± 9 mmHg P = 0.006) which was different from control (P = 0.010) but no changes in the beetroot juice (138 ± 12 compared with 137 ± 14 mmHg P = 0.41) and control group (136 ± 10 compared with 137 ± 11 mmHg P = 0.08). Diastolic BP (secondary outcome) did not change in any of the groups. A prolonged dietary intervention focusing on high-nitrate vegetable intake is an effective strategy to lower SBP in (pre)hypertensive middle-aged and older adults. This trial was registered at www.trialregister.nl as NL7814.
Comment on “Overlapping Mechanisms of Exertional Heat Stroke and Malignant Hyperthermia: Evidence vs. Conjecture”
Publisher: Springer Science and Business Media LLC
Date: 09-10-2021
Infographic. Keep it cool and beat the heat: cooling strategies for exercise in hot and humid conditions
Publisher: BMJ
Date: 19-06-2020
Changes in cytokine levels after prolonged and repeated moderate intensity exercise in middle-aged men and women
Publisher: Hindawi Limited
Date: 29-04-2018
DOI: 10.1002/TSM2.23
The Impact of Protein Supplementation on Exercise-Induced Muscle Damage, Soreness and Fatigue Following Prolonged Walking Exercise in Vital Older Adults: A Randomized Double-Blind Placebo-Controlled T
Publisher: MDPI AG
Date: 17-06-2020
DOI: 10.3390/NU12061806
Abstract: Background: It is unknown whether protein supplementation can enhance recovery of exercise-induced muscle damage in older adults who have a disturbed muscle protein synthetic response. We assessed whether protein supplementation could attenuate exercise-induced muscle damage and soreness after prolonged moderate-intensity walking exercise in older adults. Methods: In a double-blind, placebo-controlled intervention study, 104 subjects (81% male, ≥65 years) used either a protein (n = 50) or placebo supplement (n = 54) during breakfast and directly after exercise. Within a walking event, study subjects walked 30/40/50 km per day on three consecutive days. Muscle soreness and fatigue were determined with a numeric rating scale, and creatine kinase (CK) concentrations and serum inflammation markers were obtained. Results: Habitual protein intake was comparable between the protein (0.92 ± 0.27 g/kg/d) and placebo group (0.97 ± 0.23 g/kg/d, p = 0.31). At baseline, comparable CK concentrations were found between the protein and the placebo group (110 (IQR: 84–160 U/L) and 115 (IQR: 91–186 U/L), respectively, p = 0.84). Prolonged walking (protein: 32 ± 9 km/d, placebo: 33 ± 6 km/d) resulted in a cumulative increase of CK in both the protein (∆283 (IQR: 182–662 U/L)) and placebo group (∆456 (IQR: 209–885 U/L)) after three days. CK elevations were not significantly different between groups (p = 0.43). Similarly, no differences in inflammation markers, muscle soreness and fatigue were found between groups. Conclusions: Protein supplementation does not attenuate exercise-induced muscle damage, muscle soreness or fatigue in older adults performing prolonged moderate-intensity walking exercise.
Non-Invasive Monitoring of Inflammation in Inflammatory Bowel Disease Patients during Prolonged Exercise via Exhaled Breath Volatile Organic Compounds
Publisher: MDPI AG
Date: 03-03-2022
Abstract: The aim of this study was to investigate volatile organic compounds (VOCs) in exhaled breath as possible non-invasive markers to monitor the inflammatory response in inflammatory bowel disease (IBD) patients as a result of repeated and prolonged moderate-intensity exercise. We included 18 IBD patients and 19 non-IBD in iduals who each completed a 30, 40, or 50 km walking exercise over three consecutive days. Breath and blood s les were taken before the start of the exercise event and every day post-exercise to assess changes in the VOC profiles and cytokine concentrations. Proton transfer reaction time-of-flight mass spectrometry (PTR-ToF-MS) was used to measure exhaled breath VOCs. Multivariate analysis, particularly ANOVA-simultaneous component analysis (ASCA), was employed to extract relevant ions related to exercise and IBD. Prolonged exercise induces a similar response in breath butanoic acid and plasma cytokines for participants with or without IBD. Butanoic acid showed a significant correlation with the cytokine IL-6, indicating that butanoic acid could be a potential non-invasive marker for exercise-induced inflammation. The findings are relevant in monitoring personalized IBD management.
Exhaled Breath Reflects Prolonged Exercise and Statin Use during a Field Campaign
Publisher: MDPI AG
Date: 24-03-2021
Abstract: Volatile organic compounds (VOCs) in exhaled breath provide insights into various metabolic processes and can be used to monitor physiological response to exercise and medication. We integrated and validated in situ a s ling and analysis protocol using proton transfer reaction time-of-flight mass spectrometry (PTR-ToF-MS) for exhaled breath research. The approach was demonstrated on a participant cohort comprising users of the cholesterol-lowering drug statins and non-statin users during a field c aign of three days of prolonged and repeated exercise, with no restrictions on food or drink consumption. The effect of prolonged exercise was reflected in the exhaled breath of participants, and relevant VOCs were identified. Most of the VOCs, such as acetone, showed an increase in concentration after the first day of walking and subsequent decrease towards baseline levels prior to walking on the second day. A cluster of short-chain fatty acids including acetic acid, butanoic acid, and propionic acid were identified in exhaled breath as potential indicators of gut microbiota activity relating to exercise and drug use. We have provided novel information regarding the use of breathomics for non-invasive monitoring of changes in human metabolism and especially for the gut microbiome activity in relation to exercise and the use of medication, such as statins.
A Heart Rate Based Algorithm to Estimate Core Temperature Responses in Elite Athletes Exercising in the Heat
Publisher: Frontiers Media SA
Date: 22-06-2022
DOI: 10.3389/FSPOR.2022.882254
Abstract: Non-invasive non-obtrusive continuous and real-time monitoring of core temperature (T c ) may enhance pacing strategies, the efficacy of heat mitigation measures, and early identification of athletes at risk for heat-related disorders. The Estimated Core Temperature (ECTemp™) algorithm uses sequential heart rate (HR) values to predict T c . We examined the validity of ECTemp™ among elite athletes exercising in the heat. 101 elite athletes performed an exercise test in simulated hot and humid environmental conditions (ambient temperature: 31.6 ± 1.0°C, relative humidity: 74 ± 5%). T c was continuously measured using a validated ingestible telemetric temperature capsule system. In addition, HR was continuously measured and used to compute the estimated core temperature (T c−est ) using the ECTemp™ algorithm. Athletes exercised for 44 ± 10 min and n = 5,025 readouts of T c (range: 35.8–40.4°C), HR (range: 45–207 bpm), and T c−est (range: 36.7–39.9°C) were collected. T c−est demonstrated a small yet significant bias of 0.15 ± 0.29°C ( p & 0.001) compared to T c , with a limit of agreement of ±0.45°C and a root mean square error of 0.35 ± 0.18°C. Utilizing the ECTemp™ algorithm as a diagnostic test resulted in a fair to excellent sensitivity (73–96%) and specificity (72–93%) for T c−est thresholds between 37.75 and 38.75°C, but a low to very-low sensitivity (50–0%) for T c−est thresholds & .0°C, due to a high prevalence of false-negative observations. ECTemp™ provides a valuable and representative indication of thermal strain in the low- to mid-range of T c values observed during exercise in the heat. It may, therefore, be a useful non-invasive and non-obtrusive tool to inform athletes and coaches about the estimated core temperature during controlled hyperthermia heat acclimation protocols. However, the ECTemp™ algorithm, in its current form, should not solely be used to identify athletes at risk for heat-related disorders due to low sensitivity and high false-negative rate in the upper end of the T c spectrum.
Effects of Cooling During Exercise on Thermoregulatory Responses of Men With Paraplegia.
Publisher: Oxford University Press (OUP)
Date: 05-2016
DOI: 10.2522/PTJ.20150266
Abstract: People with spinal cord injury (SCI) have an altered afferent input to the thermoregulatory center, resulting in a reduced efferent response (vasomotor control and sweating capacity) below the level of the lesion. Consequently, core body temperature rises more rapidly during exercise in in iduals with SCI compared with people who are able-bodied. Cooling strategies may reduce the thermophysiological strain in SCI. The aim of this study was to examine the effects of a cooling vest on the core body temperature response of people with a thoracic SCI during submaximal exercise. Ten men (mean age=44 years, SD=11) with a thoracic lesion (T4–T5 or below) participated in this randomized crossover study. Participants performed two 45-minute exercise bouts at 50% maximal workload (ambient temperature 25°C), with participants randomized to a group wearing a cooling vest or a group wearing no vest (separate days). Core body temperature and skin temperature were continuously measured, and thermal sensation was assessed every 3 minutes. Exercise resulted in an increased core body temperature, skin temperature, and thermal sensation, whereas cooling did not affect core body temperature. The cooling vest effectively decreased skin temperature, increased the core-to-trunk skin temperature gradient, and tended to lower thermal sensation compared with the control condition. The lack of differences in core body temperature among conditions may be a result of the relative moderate ambient temperature in which the exercise was performed. Despite effectively lowering skin temperature and increasing the core-to-trunk skin temperature gradient, there was no impact of the cooling vest on the exercise-induced increase in core body temperature in men with low thoracic SCI.
Infographic. Cooling strategies to attenuate PPE-induced heat strain during the COVID-19 pandemic.
Publisher: BMJ
Date: 10-06-2020
Validity and reliability of the myTemp ingestible temperature capsule
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.JSAMS.2017.06.006
Abstract: An accurate and non-invasive measurement of core body temperature (Tc) is of great importance to quantify exercise-induced increases in Tc in athletes or to assess changes in Tc in patient populations. The use of ingestible gastrointestinal telemetric temperature capsules is widely accepted as a surrogate marker for Tc, but widespread implementation is lacking due to the high costs of these disposable capsules. A new and cheaper temperature capsule system (i.e. myTemp) was recently introduced. The aim of present study is to determine the validity and test-retest reliability of the myTemp system. Ex-vivo experimental study. Fifteen ingestible temperature capsules (myTemp, Nijmegen, Netherlands) were tested in a highly temperature controlled water bath, in which the water temperature gradually increased from 34°C to 44°C. The study protocol was performed twice for each temperature capsule. Mean difference between myTemp temperature and water bath temperature was -0.001±0.005°C (Limit of Agreement (LOA): ±0.011°C) during Trial 1 (p=0.11) and -0.001±0.006°C (LOA: ±0.012°C) during Trial 2 (p=0.039). Furthermore, an Intraclass Correlation Coefficient (ICC) of 1.00 was found for both trials. A systematic difference between Trials 1 and 2 of 0.004±0.008°C (LOA: ±0.015°C) was found (p<0.001), whereas the ICC between both trials was 1.00 and the standard error of measurement was 0.005°C. Although we found a systematic bias for the sensitivity (-0.001°C) and reliability (0.004°C), these values can be considered insignificant from a physiological and clinical perspective. Thus, the myTemp ingestible temperature capsule is a valid technique to measure (water) temperature under controlled circumstances.
Core Temperature and Sweating in Men and Women During a 15-km Race in Cool Conditions
Publisher: Human Kinetics
Date: 09-2020
Abstract: Purpose : Studies often assess the impact of sex on the relation between core body temperature (CBT), whole-body sweat rate (WBSR), and heat production during exercise in laboratory settings, but less is known in free-living conditions. Therefore, the authors compared the relation between CBT, WBSR, and heat production between sexes in a 15-km race under cool conditions. Methods : During 3 editions of the Seven Hills Run (Nijmegen, the Netherlands) with similar ambient conditions (8–12°C, 80–95% relative humidity), CBT and WBSR were measured among 375 participants (52% male) before and immediately after the 15-km race. Heat production was estimated using initial body mass and mean running speed, assuming negligible external work. Results : Men finished the race in 76 (12) minutes and women in 83 (13) minutes ( P .001, effect size [ES] = 0.55). Absolute heat production was higher in men than in women (1185 [163] W vs 867 [122] W, respectively, P .001, ES = 1.47), even after normalizing to body mass (15.0 [2.2] W/kg vs 13.8 [1.9] W/kg, P .001, ES = 0.56). Finish CBT did not differ between men and women (39.2°C [0.7°C] vs 39.2°C [0.7°C], P = .71, ES = 0.04). Men demonstrated a greater increase in CBT (1.5°C [0.8°C] vs 1.3°C [0.7°C], respectively, P = .013, ES = 0.31) the sex difference remains after correcting for heat production ( P = .004). WBSR was larger in men (18.0 [6.9] g/min) than in women (11.4 [4.7] g/min P .001, ES = 0.97). A weak correlation between WBSR and heat production was found irrespective of sex ( R 2 = .395, P .001). Conclusions : WBSR was associated with heat production, irrespective of sex, during a self-paced 15-km running race in cool environmental conditions. Men had a higher ΔCBT than women.
Optimal low-cost cooling strategies for infant strollers during hot weather
Publisher: Informa UK Limited
Date: 07-02-2023
Validity, Reliability, and Inertia of Four Different Temperature Capsule Systems
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2018
Effectiveness of collagen supplementation on pain scores in healthy individuals with self-reported knee pain: A randomized controlled trial
Publisher: Canadian Science Publishing
Date: 07-2020
Abstract: The purpose of this study was to examine the effects of 12 weeks collagen peptide (CP) supplementation on knee pain and function in in iduals with self-reported knee pain. Healthy physically active in iduals (n = 167 aged 63 [interquartile range = 56–68] years) with self-reported knee pain received 10 g/day of CP or placebo for 12 weeks. Knee pain and function were measured with the Visual Analog Scale (VAS), the Lysholm questionnaire, and the Knee injury and Osteoarthritis Outcome Score (KOOS). Furthermore, we assessed changes in inflammatory, cartilage, and bone (bio)markers. Measurements were conducted at baseline and after 12 weeks of supplementation. Baseline VAS did not differ between CP and placebo (4.7 [2.5–6.1] vs. 4.7 [2.8–6.2], p = 0.50), whereas a similar decrease in VAS was observed after supplementation (−1.6 ± 2.4 vs. −1.9 ± 2.6, p = 0.42). The KOOS and Lysholm scores increased after supplementation in both groups (p values 0.001), whereas the increase in the KOOS and Lysholm scores did not differ between groups (p = 0.28 and p = 0.76, respectively). Furthermore, CP did not impact inflammatory, cartilage, and bone (bio)markers (p values 0.05). A reduced knee pain and improved knee function were observed following supplementation, but changes were similar between groups. This suggests that CP supplementation over a 12-week period does not reduce knee pain in healthy, active, middle-aged to elderly in iduals. Novelty CP supplementation over a 12-week period does not reduce knee pain in healthy, active, middle-aged to elderly in iduals. CP supplementation over a 12-week period does not impact on inflammatory, cartilage, and bone (bio)markers in healthy, active, middle-aged to elderly in iduals.
Identification of Drug Resistance Determinants in a Clinical Isolate of Pseudomonas aeruginosa by High-Density Transposon Mutagenesis
Publisher: American Society for Microbiology
Date: 21-02-2020
DOI: 10.1128/AAC.01771-19
Abstract: With the aim to identify potential new targets to restore antimicrobial susceptibility of multidrug-resistant (MDR) Pseudomonas aeruginosa isolates, we generated a high-density transposon (Tn) insertion mutant library in an MDR P. aeruginosa bloodstream isolate (isolate ID40). The depletion of Tn insertion mutants upon exposure to cefepime or meropenem was measured in order to determine the common resistome for these clinically important antipseudomonal β-lactam antibiotics.
Performance and thermoregulation of Dutch Olympic and Paralympic athletes exercising in the heat: Rationale and design of the Thermo Tokyo study: The journal Temperature toolbox
Publisher: Informa UK Limited
Date: 02-06-2021
Cooling interventions for athletes: An overview of effectiveness, physiological mechanisms, and practical considerations
Publisher: Informa UK Limited
Date: 03-01-2017
Impact of acute versus repetitive moderate intensity endurance exercise on kidney injury markers
Publisher: Wiley
Date: 12-2017
DOI: 10.14814/PHY2.13544
Comparison of two telemetric intestinal temperature devices with rectal temperature during exercise
Publisher: IOP Publishing
Date: 29-03-2018
Abstract: The discomfort caused by rectal probes and esophageal probes for the estimation of body core temperature has triggered the development of gastrointestinal (GI) capsules that are easily accepted by athletes and workers due to their non-invasive characteristics. We compare two new GI capsule devices with rectal temperature during cycle ergometer exercise and rest. Eight participants followed a protocol of (i) 30 min exercise with a power output of 130 W, (ii) 5 min rest, (iii) 10 min self-paced maximum exercise, and (iv) 15 min rest. Core temperature was measured using two GI-capsule devices (e-Celsius and myTemp) and rectal temperature. The myTemp system provided only slightly different temperatures to the rectal temperature probe during rest and exercise. However, the factory-calibrated e-Celsius system showed a systematic rectal temperature underestimation of 0.2 °C that is corrected in the 2018 versions. Both GI capsules reacted faster to temperature changes in the body compared to the rectal temperature probe during the rest period following maximum exercise. The GI-capsules react faster to temperature changes in the body compared to the rectal temperature probe, in particular during the rest period following exercise.
Time-motion analysis in the big data era: A promising method to assess the effects of heat stress on physical performance
Publisher: Informa UK Limited
Date: 23-05-2018
Thermoregulatory, Cardiovascular and Perceptual Responses of Spectators of a Simulated Football Match in Hot and Humid Environmental Conditions
Publisher: MDPI AG
Date: 31-03-2023
Abstract: Major sporting events are often scheduled in thermally challenging environments. The heat stress may impact athletes but also spectators. We examined the thermal, cardiovascular, and perceptual responses of spectators watching a football match in a simulated hot and humid environment. A total of 48 participants (43 ± 9 years n = 27 participants years and n = 21 participants ≥50 years, n = 21) watched a 90 min football match in addition to a 15 min baseline and 15 min halftime break, seated in an environmental chamber (Tair = 31.9 ± 0.4 °C RH = 76 ± 4%). Gastrointestinal temperature (Tgi), skin temperature (Tskin), and heart rate (HR) were measured continuously throughout the match. Mean arterial pressure (MAP) and perceptual parameters (i.e., thermal sensation and thermal comfort) were scored every 15 min. Tri (37.3 ± 0.4 °C to 37.4 ± 0.3 °C, p = 0.11), HR (76 ± 15 bpm to 77 ± 14 bpm, p = 0.96) and MAP (97 ± 10 mm Hg to 97 ± 10 mm Hg, p = 0.67) did not change throughout the match. In contrast, an increase in Tskin (32.9 ± 0.8 °C to 35.4 ± 0.3 °C, p 0.001) was found. Further, 81% of participants reported thermal discomfort and 87% a (slightly) warm thermal sensation at the end of the match. Moreover, the thermal or cardiovascular responses were not affected by age (all p-values 0.05). Heat stress induced by watching a football match in simulated hot and humid conditions does not result in substantial thermal or cardiovascular strain, whereas a significant perceptual strain was observed.
Precooling and percooling (cooling during exercise) both improve performance in the heat: a meta-analytical review.
Publisher: BMJ
Date: 19-04-2014
DOI: 10.1136/BJSPORTS-2013-092928
Abstract: Exercise increases core body temperature (Tc), which is necessary to optimise physiological processes. However, excessive increase in Tc may impair performance and places participants at risk for the development of heat-related illnesses. Cooling is an effective strategy to attenuate the increase in Tc. This meta-analysis compares the effects of cooling before (precooling) and during exercise (percooling) on performance and physiological outcomes. A computerised literature search, citation tracking and hand search were performed up to May 2013. 28 studies met the inclusion criteria, which were trials that examined the effects of cooling strategies on exercise performance in men, while exercise was performed in the heat (>30°C). 20 studies used precooling, while 8 studies used percooling. The overall effect of precooling and percooling interventions on exercise performance was +6.7±0.9% (effect size (ES)=0.43). We found a comparable effect (p=0.82) of precooling (+5.7±1.0% (ES=0.44)) and percooling (+9.9±1.9% (ES=0.40)) to improve exercise performance. A lower finishing Tc was found in precooling (38.9°C) compared with control condition (39.1°C, p=0.03), while Tc was comparable between conditions in percooling studies. No correlation between Tc and performance was found. We found significant differences between cooling strategies, with a combination of multiple techniques being most effective for precooling (p<0.01) and ice vest for percooling (p=0.02). Cooling can significantly improve exercise performance in the heat. We found a comparable ES for precooling and percooling on exercise performance, while the type of cooling technique importantly impacts the effects. Precooling lowered the finishing core temperature, while there was no correlation between Tc and performance.
Beat the heat: How to become a gold medalist at the Tokyo Olympics
Publisher: Informa UK Limited
Date: 03-07-2021
The potential for indoor fans to change air conditioning use while maintaining human thermal comfort during hot weather: an analysis of energy demand and associated greenhouse gas emissions
Publisher: Elsevier BV
Date: 04-2022
Refractory neutrophils and monocytes in patients with inflammatory bowel disease after repeated bouts of prolonged exercise
Publisher: Wiley
Date: 08-03-2021
DOI: 10.1002/CYTO.B.21996
Abstract: Neutrophils and monocytes are key immune effector cells in inflammatory bowel disease (IBD) that is associated with chronic inflammation in the gut. Patients with stable IBD who perform exercise have significantly fewer flare‐ups of the disease, but no underlying mechanism has been identified. Therefore, the aim of this study was to compare the responsiveness/refractoriness of these innate immune cells after repeated bouts of prolonged exercise in IBD patients and controls. Patients with IBD and age‐ and gender‐matched healthy controls were recruited from a cohort of walkers participating in a 4‐day walking event. Blood analysis was performed at baseline and after 3 days of walking. Responsiveness to the bacterial/mitochondrial‐stimulus N‐Formylmethionine‐leucyl‐phenylalanine (fMLF) was tested in granulocytes and monocytes by measuring the expression of activation markers after adding this stimulus to whole blood. In total 38 participants (54 ± 12 years) were included in this study: 19 walkers with and 19 walkers without IBD. After 3 days of prolonged exercise, a significant increase in responsiveness to fMLF was observed in all participants irrespective of disease. However, IBD patients showed significantly less responsiveness in neutrophils and monocytes, compared with non‐IBD walkers. Increased responsiveness of neutrophils and monocyte to fMLF was demonstrated after repetitive bouts of prolonged exercise. Interestingly, this exercise was associated with relative refractoriness of both neutrophils and monocytes in IBD patients. These refractory cells might create a lower inflammatory state in the intestine providing a putative mechanism for the decrease in flare‐ups in IBD patients after repeated exercise.
RYR1-Related Rhabdomyolysis: A Spectrum of Hypermetabolic States Due to Ryanodine Receptor Dysfunction
Publisher: Bentham Science Publishers Ltd.
Date: 2022
DOI: 10.2174/1381612827666210804095300
Abstract: Variants in the ryanodine receptor-1 gene (RYR1) have been associated with a wide range of neuromuscular conditions, including various congenital myopathies and malignant hyperthermia (MH). More recently, a number of RYR1 variants, mostly MH-associated, have been demonstrated to contribute to rhabdomyolysis events not directly related to anesthesia in otherwise healthy in iduals. This review focuses on RYR1-related rhabdomyolysis in the context of several clinical presentations (i.e., exertional rhabdomyolysis, exertional heat illnesses and MH), and conditions involving a similar hypermetabolic state, in which RYR1 variants may be present (i.e., neuroleptic malignant syndrome and serotonin syndrome). The variety of triggers that can evoke rhabdomyolysis, on their own or in combination, as well as the number of potentially associated complications, illustrates that this is a condition relevant to several medical disciplines. External triggers include but are not limited to strenuous physical exercise, especially if unaccustomed or performed under challenging environmental conditions (e.g., high ambient temperature or humidity), alcohol/illicit drugs, prescription medication (in particular statins, other anti-lipid agents, antipsychotics and antidepressants) infection, or heat. Amongst all patients presenting with rhabdomyolysis, genetic susceptibility is present in a proportion, with RYR1 being one of the most common genetic causes. Clinical clues for a genetic susceptibility include recurrent rhabdomyolysis, creatine kinase (CK) levels above 50 times the upper limit of normal, hyperCKemia lasting for 8 weeks or longer, drug/medication doses insufficient to explain the rhabdomyolysis event, and positive family history. For the treatment or prevention of RYR1-related rhabdomyolysis, the RYR1 antagonist dantrolene can be administered, both in the acute phase or prophylactically in patients with a history of muscle cr s and/or recurrent rhabdomyolysis events. Aside from dantrolene, several other drugs are being investigated for their potential therapeutic use in RYR1-related disorders. These findings offer further therapeutic perspectives for humans, suggesting an important area for future research.
Cytokine responses to repeated, prolonged walking in lean versus overweight/obese individuals.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.JSAMS.2018.07.019
Abstract: Obesity is characterized by a pro-inflammatory state, which plays a role in the pathogenesis of metabolic and cardiovascular disease. An exercise bout causes a transient increase in pro-inflammatory cytokines, whilst training has anti-inflammatory effects. No previous study examined whether the exercise-induced increase in pro-inflammatory cytokines is altered with repeated prolonged exercise bouts and whether this response differs between lean and overweight/obese in iduals. Lean (n=25, BMI 22.9±1.5kg/m Circulating cytokines (IL-6, IL-10, TNF-α, IL-1β and IL-8) were examined at baseline and <30min after the finish of each exercise day. At baseline, no differences in circulating cytokines were present between groups. In response to prolonged exercise, all cytokines increased on day 1 (IL-1β: P=0.02 other cytokines: P<0.001). IL-6 remained significantly elevated during the 4 exercise days, when compared to baseline. IL-10, TNF-α, IL-1β and IL-8 returned to baseline values from exercise day 2 (IL-10, IL-1β, IL-8) or exercise day 3 (TNF-α) onward. No significant differences were found between groups for all cytokines, except IL-8 (Time*Group Interaction P=0.02). These data suggest the presence of early adaptive mechanisms in response to repeated prolonged walking, demonstrated by attenuated exercise-induced elevations in cytokines on consecutive days that occur similar in lean and overweight/obese in iduals.
Exercise Performance and Thermoregulatory Responses of Elite Athletes Exercising in the Heat: Outcomes of the Thermo Tokyo Study
Publisher: Springer Science and Business Media LLC
Date: 15-08-2021
DOI: 10.1007/S40279-021-01530-W
Abstract: We examined the impact of simulated Tokyo 2020 environmental condition on exercise performance, thermoregulatory responses and thermal perception among Dutch elite athletes. 105 elite athletes from different sport disciplines performed two exercise tests in simulated control (15.9 ± 1.2 °C, relative humidity (RH) 55 ± 6%) and Tokyo (31.6 ± 1.0 °C, RH 74 ± 5%) environmental conditions. Exercise tests consisted of a 20-min warm-up (70% HR max ), followed by an incremental phase until volitional exhaustion (5% workload increase every 3 min). Gastrointestinal temperature ( T gi ), heart rate, exercise performance and thermal perception were measured. Time to exhaustion was 16 ± 8 min shorter in the Tokyo versus the control condition (− 26 ± 11%, whereas peak power output decreased with 0.5 ± 0.3 W/kg (16 ± 7%). Greater exercise-induced increases in T gi (1.8 ± 0.6 °C vs. 1.5 ± 0.5 °C, p 0.001) and higher peak T gi (38.9 ± 0.6 °C vs. 38.7 ± 0.4 °C, p 0.001) were found in the Tokyo versus control condition. Large interin idual variations in exercise-induced increase in T gi (range 0.7–3.5 °C) and peak T gi (range 37.6–40.4 °C) were found in the Tokyo condition, with greater T gi responses in endurance versus mixed- and skill-trained athletes. Peak thermal sensation and thermal comfort scores deteriorated in the Tokyo condition, with aggravated responses for power versus endurance- and mixed-trained athletes. Large performance losses and T gi increases were found among elite athletes exercising in simulated Tokyo conditions, with a substantial interin idual variation and significantly different responses across sport disciplines. These findings highlight the importance of an in idual approach to optimally prepare athletes for safe and maximal exercise performance during the Tokyo Olympics.
Heat Strain and Use of Heat Mitigation Strategies among COVID-19 Healthcare Workers Wearing Personal Protective Equipment—A Retrospective Study
Publisher: MDPI AG
Date: 08-02-2022
Abstract: The combination of an exacerbated workload and impermeable nature of the personal protective equipment (PPE) worn by COVID-19 healthcare workers increases heat strain. We aimed to compare the prevalence of heat strain symptoms before (routine care without PPE) versus during the COVID-19 pandemic (COVID-19 care with PPE), identify risk factors associated with experiencing heat strain, and evaluate the access to and use of heat mitigation strategies. Dutch healthcare workers (n = 791) working at COVID-19 wards for ≥1 week, completed an online questionnaire to assess personal characteristics, heat strain symptoms before and during the COVID-19 pandemic, and the access to and use of heat mitigation strategies. Healthcare workers experienced ~25× more often heat strain symptoms during medical duties with PPE (93% of healthcare workers) compared to without PPE (30% of healthcare workers OR = 25.57 (95% CI = 18.17–35.98)). Female healthcare workers and those with an age years were most affected by heat strain, whereas exposure time and sports activity level were not significantly associated with heat strain prevalence. Cold drinks and ice slurry ingestion were the most frequently used heat mitigation strategies and were available in 63.5% and 30.1% of participants, respectively. Our findings indicate that heat strain is a major challenge for COVID-19 healthcare workers, and heat mitigations strategies are often used to counteract heat strain.
The effects of physical exercise on the assessment of kidney function
Publisher: American Physiological Society
Date: 05-2020
Thermoregulatory, metabolic, and cardiovascular responses during 88 min of full‐body ice immersion – A case study
Publisher: Wiley
Date: 12-2019
DOI: 10.14814/PHY2.14304
Impact of acuteversusprolonged exercise and dehydration on kidney function and injury
Publisher: Wiley
Date: 06-2018
DOI: 10.14814/PHY2.13734
The Biophysics of Human Heat Exchange
Publisher: Springer International Publishing
Date: 2019
Reply to Chapman et al.
Publisher: American Physiological Society
Date: 07-2020
Developing a geospatial measure of change in core temperature for migrating persons in the Mexico-U.S. border region
Publisher: Elsevier BV
Date: 11-2020
Thermoregulation and fluid balance during a 30-km march in 60- versus 80-year-old subjects
Publisher: Springer Science and Business Media LLC
Date: 19-11-2014
Impact of a COVID-19 infection on exercise levels of recreational athletes one- and three-months post-infection
Publisher: Informa UK Limited
Date: 02-10-2022
DOI: 10.1080/02640414.2022.2140919
Abstract: We examined the effect of a COVID-19 infection on changes in exercise levels in recreational athletes in the first three months after infection, and identified personal factors associated with a larger change in exercise level and recovery time. Recreational athletes (n=4360) completed an online questionnaire on health and exercise levels. 601 Athletes have had a diagnostically confirmed COVID-19 infection, while 3479 athletes did not (non-COVID-19 group). Exercise levels (in MET-min/week) were examined prior to (2019) and during the COVID-19 pandemic (2020) for the non-COVID-19 group, and in 2019, 1-month pre-COVID-19 infection, 1-month post-COVID-19 infection and 3 months post-COVID-19 infection in the COVID-19 group. Median exercise level at baseline in the COVID-19 group was 3528 (IQR=1488-5760) MET-min/week. One-month post-COVID-19 infection, exercise level dropped 58% (2038 MET-min/week), which partly stabilized to 36% (1256 MET-min/week) below baseline values 3 months post-COVID-19 infection. Moreover, in both the COVID-19 (pre-COVID-19 infection) and non-COVID-19 group exercise levels during the pandemic decreased with ~260 MET-min/week. These results illustrate that even a relatively physically active population of recreational athletes is significantly affected by a COVID-19 infection, particularly those athletes who are overweight. COVID-19 disease burden, age, sex, comorbidities and smoking were not associated with reduced exercise levels.
Using an Ingestible Telemetric Temperature Pill to Assess Gastrointestinal Temperature During Exercise.
Publisher: MyJove Corporation
Date: 07-10-2015
DOI: 10.3791/53258
Trends in hepatocellular carcinoma among people with HBV or HCV notification in Australia (2000-2014).
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.JHEP.2016.08.010
Abstract: This study evaluates trends in hepatocellular carcinoma (HCC) among people with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection in New South Wales (NSW), Australia between 2000 and 2014. Data on HBV and HCV notifications between January 1993 and December 2012 were linked to the NSW Admitted Patients Data Collection database between July 2000 and June 2014 and NSW Registry of Births Deaths and Marriages. The burden, crude and age-standardised incidence of HCC based on first hospitalization were calculated. In NSW between 2000-2014, there were 54,399, 93,099 and 3,809 in iduals notified with HBV, HCV and HBV/HCV coinfection respectively. There were 725 (1.3%) with HCC among those with HBV notification as compared to 1,309 with HCC (1.4%) in those with HCV notification. The population-level burden of new HCC cases per year has stabilised in the HBV cohort (53 in 2001 and 44 in 2013), but increased markedly in the HCV cohort (49 in 2001 to 151 in 2013). The age-standardised incidence rates of HCC (per 1,000 person-years) declined from 2.3 (95% confidence interval (CI) 1.4, 3.1) in 2001 to 0.9 (95% CI 0.6, 1.2) in 2012 among those with HBV and remained stable between 2001 (1.4 95% CI 0.8, 1.9) and 2012 (1.5 95% CI 1.2, 1.7) in those with HCV. Main factors associated with HCC in those with HBV included later study period (2005-2009 2010-2014) (hazard ratio (HR)=0.54, 95% CI 0.42, 0.70), male gender (HR=4.50, 95% CI 3.6, 5.6), Asia-Pacific country of birth (HR=3.84, 95% CI 2.58, 5.71) and alcohol dependency (HR=2.84, 95% CI 1.95, 4.13). Main factors associated with HCC in those with HCV included male gender (HR=2.56, 95% CI 2.20, 2.98), rural place of residence (HR=0.73, 95% CI 0.62, 0.86), Asia-Pacific country of birth (HR=2.37, 95% CI 1.99, 2.82) and alcohol dependency (HR=3.90, 95% CI 3.39, 4.49). In idual-level risk of HBV-related HCC has declined, suggesting an impact of more effective antiviral therapy from mid-2000s. In contrast, the interferon-containing HCV treatment era had no impact on in idual-level HCV-related HCC risk and has seen escalating population-level HCC burden. In idual-level risk of HBV-related HCC has declined, suggesting an impact of more effective antiviral therapy from mid-2000s. In contrast, the interferon-containing HCV treatment era had no impact on in idual-level HCV-related HCC risk and has seen escalating population-level HCC burden.
Cooling vests alleviate perceptual heat strain perceived by COVID-19 nurses
Publisher: Informa UK Limited
Date: 20-01-2021
Protein supplementation improves lean body mass in physically active older adults: a randomized placebo‐controlled trial
Publisher: Wiley
Date: 07-03-2019
DOI: 10.1002/JCSM.12394
The Multi-Objective Optimization of Powertrain Design and Energy Management Strategy for Fuel Cell–Battery Electric Vehicle
Publisher: MDPI AG
Date: 22-05-2022
DOI: 10.3390/SU14106320
Abstract: Considering the limited driving range and inconvenient energy replenishment way of battery electric vehicle, fuel cell electric vehicles (FC EVs) are taken as a promising way to meet the requirements for long-distance low-carbon driving. However, due to the limitation of FC power ability, a battery is usually adopted as the supplement power source to fill the gap between the requirement of driving and the serviceability of FC. In consequence, energy management is essential and crucial to an efficient power flow to the wheel. In this paper, a self-optimizing power matching strategy is proposed, considering the energy efficiency and battery degradation, via implementing a deep deterministic policy gradient. Based on the proposed strategy, less energy consumption and longer FC and battery life can be expected in FC EV powertrain with optimal hybridization degree.
Exercise-induced cardiac troponin T release in veteran athletes recovered from COVID-19
Publisher: Oxford University Press (OUP)
Date: 03-03-2022
The Impact of Central and Peripheral Cyclooxygenase Enzyme Inhibition on Exercise-Induced Elevations in Core Body Temperature.
Publisher: Human Kinetics
Date: 05-2016
Abstract: Exercise increases core body temperature ( T C ) due to metabolic heat production. However, the exercise-induced release of inflammatory cytokines including interleukin-6 (IL-6) may also contribute to the rise in T C by increasing the hypothalamic temperature set point. This study investigated whether the exercise-induced increase in T C is partly caused by an altered hypothalamic temperature set point. Fifteen healthy, active men age 36 ± 14 y were recruited. Subjects performed submaximal treadmill exercise in 3 randomized test conditions: (1) 400 mg ibuprofen and 1000 mg acetaminophen (IBU/APAP), (2) 1000 mg acetaminophen (APAP), and (3) a control condition (CTRL). Acetaminophen and ibuprofen were used to block the effect of IL-6 at a central and peripheral level, respectively. T C , skin temperature, and heart rate were measured continuously during the submaximal exercise tests. Baseline values of T C , skin temperature, and heart rate did not differ across conditions. Serum IL-6 concentrations increased in all 3 conditions. A significantly lower peak T C was observed in IBU/APAP (38.8°C ± 0.4°C) vs CTRL (39.2°C ± 0.5°C, P = .02) but not in APAP (38.9°C ± 0.4°C) vs CTRL. Similarly, a lower Δ T C was observed in IBU/APAP (1.7°C ± 0.3°C) vs CTRL (2.0°C ± 0.5°C, P .02) but not in APAP (1.7°C ± 0.5°C) vs CTRL. No differences were observed in skin temperature and heart-rate responses across conditions. The combined administration of acetaminophen and ibuprofen resulted in an attenuated increase in T C during exercise compared with a CTRL. This observation suggests that a prostaglandin-E2-induced elevated hypothalamic temperature set point may contribute to the exercise-induced rise in T C .
Thermoregulatory burden of elite sailing athletes during exercise in the heat: A pilot study
Publisher: Informa UK Limited
Date: 13-11-2018
Ionized and Total Magnesium Levels Change during Repeated Exercise in Older Adults
Publisher: Springer Science and Business Media LLC
Date: 18-05-2019
DOI: 10.1007/S12603-019-1205-Y
Abstract: Magnesium is essential for health and performance. Sub-optimal levels have been reported for older persons. In addition, physical exercise is known to temporally decrease magnesium blood concentrations. To investigate these observations in conjunction we assessed total (tMg) and ionized magnesium (iMg) concentrations in plasma and whole blood, respectively, during 4 consecutive days of exercise in very old vital adults. 68 participants (age 83.7±1.9 years) were monitored on 4 consecutive days at which they walked 30-40km (average ~8 hours) per day at a self-determined pace. Blood s les were collected one or two days prior to the start of exercise (baseline) and every walking day immediately post-exercise. S les were analysed for tMg and iMg levels. Baseline tMg and iMg levels were 0.85±0.07 and 0.47±0.07 mmol/L, respectively. iMg decreased after the first walking day (-0.10±0.09 mmol/L, p<.001), increased after the second (+0.11±0.07 mmol/L, p<.001), was unchanged after the third and decreased on the final walking day, all compared to the previous day. tMg was only higher after the third walking day compared to the second walking day (p=.012). In 88% of the participants, iMg levels reached values considered to be sub-optimal at day 1, in 16% of the participants values were sub-optimal for tMg at day 2. Prolonged moderate intensity exercise caused acute effects on iMg levels in a degree comparable to that after a bout of intensive exercise. These effects were not associated with drop-out or health problems. After the second consecutive day of exercise, levels were returned to baseline values, suggesting rapid adaptation/resilience in this population.
Comprehensive multivariate evaluation of the effects on cell phenotypes in multicolor flow cytometry data using ANOVA simultaneous component analysis
Publisher: Wiley
Date: 19-05-2022
DOI: 10.1002/CEM.3402
Abstract: This work proposes an approach to assess the effects observed in multicolor flow cytometry (MFC) experiments, for all markers and experimental factors simultaneously. It achieves this end by extending ANOVA simultaneous component analysis (ASCA), a multivariate version of ANOVA, to flow cytometry data. It is based on an initial multiset PCA model to describe the main variation patterns of cell marker expression, followed by an ASCA model on the histograms built from these PCA scores. This approach allows for determining the variations in cell phenotype distribution that are related to the experimental design. On a data set from a study of the immune response to prolonged physical exercise, the proposed method computed the effect size and statistical significance of all the experimental factors and their interactions. Most notably, it provided easily interpretable submodels for the overall effect of the walking exercise and for the interaction between exercise and the responsiveness to a bacterial stimulus. The application of a time‐guided sequential clustering algorithm to the ASCA scores revealed a stratification of the studied in iduals based on their neutrophil activation dynamics. These effects were not clearly detectable using PCA alone. In comparison with pairwise classification models by DAMACY (a discriminant analysis method for MFC data), ASCA results were less detailed in describing differences between specific s les, but had the advantage of modeling several factors and levels simultaneously. Such characteristics make the proposed implementation of ASCA an effective and complementary addition to the chemometric methodologies for the analysis of MFC data.
Real-Time Observations of Food and Fluid Timing During a 120 km Ultramarathon.
Publisher: Frontiers Media SA
Date: 04-05-2018
Repeated prolonged moderate-intensity walking exercise does not appear to have harmful effects on inflammatory markers in patients with inflammatory bowel disease.
Publisher: Informa UK Limited
Date: 19-11-2020
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