Sports Performance:
MUS, Stress and Chronic low-grade Inflammation
Antonio Urso and Dario Boschiero
Antonio Urso, Italy - FIPE and EWF President
Dario Boschiero, Italy - President Open Academy of Medicine, Director of R&D of BioTekna
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Performance and Health
Health is a state of complete
physical, mental and social
well-being and not merely the
absence of disease or infirmity.
The Definition has not been amended since 1948.
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Sport Performance and Health
The athlete's sport performance is clearly influenced by his state
of well being, but although this is a shared principle, it is not
easy to get a picture to assess the overall state of well-being
and physical and mental performance.
In modern society the request of increase or maintenance of the
performance is a must not only in sports but in all areas of our
complex life with more and more demand for adaptability in
a presence of persistent stressors or stimuli.
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Performance and Health
Performance it is a multidimensional concept, which includes
both physiological, psychological and proprioceptive variables.
There is still no real definition but the term has become
commonly used in medicine for a long time.
There is no gold-standard measurement.
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Sport Performance and Health
This is a very complex phenomenon and
regulated by the Stress System, low-grade
inflammatory processes, the circadian
rhythms and the most important elements of
the body composition such as muscle, IMAT
(skeletal muscle fat infiltration), fat and bone.
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Dario Boschiero Open Academy of Medicine 2016
Performance and Health
Performance, Health and related factor:
-
Physiological
Autonomic nervous system
Psychological
Cognitive
Proprioceptive and biomechanical
Physical factors
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Human Performance
Physiological performance refers to the normal and healthy functioning of the body and its organs.
Physical performance refers to the ability to perform some physical tasks with greater intensity, speed
or power. The physical performance improvements or recovery may have a beneficial physiological
effect for people engaged in physical activities but also to perform common tasks, for several reasons.
EFSA Journal 2012;10(7):2817
Proprioceptive performance is the body's ability to determine where all his parts are at a given
moment; the improvement of these skills has an important role in the sport, in business and generally
where asked an increase of the mental and physical abilities
Cognitive performance is our ability to acquire and use knowledge. Behind this simple definition it
hides a complex of brain skills that we use in every action without even realizing it.
Psychology Performance identifies the study of motivation and psychomotor performance in sports,
fitness, family, at the workplace, eg as surgery or the armed forces. Research and consulting in this
field focuses on individual performance and the mind-body connection, as well as coaching, team
training and team working to help patients, athletes, artists, musicians and other professionals to
achieve their maximum performance potential.
ANS Performance identifies the quality of the Autonomic Nervous System.
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Performance and Health
the complexity of the phenomenon
aging
exercise
sport
nutrition
stress
exogenous
stress
endogenous
acute
hydration
inflammation
change in body
composition and
psychophysical
performance
life style
disorders
diseases
chronic
inflammation
circadian
MUS
rhythms emotions General Adaptation
Syndrome
somatisation and
psychological
bodily distress
expressions
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Dario Boschiero Open Academy of Medicine 2016
Sport Performance and Health
The sports subject needs specific assessments
towards generic meaning of the term "well-being",
even if he enjoys a state of above-average health.
In order to promote the increase of the performance
you need to evaluate all the types of imbalances
that could reduce the athlete's psychophysical
performance and well-being, although do not result
in well-defined clinical outcomes.
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medically unexplained symptoms (MUS)
The subjective perception of well being has a first abutment in
the onset of the medically unexplained symptoms (MUS), or in a
series of subclinical disorders of functional nature extensively
analyzed in the international literature:
chronic and persistent fatigue not relieved by sleeping
mood disorders
cold hands and feet
persistent insomnia or sleepiness
anxiety, apathy
changes in appetite (excessive hunger or lack of appetite)
heartburn, stomach fullness , bloating after meals, nausea
constipation or altered bowel movement
irritable bowel syndrome
altered perspiration
MUS examples – Medically Unexplained Symptoms
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2013
- Medically unexplained symptoms are common
- All symptoms should be treated seriously, regardless of cause
- Explanations should integrate psychological and biological factors and provide patients and
doctors with a model for managing the condition
- Anxiety and depression often present with medically unexplained symptoms
[Hatcher, S.; Arroll, B. (May 2008). "Assessment and management of medically unexplained symptoms".
BMJ (Clinical research ed.) 336 (7653): 1124–1128]
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MUS® - Medically Unexplained Symptoms Self-Evaluation
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BioTekna 1996 - 2016 MUS ®
negative loop
persistent
over time
+ 6 months
- Dysregulation of the autonomic nervous
system (low HRV)
- Dysregulation of the HPA axis (flat cortisol)
- Adverse changes body composition
- MUS become stressors
Improving the Classification of Medically Unexplained Symptoms in Primary Care
Eur.J.Psychiat.Vol.21, N.°1, (25-36) 2007
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Rev. Dario Boschiero Open Academy of Medicine 2016
MUS is an index of
chronic stress and inflammation
Eur J Clin Invest. 2014 Nov 28. doi: 10.1111/eci.12388.
STRESS AND INFLAMMATORY BIOMARKERS AND SYMPTOMS ARE
ASSOCIATED WITH BIO-IMPEDANCE MEASURES
C.Tsigos, D. Boschiero and G.P. Chrousos
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Stress and inflammatory biomarkers and symptoms are associated
with bioimpedance measures: Muscle Mass – ECW%
healthy
loss of strength
hsCRP high
Cortisol flat
hpa axis dysfunction
ANS dysfunction
Sarcopenia?
Dynapenia?
Stress & CIDs
MUS
obesity?
osteopenia osteoporosis?
Tsigos C, Stefanaki C, Lambrou GI, Boschiero D, Chrousos GP. Stress and inflammatory biomarkers
and symptoms are associated with bioimpedance measures. Eur J Clin Invest. 2015;45:126-134
Rev. Dario Boschiero Open Academy of Medicine 2016
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MUS and heart rate variability (HRV - PPG)
dysregulation of the
autonomic nervous system
low psychophysical
performance
good psychophysical
performance
high adaptive capacity
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Dario Boschiero Open Academy of Medicine 2014
maintain and recover circadian rhythms
HPA axis and SNS: cooperation and synchronization are important
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Straub RH - Open Academy of Medicine 2016
maintain and recover circadian rhythms
HPA axis and SNS:
Clin Rheumatol. 2016 Apr 26. Increased extracellular water measured by bioimpedance and by increased
serum levels of atrial natriuretic peptide in RA patients-signs of volume overload.
Straub RH, Ehrenstein B, Günther F, Rauch L, Trendafilova N, Boschiero D, Grifka J, Fleck M3.
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Chronic stress can lead to development of the metabolic syndrome
and a change of body composition with MUS and CIDs
loss of heart rate variability
reduced SDNN, RMSSD
flat HPA axis
loss of glycogen mass
loss of
Skeletal muscle
and potassium
(TBK)
Increase in ECW%
grade inflammation
MUS
Increased FM and
AAT (visceral fat)
IMAT increase
(Intramuscular fat)
Bone loss
Stress and disorders of the stress system
Chrousos, G.P. NATURE Reviews Endocrinology 5, 374–381 (2009)
Abbreviations: ABP, arterial blood pressure; ACTH, adrenocorticotropic hormone; APr, acute-phase reactants; AvP, arginine vasopressin; CrH,
corticotropinreleasing hormone; iCrH, immune CrH; e, epinephrine; e2, estradiol; GH, growth hormone; HPA, hypothalamic–pituitary–adrenal; iGF-i,
insulin-like growth factor i; iL-6, interleukin 6; LC, locus ceruleus; LH, luteinizing hormone; Ne, norepinephrine; T, testosterone; TG, triglycerides.
Rev. Dario Boschiero Open Academy of Medicine 2016
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the role of muscle on health and performance
Skeletal muscle mass
immunomodulation
Support
Movement
Power
glycogen storage
Energy regulation
Miochine
Gene Ther. 2011 Feb;18(2):109-16. Epub 2010 Oct 7. Skeletal muscle cells: from local inflammatory response to active immunity. Marino M, Scuderi F,
Provenzano C, Bartoccioni E.
Curr Opin Pharmacol. 2008 Jun;8(3):346-51. Epub 2008 Apr 15.Skeletal muscle as an immunogenic organ.Nielsen S, Pedersen BK.
Published online 2005 December 6. HEPATIC GLYCOGEN SYNTHASE DEFICIENCY: AN INFREQUENTLY RECOGNIZED CAUSE OF KETOTIC
HYPOGLYCEMIA. David A. Weinstein, Catherine E. Correia, Andrew C. Saunders and Joseph I. Wolfsdorf.
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MUS, stress and chronic inflammation:
loss of muscle mass and performance
Testosterone
catecholamines
Cortisol
(Adrenaline)
(noradrenaline)
Insulin
Skeletal muscle
mass
Am J Clin Nutr August 2004 vol. 80. Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MINOS study. contrib-group13contrib-group-13Pawel Szulc, François Duboeuf, François Marchand, and Pierre D Delmas
Eur J Endocrinol May 1, 2011 164 811-817. Testosterone but not estradiol level is positively related to muscle strength and physical performance
independent of muscle mass: a cross-sectional study in 1489 older men. Tung Wai Auyeung, Jenny Shun Wah Lee, Timothy Kwok, Jason Leung, Claes
Ohlsson, Liesbeth Vandenput, Ping Chung Leung and Jean Woo.
J Clin Endocrinol Metab. 2009 Jun;94(6):1991-2001. Epub 2009 Mar 17. Testosterone and growth hormone improve body composition and muscle
performance in older men. Sattler FR, Castaneda-Sceppa C, Binder EF, Schroeder ET, Wang Y, Bhasin S, Kawakubo M, Stewart Y, Yarasheski KE, Ulloor J,
Colletti P.
J Gerontol A Biol Sci Med Sci. 2011 Jan;66(1):122-9. Epub 2010 Nov 8. Testosterone threshold levels and lean tissue mass targets needed to enhance
skeletal muscle strength and function: the HORMA trial. Sattler F, Bhasin S, He J, Chou CP, Castaneda-Sceppa C, Yarasheski K, Binder E, Schroeder ET,
Kawakubo M, Zhang A, Roubenoff R, Azen S.
Am J Clin Nutr 2005;82:531–7. serum albumin concentration and change in muscle mass: the Health, Aging and Body Composition Study
Eur J Appl Physiol Occup Physiol. 1996;73(1-2):66-72.Hormonal regulation of skeletal muscle hypertrophy in rats: the testosterone to cortisol ratio.Crowley
MA, Matt KS.
Diabetes Care. 2011 Nov;34(11):2381-6. Epub 2011 Sep 16. Insulin sensitizers may attenuate lean mass loss in older men with diabetes. Lee CG, Boyko EJ,
Barrett-Connor E, Miljkovic I, Hoffman AR, Everson-Rose SA, Lewis CE, Cawthon PM,;Osteoporotic Fractures in Men (MrOS) Study Research Group.
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Annu Rev Nutr. 1997;17:457-85.Hormonal regulation of human muscle protein metabolism. Rooyackers OE, Nair KS.
Baillieres Clin Endocrinol Metab. 1996 Oct;10(4):551-70.The hormonal control of protein metabolism.Umpleby AM, Russell-Jones DL.
the role of bone, muscle, and fat on health and performance
Negative Loop
Chronic Stress, CIDs and MUS
MUS
interrelationships between bone, muscle, and adipose tissue in the osteosarcopenic syndrome. IMAT, intramuscular
adipose tissue; GH, growth hormone; IGF, insulin-like growth factor I; ROS, reactive oxygen species
J Cachexia Sarcopenia Muscle. 2014 Sep;5(3):183-92.
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From Performance and Health to chronic stress and MUS
ed
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a
reg
is fl
s
Chronic
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y
a
d
A
m
P
y
H
ste ariabilit
y
s
Stress
s
v
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e
t
v
r
a
ne heart r
c
i
m
“PPG”
no rt rate+
o
t
u
a
hea
Change
of Body
Composition
“BIA-ACC”
Negative
Loop
chron
ic inf
ECW
lamm
%+
ation
Skele
FM%
+ AA
T(vis tal Muscle
ceral
IMAT
fat)+ +
MUS
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Dario Boschiero Open Academy of Medicine 2016
From Performance and Health to chronic stress and MUS
Optimal Performance and Health
Health+
MUS
min
max
Disorders
Diseases
HPA flat low
PNS%+
altered
circadian
rhythm
max
Disorders
Diseases
altered
circadian
rhythm
HPA flat high
SNS%+
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From Performance and Health
to
chronic stress, MUS and
chronic low-grade inflammation
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Assessment Human Body Composition
Muscle Mass (SMI) – FM% analysis - healthy without MUS, Stress and CIDs
Optimal Performance
and Health
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Assessment Human Body Composition
Muscle Mass (SMI) – FM% analysis – MUS, Stress and CIDs without pathologies
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Assessment Human Body Composition
Muscle Mass (SMI) – FM% analysis – IMAT inf 1.5%
Optimal Performance
and Health
Gennaio - Maggio 2015
Autore: D. Boschiero
Open Academy of Medicine
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Assessment Human Body Composition
Muscle Mass (SMI) – FM% analysis – IMAT 1.5% - 2% healthy without CIDs
Gennaio - Maggio 2015
Autore: D. Boschiero
Open Academy of Medicine
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Assessment Human Body Composition
Muscle Mass (SMI) – FM% analysis – IMAT 2% + MUS, Stress and CIDs
Gennaio - Maggio 2015
Autore: D. Boschiero
Open Academy of Medicine
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Assessment Human Body Composition
Muscle Mass (SMI) – FM% analysis – IMAT 3% multi-pathologies
Gennaio - Maggio 2015
Autore: D. Boschiero
Open Academy of Medicine
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Osteopenia/osteoporosis,
sarcopenia, and obesity
are commonly observed in the
process of aging
if you do not control the
MUS, Stress and
chronic low-grade inflammation
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Body Composition and Age
Muscle Mass (SMI) – FM% analysis – Age 10 - 20
Optimal Performance
and Health
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Body Composition and Age
Muscle Mass (SMI) – FM% analysis – Age 21 - 30
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Body Composition and Age
Muscle Mass (SMI) – FM% analysis – Age 31 - 40
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Body Composition and Age
Muscle Mass (SMI) – FM% analysis – Age 41 - 50
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Body Composition and Age
Muscle Mass (SMI) – FM% analysis – Age 51 - 60
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Body Composition and Age
Muscle Mass (SMI) – FM% analysis – Age 61 +
Osteosarcopenic obesity
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thanks for your
attention
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