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To ice or not to ice? Icing promotes muscle regeneration after mild injury

Cumulative research by a multi-institutional Japanese research collaboration reveals that ‘to ice or not to ice’ may depend on the degree of muscle injury.

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Applying ice to a muscle injury is a widespread first-aid treatment, but exactly what effect does this have on the muscle regeneration and does it really help? Cumulative research by a multi-institutional Japanese research collaboration reveals that ‘to ice or not to ice’ may depend on the degree of muscle injury.

In their latest research, the group consisting of Associate Professor ARAKAWA Takamitsu and Master’s student NAGATA Itsuki (from Kobe University’s Graduate School of Health Sciences), and Assistant Professor KAWASHIMA Masato (Kawasaki University of Medical Welfare) et al. have shown that applying ice to muscle damage in a small percentage of muscle fibers in rats promotes muscle regeneration. This is believed to be the first study in the world to show benefits of icing on muscle repair. In conjunction with their previous study on serious muscle injuries (‘Icing muscle injuries may delay recovery’), it is hoped that these results can be used as a basis for more accurate guidelines on whether or not to ice such injuries.

These research findings were first reported in the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology on March 6, 2023.

Main Points

  • The experiments showed that applying ice after a mild muscle injury promotes muscle regeneration.
  • This is believed to be the first time in the world that a study has shown a positive effect of icing on muscle regeneration.
  • The researchers showed that the extent of the injury may have a greater impact on the effectiveness of icing than the method or timing employed.
  • The findings of this ongoing research will lead to the spread of more accurate information on the effects of icing throughout hospitals, and in the realms of sports and physical education.

‘RICE treatment’ is a common approach for treating the acute phase of sports injuries. This acronym stands for Rest, Ice, Compression and Elevation and it is also often used in physical education in schools and even clinical settings. There are a variety of subsequent steps that can be taken to treat the injury afterwards, yet opinions vary as to whether or not icing should be applied. However, there is a lack of evidence on the benefits of icing.

The current research team has conducted many experiments to investigate the effectiveness of icing, which led them to publish their previous findings (‘Icing muscle injuries may delay recovery’ ). However, no previous animal experiments have indicated that icing promotes muscle regeneration.

In this study, the researchers focused on altering the severity of the muscle injury in the experiments. The reasoning behind this was that the majority of sports-related muscle injuries are limited; in other words less than 10% of the overall number of muscle fibers (myofibers) are damaged and necrotized. However, all animal experiments up until now had looked at more serious injuries where over 20% of the myofibers were damaged.

Thus, the team devised an animal model for mild muscle injuries, and experimented with applying ice after injury using a similar method as before.

After the animal was anaesthetized, the muscle was exposed and clamped between forceps to induce injury. In their previous experiments, the researchers attached a 500g weight to the forceps, which induced an injury that affected 20% of the total number of fibers in the muscle. In the present study, they tried attaching a 250g weight to the forceps and demonstrated that this could be used to consistently injure 4% of the fibers (Figure 1). This is similar to the degree of injury that often occurs after sports activities such as vigorous exercise or long-distance marathon running.

Icing was carried out by placing polyethylene bags of ice on surface of the skin over three 30-minute sessions per day, with each session being 1.5 hours apart. This was continued until two days after injury for a total of 9 icing sessions (i.e. immediately after injury = 3 sessions, 1 day after injury = 3 sessions, 2 days after injury = 3 sessions). The icing method was the same as in the previously reported study (‘Icing muscle injuries may delay recovery’).

Observations of muscles that were regenerating in the icing group and no-icing group 2 weeks after injury revealed significant differences in the size of regenerating fibers in cross-sections (Figure 2). In other words, this demonstrated the possibility that skeletal muscle regeneration is promoted by icing.

Macrophages are immune cells that orchestrate the reparative process of injured muscle. Pro-inflammatory macrophages accumulate in the damaged site soon after injury occurs, however they express an inducible nitric oxide synthase (iNOS), which has a disadvantageous side-effect of expanding the injury’s sizeThe results of this team’s experiments revealed that icing after mild muscle injury reduces the accumulation of iNOS-expressing pro-inflammatory macrophagesBy causing this phenomenon, icing prevents the expansion of muscle injury size.

In other words, icing attenuates the recruitment of pro-inflammatory macrophages in the injury site. This was also reported in their previous study (‘Icing muscle injuries may delay recovery’), demonstrating that this is an effect caused by icing regardless of whether the muscle injury is serious or mild. In the previous study, icing was found to delay the regeneration of muscle after a serious injury that destroyed many fibers because the pro-inflammatory macrophages were unable to sufficiently phagocytose (*5) the injured muscle. In contrast to this, the current study shows that icing has a positive effect when the muscle injury is mild because it prevents the secondary expansion of the muscle injury caused by the pro-inflammatory macrophages. It suggests that this particular effect of icing is connected to the promotion of muscle regeneration.

Icing has been used in the treatment of muscle injuries for a long time, however the positive effects of icing had yet to be elucidated until now. This study has shown that icing can promote muscle regeneration when used to treat commonly-occurring mild muscle injuries.

However, this does not mean that icing is effective for all types or degree of muscle injury. The researchers aim to further elucidate and raise awareness of this. For example, the group’s previous study showed that icing actually inhibited regeneration in cases of serious muscle injury. In addition, the term ‘muscle injury’ also includes extremely minute injuries that have yet to be observed through the team’s animal experiments, so it is still unclear as to what effect icing has on the repair from such microtraumas.

The researchers’ next challenge is to determine the extent of muscle injury up to which icing is appropriate. By building upon their previous investigations, they aim to contribute towards guidelines that will enable people in sports and clinical rehabilitation to make accurate judgements about whether or not to ice an injury.

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Wellness

Whether you exercise regularly or one-to-two days a week, weight loss is possible

Whether you engage in physical activity on a regular basis or one-to-two days a week, both options produce weight loss suggests a new study published in the journal Obesity.

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Whether you engage in physical activity on a regular basis or one-to-two days a week, both options produce weight loss suggests a new study published in the journal Obesity, The Obesity Society’s (TOS) flagship journal. The study is the first of its kind to examine the association between physical activity patterns and objectively-measured fat tissue mass.

Guidelines from the World Health Organization recommend that adults perform at least 150 minutes per week of moderate physical activity, 75 minutes per week of vigorous physical activity or an equivalent combination of both intensities. However, many individuals find it challenging to meet this recommendation due to physical activity being time consuming in a fast-paced society. The new study found that people defined by researchers as “weekend warriors”—individuals who condense their exercise into one-to-two days a week—can also lose weight similar to individuals who exercise on a regular basis as long as they achieved the recommended goals.

“The weekend warrior pattern is worth promoting in individuals who cannot meet the recommended frequency in current guidelines,” said Lihua Zhang, health care scientist, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Zhang is one of the corresponding authors of the study.

Zhang suggested that office workers, bus drivers and other employees who have to sit for many hours during the work day care about the research. “Those people are struggling to catch up in their exercise plan in daily life to offset the hazard of a sedentary lifestyle but have less free time to get to the gym,” she said. “Our study could offer them an alternative choice to keep fit,” said Zhang, who added that there are suitable activities for weekend warriors such as climbing, hiking, cycling or running.

Researchers extracted data from more than 9,600 participants in the National Health and Nutrition Examination Survey from 2011 to 2018. Participants ranged in age from 20- to 59-years-old.

Abdominal and general adiposity were assessed by dual-energy x-ray absorptiometry (DXA)—a non-invasive and easily accessible body composition scan—and anthropometric measures. Physical activity levels were collected from the Global Physical Activity Questionnaire and classified as inactive, weekend warrior and regularly active. Survey linear regression models were used to assess associations between physical activity patterns and adiposity indicators.

Results showed that 772 participants reported the weekend warrior pattern and 3,277 reported the regularly active pattern. Compared to the 5,580 inactive participants, both the weekend warrior and regular active groups had lower DXA-measured abdominal adiposity, waist circumference, whole-body fat mass and body mass index. These two groups were also younger, more likely to be non-Hispanic White, have higher educational backgrounds, and less likely to be unemployed or to have hypertension or diabetes.

“On a high level, this study reaffirms the old adage about physical activity and health: any activity is better than no activity. Notably, the weekend warriors’ workout was of higher intensity and longer duration, and more intensity and longer duration correlated with even lower abdominal fat. The main takeaway, though, is that people should be active in any manner that suits their lifestyle,” said Assistant Professor of Clinical Medicine Beverly Tchang, MD, DABOM, Comprehensive Weight Control Center, Weill Cornell Medicine in New York. Tchang was not associated with the research study.

Steven B. Heymsfield, MD, professor, Pennington Biomedical Research Center, Baton Rouge, La., who was also not associated with the study added, “Findings in a cross-sectional sample such as reported by the study’s researchers need confirmation in prospective longitudinal studies.”

Other authors of the study include Lubi Lei, Jingkuo Li, Wei Wang, Yanwu Yu, Boxuan Pu and Yue Peng, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Another corresponding author, Zhenyan Zhao, is from the Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

The authors declared no conflicts of interest.

The study, titled “The Associations of ‘Weekend Warrior’ and Regularly Active Physical Activity with Abdominal and General Adiposity in U.S. Adults,” will be published in the April 2024 issue of Obesity.

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NewsMakers

Light exercise could be the key to reversing childhood obesity linked to sedentariness

Each minute spent sedentary was associated with a 1.3-gram increase in total body fat mass. Both male and female children gained an average of 10kg of fat mass during growth from childhood until young adulthood. However, sedentary time potentially contributed 700 grams to 1kg of fat mass (approximately seven to ten percent) of the total fat mass gained during growth from childhood until young adulthood.

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Increased sedentary time as a child through adolescence is directly linked to childhood obesity, but new research has found light physical activity may completely reverse the adverse process.

The study – conducted in collaboration with between University of Exeter, University of Eastern Finland, University of Bristol, and University of Colorado and published in Nature Communications – is the largest and longest follow-up to objectively measure physical activity and fat mass, using the University of Bristol’s Children of the 90s data (also known as the Avon Longitudinal Study of Parents and Children). The study included 6,059 children (53 percent female) aged 11 years who were followed up until the age of 24.

Recent reports concluded that more than 80 percent of adolescents across the globe do not meet the World Health Organization’s (WHO) recommended average of 60 minutes a day of moderate-to-vigorous physical activity. It is estimated that physical inactivity will have caused 500 million new cases of heart disease, obesity, diabetes, or other noncommunicable diseases by 2030, costing £21-million annually. This alarming forecast regarding the morbid danger of physical inactivity necessitates urgent research on the most effective preventive approach.

Yet results from this new study shows that moderate-to-vigorous physical activity is up to ten times less effective than light physical activity in decreasing overall gain in fat mass.

Dr Andrew Agbaje of the University of Exeter led the study and said: “These new findings strongly emphasise that light physical activity may be an unsung hero in preventing fat mass obesity from early life. It is about time the world replaced the mantra of ‘an average of 60 minutes a day of moderate-to-vigorous physical activity’ with ‘at least 3 hours a day of light physical activity’. Light physical activity appears to be the antidote to the catastrophic effect of sedentary time in the young population.”

During the study, a waist-worn accelerometer measured sedentary time, light physical activity, and moderate-to-vigorous physical activity among participants at ages 11, 15, and 24 years. Dual-energy X-ray absorptiometry-measured fat mass and skeletal muscle mass were also collected at the same ages and fasting blood samples were repeatedly measured for glucose, insulin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, and high-sensitivity C-reactive protein. In addition, blood pressure, heart rate, smoking status, socio-economic status, and family history of cardiovascular disease were measured and controlled for in the analyses.

During the 13-year follow-up, sedentary time increased from approximately six hours a day in childhood to nine hours a day in young adulthood. Light physical activity decreased from six hours a day to three hours a day, while moderate-to-vigorous physical activity was relatively stable at around 50 minutes a day from childhood through young adulthood.

It was observed that each minute spent sedentary was associated with a 1.3-gram increase in total body fat mass. Both male and female children gained an average of 10kg of fat mass during growth from childhood until young adulthood. However, sedentary time potentially contributed 700 grams to 1kg of fat mass (approximately seven to ten percent) of the total fat mass gained during growth from childhood until young adulthood. A 1kg increase in fat has been linked to a 60-percent higher risk of premature death in a person’s early 50s.

Each minute spent in light physical activity during growth from childhood through young adulthood was associated with a 3.6-gram reduction in total body fat mass. This implies that cumulative light physical activity decreased total body fat mass by 950 grams to 1.5kg during growth from childhood to young adulthood, (approximately 9.5 to 15 percent decrease in overall gain in fat mass during the 13-year observation period). Examples of light physical activity are long walks, house chores, slow dancing, slow swimming, and slow bicycling.

In contrast, time spent in moderate-to-vigorous physical activity – including meeting the 60 minutes a day recommended by the WHO – during growth from childhood through young adulthood was associated with 70 to 170 grams (approximately 0.7 to 1.7 percent) reduction in total body fat mass. Prior to this study, it has not been possible to quantify the long-term contribution of sedentary time to fat mass obesity and the magnitude by which physical activity may reduce it. But this study confirmed the report from a recent meta-analysis of 140 school-based randomised controlled trials across the globe that engaging in moderate-to-vigorous physical activity had minimal or no effect in reducing childhood BMI-obesity.

Dr Andrew Agbaje of the University of Exeter said: “Our study provides novel information that would be useful in updating future health guidelines and policy statements. Public health experts, health policymakers, health journalists and bloggers, paediatricians, and parents should encourage continued and sustained participation in light physical activity to prevent childhood obesity.”

The paper entitled ‘Effects of Accelerometer-based Sedentary Time and Physical Activity on DEXA-measured Fat Mass in 6059 Children’ is published in Nature Communications.

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Health

Self-care for sick days

To help navigate this cough, cold and flu season, consider these tips.

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Cooler weather inevitably means cough, cold and flu season isn’t far behind. Now is the time to take precautions and set yourself up with healthy habits.

“As much as we try, avoiding viruses, bacteria and germs to prevent getting sick can be a challenge,” Dr. Tim Tiutan, MD, said. “However, being prepared with the right remedies, listening to your body and its symptoms and remaining diligent with a healthy routine is just as important as treating symptoms head on.”

To help navigate this cough, cold and flu season, consider these tips from Tiutan and the experts at Mucinex.

Prepare and Prevent
You won’t find a foolproof way to keep germs away, but you can lessen your chances of getting sick and make sure you’re equipped to weather an illness.

  • Practice healthy habits. Keeping your body in prime condition can help ensure you’re in the best condition possible to fight back when germs attack. That means keeping up with exercise and ensuring you’re getting enough vitamins and nutrients through a well-balanced diet.
  • Get a flu shot. The flu shot gives your body a head start in fighting back against flu bugs. If you’re exposed to the flu after receiving the shot, your body can immediately go on the offensive against those germs. You may not stay completely symptom-free, but you’re more likely to experience a mild case and be back on your feet quicker.
  • Restock the medicine cabinet. The start of cough, cold and flu season is an ideal time to dig through your medicine cabinet. Start by discarding any medications that are out of date and make a list of anything you need to replenish. Be sure to include pain relievers, fever reducers, decongestants, antihistamines and cough syrups to fight symptoms. It’s also a good time to restock items like tissues, cough drops, hand sanitizer and anti-bacterial soap.

Treat Symptoms
Although the flu can hit fast, it’s often hard to tell at first whether your symptoms are due to a simple cough, cold or a case of the flu. Either way, managing symptoms like a cough can bring relief and help you keep comfortable and get plenty of rest.

  • Give your body time to heal. Sleep plays an important role in your overall health, especially when you’re under the weather. On average, you need 7-9 hours each night to give your body enough time to fully recharge. When you’re sick, you likely need even more, and it’s a good idea to dial back your activity level, too. Pushing your physical limits often only delays your recovery time.
  • Take medications as directed. Nagging symptoms can often keep you from getting the sleep you need. One way to give your body the break it needs is to effectively manage symptoms. A hacking cough is a common symptom that can be painful and disrupt your sleep. Consider an option like Mucinex DM 12-Hour, a cough suppresent which relieves chest congestion and thins and loosens mucus, giving you an extended reprieve. It’s clinically proven to last up to 12 hours, provides relief for chest congestion and makes coughs more productive.

Prevent Spread
Getting sick may be beyond your complete control, but you can take steps to protect others from germs when you’re feeling ill.

  • Keep germs to yourself. Washing your hands often, covering your nose and mouth with a tissue when you cough or sneeze and sneezing into your elbow if you don’t have a tissue are simple ways you can limit the spread of germs, especially within your home or workspace. Frequently wiping down high-touch surfaces can also help reduce the spread of germs.
  • Skip socializing. If you’re feeling under the weather, stay home. Even a mild cold can easily spread, and an illness that affects you mildly could cause significant distress for someone else. Avoid unnecessary errands and take advantage of services like curbside pickup if you must get out. Also check with your employer about working remotely if you’re up to it.

Cold vs. Flu
There’s a lot of overlap between cold and flu symptoms, so it can be tricky to figure out whether the bug you’re fighting is a cold or influenza and how to tackle it.

While both the common cold and the flu are respiratory illnesses, they are not caused by the same viruses. Although colds are inconvenient, they are far less likely to develop into anything more serious, as the flu can.

What is a Cold?
Generally, colds are milder than the flu, and more likely to cause runny or stuffy noses (while the flu can cause stuffy or runny noses, it’s less likely to do so). You won’t feel good, but you’ll probably be able to do some or all of your daily tasks. The flu typically hits harder, making it difficult to go to work or follow your usual routine.

What is the Flu?
The flu often feels worse than a cold; you might experience the same symptoms but amplified. The flu comes with more pain and fever than a cold. Common flu symptoms include sore throat, chills, fever, runny or stuffy nose, muscle fatigue or aches and headaches. The flu can also develop into more serious conditions and complications, making it more dangerous than the average cold. While the common cold is rarely serious, the flu can be dangerous for young children, the elderly, pregnant women and people with compromised immune systems.

Treating a Cold vs. Flu
You can be vaccinated against the flu. There is no such vaccine for common colds. If your provider recommends it, getting the flu vaccine each year can go a long way toward preventing sickness.

Whether you have a cold or the flu, symptom relief is largely the same. Get plenty of rest, drink plenty of fluids and take over-the-counter medicines to relieve symptoms. Stay home to avoid spreading sickness. Wash your hands frequently and cover your mouth when you cough or sneeze.

Watch for shortness of breath, chest or abdomen pain, confusion, sudden dizziness, severe or persistent vomiting and flu symptoms that improve then return with fever and worse cough. If you experience any of these symptoms, consult a doctor.

Find more ways to stay healthy and limit symptoms by visiting Mucinex.com.

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