Translational exercise biomedicine – where do we go?

Integrated exercise physiology, biology, health, pathophysiology and disease

Under this topic, the first issue of TEB includes one perspective [1] and one narrative review [2] paper. The perspective paper “Toward an integrative approach to translational exercise biomedicine” by Fan et al. highlighted the complexity of exercise interventions that impact the human body through various physiological networks [1]. Deciphering precise mechanisms linking specific types of exercise to particular adaptations remains a hurdle. However, systems biology provides network-level perspectives that can personalize lifestyle prescriptions, such as exercise. The emergent concepts of piezoelectric elements/devices, autophagy, and microbiome are revolutionizing our understanding of how mechanical force signals impact our bodily systems. By embracing a holistic approach to health, individuals can take control of their well-being and achieve a better quality of life. The authors brought up three key questions for future studies: What are the molecular and cellular mechanisms behind the benefits of exercise? How does mechanical strain influence physiological and pathological processes within living systems? Can classic exercise science be precisely translated into personalized exercise medicine, given the lack of solid molecular and cellular evidence to support the research on exercise in general?

The review paper of this topic by Wilkinson et al. is entitled “Metabolomic and proteomic insights and frameworks in exercise biomedicine” [2] and focuses on methods useable to decipher precise mechanisms explaining the various effects of exercise. The field of OMICs is advancing rapidly in health, metabolic conditions, and aging. Tissue level analysis is essential for identifying organ-specific features. Stable isotope tracing to proteomics and metabolomics represents the next research phase, overcoming the limitations of ‘point in time’ OMICs. These methods have helped identifying how individual protein turnover and metabolite flux may explain exercise responses. The application of these methods will provide new insights into translational exercise biomedicine. Collectively, the abovementioned two articles highlight future directions of translational exercise biomedicine for which the newly established Journal TEB provides an excellent platform.

Personalized and advanced exercise prescription for health and chronic diseases

Under this topic, the first issue of TEB includes two randomized controlled trials (RCT). The paper entitled “Effects of 12 weeks of power-oriented resistance training plus high-intensity interval training on metabolic syndrome factors in older people with COPD: a randomized controlled trial” by Romero-Valia et al. [3] comprises a secondary analysis that aimed to assess the effects of an exercise training program combining power-oriented resistance training (RT) and high-intensity interval training (HIIT) on metabolic syndrome (MetS) markers in older people with COPD. They found that the combination of RT and HIIT might be an excellent time-efficient option to treat older people with different comorbidities. The intervention improved mean arterial pressure, prevented an increase in waist circumference and lowered an index of metabolic syndrome in older people with chronic obstructive pulmonary disease. The individualized exercise training program consisting of two 30 min sessions per week was well tolerated by older people with COPD and proved feasible in the clinical setting.

The second RCT paper by Coe et al. [4] entitled “The effect of breaking sitting time with physical activity breaks on cognitive performance in young people with Cerebral Palsy: an exposure response cross-over feasibility design” used a randomized three-arm exposure-response cross-over feasibility design to assess if interrupting sedentary behavior with physical activity breaks improves cognitive performance in young people with Cerebral Palsy. Research has found that short bursts of physical activity interventions can potentially improve cognitive performance in young people with cerebral palsy. This trial expands on previous findings by showing that cognitive performance responses to different physical activity exposures vary, highlighting the importance of conducting further trials and considering individual tailoring of physical activity. Collectively, these two articles highlight the “new” findings regarding translational theory into practice.

Physical activity/inactivity and health across the lifespan

In this section, we aimed to cover physical activity/inactivity related health issues across the lifespan including both basic and clinical studies. This issue we had an original study by Juppi et al. entitled “Menopausal transition alters female skeletal muscle transcriptome” [5]. The authors applied a multi-RNA omics approach to study the muscle transcriptome in women transitioning to post-menopause. Around half of the human population experiences menopause, which causes numerous physiological changes and increases the risk of disease. Skeletal muscle is among the tissues affected by menopause, but there remains an insufficient knowledge about the changes happening at the transcriptome-wide level during this transition. Skeletal muscle comprises 40 % of the body weight and is necessary for movement, balance, heat production, and amino acid storage. It also plays a critical role in metabolism, tissue signaling, and overall health. The authors found 30 differentially expressed (DE) mRNA genes in early menopausal women and 19 in late menopausal women, participating in cell death, growth, and environmental interaction pathways. They identified 10 DE lncRNA transcripts and putative regulatory networks affected by estradiol availability but no DE miRNAs. The observed DE genes and their regulatory networks may offer novel insights into how changes in gene transcription at certain time points of life may affect body composition during and after menopause. This paper provides insights into the relationship between physical activity-related issues and health across the lifespan.

Sports medicine and movement science

In this section, we attempt to transfer knowledge from sports medicine to exercise science in non-athlete training. An original study by Muniz-Pardos et al. [6], “Acute effects of transcranial direct current stimulation on cycling performance in trained male athletes”, assessed the acute effects of transcranial direct current stimulation (tDCS) on cycling performance in trained male cyclists. 11 male cyclists were tested under either tDCS or sham during maximal incremental exercise, and nine cyclists performed constant-load exercise (CLE) at 62 % of peak power output followed by a 15 km time trial. tDCS decreased heart rate (HR) and increased oxygen uptake (VO2), non-esterified fatty acids, and glycerol concentrations during CLE. It also improved 15 km time trial performance by 3.6 % without affecting ratings of perceived exertion (RPE), HR, or blood lactate. The study suggests that transcranial direct current stimulation is a non-invasive modality of brain stimulation that can alter brain excitability and the autonomic nervous system, which has been shown to reduce the perception of effort during exercise and potentially improve exercise performance. The implications of using this methodology in this research are more related to human performance than health. However, this has shown to be a safe practice under the doses used (20 min, 2 mA) in numerous articles not only performed in athletes but also can be applied to those non-athletes who have taken exercise as their hobby and would like to improve their physical fitness level which, in turn, affects health as well.

Interaction of exercise with diet, nutrition and/or medication

Under this topic, we explore how exercise interacts with diet, nutrition, and medication from a multidisciplinary approach. A narrative review entitled “Towards optimizing exercise prescription for type 2 diabetes: Modulating exercise parameters to strategically improve glucose control” by Marcotte-Chénard and Little [7] has summarized optimizing exercise prescription for type 2 diabetes (T2D). Type 2 Diabetes is a complicated condition that requires a holistic approach to management, including pharmacological interventions and lifestyle changes. Exercise prescription can be tailored to optimize glycemic control through factors such as exercise types, volume, intensity, frequency, and timing. A framework has been proposed for healthcare professionals to personalize exercise prescriptions. By adjusting exercise routines, it is possible to enhance T2D management, reduce comorbidity risk, and improve quality of life. The paper bridges the gap between the clinical health benefits of exercise and the underlying mechanisms to change and optimize clinical practice, health promotion, and exercise guidelines.

Exercise and E-health, M-health, AI and technology

In this section, we aim to address the application of technologies in exercise science and health. Currently, it is underutilized in clinical practice due to a lack of applicable methodology. Moreover, the standardization and documentation are insufficient, decreasing the clinical impact of therapeutic training. The paper by Weber et al., “Therapeutic Resistance Training: Proposal for an Algorithm-Based Approach” [8], uses an algorithm-based approach to treat sarcopenia and other immobilization-induced muscle disorders, enhancing standardization and documentation while reducing resource efforts in clinical practice and research. Therapeutic resistance training has many benefits, but it faces barriers in clinics due to a lack of awareness and communication deficits between medical professionals. Resistance training is also believed to require expensive equipment, and medical staff is overworked. To overcome these barriers, a multidisciplinary and simplistic approach is needed to provide a standardized training plan applicable to all patients. The Network of Expertise in Immobilization-related Muscle Disorders suggests an algorithmic approach that can be applied to all patients, from bed-ridden to those with restricted mobility. The proposed algorithm aims to apply to all patients but may not be optimal and can be challenged by alternative algorithms in the future. This paper shows how technology can improve exercise and therapy practices.

The purpose of this first issue is to give an impression and overview on the subject of “translational exercise biomedicine” from various disciplines, encouraging further discussion. However, we understand that the topics covered in the first issue are not comprehensive and should be considered only as a spotlight on translational exercise biomedicine.

TEB is an international platform for disseminating interdisciplinary research in exercise interventions and the underlying mechanisms that improve human health. Compared to other journals in this field, TEB will focus on translation and how mechanistic findings in exercise can be applied to improve health, target disease pathophysiology, and/or change clinical practice through mechanism-based exercise prescription. While exercise prescription will be an important area of focus, it will not be the sole focus of TEB. With the increasing emphasis on interdisciplinary and translational research, authors working on inter- and multi-disciplinary teams or on the boundaries of the translational spectrum will have a platform to publish their work in TEB.