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Role of carbohydrate in central fatigue: a systematic review

Khong TK, Selvanayagam VS, Sidhu SK, Yusof A

Scand J Med Sci Sports, 2017 Apr;27(4):376-384.
PMID: 27714855 DOI: 10.1111/sms.12754

Carbohydrate (CHO) depletion is linked to neuromuscular fatigue during exercise. While its role at peripheral level is relatively well understood, less is known about its impact centrally. The aim of this systematic review was to critically analyze the effects of CHO on central fatigue (CF) assessed by various neurophysiological techniques. Four databases were searched using PRISMA guidelines through February 2016. The inclusion criteria were: CHO as intervention against a placebo control, fatigue induced by prolonged exercise and assessed using neurophysiological measures [voluntary activation (VA), superimposed twitch (SIT), M-wave, electromyography], alongside maximal voluntary contraction (MVC). Seven papers were reviewed, where exercise duration lasted between 115 and 180 min. CHO improved exercise performance in three studies, whereby two of them attributed it to CF via attenuation of VA and SIT reductions, while the other indicated peripheral involvement via attenuation of M-wave reduction. Although a few studies suggest that CHO attenuates CF, data on its direct effects on neurophysiological outcome measures are limited and mixed. Generally, measures employed in these studies were inadequate to conclude central contribution to fatigue. Factors including the techniques used and the lack of controls render additional confounding factors to make definitive deductions. Future studies should employ consistent techniques and appropriate neurophysiological controls to distinguish CHO effect at central level. The use of pharmacological intervention should be incorporated to elucidate involvement of central mechanisms.

Matched MeSH terms: Fatigue/prevention & control
Fatigue-related crashes involving express buses in Malaysia: will the proposed policy of banning the early-hour operation reduce fatigue-related crashes and benefit overall road safety?

Mohamed N, Mohd-Yusoff MF, Othman I, Zulkipli ZH, Osman MR, Voon WS

Accid Anal Prev, 2012 Mar;45 Suppl:45-9.
PMID: 22239931 DOI: 10.1016/j.aap.2011.09.025

Fatigue-related crashes have long been the topic of discussion and study worldwide. The relationship between fatigue-related crashes and time of day is well documented. In Malaysia, the possibility of banning express buses from operating during the early-hours of the morning has emerged as an important consideration for passenger safety. This paper highlights the findings of an impact assessment study. The study was conducted to determine all possible impacts prior to the government making any decision on the proposed banning. This study is an example of a simple and inexpensive approach that may influence future policy-making process. The impact assessment comprised two major steps. The first step involved profiling existing operation scenarios, gathering information on crashes involving public express buses and stakeholders' views. The second step involved a qualitative impact assessment analysis using all information gathered during the profiling stage to describe the possible impacts. Based on the assessment, the move to ban early-hour operations could possibly result in further negative impacts on the overall road safety agenda. These negative impacts may occur if the fundamental issues, such as driving and working hours, and the need for rest and sleep facilities for drivers, are not addressed. In addition, a safer and more accessible public transportation system as an alternative for those who choose to travel at night would be required. The proposed banning of early-hour operations is also not a feasible solution for sustainability of express bus operations in Malaysia, especially for those operating long journeys. The paper concludes by highlighting the need to design a more holistic approach for preventing fatigue-related crashes involving express buses in Malaysia.

Matched MeSH terms: Fatigue/prevention & control*
Effects of Tualang Honey on Cancer Related Fatigue: A Multicenter Open-label Trial of H&N Cancer Patients

Ramasamy V, Binti Mat Lazim N, Abdullah B, Singh A

Gulf J Oncolog, 2019 May;1(30):43-51.
PMID: 31242981

INTRODUCTION: Cancer related fatigue (CRF) is a problem experienced by head and neck cancer patients, especially those who undergo chemoradiation therapy. CRF may persist for years post chemoradiation therapy and significantly impair their quality of life (QOL). Tualang honey is rich in amino acids, vitamins, minerals and enzymes. It is proven to have anti-inflammatory, antioxidant and anti-tumour properties. As CRF is related to inflammatory mediators, the effects of Tualang Honey may improve CRF. The aim of this study is to determine if Tualang honey has a role in improving CRF and quality of life among head and neck cancer patients post chemoradiation.
METHODOLOGY: In this open labelled randomized clinical trial, 40 participants aged between 18 and 65 with head and neck cancer who completed chemotherapy and/or radiotherapy in Hospital USM, Kelantan Malaysia or Hospital Taiping were recruited and randomized into two groups: Tualang honey (experimental) group or Vitamin C (control) group. They were prescribed with either daily oral Tualang honey 20mg or vitamin C tablet 100 mg for 8 weeks. Level of fatigue and quality of life were measured using FACIT-Fatigue and FACT H&N questionnaires at baseline, 4 weeks and 8 weeks. The white cell count and C-reactive protein level were also measured at baseline, 4 weeks and 8 weeks.
RESULTS: After four and eight weeks of treatment with Tualang honey or Vitamin C, the fatigue level for experimental group was better than in the control group, and the differences were statistically significant (p<0.05). Statistically significant improvements were seen on quality of life (p<0.05) for the experimental group at week 8, however, no significant improvements were seen in white cell count and C-reactive protein level between control and experimental group.
CONCLUSION: Our research provided support for the use of Tualang honey to improve CRF and QOL in head and neck cancer patients post chemotherapy or radiotherapy.

Matched MeSH terms: Fatigue/prevention & control*
Fulltext Effect of quantity and quality of pre-exercise carbohydrate meals on central fatigue

Khong TK, Selvanayagam VS, Hamzah SH, Yusof A

J Appl Physiol (1985), 2018 10 01;125(4):1021-1029.
PMID: 29975601 DOI: 10.1152/japplphysiol.00221.2018

Both the quantity and quality of pre-exercise carbohydrate (CHO) meals have been shown to improve endurance performance. However, their role in attenuating central fatigue (CF) is inconclusive. The use of neurophysiological techniques, such as voluntary activation (VA) and the central activation ratio (CAR), alongside maximum voluntary contraction (MVC) and sustained MVC (sMVC) can provide information on CF. Hence, the objective of this study was to investigate the effects of isocaloric pre-exercise meals: 1) a high versus low quantity of CHO and 2) a high quantity of CHO with a high versus low glycemic index (GI) on MVC, VA, and CAR following a 90-min run. The high and low quantity of CHO was 1.5 and 0.8 g/kg body wt, respectively, and high and low GI was ~75 and ~40, respectively. Blood insulin, serotonin, tryptophan, and gaseous exchange were also measured. High CHO preserved sMVC, VA, CAR, and serotonin postrunning with greater CHO oxidation and insulin response, whereas in low CHO, greater reductions in sMVC, VA, and CAR were accompanied by higher serotonin and fat oxidation with lower insulin response. These observations indicate central involvements. Meanwhile, high GI CHO better preserved force (sMVC), CAR, and tryptophan with greater CHO oxidation and insulin response compared with low GI. The findings of this study suggest that pre-exercise meals with varying quantity and quality of CHO can have an effect on CF, where greater CHO oxidation and insulin response found in both high CHO and high GI lead to attenuation of CF. NEW & NOTEWORTHY This paper examined the effects of carbohydrate interventions (high and low: quantity and quality wise) on central activity during prolonged exercise using mainly neurophysiological techniques along with gaseous exchange and blood insulin, serotonin, and tryptophan data.

Matched MeSH terms: Fatigue/prevention & control*
Fulltext Development and validation of Work-Related Activities during Non-Work Time Scale (WANTS) for doctors

Mohd Fauzi MF, Mohd Yusoff H, Mat Saruan NA, Muhamad Robat R

PLoS One, 2020;15(11):e0241577.
PMID: 33206663 DOI: 10.1371/journal.pone.0241577

Work-related activities during non-work time may influence the intershift recovery of post-work fatigue. Currently there is no valid and reliable scale available to measure the frequency for such activities among doctors. Therefore, this study aims to develop and validate 'Work-Related Activities during Non-Work Time Scale' (WANTS) that measure the frequency of work-related activities during non-work time for doctors. This was a scale development and validation study among doctors involving item generation, content and construct validation, and reliability assessment. 23-item seven-point Likert-type scale was developed through deductive (literature search) and inductive (interview with source population, authors' experiences, and expert opinion) methods. The content-validated scale was pre-tested, and the improved scale was subsequently administered to randomly-selected 460 doctors working at public hospital setting. Response rate was 77.76% (n = 382). Initial exploratory factor analysis (EFA) with principal axis factoring (PAF) using varimax rotation revealed unstable six-factor structure consisting of 17 variables; thus, we tested one- to six-factor model, and found that four-factor model is the most stable. Further analysis with principal component analysis (PCA) with a single component on each factor found that 17-variables four-factor model is stable. These factors were labelled as 'work-related thought', 'work-to-home conversation', 'task spillover' and 'superior-subordinate communication'. It showed good internal consistency with overall alpha value of 0.837. The scale is thus valid and reliable for measuring the frequency of each construct of work-related activities during non-work time among doctors.

Matched MeSH terms: Mental Fatigue/prevention & control*
Truck driver fatigue risk assessment and management: a multinational survey

Adams-Guppy J, Guppy A

Ergonomics, 2003 Jun 20;46(8):763-79.
PMID: 12745978 DOI: 10.1080/0014013021000056980

As part of an organizational review of safety, interviews and questionnaire surveys were performed on over 700 commercial goods drivers and their managers within a series of related companies operating across 17 countries. The results examine the reported incidence of fatigue-related problems in drivers and their associations with near miss and accident experience as well as work and organizational factors. Experience of fatigue problems while driving was linked to time of day and rotation of shifts, though most associations were small. There were significant associations found between fatigue experiences and driver and management systems of break taking and route scheduling. The quantitative combined with qualitative information suggested that, where feasible, more flexible approaches to managing the scheduling and sequencing of deliveries assisted drivers in managing their own fatigue problems through appropriate break-taking. The results are interpreted within the overarching principles of risk assessment and risk control.

Matched MeSH terms: Fatigue/prevention & control
Fulltext Dietary Changes and Its Impact on Quality of Life among Malay Breast and Gynaecological Cancer Survivors in Malaysia

Zainordin NH, Abd Talib R, Shahril MR, Sulaiman S, A Karim N

Asian Pac J Cancer Prev, 2020 Dec 01;21(12):3689-3696.
PMID: 33369469 DOI: 10.31557/APJCP.2020.21.12.3689

OBJECTIVE: Fear of cancer recurrent, side effects of treatment and belief in food taboos encourage cancer survivors to make changes in their dietary practices after diagnosis of cancer. The objective of this study was to determine the impact of dietary changes on quality of life (QoL) among Malay breast and gynaecological cancer survivors.
METHODS: Questionnaire of dietary changes was modified from WHEL study and adapted to typical Malay's food intake in Malaysia. A total of 23 items were listed and categorized by types of food and cooking methods. Four categories of changes "increased", "decreased", "no changes" or "stopped" were used to determine the changes in dietary practices. Score one (+1) is given to positive changes by reference to WCRF/AICR and Malaysia Dietary Guideline healthy eating recommendations. Malay EORTC QLQ-C30 were used to determine the QoL. Sociodemographic, clinical characteristics and anthropometric measurement were also collected.
RESULTS: The mean age of the subjects (n=77) was 50.7±7.8 years old with duration of survivorship 4.0±3.1 years. Subjects mean BMI was 27.8±4.9 kg/m2 which indicate subjects were 31.2% overweight and 32.5% obese. The percentage score of positive dietary changes was 34.7±16.4%. Positive dietary changes were increased intake of green leafy vegetable (49.4%), cruciferous vegetable (46.8%) and boiling cooking methods (45.5%). Subjects reduced their intake of red meat (42.9%), sugar (53.2%) and fried cooking method (44.2%). Subjects stopped consuming milk (41.6%), c 2008-5862 heese (33.8%) and sweetened condensed milk (33.8%). With increasing positive dietary changes, there was a significant improvement on emotional function (rs=0.27; p=0.016) and reduced fatigue symptoms (rs=-0.24; p=0.033).
CONCLUSION: Positive changes in dietary intake improved emotional function and reduced fatigue symptoms after cancer treatment. By knowing the trend of food changes after cancer treatment, enables the formation of healthy food intervention implemented more effective.

Matched MeSH terms: Fatigue/prevention & control*