@misc{GschwindKressigLacroixetal.2013, author = {Gschwind, Yves J. and Kressig, Reto W. and Lacroix, Andre and M{\"u}hlbauer, Thomas and Pfenninger, Barbara and Granacher, Urs}, title = {A best practice fall prevention exercise program to improve balance, strength/power, and psychosocial health in older adults}, series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, number = {604}, issn = {1866-8364}, doi = {10.25932/publishup-42710}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-427104}, pages = {15}, year = {2013}, abstract = {Background: With increasing age neuromuscular deficits (e.g., sarcopenia) may result in impaired physical performance and an increased risk for falls. Prominent intrinsic fall-risk factors are age-related decreases in balance and strength / power performance as well as cognitive decline. Additional studies are needed to develop specifically tailored exercise programs for older adults that can easily be implemented into clinical practice. Thus, the objective of the present trial is to assess the effects of a fall prevention program that was developed by an interdisciplinary expert panel on measures of balance, strength / power, body composition, cognition, psychosocial well-being, and falls self-efficacy in healthy older adults. Additionally, the time-related effects of detraining are tested. Methods/Design: Healthy old people (n = 54) between the age of 65 to 80 years will participate in this trial. The testing protocol comprises tests for the assessment of static / dynamic steady-state balance (i.e., Sharpened Romberg Test, instrumented gait analysis), proactive balance (i.e., Functional Reach Test; Timed Up and Go Test), reactive balance (i.e., perturbation test during bipedal stance; Push and Release Test), strength (i.e., hand grip strength test; Chair Stand Test), and power (i.e., Stair Climb Power Test; countermovement jump). Further, body composition will be analysed using a bioelectrical impedance analysis system. In addition, questionnaires for the assessment of psychosocial (i.e., World Health Organisation Quality of Life Assessment-Bref), cognitive (i.e., Mini Mental State Examination), and fall risk determinants (i.e., Fall Efficacy Scale -International) will be included in the study protocol. Participants will be randomized into two intervention groups or the control / waiting group. After baseline measures, participants in the intervention groups will conduct a 12-week balance and strength / power exercise intervention 3 times per week, with each training session lasting 30 min. (actual training time). One intervention group will complete an extensive supervised training program, while the other intervention group will complete a short version (` 3 times 3') that is home-based and controlled by weekly phone calls. Post-tests will be conducted right after the intervention period. Additionally, detraining effects will be measured 12 weeks after program cessation. The control group / waiting group will not participate in any specific intervention during the experimental period, but will receive the extensive supervised program after the experimental period. Discussion: It is expected that particularly the supervised combination of balance and strength / power training will improve performance in variables of balance, strength / power, body composition, cognitive function, psychosocial well-being, and falls self-efficacy of older adults. In addition, information regarding fall risk assessment, dose-response-relations, detraining effects, and supervision of training will be provided. Further, training-induced health-relevant changes, such as improved performance in activities of daily living, cognitive function, and quality of life, as well as a reduced risk for falls may help to lower costs in the health care system. Finally, practitioners, therapists, and instructors will be provided with a scientifically evaluated feasible, safe, and easy-to-administer exercise program for fall prevention.}, language = {en} } @misc{JafarnezhadgeroShadMajlesietal.2017, author = {Jafarnezhadgero, Amir Ali and Shad, Morteza Madadi and Majlesi, Mahdi and Granacher, Urs}, title = {A comparison of running kinetics in children with and without genu varus}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-403326}, pages = {15}, year = {2017}, abstract = {Introduction Varus knee alignment has been identified as a risk factor for the progression of medial knee osteoarthritis. However, the underlying mechanisms have not been elucidated yet in children. Thus, the aims of the present study were to examine differences in ground reaction forces, loading rate, impulses, and free moment values during running in children with and without genu varus. Methods Thirty-six boys aged 9-14 volunteered to participate in this study. They were divided in two age-matched groups (genu varus versus healthy controls). Body weight adjusted three dimensional kinetic data (Fx, Fy, Fz) were collected during running at preferred speed using two Kistler force plates for the dominant and non-dominant limb. Results Individuals with knee genu varus produced significantly higher (p = .01; d = 1.09; 95\%) body weight adjusted ground reaction forces in the lateral direction (Fx) of the dominant limb compared to controls. On the non-dominant limb, genu varus patients showed significantly higher body weight adjusted ground reaction forces values in the lateral (p = .01; d = 1.08; 86\%) and medial (p < .001; d = 1.55; 102\%) directions (Fx). Further, genu varus patients demonstrated 55\% and 36\% greater body weight adjusted loading rates in the dominant (p < .001; d = 2.09) and non-dominant (p < .001; d = 1.02) leg, respectively. No significant between-group differences were observed for adjusted free moment values (p>.05). Discussion Higher mediolateral ground reaction forces and vertical loading rate amplitudes in boys with genu varus during running at preferred running speed may accelerate the development of progressive joint degeneration in terms of the age at knee osteoarthritis onset. Therefore, practitioners and therapists are advised to conduct balance and strength training programs to improve lower limb alignment and mediolateral control during dynamic movements.}, language = {en} } @misc{SlimaniParavlicGranacher2018, author = {Slimani, Maamer and Paravlic, Armin and Granacher, Urs}, title = {A Meta-Analysis to Determine Strength Training Related Dose-Response Relationships for Lower-Limb Muscle Power Development in Young Athletes}, series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, number = {472}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-417738}, pages = {14}, year = {2018}, abstract = {It is well-documented that strength training (ST) improves measures of muscle strength in young athletes. Less is known on transfer effects of ST on proxies of muscle power and the underlying dose-response relationships. The objectives of this meta-analysis were to quantify the effects of ST on lower limb muscle power in young athletes and to provide dose-response relationships for ST modalities such as frequency, intensity, and volume. A systematic literature search of electronic databases identified 895 records. Studies were eligible for inclusion if (i) healthy trained children (girls aged 6-11 y, boys aged 6-13 y) or adolescents (girls aged 12-18 y, boys aged 14-18 y) were examined, (ii) ST was compared with an active control, and (iii) at least one proxy of muscle power [squat jump (SJ) and countermovement jump height (CMJ)] was reported. Weighted mean standardized mean differences (SMDwm) between subjects were calculated. Based on the findings from 15 statistically aggregated studies, ST produced significant but small effects on CMJ height (SMDwm = 0.65; 95\% CI 0.34-0.96) and moderate effects on SJ height (SMDwm = 0.80; 95\% CI 0.23-1.37). The sub-analyses revealed that the moderating variable expertise level (CMJ height: p = 0.06; SJ height: N/A) did not significantly influence ST-related effects on proxies of muscle power. "Age" and "sex" moderated ST effects on SJ (p = 0.005) and CMJ height (p = 0.03), respectively. With regard to the dose-response relationships, findings from the meta-regression showed that none of the included training modalities predicted ST effects on CMJ height. For SJ height, the meta-regression indicated that the training modality "training duration" significantly predicted the observed gains (p = 0.02), with longer training durations (>8 weeks) showing larger improvements. This meta-analysis clearly proved the general effectiveness of ST on lower-limb muscle power in young athletes, irrespective of the moderating variables. Dose-response analyses revealed that longer training durations (>8 weeks) are more effective to improve SJ height. No such training modalities were found for CMJ height. Thus, there appear to be other training modalities besides the ones that were included in our analyses that may have an effect on SJ and particularly CMJ height. ST monitoring through rating of perceived exertion, movement velocity or force-velocity profile could be promising monitoring tools for lower-limb muscle power development in young athletes.}, language = {en} } @misc{PeitzBehringerGranacher2019, author = {Peitz, Matti and Behringer, Michael and Granacher, Urs}, title = {A systematic review on the effects of resistance and plyometric training on physical fitness in youth}, series = {Postprints der Universit{\"a}t Potsdam Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam Humanwissenschaftliche Reihe}, number = {498}, issn = {1866-8364}, doi = {10.25932/publishup-42220}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-422201}, year = {2019}, abstract = {Introduction To date, several meta-analyses clearly demonstrated that resistance and plyometric training are effective to improve physical fitness in children and adolescents. However, a methodological limitation of meta-analyses is that they synthesize results from different studies and hence ignore important differences across studies (i.e., mixing apples and oranges). Therefore, we aimed at examining comparative intervention studies that assessed the effects of age, sex, maturation, and resistance or plyometric training descriptors (e.g., training intensity, volume etc.) on measures of physical fitness while holding other variables constant. Methods To identify relevant studies, we systematically searched multiple electronic databases (e.g., PubMed) from inception to March 2018. We included resistance and plyometric training studies in healthy young athletes and non-athletes aged 6 to 18 years that investigated the effects of moderator variables (e.g., age, maturity, sex, etc.) on components of physical fitness (i.e., muscle strength and power). Results Our systematic literature search revealed a total of 75 eligible resistance and plyometric training studies, including 5,138 participants. Mean duration of resistance and plyometric training programs amounted to 8.9 ± 3.6 weeks and 7.1±1.4 weeks, respectively. Our findings showed that maturation affects plyometric and resistance training outcomes differently, with the former eliciting greater adaptations pre-peak height velocity (PHV) and the latter around- and post-PHV. Sex has no major impact on resistance training related outcomes (e.g., maximal strength, 10 repetition maximum). In terms of plyometric training, around-PHV boys appear to respond with larger performance improvements (e.g., jump height, jump distance) compared with girls. Different types of resistance training (e.g., body weight, free weights) are effective in improving measures of muscle strength (e.g., maximum voluntary contraction) in untrained children and adolescents. Effects of plyometric training in untrained youth primarily follow the principle of training specificity. Despite the fact that only 6 out of 75 comparative studies investigated resistance or plyometric training in trained individuals, positive effects were reported in all 6 studies (e.g., maximum strength and vertical jump height, respectively). Conclusions The present review article identified research gaps (e.g., training descriptors, modern alternative training modalities) that should be addressed in future comparative studies.}, language = {en} } @misc{HammamiChaabeneKharratetal., author = {Hammami, Raouf and Chaabene, Helmi and Kharrat, Fatma and Werfelli, Hanen and Duncan, Michael and Rebai, Haithem and Granacher, Urs}, title = {Acute effects of different balance exercise types on selected measures of physical fitness in youth female volleyball players}, series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, number = {713}, issn = {1866-8364}, doi = {10.25932/publishup-51747}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-517477}, pages = {10}, abstract = {Background Earlier studies have shown that balance training (BT) has the potential to induce performance enhancements in selected components of physical fitness (i.e., balance, muscle strength, power, speed). While there is ample evidence on the long-term effects of BT on components of physical fitness in youth, less is known on the short-term or acute effects of single BT sessions on selected measures of physical fitness. Objective To examine the acute effects of different balance exercise types on balance, change-of-direction (CoD) speed, and jump performance in youth female volleyball players. Methods Eleven female players aged 14 years participated in this study. Three types of balance exercises (i.e., anterior, posterolateral, rotational type) were conducted in randomized order. For each exercise, 3 sets including 5 repetitions were performed. Before and after the performance of the balance exercises, participants were tested for their static balance (center of pressure surface area [CoP SA] and velocity [CoP V]) on foam and firm surfaces, CoD speed (T-Half test), and vertical jump height (countermovement jump [CMJ] height). A 3 (condition: anterior, mediolateral, rotational balance exercise type) × 2 (time: pre, post) analysis of variance was computed with repeated measures on time. Results Findings showed no significant condition × time interactions for all outcome measures (p > 0.05). However, there were small main effects of time for CoP SA on firm and foam surfaces (both d = 0.38; all p < 0.05) with no effect for CoP V on both surface conditions (p > 0.05). For CoD speed, findings showed a large main effect of time (d = 0.91; p < 0.001). However, for CMJ height, no main effect of time was observed (p > 0.05). Conclusions Overall, our results indicated small-to-large changes in balance and CoD speed performances but not in CMJ height in youth female volleyball players, regardless of the balance exercise type. Accordingly, it is recommended to regularly integrate balance exercises before the performance of sport-specific training to optimize performance development in youth female volleyball players.}, language = {en} } @misc{WerfelliHammamiSelmietal.2021, author = {Werfelli, Hanen and Hammami, Raouf and Selmi, Mohamed Amine and Selmi, Walid and Gabrilo, Goran and Clark, Cain C. T. and Duncan, Michael and Sekulic, Damir and Granacher, Urs and Rebai, Haithem}, title = {Acute Effects of Different Plyometric and Strength Exercises on Balance Performance in Youth Weightlifters}, series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, issn = {1866-8364}, doi = {10.25932/publishup-54310}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-543109}, pages = {11}, year = {2021}, abstract = {Background: High-intensity muscle actions have the potential to temporarily improve the performance which has been denoted as postactivation performance enhancement. Objectives: This study determined the acute effects of different stretch-shortening (fast vs. low) and strength (dynamic vs. isometric) exercises executed during one training session on subsequent balance performance in youth weightlifters. Materials and Methods: Sixteen male and female young weightlifters, aged 11.3±0.6years, performed four strength exercise conditions in randomized order, including dynamic strength (DYN; 3 sets of 3 repetitions of 10 RM) and isometric strength exercises (ISOM; 3 sets of maintaining 3s of 10 RM of back-squat), as well as fast (FSSC; 3 sets of 3 repetitions of 20-cm drop-jumps) and slow (SSSC; 3 sets of 3 hurdle jumps over a 20-cm obstacle) stretch-shortening cycle protocols. Balance performance was tested before and after each of the four exercise conditions in bipedal stance on an unstable surface (i.e., BOSU ball with flat side facing up) using two dependent variables, i.e., center of pressure surface area (CoP SA) and velocity (CoP V). Results: There was a significant effect of time on CoP SA and CoP V [F(1,60)=54.37, d=1.88, p<0.0001; F(1,60)=9.07, d=0.77, p=0.003]. In addition, a statistically significant effect of condition on CoP SA and CoP V [F(3,60)=11.81, d=1.53, p<0.0001; F(3,60)=7.36, d=1.21, p=0.0003] was observed. Statistically significant condition-by-time interactions were found for the balance parameters CoP SA (p<0.003, d=0.54) and CoP V (p<0.002, d=0.70). Specific to contrast analysis, all specified hypotheses were tested and demonstrated that FSSC yielded significantly greater improvements than all other conditions in CoP SA and CoP V [p<0.0001 (d=1.55); p=0.0004 (d=1.19), respectively]. In addition, FSSC yielded significantly greater improvements compared with the two conditions for both balance parameters [p<0.0001 (d=2.03); p<0.0001 (d=1.45)]. Conclusion: Fast stretch-shortening cycle exercises appear to be more effective to improve short-term balance performance in young weightlifters. Due to the importance of balance for overall competitive achievement in weightlifting, it is recommended that young weightlifters implement dynamic plyometric exercises in the fast stretch-shortening cycle during the warm-up to improve their balance performance.}, language = {en} } @misc{ChaabeneBehmNegraetal.2019, author = {Chaabene, Helmi and Behm, David G. and Negra, Yassine and Granacher, Urs}, title = {Acute Effects of Static Stretching on Muscle Strength and Power}, series = {Postprints der Universit{\"a}t Potsdam Humanwissenschaftliche Reihe}, journal = {Postprints der Universit{\"a}t Potsdam Humanwissenschaftliche Reihe}, number = {585}, issn = {1866-8364}, doi = {10.25932/publishup-44003}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-440036}, pages = {8}, year = {2019}, abstract = {The effects of static stretching (StS) on subsequent strength and power activities has been one of the most debated topics in sport science literature over the past decades. The aim of this review is (1) to summarize previous and current findings on the acute effects of StS on muscle strength and power performances; (2) to update readers' knowledge related to previous caveats; and (3) to discuss the underlying physiological mechanisms of short-duration StS when performed as single-mode treatment or when integrated into a full warm-up routine. Over the last two decades, StS has been considered harmful to subsequent strength and power performances. Accordingly, it has been recommended not to apply StS before strength- and power-related activities. More recent evidence suggests that when performed as a single-mode treatment or when integrated within a full warm-up routine including aerobic activity, dynamic-stretching, and sport-specific activities, short-duration StS (≤60 s per muscle group) trivially impairs subsequent strength and power activities (∆1-2\%). Yet, longer StS durations (>60 s per muscle group) appear to induce substantial and practically relevant declines in strength and power performances (∆4.0-7.5\%). Moreover, recent evidence suggests that when included in a full warm-up routine, short-duration StS may even contribute to lower the risk of sustaining musculotendinous injuries especially with high-intensity activities (e.g., sprint running and change of direction speed). It seems that during short-duration StS, neuromuscular activation and musculotendinous stiffness appear not to be affected compared with long-duration StS. Among other factors, this could be due to an elevated muscle temperature induced by a dynamic warm-up program. More specifically, elevated muscle temperature leads to increased muscle fiber conduction-velocity and improved binding of contractile proteins (actin, myosin). Therefore, our previous understanding of harmful StS effects on subsequent strength and power activities has to be updated. In fact, short-duration StS should be included as an important warm-up component before the uptake of recreational sports activities due to its potential positive effect on flexibility and musculotendinous injury prevention. However, in high-performance athletes, short-duration StS has to be applied with caution due to its negligible but still prevalent negative effects on subsequent strength and power performances, which could have an impact on performance during competition.}, language = {en} } @misc{FuehnerGranacherGolleetal.2021, author = {F{\"u}hner, Thea Heidi and Granacher, Urs and Golle, Kathleen and Kliegl, Reinhold}, title = {Age and sex effects in physical fitness components of 108,295 third graders including 515 primary schools and 9 cohorts}, series = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, issn = {1866-8364}, doi = {10.25932/publishup-54982}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-549827}, pages = {1 -- 13}, year = {2021}, abstract = {Children's physical fitness development and related moderating effects of age and sex are well documented, especially boys' and girls' divergence during puberty. The situation might be different during prepuberty. As girls mature approximately two years earlier than boys, we tested a possible convergence of performance with five tests representing four components of physical fitness in a large sample of 108,295 eight-year old third-graders. Within this single prepubertal year of life and irrespective of the test, performance increased linearly with chronological age, and boys outperformed girls to a larger extent in tests requiring muscle mass for successful performance. Tests differed in the magnitude of age effects (gains), but there was no evidence for an interaction between age and sex. Moreover, "physical fitness" of schools correlated at r = 0.48 with their age effect which might imply that "fit schools" promote larger gains; expected secular trends from 2011 to 2019 were replicated.}, language = {en} } @misc{StelzelSchauenburgRappetal.2017, author = {Stelzel, Christine and Schauenburg, Gesche and Rapp, Michael A. and Heinzel, Stephan and Granacher, Urs}, title = {Age-Related Interference between the Selection of Input-Output Modality Mappings and Postural Control}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-395733}, pages = {15}, year = {2017}, abstract = {Age-related decline in executive functions and postural control due to degenerative processes in the central nervous system have been related to increased fall-risk in old age. Many studies have shown cognitive-postural dual-task interference in old adults, but research on the role of specific executive functions in this context has just begun. In this study, we addressed the question whether postural control is impaired depending on the coordination of concurrent response-selection processes related to the compatibility of input and output modality mappings as compared to impairments related to working-memory load in the comparison of cognitive dual and single tasks. Specifically, we measured total center of pressure (CoP) displacements in healthy female participants aged 19-30 and 66-84 years while they performed different versions of a spatial one-back working memory task during semi-tandem stance on an unstable surface (i.e., balance pad) while standing on a force plate. The specific working-memory tasks comprised: (i) modality compatible single tasks (i.e., visual-manual or auditory-vocal tasks), (ii) modality compatible dual tasks (i.e., visual-manual and auditory-vocal tasks), (iii) modality incompatible single tasks (i.e., visual-vocal or auditory-manual tasks), and (iv) modality incompatible dual tasks (i.e., visual-vocal and auditory-manual tasks). In addition, participants performed the same tasks while sitting. As expected from previous research, old adults showed generally impaired performance under high working-memory load (i.e., dual vs. single one-back task). In addition, modality compatibility affected one-back performance in dual-task but not in single-task conditions with strikingly pronounced impairments in old adults. Notably, the modality incompatible dual task also resulted in a selective increase in total CoP displacements compared to the modality compatible dual task in the old but not in the young participants. These results suggest that in addition to effects of working-memory load, processes related to simultaneously overcoming special linkages between input- and output modalities interfere with postural control in old but not in young female adults. Our preliminary data provide further evidence for the involvement of cognitive control processes in postural tasks.}, language = {en} } @misc{JararnezhadgeroMamashliGranacher2021, author = {Jararnezhadgero, AmirAli and Mamashli, Elaheh and Granacher, Urs}, title = {An Endurance-Dominated Exercise Program Improves Maximum Oxygen Consumption, Ground Reaction Forces, and Muscle Activities in Patients With Moderate Diabetic Neuropathy}, series = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, journal = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe}, publisher = {Universit{\"a}tsverlag Potsdam}, address = {Potsdam}, issn = {1866-8364}, doi = {10.25932/publishup-54118}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-541182}, pages = {1 -- 15}, year = {2021}, abstract = {Background: The prevalence of diabetes worldwide is predicted to increase from 2.8\% in 2000 to 4.4\% in 2030. Diabetic neuropathy (DN) is associated with damage to nerve glial cells, their axons, and endothelial cells leading to impaired function and mobility. Objective: We aimed to examine the effects of an endurance-dominated exercise program on maximum oxygen consumption (VO2max), ground reaction forces, and muscle activities during walking in patients with moderate DN. Methods: Sixty male and female individuals aged 45-65 years with DN were randomly assigned to an intervention (IG, n = 30) or a waiting control (CON, n = 30) group. The research protocol of this study was registered with the Local Clinical Trial Organization (IRCT20200201046326N1). IG conducted an endurance-dominated exercise program including exercises on a bike ergometer and gait therapy. The progressive intervention program lasted 12 weeks with three sessions per week, each 40-55 min. CON received the same treatment as IG after the post-tests. Pre- and post-training, VO2max was tested during a graded exercise test using spiroergometry. In addition, ground reaction forces and lower limbs muscle activities were recorded while walking at a constant speed of ∼1 m/s. Results: No statistically significant baseline between group differences was observed for all analyzed variables. Significant group-by-time interactions were found for VO2max (p < 0.001; d = 1.22). The post-hoc test revealed a significant increase in IG (p < 0.001; d = 1.88) but not CON. Significant group-by-time interactions were observed for peak lateral and vertical ground reaction forces during heel contact and peak vertical ground reaction force during push-off (p = 0.001-0.037; d = 0.56-1.53). For IG, post-hoc analyses showed decreases in peak lateral (p < 0.001; d = 1.33) and vertical (p = 0.004; d = 0.55) ground reaction forces during heel contact and increases in peak vertical ground reaction force during push-off (p < 0.001; d = 0.92). In terms of muscle activity, significant group-by-time interactions were found for vastus lateralis and gluteus medius during the loading phase and for vastus medialis during the mid-stance phase, and gastrocnemius medialis during the push-off phase (p = 0.001-0.044; d = 0.54-0.81). Post-hoc tests indicated significant intervention-related increases in vastus lateralis (p = 0.001; d = 1.08) and gluteus medius (p = 0.008; d = 0.67) during the loading phase and vastus medialis activity during mid-stance (p = 0.001; d = 0.86). In addition, post-hoc tests showed decreases in gastrocnemius medialis during the push-off phase in IG only (p < 0.001; d = 1.28). Conclusions: This study demonstrated that an endurance-dominated exercise program has the potential to improve VO2max and diabetes-related abnormal gait in patients with DN. The observed decreases in peak vertical ground reaction force during the heel contact of walking could be due to increased vastus lateralis and gluteus medius activities during the loading phase. Accordingly, we recommend to implement endurance-dominated exercise programs in type 2 diabetic patients because it is feasible, safe and effective by improving aerobic capacity and gait characteristics.}, language = {en} }