TY - JOUR A1 - El-Ashker, Said A1 - Chaabene, Helmi A1 - Prieske, Olaf A1 - Abdelkafy, Ashraf A1 - Ahmed, Mohamed A. A1 - Muaidi, Qassim I. A1 - Granacher, Urs T1 - Effects of Neuromuscular Fatigue on Eccentric Strength and Electromechanical Delay of the Knee Flexors BT - The Role of Training Status JF - Frontiers in Physiology N2 - Purpose: To examine the effects of fatiguing isometric contractions on maximal eccentric strength and electromechanical delay (EMD) of the knee flexors in healthy young adults of different training status. Methods: Seventy-five male participants (27.7 ± 5.0 years) were enrolled in this study and allocated to three experimental groups according to their training status: athletes (ATH, n = 25), physically active adults (ACT, n = 25), and sedentary participants (SED, n = 25). The fatigue protocol comprised intermittent isometric knee flexions (6-s contraction, 4-s rest) at 60% of the maximum voluntary contraction until failure. Pre- and post-fatigue, maximal eccentric knee flexor strength and EMDs of the biceps femoris, semimembranosus, and semitendinosus muscles were assessed during maximal eccentric knee flexor actions at 60, 180, and 300°/s angular velocity. An analysis of covariance was computed with baseline (unfatigued) data included as a covariate. Results: Significant and large-sized main effects of group (p ≤ 0.017, 0.87 ≤ d ≤ 3.69) and/or angular velocity (p < 0.001, d = 1.81) were observed. Post hoc tests indicated that regardless of angular velocity, maximal eccentric knee flexor strength was lower and EMD was longer in SED compared with ATH and ACT (p ≤ 0.025, 0.76 ≤ d ≤ 1.82) and in ACT compared with ATH (p = ≤0.025, 0.76 ≤ d ≤ 1.82). Additionally, EMD at post-test was significantly longer at 300°/s compared with 60 and 180°/s (p < 0.001, 2.95 ≤ d ≤ 4.64) and at 180°/s compared with 60°/s (p < 0.001, d = 2.56), irrespective of training status. Conclusion: The main outcomes revealed significantly higher maximal eccentric strength and shorter eccentric EMDs of knee flexors in individuals with higher training status (i.e., athletes) following fatiguing exercises. Therefore, higher training status is associated with better neuromuscular functioning (i.e., strength, EMD) of the hamstring muscles in fatigued condition. Future longitudinal studies are needed to substantiate the clinical relevance of these findings. KW - muscle activation KW - hamstring muscles KW - latency KW - injury risk KW - physical fitness expertise Y1 - 2019 U6 - https://doi.org/10.3389/fphys.2019.00782 SN - 1664-042X VL - 10 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Saidi, Karim A1 - Ben Abderrahman, Abderraouf A1 - Boullosa, Daniel A1 - Dupont, Grégory A1 - Hackney, Anthony C. A1 - Bideau, Benoit A1 - Pavillon, Thomas A1 - Granacher, Urs A1 - Zouhal, Hassane T1 - The Interplay Between Plasma Hormonal Concentrations, Physical Fitness, Workload and Mood State Changes to Periods of Congested Match Play in Professional Soccer Players JF - Frontiers in Physiology N2 - Background: The regular assessment of hormonal and mood state parameters in professional soccer are proposed as good indicators during periods of intense training and/or competition to avoid overtraining. Objective: The aim of this study was to analyze hormonal, psychological, workload and physical fitness parameters in elite soccer players in relation to changes in training and match exposure during a congested period of match play. Methods: Sixteen elite soccer players from a team playing in the first Tunisian soccer league were evaluated three times (T1, T2, and T3) over 12 weeks. The non-congested period of match play was from T1 to T2, when the players played 6 games over 6 weeks. The congested period was from T2 to T3, when the players played 10 games over 6 weeks. From T1 to T3, players performed the Yo-Yo intermittent recovery test level 1 (YYIR1), the repeated shuttle sprint ability test (RSSA), the countermovement jump test (CMJ), and the squat jump test (SJ). Plasma Cortisol (C), Testosterone (T), and the T/C ratio were analyzed at T1, T2, and T3. Players had their mood dimensions (tension, depression, anger, vigor, fatigue, confusion, and a Total Mood Disturbance) assessed through the Profile of Mood State questionnaire (POMS). Training session rating of perceived exertion (sRPE) was also recorded on a daily basis in order to quantify internal training load and elements of monotony and strain. Results: Significant performance declines (T1 < T2 < T3) were found for SJ performance (p = 0.04, effect size [ES] ES₁₋₂ = 0.15−0.06, ES₂₋₃ = 0.24) from T1 to T3. YYIR1 performance improved significantly from T1 to T2 and declined significantly from T2 to T3 (p = 0.001, ES₁₋₂ = 0.24, ES₂₋₃ = −2.54). Mean RSSA performance was significantly higher (p = 0.019, ES₁₋₂ = −0.47, ES₂₋₃ = 1.15) in T3 compared with T2 and T1. Best RSSA performance was significantly higher in T3 when compared with T2 and T1 (p = 0.006, ES₂₋₃ = 0.47, ES₁₋₂ = −0.56), but significantly lower in T2 when compared with to T1. T and T/C were significantly lower in T3 when compared with T2 and T1 (T: p = 0.03, ES₃₋₂ = −0.51, ES₃₋₁ = −0.51, T/C: p = 0.017, ES₃₋₂ = −1.1, ES₃₋₁ = −1.07). Significant decreases were found for the vigor scores in T3 when compared to T2 and T1 (p = 0.002, ES₁₋₂ = 0.31, ES₃₋₂ = −1.25). A significant increase was found in fatigue scores in T3 as compared to T1 and T2 (p = 0.002, ES₁₋₂ = 0.43, ES₂₋₃ = 0.81). A significant increase was found from T1 < T2 < T3 intension score (p = 0.002, ES₁₋₂ = 1.1, ES₂₋₃ = 0.2) and anger score (p = 0.03, ES₁₋₂ = 0.47, ES₂₋₃ = 0.33) over the study period. Total mood disturbance increased significantly (p = 0.02, ES₁₋₂ = 0.91, ES₂₋₃ = 1.1) from T1 to T3. Between T1-T2, significant relationships were observed between workload and changes in T (r = 0.66, p = 0.003), and T/C ratio (r = 0.62, p = 0.01). There were significant relationships between performance in RSSAbest and training load parameters (workload: r = 0.52, p = 0.03; monotony: r = 0.62, p = 0.01; strain: r = 0.62, p = 0.009). Between T2-T3, there was a significant relationship between Δ% of total mood disturbance and Δ% of YYIR1 (r = −0.54; p = 0.04), RSSAbest (r = 0.58, p = 0.01), SJ (r = −0,55, p = 0.01), T (r = 0.53; p = 0.03), and T/C (r = 0.5; p = 0.04). Conclusion: An intensive period of congested match play significantly compromised elite soccer players’ physical and mental fitness. These changes were related to psychological but not hormonal parameters; even though significant alterations were detected for selected measures. Mood monitoring could be a simple and useful tool to determine the degree of preparedness for match play during a congested period in professional soccer. KW - training KW - hormones KW - overtraining KW - overreaching KW - recovery Y1 - 2020 U6 - https://doi.org/10.3389/fphys.2020.00835 SN - 1664-042X VL - 11 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Zouhal, Hassane A1 - Ben Abderrahman, Abderraouf A1 - Dupont, Gregory A1 - Truptin, Pablo A1 - Le Bris, Régis A1 - Le Postec, Erwan A1 - Sghaeir, Zouita A1 - Brughelli, Matt A1 - Granacher, Urs A1 - Bideau, Benoit T1 - Effects of Neuromuscular Training on Agility Performance in Elite Soccer Players JF - Frontiers in Physiology N2 - Background: Agility in general and change-of-direction speed (CoD) in particular represent important performance determinants in elite soccer. Objectives: The objectives of this study were to determine the effects of a 6-week neuromuscular training program on agility performance, and to determine differences in movement times between the slower and faster turning directions in elite soccer players. Materials and Methods: Twenty male elite soccer players from the Stade Rennais Football Club (Ligue 1, France) participated in this study. The players were randomly assigned to a neuromuscular training group (NTG, n = 10) or an active control (CG, n = 10) according to their playing position. NTG participated in a 6-week, twice per week neuromuscular training program that included CoD, plyometric and dynamic stability exercises. Neuromuscular training replaced the regular warm-up program. Each training session lasted 30 min. CG continued their regular training program. Training volume was similar between groups. Before and after the intervention, the two groups performed a reactive agility test that included 180° left and right body rotations followed by a 5-m linear sprint. The weak side was defined as the left/right turning direction that produced slower overall movement times (MT). Reaction time (RT) was assessed and defined as the time from the first appearance of a visual stimulus until the athlete’s first movement. MT corresponded to the time from the first movement until the athlete reached the arrival gate (5 m distance). Results: No significant between-group baseline differences were observed for RT or MT. Significant group x time interactions were found for MT (p = 0.012, effect size = 0.332, small) for the slower and faster directions (p = 0.011, effect size = 0.627, moderate). Significant pre-to post improvements in MT were observed for NTG but not CG (p = 0.011, effect size = 0.877, moderate). For NTG, post hoc analyses revealed significant MT improvements for the slower (p = 0.012, effect size = 0.897, moderate) and faster directions (p = 0.017, effect size = 0.968, moderate). Conclusion: Our results illustrate that 6 weeks of neuromuscular training with two sessions per week included in the warm-up program, significantly enhanced agility performance in elite soccer players. Moreover, improvements were found on both sides during body rotations. Thus, practitioners are advised to focus their training programs on both turning directions. KW - laterality KW - football KW - footedness KW - eyedness KW - rotation KW - team sport Y1 - 2019 U6 - https://doi.org/10.3389/fphys.2019.00947 SN - 1664-042X VL - 10 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Coppalle, Sullivan A1 - Ravé, Guillaume A1 - Moran, Jason A1 - Salhi, Iyed A1 - Ben Abderrahman, Abderraouf A1 - Zouita, Sghaeir A1 - Granacher, Urs A1 - Zouhal, Hassane T1 - Internal and External Training Load in Under-19 versus Professional Soccer Players during the In-Season Period JF - International Journal of Environmental Research and Public Health N2 - This study aimed to compare the training load of a professional under-19 soccer team (U-19) to that of an elite adult team (EAT), from the same club, during the in-season period. Thirty-nine healthy soccer players were involved (EAT [n = 20]; U-19 [n = 19]) in the study which spanned four weeks. Training load (TL) was monitored as external TL, using a global positioning system (GPS), and internal TL, using a rating of perceived exertion (RPE). TL data were recorded after each training session. During soccer matches, players’ RPEs were recorded. The internal TL was quantified daily by means of the session rating of perceived exertion (session-RPE) using Borg’s 0–10 scale. For GPS data, the selected running speed intensities (over 0.5 s time intervals) were 12–15.9 km/h; 16–19.9 km/h; 20–24.9 km/h; >25 km/h (sprint). Distances covered between 16 and 19.9 km/h, > 20 km/h and >25 km/h were significantly higher in U-19 compared to EAT over the course of the study (p = 0.023, d = 0.243, small; p = 0.016, d = 0.298, small; and p = 0.001, d = 0.564, small, respectively). EAT players performed significantly fewer sprints per week compared to U-19 players (p = 0.002, d = 0.526, small). RPE was significantly higher in U-19 compared to EAT (p = 0.001, d = 0.188, trivial). The external and internal measures of TL were significantly higher in the U-19 group compared to the EAT soccer players. In conclusion, the results obtained show that the training load is greater in U19 compared to EAT. KW - monitoring KW - global positioning system KW - elite athletes KW - academy KW - RPE Y1 - 2020 U6 - https://doi.org/10.3390/ijerph18020558 SN - 1660-4601 VL - 18 IS - 2 PB - MDPI AG CY - Basel ER - TY - JOUR A1 - Eichler, Sarah A1 - Völler, Heinz A1 - Reibis, Rona Katharina A1 - Wegscheider, Karl A1 - Butter, Christian A1 - Harnath, Axel A1 - Salzwedel, Annett T1 - Geriatric or cardiac rehabilitation? BT - Predictors of treatment pathways in advanced age patients after transcatheter aortic valve implantation JF - BMC Cardiovascular Disorders N2 - Background Aim of the study was to find predictors of allocating patients after transcatheter aortic valve implantation (TAVI) to geriatric (GR) or cardiac rehabilitation (CR) and describe this new patient group based on a differentiated characterization. Methods From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in this prospective multicentric cohort study. Before intervention, sociodemographic parameters, echocardiographic data, comorbidities, 6-min walk distance (6MWD), quality of life and frailty (score indexing activities of daily living [ADL], cognition, nutrition and mobility) were documented. Out of these, predictors for assignment to CR or GR after TAVI were identified using a multivariable regression model. Results After TAVI, 249 patients (80.7 ± 5.1 years, 59.0% female) underwent CR (n = 198) or GR (n = 51). GR patients were older, less physically active and more often had a level of care, peripheral artery disease as well as a lower left ventricular ejection fraction. The groups also varied in 6MWD. Furthermore, individual components of frailty revealed prognostic impact: higher values in instrumental ADL reduced the probability for referral to GR (OR:0.49, p <  0.001), while an impaired mobility was positively associated with referral to GR (OR:3.97, p = 0.046). Clinical parameters like stroke (OR:0.19 of GR, p = 0.038) and the EuroSCORE (OR:1.04 of GR, p = 0.026) were also predictive. Conclusion Advanced age patients after TAVI referred to CR or GR differ in several parameters and seem to be different patient groups with specific needs, e.g. regarding activities of daily living and mobility. Thus, our data prove the eligibility of both CR and GR settings. KW - TAVI KW - Treatment pathways KW - Frailty KW - Geriatric rehabilitation Y1 - 2019 U6 - https://doi.org/10.1186/s12872-020-01452-x SN - 1471-2261 VL - 20 PB - BioMed Central CY - London ER - TY - JOUR A1 - Gebel, Arnd A1 - Busch, Aglaja A1 - Stelzel, Christine A1 - Hortobágyi, Tibor A1 - Granacher, Urs T1 - Effects of Physical and Mental Fatigue on Postural Sway and Cortical Activity in Healthy Young Adults JF - Frontiers in Human Neuroscience N2 - Physical fatigue (PF) negatively affects postural control, resulting in impaired balance performance in young and older adults. Similar effects on postural control can be observed for mental fatigue (MF) mainly in older adults. Controversial results exist for young adults. There is a void in the literature on the effects of fatigue on balance and cortical activity. Therefore, this study aimed to examine the acute effects of PF and MF on postural sway and cortical activity. Fifteen healthy young adults aged 28 ± 3 years participated in this study. MF and PF protocols comprising of an all-out repeated sit-to-stand task and a computer-based attention network test, respectively, were applied in random order. Pre and post fatigue, cortical activity and postural sway (i.e., center of pressure displacements [CoPd], velocity [CoPv], and CoP variability [CV CoPd, CV CoPv]) were tested during a challenging bipedal balance board task. Absolute spectral power was calculated for theta (4–7.5 Hz), alpha-2 (10.5–12.5 Hz), beta-1 (13–18 Hz), and beta-2 (18.5–25 Hz) in frontal, central, and parietal regions of interest (ROI) and baseline-normalized. Inference statistics revealed a significant time-by-fatigue interaction for CoPd (p = 0.009, d = 0.39, Δ 9.2%) and CoPv (p = 0.009, d = 0.36, Δ 9.2%), and a significant main effect of time for CoP variability (CV CoPd: p = 0.001, d = 0.84; CV CoPv: p = 0.05, d = 0.62). Post hoc analyses showed a significant increase in CoPd (p = 0.002, d = 1.03) and CoPv (p = 0.003, d = 1.03) following PF but not MF. For cortical activity, a significant time-by-fatigue interaction was found for relative alpha-2 power in parietal (p < 0.001, d = 0.06) areas. Post hoc tests indicated larger alpha-2 power increases after PF (p < 0.001, d = 1.69, Δ 3.9%) compared to MF (p = 0.001, d = 1.03, Δ 2.5%). In addition, changes in parietal alpha-2 power and measures of postural sway did not correlate significantly, irrespective of the applied fatigue protocol. No significant changes were found for the other frequency bands, irrespective of the fatigue protocol and ROI under investigation. Thus, the applied PF protocol resulted in increased postural sway (CoPd and CoPv) and CoP variability accompanied by enhanced alpha-2 power in the parietal ROI while MF led to increased CoP variability and alpha-2 power in our sample of young adults. Potential underlying cortical mechanisms responsible for the greater increase in parietal alpha-2 power after PF were discussed but could not be clearly identified as cause. Therefore, further future research is needed to decipher alternative interpretations. KW - balance KW - cognitive/muscular fatigue KW - EEG KW - theta KW - alpha-2 Y1 - 2022 U6 - https://doi.org/10.3389/fnhum.2022.871930 SN - 1662-5161 VL - 16 SP - 1 EP - 14 PB - Frontiers Media S.A. CY - Lausanne, Schweiz ER - TY - JOUR A1 - Aloui, Ali A1 - Tayech, Amel A1 - Arbi Mejri, Mohamed A1 - Makhlouf, Issam A1 - Clark, Cain C. T. A1 - Granacher, Urs A1 - Zouhal, Hassane A1 - Ben Abderrahman, Abderraouf T1 - Reliability and Validity of a New Taekwondo-Specific Change-of-Direction Speed Test With Striking Techniques in Elite Taekwondo Athletes: A Pilot Study JF - Frontiers in Physiology N2 - The purpose of this study was to examine the test-retest reliability, and convergent and discriminative validity of a new taekwondo-specific change-of-direction (COD) speed test with striking techniques (TST) in elite taekwondo athletes. Twenty (10 males and 10 females) elite (athletes who compete at national level) and top-elite (athletes who compete at national and international level) taekwondo athletes with an average training background of 8.9 ± 1.3 years of systematic taekwondo training participated in this study. During the two-week test-retest period, various generic performance tests measuring COD speed, balance, speed, and jump performance were carried out during the first week and as a retest during the second week. Three TST trials were conducted with each athlete and the best trial was used for further analyses. The relevant performance measure derived from the TST was the time with striking penalty (TST-TSP). TST-TSP performances amounted to 10.57 ± 1.08 s for males and 11.74 ± 1.34 s for females. The reliability analysis of the TST performance was conducted after logarithmic transformation, in order to address the problem of heteroscedasticity. In both groups, the TST demonstrated a high relative test-retest reliability (intraclass correlation coefficients and 90% compatibility limits were 0.80 and 0.47 to 0.93, respectively). For absolute reliability, the TST’s typical error of measurement (TEM), 90% compatibility limits, and magnitudes were 4.6%, 3.4 to 7.7, for males, and 5.4%, 3.9 to 9.0, for females. The homogeneous sample of taekwondo athletes meant that the TST’s TEM exceeded the usual smallest important change (SIC) with 0.2 effect size in the two groups. The new test showed mostly very large correlations with linear sprint speed (r = 0.71 to 0.85) and dynamic balance (r = −0.71 and −0.74), large correlations with COD speed (r = 0.57 to 0.60) and vertical jump performance (r = −0.50 to −0.65), and moderate correlations with horizontal jump performance (r = −0.34 to −0.45) and static balance (r = −0.39 to −0.44). Top-elite athletes showed better TST performances than elite counterparts. Receiver operating characteristic analysis indicated that the TST effectively discriminated between top-elite and elite taekwondo athletes. In conclusion, the TST is a valid, and sensitive test to evaluate the COD speed with taekwondo specific skills, and reliable when considering ICC and TEM. Although the usefulness of the TST is questioned to detect small performance changes in the present population, the TST can detect moderate changes in taekwondo-specific COD speed. KW - taekwondo-specific testing KW - sport-specific performance KW - striking combat sports KW - sensitivity KW - taekwondo electronic scoring system Y1 - 2022 U6 - https://doi.org/10.3389/fphys.2022.774546 SN - 1664-042X VL - 13 SP - 1 EP - 15 PB - Frontiers CY - Lausanne, Schweiz ER - TY - JOUR A1 - Pavillon, Thomas A1 - Tourny, Claire A1 - Ben Abderrahman, Abderraouf A1 - Salhi, Iyed A1 - Zouita, Sghaeir A1 - Rouissi, Mehdi A1 - Hackney, Anthony C. A1 - Granacher, Urs A1 - Zouhal, Hassane T1 - Sprint and jump performances in highly trained young soccer players of different chronological age BT - Effects of linear VS. CHANGE–OF–DIRECTION sprint training JF - Journal of Exercise Science & Fitness N2 - Objective The aim of this study was to examine the effects of two different sprint-training regimes on sprint and jump performances according to age in elite young male soccer players over the course of one soccer season. Methods Players were randomly assigned to two training groups. Group 1 performed systematic change-of-direction sprints (CODST, U19 [n = 9], U17 [n = 9], U15 [n = 10]) while group 2 conducted systematic linear sprints (LST, U19 [n = 9], U17 [n = 9], U15 [n = 9]). Training volumes were similar between groups (40 sprints per week x 30 weeks = 1200 sprints per season). Pre and post training, all players performed tests for the assessment of linear and slalom sprint speed (5-m and 10-m), countermovement jump, and maximal aerobic speed performance. Results For all physical fitness measures, the baseline-adjusted means data (ANCOVA) across the age groups showed no significant differences between LST and CODST at post (0.061 < p < 0.995; 0.0017 < d < 1.01). The analyses of baseline-adjusted means for all physical fitness measures for U15, U17, and U19 (LST vs. CODST) revealed no significant differences between LST and CODST for U15 (0.213 < p < 0.917; 0.001 < d < 0.087), U17 (0.132 < p < 0.976; 0.001 < d < 0.310), and U19 (0.300 < p < 0.999; 0.001 < d < 0.049) at post. Conclusions The results from this study showed that both, LST and CODST induced significant changes in the sprint, lower limbs power, and aerobic performances in young elite soccer players. Since no significant differences were observed between LST and CODST, the observed changes are most likely due to training and/or maturation. Therefore, more research is needed to elucidate whether CODST, LST or a combination of both is beneficial for youth soccer athletes’ performance development. KW - Football KW - Repeated sprint KW - Performance KW - Speed Y1 - 2020 U6 - https://doi.org/10.1016/j.jesf.2020.10.003 SN - 1728-869x VL - 19 IS - 2 SP - 81 EP - 90 PB - Elsevier CY - Singapore ER - TY - JOUR A1 - Jafarnezhadgero, Amir Ali A1 - Noroozi, Raha A1 - Fakhri Mirzanag, Ehsan A1 - Granacher, Urs A1 - de Souza Castelo Oliveira, Anderson T1 - The Impact of COVID-19 and Muscle Fatigue on Cardiorespiratory Fitness and Running Kinetics in Female Recreational Runners JF - Frontiers in Physiology N2 - Background: There is evidence that fully recovered COVID-19 patients usually resume physical exercise, but do not perform at the same intensity level performed prior to infection. The aim of this study was to evaluate the impact of COVID-19 infection and recovery as well as muscle fatigue on cardiorespiratory fitness and running biomechanics in female recreational runners. Methods: Twenty-eight females were divided into a group of hospitalized and recovered COVID-19 patients (COV, n = 14, at least 14 days following recovery) and a group of healthy age-matched controls (CTR, n = 14). Ground reaction forces from stepping on a force plate while barefoot overground running at 3.3 m/s was measured before and after a fatiguing protocol. The fatigue protocol consisted of incrementally increasing running speed until reaching a score of 13 on the 6–20 Borg scale, followed by steady-state running until exhaustion. The effects of group and fatigue were assessed for steady-state running duration, steady-state running speed, ground contact time, vertical instantaneous loading rate and peak propulsion force. Results: COV runners completed only 56% of the running time achieved by the CTR (p < 0.0001), and at a 26% slower steady-state running speed (p < 0.0001). There were fatigue-related reductions in loading rate (p = 0.004) without group differences. Increased ground contact time (p = 0.002) and reduced peak propulsion force (p = 0.005) were found for COV when compared to CTR. Conclusion: Our results suggest that female runners who recovered from COVID-19 showed compromised running endurance and altered running kinetics in the form of longer stance periods and weaker propulsion forces. More research is needed in this area using larger sample sizes to confirm our study findings. KW - hospitalization KW - running mechanics KW - ground reaction forces KW - virus infection KW - COVID-19 Y1 - 2022 U6 - https://doi.org/10.3389/fphys.2022.942589 SN - 1664-042X VL - 13 SP - 1 EP - 10 PB - Frontiers CY - Lausanne, Schweiz ER - TY - JOUR A1 - Lesinski, Melanie A1 - Schmelcher, Alina A1 - Herz, Michael A1 - Puta, Christian A1 - Gabriel, Holger A1 - Arampatzis, Adamantios A1 - Laube, Gunnar A1 - Büsch, Dirk A1 - Granacher, Urs T1 - Maturation-, age-, and sex-specific anthropometric and physical fitness percentiles of German elite young athletes JF - Plos One N2 - The aim of this study was to establish maturation-, age-, and sex-specific anthropometric and physical fitness percentile reference values of young elite athletes from various sports. Anthropometric (i.e., standing and sitting body height, body mass, body mass index) and physical fitness (i.e., countermovement jump, drop jump, change-of-direction speed [i.e., T-test], trunk muscle endurance [i.e., ventral Bourban test], dynamic lower limbs balance [i.e., Y-balance test], hand grip strength) of 703 male and female elite young athletes aged 8–18 years were collected to aggregate reference values according to maturation, age, and sex. Findings indicate that body height and mass were significantly higher (p<0.001; 0.95≤d≤1.74) in more compared to less mature young athletes as well as with increasing chronological age (p<0.05; 0.66≤d≤3.13). Furthermore, male young athletes were significantly taller and heavier compared to their female counterparts (p<0.001; 0.34≤d≤0.50). In terms of physical fitness, post-pubertal athletes showed better countermovement jump, drop jump, change-of-direction, and handgrip strength performances (p<0.001; 1.57≤d≤8.72) compared to pubertal athletes. Further, countermovement jump, drop jump, change-of-direction, and handgrip strength performances increased with increasing chronological age (p<0.05; 0.29≤d≤4.13). In addition, male athletes outperformed their female counterpart in the countermovement jump, drop jump, change-of-direction, and handgrip strength (p<0.05; 0.17≤d≤0.76). Significant age by sex interactions indicate that sex-specific differences were even more pronounced with increasing age. Conclusively, body height, body mass, and physical fitness increased with increasing maturational status and chronological age. Sex-specific differences appear to be larger as youth grow older. Practitioners can use the percentile values as approximate benchmarks for talent identification and development. KW - biological maturation KW - reliability KW - validity KW - performance KW - physiology KW - maturity KW - injury KW - talent Y1 - 2020 U6 - https://doi.org/10.1371/journal.pone.0237423 SN - 1932-6203 VL - 15 IS - 8 PB - Plos One CY - San Francisco, California ER - TY - JOUR A1 - Nevill, Alan M. A1 - Negra, Yassine A1 - Myers, Tony D. A1 - Duncan, Michael J. A1 - Chaabene, Helmi A1 - Granacher, Urs T1 - Are Early or Late Maturers Likely to Be Fitter in the General Population? JF - International Journal of Environmental Research and Public Health N2 - The present study aims to identify the optimal body-size/shape and maturity characteristics associated with superior fitness test performances having controlled for body-size, sex, and chronological-age differences. The sample consisted of 597 Tunisian children (396 boys and 201 girls) aged 8 to 15 years. Three sprint speeds recorded at 10, 20 and 30 m; two vertical and two horizontal jump tests; a change-of-direction and a handgrip-strength tests, were assessed during physical-education classes. Allometric modelling was used to identify the benefit of being an early or late maturer. Findings showed that being tall and light is the ideal shape to be successful at most physical fitness tests, but the height-to-weight “shape” ratio seems to be test-dependent. Having controlled for body-size/shape, sex, and chronological age, the model identified maturity-offset as an additional predictor. Boys who go earlier/younger through peak-height-velocity (PHV) outperform those who go at a later/older age. However, most of the girls’ physical-fitness tests peaked at the age at PHV and decline thereafter. Girls whose age at PHV was near the middle of the age range would appear to have an advantage compared to early or late maturers. These findings have important implications for talent scouts and coaches wishing to recruit children into their sports/athletic clubs. KW - youth KW - fitness tests KW - allometry KW - body shape KW - biological age Y1 - 2021 U6 - https://doi.org/10.3390/ijerph18020497 SN - 1660-4601 VL - 18 IS - 2 PB - MDPI CY - Basel ER - TY - JOUR A1 - Jafarnezhadgero, Amir Ali A1 - Alavi-Mehr, Seyed Majid A1 - Granacher, Urs T1 - Effects of anti-pronation shoes on lower limb kinematics and kinetics in female runners with pronated feet BT - The role of physical fatigue JF - PLoS ONE N2 - Physical fatigue and pronated feet constitute two risk factors for running-related lower limb injuries. Accordingly, different running shoe companies designed anti-pronation shoes with medial support to limit over pronation in runners. However, there is little evidence on the effectiveness and clinical relevance of anti-pronation shoes. This study examined lower limb kinematics and kinetics in young female runners with pronated feet during running with antipronation versus regular (neutral) running shoes in unfatigued and fatigued condition. Twenty-six female runners aged 24.1±5.6 years with pronated feet volunteered to participate in this study. Kinetic (3D Kistler force plate) and kinematic analyses (Vicon motion analysis system) were conducted to record participants’ ground reaction forces and joint kinematics when running with anti-pronation compared with neutral running shoes. Physical fatigue was induced through an individualized submaximal running protocol on a motorized treadmill using rate of perceived exertion and heart rate monitoring. The statistical analyses indicated significant main effects of “footwear” for peak ankle inversion, peak ankle eversion, and peak hip internal rotation angles (p<0.03; d = 0.46–0.95). Pair-wise comparisons revealed a significantly greater peak ankle inversion angle (p<0.03; d = 0.95; 2.70°) and smaller peak eversion angle (p<0.03; d = 0.46; 2.53°) when running with anti-pronation shoes compared with neutral shoes. For kinetic data, significant main effects of “footwear” were found for peak ankle dorsiflexor moment, peak knee extensor moment, peak hip flexor moment, peak hip extensor moment, peak hip abductor moment, and peak hip internal rotator moment (p<0.02; d = 1.00–1.79). For peak positive hip power in sagittal and frontal planes and peak negative hip power in horizontal plane, we observed significant main effects of “footwear” (p<0.03; d = 0.92–1.06). Pairwise comparisons revealed that peak positive hip power in sagittal plane (p<0.03; d = 0.98; 2.39 w/kg), peak positive hip power in frontal plane (p = 0.014; d = 1.06; 0.54 w/kg), and peak negative hip power in horizontal plane (p<0.03; d = 0.92; 0.43 w/kg) were greater with anti-pronation shoes. Furthermore, the statistical analyses indicated significant main effects of “Fatigue” for peak ankle inversion, peak ankle eversion, and peak knee external rotation angles. Pair-wise comparisons revealed a fatigue-induced decrease in peak ankle inversion angle (p<0.01; d = 1.23; 2.69°) and a fatigue-induced increase in peak knee external rotation angle (p<0.05; d = 0.83; 5.40°). In addition, a fatigue-related increase was found for peak ankle eversion (p<0.01; d = 1.24; 2.67°). For kinetic data, we observed a significant main effect of “Fatigue” for knee flexor moment, knee internal rotator moment, and hip extensor moment (p<0.05; d = 0.83–1.01). The statistical analyses indicated significant a main effect of “Fatigue” for peak negative ankle power in sagittal plane (p<0.01; d = 1.25). Finally, we could not detect any significant footwear by fatigue interaction effects for all measures of joint kinetics and kinematics. Running in anti-pronation compared with neutral running shoes produced lower peak moments and powers in lower limb joints and better control in rear foot eversion. Physical fatigue increased peak moments and powers in lower limb joints irrespective of the type of footwear. KW - hip KW - running KW - feet KW - skeletal joints KW - ankles KW - knees KW - material fatigue KW - body limbs Y1 - 2019 U6 - https://doi.org/10.1371/journal.pone.0216818 SN - 1932-6203 VL - 14 IS - 5 PB - Public Library of Science CY - San Francisco ER - TY - JOUR A1 - Granacher, Urs A1 - Lacroix, Andre A1 - Roettger, Katrin A1 - Gollhofer, Albert A1 - Mühlbauer, Thomas T1 - Relationships between trunk muscle strength, spinal mobility, and balance performance in older adults JF - Journal of aging and physical activity N2 - This study investigated associations between variables of trunk muscle strength (TMS), spinal mobility, and balance in seniors. Thirty-four seniors (sex: 18 female, 16 male; age: 70 +/- 4 years; activity level: 13 +/- 7 hr/week) were tested for maximal isometric strength (MIS) of the trunk extensors, flexors, lateral flexors, rotators, spinal mobility, and steady-state, reactive, and proactive balance. Significant correlations were detected between all measures of TMS and static steady-state balance (r = .43.57, p < .05). Significant correlations were observed between specific measures of TMS and dynamic steady-state balance (r = .42.55, p < .05). No significant correlations were found between all variables of TMS and reactive/proactive balance and between all variables of spinal mobility and balance. Regression analyses revealed that TMS explains between 1-33% of total variance of the respective balance parameters. Findings indicate that TMS is related to measures of steady-state balance which may imply that TMS promoting exercises should be integrated in strength training for seniors. KW - elderly KW - core KW - gait KW - postural balance KW - force KW - physical performance Y1 - 2014 U6 - https://doi.org/10.1123/JAPA.2013-0108 SN - 1063-8652 SN - 1543-267X VL - 22 IS - 4 SP - 490 EP - 498 PB - Human Kinetics Publ. CY - Champaign ER - TY - JOUR A1 - Delfan, Maryam A1 - Juybari, Raheleh Amadeh A1 - Gorgani-Firuzjaee, Sattar A1 - Nielsen, Jens Høiriis A1 - Delfan, Neda A1 - Laher, Ismail A1 - Saeidi, Ayoub A1 - Granacher, Urs A1 - Zouhal, Hassane T1 - High-Intensity Interval Training Improves Cardiac Function by miR-206 Dependent HSP60 Induction in Diabetic Rats JF - Frontiers in Cardiovascular Medicine N2 - Objective: A role for microRNAs is implicated in several biological and pathological processes. We investigated the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on molecular markers of diabetic cardiomyopathy in rats. Methods: Eighteen male Wistar rats (260 ± 10 g; aged 8 weeks) with streptozotocin (STZ)-induced type 1 diabetes mellitus (55 mg/kg, IP) were randomly allocated to three groups: control, MICT, and HIIT. The two different training protocols were performed 5 days each week for 5 weeks. Cardiac performance (end-systolic and end-diastolic dimensions, ejection fraction), the expression of miR-206, HSP60, and markers of apoptosis (cleaved PARP and cytochrome C) were determined at the end of the exercise interventions. Results: Both exercise interventions (HIIT and MICT) decreased blood glucose levels and improved cardiac performance, with greater changes in the HIIT group (p < 0.001, η2: 0.909). While the expressions of miR-206 and apoptotic markers decreased in both training protocols (p < 0.001, η2: 0.967), HIIT caused greater reductions in apoptotic markers and produced a 20% greater reduction in miR-206 compared with the MICT protocol (p < 0.001). Furthermore, both training protocols enhanced the expression of HSP60 (p < 0.001, η2: 0.976), with a nearly 50% greater increase in the HIIT group compared with MICT. Conclusions: Our results indicate that both exercise protocols, HIIT and MICT, have the potential to reduce diabetic cardiomyopathy by modifying the expression of miR-206 and its downstream targets of apoptosis. It seems however that HIIT is even more effective than MICT to modulate these molecular markers. KW - diabetes KW - apoptosis KW - miRNAs KW - exercise KW - cardiomyopathy Y1 - 2022 U6 - https://doi.org/10.3389/fcvm.2022.927956 SN - 2297-055X VL - 9 SP - 1 EP - 11 PB - Frontiers CY - Lausanne, Schweiz ER - TY - JOUR A1 - Jafarnezhadgero, Amir Ali A1 - Shad, Morteza Madadi A1 - Majlesi, Mahdi A1 - Granacher, Urs T1 - A comparison of running kinetics in children with and without genu varus BT - A cross sectional study JF - PLoS ONE N2 - 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. Y1 - 2017 U6 - https://doi.org/10.1371/journal.pone.0185057 SN - 1932-6203 VL - 12 IS - 9 PB - PLoS CY - Lawrence, Kan. ER - TY - JOUR A1 - Zinke, Fridolin A1 - Warnke, Torsten A1 - Gäbler, Martijn A1 - Granacher, Urs T1 - Effects of Isokinetic Training on Trunk Muscle Fitness and Body Composition in World-Class Canoe Sprinters JF - Frontiers in Physiology N2 - In canoe sprint, the trunk muscles play an important role in stabilizing the body in an unstable environment (boat) and in generating forces that are transmitted through the shoulders and arms to the paddle for propulsion of the boat. Isokinetic training is well suited for sports in which propulsion is generated through water resistance due to similarities in the resistive mode. Thus, the purpose of this study was to determine the effects of isokinetic training in addition to regular sport-specific training on trunk muscular fitness and body composition in world-class canoeists and to evaluate associations between trunk muscular fitness and canoe-specific performance. Nine world-class canoeists (age: 25.6 ± 3.3 years; three females; four world champions; three Olympic gold medalists) participated in an 8-week progressive isokinetic training with a 6-week block “muscle hypertrophy” and a 2-week block “muscle power.” Pre- and post-tests included the assessment of peak isokinetic torque at different velocities in concentric (30 and 140∘s-1) and eccentric (30 and 90∘s-1) mode, trunk muscle endurance, and body composition (e.g., body fat, segmental lean mass). Additionally, peak paddle force was assessed in the flume at a water current of 3.4 m/s. Significant pre-to-post increases were found for peak torque of the trunk rotators at 30∘s-1 (p = 0.047; d = 0.4) and 140∘s-1 (p = 0.014; d = 0.7) in concentric mode. No significant pre-to-post changes were detected for eccentric trunk rotator torque, trunk muscle endurance, and body composition (p > 0.148). Significant medium-to-large correlations were observed between concentric trunk rotator torque but not trunk muscle endurance and peak paddle force, irrespective of the isokinetic movement velocity (all r ≥ 0.886; p ≤ 0.008). Isokinetic trunk rotator training is effective in improving concentric trunk rotator strength in world-class canoe sprinters. It is recommended to progressively increase angular velocity from 30∘s-1 to 140∘s-1 over the course of the training period. KW - peak torque KW - canoe racing KW - core strength KW - sport-specific performance KW - elite athletes Y1 - 2019 U6 - https://doi.org/10.3389/fphys.2019.00021 SN - 1664-042X VL - 10 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Warschburger, Petra A1 - Wortmann, Hanna Rosalie A1 - Gisch, Ulrike Alexandra A1 - Baer, Nadja-Raphaela A1 - Schenk, Liane A1 - Anton, Verena A1 - Bergmann, Manuela M. T1 - An experimental approach to training interoceptive sensitivity BT - study protocol for a pilot randomized controlled trial JF - Nutrition Journal N2 - Background Eating in absence of hunger is quite common and often associated with an increased energy intake co-existent with a poorer food choice. Intuitive eating (IE), i.e., eating in accordance with internal hunger and satiety cues, may protect from overeating. IE, however, requires accurate perception and processing of one’s own bodily signals, also referred to as interoceptive sensitivity. Training interoceptive sensitivity might therefore be an effective method to promote IE and prevent overeating. As most studies on eating behavior are conducted in younger adults and close social relationships influence health-related behavior, this study focuses on middle-aged and older couples. Methods The present pilot randomized intervention study aims at investigating the feasibility and effectiveness of a 21-day mindfulness-based training program designed to increase interoceptive sensitivity. A total of N = 60 couples participating in the NutriAct Family Study, aged 50–80 years, will be recruited. This randomized-controlled intervention study comprises three measurement points (pre-intervention, post-intervention, 4-week follow-up) and a 21-day training that consists of daily mindfulness-based guided audio exercises (e.g., body scan). A three-arm intervention study design is applied to compare two intervention groups (training together as a couple vs. training alone) with a control group (no training). Each measurement point includes the assessment of self-reported and objective indicators of interoceptive sensitivity (primary outcome), self-reported indicators of intuitive and maladaptive eating (secondary outcomes), and additional variables. A training evaluation applying focus group discussions will be conducted to assess participants’ overall acceptance of the training and its feasibility. Discussion By investigating the feasibility and effectiveness of a mindfulness-based training program to increase interoceptive sensitivity, the present study will contribute to a deeper understanding of how to promote healthy eating in older age. KW - Digital intervention KW - Older adults KW - Interoception KW - Eating behavior KW - Intuitive eating KW - Partnership KW - Mindfulness KW - Randomized-controlled trial KW - NutriAct Family Study KW - Mixed methods Y1 - 2022 U6 - https://doi.org/10.1186/s12937-022-00827-4 SN - 1475-2891 VL - 21 PB - Springer Nature CY - London ER - TY - JOUR A1 - Wortmann, Hanna Rosalie A1 - Gisch, Ulrike Alexandra A1 - Bergmann, Manuela M. A1 - Warschburger, Petra T1 - Exploring the longitudinal stability of food neophilia and dietary quality and their prospective relationship in older adults BT - a cross-lagged panel analysis JF - Nutrients N2 - Poor dietary quality is a major cause of morbidity, making the promotion of healthy eating a societal priority. Older adults are a critical target group for promoting healthy eating to enable healthy aging. One factor suggested to promote healthy eating is the willingness to try unfamiliar foods, referred to as food neophilia. This two-wave longitudinal study explored the stability of food neophilia and dietary quality and their prospective relationship over three years, analyzing self-reported data from N = 960 older adults (MT1 = 63.4, range = 50–84) participating in the NutriAct Family Study (NFS) in a cross-lagged panel design. Dietary quality was rated using the NutriAct diet score, based on the current evidence for chronic disease prevention. Food neophilia was measured using the Variety Seeking Tendency Scale. The analyses revealed high a longitudinal stability of both constructs and a small positive cross-sectional correlation between them. Food neophilia had no prospective effect on dietary quality, whereas a very small positive prospective effect of dietary quality on food neophilia was found. Our findings give initial insights into the positive relation of food neophilia and a health-promoting diet in aging and underscore the need for more in-depth research, e.g., on the constructs’ developmental trajectories and potential critical windows of opportunity for promoting food neophilia. KW - food neophilia KW - dietary quality KW - NutriAct Family Study KW - cross-lagged panel analysis KW - healthy eating Y1 - 2023 U6 - https://doi.org/10.3390/nu15051248 SN - 2072-6643 VL - 15 IS - 5 PB - MDPI CY - Basel ER - TY - JOUR A1 - Wippert, Pia-Maria A1 - Puschmann, Anne-Katrin A1 - Drießlein, David A1 - Arampatzis, Adamantios A1 - Banzer, Winfried A1 - Beck, Heidrun A1 - Schiltenwolf, Marcus A1 - Schmidt, Hendrik A1 - Schneider, Christian A1 - Mayer, Frank T1 - Development of a risk stratification and prevention index for stratified care in chronic low back pain. Focus: yellow flags (MiSpEx network) JF - Pain reports N2 - Introduction: Chronic low back pain (LBP) is a major cause of disability; early diagnosis and stratification of care remain challenges. Objectives: This article describes the development of a screening tool for the 1-year prognosis of patients with high chronic LBP risk (risk stratification index) and for treatment allocation according to treatment-modifiable yellow flag indicators (risk prevention indices, RPI-S). Methods: Screening tools were derived from a multicentre longitudinal study (n = 1071, age >18, intermittent LBP). The greatest prognostic predictors of 4 flag domains ("pain," "distress," "social-environment," "medical care-environment") were determined using least absolute shrinkage and selection operator regression analysis. Internal validity and prognosis error were evaluated after 1-year follow-up. Receiver operating characteristic curves for discrimination (area under the curve) and cutoff values were determined. Results: The risk stratification index identified persons with increased risk of chronic LBP and accurately estimated expected pain intensity and disability on the Pain Grade Questionnaire (0-100 points) up to 1 year later with an average prognosis error of 15 points. In addition, 3-risk classes were discerned with an accuracy of area under the curve = 0.74 (95% confidence interval 0.63-0.85). The RPI-S also distinguished persons with potentially modifiable prognostic indicators from 4 flag domains and stratified allocation to biopsychosocial treatments accordingly. Conclusion: The screening tools, developed in compliance with the PROGRESS and TRIPOD statements, revealed good validation and prognostic strength. These tools improve on existing screening tools because of their utility for secondary preventions, incorporation of exercise effect modifiers, exact pain estimations, and personalized allocation to multimodal treatments. KW - Back pain prognosis KW - Back pain diagnosis KW - Pain screening KW - PROGRESS/TRIPOD KW - Prediction of disability/intensity KW - Yellow flags KW - Exercise Y1 - 2017 U6 - https://doi.org/10.1097/PR9.0000000000000623 VL - 9 SP - 1 EP - 11 PB - Wolters Kluwer Health CY - Riverwoods, IL ER - TY - JOUR A1 - Schaefer, Laura A1 - Bittmann, Frank T1 - Muscular Pre-Activation Can Boost the Maximal Explosive Eccentric Adaptive Force JF - Frontiers in Physiology N2 - The improvement of power is an objective in training of athletes. In order to detect effective methods of exercise, basic research is required regarding the mechanisms of muscular activity. The purpose of this study is to investigate whether or not a muscular pre-activation prior to an external impulse-like force impact has an effect on the maximal explosive eccentric Adaptive Force (xpAFeccmax). This power capability combines different probable power enhancing mechanisms. To measure the xpAFeccmax an innovative pneumatic device was used. During measuring, the subject tries to hold an isometric position as long as possible. In the moment in which the subjects’ maximal isometric holding strength is exceeded, it merges into eccentric muscle action. This process is very close to motions in sports, where an adaptation of the neuromuscular system is required, e.g., force impacts caused by uneven surfaces during skiing. For investigating the effect of pre-activation on the xpAFeccmax of the quadriceps femoris muscle, n = 20 subjects had to pass three different pre-activation levels in a randomized order (level 1: 0.4 bar, level 2: 0.8 bar, level 3: 1.2 bar). After adjusting the standardized pre-pressure by pushing against the interface, an impulse-like load impacted on the distal tibia of the subject. During this, the xpAFeccmax was detected. The maximal voluntary isometric contraction (MVIC) was also measured. The torque values of the xpAFeccmax were compared with regard to the pre-activation levels. The results show a significant positive relation between the pre-activation of the quadriceps femoris muscle and the xpAFeccmax (male: p = 0.000, η2= 0.683; female: p = 0.000, η2= 0.907). The average percentage increase of torque amounted +28.15 ± 25.4% between MVIC and xpAFeccmax with pre-pressure level 1, +12.09 ± 7.9% for the xpAFeccmax comparing pre-pressure levels 1 vs. 2 and +2.98 ± 4.2% comparing levels 2 and 3. A higher but not maximal muscular activation prior to a fast impacting eccentric load seems to produce an immediate increase of force outcome. Different possible physiological explanatory approaches and the use as a potential training method are discussed. KW - Adaptive Force KW - neuromuscular pre-activation KW - power improvement KW - muscular activity KW - adaptation to external force impact Y1 - 2019 U6 - https://doi.org/10.3389/fphys.2019.00910 SN - 1664-042X VL - 10 PB - Frontiers Research Foundation CY - Lausanne ER -