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Institute
- Department Sport- und Gesundheitswissenschaften (149) (remove)
(1) Background: People with HIV (PWH) may perform more than one type of exercise cumulatively. The objective of this study is to investigate recreational exercise and its association with health-related quality of life (HRQOL) and comorbidities in relation to potential covariates. (2) Methods: The HIBES study (HIV-Begleiterkrankungen-Sport) is a cross-sectional study for people with HIV. The differences between non-exercisers versus exercisers (cumulated vs. single type of exercises) were investigated using regression models based on 454 participants. (3) Results: Exercisers showed a higher HRQOL score compared to non-exercisers (Wilcox r = 0.2 to 0.239). Psychological disorders were identified as the main covariate. Participants performing exercise cumulatively showed higher scores in duration, frequency, and intensity when compared to participants performing only one type of exercise. The mental health summary score was higher for the cumulated and single type of exercise if a psychological disorder existed. Duration and intensity were associated with an increase of HRQOL, whilst a stronger association between psychological disorders and exercise variables were evident. Exercise duration (minutes) showed a significant effect on QOL (standardized beta = 0.1) and for participants with psychological disorders (standardized beta = 0.3), respectively. (4) Conclusions: Psychological disorders and other covariates have a prominent effect on HRQOL and its association with exercise. For PWH with a psychological disorder, a stronger relationship between HRQOL with exercise duration and intensity emerged. However, differentiation of high-HRQOL individuals warrants further investigation by considering additional factors.
Food Neophilie
(2023)
Trotz der eindeutigen Vorteile einer ausgewogenen Ernährung halten sich viele Menschen weltweit nicht an entsprechende Ernährungsrichtlinien. Um angemessene Strategien zur Unterstützung einer gesundheitsfördernden Ernährung zu entwickeln, ist ein Verständnis der zugrunde liegenden Faktoren unerlässlich. Insbesondere die Gruppe der älteren Erwachsenen stellt dabei eine wichtige Zielgruppe für ernährungsbezogene Präventions- und Interventionsansätze dar. Einer der vielen Faktoren, die als Determinanten einer gesundheitsfördernden Ernährung diskutiert werden, ist die Food Neophilie, also die Bereitschaft, neue und unbekannte Lebensmittel auszuprobieren. Aktuelle Forschungsergebnisse legen nahe, dass die Food Neophilie positiv mit einer gesundheitsfördernden Ernährung in Verbindung steht, allerdings ist die bisherige Forschung in diesem Bereich äußerst begrenzt. Das Ziel der Dissertation war es, das Konstrukt der Food Neophilie sowie seine Beziehung zu gesundheitsförderndem Ernährungsverhalten im höheren Erwachsenenalter grundlegend zu erforschen, um das Potenzial der Food Neophilie für die Gesundheitsförderung älterer Erwachsener besser zu verstehen. Dabei wurde im Rahmen der ersten Publikation zunächst untersucht, wie sich das Konstrukt der Food Neophilie reliabel und valide erfassen lässt, um weiterführende Untersuchungen der Food Neophilie zu ermöglichen. Die psychometrische Validierung der deutschen Version der Variety Seeking Tendency Scale (VARSEEK) basierte auf zwei unabhängigen Stichproben mit insgesamt N = 1000 Teilnehmenden und bestätigte, dass es sich bei der Skala um ein reliables und valides Messinstrument zur Erfassung der Food Neophilie handelt. Darauf aufbauend wurde im Rahmen der zweiten Publikation die Beziehung der Food Neophilie und der Ernährungsqualität über die Zeit hinweg analysiert. Die prospektive Untersuchung von N = 960 Teilnehmenden des höheren Erwachsenenalters (M = 63.4 Jahre) anhand einer Cross-Lagged-Panel-Analyse ergab hohe zeitliche Stabilitäten der Food Neophilie und der Ernährungsqualität über einen Zeitraum von drei Jahren. Es zeigte sich zudem ein positiver querschnittlicher Zusammenhang zwischen der Food Neophilie und der Ernährungsqualität, jedoch wurde die Food Neophilie nicht als signifikante Determinante der Ernährungsqualität über die Zeit hinweg identifiziert. In der dritten Publikation wurden schließlich nicht nur die individuellen Auswirkungen der Food Neophilie auf die Ernährungsqualität betrachtet, sondern auch potenzielle dynamische Wechselwirkungen innerhalb von Partnerschaften einbezogen. Hierzu erfolgte mittels eines Actor-Partner-Interdependence-Modells eine Differenzierung potenzieller intra- und interpersoneller Einflüsse der Food Neophilie auf die Ernährungsqualität. Im Rahmen der dyadischen Analyse zeigte sich bei N = 390 heterosexuellen Paaren im höheren Erwachsenenalter (M = 64.0 Jahre) ein Dominanzmuster: Während die Food Neophilie der Frauen positiv mit ihrer eigenen Ernährungsqualität und der ihrer Partner zusammenhing, war die Food Neophilie der Männer nicht mit der Ernährungsqualität des Paares assoziiert. Insgesamt leistet die vorliegende Dissertation einen wertvollen Beitrag zum umfassenden Verständnis der Food Neophilie sowie ihrer Rolle im Kontext der Ernährungsgesundheit älterer Erwachsener. Trotz fehlender Vorhersagekraft über die Zeit hinweg deutet der positive Zusammenhang zwischen Food Neophilie und Ernährungsqualität darauf hin, dass die Fokussierung auf eine positive und neugierige Einstellung gegenüber Lebensmitteln eine innovative Perspektive für Präventions- und Interventionsansätze zur Unterstützung einer gesundheitsfördernden Ernährung älterer Erwachsener bieten könnte.
Background:
Deception can distort psychological tests on socially sensitive topics. Understanding the cerebral
processes that are involved in such faking can be useful in detection and prevention of deception. Previous research
shows that faking a brief implicit association test (BIAT ) evokes a characteristic ERP response. It is not yet known
whether temporarily available self-control resources moderate this response. We randomly assigned 22 participants
(15 females, 24.23
±
2.91
years old) to a counterbalanced repeated-measurements design. Participants first com-
pleted a Brief-IAT (BIAT ) on doping attitudes as a baseline measure and were then instructed to fake a negative dop
-
ing attitude both when self-control resources were depleted and non-depleted. Cerebral activity during BIAT perfor
-
mance was assessed using high-density EEG.
Results:
Compared to the baseline BIAT, event-related potentials showed a first interaction at the parietal P1,
while significant post hoc differences were found only at the later occurring late positive potential. Here, signifi-
cantly decreased amplitudes were recorded for ‘normal’ faking, but not in the depletion condition. In source space,
enhanced activity was found for ‘normal’ faking in the bilateral temporoparietal junction. Behaviorally, participants
were successful in faking the BIAT successfully in both conditions.
Conclusions:
Results indicate that temporarily available self-control resources do not affect overt faking success on
a BIAT. However, differences were found on an electrophysiological level. This indicates that while on a phenotypical
level self-control resources play a negligible role in deliberate test faking the underlying cerebral processes are markedly different.
Background: Healthy university students have been shown to use psychoactive substances, expecting them to be functional means for enhancing their cognitive capacity, sometimes over and above an essentially proficient level. This behavior called Neuroenhancement (NE) has not yet been integrated into a behavioral theory that is able to predict performance. Job Demands Resources (JD-R) Theory for example assumes that strain (e.g. burnout) will occur and influence performance when job demands are high and job resources are limited at the same time. The aim of this study is to investigate whether or not university students’ self-reported NE can be integrated into JD-R Theory’s comprehensive approach to psychological health and performance.
Methods: 1,007 students (23.56 ± 3.83 years old, 637 female) participated in an online survey. Lifestyle drug, prescription drug, and illicit substance NE together with the complete set of JD-R variables (demands, burnout, resources, motivation, and performance) were measured. Path models were used in order to test our data’s fit to hypothesized main effects and interactions.
Results: JD-R Theory could successfully be applied to describe the situation of university students. NE was mainly associated with the JD-R Theory’s health impairment process: Lifestyle drug NE (p < .05) as well as prescription drug NE (p < .001) is associated with higher burnout scores, and lifestyle drug NE aggravates the study demands-burnout interaction. In addition, prescription drug NE mitigates the protective influence of resources on burnout and on motivation.
Conclusion: According to our results, the uninformed trying of NE (i.e., without medical supervision) might result in strain. Increased strain is related to decreased performance. From a public health perspective, intervention strategies should address these costs of non-supervised NE. With regard to future research we propose to model NE as a means to reach an end (i.e. performance enhancement) rather than a target behavior itself. This is necessary to provide a deeper understanding of the behavioral roots and consequences of the phenomenon.
Background: The use of psychoactive substances to neuroenhance cognitive performance is prevalent. Neuroenhancement (NE) in everyday life and doping in sport might rest on similar attitudinal representations, and both behaviors can be theoretically modeled by comparable means-to-end relations (substance-performance). A behavioral (not substance-based) definition of NE is proposed, with assumed functionality as its core component. It is empirically tested whether different NE variants (lifestyle drug, prescription drug, and illicit substance) can be regressed to school stressors.
Findings: Participants were 519 students (25.8 +/- 8.4 years old, 73.1% female). Logistic regressions indicate that a modified doping attitude scale can predict all three NE variants. Multiple NE substance abuse was frequent. Overwhelming demands in school were associated with lifestyle and prescription drug NE.
Conclusions: Researchers should be sensitive for probable structural similarities between enhancement in everyday life and sport and systematically explore where findings from one domain can be adapted for the other. Policy makers should be aware that students might misperceive NE as an acceptable means of coping with stress in school, and help to form societal sensitivity for the topic of NE among our younger ones in general.
Background: Neuroenhancement (NE), the use of psychoactive substances in order to enhance a healthy individual's cognitive functioning from a proficient to an even higher level, is prevalent in student populations. According to the strength model of self-control, people fail to self-regulate and fall back on their dominant behavioral response when finite self-control resources are depleted. An experiment was conducted to test the hypothesis that ego-depletion will prevent students who are unfamiliar with NE from trying it.
Findings: 130 undergraduates, who denied having tried NE before (43% female, mean age = 22.76 +/- 4.15 years old), were randomly assigned to either an ego-depletion or a control condition. The dependent variable was taking an "energy-stick" (a legal nutritional supplement, containing low doses of caffeine, taurine and vitamin B), offered as a potential means of enhancing performance on the bogus concentration task that followed. Logistic regression analysis showed that ego-depleted participants were three times less likely to take the substance, OR = 0.37, p = .01.
Conclusion: This experiment found that trying NE for the first time was more likely if an individual's cognitive capacities were not depleted. This means that mental exhaustion is not predictive for NE in students for whom NE is not the dominant response. Trying NE for the first time is therefore more likely to occur as a thoughtful attempt at self-regulation than as an automatic behavioral response in stressful situations. We therefore recommend targeting interventions at this inter-individual difference. Students without previous reinforcing NE experience should be provided with information about the possible negative health outcomes of NE. Reconfiguring structural aspects in the academic environment (e.g. lessening workloads) might help to deter current users.
Quantified Self, die pro-aktive Selbstvermessung von Menschen, hat sich in den letzten Jahren von einer Nischenanwendung zu einem Massenphänomen entwickelt. Dabei stehen den Nutzern heute vielfältige technische Unterstützungsmöglichkeiten, beispielsweise in Form von Smartphones, Fitness-Trackern oder Gesundheitsapps zur Verfügung, welche eine annähernd lückenlose Überwachung unterschiedlicher Kontextfaktoren einer individuellen Lebenswirklichkeit erlauben.
In der Folge widmet sich diese Arbeit unter anderem der Fragestellung, inwieweit diese intensive und eigen-initiierte Beschäftigung, insbesondere mit gesundheitsbezogenen Daten, die weitgehend als objektiviert und damit belastbar gelten, die Gesundheitskompetenz derart aktiver Menschen erhöhen kann. Darüber hinaus werden Aspekte untersucht, inwieweit die neuen Technologien in der Lage sind, spezifische medizinische Erkenntnisse zu vertiefen und in der Konsequenz die daraus resultierenden Behandlungsprozesse zu verändern.
Während der Ursprung des Quantified Self im 2. Gesundheitsmarkt liegt, geht die vorliegende Arbeit der Frage nach, welche strukturellen, personellen und prozessualen Anknüpfungspunkte perspektivisch im 1. Gesundheitsmarkt existieren werden, wenn ein potentieller Patient in einer stärker emanzipierten Weise den Wunsch verspürt, oder eine entsprechende Forderung stellt, seine gesammelten Gesundheitsdaten in möglichst umfassender Form in eine medizinische Behandlung zu integrieren.
Dabei werden auf der einen Seite aktuelle Entwicklungen im 2. Gesundheitsmarkt untersucht, die gekennzeichnet sind von einer hohen Dynamik und einer großen Intransparenz. Auf der anderen Seite steht der als stark reguliert und wenig digitalisiert geltende 1. Gesundheitsmarkt mit seinen langen Entwicklungszyklen und ausgeprägten Partikularinteressen der verschiedenen Stakeholder.
In diesem Zuge werden aktuelle Entwicklungen des zugrunde liegenden Rechtsrahmens, speziell im Hinblick auf stärker patientenzentrierte und digitalisierte Normen untersucht, wobei insbesondere das Digitale Versorgung Gesetz eine wichtige Rolle einnimmt.
Ziel der Arbeit ist die stärkere Durchdringung von Wechselwirkungen an der Schnittstelle zwischen den beiden Gesundheitsmärkten in Bezug auf die Verwendung von Technologien der Selbstvermessung, um in der Folge zukünftige Geschäftspotentiale für existierende oder neu in den Markt drängende Dienstleister zu eruieren.
Als zentrale Methodik kommt hier eine Delphi-Studie zum Einsatz, die in einem interprofessionellen Ansatz versucht, ein Zukunftsbild dieser derzeit noch sehr jungen Entwicklungen für das Jahr 2030 aufzuzeigen. Eingebettet werden die Ergebnisse in die Untersuchung einer allgemeinen gesellschaftlichen Akzeptanz der skizzierten Veränderungen.
Background: The back pain screening tool Risk-Prevention-Index Social (RPI-S) identifies the individual psychosocial risk for low back pain chronification and supports the allocation of patients at risk in additional multidisciplinary treatments. The study objectives were to evaluate (1) the prognostic validity of the RPI-S for a 6-month time frame and (2) the clinical benefit of the RPI-S.
Methods: In a multicenter single-blind 3-armed randomized controlled trial, n = 660 persons (age 18–65 years) were randomly assigned to a twelve-week uni- or multidisciplinary exercise intervention or control group. Psychosocial risk was assessed by the RPI-S domain social environment (RPI-SSE) and the outcome pain by the Chronic Pain Grade Questionnaire (baseline M1, 12-weeks M4, 24-weeks M5). Prognostic validity was quantified by the root mean squared error (RMSE) within the control group. The clinical benefit of RPI-SSE was calculated by repeated measures ANOVA in intervention groups.
Results: A subsample of n = 274 participants (mean = 38.0 years, SD 13.1) was analyzed, of which 30% were classified at risk in their psychosocial profile. The half-year prognostic validity was good (RMSE for disability of 9.04 at M4 and of 9.73 at M5; RMSE for pain intensity of 12.45 at M4 and of 14.49 at M5). People at risk showed significantly stronger reduction in pain disability and intensity at M4/M5, if participating in a multidisciplinary exercise treatment. Subjects at no risk showed a smaller reduction in pain disability in both interventions and no group differences for pain intensity. Regarding disability due to pain, around 41% of the sample would gain an unfitted treatment without the back pain screening.
Conclusion: The RPI-SSE prognostic validity demonstrated good applicability and a clinical benefit confirmed by a clear advantage of an individualized treatment possibility.
Background Low back pain (LBP) is a common pain syndrome in athletes, responsible for 28% of missed training days/year. Psychosocial factors contribute to chronic pain development. This study aims to investigate the transferability of psychosocial screening tools developed in the general population to athletes and to define athlete-specific thresholds.
Methods Data from a prospective multicentre study on LBP were collected at baseline and 1-year follow-up (n=52 athletes, n=289 recreational athletes and n=246 non-athletes). Pain was assessed using the Chronic Pain Grade questionnaire. The psychosocial Risk Stratification Index (RSI) was used to obtain prognostic information regarding the risk of chronic LBP (CLBP). Individual psychosocial risk profile was gained with the Risk Prevention Index – Social (RPI-S). Differences between groups were calculated using general linear models and planned contrasts. Discrimination thresholds for athletes were defined with receiver operating characteristics (ROC) curves.
Results Athletes and recreational athletes showed significantly lower psychosocial risk profiles and prognostic risk for CLBP than non-athletes. ROC curves suggested discrimination thresholds for athletes were different compared with non-athletes. Both screenings demonstrated very good sensitivity (RSI=100%; RPI-S: 75%–100%) and specificity (RSI: 76%–93%; RPI-S: 71%–93%). RSI revealed two risk classes for pain intensity (area under the curve (AUC) 0.92(95% CI 0.85 to 1.0)) and pain disability (AUC 0.88(95% CI 0.71 to 1.0)).
Conclusions Both screening tools can be used for athletes. Athlete-specific thresholds will improve physicians’ decision making and allow stratified treatment and prevention.
Stress and pain
(2022)
Introduction: Low back pain (LBP) leads to considerable impairment of quality of life worldwide and is often accompanied by psychosomatic symptoms.
Objectives: First, to assess the association between stress and chronic low back pain (CLBP) and its simultaneous appearance with fatigue and depression as a symptom triad. Second, to identify the most predictive stress-related pattern set for CLBP for a 1-year diagnosis.
Methods: In a 1-year observational study with four measurement points, a total of 140 volunteers (aged 18–45 years with intermittent pain) were recruited. The primary outcomes were pain [characteristic pain intensity (CPI), subjective pain disability (DISS)], fatigue, and depressive mood. Stress was assessed as chronic stress, perceived stress, effort reward imbalance, life events, and physiological markers [allostatic load index (ALI), hair cortisol concentration (HCC)]. Multiple linear regression models and selection procedures for model shrinkage and variable selection (least absolute shrinkage and selection operator) were applied. Prediction accuracy was calculated by root mean squared error (RMSE) and receiver-operating characteristic curves.
Results: There were 110 participants completed the baseline assessments (28.2 7.5 years, 38.1% female), including HCC, and a further of 46 participants agreed to ALI laboratory measurements. Different stress types were associated with LBP, CLBP, fatigue, and depressive mood and its joint occurrence as a symptom triad at baseline; mainly social-related stress types were of relevance. Work-related stress, such as “excessive demands at work”[b = 0.51 (95%CI -0.23, 1.25), p = 0.18] played a role for upcoming chronic pain disability. “Social overload” [b = 0.45 (95%CI -0.06, 0.96), p = 0.080] and “over-commitment at work” [b = 0.28 (95%CI -0.39, 0.95), p = 0.42] were associated with an upcoming depressive mood within 1-year. Finally, seven psychometric (CPI: RMSE = 12.63; DISS: RMSE = 9.81) and five biomarkers (CPI: RMSE = 12.21; DISS: RMSE = 8.94) could be derived as the most predictive pattern set for a 1-year prediction of CLBP. The biomarker set showed an apparent area under the curve of 0.88 for CPI and 0.99 for DISS.
Conclusion: Stress disrupts allostasis and favors the development of chronic pain, fatigue, and depression and the emergence of a “hypocortisolemic symptom triad,” whereby the social-related stressors play a significant role. For translational medicine, a predictive pattern set could be derived which enables to diagnose the individuals at higher risk for the upcoming pain disorders and can be used in practice.
Since 1998, elite athletes’ sport injuries have been monitored in single sport event, which leads to the development of first comprehensive injury surveillance system in multi-sport Olympic Games in 2008. However, injury and illness occurred in training phases have not been systematically studied due to its multi-facets, potentially interactive risk related factors. The present thesis aim to address issues of feasibility of establishing a validated measure for injury/illness, training environment and psychosocial risk factors by creating the evaluation tool namely risk of injury questionnaire (Risk-IQ) for elite athletes, which based on IOC consensus statement 2009 recommended content of preparticipation evaluation(PPE) and periodic health exam (PHE).
A total of 335 top level athletes and a total of 88 medical care providers from Germany and Taiwan participated in tow “cross-sectional plus longitudinal” Risk-IQ and MCPQ surveys respectively. Four categories of injury/illness related risk factors questions were asked in Risk-IQ for athletes while injury risk and psychological related questions were asked in MCPQ for MCP cohorts. Answers were quantified scales wise/subscales wise before analyzed with other factors/scales. In addition, adapted variables such as sport format were introduced for difference task of analysis.
Validated with 2-wyas translation and test-retest reliabilities, the Risk-IQ was proved to be in good standard which were further confirmed by analyzed results from official surveys in both Germany and Taiwan. The result of Risk-IQ revealed that elite athletes’ accumulated total injuries, in general, were multi-factor dependent; influencing factors including but not limited to background experiences, medical history, PHE and PPE medical resources as well as stress from life events. Injuries of different body parts were sport format and location specific. Additionally, medical support of PPE and PHE indicated significant difference between German and Taiwan.
The result of the present thesis confirmed that it is feasible to construct a comprehensive evalua-tion instrument for heterogeneous elite athletes cohorts’ risk factor analysis for injury/illness oc-curred during their non-competition periods. In average and with many moderators involved, Ger-man elite athletes have superior medical care support yet suffered more severe injuries than Tai-wanese counterparts. Opinions of injury related psychological issues reflected differently on vari-ous MCP groups irrespective of different nationalities. In general, influencing factors and interac-tions existed among relevant factors in both studies which implied further investigation with multiple regression analysis is needed for better understanding.
Background: The worldwide prevalence of diabetes has been increasing in recent years, with a projected prevalence of 700 million patients by 2045, leading to economic burdens on societies. Type 2 diabetes mellitus (T2DM), representing more than 95% of all diabetes cases, is a multifactorial metabolic disorder characterized by insulin resistance leading to an imbalance between insulin requirements and supply. Overweight and obesity are the main risk factors for developing type 2 diabetes mellitus. The lifestyle modification of following a healthy diet and physical activity are the primary successful treatment and prevention methods for type 2 diabetes mellitus. Problems may exist with patients not achieving recommended levels of physical activity. Electrical muscle stimulation (EMS) is an increasingly popular training method and has become in the focus of research in recent years. It involves the external application of an electric field to muscles, which can lead to muscle contraction. Positive effects of EMS training have been found in healthy individuals as well as in various patient groups. New EMS devices offer a wide range of mobile applications for whole-body electrical muscle stimulation (WB-EMS) training, e.g., the intensification of dynamic low-intensity endurance exercises through WB-EMS. This dissertation project aims to investigate whether WB-EMS is suitable for intensifying low-intensive dynamic exercises such as walking and Nordic walking.
Methods: Two independent studies were conducted. The first study aimed to investigate the reliability of exercise parameters during the 10-meter Incremental Shuttle Walk Test (10MISWT) using superimposed WB-EMS (research question 1, sub-question a) and the difference in exercise intensity compared to conventional walking (CON-W, research question 1, sub-question b). The second study aimed to compare differences in exercise parameters between superimposed WB-EMS (WB-EMS-W) and conventional walking (CON-W), as well as between superimposed WB-EMS (WB-EMS-NW) and conventional Nordic walking (CON-NW) on a treadmill (research question 2). Both studies took place in participant groups of healthy, moderately active men aged 35-70 years. During all measurements, the Easy Motion Skin® WB-EMS low frequency stimulation device with adjustable intensities for eight muscle groups was used. The current intensity was individually adjusted for each participant at each trial to ensure safety, avoiding pain and muscle cramps. In study 1, thirteen individuals were included for each sub question. A randomized cross-over design with three measurement appointments used was to avoid confounding factors such as delayed onset muscle soreness. The 10MISWT was performed until the participants no longer met the criteria of the test and recording five outcome measures: peak oxygen uptake (VO2peak), relative VO2peak (rel.VO2peak), maximum walk distance (MWD), blood lactate concentration, and the rate of perceived exertion (RPE).
Eleven participants were included in study 2. A randomized cross-over design in a study with four measurement appointments was used to avoid confounding factors. A treadmill test protocol at constant velocity (6.5 m/s) was developed to compare exercise intensities. Oxygen uptake (VO2), relative VO2 (rel.VO2) blood lactate, and the RPE were used as outcome variables. Test-retest reliability between measurements was determined using a compilation of absolute and relative measures of reliability. Outcome measures in study 2 were studied using multifactorial analyses of variances.
Results: Reliability analysis showed good reliability for VO2peak, rel.VO2peak, MWD and RPE with no statistically significant difference for WB-EMS-W during 10WISWT. However, differences compared to conventional walking in outcome variables were not found. The analysis of the treadmill tests showed significant effects for the factors CON/WB-EMS and W/NW for the outcome variables VO2, rel.VO2 and lactate, with both factors leading to higher results. However, the difference in VO2 and relative VO2 is within the range of biological variability of ± 12%. The factor combination EMS∗W/NW is statistically non-significant for all three variables. WB-EMS resulted in the higher RPE values, RPE differences for W/NW and EMS∗W/NW were not significant.
Discussion: The present project found good reliability for measuring VO2peak, rel. VO2peak, MWD and RPE during 10MISWT during WB-EMS-W, confirming prior research of the test. The test appears technically limited rather than physiologically in healthy, moderately active men. However, it is unsuitable for investigating differences in exercise intensities using WB-EMS-W compared to CON-W due to different perceptions of current intensity between exercise and rest. A treadmill test with constant walking speed was conducted to adjust individual maximum tolerable current intensity for the second part of the project. The treadmill test showed a significant increase in metabolic demands during WB-EMS-W and WB-EMS-NW by an increased VO2 and blood lactate concentration. However, the clinical relevance of these findings remains debatable. The study also found that WB-EMS superimposed exercises are perceived as more strenuous than conventional exercise. While in parts comparable studies lead to higher results for VO2, our results are in line with those of other studies using the same frequency. Due to the minor clinical relevance the use of WB-EMS as exercise intensification tool during walking and Nordic walking is limited. High device cost should be considered. Habituation to WB-EMS could increase current intensity tolerance and VO2 and make it a meaningful method in the treatment of T2DM. Recent figures show that WB-EMS is used in obese people to achieve health and weight goals. The supposed benefit should be further investigated scientifically.
Objective:
Depression and coronary heart disease (CHD) are highly comorbid conditions. Brain-derived neurotrophic factor (BDNF) plays an important role in cardiovascular processes. Depressed patients typically show decreased BDNF concentrations. We analysed the relationship between BDNF and depression in a sample of patients with CHD and additionally distinguished between cognitive-affective and somatic depression symptoms. We also investigated whether BDNF was associated with somatic comorbidity burden, acute coronary syndrome (ACS) or congestive heart failure (CHF).
Methods:
The following variables were assessed for 225 hospitalised patients with CHD: BDNF concentrations, depression [Patient Health Questionnaire-9 (PHQ-9)], somatic comorbidity (Charlson Comorbidity Index), CHF, ACS, platelet count, smoking status and antidepressant treatment.
Results:
Regression models revealed that BDNF was not associated with severity of depression. Although depressed patients (PHQ-9 score >7) had significantly lower BDNF concentrations compared to non-depressed patients (p = 0.04), this was not statistically significant after controlling for confounders (p = 0.15). Cognitive-affective symptoms and somatic comorbidity burden each closely missed a statistically significant association with BDNF concentrations (p = 0.08, p = 0.06, respectively). BDNF was reduced in patients with CHF (p = 0.02). There was no covariate-adjusted, significant association between BDNF and ACS.
Conclusion:
Serum BDNF concentrations are associated with cardiovascular dysfunction. Somatic comorbidities should be considered when investigating the relationship between depression and BDNF.
Exercise or not?
(2023)
Objective: Individuals’ decisions to engage in exercise are often the result of in-the-moment choices between exercise and a competing behavioral alternative. The purpose of this study was to investigate processes that occur in-the-moment (i.e., situated processes) when individuals are faced with the choice between exercise and a behavioral alternative during a computerized task. These were analyzed against the background of interindividual differences in individuals’ automatic valuation and controlled evaluation of exercise.
Method: In a behavioral alternatives task 101 participants were asked whether they would rather choose an exercise option or a behavioral alternative in 25 trials. Participants’ gaze behavior (first gaze and fixations) was recorded using eye-tracking. An exercise-specific affect misattribution procedure (AMP) was used to assess participants’ automatic valuation of exercise before the task. After the task, self-reported feelings towards exercise (controlled evaluation) and usual weekly exercise volume were assessed. Mixed effects models with random effects for subjects and trials were used for data analysis.
Results: Choosing exercise was positively correlated with individuals’ automatic valuation (r = 0.20, p = 0.05), controlled evaluation (r = 0.58, p < 0.001), and their weekly exercise volume (r = 0.43, p < 0.001). Participants showed no bias in their initial gaze or number of fixations towards the exercise or the non-exercise alternative. However, participants were 1.30 times more likely to fixate on the chosen alternative first and more frequently, but this gaze behavior was not related to individuals’ automatic valuation, controlled evaluation, or weekly exercise volume.
Conclusion: The results suggest that situated processes arising from defined behavioral alternatives may be independent of individuals’ general preferences. Despite one’s best general intention to exercise more, the choice of a non-exercise alternative behavior may seem more appealing in-the-moment and eventually be chosen. New psychological theories of health behavior change should therefore better consider the role of potentially conflicting alternatives when it comes to initiating physical activity or exercise.
The field of exercise psychology has established robust evidence on the health benefits of physical activity. However, interventions to promote sustained exercise behavior have often proven ineffective. This dissertation addresses challenges in the field, particularly the neglect of situated and affective processes in understanding and changing exercise behavior. Dual process models, considering both rational and affective processes, have gained recognition. The Affective Reflective Theory of Physical Inactivity and Exercise (ART) is a notable model in this context, positing that situated processes in-the-moment of choice influence exercise decisions and subsequent exercise behavior.
The dissertation identifies current challenges within exercise psychology and proposes methodological and theoretical advancements. It emphasizes the importance of momentary affective states and situated processes, offering alternatives to self-reported measures and advocating for a more comprehensive modeling of individual variability. The focus is on the affective processes during exercise, theorized to reappear in momentary decision-making, shaping overall exercise behavior.
The first publication introduces a new method by using automated facial action analysis to measure variable affective responses during exercise. It explores how these behavioral indicators covary with self-reported measures of affective valence and perceived exertion. The second publication delves into situated processes at the moment of choice between exercise and non-exercise options, revealing that intraindividual factors play a crucial role in explaining exercise-related choices. The third publication presents an open-source research tool, the Decisional Preferences in Exercising Test (DPEX), designed to capture repeated situated decisions and predict exercise behavior based on past experiences.
The findings challenge previous assumptions and provide insights into the complex interplay of affective responses, situated processes, and exercise choices. The dissertation underscores the need for individualized interventions that manipulate affective responses during exercise and calls for systematic testing to establish causal links to automatic affective processes and subsequent exercise behavior. This dissertation highlights the necessity for methodological and conceptual refinements in understanding and promoting exercise behavior, ultimately contributing to the broader goal of combating increasing inactivity trends.
Throughout the years 2020 and 2021, schools were temporarily closed to slow the spread of SarsCoV-2. For some periods, children were locked out of sports in schools (physical education lessons, school sports working groups) and organized sports in sports clubs which often resulted in physical inactivity. Did these restrictions affect children’s physical fitness? The EMOTIKON project (www.uni-potsdam.de/emotikon) annually assesses the physical fitness (cardiorespiratory endurance [6-minute-run test], coordination [star-run test], speed [20-m sprint test], lower [standing long jump test] and upper [ball push test] limbs muscle power, and balance [one-legged stance test]) of all third graders in the Federal State of Brandenburg, Germany. Participation is mandatory for all public primary schools. In the falls from 2016 to 2021, 83,476 keyage children (i.e., school enrollment according to the legal key date, between eight and nine years in third grade) from 512 schools were assessed with the EMOTIKON test battery. We tested the Covid pandemic effect on a composite score of the four highly correlated physical fitness tests assessing cardiorespiratory endurance, coordination, speed and powerLOW and on another composite score of the three running tests (cardiorespiratory endurance, coordination, speed), as well as separately on all six physical fitness components. Secular trends for each of the physical fitness components and differences between schools and children were taken into account in linear mixed models. We found a negative Covid pandemic effect on the two composite physical fitness scores, as well as on cardiorespiratory endurance, coordination, and speed. We found a positive Covid pandemic effect on powerLOW. Coordination was associated with the largest negative Covid pandemic effect, also passing the threshold of smallest meaningful change (SMC, i.e., 0.2 Cohen’s d) when accumulated across two years. Given the educational context, Covid pandemic effects were also compared relative to the expected age-related development of the physical fitness components between eight and nine years. The Covid pandemic-related developmental costs/gains ranged from three to seven months relative to a longitudinal age effect, and from five to 17 months relative to a cross-sectional age effect. We propose that a longitudinal assessment yields a more reliable estimate of the developmental (age-related) gain than a cross-sectional one. Therefore, we consider the smaller Covid pandemic-related developmental costs/gains to be more credible. Interestingly, on the school level, „fitter” schools (relatively higher Grand Mean) exhibited larger negative Covid pandemic effects than schools with a lower physical fitness score. Negative Covid pandemic effects for the three run tasks were also found by Bähr et al. (2022), who tested the physical fitness of 16,496 Thuringian third-graders from 292 schools with the same six physical fitness tests used in EMOTIKON. Our results may be used to prioritize health-related interventions.
Objective: The aim of the present study was to examine the effect of Cold Water Immersion (CWI) on the recovery of physical performance, hematological stress markers and perceived wellness (i.e., Hooper scores) following a simulated Mixed Martial Arts (MMA) competition.
Methods: Participants completed two experimental sessions in a counter-balanced order (CWI or passive recovery for control condition: CON), after a simulated MMAs competition (3 x 5-min MMA rounds separated by 1-min of passive rest). During CWI, athletes were required to submerge their bodies, except the trunk, neck and head, in the seated position in a temperature-controlled bath (similar to 10 degrees C) for 15-min. During CON, athletes were required to be in a seated position for 15-min in same room ambient temperature. Venous blood samples (creatine kinase, cortisol, and testosterone concentrations) were collected at rest (PRE-EX, i.e., before MMAs), immediately following MMAs (POST-EX), immediately following recovery (POST-R) and 24 h post MMAs (POST-24), whilst physical fitness (squat jump, countermovement-jump and 5- and 10-m sprints) and perceptual measures (well-being Hooper index: fatigue, stress, delayed onset muscle soreness (DOMS), and sleep) were collected at PRE-EX, POST-R and POST-24, and at PRE-EX and POST-24, respectively.
Results: The main results indicate that POST-R sprint (5- and 10-m) performances were 'likely to very likely' (d = 0.64 and 0.65) impaired by prior CWI. However, moderate improvements were in 10-m sprint performance were 'likely' evident at POST-24 after CWI compared with CON (d = 0.53). Additionally, the use of CWI 'almost certainly' resulted in a large overall improvement in Hooper scores (d = 1.93). Specifically, CWI 'almost certainly' resulted in improved sleep quality (d = 1.36), stress (d = 1.56) and perceived fatigue (d = 1.51), and 'likely' resulted in a moderate decrease in DOMS (d = 0.60).
Conclusion: The use of CWI resulted in an enhanced recovery of 10-m sprint performance, as well as improved perceived wellness 24-h following simulated MMA competition.
Professionelle GT Langstreckenmotorsportler (Rennfahrer) müssen den hohen motorischen und kognitiven Ansprüchen ohne Verlust der Performance während eines Rennens endgegenwirken können. Sie müssen stets, bei hoher Geschwindigkeit fokussiert und konzentriert auf ihr Auto, die Rennstrecke und ihre Gegner reagieren können. Darüber hinaus sind Rennfahrer zusätzlich durch die notwendige Kommunikation im Auto mit den Ingenieuren und Mechanikern in der Boxengasse gefordert. Daten über die tatsächliche Beanspruchung und häufig auftretende Beschwerden und/oder Verletzung von Profiathleten liegen kaum vor. Für eine möglichst gute Performance im Auto während eines Rennens ist es notwendige neben der körperlichen Beanspruchung auch die häufigen Krankheitsbilder zu kennen. Auf Basis dessen kann eine optimale Prävention oder notwendige Therapie zur möglichst schnellen Reintegration in den Sport abgeleitet und entwickelt werden. Die vorliegende Arbeit befasst sich durch ein regelmäßiges Gesundheitsmonitoring mit der Erfassung häufiger Beschwerden und oder Verletzungen im GT Langestreckenmotorsport zur Ableitung eines präventiven (trainingstherapeutischen) und therapeutischen Konzeptes. Darüber hinaus, soll über die Einschätzung der körperlichen Leistungsfähigkeit der Athleten, auf Basis der Beanspruchung im Rennfahrzeug ein mögliches Trainingskonzept in Abhängigkeit der Saison entwickelt werden.
Insgesamt wurden über 15 Jahre (2003-2017) 37 männliche Athleten aus dem GT Langstreckenmotorsport 353mal im Rahmen eines Gesundheitsmonitorings untersucht. Dabei wurden Athleten maximal 14 Jahre und mindestens 1 Jahr sportmedizinische betreut. Diese 2x im Jahr stattfindende Untersuchung beinhaltete im Wesentlichen eine sportmedizinische Untersuchung zur Einschätzung der Tauglichkeit für den Sport und die Erfassung der körperlichen Leistungsfähigkeit. Über das Gesundheitsmonitoring hinaus erfolgte die Betreuung zusätzlich an der Rennstrecke zur weiteren Erfassung der Beschwerden, Erkrankungen und Verletzungen der Athleten während ihrer sportartspezifischen Belastung. Zusammengefasst zeigen die Athleten geringe Prävalenzen und Inzidenzen der Krankheitsbilder bzw. Beschwerden. Ein Unterschied der Prävalenzen zeigt sich zwischen den Gesundheitsuntersuchungen und der Betreuung an der Rennstrecke. Die häufigsten Beschwerdebilder zeigen sich aus Orthopädie und Innerer Medizin. So sind Infekte der oberen Atemwege sowie Allergien neben Beschwerden der unteren Extremität und der Wirbelsäule am häufigsten. Demzufolge werden vorrangig physio- und trainingstherapeutische Konsequenzen abgeleitet. Eine medikamentöse Therapie erfolgt im Wesentlichen während der Rennbetreuung. Zur Reduktion der orthopädischen und internistischen Beschwerden sollten präventive Maßnahmen mehr betont werden. Die körperliche Leistungsfähigkeit zeigt im Wesentlichen über die Untersuchungsjahre eine stabile Performance für die Ausdauer-, Kraft und sensomotorische Leistungsfähigkeit. Die Ausdauerleistungsfähigkeit kann in Abhängigkeit der Sportartspezifik mit einer guten bis sehr guten Ausprägung definiert werden. Die Kraftleistungsfähigkeit und die sensomotorische Leistungsfähigkeit lassen sportartspezifische Unterschiede zu und sollte körpergewichtsbezogen betrachtet werden.
Ein sportmedizinisches und trainingstherapeutisches Konzept müsste demnach eine regelmäßige ärztlich-medizinische Untersuchung mit dem Fokus der Orthopädie, Inneren Medizin und Hals- Nasen-Ohren-Kunde beinhalten. Darüber hinaus sollte eine regelmäßige Erfassung der körperlichen Leistungsfähigkeit zur möglichst effektiven Ableitung von Trainingsinhalten oder Präventionsmaßnahmen berücksichtig werden. Auf Grundlage der hohen Reisetätigkeit und der ganzjährigen Saison könnte ein 1-2x jährlich stattfindendes Trainingslager, im Sinne eines Grundlagen- und Aufbautrainings zur Optimierung der Leistungsfähigkeit beitragen, das Konzept komplementieren. Zudem scheint eine ärztliche Rennbetreuung notwendig.
Aim The aim of the present study was to examine young female volleyballers’ body build, physical abilities, technical skills and psychophysiological properties in relation to their performance at competitions. The sample consisted of 46 female volleyballers aged 13-16 years. 49 basic anthropometric measurements were measured and 65 proportions and body composition characteristics were calculated. 9 physical ability tests, 9 volleyball technical skills tests and 21 psychophysiological tests were carried out. The game performance was recorded by the computer program Game. The program enabled to fix the performance of technical elements in case of each player. The computer program Game calculated the index of proficiency in case of each girl for each element. The first control group consisted of 74 female volleyballers aged 13–15 years with whom reduced anthropometry was provided and 28 games were recorded. The second control group consisted of 586 ordinary schoolgirls aged 13–16 years with whom full anthropometry was provided. Results In order to systematize all anthropometric characteristics, we first studied the essence of the anthropometric structure of the body as a whole. It turned out to be a characteristic system where all variables are in significant correlation between one another and where the leading characteristics are height and weight. Therefore we based the classification on the mean height and weight of the whole sample. We formed a 5 class SD classification. There are three classes of concordance between height and weight: small height – small weight, medium height – medium height, big height – big weight. The other two classes were classes of disconcordance between height and weight- pycnomorphs and leptomorphs. We managed to show that gradual increase in height and weight brought about statistically significant increase in length, breadth and depth measurements, circumferences, bone thicknesses and skinfolds. There were also systematic changes in indeces and body composition characteristics. Pycnomorphs and leptomorphs also showed differences specific to their body types in body measurements and body composition. The results of all tests were submitted to basic statistical analysis and all correlations were found between all the tests (volleyball technical skills, psychophysiological abilities, physical abilities), and all basic anthropometric variables (n = 49) and all proportions and body composition characteristics (n = 65). All anthropometric measurements and test results were correlated with the index of proficiency for all elements of the game. The best linear regression models were calculated for predicting proficiency in different elements of the game. We can see that body build and all kind of tests took part in predicting the proficiency of the game. The most essential for performing attack, block and feint were anthropometric and psychophysiological models. The studied complex of body build characteristics and tests results determine the players’ proficiency at competitions, are an important tool for testing the player’s individual development, enable to choose volleyballers from among schoolgirls and represent the whole body constitutional model of a young female volleyballer. Outlook Our outlook for the future is to continue recording of all Estonian championship games with the computer program Game, to continue the players’ anthropometric measuring and psychophysiological testing at competitions and to compile a national register for assessment of development of individual players and teams.
Kultur gibt den Menschen eine Orientierung. Sie machen darin ganz spezifische Erfahrungen. Hieraus entwickeln sich auch motivationale Orientierungen. Dadurch werden andere Erfahrungen gemacht, die Sportler können andere Motivation und Volition entwickeln. Dabei sind mehr kollektivistische Kulturen eher vermeidungs-motiviert und mehr individualistische Kulturen mehr erfolgsorientiert. Beim Kollektivismus erscheint die Leistungsmotivation eher unter einem sozialen Aspekt, nämlich die Auseinandersetzung mit einem Gütemaßstab, der eher von außen vorgegeben wird und weniger einem ausschließlich eigenen Maßstab. Ägypten erweist sich im Vergleich zu Deutschland als eine eher kollektivistisch geprägte Kultur. Daraus ergeben sich folgende Unterschiede: Einen signifikanten Unterschied zwischen deutschen und ägyptischen Ringern gibt es in der Wettkampforientierung und bei der Sieg- bzw. Gewinn-Orientierung. Die ägyptischen Ringer habe eine höhere Ausprägung als die Deutschen. Sie weisen auch eine etwas höhere Zielorientierung auf als die Deutschen. Entgegen den Erwartungen zeigte sich, dass es keine signifikanten Unterschiede zwischen den ägyptischen und deutschen Ringern gibt in der Variable: Sieg- bzw. Gewinn-Orientierung. Die Furcht vor Misserfolg sowie auch die Hoffnung auf Erfolg liegen höher bei den Ägyptern als bei den Deutschen. Bezogen auf die Modi der Handlungskontrolle verfügen die Deutschen Ringer über eine höher Ausprägung auf allen drei Komponenten. Sie haben eine höhere Handlungsorientierung nach Misserfolg, eine höhere Handlungsplanung sowie eine höhere Handlungstätigkeitsausführung. Diese kulturell kontrastive Studie über die psychologischen Aspekte, im Bereich der Leistungsmotivation und der Handlungskontrolle, kann für die Sportart Ringen sehr nützlich werden, da sie sehr wichtig ist beim Erkennen der sportlichen Überlegenheits- und Schwächemerkmale. Sie wiederspiegelt auch die Hochstimmung in den entwickelten Staaten oder die Misere in den anderen Staaten. Aus den interkulturellen Unterschieden in der Motivation und Volition können somit verschiedene Maßnahmen zu sportpsychologischen Interventionen entwickelt werden. Es sollte unbedingt darauf wert gelegt werden, dass die kulturell bedingten Unterschiede im Trainingsalltag beachtet werden, bei Teams, die aus Personen aus unterschiedlichen Kulturkreisen stammen.
Models employed in exercise psychology highlight the role of reflective processes for explaining behavior change. However, as discussed in social cognition literature, information-processing models also consider automatic processes (dual-process models). To examine the relevance of automatic processing in exercise psychology, we used a priming task to assess the automatic evaluations of exercise stimuli in physically active sport and exercise majors (n = 32), physically active nonsport majors (n = 31), and inactive students (n = 31). Results showed that physically active students responded faster to positive words after exercise primes, whereas inactive students responded more rapidly to negative words. Priming task reaction times were successfully used to predict reported amounts of exercise in an ordinal regression model. Findings were obtained only with experiential items reflecting negative and positive consequences of exercise. The results illustrate the potential importance of dual-process models in exercise psychology.
Die vorliegende Untersuchung analysierte den direkten Zusammenhang eines berufsbezogenen Angebots Sozialer Gruppenarbeit mit dem Ergebnis beruflicher Wiedereingliederung bei Rehabilitandinnen und Rehabilitanden in besonderen beruflichen Problemlagen. Sie wurde von der Deutschen Rentenversicherung Bund als Forschungsprojekt vom 01.01.2013 bis 31.12. 2015 gefördert und an der Professur für Rehabilitationswissenschaften der Universität Potsdam realisiert.
Die Forschungsfrage lautete: Kann eine intensive sozialarbeiterische Gruppenintervention im Rahmen der stationären medizinischen Rehabilitation soweit auf die Stärkung sozialer Kompetenzen und die Soziale Unterstützung von Rehabilitandinnen und Rehabilitanden einwirken, dass sich dadurch langfristige Verbesserungen hinsichtlich der beruflichen Wiedereingliederung im Vergleich zur konventionellen Behandlung ergeben?
Die Studie gliederte sich in eine qualitative und eine quantitative Erhebung mit einer zwischenliegenden Intervention. Eingeschlossen waren 352 Patientinnen und Patienten im Alter zwischen 18 und 65 Jahren mit kardiovaskulären Diagnosen, deren Krankheitsbilder häufig von komplexen Problemlagen begleitet sind, verbunden mit einer schlechten sozialmedizinischen Prognose.
Die Evaluation der Gruppenintervention erfolgte in einem clusterrandomisierten kontrollierten Studiendesign, um einen empirischen Nachweis darüber zu erbringen, inwieweit die Intervention gegenüber der regulären sozialarbeiterischen Behandlung höhere Effekte erzielen kann. Die Interventionsgruppen nahmen am Gruppenprogramm teil, die Kontrollgruppen erhielten die reguläre sozialarbeiterische Behandlung.
Im Ergebnis konnte mit dieser Stichprobe kein Nachweis zur Verbesserung der beruflichen Wiedereingliederung, der gesundheitsbezogenen Arbeitsfähigkeit, der Lebensqualität sowie der Sozialen Unterstützung durch die Teilnahme am sozialarbeiterischen Gruppenprogramm erbracht werden. Die Return-To-Work-Rate betrug 43,7 %, ein Viertel der Untersuchungsgruppe befand sich nach einem Jahr in Arbeitslosigkeit. Die durchgeführte Gruppenintervention ist dem konventionellen Setting Sozialer Arbeit als gleichwertig anzusehen.
Schlussfolgernd wurde auf eine sozialarbeiterische Unterstützung der beruflichen Wiedereingliederung über einen längeren Zeitraum nach einer kardiovaskulären Erkrankung verwiesen, insbesondere durch wohnortnahe Angebote zu einem späteren Zeitpunkt bei stabilerer Gesundheit. Aus den Erhebungen ließen sich mögliche Erfolge bei engerer Kooperation zwischen dem Fachbereich der Sozialen Arbeit und der Psychologie ableiten. Ebenfalls gab es Hinweise auf die einflussreiche Rolle der Angehörigen, die durch Einbindung in die Soziale Beratung unterstützend auf den Wiedereingliederungsprozess wirken könnten. Die Passgenauigkeit der untersuchten sozialarbeiterischen Gruppeninterventionen ist durch eine gezielte Soziale Diagnostik zu verbessern.
Background
The metabolic syndrome (MetS) is a risk cluster for a number of secondary diseases. The implementation of prevention programs requires early detection of individuals at risk. However, access to health care providers is limited in structurally weak regions. Brandenburg, a rural federal state in Germany, has an especially high MetS prevalence and disease burden. This study aims to validate and test the feasibility of a setup for mobile diagnostics of MetS and its secondary diseases, to evaluate the MetS prevalence and its association with moderating factors in Brandenburg and to identify new ways of early prevention, while establishing a “Mobile Brandenburg Cohort” to reveal new causes and risk factors for MetS.
Methods
In a pilot study, setups for mobile diagnostics of MetS and secondary diseases will be developed and validated. A van will be equipped as an examination room using point-of-care blood analyzers and by mobilizing standard methods. In study part A, these mobile diagnostic units will be placed at different locations in Brandenburg to locally recruit 5000 participants aged 40-70 years. They will be examined for MetS and advice on nutrition and physical activity will be provided. Questionnaires will be used to evaluate sociodemographics, stress perception, and physical activity. In study part B, participants with MetS, but without known secondary diseases, will receive a detailed mobile medical examination, including MetS diagnostics, medical history, clinical examinations, and instrumental diagnostics for internal, cardiovascular, musculoskeletal, and cognitive disorders. Participants will receive advice on nutrition and an exercise program will be demonstrated on site. People unable to participate in these mobile examinations will be interviewed by telephone. If necessary, participants will be referred to general practitioners for further diagnosis.
Discussion
The mobile diagnostics approach enables early detection of individuals at risk, and their targeted referral to local health care providers. Evaluation of the MetS prevalence, its relation to risk-increasing factors, and the “Mobile Brandenburg Cohort” create a unique database for further longitudinal studies on the implementation of home-based prevention programs to reduce mortality, especially in rural regions.
Trial registration
German Clinical Trials Register, DRKS00022764; registered 07 October 2020—retrospectively registered.
Die wachsenden Kosten für die Behandlung chronischer lumbaler Rückenschmerzen stehen zunehmend in Diskrepanz mit den begrenzten Mitteln für das Gesundheitswesen. Untersuchungen zeigen, dass aktive Trainingsprogramme, je früher sie eingesetzt werden, einen positiven Einfluss auf die Senkung von Kosten für die Gesellschaft haben. Ein rechtzeitiger Einsatz der medizinischen Kräftigungstherapie bei Rückenschmerzpatienten ist somit unter rehabilitativen Gesichtspunkten notwendig. Insbesondere das Training im Wasser gestattet gelenkschonende Übungen in frühen Phasen der Rehabilitation und lassen eine raschere Wiederherstellung erwarten. Über die körperlichen Auswirkungen therapeutischer Trainingsmaßnahmen im Wasser sind bis dato wenige Studien verfügbar, welche die Wirkung des Mediums Wasser auf konditionelle Parameter objektiv quantifizieren und bewerten. Jedoch sind bislang die Möglichkeiten für ein gezieltes Krafttraining im Wasser begrenzt. Eine gerätetechnische Entwicklung, die ein rumpfstabilisierendes Krafttraining im Warmwasser ermöglicht, lässt im Vergleich zu herkömmlichen Trainingsmöglichkeiten eine noch effizientere rehabilitative Behandlung erwarten. Es wird die Fragestellung verfolgt, inwieweit aktive Trainingsformen im Wasser die Maximalkraft und die neuromuskuläre Funktion der Rumpfmuskulatur, sowie den Schmerz von Rückenpatienten beeinflussen. Ferner soll im Rahmen der Untersuchungen die Effektivität eines neu entwickelten Wassertrainingsgerätes geprüft werden. Die Untersuchungen der Ergebnisse von 80 weiblichen Probanden (in fünf Gruppen aufgeteilt: Kontrollgruppe, Aquajogging, Aquarücken, Aquagerät und Rückengymnastik an Land) zeigen, dass durch aktive Interventionsmaßnahmen eine Verbesserung der Kraftfähigkeit und eine Reduzierung von Schmerzen erzielt werden kann. Hingegen kommt es in der Kontrollgruppe, ohne Trainingsanwendungen, zur Stagnation des chronischen Schmerzzustandes, sogar zur Verschlechterung der Kraftentwicklung der Rückenstreckmuskulatur. In allen Trainingsgruppen konnten kurzfristig und mittelfristig weniger Muskelfunktionsstörungen nachgewiesen werden. Bei Betrachtung der Kraftentwicklung der unteren Rumpfmuskulatur fällt auf, dass die höchsten Zuwächse der Bauchmuskelkraft in den Gruppen Aquarücken und Aquagerät festzustellen sind. Die Kraft der Rückenstreckermuskulatur entwickelte sich in der Gruppe Aquagerät mit einer Steigerung von 55% nach der Intervention am stärksten. Es kann die Hypothese aufgestellt werden, dass das Training im warmen Wasser unter stabilisierten Voraussetzungen eine effizientere Methode zur Stärkung der unteren Rumpfmuskulatur zu sein scheint. Bei der Entwicklung der Kraft der oberen Rücken- und Schultergürtelmuskulatur kommt es in den Gruppen Aquajogging und Aquarücken zu den größten Steigerungen. Dies könnte mit der höheren Aktivität der Arme im Übungsprogramm zusammenhängen. Positiv ist die hohe Reduzierung der Schmerzen in allen Trainingsgruppen zu bewerten. Jedoch ist bei Betrachtung der Ergebnisse festzustellen, dass für eine weitere Manifestierung der Trainingserfolge ein weiterführendes Training bedeutsam ist. Die Ergebnisse dieser Studie belegen, dass durch ein gezieltes Training im Wasser und an Land über 6 Wochen, je zweimal pro Woche, deutliche Verbesserungen in der Entwicklung von Kraft, Schmerzintensität, Funktionseinschränkung und Muskelfunktion möglich sind. Ferner werden in dieser Arbeit positive Zusammenhänge zwischen den Entwicklungen Schmerzintensität und Rückenstreckerkraft, sowie Schmerzintensität und Bauchmuskelkraft beobachtet. Zwischen den Versuchsgruppen im Wasser und der Versuchsgruppe an Land konnten nur geringe Unterschiede in den Ergebnissen nachgewiesen werden. Jedoch geben die Resultate Hinweis darauf, dass bei höheren Schmerzintensitäten die Intervention im Wasser die Therapie der Wahl zu sein scheint. Die Resultate dieser Untersuchungen machen deutlich, dass der Einsatz eines Wassertrainingsgerätes in der Therapie chronischer Rückenschmerzpatienten eine effiziente Methode zur Senkung von Schmerzen und zur Steigerung der Kraft der Rücken- und Bauchmuskulatur ist. Vorteile des Wassertraingsgerätes sind die gute Stabilisation des Beckens, trotz auftriebswirksamer Mechanismen im Wasser, die bedienerfreundliche Handhabung, der separat einstellbare Widerstand, die schnellen Therapieerfolge und die hohe Motivation der Kursteilnehmer. Diese Beobachtungen lassen eine effizientere Therapie und damit Kostenersparnisse vermuten. Nachteile sind das hohe Gewicht des Wassertraingsgerätes und die relativ hohen Anschaffungskosten. Die hohe Reduzierung der Schmerzintensität bei den Probanden, die am Wassertrainingsgerät Interventionen durchführten, lassen vermuten, dass diese Geräteanwendungen für Patienten mit sehr schmerzhaften oder subakuten Verlaufsformen besonders geeignet ist. Der schonende Charakter der Aquatherapie und der Einsatz eines neuen Wassertrainingsgerätes unterstützt in effektiver Weise die modernen Konzepte der Rehabilitation chronischer Rückenschmerzpatienten.
The general purpose of this systematic review was to summarize, structure and evaluate the findings on automatic evaluations of exercising. Studies were eligible for inclusion if they reported measuring automatic evaluations of exercising with an implicit measure and assessed some kind of exercise variable. Fourteen nonexperimental and six experimental studies (out of a total N = 1,928) were identified and rated by two independent reviewers. The main study characteristics were extracted and the grade of evidence for each study evaluated. First, results revealed a large heterogeneity in the applied measures to assess automatic evaluations of exercising and the exercise variables. Generally, small to large-sized significant relations between automatic evaluations of exercising and exercise variables were identified in the vast majority of studies. The review offers a systematization of the various examined exercise variables and prompts to differentiate more carefully between actually observed exercise behavior (proximal exercise indicator) and associated physiological or psychological variables (distal exercise indicator). Second, a lack of transparent reported reflections on the differing theoretical basis leading to the use of specific implicit measures was observed. Implicit measures should be applied purposefully, taking into consideration the individual advantages or disadvantages of the measures. Third, 12 studies were rated as providing first-grade evidence (lowest grade of evidence), five represent second-grade and three were rated as third-grade evidence. There is a dramatic lack of experimental studies, which are essential for illustrating the cause-effect relation between automatic evaluations of exercising and exercise and investigating under which conditions automatic evaluations of exercising influence behavior. Conclusions about the necessity of exercise interventions targeted at the alteration of automatic evaluations of exercising should therefore not be drawn too hastily.
The mechanical muscular oscillations are rarely the objective of investigations regarding the identification of a biomarker for Parkinson’s disease (PD). Therefore, the aim of this study was to investigate whether or not this specific motor output differs between PD patients and controls. The novelty is that patients without tremor are investigated performing a unilateral isometric motor task. The force of armflexors and the forearm acceleration (ACC) were recorded as well as the mechanomyography of the biceps brachii (MMGbi), brachioradialis (MMGbra) and pectoralis major (MMGpect) muscles using a piezoelectric-sensor-based system during a unilateral motor task at 70% of the MVIC. The frequency, a power-frequency-ratio, the amplitude variation, the slope of amplitudes and their interlimb asymmetries were analysed. The results indicate that the oscillatory behavior of muscular output in PD without tremor deviates from controls in some parameters: Significant differences appeared for the power-frequency-ratio (p = 0.001, r = 0.43) and for the amplitude variation (p = 0.003, r = 0.34) of MMGpect. The interlimb asymmetries differed significantly concerning the power-frequency-ratio of MMGbi (p = 0.013, r = 0.42) and MMGbra (p = 0.048, r = 0.39) as well as regarding the mean frequency (p = 0.004, r = 0.48) and amplitude variation of MMGpect (p = 0.033, r = 0.37). The mean (M) and variation coefficient (CV) of slope of ACC differed significantly (M: p = 0.022, r = 0.33; CV: p = 0.004, r = 0.43). All other parameters showed no significant differences between PD and controls. It remains open, if this altered mechanical muscular output is reproducible and specific for PD.
The link between emotions and motor function has been known for decades but is still not clarified. The Adaptive Force (AF) describes the neuromuscular capability to adapt to increasing forces and was suggested to be especially vulnerable to interfering inputs. This study investigated the influence of pleasant an unpleasant food imagery on the manually assessed AF of elbow and hip flexors objectified by a handheld device in 12 healthy women. The maximal isometric AF was significantly reduced during unpleasant vs. pleasant imagery and baseline (p < 0.001, dz = 0.98–1.61). During unpleasant imagery, muscle lengthening started at 59.00 ± 22.50% of maximal AF, in contrast to baseline and pleasant imagery, during which the isometric position could be maintained mostly during the entire force increase up to ~97.90 ± 5.00% of maximal AF. Healthy participants showed an immediately impaired holding function triggered by unpleasant imagery, presumably related to negative emotions. Hence, AF seems to be suitable to test instantaneously the effect of emotions on motor function. Since musculoskeletal complaints can result from muscular instability, the findings provide insights into the understanding of the causal chain of linked musculoskeletal pain and mental stress. A case example (current stress vs. positive imagery) suggests that the approach presented in this study might have future implications for psychomotor diagnostics and therapeutics.
The Adaptive Force (AF) reflects the neuromuscular capacity to adapt to external loads during holding muscle actions and is similar to motions in real life and sports. The maximal isometric AF (AFisomax) was considered to be the most relevant parameter and was assumed to have major importance regarding injury mechanisms and the development of musculoskeletal pain. The aim of this study was to investigate the behavior of different torque parameters over the course of 30 repeated maximal AF trials. In addition, maximal holding vs. maximal pushing isometric muscle actions were compared. A side consideration was the behavior of torques in the course of repeated AF actions when comparing strength and endurance athletes. The elbow flexors of n = 12 males (six strength/six endurance athletes, non-professionals) were measured 30 times (120 s rest) using a pneumatic device. Maximal voluntary isometric contraction (MVIC) was measured pre and post. MVIC, AFisomax, and AFmax (maximal torque of one AF measurement) were evaluated regarding different considerations and statistical tests. AFmax and AFisomax declined in the course of 30 trials [slope regression (mean ± standard deviation): AFmax = −0.323 ± 0.263; AFisomax = −0.45 ± 0.45]. The decline from start to end amounted to −12.8% ± 8.3% (p < 0.001) for AFmax and −25.41% ± 26.40% (p < 0.001) for AFisomax. AF parameters declined more in strength vs. endurance athletes. Thereby, strength athletes showed a rather stable decline for AFmax and a plateau formation for AFisomax after 15 trials. In contrast, endurance athletes reduced their AFmax, especially after the first five trials, and remained on a rather similar level for AFisomax. The maximum of AFisomax of all 30 trials amounted 67.67% ± 13.60% of MVIC (p < 0.001, n = 12), supporting the hypothesis of two types of isometric muscle action (holding vs. pushing). The findings provided the first data on the behavior of torque parameters after repeated isometric–eccentric actions and revealed further insights into neuromuscular control strategies. Additionally, they highlight the importance of investigating AF parameters in athletes based on the different behaviors compared to MVIC. This is assumed to be especially relevant regarding injury mechanisms.
The mechanotendography (MTG) is a method for analyzing the mechanical oscillations of tendons during muscular actions. The aim of this investigation was to evaluate the technical reliability of a piezo-based measurement system used for MTG. The reliability measurements were performed by using audio samples played by a subwoofer. The thereby generated pressure waves were recorded by a piezo-based measurement system. An audio of 40 Hz sine oscillations and four different formerly in vivo recorded MTG-signals were converted into audio files and were used as test signals. Five trials with each audio were performed and one audio was used for repetition trials on another day. The signals’ correlation was estimated by Spearman (MCC) and intraclass correlation coefficients (ICC(3,1)), Cronbach’s alpha (CA) and by mean distances (MD). All parameters were compared between repetition and randomized matched signals. The repetition trials show high correlations (MCC: 0.86 ± 0.13, ICC: 0.89 ± 0.12, CA: 0.98 ± 0.03), low MD (0.03 ± 0.03V) and differ significantly from the randomized matched signals (MCC: 0.15 ± 0.10, ICC: 0.17 ± 0.09, CA: 0.37 ± 0.16, MD: 0.19 ± 0.01V) (p = 0.001 – 0.043). This speaks for an excellent reliability of the measurement system. Presuming the skin above superficial tendons oscillates adequately, we estimate this tool as valid for the application in musculoskeletal system.
Long COVID patients show symptoms, such as fatigue, muscle weakness and pain. Adequate diagnostics are still lacking. Investigating muscle function might be a beneficial approach. The holding capacity (maximal isometric Adaptive Force; AFisomax) was previously suggested to be especially sensitive for impairments. This longitudinal, non-clinical study aimed to investigate the AF in long COVID patients and their recovery process. AF parameters of elbow and hip flexors were assessed in 17 patients at three time points (pre: long COVID state, post: immediately after first treatment, end: recovery) by an objectified manual muscle test. The tester applied an increasing force on the limb of the patient, who had to resist isometrically for as long as possible. The intensity of 13 common symptoms were queried. At pre, patients started to lengthen their muscles at ~50% of the maximal AF (AFmax), which was then reached during eccentric motion, indicating unstable adaptation. At post and end, AFisomax increased significantly to ~99% and 100% of AFmax, respectively, reflecting stable adaptation. AFmax was statistically similar for all three time points. Symptom intensity decreased significantly from pre to end. The findings revealed a substantially impaired maximal holding capacity in long COVID patients, which returned to normal function with substantial health improvement. AFisomax might be a suitable sensitive functional parameter to assess long COVID patients and to support therapy process
In sports and movement sciences isometric muscle function is usually measured by pushing against a stable resistance. However, subjectively one can hold or push isometrically. Several investigations suggest a distinction of those forms. The aim of this study was to investigate whether these two forms of isometric muscle action can be distinguished by objective parameters in an interpersonal setting. 20 subjects were grouped in 10 same sex pairs, in which one partner should perform the pushing isometric muscle action (PIMA) and the other partner executed the holding isometric muscle action (HIMA). The partners had contact at the distal forearms via an interface, which included a strain gauge and an acceleration sensor. The mechanical oscillations of the triceps brachii (MMGtri) muscle, its tendon (MTGtri) and the abdominal muscle (MMGobl) were recorded by a piezoelectric-sensor-based measurement system. Each partner performed three 15s (80% MVIC) and two fatiguing trials (90% MVIC) during PIMA and HIMA, respectively. Parameters to compare PIMA and HIMA were the mean frequency, the normalized mean amplitude, the amplitude variation, the power in the frequency range of 8 to 15 Hz, a special power-frequency ratio and the number of task failures during HIMA or PIMA (partner who quit the task). A “HIMA failure” occurred in 85% of trials (p < 0.001). No significant differences between PIMA and HIMA were found for the mean frequency and normalized amplitude. The MMGobl showed significantly higher values of amplitude variation (15s: p = 0.013; fatiguing: p = 0.007) and of power-frequency-ratio (15s: p = 0.040; fatiguing: p = 0.002) during HIMA and a higher power in the range of 8 to 15 Hz during PIMA (15s: p = 0.001; fatiguing: p = 0.011). MMGtri and MTGtri showed no significant differences. Based on the findings it is suggested that a holding and a pushing isometric muscle action can be distinguished objectively, whereby a more complex neural control is assumed for HIMA.
Inter-brain synchronization is primarily investigated during social interactions but had not been examined during coupled muscle action between two persons until now. It was previously shown that mechanical muscle oscillations can develop coherent behavior between two isometrically interacting persons. This case study investigated if inter-brain synchronization appears thereby, and if differences of inter- and intrapersonal muscle and brain coherence exist regarding two different types of isometric muscle action. Electroencephalography (EEG) and mechanomyography/mechanotendography (MMG/MTG) of right elbow extensors were recorded during six fatiguing trials of two coupled isometrically interacting participants (70% MVIC). One partner performed holding and one pushing isometric muscle action (HIMA/PIMA; tasks changed). The wavelet coherence of all signals (EEG, MMG/MTG, force, ACC) were analyzed intra- and interpersonally. The five longest coherence patches in 8–15 Hz and their weighted frequency were compared between real vs. random pairs and between HIMA vs. PIMA. Real vs. random pairs showed significantly higher coherence for intra-muscle, intra-brain, and inter-muscle-brain activity (p < 0.001 to 0.019). Inter-brain coherence was significantly higher for real vs. random pairs for EEG of right and central areas and for sub-regions of EEG left (p = 0.002 to 0.025). Interpersonal muscle-brain synchronization was significantly higher than intrapersonal one, whereby it was significantly higher for HIMA vs. PIMA. These preliminary findings indicate that inter-brain synchronization can arise during muscular interaction. It is hypothesized both partners merge into one oscillating neuromuscular system. The results reinforce the hypothesis that HIMA is characterized by more complex control strategies than PIMA. The pilot study suggests investigating the topic further to verify these results on a larger sample size. Findings could contribute to the basic understanding of motor control and is relevant for functional diagnostics such as the manual muscle test which is applied in several disciplines, e.g., neurology, physiotherapy.
Synchronisationsphänomene myotendinöser Oszillationen interagierender neuromuskulärer Systeme
(2014)
Muskeln oszillieren nachgewiesener Weise mit einer Frequenz um 10 Hz. Doch was geschieht mit myofaszialen Oszillationen, wenn zwei neuromuskuläre Systeme interagieren? Die Dissertation widmet sich dieser Fragestellung bei isometrischer Interaktion. Während der Testmessungen ergaben sich Hinweise für das Vorhandensein von möglicherweise zwei verschiedenen Formen der Isometrie. Arbeiten zwei Personen isometrisch gegeneinander, können subjektiv zwei Modi eingenommen werden: man kann entweder isometrisch halten – der Kraft des Partners widerstehen – oder isometrisch drücken – gegen den isometrischen Widerstand des Partners arbeiten. Daher wurde zusätzlich zu den Messungen zur Interaktion zweier Personen an einzelnen Individuen geprüft, ob möglicherweise zwei Formen der Isometrie existieren. Die Promotion besteht demnach aus zwei inhaltlich und methodisch getrennten Teilen: I „Single-Isometrie“ und II „Paar-Isometrie“. Für Teil I wurden mithilfe eines pneumatisch betriebenen Systems die hypothetischen Messmodi Halten und Drücken während isometrischer Aktion untersucht. Bei n = 10 Probanden erfolgte parallel zur Aufzeichnung des Drucksignals während der Messungen die Erfassung der Kraft (DMS) und der Beschleunigung sowie die Aufnahme der mechanischen Muskeloszillationen folgender myotendinöser Strukturen via Mechanomyo- (MMG) bzw. Mechanotendografie (MTG): M. triceps brachii (MMGtri), Trizepssehne (MTGtri), M. obliquus externus abdominis (MMGobl). Pro Proband wurden bei 80 % der MVC sowohl sechs 15-Sekunden-Messungen (jeweils drei im haltenden bzw. drückenden Modus; Pause: 1 Minute) als auch vier Ermüdungsmessungen (jeweils zwei im haltenden bzw. drückenden Modus; Pause: 2 Minuten) durchgeführt. Zum Vergleich der Messmodi Halten und Drücken wurden die Amplituden der myofaszialen Oszillationen sowie die Kraftausdauer herangezogen. Signifikante Unterschiede zwischen dem haltenden und dem drückenden Modus zeigten sich insbesondere im Bereich der Ermüdungscharakteristik. So lassen Probanden im haltenden Modus signifikant früher nach als im drückenden Modus (t(9) = 3,716; p = .005). Im drückenden Modus macht das längste isometrische Plateau durchschnittlich 59,4 % der Gesamtdauer aus, im haltenden sind es 31,6 % (t(19) = 5,265, p = .000). Die Amplituden der Single-Isometrie-Messungen unterscheiden sich nicht signifikant. Allerdings variieren die Amplituden des MMGobl zwischen den Messungen im drückenden Modus signifikant stärker als im haltenden Modus. Aufgrund dieser teils signifikanten Unterschiede zwischen den beiden Messmodi wurde dieses Setting auch im zweiten Teil „Paar-Isometrie“ berücksichtigt. Dort wurden n = 20 Probanden – eingeteilt in zehn gleichgeschlechtliche Paare – während isometrischer Interaktion untersucht. Die Sensorplatzierung erfolgte analog zu Teil I. Die Oszillationen der erfassten MTG- sowie MMG-Signale wurden u.a. mit Algorithmen der Nichtlinearen Dynamik auf ihre Kohärenz hin untersucht. Durch die Paar-Isometrie-Messungen zeigte sich, dass die Muskeln und die Sehnen beider neuromuskulärer Systeme bei Interaktion im bekannten Frequenzbereich von 10 Hz oszillieren. Außerdem waren sie in der Lage, sich bei Interaktion so aufeinander abzustimmen, dass sich eine signifikante Kohärenz entwickelte, die sich von Zufallspaarungen signifikant unterscheidet (Patchanzahl: t(29) = 3,477; p = .002; Summe der 4 längsten Patches: t(29) = 7,505; p = .000). Es wird der Schluss gezogen, dass neuromuskuläre Komplementärpartner in der Lage sind, sich im Sinne kohärenten Verhaltens zu synchronisieren. Bezüglich der Parameter zur Untersuchung der möglicherweise vorhandenen zwei Formen der Isometrie zeigte sich bei den Paar-Isometrie-Messungen zwischen Halten und Drücken ein signifikanter Unterschied bei der Ermüdungscharakteristik sowie bezüglich der Amplitude der MMGobl. Die Ergebnisse beider Teilstudien bestärken die Hypothese, dass zwei Formen der Isometrie existieren. Fraglich ist, ob man überhaupt von Isometrie sprechen kann, da jede isometrische Muskelaktion aus feinen Oszillationen besteht, die eine per Definition postulierte Isometrie ausschließen. Es wird der Vorschlag unterbreitet, die Isometrie durch den Begriff der Homöometrie auszutauschen. Die Ergebnisse der Paar-Isometrie-Messungen zeigen u.a., dass neuromuskuläre Systeme in der Lage sind, ihre myotendinösen Oszillationen so aufeinander abzustimmen, dass kohärentes Verhalten entsteht. Es wird angenommen, dass hierzu beide neuromuskulären Systeme funktionell intakt sein müssen. Das Verfahren könnte für die Diagnostik funktioneller Störungen relevant werden.
Background: Change-of-direction (CoD) is a necessary physical ability of a field sport and may vary in youth players according to their maturation status.
Objectives: The aim of this study is: to compare the effectiveness of a 6-week CoD training intervention on dynamic balance (CS-YBT), horizontal jump (5JT), speed (10 and 30-m linear sprint times), CoD with (15 m-CoD + B) and without (15 m-CoD) the ball, in youth male soccer players at different levels of maturity [pre- and post-peak height velocity (PHV)].
Materials and Methods: Thirty elite male youth soccer players aged 10–17 years from the Tunisian first division participated in this study. The players were divided into pre- (G1, n = 15) and post-PHV (G2, n = 15) groups. Both groups completed a similar 6-week training program with two sessions per week of four CoD exercises. All players completed the following tests before and after intervention: CS-YBT; 5 JT; 10, 30, and 15 m-CoD; and 15 m-CoD + B, and data were analyzed using ANCOVA.
Results: All 30 players completed the study according to the study design and methodology. Adherence rate was 100% across all groups, and no training or test-related injuries were reported. Pre-PHV and post-PHV groups showed significant amelioration post-intervention for all dependent variables (after test > before test; p < 0.01, d = 0.09–1.51). ANOVA revealed a significant group × time interaction only for CS-YBT (F = 4.45; p < 0.04; η2 = 0.14), 5JT (F = 6.39; p < 0.02; η2 = 0.18), and 15 m-CoD (F = 7.88; p < 0.01; η2 = 0.22). CS-YBT, 5JT, and 15 m-CoD improved significantly in the post-PHV group (+ 4.56%, effect size = 1.51; + 4.51%, effect size = 1.05; and -3.08%, effect size = 0.51, respectively), more than the pre-PHV group (+ 2.77%, effect size = 0.85; + 2.91%, effect size = 0.54; and -1.56%, effect size = 0.20, respectively).
Conclusion: The CoD training program improved balance, horizontal jump, and CoD without the ball in male preadolescent and adolescent soccer players, and this improvement was greater in the post-PHV players. The maturity status of the athletes should be considered when programming CoD training for soccer players.
Effects of the barbell load on the acceleration phase during the snatch in Olympic weightlifting
(2020)
The load-depended loss of vertical barbell velocity at the end of the acceleration phase limits the maximum weight that can be lifted. Thus, the purpose of this study was to analyze how increased barbell loads affect the vertical barbell velocity in the sub-phases of the acceleration phase during the snatch. It was hypothesized that the load-dependent velocity loss at the end of the acceleration phase is primarily associated with a velocity loss during the 1st pull. For this purpose, 14 male elite weightlifters lifted seven load-stages from 70–100% of their personal best in the snatch. The load–velocity relationship was calculated using linear regression analysis to determine the velocity loss at 1st pull, transition, and 2nd pull. A group mean data contrast analysis revealed the highest load-dependent velocity loss for the 1st pull (t = 1.85, p = 0.044, g = 0.49 [−0.05, 1.04]) which confirmed our study hypothesis. In contrast to the group mean data, the individual athlete showed a unique response to increased loads during the acceleration sub-phases of the snatch. With the proposed method, individualized training recommendations on exercise selection and loading schemes can be derived to specifically improve the sub-phases of the snatch acceleration phase. Furthermore, the results highlight the importance of single-subject assessment when working with elite athletes in Olympic weightlifting.
This study examined the concurrent validity of an inverse dynamic (force computed from barbell acceleration [reference method]) and a work-energy (force computed from work at the barbell [alternative method]) approach to measure the mean vertical barbell force during the snatch using kinematic data from video analysis. For this purpose, the acceleration phase of the snatch was analyzed in thirty male medal winners of the 2018 weightlifting World Championships (age: 25.2±3.1 years; body mass: 88.9±28.6 kg). Vertical barbell kinematics were measured using a custom-made 2D real-time video analysis software. Agreement between the two computational approaches was assessed using Bland-Altman analysis, Deming regression, and Pearson product-moment correlation. Further, principal component analysis in conjunction with multiple linear regression was used to assess whether individual differences related to the two approaches are due to the waveforms of the acceleration time-series data. Results indicated no mean difference (p > 0.05; d = −0.04) and an extremely large correlation (r = 0.99) between the two approaches. Despite the high agreement, the total error of individual differences was 8.2% (163.0 N). The individual differences can be explained by a multiple linear regression model (R2adj = 0.86) on principal component scores from the principal component analysis of vertical barbell acceleration time-series waveforms. Findings from this study indicate that the individual errors of force measures can be associated with the inverse dynamic approach. This approach uses vertical barbell acceleration data from video analysis that is prone to error. Therefore, it is recommended to use the work-energy approach to compute mean vertical barbell force as this approach did not rely on vertical barbell acceleration.
Introduction: Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR) programs. Although the association between cardiovascular diseases and cognitive impairments (CIs) is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far.
Methods: In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8% men) with coronary artery disease following an acute coronary event (ACE) were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA) upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI.
Results: At admission to CR, the CI (MoCA score < 26) was determined in 182 patients (36.7%). Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7%, P = 0.046), heavy (physically demanding) workloads (26.4 vs 17.8%, P < 0.001), sick leave longer than 1 month prior to CR (28.6 vs 18.5%, P = 0.026), reduced exercise capacity (102.5 vs 118.8 W, P = 0.006), and a shorter 6-min walking distance (401.7 vs 421.3 m, P = 0.021) compared to no CI group. The age- and education-adjusted model showed positive associations with CI only for sick leave more than 1 month prior to ACE (odds ratio [OR] 1.673, 95% confidence interval 1.07–2.79; P = 0.03) and heavy workloads (OR 2.18, 95% confidence interval 1.42–3.36; P < 0.01).
Conclusion: The prevalence of CI in CR was considerably high, affecting more than one-third of cardiac patients. Besides age and education level, CI was associated with heavy workloads and a longer sick leave before ACE.
Intervertebral disc (IVD) cells are naturally exposed to high osmolarity and complex mechanical loading, which drive microenvironmental osmotic changes. Age- and degeneration-induced degradation of the IVD's extracellular matrix causes osmotic imbalance, which, together with an altered function of cellular receptors and signalling pathways, instigates local osmotic stress. Cellular responses to osmotic stress include osmoadaptation and activation of pro-inflammatory pathways. This review summarises the current knowledge on how IVD cells sense local osmotic changes and translate these signals into physiological or pathophysiological responses, with a focus on inflammation. Furthermore, it discusses the expression and function of putative membrane osmosensors (e.g. solute carrier transporters, transient receptor potential channels, aquaporins and acid-sensing ion channels) and osmosignalling mediators [e.g. tonicity responseelement-binding protein/nuclear factor of activated T-cells 5 (TonEBP/NFAT5), nuclear factor kappa-lightchain-enhancer of activated B cells (NF-kappa B)] in healthy and degenerated IVDs. Finally, an overview of the potential therapeutic targets for modifying osmosensing and osmosignalling in degenerated IVDs is provided.
Die intensive Auswertung unterschiedlicher schriftlicher und mündlicher Quellen sowie die Erschließung von damals "geheimer" Literatur für die Forschung heute ermöglicht eine differenzierte Rekonstruktion historischer Abläufe. Die vorliegende Arbeit nutzt diesen Zugang zur Darstellung von kleineren und größeren DDR-internen sportpolitischen Strukturwandlungen der 1960er und 1970er Jahre, die ihren Höhepunkt in einer dramatischen Umsteuerung des DDR-Hochleistungssports fanden. Es wird gezeigt, wie die Akteure unter Führung von Manfred EWALD, gewähltem Mitglied des SED-Zentralkomitees, einer Zentralfigur des DDR-Sports (vergleichbar mit der Bedeutung eines Willi DAUME im Westen) zwischen Systemzwängen und individueller Handlungsfreiheit innerhalb des Rahmens einer Diktatur in der Phase des Wechsels von Walter ULBRICHT zu Erich HONECKER eine Effektivierung des zentralistischen Modells durchsetzten (eine Parallele zum Ansatz von Monika KAISER). Im Gegensatz zu vielen kontroversen Erklärungsmodellen belegt der Verf., dass die Medaillenerfolge durch die zentrale Steuerung aller Abläufe gewährleistet wurden. Ohne SED-Auftrag wurde 1967 die "Leistungssportkommission der DDR" (LSK der DDR) gebildet. Im Unterschied zu den zahlreichen vom Verf. erstmals dargestellten Vorgängermodellen war diese SED-LSK "oberhalb des DTSB" angesiedelt und erteilte ihm Parteiaufträge - die Unterordnung des organisierten Sports unter die Autorität des Zentralkomitee machte angesichts der "Nationalen Fronten" von Armeesportvereinigung "Vorwärts" und Sportvereinigung "Dynamo" (SPITZER) jegliche zentrale Sportpolitik erst durchsetzbar. Zur "LSK der DDR" waren SED-Mitglieder abgeordnet, welche ihr Sachgebiet vertraten und nach gemeinsamer Beschlussfassung die Ergebnisse der LSK-Arbeit wiederum in ihrem jeweiligen Tätigkeitsfeld durchzusetzen hatten, was in der Diss. ausgeführt wird. Sportvertreter ebenso wie hochrangige Abgesandte der Ministerien, die mit der Produktion von Gütern für den Hochleistungssport befasst waren, gehörten den LSK-Gremien an, die auch die DDR-Sportwissenschaft steuerten; es lässt sich sogar nachweisen, dass die Herrschaft über diesen wichtigen Apparat sowie die Dopingforschung ein Hauptmotiv der LSK-Bildung gewesen ist. Durch seine Quellenorientierung und die Fülle an Belegen gibt die vorliegende Arbeit neue Anreize zur Auseinandersetzung mit dem Phänomen der Steuerung des Hochleistungssports in der DDR - auch über den Untersuchungszeitraum hinaus. Die Untersuchung wurde von der Humanwissenschaftlichen Fakultät der Universität Potsdam als Dissertation angenommen. Sie geht auf ein Stipendium dieser Universität zurück; das Verfahren konnte mit einem Prädikat abgeschlossen werden. Gutachter waren Prof. Dr. Dr. Gertrud PFISTER, Kopenhagen, Prof. Dr. Christoph KLEßMANN, Potsdam, und der Betreuer, Steady Visiting Prof. Univ. Odense, Priv.-Doz. Dr. habil. Giselher SPITZER, Berlin / Potsdam / Odense (Dänemark).
Background
Artificial intelligence (AI) is one of the most promising areas in medicine with many possibilities for improving health and wellness. Already today, diagnostic decision support systems may help patients to estimate the severity of their complaints. This fictional case study aimed to test the diagnostic potential of an AI algorithm for common sports injuries and pathologies.
Methods
Based on a literature review and clinical expert experience, five fictional “common” cases of acute, and subacute injuries or chronic sport-related pathologies were created: Concussion, ankle sprain, muscle pain, chronic knee instability (after ACL rupture) and tennis elbow. The symptoms of these cases were entered into a freely available chatbot-guided AI app and its diagnoses were compared to the pre-defined injuries and pathologies.
Results
A mean of 25–36 questions were asked by the app per patient, with optional explanations of certain questions or illustrative photos on demand. It was stressed, that the symptom analysis would not replace a doctor’s consultation. A 23-yr-old male patient case with a mild concussion was correctly diagnosed. An ankle sprain of a 27-yr-old female without ligament or bony lesions was also detected and an ER visit was suggested. Muscle pain in the thigh of a 19-yr-old male was correctly diagnosed. In the case of a 26-yr-old male with chronic ACL instability, the algorithm did not sufficiently cover the chronic aspect of the pathology, but the given recommendation of seeing a doctor would have helped the patient. Finally, the condition of the chronic epicondylitis in a 41-yr-old male was correctly detected.
Conclusions
All chosen injuries and pathologies were either correctly diagnosed or at least tagged with the right advice of when it is urgent for seeking a medical specialist. However, the quality of AI-based results could presumably depend on the data-driven experience of these programs as well as on the understanding of their users. Further studies should compare existing AI programs and their diagnostic accuracy for medical injuries and pathologies.
To grant high-quality evidence-based research in the field of exercise sciences, it is often necessary for various institutions to collaborate over longer distances and internationally. Here, not only with regard to the recent COVID-19-pandemic, digital means provide new options for remote scientific exchanges. This thesis is meant to analyse and test digital opportunities to support the dissemination of knowledge and instruction of investigators about defined examination protocols in an international multi-center context.
The project consisted of three studies. The first study, a questionnaire-based survey, aimed at learning about the opinions and preferences of digital learning or social media among students of sport science faculties in two universities each in Germany, the UK and Italy. Based on these findings, in a second study, an examination video of an ultrasound determination of the intima-media-thickness and diameter of an artery was distributed by a messenger app to doctors and nursing personnel as simulated investigators and efficacy of the test setting was analysed. Finally, a third study integrated the use of an augmented reality device for direct remote supervision of the same ultrasound examinations in a long-distance international setting with international experts from the fields of engineering and sports science and later remote supervision of augmented reality equipped physicians performing a given task.
The first study with 229 participating students revealed a high preference for YouTube to receive video-based knowledge as well as a preference for using WhatsApp and Facebook for peer-to-peer contacts for learning purposes and to exchange and discuss knowledge. In the second study, video-based instructions send by WhatsApp messenger
showed high approval of the setup in both study groups, one with doctors familiar with the use of ultrasound technology as well as one with nursing staff who were not familiar with the device, with similar results in overall time of performance and the measurements of the femoral arteries. In the third and final study, experts from different continents were connected remotely to the examination site via an augmented reality device with good transmission quality. The remote supervision to doctors ́ examination produced a good interrater correlation. Experiences with the augmented reality-based setting were rated as highly positive by the participants. Potential benefits of this technique were seen in the fields of education, movement analysis, and supervision.
Concluding, the findings of this thesis were able to suggest modern and addressee- centred digital solutions to enhance the understanding of given examinations techniques of potential investigators in exercise science research projects. Head-mounted augmented reality devices have a special value and may be recommended for collaborative research projects with physical examination–based research questions. While the established setting should be further investigated in prospective clinical studies, digital competencies of future researchers should already be enhanced during the early stages of their education.
A majority of studies documented a reduced ankle muscle activity, particularly of the peroneus longus muscle (PL), in patients with functional ankle instability (FI). It is considered valid that foot orthoses as well as sensorimotor training have a positive effect on ankle muscle activity in healthy individuals and those with lower limb overuse injuries or flat arched feet (reduced reaction time by sensorimotor exercises; increased ankle muscle amplitude by orthoses use). However, the acute- and long-term influence of foot orthoses on ankle muscle activity in individuals with FI is unknown.
AIMS: The present thesis addressed (1a) acute- and (1b) long-term effects of foot orthoses compared to sensorimotor training on ankle muscle activity in patients with FI. (2) Further, it was investigated if the orthosis intervention group demonstrate higher ankle muscle activity by additional short-term use of a measurement in-shoe orthosis (compared to short-term use of “shoe only”) after intervention. (3) As prerequisite, it was evaluated if ankle muscle activity can be tested reliably and (4) if this differs between healthy individuals and those with FI.
METHODS: Three intervention groups (orthosis group [OG], sensorimotor training group [SMTG], control group [CG]), consisting of both, healthy individuals and those with FI, underwent one longitudinal investigation (randomised controlled trial). Throughout 6 weeks of intervention, OG wore an in-shoe orthosis with a specific “PL stimulation module”, whereas SMTG conducted home-based exercises. CG served to measure test-retest reliability of ankle muscle activity (PL, M. tibialis anterior [TA] and M. gastrocnemius medialis [GM]). Pre- and post-intervention, ankle muscle activity (EMG amplitude) was recorded during “normal” unperturbed (NW) and perturbed walking (PW) on a split-belt treadmill (stimulus 200 ms post initial heel contact [IC]) as well as during side cutting (SC), each while wearing “shoes only” and additional measurement in-shoe orthoses (randomized order). Normalized RMS values (100% MVC, mean±SD) were calculated pre- (100-50 ms) and post (200-400 ms) - IC.
RESULTS: (3) Test-retest reliability showed a high range of values in healthy individuals and those with FI. (4) Compared to healthy individuals, patients with FI demonstrated lower PL pre-activity during SC, however higher PL pre-activity for NW and PW. (1a) Acute orthoses use did not influence ankle muscle activity. (1b) For most conditions, sensorimotor training was more effective in individuals with FI than long-term orthotic intervention (increased: PL and GM pre-activity and TA reflex-activity for NW, PL pre-activity and TA, PL and GM reflex-activity for SC, PL reflex-activity for PW). However, prolonged orthoses use was more beneficial in terms of an increase in GM pre-activity during SC. For some conditions, long-term orthoses intervention was as effective as sensorimotor training for individuals with FI (increased: PL pre-activity for PW, TA pre-activity for SC, PL and GM reflex-activity for NW). Prolonged orthoses use was also advantageous in healthy individuals (increased: PL and GM pre-activity for NW and PW, PL pre-activity for SC, TA and PL reflex-activity for NW, PL and GM reflex-activity for PW). (2) The orthosis intervention group did not present higher ankle muscle activity by the additional short-term use of a measurement in-shoe orthosis at re-test after intervention.
CONCLUSION: High variations of reproducibility reflect physiological variability in muscle activity during gait and therefore deemed acceptable. The main findings confirm the presence of sensorimotor long-term effects of specific foot orthoses in healthy individuals (primary preventive effect) and those with FI (therapeutic effect). Neuromuscular compensatory feedback- as well as anticipatory feedforward adaptation mechanism to prolonged orthoses use, specifically of the PL muscle, underpins the key role of PL in providing essential dynamic ankle joint stability. Due to its advantages over sensorimotor training (positive subjective feedback in terms of comfort, time-and-cost-effectiveness), long-term foot orthoses use can be recommended as an applicable therapy alternative in the treatment of FI. Long-term effect of foot orthoses in a population with FI must be validated in a larger sample size with longer follow-up periods to substantiate the generalizability of the existing outcomes.
Hintergrund: In Deutschland stellt der akute Myokardinfarkt (MI) eine der häufigsten Todesursachen dar. Als Ursache für regionale Unterschiede bei den Mortalitätsraten werden divergente Versorgungsstrukturen vermutet. Ziel der Untersuchung war, diese Fragestellung anhand anonymisierter krankenkassenbasierter Abrechnungsdaten zu evaluieren.
Methodik: Standardisierte Hospitalisierungs- sowie Krankenhaus- und Ein-Jahres-Mortalitätsraten nach MI wurden anhand anonymisierter Versichertendaten einer gesetzlichen Krankenkasse für das Jahr 2012 und die Bundesländer Berlin, Brandenburg und Mecklenburg-Vorpommern ermittelt (n=1.387.084, 46.3% male, 60.9 ± 18,2 years). Weiterhin wurden prädiktive Einflussfaktoren auf die Ein-Jahres-Mortalität, auf die Durchführung invasiver Prozeduren und auf eine leitliniengerechte pharmakotherapeutische Sekundärprävention analysiert.
Ergebnisse: 6.733 Patienten (73,7 ±13,0 Jahre, 56,7% männlich) wurden identifiziert. Obwohl für das Bundesland Berlin eine höhere Hospitalisierungsrate als in Mecklenburg-Vorpommern ermittelt werden konnte, ließen sich bei der Krankenhaus- und 1-Jahres-Mortalität keine signifikant abweichenden Raten zwischen den Bundesländern beobachten. Die Durchführung einer Koronarangiographie (OR: 0,42 [0,35-0,51]) und eine leitliniengerechte Pharmakotherapie (OR: 0,14 [0,12-0,17] waren mit einer geringeren 1-Jahres-Mortalität assoziiert. Die Durchführung einer Koronarangiographie und eine leitliniengerechte Pharmakotherapie von Patienten nach Myokardinfarkt wurde hingegen primär durch Alter und Geschlecht, nicht aber durch das Bundesland determiniert.
Folgerung: Eine regional divergierende stationäre und postinfarzielle Versorgung auf Bundesland-Ebene kann anhand der vorliegenden Daten nicht nachgewiesen werden.
Introduction: Cystic fibrosis (CF) is a genetic disease which disrupts the function of an epithelial surface anion channel, CFTR (cystic fibrosis transmembrane conductance regulator). Impairment to this channel leads to inflammation and infection in the lung causing the majority of morbidity and mortality. However, CF is a multiorgan disease affecting many tissues, including vascular smooth muscle. Studies have revealed young people with cystic fibrosis lacking inflammation and infection still demonstrate vascular endothelial dysfunction, measured per flow-mediated dilation (FMD). In other disease cohorts, i.e. diabetic and obese, endurance exercise interventions have been shown improve or taper this impairment. However, long-term exercise interventions are risky, as well as costly in terms of time and resources. Nevertheless, emerging research has correlated the acute effects of exercise with its long-term benefits and advocates the study of acute exercise effects on FMD prior to longitudinal studies. The acute effects of exercise on FMD have previously not been examined in young people with CF, but could yield insights on the potential benefits of long-term exercise interventions.
The aims of these studies were to 1) develop and test the reliability of the FMD method and its applicability to study acute exercise effects; 2) compare baseline FMD and the acute exercise effect on FMD between young people with and without CF; and 3) explore associations between the acute effects of exercise on FMD and demographic characteristics, physical activity levels, lung function, maximal exercise capacity or inflammatory hsCRP levels.
Methods: Thirty young volunteers (10 people with CF, 10 non-CF and 10 non-CF active matched controls) between the ages of 10 and 30 years old completed blood draws, pulmonary function tests, maximal exercise capacity tests and baseline FMD measurements, before returning approximately 1 week later and performing a 30-min constant load training at 75% HRmax. FMD measurements were taken prior, immediately after, 30 minutes after and 1 hour after constant load training. ANOVAs and repeated measures ANOVAs were employed to explore differences between groups and timepoints, respectively. Linear regression was implemented and evaluated to assess correlations between FMD and demographic characteristics, physical activity levels, lung function, maximal exercise capacity or inflammatory hsCRP levels. For all comparisons, statistical significance was set at a p-value of α < 0.05.
Results: Young people with CF presented with decreased lung function and maximal exercise capacity compared to matched controls. Baseline FMD was also significantly decreased in the CF group (CF: 5.23% v non-CF: 8.27% v non-CF active: 9.12%). Immediately post-training, FMD was significantly attenuated (approximately 40%) in all groups with CF still demonstrating the most minimal FMD. Follow-up measurements of FMD revealed a slow recovery towards baseline values 30 min post-training and improvements in the CF and non-CF active groups 60 min post-training. Linear regression exposed significant correlations between maximal exercise capacity (VO2 peak), BMI and FMD immediately post-training.
Conclusion: These new findings confirm that CF vascular endothelial dysfunction can be acutely modified by exercise and will aid in underlining the importance of exercise in CF populations. The potential benefits of long-term exercise interventions on vascular endothelial dysfunction in young people with CF warrants further investigation.
The relevance for in vitro three-dimensional (3D) tissue culture of skin has been present for almost a century. From using skin biopsies in organ culture, to vascularized organotypic full-thickness reconstructed human skin equivalents, in vitro tissue regeneration of 3D skin has reached a golden era. However, the reconstruction of 3D skin still has room to grow and develop. The need for reproducible methodology, physiological structures and tissue architecture, and perfusable vasculature are only recently becoming a reality, though the addition of more complex structures such as glands and tactile corpuscles require advanced technologies. In this review, we will discuss the current methodology for biofabrication of 3D skin models and highlight the advantages and disadvantages of the existing systems as well as emphasize how new techniques can aid in the production of a truly physiologically relevant skin construct for preclinical innovation.
This meta-analysis aimed to assess the effects of plyometric jump training (PJT) on volleyball players’ vertical jump height (VJH), comparing changes with those observed in a matched control group. A literature search in the databases of PubMed, MEDLINE, Web of Science, and SCOPUS was conducted. Only randomized-controlled trials and studies that included a pre-to-post intervention assessment of VJH were included. They involved only healthy volleyball players with no restrictions on age or sex. Data were independently extracted from the included studies by two authors. The Physiotherapy Evidence Database scale was used to assess the risk of bias, and methodological quality, of eligible studies included in the review. From 7,081 records, 14 studies were meta-analysed. A moderate Cohen’s d effect size (ES = 0.82, p <0.001) was observed for VJH, with moderate heterogeneity (I2 = 34.4%, p = 0.09) and no publication bias (Egger’s test, p = 0.59). Analyses of moderator variables revealed no significant differences for PJT program duration (≤8 vs. >8 weeks, ES = 0.79 vs. 0.87, respectively), frequency (≤2 vs. >2 sessions/week, ES = 0.83 vs. 0.78, respectively), total number of sessions (≤16 vs. >16 sessions, ES = 0.73 vs. 0.92, respectively), sex (female vs. male, ES = 1.3 vs. 0.5, respectively), age (≥19 vs. <19 years of age, ES = 0.89 vs. 0.70, respectively), and volume (>2,000 vs. <2,000 jumps, ES = 0.76 vs. 0.79, respectively). In conclusion, PJT appears to be effective in inducing improvements in volleyball players’ VJH. Improvements in VJH may be achieved by both male and female volleyball players, in different age groups, with programs of relatively low volume and frequency. Though PJT seems to be safe for volleyball players, it is recommended that an individualized approach, according to player position, is adopted with some players (e.g. libero) less prepared to sustain PJT loads.
Einleitung
Die Implantation einer Knie- oder Hüft-Totalendoprothese (TEP) ist eine der häufigsten operativen Eingriffe. Im Anschluss an die Operation und die postoperative Rehabilitation stellt die Bewegungstherapie einen wesentlichen Bestandteil der Behandlung zur Verbesserung der Gelenkfunktion und der Lebensqualität dar. In strukturschwachen Gebieten werden entsprechende Angebote nur in unzureichender Dichte vorgehalten. Zudem zeichnet sich ein flächendeckender Fachkräftemangel im Bereich der Physiotherapie ab. Die Tele-Nachsorge bietet daher einen innovativen Ansatz für die postrehabilitative Versorgung der Patienten. Das Ziel der vorliegenden Untersuchung war die Überprüfung der Wirksamkeit einer interaktiven Tele-Nachsorgeintervention für Patienten mit Knie- oder Hüft-TEP im Vergleich zur herkömmlichen Versorgung (usual care). Dazu wurden die Funktionalität und die berufliche Wiedereingliederung untersucht.
Methode
Zwischen August 2016 und August 2017 wurden 111 Patienten (54,9 ± 6,8 Jahre, 54,3 % weiblich) zu Beginn ihrer stationären Anschlussheilbehandlung nach Implantation einer Knie- oder Hüft-TEP in diese randomisiert, kontrolliert, multizentrische Studie eingeschlossen. Nach Entlassung aus der orthopädischen Anschlussrehabilitation (Baseline) führte die Interventionsgruppe (IG) ein dreimonatiges interaktives Training über ein Telerehabilitationssystem durch. Hierfür erstellte ein betreuender Physiotherapeut einen individuellen Trainingsplan aus 38 Übungen zur Verbesserung der Kraft sowie der posturalen Kontrolle. Zur Anpassung des Trainingsplans übermittelte das System dem Physiotherapeuten Daten zur Quantität sowie zur Qualität des Trainings. Die Kontrollgruppe (KG) konnte die herkömmlichen Versorgungsangebote nutzen. Zur Beurteilung der Wirksamkeit der Intervention wurde die Differenz der Verbesserung im 6MWT zwischen der IG und der KG nach drei Monaten als primärer Endpunkt definiert. Als sekundäre Endpunkte wurden die Return-to-Work-Rate sowie die funktionelle Mobilität mittels des Stair Ascend Tests, des Five-Times-Sit-to-Stand Test und des Timed Up and Go Tests untersucht. Weiterhin wurden die gesundheitsbezogene Lebensqualität mit dem Short-Form 36 (SF-36) und die gelenkbezogenen Einschränkungen mit dem Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) evaluiert. Der primäre und die sekundären Endpunkte wurden anhand von baseline-adjustierten Kovarianzanalysen im intention-to-treat-Ansatz ausgewertet. Zusätzlich wurde die Teilnahme an Nachsorgeangeboten und die Adhärenz der Interventionsgruppe an der Tele-Nachsorge erfasst und evaluiert.
Ergebnisse
Zum Ende der Intervention wiesen beide Gruppen einen statistisch signifikanten Anstieg ihrer 6MWT Strecke auf (p < 0,001). Zu diesem Zeitpunkt legten die Teilnehmer der IG im Mittel 530,8 ± 79,7 m, die der KG 514,2 ± 71,2 m zurück. Dabei betrug die Differenz der Verbesserung der Gehstrecke in der IG 88,3 ± 57,7 m und in der KG 79,6 ± 48,7 m. Damit zeigt der primäre Endpunkt keine signifikanten Gruppenunterschiede (p = 0,951). Bezüglich der beruflichen Wiedereingliederung konnte jedoch eine signifikant höhere Rate in der IG (64,6 % versus 46,2 %; p = 0,014) festgestellt werden. Für die sekundären Endpunkte der funktionellen Mobilität, der Lebensqualität und der gelenkbezogenen Beschwerden belegen die Ergebnisse eine Gleichwertigkeit beider Gruppen zum Ende der Intervention.
Schlussfolgerung
Die telemedizinisch assistierte Bewegungstherapie für Knie- oder Hüft-TEP Patienten ist der herkömmlichen Versorgung zur Nachsorge hinsichtlich der erzielten Verbesserungen der funktionellen Mobilität, der gesundheitsbezogenen Lebensqualität und der gelenkbezogenen Beschwerden gleichwertig. In dieser Patientenpopulation ließen sich klinisch relevante Verbesserungen unabhängig von der Form der Bewegungstherapie erzielen. Im Hinblick auf die berufliche Wiedereingliederung zeigte sich eine signifikant höhere Rate in der Interventionsgruppe. Die telemedizinisch assistierte Bewegungstherapie scheint eine geeignete Versorgungsform der Nachsorge zu sein, die orts- und zeitunabhängig durchgeführt werden kann und somit den Bedürfnissen berufstätiger Patienten entgegenkommt und in den Alltag der Patienten integriert werden kann. Die Tele-Nachsorge sollte daher als optionale und komplementäre Form der postrehabilitativen Nachsorge angeboten werden. Auch im Hinblick auf den zunehmenden Fachkräftemangel im Bereich der Physiotherapie und bestehende Versorgungslücken in strukturschwachen Gebieten kann der Einsatz der Tele-Nachsorge innovative und bedarfsgerechte Lösungsansätze bieten.
Der tänzerische Kreativitätstest stellt ein valides Instrumentarium dar, welches auf tanzspezifischen Aufgaben basiert und für die differenzierte und standardisierte Erfassung der tänzerischen Kreativität bei Kindern im Alter von 8 bis 12 Jahren konzipiert ist. Mit dem tänzerischen Kreativitätstest können nicht nur Fragestellungen zum Stand sowie zur Entwicklung tänzerisch-kreativer Fähigkeiten im Kindesalter bearbeitet werden, sondern er liefert auch wertvolle Informationen für die Optimierung von Trainings-, Förder- und Vermittlungsmaßnahmen. Erfasst werden folgende tänzerisch-kreativen Fähigkeiten: 1) Vielfalt und Originalität in der Fortbewegung und in Körperpositionen sowie 2) Ideenreichtum, Vielfalt und Originalität in der Gestaltung von Bewegungspatterns und -kompositionen. Dieser Test lässt sich mit größeren Gruppen und minimalem materiellen Aufwand durchführen, ist zeitlich unbeschränkt und ermöglicht es, unterschiedliche Leistungsniveaus zu identifizieren. Der tänzerische Kreativitätstest bietet Forschenden und Lehrkräften eine wertvolle Möglichkeit, die tänzerisch-kreativen Fähigkeiten von Kindern zu analysieren und zu fördern.
The post-antiretroviral therapy era has transformed HIV into a chronic disease and non-HIV comorbidities (i.e., cardiovascular and mental diseases) are more prevalent in PLWH. The source of these non-HIV comorbidities aside from traditional risk factor include HIV infection, inflammation, distorted immune activation, burden of chronic diseases, and unhealthy lifestyle like sedentarism. Exercise is known for its beneficial effects in mental and physical health; reasons why exercise is recommended to prevent and treat difference cardiovascular and mental diseases in the general population. This cumulative thesis aimed to comprehend the relation exercise has to non-HIV comorbidities in German PLWH. Four studies were conducted to 1) understand exercise effects in cardiorespiratory fitness and muscle strength on PLWH through a systematic review and meta-analyses and 2) determine the likelihood of German PLWH developing non-HIV comorbidities, in a cross-sectional study. Meta-analytic examination indicates PLWH cardiorespiratory fitness (VO2max SMD = 0.61 ml·kg·min-1, 95% CI: 0.35-0.88, z = 4.47, p < 0.001, I2 = 50%) and strength (of remark lowerbody strength by 16.8 kg, 95% CI: 13–20.6, p< 0.001) improves after an exercise intervention in comparison to a control group. Cross-sectional data suggest exercise has a positive effect on German PLWH mental health (less anxiety and depressive symptoms) and protects against the development of anxiety (PR: 0.57, 95%IC: 0.36 – 0.91, p = 0.01) and depression (PR: 0.62, 95%IC: 0.41 – 0.94, p = 0.01). Likewise, exercise duration is related to a lower likelihood of reporting heart arrhythmias (PR: 0.20, 95%IC: 0.10 – 0.60, p < 0.01) and exercise frequency to a lower likelihood of reporting diabetes mellitus (PR: 0.40, 95%IC: 0.10 – 1, p < 0.01) in German PLWH. A preliminary recommendation for German PLWH who want to engage in exercise can be to exercise ≥ 1 time per week, at an intensity of 5 METs per session or > 103 MET·min·day-1, with a duration ≥ 150 minutes per week. Nevertheless, further research is needed to comprehend exercise dose response and protective effect for cardiovascular diseases, anxiety, and depression in German PLWH.
Development of chronic pain after a low back pain episode is associated with increased pain sensitivity, altered pain processing mechanisms and the influence of psychosocial factors. Although there is some evidence that multimodal therapy (such as behavioral or motor control therapy) may be an important therapeutic strategy, its long-term effect on pain reduction and psychosocial load is still unclear. Prospective longitudinal designs providing information about the extent of such possible long-term effects are missing. This study aims to investigate the long-term effects of a homebased uni- and multidisciplinary motor control exercise program on low back pain intensity, disability and psychosocial variables. 14 months after completion of a multicenter study comparing uni- and multidisciplinary exercise interventions, a sample of one study center (n = 154) was assessed once more. Participants filled in questionnaires regarding their low back pain symptoms (characteristic pain intensity and related disability), stress and vital exhaustion (short version of the Maastricht Vital Exhaustion Questionnaire), anxiety and depression experiences (the Hospital and Anxiety Depression Scale), and pain-related cognitions (the Fear Avoidance Beliefs Questionnaire). Repeated measures mixed ANCOVAs were calculated to determine the long-term effects of the interventions on characteristic pain intensity and disability as well as on the psychosocial variables. Fifty four percent of the sub-sample responded to the questionnaires (n = 84). Longitudinal analyses revealed a significant long-term effect of the exercise intervention on pain disability. The multidisciplinary group missed statistical significance yet showed a medium sized long-term effect. The groups did not differ in their changes of the psychosocial variables of interest. There was evidence of long-term effects of the interventions on pain-related disability, but there was no effect on the other variables of interest. This may be partially explained by participant's low comorbidities at baseline. Results are important regarding costless homebased alternatives for back pain patients and prevention tasks. Furthermore, this study closes the gap of missing long-term effect analysis in this field.