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Cognitive resources contribute to balance control. There is evidence that mental fatigue reduces cognitive resources and impairs balance performance, particularly in older adults and when balance tasks are complex, for example when trying to walk or stand while concurrently performing a secondary cognitive task.
We conducted a systematic literature search in PubMed (MEDLINE), Web of Science and Google Scholar to identify eligible studies and performed a random effects meta-analysis to quantify the effects of experimentally induced mental fatigue on balance performance in healthy adults. Subgroup analyses were computed for age (healthy young vs. healthy older adults) and balance task complexity (balance tasks with high complexity vs. balance tasks with low complexity) to examine the moderating effects of these factors on fatigue-mediated balance performance.
We identified 7 eligible studies with 9 study groups and 206 participants. Analysis revealed that performing a prolonged cognitive task had a small but significant effect (SMDwm = −0.38) on subsequent balance performance in healthy young and older adults. However, age- and task-related differences in balance responses to fatigue could not be confirmed statistically.
Overall, aggregation of the available literature indicates that mental fatigue generally reduces balance in healthy adults. However, interactions between cognitive resource reduction, aging and balance task complexity remain elusive.
The aim of this case series approach was to analyze weekly changes in force-velocity relationship (FvR) parameters ((v) over bar, (F) over bar (0), (P) over bar (max)) and theoretical snatch performance (snatchth) assessed through a specific snatch pull test in preparation of the European and World Championships in 2 male elite weightlifters.
A second aim was to examine associations of training load (volume, volume load, average load), barbell -, and snatchth over a period of 2 macrocycles in preparation of the same competitions. FvR-parameters, snatchth, training load data, and body mass were assessed weekly over 40 weeks.
Using the smallest real difference approach, significant (p <= 0.05) decreases in (v) over bar (0) and increases in (v) over bar, (F) over bar (0), (P) over bar (max), and snatchth were found within macrocycles.
However, the large significant loss in body mass (approximate to 11%) in athlete 1 during macrocycle 2 represents most likely a main factor for diminished (P) over bar (max), and snatchth in macrocycle 2.
Based on cross-correlation analyses, barbell FvR-parameters and snatchth were significantly (p <= 0.05) associated with maximal strength, muscle power, and speed training load variables.
Moderate correlations (0.31-0.47) were found between training load and (P) over bar (max) and snatchth in athlete 2. It can be concluded that the applied training loads elicits improvements in <(P)(max) and snatchth because the athlete approached the main competitions.
However, because of the large loss in body mass, the relations between training load and barbell FvR-parameters and snatchth were less clear in athlete 1. It seems that a loss in body mass as a result of a change in bodyweight category mitigates <(P)over bar>(max) development during the macrocycle and hindered to reach peak snatchth at the main competitions.
Background
To improve propulsion during running, athletes often wear spike shoes designed for training and/or competition. Running with spike shoes may cause pain and/or injuries. To address this problem, a modified spike shoe was tested. This study aimed to evaluate the effects of running with dual-versus single-stiffness spike running shoes on running mechanics in long-distance runners with pronated feet.
Methods
Sixteen male elite (national competitive level) runners (5000 or 10,000 m) aged 28.2 ± 2.5 years with pronated feet volunteered to participate in this study. To be included, participants had to have achieved personal best race times over 5- and/or 10-km races under 17 or 34 min during official running competitions. All participants were heel strikers and had a history of 11.2 ± 4.2 years of training. For the assessment of running kinetics, a force plate was imbedded into a walkway. Running kinematics were recorded using a Vicon-motion-capture system. Nike Zoom Rival shoes (Nike, Nike Zoom Rival, USA) were selected and adapted according to spike softness and stiffness. Participants ran at a constant speed of ~4.0 m/s across the walkway with both shoe conditions in randomized order. Six trials were recorded per condition. The main outcomes included peak ground reaction forces and their time-to-peak, average and instantaneous vertical loading rates, free moments, and peak ankle eversion angles.
Results
Paired t-tests revealed significantly lower lateral (p = 0.021, d = 0.95) and vertical (p = 0.010, d = 1.40) forces at heel contact during running with dual-stiffness spike shoes. Running with dual-stiffness spike shoes resulted in a significantly longer time-to-peak vertical (p = 0.004, d = 1.40) force at heel contact. The analysis revealed significantly lower average (p = 0.005, d = 0.46) and instantaneous (p = 0.021, d = 0.49) loading rates and peak negative free moment amplitudes (p = 0.016, d = 0.81) when running with dual-stiffness spike shoes. Finally, significantly lower peak ankle eversion angles were observed with dual-stiffness spike shoes (p < 0.001, d = 1.29).
Conclusions
Running in dual- compared with single-stiffness spike distance running shoes resulted in lower loading rates, free moment amplitudes, and peak ankle eversion angles of long-distance runners with pronated feet.
Postural balance represents a fundamental movement skill for the successful performance of everyday and sport-related activities. There is ample evidence on the effectiveness of balance training on balance performance in athletic and non-athletic population. However, less is known on potential transfer effects of other training types, such as plyometric jump training (PJT) on measures of balance. Given that PJT is a highly dynamic exercise mode with various forms of jump-landing tasks, high levels of postural control are needed to successfully perform PJT exercises. Accordingly, PJT has the potential to not only improve measures of muscle strength and power but also balance. To systematically review and synthetize evidence from randomized and non-randomized controlled trials regarding the effects of PJT on measures of balance in apparently healthy participants. Systematic literature searches were performed in the electronic databases PubMed, Web of Science, and SCOPUS. A PICOS approach was applied to define inclusion criteria, (i) apparently healthy participants, with no restrictions on their fitness level, sex, or age, (ii) a PJT program, (iii) active controls (any sport-related activity) or specific active controls (a specific exercise type such as balance training), (iv) assessment of dynamic, static balance pre- and post-PJT, (v) randomized controlled trials and controlled trials. The methodological quality of studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. This meta-analysis was computed using the inverse variance random-effects model. The significance level was set at p <0.05. The initial search retrieved 8,251 plus 23 records identified through other sources. Forty-two articles met our inclusion criteria for qualitative and 38 for quantitative analysis (1,806 participants [990 males, 816 females], age range 9–63 years). PJT interventions lasted between 4 and 36 weeks. The median PEDro score was 6 and no study had low methodological quality (≤3). The analysis revealed significant small effects of PJT on overall (dynamic and static) balance (ES = 0.46; 95% CI = 0.32–0.61; p < 0.001), dynamic (e.g., Y-balance test) balance (ES = 0.50; 95% CI = 0.30–0.71; p < 0.001), and static (e.g., flamingo balance test) balance (ES = 0.49; 95% CI = 0.31–0.67; p < 0.001). The moderator analyses revealed that sex and/or age did not moderate balance performance outcomes. When PJT was compared to specific active controls (i.e., participants undergoing balance training, whole body vibration training, resistance training), both PJT and alternative training methods showed similar effects on overall (dynamic and static) balance (p = 0.534). Specifically, when PJT was compared to balance training, both training types showed similar effects on overall (dynamic and static) balance (p = 0.514). Conclusion: Compared to active controls, PJT showed small effects on overall balance, dynamic and static balance. Additionally, PJT produced similar balance improvements compared to other training types (i.e., balance training). Although PJT is widely used in athletic and recreational sport settings to improve athletes' physical fitness (e.g., jumping; sprinting), our systematic review with meta-analysis is novel in as much as it indicates that PJT also improves balance performance. The observed PJT-related balance enhancements were irrespective of sex and participants' age. Therefore, PJT appears to be an adequate training regime to improve balance in both, athletic and recreational settings.
Background: The prevalence of diabetes worldwide is predicted to increase from 2.8% in 2000 to 4.4% in 2030. Diabetic neuropathy (DN) is associated with damage to nerve glial cells, their axons, and endothelial cells leading to impaired function and mobility.
Objective: We aimed to examine the effects of an endurance-dominated exercise program on maximum oxygen consumption (VO2max), ground reaction forces, and muscle activities during walking in patients with moderate DN.
Methods: Sixty male and female individuals aged 45–65 years with DN were randomly assigned to an intervention (IG, n = 30) or a waiting control (CON, n = 30) group. The research protocol of this study was registered with the Local Clinical Trial Organization (IRCT20200201046326N1). IG conducted an endurance-dominated exercise program including exercises on a bike ergometer and gait therapy. The progressive intervention program lasted 12 weeks with three sessions per week, each 40–55 min. CON received the same treatment as IG after the post-tests. Pre- and post-training, VO2max was tested during a graded exercise test using spiroergometry. In addition, ground reaction forces and lower limbs muscle activities were recorded while walking at a constant speed of ∼1 m/s.
Results: No statistically significant baseline between group differences was observed for all analyzed variables. Significant group-by-time interactions were found for VO2max (p < 0.001; d = 1.22). The post-hoc test revealed a significant increase in IG (p < 0.001; d = 1.88) but not CON. Significant group-by-time interactions were observed for peak lateral and vertical ground reaction forces during heel contact and peak vertical ground reaction force during push-off (p = 0.001–0.037; d = 0.56–1.53). For IG, post-hoc analyses showed decreases in peak lateral (p < 0.001; d = 1.33) and vertical (p = 0.004; d = 0.55) ground reaction forces during heel contact and increases in peak vertical ground reaction force during push-off (p < 0.001; d = 0.92). In terms of muscle activity, significant group-by-time interactions were found for vastus lateralis and gluteus medius during the loading phase and for vastus medialis during the mid-stance phase, and gastrocnemius medialis during the push-off phase (p = 0.001–0.044; d = 0.54–0.81). Post-hoc tests indicated significant intervention-related increases in vastus lateralis (p = 0.001; d = 1.08) and gluteus medius (p = 0.008; d = 0.67) during the loading phase and vastus medialis activity during mid-stance (p = 0.001; d = 0.86). In addition, post-hoc tests showed decreases in gastrocnemius medialis during the push-off phase in IG only (p < 0.001; d = 1.28).
Conclusions: This study demonstrated that an endurance-dominated exercise program has the potential to improve VO2max and diabetes-related abnormal gait in patients with DN. The observed decreases in peak vertical ground reaction force during the heel contact of walking could be due to increased vastus lateralis and gluteus medius activities during the loading phase. Accordingly, we recommend to implement endurance-dominated exercise programs in type 2 diabetic patients because it is feasible, safe and effective by improving aerobic capacity and gait characteristics.
Background: The standard method to treat physically active patients with anterior cruciate ligament (ACL) rupture is ligament reconstruction surgery. The rehabilitation training program is very important to improve functional performance in recreational athletes following ACL reconstruction.
Objectives: The aims of this study were to compare the effects of three different training programs, eccentric training (ECC), plyometric training (PLYO), or combined eccentric and plyometric training (COMB), on dynamic balance (Y-BAL), the Lysholm Knee Scale (LKS), the return to sport index (RSI), and the leg symmetry index (LSI) for the single leg hop test for distance in elite female athletes after ACL surgery.
Materials and Methods: Fourteen weeks after rehabilitation from surgery, 40 elite female athletes (20.3 ± 3.2 years), who had undergone an ACL reconstruction, participated in a short-term (6 weeks; two times a week) training study. All participants received the same rehabilitation protocol prior to the training study. Athletes were randomly assigned to three experimental groups, ECC (n = 10), PLYO (n = 10), and COMB (n = 10), and to a control group (CON: n = 10). Testing was conducted before and after the 6-week training programs and included the Y-BAL, LKS, and RSI. LSI was assessed after the 6-week training programs only.
Results: Adherence rate was 100% across all groups and no training or test-related injuries were reported. No significant between-group baseline differences (pre-6-week training) were observed for any of the parameters. Significant group-by-time interactions were found for Y-BAL (p < 0.001, ES = 1.73), LKS (p < 0.001, ES = 0.76), and RSI (p < 0.001, ES = 1.39). Contrast analysis demonstrated that COMB yielded significantly greater improvements in Y-BAL, LKS, and RSI (all p < 0.001), in addition to significantly better performances in LSI (all p < 0.001), than CON, PLYO, and ECC, respectively.
Conclusion: In conclusion, combined (eccentric/plyometric) training seems to represent the most effective training method as it exerts positive effects on both stability and functional performance in the post-ACL-surgical rehabilitation period of elite female athletes.
Previous studies have not considered the potential influence of maturity status on the relationship between mental imagery and change of direction (CoD) speed in youth soccer. Accordingly, this cross-sectional study examined the association between mental imagery and CoD performance in young elite soccer players of different maturity status. Forty young male soccer players, aged 10-17 years, were assigned into two groups according to their predicted age at peak height velocity (PHV) (Pre-PHV; n = 20 and Post-PHV; n = 20). Participants were evaluated on soccer-specific tests of CoD with (CoDBall-15m) and without (CoD-15m) the ball. Participants completed the movement imagery questionnaire (MIQ) with the three- dimensional structure, internal visual imagery (IVI), external visual imagery (EVI), as well as kinesthetic imagery (KI). The Post-PHV players achieved significantly better results than Pre-PHV in EVI (ES = 1.58, large; p < 0.001), CoD-15m (ES = 2.09, very large; p < 0.001) and CoDBall-15m (ES = 1.60, large; p < 0.001). Correlations were significantly different between maturity groups, where, for the pre-PHV group, a negative very large correlation was observed between CoDBall-15m and KI (r = –0.73, p = 0.001). For the post-PHV group, large negative correlations were observed between CoD-15m and IVI (r = –0.55, p = 0.011), EVI (r = –062, p = 0.003), and KI (r = –0.52, p = 0.020). A large negative correlation of CoDBall-15m with EVI (r = –0.55, p = 0.012) and very large correlation with KI (r = –0.79, p = 0.001) were also observed. This study provides evidence of the theoretical and practical use for the CoD tasks stimulus with imagery. We recommend that sport psychology specialists, coaches, and athletes integrated imagery for CoD tasks in pre-pubertal soccer players to further improve CoD related performance.
Background
High prevalence rates have been reported for physical inactivity, mobility limitations, and falls in older adults. Home-based exercise might be an adequate means to increase physical activity by improving health- (i.e., muscle strength) and skill-related components of physical fitness (i.e., balance), particularly in times of restricted physical activity due to pandemics.
Objective
The objective of this study was to examine the effects of home-based balance exercises conducted during daily tooth brushing on measures of balance and muscle strength in healthy older adults.
Methods
Fifty-one older adults were randomly assigned to a balance exercise group (n = 27; age: 65.1 ± 1.1 years) or a passive control group (n = 24; age: 66.2 ± 3.3 years). The intervention group conducted balance exercises over a period of eight weeks twice daily for three minutes each during their daily tooth brushing routine. Pre- and post-intervention, tests were included for the assessment of static steady-state balance (i.e., Romberg test), dynamic steady-state balance (i.e., 10-m single and dual-task walk test using a cognitive and motor interference task), proactive balance (i.e., Timed-Up-and-Go Test [TUG], Functional-Reach-Test [FRT]), and muscle strength (i.e., Chair-Rise-Test [CRT]).
Results
Irrespective of group, the statistical analysis revealed significant main effects for time (pre vs. post) for dual-task gait speed (p < .001, 1.12 ≤ d ≤ 2.65), TUG (p < .001, d = 1.17), FRT (p = .002, d = 0.92), and CRT (p = .002, d = 0.94) but not for single-task gait speed and for the Romberg-Test. No significant group × time interactions were found for any of the investigated variables.
Conclusions
The applied lifestyle balance training program conducted twice daily during tooth brushing routines appears not to be sufficient in terms of exercise dosage and difficulty level to enhance balance and muscle strength in healthy adults aged 60–72 years. Consequently, structured balance training programs using higher exercise dosages and/or more difficult balance tasks are recommended for older adults to improve balance and muscle strength.
Background
High prevalence rates have been reported for physical inactivity, mobility limitations, and falls in older adults. Home-based exercise might be an adequate means to increase physical activity by improving health- (i.e., muscle strength) and skill-related components of physical fitness (i.e., balance), particularly in times of restricted physical activity due to pandemics.
Objective
The objective of this study was to examine the effects of home-based balance exercises conducted during daily tooth brushing on measures of balance and muscle strength in healthy older adults.
Methods
Fifty-one older adults were randomly assigned to a balance exercise group (n = 27; age: 65.1 ± 1.1 years) or a passive control group (n = 24; age: 66.2 ± 3.3 years). The intervention group conducted balance exercises over a period of eight weeks twice daily for three minutes each during their daily tooth brushing routine. Pre- and post-intervention, tests were included for the assessment of static steady-state balance (i.e., Romberg test), dynamic steady-state balance (i.e., 10-m single and dual-task walk test using a cognitive and motor interference task), proactive balance (i.e., Timed-Up-and-Go Test [TUG], Functional-Reach-Test [FRT]), and muscle strength (i.e., Chair-Rise-Test [CRT]).
Results
Irrespective of group, the statistical analysis revealed significant main effects for time (pre vs. post) for dual-task gait speed (p < .001, 1.12 ≤ d ≤ 2.65), TUG (p < .001, d = 1.17), FRT (p = .002, d = 0.92), and CRT (p = .002, d = 0.94) but not for single-task gait speed and for the Romberg-Test. No significant group × time interactions were found for any of the investigated variables.
Conclusions
The applied lifestyle balance training program conducted twice daily during tooth brushing routines appears not to be sufficient in terms of exercise dosage and difficulty level to enhance balance and muscle strength in healthy adults aged 60–72 years. Consequently, structured balance training programs using higher exercise dosages and/or more difficult balance tasks are recommended for older adults to improve balance and muscle strength.
Background
To improve propulsion during running, athletes often wear spike shoes designed for training and/or competition. Running with spike shoes may cause pain and/or injuries. To address this problem, a modified spike shoe was tested. This study aimed to evaluate the effects of running with dual-versus single-stiffness spike running shoes on running mechanics in long-distance runners with pronated feet.
Methods
Sixteen male elite (national competitive level) runners (5000 or 10,000 m) aged 28.2 ± 2.5 years with pronated feet volunteered to participate in this study. To be included, participants had to have achieved personal best race times over 5- and/or 10-km races under 17 or 34 min during official running competitions. All participants were heel strikers and had a history of 11.2 ± 4.2 years of training. For the assessment of running kinetics, a force plate was imbedded into a walkway. Running kinematics were recorded using a Vicon-motion-capture system. Nike Zoom Rival shoes (Nike, Nike Zoom Rival, USA) were selected and adapted according to spike softness and stiffness. Participants ran at a constant speed of ~4.0 m/s across the walkway with both shoe conditions in randomized order. Six trials were recorded per condition. The main outcomes included peak ground reaction forces and their time-to-peak, average and instantaneous vertical loading rates, free moments, and peak ankle eversion angles.
Results
Paired t-tests revealed significantly lower lateral (p = 0.021, d = 0.95) and vertical (p = 0.010, d = 1.40) forces at heel contact during running with dual-stiffness spike shoes. Running with dual-stiffness spike shoes resulted in a significantly longer time-to-peak vertical (p = 0.004, d = 1.40) force at heel contact. The analysis revealed significantly lower average (p = 0.005, d = 0.46) and instantaneous (p = 0.021, d = 0.49) loading rates and peak negative free moment amplitudes (p = 0.016, d = 0.81) when running with dual-stiffness spike shoes. Finally, significantly lower peak ankle eversion angles were observed with dual-stiffness spike shoes (p < 0.001, d = 1.29).
Conclusions
Running in dual- compared with single-stiffness spike distance running shoes resulted in lower loading rates, free moment amplitudes, and peak ankle eversion angles of long-distance runners with pronated feet.
Background/objective
Dry land-training (e.g., plyometric jump training) can be a useful mean to improve swimming performance. This study examined the effects of an 8-week plyometric jump training (PJT) program on jump and sport-specific performances in prepubertal female swimmers.
Methods
Twenty-two girls were randomly assigned to either a plyometric jump training group (PJTG; n = 12, age: 10.01 ± 0.57 years, maturity-offset = -1.50 ± 0.50, body mass = 36.39 ± 6.32 kg, body height = 146.90 ± 7.62 cm, body mass index = 16.50 ± 1.73 kg/m2) or an active control (CG; n = 10, age: 10.50 ± 0.28 years, maturity-offset = -1.34 ± 0.51, body mass = 38.41 ± 9.42 kg, body height = 143.60 ± 5.05 cm, body mass index = 18.48 ± 3.77 kg/m2). Pre- and post-training, tests were conducted for the assessment of muscle power (e.g., countermovement-jump [CMJ], standing-long-jump [SLJ]). Sport-specific-performances were tested using the timed 25 and 50-m front crawl with a diving-start, timed 25-m front crawl without push-off from the wall (25-m WP), and a timed 25-m kick without push-off from the wall (25-m KWP).
Results
Findings showed a significant main effect of time for the CMJ (d = 0.78), the SLJ (d = 0.91), 25-m front crawl test (d = 2.5), and the 25-m-KWP (d = 1.38) test. Significant group × time interactions were found for CMJ, SLJ, 25-m front crawl, 50-m front crawl, 25-m KWP, and 25-m WP test (d = 0.29–1.63) in favor of PJTG (d = 1.34–3.50). No significant pre-post changes were found for CG (p > 0.05).
Conclusion
In sum, PJT is effective in improving muscle power and sport-specific performances in prepubertal swimmers. Therefore, PJT should be included from an early start into the regular training program of swimmers.
Background
Earlier studies have shown that balance training (BT) has the potential to induce performance enhancements in selected components of physical fitness (i.e., balance, muscle strength, power, speed). While there is ample evidence on the long-term effects of BT on components of physical fitness in youth, less is known on the short-term or acute effects of single BT sessions on selected measures of physical fitness.
Objective
To examine the acute effects of different balance exercise types on balance, change-of-direction (CoD) speed, and jump performance in youth female volleyball players.
Methods
Eleven female players aged 14 years participated in this study. Three types of balance exercises (i.e., anterior, posterolateral, rotational type) were conducted in randomized order. For each exercise, 3 sets including 5 repetitions were performed. Before and after the performance of the balance exercises, participants were tested for their static balance (center of pressure surface area [CoP SA] and velocity [CoP V]) on foam and firm surfaces, CoD speed (T-Half test), and vertical jump height (countermovement jump [CMJ] height). A 3 (condition: anterior, mediolateral, rotational balance exercise type) × 2 (time: pre, post) analysis of variance was computed with repeated measures on time.
Results
Findings showed no significant condition × time interactions for all outcome measures (p > 0.05). However, there were small main effects of time for CoP SA on firm and foam surfaces (both d = 0.38; all p < 0.05) with no effect for CoP V on both surface conditions (p > 0.05). For CoD speed, findings showed a large main effect of time (d = 0.91; p < 0.001). However, for CMJ height, no main effect of time was observed (p > 0.05).
Conclusions
Overall, our results indicated small-to-large changes in balance and CoD speed performances but not in CMJ height in youth female volleyball players, regardless of the balance exercise type. Accordingly, it is recommended to regularly integrate balance exercises before the performance of sport-specific training to optimize performance development in youth female volleyball players.
Aim The purpose of this study was to examine physical fitness and psycho-cognitive performance and their associations in young and middle-aged workers with primarily physical versus mental work demands. Subjects and methods Healthy young and middle-aged workers (73 men, age = 33 +/- 7 years; 75 women, age = 35 +/- 9 years) were recruited from German small-to-medium-sized enterprises (< 250 employees) and classified into groups with primarily mental (MD) or physical demands (PD) at work. Participants were tested for cardiorespiratory fitness, trunk flexor/extensor muscular endurance, handgrip strength, balance, leg muscle power, perceived stress, cognitive performance, and work ability. Results Ninety-four workers were allocated to the MD (53% females) and 54 to the PD (46% females) groups. The MD group showed significantly better balance, trunk extensor muscular endurance, and cognitive performance (p < 0.035, 0.35 <= d <= 0.55) and less stress compared with the PD group (p < 0.023, d = 0.38). Group-specific Spearman rank correlation analysis (r(S)) revealed significant small-to-medium-sized correlations between physical fitness and cognitive performance (- 0.205 <= r(S) <= 0.434) in the MD and PD groups. Significant small-to-medium-sized correlations were found for physical fitness and stress/work ability (0.211 <= r(S) <= 0.301) in the MD group only. Further, associations of trunk extensor muscular endurance and work ability were significantly higher in the MD group (r(S) = 0.240) compared with the PD group (r(S) = - 0.141; z = 2.16, p = 0.031). Conclusions MD workers showed better physical fitness measures (balance, trunk extensor muscular endurance) and cognitive performance and lower levels of perceived stress compared with PD workers. Small-to-medium-sized associations between physical fitness and psycho-cognitive performance measures indicate that gains in physical fitness may at least partly contribute to psycho-cognitive performance and/or vice versa, particularly in MD workers.
Many adults older than 60 yr experience mobility limitations. Although physical exercise improves older adults' mobility, differences in baseline mobility produce large variations in individual responses to interventions, and these responses could further vary by the type and dose of exercise. Here, we propose an exercise prescription model for older adults based on their current mobility status.
Background: The prevalence of diabetes worldwide is predicted to increase from 2.8% in 2000 to 4.4% in 2030. Diabetic neuropathy (DN) is associated with damage to nerve glial cells, their axons, and endothelial cells leading to impaired function and mobility.
Objective: We aimed to examine the effects of an endurance-dominated exercise program on maximum oxygen consumption (VO2max), ground reaction forces, and muscle activities during walking in patients with moderate DN.
Methods: Sixty male and female individuals aged 45–65 years with DN were randomly assigned to an intervention (IG, n = 30) or a waiting control (CON, n = 30) group. The research protocol of this study was registered with the Local Clinical Trial Organization (IRCT20200201046326N1). IG conducted an endurance-dominated exercise program including exercises on a bike ergometer and gait therapy. The progressive intervention program lasted 12 weeks with three sessions per week, each 40–55 min. CON received the same treatment as IG after the post-tests. Pre- and post-training, VO2max was tested during a graded exercise test using spiroergometry. In addition, ground reaction forces and lower limbs muscle activities were recorded while walking at a constant speed of ∼1 m/s.
Results: No statistically significant baseline between group differences was observed for all analyzed variables. Significant group-by-time interactions were found for VO2max (p < 0.001; d = 1.22). The post-hoc test revealed a significant increase in IG (p < 0.001; d = 1.88) but not CON. Significant group-by-time interactions were observed for peak lateral and vertical ground reaction forces during heel contact and peak vertical ground reaction force during push-off (p = 0.001–0.037; d = 0.56–1.53). For IG, post-hoc analyses showed decreases in peak lateral (p < 0.001; d = 1.33) and vertical (p = 0.004; d = 0.55) ground reaction forces during heel contact and increases in peak vertical ground reaction force during push-off (p < 0.001; d = 0.92). In terms of muscle activity, significant group-by-time interactions were found for vastus lateralis and gluteus medius during the loading phase and for vastus medialis during the mid-stance phase, and gastrocnemius medialis during the push-off phase (p = 0.001–0.044; d = 0.54–0.81). Post-hoc tests indicated significant intervention-related increases in vastus lateralis (p = 0.001; d = 1.08) and gluteus medius (p = 0.008; d = 0.67) during the loading phase and vastus medialis activity during mid-stance (p = 0.001; d = 0.86). In addition, post-hoc tests showed decreases in gastrocnemius medialis during the push-off phase in IG only (p < 0.001; d = 1.28).
Conclusions: This study demonstrated that an endurance-dominated exercise program has the potential to improve VO2max and diabetes-related abnormal gait in patients with DN. The observed decreases in peak vertical ground reaction force during the heel contact of walking could be due to increased vastus lateralis and gluteus medius activities during the loading phase. Accordingly, we recommend to implement endurance-dominated exercise programs in type 2 diabetic patients because it is feasible, safe and effective by improving aerobic capacity and gait characteristics.
Purpose
The objective of the investigation was to determine the concomitant effects of upper arm blood flow restriction (BFR) and inversion on elbow flexors neuromuscular responses.
Methods
Randomly allocated, 13 volunteers performed four conditions in a within-subject design: rest (control, 1-min upright position without BFR), control (1-min upright with BFR), 1-min inverted (without BFR), and 1-min inverted with BFR. Evoked and voluntary contractile properties, before, during and after a 30-s maximum voluntary contraction (MVC) exercise intervention were examined as well as pain scale.
Results
Inversion induced significant pre-exercise intervention decreases in elbow flexors MVC (21.1%, Z2p = 0.48, p = 0.02) and resting evoked twitch forces (29.4%, Z2p = 0.34, p = 0.03). The 30-s MVC induced significantly greater pre- to post-test decreases in potentiated twitch force (Z2p = 0.61, p = 0.0009) during inversion (75%) than upright (65.3%) conditions. Overall, BFR decreased MVC force 4.8% (Z2p = 0.37, p = 0.05). For upright position, BFR induced 21.0% reductions in M-wave amplitude (Z2p = 0.44, p = 0.04). There were no significant differences for electromyographic activity or voluntary activation as measured with the interpolated twitch technique. For all conditions, there was a significant increase in pain scale between the 40-60 s intervals and post-30-s MVC (upright< inversion, and without BFR< BFR).
Conclusion
The concomitant application of inversion with elbow flexors BFR only amplified neuromuscular performance impairments to a small degree. Individuals who execute forceful contractions when inverted or with BFR should be cognizant that force output may be impaired.
Background: The standard method to treat physically active patients with anterior cruciate ligament (ACL) rupture is ligament reconstruction surgery. The rehabilitation training program is very important to improve functional performance in recreational athletes following ACL reconstruction.
Objectives: The aims of this study were to compare the effects of three different training programs, eccentric training (ECC), plyometric training (PLYO), or combined eccentric and plyometric training (COMB), on dynamic balance (Y-BAL), the Lysholm Knee Scale (LKS), the return to sport index (RSI), and the leg symmetry index (LSI) for the single leg hop test for distance in elite female athletes after ACL surgery.
Materials and Methods: Fourteen weeks after rehabilitation from surgery, 40 elite female athletes (20.3 ± 3.2 years), who had undergone an ACL reconstruction, participated in a short-term (6 weeks; two times a week) training study. All participants received the same rehabilitation protocol prior to the training study. Athletes were randomly assigned to three experimental groups, ECC (n = 10), PLYO (n = 10), and COMB (n = 10), and to a control group (CON: n = 10). Testing was conducted before and after the 6-week training programs and included the Y-BAL, LKS, and RSI. LSI was assessed after the 6-week training programs only.
Results: Adherence rate was 100% across all groups and no training or test-related injuries were reported. No significant between-group baseline differences (pre-6-week training) were observed for any of the parameters. Significant group-by-time interactions were found for Y-BAL (p < 0.001, ES = 1.73), LKS (p < 0.001, ES = 0.76), and RSI (p < 0.001, ES = 1.39). Contrast analysis demonstrated that COMB yielded significantly greater improvements in Y-BAL, LKS, and RSI (all p < 0.001), in addition to significantly better performances in LSI (all p < 0.001), than CON, PLYO, and ECC, respectively.
Conclusion: In conclusion, combined (eccentric/plyometric) training seems to represent the most effective training method as it exerts positive effects on both stability and functional performance in the post-ACL-surgical rehabilitation period of elite female athletes.
Postural balance represents a fundamental movement skill for the successful performance of everyday and sport-related activities. There is ample evidence on the effectiveness of balance training on balance performance in athletic and non-athletic population. However, less is known on potential transfer effects of other training types, such as plyometric jump training (PJT) on measures of balance. Given that PJT is a highly dynamic exercise mode with various forms of jump-landing tasks, high levels of postural control are needed to successfully perform PJT exercises. Accordingly, PJT has the potential to not only improve measures of muscle strength and power but also balance. To systematically review and synthetize evidence from randomized and non-randomized controlled trials regarding the effects of PJT on measures of balance in apparently healthy participants. Systematic literature searches were performed in the electronic databases PubMed, Web of Science, and SCOPUS. A PICOS approach was applied to define inclusion criteria, (i) apparently healthy participants, with no restrictions on their fitness level, sex, or age, (ii) a PJT program, (iii) active controls (any sport-related activity) or specific active controls (a specific exercise type such as balance training), (iv) assessment of dynamic, static balance pre- and post-PJT, (v) randomized controlled trials and controlled trials. The methodological quality of studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. This meta-analysis was computed using the inverse variance random-effects model. The significance level was set at p <0.05. The initial search retrieved 8,251 plus 23 records identified through other sources. Forty-two articles met our inclusion criteria for qualitative and 38 for quantitative analysis (1,806 participants [990 males, 816 females], age range 9–63 years). PJT interventions lasted between 4 and 36 weeks. The median PEDro score was 6 and no study had low methodological quality (≤3). The analysis revealed significant small effects of PJT on overall (dynamic and static) balance (ES = 0.46; 95% CI = 0.32–0.61; p < 0.001), dynamic (e.g., Y-balance test) balance (ES = 0.50; 95% CI = 0.30–0.71; p < 0.001), and static (e.g., flamingo balance test) balance (ES = 0.49; 95% CI = 0.31–0.67; p < 0.001). The moderator analyses revealed that sex and/or age did not moderate balance performance outcomes. When PJT was compared to specific active controls (i.e., participants undergoing balance training, whole body vibration training, resistance training), both PJT and alternative training methods showed similar effects on overall (dynamic and static) balance (p = 0.534). Specifically, when PJT was compared to balance training, both training types showed similar effects on overall (dynamic and static) balance (p = 0.514). Conclusion: Compared to active controls, PJT showed small effects on overall balance, dynamic and static balance. Additionally, PJT produced similar balance improvements compared to other training types (i.e., balance training). Although PJT is widely used in athletic and recreational sport settings to improve athletes' physical fitness (e.g., jumping; sprinting), our systematic review with meta-analysis is novel in as much as it indicates that PJT also improves balance performance. The observed PJT-related balance enhancements were irrespective of sex and participants' age. Therefore, PJT appears to be an adequate training regime to improve balance in both, athletic and recreational settings.
Reference values and validation of the 1-minute sit-to-stand test in healthy 5-16-year-old youth
(2021)
Objectives:
It is essential to have simple, reliable and valid tests to measure children's functional capacity in schools or medical practice. The 1-minute sit-to-stand (STS) test is a quick fitness test requiring little equipment or space that is increasingly used in both healthy populations and those with chronic disease. We aimed to provide age-specific and sex-specific reference values of STS test in healthy children and adolescents and to evaluate its short-term reliability and construct validity.
Design setting and participants:
Cross-sectional convenience sample from six public schools and one science fair in central Europe. Overall, 587 healthy participants aged 5-16 years were recruited and divided into age groups of 3 years each.
Outcomes:
1-minute STS. To evaluate short-term reliability, some children performed the STS test twice. To evaluate construct validity, some children also performed a standing long jump (SLJ) and a maximal incremental exercise test.
Results:
Data from 547 youth aged 5-16 years were finally included in the analyses. The median number of repetitions in 1 min in males (females) ranged from 55 [95% CI: 38 to 72] (53 [95% CI: 35 to 76]) in 14-16-year olds to 59 [95% CI: 41 to 77] (60 [95% CI: 38 to 77]) in 8-10-year olds. Children who repeated STS showed a learning effect of on average 4.8 repetitions more than the first test (95% limits of agreement: -6.7 to 16.4). Moderate correlations were observed between the STS and the SLJ (r=0.48) tests and the maximal exercise test (r=0.43).
Conclusions:
The reported STS reference values can be used to interpret STS test performance in children and adolescents. The STS appears to have good test- retest reliability, but a learning effect of about 10%. The association of STS with other measures of physical fitness should be further explored in a larger study and technical standards for its conduct are needed.
Background:
This double-blinded randomized-controlled-trial aimed to identify the effects of an elastic band resistance training on walking kinetics and muscle activities in young adults with genu valgus.
Methods:
Forty-two male young adults aged 22.5(2.7) years with genu valgus were randomly allocated to two experimental groups. The intervention group (n = 21) conducted a 14-weeks elastic band resistance training. The control group was passive during the intervention period and received the same treatment after the post-tests. Pre and post training, ground reaction forces and lower limb muscle activities were recorded during walking.
Findings:
Results revealed significant group-by-time interactions for peak medial ground reaction force and timeto-peak for posterior ground reaction force in favor of the intervention group (p < 0.012; d = 0.83-3.76). Resistance training with elastic bands resulted in significantly larger peak medial ground reaction force (p < 0.001; d = 1.45) and longer time-to-peak for posterior ground reaction force (p < 0.001; d = 1.85). Finding showed significant group-by-time interactions for peak positive free moment amplitudes in favor of the intervention group (p < 0.001; d = 1.18-2.02). Resistance training resulted in a lower peak positive free moment amplitude (p = 0.001; d = 1.46). With regards to muscle activities, the analysis revealed significant group-by time interactions for rectus femoris and gluteus medius activities during the push-off phase in favor of the intervention group (p < 0.038; d = 0.68-0.89). Resistance training induced higher rectus femoris (p = 0.038; d = 0.84) and gluteus medius (p = 0.007; d = 0.54) activities.
Interpretation:
This study proved the effectiveness of resistance training using elastic bands on kinetics and muscle activities during walking in male adults with genu valgus disorder. Given that this training regime is low cost, effective, and easy-to-administer, we suggest that it should be implemented as a rehabilitative or preventive means for young adults with genu valgus.