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Reference values and validation of the 1-minute sit-to-stand test in healthy 5-16-year-old youth
(2021)
Haile, Sarah R. ; Fühner, Thea Heidi ; Granacher, Urs ; Stocker, Julien ; Radtke, Thomas ; Kriemler, Susi
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: 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.
The termprocess modelis widely used, but rarely agreed upon. This paper proposes a framework for characterizing and building cognitive process models. Process models model not only inputs and outputs but also model the ongoing information transformations at a given level of abstraction. We argue that the following dimensions characterize process models: They have a scope that includes different levels of abstraction. They specify a hypothesized mental information transformation. They make predictions not only for the behavior of interest but also for processes. The models' predictions for the processes can be derived from the input, without reverse inference from the output data. Moreover, the presumed information transformation steps are not contradicting current knowledge of human cognitive capacities. Lastly, process models require a conceptual scope specifying levels of abstraction for the information entering the mind, the proposed mental events, and the behavior of interest. This framework can be used for refining models before testing them or after testing them empirically, and it does not rely on specific modeling paradigms. It can be a guideline for developing cognitive process models. Moreover, the framework can advance currently unresolved debates about which models belong to the category of process models.
Restrictive means to reduce the spread of the COVID-19 pandemic have not only imposed broad challenges on mental health but might also affect cognitive health. Here we asked how restriction-related changes influence cognitive performance and how age, perceived loneliness, depressiveness and affectedness by restrictions contribute to these effects. 51 Germans completed three assessments of an online based study during the first lockdown in Germany (April 2020), a month later, and during the beginning of the second lockdown (November 2020). Participants completed nine online cognitive tasks of the MyBrainTraining and online questionnaires about their perceived strain and impact on lifestyle factors by the situation (affectedness), perceived loneliness, depressiveness as well as subjective cognitive performance. The results suggested a possible negative impact of depressiveness and affectedness on objective cognitive performance within the course of the lockdown. The younger the participants, the more pronounced these effects were. Loneliness and depressiveness moreover contributed to a worse evaluation of subjective cognition. In addition, especially younger individuals reported increased distress. As important educational and social input has partly been scarce during this pandemic and mental health problems have increased, future research should also assess cognitive long-term consequences.
Biological maturation has been shown to affect male youths' responses to plyometric training (PT). However, to date, no researcher has examined the effect of maturation on the effects of PT in female youth. We undertook the first controlled intervention study to examine this, focusing on adaptive responses to countermovement jump (CMJ), reactive strength index (RSI), and change of direction (COD) performance in groups of female youth divided by maturation status (years from peak height velocity [PHV]). The training program lasted 7 weeks with subjects undertaking 2 sessions of PT per week. In the mid-PHV group, there was a small increase (effect size; 90% confidence interval = 0.40; -0.23 to 1.03) in CMJ performance. No changes were observed in the post-PHV group (0.02; -0.68 to 0.72). For RSI, there was a moderate increase in the mid-PHV group (0.94; 0.29-1.59) with only a trivial increase in the post-PHV group (0.06; -0.65 to 0.76). The intervention exerted no positive effect on COD performance in any group. Plyometric training seems to enhance CMJ and RSI in female youth, although the magnitude of adaptation could be affected by maturation status. A twice-per-week program of multidirectional jumping and hopping, with bilateral and unilateral components, can be used as a preparatory precursor to physical education classes or recreational sport.
Case report
(2023)
The increasing prevalence of Long COVID is an imminent public health disaster, and established approaches have not provided adequate diagnostics or treatments. Recently, anesthetic blockade of the stellate ganglion was reported to improve Long COVID symptoms in a small case series, purportedly by "rebooting" the autonomic nervous system. Here, we present a novel diagnostic approach based on the Adaptive Force (AF), and report sustained positive outcome for one severely affected Long COVID patient using individualized pulsed electromagnetic field (PEMF) at the area C7/T1. AF reflects the capacity of the neuromuscular system to adapt adequately to external forces in an isometric holding manner. In case, maximal isometric AF (AFiso(max)) is exceeded, the muscle merges into eccentric muscle action. Thereby, the force usually increases further until maximal AF (AFmax) is reached. In case adaptation is optimal, AFiso(max) is similar to 99-100% of AFmax. This holding capacity (AFiso(max)) was found to be vulnerable to disruption by unpleasant stimulus and, hence, was regarded as functional parameter. AF was assessed by an objectified manual muscle test using a handheld device. Prior to treatment, AFiso(max) was considerably lower than AFmax for hip flexors (62 N = similar to 28% AFmax) and elbow flexors (71 N = similar to 44% AFmax); i.e., maximal holding capacity was significantly reduced, indicating dysfunctional motor control. We tested PEMF at C7/T1, identified a frequency that improved neuromuscular function, and applied it for similar to 15 min. Immediately post-treatment, AFiso(max) increased to similar to 210 N (similar to 100% AFmax) at hip and 184 N (similar to 100% AFmax) at elbow. Subjective Long COVID symptoms resolved the following day. At 4 weeks post-treatment, maximal holding capacity was still on a similarly high level as for immediately post-treatment (similar to 100% AFmax) and patient was symptom-free. At 6 months the patient's Long COVID symptoms have not returned. This case report suggests (1) AF could be a promising diagnostic for post-infectious illness, (2) AF can be used to test effective treatments for post-infectious illness, and (3) individualized PEMF may resolve post-infectious symptoms.
Tschorn, Mira ; Kuhlmann, Stella Linnea ; Rieckmann, Nina ; Beer, Katja ; Grosse, Laura ; Arolt, Volker ; Waltenberger, Johannes ; Haverkamp, Wilhelm ; Müller-Nordhorn, Jacqueline ; Hellweg, Rainer ; Ströhle, Andreas
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.
Tschorn, Mira ; Kuhlmann, Stella Linnea ; Rieckmann, Nina ; Beer, Katja ; Grosse, Laura ; Arolt, Volker ; Waltenberger, Johannes ; Haverkamp, Wilhelm ; Müller-Nordhorn, Jacqueline ; Hellweg, Rainer ; Ströhle, Andreas
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.
Real options are widely applied in strategic and operational decision-making, allowing for managerial flexibility in uncertaincontexts. Increased scholarly interest has led to an extensive but fragmented research landscape. We aim to measure andsystematize the research field quantitatively. To achieve this goal, we conduct bibliometric performance analyses and bibliographiccoupling analyses with an in-depth content review. The results of the performance analyses show an increasing interest in realoptions since the beginning of the 2000s and identify the most influential journals and authors. The science mappings reveal sixand seven research clusters over the last two decades. Based on an in-depth analysis of their themes, we develop a researchframework comprising antecedents, application areas, internal and external contingencies, and uncertainty resolution throughreal option valuation or reasoning. We identify several gaps in that framework, which we propose to tackle in future research.
Palma-Muñoz, Ignacio ; Ramírez-Campillo, Rodrigo ; Azocar-Gallardo, Jairo ; Álvarez, Cristian ; Asadi, Abbas ; Moran, Jason ; Chaabene, Helmi
This study examined the effect of 6 weeks of progressed and nonprogressed volume-based overload plyometric training (PT) on components of physical fitness and body composition measures in young male basketball players, compared with an active control group. Subjects were randomly assigned to a progressed PT (PPT, n = 7; age = 14.6 +/- 1.1 years), a non-PPT (NPPT, n = 8, age = 13.8 +/- 2.0 years), or a control group (CG, n = 7, age = 14.0 +/- 2.0 years). Before and after training, body composition measures (muscle mass and fat mass), countermovement jump with arms (CMJA) and countermovement jump without arms (CMJ), horizontal bilateral (HCMJ) and unilateral jump with right leg (RJ) and left leg (LJ), 20-cm drop jump (DJ20), sprint speed (10 m sprint), and change of direction speed (CODS [i.e., T-test]) were tested. Significant effects of time were observed for muscle and fat mass, all jump measures, and CODS (all p < 0.01; d = 0.37-0.83). Significant training group x time interactions were observed for all jump measures (all p < 0.05; d = 0.24-0.41). Post hoc analyses revealed significant pre-post performance improvements for the PPT (RJ and LJ: increment 18.6%, d = 0.8 and increment 22.7%, d = 0.9, respectively; HCMJ: increment 16.4%, d = 0.8; CMJ: increment 22.4%, d = 0.7; CMJA: increment 23.3%, d = 0.7; and DJ20: increment 39.7%, d = 1.1) and for the NPPT group (LJ: increment 14.1%, d = 0.4; DJ20: increment 32.9%, d = 0.8) with greater changes after PPT compared with NPPT for all jump measures (all p < 0.05; d = 0.21-0.81). The training efficiency was greater (p < 0.05; d = 0.22) after PPT (0.015% per jump) compared with NPPT (0.0053% per-jump). The PPT induced larger performance improvements on measures of physical fitness as compared to NPPT. Therefore, in-season progressive volume-based overload PT in young male basketball players is recommended.