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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.
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
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.
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.
Depressive disorders are associated with reduced life satisfaction and ability to work. The waiting time for psychotherapy in Germany is currently between three and six months. Accordingly, there is a need for alternative, evidence-based treatment options that are made accessible to patients at a low threshold. A large number of empirical studies prove the effectiveness of exercise in mild and moderate depression. For further conceptualization and quality assurance of exercise as a treatment option, it is necessary to understand the concrete mechanisms of action. In addition to physiological factors, psychological factors also play a role in the effect. As a meta-theory of human experience and behavior, Self-Determination Theory (SDT) provides a useful frame for understanding psychological mechanisms of action with concrete implications for treatment practice. The conceptual extension of SDT to include the frustration of basic psychological needs in addition to need satisfaction is proving useful in the study of mental illness. The first part of this dissertation consists of two publications that validate relevant measurement instruments in this context. The first questionnaire measures the extent of generally experienced satisfaction and frustration of the basic psychological needs for autonomy, competence, and relatedness. The second questionnaire measures the experienced satisfaction of needs by the instructor (here: exercise therapist). The second part of the dissertation includes two publications that examine and classify the satisfaction and frustration of basic psychological needs in depressive symptoms. Differences in the extent of need satisfaction and need frustration between a sample with depression and a sample without depressive symptoms are examined. Further, the relationship between need frustration and depressive symptoms is placed in the context of established pathological processes (emotional dysregulation, rumination). The main findings of this work show that by adding the dimension of need frustration to Basic Psychological Needs Theory, SDT now covers a broader spectrum on the health-disease continuum. In doing so, SDT focuses on the psychological impact of social environments. In addition to the nonfulfillment of basic psychological needs, it is primarily experienced need frustration that is a general vulnerability factor for the occurrence of psychological illness. Moreover, the unbalanced satisfaction of basic psychological needs possibly indicates a conflicting experience between the needs. For the treatment practice it can be deduced that an autonomy-supporting atmosphere, which enables the balanced satisfaction of all three needs, is central for the treatment success.
Satisfaction and frustration of the needs for autonomy, competence, and relatedness, as assessed with the 24-item Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS), have been found to be crucial indicators of individuals’ psychological health. To increase the usability of this scale within a clinical and health services research context, we aimed to validate a German short version (12 items) of this scale in individuals with depression including the examination of the relations from need frustration and need satisfaction to ill-being and quality of life (QOL). This cross-sectional study involved 344 adults diagnosed with depression (Mage (SD) = 47.5 years (11.1); 71.8% females). Confirmatory factor analyses indicated that the short version of the BPNSFS was not only reliable, but also fitted a six-factor structure (i.e., satisfaction/frustration X type of need). Subsequent structural equation modeling showed that need frustration related positively to indicators of ill-being and negatively to QOL. Surprisingly, need satisfaction did not predict differences in ill-being or QOL. The short form of the BPNSFS represents a practical instrument to measure need satisfaction and frustration in people with depression. Further, the results support recent evidence on the importance of especially need frustration in the prediction of psychopathology.
Satisfaction and frustration of the needs for autonomy, competence, and relatedness, as assessed with the 24-item Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS), have been found to be crucial indicators of individuals’ psychological health. To increase the usability of this scale within a clinical and health services research context, we aimed to validate a German short version (12 items) of this scale in individuals with depression including the examination of the relations from need frustration and need satisfaction to ill-being and quality of life (QOL). This cross-sectional study involved 344 adults diagnosed with depression (Mage (SD) = 47.5 years (11.1); 71.8% females). Confirmatory factor analyses indicated that the short version of the BPNSFS was not only reliable, but also fitted a six-factor structure (i.e., satisfaction/frustration X type of need). Subsequent structural equation modeling showed that need frustration related positively to indicators of ill-being and negatively to QOL. Surprisingly, need satisfaction did not predict differences in ill-being or QOL. The short form of the BPNSFS represents a practical instrument to measure need satisfaction and frustration in people with depression. Further, the results support recent evidence on the importance of especially need frustration in the prediction of psychopathology.
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.
Background and aims:
To succeed in competition, elite team and individual athletes often seek the development of both, high levels of muscle strength and power as well as cardiorespiratory endurance. In this context, concurrent training (CT) is a commonly applied and effective training approach. While being exposed to high training loads, youth athletes (≤ 18 years) are yet underrepresented in the scientific literature. Besides, immunological responses to CT have received little attention. Therefore, the aims of this work were to examine the acute (< 15min) and delayed (≥ 6 hours) effects of dif-ferent exercise order in CT on immunological stress responses, muscular fitness, metabolic response, and rating of perceived exertion (RPE) in highly trained youth male and female judo athletes.
Methods:
A total of twenty male and thirteen female participants, with an average age of 16 ± 1.8 years and 14.4 ± 2.1 years, respectively, were included in the study. They were randomly assigned to two CT sessions; power-endurance versus endurance-power (i.e., study 1), or strength-endurance versus endurance-strength (i.e., study 2). Markers of immune response (i.e., white-blood-cells, granulocytes, lymphocytes, mon-ocytes, and lymphocytes, granulocyte-lymphocyte-ratio, and systemic-inflammation-index), muscular fitness (i.e., counter-movement jump [CMJ]), metabolic responses (i.e., blood lactate, glucose), and RPE were collected at different time points (i.e., PRE12H, PRE, MID, POST, POST6H, POST22H).
Results (study 1):
There were significant time*order interactions for white-blood-cells, lymphocytes, granulocytes, monocytes, granulocyte-lymphocyte-ratio, and systemic-inflammation-index. The power-endurance order resulted in significantly larger PRE-to-POST increases in white-blood-cells, monocytes, and lymphocytes while the endur-ance-power order resulted in significantly larger PRE-to-POST increases in the granu-locyte-lymphocyte-ratio and systemic-inflammation-index. Likewise, significantly larger increases from PRE-to-POST6H in white-blood-cells and granulocytes were observed following the power-endurance order compared to endurance-power. All markers of immune response returned toward baseline values at POST22H. Moreover, there was a significant time*order interaction for blood glucose and lactate. Following the endur-ance-power order, blood lactate and glucose increased from PRE-to-MID but not from PRE-to-POST. Meanwhile, in the power-endurance order blood lactate and glucose increased from PRE-to-POST but not from PRE-to-MID. A significant time*order inter-action was observed for CMJ-force with larger PRE-to-POST decreases in the endur-ance-power order compared to power-endurance order. Further, CMJ-power showed larger PRE-to-MID performance decreases following the power-endurance order, com-pared to the endurance-power order. Regarding RPE, significant time*order interactions were noted with larger PRE-to-MID values following the endurance-power order and larger PRE-to-POST values following the power-endurance order.
Results (study 2):
There were significant time*order interactions for lymphocytes, monocytes, granulocyte-lymphocyte-ratio, and systemic-inflammation-index. The strength-endurance order resulted in significantly larger PRE-to-POST increases in lymphocytes while the endurance-strength order resulted in significantly larger PRE-to-POST increases in the granulocyte-lymphocyte-ratio and systemic-inflammation-index. All markers of the immune system returned toward baseline values at POST22H. Moreover, there was a significant time*order interaction for blood glucose and lactate. From PRE-to-MID, there was a significantly greater increase in blood lactate and glu-cose following the endurance-strength order compared to strength-endurance order. Meanwhile, from PRE-to-POST there was a significantly higher increase in blood glu-cose following the strength-endurance order compared to endurance-strength order. Regarding physical fitness, a significant time*order interaction was observed for CMJ-force and CMJ-power with larger PRE-to-MID increases following the endurance-strength order compared to the strength-endurance order. For RPE, significant time*order interactions were noted with larger PRE-to-MID values following the endur-ance-power order and larger PRE-to-POST values following the power-endurance or-der.
Conclusions:
The primary findings from both studies revealed order-dependent effects on immune responses. In male youth judo athletes, the results demonstrated greater immunological stress responses, both immediately (≤ 15 min) and delayed (≥ 6 hours), following the power-endurance order compared to the endurance-power order. For female youth judo athletes, the results indicated higher acute, but not delayed, order-dependent changes in immune responses following the strength-endurance order compared to the endurance-strength order. It is worth noting that in both studies, all markers of immune system response returned to baseline levels within 22 hours. This suggests that successful recovery from the exercise-induced immune stress response was achieved within 22 hours. Regarding metabolic responses, physical fitness, and perceived exertion, the findings from both studies indicated acute (≤ 15 minutes) alterations that were dependent on the exercise order. These alterations were primarily influ-enced by the endurance exercise component. Moreover, study 1 provided substantial evidence suggesting that internal load measures, such as immune markers, may differ from external load measures. This indicates a disparity between immunological, perceived, and physical responses following both concurrent training orders. Therefore, it is crucial for practitioners to acknowledge these differences and take them into consideration when designing training programs.
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.
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 relevance of physical fitness for children’s and adolescents’ health is indisputable and it is crucial to regularly assess and evaluate children’s and adolescents’ individual physical fitness development to detect potential negative health consequences in time. Physical fitness tests are easy-to-administer, reliable, and valid which is why they should be widely used to provide information on performance development and health status of children and adolescents. When talking about development of physical fitness, two perspectives can be distinguished. One perspective is how the physical fitness status of children and adolescents changed / developed over the past decades (i.e., secular trends). The other perspective covers the analyses how physical fitness develops with increasing age due to growth and maturation processes. Although, the development of children’s and adolescents’ physical fitness has been extensively described and analyzed in the literature, still some questions remain to be uncovered that will be addressed in the present doctoral thesis.
Previous systematic reviews and meta-analyses have examined secular trends in children’s and adolescents’ physical fitness. However, considering that those analyses are by now 15 years old and that updates are available only to limited components of physical fitness, it is time to re-analyze the literature and examine secular trends for selected components of physical fitness (i.e., cardiorespiratory endurance, muscle strength, proxies of muscle power, and speed). Fur-thermore, the available studies on children’s development of physical fitness as well as the ef-fects of moderating variables such as age and sex have been investigated within a long-term ontogenetic perspective. However, the effects of age and sex in the transition from pre-puberty to puberty in the ninth year of life using a short-term ontogenetic perspective and the effect of timing of school enrollment on children’s development of physical fitness have not been clearly identified. Therefore, the present doctoral thesis seeks to complement the knowledge of children’s and adolescents’ physical fitness development by updating secular trend analysis in selected components of physical fitness, by examining short-term ontogenetic cross-sectional developmental differences in children`s physical fitness, and by comparing physical fitness of older- and younger-than-keyage children versus keyage-children. These findings provide valuable information about children’s and adolescents’ physical fitness development to help prevent potential deficits in physical fitness as early as possible and consequently ensure a holistic development and a lifelong healthy life.
Initially, a systematic review to provide an ‘update’ on secular trends in selected components of physical fitness (i.e., cardiorespiratory endurance, relative muscle strength, proxies of muscle power, speed) in children and adolescents aged 6 to 18 years was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guidelines. To examine short-term ontogenetic cross-sectional developmental differences and to compare physical fitness of older- and younger-than-keyage children versus keyage-children physical fitness data of 108,295 keyage-children (i.e., aged 8.00 to 8.99 years), 2,586 younger-than-keyage children (i.e., aged 7.00 to 7.99 years), and 26,540 older-than-keyage children (i.e., aged 9.00 to 9.99 years) from the third grade were analyzed. Physical fitness was assessed through the EMOTIKON test battery measuring cardiorespiratory endurance (i.e., 6-min-run test), coordina-tion (i.e., star-run test), speed (i.e., 20-m linear sprint test), and proxies of lower (i.e., standing long jump test) and upper limbs (i.e., ball-push test) muscle power. Statistical inference was based on Linear Mixed Models.
Findings from the systematic review revealed a large initial improvement and an equally large subsequent decline between 1986 and 2010 as well as a stabilization between 2010 and 2015 in cardiorespiratory endurance, a general trend towards a small improvement in relative muscle strength from 1972 to 2015, an overall small negative quadratic trend for proxies of muscle power from 1972 to 2015, and a small-to-medium improvement in speed from 2002 to 2015. Findings from the cross-sectional studies showed that even in a single prepubertal year of life (i.e., ninth year) physical fitness performance develops linearly with increasing chronological age, boys showed better performances than girls in all physical fitness components, and the components varied in the size of sex and age effects. Furthermore, findings revealed that older-than-keyage children showed poorer performance in physical fitness compared to keyage-children, older-than-keyage girls showed better performances than older-than-keyage boys, and younger-than-keyage children outperformed keyage-children.
Due to the varying secular trends in physical fitness, it is recommended to promote initiatives for physical activity and physical fitness for children and adolescents to prevent adverse effects on health and well-being. More precisely, public health initiatives should specifically consider exercising cardiorespiratory endurance and muscle strength because both components showed strong positive associations with markers of health. Furthermore, the findings implied that physical education teachers, coaches, or researchers can utilize a proportional adjustment to individually interpret physical fitness of prepubertal school-aged children. Special attention should be given to the promotion of physical fitness of older-than-keyage children because they showed poorer performance in physical fitness than keyage-children. Therefore, it is necessary to specifically consider this group and provide additional health and fitness programs to reduce their deficits in physical fitness experienced during prior years to guarantee a holistic development.
Krafttraining ist ein etabliertes Mittel für die Entwicklung körperlicher Fitness und sport-artspezifischer Leistungen in verschiedenen Sportarten. Dabei scheint dem Krafttraining auch im Hinblick auf den langfristigen Leistungsaufbau im Nachwuchsleistungssport Rudern eine besondere Rolle zuzukommen. Die vorliegende Arbeit widmet sich der Optimie-rung der Leistungsdiagnostik sowie der Bewertung der Effektivität von Krafttrainingsmethoden zur Verbesserung der körperlichen Fitness und der sportartspezifischen Leistung im Nachwuchsleistungsrudern.
Die erste Studie im Rahmen dieser kumulativen Arbeit beinhaltet die Analyse eines sport-artspezifischen Anforderungsprofils der Sportart Rudern. Die Studienergebnisse zeigen, dass die Energiebereitstellung im Ruderwettkampf zu einem großen Anteil aus aeroben und zu einem geringen Anteil aus anaeroben Stoffwechselprozessen erfolgt. Während der vier Phasen des rudertechnischen Leitbildes werden nahezu alle großen Muskelgruppen beansprucht. Aufgrund der hohen Trainingsumfänge auf internationalem Leistungsniveau besteht bei Ruderern ein erhöhtes Risiko, Verletzungen im lumbalen Rückensegment, den Knien sowie den Rippen zu erleiden.
Im Rahmen der zweiten Studie wurden die Effekte von Krafttraining auf die körperliche Fitness und die sportartspezifische Leistung von Ruderern unterschiedlichen Expertisen-niveaus untersucht. Die Studienergebnisse zeigen, dass signifikante kleine Effekte des Krafttrainings auf die körperliche Fitness (Maximalkraft der unteren Gliedmaßen) und auf die sportartspezifische Leistung existieren. Subgruppenanalysen für Krafttrainingstyp und Expertisenniveau zeigten nicht signifikante Unterschiede zwischen den jeweiligen Subgruppen der Ruderer.
Die dritte Studie analysierte die Zusammenhänge zwischen der biologischen Reife, der Körperkonstitution und der körperlichen Fitness mit der Leistung auf dem Ruderergometer über 700-m bei weiblichen Nachwuchseliteruderern. Die Analyse zeigte signifikante mittle-re bis hohe Zusammenhänge zwischen der biologischen Reife, Kennwerten der Körperkonstitution, der körperlichen Fitness (z. B. Maximalkraft, Kraftausdauer) und der Leistung auf dem Ruderergometer. Zusätzlich konnte gezeigt werden, dass die Prädiktoren Körperkonstitution (Magermasse) und Kraftausdauer (Bourban-Test) die Leistung des 700-m Ruderergometertest am besten abbilden.
Die vierte Studie untersuchte die Effekte von zwei unterschiedlichen Krafttrainingsmetho-den, die jeweils über neun Wochen durchgeführt wurden, auf die körperliche Fitness und die Leistung auf dem Ruderergometer bei weiblichen Elite-Nachwuchsruderern. Die Stu-dienergebnisse zeigen, dass beide Gruppen signifikante Steigerungen auf ausgewählte Komponenten der körperlichen Fitness (z. B. Maximalkraft, Schnellkraft, anaerobe Aus-dauer und Richtungswechselgeschwindigkeit) und die sportartspezifische Leistung erzielten. Signifikant größere Zuwächse resultierten nach Krafttraining mit höheren Intensitäten [HI] bei gleichem Volumen im Vergleich zu Kraftausdauertraining [KA] in ausgewählten Komponenten der körperlichen Fitness (z. B. Maximalkraft). Im Gegensatz dazu, führte KA bei gleichem Volumen im Vergleich zu HI zu größeren Steigerungen der sportartspezifischen Leistung.
Zusammenfassend zeigen die Ergebnisse, dass Krafttraining ein effektives Mittel zur Steigerung ausgewählter Komponenten der körperlichen Fitness und der sportartspezifischen Leistung in der Sportart Rudern für RuderInnen und im Speziellen für den Nachwuchssport ist. Insbesondere im Nachwuchsleistungsrudern zeigte sich, dass HI zusätzlich zum regulären Rudertraining effektiver zur Verbesserung der körperlichen Fitness (z. B. Maximalkraft) ist als KA. Zur Verbesserung der sportartspezifischen Leistung jedoch, stellte KA im Vergleich zu HI bei weiblichen Elite-Nachwuchsruderern die effektivere Krafttrainings-methode dar. Weiterhin wird Trainern im Nachwuchsrudersport empfohlen, ausgewählte Merkmale der biologischen Reife, Körperkonstitution sowie der körperlichen Fitness (Maximalkraft, Kraftausdauer) für die Talententwicklung zu berücksichtigen.
Background: Physical fitness is a key aspect of children’s ability to perform activities of daily living, engage in leisure activities, and is associated with important health characteristics. As such, it shows multi-directional associations with weight status as well as executive functions, and varies according to a variety of moderating factors, such as the child’s gender, age, geographical location, and socioeconomic conditions and context. The assessment and monitoring of children’s physical fitness has gained attention in recent decades, as has the question of how to promote physical fitness through the implementation of a variety of programs and interventions. However, these programs and interventions rarely focus on children with deficits in their physical fitness. Due to their deficits, these children are at the highest risk of suffering health impairments compared to their more average fit peers. In efforts to promote physical fitness, schools could offer promising and viable approaches to interventions, as they provide access to large youth populations while providing useful infrastructure. Evidence suggests that school-based physical fitness interventions, particularly those that include supplementary physical education, are useful for promoting and improving physical fitness in children with normal fitness. However, there is little evidence on whether these interventions have similar or even greater effects on children with deficits in their physical fitness. Furthermore, the question arises whether these measures help to sustainably improve the development/trajectories of physical fitness in these children.
The present thesis aims to elucidate the following four objectives: (1) to evaluate the effects of a 14 week intervention with 2 x 45 minutes per week additional remedial physical education on physical fitness and executive function in children with deficits in their physical fitness; (2) to assess moderating effects of body height and body mass on physical fitness components in children with physical fitness deficits; (3) to assess moderating effects of age and skeletal growth on physical fitness in children with physical fitness deficits; and (4) to analyse moderating effects of different physical fitness components on executive function in children with physical fitness deficits.
Methods: Using physical fitness data from the EMOTIKON study, 76 third graders with physical fitness deficits were identified in 11 schools in Brandenburg state that met the requirements for implementing a remedial physical education intervention (i.e., employing specially trained physical education teachers). The fitness intervention was implemented in a cross-over design and schools were randomly assigned to either an intervention-control or control-intervention group. The remedial physical education intervention consisted of a 14 week, 2 x 45 minutes per week remedial physical education curriculum supplemented by a physical exercise homework program. Assessments were conducted at the beginning and end of each intervention and control period, and further assessments were conducted at the beginning and end of each school year until the end of sixth grade. Physical fitness as the primary outcome was assessed using fitness tests implemented in the EMOTIKON study (i.e., lower body muscular strength (standing long jump), speed (20 m sprint), cardiorespiratory fitness (6 min run), agility (star run), upper body muscular strength (ball push test), and balance (one leg balance)). Executive functions as a secondary outcome were assessed using attention and psychomotor processing speed (digit symbol substitution test), mental flexibility and fine motor skills (trail making test), and inhibitory control (Simon task). Anthropometric measures such as body height, body mass, maturity offset, and body composition parameters, as well as socioeconomic information were recorded as potential moderators.
Results: (1) The evaluation of possible effects of the remedial physical education intervention on physical fitness and executive functions of children with deficits in their physical fitness did not reveal any detectable intervention-related improvements in physical fitness or executive functions. The implemented analysis strategies also showed moderating effects of body mass index (BMI) on performance in 6 min run, star run, and standing long jump, with children with a lower BMI performing better, moderating effects of proximity to Berlin on performance in the 6 min run and standing long jump, better performances being found in children living closer to Berlin, and overall gendered differences in executive function test performance, with boys performing better compared to girls. (2) Analysing moderating effects of body height and body mass on physical fitness performance, better overall physical fitness performance was found for taller children. For body mass, a negative effect was found on performance in the 6 min run (linear), standing long jump (linear), and 20 m sprint (quadratic), with better performance associated with lighter children, and a positive effect of body mass on performance in the ball push test, with heavier children performing better. In addition, the analysis revealed significant interactions between body height and body mass on performance in 6 min run and 20 m sprint, with higher body mass being associated with performance improvements in larger children, while higher body mass was associated with performance declines in smaller children. In addition, the analysis revealed overall age-related improvements in physical fitness and was able to show that children with better overall physical fitness also elicit greater age-related improvements. (3) In the analysis of moderating effects of age and maturity offset on physical fitness performances, two unrotated principal components of z-transformed age and maturity offset values were calculated (i.e., relative growth = (age + maturity offset)/2; growth delay = (age - maturity offset)) to avoid colinearity. Analysing these constructs revealed positive effects of relative growth on performances in star run, 20 m sprint, and standing long jump, with children of higher relative growth performing better. For growth delay, positive effects were found on performances in 6 min run and 20 m sprint, with children having larger growth delays showing better performances. Further, the model revealed gendered differences in 6 min run and 20 m sprint performances with girls performing better than boys. (4) Analysing the effects of physical fitness tests on executive function revealed a positive effect of star run and one leg balance performance and a negative effect of 6 min run performance on reaction speed in the Simon task. However, these effects were not detectable when individual differences were accounted for. Then these effects showed overall positive effects, with better performances being associated with faster reaction speeds. In addition, the analysis revealed a positive correlation between overall reaction speed and effects of the 6 min run, suggesting that children with greater effects of 6 min run had faster overall reaction speeds. Negative correlations were found between star run effects and age effects on Simon task reaction speed, meaning that children with larger star run effects had smaller age effects, and between 6 min run effects and star run effects on Simon task reaction speed, meaning that children with larger 6 min run effects tended to have smaller star run effects on Simon task reaction speed and vice versa.
Conclusions: (1) The lack of detectable intervention-related effects could have been caused by an insufficient intervention period, by the implementation of comprehensive and thus non- specific exercises, or by both. Accordingly, longer intervention periods and/or more specific exercises may have been more beneficial and could have led to detectable improvements in physical fitness and/or executive function. However, it remains unclear whether these interventions can benefit children with deficits in physical fitness, as it is possible that their deficits are not caused by a mere lack of exercise, but rather depend on the socioeconomic conditions of the children and their families and areas. Therefore, further research is needed to assess the moderation of physical fitness in children with physical fitness deficits and, in particular, the links between children’s environment and their physical fitness trajectories. (2) Findings from this work suggest that using BMI as a composite of body height and body mass may not be able to capture the variation associated with these parameters and their interactions. In particular, because of their multidirectional associations, further research would help elucidate how BMI and its subcomponents influence physical fitness and how they vary between children with and without physical fitness deficits. (3) The assessment of growth- related changes indicated negative effects associated with the growth spurt approaching age of peak height velocity, and furthermore showed significant differences in these effects between children. Thus, these effects and possible interindividual differences should be considered in the assessment of the development of physical fitness in children. (4) Furthermore, this work has shown that the associations between physical fitness and executive functions vary between children and may be moderated by children’s socioeconomic conditions and the structure of their daily activities. Further research is needed to explore these associations using approaches that account for individual variance.
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.
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
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 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.
Ziel der Studie: Die langfristige Nutzung telemedizinischer Angebote hängt nicht nur von deren Wirksamkeit, sondern auch von der Akzeptanz und Zufriedenheit der Patienten ab. Für eine telemedizinische Bewegungstherapie für Patienten nach Implantation einer Knie- oder Hüft-Totalendoprothese und erfolgter Anschlussrehabilitation wurde die Wirksamkeit bereits in einer randomisiert kontrollierten Studie untersucht. Dieser Beitrag fokussiert die Akzeptanz und das Nutzungsverhalten der Patienten hinsichtlich des eingesetzten telerehabilitativen Systems.
Methodik: Zur Erfassung der Technikakzeptanz wurden 48 Patienten (53±7 Jahre; 26 Frauen; 35 Hüft-/13 Knie-TEP) im Anschluss an eine dreimonatige telemedizinische Bewegungstherapie mittels des Telehealth Usability Questionnaire befragt. Der Fragebogen besteht aus 21 Items (siebenstufige Likert-Skala) in sechs Skalen (z. B. Nützlichkeit, Qualität der Interaktionen, Verlässlichkeit). In einer zusätzlichen Skala wurden systemspezifische Fragen zusammengefasst. Die Ergebnisse wurden als Skalenprozent (100 ≙ vollkommene Zustimmung) dargestellt. Das Nutzungsverhalten wurde anhand systemgenerierter Prozessdaten zum Training sowie zu integrierten Sprach-/Textnachrichten untersucht.
Ergebnisse: Die TUQ-Skalen „Nützlichkeit“ (Mdn 95,2) sowie „Benutzerfreundlichkeit und Erlernbarkeit“ (Mdn 92,9) wurden am höchsten bewertet, während die „Verlässlichkeit“ (Mdn 57,1) und „Qualität der Interaktionen“ (Mdn 71,4) die geringsten Ausprägungen zeigten. Die systemspezifische Skala wurde im oberen Quartil eingeordnet (Mdn 85,7).
In der ersten Woche führten 39 Patienten (81%), in der zweiten 45 Patienten (94%) mindestens eine Trainingsübung mit dem System durch. Der Anteil aktiver Patienten (≥1 Übung/Woche) reduzierte sich im weiteren Verlauf auf 75% (n=36) in der 7. Woche und 48% (n=23) in der 12. Woche. Die systemeigenen Kommunikationsmöglichkeiten wurden nach Therapiestart zunächst häufig genutzt: in der ersten Woche sendeten 42 Patienten (88%) Nachrichten, 47 Patienten (98%) erhielten Nachrichten von ihrem Therapeuten. In der 7. Woche sendeten/erhielten 9 (19%) bzw. 13 (27%) Patienten Nachrichten über das System.
Schlussfolgerung: Die Patienten nahmen die telemedizinische Bewegungstherapie überwiegend als nützlich und benutzerfreundlich wahr und schienen im Wesentlichen mit dem System zufrieden, das sich damit für den kurzfristigen Einsatz von 6 bis 8 Wochen im Anschluss an eine Anschlussrehabilitation als gut geeignet zeigte.
Turnschuhdiplomatie
(2022)
Auch wenn der Sport der DDR mit seinen Rekorden und Medaillen als eines ihrer weltweiten Aushängeschilder galt, fehlte bisher eine detaillierte Unter- suchung ihrer internationalen Sportbeziehungen. Der vorliegende Band holt dies in Form einer erstmaligen außen- und sportpolitischen Kontinentalstudie am Beispiel Afrikas nach und erörtert, welche Rolle die vielfältigen Facetten des Sports in der Afrikapolitik der DDR spielten und mit welchen Interessen diese u.a. in den Bereichen der Diplomatie, der kulturellen Auslandsarbeit, des Leistungssports oder des Außenhandels verknüpft waren. Die 610 Seiten starke Schrift beleuchtet die Zeit von 1955 bis 1990 und stützt sich dabei u.a. auf über 2200 (teils erstmals recherchierte) Quellen- und Literaturnachweise. Schwerpunkte bilden hierbei u.a. ausführliche Länder- und Regional- studien für Nordafrika (Ägypten, Algerien), Westafrika (Ghana, Mali, Guinea) sowie zu Äthiopien und Mosambik.
Intervention in the form of core-specific stability exercises is evident to improve trunk stability. The purpose was to assess the effect of an additional 6 weeks sensorimotor or resistance training on maximum isokinetic trunk strength and response to sudden dynamic trunk loading (STL) in highly trained adolescent athletes. The study was conducted as a single-blind, 3-armed randomized controlled trial. Twenty-four adolescent athletes (14f/10 m, 16 +/- 1 yrs.;178 +/- 10 cm; 67 +/- 11 kg; training sessions/week 15 +/- 5; training h/week 22 +/- 8) were randomized into resistance training (RT; n = 7), sensorimotor training (SMT; n = 10), and control group (CG; n = 7). Athletes were instructed to perform standardized, center-based training for 6 weeks, two times per week, with a duration of 1 h each session. SMT consisted of four different core-specific sensorimotor exercises using instable surfaces. RT consisted of four trunk strength exercises using strength training machines, as well as an isokinetic dynamometer. All participants in the CG received an unspecific heart frequency controlled, ergometer-based endurance training (50 min at max. heart frequency of 130HF). For each athlete, each training session was documented in an individual training diary (e.g., level of SMT exercise; 1RM for strength exercise, pain). At baseline (M1) and after 6 weeks of intervention (M2), participants' maximum strength in trunk rotation (ROM:63 degrees) and flexion/extension (ROM:55 degrees) was tested on an isokinetic dynamometer (concentric/eccentric 30 degrees/s). STL was assessed in eccentric (30 degrees/s) mode with additional dynamometer-induced perturbation as a marker of core stability. Peak torque [Nm] was calculated as the main outcome. The primary outcome measurements (trunk rotation/extension peak torque: con, ecc, STL) were statistically analyzed by means of the two-factor repeated measures analysis of variance (alpha = 0.05). Out of 12 possible sessions, athletes participated between 8 and 9 sessions (SMT: 9 +/- 3; RT: 8 +/- 3; CG: 8 +/- 4). Regarding main outcomes of trunk performance, experimental groups showed no significant pre-post difference for maximum trunk strength testing as well as for perturbation compensation (p > 0.05). It is concluded, that future interventions should exceed 6 weeks duration with at least 2 sessions per week to induce enhanced trunk strength or compensatory response to sudden, high-intensity trunk loading in already highly trained adolescent athletes, regardless of training regime.
MOVE
(2022)
Background and Objectives: Low back pain is a worldwide health problem. An early diagnosis is required to develop personalized treatment strategies. The Risk Stratification Index (RSI) was developed to serve the purpose. The aim of this pilot study is to cross-culturally translate the RSI to a French version (RSI-F) and evaluate the test-retest reliability of RSI-F using a French active population. Materials and Methods: The RSI was translated from German to French (RSI-F) based on the guidelines of cross-cultural adaptation of self-report measures. A total of 42 French recreational athletes (age 18–63 years) with non-specific low back pain were recruited and filled in the RSI-F twice. The test-retest reliability was examined using intraclass correlation coefficient (ICC1,2) and Pearson correlation coefficient. Results: Finally, 33 questionnaires were analyzed (14 males and 19 females, age 31 ± 10 years, 9.5 ± 3.2 h/week of training). The test-retest of RSI-F CPI and DISS were excellent (CPI: ICC1,2 = 0.989, p < 0.001; r = 0.989, p < 0.001; DISS: ICC1,2 = 0.991, p < 0.001; r = 0.991, p < 0.001), as well as Korff pain intensity (ICC1,2 = 0.995, p < 0.001; r = 0.995, p < 0.001) and disability (ICC1,2 = 0.998, p < 0.001; r = 0.998, p < 0.001). Conclusion: The RSI-F is linguistically accurate and reliable for use by a French-speaking active population with non-specific low back pain. The RSI-F is considered a tool to examine the evolution of psychosocial factors and therefore the risk of chronicity and the prognostic of pain. Further evaluations, such as internal, external validity, and responsiveness should be evaluated in a larger population.
Die Sportpsychiatrie und -psychotherapie ist ein relativ junges Arbeitsgebiet, das sich insbesondere mit zwei Schwerpunkten befasst: zum einen mit den Besonderheiten in Diagnostik und Therapie psychischer Erkrankungen bei Leistungssportler:innen sowie Bewegung und Sport in der Entstehung und Behandlung psychischer Erkrankungen. Während alle psychischen Erkrankungen prinzipiell auch bei (Leistungs‑)Sportler:innen auftreten können, gibt es darüber hinaus sport(art)spezifische psychische Erkrankungen, wie z. B. die Anorexia athletica und andere Essstörungen, die chronisch traumatische Enzephalopathie, Missbrauch und Abhängigkeit von leistungssteigernden Substanzen (Doping) oder die Muskeldysmorphie. In qualitativ hochwertigen klinischen Studien konnte die therapeutische Wirksamkeit von Bewegung und Sport bei verschiedenen psychischen Erkrankungen belegt werden. Ein sportpsychiatrisches Basiswissen sollten alle in Psychiatrie und Psychotherapie klinisch Tätigen besitzen.
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.
Muscle quality defined as the ratio of muscle strength to muscle mass disregards underlying factors which influence muscle strength. The aim of this review was to investigate the relationship of phase angle (PhA), echo intensity (EI), muscular adipose tissue (MAT), muscle fiber type, fascicle pennation angle (θf), fascicle length (lf), muscle oxidative capacity, insulin sensitivity (IS), neuromuscular activation, and motor unit to muscle strength. PubMed search was performed in 2021. The inclusion criteria were: (i) original research, (ii) human participants, (iii) adults (≥18 years). Exclusion criteria were: (i) no full-text, (ii) non-English or -German language, (iii) pathologies. Forty-one studies were identified. Nine studies found a weak–moderate negative (range r: [−0.26]–[−0.656], p < 0.05) correlation between muscle strength and EI. Four studies found a weak–moderate positive correlation (range r: 0.177–0.696, p < 0.05) between muscle strength and PhA. Two studies found a moderate-strong negative correlation (range r: [−0.446]–[−0.87], p < 0.05) between muscle strength and MAT. Two studies found a weak-strong positive correlation (range r: 0.28–0.907, p < 0.05) between θf and muscle strength. Muscle oxidative capacity was found to be a predictor of muscle strength. This review highlights that the current definition of muscle quality should be expanded upon as to encompass all possible factors of muscle quality.
Muscle quality defined as the ratio of muscle strength to muscle mass disregards underlying factors which influence muscle strength. The aim of this review was to investigate the relationship of phase angle (PhA), echo intensity (EI), muscular adipose tissue (MAT), muscle fiber type, fascicle pennation angle (θf), fascicle length (lf), muscle oxidative capacity, insulin sensitivity (IS), neuromuscular activation, and motor unit to muscle strength. PubMed search was performed in 2021. The inclusion criteria were: (i) original research, (ii) human participants, (iii) adults (≥18 years). Exclusion criteria were: (i) no full-text, (ii) non-English or -German language, (iii) pathologies. Forty-one studies were identified. Nine studies found a weak–moderate negative (range r: [−0.26]–[−0.656], p < 0.05) correlation between muscle strength and EI. Four studies found a weak–moderate positive correlation (range r: 0.177–0.696, p < 0.05) between muscle strength and PhA. Two studies found a moderate-strong negative correlation (range r: [−0.446]–[−0.87], p < 0.05) between muscle strength and MAT. Two studies found a weak-strong positive correlation (range r: 0.28–0.907, p < 0.05) between θf and muscle strength. Muscle oxidative capacity was found to be a predictor of muscle strength. This review highlights that the current definition of muscle quality should be expanded upon as to encompass all possible factors of muscle quality.
In recent years digital technologies have become a major means for providing health-related services and this trend was strongly reinforced by the current Coronavirus disease 2019 (COVID-19) pandemic. As it is well-known that regular physical activity has positive effects on individual physical and mental health and thus is an important prerequisite for healthy aging, digital technologies are also increasingly used to promote unstructured and structured forms of physical activity. However, in the course of this development, several terms (e.g., Digital Health, Electronic Health, Mobile Health, Telehealth, Telemedicine, and Telerehabilitation) have been introduced to refer to the application of digital technologies to provide health-related services such as physical interventions. Unfortunately, the above-mentioned terms are often used in several different ways, but also relatively interchangeably. Given that ambiguous terminology is a major source of difficulty in scientific communication which can impede the progress of theoretical and empirical research, this article aims to make the reader aware of the subtle differences between the relevant terms which are applied at the intersection of physical activity and Digital Health and to provide state-of-art definitions for them.
Introduction
Anthropometric and physical fitness data can predict sport-specific performance (e.g., canoe sprint race time) in young athletes. Of note, inter-item correlations (i.e., multicollinearity) may exist between tests assessing similar physical qualities. However, multicollinearity among tests may change across age and/or sex due to age-/sex-specific non-linear development of test performances. Therefore, the present study aimed at analyzing inter-item correlations between anthropometric, physical fitness, and sport-specific performance data as a function of age and sex in young canoe sprint athletes.
Methods
Anthropometric, physical fitness, and sport-specific performance data of 618 male and 297 female young canoe sprint athletes (discipline: male/female kayak, male canoe) were recorded during a national talent identification program between 1992 and 2019. For each discipline, a correlation matrix (i.e., network analysis) was calculated for age category (U13, U14, U15, U16) and sex including anthropometrics (e.g., standing body height, body mass), physical fitness (e.g., cardiorespiratory endurance, muscle power), and sport-specific performance (i.e., 250 and 2,000-m on-water canoe sprint time). Network plots were used to explore the correlation patterns by visual inspection. Further, trimmed means (mu(trimmed)) of inter-item Pearson's correlations coefficients were calculated for each discipline, age category, and sex. Effects of age and sex were analyzed using one-way ANOVAs.
Results
Visual inspection revealed consistent associations among anthropometric measures across age categories, irrespective of sex. Further, associations between physical fitness and sport-specific performance were lower with increasing age, particularly in males. In this sense, statistically significant differences for mu(trimmed) were observed in male canoeists (p < 0.01, xi = 0.36) and male kayakers (p < 0.01, xi = 0.38) with lower mu(trimmed) in older compared with younger athletes (i.e., >= U15). For female kayakers, no statistically significant effect of age on mu(trimmed) was observed (p = 0.34, xi = 0.14).
Discussion
Our study revealed that inter-item correlation patterns (i.e., multicollinearity) of anthropometric, physical fitness, and sport-specific performance measures were lower in older (U15, U16) versus younger (U13, U14) male canoe sprint athletes but not in females. Thus, age and sex should be considered to identify predictors for sport-specific performance and design effective testing batteries for talent identification programs in canoe sprint athletes.
Hintergrund
Steigende Adipositasprävalenzen im Kindes- und Jugendalter sind geprägt von ungesunden Lebensweisen wie geringer Bewegung durch hohen Medienkonsum. Neueste Studien nutzen die Erreichbarkeit dieser Zielgruppe durch digitale Medien, womit Technologien neue Ansätze in der Interventionsgestaltung der Gewichtsreduktion darstellen. Allerdings stellt sich die Frage, welche digitalen Kombinationen und methodischen Programmkonzepte effektive Body-Mass-Index(BMI)-Veränderungen bedingen.
Ziel
Um Erkenntnisse über effektive Maßnahmengestaltung und Medieneinsatz zu gewinnen, sollen digitale Interventionsstrategien zur BMI-Reduktion übergewichtiger Kinder und Jugendlicher analysiert und bewertet werden.
Methoden
Ein systematischer Review wurde in den Datenbanken Medline via PubMed, Science Direct und Web of Science zur Analyse von Studien aus den Jahren 2016 bis 2021 über Veränderungen im BMI und BMI-Z-Score von übergewichtigen und adipösen 6‑ bis 18-Jährigen durchgeführt. Die methodische Studienqualität wurde nach den Richtlinien des Cochrane Risk of Bias bewertet.
Ergebnisse
Aus 3974 Studien wurden 7 Artikel identifiziert, die den Einsatz von Fitnessarmbändern, Smartphones und computerbasierten Programmen beschreiben. Alle Medien erzielten BMI-Reduktionen, wobei Smartphoneinterventionen via Anrufe und Nachrichten die signifikantesten Veränderungen bewirkten.
Diskussion
Smartphones bieten als Anbieter digitaler Programme (z. B. Apps) effektive Ansatzpunkte zur Adipositasreduktion. Auf Basis der Datenlage bestätigt sich neben der Auswahl und der Kombination mehrerer Medien die Relevanz des Familieneinbezugs und die methodische Fundierung der Maßnahmen. Aufgrund des jungen Alters der Teilnehmenden müssen mediale Interventionen zielgruppengerecht zugänglich gemacht werden.
Einleitung
Mehr als ein Drittel der PatientInnen im berufsfähigen Alter in der kardiologischen Anschlussrehabilitation (AR) sind von besonderen beruflichen Problemlagen (BBPL) betroffen. Die BBPL sind durch eine negative subjektive Erwerbsprognose (SE) determiniert, die wiederum auf eine deutlich reduzierte Wahrscheinlichkeit der beruflichen Wiedereingliederung hindeutet. Diese Studie hatte die Exploration von persönlich bestimmenden Faktoren der SE zum Ziel, um Impulse für die patientInnenzentrierte Betreuung in der AR ableiten zu können.
Methoden
Die monozentrische explorative qualitative Studie basierte auf leitfadengestützten Einzelinterviews mit PatientInnen der kardiologischen AR. Hierfür wurden 20 PatientInnen mit BBPL (Hauptstichprobe) und 5 ohne BBPL (Kontraststichprobe) in QIV/2021 eingeschlossen. Die Stichprobenauswahl erfolgte nach dem Prinzip des theoretischen Samplings mit sich überschneidender Rekrutierungs- und Auswertungsphase. Die Auswertung erfolgte mittels thematischer Analyse, wobei die Interviews sinngemäß auf Aussagen (Codes) reduziert und anschließend in Schlüsselthemen zusammengefasst wurden.
Ergebnisse
Insgesamt wurden sieben Schlüsselthemen generiert. Die ersten beiden umfassen (1) umwelt- und (2) personenbezogene Aspekte (z. B. (1): Personalsituation, Auswirkungen der Pandemie; (2) Selbstwahrnehmung, Arbeitsplatzeinflüsse). Die weiteren Themen schließen (4) krankheitsbezogene Vorerfahrungen (z. B. Erfahrungen mit Gesundheitssystem, familiäre Prädisposition) und (5) Zukunftsvorstellungen (z. B. Prioritätenänderung, Rauchentwöhnung) ein. Darüber hinaus wurden drei spezifische Themen identifiziert: (5) die Gesundheitswahrnehmung einschließlich der empfundenen Belastbarkeit, (6) die Veränderbarkeit der Arbeitsbedingungen und (7) die Angst, wieder zu erkranken. Alle befragten RehabilitandInnen planten die Rückkehr in die Berufstätigkeit sowie umfassende Veränderungen des Gesundheitsverhaltens im Privatleben und am Arbeitsplatz.
Schlussfolgerung
Im Zusammenhang mit der BBPL wurden psychosoziale Aspekte deutlich häufiger thematisiert als medizinische. Auffallend war zudem, dass alle befragten RehabilitandInnen den beruflichen Wiedereinstieg planten, auch bei negativer SE. Diese wurde durch Faktoren bestimmt, die als Folge einer Neubewertung der persönlichen Prioritäten nach stattgehabten Akutereignis zu betrachten sind. Zur Unterstützung der Krankheitsverarbeitung sowie zur Förderung der Teilhabe einschließlich des Wiedereinstiegs in das Berufsleben scheint die interprofessionelle Erarbeitung eines individuell-differenzierten Handlungsplans mit Nachsorgeoptionen in der kardiologischen AR für die betroffenen PatientInnen sinnvoll.
Background and Aims Wearable inertial sensors may offer additional kinematic parameters of the shoulder compared to traditional instruments such as goniometers when elaborate and time-consuming data processing procedures are undertaken. However, in clinical practice simple-real time motion analysis is required to improve clinical reasoning. Therefore, the aim was to assess the criterion validity between a portable "off-the-shelf" sensor-software system (IMU) and optical motion (Mocap) for measuring kinematic parameters during active shoulder movements. Methods 24 healthy participants (9 female, 15 male, age 29 +/- 4 years, height 177 +/- 11 cm, weight 73 +/- 14 kg) were included. Range of motion (ROM), total range of motion (TROM), peak and mean angular velocity of both systems were assessed during simple (abduction/adduction, horizontal flexion/horizontal extension, vertical flexion/extension, and external/internal rotation) and complex shoulder movements. Criterion validity was determined using intraclass-correlation coefficients (ICC), root mean square error (RMSE) and Bland and Altmann analysis (bias; upper and lower limits of agreement). Results ROM and TROM analysis revealed inconsistent validity during simple (ICC: 0.040-0.733, RMSE: 9.7 degrees-20.3 degrees, bias: 1.2 degrees-50.7 degrees) and insufficient agreement during complex shoulder movements (ICC: 0.104-0.453, RMSE: 10.1 degrees-23.3 degrees, bias: 1.0 degrees-55.9 degrees). Peak angular velocity (ICC: 0.202-0.865, RMSE: 14.6 degrees/s-26.7 degrees/s, bias: 10.2 degrees/s-29.9 degrees/s) and mean angular velocity (ICC: 0.019-0.786, RMSE:6.1 degrees/s-34.2 degrees/s, bias: 1.6 degrees/s-27.8 degrees/s) were inconsistent. Conclusions The "off-the-shelf" sensor-software system showed overall insufficient agreement with the gold standard. Further development of commercial IMU-software-solutions may increase measurement accuracy and permit their integration into everyday clinical practice.
Wearable resistance allows individualized loading for sport specific movements and can lead to specific strength adaptations benefiting the athlete. The objective was to determine biomechanical changes during running with lower limb light-weight wearable resistance. Fourteen participants (age: 28 +/- 4 years; height: 180 +/- 8 cm; body mass: 77 +/- 6 kg) wore shorts and calf sleeves of a compression suit allowing attachment of light loads. Participants completed four times two mins 20-m over-ground shuttle running bouts at 3.3 m*s(-1) alternated by three mins rest. The first running bout was unloaded and the other three bouts were under randomised loaded conditions (1%, 3% and 5% additional loading of the individual body mass). 3D motion cameras and force plates recorded kinematic and kinetic data at the midpoint of each 20-m shuttle. Friedman-test for repeated measures and linear mixed effect model analysis were used to determine differences between the loading conditions (alpha = 0.05). Increased peak vertical ground reaction force (2.7 N/kg to 2.74 N/kg), ground contact time (0.20 s to 0.21 s) and decreased step length (1.49 m to 1.45 m) were found with additional 5 % body mass loading compared to unloaded running (0.001 > p < 0.007). Marginally more knee flexion and hip extension and less plantarflexion was seen with higher loading. Differences in the assessed parameters were present between each loading condition but accompanied by subject variability. Further studies, also examining long term effects, should be conducted to further inform use of this training tool.
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.
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.
Forced to stay at home
(2022)
The effects of COVID-19-related lockdowns on deterioration of mental health and use of exercise to remediate such effects has been well documented in numerous populations. However, it remains unknown how lockdown restrictions impacted individuals differently and who was more likely to change their exercise behavior and experience negative well-being. The current study examined exercise dependence as a risk factor and its impact on exercise behavior and mood during the initial COVID-19 lockdowns on a global scale in 11,898 participants from 17 countries. Mixed effects models revealed that reducing exercise behavior was associated with a stronger decrease in mood for individuals at risk of exercise dependence compared to individuals at low risk of exercise dependence. Participants at high risk and exercising more prior to the pandemic reported the most exercise during lockdown. Effects of lowered mood were most pronounced in participants with high risk of exercise dependence who reported greater reduction in exercise frequency during lockdown. These results support recent etiological evidence for exercise dependence and add to a growing body of literature documenting mental health effects related to COVID-19.
Purpose
This randomised controlled trial examined the effect of an 8-week volume-equated programme of Nordic hamstring exercise (NHE) training, executed at frequencies of 1- or 2-days per week, on fitness (10 m and 40 m sprint, '505' change of direction [COD] and standing long jump [SLJ]) in male youth soccer players (mean age: 16.4 0.81 years).
Method
Players were divided into an experimental group (n = 16) which was further subdivided into 1-day (n = 8) and 2-day (n = 8) per week training groups and a control group (n = 8).
Results
There were significant group-by-time interactions for 10-m sprint (p<0.001, eta(2) = 0.120, d = 2.05 [0.57 to 3.53]), 40-m sprint (p = 0.001, eta(2) = 0.041, d = 1.09 [-0.23 to 2.4]) and COD (p = 0.002, eta(2) = 0.063, d = 1.25 [-0.09 to 2.59). The experimental group demonstrated a 'very large' effect size (d = 3.02 [1.5 to 4.54]) in 10-m sprint, and 'large' effect sizes in 40-m sprint (d = 1.94 [0.98 to 2.90]) and COD (d = 1.84 [0.85 to 2.83). The control group showed no significant changes. There were no significant differences between the 1-day and 2-day training groups. In three of the four tests (40 m, COD, SLJ) the 2-day group demonstrated larger effect sizes. Ratings of perceived exertion (RPE) were significantly lower in the 2-day group (p<0.001, 3.46 [1.83 to 5.04).
Conclusion
The NHE increases fitness in youth soccer players and there may be advantages to spreading training over two days instead of one.
Effects of intermittent hypoxia-hyperoxia on performance- and health-related outcomes in humans
(2022)
Background:
Intermittent hypoxia applied at rest or in combination with exercise promotes multiple beneficial adaptations with regard to performance and health in humans. It was hypothesized that replacing normoxia by moderate hyperoxia can increase the adaptive response to the intermittent hypoxic stimulus.
Objective:
Our objective was to systematically review the current state of the literature on the effects of chronic intermittent hypoxia-hyperoxia (IHH) on performance- and health-related outcomes in humans.
Methods:
PubMed, Web of Science (TM), Scopus, and Cochrane Library databases were searched in accordance with PRISMA guidelines (January 2000 to September 2021) using the following inclusion criteria: (1) original research articles involving humans, (2) investigation of the chronic effect of IHH, (3) inclusion of a control group being not exposed to IHH, and (4) articles published in peer-reviewed journals written in English.
Results:
Of 1085 articles initially found, eight studies were included. IHH was solely performed at rest in different populations including geriatric patients (n = 1), older patients with cardiovascular (n = 3) and metabolic disease (n = 2) or cognitive impairment (n = 1), and young athletes with overtraining syndrome (n = 1). The included studies confirmed the beneficial effects of chronic exposure to IHH, showing improvements in exercise tolerance, peak oxygen uptake, and global cognitive functions, as well as lowered blood glucose levels. A trend was discernible that chronic exposure to IHH can trigger a reduction in systolic and diastolic blood pressure. The evidence of whether IHH exerts beneficial effects on blood lipid levels and haematological parameters is currently inconclusive. A meta-analysis was not possible because the reviewed studies had a considerable heterogeneity concerning the investigated populations and outcome parameters.
Conclusion:
Based on the published literature, it can be suggested that chronic exposure to IHH might be a promising non-pharmacological intervention strategy for improving peak oxygen consumption, exercise tolerance, and cognitive performance as well as reducing blood glucose levels, and systolic and diastolic blood pressure in older patients with cardiovascular and metabolic diseases or cognitive impairment. However, further randomized controlled trials with adequate sample sizes are needed to confirm and extend the evidence. This systematic review was registered on the international prospective register of systematic reviews (PROSPERO-ID: CRD42021281248) (https://www.crd.york.ac.uk/prospero/).
Fatigue has been defined differently in the literature depending on the field of research. The inconsistent use of the term fatigue complicated scientific communication, thereby limiting progress towards a more in-depth understanding of the phenomenon. Therefore, Enoka and Duchateau (Med Sci Sports Exerc 48:2228-38, 2016, [3]) proposed a fatigue framework that distinguishes between trait fatigue (i.e., fatigue experienced by an individual over a longer period of time) and motor or cognitive task-induced state fatigue (i.e., self-reported disabling symptom derived from the two interdependent attributes performance fatigability and perceived fatigability). Thereby, performance fatigability describes a decrease in an objective performance measure, while perceived fatigability refers to the sensations that regulate the integrity of the performer. Although this framework served as a good starting point to unravel the psychophysiology of fatigue, several important aspects were not included and the interdependence of the mechanisms driving performance fatigability and perceived fatigability were not comprehensively discussed. Therefore, the present narrative review aimed to (1) update the fatigue framework suggested by Enoka and Duchateau (Med Sci Sports Exerc 48:2228-38, 2016, [3]) pertaining the taxonomy (i.e., cognitive performance fatigue and perceived cognitive fatigue were added) and important determinants that were not considered previously (e.g., effort perception, affective valence, self-regulation), (2) discuss the mechanisms underlying performance fatigue and perceived fatigue in response to motor and cognitive tasks as well as their interdependence, and (3) provide recommendations for future research on these interactions. We propose to define motor or cognitive task-induced state fatigue as a psychophysiological condition characterized by a decrease in motor or cognitive performance (i.e., motor or cognitive performance fatigue, respectively) and/or an increased perception of fatigue (i.e., perceived motor or cognitive fatigue). These dimensions are interdependent, hinge on different determinants, and depend on body homeostasis (e.g., wakefulness, core temperature) as well as several modulating factors (e.g., age, sex, diseases, characteristics of the motor or cognitive task). Consequently, there is no single factor primarily determining performance fatigue and perceived fatigue in response to motor or cognitive tasks. Instead, the relative weight of each determinant and their interaction are modulated by several factors.
Background
There is evidence that in older adults the combination of strength training (ST) and endurance training (ET) (i.e., concurrent training [CT]) has similar effects on measures of muscle strength and cardiorespiratory endurance (CRE) compared with single-mode ST or ET, respectively. Therefore, CT seems to be an effective method to target broad aspects of physical fitness in older adults.
Objectives
The aim was to examine the effects of CT on measures of physical fitness (i.e., muscle strength, power, balance and CRE) in healthy middle-aged and older adults aged between 50 and 73 years. We also aimed to identify key moderating variables to guide training prescription.
Study Design
We conducted a systematic review with meta-analysis of randomized controlled trials.
Data Sources
The electronic databases PubMed, Web of Science Core Collection, MEDLINE and Google Scholar were systematically searched until February 2022.
Eligibility Criteria for Selecting Studies We included randomized controlled trials that examined the effects of CT versus passive controls on measures of physical fitness in healthy middle-aged and older adults aged between 50 and 73 years.
Results
Fifteen studies were eligible, including a total of 566 participants. CT induced moderate positive effects on muscle strength (standardized mean difference [SMD] = 0.74) and power (SMD = 0.50), with a small effect on CRE (SMD = 0.48). However, no significant effects were detected for balance (p > 0.05). Older adults > 65 years (SMD = 1.04) and females (SMD = 1.05) displayed larger improvements in muscle strength compared with adults <= 65 years old (SMD = 0.60) and males (SMD = 0.38), respectively. For CRE, moderate positive effects (SMD = 0.52) were reported in those <= 65 years old only, with relatively larger gains in females (SMD = 0.55) compared with males (SMD = 0.45). However, no significant differences between all subgroups were detected. Independent single training factor analysis indicated larger positive effects of 12 weeks (SMD = 0.87 and 0.88) compared with 21 weeks (SMD = 0.47 and 0.29) of CT on muscle strength and power, respectively, while for CRE, 21 weeks of CT resulted in larger gains (SMD = 0.62) than 12 weeks (SMD = 0.40). For CT frequency, three sessions per week produced larger beneficial effects (SMD = 0.91) on muscle strength compared with four sessions (SMD = 0.55), whereas for CRE, moderate positive effects were only noted after four sessions per week (SMD = 0.58). A session duration of > 30-60 min generated larger improvements in muscle strength (SMD = 0.99) and power (SMD = 0.88) compared with > 60-90 min (SMD = 0.40 and 0.29, respectively). However, for CRE, longer session durations (i.e., > 60-90 min) seem to be more effective (SMD = 0.61) than shorter ones (i.e., > 30-60 min) (SMD = 0.34). ET at moderate-to-near maximal intensities produced moderate (SMD = 0.64) and small positive effects (SMD = 0.49) on muscle strength and CRE, respectively, with no effects at low intensity ET (p > 0.05). Finally, intra-session ST before ET produced larger gains in muscle strength (SMD = 1.00) compared with separate sessions (SMD = 0.55), whereas ET and ST carried out separately induced larger improvements in CRE (SMD = 0.58) compared with intra-session ET before ST (SMD = 0.49).
Conclusions
CT is an effective method to improve measures of physical fitness (i.e., muscle strength, power, and CRE) in healthy middle-aged and older adults aged between 50 and 73 years, regardless of sex. Results of independent single training factor analysis indicated that the largest effects on muscle strength were observed after 12 weeks of training, > 30-60 min per session, three sessions per week, higher ET intensities and when ST preceded ET within the same session. For CRE, the largest effects were noted after 21 weeks of training, four sessions per week, > 60-90 min per session, higher ET intensities and when ET and ST sessions were performed separately. Regarding muscle power, the largest effects were observed after 12 weeks of training and > 30-60 min per session.
The affective response during exercise is an important factor for long-term exercise adherence. Pottratz et al. suggested affective priming as a behavioral intervention for the enhancement of exercise-related affect. The present paper aims to replicate and extend upon these findings. We conducted a close replication with 53 participants completing a brisk walking task in two conditions (prime vs. no prime). Affective valence was assessed during exercise, and exercise enjoyment and remembered/forecasted pleasure were assessed postexercise. We could not replicate the findings of Pottratz et al., finding no evidence for positive changes in psychological responses in the priming condition. However, linear mixed models demonstrated significant interindividual differences in how participants responded to priming. These results demonstrate that affective priming during exercise does not work for everyone under every circumstance and, thus, provide an important contribution to the understanding of boundary conditions and moderating factors for priming in exercise psychology.
The interaction of physical activity and brain function with respect to what we now
call successful aging has been and remains extensively studied. In general, a wealth of
studies indicates that short- and long-term physical activity can induce neuroplasticity
even in the adult brain, can enhance cognitive performance positively and may reduce the
risk of neurodegenerative diseases. However, the underlying neurobiological mechanisms
of physical activity on the human central nervous systems are not yet fully understood.
Additionally, what type of exercise might be optimal for keeping the brain fit in old age
and whether imagined as opposed to real exercise has the potential to be effective as well
is not yet clear. In this Special Issue of Brain Sciences, six high-quality articles assess the
mentioned open questions.
This study aimed to investigate the effects of eight weeks of barefoot running exercise on sand versus control on measures of walking kinetics and muscle activities in individuals with diagnosed pronated feet. Sixty physically active male adults with pronated feet were randomly allocated into an intervention or a waiting control group. The intervention group conducted an 8-weeks progressive barefoot running exercise program on sand (e.g., short sprints) with three weekly sessions. Pre and post intervention, participants walked at a constant speed of 1.3 m/s +/- 5% on a 18 m walkway with a force plate embedded in the middle of the walkway. Results showed significant group-by-time interactions for peak impact vertical and lateral ground reaction forces. Training but not control resulted in significantly lower peak impact vertical and lateral ground reaction forces. Significant group-by-time interactions were observed for vastus lateralis activity during the loading phase. Training-induced increases were found for the vastus lateralis in the intervention but not in the control group. This study revealed that the applied exercise program is a suitable means to absorb ground reaction forces (e.g., lower impact vertical and lateral peaks) and increase activities of selected lower limb muscles (e.g., vastus lateralis) when walking on stable ground.
Purpose: The aim of this study was to compare the effects of moderate intensity, low volume (MILV) vs. low intensity, high volume (LIHV) strength training on sport-specific performance, measures of muscular fitness, and skeletal muscle mass in young kayakers and canoeists.
Methods: Semi-elite young kayakers and canoeists (N = 40, 13 ± 0.8 years, 11 girls) performed either MILV (70–80% 1-RM, 6–12 repetitions per set) or LIHV (30–40% 1-RM, 60–120 repetitions per set) strength training for one season. Linear mixed-effects models were used to compare effects of training condition on changes over time in 250 and 2,000 m time trials, handgrip strength, underhand shot throw, average bench pull power over 2 min, and skeletal muscle mass. Both between- and within-subject designs were used for analysis. An alpha of 0.05 was used to determine statistical significance.
Results: Between- and within-subject analyses showed that monthly changes were greater in LIHV vs. MILV for the 2,000 m time trial (between: 9.16 s, SE = 2.70, p < 0.01; within: 2,000 m: 13.90 s, SE = 5.02, p = 0.01) and bench pull average power (between: 0.021 W⋅kg–1, SE = 0.008, p = 0.02; within: 0.010 W⋅kg–1, SE = 0.009, p > 0.05). Training conditions did not affect other outcomes.
Conclusion: Young sprint kayakers and canoeists benefit from LIHV more than MILV strength training in terms of 2,000 m performance and muscular endurance (i.e., 2 min bench pull power).
Background: In terms of physiological and biomechanical characteristics, over-pronation of the feet has been associated with distinct muscle recruitment patterns and ground reaction forces during running.
Objective: The aim of this study was to evaluate the effects of running on sand vs. stable ground on ground-reaction-forces (GRFs) and electromyographic (EMG) activity of lower limb muscles in individuals with over-pronated feet (OPF) compared with healthy controls.
Methods: Thirty-three OPF individuals and 33 controls ran at preferred speed and in randomized-order over level-ground and sand. A force-plate was embedded in an 18-m runway to collect GRFs. Muscle activities were recorded using an EMG-system. Data were adjusted for surface-related differences in running speed.
Results: Running on sand resulted in lower speed compared with stable ground running (p < 0.001; d = 0.83). Results demonstrated that running on sand produced higher tibialis anterior activity (p = 0.024; d = 0.28). Also, findings indicated larger loading rates (p = 0.004; d = 0.72) and greater vastus medialis (p < 0.001; d = 0.89) and rectus femoris (p = 0.001; d = 0.61) activities in OPF individuals. Controls but not OPF showed significantly lower gluteus-medius activity (p = 0.022; d = 0.63) when running on sand.
Conclusion: Running on sand resulted in lower running speed and higher tibialis anterior activity during the loading phase. This may indicate alterations in neuromuscular demands in the distal part of the lower limbs when running on sand. In OPF individuals, higher loading rates together with greater quadriceps activity may constitute a proximal compensatory mechanism for distal surface instability.
Developmental Gains in Physical Fitness Components of Keyage and Older-than-Keyage Third-Graders
(2022)
Children who were enrolled according to legal enrollment dates (i.e., keyage third-graders aged eight to nine years) exhibit a positive linear physical fitness development (Fühner et al., 2021). However, children who were enrolled with a delay of one year or who repeated a grade (i.e., older-than-keyage children [OTK] aged nine to ten years in third grade) appear to exhibit a poorer physical fitness relative to what could be expected given their chronological age (Fühner et al., 2022). However, because Fühner et al. (2022) compared the performance of OTK children to predicted test scores that were extrapolated based on the data of keyage children, the observed physical fitness of these children could either indicate a delayed physical-fitness development or some physiological or psychological changes occurring during the tenth year of life. We investigate four hypotheses about this effect. (H1) OTK children are biologically younger than keyage children. A formula transforming OTK’s chronological age into a proxy for their biological age brings some of the observed cross-sectional age-related development in line with the predicted age-related development based on the data of keyage children, but large negative group differences remain. Hypotheses 2 to 4 were tested with a longitudinal assessment. (H2) Physiological changes due to biological maturation or psychological factors cause a stagnation of physical fitness development in the tenth year of life. H2 predicts a decline of performance from third to fourth grade also for keyage children. (H3) OTK children exhibit an age-related (temporary) developmental delay in the tenth year of life, but later catch up to the performance of age-matched keyage children. H3 predicts a larger developmental gain for OTK than for keyage children from third to fourth grade. (H4) OTK children exhibit a sustained physical fitness deficit and do not catch up over time. H4 predicts a positive development for keyage and OTK children, with no greater development for OTK compared to keyage children. The longitudinal study was based on a subset of children from the EMOTIKON project (www.uni-potsdam.de/emotikon). 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 1,274 children (1,030 keyage and 244 OTK children) from 32 different schools was tested in third grade and retested one year later in fourth grade. Results: (a) Both keyage and OTK children exhibit a positive longitudinal development from third to fourth grade in all six physical fitness components. (b) There is no evidence for a different longitudinal development of keyage and OTK children. (c) Keyage children (approximately 9.5 years in fourth grade) outperform age-matched OTK children (approximately 9.5 years in third grade) in all six physical fitness components. The results show that the physical fitness of OTK children is indeed impaired and are in support of a sustained difference in physical fitness between the groups of keyage and OTK children (H4).
This study aimed at examining the effects of nine weeks of sand-based plyometric jump training (PJT) combined with endurance running on either outdoor or treadmill surface on measures of physical fitness. Male participants (age, 20.1 +/- 1.7 years) were randomly assigned to a sand-based PJT combined with endurance running on outdoor surface (OT, n = 25) or treadmill surface (TT, n = 25). The endurance miming intervention comprised a mixed training method, i.e., long slow distance, tempo, and interval running drills. A control group was additionally included in this study (CG, n = 25). Participants in CG followed their regular physical activity as OT and TT but did not receive any specific intervention. Individuals were assessed for their 50-m linear sprint time, standing long jump (SLJ) distance, cardiorespiratory fitness (i.e., Cooper test), forced vital capacity (FVC), calf girth, and resting heart rate (RHR). A three (groups: OT, TT, CG) by two (time: pre, post) ANOVA for repeated measures was used to analyze the exercise-specific effects. In case of significant group-by-time interactions, Bonferroni adjusted paired (within-group) and independent (between-group comparisons at post) t-tests were used for post-hoc analyses. Significant group-by-time interactions were found for all dependent variables (p < 0.001 - 0.002, eta(2)(p) = 0.16 - 0.78). Group-specific post-hoc tests showed improvements for all variables after OT (p < 0.001, Hedges'g effect size [g] = 0.05 - 1.94) and TT (p < 0.001, g = 0.04 - 2.73), but not in the CG (p = 0.058 - 1.000, g = 0.00 - 0.34). Compared to CG, OT showed larger SLJ (p = 0.001), cardiorespiratory fitness (p = 0.004), FVC (p = 0.008), and RHR (p < 0.001) improvements. TT showed larger improvements in SLJ (p = 0.036), cardiorespiratory fitness (p < 0.001), and RHR (p < 0.001) compared with CG. Compared to OT, TT showed larger improvements for SLJ (p = 0.018). In conclusion, sand-based PJT combined with either OT or TT similarly improved most measures of physical fitness, with greater SLJ improvement after TT. Coaches may use both concurrent exercise regimes based on preferences and logistical constrains (e.g., weather; access to treadmill equipment).
Associations between measures of physical fitness and cognitive performance in preschool children
(2022)
Background:
Given that recent studies report negative secular declines in physical fitness, associations between fitness and cognition in childhood are strongly discussed. The preschool age is characterized by high neuroplasticity which effects motor skill learning, physical fitness, and cognitive development. The aim of this study was to assess the relation of physical fitness and attention (including its individual dimensions (quantitative, qualitative)) as one domain of cognitive performance in preschool children. We hypothesized that fitness components which need precise coordination compared to simple fitness components are stronger related to attention.
Methods:
Physical fitness components like static balance (i.e., single-leg stance), muscle strength (i.e., handgrip strength), muscle power (i.e., standing long jump), and coordination (i.e., hopping on one leg) were assessed in 61 healthy children (mean age 4.5 +/- 0.6 years; girls n = 30). Attention was measured with the "Konzentrations-Handlungsverfahren fur Vorschulkinder" [concentration-action procedure for preschoolers]). Analyses were adjusted for age, body height, and body mass.
Results:
Results from single linear regression analysis revealed a significant (p < 0.05) association between physical fitness (composite score) and attention (composite score) (standardized ss = 0.40), showing a small to medium effect (F-2 = 0.14). Further, coordination had a significant relation with the composite score and the quantitative dimension of attention (standardized ss = 0.35; p < 0.01; standardized ss = - 0.33; p < 0.05). Coordination explained about 11% (composite score) and 9% (quantitative dimension) of the variance in the stepwise multiple regression model.
Conclusion:
The results indicate that performance in physical fitness, particularly coordination, is related to attention in preschool children. Thus, high performance in complex fitness components (i.e., hopping on one leg) tends to predict attention in preschool children. Further longitudinal studies should focus on the effectiveness of physical activity programs implementing coordination and complex exercises at preschool age to examine cause-effect relationships between physical fitness and attention precisely.
Background:
Social isolation through quarantine represents an effective means to prevent COVID-19 infection. A negative side-effect of quarantine is low physical activity.
Research question:
What are the differences of running kinetics and muscle activities of recreational runners with a history of COVID-19 versus healthy controls?
Methods:
Forty men and women aged 20-30 years participated in this study and were divided into two experimental groups. Group 1 (age: 24.1 +/- 2.9) consisted of participants with a history of COVID-19 (COVID group) and group 2 (age: 24.2 +/- 2.7) of healthy age and sex-matched controls (controls). Both groups were tested for their running kinetics using a force plate and electromyographic activities (i.e., tibialis anterior [TA], gastrocnemius medialis [Gas-M], biceps femoris [BF], semitendinosus [ST], vastus lateralis [VL], vastus medialis [VM], rectus femoris [RF], gluteus medius [Glut-M]).
Results:
Results demonstrated higher peak vertical (p = 0.029; d=0.788) and medial (p = 0.004; d=1.119) ground reaction forces (GRFs) during push-off in COVID individuals compared with controls. Moreover, higher peak lateral GRFs were found during heel contact (p = 0.001; d=1.536) in the COVID group. COVID-19 individuals showed a shorter time-to-reach the peak vertical (p = 0.001; d=3.779) and posterior GRFs (p = 0.005; d=1.099) during heel contact. Moreover, the COVID group showed higher Gas-M (p = 0.007; d=1.109) and lower VM activity (p = 0.026; d=0.811) at heel contact.
Significance:
Different running kinetics and muscle activities were found in COVID-19 individuals versus healthy controls. Therefore, practitioners and therapists are advised to implement balance and/or strength training to improve lower limbs alignment and mediolateral control during dynamic movements in runners who recovered from COVID-19.
Purpose:
This study aimed to examine the effects of individualized-load power training (IPT) versus traditional moderate-load power training (TPT) on strength, power, jump performance, and body composition in elite young Nordic athletes.
Methods:
In a randomized crossover design, 10 young male athletes (ski jumpers, Nordic combined athletes) age 17.5 (0.6) years (biological maturity status: +3.5 y postpeak height velocity) who competed on a national or international level performed 5 weeks of IPT (4 x 5 repetitions at 49%-72% 1-repetiton maximum [RM]) and TPT (5 x 5 repetitions at 50%-60% 1-RM) in addition to their regular training. Testing before, between, and after both training blocks comprised the assessment of muscle strength (loaded back squat 3-RM), power (maximal loaded back squat power), jump performance (eg, drop-jump height, reactive strength index), and body composition (eg, skeletal muscle mass).
Results:
Significant, large-size main effects for time were found for muscle strength (P < .01; g = 2.7), reactive strength index (P = .03; g= 1.6), and drop jump height (P = .02; g= 1.9) irrespective of the training condition (IPT, TPT). No significant time-by-condition interactions were observed. For measures of body composition, no significant main effects of condition and time or time-by-condition interactions were found.
Conclusions:
Our findings demonstrate that short-term IPT and TPT at moderate loads in addition to regular training were equally effective in improving measures of muscle strength (loaded back squat 3-RM) and vertical jump performance (reactive strength index, drop jump, and height) in young Nordic athletes.
Background: In terms of physiological and biomechanical characteristics, over-pronation of the feet has been associated with distinct muscle recruitment patterns and ground reaction forces during running.
Objective: The aim of this study was to evaluate the effects of running on sand vs. stable ground on ground-reaction-forces (GRFs) and electromyographic (EMG) activity of lower limb muscles in individuals with over-pronated feet (OPF) compared with healthy controls.
Methods: Thirty-three OPF individuals and 33 controls ran at preferred speed and in randomized-order over level-ground and sand. A force-plate was embedded in an 18-m runway to collect GRFs. Muscle activities were recorded using an EMG-system. Data were adjusted for surface-related differences in running speed.
Results: Running on sand resulted in lower speed compared with stable ground running (p < 0.001; d = 0.83). Results demonstrated that running on sand produced higher tibialis anterior activity (p = 0.024; d = 0.28). Also, findings indicated larger loading rates (p = 0.004; d = 0.72) and greater vastus medialis (p < 0.001; d = 0.89) and rectus femoris (p = 0.001; d = 0.61) activities in OPF individuals. Controls but not OPF showed significantly lower gluteus-medius activity (p = 0.022; d = 0.63) when running on sand.
Conclusion: Running on sand resulted in lower running speed and higher tibialis anterior activity during the loading phase. This may indicate alterations in neuromuscular demands in the distal part of the lower limbs when running on sand. In OPF individuals, higher loading rates together with greater quadriceps activity may constitute a proximal compensatory mechanism for distal surface instability.
Background:
From birth to young adulthood, health and development of young people are strongly linked to their living situation, including their family's socioeconomic position (SEP) and living environment. The impact of regional characteristics on development in early childhood beyond family SEP has been rarely investigated. This study aimed to identify regional predictors of global developmental delay at school entry taking family SEP into consideration.
Method:
We used representative, population-based data from mandatory school entry examinations of the German federal state of Brandenburg in 2018/2019 with n=22,801 preschool children. By applying binary multilevel models, we hierarchically analyzed the effect of regional deprivation defined by the German Index of Socioeconomic Deprivation (GISD) and rurality operationalized as inverted population density of the children's school district on global developmental delay (GDD) while adjusting for family SEP (low, medium and high)
Results:
Family SEP was significantly and strongly linked to GDD. Children with the highest family SEP showed a lower odds for GDD compared to a medium SEP (female: OR=4.26, male: OR=3.46) and low SEP (female: OR=16.58, male: OR=12.79). Furthermore, we discovered a smaller, but additional and independent effect of regional socioeconomic deprivation on GDD, with a higher odds for children from a more deprived school district (female: OR=1.35, male: OR=1.20). However, rurality did not show a significant link to GDD in preschool children beyond family SEP and regional deprivation.
Conclusion:
Family SEP and regional deprivation are risk factors for child development and of particular interest to promote health of children in early childhood and over the life course.
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.
Sedentarism is a risk factor for depression and anxiety. People living with the human immunodeficiency virus (PLWH) have a higher prevalence of anxiety and depression compared to HIV-negative individuals. This cross-sectional study (n = 450, median age 44 (19-75), 7.3% females) evaluates the prevalence rates and prevalence ratio (PR) of anxiety and/or depression in PLWH associated with recreational exercise. A decreased likelihood of having anxiety (PR=0.57; 0.36-0.91; p = 0.01), depression (PR=0.41; 0.36-0.94; p=0.01), and comorbid anxiety and depression (PR = 0,43; 0.24-0.75; p=0.002) was found in exercising compared to non-exercising PLWH. Recreational exercise is associated with a lower risk for anxiety and/or depression. Further prospective studies are needed to provide insights on the direction of this association.
Introduction: The implementation of medical video consultations in nursing homes can support primary care in rural areas and counteract the shortage of physicians. So far, video consultations have been limited to pilot projects and have not yet been comprehensively implemented. The present study addresses potentials of video consultations and challenges that may arise during the implementation of medical video consultations. Methods: Twenty-one guided interviews (pre-implementation: n = 13; post-implementation: n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). The data was analyzed using qualitative content analysis. The results were contrasted in a pre-post analysis. Results: Almost all of the interviewees' expectations regarding video consultations described prior to implementation have been met: time savings, improved communication, reduction of information breaks and increase in the quality of care. After implementation, other unexpected advantages of telemedical care became apparent, such as the possibility of regular monitoring or the improved ability to plan routine visits without interrupting the daily schedule. At the same time, the implementation of video consultations is associated with the following challenges: defining responsibilities, acquiring experience in handling video consultation tools, providing for sufficient qualification and training, dealing with new billing modalities as well as missing links between nursing documentation and medical information systems. Discussion: Video consultations can improve health care routines in nursing homes, lead to a wider availability of medical services, and contribute to improving patient safety and the quality of care. However, various aspects and contextual factors need to be addressed when implementing video consultations. These include: implementation of technical requirements, initial training with test consultations, continuous interactive development of potential fields of application, and the definition of the respective responsibilities of caregivers, physicians and medical assistants.
Ethical, legal, and social implications of symptom checker Apps in primary Health Care (CHECK.APP)
(2022)
Background:
Symptom checker apps (SCAs) are accessible tools that provide early symptom assessment for users. The ethical, legal, and social implications of SCAs and their impact on the patient-physician relationship, the health care providers, and the health care system have sparsely been examined. This study protocol describes an approach to investigate the possible impacts and implications of SCAs on different levels of health care provision. It considers the perspectives of the users, nonusers, general practitioners (GPs), and health care experts.
Objective:
We aim to assess a comprehensive overview of the use of SCAs and address problematic issues, if any. The primary outcomes of this study are empirically informed multi-perspective recommendations for different stakeholders on the ethical, legal, and social implications of SCAs.
Methods:
Quantitative and qualitative methods will be used in several overlapping and interconnected study phases. In study phase 1, a comprehensive literature review will be conducted to assess the ethical, legal, social, and systemic impacts of SCAs. Study phase 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCAs in Germany as well as the predictors for SCA usage. Study phase 3 will investigate self-observational diaries and user interviews, which will be analyzed as integrated cases to assess user perspectives, usage pattern, and arising problems. Study phase 4 will comprise GP interviews to assess their experiences, perspectives, self-image, and concepts and will be analyzed with the basic procedure by Kruse. Moreover, interviews with health care experts will be conducted in study phase 3 and will be analyzed by using the reflexive thematical analysis approach of Braun and Clark.
Results:
Study phase 1 will be completed in November 2021. We expect the results of study phase 2 in December 2021 and February 2022. In study phase 3, interviews are currently being conducted. The final study endpoint will be in February 2023.
Conclusions:
The possible ethical, legal, social, and systemic impacts of a widespread use of SCAs that affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multifaceted and diverse empirical basis for a broad discussion on these implications.
Introduction Physical activity among children and adolescents remains insufficient, despite the substantial efforts made by researchers and policymakers. Identifying and furthering our understanding of potential modifiable determinants of physical activity behaviour (PAB) and sedentary behaviour (SB) is crucial for the development of interventions that promote a shift from SB to PAB. The current protocol details the process through which a series of systematic literature reviews and meta-analyses (MAs) will be conducted to produce a best-evidence statement (BESt) and inform policymakers. The overall aim is to identify modifiable determinants that are associated with changes in PAB and SB in children and adolescents (aged 5-19 years) and to quantify their effect on, or association with, PAB/SB. Methods and analysis A search will be performed in MEDLINE, SportDiscus, Web of Science, PsychINFO and Cochrane Central Register of Controlled Trials. Randomised controlled trials (RCTs) and controlled trials (CTs) that investigate the effect of interventions on PAB/SB and longitudinal studies that investigate the associations between modifiable determinants and PAB/SB at multiple time points will be sought. Risk of bias assessments will be performed using adapted versions of Cochrane's RoB V.2.0 and ROBINS-I tools for RCTs and CTs, respectively, and an adapted version of the National Institute of Health's tool for longitudinal studies. Data will be synthesised narratively and, where possible, MAs will be performed using frequentist and Bayesian statistics. Modifiable determinants will be discussed considering the settings in which they were investigated and the PAB/SB measurement methods used. Ethics and dissemination No ethical approval is needed as no primary data will be collected. The findings will be disseminated in peer-reviewed publications and academic conferences where possible. The BESt will also be shared with policy makers within the DE-PASS consortium in the first instance. Systematic review registration CRD42021282874.
The Influence of acute sprint interval training on cognitive performance of healthy younger adults
(2022)
There is considerable evidence showing that an acute bout of physical exercises can improve cognitive performance, but the optimal exercise characteristics (e.g., exercise type and exercise intensity) remain elusive. In this regard, there is a gap in the literature to which extent sprint interval training (SIT) can enhance cognitive performance. Thus, this study aimed to investigate the effect of a time-efficient SIT, termed as "shortened-sprint reduced-exertion high-intensity interval training" (SSREHIT), on cognitive performance. Nineteen healthy adults aged 20-28 years were enrolled and assessed for attentional performance (via the d2 test), working memory performance (via Digit Span Forward/Backward), and peripheral blood lactate concentration immediately before and 10 min after an SSREHIT and a cognitive engagement control condition (i.e., reading). We observed that SSREHIT can enhance specific aspects of attentional performance, as it improved the percent error rate (F%) in the d-2 test (t (18) = -2.249, p = 0.037, d = -0.516), which constitutes a qualitative measure of precision and thoroughness. However, SSREHIT did not change other measures of attentional or working memory performance. In addition, we observed that the exercise-induced increase in the peripheral blood lactate levels correlated with changes in attentional performance, i.e., the total number of responses (GZ) (r(m) = 0.70, p < 0.001), objective measures of concentration (SKL) (r(m) = 0.73, p < 0.001), and F% (r(m) = -0.54, p = 0.015). The present study provides initial evidence that a single bout of SSREHIT can improve specific aspects of attentional performance and conforming evidence for a positive link between cognitive improvements and changes in peripheral blood lactate levels.
Studies have evaluated the effectiveness of dual career (DC) support services among student-athletes by examining scholastic performances.
These studies investigated self-reported grades student-athletes or focused on career choices student-athletes made after leaving school. Most of these studies examined scholastic performances cross-sectionally among lower secondary school student-athletes or student-athletes in higher education.
The present longitudinal field study in a quasi-experimental design aims to evaluate the development of scholastic performances among upper secondary school students aged 16-19 by using standardized scholastic assessments and grade points in the subject English over a course of 3-4 years.
A sample of 159 students (54.4% females) at three German Elite Sport Schools (ESS) and three comprehensive schools participated in the study. The sample was split into six groups according to three criteria: (1) students' athletic engagement, (2) school type attendance, and (3) usage of DC support services in secondary school.
Repeated-measurement analyses of variance were conducted in order to evaluate the impact of the three previously mentioned criteria as well as their interaction on the development of scholastic performances.
Findings indicated that the development of English performance levels differ among the six groups.
Sarcopenic obesity is increasingly found in youth, but its health consequences remain unclear.
Therefore, we studied the prevalence of sarcopenia and its association with cardiometabolic risk factors as well as muscular and cardiorespiratory fitness using data from the German Children's Health InterventionaL Trial (CHILT III) programme.
In addition to anthropometric data and blood pressure, muscle and fat mass were determined with bioelectrical impedance analysis.
Sarcopenia was classified via muscle-to-fat ratio. A fasting blood sample was taken, muscular fitness was determined using the standing long jump, and cardiorespiratory fitness was determined using bicycle ergometry. Of the 119 obese participants included in the analysis (47.1% female, mean age 12.2 years), 83 (69.7%) had sarcopenia. Affected individuals had higher gamma-glutamyl transferase, higher glutamate pyruvate transaminase, higher high-sensitivity C-reactive protein, higher diastolic blood pressure, and lower muscular and cardiorespiratory fitness (each p < 0.05) compared to participants who were 'only' obese.
No differences were found in other parameters. In our study, sarcopenic obesity was associated with various disorders in children and adolescents.
However, the clinical value must be tested with larger samples and reference populations to develop a unique definition and appropriate methods in terms of identification but also related preventive or therapeutic approaches.
Isometric muscle function
(2022)
The cumulative dissertation consists of four original articles. These considered isometric muscle ac-tions in healthy humans from a basic physiological view (oxygen and blood supply) as well as possibilities of their distinction. It includes a novel approach to measure a specific form of isometric hold-ing function which has not been considered in motor science so far. This function is characterized by an adaptation to varying external forces with particular importance in daily activities and sports.
The first part of the research program analyzed how the biceps brachii muscle is supplied with oxygen and blood by adapting to a moderate constant load until task failure (publication 1). In this regard, regulative mechanisms were investigated in relation to the issue of presumably compressed capillaries due to high intramuscular pressures (publication 2).
Furthermore, it was examined if oxygenation and time to task failure (TTF) differs compared to an-other isometric muscle function (publication 3). This function is mainly of diagnostic interest by measuring the maximal voluntary isometric contraction (MVIC) as a gold standard. For that, a person pulls on or pushes against an insurmountable resistance. However, the underlying pulling or pushing form of isometric muscle action (PIMA) differs compared to the holding one (HIMA).
HIMAs have mainly been examined by using constant loads. In order to quantify the adaptability to varying external forces, a new approach was necessary and considered in the second part of the research program. A device was constructed based on a previously developed pneumatic measurement system. The device should have been able to measure the Adaptive Force (AF) of elbow ex-tensor muscles. The AF determines the adaptability to increasing external forces under isometric (AFiso) and eccentric (AFecc) conditions. At first, it was questioned if these parameters can be relia-bly assessed by use of the new device (publication 4). Subsequently, the main research question was investigated: Is the maximal AFiso a specific and independent variable of muscle function in comparison to the MVIC? Furthermore, both research parts contained a sub-question of how results can be influenced.
Parameters of local oxygen saturation (SvO2) and capillary blood filling (rHb) were non-invasively recorded by a spectrophotometer during maximal and submaximal HIMAs and PIMAs.
These were the main findings: Under load, SvO2 and rHb always adjusted into a steady state after an initial decrease. Nevertheless, their behavior could roughly be categorized into two types. In type I, both parameters behaved nearly parallel to each other. In contrast, their progression over time was partly inverse in type II. The inverse behavior probably depends on the level of deoxygenation since rHb increased reliably at a suggested threshold of about 59% SvO2. This triggered mechanism and the found homeostatic steady states seem to be in conflict with the concept of mechanically compressed capillaries and consequently with a restricted blood flow. Anatomical configuration of blood vessels might provide one hypothetical explanation of how blood flow might be maintained. HIMA and PIMA did not differ regarding oxygenation and allocation to the described types. The TTF tended to be longer during PIMA.
As a sub-question, oxygenation and TTF were compared between (HIMA) and intermittent voluntary muscle twitches during a weight holding task. TTF but not oxygenation differed significantly
(Twitch > HIMA). A changed neuromuscular control might serve as a speculative explanation of how the results can be explained. This is supported by the finding that the TTF did not correlate significantly with the extent of deoxygenation irrespective of the performed task (HIMA, PIMA or Twitch).
Other neuromuscular aspects of muscle function were considered in second part of the re-search program. The new device mentioned above detected different force capacities within four trials at two days each. Among AF measurements, the functional counterpart of a concentric muscle action merging into an isometric one was analyzed in comparison to the MVIC.
Based on the results, it can be assumed that a prior concentric muscle action does not influence the MVIC. However, the results were inconsistent and possibly influenced by systematic errors. In con-trast, maximal variables of the AF (AFisomax and AFeccmax) could be measured in a reliable way which is indicated by a high test-retest reliability. Despite substantial correlations between force variables, the AFisomax differed significantly from MVIC and AFmax, which was identical with AFeccmax in almost all cases. Moreover, AFisomax revealed the highest variability between trials.
These results indicate that maximal force capacities should be assessed separately. The adaptive holding capacity of a muscle can be lower compared to a commonly determined MVIC. This is of relevance since muscles frequently need to respond adequately to external forces. If their response does not correspond to the external impact, the muscle is forced to lengthen. In this scenario, joints are not completely stabilized and an injury may occur. This outlined issue should be addressed in future research in the field of sport and health sciences.
At last, the dissertation presents another possibility to quantify the AFisomax by use of a handheld device applied in combination with a manual muscle test. This assessment delivers a more practical way for clinical purposes.
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.
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.
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.
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.
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.
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.
Adaptive Force (AF) reflects the capability of the neuromuscular system to adapt adequately to external forces with the intention of maintaining a position or motion. One specific approach to assessing AF is to measure force and limb position during a pneumatically applied increasing external force. Through this method, the highest (AFmax), the maximal isometric (AFisomax) and the maximal eccentric Adaptive Force (AFeccmax) can be determined. The main question of the study was whether the AFisomax is a specific and independent parameter of muscle function compared to other maximal forces. In 13 healthy subjects (9 male and 4 female), the maximal voluntary isometric contraction (pre- and post-MVIC), the three AF parameters and the MVIC with a prior concentric contraction (MVICpri-con) of the elbow extensors were measured 4 times on two days. Arithmetic mean (M) and maximal (Max) torques of all force types were analyzed. Regarding the reliability of the AF parameters between days, the mean changes were 0.31–1.98 Nm (0.61%–5.47%, p = 0.175–0.552), the standard errors of measurements (SEM) were 1.29–5.68 Nm (2.53%–15.70%) and the ICCs(3,1) = 0.896–0.996. M and Max of AFisomax, AFmax and pre-MVIC correlated highly (r = 0.85–0.98). The M and Max of AFisomax were significantly lower (6.12–14.93 Nm; p ≤ 0.001–0.009) and more variable between trials (coefficient of variation (CVs) ≥ 21.95%) compared to those of pre-MVIC and AFmax (CVs ≤ 5.4%). The results suggest the novel measuring procedure is suitable to reliably quantify the AF, whereby the presented measurement errors should be taken into consideration. The AFisomax seems to reflect its own strength capacity and should be detected separately. It is suggested its normalization to the MVIC or AFmax could serve as an indicator of a neuromuscular function.
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.
Background: To handle the competition demands, sparring drills are used for specific technical–tactical training as well as physical–physiological conditioning in combat sports. While the effects of different area sizes and number of within-round sparring partners on physiological and perceptive responses in combats sports were examined in previous studies, technical and tactical aspects were not investigated. This study investigated the effect of different within-round sparring partners number (i.e., at a time; 1 vs. 1, 1 vs. 2, and 1 vs. 4) and area sizes (2 m × 2 m, 4 m × 4 m, and 6 m × 6 m) variation on the technical–tactical aspects of small combat games in kickboxing.
Method: Twenty male kickboxers (mean ± standard deviation, age: 20.3 ± 0.9 years), regularly competing in regional and national events randomly performed nine different kickboxing combats, lasting 2 min each. All combats were video recorded and analyzed using the software Dartfish.
Results: Results showed that the total number of punches was significantly higher in 1 versus 4 compared with 1 versus 1 (p = 0.011, d = 0.83). Further, the total number of kicks was significantly higher in 1 versus 4 compared with 1 versus 1 and 1 versus 2 (p < 0.001; d = 0.99 and d = 0.83, respectively). Moreover, the total number of kick combinations was significantly higher in 1 versus 4 compared with 1 versus 1 and 1 versus 2 (p < 0.001; d = 1.05 and d = 0.95, respectively). The same outcome was significantly lower in 2 m × 2 m compared with 4 m × 4 m and 6 m × 6 m areas (p = 0.010 and d = − 0.45; p < 0.001 and d = − 0.6, respectively). The number of block-and-parry was significantly higher in 1 versus 4 compared with 1 versus 1 (p < 0.001, d = 1.45) and 1 versus 2 (p = 0.046, d = 0.61) and in 2 m × 2 m compared with 4 m × 4 m and 6 × 6 m areas (p < 0.001; d = 0.47 and d = 0.66, respectively). Backwards lean actions occurred more often in 2 m × 2 m compared with 4 m × 4 m (p = 0.009, d = 0.53) and 6 m × 6 m (p = 0.003, d = 0.60). However, the number of foot defenses was significantly lower in 2 m × 2 m compared with 6 m × 6 m (p < 0.001, d = 1.04) and 4 m × 4 m (p = 0.004, d = 0.63). Additionally, the number of clinches was significantly higher in 1 versus 1 compared with 1 versus 2 (p = 0.002, d = 0.7) and 1 versus 4 (p = 0.034, d = 0.45).
Conclusions: This study provides practical insights into how to manipulate within-round sparring partners’ number and/or area size to train specific kickboxing technical–tactical fundamentals.
Background/Purpose
Muscular reflex responses of the lower extremities to sudden gait disturbances are related to postural stability and injury risk. Chronic ankle instability (CAI) has shown to affect activities related to the distal leg muscles while walking. Its effects on proximal muscle activities of the leg, both for the injured- (IN) and uninjured-side (NON), remain unclear. Therefore, the aim was to compare the difference of the motor control strategy in ipsilateral and contralateral proximal joints while unperturbed walking and perturbed walking between individuals with CAI and matched controls.
Materials and methods
In a cross-sectional study, 13 participants with unilateral CAI and 13 controls (CON) walked on a split-belt treadmill with and without random left- and right-sided perturbations. EMG amplitudes of muscles at lower extremities were analyzed 200 ms after perturbations, 200 ms before, and 100 ms after (Post100) heel contact while walking. Onset latencies were analyzed at heel contacts and after perturbations. Statistical significance was set at alpha≤0.05 and 95% confidence intervals were applied to determine group differences. Cohen’s d effect sizes were calculated to evaluate the extent of differences.
Results
Participants with CAI showed increased EMG amplitudes for NON-rectus abdominus at Post100 and shorter latencies for IN-gluteus maximus after heel contact compared to CON (p<0.05). Overall, leg muscles (rectus femoris, biceps femoris, and gluteus medius) activated earlier and less bilaterally (d = 0.30–0.88) and trunk muscles (bilateral rectus abdominus and NON-erector spinae) activated earlier and more for the CAI group than CON group (d = 0.33–1.09).
Conclusion
Unilateral CAI alters the pattern of the motor control strategy around proximal joints bilaterally. Neuromuscular training for the muscles, which alters motor control strategy because of CAI, could be taken into consideration when planning rehabilitation for CAI.
Schomoller, A, Schugardt, M, Kotsch, P, and Mayer, F. The effect of body composition on cycling power during an incremental test in young athletes. J Strength Cond Res 35(11): 3225-3231, 2021-As body composition (BC) is a modifiable factor influencing sports performance, it is of interest for athletes and coaches to optimize BC to fulfill the specific physical demands of one sport discipline. The purpose of this study is to test the impact of body fat (BF) and fat-free mass (FFM) on aerobic performance in young athletes. Body composition parameters were evaluated among gender and age groups of young athletes undergoing their mandatory health examination. The maximal power (in Watts per kilogram body mass) of a stepwise incremental ergometer test was compared between 6 BC types: high BF, high FFM, high BF and high FFM, normal BC values, low BF, and low FFM. With increasing age (11-13 vs. 14-16 years) BF decreased and FFM increased in both genders. Both BC parameters, as well as body mass, correlated moderately with performance output (r = 0.36-0.6). Subjects with high BF or high FFM or both had significantly lower ergometer test results compared with those with low BF and FFM in all age and gender groups (p < 0.05). The finding that high levels of BF and FFM are detrimental for cycle power output is important to consider in disciplines that demand high levels of aerobic and anaerobic performance.
Mechanotendography
(2021)
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.
Eccentric exercise is discussed as a treatment option for clinical populations, but specific responses in terms of muscle damage and systemic inflammation after repeated loading of large muscle groups have not been conclusively characterized. Therefore, this study tested the feasibility of an isokinetic protocol for repeated maximum eccentric loading of the trunk muscles. Nine asymptomatic participants (5 f/4 m; 34±6 yrs; 175±13 cm; 76±17 kg) performed three isokinetic 2-minute all-out trunk strength tests (1x concentric (CON), 2x eccentric (ECC1, ECC2), 2 weeks apart; flexion/extension, 60°/s, ROM 55°). Outcomes were peak torque, torque decline, total work, and indicators of muscle damage and inflammation (over 168 h). Statistics were done using the Friedman test (Dunn’s post-test). For ECC1 and ECC2, peak torque and total work were increased and torque decline reduced compared to CON. Repeated ECC bouts yielded unaltered torque and work outcomes. Muscle damage markers were highest after ECC1 (soreness 48 h, creatine kinase 72 h; p<0.05). Their overall responses (area under the curve) were abolished post-ECC2 compared to post-ECC1 (p<0.05). Interleukin-6 was higher post-ECC1 than CON, and attenuated post-ECC2 (p>0.05). Interleukin-10 and tumor necrosis factor-α were not detectable. All markers showed high inter-individual variability. The protocol was feasible to induce muscle damage indicators after exercising a large muscle group, but the pilot results indicated only weak systemic inflammatory responses in asymptomatic adults.
Objective: To assess the reliability of measurements of paraspinal muscle transverse relaxation times (T2 times) between two observers and within one observer on different time points. <br /> Methods: 14 participants (9f/5m, 33 +/- 5 years, 176 +/- 10 cm, 73 +/- 12 kg) underwent 2 consecutive MRI scans (M1,M2) on the same day, followed by 1 MRI scan 13-14 days later (M3) in a mobile 1.5 Tesla MRI. T2 times were calculated in T-2 weighted turbo spin- echo-sequences at the spinal level of the third lumbar vertebrae (11 slices, 2 mm slice thickness, 1 mm interslice gap, echo times: 20, 40, 60, 80, 100 ms) for M. erector spinae (ES) and M. multifidius (MF). The following reliability parameter were calculated for the agreement of T2 times between two different investigators (OBS1 & OBS2) on the same MRI (inter rater reliability, IR) and by one investigator between different MRI of the same participant (intersession variability, IS): Test-Retest Variability (TRV, Differences/Mean*100); Coefficient of Variation (CV, Standard deviation/Mean*100); Bland-Altman Analysis (systematic bias = Mean of the Differences; Upper/Lower Limits of Agreement = Bias+/-1.96*SD); Intraclass Correlation Coefficient 3.1 (ICC) with absolute agreement, as well as its 95% confidence interval. <br /> Results: Mean TRV for IR was 2.6% for ES and 4.2% for MF. Mean TRV for IS was 3.5% (ES) and 5.1% (MF). Mean CV for IR was 1.9 (ES) and 3.0 (MF). Mean CV for IS was 2.5% (ES) and 3.6% (MF). A systematic bias of 1.3 ms (ES) and 2.1 ms (MF) were detected for IR and a systematic bias of 0.4 ms (ES) and 0.07 ms (MF) for IS. ICC for IR was 0.94 (ES) and 0.87 (MF). ICC for IS was 0.88 (ES) and 0.82 (MF). <br /> Conclusion: Reliable assessment of paraspinal muscle T2 time justifies its use for scientific purposes. The applied technique could be recommended to use for future studies that aim to assess changes of T2 times, e.g. after an intense bout of eccentric exercises.
The regulation of oxygen and blood supply during isometric muscle actions is still unclear. Recently, two behavioral types of oxygen saturation (SvO(2)) and relative hemoglobin amount (rHb) in venous microvessels were described during a fatiguing holding isometric muscle action (HIMA) (type I: nearly parallel behavior of SvO(2) and rHb; type II: partly inverse behavior). The study aimed to ascertain an explanation of these two regulative behaviors. Twelve subjects performed one fatiguing HIMA trial with each arm by weight holding at 60% of the maximal voluntary isometric contraction (MVIC) in a 90 & DEG; elbow flexion. Six subjects additionally executed one fatiguing PIMA trial by pulling on an immovable resistance with 60% of the MVIC with each side and same position. Both regulative types mentioned were found during HIMA (I: n = 7, II: n = 17) and PIMA (I: n = 3, II: n = 9). During the fatiguing measurements, rHb decreased initially and started to increase in type II at an average SvO(2)-level of 58.75 & PLUSMN; 2.14%. In type I, SvO(2) never reached that specific value during loading. This might indicate the existence of a threshold around 59% which seems to trigger the increase in rHb and could explain the two behavioral types. An approach is discussed to meet the apparent incompatibility of an increased capillary blood filling (rHb) despite high intramuscular pressures which were found by other research groups during isometric muscle actions.
Einleitung
Ältere Patienten mit Herzklappenerkrankungen werden zunehmend häufig mit der kathetergestützten Aortenklappenimplantation (Transcatheter Aortic Valve Implantation, TAVI) oder dem MitraClip®-Verfahren behandelt. In der kardiologischen Rehabilitation nimmt infolgedessen die Patientenpopulation der Hochbetagten stetig zu. Die funktionale Gesundheit dieser Patienten wird durch häufig auftretende, sogenannte geriatrische Syndrome wie Multimorbidität, Mangelernährung, Gebrechlichkeit oder Sturzereignisse beeinflusst. Insbesondere die eingeschränkte Mobilität und Mangelernährung sind wichtige Prädiktoren für die Prognose der Patienten nach TAVI.
Etablierte Verfahren, um die körperliche Leistungsfähigkeit von kardiologischen Rehabilitanden zu beurteilen, sind die Belastungsergometrie und der 6-Minuten-Gehtest. Allerdings ist nahezu die Hälfte der hochbetagten Patienten nicht in der Lage, eine Belastungsergometrie durchzuführen. Bislang erfolgt in der kardiologischen Rehabilitation keine differenzierte Erfassung des funktionellen Status hinsichtlich Mobilität, Kraft und Gleichgewicht, um die geriatrischen Syndrome individuell zu beurteilen. Darüber hinaus werden keine Assessments zur Erfassung des Ernährungsstatus eingesetzt.
Daher war es das Ziel der vorliegenden Arbeit, die Ausprägung des funktionellen und nutritiven Status älterer Patienten anhand geeigneter Assessments in der kardiologischen Rehabilitation zu ermitteln.
Methode
Zwischen Oktober 2018 und Juni 2019 nahmen Patienten im Alter von 75 Jahren oder älter nach TAVI, atrioventrikulärer Intervention mittels MitraClip®-Verfahren (AVI) oder perkutaner Koronarintervention (PCI) an der Studie teil. Zu Beginn der kardiologischen Rehabilitation wurden soziodemografische Daten, echokardiografische Parameter (z. B. links und rechtsventrikuläre Ejektionsfraktion, Herzrhythmus) und Komorbiditäten (z. B. Diabetes mellitus, Niereninsuffizienz, orthopädische Erkrankungen) erhoben, um die Patientenpopulation zu beschreiben. Zusätzlich wurde die Gebrechlichkeit der Rehabilitanden mit dem Index von Stortecky et al., bestehend aus den Komponenten Kognition, Mobilität, Ernährung und Aktivitäten des täglichen Lebens, beurteilt.
Der 6-Minuten-Gehtest diente zur Ermittlung der körperlichen Leistungsfähigkeit der Patienten. Die Mobilität wurde mit Hilfe des Timed-Up-and-Go-Tests, die Ganggeschwindigkeit mit dem Gait Speed Test und die Handkraft mit dem Hand Grip Test erfasst.
Für die Objektivierung des Gleichgewichts wurde eine Kraftmessplatte (uni- und bipedaler Stand mit geöffneten und geschlossenen Augen) erprobt, die bislang bei älteren Rehabilitanden noch nicht eingesetzt wurde.
Der Ernährungsstatus wurde mit dem Mini Nutritional Assessment-Short Form und den ernährungsbezogenen Laborparametern (Hämoglobin, Serumalbumin, Eiweißkonzentration) erfasst.
Die Eignung der Assessments bewerteten wir anhand folgender Kriterien: Durchführbarkeit (bei ≥ 95 % der Patienten durchführbar), Sicherheit (< 95 % Stürze oder andere unerwünschte Ereignisse) und der Pearson-Korrelationen zwischen den funktionellen Tests und dem Goldstandard 6-Minuten-Gehtest sowie den Laborparametern und dem Mini Nutritional Assessment-Short Form.
Ergebnisse
Es wurden 124 Patienten (82 ± 4 Jahre, 48 % Frauen, 5 ± 2 Komorbiditäten, 9 ± 3 Medikamente) nach TAVI (n = 59), AVI (n = 21) und PCI (n = 44) konsekutiv in die Studie eingeschlossen.
Etwa zwei Drittel aller Patienten der Gesamtpopulation waren als gebrechlich zu klassifizieren, bei einer mittleren Punktzahl von 2,9 ± 1,4. Annähernd die Hälfte der Patienten zeigte eine eingeschränkte körperliche Leistungsfähigkeit aufgrund einer reduzierten 6-Minuten-Gehstrecke (48 % < 350 m) sowie eine eingeschränkte Mobilität im Timed-Up-and-Go-Test (55 % > 10 s). Es wurden eine mittlere Gehstrecke von 339 ± 131 m und eine durchschnittliche Zeit im Timed-Up-and-Go-Test von 11,4 ± 6,3 s erzielt. Darüber hinaus wies ein Viertel der Patienten eine eingeschränkte Ganggeschwindigkeit (< 0,8 m/s) auf und etwa 35 % von Ihnen zeigten eine reduzierte Handkraft (Frauen/Männer < 16/27 kg). Im Mittel wurde eine Geschwindigkeit von 1,0 ± 0,2 m/s im Gait Speed Test sowie eine Handkraft von 24 ± 9 kg im Hand Grip Test erreicht. Ein Risiko einer Mangelernährung konnte bei 38 % (< 12 Punkte) der Patienten nachgewiesen werden bei einer mittleren Punktzahl von 11,8 ± 2,2 im Mini Nutritional Assessment-Short Form.
Im Vergleich zwischen den einzelnen Subpopulationen bestanden keine statistisch signifikanten Unterschiede in den Ergebnissen der funktionellen Assessments. Bezüglich des Ernährungsstatus wiesen allerdings die Patienten nach AVI einen statistisch signifikant niedrigeren Punktewert im Mini Nutritional Assessment-Short Form (10,3 ± 3,0 Punkte) auf als die Patienten nach TAVI (12,0 ± 1,8 Punkte) und PCI (12,1 ± 2,1 Punkte), wobei etwa 57 % der Patienten nach AVI, 38 % nach TAVI und 50 % nach PCI ein Risiko einer Mangelernährung zeigten.
Mit Ausnahme der Tests auf der Kraftmessplatte waren alle Assessments durchführbar und sicher. Während 86 % der Patienten den bipedalen Stand mit geschlossenen Augen auf der Kraftmessplatte durchführen konnten und damit nahezu den Grenzwert von 95 % erreichten, war der unipedale Stand mit 12 % an durchführbaren Messungen weit von diesem entfernt.
Der Gait Speed Test (r = 0,79), Timed-Up-and-Go-Test (r = 0,68) und Hand Grip Test (r = 0,33) korrelierten signifikant mit dem 6-Minuten-Gehtest, Hämoglobin (r = 0,20) und Albumin (r = 0,24) korrelierten mit dem Mini Nutritional Assessment-Short Form.
Schlussfolgerung
Über die bestehende Multimorbidität und Multimedikation hinaus wiesen die untersuchten Patienten vor allem eine eingeschränkte Mobilität und ein Risiko einer Mangelernährung auf, wobei die Subpopulation nach AVI besonders betroffen war.
Um den Bedürfnissen hochbetagter Rehabilitanden nach kathetergestützer Intervention gerecht zu werden, ist eine individuelle Behandlung der einzelnen Defizite erforderlich, mit besonderer Berücksichtigung der Komorbiditäten sowie der geriatrischen Kofaktoren. Aufgrund des multidisziplinären Ansatzes erfüllt die kardiologische Rehabilitation bereits die Voraussetzung, hochbetagte Patienten bedarfsgerecht zu behandeln, jedoch mangelt es an Assessments, um die individuellen Defizite der Patienten zu identifizieren
Der Gait Speed Test, der Timed-Up-and-Go-Test und der Hand Grip Test sollten daher in den klinischen Alltag der kardiologischen Rehabilitation implementiert werden, um die körperliche Funktion und Leistungsfähigkeit älterer Patienten detailliert zu beurteilen. In Kombination dieser Assessments mit dem Mini Nutritional Assessment-Short Form können die individuellen funktionellen und nutritiven Bedürfnisse der Patienten während der Rehabilitation erkannt und mit geeigneten Maßnahmen die weitere Ausbildung geriatrischer Syndrome gemindert werden.
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.
The scapula plays a significant role in efficient shoulder movement. Thus, alterations from typical scapular motion during upper limb movements are thought to be associated with shoulder pathologies. However, a clear understanding of the relationship is not yet obtained.. Scapular alterations may only represent physiological variability as their occurrence can appear equally as frequent in individuals with and without shoulder disorders. Evaluation of scapular motion during increased load might be a beneficial approach to detect clinically relevant alterations. However, functional motion adaptations in response to maximum effort upper extremity loading has not been established yet. Therefore, the overall purpose of this research project was to give further insight in physiological adaptations of scapular kinematics and their underlying scapular muscle activity in response to high demanding shoulder movements in healthy asymptomatic individuals. Prior to the investigation of the effect of various load situation, the reproducibility of scapular kinematics and scapular muscle activity were evaluated under maximum effort arm movements. Healthy asymptomatic adults performed unloaded and maximal loaded concentric and eccentric isokinetic shoulder flexion and extension movements in the scapular plane while scapular kinematics and scapular muscle activity were simultaneously assessed. A 3D motion capture system (infra-red cameras & reflective markers) was utilized to track scapular and humerus motion in relation to the thorax. 3D scapular position angles were given for arm raising and lowering between humerus positions of 20° and 120° flexion. To further characterize the scapular pattern, the scapular motion extent and scapulohumeral rhythm (ratio of scapular and humerus motion extent) were determined. Muscle activity of the upper and lower trapezius and the serratus anterior were assessed with surface electromyography. Amplitudes were calculated for the whole ROM and four equidistant movement phases. Reliability was characterized by overall moderate to good reproducibility across the load conditions. Irrespective of applied load, scapular kinematics followed a motion pattern of continuous upward rotation, posterior tilt and external rotation during arm elevation and a continuous downward rotation, anterior tilt and internal rotation during arm lowering. However, kinematics were altered between maximal loaded and unloaded conditions showing increased upward rotation, reduced posterior tilt and external rotation. Further, the scapulohumeral rhythm was decreased and scapular motion extent increased under maximal loaded movements. Muscle activity during maximum effort were of greater magnitude and differed in their pattern in comparison to the continuous increase and decrease of activity during unloaded shoulder flexion and extension. Relationships between scapular kinematics and their underlying scapular muscle activity could only be identified for a few isolated combinations, whereas the majority showed no associations. Scapular kinematics and scapular muscle activity pattern alter according to the applied load. Alterations between the load conditions comply in magnitude and partially in direction with differences seen between symptomatic and asymptomatic individuals. Even though long-term effects of identified adaptations in response to maximum load are so far unclear, deviations from typical scapular motion or muscle activation should not per se be seen as indicators of shoulder impairment. However, evaluation of alterations in scapular motion and activation in response to maximum effort may have the potential to identify individuals that are unable to cope with increased upper limb demands. Findings further challenge the understanding of scapular motion and stabilization by the trapezius and serratus anterior muscles, as clear relationships between the underlying scapular muscle activity and scapular kinematics were neither observed during unloaded nor maximal loaded shoulder movements.
Extracellular vesicles: potential mediators of psychosocial stress contribution to osteoporosis?
(2021)
Osteoporosis is characterized by low bone mass and damage to the bone tissue’s microarchitecture, leading to increased fracture risk. Several studies have provided evidence for associations between psychosocial stress and osteoporosis through various pathways, including the hypothalamic-pituitary-adrenocortical axis, the sympathetic nervous system, and other endocrine factors. As psychosocial stress provokes oxidative cellular stress with consequences for mitochondrial function and cell signaling (e.g., gene expression, inflammation), it is of interest whether extracellular vesicles (EVs) may be a relevant biomarker in this context or act by transporting substances. EVs are intercellular communicators, transfer substances encapsulated in them, modify the phenotype and function of target cells, mediate cell-cell communication, and, therefore, have critical applications in disease progression and clinical diagnosis and therapy. This review summarizes the characteristics of EVs, their role in stress and osteoporosis, and their benefit as biological markers. We demonstrate that EVs are potential mediators of psychosocial stress and osteoporosis and may be beneficial in innovative research settings.
With the 2012 EU guidelines on dual careers (DC), DC research gained increasing awareness in Europe focussing particularly on student-athletes' motivation. The Student Athletes' Motivation toward Sports and Academics Questionnaire (SAMSAQ), arguably the most prominent instrument in this research area, has been used in various cross-cultural studies assessing DC motivation. The present investigation contributes to the cross-cultural discourse aiming to (1) adapt the SAMSAQ for the German context and adolescent secondary school student-athletes, and (2) evaluate the German pre-version. A sample of 208 student-athletes (52.4% females, mean age = 17.4 years, 49.5% at squad level) at three German Elite Sport Schools participated in the study. The investigation was split into two parts. First, the SAMSAQ was adapted to the German context and tested. In the second part, the first pre-version was revised. A series of exploratory factor analyses were applied to verify the factor structure of both German SAMSAQ pre-versions. Eight different factor models based on item removal were compared. Neither model demonstrated good results for the replication of previous findings or a meaningful solution in terms of content. Reasons for the deviations between the original and target SAMSAQ factor structures can be found in the different target groups and the culturally different approaches to career assistant programmes as well as in the theoretical background of the instrument. Since neither model was identified as acceptable, the findings indicate that a new instrument needs to be developed for assessing student-athletes' DC motivation along their pathways in different cross-cultural contexts.
Das Hauptziel der Bachelorarbeit stellt eine theoretische Auseinandersetzung mit dem Thema Wassergewöhnung im eigenen Zuhause dar. Ausgehend von dieser Ausführung erstellt die Autorin als Theorie-Praxis-Transfer eine Handreichung für Erziehungsberechtigte mit den relevantesten Informationen ihrer Qualifikationsarbeit in komprimierter Form. Damit die Erziehungsberechtigten ihren Kindern proaktiv zur Seite stehen können, soll die Handreichung adressat*innengerecht und prägnant sein, ohne den Erziehungsberechtigten essenzielle Details vorzuenthalten. Die Erziehungsberechtigten erhalten eine Handreichung, welche die bedeutendsten Informationen rund um die Wassergewöhnung zu Hause enthält. Sie erfahren unter anderem etwas über die höchstmögliche Aufenthaltsdauer der Kinder im Wasser und die optimale Temperatur des Badewassers. Außerdem erhalten sie wichtige Informationen rund um die Körperreaktionen, welche durch oder im Wasser auftreten können. Das sind bspw. der Lidschlussreflex oder der Kältereiz. Sie werden über essenzielle Sicherheitsaspekte informiert und erhalten eine kompakte Darstellung über Verhaltensregeln, den sogenannten do’s and dont‘s. Die Übungen/Spiele werden nach den aktuellen Vorgaben der DGUV (2019) für die Inhalte der Wassergewöhnung ausgewählt und nach den heimischen Voraussetzungen strukturiert sein. In der Handreichung werden zudem auch Übungen/Spiele zu finden sein, bei welchen keine Eigenschaften oder Wirkungen des Wassers kennengelernt werden. Atem- und Tauchübungen werden in der Handreichung ebenso beschrieben. Die Angst vor dem Wasser stellt, sobald sie sich manifestiert, bekanntlich das größte Hindernis der Nichtschwimmer*innen dar (DGUV, 2019). Darum möchte die Autorin mit der Aufklärung über diese Angst in ihrer Qualifikationsarbeit und der Handreichung bewirken, dass die Erziehungsberechtigten in der Lage sind, den Kindern das Angstgefühl gegenüber dem Wasser zu nehmen oder ihre Angstfreiheit beizubehalten und um daran anschließend den Kindern Freude an der Bewegung im Wasser zu ermöglichen. „Je mehr Freude die Kinder im Kleinkindalter am Baden haben, je weniger Angst sie mit dem Medium verbinden, umso schneller erlernen sie später das Schwimmen“ (DGUV, 2016, S. 6).
Die theoretischen Grundlagen der Handreichungen stellen die zentralen Aspekte und Ziele der Wassergewöhnung dar. Diese werden der, im Rahmen Schule, bedeutsamen Publikation der Deutschen Gesetzlichen Unfallversicherung aus dem Jahr 2019 entnommen. Hierbei handelt es sich um die Wahrnehmung der spezifischen Voraussetzungen des Wassers sowie deren Annäherung und Gewöhnung. Die Kinder erfahren die Eigenschaften Dichte, Druck und Temperatur des Elements und den Einfluss des Wassers auf den Körper. Das sind Wasserwiderstand, Auftrieb und die Wasserkraft. So werden die Übungen, in denen die Kinder das Wasser kennenlernen, beziehungsweise zum ersten Mal intensiv in Berührung mit diesem kommen, zu Beginn erwähnt. Anschließend folgen Übungen, überwiegend in Spielformen, bei denen die Freude geweckt werden soll. Als letzte Phase folgen Übungen, bei welchen der spezifische Umgang mit dem Wassers vonnöten ist. Diese Struktur ist an den ersten drei Phasen nach Baumeisters (1984) Methodik zur Wassergewöhnung orientiert. So wird zudem das methodische Prinzip vom Einfachen zum Komplexen als theoretische Grundlage verwendet. Legahn (2007) beschreibt einige Lernmodelle, die je nach Alter und Entwicklungsstand bei der Wassergewöhnung angewendet werden können. In der Handreichung wird die Autorin auf diese zurückgreifen und passende Lerntechniken ausführen. Beispiele hierfür sind unter anderem das Lernen am Modell (Nachahmung von Personen, Tieren oder Puppen) oder das Aktive Lernen (ein spielerischer Bewegungsaufbau verbessert die Fertigkeiten). Die benötigten Materialien werden in der Handreichung unter der Überschrift der Übungen/Spiele ausgeführt und dienen als erste Information. Neben der Überschrift werden die möglichen Eigenschaften und Wirkungen des Wassers, welche in dieser spezifischen Übung kennengelernt werden, benannt. Das sind beispielsweise Druck und Auftrieb für Wasserdruck und Wasserauftrieb. Darunter wird die jeweilige Übung beschrieben. Als Visualisierung erstellt die Autorin selbstständig gezeichnete Bilder. Unterhalb dieser Bilder befindet sich oft auch eine passende Spielvariante, um mit dieser Übung noch zusätzlich Freude zu wecken. Ebenso werden auch mehrmals passende Übungsformen oder Tipps erwähnt.
Eccentric exercise is discussed as a treatment option for clinical populations, but specific responses in terms of muscle damage and systemic inflammation after repeated loading of large muscle groups have not been conclusively characterized. Therefore, this study tested the feasibility of an isokinetic protocol for repeated maximum eccentric loading of the trunk muscles. Nine asymptomatic participants (5 f/4 m; 34±6 yrs; 175±13 cm; 76±17 kg) performed three isokinetic 2-minute all-out trunk strength tests (1x concentric (CON), 2x eccentric (ECC1, ECC2), 2 weeks apart; flexion/extension, 60°/s, ROM 55°). Outcomes were peak torque, torque decline, total work, and indicators of muscle damage and inflammation (over 168 h). Statistics were done using the Friedman test (Dunn’s post-test). For ECC1 and ECC2, peak torque and total work were increased and torque decline reduced compared to CON. Repeated ECC bouts yielded unaltered torque and work outcomes. Muscle damage markers were highest after ECC1 (soreness 48 h, creatine kinase 72 h; p<0.05). Their overall responses (area under the curve) were abolished post-ECC2 compared to post-ECC1 (p<0.05). Interleukin-6 was higher post-ECC1 than CON, and attenuated post-ECC2 (p>0.05). Interleukin-10 and tumor necrosis factor-α were not detectable. All markers showed high inter-individual variability. The protocol was feasible to induce muscle damage indicators after exercising a large muscle group, but the pilot results indicated only weak systemic inflammatory responses in asymptomatic adults.
Background: To handle the competition demands, sparring drills are used for specific technical–tactical training as well as physical–physiological conditioning in combat sports. While the effects of different area sizes and number of within-round sparring partners on physiological and perceptive responses in combats sports were examined in previous studies, technical and tactical aspects were not investigated. This study investigated the effect of different within-round sparring partners number (i.e., at a time; 1 vs. 1, 1 vs. 2, and 1 vs. 4) and area sizes (2 m × 2 m, 4 m × 4 m, and 6 m × 6 m) variation on the technical–tactical aspects of small combat games in kickboxing.
Method: Twenty male kickboxers (mean ± standard deviation, age: 20.3 ± 0.9 years), regularly competing in regional and national events randomly performed nine different kickboxing combats, lasting 2 min each. All combats were video recorded and analyzed using the software Dartfish.
Results: Results showed that the total number of punches was significantly higher in 1 versus 4 compared with 1 versus 1 (p = 0.011, d = 0.83). Further, the total number of kicks was significantly higher in 1 versus 4 compared with 1 versus 1 and 1 versus 2 (p < 0.001; d = 0.99 and d = 0.83, respectively). Moreover, the total number of kick combinations was significantly higher in 1 versus 4 compared with 1 versus 1 and 1 versus 2 (p < 0.001; d = 1.05 and d = 0.95, respectively). The same outcome was significantly lower in 2 m × 2 m compared with 4 m × 4 m and 6 m × 6 m areas (p = 0.010 and d = − 0.45; p < 0.001 and d = − 0.6, respectively). The number of block-and-parry was significantly higher in 1 versus 4 compared with 1 versus 1 (p < 0.001, d = 1.45) and 1 versus 2 (p = 0.046, d = 0.61) and in 2 m × 2 m compared with 4 m × 4 m and 6 × 6 m areas (p < 0.001; d = 0.47 and d = 0.66, respectively). Backwards lean actions occurred more often in 2 m × 2 m compared with 4 m × 4 m (p = 0.009, d = 0.53) and 6 m × 6 m (p = 0.003, d = 0.60). However, the number of foot defenses was significantly lower in 2 m × 2 m compared with 6 m × 6 m (p < 0.001, d = 1.04) and 4 m × 4 m (p = 0.004, d = 0.63). Additionally, the number of clinches was significantly higher in 1 versus 1 compared with 1 versus 2 (p = 0.002, d = 0.7) and 1 versus 4 (p = 0.034, d = 0.45).
Conclusions: This study provides practical insights into how to manipulate within-round sparring partners’ number and/or area size to train specific kickboxing technical–tactical fundamentals.
The survey of the prevalence of chronic ankle instability in elite Taiwanese basketball athletes
(2021)
BACKGROUND: Ankle sprains are common in basketball. It could develop into Chronic Ankle Instability (CAI) causing decreased quality of life, functional performance, early osteoarthritis, and increased risk of other injuries. To develop a strategy of CAI prevention, localized epidemiology data and a valid/reliable tool are essential. However, the epidemiological data of CAI is not conclusive from previous studies and the prevalence of CAI in Taiwanese basketball athletes are not clear. In addition, a valid and reliable tool among the Taiwan-Chinese version to evaluate ankle instability is missing.
PURPOSE: The aims were to have an overview of the prevalence of CAI in sports population using a systematic review, to develop a valid and reliable cross-cultural adapted Cumberland Ankle Instability Tool Questionnaire (CAIT) in Taiwan-Chinese (CAIT-TW), and to survey the prevalence of CAI in elite basketball athletes in Taiwan using CAIT-TW.
METHODS: Firstly, a systematic search was conducted. Research articles applying CAI related questionnaires in order to survey the prevalence of CAI were included in the review. Second, the English version of CAIT was translated and cross-culturally adapted into the CAIT-TW. The construct validity, test-retest reliability, internal consistency, and cutoff score of CAIT-TW were evaluated in an athletic population (N=135). Finally, the cross-sectional data of CAI prevalence in 388 elite Taiwanese basketball athletes were presented. Demographics, presence of CAI, and difference of prevalence between gender, different competitive levels and play positions were evaluated.
RESULTS: The prevalence of CAI was 25%, ranging between 7% and 53%. The prevalence of CAI among participants with a history of ankle sprains was 46%, ranging between 9% and 76%. In addition, the cross-cultural adapted CAIT-TW showed a moderate to strong construct validity, an excellent test-retest reliability, a good internal consistency, and a cutoff score of 21.5 for the Taiwanese athletic population. Finally, 26% of Taiwanese basketball athletes had unilateral CAI while 50% of them had bilateral CAI. In addition, women athletes in the investigated cohort had a higher prevalence of CAI than men. There was no difference in prevalence between competitive levels and among play positions.
CONCLUSION: The systematic review shows that the prevalence of CAI has a wide range among included studies. This could be due to the different exclusion criteria, age, sports discipline, or other factors among the included studies. For future studies, standardized criteria to investigate the epidemiology of CAI are required. The CAI epidemiological study should be prospective. Factors affecting the prevalence of CAI ability should be investigated and described. The translated CAIT-TW is a valid and reliable tool to differentiate between stable and unstable ankles in athletes and may further apply for research or daily practice in Taiwan. In the Taiwanese basketball population, CAI is highly prevalent. This might relate to the research method, preexisting ankle instability, and training-related issues. Women showed a higher prevalence of CAI than men. When applying the preventive measure, gender should be taken into consideration.
Das Therapiemanagement bei Lipödem stellt auf Grund unzureichenden Wissensstandes in entscheidenden Aspekten eine besondere Herausforderung dar. Da die Pathogenese der Erkrankung nicht hinreichend geklärt ist und bislang kein pathognomonisches Diagnostikkriterium definiert wurde, beklagen viele Betroffene einen langjährigen Leidensweg bis zur Einleitung von Therapiemaßnahmen. Durch Steigerung der Awareness der Erkrankung in den letzten Jahren konnten die Intervalle bis zur korrekten Diagnose erfreulicherweise erheblich verkürzt werden. Obwohl die Zuordnung der Beschwerden zu einer klar definierten Erkrankung für viele Patientinnen eine Erleichterung ist, stellt die Erkenntnis über begrenzte Therapiemöglichkeiten häufig eine neuerliche Belastung dar.
Als Konsequenz der ungeklärten Pathogenese konnte bis dato keine kausale Therapie für das Lipödem definiert werden. Zu Beginn waren die Möglichkeiten konservativer Behandlungsstrategien nur eingeschränkt in den Rahmen eines allgemeingültigen Konzeptes involviert und insbesondere Limitationen nicht klar definiert. Obwohl in diversen Bereichen der Therapie weiterhin keine ausreichende Evidenz besteht, konnten durch eine systematische Aufarbeitung die grundsätzlichen Behandlungsoptionen in Relation zueinander gesetzt werden. Betroffene Patientinnen, sowie die verschiedenen in die Behandlung integrierte medizinische Disziplinen verfügen somit über einen grundsätzlichen Handlungsalgorithmus, deren Empfehlungen über einfache Rezeptierung von Lymphdrainage und Kompressionsbekleidung hinausgehen. Durch kritische Reflexion der geltenden Dogmata wurde ein interdisziplinärer Leitfaden vorgeschlagen, der auf nachvollziehbare Weise im Sinne eines Stufenschemas alle wesentlichen Therapiesäulen in einen allgemeingültigen Behandlungsplan einbindet.
Im vielschichten Management der Erkrankung verbleibt die operative Behandlung, die Liposuktion, allerdings häufig als „ultima ratio“ nach ausbleibender Linderung unter konservativen Therapiemaßnahmen. Die wesentliche Zielstellung der vorliegenden Arbeit konzentriert sich demnach auf die Optimierung des operativen Vorgehens in der Durchführung von Liposuktionen bei Patientinnen mit Lipödem und zeigt sowohl Grenzen der Indikationsstellung, als auch Potenzial des Behandlungserfolges im Langzeitverlauf auf. Langzeitergebnisse zeigen, dass die Liposuktion als sicherer Eingriff mit dem Potenzial einer nachhaltigen Symptomreduktion für Lipödem-Patientinnen angesehen werden kann. Betont werden soll zudem die Notwendigkeit der Verzahnung operativer Maßnahmen mit konservativen Therapien und somit die Integration der Liposuktion als sinnvolle Behandlungsalternative in ein klar umrissenes Therapiekonzept.
Methodisch greift die Arbeit auf insgesamt 10 Publikationen zurück. Die hier postulierte mehrzeitige Megaliposuktion zur Therapie des Lipödems, mit summierten Gesamtaspirationsvolumina über alle Eingriffe von bis zu 66.000 ml, konnte als evidenzbasiertes Therapieverfahren bestätigt und validiert werden. Die beschriebenen niedrigen Komplikationsraten sind unter Anderem Resultat einer differenzierten, individualisierten perioperativen Strategie. Neben der Berücksichtigung grundsätzlicher methodischer Prinzipien existieren allerdings vielfältige Variationen, deren Implikationen auf Komplikationsraten jeweils differenziert zu betrachten sind. Es existiert zwar kein Konsensus für ein allgemeingültiges Standardverfahren der Liposuktion, allerdings konnten zahlreiche Elemente im perioperativen Management definiert werden, die unabhängig von der verwendeten Operationstechnik einen potenziellen positiven Einfluss auf das Outcome haben. Obwohl die Liposuktion bei Lipödem somit zusammenfassend mittlerweile als sicheres Verfahren gelten kann, sind einige Aspekte weiterhin nicht abschließend geklärt. Hierbei stehen vor allem das Volumenmanagement und die standardisierte Festlegung des maximalen Aspirationsvolumens im Fokus.
Die Analyse verschiedener Kovariablen auf die Linderung Lipödem-assoziierter Symptome nach Liposuktion zeigt, dass Alter, Body-Mass-Index (BMI) und präoperatives Stadium der Erkrankung einen signifikanten Einfluss auf das postoperative Ergebnis haben und in der Planung des mehrzeitigen operativen Vorgehens berücksichtigt werden müssen. BMI- oder körpergewichtsabhängige Zielgrößen der Absaugvolumina waren als Prognosefaktor für das postoperative Outcome dagegen nicht relevant. Inwieweit dies möglicherweise an der Überschreitung des „notwendigen“ Volumengrenzwerts für adäquate Symptomlinderung durch reguläre Durchführung von Megaliposuktionen liegen könnte, oder ob dieser Parameter tatsächlich keinen Einfluss auf das Ergebnis nach Operation besitzt, konnte nicht abschließend geklärt werden.
Weiterhin konnte ein positiver Nutzen auf assoziierte Begleiterkrankungen bei Lipödem nachgewiesen werden. Das Spektrum der Behandlungsmethoden kann durch reguläre Integration der Liposuktion in das Therapieschema somit um eine nachhaltige Alternative sinnvoll ergänzt werden. Im Unterschied zur alleinigen konservativen Therapie kann hierdurch ein wesentlicher Schritt weg von der alleinigen symptomatischen Therapie gemacht werden. Zudem die vielfältige Symptomatik der diversen assoziierten Komorbiditäten zu berücksichtigen. Als Konsequenz und für die Notwendigkeit eines ganzheitlichen, interdisziplinären Therapieansatzes wäre der Terminus „Lipödem-Syndrom“ möglicherweise treffender und wird zur Diskussion gestellt.
Für ein gesondertes Patientenklientel wurden zudem basale Grundsätze im perioperativen Vorgehen differenziert aufgearbeitet. Lipödem-Patientinnen mit begleitendem von-Willebrand-Syndrom stellen im Hinblick auf Blutungskomplikationen eine außerordentliche Herausforderung dar. Die vorliegenden evidenzbasierten Empfehlungen zum Therapiemanagement dieser Patientinnen bei Eingriffen ähnlicher Risikoklassifizierung wurden systematisch aufgearbeitet und in Bezug zu den speziellen Anforderungen bei Megaliposuktionen gebracht. Das dabei erarbeitete Therapieschema wird die präoperative Detektion von Koagulopathien im Allgemeinen, sowie die perioperative Komplikationsrate bei von-Willebrand-Patientinnen im Speziellen zukünftig erheblich verbessern.
Zusammenfassend konnte somit ein allgemeingültiger Algorithmus für die moderne und langfristig erfolgreiche Therapie von Lipödem-Patientinnen mit besonderem Fokus auf die Megaliposuktion erarbeitet werden. Bei adäquatem perioperativem Management und Berücksichtigung der großen Volumenverschiebungen kann der Eingriff komplikationsarm und sicher durchgeführt werden. Nicht abschließend geklärt ist derzeit die Pathophysiologie der Erkrankung wobei eine immunologische Genese sowie die primäre Pathologie des Lymphgefäßsystems bzw. der Fett(vorläufer)zellen als Erklärungmodelle favorisiert werden. Die Entwicklung diagnostischer Biomarker sollte dabei verfolgt werden.
Background: Chronic ankle instability, developing from ankle sprain, is one of the most common sports injuries. Besides it being an ankle issue, chronic ankle instability can also cause additional injuries. Investigating the epidemiology of chronic ankle instability is an essential step to develop an adequate injury prevention strategy. However, the epidemiology of chronic ankle instability remains unknown. Therefore, the purpose of this study was to investigate the epidemiology of chronic ankle instability through valid and reliable self-reported tools in active populations.
Methods: An electronic search was performed on PubMed and Web of Science in July 2020. The inclusion criteria for articles were peer-reviewed, published between 2006 and 2020, using one of the valid and reliable tools to evaluate ankle instability, determining chronic ankle instability based on the criteria of the International Ankle
Consortium, and including the outcome of epidemiology of chronic ankle instability. The risk of bias of the included studies was evaluated with an adapted tool for the sports injury review method.
Results: After removing duplicated studies, 593 articles were screened for eligibility. Twenty full-texts were screened and finally nine studies were included, assessing 3804 participants in total. The participants were between 15 and 32 years old and represented soldiers, students, athletes and active individuals with a history of ankle sprain. The prevalence of chronic ankle instability was 25%, ranging between 7 and 53%. The prevalence of chronic ankle instability within participants with a history of ankle sprains was 46%, ranging between 9 and 76%. Five included studies identified chronic ankle instability based on the standard criteria, and four studies applied adapted exclusion criteria to conduct the study. Five out of nine included studies showed a low risk of bias.
Conclusions: The prevalence of chronic ankle instability shows a wide range. This could be due to the different exclusion criteria, age, sports discipline, or other factors among the included studies. For future studies, standardized criteria to investigate the epidemiology of chronic ankle instability are required. The epidemiology of
CAI should be prospective. Factors affecting the prevalence of chronic ankle instability should be investigated and clearly described.
Objective:
Therapist competence is considered essential for the success of psychotherapy. Feedback is an intervention which has the potential to improve therapist competence. The present study investigated whether competence feedback leads to an improvement of therapist competence and patient outcome.
Method:
Sixty-seven master-level clinical trainees were randomly assigned to either a competence feedback group (CFG) or a control group (CG). Patients with a diagnosis of major depression (N = 114) were randomly assigned to CFG or CG. Treatment included 20 individual sessions of cognitive behavioral therapy (CBT). In CFG, therapists received, parallel to the treatment, five competence feedbacks, based on videotaped therapy sessions. Independent raters assessed therapist competence with the Cognitive Therapy Scale (CTS) and provided the competence feedback. Patient outcome was evaluated with the Beck Depression Inventory-II (BDI-II) and therapeutic alliance (Helping Alliance Questionnaire [HAQ]) from both therapist's (HAQ-T) and patient's (HAQ-P) perspective were evaluated after each of the 20 sessions.
Results:
(a) Therapist competence (CTS) increased significantly more for CFG than CG. (b) Depression (BDI-II) decreased significantly across sessions for both groups, but without evidence for a group-differential benefit for the CFG. (c) Therapeutic alliance (HAQ-T/P) increased significantly across sessions for both groups from both perspectives, but without group differences. (d) There is a positive effect of BDI-II on CTS at the beginning and a negative effect of CTS on BDI-II at the end of therapy.
Conclusion:
Competence feedback improves therapists' independently rated competence, but there is no evidence that competence feedback in CBT leads to better outcome.
What is the public health significance of this article? This study suggests the substantial value of systematic competence feedback for improving therapist competence in the psychotherapy of depression. No significant effect of competence feedback on the reduction of reported depressive symptoms was found.
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.
Background
Depression is one of the key factors contributing to difficulties in one’s ability to work, and serves as one of the major reasons why employees apply for psychotherapy and receive insurance subsidization of treatments. Hence, an increasing and growing number of studies rely on workability assessment scales as their primary outcome measure. The Work and Social Assessment Scale (WSAS) has been documented as one of the most psychometrically reliable and valid tools especially developed to assess workability and social functioning in patients with mental health problems. Yet, the application of the WSAS in Germany has been limited due to the paucity of a valid questionnaire in the German language. The objective of the present study was to translate the WSAS, as a brief and easy administrable tool into German and test its psychometric properties in a sample of adults with depression.
Methods
Two hundred seventy-seven patients (M = 48.3 years, SD = 11.1) with mild to moderately severe depression were recruited. A multistep translation from English into the German language was performed and the factorial validity, criterion validity, convergent validity, discriminant validity, internal consistency, and floor and ceiling effects were examined.
Results
The confirmatory factor analysis results confirmed the one-factor structure of the WSAS. Significant correlations with the WHODAS 2–0 questionnaire, a measure of functionality, demonstrated good convergent validity. Significant correlations with depression and quality of life demonstrated good criterion validity. The WSAS also demonstrated strong internal consistency (α = .89), and the absence of floor and ceiling effects indicated good sensitivity of the instrument.
Conclusions
The results of the present study demonstrated that the German version of the WSAS has good psychometric properties comparable to other international versions of this scale. The findings recommend a global assessment of psychosocial functioning with the sum score of the WSAS.
Background
Recent research emphasized the role of inflammatory processes in the pathophysiology of depression. Theories hypothesizes that life events (LE) can affect the immune system and trigger depressive symptoms. LE are also considered as one of the best predictors for the onset and course of depressive disorders.
Methods
Observational study across three treatment settings: n=208 depressive patients (75.5%f, M 46.6 y) were examined on depression (BDI-II), life events (ILE) and inflammatory markers (IL-6, CRP, fibrinogen, ICAM-1, TNF-alpha, E-selectin) at baseline (t0), 5-week(t1) and 5-month(t2) follow-up. Effects and interactions were analyzed with regression models.
Results
LE were associated with depressive symptoms at t0 (beta=.209; p=.002) and both follow-ups. Except for CRP, which was linked to depression symptoms at t2 (betai=-.190; p=.032), there were no effects of inflammatory markers on depressive symptoms. At t1, an interaction between CRP and LE in total (beta=-.249; p=.041) was found as well as for LE in the past five years (beta=-.122; p=.027). Similar interactions were found between cumulative LE and ICAM-1 (beta=-.197; p=.003) and IL-6 (beta=-.425; p=.001).
Conclusion
The cumulative burden of LE effects symptoms and treatment outcome in depressive patients. There is some evidence that inflammatory marker may have long-term effects on treatment outcome as they seem to weaken the determining relation between LE and depression.
Klinische Analyse der physiologischen und pathologischen Sehnenadaptation an sportliche Belastung
(2021)
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.
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.
Characterization of scapular kinematics under demanding load conditions might aid to distinguish between physiological and clinically relevant alterations. Previous investigations focused only on submaximal external load situations. How scapular movement changes with maximal load remains unclear. Therefore, the present study aimed to evaluate 3D scapular kinematics during unloaded and maximal loaded shoulder flexion and extension. Twelve asymptomatic individuals performed shoulder flexion and extension movements under unloaded and maximal concentric and eccentric loaded isokinetic conditions. 3D scapular kinematics assessed with a motion capture system was analyzed for 20° intervals of humeral positions from 20° to 120° flexion. Repeated measures ANOVAs were used to evaluate kinematic differences between load conditions for scapular position angles, scapulohumeral rhythm and scapular motion extent. Increased scapular upward rotation was seen during shoulder flexion and extension as well as decreased posterior tilt and external rotation during eccentric and concentric arm descents of maximal loaded compared to unloaded conditions. Load effects were further seen for the scapulohumeral rhythm with greater scapular involvement at lower humeral positions and increased scapular motion extent under maximal loaded shoulder movements. With maximal load applied to the arm physiological scapular movement pattern are induced that may imply both impingement sparing and causing mechanisms.
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.