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Institut
- Department Sport- und Gesundheitswissenschaften (31) (entfernen)
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.
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.
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.
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.
Background: The worldwide prevalence of diabetes has been increasing in recent years, with a projected prevalence of 700 million patients by 2045, leading to economic burdens on societies. Type 2 diabetes mellitus (T2DM), representing more than 95% of all diabetes cases, is a multifactorial metabolic disorder characterized by insulin resistance leading to an imbalance between insulin requirements and supply. Overweight and obesity are the main risk factors for developing type 2 diabetes mellitus. The lifestyle modification of following a healthy diet and physical activity are the primary successful treatment and prevention methods for type 2 diabetes mellitus. Problems may exist with patients not achieving recommended levels of physical activity. Electrical muscle stimulation (EMS) is an increasingly popular training method and has become in the focus of research in recent years. It involves the external application of an electric field to muscles, which can lead to muscle contraction. Positive effects of EMS training have been found in healthy individuals as well as in various patient groups. New EMS devices offer a wide range of mobile applications for whole-body electrical muscle stimulation (WB-EMS) training, e.g., the intensification of dynamic low-intensity endurance exercises through WB-EMS. This dissertation project aims to investigate whether WB-EMS is suitable for intensifying low-intensive dynamic exercises such as walking and Nordic walking.
Methods: Two independent studies were conducted. The first study aimed to investigate the reliability of exercise parameters during the 10-meter Incremental Shuttle Walk Test (10MISWT) using superimposed WB-EMS (research question 1, sub-question a) and the difference in exercise intensity compared to conventional walking (CON-W, research question 1, sub-question b). The second study aimed to compare differences in exercise parameters between superimposed WB-EMS (WB-EMS-W) and conventional walking (CON-W), as well as between superimposed WB-EMS (WB-EMS-NW) and conventional Nordic walking (CON-NW) on a treadmill (research question 2). Both studies took place in participant groups of healthy, moderately active men aged 35-70 years. During all measurements, the Easy Motion Skin® WB-EMS low frequency stimulation device with adjustable intensities for eight muscle groups was used. The current intensity was individually adjusted for each participant at each trial to ensure safety, avoiding pain and muscle cramps. In study 1, thirteen individuals were included for each sub question. A randomized cross-over design with three measurement appointments used was to avoid confounding factors such as delayed onset muscle soreness. The 10MISWT was performed until the participants no longer met the criteria of the test and recording five outcome measures: peak oxygen uptake (VO2peak), relative VO2peak (rel.VO2peak), maximum walk distance (MWD), blood lactate concentration, and the rate of perceived exertion (RPE).
Eleven participants were included in study 2. A randomized cross-over design in a study with four measurement appointments was used to avoid confounding factors. A treadmill test protocol at constant velocity (6.5 m/s) was developed to compare exercise intensities. Oxygen uptake (VO2), relative VO2 (rel.VO2) blood lactate, and the RPE were used as outcome variables. Test-retest reliability between measurements was determined using a compilation of absolute and relative measures of reliability. Outcome measures in study 2 were studied using multifactorial analyses of variances.
Results: Reliability analysis showed good reliability for VO2peak, rel.VO2peak, MWD and RPE with no statistically significant difference for WB-EMS-W during 10WISWT. However, differences compared to conventional walking in outcome variables were not found. The analysis of the treadmill tests showed significant effects for the factors CON/WB-EMS and W/NW for the outcome variables VO2, rel.VO2 and lactate, with both factors leading to higher results. However, the difference in VO2 and relative VO2 is within the range of biological variability of ± 12%. The factor combination EMS∗W/NW is statistically non-significant for all three variables. WB-EMS resulted in the higher RPE values, RPE differences for W/NW and EMS∗W/NW were not significant.
Discussion: The present project found good reliability for measuring VO2peak, rel. VO2peak, MWD and RPE during 10MISWT during WB-EMS-W, confirming prior research of the test. The test appears technically limited rather than physiologically in healthy, moderately active men. However, it is unsuitable for investigating differences in exercise intensities using WB-EMS-W compared to CON-W due to different perceptions of current intensity between exercise and rest. A treadmill test with constant walking speed was conducted to adjust individual maximum tolerable current intensity for the second part of the project. The treadmill test showed a significant increase in metabolic demands during WB-EMS-W and WB-EMS-NW by an increased VO2 and blood lactate concentration. However, the clinical relevance of these findings remains debatable. The study also found that WB-EMS superimposed exercises are perceived as more strenuous than conventional exercise. While in parts comparable studies lead to higher results for VO2, our results are in line with those of other studies using the same frequency. Due to the minor clinical relevance the use of WB-EMS as exercise intensification tool during walking and Nordic walking is limited. High device cost should be considered. Habituation to WB-EMS could increase current intensity tolerance and VO2 and make it a meaningful method in the treatment of T2DM. Recent figures show that WB-EMS is used in obese people to achieve health and weight goals. The supposed benefit should be further investigated scientifically.
The 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.
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.
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.
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.
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.
Background and objectives: The intricate interdependencies between the musculoskeletal and neural systems build the foundation for postural control in humans, which is a prerequisite for successful performance of daily and sports-specific activities. Balance training (BT) is a well-established training method to improve postural control and its components (i.e., static/dynamic steady-state, reactive, proactive balance). The effects of BT have been studied in adult and youth populations, but were systematically and comprehensively assessed only in young and old adults. Additionally, when taking a closer look at established recommendations for BT modalities (e.g., training period, frequency, volume), standardized means to assess and control the progressive increase in exercise intensity are missing. Considering that postural control is primarily neuronally driven, intensity is not easy to quantify. In this context, a measure of balance task difficulty (BTD) appears to be an auspicious alternative as a training modality to monitor BT and control training progression. However, it remains unclear how a systematic increase in BTD affects balance performance and neurophysiological outcomes. Therefore, the primary objectives of the present thesis were to systematically and comprehensively assess the effects of BT on balance performance in healthy youth and establish dose-response relationships for an adolescent population. Additionally, this thesis aimed to investigate the effects of a graded increase in BTD on balance performance (i.e., postural sway) and neurophysiological outcomes (i.e, leg muscle activity, leg muscle coactivation, cortical activity) in adolescents.
Methods: Initially, a systematic review and meta-analysis on the effects of BT on balance performance in youth was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guidelines. Following this complementary analysis, thirteen healthy adolescents (3 female/ 10 male) aged 16-17 years were enrolled for two cross-sectional studies. The participants executed bipedal balance tasks on a multidirectional balance board that allowed six gradually increasing levels of BTD by narrowing the balance boards’ base of support. During task performance, two pressure sensitive mats fixed on the balance board recorded postural sway. Leg muscle activity and leg muscle coactivation were assessed via electromyography while electroencephalography was used to monitor cortical activity.
Results: Findings from the systematic review and meta-analysis indicated moderate-to-large effects of BT on static and dynamic balance performance in youth (static: weighted mean standardized mean differences [SMDwm] = 0.71; dynamic: SMDwm = 1.03). In adolescents, training-induced effects were moderate and large for static (SMDwm = 0.61) and dynamic (SMDwm = 0.86) balance performance, respectively. Independently (i.e. modality-specific) calculated dose-response relationships identified a training period of 12 weeks, a frequency of two training sessions per week, a total of 24-36 sessions, a duration of 4-15 minutes, and a total duration of 31-60 minutes as the training modalities with the largest effect on overall balance performance in adolescents. However, the implemented meta-regression indicated that none of these training modalities (R² = 0%) could predict the observed performance-increasing effects of BT.
Results from the first cross-sectional study revealed that a gradually increasing level of BTD caused increases in postural sway (p < 0.001; d = 6.36), higher leg muscle activity (p < 0.001; 2.19 < d < 4.88), and higher leg muscle coactivation (p < 0.001; 1.32 < d < 1.41). Increases in postural sway and leg muscle activity were mainly observed during low and high levels of task difficulty during continuous performance of the respective balance task. Results from the second cross-sectional study indicated frequency-specific increases/decreases in cortical activity of different brain areas (p < 0.005; 0.92 < d < 1.80) as a function of BTD. Higher cortical activity within the theta frequency band in the frontal and central right brain areas was observed with increasing postural demands. Concomitantly, activity in the alpha-2 frequency band was attenuated in parietal brain areas.
Conclusion: BT is an effective method to increase static and dynamic balance performance and, thus, improve postural control in healthy youth populations. However, none of the reported training modalities (i.e., training period, frequency, volume) could explain the effects on balance performance. Furthermore, a gradually increasing level of task difficulty resulted in increases in postural sway, leg muscle activity, and coactivation. Frequency and brain area-specific increases/decreases in cortical activity emphasize the involvement of frontoparietal brain areas in regulatory processes of postural control dependent on BTD. Overall, it appears that increasing BTD can be easily accomplished by narrowing the base of support. Since valid methods to assess and quantify BT intensity do not exist, increasing BTD appears to be a very useful candidate to implement and monitor progression in BT programs in healthy adolescents.
Introduction: Cystic fibrosis (CF) is a genetic disease which disrupts the function of an epithelial surface anion channel, CFTR (cystic fibrosis transmembrane conductance regulator). Impairment to this channel leads to inflammation and infection in the lung causing the majority of morbidity and mortality. However, CF is a multiorgan disease affecting many tissues, including vascular smooth muscle. Studies have revealed young people with cystic fibrosis lacking inflammation and infection still demonstrate vascular endothelial dysfunction, measured per flow-mediated dilation (FMD). In other disease cohorts, i.e. diabetic and obese, endurance exercise interventions have been shown improve or taper this impairment. However, long-term exercise interventions are risky, as well as costly in terms of time and resources. Nevertheless, emerging research has correlated the acute effects of exercise with its long-term benefits and advocates the study of acute exercise effects on FMD prior to longitudinal studies. The acute effects of exercise on FMD have previously not been examined in young people with CF, but could yield insights on the potential benefits of long-term exercise interventions.
The aims of these studies were to 1) develop and test the reliability of the FMD method and its applicability to study acute exercise effects; 2) compare baseline FMD and the acute exercise effect on FMD between young people with and without CF; and 3) explore associations between the acute effects of exercise on FMD and demographic characteristics, physical activity levels, lung function, maximal exercise capacity or inflammatory hsCRP levels.
Methods: Thirty young volunteers (10 people with CF, 10 non-CF and 10 non-CF active matched controls) between the ages of 10 and 30 years old completed blood draws, pulmonary function tests, maximal exercise capacity tests and baseline FMD measurements, before returning approximately 1 week later and performing a 30-min constant load training at 75% HRmax. FMD measurements were taken prior, immediately after, 30 minutes after and 1 hour after constant load training. ANOVAs and repeated measures ANOVAs were employed to explore differences between groups and timepoints, respectively. Linear regression was implemented and evaluated to assess correlations between FMD and demographic characteristics, physical activity levels, lung function, maximal exercise capacity or inflammatory hsCRP levels. For all comparisons, statistical significance was set at a p-value of α < 0.05.
Results: Young people with CF presented with decreased lung function and maximal exercise capacity compared to matched controls. Baseline FMD was also significantly decreased in the CF group (CF: 5.23% v non-CF: 8.27% v non-CF active: 9.12%). Immediately post-training, FMD was significantly attenuated (approximately 40%) in all groups with CF still demonstrating the most minimal FMD. Follow-up measurements of FMD revealed a slow recovery towards baseline values 30 min post-training and improvements in the CF and non-CF active groups 60 min post-training. Linear regression exposed significant correlations between maximal exercise capacity (VO2 peak), BMI and FMD immediately post-training.
Conclusion: These new findings confirm that CF vascular endothelial dysfunction can be acutely modified by exercise and will aid in underlining the importance of exercise in CF populations. The potential benefits of long-term exercise interventions on vascular endothelial dysfunction in young people with CF warrants further investigation.
Back pain is a problem in adolescent athletes affecting postural control which is an important requirement for physical and daily activities whether under static or dynamic conditions. One leg stance and star excursion balance postural control tests are effective in measuring static and dynamic postural control respectively. These tests have been used in individuals with back pain, athletes and non-athletes without first establishing their reliabilities. In addition to this, there is no published literature investigating dynamic posture in adolescent athletes with back pain using the star excursion balance test. Therefore, the aim of the thesis was to assess deficit in postural control in adolescent athletes with and without back pain using static (one leg stance test) and dynamic postural (SEBT) control tests.
Adolescent athletes with and without back pain participated in the study. Static and dynamic postural control tests were performed using one leg stance and SEBT respectively. The reproducibility of both tests was established. Afterwards, it was determined whether there was an association between static and dynamic posture using the measure of displacement of the centre pressure and reach distance respectively. Finally, it was investigated whether there was a difference in postural control in adolescent athletes with and without back pain using the one leg stance test and the SEBT.
Fair to excellent reliabilities was recorded for the static (one leg stance) and dynamic (star excursion balance) postural control tests in the subjects of interest. No association was found between variables of the static and dynamic tests for the adolescent athletes with and without back pain. Also, no statistically significant difference was obtained between adolescent athletics with and without back pain using the static and dynamic postural control test.
One leg stance test and SEBT can be used as measures of postural control in adolescent athletes with and without back pain. Although static and dynamic postural control might be related, adolescent athletes with and without back pain might be using different mechanisms in controlling their static and dynamic posture. Consequently, static and dynamic postural control in adolescent athletes with back pain was not different from those without back pain. These outcome measures might not be challenging enough to detect deficit in postural control in our study group of interest.
Background and objectives: Drop jumps (DJs) are well-established exercise drills during plyometric training. Several sports are performed under unstable surface conditions (e.g., soccer, beach volleyball, gymnastics). To closely mimic sport-specific demands, plyometric training includes DJs on both stable and unstable surfaces. According to the mechanical properties of the unstable surface (e.g., thickness, stiffness), altered temporal, mechanical, and physiological demands have been reported from previous cross-sectional studies compared with stable conditions. However, given that the human body simultaneously interacts with various factors (e.g., drop height, footwear, gender) during DJs on unstable surfaces, the investigation of isolated effects of unstable surface conditions might not be sufficient for designing an effective and safe DJ stimulus. Instead, the combined investigation of different factors and their interaction with surface instability have to be taken into consideration. Therefore, the present doctoral thesis seeks to complement our knowledge by examining the main and interaction effects of surface instability, drop height, footwear, and gender on DJ performance, knee joint kinematics, and neuromuscular activation.
Methods: Healthy male and female physically active sports science students aged 19-26 years participated in the cross-sectional studies. Jump performance, sagittal and frontal plane knee joint kinematics, and leg muscle activity were measured during DJs on stable (i.e., firm force plate) and (highly) unstable surfaces (i.e., one or two AIREX® balance pads) from different drop heights (i.e., 20 cm, 40 cm, 60 cm) or under multiple footwear conditions (i.e., barefoot, minimal shoes, cushioned shoes).
Results: Findings revealed that surface instability caused a DJ performance decline, reduced sagittal plane knee joint kinematics, and lower leg muscle activity during DJs. Sagittal plane knee joint kinematics as well as leg muscle activity decreased even more with increasing surface instability (i.e., two vs. one AIREX® balance pads). Higher (60 cm) compared to lower drop heights (≤ 40 cm) resulted in a DJ performance decline. In addition, increased sagittal plane knee joint kinematics as well as higher shank muscle activity were found during DJs from higher (60 cm) compared to lower drop heights (≤ 40 cm). Footwear properties almost exclusively affected frontal plane knee joint kinematics, indicating larger maximum knee valgus angles when performing DJs barefoot compared to shod. Between the different shoe properties (i.e., minimal vs. cushioned shoes), no significant differences during DJs were found at all. Only a few significant surface-drop height as well as surface-footwear interactions were found during DJs. They mainly indicated that drop height- and footwear-related effects are more pronounced during DJs on unstable compared to stable surfaces. In this regard, the maximum knee valgus angle was significantly greater when performing DJs from high drop heights (60 cm), but only on highly unstable surface. Further, braking and push-off times were significantly longer when performing DJs barefoot compared to shod, but only on unstable surface. Finally, analyses indicated no significant interactions with the gender factor.
Conclusions: The findings of the present cumulative thesis indicate that stable rather than unstable surfaces as well as moderate (≤ 40 cm) rather than high (60 cm) drop heights provide sufficient stimuli to perform DJs. Furthermore, findings suggest that DJs on highly unstable surfaces (i.e., two AIREX® balance pads) from high drop heights (60 cm) as well as barefoot compared to shod seem to increase maximal knee valgus angle/stress by providing a more harmful DJ stimulus. Neuromuscular activation strategies appear to be modified by surface instability and drop height. However, leg muscle activity is only marginally effected by footwear and by the interactions of various external factors i.e., surface instability, drop height, footwear). Finally, gender did not significantly modulate the main or interaction effects of the observed external factors during DJs.
BACKGROUND: Physical activity involving high spinal load has been exposed to possess a crucial impact in the genesis of acute and chronic low back pain and disorder. Vigorous spinal loads are surmised in drop landings, for which strenuous bending loads were formerly evinced for the lower extremity structures. Thus far, clinical studies revealed that repetitive landing impacts can evoke benign structural adaptions or damage to the lumbar vertebrae. Though, causes for these observations are hitherto not conclusively evinced; since actual spinal load has to date not been experimentally documented. Moreover, it is yet undetermined how physiological activation of trunk musculature compensates for landing impact induced spinal loads, and to which extend trunk activity and spinal load are affected by landing demands and performer characteristics. AIMS of this study are 1. the localisation and quantification of spinal bending loads under various landing demands and 2. the identification of compensatory trunk muscular activity pattern, which potentially alleviate spinal load magnitudes. Three consecutive Hypotheses (H1 - H3) were hereto postulated: H1 posits that spinal bending loads in segregated motion planes can feasibly and reliably be evaluated from peak spine segmental angular accelerations. H2 furthermore assumes that vertical drop landings elicit highest spine bending load in sagittal flexion of the lumbar spine. Based on these verifications, a second study shall prove the successive hypothesis (H3) that diversified landing conditions, like performer’s landing familiarity and gender, as an implementation of an instantaneous follow-up task, affect the emerging lumbar spinal bending load. Herein it is moreover surmised that lumbar spinal bending loads under distinct landing conditions are predominantly modulated by herewith disparately deployed conditioned pre-activations of trunk muscles. METHODS: To test the above arrayed hypothesis, two successive studies were carried out. In STUDY 1, 17 subjects were repetitively assessed performing various drop landings (heigth: 15, 30, 45, 60cm; unilateral, bilateral, blindfolded, catching a ball) in a test-retest-design. Herein individual peak angular accelerations [αMAX] were derived from three-dimensional motion data of four trunk-segments (upper thoracic, lower thoracic, lumbar, pelvis). αMAX was herein assessed in flexion, lateral flexion, and rotation of each spinal joint, formed by two adjacent segments. Reliability of αMAX within and between test-days was evaluated by CV%, ICC 2.1, TRV%, and Bland & Altman Analysis (BIAS±LoA). Subsequently, peak flexion acceleration of the lumbo-pelvic joint [αFLEX[LS-PV]] was statistically compared to αMAX expressions of each other assessed spinal joint and motion plane (Mean ±SD, Independent Samples T-test). STUDY 2 deliberately assessed mere peak lumbo-pelvic flexion accelerations [αFLEX[LS-PV]] and electro-myographic trunk pre-activity prior to αFLEX[LS-PV] on 43 subjects performing varied landing tasks (height 45cm; with definite or indefinite predictability of a subsequent instant follow up jump). Subjects were contrasted with respect to their previous landing familiarity ( >1000 vs. <100 landings performed in the past 10 years) and gender. Differences of αFLEX[LS-PV] and muscular pre-activity between contrasted subject groups as between landing tasks were equally statistically tested by three-way mixed ANOVA with Post-hoc tests. Associations between αFLEX[LS-PV] and muscular pre-activity were factor-specifically assessed by Spearman’s rank order correlation coefficient (rS). Complementarily, muscular pre-activity was subdivided by landing phases [DROP, IMPACT] and discretely assessed for phase specific associations to αFLEX[LS-PV]. Each muscular activity was moreover pairwise compared between DROP and IMPACT (Mean ±SD, Dependent Samples T-test). RESULTS: αMAX was presented with overall high variability within test-days (CV =36%). Lowest intra-individual variability and highest reproducibility of αMAX between test-days was shown in flexion of the spine. αFLEX[LS-PV] showed largely consistent sig. higher magnitudes compared to αMAX presented in more cranial spinal joints and other motion planes. αFLEX[LS-PV] moreover gradually increased with escalations in landing heights. Landing unfamiliar subjects presented sig. higher αFLEX[LS-PV] in contrast to landing familiar ones (p=.016). M. Obliquus Int. with M. Transversus Abd. (66 ±32%MVC) and M. Erector Spinae (47 ±15%MVC) presented maredly highest activity in contrast to lowest activity of M. Rectus Abd. (10 ±4%MVC). Landing unfamiliar subjects showed compared to landing familiar ones sig. higher activity of M. Obliquus Ext. (17 ±8%MVC, 12 ±7%MVC, p= .044). M. Obliquus Ext. and its co-contraction ratio with M. Erector Spinae moreover exhibited low but sig. positive correlations to αFLEX[LS-PV] (rs=.39, rs=.31). Each trunk muscule distributed larger shares of its activity to DROP, whereas peak activations of most muscles emerged in the proportionally shorter IMPACT phase. Commonly increased muscular pre-activation particularly at IMPACT was found in landings with a contrived follow up jump and in female subjects, whereby αFLEX[LS-PV] was hereof only marginally affected. DISCUSSION: Highest spine segmental angular accelerations in drop landings emerge in sagittal flexion of the lumbar spine. The compensatory stabilisation of the spine appears to be preponderantly provided by a dorso-ventral co-contraction of M. Obliquus Int., M. Transversus Abd. and M. Erector Spinae. Elevated pre-activity of M. Obliquuis Ext. supposably characterises poor landing experience, which might engender increased bending loads to the lumbar spine. A pervasive large variability of spinal angular accelerations measured across all landing types, suggests a multifarious utilisation of diverse mechanisms compensating for spinal impacts in landing performances. A standardised assessment and valid evaluation of landing evoked lumbar bending loads is hereof largley confined. CONCLUSION: Drop landings elicit most strenuous lumbo-pelvic flexion accelerations, which can be appraised as representatives for high energetic bending loads to the spine. Such entail the highest risk to overload the spinal tissue, when landing demands exceed the individual’s landing skill. Previous landing experience and training appears to effectively improve muscular spine stabilisation pattern, diminishing spinal bending loads.
Trunk loading and back pain
(2017)
An essential function of the trunk is the compensation of external forces and loads in order to guarantee stability. Stabilising the trunk during sudden, repetitive loading in everyday tasks, as well as during performance is important in order to protect against injury. Hence, reduced trunk stability is accepted as a risk factor for the development of back pain (BP). An altered activity pattern including extended response and activation times as well as increased co-contraction of the trunk muscles as well as a reduced range of motion and increased movement variability of the trunk are evident in back pain patients (BPP). These differences to healthy controls (H) have been evaluated primarily in quasi-static test situations involving isolated loading directly to the trunk. Nevertheless, transferability to everyday, dynamic situations is under debate. Therefore, the aim of this project is to analyse 3-dimensional motion and neuromuscular reflex activity of the trunk as response to dynamic trunk loading in healthy (H) and back pain patients (BPP).
A measurement tool was developed to assess trunk stability, consisting of dynamic test situations. During these tests, loading of the trunk is generated by the upper and lower limbs with and without additional perturbation. Therefore, lifting of objects and stumbling while walking are adequate represents. With the help of a 12-lead EMG, neuromuscular activity of the muscles encompassing the trunk was assessed. In addition, three-dimensional trunk motion was analysed using a newly developed multi-segmental trunk model. The set-up was checked for reproducibility as well as validity. Afterwards, the defined measurement set-up was applied to assess trunk stability in comparisons of healthy and back pain patients.
Clinically acceptable to excellent reliability could be shown for the methods (EMG/kinematics) used in the test situations. No changes in trunk motion pattern could be observed in healthy adults during continuous loading (lifting of objects) of different weights. In contrast, sudden loading of the trunk through perturbations to the lower limbs during walking led to an increased neuromuscular activity and ROM of the trunk. Moreover, BPP showed a delayed muscle response time and extended duration until maximum neuromuscular activity in response to sudden walking perturbations compared to healthy controls. In addition, a reduced lateral flexion of the trunk during perturbation could be shown in BPP.
It is concluded that perturbed gait seems suitable to provoke higher demands on trunk stability in adults. The altered neuromuscular and kinematic compensation pattern in back pain patients (BPP) can be interpreted as increased spine loading and reduced trunk stability in patients. Therefore, this novel assessment of trunk stability is suitable to identify deficits in BPP. Assignment of affected BPP to therapy interventions with focus on stabilisation of the trunk aiming to improve neuromuscular control in dynamic situations is implied. Hence, sensorimotor training (SMT) to enhance trunk stability and compensation of unexpected sudden loading should be preferred.
Introduction: Carbohydrate (CHO) and fat are the main substrates to fuel prolonged endurance exercise, each having its oxidation patterns regulated by several factors such as intensity, duration and mode of the activity, dietary intake pattern, muscle glycogen concentrations, gender and training status. Exercising at intensities where fat oxidation rates are high has been shown to induce metabolic benefits in recreational and health-oriented sportsmen. The exercise intensity (Fatpeak) eliciting peak fat oxidation rates is therefore of particular interest when aiming to prescribe exercise for the purpose of fat oxidation and related metabolic effects. Although running and walking are feasible and popular among the target population, no reliable protocols are available to assess Fatpeak as well as its actual velocity (VPFO) during treadmill ergometry. Moreover, to date, it remains unclear how pre-exercise CHO availability modulates the oxidative regulation of substrates when exercise is conducted at the intensity where the individual anaerobic threshold (IAT) is located (VIAT). That is, a metabolic marker representing the upper border where constant load endurance exercise can be sustained, being commonly used to guide athletic training or in performance diagnostics. The research objectives of the current thesis were therefore, 1) to assess the reliability and day-to-day variability of VPFO and Fatpeak during treadmill ergometry running; 2) to assess the impact of high CHO (HC) vs. low CHO (LC) diets (where on the LC day a combination of low CHO diet and a glycogen depleting exercise was implemented) on the oxidative regulation of CHOs and fat while exercise is conducted at VIAT. Methods: Research objective 1: Sixteen recreational athletes (f=7, m=9; 25 ± 3 y; 1.76 ± 0.09 m; 68.3 ± 13.7 kg; 23.1 ± 2.9 kg/m²) performed 2 different running protocols on 3 different days with standardized nutrition the day before testing. At day 1, peak oxygen uptake (VO2peak) and the velocities at the aerobic threshold (VLT) and respiratory exchange ratio (RER) of 1.00 (VRER) were assessed. At days 2 and 3, subjects ran an identical submaximal incremental test (Fat-peak test) composed of a 10 min warm-up (70% VLT) followed by 5 stages of 6 min with equal increments (stage 1 = VLT, stage 5 = VRER). Breath-by-breath gas exchange data was measured continuously and used to determine fat oxidation rates. A third order polynomial function was used to identify VPFO and subsequently Fatpeak. The reproducibility and variability of variables was verified with an intraclass correlation coefficient (ICC), Pearson’s correlation coefficient, coefficient of variation (CV) and the mean differences (bias) ± 95% limits of agreement (LoA). Research objective 2: Sixteen recreational runners (m=8, f=8; 28 ± 3 y; 1.76 ± 0.09 m; 72 ± 13 kg; 23 ± 2 kg/m²) performed 3 different running protocols, each allocated on a different day. At day 1, a maximal stepwise incremental test was implemented to assess the IAT and VIAT. During days 2 and 3, participants ran a constant-pace bout (30 min) at VIAT that was combined with randomly assigned HC (7g/kg/d) or LC (3g/kg/d) diets for the 24 h before testing. Breath-by-breath gas exchange data was measured continuously and used to determine substrate oxidation. Dietary data and differences in substrate oxidation were analyzed with a paired t-test. A two-way ANOVA tested the diet X gender interaction (α = 0.05). Results: Research objective 1: ICC, Pearson’s correlation and CV for VPFO and Fatpeak were 0.98, 0.97, 5.0%; and 0.90, 0.81, 7.0%, respectively. Bias ± 95% LoA was -0.3 ± 0.9 km/h for VPFO and -2 ± 8% of VO2peak for Fatpeak. Research objective 2: Overall, the IAT and VIAT were 2.74 ± 0.39 mmol/l and 11.1 ± 1.4 km/h, respectively. CHO oxidation was 3.45 ± 0.08 and 2.90 ± 0.07 g/min during HC and LC bouts respectively (P < 0.05). Likewise, fat oxidation was 0.13 ± 0.03 and 0.36 ± 0.03 g/min (P < 0.05). Females had 14% (P < 0.05) and 12% (P > 0.05) greater fat oxidation compared to males during HC and LC bouts, respectively. Conclusions: Research objective 1: In summary, relative and absolute reliability indicators for VPFO and Fatpeak were found to be excellent. The observed LoA may now serve as a basis for future training prescriptions, although fat oxidation rates at prolonged exercise bouts at this intensity still need to be investigated. Research objective 2: Twenty-four hours of high CHO consumption results in concurrent higher CHO oxidation rates and overall utilization, whereas maintaining a low systemic CHO availability significantly increases the contribution of fat to the overall energy metabolism. The observed gender differences underline the necessity of individualized dietary planning before exerting at intensities associated with performance exercise. Ultimately, future research should establish how these findings can be extrapolated to training and competitive situations and with that provide trainers and nutritionists with improved data to derive training prescriptions.
Background and objectives: Age-related losses of lower extremity muscle strength/power and deficits in static and particularly dynamic balance are associated with impaired functional performance and the occurrence of falls. It has been shown that balance and resistance training have the potential to improve balance and muscle strength in healthy older adults. However, it is still open to debate how the effectiveness of balance and resistance training in older adults is influenced by different factors. This includes the role of trunk muscle strength, the comprehensive effects of combined balance and resistance training, and the role of exercise supervision. Therefore, the primary objectives of this doctoral thesis are to investigate the relationship between trunk muscle strength and balance performance and to examine the effects of an expert-based balance and resistance training protocol on various measures of balance and lower extremity muscle strength/power in older adults. Furthermore, the impact of supervised versus unsupervised balance and/or resistance training interventions in the elderly will be evaluated.
Methods: Healthy older adults aged 63-80 years were included in a cross-sectional study, a longitudinal study, and a meta-analysis (range group means meta-analysis: 65.3-81.1 years) registering balance and muscle strength/power performance. Different measures of balance (i.e., static/dynamic, proactive, reactive) were examined using clinical (e.g., Romberg test) and instrumented tests (e.g., 10 meter walking test on a sensor-equipped walkway). Isometric strength of the trunk muscles was assessed using instrumented trunk muscle strength apparatus and lower extremity dynamic muscle strength/power was examined using clinical tests (e.g., Chair Stand Test). Further, a combined balance and resistance training protocol was applied to examine training-induced effects on balance and muscle strength/power as well as the role of supervision in older adults.
Results: Findings revealed that measures of trunk muscle strength and static steady-state balance as well as specific measures of dynamic steady-state balance were significantly associated in the elderly (0.42 ≤ r ≤ 0.57). Combined balance and resistance training significantly improved older adults' static/dynamic steady-state (e.g., Romberg test; habitual gait speed), pro-active (e.g., Timed Up and Go Test), and reactive balance (e.g., Push and Release Test) as well as muscle strength/power (e.g., Chair Stand Test) (0.62 ≤ Cohen’s d ≤ 2.86; all p < 0.05). Supervised compared to unsupervised balance and/or resistance training was superior in enhancing older adults' balance and muscle strength/power performance regarding all observed outcome categories [longitudinal study: effects for the supervised group 0.26 ≤ d ≤ 2.86, effects for the unsupervised group 0.06 ≤ d ≤ 2.30; meta-analysis: all between-subject standardized mean differences (SMDbs) in favor of the supervised training programs 0.24-0.53]. The meta-analysis additionally showed larger effects in favor of supervised interventions when compared to completely unsupervised interventions (0.28 ≤ SMDbs ≤ 1.24). These effects in favor of the supervised programs faded when compared with studies that implemented a small amount of supervised sessions in their unsupervised interventions (−0.06 ≤ SMDbs ≤ 0.41).
Conclusions: Trunk muscle strength is associated with steady-state balance performance and may therefore be integrated in fall-preventive exercise interventions for older adults. The examined positive effects on a large number of important intrinsic fall risk factors (e.g., balance deficits, muscle weakness) imply that particularly the combination of balance and resistance training appears to be a feasible and effective exercise intervention for fall prevention. Owing to the beneficial effects of supervised compared to unsupervised interventions, supervised sessions should be integrated in fall-preventive balance and/or resistance training programs for older adults.