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Background
Earlier studies have shown that balance training (BT) has the potential to induce performance enhancements in selected components of physical fitness (i.e., balance, muscle strength, power, speed). While there is ample evidence on the long-term effects of BT on components of physical fitness in youth, less is known on the short-term or acute effects of single BT sessions on selected measures of physical fitness.
Objective
To examine the acute effects of different balance exercise types on balance, change-of-direction (CoD) speed, and jump performance in youth female volleyball players.
Methods
Eleven female players aged 14 years participated in this study. Three types of balance exercises (i.e., anterior, posterolateral, rotational type) were conducted in randomized order. For each exercise, 3 sets including 5 repetitions were performed. Before and after the performance of the balance exercises, participants were tested for their static balance (center of pressure surface area [CoP SA] and velocity [CoP V]) on foam and firm surfaces, CoD speed (T-Half test), and vertical jump height (countermovement jump [CMJ] height). A 3 (condition: anterior, mediolateral, rotational balance exercise type) × 2 (time: pre, post) analysis of variance was computed with repeated measures on time.
Results
Findings showed no significant condition × time interactions for all outcome measures (p > 0.05). However, there were small main effects of time for CoP SA on firm and foam surfaces (both d = 0.38; all p < 0.05) with no effect for CoP V on both surface conditions (p > 0.05). For CoD speed, findings showed a large main effect of time (d = 0.91; p < 0.001). However, for CMJ height, no main effect of time was observed (p > 0.05).
Conclusions
Overall, our results indicated small-to-large changes in balance and CoD speed performances but not in CMJ height in youth female volleyball players, regardless of the balance exercise type. Accordingly, it is recommended to regularly integrate balance exercises before the performance of sport-specific training to optimize performance development in youth female volleyball players.
The link between emotions and motor control has been discussed for years. The measurement of the Adaptive Force (AF) provides the possibility to get insights into the adaptive control of the neuromuscular system in reaction to external forces. It was hypothesized that the holding isometric AF is especially vulnerable to disturbing inputs. Here, the behavior of the AF under the influence of positive (tasty) vs. negative (disgusting) food imaginations was investigated. The AF was examined in n = 12 cases using an objectified manual muscle test of the hip flexors, elbow flexors or pectoralis major muscle, performed by one of two experienced testers while the participants imagined their most tasty or most disgusting food. The reaction force and the limb position were measured by a handheld device. While the slope of force rises and the maximal AF did not differ significantly between tasty and disgusting imaginations (p > 0.05), the maximal isometric AF was significantly lower and the AF at the onset of oscillations was significantly higher under disgusting vs. tasty imaginations (both p = 0.001). A proper length tension control of muscles seems to be a crucial functional parameter of the neuromuscular system which can be impaired instantaneously by emotionally related negative imaginations. This might be a potential approach to evaluate somatic reactions to emotions.
Background: The prevalence of diabetes worldwide is predicted to increase from 2.8% in 2000 to 4.4% in 2030. Diabetic neuropathy (DN) is associated with damage to nerve glial cells, their axons, and endothelial cells leading to impaired function and mobility.
Objective: We aimed to examine the effects of an endurance-dominated exercise program on maximum oxygen consumption (VO2max), ground reaction forces, and muscle activities during walking in patients with moderate DN.
Methods: Sixty male and female individuals aged 45–65 years with DN were randomly assigned to an intervention (IG, n = 30) or a waiting control (CON, n = 30) group. The research protocol of this study was registered with the Local Clinical Trial Organization (IRCT20200201046326N1). IG conducted an endurance-dominated exercise program including exercises on a bike ergometer and gait therapy. The progressive intervention program lasted 12 weeks with three sessions per week, each 40–55 min. CON received the same treatment as IG after the post-tests. Pre- and post-training, VO2max was tested during a graded exercise test using spiroergometry. In addition, ground reaction forces and lower limbs muscle activities were recorded while walking at a constant speed of ∼1 m/s.
Results: No statistically significant baseline between group differences was observed for all analyzed variables. Significant group-by-time interactions were found for VO2max (p < 0.001; d = 1.22). The post-hoc test revealed a significant increase in IG (p < 0.001; d = 1.88) but not CON. Significant group-by-time interactions were observed for peak lateral and vertical ground reaction forces during heel contact and peak vertical ground reaction force during push-off (p = 0.001–0.037; d = 0.56–1.53). For IG, post-hoc analyses showed decreases in peak lateral (p < 0.001; d = 1.33) and vertical (p = 0.004; d = 0.55) ground reaction forces during heel contact and increases in peak vertical ground reaction force during push-off (p < 0.001; d = 0.92). In terms of muscle activity, significant group-by-time interactions were found for vastus lateralis and gluteus medius during the loading phase and for vastus medialis during the mid-stance phase, and gastrocnemius medialis during the push-off phase (p = 0.001–0.044; d = 0.54–0.81). Post-hoc tests indicated significant intervention-related increases in vastus lateralis (p = 0.001; d = 1.08) and gluteus medius (p = 0.008; d = 0.67) during the loading phase and vastus medialis activity during mid-stance (p = 0.001; d = 0.86). In addition, post-hoc tests showed decreases in gastrocnemius medialis during the push-off phase in IG only (p < 0.001; d = 1.28).
Conclusions: This study demonstrated that an endurance-dominated exercise program has the potential to improve VO2max and diabetes-related abnormal gait in patients with DN. The observed decreases in peak vertical ground reaction force during the heel contact of walking could be due to increased vastus lateralis and gluteus medius activities during the loading phase. Accordingly, we recommend to implement endurance-dominated exercise programs in type 2 diabetic patients because it is feasible, safe and effective by improving aerobic capacity and gait characteristics.
Background: The prevalence of diabetes worldwide is predicted to increase from 2.8% in 2000 to 4.4% in 2030. Diabetic neuropathy (DN) is associated with damage to nerve glial cells, their axons, and endothelial cells leading to impaired function and mobility.
Objective: We aimed to examine the effects of an endurance-dominated exercise program on maximum oxygen consumption (VO2max), ground reaction forces, and muscle activities during walking in patients with moderate DN.
Methods: Sixty male and female individuals aged 45–65 years with DN were randomly assigned to an intervention (IG, n = 30) or a waiting control (CON, n = 30) group. The research protocol of this study was registered with the Local Clinical Trial Organization (IRCT20200201046326N1). IG conducted an endurance-dominated exercise program including exercises on a bike ergometer and gait therapy. The progressive intervention program lasted 12 weeks with three sessions per week, each 40–55 min. CON received the same treatment as IG after the post-tests. Pre- and post-training, VO2max was tested during a graded exercise test using spiroergometry. In addition, ground reaction forces and lower limbs muscle activities were recorded while walking at a constant speed of ∼1 m/s.
Results: No statistically significant baseline between group differences was observed for all analyzed variables. Significant group-by-time interactions were found for VO2max (p < 0.001; d = 1.22). The post-hoc test revealed a significant increase in IG (p < 0.001; d = 1.88) but not CON. Significant group-by-time interactions were observed for peak lateral and vertical ground reaction forces during heel contact and peak vertical ground reaction force during push-off (p = 0.001–0.037; d = 0.56–1.53). For IG, post-hoc analyses showed decreases in peak lateral (p < 0.001; d = 1.33) and vertical (p = 0.004; d = 0.55) ground reaction forces during heel contact and increases in peak vertical ground reaction force during push-off (p < 0.001; d = 0.92). In terms of muscle activity, significant group-by-time interactions were found for vastus lateralis and gluteus medius during the loading phase and for vastus medialis during the mid-stance phase, and gastrocnemius medialis during the push-off phase (p = 0.001–0.044; d = 0.54–0.81). Post-hoc tests indicated significant intervention-related increases in vastus lateralis (p = 0.001; d = 1.08) and gluteus medius (p = 0.008; d = 0.67) during the loading phase and vastus medialis activity during mid-stance (p = 0.001; d = 0.86). In addition, post-hoc tests showed decreases in gastrocnemius medialis during the push-off phase in IG only (p < 0.001; d = 1.28).
Conclusions: This study demonstrated that an endurance-dominated exercise program has the potential to improve VO2max and diabetes-related abnormal gait in patients with DN. The observed decreases in peak vertical ground reaction force during the heel contact of walking could be due to increased vastus lateralis and gluteus medius activities during the loading phase. Accordingly, we recommend to implement endurance-dominated exercise programs in type 2 diabetic patients because it is feasible, safe and effective by improving aerobic capacity and gait characteristics.
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.
Communicating uncertainties in scientific evidence is important to accurately reflect scientific knowledge , increase public understanding of uncertainty, and to signal transparency and honesty in reporting. While techniques have been developed to facilitate the communication of uncertainty, many have not been empirically tested, compared for communicating different types of uncertainty, or their effects on different cognitive, trust, and behavioral outcomes have not been evaluated. The present study examined how a point estimate, imprecise estimate, conflicting estimates, or a statement about the lack of evidence about treatment effects, influenced participant's responses to communications about medical evidence. For each type of uncertainty, we adapted three display formats to communicate the information: tables, bar graphs, and icon arrays. We compared participant's best estimates of treatment effects, as well as effects on recall, subjective evaluations (understandability and usefuleness), certainty perceptions, perceptions of trustworthiness of the information, and behavioral intentions. We did not find any detrimental effects from communicating imprecision or conflicting estimates relative to a point estimate across any outcome. Furthermore, there were more favorable responses to communicating imprecision or conflicting estimates relative to lack of evidence, where participants estimated the treatment would improve outcomes by 30-50% relative to a placebo. There were no differences across display formats, suggesting that, if well-designed, it may not matter which format is used. Future research on specific display formats or uncertainty types and with larger sample sizes would be needed to detect small effects. Implications for the communication of uncertainty are discussed.
This study examined the concurrent validity of an inverse dynamic (force computed from barbell acceleration [reference method]) and a work-energy (force computed from work at the barbell [alternative method]) approach to measure the mean vertical barbell force during the snatch using kinematic data from video analysis. For this purpose, the acceleration phase of the snatch was analyzed in thirty male medal winners of the 2018 weightlifting World Championships (age: 25.2±3.1 years; body mass: 88.9±28.6 kg). Vertical barbell kinematics were measured using a custom-made 2D real-time video analysis software. Agreement between the two computational approaches was assessed using Bland-Altman analysis, Deming regression, and Pearson product-moment correlation. Further, principal component analysis in conjunction with multiple linear regression was used to assess whether individual differences related to the two approaches are due to the waveforms of the acceleration time-series data. Results indicated no mean difference (p > 0.05; d = −0.04) and an extremely large correlation (r = 0.99) between the two approaches. Despite the high agreement, the total error of individual differences was 8.2% (163.0 N). The individual differences can be explained by a multiple linear regression model (R2adj = 0.86) on principal component scores from the principal component analysis of vertical barbell acceleration time-series waveforms. Findings from this study indicate that the individual errors of force measures can be associated with the inverse dynamic approach. This approach uses vertical barbell acceleration data from video analysis that is prone to error. Therefore, it is recommended to use the work-energy approach to compute mean vertical barbell force as this approach did not rely on vertical barbell acceleration.
This study examined the concurrent validity of an inverse dynamic (force computed from barbell acceleration [reference method]) and a work-energy (force computed from work at the barbell [alternative method]) approach to measure the mean vertical barbell force during the snatch using kinematic data from video analysis. For this purpose, the acceleration phase of the snatch was analyzed in thirty male medal winners of the 2018 weightlifting World Championships (age: 25.2±3.1 years; body mass: 88.9±28.6 kg). Vertical barbell kinematics were measured using a custom-made 2D real-time video analysis software. Agreement between the two computational approaches was assessed using Bland-Altman analysis, Deming regression, and Pearson product-moment correlation. Further, principal component analysis in conjunction with multiple linear regression was used to assess whether individual differences related to the two approaches are due to the waveforms of the acceleration time-series data. Results indicated no mean difference (p > 0.05; d = −0.04) and an extremely large correlation (r = 0.99) between the two approaches. Despite the high agreement, the total error of individual differences was 8.2% (163.0 N). The individual differences can be explained by a multiple linear regression model (R2adj = 0.86) on principal component scores from the principal component analysis of vertical barbell acceleration time-series waveforms. Findings from this study indicate that the individual errors of force measures can be associated with the inverse dynamic approach. This approach uses vertical barbell acceleration data from video analysis that is prone to error. Therefore, it is recommended to use the work-energy approach to compute mean vertical barbell force as this approach did not rely on vertical barbell acceleration.
Purpose
The objective of the investigation was to determine the concomitant effects of upper arm blood flow restriction (BFR) and inversion on elbow flexors neuromuscular responses.
Methods
Randomly allocated, 13 volunteers performed four conditions in a within-subject design: rest (control, 1-min upright position without BFR), control (1-min upright with BFR), 1-min inverted (without BFR), and 1-min inverted with BFR. Evoked and voluntary contractile properties, before, during and after a 30-s maximum voluntary contraction (MVC) exercise intervention were examined as well as pain scale.
Results
Inversion induced significant pre-exercise intervention decreases in elbow flexors MVC (21.1%, Z2p = 0.48, p = 0.02) and resting evoked twitch forces (29.4%, Z2p = 0.34, p = 0.03). The 30-s MVC induced significantly greater pre- to post-test decreases in potentiated twitch force (Z2p = 0.61, p = 0.0009) during inversion (75%) than upright (65.3%) conditions. Overall, BFR decreased MVC force 4.8% (Z2p = 0.37, p = 0.05). For upright position, BFR induced 21.0% reductions in M-wave amplitude (Z2p = 0.44, p = 0.04). There were no significant differences for electromyographic activity or voluntary activation as measured with the interpolated twitch technique. For all conditions, there was a significant increase in pain scale between the 40-60 s intervals and post-30-s MVC (upright< inversion, and without BFR< BFR).
Conclusion
The concomitant application of inversion with elbow flexors BFR only amplified neuromuscular performance impairments to a small degree. Individuals who execute forceful contractions when inverted or with BFR should be cognizant that force output may be impaired.
Biological maturation has been shown to affect male youths' responses to plyometric training (PT). However, to date, no researcher has examined the effect of maturation on the effects of PT in female youth. We undertook the first controlled intervention study to examine this, focusing on adaptive responses to countermovement jump (CMJ), reactive strength index (RSI), and change of direction (COD) performance in groups of female youth divided by maturation status (years from peak height velocity [PHV]). The training program lasted 7 weeks with subjects undertaking 2 sessions of PT per week. In the mid-PHV group, there was a small increase (effect size; 90% confidence interval = 0.40; -0.23 to 1.03) in CMJ performance. No changes were observed in the post-PHV group (0.02; -0.68 to 0.72). For RSI, there was a moderate increase in the mid-PHV group (0.94; 0.29-1.59) with only a trivial increase in the post-PHV group (0.06; -0.65 to 0.76). The intervention exerted no positive effect on COD performance in any group. Plyometric training seems to enhance CMJ and RSI in female youth, although the magnitude of adaptation could be affected by maturation status. A twice-per-week program of multidirectional jumping and hopping, with bilateral and unilateral components, can be used as a preparatory precursor to physical education classes or recreational sport.
Wick, K, Kriemler, S, and Granacher, U. Effects of a strength-dominated exercise program on physical fitness and cognitive performance in preschool children. J Strength Cond Res 35(4): 983-990, 2021-Childhood is characterized by high neuroplasticity that affords qualitative rather than quantitative components of physical activity to maximize the potential to sufficiently develop motor skills and foster long-term engagement in regular physical activity. This study examined the effects of an integrative strength-dominated exercise program on measures of physical fitness and cognitive performance in preschool children. Children aged 4-6 years from 3 kindergartens were randomized into an intervention (INT) group (n = 32) or a control group (n = 22). The 10-week intervention period was conducted 3 times per week (each session lasted 30 minutes) and included exercises for the promotion of muscle strength and power, coordination, and balance. Pre and post training, tests were conducted for the assessment of muscle strength (i.e., handgrip strength), muscle power (i.e., standing long jump), balance (i.e., timed single-leg stand), coordination (hopping on right/left leg), and attentional span (i.e., "Konzentrations-Handlungsverfahren fur Vorschulkinder" [concentration-action procedure for preschoolers]). Results from 2 x 2 repeated-measures analysis of covariance revealed a significant (p <= 0.05) and near significant (p = 0.051) group x time interaction for the standing long jump test and the Konzentrations-Handlungsverfahren. Post hoc tests showed significant pre-post changes for the INT (p < 0.001; d = 1.53) but not the CON (p = 0.72; d = 0.83). Our results indicate that a 10-week strength-dominated exercise program increased jump performance with a concomitant trend toward improvements in attentional capacity of preschool children. Thus, we recommend implementing this type of exercise program for preschoolers.
Background:
This double-blinded randomized-controlled-trial aimed to identify the effects of an elastic band resistance training on walking kinetics and muscle activities in young adults with genu valgus.
Methods:
Forty-two male young adults aged 22.5(2.7) years with genu valgus were randomly allocated to two experimental groups. The intervention group (n = 21) conducted a 14-weeks elastic band resistance training. The control group was passive during the intervention period and received the same treatment after the post-tests. Pre and post training, ground reaction forces and lower limb muscle activities were recorded during walking.
Findings:
Results revealed significant group-by-time interactions for peak medial ground reaction force and timeto-peak for posterior ground reaction force in favor of the intervention group (p < 0.012; d = 0.83-3.76). Resistance training with elastic bands resulted in significantly larger peak medial ground reaction force (p < 0.001; d = 1.45) and longer time-to-peak for posterior ground reaction force (p < 0.001; d = 1.85). Finding showed significant group-by-time interactions for peak positive free moment amplitudes in favor of the intervention group (p < 0.001; d = 1.18-2.02). Resistance training resulted in a lower peak positive free moment amplitude (p = 0.001; d = 1.46). With regards to muscle activities, the analysis revealed significant group-by time interactions for rectus femoris and gluteus medius activities during the push-off phase in favor of the intervention group (p < 0.038; d = 0.68-0.89). Resistance training induced higher rectus femoris (p = 0.038; d = 0.84) and gluteus medius (p = 0.007; d = 0.54) activities.
Interpretation:
This study proved the effectiveness of resistance training using elastic bands on kinetics and muscle activities during walking in male adults with genu valgus disorder. Given that this training regime is low cost, effective, and easy-to-administer, we suggest that it should be implemented as a rehabilitative or preventive means for young adults with genu valgus.
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
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.
Background
To improve propulsion during running, athletes often wear spike shoes designed for training and/or competition. Running with spike shoes may cause pain and/or injuries. To address this problem, a modified spike shoe was tested. This study aimed to evaluate the effects of running with dual-versus single-stiffness spike running shoes on running mechanics in long-distance runners with pronated feet.
Methods
Sixteen male elite (national competitive level) runners (5000 or 10,000 m) aged 28.2 ± 2.5 years with pronated feet volunteered to participate in this study. To be included, participants had to have achieved personal best race times over 5- and/or 10-km races under 17 or 34 min during official running competitions. All participants were heel strikers and had a history of 11.2 ± 4.2 years of training. For the assessment of running kinetics, a force plate was imbedded into a walkway. Running kinematics were recorded using a Vicon-motion-capture system. Nike Zoom Rival shoes (Nike, Nike Zoom Rival, USA) were selected and adapted according to spike softness and stiffness. Participants ran at a constant speed of ~4.0 m/s across the walkway with both shoe conditions in randomized order. Six trials were recorded per condition. The main outcomes included peak ground reaction forces and their time-to-peak, average and instantaneous vertical loading rates, free moments, and peak ankle eversion angles.
Results
Paired t-tests revealed significantly lower lateral (p = 0.021, d = 0.95) and vertical (p = 0.010, d = 1.40) forces at heel contact during running with dual-stiffness spike shoes. Running with dual-stiffness spike shoes resulted in a significantly longer time-to-peak vertical (p = 0.004, d = 1.40) force at heel contact. The analysis revealed significantly lower average (p = 0.005, d = 0.46) and instantaneous (p = 0.021, d = 0.49) loading rates and peak negative free moment amplitudes (p = 0.016, d = 0.81) when running with dual-stiffness spike shoes. Finally, significantly lower peak ankle eversion angles were observed with dual-stiffness spike shoes (p < 0.001, d = 1.29).
Conclusions
Running in dual- compared with single-stiffness spike distance running shoes resulted in lower loading rates, free moment amplitudes, and peak ankle eversion angles of long-distance runners with pronated feet.
This study examined the effect of 6 weeks of progressed and nonprogressed volume-based overload plyometric training (PT) on components of physical fitness and body composition measures in young male basketball players, compared with an active control group. Subjects were randomly assigned to a progressed PT (PPT, n = 7; age = 14.6 +/- 1.1 years), a non-PPT (NPPT, n = 8, age = 13.8 +/- 2.0 years), or a control group (CG, n = 7, age = 14.0 +/- 2.0 years). Before and after training, body composition measures (muscle mass and fat mass), countermovement jump with arms (CMJA) and countermovement jump without arms (CMJ), horizontal bilateral (HCMJ) and unilateral jump with right leg (RJ) and left leg (LJ), 20-cm drop jump (DJ20), sprint speed (10 m sprint), and change of direction speed (CODS [i.e., T-test]) were tested. Significant effects of time were observed for muscle and fat mass, all jump measures, and CODS (all p < 0.01; d = 0.37-0.83). Significant training group x time interactions were observed for all jump measures (all p < 0.05; d = 0.24-0.41). Post hoc analyses revealed significant pre-post performance improvements for the PPT (RJ and LJ: increment 18.6%, d = 0.8 and increment 22.7%, d = 0.9, respectively; HCMJ: increment 16.4%, d = 0.8; CMJ: increment 22.4%, d = 0.7; CMJA: increment 23.3%, d = 0.7; and DJ20: increment 39.7%, d = 1.1) and for the NPPT group (LJ: increment 14.1%, d = 0.4; DJ20: increment 32.9%, d = 0.8) with greater changes after PPT compared with NPPT for all jump measures (all p < 0.05; d = 0.21-0.81). The training efficiency was greater (p < 0.05; d = 0.22) after PPT (0.015% per jump) compared with NPPT (0.0053% per-jump). The PPT induced larger performance improvements on measures of physical fitness as compared to NPPT. Therefore, in-season progressive volume-based overload PT in young male basketball players is recommended.
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.
Extracellular vesicles
(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.
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.
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.
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: Change-of-direction (CoD) is a necessary physical ability of a field sport and may vary in youth players according to their maturation status.
Objectives: The aim of this study is: to compare the effectiveness of a 6-week CoD training intervention on dynamic balance (CS-YBT), horizontal jump (5JT), speed (10 and 30-m linear sprint times), CoD with (15 m-CoD + B) and without (15 m-CoD) the ball, in youth male soccer players at different levels of maturity [pre- and post-peak height velocity (PHV)].
Materials and Methods: Thirty elite male youth soccer players aged 10–17 years from the Tunisian first division participated in this study. The players were divided into pre- (G1, n = 15) and post-PHV (G2, n = 15) groups. Both groups completed a similar 6-week training program with two sessions per week of four CoD exercises. All players completed the following tests before and after intervention: CS-YBT; 5 JT; 10, 30, and 15 m-CoD; and 15 m-CoD + B, and data were analyzed using ANCOVA.
Results: All 30 players completed the study according to the study design and methodology. Adherence rate was 100% across all groups, and no training or test-related injuries were reported. Pre-PHV and post-PHV groups showed significant amelioration post-intervention for all dependent variables (after test > before test; p < 0.01, d = 0.09–1.51). ANOVA revealed a significant group × time interaction only for CS-YBT (F = 4.45; p < 0.04; η2 = 0.14), 5JT (F = 6.39; p < 0.02; η2 = 0.18), and 15 m-CoD (F = 7.88; p < 0.01; η2 = 0.22). CS-YBT, 5JT, and 15 m-CoD improved significantly in the post-PHV group (+ 4.56%, effect size = 1.51; + 4.51%, effect size = 1.05; and -3.08%, effect size = 0.51, respectively), more than the pre-PHV group (+ 2.77%, effect size = 0.85; + 2.91%, effect size = 0.54; and -1.56%, effect size = 0.20, respectively).
Conclusion: The CoD training program improved balance, horizontal jump, and CoD without the ball in male preadolescent and adolescent soccer players, and this improvement was greater in the post-PHV players. The maturity status of the athletes should be considered when programming CoD training for soccer players.
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.
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.
Klinische Analyse der physiologischen und pathologischen Sehnenadaptation an sportliche Belastung
(2021)
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.
The mechanical muscular oscillations are rarely the objective of investigations regarding the identification of a biomarker for Parkinson’s disease (PD). Therefore, the aim of this study was to investigate whether or not this specific motor output differs between PD patients and controls. The novelty is that patients without tremor are investigated performing a unilateral isometric motor task. The force of armflexors and the forearm acceleration (ACC) were recorded as well as the mechanomyography of the biceps brachii (MMGbi), brachioradialis (MMGbra) and pectoralis major (MMGpect) muscles using a piezoelectric-sensor-based system during a unilateral motor task at 70% of the MVIC. The frequency, a power-frequency-ratio, the amplitude variation, the slope of amplitudes and their interlimb asymmetries were analysed. The results indicate that the oscillatory behavior of muscular output in PD without tremor deviates from controls in some parameters: Significant differences appeared for the power-frequency-ratio (p = 0.001, r = 0.43) and for the amplitude variation (p = 0.003, r = 0.34) of MMGpect. The interlimb asymmetries differed significantly concerning the power-frequency-ratio of MMGbi (p = 0.013, r = 0.42) and MMGbra (p = 0.048, r = 0.39) as well as regarding the mean frequency (p = 0.004, r = 0.48) and amplitude variation of MMGpect (p = 0.033, r = 0.37). The mean (M) and variation coefficient (CV) of slope of ACC differed significantly (M: p = 0.022, r = 0.33; CV: p = 0.004, r = 0.43). All other parameters showed no significant differences between PD and controls. It remains open, if this altered mechanical muscular output is reproducible and specific for PD.
The mechanical muscular oscillations are rarely the objective of investigations regarding the identification of a biomarker for Parkinson’s disease (PD). Therefore, the aim of this study was to investigate whether or not this specific motor output differs between PD patients and controls. The novelty is that patients without tremor are investigated performing a unilateral isometric motor task. The force of armflexors and the forearm acceleration (ACC) were recorded as well as the mechanomyography of the biceps brachii (MMGbi), brachioradialis (MMGbra) and pectoralis major (MMGpect) muscles using a piezoelectric-sensor-based system during a unilateral motor task at 70% of the MVIC. The frequency, a power-frequency-ratio, the amplitude variation, the slope of amplitudes and their interlimb asymmetries were analysed. The results indicate that the oscillatory behavior of muscular output in PD without tremor deviates from controls in some parameters: Significant differences appeared for the power-frequency-ratio (p = 0.001, r = 0.43) and for the amplitude variation (p = 0.003, r = 0.34) of MMGpect. The interlimb asymmetries differed significantly concerning the power-frequency-ratio of MMGbi (p = 0.013, r = 0.42) and MMGbra (p = 0.048, r = 0.39) as well as regarding the mean frequency (p = 0.004, r = 0.48) and amplitude variation of MMGpect (p = 0.033, r = 0.37). The mean (M) and variation coefficient (CV) of slope of ACC differed significantly (M: p = 0.022, r = 0.33; CV: p = 0.004, r = 0.43). All other parameters showed no significant differences between PD and controls. It remains open, if this altered mechanical muscular output is reproducible and specific for PD.
The 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.
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.
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.
Background:
Osteoporosis is a growing public health problem. It is known that stress-related diseases such as depression may impair bone quality and lead to osteoporosis. The association between psychosocial stress and bone health may be triggered by alterations of mitochondrial function and cell signaling and intercellular communication. In this context, extracellular vesicles (EVs) may be relevant due to their crucial role in intercellular communicators through the transfer of cargo.
Aim:
This narrative review aims to summarize if the cargo of extracellular vesicles can constitute a biological link between psychosocial stress and osteoporosis.
Methods:
To evaluate this research question, a thorough literature search was conducted using PubMed, Google Scholar, and Science Direct. The research keywords are allostatic load, bone remodeling, microRNA, osteoblast, and osteoclast. A total of 21 articles were included in the narrative review.
Results:
We found that certain miRNAs in EVs, including miR-126a-3p, miR-128-3p, and miR-187-5p, have been described as crucial players in both psychosocial stress and osteoporosis.
Discussion:
This review describes EVs and their cargo as a potential mediator linking psychosocial stress and osteoporosis for the first time by highlighting common crucial miRNAs. However, based on the included studies, it is unclear whether EV-mediated transport of biological cargoes can alter the function of target cells in a real physiological environment.
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
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.
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.
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.
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.
This study provides the first representative analysis of error estimations and willingness to accept errors in a Western country (Germany) with regards to algorithmic decision-making systems (ADM). We examine people's expectations about the accuracy of algorithms that predict credit default, recidivism of an offender, suitability of a job applicant, and health behavior. Also, we ask whether expectations about algorithm errors vary between these domains and how they differ from expectations about errors made by human experts. In a nationwide representative study (N = 3086) we find that most respondents underestimated the actual errors made by algorithms and are willing to accept even fewer errors than estimated. Error estimates and error acceptance did not differ consistently for predictions made by algorithms or human experts, but people's living conditions (e.g. unemployment, household income) affected domain-specific acceptance (job suitability, credit defaulting) of misses and false alarms. We conclude that people have unwarranted expectations about the performance of ADM systems and evaluate errors in terms of potential personal consequences. Given the general public's low willingness to accept errors, we further conclude that acceptance of ADM appears to be conditional to strict accuracy requirements.
Aim The purpose of this study was to examine physical fitness and psycho-cognitive performance and their associations in young and middle-aged workers with primarily physical versus mental work demands. Subjects and methods Healthy young and middle-aged workers (73 men, age = 33 +/- 7 years; 75 women, age = 35 +/- 9 years) were recruited from German small-to-medium-sized enterprises (< 250 employees) and classified into groups with primarily mental (MD) or physical demands (PD) at work. Participants were tested for cardiorespiratory fitness, trunk flexor/extensor muscular endurance, handgrip strength, balance, leg muscle power, perceived stress, cognitive performance, and work ability. Results Ninety-four workers were allocated to the MD (53% females) and 54 to the PD (46% females) groups. The MD group showed significantly better balance, trunk extensor muscular endurance, and cognitive performance (p < 0.035, 0.35 <= d <= 0.55) and less stress compared with the PD group (p < 0.023, d = 0.38). Group-specific Spearman rank correlation analysis (r(S)) revealed significant small-to-medium-sized correlations between physical fitness and cognitive performance (- 0.205 <= r(S) <= 0.434) in the MD and PD groups. Significant small-to-medium-sized correlations were found for physical fitness and stress/work ability (0.211 <= r(S) <= 0.301) in the MD group only. Further, associations of trunk extensor muscular endurance and work ability were significantly higher in the MD group (r(S) = 0.240) compared with the PD group (r(S) = - 0.141; z = 2.16, p = 0.031). Conclusions MD workers showed better physical fitness measures (balance, trunk extensor muscular endurance) and cognitive performance and lower levels of perceived stress compared with PD workers. Small-to-medium-sized associations between physical fitness and psycho-cognitive performance measures indicate that gains in physical fitness may at least partly contribute to psycho-cognitive performance and/or vice versa, particularly in MD workers.
This study examined the effects of an 8-week plyometric training (PT) program on components of physical fitness in young female handball players. Twenty-one female adolescent handball players were assigned to an experimental group (EG, n = 12; age = 15.9 +/- 0.2 years) or an active control group (CG, n = 9, age = 15.9 +/- 0.3 years). While EG performed plyometric exercises in replacement of some handball-specific drills, CG maintained the regular training schedule. Baseline and follow-up tests were performed for the assessment of linear speed (i.e., 5-, 10-, and 20-m time), change-of-direction (CoD) speed (i.e., T-test time), muscle power (i.e., countermovement jump [CMJ] height and reactive strength index [RSI]), and repeated sprint ability (RSA) (RSA total time [RSA(total)], RSA best time [RSA(best)], and RSA fatigue index [RSA(FI)]). Data were analyzed using magnitude-based inferences. Within-group analyses for the EG revealed moderate-to-large improvements for the 5-m (effect size [ES] = 0.81 [0.1-1.5]), 10-m sprint time (ES = 0.84 [0.1-1.5]), RSI (ES = 0.75 [0.1-1.4]), RSA(FI) (ES = 0.65 [0.0-1.3]), and T-test time (ES = 1.46 [0.7-2.2]). Trivial-to-small ES was observed for RSA(best) (ES = 0.18 [-0.5 to 0.9]), RSA(total) (ES = 0.45 [-0.2 to 1.1]), 20-m sprint time (ES = 0.56 [-0.1 to 1.2]), and CMJ height (ES = 0.57 [-0.1 to 1.3]). For the CG, within-group analyses showed a moderate performance decline for T-test time (ES = -0.71 [-1.5 to 0.1]), small decreases for 5-m sprint time (ES = -0.46 [-1.2 to 0.3]), and a trivial decline for 10-m (ES = -0.10 [-0.9 to 0.7]) and 20-m sprint times (ES = -0.16 [-0.9 to 0.6]), RSA(total) (ES = 0.0 [-0.8 to 0.8]), and RSA(best) (ES = -0.20 [-0.9 to 0.6]). The control group achieved trivial-to-small improvements for CMJ height (ES = 0.10 [-0.68 to 0.87]) and RSI (ES = 0.30 [-0.5 to 1.1]). In conclusion, a short-term in-season PT program, in replacement of handball-specific drills, is effective in improving measures of physical fitness (i.e., linear/CoD speed, jumping, and RSA) in young female handball players.
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.
Recreational exercising and self-reported cardiometabolic diseases in German people living with HIV
(2021)
Exercise is known for its beneficial effects on preventing cardiometabolic diseases (CMDs) in the general population. People living with the human immunodeficiency virus (PLWH) are prone to sedentarism, thus raising their already elevated risk of developing CMDs in comparison to individuals without HIV. The aim of this cross-sectional study was to determine if exercise is associated with reduced risk of self-reported CMDs in a German HIV-positive sample (n = 446). Participants completed a self-report survey to assess exercise levels, date of HIV diagnosis, CD4 cell count, antiretroviral therapy, and CMDs. Participants were classified into exercising or sedentary conditions. Generalized linear models with Poisson regression were conducted to assess the prevalence ratio (PR) of PLWH reporting a CMD. Exercising PLWH were less likely to report a heart arrhythmia for every increase in exercise duration (PR: 0.20: 95% CI: 0.10–0.62, p < 0.01) and diabetes mellitus for every increase in exercise session per week (PR: 0.40: 95% CI: 0.10–1, p < 0.01). Exercise frequency and duration are associated with a decreased risk of reporting arrhythmia and diabetes mellitus in PLWH. Further studies are needed to elucidate the mechanisms underlying exercise as a protective factor for CMDs in PLWH.
Reference values and validation of the 1-minute sit-to-stand test in healthy 5-16-year-old youth
(2021)
Objectives:
It is essential to have simple, reliable and valid tests to measure children's functional capacity in schools or medical practice. The 1-minute sit-to-stand (STS) test is a quick fitness test requiring little equipment or space that is increasingly used in both healthy populations and those with chronic disease. We aimed to provide age-specific and sex-specific reference values of STS test in healthy children and adolescents and to evaluate its short-term reliability and construct validity.
Design setting and participants:
Cross-sectional convenience sample from six public schools and one science fair in central Europe. Overall, 587 healthy participants aged 5-16 years were recruited and divided into age groups of 3 years each.
Outcomes:
1-minute STS. To evaluate short-term reliability, some children performed the STS test twice. To evaluate construct validity, some children also performed a standing long jump (SLJ) and a maximal incremental exercise test.
Results:
Data from 547 youth aged 5-16 years were finally included in the analyses. The median number of repetitions in 1 min in males (females) ranged from 55 [95% CI: 38 to 72] (53 [95% CI: 35 to 76]) in 14-16-year olds to 59 [95% CI: 41 to 77] (60 [95% CI: 38 to 77]) in 8-10-year olds. Children who repeated STS showed a learning effect of on average 4.8 repetitions more than the first test (95% limits of agreement: -6.7 to 16.4). Moderate correlations were observed between the STS and the SLJ (r=0.48) tests and the maximal exercise test (r=0.43).
Conclusions:
The reported STS reference values can be used to interpret STS test performance in children and adolescents. The STS appears to have good test- retest reliability, but a learning effect of about 10%. The association of STS with other measures of physical fitness should be further explored in a larger study and technical standards for its conduct are needed.
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.
Lesinski, M, Prieske, O, Chaabene, H, and Granacher, U. Seasonal effects of strength endurance vs. power training in young female soccer athletes. J Strength Cond Res 35(12S): S90-S96, 2021-This study examined the seasonal effects of strength endurance training (SET) vs. power training (PT) on physical fitness and body composition in young female soccer players. Thirty-six young female elite soccer players (15 +/- 1 years; maturity offset +3 +/- 1 years) were allocated to progressive SET (n = 19) or PT (n = 17). Over the course of one soccer season, SET performed slow movement velocity, moderate intensity (50-60% of the 1 repetition maximum [1RM]; 20-40 repetitions) strength exercises while PT performed moderate-to-high intensity (50-95% of the 1RM; 3-8 repetitions), high movement velocity strength exercises (2 sessions center dot wk(-1)). Before and after training, tests were performed for the assessment of muscle strength (1RM leg press), jump performance (countermovement jump [CMJ], drop jump [DJ]), muscular endurance (ventral Bourban test), linear speed (10 m, 20 m), change-of-direction (CoD) speed (T-test), dynamic balance (Y-balance test), sport-specific performance (kicking velocity), and body composition (lean body mass and fat mass). An analysis of covariance was used to test for between-group differences at post-test with baseline values as covariate. No significant between-group differences were observed in terms of total training volume over the respective soccer seasons (p = 0.069; d = 0.68). At post-test, SET showed significantly better ventral Bourban and T-test performances (d = 1.28-2.28; p = 0.000-0.001) compared with PT. However, PT resulted in significantly better 1RM leg press, DJ, 10-m, and 20-m sprint performances (d = 0.85-1.44; p = 0.000-0.026). No significant between-group differences were observed at post-test for CMJ, Y-balance test, kicking performance, and body composition (d = 0.20-0.74, p = 0.051-0.594). Our findings are mainly in accordance with the principle of training specificity. Both SET and PT are recommended to be implemented in young female elite soccer players according to the respective training period.
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.
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).
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.