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Background: The worldwide prevalence of diabetes has been increasing in recent years, with a projected prevalence of 700 million patients by 2045, leading to economic burdens on societies. Type 2 diabetes mellitus (T2DM), representing more than 95% of all diabetes cases, is a multifactorial metabolic disorder characterized by insulin resistance leading to an imbalance between insulin requirements and supply. Overweight and obesity are the main risk factors for developing type 2 diabetes mellitus. The lifestyle modification of following a healthy diet and physical activity are the primary successful treatment and prevention methods for type 2 diabetes mellitus. Problems may exist with patients not achieving recommended levels of physical activity. Electrical muscle stimulation (EMS) is an increasingly popular training method and has become in the focus of research in recent years. It involves the external application of an electric field to muscles, which can lead to muscle contraction. Positive effects of EMS training have been found in healthy individuals as well as in various patient groups. New EMS devices offer a wide range of mobile applications for whole-body electrical muscle stimulation (WB-EMS) training, e.g., the intensification of dynamic low-intensity endurance exercises through WB-EMS. This dissertation project aims to investigate whether WB-EMS is suitable for intensifying low-intensive dynamic exercises such as walking and Nordic walking.
Methods: Two independent studies were conducted. The first study aimed to investigate the reliability of exercise parameters during the 10-meter Incremental Shuttle Walk Test (10MISWT) using superimposed WB-EMS (research question 1, sub-question a) and the difference in exercise intensity compared to conventional walking (CON-W, research question 1, sub-question b). The second study aimed to compare differences in exercise parameters between superimposed WB-EMS (WB-EMS-W) and conventional walking (CON-W), as well as between superimposed WB-EMS (WB-EMS-NW) and conventional Nordic walking (CON-NW) on a treadmill (research question 2). Both studies took place in participant groups of healthy, moderately active men aged 35-70 years. During all measurements, the Easy Motion Skin® WB-EMS low frequency stimulation device with adjustable intensities for eight muscle groups was used. The current intensity was individually adjusted for each participant at each trial to ensure safety, avoiding pain and muscle cramps. In study 1, thirteen individuals were included for each sub question. A randomized cross-over design with three measurement appointments used was to avoid confounding factors such as delayed onset muscle soreness. The 10MISWT was performed until the participants no longer met the criteria of the test and recording five outcome measures: peak oxygen uptake (VO2peak), relative VO2peak (rel.VO2peak), maximum walk distance (MWD), blood lactate concentration, and the rate of perceived exertion (RPE).
Eleven participants were included in study 2. A randomized cross-over design in a study with four measurement appointments was used to avoid confounding factors. A treadmill test protocol at constant velocity (6.5 m/s) was developed to compare exercise intensities. Oxygen uptake (VO2), relative VO2 (rel.VO2) blood lactate, and the RPE were used as outcome variables. Test-retest reliability between measurements was determined using a compilation of absolute and relative measures of reliability. Outcome measures in study 2 were studied using multifactorial analyses of variances.
Results: Reliability analysis showed good reliability for VO2peak, rel.VO2peak, MWD and RPE with no statistically significant difference for WB-EMS-W during 10WISWT. However, differences compared to conventional walking in outcome variables were not found. The analysis of the treadmill tests showed significant effects for the factors CON/WB-EMS and W/NW for the outcome variables VO2, rel.VO2 and lactate, with both factors leading to higher results. However, the difference in VO2 and relative VO2 is within the range of biological variability of ± 12%. The factor combination EMS∗W/NW is statistically non-significant for all three variables. WB-EMS resulted in the higher RPE values, RPE differences for W/NW and EMS∗W/NW were not significant.
Discussion: The present project found good reliability for measuring VO2peak, rel. VO2peak, MWD and RPE during 10MISWT during WB-EMS-W, confirming prior research of the test. The test appears technically limited rather than physiologically in healthy, moderately active men. However, it is unsuitable for investigating differences in exercise intensities using WB-EMS-W compared to CON-W due to different perceptions of current intensity between exercise and rest. A treadmill test with constant walking speed was conducted to adjust individual maximum tolerable current intensity for the second part of the project. The treadmill test showed a significant increase in metabolic demands during WB-EMS-W and WB-EMS-NW by an increased VO2 and blood lactate concentration. However, the clinical relevance of these findings remains debatable. The study also found that WB-EMS superimposed exercises are perceived as more strenuous than conventional exercise. While in parts comparable studies lead to higher results for VO2, our results are in line with those of other studies using the same frequency. Due to the minor clinical relevance the use of WB-EMS as exercise intensification tool during walking and Nordic walking is limited. High device cost should be considered. Habituation to WB-EMS could increase current intensity tolerance and VO2 and make it a meaningful method in the treatment of T2DM. Recent figures show that WB-EMS is used in obese people to achieve health and weight goals. The supposed benefit should be further investigated scientifically.
Objective:
Depression and coronary heart disease (CHD) are highly comorbid conditions. Brain-derived neurotrophic factor (BDNF) plays an important role in cardiovascular processes. Depressed patients typically show decreased BDNF concentrations. We analysed the relationship between BDNF and depression in a sample of patients with CHD and additionally distinguished between cognitive-affective and somatic depression symptoms. We also investigated whether BDNF was associated with somatic comorbidity burden, acute coronary syndrome (ACS) or congestive heart failure (CHF).
Methods:
The following variables were assessed for 225 hospitalised patients with CHD: BDNF concentrations, depression [Patient Health Questionnaire-9 (PHQ-9)], somatic comorbidity (Charlson Comorbidity Index), CHF, ACS, platelet count, smoking status and antidepressant treatment.
Results:
Regression models revealed that BDNF was not associated with severity of depression. Although depressed patients (PHQ-9 score >7) had significantly lower BDNF concentrations compared to non-depressed patients (p = 0.04), this was not statistically significant after controlling for confounders (p = 0.15). Cognitive-affective symptoms and somatic comorbidity burden each closely missed a statistically significant association with BDNF concentrations (p = 0.08, p = 0.06, respectively). BDNF was reduced in patients with CHF (p = 0.02). There was no covariate-adjusted, significant association between BDNF and ACS.
Conclusion:
Serum BDNF concentrations are associated with cardiovascular dysfunction. Somatic comorbidities should be considered when investigating the relationship between depression and BDNF.
Exercise or not?
(2023)
Objective: Individuals’ decisions to engage in exercise are often the result of in-the-moment choices between exercise and a competing behavioral alternative. The purpose of this study was to investigate processes that occur in-the-moment (i.e., situated processes) when individuals are faced with the choice between exercise and a behavioral alternative during a computerized task. These were analyzed against the background of interindividual differences in individuals’ automatic valuation and controlled evaluation of exercise.
Method: In a behavioral alternatives task 101 participants were asked whether they would rather choose an exercise option or a behavioral alternative in 25 trials. Participants’ gaze behavior (first gaze and fixations) was recorded using eye-tracking. An exercise-specific affect misattribution procedure (AMP) was used to assess participants’ automatic valuation of exercise before the task. After the task, self-reported feelings towards exercise (controlled evaluation) and usual weekly exercise volume were assessed. Mixed effects models with random effects for subjects and trials were used for data analysis.
Results: Choosing exercise was positively correlated with individuals’ automatic valuation (r = 0.20, p = 0.05), controlled evaluation (r = 0.58, p < 0.001), and their weekly exercise volume (r = 0.43, p < 0.001). Participants showed no bias in their initial gaze or number of fixations towards the exercise or the non-exercise alternative. However, participants were 1.30 times more likely to fixate on the chosen alternative first and more frequently, but this gaze behavior was not related to individuals’ automatic valuation, controlled evaluation, or weekly exercise volume.
Conclusion: The results suggest that situated processes arising from defined behavioral alternatives may be independent of individuals’ general preferences. Despite one’s best general intention to exercise more, the choice of a non-exercise alternative behavior may seem more appealing in-the-moment and eventually be chosen. New psychological theories of health behavior change should therefore better consider the role of potentially conflicting alternatives when it comes to initiating physical activity or exercise.
The field of exercise psychology has established robust evidence on the health benefits of physical activity. However, interventions to promote sustained exercise behavior have often proven ineffective. This dissertation addresses challenges in the field, particularly the neglect of situated and affective processes in understanding and changing exercise behavior. Dual process models, considering both rational and affective processes, have gained recognition. The Affective Reflective Theory of Physical Inactivity and Exercise (ART) is a notable model in this context, positing that situated processes in-the-moment of choice influence exercise decisions and subsequent exercise behavior.
The dissertation identifies current challenges within exercise psychology and proposes methodological and theoretical advancements. It emphasizes the importance of momentary affective states and situated processes, offering alternatives to self-reported measures and advocating for a more comprehensive modeling of individual variability. The focus is on the affective processes during exercise, theorized to reappear in momentary decision-making, shaping overall exercise behavior.
The first publication introduces a new method by using automated facial action analysis to measure variable affective responses during exercise. It explores how these behavioral indicators covary with self-reported measures of affective valence and perceived exertion. The second publication delves into situated processes at the moment of choice between exercise and non-exercise options, revealing that intraindividual factors play a crucial role in explaining exercise-related choices. The third publication presents an open-source research tool, the Decisional Preferences in Exercising Test (DPEX), designed to capture repeated situated decisions and predict exercise behavior based on past experiences.
The findings challenge previous assumptions and provide insights into the complex interplay of affective responses, situated processes, and exercise choices. The dissertation underscores the need for individualized interventions that manipulate affective responses during exercise and calls for systematic testing to establish causal links to automatic affective processes and subsequent exercise behavior. This dissertation highlights the necessity for methodological and conceptual refinements in understanding and promoting exercise behavior, ultimately contributing to the broader goal of combating increasing inactivity trends.
Throughout the years 2020 and 2021, schools were temporarily closed to slow the spread of SarsCoV-2. For some periods, children were locked out of sports in schools (physical education lessons, school sports working groups) and organized sports in sports clubs which often resulted in physical inactivity. Did these restrictions affect children’s physical fitness? The EMOTIKON project (www.uni-potsdam.de/emotikon) annually assesses the physical fitness (cardiorespiratory endurance [6-minute-run test], coordination [star-run test], speed [20-m sprint test], lower [standing long jump test] and upper [ball push test] limbs muscle power, and balance [one-legged stance test]) of all third graders in the Federal State of Brandenburg, Germany. Participation is mandatory for all public primary schools. In the falls from 2016 to 2021, 83,476 keyage children (i.e., school enrollment according to the legal key date, between eight and nine years in third grade) from 512 schools were assessed with the EMOTIKON test battery. We tested the Covid pandemic effect on a composite score of the four highly correlated physical fitness tests assessing cardiorespiratory endurance, coordination, speed and powerLOW and on another composite score of the three running tests (cardiorespiratory endurance, coordination, speed), as well as separately on all six physical fitness components. Secular trends for each of the physical fitness components and differences between schools and children were taken into account in linear mixed models. We found a negative Covid pandemic effect on the two composite physical fitness scores, as well as on cardiorespiratory endurance, coordination, and speed. We found a positive Covid pandemic effect on powerLOW. Coordination was associated with the largest negative Covid pandemic effect, also passing the threshold of smallest meaningful change (SMC, i.e., 0.2 Cohen’s d) when accumulated across two years. Given the educational context, Covid pandemic effects were also compared relative to the expected age-related development of the physical fitness components between eight and nine years. The Covid pandemic-related developmental costs/gains ranged from three to seven months relative to a longitudinal age effect, and from five to 17 months relative to a cross-sectional age effect. We propose that a longitudinal assessment yields a more reliable estimate of the developmental (age-related) gain than a cross-sectional one. Therefore, we consider the smaller Covid pandemic-related developmental costs/gains to be more credible. Interestingly, on the school level, „fitter” schools (relatively higher Grand Mean) exhibited larger negative Covid pandemic effects than schools with a lower physical fitness score. Negative Covid pandemic effects for the three run tasks were also found by Bähr et al. (2022), who tested the physical fitness of 16,496 Thuringian third-graders from 292 schools with the same six physical fitness tests used in EMOTIKON. Our results may be used to prioritize health-related interventions.
Objective: The aim of the present study was to examine the effect of Cold Water Immersion (CWI) on the recovery of physical performance, hematological stress markers and perceived wellness (i.e., Hooper scores) following a simulated Mixed Martial Arts (MMA) competition.
Methods: Participants completed two experimental sessions in a counter-balanced order (CWI or passive recovery for control condition: CON), after a simulated MMAs competition (3 x 5-min MMA rounds separated by 1-min of passive rest). During CWI, athletes were required to submerge their bodies, except the trunk, neck and head, in the seated position in a temperature-controlled bath (similar to 10 degrees C) for 15-min. During CON, athletes were required to be in a seated position for 15-min in same room ambient temperature. Venous blood samples (creatine kinase, cortisol, and testosterone concentrations) were collected at rest (PRE-EX, i.e., before MMAs), immediately following MMAs (POST-EX), immediately following recovery (POST-R) and 24 h post MMAs (POST-24), whilst physical fitness (squat jump, countermovement-jump and 5- and 10-m sprints) and perceptual measures (well-being Hooper index: fatigue, stress, delayed onset muscle soreness (DOMS), and sleep) were collected at PRE-EX, POST-R and POST-24, and at PRE-EX and POST-24, respectively.
Results: The main results indicate that POST-R sprint (5- and 10-m) performances were 'likely to very likely' (d = 0.64 and 0.65) impaired by prior CWI. However, moderate improvements were in 10-m sprint performance were 'likely' evident at POST-24 after CWI compared with CON (d = 0.53). Additionally, the use of CWI 'almost certainly' resulted in a large overall improvement in Hooper scores (d = 1.93). Specifically, CWI 'almost certainly' resulted in improved sleep quality (d = 1.36), stress (d = 1.56) and perceived fatigue (d = 1.51), and 'likely' resulted in a moderate decrease in DOMS (d = 0.60).
Conclusion: The use of CWI resulted in an enhanced recovery of 10-m sprint performance, as well as improved perceived wellness 24-h following simulated MMA competition.
Professionelle GT Langstreckenmotorsportler (Rennfahrer) müssen den hohen motorischen und kognitiven Ansprüchen ohne Verlust der Performance während eines Rennens endgegenwirken können. Sie müssen stets, bei hoher Geschwindigkeit fokussiert und konzentriert auf ihr Auto, die Rennstrecke und ihre Gegner reagieren können. Darüber hinaus sind Rennfahrer zusätzlich durch die notwendige Kommunikation im Auto mit den Ingenieuren und Mechanikern in der Boxengasse gefordert. Daten über die tatsächliche Beanspruchung und häufig auftretende Beschwerden und/oder Verletzung von Profiathleten liegen kaum vor. Für eine möglichst gute Performance im Auto während eines Rennens ist es notwendige neben der körperlichen Beanspruchung auch die häufigen Krankheitsbilder zu kennen. Auf Basis dessen kann eine optimale Prävention oder notwendige Therapie zur möglichst schnellen Reintegration in den Sport abgeleitet und entwickelt werden. Die vorliegende Arbeit befasst sich durch ein regelmäßiges Gesundheitsmonitoring mit der Erfassung häufiger Beschwerden und oder Verletzungen im GT Langestreckenmotorsport zur Ableitung eines präventiven (trainingstherapeutischen) und therapeutischen Konzeptes. Darüber hinaus, soll über die Einschätzung der körperlichen Leistungsfähigkeit der Athleten, auf Basis der Beanspruchung im Rennfahrzeug ein mögliches Trainingskonzept in Abhängigkeit der Saison entwickelt werden.
Insgesamt wurden über 15 Jahre (2003-2017) 37 männliche Athleten aus dem GT Langstreckenmotorsport 353mal im Rahmen eines Gesundheitsmonitorings untersucht. Dabei wurden Athleten maximal 14 Jahre und mindestens 1 Jahr sportmedizinische betreut. Diese 2x im Jahr stattfindende Untersuchung beinhaltete im Wesentlichen eine sportmedizinische Untersuchung zur Einschätzung der Tauglichkeit für den Sport und die Erfassung der körperlichen Leistungsfähigkeit. Über das Gesundheitsmonitoring hinaus erfolgte die Betreuung zusätzlich an der Rennstrecke zur weiteren Erfassung der Beschwerden, Erkrankungen und Verletzungen der Athleten während ihrer sportartspezifischen Belastung. Zusammengefasst zeigen die Athleten geringe Prävalenzen und Inzidenzen der Krankheitsbilder bzw. Beschwerden. Ein Unterschied der Prävalenzen zeigt sich zwischen den Gesundheitsuntersuchungen und der Betreuung an der Rennstrecke. Die häufigsten Beschwerdebilder zeigen sich aus Orthopädie und Innerer Medizin. So sind Infekte der oberen Atemwege sowie Allergien neben Beschwerden der unteren Extremität und der Wirbelsäule am häufigsten. Demzufolge werden vorrangig physio- und trainingstherapeutische Konsequenzen abgeleitet. Eine medikamentöse Therapie erfolgt im Wesentlichen während der Rennbetreuung. Zur Reduktion der orthopädischen und internistischen Beschwerden sollten präventive Maßnahmen mehr betont werden. Die körperliche Leistungsfähigkeit zeigt im Wesentlichen über die Untersuchungsjahre eine stabile Performance für die Ausdauer-, Kraft und sensomotorische Leistungsfähigkeit. Die Ausdauerleistungsfähigkeit kann in Abhängigkeit der Sportartspezifik mit einer guten bis sehr guten Ausprägung definiert werden. Die Kraftleistungsfähigkeit und die sensomotorische Leistungsfähigkeit lassen sportartspezifische Unterschiede zu und sollte körpergewichtsbezogen betrachtet werden.
Ein sportmedizinisches und trainingstherapeutisches Konzept müsste demnach eine regelmäßige ärztlich-medizinische Untersuchung mit dem Fokus der Orthopädie, Inneren Medizin und Hals- Nasen-Ohren-Kunde beinhalten. Darüber hinaus sollte eine regelmäßige Erfassung der körperlichen Leistungsfähigkeit zur möglichst effektiven Ableitung von Trainingsinhalten oder Präventionsmaßnahmen berücksichtig werden. Auf Grundlage der hohen Reisetätigkeit und der ganzjährigen Saison könnte ein 1-2x jährlich stattfindendes Trainingslager, im Sinne eines Grundlagen- und Aufbautrainings zur Optimierung der Leistungsfähigkeit beitragen, das Konzept komplementieren. Zudem scheint eine ärztliche Rennbetreuung notwendig.
Aim The aim of the present study was to examine young female volleyballers’ body build, physical abilities, technical skills and psychophysiological properties in relation to their performance at competitions. The sample consisted of 46 female volleyballers aged 13-16 years. 49 basic anthropometric measurements were measured and 65 proportions and body composition characteristics were calculated. 9 physical ability tests, 9 volleyball technical skills tests and 21 psychophysiological tests were carried out. The game performance was recorded by the computer program Game. The program enabled to fix the performance of technical elements in case of each player. The computer program Game calculated the index of proficiency in case of each girl for each element. The first control group consisted of 74 female volleyballers aged 13–15 years with whom reduced anthropometry was provided and 28 games were recorded. The second control group consisted of 586 ordinary schoolgirls aged 13–16 years with whom full anthropometry was provided. Results In order to systematize all anthropometric characteristics, we first studied the essence of the anthropometric structure of the body as a whole. It turned out to be a characteristic system where all variables are in significant correlation between one another and where the leading characteristics are height and weight. Therefore we based the classification on the mean height and weight of the whole sample. We formed a 5 class SD classification. There are three classes of concordance between height and weight: small height – small weight, medium height – medium height, big height – big weight. The other two classes were classes of disconcordance between height and weight- pycnomorphs and leptomorphs. We managed to show that gradual increase in height and weight brought about statistically significant increase in length, breadth and depth measurements, circumferences, bone thicknesses and skinfolds. There were also systematic changes in indeces and body composition characteristics. Pycnomorphs and leptomorphs also showed differences specific to their body types in body measurements and body composition. The results of all tests were submitted to basic statistical analysis and all correlations were found between all the tests (volleyball technical skills, psychophysiological abilities, physical abilities), and all basic anthropometric variables (n = 49) and all proportions and body composition characteristics (n = 65). All anthropometric measurements and test results were correlated with the index of proficiency for all elements of the game. The best linear regression models were calculated for predicting proficiency in different elements of the game. We can see that body build and all kind of tests took part in predicting the proficiency of the game. The most essential for performing attack, block and feint were anthropometric and psychophysiological models. The studied complex of body build characteristics and tests results determine the players’ proficiency at competitions, are an important tool for testing the player’s individual development, enable to choose volleyballers from among schoolgirls and represent the whole body constitutional model of a young female volleyballer. Outlook Our outlook for the future is to continue recording of all Estonian championship games with the computer program Game, to continue the players’ anthropometric measuring and psychophysiological testing at competitions and to compile a national register for assessment of development of individual players and teams.
Kultur gibt den Menschen eine Orientierung. Sie machen darin ganz spezifische Erfahrungen. Hieraus entwickeln sich auch motivationale Orientierungen. Dadurch werden andere Erfahrungen gemacht, die Sportler können andere Motivation und Volition entwickeln. Dabei sind mehr kollektivistische Kulturen eher vermeidungs-motiviert und mehr individualistische Kulturen mehr erfolgsorientiert. Beim Kollektivismus erscheint die Leistungsmotivation eher unter einem sozialen Aspekt, nämlich die Auseinandersetzung mit einem Gütemaßstab, der eher von außen vorgegeben wird und weniger einem ausschließlich eigenen Maßstab. Ägypten erweist sich im Vergleich zu Deutschland als eine eher kollektivistisch geprägte Kultur. Daraus ergeben sich folgende Unterschiede: Einen signifikanten Unterschied zwischen deutschen und ägyptischen Ringern gibt es in der Wettkampforientierung und bei der Sieg- bzw. Gewinn-Orientierung. Die ägyptischen Ringer habe eine höhere Ausprägung als die Deutschen. Sie weisen auch eine etwas höhere Zielorientierung auf als die Deutschen. Entgegen den Erwartungen zeigte sich, dass es keine signifikanten Unterschiede zwischen den ägyptischen und deutschen Ringern gibt in der Variable: Sieg- bzw. Gewinn-Orientierung. Die Furcht vor Misserfolg sowie auch die Hoffnung auf Erfolg liegen höher bei den Ägyptern als bei den Deutschen. Bezogen auf die Modi der Handlungskontrolle verfügen die Deutschen Ringer über eine höher Ausprägung auf allen drei Komponenten. Sie haben eine höhere Handlungsorientierung nach Misserfolg, eine höhere Handlungsplanung sowie eine höhere Handlungstätigkeitsausführung. Diese kulturell kontrastive Studie über die psychologischen Aspekte, im Bereich der Leistungsmotivation und der Handlungskontrolle, kann für die Sportart Ringen sehr nützlich werden, da sie sehr wichtig ist beim Erkennen der sportlichen Überlegenheits- und Schwächemerkmale. Sie wiederspiegelt auch die Hochstimmung in den entwickelten Staaten oder die Misere in den anderen Staaten. Aus den interkulturellen Unterschieden in der Motivation und Volition können somit verschiedene Maßnahmen zu sportpsychologischen Interventionen entwickelt werden. Es sollte unbedingt darauf wert gelegt werden, dass die kulturell bedingten Unterschiede im Trainingsalltag beachtet werden, bei Teams, die aus Personen aus unterschiedlichen Kulturkreisen stammen.
Models employed in exercise psychology highlight the role of reflective processes for explaining behavior change. However, as discussed in social cognition literature, information-processing models also consider automatic processes (dual-process models). To examine the relevance of automatic processing in exercise psychology, we used a priming task to assess the automatic evaluations of exercise stimuli in physically active sport and exercise majors (n = 32), physically active nonsport majors (n = 31), and inactive students (n = 31). Results showed that physically active students responded faster to positive words after exercise primes, whereas inactive students responded more rapidly to negative words. Priming task reaction times were successfully used to predict reported amounts of exercise in an ordinal regression model. Findings were obtained only with experiential items reflecting negative and positive consequences of exercise. The results illustrate the potential importance of dual-process models in exercise psychology.