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Purpose: This pilot study assessed the safety and effects of progressive functional high-intensity training in a group setting for adolescents with unilateral cerebral palsy (CP) on daily function indicators., Methods: Nine adolescents (mean age 16.9 years, GMFCS levels I-II) participated in 12 weeks of training (2x/week). Evaluations included 3D gait analysis, the 6-min walking test (6MWT), clinical exams, and the Gross Motor Function Measure-66 (GMFM-66)., Results: No adverse events occurred, and GMFM-66 scores significantly improved ( p  = .031, Δ = 2.19%). Although increases in 6MWT ( p  = .09, Δ = 29.8 m) performance and propulsion ratio ( p  = .067, Δ = 5.4%) for the affected leg were observed, they were not statistically significant., Discussion: The study suggests that this training is safe and may enhance gross motor function, endurance, and gait asymmetry in unilateral CP. Future research should include upper limb evaluations and out-of-clinic motion analysis with wearable inertial measurement units (IMUs) to provide a more comprehensive assessment of functional movements.

Stroke survivors commonly face challenges such as reduced physical activity and cardiorespiratory fitness (CRF) as well as balance and gait impairments, exacerbating their disability. While high-intensity exercise interventions have demonstrated some potential, their effects on these items remain uncertain. Therefore, our study aimed to investigate the impact of high-intensity training protocols on CRF, gait ability, and balance in stroke survivor populations. Two independent investigators systematically searched five databases for relevant RCTs following the PICO model. Through a systematic review of 25 RCTs published up to 31 May 2023, including adult first-stroke survivors, comparing high-intensity exercise training versus low-to-mild or no exercises, we evaluated outcomes such as the Six-Minute Walking Test (6 MWT), peak oxygen uptake (VO2peak), Ten-Meter Walk Test (10 MWT), Berg Balance Scale (BBS), and Timed Up and Go test (TUG). The protocol was registered in PROSPERO (registration number CRD42023456773). Meta-analyses indicated significant enhancements in CRF, as measured by 6 MWT and VO2peak, following high-intensity exercise interventions. However, no significant differences were observed in BBS, 10 MWT, and TUG. Our findings underscore the potential of high-intensity exercise interventions in ameliorating CRF among stroke survivors, although further research involving standardized protocols and long-term follow-ups is imperative to optimize rehabilitation outcomes.

Aim: Our goal was to examine the effect of high-intensity physical activity on changes in the lipid profile, complete blood count (CBC), iron metabolism, and kidney and liver function tests of professional water polo players., Methods: This study included twenty professional male water polo players. Blood sampling was carried out at the beginning of the season and during periods of high-intensity training. CBCs were determined with a Siemens Advia 2120i hematology analyzer. A Beckman CoulterAU680 chemistry analyzer was used to determine the serum concentrations/activities of lipid profiles and liver and kidney function test analytes. The lipid athlete scores were also determined., Results: The mean corpuscular volume ( p = 0.006), platelet count ( p = 0.008), and mean platelet volume ( p < 0.001) significantly decreased during the high-intensity period, compared with the beginning of the season. The total iron-binding capacity increased ( p = 0.001), and ferritin concentrations significantly declined ( p = 0.017). The lipid profiles revealed a significant difference between phases, with slight increases in serum total ( p = 0.025) and LDL cholesterol ( p = 0.002) levels and a decrease in triglyceride concentrations ( p = 0.040) in the high-intensity period. During the high-intensity period, the liver and kidney function tests showed a substantial positive effect on lactate dehydrogenase levels ( p < 0.001), aspartate aminotransferase ( p = 0.028) serum activity, and total protein concentrations ( p = 0.033), compared with the beginning of the season., Conclusions: Water polo players might exhibit a decrease in some CBC parameters, an increase in LDL cholesterol, and a decrease in liver function biomarkers due to intense training at the peak of the competitive season. Kidney function biomarkers remain unchanged.

The purpose of this study was to investigate the effect of whole-body cryotherapy (WBC) on acute recovery after a single high-intensity training day. Twelve elite professional male rowers from the national aquatic training base. They were randomly divided into a WBC group (n = 6) and a control group (CON group, n = 6). They performed a high-intensity training program, with a single session immediately followed by WBC (-110°C, 3 min) or recovered naturally for 3 min (CON group). Rowing performance, skin temperature, heart rate, blood pressure, and blood lactate concentrations were recorded before training, immediately, 5 min, and 15 min after the intervention. Blood samples were collected early in the morning of the day of intervention and that of the following day. The results indicated that 1) the blood lactate concentrations after WBC were significantly lower than pre-training ( p < 0.05); 2) the maximum power significantly decreased immediately after WBC compared to pre-training ( p < 0.05); 3) a significant main effect of time was observed for average speed, which significantly decreased after WBC ( p < 0.05); 4) a significant main effect of time for blood parameters was observed. Specifically, hematocrit, cortisol, and hemoglobin were significantly lower after WBC than pre-intervention, whereas testosterone/cortisol was significantly higher than pre-intervention ( p < 0.05). The results of this study showed that a single session of WBC had a positive effect on accelerating the elimination of blood lactate after HIT, but did not significantly change rowing performance and physiological parameters. A single session of WBC was not an effective strategy for elite rowers for acute recovery after HIT., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Huang, Dan, Wang, Ren, Liu and Li.)

Background: Temporomandibular joint disorders affect the temporomandibular joint (TMJ), masticatory muscles, and associated structures. Symptoms include TMJ pain, limited jaw movement, muscle tenderness, and referred pain. Physical activity can alleviate musculoskeletal pain. This study explored the link between physical fitness (high and low intensity) and temporomandibular disorder (TMD) incidence., Methodology: Sixty patients were divided into three groups in this comparative study. Group I underwent 30 minutes of high-intensity aerobic training. Group II had 30 minutes of low-intensity yoga sessions weekly. Group III received health education. TMD was diagnosed using the Fonseca Anamnestic Index (FAI). Pain intensity was measured using the Visual Analogue Scale (VAS) and the Pain Self-Efficacy Questionnaire (PSEQ)., Results: Of the participants, 38.1% were males and 61.9% were females. TMD severity was mild (25.0%), moderate (55.0%), and severe (20.0%). High-intensity training groups had higher TMD symptom severity than low-intensity groups (p = 0.001). VAS scores increased in group I and decreased in group II (significant). PSEQ scores decreased in group I and increased significantly in group II. Group III showed no significant differences in PSEQ scores., Conclusion: High-intensity training resulted in moderate TMD symptoms. Low-intensity training was beneficial for TMD pain. The study recommends combining low-intensity physical workouts with medications to alleviate TMD., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. People's College of Dental Sciences and Research Centre, Bhopal issued approval EC244224. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Verma et al.)

The aim of the study was to investigate the effect of two long-term reduced concurrent training modalities, in which participants performed one training session every either 7 or 14 days, after 12 weeks of systematic concurrent resistance and aerobic training, on lower extremities' muscle strength, power, and morphology in young females. After the 12-week training period, participants were assigned into three groups and performed either one training session every 7 days (G7) or once every 14 days (G14), or detraining (GD), for 12 weeks, followed by 12 additional weeks of detraining. The following were measured before, after the systematic training period, after the end of the reduced training frequency period, and after the end of complete detraining: body composition, leg press 1-RM, countermovement jump, quadriceps cross-sectional area (CSA), vastus lateralis muscle architecture, and maximum aerobic power. Performance and muscle mass increased after the initial 12-week training period. Thereafter, leg press 1-RM, quadriceps CSA, and aerobic power remained unchanged in the G7 group, but decreased in G14 (-4.4 ± 3.5%; -5.9 ± 1.8%; -9.0 ± 7.8%, respectively, p < 0.05), maintaining 95.6 ± 3.5%, 94.1 ± 1.8%, and 91.0 ± 7.8% of the initial training adaptations, respectively. In conclusion, performing one training session every 2 weeks for 3 months may preserve 90 to 95% of the muscle mass/strength and aerobic power adaptations achieved with systematic concurrent training.

Purpose: Without appropriate standardization of exercise doses, comparing high- (HI) and low-intensity (LI) training outcomes might become a matter of speculation. In athletic preparation, proper quantification ensures an optimized stress-to-recovery ratio. This review aims to compare HI and LI doses by estimating theoretically the conversion ratio, 1:x, between HI and LI: How many minutes, x, of LI are equivalent to 1 minute of HI using various quantification methods? A scrutinized analysis on how the dose increases in relation to duration and intensity was also made., Analysis: An estimation was conducted across 4 categories encompassing 10 different approaches: (1) "arbitrary" methods, (2) physiological and perceptual measurements during exercise, (3) postexercise measurements, and comparison to (4a) acute and (4b) chronic intensity-related maximum dose. The first 2 categories provide the most conservative estimation for the HI:LI ratio (1:1.5-1:10), and the third, slightly higher (1:4-1:11). The category (4a) provides the highest estimation (1:52+) and (4b) suggests 1:10 to 1:20. The exercise dose in the majority of the approaches increase linearly in relation to duration and exponentially in relation to intensity., Conclusions: As dose estimations provide divergent evaluations of the HI:LI ratio, the choice of metric will have a large impact on the research designs, results, and interpretations. Therefore, researchers should familiarize themselves with the foundations and weaknesses of their metrics and justify their choice. Last, the linear relationship between duration and exercise dose is in many cases assumed rather than thoroughly tested, and its use should be subjected to closer scrutiny.

Background: The main purpose of this study was to determine the effects of a high-intensity interval training (HIIT) intervention in the context of moderate alcohol consumption on cognitive performance in healthy young adults., Methods: We conducted a 10-week HIIT program along with four types of beverages with/without alcohol content. A total of 75 healthy adults (18-40 years old; 46% female) were allocated to either a control Non-Training group or an HIIT program group (2 days/week). Using block randomization, participants in the HIIT group were further allocated to an HIIT-Alcohol group (alcohol beer or sparkling water with vodka added, 5.4%) or an HIIT-NonAlcohol group (sparkling water or non-alcohol beer, 0.0%). The control group was instructed to maintain an active lifestyle but did not undergo any regular training. A comprehensive neuropsychological battery was used to evaluate cognitive performance (i.e., memory, working memory, processing speed, inhibitory control, and verbal fluency). Changes from baseline to week 10 were included in the main analyses., Results: All groups improved in all neuropsychological measures (all p ≤ 0.001), independent of sex and alcohol consumption, with no statistical differences between groups (all p > 0.05). Furthermore, larger increases in maximal oxygen uptake were associated with greater improvements in processing speed, inhibitory control, and verbal fluency (all p < 0.050)., Conclusions: Although the improvements found in cognitive performance cannot be attributed to the HIIT intervention, no significant impairments in cognitive functions were noted due to moderate alcohol intake. Furthermore, our results confirmed that exercise-induced physical fitness improvements were associated with cognitive performance enhancements in young healthy adults.

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Background: This study aimed to evaluate the physiological and metabolic adaptations to an eight-week running intervention with whole-body electromyostimulation (wbEMS) compared to running without wbEMS., Methods: In a randomized controlled trial (RCT), 59 healthy participants (32 female/ 27 male, 41 ± 7 years, rel.V̇O 2max 40.2 ± 7.4 ml/min/kg) ran twice weekly à 20 min for eight weeks either with a wbEMS suit (EG) or without wbEMS (control group, CG). Before and after the intervention, (i) rel.V̇O 2max , heart rate and time to exhaustion were recorded with an incremental step test with an incremental rate of 1.20 km/h every 3 min. They were interpreted at aerobic and (indirect) anaerobic lactate thresholds as well as at maximum performance. (ii) Resting metabolic rate (RQ) as well as (iii) body composition (%fat) were assessed., Results: Following the intervention, V̇O 2max was significantly enhanced for both groups (EG ∆13 ± 3%, CG ∆9 ± 3%). Velocity was elevated at lactate thresholds and maximum running speed (EG ∆3 ± 1%, CG ∆2 ± 1%); HR max was slightly reduced by -1 beat/min. No significant changes were observed for time until exhaustion and lactate. RQ was significantly enhanced following both trainings by + 7%. %fat was reduced for both groups (EG ∆-11 ± 3%, CG ∆-16 ± 5%), without any changes in body mass. Results did not differ significantly between groups., Conclusions: Both interventions had a positive impact on aerobic power. The rightward shift of the time-velocity graph points towards improved endurance performance. The effects of wbEMS are comparable to those after high-intensity training and might offer a time-efficient alternative to affect physiological and metabolic effects., Trial Registration: German Clinical Trials Register, ID DRKS00026827, date 10/26/21., (© 2023. BioMed Central Ltd., part of Springer Nature.)

A single bout of cardiovascular exercise can have a cascade of physiological effects, including increased blood flow to the brain. This effect has been documented across multiple modalities, yet studies have reported mixed findings. Here, we systematically review evidence for the acute effect of cardiovascular exercise on cerebral blood flow across a range of neuroimaging techniques and exercise characteristics. Based on 52 studies and a combined sample size of 1,174 individuals, our results indicate that the acute effect of cardiovascular exercise on cerebral blood flow generally follows an inverted U-shaped relationship, whereby blood flow increases early on but eventually decreases as exercise continues. However, we also find that this effect is not uniform across studies, instead varying across a number of key variables including exercise characteristics, brain regions, and neuroimaging modalities. As the most comprehensive synthesis on the topic to date, this systematic review sheds light on the determinants of exercise-induced change in cerebral blood flow, a necessary step toward personalized interventions targeting brain health across a range of populations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: Exercise proved to reduce cancer-related symptoms and prolong survival in some cancer types. However, brain tumor patients are often advised against strenuous exercise. Here, we summarize our experience with a submaximal exercise program for glioma patients: ActiNO (Active in Neuro-Oncology)., Methods: Glioma patients were invited to participate in the program. Since 2011, a sports scientist individualized two one-hour sessions per week adapted to the patients' symptoms. One session consisted of bicycle ergometry (average workload: 75% of maximum heart rate), the other of whole-body resistance training. Both sessions were further complimented by coordinative elements. Cardiorespiratory fitness was assessed using the "Physical Work Capacity" procedure. Patients were followed up regularly to assess adherence to the program and disease activity., Results: Until December 2019, 45 glioma patients, median-aged 49 years (IQR 42-59), were included in the analysis. Most patients suffered from glioblastoma (58%), followed by diffuse lower-grade astrocytoma (29%). In overall 1828 training sessions, two minor epileptic events occurred (1 speech arrest; 1 focal seizure). During fitness assessment, all patients achieved at least 75% of their age-adjusted maximum heart rate. Peak workload averaged 172 W (95% CI 156-187). Median survival of participating glioblastoma patients was 24.1 months (95% CI 8.6-39.5)., Conclusion: This supervised training program with submaximal exertion was feasible and safe in glioma regardless of WHO grading. Based on these experiences, we initiated a prospective multicenter study to objectify improvements in physical performance and quality of life in patients with glioblastoma., (© 2023. The Author(s).)

The aim of this study was to investigate the effects of 12 weeks of high-intensity training with astaxanthin supplementation on adipokine levels, insulin resistance and lipid profiles in males with obesity. Sixty-eight males with obesity were randomly stratified into four groups of seventeen subjects each: control group (CG), supplement group (SG), training group (TG), and training plus supplement group (TSG). Participants underwent 12 weeks of treatment with astaxanthin or placebo (20 mg/d capsule daily). The training protocol consisted of 36 sessions of high-intensity functional training (HIFT), 60 min/sessions, and three sessions/week. Metabolic profiles, body composition, anthropometrical measurements, cardio-respiratory indices and adipokine [Cq1/TNF-related protein 9 and 2 (CTRP9 and CTRP2) levels, and growth differentiation factors 8 and 15 (GDF8 and GDF15)] were measured. There were significant differences for all indicators between the groups (p < 0.05). Post-hoc analysis indicated that the levels of CTRP9, CTRP2, and GDF8 were different from CG (p < 0.05), although levels of GDF15 were similar to CG (p > 0.05). Levels of GDF8 were similar in the SG and TG groups (p > 0.05), with reductions of GDF15 levels in both training groups (p < 0.05). A total of 12 weeks of astaxanthin supplementation and exercise training decreased adipokines levels, body composition (weight, %fat), anthropometrical factors (BMI), and improved lipid and metabolic profiles. These benefits were greater for men with obesity in the TSG group.

This study investigated whether high-intensity exercise training alters the effect of N -acetylcysteine (a precursor of antioxidant glutathione) on exercise-related muscle ionic shifts. We assigned 20 recreationally-active men to 6 weeks of high-intensity exercise training, comprising three weekly sessions of 4-10 × 20-s all-out bouts interspersed by 2 min recovery (SET, n = 10), or habitual lifestyle maintenance (n = 10). Before and after SET, we measured ionic shifts across the working muscle, using leg arteriovenous balance technique, during one-legged knee-extensor exercise to exhaustion with and without N -acetylcysteine infusion. Furthermore, we sampled vastus lateralis muscle biopsies for analyses of metabolites, mitochondrial respiratory function, and proteins regulating ion transport and antioxidant defense. SET lowered exercise-related H + , K + , lactate - , and Na + shifts and enhanced exercise performance by ≈45%. While N -acetylcysteine did not affect exercise-related ionic shifts before SET, it lowered H + , HCO 3 - , and Na + shifts after SET. SET enhanced muscle mitochondrial respiratory capacity and augmented the abundance of Na + /K + -ATPase subunits (α 1 and β 1 ), ATP-sensitive K + channel subunit (Kir6.2), and monocarboxylate transporter-1, as well as superoxide dismutase-2 and glutathione peroxidase-1. Collectively, these findings demonstrate that high-intensity exercise training not only induces multiple adaptations that enhance the ability to counter exercise-related ionic shifts but also potentiates the effect of N -acetylcysteine on ionic shifts during exercise.

Context: Bushen Yiyuan recipe (BYR) is an effective Chinese prescription with antifatigue and antioxidation effects., Objective: The effects of BYR on testosterone synthesis in rat Leydig cells with exercise-induced low serum testosterone levels (EILST) are assessed., Materials and Methods: Thirty-two Sprague-Dawley rats were chronically trained for 6 weeks to establish an EILST model. EILST rats were divided into model (physiological saline), EFE (700 mg/kg ethanol extract of Epimedii folium , the dried leaves of Epimedium brevicornu Maxim [Berberidaceae]), and BYR groups (350 and 700 mg/kg) for 6 weeks. Expression of HMG-CoA, LDL-R, SR-BI, STAR and CYP11A1 were quantified by RT qPCR and Western blots., Results: Compared with the model group (115.52 ± 13.05 μg/dL; 67.83 ± 14.29; 0.32 ± 0.04; 0.33 ± 0.02; 0.38 ± 0.01), serum testosterone, testosterone/cortisol ratio, HMG-CoA, STAR and CYP11A1 relative protein expression significantly increased in low-dose BYR (210.60 ± 5.08 μg/dL; 119.38 ± 13.02; 0.47 ± 0.01; 0.46 ± 0.03; 0.46 ± 0.02), high-dose BYR (220.57 ± 14.71 μg/dL; 124.26 ± 14.79; 0.49 ± 0.02; 0.42 ± 0.03; 0.51 ± 0.02), and EFE groups (206.83 ± 5.54 μg/dL; 119.53 ± 25.04; 0.45 ± 0.02; 0.42 ± 0.02; 0.41 ± 0.02) (all p  < 0.01, except for CYP11A1 in EFE group). HMG-CoA, STAR and CYP11A1 mRNA relative expression significantly increased in low-dose and high-dose BYR group compared to model group (all p  < 0.01)., Conclusions: BYR affects endogenous cholesterol synthesis and testosterone synthesis to prevent and treat EILST levels in rats. It can improve the body's sports ability.

Purpose: We investigated whether 4 weeks of intensified training consisting of speed endurance training (SET) enhanced high-intensity exercise performance in youth national-team ice hockey players., Methods: Utilizing a randomized crossover design, we subjected 17 players to 4 weeks of SET, comprising 6 to 10 × 20 seconds at maximal effort (>95% maximum ice skating speed) with 120-second recovery performed 3 times weekly, or maintenance of regular training (control period). Before and after each period, players completed ice-hockey-specific tests on ice, including a Yo-Yo Intermittent Recovery Level 1 test, a 30-m sprint test, and an agility test. On a separate day, players were assessed for body composition with dual-energy X-ray absorptiometry and performed countermovement jump, maximal voluntary isometric knee extensor contraction, a 15-second maximal sprint test, and a submaximal and incremental test on a bike ergometer in which pulmonary oxygen consumption was determined., Results: Yo-Yo Intermittent Recovery Level 1 test performance increased (P < .001) by 14% (95% CI, 201-496 m) during the SET period. Maximal pulmonary oxygen consumption (P < .05) and time to exhaustion (P < .05) were 4.8% and 6.5% higher, respectively, after the SET period than before. Fat-free mass increased (P < .01) during the SET period by 1.7 kg (95% CI, 1.0-2.5), whereas fat mass remained unchanged. These effects were superior to the control period., Conclusions: These findings underpin the effectiveness of SET for improving on-ice high-intensity performance and highlight that elite ice hockey players can benefit from implementing SET.

Background: Prehabilitation is a promising modality for improving patient-related outcomes after major surgery; however, very little research has been done for those who may need it the most: the elderly and the frail. This study aimed to investigate the feasibility of a short course multimodal prehabilitation prior to primary surgery in high-risk, frail patients with colorectal cancer and WHO performance status I and II., Methods: The study was conducted as a single-center, prospective one-arm feasibility study of eight patients with colon cancer between October 4, 2018, and January 14, 2019. The intervention consisted of a physical training program tailored to the patients with both high-intensity interval training and resistance training three times a week in sessions of approximately 1 h in length, for a duration of at least 4 weeks, nutritional support with protein and vitamins, a consultation with a dietician, and medical optimization prior to surgery. Feasibility was evaluated regarding recruitment, retention, compliance and adherence, acceptability, and safety. Retention was evaluated as the number of patients that completed the intervention, with a feasibility goal of 75% completing the intervention. Compliance with the high-intensity training was evaluated as the number of sessions in which the patient achieved a minimum of 4 min > 90% of their maximum heart rate and adherence as the attended out of the offered training sessions., Results: During the study period, 64 patients were screened for eligibility, and out of nine eligible patients, eight patients were included and seven completed the intervention (mean age 80, range 66-88). Compliance to the high-intensity interval training using 90% of maximum heart rate as the monitor of intensity was difficult to measure in several patients; however, adherence to the training sessions was 87%. Compliance with nutritional support was 57%. Half the patients felt somewhat overwhelmed by the multiple appointments and six out of seven reported difficulties with the dosage of protein., Conclusions: This one-arm feasibility study indicates that multimodal prehabilitation including high-intensity interval training can be performed by patients with colorectal cancer and WHO performance status I and II., Trial Registration: Clinicaltrials.gov : the study current feasibility study was conducted prior to the initiation of a full ongoing randomized trial registered by NCT04167436; date of registration: November 18, 2019. Retrospectively registered. No separate prospectively registration of the feasibility trial was conducted but outlined by the approved study protocol (Danish Scientific Ethical Committee SJ-607)., (© 2022. The Author(s).)

Background: Firefighting is a strenuous profession requiring adequate levels of fitness for effective job performance. Providing firefighters with a safe and effective fitness program is essential for optimal performance. The purpose of this project was to examine changes in various parameters of physical fitness and firefighter ability following a 7-week high intensity functional training (HIFT) program., Methods: Participants were male firefighter recruits ( N = 89; age = 27.1 ± 4.2 years, height = 1.78 ± 0.1 m, BMI = 28.1 ± 4.2) enrolled in a Basic Operations Firefighter Academy. Fitness and firefighting ability (via the Academy Firefighter Challenge) were assessed at Weeks 1 and 7 of the Academy., Results: Significant improvements in both fitness and firefighter ability were seen following the HIFT program. Specifically, fitness (BMI, cardiovascular fitness, muscular endurance) improved significantly [Hotelling's T 2 = 8.98, F (5, 84) = 150.92, p < 0.001, η 2 p = 0.90]. Firefighter ability also improved significantly [Hotelling's T 2 = 3.95, F (7, 88) = 46.26, p < 0.001, η 2 p = 0.80]., Conclusions: Following a 7-week Basic Operations Firefighter Academy that included daily HIFT, significant increases in fitness and firefighting ability were observed. These findings suggest that HIFT appears to be an effective means of improving fitness and firefighting ability in recruit firefighters.

The purposes of our study were to investigate the physiological and biomechanical responses to low-intensity (LI) and high-intensity (HI) roller ski skating on varying terrain and compare these responses between training intensities. Nine elite male skiers performed treadmill roller skiing consisting of two 21 min sessions (7 × 3 min laps) at LI and HI with the same set inclines and intensity-dependent speeds (LI/HI: distance: 5.8/7.5 km, average speed: 16.7/21.3 km/h). Physiological and biomechanical variables were measured continuously, and each movement cycle and sub-technique employed were detected and classified with a machine learning model. Both the LI and HI sessions induced large terrain-dependent fluctuations (relative to the maximal levels) in heart rate (HR, 17.7 vs. 12.2%-points), oxygen uptake ( V . O 2 , 33.0 vs. 31.7%-points), and muscle oxygen saturation in the triceps brachii (23.9 vs. 33.4%-points) and vastus lateralis (12.6 vs. 24.3%-points). A sub-technique dependency in relative power contribution from poles and skis exhibited a time-dependent shift from Lap 1 to Lap 7 toward gradually more ski power (6.6 vs. 7.8%-points, both p < 0.01). The terrain-dependent fluctuations did not differ between LI and HI for V . O 2 ( p = 0.50), whereas HR fluctuated less ( p < 0.01) and displayed a time-dependent increase from Lap 2 to Lap 7 (7.8%-points, p > 0.01) during HI. Oxygen saturation shifted 2.4% points more for legs than arms from LI to HI ( p > 0.05) and regarding sub-technique, 14.7% points more G3 on behalf of G2 was employed on the steepest uphill during HI ( p < 0.05). Within all sub-techniques, cycle length increased two to three times more than cycle rate from LI to HI in the same terrains, while the corresponding poling time decreased more than ski contact time (all p > 0.05). In sum, both LI and HI cross-country (XC) skiing on varying terrain induce large terrain-dependent physiological and biomechanical fluctuations, similar to the patterns found during XC skiing competitions. The primary differences between training intensities were the time-dependent increase in HR, reduced relative oxygen saturation in the legs compared to the arms, and greater use of G3 on steep uphill terrain during HI training, whereas sub-technique selection, cycle rate, and pole vs. ski power distribution were similar across intensities on flat and moderately uphill terrain., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Seeberg, Kocbach, Danielsen, Noordhof, Skovereng, Meyer and Sandbakk.)

Background and Purpose: Regaining functional independence and independent living is challenging in hospitalized geriatric patients. Different from community dwelling and institutionalized older people, geriatric patients on rehabilitation wards generally receive more frequent and structured physiotherapy with the primary aim to discharge them to their home or place of residence. There is a paucity of evidence concerning the structure and components of physiotherapy programs to improve functional performance in this particular group. In this paper, we describe how we developed the Geriatric Activation Program Pellenberg (GAPP) based on patients' needs and available literature., Methods: We searched the literature on physiotherapy interventions focusing on the core components for improvement of functional performance: strength, balance, function, (gait)speed, coordination, and endurance training. Based on physiotherapist staffing and physiotherapy time allocated to each patient, we organized the practical, daily delivery of the program., Results: GAPP is a 5-day program, repeated weekly, delivered by physiotherapists and physiotherapy students. Each day, one or a combination of two to three different core components of functional performance is trained intensively in 45-min sessions. A set of standard exercises is constantly adjusted to each patients' capacity. On day 5, there is a mix of these core elements in a group session (e.g., chair-dance, table tennis, karate) and the Berg Balance Scale is completed to evaluate progress., Conclusion: GAPP is a multicomponent physiotherapy program for hospitalized patients on a geriatric rehabilitation ward, aimed at improving functional performance., (© 2021 John Wiley & Sons Ltd.)

Background: Functional fitness training (FFT) is a new exercise modality that targets functional multi-joint actions via both muscle-strengthening exercises and aerobic training intervals. The aim of the study was to examine muscle recovery over a 20 min period after an FFT workout in trained adults., Materials and Methods: Participants were 28 healthy trained subjects. In a single session, a countermovement jump (CMJ) was performed to determine several mechanical variables (jump height, maximum velocity, power) before (preFFT) and 4, 10, and 20 min after the FFT workout (postFFT). In parallel, capillary blood lactate concentrations were measured pre- and 3 min postFFT. Heart rate was also measured before and after the workout, and perceived exertion was measured postFFT., Results: Significant differences between the time points preFFT and 4 min and 10 min postFFT, respectively, were produced in jump height ( p = 0.022, p = 0.034), maximum velocity ( p = 0.016, p = 0.005), average power relative ( p = 0.018, p = 0.049), and average power total ( p = 0.025, p = 0.049). No differences were observed in any of the variables recorded preFFT and 20 min postFFT., Conclusions: While mechanical variables indicating muscle fatigue were reduced 4 and 10 min postFFT, pre-exercise jump ability only really started to recover 20 min after FFT although not reaching pre-exercise levels. This means that ideally intervals of around 20 min of rest should be implemented between training bouts.

Objective: To study the changes in urine metabolism in female water polo players before and after high-intensity training by using ultra-high performance liquid chromatography-mass spectrometry, and to explore the biometabolic characteristics of urine after training and competition., Methods: Twelve young female water polo players (except goalkeepers) from Shanxi Province were selected. A 4-week formal training was started after 1 week of acclimatization according to experimental requirements. Urine samples (5 mL) were collected before formal training, early morning after 4 weeks of training, and immediately after 4 weeks of training matches, and labeled as T1, T2, and T3, respectively. The samples were tested by LC-MS after pre-treatment. XCMS, SIMCA-P 14.1, and SPSS16.0 were used to process the data and identify differential metabolites., Results: On comparing the immediate post-competition period with the pre-training period (T3 vs. T1), 24 differential metabolites involved in 16 metabolic pathways were identified, among which niacin and niacinamide metabolism and purine metabolism were potential post-competition urinary metabolic pathways in the untrained state of the athletes. On comparing the immediate post-competition period with the post-training period (T3 vs. T2), 10 metabolites involved in three metabolic pathways were identified, among which niacin and niacinamide metabolism was a potential target urinary metabolic pathway for the athletes after training. Niacinamide, 1-methylnicotinamide, 2-pyridone, L-Gln, AMP, and Hx were involved in two metabolic pathways before and after the training., Conclusion: Differential changes in urine after water polo games are due to changes in the metabolic pathways of niacin and niacinamide.

Background: The Italian government promoted social distancing, in which the suspension of any social event, suspension of all activities practiced in gyms, sports centers and their closure was ordered. The social distancing in the school environment and the use of strategies to limit viral infection are not very compatible with group motor activity and team sports. The aim of this study is to verify the effectiveness of a CrossFit program in order to mitigate the deficits in fitness caused by COVID-19 prevention measures and to evaluate the effects on self-efficacy in a group of young adolescents. Methodsː 30 healthy participants were randomly allocated into an intervention group (IG) that performed the 8 weeks CrossFit training program or control group (CG). Physical fitness tests (i.e., Squat, push-up, lunge, and 20 m run) and psychological measures Regulatory Emotional Self-Efficacy scale (RESE) were performed at baseline and after 8 weeks. Resultsː After 8 weeks, the intervention group showed significant improvements for all fitness tests ( p < 0.0001). Additionally, higher scores for the RESE negative and positive ( p < 0.0001) scales were found in the intervention group. No statistical differences were found in the control group except for the push up test. Conclusionsː the 8-week CrossFit intervention program could positively affect the general physical well-being and improve the emotional perceived self-efficacy in healthy adolescents.

Improving cardiorespiratory fitness (CRFit) in cancer patients is crucial to increase survivorship, promote health, and improve quality of life. High-intensity training (HIT) has the potential to increase CRFit, perhaps better than other exercise modalities, but the extant evidence has yet to be fully explored. This systematic review and meta-analysis aimed to evaluate the effects of HIT on CRFit in cancer patients and survivors and to identify the optimal characteristics of the interventions (eg, cancer type, intervention timing, exercise modality, intervention's duration, and the number of minutes of high-intensity exercise in each session). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A total of 31 articles (2515 participants) were included in the systematic review and 25 in the meta-analyses. CRFit significantly improved with HIT in comparison with a control group (P < .00001, SMD = 0.44 and a 95% confidence interval from 0.25 to 0.64). The results obtained in the sub-analysis were statistically significant except the comparison with the active group CRFit (P = .13). The results showed that higher effects could be achieved in: patients starting to exercise before treatment, interventions longer than eight weeks, programs including exclusively cardiovascular training and with a high-intensity part of session duration of at least 20 minutes., (© 2020 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

The number of adolescents and children in elite and high-intensity mass sports is increasing, with respect to industrial nations. High-intensity training can cause overload due to the increased traction effect, particularly on tendon and muscle insertion sites. Apophyses are the center for ossification in tendon and muscle insertions and are therefore particularly vulnerable in youths to overload-related pathologies. Core measures in the prevention are a systematic planning of training and the avoidance of mechanical overstraining in the growth period. An exact imaging enables the diagnosis of apophyseal structural damage at an early stage, which in this phase can be healed by a pause in training and conservative measures.

Background: Type 1 diabetes mellitus (T1DM) is commonly associated with premature loss of muscle function, ankle dorsiflexion and dynamic balance. Those impairments, usually, lead to physical functionality deterioration. High-intensity interval training is an efficient and safety methodology since it prevents hypoglycemia and not requires much time, which are the main barriers for this population to practice exercise and increase physical conditioning. We hypothesized that a 6-week HIIT program performed on a cycle ergometer would increase lower limb muscle power, ankle dorsiflexion range of motion and dynamic balance without hypoglycemic situations., Methods: A total of 19 diagnosed T1DM subjects were randomly assigned to HIIT group ( n = 11; 6-week HIIT protocol) or Control group ( n = 8; no treatment). Lower limb strength was evaluated through velocity execution in squat with three different overloads. Weight bearing lunge test (WBLT) was performed to test ankle dorsiflexion range of motion and Y-Balance test (YBT) was the test conducted to analyze dynamic balance performance., Results: Velocity in squat improved a 11.3%, 9.4% and 10.1% ( p < 0.05) with the 50%, 60% and 70% of their own body mass overload respectively, WBLT performance increased a 10.43% in the right limb and 15.45% in the left limb. YBT showed improvements in all directions (right limb-left limb): Anterior (4.3-6.1%), Posteromedial (1.8-5.2%) and Posterolateral (3.4-4.5%) in HIIT group ( p < 0.05), unlike control group that did not experience any significant change in any of the variables ( p > 0.05)., Conclusion: A 6-week HIIT program is safe and effective to improve execution velocity in squat movement, a fundamental skill in daily living activities, as well as ankle dorsiflexion range of motion and dynamic balance to reduce foot ulcers, risk falls and functional impairments. HIIT seems an efficient and safety training methodology not only for overcome T1DM barriers for exercising but also for improving functional capacities in T1DM people., Competing Interests: The authors declare that they have no competing interests., (© 2020 Alarcón-Gómez et al.)

The randomized "Testicular cancer and Aerobic and Strength Training trial" (TAST-trial) aimed to evaluate the effect of high-intensity interval training (HIIT) on cardiorespiratory fitness during cisplatin-based chemotherapy (CBCT) for testicular cancer (TC). Here, we report on an unexpected high number of thromboembolic (TE) events among patients randomized to the intervention arm, and on a review of the literature on TE events in TC patients undergoing CBCT. Patients aged 18 to 60 years with a diagnosis of metastatic germ cell TC, planned for 3 to 4 CBCT cycles, were randomized to a 9 to 12 weeks exercise intervention, or to a single lifestyle counseling session. The exercise intervention included two weekly HIIT sessions, each with 2 to 4 intervals of 2 to 4 minutes at 85% to 95% of peak heart rate. The study was prematurely discontinued after inclusion of 19 of the planned 94 patients, with nine patients randomized to the intervention arm and 10 to the control arm. Three patients in the intervention arm developed TE complications; two with pulmonary embolism and one with myocardial infarction. All three patients had clinical stage IIA TC. No TE complications were observed among patients in the control arm. Our observations indicate that high-intensity aerobic training during CBCT might increase the risk of TE events in TC patients, leading to premature closure of the TAST-trial., (© 2020 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

High-intensity training (HIT) improves rehabilitation outcomes such as functional disability and physical performance in several chronic disorders. Promising results were also found in chronic nonspecific low back pain (CNSLBP). However, the impact of different exercise modes on HIT effectiveness in CNSLBP remains unclear. Therefore, this study evaluated the effectiveness of various HIT exercise modes and compared differences between these modes, on pain intensity, disability, and physical performance, as a therapeutic intervention for persons with CNSLBP. In a randomized comparative trial, consisting of a 12-week program, persons with CNSLBP were divided into four HIT groups, i.e., cardiorespiratory interval training coupled with either general resistance training, core strength training, combined general resistance and core strength training, or mobility exercises. Before and after the program, the Numeric Pain Rating Scale (NPRS), Modified Oswestry Disability Index (MODI), and Patient Specific Functioning Scale (PSFS) were recorded, and a cardiopulmonary exercise test (VO 2 max, cycling time) and isometric trunk strength test (maximum muscle torque) were performed. Eighty participants (mean age: 44.0 y, 34 males) were included. Improvements were found within all groups after the HIT programs and ranged from -39 to -57% on the NPRS, +27 to +64% on the MODI, +38 to +89% on the PSFS, +7 to +14% on VO 2 max, and +11 to +18% on cycling time. No differences between groups were found. High-intensity cardiorespiratory interval training improves CNSLBP rehabilitation outcomes when performed with other HIT exercise modes or mobility exercises. Hence, when setting up an exercise therapy program in CNSLBP rehabilitation, various HIT modes can be considered as therapy modalities., Competing Interests: The authors report no conflicts of interest.

Background . Many research studies attempting to improve locomotor function following motor incomplete spinal cord injury (iSCI) focus on providing stepping practice. However, observational studies of physical therapy strategies suggest the amount of stepping practice during clinical rehabilitation is limited; rather, many interventions focus on mitigating impairments underlying walking dysfunction. Objective . The purpose of this blinded-assessor randomized trial was to evaluate the effects of task-specific versus impairment-based interventions on walking outcomes in individuals with iSCI. Methods . Using a crossover design, ambulatory participants with iSCI >1-year duration performed either task-specific (upright stepping) or impairment-based training for up to 20 sessions over ≤6 weeks, with interventions alternated after >4 weeks delay. Both strategies focused on achieving higher cardiovascular intensities, with training specificity manipulated by practicing only stepping practice in variable contexts or practicing tasks targeting impairments underlying locomotor dysfunction (strengthening, balance tasks, and recumbent stepping). Results . Significantly greater increases in fastest overground and treadmill walking speeds were observed following task-specific versus impairment-based training, with moderate associations between differences in amount of practice and outcomes. Gains in balance confidence were also observed following task-specific vs impairment-based training, although incidence of falls was also increased with the former protocol. Limited gains were observed with impairment-based training except for peak power during recumbent stepping tests. Conclusion . The present study reinforces work from other patient populations that the specificity of task practice is a critical determinant of locomotor outcomes and suggest impairment-based exercises may not translate to improvements in functional tasks. Clinical Trial Registration URL . https://clinicaltrials.gov/ ; Unique Identifier: NCT02115685.

Mouth rinsing has been proposed as a strategy to minimize performance decrements during Ramadan. We investigated the effect of 4 weeks of Ramadan on kicking performance in 27 Taekwondo athletes performing weekly Taekwondo Anaerobic Intermittent Kick Tests (TAIKT). The effects of a placebo, 6.4% glucose and 6-mg/kg caffeine mouth rinses on TAIKT performance and perceived exertion were investigated before, during weekly training sessions, and after Ramadan in a counterbalanced, crossover design. Ramadan had a significant negative impact on the percentage of successful kicks in Week 1 of Ramadan (pre: 76.7±0.4%, Week 1: 69.9±3.2%). The percentage of successful kicks was significantly greater in the caffeine mouth rinse condition compared to the glucose and placebo conditions during the first 3 weeks of Ramadan (caffeine: 38.3±6.8%, glucose: 36.4±6.9%, placebo: 36.0±6.5%). Caffeine decreased perceived exertion during Ramadan (0.74-1.15 AU, p>0.05). Our results showed that Ramadan had a significant negative effect on repeated high-intensity kicking efforts that should be considered when training and competing. Additionally, there were significant positive effects of a caffeine mouth rinse in a sport-specific test. These data suggest that athletes can consider mouth rinsing as a strategy to enhance performance when undertaking training or competition during a period of privation.

Aspirin is a common nonsteroidal anti-inflammatory drug used to reduce fever, pain, and inflammation. However, aspirin's anti-inflammatory properties may also prevent increased levels of blood lactate dehydrogenase, vascular arterial stiffness and oxidative stress induced by high-intensity exercise. The purpose of this study was to investigate the effects of 4 weeks of aspirin supplementation on lactate dehydrogenase activity, lactate, arterial stiffness, and antioxidant capacity during high-intensity exercise in Taekwondo athletes. Participants were randomly divided into two groups: aspirin supplementation (n = 10) and placebo-control (n = 10). Blood levels of lactate dehydrogenase (LDH) enzyme activity and lactate were assessed to examine muscle damage and carotid-to-radial pulse wave velocity and the augmentation index were measured to examine arterial stiffness. Blood levels of superoxide dismutase, malondialdehyde, and glutathione peroxidase were assessed to determine antioxidant capacity and levels of oxidative stress. There were significant group × time interactions for enzyme activity of LDH (Δ-60 ± 24.36 U/L) and carotid-to-radial pulse wave velocity (Δ-1.33 ± 0.54 m/s), which significantly decreased (p < 0.05) following aspirin supplementation compared to placebo-control. Superoxide dismutase (Δ359 ± 110 U/gHb) and glutathione peroxidase (Δ28.2 ± 10.1 U/gHb) significantly decreased while malondialdehyde (0Δ3.0 ± 0.1 mmol/mL) significantly increased (p < 0.05) in the placebo-control group compared to the supplementation group. However, there were no changes in lactate concentration levels or augmentation index. These results reveal that low-dose aspirin supplementation would be a useful supplementation therapy to prevent high-intensity exercise training-induced increases in oxidative damage, inflammation, skeletal muscle fatigue, and arterial stiffness in elite Taekwondo athletes., (© 2020 Sang Ho Lee, Elizabeth J. Pekas, Seungyong Lee, Ronald J. Headid III, Song-Young Park, published by Sciendo.)

BDNF is associated with brain health and positively modulated by exercise; however, the influence of physical fitness status on BDNF is incipient. This study investigated the BDNF response after acute-exercise sessions performed at low, moderate, and high intensities and the relationship between physical fitness status and BDNF response. Twenty-eight men, divided according to physical fitness status (<50th or >50th percentile for VO 2max ), performed three randomised acute exercise sessions at low (90% of VT1), moderate (midpoint between VT1-VT2), and high (midpoint between VT2-W max ) intensities until exhaustion or for up to 60 min. Lactate and BDNF were determined pre and post-exercises. For BDNF, there were main effects of time ( p  = 0.003) and interaction ( p  < 0.001), showing an increase post high-intensity exercise ( p  < 0.001). Changes in BDNF presented differences between conditions ( p  < 0.001) with greater increase in high-intensity compared with the others ( p  = 0.003). For lactate, there were main effects of time ( p  < 0.001), condition ( p  < 0.001), and interaction ( p  < 0.001) with greater concentration in high-intensity. High-intensity exercise exhibited inverse correlation between the changes in BDNF and lactate (r=-0.38, p  = 0.044). There was significant correlation between BDNF and VO 2max for moderate ( r  = -0.57, p  = 0.002) and a trend for high-intensity condition ( r  = -0.37, p  = 0.050) and when evaluating BDNF according to physical fitness level, it was observed that subjects with lower physical fitness levels had greater increases in BDNF in short-time high-intensity exercise ( p  = 0.041). In conclusion, short-time high-intensity exercise seems to be more efficient in increasing BDNF concentration, and physical fitness level influences this response, as healthy individuals with lower physical fitness levels were more responsive.

Background: High-intensity interval training (HIIT) is a well-established training modality to improve aerobic and anaerobic capacity. However, sex-specific aspects of different HIIT protocols are incompletely understood. This study aimed to compare two HIIT protocols with different recovery periods in moderately trained females and males and to investigate whether sex affects high-intensity running speed and speed decrement. Methods: Fifty moderately trained participants (30 females and 20 males) performed an exercise field test and were randomized by lactate threshold (LT) to one of two time- and workload-matched training groups. Participants performed a 4-week HIIT intervention with two exercise sessions/week: Group 1 (4 × 30,180 HIIT), 30-s all-out runs, 180-s active recovery and Group 2 (4 × 30,30 HIIT), 30-s all-out runs, 30-s active recovery. High-intensity runs were recorded, and speed per running bout, average speed per session, and speed decrement were determined. Blood lactate measurements were performed at baseline and follow-up at rest and immediately post-exercise. Results: Females and males differed in running speed at LT and maximal running speed determined during exercise field test (speed at LT, females: 10.65 ± 0.84 km h -1 , males: 12.41 ± 0.98 km h -1 , p < 0.0001; maximal speed, females: 14.55 ± 1.05 km h -1 , males: 17.41 ± 0.68 km h -1 , p < 0.0001). Estimated maximal oxygen uptake was ~52.5 ml kg -1 min -1 for females and 62.6 ml kg -1 min -1 for males ( p < 0.0001). Analysis of HIIT protocols revealed an effect of sex on change in speed decrement (baseline vs. follow-up) in that females showed significant improvements only in the 4 × 30:30 HIIT group ( p = 0.0038). Moreover, females performing the 4 × 30:30 protocol presented increased speed per bout and average speed per session at follow-up (all p ≤ 0.0204), while no effect was detected for females performing the 4 × 30:180 protocol. Peak blood lactate levels increased in all HIIT groups (all p < 0.05, baseline vs. follow-up), but males performing the 4 × 30:180 protocol showed no difference in lactate levels. Conclusions: If not matched for physical performance, females, but not males, performing a 4 × 30 HIIT protocol with shorter recovery periods (30 s) present increased average high-intensity running speed and reduced speed decrement compared to longer recovery periods (180 s). We conclude that female- and male-specific HIIT protocols should be established since anthropometric and physiological differences across sexes may affect training performance in real-world settings., (Copyright © 2020 Schmitz, Niehues, Thorwesten, Klose, Krüger and Brand.)

Regular physical activity significantly affects lipid status. In this literature review, the specific features of athletes blood lipid profiles were analysed. Professional athletes blood lipid status was found considerably preferable compared to sex- and age-matched sedentary population. Regardless of endurance or power type of sports activities, athletes perform lower levels of TC, LDL-C and TG and comparable or higher blood levels of HDL-C. The differences in blood lipids levels and sports disciplines were introduced. Although there are much more factors as diet, place of origin, training regime, and even genetic predisposition that should be taken into consideration for future research., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Purpose: To investigate fluctuations in speed, work rate, and heart rate (HR) when cross-country ski skating across varying terrains at different endurance-training intensities., Methods: Seven male junior Norwegian skiers performed maximal-speed (Vmax) tests in both flat and uphill terrains. Thereafter, 5-km sessions at low (LIT), moderate (MIT), and high intensity (HIT) were performed based on their own perception of intensity while monitored by a global navigation satellite system with integrated barometry and accompanying HR monitor., Results: Speed, HR, and rating of perceived exertion gradually increased from LIT to MIT and HIT, both for the total course and in flat and uphill terrains (all P < .05). Uphill work rates (214 [24] W, 298 [27] W, and 350 [54] W for LIT, MIT, and HIT, respectively) and the corresponding percentage of maximal HR (79.2% [6.1]%, 88.3% [2.4]%, and 91.0% [1.7]%) were higher than in flat terrain (159 [16] W, 206 [19] W, and 233 [72] W vs 72.3% [6.3]%, 83.2% [2.3]%, and 87.4% [2.0]% for LIT, MIT, and HIT, respectively) (all P < .01). In general, ∼13% point lower utilization of maximal work rate was reached in uphill than in flat terrain at all intensities (all P < .01)., Conclusions: Cross-country ski training across varying terrains is clearly interval based in terms of speed, external work rate, and metabolic intensity for all endurance-training intensities. Although work rate and HR were highest in uphill terrain at all intensities, the utilization of maximal work rate was higher in flat terrain. This demonstrates the large potential for generating external work rate when uphill skiing and the corresponding downregulation of effort due to the metabolic limitations.

Background: Block periodization (BP) has been proposed as an alternative to traditional (TRAD) organization of the annual training plan for endurance athletes., Objective: To our knowledge, this is the first meta-analysis to evaluate the effect BP of endurance training on endurance performance and factors determinative for endurance performance in trained- to well-trained athletes., Methods: The PubMed, SPORTdiscus and Web of Science databases were searched from inception to August 2019. Studies were included if the following criteria were met: 1) the study examined a block-periodized endurance training intervention; 2) the study had a one-, two or multiple group-, crossover- or case-study design; 3) the study assessed at least one key endurance variable before and after the intervention period. A total of 2905 studies were screened, where 20 records met the eligibility criteria. Methodological quality for each study was assessed using the PEDro scale. Six studies were pooled to perform meta-analysis for maximal oxygen uptake (VO 2 max) and maximal power output (Wmax) during an incremental exercise test to exhaustion. Due to a lower number of studies and heterogenous measurements, other performance measures were systematically reviewed., Results: The meta-analyses revealed small favorable effects for BP compared to TRAD regarding changes in VO 2 max (standardized mean difference, 0.40; 95% CI=0.02, 0.79) and Wmax (standardized mean difference, 0.28; 95% CI=0.01, 0.54). For changes in endurance performance and workload at different exercise thresholds BP generally revealed moderate- to large-effect sizes compared to TRAD., Conclusion: BP is an adequate, alternative training strategy to TRAD as evidenced by superior training effects on VO 2 max and Wmax in athletes. The reviewed studies show promising effects for BP of endurance training; however, these results must be considered with some caution due to small studies with generally low methodological quality (mean PEDro score =3.7/10)., Competing Interests: The authors report no conflicts of interest in this work., (© 2019 Mølmen et al.)

Background: We investigated the biomarkers of insulin action as well as changes in free fatty acids and lactate concentration after an acute soccer session pre and post training with caloric-restricted diet versus diet alone in type 2 diabetes (T2D) patients., Methods: Fifty-one middle-aged (61.1 ± 6.4 years) T2D patients were randomly allocated to the soccer+diet group (SDG) or the diet group (DG). The control group comprised T2D patients observing a caloric-restricted diet who did not receive soccer training. Over 12 weeks, SDG performed 3 × 40 min per week of soccer training., Results: The first soccer session for SDG induced acute increases in blood lactate (1.4 ± 0.1-6.0 ± 0.7 mmol/l, P < 0.05) and glucagon levels (112.1 ± 6.2-142.9 ± 8.0 pg/ml, P < 0.05), whereas glucose and insulin levels remained unchanged. Moreover, this session showed suppressed insulin levels as well as higher free fatty acids, lactate levels and glucagon/insulin ratio compared to DG (p < 0.05). After 12 weeks, a baseline decrease was observed in glucagon, leptin and lactate levels in SDG and DG (p < 0.05), whereas HOMA-IR, Adipo-IR and glucose levels were lower only in SDG (p < 0.05). At the last soccer training session, the blood lactate response was significantly lower than for the first session (4.0 ± 0.4 vs 6.0 ± 0.7 mmol/l). At 48 h pre intervention, a decrease was observed in leptin levels (p < 0.05), which remained lower post intervention. The positive correlation between leptin and insulin, and the lower levels after training, could be attributed to the improved insulin sensitivity along with the weight loss observed in both groups (~3.4 kg for DG and 3.7 kg for SDG)., Conclusion: Acute soccer sessions markedly improved insulin action markers in T2D patients, while the cumulative effects enhanced insulin sensitivity and decreased risk factors associated with cardiovascular disease after 12 weeks of intervention better than caloric-restricted diet., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: The influence of hormonal contraceptives (HC) on inflammation and body composition after high-intensity combined strength and endurance training was investigated., Design: Active healthy women formed two training groups: HC users (HCU, n = 9) and those who had never used HC (NHC, n = 9). Training included two strength training sessions and two high-intensity interval training sessions per week for 10 weeks., Methods: Before (PRE) and after (POST) the training intervention, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1beta (IL-1β) concentrations were measured. Dual-energy X-ray absorptiometry was used to estimate fat mass (FM), abdominal fat mass (aFM), and lean mass (LM)., Results: Circulating concentrations of hs-CRP decreased significantly in the NHC from pre to post with -0.46 mg l -1 (95% CI: -0.78, -0.14, p = 0.009, ES = 0.434), whereas a significant increase was observed in HCU from pre to post with 0.89 mg l -1 (95% CI: 1.66, 0.12, p = 0.048, ES = 1.988) with a significant between-group difference (p = 0.015). In addition, hs-CRP concentration was significantly higher in HCU than in NHC after training (p = 0.036) at post. Lean mass increased significantly more in NHC than in HCU (p = 0.049)., Conclusions: High-intensity combined strength and endurance training can modify inflammation and body composition of women. The present study showed that inflammation, in terms of hs-CRP was higher post training in HCU than NHC, which may be associated with smaller gains in lean mass in response to training., (Copyright © 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

CrossFit is high-intensity interval training involving routines called 'workouts of the day' (WOD). The aim of the present study is to analyse biochemical parameters and physical performance after two modalities of CrossFit WODs, and to evaluate 48-hour recovery. Twelve trained CrossFit practitioners (age: 30.4 ± 5.37 years; VO 2 max: 47.8 ± 3.63 ml/min/kg; 1RM Power Clean: 93.2 ± 7.62 kg) participated in the study. A crossover design was applied, and participants completed two modalities of WODs on separate days: WOD1 (as many rounds as possible) and WOD2 (rounds for time). Blood lactate, ratings of perceived exertion and heart rate were measured to determine the intensity of training sessions. Biochemical parameters and physical performance were evaluated before, immediately after, 24 hours after and 48 hours after exercise. There were significant differences in intensity between WOD1 and WOD2 (lactate: 13.3±1.87 vs. 18.38±2.02 mmol/L, heart rate mean: 127.6±11.1 vs. 159.8±12.1 bpm), and blood glucose concentrations were significantly higher after WOD2 (135.4 ± 19.6 vs. 167.4±19.6 mg/dL). After exercise, WOD1 and WOD2 caused significant increases of hepatic transaminases, creatine phosphokinase and blood glucose, as well as a large decrease in the physical performance evaluated by the plank test. All these values returned to baseline by 48 hours after exercise. Both WODs caused metabolic and muscular stress, as well as a decrease in physical performance. All the levels recovered at 48 hours, so the stress caused by CrossFit WODs did not induce a pathological state., Competing Interests: All authors declare no conflicts of interest., (Copyright © Biology of Sport 2019.)

Background and objectives : Adipose tissue and skeletal muscle secrete adiponectin, a hormone abundantly secreted by adipocytes, that through the adiponectin receptor, regulate glucose and lipid metabolism. Adiponectin appears to protect skeletal muscles from inflammatory damage induced by oxidative stress. It has been suggested that decreased adiponectin levels could be associated with pathologic conditions, including obesity and diabetes. Furthermore, some studies suggest that exercise could have a beneficial effect by increasing adiponectin levels, but this observation remains controversial. It is also unknown if physical exercise modifies adiponectin expression in skeletal muscles. The aim of this study was to investigate the effect of chronic exercise on serum adiponectin and adiponectin expression in slow-twitch (soleus) and fast-twitch (plantaris) muscles in healthy rats. Materials and methods : Two-month-old male Wistar rats were randomly divided into three groups with n = 6 in each group: control (C), moderate-intensity training (MIT), and high-intensity training (HIT). The rats were conditioned to run on a treadmill for the 8-week period. Forty-eight hours after the last session, blood samples were collected for adiponectin measurements and total RNA was isolated from plantaris and soleus muscles to measure by RT-qPCR adiponectin receptor 1 and adiponectin mRNA expression level. Results : MIT and HIT groups had reduced adiponectin protein levels in serum and the plantaris muscle, but not changes in adiponectin protein were observed in the soleus muscle. No significant differences in Adiponectin receptor 1 (AdipoR1) gene expression were observed following intense or moderate exercise in either muscle group studied. Conclusions: Our study shows that decreasing levels of circulating adiponectin is a result of physical exercise and should not be generalized as a predictive marker of disease.

The training intensity distribution (TID) of endurance athletes has retrieved substantial scientific interest since it reflects a vital component of training prescription: (i) the intensity of exercise and its distribution over time are essential components for adaptation to endurance training and (ii) the training volume (at least for most endurance disciplines) is already near or at maximum, so optimization of training procedures including TID have become paramount for success. This paper aims to elaborate the polarization-index (PI) which is calculated as log 10 (Zone 1/Zone 2 ∗ Zone 3 ∗ 100), where Zones 1-3 refer to aggregated volume (time or distance) spent with low, mid, or high intensity training. PI allows to distinguish between non-polarized and polarized TID using a cut-off > 2.00 a.U. and to quantify the level of a polarized TID. Within this hypothesis paper, examples from the literature illustrating the usefulness of PI-calculation are discussed as well as its limitations. Further it is elucidated how the PI may contribute to a more precise definition of TID descriptors.

Background: Aphasia is the loss or impairment of language functions and affects everyday social life. The disorder leads to the inability to understand and be understood in both written and verbal communication and affects the linguistic modalities of auditory comprehension, verbal expression, reading, and writing. Due to heterogeneity of the impairment, therapy must be adapted individually and dynamically to patient needs. An important factor for successful aphasia therapy is dose and intensity of therapy. Tablet computer-based apps are a promising treatment method that allows patients to train independently at home, is well accepted, and is known to be beneficial for patients. In addition, it has been shown to ease the burden of therapists., Objective: The aim of this project was to develop an adaptive multimodal system that enables aphasic patients to train at home using language-related tasks autonomously, allows therapists to remotely assign individualized tasks in an easy and time-efficient manner, and tracks the patient's progress as well as creation of new individual exercises., Methods: The system consists of two main parts: (1) the patient's interface, which allows the patient to exercise, and (2) the therapist's interface, which allows the therapist to assign new exercises to the patient and supervise the patient's progress. The pool of exercises is based on a hierarchical language structure. Using questionnaires, therapists and patients evaluated the system in terms of usability (ie, System Usability Scale) and motivation (ie, adapted Intrinsic Motivation Inventory)., Results: A total of 11 speech and language therapists (age: mean 28, SD 7 years) and 15 patients (age: mean 53, SD 10 years) diagnosed with aphasia participated in this study. Patients rated the Bern Aphasia App in terms of usability (scale 0-100) as excellent (score >70; Z=-1.90; P=.03) and therapists rated the app as good (score >85; Z=-1.75; P=.04). Furthermore, patients enjoyed (scale 0-6) solving the exercises (score>3; mean 3.5, SD 0.40; Z=-1.66; P=.049)., Conclusions: Based on the questionnaire scores, the system is well accepted and simple to use for patients and therapists. Furthermore, the new tablet computer-based app and the hierarchical language exercise structure allow patients with different types of aphasia to train with different doses and intensities independently at home. Thus, the novel system has potential for treatment of patients with aphasia as a supplement to face-to-face therapy., (©Stephan Moreno Gerber, Narayan Schütz, Arif Sinan Uslu, Nadine Schmidt, Carina Röthlisberger, Patric Wyss, Sandra Perny, Corina Wyss, Monica Koenig-Bruhin, Prabitha Urwyler, Thomas Nyffeler, Laura Marchal-Crespo, Urs Peter Mosimann, René Martin Müri, Tobias Nef. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 26.04.2019.)

Background: Aerobic exercise is an effective treatment to improve aerobic capacity following stroke and might also improve cognitive impairments in sub-acute stroke survivors. The aim of the study was to assess the effect of high-intensity aerobic exercise on cognitive impairments in sub-acute stroke survivors., Methods: A pilot, randomised controlled trial on the effects of aerobic exercise on cognitive impairments of stroke patients in the sub-acute (1-3 months) phase was conducted. Thirty patients with moderate cognitive impairments (maximum score of 5 on at least two items on the cognitive subscales of the Functional Independence Measure [FIM]) were included in the study and randomly assigned to either the intervention group - performing high-intensity aerobic exercise (above 70% of maximum heart rate), or the control group - performing low-intensity aerobic exercise (below 60%). Patients in both groups exercised for 50 min twice a week for 4 weeks. Primary neuropsychological outcome: Trail Making Test B., Results: Thirty stroke patients completed the interventions. The results showed that the high-intensity group, compared with the low-intensity group, achieved significant improvements on Trail Making Test B, which assesses processing speed and divided attention ( P  = .04 after training and P  = .01 at follow-up). However, the significant improvements on Trail Making Test B might relate to a ceiling effect in the control group., Conclusions: This study does not provide evidence to support that aerobic exercise can improve cognition in stroke survivors, even though significant improvement was revealed on the primary outcome in sub-acute stroke survivors following high-intensity aerobic exercise compared with low-intensity general exercise., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To compare the acute and chronic effects of high-intensity intermittent training (HIIT) and moderate-intensity continuous training (MICT) on indices of cardio-metabolic health: (HDL-c, total cholesterol, triglycerides, heart ratio, and phase angle/PhA) in physically active men., Methods: Twenty active men were randomly allocated to HIIT (n = 10), or MICT (n = 10) for 5 weeks, three times per week. HIIT consisted of running 5 km with 1-min at 100% of maximal aerobic speed interspersed by 1-min passive recovery while subjects in MICT group ran continuously the same 5 km at 70% of maximal aerobic speed. Blood samples were collected at different moments during the first and last exercise session. Before and after 5 weeks of both exercise training protocols, heart ratio (during exercise session) and PhA were measured pre and post-exercise training., Results: Fasting HDL-c levels did not change after 5 weeks of HIIT or MICT. Perceptual variation of HDL pre and post training (fed state) tended to differ between HIIT and MICT (p = 0.09). All lipoproteins parameters (HDL-c, total cholesterol, triglycerides and non-HDL) were increased in post-acute exercise session compared to pre-exercise during the first and last training session, these being observed after both training protocols. PhA and heart rate measured at different times during the first and last training session were not affected in both training protocols., Conclusion: These results indicate that HIIT and MICT modify the post-exercise lipoprotein profile acutely. On the other hand, only HIIT tended to increase HDL-c levels chronically., (Copyright © 2019 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Background: High-intensity, variable stepping training can improve walking speed in individuals poststroke, although neuromuscular strategies used to achieve faster speeds are unclear. We evaluated changes in joint kinetics and neuromuscular coordination following such training; movement strategies consistent with intact individuals were considered evidence of recovery and abnormal strategies indicative of compensation., Methods: A total of 15 individuals with stroke (duration: 23 ± 30 months) received ≤40 sessions of high-intensity stepping in variable contexts (tasks and environments). Lower-extremity kinetics and electromyographic (EMG) activity were collected prior to (BSL) and following (POST) training at peak treadmill speeds and speeds matched to peak BSL (MATCH). Primary measures included positive (concentric) joint and total limb powers, measures of interlimb (paretic/nonparetic powers) and intralimb compensation (hip/ankle or knee/ankle powers), and muscle synergies calculated using nonnegative matrix factorization., Results: Gains in most positive paretic and nonparetic joint powers were observed at higher speeds at POST, with decreased interlimb compensation and limited changes in intralimb compensation. There were very few differences in kinetic measures between BSL to MATCH conditions. However, the number of neuromuscular synergies increased significantly following training at both POST and MATCH conditions, indicating gains from training rather than altered speeds. Despite these results, speed improvements were associated primarily with changes in nonparetic versus paretic powers., Conclusion: Gains in locomotor function were accomplished by movement strategies consistent with both recovery and compensation. These and other data indicate that both strategies may be necessary to maximize walking function in patients poststroke.

Objective:: Inspiratory muscle training (IMT) improves prognostic clinical variables in patients with heart failure. However, the optimal intensity for increasing those outcomes remains unclear. Thus, we aimed to determine whether high-intensity inspiratory muscle training (HIIMT) improves exercise capacity and respiratory muscle strength in patients with heart failure with reduced ejection fraction (HFrEF)., Methods:: We searched for randomized controlled clinical trials at MEDLINE, the Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, SciELO and CINAHL from the earliest date available to May 2018. Primary studies on HIIMT against low-intensity IMT or sham-IMT that evaluated exercise capacity and inspiratory muscle strength were included. Two independent reviewers evaluated the eligibility of studies retrieved from the databases. Disagreements were resolved by discussion or by a third reviewer. Weighted mean difference (WMD), standardized mean difference (SMD) and 95% confidence interval (CI) were estimated by random effect models., Results:: Five studies met the eligibility criteria (138 patients). HIIMT improved VO 2 peak (WMD 2.65 mL kg -1  min -1 ; 95% CI: 2.2 to 3.1 mL kg -1  min -1 ), walking tests (SMD 1.71; 95% CI: 0.83 to 2.59) and maximal inspiratory pressure (WMD 16.63 cmH 2 O; 95% CI: 10.34 to 22.91 cmH 2 O). The estimate for potential risks of adverse events was not performed because of the low prevalence of reports in primary studies., Conclusion:: HIIMT seems to be a useful strategy for improving exercise capacity and inspiratory muscle strength in HFrEF patients.

Vitamin D insufficiency may be associated with increased risk of upper respiratory tract infection (URTI) in athletes. This study examined the effects of vitamin D₃ supplementation on salivary immune functions and symptoms of URTI in vitamin D-insufficient taekwondo athletes. Twenty-five male taekwondo athletes, aged 19⁻22 years with vitamin D insufficiency [serum 25-hydroxyvitamin-D concentrations (25(OH)D, 31.3 ± 1.39 nmol/L)], participated in this study. They were randomized to receive 5000 IU/day of vitamin D₃ ( n = 13) or placebo capsule ( n = 12) during 4 weeks of winter training. Blood samples were collected two times (pre- and post-tests) for analyzing serum 25(OH)D concentration while salivary samples were obtained three times (pre-, mid-, and post-tests) for secretory immunoglobulin A (SIgA) and lactoferrin analyses. The symptoms of URTI were reported daily during the intervention. Serum 25(OH)D concentration significantly increased by 255.6% in the vitamin D group, whereas in the placebo group it did not change ( p < 0.001). While the significant increase in SIgA was observed in both groups ( p < 0.001), elevated salivary lactoferrin level in response to winter training was found only in the placebo group ( p = 0.011). The change in serum 25(OH)D concentration was negatively associated with total URTI symptoms ( r = -0.435, p = 0.015). Vitamin D₃ supplementation may be effective in reducing the symptoms of URTI during winter training in vitamin D-insufficient taekwondo athletes.

Current guidelines recommend that patients with hypertrophic cardiomyopathy (HCM) not partake in high-intensity exercise due to the increased risk of sudden cardiac death. But individuals with genetic cardiomyopathies are not immune from cardiometabolic diseases, and inactivity is common in patients with HCM, likely due to fear of exercise-induced adverse events. The RESET-HCM trial (Study of Exercise Training in Hypertrophic Cardiomyopathy) illustrated that although moderate-intensity exercise may be safe in this population, the increase in cardiorespiratory fitness achieved with this training paradigm is modest. High-intensity exercise is an efficacious stimulus for increasing cardiorespiratory fitness in chronic disease populations. Such increases in fitness are associated with substantial reductions in cardiovascular mortality and may outweigh the theoretical risks associated with exercise in patients with HCM. The goal of this review is to examine the evidence supporting the safety and efficacy of different intensities of exercise training in HCM, and consider novel strategies to improve fitness., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the acute effects of high-intensity exercise on blood hepcidin levels and other iron metabolic and hematological parameters in highly trained athletes of dragon boating as a sport performed in a sitting position., Methods: We conducted an exercise intervention study with a pre- and posttest blood measurement to determine the effects of high-intensity training on hematological and iron metabolic parameters in both male (n = 19) and female (n = 12) elite athletes of the German national dragon boating team. The study took place during the final training camp before the European championships. Blood samples were collected at baseline and 3 h after 3 consecutive high-intensity training bouts at the same day, each one lasting 1 h in duration., Results: After exercise, leukocytes, CPK, CKMB, and hepcidin levels increased significantly both in men and women. In contrast, iron concentrations decreased significantly. No gender-related differences were found. Compared with baseline, the postexercise concentrations of serum iron decreased significantly both in men [99.3 ± 46.3 to 61.2 ± 20.9 µg/dL (p < 0.001)] and in women [116.3 ± 34 to 67.1 ± 21.8 µg/dL (p < 0.001)] without a gender difference (p = 0.28). Hepcidin levels increased significantly both in men [9.1 ± 6.5 to 12.2 ± 5.8 ng/mL (p < 0.001)] and in women [8.0 ± 4.6 to 11.7 ± 5.7 ng/mL (p < 0.001)] without a significant gender difference in hepcidin changes (p = 0.34)., Conclusions: In conclusion, three consecutive high-intensity training bouts lead to elevated hepcidin levels and decreased iron levels in elite athletes of dragon boating. The increase in hepcidin levels may contribute to the risk of anemia in these athletes.

The effect of high-intensity training (HIT) on mitochondrial ADP sensitivity and respiratory capacity was investigated in human skeletal muscle and subcutaneous adipose tissue (SAT). Twelve men and women underwent 6 weeks of HIT (7 × 1 min at app. 100% of maximal oxygen uptake (VO 2max )). Mitochondrial respiration was measured in permeabilized muscle fibers and in abdominal SAT. Mitochondrial ADP sensitivity was determined using Michaelis Menten enzyme kinetics. VO 2max , body composition and citrate synthase (CS) activity (skeletal muscle) and mtDNA (SAT) were measured before and after training. VO 2max increased from 2.6 ± 0.2 to 2.8 ± 0.2 L O 2 /min (P = 0.011) accompanied by a decreased mitochondrial ADP sensitivity in skeletal muscle (K m : 0.14 ± 0.02 to 0.29 ± 0.03 mmol/L ADP (P = 0.002)), with no changes in SAT (K m : 0.12 ± 0.02 to 0.16 ± 0.05 mmol/L ADP; P = 0.186), following training. Mitochondrial respiratory capacity increased in skeletal muscle from 57 ± 4 to 67 ± 4 pmol O 2 ·mg -1 ·sec -1 (P < 0.001), but decreased with training in SAT from 1.3 ± 0.1 to 1.0 ± 0.1 pmol O 2 ·mg -1 ·sec -1 (P < 0.001). CS activity increased (P = 0.027) and mtDNA was unchanged following training. Intrinsic mitochondrial respiratory capacity was unchanged in skeletal muscle, but increased in SAT after HIT. In summary, our results demonstrate that mitochondrial adaptations to HIT in skeletal muscle are comparable to adaptations to endurance training, with an increased mitochondrial respiratory capacity and CS activity. However, mitochondria in SAT adapts differently compared to skeletal muscle mitochondria, where mitochondrial respiratory capacity decreased and mtDNA remained unchanged after HIT., (© 2018 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.)