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Zusammenfassung Hintergrund und Zielsetzung Der Selektivvertrag zzur Versorgung im Fachgebiet Orthopädie in Baden-Württemberg (FAV Orthopädie) gemäß § 73c SGB V hat das Ziel, die Über‑, Unter- und Fehlversorgung bei muskuloskeletalen Erkrankungen zu mindern und durch eine leitliniengerechte Patientenversorgung die Qualität dieser zu verbessern. Ein Kernelement der FAV Orthopädie ist die Einführung einer Pauschale für eine motivationale und präventiven Beratung zur Lebensstiländerung und Stärkung des Selbstmanagements nach einem für das FAV Orthopädie entwickelten 4‑Stufen-Konzept. Ziel unserer Untersuchung war es, die Implementierbarkeit des FAV Orthopädie aus Sicht der teilnehmenden Ärztinnen und Ärzten und medizinischen Fachangestellten zu erfassen, die Implementierungstreue der Lebensstilberatung nach dem 4‑Stufen-Konzept, den selbsteingeschätzten Beratungserfolg sowie Barrieren der Lebensstilberatung zu dokumentieren. Methode Es wurde eine anonyme Onlinebefragung der beiden Zielgruppen durchgeführt. Die Implementierbarkeit wurde mithilfe des Hexagon-Tools erfasst. Die Teilnehmenden gaben zudem an, welche Beratungsinhalte sie nach dem 4‑Stufen-Konzept durchführen (Implementierungstreue) und welche Hindernisse hierbei auftraten (Barrieren). Der selbsteingeschätzte Beratungserfolg wurde für die Bereiche Bewegung, Ernährung, Rauchen und Stressmanagement dokumentiert. Die Daten wurden deskriptiv ausgewertet. Ergebnisse Ein Drittel der angeschriebenen Ärztinnen und Ärzten (n = 191) und 101 medizinische Fachangestellte haben die Fragen bzgl. der Umsetzung beantwortet. Die Mehrheit schätzte die Implementierbarkeit des FAV Orthopädie positiv ein. Es zeigte sich eine (sehr) hohe Implementierungstreue (Lebensstilberatung nach dem 4‑Stufen-Konzept; n = 53 Ärztinnen und Ärzte; n = 81 medizinische Fachangestellte). Während etwas mehr als ein Drittel der Ärztinnen und Ärzte keine Barrieren sah, gaben über 60 % weiterhin Barrieren zur routinemäßigen Beratung an. Der Beratungserfolg beider befragten Berufsgruppen wurde im Bereich Bewegung als relativ hoch, in den Bereichen Ernährung und Stressmanagement als mäßig und im Bereich Raucherentwöhnung als eher gering eingeschätzt. Diskussion Nach den vorliegenden Daten lässt sich der FAV Orthopädie in den Praxisalltag integrieren. Der FAV stellt Rahmenbedingungen her, die eine hohe Lebensstilberatungsprävalenz ermöglichen, auch wenn teilweise weiterhin von räumlichen und zeitlichen Barrieren sowie patientenbezogenen Hindernissen berichtet wird. Resümierend liefert unsere Studie erste Hinweise dafür, dass der FAV Orthopädie die biopsychosoziale und leitliniengerechte Versorgung im Bereich muskuloskeletalen Erkrankungen stärkt.

Context Athletes with anterior cruciate ligament (ACL) reconstruction (ACLR) exhibit increased cortical motor planning during simple sensorimotor tasks compared with healthy athletes serving as control groups. This may interfere with proper decision making during time-constrained movements, elevating the reinjury risk. Objective To compare cortical motor planning and biomechanical stability during jump landings between participants with ACLR and healthy individuals. Design Cross-sectional study. Setting Laboratory. Patients or Other Participants Ten men with ACLR (age = 28 ± 4 years, time after surgery = 63 ± 35 months) and 17 healthy men (age = 28 ± 4 years) completed 43 ± 4 preplanned (landing leg shown before takeoff) and 51 ± 5 unplanned (visual cue during flight) countermovement jumps with single-legged landings. Main Outcome Measure(s) Movement-related cortical potentials (MRCPs) and frontal θ frequency power before the jump were analyzed using electroencephalography. Movement-related cortical potentials were subdivided into 3 successive 0.5-second time periods (readiness potential [RP]-1, RP-2, and negative slope [NS]) relative to movement onset, with higher values indicating more motor planning. Theta power was calculated for the last 0.5 second before movement onset, with higher values demonstrating more focused attention. Biomechanical landing stability was measured via peak vertical ground reaction force, time to stabilization, and center of pressure. Results Both the ACLR and healthy groups evoked MRCPs at all 3 time periods. During the unplanned task analyzed using P values and Cohen d, the ACLR group exhibited slightly higher but not different MRCPs, achieving medium effect sizes (RP-1: P = .25, d = 0.44; RP-2: P = .20, d = 0.53; NS: P = .28, d = 0.47). The ACLR group also showed slightly higher θ power values that were not different during the preplanned (P = .18, d = 0.29) or unplanned (P = .42, d = 0.07) condition, achieving small effect sizes. The groups did not differ in their biomechanical outcomes (P values > .05). No condition × group interactions occurred (P values > .05). Conclusions Our jump-landing task evoked MRCPs. Although not different between groups, the observed effect sizes provided the first indication that men with ACLR might have consistently relied on more cortical motor planning associated with unplanned jump landings. Confirmatory studies with larger sample sizes are warranted.

Purpose Physical activity is associated with altered levels of circulating microRNAs (ci-miRNAs). Changes in miRNA expression have great potential to modulate biological pathways of skeletal muscle hypertrophy and metabolism. This study was designed to determine whether the profile of ci-miRNAs is altered after different approaches of endurance exercise. Methods Eighteen healthy volunteers (aged 24 ± 3 years) participated this three-arm, randomized-balanced crossover study. Each arm was a single bout of treadmill-based acute endurance exercise at (1) 100% of the individual anaerobic threshold (IANS), (2) at 80% of the IANS and (3) at 80% of the IANS with blood flow restriction (BFR). Load-associated outcomes (fatigue, feeling, heart rate, and exhaustion) as well as acute effects (circulating miRNA patterns and lactate) were determined. Results All training interventions increased the lactate concentration (LC) and heart rate (HR) (p p p = 0.037 and p = 0.003). The level of miR-142-5p and miR-197-3p were up-regulated in both interventions without BFR (p p = 0.038). In LI-BFR, the level of miR-342-3p and miR-424-5p was confirmed to be up-regulated (p p = 0.011, r = − 0.343/miR-199a-3p, p = 0.045, r = − 0.274/miR-125b-5p, p = 0.026, r = − 0.302). Two partial correlations (intervention partialized) showed a systematic impact of the type of exercise (LI-BFR vs. HI) (miR-99a-59: r = − 0.280/miR-199a-3p: r = − 0.293). Conclusion MiRNA expression patterns differ according to type of activity. We concluded that not only the intensity of the exercise (LC) is decisive for the release of circulating miRNAs—as essential is the type of training and the oxygen supply.

Mild cognitive impairment (MCI) is a clinical syndrome characterised by persistent cognitive deficits that do not yet fulfil the criteria of dementia. Delaying the onset of dementia using secondary preventive measures such as physical activity and exercise can be a safe way of reducing the risk of further cognitive decline and maintaining independence and improving quality of life. The aim is to systematically review the literature to assess the effectiveness of physical activity and exercise interventions to improve long-term patient-relevant cognitive and non-cognitive outcomes in people living with MCI, including meta-analyses if applicable.We will systematically search five electronic databases from 1995 onward to identify trials reporting on the effectiveness of physical activity and exercise interventions to improve long-term (12+ months) patient-relevant cognitive and non-cognitive outcomes in adults (50+ years) with MCI. Screening procedures, selection of eligible full-texts, data extraction and risk of bias assessment will be performed in dual-review mode. Additionally, the reporting quality of the exercise interventions will be assessed using the Consensus on Exercise Reporting Template. A quantitative synthesis will only be conducted if studies are homogeneous enough for effect sizes to be pooled. Where quantitative analysis is not applicable, data will be represented in a tabular form and synthesised narratively. People living with MCI will be involved in defining outcome measures most relevant to them in order to assess in how far randomised controlled trials report endpoints that matter to those concerned.Results will be disseminated to both scientific and lay audiences by creating a patient-friendly video abstract. This work will inform professionals in primary care about the effectiveness of physical activity and exercise interventions and support them to make evidence-based exercise recommendations for the secondary prevention of dementia in people living with MCI. No ethical approval required.CRD42021287166.

This study investigates if lower extremity open-skill training impacts perception and cognitive processing abilities or just influences task related motor abilities. Twenty-two participants (24.7 ± 2.4years; 11 males, 11 females) were randomly allocated either into the group that trained on a computerized device or to the control group. Prior to and following the 4-week study period, motor performance was assessed using drop jump, hexagon test, postural control and lower extremity choice reaction. Perception, cognitive processing and task inhibition were captured using validated neurocognitive tests. Repeated measurements analyses of co-variances (ANCOVAs) were performed. They revealed a time (before and after intervention) × group (training vs. control) effect on lower extremity choice reaction and hexagon (

This study assessed the injury incidence, mechanisms, and associated potential risk factors for hip-hop, popping, locking, house, and breaking dance styles. Data were collected from June to November 2015. The retrospective cohort study included 146 dancers (female: N = 67; age = 20 ± 4.2 years; males: N = 79; age = 22.9 ± 5.8 years) who completed a questionnaire that collected data concerning training hours, injuries, self-reported injury causes, treatment, and recovery time over the last 5 years. For the last 5 years, 52% (N = 76) of the dancers reported 159 injuries and, in the year prior to the survey, 31.5% (N = 46) reported a total of 75 injuries. Overall, 0.61 injuries (5 years) and 1.156 injuries (1 year) per 1,000 hours exposure time occurred. For breaking, 1.286 injuries (5 years) and 2.456 injuries (1 year) per 1,000 hours exposure time were calculated, while the other dance styles accumulatively reached 0.151 injuries (5 years) and 0.318 injuries (1 year) per 1,000 hours of exposure time. Breakers reported most injuries at the upper extremities, followed by the lower extremities, trunk, and head and neck region. Most injuries in hip-hop occurred at the lower extremities, mainly affecting the knees, followed by groin and ankle. Injuries experienced by popping and locking dancers only involved the lower extremities. In house, the lower extremities were affected most frequently, followed by the trunk. A total of 65.3% of the dancers experienced time loss, with a duration of 12.7 ± 21.3 weeks. Breakers experience significantly more injuries than dancers of the other styles. Injury risk among dancers of all the styles studied can be considered low compared to soccer players, swimmers, and long-distance runners.

Gegenwartig kursieren zahlreiche Vorschlage zur potenziellen Wirksamkeit von Traditioneller Chinesischer Medizin (TCM)/Akupunktur in der Therapie von SARS-CoV-2-Infektionen und assoziierten Symptomen. Stand dieser Uberlegungen sind insbesondere molekularvirologische, aber auch klinische Untersuchungen aus der SARS-Epidemie 2002/2003. Ein Wirksamkeitsnachweis von chinesischen Arzneimitteln mit antiviralem Potenzial in Bezug auf SARS-CoV‑2 steht grostenteils aus. Klinische Daten stutzen sich nahezu ausschlieslich auf Studien vor Beginn der Coronapandemie. Gegenwartig finden sich nur international publizierte Fallberichte sowie in China berichtete Beobachtungsstudien. Vielversprechend ist eine grose Zahl registrierter prospektiver Studien, die gegenwartig durchgefuhrt werden. Die Evidenzlage fur die nichtpharmakologischen Therapiesaulen der TCM ist sehr schwach. Auf Basis der Datenlage ist eine Kombination westlicher und TCM-Masnahmen in der westlichen Welt nur nach Ausschopfung der konventionellen Masnahmen gerechtfertigt.

Background Inadequate reactions to unforeseen external stimuli are regarded as a major cause for non-contact anterior cruciate ligament (ACL) injuries. We aimed to delineate a potential deficit in the ability to perform unanticipated jump-landing manoeuvres, its sustainability and potential as a new outcome measure after ACL-reconstruction. Methods Physically active adults (n = 27, 13 females, 14 males, 29.7 standard deviation 3.1 years) with a history of unilateral ACL rupture and subsequent reconstruction (6 months to 7 years ago), cleared for return to sports, were included. All participants performed counter-movement jumps with unanticipated single leg landings. Visual information shown after jump take-off indicated the required landing leg. Jump time [s] and successfulness [yes/no], vertical peak ground reaction forces at landing [N], as well as time to stabilisation after landing [s] and path length of the centre of pressure (CoP, [mm]) were calculated. Limb symmetry ratios were determined and analysed for their association with the time since surgery. Findings Time since ACL reconstruction was logarithmically (basis 10) associated with side symmetry improvements in peak ground reaction force (R2 = 0.23, p Interpretation A deficit in unanticipated jump-landing ability seems to persist far beyond surgical restoration of mechanical stability and resumption of initial physical activities levels. The assessment of the ability to suddenly adapt movements to unanticipated visual stimuli may be a relevant complementary component within current functional testing canon in monitoring therapy success and return to sport testing.

Sleep-loss is a severe problem in night-shift workers. It causes fatigue and a decrease in awareness that may be counter-acted by exercise. This randomised controlled study in 22 university students investigated the effects of exercise to prevent loss of cognitive and physical performance following sleep deprivation. We were comparing a single bout of a 20-minutes circuit training to control in an experimental setting of overnight sleep loss. Outcomes included memory, cognitive tasks, and physical parameters. The occurrence of false memories was considered being the main outcome.Exercise did not exert significant effects on false memories (p = 0.456). We could detect a trend to significance (p < 0.01) assessing cognitive dimensions, i.e. selective and sustained attention, and visual scanning speed. This revealed strong effects of exercise on attention (p = 0.091; Cohen’s d = 0.76; ∆14%), cognitive performance, performance speed, and perceived sleepiness (p = 0.008; d = 0.60; ∆2.4 cmVAS). This study failed to show effects of exercise on memory function. Still, medium to strong effects on attention and consciousness can be considered clinically relevant. The results of this study encourage further research to determine its practicability and meaningfulness among night-shift workers.Trial registration: German Clinical Trials Register, DRKS00010655, registered 21. June 2016.

Fitness and exercise may counteract the detrimental metabolic and mood adaptations during prolonged sitting. This study distinguishes the immediate effects of a single bout vs. work-load and intensity-matched repeated exercise breaks on subjective well-being, blood glucose, and insulin response (analyzed as area under the curve) during sedentary time; and assesses the influence of fitness and caloric intake on metabolic alterations during sedentariness. Eighteen women underwent cardiopulmonary exercise testing and three 4 h sitting interventions: two exercise interventions (70% VO

In March 2020, the COVID-19 outbreak led to the declaration of a pandemic. The accompanying restrictions on public life caused a change in the training routines of athletes worldwide. The present study aimed to investigate the effects of a 13-week supervised home training program on physical performance, sleep quality, and health-related quality of life in professional youth soccer players during the first COVID-19 lockdown in Germany.Eight professional soccer players (age range 16-19; height: 1.81 ± 0.07 m; body weight: 72.05 ± 6.96 kg) from a Bundesliga team in Germany participated in this study. During the lockdown, they trained 5-6 days per week with home-based training plans and were monitored via tracking apps and video training. To determine the effects of home training, measurements were taken before (March 2020) and after (June 2020) the home training period. Bioelectrical impedance analysis was used to determine body composition, and an isokinetic strength test and a treadmill step test, including lactate measurements, were used to measure physical performance. Two questionnaires were responded to in order to assess health-related quality of life [Short-Form 36 Health Survey (SF-36)] and sleep quality (Pittsburgh Sleep Quality Index).When comparing measurements before and after the home training period, we observed significant increases in the following variables: body weight (72.05 ± 6.96 kg vs. 73.50 ± 6.68 kg,The COVID-19 lockdown led to an increase in body composition parameters and showed an improvement in the MCS and scores on the general and mental health subscales of the SF-36. Physical performance and sleep quality could be maintained during the home training period. These observations may help trainers for future training planning during longer interruptions in soccer training.

Germany experienced a 6-month second lockdown (November 2020-April 2021) during the COVID-19 pandemic, which included the closure of all physical activity (PA) facilities. The use of online exercise classes (OECs) was promoted by public health and exercise organizations. Using the present cross-sectional online survey, we assess the use of and opinion towards OECs in Germany during the second lockdown. We used contingency tables and the Chi

Der Mensch ist auf Bewegung angelegt: Bewegung ist die naturliche Grundlage seiner korperlichen und psychischen Gesundheit. Ein Grosteil der Bevolkerung, Erwachsene wie Kinder, erfullt aber nicht die aus praventivmedizinischer Sicht geltenden Empfehlungen zur korperlichen Aktivitat. Dabei ist Bewegungsarmut ein bedeutsamer Risikofaktor fur chronische Erkrankungen, fruhzeitigen Verlust der Selbststandigkeit und Mortalitat. Regelmasige korperliche Aktivitat stellt auch bei schon bestehenden chronischen Erkrankungen eine Gesundheitsressource dar. Sie kann die (medikamentose) Therapie sinnvoll erganzen und die Leistungsfahigkeit starken. Neben den somatischen Effekten erhoht Bewegung das Wohlbefinden und die Lebensqualitat von sowohl Gesunden als auch chronisch Kranken, weist eine stressregulierende Wirkung auf und kann die Schlafqualitat verbessern. Daruber hinaus ist es nie zu spat anzufangen: die positiven Effekte der Bewegung entfalten sich auch, wenn sie erst im spaten Alter aufgenommen wird.

Background Walking is the preferred therapy for peripheral arterial disease in early stage. An effect of walking exercise is the increase of blood flow and fluid shear stress, leading, triggered by arteriogenesis, to the formation of collateral blood vessels. Circulating micro-RNA may act as an important information transmitter in this process. We investigated the acute effects of a single bout of 1) aerobic walking with moderate intensity; and 2) anaerobic walking with vigorous intensity on miRNA parameters related to vascular collateral formation. Methods Ten (10) patients with peripheral arterial disease with claudication (age 72 ± 7 years) participated in this two-armed, randomized-balanced cross-over study. The intervention arms were single bouts of supervised walking training at (1) vigorous intensity on a treadmill up to volitional exhaustion and (2) moderate intensity with individual selected speed for a duration of 20 min. One week of washout was maintained between the arms. During each intervention, heart rate was continuously monitored. Acute effects on circulating miRNAs and lactate concentration were determined using pre- and post-intervention measurement comparisons. Results Vigorous-intensity walking resulted in a higher heart rate (125 ± 21 bpm) than the moderate-intensity intervention (88 ± 9 bpm) (p p = 0.005; 3.3 ± 1.2 mmol/l), but not after moderate exercising (p > 0.05; 1.7 ± 0.6 mmol/l). The circulating levels of miR-142-5p and miR-424-5p were up-regulated after moderate-intensity (p p > 0.05). Conclusion Moderate-intensity walking seems to be more feasible than vigorous exercises to induce changes of blood flow and endurance training-related miRNAs in patients with peripheral arterial disease. Our data thus indicates that effect mechanisms might follow an optimal rather than a maximal dose response relation. Steady state walking without the necessity to reach exhaustion seems to be better suited as stimulus.

Beneficial acute effects of resistance exercise on cognitive functions may be modified by exercise intensity or by habitual physical activity. Twenty-six participants (9 female and 17 male; 25.5 ± 3.4 years) completed four resistance exercise interventions in a randomized order on separate days (≥48 h washout). The intensities were set at 60%, 75%, and 90% of the one repetition maximum (1RM). Three interventions had matched workloads (equal resistance*nrepetitions ). One intervention applied 75% of the 1RM and a 50% reduced workload (resistance*nrepetitions = 50%). Cognitive attention (Trail Making Test A-TMTA), task switching (Trail Making Test B-TMTB), and working memory (Digit Reading Spans Backward) were assessed before and immediately after exercise. Habitual activity was assessed as MET hours per week using the International Physical Activity Questionnaire. TMTB time to completion was significantly shorter after exercise with an intensity of 60% 1RM and 75% 1RM and 100% workload. Friedman test indicated a significant effect of exercise intensity in favor of 60% 1RM. TMTA performance was significantly shorter after exercise with an intensity of 60% 1RM, 90% 1RM, and 75% 1RM (50% workload). Habitual activity with vigorous intensity correlated positively with the baseline TMTB and Digit Span Forward performance but not with pre- to post-intervention changes. Task switching, based on working memory, mental flexibility, and inhibition, was beneficially influenced by acute exercise with moderate intensity whereas attention performance was increased after exercise with moderate and vigorous intensity. The effect of regular activity had no impact on acute exercise effects.

In football, unpredictable events (e.g. unexpected landings) seem to play a crucial role in the mechanism of non-contact knee injuries. This study investigated the effects of a single bout of an injury preventive warmup protocol on biomechanical landing stability and decision-making quality during preplanned and unanticipated jump-landings. A crossover study on 18 male amateur football players was performed. The participants completed a standard (ergometer) and an injury-preventive warmup protocol (Prevent injury and Enhance Performance (PEP)) on two different test days. After each protocol, participants performed countermovement jumps with preplanned (landing side displayed before takeoff) and unanticipated (landing side shown after takeoff) single-leg landings on a force plate. Outcomes were landing stability (height and time of the maximum vertical ground reaction force (pGRF), center of pressure (CoP), the number of standing errors (ground contact with free leg)) and decision-making quality (landing error (wrong foot) count). Carry-over and crossover-tests were performed to find potential between-condition-differences. No carry-over effects occurred (p > .05). The PEP led to a reduced CoP trace length (-18.4 ± 32.2%, p = .021) and earlier occurrence of pGRF (-4.72 ± 6.78%, p = .017) in the preplanned condition. No significant between-treatment-differences occurred within the unanticipated landings and decision-making quality (p > .05). The primarily neuromuscular warmup protocol affects landing stability in the preplanned condition. However, it does not seem to better prepare football players for unpredictable events than a standard warmup.Trial registration: German Clinical Trials Register identifier: DRKS00016942.

Introduction Return to sports (RTS) clearance after anterior cruciate ligament (ACL) reconstruction typically includes multiple assessments. The ability of these tests to assess the risk of a reinjury remains unknown. Purpose To assess and rate RTS self-reported function and functional tests on prognostic value for reinjury risk after ACL reconstruction and RTS. Study design Systematic review on level 2 studies. Methods PubMed, Web of Knowledge, Cochrane Library, and Google Scholar databases were searched for articles published before March 2018. Original articles in English or German that examined reinjury risks/rates after primary (index) ACL injury, ACL reconstruction, and RTS were included. All RTS functional tests used in the included studies were analyzed by retrieving an effect size with predictive value (odds ratio, relative risk (risk ratio), positive predictive value, positive likelihood ratio, or hazard rate). Results A total of 276 potential studies were found; eight studies (moderate to high quality) on 6140 patients were included in the final analysis. The reinjury incidence recorded in the included studies ranged from 1.5% to 37.5%. Four studies reported a combination of isokinetic quadriceps strength at different velocities and a number of hop tests as predictive with various effect sizes. One reported isokinetic hamstring to quadriceps ratio (hazard rate = 10.6) as predictive. Two studies reported functional questionnaires (knee injury and osteoarthritis outcome score and Tampa Scale of Kinesiophobia-11; RR = 3.7-13) and one study showed that kinetic and kinematic measures during drop vertical jumps were predictive (odds ratio, 2.3-8.4) for reinjury and/or future revision surgery. Conclusions Based on level 2 evidence, passing a combination of functional tests with predetermined cutoff points used as RTS criteria is associated with reduced reinjury rates. A combination of isokinetic strength and hop tests is recommended during RTS testing.

Exercise has been shown to counteract age-related volume decreases in the human brain, and in this imaging study, we ask whether the same holds true for the microstructure of the cortex. Healthy older adults (n = 47, 65-90 years old) either exercised three times a week on a stationary bike or maintained their usual physical routine over a 12-week period. Quantitative longitudinal relaxation rate (R1 ) magnetic resonance imaging (MRI) maps were made at baseline and after the 12-week intervention. R1 is commonly taken to reflect cortical myelin density. The change in R1 (ΔR1 ) was significantly increased in a region of interest (ROI) in the primary motor cortex containing motor outputs to the leg musculature in the exercise group relative to the control group (p = .04). The change in R1 in this ROI correlated with an increase in oxygen consumption at the first ventilatory threshold (VT1) (p = .04), a marker of improvement in submaximal aerobic performance. An exploratory analysis across the cortex suggested that the correlation was predominately confined to the leg representation in the motor cortex. This study suggests that microstructural declines in the cortex of older adults may be staved off by exercise.

Zusammenfassung Hintergrund Trotz einer steigenden Anzahl an Rehabilitationssportgruppen für Krebspatienten wird häufig von Schwierigkeiten beim Zugang zu entsprechenden wohnortnahen Angeboten berichtet. Ziel der Untersuchung war daher die Erhebung von Zugangswegen sowie wahrgenommenen Barrieren und Einflussgrößen für den Einstieg und die langfristige Teilnahme am Rehabilitationssport für Krebspatienten. Methode An der quantitativen und qualitativen Befragung beteiligten sich 189 Teilnehmer aus 21 ambulanten Rehabilitationssportgruppen (63±10 J.; 96 % weiblich; 82 % Brustkrebs; Rehasport-Teilnahme seit im Median 29 Monaten). Mittels standardisiertem Instrument (offene und geschlossene Fragen; validierte Skalen) wurden systematisch Faktoren erfasst, die Einstieg und Teilnahme am Rehabilitationssport potenziell beeinflussen können (z. B. Barrieren, Motive). Ergebnisse Vor dem Einstieg hatten 151 (80 %) der Befragten eine Empfehlung für die Teilnahme am Rehabilitationssport bekommen (40 % Stationäre Rehabilitation / Anschlussheilbehandlung; 24 % Familie / Freunde; 16 % Onkologe; 11 % Personal der onkologischen Einrichtung; 10 % Hausarzt / Gynäkologe). Hindernisse / Bedenken vor dem Einstieg umfassten insbesondere eine als zu starke wahrgenommene Müdigkeit / Erschöpfung (37 %), zu starke Schmerzen / Unwohlsein (15 %) und das Gefühl einer therapie- / erkrankungsbedingt zu geringen Fitness (14 %) sowie fehlende Kenntnisse über passende Angebote (19 %) und unzureichende Empfehlungen (13 %). Primäre Motive für den Einstieg und die Teilnahme am Rehabilitationssport liegen in einer Verbesserung von Gesundheit und Wohlbefinden (97 bzw. 93 %) sowie einer Reduktion von (Krankheits-)Beschwerden (96 %) und Rezidivrisiko (82 %). Fast alle Teilnehmer (n = 185; 98 %) wollen nach der Teilnahme am Rehasport weiterhin regelmäßig körperlich-sportlich aktiv bleiben (74 % im Sportverein, davon 36 % zusätzlich privat; 17 % ausschließlich privat). Gut 2 / 3 der Befragten (68 %) haben Interesse, an weiteren regulären Vereinssport-Angeboten teilzunehmen, 38 % kennen keine anderen Angebote bzw. Möglichkeiten im Verein. Diskussion Konkrete Empfehlungen und adäquate Aufklärung über Durchführbarkeit, Nutzen und Möglichkeiten von Rehabilitationssport scheinen für den Einstieg in eine entsprechende Krebssportgruppe relevant. Informationen zu Angeboten und Möglichkeiten, bestenfalls bereits während der Krebstherapie, könnten den Einstieg in den Rehasport und konsekutiv einen aktiven Lebensstil sowie die Nutzung des Potenzials von Bewegung unterstützen.

Introduction Preliminary evidence indicates beneficial acute effects of resistance exercise on domain-specific cognitive function. Studies on dose response relationships and underlying mechanisms so far failed to deduce the impact of intensity and overall workload. Objective To analyze the impact of different intensities and workloads on effects of full body resistance training on cognitive attention, executive function performance, and affective response. Methods Twenty-six volunteers (9 (35%) female, age 25.9 ± 4.0 years) participated in three workload-matched (60%, 75% and 90% one repetition maximum intensity (1RM) resistance exercise interventions (RE)) and one workload reduced but intensity matched (75% 1RM, 50% overall workload) RE. Order was randomized, REs were on separate days with ≥48 h washout in between. Stroop Test performance (Attention: word and color condition; Interference control: word color interference), self-perceived levels of arousal and ability to concentrate were assessed before and after each RE. Results Workload-matched REs induced significant changes in attention and interference control. The workload reduced 75% 1RM RE induced changes in interference control, but no changes in attention performance. 75% 1RM exercise with full and 50% workload induced significant changes in arousal. Only 75% 1RM exercise with full workload significantly increased participants ability to concentrate. The repeated measures ANCOVA (Covariates: sex and fluid intelligence) indicated greater changes of interference control after 60% 1RM compared to 90% 1RM RE and greater changes of attention performance after 90% 1RM compared to 75% 1RM and 50% workload RE. Discussion Higher cognitive functions such as interference control seem to particularly benefit from moderate intensity RE whereas lower cognitive functions may be stimulated by higher intensity and higher workload RE. Self-perceived subjective factors did not mediate these dose response relationships. Future studies could analyze changes in cortisol levels, oxygenation, blood flow or electrophysiological signals to deduce triggers for increased stimulus-driven brain response and more controlled brain function.

Zusammenfassung Einleitung Präventive Bewegungsberatungen durch niedergelassene Ärzte sind aktuell in Deutschland nicht großflächig implementiert. Das „Rezept für Bewegung“ will das ärztliche Bewegungsberatungsgespräch für inaktive Patienten verbindlicher gestalten. Ziel der Studie war es, die Wahrnehmung der Beratungsqualität aus Patientensicht und die daraus resultierenden Handlungsabsichten und -konsequenzen systematisch zu erfassen. Methode Unter Verwendung eines standardisierten 17-Item-Instruments wurden 173 Patienten 3,9 ± 1,0 Monat(e) nach ärztlicher Beratung hinsichtlich Beratungszufriedenheit sowie Handlungsintention und -konsequenz anonym befragt. Die Dissemination erfolgte durch 12 kooperierende Arztpraxen in 8 Sportkreisen des Landessportbundes Hessen. Ergebnisse Gemäß Fragebogenrücklauf konnten Angaben von 51 Patienten (56,1 ± 13,3 Jahre; 35w.) in die Auswertung eingeschlossen werden. Knapp 2/3 der Befragten waren in ihrer Lebensspanne vor Beratung sehr geringfügig körperlich aktiv (≤ 60 min/Woche). Die Beratung zum „Rezept für Bewegung“ wurde in 63 % der Fälle mit gut bis sehr gut bewertet. Nach eigenen Angaben besuchten mehr als die Hälfte der Befragten im Anschluss ein Bewegungsangebot im Verein, 53 % trieben mehr Sport, 51 % gestalteten ihren Alltag körperlich aktiver. Befragte, die die Ausführlichkeit der Beratung als gut bewerteten, trieben nach eigenen Angaben in der Folge der Beratung signifikant häufiger Sport als vor der Beratung OR 3,16 (95 % KI 1,07 – 9,33). Fast die Hälfte der Befragten wünschten sich zur Erleichterung des Einstieges in ein Bewegungsangebot mehr Unterstützung von ihrer Krankenkasse. Diskussion Ärztliche Beratung im Sinne des „Rezepts für Bewegung“ kann als ergänzendes Instrument zur Sensibilisierung für das Thema Bewegung und Gesundheit unterstützen und zu entsprechender Steigerung der körperlichen Aktivität beitragen.

Current evidence indicates a strong relation between improved visuomotor choice reaction time (VMRT) and a reduced risk of lower extremity injury, making both lower- and upper extremity VMRT training paradigms valuable to athletes. This investigation studied as yet unconfirmed crossover effects of upper extremity training on lower extremity performance; and we evaluated underlying relevant perceptual and cognitive adaptations. In this three-armed, randomized, controlled intervention, we used a computerized training device to compare participants receiving four weeks of upper ( n = 12) and lower ( n = 12) extremity VMRT training with a control group ( n = 13) of healthy participants. Collectively, our participants had a mean age of 24.6 years ( SD = 2.2), a mean height of 173 cm ( SD = 10), and a mean weight of 69.6 kg ( SD = 12.1); 57% ( n = 21) were female and 43% ( n = 16) were male. We assessed participants’ upper and lower extremity VMRT performance and domain-specific perceptual and cognitive abilities before and after intervention and analyzed differences between their before and after performances. Lower extremity training enhanced VMRT performances for both lower extremity and crossover upper extremity. Upper extremity training improved VMRT for upper extremity and increased cognitive choice reaction performance but yielded no crossover effects to lower extremity. We found no effects of VMRT training on other domain-specific cognitive performance markers (attention, executive function, memory, or working memory). VMRT training modulated only task-specific cognitive performance and induced crossover effects from lower extremity training to upper extremity performance but not vice versa.

Summary Objectives Acute pain in sports tells us what not to do. Persisting pain limits the athletes’ activity and threatens his career. The reduction of pain is sought being highly beneficial for the sportsman, as it is shown that pain has only a weak connection to injury but a strong connection to the body image. Thus, pain therapy in sports medicine is a primary need of the athlete. Principle treatment goals are pain relief and return to play as quick as possible. Therapies in sports should primarily focus on conservative than on invasive approaches, with drugs being avoided as far as possible. There is a broad range of treatment approaches that could be applied in concert based on scientific and clinical decision making to reduce symptom severity, pain-associated dysfunction, and the risk of pain to be a tremendous cut in an elite athlete's career. Knowledge on this non-pharmacologic conservative pain medicine should not be restricted to health professionals, but the whole entourage of the athlete. This review highlights the current evidence with a focus on recreational and elite athletes. Based on their clinical evidence, it is hands-on techniques that can be recommended (Grade A: nerve blocks and injection techniques, ultrasound and laser therapy, manipulation mobilization, massage and traction; Grade B: acupuncture and dry needling). The occurrence of possible side-effects is, as far as reported, very unlikely. However, the methodological quality of the majority of retrieved studies limits the overall generalizability. Conclusion Conservative non-pharmacologic therapies reflect an adequate strategy to relief pain in elite athletes. Chronic states of pain reflect more complex scenarios requiring further comprehensive techniques. Future research should thus also address multimodal approaches combining several of the mentioned therapies.

Athletes with anterior cruciate ligament (ACL) reconstruction exhibit increased cortical motor planning during simple sensorimotor tasks compared to healthy controls. This may interfere with proper decision-making during time-constrained movements elevating the re-injury risk.To compare cortical motor planning and biomechanical stability during jump-landings between participants with ACL-reconstruction and healthy individuals.Cross-sectional exploratory study.Laboratory patients or other participants: Ten males with ACL-reconstruction (28±4 yrs., 63±35 months post-surgery) and 17 healthy males (28±4 yrs.) completed pre-planned (landing leg shown before take-off; n=43±4) and unplanned (visual cue during flight; n=51±5) countermovement-jumps with single-leg-landings.Movement-related cortical potentials (MRCP) and frontal theta frequency power before the jump were analyzed using electroencephalography. MRCP were subdivided into three successive 0.5 sec epochs (readiness potential 1 and 2; RP and negative slope; NS) relative to movement onset (higher values indicative of more motor planning). Theta power was calculated for the last 0.5 sec prior to movement onset (higher values indicative of more focused attention). Biomechanical landing stability was measured via vertical peak ground reaction force, time to stabilization, and center of pressure.Both conditions evoked MRCP at all epochs in both groups. During the unplanned condition, the ACL-reconstructed group exhibited slightly, but not significantly higher MRCP (RP-1:p=0.651, d=0.44, RP-2:p=0.451, d=0.48; NS:p=0.482, d=0.41). The ACL-reconstructed group also showed slightly higher theta power values during the pre-planned (p=0.175, d=0.5) and unplanned condition (p=0.422, d=0.3) reaching small to moderate effect sizes. In none of the biomechanical outcomes, both groups differed significantly (p0.05). No significant condition and group interactions occurred (p0.05).Our jump-landing task evoked MRCP. Although not significant between groups, the observed effect sizes provide first indication that males with ACL-reconstruction may persistently rely on more cortical motor planning associated with unplanned jump-landings. Confirmatory studies with larger sample sizes are warranted.clinicalTrials.gov (NCT03336060).

OBJECTIVE To investigate acute effects of a single bout of football specific neuromuscular injury preventive warm-up on potential anterior cruciate ligament (ACL) re-injury risk factors during anticipated and unanticipated jump-landings. DESIGN Crossover. METHODS Fourteen participants (mean ± SD age, 23.4 ± 4.1 years) 6-24 months after ACL reconstruction performed the Prevent Injury and Enhance Performance (PEP) and bicycle ergometer warm-up in a randomised sequence. Washout phase was one week. Countermovement jumps with anticipated and unanticipated single-leg-landings were assessed. Decision-making quality was measured using landing error count. RESULTS No carry-over effects occurred (p > 0.05). The unanticipated task produced significantly higher peak ground reaction forces (Δ+4%, F(11) = 3.46, p

Purpose: The aim of the study was to compare the functional status of patients with advanced gastrointestinal and breast cancer prior treatment to healthy age-matched volunteers. Methods: In this 3-arm cross-sectional study female patients with advanced cancer (UICC ≥ III) (gastrointestinal: n=17; 68.4±5.6years; BMI: 24±5.1kg/m2; breast: n=17; 64.1±7.8years; BMI: 23.6±3.7kg/m2) before first-line chemotherapy and 17 healthy age-matched women (68.6±5.8years; BMI 24.6±3.2kg/m2) were included. The functional status was assessed using the short physical performance battery (SPPB). A capacitive force platform was used for gait speed recordings during free level walking. Maximal isometric voluntary contraction force (MIVF) of the quadriceps muscle was assessed by a strain gauge force system. Body composition was obtained from bioelectrical-impedance-analysis. Physical activity was assessed via accelerometry. Results: Compared to the healthy controls and to patients with breast cancer, gastrointestinal cancer patients have lower values in the SPPB (10.4±1.3vs.8.9±2.0 vs.6.8±2.6; pConclusions: Already prior treatment patients with advanced gastrointestinal cancer have a reduced functional status compared to breast cancer patients and healthy controls. Gait speed, phase angle and MIVF are below cut-off values for a low prognosis of survival. This physical deconditioning prior treatment might influence the toxicity of the therapy. Thus, supportive interventions to improve the functional status and to support the treatment in patients with advanced gastrointestinal cancer seems to be of high concern.Trial Registration: Registered study at ClinicalTrials.gov (NCT02677129).

BACKGROUND: A considerable part of patients with non-specific low back pain (LBP) suffer from a recurrence of symptoms after therapy cessation. OBJECTIVE: The aim of this cohort study was to evaluate the predictive value of active and passive treatments and treatment modalities on a recurrence of low back pain after cessation of medically prescribed therapy. METHODS: Patients with non-specific LBP from a health- and therapy-center were included. Treatments were monitored and categorized as active or passive. During one year after therapy cessation, patients were monitored to retrieve information about recurrence of symptoms. Patients were dichotomized (recurrence versus no recurrence). An ROC-Analysis was used to determine optimal cut-offs for relevant treatment characteristics’ (passive versus active; frequency) impact on recurrence risk. The relative risk for a recurrence was calculated based on Chi2-test. RESULTS: Data from 96 participants (56 females, 40 males, mean age 49 years, standard deviation 11 years) were analysed. A total of 34 participants had recurring LBP. The frequency of active treatment differed significantly between groups with or without recurrence (p< 0.05). A therapy frequency of 1.45 active treatments/week was a sensitive cut-off (sensitivity: 0.73) to discriminate the recurrence groups. Participants with an active therapy frequency of less than 1.45 treatments per week showed an 82% increased relative recurrence risk (RR: 1.824 (95%-CI: 1.077–3.087)). CONCLUSIONS: The results empathize the importance of active treatments (i.e. exercise) in the therapy and (secondary) prevention of non-specific LBP. Less than 1.45 active treatment sessions/week increases the 1-year-risk of a recurrence by 82%. Performing at least two treatments sessions per week is therefore recommended.

The effects of exercise interventions on unspecific chronic low back pain (CLBP) have been investigated in many studies, but the results are inconclusive regarding exercise types, efficiency, and sustainability. This may be because the influence of psychosocial factors on exercise induced adaptation regarding CLBP is neglected. Therefore, this study assessed psychosocial characteristics, which moderate and mediate the effects of sensorimotor exercise on LBP. A single-blind 3-arm multicenter randomized controlled trial was conducted for 12-weeks. Three exercise groups, sensorimotor exercise (SMT), sensorimotor and behavioral training (SMT-BT), and regular routines (CG) were randomly assigned to 662 volunteers. Primary outcomes (pain intensity and disability) and psychosocial characteristics were assessed at baseline (M1) and follow-up (3/6/12/24 weeks, M2-M5). Multiple regression models were used to analyze whether psychosocial characteristics are moderators of the relationship between exercise and pain, meaning that psychosocial factors and exercise interact. Causal mediation analysis were conducted to analyze, whether psychosocial characteristics mediate the exercise effect on pain. A total of 453 participants with intermittent pain (mean age = 39.5 ± 12.2 years, f = 62%) completed the training. It was shown, that depressive symptomatology (at M4, M5), vital exhaustion (at M4), and perceived social support (at M5) are significant moderators of the relationship between exercise and the reduction of pain intensity. Further depressive mood (at M4), social-satisfaction (at M4), and anxiety (at M5 SMT) significantly moderate the exercise effect on pain disability. The amount of moderation was of clinical relevance. In contrast, there were no psychosocial variables which mediated exercise effects on pain. In conclusion it was shown, that psychosocial variables can be moderators in the relationship between sensorimotor exercise induced adaptation on CLBP which may explain conflicting results in the past regarding the merit of exercise interventions in CLBP. Results suggest further an early identification of psychosocial risk factors by diagnostic tools, which may essential support the planning of personalized exercise therapy. Level of Evidence: Level I. Clinical Trial Registration: DRKS00004977, LOE: I, MiSpEx: grant-number: 080102A/11-14. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004977.

BackgroundIn team-sports such as football or basketball, athletes need to rapidly adapt their motor plans and actions to unanticipated changes in the environment. Unanticipated jump-landing tasks have been found to elevate the risk of non-contact anterior cruciate ligament (ACL) injuries compared to an anticipated condition. ACL-reconstructed individuals may have greater difficulties to maintain neuromuscular control under unanticipated conditions exposing them to a higher reinjury risk during the game. The planned trial aims to investigate the acute effects of a team-sport specific injury prevention programme on potential ACL reinjury risk factors under anticipated and unanticipated jump-landings.Methods and design:Single center randomized controlled crossover trial. Female and male ACL-reconstructed participants cleared for return to sports (≥ 6 months and ≤ 24 months post-reconstruction) will be included. In a randomized sequence and with a washout phase of one week in between, the participants will perform an injury preventive warm-up protocol (PEP; strengthening, flexibility, plyometry and agility) and a standard warm-up program (bicycle ergometer). Both interventions will last for 12 minutes and will be conducted at moderate intensity (BORG scale: 12 to 14). After each warm-up, participants will perform counter movement jumps with single-leg landings on a force plate. Prior to the jump, a left or right footprint (equally distributed) will be indicated on a screen. Under the anticipated condition, the participants will be informed before the jump that the displayed footprint will not change after take-off. Under the unanticipated condition, the participants will not know whether the target landing side will remain the same (consistent with pre-movement expectations) or change (inconsistent). Under both unanticipated conditions, this information will be displayed 0.1 second after take-off and thus approximately 0.3 seconds before landing.Parametric/non-parametric crossover-analyses (carryover-tests and crossover test) for between-conditions comparisons will be applied. Trial registration: German Clinical Trials Register, identification number DRKS00016942. Registered on May 24, 2019.

Measures aiming at containing the Coronavirus disease 2019 (COVID-19) include isolation, social distancing, and quarantine. Quarantine and other lockdown instruments show promise in reducing the number of COVID-19 infections and deaths. It is reasonable to assume that lockdown leads to reduced levels of physical activity in the general population. Potential detrimental health effects of lockdown, such as psychological distress and physical inactivity induced maladaptations must be addressed. The current review summarizes harmful effects of limited physical activity on mental and physical health due to social distancing and quarantine and highlights the effects of simple physical activity regimes counteracting these detrimental effects, with a special emphasis on acute effects.

Background Motor function, such as strength asymmetries of the lower extremities and impaired dynamic stability, have a predictive value for the risk of injury. The present study aimed to reveal potential associations between injury and motor performance. Methods Two hundred and five male youth elite (association) football (soccer) players (mean: 13.5±4.5 years, 57.2±30.2 kg, 168±35 cm) were included. A test battery was conducted twice per season, over two consecutive seasons (four times). Mobility (Sit and Reach Test, SnR), dynamic stability (Single Leg Hop for Distance, SLHD), linear sprinting speed (10 m, 30 m [s]), agility (Zig-Zag test with and without dribbling a ball [s]), jump performance (countermovement jump (CMJ) and drop jump (DJ), in cm) and maximal isometric voluntary force (MIVF, in N) of the knee extensors and flexors were assessed. All injuries occurring over the two-year period, as well as training and competition exposure time, were collected and used as grouping variables for statistical difference testing. Results One hundred and twenty-five injuries in 93 players occurred (an injury incidence of 2.7/1000 hours of exposure). Age was associated with injury incidence (r=0.191; P=0.006). Neither DJ, CMJ, SnR nor agility performance were statistically different between injured and non-injured participants (P>0.05). Group differences did occur for sprint and strength (P=0.011; P=0.016), but these lapsed after the inclusion of age as a covariate. Only for SLHD symmetry was a non-significant trend evident after the correction for age (P=0.08). Conclusions The occurrence of musculoskeletal injuries in junior football players are, probably, not related to baseline motor function. Group differences between injured and non-injured youth elite football players are mostly explained by age. Only the symmetry in SLHD could be a potential risk factor for injuries and merits further investigation.

Physical activity counseling in primary health care is regarded as a useful complementary preventive and therapeutic measure and is advocated by leading public health institutions. This integrative review summarizes the available data on physical activity counseling in primary care in Germany. A systematic literature search in various databases (peer reviewed and grey literature) was carried out for quantitative and qualitative studies on physical activity counseling and use of “Exercise on Prescription”. The 25 studies included show a very high methodological diversity and, in some cases, considerable risks of bias, with limited comparability across studies. Counseling was provided in all studies by physicians. They report frequent physical activity counseling, which is partly confirmed and partly refuted by patient data. The use of “Exercise on Prescription” is at a very low level. Information on the frequency of physical activity counseling in Germany varies depending on data source and is sometimes contradictory. Our review provides a synthesis of various perspectives on routine physical activity counseling in primary care in Germany. Future studies using standardized and validated instruments in representative samples are needed to further knowledge on counseling and to be able to establish trends in prevalence. Strengthening the topics of physical activity and health and physical activity counseling in medical curriculum is strongly recommended.

Zusammenfassung. Chronisch unspezifische Rückenschmerzen (CURS) gehören international zu den häufigsten Schmerzphänomenen und können für Athletinnen und Athleten karrierelimitierend sein. Knapp ein Drittel der jährlichen Trainingsausfallzeiten werden auf CURS zurückgeführt. In der Entstehung von chronischen Schmerzen ist ein multifaktorielles Ätiologiemodell mit einem signifikanten Einfluss psychosozialer Risikofaktoren evident. Obwohl dies in der Allgemeinbevölkerung bereits gut erforscht ist, gibt es in der Sportwissenschaft vergleichsweise wenige Arbeiten darüber. Dieses Thema wird daher in drei Multicenterstudien und zahlreichen Teilstudien des MiSpEx-Netzwerks ( Medicine in Spine-Exercise-Network, Förderzeitraum 2011 – 2018) aufgegriffen. Entsprechend der Empfehlung einer frühzeitigen Diagnostik von Chronifizierungsfaktoren in der „Nationalen Versorgungsleitlinie Kreuzschmerz“, beschäftigt sich das Netzwerk u. a. mit der Überprüfung, Entwicklung und Evaluation diagnostischer Möglichkeiten. Der vorliegende Beitrag beschreibt die Entwicklung einer Diagnostik von psychosozialen Risikofaktoren, die einerseits eine Einschätzung des Risikos der Entwicklung von CURS und andererseits eine individuelle Zuweisung zu (Trainings)Interventionen erlaubt. Es wird die Entwicklungsrationale beschrieben und dabei verschiedene methodische Herangehensweisen und Entscheidungssequenzen reflektiert.

BACKGROUND Little is known on the accuracy of coaches' ratings of game-specific physical abilities in elite youth football players. The present study on elite youth football players aims to assess whether: 1) the coaches' subjective assessment of the level of performance of each athlete within the team is in accordance with objectively collected data; and 2) the coaches rate changes in the athletes' performance level accurately or not. METHODS Data on jumping ability, sprinting speed, change of direction and strength were collected in seven age groups at a football youth academy (N.=150). The diagnostic battery was repeated after seven months (N.=138). Before the second session, the head coaches completed Likert-scaled closed questions on: 1) the importance of running speed and reactive strength components and their relevance to the individual game performance of each of their athletes; 2) the level of performance of their athletes; 3) the change between the first and second performance testing results. Validity and sensitivity of change of their ratings in comparison to the performance data were calculated using analyses of interrelationship. RESULTS The data of the head coaches showed a low to medium effect size in the agreement with the performance data (Cohen's W=0.33-0.71). The evaluation of the change in level of performance was poorer (Cohen's W=0.04-0.2; not statistically significant). CONCLUSIONS Our results underline that functional/physical testing twice during a season may be crucial for displaying performance levels of elite youth football players. Simple self-reported ratings by the coach may be valid in recent performance level assessment but not for performance changes.

As formula diets have demonstrated to be effective in reducing weight, we hypothesised that in patients with overweight or obesity and accompanied cardiovascular risk factors, combining a liquid formula diet with a lifestyle intervention is superior in reducing weight and improving cardiovascular risk factors than lifestyle intervention alone.In this multicenter RCT 463 participants with overweight or obesity (BMI: 27-35 kg/m²; at least one additional co-morbidity of the metabolic syndrome) were randomised (1:2) into either a control group with lifestyle intervention only (CON, n = 155) or a lifestyle intervention group including a liquid meal replacement (INT, n = 308). Both groups used telemonitoring devices (scales and pedometers), received information on healthy diet and were instructed to increase physical activity. Telemonitoring devices automatically transferred data into a personalised online portal and acquired data were discussed. INT obtained a liquid meal replacement substituting three meals/day (~1200 kcal) within the first week. During weeks 2-4, participants replaced two meals/day and during weeks 5-26 only one meal/day was substituted (1300-1500 kcal/day). Follow-up was conducted after 52 weeks. Intention-to-treat analyses were performed. Primary outcome was weight change. Secondary outcomes comprised changes in cardiometabolic risk factors including body composition and laboratory parameters.From the starting cohort 360 (78%, INT: n = 244; CON: n = 116) and 317 (68%, INT: n = 216; CON: n = 101) participants completed the 26-weeks intervention phase and the 52-weeks follow-up. The estimated treatment difference (ETD) between both groups was -3.2 kg [-4.0; -2.5] (P 0.001) after 12 weeks and -1.8 kg [-2.8; -0.8] (P 0.001) after 52 weeks.A low-intensity lifestyle intervention combined with a liquid meal replacement is superior regarding weight reduction and improvement of cardiovascular risk factors than lifestyle intervention alone.

Although growing evidence underlines the benefits of physical activity as supportive intervention for cancer patients, sparse data are available for exercise in patients with advanced disease stages, in particular for gastrointestinal cancer (GIC) patients who experience specific disease-associated limitations. Thus, the aim of this study is to evaluate the effects of home-based moderate intensity exercise on functional capacity, activities of daily living (ADL) and body composition in patients with advanced GIC during first-line chemotherapy.Participants (GIC, UICC III-IV; n = 44) were randomly assigned to home-based physical activity programme of 150 min moderate walking per week or a control group (CG). Functional status (SPPB: gait speed, balance, lower extremity muscle strength), postural sway, chemotherapy-induced peripheral neuropathy, nutritional state (Mini Nutritional Assessment, MNA) and lean body mass were assessed according to established recommendations. All tests were performed before chemotherapy (T0), after two chemotherapy cycles (T1) and after 12 weeks (T2).SPPB changes from T1 to T2 differed between groups with a comparably greater decrease in the CG (p .05), but no changes or group differences over the whole study period (T0 to T2) were found. Exercise improved postural sway (T0 to T1; T0 toT2) and lean body mass (T1 to T2; T0 to T2) compared to the control group (p .05). Gait speed, peripheral neuropathy and strength did not differ between groups (p .05).Our results indicate that a home-based physical activity improves postural sway and body composition and might stabilize functional capacity in patients with advanced GIC during chemotherapy. Although the other outcomes did not differ between groups, aforementioned effects might contribute to a maintenance of independency in ADL and a better treatment tolerance and thus enhance patients' quality of life.

The aim of this cross-sectional study was to determine the associations of objectively assessed habitual physical activity and physical performance with brain plasticity outcomes and brain-derived neurotrophic factor (BDNF) levels in cognitively healthy older adults. Physical performance was analyzed based on cardiopulmonary exercise-testing data and accelerometer-based physical activity was analyzed as total activity counts, sedentary time, light physical activity and moderate to vigorous physical activity. Brain plasticity outcomes included magnetic resonance spectroscopy (MRS)-based markers, quantitative imaging-based hippocampal volume and BDNF serum levels. The association between physical performance and hippocampal volume was strongly influenced by participants' education, sex, age and BMI. Confounder-controlled correlation revealed significant associations of brain plasticity outcomes with physical activity but not with performance. MRS-based adenosine triphosphate to phosphocreatine and glycerophosphocholine to phosphocreatine ratios were significantly associated with accelerometer total activity counts. BDNF was detrimentally associated with sedentary time but beneficially related to accelerometer total activity counts and moderate to vigorous physical activity. Exceeding the current moderate to vigorous physical activity recommendations led to significantly higher BDNF levels. Our results indicate that regular physical activity might be beneficial for preserving brain plasticity in higher age. In this study these associations were not mediated significantly by physical performance. Overall physical activity and exceeding current moderate to vigorous physical activity recommendations were positively associated with BDNF. Sedentary behavior, however, seems to be negatively related to neurotrophic factor bioavailability in the elderly.

Objectives To investigate the practices and attitudes of professional basketball head coaches towards injury prevention. Design Survey. Setting Elite-level basketball. Participants Head coaches of all 366 German professional teams. Main outcome measures Use of injury risk screening methods, rated importance of different musculoskeletal injuries and rated effectiveness of preventive interventions. Results Eighty-three of 366 invited coaches (23%) responded to the survey. No non-response bias was detected. Only one of three teams conducts systematic injury screenings. The most commonly used test was the functional movement screen (73.1% of users), while balance and strength testing (both 38.5%) were least prevalent. Top-rated preventive interventions included balance and strength training, training of functional movement patterns, and stretching. In contrast, passive interventions, e.g. the use of orthoses, were not considered effective. The involvement of a health professional (e.g. physiotherapist) was associated with the performance of injury screening, but not with the choice of specific tests or preventive strategies. Conclusions The methods applied to conduct injury screening and prevent musculoskeletal disorders in German professional basketball teams seem only partially backed by scientific evidence. Although not correlated with the tests and interventions used, the involvement of health-related stakeholders might help to identify players at increased injury risk.

Idiopathic as well as nonspecific low back pain is relevant in health care systems as well as inleisure and high-performance sports. Neuromuscular and/or structural deficits, mostly accompanied by biopsychological factors,are known risk factors for both the onset and chronification of symptoms. Meta-analytic evidence describes positive effects of physical activity. However, type, dose-response relation, minimum of training required and setting-specific implementation has not been fully clarified. Since 2011, the national research network „Medicine in Spine Exercise“ [MiSpEx] has been following a project layout called „Ran Rucken“ focussing on the development and validation of intervention programs including neuromuscular and pain adaptation moderated by individual training status, pain behaviour, allostatic load and social settings. Overall about 8000 patients and athletes have been and are being followed experimentally and clinically in 34 studies. It could be shown that a training program focussing on compensation of external loads elicited by perturbations is effective in prevention and rehabilitation in both athletes and general population. Besides validation of further consecutively developed programs emphasis is put on the evaluation of transfer strategies to medical systems, sports as well as general population. Finally, the evaluation of an efficient dose-response relation is addressed.

Validated strategies and guidelines for a safe and individualized diagnosis and return-to-play (RTP) after concussion in rugby are needed. Little is known about the state of knowledge, frequency of use and application barriers of state-of-the-art guidelines among decision-makers in professional or semi-professional rugby teams. Participants (n = 195) from the coaching team (head coach, assistance coach, athletic coach), the medical team (physiotherapist, physician, rehabilitation therapist, neuropsychologist), or from the officials of a professional or semi-professional rugby team (top three major leagues in Germany), filled in a questionnaire on their knowledge, frequency of use and application barriers of evidence-based guidelines (Graduated RTP protocol and The 5R). Depending on their function in the team and on the league of play, the state of knowledge and application of the diagnostic tools and the RTP guidelines differ. A considerable number are aware of one or both guidelines, but do not apply these guidelines (up to 27% of respondants). The main reasons for the non-usage were not my decision (59%), use of concurrent guidelines (54%), each player must decide by his own (36%), never experienced a concussion in my players (30%), other (19%), the guideline is useless (18%) and a player may play despite a concussion (14%). Raising awareness of the state-of-the-art guidelines is important to educate further the coaching, medical and official team members in identifying symptoms and executing the RTP-process in accordance with evidence-based strategies.