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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.

While obesity impairs health-related quality of life (HRQOL), lifestyle interventions targeting weight reduction have been effective in improving HRQOL. Therefore, we hypothesised that a meal replacement-based lifestyle intervention, which has been shown to successfully reduce weight, would also improve HRQOL more effectively than a lifestyle intervention alone. In the international, multicenter, randomised-controlled ACOORH-trial (Almased-Concept-against- Overweight-and-Obesity-and-Related-Health-Risk), overweight or obese participants with elevated risk for metabolic syndrome (n = 463) were randomised into two groups. Both groups received telemonitoring devices and nutritional advice. The intervention group additionally used a protein-rich, low-glycaemic meal replacement for 6 months. HRQOL was estimated at baseline, after 3 and 12 months, using the SF-36 questionnaire, and all datasets providing HRQOL data (n = 263) were included in this predefined subanalysis. Stronger improvements in the physical component summary (PCS) were observed in the intervention compared to the control group, peaking after 3 months (estimated treatment difference 2.7 [1.2; 4.2]; p < 0.0001), but also in the long-term. Multiple regression analysis demonstrated that insulin levels and the achieved weight loss were associated with the mental component summary (MCS) after 12 months (p < 0.05). Thus, meal replacement-based lifestyle intervention is not only effective in weight reduction but, concomitantly, in enhancing HRQOL.

Physical exercise has been shown to alter sensory functions, such as sensory detection or perceived pain. However, most contributing studies rely on the assessment of single thresholds, and a systematic testing of the sensory system is missing. This randomised, controlled cross-over study aims to determine the sensory phenotype of healthy young participants and to assess if sub-maximal endurance exercise can impact it. We investigated the effects of a single bout of sub-maximal running exercise (30 min at 80% heart rate reserve) compared to a resting control in 20 healthy participants. The sensory profile was assessed applying quantitative sensory testing (QST) according to the protocol of the German Research Network on Neuropathic Pain. QST comprises a broad spectrum of thermal and mechanical detection and pain thresholds. It was applied to the forehead of study participants prior and immediately after the intervention. Time between cross-over sessions was one week. Sub-maximal endurance exercise did not significantly alter thermal or mechanical sensory function (time × group analysis) in terms of detection and pain thresholds. The sensory phenotypes did not indicate any clinically meaningful deviation of sensory function. The alteration of sensory thresholds needs to be carefully interpreted, and only systematic testing allows an improved understanding of mechanism. In this context, sub-maximal endurance exercise is not followed by a change of thermal and mechanical sensory function at the forehead in healthy volunteers.

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.

When sports are part of a person’s profession or education, their careers are often handicapped by pain, a complex physical and mental state that may already occur at lower career stages. This study was designed to assess the occurrence of pain among sports students and the prevalence of relevant contributing psychosocial co-factors. Exploratory cross-sectional study surveying students at 89 sports faculties of universities in the DACH region using the German Sports Pain Questionnaire. It includes several validated surveys related to pain occurrence in different body regions, injuries, pain diagnoses and pain intensity, depression, anxiety, stress, self-compassion, analgesic and alcohol consumption, as well as sleep quality, health-related quality of life and impairments of quality of life by pain. A total of 865 sports students gave consent to participate in the study, and 664 participants (78%; 23.3 ± 2.84 years, 60% female, 40% male) completed the full survey. More than half of the students (53%; n = 403) showed current pain in 2-5 regions of the body, while subjective pain tolerance was enhanced. General injuries or accidents, medically and self-diagnosed pain diagnoses during the last eight weeks were reported by 30%. A current pain intensity ≥ 3 NRS was prevalent in 28% (n = 205), which correlated with increased pain-related biopsychosocial scores. Sports students had increased scores for depression, anxiety and stress, and self-compassion was reduced (compared to age-controlled national reference data, sports students head increased scores). The mean weekly training workload was 5-7 hours. Analgesics and alcohol consumption was increased, 61% reported insomnia. Across sports students, pain and biopsychosocial burden seem significantly increased when compared to other students and age-controlled cohorts. The data implies the need of giving greater importance to pain management at least from the time of sports studies in order to prevent pain and health risks in sports.

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

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

Low-caloric formula diets can improve hemodynamic parameters of patients with type 2 diabetes. We, therefore, hypothesized that persons with overweight or obesity can benefit from a high-protein, low-glycemic but moderate-caloric formula diet. This post-hoc analysis of the Almased Concept against Overweight and Obesity and Related Health Risk- (ACOORH) trial investigated the impact of a lifestyle intervention combined with a formula diet (INT, n = 308) compared to a control group with lifestyle intervention alone (CON, n = 155) on hemodynamic parameters (systolic and diastolic blood pressure (SBP, DBP), resting heart rate (HR), and pulse wave velocity (PWV)) in high-risk individuals with prehypertension or hypertension. INT replaced meals during the first 6 months (1 week: 3 meals/day; 2–4 weeks: 2 meals/day; 5–26 weeks: 1 meal/day). Study duration was 12 months. From the starting cohort, 304 (68.3%, INT: n = 216; CON: n = 101) participants had a complete dataset. Compared to CON, INT significantly reduced more SBP (−7.3 mmHg 95% CI [−9.2; −5.3] vs. −3.3 mmHg [−5.9; −0.8], p < 0.049) and DBP (−3.7 mmHg [−4.9; −2.5] vs. −1.4 mmHg [−3.1; 0.2], p < 0.028) after 12 months. Compared to CON, INT showed a pronounced reduction in resting HR and PWV after 6 months but both lost significance after 12 months. Changes in SBP, DBP, and PWV were significantly associated positively with changes in body weight and fat mass (all p < 0.05) and resting HR correlated positively with fasting insulin (p < 0.001) after 12 months. Combining a lifestyle intervention with a high-protein and low-glycemic formula diet improves hemodynamic parameters to a greater extent than lifestyle intervention alone in high-risk individuals with overweight and obesity.

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.

In the second wave of the COVID-19 pandemic in Germany, lockdown measures were reinstalled and were in place between November 2020 and April 2021, including the closure of physical activity facilities. The aim of the current online survey was to assess the lockdown effects on physical activity and well-being in the general population. Pre-lockdown vs. lockdown differences were tested with the Χ2 test and the Student’s t-test for paired data. Predictor variables to explain compliance with physical activity recommendations were identified using a fixed-effects binary logistic regression analysis. Data of 993 respondents were analyzed. Transport-related and leisure-time physical activity decreased (p < 0.001, d = 0.25, and p < 0.001, d = 0.33, respectively). Compliance with physical activity recommendations decreased from 42.2% to 29.4% (chi2 (1, 1986) = 35.335, p < 0.001, V = 0.13). Well-being decreased significantly (t (990) = 23.405, p < 0.001) by 16.3 points (d = 0.74). Physical activity and well-being declined in German adults during the second COVID-19-related lockdown. Physical activity should be promoted also in light of the emerging evidence on its protective effects against COVID-19.

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.