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Incorporation of MAX phase to fabricate low-carbon refractories has been recently proposed. Among them, Cr 2 AlC was the undoubtedly one which was regarded as the most potential candidates for applications, due to the excellent chemical stability of chromium oxide. In this work, the influence of Cr 2 AlC on the thermal shock resistance and corrosion resistance of Al 2 O 3 -Cr 2 AlC-C refractories were investigated. The results indicated that the residual strength ratio still maintained stability when flake graphite content reduced from 9 wt% to 4 wt%. While the corrosion resistance of the sample with 4 wt% graphite and 5 wt% Cr 2 AlC increased approximately 40% compared with regular Al 2 O 3 -C refractories with 9 wt% graphite. The degradation mechanisms and interactions of Al 2 O 3 -Cr 2 AlC-C refractories in contact with MnO-rich slag were studied, and the role of Cr 2 AlC was elucidated. [ABSTRACT FROM AUTHOR]

Quadrupedal movement training (QMT) is a unique form of bodyweight training shown to improve flexibility, FMS scores, and proprioception, however, little is known about its muscle activation characteristics. Therefore, the purpose of this study was to compare surface EMG (sEMG) activity of muscles of the trunk, upper, and lower extremity during QMT movements and common traditional bodyweight exercises (TRA). Twenty (males n = 9) participants (age: 27.5 ± 10.8 yrs, height: 169.0 ± 7.0 cm, mass: 66.6 ± 10.9 kg) were prepped and fitted with sEMG electrodes on their right-side bicep brachii, medial deltoid, triceps brachii, pectoralis major, latissimus dorsi, rectus abdominus, rectus femoris and bicep femoris. Following completion of maximal voluntary isometric contraction (MVIC) tests for normalization, participants performed 4 repetitions of 8 QMT exercises (from the Animal Flow™ system) and 3 TRA exercises (pushup, squat and forearm plank) in random order. The pooled peak muscle activations of all QMT exercises resulted in moderate (21–40% MVIC) to very high (>60% MVIC) peak muscle activation levels for each muscle group with significantly higher (p > 0.05) muscle activation for the biceps (47.72 ± 21.41%), deltoid (66.58 ± 11.39%), and latissimus dorsi (62.81 ± 18.14%) than the pushup (23.31 ± 16.95, 45.63 ± 18.59, 29.17 ± 20.58% respectively) and significantly higher activation of the bicep femoris (41.89 ± 13.83%) than the squat (17.79 ± 11.12%). TRA (pushup) showed significantly higher activation of the triceps and pectoralis. There were no differences in rectus femoris or rectus abdominus. Muscle activation levels during QMT are comparable to or higher than common traditional bodyweight exercises and therefore may be an appealing strategy for training multiple muscle groups simultaneously. [ABSTRACT FROM AUTHOR]

The muscle thickness (MT) acutely increases in response to the redirection of blood flow during exercise, with this muscle swelling being a proxy to quantify the degree of muscle stimuli and involvement in an exercise. The present study aims to compare the MT acute variations between the biceps brachii (BB) and brachialis (BRA) muscles in two different unilateral exercises, the dumbbell curl (DC) and dumbbell row (DR). Sixteen well-trained young males performed a 10-repetition maximum (10RM) load test and retest for each exercise. Four sets were performed with the 10RM load for each exercise until the concentric failure. The BB and BRA muscles MT were measured pre and post-intervention with a B-mode ultrasound images. The main finding of this study was that, when DC is performed, the BB presented greater MT changes (18.67% ± 6.23) compared to BRA (12.27% ± 6.20) (p = 0.025), and compared to BB when performed in DR (12.23% ± 6.03) (p = 0.024). It was also found that BB greatest increase from BRA was not observed in DR and the BRA results were similar in both exercises. These results indicate that the structural acute responses can be muscle-specific among the elbow flexors muscles for the single-joint exercise and also exercise-specific. Therefore, either one of these two exercises can be chosen to stimulate BRA, but it would be interesting to use DC to offer greater stimuli for BB. [ABSTRACT FROM AUTHOR]

Traditional exercises using an elastic band are often standard in clinical practice to gain muscle strength. Additionally, functional exercises are considered more representative of functional tasks or sport. However, it is unclear whether functional exercises are comparable to traditional exercises in activating the ankle joint and foot. The purpose of this study was to analyze the effects of functional exercise and traditional exercise on the muscle activity of the ankle joint and foot. Thirty women participated in this study. Using surface electromyographic, muscle activation of the Tibialis Anterior (TA), Peroneus Longus (FL), Peroneus Short (FC), Gastrocnemius Medialis (GM) and Flexor Digitorum Shortus (FCD) was measured in nine exercises (dorsiflexion with an elastic band, plantar flexion with an elastic band, inversion with an elastic band, eversion with an elastic band, towel curl, standing plantar flexion, squats with an elastic band on the foot, diagonal propulsion and propulsion with peroneal stimulation). The muscle activation was normalized by the activation in maximum voluntary isometric contraction. Functional exercises showed larger mean EMG amplitudes than the traditional exercises for all muscle groups (p > 0.05). Functional exercises provoked more activation compared with the traditional exercises. Functional exercises can be indicated to improve muscle function and functional task performance in populations that suffer dysfunction in ankle joint and foot. [ABSTRACT FROM AUTHOR]

The three portions of the deltoid muscle (anterior, middle, and posterior) are primary movers of several strengthening exercises and their contribution to different exercises can be measured using surface electromyography. To systematically review studies that evaluated the activation of commonly used exercises and their variations. A search was conducted in PubMed (MEDLINE), Web of Science, Scopus and SciELO. Thirty-three studies met the inclusion criteria, evaluating at least one deltoid portion during conventional isotonic exercises (minimum load: 60% of one-repetition maximum or body weight) and reporting normalized values. Similar exercises were grouped, averaged, and ranked according to the resulting activation. Individual exercise variations were also ranked. For anterior deltoid, horizontal adductions (inclined) and horizontal adductions (horizontal) generated the greatest activation, while the inclined dumbbell fly was the individual exercise with greatest activation; for middle deltoid, abductions and horizontal abductions presented the greatest activation, with lateral raises associated with internal rotation being the exercise producing greatest activation. For posterior deltoid, pull-ups generated greatest activation, with the standard pull-up and the inverted row with a suspension device requiring the greatest individual exercise activation. These findings can be useful for coaches and practitioners when choosing the most appropriate exercise for strengthening programs. [ABSTRACT FROM AUTHOR]

• Hand motor interventions improve cognition post-stroke according to meta-analysis. • Robot-assisted and strength training are probably the most effective approaches. • Virtual reality and conventional rehabilitation were less effective. • There is limited evidence on their effects on specific cognitive domains. To synthetize the evidence on the effects of hand rehabilitation (RHB) interventions on cognition post-stroke and compare their efficacy. PubMed, Embase, Cochrane, Scopus, Web of Science, and CINAHL were searched from inception to November 2022. Randomized controlled trials conducted in adults with stroke where the effects of hand motor interventions on any cognitive domains were assessed. Data were extracted by 2 independent reviewers. A Bayesian Network Meta-analysis (NMA) was applied for measures with enough studies and comparisons. Risk of bias was assessed with the Cochrane Risk of Bias tool. Fifteen studies were included in qualitative synthesis, and 11 in NMA. Virtual reality (VR) (n=7), robot-assisted (n=5), or handgrip strength (n=3) training were the experimental interventions and conventional RHB (n=14) control intervention. Two separate NMA were performed with MoCA (n=480 participants) and MMSE (n=350 participants) as outcome measures. Both coincided that the most probable best interventions were robot-assisted and strength training, according to SUCRA and rankogram, followed by conventional RHB and VR training. No significant differences between any of the treatments were found in the MoCA network, but in the MMSE, robot-assisted and strength training were significantly better than conventional RHB and VR. No significant differences between robot-assisted and strength training were found nor between conventional RHB and VR. Motor interventions can improve MoCA/MMSE scores post-stroke. Most probable best interventions were robot-assisted and strength training. Limited literature assessing domain-specific cognitive effects was found. [ABSTRACT FROM AUTHOR]

When strength training (ST) sets are performed to muscular failure over successive sets, a reduction in performance is expected, which would compromise training volume (TV). One method to sustain repetitions and limit the volume impairment is to acutely reduce the load over successive sets. However, previous studies did not investigate this load reduction in different exercise orders. The aim of the present study was to investigate the effect of progressive 10% load reductions on TV with different exercise orders. Eleven healthy men performed four protocols: multi- to single-joint (MS) protocol and single- to multi-joint (SM) protocol were performed with a constant 10-RM load or with a 10% load reduction over successive sets (MS10 and SM10), respectively. The results showed that the two load reduction protocols had significantly greater TV versus the two protocols without load reduction, independent of the order (P < 0.05). Significantly greater total volume was achieved on the last exercise of a sequence with load reduction versus without load reduction (P > 0.05). Training volume can be maintained more effectively when a load reduction of 10% is progressively applied over successive sets. [ABSTRACT FROM AUTHOR]

• Among Korean adults ≥65y, 25% of men and 36% of women had low muscle strength. • Only 16% of Korean adults met the recommended nutrient intake of dietary vitamin C. • Dietary vitamin C intake was correlated with handgrip strength in Korean women. • Korean women ≥65y with low dietary vitamin C had a higher risk of possible sarcopenia. Although vitamin C is one of the most important antioxidants, its effect on muscle quality is not fully understood. Therefore, we hypothesized that low dietary vitamin C intake is associated with low muscle strength. To test the hypothesis, a single 24-h dietary recall and handgrip strength test of 10,883 younger adults 19-64 y and 3,961 older adults ≥65 y from the seventh Korea National Health and Examination Survey (KNHANES VII 2016-2018) was analyzed by multivariable linear and logistic regression models, and low muscle strength was defined as handgrip strength <28 kg for men and <18 kg for women. Approximately 15.5% of Korean adults met the recommended intake of dietary vitamin C, and those with higher dietary vitamin C intake had higher total energy and protein intake. After adjusting for confounding variables, including age, body mass index, total energy intake, household income, alcohol consumption, smoking, resistance exercise, medical condition, and dietary intake of protein, vitamin E, and β-carotene, dietary vitamin C was correlated with maximal handgrip strength in younger women 19-64 y (β = 0.002; SE = 0.001; P -value =.026) and older women ≥65 y (β = 0.005; SE = 0.002; P -value =.013). Among older women ≥65 y, those in the lowest quartile of dietary vitamin C intake had a higher risk of low muscle strength compared to those in the highest quartile after adjustment of confounding factors (odds ratio, 2.16; 95% confidence interval, 1.49-3.15). These results imply that adequate dietary vitamin C intake may reduce the risk of sarcopenia in older Korean women. Dietary vitamin C was shown to be inversely associated with the risk of low muscle strength in older Korean women. Although no association between the two variables among younger men 19-64 y, older men ≥65 y, and women 19-64 y was observed, older Korean women ≥65 y in the lowest quartile of vitamin C intake had significantly higher odds of low muscle strength compared to those in the highest quartile with adjustment for confounding variables (OR, 2.16; 95% CI, 1.49-3.15). [Display omitted] [ABSTRACT FROM AUTHOR]

• Maximal hip and knee extension muscle strength increased by the training program. • Apathy and anxiety decreased after the 12-week training. • Muscle hypertrophy was induced by resistance training. Myotonic dystrophy type 1 (DM1) is a hereditary disease characterized by muscular impairments. Fundamental and clinical positive effects of strength training have been reported in men with DM1, but its impact on women remains unknown. We evaluated the effects of a 12-week supervised strength training on physical and neuropsychiatric health. Women with DM1 performed a twice-weekly supervised resistance training program (3 series of 6–8 repetitions of squat, leg press, plantar flexion, knee extension, and hip abduction). Lower limb muscle strength, physical function, apathy, anxiety and depression, fatigue and excessive somnolence, pain, and patient-reported outcomes were assessed before and after the intervention, as well as three and six months after completion of the training program. Muscle biopsies of the vastus lateralis were also taken before and after the training program to assess muscle fiber growth. Eleven participants completed the program (attendance: 98.5 %). Maximal hip and knee extension strength (p < 0.006), all One-Repetition Maximum strength measures (p < 0.001), apathy (p = 0.0005), depression (p = 0.02), pain interference (p = 0.01) and perception of the lower limb function (p = 0.003) were significantly improved by training. Some of these gains were maintained up to six months after the training program. Strength training is a good therapeutic strategy for women with DM1. [ABSTRACT FROM AUTHOR]

Although the important roles of proprioception and neuromuscular control in carpal instabilities under laboratory conditions have been recognized, only a few studies have translated this knowledge into a routine clinical practice. This study aimed to evaluate the results of a personalized rehabilitation in patients with carpal instability on functionality and pain intensity. This was a case series study. This case series included 39 adults (mean age: 38.2 ± 14.0 years; 16/23 females/males) diagnosed with carpal instability (radial or ulnar) with indication for orthopedic treatment. The disabilities of the arm, shoulder, and hand questionnaire was used to assess upper limb functionality. Pain perception was assessed using a visual analog scale. Exercise-based physiotherapy interventions were performed according to the clinical needs of the patients for at least 6 weeks (2-3 sessions per week). For the treatment of radial instability (n = 13), strengthening exercises of the abductor pollicis longus, extensor carpi radialis longus, flexor carpi radialis, and pronator quadratus muscles were prescribed. For the treatment of ulnar instability (n = 24), extensor carpi ulnaris and pronator quadratus were trained. All patients underwent proprioceptive training in open kinetic chain and closed kinetic chain, as well as strengthening of the unaffected hand. Changes before and after treatment were compared using the nonparametric Wilcoxon signed rank test. A significant improvement with a large effect size in disabilities of the arm, shoulder, and hand (P <.001; d = 2.9) and visual analog scale (P <.001; d = 3.2) scores were obtained after treatment. Moreover, the changes were greater than the minimal clinically important difference of 10.8 and 1.4, respectively. Similar results were found when patients with radial instability and ulnar instability were analyzed separately. Personalized training with specific proprioception and strengthening exercises produces improvements in functionality and pain perception in our cohort of people with carpal instability. These results highlight the importance of multicomponent exercise in the treatment of wrist instability. Future randomized clinical trials should further investigate the effectiveness of this protocol. • The protocol included strength training exercises combined with proprioceptive and cross-education training. • The combined exercise program showed benefits for function and pain in patients with carpal instability. • This protocol could be a valid alternative as a nonsurgical treatment for carpal instabilities. [ABSTRACT FROM AUTHOR]

The present study aimed to determine the magnitude and intervention time of resistance training required to generate adaptations in the muscle thickness of the quadriceps muscle obtained by ultrasound in healthy adults. A systematic review with meta-analysis was conducted on studies recovered from Pubmed, Web of Science, and Scopus databases up to March 2022. The study selection process was carried out by two independent researchers, with the presence of a third researcher in case of disagreements. The methodological quality of the studies was determined with the TESTEX scale, and the risk of bias analysis was determined using Cochrane's RoB 2.0 tool. The meta-analysis used the inverse of the variance with a fixed model, and the effect size was reported by the standardized mean difference (SMD) with a confidence interval of 95%. Ten studies were included in a meta-analysis. The overall analysis of the studies demonstrated an SMD = 0.35 [95% CI: 0.13–0.56] (P = 0.002), with a low heterogeneity of I2 = 0% (P = 0.52). No publication bias was detected using a funnel plot followed by Egger's test (P = 0.06). The degree of certainty of the meta-analysis was high using the GRADE tool. We found that resistance training can generate significant average increases of 16.6% in muscle thickness obtained by ultrasound in the quadriceps femoris muscles of healthy adults. However, the subgroup analysis showed that significant effect sizes were only observed after eight weeks of training. • The ultrasound technique could monitor increases in quadriceps femoris muscle thickness resulting from resistance training. • A weighted average increase of 16.6% in muscle thickness was observed resulting from resistance training. • This research adopted the PRISMA guidelines, TESTEX scale, Cochrane's RoB 2.0 tool, and GRADE scale. [ABSTRACT FROM AUTHOR]

Recent research interest has grown in exploring the role of muscles, isometric contraction, proprioception, and neuromuscular control in addressing dynamic scapholunate and lunotriquetral joint instability, marking a shift in the understanding of wrist stability. To present a comprehensive review of the carpal ligaments anatomy and wrist biomechanics, with a particular focus on the role of proprioception in dynamic carpal stability and their role in managing scapholunate (SL) and lunotriquetral (LTq) dynamic instabilities. We conducted a systematic search of the literature and review of the most relevant papers published and indexed in pubmed, related to wrist biomechanics, proprioception and its contribution to carpal dynamic stability. The study involved a comprehensive review of neuromuscular mechanisms in dynamic stabilization of the carpus, based on cadaver studies. The 3D position of the scaphoid, triquetrum, and capitate was monitored before and after tendon loading. The extensor carpi ulnaris (ECU) and the flexor carpi radialis (FCR) are identified as the primary pronators of the midcarpal joint. The ECU's pronation effect can potentially strain the scapholunate ligament, while the supinator muscles, the abductor pollicis longus (APL), the extensor carpi radialis longus (ECRL), and the flexor carpi ulnaris (FCU), have a protective role, particularly in cases of scapholunate ligament dysfunctions. The FCR, despite being a pronator of the distal row, has a beneficial effect as it provokes supination of the scaphoid. Comprehending carpal dysfunctions and instabilities hinges on understanding carpal anatomy and normal biomechanics. Proprioception, encompassing joint position sensation and neuromuscular control, is pivotal for stability. Biomechanical research informs tailored muscle strengthening for specific carpal issues. Supinator muscles should be strengthened for SL injuries, and ECU-focused strengthening and proprioceptive training are key for dynamic LTq instabilities. Ongoing research should delve into the intricate relationship between carpal ligaments, muscles, and proprioception to enhance wrist stability. • Forearm muscles are categorized as carpal pronators or supinators based on their effect during traction in neutral rotation. • The carpal pronator muscles are the extensor carpi ulnaris and the flexor carpi radialis. • The carpal supinator muscles are the abductor pollicis longus, extensor carpi radialis longus, and flexor carpi ulnaris. • Scapholunate dysfunction may benefit from strengthening and proprioceptive training of the supinator muscles and flexor carpi radialis. • Lunotriquetral dysfuntions may benefit from strengthening and proprioceptive training of the extensor carpi ulnaris. [ABSTRACT FROM AUTHOR]

• Improvements in disability scores were clinically relevant with both programs. • Mobility improved by 29% and pain was reduced by 57% in the combined program. • Strength improved in both groups but with a greater effect size in combined program. • Improvements in disability, pain, mobility and strength were maintained 1-month later. Thumb carpometacarpal osteoarthritis (CMC OA) greatly affects post-menopausal women. It is characterized by pain and functional deficits that limit the performance of activities of daily life and affect quality of life. Analyze the effects of 4/weeks strength training, with and without proprioceptive neuromuscular facilitation (PNF) on the disability among post-menopausal women with thumb CMC OA. Secondly, analyze the effects on pain, mobility, and strength. Superiority randomized clinical trial. 42 women were randomly allocated to strength training program (SEG, n = 21) and to a strength training plus PNF therapy program (PNFG, n = 21). The Disability (disabilities of the arm, shoulder and hand questionnaire), pain (visual analogue scale), mobility (Kapandji Test), and hand strength were evaluated pre, post intervention (at 4 weeks) and follow-up (at 8 weeks). Disability was significantly reduced in both groups after intervention, but reduction was statistically superior in PNFG (between-group mean difference [MD] = -16.69 points; CI = -21.56:-11.82; P <.001; d = 2.14). Similar results were observed for secondary outcomes: pain (MD = -2.03; CI = -2.83:-1.22; P <.001; d = 1.58), mobility (MD = 0.96; CI = 0.52:1.38; P <.001; d = 1.40) and strength (grip: MD = 3.47kg; CI = 1.25:5.69; P =.003; d = 0.97, palmar: MD = 0.97kg; CI = 0.14:1.80; P =.024; d = 0.72, tip: MD = 1.12kg; CI = 0.41:1.83; P =.003; d = 0.99 and key pinch: MD = 0.85kg; CI = 0.001:1.70; P =.049; d = 0.62). These improvements were maintained at follow-up. The combination of PNF exercises and strength training is more effective for reducing disability pain and improve mobility and strength in post-menopausal women with CMC OA than a programme based solely on strength. [ABSTRACT FROM AUTHOR]

Tactical athletes need to develop strength and lower limb lean mass (LL LM) to perform effectively. Resistance training (RT) is the most effective way to achieve these goals. Two periodization models stand out: traditional linear periodization (TLP) and daily undulating periodization (DUP). To verify the effect of lower limb RT with TLP and DUP on isotonic and isokinetic muscle strength and lean mass in tactical athletes. Thirty-five Brazilian Army military (21.57 ± 2.02 years; 81.81 ± 11.19 Kg; 177.79 ± 6.88 cm) were divided into two treatment groups and one active control group. The treatment groups performed 9 weeks of supervised RT (18 sessions), consisting of free weight exercises in this order: back squat, squat lunge, deadlift, and stiff legged deadlift. Dynamic isotonic muscle strength, lean mass, and isokinetic knee extension and flexion were assessed at baseline and post treatment period. There was a significant pre-post difference in dynamic isotonic muscle strength (TLP, P < 0.001; DUP, P < 0.001) and lean mass (TLP, P = 0.034; DUP, P = 0.003) of LL LM in both treatment groups. However, effect sizes (ES) and variations (%Δ) of gains were greater in the DUP group both in muscle strength (TLP, ES = 1.55, %Δ = 30.97; DUP, ES = 2.55, %Δ = 36.02), and in lean mass (TLP, ES = 0.13, %Δ = 2.07; DUP, ES = 0.44, %Δ = 2.95). For isokinetic knee flexion strength, a significant difference was found between the TLP versus CON. Both lower limb RT periodization models provided gains in muscle strength and lean mass, with a small advantage for the DUP approach. In the isokinetic knee flexion strength, the TLP was more effective. • Lower limb RT with DUP is slightly more efficient than TLP for developing muscle strength and lean mass in tactical athletes. • "Trivial" and "small" lean mass gains provided "moderate" and "large" gains in muscle strength, respectively. • When there is muscle imbalance in isokinetic strength, generally the need for strength gains is in the posterior chain. In this context, lower limb RT with TLP is more effective for isokinetic strength gains in hamstrings. [ABSTRACT FROM AUTHOR]

• Resistance training improves body adiposity, metabolic risk, and inflammation in postmenopausal and older females. • High-volume resistance training elicits greater improvements in metabolic risk and inflammation outcomes. • We identified an optimal dosage for resistance training prescription in this population. This meta-analytical study aimed to explore the effects of resistance training (RT) volume on body adiposity, metabolic risk, and inflammation in postmenopausal and older females. A systematic search was performed for randomized controlled trials in PubMed, Scopus, Web of Science, and SciELO. Randomized controlled trials with postmenopausal and older females that compared RT effects on body adiposity, metabolic risk, and inflammation with a control group (CG) were included. Independent reviewers selected the studies, extracted the data, and performed the risk of bias and certainty of the evidence (Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)) evaluations. Total body and abdominal adiposity, blood lipids, glucose, and C-reactive protein were included for meta-analysis. A random-effects model, standardized mean difference (Hedges' g), and 95% confidence interval (95%CI) were used for meta-analysis. Twenty randomized controlled trials (overall risk of bias: some concerns; GRADE: low to very low) with overweight/obese postmenopausal and older females were included. RT groups were divided into low-volume RT (LVRT, ∼44 sets/week) and high-volume RT (HVRT, ∼77 sets/week). Both RT groups presented improved body adiposity, metabolic risk, and inflammation when compared to CG. However, HVRT demonstrated higher effect sizes than LVRT for glucose (HVRT = –1.19; 95%CI: –1.63 to –0.74; LVRT = –0.78; 95%CI:–1.15 to –0.41) and C-reactive protein (HVRT = –1.00; 95%CI: –1.32 to –0.67; LVRT = –0.34; 95%CI, –0.63 to –0.04)) when compared to CG. Compared to CG, HVRT protocols elicit greater improvements in metabolic risk and inflammation outcomes than LVRT in overweight/obese postmenopausal and older females. [Display omitted] [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) public health protocols required medical educators to rapidly move curricula online. This included academic detailing (AD), a form of one-to-one or small group educational outreach for primary care providers (PCPs). This study aimed to contribute to the sparse evidence base exploring virtual AD by exploring strengths, challenges, and best practices. This case study drew on 3 methods: (1) observations of AD visits (n = 5 sessions), (2) group (n = 6 detailers) and one-on-one interviews (n = 5 PCPs, n = 3 detailing staff), and (3) document analysis of curriculum and policy documents (n = 10 documents). Our analysis identified several strengths of virtual detailing: (1) inherent benefits of virtual programming, (2) pre-existing strengths in program leadership, (3) global move toward telehealth amid COVID, (4) pre-existing detailing relationships, and (5) pre-existing roles and attributes of pharmacists. Several challenges were also identified: (1) virtual presence in group visits, (2) establishing consistency across modalities, and (3) technological issues. Virtual detailing has posed unique challenges and opportunities for innovation. Our study supports a blended model moving forward—one that balances strengths and challenges of virtual and in-person delivery and considers logistics, efficiencies, environmental impacts, and unique participant needs. [ABSTRACT FROM AUTHOR]

Although physical activity is widely recommended for reducing cardiovascular and all-cause mortality risks, female individuals consistently lag behind male individuals in exercise engagement. The goal of this study was to evaluate whether physical activity derived health benefits may differ by sex. In a prospective study of 412,413 U.S. adults (55% female, age 44 ± 17 years) who provided survey data on leisure-time physical activity, we examined sex-specific multivariable-adjusted associations of physical activity measures (frequency, duration, intensity, type) with all-cause and cardiovascular mortality from 1997 through 2019. During 4,911,178 person-years of follow-up, there were 39,935 all-cause deaths including 11,670 cardiovascular deaths. Regular leisure-time physical activity compared with inactivity was associated with 24% (HR: 0.76; 95% CI: 0.73-0.80) and 15% (HR: 0.85; 95% CI: 0.82-0.89) lower risk of all-cause mortality in women and men, respectively (Wald F = 12.0, sex interaction P < 0.001). Men reached their maximal survival benefit of HR 0.81 from 300 min/wk of moderate-to-vigorous physical activity, whereas women achieved similar benefit at 140 min/wk and then continued to reach a maximum survival benefit of HR 0.76 also at ∼300 min/wk. Sex-specific findings were similar for cardiovascular death (Wald F = 20.1, sex interaction P < 0.001) and consistent across all measures of aerobic activity as well as muscle strengthening activity (Wald F = 6.7, sex interaction P = 0.009). Women compared with men derived greater gains in all-cause and cardiovascular mortality risk reduction from equivalent doses of leisure-time physical activity. These findings could enhance efforts to close the "gender gap" by motivating especially women to engage in any regular leisure-time physical activity. [Display omitted] [ABSTRACT FROM AUTHOR]

• Adipose tissue-derived hormone levels did not change after 10 weeks resistance training. • Hunger and energy intake did not change after 10 weeks resistance training. • Fat-free mass and performance increased after 10 weeks resistance training. • Capsiate supplementation did not potentiate the benefits of 10 weeks resistance training. Capsiate (CAP) is a nonpungent capsaicin analog (Capsicum annuum L. extract) that has been studied as a potential antiobesity agent. However, the interaction between chronic CAP supplementation and resistance training is not clear. The purpose of this study was to examine the changes in adipose tissue–derived hormones, body composition, appetite, and muscle strength after 10 weeks of resistance training, combined with chronic CAP supplementation in healthy untrained men. We hypothesized that CAP could induce higher benefits when combined with resistance training after 10 weeks of intervention compared to resistance training alone. Twenty-four young men (age, 22.0 ± 2.9) were randomized to either capsiate supplementation (CAP = 12 mg/day) or placebo (PL), and both groups were assigned to resistance training. Body composition, leptin and adiponectin concentrations, subjective ratings of appetite, energy intake, and exercise performance were assessed at before and after 10 weeks of progressive resistance training. There was a significant increase in body mass (P <.001), fat-free mass (CAP: 58.0 ± 7.1 vs. post, 59.7 ± 7.1 kg; PL: pre, 58.4 ± 7.3 vs. post, 59.8 ± 7.1 kg; P <.001), resting metabolic rate (CAP: pre, 1782.9 ± 160.6 vs. post, 1796.3 ± 162.0 kcal; PL: pre, 1733.0 ± 148.9 vs. post, 1750.5 ± 149.8 kcal; P <.001), maximal strength at 45 leg press (P <.001) and bench press (P <.001) in both groups, but no significant (P >.05) supplementation by training period interaction nor fat mass was observed. For subjective ratings of appetite, energy intake, leptin, and adiponectin, no significant effect of supplementation by training period interaction was observed (P >.05). In conclusion, 10 weeks of resistance training increased total body weight, muscle mass, and maximum strength in healthy untrained men; however, CAP supplementation (12 mg, 7 days per week) failed to change adipose tissue–derived hormones, appetite, body composition and muscle strength in this population. Registered under Brazilian Registry of Clinical Trials (RBR-8cz9kfq). Ten weeks of resistance training increased total body weight, muscle mass, and maximum strength in healthy untrained men, who were not obese; however, capsiate supplementation (12 mg, 7 days per week) did not change adipose tissue–derived hormones, appetite, body composition, or muscle strength in this population. [Display omitted] [ABSTRACT FROM AUTHOR]

The squat is used in athletic and clinical settings. However, the coordination of the lower extremity during the lift is not well understood. The purpose was to compare the peak moments of the lower extremity joints at three squat depths (above parallel, parallel and full) and three squat loads (unloaded, 50 % 1 repetition maximum, and 85 % of depth specific 1 repetition maximum) and find their contribution to support (M s). Nineteen females performed squats in a randomized order. Inverse dynamics and Winter's M s equation were used to calculate peak moments of the hip, knee and ankle and calculate their contribution to M s (α < 0.05). Peak hip and ankle extensor moments varied with load but not depth and were greatest when using 85 % 1 repetition maximum. Peak knee extensor moments demonstrated a depth by load interaction. Within each depth as load increased so too did peak knee extensor moments and were highest squatting below parallel when loaded. The hip and knee contribution to M s demonstrated a depth by load interaction while the ankle was only influenced by load. Within each depth as load increased hip contribution increased whereas the knee decreased contribution. When squatting with load the contribution of the hip decreased at below parallel while the knee increased. To maximize peak hip moments squat with high load and to maximize peak knee moments squat deep with high load; however, depth and load dosages should be taken into consideration based on the status and goals of the individual. [ABSTRACT FROM AUTHOR]

Prior work regarding post-activation performance enhancement (PAPE) has shown that various resistance training methods and conditioning activities may induce a PAPE effect such as free weight resistance, accommodating resistance or isoinertial resistance. However, the accommodating resistance and other types of resistance have rarely been directly compared. Thus, the aim of this study was to compare the effects of two different conditioning activities (CA) - a trap bar deadlift with (FW + AR condition) or without (FW condition) accommodating resistance - on subsequent squat jump (SJ) performance after a short rest interval of 90s. The study had a cross-over design and fifteen strength trained males (mean age: 22.9 ± 2.1 years; mean relative strength level 2.01 ± 0.27 kg/body mass) participated in one familiarization, two experimental and one control session (CNTR condition). Two CAs were implemented throughout the study - a single set of 3 repetitions of a trap bar deadlift at 80 % of 1RM using solely free weight resistance or with the addition of approximately 15 % of 1RM elastic band tension. The SJ measurements were performed at the baseline and 90s after CAs. The FW + AR condition significantly improved subsequent SJ performance (p < 0.05, effect size 0.34) whereas the FW and CNTR conditions were found to be ineffective to acutely enhance performance. Our results suggest that the addition of accommodating resistance is superior to free weight resistance in order to acutely improve jump performance after a 90s rest interval. To observe the performance enhancement effect with solely free weight resistance it should be considered to introduce alteration in loading strategies or possibly lengthening the rest interval. [ABSTRACT FROM AUTHOR]

How much do active pelvic movements on a Swiss ball during labour affect maternal and neonatal outcomes? A randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis. Two-hundred parturient women. The experimental group performed pelvic anteversion and retroversion, lateral pelvic tilts and circular hip movements according to individual obstetric evaluation (foetal station and position, cervical dilatation and the presence of early pushing urge) on a Swiss ball. The control group received usual care. Both groups were permitted to walk and shower. The primary outcome was the duration of the first stage of labour. The secondary outcomes were the duration of the second stage of labour, pain intensity, delivery mode, medication use, local swelling, fatigue, anxiety, satisfaction and neonatal outcomes. The experimental intervention reduced the duration of labour by 179 minutes (95% CI 146 to 213) in stage one and 19 minutes (95% CI 13 to 25) in stage two. It decreased pain by approximately 2 points (95% CI 2 to 2) on a 0-to-10 scale at 30, 60 and 90 minutes. It reduced the risk of a caesarean section (ARR 0.14, 95% CI 0.03 to 0.25; NNT 7, 95% CI 4 to 32) and vulvar swelling (ARR 0.11, 95% CI 0.03 to 0.19; NNT 9, 95% CI 5 to 31). It reduced fatigue by 18 points (95% CI 16 to 21) on a 15-to-75-point scale and anxiety by 9 points (95% CI 8 to 11) on an 18-to-72-point scale. Other effects were negligible or unclear. Active pelvic movements on a Swiss ball during labour reduced the duration of labour, pain intensity, and maternal fatigue and anxiety; they also lowered the risk of caesarean section and vulvar swelling. Several effects exceeded the smallest worthwhile effect. NCT04124835. [ABSTRACT FROM AUTHOR]

Effects on strength performance and muscle activation in the contralateral limb have been observed after training with the ipsilateral limb (IL). Cross fatigue effects in the contralateral limb (CL) can occur at intervals of up to 48 h after a training session performed with the ipsilateral limb. The objective of this study was to verify the effect of a training session in the ipsilateral limb, on the strength and activation of the muscles in the contralateral limb also submitted to the training protocol. 10 untrained men (mean ± SD: age = 23.7 ± 4.9 years) performed unilateral knee extension with both limbs in equated protocols, in two conditions with different intervals between limbs – 20 min and 24 h. There were no differences in the comparison of the force produced between the pre x post interventions with the CL limb, as well as in the activation of the quadriceps during its performance. These results were similar for the two different intervals between the protocols. It was concluded that when the CL member performs the protocol after the IL, the responses in the CL depend mainly on the requirement imposed on the protocol performed by this member, without influence of the training protocol performed previously with the IL member. [ABSTRACT FROM AUTHOR]

• Acute strength exercise facilitates weak contextual fear memory consolidation. • NMDA-receptors and associated pathways are related to consolidation process. • Later overexpression of BDNF and synapsin I by exercise were NMDA dependent. The benefits of aerobic exercises for memory are known, but studies of strength training on memory consolidation are still scarce. Exercise stimulates the release of metabolites and myokines that reaching the brain stimulate the activation of NMDA-receptors and associated pathways related to cognition and synaptic plasticity. The aim of the present study was to investigate whether the acute strength exercise could promote the consolidation of a weak memory. We also investigated whether the effects of strength exercise on memory consolidation and on the BDNF and synapsin I levels depends on the activation of NMDA-receptors. Male Wistar rats were submitted to strength exercise session after a weak training in contextual fear conditioning paradigm to investigate the induction of memory consolidation. To investigate the participation of NMDA-receptors animals were submitted to contextual fear training and strength exercise and infused with MK801 or saline immediately after exercise. To investigate the participation of NMDA-receptors in BDNF and synapsin I levels the animals were submitted to acute strength exercise and infused with MK801 or saline immediately after exercise (in absence of behavior experiment). Results showed that exercise induced the consolidation of a weak memory and this effect was dependent on the activation of NMDA-receptors. The hippocampal overexpression of BDNF and Synapsin I through exercise where NMDA-receptors dependent. Our findings showed that strength exercise strengthened fear memory consolidation and modulates the overexpression of BDNF and synapsin I through the activation of NMDA-receptors dependent signaling pathways. [ABSTRACT FROM AUTHOR]

Interactions between statin therapy and physical exercise complicate effective cardiovascular prevention. Emerging evidence suggests that muscle strain related changes in the expression of the glucocorticoid-induced leucine zipper (GILZ) may be involved. Therefore, we measured GILZ mRNA expression levels in M. vastus lateralis samples of 32 healthy individuals before and after a standardized bout of strength or endurance exercise. Overall, we found a highly significant downregulation of GILZ after exercise training (p < 0.001). Within-subgroup changes were statistically significant only after strength training, supporting the role of muscle (as opposed to cardiocirculatory) strain. If confirmed, this may help fitting training recommendations and medication. [ABSTRACT FROM AUTHOR]

• Patients with lower extremity arterial disease present with cardiac autonomic dysfunction. • Walking training enhances cardiac parasympathetic modulations in this population. • We recommended the use of a checklist for future trials assessing heart rate variability. To perform a systematic review of studies assessing the effects of regular exercise on heart rate variability (HRV) in individuals with lower extremity arterial disease (LEAD) and symptoms of claudication. A systematic search in the electronic databases MEDLINE, Embase, and Scielo, was conducted and updated on January 21, 2023. Randomized clinical trials investigating patients with LEAD and IC, assessing ≥ 4 wk of exercise interventions, and reporting at least one HRV measure (e.g., time or frequency domains) at baseline and follow-up were included. Two reviewers independently screened studies for inclusion, performed data extraction, and quality assessment of included studies. Data from 7 trials were included (i.e., 5 walking, 1 resistance, and 1 isometric handgrip training), totaling 327 patients (66% males; range: 61 - 68 yr; ankle brachial index: 0.4 - 0.7). Following exercise training, three studies investigating walking training reported an increase in parasympathetic modulation indices and/or a decrease in sympathetic modulation indices (n = 2) as well as an increase in non-linear indices (n = 1). The current evidence is weak, and larger randomized controlled trials are needed to confirm the efficacy of exercise training in improving HRV. Additionally, the high divergence in the methodology of studies indicated the need for standard tools to improve the quality of HRV measurements in exercise trials. It is recommended to use standard procedures in future trials investigating HRV. [ABSTRACT FROM AUTHOR]

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Skeletal muscle strength is reduced in patients with schizophrenia, contributing to their impaired physical health, functional performance, and potentially mental health challenges. Although short-term training programs have shown promising results, improving muscle strength and functional performance, it is unknown how exercise can be successfully integrated into the long-term clinical care of outpatients with schizophrenia. To investigate effects of strength training with adherence support in a collaborative care model. We randomized 28 men and 20 women (mean ± SD, 35 ± 11 years) to leg press maximal strength training (MST) with 4 sets at 90 % of one repetition maximum (1RM) 2 × week, facilitated by municipal service and professional supervision (TG), or a control group (CG). The TG increased scaled leg press 1RM (0–3 months: 19 %; 0–6 months: 31 %, 0–12 months: 40 %, all p <.001, and 3–12 months: 18 %, p <.05) and power (0–3 months, 11 %; 0–6 months: 22 %, 0–12 months: 26 %, all p <.001, and 3–12 months: 13 %, p <.05) throughout the 1-year period compared to the CG. The increased muscle strength was accompanied by improved sit-to-stand performance (20 %) after 12 months (p <.001). Both groups also exhibited within-group improvements in walking work efficiency after 6 months (TG: 13 %; CG: 23 %) and 1 year (TG: 11 %; CG: 21 %, p <.01–0.05), but with no evident differences between the groups. Stair climbing performance remained unchanged. Our results reveal that strength training can successfully be integrated as a part of long-term clinical care of outpatients with schizophrenia, contributing to improved functional performance. [ABSTRACT FROM AUTHOR]

The objective of this study was to test if resistance training induced muscle hypertrophy leads to greater strength gains. Nine untrained men had their upper limbs randomly divided into two conditions: hypertrophy + strength (HST) and strength (ST) training. Participants trained twice a week for 10 weeks. HST-arm performed a hypertrophy-oriented training protocol for 6 weeks and then a 4-week strength-oriented training; while ST-arm did not train during the initial 6 weeks and performed the 4-week strength-oriented training. Hypertrophy-oriented training consisted in 3 sets at 40% of 1RM until failure in the unilateral pull-down exercise, and strength-oriented training consisted of 3 sets of five 5-s maximal elbow flexion isometric contraction. Muscle thickness, 1RM and maximal voluntary isometric contraction (MVIC) were assessed before (pre), after 6 weeks (mid) and at the end of the 10-week (post) training period. Muscle thickness and 1RM did not change in both arms (P > 0.05). However, HST was the only condition that elicited a change in MVIC (P = 0.03). Although no changes in muscle size was observed, only the group that performed the hypertrophy-oriented training increased strength during the strength-oriented period. Although we did not find differences in strength increase between the experimental conditions, we speculate that it may be interesting to include a period of hypertrophy-oriented training before strength-oriented training, as we have reported increased strength in this condition. [ABSTRACT FROM AUTHOR]

Several studies reported the efficacy of exercise therapy in hand and wrist tendinopathy. However, no systematic review synthesized the effect of exercise therapy on these patients. This study aimed to perform a systematic review to summarize evidence if exercise therapy may be considered an effective treatment in conservative management for patients with hand and wrist tendinopathy. This was a systematic review. A literature search in MEDLINE, Cochrane Library, PEDro, and Embase was conducted from their inception until April 10, 2022. Two independent reviewers included the studies administering exercise therapy in patients with hand and/or wrist tendinopathy in the review and extrapolated the data. Methodological quality was assessed using the framework developed by Murad et al for case reports and case series and the PEDro score for clinical trials. Seven case reports, 3 case series, and 2 randomized controlled studies were included and methodologically evaluated, obtaining a low score for all the analyzed studies. The total number of included patients in the analyzed studies was 106, of which 54 were female, 13 were male, and 39 were not specified. The type of exercise was widespread and often not really well described: it varies from eccentric forearm training to mobilization with movement, passing through strengthening exercises, grip proprioception training, and self-management exercises according to the McKenzie method. The dosage was often not precise, making it difficult to reproduce the therapeutic proposals. Exercise therapy was always administered together with different treatments; therefore, its efficacy alone is difficult to distinguish, although in some cases, the patients improved pain and functionality. Evidence on the efficacy of exercise therapy in patients with hand and wrist tendinopathies is limited. Future research is strongly recommended to determine the appropriate dosage of the exercise therapy to determine clinical changes in these patients. • Exercise therapy for wrist and hand tendinopathies is widespread used, but no systematic review summarized evidence. • In literature, the type of exercise was heterogeneous and often not really well described. • Exercise therapy was always administered together with different treatments. • Efficacy of exercise therapy alone is difficult to distinguish, although in some cases, studies reported an improvement of pain and functionality. [ABSTRACT FROM AUTHOR]

Knowledge-based planning (KBP) is a valuable tool for generating plans of consistent quality across planners and institutions. It also provides a training tool for planners new to a treatment planning system. This study assessed the feasibility of implementing KBP for a de-novo linear accelerator (LINAC) with integrated positron emission tomography for biology-guided radiotherapy. The focus of this study was lung SBRT plans due to their greater quantity in the small pool of completed image-guided radiotherapy (IGRT) treatments on our PET/CT-LINAC. To reach sufficient statistical strength in the model training, 50 historical clinical plans of right lung SBRT treatments (50 or 55 Gy, 5 fractions) on our C-arm machines were used to train an in-house developed KBP model using the available tool in a commercial treatment planning system (TPS). External validations (open loop) were performed with 9 clinical C-arm plans to fine tune the model. The C-arm backup plans of three right lung SBRT patients on the PET/CT-LINAC were used to assess the performance of the model. The individually derived KBP templates of the three patients were manually converted into the treatment planning system of the PET/CT-LINAC machine as a starting point for plan optimization and dose calculation. The plans generated in this manner (KBP model-informed plans) were compared with their corresponding clinical plans generated in the same TPS of the PET/CT-LINAC in terms of the dose-volume parameters of planning target volumes (PTV) and organs at risk (OAR). The KBP model-informed plans achieved our clinical goals of acceptable ranges within one round of optimization. Compared to their corresponding clinical plans, the KBP plans showed advantages in dose sparing over general OARs, though some OARs resulted in larger maximum doses. The difference of V20Gy in lungs between the KBP-informed and clinical plans was within ± 1%. The conformity indices of PTVs in the KBP plans were 0.22 ± 0.20 larger on average. The dose of D2cm was generally higher, which is expected since neither 'Ring' structures nor a 'Body-(PTV+2cm)' structure was included in the model. This study demonstrated the capability and utility of a KBP tool in handling the geometric and dosimetric variations in plans that were generated and delivered in a de-novo PET/CT-LINAC system. The KBP-derived planning template for lung SBRT cases was able to generate an initial iteration of clinical plans in the TPS of the PET/CT-LINAC that were within clinical guidelines, particularly for OARs. The sub-optimal performance of target conformity and coverage can be improved in the future by including 'Ring' structures in the model. The preliminary results suggest a promising potential application of KBP in the PET/CT-LINAC system, as more clinical plans of the system become available. Furthermore, this study is also being extended to other treatment sites with more complicated geometries. [ABSTRACT FROM AUTHOR]

Purpose to evaluate the prevalence and temporal trends in adherence to muscle-strengthening activity (MSA) guidelines among the US population from 1997 to 2018 (pre-Covid 19). We used nationally representative data from the National Health Interview Survey of the US (NHIS; a cross-sectional household interview survey). We pooled data from 22 consecutive cycles (1997 to 2018) and estimated prevalence and trends of adherence to MSA guidelines among adults aged 18–24 years, 25–34 years, 35–44 years, 45–64 years, and ≥ 65 years. A total of 651,682 participants (mean age 47.7 years [SD = 18.0], 55.8% women) were included. The overall prevalence of adherence to MSA guidelines significantly increased (p <.001) from 1997 to 2018 (19.8% to 27.2%, respectively). Adherence levels significantly increased (p <.001) for all age groups from 1997 to 2018. Compared with their white non-Hispanic counterparts, the odds ratio for Hispanic females was 0.5 (95% CI = 0.4–0.6). It is over a 20-year span, adherence to MSA guidelines increased across all age groups, although the overall prevalence remained below 30%. Future intervention strategies to promote MSA are required with a particular focus on older adults, women, Hispanic women, current smokers, those with low educational levels, and those with functional limitations or chronic conditions. • Adherence to MSA is an considered a important preventive factor for both chronic conditions and mortality. • Adherence to MSA guidelines increased across all age groups, although the overall prevalence remained within 30%. • Future strategies are required with a particular focus on population subgroups with lower adherence to MSA guidelines. [ABSTRACT FROM AUTHOR]

Several techniques exist to measure fat-free mass (FFM). Accordingly, this study is based on data from our recent trial comparing the sensitivity of the main field methods available with that of dual-energy X-ray absorptiometry (DXA) as reference and analyzing the cross-sectional accuracy of these field methods in recreationally resistance-trained males. We hypothesized that the use of these techniques would lead to varying estimates of FFM compared with DXA. Participants (N = 23; 21.4 ± 3.3 years) completed a 10-week resistance training plus diet intervention designed to optimize hypertrophy. FFM was determined by bioelectrical impedance analysis (BIA), 23 anthropometric equations, and DXA. After the intervention, FFM increased significantly according to BIA and most anthropometric estimates, but this increase was not detected by 2 anthropometric equations or by DXA. Only 1 of these 2 equations showed significant correlation with DXA and no standardized or significant differences to this reference method, although it did display significant heteroscedasticity. In our cross-sectional analysis, only 1 anthropometric equation gave rise to good accuracy as confirmed by DXA. Our findings indicate that the use of different techniques to assess FFM gains in response to a hypertrophic intervention yields different results. BIA with general embedded equations should not be used to monitor a young male adult's body composition. To monitor FFM over time, we would recommend the Dunne et al. equation (2) as the most sensitive field method, and to assess FFM cross-sectionally, equation (1) of these authors is the most accurate field method. This study compares the sensitivity and the cross-sectional accuracy of BIA and anthropometry using DXA as a reference in resistance-trained males. Fat-free mass was significantly increased according to BIA and to most anthropometric estimates, but not according to 2 anthropometric equations or to DXA. Anthropometric equations (1) and (2) of Dunne et al. [20] reported the best sensitivity and the best accuracy, respectively. BIA, bioimpedance analysis; DXA, dual-energy X-ray absorptiometry [Display omitted] [ABSTRACT FROM AUTHOR]

Players must be capable to have a good change-of-direction (COD) skill aiming to be the fastest as possible to react immediately to the opponent or even to help players to be more agile since COD is a physical determinant of agility. Thus, the aim of this study was to test the effects of a six-week combined training intervention in the COD and countermovement jump (CMJ) of young soccer players, while comparing with a control group only performing the regular field-based training sessions. A sample of 80 non-professional players (40 experimental group and 40 control group) between the ages of ten and twelve was taken [(Age: 10.70 ± 1.02)]. The tests that were carried out from the beginning to the end of the intervention were: CMJ test, 505COD Test and Illinois Test. Paired sample t-test was used for determining differences as a repeated measures analysis (pre– post). An ANCOVA test was performed using the pretest as a covariate and the times pre and post as factors. Repeated measures ANCOVA revealed significant influence of baseline level on the 5–0–5 COD (p = 0.001; η p 2 =0.170), the Illinois (p = 0.018; η p 2 =0.070) and the CMJ (p = 0.047; η p 2 =0.050). Significant interactions group*time (p < 0.001; η p 2 =0.137), 5–0–5 COD (p < 0.001; η p 2 =0.274), and CMJ (p < 0.001; η p 2 =0.392) were found, while no significant interactions were found in Illinois (p = 0.293; η p 2 =0.014). The current research revealed that a combined training intervention consisting of strength training, plyometrics, and running techniques can be significantly beneficial for improving COD performance and CMJ. • Combined training can be significantly beneficial for improving COD and CMJ. • The effects of the 6-week period were significant than those found in the control group. • Plyometric training may improve the ability to be fast in linear speed. [ABSTRACT FROM AUTHOR]

Analyze whether the effects of lower limb resistance training on pain and self-reported function were associated with the exercise volume prescribed for women with patellofemoral pain (PFP). A systematic search was undertaken in four databases from inception to May 2023. Eligible trials examined the effects of resistance training programs on pain (visual analogue scale or numerical pain scale) and function (Anterior Knee Pain Scale) in women with PFP. Meta-analysis was undertaken with a random-effects model. The association of resistance training volume-related variables with mean difference effects on pain and function were tested by exploratory univariable meta-regression models. From 1,404 estudies retained for screening after duplicate removals, 16 studies (579 patients) were included. Changes in knee pain were inversely associated with weekly training frequency (β = 0.5 ± 0.2, P = 0.012). No associations were found between the amount of resistance exercise prescribed per session or per week and effects on pain. Changes in function were associated with the number of sets per week (β = 0.1 ± 0.1, P = 0.044) and number of sets per session (β = 0.6 ± 0.2, P < 0.001) over the intervention. Most favorable results were achieved with 17 to 27 sets per session and >45 sets per week. The amount of prescribed resistance exercise does not seem to be critical for pain reduction in women with PFP. However, our findings support a dose-response effect in terms of improving function. • Pain reduction had no clear association with the amount of resistance exercise. • There was a dose-response effect for enhancement of self-reported function. • Most favorable outcomes were achieved with 17–27 sets per session. [ABSTRACT FROM AUTHOR]

In the prediction of time series, the echo state network (ESN) exhibits exclusive strengths and a unique training structure. Based on ESN model, a pooling activation algorithm consisting noise value and adjusted pooling algorithm is proposed to enrich the update strategy of the reservoir layer in ESN. The algorithm optimizes the distribution of reservoir layer nodes. And the nodes set will be more matched to the characteristics of the data. In addition, we introduce a more efficient and accurate compressed sensing technique based on the existing research. The novel compressed sensing technique reduces the amount of spatial computation of methods. The ESN model based on the above two techniques overcomes the limitations in traditional prediction. In the experimental part, the model is validated with different chaotic time series as well as multiple stocks, and the method shows its efficiency and accuracy in prediction. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the relationship between unilateral leg strength, associated asymmetries and the injuries suffered by sub-elite Rugby League (RL) players in one competitive season. A prospective cohort design was used. Unilateral leg strength was measured using the rear foot elevated split squat five repetition maximum test. Injuries were recorded using the Orchard classification system and were used to quantify relative risk (RR), mean severity, burden, player availability and survival time. No measures of leg strength were related to RR, relative leg strength was found to have a significant, but not meaningful correlation with total time lost to lower body injury, lower body injury burden and lower body injury survival time. The data from the current study indicates a possible positive effect of increasing relative leg strength for injury outcomes in sub-elite RL players. This supports a heuristic that multi-joint lower body strength training for RL players has a potential dual effect of enhancing physical performance and reducing injury time loss, with minimal risk of harm. • First study to examine unilateral leg strength and asymmetry for injuries in UK sub-elite Rugby League. • A comprehensive analysis and novel approach of analysing injury. • Injuries were not related to either absolute unilateral leg strength or asymmetry between legs. • Increasing relative strength showing possible benefits and limited probability of harm. [ABSTRACT FROM AUTHOR]

• We study professional basketball players with thumb ulnar collateral injury. • Patients are treated with internal brace augmentation. • Patients undergo a novel accelerated rehabilitation protocol post-operatively. • Our patients successfully return to sport within 5-6 weeks. Case series. Rehabilitation protocols following thumb metacarpophalangeal (MCP) ulnar collateral ligament (UCL) repair typically do not allow for return to sport until 12 weeks post-surgery. The potential for accelerated rehabilitation following thumb MCP UCL repair with suture tape augmentation has yet to be explored. To describe the accelerated rehabilitation following thumb MCP UCL repair with the suture tape augmentation in professional basketball players. Three professional basketball players underwent thumb MCP UCL repair with suture tape augmentation. The athletes followed an accelerated rehabilitation program post-surgery that began with range-of-motion exercises at 2-3 days, proximal strengthening at 7-10 days, grip/pinch strengthening at 1-2 weeks, followed by progressive sport specific intervention with a custom orthosis. At 5-6 weeks post-surgery, active thumb MCP range of motion returned to 83%-100%, grip strength to 81%-100%, and tripod pinch strength to 73%-78% of the contralateral side. All athletes successfully returned to sport within 5-6 weeks post-surgery. This is the first clinical application of an accelerated rehabilitation protocol in athletes following thumb MCP UCL repair. In this series, professional basketball players were able to return to sport in half the routine recovery time. Further prospective studies re-thinking current rehabilitation protocols are warranted. [ABSTRACT FROM AUTHOR]

One of the most popular training methods in weight rooms is the pyramidal. Despite this, its superiority over traditional training is still speculative. To review the effects of pyramid strength training on acute responses and long-term adaptations of this training method. The research was performed in PubMed, BIREME/BVS and Google Scholar databases using the search words in different combinations: 'strength training', 'resistance training', 'resistance exercise', 'strength exercise', 'pyramid', 'system pyramidal', 'crescent pyramid' and 'decrescent pyramid'. As inclusion criteria were considered: studies in English, which compared the effects of pyramidal training versus traditional training on acute responses and long-term adaptations. The TESTEX scale (0–15 points) was used to assess the methodological quality of the studies. This article included 15 studies (6 acute effect studies and 9 longitudinal studies), which evaluated hormonal, metabolic and performance responses, strength gains and muscle hypertrophy of strength training in pyramidal and traditional format. Studies were rated between good and excellent quality. The pyramid training protocol was not superior to the traditional protocol on acute physiological responses, strength gains and muscle hypertrophy. From a practical point of view, these findings allow us to say that the manipulation of this training method could be based on issues of periodization, motivation and/or even in personal preference. But, this is based on studies developed with repetition zones between 8 and 12 and/or intensities between 67% and 85% of 1RM. [ABSTRACT FROM AUTHOR]

The effects of strength training on muscle strength imbalance are unclear in professional soccer players. As a result, this study examined the effects of an 8-week strength training program comprising eccentric-emphasized prone leg curl adjusted according to the individual strength imbalance status. Ten professional soccer players (26.0 ± 3.6 yrs) participated in the study. Players who had a ≥ 10% contralateral imbalance in knee flexors eccentric peak torque (n = 6) performed two additional repetitions per set in the low-strength limb (high-volume, HV) compared to the high-strength limb (low-volume, LV). Isokinetic concentric knee extension and concentric and eccentric knee flexion peak torque (PT) and derived contralateral imbalances and conventional and functional hamstring-to-quadriceps ratios (H:Q) were assessed at baseline and after 8 weeks. Differences at baseline were assessed using paired-sample T-tests, and a two-way (limb x time) repeated measures analysis of covariance (ANCOVA) for changes over time. A significant improvement in the eccentric knee flexion PT was observed in both limbs after 8 weeks (P < 0.05), with greater effects observed in the HV limb (25.0 N m, 95% CI: 15.1–34.9 N m). Significant decreases were also observed in the contralateral imbalances from concentric knee extension and flexion and eccentric knee flexion PT (P < 0.05). Differences were not observed in concentric knee extension and flexion PT (P > 0.05). A short-term eccentric-emphasized leg curl intervention adjusted by the initial knee flexors eccentric strength was an efficient method to improve knee flexors strength imbalance in professional soccer players. [ABSTRACT FROM AUTHOR]

Nonshivering thermogenesis, a component of whole-body energy expenditure, is regulated by many factors. The effect of a high-fat diet and endurance training was not yet explored on many NST factors at thermoneutrality. This study aimed to probe a high-fat diet and endurance training effect on newly identified NST factors, specifically Uncoupling Protein 1 -independent agents, at thermoneutrality. C57BL/6 mice were assigned into four groups including, Control, HFD, ET, and HFD-ET. The mice were housed at 28 °C (as a thermoneutrality). HFD group was fed an HFD for 12 weeks, and ET group had continuous running for six weeks. Likewise, HFD-ET group was submitted to ET for six weeks besides feeding HFD for 12 weeks. Real-time–PCR was used to assay the mRNA expression of NST-factors. The high-fat diet caused a significant increase in Uncoupling Protein 1 and Sarcolipin gene expression in brown fat and soleus muscle at thermoneutrality, respectively. Endurance training also caused a rise in Mitocondria Creatin Kinase 2 expression in beige fat. Neither the high-fat diet nor endurance training significantly changed the expression of Ca2+cyle-related factors and Uncoupling Protein 1 in beige fat. Endurance training restrained the increasing effect of the high-fat diet on the expression of brown fat's Uncoupling Protein 1 and Sarcolipin at thermoneutrality. The high-fat diet and endurance training may not homogeneously affect the NST factors under thermoneutrality. However, endurance training appears to be able to modulate the High-fat diet-induced nonshivering thermogenesis. [ABSTRACT FROM AUTHOR]

Strength training is not usually an important aspect of the training programme for swimmers. Instead, more emphasis is placed on traditional swimming training, which focuses mainly on endurance work. This is why in this study a systematic review is carried out with the aim of observing the effects that can be caused by a swimming training programme in which strength work is carried out, while maintaining traditional swimming training. Considering the PRISMA statement, the Web of Science (WOS) database was used to search for articles, taking those published between 2017 and 2022. A total of 387 articles were identified, from which, after passing all criteria, 19 were chosen as the study sample. After analysis, it was found that addressing strength enhancement work within programming can have a positive transfer on short-medium distance swimming performance, improving force transmission and stroke biomechanics. This indicates that it would be appropriate to plan the training microcycles with strength sessions separated from the swimming sessions, without increasing the training volume too much, so as not to cause greater fatigue in the swimmer. [ABSTRACT FROM AUTHOR]

Despite growing emphasis on the benefits of physical activity for promoting mental health, inclusion of muscle-strengthening (MS) (e.g., body-weight exercises, resistance machines) activities is limited. Notably, few studies collectively assess MS behavioural frequency, duration, and intensity. To address the gap, the current study examined associations between frequency (days), intensity (rating of perceived exertion in relation to repetitions in reserve [RPE/RIR]), and duration (minutes per typical session) of MS activities on anxiety, depression, and mental well-being. A cross-sectional study of 601 participants (Mean age = 30.92 years [SD = 12.70]; 57.7 % female) across Ireland was conducted. Participants completed a self-report questionnaire containing MS instruments previously used, or adapted from valid and reliable measures (i.e., International Physical Activity Questionnaire IPAQ, RPE/RIR), alongside, the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8) and the Mental Health Continuum- Short Form (MHC-SF). A multivariate regression model was tested in MPLUS, using dummy coding for MS frequency in relation to no activity (i.e., 0-days) non-adherence (i.e., 1-day), adherence (i.e., 2-days) and enhanced adherence (i.e., ≥3 days) to the MS public health guidelines, with the mental health variables representing the dependent variables. Intensity and duration were specified in the model as continuous variables; gender and age were included as statistical controls. Three or more days engaged in MS activities was associated with fewer anxiety (β = −0.12, p <.05) and depression (β = −0.14, p <.01) symptoms. Increased intensity had a negative association with anxiety (β = −0.10, p <.05) and depression (β = −0.15, p <.001). Unexpectedly, adherence to the MS guidelines (2-days) did not predict any of the mental health outcomes, whereas 1-day of MS activity was associated with fewer depression symptoms (β = −0.11). No effects were observed for mental well-being, and MS duration exerted a null effect across all mental health outcomes. Higher frequency and intensity of MS activities may protect against anxiety and depression symptoms. Doing some MS activities (at least 1-day) is likely more beneficial than none for depression. Evidence-based, MS interventions may help curb mental illness rates, and future longitudinal, intervention-based research could consider inclusion of MS frequency, intensity and duration variables to enhance efforts to identify at-risk groups and trends within physical activity and mental illness surveillance. • Few studies collectively assess the frequency, intensity and duration of muscle-strengthening physical activities (MS). • MS frequency was dummy coded in relation to no activity (0-days), non-adherence (1-day), adherence (2-days), and enhanced adherence (3-days or more) of the public health guidelines, and regressed onto mental health outcomes alongside MS duration and intensity. • Higher frequency and intensity of MS activities protected against depression and anxiety. • Findings support the rationale for co-produced, evidence-based, MS interventions to help curb mental illness rates. [ABSTRACT FROM AUTHOR]

Awareness of the value of aquatic exercise (AE) in the postoperative rehabilitation has increased, and several inherent advantages of AE, such as adjustment of both resistance and muscle strengthening parameters makes good rationale for its inclusion in postoperative rehabilitation. This study aimed to determine and compare the benefits of AE and land-based exercise (LBE) on pain, functionality, and quality of life after arthroscopic partial meniscectomy (APM). This randomized controlled study included 30 middle-aged (35–50), physically active patients who were randomized into LBE (n = 15) and AE (n = 15) groups after APM for a degenerative meniscal tear. Visual analogue scale (VAS), Short Form-36 (SF-36), single-leg hop test and Lysholm questionnaire scores in addition to isokinetic muscle strength values were evaluated at baseline, at fourth week immediately after cessation of exercise program and at eighth week follow-up visits. The exercise sessions were conducted in 1-h sessions per day, three days a week for a total of four weeks. Significant improvement was observed in the VAS, single-leg hop test, Lysholm questionnaire, and most of SF-36 subscale scores in both groups at both fourth and eighth follow-ups. Isokinetic dynamometer revealed significant improvement in the peak torque values for extension at angular velocities of 60° and 180° at both follow-ups in the AE group. LBE group showed significant improvement in the peak torque value for extension only at an angular velocity of 60° only at fourth week follow-up. There was no significant difference between groups for any of these parameters at any of the follow-ups. Both AE and LBE programs had significantly improved pain, function, isokinetic muscle strength, and quality of life in patients after APM. Either type of exercise is essential as part of the rehabilitation protocol for good clinical outcomes after APM and should not be neglected (level II). NCT04925726. [ABSTRACT FROM AUTHOR]

• Three-quarters of European adults do not report any muscle-strengthening exercise. • Irrespective of the aerobic exercise level, the addition of muscle-strengthening exercise was associated with a lower obesity prevalence. • A physical activity routine that includes a combination of aerobic and muscle-strengthening exercise is likely to be the most beneficial for the maintenance of a healthy weight. Emerging epidemiological evidence suggests that compared to engaging in 1 activity mode alone, a combination of moderate-to-vigorous physical activity (MVPA: brisk walking/jogging, cycling) and muscle-strengthening exercise (MSE: push-ups/sit-ups, using weight machines) has more favorable associations with optimal weight status. However, few studies have examined the dose-dependent and joint associations of MVPA and MSE with obesity. Based on cross-sectional analyses of the European Health Interview Survey Wave 2 (2013–2014), we examined prevalence ratios (PRs) of joint and stratified associations between MVPA (4 categories: (i) 0 min/week, (ii) 1–149 min/week, (iii) 150–299 min/week, and (iv) ≥300 min/week) and MSE (3 categories: (i) 0 day/week, (ii) 1 day/week, and (iii) ≥2 days/week) with body mass index-defined obesity (body mass index of ≥30.0 kg/m2) using Poisson regression with robust error variance. PRs were examined unadjusted and adjusted for sociodemographic and lifestyle characteristics (e.g., sex, age, education, income, and smoking status). Data were available for 280,456 adults (≥18 years), of which 46,166 (15.5%) were obese. The interaction MVPA × MSE guideline adherence was statistically significant for obesity (p ≤ 0.05). The joint MVPA–MSE analysis showed that compared to the reference group (i.e., no MVPA and no MSE), the PRs followed a dose-dependent pattern, with the lowest observed among those reporting ≥150 MVPA min/week and ≥1 MSE days/week (PR: 0.43; 95% confidence interval: 0.41–0.46). When stratified across each MVPA strata, the PRs were mostly lower among those engaging in MSE 1 day/week, as compared to those doing MSE ≥2 days/week. There was evidence for a dose-dependent association between joint MVPA–MSE with a reduced prevalence of obesity. Public health strategies for the prevention and management of obesity should recommend both MVPA and MSE. [Display omitted] [ABSTRACT FROM AUTHOR]

Resistance training (RT) is an often ignored but essential component of physical health. The functioning of the musculoskeletal system declines with age, resulting in sarcopenia, loss of muscle strength and power, decrease in muscle flexibility and balance. Other pertinent age-related changes include decline in basal metabolic rate, increase in fat mass, and decrease in bone mineral density. Such primary aging can be accentuated by the concomitant presence of comorbid conditions, such as insulin resistance and diabetes, obesity, inflammatory conditions, and physical inactivity (PI). The latter is often promoted by the presence of musculoskeletal conditions, such as osteoarthritis, back pain, and osteoporosis, which are quite common in society. RT can diminish long-term joint stress, "resist" age-related physiological deterioration and improve health outcomes through its ability to increase muscle strength and mass, balance the distribution of forces within a joint, increase basal metabolic rate and bone density, reduce body fat and cardiac risk factors, enhance endothelial function, and promote cognitive function and psychological well-being. Accordingly, health providers should screen for PI, lack of RT, and mobility risks using short screening questions, and employ simple functional tests, when indicated, to evaluate patients for impairment in gait, muscle strength, flexibility, and balance. This review also provides general principles for initiating and conducting RT and provides general and specific examples of resistance training programs, which should be individualized for patients through the evaluation and guidance by appropriate health providers, physical therapists, and certified trainers. [ABSTRACT FROM AUTHOR]

To observe the effect of strength training of the nonhemiplegic side (NHS) on balance function, mobility, and muscle strength of patients with stroke. A single-blinded (evaluator) randomized controlled trial. A tertiary hospital rehabilitation center. 139 patients with first stroke (N=139) were recruited and randomly separated into a trial (n=69) or control group (n=70). The control group underwent usual rehabilitation training, including step training and trunk control training in standing position. The trial group underwent strength training of NHS on the basis of usual rehabilitation training. The strength training of NHS included lower limb stepping training with resisting elastic belt and upper limb pulling elastic belt training in standing position. The training for both groups was 45 min, once a day, 5 days a week for 6 weeks. Balance evaluation was done with the Berg Balance Scale (BBS); mobility assessment with the 6-minute walk test (6-MWT); activities of daily life was examined via the modified Barthel Index (MBI); muscle strengths of the biceps brachii, iliopsoas, and quadriceps were measured via the isokinetic muscle strength testing system. All assessments were performed at baseline (T 0) and after intervention (T 1). The trial group performed better than control group in BBS scores (adjusted mean difference: 6.83; 95% confidence interval [CI]: 4.71-8.94) and 6-MWT (adjusted mean difference: 50.32; 95% CI: 40.58-60.05) after intervention. In terms of muscle strength of the hemiplegic side, the trial group displayed greater gains in biceps brachii, iliopsoas, and quadriceps than control group after intervention. Strength training of the NHS can promote recovery of balance, mobility, and muscle strength of the paretic side of patients with stroke. [ABSTRACT FROM AUTHOR]

• The benefits of inspiratory muscle training for older adults are beyond physical capacity;. • Inspiratory muscle training improves cardiac autonomic control and endothelial function;. • Inspiratory muscle training reduces postural instability while enhancing cerebrovascular control;. • Inspiratory muscle training improves dynamic and quasi-static postural balance;. Systematic reviews support the benefits of inspiratory muscle training (IMT) for exercise performance. Recently, many health benefits from IMT have been reported in older adults. Therefore, this work reviewed the literature focusing on IMT effects beyond physical performance in older adults, such as cardiorespiratory, metabolic, and postural balance outcomes. Searches were conducted with the following terms: ("respiratory muscle training" OR "inspiratory muscle training") OR ("inspiratory muscle strength training") AND ("elderly" OR "older" OR "aging" OR "aging"), and using the databases: MEDLINE (PubMed), SCOPUS and EUROPE PMC. Of the 356 articles found, 13 matched the inclusion criteria after screening. Based on reviewed studies, four to eight weeks of IMT (Mostly from 50 % up to 75 % of MIP, 7 days/week) improve cardiac autonomic control at rest and post-exercise, cerebrovascular response to orthostatic stress, static and dynamic balance, blood pressure control, endothelial function, and oxidative stress in older adults. The benefits of IMT in cardiac autonomic and vascular functions are reversed after training cessation. It thus appears that IMT promotes broad physiological gains for the older population. It is necessary to carry out more randomized clinical trials on the subject to confirm the findings of this research. [ABSTRACT FROM AUTHOR]

• The home-based device-supported resistance training is safe and feasible. • The home-based device-supported resistance training positively affects walking parameters and lower limbs' maximal force. • This approach should be incentivized when barriers to participation in traditional resistance exercise programs are present. Aging is characterized by a physiological decline in physical function, muscle mass, strength, and power. Home-based resistance training interventions have gained increasing attention from scientists and healthcare system operators, but their efficacy is yet to be fully determined. to verify the safety, feasibility, and efficacy of a home-based resistance training program delivered by innovative technological solution in healthy older adults. 73 participants (36 females) were randomly allocated to either a control (C) or an intervention (I) group consisting of a 6-months home-based resistance training program delivered through an innovative technological solution, which included a wearable inertial sensor and a dedicated tablet. The safety and feasibility of the intervention were assessed by recording training-related adverse events and training adherence. Body composition, standing static balance, 10-meter walking, and loaded 5 sit-to-stand tests were monitored to quantify efficacy. No adverse events were recorded. Adherence to the training program was relatively high (61 % of participants performed the target 3 sessions) in the first trimester, significantly dropping during the second one. The intervention positively affected walking parameters (p < 0.05) and maximal force (p = 0.009) while no effect was recorded on body composition, balance, and muscle power. The home-based device-supported intervention was safe and feasible, positively affecting walking parameters and lower limbs' maximal force. This approach should be incentivized when barriers to participation in traditional resistance exercise programs are present. [ABSTRACT FROM AUTHOR]

Older adults are at risk of developing new or worsened disability when hospitalized for acute medical illness. This study is a secondary analysis of the STAND-Cph trial on the effect of a simple strength training intervention initiated during hospitalization and continued after discharge. We investigated the between-group difference in change in functional performance outcomes, the characteristics of patients who experienced a relevant effect of the intervention, and the characteristics of those who were compliant with the intervention, using an expanded sample size as protocolized. The STAND-Cph was a randomized controlled trial conducted at a major Danish university hospital. Acutely admitted older adult patients (65+) from the Emergency Department were randomized to the intervention group receiving progressive strength training and a protein supplement during and after hospitalization (12 sessions over 4 weeks) or control group receiving usual care. The primary outcome was the de Morton Mobility Index assessed at baseline and 4 weeks after discharge. The secondary outcomes were 24-h mobility (assessed by ActivPAL accelerometers), isometric knee-extension strength, 30 s. sit-to-stand performance, and habitual gait speed. Between September 2013 and September 2018, a total of 158 patients were included and randomized to either the intervention group (N = 80; mean age 79.9 ± 7.6 years) or the control group (N = 78; mean age 80.8 ± 7.4 years). We found no significant between-group difference in change in our primary outcome (p > 0.05). Both the intention-to-treat (difference in change 0.14 Nm/kg (95 % CI 0.03;0.24), p = 0.01) and the per protocol (difference in change 0.16 Nm/kg (95 % CI 0.04;0.29), p = 0.008) analyses showed that between baseline and 4 weeks, knee-extension strength increased significantly more in the intervention group than in the control group. Also, the per protocol analysis showed that the intervention group increased their daily number of steps significantly more than the control group (difference in change 1088 steps (95 % CI 44; 2132); p = 0.04). When examining subgroups of patients, we found no significant differences neither between those who experienced a clinically relevant improvement in the de Morton Mobility Index and those who did not, nor between those who were compliant and those who were not. This exploratory analysis indicates that while simple progressive strength training and protein supplementation does not improve functional performance assessed by the de Morton Mobility Index, it can benefit specific facets of physical activity and muscle strength among geriatric patients. • Older adults are at risk of developing new disability when hospitalized. • We report on the effect of simple strength training continued after discharge. • We found a significant increase in knee-extension strength and daily steps. • Simple strength training can benefit facets of physical activity and strength. • Simple strength training should be considered in geriatric patients. [ABSTRACT FROM AUTHOR]