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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.

A glenohumeral internal rotation deficit (GIRD) of the shoulder, is associated with an increased risk of shoulder injuries in tennis athletes. The aim of the present study was to reveal the impact of 1) age, sex, specific training data (i.e. training volume, years of tennis practice, years of competitive play) and 2) upper extremity injuries on GIRD in youth competitive tennis athletes. A cross-sectional retrospective study design was adopted. Youth tennis players (n = 27, 12.6 ± 1.80 yrs., 18 male) belonging to an elite tennis squad were included. After documenting the independent variables (anthropometric data, tennis specific data and history of injury), the players were tested for internal (IR) and external (ER) shoulder rotation range of motion (RoM, [°]). From these raw values, the GIRD parameters ER/IR ratio and side differences and TRoM side differences were calculated. Pearson’s correlation analyses were performed to find potential associations of the independent variables with the GIRD outcomes. A significant positive linear correlation between the years of tennis training and IR side asymmetry occurred (p

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.

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.

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.

Background Although anterior cruciate ligament (ACL) tear-prevention programs may be effective in the (secondary) prevention of a subsequent ACL injury, little is known, yet, on their effectiveness and feasibility. This study assesses the effects and implementation capacity of a secondary preventive motor-control training (the Stop-X program) after ACL reconstruction. Methods and design A multicenter, single-blind, randomized controlled, prospective, superiority, two-arm design is adopted. Subsequent patients (18–35 years) with primary arthroscopic unilateral ACL reconstruction with autologous hamstring graft are enrolled. Postoperative guideline rehabilitation plus Classic follow-up treatment and guideline rehabilitation plus the Stop-X intervention will be compared. The onset of the Stop-X program as part of the postoperative follow-up treatment is individualized and function based. The participants must be released for the training components. The endpoint is the unrestricted return to sport (RTS) decision. Before (where applicable) reconstruction and after the clearance for the intervention (aimed at 4–8 months post surgery) until the unrestricted RTS decision (but at least until 12 months post surgery), all outcomes will be assessed once a month. Each participant is consequently measured at least five times to a maximum of 12 times. Twelve, 18 and 24 months after the surgery, follow-up-measurements and recurrence monitoring will follow. The primary outcome assessement (normalized knee-separation distance at the Drop Jump Screening Test (DJST)) is followed by the functional secondary outcomes assessements. The latter consist of quality assessments during simple (combined) balance side, balance front and single-leg hops for distance. All hop/jump tests are self-administered and filmed from the frontal view (3-m distance). All videos are transferred using safe big content transfer and subsequently (and blinded) expertly video-rated. Secondary outcomes are questionnaires on patient-reported knee function, kinesiophobia, RTS after ACL injury and training/therapy volume (frequency – intensity – type and time). All questionnaires are completed online using the participants’ pseudonym only. Group allocation is executed randomly. The training intervention (Stop-X arm) consists of self-administered home-based exercises. The exercises are step-wise graduated and follow wound healing and functional restoration criteria. The training frequency for both arms is scheduled to be three times per week, each time for a 30 min duration. The program follows current (secondary) prevention guidelines. Repeated measurements gain-score analyses using analyses of (co-)variance are performed for all outcomes. Trial registration German Clinical Trials Register, identification number DRKS00015313. Registered on 1 October 2018.

Background Individuals afflicted with nonspecific chronic low back pain (CLBP) exhibit altered fundamental movement patterns. However, there is a lack of validated analysis tools. The present study aimed to elucidate the measurement properties of a functional movement analysis (FMA) in patients with CLBP. Methods In this validation (cross-sectional) study, patients with CLPB completed the FMA. The FMA consists of 11 standardised motor tasks mimicking activities of daily living. Four investigators (two experts and two novices) evaluated each item using an ordinal scale (0–5 points, one live and three video ratings). Interrater reliability was computed for the total score (maximum 55 points) using intra class correlation and for the individual items using Cohen’s weighted Kappa and free-marginal Kappa. Validity was estimated by calculating Spearman’s Rho correlations to compare the results of the movement analysis and the participants’ self-reported disability, and fear of movement. Results Twenty-one participants (12 females, 9 males; 42.7 ± 14.3 years) were included. The reliability analysis for the sum score yielded ICC values between .92 and.94 (p .05). The study population showed comparably low pain levels, low scores of kinesiophobia and disability. Conclusion The functional movement analysis displays excellent reliability for both, live and video rating. Due to the low levels of disability and pain in the present sample, further research is necessary to conclusively judge validity.

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.

Lifestyle interventions, including meal replacement, are effective in the prevention and treatment of type-2-diabetes and obesity. Since insulin is the key weight regulator, we hypothesised that the addition of meal replacement to a lifestyle intervention reduces insulin levels more effectively than lifestyle intervention alone. In the international multicentre randomised controlled ACOORH (Almased Concept against Overweight and Obesity and Related Health Risk) trial, overweight or obese persons who meet the criteria for metabolic syndrome (n = 463) were randomised into two groups. Both groups received nutritional advice focusing on carbohydrate restriction and the use of telemonitoring devices. The intervention group substituted all three main meals per day in week 1, two meals per day in weeks 2–4, and one meal per day in weeks 5–26 with a protein-rich, low-glycaemic meal replacement. Data were collected at baseline and after 1, 3, 6 and 12 months. All datasets providing insulin data (n = 446) were included in this predefined subanalysis. Significantly higher reductions in insulin (−3.3 ± 8.7 µU/mL vs. −1.6 ± 9.8 µU/mL), weight (−6.1 ± 5.2 kg vs. −3.2 ± 4.6 kg), and inflammation markers were observed in the intervention group. Insulin reduction correlated with weight reduction and the highest amount of weight loss (−7.6 ± 4.9 kg) was observed in those participants with an insulin decrease &gt, 2 µU/mL. These results underline the potential for meal replacement-based lifestyle interventions in diabetes prevention, and measurement of insulin levels may serve as an indicator for adherence to carbohydrate restriction.

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

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

Lifestyle interventions have been shown to reverse hyperglycemia to normoglycemia. However, these effects are not long-lasting and are accompanied with high dropout rates. As formula diets have been shown to be simple in usage and effective in improving glycemic control, we hypothesised that adding a low-carbohydrate and energy deficit formula diet to a low-intensity lifestyle intervention is superior in reversing prediabetes compared with lifestyle intervention alone. In this predefined subanalysis of an international, multicenter randomised controlled trial (Almased Concept against Overweight and Obesity and Related Health Risk (ACOORH) study (ID DRKS00006811)), 141 persons with prediabetes were randomised (1:2) into either a control group with lifestyle intervention only (CON, n = 45) or a lifestyle intervention group accompanied with a formula diet (INT, n = 96). Both groups were equipped with telemonitoring devices. INT received a low-carbohydrate formula diet substituting three meals/day (~1200 kcal/day) within the first week, two meals/day during week 2–4, and one meal/day during week 5–26 (1300–1500 kcal/day). Follow-up was performed after 52 weeks and 105 participants (75%, INT: n = 74, CON: n = 31) finished the 26-week intervention phase. Follow-up data after 52 weeks were available from 93 participants (66%, INT: n = 65, CON: n = 28). Compared with CON, significantly more INT participants converted to normoglycemia after 52 weeks (50% vs. 31%, p &lt, 0.05). The risk reduction led to a number-needed-to-treat of 5.3 for INT. Lifestyle intervention with a low-carbohydrate formula diet reduces prediabetes prevalence stronger than lifestyle intervention alone and is effective for type 2 diabetes prevention.

Background: This study investigated whether work ability is associated with the duration of unemployment, heart rate variability (HRV), and the level of physical activity. Methods: Thirty-four unemployed persons (mean 55.7 ± standard deviation 33.3 years, 22 female, 12 male, unemployed: range 1−22.5 years) participated in the cross-sectional study. The Work Ability Index (WAI) and International Physical Activity Questionnaire (IPAQ) were applied. Short-term (five minutes) resting HRV (Low Frequency (LF), High Frequency (HF), Total Power (TP)) was collected. Results: Work ability was positively associated with the HRV: LF (r = 0.383; p = 0.025), HF (r = 0.412; p = 0.015) and TP (r = 0.361; p = 0.036). The WAI showed a positive linear correlation with the amount of total physical activity (r = 0.461; p = 0.006) as well as with the amount of moderate to vigorous physical activity (r = 0.413; p = 0.015). No association between the WAI and the duration of unemployment occurred. Conclusions: the relation between self-perceived work ability, health-associated parameters, the HRV and the level of physical activity points out the relevance of health-care exercise and the need of stress-reducing interventions to improve perceived work ability. Our results point out the need for the further and more holistic development of healthcare for the unemployed.

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

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

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

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

Mobile phone tasks like texting, typing, and dialling during walking are known to impact gait characteristics. Beyond that, the effects of performing smartphone-typical actions like researching and taking self-portraits (selfie) on gait have not been investigated yet.We aimed to investigate the effects of smartphone usage on relevant gait characteristics and to reveal potential association of basic cognitive and walking plus smartphone dual-task abilities.Our cross-sectional, cross-over study on physically active, healthy participants was performed on two days, interrupted by a 24-h washout in between. Assessments were: 1) Cognitive testing battery consisting of the trail making test (TMT A and B) and the Stroop test 2) Treadmill walking under five smartphone usage conditions: no use (control condition), reading, dialling, internet searching and taking a selfie in randomized order. Kinematic and kinetic gait characteristics were assessed to estimate conditions influence.In our sample of 36 adults (24.6 ± 1 years, 23 female, 13 male), ANCOVAs followed by post-hoc t-tests revealed that smartphone usage impaired all tested gait characteristics: gait speed (decrease, all conditions): F = 54.7, p 0.001; cadence (increase, all): F = 38.3, p 0.001; double stride length (decrease, all): F = 33.8, p 0.001; foot external rotation (increase during dialling, researching, selfie): F = 16.7, p 0.001; stride length variability (increase): F = 11.7, p 0.001; step width variability (increase): F = 5.3, p 0.001; step width (Friedmann test and Wilcoxon Bonferroni-Holm-corrected post-hoc analyses, increase): Z = -2.3 to -2.9; p 0.05); plantar pressure proportion (increase during reading and researching) (Z = -2.9; p 0.01). The ability to keep usual gait quality during smartphone usage was systematically associated with the TMT B time regarding cadence and double stride length for reading (r = -0.37), dialling (r = -0.35) and taking a selfie (r = -0.34).Smartphone usage substantially impacts walking characteristics in most situations. Changes of gait patterns indicate higher cognitive loads and lower awareness.

The health effects of light-intensity physical activity (PA) are not well known today. We conducted a systematic review to assess the association of accelerometer-measured light-intensity PA with modifiable health outcomes in adults and older adults. A systematic literature search up to March 2016 was performed in the PubMed, EMBASE, Web of Science and Google Scholar electronic databases, without language limitations, for studies of modifiable health outcomes in adults and older adults in the National Health and Nutrition Examination Survey accelerometer dataset. Overall, 37 cross-sectional studies and three longitudinal studies were included in the analysis, with considerable variation observed between the studies with regard to their operationalization of light-intensity PA. Light-intensity PA was found to be beneficially associated with obesity, markers of lipid and glucose metabolism, and mortality. Few data were available on musculoskeletal outcomes and results were mixed. Observational evidence that light-intensity PA can confer health benefits is accumulating. Currently inactive or insufficiently active people should be encouraged to engage in PA of any intensity. If longitudinal and intervention studies corroborate our findings, the revision of PA recommendations to include light-intensity activities, at least for currently inactive populations, might be warranted.

We aimed to compare the potential acute effects of single bouts of a classic prevention and a risk factor-focus training aiming to target modifiable anterior cruciate ligament (ACL) rupture risk factors and the impact of neuromuscular fatigue on relevant ACL rupture risk factors.Two preventive warm-up (standard and ACL rupture risk factor training) and one inactive arm were compared; each of these were followed by a standardized neuromuscular fatigue protocol. The assessments included two Trail making tests (TMT-A; TMT-B, time to complete), drop jump landings (knee separation distance, normalized at hip width), as well as unanticipated counter movement jump landings (time to stabilization and peak ground reaction force).We included 18 participants (25±2years). No differences were found between times and conditions for TMT (P0.05). A significant time effect occurred in time to stabilization (F=2.6; P0.05) and a significant time*baseline-value*jumping time interaction was seen in peak ground reaction force (F=3.1; P0.05). No time effect was found for any knee separation distance (F=.1-2.4; P0.05); but a significant time*baseline-value*jumping time interaction was seen at initial ground contact (F=2.8; P0.05), and lowest point (F=4.2; P0.01).Risk factor-focus and classic warm-up may not differ in their acute effects on modifiable functional ACL (re-)injury risks factors.

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.

Background Crepitus of the knee may mirror structural and functional changes in the joint during motion. Although the magnitude of these sounds increases with greater cartilage damage, it is unclear whether knee joint sounds also reflect joint loading. Methods Twelve healthy volunteers (mean 26 (SD 3.6) years, 7 females) participated in the randomized-balanced crossover study. Knee joint sounds were recorded (linear sampling, 5512 Hz) by means of two microphones, one placed on the medial tibial plateau and one on the patella. Two activities of daily living (standing up from/sitting down on a bench; descending stairs) and three open kinetic chain knee extension-flexion cycles (passive movement, 10% and 40% loading of the individual one repetition maximum) were performed. Each participant carried out three sets of five repetitions and three sets of 15 steps downwards (stairs), respectively. For data analysis, the mean sound amplitude and the median power frequency for each loading condition were determined. Friedman test and Bonferroni-Holm adjusted post-hoc test were performed to detect differences between conditions. Findings We obtained significant differences between joint sound amplitudes for all movements, both measured at the medial tibial plateau (Chi2 = 20.7, p Interpretation Overall, the larger the supposed knee joint loading was, the louder was the recorded knee crepitus. Consequently, vibroarthrographically assessed knee joint sounds can differ across knee joint loading conditions.

Purpose Foam Rolling (FR), aims to mimic the effects of manual therapy and tackle dysfunctions of the skeletal muscle and connective tissue. It has been shown to induce improvements in flexibility, but the underlying mechanisms are poorly understood. The aim of the present study was to further elucidate the acute, systemic and tissue-specific responses evoked by FR. Methods In a crossover study, 16 (34 ± 6y, 6f) participants received all of the following interventions in a random order: a) 2 × 60 seconds of FR at the anterior thigh, b) 2 × 60 seconds of passive static stretching of the anterior thigh (SS), and c) no intervention (CON). Maximal active and passive knee flexion range of motion (ROM), passive stiffness, sliding of fascial layers, as well as knee flexion angle of first subjectively perceived stretch sensation (FSS) were evaluated before and directly after each intervention. Results Flexibility increased only after, FR (active (+1.8 ± 1.9%) and passive ROM (+3.4 ± 2.7%), p = .006, respectively) and SS (passive ROM (+3.2 ± 3.5%), p = .002). Angle of FSS was altered following FR (+4.3° (95% CI: 1.4°–7.2°)) and SS (+6.7° (3.7°–9.6°)), while tissue stiffness remained unchanged after any intervention compared to baseline. Movement of the deepest layer (−5.7 mm (−11.3 mm to −0.1 mm)) as well as intrafascial sliding between deep and superficial layer (−4.9 mm (−9.mm to −0.7 mm)) decreased only after FR. Conclusion FR improved knee flexion ROM without altering passive stiffness, but modified the perception of stretch as well as the mobility of the deep layer of the fascia lata. The mechanisms leading to altered fascial sliding merit further investigation.

We aimed to delineate if unanticipated jump-landing assessments delivers complementary information to those of commonly used hop and jump tests after anterior cruciate ligament reconstruction.Eleven participants (5 males) performed a series of unanticipated jump-landings and traditional hop and jump performance tests (single leg hops for distance, triple crossover hops for distance and drop jumps). The number of mistrials, time to stabilization and peak ground reaction force (pGRF) at landing and jump/hop distance were measured. Pearson correlations to find potential associations between the unanticipated jump-landing-values and the traditional jump/hop performance tests were calculated twice: once for the affected and once for the unaffected legs. t-Tests for dependent samples were used to detect differences between affected and unaffected leg within each test condition.The pGRF at unanticipated landing significantly correlated to the pGRF at drop jump landing (r = 0.68) and the hopping distance after the triple crossover hops (r = 0.71, each p .05). No other significant correlation occurred (p .05). Hopping distance after single leg hops (mean: 110.2 cm vs. 95.5 cm) and triple crossover hops for distance (mean: 315.3 cm vs. 294.2 cm) showed significant differences between the unaffected and the reconstructed leg (p .05). Other parameters showed no significant between-legs differences (p .05).Both, the reconstructed and the contralateral leg seems to be affected. Unanticipated jump landing tasks deliver information beyond those of commonly used jump and hop tests, the thereby assessed abilities may thus be a complementary aspect of dynamic knee function than those assessed with classic tests.

Cognitive skills such as working memory or inhibitory control are suggested to have an impact on injury risk during time-constrained athletic movements. Thus, the aim of this study was to gain further insights into the cognitive processes associated with biomechanical stability in unplanned jump-landings.Cross-sectional.Twenty male participants (27±4years) performed 70 counter-movement jumps with single-leg landings on a pressure plate. Equally balanced and in randomized order, these were to be performed either planned (landing leg indicated before take-off) or unplanned (visual cue during flight). Biomechanical stability was estimated from vertical peak ground reaction force (pGRF), time to stabilization (TTS), center of pressure path length (COP), and the number of standing errors (ground touch with free leg). In addition, decision-making was assessed as the amount of landing errors (wrong/both feet) in the unplanned condition. Cognitiive function was measured using computerized as well as pen-and-paper-testing.Unplanned landings produced higher COP values (p0.001, d=1.1) and more standing errors (p0.001, d=0.9) than the pre-planned condition. Decreased postural stability (COP) was related to lower inhibitory control (p=0.036, r=0.48). There was a correlation between the increase in standing errors and better cognitive flexibility/working memory (p=0.037, r=-0.48) and short-term memory (p=0.028, r=0.50). The opposite was found for the unplanned landing errors: poor decision-making was associated with deficits in cognitive flexibility/working memory (p=0.022, r=0.54) and short-term memory (p=0.019, r=-0.55).Cognitive function may be an important, but under-researched moderator of unplanned jump-landing safety. Further research should elucidate the development of training methods aiming to improve movement-related decision-making and landing stability under time constraints.

We tested if ACL-reconstructed participants show a decreased quadriceps torque, a lower muscle endurance capacity and a higher peak torque variability compared to unimpaired control participants prior to and following local muscle fatigue. Participants (

Lower limb stretching based on myofascial chains has been demonstrated to increase cervical range of motion (ROM) in the sagittal plane. It is, however, unknown whether such remote exercise is as effective as local stretching. To resolve this research deficit, 63 healthy participants (36 ± 13 years, ♂32) were randomly assigned to one of three groups: remote stretching of the lower limb (LLS), local stretching of the cervical spine (CSS) or inactive control (CON). Prior (M1), immediately post (M2) and 5 min following intervention (M3), maximal cervical ROM was assessed. Non-parametric data analysis (Kruskal-Wallis tests and adjusted post hoc Dunn tests) revealed significant differences between the disposed conditions. With one exception (cervical spine rotation after CSS at M2, P .05), both LLS and CSS increased cervical ROM compared to the control group in all movement planes and at all measurements (P .05). Between LLS and CSS, no statistical differences were found (P .05). Lower limb stretching based on myofascial chains induces similar acute improvements in cervical ROM as local exercise. Therapists might consequently consider its use in programme design. However, as the attained effects do not seem to be direction-specific, further research is warranted in order to provide evidence-based recommendations.

Gallardo-Fuentes, F, Gallardo-Fuentes, J, Ramirez-Campillo, R, Balsalobre-Fernandez, C, Martinez, C, Caniuqueo, A, Canas, R, Banzer, W, Loturco, I, Nakamura, FY, and Izquierdo, M. Intersession and intrasession reliability and validity of the My Jump app for measuring different jump actions in trained male and female athletes. J Strength Cond Res 30(7): 2049-2056, 2016-The purpose of this study was to analyze the concurrent validity and reliability of the iPhone app named My Jump for measuring jump height in 40-cm drop jumps (DJs), countermovement jumps (CMJs), and squat jumps (SJs). To do this, 21 male and female athletes (age, 22.1 ± 3.6 years) completed 5 maximal DJs, CMJs, and SJs on 2 separate days, which were evaluated using a contact platform and the app My Jump, developed to calculate jump height from flight time using the high-speed video recording facility on the iPhone. A total of 630 jumps were compared using the intraclass correlation coefficient (ICC), Bland-Altman plots, Pearson's product moment correlation coefficient (r), Cronbach's alpha (α), and coefficient of variation (CV). There was almost perfect agreement between the measurement instruments for all jump height values (ICC = 0.97-0.99), with no differences between the instruments (p > 0.05; mean difference of 0.2 cm). Almost perfect correlation was observed between the measurement instruments for SJs, CMJs, and DJs (r = 0.96-0.99). My Jump showed very good within-subject reliability (α = 0.94-0.99; CV = 3.8-7.6) and interday reliability (r = 0.86-0.95) for SJs, CMJs, and DJs in all subjects. Therefore, the iPhone app named My Jump provides reliable intersession and intrasession data, as well as valid measurements for maximal jump height during fast (i.e., DJs) and slow (i.e., CMJs) stretch-shortening cycle muscle actions, and during concentric-only explosive muscle actions (i.e., SJs), in both male and female athletes in comparison with a professional contact platform.

Fatigue protocols have been used over the years to examine muscular exhaustion. As an alternative to approaches in laboratory settings, functional agility protocols claiming to mimic the multifaceted loads of athletic activity have been proposed. This study aimed to examine the effects of a functional agility short-term fatigue protocol (FAST-FP) on neuromuscular function. Twenty-eight healthy sports students (15 males, aged 24.3 ± 2.4 years) completed the FAST-FP, which consists of four components: three counter-movement jumps (90% of individual maximum), a 20-s bout of step-ups, three bodyweight squats and an agility run. Tasks were repeated until the participants no longer achieved the required jump height in two consecutive sets. Outcomes (pre-post) encompassed subjective exhaustion (visual analogue scale [VAS]), maximum isometric voluntary force of the knee extensors (MIVF), reactive strength index (RSI), mean power frequency (MPF, measured using surface electromyography) and maximum knee range of motion (ROM). Post-intervention, VAS (+54 mm) increased significantly, while MIVF (-6.1%), RSI (-10.7%) and MPF (-4.1%) were reduced (p 0.05). No changes were observed for ROM (p 0.05). The FAST-FP induces small-to-moderate impairments in neuromuscular function and considerable self-perceived fatigue. Current evidence on exhaustion developing in team sports suggests that this magnitude of fatigue is similar. The protocol might thus be valuable in the evaluation of treatments counteracting post-match fatigue in team sports.

BACKGROUND Low back pain patients have been suggested to exhibit dysfunctional spinal movement patterns. However, there is a lack of clinically applicable but valid and reliable assessment tools, helping to discriminate normal and pathologically altered movement. OBJECTIVE We aimed to examine whether kinematic parameters determined with an ultrasound-based motion analysis and thereof derived chromokinegraphical angle-time matrices (CATMAs) are able to discriminate between non-symptomatic and symptomatic movement behaviour in individuals with non-specific chronic (CLBP), specific low back pain (SLBP), and controls. METHODS Thoracic and lumbar spine range of motion (ROM [∘]); angular velocity (V [∘/sec]) and side-to-side differences [%] during a lateral flexion movement were assessed in 17 healthy participants, 16 individuals with CLBP and 11 SLBP patients. CATMAs ratings of two investigators (6-item Likert scale) were dichotomised, classifying the observed movement as physiological or non-physiological. Intrarater and interrater reliability were estimated using kappa statistics and Cronbach's Alpha. T-tests and a ROC analysis to determine optimal cut-offs for the separation of the collectives as well as contingency tables for selectivity of the cut-offs (motor outcomes) were calculated. RESULTS CATMA ratings displayed partly moderate to good (rater B; i.e. CLBP vs. controls) and partly insufficient discriminant validity (rater A). Due to this, inter-rater reliability was poor (k= 0.061 to 0.135), while intra-rater-reliability was moderate to good for both raters (k= 0.329 to 0.625) except for SLBP vs. controls (rater A; k=-0.18). Regarding kinematics, group differences occurred neither in ROM nor in V (p> 0.05), but in terms of the relative side comparison between CLBP and controls (p

Current evidence suggests that the loss of mechanoreceptors after anterior cruciate ligament (ACL) tears might be compensated by increased cortical motor planning. This occupation of cerebral resources may limit the potential to quickly adapt movements to unforeseen external stimuli in the athletic environment. To date, studies investigating such neural alterations during movement focused on simple, anticipated tasks with low ecological validity. This trial, therefore, aims to investigate the cortical and biomechanical processes associated with more sport-related and injury-related movements in ACL-reconstructed individuals.ACL-reconstructed participants and uninjured controls will perform repetitive countermovement jumps with single leg landings. Two different conditions are to be completed: anticipated (n=35) versus unanticipated (n=35) successful landings. Under the anticipated condition, participants receive the visual information depicting the requested landing leg prior to the jump. In the unanticipated condition, this information will be provided only about 400 msec prior to landing. Neural correlates of motor planning will be measured using electroencephalography. In detail, movement-related cortical potentials, frequency spectral power and functional connectivity will be assessed. Biomechanical landing quality will be captured via a capacitive force plate. Calculated parameters encompass time to stabilisation, vertical peak ground reaction force, and centre of pressure path length. Potential systematic differences between ACL-reconstructed individuals and controls will be identified in dependence of jumping condition (anticipated/ unanticipated, injured/uninjured leg and controls) by using interference statistics. Potential associations between the cortical and biomechanical measures will be calculated by means of correlation analysis. In case of statistical significance (α0.05.) further confounders (cofactors) will be considered.The independent Ethics Committee of the University of Frankfurt (Faculty of Psychology and Sports Sciences) approved the study. Publications in peer-reviewed journals are planned. The findings will be presented at scientific conferences.At the time of submission of this manuscript, recruitment is ongoing.NCT03336060; Pre-results.

BACKGROUND Most methods assessing soft tissue stiffness are associated with high costs and considerable technical effort. A previous study demonstrated that the tissue compliance meter represents an affordable alternative with straightforward handling. However, little data exists describing its measurement properties. OBJECTIVE The study aimed to elucidate the reliability and validity of a semi-electronic tissue compliance meter (STCM). METHODS Tissue stiffness at the lateral calf was examined in 34 healthy participants (24 ± 5 yrs, 21 men). Measurements on two consecutive days were used to estimate test-retest reliability, day-to-day reliability and inter-rater reliability. Validity was examined twofold. Firstly, STCM data were correlated with those of another method, the myotonometry. Secondly, STCM measurements at different levels of isometric contraction (M.gastrocnemius) were examined for systematic differences. RESULTS Intraclass correlations (ICC) revealed high test-retest reliability (ICC 0.84, 95% CI: 0.70 to 0.92; p< 0.05) and day-to-day reliability (0.84, 0.71 to 0.92; p< 0.05). Inter-rater reliability was sufficient to good (0.75, 0.56 to 0.87; p< 0.05). Cross-validation with myotonometry revealed a strong correlation of both methods (r= 0.86; p< 0.05). Stiffness assessments during isometric contraction demonstrated that the STCM can discriminate different force levels (χ2= 57.1, p< 0.05). CONCLUSIONS The STCM provides valid and reliable measurements of tissue stiffness. Further study is needed to provide norm values for different body regions and to reveal alterations in patients with musculoskeletal disorders.

A media-based collection and further analysis of relative return to play (RTP) rates and the corresponding quality of play after anterior cruciate ligament (ACL) rupture in top-level football was the aim of our study. In the 5-year case-control study, male players from the first two leagues of the five top leagues in Europe, who sustained a total ACL rupture during the season 2010/11 and/or 2011/12, were included. For them and a matched control sample (ratio 1:2), data were retrieved from the publicly available and validated media-based platforms (transfermarkt.de & whoscored.com) until the end of season 2016/17. Injury and return to play-specific data were calculated as rate ratios (RR) to compare the injured and matched control athletes rates and as a survival analysis (log-rank test; career duration). Overall, 132 ACL-injuries in 125 players occurred. The RTP rate was 98.2%, and the RTP to the same level was 59.4%. Five years post-RTP, 69.9% of the ACL group were still engaged in football (RR = 87%), 40.9% at the same level (RR = 72%). Survival analysis revealed a systematic group difference in career duration compared to controls (Cox-Mantel's χ2 = 5.8; P = 0.016). Game performance (scoring points, P

OBJECTIVE To compare the exercise loads and cognitive effects of a classical workplace program from that for a motor-cognitive coordination workplace intervention. METHODS Twenty-eight (28) employed adults (women 19, men 9) participated in a motor-cognitive coordination and a classical workplace health promotion exercise intervention. Effects on attention and cognition (trail making test [TMT]) as well as exercise load (heart rate and rates of perceived exhaustion [RPE]) were assessed. RESULTS The motor-cognitive intervention does not improve cognitive abilities (TMT-A: -4.6 ± 2.2 seconds; TMT-B: -8.5 ± 3.2 seconds) to a greater extent than the classical workplace health enhancement training (TMT-A: -4.6 ± 3.1 seconds; TMT-B: -7.4 ± 3.9 seconds) (P

Context: Recent research has underpinned the occurrence of nonlocal exercise effects. For instance, self-myofascial release (SMR) of the plantar fascia increases hamstring extensibility. A possible mechanism consists in a mechanical force transmission across myofascial chains. However, as the degree of structural continuity in these chains decreases with age, the magnitude of the above described remote effects might also be reduced throughout a lifespan. Objective: To examine the age dependency of nonlocal exercise effects following plantar fascia SMR. Design: Regression experimental study. Setting: General population. Participants: 168 healthy participants (Mage = 45 [21] y, 85 males). Intervention: One 120 s bout of plantar foot SMR, performed in standing position. Main Outcomes Measure: Hamstring extensibility was assessed using sit and reach testing. Relative pre–post differences were classified as no improvement, clinically nonrelevant improvement, or clinically relevant improvement according to previously published data. The age dependency of the effects was calculated by means of multinomial stepwise logistic regression. If the latter revealed other factors than age to affect treatment effectivity, their effect was eliminated using partial correlation. Results: SMR increased hamstring extensibility by 10.1% (pre: 24.9 [9.7] cm, post: 27.4 [9.3] cm, P r2 = .32, P r = .29, P Conclusions: Plantar foot SMR increases hamstring extensibility, which is explained by age to a small degree. Additional research is warranted to delineate the substrate of remote exercise effects. Besides mechanical force transmission, cortical adaptations might also represent the driving factor.

A growing body of literature suggests that physical activity might alleviate the age-related neurodegeneration and decline of cognitive function. However, most of this evidence is based on data investigating the association of exercise interventions or current physical activity behavior with cognitive function in elderly subjects. We performed a systematic review and hypothesize that physical activity during the adult life span is connected with maintained domain-specific cognitive functions during late adulthood defined as age 60+ years. We performed a systematic literature search up to November 2017 in PubMed, Web of Science, and Google Scholar without language limitations for studies analyzing the association of leisure physical activity during the adult life span (age 18+ years) and domain-specific cognitive functions in older adults (age 60+ years). The literature review yielded 14,294 articles and after applying inclusion and exclusion criteria, nine cross-sectional and 14 longitudinal studies were included. Moderate- and vigorous-intensity leisure physical activity was associated with global cognitive function and specific cognitive domains including executive functions and memory but not attention or working memory. Most studies assessed mid- to late-adulthood physical activity, thus information concerning the influence of young adult life-span physical activity is currently lacking. Observational evidence that moderate- and vigorous-intensity leisure physical activity is beneficially associated with maintained cognitive functions during old age is accumulating. Further studies are necessary to confirm a causal link by assessing objective physical activity data and the decline of cognitive functions at multiple time points during old age.

A small share of the world's population meets current physical activity guidelines, which recommend regular engagement in endurance, strength, and neuromotor exercise. As lack of time represents a major cause of inactivity, multidimensional training methods with short durations may provide a promising alternative to classical, volume-oriented approaches focusing on one biomotor ability. This trial examined the effects of a high-intensity functional circuit training (HIFCT) on motor performance and exercise motivation in untrained adults.Thirty-three inactive participants were randomly allocated to two groups exercising for six weeks. The intervention group (HIFCT, n = 20) 3×/week performed functional whole-body exercises in a circuit. Each 15-minute workout included repetitive 20s all-out bouts with 10s breaks. In the comparison group (moderate aerobic exercise, MAE, n = 13), the participants walked 3×/week for 50 minutes at moderate intensity. Measured motor outcomes were cycling endurance capacity (respiratory threshold, maximum workload), maximum strength (leg and chest press), postural control (force plate), and jump capacity (counter-movement jump, single leg hop for distance); exercise motivation was assessed using the self-concordance index.In comparison with MAE, HIFCT enhanced maximum leg strength (between-group difference of relative pre- to post-changes of 5.0%), shoulder strength (7.6%), and endurance workload (5.0%; P 0.05), while increasing motivation to exercise (+5.5 points, P 0.05). No between-group differences occurred for postural control and jump capacity (P 0.05).Despite considerably shorter training duration, HIFCT enhances motor function and motivation to exercise more effectively than MAE. Further research should investigate the long-term adherence to the program and its effectiveness in other settings.

Context: Foam rolling (FR) increases joint range of motion (RoM), but the optimal training parameters are unknown. Objective: To investigate the effect of FR velocity on RoM and tissue stiffness. Design: Randomized, controlled crossover trial. Setting: University. Participants: A total of 17 healthy, physically active adults (10 females; 25 [2] y). Interventions: (1) Four 45-second high-velocity FR of the anterior thigh (FAST-FR), (2) four 45-second slow-velocity FR of the anterior thigh (SLOW-FR), and (3) inactive control. Outcome Measures: Maximal knee-flexion RoM (ultrasonic movement analysis) and anterior thigh tissue stiffness (semielectronic tissue compliance meter) assessed pre, immediately post (T0), as well as 5 (T5) and 10 (T10) minutes postintervention. Statistical analysis included Friedman tests with adjusted post hoc comparisons (Wilcoxon tests). Results: According to omnibus testing, RoM remained unchanged in all 3 conditions and at all time points (P > .05), while differences were found for tissue stiffness (P P P P P > .05). Conclusions: FR of the anterior thigh decreases myofascial stiffness regardless of velocity. The lack of effects on RoM contrasts findings of recent literature and warrants further investigation.

Despite the evidence suggesting physical activity (PA) as a major factor for the prevention of age-related cognitive decline, only a few studies have systematically investigated the impact of leisure PA during the lifespan (LLPA). This study investigates the effects of LLPA on cognitive function (CF) and brain plasticity (BP) in old age.Participants' (n = 50, 72 ± 5 yrs, 27 females) LLPA energy expenditure and volume was assessed via a validated questionnaire investigating five epochs (14-80 yrs). Using current WHO PA recommendations as reference, participants were stratified into energy expenditure and volume groups. CF outcomes were attention, executive functions, working memory and memory. BP was assessed using magnetic resonance spectroscopy (MRSI) and brain derived neurotropic factor (BDNF).Correlation analysis revealed associations of mean LLPA energy expenditure with attention (CF) and N-acetylaspartate to choline ratios (NAA/Cho) (MRSI). ANOVA revealed higher interference control performance (CF) and NAA/Cho in participants complying with current PA recommendations (2-3 h per week) compared to non-compliers. Further CF and BP outcomes including BDNF were not associated with LLPA.Lifelong adherence to minimum recommended PA seems to be associated with markers of cognitive function and neuronal integrity in old age.

Prostate cancer (PCa) is a disease of increasing medical significance worldwide. In developed countries, PCa is the most common non-skin cancer in men, and one of the leading causes of cancer-related deaths. Exercise is one of the environmental factors that have been shown to influence cancer risk. Moreover, systemic reviews and meta-analysis have suggested that total physical activity is related to a decrease in the risk of developing PCa. In addition, epidemiological studies have shown that exercise, after diagnosis, has benefits regarding PCa development, and positive outcome in patients under treatment. The standard treatment for locally advanced or metastatic PCa is Androgen deprivation therapy (ADT). ADT produces diverse side effects, including loss of libido, changes in body composition (increase abdominal fat), and reduced muscle mass, and muscle tone. Analysis of numerous research publications showed that aerobic and/or resistance training improve patient's physical condition, such us, cardiorespiratory fitness, muscle strength, physical function, body composition, and fatigue. Therefore, exercise might counteract several ADT treatment-induced side effects. In addition of the aforementioned benefits, epidemiological, and in vitro studies have shown that exercise might decrease PCa development. Thus, physical activity might attenuate the risk of PCa and supervised exercise intervention might improve deleterious effects of cancer treatment, such as ADT side effects. This review article provides evidence indicating that exercise could complement, and potentiate, the current standard treatments for advanced PCa, probably by creating an unfavorable microenvironment that can negatively affect tumor development, and progression.

Sports medical examinations of juvenile athletes provide an opportunity for preventive measures against sports-related diseases. Determining the leg axis deviation as a risk factor for future constraints may offer approaches for such measures. Data were obtained from 789 youth athletes: 166 with coronal plane knee misalignment and 623 without. After a seven-year period, 64 participants (m: 33, f: 31) from both groups were reassessed for the incidence of nonspecific chronic low back pain (CLBP). To distinguish participants with increased risk for CLBP, contingency tables for comparison of expected and joint frequency distribution testing and receivers operating characteristic (ROC) analyses for the weekly training time were conducted. Subjects with an initial diagnosed knee misalignment showed increased risk for the development of CLBP (CHI2 = 4.2, p < .05, OR = 3.4) compared to participants without knee misalignment. In athletes with knee misalignment, ROC analysis revealed an optimal cut-off of 6.75 h/w (AUC = 0.8; Chi2 = 4.2, p < .05, OR = 8.0). In athletes without leg axis deviation, no association to training volume was detected. Our results suggest a predictive value of knee misalignment on the later occurrence of CLBP in young competitive athletes and underline the importance of an examination of the motor system during sports medical assessments in youth athletes. Training volume of almost more than 7 h a week enhances this risk.

Objective To assess how different decision-guiding factors, such as health- and performance-related stakeholders, as well as evidence-based guidelines, support the process-oriented final positive return-to-play (RTP) decision of head coaches responsible for semiprofessional sport teams. Design Cross-sectional survey. Setting Team sport. Participants A survey consisting of questions on the importance of different decision-guiding factors used when making the RTP decision after injuries was administered to and completed by head coaches (N=238) of semiprofessional players' teams. Interventions Not applicable. Main Outcome Measures With respect to helpfulness in the RTP decision-making process, the coaches rated both the importance of the opinions of physicians, physiotherapists, strength and conditioning coaches, and the athletes themselves, and the importance of the general and injury-specific RTP guidelines. Results Our survey revealed that the head coaches rely on physicians and physiotherapists to a large extent, to the athletes and to themselves to a medium extent, and to strength and conditioning coaches and RTP guidelines to a small but still relevant extent. The coaches' efforts to seek a shared decision-making process in RTP are, hence, partially evident. Conclusions A multitude of actuators intervene when making the RTP decision. The professionalization of the RTP process in semiprofessional sports includes the athletes themselves, the head coaches, the (external) physicians, the (external) physiotherapists, and the strength and conditioning coaches based on general RTP decision-making models and specific criteria related to injury type, sports type, level, and playing position. The development of awareness and implementation strategies of RTP models should be subject to further research.

BACKGROUND The aim of this study was to determine the effects of a multidisciplinary exercise program on physical fitness, metabolic profile and nutritional status of obese patients. METHODS Seventeen women and four men (N.=21, age 18 to 60 years), with severe obesity (BMI=35-40 kg/m2, N.=7), morbid obesity (BMI=40-50 kg/m2, N.=9), and super obesity (BMI>50 kg/m2, N.=5), took part in a physical exercise program with nutritional and psychological support. The intermittent physical exercise program was applied three times per week (1 hour/session), with 4-8 exercises with weights. Three series were carried out for 60 s each, with increasing intensity leading to exhaustion at the end of the period and with 1-2 min recovery between series. Outcomes include the BMI, waist contour, blood pressure, cardiorespiratory fitness, exercise capacity, maximum dynamic strength, hand grip strength, basal glucose and lipid profiles. RESULTS The patients decreased in weight and BMI (P

National physical activity recommendations are regarded as crucial elements of comprehensive physical activity promotion strategies. To date, Germany has no such national physical activity recommendations. The aim of this study was to provide physical activity recommendations based on a comprehensive summary of scientific evidence on the relationships between physical activity and a range of health outcomes in adults and older adults. The recommendations were developed in a 3-phase process (systematic literature review, development and use of quality criteria, synthesis of content) based on already existing high-quality guidelines. Based on the analysis of documents included in this study, the following recommendations were formulated. To gain wide-ranging health benefits, adults and older adults should be physically active regularly and avoid inactivity. Adults and older adults should carry out at least 150 min/week moderate intensity or 75 min/week high intensity aerobic activity. Adults and older adults can also reach the recommended amount of physical activity by performing activities in an appropriate combination in both intensity ranges. Optimally, physical activity should be distributed over the week and it can be accumulated in bouts of at least 10 min. Physical activity beyond 150 min/week yields further health benefits. At the same time, physical activity below 150 min/week is associated with meaningful health gains. Accordingly, all adults and older adults should be encouraged to be physically active whenever possible. Adults and older adults should also perform muscle strengthening activities at least twice a week. Regular balance exercises (3 times a week) can reduce the risk of falls in older adults. Adults and older adults should avoid long periods of sitting and should break up sitting time by physical activity. Physical activity can lead to adverse events, such as musculoskeletal injuries, which can be mitigated through appropriate measures. All in all, the benefits of regular physical activity overweigh by far the risks in both adults and older adults.

Purpose The present study aims to develop age-dependent cutoff values in a quasi-experimental, cross-sectional diagnostic test study. Methods One hundred and twenty (120) asymptomatic subjects (n = 100, 36$, 18 75 years, for normative values; n = 20, 23–75 years, 15$, for selectivity analyses) and 20 patients suffering from idiopathic neck pain (selectivity analyses, 22–71 years, 15$) were included. Subjects performed five repetitive maximal cervical flexion/extension movements in an upright sitting position. Cervical kinematic characteristics (maximal range of motion (ROM), coefficient of variation (CV) and mean conjunct movements in rotation and flexion (CM)) were calculated from raw 3D ultrasonic data. Regression analyses were conducted to reveal associations between kinematic characteristics and age and gender and thus to determine normative values for healthy subjects. Results Age explains 53 % of the variance in ROM (decrease 10.2 per decade), 13 % in CV (increase 0.003 per decade) and 9 % in CM (increase 0.57 per decade). Receivers operating characteristic (ROC) analyses were conducted for differences between individual values of the kinematic characteristics and normative values to optimise cutoff values for distinguishing patients from unimpaired subjects (20 patients and 20 healthy). Cutoff values distinguished asymptomatic subjects’ and chronic nonspecific neck patient’s movement characteristics with sufficient quality (sensitivity 70–80 %, specificity 65–70 %). Conclusions By including such classifications, the present findings expand actual research stating an age-related decrease in kinematic behaviour only using categorising span widths across decades. Future study is warranted to reveal our results’ potential applicability for intervention onset decision making for idiopathic neck pain patients.