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Nina Schaller,1 Helge Krusemark,1 Esther Mende,1 Michael Weiß,1 Bianca Spanier,1 Otto Zelger,1 Jan Bischof,1 Bernhard Haller,2 Martin Halle,1,3,&ast; Monika Siegrist1,&ast; 1Department of Prevention and Sports Medicine, School of Medicine, University Hospital ‘rechts der Isar’, Technical University of Munich, Munich, Germany; 2Institute of AI and Informatics in Medicine, University Hospital ‘rechts der Isar’, Technical University of Munich, Munich, Germany; 3DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany&ast;These authors contributed equally to this workCorrespondence: Nina Schaller, Department of Prevention and Sports Medicine, School of Medicine, University Hospital ‘rechts der Isar’, Technical University of Munich, Georg-Brauchle-Ring 56, Munich, 80992, Germany, Tel +49 89 289 24441, Fax +49 89 289 24451, Email nina.schaller@mri.tum.dePurpose: Mobility is a crucial factor for independence and quality of life in old age. Nevertheless, many old people in retirement homes do not meet the physical activity recommendations. The aim of the Bestform-F – Best Function of Range of Motion feasibility study (bestform-F) was to evaluate the feasibility of implementing a machine-based multimodal exercise training program in older residents in retirement homes.Materials and Methods: The participants (n = 77) were recruited from two retirement homes and took part in a six-month multimodal exercise training program (2x/week, 45 minutes) on pneumatic strength training machines, a balance platform and bicycle ergometers. Feasibility criteria were recruitment number ≥ 35 participants within six months, dropout rate < 40% of participants within six months of exercise, and training adherence ≥ 50% of participants taking part in at least 50% of offered training sessions. Additionally, physical performance, fear of falling, cognitive function, and quality of life were assessed at baseline and after six months.Results: For the bestform-F study, 77 (85.6 ± 6.6 years; 78% women) out of 215 eligible residents from two senior residences were recruited. The dropout rate over six months was 10% (8/77 participants). The training adherence rate for the finishing participants was 77% (53/69 participants). In addition to the achieved feasibility criteria, significant improvements were recorded in the Chair Stand Test, Six-Minute Walk Test, and fear of falling after six months.Conclusion: All feasibility criteria have been fulfilled. The high number of recruited participants, the low dropout rate, and high adherence to the training program confirm the feasibility of a multimodal machine-based exercise training program offered to residents in retirement homes. The results provide a basis for a cluster-randomized controlled trial aimed at further investigating the efficacy of the bestform-F program.Keywords: machine-based exercise, seniors, sarcopenia, mobility, resistance training, balance

Arterial hypertension is the most important modifiable cardiovascular risk factor for all-cause morbidity and mortality worldwide. It is associated with an increased risk of cardiovascular diseases (CVD) and cognitive impairment. In this regard, accumulating evidence points to beneficial effects of intensified blood pressure lowering by implementation of protective lifestyle patterns (e.g. physical activity, diet) or pharmacotherapy. The aim of this clinical review is to summarize the role of physical activity and/or exercise in prevention and treatment of arterial hypertension.Epidemiology, prospective observational studies, and randomized controlled trials have shown positive effects of physical activity on blood pressure levels in patients with hypertension and in patients with high-normal and normal blood pressure. Thus, physical activity can prevent or slow down micro- and macrovascular end-organ damage. Physical activity should be recommended for prevention and treatment of all hypertension grades, but most patients with hypertension will concomitantly require drug treatment (depending on hypertension grade and individual cardiovascular risk profile).Currently, increasing attention is directed to the role of personalized exercise prescriptions for prevention and treatment of arterial hypertension and for addressing cardiometabolic risk.Key Words: Exercise, Prevention, Lifestyle, Cardiovascular Risk Factor, Cardiovascular Diseases

Introduction: An infection with SARS-CoV-2 is relevant especially in high-performance sport due to possible organ damage and reduced performance which occurs in individual cases. Various recommendations are found in the literature concerning when safe return to sports is possible and what examinations are suitable to support this decision. The dominance of other virus variants than those at the start of the pandemic makes revision of earlier recommendations necessary. Methods and Analysis: The recommended actions are based on the currently-available scientific knowledge of the pathogenicity of the virus and on clinical experiences in general and elite athletes. Twenty-one recommended actions were proposed by the Scientific Council of the DGSP, discussed and agreed on in consensus with experts from German-language sports-medical facilities and evaluated by an independent co-author. The resultant position paper was subsequently released by mutual agreement. Results: The recommendations are oriented to the severity of the course and the symptoms. The required medical diagnostic is deduced therefrom. During persistent symptoms, sports should be paused and training only begun again at low intensity after a three-day symptom-free period. If COVID-19-associated complaints recur, physical exertion should be stopped and a doctor consulted. After moderate and serious course, medical diagnostics are required prior to the start of training. Summary: To prevent a health risk due to sports and thereby resultant organ damage after a SARS-CoV-2 infection, a procedure adapted to the symptoms and course before return to training and finally to competitive sports is recommended.

Folate (vitamin B9) is involved in one-carbon transfer reactions and plays a significant role in nucleic acid synthesis and control of cellular proliferation, among other key cellular processes. It is now recognized that the role of folates in different stages of carcinogenesis is complex, and more research is needed to understand how folate reactions become dysregulated in cancers and the metabolic consequences that occur as a result. ALDH1L1 (cytosolic 10-formyltetrahydrofolate dehydrogenase), an enzyme of folate metabolism expressed in many tissues, is ubiquitously downregulated in cancers and is not expressed in cancer cell lines. The RT4 cell line (derived from papillary bladder cancer) which expresses high levels of ALDH1L1 represents an exception, providing an opportunity to explore the metabolic consequences of the loss of this enzyme. We have downregulated this protein in RT4 cells (shRNA driven knockdown or CRISPR driven knockout) and compared metabolomes of ALDH1L1-expressing and -deficient cells to determine if metabolic changes linked to the loss of this enzyme might provide proliferative and/or survival advantages for cancer cells. In this study, cell extracts were analyzed using Ultra High Performance Liquid Chromatography High Resolution Mass Spectrometry (UHPLC-HR-MS). A total of 13,339 signals were identified or annotated using an in-house library and public databases. Supervised and unsupervised multivariate analysis revealed metabolic differences between RT4 cells and ALDH1L1-deficient clones. Glycine (8-fold decrease) and metabolites derived from S-adenosylmethionine utilizing pathways were significantly decreased in the ALDH1L1-deficient clones, compared with RT4 cells. Other changes linked to ALDH1L1 downregulation include decreased levels of amino acids, Krebs cycle intermediates, and ribose-5-phosphate, and increased nicotinic acid. While the ALDH1L1-catalyzed reaction is directly linked to glycine biosynthesis and methyl group flux, its overall effect on cellular metabolism extends beyond immediate metabolic pathways controlled by this enzyme.

Problem: The skin is exposed to numerous stresses during sport. In addition to infection-related or allergic triggers, the development of sport-associated skin diseases depends on the discipline practiced and can be caused by mechanical stressors, thermal damage, and UV radiation. Methods: This review intends to give an overview of study results on the incidence and prevalence of skin diseases in competitive athletes. Publications describing case reports of the outbreak of a specific skin disease within a small cohort of athletes of a defined discipline were included as well as publications comparing the incidence of dermatoses between different disciplines based on large study cohorts.Results: Most studies focus on the analysis of the ocurrence of certain skin diseases in athletes of only one defined discipline, in most cases athletes performing sports with close body contact. Hardly any studies deal with dermatoses in competitive athletes among multiple disciplines. This review displays the occurrence of infectious, allergic, traumatic, UV-induced, and sebaceous dermatoses in competitive athletes by taking different disciplines into account.Discussion: Depending on the training environment, flow of movement, climatic influences and other factors, certain skin diseases occur frequently in athletes of specific disciplines.Key Words: High-Performance Athlete, Skin Disease, Training, Specific Disciplines

Vitamin D (VitD) and its physiological function in regulating calcium/phosphorus absorption and bone remineralization werefirst described in the early 20thcentury. A better understanding of VitD signaling has advanced our understanding of the importance of adequate VitD status to human health and performance. Tissues relevant to athletes which depend on VitD for optimal function include innate and adaptive immune system, skeletal muscle, and bone. Cross-sectional studies have shown that more than half of athletes are deficient and/or insufficient in VitD. Correcting insufficiency, the suggested target of25(OH)D blood levels above 30 ng/ml has the potential to optimize various aspects related to performance and regeneration in VitD insufficient athletes. This might help athletes to reach their full potential. Of note, there is no evidence pointing to actual or potential health risks of VitD levels within the recommended limits. VitD is therefore not on the list of prohibited substances of the world anti-doping agency.To avoid toxicity, VitD status should be monitored and supplementation strategies should be individualized and target-oriented. In terms of effectiveness and safety, low-dosed, continuous supplementation strategies of VitD are superior to intermittent application of supraphysiological boluses. The concept of synergy between nutrients lends qualified support tothe assumption that VitD bioavailability and function depend on meal context and onthefat-soluble vitamins A and K2 as well as the minerals magnesium and zinc. KEY WORDS: Regeneration, Immune System, Muscular Function, Bone Health, Supplementation Strategies

Objective: Existing literature has shown heart rate recovery one minute (HRR1) after exercise termination in cardiopulmonary exercise testing (CPET) to correlate with performance, although no data exist on HRR3 and 5 in a population without manifest cardiovascular disease. We aimed to analyze whether HRR3 and 5 correlate with relative oxygen uptake at peak performance (V O2peak) and maximal power (Pmax) as well as with weekly physical activity (PA).Methods: We conducted a sub-analysis of the Euro(pean)Ex(ercise) trial enrolling subjects between 50 and 70 years of age without manifest cardiovascular disease (n=59). Subjects underwent CPET following an individualized ramp protocol with an exercise duration between 10 and 14 minutes. Results: V O2peak (35.69.0 ml/kg/min) and Pmax(245.380.4 W) correlated significantly with HRR1 (22.67.9/min, both p5h/week (8.82.0) differed significantly from those with no regular sports in terms of HRR5 (p

Ellen Freiberger,1 Wolfgang A Blank,2 Johannes Salb,1 Barbara Geilhof,3 Christian Hentschke,1 Peter Landendoerfer,2 Martin Halle,3 Monika Siegrist31Institute of Sport Science and Sport Universität Erlangen-Nürnberg, Nuremberg, Germany; 2Institute of General Practice, Technische Universität München, Munich, Germany; 3Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Munich, GermanyPurpose: To study the feasibility of first, reaching functionally declined, but still independent older persons at risk of falls through their general practitioner (GP) and second, to reduce their physiological and psychological fall risk factors with a complex exercise intervention. We investigated the effects of a 16-week exercise intervention on physiological (function, strength, and balance) and psychological (fear of falling) outcomes in community-dwelling older persons in comparison with usual care. In addition, we obtained data on adherence of the participants to the exercise program.Methods: Tests on physical and psychological fall risk were conducted at study inclusion, and after the 16-week intervention period in the GP office setting. The 16-week intervention included progressive and challenging balance, gait, and strength exercise as well as changes to behavioral aspects. To account for the hierarchical structure in the chosen study design, with patients nested in GPs and measurements nested in patients, a three-level linear mixed effects model was determined for analysis.Results: In total, 33 GPs recruited 378 participants (75.4% females). The mean age of the participants was 78.1 years (standard deviation 5.9 years). Patients in the intervention group showed an improvement in the Timed-Up-and-Go-test (TUG) that was 1.5 seconds greater than that showed by the control group, equivalent to a small to moderate effect. For balance, a relative improvement of 0.8 seconds was accomplished, and anxiety about falls was reduced by 3.7 points in the Falls Efficacy Scale–International (FES-I), in the intervention group relative to control group. In total, 76.6% (N = 170) of the intervention group participated in more than 75% the supervised group sessions.Conclusion: The strategy to address older persons at high risk of falling in the GP setting with a complex exercise intervention was successful. In functionally declined, community-dwelling, older persons a complex intervention for reducing fall risks was effective compared with usual care.Keywords: complex exercise intervention, functional declined community-dwelling older persons

The literature offers few recommendations for sequencing exposure to treatment conditions with individuals with multiply maintained destructive behavior. Identifying relative preference for the functional reinforcers maintaining destructive behavior may be one means of guiding that decision. The present study presents a preliminary attempt at developing a robust relative preference and reinforcer assessment for individuals with multiply maintained destructive behavior. Guided and free‐choice trials were implemented in which participants chose between two multiple‐schedule arrangements, each of which programmed signaled periods of isolated reinforcer availability and unavailability. Consistent participant choice and responding during free‐choice trials was then used to thin the corresponding schedule of reinforcement. The results demonstrated a strong preference for one of the two functional reinforcers for all four participants, yet preferences differed across participants and were not well predicted by responding in prior analyses. [ABSTRACT FROM AUTHOR]

Endurance sports carry a high risk of exercise addiction (EA) compared to other physical activities. Previous research has established a link between EA and depressive symptoms. The aim of this study was to evaluate a sample of amateur marathoners concerning risk of EA and investigate the relationship to fitness measures, affect and the general level of functioning. We included 72 (19.4% female) marathon runners. The Exercise Addiction Inventory (EAI), the global assessment of functioning (GAF), the international physical activity questionnaire (IPAQ), the Beck-Depression Inventory (BDI) and the Positive and Negative Affect Schedule (PANAS) were assessed alongside demographic measures, maximum oxygen uptake (cardio pulmonary exercise test), BMI and training volume. In this sample five individuals at-risk could be identified (6.94%). No significant associations were found regarding demographics and EA. Higher values of EA were associated with a reduced level of general functioning (r = −.35; p =.003), higher values of depressive symptoms (r =.36; p =.003) and negative affect (r =.27; p =.022) while no increased training volume or higher performance were observed. A regression analysis identified the IPAQ as predictor for risk of EA (PANAS-NA marginally significant). Marathon running at the amateur level showed a lower risk of developing an exercise addiction than expected. Important associations of EA could be identified in our study (IPAQ, PANAS-NA, GAF, BDI). Trial registration: German Clinical Trials Register identifier: DRKS00012496. [ABSTRACT FROM AUTHOR]

The purpose of the current study was to conduct a systematic replication of Fiske et al. (2015) to extend the behavior‐analytic literature on token reinforcement. Specifically, the researchers addressed several of the limitations of Fiske et al. by including specific conditioning procedures, creating a controlled history of reinforcement with the token system, including participants with and without disabilities to extend the generality of the findings, and equating the magnitude of reinforcement across the primary and paired‐token conditions. The current study evaluated the reinforcing value of tokens by using progressive‐ratio schedules to compare the efficacy of primary reinforcement, paired tokens, and unpaired tokens. The results suggest that paired tokens may function as reinforcers, but they were not as consistently effective as primary reinforcers. [ABSTRACT FROM AUTHOR]