Knee osteoarthritis (OA) is the most common joint disease worldwide. Exercise therapy has been identified as a first-line treatment option in patients suffering from knee OA. High-intensity interval training (HIIT) is an innovative exercise modality with potential in improving various disease-related outcomes. The purpose of this review is to explore the impact of HIIT on knee OA symptoms and physical functioning. A comprehensive search of scientific electronic databases was conducted to identify the articles on the effects of HIIT on knee OA. Thirteen studies were included in this review. Nine compared the effects of HIIT with those of low-intensity training, moderate-intensity continuous training, or a control group. Three evaluated the effects of HIIT alone. Eight reported a decrease in knee OA symptoms, and eight reported an increase in physical functioning. HIIT was shown to improve knee OA symptoms and physical functioning, but also aerobic capacity, muscle strength, and quality of life with minimal or no adverse events. However, compared to other exercise modalities, no clear superiority of HIIT was found. HIIT is a promising exercise strategy in patients with knee OA: anyway, the actual quality of evidence remains very low, and more high-quality studies are needed to confirm these promising outcomes.

Postural deficits such as hyperlordosis (hollow back) or hyperkyphosis (hunchback) are relevant health issues. Diagnoses depend on the experience of the examiner and are therefore often subjective and prone to errors. Machine learning (ML) methods in combination with explainable ar-tificial intelligence (XAI) tools have proven useful for providing an objective, data-based orien-tation. However, only a few works have considered posture parameters, leaving the potential of more human-friendly XAI interpretations still untouched. Therefore, the present work proposes an objective, data-driven ML system for medical decision support that enables especially human-friendly interpretations using counterfactual explanations (CFs). Posture data for 1151 subjects were recorded by means of stereophotogrammetry. An expert-based classification of the subjects regarding the presence of hyperlordosis or hyperkyphosis was initially performed. Using a Gaussian progress classifier, the models were trained and interpreted using CFs. Label errors were flagged and re-evaluated using confident learning. Very good classification performances for both hyperlordosis and hyperkyphosis were found, whereby the re-evaluation and correction of the test labels led to a significant improvement (MPRAUC = 0.97). A statistical evaluation showed that the CFs seemed to be plausible in general. In the context of personalized medicine, the present study’s approach could be of importance for reducing diagnostic errors and thereby improving the individual adaptation of therapeutic measures. Likewise, it could be a basis for the development of apps for preventive posture assessment.

Objective: Physical inactivity is linked to chronic illnesses and disabilities among workers, especially those in high demanding jobs like teachers. Despite the global prominence of sedentary behaviour research, studies drawing the relationships between physical inactivity and multimorbidity among working teacher populations in low-and middle-countries remain untapped. This study assessed the sedentariness and health status of primary school teachers in Cape Coast Metropolis in Ghana. Method: This cross-sectional survey employed 1109 primary school teachers from the Cape Coast Metropolis in the Central Region of Ghana, using convenient sampling method. Results: Generally, the teachers were highly sedentary and reported poor health status. Other results showed no difference in sedentariness across gender, t (1107) = -0.32, p > .05. However, female teachers suffer more pain and discomfort, [t (1103.51) = - 3.07, p < .05, anxiety and depression, [t (1099.56) = - 2.85, p < .000,)], and poor health status [t (1107) = 2.14, p < .05, than their male counterparts. Also, pain and discomfort, anxiety and depression, health status and years of work significantly predicted sedentariness among the teachers, F (4, 1104) = 5.966, p=.00, R = .145, R2 = .029, adjusted R2 = .018. Conclusion: The findings suggest that individualized or personalized interventions are urgently needed to promote regular physical activity to improve the health status and reduce associated complications on the health and well-being, especially among the female primary school teachers. Given the health risks of sedentary lifestyle, behavioral interventions at the person-level (i.e., individualized- routine weekly physical activity programmes) and built environmental restructuring (e.g., creation of walkways to encourage regular walking) could be done to physical activity behavior among teachers within the Cape Coast Metropolis, and perhaps beyond.

The cavovarus deformity is characterized by a pathologic longitudinal arch elevation caused by a severe hindfoot varus and forefoot equinus deformity. This disorder includes multiple anomalies and therapies and affects 25% of the population. Cavus feet usually indicate neurologic illness, which affects sensory and motor nerves. Clinical and radiological evaluations are needed to establish each patient's optimum therapy. Failure to identify a neurologic illness may lead to inappropriate surgical treatment, recurrence, and reconstructive failure. In progressive anomalies, surgical procedures must be performed quickly in a phased protocol to prevent the malalignment from worsening. Soft tissue surgeries, osteotomies, and arthrodesis are surgical options for patients. To aid and lead practitioners in selecting the most appropriate therapy for their patients daily, we have included the most common therapeutic options currently available in this article.

COVID-19 has harmful impact on health. It is especially important for endurance athletes (EAs). Sleep and psychology influence sport performance. Aims of this study were: (1) investigation of the consequences of mild COVID-19 on sleep and psychology and (2) assessment of the conse-quences of the infection on cardiopulmonary exercise test (CPET) results. 49 EAs (males= 43; 87.76%, females= 6; 12.24%, age= 39.9±7.8 years, height= 178.4±6.8 cm, weight= 76.3±10.4 kg; BMI= 24.0±2.6 kg·m−2) underwent maximal cycling or running CPET pre- and post- COVID-19 and completed a survey. Exercise performance was deteriorated after COVID-19 (maximal oxy-gen uptake; VO2max= 47.81±7.81 vs 44.97±7.00 ml·kg·min−1 respectively pre- and post- infection; p<0.001). Waking up at night affected heart rate (HR) at the respiratory compensation point (RCP) (p=0.028). Sleep time influenced pulmonary ventilation (p=0.013), breathing frequency (p=0.010), and blood lactate concentration (Lac) (p=0.013) at RCP. Maximal power/speed (p=0.046) and HR (p=0.070) linked with the quality of sleep. Stress management and relaxation techniques linked with VO2max (p=0.046), maximal power/speed (p=0.033), and maximal Lac (p=0.045). Cardiorespiratory fitness was deteriorated after mild COVID-19 and was correlated with sleep and mental health. Medical Professionals should encourage EAs to maintain proper mental health and sleep after COVID-19 infection to facilitate recovery.

Mild impacts to the head, particularly when repetitive in nature, are increasingly recognized to have a range of significant negative implications for brain health. Much of the ongoing research in the field is focused on the neurological consequences of these injuries, and the relationship between head impacts and long-term neurodegenerative conditions such as chronic traumatic encephalopathy and Alzheimer’s disease. However, our understanding of the complex relationship between applied mechanical force at impact, brain pathophysiology, and neurological function, remains incomplete. Past research has shown that mild head impacts, even below the threshold that results in cranial fracture, induce changes in cranial bone structure and morphology. These structural and physiological changes likely have implications for the transmission of mechanical force into the underlying brain parenchyma. Here, we review this evidence in the context of the current understanding of bone mechanosensitivity and the consequences of traumatic brain injuries or concussions. We postulate that heterogeneity of the calvarium including differing bone thickness due to prior impacts, age, or individual variability, may be a modulator of outcomes following subsequent head impacts. We advocate for greater consideration of cranial responses to head injury in both experimental and computer modeling of impact biomechanics, and raise the hypothesis that calvarial bone thickness represents a novel biomarker of brain injury vulnerability after head trauma.

Background: To compare the clinical efficacy of Japas osteotomy of the middle foot and first metatarsal sequence osteotomy in treating children with cavovarus foot deformity. Methods: A retrospective analysis was performed on the clinical effect of cavovarus foot surgery from January 2012 to January 2019. Thirty light and medium cavovarus foot cases underwent osteotomy based on soft tissue release. Among them, 16 cases of 22 feet underwent first metatarsal sequence osteotomy, and 14 cases of 21 feet underwent middle foot Japas osteotomy. Ankle-posterior foot (Wicart) scoring system was used to evaluate the good and good rates of the two surgical methods. X-ray films were taken before and after the last follow-up in a standing weight-bearing position, and Meary Angle, Hibb Angle, and Pitch Angle were measured to compare the clinical efficacy of the two surgical methods in correcting the light and medium-cavovarus foot deformity.Results: (1) All patients were followed up for an average of 30 months. There was no significant difference in Meary, Hibb, and Pitch Angle between first metatarsal osteotomy and middle foot Japas osteotomy before surgery, indicating that the severity of malformation was similar between the two groups. (2) The Meary, Hibb, and Pitch Angle of the last follow-up were compared between the two groups (P>0.05), which showed no statistical significance, indicating that the two surgical methods had similar effects on cavovarus deformity correction. (3) At the most recent follow-up, there was no statistically significant difference between the two groups regarding the percentage of patients who achieved an excellent or good Wicart score; for the first metatarsal osteotomy group, the rate was 87%, and for the Japas osteotomy group was 90%; the Fisher test p>0.05 indicates that the postoperative excellent and good rates of the two treatments are comparable.II (4) Comparison of operation time and intraoperative blood loss between the two groups, P<0.05, showed statistically significant differences, indicating that the first metatarsal osteotomy had obvious advantages over Japas osteotomy operation time and intraoperative blood loss. Conclusions: There is no significant difference in postoperative efficacy between first metatarsal osteotomy and Japas osteotomy for light and medium-cavovarus with the apex of the deformity located at the medial cuneus or navicular cuneiform joint. However, the intraoperative blood loss and operative time of first metatarsal osteotomy are superior to Japas osteotomy of the middle foot, and the trauma to children is less. Therefore, the first metatarsal osteotomy can be considered a surgical procedure.

Variable during practice is widely accepted to be advantageous for motor learning and therefor a valuable strategy to effectively reduce high-risk landing mechanics and prevent primary anterior cruciate ligament (ACL) injury. Few attempts have examined the specific effects of variable train-ing in athletes who have undergone ACL reconstruction. Thereby it is still unclear to what extent the variations in different sensor areas lead to different effects. Accordingly, we compared the effects of versatile movement variations (DL) with variations of movements with emphasis on disrupting visual information (VMT) in athletes who had undergone ACL reconstruction. For-ty-five interceptive sports athletes after ACL reconstruction were randomly allocated to a DL group (n= 15), VT group (n= 15) or control group (n= 15). The primary outcome was functional performance (Triple Hop Test). The secondary outcomes included dynamic balance (Star Excur-sion Balance Test (SEBT)), biomechanics during single-leg drop-landing task hip flexion (HF), knee flexion (KF), ankle dorsiflexion (AD), knee valgus (KV), and vertical ground reaction force (VGRF), and kinesiophobia (Tampa Scale of Kinesiophobia (TSK)) assessed before and after the 8-weeks of interventions. Data were analyzed be means of 3×2 repeated measures ANOVA fol-lowed by post hoc comparison (Bonferroni) at the significance level of p≤0.05. Significant group × time interaction effects, main effect of time and main effect of group were found for triple hop test, all eight directions of SEBT, HF, KF, AD, KV, VGRF and TSK. There was no significant main ef-fect of group in HF and triple hop test. Also, significant differences in triple hop test, seven direc-tions of SEBT, HF, KF, KV, VGRF and TSK were found between control group with the DL and VMT groups. Between group differences in AD and medial direction of SEBT were not signifi-cant. Also, there was no significant differences between VMT and control groups in triple hop test and HF variables. Both motor learning (DL and VMT) programs improved outcomes in patients after ACL reconstruction. Findings suggest that DL and VMT training programs lead to compa-rable improvements in rehabilitation.

(1) Background: Within the scope of prevention studies, many researchers have indicated the need to enhance knee proprioception. Kinesiology tape is one product that claims to enhance proprioception, however, its use has not been well researched in the healthy population before. The aim of the study was to investigate if kinesiology tape application on the quadriceps muscle enhances proprioception. (2) Methods: Twelve healthy and physically active volunteers (M=7, F=5, mean age= 20.75 ± 2.14, mean BMI=22.25 ±2.34) participated in the study. With computerized, custom-built isokinetic dynamometer, we recorded perceived joint position angles (small and large angles). For force sense, we recorded maximum voluntary isometric contractions (MVIC) and differences in torques (Nm) via force matching tasks both with vision and without vision on left leg. The absolute errors for joint position sense measurements and for force matching tasks and differences in MVIC both in untaped and taped conditions for left legs of all subjects were recorded. (3) Results: Two-way repeated measures ANOVA revealed that no significant interaction existed among small and large angle groups in both the conditions nor any main condition effect was observed in both the groups. (p&gt;0.05). Similarly, no differences were accounted in force matching tasks between the taped and un-taped with vision and without vision (p=0.52 and 0.38 respectively.) Statistically insignificant increments were observed in mean torque post application. (p=0.67) (4) Conclusions: Present study suggests that immediate kinesiology tape application on quadriceps muscle offers no benefits on proprioception in terms of joint position sense and force sense hence other preventive measures to strengthen the proprioceptive system should be relied upon.

The choice of parameters for laser beams used in the treatment of musculoskeletal diseases is of great importance. First, to reach high penetration depths into biological tissue and, secondly, to achieve the required effects on a molecular level. The penetration depth depends on the wavelength since there are multiple light-absorbing and scattering molecules in tissue with different absorption spectra. The present study is the first comparing the penetration depth of 1064 nm laser light with light of a smaller wavelength (905 nm) using high-fidelity laser measurement technology. Penetration depths in two types of tissue (porcine skin and bovine muscle) were investigated. The transmittance of 1064 nm light through both tissue types was consistently higher than of 905 nm light. The largest differences (up to 5.9%) were seen in the upper 10 mm of tissue, while the difference vanished with increasing tissue thickness. The higher penetration was most likely due to a combination of lower absorption in hemoglobin and less scattering at larger wavelengths, and not due to absorption in melanin. Overall, differences in penetration depth were comparably small and high peak power and short pulse lengths of laser light seem to be more important to efficiently treat deep musculoskeletal diseases.

This study examines the effects and durability of postural exercise on gait kinematics in people with intellectual and developmental disabilities (IDD). Thirty-four men with mild IDD were assigned to either the training group (n = 19) or the control group (n = 15). The TG performed the intervention over 8 weeks, 3 days/week, 1 h/day. The results indicated that the intervention program had a significant effect on some variables of gait. Also, in the TG between post-test and follow-up, there was no significant difference, which indicated that gait variables were maintained by the TG one month after the end of the program. This study provides evidence that postural exercises can be used as an effective intervention for improving gait in individuals with IDD.

Adaptation to external forces relies on a well-functioning proprioceptive system including muscle spindle afferents. Muscle length-tension control in reaction to external forces is most important regarding the Adaptive Force (AF). This study investigated the effect of different procedures, which are assumed to influence the function of muscle spindles, on the AF. 19 elbow flexors of 12 healthy participants were assessed by an objectified manual muscle test (MMT) with different procedures: regular MMT, MMT after pre-contraction (self-estimated 20% MVIC) in lengthened position with passive return to test position (CL) and MMT after CL with a second pre-contraction in test position (CL-CT). During regular MMTs, muscles maintained their length up to 99.7±1.0% of the maximal AF (AFmax). After CL, muscles started to lengthen at 53.0±22.5% of AFmax. For CL-CT, muscles were again able to maintain the isometric position up to 98.3±5.5% of AFmax. AFisomax differed highly significantly between CL vs. CL-CT and regular MMT. CL is assumed to generate a slack of muscle spindles which led to a substantial reduction of the holding capacity. This was immediately erased by a pre-contraction in test position. The results substantiate that muscle spindle sensitivity seems to play an important role for neuromuscular functioning and musculoskeletal stability.

Abstract: Sand-cement bound screed floor layers are at risk for work-related low back pain, lumbosacral radicular syndrome and knee osteoarthritis given their working technique of level-ling screed with their trunk bended and mainly supported by their hands and knees. To reduce the exposure of the physical demands of bending of the trunk and kneeling, a manually moved screed levelling machine was developed for floor layers in the Netherlands. The aim of this pa-per is to estimate the potential health gain of the manually moved screed levelling machine on the risk of low back pain (LBP), lumbosacral radicular syndrome (LRS) and knee osteoarthritis (KOA) compared to the traditional working technique. The potential health gain was assessed using the epidemiological population estimates of the Population Attributable Fraction (PAF) and the Potential Impact Fraction (PIF) combined with work-related risk estimates for these three disorders from systematic reviews. The percentage of workers exceeding these risk esti-mates was based on worksite observations among in total 28 floor layers. For LBP, 16/18 work-ers were at risk using the traditional working technique with PAF=38%, and for the manually moved screed levelling machine this was 6/10 with PIF=13%. For LRS, these data were 16/18 with PAF=55% and 14/18 with PIF=18% and for KOA, 8/10 with PAF=35% and 2/10 with PIF=26%. A manually moved screed levelling machine might have a significant impact on the prevention of LBP, LRS and KOA among floor layers in the Netherlands and a health impact assessment is a feasible approach to assess health gains in an efficient way.

This paper aims to list the current challenges in the study of Sports Medicine in Brazil based on a review of the literature and the author's experience as a member of a transdisciplinary team in this field, as well as to discuss methods for establishing an appropriate and organized course of health activities in this context. The authors identified four significant contemporary difficulties in the field of sports medicine in Brazil that, while minor, are complicated. There is a need to publish a greater number of national studies, generate integrated knowledge through transdisciplinary research, propose sports and movement as a tool for the prevention of degenerative conditions, and research and develop better therapeutic options through transdisciplinary research. It is expected that a transdisciplinary approach will reduce divergences between the real world and science, putting an end to dogmatism, prejudice, and theoretical thinking, increasing the scientificity of sports, bringing competitive advantages, improving training, performance, and athlete health management, and contributing to the advancement of sports medicine.

Introduction: Anterior cruciate ligament (ACL) tears are a common injury among athletes, including NBA players. Advances in surgical techniques, rehabilitation protocols, and complementary therapies have greatly improved the outcomes for athletes undergoing ACL reconstruction surgery. Arthroscopic surgery has become the standard approach for ACL reconstruction due to its minimally invasive nature, resulting in less pain, faster recovery, and better outcomes. Accelerated rehabilitation protocols have been shown to improve outcomes by getting athletes back to playing sooner and with better functional outcomes than traditional rehabilitation programs. Physiotherapy has also played an important role in helping athletes return to play by using targeted exercises to improve range of motion, strength, and stability. Complementary therapies, such as phytotherapy, have also shown promise in aiding the healing process. These advancements in ACL tear treatment have the potential to improve outcomes for NBA players who suffer from these injuries and further research can help continue to improve prevention and management of these injuries. Methods: The study is a retrospective cohort study that focuses on NBA players who suffered from ACL tears and underwent reconstructive surgery between 2012 and 2022. The study excluded players who had not played prior to experiencing an ACL injury, players with a concurrent significant knee injury involving other ligaments, any other major leg injury, or a history of ACL tear in the contralateral knee. The study gathered data on 25 players and recorded game statistics for each player before and after surgery to assess the impact of ACL tears on players' game performance. The recorded data was analyzed using SPSS Statistics.Results: The mean age at injury was 26.12 ± 4.3 years, and the majority of injuries occurred on the left side. players experienced significant decreases in minutes per game and points per game, with a reduction of 5.9 and 3.5, respectively, during the season following the injury. Moreover, players exhibited a statistically significant decline in rebounds per game and assists per game, with a decrease of 0.91 and 1.11, respectively. These findings suggest that ACL injuries can have a severe impact on a player's ability to contribute to their team's success. The study did not find a significant difference in shooting percentages for two-pointers, three-pointers, and free throws before and after ACL injury. This suggests that ACL injuries do not significantly affect a player's shooting abilities. Discussion: This study focused on the incidence and impact of ACL injuries among NBA players between 2012 and 2022. The study found that ACL injuries had a significant negative impact on a player's performance, including decreases in minutes, points, rebounds, and assists per game. The mean time to return to play after ACL surgery was consistent with previous studies. The study also highlighted the importance of effective prevention, treatment, and rehabilitation strategies, with neuromuscular training programs showing promise in reducing the incidence of ACL injuries. While ACL injuries did not significantly affect shooting percentages, further research is needed to fully understand their impact on shooting performance. Conclusion: The study sheds light on the frequency and effects of ACL injuries in NBA players and emphasizes the importance of implementing effective strategies for preventing, diagnosing, and treating such injuries in order to help players recover and return to their previous level of performance.

Introduction: Fractures in older individuals are often caused by falls, with approximately 90% of hip fractures resulting from falls. The risk of falling increases with age, and while a significant portion of individuals over 65 fall at least once per year, only a small percentage of these falls result in hip fractures. Factors that influence the likelihood of a fracture occurring include the intensity of the fall and the quality of the bone, with lower bone mineral content increasing the risk of fracture. Older women, particularly those in their 70s, are significantly more prone to hip fractures and any type of fracture. Efforts to reduce the likelihood of falls or mitigate the associated trauma are more complex than treating osteoporosis, due in part to a lack of understanding of the causes and contributing factors of falls in older age.Methods: This study analyzed data from patients admitted to Carmel medical center with upper or lower limb fractures between 2017 and 2019 to determine the side of wrist fractures and compare it to patient age in order to examine whether there was a difference in the distribution of sides in distal radius fractures based on age and test the hypothesis that falls are more likely to occur on the left side due to the assumption that dominant hand gross motor skills are better preserved. The study received approval from the Institutional Helsinki Committee and used statistical analysis with a significance level of 0.05. Potential sources of bias include limited availability of reliable data for many patients and the risk of errors in fracture registration or diagnosis, although the small sample size is expected to minimize these biases.Results: In this analysis of patient data from 2019 to 2017, a binomial test found that the probability of breaking the left wrist is significantly greater than the probability of breaking the right wrist (p < 0.05), while a t-test found no difference in the distribution of fractures between the right and left wrists of the distal radius based on age (p = 0.2774). Discussion: The findings of the study are consistent with previous research, and indicate that there is no change in side preference for fractures with age. Conclusion: The probability of breaking the left wrist is approximately 1.5 times greater than the probability of breaking the right wrist.

Isometric exercises for physiotherapeutic rehabilitation are often prescribed, with little quantification of the load being prescribed. This article aimed to provide a framework and practical examples of how the physiotherapist may take a more quantitative evidence-based approach to isometric assessment, monitoring, and exercise prescription of knee osteoarthritis, by integrating a strain gauge into their practice. Strength measures to monitor were discussed. A series of fourteen studies were reviewed, with the intent of identifying isometric exercises that had been utilized in the rehabilitation of knee osteoarthritis. Of the fourteen studies, the three most identified isometric exercises were seated knee extension, knee flexion, and the supine straight leg raise. The integration of strain gauge technology with these exercises provided the focus of the remainder of the article.

This research develops the Osteoporosis Knowledge, Attitude, and Behaviors Questionnaire (OKABQ) with the intent to evaluate levels of osteoporosis knowledge, attitude and behavior change. The aims of the study were to develop and validate the OKABQ; and to establish a mediation model of the research. A quantitative, descriptive, and instrumental study was conducted in two phases: Phase I—development of the scale through Delphi Method by osteoporosis experts; Phase II—evaluation of the validity and reliability of the scale and construction of a mediation model using SmartPLS. In Phase I, the content validity index (CVI) of the questionnaire was higher than 0.96 and the inter-rater reliability (IRR) kappa was 1.00. In Phase II, exploratory factor analysis showed that two predominating factors of attitude as a mediation were addressed by the 26-item OKABQ. The indirect effect results from the estimated model indicates that attitude mediates the relationship between knowledge and behaviors (β = 0.114, t = 2.627, p < 0.001), which is positive and statistically significant. We concluded that the OKABQ is a valid measure of osteoporosis knowledge, attitude and behaviors for women with osteoporosis. These assessment results could assist healthcare providers in mitigating insufficiency on health education.

Purpose: Physical activity (PA) is likely the most important modifiable element for the growth of skeletal muscle. However, a detailed investigation of PA’s impact on preschoolers’ of skeletal muscle development is lacking. This study aimed to determine whether PA level is related to skeletal muscle thickness among preschool children. Methods: 275 healthy preschoolers between the ages 4–6 were instructed to wear an accelerometer for 4 consecutive days. The daily steps and minutes spent in moderate-to-vigorous PA (MVPA) and total PA (TPA) were examined. Muscle thickness (MT) was measured by B-mode ultrasonography. The MT was measured at the anterior (AT) and posterior thigh (PT) and the anterior (AL) and posterior lower leg (PL). Results: Boys were more physically active and engaged in significantly more TPA and MVPA on weekdays compared with girls. Compared with that on the weekends, more physical activity, and significantly greater number of daily steps and higher TPA and MVPA were recorded for both boys and girls on the weekdays. Multivariable regression analyses, after adjusting for daylight duration, indicated that a daily increase in the TPA and MVPA would lead to higher muscle size in AT (β=1.11 and β=1.37, p<0.05), and PL (β=1.18 and β=0.94, p<0.05) among preschool children. Conclusions: The time spent involved in most of the different categories of MVPA was significantly higher for boys than for girls on the weekdays and weekends. MVPA was positively correlated with greater skeletal muscle development in the lower body.

When bone substitutes materials are used, the increased risk of infection due to the none-autogenic graft is often discussed. The treatment of large bone defects in geriatric patients, often with osteoporotic bone, often presents major challenges to surgery. Bone substitutes materials are available indefinitely without the risk of additional surgery in each patient. Can bone substitutes materials be used without hesitation in the geriatric patient?Eighty-three patients suffered traumatic fractures of the distal radius, proximal humerus, and proximal tibia. The defect zones were filled with bone substitute material based on nanocrystalline hydroxyapatite (NHA) or calcium phosphate (CP). For comparison, a reference group without the void filling with a bone graft substitute (void defects, ED) was studied. All patients over the age of 64 years were retrospectively evaluated for complications and radiological outcomes. Results: 106 patients sustained traumatic fractures of the distal radius (68.9%), proximal humerus (5.7%), and proximal tibia (22.6%). No differences in infections were found when comparing the groups (p=1.0). retrospectively evaluated. The KEM group had a nonsignificantly lower rate of pseudarthrosis (p=0.09). A relative risk (RR) reduction of complications of 32.64% was observed when bone grafting material was used. The NNT for the prevention of complications was 5.99. When bone healing was assessed by radiological images, some follow-up studies showed significant differences in fracture bridging (p<0.001).Conclusions: In contrast to previous studies, bone substitutes materials can support the healing process in geriatric patients without relevant disadvantages. With an NNT of 6 regarding complications, many patients could benefit from bone graft augmentation. No increased infection rate was observed.

BACKGROUND. The aims of this study was to compare differences in daytime sleepiness between genders and qualification levels in a cohort university Chinese soccer player under 0 Covid policy restrictions in the urban area of Shanghai. METHODS. 491 questionnaires of Epworth Sleepiness Scales (ESS) were compiled online by males and females Soccer Students (SS), Semi-professional players (SP) and professional players (PP) during the ongoing measures of Shanghai lockdown. ANOVA was performed for players levels and gender. RESULTS. Significant differences were found between the 3 levels and between males and females. PP showed a very low score in the ESS (5,97) well below the threshold of 8, while SS and SP showed an ESS score above the threshold. Female showed higher scores than males. CONCLUSIONS. This study present the first data on sleepiness in Chinese soccer players of different level of qualification in a lockdown condition. Professional players has been less affected by lockdown measures than SS and SP. We can hypothesize the reasons resides in the more ordered lifestyle of PP in comparison to SS and SP, which mitigated the effects of the lockdown. Measures to improve sleep in females’ soccer player should be adopted.

When bone substitutes materials are used, the increased risk of infection due to the none-autogenic graft is often discussed. The treatment of large bone defects in geriatric patients, often with osteoporotic bone, often presents major challenges to surgery. Bone substitutes materials are available indefinitely without the risk of additional surgery in each patient. Can bone substitutes materials be used without hesitation in the geriatric patient? Eighty-three patients suffered traumatic fractures of the distal radius, proximal humerus, and proximal tibia. The defect zones were filled with bone substitute material based on nanocrystalline hydroxyapatite (NHA) or calcium phosphate (CP). For comparison, a reference group without the void filling with a bone graft substitute (void defects, ED) was studied. All patients over the age of 64 years were retrospectively evaluated for complications and radiological outcomes. Results: 106 patients sustained traumatic fractures of the distal radius (68.9%), proximal humerus (5.7%), and proximal tibia (22.6%). No differences in infections were found when comparing the groups (p=1.0). retrospectively evaluated. The KEM group had a nonsignificantly lower rate of pseudarthrosis (p=0.09). A relative risk (RR) reduction of complications of 32.64% was observed when bone grafting material was used. The NNT for the prevention of complications was 5.99. When bone healing was assessed by radiological images, some follow-up studies showed significant differences in fracture bridging (p<0.001). Conclusions: In contrast to previous studies, bone substitutes materials can support the healing process in geriatric patients without relevant disadvantages. With an NNT of 6 regarding complications, many patients could benefit from bone graft augmentation. No increased infection rate was observed.

Cognitive impairment in older adults is associated with poor gait performance, physical decline, falls and poor quality of life. This paper analyzes the feasibility and efficacy of a tango-based in-tervention in older people with cognitive impairment living in nursing homes. A multicenter study, with pre and post-test, was carried out. Intervention attendance, well-being, physical abilities (Short Physical Performance Battery), walking performance, functional capacities (Katz Index), and quality of life (Quality of Life in Alzheimer’s Disease) were assessed. Fifty-four participants (84.9 ± 6.7 years, Mini Mental State Examination 14.5 ± 7.4) completed the protocol. Intervention attendance was 92%, and the mean subjective well-being after each session was 4.5 ± 0.5 (on a five-point scale). Statistically significant improvement was found in the quality of life (p = 0.030). Non statistically significant changes were found in walking performance, physical abilities, or in functional capacities. The study shows feasibility and suggests evidence for the effects of Tango therapy on well-being and quality of life. Further studies are necessary to contrast these findings and to verify the role of Tango interventions as a holistic approach to prevent functional decline in older people with cognitive impairment.

Laser therapy devices (LTDs) operating with near-infrared laser light are increasingly being used in sports medicine. For several reasons the users cannot evaluate whether or not such devices emit laser beams according to the specifications provided by the manufacturer and the settings of the device. In this study the laser beams from two different LTDs that can be used in sports medicine were thoroughly characterized by measuring the emitted power, pulse shapes and lengths, and spatial intensity distributions using professional, high-fidelity laser measurement technology. This was repeated for three units of each LDT independently to distinguish problems of individual units from potential intrinsic instrument design errors. The laser beams from the units of one LTD agreed with the settings at the device, with the measured average power for these units being within 3.3% of the set power. In contrast, the laser beams from the units of the other LTD showed large deviations between the settings and the actual emitted light. This device came with three laser diodes that could be used independently and simultaneously. The average power differed greatly between the units as well as between the laser diodes within each unit. Some laser diodes emitted essentially no light, which could lead to a lack of treatment of patients. Other laser diodes emitted much more power than set at the device (up to 230%) that could result in skin irritations or burnings of patients. These findings indicate a need for better standardization and consistency of therapeutic laser light sources.

The practice of physical activity is an effective non-pharmacological strategy for preventing and treating chronic diseases. A large body of evidence has contributed to establishing a positive correlation between a physically active lifestyle and health benefits, including enhanced vaccination responses, lower numbers of senescent T-cells, increased T-cell proliferative capacity, lower levels of inflammatory cytokines, and improved neutrophil and macrophage function. While females are generally thought to exert more robust immune responses than males in response to a variety of challenges, and both male and female sex hormones have been suggested as mediators of immune function, research on this topic has not always been designed with a sex-specific lens. The goal of this review is to summarize the available experimental and clinical evidence linking exercise and immune function in male and female subjects, with an emphasis on sex differences and sex-specific mechanisms. Overall, the available evidence indicates that moderate exercise and physical activity improves immune function in both sexes, whereas prolonged and high-intensity exercise temporarily impairs immune responses at a higher degree in females. A role of male and female sex hormones in these sex-specific effects is also discussed.

The rowing technique is a key factor in the overall rowing performance. Nowadays the athletes’ performance is so advanced that even small differences in technique can have an impact on sport competitions. To further improve the athletes’ performance, individualized rowing is necessary. This can be achieved by intelligent measurement technology that provides direct feedback. To address this issue, we developed a novel wireless rowing measurement system (WiRMS) that acquires rowing movement and measures muscle activity using electromyography (EMG). Our measurement system is able to measure several parameters simultaneously: the rowing forces, the pressure distribution on the scull, the oar angles, the seat displacement and the boat acceleration. WiRMS was evaluated in a proof-of-concept study with seven experienced athletes performing a training on water. Evaluation results showed that WiRMS is able to assess the rower’s performance by recording the rower’s movement and force applied to the scull. We found significant correlations (p&lt;0.001) between stroke rate and drive-to-recovery ratio. By incorporating EMG data, a precise temporal assignment of the activated muscles and their contribution to the rowing motion was possible. Furthermore, we were able to show that the rower applies the force to the scull mainly with the index and middle fingers.

The purpose of this study was to clarify the attachment types of the tibialis anterior tendon (TAT) in Japanese fixed cadavers and to determine the attachment site area in three dimensions. We examined 100 feet from 50 Japanese cadavers. The TAT was classified according to differences in the number of fiber bundles as: Type I, with one fiber bundle; Type II, with two fiber bundles; and Type III, with three fiber bundles. The attachment site area of the TAT was measured using a three-dimensional scanner. Cases were Type II in 95% and Type III in 5%, with no cases of Type I identified. In Type II, mean attachment site areas were 85.2 ± 18.2 mm2 for the medial cuneiform bone (MCB) and 72.4 ± 19.0 mm2 for the first metatarsal bone (1MB), showing a significantly larger area for MCB than for 1MB. These findings suggest the possibility of ethnic differences in TAT attachment types and suggest that TAT attachments in Japanese individuals are highly likely to be Type II, with rare cases of Type III. Accurate measurement of attachment site areas is possible with appropriate three-dimensional measurements.

To create normative scores for all CrossFit® Open (CFO) workouts and compare male and female performances, official scores were collected from the official competition leaderboard for all competitors of the 2011-2022 CFO competitions. Percentiles were calculated in athletes (18 – 54 years) who completed all workouts within a single year ‘as prescribed’ and met minimum scoring thresholds. Independent t-tests revealed significant (p &lt; 0.05) sex differences for 56 of 60 workouts. In workouts scored by repetitions completed, men completed more repetitions in 18 workouts by small-to-large differences (d = 0.22-0.81), whereas women completed more repetitions in 6 workouts by small-to-medium differences (d = 0.36-0.77). When workouts were scored by time-to-completion, men were faster in 10 workouts by small-to-large differences (d = 0.23-1.12), while women were faster in three workouts by small differences (d = 0.46). In three workouts scored by load lifted, men lifted more weight by large differences (d = 2.00-2.98). All other differences were either trivial or not significant. Despite adjusted programming for men and women, the persistence of performances differences across all CFO workouts suggest resultant challenges are not the same. These normative values may be useful to training and research in male and female CrossFit® athletes.

Sports traumatic brain injury (TBI) accounts for up to 20% of all sports injuries, and the number of cases is growing year by year due to an increase in the number of people involved in sports, the growing popularity of extreme and contact sports, as well as a high level of motivation to achieve record results. Mild TBI dominates, which can provoke the development of a very wide range of complications and negative consequences. In the programs for the prevention of complications and the rehabilitation of athletes after TBI, TBI features are not sufficiently considered, which significantly differ from household, road or criminal injuries. There are no instrumental methods for diagnosing the severity of the injury. Sports TBI is characterized by repeated frequent TBI, elevated body and brain temperature, peripheral redistribution of blood flow and hypocapnia, which significantly affect cerebral blood flow. Brain injury is an independent cause of the development of cerebral hyperthermia, which significantly worsens the consequences of TBI. To diagnose sports TBI, the method of microwave radiometry of the brain (MWR) can be used. For the prevention of complications, the technology of craniocerebral hypothermia (CCH), which allows for to reduce of physical general and cerebral hyperthermia, and increases the resistance of cerebral cortex neurons to hypoxia and trauma could be used However, these approaches in sports medicine are used sporadically, which, is due to the lack of awareness of coaches and doctors of sports teams. The purpose of the review is to present MWR and CCH in sports TBI.

(1) Background: The mediolateral patella displacement is of interest for diagnostics and clinically relevant research questions. Apart from manual testing, no standardized method is currently available. Proper quantification of patella mobility is necessary to understand pathologies at the patellofemoral joint better; (2) Methods: Patella mobility was assessed in 25 healthy individuals using a Patellostabilometer, a new prototype instrument for quantification of the mediolateral patella displacement. The participants underwent measurements of the mediolateral displacement three times using the Patellostabilometer. A maximal force of 10N was applied for patella movement. Additionally, leg length, circumference of the knee, upper- and lower leg was measured. (3) Results: Lateral patella displacement of 18.27±3.76 mm (range 15.85-20.64mm, interquartile range (IQR) of 4.79) was measured. The medial patella displacement showed 24.47±6.59mm (range 19.29-29.76mm, IQR of 10.47). The test-retest measurement error was 2.32±1.76mm (IQR of 2.38mm), with five outliers. There was greater test-retest variability between the measurements of the medial displacement comparing to the lateral one (4) Conclusions: The test-retest variability reached 7% of the patella displacement. Other parameters provided no significant correlations. Based on the natural patellofemoral mobility a precise and clinically relevant quantification of patella mobility is allowed.

The combined muscle-skeletal traumas (MST) are very frequent over the last few years. The emergency care try to save the life of the patient and to receive resuscitation treatment. The role of Trauma surgeon is to choose the right moment for surgery. Aim: To present the management of patient with combined height injury, fracture stabilization, partial foot amputation, local flaps, skin grafting and HIFU – thermotherapy as scar treatment. Materials and methods: 40 years old mail patient, injured after a fall from 8 meters in an elevator shaft. After resuscitation treatment to control the shock the Imaging results are: burst fracture of L3 with spinal canal stenosis, fracture of the sacral bone Denis I, fracture of the right humerus in the proximal third, Monteggia fracture of the left arm, fracture of the proximal third of the right tibia as well as comminuted fractures of both calves and of both heel bones. Results: After a few operations his final result was well healed bone fractures and a good quality soft tissue coverage allowing the patient a satisfactory quality of life. Conclusions: Combined traumas of the muscle- skeletal system are severe, serious and difficult to manage. The good outcome in their treatment requires a team approach between the different medical specialists.

Basketball is a highly anaerobic game, that consists of high-intensity efforts followed by lower-intensity efforts. Postural deformities can be a limiting factor in achieving maximal performances in basketball. Flat feet are one of the most common deformities and they can lead to poorer performances, discomfort and pain. In this research we made an attempt to link the degree of feet flatness with sports performances among Icelandic adolescent basketball players. A sample of 100 basketball players was tested on a podoscope to establish the degree of feet flatness and all participants performed countermovement jump, 20m sprint and pushups in 30 seconds. No significant correlation was observed between feet status and sports performances. No differences were found between groups with and without flat feet, which indicates that feet flatness was not a limiting factor in achieving better results. However, we state that only strong and healthy feet might lead to excellent performance.

Objectives The aim of this study was to measure the magnitude of forces in the joints of the lower limb whilst running barefoot and compare them to the forces generated whilst wearing running shoes with a thick midsole.MethodsTwenty-three volunteers who utilised running as their main sport or a training aid ran as training aid were included in this study. Each volunteer would run down a fourteen-meter-long corridor both barefoot and with running shoes. Forces for joints of the lower limb were collected using a Vicon motion analysis system and force plates. The joint forces for the ankles, knees and hips were taken as the largest joint force experienced during the stance phase and then averaged over five running trials.ResultsThere was significant reduction in the joint forces for the ankles, knees, and hips when barefoot running compared to the shod condition.ConclusionBarefoot running could be utilised to prevent both acute and degenerative injuries of the lower limb.

Ultrasound is a well-known tool to produce thermal and non-thermal effects on cells and tissues. These effects require a correct application of ultrasound in terms of localization and acoustic energy delivered. This article describes a new device that combines ultrasound and Dry Needling treatments. The ultrasound transducer can rotate in 3D space mechanically to align itself in the direction of the needle. The transducer electronically focuses the acoustic pressure automatically on the needle tip and its surroundings. A computer, using graphical interface software, controls the angulation of the array and the focus position.

Neuromuscular symptoms in long COVID patients are common. Since adequate diagnostics are still missing, investigating muscle function might be beneficial. The holding capacity (maximal isometric Adaptive Force; AFisomax) was previously suggested to be especially vulnerable for impairments. This longitudinal, non-clinical study aimed to investigate the AF in long COVID patients in recovery process. AF parameters of elbow/hip flexors were assessed in 17 patients at three timepoints (pre: long COVID state, post: immediately after first treatment, end: recovery) by an objectified manual muscle test. The tester applied an increasing force on the limb of the patient, who had to resist isometrically for as long as possible. The intensity of 13 common symptoms were queried. At pre, patients started to lengthen their muscles at ~50% of the maximal AF (AFmax), which was then reached during eccentric motion, indicating unstable adaptation. At post and end, AFisomax increased significantly to ~99% and 100% of AFmax, respectively, reflecting stable adaptation. AFmax was statistically similar for all three timepoints. Symptoms intensity decreased significantly from pre to end. In conclusion, maximal holding capacity seems to be impaired in long COVID patients and increases with substantial health improvement. AFisomax might be a suitable sensitive functional parameter to assess long COVID patients and to support therapy process.

Background: Cardiovascular disease (CVD) has been one of the leading causes of death and disability-adjusted life years lost worldwide. Blood pressure, lipid, and cholesterol are good predictors of CVD risk and correspond upon age and physical fitness. However, few studies have explored the variation trend of CVD risk factors across different populations upon age and their muscle strength. Objective: to analysis the variation tendency of CVD risk factors in blood according to age and relative grip strength among different populations. Method: 25363 participants were recruited in this cross-sectional study and 24709 were included in the analysis. A logistic regression and a Bayesian probabilistic analysis based on Markov Chain Monte Carlo (MCMC) Modeling is conducted to build probability prediction models of hypertension, hyperlipidemia, and hypercholesterolemia according to age, relative grip strength, body weight conditions, and physical activity levels. Results: 1) age might be the main influence factor of hypertension, which is regarded as one of the primary CVD risk factors. However, although keeping a high level of physical activity might have positive effect on preventing hypertension because that individuals with normal body weight and higher physical activity shows a lower probability of being diagnosed with hypertension, it might could not prevent individuals from getting hypertension with age. 2) After 60, individuals of normal body weight seem more likely to have hyperlipidemia than those are overweight or obese. 3) Larger relative grip strength might not be able to offset the negative effects of obesity, overweight and physical inactivity on hyperlipidemia. 4) The probability of getting hypercholesterolemia varies less with age and relative grip strength. Conclusion: Body weight management and keeping high levels of physical activity are recommended at any age. It might benefit to increase some bodyweight after 60 years old.

There is increasing interest in the application of near-infrared (NIR) laser light for the treatment of various musculoskeletal disorders. The present study thoroughly examined the physical characteristics of laser beams from two different laser therapy devices that are commercially available for the treatment of musculoskeletal disorders. Then, these laser beams were used to measure the penetration depth in various biological tissues from different animal species. The key result of the present study was the finding that for all investigated tissues, most of the initial light energy was lost in the first one to two millimeters, more than 90% of the light energy was absorbed within the first ten millimeters, and there was hardly any light energy left after 15 – 20 mm of tissue. Furthermore, the investigated laser therapy devices fundamentally differed in several laser beam parameters that can have an influence on how light is transmitted through tissue. Overall, the present study showed that a laser therapy device that is supposed to reach deep layers of tissue for treatments of musculoskeletal disorders should operate with a wavelength between 800 nm and 905 nm, a top-hat beam profile, and it should emit very short pulses with a large peak power.

Repetitive transcranial magnetic stimulation (rTMS) with intensive occupational therapy improves upper limb motor paralysis and activities of daily living after stroke; however, amount of improvement according to paralysis severity remains unverified. Target activities for daily living using patients’ upper limb functions can be established by predicting the amount of change after treatment for each severity level of upper limb motor paralysis and further aid practice planning. This study estimated post-treatment score changes for each severity level of motor paralysis (no, poor, limited, notable, and full) stratified according to Action Research Arm Test (ARAT) scores before combined rTMS and intensive occupational therapy. Severity of motor paralysis was the fixed factor for analysis of covariance, delta (post-pre) of the scores was the dependent variable. Ordinal logistic regression analysis was used to compare changes in ARAT subscores in patients, divided according to paralysis severity before treatment. A multicenter retrospective cohort dataset analyzed 907 patients with stroke hemiplegia. Largest treatment-related changes in scores were observed in the Limited recovery group for upper limb motor paralysis and Full recovery group for quality-of-life activities using paralyzed upper limb. These results will help predict treatment effects and determine exercises and goal movements for occupational therapy after rTMS.

Background: Instrument-assisted soft tissue mobilization (IASTM) is thought to alter fluid dynamics in human soft tissue. The aim of this study was to investigate the influence of IASTM on the thoracolumbar fascia (TLF) on the water content of the lumbar myofascial tissue. Methods: 21 healthy volunteers were treated with IASTM. Before and after the procedure and 5 and 10 minutes later, lumbar bioimpedance was measured by bioimpedance analysis (BIA) and TLF stiffness by indentometry. Tissue temperature was recorded at the measurement time points using an infrared thermometer. Results: Bioimpedance increased significantly from 58.3 to 60.4 Ω (p < 0.001) at 10-minute follow-up after the treatment. Temperature increased significantly from 36.3 to 36.6° Celsius from 5 to 10 minutes after treatment (p = 0.029), while lumbar myofascial stiffness did not change significantly (p = 0.84). Conclusions: After the IASTM intervention, there was a significant increase in bioimpedance, likely due to a decrease in water content in myofascial lumbar tissue. Further studies in a randomized control trial design are needed to extrapolate the results in healthy subjects to a symptomatic population as well and to confirm the reliability of BIA in myofascial tissue.

This short communication reports on the initial results of a much larger, ongoing project, the aim of which is to investigate the question: could the skin microbiome, just like the gut microbiome, play a role in sports recovery and performance – and if so, could this role be as significant a one as that played by the gut microbiome? 17 high performance college athletes addressed their skin microbiome by minimizing contact with synthetic chemicals and by using topical skin supplements, shown previously to significantly increase skin microbiome biodiversity, for two weeks after training. 76% said their skin softness improved, 35% said their muscle stiffness and recovery after sport improved, 12% said their sleep quality improved, and 100% said they would be likely to use skin supplements again. Future work will use hundreds of athletes.

While shoulder injuries represent the musculoskeletal disorders (MSDs) most encountered in physical therapy, there is no consensus on their management. As attempts to provide standardized and personalized treatment, a robot-ic-assisted device combined with EMG biofeedback specifically dedicated to shoulder MSDs has been developed. The aim of this study was to determine the efficacy of an 8-week rehabilitation program (≈3 sessions a week) using a ro-botic-assisted device combined with EMG biofeedback (RA-EMG group) in comparison with a conventional program (CONV group) in patients presenting with shoulder MSDs. This study is a retrospective cohort study including data from 2010 to 2013 on patients initially involved in a physical rehabilitation program in a private clinic of Chicoutimi (Canada) for shoulder MSDs. Shoul-der flexion strength and range of motion were collected before and after the rehabilitation program. Forty-four patients participated in a conventional pro-gram using dumbbell (CONV group) while 72 of them completed a program on robot-assisted device with EMG and visual biofeedback (RA-EMG group), whereby both programs consisted in 2 sets of 20 repetitions at 60% of maximal capacity. Results showed that the RA-EMG had significantly greater benefits than the Conv group for shoulder flexion strength (+103.1% vs 67%, p = 0.016) and range of motion (+14.4% vs 6.1%, p = 0.046). The current retrospective co-hort study showed that a specific and tailored rehabilitation program with constant effort by automatic adjustment of the level of resistance was able to potentiate strength and range of motion shoulder flexion after an 8-week reha-bilitation period in comparison with a conventional approach in patients with shoulder MSDs. This study provides new insight on shoulder MSD rehabilita-tion and future research should be pursued to determine the added potential of this approach for abduction and external rotation with a randomized controlled design.

Chronic oxidative stress in long-distance runners adversely affects conditioning. Therefore, it is important to objectively assess and monitor oxidative stress but measuring oxidative stress can be invasive or require skill to measure. Therefore, this study aimed to verify whether skin autofluorescence (SAF), a noninvasive, rapid, and easily calculable metric for calculating advanced glycation end products (AGEs), is useful as an oxidative stress biomarker. The subjects were 50 young Japanese male long-distance runners (aged 20.2 ± 1.2 years); 35 average male university students (aged 19.8 ± 1.1 years) served as controls. The interactions and relationships between SAF and plasma pentosidine and oxidative stress markers (reactive oxygen metabolite-derived compounds [d-ROMs], biological antioxidant potential [BAP], and the BAP/d-ROMs ratio) in runners were examined, and SAF in the runners and controls was compared. The results suggest that plasma pentosidine in runners is associated with oxidative stress markers and that plasma pentosidine can assess oxidative stress. However, SAF was not validated as an oxidative stress marker because it was not associated with oxidative stress marker. In future, clarifying the factors affecting SAF may clarify the relationship between SAF, plasma pentosidine, and oxidative stress markers.

Instep weights cause mechanical changes, modifying muscle activity and changing ground plantar support. 30 semi-professional sprinters, randomized in 3 groups [no-weight, Ascending (50, 100, 150 and 200g), Descending (200, 150, 100 and 50g)] run 6 consecutive 50-meter series at maximum speed (first and sixth without weights); partial, total times and speed were analyzed. Instep weights were safe and well tolerated. 6th series speed decreased except in men’s ascending group, who achieved a lower time in sixth compared to first series. Weights presented in ascending order in men during warm-up could improve running time. Instep weights neuromuscular effects could compensate men’s tiredness in last series; weights could be included in training methodologies. Men training weights presented in ascending order may provide better results.

Background: The thoracolumbar fascia (TLF) is thought to play a role in the development of LBP, but it is not yet clear which factor of TLF changes is a cause and which is an effect. Therefore, some studies used the cross-correlation function (CCR) to reveal time-dependent relationships between biomechanical and neuromotor factors. Methods: Ten patients with acute low back pain (aLBP) were matched to healthy controls. Simultaneous recording of surface electromyography (sEMG) of the erector spinae muscle (ES) and dynamic ultrasound (US) images of TLF deformation were performed during trunk extension. CCR functions and Granger causality were used to describe the relationship between the two measures. Results: CCR time lags were significant higher in the aLBP group (p = 0.04). Granger causality (GC) showed a direct effect of TLF deformation on ES activation only in the aLBP group (p &lt; 0.03). Conclusions: The results suggest that in aLBP, ES activity is significantly affected by TLF, whereas this relation-ship is completely random in healthy subjects studied with CCR and GC comparisons of dynamic US imaging and sEMG data signals. Fascia-related disturbances in neuromotor control, particularly due to altered muscle spindle functions, are suspected as a possible mechanism behind this.

Low back pain is a clinically highly relevant musculoskeletal burden and is associated with inflammatory as well as degenerative processes of the intervertebral disc. However, the pathophysiology and cellular pathways contributing to this devastating condition are still poorly understood. Based on previous evidence, we hypothesize that tissue renin-angiotensin system (tRAS) components, including the SARS-CoV-2 entry receptor angiotensin-converting enzyme 2 (ACE2), are present in human nucleus pulposus (NP) cells and associated with inflammatory and degenerative processes. Experiments were performed with NP cells from 4 human donors. The existence of angiotensin II, angiotensin II type 1 receptor (AGTR1), AGTR2, MAS-receptor (MasR), and ACE2 in human NP cells was validated with immunofluorescent staining and gene expression analysis. Hereafter the cell viability was assessed after adding agonists and antagonists of the target receptors as well as angiotensin II in different concentrations for up to 48 hours of exposure. A TNF-α-induced inflammatory in vitro model was employed to assess the impact of angiotensin II addition and the stimulation or inhibition of the tRAS receptors on inflammation, tissue remodeling, expression of tRAS markers, and the release of nitric oxide (NO) into the medium. Further, protein levels of IL-6, IL-8, IL-10, and intracellular as well as secreted angiotensin II were assessed after exposing the cells to the substances, and inducible nitric oxide synthase (iNOS) levels were evaluated utilizing Western Blot. The existence of tRAS receptors and angiotensin II were validated in human NP cells. Cell viability analysis revealed no cytotoxic effects of angiotensin II. The AGTR1 inhibitor Candesartan and the MAS receptors AVE0991 showed cytotoxic effects at high concentrations (100 µM). The addition of angiotensin II only showed a mild impact on gene expression markers. However, there was a significant increase in NO secreted by the cells. The gene expression ratios of pro-inflammatory/anti-inflammatory cytokines IL-6/IL--10, IL-8/IL-10, and TNF-α /IL-10 were positively correlated with the AGTR1/AGTR2 and AGTR1/MAS1 ratios, respectively. The stimulation of the AGTR2 MAS-receptor and the inhibition of the AGTR1 receptor revealed beneficial effects on the gene expression of inflammatory and tissue remodeling markers. This finding was also present at the protein level. We did not find alterations in iNOS protein concentrations after adding the drugs. The current data showed that tRAS components are expressed in human NP cells and are associated with inflammatory and degenerative processes. Further characterization of the associated pathways is warranted. The findings indicate that tRAS modulation might be a novel therapeutic approach to intervertebral disc disease.

Background: Recent work has investigated significant force transmission between the compo-nents of myofascial chains. Misalignments in the body due to fascial thickening and shortening can therefore lead to complex compensatory patterns. For the treatment of such nonlinear cause-effect pathology, a comprehensive neuro-musculoskeletal therapy such as the Rolf Meth-od of Structural Integration (SI) could be targeted. Methods: A total of 727 subjects were retro-spectively screened from the medical records of an SI practice over a 23-year period. 383 subjects who had completed 10 basic SI sessions met eligibility criteria and were assessed for active range of motion (AROM) of the shoulder and hip before and after SI treatment. Results: Shoulder flex-ion, external and internal rotation, and hip flexion improved significantly (all p < 0.0001) after 10 SI sessions. Left shoulder flexion and external rotation of both shoulders increased more in men than in women (p < 0.0001), but were not affected by age. Conclusions: SI intervention produces multiple changes in the components of myofascial chains that could help maintain upright pos-ture in humans and reduce inadequate compensatory patterns. SI affects differently the outcome of some AROM parameters in women and men.

Background Bone fracture fixation surgery is one of the most commonly performed surgical procedures in the orthopedic field. However, fracture healing complications occur frequently, and the choice of the most optimal surgical approach often remains challenging. In the last years, computational tools have been developed with the aim to assist preoperative planning procedures of bone fracture fixation surgery. Objectives The aims of this review are (1) to provide a comprehensive overview of the state-of-the-art in computer-assisted preoperative planning of bone fracture fixation surgery, (2) to assess the clinical feasibility of the existing virtual planning approaches, and (3) to assess their clinical efficacy in terms of clinical outcomes as compared to conventional planning methods. Methods A literature search was performed in the MEDLINE-PubMed, Ovid-EMBASE, Ovid-EMCARE, Web of Science, and Cochrane libraries to identify articles reporting on the clinical use of computer-assisted preoperative planning of bone fracture fixation. Results 79 articles were included to provide an overview of the state-of-the art in virtual planning. While patient-specific geometrical model construction, virtual bone fracture reduction, and virtual fixation planning are routinely applied in virtual planning, biomechanical analysis is rarely included in the planning framework. 21 of the included studies were used to assess the feasibility and efficacy of computer-assisted planning methods. The reported total mean planning duration ranged from 22 to 258 minutes in different studies. Computer-assisted planning resulted in reduced operation time (Standardized Mean Difference (SMD): -2.19; 95% Confidence Interval (CI): -2.87, -1.50), less blood loss (SMD: -1.99; 95% CI: -2.75, -1.24), decreased frequency of fluoroscopy (SMD: -2.18; 95% CI: -2.74, -1.61), shortened fracture healing times (SMD:-0.51; 95% CI: -0.97, -0.05) and less postoperative complications (Risk Ratio (RR): 0.64, 95% CI: 0.46, 0.90). No significant differences were found in hospitalization duration. Some studies reported improvements in reduction quality and functional outcomes but these results were not pooled for meta-analysis, since the reported outcome measures were too heterogeneous. Conclusions Current computer-assisted planning approaches are feasible to be used in clinical practice and have been shown to improve clinical outcomes. Including biomechanical analysis into the framework has the potential to further improve clinical outcome.

Worldwide, depressive disorder is one of the leading determinants of disability-adjusted life years. Although the benefits associated with physical activity (PA), there is a lack of information related to depression, especially in countries like Czechia, where modern approaches to mental health care only recently emerged. The PA levels were associated with aspects of depression such as clinician-diagnosed history; different severities; continuous depression scores; and specific symptoms that characterize the depression. The multivariable-adjusted Poisson regression models were carried out on 2123 participants (45.3% men, median 48 years). Compared to subjects with insufficient PA, the moderate and high PA levels were inversely associated with clinician-diagnosed depression history (respectively, prevalence rate [PR]= 0.84; 95% CI 0.66-0.82 and PR=0.50; 95% CI 0.36-0.67); and with continuous depression scores (PR=0.85; 95% CI 0.75-0.97; and PR=0.79; 95%CI 0.70-0.90).; but only high PA showed association with depression categories (PR=0.75; 95%CI 0.60-0.95). Depressed mood and worthlessness were the symptoms associated with moderate and high PA. Tiredness, change in appetite, and problems with concentration only with high PA. Although only high PA was sufficient for people intending changes among depression categories, the moderate PA may be enough for slight changes in depressive symptoms, and a good strategy when starting.

The mental and emotional health of an athlete is crucial for their performance and well-being. Sports-related stress can significantly impair that mental health. Yoga of Immortals (YOI) is a unique combination of specific yogic postures, breathing exercises, sound therapy &amp; meditation, which has demonstrated benefit in improving measures of mental health. This study used the Sports Mind Inventory (SMI) to examine whether YOI can improve the resilience of athletes to sports-related stress. Participants were a diverse set of athletes based in Mauritius who routinely engage in a wide range of athletic activities. Participants were randomly assigned to receive four weeks of YOI or no intervention. Both groups completed the SMI questionarie at baseline and again after four weeks. The YOI intervention significantly increased the total mean SMI scores by 14%, indicating improved sports resilience and psychological health. No improvement was observed in the control group. This study demonstrates that YOI is a promising intervention in improving sports related stress.

Proximal Junctional Kyphosis (PJK) as one of the most discussed problems after corrective surgery in adolescent idiopathic scoliosis (AIS), is still not fully clarified and seems to be multifactorial. Biome-chanical and few clinical studies have shown the influence of destruction of posterior ligaments by re-section of spinous processes and some parameters concerning rod contouring as risk factors for PJK. To verify these results 192 patients with AIS and corrective surgery via posterior approach between 2009 and 2017 were included. Radiographic parameters were analyzed preoperatively (preOP), postoperatively (postOP), and with a mean follow up (FU) of 27 months. The participants were divided into two groups (PJK group and non-PJK group). The incidence of PJK was 15.6%. Contrary to the results of biomechanical studies, we could not find any significant influence of the spinous process resection. However, the PJK group had significantly larger preOP T4-T12 kyphosis (31.1°±13.93° vs. 23.3°±14.93°, p=.016). Furthermore, the PJK group showed a significantly larger rod contour angle (RCA) (8.0°±4.44° vs. 5.9°±3.28°, p=.003) and mismatch of postOP proximal junctional angle (PJA) and RCA (3.5°±5.72° vs. 0.9°±4.86°, p=.010) compared to the non-PJK group. An increase of the mismatch of postOP PJA and RCA (OR=1.14, p=.008) and a high RCA are risk factors for PJK and need to be focused on by surgeons.

This article examines older physical education (PE) teachers’ wellbeing over the course of their career in Finland. The study highlights challenges to physical and mental functioning as well as how teachers respond to these challenges. The six interviewees were over 55-year-old PE teachers, whose career had lasted for more than 30 years. Qualitative methods were used in the collection, transcription and analysis of the research data. The qualitative analysis consisted of a series of interpretations that visualised the world described by the interviewees. All the research participants had physical problems that affected their teaching and make teachers consider a potential career change. To be able to teach, teachers adapted their ways of working according to the challenges brought by age and injuries. The research participants found that the challenges caused by musculoskeletal problems and ageing were an inevitable part of the profession. They emphasised the positive sides of the work: the profession permits varied workdays. In addition, the teachers noted that their work provides them with opportunities to remain physically fit. Teaching health education is a means to lighten the workload of older teachers. PE teachers enjoy their profession and are dedicated to it, despite all the challenges. The interviewed participants clearly experienced work engagement. Our development proposal for teacher education is that future PE teachers be informed about the risks involved in the profession. Such activity helps young teachers reflect proactively on the measures taken to maintain their functioning during their career and on perspectives related to the ways of working.

Breaking up prolonged sitting by short bouts of light physical activities including standing and walking has been shown to be beneficial for people with type 2 diabetes (T2D). This paper presents the development of an android mobile app to deliver a just-in-time adaptive intervention (JITAI) to reduce sedentary time in people with T2D. A total of six design workshops were conducted with seven experts to identify design requirements, a behavioural framework, and required contextual adaptations for the development of a bespoke mobile app (iMOVE). Moreover, a focus group was conducted among people with T2D as potential end-users (N=10) to ascertain their perceptions of the app. Feedback from the focus group was used in subsequent iterations of the iMOVE app. Data were analysed using an inductive qualitative thematic analysis. Based on workshops, key features of iMOVE were developed, including simplicity (e.g., navigation, login), colours and font sizes, push notifications, messaging algorithms and a triggering system for breaking up sitting time and moving more. Based on the user testing results, a goal setting tab was added, font sizes were made larger, the brightness of colours was reduced, and a colour indicator was used to indicate device connectivity with an activity tracker. A user-centric app was developed to support people with T2D to transition from sedentary to active lifestyles.

This paper presents a modular approach to generic exergame design that combines custom physical exercises in a meaningful and motivating story. This aims to provide a tool that can be individually tailored and adapted to people with different needs, making it applicable to different diseases and states of disease. The game is based on motion capturing and integrates four example exercises that can be configured via our therapeutic web platform "Blexer-med". To prove the feasibility for a wide range of different users, evaluation tests were performed on 14 patients with various types and degrees of neuromuscular disorders, classified into three groups based on strength and autonomy. Users were free to choose their schedule and frequency. Game scores and three surveys (before, during, and after the intervention) showed similar experiences for all groups, with the most vulnerable having the most fun and satisfaction. The players were motivated by the story and by achieving high scores. The average usage time was 2.5 times per week, 20 minutes per session. Pure exercise time was about half the game time. The concept has proven feasible and forms a reasonable basis for further developments. The full 3D exercise needs further fine-tuning to enhance fun and motivation.

This study aimed to apply different complexity-based methods to surface electromyography (EMG) in order to detect neuromuscular changes after realistic warm-up and stretching procedures. Sixteen volunteers conducted two experimental sessions. They were tested before, after a standardized warm-up, and after a stretching exercise (static or neuromuscular nerve gliding technique). Tests included measurements of the knee flexion torque and EMG of biceps femoris (BF) and semitendinosus (ST) muscles. EMG was analyzed using the root mean square (RMS), sample entropy (SampEn), percentage of recurrence and determinism following a recurrence quantification analysis (%Rec and %Det) and a scaling parameter from a detrended fluctuation analysis. Torque was significantly greater after warm-up as compared to baseline and after stretching. RMS was not affected by the experimental procedure. In contrast, SampEn was significantly greater after warm-up and stretching as compared to baseline values. %Rec was not modified but %Det for BF muscle was significantly greater after stretching as compared to baseline. The a scaling parameter was significantly lower after warm-up as compared to baseline for ST muscle. From the present results, complexity-based methods applied to the EMG give additional information than linear-based methods. They appeared sensitive to detect EMG complexity increases following warm-up.

Objectives: The present study was performed to compare between two different fixation techniques and evaluate the histopathological changes which occur in temporomandibular joint (TMJ) of the dogs after surgically induced unilateral subcondylar fracture. Methods: Twenty- One healthy beagle male dogs with a mean age of 30 months were used in the present study. One of these animals was sacrificed to study the normal histology of the dog TMJ. The rest of the animals (20 animals) were operated on to induce a displaced unilateral subcondylar fracture then, the animals were randomly equally divided into 2 groups. After surgery, 5 dogs of each group were sacrificed at 2 months after surgery (Short-Term), while the remaining 5 were sacrificed at 4 months after surgery (Long-Term). The heads were separated and fixed, oscillating saw was used to articulate the entire TMJ. Specimens were decalcified, then the specimens were washed, grossed and sectioned in a sagittal plane. Tissue sections of 4 um thick were cut and stained with Hematoxylin and Eosin to be studied microscopically. Results: In group I animals, at 2 months after surgery, there was a marked hypertrophy of the articular fibrous covering of the condylar head, while at 4 months after surgery, the articular fibrous covering appeared thinner than normal, with marked decrease in thickness of the articular cartilage layer. In group II, at 2 months after plate insertion, the articular fibrous covering became hypertrophic, and the articular cartilage was markedly reduced but it was of a uniform thickness, while at 4 months after subcondylar fracture and plate fixation, no significant changes could be detected either in thickness or structure of the articular fibrous covering. Conclusion: Based on this study, it is obvious that the plate fixation group gave the most favorable results, when compared with maxillomandibular fixation (MMF) group.

Reparative osteogenesis in the damaged vertebrae is a complex cascade of morphological and biochemical processes that result in the consolidation of the vertebral body. This research was aimed at studying the features of reparative osteogenesis in damaged thoracic and lumbar vertebral bodies at different time points after injury. We analyzed the morphological findings of the vertebral tissues harvested during surgical interventions in 43 patients with recent, subacute and long-standing injuries to thoracic and lumbar spine, and found that cell differentiation in osteogenesis is closely related to angiogenesis and the metabolic cascade. In areas with sufficient oxygenation, good partial pressure of oxygen, and active growth of microvasculature the normal cycle of development and differentiation of osteoblasts and osteocytes occurs, and hypoxia and acidosis lead to pathological osteogenesis. The reclination maneuver with dorsal tools on Day 10-12 of the injury may be ineffective due to the formation of adhesions between fragments, and reclination of the body of the damaged vertebra two weeks or more after the injury is apparently doomed to failure. Timely ventral fusion performed for objective indications is the key to successful rehabilitation of patients, on the one hand, and reduction of the surgical trauma volume in the future, on the other.

Background: Upper extremities’ function impairments (UEFI) and gait impairment are frequently reported even in the early stages of Multiple Sclerosis (MS) disease. These motor deficits can negatively affect the quality of life (QOL) in MS patient. Exercise has been repeatedly introduced as a beneficial adjuvant therapy for MS, attenuating a wide range of physical and psychological symptoms without any side effects or increased risks of relapse or exacerbation in disease symptoms.Aim: This paper investigates the effect of multi-function swing suspension training (MFSST) program on upper and lower extremities’ function (ULEF), and QOL in MS women according to expanded disability status scale (EDSS) score.Design: Experimental method with a pre-test and post-test design with control group. Setting: The department of Sports Injuries and Corrective Exercise at the Shahid Bahonar University of Kerman.Population: Forty-seven MS women.Methods: Eligible subjects who matched the selection criteria were randomly assigned into three groups as follow: i. Intervention group A (EDSS of 2 – 4), ii. Intervention group B (EDSS of 4.5 – 6.5), and iii. Control group (EDSS of 2 – 6.5). The intervention groups have been trained by the SET program for a duration of 8 weeks. At baseline and after the intervention, the upper extremities’ function (UEF) and the lower extremities’ function (LEF) were assessed by 9-hole peg test (9HPT) and the timed 25-foot walk (T25FW) test, respectively. Moreover, participants’ QOL was measured using the Short Form questionnaire (SF-36).Results: A significant difference was found between the pre-test and post-test variables of walking speed and upper extremity endurance in intervention groups, and between the intervention groups and control group (P < 0.05). Compared to control group, both intervention groups showed improvements in all subscales of QOL, except emotional role limitation score.Conclusions: In summary, these results show that the present protocol of MFSST could be effective in improving ULEF and QOL in MS patients, showing the improvements after 4^th week. Moreover, this protocol was more useful for patients with an EDSS score of more than 4.5. Therefore, it seems that exercise therapy should be considered as a beneficial clinical intervention approach to improve ULEF and QOL in MS patients.

An early hypothesis in robot-assisted stroke therapy was that sensorimotor stimulation through robotic assistance is beneficial for recovery. Despite 25 years of upper-limb rehabilitation robotics research, this hypothesis remains untested barring a few studies with small sample sizes. This review aims to provide a critical summary of the current state of this hypothesis by collating evidence from rehabilitation robotics and other related therapeutic approaches. The review starts with a causal model to expose the various direct and indirect routes through which robotic assistance can aid sensorimotor recovery. The indirect routes include the influence of robotic assistance on therapy intensity, patient motivation, and active participation. The direct route is through changes in cortical networks through Hebbian(-like) learning and changes in peripheral tissue properties. There is currently mixed evidence for the direct causal effect of robotic assistance on recovery from the upper-limb rehabilitation robotics literature. However, evidence from the neuromuscular electrical stimulation literature provides some support for this causal role. Based on the data at hand, we hypothesize that the enhanced movement-related sensory feedback from robotic assistance has a direct, possibly small, causal role in the sensorimotor recovery of the upper-limb, and this effect might be detectable with high-intensity therapy. Large, high-intensity, controlled studies are warranted to support or refute the role of robotic assistance on recovery, which is both scientifically and practically important.

A common spinal condition, spondylolisthesis is the presence of a relative back or forth displacement between the upper and lower vertebra due to one vertebra being oriented away from the smooth curvature of a normal spine. Aging-related illnesses such as degenerative spondylolisthesis are especially burdensome on social welfare and health-care systems in an aging society, especially radiologists and clinical physicians. Therefore, we proposed a computer aided diagnosis algorithm, named LumbarNet, for vertebral slippage detection on clinical X-ray images. Collaborating with i) a P-grade, ii) a piecewise slope detection scheme, and iii) a dynamic shift detection routine, LumbarNet was thus specialized for analyzing complex structural patterns in lumbar spine X-ray images and outcompeted other U-Net based methods. Extensive experiments on lumbar spine X-ray images in standard clinical practices showed that LumbarNet achieved a mean intersection over union value of 0.88 in vertebral region detection and an accuracy of 88.83% in vertebral slippage detection.

This study explored the development of neuromuscular fatigue responses during progressive cycling exercise. The sample comprised 32 participants aged 22.0 ± 0.54 years who were assigned into three groups: endurance-trained group (END, triathletes, n = 10), strength-trained group (STR, body-builders, n = 10), and control group (CON, recreationally active students, n = 12). The incremental cycling exercise was performed using a progressive protocol starting with a 3 min resting measurement and then 50 W workload with subsequent constant increments of 50 W every 3 minutes until 200 W. Surface electromyography (SEMG) of rectus femoris muscles was recorded during the final 30 s of each of the four workloads. During the final 15 s of each workload, participants rated their overall perception of effort using the 20-point RPE scale. Post-hoc Tukey’s HSD testing showed significant differences between END and STR groups in MF and MPF across all workloads (p < 0.001 and p < 0.01, respectively). Athletes from END group had significantly lower AEMG responses than those from STR (p = 0.0093) and CON group (p = 0.0006). Increasing RPE points from 50 to 200 W were significantly higher in STR than in END group (p < 0.001). In conclusion, there is a significant variation in neuromuscular fatigue profiles between athletes with different training backgrounds when a cycling exercise is applied. The approximately linear trend of the SEMG and RPE values of both groups of athletes with increasing workload support the increased skeletal muscle recruitment with perceived exertion or fatiguing effect.

Background: Physical activity has been considered as a promising approach to slow down the disease process in Multiple Sclerosis (MS) patients. While the functional impairments of MS have been studied in detail, but there is limited evidence of the efficacy of exercise interventions on the Multiple Sclerosis functional composite (MSFC) score in these patients. The study aim was to in-vestigate the improvement in MSFC score by multi-function swing suspension training (MFSST) in the women with MS. Methods: The patients were divided into the intervention and control groups. A total of 47 MS patients completed the MSFC components at baseline and after the intervention. Z scores were created for each test based on control means. Results: The MSFC components showed a significant increment in comparison with the baseline levels in the four, six, and eight weeks following the first exercise session (all p<0.05). These dif-ferences in the control group were not significant. The improvement in the MSFC score and the component Z-scores in the intervention groups was found from the fourth week onwards. Conclusions: The study findings highlight that MFSST can be used as an effective treatment method in MS patients due to its positive effects on physical parameters, such as muscles strength, functional impairments, and cognitive problems.

Motor control, movement impairment and postural control recovery targeted in rehabilitation could be affected by pain. The main objective of this comprehensive review is to provide a synthesis of the effect of experimental and chronic pain on postural control throughout the available literature. After presenting the neurophysiological pathways of pain, we demonstrated that pain, preferentially localized at low back or in the leg induced postural control alteration. While proprioceptive and cortical excitability seems modified with pain, spinal modulation assessment might provide new understanding of the pain phenomenon related to postural control. Literature highlight that the motor control of trunk muscles in patient presenting with low back pain could be dichotomized in two populations, where the first one over-activate trunk muscles, the second one under-activate trunk muscles, and both generating increase of tissues loading. Taking account all this findings, will help clinician to provide adapted treatment for managing both pain and postural control.

Foot drop is a common disability in post-stroke patients and represents a challenge for the clinician. To date, Ankle Foot Orthosis (AFO) combined with conventional rehabilitation is the gold standard of rehabilitation management. AFO has a palliative mechanical action without actively restoring the associated neural function. Functional Electrical Stimulation (FES), consisting in stimulation of the peroneal nerve pathway, represents an alternative approach. By providing a FES device (Bioness L-300, BIONESS, USA) for 6 months to a post-stroke 22-year-old woman with a foot drop, our goal was to quantify its potential benefit on walking capacity. Gait parameters and the temporal evolution of the speed were collected with a specific connected sole device (Feet Me®) during the 10-meter walking, the Time Up and Go, and the 6-minute walking tests with AFO, FES or without any device (NO). As a result, the walking speed changes on 10-meters were clinically significant with an increase from baseline to 6 months in AFO and FES conditions (+0.14m-1 and +0.36m-1), without any changes in NO condition. In addition, speed decreased at about 4-minutes of the 6-minute walking test in NO and AFO conditions, while speed increased in FES conditions at baseline and after 1, 3 and 6 months. Monitoring gait speed in an endurance test after an ecological rehabilitation training program helps to examine walking performance in post-stroke patients and to propose a specific rehabilitation program depending on a fatigue threshold.

About 70% of children and adolescents with cerebral palsy experience gait impairments which affect their autonomy and well-being. Robotic-assisted gait training using the Lokomat is particu-larly promising for rehabilitation as it provides a standardized environment favoring the massive repetition of the movement, in which physical demands are low on the therapist and high training loads can be achieved. As no guidelines exist regarding training protocols and Lokomat settings, the goal of this study was to review the literature on Lokomat-assisted gait therapy and possibly make training recommendations. The twelve studies reviewed reported both positive and null effects of Lokomat training on gait. Half of the studies combined Lokomat with other types of training and only five used a control intervention to assess its benefit. Overall, training was administered 1-5 times per week for 20-60 minutes, over 1-12 weeks. Although Lokomat settings were not always described, progressively decreasing body-weight support and guidance, while increasing treadmill speed appear to be prioritized. The variety of training protocols and settings used did not allow pooling of the studies to assess effects of interventions on gait parameters in children and adoles-cents with cerebral palsy. This review highlights the need for homogenization of interventions so that clear guidelines can emerge and be applied in rehabilitation centers.

Background: This study aims to set out key clinical features of different Motoric Cognitive Risk (MCR) subtypes based on individual quantitative measures of cognitive impairment and to compare their predictive power on survival over an 8-year observation time. Methods: We analyzed data from a population-based study of 1138 subjects aged 65 years and older in south Italy. These individuals were targeted and allocated to subtypes of the MCR phenotype according to the slowness criterion plus one other different cognitive domain for each characterized phenotype. Clinical evaluation and laboratory assays, along with a comprehensive battery of neuropsychological and physical tests, completed the sample investigation. Results: MCR prevalence was found to be 9.8% (N=112), 3.6% (N=41), 3.4% (N=39), and 1.8% (N=21) for the MCR, MCR-GlobalFunction, MCR-StructuredSCC, and MCR-SCC&amp;GlobalFunction, respectively. Univariate Cox survival analysis showed an association only of the MCR-GlobalFunction subtype with a significant, 1.5-fold increased risk of overall death as compared to the other counterparts (HR 2.53, 95%CI 1.28 to 4.99, P-value&lt;0.01) over an 8-year observation period, even after major adjustment (HR 2.02, 95%CI 1.02 to 4.02). Conclusions: MCR phenotypes assigned to the MMSE cognitive domain are more likely to have an increased risk of overall mortality, 1.5-fold higher than counterparts, over 8-year observation.

Extracorporeal shock wave therapy (ESWT) is a safe and effective treatment option for various pathologies of the musculoskeletal system. Many studies addressed the molecular and cellular mechanisms of action of ESWT. However, no uniform concept could be established in this matter until now. We performed a systematic review of the effects of exposure of musculoskeletal tissue to extracorporeal shock waves (ESWs) reported in the literature. The key results were as follows: (i) compared to the effects of many other forms of therapy, the clinical benefit of ESWT does not appear to be based on a single mechanism; (ii) different tissues respond to the same mechanical stimulus in different ways; (iii) just because a mechanism of action of ESWT was described in a study does not automatically mean that this mechanism was relevant to the observed clinical effect; (iv) focused ESWs and radial ESWs seem to act in a similar way; and (v) even the most sophisticated research into the effects of exposure of musculoskeletal tissue to ESWs cannot substitute clinical research in order to determine the optimum intensity, treatment frequency and localization of ESWT.

Robot-assisted gait training (RAGT) is a promising treatment for stroke rehabilitation. Although the coordination between the upper and lower limbs is important for locomotor training, commercially available robotics for gait training mainly focus on the restoration of lower limb function. We aimed to evaluate the feasibility and usability of complex upper and lower limb RAGT in stroke patients using the GTR-A®, end effector-type robotic device. Patients with subacute stroke (N=9) received 30-minute RAGT thrice a week for two weeks (six sessions). Functionally, the hand grip strength (HGS), Functional Ambulatory Categories, modified Barthel Index, muscle strength test sum score, Berg Balance Scale, Timed Up and Go test, and Short Physical Performance Battery were used. The heart rate and a structured questionnaire were used to evaluate cardiorespiratory fitness and the usability of RAGT. Among the nine patients, all functional parameters between the baseline and post-training were significantly improved after RAGT, except for HGS and the muscle strength test. The questionnaire’s mean scores for each domain were as follows: safety 4.40±0.35, effects 4.23±0.31, efficiency 4.22±0.77, and satisfaction 4.41±0.25. The GTR-A® is a feasible and safe robotic device for patients with gait impairment after stroke. It showed functional improvement with endurance training effects.

Obesity is linked to an inflammatory process, with adipocyte release triggering insulin resistance (IR) and autonomic imbalance. A cardiovagal trainning protocol has shown favorable results in autonomic balance and decrease of inflammatory markers. The aim of this study was to analyze the autonomic behavior related to inflammatory and metabolic parameters in obese people after a cardiovagal exercise protocol. Twenty people with obesity, were distributed by their HOMA-IR value: obese without IR (n/IR) (n=8) and obese with IR (y/IR) (n=12). The cardiovagal training program was carried out in both groups for 8 weeks at a frequency of 5 times per week. A blood sample was obtained to determine insulin, leptin, TNF alpha and IL6 levels, in addition to determining the HOMA-IR index and autonomic function was measured by heart rate variability. Changes were recorded in the OB-IR group, a decrease in inflammatory markers, glycemia and a reduction of sympathetic activity after the cardiovagal training intervention. In addition, significant differences between the y/IR and n/IR groups were shown in insulin, leptin, TNFa and IL6 values. It can be concluded that after 4 weeks of intervention with a cardiovagal trainning protocol, parasympathetic modulation increased and inflammatory markers decreased in obese subjects.

: This article was not intended to be a complete report of a standard clinical trial. It is a report of the outcomes of preliminary data for validation of the CMECD procedure (Coletti Method of EMG ChemoDenervation) protocol for the treatment of chronic pain resulting from chronic muscle spasm. Methods are here detailed on how to approach the patient with chronic pain, identify the presence of chronic muscle spasm, undertake the treatment protocol and how to perform the follow up process to confirm that chronic pain secondary to chronic muscle spasm was the accurate diagnosis. Furthermore, this article presents the results of a cohort of more than 90 patients treated by the CMECD procedure regarding location and duration of prior pain, prior treatment strategies, degree of success in resolving pain and duration of relief. Outcome data consisting of patient and staff reporting of specific situations in which the chronic pain treatment was successful has been included to help establish the “believability” of outcome successes and to elucidate the potential life altering effects of successful treatment of chronic pain secondary to chronic muscle spasm. This article will hopefully increase the interest in this treatment protocol and increase the chance that a classical international clinical trial will be undertaken.

(1) Background: With continuous globalization and modernization of people's lives, lifestyle has changed dramatically, with decreased physical activity and increased unhealthy eating patterns in many nations throughout the world. With the COVID-19 pandemic and changes taking place in people’s health and lifestyles around the world, the need for rehabilitation is expected to rise in the coming years.(2)Methods: This paper analyzes the integration model of sports and health care using theoretical analysis, literature reviews, logical reasoning, and other methods.(3)Results: The integration of sports and health care in China has entered the stage of practical implementation after many years of development, forming a few representative integration patterns. Governments, communities, community hospitals, hospitals, and third-party institutions are the main participants, with the community playing an important role in the integration. Pharmacies, sports venues, and schools with sufficient staff have a relatively low participation rate.(4)Conclusion: The grading treatment has been applied in health management and sports rehabilitation, based on the development of digital medicine, a government-led grading treatment model of "health management center" can promote the participation of multiple subjects in the integration of sports and health care, solving the problems existing in the current integration process to a certain extent.

Background: It has been demonstrated that pressotherapy used post-exercise (Po-E) can influence training performance, recovery, and physiological properties. This study examined the effec-tiveness of pressotherapy on these parameters. Methods: The systematic review and meta-analysis were performed according to PRISMA guidelines. A literature search of MEDLINE, PubMed, EBSCO, Web of Science, SPORTDiscus and ClinicalTrials has been done up to March 2021. Inclusion criteria were: randomized control trials (RCTs) or cross-over studies, mean participant age be-tween 18-65 yrs., ≥ 1 exercise mechanical pressotherapy intervention. The risk of bias was assessed by the Cochrane risk-of-bias tool for RCT (RoB 2.0). Results: 12 studies comprised of 322 partici-pants have been selected. The mean sample size was n = 25. Pressotherapy significantly reduce muscle soreness(Standard Mean Difference;SMD= -0.33; CI = -0.49, -0.18; p < 0.0001; I2 = 7%). Pres-sotherapy did not significantly affect jump height (SMD = -0.04; CI =-0.36, -0.29; p = 0.82). Presso-therapy did not significantly affect creatine kinase level 24-96h after DOMS induction (SMD = 0.41; CI = -0.07, 0.89; p = 0.09; I2 = 63%). Conclusions: Only moderate benefits of using pressotherapy as a recovery intervention have been observed. Results varied between the type of exercise and used protocol. Pressotherapy should only be applied as an additional component of a more compre-hensive recovery strategy. Study PROSPERO registration number- CRD42020189382.

Background: Conclusions of meta-analyses of clinical studies may substantially influence opinions of perspective patients and stakeholders in health care. Nineteen meta-analyses of clinical studies on the management of primary knee osteoarthritis (pkOA) with stem cells, published between January 2020 and July 2021, came to inconsistent conclusions regarding the efficacy of this treatment modality. It is possible that a separate meta-analysis based on an independent, systematic assessment of clinical studies on the management of pkOA with stem cells may reach a different conclusion. Methods: PubMed, Web of Science and the Cochrane library were systematically searched for clinical studies and meta-analyses of clinical studies on the management of pkOA with stem cells. All clinical studies and meta-analyses identified were evaluated in detail, as were all sub-analyses included in the meta-analyses. Results: The inconsistent conclusions regarding the efficacy of treating pkOA with stem cells in the 19 assessed meta-analyses were most probably based on substantial differences in literature search strategies among different authors, misconceptions about meta-analyses themselves, and misconceptions about the biology of stem cells. An independent, systematic review of the literature yielded a total of 183 studies, of which 33 were randomized clinical trials, including a total of 6860 patients with pkOA. However, it was not possible to perform a scientifically sound meta-analysis. Conclusion: Clinicians should interpret the results of the 19 assessed meta-analyses of clinical studies on the management of pkOA with stem cells with caution, and should be cautious of the conclusions drawn therein. Clinicians and researchers should strive to participate in FDA and/or EMA reviewed and approved clinical trials to provide clinically and statistically valid efficacy.

Leisure-time physical activity (LTPA) is associated with access and use of public open spaces. The “President João Goulart Elevated Avenue” and current denominated “Minhocão” is a facility for leisure activities that are open for people during the night/weekends. The aim of this study was to examine if the prevalence of LTPA among individuals living in the surroundings of Minhocão is different according to proximity to, and use of, the facility. We conducted a cross-sectional study with cluster sampling with people aged ≥18 years who lived in households until 500m and between 501m to 1500m of Minhocão. The survey was conducted between December/2017 until March/2019 with an electronic questionnaire self-responded. We conducted bivariate analysis and Poisson regression to examine possible differences in LTPA according to the proximity of residences and use of Minhocão. The analysis used post-stratification weights. A total of 12,030 telephone numbers of people were drawn (≤500m = 6,942; and &gt;500m to ≤1500m = 5,088). The final sample analyzed were of 235 residents who returned the questionnaires. There was a higher prevalence of individuals engaging in at least 150 minutes per week of LTPA among users than non-users (Prevalence Ratio=2.23, IC95%1.72-2.90). People who used the park had higher prevalence of all types of LTPA than non-users. The results can serve to inform government decision-making on the future of Minhocão.

Low back pain is a common problem in the active population, and the second reason for visiting a physician. In patients with lumbar disc protrusion, the nucleus pulposus bulges against the disc and the latter protrudes into the spinal column, but the annulus fibrosus remains intact. The purpose of this study was to prove that starting an early complex rehabilitation treatment results into pain and disability reduction, and increased muscle strength and mobility in patients with lumbar disc protrusions. We performed a prospective cohort study, enrolling 60 patients (25 men and 35 women) aged between 26 to 76 years, diagnosed with lumbar disc protrusion. Patients in the experimental group registered significant improvements in all studied variables (pain, mobility, muscle strength, disability) after 6 months of treatment. The results of our study suggest that, in the lumbar disc disease, a combined rehabilitation program may be more effective in terms of pain and disability reduction, if it starts early after diagnosis. The current study proves the importance of combining electrotherapy with hydrotherapy and physical therapy. Patients who received this treatment combination showed an extremely significant improvement in pain relief, and reduction of functional disability after 6 months of treatment.

Critical illness has been recognized to acutely influence bone metabolism and, consequently, bone mineral density. The main purpose of this study was to describe bone metabolism changes in adult survivors of critical illness in the attempt to correlate changes with severity scores. It is an open, prospective, observational, monocentric study on patients admitted to the ICU was conducted, evaluating bone metabolism at baseline (within 72 hours of ICU admission), 6 months, and 12 months. Fifty-nine patients admitted to the ICU (63% males), mean age 58 ± 16 years, were enrolled. Of these, 20 patients (34%) completed the one-year follow up. At baseline, bone resorption showed an increase, which was maintained at 6 months, with normalization at 12 months. Patients showed, in a majority of cases, hypovitaminosis D with hyperparathyroidism at baseline with subsequent normalization. A trend towards a correlation was described between severity scores and serum 25(OH) vitamin D and bone turnover marker levels. These results contribute to the confirmation of a positive association between critical illness requiring ICU and bone metabolism changes. This study poses the bases for further studies to evaluate bone health in ICU patients.

The objective was to assess the instrumental validity and the test-retest reliability of a low-cost hand-held push dynamometer adapted from a load-cell based hanging scale (tHHD) to collect compressive forces in different ranges of compressive forces. Three independent raters applied 50 pre-established compressions each on the tHHD centered on a force platform in 3 distinct ranges: ~70 N, ~160 N, ~250 N. Knee isometric strength was also assessed on 19 subjects in two sessions (48h apart) using the tHHD anchored by an inelastic adjustable strap. Knee extension and flexion were assessed with the participant seated on a chair with the feet resting on the floor, knees, and hips flexed at 90°. The isometric force peaks were recorded and compared. The ICC and the Cronbach’s α showed excellent consistency and agreement for both instrumental validity and test-retest reliability, as the correlation and determination coefficients. The SEM and the MDC analysis returned adequate low values with a coefficient of variation less than 5%. The Bland-Altman results showed consistency and high levels of agreement. The tHHD is a valid method to assess the knee isometric strength, showing portability, cost-effectiveness, and user-friendly interface to provide an effective form to assess the knee isometric strength.

Purpose: While resultant maximal voluntary contraction (MVC) is commonly used to assess muscular performance, the simultaneous activation of antagonist muscles could dramatically underestimate the strength of the agonist muscles. While quantification of antagonist torque has been performed in plantar- (PF) and dorsi-flexion (DF) joint in isometric conditions, it has yet to be determined in anisometric (concentric and eccentric) conditions. Methods: The experiment was performed in 9 participants through 2 sessions (reliability). The MVCs in DF and PF were measured in isometric, concentric and eccentric conditions (10°.s^-1). Electromyographic (EMG) activities from the soleus, gastrocnemius medialis and lateralis, and tibialis anterior muscles were simultaneously recorded. The EMG biofeedback method was used to quantify antagonist torque, where participants were asked to maintain a level of EMG activity, corresponding to antagonist EMG activity and related to the muscle contraction type, according to a visual EMG bio-feedback displayed on a screen. Results: Resultant torque significantly underestimated agonist torque in DF MVC (30-65%) and to a lesser extent in PF MVC (3%). Triceps surae antagonist torque was significantly modified with muscle contraction type, showing higher antagonist torque in isometric (29 Nm) than eccentric (23 Nm, p < 0.001) and concentric (14 Nm, p < 0.001) conditions and resulting in modification of the DF MVC torque-velocity shape. The difference between DF eccentric and concentric MVC was attenuated when considered agonist torque (12%) rather than resultant torque (45%). Conclusion: Estimation of the antagonist torque in isometric or anisometric condition brings new insights to assessment of muscular performance and could result in costly misinterpretation in strength training and/or rehabilitation programs.

The purpose of this scoping review was to examine the literature on the use of anti-gravity treadmill and its effects on lower limb motor functions in children and adolescents with locomotor impairments. Four databases (MEDLINE, CINAHL, Embase, Web of Science) were searched for articles from inception to August 2021. Inclusion criteria were: (1) experimental or quasi-experimental studies using the anti-gravity training as the primary intervention; (2) studies conducted in paediatricpediatric participants; (3) articles reporting outcomes related to the lower limb functions; and (4) studies published in French or English. Fifteen articles were included in the review. Studies included children and adolescents aged 4–18 years with locomotor impairments. The intervention duration was ranged from 2 and to 12 weeks, with 2-5 sessions per week. Included studies showed reported that anti-gravity training induces improvements in muscle strength, balance, spatiotemporal gait parameters, and walking endurance in children with locomotor impairments. This review provides relevant information about the modalities, outcomes and limits associated with the anti-gravity training protocol reported in the literature. Overall, the anti-gravity treadmill training could be viewed as a valuable training modality for children with cerebral palsy. However, more precise, and comprehensive description of anti-gravity rehabilitation protocols would be useful.

Objectives: 1) to demonstrate the anti-inflammatory and anabolic effect of Ozone by determining in serum samples the biochemical levels of IL-6 and IGF-1 in knee osteoarthritis (OA) patients in a real world in Rehabilitation Setting; 2) to evaluate clinical effectiveness by Visual Analog Scale (VAS) and WOMAC scale, and biochemical effect by C-reactive protein (CRP), uric acid and erythrocyte sedimentation rate (ESR). Material and methods: 65 patients with knee OA Kellgren Lawrence (KL) grade 2 or more were analyzed in a retrospective observational study. The study run from January 2018 to September 2021. Inclusion criteria: a) patients 18 years or older; b) with knee OA KL 2º or more; c) biochemical analysis before-and-after treatment; d) pain more than 3 on VAS. Exclusion Criteria: a) previous knee surgery; b) favism; c) pregnancy; d) any other disease that originates lack of collaboration for infiltration. Primary Outcome variables: a) IL-6; b) IGF-1 in diabetes mellitus (DM)/obese and non-DM/non-obese patients; both before-and-after Ozone treatment. Secondary Outcome variables: a) CRP, b) ESR, c) uric acid, d) VAS pain, e) WOMAC pain, function and stiffness. Ozone protocol consisted of 4 sessions (once a week) of an intra-articular infiltration of 20 mL (20µg/mL concentration) of a gas mixture of Oxygen-Ozone 95-5% (produced by Ozone generator Ozonosan-α Plus ®). For biochemical evaluation, SNIBE MAGLUMI ™ IL-6 (CLIA) and SNIBE MAGLUMI ™ IGF-1 (CLIA) kits were used. CRP and uric acid were analyzed by Abbott Alinity c kit; and ESR was evaluated by DIESSE VES MATIC CUBE 30. Results: There is a linear correlation between age and OA severity. IL-6 decreased both in DM and non-DM patients and in all OA KL grades (from 2.7 to 1.59 pg/mL). IGF-1 decreased in total group (OA + DM + obesity) from 112.09 to 107.19 ng/mL. When only knee OA patients were analyzed, Ozone improved IGF-1 levels (from 100.17 to 102.03 ng/mL). Ozone decreased CRP, ESR, uric acid, and improved VAS pain, WOMAC pain, function and stiffness (p<0.05). Conclusions: Ozone is a valid option for the management of knee osteoarthritis in real world Rehabilitation Setting, because of its anti-inflammatory, metabolic and anabolic properties. Ozone downregulates pro-inflammatory IL-6 cytokine. Ozone has a metabolic/hypoglycemic effect on obese/diabetic knee osteoarthritis patients by reducing IGF-1. Ozone has an anabolic effect on non-diabetic/non-obese patients by improving IGF-1. Ozone reduces other biomarkers of inflammation (CRP, ESR and uric acid) and improves, pain, function and quality of life.

The aim of this study was to determine the extent to which the Tyme Wear smart shirt is as reliable and valid in detecting personalized ventilatory thresholds when compared to the Parvo Medics TrueOne 2400. In this validation study, 19 subjects were recruited to conduct two graded exercise test (GXT) trials. Each GXT trial was separated by seven to ten days of rest. During the GXT, gas exchange and heart rate data were collected by the TrueOne 2400 (TRUE) in addition to the ventilation data collected by the Tyme Wear smart shirt (S-PRED). Gas exchange data from TRUE was used to detect VT1 and VT2. TRUE and S-PRED VT1 and VT2 were compared to determine the reliability and validity of the smart shirt. Of the 19 subjects, data from 15 subjects were used during analysis. S-PRED exhibited excellent (ICC &gt; 0.90) reliability for detection of VT1 and VT2 utilizing time point and workload and moderate (0.90 &gt; ICC &gt; 0.75 ) reliability utilizing heart rate. TRUE exhibited excellent reliability for detection of VT1 and VT2 utilizing time point, workload, and heart rate. When compared to TRUE, S-PRED appears to underestimate the VT1 workload (p &gt; 0.05) across both trials and heart rate (p &lt; 0.05) for trial 1. However, S-PRED appears to underestimate VT2 workload (p &lt; 0.05) and heart rate (p &lt; 0.05) across both trials. The result from this study suggests that the Tyme Wear smart shirt is less valid but is comparable in reliability when compared to the gold standard. Moreover, despite the underestimation of S-PRED VT1 and VT2, the S-PRED detected personalized ventilatory thresholds will provide an adequate training workload for most individuals. In conclusion, the Tyme Wear smart shirt provides easily accessible testing to establish threshold-guided training zones but does not devalue the long-standing laboratory equivalent.

This study aimed to characterize the risk of falling in low, moderate and high risk participants from two different geographical locations using a portable force-plate. A sample of 390 older adults from South and North America were matched for age, sex, height and weight. All participants performed a standardized balance assessment using a force plate. Participants were classified in low, moderate and high risk of falling. No differences were observed between South and North American men, nor comparing North American men and women. South American women showed the significantly shorter center of pressure path length compared to other groups. The majority of the sample was categorized as having low risk of falling (male: 65.69 % and female: 61.87 %), with no differences between men and women. Also, no differences were found between North vs. South Americans, nor for falls risk levels when male and female groups were compared separately. In conclusion, South American women had better balance compatible with the status of the 50-59 years’ normative age-range. The prevalence of low falls risk was ~ 61-65 % and the prevalence of moderate to high risk was ~ 16-19 %. The frequency of fall risk did not differ significantly between North and South Americans, nor between males and females.

Background: The COVID-19 pandemic has disproportionately affected people from more deprived communities. The experience of Long Covid is similarly distributed but very few investigations have concentrated on the needs of this population. The aim of this project was to co-produce an acceptable intervention for people with Long Covid, living in communities recognised as more deprived. Methods: The intervention was based on a multi-disciplinary team using approaches from sport and exercise medicine and functional rehabilitation. The co-production process was undertaken with a stakeholder advisory group and patient public involvement representation. This study identified participants by postcode and the indices of multiple deprivation (IMD); recruitment and engagement were supported by an existing health and wellbeing service. A virtual ‘clinic’ was offered with a team of professional practitioners who met participants three times each; to directly consider their needs and offer structured advice. The acceptability of the intervention was based on the individual’s participation and their completion of the intervention. Results: Ten participants were recruited with eight completing the intervention. The partnership with an existing community health and wellbeing service was deemed to be an important way of reaching participants. Two men and six women ages ranging from 38 to 73 were involved and their needs were commonly associated with fatigue, anxiety and depression with overall de-conditioning. None reported serious hardship associated with the pandemic although most were in self-employment/part-time employment or were not working due to retirement or ill-health. Two older participants lived alone, and others were single parents and had considerable challenges associated with managing a household alongside their Long Covid difficulties. Conclusions: This paper presents the needs and perspectives of eight individuals involved in the process and discusses the needs and preferences of the group in relation to their support for self- managed recovery from Long Covid.

The COVID-19 pandemic caused significant training disruptions during the 2020-21 season due to lockdowns, quarantines, and strict adherence to pandemic protocols. The main purpose of this study was to determine how pandemic training restrictions affected training volume and performance in one collegiate swim team. Cumulative training volume data, across a 28-week season, were compared between a pandemic (2020-2021) versus non-pandemic (2019-2020) season. Swimmers were categorized into three groups (Sprinters, Mid-Distance, and Long-Distance) based on training group. Performance times in 25 swimmers who competed in Regional Championships, during both the non-pandemic and pandemic year, were compared via 1-way ANOVA. 26 male and 22 female swimmers commenced the 2020-21 (pandemic) season, with 23% of swimmers voluntarily opting out. Three COVID-19 cases were confirmed (2%) by the medical staff with no long-term effects. Significant reductions in average swim volume were verified in Sprinters (32,867±10,135 vs.14,800±7,995yards;p<0.001), Mid-Distance (26,457±10,692 vs.17,054±9.923yards;p<0.001), and Long-Distance (37,600±14,430 vs.22,254±14,418yards;p<0.001) swimmers (non-pandemic vs. pandemic season, respectively). In the Regional performance analyses, the Sprinters swam faster (n=8;-0.5±0.6secs), while Mid-Distance (n=10;0.17±2.1secs) and Long-Distance (n=7;6.0±4.9secs) swimmers swam slower (F=11.76;p=0.0003;r²=0.52). Thus, the pandemic caused significant reductions in swim training volume, with Sprinters performing better and Long-Distance swimmers performing worse at Regional Championships.

In dentistry, maxillofacial surgery, traumatology, and orthopedics, there is a need to use osteoplastic materials that have not only osteoinductive and osteoconductive properties but are also convenient for use. In the study, compositions based on collagen hydrogel were developed. Polylactide granules (PLA) or a traditional bone graft, a mixture of hydroxyapatite and β-tricalcium phosphate (HAP/β-TCP), were used for gel filling to improve mechanical osteoconductive properties of compositions. The mechanical tests showed that collagen hydrogels filled with 12 wt% highly porous PLA granules (elastic modulus 373 ± 55 kPa) or 35 wt% HAP/β-TCP granules (elastic modulus 451 ± 32 kPa) had optimal manipulative properties. All composite components were cytocompatible. The cell’s viability was above 90%, and the components’ structure facilitated the cell’s surface adhesion. The bone morphogenetic protein-2 (BMP-2) provided osteoinductive composition properties. It was impregnated directly into the collagen hydrogel with the addition of fibronectin or inside porous PLA granules. The implantation of a collagen hydrogel with BMP-2 and PLA granules into a critical-size calvarial defect in rats led to the formation of the most significant volume of bone tissue: 61 ± 15%. It was almost 2.5 times more than in the groups where a collagen-fibronectin hydrogel with a mixture of HAP/β-TCP (25 ± 7%) or a fibronectin-free composition with porous PLA granules impregnated with BMP-2 (23 ± 8%) were used. Subcutaneous implantation of the compositions also showed their high biocompatibility and osteogenic potential in the absence of a bone environment. Thus, the collagen-fibronectin hydrogel with BMP-2 and PLA granules has optimal biocompatibility, osteogenic, and manipulative properties.

Abstract: The aim of the present study was to identify the age and sex-related associations between marital status with PA and TV time. We used data from Vigitel, an annual telephone survey started in 2006 in Brazil. We applied a complex sample logistic regression model to estimate the odds for PA and TV time comparing marital statuses according to age and sex subgroups, independent of obesity, hypertension, diabetes, self-assessed poor health, and smoking. Our sample included 561,837 individuals with a TV time &gt; 3 h/day (prevalence = 25.2%) and PA &gt; 150 min/week (prevalence = 35%). Compared to single individuals, married men and women were less likely to watch TV more than 3 h/day in participants &gt; 30 years old. When compared to single, married participants were less likely to do more than 150 min of PA/week at younger age groups. Married women older than 40 years were more likely to do more than 150 min of PA/week than the single ones, while there were no differences among married men by age group. In conclusion, married individuals are less likely to spend more than 3 hours a day watching TV than single individuals. Single men and women were more likely to do more than 150 min of PA/week at younger age groups and married women older than 40 years were more likely to do 150 min of PA/week than single women.

Background: Recently, the management of musculoskeletal disorders with the patients' own stem cells, isolated from the walls of small blood vessels, which can be found in great numbers in the adipose tissue, has received considerable attention. On the other hand, there are still misconceptions about these adipose-derived regenerative cells (ADRCs) that contain vascular-associated pluripotent stem cells (vaPS cells) in regenerative medicine. Methods: Based on our previous publications on this topic, we have developed a concept to describe the significance of the ADRCs/vaPS cells in the field of orthobiologics as briefly as possible and at the same time as precisely as possible. Results: The ADRCs/vaPS cells belong to the group of orthobiologics that are based on autologous cells. Because the latter can both stimulate a patient’s body's localized self-healing power and provide new cells that can integrate into the host tissue during the healing response when the localized self-healing power is exhausted, this group of orthobiologics appears more advantageous than cell-free orthobiologics and orthobiologics that are based on allogeneic cells. Within the group of orthobiologics that are based on autologous cells, enzymatically isolated, uncultured ADRCs/vaPS cells have several advantages over non-enzymatically isolated cells/microfragmented fat as well as over uncultured bone marrow aspirate concentrate and cultured cells (adipose-derived stem cells, bone marrow-derived mesenchymal stem cells). Conclusions: The use of ADRCs/vaPS cells can be seamlessly integrated into modern orthopedic treatment concepts, which can be understood as the optimization of a process which - albeit less efficiently - also takes place physiologically. Accordingly, this new safe and effective type of treatment is attractive in terms of holistic thinking and personalized medicine.

The International System of Units (SI) was adopted in 1960 as a universal measuring system to be used for all areas of science. Sports Science papers have shown lots of inaccurate and inappropriate terms for quantification of athletes’ performance and the psychobiological responses to exercise (e.g., internal load). In biomechanics, external and internal loads are forces acting externally and internally, inducing stress and strain in the biological tissues. Therefore, the current review present simple proposals to correct the inappropriate terms: 1) do not use the term external load when referring to the assessment of exercise time, distance, displacement, speed, velocity, acceleration, torque, work, power, impulse, etc.; 2) do not use the term internal load when referring to the assessment of psychobiological stress markers (i.e., session rating of perceived exertion, heart rate, blood lactate, oxygen consumption, etc.); 3) do not use the term impulse when expressing other calculus than integrating force with respect to time, and neither strain, when expressing other phenomena than the body deformation. Instead, the term exercise intensity is universal and can be used to describe all forms of exercise. Finally, duration should precisely be described according to physical quantities (e.g., time, distance, displacement, speed, velocity, acceleration, force, torque, work, power, impulse, etc.) and the units accomplish by use of the SI. These simple quantifications can be performed for the exercises, sessions, microcycles, mesocycles and macrocycles of the athletes. Such standardization will provide a consistent and clear communication among sports scientists and all areas of science.

According to the reviewed literature, the selection system in the handball game is quite complex and requires new approaches from specialists, based on the current requirements of this game. It was found that a main selection criterion in the game of handball is the coordination abilities because the handball game is mainly based on coordination. In this paper is related the importance of coordinative abilities development in the handball game for young children (10-12 years old) selection process meet in Romania. The results are obtained from a sociological questionnaire, where 109 specialists in the handball game are interrogated, 38 of them being handball coaches, and 71 being teachers of physical education and sports with abilities in handball game. The answers delivered depend on each specialist experience, the knowledge possessed and the difficulties encountered over the years. As a general overview, in the opinion of the surveyed specialists, the selection process in the handball game for Romania does not live up to their expectations, and the development level of coordination abilities meet in 10-12 years children is medium to weak. A total of 51.9% from the respondents stressed the importance of developing coordination abilities to optimize the selection process of children for handball game, opening a new approach in the modern training methods for performance achievement.

Background Radial extracorporeal shock wave therapy (rESWT) is an attractive, non-invasive therapy option to manage fracture nonunions of superficial bones, with a reported success rate of approximately 75%. Using zebra mussels (Dreissena polymorpha), we recently demonstrated that induction of biomineralization after exposure to focused extracorporeal shock waves (fESWs) is not restricted to the region of direct energy transfer into calcified tissue. This study tested the hypothesis that radial extracorporeal shock waves (rESWs) also induce biomineralization in regions not directly exposed to the shock wave energy in zebra mussels. Methods Zebra mussels were exposed on the left valve to 1000 rESWs at different air pressure (between 0 and 4 bar), followed by incubation in calcein solution for 24 hours. Biomineralization was evaluated by investigating the fluorescence signal intensity found on sections of the left and right valves prepared two weeks after exposure. Results General linear model analysis demonstrated statistically significant (p < 0.05) effects of the applied shock wave energy as well as of the side (left/exposed vs. right/unexposed) and the investigated region of the valve (at the position of exposure vs. positions at a distance to the exposure) on the mean fluorescence signal intensity values, as well as statistically significant combined energy × region and energy × side × region effects. The highest mean fluorescence signal intensity value was found next to the umbo, i.e., not at the position of direct exposure to rESWs. Conclusions As in the application of fESWs, induction of biomineralization by exposure to rESWs may not be restricted to the region of direct energy transfer into calcified tissue. Furthermore, the results of this study may contribute to better understand why the application of higher energy flux densities beyond a certain threshold does not necessarily lead to higher success rates when treating fracture nonunions with extracorporeal shock wave therapy.

This conceptual review aimed to investigate whether "functional training" (FT) programs are different from traditional strength, power, flexibility, and endurance training programs. A search for the twenty most recent papers published involving FT was performed in the PubMed/Medline database. Definition, concepts, benefits, and the exercises employed in FT programs were analyzed. The main results were: 1) there is no agreement about a universal definition for FT; 2) FT programs aim at developing the same benefits already induced by traditional strength, power, flexibility, and endurance training programs; 3) exercises employed are also the same. The inability to define FT makes differentiation difficult. Physical training programs can be easily described and classified as strength, power, flexibility, endurance, and the specific exercises employed (e.g., traditional resistance training, ballistic exercises, plyometrics and Olympic-style weightlifting, continuous and high-intensity interval training). This proper description and classification may improve communication in sports science and improve interdisciplinary integration. Aiming to avoid confusion and misconceptions, and based on the current evidence, we recommend that the terms FT, high-intensity FT, and functional fitness training no longer describe any physical training program.

The present study aimed to investigate the effect of a motor skills training program in children with DCD considering their gender. The Movement Assessment Battery for Children (MABC-2) classified the children and assessed skill changes over time. The study was implemented at four kindergartens in the Khorezm region of Uzbekistan. In the study, all children had DCD (5.17 ± 0.70 years; 10 girls), and all indicators on MABC-2 were less than 16 percent. Participants were divided into an experimental group (n=17) receiving ten weeks of motor skills training program for 45 min twice per week, the control group (n=7) proceeded with exercises of everyday living. All children in the experimental group had a significant increase in total percentile rank of MABC-2 and concerning each domain (manual dexterity; throwing and catching; balance). In the control group, a significant decrease in the total percentile rank of MABC-2 and each domain of MABC-2 was observed. The effectiveness of the intervention program was similar across both genders. The study supports that a period of 10 weeks of a motor skills training program can increase the quality of children's motor coordination and represent a valuable procedure for physical education specialists to enhance motor skills for children with DCD.

Modern advances in molecular medicine have led to reframing osteoarthritis as a metabolically active, inflammatory disorder with local and systemic contributing factors. According to the ‘inflammatory theory’ of osteoarthritis, immune response to an initial damage is the key trigger that leads to progressive joint destruction. Several intertwined pathways are known to induce and govern articular inflammation, cartilage matrix degradation, and subchondral bone changes. Effective treatments capable of halting or delaying the progression of osteoarthritis remain elusive. As a result, supplements such as glucosamine and chondroitin sulphate are commonly used despite the lack of scientific consensus. A novel option for adjunctive therapy of osteoarthritis is LithoLexal®, a marine-derived, mineral-rich extract, that exhibited significant efficacy in clinical trials. LithoLexal® has a lattice microstructure containing a combination of bioactive rare minerals. Mechanistic research suggests that this novel treatment possesses various potential disease-modifying properties, such as suppression of nuclear factor kappa-B, interleukin 1β, tumour necrosis factor α, and cyclooxygenase-2. Accordingly, LithoLexal® can be considered a disease-modifying adjunctive therapy (DMAT). LithoLexal® monotherapy in patients with knee osteoarthritis has significantly improved symptoms and walking ability with higher efficacy than glucosamine. Preliminary evidence also suggests that LithoLexal® may allow clinicians to reduce the dose of nonsteroidal anti-inflammatory drugs in osteoarthritic patients by up to 50%. In conclusion, the multi-mineral complex, LithoLexal®, appears to be a promising candidate for DMAT of osteoarthritis, which may narrow the existing gap in clinical practice.

Abstract Although we know something about single cell neuromuscular junction, It is still mysterious how multiple skeletal muscle cells coordinate to complete the intricate spatial curve movement. Here I propose a hypothesis that skeletal muscle cell populations with action potentials are alligned according to a curved manifolds on space(a curved shape on space) and the skeletal muscle also moves according to this corresponding shape(manifolds) when an specific motor nerve impulses are transmitted. the action potential of motor nerve fibers has the characteristics of time curve manifold and this time manifold curve of motor nerve fibers come from visual cortex in which a spatial geometric manifolds are formed within the synaptic connection of neurons. This spatial geometric manifolds of the synaptic connection of neurons orginate from spatial geometric manifolds in outside nature that are transmitted to brain through the cone cells and ganglion cells of the retina.Further,the essence of life is that life is an object that can move autonomously and the essence of life's autonomous movement is the movement of proteins. theoretically, due to the infinite diversity of geometric manifold shapes in nature, the arrangement and combination of 20 amino acids should have infinite diversity, and the geometric manifold formed by protein three-dimensional spatial structure should also have infinite diversity.

The study describes the acute and delayed time course of recovery following the CrossFit® Benchmark Workout Karen. Eight trained men (28.4±6.4 years; 1RM back squat 139.1±26.0 kg) undertook the Karen protocol. The protocol consists of 150 Wall Balls, aiming to hit a target 3 meters high. Countermovement jump height (CMJ), creatine kinase (CK), and perceived recovery status scale (PRS) (general, lower and upper limbs) were assessed pre, post-0h, 24h, 48h and 72h after the session. The CK concentration 24h after was higher than pre-exercise (338.4 U/L vs. 143.3 U/L; effect size: 0.74; p≤0.05). At 48h and 72h following exercise, CK concentration had returned to baseline levels. The PRS general and of the lower limbs were lower in the 24-hours post-exercise compared to pre-exercise (PRS general: 4.7 ±1.5 and 7.9 ±1.7 mmol/L; and PRS of the lower limbs: 4.0 ±2.5 and 7.9 ±0.8, respectively). The PRS general, lower, and upper limbs were reduced at 48-post exercise compared to 72-hours post-exercise scores. Our findings provide insights into the fatigue profile and recovery in acute CrossFit® and can be useful to coaches effectively design the daily session.

In time, osteoarthritis (OA) generates the misalignment of the affected joint structures. However, due to the nature of bipedal gait, OA in the lower limb can also cause pathological gait patterns, which can generate instability and falls, with great consequence, especially in the aged population. With goniometry used to evaluate the range of motion of joints (ROM), we wanted to evaluate how gender impacts gait dynamics in OA patients. For this study we have compared 106 OA patients (male=32, female=74) to age matched controls. All participants had their right leg as dominant. Video recording of normal gait was analysed with a digital goniometry tool phone application, and the knee’s ROM was measured in midstance and midswing of the gait. During midstance, significant extension and flexion of the knee excursion have been observed in both males and females. During midswing, knee OA presents more differences, whereas subjects with hip and knee OA present changes on the dominant knee. Midstance changes suggest that the knee’s joint degenerative changes can be linked to hip OA secondary changes. Midswing changes in lower limb OA suggest a connection to the activities of daily life. Gender differences generated by OA must furthermore be studied in both lower limbs so that the best therapeutic approach can be chosen.

This study presents three forms of interdisciplinary expertise in the healthcare design context to approach a particular multifaceted problem around the current healthcare for older adult patients with chronic low-back pain (LBP). Using an interdisciplinary co-design framework, first, our design approach performs the role of an initiator to define the problem by exploring the current context of healthcare. Second, it facilitates the experiences of experts and patients to reach the roots of the problem by functioning as a mediator. Third, our approach fulfills the primary role of healthcare design in producing new meanings considering the principles of patient-centeredness. These roles significantly contributed to the design of healthcare innovations. Our framework transformed the distributed disciplinary knowledge developed while tackling the multifaceted problem into new forms of expertise for collaboration in healthcare innovation.

For orthopaedic applications, additive manufactured (AM) porous scaffolds made of absorbable metals like magnesium, zinc or iron are of particular interest. They do not only offer the potential to design and fabricate bio-mimetic or rather bone equivalent mechanical properties, they also do not need to be removed in further surgery. Located in a physiological environment, scaffolds made of absorbable metals show a decreasing Young’s modulus over time, due to product dissolution. For WE43 scaffolds, during the first days an increase of the smeared Young's modulus can be observed, which is mainly attributed to a forming substrate layer of degradation products on the struts surfaces. In this study the influence of degradation products on the stiffness properties of metallic scaffolds is investigated. For this, analytical calculations and finite element simulations are performed to study the influence of the substrate layer thickness and Young's modulus for single struts and for a new scaffold geometry with adapted polar f2cc,z unit cells. The finite element model is further validated by compression tests on AM scaffolds made from Zn1Mg. The results show, that even low thicknesses and Young's moduli of the substrate layer increases significantly the smeared Young's modulus under axial compression.

(1) Background: This report examines the unique demands of off-road triathlon (XT) by presenting physiological, field, and race data from a national champion off-road triathlete using several years of laboratory and field data to detail training and race intensity. (2) Methods: Laboratory and field data were collected when the athlete was at near peak fitness and included oxygen consumption (VO2), heart rate (HR), power output (W), and blood lactate (BLC) during cycling and running, while HR, cycling W, and running metrics were obtained from training and race data files over a period of seven years. Intensity was described using % HR max zones (Z) 1 &lt; 75%, 2 = 75 - 87%, and Zone 3 &gt; 87%, and W. An ordinary least squares analysis was used to model differences between event types. (3) Results: Weather conditions were not different across events. XT events had twice the elevation change (p&lt;0.01) and two-three times greater W’ (p&lt; 0.001) than road triathlon (ROAD), but similar HR intensity profiles (max, avg, and zones); both events are predominately performed at &gt; Z2 or higher intensity. Championship XT events were longer (p&lt;0.01) , with higher kJ expenditure (p&lt;0.001). OLS modelling suggested three variables were strongly related (R2 = 0.84; p &lt; 0.0001) to cycling performance: event type (XT vs ROAD), total meters climbed, and total bike duration. Championship XT runs were slower than either regional (p&lt;0.05) or ROAD (p&lt;0.01) runs, but HR intensity profiles similar. OLS modelling indicates that slower running is linked to either greater total bike kJ expenditure (R2 = 0.57; p&lt;0.001), or total meters gained (R2 = 0.52; p&lt;0.001). Race simulation data support these findings but failed to produce meaningful differences in running. Conclusions: XT race demands are unique and mirror MTB and trail running demands. XT athletes must be mindful of developing anaerobic fitness, technical ability, and aerobic fitness, all of which contribute to off-road cycling economy. It is unclear whether XT cycling affects subsequent running performance different from ROAD cycling.

The aim of this study was to determine gender differences in the level of motor skills and effects of a multi-year exercise program on the level of motor skills in 161 preschool children (5-6 yo). Patricipants were deployed into one control and three experimental groups. Motor skills were assessed with the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). To determine difference in scores for each BOT-2 tests between control and experimental groups, one-way ANOVA was used for girls and boys separately while two-way ANOVA was employed to determine difference between the gender in the overall BOT-2 score. The results indicates that one-year multilateral exercise program has a positive effect on the level of motor skills in preschool children. Interestingly, additional years of participation in exercise program yielded in maintenance of acquired motor skills level. Also, exercise program affected more girls than preschool boys considering both individual and composite BOT-2 scores. According to the findings of this study, presented exercise program could have potential benefits on multilateral development of the motor skills in preschool children which could facilitate balance of locomotor and manipulative skills. Therefore, integration of multilateral program intended for preschool children could be considered for implementation within the kindergarten curriculum.

Exercises for lower trapezius (LT) often use overhead positions, causing compressive forces to the subacromial space. Scapular retraction would be an alternative to activate LT muscle. Electromyography of infraspinatus (IS), upper (UT) and LT was recorded during scapular retraction under progressive adduction loads of 42 participants, divided in 2 groups: with (SP, n=26) and without shoulder pain (nSP, n=16). The adduction loads of 20, 30, 40 and 50% of the maximal voluntary contraction were applied using a load cell. Normalized electromyography and the ratio between UT and LT (UT:LT) were used for statistical analysis. No differences were observed between groups, but a condition effect occurred for all muscles: UT showed higher values at 50% vs. 20% (p=0.004); LT showed higher values on 40% and 50% (p=0.001; 0.006). Higher values for IS were noted at 40% (vs 20%; p=0.04), and at 50% (vs. 20%; p=0.001, vs. 30%, p=0.001; vs. 40%; p=0.001). UT:LT showed lower values at 50% (vs. 20%; p=0.001, and vs. 30%; p=0.016). Scapular retraction with adduction loads at 40-50% is an alternative to overhead exercises aiming to activate the LT and the IS muscles. The exercise ensures higher levels of LT and IS excitation, without increasing UT excitation.