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Paul Ritsche,1 Ralf Roth,1 Thomas Bernhard,2 Lukas Nebiker,1 Eric Lichtenstein,1 Martino Franchi,3 Jörg Spörri,4,5 Oliver Faude1 1Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland; 2FC Basel 1893, Basel, Switzerland; 3Human Neuromuscular Physiology Lab, Department of Biomedical Sciences, University of Padua, Padova, Italy; 4Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; 5University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandCorrespondence: Paul Ritsche, University of Basel, Department of Sport, Exercise and Health, Grosse Allee 6, Basel, 4052, Switzerland, Email Paul.ritsche@unibas.chPurpose: Adolescent soccer players experience distinct physiological changes due to chronological and biological maturation, impacting their soccer performance. Here, we explored age-related variations and associations between quadriceps geometry and strength in male national-level adolescent soccer players.Patients and Methods: We used ultrasonography to examine the regional architecture and morphology of the rectus femoris (RF) and vastus lateralis (VL) muscles, and we assessed knee extension strength by isometric and isokinetic dynamometry. Players were categorized into four age groups: under (U) 15 (n=18, age=13.7± 0.5 years), U16 (n=15, age=14.7± 0.5), U17 (n=19, age=15.7± 0.5), U18 (n=18, age=16.7± 0.5) and U21 (n=25, age=18.5± 0.5).Results: The absolute and relative strengths were higher in the U16 compared to U15 by 12– 15% and 6– 8%, 11– 12% and 6– 7% in the U17 compared to U16, 5– 7% and − 1– 2% in the U18 compared to U17 and 0– 15% and − 1– 11% in the U21 compared to U18 age groups, respectively. VL architecture did not change relevantly between the age groups. The muscle anatomical cross-sectional area (ACSA) of the VL and RF differed non-uniformly and muscle region-specific by 10– 36%, with highest values in the U21 age group. Moderate correlations between the VL architecture and knee extension strength in both legs were observed only in the U16 age group. The quadriceps ACSA showed age-specific correlations with knee extension strength.Conclusion: Our findings highlight non-uniform differences in quadriceps muscle morphology and absolute and relative strength among male national-level adolescent soccer players in different age groups. The correlations observed between muscle morphology or architecture and strength were muscle, muscle region, leg and age dependent.Keywords: strength, youth, muscle architecture, vastus lateralis, rectus femoris

Resistance exercise with blood flow restriction (BFR) is considered a safe and powerful training tool. Low-load (LL) resistance training with BFR results in comparable hypertrophy compared to conventional heavy-load (HL) resistance training (Centner et al., 2019). Additionally, LL training with BFR (LL-BFR) induces comparable (Grønfeldt et al., 2020) or slightly lower (Centner et al., 2019) effects on muscle strength than HL training. It is generally accepted that increases in maximum strength are mediated by muscular hypertrophy and/or neural adaptations. However, the effect of BFR on neural adaptations is scarcely investigated. The aim of this study was therefore to investigate the effects of BFR on acute neural adaptations following a single bout of resistance training. Fifteen male participants (21-35 years) volunteered to participate in this study. On three separate days, participants performed a strength training session of the right elbow flexors with either LL, LL-BFR or HL. Neuromuscular adaptations were investigated before and after each resistance training session by means of transcranial magnetic stimulation (single- and paired-pulse TMS) and peripheral nerve stimulation (Mmax). Data were acquired during submaximal sustained isometric contractions. During LL-BFR, the cuff was inflated to 50% of the individual arterial occlusion pressure to restrict venous outflow in the working musculature during exercise. The preliminary data analysis with mixed linear models revealed that, compared to baseline values, normalized MEPs (% of Mmax) from the trained biceps brachii were enhanced for HL (Cohen’s d = 0.51) but not LL-BFR (Cohen’s d = 0.03) when compared to LL. None of the groups showed relevant changes in short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). The size of Mmax decreased slightly for HL (Cohen’s d = -0.18) but not LL-BFR (Cohen’s d = 0.06) when compared to LL. This is the first study that investigated acute neural adaptations in response to resistance training with and without BFR. We observed increased MEP amplitudes after HL but not LL what is in line with previous evidence (Mason et al., 2019). Since training with BFR results in a rapid increase in motoneuronal excitability (Copithorne et al., 2020), the increased MEP are less likely caused by changes at the cortical site. Centner, C., Wiegel, P., Gollhofer, A., & König, D. (2019). Effects of blood flow restriction training on muscular strength and hypertrophy in older individuals: A systematic review and meta-analysis. Sports Medicine, 49, 95-108. https://doi.org/10.1007/s40279-018-0994-1 Copithorne, D. B., Rice, C. L., & McNeil, C. J. (2020). Effect of blood flow occlusion on corticospinal excitability during sustained low-intensity isometric elbow flexion. Journal of Neurophysiology, 123(3), 1113-1119. https://doi.org/10.1152/jn.00644.2019 Grønfeldt, B. M., Lindberg Nielsen, J., Mieritz, R. M., Lund, H., & Aagaard, P. (2020). Effect of blood-flow restricted vs heavy-load strength training on muscle strength: Systematic review and meta-analysis. Scandinavian Journal of Medicine & Science in Sports, 30(5), 837-848. https://doi.org/10.1111/sms.13632 Mason, J., Howatson, G., Frazer, A. K., Pearce, A. J., Jaberzadeh, S., Avela, J., & Kidgell, D. J. (2019). Modulation of intracortical inhibition and excitation in agonist and antagonist muscles following acute strength training. European Journal of Applied Physiology, 119, 2185-2199. https://doi.org/10.1007/s00421-019-04203-9

Retinal vessel alterations have been shown to be associated with cardiovascular risk factors and physical inactivity as early as childhood. In this context, the analysis of physical activity in children has solely been based on questionnaire assessments. The study aimed to examine the association of physical fitness performance and self-reported physical activity with retinal vessel diameters in young children. Three hundred ninety-one primary schoolchildren [7.3 years ( SD 0.4)] were examined in this cross-sectional study. The primary outcome was endurance performance measured with the 20-m shuttle run. The additional tests consisted of a 20-m sprint, jumping sidewards and balancing backwards. Retinal microcirculation was assessed using a static retinal vessel analyzer. Parents completed questionnaires about physical and sedentary activities. Endurance performance was associated with narrower retinal venular diameters [−0.9 (95% CI: −1.8; −0.1) measuring units (mu)/ unit shuttle run, P = 0.04] and a higher arteriolar to venular ratio [0.003 (−0.001; 0.006)/unit shuttle run, P = 0.06]. The sprint performance was associated with narrower retinal arterioles [4.7 (0.8; 8.6) mu/unit sprint, P = 0.02]. Indoor playing activity correlated with narrower retinal venules [−0.04 (−0.07; −0.01) mu/per unit, P = 0.02]. Our data suggest that objectively measured endurance performance relates with better retinal vessel health in early childhood. [ABSTRACT FROM AUTHOR]

Veteran football players above 40 years have rarely been subject to scientific investigations. This is worrisome because their number is considerable and their cardiovascular risk probably increased. Therefore, a cross-sectional study was conducted in 100 football players between 40 and 63 years of age. This included a medical history and physical examination, venous blood sampling, measurement of resting blood pressure, a resting electrocardiogram (ECG), an exhaustive cycle ergometry and a multistage field test. Also, measurements of heart rate and blood lactate concentration were carried out during one typical training session and one match. Participants trained 1.0 ± 0.6 sessions per week and played 27 ± 8 matches per season. Of them, 19% were smokers. Resting blood pressure was 138 ± 15/88 ± 8 mmHg. Hypertension prevalence (WHO definition) was 66%. Total cholesterol averaged 220 ± 41 mg . dl−1, HDL 46 ± 13 mg . dl−1and LDL 134 ± 33 mg . dl−1. The average 10-year risk for cardiovascular events (Framingham score) was 6%. Mean maximal power output on the cycle ergometer was 2.8 ± 0.6 W . kg−1, mean VO2peak40.0 ± 7.3 ml . min−1. kg−1. Comparing training and competition, no significant differences in cardiovascular and metabolic load were found. In summary, their cardiovascular risk was similar to age-adjusted reference values. However, they showed slightly better ergometric performance. More frequent training stimuli might be necessary to reach more favourable risk factor profiles. Training and competition lead to similar cardiocirculatory and metabolic stress which is considerably high and might put players into danger who have pre-existing cardiac disease. [ABSTRACT FROM AUTHOR]

The present study evaluated the effects of a newly developed injury prevention programme for children’s football (“FIFA 11+ Kids”) on motor performance in 7–12-year-old children. We stratified 12 football teams (under-9/-11/-13 age categories) into intervention (INT,N = 56 players) and control groups (CON,N = 67). INT conducted the 15-min warm-up programme “FIFA 11+ Kids” twice a week for 10 weeks. CON followed a standard warm-up (sham treatment). Pre- and post-tests were conducted using: single leg stance; Y-balance test; drop and countermovement jump; standing long jump; 20-m sprint; agility run; slalom dribble; and wall volley test. We used magnitude-based inferences and linear mixed-effects models to analyse performance test results. We observed likely beneficial effects favouring INT in Y-balance (right leg; +3.2%; standardised mean difference (SMD) = 0.34;P = 0.58) and agility run (+3.6%; SMD = 0.45;P = 0.008). Possibly beneficial effects were found in Y-balance, drop jump reactive strength index, drop jump height, countermovement jump, standing long jump, slalom dribble and wall volley test. At least possibly beneficial improvements in favour of “FIFA 11+ Kids” were observed in nearly all parameters. Most effects were small, but slight improvements in motor performance may potentially contribute to a reduction of injury risk. [ABSTRACT FROM AUTHOR]

The study examined effects of traditional balance vs. mat-based Pilates training on balance and trunk strength in healthy community dwellers. Forty-eight seniors were either stratified to a balance training group (BAL, n = 16, 69.1 (SD 5.8) y), Pilates training group (PIL, n = 17, 70.8 (6.5) y) or control group (CON, n = 15, 69.2 (6.1) y). BAL performed traditional balance training, while PIL conducted mat-based Pilates-exercises (8 weeks, 2 sessions/week 66 min each). Balance performance (single limb stance and perturbed kneeling, Y-Balance test), dynamic and isometric trunk flexion and extension were assessed during preand post-testing. According to the magnitudebased inference approach, substantial positive effects in favor of BAL compared to CON were found for the Y-balance score (right leg, effect size (d) = 0.68; left leg, d = 0.56), trunk extension (d = 0.68) and single leg stance (right leg, d = 0.61; left leg, d = 0.38). Dynamic (d = 0.32) and isometric (d = 0.15) trunk flexion revealed unclear effects. For the Y-balance score (right leg, d = 0.48, left leg, d = 0.75) and single leg stance (right leg, + d = 0.61 %; left leg, d = 0.67), interestingly, BAL substantially exceeded PIL. PIL vs. CON revealed unclear effects for most parameters (0.05 < d < 0.36). Mat-based Pilates training did not cause relevant adaptations in trunk strength and balance performance, whereas balance training substantially improved balance and trunk strength. [ABSTRACT FROM AUTHOR]

The study investigated the effects of slackline training (rope balancing) on balance, jump performance and muscle activity in children. Two primary-school classes (intervention, n = 21, INT: age: 10.1 (SD 0.4) y, weight: 33.1 (4.5) kg; control, n = 13, CON: age: 10.0 (SD 0.4) y, weight: 34.7 (7.4) kg) participated. Training was performed within 6 weeks, 5 times per week for 10 min each day. Balance (static and dynamic stance), countermovement jumps, reverse balancing on beams (3, 4.5 and 6 cm width), slackline standing (single- and double-limb) and electromyographic activity (soleus, gastrocnemius, tibialis anterior) were examined. INT significantly improved single- and double-limb slackline standing (double limb: 5.1 (3.4) s–17.2 (14.4) s; right leg: 8.2 (5.8) s–38.3 (36.0) s; left leg: 10.6 (5.8) s–49.0 (56.3) s; p < 0.001; 0.17 < η p ² < 0.22). Reduced left-leg dynamic sway ( − 20.8 %, p = 0.06, η p ² = 0.10), improved 4.5 cm balancing ( + 18.5 %, p = 0.08, η p ² = 0.10) and decreased muscle activity during slackline standing for the mm. soleus ( − 23 %, p = 0.10, η p ² = 0.18) and tibialis anterior ( − 26 %, p = 0.15, η p ² = 0.14) was observed for INT. Jump performance remained unchanged (p = 0.28, η p ² = 0.04). In conclusion, daily slackline training results in large slackline-specific balance improvements. Transfer effects to static and dynamic stance, reverse balancing or jumping performance seemed to be restricted. [ABSTRACT FROM AUTHOR]

This study aimed at determining the reproducibility of pacing profiles (PP) during simulated swimming trials as well as the comparison between simulated and real competitions (RC). Sixteen competitive front crawl swimmers (7 females, 9 males) performed 2 × 200 m, 2 × 400 m and 2 × 800 m tests, each test 7 days apart. All 100 m split (ST) and total times (TT) were recorded (additionally 50 m ST for the 200 m bouts). The PP of one RC within a maximum of 8 weeks before or after data acquisition was used for comparison. No difference was observed between test and retest for TT (p < 0.16). Coefficients of variation (CV) for all ST during 800 m were between 0.9 and 1.8 % (standard error of measurement (SEM) = 0.6–2.1 s), except for the last 2 sections (CV = 2.5 % and 2.9 %). During 400 m and 200 m, CV was below 1.7 % for each section (SEM = 0.4–1.7 s). Mean differences between test and retest ranged from 1.8 s (Cl: 0.1–3.4 s) in the 400 m bouts to 4.1 s (Cl: 1.3–9.5 s) for the 800 m races. Although section times were faster during all sections of RC compared to SC, PP was similar during both trials (p > 0.22). However, swimmers were faster in each section during RC. In conclusion, PP seem stable, at least during the first three quarters of the race. Furthermore, simulated trials seem to be an acceptable model to analyse PP in competitive swimming. [ABSTRACT FROM AUTHOR]

This study aimed at describing changes in stress and performance indicators throughout a competitive season in high level football. 15 players (19.5 ± 3.0 years, 181 ± 5 cm, 75.7 ± 9.0 kg) competing under professional circumstances were tested at baseline and 3 times during the season 2008/09 (in-season 1, 2, 3). Testing consisted of the Recovery-Stress Questionnaire for Athletes (Total Stress and Recovery score), vertical jump tests (counter movement and drop jump (DJ)), and a maximal ramp-like running test. Average match exposure was higher during a 3-weeks period prior to in-season 3 compared to in-season 1 and 2 (1.5 vs. 1 h/week, p = 0.05). Total Stress score was elevated at in-season 1 and 2 compared to baseline (p < 0.01) with a further increase at in-season 3 (p < 0.03; generalized eta squared (η2g) = 0.37). Total Recovery score was decreased at in-season 1 and 3 compared to baseline (p < 0.05; (η2g) = 0.21). Maximal running velocity (Vmax ) and jumping heights were not significantly affected (η2g) ≤ 0.04). Changes in DJ height and Vmax between baseline and inseason 3 were correlated with the corresponding changes in Total Stress score (r = -0.55 and r = -0.61, p < 0.03). Usual match exposure during a professional football season does not induce relevant changes in performance indicators. Accumulated stress and a lack of recovery towards the end of a season might be indicated by psychometric deteriorations. [ABSTRACT FROM AUTHOR]

Purpose: Given percentages of VO(2max) are widely used for training and study purposes although they might not result in homogeneous metabolic strain. Therefore, the homogeneity of metabolic responses to prolonged exercise at fixed percentages of VO(2max) should be investigated.Procedures: Twenty-one healthy male subjects (29+/-5 years, 77+/-8 kg, VO(2max): 59.9+/-11.8 ml min(-1)kg(-1)) performed two incremental tests to exhaustion on a cycle ergometer to determine VO(2max). Subsequently, two 60 min tests at 60 and 75% VO(2max) were conducted in randomised order. VO(2) was kept constant by adjusting the work rate. Blood lactate (La) responses as primary outcome variable to quantify metabolic strain were assessed.Findings: Mean La was 2.1+/-1.1 mmol l(-1) (min-max: 0.7-5.6 mmol l(-1)) during the 60% VO(2max) test and 4.6+/-1.9 mmol l(-1) (min-max: 2.2-8.0 mmol l(-1)) during the 75% VO(2max) test. The coefficients of variation of La amounted for 52.4 and 41.3% during the 60 and 75% VO(2max) test, respectively. La responses did not differ significantly between three subgroups of the subjects (N=7 with VO(2max)<55 ml min(-1)kg(-1), N=7 with VO(2max) 55-65 ml min(-1)kg(-1), and N=7 with VO(2 max)>65 ml min(-1)kg(-1); P>or=0.08).Conclusion: Altogether, prolonged exercise at given percentages of VO(2max) leads to inhomogeneous metabolic strain as indicated by the large variability of La responses. This holds true even in subgroups of similar aerobic capacity. Thus, intensity prescription for endurance training and study purposes should not be solely based upon percentages of VO(2max) when a comparable metabolic strain is intended. [ABSTRACT FROM AUTHOR]

The present study aimed at comparing a high-volume, low-intensity vs. low-volume, high-intensity swim training. In a randomized crossover design, 10 competitive swimmers performed two different 4-week training periods, each followed by an identical taper week. One training period was characterized by a high-training volume (HVT) whereas high-intensity training was prevalent during the other program (HIT). Before, after two and four weeks and after the taper week subjects performed psychometric and performance testing: profile of mood states (POMS), incremental swimming test (determination of individual anaerobic threshold, IAT), 100m and 400m. A small significant increase in IAT was observed after taper periods compared to pre-training (+0.01 m/s; p=0.01). Maximal 100-m and 400-m times were not significantly affected by training. The POMS subscore of "vigor" decreased slightly after both training periods (p = 0.06). None of the investigated parameters showed a significant interaction between test- time and training type (p >0.13). Nearly all (83%) subjects swam personal best times during the 3 months after each training cycle, It is concluded that, for a period of 4 weeks, high-training volumes have no advantage compared to high-intensity training of lower volume. [ABSTRACT FROM AUTHOR]

Background: Prolonged exercise may induce temporary immunosuppression with a presumed increased susceptibility for infection. However, there are only few data on immune cell function after prolonged cycling at moderate intensities typical for road cycling training sessions. Methods: The present study examined the influence on immune cell function of 4 h of cycling at a constant intensity of 70% of the individual anaerobic threshold. Interleukin-6 (IL-6) and C-reactive protein (CRP), leukocyte and lymphocyte populations, activities of natural killer (NK), neutrophils, and monocytes were examined before and alter exercise, and also on a control day without exercise. Results: Cycling for 4 h induced a moderate acute phase response with increases in IL-6 from 1.0 (SD 0.5) before to 9.6 (5.6) pg/ml 1 h after exercise and CRP from 0.5 (SI) 0.4) before to 1.8 (1.3) mg/l 1 day after exercise. Although absolute numbers of circulating NK cells, monocytes, and neutrophils increased during exercise, on a per cell basis NK cell activity, neutrophil and monocyte phagocytosis, and monocyte oxidative burst did not significantly change after exercise. However, a minor effect over time for neutrophil oxidatuve burst was noted, tending to decrease after exercise. Conclusions: Prolonged cycling at moderate intensities does not seem to seriously alter the function of cells of the first line of defence. Therefore, the influence of a single typical road cycling training session on the immune system is only moderate and appears to be safe from an immunological point of view. [ABSTRACT FROM AUTHOR]

PURPOSE: To investigate the effect of 4-d active regeneration of different duration on immunological parameters after 2 wk of intensive training. METHODS: In a cross-over design 11 male cyclists conducted 13 d of intensive training followed by 4 d of low-intensity cycling for either 1 or 3 h each day (sequence randomized). Before the intensive training (test 1), between training and regeneration (test 2), and after the regeneration period (test 3), subjects were tested in the lab: venous blood sampling (immunological parameters; flow cytometry) and incremental exercise stage test on acycle ergometer. RESULTS: Average values of lymphocytes and natural killer (NK) cells decreased significantly from test 1 to test 2 and were influenced differently by 1- and 3-h cycling (P = 0.018 and 0.039, respectively); 1-h cycling restored values from test 1, whereas 3 h led to a further decrease in lymphocyte and NK cell concentrations. This pattern was resembled by the courses of maximal heart rate and maximal blood lactate concentration during incremental cycling exercise. In leukocytes, tests 2 and 3 differed significantly from test 1 (P = 0.048 and 0.031, respectively), but there was no significant effect of the regeneration duration (P = 039). Neither the concentration of neutrophils nor the neutrophil oxidative burst was significantly influenced by the training period or by one of the regeneration phases. CONCLUSIONS: The present results indicate that low-intensity regenerative training sessions in cyclists should preferably be conducted for shorter durations than 3 h. It was demonstrated that 4-d cycling of 1 h each day reversed ergometric and immunological changes indicative of fatigue after 2 wk of intensive training. [ABSTRACT FROM AUTHOR]

Markers of cardiovascular risk and cognitive performance were assessed in 347 children. In contrast with body mass index and blood pressure, only retinal microcirculation explained a unique proportion of variance in inhibitory control and information processing, when dependencies between markers of cardiovascular risk were accounted for. [ABSTRACT FROM AUTHOR]

Santa Claus’ spatio-temporal gait characteristics, ground reaction forces during treadmill walking as well as postural sway during loaded, unloaded and cognitive interference tasks were examined in order to estimate his fall risk. Seventeen healthy males, disguised as researchers and students (age: 30 ± 10 years; height: 179 ± 6 years; weight: 76 ± 7 kg; BMI: 24 ± 2 kg/m 2 ; physical activity: 12 ± 4 h/week) and who still believe in Santa Claus randomly underwent balance and gait analyses with and without cognitive interference. The conditions were to be dressed as “Santa Claus” (wearing costume consisting of a beard, cap, robe, heavy sack with a load of 20 kg) or dressed in “normal clothing” (no costume). Spatiotemporal gait parameters (walking velocity, gait variability and stride time, length and width), ground reaction forces (GRF) (left- and right-sided heel strike and push off) and postural sway (30 s tandem stance on a force plate) were measured. “Santa-effects” (0.001 < p < 0.05; 0.21 < η p 2 < 0.72 ) and “Dual-task effects” (0.001 < p < 0.003; 0.46 < η p 2 < 0.86 ) were found for postural sway (increased sway), GRF (decreased forces for dual tasking, increased forces for the Santa condition) and the majority of spatio-temporal gait parameters. Significant “Santa” × “Dual-Task” interaction effects were not observed (0.001 < p < 0.05; 0.21 < η p 2 < 0.72 ). Relevant leg effects of GRF during walking were not found. Santa Claus faces a tremendously increased risk of falling when carrying his Christmas sack with 20 kg of presents. Cognitive loads also impair his neuromuscular performance. It is recommended that Santa trains his strength and balance before Christmas and also to avoid filling his sack with more than 20 kg of presents. Also, cognitive training may help to improve his dual task performance. [ABSTRACT FROM AUTHOR]

Introduction: Major depressive disorders (MDD) are a leading health concern worldwide. While first line medication treatments may fall short of desired therapeutic outcomes, physical activity (PA) interventions appear to be a promising and cost-effective add-on to improve symptoms of depression. This study aimed to address challenges in the assessment of PA in inpatients treated for MDD by examining the correspondence of self-reported and accelerometer-based PA., Methods: In 178 inpatients treated for MDD (mean age: M  = 41.11 years, SD = 12.84; 45.5% female) and 97 non-depressed controls (mean age: M  = 35.24 years, SD = 13.40; 36.1% female), we assessed self-reported PA via the Simple Physical Activity Questionnaire (SIMPAQ) for one week, followed by a week where PA was monitored using an accelerometer device (Actigraph wGT3x-BT). Additionally, we examined correlations between PA levels assessed with the SIMPAQ and exercise determinants in both groups., Results: Descriptively, inpatients treated for MDD showed lower levels of light PA on accelerometer-based measures, whereas they self-reported increased levels of certain types of PA on the SIMPAQ. More importantly, there was only a small degree of correspondence between self-reported and actigraphy-based PA levels in both in patients ( r  = 0.15, p  < 0.05) and controls ( r  = 0.03, ns). Only few significant correlations were found for self-reported PA (SIMPAQ subscores) and perceived fitness, whereas self-reported PA and estimated VO 2 max were unrelated. Furthermore, only weak (and mostly statistically non-significant) correlations were found between exercise determinants and SIMPAQ-based exercise behavior in both populations., Discussion: Our findings emphasize the intricate challenges in the assessment of PA, not only in inpatients treated for MDD, but also in non-depressed controls. Our findings also underline the necessity for a diversified data assessment. Further efforts are needed to refine and improve PA questionnaires for a more accurate data assessment in psychiatric patients and healthy controls., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Schilling, Cody, Kreppke, Faude, Beck, Brand, Donath, Hatzinger, Imboden, Lang, Mans, Mikoteit, Oswald, Schweinfurth-Keck and Gerber.)

Objective: To quantify and compare injury incidence between national-level, adolescent and regional-level, senior, male basketball players competing in Serbia overall and according to injury mechanism (contact, non-contact, or overuse), exposure setting (training or games), and history (new or recurrent)., Methods: A total of 218 male basketball players from 19 teams (106 senior and 112 adolescent players) volunteered to participate in the study. Descriptive data regarding game and training injury incidence were gathered across all players and reported per 10,000 athlete-exposures (AE) with 95% confidence intervals., Results: Overall, 26 injuries were reported across 52,509 AE. Ankle ( n  = 10, incidence rate [IR] = 1.90 [0.97, 3.40]) and knee injuries ( n  = 8, IR = 1.52 [0.71, 2.89]) accounted for 69% of all reported injuries, with only 1-2 injuries documented for other body regions. Ankle injuries were attributed to contact (60%, IR = 1.14 [0.46, 2.38]) or non-contact mechanisms (40%, IR = 0.76 [0.24, 1.84]). Most knee injuries occurred due to overuse (50%, IR = 0.76 [0.24, 1.84]) or non-contact mechanisms (38%, IR = 0.57 [0.15, 1.56]). Comparisons according to exposure setting revealed significantly higher knee (incidence rate ratio [IRR] = 9.95 [1.85, 53.41], p  = 0.004) and ankle (IRR = 39.79 [7.94, 384.67], p  < 0.001) injuries per 10,000 AE during games compared to training. Recurrent injuries were most prominent in the ankle (30% of all ankle injuries, p  = 0.11). Total contact ( p  = 0.04), non-contact ( p  = 0.04), and recurrent IR ( p  = 0.005) were significantly higher in senior than adolescent players., Conclusion: The players examined were most susceptible to ankle and knee injuries, particularly during games compared to training. Ankle injuries were mostly attributed to player contact, while knee injuries were mostly attributed to overuse and non-contact mechanisms. Senior players were at a greater risk of sustaining contact, non-contact and recurrent injuries than adolescent players.

Background: Skin-derived advanced glycation end products (sAGEs) have been associated with cardiovascular (CV) risk and mortality in adults. We hypothesize that cardiorespiratory fitness (CRF), body mass index (BMI) and vascular health are associated with development of sAGEs during childhood., Methods: In our prospective cohort study, 1171 children aged 6-8 years were screened for sAGEs, BMI, retinal arteriolar diameters (CRAE) and pulse wave velocity (PWV), using standardized procedures. To determine CRF a 20 m shuttle run was performed. After four 4 years, all parameters were assessed in 675 children using the same protocols., Results: Higher initial CRF levels were significantly associated with lower sAGEs (β [95 CI] -0.02 [-0.03 to -0.002] au, p = 0.022) levels at follow-up, although they showed a greater change from baseline to follow-up (β [95 CI] 0.02 [0.002 to 0.03] au, p = 0.027). Moreover, individuals with higher sAGEs at baseline showed narrower CRAE (β [95% CI] -5.42 [-8.76 to -2.08] μm, p = 0.001) at follow-up and showed a greater change in CRAE (β [95% CI] -3.99 [-7.03 to -0.96] μm, p = 0.010) from baseline to follow-up., Conclusion: Exercise and higher CRF may help mitigate the formation of AGEs during childhood, thereby reducing the risk for development of CV disease associated with AGEs-induced damage. Preventive strategies may need to target CRF early in life to achieve improvement of CV risk factors and may counteract the development of CV disease later in life., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hauser, Lona, Köchli, Streese, Infanger, Faude and Hanssen.)

Over 300 million individuals worldwide suffer from major depressive disorder (MDD). Individuals with MDD are less physically active than healthy people which results in lower cardiorespiratory fitness (CRF) and less favorable perceived fitness compared with healthy controls. Additionally, individuals with MDD may show autonomic system dysfunction. The purpose of the present study was to evaluate the CRF, perceived fitness and autonomic function in in-patients with MDD of different severity compared with healthy controls. We used data from 212 in-patients (age: 40.7 ± 12.6 y, 53% female) with MDD and from 141 healthy controls (age: 36.7 ± 12.7 y, 58% female). We assessed CRF with the Åstrand-Rhyming test, self-reported perceived fitness and autonomic function by heart rate variability (HRV). In specific, we used resting heart rate, time- and frequency-based parameters for HRV. In-patients completed the Beck Depression Inventory-II (BDI-II) to self-assess the subjectively rated severity of depression. Based on these scores, participants were grouped into mild, moderate and severe MDD. The main finding was an inverse association between depression severity and CRF as well as perceived fitness compared with healthy controls. Resting heart rate was elevated with increasing depression severity. The time-based but not the frequency-based autonomic function parameters showed an inverse association with depression severity. The pattern of results suggests that among in-patients with major depressive disorder, those with particularly high self-assessed severity scores show a lower CRF, less favorable perceived fitness and partial autonomic dysfunction compared to healthy controls. To counteract these conditions, physical activity interventions may be effective., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests. The PACINPAT trial is funded by the Swiss National Science Foundation (grant number: 321003B-179353). The authors JB, MH, CI, UEL, SM, TM, AO, AR and NS supported the patient screening and recruitment processes on the four study sites. JNK and RC recruited the participants and collected the data. EHT, LD, AE, SB, LZ and MG offered thematic support. JNK and OF were responsible for conceptualizing the manuscript. JNK conducted the statistical analyses. JNK wrote the first draft of the manuscript with assistance of OF. All listed co-authors read, contributed to and approved the final manuscript., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Consensus statements can be very influential in medicine and public health. Some of these statements use systematic evidence synthesis but others fail on this front. Many consensus statements use panels of experts to deduce perceived consensus through Delphi processes. We argue that stacking of panel members towards one particular position or narrative is a major threat, especially in absence of systematic evidence review. Stacking may involve financial conflicts of interest, but non-financial conflicts of strong advocacy can also cause major bias. Given their emerging importance, we describe here how such consensus statements may be misleading, by analysing in depth a recent high-impact Delphi consensus statement on COVID-19 recommendations as a case example. We demonstrate that many of the selected panel members and at least 35% of the core panel members had advocated towards COVID-19 elimination (zero-COVID) during the pandemic and were leading members of aggressive advocacy groups. These advocacy conflicts were not declared in the Delphi consensus publication, with rare exceptions. Therefore, we propose that consensus statements should always require rigorous evidence synthesis and maximal transparency on potential biases towards advocacy or lobbyist groups to be valid. While advocacy can have many important functions, its biased impact on consensus panels should be carefully avoided., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: During sprinting, the biceps femoris long head predominantly gets injured, while hamstring strengthening exercises predominantly activate the semitendinosus more effectively. Understanding how joint dominance influences hamstring activity may offer clarity on appropriate exercise selection in strengthening programs., Purpose: This study compared three hip-dominant hamstring exercises: the rocker, perpetuum mobile fast and slow (PMfast and PMslow) and the Nordic Hamstring exercise (NHE) on their potential to simulate sprint-like activity and kinematics., Methods: Muscle activity of the posterior kinetic chain (biceps femoris, semitendinosus, gluteus maximus, and medial gastrocnemius) was measured with surface electromyography (sEMG) during the exercises and treadmill running at 75% of the individual maximal sprint velocity in male athletes. sEMG data were normalized to maximal sprinting. 3D-motion capture was employed to assess hip and knee angles., Results: Eight male athletes were included (age: 24.0 years ± SD 2.9; body mass: 76.8 kg ± 7.7; height: 1.79 m ± 0.08). Greater activity of the hamstrings occurred during the explosive exercises ranging from 63.9% [95%CI: 56.3-71.5%] (rocker) to 49.0% [95%CI: 40.4-57.6%] (PMfast) vs. 34.0% [95%CI: 29.1-38.9%] (NHE) to 32.1% [95%CI: 26.9-37.3%] (PMslow). The rocker showed greatest hamstring and gluteus maximus activity. Biceps femoris consistently showed greater activity than the semitendinosus across all exercises in peak (mean difference: 0.16, [95%CI: 0.07-0.26]) and average (mean difference: 0.06, [95%CI: 0.01-0.11]) activity. PMfast, PMslow and NHE demonstrated less hip flexion angle at peak hamstring activity than the rocker and high-speed running and every exercise showed less hamstring elongation stress than during high-speed running., Discussion: Hamstring activity is comparable to high-intensity treadmill running for NHE and PMslow, and greater for the rocker and PMfast. Gluteus maximus activity varied, with the rocker and PMfast showing greater activity than in sprinting. All examined exercises demonstrated their peak activity at short hamstring muscle length., Level of Evidence: 3b., (© The Author(s).)

Context: A sport-related concussion (SRC) is a traumatic brain injury that is caused by biomechanical stresses and results in a complex pathophysiological process in the brain. Some in the sporting community believe that headgear (HG) can prevent SRC, and several professional Australian sports organizations, including rugby, football, and soccer clubs, recommend its use., Objective: The purpose of this study is to determine whether HG is effective in lowering the prevalence of SRC in sports., Data Sources: A systematic search for related studies published between 1985 and 2023 was conducted using the following databases: Cochrane Library, AMED, PubMed, Web of Science, and Physiotherapy Evidence Database (PEDro)., Study Selection: Only randomized controlled trials (RCTs) that investigated the effectiveness of HG in reducing SRC rate were included., Study Design: Systematic review and meta-analysis of RCTs., Level of Evidence: Level 1a., Data Extraction: Two researchers independently completed the title and abstract search and performed full-text reviews. A third reviewer was consulted to reach a consensus if any discrepancies were noted. The PEDro scale was used to evaluate the quality of the included RCTs. Data recorded from each study included authors, year of publication, type and number of players, study design, duration of the study, injury rate, compliance (%), sports/level, and exposure hours., Results: The pooled results of 6311 players and 173,383 exposure hours showed 0% SRC reduction per 1000 hours of exposure in the experimental group compared with the control group, with an injury risk ratio of 1.03 (95% CI, 0.82-1.30; P = 0.79)., Conclusion: This systematic review and meta-analysis demonstrates that HG does not prevent SRC among soccer and rugby players, and therefore the findings from this meta-analysis do not currently support the use of HG to prevent SRC in soccer or rugby., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

Major depressive disorder (MDD) is an increasingly common psychiatric illness associated with a high risk of insufficient physical activity, which in turn is associated with negative mental and physical health outcomes. Theory-based, individually tailored, in-person and remote physical activity counseling has the potential to increase physical activity levels in various populations. Given this, the present study investigated the effect of such a physical activity intervention on the physical activity behavior of in-patients with MDD. This was a multi-center, two-arm randomized controlled trial including initially insufficiently physically active adult in-patients with MDD from four study sites in Switzerland. The sample consisted of 220 participants (M age  = 41 ± 12.6 years, 52% women), 113 of whom were randomized to the intervention group and 107 to the control group. The main outcome, moderate-to-vigorous physical activity (MVPA), was assessed at three time points via hip-worn accelerometer. According to accelerometer measures, there was no significant difference in minutes spent in MVPA over a 12-month intervention period when comparing the intervention with the control group (β = -1.02, 95% CI = -10.68 to 8.64). Higher baseline physical activity significantly predicted physical activity at post and follow-up. This study showed that it is feasible to deliver an individually tailored, theory-based physical activity counseling intervention to in-patients with MDD, however yielding no significant effects on accelerometer-based MVPA levels. Further efforts are warranted to identify efficacious approaches.Trial registration: ISRCTN, ISRCTN10469580, registered on 3rd September 2018, https://www.isrctn.com/ISRCTN10469580 ., (© 2024. The Author(s).)

Abstract: Keller, M, Lichtenstein, E, Roth, R, and Faude, O. Balance training under fatigue: a randomized controlled trial on the effect of fatigue on adaptations to balance training. J Strength Cond Res 38(2): 297-305, 2024-Balance training is an effective means for injury prevention in sports. However, one can question the existing practice of putting the balance programs at the start of a training session (i.e., train in an unfatigued state) because the occurrence of injuries has been associated with fatigue. Therefore, the aim of this study was to assess the influence of balance training in a fatigued or an unfatigued state on motor performance tested in fatigued and unfatigued conditions. Fifty-two, healthy, active volunteers (28.0 years; 19 women) were randomly allocated to 1 of 3 different training groups. The BALANCE group completed 6 weeks of balance training. The other 2 groups completed the identical balance tasks either before (BALANCE-high-intensity interval training [HIIT]) or after (HIIT-BALANCE) a HIIT session. Thus, these groups trained the balance tasks either in a fatigued or in an unfatigued state. In PRE and POST tests, balance (solid ground, soft mat, wobble board) and jump performance was obtained in fatigued and unfatigued states. Balance training resulted in reduced sway paths in all groups. However, the linear models revealed larger adaptations in BALANCE-HIIT and BALANCE when compared with HIIT-BALANCE ( d = 0.22-0.71). These small to moderate effects were-despite some uncertainties-consistent for the "unfatigued" and "fatigued" test conditions. The results of this study revealed for the first time that balance training under fatigue results in diminished adaptations, even when tested in a fatigued state. Therefore, the data indicate that balance training should be implemented at the start of a training session or in an unfatigued state., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the National Strength and Conditioning Association.)

Objective: B-mode ultrasound can be used to image musculoskeletal tissues, but one major bottleneck is analyses of muscle architectural parameters (i.e., muscle thickness, pennation angle and fascicle length), which are most often performed manually., Methods: In this study we trained two different neural networks (classic U-Net and U-Net with VGG16 pre-trained encoder) to detect muscle fascicles and aponeuroses using a set of labeled musculoskeletal ultrasound images. We determined the best-performing model based on intersection over union and loss metrics. We then compared neural network predictions on an unseen test set with those obtained via manual analysis and two existing semi/automated analysis approaches (simple muscle architecture analysis [SMA] and UltraTrack). DL&#95;Track&#95;US detects the locations of the superficial and deep aponeuroses, as well as multiple fascicle fragments per image., Results: For single images, DL&#95;Track&#95;US yielded results similar to those produced by a non-trainable automated method (SMA; mean difference in fascicle length: 5.1 mm) and human manual analysis (mean difference: -2.4 mm). Between-method differences in pennation angle were within 1.5°, and mean differences in muscle thickness were less than 1 mm. Similarly, for videos, there was overlap between the results produced with UltraTrack and DL&#95;Track&#95;US, with intraclass correlations ranging between 0.19 and 0.88., Conclusion: DL&#95;Track&#95;US is fully automated and open source and can estimate fascicle length, pennation angle and muscle thickness from single images or videos, as well as from multiple superficial muscles. We also provide a user interface and all necessary code and training data for custom model development., Competing Interests: Conflict of interest The authors declare no competing interests., (Copyright © 2023 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Whole-body lifting strategies could be derived from conventional video recordings using the Stoop-Squat-Index, which quantifies the ratio between trunk forward lean and lower extremity joint flexion from 0 (full squat) to 100 (full stoop). The purpose of this study was to compare Stoop-Squat-Indices derived from conventional video recordings to those from a three-dimensional marker-based motion capture system and to evaluate interrater and intrarater reliability of the video-based approach. Thirty healthy participants lifted a 5-kg box under different conditions (freestyle, squat, stoop). Kinematic data were recorded using a Vicon motion capture system (serving as reference standard) and an iPad camera. Stoop-Squat-Indices over the entire lifting cycle were derived separately from both approaches. Agreement was assessed using mean differences (video minus motion capture) and limits of agreement. Reliability was investigated by calculating intraclass correlation coefficients (ICC) and minimal detectable changes (MDC) over the course of the lifting cycle. Systematic errors were identified with Statistical Parametric Mapping-based T-tests. Systematic errors between the video-based and the motion capture-based approach were observed among all conditions. Mean differences in Stoop-Squat-Indices over the lifting cycle ranged from -6.9 to 3.2 (freestyle), from -1.8 to 5.3 (squat) and from -2.8 to -1.1 (stoop). Limits of agreement were lower when the box was close to the floor, and higher towards upright standing. Reliability of the video-based approach was excellent for most of the lifting cycle, with ICC above 0.995 and MDC below 3.5. These findings support using a video-based assessment of Stoop-Squat-Indices to quantify whole-body lifting strategy in field., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Exercise training recommendations for seniors include the targeted training of strength, balance, endurance and flexibility domains. Agility training (AT) is conceptualized as a multi-component and time-efficient training framework for older adults to improve physical, functional and cognitive health domains that are relevant for maintaining activities of daily living. The aim of this one-year trial was to comparatively evaluate the effects of agility training on physical and cognitive function., Methods: Seventy-nine healthy older adults (AT: 61.5% female, 70.8 ± 4.8 years, 27.7 ± 4.2 kg/m 2 ; CG: 60.5% female, 69.6 ± 4.7 years, 27.5 ± 4.4 kg/m 2 ) took part in this one-year randomized controlled intervention and were either assigned to the agility training group (AT) with two weekly 60 min AT sessions or to the control group (CG), receiving no treatment. Participants were assessed pre, intermediate and post intervention for strength and power, balance, gait speed under multi-task conditions, aerobic capacity as well as cognitive performance. Linear mixed effects models were used to analyze the effect of treatment over time., Results: Fifty-four participants (AG: 25, CG: 29) were analyzed, most drop-outs attributed to COVID-19 (17/30 dropouts). Adherence was good (75%) of 90 offered sessions. Notable effects in favor of AT were found for gait parameters in single (d = 0.355, Δ = 4.3%), dual (d = 0.375, Δ = 6.1%) and triple (d = 0.376, Δ = 6.4%) task conditions, counter movement jump performance (strength and power) (d = 0.203, Δ = 6.9%), static one leg balance (d = 0.256, Δ = 12.33%) and n-back reaction time (cognitive performance) (d = 0.204, Δ = 3.8%). No effects were found for the remaining outcomes (d < 0.175)., Conclusion: AT might serve as an integrative training approach for older adults particularly improving gait and lower limb power parameters. It seems suitable to improve a broad range of seniors' health domains and should replace isolated training of these domains. However, individual variation and progression of exercises should be considered when programming agility training providing adequate challenges throughout a long-term intervention for all participants., Trial Registration: DRKS, DRKS00017469 . Registered 19 June 2019-Retrospectively registered., (© 2023. The Author(s).)

Objective: To assess the effects of a novel multicomponent neuromuscular warm-up program on lower-extremity injury incidence in basketball players competing at the regional level., Methods: A cluster randomized controlled experimental design was adopted to compare injury incidence between players exposed to the injury prevention warm-up program and those exposed to a typical warm-up program across an entire basketball season. Four teams consisting of 57 players (male: n = 42; female: n = 15) were allocated to the intervention group (age: 21.6 ± 2.5 years; height: 186.2 ± 8.8 cm; body mass: 80.0 ± 10.4 kg) and four teams consisting of 55 players (male: n = 43; female: n = 12) were allocated to the control group (age: 21.6 ± 2.6 years; height: 186.9 ± 9.1 cm; body mass: 81.5 ± 10.9 kg). The novel warm-up combined running exercises with active stretching, plyometrics, balance, strength, and agility drills. Coaching and medical staff provided details on injury incidence each week. Data analyses included the use of poisson regression analyses and the incidence rate ratio (IRR) with 95% confidence intervals (CI)., Results: The intervention group experienced a significantly lower ankle sprain incidence rate (IRR = 0.26, 95% CI = 0.05, 0.98, p = 0.02) and a tendency toward a lower knee injury incidence rate (IRR = 0.32, 95% CI = 0.03, 1.78, p = 0.07) compared to the control group. Considering only non-contact lower-extremity injuries of any type, the intervention group experienced a significantly lower incidence rate compared to the control group (IRR = 0.26, 95% CI = 0.05, 0.98, p < 0.001)., Conclusion: This multi-team study demonstrated a novel multicomponent warm-up program resulted in less lower-extremity injuries, particularly ankle sprains and knee injuries, compared to a typical warm-up program in regional-level male and female basketball players.

Background and Aims: Hypertension is a major risk factor for the development of cardiovascular disease (CVD) in adulthood. High blood pressure (BP) is associated with subclinical vascular impairments as early as childhood. We aimed to assess the association of retinal microvascular diameters and large artery pulse wave velocity (PWV) with progression of childhood BP., Methods: In our prospective Basel cohort study, 1171 children aged 6-8 years were screened for BP, body mass index, retinal vessel diameters and PWV using standardized protocols. After 4 years, all parameters were assessed in 749 children using the same protocols., Results: Children with narrower central retinal arteriolar diameters (CRAE) and higher PWV at baseline developed higher systolic BP after 4 years (β [95% CI] 0.6 [0.072 to 1.164] mmHg per 10 μm decrease, p = 0.026 and β [95% CI] 0.6 [0.331 to 0.838] mmHg per 0.1 m/s increase, p < 0.001, respectively). Children with increased systolic BP at baseline developed narrower CRAE and higher PWV at follow-up (β [95% CI] -3.3 [-4.43 to -2.09] μm per 10 mmHg increase, p < 0.001 and β [95% CI] 0.13 [0.10 to 0.16] m/s per 10 mmHg increase, p < 0.001, respectively)., Conclusions: Retinal arteriolar diameter and PWV independently predict progression of childhood BP, while initial BP is linked to development of micro- and macrovascular impairments, describing a bivariate temporal relationship between vascular health and BP. Childhood may present a window of opportunity for initiation of primary prevention strategies for the treatment of high BP to help prevent manifestation of CVD later in life., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Primary health prevention in at-risk children is receiving increased attention while less information is available on cardiovascular profile and response to exercise in healthy children. Our study examined the effects of a gross motor skill-based exercise intervention on micro- and macro-vascular health in preschoolers. This is a sub-study of a five-armed clinical trial with six kindergartens and 68 children. Four kindergartens were assigned to the intervention group (INT) and two to control groups (CON). We performed gross motor skill assessment (TGMD-2), static retinal vessel analysis, and measurements of central hemodynamics before and after the intervention. INT received one weekly exercise session for 25 weeks, while CON received no intervention. We calculated linear regressions correcting for age, sex, BMI-percentile, and baseline. We observed favorable effects in TGMD-2 for INT over CON (Cohen's d = 0.52 95% CI [0.15; 0.90]). Trivial between-group differences were observed in retinal vessel diameters (0.08 < d ≤ 0.29) and trivial to moderate differences in all other arterial stiffness parameters (-0.55 < d ≤ 0.31). Motor-skill based interventions are sensible measures to incorporate physical activity in pre-schools and improve gross motor proficiency at a very young age. The potential of motor skill-based interventions as primordial prevention strategy in healthy preschoolers needs to be further investigated.

Background: Obesity- and hypertension-related cardiovascular (CV) risk has been shown to originate in childhood. Higher body mass index (BMI) and blood pressure (BP) have been associated with increased large artery stiffness and a lower microvascular arteriolar-to-venular diameter ratio (AVR) in children. This study aimed to investigate the association of cardiorespiratory fitness (CRF) with development of BMI, BP and vascular health during childhood. Methods: In our prospective cohort study, 1,171 children aged 6-8 years were screened for CRF, BMI, BP, retinal vessel diameters and pulse wave velocity using standardized protocols. Endurance capacity was assessed by 20 m shuttle run test. After 4 years, all parameters were assessed in 664 children using the same protocols. Results: Children with a higher CRF at baseline developed a significantly lower BMI (β [95% CI] -0.09 [-0.11 to -0.06] kg/m 2 , p < 0.001), a lower systolic BP (β [95% CI] -0.09 [-0.15 to -0.03] mmHg, p = 0.004) and a higher AVR (β [95% CI] 0.0004 [0.00004 to 0.0007] units, p = 0.027) after 4 years. The indirect association of CRF with development of retinal arteriolar diameters was mediated by changes in BMI. Conclusion: Our results identify CRF as a key modulator for the risk trajectories of BMI, BP and microvascular health in children. Obesity-related CV risk has been shown to track into adulthood, and achieving higher CRF levels in children may help counteract the development of CV risk and disease not only in pediatric populations, but may also help reduce the burden of CVD in adulthood. Registration: http://www.clinicaltrials.gov/ (NCT02853747)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Hauser, Lichtenstein, Nebiker, Streese, Köchli, Infanger, Faude and Hanssen.)