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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

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.)

Abstract: Keller, M, Faude, O, Gollhofer, A, and Centner, C. Can we make blood flow restriction training more accessible? Validity of a low-cost blood flow restriction device to estimate arterial occlusion pressure. J Strength Cond Res 37(8): 1581-1587, 2023-Evidence indicates that low-load resistance training with blood flow restriction (BFR) results in comparable gains in muscle mass and muscle strength as high-load resistance training without BFR. Low-load BFR training is a promising tool for areas such as rehabilitation because individuals are exposed to low mechanical stress. However, BFR training is only safe and effective when the cuff pressure is individually adjusted to the arterial occlusion pressure (AOP). Generally, thresholds for AOP are typically determined with sophisticated laboratory material, including Doppler ultrasound and tourniquet systems. Therefore, this study investigated the validity of a low-cost BFR product with automatic AOP assessment (AirBands International) compared with the gold standard for determining the individual AOP. Valid measurements were obtained at the arms and legs in 104 healthy volunteers. For the arms ( n = 49), a Bland-Altman analysis revealed a mean difference of 7 ± 13 mm Hg between the 2 methods, with slightly higher pressure levels for the gold standard (131 ± 14 mm Hg) than for the low-cost device (125 ± 17 mm Hg). For the legs ( n = 55), the low-cost device reached its maximum pressure capacity in 70% of subjects during AOP identification, making the results on the legs unreliable. Although the low-cost device is a valid tool for identifying the individual AOP in the arms, the device cannot be recommended for use at the legs because of its limited pressure capacity. When using the low-cost device for BFR training at the arms, it is recommended to apply the cuff pressure to 60% of the individual AOP to meet current BFR training guidelines., (Copyright © 2023 National Strength and Conditioning Association.)

Objectives: Early predictors for back pain need to be identified for the development of prevention strategies starting as early as childhood. For this purpose, the relationship between physical fitness and spinal flexibility at the age of six years and its prediction for the development of non-specific back pain (BP) during childhood were analyzed., Methods: In this prospective cohort study with 4-year follow-up, school children from the Swiss Canton Basel-Stadt, aged 6-8 (2014) at baseline and 10-12 years (2018) at follow-up, were recruited from 26 primary schools ( n  = 238) within a mandatory evaluation of motor skills. Data for spinal flexibility were collected by use of a hand-held computer-assisted device and physical fitness was assessed by shuttle run performance at both time points. Occurrence of non-specific BP was determined by use of a questionnaire at follow-up., Results: Children with higher physical fitness at baseline achieved a better spinal flexibility four years later ( β [95% CI] 3.75 [2.19-5.3] degree per 1 stage increase, p  < 0.001). Higher spinal flexibility by 1 degree at baseline was associated with 2% less odds for non-specific BP at follow-up (OR [95% CI] 0.98 [0.97-0.99] per 1 degree increase, p  = 0.032). There was little evidence for a direct association between physical fitness at baseline and development of non-specific BP at follow-up (OR [95% CI] 1.13 [0.96-1.34] per 1 stage increase, p  = 0.128)., Conclusion: Fitness performance is associated with the development of better childhood spinal flexibility over four years. Moreover, a better spinal flexibility at baseline was associated with less non-specific BP at follow-up. This study suggests that physical fitness may be a key modulator of spinal flexibility which itself is a main determinant of non-specific BP during childhood development. Further long-term studies are warranted to confirm our assumptions and to prove trajectories into adolescents and adulthood., 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., (© 2023 Bade, Lona, Infanger, Endes, Roth, Faude and Hanssen.)

Background: Grip strength is used to estimate whole-body strength for health surveillance purposes. Explosive strength is considered important, yet economic measures able to detect early deterioration of neuromuscular capabilities are lacking. Whether handgrip maximum rate of force development (GRFD) or whole-body strength tests are better predictors of lower body power than handgrip maximum strength (GF max ) and their trajectories throughout the life span are unknown., Hypothesis: GRFD should be more closely related to lower body power than GF max , and its trajectories over the life span should more closely follow that of lower body power., Study Design: Cross-sectional., Level of Evidence: Level 2b., Methods: A total of 613 healthy participants aged 20 to 91 years were tested for countermovement jump peak power, GF max , handgrip rate of force development, and midthigh pull peak force (MTP). Cubic splines and linear models were built for age trajectories, generalized additive models for quintile curves, and linear regression was used to assess predictive quality., Results: Peak power (P max ) declined linearly to 60% of young adult level, with GRFD, GF max , and MTP remaining stable up to age 50 years and then declining more sharply to 52% to 71% of young adult levels. Trajectories were similar for male and female participants. GRFD (β = 0.17) and MTP (β = 0.08) were worse predictors of P max than GF max (β = 0.24) in models adjusted for age, sex, lean body mass, and vigorous physical activity levels., Conclusion: GRFD was not superior to maximum strength in predicting lower body power. For health surveillance purposes, it therefore appears that GF max tests are more economical and equally good predictors of lower body explosive strength at older age. The data provided can be used as norm values for healthy subjects., Clinical Relevance: Incorporating countermovement jump testing for early detection of declines in explosive capabilities might be advised.

Introduction: Compared to the general population, individuals with depression have an increased risk for cardiovascular diseases. Nevertheless, little is known so far whether cardiorespiratory fitness (CRF) moderates this relationship. Therefore, we examined whether common physiological cardiovascular risk factors differ between patients with depression and healthy (non-depressed) controls, whether patients and controls differ in CRF, and whether higher CRF is associated with a lower cardiovascular risk in both patients and healthy controls. Additionally, we examined whether within the patient sample, cardiovascular risk factors differ between patients with mild, moderate and severe depression, and whether the relationship between symptom severity and cardiovascular risk is moderated by patients' CRF levels., Methods: Data from a multi-centric, two-arm randomized controlled trial (RCT) was analyzed, including 210 patients (F32, single episode: n  = 72, F33, recurrent major depression: n  = 135, F31-II, bipolar type II: n  = 3) and 125 healthy controls. Waist circumference, body mass index, body fat, blood pressure, cholesterol levels, triglycerides, and blood glucose were considered as cardiovascular risk markers. CRF was assessed with a submaximal ergometer test. Differences between groups were examined via χ 2 -tests and (multivariate) analyses of covariance., Results: Compared to healthy controls, patients with depression had a higher cardiovascular risk as evident from about half of the examined indicators. In the total sample, participants with good CRF had more favourable scores across nearly all risk markers than counterparts with poor CRF. For most variables, no interaction occurred between group and fitness, indicating that in patients and controls, similar differences existed between participants with poor and good CRF. Few differences in risk markers were found between patients with mild, moderate and severe depression, and no interaction occurred between depression severity and CRF., Discussion: Patients with depression and healthy controls differ in several cardiovascular risk markers, putting patients at increased risk for CVDs. In contrast, people with good CRF show more favourable cardiovascular risk scores, a relationship which was observed in both healthy controls and patients with depression. Physical health of psychiatric patients should receive the clinical attention that it deserves. Lifestyle interventions targeting healthy diet and/or physical activity are recommended as a physically active and healthy lifestyle contributes equally to patients' mental well-being and cardiovascular health., 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 Gerber, Cody, Beck, Brand, Donath, Eckert, Hatzinger, Imboden, Kreppke, Lang, Ludyga, Mans, Mikoteit, Oswald, Schweinfurth-Keck, Zahner and Faude.)

Objective: To quantify the incidence rate of anterior cruciate ligament (ACL) injuries and ankle sprains according to player sex, playing level, and exposure setting (training vs. games) in basketball players., Methods: PubMed, MEDLINE, Google Scholar, and ScienceDirect were searched. Only studies reporting the number of ACL injuries and/or ankle sprains alongside the number of athlete-exposures (training sessions and/or games) in basketball players were included., Results: Thirty studies (17 reporting ACL injuries and 16 reporting ankle sprains) were included in the meta-analysis. Higher (p < 0.05) ACL injury incidence rates per 1000 athlete-exposures were recorded in females (female: 0.20 95% confidence intervals [0.16-0.25]; male: 0.07 [0.05-0.08]; female-to-male ratio: 3.33 [3.10-3.57]), in players competing at higher playing levels (amateur: 0.06 [0.04-0.09]; intermediate: 0.16 [0.13-0.20]; elite: 0.25 [0.14-0.64]), and in games (games: female, 0.27 [0.21-0.32]; male, 0.06 [0.03-0.08]; training: female, 0.03 [0.02-0.05]; male: 0.01 [0.00-0.02]; game-to-training ratio: 7.90 [4.88-12.91]). Higher (p < 0.05) ankle sprain incidence rates per 1000 athlete-exposures were observed in males (female: 0.82 [0.61-1.03]; male: 0.90 [0.61-1.19]; female-to-male ratio: 0.91 [0.83-0.99]), in players competing at higher playing levels (amateur: 0.54 [0.51-0.57]; intermediate: 1.12 [1.00-1.24]; elite: 1.87 [1.29-2.46]), and in games (games: 2.51 [1.85-3.16]; training: 0.80 [0.52-0.80]; game-to-training ratio: 2.77 [2.35-3.26])., Conclusion: According to player sex, ACL injury incidence rate is higher in females, while ankle sprain incidence rate is greater in males. ACL injury and ankle sprain incidence rates are greater in players competing at higher playing levels and during games compared to training., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Patients with major depressive disorder (MDD) are characterized by neurocognitive impairments and show deficits in various cognitive performance indicators, including executive function. We examined whether sustained attention and inhibitory control differ between patients with MDD and healthy controls, and whether differences exist between patients with mild, moderate, and severe depression., Methods: Clinical in-patients ( N = 212) aged 18-65 years with a current diagnosis of MDD and 128 healthy controls were recruited. Depression severity was assessed using the Beck Depression Inventory, and sustained attention and inhibitory control were assessed using the oddball and flanker tasks. The use of these tasks promises insights into executive function in depressive patients that are not biased by verbal skills. Group differences were tested via analyses of covariance., Results: Patients with MDD showed slower reaction times in both the oddball and flanker task, independent of the executive demands of the trial types. Younger participants achieved shorter reaction times in both inhibitory control tasks. After correcting for age, education, smoking, BMI, and nationality, only differences in reaction times in the oddball task were statistically significant. In contrast, reaction times were not sensitive to the symptom severity of depression., Conclusion: Our results corroborate deficits in basic information processing and specific impairments in higher-order cognitive processes in MDD patients. As difficulties in executive function underlie problems in planning, initiating, and completing goal-directed activities, they may jeopardize in-patient treatment and contribute to the recurrent nature of depression.

Background: The physical activity counseling for in-patients with major depression (PACINPAT) randomized controlled trial was launched to tackle physical inactivity for in-patients with major depressive disorder. Evidence shows that despite potential treatment effects, physical inactivity is prevalent in this population. To contribute to the assessment of how this in-person and remote, theory-based, individually tailored intervention was designed, received and effected behavior, the aim of this study was to evaluate its implementation., Methods: This implementation evaluation was conducted within a multi-center randomized controlled trial according to the Process Evaluation Framework by the Medical Research Council including the analysis of reach, dose, fidelity and adaptation. Data were collected from the implementers and the participants randomized to the intervention group of the trial., Results: The study sample comprised 95 physically inactive in-patients (mean age: 42 years, 53% women) with diagnosed major depressive disorder. The intervention reached the intended population (N = 95 in-patients enrolled in the study). The intervention dose varied between early dropouts (counseling sessions, M = 1.67) and study completers with some participants receiving a low dose (counseling sessions, M = 10.05) and high dose (counseling sessions, M = 25.37). Differences in the attendance groups were recognizable in the first two counseling sessions (duration of counseling session about 45 min in early dropouts versus 60 min for study completers). Fidelity of the in-person counseling content was partly achieved and adapted, whereas that of the remote counseling content was well achieved. Participants (86% at follow up) reported satisfaction with the implementers of the intervention. Adaptations were made to content, delivery mode and dose., Conclusion: The PACINPAT trial was implemented in the intended population, in varying doses and with adaptations made to in-person counseling content and remote counseling dose. These findings are key to understanding outcome analyses within the PACINPAT trial, further developing interventions and contributing to implementation research among in-patients with depressive disorders., Trial Registration: ISRCTN, ISRCTN10469580 , registered on 3 rd September 2018., (© 2023. The Author(s).)

Prior motor experience is thought to aid in the acquisition of new skills. However, studies have shown that balance training does not promote learning of a subsequent balance task. These results stand in contrast to the learning-to-learn paradigm, which is well described for other tasks. We therefore tested if a coordinative affinity between tasks is needed to achieve a learning-to-learn for balance control. Three groups trained different motor tasks during training phase1 (coordination ladder (COOR); bipedal wobble board (2WB); single-leg wobble board (1WB)). During training phase2, all groups trained a tiltboard balance task. Task-specific and transfer effects were evaluated for phase1. A potential learning-to-learn effect was evaluated by comparing the acquisition rates from phase2 for the tiltboard task that was used for training and testing. The results indicate task-specific adaptations after phase1 for 1WB. In contrast, 2WB showed similar improvements than 1WB and COOR (effect sizes: -0.31 to -0.38) when tested on the wobble board with bipedal stance indicating no task-specific improvement for 2WB. For phase2, the linear regression analysis showed larger adaptations for 1WB and 2WB when compared to COOR. This effect implies some uncertainty due to overlapping confidence intervals. Task-specific adaptations after phase1 were found for 1WB but not 2WB. It is discussed that the difficulty of the training task could explain these contrasting results. During phase2, larger adaptations were found for both groups that trained balance tasks during phase1. Thus, despite some uncertainty, prior balance training appears to promote adaptations of a subsequently learned balance task. Highlights Prior balance training augments the learning of a new balance task if the two tasks share certain coordinative features.The concept of "learning to learn" can probably be applied to postural control, although further studies are needed.Balance training results (partly) in task-specific adaptations with no immediate transfer to other (but unrelated) balance tasks.

Abstract: Milutinović, A, Jakovljević, V, Dabović, M, Faude, O, Radovanović, D, and Stojanović, E. Isokinetic muscle strength in elite soccer players 3 months and 6 months after anterior cruciate ligament reconstruction. J Strength Cond Res 37(4): e297-e304, 2023-The aim of this study was to evaluate interlimb symmetry in quadriceps and hamstring peak torque of elite soccer players at 3 months (stage 1) and 6 months (stage 2) after anterior cruciate ligament (ACL) reconstruction. Eight male professional soccer players competing at the highest level across different European countries, who had undergone ACL reconstruction, participated in this study. All patients underwent a supervised physiotherapy program after surgery. Data analyses included the use of separate two-way repeated-measures analyses of variance and effect sizes. Although knee extensor and flexor strength of the non-injured limb was found to be relatively unaltered ( g = -0.10 to 0.00) between stage 1 and stage 2, comparisons across time points revealed moderate improvements in quadriceps peak torque ( p = 0.01, g = 0.52), hamstring peak torque ( p = 0.07, g = 0.51), and hamstring:quadriceps (H/Q) ratio ( p = 0.03, g = -0.68) of the injured leg, as well as small-large improvements in the quadriceps ( p = 0.004, g = 1.24) and hamstring limb symmetry index (LSI) ( p = 0.056, g = 0.41). A time-dependent moderate-large asymmetry observed at stage 1 between the injured and noninjured leg in quadriceps peak torque ( p < 0.001, g = -1.83), hamstring peak torque ( p = 0.157, g = -0.67), and the H:Q ratio ( p = 0.06, g = 1.01), as well as between the hamstring and quadriceps LSI ( p = 0.03, g = -0.74) was eliminated at stage 2 ( g = -0.31 to 0.42). Our findings indicate the importance of supervised and comprehensive therapy, as well as strength screening to assist in recovery aimed at optimizing identified strength deficits following ACL reconstruction., (Copyright © 2022 National Strength and Conditioning Association.)

Purpose: The Knee Injury Osteoarthritis Outcome Score for children (KOOS-Child) is a self-administered, valid and reliable questionnaire for children and adolescents with knee disorders such as Osgood Schlatter disease, anterior knee pain, and patella dislocation. This study aimed to cross-culturally adapt the German version of the KOOS-Child questionnaire and test the reliability in two groups of children, one treated conservatively and the other surgically., Methods: A forward-backward translation of the original questionnaire into the German language was conducted. Children and adolescents between 10 and 18 years of age with knee disorders were included. Two groups were compared: sample one consisted of 24 participants with knee pain [20.8% boys; mean age = 13.4 (1.8) years treated conservatively. These participants completed the KOOS-Child questionnaire twice within two weeks to assess test-retest reliability. The second sample included 23 subjects (21.7% boys; mean age = 15.3 (1.9) years] treated surgically due to a knee disorder. They completed the questionnaire before surgery and six months postoperatively. Test-retest reliability and internal consistency were assessed using Spearman's rank correlation and Cronbach's alpha., Results: All subscales showed a good to excellent internal consistency at both measurement points in both groups (conservatively treated group: a = 0.88-0.95; surgery group a = 0.80-0.91), with the exception of the subscale knee problems (conservatively treated: a = 0.60 and 0.52; surgery: α = 0.77 and 0.66). Test-retest reliability was between r = 0.85 and 0.94., Conclusion: The predominantly good to excellent internal consistency and the high test-retest reliability justifies the use of the German adaptation of the KOOS-Child questionnaire as a reliable multidimensional instrument for measuring health status and therapeutic effects in adolescents' knee disorders., (© 2022. The Author(s).)

From a preventative perspective, leg axis and core stabilization capacities are important for soccer players and alpine skiers; however, due to different sport-specific demands, the role of laterality clearly differs and may result in functional long-term adaptations. The aims of this study are 1) to determine whether there are differences in leg axis and core stability between youth soccer players and alpine skiers and 2) between dominant and non-dominant sides, and 3) to explore the outcomes of applying common sport-specific asymmetry thresholds to these two distinct cohorts. Twenty-one highly trained/national-level soccer players (16.1 years, 95% CI: 15.6, 16.5) and 61 alpine skiers (15.7 years, 95% CI: 15.6, 15.8) participated in this study. Using a marker-based 3D motion capture system, dynamic knee valgus was quantified as the medial knee displacement ( MKD ) during drop jump landings, and core stability was quantified as the vertical displacement during deadbug bridging exercise ( DBB displacement ). For the analysis of sports and side differences, a repeated-measures multivariate analysis of variance was used. For the interpretation of laterality, coefficients of variation (CV) and common asymmetry thresholds were applied. There were no differences in MKD or DBB displacement between soccer players and skiers or between the dominant and non-dominant sides, but there was an interaction effect side*sports for both variables ( MKD : p = 0.040, η 2 p = 0.052; DBB displacement : p = 0.025, η 2 p = 0.061). On average, MKD was larger on the non-dominant side and DBB displacement laterality on the dominant side in soccer players, whereas this pattern was reversed in alpine skiers. Despite similar absolute values and asymmetry magnitudes of dynamic knee valgus and deadbug bridging performance in youth soccer players and alpine skiers, the effect on the direction of laterality was opposite even though much less pronounced. This may imply that sport-specific demands and potential laterality advantages should be considered when dealing with asymmetries in athletes., 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 Hanimann, Ellenberger, Bernhard, Franchi, Roth, Faude and Spörri.)

It is important to monitor secular trends in children's motor performance, as healthy and physically active children are more likely to become healthy and physically active adults. However, studies with regular and standardized monitoring of motor performance in childhood are scarce. Additionally, the impact of COVID-19 mitigation measures on secular trends is unknown. This study describes secular changes in balancing backwards, jumping sidewards, 20-m sprint, 20-m Shuttle Run Test (SRT) and anthropometric data in 10'953 Swiss first graders from 2014 to 2021. Multilevel mixed-effects models were used to estimate secular trends for boys vs. girls, lean vs. overweight and fit vs. unfit children. The potential influence of COVID-19 was also analysed. Balance performance decreased (2.8% per year), whereas we found improvements for jumping (1.3% per year) and BMI (-0.7% per year). 20-m SRT performance increased by 0.6% per year in unfit children. Children affected by COVID-19 measures had an increased BMI and were more overweight and obese, but motor performance was mostly higher. In our sample, secular changes in motor performance show promising tendencies from 2014 to 2021. The effects of COVID-19 mitigation measures on BMI, overweight and obesity should be monitored in additional birth cohorts and follow-up studies.

Introduction: A physical activity counseling intervention based on a motivation-volition model was developed and delivered to in-patients with Major Depressive Disorders with the aim of increasing lifestyle physical activity. The aim of this study is to evaluate the short-term outcomes of this intervention., Methods: A multi-center randomized controlled trial was conducted in four Swiss psychiatric clinics. Adults who were initially insufficiently physically active and were diagnosed with Major Depressive Disorder according to ICD-10 were recruited. The sample consisted of 113 participants in the intervention group ( M age = 42 years, 56% women) and 107 in the control group ( M age = 40 years, 49% women). Motivation and volition determinants of physical activity were assessed with questionnaires. Implicit attitudes were assessed with an Implicit Association Test. Physical activity was self-reported and measured with hip-worn accelerometers over 7 consecutive days starting on the day following the data collection., Results: According to accelerometer measures, step count decreased on average 1,323 steps less per day (95% CI = -2,215 to -431, p < 0.01) over time in the intervention group compared to the control group. A trend was recognized indicating that moderate-to-vigorous physical activity decreased on average 8.37 min less per day (95% CI = -16.98 to 0.23, p < 0.06) over time in the intervention group compared to the control group. The initial phase of the intervention does not seem to have affected motivational and volitional determinants of and implicit attitudes toward physical activity., Conclusion: Physical activity counseling may be considered an important factor in the transition from in-patient treatment. Methods to optimize the intervention during this period could be further explored to fulfill the potential of this opportunity., Clinical Trial Registration: https://www.isrctn.com/ISRCTN10469580, identifier ISRCTN10469580., 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 Cody, Beck, Brand, Donath, Faude, Hatzinger, Imboden, Kreppke, Lang, Ludyga, Mans, Mikoteit, Oswald, Schweinfurth, Zahner and Gerber.)

Purpose: Muscle anatomical cross-sectional area (ACSA) can be assessed using ultrasound and images are usually evaluated manually. Here, we present DeepACSA, a deep learning approach to automatically segment ACSA in panoramic ultrasound images of the human rectus femoris (RF), vastus lateralis (VL), gastrocnemius medialis (GM) and lateralis (GL) muscles., Methods: We trained three muscle-specific convolutional neural networks (CNN) using 1772 ultrasound images from 153 participants (age = 38.2 yr, range = 13-78). Images were acquired in 10% increments from 30% to 70% of femur length for RF and VL and at 30% and 50% of muscle length for GM and GL. During training, CNN performance was evaluated using intersection-over-union scores. We compared the performance of DeepACSA to manual analysis and a semiautomated algorithm using an unseen test set., Results: Comparing DeepACSA analysis of the RF to manual analysis with erroneous predictions removed (3.3%) resulted in intraclass correlation (ICC) of 0.989 (95% confidence interval = 0.983-0.992), mean difference of 0.20 cm 2 (0.10-0.30), and SEM of 0.33 cm 2 (0.26-0.41). For the VL, ICC was 0.97 (0.96-0.968), mean difference was 0.85 cm 2 (-0.4 to 1.31), and SEM was 0.92 cm 2 (0.73-1.09) after removal of erroneous predictions (7.7%). After removal of erroneous predictions (12.3%), GM/GL muscles demonstrated an ICC of 0.98 (0.96-0.99), a mean difference of 0.43 cm 2 (0.21-0.65), and an SEM of 0.41 cm 2 (0.29-0.51). Analysis duration was 4.0 ± 0.43 s (mean ± SD) for analysis of one image in our test set using DeepACSA., Conclusions: DeepACSA provides fast and objective segmentation of lower limb panoramic ultrasound images comparable with manual segmentation. Inaccurate model predictions occurred predominantly on low-quality images, highlighting the importance of high-quality image for accurate prediction., (Copyright © 2022 by the American College of Sports Medicine.)

High end ultrasonography devices lack in portability and are expensive. We investigated the agreement and reliability of a handheld and portable ultrasound system for human lower limb muscle architecture measurements. We captured ultrasound images of the rectus femoris (RF), vastus lateralis (VL) and gastrocnemius medialis (GM) in 36 active healthy participants (15 female, 21 male) at 50% of muscle length using the handheld Lumify (L12-4, linear-array 37 mm, Philips Healthcare, Amsterdam, Netherlands) and a high-end laboratory device (ACUSON Juniper, linear-array 54 mm, 12L3, SIEMENS Healthineers, Erlangen, Germany). We compared measurements of muscle fascicle length, pennation angle and thickness. To assess inter-session reliability of the Lumify system, participants were measured twice within 1 week. Comparing RF architecture measurements of both devices resulted in intra-class correlations (ICCs) ranging from 0.46-0.82 and standardized mean difference (SMDs) ranging from -0.45-0.05. For VL, ICCs ranged from 0.60-0.89 and SMDs ranged from -0.11-0.13. ICCs and SMDs for the GM ranged from 0.82-0.86 and -0.07-0.07. Calculating inter-session reliability for RF resulted in ICCs ranging from 0.44-0.76 and SMDs ranging from -0.38-0.15. For VL, ICCs and SMDs ranged from 0.57-0.75 and -0.13-0.02. ICCs for GM ranged from 0.75-0.92 and SMDs ranged from -0.15-0.16. Measurement of muscle thickness demonstrated the highest agreement (ICC ≥0.82) and reliability (ICC ≥0.75) across all muscles. The Lumify system was comparable to a high-end device and reliable for GM measurements. However, agreement and reliability were lower for the RF and VL. Of all evaluated architectural parameters, muscle thickness exhibited highest agreement and reliability., Competing Interests: PR and OF were under contractual agreement with Philips Healthcare. However, Philips Healthcare was neither involved in the design and conduct of the study, nor the analysis. Further, Philips Healthcare did not have any decision making or approval in the submission of this manuscript. The remaining 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 © 2022 Ritsche, Schmid, Franchi and Faude.)

Background: Diet quality indices can provide important information about relationships between diet and health independent of energy balance. The Healthy Eating Index-2015 (HEI-2015) is widely used and has been extensively evaluated. However, due to imperial units the HEI-2015 is difficult to apply in countries with metric systems. Our objective was to develop a metric version of the HEI-2015 and compare it to the original. The metric Healthy Eating Index-2015 (mHEI-2015) is intended to simplify the application of a dietary quality index in countries using the metric system., Methods: We developed a metric database logic following the methodology of the HEI-2015, which allows the application to metric databases and was applied to Food Patterns Equivalents Database (FPED). The HEI-2015 was calculated for the National Health and Nutrition Examination Survey (NHANES) 2017-2018 and the scoring standards for each component of the mHEI-2015 was calibrated against it. For the assessment of agreement between indices, HEI-2015 and mHEI-2015 were calculated for NHANES 2015-2016 and a Bland-Altman plot was created., Results: Healthy Eating Index-2015 and mHEI-2015 for the NHANES 2015-2016 averaged 52.5 ± 13.5 and 52.6 ± 13.2, respectively. The total scores as well as component scores of the indices were strongly correlated. The Bland-Altman plot revealed a high agreement of the total scores. An illustrated analysis of six different menu plans showed only minor differences between the HEI-2015 and mHEI-2015 component scores., Conclusion: The mHEI-2015 allows for superior analysis of metric dietary data to better examine the relationship between chronic diseases and diet. The streamlined metric methodology enables straightforward application to metric food databases and thus the development of country-specific indices., 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 © 2022 Kohl, Hohberg, Hauff, Lang, Faude, Gollhofer and König.)

Question: What is the effect of injury prevention programs that include balance training exercises on the incidence of ankle injuries among soccer players?, Design: Systematic review of randomised trials with meta-analysis., Participants: Soccer players of any age, sex or competition level., Interventions: The experimental intervention was an injury prevention program that included balance training exercises. The control intervention was the soccer team's usual warm-up program., Outcome Measures: Exposure-based ankle injury rates., Results: Nine articles met the inclusion criteria. The pooled results of injury prevention programs that included balance training exercises among 4,959 soccer players showed a 36% reduction in ankle injury per 1,000 hours of exposure compared to the control group with an injury risk ratio (IRR) of 0.64 (95% CI 0.54 to 0.77). The pooled results of the Fédération Internationale de Football Association (FIFA) injury prevention programs caused a 37% reduction in ankle injury (IRR 0.63, 95% CI 0.48 to 0.84) and balance-training exercises alone cause a 42% reduction in ankle injury (IRR 0.58, 95% CI 0.41 to 0.84)., Conclusions: This meta-analysis demonstrates that balance exercises alone or as part of an injury prevention program decrease the risk of ankle injuries. PROSPERO CRD42017054450., (Copyright © 2022 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Introduction: The widespread prevalence of type 2 diabetes (T2D) not only influences patients' daily lives but also has an economic impact on society. Increasing physical activity and a healthy diet can delay the progression of T2D. Although there are evidence-based recommendations on diet and physical activity, patients with T2D have difficulties implementing them. An appropriate lifestyle intervention can address this problem., Methods and Analysis: This study is based on the need to develop an intervention that helps patients to establish behavioural changes in order to achieve glycaemic control. The intervention will be evaluated in a monocentric, open-label, pragmatic, two-arm randomised controlled trial with a sample ratio of 1:1 and a parallel design. This superiority study will be conducted in Switzerland. All enrolled patients (n=90) will receive the standard medical treatment for T2D. The intervention group will receive personal health coaching by telephone and access to a smartphone and web application for 1 year. The control group will receive access to the application for 1 year and a one-time written diet and exercise recommendation. The primary outcomes are objectively measured physical activity and glycated haemoglobin. Secondary outcomes are self-reported physical activity, nutrition, cognitive mediators of changes in sport-related behaviour, blood values, medication and nutritional supplements, anthropometric data, quality of life, neuropathy and cost-effectiveness. All outcomes will be measured at baseline, at 27 weeks after inclusion and at 54 weeks after inclusion. The recruitment of participants and the measurements will be completed after 2 years. Linear mixed-effects models will be applied for each outcome variable to analyse the intervention effects., Ethics and Dissemination: This study was approved by the Ethics Committee North-western and Central Switzerland in February 2021 (ref: 2020-02755). All participants will be required to provide written informed consent. The results will be published in international peer-reviewed journals., Trial Registration Number: ISRCTN79457541., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

We aimed to analyze the number and type of contacts involving the risk of respiratory disease transmission during football match play. We analysed 50 matches from different playing levels. Two reviewers evaluated the contacts of all players in each match. We focused on between-player contacts, crowding, actions with potentially increased aerosol and droplet production and within-player hand-to-head contacts. We categorized the duels with direct contact into frontal and other ones and measured contact duration. The number of between-player contacts were similar between playing levels (median 28.3 [IQR 22.6, 33] contacts per player-hour). Frontal contacts summed up to 8% of all contacts. Contacts involving the head occurred less than once per player and match with none lasting longer than 3 s. Crowding included between two and six players and the duration was mostly less than 10 s. Aerosol and droplet producing activities were three to four times more frequent in adult compared to youth players. Our results suggest that the risk of respiratory pathogen transmission is low during football matches. This conclusion is based on the finding that most close contact situations are of short duration and on the fact that it is an outdoor sport., (© 2022. The Author(s).)

Objective: To investigate the risk of transmission among potentially infectious SARS-CoV-2-positive football players while participating in training or matches at amateur, youth and professional levels., Methods: Between August 2020 and March 2021, football players who tested positive for SARS-CoV-2 and participated in matches or training during the period of potential contagiousness were identified through media search (professional level) and a nationwide registry in Germany (amateur and youth level) to determine symptoms, source of infection and hygiene measures adopted. The definition of potentially infectious players was based on the time of a positive PCR testing and symptom onset. Transmission-relevant contacts on the pitch were evaluated through doubly reviewed video analysis., Results: Out of 1247 identified football matches and training sessions (1071 amateur and youth level, 176 professional level), 104 cases (38 training sessions, 66 matches) with 165 potentially infectious players were detected. Follow-up PCR testing at the professional level (44 cases) revealed no transmission. At the amateur and youth level, the combination of partial PCR testing (31 of 60 cases) and symptom monitoring within 14 days post-exposure (46 of 60 cases) identified 2 of 60 matches in which follow-up infections occurred that were attributed to non-football activities. This is consistent with the video analysis of 21 matches demonstrating frontal contacts were <1 per player-hour (88%, 30 of 34 players), each lasting no longer than 3 s., Conclusion: On-field transmission risk of SARS-CoV-2 in football is very low. Sources of infections in football players are most likely not related to activities on the pitch., Competing Interests: Competing interests: TM is Chairman of the Medical Committee of the DFB and UEFA. BG is member of the task force 'Sports Medicine/Special Match Operations' of the German Football League (DFL, Deutsche Fußball Liga)., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: This study analyzed physical, cardiovascular, and psychosocial health in different age groups at the far end of the lifespan., Methods: Sixty-two residential seniors participated in this cross-sectional study and were assigned according to age to either the older adults ( n = 27; age: 74.8 (3.6); f: 23) or the oldest-old group ( n = 35; age: 87.2 (5.0); f: 28). Gait speed, functional mobility, handgrip strength, and pulse wave velocity (PWV) were measured. Additionally, questionnaires to assess quality of life were applied. Mean between-group differences (Δ) and Hedge's g with 95 % confidence intervals were calculated., Results: Oldest-old had moderately lower handgrip strength (Δ = -31.3 N, 95% CI [-66.30; -1.65], Hedge's g = 0.49 [-0.97; 0.03]) and relevant lower gait speed than the older adults (Δ = -0.11 m/s [-0.28; 0.05], g = 0.34 [-0.89; 0.20]). All other physical parameters showed trivial differences. Very large effects were found in PWV in favor of the older adults (Δ = -2.65 m/s [-3.26; -2.04], g = -2.14 [-2.81; -1.36]). The questionnaires showed trivial to small differences., Conclusion: We found small differences in physical as well as psychosocial health between age groups with large inter-individual variance. Large differences were found in arterial stiffness, which increases with age. Exercise programs in nursing homes should consider physical, psychosocial, and cardiovascular variables more than age.

Enjoying Sports and Movement in Mental Illness Abstract. Sports and exercise therapy is an effective complemant in the treatment of major depression. The recommendations of at least 150 minutes of moderate or 75 minutes of intensive physical activity per week should be met to achieve positive effects of physical activity. In addition, individual needs and the physical health conditions must be considered in the planning and implementation, so that exercise will be enjoyed in the long term.

Background: Copenhagen adduction exercise (CAE) and Nordic hamstring exercise (NHE) reduce the incidence of groin and hamstring injuries. Efficient dynamic balance can improve motor performance and reduce the risk of injuries in athletes. However, the effects of these exercises on dynamic balance have not been investigated., Hypothesis: CAE and NHE, as well as a combination of both exercises, would improve dynamic balance among amateur male athletes., Study Design: Randomized controlled trial., Level of Evidence: Level 1., Methods: A total of 200 male athletes aged 21.9 ± 2.4 years were included in the study and randomly assigned to 4 groups: CAE group (n = 50), NHE group (n = 50), CAE and NHE group (n = 50), and a control group (n = 50). A total of 177 male athletes completed the study. The primary outcome measure was the limit of stability (LoS), which was measured using the Biodex Stability System to assess the performance of the dynamic balance. The LoS of the athletes' performance was measured pre- and postintervention after 6 weeks., Results: The LoS significantly improved in all treatment groups, including CAE (44.5% ± 5.3%), NHE (43.2% ± 5.3%), and CAE + NHE (48.4% ± 5.1%) groups when compared with the control group (28.3% ± 4.8%) after 6 weeks (all P s < 0.01). The improvement of LoS was significantly greater in the CAE + NHE group compared with other groups (CAE, NHE, and control groups)., Conclusion: There was a significant increase in dynamic balance performance postintervention among male athletes. CAE and NHE may improve injury prevention programs., Clinical Relevance: The results of this study provide evidence for athlete trainers and coaches to consider including the CAE and NHE as components of injury prevention programs to improve balance capacity and performance in athletes. Such improvements in balance may prevent injury risk and decrease absenteeism and injury-related financial burdens.

The risk of viral transmission of SARS-CoV-2 associated with football (soccer) training and match play is unknown. Therefore, studies on infection-relevant contacts in football are of utmost importance.A retrospective video-based analysis was performed over 3 matches with 18 SARS-CoV-2 positive players (age: 17.6 ± 3.1 years; 2 professional, 2 semi-professional and 14 youth academy players) during the pre-season in August and September 2020 in Germany. Repeated RT-PCR tests were performed in 5 of 6 teams and pre-match RT-PCR tests in 4 of 6 teams. The last RT-PCR test ranged between 5 - 14 days post-match. The most important result was that no case of virus transmission was found as documented by RT-PCR tests (and symptom monitoring up to 14 days post-match). Physical contact between contagious and non-infected players never lasted longer than 3 seconds each and the position of players during duels was almost exclusively laterally or behind each other.In conclusion, very low risk of SARS-CoV-2 transmission during football match play has been documented. Nevertheless, due to the observational retrospective design of the study, which was based on ethical reasons, inconsistent RT-PCR testing should be regarded as limitation and larger studies are needed to confirm a low probability of virus transmission.

Purpose: Hamstring muscle architecture may be associated with sprint performance and the risk of sustaining a muscle injury, both of which increase during puberty. In this study, we investigated the m. biceps femoris long head (BFlh) cross-sectional area (ACSA), fascicle length (FL) and pennation angle (PA), and sprint performance as well as their relationship in under 13 to 15 youth soccer players., Methods: We measured 85 players in under-13 (n = 29, age = 12.5 [0.1] y, height = 155.3 [6.2] cm, weight = 43.9 [7.6] kg), under-14 (n = 25, age = 13.5 [0.3] y, height = 160.6 [7.7] cm, weight = 47.0 [6.8] kg), and under-15 (n = 31, age = 14.4 [0.3] y, height = 170.0 [7.7] cm, weight = 58.1 [8.8] kg) teams. We used ultrasound to measure BFlh ACSA, FL and PA, and sprint tests to assess 10- and 30-m sprint time, maximal velocity  (vmax), and maximal acceleration (αmax). We calculated Pearson r to assess the relationship between sprint ability and architectural parameters., Results: All muscle architectural parameters increased from the under-13 to the under-15 age group (BFlh ACSA = 37%, BFlh FL = 11%, BFlh PA = 8%). All sprint performance parameters improved from the under-13 to under-15 age categories (30-m time = 7%, 10-m time = 4%, vmax = 9%, αmax = 7%). The BFlh ACSA was correlated with 30-m sprint time (r = -.61 (95% compatibility interval [CI] [-.73, -.45]) and vmax (r = .61, 95% CI [.45, .72]). A combination of BFlh ACSA and age best predicted 30-m time (R² = .47 [.33, .62]) and 10-m time (R² = .23 [.08, .38])., Conclusions: Muscle architectural as well as sprint performance parameters increase from the under-13 to under-15 age groups. Even though we found correlations for all assessed architectural parameters, BFlh ACSA was best related to the assessed sprint parameters.

Introduction: Major depression is a psychiatric disease associated with physical inactivity, which in turn affects mental and physical health. A randomized controlled trial is being implemented to facilitate physical activity in people with major depression. In March 2020, Swiss state authorities temporarily legislated a lockdown to contain the Coronavirus disease-19 (COVID-19), which influenced health, behavior and research. The aim of this study was to find out whether data gathered before and during/after the lockdown among in-patients with major depression differ with regard to psychosocial health, physical activity and related attitudes and to establish whether baseline data have been affected by the lockdown. Methods: This is a cross-sectional analysis within a randomized controlled trial. Physically inactive, adult in-patients diagnosed with major depression were recruited from four Swiss psychiatric clinics between January 2019 and December 2020. Psychosocial health was measured with questionnaires pertaining to stress, sleep and health-related quality of life. Physical activity was measured with the Simple Physical Activity Questionnaire. Explicit attitudes were measured with seven questionnaires pertaining to physical activity-related motivation and volition. Implicit attitudes toward physical activity were captured with a single target implicit association test. Results: The sample consisted of 165 participants ( n = 119 before lockdown, n = 46 during/after lockdown). No statistically significant differences were found between in-patients with major depression assessed before and during/after the COVID-19 lockdown with regard to psychosocial health (stress, p = 0.51; sleep, p = 0.70; physical component of health-related quality of life, p = 0.55; mental component of health-related quality of life, p = 0.64), self-reported physical activity ( p = 0.16) and explicit as well as implicit attitudes toward physical activity ( p = 0.94). Hence, the COVID-19-induced lockdown seems not to have led to group differences. Conclusion: Baseline data gathered in in-patients suffering from major depression who are physically inactive upon admission to in-patient treatment in Switzerland seem to be unaffected by the COVID-19-induced lockdown. To assess changes in said population regarding psychosocial health and physical activity patterns over time, longitudinal data are needed., 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 © 2021 Cody, Kreppke, Beck, Donath, Eckert, Imboden, Hatzinger, Holsboer-Trachsler, Lang, Ludyga, Mans, Mikoteit, Oswald, Rogausch, Schweinfurth, Zahner, Faude and Gerber.)

Objective: Central hemodynamics are related to cardiovascular (CV) outcomes in adults, but associations with childhood CV risk remain unclear. The study aimed to investigate the association of obesity, physical activity, and fitness with parameters of central pulse wave reflection in young prepubertal children. Methods: In this cross-sectional study, 1,324 primary school children (aged 7.2 ± 0.4 years) were screened for parameters of pulse wave reflection such as augmentation index (AIx), central pulse pressure (CPP), body mass index (BMI), and cardiorespiratory fitness (CRF) by standardized procedures for children. Results: The mean AIx and AIx@75 were 22.2 ± 7.7 and 29.2 ± 9.2%, respectively. With each unit increase in BMI, AIx [-0.226 (-0.328; -0.125)%] and AIx@75 [-0.444(-0.660; -0.229)%] decreased, whereas peak forward pulse wave increased ( p < 0.001). Increasing BMI was associated with higher CPP, but did not remain significant after adjustment for CRF and heart rate. One unit increase in CRF was associated with lower AIx@75 [-0.509(-0.844; -0.173)%, p = 0.003] and lower reflection magnitude [RM: -0.559 (-0.890; -0.227), p = 0.001], independent of body weight and height. Girls had significantly higher AIx, AIx@75, peak backward pulse wave, and RM compared with boys. Conclusion: Childhood obesity was associated with higher CPP but lower augmentation of the reflected pulse wave in children. Assessment of central blood pressures appears to be a valuable asset to childhood CV risk screening. The validity of augmentation indices during childhood development and the association with early vascular aging in children need to be verified in long-term follow-up studies. Physical activity and fitness have the potential to improve vascular hemodynamics in susceptible children and, thus, counteract vascular aging. Trial registry: ClinicalTrials.gov: Exercise and Arterial Modulation in Youth. Identifier: NCT02853747; URL: https://clinicaltrials.gov/ct2/show/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. The handling Editor declared a past collaboration with several of the authors SK, HH., (Copyright © 2021 Köchli, Deiseroth, Hauser, Streese, Schmidt-Trucksäss, Faude and Hanssen.)