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ObjectiveThis study aims to evaluate and predict the long-term effectiveness of five lifestyle interventions for individuals with eating disorders using machine learning techniques.MethodsThis study, conducted at Dr. Irandoust’s Health Center at Qazvin from August 2021 to August 2023, aimed to evaluate the effects of five lifestyle interventions on individuals with eating disorders, initially diagnosed using The Eating Disorder Diagnostic Scale (EDDS). The interventions were: (1) Counseling, exercise, and dietary regime, (2) Aerobic exercises with dietary regime, (3) Walking and dietary regime, (4) Exercise with a flexible diet, and (5) Exercises through online programs and applications. Out of 955 enrolled participants, 706 completed the study, which measured Body Fat Percentage (BFP), Waist-Hip Ratio (WHR), Fasting Blood Sugar (FBS), Low-Density Lipoprotein (LDL) Cholesterol, Total Cholesterol (CHO), Weight, and Triglycerides (TG) at baseline, during, and at the end of the intervention. Random Forest and Gradient Boosting Regressors, following feature engineering, were used to analyze the data, focusing on the interventions’ long-term effectiveness on health outcomes related to eating disorders.ResultsFeature engineering with Random Forest and Gradient Boosting Regressors, respectively, reached an accuracy of 85 and 89%, then 89 and 90% after dataset balancing. The interventions were ranked based on predicted effectiveness: counseling with exercise and dietary regime, aerobic exercises with dietary regime, walking with dietary regime, exercise with a flexible diet, and exercises through online programs.ConclusionThe results show that Machine Learning (ML) models effectively predicted the long-term effectiveness of lifestyle interventions. The current study suggests a significant potential for tailored health strategies. This emphasizes the most effective interventions for individuals with eating disorders. According to the results, it can also be suggested to expand demographics and geographic locations of participants, longer study duration, exploring advanced machine learning techniques, and including psychological and social adherence factors. Ultimately, these results can guide healthcare providers and policymakers in creating targeted lifestyle intervention strategies, emphasizing personalized health plans, and leveraging machine learning for predictive healthcare solutions.

BackgroundAlthough runner’s profiles were previously investigated, information on the training frequency and training distance for short (5 km, 10 km) and long-distance (>21 km) running is absent. The present study aimed to investigate the associations between training routines and exercise habits of recreational endurance runners considering self-reported preferred race distance [10 km, half-marathon (HM), and marathon/ultra-marathon (M/UM)] subgroups.MethodsThis is a cross-sectional study, sampling 154 recreational runners of both sexes. A web survey was used for data collection regarding age, sex, preferred distance (10-km, HM, M/UM), training routines, exercise habits, and periodized training routines. The Chi-square test (Cramer’s V) and Kruskal-Wallis test (Eta-Squared η2) with effect sizes were used for comparisons between race distances.ResultsSignificant differences were shown for anthropometric, training, and periodization characteristics. Highly significant differences were found between subgroups for the number of sessions, running kilometers, and training hours at all periods and within all four preparation conditions. M/UM runners were training more frequently, for longer durations, and ran greater distances each week.ConclusionThis finding supports the notion that training habits and periodization characteristics are different for different race distances (10-km, half marathon, marathon, and ultramarathon).

PurposeThe aim of the study was to investigate the effects of a 10-week plyometric training (PT) on changes of direction, jumping ability, repeated sprint ability, and both muscular strength and power in youth female handball players.MethodsTwenty-eight participants (age: 15.8 ± 0.2 years) were randomly divided into a plyometric group (PG; n = 14) or a control group (CG; n = 14). Significant (group × time) interaction was noted for change of direction (COD) [Modified agility T-test (T-half)], three jumping tests [squat jump (SJ), countermovement jump (CMJ) and standing long jump (SLJ)], repeated sprint ability (RSA), muscular strength (1-RM bench press and 1-RM half squat) and muscular power (force-velocity test for both upper and lower limb).ResultsWith a group × time interaction, the PG enhanced the T-half performance [p

Background: The two aspects of the influence of environmental conditions on marathon running performance and pacing during a marathon have been separately and widely investigated. The influence of environmental conditions on the pacing of age group marathoners has, however, not been considered yet.Objective: The aim of the present study was to investigate the association between environmental conditions (i.e., temperature, barometric pressure, humidity, precipitation, sunshine, and cloud cover), gender and pacing of age group marathoners in the “New York City Marathon”.Methodology: Between 1999 and 2019, a total of 830,255 finishes (526,500 males and 303,755 females) were recorded. Time-adjusted averages of weather conditions for temperature, barometric pressure, humidity, and sunshine duration during the race were correlated with running speed in 5 km-intervals for age group runners in 10 years-intervals.Results: The running speed decreased with increasing temperatures in athletes of age groups 20–59 with a pronounced negative effect for men aged 30–64 years and women aged 40–64 years. Higher levels of humidity were associated with faster running speeds for both sexes. Sunshine duration and barometric pressure showed no association with running speed.Conclusion: In summary, temperature and humidity affect pacing in age group marathoners differently. Specifically, increasing temperature slowed down runners of both sexes aged between 20 and 59 years, whereas increasing humidity slowed down runners of 80 years old.

Background: The effect of financial incentives on the quality of primary care is of high interest, and so is its sustainability after financial incentives are withdrawn.Objective: To assess both long-term effects and sustainability of financial incentives for general practitioners (GPs) in the treatment of patients with diabetes mellitus based on quality indicators (QIs) calculated from routine data from electronic medical records.Design/Participants: Randomized controlled trial using routine data from electronic medical records of patients with diabetes mellitus of Swiss GPs.Intervention: During the study period of 24 months, all GPs received bimonthly feedback reports with information on their actual treatment as reflected in QIs. In the intervention group, the reports were combined with financial incentives for quality improvement. The incentive was stopped after 12 months.Measurements: Proportion of patients meeting the process QI of annual HbA1c measurements and the clinical QI of blood pressure levels below 140/85 mmHg.Results: A total of 71 GPs from 43 different practices were included along with 3,854 of their patients with diabetes mellitus. Throughout the study, the proportion of patients with annual HbA1c measurements was stable in the intervention group (78.8–78.9%) and decreased slightly in the control group (81.5–80.2%) [odds ratio (OR): 1.21; 95% CI: 1.04–1.42, p < 0.05]. The proportion of patients achieving blood pressure levels below 140/85 mmHg decreased in the control group (51.2–47.2%) and increased in the intervention group (49.7–51.9%) (OR: 1.18; 95% CI: 1.04–1.35, p < 0.05) where it peaked at 54.9% after 18 months and decreased steadily over the last 6 months.Conclusion: After the withdrawal of financial incentives for the GPs after 12 months, some QIs still improved, indicating that 1 year might be too short to observe the full effect of such interventions. The decrease in QI achievement rates after 18 months suggests that the positive effects of time-limited financial incentives eventually wane.

AimDespite the increasing popularity of outdoor endurance running races of different distances, little information exists about the role of training and physiological characteristics of recreational runners. The aim of the present study was (a) to examine the role of training and physiological characteristics on the performance of recreational marathon runners and (b) to develop a prediction equation of men’s race time in the “Athens Authentic Marathon.”MethodsRecreational male marathon runners (n = 130, age 44.1 ± 8.6 years)—who finished the “Athens Authentic Marathon” 2017—performed a series of anthropometry and physical fitness tests including body mass index (BMI), body fat percentage (BF), maximal oxygen uptake (VO2max), anaerobic power, squat, and countermovement jump. The variation of these characteristics was examined by quintiles (i.e., five groups consisting of 26 participants in each) of the race speed. An experimental group (EXP, n = 65) was used to develop a prediction equation of the race time, which was verified in a control group (CON, n = 65).ResultsIn the overall sample, a one-way ANOVA showed a main effect of quintiles on race speed on weekly training days and distance, age, body weight, BMI, BF, and VO2max (p ≤ 0.003, η2 ≥ 0.121), where the faster groups outscored the slower groups. Running speed during the race correlated moderately with age (r = −0.36, p < 0.001) and largely with the number of weekly training days (r = 0.52, p < 0.001) and weekly running distance (r = 0.58, p < 0.001), but not with the number of previously finished marathons (r = 0.08, p = 0.369). With regard to physiological characteristics, running speed correlated largely with body mass (r = −0.52, p < 0.001), BMI (r = −0.60, p < 0.001), BF (r = −0.65, p < 0.001), VO2max (r = 0.67, p < 0.001), moderately with isometric muscle strength (r = 0.42, p < 0.001), and small with anaerobic muscle power (r = 0.20, p = 0.021). In EXP, race speed could be predicted (R2 = 0.61, standard error of the estimate = 1.19) using the formula “8.804 + 0.111 × VO2max + 0.029 × weekly training distance in km −0.218 × BMI.” Applying this equation in CON, no bias was observed (difference between observed and predicted value 0.12 ± 1.09 km/h, 95% confidence intervals −0.15, 0.40, p = 0.122).ConclusionThese findings highlighted the role of aerobic capacity, training, and body mass status for the performance of recreational male runners in a marathon race. The findings would be of great practical importance for coaches and trainers to predict the average marathon race time in a specific group of runners.

The influence of environmental conditions has been investigated for different marathon races, but not for the Berlin Marathon, the fastest marathon race course in the world. The aim of this study was to investigate the potential influence of environmental conditions such as temperature, precipitation, sunshine, and atmospheric pressure on marathon race times in the Berlin Marathon since its first event in 1974–2019. A total of n = 882,540 valid finisher records were available for analysis, of which 724,135 correspond to male and 158,405 to female runners. We performed analyses regarding performance levels considering all finishers, the top 3, the top 10, and the top 100 women and men. Within the 46 years of Berlin marathons under study, there was some level of precipitation for 18 years, and 28 years without any rain. Sunshine was predominant in 25 of the events, whilst in the other 21, cloud cover was predominant. There was no significant trend with time in any of the weather variables (e.g., no increase in temperature across the years). Overall runners became slower with increasing temperature and sunshine duration, however, elite runners (i.e., top 3 and top 10) seemed to run faster and improved their race times when the temperature increased (with women improving more than men). Top 10 women seemed to benefit more from increasing temperatures than top 10 males, and male top 100 runners seemed to benefit more from increasing temperatures than female top 100 runners. In the top three sub-group, no differences were observed between male and female correlations. In summary, in marathoners competing in the Berlin Marathon between 1974 and 2019, increasing temperatures and sunshine duration showed a different effect on different performance levels where overall runners (i.e., the general mass of runners) became slower with increasing temperature and sunshine duration, but elite runners (i.e., top 3, top 10) became faster with increasing temperatures where sex differences exist.

The aspect of participation and performance trends in marathon running has been investigated mainly in marathons held in the United States of America (e.g., “New York City Marathon,” “Boston Marathon”), but not for the fastest course in the world, the “Berlin Marathon” held in Berlin, Germany. This study aimed to examine trends in participation and performance in the “Berlin Marathon” on all its previous 46 editions from 1974 to 2019, the largest dataset ever studied in this event with 696,225 finishers (after data cleaning). Athletes in all age groups increased their participation, except for male athletes aged 20–49 years and athletes of both sexes above 79 years of age. This overall increase in participation was more pronounced in women, but still, there are more men than women participating in “Berlin Marathon” nowadays. All age group athletes decreased their performance across years overall, whereas the top ten recreational athletes improved their performance over the years. Our findings improved the knowledge about the evolution of male and female marathoners across calendar years, especially for the fastest marathon race in the world, the “Berlin Marathon.”

Objective: To analyze the proportion of dedication in each triathlon discipline (swimming, cycling, and running) and the importance of each separate discipline to predict overall performance of elite triathletes across different triathlon distances.Methods: Data from 2015 to 2020 (n = 16,667) from official races and athletes in Sprint, Olympic distance, IM 70.3 (Half-Ironman distance), and IM 140.6 (Full-Ironman distance) competitions were included. The proportion of each discipline was calculated individually and compared using general linear models by event distance, sex, and performance level. Automatic linear regression models were applied for each distance considering overall performance as the dependent variable.Results: A within-distance analysis showed that the best predictor for Sprint is cycling, for Olympic is swimming, for IM 70.3 is cycling, and for IM 140.6 is running. A between-distance analysis revealed that swimming is a better predictor in Olympic distance than in other triathlon distances. Cycling is a poor predictor for overall performance in IM 140.6, and the importance of running to predict overall performance is the highest in IM 140.6 and diminishes with decreasing race distance.Conclusion: Each discipline represents a different relative portion and importance to predict overall performance depending on the triathlon distance. Swimming is the most important predictor discipline in Sprint- and Olympic-distance triathlon, cycling in IM 70.3, and running in IM 140.6.

Background: Small-sided games (SSGs) are an adjusted form of official games that are often used in training scenarios to introduce a specific tactical issue to team sports players. Besides the acute effects of SSGs on players' performance, it is expectable that the consistent use of these drill-based games induces adaptations in the technical execution and tactical behaviors of youth team sports players.Objective: This systematic review with meta-analysis was conducted to assess the effects of SSG programs on the technical execution and tactical behaviors of young and youth team sports players.Data Sources: The data sources utilized were PubMed, Scopus, SPORTDiscus, and Web of Science.Study Eligibility Criteria: (i) Young and youth team sports players (i.e., < 18 years old) of any sex or skill level, without injury, illness, or other clinical conditions; (ii) SSGs-based programs not restricted to the duration and a minimum of one weekly training session; (iii) passive or active control groups; (iv) pre-post interventions values of technical execution and/or tactical behavior; (v) randomized and non-randomized controlled trials; and (vi) peer-reviewed original full-text studies written in English, Portuguese and/or Spanish.Results: The database search initially yielded 803 titles. From those, six articles were eligible for the systematic review and meta-analysis. None of the included studies presented tactical behavior outcomes. The results showed a small effect of SSGs on technical execution (ES = 0.59; 95% CI = 0.29 to 0.89; p < 0.001; I2 = 0.0%; Egger's test p = 0.590) when compared to controls. Sub-group analysis of the training factor revealed similar (p = 0.433) moderate (ES = 0.68, four study groups) and small (ES = 0.44, three study groups) improvements in technical execution after >17 and

The effect of different environmental conditions such as temperature, wind, barometric pressure, and precipitation has been well investigated in elite marathoners, but not by age categories (i.e., age group marathoners). The aim of the study was to investigate the potential influence of environmental conditions such as temperature, precipitation, and atmospheric pressure on marathon performance in age group marathoners competing in the ‘Berlin Marathon’ from 1974 to 2019. A total of 869,474 valid finisher records were available for analysis, of which 711,136 correspond to males and 158,338 to females. The influence of temperature, atmospheric pressure, and precipitation on marathon race times was investigated in age group marathoners grouped in 5-year-intervals. Within the 46 years of Berlin marathons under investigation, there was some level of precipitation for 18 years, and 28 years without any rain. Sunshine was predominant in 25 of the events, whilst in the other 21 years, cloud cover was predominant. Marathon race times were significantly and positively correlated with age (i.e., older runners were slower than younger runners) where the correlation was higher for males than for females. Marathon race times were significantly and positively correlated with both the hours of sunshine and the daily maximum temperature. The fastest marathon runners (meaning the minimum times) achieved the fastest race times on race days with higher maximum temperatures (i.e., 15–30°C). Daily maximum temperatures showed an influence on age group marathoners from age group 35–40 years and older. Higher precipitation levels impaired performance across most age groups. In summary, higher daily maximum temperatures (i.e., >15°C) and higher precipitation levels impaired performance of master marathoners (i.e., 35–40 years and older) competing in the ‘Berlin Marathon’ in the last 45 years. Master marathoners should start in marathon races with temperatures < 15°C and no precipitation in order to achieve a fast marathon race time.

The “Berlin Marathon” is the fastest marathon racecourse in the world and has witnessed 11 world records (WRs; eight in men and three in women). Weather conditions can have an important impact on race time and we therefore examined the influence of environmental conditions (i.e., temperature, sunshine, precipitation, barometric pressure, and cloud cover) on WRs and elite (i.e., winner, top three and top 10 finishers) marathon performances of men and women at the “Berlin Marathon” between 1974 and 2019. Average world record marathon times in men were 2:03:52 ± 0:01:19 h:min:s and 2:25:05 ± 0:08:25 h:min:s in females (p < 0.05). Male competitions were held 44 times (mean winning time: 2:09:48 ± 0:09:15 h:min:s) and female competitions 41 times (mean winning time: 02:30:35 ± 0:19:09 h:min:s; p < 0.05). World record performances were set at mean temperatures of 18.61 ± 2.59°C for men and 13.07 ± 4.01°C for women (p > 0.05). The ideal environmental conditions for world record performances for men were temperatures of 18.61°C (p > 0.05), sunny, mostly dry days, with higher atmospheric pressure and little cloud cover (all p > 0.05). In women, ideal conditions for world records performances were temperatures of 13.07°C (p > 0.05), with low atmospheric pressure (p > 0.05), but significantly more rain (p < 0.05), and with no sunshine (p < 0.05) and cloud cover (p < 0.05). With elite performances, the ideal temperatures were of 17.36 ± 4.33°C for men and 17.93 ± 4.07°C for women (p > 0.05), with little to no rain, and moderate cloud cover and sunshine (p > 0.05). In summary, novel findings are, that environmental conditions in world records performances differ between men and women, with women obtaining world records in bad weather (with rain, cloud cover, and no sunshine) and men in good weather (sunny, mostly dry days, with little cloud cover). Larger sample sizes are needed to examine sex differences and environmental conditions on world record marathon performances.

PurposeThe purpose of this study was to analyze variations of selection for competition between late and early mature players and test the relationships between anthropometry, body composition, maturation, and selection for competition.MethodsSeventy-nine youth soccer players from under-11 to under-14 participated in this study, over 6 months. Body composition and maturity offset were estimated based on anthropometric data collected. Participants were also monitored for their number of matches as starters and time of play accrued in minutes.ResultsMinutes played had large correlation coefficients with maturity offset (r = 0.58), and leg length and sitting height interaction (r = 0.56). Multiple linear regression explained 35% of the variation in minutes played (p < 0.001, R2 = 0.41, R2adjusted = 0.35, RMSE = 334.8), but only 12% of the variation in matches as starter (p = 0.04, R2 = 0.21, R2adjusted = 0.12, RMSE = 5.47) between above and below the median of the maturity offset was accounted for, respectively.ConclusionsAlthough maturation may play a role in the minutes of play accrued and matches as starters in young, it is not necessarily determining. A significant amount of the variation in the minutes of play accrued of players can be accounted for when considering body composition and anthropometric data.

Background: Mental fatigue can impact physical demands and tactical behavior in sport-related contexts. Small-sided games (SSGs) are often used to develop a specific sport-related context. However, the effects of mental fatigue on physical demands and tactical behaviors during soccer SSGs have not been aggregated for systematical assessment.Objective: This systematic review (with a meta-analysis) was conducted to compare the effects of mental fatigue vs. control conditions in terms of the total running distance and tactical behavior of soccer players during SSGs.Methods: The data sources utilized were PubMed, PsycINFO, Scielo, Scopus, SPORTDiscus, and Web of Science. The study eligibility criteria were established based on PICOS: (i) Population: healthy youth and young adult men soccer players with regular training practice and belonging to teams with regular competitions; (ii) Intervention: exposed to mental fatigue-induced protocols only before SSGs; (iii) Comparator: control conditions (passive or active not promoting mental fatigue) before SSGs; (iv) Outcomes: physical demands (total running distance) and tactical behavior (attacking behavior accuracy, pass decision-making accuracy, and space exploration index); (v) Study design: counterbalanced cross-over design; and (vi) only full-text and original articles written in English.Results: The database search initially identified 111 titles. From those, six articles were eligible for the systematic review and meta-analysis. Results showed no significant effect of fatigue on total running distance (ES = 0.13; p = 0.307) and tactical behavior (ES = 0.56; p = 0.079).Conclusions: A non-significant effect of mental fatigue on total running distance and tactical behaviors performed by soccer players during SSGs was found in this systematic review.

Trunk muscle strength and control is an important prerequisite for everyday activities among elderly people decreasing the predisposition to falls. High levels of physical exercise performed by older athletes could offer benefits to core/trunk muscle strength and postural control compared with recreational physical activities and among elderly people with lower levels of physical activity. The present study aimed to compare trunk muscle strength and postural control of older running athletes vs. older physically active adults. Participants were master road runners (RUN, n = 15, six women, 64.3 ± 3.6 years) and physically active elderly (control group, CON, n = 15, six women, 65.4 ± 5.0 years) people that were submitted to the evaluations: esthesiometer, posturography (force plate), and isokinetic test (Biodex dynamometer) of trunk muscle extension and flexion. RUN presented higher values for relative peak torque of trunk extensor muscles at 60°/s (p = 0.046) and 180°/s (p = 0.007) and relative average power during trunk extension at 60°/s (p = 0.008) and 180°/s (p = 0.004) compared to CON. CON had a higher medial-lateral oscillation speed of the center of pressure in the stable condition with eyes closed (p = 0.004) compared to RUN. RUN presented higher isokinetic torque of extensor trunk muscles and better postural control than CON. This supposedly could help with postural control and balance and contribute to the prevention of falls among the elderly. The practice of running systematically by master athletes may partially explained our findings.

The present study investigated pre-race preparation of a large sample of recreational runners competing in different race distances (e.g., shorter than half-marathon, half-marathon, marathon and ultra-marathon). An online questionnaire was used and a total of 3,835 participants completed the survey. Of those participants, 2,864 (75%) met the inclusion criteria and 1,628 (57%) women and 1,236 (43%) men remained after data clearance. Participants were categorized according to race distance in half-marathon (HM), and marathon/ultra-marathon (M/UM). Marathon and ultra-marathon data were pooled since the marathon distance is included in an ultra-marathon. The most important findings were (i) marathon and ultra-marathon runners were more likely to seek advice from a professional trainer, and (ii) spring was most commonly reported across all subgroups as the planned season for racing, (iii) training volume increased with increasing race distance, and (iv) male runners invested more time in training compared to female runners. In summary, runners competing in different race distances prepare differently for their planned race.Clinical Trial Registration:www.ClinicalTrials.gov, identifier ISRCTN73074080. Retrospectively registered 12th June 2015.

Predictive resting metabolic rate (RMR) equations are widely used to determine athletes’ resting energy expenditure (REE). However, it remains unclear whether these predictive RMR equations accurately predict REE in the athletic populations. The purpose of the study was to compare 12 prediction equations (Harris-Benedict, Mifflin, Schofield, Cunningham, Owen, Liu’s, De Lorenzo) with measured RMR in Turkish national team athletes and sedentary controls. A total of 97 participants, 49 athletes (24 females, 25 males), and 48 sedentary (28 females, 20 males), were recruited from Turkey National Olympic Teams at the Ministry of Youth and Sports. RMR was measured using a Fitmate GS (Cosmed, Italy). The results of each 12 prediction formulas were compared with the measured RMR using paired t-test. The Bland-Altman plot was performed to determine the mean bias and limits of agreement between measured and predicted RMRs. Stratification according to sex, the measured RMR was greater in athletes compared to controls. The closest equation to the RMR measured by Fitmate GS was the Harris-Benedict equation in male athletes (mean difference -8.9 (SD 257.5) kcal/day), and Liu’s equation [mean difference -16.7 (SD 195.0) kcal/day] in female athletes. However, the intra-class coefficient (ICC) results indicated that all equations, including Harris-Benedict for male athletes (ICC = 0.524) and Liu’s for female athletes (ICC = 0.575), had a moderate reliability compared to the measured RMR. In sedentary subjects, the closest equation to the measured RMR is the Nelson equation in males, with the lowest RMSE value of 118 kcal/day [mean difference: 10.1 (SD 117.2) kJ/day], whereas, in females, all equations differ significantly from the measured RMR. While Nelson (ICC = 0.790) had good and Owen (ICC = 0.722) and Mifflin (calculated using fat-free mass) (ICC = 0.700) had moderate reliability in males, all predictive equations showed poor reliability in females. The results indicate that the predictive RMR equations failed to accurately predict RMR levels in the participants. Therefore, it may not suitable to use them in determining total energy expenditure.

Introduction: Little information exists in the general population whether clinical presentation phenotypes of obstructive sleep apnea (OSA) differ in terms of sleep quality and comorbidities.Aim: The purpose of our study was to assess possible differences between symptomatic and asymptomatic OSA patients concerning syndrome's severity, patients' sleep quality, and comorbidities.Subjects and methods: First, in a nationwide, stratified, epidemiological survey, 4,118 Cypriot adult participants were interviewed about sleep habits and complaints. In the second stage of the survey, 264 randomly selected adults underwent a type III sleep study for possible OSA. Additionally, they completed the Greek version of Pittsburgh Sleep Quality Index (Gr-PSQI), Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), and Hospital Anxiety and Depression Scale (HADS).Results: From 264 enrolled participants, 155 individuals (40 females and 115 males) were first diagnosed with OSA. Among these 155 patients, 34% had ESS ≥ 10 and 49% AIS ≥ 6. One or both symptoms present categorized the individual as symptomatic (60%) and neither major symptom as asymptomatic (40%). There were no significant statistical differences (SSDs) between the two groups (symptomatic–asymptomatic) with regard to anthropometrics [age or gender; neck, abdomen, and hip circumferences; and body mass index (BMI)]. The two groups had no differences in OSA severity—as expressed by apnea–hypopnea index (AHI), oxygen desaturation index (ODI), and mean oxyhemoglobin saturation (SaO2)—and in cardiometabolic comorbidities. Symptomatic patients expressed anxiety and depression more often than asymptomatics (p < 0.001) and had poorer subjective sleep quality (Gr-PSQI, p < 0.001). According to PSQI questionnaire, there were no SSDs regarding hours in bed and the use of sleep medications, but there were significant differences in the subjective perception of sleep quality (p < 0.001), sleep efficiency (p < 0.001), duration of sleep (p = 0.001), sleep latency (p = 0.007), daytime dysfunction (p < 0.001), and finally sleep disturbances (p < 0.001).Conclusion: According to our data, OSA patients reporting insomnia-like symptoms and/or sleepiness do not represent a more severe phenotype, by the classic definition of OSA, but their subjective sleep quality is compromised, causing a vicious cycle of anxiety or depression.

The present research investigated pacing for world-class age group swimmers competing in individual medley in 200 m and 400 m. Data on 3,242 unique finishers (1,475 women and 1,767 men) competing in four Master World Championships [XV FINA WMC held in Montreal (Canada) in 2014, the XVI FINA WMC held in Kazan (RUS) in 2015, the FINA WMC held in Budapest (HUN) in 2017, and the XVIII FINA WMC held in Gwangju (KOR] in 2019) were analyzed. Men were faster than women among all age groups in both 200 and 400 m. Additionally, differences were found between almost all adjacent age groups, with the exception (p > 0.05) of age groups 25–29 to 30–34, 35–39 to 40–44 years in 200 m races and 25–29 to 30–34, 30–34 to 35–39, 35–39 to 40–44, and 45–49 to 50–54 years in 400 m races. Men showed a higher pacing variation in 200 m among all male age groups and all female age groups up to 69 years. Pace-variation pairwise comparisons between men and women showed no consistencies throughout age groups, with the exception of a higher variation in men in age groups ≥55-year-old. Men were faster for all splits and strokes in both 200 and 400 m, and significant changes were identified for each split and stroke for both men and women in both 200 and 400 m. Front crawl (freestyle, 4th split) was the fastest butterfly (1st split), backstroke (2nd split), and breaststroke (3rd split). In summary, men were faster than women for all age groups in both 200 and 400 m. Men showed a higher pacing variation in 200 m in all age groups, where women had a higher variation in age groups up to 69 years. The fastest stroke for the final spurt was front crawl, followed by butterfly, backstroke, and breaststroke. Based on these findings, coaches should advise their master athletes to focus on the final spurt in both 200 and 400 m individual medley for a fast final race time.

The purpose of this study was to examine if only child show differences on somatic growth and physical fitness compared to be a child with siblings. The participants included 542 children (boys: N = 270; girls: N = 270) between 7 and 15 years of age. Somatic growth (height, weight, body mass index) and physical fitness (handgrip strength; flexed harm hang; 60-s sit-ups; standing long jump; 10-m shuttle run and PACER test) were assessed. Variance analysis revealed significant advantages for children with siblings in the flexed arm hang (p = 0.046), 60-s sit-ups (p = 0.002), 10-m shuttle run (p = 0.013) and PACER (p = 0.032). An examination of the possible differential effect of sex on the results revealed no significance for physical fitness variables, but significant interaction were found for weight (p = 0.004) and body mass index (p = 0.005). Despite a lack of interactions between offspring and sex in physical fitness, significant differences between sexes were found in all fitness variables. In conclusion, having siblings showed to be advantageous for general physical fitness in children. This evidence may be used for future analysis and interventions in motor competence, namely considering the growing number of only children in some regions of the world.

There are multiple factors that have been studied for talent identification (TI) with regard to sport performance, such as physical and physiological parameters; psychological, social, and contextual parameters; and technical–tactical parameters. However, despite the importance of these indicators for reaching the elite, new trends seem to assure that one of the key elements in a young player is decision making (DM). Thus, in the last decades, research DM in young players has increased. Nevertheless, very little has been done in relation with DM and talented players. The purpose of this study was to analyze and compare the effectiveness, number, and duration of DM units (DMUs) of three groups of talented young players in U-10, U-12, and U-14 levels. Ninety-seven youth players participated in the study. A total of 1,087 actions were analyzed. The Nomination Scale for Identifying Football Talent was utilized to screen the talent pool (N = 18), and the Game Performance Evaluation Tool was used for analyzing the 1,087 actions completed. The results showed that the effectiveness has to be more than 80% for children to be considered talented. Moreover, a greater effectiveness of DMUs was shown in older age groups. The game speed also increased with age. It was revealed that U-12 did not follow the progression in the decisional demands in the formative stages. It is highlighted, therefore, the necessity of reviewing the organizational aspects in the U-12 age group, related mainly to the size of the pitch and the number of players, because it does not follow the same progression in regard to decisional demands. Future studies should follow this study with the U-16, U-18, and U-23 age groups, with the purpose of knowing the effectiveness, duration, and number of DMUs in older age groups. Furthermore, policy makers and teachers/coaches from both educational and soccer context must take these results into account, with the purpose of adjusting the teaching and learning process of talented children in sport.

The present study aimed to investigate the effects of intensive effort on egocentric distance perception according to different angles of view after sleep deprivation at the beginning (SDB) or at the end (SDE) of the night and after a normal sleep night (NNS). Ten male students soccer players (age 22.8 ± 1.3 years; body mass 72.0 ± 10.4 kg; body height 180.0 ± 3.0 cm) performed a repeated cycling (RS) exercise (10 × 6 s maximal cycling with 24 s in between) after SDB, SDE, and NNS. They were asked to estimate three distances (i.e. 15, 25, and 35 m) before and after RS from different angles of view [i.e. in front (0°) and in side (45° left and 45° right)]. For 35 m, distance estimation was better during NNS compared to SDB and SDE for the front and the two side angles either before or after RS (p < 0.05). Concerning 25 m, distance estimation was better after compared to before RS for the front angle during the NNS session (p < 0.05). For 15 m, distance estimation was better during NNS than SDB and SDE for the front and both side angles after RS (p < 0.05). We concluded that partial sleep deprivation negatively affected the estimation of the egocentric distance for the three angles of view either at rest or after RS exercise.

Background Aim: The aim of this study was to examine the sleep characteristics of children and explore associations with various socio-demographic factors in an area of Greece characterized by cultural diversity.Methods: A questionnaire about children's sleep habits had been distributed to parents of children who visited the pediatric outpatient clinic of University General Hospital of Alexandroupolis for a medical examination and to get a health certificate for participation in sports activities. Children with chronic health conditions were excluded.Results: In the study, 449 children (27.1% belonging to minorities) were included, aged 7.6 ± 2.9 years. Most of them (81.7%) slept after 10 p.m., with a mean nocturnal sleep duration of 9.4 ± 1.2 h. The most commonly reported disturbance was snoring (26.2%). Age and high educational level of the mother were both important determinants for sleeping late [OR 1.139 (1.033–1.255); p = 0.009 and OR 1.086 (1.004–1.175); p = 0.040, respectively]. The latter was also associated with an absence of any reported sleep disorder in children [OR 0.934 (0.877–0.994); p = 0.031]. A longer sleep duration was reported among Roma children (p = 0.022), which was more overt in girls (mean sleep duration 10.4 ± 1.6 h). In the Roma group also, the prevalence of sleep disorders was higher.Conclusion: Age progression and maternal educational level, along with cultural background, seem to be correlated with variations in the sleep characteristics of children in a culturally diverse population in Greece.

Background: Although runner’s profiles were previously investigated, information on the training frequency and training distance for short (5 km, 10 km) and long-distance (>21 km) running is absent. The present study aimed to investigate the associations between training routines and exercise habits of recreational endurance runners considering self-reported preferred race distance [10 km, half-marathon (HM), and marathon/ultra-marathon (M/UM)] subgroups. Methods: This is a cross-sectional study, sampling 154 recreational runners of both sexes. A web survey was used for data collection regarding age, sex, preferred distance (10-km, HM, M/UM), training routines, exercise habits, and periodized training routines. The Chi-square test (Cramer’s V) and Kruskal-Wallis test (Eta-Squared η²) with effect sizes were used for comparisons between race distances. Results: Significant differences were shown for anthropometric, training, and periodization characteristics. Highly significant differences were found between subgroups for the number of sessions, running kilometers, and training hours at all periods and within all four preparation conditions. M/ UM runners were training more frequently, for longer durations, and ran greater distances each week. Conclusion: This finding supports the notion that training habits and periodization characteristics are different for different race distances (10- km, half marathon, marathon, and ultramarathon). [ABSTRACT FROM AUTHOR]

Ultra-endurance races are one of the most physically and psychologically demanding sports, depending performance on several elements. The aims of the present study were (i) to analyze differences in selected psychophysiological parameters between finisher and non-finisher ultra-endurance mountain athletes, and (ii) to analyze modifications in psychophysiological parameters before and after an ultra-endurance mountain event. Selected psychophysiological variables were assessed in 46 finishers and 24 non-finishers in two over 100 km ultra-endurance races were examined. We found how an ultra-endurance mountain race produced dehydration, a decrease in systolic blood pressure, weight and leg strength muscle values, as well as an increase in heart rate and rate of perceived exertion values. Finishers presented lower systolic blood pressure, weight, body mass index, half marathon time and fluid intake before competition day compared to non-finishers. In addition, body mass index, pre-race hydration, and performance in lower distance races were predictors of performance in these ultra-endurance mountain races.

The relative age effect (RAE) on human performance has been well studied in many sports, especially in soccer; however, little information has been available about the prevalence of RAE in volleyball, and its role on anthropometric and physiological characteristics. The aim of the present study was to examine (a) the prevalence of RAE in selected (i.e., to be considered for the national team) and non-selected youth female volleyball players, and (b) the relationship of birth quarter (BQ) with anthropometric and physiological characteristics. Selected (n = 72, age 13.3 ± 0.7 years, weight 62.0 ± 7.2 kg, height 1.72 ± 0.06 m) and non-selected female volleyball players (n = 53, age 13.9 ± 1.1 years, weight 56.4 ± 7.3 kg, height 1.66 ± 0.06 m) performed a series of anthropometric and physiological tests. Twenty-six selected participants were born in the first quarter of the year, 19 in the second, 14 in the third, and 13 in the forth. The corresponding frequency by BQ in non-selected participants was 12, 12, 17, and 12. No association was observed between the number of participants and their frequency by BQ neither in the selected (χ2 = 2.79, p = 0.425) nor in the non-selected group (χ2 = 0.64, p = 0.886). Anthropometric and physiological characteristics did not vary by BQ (p > 0.05). The absence of RAE in female volleyball players and the similarities of anthropometric and physiological characteristics among BQ might be due to technical-tactical character of this sport. These findings would be of great practical value for coaches and fitness trainers working with young volleyball players.

This study compared the ability to predict performance in half-marathon races through physiological variables obtained in a laboratory test and performance variables obtained in the Cooper field test. Twenty-three participants (age: 41.6 ± 7.6 years, weight: 70.4 ± 8.1 kg, and height: 172.5 ± 6.3 cm) underwent body composition assessment and performed a maximum incremental graded exercise laboratory test to evaluate maximum aerobic power and associated cardiorespiratory and metabolic variables. Cooper’s original protocol was performed on an athletic track and the variables recorded were covered distance, rating of perceived exertion, and maximum heart rate. The week following the Cooper test, all participants completed a half-marathon race at the maximum possible speed. The associations between the laboratory and field tests and the final time of the test were used to select the predictive variables included in a stepwise multiple regression analysis, which used the race time in the half marathon as the dependent variable and the laboratory variables or field tests as independent variables. Subsequently, a concordance analysis was carried out between the estimated and actual times through the Bland-Altman procedure. Significant correlations were found between the time in the half marathon and the distance in the Cooper test (r = −0.93; p < 0.001), body weight (r = 0.40; p < 0.04), velocity at ventilatory threshold 1, (r = −0.72; p < 0.0001), speed reached at maximum oxygen consumption (vVO2max), (r = −0.84; p < 0.0001), oxygen consumption at ventilatory threshold 2 (VO2VT2) (r = −0.79; p < 0.0001), and VO2max (r = −0.64; p < 0.05). The distance covered in the Cooper test was the best predictor of time in the half-marathon, and might predicted by the equation: Race time (min) = 201.26 – 0.03433 (Cooper test in m) (R2 = 0.873, SEE: 3.78 min). In the laboratory model, vVO2max, and body weight presented an R2 = 0.77, SEE 5.28 min. predicted by equation: Race time (min) = 156.7177 – 4.7194 (vVO2max) – 0.3435 (Weight). Concordance analysis showed no differences between the times predicted in the models the and actual times. The data indicated a high predictive power of half marathon race time both from the distance in the Cooper test and vVO2max in the laboratory. However, the variable associated with the Cooper test had better predictive ability than the treadmill test variables. Finally, it is important to note that these data may only be extrapolated to recreational male runners.

The aim of the present study was to examine the role of the classical physiological model of endurance running performance – maximal oxygen uptake (VO2max), %VO2max at ventilatory thresholds (VT), work economy, lactate levels, and body composition on the prediction of short trail running performance. Eleven male trail runners (age 36.1 ± 6.5 years, sport experience 6.6 ± 3.8 years, and mean ± standard deviation) were examined for fat mass and skeletal muscle mass, and performed a graded exercise test to measure VO2max, vVO2max, and VT. Also, they participated in a short 27 km trail run with a positive elevation of +1750 m. Age, years of training and skeletal muscle mass did not correlate with race time (P > 0.05), and fat mass and body mass index (BMI) showed significant correlations with race time (P < 0.05). Heart rate, velocity and VT1 and VT2 were not associated with race time (P > 0.05). Only vVO2max (P = 0.005) and VO2max (P = 0.007) is correlated to race time. Multiple regression models for VO2max accounted for 57% of the total variance. The vVO2max model variable accounted for 60% and the fat mass model for 59.5%. Finally, the combined VO2max and fat mass model explained 83.9% of the total variance (P < 0.05 in all models). The equation for this model is “race time (min) = 203.9956−1.9001 × VO2max + 10.2816 × Fat mass%” (R2 = 0.839, SEE = 11.1 min, and P = 0.0007). The classical variable VO2max together with fat mass percent are two strong predictors for short trail running performance.

The present experiment examined the effect of content complexity on perceived cognitive load and game performance when learning basketball tactical actions from videos modeling examples displayed at different speeds. A two (presentation speed: slow vs. normal) × three (content complexity: low vs. medium vs. high) design between subjects was adopted in the experiment. Following the learning phase, 120 secondary school students were quasi-randomly assigned to six experimental conditions and required to rate their perceived cognitive and game performance. Data analyses revealed that for low complexity content, both speeds of presentation have similar effects on learning. Conversely, for medium and high complexity contents, participants exposed to the slow-presentation speed learned more efficiently than those exposed to the normal-presentation speed. The findings recommend the use of slow-speed videos when learning basketball tactical actions, particularly in playing systems with medium or high levels of complexity.

Most studies on marathon runners have focused on physiological parameters determining performance, whereas neuromuscular aspects, such as muscle strength and flexibility, have received less attention. Thus, the aim of the present study was to examine the relationship of age, body composition, and running speed with muscle strength and flexibility of recreational marathon runners. Male marathon runners (n = 130, age 44.1 ± 8.6 years, height 176 ± 6 cm, body mass 77 ± 9 body mass index 24.7 ± 2.6 kg.m–2, and race speed 10.29 ± 1.87 km/h) were separated into eight age groups (60 years). Four weeks before competing in a marathon, participants performed the sit-and-reach test (SAR), squat jumps (SJ), and countermovement jumps (CMJ), and four isometric muscle strength tests (right and left handgrip, lifting with knees extended and flexed), providing an index of overall isometric muscle strength in absolute (kg) relative to body mass values (kg.kg–1 body mass). Afterward, participants competed and finished the Athens Classic Marathon (2017), and race speed was used as an index of running performance. As an average for the whole sample, SAR was 17.6 ± 8.5 cm, SJ was 24.3 ± 4.2 cm, CMJ was 25.8 ± 4.8 cm, overall isometric muscle strength was 386 ± 59 kg in absolute values and 5.06 ± 0.78 kg/kg of body mass in relative terms. The older age groups had the lowest scores in SJ (p < 0.001, ηp2 = 0.298) and CMJ (p < 0.001, ηp2 = 0.304), whereas no age-related difference in SAR (p = 0.908, ηp2 = 0.022), absolute (p = 0.622, ηp2 = 0.042) and relative isometric muscle strength (p = 0.435, ηp2 = 0.055) was shown. Race speed correlated moderately with relative isometric strength (r = 0.42, p < 0.001), but not with the other neuromuscular measures (r < 0.13,p > 0.130). In summary, age-related differences were shown in jumping ability, but not in flexibility and isometric muscle strength. Although these parameters - except relative strength - did not relate to running speed, they were components of health-related physical fitness. Consequently, coaches and runners should consider exercises that include stretching and strengthening in their weekly program to ensure adequate levels for all components of health-related physical fitness.

The present study aimed to analyze the relationship between variables related to the internal and external loads of training and competition races as well as to athletes’ perceptions of well-being measured throughout the course of a 4-week mesocycle. It also aimed to analyze the intra- and inter-week variations in terms of training load and well-being. The study included the participation of 47 male recreational athletes competing in the national championships of trail running in Portugal (age: 34.85 ± 8.88 years; height: 1.77 ± 0.58 m; body mass: 65.89 ± 3.17 kg). During the 4 weeks, subjective perception of effort (RPE), training time (min), session-RPE (sRPE), distance covered (km), and perception of well-being (Hooper’s questionnaire) were monitored. Weekly RPE was greater in week 1 than in week 3 (p = 0.001; d = 0.563, small effect). Moreover, weekly sRPE was greater in week 1 than in week 2 (p = 0.001; d = 0.441, small effect). The correlations between the well-being variables and RPE that were found to be significant with small magnitudes are those between sleep and RPE (r = 0.287; p = 0.001), stress and RPE (r = 0.217; p = 0.001), fatigue and RPE (r = 0.191; p = 0.001), muscle soreness and RPE (r = 0.240; p = 0.001), and Hooper’s index and RPE (r = 0.279; p = 0.001). Among the variables of the Cooper test and the competition race load, it was verified that VO2max had a negative correlation of an average magnitude with pace (r = −0.396, p = 0.015). The findings of the study suggest that small variations in training stimulus during the period of analysis and increases in maximal oxygen uptake result in improvements in the performance of trail running athletes when considering the running speed in the race.

The present study aims to compare quality of life, depression, anxiety symptoms, and profile of mood state of wheelchair athletes and non-athletes. Thirty-nine basketball and rugby wheelchair athletes (n = 23, nine women, age 36.0 ± 10.0 years; body mass 66.2 ± 13.8 kg; height 170.0 ± 8.5 cm) and non-athletes (n = 16, 4 women, 39.0 ± 14.2 years; body mass 79.6 ± 17.2 kg; height 170.0 ± 6.4 cm) were recruited. Quality of life, anxiety and depressive symptoms and mood disorders were evaluated by the Medical Outcomes Short-Form Health Survey (SF-36), State-Trait Anxiety Inventory, Beck Depression Inventory and Profile of Mood State questionnaire, respectively. Comparison between groups (non-athletes vs. athletes) was performed using Student’s t-test for independent samples. No differences (p > 0.05) were found between non-athletes vs. athletes regards to quality of life, depressive and anxiety symptoms and profile of mood state. Overall, non-athletes and athletes presented medium anxiety symptoms and mild to moderate depressive symptoms. In conclusion, the wheelchair athletes and non-athletes presented similar quality of life, depressive and anxiety symptoms, and profile of mood state.

The purpose of this study is twofold: (i) analyze the variations of network centralities between close (difference of goals equal to one) and unbalanced (difference of goals equal to or greater than two) scores; and (ii) compare the centrality levels between playing positions. The passing sequences that occurred during the 64 matches played by the 32 national teams that participated in the 2018 FIFA World Cup were analyzed and coded. The network centralities of degree prestige and degree centrality were calculated based on the weighted adjacency matrices built from the passing sequences. The results reveal that higher degree centralities of midfielders occurred in unfavorable (lost) unbalanced scores (p = 0.046; ES (effect size) = 0.472). Moreover, in favorable (won) matches the higher values of degree centrality of central defenders (p = 0.014; ES: 0.458) and defensive midfielders (p = 0.004; ES: 0.715) were also found in unbalanced scores. The comparisons between positions revealed that the highest and significant degree prestige levels were found in defensive midfielders in both close (12.10%) and unbalanced scores (10.95%). In conclusion, it is possible to observe that winning by an unbalanced score significantly increased the centrality levels of the wingers and forwards in comparison to close scores. Moreover, it was also found that independent of the final score or the unbalanced score level, the defensive midfielders were the most prominent or recruited players during the passing sequences.

Periodization schedules training periods according to predicted timings of cumulative adaptations and has been at the foundation of exercise prescription. Recently, a selected body of work has highlighted that original research may be providing support for variation, but not for periodized variation. Furthermore, it has been suggested that the timings of expected adaptations have not been tested. However, it is not clear if these problems are present in meta-analyses on the subject, since they might have selected a distinct body or work. Therefore, our goal was to systematically review meta-analyses on exercise periodization, to verify whether the included periodized programs have been contrasted to two types of non-periodized programs (i.e., constant or varied) and also if the predictions concerning cumulative adaptations were tested. Data sources: Cochrane, EBSCO (Academic Search Complete, CINAHL Plus, MEDLINE, PsycINFO, SportDISCUS), ISI Web of Knowledge, PEDro, PubMed, Scielo, Scopus. Study eligibility criteria: Meta-analyses comparing periodized exercise programs with non-periodized programs. Participants and interventions: Humans following any form of training periodization. Study appraisal and synthesis methods: A checklist was used to verify whether studies included in the meta-analyses compared periodized to constant or varied, non-periodized programs, as well as whether predictions concerning the timing of adaptations were tested. None of the 21 studies included in the two meta-analyses compared periodized programs with varied, non-periodized programs. The accuracy of the predictions concerning the proposed timings of adaptations was not scrutinized by any of the 21 studies. The studies in question have focused only on strength training, meaning they are limited in scope. The limitations found in these meta-analyses suggest that consultation of original research on the subject is advisable. Systematic review registration number (PROSPERO): CRD42018111338.

The purpose of this study was twofold: first, to compare the central adiposity (CA), cardiovascular fitness (CF), and physical activity (PA) in children with different weight status, and second, to determine the associations between moderate to vigorous physical activity (MVPA) and measures of adiposity [CA and body mass index (BMI)] and CF. A sample of 244 children (boys = 120 and girls = 124), 9.7–10.8 years of age (10.3 ± 0.3 years), was measured for stature, body mass, waist circumferences, and 20-m multi-stage fitness test. PA was recorded with ankle mounted accelerometer. BMI groups were used to classify children as underweight (UW), normal weight (NW), and overweight (OW). The prevalence of being OW was 21.7 and 25% in boys and girls, respectively. Only 5.3% of the participants were found to accumulate recommended amount (≥60 min/day) of MVPA. Boys were significantly outperformed girls in terms of CF. Moreover, they were significantly more engaged in moderate and vigorous physical activities than girls. Regardless of gender, results indicated that OW children had significantly higher values in all anthropometric parameters and lower level of CF than their UW and NW counterparts. In girls, OW children were found to accrue less time engaging in MVPA than the children in UW and NW groups. In boys, OW children were found to accrue less time engaging in vigorous activities than UW and NW children. Results also showed that there were no significant differences between UW and NW girls and boys in respect to CF. Besides, UW girls were found to accrue more time engaging in MVPA than NW girls. MVPA was found to be significantly and negatively correlated with BMI and waist circumference and significantly and positively correlated with CF in both boys and girls. These discrepancies and associations highlight the considerable influences of MVPA on weight status and CF in children.

Introduction: Obstructive sleep apnea (OSA) and its cardiometabolic alterations are closely associated with visceral obesity. Patients with OSA frequently present with symptoms of depression and anxiety. Although these subjective symptoms of OSA are the result of complex biological dysregulation, it remains unclear if they have a direct effect on the dysfunction of adipose tissue.Methods: In a pilot, prospective, randomized study, we evaluated 10 recently diagnosed male patients with severe OSA by full polysomnography (PSG) and 4 male non-apneic subjects matched for age and body mass index (BMI) with abdomen adipose tissue biopsies. Subjects with diabetes/prediabetes and cardiovascular and psychiatric diseases and who are current smokers were excluded. All patients underwent anthropometric measurements and completed the following questionnaires: Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Hospital Anxiety and Depression Scale (HADS-A and HADS-D). Fasting venous blood samples were collected on the day after PSG, between 8:00 and 9:00 a.m., after an overnight fast. Fat biopsies were performed at the same time periods and adipose tissue samples of 300 mg were obtained from abdominal fat. Fat cell size, extent of fibrosis, vascularity, leukocyte common antigen inflammatory infiltration, and tissue macrophage accumulation were microscopically evaluated.Results: The mean age of the group was 47.4 ± 13.8 years, with mean BMI of 35.8 ± 4.8 kg/m2 and mean apnea-hypopnea index of 79.4 ± 46.1 events per hour of sleep (severe OSA). HADS-A and HADS-D scores were 5.8 ± 2.3 (3.0–8.0) and 4.7 ± 2.3 (2.0–8.0), respectively. HADS-A score correlated positively with macrophage accumulation in fat biopsy (r = 0.82, p = 0.047), whereas ESS, FSS, and HADS-D did not. Severity of fibrosis correlated largely with waist circumference (r = -0.66, p = 0.038) and neck circumference (r = -0.790, p = 0.006). Respiratory events correlated negatively with the extent of vascularization of adipose tissue (r = -0.614, p = 0.05).Conclusions: In the preliminary results of our pilot study, we assessed that the symptoms of anxiety mainly contribute to macrophage accumulation, whereas the increased number of respiratory events reduces the extent of vascularization in visceral fat in OSA. Based on this observation, further larger studies are required to verify if anxious OSA patients are more vulnerable to the metabolic manifestations of the syndrome.

The aim of this study was to compare the motivations of successful marathon finishers (n = 1,243) and inexperienced runners (control group, n = 296). A total of 1,537 runners with 380 women (24.7%) and 1,157 men (75.3%) completed the motivations of marathoners scales (MOMS) questionnaire and the relationships between general motivation categories and selected demographic (e.g., gender, age, and education) and training characteristics were analyzed. Successful marathon finishers did not differ significantly in motivations from the control group (p > 0.05). Trivial to small correlations with age, educational level, and training characteristics were observed. Female marathon finishers exceeded men on the motivational scales for weight concern, affiliation, psychological coping, life meaning, and self-esteem and they scored lower on competitive motivation (p < 0.05). There was also a significant relationship of some motivational aspects with level of education, experience and training frequency. These findings confirmed that age and gender differentiate motivations in both successful female and male marathon finishers and controls.

The purpose of this study was to compare the effects of different combinations of blood flow restriction (BFR) pressure and exercise intensity on aerobic, anaerobic, and muscle strength adaptations in physically active collegiate women. Thirty-two women (age 22.8 ± 2.9 years; body mass index 22.3 ± 2.7 kg/m2) were randomly assigned into four experimental training groups: (a) increasing BFR pressure with constant exercise intensity (IP-CE), (b) constant partial BFR pressure with increasing exercise intensity (CPp-IE), (c) constant complete BFR pressure with increasing exercise intensity (CPC-IE), and (d) increasing BFR pressure with increasing exercise intensity (IP-IE). The participants completed 12 training sessions comprised of repeated bouts of 2 min running on a treadmill with BFR interspersed by 1-min recovery without BFR. Participants completed a series of tests to assess muscle strength, aerobic, and anaerobic performances. Muscle strength, anaerobic power, and aerobic parameters including maximum oxygen consumption (VO2max), time to fatigue (TTF), velocity at VO2max (vVO2max), and running economy (RE) improved in all groups (p ≤ 0.01). The CPC-IE group outscored the other groups in muscle strength, RE, and TTF (p < 0.05). In summary, participants with complete occlusion experienced the greatest improvements in muscle strength, aerobic, and anaerobic parameters possibly due to increased oxygen deficiency and higher metabolic stress.

Background: To date, no study has focused on body composition characteristics and on parameters associated with skeletal muscle damage and renal function in runners participating in a 24-h winter race held under extremely cold environmental conditions (average temperature of -14.3°C).Methods: Anthropometric characteristics, plasma urea (PU), plasma creatinine (Pcr), creatine kinase (CK), plasma volume (PV) and total body water (TBW) were assessed pre- and post-race in 20 finishers (14 men and 6 women).Results: In male runners, body mass (BM) (p = 0.003) and body fat (BF) (p = 0.001) decreased [-1.1 kg (-1.4%) and -1.1 kg (-13.4%), respectively]; skeletal muscle mass (SM) and TBW remained stable (p > 0.05). In female runners, BF decreased (p = 0.036) [-1.3 kg (-7.8%)] while BM, SM and TBW remained stable (p > 0.05). The change (Δ) in BM was not related to Δ BF; however, Δ BM was related to Δ SM [r = 0.58, p = 0.007] and Δ TBW (r = 0.59, p = 0.007). Δ SM correlated with Δ TBW (r = 0.51, p = 0.021). Moreover, Δ BF was negatively associated with Δ SM (r = -0.65, p = 0.002). PV (p < 0.001), CK (p < 0.001), Pcr (p = 0.004) and PU (p < 0.001) increased and creatinine clearance (CrCl) decreased (p = 0.002). The decrease in BM was negatively related to the increase in CK (r = -0.71, p < 0.001). Δ Pcr was positively related to Δ PU (r = 0.64, p = 0.002). The decrease in CrCl was negatively associated with the increase in both PU (r = -0.72, p < 0.001) and CK (r = -0.48, p = 0.032).Conclusion: The 24-h running race under extremely cold conditions led to a significant BF decrease, whereas SM and TBW remained stable in both males and females. Nevertheless, the increase in CK, Pcr and PU was related to the damage of SM with transient impaired renal function.

The aim of this study was to investigate the effect of leg blood flow restriction (BFR) applied during a 3-a-side futsal game on strength-related parameters. Twelve male futsal players were randomly assigned into two groups (n = 6 for each group) during 10 training sessions either with or without leg BFR. Prior to and post-training sessions, participants completed a series of tests to assess anabolic hormones and leg strength. Pneumatic cuffs were initially inflated to 110% of leg systolic blood pressure and further increased by 10% after every two completed sessions. In comparison with baseline, the resting post-training levels of myostatin (p = 0.002) and IGF-1/MSTN ratio (p = 0.006) in the BFR group changed, whereas no change in the acute level of IGF-1 and myostatin after exercise was observed. Peak torque of knee extension and flexion increased in both groups (p < 0.05). A trend of increased neural activation of all heads of the quadriceps was observed in both groups, however, it was statistically significant only for rectus femoris in BFR (p = 0.02). These findings indicated that the addition of BFR to normal futsal training might induce greater neuromuscular benefits by increasing muscle activation and augmenting the hormonal response.

The aim of this study was to test associations between accumulated external load and changes in body composition, isokinetic strength, and aerobic capacity of soccer players. Twenty-three professional soccer players (age: 24.7 ± 2.8 years; height: 179.2 ± 6.3; experience: 9.7 ± 2.1 years) participated in this study. This pre-post study design was performed during 10 weeks from July to August of 2017 (4 weeks of pre-season and 6 weeks during the early season). Players were monitored daily by GPS technology and were assessed before and after a 10-week period in terms of body mass (BM), fat mass, lean mass, isokinetic strength at 60°/s, VO2max, and HRmax. Large-to-very large positive correlations were found between the sum of sprinting distance and % differences of BM [0.70, (−0.09;0.95)], HRmax [0.51, (−0.37;0.91)], agonist (quadriceps)/antagonist (hamstrings) left ratio [0.84, (0.27;0.97)] and agonist/antagonist right ratio [0.92, (0.58;0.99)]. Large positive correlations were found between the acceleration sum and % differences of VO2max [0.58, (−0.29;0.92)], quadriceps left peak torque [0.66, (−0.16;0.94)], hamstrings left peak torque [0.68, (−0.13;0.94)] and hamstrings right peak torque [0.62, (−0.22;0.93)]. Sprinting load was largely and positively associated with changes in knee strength asymmetries. Acceleration sum was largely and positively correlated with variations at VO2max and peak torques at hamstrings. In addition, dose-response relationships using external load variables were identified in professional soccer players.

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with multiple systemic manifestations and comorbidities, which contribute independently to its total morbidity and mortality. Pulmonary rehabilitation is an evidence-based intervention that is indicated for COPD patients who remain symptomatic, despite optimal pharmacological therapy. Although it is well documented in pure COPD, the role of pulmonary rehabilitation is uncertain in coexisting comorbidities. The aim of the present study was to clarify the effect of a pulmonary rehabilitation program in COPD patients with concomitant comorbidities.Methods: Thirty two patients with COPD were evaluated before and after a comprehensive pulmonary rehabilitation program, in terms of dyspnea, quality of life (QOL), pulmonary function tests and exercise capacity. The patients were also divided into two groups, according to the presence or the absence of comorbidities. Patients with none or only one comorbidity (Group 1, n = 11) were compared to those who had two or more comorbidities (Group 2, n = 21).Results: All patients significantly improved in dyspnea, as expressed by modified Medical Research Council scale and the COPD assessment Test (p < 0.001), QOL as assessed by the St. George respiratory questionnaire (p < 0.001) and exercise tolerance in six minute walking test (p < 0.001). Peak oxygen uptake relatively increased and body mass decreased in Group 1 compared to Group 2 (p < 0.05).Conclusion: Pulmonary rehabilitation in COPD seems to be beneficial for all patients, independently of the presence, the number or the nature of their comorbidities. Thus, the presence of comorbidities must not represent an exclusion criterion for patients that are referred to pulmonary rehabilitation programs.Trial Registration: Current controlled trials ISRCTN14648515 Retrospectively registered 15 February 2018.

The role of age and performance level has been investigated in runners such as marathoners, but not in multi-sports athletes such as duathletes (running, cycling, and running). Thus, the aim of the present study was to examine the combined effects of aging and performance level on pacing of duathletes competing in two different race distances. Pacing (defined as the relative contribution of cycling time, %, to the overall race time) was analyzed for 6,671 duathletes competing from 2003 to 2017 in the short distance race (10 km first run, 50 km cycling and 5 km second run) or long distance race (10 km first run, 150 km cycling and 30 km second run) of “Powerman Zofingen,” the “ITU Powerman Long Distance Duathlon World Championships.” Men were faster, older, and spent less time (%) in cycling than women in both distances races (p < 0.001). Younger age groups spent more time (%) in cycling than their older counterparts in women (both short and long distance, p = 0.036, ηp2 = 0.031, p = 0.025, ηp2 = 0.044, respectively) and men (long distance race, p < 0.001, ηp2 = 0.016). Fast performance groups spent more time (%) in cycling than their slower counterparts in short (women, p < 0.001, ηp2 = 0.057; men, p < 0.001, ηp2 = 0.035) and long distance (women, p < 0.001, ηp2 = 0.070; men, p < 0.001, ηp2 = 0.052). A small age group × performance group interaction on cycling time (%) was observed in the men’s short distance (p = 0.001, ηp2 = 0.020) – but not in the long distance or in women – with smaller differences between performance groups in the older than in the younger age groups. Women, young and fast duathletes were relatively slower in cycling than men, old and slow duathletes; that was, old duathletes were relatively faster in cycling than in running. Moreover, there was indication that the difference in pacing among performance groups might be attenuated with aging. Since fast duathletes were relatively faster in running than in cycling, slow duathletes should be encouraged to cycle slower and run faster.

Background: To date, no study has examined the hydration status of runners competing in a 24-h winter race under extremely cold environmental conditions. Therefore, the aim was to examine the effect of a 24-h race under an average temperature of -14.3°C on hydration status.Methods: Blood and urine parameters and body mass (BM) were assessed in 20 finishers (women, n = 6; men, n = 14) pre- and post-race.Results: Five (25%) ultra-runners had lower pre-race plasma sodium [Na+] and 11 (52%) had higher pre-race plasma potassium [K+] values than the reference ranges. Post-race plasma [Na+], plasma osmolality, urine osmolality and urine specific gravity remained stable (p > 0.05). The estimated fluid intake did not differ (p > 0.05) between women (0.30 ± 0.06 L/h) and men (0.46 ± 0.21 L/h). Runners with a higher number of completed ultra-marathons (r = -0.50, p = 0.024) and higher number of training kilometers (r = -0.68, p = 0.001) drank less than those with lower running experience. Pre-race and post-race plasma [Na+] were related to plasma osmolality (r = 0.65, p = 0.002, r = 0.69, p < 0.001, respectively) post-race, but not to fluid intake (p > 0.05). BM significantly decreased post-race (p = 0.002) and was not related to plasma [Na+] or fluid intake (p > 0.05). Post-race hematocrit and plasma [K+] decreased (p < 0.001) and transtubular potassium gradient increased (p = 0.008). Higher pre-race plasma [K+] was related to higher plasma [K+] loss post-race (p = -0.85, p < 0.001).Conclusion: Hydration status remained stable despite the extremely cold winter weather conditions. Overall fluid intake was probably sufficient to replenish the hydration needs of 24-h runners. Current recommendations may be too high for athletes competing in extremely cold conditions.

In recent years, outstanding performances of elderly people up to 100 years have been reported. In this case study, pacing during and recovery after a 12-h ultra-marathon were described for a 95-year old runner. The athlete achieved a total distance of 52.987 km. Pacing followed a parabolic pattern (U-shaped), where the speed decreased till the middle of the race and then increased. However, no end spurt was observed. A large main effect of lap quartile on speed was observed, where the second quartile was slower than the first quartile and forth. The smallest variability was shown in the first quartile and the largest in the second quartile. During recovery, erythrocytes, hemoglobin and hematocrit increased whereas thrombocytes and leucocytes decreased. CRP, GOT, GPT, y-GT, CK, and LDH were increased post-race and decreased to reference range during recovery. Also, creatinine and urea decreased during recovery. Creatinine clearance increased during recovery. Sodium increased during recovery and remained constantly within the reference range. During recovery body fat and visceral fat mass decreased, whereas body water and lean body mass increased. In summary, a 95-year-old man was able to run during 12 h using a U-shaped pacing and achieving a total distance of nearly 53 km. Increased selected hematological and biochemical parameters returned to pre-race values within a recovery phase of 5 days.

Telomeres are genomic complex at the end of chromosomes that protects the DNA and telomere length (TL) is related to several age-related diseases, lifespan, and cancer. On the other hand, cancer is a multifactorial disease that is responsible for reduce the quality of life and kills millions of people every year. Both, shorter TL and cancer are related and could be treated or prevented depending of the lifestyle. In this review we discuss the possible role of exercise in the relationship between shorter telomeres, telomerase activity, and cancer. In summary, there is evidence that exercise leads to less telomere attrition and exercise also may diminish the risk of cancer, these two outcomes are possible intermediated by a reduction in oxidative stress, and chronic inflammation. Although, there is evidence that shorter TL are associated with cancer, the possible mechanisms that one may lead to the other remains to be clarified. We assume that humans under cancer treatment may suffer a great decrease in quality of life, which may increase sedentary behavior and lead to increased telomere attrition. And those humans with already shorter TL likely lived under a poor lifestyle and might have an increased risk to have cancer.

Aim: The kinetic chain of the punch of boxers is characterized by the contribution of the shoulder; however, the isokinetic muscle strength of shoulder’s rotators muscles has not been well studied so far, especially with regards to performance. Therefore, the aim of the present study was (a) to profile the isokinetic muscle strength of rotators of the glenohumeral joint, bilateral (BL), unilateral (UL) and functional ratios in amateur boxers, and (b) to examine the variation of these muscle strength characteristics by performance level.Methods: Forty male amateur Greek boxers from three division levels (elite, n = 22; second division, n = 11; and third division, n = 7), and 10 non-athletes (control group) were tested, using the isokinetic dynamometer Kin-ComTM in the scapular seated position under standard conditions. We examined (i) peak torque (PT) of internal (IR) and external (ER) rotators during concentric (CON) and eccentric (ECC) contractions at low (60°/s), medium (120°/s), and high speed (180°/s), (ii) BL, (iii) UL, and (iv) functional ratios of dominant (D) and non-dominant (ND) limbs.Results: Boxers were stronger than control group in IR and ER at all speeds, and D outscored ND limb (p < 0.05). Elite boxers were stronger than group B and C (p < 0.05); however, when peak torque was expressed in relative to body mass values, these differences were attenuated. The BL ratios for the men athletes were under 10% at 60 and 180°/s, the UL ratios were lower at 60 and higher at 180°/s and significant lower in the dominant limb at all speeds. The functional ratios of IR ECC / ER CON were higher between the control group at all speeds and the ER ECC/IR CON ratios were between 60 and 180°/s, and the two limbs with higher values at 180°/s.Conclusion: Boxers had the strongest dominant limb and their BL ratios were normal at all speeds except of 120°/s ECC. The UL ratios of ECC at 120 and 180°/s of ND were normal, and at the other speeds abnormal due to high IR. In addition, the functional ratios may be related to the kinetic chain of the punch, which in turn correlates with the contribution of ER of both limbs.

Physical fitness components that relate with performance in marathon running, e.g., aerobic capacity and body composition, have been studied extensively. On the other hand, data on components of the health-related physical fitness, such as flexibility and muscle strength, were missing in this sport. Therefore, the aim of the present study was to profile force-velocity (F-v) characteristics, muscle strength and flexibility in female recreational marathon runners and to examine their relationship with age, race time and anthropometric characteristics (body fat percentage, fat-free mass – FFM, and total thigh muscle cross-sectional area – CSA). Thirty three female marathon runners (age 40.0 ± 8.9 years, body fat percentage 19.5 ± 4.6% and personal record 4:34 ± 0:39 h:min), separated into three age groups (45 years) and three performance groups (race time 4:45 h:min), performed sit-and-reach test (SAR), isometric muscle strength tests, squat jump, countermovement jump and F-v test on a cycle ergometer. The main findings of the present study were that (i) participants had moderate scores of body composition and physical fitness considering norms of the general population, (ii) the 45 age group, and the older age group had lower F0, Pmax and rPmax than their younger counterparts, (iii) the slowest performance group scored the highest in SAR, and (iv) isometric strength, F0 and Pmax correlated largely with body mass and FFM. Considering the lack of existing data on anaerobic power and neuromuscular fitness of female marathon runners, the findings reported in this study would be useful for strength and conditioning trainers to monitor the training of their athletes. Even if these parameters were not related to race time, they should be monitored regularly as they were either component of health-related physical fitness (muscle strength and flexibility) or could help runners (anaerobic power) under specific circumstances such as ascends during a race.

The Wingate anaerobic test (WAnT) has been used extensively to evaluate performance in soccer, however, a comprehensive sport-specific normative database has not been available so far. Therefore, the main aim of the present study was to develop norms of the main indices of the WAnT with regards to age in soccer. A secondary aim was to examine the relationship of WAnT with two common field tests, 20 m sprint and vertical jump, and study the variation of this relationship by age and playing position. Hundred and ninety five male soccer players (age 18.1 ± 4.9 years) performed the WAnT, and a sub-sample of 190 soccer players (age 19.4 ± 5.1 years) performed 20 m sprint, squat (SJ) and countermovement jump (CMJ). Age was related very largely with peak power (R2 = 0.57) and mean power of the WAnT (R2 = 0.60) when they were expressed in W, and largely (R2 = 0.41 and R2 = 0.33, respectively) when they were expressed in W.kg−1, whereas it did not relate with fatigue index. After being adjusted for age, a relationship of SJ (B = 3.91, 90% CI: 2.49, 5.32; R2 = 0.26), CMJ (B = 3.59, 90% CI: 2.22, 4.95; R2 = 0.24) and 20 m sprint (B = −0.06, 90% CI: −0.10; −0.01; R2 = 0.19) with peak power of the WanT was observed. In summary, Ppeak and Pmean were related very largely to age, especially during adolescence, and percentile norms of these indices were developed for 1-year age groups from 11 to 21 years old and for a single adult age group (22–39 years old). These findings on the largest dataset of soccer players ever studied would be expected to offer a practical tool to the members of the sports medicine team (e.g., exercise physiologists, fitness trainers, and coaches) working with them.