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Context: As blood flow restriction gains popularity across different populations (eg, young and older adults) and settings (eg, clinical and sports rehabilitation), the accuracy of blood flow restricted percentage becomes crucial. We aimed to compare manually measured arterial occlusion pressure (AOP) among young adults to understand whether lower limb composition affects the pressure required to achieve AOP. The results will shed light on the adequacy of published calculations used to estimate AOP in practical and research settings. Design: An observational cross-sectional study design was implemented to examine the relationship between lower limb composition, lower limb circumference, and measured AOP. Methods: Twenty-two participants (12 males, 26 [4] y, 1.74 [0.07] m, 73.2 [12.5] kg) underwent a whole-body Dual-energy X-ray Absorptiometry scan before AOP (in millimeters of mercury) and lower limb circumference (in centimeters) were determined. In a supine position, a 10-cm wide cuff was manually inflated on the dominant leg to the point where a pulse could no longer be detected by a Doppler ultrasound of the posterior tibial artery to determine AOP. Lower limb composition (fat, muscle, and bone mass [in grams]) was obtained from the Dual-energy X-ray Absorptiometry scan. Results: Lower limb muscle mass had a moderate negative relationship with AOP (r2 =.433, β = −0.004) and a moderate positive relationship with lower limb circumference (r2 =.497, β = 0.001). Lower limb circumference had the weakest relationship with AOP (r2 =.316, β = 0.050) of all measures. Conclusions: The reported relationships between lower limb muscle mass, lower limb circumference, and AOP suggest that as muscle mass increases, lower limb circumference also increases, yet AOP decreases. This implies that limb circumference should not be used as the primary measure for calculating AOP within the sampled population. We recommend individually measuring AOP when implementing blood flow restriction in all exercise modalities. [ABSTRACT FROM AUTHOR]

Context: The quadriceps femoris is consistently ranked among the muscles most prone to sustain strain injuries in sports involving kicking and sprinting actions. Given the documented preventive effect of Nordic hamstring curl programs against hamstring strain injuries, incorporating exercises that induce eccentric overload on the quadriceps could potentially help mitigate strain injuries within this muscle group. The Reverse Nordic Curl (RNC) has emerged as a viable field-based exercise for eccentrically working the quadriceps. This study aimed to compare quadriceps muscle eccentric activation during the RNC with 3 bodyweight squat-based exercises: single-leg squat (SLS), Bulgarian squat, and forward lunge. Design: Cross-sectional study. Methods: Twenty-three healthy volunteers (15 men) were monitored for rectus femoris, vastus lateralis, and vastus medialis electromyographic signal, as well as knee range of motion, while performing 10 repetitions of each exercise. Electromyography data acquired during eccentric phases were normalized by maximum voluntary isometric contraction of the knee extensors. The exercises were compared based on the electromyography and knee range of motion values. Results: RNC generated a similar rectus femoris and vastus medialis eccentric activation compared with the squat-based exercises (P >.05 for all), and a lower vastus lateralis activation than SLS (P <.001). Among the bodyweight squat-based exercises, SLS generated greater eccentric activation than forward lunge and Bulgarian squat for the 3 muscles (P <.05 for all). RNC was performed with lower knee-flexion range of motion than bodyweight squat-based exercises (P <.001). Conclusions: RNC did not produce superior eccentric quadriceps activation compared to bodyweight squat-based exercises, even proving to be less demanding for the vastus lateralis compared to the SLS. These findings may assist practitioners in selecting exercises to elicit quadriceps eccentric stimulus, with a focus on preventing strain injuries. [ABSTRACT FROM AUTHOR]

This study examined the effects of a combined virtual-reality- and gym-based physical activity (PA) program on PA levels, motor skills, and social skills of children with a developmental disability (DD). Twenty-five children with DD were randomly assigned to experimental and control groups. The intervention was conducted for 60 min, two times a week, for 12 weeks. Pre- and postintervention assessments encompassing PA levels measured via Gravity Estimator of Normal Everyday Activity, motor skills evaluated using the Test of Gross Motor Development-Third Edition, and social skills gauged via the Social Skills Rating System-Parent were conducted. Additionally, a follow-up assessment was administered to the experimental group 12 weeks postintervention. The findings unequivocally demonstrate that the combined virtual-reality- and gym-based PA program yielded significant enhancements in PA levels, motor skills, and social skills among children with DD in the experimental group. Notably, these improvements were sustained 12 weeks after the intervention. These findings may help professionals develop and implement better PA programs for children with DD. [ABSTRACT FROM AUTHOR]

Background: Detraining is the partial or complete loss of physical training-induced adaptations as a result of exercise interruption or reduction. The COVID-19 pandemic led to the discontinuation of many older adult exercise programs and led to increased depressive symptoms (DS), increased sedentary behavior (SB), and decreased quality of life (QoL). Objective: To evaluate the effects of detraining, in the pandemic, on physical capacity and its relationship with DS, QoL, and SB of community-dwelling older adults. Methods: The physical capacity (static balance, dynamic balance, and lower limb and handgrip strength) of 35 participants was assessed prepandemic and after 18 and 24 months of the pandemic. DS, QoL, and SB were evaluated only at 18-month period. The analysis of variance for repeated measures or the Friedman and Pearson or Spearman tests were used for statistical analysis. Results: There was a decline in dynamic balance (p <.001) and strength in the lower limbs (p <.001) in the first 18 months, as well as maintenance in the following 6 months. The reduction in dynamic balance during the 18 months of the pandemic was associated with greater DS (p =.015; r =.414) and worse QoL (p =.024; r = −.381) in this period. More time spent on SB (p =.024; r =.386) in the 18th month was associated with worse dynamic balance in the following 6 months. Conclusion: Detraining in the pandemic setting led to long-lasting harmful effects, which can last for 2 years, on the physical capacity of community-dwelling older adults. Implication: Our findings highlight how periods of detraining can interfere in physical and mental health of older adults. [ABSTRACT FROM AUTHOR]

Background: Although the physical activities have demonstrated efficacy in improving physical self-perception, the findings of available studies in college students were conflicting. This review aimed to examine the effects of physical activity interventions on physical self-perception in college students. Methods: Web of Science, PubMed, Cochrane Library, EBSCOhost, Embase, Scopus, CNKI, WanFang, and Chinese Technical Periodicals were searched from inception to April 2024. Studies were included if they were randomized controlled trials (RCTs) or non-RCTs (non-RCTs) that examined the effects of physical activity interventions on college students' physical self-perception. Random-effects models were used in meta-analyses to synthesize effect sizes. Results: Forty studies (17 RCTs and 23 non-RCTs) with 4955 participants were included in this meta-analysis. Overall, physical activity interventions had small to moderate significant effect on physical self-worth (standardized mean difference [SMD] = 0.44, P <.00001), perceived sports competence (SMD = 0.60, P <.00001), perceived physical condition (SMD = 0.45, P <.00001), perceived physical strength (SMD = 0.53, P <.00001), and perceived body attractiveness (SMD = 0.54, P <.00001). Significant differences were observed in study design (P =.031–.039), intervention type (P =.003–.031), and intervention duration (P =.002–.036) for some aspects of physical self-perception, such as perceived physical strength and perceived body attractiveness. Conclusions: Physical activity interventions have beneficial effects on physical self-perception in college students, especially those conducted for 12 weeks, 3 times or more per week, lasting 90 minutes or more per session. Large, high-quality RCTs are required to further confirm these findings. [ABSTRACT FROM AUTHOR]

Among the few interventions that exist to decrease weight stigma in exercise settings, none include a long-term follow-up to assess if changes are sustained. The aim of this study was to assess if a weight stigma intervention that showed success in improving fat attitudes among university recreation center professionals had sustained effects after three months, compared to a control group. Participants were 46 university recreation center professionals who took the Fat Attitudes Assessment Toolkit before completing a two-hour self-paced online intervention or control course, after course completion, and at a three-month follow-up. At follow-up, participants in the intervention group showed significant improvement in total fat attitudes, F (2, 88) = 7.94, p <.001, η2p = 0.15 and in fat acceptance, F (2, 88) = 4.25, p =.017, η2p = 0.09. Future studies should further develop interventions and assess results in larger samples and after longer periods of time. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effects of 6-week barbell weighted-jump-squat (WJS) training with and without eccentric load reduction on explosive performance. Methods: Twenty well-trained male athletes were randomly assigned to either an experimental group (n = 10) or a control group (n = 10). Participants completed 12 WJS training sessions (6 sets of 5 repetitions of barbell back squat at 30% of 1-repetition maximum [1RM]) twice a week over a 6-week period. While the control group used 0% eccentric loading (ie, traditional WJS), the experimental group utilized a 50% eccentric loading reduction with a mechanical braking unit (ie, eccentric load set at 15% of 1RM). Performance assessments, including countermovement jump, 20-m sprint, standing long jump, and 1RM barbell back squat, were conducted both before (pretests) and after (posttests) the intervention. Results: Both the experimental group and the control group demonstrated a significant increase in countermovement-jump height (+6.4% [4.0%] vs +4.9% [5.7%]; P <.001) and peak power output (+2.3% [2.7%] vs +1.9% [5.1%]; P =.017), faster 20-m sprint times (+9.4% [4.8%] vs +9.2% [5.5%]; P <.001), longer standing long jump (+3.1% [2.5%] vs +3.0% [3.3%]; P <.001), and higher 1RM back squat (+6.4% [4.0%] vs +4.9% [5.7%]; P <.001) from pretests to posttests. However, there was no significant condition × time interaction for any variable (all P ≥.294). Conclusions: Both WJS training methods, with and without load reduction in the eccentric phase, effectively enhance explosive performance. Nevertheless, athletes in later stages of injury rehabilitation or intense training may find reducing eccentric load a more tolerable strategy for achieving similar performance gains compared with traditional isoinertial loading. [ABSTRACT FROM AUTHOR]

Context: We designed this study to investigate the effects of 2 myofascial release techniques, Instrument-Assisted Soft Tissue Mobilization (IASTM) and Foam Roller (FR), on pain, joint range of motion, and muscle strength in athletes suffering from iliotibial band (ITB) tightness. Design: A total of 39 male soccer players were enrolled in this randomized controlled trial, aged between 18 and 23 years who were divided into 3 groups: Only Exercise, IASTM, and FR. Methods: All participants performed daily strengthening and stretching exercises, while 1 group added IASTM, and the other added FR to the exercise program. We evaluated ITB tightness with the Ober test and an inclinometer, pressure pain threshold, using an algometer, and we evaluated muscle strength with the Cybex Norm Isokinetic device. Results: We found that all 3 groups exhibited an increase in the Ober inclination angle after the interventions (P =.001), but the increase was greater for participants in the IASTM and FR groups, compared with exercise alone. Additionally, both the IASTM and FR groups displayed an increased pressure pain threshold (P =.001), whereas there was no change in the control group. Moreover, while all 3 groups experienced an increase in hip muscle strength (P =.001), the IASTM and FR groups exhibited a greater increase compared with exercise alone (P =.001). Conclusions: Based on these findings, exercise improves pain, range of motion, and muscle strength in athletes with ITB tightness, and IASTM, and FR techniques enhanced exercise effects but did not differ from one another. While our study demonstrated that both IASTM and FR techniques significantly enhance the benefits of exercise for athletes with ITB tightness, further research could delve into the long-term effects of these interventions. [ABSTRACT FROM AUTHOR]

Context: To stabilize the humeral head within the glenoid fossa during arm elevation, the rotator cuff muscles may contribute through internal and external rotation. The main purpose of the current study was to compare the acromiohumeral distance between athletes with primary subacromial impingement syndrome who received progressive resistance exercises consisting of either shoulder internal or external rotation. Design: A randomized and controlled clinical study. Methods: Thirty athletes with primary subacromial impingement syndrome were enrolled and randomly divided into 2 experimental groups. The progressive resistance exercise protocol in experimental group I comprised shoulder internal rotation, while in experimental group II consisted of shoulder external rotation. The experimental groups worked out 3 days a week for 6 weeks. The experimental groups were compared with the control group consisting of 15 healthy athletes. The acromiohumeral distance was measured before and after the intervention using an ultrasound machine under the passive and active across no arm elevation and 45°of arm elevation. Results: The acromiohumeral distance significantly increased in both experimental groups under the passive and active arm positions following the intervention (P <.001), with no significant differences detected between the experimental groups (P >.665). The paired comparisons of the acromiohumeral distance discrepancy indicated a significant difference between the control group and each experimental group under the active and passive arm positions (P <.001), while no significant difference was observed between the experimental groups (P >.999). Conclusions: The present study revealed, for the first time, that both progressive resistance exercise protocols involving either the shoulder internal or the external rotation increased the acromiohumeral distance in individuals with primary subacromial impingement syndrome and improved associated pain and disabilities. [ABSTRACT FROM AUTHOR]

Context: The best current evidence supports the effectiveness of neuromuscular training in reducing the risk of injury; however, the rate of anterior cruciate ligament (ACL) injuries is still high. Neurocognitive training (NT) has successfully improved biomechanical risk factors, but they have been considered in only a few studies. Objective: To review the literature to determine the effect of NT on biomechanical risk factors related to ACL injury in athletes. Evidence Acquisition: We searched PubMed, Google Scholar, Scopus, Science Direct, and the Physiotherapy Evidence Database from inception to August 2011. We included randomized controlled trials that used motor learning approaches and injury prevention programs to investigate kinematic and kinetic risk factors related to ACL injury. The quality of each clinical trial study was evaluated by the Physiotherapy Evidence Database scale. The eligibility criteria were checked based on the PICOS (population, intervention, comparison, outcome, and study type) framework. Evidence Synthesis: A total of 9 studies were included in the final analysis. Motor learning approaches include internal and external focus of attention, dual tasks, visual motor training, self-control feedback, differential learning, and linear and nonlinear pedagogy, combined with exercise programs. In most of the studies that used NT, a significant decrease in knee valgus; tibial abduction and external rotation; ground reaction force; and an increase in knee-, trunk-, hip-, and knee-flexion moment was observed. Conclusion: In classical NT, deviation from the ideal movement pattern especially emphasizing variability and self-discovery processes is functional in injury prevention and may mitigate biomechanical risk factors of ACL injuries in athletes. Practitioners are advised to use sport-specific cognitive tasks in combination with neuromuscular training to simulate loads of the competitive environment. This may improve ACL injury risk reduction and rehabilitation programs. [ABSTRACT FROM AUTHOR]

Background: Pickleball has grown tremendously in recent years, yet little evidence exists regarding pickleball-related injuries. This scoping review extends current work on pickleball participation by identifying positive and negative health effects associated with the sport. We summarize how pickleball impacts the health and well-being of adult participants. Methods: Searches were conducted on MEDLINE, CINAHL, ProQuest Nursing, ERIC, SPORTDiscus, PsycINFO, Scopus, CBCA Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses. Selected studies considered aspects of health and/or well-being of adult pickleball participants. Using the population/concept/context framework, participants were healthy, able-bodied adults 18 years of age or over, who had played pickleball at least once. The positive and negative outcomes of pickleball on participants' health and well-being (concept) within the context of pickleball participation were examined. Full-text articles written in English since 2013 were included. Extracted data were tabulated, and a descriptive summary with thematic analysis was completed. Results: This scoping review comprised 27 articles that met the inclusion criteria. Pickleball is promising as an exercise intervention for all adults, and there is evidence of positive social and psychological effects, and health and fitness benefits to participating in pickleball by older adults. Conclusions: Although we are still in the early stages of studying pickleball, there have been some documented health benefits of using the sport as a physical exercise intervention for adults. More research is needed on the types, prevalence, and severity of pickleball injuries and the sport's impact on younger players. [ABSTRACT FROM AUTHOR]

Physical activity levels during skilled nursing facility (SNF) rehabilitation fall far below what is needed for successful community living and to prevent adverse events. This feasibility study's purpose was to evaluate the feasibility, acceptability, and preliminary effectiveness of an intervention designed to improve physical activity in patients admitted to SNFs for short-term rehabilitation. High-Intensity Rehabilitation plus Mobility combined a high-intensity (i.e., high weight, low repetition), progressive (increasing in difficulty over time), and functional resistance rehabilitation intervention with a behavioral economics-based physical activity program. The behavioral economics component included five mobility sessions/week with structured goal setting, gamification, and loss aversion (the idea that people are more likely to change a behavior in response to a potential loss over a potential gain). SNF physical therapists, occupational therapists, and a mobility coach implemented the High-Intensity Rehabilitation plus Mobility protocol with older Veterans (n = 18) from a single SNF. Participants demonstrated high adherence to the mobility protocol and were highly satisfied with their rehabilitation. Treatment fidelity scores for clinicians were ≥95%. We did not observe a hypothesized 40% improvement in step counts or time spent upright. However, High-Intensity Rehabilitation plus Mobility participants made clinically important improvements in short physical performance battery scores and gait speed from admission to discharge that were qualitatively similar to or slightly higher than historical cohorts from the same SNF that had received usual care or high-intensity rehabilitation alone. These results suggest a structured physical activity program can be feasibly combined with high-intensity rehabilitation for SNF residents following a hospital stay. [ABSTRACT FROM AUTHOR]

Context: Poor knee biomechanics contribute to knee joint injuries. Neuromuscular control over knee position is partially derived from the hip. It is unknown whether isolated activation training of the gluteal muscles improves lower-extremity frontal plane mechanics. This study examined if a home-based hip muscle activation program improves performance on the Forward Step-Down Test as well as increases surface electromyography (sEMG) activation of the gluteal muscles. Design: The study utilized a single-group repeated-measures design. Methods: Thirty-five participants (24 females, mean age = 23.17 [SD 1.36] years) completed an 8-week hip muscle activation program. The Forward Step-Down Test score and sEMG of gluteus maximus and medius were assessed preintervention and postintervention. Results: Forward Step-Down Test scores improved significantly from preintervention (Mdn = 3.5) to postintervention (Mdn = 3.0, T = 109, P =.010, r =.31.), but this result did not meet clinical significance. sEMG analysis revealed a significant increase in mean gluteus maximus activation (P =.028, d = 1.19). No significant dose–response relationship existed between compliance and the Forward Step-Down Test scores or sEMG results. Conclusions: A home-based hip activation program increases gluteus maximus activation without clinically significant changes in frontal plane movement quality. Future studies may find clinical relevance by adding motor learning to the activation training program to improve functional muscle use. [ABSTRACT FROM AUTHOR]

We aimed to investigate the effects of dual- and single-task training in older adults with age-related hearing loss. Intervention groups included single-, dual-task training, and control groups. The dual- and single-task trainings were held 2 days a week for 40 min for a total of 10 sessions for 5 weeks. We evaluated physical, cognitive, and auditory functions, quality-of-life, balance, concerns about falling, independence in activities of daily living, and dual-task performance. A total of 42 patients fully participated in this study. Statistically significant differences were observed in chair stand, chair sit-and-reach, global cognitive function, and delayed recall between the intervention groups and control group (p <.05). There was no statistically significant difference in quality-of-life, balance, falling concerns, independence in activities of daily living, and dual-task performance between all groups (p >.05). In conclusion, single- and dual-task training had a positive effect on physical and cognitive functioning in older adults with age-related hearing loss. [ABSTRACT FROM AUTHOR]

Purpose: Musculoskeletal strength can be impaired in pediatric solid organ transplant recipients. Exercise training programs can be beneficial but in-person delivery can be challenging; virtual exercise programs can alleviate some of these challenges. This feasibility study aimed to deliver an 8-week virtual exercise program in pediatric solid organ transplant recipients. Method: Program delivery occurred 3 times per week for 30 minutes. An exercise stress test was completed prior to program start. The Bruininks-Oseretsky Test of Motor Proficiency strength subtest and self-report surveys were used to assess musculoskeletal strength, quality of life, fatigue, and physical activity. Contact was maintained through a text messaging platform. Z scores were calculated using standardized normative data. Medians (interquartile range) are reported for all other data. Results: Eleven participants completed the program (2 liver, 5 kidney, 4 heart; 58% females; median age = 11.5 [10.3–13.8] y). Six participants attended ≥60% of classes, 5 participants attended <50% of classes. After 8 weeks, strength scores improved (Z score, Pre: −1.0 [−1.65 to −0.60] to Post: −0.2 [−1.30 to 0.40]; P =.007) with no change in other outcome measures. Conclusion: The virtual exercise program was delivered without technical issues and received positive participant feedback. Engagement and costs need to be considered. [ABSTRACT FROM AUTHOR]

Purpose: The optimal approach to hamstring training is heavily debated. Eccentric exercises reduce injury risk; however, it is argued that these exercises transfer poorly to improved hamstring function during sprinting. Some argue that other exercises, such as isometric exercises, result in better transfer to running gait and should be used when training to improve performance and reduce injury risk. Given the performance requirements of the hamstrings during the terminal swing phase, where they are exposed to high strain, exercises should aim to improve the torque production during this phase. This should improve the hamstrings' ability to resist overlengthening consequently, improving performance and limiting strain injury. Most hamstring training studies fail to assess running kinematics postintervention. Of the limited evidence available, only eccentric exercises demonstrate changes in swing-phase kinematics following training. Studies of other exercise modalities investigate effects on markers of performance and injury risk but do not investigate changes in running kinematics. Conclusions: Despite being inconsistent with principles of transfer, current evidence suggests that eccentric exercises result in transfer to swing-phase kinematics. Other exercise modalities may be effective, but the effect of these exercises on running kinematics is unknown. [ABSTRACT FROM AUTHOR]

This study evaluated physical activity interventions designed for individuals with visual impairments and sought to guide health intervention scientists aiming to promote physical activity in this demographic. We delved into the specifics of participants' visual impairments, intervention features, accommodation approaches, and replicability prospects. The search spanned four databases, namely PubMed, CINAHL, SportDiscus, and Scopus, providing a wide scope and diversity of potential studies. There were no restrictions on publication years. We reviewed 13 studies, totaling 15 interventions. A consensus on visual-impairment definitions remains elusive, and the intervention dosages displayed variability. Notably, 66.7% (n = 7) integrated behavior-change techniques to amplify physical activity levels. Multiple studies employed audio descriptions as an accommodation method. While most studies provided adequate information for potential replication, detailed study protocols were frequently absent. It is essential for developed interventions to be persistently evaluated and fine-tuned to optimize results. [ABSTRACT FROM AUTHOR]

Clinical Scenario: The fascial relationship between scapular muscles and abdominal muscles has been documented from previous studies. However, it is not yet clear whether voluntary abdominal contraction has a beneficial effect on scapular muscle activity during shoulder exercises. Clinical Question: Do scapulothoracic muscle activation levels increase if shoulder exercises are performed with voluntary abdominal activation? Summary of Key Finding: After the literature review, 4 cross-sectional studies met the inclusion criteria and were included in this critically appraised topic. Clinical Bottom Line: There is moderate evidence to support dynamic shoulder exercises with voluntary abdominal contraction can increase trapezius and serratus anterior muscle activation level in asymptomatic shoulders. Strength and Recommendation: Findings from 4 cross-sectional trials indicate that there is moderate evidence supporting that dynamic shoulder exercises performed with voluntary abdominal contraction can increase scapular muscle activity. [ABSTRACT FROM AUTHOR]

Background: Relative energy deficiency in sport (REDs) is a condition that is associated with negative health and performance outcomes in athletes. Insufficient energy intake relative to exercise energy expenditure, resulting in low energy availability, is the underlying cause, which triggers numerous adverse physiological consequences including several associated with musculoskeletal (MSK) health and neuromuscular performance. Purpose: This commentary aims to (1) discuss the health and performance implications of REDs on the skeletal and neuromuscular systems and (2) examine the role that MSK training (ie, strength and plyometric training) during treatment and return to performance following REDs might have on health and performance in athletes, with practical guidelines provided. Conclusions: REDs is associated with decreases in markers of bone health, lean body mass, maximal and explosive strength, and muscle work capacity. Restoration of optimal energy availability, mainly through an increase in energy intake, is the primary goal during the initial treatment of REDs with a return to performance managed by a multidisciplinary team of specialists. MSK training is an effective nonpharmacological component of treatment for REDs, which offers multiple long-term health and performance benefits, assuming the energy needs of athletes are met as part of their recovery. Supervised, prescribed, and gradually progressive MSK training should include a combination of resistance training and high-impact plyometric-based exercise to promote MSK adaptations, with an initial focus on achieving movement competency. Progressing MSK training exercises to higher intensities will have the greatest effects on bone health and strength performance in the long term. [ABSTRACT FROM AUTHOR]

Insomnia treatment among individuals with comorbid insomnia and obstructive sleep apnea is suboptimal. In a pilot randomized controlled trial, 19 individuals with comorbid insomnia and obstructive sleep apnea were allocated to one of two arms: EX + EX, consisting of two 8-week phases of exercise training (EX), or RE + CBTiEX, encompassing 8 weeks of relaxation training (RE) followed by 8 weeks of combined cognitive-behavioral therapy and exercise (CBTiEX). Outcomes included Insomnia Severity Index (ISI), polysomnography, and cardiorespiratory fitness measures. A mixed-model analysis of variance revealed a Group × Time interaction on peak oxygen consumption change, F(1, 14) = 10.1, p =.007, and EX increased peak oxygen consumption (p =.03, g′ = −0.41) and reduced ISI (p =.001, g′ = 0.82) compared with RE (p =.49, g = 0.16) post-8 weeks. Post-16 weeks, there was a significant Group × Time interaction (p =.014) driven by RE + CBTiEX yielding a larger improvement in ISI (p =.023, g′ = 1.48) than EX + EX (p =.88, g′ < 0.1). Objective sleep was unchanged. This study showed promising effects of regular EX alone and combined with cognitive-behavioral therapy for insomnia on ISI in comorbid insomnia and obstructive sleep apnea. [ABSTRACT FROM AUTHOR]

Physical function is regarded as the cornerstone of healthy aging, and exercise is an important determinant of healthy aging. This study examined the feasibility and physiological (heart rate, blood pressure, blood lactate, and rate of perceived exertion) and psychological (enjoyment) response resulting from an acute progressive sled-push (SLP) exercise session using the novel XPO Sled Trainer in older adults and compared that with walking (WKC) condition. The exercise session comprised six exercise bouts at 75%, 85%, 100% (2×), and 125% (2×) of normal velocity with a 2-min rest between bouts. Thirty-six older adults were randomly allocated into either the SLP or WKC conditions. No adverse events were observed during the exercise session, and all participants completed the exercise protocol as prescribed. One-third of the participants in the SLP group reported minimal body discomfort. Significantly higher responses were observed for all physiological variables as the intensity of the exercise increased in the SLP group compared with the WKC group (p <.001). The SLP group presented a decline in enjoyment as the intensity of the exercise increased (during), but similar enjoyment level than the WKC group for the overall exercise session (p =.711). Our findings support the viability and safety of SLP exercise using the XPO Sled Trainer in older adults. Such exercise demonstrated an intensity-driven modality that may have potential to elucidate positive adaptations in the cardiovascular system of older adults with acceptable levels of enjoyment. [ABSTRACT FROM AUTHOR]

Background: Women with higher body mass index report low rates of and face unique barriers to exercise. Increasing exercise participation can improve mental and physical health independent of weight loss; however, most exercise programs targeting this population focus predominately on losing weight. This paper aims to describe the development of Fit&Fab, a community-based exercise intervention focused on increasing exercise participation and enjoyment for women with obesity. Methods: In partnership with the YMCA, we recruited women ages 35–64 years (body mass index ≥ 30) to participate in 4 focus groups to understand exercise preferences. Formative work was used to identify theory constructs and associated intervention components. Women from the focus groups were recruited for a community advisory board that finalized the intervention design, recruitment, and evaluation plan. Results: Focus groups participants (N = 29) preferred to exercise without men and wanted a cohort-style class that included women of similar exercise levels and body types, incorporated social support, fun activities, and broke exercise into smaller bouts. They wanted a supportive instructor who was fit but understood weight-related challenges. The community advisory board and research team used focus group findings to inform design of the final intervention including group exercise classes, psychosocial support sessions, personalized training, exercise tracking, outcome monitoring, and rewards. Conclusions: Our findings emphasize the need to focus on exercise enjoyment and benefits other than losing weight to improve exercise participation among women with higher body mass index. In addition to having outcomes other than weight loss, exercise interventions with this population should also consider group composition, instructor, and class format. [ABSTRACT FROM AUTHOR]

Purpose: To determine between-limbs differences in isometric rate of force development (RFD) measured during open- (OKC) and closed-kinetic-chain (CKC) strength testing and establish which method had the strongest relationship to single-leg vertical-jump performance and knee mechanics after anterior cruciate ligament (ACL) reconstruction. Methods: Subjects (n = 19) 1 to 5 years from ACL reconstruction performed isometric knee extensions (OKC), unilateral isometric midthigh pulls (CKC), and single-leg vertical jumps on the ACL-involved and -noninvolved limbs. Between-limbs differences were assessed using paired t tests, and the relationship between RFD, jump performance, and knee mechanics was assessed using correlation coefficients (r; P ≤.05). Results: There were significant between-limbs differences in OKC RFD (P =.008, d = −0.69) but not CKC RFD. OKC RFD in the ACL-involved limb had a strong association with jump height (r =.64, P =.003), knee-joint power (r =.72, P <.001), and peak knee-flexion angle (r =.72, P =.001). CKC RFD in the ACL-involved limb had a strong association with jump height (r =.65, P =.004) and knee-joint power (r =.67, P =.002) but not peak knee-flexion angle (r =.40, P =.09). Conclusions: While both OKC and CKC RFD were strongly related to jump performance and knee-joint power, OKC RFD was able to detect between-limbs RFD asymmetries and was strongly related to knee-joint kinematics. These findings indicate that isometric knee extension may be optimal for assessing RFD after ACL reconstruction. [ABSTRACT FROM AUTHOR]

Context: Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. Case Presentation: Three patients were referred for dry needling once a week for 6 weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). Management and Outcomes: The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6 weeks. Conclusions: This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term. [ABSTRACT FROM AUTHOR]

Purpose: Core strength is vital for athletic performance, and many more exercises that involve the kinetic chain have been designed for able-bodied athletes. Disabilities that impair the kinetic chain can reduce the effectiveness of strength training. However, the impact of amputation on core strength training of people with disabilities and its underlying mechanism remains unclear. This study aimed to evaluate the muscle activation patterns and levels in athletes with amputation during 4 basic and modified weight-bearing core strength-training exercises. Methods: Fifteen elite athletes with unilateral amputation (170.6 [7.3] cm; 63.9 [11.9] kg; 25.9 [5.3] y) volunteered for this study. Surface electromyography was used to measure the muscle activity mainly in the lumbopelvic–hip complex-stabilizing muscles during 4 kinetic chain trunk exercises with and without modifications. Results: The significance level was set at α =.05. The results showed a significant difference in muscle activation between different body sides (P <.05). Specifically, amputation on the support position resulted in a diagonal pattern of muscle activation, and amputation on the free distal segments resulted in a unilateral dominant pattern with higher activation in muscles on the nonamputated side (P <.05). Modifications led to significant decreases in muscle activation asymmetry index (P <.05). Conclusions: Amputation caused muscle activation asymmetry and 2 activation patterns. Modifications by enhancing proximal stability and adjusting distal loading effectively reduced the asymmetry of muscle activation. Coaches and clinicians can use these results to tailor exercises for athletes with disabilities in training and rehabilitation. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the preliminary effects of movement pattern training (MoveTrain) versus strengthening/flexibility (standard) treatment on hip and pelvic biomechanics in patients with chronic hip-related groin pain. This is a secondary analysis of data collected during a pilot randomized clinical trial. Thirty patients with hip pain, between the ages of 15 and 40 years, were randomized to MoveTrain or standard. Both groups completed 10 treatment sessions over 12 weeks along with a daily home exercise program. Three-dimensional motion analysis was used to collect kinematic and kinetic data of the pelvis and hip during a single-leg squat task at pretreatment and immediately posttreatment. Compared with the standard group, the MoveTrain group demonstrated smaller hip adduction angles (P =.006) and smaller hip external adduction moments (P =.008) at posttreatment. The desired changes to hip joint biomechanics, as found in this study, may require specificity in training that could allow health care professionals to better customize the rehabilitation of patients with hip pain. These findings can also be applied to the design and implementation of future clinical trials to strengthen our understanding of the long-term implications of different rehabilitation techniques for patients with hip pain. [ABSTRACT FROM AUTHOR]

This study investigated the impact of multimorbidity patterns on physical activity and capacity outcomes over the course of a year-long exercise intervention, and on physical activity 1 year later. Participants were 314 physically inactive community-dwelling men and women aged 70–85 years, with no contraindications for exercise at baseline. Physical activity was self-reported. Physical capacity measurements included five-time chair-stand time, 6-minute walking distance, and maximal isometric knee-extension strength. The intervention included supervised and home-based strength, balance, and walking exercises. Multimorbidity patterns comprised physician-diagnosed chronic disease conditions as a predictor cluster and body mass index as a measure of obesity. Multimorbidity patterns explained 0%–12% of baseline variance and 0%–3% of the change in outcomes. The magnitude and direction of the impact of unique conditions varied by outcome, time point, and sex. Multimorbid older adults with no contraindications for exercise may benefit from multimodal physical training. [ABSTRACT FROM AUTHOR]

Many studies have shown that personalized exergames have a positive effect on promoting regular and proper exercise. However, there is no consensus on the design characteristics and evaluation of exergames. This systematic review of published research literature aimed to explore the general characteristics, personalization characteristics, and evaluation of personalized exergames for middle-aged and older people. We screened published studies in the Web of Science, Scopus, PubMed, ACM, and IEEE Xplore databases, extracted data, and performed a thematic analysis according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Three main themes and nine subthemes were generated from 24 included papers. Moreover, a personalization model (FACTS) and evaluation system (PMSS) of exergames were developed. Personalized exergames had potential positive effects on motivating middle-aged and older people to exercise and improve their health, particularly physical, mental, and social health. However, more fine-grained studies on personalized exergames are necessary in the future. [ABSTRACT FROM AUTHOR]

Background: Few mobile health resistance-based physical activity interventions have targeted community-dwelling adults. "Ecofit" is a multicomponent intervention that promotes resistance and aerobic activities using smartphone technology, outdoor gyms, and social support. This study evaluated process evaluation outcomes of the ecofit randomized controlled trial: (1) the acceptability and usability of the ecofit smartphone app and app user workouts; (2) perceptions of factors influencing outdoor gym use; and (3) the fidelity, reach, recruitment, and dose received of the ecofit program. Methods: Process data were collected through program evaluation surveys at 3 months, and app usage data were collected via the intervention platform for up to 3 months. Data were analyzed using descriptive statistics. Results: The survey was completed by 57% (n = 69) of eligible participants. The majority (93%) believed the app provided them with sufficient information to perform muscle-strengthening activities. Approximately half (51%) agreed that the goal-setting function encouraged them to complete their workouts, and 42% agreed that the self-assessment helped them monitor progress. "Proximity" to outdoor gyms emerged as the most important factor for choosing locations to workout (mean = 5.5, SD = 1.1). Participants logged a median of 5.5 (interquartile range = 19) workouts and 1 (interquartile range = 1) upper- and lower-body muscular fitness self-assessment. Conclusions: The ecofit app provided participants with sufficient skills to perform unsupervised resistance training exercises using mobile health. Only half of the participants regarded self-assessments and goal setting as useful, suggesting a need for modifications to how these are implemented. Mobile health remains a promising delivery platform to promote unsupervised resistance training, although more research is needed to improve uptake. [ABSTRACT FROM AUTHOR]

Exercise professionals often hold anti-fat attitudes, which contribute to weight stigma and discrimination in physical activity contexts. This study examined the effects of an online weight stigma intervention on exercise professionals' attitudes toward fatness. Participants were 105 exercise professionals who were employed at least part-time at university recreation centers in the United States. In this randomized controlled trial, participants were randomized into an intervention online course to decrease weight stigma or a control online course to learn about communication techniques to enhance motivation for physical activity. Attitudes about fatness were assessed at pre- and post-course using the Fat Attitudes Assessment Toolkit (FAAT). There were significant increases in the fat acceptance composite score in the intervention group compared to the control group, suggesting recreation center staff who completed the intervention WIT FITS course experienced more positive evaluations of fat people as a result of the intervention. [ABSTRACT FROM AUTHOR]

Purpose: To examine the impact of oral contraceptive (OC) phases on performance, physiological, and subjective responses to prolonged, intensive exercise when carbohydrate (CHO) stores are reduced. Methods: Ten well-trained female cyclists using monophasic OC completed 4 identical trials (>150 min) under conditions of in-trial 60-g·h−1 CHO supplementation (CHO+) or placebo (CHO−) during the sugar- (SUG) and active-pill (ACT) phases of their OC cycle. Each trial comprised two 400-kcal time trials (TT) separated by 1 hour of submaximal cycling at first ventilatory threshold. Results: Change in completion time from TT1 to TT2 was minimized in CHO+ compared with CHO− (4.06 [2.55] vs 6.08 [5.33] min; P =.019, effect size = −0.36). An interaction effect of OC and CHO was observed for time to complete TT (P =.006), mean TT power (P =.002), mean TT heart rate (P =.002), and posttrial emotional balance (P =.020) and negative emotional state (P =.033). In ACT, mean TT power and heart rate were higher in CHO+ when compared with CHO−, resulting in faster TTs in CHO+ and improved posttrial emotional well-being. When CHO was not supplemented, TT power and heart rate were higher in SUG when compared with ACT, resulting in faster TTs in SUG and improved posttrial emotional balance. Conclusion: CHO depletion during ACT negatively influenced TT performance and emotional well-being when compared with SUG. Irrespective of OC pill phase, CHO supplementation should be prioritized to sustain performance and improve postexercise recovery–stress balance. [ABSTRACT FROM AUTHOR]

Context: Blood flow restriction (BFR) is a rehabilitation tool which may introduce a constraint, similar to muscle fatigue, that challenge patients' sensorimotor system during balance exercises. The purpose of our study was to examine whether adding BFR to dynamic balance exercises produced a decrease in balance performance and an increase in ratings of perceived exertion and instability in individuals with chronic ankle instability (CAI) compared with dynamic balance exercises without BFR. Designs: Crossover design. Methods: Our sample included N = 25 young adults with a history of CAI. Participants completed 2 laboratory visits. At each visit, participants completed 4 sets (30×-15×-15×-15×) of dynamic balance exercises, performed similar to the modified star excursion balance test (SEBT), once with BFR and once with control (no BFR) conditions. We measured composite SEBT scores at baseline and during the final repetitions of each set of balance exercise (sets 1–4). We also measured ratings of perceived exertion and instability following each balance exercise set. Results: We observed no difference in composite SEBT scores between conditions at baseline; however, composite SEBT scores were significantly lower during all balance exercises sets 1 to 4 with the BFR condition compared with control. During the BFR condition, composite SEBT scores were significantly lower during all balance exercise sets compared with baseline. During the control condition, composite SEBT scores did not significantly change between baseline and each balance exercise set. Ratings of perceived exertion and instability scores were significantly greater in the BFR group compared with the control group during all balance exercise sets. Conclusions: Individuals with CAI demonstrated lower composite SEBT scores and greater perceived instability and exertion during dynamic balance exercise with BFR compared to without BFR. BFR introduced a novel muscle fatigue constraint during dynamic balance exercises in individuals with CAI. Additional research is needed to determine if adding BFR to balance training could improve clinical outcomes in CAI patients. [ABSTRACT FROM AUTHOR]

Recently renamed, metabolic dysfunction-associated steatotic liver disease remains a leading cause of chronic liver disease worldwide. Regular physical activity is recommended as a treatment for all with this condition because it is highly efficacious, especially when exercise training is undertaken with a specific goal in mind. Despite decades of research demonstrating exercises efficacy, key questions remain about the mechanism of benefit and most efficacious dose, as well as the independent impact on liver histology. To answer these questions, we present the design of a 16-week randomized controlled clinical trial of 45 adults aged 18-69 years with metabolic dysfunction-associated steatohepatitis. The primary aim of this study is to better understand the dose required and mechanisms to explain how exercise impacts multiple clinical end points in metabolic dysfunction-associated steatohepatitis. The primary outcome is MRI-measured liver fat. Secondary outcomes include other biomarkers of liver fibroinflammation, liver histology, and mechanistic pathways, as well as cardiometabolic risk and quality of life. This is the first study to compare different doses of exercise training to determine if there is a differential impact on imaging and serum biomarkers as well as liver histology.

Background: Weakness of the shoulder girdle muscles has been reported in patients with chronic lateral elbow tendinopathy. The aim of this study was to assess the short- and long-term effects of a conventional treatment plus scapular exercises program in patients with chronic lateral elbow tendinopathy. Methods: A single-group prestudy and poststudy were conducted. The primary outcome was the Patient-Rated Tennis Elbow Evaluation questionnaire score. Secondary outcomes were grip strength; Disabilities of the Arm, Shoulder, and Hand questionnaire score; Visual Analogue Scale score at rest and at grip, and presence of scapular dyskinesis. Results: A total of 65 patients (72.3% females), with a mean age of 41.8 years, were analyzed. At the end of 6 weeks, the results showed clinically and statistically significant differences (P< .05). At 1-year follow-up, the differences were: Patient-Rated Tennis Elbow Evaluation -31 points (P<.001); grip strength +33.6% (P<.001); Disabilities of the Arm, Shoulder, and Hand -34.2 points (P < .001); Visual Analogue Scale at rest -2.5 cm (P < .001); and Visual Analogue Scale at grip -2.3 cm (P < .001). Conclusion: At the end of 6 weeks and at 1-year follow-up, conventional treatment plus scapular exercises program showed statistically and clinically significant differences in all functional outcomes assessed in patients with lateral elbow tendinopathy. [ABSTRACT FROM AUTHOR]

Assessing bone's response to physical activity interventions is challenging. This randomized controlled trial investigates if changes in bone turnover markers can offer an early evaluation of a physical activity intervention's effectiveness in improving bone mineral density (BMD) in premenopausal women. Participants in the intervention group (n = 27, with 24 completing the trial) were instructed to walk at least 10,000 steps every day on a brisk walk and to execute 60 jumps daily, each surpassing 4g of acceleration, using an accelerometer-based wearable device. Meanwhile, the control group (n = 26, with 18 completing the trial) continued with their usual lifestyle. Bone turnover markers, comprising of C-terminal telopeptide of Type I collagen, procollagen Type 1 N-terminal propeptide, and total osteocalcin (carboxylated and undercarboxylated) were measured at baseline and midway through the intervention (3 months). Dual-energy X-ray absorptiometry scans of the hip and lumbar spine were conducted at baseline and the end of the intervention (6 months) to estimate BMD. Analysis of covariance exhibited significant differences between groups in procollagen Type 1 N-terminal propeptide (−6.74 μg/L, p =.023) and C-terminal telopeptide of Type I collagen (−83 ng/L, p =.043) after 3 months, and in femoral neck BMD (+0.024 g/cm2, p =.016), total hip BMD (+0.036 g/cm2, p =.004), and lumbar spine BMD (+0.026 g/cm2, p =.020) after 6 months. A significant correlation (r = −.73; p <.001) was detected between reductions in C-terminal telopeptide of Type I collagen and increases in femoral neck BMD. In conclusion, this intervention improved BMD in premenopausal women, with bone turnover markers potentially useful for early intervention assessment, though further research is needed. [ABSTRACT FROM AUTHOR]

Exercise is the single most effective strategy to reduce the risk of falls. Online classes have grown in popularity, but the benefits of online classes remain unknown. Zoomers on the Go is a peer-led 12-week exercise program offered twice weekly to adults 50+ years old. The main outcome was lower body strength measured by the 30-s chair stand test. Other outcomes included dropout, attendance, balance, cardiorespiratory fitness, and perceived health. A total of 74 participants (age 66.3 ± 7.1 years) in the online group and 84 participants in the in-person group (age 67.3 ± 7.2 years) completed the program, with attendance for the online group. Both groups significantly improved their 30-s chair stand, cardiorespiratory fitness, and balance (p <.001) with no difference in functional benefits between groups. The in-person group improved their perceived health and significantly reduced levels of stress and depression, while no such changes were observed in the online group. [ABSTRACT FROM AUTHOR]

Despite a strong body of evidence supporting benefits of exercise to reduce severity of motor symptoms of Parkinson's Disease (PD) over time, research on the immediate impact of exercise as an adjunctive therapy for nonpharmacologic management of motor symptoms and mobility performance in people with PD is limited. The purpose of this study was to examine immediate effects of a single bout of high-cadence cycling on motor symptoms of PD and performance-based outcomes. Twenty individuals with idiopathic PD participated in a pretest/posttest study investigating immediate impacts of a single high-cadence cycling session on performance-based outcomes across multiple domains of motor function, mobility, and balance. Outcomes were analyzed based on time since last dose of levodopa/carbidopa medication. Immediate improvements were observed in motor symptoms of PD with significant improvements in performance across multiple balance systems, dynamic gait, and upper-extremity coordination following a cycling intervention. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effect of a Nordic hamstring exercise intervention on biceps femoris long head, semitendinosus, and semimembranosus muscle's activity and relative contributions through multichannel electromyography. Twenty-four injury-free male basketball players (mean age 20 [3] y) were randomly assigned to a 12-week intervention (n = 13) or control group (n = 11). The primary outcome measures were normalized muscle activity (percentage of maximal voluntary isometric contraction, %MVIC) and relative contribution of hamstring muscles over 12 weeks. No effects were found on any of the primary outcome measures. Between-group differences over 12 weeks were 2.7%MVIC (95% confidence interval 95% CI, −0.7 to 6.1) for the biceps femoris long head, 3.4%MVIC (95% CI, −1.4 to 8.2) for the semitendinosus, and 0.8%MVIC (95% CI, −3.0 to 4.6) for the semimembranosus, P =.366. Between-group differences over 12 weeks were 1.0% relative contribution (%con; 95% CI, −3.0 to 5.1) for the biceps femoris long head, 2.2% relative contribution (95% CI, −2.8 to 7.2) for the semitendinosus, and −3.3% relative contribution (95% CI, −6.4 to −0.1) for the semimembranosus P =.258. A positive value implies a higher value for the Nordic group. A Nordic hamstring exercise intervention did not affect the level of muscle activity and relative contribution of hamstring muscles in performance of the Nordic hamstring exercise. [ABSTRACT FROM AUTHOR]

The purpose of this study was to test the feasibility and acceptability of a staff-delivered physical exercise program embedded into the daily lives of older adults living in nursing homes. A randomized controlled pilot feasibility study was carried out, which included quantitative, qualitative, and economic assessments at baseline, 12 weeks, and 12 months. Two nursing homes (one intervention and one control) took part. The exercise program was carried out on 3 days per week for 12 weeks and consisted of a program of Morning Movement (walking and sit-to-stand exercises) and Activity Bursts. The results confirm that the intervention and study processes are largely acceptable and feasible to implement in the nursing home setting. Potential short-term improvements in physical mobility and quality of life were noticed as positive mean changes and supported by qualitative assessment. Future randomized controlled trials should consider using the 6-meter walk test and refining nursing home and participant eligibility criteria. [ABSTRACT FROM AUTHOR]

Long COVID, or post-acute sequelae of COVID-19 (PASC), represents a complex condition with persistent symptoms following SARS-Cov-2 infection. The symptoms include fatigue, dyspnoea, cognitive impairment, decreased quality of life in variable levels of severity. Potential mechanisms behind long COVID include vascular damage, immune dysregulation and viral persistence. Diagnosing long COVID involves medical evaluation by multidisciplinary team and assessment of persistent symptoms with scoring systems in development. Treatment strategies are symptom-focused, encompassing multidisciplinary care, rehabilitation and tailored exercise programmes. Pulmonary rehabilitation, an effective and critical component of long COVID management, has shown promise, particularly for patients with respiratory symptoms such as dyspnoea. These programmes, which combine exercise, breathing techniques, education and psychological support, improve symptoms, quality of life and overall recovery. Innovative technologies, such as telemedicine, wearable devices, telerehabilitation, are transforming long COVID management. Telemedicine facilitates consultations and interventions, eliminating healthcare access barriers. Wearable devices enable remote and continuous monitoring of patients during their rehabilitation activities. Telerehabilitation has proven to be safe and feasible and to have high potential for COVID-19 recovery. This review provides a concise overview of long COVID, encompassing its definition, prevalence, mechanisms, clinical manifestations, diagnosis and management approaches. It emphasizes the significance of multidisciplinary approach in diagnosis and treatment of long COVID, with focus on pulmonary rehabilitation and innovative technology advances to effectively address the management of long COVID.

OBJECTIVE: To develop evidence- and consensus-based clinical practice guidelines for management of high-tone pelvic floor dysfunction (HTPFD). High-tone pelvic floor dysfunction is a neuromuscular disorder of the pelvic floor characterized by non-relaxing pelvic floor muscles, resulting in lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no uniformly accepted guidelines to direct the management of these patients. METHODS: A Delphi method of consensus development was used, comprising three survey rounds administered anonymously via web-based platform (Qualtrics XM) to national experts in the field of HTPFD recruited through targeted invitation between September and December 2021. Eleven experts participated with backgrounds in urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT) participated. Panelists were asked to rate their agreement with rated evidence-based statements regarding HTPFD treatment. Statements reaching consensus were used to generate a consensus treatment algorithm. RESULTS: A total of 31 statements were reviewed by group members at the first Delphi round with 10 statements reaching consensus. 28 statements were reposed in the second round with 17 reaching consensus. The putative algorithm met clinical consensus in the third round. There was universal agreement for PFPT as first-line treatment for HTPFD. If satisfactory symptom improvement is reached with PFPT, the patient can be discharged with a home exercise program. If no improvement after PFPT, second-line options include trigger or tender point injections, vaginal muscle relaxants, and cognitive behavioral therapy, all of which can also be used in conjunction with PFPT. Onabotulinumtoxin A injections should be used as third line with symptom assessment after 2-4 weeks. There was universal agreement that sacral neuromodulation is fourth-line intervention. The largest identified barrier to care for these patients is access to PFPT. For patients who cannot access PFPT, experts recommend at-home, guided pelvic floor relaxation, self-massage with vaginal wands, and virtual PFPT visits. CONCLUSION: A stepwise approach to the treatment of HTPFD is recommended, with patients often necessitating multiple lines of treatment either sequentially or in conjunction. However, PFPT should be offered first line.

Context: The medial collateral ligament is the most commonly injured ligament in the knee. The high-speed pivoting and agility movements that are common in the sport of American Football put participants at an increased risk for a valgus force stress from contact or noncontact injuries. Positional release therapy (PRT) also considered strain/counterstrain focuses on releasing the tension in a tissue through unloading the involved body part. Case Presentation: Two male student-athletes participating in football with a mean age of 20.5 years were diagnosed by a physician with medial collateral ligament grade 2 sprain. Both patients sustained their injuries in a regular season game with a contact valgus force from an opposing player. Management and Outcomes: After the initial 72 hours of compression, elevation, and cryotherapy, the patients were both treated with PRT followed by progressive loading exercises. Following 4 treatment sessions of PRT over the next 6 days, the patients started with quadriceps engagement exercises, single-leg squats to 60° knee flexion, side steps, triceps dips, slow controlled lunges, and toe walk. The patients progressed to full body weight squats, single-leg landing, step-up tri-extension, and sidekicks with a leg on table. Then, the patients completed function movements and sports-specific exercises. Conclusions: In this case series, 2 patients competing in intercollege American Football were treated with PRT and progressive loading exercises to facilitate return to unrestricted activities and improve outcome measures. Commonly, a grade 2 medial collateral ligament sprain is conservatively treated with return to sport taking 20 days on average. In this type 2 case series, the clinician found success utilizing PRT early in the recovery process, which in these 2 cases lead to restoration of function, outcome measure improvement, and an expedited return to sport. The expedited return to sport occurred at an average of 18 days for these patients. [ABSTRACT FROM AUTHOR]

Context: This study investigated individual sociocognitive factors from the theory of planned behavior and their relationship to exercise for postconcussion recovery. Design and Methods: Four hundred and fifty-nine Australian adults, two-thirds of whom had no concussion history (66%), completed an online survey of their beliefs and attitudes toward exercise for postconcussion recovery. Secondary questions evaluated program design features that could affect engagement (eg, session frequency). Results: Structured equation modeling found that subjective norms were the strongest significant predictor of intention to participate in exercise for postconcussion recovery. Perceived behavioral control was also a significant predictor of intention to participate but to a lesser extent. Attitude did not predict participation intention. The design features identified as key were personalization and being supervised during the program. Conclusions: This study found that people's intention to participate in a program of exercise postconcussion recovery is shaped by individual psychological factors and identified program design features that could be adjusted for increased engagement. Program success could be maximized through strategies such as supporting individuals to have a stronger sense of control over their participation through the choice of session timing or frequency and harnessing the influence of significant others via supportive messaging from key professionals. [ABSTRACT FROM AUTHOR]

Background: Children with inflammatory bowel disease (IBD) experience extraintestinal side effects including altered body composition, impaired muscle strength, and aerobic capacity. Exercise training may remedy these issues. Purpose: To assess the feasibility, safety, participant satisfaction, and efficacy of a training program for youth with IBD. Methods: Children with IBD completed 16 weeks of training (2 supervised + 1 home sessions per week). Feasibility was assessed by tracking recruitment, adherence, and compliance rates. Safety was assessed by tracking symptoms and adverse events. Posttraining interviews gauged satisfaction. Circulating inflammatory markers, body composition, muscle strength, aerobic fitness, and habitual physical activity were measured at baseline, midtraining (8 wk), and posttraining. Results: Eleven youth were recruited and 10 completed the study. Participants adhered to 28 (1) of 32 prescribed supervised sessions and 8 (4) of 16 prescribed home sessions. There were no adverse events, and overall feedback on training was positive. Posttraining, we observed an increase in lean mass (+2.4 [1.1] kg), bone density (+0.0124 [0.015] g·cm−2), aerobic fitness (+2.8 [5.7] mL·kg LM−1· min−1), and vigorous physical activity levels (+13.09 [8.95] min·h−1) but no change in inflammation or muscle strength. Conclusion: Supervised exercise training is feasible, safe, and effective for youth with IBD and should be encouraged. [ABSTRACT FROM AUTHOR]

Online exercise programming has surged in popularity; however, little is known about older adults' perceptions and experiences of online exercise. The purpose of this study was to qualitatively examine older adults' (aged 59–82 years) experiences and perceptions of an online exercise program during the COVID-19 pandemic. Nineteen individuals (individuals who used the online exercise program and those who did not) completed a semistructured interview. Three main themes were generated from the data using reflexive thematic analysis: (a) can online exercise really work for older adults? (b) technology attitudes and experiences influence online participation, and (c) barriers and advantages of the online exercise program and the home environment. Most participants who took part were able to overcome initial barriers through technical support and experience. Our findings highlight ways to promote advantages and address barriers of online exercise for older adults and emphasize the importance of fostering social experiences and training online exercise instructors. [ABSTRACT FROM AUTHOR]

Context: Bridge exercises are extensively used in trunk-strengthening programs. The aim of this study was to investigate the effect of bridging duration on lateral abdominal muscle thickness and gluteus maximus activation. Design: Cross-sectional. Methods: Twenty-five young males participated in this study. Transversus abdominal (TrA), external and internal oblique ultrasound thickness, gluteus maximus electromyographic activation, and sacral tilt angle were simultaneously measured for every second during 30-second bridging exercise. The contraction thickness ratio and root mean squared signal (normalized to maximum isometric contraction signal) during 6 exercise durations (from 0 to 5, 10, 15, 20, 25, and 30 s) were also calculated and compared using analysis of variance designs. Results: TrA and internal oblique contraction thickness ratio and gluteus maximus root mean squared increased during the first 8 to 10 seconds and remained elevated until the end of the 30-second exercise (P <.05). External oblique contraction thickness ratio declined during exercise (P <.05). Five-second bridging showed less TrA thickness and anteroposterior and mediolateral sacral tilt angle and a lower anteroposterior tilt variability compared with bridges, which lasted more than 10 seconds (P <.05). Conclusions: Bridge exercises longer than 10 seconds may be better for promoting TrA recruitment than bridges of shorter duration. Clinicians and exercise specialists could adjust the duration of bridge exercise based on the aims of the exercise program. [ABSTRACT FROM AUTHOR]

Context: Hip muscle imbalance, especially between gluteal muscles and tensor fasciae latae (TFL), is one of the risk factors for developing low back pain which should be considered in rehabilitation programs. This study compared the effect of exercises with gluteal-to-TFL muscle activation index above and below 50 on pain intensity, disability, and lower limbs' range of motion (ROM) in patients with nonspecific chronic low back pain. Design: A semiexperimental intervention study with a pretest and posttest. Methods: A total of 45 patients with nonspecific chronic low back pain were randomly divided into 2 experimental groups of gluteal-to-TFL muscle activation index above 50 (n = 15), below 50 (n = 15), and a control group (n = 15). Pain intensity (visual analog scale), disability (Roland–Morris Disability Questionnaire), and lower limbs' ROM including hip extension, hip abduction, hip external rotation, and knee extension (goniometer) were assessed at pretest and after 8 weeks of intervention. Results: Within-group comparison showed significant improvement of pain, disability, and ROMs in both experimental groups. No significant changes were observed in the control group. In between-group analysis, significant differences were observed in group of gluteal-to-TFL muscle activation index above 50 for only pain (P =.03) and disability (P =.01). For ROMs, although clinical improvement of lower limbs' ROMs was higher in group of gluteal-to-TFL muscle activation index above 50, no statistically significant differences were found between 2 experimental groups. Both experimental groups were superior to the control group for all outcomes. Conclusions: Findings indicate the statistically and clinically superior effectiveness of exercises with a gluteal-to-TFL muscle activation index above 50 in the reduction of pain and disability. Based on the clinical significance of exercises with a gluteal-to-TFL muscle activation index above 50 for improving ROMs, utilizing specific exercises that more activated gluteal muscle compared to TFL is recommended for patient with restricted lower limbs' ROMs. [ABSTRACT FROM AUTHOR]

Context: Different resistance exercise determinants modulate the musculotendinous adaptations following eccentric hamstring training. The Nordic Hamstring Exercise (NHE) can be performed 2-fold: the movement velocity irreversibly increases toward the end of the range of motion or it is kept constant. Design: This cross-sectional study aimed to investigate if the downward acceleration angle (DWAangle) can be used as a classification parameter to distinguish between increasing and constant velocity NHE execution. Furthermore, the kinetic and kinematic differences of these 2 NHE execution conditions were examined by analyzing the DWAangle in relation to the angle of peak moment. Methods: A total of 613 unassisted NHE repetitions of 12 trained male sprinters (22 y, 181 cm, 76 kg) were analyzed. Results: The majority of analyzed parameters demonstrated large effects. NHEs with constant velocity (n = 285) revealed significantly higher impulses (P <.001; d = 2.34; + 61%) and fractional time under tension (P <.001; d = 1.29; +143%). Although the generated peak moments were significantly higher for constant velocity (P =.003; d = 0.29; +4%), they emerged at similar knee flexion angles (P =.167; d = 0.28) and revealed on average just low relationships to the DWAangle ( R mean 2 = 22.4 %). DWAangle highly correlated with the impulse ( R mean 2 = 60.8 %) and δ (DWAangle–angle of peak moment; R mean 2 = 83.6 %). Conclusions: Relating DWAangle to angle of peak moment assists to distinguish between significantly different NHE execution, which will potentially elicit different musculotendinous adaptations. These insights are essential for coaches and athletes to understand how to manipulate eccentric hamstring training to change its purpose. [ABSTRACT FROM AUTHOR]

Neck adipose tissue (NAT) accumulation and neck circumference are independent predictors of cardiometabolic risk (CMR) and low-grade chronic inflammation in young adults. The present study examines whether a 24-week concurrent exercise intervention can reduce NAT volume and neck circumference in young adults, and whether any changes in these variables are related to changes in body composition, CMR, and the inflammatory profile. Seventy-four participants (51 women, age 22 ± 2 years) were included in the main analyses, after being randomly assigned to either a (a) control (n = 34), (b) moderate-intensity exercise (n = 19), or (c) vigorous-intensity exercise (n = 21) group. Participants in the exercise groups trained 3–4 days/week (endurance + resistance exercise training). NAT volume and NAT distribution across different depots were estimated using computed tomography before and after the intervention. Anthropometric variables, body composition (determined by dual-energy X-ray absorptiometry), and CMR/inflammatory markers were also recorded. The exercise intervention did not reduce the total NAT volume, nor was NAT distribution affected (p >.05). However, it did reduce neck circumference in the vigorous-intensity exercise group compared with the moderate-intensity exercise and control groups (by 0.8 and 1 cm, respectively, p ≤.05). Changes in total NAT and neck circumference were positively, albeit weakly, related (adj. R2:.05–.21, all p ≤.05) to changes in body weight and adiposity, leptin (only total NAT), and CMR (only neck circumference). Altogether 24 weeks of concurrent exercise does not appear to reduce NAT accumulation in young adults, but may slightly reduce neck circumference in those who partake in vigorous exercise. [ABSTRACT FROM AUTHOR]