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Argyropoulou D, Nomikos T, Terzis G, Karakosta M, Aphamis G, Geladas ND, Paschalis V. The Effect of Chronic Dietary Protein Manipulation on Amino Acids' Profile and Position Sense in the Elderly Suffering from Type 2 Diabetes Mellitus. J Funct Morphol Kinesiol 2024; 9:62. [PMID: 38651420 PMCID: PMC11036287 DOI: 10.3390/jfmk9020062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
Dietary protein with adequate essential amino acids effectively stimulates protein synthesis and improves muscle mass. Musculoskeletal disorders in lower or upper limbs are not uncommon among patients with type II diabetes mellitus (T2DM). Therefore, this study primarily examines the effects of chronic dietary protein manipulation on amino acids' profile and position sense in the elderly suffering from T2DM. A total of 26 individuals suffering from non-insulin-dependent T2DM (age > 55 years old) participated in a 12 week nutritional intervention. The subjects were randomly assigned and the control group received 0.8-1.0 g protein/kg/day, while the intervention group received 1.2-1.5 g protein/kg/day. Lean body mass, muscle strength, and position sense were assessed at baseline, as well as at the 6th and 12th week of the intervention. Only in the intervention group, the essential amino acids intake met the current nutritional recommendations (p < 0.05), while, by the 12th week, only the intervention group showed significant improvement in the muscle strength of knee (p < 0.05) and shoulder (p < 0.05) extension. On the contrary, in the control group, a significant decline in appendicular lean mass (p < 0.05) was observed by the 12th week. Position sense at the knee joint revealed a tendency for improvement in the intervention group by the 12th week (main effect of time p = 0.072). In the present investigation, it was revealed that the higher protein intake in the intervention group seemed to have positive effects on muscle strength and nearly positive effects on position sense.
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Affiliation(s)
- Dionysia Argyropoulou
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece; (D.A.); (G.T.); (N.D.G.)
| | - Tzortzis Nomikos
- Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece; (T.N.); (M.K.)
| | - Gerasimos Terzis
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece; (D.A.); (G.T.); (N.D.G.)
| | - Myrto Karakosta
- Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece; (T.N.); (M.K.)
| | - George Aphamis
- Department of Life Sciences, University of Nicosia, Nicosia 1700, Cyprus;
| | - Nickos D. Geladas
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece; (D.A.); (G.T.); (N.D.G.)
| | - Vassilis Paschalis
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece; (D.A.); (G.T.); (N.D.G.)
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Leonhardt TPM, Bristol A, McLaurin N, Forbes SC, Tanaka H, Frings-Meuthen P, Pesta D, Rittweger J, Chilibeck PD. Dietary Intake of Athletes at the World Masters Athletics Championships as Assessed by Single 24 h Recall. Nutrients 2024; 16:564. [PMID: 38398888 PMCID: PMC10893199 DOI: 10.3390/nu16040564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Proper dietary intake is important for masters athletes because of the physiological changes that occur with aging and the unique nutritional needs when competing at high levels. We evaluated the dietary intake of masters athletes competing at the World Masters Athletics Championships (outdoor games, Tampere, Finland, 2022, and indoor games, Torun, Poland, 2023). A total of 43 athletes (16 females and 27 males, mean age 59.2 ± 10.3 y, height 168 ± 8 cm, and body mass 62.3 ± 10.8 kg) participating in endurance (n = 21), sprint (n = 16), jumping (2), multi-component (e.g., decathlon; n = 3), and throwing (n = 1) events provided 24 h dietary recalls while participating in the games. Carbohydrate intake was below the recommended levels for endurance athletes. Protein intake was below the recommended levels for masters athletes, except for female athletes involved in power events (i.e., sprinters and jumpers). Other nutrient intakes that were below the recommended levels included vitamins D and E, calcium, potassium, vitamin A (except for female endurance athletes), folate (except for female power athletes), vitamin C for female endurance athletes, vitamin K and fiber for males, and zinc for endurance athletes. We conclude that while competing at world championships, many athletes are not consuming the recommended levels of carbohydrates, protein, and micronutrients. Athletes attending these games would benefit from increased nutritional support.
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Affiliation(s)
- Taylor P. M. Leonhardt
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada; (T.P.M.L.); (A.B.)
| | - Ainsley Bristol
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada; (T.P.M.L.); (A.B.)
| | - Natalie McLaurin
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX 78712, USA; (N.M.); (H.T.)
| | - Scott C. Forbes
- Faculty of Education, Department of Physical Education Studies, Brandon University, Brandon, MB R7A 6A9, Canada;
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX 78712, USA; (N.M.); (H.T.)
| | - Petra Frings-Meuthen
- Institute of Aerospace Medicine, German Aerospace Center (DLR), D-51147 Cologne, Germany; (P.F.-M.); (D.P.); (J.R.)
| | - Dominik Pesta
- Institute of Aerospace Medicine, German Aerospace Center (DLR), D-51147 Cologne, Germany; (P.F.-M.); (D.P.); (J.R.)
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), D-51147 Cologne, Germany; (P.F.-M.); (D.P.); (J.R.)
| | - Philip D. Chilibeck
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada; (T.P.M.L.); (A.B.)
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Guo S, Shaoni GLL, Stuart-Smith WA, Davies AJ, Gifford JA. Dietary Intake of Masters Athletes: A Systematic Review. Nutrients 2023; 15:4973. [PMID: 38068832 PMCID: PMC10708321 DOI: 10.3390/nu15234973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
Dietary practices of masters athletes (MAs) may promote healthy ageing; however, they are poorly understood. The aims of this systematic review were to synthesise the literature on the dietary intakes of MAs and undertake comparisons between younger (35-50 years) and older (>50 years) MAs and the general population. A search was conducted across seven databases to identify relevant publications for screening and data extraction. Averages for energy intake (EI), macronutrients, and micronutrients were compared with data from the 2011-2012 Australian Health Survey (general population). Twenty-six studies (n = 2819) were included. Energy intake was higher for older (8908 kJ/d versus 7792 kJ/d) but not younger MAs (9073 kJ/d versus 8872 kJ/d) versus the general population. Younger versus older male MAs had higher energy and macronutrient intakes. Energy intake for older was comparable to younger female MAs (7819 kJ/d versus 7485 kJ/d), but older had higher protein, lower carbohydrate, and higher micronutrient intakes. Micronutrient intake was higher in MAs than the general population. Similar EIs for older MAs and younger general population may indicate potential for a higher-quality diet. Younger female MAs may restrict or misreport EI, requiring further investigation. There is a need for more comprehensive assessments of dietary intake in MAs to ascertain diet quality in relation to health.
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Affiliation(s)
- Sheran Guo
- Discipline of Nutrition and Dietetics, School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (S.G.); (W.A.S.-S.)
| | - Gabriella L. L. Shaoni
- Discipline of Nutrition and Dietetics, School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (S.G.); (W.A.S.-S.)
| | - Wendy A. Stuart-Smith
- Discipline of Nutrition and Dietetics, School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (S.G.); (W.A.S.-S.)
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, North Sydney, NSW 2060, Australia
| | - Alyse J. Davies
- Discipline of Nutrition and Dietetics, School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (S.G.); (W.A.S.-S.)
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Janelle A. Gifford
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
- Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Sport and Physical Activity Research and Teaching Network (SPARTAN), The University of Sydney, Camperdown, NSW 2006, Australia
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Methenitis S, Papadopoulou SK, Panayiotou G, Kaprara A, Hatzitolios A, Skepastianos P, Karali K, Feidantsis K. Nutrition, body composition and physical activity have differential impact on the determination of lipidemic blood profiles between young females with different blood cholesterol concentrations. Obes Res Clin Pract 2023; 17:25-33. [PMID: 36641266 DOI: 10.1016/j.orcp.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/01/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This cross-sectional study explored whether nutrition, body composition, and physical activity energy expenditure (PAΕΝ) have a differential impact on lipidemic blood profiles among young females with different blood cholesterol concentrations. METHODS One hundred thirty-five young female students (N = 135) were allocated into three groups according to their blood cholesterol concentrations (Chol): (A) Normal [NL; Chol: < 200 mg·dL-1; n = 56 Age: 21.4 ± 2.6 yrs, Body Mass Index (BMI): 22.1 ± 2.0 kg·m-2], (B) Borderline (BL; Chol: ≥200 mg·dL-1 and <240 mg·dL-1; n = 44 Age: 21.6 ± 2.5 yrs, BMI: 24.2 ± 3.1 kg·m-2) and (C) High level (HL; Chol: ≥240 mg·dL-1; n = 35 Age: 22.5 ± 2.4 yrs, BMI: 28.9 ± 2.1 kg·m-2). Body composition [bioelectrical impedance analysis including lean body mass (LBM) and body fat mass], nutritional intake (recall questionnaire), daily physical activity energy expenditure through activity trackers and resting blood lipids concentrations were evaluated. RESULTS Multiple linear regression analyses revealed that in the NL group, lean mass, daily PAΕΝ and daily energy balance were the determinant parameters of blood lipidemic profiles (B: -0.815 to 0.700). In the BL group, nutrition, body composition and daily physical activity energy expenditure exhibited similar impacts (B: -0.440 to 0.478). In the HL group, nutritional intake and body fat mass determined blood lipidemic profile (B: -0.740 to 0.725). CONCLUSION Nutrition, body composition and daily PAΕΝ impact on blood lipids concentration is not universal among young females. In NL females, PAEN, energy expenditure and LBM are the strongest determinants of blood lipids, while in HL females, nutritional intake and body fat mass are. As PAΕΝ increases, the importance of nutrition and body fat decreases, and vice versa.
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Affiliation(s)
- Spyridon Methenitis
- Sports Performance Laboratory, School of Physical Education & Sports Science, National and Kapodistrian University of Athens, Athens GR-17237, Greece; Department of Nutrition Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, P.O. Box 141, Sindos GR-57400, Thessaloniki, Greece; Theseus, Physical Medicine and Rehabilitation Center, Athens, Greece
| | - Sousana K Papadopoulou
- Department of Nutrition Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, P.O. Box 141, Sindos GR-57400, Thessaloniki, Greece
| | - George Panayiotou
- Laboratory of Exercise, Health and Human Performance, Applied Sport Science Postgraduate Program, Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Athina Kaprara
- Laboratory of Sports Medicine, School of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Greece
| | - Apostolos Hatzitolios
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Greece
| | - Petros Skepastianos
- Department of Biomedical Sciences, Faculty of Health Sciences, International Hellenic University, P.O. Box 141, Sindos GR-57400, Thessaloniki, Greece
| | - Konstantina Karali
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Greece
| | - Konstantinos Feidantsis
- Department of Nutrition Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, P.O. Box 141, Sindos GR-57400, Thessaloniki, Greece.
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Burtscher J, Strasser B, Burtscher M, Millet GP. The Impact of Training on the Loss of Cardiorespiratory Fitness in Aging Masters Endurance Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191711050. [PMID: 36078762 PMCID: PMC9517884 DOI: 10.3390/ijerph191711050] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 05/16/2023]
Abstract
Elite masters endurance athletes are considered models of optimal healthy aging due to the maintenance of high cardiorespiratory fitness (CRF) until old age. Whereas a drop in VO2max in masters athletes has been broadly investigated, the modifying impact of training still remains a matter of debate. Longitudinal observations in masters endurance athletes demonstrated VO2max declines between -5% and -46% per decade that were closely related to changes in training volume. Here, using regression analyses, we show that 54% and 39% of the variance in observed VO2max decline in male and female athletes, respectively is explained by changes in training volume. An almost linear VO2max decrease was observed in studies on young and older athletes, as well as non-athletes, starting a few days after training cessation, with a decline of as much as -20% after 12 weeks. Besides a decline in stroke volume and cardiac output, training cessation was accompanied by considerable reductions in citrate synthase and succinate dehydrogenase activity (reduction in mitochondrial content and oxidative capacity). This reduction could largely be rescued within similar time periods of training (re)uptake. It is evident that training reduction or cessation leads to a considerably accelerated VO2max drop, as compared to the gradual aging-related VO2max decline, which can rapidly nullify many of the benefits of preceding long-term training efforts.
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Affiliation(s)
- Johannes Burtscher
- Department of Biomedical Sciences, University of Lausanne, CH-1015 Lausanne, Switzerland
- Institute of Sport Sciences, University of Lausanne, CH-1015 Lausanne, Switzerland
| | - Barbara Strasser
- Medical Faculty, Sigmund Freud Private University, A-1020 Vienna, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, A-6020 Innsbruck, Austria
- Correspondence:
| | - Gregoire P. Millet
- Department of Biomedical Sciences, University of Lausanne, CH-1015 Lausanne, Switzerland
- Institute of Sport Sciences, University of Lausanne, CH-1015 Lausanne, Switzerland
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Nomikos T, Methenitis S, Panagiotakos DB. The emerging role of skeletal muscle as a modulator of lipid profile the role of exercise and nutrition. Lipids Health Dis 2022; 21:81. [PMID: 36042487 PMCID: PMC9425975 DOI: 10.1186/s12944-022-01692-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
The present article aims to discuss the hypothesis that skeletal muscle per se but mostly its muscle fiber composition could be significant determinants of lipid metabolism and that certain exercise modalities may improve metabolic dyslipidemia by favorably affecting skeletal muscle mass, fiber composition and functionality. It discusses the mediating role of nutrition, highlights the lack of knowledge on mechanistic aspects of this relationship and proposes possible experimental directions in this field.
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Affiliation(s)
- Tzortzis Nomikos
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece.
| | - Spyridon Methenitis
- Sports Performance Laboratory, School of Physical Education and Sports. Science, National and Kapodistrian University of Athens, Athens, Greece.,Theseus, Physical Medicine and Rehabilitation Center, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece
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Stavroulakis G, Methenitis S, Koutroulis G, Xanthis D, Cherouveim E, Kroupis C, Anastasiadis G, Ketselidi K, Vlachopoulou E, Tsolakis C, Koulouvaris P. Exploring the predictors and prognostic significance of exercise-induced cardiac troponin release in master athletes following a 28km mountain race. The Vamvakou Research Project. Biomarkers 2022; 27:418-426. [PMID: 35383512 DOI: 10.1080/1354750x.2022.2062449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Ιntroduction. Etiology and significance of exercise-induced troponin release remains a contentious issue. We investigated the effect of a 28km mountain run on cardiac troponin I (cTnI), in relation to training, performance, nutritional, biochemical and echocardiography variables, in a group of 25 recreational male master athletes.Μaterial and methods. A comprehensive list of variables related with nutrition, training, performance and echocardiography, was collected pre- and post-race. Twenty four months later, outcomes regarding cardiovascular events was obtained.Results. Serum cTnI values were increased after the race, with mean values rising from 7.2 ± 2.2 (before) to 80.0 ± 33.2ng/L (post race), (p < 0.001) and 23/25(92%) exceeding Upper Reference limit (50ng/L). Echocardiography did not reveal significant alterations, or correlations with cTnI values. The % difference in hs-cTnI concentrations pre- and post race correlated positively with age, race-induced changes of selected muscle damage indices, resistance training volume, and negatively with endurance capacity and training volume (r: -0.727 to 0.725, p < 0.05). All athletes reported no cardiovascular event during the 24 month period post race.Conclusion. cTnI elevation induced by a 28km mountain running race was not correlated with echocardiographic, nutritional parameters and was less pronounced in athletes with larger endurance training history, in contrast with resistance training and age.
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Affiliation(s)
- George Stavroulakis
- Sports Excellence, 1st Orthopedics Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece.,Division of Cardiology, Hygeias Melathron, Athens, Greece
| | - Spyridon Methenitis
- Sports Excellence, 1st Orthopedics Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece.,Sports Performance Laboratory, School of Physical Education & Sports Science, National and Kapodistrian University of Athens, Greece
| | | | | | - Eugenia Cherouveim
- Sports Excellence, 1st Orthopedics Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece.,Sports Performance Laboratory, School of Physical Education & Sports Science, National and Kapodistrian University of Athens, Greece
| | - Christos Kroupis
- Sports Excellence, 1st Orthopedics Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | | | - Kleopatra Ketselidi
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University of Athens, Greece
| | - Elpiniki Vlachopoulou
- Department of Nutrition Sciences and Dietology, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Charilaos Tsolakis
- Sports Excellence, 1st Orthopedics Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece.,Sports Performance Laboratory, School of Physical Education & Sports Science, National and Kapodistrian University of Athens, Greece
| | - Panagiotis Koulouvaris
- Sports Excellence, 1st Orthopedics Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
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Knechtle B, McGrath C, Goncerz O, Villiger E, Nikolaidis PT, Marcin T, Sousa CV. The Role of Environmental Conditions on Master Marathon Running Performance in 1,280,557 Finishers the 'New York City Marathon' From 1970 to 2019. Front Physiol 2021; 12:665761. [PMID: 34079472 PMCID: PMC8165243 DOI: 10.3389/fphys.2021.665761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/14/2021] [Indexed: 01/29/2023] Open
Abstract
Aim: This study investigated the influence of weather conditions on running performance in female and male age group runners in the largest marathon in the world, the “New York City Marathon.” Methods: The analysis included data from 1,280,557 finishers the “New York City Marathon” from the years 1970 to 2019. Linear mixed models for men and women finishers with race time (min) as dependent variable and 5-year age groups, temperature, wind and relative humidity tertiles (low, medium, high) as independent factors and finisher as random intercept was performed. Additional models with an interaction between age groups and one weather variable each were performed. Results: Temperature was positively associated with race time while wind speed and humidity were negatively associated (p < 0.001). Men were significantly greater affected wind speed and humidity than women (p < 0.001 for interaction) but not by temperature (p = 0.17 for interaction). With an average of 8 min longer race time, high temperature had the greatest effect on race time. The effect of high humidity on race time was significantly increased in 40–59 years old men and 25–65 years old women. High temperatures had an increased effect on race time in 30–64 years old men and 40–64 years old women. The inverse association between race time and high wind speed was pronounced in finishers with younger age. Conclusion: Performance was lower on days with high temperature, low humidity and low wind speed. Men seemed to benefit more from higher humidity and wind speed than women. Aged (70 +) finishers were not greater affected by high temperatures.
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Affiliation(s)
- Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.,Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Carlyn McGrath
- Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Olivia Goncerz
- Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Elias Villiger
- Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | | | - Thimo Marcin
- Research Department, Berner Reha Zentrum, Bern, Switzerland
| | - Caio Victor Sousa
- Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
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