Effect of Blood Flow Restriction during the Rest Periods of Squats on Accuracy of Estimated Repetitions to Failure

This study investigated the impact of resistance training with blood flow restriction during rest (BFRrest) on the accuracy of estimated repetitions to failure (ERF). It also explored associations between error in ERF and mean concentric velocity (MCV) along with physiological responses. In a randomised cross-over study, 18 male trainers (23.4 ± 2.7 years) performed three sets of squats at 70% of their one-repetition maximum until failure. One session integrated BFRrest, while another employed traditional passive inter-set rest (TRAD) during the 3 min inter-set rest intervals. Cardiorespiratory and metabolic measures were taken in the inter-set recovery periods. The results revealed no significant differences between BFRrest and TRAD in terms of ERF and error in ERF. A notable set effect for ERF was observed, with a greater ERF during set 1 compared to sets 2 and 3 (p < 0.001). Additionally, a lower error in ERF was observed during sets 2 and 3 compared to set 1 (p < 0.001). Error in ERF were strongly associated with the respiratory exchange ratio, and moderately associated with end-tidal carbon dioxide partial pressure, carbon dioxide output, and MCV variables. Notably, the precision of ERF seems to be predominantly influenced by indicators of physiological stress rather than the incorporation of BFRrest.

Bimanual Movement Characteristics and Real-World Performance Following Hand-Arm Bimanual Intensive Therapy in Children with Unilateral Cerebral Palsy

The purpose of this study was to quantify characteristics of bimanual movement intensity during 30 h of hand-arm bimanual intensive therapy (HABIT) and bimanual performance (activities and participation) in real-world settings using accelerometers in children with unilateral cerebral palsy (UCP). Twenty-five children with UCP participated in a 30 h HABIT program. Data were collected from bilateral wrist-worn accelerometers during 30 h of HABIT to quantify the movement intensity and three days pre- and post-HABIT to assess real-world performance gains. Movement intensity and performance gains were measured using six standard accelerometer-derived variables. Bimanual capacity (body function and activities) was assessed using standardized hand function tests. We found that accelerometer variables increased significantly during HABIT, indicating increased bimanual symmetry and intensity. Post-HABIT, children demonstrated significant improvements in all accelerometer metrics, reflecting real-world performance gains. Children also achieved significant and clinically relevant changes in hand capacity following HABIT. Therefore, our findings suggest that accelerometers can objectively quantify bimanual movement intensity during HABIT. Moreover, HABIT enhances hand function as well as activities and participation in real-world situations in children with UCP.

Soccer, Sleep, Repeat: Effects of Training Characteristics on Sleep Quantity and Sleep Architecture

Due to the high demands of competitive sports, the sleep architecture of adolescent athletes may be influenced by their regular training. To date, there is no clear evidence on how training characteristics (intensity, time of day, number of sessions) influence sleep quality and quantity. 53 male soccer players (M = 14.36 years, SD = 0.55) of Austrian U15 (n = 45) and U16 elite teams (n = 8) were tested on at least three consecutive days following their habitual training schedules. Participants completed daily sleep protocols (7 a.m., 8 p.m.) and questionnaires assessing sleep quality (PSQI), chronotype (D-MEQ), competition anxiety (WAI-T), and stress/recovery (RESTQ). Electrocardiography (ECG) and actigraphy devices measured sleep. Using sleep protocols and an ECG-based multi-resolution convolutional neural network (MCNN), we found that higher training intensity leads to more wake time, that later training causes longer sleep duration, and that one training session per day was most advantageous for sleep quality. In addition, somatic complaints assessed by the WAI-T negatively affected adolescent athletes' sleep. Individual training loads and longer recovery times after late training sessions during the day should be considered in training schedules, especially for adolescent athletes. MCNN modeling based on ECG data seems promising for efficient sleep analysis in athletes.

The Evolution of World-Class Endurance Training: The Scientist's View on Current and Future Trends

BACKGROUND

Elite sport is continuously evolving. World records keep falling and athletes from a longer list of countries are involved.

PURPOSE

This commentary was designed to provide insights into present and future trends associated with world-class endurance training based on the perspectives, experience, and knowledge of an expert panel of 25 applied sport scientists.

RESULTS

The key drivers of development observed in the past 10-15 years were related to (1) more accessible scientific knowledge for coaches and athletes combined with (2) better integration of practical and scientific exchange across multidisciplinary perspectives within professionalized elite athlete support structures, as well as (3) utilization of new technological advances. Based on these perspectives, we discerned and exemplified the main trends in the practice of endurance sports into the following categories: better understanding of sport-specific demands; improved competition execution; larger, more specific, and more precise training loads; improved training quality; and a more professional and healthier lifestyle. The main areas expected to drive future improvements were associated with more extensive use of advanced technology for monitoring and prescribing training and recovery, more precise use of environmental and nutritional interventions, better understanding of athlete-equipment interactions, and greater emphasis on preventing injuries and illnesses.

CONCLUSIONS

These expert insights can serve as a platform and inspiration to develop new hypotheses and ideas, encourage future collaboration between researchers and sport practitioners, and, perhaps most important, stimulate curiosity and further collaborative studies about the training, physiology, and performance of endurance athletes.

Effects of rest interval and training intensity on jumping performance: a systematic review and meta-analysis investigating post-activation performance enhancement

Background: There is no clear agreement regarding the ideal rest interval and training intensity to optimize post-activation performance enhancement (PAPE) after barbell squat (BS). Therefore, the aim of this study was to investigate the effects of rest interval and training intensity on jumping performance due to PAPE. Methods: Searches were performed in PubMed, Web of Science, and EBSCO databases. We included studies that satisfied the following criteria: (1) eligible studies should be randomized controlled trials; (2) eligible studies should investigate the acute effect of barbell squat-induced PAPE on jump performance; (3) eligible studies should use countermovement jump, squat jump, or vertical jump as the outcome measure. Results: From 2518 search records initially identified, 19 studies were eligible for meta-analysis. Our meta-analysis results showed that BS had no significant effect on improving jumping performance due to PAPE (Cohen's d = 0.09, p = 0.08). Subgroup analysis showed that rest interval between 0-1 min was detrimental to jumping performance (Cohen's d = -0.33, p < 0.01), while rest intervals between 4-7 min (Cohen's d = 0.31, p < 0.01) and 8-9 min (Cohen's d = 0.26, p = 0.02) provided favorable jumping performance outcomes. In addition, low-intensity and moderate-intensity BS had no significant effect on jump performance, while high-intensity BS showed results consistent with rest interval. Conclusion: Our study indicated that both low-intensity and moderate-intensity BS failed to induce PAPE, and it is recommended that future studies use high-intensity BS to induce PAPE. A rest interval of 4-9 min had a beneficial impact on jump height, and an interval range of 4-7 min seems to be the best rest interval between conditioning activity and jumping performance.

The Impact of Aerobic Exercise on HDL Quantity and Quality: A Narrative Review

High-density lipoproteins comprise roughly 25-30% of the circulating proteins involved in the transport of lipids in circulation. These particles differ in size and lipid composition. Recent evidence suggests that the quality of HDL particles (which depends on shape, size and the composition of proteins and lipids determining HDL functionality) may be more important than their quantity. The functionality of HDL is mirrored by its cholesterol efflux activity, as well as its antioxidant (including the protection of LDL against oxidation), anti-inflammatory and antithrombotic properties. The results of many studies and meta-analyses imply the beneficial impact of aerobic exercise on HDL-C levels. Physical activity was found to be usually associated with an increase in HDL cholesterol and a decrease in LDL cholesterol and triglycerides. Exercise, apart from inducing quantitative alterations in serum lipids, exerts a beneficial impact on HDL particle maturation, composition and functionality. The Physical Activity Guidelines Advisory Committee Report underlined the importance of establishing a program recommending exercises that enable attainment of maximal advantage at the lowest level of risk. The aim of this manuscript is to review the impact of different types of aerobic exercise (various intensities and durations) on the level and quality of HDL.

Active Video Games Performance and Heart Rate on the Wii or Kinect in Children with and without Developmental Coordination Disorder

Our objective was to compare changes in game performance and intensity of heart rate (HR) between two types of active video game (AVG) in children with and without Developmental Coordination Disorder (DCD). Additionally, we assessed the level of improvement per game as well as the perceived exertion and enjoyment during training. Seventy-six children, 36 with DCD and 40 without (TD) were randomly assigned to a 5-week program of Wii-Fit or Xbox-Kinect training 2× a week. The steepness of the performance curves was not different between consoles, nor between groups. Playing Kinect games resulted in higher HR in both groups. Wii and Kinect seem to be comparable AVG consoles that can be used for children with and without DCD, with the Kinect reaching a higher intensity of training.

Monitoring Internal Training Intensity Correlated with Neuromuscular and Well-Being Status in Croatian Professional Soccer Players during Five Weeks of the Pre-Season Training Phase

This study aimed to investigate the changes in internal training intensity, well-being, and countermovement jump (CMJ) performance and to determine their relationship across five weeks of the pre-season training phase in professional soccer players. A total of 22 professional male soccer players (age = 21.7 ± 4 years, body height = 185.9 ± 6.3 cm, body weight = 79 ± 6.3 kg, BMI = 22.8 ± 1.4 kg·m−2; VO2max = 52.9 ± 3.2) from the Croatian Second League voluntary participated in this study. The players spent 2230 ± 117 min in 32 technical/tactical and strength/conditioning training sessions, mostly at the low intensity zone (61%), and played 8 friendly matches at a high intensity (>90%). A one-way repeated measure of analysis ANOVA revealed a significant difference between weeks in CMJ performance (F(1,22) = 11.8, p < 0.001), with CMJ height in weeks 4 and 5 being likely to very likely higher than that noted in week 1. Moreover, significant differences between weeks were found in all internal training intensity measures (average [F(1,22) = 74.8, p < 0.001] and accumulated weekly internal training intensity [F(1,22) = 55.4, p < 0.001], training monotony [F(1,22) = 23.9, p < 0.001], and training strain [F(1,22) = 34.5, p < 0.001]). Likewise, differences were observed for wellness status categories (fatigue [F(1,22) = 4.3, p = 0.003], sleep [F(1,22) = 7.1, p < 0.001], DOMS [F(1,22) = 5.7, p < 0.001], stress [F(1,22) = 15.6, p < 0.001]), mood [F(1,22) = 12.7, p < 0.001], and overall well-being status score (F(1,22) = 13.2, p < 0.001). Correlation analysis showed large negative correlations between average weekly internal training intensity and fatigue (r = −0.63, p = 0.002), DOMS (r = −0.61, p = 0.003), and WBI (r = −0.53, p = 0.011). Additionally, fatigue was significantly associated (large negative correlation) with accumulated weekly internal training intensity (r = −0.51, p = 0.014) and training strain (r = −0.61, p = 0.003). Small, but non-significant, correlations were found between CMJ performance and wellness status measures. These findings highlight the utility and simplicity of monitoring tools to improve athletes’ performance.

Effects of Variable-Resistance Training Versus Constant-Resistance Training on Maximum Strength: A Systematic Review and Meta-Analysis

Greater muscular strength is generally associated with superior sports performance, for example, in jumping, sprinting, and throwing. This meta-analysis aims to compare the effects of variable-resistance training (VRT) and constant-resistance training (CRT) on the maximum strength of trained and untrained subjects. PubMed, Web of Science, and Google Scholar were comprehensively searched to identify relevant studies published up to January 2022. Fourteen studies that met the inclusion criteria were used for the systematic review and meta-analysis. Data regarding training status, training modality, and type of outcome measure were extracted for the analyses. The Cochrane Collaboration tool was used to assess the risk of bias. The pooled outcome showed improved maximum strength with VRT, which was significantly higher than that with CRT (ES = 0.80; 95% CI: 0.42−1.19) for all the subjects. In addition, trained subjects experienced greater maximum-strength improvements with VRT than with CRT (ES = 0.57; 95% CI: 0.22−0.93). Based on subgroup analyses, maximum-strength improvement with a VRT load of ≥80% of 1 repetition maximum (1RM) was significantly higher than that with CRT (ES = 0.76; 95% CI: 0.37−1.16) in trained subjects, while no significant differences were found between VRT and CRT for maximum-strength improvement when the load was <80% (ES = 0.00; 95% CI: −0.55−0.55). The untrained subjects also achieved greater maximum strength with VRT than with CRT (ES = 1.34; 95% CI: 0.28−2.40). Interestingly, the improved maximum strength of untrained subjects with a VRT load of <80% of 1RM was significantly higher than that with CRT (ES = 2.38; 95% CI: 1.39−3.36); however, no significant differences were noted between VRT and CRT when the load was ≥80% of 1RM (ES = −0.04; 95% CI: −0.89−0.81). Our findings show that subjects with resistance training experience could use a load of ≥80% of 1RM and subjects without resistance training experience could use a load of <80% of 1RM to obtain greater VRT benefits.

A Guide to Different Intensities of Exercise, Vaccination, and Sports Nutrition in the Course of Preparing Elite Athletes for the Management of Upper Respiratory Infections during the COVID-19 Pandemic: A Narrative Review

Elite athletes use high-intensity training to maintain their fitness level. However, intense training can harm the immune system, making athletes suspectable to COVID-19 and negatively affecting their performance. In addition, the diet of athletes should be appreciated more as it is another influencer of the immune system, especially during the COVID 19 pandemic. The other important issue elite athletes face currently is vaccination and its possible intervention with their training. The present study attempts to discuss the impact of different training intensities, nutritional strategies, and vaccination on the immune system function in elite athletes. To this end, Scopus, ISC, PubMed, Web of Science, and Google Scholar databases were searched from 1988 to 2021 using the related keywords. The results of our review showed that although high-intensity exercise can suppress the immune system, elite athletes should not stop training in the time of infection but use low- and moderate-intensity training. Moderate-intensity exercise can improve immune function and maintain physical fitness. In addition, it is also better for athletes not to undertake high-intensity training at the time of vaccination, but instead perform moderate to low-intensity training. Furthermore, nutritional strategies can be employed to improve immune function during high-intensity training periods.

How Do the Effects of an 8-Week Intervention Influence Subsequent Performance Development in Cross-Country Skiers?

PURPOSE

To investigate how the effects of increased low- versus high-intensity endurance training in an 8-week intervention influenced the subsequent development of performance and physiological indices in cross-country skiers.

METHODS

Forty-four (32 men and 12 women) junior cross-country skiers were randomly assigned into a low-intensity training group (LITG, n = 20) or high-intensity training group (HITG, n = 24) for an 8-week intervention followed by 5 weeks of standardized training with similar intensity distribution, and thereafter 14 weeks of self-chosen training. Performance and physiological indices in running and in roller-ski skating were determined preintervention, after the intervention, and after the standardized training period. Roller-ski skating was also tested after the period of self-chosen training.

RESULTS

No between-groups changes from preintervention to after the standardized training period were found in peak speed when incremental running and roller-ski skating (P = .83 and .51), although performance in both modes was improved in the LITG (2.4% [4.6%] and 3.3% [3.3%], P < .05) and in roller-ski skating for HITG (2.6% [3.1%], P < .01). While improvements in maximal oxygen consumption running and peak oxygen uptake roller-ski skating were greater in HITG than in LITG from preintervention to after the intervention, no between-groups differences were found from preintervention to after the standardized training period (P = .50 and .46), although peak oxygen uptake in roller-ski skating significantly improved in HITG (5.7% [7.0%], P < .01). No changes either within or between groups were found after the period of self-chosen training.

CONCLUSIONS

Differences in adaptations elicited by a short-term intervention focusing on low- versus high-intensity endurance training had little or no effect on the subsequent development of performance or physiological indices following a period of standardized training in cross-country skiers.

Effect of Intensity on Changes in Cardiac Autonomic Control of Heart Rate and Arterial Stiffness After Equated Continuous Running Training Programs

Background: It is well known that exercise training has positive effects on both cardiac autonomic function and arterial stiffness (AS). However, it is not clear that which exercise training variables, intensity or volume, or both, play a crucial role in this regard. This study investigates the chronic effects of high-volume moderate-intensity training (HVMIT) and low-volume high-intensity training (LVHIT) on heart rate variability (HRV) and AS in sedentary adult men.

Materials and Methods: Notably, 45 males (age: 42 ± 5.7 years) were randomly assigned to a control (n = 15), HVMIT (n = 15), or LVHIT (n = 15). The HVMIT group ran three times per week on a treadmill at 50–60% of VO₂max for 45–60 min, while the LVHIT trained at 70–85% of VO₂max for 25–40 min. Both training protocols were equated by caloric expenditure. HRV, pulse wave velocity (PWV), hemodynamic variables, and body composition were measured before and after 12 weeks.

Results: Both protocols (i.e., HVMIT and LVHIT) significantly increased the SD of normal sinus beat intervals (SDNN) and high-frequency (HF) bands (p < 0.05) after 12 weeks. Whereas the low-frequency (LF)-HF ratio decreased significantly in both training protocols (p < 0.05); however, these changes were significantly greater in the LVHIT protocol (p < 0.05). Furthermore, the root mean square of successive RR interval differences (RMSSD) significantly increased only in the LVHIT (p < 0.05). Moreover, a significant decrease in LF and PWV was only observed following the LVHIT protocol (p < 0.05). Some measures of HRV and PWV were significantly correlated (r = 0.275–0.559; p < 0.05).

Conclusion: These results show that the LVHIT protocol was more efficient for improving HRV variables and PWV than the HVMIT protocol after 12 weeks of continuous running training. Interestingly, changes in some HRV parameters were related to changes in PWV. Further studies should elaborate on the link between central and peripheral cardiovascular adaptations after continuous and intermittent training regimens differing in intensity.

Hydration Status and Fluid Replacement Strategies of High-Performance Adolescent Athletes: An Application of Machine Learning to Distinguish Hydration Characteristics

There are limited data on the fluid balance characteristics and fluid replenishment behaviors of high-performance adolescent athletes. The heterogeneity of hydration status and practices of adolescent athletes warrant efficient approaches to individualizing hydration strategies. This study aimed to evaluate and characterize the hydration status and fluid balance characteristics of high-performance adolescent athletes and examine the differences in fluid consumption behaviors during training. In total, 105 high-performance adolescent athletes (male: 66, female: 39; age 14.1 ± 1.0 y) across 11 sports had their hydration status assessed on three separate occasions—upon rising and before a low and a high-intensity training session (pre-training). The results showed that 20–44% of athletes were identified as hypohydrated, with 21–44% and 15–34% of athletes commencing low- and high-intensity training in a hypohydrated state, respectively. Linear mixed model (LMM) analyses revealed that athletes who were hypohydrated consumed more fluid (F (1.183.85)) = 5.91, (p = 0.016). Additional K-means cluster analyses performed highlighted three clusters: “Heavy sweaters with sufficient compensatory hydration habits,” “Heavy sweaters with insufficient compensatory hydration habits” and “Light sweaters with sufficient compensatory hydration habits”. Our results highlight that high-performance adolescent athletes with ad libitum drinking have compensatory mechanisms to replenish fluids lost from training. The approach to distinguish athletes by hydration characteristics could assist practitioners in prioritizing future hydration intervention protocols.

High-Intensity Interval Training for Heart Failure Patients With Preserved Ejection Fraction (HIT-HF)-Rational and Design of a Prospective, Randomized, Controlled Trial

Background: The pathophysiology of HF with preserved ejection fraction (HFpEF) has not yet been fully understood and HFpEF is often misdiagnosed. Remodeling and fibrosis stimulated by inflammation appear to be main factors for the progression of HFpEF. In contrast to patients with HF with reduced ejection fraction, medical treatment in HFpEF is limited to relieving HF symptoms. Since mortality in HFpEF patients remains unacceptably high with a 5-year survival rate of only 30%, new treatment strategies are urgently needed. Exercise seems to be a valid option. However, the optimal training regime still has to be elucidated. Therefore, the aim of the study is to investigate the effects of a high-intensity interval (HIT) training vs. a moderate continuous training (MCT) on exercise capacity and disease-specific mechanisms in a cohort of patients with HFpEF. Methods: The proposed study will be a prospective, randomized controlled trial in a primary care setting including 86 patients with stable HFpEF. Patients will undergo measurements of exercise capacity, disease-specific blood biomarkers, cardiac and arterial vessel structure and function, total hemoglobin mass, metabolic requirements, habitual physical activity, and quality of life (QoL) at baseline and follow-up. After the baseline visit, patients will be randomized to the intervention or control group. The intervention group (n = 43) will attend a supervised 12-week HIT on a bicycle ergometer combined with strength training. The control group (n = 43) will receive an isocaloric supervised MCT combined with strength training. After 12 weeks, study measurements will be repeated in all patients to quantify the effects of the intervention. In addition, telephone interviews will be performed at 6 months, 1, 2, and 3 years after the last visit to assess clinical outcomes and QoL. Discussion: We anticipate clinically significant changes in exercise capacity, expressed as VO_2peak, as well as in disease-specific mechanisms following HIT compared to MCT. Moreover, the study is expected to add important knowledge on the pathophysiology of HFpEF and the clinical benefits of a training intervention as a novel treatment strategy in HFpEF patients, which may help to improve both QoL and functional status in affected patients. Trial registration: ClinicalTrials.gov, identifier: NCT03184311, Registered 9 June 2017.

The Effects Aerobic Fitness has on Heart Rate Responses for a Custody Assistant Recruit Class Performing a Formation Run

This study measured the heart rate (HR) responses to a formation run (group run completed along a set route) performed by higher fitness (HF), moderate fitness (MF), or lower fitness (LF) custody assistant (CA) recruits. Retrospective data from 26 recruits (12 males, 14 females) were analyzed. Prior to academy training, a YMCA step test was administered. Recruits were divided into three groups based on recovery HR: top 25% were HF; bottom 25% were LF; the rest were MF. Recruit HR was measured during a formation run completed at an ~11-minute mile · pace^-1. HR zones were defined as: very light (< 57% of age-predicted maximum heart rate [HR_max]); light (57%-63% HR_max); moderate (64%-76% HR_max); vigorous (77%-95% HR_max); and very vigorous (> 95% HR_max). A one-way ANOVA, with Bonferroni post hoc, calculated between-group differences in time spent and percentage of total time in the HR zones during the run; effect sizes (d) were also calculated. HF recruits spent a significantly longer time and percentage of total time in the very light HR zone compared to the LF group (p ≤ 0.039; d = 1.20-1.35). There were no other significant between-group differences (p = 0.070-0.980). HF CA recruits spent more time in the very light training zone compared to the other groups (d = 0.92-1.35), which may not be optimal for aerobic adaptations. LF recruits spent more time in the vigorous-to-very vigorous HR zones (~45 minutes; 70% of the run). These recruits may potentially be working above their current capacity. Formation runs may not be the most efficient aerobic conditioning method for all CA recruits.

Training Session and Detraining Duration Affect Lower Limb Muscle Strength Maintenance in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

Muscle strength after detraining is still higher than the level before training, which is an important issue for middle-aged and older adults. The purpose of the present study was to examine the effects of detraining duration (DD), resistance training duration (RTD), and intensity on the maintenance of resistance training (RT) benefits after detraining in middle-aged and older adults. A systematic search yielded 15 randomized control trails (n = 383) eligible for inclusion. The results showed that RTD ≥ 24 weeks and DD ≥ RTD, the RT benefits were still significantly maintained even with medium and low intensity (standardized mean difference = 1.16, 95% confidence interval, CI [0.38, 1.94], p = .004). When RTD < 24 weeks and DD ≤ RTD, only the high-intensity groups maintained the RT benefits (DD, 4-6 weeks: standardized mean difference = 0.71, 95% CI [0.34, 1.08], p = .0002; DD 8-16 weeks: standardized mean difference = 1.35, 95% CI [0.66, 2.04], p = .0001). However, when DD > RTD, the RT benefits were not maintained even with high intensity. In summary, when RTD was less than 24 weeks, RTD > DD was an important factor in maintaining muscle strength.

Effects of different intensities of continuous training on vascular inflammation and oxidative stress in spontaneously hypertensive rats

We aimed to study the effects and underlying mechanism of different intensities of continuous training (CT) on vascular inflammation and oxidative stress in spontaneously hypertensive rats (SHR). Rats were divided into five groups (n = 12): Wistar‐Kyoto rats sedentary group (WKY‐S), sedentary group (SHR‐S), low‐intensity CT group (SHR‐L), medium‐intensity CT group (SHR‐M) and high‐intensity CT group (SHR‐H). Changes in body mass, heart rate and blood pressure were recorded. The rats were euthanized after 14 weeks, and blood and vascular tissue samples were collected. Haematoxylin and Eosin staining was used to observe the aortic morphology, and Western blot was used to detect the expression of mesenteric artery proteins. After CT, the mean arterial pressures improved in SHR‐L and SHR‐M and increased in SHR‐H compared with those in SHR‐S. Vascular inflammation and oxidative stress levels significantly subsided in SHR‐L and SHR‐M (p < 0.05), whereas in SHR‐H, only vascular inflammation significantly subsided (p < 0.05), and oxidative stress remained unchanged (p > 0.05). AMPK and SIRT1/3 expressions in SHR‐L and SHR‐M were significantly up‐regulated than those in SHR‐S (p < 0.05). These results indicated that low‐ and medium‐intensity CT can effectively reduce the inflammatory response and oxidative stress of SHR vascular tissue, and high‐intensity CT can improve vascular tissue inflammation but not oxidative stress.

Birth sex ratio in the offspring of professional male soccer players: influence of exercise training load

STUDY QUESTION

Can the exercise training load of elite male athletes influence the sex ratio of their offspring?

SUMMARY ANSWER

This is the first study assessing the influence of exercise training load on the offspring sex ratio of children from male professional athletes, observing a bias toward more females being born as a result of both high-intensity and high-volume loads, with intensity having the greatest effect.

WHAT IS KNOWN ALREADY

There is a relatively constant population sex ratio of males to females among various species; however, certain events and circumstances may alter this population sex ratio favoring one sex over the other.

STUDY DESIGN, SIZE, DURATION

Observational, descriptive cross-sectional study with a duration of 3 months.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Seventy-five male professional soccer players from First Division soccer teams. Offspring variables were sex of the offspring, number of children and order of birth. Exercise training variables were volume and intensity.

MAIN RESULTS AND THE ROLE OF CHANCE

Total offspring was 122 children (52 males (42.6%), 70 females (57.4%)). Analysis revealed that increase in either the volume (P < 0.001) or intensity (P < 0.001) of training by the players shifted the birth offspring ratio more toward females. Within the sample of females born, more births (i.e. number) were observed as a consequence of training at the highest intensity (45 out of 70; P < 0.001), no such pattern occurred within males (P > 0.05). When female versus male births were compared within each intensity, only the high-intensity comparison was significant (45 (75%) females vs 15 (25%) males, P < 0.001).

LIMITATIONS, REASONS FOR CAUTION

While this is the first study assessing differences in the sex ratio of the offspring of male athletes (i.e. soccer players), we acknowledge there are limitations and confounders within our approach; e.g. small sample size, ethnic background and variations in the timing of intercourse relative to ovulation as well as in sex hormone levels. As such, we propose that future research is needed to confirm or refute our findings. It is recommended that such work expand on the measurements obtained and conduct direct assessment of sperm characteristics.

WIDER IMPLICATIONS OF THE FINDINGS

The findings of the study support the fact that different stressors on the body may alter the sex of the offspring. While in the present study the stressor is the excessive training load of soccer players, other events may lead to similar results. The bias in offspring sex ratio may have important implications for demography and population dynamics, as well as genetic trait inheritance.

STUDY FUNDING/COMPETING INTEREST(S)

There is no funding nor competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Effects of Graded Exergames on Fitness Performance in Elementary School Children With Developmental Coordination Disorder

Developmental Coordination Disorder (DCD) is a common childhood disorder affecting movement and coordination skills, fitness, and academic performance. Increased physical fitness may have a positive influence on physical and mental health outcomes in children with DCD. Yet, little has been done to develop interventions to improve fitness performance in this group. The purpose of this study was to determine the effects of graded exergames in 7 to 12-year-old children with DCD and typically developing (TD) peers. Participants (32 DCD and 28 TD children) received a 30-min training session twice weekly for 10 weeks. Performance on motor coordination (MABC-2 test), balance, aerobic, and anaerobic fitness tests were assessed at the beginning and end of training. In addition, enjoyment and perception of exertion were measured for each participant during the training period. Both children with DCD and TD children significantly improved on motor coordination, balance, aerobic, and anaerobic fitness at the end of the training. A significant Group by Time interaction was observed on the MABC-2 total [F (1, 55) = 13.19; p < 0.001] and balance scores [F (1, 55) = 26.83; p < 0.0001], with the DCD group demonstrating larger improvements than the TD children. Both groups enjoyed the program throughout the training period even though they rated the training to be of high intensity. These findings indicate that graded exergames may serve as potential treatment for impaired fitness in children with DCD. Regular participation in graded exergames in school settings may be needed to enhance and maintain fitness performance in young children with and without DCD.

High versus Low-Moderate Intensity Exercise Training Program as an Adjunct to Antihypertensive Medication: A Pilot Clinical Study

OBJECTIVE

In this pilot clinical study we investigated the effect on blood pressure (BP) of two community-based exercise training programs of high (HIT) vs. low-moderate intensity (LMIT) in hypertensive individuals receiving at least one antihypertensive drug.

METHODS

The study included two phases of physical exercises based on 1-h session, 3 days/week for 12 and 16 weeks, respectively, separately by a 7-week resting period. Each phase was preceded by a four-week conditioning training period. According to the average maximal heart rate at baseline, participants were randomized to HIT (80-90%), LMIT (50-70%) or no-exercise (control). Heart rate was monitored during workout and BP profiles were registered by ambulatory BP monitoring at the beginning and end of each phase.

RESULTS

Of 60 individuals randomized, 44 completed the study (HIT, n = 10; LMIT, n = 16; controls, n = 18). BP levels were significantly reduced after the second phase for both LMIT (SBP -3.1 mmHg, DBP -2.4 mmHg) and HIT (SBP -10.8 mmHg, DBP -8.3 mmHg). Similar levels of improvement were also found in daytime and night-time BP. Mean attendance of the prescribed training sessions was 87.4 ± 6.2% for HIT and 87.4 ± 5.3% for LMIT during the first phase and 84.1 ± 5.0% and 85.2 ± 5.9% during the second phase, respectively (p = 0.047).

CONCLUSION

Both HIT and LMIT exercise training programs reduced BP but the HIT modality showed a lower rate of compliance with proposed training schedule. Intensity of training should be individually prescribed to improve tolerance to more high intensity exercises.

Quantifying Training Demands of a 2-Week In-Season Squash Microcycle

PURPOSE

To quantify the demands of specific on- and off-court sessions, using internal and external training load metrics, in elite squash.

METHODS

A total of 15 professional squash players (11 males and 4 females) wore a 100-Hz triaxial accelerometer/global positioning system unit and heart rate monitor during on-court "Group," "Feeding," "Ghosting," "Matchplay," and off-court "Conditioning" sessions across a 2-week in-season microcycle. Comparisons of absolute training load (total values) and relative intensity (per minute) were made between sessions for internal (session rating of perceived exertion, differential rating of perceived exertion, TRIMP) and external (Playerload, very high-intensity movements [>3.5 m·s-2]) metrics.

RESULTS

The Group sessions were the longest (79 [12] min), followed by Feeding (55 [15] min), Matchplay (46 [17] min), Conditioning (37 [9] min), and Ghosting (35 [6] min). Time >90% maximum heart rate was the lowest during Feeding (vs all others P < .05) but other sessions were not different (all P > .05). Relative Playerload during Conditioning (14.3 [3.3] arbitrary unit [a.u.] per min, all P < .05) was higher than Ghosting (7.5 [1.2] a.u./min) and Matchplay (6.9 [1.5] a.u./min), with no difference between these 2 sessions (P ≥ .999). Conditioning produced the highest Playerloads (519 [153] a.u., all P < .001), with the highest on-court Playerloads from Group (450 [94] a.u., all P < .001). The highest session rating of perceived exertion (all P < .001), Edward's TRIMP (all P < .001), and TEAM-TRIMP (all P < .019) occurred during the Group sessions.

CONCLUSIONS

Squash Matchplay does not systematically produce the highest training intensities and loads. Group sessions provide the highest training loads for many internal and external parameters and, therefore, play a central role within the training process. These findings facilitate planning or adjustment of intensity, volume, and frequency of sessions to achieve desirable physical outcomes.

25 Years of Session Rating of Perceived Exertion: Historical Perspective and Development

The session rating of perceived exertion (sRPE) method was developed 25 years ago as a modification of the Borg concept of rating of perceived exertion (RPE), designed to estimate the intensity of an entire training session. It appears to be well accepted as a marker of the internal training load. Early studies demonstrated that sRPE correlated well with objective measures of internal training load, such as the percentage of heart rate reserve and blood lactate concentration. It has been shown to be useful in a wide variety of exercise activities ranging from aerobic to resistance to games. It has also been shown to be useful in populations ranging from patients to elite athletes. The sRPE is a reasonable measure of the average RPE acquired across an exercise session. Originally designed to be acquired ∼30 minutes after a training bout to prevent the terminal elements of an exercise session from unduly influencing the rating, sRPE has been shown to be temporally robust across periods ranging from 1 minute to 14 days following an exercise session. Within the training impulse concept, sRPE, or other indices derived from sRPE, has been shown to be able to account for both positive and negative training outcomes and has contributed to our understanding of how training is periodized to optimize training outcomes and to understand maladaptations such as overtraining syndrome. The sRPE as a method of monitoring training has the advantage of extreme simplicity. While it is not ideal for the precise recording of the details of the external training load, it has large advantages relative to evaluating the internal training load.

Rehabilitation Effects of Fatigue-Controlled Treadmill Training After Stroke: A Rat Model Study

Background: Traditional rehabilitation with uniformed intensity would ignore individual tolerance and introduce the second injury to stroke survivors due to overloaded training. However, effective control of the training intensity of different stroke survivors is still lacking. The purpose of the study was to investigate the rehabilitative effects of electromyography (EMG)-based fatigue-controlled treadmill training on rat stroke model. Methods: Sprague-Dawley rats after intracerebral hemorrhage and EMG electrode implantation surgeries were randomly distributed into three groups: the control group (CTRL, n = 11), forced training group (FOR-T, n = 11), and fatigue-controlled training group (FAT-C, n = 11). The rehabilitation interventions were delivered every day from day 2 to day 14 post-stroke. No training was delivered to the CTRL group. The rats in the FOR-T group were forced to run on the treadmill without rest. The fatigue level was monitored in the FAT-C group through the drop rate of EMG mean power frequency, and rest was applied to the rats when the fatigue level exceeded the moderate fatigue threshold. The speed and accumulated running duration were comparable in the FAT-C and the FOR-T groups. Daily evaluation of the motor functions was performed using the modified Neurological Severity Score. Running symmetry was investigated by the symmetry index of EMG bursts collected from both hind limbs during training. The expression level of neurofilament-light in the striatum was measured to evaluate the neuroplasticity. Results: The FAT-C group showed significantly lower modified Neurological Severity Score compared with the FOR-T (P ≤ 0.003) and CTRL (P ≤ 0.003) groups. The FAT-C group showed a significant increase in the symmetry of hind limbs since day 7 (P = 0.000), whereas the FOR-T group did not (P = 0.349). The FAT-C group showed a higher concentration of neurofilament-light compared to the CTRL group (P = 0.005) in the unaffected striatum and the FOR-T group (P = 0.021) in the affected striatum. Conclusion: The treadmill training with moderate fatigue level controlled was more effective in motor restoration than forced training. The fatigue-controlled physical training also demonstrated positive effects in the striatum neuroplasticity. This study indicated that protocol with individual fatigue-controlled training should be considered in both animal and clinical studies for better stroke rehabilitation.

Greater effects of high- compared with moderate-intensity interval training on thyroid hormones in overweight/obese adolescent girls

OBJECTIVES

To investigate the effects of 12-week high-intensity- (HIIT) vs. moderate-intensity-interval training (MIIT) on thyroid stimulating hormone (TSH) and thyroxine (T4) and insulin-resistance in overweight/obese adolescent girls.

METHODS

Twenty four adolescent girls (age 16.5±1.36 yrs) were randomly allocated into three groups: (1) HIIT (2 blocks per session of 6-8 bouts of 30 s runs at 100-110% maximal aerobic speed (MAS), with 30 s active recovery between bouts at 50% MAS; n=8), (2) MIIT (2 blocks per session of 6-8 bouts of 30 s runs at 70-80% MAS, with 30 s active recovery between bouts at 50% MAS; n=8) and (3) control group (no exercise, n=8). Each training groups engaged in three sessions per week during three months. Anthropometric parameters, aerobic capacity, homeostasis model assessment index for insulin resistance (HOMA-IR) as well as plasma TSH and T4 levels were assessed in all subjects before- and after-training.

RESULTS

Following both training programs, body mass, body mass index Z-score, waist circumference and body fat decreased, while aerobic capacity increased. However, TSH and T4 concentrations decreased only after the HIIT (-30.47%, p<0.05, ES=1.42 and -12.86%, p<0.05, ES=1.18; respectively). The HOMA-IR decreased in both training groups (-26.25%, p<0.05, ES=1.87 for MIIT and -21.72%, p<0.05, ES=2.14 for HIIT).

CONCLUSION

Twelve weeks of HIIT was effective in reducing circulating TSH and T4 levels, unlike MIIT, in overweight/obese adolescent girls. These findings indicated that the stimulation of pituitary-thyroid function is more sensitive to training intensity than training duration. Further studies are needed to confirm this conclusion.

The Influence of Aerobic Fitness on Heart Rate Responses of Custody Assistant Recruits during Circuit Training Sessions

This study captured heart rate (HR) responses of custody assistant (CA) recruits undertaking circuit training sessions. Data from 10 male and 12 female CA recruits were analyzed. Based on YMCA step test recovery HR, recruits were divided into higher fitness (HF; top 25%), lower fitness (LF; bottom 25%), and moderate fitness (MF; remaining recruits) groups. HR was measured during two circuit training sessions featuring calisthenics and running. HR zones were defined as: very light (<57% of age-predicted maximum heart-rate [HRmax]); light (57-63% HRmax); moderate (64-76% HRmax); vigorous (77-95% HRmax); and very vigorous (>95% HRmax). A one-way ANOVA, with Bonferroni post hoc, calculated between-group differences in time spent, and percentage of total time, in the HR zones. In session one, the LF group spent less time in the light training zone compared to the MF group, and more time in the very vigorous zone compared to the HF group (p = 0.027-0.047). In session two, the LF group spent more time in the moderate zone compared to both groups, and a greater percentage of time in the very vigorous zone compared to the MF group (p = 0.002-0.004). LF recruits generally worked harder during circuit training than their fitter counterparts, which supported recommendations for ability-based modifications.

Using Velocity to Predict the Maximum Dynamic Strength in the Power Clean

The primary aim of the present study was to examine the commonly performed training exercise for athlete preparation. Twenty-two recreationally trained males (age: 26.3 ± 4.1 y, height: 1.80 ± 0.07 m; body mass (BM): 87.01 ± 13.75 kg, 1-repetitoon maximum(1-RM)/BM: 0.90 ± 0.19 kg) participated in the present study. All subjects had their 1-RM power clean tested with standard procedures. On a separate testing day, subjects performed three repetitions at 30% and 45%, and two repetitions at 70% and 80% of their 1-RM power clean. During all trials during both sessions, peak velocity (PV) and mean velocity (MV) were measured with the use of a GymAware device. There were no significant differences between the actual and estimated 1-RM power clean (p = 0.37, ES = −0.11) when the load-PV profile was utilized. There was a large typical error (TE) present for the load-PV- and load-MV-estimated 1-RM values. Additionally, the raw TE exceeded the smallest worthwhile change for both load-PV and load-MV profile results. Based upon the results of this study, the load-velocity profile is not an acceptable tool for monitoring power clean strength.

Eleven Years' Monitoring of the World's Most Successful Male Biathlete of the Last Decade

PURPOSE

To report the changes in the training characteristics, performance, and heart-rate variability (HRV) of the world's most successful male biathlete of the last decade.

METHOD

During the analyzed 11-year (2009-2019) period, the participant won 7 big crystal globes, corresponding to the winner of the International Biathlon Union World Cup. The training characteristics are reported as yearly volume (in hours) of low-intensity training (LIT), moderate- and high-intensity training, and speed and strength training. Performance was quantified by the number of World Cup top-3 positions per season. HRV was expressed as low- and high-frequency spectral power (in milliseconds squared), root-mean-square difference of successive R-R interval (in milliseconds), and heart rate (in beats per minute).

RESULTS

The training volume increased from 530 to ∼700 hours per year in 2009-2019, with a large polarization in training intensity distribution (ie, LIT 86.3% [2.9%]; moderate-intensity training 3.4% [1.5%]; high-intensity training 4.0% [0.7%]; strength 6.3% [1.6%]). The number of top-3 positions increased from 2 to 24-26 in 2009-2018 but decreased to 6 in 2019. The mean supine values in the root-mean-square difference of successive R-R interval and high-frequency spectral power divided by heart rate increased until 2015, which were stable over 2016-2018 but decreased in 2019. The number of top-3 positions was related to the total (r = .66, P = .02) and LIT (r = .92, P < .001) volume and to several markers of supine parasympathetic activity.

CONCLUSION

The improvement in performance of the participant was mainly determined by the progressive increase in training volume, especially performed at low intensity, and was correlated to parasympathetic activity markers. This case study confirms the effectiveness of the training method, with a large amount of LIT in an elite endurance athlete, and of regular HRV monitoring.

The Multidisciplinary Process Leading to Return From Underperformance and Sustainable Success in the World's Best Cross-Country Skier

PURPOSE

To investigate the factors associated with underperformance and the subsequent changes in training characteristics and supportive actions when returning to the world's best cross-country skier.

METHODS

The participant is the most decorated winter Olympian, with 8 Olympic gold medals, 18 World Championship titles, and 114 World Cup victories. Training data were categorized by training form (endurance, strength, and speed); intensity (low, moderate, and high); and mode (running, cycling, and skiing/roller skiing). In addition, test data were retrospectively analyzed, and interviews were performed with the participant and her support team.

RESULTS

After the competitive season, the participant had 8 weeks without systematic training and an evaluation process aiming to detect the factors contributing to underperformance. Here physiological, technical, and psychological challenges were detected. As a consequence, the participant included less high-intensity training (1.2 vs 2.1 sessions/wk, P = .011); more moderate-intensity training (0.9 vs 0.4 sessions/wk, P = .016); and more low-intensity training (6.9 vs 5.9 sessions/wk, P = .036) during the general preparation phase but with similar total endurance training load as previous season. In addition, more strength training (1.6 vs 1.1 h/wk, P = .036) and new ski-specific strength exercises were included. Finally, the athlete's autonomy when planning and adjusting training was increased, nontraining stressors were reduced, more frequent testing was included, systematic mental training was initiated, her nutritional strategy was adjusted, and her asthma treatment was optimized.

CONCLUSIONS

Overall, the current case study could be used as a framework for the holistic approach to treating an overtraining condition and for generation of new hypothesis in this exiting area.

Maximal Heart Rate for Swimmers

The main purpose of this study was to identify whether a different protocol to achieve maximal heart rate should be used in sprinters when compared to middle-distance swimmers. As incorporating running training into swim training is gaining increased popularity, a secondary aim was to determine the difference in maximal heart rate between front crawl swimming and running among elite swimmers. Twelve elite swimmers (4 female and 8 male, 7 sprinters and 5 middle-distance, age 18.8 years and body mass index 22.9 kg/m²) swam three different maximal heart rate protocols using a 50 m, 100 m and 200 m step-test protocol followed by a maximal heart rate test in running. There were no differences in maximal heart rate between sprinters and middle-distance swimmers in each of the swimming protocols or between land and water (all p ≥ 0.05). There were no significant differences in maximal heart rate beats-per-minute (bpm) between the 200 m (mean ± SD; 192.0 ± 6.9 bpm), 100 m (190.8 ± 8.3 bpm) or 50 m protocol (191.9 ± 8.4 bpm). Maximal heart rate was 6.7 ± 5.3 bpm lower for swimming compared to running (199.9 ± 8.9 bpm for running; p = 0.015). We conclude that all reported step-test protocols were suitable for achieving maximal heart rate during front crawl swimming and suggest that no separate protocol is needed for swimmers specialized on sprint or middle-distance. Further, we suggest conducting sport-specific maximal heart rate tests for different sports that are targeted to improve the aerobic capacity among the elite swimmers of today.

Effects of Increasing Balance Task Difficulty on Postural Sway and Muscle Activity in Healthy Adolescents

Evidence-based prescriptions for balance training in youth have recently been established. However, there is currently no standardized means available to assess and quantify balance task difficulty (BTD). Therefore, the objectives of this study were to examine the effects of graded BTD on postural sway, lower limb muscle activity and coactivation in adolescents. Thirteen healthy high-school students aged 16 to 17 volunteered to participate in this cross-sectional study. Testing involved participants to stand on a commercially available balance board with an adjustable pivot that allowed six levels of increasing task difficulty. Postural sway [i.e., total center of pressure (CoP) displacements] and lower limb muscle activity were recorded simultaneously during each trial. Surface electromyography (EMG) was applied in muscles encompassing the ankle (m. tibialis anterior, medial gastrocnemius, peroneus longus) and knee joint (m. vastus medialis, biceps femoris). The coactivation index (CAI) was calculated for ankle and thigh muscles. Repeated measures analyses of variance revealed a significant main effect of BTD with increasing task difficulty for postural sway (p < 0.001; d = 6.36), muscle activity (p < 0.001; 2.19 < d < 4.88), and CAI (p < 0.001; 1.32 < d < 1.41). Multiple regression analyses showed that m. tibialis anterior activity best explained overall CoP displacements with 32.5% explained variance (p < 0.001). The observed increases in postural sway, lower limb muscle activity, and coactivation indicate increasing postural demands while standing on the balance board. Thus, the examined board can be implemented in balance training to progressively increase BTD in healthy adolescents.

Development and Feasibility of a Regulated, Supramaximal High-Intensity Training Program Adapted for Older Individuals

Background: High-intensity training (HIT) with extremely short intervals (designated here as supramaximal HIT) is a time-efficient training method for health and performance. However, a protocol for regulation and control of intensity is missing, impeding implementation in various groups, such as older individuals.

Methods: This study presents the development and characteristics of a novel training protocol with regulated and controlled supramaximal intervals adapted for older people. Using both quantitative and qualitative analyses, we explored the feasibility of the program, performed in a group training setting, with physically active older individuals (aged 65–75, n = 7; five women). The developed supramaximal HIT program consisted of 10 × 6 s cycle sprint intervals with ∼1 min of active recovery with the following key characteristics: (1) an individual target power output was reached and maintained during all intervals and regulated and expressed as the percentage of the estimated maximum mean power output for the duration of the interval (i.e., 6 s); (2) pedaling cadence was standardized for all participants, while resistance was individualized; and (3) the protocol enabled controlled and systematic adjustments of training intensity following standardized escalation criteria.

Aim: Our aim was to test the feasibility of a novel training regimen with regulated and controlled supramaximal HIT, adapted for older people. The feasibility criteria for the program were to support participants in reaching a supramaximal intensity (i.e., power output > 100% of estimated VO₂ max), avoid inducing a negative affective response, and have participants perceive it as feasible and acceptable.

Results: All feasibility criteria were met. The standardized escalation procedure provided safe escalation of training load up to a supramaximal intensity (around three times the power output at estimated VO₂ max). The participants never reported negative affective responses, and they perceived the program as fun and feasible.

Conclusion: This novel program offers a usable methodology for further studies on supramaximal HIT among older individuals with different levels of physical capacity. Future research should explore the effects of the program in various populations of older people and their experiences and long-term adherence compared with other forms of training.

Block vs. Traditional Periodization of HIT: Two Different Paths to Success for the World's Best Cross-Country Skier

In short-term studies, block periodization of high-intensity training (HIT) has been shown to be an effective strategy that enhances performance and related physiological factors. However, long-term studies and detailed investigations of macro, meso, and micro-periodization of HIT blocks in world-class endurance athletes are currently lacking. In a recent study, we showed that the world’s most successful cross-country (XC) skier used two different periodization models with success throughout her career. One including extensive use of HIT blocks, namely BP, and one using a traditional method namely TRAD. In this study, we compare BP with TRAD in two comparable successful seasons and provide a detailed description of the annual use of HIT blocks in BP. The participant is the most-decorated winter Olympian, with 8 Olympic gold medals, 18 world championship titles, and 114 world cup victories. Training data was categorized by training form (endurance, strength, and speed), intensity [low (LIT), moderate (MIT), and HIT], and mode (running, cycling, and skiing/roller skiing). No significant difference was found in the total endurance training load between BP and TRAD. However, training volume in BP was lower compared to TRAD (15 ± 6 vs. 18 ± 7 h/wk, P = 0.001), mainly explained by less LIT (13 ± 5 vs. 15 ± 5 h/wk, P = 0.004). Lower volume of MIT was also performed in BP compared to TRAD (13 vs. 38 sessions/year), whereas the amount of HIT was higher in BP (157 vs. 77 sessions/year). While BP included high amounts of HIT already from the first preparation period, followed by a reduction toward the competition period, TRAD had a progressive increase in HIT toward the competition period. In BP, the athlete performed seven HIT blocks, varying from 7 to 11 days, each including 8–13 HIT sessions. This study provides novel insights into successful utilization of two different periodization models in the worlds best XC skier, and illustrates the macro, meso and micro- periodization of HIT blocks to increase the overall amount of HIT.

Development, Dynamic Modeling, and Multi-Modal Control of a Therapeutic Exoskeleton for Upper Limb Rehabilitation Training

Robot-assisted training is a promising technology in clinical rehabilitation providing effective treatment to the patients with motor disability. In this paper, a multi-modal control strategy for a therapeutic upper limb exoskeleton is proposed to assist the disabled persons perform patient-passive training and patient-cooperative training. A comprehensive overview of the exoskeleton with seven actuated degrees of freedom is introduced. The dynamic modeling and parameters identification strategies of the human-robot interaction system are analyzed. Moreover, an adaptive sliding mode controller with disturbance observer (ASMCDO) is developed to ensure the position control accuracy in patient-passive training. A cascade-proportional-integral-derivative (CPID)-based impedance controller with graphical game-like interface is designed to improve interaction compliance and motivate the active participation of patients in patient-cooperative training. Three typical experiments are conducted to verify the feasibility of the proposed control strategy, including the trajectory tracking experiments, the trajectory tracking experiments with impedance adjustment, and the intention-based training experiments. The experimental results suggest that the tracking error of ASMCDO controller is smaller than that of terminal sliding mode controller. By optimally changing the impedance parameters of CPID-based impedance controller, the training intensity can be adjusted to meet the requirement of different patients.

High-Intensity Interval Training Performed by Young Athletes: A Systematic Review and Meta-Analysis

Background: High-intensity interval training (HIIT) is as a time-efficient alternative to moderate- or low-intensity continuous exercise for improving variables related to endurance and anaerobic performance in young and adolescent athletes.

Objectives: To assess original research about enhancement of endurance and anaerobic exercise performance in young and adolescent athletes performing HIIT.

Method: Relevant articles published in peer-reviewed journals were retrieved from the electronic databases PubMed and SPORTDiscus in December 2017. Inclusion criteria were: (i) controlled trials (HIIT vs. alternative training protocol) with pre-post design; (ii) healthy young athletes (≤18 years); (iii) assessing variables related to endurance and exercise performance. Hedges' g effect size (ES), and associated 95% confidence intervals were calculated for comparison of any outcome between experimental (HIIT) and alternative training protocol.

Results: Twenty four studies, involving 577 athletes (mean age: 15.5 ± 2.2 years), were included in this review. HIIT exerted no or small positive mean ES on peak oxygen uptake (VO_2peak), running performance, repeated sprint ability, jumping performance and submaximal heart rate. Although the mean ES for changes in VO_2peak with HIIT is small (mean g = 0.10±0.28), the average increase in VO_2peak from pre to post HIIT-interventions were 7.2 ± 6.9% vs. 4.3 ± 6.9% with any other alternative intervention. HIIT largely and positively affected running speed and oxygen consumption at various lactate- or ventilatory-based thresholds, as well as for sprint running performance. Calculations showed negative mean ES for change-of-direction ability (large), and peak blood lactate concentrations (small). Mean duration per training session for HIIT was shorter than for control interventions (28 ± 15 min vs. 38 ± 24 min).

Conclusion: The present findings suggest that young athletes performing HIIT may improve certain important variables related to aerobic, as well as anaerobic, performance. With HIIT, most variables related to endurance improved to a higher extent, compared to alternative training protocols. However, based on ES, HIIT did not show clear superiority to the alternative training protocols. Nevertheless, young athletes may benefit from HIIT as it requires less time per training session leaving more time for training sport specific skills.

Upper-Body Muscular Endurance Training Improves Performance Following 50 min of Double Poling in Well-Trained Cross-Country Skiers

This study investigated the effect of muscular endurance training on O₂-cost and performance in double poling (DP) on a rollerski treadmill. Twenty-two well-trained cross-country skiers (31 ± 4 years, 77 ± 9 kg, 181 ± 8 cm, VO_2max running: 64 ± 5 mL·kg⁻¹·min⁻¹) were counter-balanced to either a combined muscular endurance and running interval training group [MET; n = 11 (♂ = 9, ♀ = 2)], or an endurance running interval training group [ET; n = 11 (♂ = 9, ♀ = 2)]. Both groups continued their normal low-and moderate intensity training, but replaced 2 weekly high intensity-training sessions with two project-specific sessions for 6 weeks. In these sessions, MET combined upper-body muscular endurance training (4 × 30 repetitions, 90 s rest between sets) and running intervals (3 × 4 or 2 × 6 min, 3 min rest), while ET performed running intervals only (6 × 4 or 4 × 6 min, 3 min rest). The DP test-protocol consisted of 50 min submaximal poling for O₂-cost measurement, followed by a self-paced 1,000-m performance test. In addition, subjects performed a VO_2max test in running. MET increased muscular endurance (P < 0.05) and 1RM in simulated DP (P < 0.01) more than ET. Further, MET reduced the 1,000-m time and O₂-cost compared to baseline values (P < 0.05), and tended to improve the 1,000-m time more than ET (P = 0.06). There were no changes in VO_2max running or VO_2peak DP in either MET or ET. In conclusion, 6 weeks of muscular endurance training increased both muscular endurance and 1RM in simulated DP. Further, specific upper-body muscular endurance training improved DP performance and thus, seems as a promising training model to optimize performance in well-trained cross-country skiers.

Robot-assisted gait training might be beneficial for more severely affected children with cerebral palsy

PURPOSE

Robot-assisted gait training (RAGT) can complement conventional therapies in children with cerebral palsy. We investigated changes in walking-related outcomes between children with different Gross Motor Function Classification System (GMFCS) levels and the dose-response relationship.

METHODS

Data from 67 children (3.9-19.9 years) with GMFCS levels II-IV were evaluated retrospectively. Every child received RAGT with the Lokomat complementing a multidisciplinary rehabilitation program. Changes in various walking-related outcomes were assessed.

RESULTS

Walking-related outcomes did not improve differently between GMFCS level groups. Significant within-group improvements were mainly observed in children with GMFCS level IV. A dose-response relationship was present for children with GMFCS levels III and IV.

CONCLUSIONS

Our results indicated that, although children with a GMFCS level IV walked less during an average Lokomat session, they experienced significant improvements in walking-related outcomes. Further, training dose correlated with changes in walking-related outcomes. However, between-group differences in changes in walking-related outcomes were not significant.

Quantification of Training Load During Return to Play After Upper- and Lower-Body Injury in Australian Rules Football

CONTEXT

Training volume, intensity, and distribution are important factors during periods of return to play.

PURPOSE

To quantify the effect of injury on training load (TL) before and after return to play (RTP) in professional Australian Rules football.

METHODS

Perceived training load (RPE-TL) for 44 players was obtained for all indoor and outdoor training sessions, while field-based training was monitored via GPS (total distance, high-speed running, mean speed). When a player sustained a competition time-loss injury, weekly TL was quantified for 3 wk before and after RTP. General linear mixed models, with inference about magnitudes standardized by between-players SDs, were used to quantify effects of lower- and upper-body injury on TL compared with the team.

RESULTS

While total RPE-TL was similar to the team 2 wk before RTP, training distribution was different, whereby skills RPE-TL was likely and most likely lower for upper- and lower-body injury, respectively, and most likely replaced with small to very large increases in running and other conditioning load. Weekly total distance and high-speed running were most likely moderately to largely reduced for lower- and upper-body injury until after RTP, at which point total RPE-TL, training distribution, total distance, and high-speed running were similar to the team. Mean speed of field-based training was similar before and after RTP compared with the team.

CONCLUSIONS

Despite injured athletes' obtaining comparable TLs to uninjured players, training distribution is different until after RTP, indicating the importance of monitoring all types of training that athletes complete.

Benefits of extending and adjusting the level of difficulty on computerized cognitive training for children with intellectual disabilities

Training on working memory (WM) improves attention and WM in children with attention-deficit hyperactivity disorder and memory impairments. However, for children with intellectual disabilities (ID), the results have been less encouraging. In this preliminary study it was hypothesized that children with ID would benefit from an extended amount of training and that the level of difficulty during training would affect the outcome. We included 21 children with mild or moderate ID aged 8–13 years. They went through between 37 and 50 training sessions with an adaptive computerized program on WM and non-verbal reasoning (NVR). The children were divided into two subgroups with different difficulty levels during training. The transfer to untrained cognitive tests was compared to the results of 22 children with ID training only 25 sessions, and to a control group. We found that the training group with the extended training program improved significantly on a block design task measuring NVR and on a WM task compared to the control group. There was also a significantly larger improvement on block design relative to the training group with the shorter training time. The children that received easier training tasks also improved significantly more on a verbal WM task compared to children with more demanding tasks. In conclusion, these preliminary data suggest that children with ID might benefit from cognitive training with longer training periods and less demanding tasks, compared to children without disabilities.

Optimising exercise training in prevention and treatment of diastolic heart failure (OptimEx-CLIN): rationale and design of a prospective, randomised, controlled trial

BACKGROUND

Heart failure with preserved left ventricular ejection fraction (HFpEF) currently affects more than seven million Europeans and is the only cardiovascular disease increasing in prevalence and incidence. No pharmacological agent has yet been shown to improve symptoms or prognosis. The most promising way to improve pathophysiology and deprived exercise-tolerance in HFpEF patients seems to be exercise training, but the optimal approach and dose of exercise is still unknown.

OBJECTIVES

The major objective of the optimising exercise training in prevention and treatment of diastolic heart failure study (OptimEx-CLIN) is to define the optimal dose of exercise training in patients with HFpEF. In order to optimise adherence, supervision and economic aspects of exercise training a novel telemedical approach will be introduced and investigated.

STUDY DESIGN

In a prospective randomised multi-centre study, 180 patients with stable symptomatic HFpEF will be randomised (1:1:1) to moderate intensity continuous training, high intensity interval training, or a control group. The training intervention includes three months supervised followed by nine months of telemedically monitored home-based training. The primary endpoint is change in exercise capacity, defined as change in peak oxygen uptake (VO2peak) after three months, assessed by cardiopulmonary exercise testing. Secondary endpoints include diastolic filling pressure (E/e') and further echocardiographic and cardiopulmonary exercise testing (CPX) parameters, biomarkers, quality of life and endothelial function. Training sessions and physical activity will be monitored and documented throughout the study with accelerometers and heart rate monitors developed on a telemedical platform for the OptimEx-CLIN study. Inclusion of patients started in July 2014, first results are expected in 2017.

Effect of Endurance Cardiovascular Training Intensity on Erectile Dysfunction Severity in Men With Ischemic Heart Disease

The protective effect of physical activity on arteries is not limited to coronary vessels, but extends to the whole arterial system, including arteries, in which endothelial dysfunction and atherosclerotic changes are one of the key factors affecting erectile dysfunction development. The objective of this study was to report whether the endurance training intensity and training-induced chronotropic response are linked with a change in erectile dysfunction intensity in men with ischemic heart disease. A total of 150 men treated for ischemic heart disease, who suffered from erectile dysfunction, were analyzed. The study group consisted of 115 patients who were subjected to a cardiac rehabilitation program. The control group consisted of 35 patients who were not subjected to any cardiac rehabilitation. An IIEF-5 (International Index of Erectile Function) questionnaire was used for determining erectile dysfunction before and after cardiac rehabilitation. Cardiac training intensity was objectified by parameters describing work of endurance training. The mean initial intensity of erectile dysfunction in the study group was 12.46 ± 6.01 (95% confidence interval [CI] = 11.35-13.57). Final erectile dysfunction intensity (EDI) assessed after the cardiac rehabilitation program in the study group was 14.35 ± 6.88 (95% CI = 13.08-15.62), and it was statistically significantly greater from initial EDI. Mean final training work was statistically significantly greater than mean initial training work. From among the parameters describing training work, none were related significantly to reduction of EDI. In conclusion, cardiac rehabilitation program-induced improvement in erection severity is not correlated with endurance training intensity. Chronotropic response during exercise may be used for initial assessment of change in cardiac rehabilitation program-induced erection severity.

Web-based cognitive training: patient adherence and intensity of treatment in an outpatient memory clinic

Background

Cognitive training has been playing an increasing role in the treatment of patients with cognitive deficits. This type of intervention, namely its intensity, can be optimized by incorporating information technology-based systems.

Objective

The intent of the study was to determine the treatment intensity and patient adherence to home-based cognitive training strategies (Web-based cognitive training).

Methods

A cohort of 45 patients with neurologic and psychiatric diseases attending an outpatient memory clinic (average age 50.7 years, SD 17.0; average education 7.8 years, SD 4.9) was followed over 18 months. Participants were challenged to use a Web-based cognitive training system, “COGWEB”, on a daily basis, and fulfilled at least four weeks of training supervised remotely. Additionally, 11 patients attended face-to-face sessions.

Results

The average duration of continuous cognitive training was 18.8 weeks (SD 18.9). Each patient performed on average 363.5 minutes/week (SD 136.6). At 6-month follow-up, 82.8% complied with their treatment plan. The average proportion of complete weeks was 0.75 (SD 0.22). Patients with dementia trained more intensively (444.6 minutes/week), followed by patients with static brain lesion (414.5 minutes/week; P=.01). The group that held face-to-face sessions performed more training overall (481.4 vs 366.9 minutes/week), achieving a stronger expression and statistical significance in the last week of training (652.6 versus 354.9 minutes/week, P=.027).

Conclusions

Overall, the weekly training intensity was high. Patients with dementia and static lesions performed more cognitive training. Face-to-face sessions were associated with higher intensities. The combination of classical methods with information technology systems seems to ensure greater training intensity.