Achieving a comprehensive understanding of a particular phenomenon is a key concern of science. However, the inherent complexity of real-world phenomena can rarely be captured by a single theory, study, or assessment method. Therefore, it is necessary to approach a particular phenomenon from different perspectives to make robust and reliable assumptions about it (5, 16). Such an approach, which combines evidence from different sources to address the same phenomenon/research question, is widely referred to as triangulation (7, 25).
Due to its time-efficient and joint-friendly character, whole-body electromyostimulation (WB-EMS) attracts sportspeople and athletes of different disciplines. Nevertheless, whilst some trials reported positive effects of WB-EMS on performance parameters, the study situation is very inconsistent. Thus, the present meta-analysis aimed to summarize the effect of WB-EMS on maximum muscle power and endurance performance in sportspeople. Five electronic databases (Medline, CINAHL, CENTRAL, Web of Science, SportDiscus) were searched until 03/06/2025 according to the PRISMA scheme. Applying a random-effect model that includes the inverse heterogeneity model, effects sizes (SMD) and 95%-confidence intervals (95%-CI) were calculated. Subgroup-analyses focused on different modes of WB-EMS. The search identified 13 eligible trials with 14 WB-EMS and 13 control groups. In summary, we observed positive effects of WB-EMS on maximum hip/lower extremity power (13 studies, SMD: 0.48, 95%-CI: 0.04 to 0.91). Subgroup analyses revealed positive effects of superimposed WB-EMS versus underlying voluntary exercise (10 studies, SMD: 0.46, 95%-CI: 0.03 to 0.89). Heterogeneity between the trial results was moderate to substantial in both cases (I2=58% and I2=62%). The few WB-EMS trials (n=3) that addressed endurance performance (i.e. V˙O2peak) reported inconclusive and, on average, non-significant results (SMD: 0.32, 95%-CI: -0.19 to 0.84). The present study provided considerable evidence for a favorable effect of superimposed WB-EMS on maximum power in already well-trained sportspeople and athletes. By contrast, positive evidence for the effects of WB-EMS on endurance performance is lacking, particularly due to the varying research issues of the studies and diverging exercise protocols. Key Words: Electrostimulation, Performance, Well-Trained People, Quantitative Analysis, Stystematic Review, Meta-Analysis
Aim: This pilot study successfully established a framework for IMU-based technique diagnostics in hammer throwing, demonstrating that a single wrist-worn sensor provides high-fidelity data for both performance analysis and injury prevention. By deriving 19 specific parameters based on a biomechanical rationale of progressive acceleration, the research bridge the gap between raw inertial data and elite coaching requirements. Key Findings and Statistical Insights: The application of repeated measures correlation revealed that performance determinants are highly individualized. Advanced athletes (Athletes 1 and 2) exhibited a significantly higher number of parameters that correlated strongly with throwing distance, particularly regarding acceleration magnitudes in the final turns. Furthermore, technical proficiency was objectively quantified through the Coefficient of Variation (CV). Technical Progression and Rhythmic Structure: The analysis of acceleration time courses confirmed that optimal technical execution is marked by a steep increase in acceleration during the power position of the final turn. The derived acceleration ratios (Qa) provided an objective measure of the rhythmic buildup, identifying whether an athlete maintained sufficient “acceleration reserve” for the final phase of the throw. Clinical and Practical Implications: From a sports medicine perspective, this study highlights the potential of wearable technology for proactive injury prevention. By monitoring intra-individual variability in real-time, the sensor can detect early signs of neuromuscular fatigue. A sudden rise in the CV serves as a proxy for technical instability, which increases the risk of suboptimal joint loading and acute musculoskeletal strain under high centrifugal forces. Thus, IMU-based monitoring facilitates a biofeedback-driven approach to training load management. Future Perspectives: In conclusion, the wrist-worn sensor appears to be a valid and practical tool for analyzing movement execution in elite junior athletes. Future research should expand this scope to a longitudinal outlook, investigating how alternating implement weights (overweight/underweight) impacts the rhythmic structure and long-term technical stability. Such data will be crucial for refining individualized training protocols and ensuring the long-term orthopedic health of developing elite throwers. Key Words: Athletic Performance, Monitoring, Pilot Study, IMU-Technique, Movement Analyzation, Individualized Training Protocol
Background: In professional soccer, the use of external measures such as GPS data and functional performance screenings to control load, recovery and injury prevention is well established. However, internal biomarkers have so far only been used to a limited extent, as their collection is usually invasive, cost-intensive and difficult to implement at high-frequency. This work aims to present a first practical approach for high-frequency, saliva-based multi-omics biomarker monitoring in professional soccer and explores potential applications. Methods: Twenty-six male first-team players were monitored over an entire season, providing 3-5 saliva samples per week, resulting in 2,554 samples analyzed for 92 biomarkers. Samples were collected using Salivette® Cortisol swabs and analyzed via liquid chromatography-tandem mass spectrometry (intra-assay CV <5%). Individual reference ranges were calculated using a Bayesian inference model with adaptive temporal weighting and outlier detection, combining individual and population data to derive 95% confidence intervals. The analyses focused on selected biomarkers related to hydration, metabolism, stress, and inflammation. Results: Four representative cases showed marked deviations from their individual 95% reference ranges, each linked to distinct physiological conditions: temporary dehydration (total protein: team average 0.49±0.38 mg/ml; individual range 0.33-2.27 mg/mL), incorrect use of dietary supplements (melatonin: 0.28±5.17 ng/mL; 0.001-123.016 ng/mL), elevated stress (cortisol: 3.76±3.39 ng/mL; 0.004-41.836 ng/ml) and medication influences (cortisone: 9.53±5.82 ng/ml; 0.002-10.737 ng/ml). Conclusion: This study represents a first promising attempt to implement saliva-based biomarker assessment in professional soccer, which can support medical staff, nutritionists, and coaches in identifying early signs of maladaptation, optimizing recovery strategies, and enabling timely, individualized interventions throughout the season. Further research is needed to validate these findings and investigate their scalability to other sports. Key Words: Internal Load, Biomarker, Training, Nutrition
Cardiovascular diseases are still the leading cause of morbidity and mortality worldwide. Current research indicates that arterial stiffness is an independent risk factor for cardiovascular diseases and represents a potential target for personalized prevention and therapeutic approaches. Physical activity is a low-cost intervention for vascular prevention via pleiotropic mechanisms (e.g., reduced systemic inflammation, improved endothelial function, reduced arterial stiffness). In this clinical review we (i) highlight the clinical significance of arterial stiffness, (ii) recap current measurement methods, (iii) summarize the current evidence of the effects of physical activity on arterial stiffness and (iv) outline future directions for arterial stiffness research in sports medicine. Key Words: Prevention, Exercise, Vascular Aging, Cardiovascular Disease, Intervention, Inflammation, Cardiology
Objectives: Maximal cardiorespiratory capacity in terms of maximal oxygen uptake (V˙O2max) declines with age. Submaximal exercise parameters, such as the regulation of the cardiorespiratory system (kinetics) as an indicator of cardiorespiratory fitness, seem to be less influenced by age and are preserved by sufficient physical activity. However, kinetics parameters seem to be affected by the habitual type of locomotion in daily life. Hence, kinetics parameters are compared between younger and older adults with similar levels of physical activity for treadmill and cycle ergometry. Methods: 16 younger (28±6 yrs) and 19 older (65±6 yrs) participants were tested on a cycle and treadmill ergometer, respectively. The protocols consisted of randomly changing moderate work rates. Kinetics parameters were assessed via time series analysis. Higher maxima at smaller lags indicate faster kinetics responses. Key results: Time courses for HR kinetics were similar in younger and older adults with equal levels of physical activity (p=0.763), while V˙O2 kinetics were slightly faster for older adults during treadmill but not cycling exercise for several lags (p<0.05). For the older adults, V˙O2 kinetics, but not HR kinetics were faster during treadmill exercise, compared with cycling for several lags (p<0.05), while for the younger adults, faster V˙O2 kinetics were noticed for cycling compared with treadmill exercise for several lags (p<0.05). Conclusion: The type of ergometry seems to be relevant to assess cardiorespiratory kinetics in younger and older adults. This should be considered in clinical practice, after the findings have been evaluated in a frailer group of participants. Key Words: Cardiorespiratory Fitness, Older Adults, Treadmill Exercise, Cycling Exercise
Objective: Studies have proven the potential of the calculated maximal lactate steady-state (cMLSS) as a practical and time-efficient way to determine MLSS. Purpose of this study was to compare traditional approaches to distinguish the heavy from the severe exercise intensity domain with the cMLSS to evaluate its potential for physiological threshold determination. Methods: Fifteen triathletes (3 women, 12 men; age: 37.63±11.47yr, bodyweight: 77.1±8.9kg, height: 178.5±8.1cm, maximum oxygen consumption [V˙O2MAX]: 52.6±5.9ml·min-1·kg-1) performed an isokinetic sprint of 15s to determine maximal glycolytic rate (vLaMAX) followed by an incremental test with assessment of gas exchange to determine V˙O2MAX and second ventilatory threshold (VT2). The calculation of cMLSS was conducted using V˙O2MAX and vLaMAX. Reverse lactate test (RLT) was performed on a separate day and the protocol (priming stages, one stage at estimated 105% of MLSS and reverse segments) was accompanied by blood lactate samples. Power at experimental thresholds (VT2, RLT) and cMLSS was compared using statistical methods for assessing agreement. Results: Cycling power ±SD for RLT, cMLSS and VT2 was assessed at 236±34W, 229±38W and 250±36W. Intraclass correlation coefficients (ICC3,1) ranged from good (RLT vs. cMLSS: ICC3,1=0.806) to moderate (VT2 vs. cMLSS: ICC3,1=0.699). However, there were significant differences for VT2 vs. cMLSS (p=0.012, d=0.740), but not for RLT vs. cMLSS (p=0.268, d=0.310). Conclusion: The results accord to published comparisons of threshold concepts, also showing large individual differences. The observed deviations could originate from the methodological procedure, but are most likely attributable to divergent underlying physiological mechanisms of respiratory and metabolic responses during exercise. The cMLSS includes more information about the interaction of endurance performance determinants (V˙O2MAX, vLaMAX) and could give more goal-oriented training recommendations. Key Words: Threshold Concepts, Performance Determinants, Calculated Maximal Lactate Steady-State (cMLSS), V˙O2MAX, vLaMAX
This clinical review presents definitions of sarcopenia, diagnostic tools and criteria, as well as recommended therapeutic measures. Current consensus papers and guidelines were systematically identified, and their key statements were compared with the latest recommendations from the European Working Group on Sarcopenia in Older People. Finally, three consensus papers were included for comparison. The consensus papers revealed both similarities and differences with regard to the underlying disease construct, screening procedures, diagnostic thresholds, and therapeutic recommendations. Some of the observed differences can be explained by population-specific factors, such as ethnic differences in body composition, different lifestyles, and different healthcare infrastructures. Nevertheless, this review provides a valuable point of orientation and a foundation for clinical decision-making. Key Words: Muscle, Aging, Exercise, Nutrition, Therapeutic Recommendations, Lifestyle, Health Care
Objective: This study examined how professional and academy-level female soccer players perceive the impact of menstrual symptoms on their athletic performance and assessed the relationship between symptom severity and perceived performance impairment. Methods: In this cross-sectional survey, 106 players in Austria completed an online questionnaire evaluating the severity of physical and mental menstrual symptoms and their perceived impact on performance. Paired-sample t-tests were used to compare symptom severity with perceived performance impairment. Results: Players reported that physical symptoms impaired performance significantly more than their reported severity, whereas mental symptom severity and perceived impact were nearly identical. Strong positive correlations were observed between symptom severity and perceived performance impairment for both physical and mental symptoms, indicating that athletes with more intense symptoms consistently reported greater performance limitations. Implications: These findings highlight the relevance of menstrual symptom burden in elite women’s soccer and emphasize the need for cycle-aware training environments. Increased awareness and individualized symptom-management strategies may help optimize performance, support athlete well-being, and facilitate more informed coaching practices. Key Words: Sports Performance, Performance Impairment, Professional Soccer Players, Individualized Management
Background: Traditional training methods often lack motivational appeal, resulting in poor adherence. This proof-of-concept study examines the effects of a balance training system on cognitive and motoric function in community-dwelling older adults (CD) as well as in patients in geriatric rehabilitation (GR). Methods: The CD sample consisted of 12 participants (4 male, 8 female, age: 70.9±4.1 years, intervention: 2x/week 20–25-min. for six weeks). 15 patients in GR were included (10 women, 5 men, age: 84.7±4.2 years; intervention: 5x/week 20–25 min. 3 weeks). Prae- and post-assessments included Montreal Cognitive Assessment test (MoCA), Timed Up and Go Test (TUG) under single- (ST) and dual-task (DT) conditions, gait speed test (GSS) and Sit-to-Stand Test (STS). For the statistical analysis, a pre-post comparison was carried out within the groups and the effect size was determined. Results: The intervention groups demonstrated improvements across all tests after the balance training system (prae vs post: MoCA, CD: 25.7±2.4 vs. 27.7±1.9; GR: 23.2±4.0 vs. 24.3±3.4; TUG ST, CD: 5.9±0.6 s vs. 5.2±0.4 s; GR: 15.4±8.0 vs. 11.8±5.8 s ; TUG DT (costs) CD: 1.3±1.0 s vs. 1.0±0.8 s; GR 21.6±9.1 vs. 16.1±7.7 s; GSS: CD: 1.7±0.3 m/s vs. 2.0±0.2 m/s; GR: 0.9±0.2 vs. 1.0±0.2 m/s; STS: CD:13.7±2.5 to 15.7±2.8; GR: 11.5±7.0 vs. 16.2±8.3). All improvements despite GR TUG DT costs reached statistical significance. Discussion: The findings indicate positive effects of a balance training system on cognitive function and functional mobility in older adults. The study highlights the potential of exergames as an effective training method alternative for the elderly. Key Words: Community-Dwelling Older Adults (Cd), Gait Speed Test (Gss), Timed Up And Go Test (Tug), Sit-To-Stand Test (Sts), Dual-Task Conditions
Objectives: Glucagon-like peptide-1 (GLP-1) receptor agonists and dual incretin therapies achieve clinically meaningful weight loss and improve glycemic control and cardiometabolic risk factors in routine care. Because the quality of weight loss matters, reduction in Du al-energy X-ray absorptiometry (DXA) -derived fat-free mass (FFM) during pharmacological weight loss raises concern that muscle-related compartments may also be affected and highlights an implementation gap in obesity care. › Methods: This clinical practice review used a structured narrative synthesis of literature identified through PubMed/MEDLINE, Cochrane CENTRAL, Google Scholar, Semantic Scholar, guidelines and consensus sources and reference-list screening. The search focused on pharmaco therapy-associated changes in body composition, dietary protein targets during energy restriction, and practical exercise strategies including eccentric training. Literature was considered according to direct relevance, clinical applicability, and co
Objective: Athletes who regularly train outdoors are more likely to be exposed to ultraviolet (UV) radiation, a major risk factor for skin cancer. However, the importance of adequate UV protection in sports is still an underdiscussed topic among athletes and officials. We developed a strategy for UV protection consultation (UVPC) for compulsory preparticipation physical evaluations (PPEs) and conducted this study to explore athletes’ UV exposure and protective behaviors, as well as feasibility and acceptance of UVPC. Methods: In a cross-sectional study, we administered a survey to athletes who underwent a PPE at one of 23 participating certified sports medicine centers in Germany (22 in Saxony, 1 in Schleswig-Holstein) from February to June 2025. The questionnaire assessed individual UV exposure and protective behaviors. Based on the results, sports physicians provided a structured UVPC. Physicians provided online feedback on feasibility and acceptance of the procedure. The outcomes are described descriptively. Regression analyses were conducted to identify factors associated with protective behaviors. Results: Athletes’ (N=375; mean age=16 years; male=50%) UV exposure varied greatly by sport. Increasing outdoor training time and prior sunburn were significantly associated with protective behaviors. Half of the athletes received a UVPC. The procedure was feasible and well-accepted by the majority of physicians (N=9). Conclusions: Overall, a UVPC is feasible and well-accepted in its suggested form within PPE. Athletes’ individual UV exposure should be considered for a more targeted approach.
Background: Chronic non-specific low back pain (NSLBP) affects up to 80% of adults worldwide, causing disability, reduced quality of life, and substantial socioeconomic costs. Afferent-stimulating insoles activate plantar mechanoreceptors to modulate muscle tone and reflex-based postural adaptations. Methods: In this single-blinded randomized controlled trial at the MEDICUM Rhein-Ahr-Eifel health center (Germany; January 2023-April 2025; DORSO-RELAX study, DRKS-ID: DRKS00038213), 80 adults with chronic NSLBP (>12 weeks) were randomized to afferent-stimulating (SM) or static-supportive (ST) insoles (n=40 each). sEMG of the erector spinae at L5, pain intensity (Numeric Rating scale, NRS), and health-related quality of life (SF-36; Physical and Mental Component Scores [PCS, MCS]) were assessed at T1, T2, and T3. Mann-Whitney U tests and confirmatory two-way mixed ANOVA (time × group) were applied; effect sizes (r, η²Ρ) calculated. Results: Seventy-six participants completed the study (SM=37, ST=39). The SM group showed significant reductions in paraspinal muscle tone [sEMG] (p<.01, r=0.32) and greater improvements in mental component score [MCS] (p<.01, r=0.29), and a significant reduction in pain [NRS] (T1-T2 only; p<.05, r=0.21). Mixed ANOVA confirmed significant time × group interactions for sEMG and MCS (p<.01, η²Ρ=0.07) and main effects of time for NRS and PCS (p<.001). No adverse events occurred. Conclusion: Afferent-stimulating insoles reduced paraspinal muscle tone and improved mental well-being and may reduce pain, supporting their potential as a non-invasive intervention for chronic NSLBP.
Objective: This study aimed to conduct a bibliometric analysis of the 100 most-cited publications on youth strength training to identify influential literature, major contributors, research hotspots, and thematic development in the field. Methods: Data were retrieved from the Web of Science Core Collection on March 20, 2026. After screening according to predefined criteria, the 100 most-cited eligible publications involving children, adolescents, or young athletes were included. Microsoft Excel and Bibliometrix/Biblioshiny (R) were used to analyze publication characteristics, source distribution, leading contributors, collaboration patterns, keyword occurrence, and temporal thematic trends. Results: The dataset included 100 publications published between 1984 and 2021 across 43 sources, involving 455 authors. The most-cited article was the 2009 National Strength and Conditioning Association position statement on youth resistance training. The literature was concentrated in a small number of core journals, led by the Journal of Strength and Conditioning Research. The United States ranked first in both scientific production and citation impact. The highly cited literature was mainly organized around six domains: guidelines and safety, athletic performance, obesity and metabolic health, neuromuscular adaptation, broader health-related outcomes, and applied implementation. Temporal keyword trends indicated a shift from early concerns with safety and developmental feasibility toward performance enhancement, health-related application, and evidence-informed practice. Conclusion: Youth strength training research has evolved from a safety-focused stage into a more mature and interdisciplinary field characterized by performance, health, and practical application. This study provides a structured overview of the field’s influential knowledge base and may help guide future research, evidence synthesis, and practical program design for young populations. Key Words: Youth, Strength Training, Resistance Training, Bibliometric Analysis, Research Hotspots, Thematic Evolution
Background: Contemporary football demands have intensified the need for effective post-match recovery strategies. While cryotherapy and compression therapy are widely implemented, their specific effectiveness in football populations remains inadequately synthesized. Objective: To systematically evaluate the effectiveness of cryotherapy, compression therapy, and their combined application for post-match recovery in football players through comprehensive analysis of high-quality evidence. Methods: We conducted a systematic review following PRISMA 2020 guidelines with prospective registration (PROSPERO: CRD42024613263). Nine databases were systematically searched from January 2013 through September 2025. Randomized controlled trials, systematic reviews, and meta-analyses examining cryotherapy and compression therapy for post-match recovery in football players were included. Quality assessment utilized Joanna Briggs Institute Critical Appraisal Tools. Results: From 4,847 identified records, 15 studies met inclusion criteria, encompassing 2,234 participants (mean age 22.8±4.1 years, 91% male). Studies included 10 randomized controlled trials, 3 systematic reviews, and 2 meta-analyses. Cold water immersion demonstrated the strongest evidence base (7 studies), followed by compression therapy (4 studies), combined interventions (3 studies), and whole-body cryotherapy (2 studies). Cold water immersion significantly reduced muscle soreness compared to passive recovery (mean difference: -1.6 VAS units, 95% CI: -2.4 to -0.8, p<0.001) and enhanced performance recovery (effect size: 0.68, 95% CI: 0.42-0.94, p<0.001). Compression therapy showed moderate effectiveness for pain reduction (effect size: 0.45, 95% CI: 0.21-0.69, p=0.002). Quality assessment revealed 73.3% of studies achieving low risk of bias. Conclusion: Strong evidence supports implementing cryotherapy and compression therapy for football players recovery. Optimal protocols include 10-15 minutes cold water immersion at 10-15°C immediately post-match, with compression therapy beneficial during extended recovery periods. However, placebo effects require consideration when interpreting subjective recovery measures.
Introduction: Relative Energy Deficiency in Sport (RED-S) results from low energy availability and negatively affects athlete health and performance. Data on RED-S prevalence among Indian athletes remain limited. This study aimed to quantify the prevalence of RED-S risk and examine whether lower energy intake is associated with impaired physical performance among young athletes. Methods: A total of 316 endurance state and national-level athletes (18-25 years) from Tamil Nadu, India, were recruited using purposive sampling. RED-S risk was assessed using the Relative Energy Deficiency in Sport Screening Tool (RST). Dietary intake was evaluated using a 24-hour dietary recall and food frequency questionnaire, and physical fitness performance was assessed using standardized tests of cardiovascular endurance, muscular endurance, muscular strength, and flexibility. Group differences were analysed using chi-square tests and ANOVA. Results: Moderate-to-high RED-S risk was observed in 73% of female and 51% of male athletes (χ²=8.58, p<0.01). Mean energy and nutrient intakes were below ICMR-RDA 2024 recommendations in both sexes. Athletes classified as low RED-S risk demonstrated significantly superior cardiovascular endurance, muscular endurance, and flexibility compared to high-risk athletes (p<0.05). Associations between lower energy intake and poorer performance outcomes were more pronounced among females. Conclusion: This study provides first quantitative evidence of a high prevalence of RED-S risk among Indian athletes and demonstrates its association with inadequate dietary intake and reduced physical performance. Early screening and targeted nutrition interventions are essential to protect athlete health and optimize performance.
Heat Shock Protein 70 (HSP70) is a highly conserved molecular chaperone involved in proteostasis, inflammatory regulation and oxidative stress responses. Aging is associated with a reduced capacity to induce HSP70, which may compromise cellular resilience. Exercise is recommended as a key non-pharmacological strategy to counteract age-related functional decline, but its effects on HSP70 signaling in older humans have not been comprehensively summarized. The aim of this review was to synthesize human evidence on how physical exercise affects HSP70 expression and related inflammatory and oxidative stress pathways in aging populations. Following PRISMA 2020 guidelines, we systematically searched PubMed, Scopus, ScienceDirect and SPORTDiscus from 2012 to May 2025 for peer-reviewed human intervention studies involving adults ≥60 years, a structured exercise component, and at least one HSP70-related outcome. Thirteen studies met the eligibility criteria, including 11 randomized controlled trials and 2 non-randomiz
