In 2019, climate change and air pollution in combination with non-communicable diseases were the two top threats to health, with 70% of non-communicable diseases caused by air pollution and affecting the lungs. Chronic respiratory disease (CRD) thus was placed fourth as a global cause for mortality in 2021. While physical activity is the most efficient and cost-effective tool to manage CRDs through reduction in the risk of hospital admissions, all-cause mortality, and increases in the quality of life (Garcia-Aymerich et al. 2006; Schrempft et al., 2019), two critical research gaps hinder the optimal integration of physical activity into the management of CRDs. First, the interaction between physical activity and air-pollution, and their downstream health effects are still largely unknown. When exposed to both concomitantly, the inhaled volume of pollutants is increased, thus physical activity could catalyze the risks from air pollution. Second, sex- and gender-based differences in the phenotypes of CRD and physical activity behaviors exist. Women report lower quality of life, more severe feelings of breathlessness and cough, and participate in less physical activity than men (Clougherty., 2010). The objective of INCLUDE is thus to comprehensively study the effects and implications of sex and gender on the combined effects of physical activity and air pollution exposure in older individuals with and without CRD. Methodologically, the project is multi-centric, where 180 participants over the age of 60, both sexes, and broad gender characteristics will participate in the study in either Basel, Zurich, or Barcelona (60 participants at each site). We will identify how sex and gender affect physical activity experiences and responses (1) qualitatively though semi-structured interviews; (2) quantitatively through real-world walking in higher and lower air pollution wherein cardiopulmonary responses and gait characteristics will be measured with field-based and wearable devices; and (3) with an advisory board. The expected results and impact of the INCLUDE project are to understand and quantify how sex and gender affect acute and long-term respiratory health when older individuals are concomitantly exposed to both air pollution and physical activity. Our mixed-methods research approach in combination with our advisory board will guide urban planning, policy, clinicians, and future research. References: Clougherty, J. E. (2010). A growing role for gender analysis in air pollution epidemiology. Environmental Health Perspectives, 118(2), 167–176. https://doi.org/10.1289/ehp.0900994 Garcia-Aymerich, J., Lange, P., Benet, M., Schnohr, P., & Antó, J. M. (2006). Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: A population based cohort study. Thorax, 61(9), 772–778. https://doi.org/10.1136/thx.2006.060145 Schrempft, S., Jackowska, M., Hamer, M., & Steptoe, A. (2019). Associations between social isolation, loneliness, and objective physical activity in older men and women. BMC Public Health, 19(1), 74. https://doi.org/10.1186/s12889-019-6424-y

Abstract Background This cross-sectional study examined whether exposure to long-term resistance and endurance training can counteract muscular weakness on a functional, neurological and structural level in adolescents with cerebral palsy (CP) compared to typically-developed peers (TD) depending on training status. Methods Five trained (4 males; mean age: 19.8) and four untrained adolescents with CP (3 males; 20.2) were compared to nine age- and sex-matched TD trained (7 males; 19.8) and nine untrained peers (7 males; 20.3). Isometric and isokinetic measurements assessed strength in knee flexion and extension, voluntary activation (VA) was assessed using the twitch interpolation technique and ultrasound imaging of the quadriceps was performed to assess anatomical cross-sectional area (ACSA) and architecture. Results Linear regression models revealed that CP trained had lower absolute isometric strength (dominant: -18% [-48; 11]; non-dominant: -35% [-58; -11]) than TD untrained while CP untrained showed between 29% and 33% lower strength than TD untrained. VA in CP trained (dominant: -13% [-23; -3]; non-dominant: -10% [-30; 11]) and CP untrained (dominant: -14% [-23; -4]; non-dominant: -8% [-29; 13]) showed similar deficits compared to TD untrained. CP trained showed higher ACSA than TD untrained in the dominant leg of the vastus lateralis muscle (+ 16% [-7; 38]), while the non-dominant side showed lower values (-18% [-45; 9]). Conclusion Exposure to long-term resistance and endurance training is associated with a reduced gap in muscle strength and muscle volume in the dominant leg of adolescents with CP while neural drive does not seem to be affected through training exposure. It is discussed that training load might have been too low in the non-dominant leg of CP trained to induce relevant neuromuscular adaptations. Trial registration ClinicalTrials.gov Identifier NCT05859360, date of registration May 16, 2023.

Low-load blood-flow restriction (BFR) training is a potential alternative to high-load (HL) resistance training, especially when mechanical stress must be minimized. However, its effects on neuromuscular activation remain unclear. This randomized controlled trial compared changes in voluntary activation (VA) and neuromuscular performance following 8 weeks of BFR versus HL knee extensor training and examined the effects of a subsequent 2-week HL phase in both groups. Thirty-seven healthy adults (37-59 years, 22 female) underwent progressive BFR or HL training for 8 weeks (phase 1), followed by 2 weeks of HL training on knee extensor muscles (phase 2). Outcomes included VA, maximal isometric and dynamic leg extension and leg press strength, rate of force development (RFD), and jump performance. Linear mixed models were used to analyze group*time interactions; Cohen's d effect sizes are reported. After both training phases, the BFR group showed smaller improvements than HL in VA (d = -0.31 to -0.37), maximal isometric strength (d = -0.07 to -0.27), dynamic strength (d = -0.18 to -0.75), and RFD (d = -0.48 to -0.54). Jump performance showed trivial between-group differences (d = -0.01 to -0.05). Although a subsequent 2-week HL phase improved outcomes in the BFR group, it did not fully restore neural adaptations to the level of continuous HL training. These findings underscore the essential role of mechanical loading in optimizing neuromuscular function. While BFR may serve as a useful preparatory method in contexts where high loads are initially contraindicated, follow-up HL training is required to maximize neuromuscular adaptation. Trial Registration: This study was preregistered on the Open Science Framework (DOI: 10.17605/OSF.IO/DA6SV).

Muscular strength training is recommended to older adults to maintain mobility and quality of life by preventing sarcopenia. Research in younger individuals indicates that resistance training performed to failure can stimulate similar muscle growth across a wide range of loads (Schoenfeld et al., 2017). For older adults, low load resistance training may offer a joint-friendly alternative while still promoting muscle hypertrophy. Moreover, resistance training is associated with maintained cognitive function (Herold et al., 2019). The aim of this study was to compare the effects of eight weeks of low load resistance training to failure compared to high loads on muscle strength and executive function in older adults. In this randomized controlled trial 16 (6 men, 10 women, 64.7 ± 4.2 years, 24.0 ± 3.3 kg/m2) older adults performed resistance training at 40% or 60% 1-repetition maximum (RM) to failure, two times per week for 8 weeks. Leg extension and curl with two legs were performed, and leg press with each leg separately. 1-RM was estimated by a 5-RM test. Executive function was assessed by computerized Eriksen-flanker (EF) and Go/No-Go tests (GNG). Mixed effects models were used accounting for differences in sex, age and BMI. Percentage effect sizes and 95% confidence intervals are reported. Leg curl and extension strength increased on average by 9.4% (-11.7; +30.6) and 10.0% (-7.1; +27.2 more in the low load group. Leg press performance was increased more in the high load group. The left side improved by +16.9% (-0.3; 33.5) and the right side by 6.9% (-0.8; +14.7). For executive function, processing speed in low demand tasks increased by 13.4% (-0.4; +26.4) in the EF test and 6.7% (-12.7; +26.1) in the GNG test in favor of the low load group while in high demand tasks it increased by 18.4% (-3.7; +40.6) in the EF test in favor of the low load group but was decreased in the GNG test by 16.4% (- 9.7; +42.6). Interference costs in the EF test were increased by 181% (-4.4, +368) in the high load group. Both groups improved their strength with slight advantages to low or high load training depending on selected exercise. To the authors’ surprise, cognitive function seemed to be negatively affected by high load training to failure with declines in processing speed in both cognitive tests. Cognitive inhibition parameters showed diverging results. The potential of a positive effects of lower loads on cognitive performance in the presence of similar improvements in strength should be investigated further and should be considered for older adults, a population highly interested in maintaining cognitive health. References Schoenfeld, B. J., Grgic, J., Ogborn, D., & Krieger, J. W. (2017). Strength and Hypertrophy Adaptations Between Low- vs. High-Load Resistance Training: A Systematic Review and Meta-analysis. Journal of Strength and Conditioning Research, 31(12), 3508–3523. https://doi.org/10.1519/jsc.0000000000002200 Herold, F., Törpel, A., Schega, L., & Müller, N. G. (2019). Functional and/or structural brain changes in response to resistance exercises and resistance training lead to cognitive improvements—A systematic review. European Review of Aging and Physical Activity, 16, 10. https://doi.org/10.1186/s11556-019-0217-2

BACKGROUND:Declining physical fitness and rising obesity in children call for effective interventions. Integrating kettlebell training into the classroom may provide a practical way to overcome existing barriers. This study examined its feasibility and effectiveness on second graders' motor performance, attention, and health. METHODS:Three classes (pre n = 61; post n = 47) performed daily 15-min kettlebell training for 7 weeks, while two classes (pre n = 33; post n = 31) served as controls. Pre/post assessments included mid-thigh pull, grip strength, countermovement jump, sprint, shuttle run, eye-hand coordination, side hop test, Flanker task, body composition, and blood pressure. Linear mixed models analyzed group differences, reporting Cohen's d and 95% confidence intervals (CIs). RESULTS:Small effects were observed in sprint (p = 0.01, d = 0.46, 95% CI [0.20-0.73], Δ = +3.6% [1.5-5.6]) and mid-thigh pull (p = 0.14, d = 0.28 [-0.08 to 0.64], Δ = +5.5% [-1.7 to 12.6]). IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Fun, safe, and regular sessions with simple routines and age-appropriate exercises are required. CONCLUSION:This classroom-integrated program is feasible and effective, particularly for enhancing lower-body strength and promoting movement during the school day. TRIAL REGISTRATION:NCT06910085.

Cardiovascular disease is one of the leading causes of death worldwide and accounts for high levels of morbidity (GBD 2021 Risk Factors Collaborators, 2024). It emerges from cardiovascular risk factors such as elevated blood pressure, overweight and obesity, low cardiorespiratory fitness and physical inactivity (Kartiosuo et al., 2024). These risk factors can already induce subclinical vascular changes during childhood which track into adulthood and may lead to manifest cardiovascular disease later in life (Bao et al., 1995; Hauser et al. 2023; Lindberg et al. 2020). Physical inactivity is an established modifiable risk factor for cardiovascular disease, contributing to increased cardiovascular morbidity and mortality across the lifespan (GBD 2021 Risk Factors Collaborators, 2024). However, many children and adolescents do not reach the recommended amount of physical activity and are overweight or obese (Guthold et al., 2020). This highlights the urgent need for evidence-based, targeted interventions aimed at enhancing physical activity levels and preventing excessive weight gain in this population. We therefore aim to assess the effects of a one-year exercise intervention on vascular health and cardiovascular risk factors in children and adolescents with overweight and obesity. The objectives of this controlled study are: 1) to analyze the effect of a one-year structured exercise intervention in children and adolescents with overweight or obesity on their vascular health, as measured by retinal vessel diameters using static retinal vessel analysis, and 2) to analyze if a one-year structured exercise intervention in children and adolescents with overweight or obesity will lead to a reduction in body fat percentage, a decrease in systolic and diastolic blood pressure, and higher cardiorespiratory fitness. In this controlled intervention study based on the now! project, each of the three cohorts consists of 56 adolescents aged 12 to 14 years in the intervention group undergoing a structured exercise intervention and 28 adolescents in the control group. They will be screened for anthropometry, blood pressure, retinal vessel diameters, maximal strength assessment, cardiorespiratory fitness, cognition and lifestyle assessments. The relevance of this study lies in addressing modifiable cardiovascular risk factors in children with overweight and obesity through a structured exercise intervention and in evaluating their vascular health using retinal vessel analysis, a sensitive marker for early microvascular alterations. These findings will provide valuable evidence to support long-term promotion of exercise aimed at preventing the development of cardiovascular disease in children and adolescents, including integration into cantonal physical activity promotion strategies with low-barrier accessibility and potential nationwide scalability. References Bao, W., Threefoot, S.A., Srinivasan, S.R. and Berenson, G.S. (1995) Essential Hypertension Predicted by Tracking of Elevated Blood Pressure from Childhood to Adulthood: The Bogalusa Heart Study. The American Journal of Hypertension, 8, 657-665. https://doi.org/10.1016/0895-7061(95)00116-7 GBD 2021 Risk Factors Collaborators. (2024). Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021. The Lancet, 403(10440), 2162-2203. https://doi.org/10.1016/S0140-6736(24)00933-4 Guthold R et al. (2020). Global Trends in Physical Activity among Adolescents: A Pooled Analysis of 298 Population-Based Surveys with 1.6 Million Participants. Lancet Child & Adolescent Health, 4, 23-35. https://doi.org/10.1016/S2352-4642(19)30323-2 Hauser, C., Lona, G., Köchli, S., Streese, L., Infanger, D., Faude, O., & Hanssen, H. (2023). Bivariate relation of vascular health and blood pressure progression during childhood. Atherosclerosis, 381, Article 117215. https://doi.org/10.1016/j.atherosclerosis.2023.117215 Kartiosuo, N., Raitakari, O. T., Juonala, M., et al. (2024). Cardiovascular risk factors in childhood and adulthood and their life-course association with cardiovascular disease. JAMA Network Open, 7(6), e2418148. https://doi.org/10.1001/jamanetworkopen.2024.18148 Lindberg, L., Danielsson, P., Persson, M., Marcus, C., & Hagman, E. (2020). Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study. PLOS Medicine, 17(3), e1003078. https://doi.org/10.1371/journal.pmed.1003078

OBJECTIVES:This study aims to evaluate the effectiveness of the dbcoach intervention in improving key health outcomes in patients with type 2 diabetes. DESIGN:The study employed a pragmatic randomized controlled trial with 100 participants randomly assigned to either an intervention group receiving 12 months of telephone-based coaching plus standard care, or a control group receiving standard care only. METHODS:Primary outcomes were objectively measured moderate-to-vigorous physical activity and glycated hemoglobin, while secondary outcomes included further physical activity measures, diet, anthropometrics, medication, and quality of life. Data were collected at baseline as well as after 6 and 12 months. Linear mixed-effects models were employed for analysis. RESULTS:The intervention improved moderate-to-vigorous physical activity (Cohen's d = 0.51; 95 % confidence interval: 0.11, 0.90) with an increase of 14.2 (95 % confidence interval: 3.0, 25.3) minutes per day. However, the effect on glycated hemoglobin was negligible (95 % confidence interval: -0.20; 0.32, -0.72). Sedentary behavior was decreased (Cohen's d = -0.20; -0.71, 0.31). Analysis of medication showed variability, with decreased use of total insulin (rate ratio = 0.82; confidence interval 0.50, 3.03), but higher overall diabetes medication in the intervention group. There were no differences in diet (Cohen's d = -0.12; 95 % confidence interval: -0.78, 0.53) and BMI (Cohen's d = 0.01; 95% confidence interval: -0.16, 0.15). CONCLUSIONS:The dbcoach intervention increased physical activity but did not impact glycated hemoglobin in type 2 diabetes patients. While the intervention can enhance physical activity, additional strategies may be necessary for glycemic control.

Downhill and uphill running alter running kinematics, changing force distributions and muscle activities. While changes in the lower limbs have received more attention, research on the back and pelvis remains scarce. Understanding grade-specific changes in the trunk is crucial for developing injury prevention strategies and return-to-activity protocols after back injuries. This study examined how running on six different gradients (ranging from -15% downhill to +15% uphill) affects back and pelvic posture, as well as muscle activity in trunk and lower limb muscles. Twelve healthy recreational runners (6 women, 6 men) participated in a descriptive laboratory study. Kinematic variables (lumbar lordosis, hip drop, pelvic tilt, and trunk inclination) were assessed via 3D motion capture. Surface electromyography recorded muscle activity, normalized to maximum voluntary isometric contraction (MVIC), in selected trunk and lower limb muscles, including the medial gastrocnemius, semitendinosus, biceps femoris, gluteus maximus, gluteus medius, vastus lateralis, rectus abdominis, external oblique, and erector spinae. A linear mixed-effects model with random intercepts was used to compare each gradient to level running. Cohen's d was calculated to quantify effect sizes. Compared to level running lumbar lordosis was increased at -15% (mean difference [MD]: 1.2 ± 4.9 degrees, Cohen's d = 0.73, p-value = 0.007) and decreased at +15% (MD: -1 ± 3.6 degrees, d = 0.39, p = 0.290). Total hip drop decreased at -15% (MD: 14.2 ± 11 mm, d = 1.93, p < 0.001). Muscular activity of certain lower limb muscles was higher at steep downhill and uphill gradients. While the abdominals showed no consistent changes across gradients, activity of erector spinae was reduced at -10% and -5%. Downhill running increases lumbar lordosis, potentially elevating the risk of lumbar spine overload. When attempting to prevent and rehabilitate lower back injuries, a progression starting with uphill, followed by level and lastly by downhill running, may be advisable. Gradient-specific training should be considered due to the distinct neuromuscular demands across inclines. 3b.

Introduction Alternative approaches to fall prevention programs for older adults have been called for. Agility training, which blends functional movements, stop-and-go actions, direction changes, strength, balance, and cognitive tasks (Donath et al., 2016), appears potentially more effective than traditional strength and balance training methods (Lichtenstein et al., 2020). However, long-term applications often lack considerations of individual progression and reactive decision-making (Lichtenstein et al., 2023). Addressing the need for quick, unforeseen reactions in fall-risk situations, we explored a novel training tailored to individual progress with complex reactive elements. The aim was to enhance neuromuscular and cognitive performance, as well as psychosocial health outcomes in healthy older adults. Methods Forty-six healthy older adults (28 females, mean age 69.5 ± 6.8 years, BMI 25.9 ± 3.4 kg/m²) were randomly assigned to either a control (CON) or agility training (AT) group. The AT program, conducted over a period of 16 weeks (twice per week), involved tasks that progressed in complexity and placed high demands on cognitive skills, strength, balance by applying reactive light systems. Cognitive assessments included the Eriksen-flanker and Go/No-Go tasks, while neuromuscular assessments involved tandem stance, countermovement jump, grip strength, and leg dynamometry. Gait tests were conducted under both single and dual-task conditions. Psychosocial health was evaluated using surveys such as CES-D, WHO-QoL-Bref, ISI, FES-I, and PSS. Data analysis was performed using linear mixed-effects models, examining group×time interactions standardized to baseline standard deviation. Results Compliance was high (85.2 ± 8.3%), and dropouts were low (10.8%). After controlling for age, sex, and BMI, the analysis revealed, on average, at least small effects in favor of the AT group for Go/No-Go task parameters (0.18 < d < 0.47), perceived stress (d = 0.42), psychosocial well-being (d = 0.33), social relationships (d = 0.26), as well as single-task gait speed (d = 0.34). In contrast, effect sizes in favor of the control group were found for reaction time (d = 0.34). Neither strength, explosiveness, and balance parameters, nor physical well-being and fear of falling data showed notable between-group differences (d < 0.2). For effects in favor of the AT group, small negative to moderate positive effects are also compatible with the data. Discussion/Conclusion In this group of very fit and healthy older adults, agility training appears insufficient to markedly improve neuromuscular parameters but may potentially serve to slightly enhance response inhibition and mental health over a 16-week period. The application of the training program in less fit populations should be considered along with potential methods for investigating exercise performance with incorporated cognitive tasks. References Donath, L., van Dieën, J. H., Faude, O., & Wolf, P. (2016). Exercise-based fall prevention in the elderly: What about agility? Sports Medicine, 46, 143–149. https://doi.org/10.1007/s40279-015-0389-5 Lichtenstein, E., Erlacher, D., & Gronwald, T. (2020). Agility-based exercise training compared to traditional strength and balance training in older adults: A pilot randomized trial. PeerJ, 8, e8781. https://doi.org/10.7717/peerj.8781 Lichtenstein, E., Erlacher, D., & Gronwald, T. (2023). Agility training to integratively promote neuromuscular, cardiorespiratory and cognitive function in healthy older adults: A one-year randomized-controlled trial. European Review of Aging and Physical Activity, 20(1), 21. https://doi.org/10.1186/s11556-023-00331-6

Introduction Low-load Blood Flow Restriction training (BFRT) is a viable alternative to high-load resistance training (HLT), especially for clinical populations, due to its lower mechanical tension (Centner et al., 2019). Despite using lower loads, BFRT achieves comparable or slightly lower gains in muscle hypertrophy and strength than HLT. However, neural adaptations after low-load BFRT remain poorly understood and are hypothesized to be less pronounced (Centner & Lauber, 2020). Thus, this study aimed to compare the effects of BFRT and HLT, as well as the sequential application of HLT following BFRT, to address potential gaps in neuromuscular adaptation (Duchateau et al., 2021). Methods In this 10-week randomized controlled trial, 37 healthy male and female adults (35-60 years) completed progressive resistance training for knee extensors either 8 weeks with low-load BFRT followed by 2 weeks of HLT, or exclusively HLT. Measurements at baseline including familiarization (PRE1 and PRE2), 8 weeks (MID) and 10 weeks (POST) included maximal voluntary contraction of knee extensors (MVC), leg press strength (LP), voluntary activation (VA, via electrical muscle stimulation) and vastus lateralis muscle volume (V_VL, via ultrasound at 30-70% femur length). Linear mixed models were used to analyze group differences over time, with Cohen’s d effect sizes. Here, we report the preliminary data of 20 participants. Results Reliability between PRE1 and PRE2 was excellent for MVC and V_VL (ICC>0.98) and good for LP (ICC=0.88). From PRE2 to POST, MVC showed a moderate overall increase (+14.7%, d=0.49), while from MID to POST the BFRT group benefited slightly more (d=-0.14). LP increased similarly in both groups at MID (+5.9), but at POST, the HLT group demonstrated a greater increase compared to the BFRT group (+14.8%, d=0.32). No meaningful differences in VA changes were observed between groups or across timepoint, however, the interaction at POST favored more change in BFRT compared to HLT (d=-0.3). Both groups showed comparable increases in V_VL, with negligible differences between groups (+3.4%, d=0.05). Discussion/Conclusion The results of the analyzed sub-sample imply that BFRT and HLT lead to similar changes in maximal force, neural adaptation, and muscle size, however, a large variability was found. The greater increase in VA and MVC in the BFRT group at POST suggests that sequential HLT training after BFRT may enhance performance more than HLT alone (Duchateau et al., 2021). The analysis of the remaining participants may help clarify these effects and enlighten, how mechanical tension and metabolic stress contribute to neural adaptations. References Centner, C., & Lauber, B. (2020). A systematic review and meta-analysis on neural adaptations following blood flow restriction training: What we know and what we don’t know. Frontiers in Physiology, 11, Article 887. https://doi.org/10.3389/fphys.2020.00887 Centner, C., Wiegel, P., Gollhofer, A., & König, D. (2019). Effects of blood flow restriction training on muscular strength and hypertrophy in older individuals: A systematic review and meta-analysis. Sports Medicine, 49(1), 95–108. https://doi.org/10.1007/s40279-018-0994-1 Duchateau, J., Stragier, S., Baudry, S., & Carpentier, A. (2021). Strength training: In search of optimal strategies to maximize neuromuscular performance. Exercise and Sport Sciences Reviews, 49(1), 2. https://doi.org/10.1249/JES.0000000000000234

BackgroundDespite regular physical activity, aging typically results in reduced strength, balance and cognitive performance. Multi-component exercise programs address these declines. This study investigated the impact of a novel reactive agility training (RAT) program on neuromuscular and cognitive functions in healthy older adults.MethodsA two-arm randomized controlled trial included 46 community-dwelling participants aged 60 and above. Participants were randomly assigned to either a RAT intervention group or a control group receiving exercise recommendations. The RAT group trained twice weekly for 16 weeks. Primary outcomes focused on knee extension strength, while secondary outcomes included executive function tests (Flanker and Go/No-Go), gait speed, balance, grip strength, counter-movement jumps, and knee flexion strength. Data were analyzed using linear mixed models.ResultsOf the 46 participants, 41 (69.8 ± 7.1 years, 25.7 ± 3.4 kg/m², 26 females) completed the study with 85.2% compliance. The RAT group exhibited a 4.4% improvement in single-task gait speed compared to the control group, though other neuromuscular outcomes showed minimal differences. Cognitive improvements were observed, with a 25% reduction in Flanker task interference and a 16% enhancement in reaction time variability. Subgroup analysis suggested greater physical improvements in participants with lower baseline physical activity.ConclusionsWhile the reactive agility training led to modest gains in gait speed and cognitive functions such as inhibitory control, it did not boost overall neuromuscular performance. However, RAT may serve as an engaging exercise option for maintaining physical activity in older adults. Further research should explore its long-term effects and applicability in less fit populations.

To investigate whether quantifying both the absolute and relative intensity of physical activity (PA) improves understanding of age, sex, and occupation-related differences in PA in healthy adults aged 20–89. In the cross-sectional COmPLETE study, participants (N = 460, 48

Numerous studies have explored the impact of controlled exercise interventions in type 2 diabetes, as physical activity can positively influence its progression. However, our understanding of how broader lifestyle interventions can effectively promote physical activity in practical real-world scenarios remains limited. This systematic review and meta-analysis aimed to investigate the potential of lifestyle interventions targeting the promotion of physical activity on physical activity outcomes and glycated hemoglobin (HbA1c), providing a comprehensive understanding of both behavioral and clinical impacts. We performed a systematic review and meta-analysis, searching three databases and examined the study design, structure, and content of the lifestyle interventions. We assessed physical activity and HbA1c as endpoints and performed a multivariate meta-regression to explore physical activity’s impact on HbA1c. This review incorporated 13 studies (n = 5301 patients), with heterogeneity in intervention designs, components, and durations. Lifestyle interventions showed a slight increase in physical activity, equivalent to an average of 9.0 min more total physical activity per day (95

Aims To investigate how physical activity (PA) volume, intensity, duration, and fragmentation are associated with the risk of all-cause and cardiovascular disease mortality. To produce centile curves for PA volume and intensity representative of US adults.Methods and results This study is based on the observational 2011-2014 National Health and Nutrition Examination Survey (NHANES). Adults (age, >= 20) with valid accelerometer, covariate, and mortality data were included. Average acceleration (AvAcc), intensity gradient (IG), and total PA served as proxies for volume, intensity, and duration of PA, respectively. Weighted Cox proportional hazard models estimated associations between outcome and PA metrics. In 7518 participants (52.0% women, weighted median age of 49), there were curvilinear inverse dose-response relationships of all-cause mortality risk (81-month follow-up) with both AvAcc [-14.4% (95% CI, -8.3 to -20.1%) risk reduction from 25th to 50th percentile] and IG [-37.1% (95% CI, -30.0 to -43.4%) risk reduction from 25th to 50th percentile], but for cardiovascular disease (CVD) mortality risk (n = 7016, 82-month follow-up) only with IG [-41.0% (95% CI, -26.7 to -52.4%) risk reduction from the 25th to 50th percentile]. These relationships plateau at AvAcc: similar to 35-45 mg and IG: -2.7 to -2.5. Associations of PA with all-cause and cardiovascular disease mortality are primarily driven by intensity and secondary by volume. Centile curves for volume and intensity were generated.Conclusion Intensity is a main driver of reduced mortality risk suggesting that the intensity of PA rather than the quantity matters for longevity. The centile curves offer guidance for achieving desirable PA levels for longevity. This study shows that the distribution of the intensity of physical activity accumulated across the day may be more important for mortality reduction than the quantity (volume), underscoring the relevance of integrating physical activity of higher intensity into daily routines for health optimization. Higher physical activity intensity is more closely associated with reduced mortality risk than physical activity volume, particularly for cardiovascular disease mortality.We provide initial evidence suggesting health benefits when accumulating intense physical activity in continuous bouts rather than sporadically across the day. Graphical Abstract

Background:Acute improvement in range of motion(ROM)is a widely reported effect of stretching and foam rolling,which is commonly explained by changes in pain threshold and/or musculotendinous stiffness.Interestingly,these effects were also reported in response to various other active and passive interventions that induce responses such as enhanced muscle temperature.Therefore,we hypothesized that acute ROM enhancements could be induced by a wide variety of interventions other than stretching or foam rolling that promote an increase in muscle temperature. Methods:After a systematic search in PubMed,Web of Science,and SPORTDiscus databases,38 studies comparing the effects of stretching and foam rolling with several other interventions on ROM and passive properties were included.These studies had 1 134 participants in total,and the data analysis resulted in 140 effect sizes(ESs).ES calculations were performed using robust variance estimation model with R-package. Results:Study quality of the included studies was classified as fair(PEDro score=4.58)with low to moderate certainty of evidence.Results showed no significant differences in ROM(ES=0.01,p=0.88),stiffness(ES=0.09,p=0.67),or passive peak torque(ES=-0.30,p=0.14)between stretching or foam rolling and the other identified activities.Funnel plots revealed no publication bias. Conclusion:Based on current literature,our results challenge the established view on stretching and foam rolling as a recommended component of warm-up programs.The lack of significant difference between interventions suggests there is no need to emphasize stretching or foam rolling to induce acute ROM,passive peak torque increases,or stiffness reductions.

Background Sprinting is a crucial task in many sports and remains the major activity during which hamstring muscle injuries occur (Schache et al., 2012). Though the biceps femoris long head predominantly gets injured (Grange et al., 2023), hamstring strengthening exercises frequently seem to activate the semitendinosus more effectively (Bourne et al., 2017). A better understanding of how joint dominance influences activation levels of hamstring muscles may offer more clarity on the appropriate exercise selection in strengthening programs. Purpose This study compared 3 hip-dominant hamstring exercises (the rocker, perpetuum mobile fast and slow; PMfast and PMslow) and the Nordic Hamstring exercise (NHE) on their potential to simulate sprint-like activity and kinematics. Methods Muscle activity of the posterior kinetic chain (mm. biceps femoris, semitendinosus, gluteus maximus and gastrocnemius medialis) was measured with surface electromyography (sEMG) during every exercise and treadmill running at 75% of the individual maximal sprint velocity in 8 male athletes (age: 24.0 years ± SD 2.9; body mass: 76.8 kg ± 7.7; height: 1.79 m ± 0.08). sEMG data was normalized to maximal sprinting. 3D-motion capture was employed to assess hip and knee angles. Results This study revealed higher activity of the hamstrings for the explosive exercises ranging from 63.9% [95%CI: 56.3-71.5%] (rocker) to 49.0% [95%CI: 40.4-57.6%] (PMfast) vs. 34.0% [95%CI: 29.1-38.9%] (NHE) to 32.1% [95%CI: 26.9-37.3%] (PMslow). The rocker especially showed highest hamstring and m. gluteus maximus activity. M. biceps femoris consistently showed higher activity than m. semitendinosus across all exercises in peak (mean difference: 0.16, [95%CI: 0.07-0.26]) and average (mean difference: 0.06, [95%CI: 0.01-0.11]) activity. PMfast, PMslow and NHE demonstrated lower hip flexion angle of peak hamstring activity than the rocker and high-speed running and every exercise showed lower hamstring elongation stress than during high-speed running. Discussion Hamstring activity is comparable to high-intensity treadmill running for NHE and PMslow, and higher for the rocker and PMfast. M. gluteus maximus activity varied, with the rocker and PMfast showing higher activity than in sprinting. All examined exercises demonstrated their peak activity at short hamstring muscle length. What this study adds to the existing knowledge This study generated first data on sprint-specificity of two not yet investigated versions of a unilateral hip thrust. Similar or higher activity than during sprinting and BFlh selectivity was reached through explosive, closed kinetic chain, hip-dominant movement. References Bourne, M. N., Williams, M. D., Opar, D. A., Al Najjar, A., Kerr, G. K., & Shield, A. J. (2017). Impact of exercise selection on hamstring muscle activation. British Journal of Sports Medicine, 51(13), 1021-1028. https://doi.org/10.1136/bjsports-2015-095739 Grange, S., Reurink, G., Nguyen, A. Q., Riviera-Navarro, C., Foschia, C., Croisille, P., & Edouard, P. (2023). Location of hamstring injuries based on magnetic resonance imaging: A systematic review. Sports Health, 15(1), 111-123. https://doi.org/10.1177/19417381211071010 Schache, A. G., Dorn, T. W., Blanch, P. D., Brown, N. A., & Pandy, M. G. (2012). Mechanics of the human hamstring muscles during sprinting. Medicine & Science in Sports & Exercise, 44(4), 647-658. https://doi.org/10.1249/MSS.0b013e318236a3d2

Introduction An increase in Type 2 diabetes (T2D) cases worldwide can be attributed to the prevalence of an unhealthy lifestyle. Engaging in regular exercise can significantly benefit individuals with T2D (Colberg et al., 2016). A multitude of studies have explored this impact through controlled exercise interventions (Hou et al., 2023). Nevertheless, our understanding of how lifestyle interventions can effectively promote physical activity (PA) and positively influence the progression of T2D in practical, real-world scenarios remains limited. The objective of this systematic review with meta-analysis is to investigate the impact of lifestyle interventions targeting the promotion of PA on glycated hemoglobin (HbA1c) levels and PA outcomes. Furthermore, the aim is to examine whether lifestyle interventions influence PA and therefore HbA1c. Methods We searched three databases (MEDLINE via PubMed, PsycINFO, and SPORTdiscus) using the expanded search strategy of “Type 2 diabetes” AND “lifestyle intervention” AND “randomized controlled trial” AND “physical activity” AND “HEMOGLOBIN A1C”. In order to provide a comprehensive overview, we examine the design of the studies and the structure of the lifestyle interventions. To address the aim of this study, we conducted a meta-analysis with the outcomes PA and HbA1c. Moreover, we performed a multivariate meta-regression analysis to explore the impact of the moderator variable, PA, on the study effect sizes of HbA1c. Results This review incorporated 12 studies (n = 2513 patients), exploring multiple lifestyle interventions with heterogeneity in design, components, and duration. Regarding PA outcomes, we found an increase in PA (g = 0.33, 95% CI = 0.21,0.45), with no disparity between objective and self-reported measurements of PA. For HbA1c, the effect size was g = -0.07 (95% CI -0.17,0.04). In multivariate meta-regression, the intercept was 0.004 (SE = 0.06, 95% CI -0.11,0.12), and the PA coefficient as a moderator was -0.05 (SE = 0.06, 95% CI -0.18,0.07). These findings suggest that physical activity does not act as a moderator for changes in HbA1c in the examined studies. Discussion/Conclusion The studies showed a small effect in increasing PA. Lifestyle interventions had no relevant impact on HbA1c compared to control conditions, and the role of PA as a moderator was inconclusive. Further research is required to determine if structured exercise programs, known for positively affecting HbA1c, could be a better alternative to lifestyle interventions for individuals with T2D. Additionally, there is a need to investigate ways to enhance the efficacy of lifestyle interventions in influencing PA and HbA1c levels. References Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., Horton, E. S., Castorino, K., & Tate, D. F. (2016). Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(11), 2065-2079. https://doi.org/10.2337/dc16-1728 Hou, L., Wang, Q., Pan, B., Li, R., Li, Y., He, J., Qin, T., Cao, L., Zhang, N., & Cao, C. (2023). Exercise modalities for type 2 diabetes: A systematic review and network meta‐analysis of randomized trials. Diabetes/Metabolism Research and Reviews, 39(1), Article e3591. https://doi.org/10.1002/dmrr.3591

Supplemental Digital Content is Available in the Text. Keller, M, Lichtenstein, E, Roth, R, and Faude, O. Balance training under fatigue: a randomized controlled trial on the effect of fatigue on adaptations to balance training. J Strength Cond Res 38(2): 297-305, 2024-Balance training is an effective means for injury prevention in sports. However, one can question the existing practice of putting the balance programs at the start of a training session (i.e., train in an unfatigued state) because the occurrence of injuries has been associated with fatigue. Therefore, the aim of this study was to assess the influence of balance training in a fatigued or an unfatigued state on motor performance tested in fatigued and unfatigued conditions. Fifty-two, healthy, active volunteers (28.0 years; 19 women) were randomly allocated to 1 of 3 different training groups. The BALANCE group completed 6 weeks of balance training. The other 2 groups completed the identical balance tasks either before (BALANCE-high-intensity interval training [HIIT]) or after (HIIT-BALANCE) a HIIT session. Thus, these groups trained the balance tasks either in a fatigued or in an unfatigued state. In PRE and POST tests, balance (solid ground, soft mat, wobble board) and jump performance was obtained in fatigued and unfatigued states. Balance training resulted in reduced sway paths in all groups. However, the linear models revealed larger adaptations in BALANCE-HIIT and BALANCE when compared with HIIT-BALANCE (d = 0.22-0.71). These small to moderate effects were-despite some uncertainties-consistent for the "unfatigued" and "fatigued" test conditions. The results of this study revealed for the first time that balance training under fatigue results in diminished adaptations, even when tested in a fatigued state. Therefore, the data indicate that balance training should be implemented at the start of a training session or in an unfatigued state.