Classifying demographic groups of humans from gait patterns is desirable from several long-standing diagnostic and monitoring perspectives. IMU recorded gait patterns are mapped into a nonlinear dynamic representation space using criticality analysis and subsequently classified using standard Support Vector Machines. Inertial-only gait recordings were found to readily classify in the CA representations. Accuracies across age categories for female versus male were 72.77%, 78.95%, and 80.11% for σ=0.1, 1, and 10, respectively; within the female group, accuracies were 73.36%, 76.70%, and 78.90%; and within the male group, 77.65%, 81.48%, and 81.05%. These results show that dynamic biological data are easily classifiable when projected into the nonlinear space, while classifying the data without this is not nearly as effective.

Background:Technology-assisted physical activity interventions for older adults in their home-based environment have been used to promote physical activity. Previous research has reported that such interventions benefit body composition, aerobic fitness, cognitive abilities, and postural control, reducing the risk of falls and maintaining regular physical activity among the older population. Objective:While previous reviews on technology-assisted physical activity interventions focused on health-related outcomes, this scoping review explores the characteristics of the technology in relation to the characteristics of populations, purpose of the activity, and usability in terms of adverse events, drop-outs, adherence, and user experience. Methods:A full search was performed in Medline, Embase, CINAHL, SportDiscus, and Web of Science. Sources were considered for inclusion if the participants aged on average 60 years and older, if the physical activity intervention was assisted by technology, and if performed within home-based environments. Results:We identified 8496 sources. After title and abstract screening, 455 full texts were assessed, and 148 were included, representing 12,717 participants aged 74 (SD 6) years. In total, 63% (93/148) of the sources reported on the population's health status. The main purpose of the interventions was balance (75/148, 51%), and strength and power (64/148, 43%) and the intervention purposes were not related to the embedded technology. In studies where the participant's health status was reported as healthy, 53% (78/148) implemented exergames compared to only 27% (40/148) in studies with participants with a clinical condition. Mobile apps (30/148, 20%) and trackers (16/148, 11%) were implemented likewise in both groups. The technology was embedded to provide continuous exercise information (40/148, 27%) and exercise feedback (40/148, 27%) or to record real-time movement data (38/148, 26%). Adverse events were reported in 46% (68/148) of the sources with three quarters (49/68) reporting no adverse events. Only two mild events were related to technology. Dropout rates were reported in 68% (100/148) of the sources, with no differences between intervention (16 SD 16%) and control (14 SD 12%) groups. Dropout reasons related to technology are only 3% (3/100). Adherence was reported in 53% (79/148) sources and was slightly higher in the intervention group (80 SD 18%) compared to the control group (71 SD 25%). A significantly higher adherence was found between interventions that were tailored (83 SD 15%) versus those that were not (75 SD 21%). General enjoyment of the technology was captured in 37% (55/148) of the sources. Within those sources, 91% rated positive (91/100), 7% neutral (7/100), and 2% negative (2/100). Occasionally reported wishes were related to goal setting, feedback, technical support, exercise variation, and social setting. Conclusions:Various technologies were successfully used in healthy and clinical older populations, though evidence regarding their implementation in physical activity interventions in hospital settings remains limited. The embedded technology was not a reason for additional dropouts, led to slightly better adherence, and adverse events were rarely related to technology. When assessed, the technology was well accepted and positively enjoyed.

We go beyond cross-sectional studies of executive functioning (EF) to investigate intraindividual dynamics of accuracy and response-times. Forty-three 8-11 year-old children (Mage = 9 years 11 months, 51.2 % boys) completed the Mixed block (including both congruent and incongruent trials) of the Hearts and Flowers task on tablets twice per school-day during two weeks (nti = 651). Specifying Residual Dynamic Structural Equation Models (RDSEM) novel findings emerged. Children became less accurate and respond faster over time. Both state-accuracy and state-response-time were relatively stable over time. State-accuracy-on-response-time-slopes showed that children with a relatively lower trait-accuracy performed more accurately when they slowed down. In contrast, children with a relatively higher trait-accuracy performed at the same level of accuracy regardless whether they accelerated or decelerated. An intraindividual approach to EF provides an important window into the children's accuracy-speed trade-off and cognition in a naturalistic school context. Educational relevance: While developmental trends of children's executive functions and between-person differences are relatively well established in the literature, we know less about the processes from situation to situation in everyday learning environments. For learning, children rely on their self-monitoring and self-regulation to adjust their pace in learning contexts, for example slowing down for new topics, or speeding up for known contents. Teachers monitor children's accuracy both as immediate and longer-term outcomes, and can provide feedback to them in case they need to slow down, or nudge them to speed up in learning situations. In order to understand how children regulate this speed/accuracy trade-off from one lesson to another, from one day to another, we investigated how their executive functions (EF) unfolded during lessons and days at school. In particular, we investigated the dynamics between accuracies (how correctly they responded) and response times (how fast they responded) when they completed the Mixed bock of the Hearts and Flowers executive function task up to twice a day for ten school days. Importantly we found when children with lower overall accuracy performed more accurately when they slowed down, while speed had no impact on the accuracy of children with higher overall accuracy. This speed/accuracy trade-off is as important for learning tasks at school as it is for completing EF tasks. Understanding how this speed/accuracy trade-off ebbs and flows lesson-to-lesson and dayto-day for different children gives unique insights into variability in cognitive capacities that teachers encounter each lesson. It is in this situation-to-situation context that teachers interact with, get involved with, dedicate resources to, and provide support to children depending on their need for slowing down or speeding up.

Abstract Background Motor competence (MC) is a key component reflecting one’s ability to execute motor tasks and is an important predictor of physical fitness. For adolescents, understanding the factors affecting MC is pertinent to their development of more sophisticated sporting skills. Previous studies considered the influence of poor proprioceptive ability on MC, however, the relationship between lower limb joint position sense, kinematic control, and MC is not well understood. Therefore, the aim of this study was to determine the relation between joint position sense and kinematic control with MC in adolescents during a lower limb movement reproduction task. Methods This study was a cross-sectional design. Young people (n = 427, 196 girls and 231 boys) aged 13 to 14 years were recruited. A movement reproduction task was used to assess joint position sense and kinematic control, while the Movement Assessment Battery for Children (mABC-2) was used to assess MC. In this study, participants were categorized into the Typically Developed (TD, n = 231) and Probable Developmental Coordination Disorder (DCD, n = 80) groups for further analysis of joint position sense, kinematic control, and MC between groups. Results Kinematic data, specifically normalized jerk, showed a significant correlation with MC. There was no correlation between knee joint position sense and MC, and no group differences between DCD and TD were found. Conclusions Joint position sense should not be used as a measure to distinguish TD and DCD. Rather than joint position sense, control of kinematic movement has a greater influence on the coordination of the lower limbs in adolescents. Movement control training should be implemented in the clinical setting to target kinematic control, rather than focus on joint position sense practice, to improve motor competency. Trial Registration Identifier NCT03150784. Registered 12 May 2017, https://clinicaltrials.gov/study/NCT03150784.

This study investigates the temporal dynamics and affective associations related to executive function (EF) performance in primary school classrooms using an intensive longitudinal design. Data were collected from 35 students aged 8.9 to 11.4 years. Participants reported their affective experiences and completed EF measures three times daily following a fixed sampling schedule. The data collection spanned two consecutive school weeks across three primary school classrooms. Utilising Dynamic Structural Equation Modeling (DSEM), we examined 505 measurements of EF tasks and self-reported affective states over two weeks. The findings reveal significant within-person variability in EF, accounting for 52% of the observed variance, with performance declining later in the day and week. At the within-person level, positive affect was associated with improved EF performance, while negative affect was associated with poorer EF. No significant between-person relationships were found. These results underscore the importance of considering within-person processes and affective experiences in educational settings and highlight the need for further research employing intensive longitudinal methods to better understand the nuanced dynamics of affect and EF in real-world classroom environments.

Background: Exercise is recommended as the first -line management for knee osteoarthritis (KOA); however, it is difficult to determine which specific exercises are more effective. This study aimed to explore the potential mechanism and effectiveness of a leg -swinging exercise practiced in China, called 'KOA pendulum therapy' (KOAPT). Intraarticular hydrostatic and dynamic pressure (IHDP) are suggested to partially explain the signs and symptoms of KOA. As such this paper set out to explore this mechanism in vivo in minipigs and in human volunteers alongside a feasibility clinical trial. The objective of this study is 1) to analyze the effect of KOAPT on local mechanical and circulation environment of the knee in experimental animals and healthy volunteers; and 2) to test if it is feasible to run a large sample, randomized/single blind clinical trial. Methods: IHDP of the knee was measured in ten minipigs and ten volunteers (five healthy and five KOA patients). The effect of leg swinging on synovial blood flow and synovial fluid content depletion in minipigs were also measured. Fifty KOA patients were randomly divided into two groups for a feasibility clinical trial. One group performed KOAPT (targeting 1000 swings/leg/day), and the other performed walking exercise (targeting 4000 steps/day) for 12 weeks with 12 weeks of follow-up. Results: The results showed dynamic intra-articular pressure changes in the knee joint, increases in local blood flow, and depletion of synovial fluid contents during pendulum leg swinging in minipigs. The intra-articular pressure in healthy human knee joints was -11.32 +/- 0.21 (cmH(2)O), whereas in KOA patients, it was -3.52 +/- 0.34 (cmH(2)O). Measures were completed by 100% of participants in all groups with 95-98% adherence to training in both groups in the feasibility clinical trial. There were significant decreases in the Oxford knee score in both KOAPT and walking groups after intervention (p < 0.01), but no significant differences between the two groups. Conclusion: We conclude that KOAPT exhibited potential as an intervention to improve symptoms of KOA possibly through a mechanism of normalising mechanical pressure in the knee; however, optimisation of the method, longer -term intervention and a large sample randomized -single blind clinical trial with a minimal 524 cases are needed to demonstrate whether there is any superior benefit over other exercises. The translational potential of this article: The research aimed to investigate the effect of an ancient leg -swinging exercise on knee osteoarthritis. A minipig animal model was used to establish the potential mechanism underlying the exercise of knee osteoarthritis pendulum therapy, followed by a randomised, single-blind feasibility clinical trial in comparison with a commonly -practised walking exercise regimen. Based on the results of the feasibility trial, a large sample clinical trial is proposed for future research, in order to develop an effective exercise therapy for KOA.

[This corrects the article DOI: 10.3389/fnins.2023.1187790.].

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Background: Gait deficits are common among people with multiple sclerosis (PwMS). Therefore, investigating factors that may influence walking in PwMS is important. Previous studies in older adults and other neurological populations demonstrated the relationship between sleep quality and gait performance. Despite the fact that the prevalence of poor sleep quality is very high among PwMS, little is known about the effect of sleep quality on gait among PwMS. Objective: This study aimed to explore the relationship between sleep quality and gait performance in PwMS. Methods: Forty-one PwMS participated in the study between February 2019 and December 2019. Participants were asked to walk at a self-selected speed over 10[Formula: see text]m with an inertial measurement unit (IMU) attached over the back. Walking speed, step length (left and right), and step time were calculated. Sleep was estimated objectively using a wrist-worn triaxle-accelerometer; the derived parameters were sleep efficiency (SE) and the number of awakening after sleep onset (NASO). Results: SE significantly correlated with step length ([Formula: see text]). Furthermore, the NASO significantly correlated with gait speed ([Formula: see text]), and step-time ([Formula: see text]). These correlations remained significant even after adjusting for age and disease duration. Conclusion: We observed that when corrected for disease duration and age there were relationships between NASO and SE to gait parameters; these observations warrant further investigations.

BACKGROUND:Children with reduced motor competence (MC) have reported differences in their walking performance when compared to their typically developed peers, albeit, with inconsistent results. RESEARCH QUESTIONS:What is the effect of reduced balance on walking performance in adolescent boys and girls under cognitive-motor interference conditions? METHODS:This cross-sectional study assessed motor competence, in adolescents aged 13-14 years, using the Movement Assessment Battery for Children 2nd edition and walking performance from gait parameters derived from an inertial measurement unit placed over the estimated centre of mass. Each participant performed two 10 m straight-line walks at their self-selected speed. These consisted of a walk with no distractions and a cognitive-motor interference walk (reciting the alternate letters of the alphabet out loud). A two-way mixed ANOVA was used to assess for significant interactions. RESULTS:365 adolescents, (low balance = 58, typical balance = 307) participated in this study (boys = 204, girls = 161). Significant interactions were reported between MC groups and walking condition for walking speed in boys (F(1,195) = 5.23, p= 0.02, ηp2 = 0.03) and girls (F(1,154) = 4.05, p= 0.046, ηp2 = 0.03). Both sexes with low balance reduced their walking speed to a greater extent than their typically developed peers under cognitive-motor interference conditions compared to the single-task walk. In addition, boys with low balance reported increased stride length variability (F(1,198)= 4.40, p= 0.037, ηp2= 0.02) compared to typically developed peers. SIGNIFICANCE:Adolescents with low balance report altered walking. Our data could support a better understanding of the relationship between balance and gait and may help the development of interventions to support those with difficulties.

In China, swinging the leg backwards and forwards is a commonly used therapy for people with osteoarthritis of the knee. One rationale is that movement without weightbearing may reduce pain of the knee by strengthening the muscles and changing the dynamic pressure of at the at the knee. There have been no studies evaluating its effectiveness. Before undertaking a large trial, a pilot study is needed to establish feasibility and an estimate of the sample size needed. This will be a parallel-group, assessor-masked, randomised, controlled study comparing the effect of pendulum leg swinging against an equivalent time of walking exercise. Patients will be recruited from the outpatient and inpatient orthopaedic surgery services in a large, class III general hospital in Wuhan, China. To be selected they must have clinically diagnosed osteoarthritis of the knee. Patients will be excluded if they have additional knee disease, have had hip or knee arthroplasty or a tibial osteotomy, are taking steroids or have done so in the preceding three months, have another illness affecting mobility or participation in the study, are pregnant, or have a body mass index (BMI) over 35. They will be allocated randomly using sealed, prefilled envelopes on a 1:1 basis. Data will be collected by masked observers at baseline and 12 weeks with additional 12 weeks follow-up. Measures include the Oxford Knee Score, the six-minute walking distance, pain measured on a numerical rating scale, the 30 second sit-to-stand test, quadriceps muscle strength, and accelerometer data. Feasibility data will record data-completion rates, recruitment and retention rates, adherence with treatment, and patient experience including adverse events. The two interventions will involve a gradual increase of exercise between baseline and 6 weeks with a further six weeks at the level set for each patient. Data analysis will be descriptive, with comparative analysis on outcome measures to give an estimate of sample size needed in a full trial. This feasibility trial started in October 2021 and completed in October 2022. A total of 174 participants were recruited and 50 patients were accepted for this trial. There were 24 cases in control (walking) group and 26 in KOAPT group. All patients completed 12 weeks intervention and 12 weeks follow-up. Swinging the leg like a pendulum combines exercise and movement of the knee without bearing weight. Exercise is known to give some benefit but it is not known whether joint movement without weight-baring has any beneficial effect. A large trial would be needed. This trial will establish how feasible it might be to undertake a large trial. Registry: Chinese Clinical Trial Registry Number: ChiCTR2100051275 Date: 17th September 2021 URL: https://www.chictr.org.cn/historyversionpuben.aspx?regno=ChiCTR2100051275

Purpose: This study set out to identify the extent of the relationships between subsections of the Movement Assessment Battery for Children 2nd Edition - MABC2 (manual dexterity, aiming and catching, and balance) to PA, CRF and BMI in adolescents. Methods: Height, BMI, the MABC2, a 20m shuttle run test and wrist-worn accelerometery PA levels (mins) were measured. Multivariable linear regression models, adjusting for sex, height and BMI were used to assess the relationship of the three subsections of the MABC2 with PA, CRF and BMI. Results: A total of 155 adolescents, aged 13-14 years, took part in this study (77 girls, 78 boys). Balance reported significant relationships with moderate to vigorous PA (unstandardised Beta B=0.15, 95%CI 0.02-0.28), vigorous PA (B=0.06, 95%CI 0.02-0.09) and BMI (B=-0.01, 95%CI -0.02-0.005). Balance in addition to aiming and catching skills were both significantly related to adolescent CRF (B=0.30, 95%CI 0.17-0.42 and B=0.29, 95%CI 0.14-0.45, respectively). Conclusion: This study suggests that balance is the strongest correlate skill to achieving the highest intensities of PA and healthier BMI status in adolescents.           .

Introduction: Despite a wide variety of clinical presentations in hereditary Mitochondrial Diseases, muscle fatigue is a common theme and impairs a patient's quality of life and ability to function. Current treatments are only supportive and include nutritional supplementation and physical therapy. Photobiomodulation therapy (PBMT) using low-intensity, narrow spectrum light in the red/near infrared (NIR) range, from a low-level laser or light-emitting diode sources, enhances mitochondrial function in preclinical and clinical studies on a range of conditions. However, little research has been done on the effectiveness of photobiomodulation in hereditary mitochondrial disorders. Methods: We performed a scoping review of the evidence of the beneficial effects of photobiomodulation for treating the muscle-related symptoms of hereditary mitochondrial disease. Results: No studies regarding photobiomodulation in hereditary mitochondrial disease were identified. However, in other clinical conditions featuring acquired mitochondrial impairment, we identified studies that suggested improved function, although sample sizes were small in number and statistical power. Conclusion: There is emerging evidence of efficacy for PBMT for diseases involving acquired mitochondrial insufficiency. We identified no published research on PBMT in hereditary mitochondrial disease, but this review confirms a theoretical rationale for a positive effect and suggests further research.

BACKGROUND:Diabetes mellitus (DM) is a clinical condition that affects gait performance and control in millions of individuals worldwide. Contrary to basic spatiotemporal parameters, gait-based spectral analysis may provide useful insights into gait neuromotor control. Hence, this study was set to investigate the spectral content of gait at the preferred speed in patients with DM. METHODS:Total 1117 individuals [658 DM and 649 healthy adults (HA)] performed a 10 m walk while wearing an inertial measurement unit over the fourth lumbar vertebra. Mann-Whitney-U test was used for between-group gait parameters comparisons. RESULTS:DM group had a slower step time (1.2%, p < 0.05) and gait speed (2.4%, p < 0.05) than HA. Additionally, DM individuals showed reduced dominant frequency (DM:0.24 Hz vs HA:0.25 Hz on average, p < 0.05). Increased antero-posterior and vertical dominant frequency width (DM:1.73 Hz vs HA:1.76 Hz on average, p < 0.05) and medio-lateral relative power spectral density at the dominant frequency (DM:6.19% vs HA:5.96%, p < 0.05). CONCLUSIONS:It was demonstrated for the first time that the gait spectral content, not only corroborates spatiotemporal characteristics, but also provides further insight into their neuromotor control deficits in diabetic patients. Ultimately, this type of analysis in the diabetic population can help guide the therapeutic interventions to prevent diabetic foot.

Background: Developmental coordination disorder affects approximately 6% of children, interfering with participation in physical activity and can persist through adulthood. However, no studies have investigated the neuromotor mechanisms of learning of a novel task with rhythmic cueing.Methods: Movement Assessment Battery for Children-2nd edition was used to identify 48 children with probable developmental coordination disorder (13.9 +/- 0.05 yrs., 27% male) and 37 typically developed (13.9 +/- 0.10 yrs., 54% male). While instrumented with an inertial measurement unit, both groups performed a novel rhythmic stepping task and with a concurrent auditory stroop test (dual-task), underwent seven weeks of intervention with step training with rhythmic cuing and were tested for retention five weeks post-intervention.Findings: Initially, the group with probable developmental coordination disorder had a higher variability of step timing (coefficient of variation: 0.08 +/- 0.003-typically developed - 0.09 +/- 0.004-probable developmental co-ordination disorder, p < 0.05) and a frequency of peak power spectral density further from the target 0.5 Hz (0.50 +/- 0.002 Hz-typically developed - 0.51 +/- 0.003 Hz-probable developmental coordination disorder, p < 0.05), and were more affected by the dual-task: power spectral density at 0.5 Hz (-7.2 +/- 3.3%-typically developed --13.4 +/- 4.6%-prob_DCD, p < 0.05) and stroop test errors (6.4 +/- 1.1%-typically developed --11.1 +/- 2.4%-probable developmental coordination disorder, p < 0.05). The intervention led to similar improvements in both groups in coefficient of variation of step timing (0.12 +/- 0.01-Pre - 0.07 +/- 0.002-Post, p < 0.05), frequency of the peak power spectral density (0.51 +/- 0.005 Hz-Pre - 0.50 +/- 0.001 Hz-Post, p < 0.05) and relative power spectral density bandpower (3.2 +/- 0.2%-Pre - 5.9 +/- 0.3%-Post, p < 0.05). All improvements were retained after five weeks post-training. Interpretation: Rhythmic cueing shows strong promise for enhancing motor learning in children with probable developmental coordination disorder.Trial registration: Retrospectively registered on ClinicalTrials.gov with reference: NCT03150784

Developmental coordination disorder (DCD) is characterized by motor learning deficits that are poorly understood within whole-body activities context. Here we present results of one of the largest non-randomized interventional trials combining brain imaging and motion capture techniques to examine motor skill acquisition and its underpinning mechanisms in adolescents with and without DCD. A total of 86 adolescents with low fitness levels (including 48 with DCD) were trained on a novel stepping task for a duration of 7 weeks. Motor performance during the stepping task was assessed under single and dual-task conditions. Concurrent cortical activation in the prefrontal cortex (PFC) was measured using functional near-infrared spectroscopy (fNIRS). Additionally, structural and functional magnetic resonance imaging (MRI) was conducted during a similar stepping task at the beginning of the trial. The results indicate that adolescents with DCD performed similarly to their peers with lower levels of fitness in the novel stepping task and demonstrated the ability to learn and improve motor performance. Both groups showed significant improvements in both tasks and under single- and dual-task conditions at post-intervention and follow-up compared to baseline. While both groups initially made more errors in the Stroop task under dual-task conditions, at follow-up, a significant difference between single- and dual-task conditions was observed only in the DCD group. Notably, differences in prefrontal activation patterns between the groups emerged at different time points and task conditions. Adolescents with DCD exhibited distinct prefrontal activation responses during the learning and performance of a motor task, particularly when complexity was increased by concurrent cognitive tasks. Furthermore, a relationship was observed between MRI brain structure and function measures and initial performance in the novel stepping task. Overall, these findings suggest that strategies that address task and environmental complexities, while simultaneously enhancing brain activity through a range of tasks, offer opportunities to increase the participation of adolescents with low fitness in physical activity and sports.

ObjectiveIt is generally believed that gait characteristics of diabetic neuropathic patients differ from those of non-diabetic ones. However, it is still unclear how the abnormal foot sensation influences the gait during walking in type 2 diabetes mellitus (T2DM). For the purpose of gaining a better insight into the alterations of detailed gait parameters and figuring out important aspects in the gait indexes by peripheral neuropathy in elder T2DM patients, we compared the gait features in participants with normal glucose tolerance (NGT) controls and diabetic individuals complicated by peripheral neuropathy or not.Subjects and methodsGait parameters were observed during the 10-m walk on flat land among different conditions of diabetes in 1,741 participants from three clinical centers. Subjects were divided into four groups: persons with NGT were taken as the control group; patients with T2DM included three subgroups: DM control (no chronic complications), DM-DPN (DM complicated by only peripheral neuropathy), and DM-DPN+LEAD (DM complicated by both neuropathy and artery disease). The clinical characteristics and gait parameters were assessed and compared among these four groups. Analyses of variance were employed to verify possible differences of gait parameters between groups and conditions. Stepwise multivariate regression analysis was performed to reveal possible predictors of gait deficits. Receiver operating characteristic (ROC) curve analysis was employed to find any discriminatory power of diabetic peripheral neuropathy (DPN) for the step time.ResultsIn participants burdened with DPN, whether complicated by lower extremity arterial disease (LEAD) or not, step time increased sharply (p < 0.05). Stepwise multivariate regression models showed that independent variables of gait abnormality were sex, age, leg length, vibration perception threshold (VPT), and ankle-brachial index (ABI) (p < 0.01). Meanwhile, VPT was a significant independent predictor of step time, spatiotemporal variability (SDA), and temporal variability (SDB) (p < 0.05). ROC curve analysis was explored to find the discriminatory power of DPN for the occurrence of increased step time. The area under the curve (AUC) value was 0.608 (95% CI: 0.562–0.654, p < 0.01), and the cutoff point was 538.41 ms accompanied by a higher VPT. A significant positive association was observed between increased step time and the highest VPT group [odds ratio (OR) = 1.83, 95% CI: 1.32–2.55, p< 0.01]. In female patients, this OR value elevated to 2.16 (95% CI: 1.25–3.73, p< 0.01).ConclusionsIn addition to sex, age, and leg length, VPT was a distinct factor that associated with altered gait parameters. DPN is associated with increased step time, and the step time increases with worsening VPT in type 2 diabetes.

Objectives The objective was to determine recent cross-sectional trends in health-related fitness (HRF) in secondary school students by studying the 13-14 years old age group repeatedly over 6 years, considering parallel national trends in physical education (PE). Methods Height, weight, broad jump, grip strength, 20 m shuttle run and throwing and catching skills were measured by the same research team using standardised techniques from 2014 to 2019. Trends in these HRF measures were assessed by linear regression, adjusting for school, sex and height. Interactions with fitness and body mass index (BMI) were tested. The number of PE lessons reported in the UK Annual School Workforce Census between 2010 and 2019 for all state-funded secondary schools was analysed. Results Grip strength (B=-0.60, 95% CI -0.78 to -0.41), broad jump (B=-1.16, 95% CI -1.99 to -0.34), 20 m shuttle run (B=-1.85, 95% CI -2.58 to -1.12) and throwing and catching skills (B=-0.12, 95% CI -0.15 to -0.08) declined significantly over the study period. There was a greater reduction in broad jump and grip strength in adolescents with low fitness and a greater reduction in fitness and motor competence in adolescents with normal BMI. These declines coincided with a 16% reduction nationally in secondary school PE between 2010 (333 800 hours) and 2019 (280 725 hours). Conclusion Adolescent HRF has declined in recent years, in parallel with PE lessons. Declines were observed across all young people and particularly those of low fitness and normal BMI. To reach the majority of young people, policy makers could increase PE in schools to increase activity and prevent worsening fitness and health in future generations.

Background: Despite extensive literature regarding laboratory-based balance perturbations, there is no up-to-date systematic review of methods. This systematic review aimed to assess current perturbation methods and outcome variables used to report participant biomechanical responses during walking. Methods: Web of Science, CINAHL, and PubMed online databases were searched, for records from 2015, the last search was on 30th of May 2022. Studies were included where participants were 18+ years, with or without clinical conditions, conducted in non-hospital settings. Reviews were excluded. Participant descriptive, perturbation method, outcome variables and results were extracted and summarised. Bias was assessed using the Appraisal tool for Cross-sectional Studies risk of bias assessment tool. Qualitative analysis was performed as the review aimed to investigate methods used to apply perturbations. Results: 644 records were identified and 33 studies were included, totaling 779 participants. The most frequent method of balance perturbation during gait was by means of a treadmill translation. The most frequent outcome variable collected was participant step width, closely followed by step length. Most studies reported at least one spatiotemporal outcome variable. All included studies showed some risk of bias, generally related to reporting of sampling approaches. Large variations in perturbation type, duration and intensity and outcome variables were reported. Conclusions: This review shows the wide variety of published laboratory perturbation methods. Moreover, it demonstrates the significant impact on outcome measures of a study based on the type of perturbation used. Registration: PROSPERO ID: CRD42020211876.

Objective: Experimental studies show small to moderate effects of both acute and regular physical activity on executive functions, these being strongly associated with academic performance at school. In order to understand the naturally occurring associations between primary school-aged children's working memory, self-reported sustained attention, and physical activity, 35 children (M-age = 9.8 years, range = 7.6-11.4 years old) in Years 3-6 of primary school took part in a two-week long intraindividual study. Methods: Participants wore an accelerometer wristband throughout the study, and carried out a working memory task (digit recall) and completed a sustained attention measure each morning and afternoon, giving 517 timepoints nested in 4-10 school-days (M-obs = 15.8 situations, n(obs) = 4-18). Results: Using multilevel structural equation models (MSEM), we found that working memory was stable across time (within-person b = 0.29) and trait-like (ICCs = 0.58). Across situations, state-working memory was higher later in the calendar week. Acute moderate to vigorous physical activity (MVPA) was not associated with stateworking memory, but exertion of a higher level of MVPA than usual the previous day was associated with lower state-working memory the following day. Trait-sustained attention (across the two weeks) predicted higher trait-working memory and older students outperformed younger students. Conclusions: Implications for timing and intensity of students' physical activity in educational settings is discussed.