INTRODUCTION & AIMS: The safe upper limits of exercise participation during pregnancy, as well as the adaptations active individuals make to their weekly training throughout gestation, are unclear. The aim of this study was to investigate how individuals who were physically active in the six months prior to conception exercise throughout pregnancy and in the first 12 weeks postpartum. METHODS: We recruited participants who were <26 weeks’ pregnant, and reported being physically active in the six months prior to conception. Participants recorded their exercise sessions completed throughout their pregnancy and the first 12 weeks postpartum using an exercise app, wearable device, or digital training diary, and shared information about maternal and neonatal health outcomes via online surveys. Mixed-effects models were used to analyse weekly changes in participants’ total exercise duration, session duration, exercise frequency, and aerobic exercise intensity and volume throughout the study period. RESULTS: Data from 43 participants were included in the analysis. Multiple participants exercised above recommended weekly durations (i.e., >300 minutes per week) during at least one week of pregnancy. Despite this, participants progressively decreased their weekly exercise duration throughout the second and third trimesters, and gradually increased during the first 12 weeks postpartum. CONCLUSION: This study highlights that some active individuals exceed current antenatal exercise recommendations, yet still progressively modify their exercise participation throughout pregnancy. Our findings highlight the importance of providing individualised physical activity recommendations, and considering antenatal training in the context of previous exercise behaviours. An individualised approach is needed to best support people who wish to remain active throughout pregnancy and the early postpartum period.

OBJECTIVE:To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. DESIGN:Systematic review and network meta-analysis. METHODS:Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. DATA SOURCES:Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES:Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. RESULTS:218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. CONCLUSIONS:Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42018118040.

Maximum running speed is a performance determinant in para-athletics and cerebral palsy football. Sixty international para-athletes with brain impairments completed five activity-limitation tests (standing broad jump, four bounds for distance, split jumps, 10-m speed skip, and running in place) and two criterion tests (40-m sprint and modified agility test). The same three tests (standing broad jump, four bounds for distance, and 10-m speed skip) that correlated with running performance in nondisabled runners (.67 < r < -.82; p < .05; 75% of variance) also correlated in para-athletes with brain impairments (.41 < r < -.62; p < .01; 55% of variance). Standing broad jump, four bounds for distance, split jumps, and running in place also correlated with change-of-direction speed (.43 < r < -.63; p < .01; 58% of variance). Results indicate that methods of classification for para-athletics with nondisabled runners are also valid with para-athletes with brain impairments, and new sport-specific relationships were found for assessing the performance of rapid and short sprints toward different directions, specific of a team para-sport like cerebral palsy football.

INTRODUCTION Regular moderate intensity exercise throughout pregnancy provides significant benefits to both maternal and foetal cardiovascular health outcomes. Current exercise guidelines recommend a combination of moderate intensity aerobic and resistance training (RT). However, there is limited research exploring the cardiovascular effects of higher intensities (vigorous/high) in comparison to common pregnancy exercise modalities such as RT and Pilates (PIL). AIM: To investigate the acute effects of three modes of exercise (resistance, vigorous aerobic intervals and Pilates) during trimester two (T2) and three (T3) of pregnancy on measures of arterial stiffness (pulse wave velocity [PWV]) and blood pressure (BP). METHODS Eleven women with uncomplicated pregnancies (age 32 ± 3 years, pre-pregnancy BMI 23.9 ± 3.5 kg/m2) completed testing in T2 (average 20 ± 1.6 weeks gestation) and T3 (average 29 ± 2.5 weeks gestation). Participants performed one each of vigorous intensity interval training (VIIT) (∼33 min), resistance training (RT) (∼35 min) and Pilates (PIL) (∼35 min) in T2 and T3 in randomised order approximately 1 week apart each trimester. Resting outcome measures of PWV, BP and foetal heart rate (FHR) were obtained following 5 minutes of rest and again immediately and 10 minutes post exercise session. BP, maternal heart rate (MHR), and rating of perceived exertion (RPE) were monitored throughout. RESULTS There was no difference in the acute PWV response to each type of exercise across the trimesters (1 min VIIT: T2 = 5.53 ± 0.85m/s, T3 = 5.26 ± 0.67m/s, 95%CI[-1.36-0.67]; RT: T2 = 5.4 ± 0.80m/s, T3 = 5.48 ± 0.56m/s, 95%CI[-0.88-1.10]; PIL: T2 = 5.44 ± 0.68m/s, T3 = 5.44 ± 0.68m/s, 95%CI[-0.93-1.01]). There was no significant difference in the acute response in SBP to VIIT (T2 = 116 ± 12.1mmHg, T3 = 122 ± 7.2mmHg, 95%CI[-0.42 - 1.65]. SBP was significantly higher in T3 than T2 1 minute following PIL (T2 = 110 ± 5.8mmHg, T3 = 121 ± 11.7mmHg, 95%CI[0.04-2.1]) and 10 minutes following RT (T2 = 105 ± 10.1mmHg, T3 = 116 ± 5.0mmHg, 95%CI[0.27 - 2.46]. CONCLUSION VIIT, RT and PIL appear to elicit similar post-exercise haemodynamic and arterial stiffness responses in both the mother and foetus. As such, VIIT may be a suitable addition to standard moderate intensity and RT prescription during an uncomplicated pregnancy.

Background In Australia, one-third of people ≥15 years perform regular resistance training and 90% of those do not meet current health guidelines. All age groups should engage in regular resistance exercise, to maintain strength and function. Objectives To identify trends in powerlifting competition participation in Australia by sex and age group from 1968 to 2022, and to compare the strength of powerlifting competitors to population age- and sex-based normative values. Method The number of unique participants and total competition entries for each year were analysed using Australian powerlifting competition data. Subdomains of age and sex were investigated, and mean ± SD, frequency, range, and trend analyses reported. United Nations age classifications were used to identify age trends. Comparisons to population strength norms were explored descriptively. Results We included 21,514 individual competitors from 1942 powerlifting competitions between 1968 and 2022. Exponential growth was seen in competition entries from 115 in 1981, to 759 in 1994, 1014 in 2011, and to 6803 in 2022, (R2 = 0.86). At first participation 18–25-year olds (51.1%) followed by ≥36 years (16%) were most represented. Strength comparison to available population norms demonstrates superior upper- (bench press [most competitors above 70th percentile) and lower-body (squat [majority rated ‘excellent’) strength. Conclusions Superior strength levels of powerlifters further the evidence base for this sport as an effective way to develop muscular strength, with low injury. We advocate for public health promotion and additional support for powerlifting as an underutilised community health tool.

Background: Regular exercise performed during pregnancy has been shown to reduce the risk of developing perinatal gestational hypertensive conditions. Further evidence on the exact parameters of exercise needed to explain these beneficial responses is required, within both uncomplicated and at-risk pregnancies. Objective: The aim of this systematic review and meta-analysis was to investigate the effects of aerobic and resistance exercise on blood pressure during pregnancy. Design: Systematic review and meta-analysis. Data Sources and Methods: An online search of six search engines was conducted up to February 2023. Randomized controlled trials, quasi-experimental, cohort, and longitudinal studies were included. Studies included an acute exercise bout or intervention of land-based aerobic and/or resistance exercise during any trimester in uncomplicated and at-risk pregnancies. Outcomes included mean arterial pressure (MAP), or systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results: Following the removal of duplicates, 1538 articles were screened with 59 studies meeting the inclusion criteria for the review (randomized controlled trials (RCTs) n = 34, clinical trials n = 19, cohort n = 5 and cross-sectional n = 2), and 21 studies included in the meta-analysis. A random effects model was used with mean difference calculated in mmHg. Overall, there were no statistically significant effects of exercise on resting blood pressure (BP) outcomes in pregnant women with normal blood pressure compared to control/usual care populations following intervention (SBP mean diff -1.54 mmHg (favours intervention), p = 0.38; DBP mean diff -2.25 mmHg (favours intervention), p = 0.1; MAP mean diff -1.75 mmHg (favours intervention), p = 0.31). In at-risk pregnant women, both aerobic and combination exercise significantly reduced BP outcomes compared to control (SBP mean diff -3.91 mmHg, p < 0.01; DBP mean diff -2.9 mmHg, p = 0.01; MAP mean diff -2.38 mmHg, p = 0.01). Twenty-seven studies reported an acute increase in SBP and DBP during aerobic exercise, with no difference found between uncomplicated and at-risk pregnancies. Conclusions: Compared to usual care, aerobic and/or resistance exercise performed throughout uncomplicated pregnancy had no influence on blood pressure. Pregnant women with no diagnosed complications should be encouraged to exercise regularly due to the multitude of known benefits. In women who are at risk of, or diagnosed, with gestational hypertensive conditions during pregnancy, moderate to vigorous exercise during pregnancy improves blood pressure outcomes. Higher risk pregnancies may reduce their risk of future cardiovascular complications through regular exercise training during pregnancy. Registration: CRD42020159998.

Abstract Background The ability for athletes to gain a competitive advantage over their opponents is well recognised. At times, this advantage may be considered a marginal gain. However, in the context of competition, marginal advantages may be the difference between winning and losing. This investigation explores how competition factors influence the odds of competitive success (i.e. winning) in powerlifting (PL) to assist athletes and coaches in achieving a competitive advantage. Methods A cross-sectional, retrospective analysis of competition data from raw/classic, Australian powerlifting competitions 2010–2019 was conducted. Data included 10,599 competition entries (males: n = 6567 [62%], females: n = 4032 [38%]). Independent t-tests were used to compare continuous data between sexes or winners and non-winners at an event. Cohen’s d and the 95% confidence interval (d [95% CI]) were calculated. Univariate odds of winning an event based on independent variables (age [irrespective of category], sex, body weight and weight of first lift attempt [regardless of success]), were assessed by separate simple logistic regression. Results When compared to males, the odds of winning for females were 50% greater (OR [95% CI] 1.500 [1.384, 1.625]; P < 0.001). Athletes who had larger first lift attempts (Squat: + 7.0 kg P < 0.001, Bench Press: + 3.2 kg P < 0.001, and Deadlift: + 6.1 kg P < 0.001and competed for a longer period (winners: 401 vs non-winners: 304 days, P < 0.001) had an increased likelihood winning. Age was associated with increased odds of success for males (OR [95% CI] 1.014 [1.009, 1.019], P < 0.001) per additional year of age for males, but not females (P = 0.509). Conclusions Multiple factors appear to contribute to the likelihood of winning a PL competition. These results may help coaches to develop competition and training strategies that optimise athletes’ likelihood of competitive success in PL.

ABSTRACT Purpose Understanding strength changes with resistance training is important in human performance. It also enables better understanding into the expected magnitude of strength increase and factors that influence this change over time. Methods Squat, bench press, and deadlift scores were collated from 407 powerlifting meets (n = 1896 unique competitors: ~625 females, ~1270 males) between 2003 and 2018. Absolute (in kilograms) and relative starting strength (in kilograms per body weight) for each lift type was expressed for both sexes. Maximum and overall strength gain per day and per year (in kilograms) was calculated by comparing first and final, or maximum scores for each lift, respectively, and considered based on strength quartile classification. Paired and independent t-tests compared strength changes from baseline and between sexes. One-way ANOVAs compared strength changes between quartiles. Pearson correlations assessed relationships between strength changes over time, and baseline strength, number of competitions, and total days competing. Results Maximum strength adaptations were greater for squat (20.2–25.4 kg·yr−1) and deadlift (18.1–21.1 kg·yr−1) compared with bench press (10.5–12.8 kg·yr−1, P ≤ 0.001). However, the change in absolute (all lifts: P = 0.247–0.379) and relative strength (all lifts: P = 0.641–0.821) did not differ between sexes. For females, maximum strength gain per day did not differ by quartile (all lifts: P = 0.091–0.746), nor did overall strength gain per day (P = 0.151–0.575). Conversely, males in the fourth quartile generally displayed lower maximum and overall strength gain per day. Conclusions These findings show differences in strength gain between upper- and lower-body lifts, but not sex differences in the change in strength. In line with previous research, the strongest males likely gain strength more slowly than weaker counterparts. Professionals should consider this information in the training, assessment, and long-term benchmarking of athletes whose sports require a focus on muscular strength.

BACKGROUND: To date, there is no evidence to support the optimal competition strategy for success in powerlifting competitions. The pur -pose of this study was to analyze powerlifting (PL) competition data to assess the relationship between squat attempts, the success of each lift attempt, and weight increase between attempts, with winning. METHODS: The analysis from 'raw' Powerlifting Australia sanctioned competitions held between 2008 and 2019 included 10,672 individual competition entries (males: N.=6617, females: N.=4055). We reported Cohen's d, statistical significance, 95% confidence intervals and the uni-variate odds of winning an event. Factors were assessed by separate simple logistic regression and reported as an odds ratio. RESULTS: Overall, first squat attempt weight for those who won was on average 7.0 kg greater (P<0.001, d=0.14 [0.10, 0.18]) than for non-winners. In the total sample, athletes selected opening attempts which were an average of 92% of their achieved maximum on the day with 93.5% of competitors improving on this weight in subsequent attempts. Winners had a 0.5 kg (P<0.001, d=0.10 [0.06, 0.14]) greater absolute increase in weight between first and second lift attempts than non-winners. Overall,-68% of winners successfully lifted their third attempt weight compared to-64% of non-winners (P<0.001). CONCLUSIONS: A powerlifting athlete's odds of winning a competition overall are significantly increased by selecting a larger opening squat attempt weight than competitors and completing the attempt successfully. The opening squat may be one of the most important lifts during competition.

Abstract Latella, C, Teo, W-P, Spathis, J, and van den Hoek, D. Long-term strength adaptation: A 15-year analysis of powerlifting athletes. J Strength Cond Res 34(9): 2412–2418, 2020—Strength is a fundamental component of athletic performance and development. This investigation examined the long-term strength development of powerlifting (PL) athletes. The rate of strength gain/day was assessed in 1897 PL athletes (F = 626, M = 1,271) over a 15-year period (2003–2018). Independent T-tests explored sex differences in baseline absolute (kg) and relative strength (kg·body mass−1 [bm]) recorded from the first competition, and strength gain/day (kg·d−1). Analyses based on initial strength quartiles were conducted using one-way analysis of variances with significance set at p < 0.05. Bivariate correlational analysis tested for relationships between strength gain/day and baseline strength, the number of competitions, and mean days between competitions. Males had greater absolute (M: 513.3 ± 99.8 kg, F: 289.4 ± 55.7 kg, p < 0.001) and relative (M: 5.89 ± 1.04 kg·bm−1, F: 4.27 ± 0.85 kg·bm−1, p < 0.001) strength at baseline. Overall, strength gain/day (F: 0.12 ± 0.69 kg·d−1, M: 0.15 ± 0.44 kg·d−1, p = 0.318) was similar between sexes. However, the strongest males showed a lower rate of strength improvement (0.102 kg·d−1) compared with least strong males (0.211 kg·d−1), p = 0.010. No differences were observed across quartiles for females. Correlational analyses revealed significant but weak negative relationships between strength gain/day and the mean days between competitions for females (r2 = −0.120, p = 0.003) and males (r2 = −0.190, p < 0.001). Similar relationships were observed for baseline strength (r2 = −0.073, p = 0.009) and the number of competitions (r2 = −0.111, p < 0.001) for males. The results suggest similar strength adaptation between sexes. The strongest males improve more slowly, possibly due to a ceiling effect. Collectively, the findings provide novel evidence of real-world long-term strength adaptations that may be particularly useful to understand athlete development, to aid periodized programming, and to benchmark strength over time.

Pearson, J, Spathis, JG, van den Hoek, DJ, Owen, PJ, Weakley, J, and Latella, C. Effect of competition frequency on strength performance of powerlifting athletes. J Strength Cond Res 34(5): 1213-1219, 2020-Powerlifting (PL) requires athletes to achieve the highest possible "total" weight lifted across squat, bench press, and deadlift. Athletes compete multiple times per year; however, it is not well understood how often PL athletes should compete to facilitate maximal strength performance. This study investigated the effect of competition frequency on strength (relative and absolute) in PL athletes over a 12-month period. Results across all male (n = 563, mean +/- SD; age; 28 +/- 10 years, body mass; 89.3 +/- 19.3 kg) and female (n = 437, age; 31 +/- 11 years, body mass; 70.1 +/- 15.8 kg) PL athletes were collated. Total competition scores were used to calculate absolute and relative strength for each competition. Linear mixed models with random effects, and effect sizes +/- 95% confidence intervals compared competition frequency and total score for (a) all, (b) male, and (c) female competition entries, respectively. The association between total score at each competition was assessed with Pearson's correlation coefficient for the same independent variables. Results demonstrate greater absolute strength at competition 2 for all athletes (5.1%: p = 0.043: d = 0.16) and males (2.9%: p = 0.049: d = 0.15). For females, absolute strength was greater at competition 5 compared to 1 (12.0%: p = 0.001: d = 0.65) and 2 (9.6%: p = 0.007: d = 0.50). Weak positive correlations for relative strength and number of times competed for males were evident between competitions 1 to 4 (r(2) = 0.070-0.085, p = 0.003-0.043). For females, 3 competitions weakly correlated with absolute strength (r(2) = 0.106, p = 0.016). PL athletes who compete multiple times per year are more likely to achieve higher totals; however, there is an upper limit to the number of competitions (4 per year) that seem to allow a performance increase.

Chronic metabolic health diseases are increasing worldwide placing strain on healthcare systems and importantly, impacting individuals' quality of life. It is well established that many chronic diseases are associated with inflammation and oxidative stress. Exercise is a known strategy to manage and treat inflammation in animals and humans. Understanding the mechanisms which cause acute and chronic changes to systems via various exercise protocols may provide insights into how we can better clinically manage patients with inflammatory and oxidative stress associated diseases. Nrf2 is a basic leucine transcription factor which regulates the expression of antioxidant proteins to protect against damage caused by electrophilic or oxidative stress. The aim of this narrative review is to provide an overview of the literature which has investigated the relationship between acute and chronic exercise training and Nrf2 protein, mRNA and Nrf2-ARE binding activity. This narrative review presents analysis of twenty-nine articles presenting studies using animals and humans. Findings from animal models suggest that exercise increases all molecular aspects of the Nrf2-ARE pathway in all tissues studied. It was noted that there seems to be an age-related decline in Nrf2 protein upregulation with exercise training. In humans, however, there is a lack of evidence to support this claim.

ABSTRACT Little is known about the effectiveness of simulation in health professionals who are ‘hands-off’ practitioners such as, exercise physiologists. The aim of this study was to evaluate the effectiveness of using simulation, towards improving knowledge, confidence and experience in exercise physiology students. Fifty-two (Mage = 22 years) students participated in weekly learning activities involving role-play simulation of a client with a neurological health condition. Students completed a modified Participant Perception Indicator survey to evaluate knowledge, experience and confidence attributes and a Student Assessment of Learning Gains survey to evaluate the effectiveness of the class pedagogy. Students learning was assessed by written exams. Knowledge, experience and confidence all significantly improved after participation in simulation and client preparation and design and discussion of exercises contributed to learning. Simulation may be suitable in developing students self-reported knowledge, experience and confidence in working with neurological case for exercise physiologists. Abbreviations: PPI: participant perception indicator; SALG: student assessment of learning gains

Objectives: The International Paralympic Committee has mandated that International Sport Federations develop sport-specific classification systems that are evidence-based. This study examined the predictive and convergent validity of instrumented tapping tasks to classify motor coordination impairments in Para swimming. Design: Cross-sectional. Methods: Thirty non-disabled participants and twenty-one Para swimmers with brain injury completed several instrumented tapping tasks as an assessment of upper and lower limb motor coordination. Para swimmers also completed a maximal freestyle swim to obtain a performance measure. The predictive and convergent validity of instrumented tapping tasks was examined by establishing differences in test measures between participants with and without brain injury and defining the strength of association between test measures and maximal freestyle swim speed in Para swimmers, respectively. Results: Random forest successfully classified 96% of participants with and without brain injury using test measures derived from instrumented tapping tasks. Most test measures had moderate to high correlations (r= 0.54 to 0.72; p < 0.01) with maximal freestyle swim speed and collectively explained up to 72% of the variance in maximal freestyle swim performance in Para swimmers with brain injury. Conclusions: The results of this study evidence the predictive and convergent validity of instrumented tapping tasks to classify motor coordination impairments in Para swimmers with brain injury. These tests can be included in revised Para swimming classification to improve the objectivity and transparency in determining athlete eligibility and sport class for these Para athletes. (C) 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

High intensity interval training (HIIT) is now recognized in international clinical-based exercise guidelines as an appropriate and beneficial adjunct to moderate intensity continuous training. HIIT involves alternating periods of high intensity aerobic exercise with light recovery exercise or no exercise, allowing for greater physiological stimulus and adaptation than moderate intensity continuous training (MICT) for cardiorespiratory fitness and other cardiometabolic processes. However, there is no universal criteria or framework for the prescription and monitoring of HIIT in clinical populations, and safety concerns remain a common barrier for implementing HIIT as standard care. Historically, exercise intensity has been prescribed using heart rate (HR) targets derived from either a predicted maximal HR (HRmax) or from an attempt to objectively measure HRmax. However, using this approach alone has a number of limitations. Here we provide guidelines to improve the delivery of HIIT in cardiometabolic populations using 1) a framework for HIIT prescription using a combination of objective and subjective measures of exercise intensity, and 2) clinical considerations for assessment and monitoring to maximize patient safety. The framework involves an individualized step-by-step process to calculate, validate, and calibrate HR target zones for HIIT training to allow for appropriate workload prescription and progression. We strongly recommend this framework be used in future clinical trials investigating HIIT.

Objectives: To evaluate the reliability of swimming-specific range of movement tests developed in order to permit evidenced-based classification in the sport of para swimming. Design: Test-retest intra- and inter-examiner reliability. Setting: International Swimming training camps and university exercise science departments. Participants: 42 non-disabled participants(mean age 23.2 years) and 24 Para swimmers(mean age 28.5 years). Main outcome measures: Intra- and inter-examiner reliability of a battery of novel active range of motion tests. Results: Good to excellent intra-examiner reliability was found for the majority (32/34) of tests in non-disabled participants (ICC = 0.85-0.98). SEM values ranged from 1.18 degrees to 6.11 degrees. Similarly, good to excellent inter-examiner reliability was found for the majority (35/42) of tests in non-disabled participants (ICC = 0.85-0.98). SEM values range from 0.73 degrees to 6.52 degrees. Para swimmers exhibited significantly reduced range of motion compared to non-disabled participants. Conclusions: The large majority of ROM tests included in this novel battery were reliable both within and between examiners in non-disabled participants. The tests were found to differentiate between non-disabled participants and Para swimmers with hypertonia or impaired muscle power. (C) 2018 Elsevier Ltd. All rights reserved.