OBJECTIVES:This study explored the effects of High-definition transcranial direct current stimulation (HD-tDCS) with Bosu-ball training on cortical activation and ankle-foot function among individuals with chronic ankle instability (CAI). DESIGN:Single-blind randomized sham-controlled trial. SETTING:Biomechanics laboratory. METHODS:Thirty-seven participants were allocated to tDCS+Bosu group (n=19) and Bosu group (n=18), received 6-week active or sham HD-tDCS with Bosu ball training. Change values of oxyhemoglobin concentration (ΔHbO2) and Foot and Ankle Ability Measure (FAAM) were measured pre- and post-intervention. Two-way analysis of variance and Pearson correlation analysis were applied. RESULTS:We detected significant group-by-time interactions in ΔHbO2 for the affected and non-affected side premotor cortex and supplementary motor area (PMC & SMA, channel 4: P=0.048; channel 14: P=0.047) and the affected side primary motor cortex (M1, channel 6: P=0.049), and significant time effects for the affected and non-affected side PMC & SMA (channel 2: P=0.043; channel 12: P=0.047), M1 (channel 5: P=0.041; channel 15: P=0.027; channel 16: P=0.049), primary somatosensory cortex (S1, channel 7: P=0.039; channel 17: P=0.043) and somatosensory association cortex (SAC, channel 8: P=0.021; channel 19: P=0.035). We detected significant interaction in the FAAM Sports subscale (P=0.046), and significant time effect in the FAAM Activities of Daily Living subscale (ADL subscale) (P<0.001). The increments in ΔHbO2 of channels 4, 5, 16, 19 were moderately positively correlated with the increment in scores of the FAAM Sports subscale (P=0.015, P=0.006, P=0.008, P=0.003). The increment in ΔHbO2 of channel 7 was weakly positively correlated with the increment in scores of the FAAM Sports (P=0.049) and ADL subscales (P=0.038). CONCLUSIONS:Bosu-ball training increased cortical activation and improved ankle-foot function among individuals with CAI, and yielded more improvements with active HD-tDCS. The increment of cortical activation was positively correlated with the improvement of ankle-foot function.

Chronic stress disrupts homeostasis in the brain and body, leading to anxiety, depression, and cardiovascular and metabolic dysfunction. Although exercise can counter these effects, the mechanisms are scattered across fields and not yet integrated. This review proposes a multi-scale framework. Exercise is not only stress-relieving; it is also a controllable challenge that can recalibrate the system when repeated bouts are matched by sufficient recovery and bioenergetic support. We propose that repeated exercise engages a stress response–adaptation–recovery cycle, in which peripheral signals from skeletal muscles, liver, adipose tissue and gut convey body metabolic state to the brain and are consolidated into durable plasticity only when mitochondrial capacity, substrate availability, and redox balance permit recovery. These signals pass through the blood-brain barrier and engage plasticity switches, including neurotrophic signals, epigenetic modification and metabolic coupling, thus stabilizing the neural circuits of threat appraisal, reward processing and contextual memory. By integrating these dimensions, we clarify how exercise can transform short-term physical stress into lasting resilience and provide direction for future research.

Background Low energy availability (LEA) can negatively impact athletes’ physiological function and performance. This study aims to examine the prevalence of LEA in Chinese female combat athletes and monitor changes in physiological function and performance during the pre-competition period.Method We assessed the incidence of low energy availability (LEA) and eating disorder (ED) risks in 84 female combat athletes (judo, freestyle wrestling, and sanda) from Beijing using the Low Energy Availability in Females Questionnaire (LEAF-Q) and the Eating Disorder Examination Questionnaire (EDE-Q). From this group, 11 judo athletes who were preparing for competition were selected and divided into a low energy availability (LEA) group and a non-LEA group based on their energy availability levels. Dietary intake, training energy expenditure, body composition, resting metabolic rate, blood markers, and special judo fitness tests were monitored at 4 weeks, 2 weeks, and 0 weeks before the competition.Results Among the 84 athletes, 45.2% of athletes (n = 38) were at increased risk of LEA, and 21.4% of athletes (n = 18) were classified as high in eating disorder risk. There were no significant differences in LEA and ED risk between elite and recreational athletes. Among the 11 athletes preparing for competition, 6 athletes (45.5%) were in a state of LEA at the initial stage (4 weeks before the competition), and by the competition week, all 11 athletes exhibited LEA. Additionally, athletes in the LEA group experienced significant reductions in VO2 and resting metabolic rate at 0 week of the competition compared to 4 weeks prior (p < 0.05). Thyroid function indicators and IGF-1 levels of LEA group also significantly decreased (p < 0.05). After completing the four-week pre-competition weight loss, heart rate recovery during the special judo fitness test improved significantly in both the LEA and non-LEA groups (p < 0.05).Conclusion The current study identified a risk of LEA among Chinese female combat sport athletes, with no significant difference in the prevalence of LEA between elite and recreational athletes. It is essential for Chinese coaches and sports medicine staff to implement LEA-related nutritional education across all performance levels. Moreover, preventive measures during training are recommended to mitigate the impact of LEA on physiological function during the pre-competition weight loss phase.

The aim of this study is to explore the differences in cortical activation and gait performance during turning walking under cognitive dual-task conditions between young and older adults during cognitive-turning dual task walking, as well as variations in brain functional connectivity in this context. Seventeen young adults and seventeen older adults were included in the study. All participants completed two tasks: a figure-eight turning walk (single-task, ST) and a figure-eight turning walking while performing a digital alert cognitive task (dual-task, DT). Data collection was conducted using functional near-infrared spectroscopy and a three-dimensional motion capture system to extract and calculate the activation of motor and sensory cortices, functional connectivity, and gait parameters. Compared to ST, the cortical activation in the young adults was significantly increased during DT (p ≤ 0.041) and was higher than that of the older adults (p ≤ 0.003); the older adults showed no significant change in cortical activation, and the stride length decreased (p = 0.013) and was lower than that of the young adults (p = 0.023). Additionally, compared to ST, the functional connectivity between primary somatosensory cortex and other brain regions increased in the older adults during DT (p ≤ 0.035). The older adults are more likely to fall when performing cognitive-turning DT. One of the important reasons for the difference between them and young adults is the distinct brain modulation mechanisms employed by the two groups when facing challenging dual tasks. Enhancing brain functional connectivity may be a more effective strategy for the older adults to promoting dual-task performance. This study provides insights for aging-related steering disorders and more evidence for the influence of aging on neuro-motor control mechanism.

Chronic pain is a prevalent health condition that imposes a significant burden on the global health system. Health literacy is a determinant of the quality of pain management which directly impacts public and individual health. However, the existing health literacy measurements have predominantly focused on medical models stemmed from Western culture and the knowledge of non-Western health models has largely been neglected. This review scopes refereed health literacy publications with regard to traditional Chinese medicine and chronic pain to explore and identify 1) the conceptual basis underlying the development of traditional Chinese medicine health literacy in this area, and 2) measurement tools used in this area and their associated psychometric qualities. Twenty-eight journal articles were assessed and the results showed that most studies’ conceptual frameworks were unable to cover three key health literacy aspects defined by the World Health Organization (access, understand, and apply). Furthermore, the identified health literacy measurement tools generally lacked rigorous psychometric evaluation. Future studies should focus on exploring a comprehensive model that encompasses various health models and developing measurement tools with more culturally representative psychometric assessments.

IntroductionChronic Ankle Instability (CAI) is a musculoskeletal condition that evolves from acute ankle sprains, and its underlying mechanisms have yet to reach a consensus. Mounting evidence suggests that neuroplastic changes in the brain following ankle injuries play a pivotal role in the development of CAI. Balance deficits are a significant risk factor associated with CAI, yet there is a scarcity of evidence regarding the sensorimotor cortical plasticity related to balance control in affected individuals. This study aims to evaluate the differences in cortical activity and balance abilities between patients with CAI and uninjured individuals during a single-leg stance, as well as the correlation between these factors, in order to elucidate the neurophysiological alterations in balance control among patients with CAI.MethodsThe study enrolled 24 patients with CAI and 24 uninjured participants. During single-leg stance, cortical activity was measured using a functional near-infrared spectroscopy (fNIRS) system, which included assessments of the pre-motor cortex (PMC), supplementary motor area (SMA), primary motor cortex (M1), and primary somatosensory cortex (S1). Concurrently, balance parameters were tested utilizing a three-dimensional force platform.ResultsIndependent sample t-tests revealed that, compared with the uninjured individuals, the patients with CAI exhibited a significant increase in the changes of oxyhemoglobin concentration (ΔHbO) during single-leg stance within the left S1 at Channel 5 (t = 2.101, p = 0.041, Cohen’s d = 0.607), left M1 at Channel 6 (t = 2.363, p = 0.022, Cohen’s d = 0.682), right M1 at Channel 15 (t = 2.273, p = 0.029, Cohen’s d = 0.656), and right PMC/SMA at Channel 11 (t = 2.467, p = 0.018, Cohen’s d = 0.712). Additionally, the center of pressure root mean square (COP-RMS) in the mediolateral (ML) direction was significantly greater (t = 2.630, p = 0.012, Cohen’s d = 0.759) in the patients with CAI. Furthermore, a moderate positive correlation was found between ML direction COP-RMS and ΔHbO2 in the M1 (r = 0.436; p = 0.033) and PMC/SMA (r = 0.488, p = 0.016), as well as between anteroposterior (AP) direction COP-RMS and ΔHbO in the M1 (r = 0.483, p = 0.017).ConclusionPatients with CAI demonstrate increased cortical activation in the bilateral M1, ipsilateral PMC/SMA, and contralateral S1. This suggests that patients with CAI may require additional brain resources to maintain balance during single-leg stance, representing a compensatory mechanism to uphold task performance amidst diminished lateral balance ability in the ankle joint.

Background This study aimed to compare the balance ability and functional brain oxygenation in the prefrontal cortex (PFC) among older adults with mild cognitive impairment (MCI) under single and dual tasks, and also investigate their relationship. Neural regulatory mechanisms of the brain in the MCI were shed light on in balance control conditions. Methods 21 older adults with MCI (female = 12, age: 71.19 ± 3.36 years) were recruited as the experimental group and 19 healthy older adults (female = 9, age: 70.16 ± 4.54 years) as the control group. Participants completed balance control of single task and dual task respectively. Functional near-infrared spectroscopy (fNIRS) and force measuring platform are used to collect hemodynamic signals of the PFC and center of pressure (COP) data during the balance task, respectively. Results The significant Group*Task interaction effect was found in maximal displacement of the COP in the medial-lateral (ML) direction (D-ml), 95% confidence ellipse area (95%AREA), root mean square (RMS), the RMS in the ML direction (RMS-ml), the RMS in the anterior-posterior (AP) direction (RMS-ap), sway path (SP), the sway path in the ML direction (SP-ml), and the sway path in the AP direction (SP-ap). The significant group effect was detected for five regions of interest (ROI), namely the left Brodmann area (BA) 45 (L45), the right BA45 (R45), the right BA10 (R10), the left BA46 (L46), and the right BA11 (R11). Under single task, maximal displacement of the COP in the AP direction (D-ap), RMS, and RMS-ap were significantly negatively correlated with R45, L45, and R11 respectively. Under dual task, both RMS and 95%AREA were correlated positively with L45, and both L10 and R10 were positively correlated with RMS-ap. Conclusion The MCI demonstrated worse balance control ability as compared to healthy older adults. The greater activation of PFC under dual tasks in MCI may be considered a compensatory strategy for maintaining the standing balance. The brain activation was negatively correlated with balance ability under single task, and positively under dual task. Trial registration ChiCTR2100044221 , 12/03/2021.

Objective: Postural stability is essential for high-level physical activities after anterior cruciate ligament reconstruction (ACLR). This study was conducted to investigate the relationship of muscle strength, joint kinesthesia, and plantar tactile sensation to dynamic and static postural stability among patients with anterior cruciate ligament reconstruction. Methods: Forty-four patients over 6 months post anterior cruciate ligament reconstruction (age: 27.9 ± 6.8 years, height: 181.7 ± 8.7 cm, weight: 80.6 ± 9.4 kg, postoperative duration: 10.3 ± 3.6 months) participated in this study. Their static and dynamic postural stability, muscle strength, hamstring/quadriceps ratio, joint kinesthesia, and plantar tactile sensation were measured. Partial correlations were used to determine the correlation of the above-mentioned variables with time to stabilization (TTS) and root mean square of the center of pressure (COP-RMS) in anterior-posterior (AP) and mediolateral (ML) directions. Results: Both TTSAP and TTSML were related to muscle strength and joint kinesthesia of knee flexion and extension; COP-RMSAP was correlated with plantar tactile sensations at great toe and arch, while COP-RMSML was correlated with joint kinesthesia of knee flexion, and plantar tactile sensation at great toe and heel. Dynamic stability was sequentially correlated with strength and joint kinesthesia, while static stability was sequentially correlated with plantar tactile sensation and joint kinesthesia. Conclusion: Among patients with anterior cruciate ligament reconstruction, strength is related to dynamic postural stability, joint kinesthesia is related to dynamic and static postural stability, and plantar tactile sensation is related to static postural stability. Strength has a higher level of relationship to dynamic stability than joint kinesthesia, and plantar tactile sensation has a higher level of relationship to static stability than joint kinesthesia.

The onset of fatigue disrupts the functioning of the autonomic nervous system (ANS), potentially elevating the risk of life-threatening incidents and impairing daily performance. Previous studies mainly focused on physical fatigue (PF) and mental fatigue (MF) effects on the ANS, with limited knowledge concerning the influence of physical-mental fatigue (PMF) on ANS functionality. This study aimed to assess the immediate impact of PMF on ANS function and to compare its effects with those of PF and MF on ANS function. Thirty-six physically active college students (17 females) without burnout performed 60-min cycling exercises, AX-Continuous Performance Task (AX-CPT), and cycling combined with AX-CPT to induce PF, MF, and PMF respectively. Subjective fatigue levels were measured using the Rating of Perceived Exertion scale and the Visual Analog Scale-Fatigue. Heart rate variability was measured before and after each protocol to assess cardiac autonomic function. The proposed tasks successfully induced PF, MF, and PMF, demonstrated by significant changes in subjective fatigue levels. Compared with baseline, PMF decreased the root mean square of successive differences (RMSSD) between normal heartbeats (P < 0.001, d = 0.50), the standard deviation of normal-to-normal RR intervals (SDNN) (P < 0.01, d = 0.33), and the normalized high-frequency (nHF) power (P < 0.001, d = 0.32) while increased the normalized low-frequency (nLF) power (P < 0.001, d = 0.35) and the nLF/nHF ratio (P < 0.001, d = 0.40). Compared with MF, PMF significantly decreased RMSSD (P < 0.001, η2 = 0.431), SDNN (P < 0.001, η2 = 0.327), nLF (P < 0.01, η2 = 0.201), and nHF (P < 0.001, η2 = 0.377) but not the nLF/nHF ratio. There were no significant differences in ΔHRV (i.e., ΔRMSSD, ΔSDNN, ΔnLF/nHF, ΔnLF, and ΔnHF), heart rate, and training impulse between PF- and PMF-inducing protocols. Cognitive performance (i.e., accuracy) in AX-CPT during the PMF-inducing protocol was significantly lower than that during the MF-inducing protocol (P < 0.001, η2 = 0.101). PF and PMF increased sympathetic activity and decreased parasympathetic activity, while MF enhanced parasympathetic activity.

This study aimed to explore the effects of fatigue on the balance and ankle proprioception during drop landing of individuals with chronic ankle instability (CAI). A total of 35 participants with unilateral CAI and 35 healthy participants participated in this study. A static balance test, dynamic balance test, and ankle proprioception test were conducted before and after fatigue. Fatigue was induced with turn back runs and vertical jumps protocol. Sway distance of the center of pressure (COP), root mean square of the COP (RMS), total excursions (TOTEX), mean velocity (MVELO), 95% confidence ellipse area of the COP movements (95% AREA), Normalise Reach Distance in the anterior (ANT), posteromedial (PM), and posterolateral (PL) directions, and the area under the curve (AUC) were calculated and analyzed. There were significant group by fatigue interactions for static balance variables, normalise reach distance in the PM and PL directions, and AUC. Fatigue reduced balance and ankle proprioception in individuals with CAI. After fatigue, static and dynamic balance and ankle proprioception during drop landing were significantly worse in the CAI group than in the control group. Fatigue had a significant negative effect on balance and ankle proprioception in CAI patients. Therefore, fatigue may be an important factor causing repeated ankle sprain in CAI patients.

PURPOSE: Medial Tibial Stress Syndrome(MTSS) is a injury that occurs the posteromedial tibial border. Some studies speculate the muscle traction creates stress stimulation that damages the structure of cortical bone of tibial and lead to the development of MTSS. But this hypothesis is indirectly speculated based on anatomical studies and lacks evidence under dynamic conditions. The aim of this study was using computer simulation to see if it is possible for muscles to influence tibial stress through "muscle traction " while running. METHODS: The motion data of 20 subjects running were imported into Anybody Modeling System for simulation to obtain the muscle strength and elastic potential energy of the soleus(SOL), flexor digitorum longus(FDL) and tibialis posterior(TP) during the support phase of gait, as well as the boundary conditions attached to the tibia; then, the boundary conditions were applied to the tibia model and imported into Abaqus for calculation the von-Mises stress at the posteromedial tibial; finally, a regression model between the stress and the strength, elastic potential energy of the muscles was established. RESULTS: The R2 of the regression model was 0.947, F = 294.41; (2) Correlations(β)between the elastic potential energy of SOL, FDL, TP and the stress were 0.281 (T = 18.831, P < 0.001), -0.102 (T = -4.823, P < 0.001), -0.361 (T = -21.262, P < 0.001), respectively; (3) Correlations between the muscle strength of SOL, FDL, TP and the stress were -0.038 (T = 0.035, P = 0.882), -0.175 (T = -12.107, P < 0.001), 0.286 (T = 12.238, P < 0.001), respectively. CONCLUSION: (1) The elastic potential energy of SOL and strength of TP are positively correlated with stress, the higher their values, the higher the stress of the tibia, which is consisten t with the hypothesis of muscle traction, but the strength of SOL, FDL,elastic potential energy of TP, FDL are negatively correlated with stress, the higher their values, the lower the stress of the tibial, which is contrary to the hypothesis of traction theory; (2) The results do not fully support the muscle traction hypothesis, more studies are needed to verify the reliability of this hypothesis in dynamic condition (like walking or running).

BackgroundWith aging, the cognitive function of the prefrontal cortex (PFC) declined, postural control weakened, and fall risk increased. As a mind–body exercise, regular Tai Chi practice could improve postural control and effectively prevent falls; however, underlying brain mechanisms remained unclear, which were shed light on by analyzing the effect of Tai Chi on the PFC in older adults by means of functional near-infrared spectroscopy (fNIRS).Methods36 healthy older adults without Tai Chi experience were divided randomly into Tai Chi group and Control group. The experiment was conducted four times per week for 16 weeks; 27 participants remained and completed the experiment. Negotiating obstacle task (NOT) and negotiating obstacle with cognitive task (NOCT) were performed pre- and post-intervention, and Brodmann area 10 (BA10) was detected using fNIRS for hemodynamic response. A three-dimensional motion capture system measured walking speed.ResultsAfter intervention in the Tai Chi group under NOCT, the HbO2 concentration change value (ΔHbO2) in BA10 was significantly greater (right BA10: p = 0.002, left BA10: p = 0.001), walking speed was significantly faster (p = 0.040), and dual-task cost was significantly lower than pre-intervention (p = 0.047). ΔHbO2 in BA10 under NOCT was negatively correlated with dual-task cost (right BA10: r = −0.443, p = 0.021, left BA10: r = −0.448, p = 0.019). There were strong negative correlations between ΔHbO2 and ΔHbR under NOCT either pre-intervention (left PFC r = −0.841, p < 0.001; right PFC r = −0.795, p < 0.001) or post-intervention (left PFC r = −0.842, p < 0.001; right PFC r = −0.744, p < 0.001).ConclusionTai Chi practice might increase the cognitive resources in older adults through the PFC bilateral activation to prioritize gait performance during negotiating obstacles under a dual-task condition.

Purpose: To determine the best wearing position of accelerometers in estimating energy expenditure(EE) of rope skipping and establish the predictive equation of EE. Methods: 38 college students(19 males, age 23 ± 2.8) completed 3-min rope jumping tests at different paces(60 bpm; 100 bpm and 130 bpm), when they were worn with tri-axial accelerometers(waist, wrist and ankle) and portable indirect calorimeter. Pearson correlation was used to analyze the correlation between physiological indicators and EE, and multiple linear regression(stepwise) was used to establish the EE predictive equation. Results: The tolerances of the three positions of predictive equations established based on the waist, wrist, and ankle accelerometers were all greater than 0.1, and the VIF value is less than 10, indicating that the equations do not have multicollinearity. The Durbin-Watson test value was 1.672-1.766, indicating that the physiological indicators are independent of each other and there was no autocorrelation. The F values of the predictive equations were 54.381, 53.295 and 52.009 (P < 0.001). Compared among the three positions of predictive equations, the R and the adjusted R2 of the EE equation established by the waist accelerometer data were both the maximum (0.746 and 0.732), and the root mean squared error (RMSE) is also lower than that of the predictive equationS established by the wrist and ankle data, indicating that the waist accelerometer had a better degree of explanation compared with the wrist and ankle (Table 1) Conclusion: The rope skipping energy expenditure equation established by weight, total body fat%, number of rope skipping and waist accelerometer Z-axis count value has the best predictive effect. When using an accelerometer to measure and predict the energy expenditure of rope skipping in a large sample test, it is recommended to use the waist as the best wearing position.

Background Knee osteoarthritis (KOA) is a common degenerative disease that causes pain, functional impairment, and reduced quality of life. Resistance training is considered as an effective approach to reduce the risk of muscle weakness in patients with KOA. Blood flow restriction (BFR) with low-load resistance training has better clinical outcomes than low-load resistance training alone. However, the degree of BFR which works more effectively with low-load resistance training has not been determined. The purpose of this study is to evaluate the effectiveness of different degrees of BFR with low-load resistance training in patients with KOA on pain, self-reported function, physical function performance, muscle strength, muscle thickness, and quality of life. Methods This is a study protocol for a randomized, controlled trial with blinded participants. One hundred individuals will be indiscriminately assigned into the following groups: two training groups with a BFR at 40% and 80% limb occlusion pressure (LOP), a training group without BFR, and a health education group. The three intervention groups will perform strength training for the quadriceps muscles twice a week for 12 weeks, while the health education group will attend sessions once a week for 12 weeks. The primary outcome is pain. The secondary outcomes include self-reported function, physical function performance, muscle strength of the knee extensors, muscle mass of the quadriceps, quality of life, and adverse events. Intention-to-treat analysis will be conducted for individuals who withdraw during the trial. Discussion Previous studies have shown that BFR with low-load resistance training is more effective than low-load resistance training alone; however, a high degree of BFR may cause discomfort during training. If a 40% LOP for BFR could produce similar clinical outcomes as an 80% LOP for BFR, resistance training with a low degree of BFR can be chosen for patients with KOA who are unbearable for a high degree of BFR. Trial registration Chinese Clinical Trial Registry ChiCTR2000037859 ( http://www.chictr.org.cn/edit.aspx?pid=59956&htm=4 ). Registered on 2 September 2020

Objective: The objective of this review is to map the details of school-based interventions used to improve health literacy of senior high school students. Introduction: The global prevalence of poor adult health literacy is caused, in part, by limited health education in secondary schools. Enhancing adolescent health literacy could potentially improve adult health literacy, health behavior, and health outcomes. Inclusion criteria: Studies investigating school-based interventions to improve health literacy of senior high school students, regardless of design, characteristics, and assessment tools, will be eligible for inclusion. Studies that provide combined data (senior high school students mixed with other students) or have a compulsory component outside of school will be excluded. Methods: MEDLINE, Embase, ProQuest Education Journals, Education Research Complete, SAGE Journals, and Index New Zealand will be searched for journal articles published in English since 1998. Two independent reviewers will screen titles and abstracts for eligibility, retrieve potentially relevant papers in full, and extract data from included studies. A third reviewer will resolve any disagreements. Quantitative analysis (eg, frequency analysis) will indicate geographic region of studies, design and targeted population (school grade of study participants); the mode of delivery (extracurricular or during school hours, implemented by teachers or other professionals), duration, and health literacy model and domain of the interventions. Descriptive qualitative content analysis will be used to summarize, code and classify key characteristics of the interventions (eg, teaching models and strategies, content, and related skills) and main outcomes related to health literacy into meaningful categories.

ObjectiveThe studies showed the benefits of virtual reality training (VRT) for functional mobility and balance in older adults. However, a large variance in the study design and results is presented. We, thus, completed a systematic review and meta-analysis to quantitatively examine the effects of VRT on functional mobility and balance in healthy older adults.MethodsWe systematically reviewed the publications in five databases. Studies that examine the effects of VRT on the measures of functional mobility and balance in healthy older adults were screened and included if eligible. Subgroup analyses were completed to explore the effects of different metrics of the intervention design (e.g., session time) on those outcomes related to functional mobility and balance.ResultsFifteen studies of 704 participants were included. The quality of these studies was good. Compared to traditional physical therapy (TPT), VRT induced greater improvement in TUG (MD = −0.31 s, 95% CI = −0.57 to −0.05, p = 0.02, I2 = 6.34%) and one-leg stance with open eyes (OLS-O) (MD = 7.28 s, 95% CI = 4.36 to 10.20, p = 0.00, I2 = 36.22%). Subgroup analyses revealed that immersive VRT with more than 800 min of total intervention time over 8 weeks and at least 120 min per week and/or designed by the two motor-learning principles was optimal for functional mobility and balance.ConclusionVirtual reality training can significantly improve functional mobility and balance in healthy older adults compared to TPT, and the findings provided critical knowledge of the optimized design of VRT that can inform future studies with more rigorous designs.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021297085].

Background Considerable evidence showed that repetitive transcranial magnetic stimulation (rTMS) can improve standing balance and walking performance in older adults with age-related neurological disorders. We here thus completed a systematic review and meta-analysis to quantitatively examine such benefits of rTMS. Methods A search strategy based on the PICOS principle was used to obtain the literature in 4 databases. The screening and assessments of quality and risk of bias in the included studies were independently completed by 2 researchers. Outcomes included scales related to standing balance, Timed Up and Go (TUG) time, and walking speed/time/distance. Results Twenty-three studies consisting of 532 participants were included, and the meta-analysis was completed on 21 of these studies. The study quality was good. Compared to control, rTMS induced both short-term (<= 3 days after last intervention session) and long-term (>= 1 month following last intervention session) significant improvements in balance scales (eg, Berg Balance Scale), TUG time, and walking speed/time/distance (short-term: standardized mean difference [SMD] = 0.26-0.34, 95% confidence interval [CI] = 0.05-0.62; long-term: SMD = 0.40-0.47, 95% CI = 0.04-0.79) for both PD and stroke cohorts. Subgroup analyses suggested that greater than 9 sessions of high-frequency rTMS targeting primary motor cortex with greater than 3 000 pulses/wk can maximize such benefits. Only a few mild-to-moderate adverse events/side effects were reported, which were similar between rTMS and control group. Conclusion The results suggest that rTMS holds promise to improve balance and walking performance in older adults with age-related neurological disorders. Future studies with more rigorous design are needed to confirm the observations in this work.

Background Ankle instability limits physical activities and undermines a person’s quality of life. Tai Chi’s health benefits have been reported in different population groups. However, the effects of Tai Chi on neuromuscular function among young adults with functional ankle instability (FAI) remain unclear. Therefore, we aim to investigate the effect of Tai Chi on young adults with FAI. Methods This study will be conducted as a randomized controlled trial with blinded assessors. A total of 104 young adults with FAI will be recruited and randomly assigned to intervention and control groups. The participants in the simplified Tai Chi exercise program (STCEP) group will receive a 12-week Tai Chi training. The participants in the control group will receive a low-intensity exercise program and health education for 12 weeks. The primary and secondary outcomes will be assessed at baseline, 4th, 8th, and 12th weeks. Primary outcome measures will include the Cumberland Ankle Instability Tool (CAIT) score, kinematics/kinetics data, electromyography during single-leg landing tasks, and the modified Star Excursion Balance Test (mSEBT). Secondary outcome measures will include the total time of Dynamic Leap and Balance Test (DLBT), ankle muscle strength, and ankle proprioception. Discussion This study will investigate the effects of Tai Chi exercise on the neuromuscular function of patients with FAI, as indicated by ankle joint biomechanics, ankle proprioception, balance, ankle muscle strength, and ankle muscle activation. Results will demonstrate that Tai Chi can be an effective exercise for young adults with FAI. Trial registration Chinese Clinical Trial Registry ChiCTR2100044089 . Registered on 10 March 2021

Abstract The predominant pathological manifestation of osteoarthritis (OA) is articular cartilage damage. Chondrocytes are the only cell type present in articular cartilage. The proportion of chondrocytes inflammation and apoptosis correlated significantly with the degree of articular cartilage degeneration and progression of OA. Irisin is released from myocytes during physical activity, and acts as a link between muscles and other tissues and organs. Many studies have confirmed the multifunctional role of Irisin and the beneficial effects of this molecule on bone development and regeneration. Little is known about the mechanisms of Irisin on chondrocytes and the development of OA. This study aimed to investigate the mechanisms and effects of Irisin on interleukin-1β (IL-1β)-induced rat chondrocytes. Our results revealed that Irisin improved IL-1β-induced growth inhibition in chondrocytes and attenuated the production of reactive oxygen species (ROS). And Irisin decreased the expression of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) and exerted anti-apoptotic effects by the extracellular signal-regulated kinases (ERK) signaling pathway. In conclusion, Irisin acts through the ERK signaling pathway to protect against IL-1β-induced chondrocytes injury by reducing excessive ROS, inhibiting inflammation and apoptosis. The present study sheds new light on the chondroprotective actions of this myokine, and further develops the therapeutic targets of Irisin for bone and cartilage disorders including OA.

Objective: This study examined the effects of 12-week complex training (CT) programs on professional firefighters’ occupational activities, strength, and power. Methods: Thirty men professional firefighters were randomly assigned to the CT group (n = 15) and control group (n = 15). The CT group performed complex training and the control group completed resistance training (RT) twice a week over 12 weeks. The occupational activities, strength, and power were assessed at baseline and immediately after the intervention by measuring the performance of 100 m load-bearing run (100 m LR), 60 m shoulder ladder run (60 m SLR), 5 m × 20 m shuttle run (5 m × 20 m SR), 4th-floor climbing rope (4th-floor CR), countermovement jump with arm swing (CMJas), seated medicine-ball throw (SMT), one-repetition maximum bench press (1RM BP), and one-repetition maximum back squat (1RM BS). Results: The results showed that compared to RT, CT induced significantly greater improvements in 60 m SLR (p = 0.007), 4th-floor CR (p = 0.020), CMJas (p = 0.001), and SMT (p < 0.001). Conclusion: These findings suggest that CT is a novel intervention with great promise of improving professional firefighters’ occupational activities, strength, and power.