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Background Balance training is considered an important means to decrease fall rates in seniors. Whether virtual reality training (VRT) might serve as an appropriate treatment strategy to improve neuromuscular fall risk parameters in comparison to alternative balance training programs (AT) is as yet unclear. Objective To examine and classify the effects of VRT on fall-risk relevant balance performance and functional mobility compared to AT and an inactive control condition (CON) in healthy seniors. Data Sources The literature search was conducted in five databases (CINAHL, EMBASE, ISI Web of Knowledge, PubMed, SPORTDiscus). The following search terms were used with Boolean conjunction: (exergam* OR exer-gam* OR videogam* OR video-gam* OR video-based OR computer-based OR Wii OR Nintendo OR X-box OR Kinect OR play-station OR playstation OR virtua* realit* OR dance dance revolution) AND (sport* OR train* OR exercis* OR intervent* OR balanc* OR strength OR coordina* OR motor control OR postur* OR power OR physical* OR activit* OR health* OR fall* risk OR prevent*) AND (old* OR elder* OR senior*). Study Selection Randomized and non-randomized controlled trials applying VRT as interventions focusing on improving standing balance performance (single and double leg stance with closed and open eyes, functional reach test) and functional mobility (Berg balance scale, Timed-up and go test, Tinetti test) in healthy community-dwelling seniors of at least 60 years of age were screened for eligibility. Data Extraction Eligibility and study quality (PEDro scale) were independently assessed by two researchers. Standardized mean differences (SMDs) served as main outcomes for the comparisons of VRT versus CON and VRT versus AT on balance performance and functional mobility indices. Statistical analyses were conducted using a random effects inverse-variance model. Results Eighteen trials (mean PEDro score: 6 ± 2) with 619 healthy community dwellers were included. The mean age of participants was 76 ± 5 years. Meaningful effects in favor of VRT compared to CON were found for balance performance [ p  < 0.001, SMD: 0.77 (95 % CI 0.45–1.09)] and functional mobility [ p  = 0.004, SMD: 0.56 (95 % CI 0.25–0.78)]. Small overall effects in favor of AT compared to VRT were found for standing balance performance [ p  = 0.31, SMD: −0.35 (95 % CI −1.03 to 0.32)] and functional mobility [p = 0.05, SMD: −0.44 (95 % CI: −0.87 to 0.00)]. Sensitivity analyses between “weaker” ( n  = 9, PEDro ≤5) and “stronger” ( n  = 9, PEDro ≥6) studies indicated that weaker studies showed larger effects in favor of VRT compared to CON regarding balance performance ( p  < 0.001). Conclusions Although slightly less effective than AT, VRT-based balance training is an acceptable method for improving balance performance as well as functional mobility outcomes in healthy community dwellers. VRT might serve as an attractive complementary training approach for the elderly. However, more high-quality research is needed in order to derive valid VRT recommendations compared to both AT and CON.

Background Mindfulness as a present-oriented form of mental training affects cognitive processes and is increasingly considered meaningful for sport psychological training approaches. However, few intervention studies have examined the effects of mindfulness practice on physiological and psychological performance surrogates or on performance outcomes in sports. Objective The aim of the present meta-analytical review was to examine the effects of mindfulness practice or mindfulness-based interventions on physiological and psychological performance surrogates and on performance outcomes in sports in athletes over 15 years of age. Data Sources A structured literature search was conducted in six electronic databases (CINAHL, EMBASE, ISI Web of Knowledge, PsycINFO, MEDLINE and SPORTDiscus). The following search terms were used with Boolean conjunction: (mindful* OR meditat* OR yoga) AND (sport* OR train* OR exercis* OR intervent* OR perform* OR capacity OR skill*) AND (health* OR adult* OR athlete*). Study Selection Randomized and non-randomized controlled studies that compared mindfulness practice techniques as an intervention with an inactive control or a control that followed another psychological training program in healthy sportive participants were screened for eligibility. Data Extraction Eligibility and study quality [Physiotherapy Evidence Database (PEDro)] scales were independently assessed by two researchers. A third independent researcher was consulted to achieve final consensus in case of disagreement between both researchers. Standardized mean differences (SMDs) were calculated as weighted Hedges’ g and served as the main outcomes in comparing mindfulness practice versus control. Statistical analyses were conducted using a random-effects inverse-variance model. Results Nine trials of fair study quality (mean PEDro score 5.4, standard deviation 1.1) with 290 healthy sportive participants (athletics, cyclists, dart throwers, hammer throwers, hockey players, hurdlers, judo fighters, rugby players, middle-distance runners, long-distance runners, shooters, sprinters, volleyball players) were included. Intervention time varied from 4 weeks to over 2 years. The practice frequency lasted from twice daily to just once a week, and the mean session time covered 50–60 min. In favor of mindfulness practice compared with the control condition, large effects with narrow confidence limits and low heterogeneity were found for mindfulness scores [SMD 1.03, 90% confidence interval (CI) 0.67–1.40, p  < 0.001, I 2  = 17%]. Physiological performance indices depicted wide confidence limits accompanied with very large heterogeneity. However, the effect sizes remained very large, with confidence limits that did not overlap zero (SMD 3.62, 90% CI 0.03–7.21, p  = 0.10, I 2  = 98%). Moderate to large effects were observed for both psychological performance surrogates (SMD 0.72, 90% CI 0.46–0.98, p  < 0.001, I 2  = 14%) and performance outcomes in shooting and dart throwing (SMD 1.35, 90% CI 0.61–2.09, p  = 0.003, I 2  = 82%). Conclusions Mindfulness practice consistently and beneficially modulates mindfulness scores. Furthermore, physiological and psychological surrogates improved to a meaningful extent following mindfulness practice, as well as performance outcomes in shooting and dart throwing. It seems reasonable to consider mindfulness practice strategies as a regular complementary mental skills training approach for athletes, at least in precision sports; however, more high-quality, randomized, controlled trials on mindfulness practice and performance improvements in diverse sport settings are needed.

Annually, one in three seniors aged over 65 years fall. Balance and strength training can reduce neuromuscular fall risk factors and fall rates. Besides conventional balance and strength training, explosive or high-velocity strength training, eccentric exercises, perturbation-based balance training, trunk strength, and trunk control have also been emphasized. In contrast, aerobic exercise has to date not been included in fall-prevention studies. However, well-developed endurance capacity might attenuate fatigue-induced declines in postural control in sports-related or general activities of daily living. Physical performance indices, such as balance, strength, and endurance, are generally addressed independently in exercise guidelines. This approach seems time consuming and may impede integrative training of sensorimotor, neuromuscular, and cardiocirculatory functions required to deal with balance-threatening situations in the elderly. An agility-based conceptual training framework comprising perception and decision making (e.g., visual scanning, pattern recognition, anticipation) and changes of direction (e.g., sudden starts, stops and turns; reactive control; concentric and eccentric contractions) might enable an integrative neuromuscular, cardiocirculatory, and cognitive training. The present paper aims to provide a scientific sketch of how to build such an integrated modular training approach, allowing adaptation of intensity, complexity, and cognitive challenge of the agility tasks to the participant’s capacity. Subsequent research should address the (1) link between agility and fall risk factors as well as fall rates, (2) benefit–risk ratios of the proposed approach, (3) psychosocial aspects of agility training (e.g., motivation), and (4) logistical requirements (e.g., equipment needed).

Background The promotion of sport and physical activity (PA) for children is widely recommended to support a healthy lifestyle, but being engaged in sport bears the risk of sustaining injuries. Injuries, in turn, can lead to a reduction in current and future involvement in PA and, therefore, may negatively affect future health as well as quality of life. Thus, sports injury prevention is of particular importance in youth. Objective The aim of this systematic review was to quantify the effectiveness of exercise-based injury prevention programs in child and adolescent sport in general, and with respect to different characteristics of the target group, injury prevention program, and outcome variables. Data Sources An Internet-based literature search was conducted in six databases (CINAHL, Cochrane, EMBASE, ISI Web of Science, PubMed, SPORTDiscus) using the following search terms with Boolean conjunction: (sport injur* OR athletic injur* OR sport accident*) AND (prevent* OR prophylaxis OR avoidance) AND (child* OR adolescent OR youth). Study Selection Randomized controlled trials and controlled intervention studies in organized sport, published in English in a peer-reviewed journal, analyzing the effects of an exercise-based injury prevention program in athletes younger than 19 years of age. Data Extraction Two reviewers evaluated eligibility and methodological quality. Main outcome extracted was the rate ratio (RR). Statistical analyses were conducted using the inverse-variance random effects model. Results Twenty-one trials, conducted on a total of 27,561 athletes (median age 16.7 years [range 10.7–17.8]), were included. The overall RR was 0.54 (95 % CI 0.45–0.67) [ p  < 0.001]. Girls profited more from injury prevention than boys ( p  = 0.05). Both prevention programs with a focus on specific injuries (RR 0.48 [95 % CI 0.37–0.63]) and those aiming at all injuries (RR 0.62 [95 % CI 0.48–0.81]) showed significant reduction effects. Pre-season and in-season interventions were similarly beneficial ( p  = 0.93). Studies on programs that include jumping/plyometric exercises showed a significant better ( p  = 0.002) injury preventive effect (RR 0.45 [95 % CI 0.35–0.57], Z  = 6.35, p  < 0.001) than studies without such exercises (RR 0.74 [95 % CI 0.61–0.90], Z  = 3.03, p  = 0.002). Conclusions The results provide good evidence and clearly demonstrate beneficial effects of exercise-based injury prevention programs in youth sports as they can result in statistically significant and practically relevant injury reduction. In particular, multimodal programs including jumping/plyometric exercises can be recommended. However, there is a considerable lack of data for children (under 14 years of age) and for individual sports in general. Future research should include these groups and focus on the effect of specific exercises and compliance.

Open-access scripts to perform muscle anatomical cross-sectional area (ACSA) evaluation in ultrasound images are currently unavailable. This study presents a novel semi-automatic ImageJ script (named “ACSAuto”) for quantifying the ACSA of lower limb muscles. We compared manual ACSA measurements from 180 ultrasound scans of vastus lateralis (VL) and rectus femoris (RF) muscles to measurements assessed by the ACSAuto script. We investigated inter- and intra-investigator reliability of the script. Consecutive-pairwise intra-class correlations (ICC) and standard error of measurement (SEM) with 95% compatibility interval were calculated. Bland–Altman analyses were employed to test the agreement between measurements. Comparing manual and ACSAuto measurements, ICCs and SEMs ranged from 0.96 to 0.999 and 0.12 to 0.96 cm 2 (1.2–5.9%) and mean bias was smaller than 0.5 cm 2 (4.3%). Inter-investigator comparison revealed ICCs, SEMs and mean bias ranging from 0.85 to 0.999, 0.07 to 1.16 cm 2 (0.9–7.6%) and − 0.16 to 0.66 cm 2 (− 0.6 to 3.2%). Intra-investigator comparison revealed ICCs, SEMs and mean bias between 0.883–0.998, 0.07–0.93 cm 2 (1.1–7.6%) and − 0.80 to 0.15 cm 2 (− 3.4 to 1.8%). Image quality needs to be high for efficient and accurate ACSAuto analyses. Taken together, the ACSAuto script represents a reliable tool to measure RF and VL ACSA, is comparable to manual analysis and can reduce time needed to evaluate ultrasound images.

ObjectiveTo investigate the risk of transmission among potentially infectious SARS-CoV-2-positive football players while participating in training or matches at amateur, youth and professional levels.MethodsBetween August 2020 and March 2021, football players who tested positive for SARS-CoV-2 and participated in matches or training during the period of potential contagiousness were identified through media search (professional level) and a nationwide registry in Germany (amateur and youth level) to determine symptoms, source of infection and hygiene measures adopted. The definition of potentially infectious players was based on the time of a positive PCR testing and symptom onset. Transmission-relevant contacts on the pitch were evaluated through doubly reviewed video analysis.ResultsOut of 1247 identified football matches and training sessions (1071 amateur and youth level, 176 professional level), 104 cases (38 training sessions, 66 matches) with 165 potentially infectious players were detected. Follow-up PCR testing at the professional level (44 cases) revealed no transmission. At the amateur and youth level, the combination of partial PCR testing (31 of 60 cases) and symptom monitoring within 14 days post-exposure (46 of 60 cases) identified 2 of 60 matches in which follow-up infections occurred that were attributed to non-football activities. This is consistent with the video analysis of 21 matches demonstrating frontal contacts were <1 per player-hour (88%, 30 of 34 players), each lasting no longer than 3 s.ConclusionOn-field transmission risk of SARS-CoV-2 in football is very low. Sources of infections in football players are most likely not related to activities on the pitch.

Background Gait analysis serves as an important tool for clinicians and other health professionals to assess gait patterns related to functional limitations due to neurological or orthopedic conditions. The purpose of this study was to assess the validity of a body-worn inertial sensor system (RehaGait®) for measuring spatiotemporal gait characteristics compared to a stationary treadmill (Zebris) and the reliability of both systems at different walking speeds and slopes. Methods Gait analysis was performed during treadmill walking at different speeds (habitual walking speed (normal speed); 15 % above normal walking speed; 15 % below normal walking speed) and slopes (0 % slope; 15 % slope) in 22 healthy participants twice 1 week apart. Walking speed, stride length, cadence and stride time were computed from the inertial sensor system and the stationary treadmill and compared using repeated measures analysis of variance. Effect sizes of differences between systems were assessed using Cohen’s d, and limits of agreement and systematic bias were computed. Results The RehaGait® system slightly overestimated stride length (+2.7 %) and stride time (+0.8 %) and underestimate cadence (−1.5 %) with small effect sizes for all speeds and slopes (Cohen’s d ≤ 0.44) except slow speed at 15 % slope (Cohen’s d > 0.80). Walking speed obtained with the RehaGait® system closely matched the speed set on the treadmill tachometer. Intraclass correlation coefficients (ICC) were excellent for speed, cadence and stride time and for stride length at normal and fast speed at 0 % slope (ICC: .91–1.00). Good ICC values were found for stride length at slow speed at 0 % slope and all speeds at 15 % slope (ICC: .73–.90). Both devices had excellent reliability for most gait characteristics (ICC: .91–1.00) except good reliability for the RehaGait® for stride length at normal and fast speed at 0 % slope and at slow speed at 15 % slope (ICC: .80–.87). Conclusions Larger limits of agreement for walking at 15 % slope suggests that uphill walking may influence the reliability of the RehaGait® system. The RehaGait® is a valid and reliable tool for measuring spatiotemporal gait characteristics during level and inclined treadmill walking.

PurposeIncomplete maturation and aging-induced declines of the neuromuscular system affect postural control both in children and older adults and lead to high fall rates. Age-specific comparisons of the modulation of ankle muscle activation and behavioral center of pressure (COP) indices during upright stance have been rarely conducted. The objective of the present study was to quantify aging effects on a neuromuscular level. Thus, surface electromyography (SEMG) modulation and co-activity of ankle muscles during single-leg standing was compared in healthy children, young adults and seniors.MethodsPostural steadiness (velocity and mean sway frequency of COP), relative muscle activation (SEMG modulation) and co-activation of two ankle muscles (tibialis anterior, TA; soleus, SO) were examined during single-leg stance in 19 children [age, 9.7 (SD 0.5) years], 30 adults [23.3 (1.5) years] and 29 seniors [62.7 (6.1) years].ResultsVelocity of COP in medio-lateral and anterior–posterior directions, mean sway frequency in anterior–posterior direction, relative muscle activation (TA and SO) and co-activation revealed large age effects (P < 0.003, ηp2 > 0.14). Post-hoc comparisons indicated higher COP velocities, anterior–posterior frequencies, relative SO activation and co-activation in children and seniors when compared with adults. Relative TA activation was higher in children and adults compared with seniors (P < 0.001).ConclusionsIncreased postural sway in children and seniors seems to be counteracted with higher TA/SO co-activity and SO modulation. However, TA modulation is higher in children and adults, whereas seniors’ TA modulation capacity is diminished. An aging-induced decline of TA motor units might account for deteriorations of TA modulation in seniors.

Higher task-specific pain-related fear has been linked to restricted lumbar spine range of motion (ROM) during lightweight object lifting in chronic low back pain (LBP) patients and reduced lumbar spine flexion angles in healthy individuals, suggesting protective movement strategies. However, it remains unclear whether these findings apply to individuals who repetitively lift heavier objects at work. This study aimed to determine whether the effect of task-specific pain-related fear on lifting kinematics differs between individuals with (LIFTER) and without (NON-LIFTER) occupations involving repetitive lifting, and to quantify how this effect depends on object weight, task (lifting or lowering), and LBP history. 156 healthy individuals provided information on previous LBP episodes, completed pain-related fear questionnaires, and lifted 5-kg and 15-kg boxes. Kinematic outcomes included lumbar spine ROM and whole-body lifting strategy. Linear mixed models revealed that the effect of task-specific pain-related fear on lumbar spine ROM significantly differed between group (NON-LIFTER vs. LIFTER: -0.087), weight (5 kg vs. 15 kg: 0.026), and task (lifting vs. lowering: 0.059), but not LBP history (No LBP vs. LBP: -0.005). Higher task-specific pain-related fear was associated with reduced lumbar spine ROM in NON-LIFTER but not in LIFTER, suggesting that fear-driven protective movement strategies vary by occupation.

We aimed to analyze the number and type of contacts involving the risk of respiratory disease transmission during football match play. We analysed 50 matches from different playing levels. Two reviewers evaluated the contacts of all players in each match. We focused on between-player contacts, crowding, actions with potentially increased aerosol and droplet production and within-player hand-to-head contacts. We categorized the duels with direct contact into frontal and other ones and measured contact duration. The number of between-player contacts were similar between playing levels (median 28.3 [IQR 22.6, 33] contacts per player-hour). Frontal contacts summed up to 8% of all contacts. Contacts involving the head occurred less than once per player and match with none lasting longer than 3 s. Crowding included between two and six players and the duration was mostly less than 10 s. Aerosol and droplet producing activities were three to four times more frequent in adult compared to youth players. Our results suggest that the risk of respiratory pathogen transmission is low during football matches. This conclusion is based on the finding that most close contact situations are of short duration and on the fact that it is an outdoor sport.