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Motor imagery (MI) has been a widely used strategy in the past two decades to enhance physical capabilities among orthopaedic patients. However, its effectiveness is still questioned, since the demonstrated effects were likely task-dependent, with little evidence of transfer to tasks not specifically trained with MI. The aim of this study was to investigate whether an MI practice focused on maximal isometric knee extension strength, causes additional specific and general adaptations upon neuromuscular and functional variables when compared to conventional rehabilitation only, in patients submitted to total knee arthroplasty (TKA). Parallel group randomized controlled clinical trial. Thirty-four patients (56% man) submitted to TKA. Patients were randomly assigned to an MI practice group (MIp: 15 minutes per day/5 days per week in addition to routine physical therapy) or control group (CON) that performed routine physical therapy alone for four weeks. The maximal isometric knee extension strength of the operated leg was defined as the primary outcome. Secondary outcomes were spatial and temporal gait parameters, 30-second chair sit-to-stand performance, a self-reported physical function assessed by the Lower Extremity Functional Scale (LEFS) questionnaire, and an MI ability score. All measurements were conducted before and one month after TKA. Significant differences in treatment effects were observed for the MIp group compared to CON: the MIp showed less strength decrease (ES = 1.15, 95% CI: 0.32, 1.99, p = 0.022); faster self-selected speed under single (ES = 2.12, 95% CI: 1.16, 3.08, p = 0.001) and dual task (ES = 1.59, large, 95% CI: 0.67, 2.50, p = 0.002) conditions; brisk-pace gait speed during single (ES = 1.32, 95% CI: 0.47, 2.17, p = 0.020) and dual task conditions (ES = 1.31, large, 95% CI: 0.38, 2.23, p = 0.013); improved chair sit-to-stand (ES = 1.45, large, 95% CI: 0.58, 2.31, p = 0.004) performance; and a higher score on MI ability questionnaires for kinaesthetic imagery (KI) (ES = 0.55, 95% CI: -0.23, 1.34, p = 0.010) and internal visual imagery (EVI) (ES = 0.99, 95% CI: 0.18, 1.80, p = 0.039) scales, respectively. In addition, only MIp showed unaltered single and double support periods, as well as stride length and cadence during single task self-selected gait condition. Finally, analysis showed that the improved MI ability score achieved at the end of MI training was significantly correlated with the changes in the strength of the operated leg (kinaesthetic imagery: r = 0.741, p = 0.004; and internal visual imagery: r = 0.623, p = 0.023). MI training, when added in a corollary to routine physical therapy, led to improvements in both specific and general adaptations that were related to patients' physical capabilities. While future studies must also evaluate the long-term effects, conducting MI training during acute and post-acute rehabilitation phases is advised, especially when the extent and range of physical exercise is limited or made impossible. ClinicalTrials.gov NCT03684148.

Background This study aimed to investigate: (a) the effects of aerobic training (AT) on brachial artery endothelial function, measured by flow-mediated dilatation ( ba FMD) and whether changes in ba FMD are associated with changes in other cardiovascular health markers in healthy adults; (b) whether intra-individual response differences (IIRD) in ba FMD improvement exist following AT; and (c) the association between participants’ baseline characteristics and exercise-induced changes in ba FMD. Methods The search conducted across six databases (PubMed, Web of Science, CINAHL, EMBASE, the Cochrane Central Register of Controlled Trials, and EBSCOhost) identified 12 eligible studies. We conducted both traditional meta-analyses identifying the effects of the intervention and IIRD. IIRD meta-analysis was performed to assess if true IIRD between AT and the control group exists for ba FMD. The methodological quality of included studies was assessed by the PEDro scale, while GRADE assessment was used for certainty of evidence evaluation. Results In total, 12 studies with 385 participants (51% male, 46.3 ± 17.3 [years]) were included in the current review. Meta-analysis revealed improvement in ba FMD post-AT ( small MD = 1.92%, 95% CI 0.90 to 2.94, p  = 0.001). The standard deviation of change scores in the intervention and control groups suggests that most of the variation in the observed change from pre-to-post intervention is due to other factors (e.g., measurement error, biological variability etc.) unrelated to the intervention itself. However, subgroup meta-analysis revealed that significantly trivial IIRD exists following AT in prehypertensive individuals. Conclusions The study found small improvements in ba FMD, suggesting an average 19.2% reduction in cardiovascular disease (CVD) risk, with some individuals—such as prehypertensive individuals—potentially experiencing even greater benefits from AT. However, a meta-analysis based on IIRD suggests that factors unrelated to AT predominantly explain ba FMD changes. Further research is needed to better understand response variability in individuals with cardiovascular risk factors, and longer studies are required to assess IIRD in the general population. Key points In this meta-analysis of 12 randomized controlled trials, aerobic training (AT) intervention revealed small improvements in brachial artery endothelial function measured by flow-mediated dilatation ( ba FMD) technique in the healthy adult population. Based on prior evidence indicating that a 1% increase in ba FMD is associated with a 10% reduction in cardiovascular disease (CVD) risk, the pooled results demonstrate an average 19.2% decrease in CVD risk following AT. Notably, some individuals may experience even greater benefits from AT. Conversely, meta-analysis based on intra-individual response difference (IIRD) suggests that factors unrelated to the intervention itself mostly contribute to the observed changes in ba FMD, whereas prehypertension appeared to moderate the IIRD in ba FMD improvement following AT. Current evidence indicates that response heterogeneity following AT can be expected in individuals with increased cardiovascular risk factors, such as elevated systolic blood pressure, and this warrants further investigation.

Background Motor imagery (MI) is effective in improving motor performance in the healthy asymptomatic adult population. However, its possible effects among older orthopaedic patients are still poorly investigated. Therefore, this study explored whether the addition of motor imagery to routine physical therapy reduces the deterioration of quadriceps muscle strength and voluntary activation (VA) as well as other variables related to motor performance in patients after total knee arthroplasty (TKA). Methods Twenty-six patients scheduled for TKA were randomized to either MI practice combined with routine physical therapy group (MIp) or to a control group receiving physical therapy alone (CON). MIp consisted of maximal voluntary isometric contraction (MViC) task: 15 min/day in the hospital, then 5 times/week in their homes for 4 weeks. MViC and VA of quadriceps muscle, knee flexion and extension range of motion, pain level, along with a Timed Up-and-Go Test (TUG) and self-reported measure of physical function (assessed using the Oxford Knee Score questionnaire [OKS]) were evaluated before (PRE) and 1 month after surgery (POST). Results Significantly better rehabilitation outcomes were evident on the operated leg for the MIp group compared to CON: at POST, the MIp showed lower strength decrease ( p = 0.012, η 2 = 0.237) and unaltered VA, significantly greater than CON ( p = 0.014, η 2 = 0.227). There were no significant differences in knee flexion and extension range of motion and pain level ( p > 0.05). Further, MIp patients performed better in TUG ( p < 0.001, η 2 = 0.471) and reported better OKS scores ( p = 0.005, η 2 = 0.280). The non-operated leg showed no significant differences in any outcomes at POST (all p > 0.05). In addition, multiple linear regression analysis showed that failure of voluntary activation explained 47% of the quadriceps muscle strength loss, with no significant difference in perceived level of pain. Conclusion MI practice, when added to physical therapy, improves both objective and subjective measures of patients’ physical function after TKA, and facilitates transfer of MI strength task on functional mobility. Trial registration Retrospectively registered on ClinicalTrials.gov NCT03684148

For patients with osteoarthritis who have undergone total knee arthroplasty (TKA), quadriceps strength is a major determinant of general physical function regardless of the parameters adopted for functional assessment. Understanding the time course of quadriceps strength recovery and effectiveness of different rehabilitation protocols is a must. Therefore, the aim of this study was to: (i) determine the magnitude of maximal voluntary strength (MVS) loss and the time course of recovery of the quadriceps muscle following TKA, (ii) identify potential moderators of strength outcomes, and (iii) investigate whether different rehabilitation practices can moderate the strength outcomes following TKA, respectively. General scientific databases and relevant journals in the field of orthopedics were searched, identifying prospective studies that investigated quadriceps' MVS pre-to post-surgery. Seventeen studies with a total of 832 patients (39% males) were included. Results showed that in the early post-operative days, the involved quadriceps' MVS markedly declined, after which it slowly recovered over time in a linear fashion. Thus, the greatest decline of the MVS was observed 3 days after TKA. When compared to pre-operative values, the MVS was still significantly lower 3 months after TKA and did not fully recover up to 6 months following TKA. Furthermore, a meta-regression analysis identified that the variables, time point of evaluation, patient age, sex, and BMI, significantly moderate the MVS of the quadriceps muscle. The analyzed literature data showed that the decrease in strength of the involved quadriceps muscles following TKA is considerable and lasts for several months post-surgery. Therefore, we recommend to specifically target the strengthening of knee extensor muscles, preserve motor control, and apply appropriate nutrition to ensure a holistic quadriceps muscle recovery. Since age, sex, and BMI were found to be moderating factors in patients' recovery, further research should include specific analyses considering these moderators.

The aim of the present study was to describe the morphological and performance characteristics of elite handball players using data collected over the last two decades within the talent evaluation program of the Slovenian Handball Federation. A total of 1066 elite male handball players selected for one of the Slovenian national teams (U17, U19, U21 or senior) were recruited. The data were collected from 2007/8 to the 2021/22 season. The main effects were observed for: body height, body weight, and body mass index (BMI). The muscle mass percentage differed only between different age categories (p = 0.003; η2 = 0.015), while the fat mass percentage (FM%) differed between playing positions (p < 0.001; η2 = 0.107). Post-hoc comparisons showed that, within senior handball players, pivot players were 6.46 cm (p = 0.009) taller than wing players and heavier than goalkeepers (12.43 kg, p = 0.004), backcourts (13.30 kg, p < 0.001) and wings (17.83 kg, p < 0.001). Moreover, pivots had a greater BMI than goalkeepers (2.3 kg/m2, p = 0.003), backcourts (2.62 kg/m2, p < 0.001), and wings (3.07 kg/m2, p < 0.001), while FM% was significantly higher in pivots compared to wings (4.32%, p = 0.010). Taking into consideration playing positions and age, the main effects were also observed for squat jump height, countermovement jump height, end-running speed, and VO2max (all p < 0.001; η2 = 0.017 to 0.091). Both morphological and performance characteristics clearly differ across playing positions and age categories, which should be a valuable guide for coaches to develop position-specific talent identification programs and training plans.

The objectives of this study were to investigate the reliability, validity, and usefulness of the 30–15 intermittent fitness test (30–15 IFT ) in soldiers. The 34 infantry members of the Slovenian armed forces were recruited as participants. Participants performed the continuous incremental treadmill test (TR), a 2-mile run (2 MR ) test, and two 30–15 IFT tests. Additionally, participants were divided into a highest-scoring group (HSG) and a lowest-scoring group (LSG) based on their scores on the Army Physical Fitness Test. A very high reliability ratings were observed for 30–15 IFT measures, as follows: end-running speed (ERS) ERS IFT (ICC = 0.971) , maximal heart rate (HR max ) HR maxIFT (IC = 0.960) , and maximal relative oxygen consumption (VO 2max ) VO 2max-IFT (ICC = 0.975) . Although 30–15 IFT measures demonstrated high correlations (r = 0.695–0.930) to the same measures of TR test, ERS, HR max and VO 2max were higher in the 30–15 IFT (p > 0.05) . Furthermore, ERS IFT and predicted VO 2maxIFT were higher in HSG compared to LSG, whereas HR max did not differ. The results of this study show that the 30–15 IFT test is a reliable, valid and useful tool for assessing cardiorespiratory fitness in the armed forces. Moreover, the ERS and predicted VO 2 max values derived from the 30–15 IFT could be considered more sensitive markers of combat readiness than the parameters derived from the TR and 2 MR tests. Trial registration number: NCT05218798.

This systematic literature review (SLR) aimed to comprehensively synthesize existing studies that have reported on TMG-derived parameters of lower extremities in soccer players. The PubMed, Web of Science, and EBSCOHost (including MEDLINE, SPORTDiscuss, ERIC, DOAJ, and SCOPUS) databases were searched from inception to the 31 of August, 2023. Reports were eligible if they satisfied the following criteria: recruited active soccer players, with no restriction on race, sex, age, level of expertise, or health status; studies utilizing TMG for measuring muscle contractile properties. In total, 25 published journal articles from 22 original studies were included in the current review, encompassing a total of 1224 participants (4% females). The analysis considered various muscles, with the biceps femoris (BF), rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), semitendinosus (ST), gastrocnemius lateralis (GL), and gastrocnemius medialis (GM) being investigated. Significant variations were observed in TMG parameters across different muscles, age categories, and levels of play. The quality of evidence varied from low to moderate for all analyses. The meta-regression analysis indicated that age moderated several TMG-derived parameters in lower limb muscles including BF Vc, RF Td and Vc, ST Dm and sustain time, VL Dm, Tc, Td and relaxation time (Tr), and VM Tc, Td and Tr, respectively. In conclusion, the current review illuminated the multifaceted applications of TMG in assessing lower extremity muscles in soccer players. Beyond evaluating muscle contractile properties in various superficial muscles of the lower limbs in soccer players, TMG-derived parameters may serve as potentially valuable markers in identifying neuromuscular risk factors for anterior cruciate ligament injuries and predicting hamstring-related injuries.

Background This study investigated the comparative acute effects of 3 × 30 s of vibration foam rolling (VFR) or percussive massage (PM) on the hamstring muscles, specifically range of motion (ROM), maximum voluntary isometric contraction (MVIC), and muscle stiffness, using shear wave elastography (SWE), tensiomyography (TMG), and the MyotonPro. Further, the correlation between the three stiffness measures was examined. Methods Seventeen participants (27.1 ± 3.1 years; 7 females) were randomized to VFR or PM on two occasions. Muscle stiffness of the biceps femoris (BF) was assessed at baseline and immediately post-intervention with SWE, TMG, and the MyotonPro. A sit-and-reach test was conducted and MVIC of the hamstring muscles was measured unilaterally. Results A significant time effect was observed for MVIC torque (p = 0.01, ƞ² = 0.319). ROM and BF muscle stiffness were unaffected by either intervention. No significant associations were found between the stiffness measurements from the three techniques. Conclusion The acute application of 3 × 30 s of VFR or PM did not enhance ROM or alter BF muscle stiffness. However, both interventions reduced MVIC torque, with no significant difference between them. The lack of correlation between the SWE, TMG, and MyotonPro measurements suggests that these techniques cannot be used or interpreted interchangeably.

Background Brachial artery endothelial function, measured by the flow-mediated dilatation (FMD) technique, serves as a surrogate for coronary endothelial function and is recognized as an independent predictor of cardiovascular disease risk. Despite the known benefits of physical exercise interventions (PEI) in improving endothelial function, limited evidence exists to guide practitioners on the most effective form of PEI for enhancing endothelial function. The aim of this article is to investigate the effects of different PEI modalities on brachial artery FMD, and to establish the most effective PEI through a systematic review and network meta-analysis (NMA). Methods PubMed, WoS, CINAHL, EMBASE, CENTRAL and EBSCOhost search was conducted from inception to February 20th, 2025. Randomized controlled studies investigating the effects of PEI on brachial artery FMD in adults were included. Both pairwise and Bayesian NMA were conducted using random-effects model to compare different PEI modalities within primary (aerobic training, resistance training and combined training) and secondary (continuous aerobic training vs. interval aerobic training vs. dynamic resistance training vs. combined training) categorizations. The PEI effectiveness was ranked using the surface under the cumulative ranking curve (SUCRA). Results In total, 84 studies with 3596 participants (43% females, 51.9 ± 15.1 years of age) were included in the analysis. Summarized evidence of 119 effect sizes through pairwise comparisons showed improvement in FMD (mean difference [MD], 2.24%; 95% confidence interval [CI] 1.90–2.58, p < 0.001) following different PEI, without difference between magnitude of the effect between healthy and asymptomatic individuals (Q, 1.27, p = 0.260). As shown in the NMA, the rank order within a primary classification showed aerobic training as the most effective (SUCRA: 89.8%, MD, 2.37%, 95% credible interval [CrI] 1.95–2.80) followed by resistance training (SUCRA: 66.0%, MD, 2.07%, 95% CrI, 1.34–2.79), and combined (aerobic and resistance) training (SUCRA: 44.1%, MD, 1.67%, 95% CrI, 0.73–2.6). Secondary NMA identified interval aerobic training as the most effective (SUCRA: 99.1%, MD, 3.07%, 95% CrI, 1.37–3.76), which showed to be more effective than continuous aerobic training (MD, 1.08%), dynamic resistance training (MD, 1.04%), and combined training (MD, 1.36%). Moreover, a negative association was found between FMD improvement and both intervention duration and overall training load, while positive associations were observed with weekly training frequency, single session duration, and weekly training duration. Conclusions Various PEI modalities have demonstrated effectiveness in improving brachial artery FMD, with interval aerobic exercises of higher intensities emerging as the most effective based on current evidence, followed by dynamic resistance training, continuous aerobic training and combined training. These findings have significant implications for informing future exercise guidelines aimed at both prevention and treatment of endothelial dysfunction. The study protocol was prospectively registered in PROSPERO online registry: ID: CRD42023453202 Key points In this meta-analysis of 84 randomized controlled trials, physical exercise interventions (PEIs) in general significantly increased brachial artery endothelial function measured by flow-mediated dilatation (FMD) technique in the adult population. This large-scale systematic review and network meta-analysis showed that aerobic training, resistance training and combined training are all effective in enhancing brachial artery FMD. Although various PEIs have demonstrated effectiveness in enhancing brachial artery FMD, interval aerobic exercises of higher intensities are emerging as the most effective based on current evidence. The findings from network meta-regression analyses suggest that greater improvements following PEI can be achieved by increasing the duration of acute stimuli (an additional half-hour of training = 0.80% increase in FMD) and weekly training exposure (an additional two and a half hours of training on weekly basis = 0.50% increase in FMD).

Background Motor imagery (MI), a mental simulation of a movement without overt muscle contraction, has been largely used to improve general motor tasks. However, the effects of MI practice on maximal voluntary strength (MVS) remain equivocal. Objectives The aims of this meta-analysis were to (1) estimate whether MI practice intervention can meaningfully improve MVS in healthy adults; (2) compare the effects of MI practice on MVS with its combination with physical practice (MI-C), and with physical practice (PP) training alone; and (3) investigate the dose–response relationships of MI practice. Data Sources and Study Eligibility Seven electronic databases were searched up to April 2017. Initially 717 studies were identified; however, after evaluation of the study characteristics, data from 13 articles involving 370 participants were extracted. The meta-analysis was completed on MVS as the primary parameter. In addition, parameters associated with training volume, training intensity, and time spent training were used to investigate dose–response relationships. Results MI practice moderately improved MVS. When compared to conventional PP, effects were of small benefit in favour of PP. MI-C when compared to PP showed unclear effects. MI practice produced moderate effects in both upper and lower extremities on MVS. The cortical representation area of the involved muscles did not modify the effects. Meta-regression analysis revealed that (a) a training period of 4 weeks, (b) a frequency of three times per week, (c) two to three sets per single session, (d) 25 repetitions per single set, and (e) single session duration of 15 min were associated with enhanced improvements in muscle strength following MI practice. Similar dose–response relationships were observed following MI and PP. Conclusions The present meta-analysis demonstrates that compared to a no-exercise control group of healthy adults, MI practice increases MVS, but less than PP. These findings suggest that MI practice could be considered as a substitute or additional training tool to preserve muscle function when athletes are not exposed to maximal training intensities.