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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.

Evidence suggests athletes with lower baseline cognitive performance are at higher risk of musculoskeletal injuries. This prospective cohort study investigates basic and executive cognitive functions in predicting injuries in 78 professional male football (soccer) players from four Slovenian first league teams. Data were collected during the 2018/2019 winter break, and injuries recorded in the second half of that and the 2019/2020 season. Cognitive functions assessed by computerized tests (PsyToolkit) included psychomotor vigilance (simple, choice reaction time) and visuospatial memory (Corsi-block-tapping-test), while pen-and-paper tests assessed motor speed, visual scanning, and executive functions (TMT; Delis-Kaplan-Executive-Function-System). Forty-two players sustained at least one musculoskeletal injury (9 contact injuries), 36 remained injury-free. Logistic regression analyses indicated that none of the cognitive measures significantly influenced injury occurrence ( p  > 0.05). However, non-significant trends were observed for the TMT ratio score ( p  = 0.065, OR = 1.64), reflecting cognitive flexibility, and for TMT-A ( p  = 0.05, OR = 0.60), reflecting visual scanning. Specifically, players with lower cognitive flexibility showed a 64% increase in the odds of sustaining an injury, while better visual scanning performance was associated with a 40% reduction in injury odds. No significant association was found between basic or executive cognitive functions and musculoskeletal injuries in professional male football players. However, a non-significant trend suggested that lower cognitive flexibility may be associated with increased injury risk. These findings underscore the need for larger studies to better clarify the role of executive functions in assessing injury risk in football.

This study aimed at determining whether the combination of action observation and motor imagery (AO + MI) of locomotor tasks could positively affect rehabilitation outcome after hip replacement surgery. Of initially 405 screened participants, 21 were randomly split into intervention group (N=10; mean age = 64 y; AO + MI of locomotor tasks: 30 min/day in the hospital, then 3×/week in their homes for two months) and control group (N=11, mean age = 63 y, active controls). The functional outcomes (Timed Up and Go, TUG; Four Step Square Test, FSST; and single- and dual-task gait and postural control) were measured before (PRE) and 2 months after surgery (POST). Significant interactions indicated better rehabilitation outcome for the intervention group as compared to the control group: at POST, the intervention group revealed faster TUG (p=0.042), FSST (p=0.004), and dual-task fast-paced gait speed (p=0.022), reduced swing-time variability (p=0.005), and enhanced cognitive performance during dual tasks while walking or balancing (p<0.05). In contrast, no changes were observed for body sway parameters (p≥0.229). These results demonstrate that AO + MI is efficient to improve motor-cognitive performance after hip surgery. Moreover, only parameters associated with locomotor activities improved whereas balance skills that were not part of the AO + MI intervention were not affected, demonstrating the specificity of training intervention. Overall, utilizing AO + MI during rehabilitation is advised, especially when physical practice is limited.

Background The COVID-19 pandemic situation with the lockdown of public life caused serious changes in people's everyday practices. The study evaluates the differences between Slovenia and Italy in health-related everyday practices induced by the restrictive measures during first wave of the COVID-19 pandemic. Methods The cross-sectional cohort study examined changes through an online survey conducted in nine European countries from April 15–28, 2020. The survey included questions from a simple activity inventory questionnaire (SIMPAQ), the European Health Interview Survey, and some other questions. To compare difference in changes between European countries we examined Italy with severe and its neighbour country Slovenia with low incidence and victims of COVID-19 epidemic. 956 valid responses from Italy ( N  = 511; 50% males) and Slovenia ( N  = 445; 26% males) were investigated. Results During the survey, there was a 4.7-fold higher incidence and 12.1-fold more deaths (per 100,000) in Italy than in Slovenia. Barring periods and measures were similar, the latter more stringent in Italy. We found more changes in Italy than in Slovenia: physical inactivity increased (Italy: + 65% vs. Slovenia: + 21%; p  < 0.001), walking time decreased (Italy: -68% vs. Slovenia: -4.4%; p  < 0.001); physical work increased by 38% in Slovenia ( p  < 0.001), and recreation time decreased by 37% in Italy ( p  < 0.001). Italians reported a decrease in quality of general health, fitness level, psychological well-being, quality of life and care for own health ( p  < 0.001); Slovenians showed a decline in psychological well-being and quality of life ( p  < 0.001) but generally had a higher concern for their own health ( p  = 0.005). In pooled participants, changes in eating habits (meal size and consumption of unhealthy food), age and physical inactivity were positively correlated with increases in body mass, while changes in general well-being and concern for health were negatively correlated. Conclusion The study shows that the negative impact of COVID -19 measures is greater in Italy where the pandemic COVID -19 was more prevalent than in Slovenia with low prevalence. Additional consideration should be given to the negative impact of COVID-19 measures on some health-related lifestyle variables when implementing further measures to mitigate the COVID-19 pandemic.

Backgroud Sarcopenia is a common skeletal muscle syndrome that is common in older adults but can be mitigated by adequate and regular physical activity. The development and severity of sarcopenia is favored by several factors, the most influential of which are a sedentary lifestyle and physical inactivity. The aim of this observational longitudinal cohort study was to evaluate changes in sarcopenia parameters, based on the EWGSOP2 definition in a population of active older adults after eight years. It was hypothesized that selected active older adults would perform better on sarcopenia tests than the average population. Methods The 52 active older adults (22 men and 30 women, mean age: 68.4 ± 5.6 years at the time of their first evaluation) participated in the study at two time points eight-years apart. Three sarcopenia parameters were assessed at both time points: Muscle strength (handgrip test), skeletal muscle mass index, and physical performance (gait speed), these parameters were used to diagnose sarcop0enia according to the EWGSOP2 definition. Additional motor tests were also performed at follow-up measurements to assess participants’ overall fitness. Participants self-reported physical activity and sedentary behavior using General Physical Activity Questionnaire at baseline and at follow-up measurements. Results In the first measurements we did not detect signs of sarcopenia in any individual, but after 8 years, we detected signs of sarcopenia in 7 participants. After eight years, we detected decline in ; muscle strength (-10.2%; p  < .001), muscle mass index (-5.4%; p  < .001), and physical performance measured with gait speed (-28.6%; p  < .001). Similarly, self-reported physical activity and sedentary behavior declined, too (-25.0%; p  = .030 and − 48.5%; p  < .001, respectively). Conclusions Despite expected lower scores on tests of sarcopenia parameters due to age-related decline, participants performed better on motor tests than reported in similar studies. Nevertheless, the prevalence of sarcopenia was consistent with most of the published literature. Trial registration The clinical trial protocol was registered on ClinicalTrials.gov, identifier: NCT04899531.

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

Older individuals experience cardiovascular dysfunction during extended bedridden hospital or care home stays. Bed rest is also used as a model to simulate accelerated vascular deconditioning occurring during spaceflight. This study investigates changes in retinal microcirculation during a ten-day bed rest protocol. Ten healthy young males (22.9 ± 4.7 years; body mass index: 23.6 ± 2.5 kg·m –2 ) participated in a strictly controlled repeated-measures bed rest study lasting ten days. High-resolution images were obtained using a hand-held fundus camera at baseline, daily during the 10 days of bed rest, and 1 day after re-ambulation. Retinal vessel analysis was performed using a semi-automated software system to obtain metrics for retinal arteriolar and venular diameters, central retinal artery equivalent and central retinal vein equivalent, respectively. Data analysis employed a mixed linear model. At the end of the bed rest period, a significant decrease in retinal venular diameter was observed, indicated by a significantly lower central retinal vein equivalent (from 226.1 µm, CI 8.90, to 211.4 µm, CI 8.28, p = .026), while no significant changes in central retinal artery equivalent were noted. Prolonged bed rest confinement resulted in a significant (up to 6.5%) reduction in retinal venular diameter. These findings suggest that the changes in retinal venular diameter during bedrest may be attributed to plasma volume losses and reflect overall (cardio)-vascular deconditioning.

The degree of deterioration in sarcopenia parameters may be affected by a person's level of physical activity (PA) and sedentary behavior (SB). Our study focused on examining the PA and SB of active older adults including those with and without history of sports in youth. Forty-four participants (20 men and 24 women, mean age of total sample 76.1 ± 5.2 years) were included in analysis of PA, SB habits and sarcopenia parameters, determined by skeletal muscle index, hand-grip strength, gait speed, Timed Up and Go tests (TUG). PA and SB were recorded with accelerometers. Our primary aim was to compare participants with (AH) or without a sport history in youth (NAH), in their sarcopenia parameters and PA and SB habits. When divided participants in two groups (AH and NAH) and adjusting for age, we have detected the differences for skeletal muscle index ( = 0.007) and hand-grip strength ( = 0.004) in favor of participants who were engaged in sports in youth. We did not find any differences in PA and SB habits between the AH and NAH groups. After adjusting for age, participants with a higher number of daily steps, longer moderate to vigorous physical activity (MVPA) bouts, a higher number of MVPA bouts in a day and higher overall MVPA engagement achieved better results in hand-grip strength and TUG. Participants with lower SB had better TUG and gait speed results. Our findings suggest that engaging in sports activities in youth can make a difference with sarcopenia parameters. Although we found no differences in PA and SB habits between participants with AH and NAH, participants with an athlete history performed better results in sarcopenia parameters.

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.

The pathophysiological mechanisms underlining constipation are incompletely understood, but prolonged bed rest is commonly considered a relevant determinant. Our primary aim was to study the effect of long-term physical inactivity on determining a new onset of constipation. Secondary aim were the evaluation of changes in stool frequency, bowel function and symptoms induced by this prolonged physical inactivity. Ten healthy men underwent a 7-day run-in followed by 35-day study of experimentally-controlled bed rest. The study was sponsored by the Italian Space Agency. The onset of constipation was evaluated according to Rome III criteria for functional constipation. Abdominal bloating, flatulence, pain and urgency were assessed by a 100mm Visual Analog Scales and bowel function by adjectival scales (Bristol Stool Form Scale, ease of passage of stool and sense of incomplete evacuation). Daily measurements of bowel movements was summarized on a weekly score. Pre and post bed rest Quality of Life (SF-36), general health (Goldberg's General Health) and depression mood (Zung scale) questionnaires were administered. New onset of functional constipation fulfilling Rome III criteria was found in 60% (6/10) of participants (p=0.03). The score of flatulence significantly increased whilst the stool frequency significantly decreased during the week-by-week comparisons period (repeated-measures ANOVA, p=0.02 and p=0.001, respectively). Stool consistency and bowel symptoms were not influenced by prolonged physical inactivity. In addition, no significant changes were observed in general health, in mood state and in quality of life at the end of bed rest. Our results provide evidence that prolonged physical inactivity is relevant etiology in functional constipation in healthy individuals. The common clinical suggestion of early mobilization in bedridden patients is supported as well.