Cardiovascular diseases remain the leading cause of death worldwide. Above-normal blood pressure is the primary modifiable risk factor for cardiovascular diseases and rates of blood pressure control remain suboptimal. Aerobic and resistance exercise are recommended lifestyle interventions for lowering blood pressure; however, adherence to exercise guidelines is low, contributing to poor rates of blood pressure control. Thus, alternative forms of physical activity that lower blood pressure and promote adherence are needed. This review examines isometric exercise, the Weekend Warrior physical activity pattern, and heat therapy as strategies for blood pressure lowering. Randomized controlled trials support isometric exercise for lowering blood pressure; however, the mechanisms of action require further investigation. The Weekend Warrior physical activity pattern, i.e., concentrating physical activity in 1–2 d/wk, is associated with lower rates of hypertension in cohort studies, but clinical trials are lacking. Cohort studies also support that regular sauna use is associated with lower rates of cardiovascular diseases. Small clinical trials also suggest that heat therapy can lower blood pressure; however, study designs are heterogeneous and the results are mixed. Overall, isometric exercise, the Weekend Warrior physical activity pattern, and heat therapy represent potential lifestyle approaches for lowering blood pressure and reducing cardiovascular disease risk.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Integrating proprioceptive and neuromuscular exercises into the FIFA 11+  Kids program may enhance motor performance and postural stability in youth athletes. This study aimed to determine the effects of a 12-week combined FIFA 11+  Kids and proprioceptive–neuromuscular training program (three sessions/wk) compared with regular standard soccer training on physical and postural performance in young male soccer players aged 12–13 years. Forty players (aged 12.19±0.59 years) were randomly assigned to an experimental group (n=20) or control group (n=20). Pre- and post-tests included anthropometry, linear sprints (5–10–20 m), vertical jumps (countermovement jump and squat jump), agility, Y-Balance, and stabilometric assessment (eyes open/closed). In the experimental group, body fat showed a non-significant downward trend (−2.93%; p=0.081), while leg muscle volume significantly increased (+5.53%; group×time: p=0.007; η p 2=0.183) alongside fat-free-mass (+2.41%; p=0.015). Sprint performance improved significantly at 5 m (5.16%; p=0.004; η p 2=0.206), 10 m (4.75%; p=0.008; η p 2=0.270), and 20 m (3.28%; p=0.019). Countermovement jump and squat jump also improved (7.63–14.97%; p=0.046 and p=0.002, respectively). Y-Balance scores and postural stability improved, particularly unipodal mediolateral sway (−35.19%; p=0.001; η p 2=0.224). Conversely, the control group showed no significant changes across anthropometric, performance, balance, or stabilometric parameters. The combined program effectively enhanced athletic performance, body composition, and postural control, strongly supporting its systematic implementation within youth soccer training programs.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Clarifying whether osteochondral lesions of the talus are associated with coronal plane ankle and hindfoot alignment abnormalities is critical for guiding surgical decisions such as supramalleolar or calcaneal osteotomy. This retrospective case series included 142 consecutive patients with osteochondral lesions treated between August 2014 and April 2019, with 111 patients met the inclusion and exclusion criteria and were enrolled finally. Patient data were carefully extracted and cross-checked, and the lesion location was determined via computed tomography or magnetic resonance imaging, grouping patients into 91 medial and 20 lateral cases. Standard weight-bearing radiographs were used to measure the tibial anterior surface angle, tibial axis–medial malleolus angle, tibio-talar angle, tibial lateral surface angle, hindfoot alignment angle, and lesion area. Inter-rater reliability assessed by intraclass correlation coefficients (≥ 0.85) showed excellent agreement. The medial group had a significantly older mean age (48.32 vs. 30.25 y, p < 0.01), greater hindfoot varus, larger tibial axis–medial malleolus angle, and smaller lesion area (p < 0.05), while no significant differences were found in the tibial anterior surface angle, tibio-talar angle, or tibial lateral surface angle. These findings indicate that medial osteochondral lesions of the talus correlate with hindfoot varus, emphasizing the need to assess and adjust alignment during clinical treatment.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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This study aimed to compare the effects of two bench press training programs differing in velocity loss modulation (stable vs. progressive) on strength and hypertrophic adaptations. Twenty-four resistance-trained men were randomly assigned to a stable velocity loss group or a progressive velocity loss group. Subjects trained the bench press for 8 weeks, 15 sessions, performing three sets per session at a 65–75% one-repetition maximum. The stable velocity loss group trained with a constant 25% velocity loss, whereas the progressive velocity loss group followed a progressive strategy (0-12.5-25-37.5-50% velocity loss). Assessments conducted before and after training included pectoralis major cross-sectional area, a progressive loading test, and the maximum number of repetitions in bench press. No significant differences in velocity loss between groups were observed during the training program (~26%). A significant main “time” effect was observed for all variables, with no significant group × time interactions. Only the progressive velocity loss group obtained significant increases in cross-sectional area (effect size=0.31), while only the stable velocity loss group significantly improved maximal unloaded velocity (effect size=0.80). Both stable and progressive velocity loss programming were effective at improving strength performance in bench press. However, stable velocity loss strategies may be preferable for athletes prioritizing high-velocity performance, whereas progressive velocity loss approaches may be more advantageous for hypertrophy-oriented athletes.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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To investigate the effects of descent from moderate altitude combined with exposure to high ambient temperatures on plasma volume, a repeated measures design was used in young male cyclists (n=10). The cyclists (age: 18.2±1.2 y and maximal oxygen uptake​:​​​​​​ 62.0±4.1 mL/kg/min), who lived at an altitude of 2,600 m, trained at a lower altitude (450 m) for 7 days. Hematological variables were measured prior to descent, at low altitude, and 1 day after returning to 2,600 m. Hemoglobin mass was measured before descent and used for the indirect calculation of plasma volume. Hemoglobin concentration decreased from 17.1±0.7 g/dL to 15.9±0.6 by day 1 and to 15.4±0.3 g/dL by day 5 (both p<0.001) and then increased to 16.5±0.7 g/dL the day after returning to the initial altitude. Plasma volume increased from 2,946±463 mL by 12.9±6.6% on day 1, reached a maximum of 16.2±9.7% on day 5 (both p<0.01), and decreased again to+7.4±9.5% after returning to the altitude. The change from moderate to low altitude leads to a rapid increase in plasma volume, which can be expected to affect performance by reducing oxygen transport capacity and increasing maximal cardiac output. Additionally, the athlete’s biological passport may be affected erroneously.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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The present study aimed to assess the reliability, responsiveness, and age-related and competitive level differences of a 25-m change of direction maneuver (V-cut test) in football players. Two-hundred and eighty-nine male football players performed the V-cut test. Thirty-four players underwent the test on two occasions, separated by 5–7 days, to assess test–retest reliability. Eighty-six young players performed the V-cut test three times, separated by 12 weeks, to analyze responsiveness. Finally, 89 young players of different ages (U-15 to U-20) and 80 adult players of different competitive levels performed the V-cut test several times throughout the season to examine between-group differences. Reliability analysis showed a high intraclass correlation coefficient of 0.94 and a low coefficient of variation of 0.8%. The responsiveness was dependent on maturity status, showing a positive response in pre-peak height velocity (short-term p<0.05) or post-peak height velocity (short- and long-term p<0.05) players, although the peak height velocity group did not exceed the minimal detectable change. Age-related (effect size [ES]: 0.93–5.68) and competitive-level difference (ES: 0.57–1.96) analyses reported better V-cut test performance as age and competitive-level increased in football players. The V-cut test is reliable for assessing change of direction ability and can be used to monitor change of direction ability depending on maturity, allowing it to differentiate between players of different ages and levels.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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This study investigated whether acutely consuming a large dose of a highly acidic beverage (orange juice) affects blood pH, muscle oxygenation or exercise performance in young active men. Thirteen participants completed two experimental phases. In Phase A, subjects ingested either orange juice with added sodium bicarbonate (pH 6.72±0.32; placebo) or orange juice (pH 3.50±0.99), randomly assigned. Blood pH and muscle oxygenation were monitored over 40 minutes following the ingestion of both beverages to identify any beverage-induced changed in blood pH and muscle oxygenation to guide sampling times for Phase B. In Phase B, participants consumed the same beverage as in Phase A, followed by assessments of anaerobic (Wingate test) and aerobic (peak oxygen consumption) performances, along with continuous muscle oxygenation monitoring. Results showed no significant differences (p>0.05) between treatments in blood pH, aerobic or anaerobic performance, or muscle oxygenation parameters. The acute ingestion of a highly acidic beverage like orange juice does not disrupt acid–base regulatory mechanisms or impair physiological or performance outcomes in healthy active men. These findings highlight the robustness of the body’s acid–base regulatory mechanisms and offer direct empirical evidence countering publicly circulated claims that normal dietary acidity impairs physiological function or exercise performance.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Foot muscle strength influences jumping performance, but adaptation differences between barefoot and shod training remain unclear. This study compared the effects of an 8-week training program performed barefoot (BARE), shod (SHOD), or without training (CON). Healthy habitually SHOD non-athlete adults (age: 39.0±10.6 y; height: 1.61±0.08 m; body mass: 61.5±9.8 kg) were assigned to BARE (n=19), SHOD (n=17), or CON (n=17) groups. Participants in the training groups performed 60-minute sessions twice weekly. Toe flexor strength, foot arch height, and jump performance were assessed at baseline and weeks 2, 4, 6, and 8. In the BARE group, toe flexor strength increased by 8.3% at week 2 (p≤0.05) and continued to improve through weeks 4–8 (p≤0.01, effect size=1.17), whereas gains in the SHOD group appeared at week 4 and were limited to baseline comparisons. Vertical jump height improved similarly across groups, whereas standing broad jump distance improved in the BARE group after 8 weeks (p≤0.01) and was greater than that in the CON group (p≤0.01, effect size=1.12). These findings suggest that identical barefoot training induces earlier and progressive improvements in foot muscle strength and may contribute to improved forward jump performance.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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This study aimed to (1) identify acute changes in supraspinatus and biceps longus tendon thickness after pitching and (2) determine the relationship between changes in tendon thickness and changes in glenohumeral range of motion after pitching. Fourteen healthy men with at least 5 years of baseball experience as baseball players performed 100 full-effort fast ball pitches. Tendon thicknesses and the glenohumeral internal rotation range of motion were measured before, immediately after, and 24 hours after pitching. One-way repeated-measures analysis of variance or the Friedman test with Bonferroni post hoc comparisons was performed to compare changes in tendon thicknesses and glenohumeral range of motion due to repetitive pitching and to identify the relationships between changes in tendon thicknesses and in glenohumeral internal rotation range of motion. The supraspinatus and biceps longus tendon thicknesses increased immediately (p<0.001) and 24 hours after pitching (supraspinatus: p=0.024 and biceps longus: p<0.001). The glenohumeral internal rotation range of motion decreased immediately after pitching (p<0.001) but not at 24 hours (p=0.086). The decreased glenohumeral internal rotation range of motion was associated with increased supraspinatus tendon thickness immediately after pitching (r=− 0.77 and p=0.001). Our results suggest that it takes time for tendon swelling to improve in pitchers after high-velocity repetitive pitches.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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High-density surface electromyography has recently emerged as a tool to investigate neuromuscular function across different motor tasks. Muscle fiber conduction velocity, a biophysical marker estimated from high-density surface electromyography signals, quantifies the speed of action potential propagation along muscle fibers. Currently, little information is available on the responses of muscle fiber conduction velocity during dynamic exercise. We therefore explored how cycling within two distinct exercise-intensity domains (heavy and severe) elicited substantial changes in vastus lateralis muscle fiber conduction velocity. Furthermore, we compared muscle fiber conduction velocity with averaged rectified values obtained from the same high-density surface electromyography signals, and we tested differences in their respective intra-individual variability. In the severe-intensity domain, muscle fiber conduction velocity decreased from 4.44±0.22 to 4.03±0.22 m∙s−1, whereas in the heavy-intensity domain, it increased from 4.56±0.33 to 5.02±0.42 m∙s−1 (p<0.001). Although both muscle fiber conduction velocity and averaged rectified values changed significantly over time, indicating the myoelectric manifestation of fatigue in the severe domain, muscle fiber conduction velocity showed less variability within single time points. These findings suggest that muscle fiber conduction velocity is a more robust indicator of myoelectric fatigue than averaged rectified values, even in highly dynamic contractions like cycling.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Exercise-associated gastrointestinal symptoms stemming from exercise-induced gastrointestinal syndrome are a common feature of sports participation. Exercise-associated gastrointestinal symptoms have the potential to directly impair sports performance or could indicate something more sinister warranting medical attention. Managing the underlying pathophysiological pathways of exercise-induced gastrointestinal syndrome is key to reducing exercise-associated gastrointestinal symptoms in athletes during their sporting activities. Recent advancements in exercise gastroenterology have enhanced the understanding of pathophysiology, assessment methodologies, prevention and management strategies. The current narrative review aims to provide a professional practice guide for the identification, assessment, intervention, and monitoring of exercise-induced gastrointestinal syndrome and exercise-associated gastrointestinal symptoms. A referral pathway and a four-phase approach to athlete support have been proposed. The athlete support pathway components include initial clinical assessment, gastrointestinal assessment during exercise, implementation of evidenced-informed prevention or management strategies based on the gastrointestinal assessment during exercise data interpretation, and ongoing monitoring and adjustment in real-world settings. This structured approach has been shown to reduce exercise-associated gastrointestinal symptoms and potentially mitigate underlying medical risks arising from exercise-induced gastrointestinal syndrome.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Lower extremity fractures are relatively common in winter sports. This retrospective descriptive study evaluated the demographics, injury mechanisms, and environmental factors associated with lower leg fractures (below the knee, excluding tibial plateau and fibular head fractures) among patients treated at a Colorado clinic during the 2012/13 to 2016/17 ski seasons. The chart review confirmed diagnoses and assessed associated factors. A total of 346 lower leg, ankle, and/or foot fractures were identified, representing 5.4% of all visits. The average patient age was 33.1 years (range 4–74), and 60.7% were men. Most injuries were ski-related (84.7%). The majority of fractures were sustained among skiers and snowboarders who self-identified as a beginner or an intermediate skill level (64.8%), on easy or intermediate runs (64.9%). The most common injuries were complete tibia/fibula fractures (36.4%), isolated tibia fractures (28.3%), and lateral malleolus fractures (26.9%). Of the complete tibia/fibula fractures, 57.0% were “boot-top” fractures. Danis–Weber B was the most frequent type of lateral malleolus fracture (73.6%). Only 12 foot fractures were recorded. In conclusion, lower leg fractures were more common in skiers than snowboarders and in men than women. Most fractures occurred on mild-to-moderate runs, with lower risk in older individuals. Tibia/fibula fractures were most common, followed by lateral malleolus fractures.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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The present study aimed to investigate the development of physical performance attributes across one competition year in male youth soccer players from different playing levels, while controlling for baseline performance, chronological age, and biological maturity. A total of 175 male Scottish youth soccer players from three distinct playing levels, such as grassroots, professional youth, and performance school, were recruited. Physical testing (linear sprint, change of direction, squat jump, and Yo-Yo Intermittent Recovery Test Level 1) was conducted for all players to establish baseline fitness and then repeated under matched conditions at the end of the same competition year. A Bayesian approach was used to estimate the size of any change in each physical test over the season, estimate the uncertainty around these changes, and estimate the probability of direction of these changes. In all cases, the players improved fitness testing metrics. The grassroot group made the greatest changes in physical performances but did not match absolute performance of the professional youth and performance school groups. Our results provide meaningful benchmark data for evaluating and interpreting isolated physical fitness metrics between distinct youth playing levels and may augment the ongoing critique of the discriminative ability of isolated physical fitness tests in youth soccer.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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This study investigated the temporal dynamics of metabolic energy contributions during maximal cycling sprints lasting up to 60 seconds and explored their association with key performance metrics in elite track cyclists. Fifteen elite male track cyclists (11 sprint specialists and 4 endurance specialists) performed four maximal sprints of 3, 8, 12, and 60 seconds, as well as a cardiopulmonary exercise test. Alactic, lactic, and aerobic energy contributions were quantified based on the net energy supply methodology. Energy system contributions demonstrated clear temporal specificity: the alactic pathway dominated shorter sprints (3 s: 87±4%, 8 s: 61±5%, and 12 s: 50±6%), while the lactic pathway became the primary contributor during 60-second efforts (42±4%). Despite significant inter-individual differences in sprint performance, relative energy system contributions remained consistent across athletes. Neuromuscular performance metrics, particularly maximal power output and anaerobic power reserve, emerged as primary determinants of early sprint performance, while anaerobic work capacity became increasingly important for sustaining power output during extended efforts, underscoring the importance of both neuromuscular performance and fatigue resistance. These findings support a hierarchical but metabolically interdependent model of sprint performance, in which anaerobic power initiates performance but requires aerobic support to preserve high-intensity output under fatigue. This framework informs the design of training periodization, targeted interventions, supplementation strategies, and recovery protocols in sports requiring maximal efforts lasting up to 60 seconds.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Periodontitis is a chronic inflammatory condition that involves bone resorption and leads to tooth loss. This study aimed to evaluate the biological plausibility of exercise’s potential impact on periodontal repair in rats. Forty-eight male Wistar rats received cotton ligatures around the lower first molars bilaterally. After 7 days, all animals were allocated to the following groups: control (ligature removal), early treatment (ligature removal+exercise) and late treatment (exercise alone for 28 days and then ligature removal; n=16 per group). All groups were evaluated at 28 and 56 days. Swimming exercise was performed 5 days/wk. Mandibles, blood and gingiva were collected for radiographic, histological and inflammatory analysis using multiplex. At 56 days, both exercise groups showed significantly lower bone loss compared to the control group. Histological analysis revealed that early treatment promoted increased percentages of fibroblasts and blood vessels. Late treatment provided statistically higher serum vascular endothelial growth factor levels than early treatment or control groups. In gingiva, the epidermal growth factor level was significantly higher in the exercise groups compared to the control. In conclusion, late or early treatment including exercise improved bone repair in rats, possibly through growth factor modulation.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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The interference effect associated with concurrent training has been widely debated. A recent model suggests that including sprint interval training as the endurance component may attenuate this effect. However, studies examining the impact of sprint interval training-based concurrent training on neuromuscular and cardiorespiratory adaptations are limited. This systematic review with meta-analysis evaluated the effects of concurrent training programs including sprint interval training on strength, hypertrophy, maximum oxygen consumption, and sprint performance. Searches were conducted in PubMed, Embase, and SPORTDiscus, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Randomized controlled trials in healthy adults (≥18 y) comparing sprint interval training-based concurrent training with resistance training alone, including at least six supervised sessions over 2 weeks, were eligible. Nine studies (177 participants) met the inclusion criteria. Pooled analyses showed no significant differences between sprint interval training combined with resistance training and resistance training alone for lower-body strength (standardized mean difference=0.01; p = 0.94), upper-body strength (standardized mean difference=− 0.06; p = 0.83), jump performance (standardized mean difference=0.11; p = 0.11), or sprint performance (standardized mean difference=− 0.01; p = 0.95). However, sprint interval training combined with resistance training significantly improved maximum oxygen consumption compared with resistance training alone (standardized mean difference=0.78; p = 0.001). Sensitivity analysis revealed greater jump gains with short sprint protocols (≤10 s; standardized mean difference=0.41; p = 0.025). These findings indicate that introducing sprint interval training into concurrent training enhances cardiorespiratory fitness without compromising strength or power and may potentiate jump performance when short sprints are used.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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The purpose of the current study was to identify the influence of individual characteristics on differences in body fat percentage between air displacement plethysmography and dual-energy X-ray absorptiometry (change in body fat percentage) in 360 collegiate student-athletes. Body fat percentage was obtained from air displacement plethysmography and dual-energy X-ray absorptiometry. A 2 (sex)×3 (Brozek body fat percentage, Siri body fat percentage, and dual-energy x-ray absorptiometry body fat percentage) analysis of variance was used to evaluate the difference between the body fat percentages obtained from air displacement plethysmography and dual-energy x-ray absorptiometry in men and women. The agreement between air displacement plethysmography and dual-energy X-ray absorptiometry was evaluated via Bland–Altman plot and linear regression. Multiple linear regression was used to identify the influence of sex, race, height, and body mass on the change in body fat percentages. Dual-energy X-ray absorptiometry yielded greater body fat percentages in both men (4.8±2.8; p < 0.001) and women (2.2±2.9; p < 0.001) compared to air displacement plethysmography measurements. Proportional and systematic biases were observed between air displacement plethysmography and dual-energy X-ray absorptiometry. Race, height, and mass were significant predictors of the body fat percentage difference between air displacement plethysmography and dual-energy X-ray absorptiometry (R 2=0.445, p<0.001, and standard error of the estimate=2.527). The present study suggests that air displacement plethysmography underestimates body fat percentages when compared to dual-energy X-ray absorptiometry and this underestimation may not be the same for every athlete due to their individual characteristics.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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The aim of this study was two-fold. Firstly, to assess whether uphill walking economy was related with step and ventilatory kinematics. Secondly, to examine whether uphill walking economy represented an independent performance factor in ultra-trail races. Thirty-six athletes (25 men and 11 women) completed an uphill peak exercise test and an uphill walking economy test 4–8 weeks before a 106-km ultra-trail race. Ventilatory and gait parameters were recorded during uphill walking. Body composition, jumping, and isometric and inspiratory strength were also measured. Step length and tidal volume were associated (r=0.72; p < 0.001) and they correlated with uphill walking economy (r between 0.47 and 0.58;p < 0.01). Peak speed and running power and speed and running power linked to ventilatory thresholds all correlated with race time (r between 0.51 and 0.80;p < 0.01). Uphill walking economy, when expressed as a percentage of peak oxygen uptake, explained 58% of performance variation; however, multiple regression analysis revealed that the best model comprised peak oxygen uptake alone, predicting 79% of performance. In conclusion, longer step length and greater tidal volume align with lower energy expenditure during uphill walking. Uphill walking economy is not an independent performance factor in ultra-trail races. Uphill-obtained peak oxygen uptake predicts a large percentage of performance variation in ultra-trail races.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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The R577X polymorphism in the α-actinin-3 gene (ACTN3) influences the expression of α-actinin-3, and previous studies have reported its association with muscle strength and power performance. This systematic review and meta-analysis aimed to clarify the relationship between the ACTN3 R577X polymorphism and various indicators of muscle strength and power. A systematic search of PubMed and Web of Science was conducted on 15 October 2025, and studies were included if they were published in English, involved healthy human participants, assessed muscle function, and analyzed the ACTN3 R577X genotype. Muscle function outcomes examined in this review included maximum voluntary contraction, one-repetition maximum, isokinetic strength, jump performance, sprint performance, Wingate test, chair stand test, and walking test. Fifty-three articles were included in the meta-analysis. One-repetition maximum, maximum voluntary contraction and jump performance showed a significant association with the ACTN3 R577X polymorphism in the additive model and were higher for the RR, RX and XX genotypes (one-repetition maximum: p = 0.005, maximum voluntary contraction: p = 0.006, and jump performance: p = 0.003). There was no significant association between the ACTN3 R577X polymorphism and other measurements. This study suggests that the ACTN3 R577X polymorphism is associated with one-repetition maximum, maximum voluntary contraction, and jump performance in the additive model and the impact may be stronger among men.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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The aim of the present study was to determine the responsiveness of health-related field-based physical fitness tests in adults. A total of 62 non-active participants aged 18–64 years were randomized into the intervention (n = 31) and control (n = 31) groups. The exercise program included three sessions/wk (60 min per session) of multicomponent exercise training for 12 weeks. The control group continued with their usual routines. Pre–post differences were explored with pairwise comparison analysis of variance for each group. The proportion of responders/non-responders and the percentage of the population that was expected to respond to the intervention were calculated. None of the tests changed pre–post in the control group (all p > 0.05 and Cohen’s d ≤ 0.2). In the intervention group, overall, all tests were found to be responsive (all p < 0.01) after the exercise program with an effects size improvement of moderate to large (all Cohen’s d > 0.50), except the body weight, waist circumference, and handgrip (Cohen’s d ≤ 0.1). In absolute terms, the pre- and post-test differences in the intervention group were –0.94 kg in body weight, –0.84 cm in waist circumference, 1.30 stages in the 20-m shuttle run test, –82.62 s in the 2-km walk test, 62.50 m in the 6-min walk test, –0.33 s in the 6-m gait speed test, –0.71 s in the timed up & go test, –1.23 s in the 4 x 10-m shuttle run test, 1.35 kg in the handgrip test, 17.25 cm in the standing long jump test, 3.62 repetitions in the 30-s sit to stand test and 44.11 s in the prone bridging test. The proportion of individual responders was >46%, while the proportion of the population expected to respond was >85% in most of the tests evaluated, except for the anthropometric and handgrip tests. The proportion of individual responders was>46%, while the proportion of the population expected to respond was>85% in most of the tests evaluated. All the health-related field-based physical fitness tests were found to be responsive following a 12-week multicomponent exercise training program, except the anthropometric and handgrip tests, which were less responsive than the others and might require specifically targeted interventions to respond further.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Overall performance in triathlon is largely determined by cycling and running performances, which depend on maximal and submaximal physiological factors. This study assessed the associations of these physiological factors between running and cycling in well-trained triathletes. Thirty-one male triathletes (age: 25±1 y; maximal aerobic capacity: 63.6±0.7 mL min−1 kg−1), competing in Olympic to long distance triathlon, participated in this study. Physiological parameters (maximal aerobic capacity, movement economy, fractional utilization at 4 mmol L−1 blood lactate, energy consumption, and maximal fat oxidation rate) were assessed using a combined step and a ramp protocol for cycling and running, respectively. Testing sessions were separated by 48–96 hours. Movement economy and energy consumption were analyzed at 50, 60, and 70% of each participant’s maximal aerobic capacity. All cycling performance parameters correlated with those of running. Thereby, the maximal aerobic capacity showed a correlation of ρ=0.81, and the relative use of maximal aerobic capacity at a 4 mmol L-1 lactate concentration a correlation of ρ=0.49. Furthermore, the maximal fat oxidation rate was statistically correlated with ρ=0.44, while movement economy (ρ=0.79–0.85) as well as energy consumption (ρ=0.46–0.52) showed statistical correlations over all three intensity zones (50–70%, all p < 0.050). In well-trained triathletes, central parameters like maximal aerobic capacity show strong correlations between cycling and running, while submaximal, peripheral indicators appear more discipline-specific. Thus, training should be aligned with the targeted physiological adaptation.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Cardiorespiratory fitness is a strong predictor of health and mortality. However, its gold-standard assessment, peak oxygen uptake via cardiopulmonary exercise testing, is not always feasible in clinical practice. This study aimed to (1) develop exercise-based cardiorespiratory fitness prediction models for people with vestibular hypofunction and (2) evaluate the applicability of existing models to this population. Fifty-four adults with unilateral or bilateral vestibular hypofunction (56% women) completed maximal cardiopulmonary exercise testing for peak oxygen uptake determination. Cardiorespiratory fitness prediction models were developed using maximal vestibular hypofunction and submaximal vestibular hypofunction (vestibular hypofunction-specific submaximal prediction model with gas-based analysis and vestibular hypofunction-specific submaximal prediction model without gas-based analysis) test characteristics. A 100-fold repeated cross-validation assessed model accuracy, maximal vestibular hypofunction (r=0.90 and standard error of the estimate=3.0), vestibular hypofunction-specific submaximal prediction model with gas-based analysis (r=0.86 and standard error of the estimate=3.6), and vestibular hypofunction-specific submaximal prediction model without gas-based analysis (r=0.79 and standard error of the estimate=4.3) showed high predictive accuracy, with minimal bias (< 1%). Existing equations misestimated cardiorespiratory fitness (effect size=0.56–0.68, large). Predictions within one or more metabolic equivalent of task were higher for vestibular hypofunction models, reaching up to 8–9 out of 10 individual cases. The newly developed vestibular hypofunction-specific models offer more accurate, clinically applicable tools for cardiorespiratory fitness estimation across various clinical scenarios, including settings where maximal testing is not feasible. An automated calculator was developed to support clinical implementation in vestibular hypofunction management.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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The incidence of ankle sprains and chronic ankle instability is higher in women than in men. One sex-specific factor may be the greater ligamentous laxity in women compared with men, potentially influenced by estrogen and relaxin activity. This study aimed to investigate changes in ankle joint laxity and its association with hormone levels in women with and without recurrent ankle sprains. Eleven female college students with recurrent ankle sprains and seven students with no or a single prior sprain participated. Ankle joint laxity was assessed using an ankle arthrometer with a 125-N load for anterior–posterior displacement and with a 4000 N-mm for inversion–eversion rotation. Serum estradiol and relaxin-2 levels were measured. Ankle laxity assessments and blood sampling were performed in the follicular, ovulation, and luteal phases of the participant’s individual menstrual cycle. A significant group×phase interaction was found for inversion–eversion ankle joint laxity; however, post hoc analyses adjusted for Bonferroni multiple comparisons were not significant, implying a lack of clinical interest or potential sampling fluctuations. A positive correlation was found between serum relaxin-2 level and anterior–posterior ankle joint laxity during the luteal phase (r=0.557 and p=0.048). This association should be interpreted as an observational finding that may help generate hypotheses regarding potential hormone-related factors in ankle sprains in women.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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The effectiveness of the Football+- and 11+-programs in improving landing quality among players with a history of severe ankle or knee injury remains unexplored. This study examined (i) the efficacy of these programs in developing landing assessed via the Landing Error Scoring System (LESS) and (ii) the association between injury history and landing quality. Fifty-six amateur female players (24.12±5.37 y) reported their injury history and completed the LESS test before and after a 4-month intervention. Repeated-measures analysis of variance and independent t-tests analyzed the outcomes at p≤0.05. Players with a history of severe ankle (6.33±1.53; p = 0.019 and d = –0.76) or knee (5.92±0.74; p =0.041, d =–0.77) injury exhibited higher LESS scores compared to the non-injured counterparts (5.25±1.37). Analysis of variance revealed a significant time (p = 0.001 and η 2 = 0.31) and time-group effects (p = 0.002 and η 2 = 0.24) following the 11+ (5.59±1.35 vs. 5.04±1.47) and the Football+ (5.76±1.55 vs. 4.65±1.37). A history of severe knee or ankle injury reduces the landing quality. Both the Football+ and 11+ improved landing, with the Football+ demonstrating greater efficacy. Previously injured players benefited most, although their landing performance remained inferior to non-injured peers. While the injury history is traditionally regarded as a non-modifiable risk factor, targeted neuromuscular programs may partially mitigate its impact on movement quality.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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This study investigated the effects of different session volumes on perceptual, performance, and morphological changes and their transient responses following the experimental sessions. Thirteen trained men (training experience: 5.1±1.3 y; 10 repetition-maximum squat: 131±23 kg) completed three counterbalanced experimental sessions consisting of 7, 14, or 21 total sets per session targeting the lower body. A 10 repetition-maximum test was used as a performance marker. Anterior thigh muscle thickness and echo-intensity were assessed at baseline, immediately after the session, 24, 48, and 72 hours after experimental sessions. Perceived recovery status was assessed at baseline, 24, 48, and 72 hours after experimental sessions. Rating of perceived exertion was recorded post-session only. The 14- and 21-SETS conditions resulted in greater volume load (p<0.05). Perceived recovery status and rating of perceived exertion were significantly affected by training volume (p<0.05), particularly in the 21-SETS condition, which induced higher rating of perceived exertion and lower perceived recovery status than the other conditions. No conditions or condition-by-time effects were observed for muscle thickness, echo-intensity, or 10 repetition-maximum–volume load (p>0.05). Despite distinct perceptual and volume load differences, no sustained muscle swelling or evidence of edema was observed, as muscle thickness and echo-intensity measurements returned to baseline within 24 hours post-session across all conditions.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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The aim of this review was to evaluate the impact of strength training on hamstring muscle strength and physical performance in football players. A systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and the protocol was registered in PROSPERO. A literature search was performed using four electronic databases, such as Web of Science, SCOPUS, SportDiscuss, and PubMed. Randomized controlled trials conducted with football players aged 15 years or older were included. The studies were grouped according to moderating variables such as training protocol and physical performance outcomes. A total of 20 studies met the inclusion criteria for this review, with 10 studies included in the meta-analysis. Strength training programs demonstrated moderate to large effects on both concentric and eccentric strength of the hamstrings and quadriceps, as well as on physical performance measures such as jumping and sprinting. Eccentric overload training produced the most significant benefits in sprint and jump performance. Strength training, particularly eccentric training, significantly improves both the hamstring muscle strength and the physical performance in male football players aged 15 years and older, highlighting its importance for injury prevention and sport performance enhancement. However, additional research is needed to evaluate whether similar benefits can be observed in female players and younger age groups.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Considerable concerns have been raised regarding potential neurocognitive deficits associated with participation in contact and collision sports. The purpose of this study was to assess the effect of sport-type participation on cognitive performance during the trail making test. We assessed 543 student-athletes from two universities, classified as collision, contact, or non-contact sport athletes, who performed the trail making test. Three analyses of covariance compared performance with common confounders as covariates. There was no difference between trail making test-A (p=0.381) and trail making test-B (p =0.063) times. There was a significant main effect for trail making test difference performance (non-contact: 17.3+9.1 s, contact: 20.1+10.5 s, and collision: 24.3+11.8 s; F=6.278, p=0.002, and η p 2=0.020). There was a significant post-hoc difference only between the contact/collision and non-contact groups (p=0.001 and d=0.66). Collision sport athletes exhibited worse trail making test difference performance, warranting ongoing cognitive assessments with longitudinal designs. However, collision sport athlete’s performance was better than general college students supporting the positive benefits of physical activity on cognitive performance.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Sex differences in performance loss above critical power in professional cycling are underexplored, yet crucial for tailoring training and race strategies. This study examined sex-specific differences in performance loss above critical power across accumulated work levels and effort durations in elite cyclists. Power output data from 16 female and 17 male WorldTour professionals were analyzed over one season. Performance loss was quantified after 1–5 kJ kg–1 accumulated work above critical power (∫(power output - critical power) dt for power output>critical power, normalized to body mass). Power decay was assessed for efforts of 5 and 30 seconds and 1, 5, 10, and 20 minutes. A small sex difference emerged at 1 kJ kg–1 (women: 3.73±4.12% vs. men: 2.44±4.23%, p=0.031, and d=0.31), with no differences at 2–4 kJ kg–1. At 5 kJ kg–1, men showed less loss (women: 29.58±29.35% vs. men: 16.58±10.44%, p<0.001, and d=0.60). Women exhibited greater decay in 5-minute efforts from 1 kJ kg–1 (p≤0.001) and 10–20 minute efforts from 1 to 2 kJ kg–1 (p<0.05), with gaps widening at higher work levels. Men had higher estimated maximum oxygen uptake and critical power, enabling better sustainability under high-intensity fatigue, likely due to superior aerobic capacity.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Intermittent hypoxia combined with physical training may enhance performance and health parameters but can impair session quality, limiting adaptations. To address these drawbacks, inter-effort recovery hypoxia has been proposed. This study investigated the effects of a 5-week inter-effort recovery hypoxia protocol followed by a 1-week tapering period in recreational runners. Twenty-four men were allocated to an inter-effort recovery hypoxia group (n = 11) or a normoxia group (n = 13) and assessed for body composition, hematological profile, running economy, maximum velocity, and peak oxygen uptake before training (W0), after training (W6), and after tapering (W8). Training consisted of 3 weekly sessions for 5 weeks: a 5-minute warm-up at 60% of maximum velocity, ten 1-minute effort at 120% (wk 1–3) or 130% (wk 4 and 5) of maximum velocity with 2-minute passive recovery, and 5-minute cool-down at 60% of maximum velocity. The inter-effort recovery hypoxia group inhaled hypoxic air (fraction of inspired oxygen=0.136) during warm-up, recovery bouts, and cool-down. Outcomes were analyzed using generalized linear mixed models. Peak oxygen uptake increased in the inter-effort recovery hypoxia group at W6 (+7%) and W8 (+10%), while the normoxia group improved at W8 (+7%), without group differences; running economy improved in the normoxia group at W8 (+10%). No significant changes occurred in erythropoietin, erythrocytes, hemoglobin, reticulocytes, or body composition. The 5-week inter-effort recovery hypoxia protocol enhanced peak oxygen uptake without hematological changes, indicating a feasible and non-erythropoietic strategy for improving aerobic fitness.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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This study examined positional differences in the intermittent nature of efforts during professional football matches and compared two analytical models: one using a fixed metabolic power threshold (Pmet20) and another based on the relationship between oxygen consumption and metabolic power (VO2–Pmet). Data were collected from 24 First Division players in Cyprus across 50 matches during the 2022–2023 season using GPS technology (WIMU Pro System). High and low metabolic load efforts were analyzed. Results showed significant positional differences in both the duration and intensity of high metabolic load efforts and low metabolic load efforts. Compared to the Pmet20 model, the VO2–Pmet method identified approximately twice longer high metabolic load effort durations (≈4.1 vs. 2.1 s) and about 70–150% more detected efforts across positions, together with shorter recovery intervals. A notable decline in low metabolic load effort intensity between halves was linked to reduced performance. These findings highlight the dynamic interplay between aerobic and anaerobic systems in football and emphasize the need for position-specific training. Practical applications include designing training programs that reflect the unique intermittent demands of each position, focusing on both high-intensity efforts and recovery. This study provides a robust framework for understanding the football’s intermittent nature and offers actionable strategies to enhance player performance through tailored conditioning.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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We evaluated performance and salary outcomes following ulnar collateral ligament surgery in Major League Baseball pitchers. This retrospective cohort included 277 pitchers who underwent surgery between 2000 and 2024. Among the 267 pitchers with available return-to-play data, 85% returned to professional competition and 35% had a multiyear contract at the time of injury. Performance, measured as league-adjusted changes in earned run average, fielding independent pitching, and walks plus hits per inning pitched, declined significantly after return (earned run average:+1.45, 95% confidence interval: 0.63–2.26, and p=0.01; fielding independent pitching:+0.88, 95% confidence interval: 0.50–1.27, and p<0.01; walks plus hits per inning pitched:+0.26, 95% confidence interval: 0.14–0.37, and p<0.01). In contrast, salary increased by an average of 16.6% after era adjustment. In multivariable models, greater Major League Baseball experience before injury (p=0.03), higher pre-injury wins above replacement (p<0.01), and multiyear contract status (p<0.01) independently predicted higher post-injury salary, while age, handedness, and in-season injury were not significant. Having a multiyear contract was also the only significant predictor of return-to-play (p=0.049). Overall, Major League Baseball pitchers demonstrated significant performance declines despite salary growth, reflecting service-time progression and contractual security rather than immediate post-injury output.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Futsal is a high-intensity sport with a significant risk of injury; however, current literature lacks consensus on the most prevalent injury patterns in this discipline. This study aims to describe the types and frequencies of injuries sustained by elite futsal players. We conducted an observational, retrospective analysis of injuries recorded over nine consecutive seasons within a single club, encompassing six different competitive categories. A total of 214 male athletes were monitored, representing 671 player-seasons, during which 1,043 injuries were documented. Muscle–tendon injuries of the thigh were the most frequently reported, followed by ligament injuries of the knee and ankle. Among muscle–tendon injuries, biceps femoris was the most injured muscle, while anterior cruciate ligament ruptures were the injuries associated with a higher time-loss. These findings highlight the specific anatomical regions most vulnerable to injury in elite futsal and underscore the need for targeted prevention strategies. By providing a detailed injury profile across multiple competitive levels, this study provides a starting point for the development of evidence-based injury prevention and rehabilitation programs.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Every paper in the International Journal of Sports Medicine from 1980 to 2024 (n=5,176) was reviewed to quantify female and male research participants and authors. Female individuals accounted for 23% of participants. One contributor to this under-representation is that the number of studies that include male participants is 3,847 versus 1,826 studies with female participants. Also, 417 studies included only female participants versus 2,436 studies including only male participants. Furthermore, female authors accounted for 18% of the total authors over the history of the International Journal of Sports Medicine (1,947 female and 8,698 male authors). There were also 859 papers with female first/last authors versus 1,212 papers with male first/last authors. Thus, this journal has substantially less of HERstory than HIStory, in terms of research participants and manuscript authors. Using these data, we also ‘forecast’ when equal representation might be achieved (when the number of female and male authors/participants at that time would be equal in a given year). The predicted timelines to achieve this were: ~800 years for female research participants, ~ 46 years for female participant studies, ~ 155 years for female only participant studies, ~22 years for female and male authors, and ~ 13 years for female and male first/last authors.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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The objective was to analyze the effect of anodic transcranial direct current stimulation over the the primary motor cortex (M1) on resistance exercise in mentally fatigued individuals. Thirty-five participants performed a Stroop task to induce mental fatigue until they reached 50 mm on the visual analogue scale under three different conditions in a randomized, double-blind, crossover experimental trial. The participants completed a resistance training session with six sets for muscle failure with fixed load (Vload=1 ms-1) after the Stroop task. During the resistance training session, performance parameters as the maximum number of repetitions, power output, and bar velocity were recorded with a linear encoder. Muscle activation (surface electromyography) and the rating of perceived exertion were also measured throughout the resistance training session. The maximum number of repetitions, mean power output, and mean velocity were higher under the anodic transcranial direct current stimulation condition when compared to the sham and control conditions (p<0.05). Meanwhile, the relative surface electromyographic activity of the vastus lateralis, and the rating of perceived exertion per set were lower under the anodic transcranial direct current stimulation condition when compared to sham and control conditions (p<0.05). This study suggest that anodic transcranial direct current stimulation-induced arousal over the left-M1 brain area thus improving the resistance exercise performances while reducing vastus lateralis surface electromyographic activity and rating of perceived exertion in mentally fatigued subjects.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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This study examined the muscle oxygen saturation profiles of core and thigh muscles during cycling and investigated their relationship with gross efficiency across various cycling intensities. Eleven male cyclists and triathletes performed a graded exercise test using a cycle ergometer. Muscle oxygen saturation was measured in the vastus lateralis, biceps femoris long head, erector spinae, and external oblique muscles at each intensity level, along with gross efficiency. The percentage of peak power output at which muscle oxygen saturation began to decrease significantly from the initial load was 60% in the vastus lateralis, 80% in the biceps femoris long head, and 70% in both the erector spinae and external oblique muscles (p<0.05 or p<0.01). In contrast, no significant differences in deoxygenation between muscles were observed at intensities between 60% and 90% of peak power output. At 80% of peak power output, a significant positive correlation was found between gross efficiency and oxygen saturation in the erector spinae (r=0.745, p<0.01). In conclusion, the oxygen saturation profile of core muscles are comparable to those of thigh muscles, and oxygen saturation in the erector spinae may contribute to gross efficiency during high-intensity cycling.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Fastpitch softball is popular among adolescent and collegiate female athletes. Softball pitchers are susceptible to overuse injuries, and clinical and performance outcome measures can be used to evaluate injury risk and readiness to return to play. Our purpose was to examine clinical and performance-related outcome measures in pitchers using a systematic review of the softball literature published since 1990. PubMed, Embase, CINAHL, and SPORTDiscus databases were searched using the term “softball” AND “pitching” OR “injuries”. Inclusion criteria were studies reporting clinical or performance outcomes like strength, range of motion, anthropometrics, and patient-reported measures. A preliminary screening of studies was completed based on abstracts. Full-text articles were reviewed by two reviewers. Thirty-seven studies met all inclusion criteria. The risk of bias was low for all included studies. Studies reporting body composition (n = 4), range of motion (n = 10), strength (n=12), functional testing (n=4), and patient-reported outcomes (n=3) were included in data extraction. There was a high degree of variability in outcome measures used to evaluate softball pitchers. Ten case studies were included in the discussion of results. Researchers would benefit from a standardized list and protocol for clinical and performance outcome measures used for softball pitchers. This systematic review identifies important gaps in the literature.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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