Detraining: loss of training-induced physiological and performance adaptations. Part II: Long term insufficient training stimulus

Effects of detraining on left ventricular mass in endurance-trained individuals: a systematic review and meta-analysis

AIMS

Detraining refers to a loss of training adaptations resulting from reductions in training stimulus due to illness, injury, or active recovery breaks in a training cycle and is associated with a reduction in left ventricular mass (LVM). The purpose of this study was to conduct a systematic review and meta-analysis to determine the influence of detraining on LVM in endurance-trained, healthy individuals.

METHODS AND RESULTS

Using electronic databases (e.g. EMBASE and MEDLINE), a literature search was performed looking for prospective detraining studies in humans. Inclusion criteria were adults, endurance-trained individuals with no known chronic disease, detraining intervention >1 week, and pre- and post-detraining LVM reported. A pooled statistic for random effects was used to assess changes in LVM with detraining. Fifteen investigations (19 analyses) with a total of 196 participants (ages 18-55 years, 15% female) met inclusion criteria, with detraining ranging between 1.4 and 15 weeks. The meta-analysis revealed a significant reduction in LVM with detraining (standardized mean difference = -0.586; 95% confidence interval = -0.817, -0.355; P < 0.001). Independently, length of detraining was not correlated with the change in LVM. However, a meta-regression model revealed length of the detraining, when training status was accounted for, was associated with the reduction of LVM (Q = 15.20, df = 3, P = 0.0017). Highly trained/elite athletes had greater reductions in LVM compared with recreational and newly trained individuals (P < 0.01). Limitations included relatively few female participants and inconsistent reporting of intervention details.

CONCLUSION

In summary, LVM is reduced following detraining of one week or more. Further research may provide a greater understanding of the effects of sex, age, and type of detraining on changes in LVM in endurance-trained individuals.

The COVID-19 lockdown as a model of detraining in division 1 college softball players

BACKGROUND

The COVID-19 pandemic interrupted the organized training of softball players, similar to the abrupt cessation of sports participation that can happen after an injury. Thus, the COVID-19 pandemic offers a unique model to study how sudden detraining influences softball players.

METHODS

We recruited a sample of convenience of National Collegiate Athletic Association Division 1 softball players. They participated in three data collections: pre-lockdown (Jan 2020, T1), post-lockdown (Sept 2020, T2), and before the 2021 season (Jan 2021, T3). Between T1 and T2, players received an at-home conditioning and throwing program, but compliance was not strictly monitored. Between T2-T3, players resumed formal fall training (team-organized workouts, on-field practice, and within-team scrimmage games). At each time point, we collected bilaterally: 1) shoulder internal rotation (IR) and external rotation (ER) range of motion (ROM); 2) shoulder IR and ER strength; 3) hip IR and ER ROM; and 4) hip abduction and extension strength. We used four independent (2 Sides × 3 Timepoints) MANOVA with repeated measures; we followed up significant MANOVA main effect of time with Sidak posthoc tests for pairwise comparisons between time points.

RESULTS

Fifteen players participated in this study. We found a significant MANOVA main effect of time for shoulder and hip ROM (p < 0.01). Between T1-T2, dominant shoulder ER ROM decreased 6.5°, dominant shoulder IR ROM increased 4.3°, and lead hip IR ROM increased 4.4°. Between T2-T3, dominant shoulder ER ROM increased 6.3° and trail hip ER ROM increased 5.9°. We found a significant MANOVA main effect of time for shoulder strength (p = 0.03) but not for hip strength (p = 0.18). Between T2-T3, non-dominant shoulder IR and ER increased 1.8 kg and 1.5 kg, respectively.

CONCLUSION

A sudden and prolonged cessation of organized training generated changes in shoulder and hip ROM but affected strength to a lesser extent. The loss of shoulder ER and increased lead hip IR ROM are maladaptive as they are associated with injury in overhead athletes. Resuming team-organized training and scrimmage reversed some (shoulder ER), but not all of these changes. Practitioners should monitor clinical variables regularly and be aware of potential changes due to unexpected and prolonged interruptions in training, such as when players suffer sports-related injuries.

Role of hierarchy structure on the mechanical adaptation of self-healing hydrogels under cyclic stretching

Soft materials with mechanical adaptability have substantial potential for various applications in tissue engineering. Gaining a deep understanding of the structural evolution and adaptation dynamics of soft materials subjected to cyclic stretching gives insight into developing mechanically adaptive materials. Here, we investigate the effect of hierarchy structure on the mechanical adaptation of self-healing hydrogels under cyclic stretching training. A polyampholyte hydrogel, composed of hierarchical structures including ionic bonds, transient and permanent polymer networks, and bicontinuous hard/soft-phase networks, is adopted as a model. Conditions for effective training, mild overtraining, and fatal overtraining are demonstrated in soft materials. We further reveal that mesoscale hard/soft-phase networks dominate the long-term memory effect of training and play a crucial role in the asymmetric dynamics of compliance changes and the symmetric dynamics of hydrogel shape evolution. Our findings provide insights into the design of hierarchical structures for adaptive soft materials.

Prevalence of Obesity and Lifestyle Risk Factors Following Two Years' COVID-19 Related Service Closure at Wellness Center, Primary Health Care

Background

COVID-19 lockdown has affected health behaviors and daily life in unprecedented ways. This study aimed to assess (i) the prevalence of lifestyle behaviors including physical activity, sedentary behavior, sleep, and stress levels during the COVID confinement, and (ii) evaluate anthropometric measures, body composition, cardiopulmonary and muscular endurance among regular Wellness Center attendees, following two years' service closure.

Methods

A cross-sectional study was undertaken between 1st June 2022 and 30th January 2023. A structured validated questionnaire was utilized to retrospectively collect data related to the closure period, and quantitative objective measurements were obtained at the time of data collection.

Results

A total of 100 adults with a mean age of 49.6 ± 10.5 years, mostly female (80%) and Qatari (76%) participated in the study. The results revealed high rates of low physical activity (47%), sedentary behavior (62%), poor sleep (58%), and stress levels (61% moderate and 5% high). Results also confirmed high prevalence of obesity (57%) marked by BMI and body circumferences, fat mass (34 ± 10.5 kg)/fat percentage (42.7 ± 7.2%) and muscle mass (20.6 ± 5.4 kg)/muscle percentage (25.4 ± 3.9%) above and below normal levels, respectively. The average cardiopulmonary (mean VO2 MAX was 15.5 ± 11 mL O2kg-1min-1) and muscular endurance (pushups per min 19 ± 8.9, L-sit 46 ± 35 secs, plank 42.7 ± 27.8 secs) were distinctly below normal levels for age and sex.

Conclusion

The findings indicate that physically active adults have experienced adverse lifestyle behaviors during the COVID-19 lockdown. Obesity, unfavorable body composition, low cardiopulmonary and muscular endurance were evident. More emphasis should be put on the development of targeted intervention strategies to promote positive lifestyle behaviors during any potential future crises.

Effects of a Short-Term Detraining Period on the Strength Deficit and Functional Performance of Highly Trained Soccer Players

ABSTRACT

Loturco, I, Grazioli, R, Veeck, F, Nakamura, FY, Inácio, M, Schons, P, Preissler, A, Pinto, RS, Pereira, LA, McGuigan, MR, and Cadore, EL. Effects of a short-term detraining period on the strength deficit and functional performance of highly trained soccer players. J Strength Cond Res 37(10): 2058-2063, 2023-The aim of this study was to examine the effects of a 4-week detraining period on the neuromuscular performance of highly trained soccer players. Pre and post detraining, 18 adult soccer players (age: 27 ± 4.9 years; height: 180.2 ± 7.1 cm; body mass [BM]: 78.9 ± 7.6 kg) performed vertical jumps, 20-m linear sprints, curve sprint and change of direction speed tests, and a progressive loading test in the half-squat exercise with loads corresponding to 50, 100, and 150% of the players' BM to assess the peak-force (PF), mean power (MP), and strength-deficit (SDef). Pre and post differences in the variables of interest were analyzed using paired t -tests and effect sizes (ES). No significant changes were detected for vertical jumping height and sprint times. Higher PF at 50 and 100% BM and lower SDef were shown when comparing pre- and postassessments (ES = 0.66, 0.68, 0.55; p = 0.018, 0.016, and 0.046, respectively). The MP at 50 and 100% BM increased significantly after the detraining phase (ES = 0.56, 0.82; p = 0.049 and 0.007, respectively). The results indicate that these athletes were able to maintain and achieve satisfactory levels of performance after a short period of training cessation. Interestingly, some strength- and power-derived parameters improved significantly after short-term detraining, which may have important implications for training programs aimed at maximizing speed and power performance. It is recommended that coaches test their players not only at the beginning but also at the end of the season, to better evaluate variations in performance and thus create more efficient and tailored training strategies.

Long-term detraining reverses the improvement of lifelong exercise on skeletal muscle ferroptosis and inflammation in aging rats: fiber-type dependence of the Keap1/Nrf2 pathway

We investigated the effects of lifelong aerobic exercise and 8 months of detraining after 10 months of aerobic training on circulation, skeletal muscle oxidative stress, and inflammation in aging rats. Sprague-Dawley rats were randomly assigned to the control (CON), detraining (DET), and lifelong aerobic training (LAT) groups. The DET and LAT groups began aerobic treadmill exercise at the age of 8 months and stopped training at the 18th and 26th month, respectively; all rats were sacrificed when aged 26 months. Compared with CON, LAT remarkably decreased serum and aged skeletal muscle 4-hydroxynonenal (4-HNE) and 8-hydroxy-2-deoxyguanosine (8-OHdG) levels. Superoxide dismutase 2(SOD2) levels were higher in the LAT group than in the CON group in skeletal muscle. However, DET remarkably decreased SOD2 protein expression and content in the skeletal muscle and increased malondialdehyde (MDA) level compared with LAT. Compared with LAT, DET remarkably downregulated adiponectin and upregulated tumor necrosis factor alpha (TNF-α) expression, while phosphoinositide 3-kinase (PI3K), protein kinase B (AKT), and 70-kDa ribosomal protein S6 kinase (P70S6K) protein expression decreased, and that of FoxO1 and muscle atrophy F-box (MAFbX) proteins increased in the quadriceps femoris. Adiponectin and TNF-α expression in the soleus muscle did not change between groups, whereas that of AKT, mammalian target of rapamycin (mTOR), and P70S6K was lower in the soleus in the DET group than in that in the LAT group. Compared with that in the LAT group, sestrin1 (SES1) and nuclear factor erythroid 2-related factor 2 (Nrf2) protein expression in the DET group was lower, whereas Keap1 mRNA expression was remarkably upregulated in the quadriceps femoris. Interestingly, the protein and mRNA levels of SES1, Nrf2, and Keap1 in soleus muscle did not differ between groups. LAT remarkably upregulated ferritin heavy polypeptide 1(FTH), glutathione peroxidase 4(GPX4), and solute carrier family 7member 11 (SLC7A11) protein expression in the quadriceps femoris and soleus muscles, compared with CON. However, compared with LAT, DET downregulated FTH, GPX4, and SLC7A11 protein expression in the quadriceps femoris and soleus muscles. Long-term detraining during the aging phase reverses the improvement effect of lifelong exercise on oxidative stress, inflammation, ferroptosis, and muscle atrophy in aging skeletal muscle. The quadriceps femoris is more evident than the soleus, which may be related to the different changes in the Keap1/Nrf2 pathway in different skeletal muscles.

Effect of Moderate-Intense Training and Detraining on Glucose Metabolism, Lipid Profile, and Liver Enzymes in Male Wistar Rats: A Preclinical Randomized Study

Exercise training positively regulates glucose metabolism. This study investigated the impact of training and detraining on glucose metabolism, lipid profiles, and liver enzymes. Twenty-six rats completed an initial 4-week moderate-intense training (T0-T4). Then, the animals were randomly assigned to two groups at the end of week 4: AT4: detraining for 8 weeks; AT8: training for 8 weeks and 4-week detraining. Six animals were sacrificed at T0 and T4, four animals/group at T8, and three/group at T12. The study continued for 12 weeks, and all parameters were assessed at T0, T4, T8, and T12. IPGTT significantly improved after 4 weeks of training (p < 0.01) and was further reduced in AT8 at T8. In AT8, 8-week training significantly reduced total cholesterol at T4 and T12 vs. T0 (p < 0.05), LDL at T4, T8, and T12 vs. T0 (p < 0.01), ALP at T8, T12 vs. T0 (p < 0.01), and increased HDL at T8 and ALT at T8 and T12 vs. T0 (p < 0.05). Triglycerides and hexokinase activity increased significantly at T4 and T8 (p < 0.05) and then decreased at T12 in AT8. Pyruvate and glycogen increased at T12 in AT8 vs. AT4. Eight-week training improved LPL and ATGL expressions. Training positively modulated insulin, glucose metabolism, and lipid profiles, but detraining reduced the benefits associated with the initial training.

Eighteen-Month Changes in Physical Activity, Body Weight, Quadriceps Strength, and Gait Biomechanics during the COVID-19 Pandemic

PURPOSE

This study assessed the effects of the COVID-19 pandemic restrictions/lockdowns on physical activity levels, body mass, quadriceps strength, and gait biomechanics over 18 months.

METHODS

Ten healthy men were assessed at baseline (~14 wk before first lockdown) and 17.9 ± 0.3 months later (<1 wk after second lockdown). At both times, physical activity levels, body mass, and quadriceps strength were acquired using the International Physical Activity Questionnaire, a force plate, and a dynamometer, respectively. Gait data were also acquired using a motion capture system and force plates during self-paced walking, from which spatiotemporal parameters, knee angles, and external moments were computed. Baseline and follow-up measurements were compared using two-tailed paired t -tests ( α = 0.05).

RESULTS

At follow-up, participants spent less time doing vigorous physical activity (∆ = -76 ± 157 min·wk -1 , P = 0.048), exhibited a tendency toward increased sedentary time (∆ = +120 ± 162 min·d -1 , P = 0.056), weighed more (∆ = +2.5 ± 2.8 kg, P = 0.021), and showed a trend toward reduced quadriceps strength (∆ = -0.29 ± 0.45 (N·m)·kg -1 , P = 0.071) compared with baseline. At follow-up, participants walked slower (∆ = -0.09 ± 0.07 m·s -1 , P = 0.005), had greater knee flexion angles at heel strike (∆ = +2.2° ± 1.8°, P = 0.004) and during late stance (∆ = +2.2° ± 1.8°, P = 0.004), had reduced knee extension moments (∆ = -0.09 ± 0.09 (N·m)·kg -1 , P = 0.012) and knee internal rotation moments (∆ = -0.02 ± 0.02 (N·m)·kg -1 , P = 0.012) during late stance.

CONCLUSIONS

Healthy men exhibited reduced physical activity levels, increased body weight, a tendency toward reduced quadriceps strength, and altered gait biomechanics over the initial 18 months of the COVID-19 pandemic-alterations that could have far-reaching health consequences.

Effect of two weeks of training cessation on concentric and eccentric knee muscle strength in highly trained sprinters

Athletes often experience short-term training cessation because of injury, illness, post-season vacation, or other reasons. Limited information is available about the effect of short-term (less than four weeks) training cessation on muscle strength in athletes. Sprinting athletes must maintain knee extension and flexion strength to reduce the risk of sprint-type hamstring strain injury. This study aimed to identify whether and to what extent knee extension and flexion torque in concentric and eccentric contractions is reduced by two weeks of training cessation in sprinters. Before and after the training cessation, maximal voluntary isokinetic knee extension and flexion torque in slow and fast concentric (60 and 300°/s) and slow eccentric (60°/s) contractions were assessed in 13 young male highly trained sprinters (average World Athletics points = 978). Knee flexion torque during the bilateral Nordic hamstring exercise (NHE) was also measured. After the training cessation, isokinetic concentric at 300°/s and eccentric torque were significantly reduced in both knee extension and flexion. There was no difference in the magnitude of reduction between isokinetic knee extension and flexion torques in all conditions. The relative changes were more notable in eccentric (-15.0%) than in concentric contraction at 60°/s (-0.7%) and 300°/s (-5.9%). Knee flexion torque during the NHE also declined (-7.9% and -9.9% in the dominant and non-dominant legs, respectively). There was no significant correlation between the relative reductions in isokinetic knee flexion torque and knee flexion torque during the NHE. The findings suggest that sprinters and their coaches should focus on recovering fast concentric and slow eccentric knee extension and flexion strength after two weeks of training cessation.

Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial

Importance

Exercise, cognitive training, and vitamin D may enhance cognition in older adults with mild cognitive impairment (MCI).

Objective

To determine whether aerobic-resistance exercises would improve cognition relative to an active control and if a multidomain intervention including exercises, computerized cognitive training, and vitamin D supplementation would show greater improvements than exercise alone.

Design, Setting, and Participants

This randomized clinical trial (the SYNERGIC Study) was a multisite, double-masked, fractional factorial trial that evaluated the effects of aerobic-resistance exercise, computerized cognitive training, and vitamin D on cognition. Eligible participants were between ages 65 and 84 years with MCI enrolled from September 19, 2016, to April 7, 2020. Data were analyzed from February 2021 to December 2022.

Interventions

Participants were randomized to 5 study arms and treated for 20 weeks: arm 1 (multidomain intervention with exercise, cognitive training, and vitamin D), arm 2 (exercise, cognitive training, and placebo vitamin D), arm 3 (exercise, sham cognitive training, and vitamin D), arm 4 (exercise, sham cognitive training, and placebo vitamin D), and arm 5 (control group with balance-toning exercise, sham cognitive training, and placebo vitamin D). The vitamin D regimen was a 10 000 IU dose 3 times weekly.

Main Outcomes and Measures

Primary outcomes were changes in ADAS-Cog-13 and Plus variant at 6 months.

Results

Among 175 randomized participants (mean [SD] age, 73.1 [6.6] years; 86 [49.1%] women), 144 (82%) completed the intervention and 133 (76%) completed the follow-up (month 12). At 6 months, all active arms (ie, arms 1 through 4) with aerobic-resistance exercise regardless of the addition of cognitive training or vitamin D, improved ADAS-Cog-13 when compared with control (mean difference, -1.79 points; 95% CI, -3.27 to -0.31 points; P = .02; d = 0.64). Compared with exercise alone (arms 3 and 4), exercise and cognitive training (arms 1 and 2) improved the ADAS-Cog-13 (mean difference, -1.45 points; 95% CI, -2.70 to -0.21 points; P = .02; d = 0.39). No significant improvement was found with vitamin D. Finally, the multidomain intervention (arm 1) improved the ADAS-Cog-13 score significantly compared with control (mean difference, -2.64 points; 95% CI, -4.42 to -0.80 points; P = .005; d = 0.71). Changes in ADAS-Cog-Plus were not significant.

Conclusions and Relevance

In this clinical trial, older adults with MCI receiving aerobic-resistance exercises with sequential computerized cognitive training significantly improved cognition, although some results were inconsistent. Vitamin D supplementation had no effect. Our findings suggest that this multidomain intervention may improve cognition and potentially delay dementia onset in MCI.

Trial Registration

ClinicalTrials.gov Identifier: NCT02808676.

Effect of Exercise and Detraining on Signs of Puberty and Selected Inflammatory Markers in Girls with Precocious Puberty

PURPOSE

We examined the effects of aerobic exercise and detraining on adiponectin, resistin, tumor necrosis factor alpha (TNF-α), white blood cell, and pubertal signs (uterine length, ovarian volume, luteinizing hormone [LH], and follicle-stimulating hormone [FSH]) in girls with central precocious puberty (CPP).

METHODS

Thirty girls with CPP (7-9 yr old) were randomly divided into CPP and CPP + Exercise (EX) groups. Fifteen healthy age-matched girls without precocious puberty participated for comparison with CPP. Subjects in the CPP + EX group attended 12 wk of aerobic exercise protocol three sessions a week. In the baseline, after completing the exercise protocol and after 4 wk of detraining, all the parameters were measured. In the CPP and healthy groups, all the parameters were measured in all three stages. To measure adiponectin, resistin, and TNF-α, the ELISA method was used. LH and FSH were measured by electrochemiluminescence immunoassay. White blood cell counts were analyzed by an automated blood cell counter. Repeated-measures ANOVA was used to analyze the results.

RESULTS

CPP girls have lower adiponectin ( P = 0.01) and higher TNF-α levels ( P = 0.001) than healthy girls. In the CPP + EX group, after 12 wk, body weight and fat mass decreased, and adiponectin increased significantly ( P = 0.02). Resistin ( P = 0.02), TNF-α ( P = 0.02), neutrophils ( P = 0.01), and signs of puberty significantly ( P < 0.05) decreased. After detraining, no significant change was observed except TNF-α, which increased significantly ( P = 0.03). In the CPP group, no significant change was observed in any of the parameters; only LH ( P = 0.0001) and uterine length and ovarian volume ( P = 0.003, P = 0.001) decreased after 12 and 16 wk, respectively.

CONCLUSIONS

Aerobic exercise can have a positive effect on the state of inflammation and pubertal signs. Positive effects remain after 4 wk of detraining.

Impact of the COVID-19 Pandemic Hiatus From Sports Activities on Injuries Observed Among Division I NCAA Athletes

Background

The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted athletic activities, including those in the Pacific 12 (Pac-12) Conference of the National Collegiate Athletic Association. It is currently unknown how the disruption in training and competition impacted athletes' risk of injury upon resumption of activities.

Purpose

To describe and compare the rate, timing, mechanism, and severity of injuries among collegiate athletes across multiple sports in the Pac-12 Conference before and after the COVID-19 pandemic-associated hiatus of intercollegiate athletic activities.

Study Design

Descriptive epidemiology study.

Methods

Descriptive and injury data among intercollegiate athletes from both the season before the hiatus and the season after the hiatus were acquired from the Pac-12 Health Analytics Program database. Injury elements (timing of injury onset, injury severity, mechanism, recurrence, outcome, need for procedural intervention, and event segment during which the injury took place) were compared by time using the chi-square test and a multivariate logistic regression model. Subgroup analyses were performed on knee and shoulder injuries among athletes participating in sports with traditionally high rates of knee and shoulder injuries.

Results

A total of 12,319 sports-related injuries across 23 sports were identified, with 7869 pre-hiatus injuries and 4450 post-hiatus injuries. There was no difference in the overall incidence of injury between the pre-hiatus and post-hiatus seasons. However, the proportion of noncontact injuries was higher in the post-hiatus season for football, baseball, and softball players, and the proportion of nonacute injuries in the post-hiatus season was higher among football, basketball, and rowing athletes. Finally, the overall proportion of injuries sustained by football players in the final 25% of competition or practice was higher in the post-hiatus season.

Conclusion

Athletes competing in the post-hiatus season were observed to have higher rates of noncontact injuries and injuries sustained in the final 25% of competition. This study demonstrates that the COVID-19 pandemic has had varied effects on athletes from different sports, suggesting that many factors must be considered when designing return-to-sports programs for athletes after an extended absence from organized training.

Soccer Players' Sleep Quality and Training Load Were Affected by the COVID-19 Lockdown: An International Survey

BACKGROUND

The effect of the 2020 COVID-19 lockdown on athlete sleep and training behavior is documented, albeit without a worldwide soccer-specific focus.

METHOD

Soccer (football) players (N = 1639; 30 countries; age 22.5 [5.7] y; 81% ≤25 y; 56% male; 30% elite; 66% Muslim) answered a retrospective, cross-sectional questionnaire related to their behavioral habits before and during COVID-19 lockdown (survey period July to September 2020), including (1) Pittsburgh Sleep Quality Index PSQI, (2) Insomnia Severity Index (ISI), (3) bespoke questions about training behaviors, and (4) Muslim player focused sleep and training behavior questions.

RESULTS

During lockdown (compared to prelockdown), PSQI (P < .001; moderate effect size [ES]) and ISI (P < .001; moderate ES) scores were higher in the overall sample and in elite versus nonelite (PSQI: P < .05; small ES and ISI: P < .001; small ES), >25 years versus ≤25 years (PSQI: P < .01; small ES and ISI: P < .001; moderate ES), females versus males (PSQI: P < .001; small ES), <1 month versus >1 month lockdown (PSQI: P < .05; small ES and ISI: P < .05; small ES), and players maintaining versus reducing training intensity (PSQI: P < .001; moderate ES and ISI: P < .001; small ES). Muslim players (41%) reported unfavorable sleep and/or training behaviors during Ramadan in lockdown compared to lockdown outside of Ramadan.

CONCLUSIONS

Specific subgroups appear more vulnerable to lockdown effects, with training-intensity maintenance moderating negative effects relative to sleep. Policy and support (respectful of subgroup nuances) during lockdown-like challenges that facilitate training (including intensity) appear prudent, given their favorable relationship with sleep, mental health, and physical health, in the present data and elsewhere.

Lessons from the COVID-19 pandemic: Insights into effective training strategies for physical development in football

Professional soccer players typically perform regular training sessions and match play for most of the yearly macrocycle with limited time focused on solely developing physical development. The COVID-19 outbreak in 2020 caused mass disruption to professional soccer but provided an opportunity for an alternative approach to training in attempt to develop professional soccer players physical fitness levels. In a non-randomised and non-controlled study, we aimed to assess the effectiveness of a 13-week remote based physical training programme on physical fitness levels in elite professional soccer players. Twenty professional soccer players undertook body composition assessments, a countermovement jump (CMJ) test, eccentric hamstring strength test and a submaximal 30-15 intermittent fitness test (IFT) pre- and post-remote based training programme. Body mass (79.3 ± 6.7 vs. 80.0 ± 7.3 kg), skinfold thickness (54.1 ± 14.8 vs. 56.7 ± 15.2 mm), maximum CMJ height (38.4 ± 3.4 vs. 40.9 ± 4.1 cm), eccentric hamstring strength (1035 ± 158 vs. 1009 ± 140 n) and percentage max heart rate reached in submaximal 30-15 IFT (81.3 ± 5.2 vs. 82.3 ± 7.3%) were maintained (all P > 0.05) from pre- to post training programme, respectively. Although team-based soccer specific training load was removed, and the training programmes prescribed had an increased physical focus, fitness levels were maintained. This suggests that alternative modes of training can potentially be used in instances where team-based soccer specific training load isn't required or is unavailable, without negatively impacting physical development.

The Psychology of Athletic Tapering in Sport: A Scoping Review

Taper is a common training strategy used to reduce fatigue and enhance athletic performance. However, currently, no review has summarised what psychological research has been conducted examining taper, what this research shows and what future research needs to be undertaken to extend the field. Consequently, a scoping review was conducted with three aims: (a) to determine the characteristics of psychological research examining taper, (b) to summarise psychological research collected during taper with adult athletes and coaches, and (c) to identify gaps in psychological research examining taper. Forty-eight articles were identified following an exhaustive search strategy and charted following scoping review guidelines. Results showed most research was quantitative, used a longitudinal design, was conducted in swimming, triathlon, cycling or across multiple sports, and used a university-, regional- or national-level male athlete sample. Eight themes were developed to summarise the research: Mood, Perception of Effort, Perceived Fatigue and Wellness, Recovery-Stress, Taper as a Stressor, Stress Tolerance, Psychological Preparation and Cognitive Functioning. Additionally, four research recommendations were identified: (a) conducting exploratory research that examines the impact taper has on athletes' and coaches' competition preparation and stress experience, (b) asking more advanced psychological questions and conducting multi-disciplinary research, (c) including a more diverse participant sample in studies and (d) examining the impact of psychological interventions during taper. Overall, this scoping review has highlighted the limited research examining the psychology of taper and the need for focused research that asks more complex questions across diverse populations.

Looking back on the COVID-19 pandemic in an elite sports team using whole genome sequencing

Objectives

The aim of this study was to investigate the effectiveness of infection control measures to prevent transmission of SARS-CoV-2 within a professional sports team using whole genome sequencing (WGS).

Design

Prospective cohort study.

Methods

74 players and staff members of a Dutch professional male football team were followed from August 2020 until May 2021. A set of health and safety measures were introduced and all participants underwent regular SARS-CoV-2 RNA testing. All positive samples were subsequently sequenced (Nanopore sequencing) to assess whether infections were acquired within the training center or in the community.

Results

Throughout the study period, 13 participants tested positive for SARS-CoV-2. The phylogenetic analysis revealed 3 clusters (of 2 and 3 cases respectively), indicating that 3/13 cases (23%) acquired infection from another player or staff member. The first cluster was diagnosed upon enrolment, thus transmission had occurred prior to the implementation of health and safety protocols. Finally, 4 cases were diagnosed prior to symptom onset, emphasizing that frequent testing leads to early detection and isolation.

Conclusion

These data show that a combination of regular testing and basic control measures can prevent outbreaks of COVID-19 in a professional sports team. WGS is an important tool to distinguish between infections introduced from the community and infections transmitted between athletes.

Using Rational Emotive Behavior Therapy to Improve Psychological Adaptation among Future Coaches in the Post-Pandemic Era

This study aims to demonstrate that applying rational emotional behavior theory (REBT) concepts can help to improve the psychological adaptation of future coaches in the post-pandemic era. The current research utilizes a qualitative approach with a sample of 14 future coaches, namely, students of the study program “Training systems” at Lithuanian Sports University. These students are also active athletes (basketball players). Interview questions were developed based on the ABC(DE) model, and answers were analyzed following the methodology of content analysis. In general, our findings fit the ABC(DE) framework. However, there are several important exceptions. During discussions, participants presented their basic beliefs in the form of statements rather than demands. The ABC(DE) framework predicts the latter. Furthermore, participants’ automatic thoughts are not logical derivatives of their basic beliefs, contrary to the REBT theory. However, it is possible to interpret basic beliefs as an explanation for automatic thoughts, meaning that this interpretation seemingly does not contradict the theoretical principles of REBT. As such, REBT appears to be helpful for better understanding the psychological adaptation problems that arose during the pandemic and are relevant in the post-pandemic era.

Cardiorespiratory optimal point as a submaximal evaluation tool in endurance athletes: An exploratory study

Introduction: The cardiorespiratory optimal point (COP) represents the lowest minute ventilation to oxygen consumption ratio (VE/VO2) and can be estimated during a CPET at submaximal intensity when an exercise test until volitional fatigue is not always advisable (i.e., a conflict zone where you cannot be confident of the security because near-competition, off-season, among other). COP's physiological components have not been wholly described yet. Therefore, this study seeks to identify the determinants of COP in highly trained athletes and its influence on maximum and sub-maximum variables during CPET through principal c omponent analysis (PCA) (explains the dataset's variance). Methods: Female (n = 9; age, 17.4 ± 3.1 y; maximal VO2 [VO2max]), 46.2 ± 5.9 mL/kg/min) and male (n = 24; age, 19.7 ± 4.0 y; VO2max, 56.1 ± 7.6 mL/kg/min) athletes performed a CPET to determine the COP, ventilatory threshold 1 (VT1) and 2 (VT2), and VO2max. The PCA was used to determine the relationship between variables and COP, explaining their variance. Results: Our data revealed that females and males displayed different COP values. Indeed, males showed a significant diminished COP compared to the female group (22.6 ± 2.9 vs. 27.2 ±3.4 VE/VO2, respectively); nevertheless, COP was allocated before VT1 in both groups. Discussion: PC analysis revealed that the COP variance was mainly explained (75.6%) by PC1 (expired CO₂ at VO2max) and PC2 (VE at VT2), possibly influencing cardiorespiratory efficiency at VO2max and VT2. Our data suggest that COP could be used as a submaximal index to monitor and assess cardiorespiratory system efficiency in endurance athletes. The COP could be particularly useful during the offseason and competitive periods and the return to the sports continuum.

Effects of the COVID-19 confinement period on hip strength, flexibility and muscle injury rate in professional soccer players

OBJECTIVES

This study aimed to examine the effects of COVID-19 confinement on hamstring eccentric strength, hip adduction-abduction strength, and posterior chain flexibility in professional male soccer players. We also aimed to investigate whether muscle strength and flexibility would change when the players returned to play after COVID-19 confinement.

METHODS

Thirty professional male soccer (Age; 24.9 ± 4.8 yrs, BMI; 22.7 ± 1.4 kg/m²) players participated in this study. Hamstring eccentric strength, hip abduction-adduction strength and posterior chain flexibility (PCF) were measured before (time 1) and after the home confinement period (time 2) and after return to play (time 3). Repeated measures of ANOVA was used for statistical analysis.

RESULTS

PCF decreased from time 1 to time 2 (p = 0.005) but it increased from time 2 to time 3 (p = 0.03). Hamstring eccentric strength decreased from time 1 to time 2 for both dominant (p = 0.002) and non-dominant (p = 0.04) limbs and no difference was observed between time 2 and time 3 (p > 0.05). Hip abductor and adductor strength did not change between time 1 and time 2 (p > 0.05) but they increased from time 2 and time 3 in the dominant limb (p < 0.05). Five players (16%) had muscle injuries including hamstrings and adductors when they returned to play.

CONCLUSION

This study showed that 8-week COVID-19 confinement had an adverse effect on hamstring eccentric strength and PCF and 3 players had hamstring muscle injuries when they returned to play. Therefore, soccer players can be at risk of hamstring muscle injuries due to long-term detraining. Hip abductor and adductor strength seem not to be negatively affected by 8-week COVID-19 confinement. However, 2 players had adductor strain when they returned to play.

Effect of a home-based exercise training program on anthropometric characteristics and exercise performance during Covid-19 quarantine in young high-level kayak athletes

Purpose

The Covid-19 restriction exposed most athletes to insufficient training stimuli leading to detraining. This study investigated whether a home-based exercise training program could preserve body composition and exercise performance in young high-level kayak athletes during Covid-19 restriction.

Methods

Seventeen healthy young high-level kayak athletes (10 males and 7 females), aged 14.7 ± 1 yrs, participated in this study. A 7-week home-based training program was followed during Covid-19 restriction. Baseline measurements were assessed 4 weeks before Covid-19 pandemic and ended on 4 May 2020. Body composition, flexibility, isometric muscle trunk strength (Biodex), anaerobic power (30-s all-out trial), and aerobic capacity (4-min maximal test) were evaluated. Personal daily loads and wellness details were collected with AthleteMonitoring.com software.

Results

Home-based exercise training program was effective to improve flexibility (9.20 ± 2.85%) and lean body mass (3.96 ± 0.89%), to maintain muscle strength, anaerobic power, body mass, and body fat percentage but insufficient to maintain aerobic capacity (- 8.96 ± 2.49%).

Conclusion

The findings of the present study potentially highlight the importance of the implementation of such a program to minimize the detraining effect on young athletes during periods of movement restriction caused by pandemics.

Physiological and mental health changes in cancer patients during the COVID-19 state of emergency

Backgrounds

Due to the COVID-19 pandemic that we are currently facing, many governments across the world have declared a state of emergency and even confinements. This stressful situation, in addition to prolonged stays at home, may imply a radical change in lifestyle behavior and physical activity (PA). The aim of this study is to evaluate the physiological and psychological effects in cancer patients who changed their PA habits during the COVID-19 state of emergency in Spain.

Methods

Thirty-three participants were evaluated pre- and post-state of emergency. A series of questionnaires was used to assess cancer-specific quality of life.

Results

The most relevant results revealed significantly lower walking time (p < 0.001) and sitting time (p = 0.014). Upper and lower body strength also decreased significantly (p = 0.009 and 0.012, respectively) and oxygen consumption (VO2 peak) (p = 0.023). None of the parameters analysed showed significant differences for psychological aspects (QLQ-C-30 and SF-36) and body composition.

Conclusion

Lower physical activity leads to negative physiological adaptation, particularly affecting cardiovascular and strength levels. While it is important to maintain the general population's amount and intensity of exercise, this particularly vulnerable group's physical capacity is vital to their health and well-being.

Effects of COVID-19 Sport Suspension on Injury Rates in Elite Athletes: A Critically Appraised Topic

Clinical Scenario: With the enforcement of COVID-19 lockdown restrictions, sports teams worldwide were required to make drastic adjustments to their training regimen. This prolonged sport suspension resulted in a significant decrease in off-season and preseason training periods. Clinical Question: Are professional athletes who experienced a sport suspension during the COVID-19 pandemic at a higher risk of injury once they return to competition compared with pre-COVID-19 seasons? Summary of Key Findings: The literature was searched for articles examining the effects of COVID-19 sport suspension on athletic injury rates in elite athletes. A total of 240 articles were retrieved, and after exclusion criteria and removal of duplicates, four retrospective cohort studies remained. An increase in injury rates across studies after their sport suspension compared with pre-COVID-19 seasons was found. Clinical Bottom Line: The extended suspension from physical activity increased the risk of injury as players returned to sport training post-COVID-19 restrictions. While these studies demonstrated the effects on elite-level athletes, prolonged sport suspension may impact different patient populations. Strength of Recommendation: Based on the Strength of Recommendation Taxonomy Scale, this critically appraised topic received a B grade for consistent but limited-quality patient-oriented evidence, with a low number of articles included.

Does Stretching Training Influence Muscular Strength? A Systematic Review With Meta-Analysis and Meta-Regression

ABSTRACT

Thomas, E, Ficarra, S, Nunes, JP, Paoli, A, Bellafiore, M, Palma, A, and Bianco, A. Does stretching training influence muscular strength? A systematic review with meta-analysis and meta-regression. J Strength Cond Res 37(5): 1145-1156, 2023-The aim of this study was to review articles that performed stretching training and evaluated the effects on muscular strength. Literature search was performed using 3 databases. Studies were included if they compared the effects on strength following stretching training vs. a nontraining control group or stretching training combined with resistance training (RT) vs. an RT-only group, after at least 4 weeks of intervention. The meta-analyses were performed using a random-effect model with Hedges' g effect size (ES). A total of 35 studies ( n = 1,179 subjects) were included in this review. The interventions lasted for a mean period of 8 weeks (range, 4-24 weeks), 3-4 days per week, applying approximately 4 sets of stretching of approximately 1-minute duration. The meta-analysis for the stretching vs. nontraining control group showed a significant small effect on improving dynamic (k = 14; ES = 0.33; p = 0.007) but not isometric strength (k = 8; ES = 0.10; p = 0.377), following static stretching programs (k = 17; ES = 0.28; p = 0.006). When stretching was added to RT interventions, the main analysis indicated no significant effect (k = 17; ES = -0.15; p = 0.136); however, moderator analysis indicated that performing stretching before RT sessions has a small but negative effect (k = 7; ES = -0.43; p = 0.014); the meta-regression revealed a significant negative association with study length (β = -0.100; p = 0.004). Chronic static stretching programs increase dynamic muscular strength to a small magnitude. Performing stretching before RT and for a prolonged time (>8 weeks) can blunt the strength gains to a small-to-moderate magnitude. Performing stretching in sessions distant from RT sessions might be a strategy to not hinder strength development.

The Relationship between Training Cycle-Dependent Fluctuations in Resting Blood Lactate Levels and Exercise Performance in College-Aged Rugby Players

An increase in resting blood lactate (La^-) concentration due to metabolic conditions has been reported. However, it is not clear whether resting La^- changes with training cycles in athletes. The purpose of this study was to test the hypotheses that (1) the morning resting La^- levels are lower in periods of high training compared to periods of low training and (2) these changes in La^- concentration are related to athletes' metabolic capacity during exercise in male college-aged rugby players. Resting La^- and blood glucose concentrations were measured in the morning in eight league rugby players during the summer pre-season period (Pre-period), the training and competition season period (TC-period), and the winter post-season period (Post-period). In each period, anaerobic power, La^- concentration, and respiratory responses were measured during the 40 s maximal Wingate anaerobic test (WT). The resting La^- concentration in the morning was significantly lower in the TC-Period (1.9 ± 0.6 mmol/L) than in the Post-Period (2.3 ± 0.9 mmol/L). The rate of decrease in La^- level immediately after the 40 s WT was significantly higher in the TC-Period than in the Post-Period. The resting La^- concentration was significantly correlated with the peak oxygen uptake and the carbon dioxide output during the WT. These results support the hypothesis that an athlete's training cycle (i.e., in season and off season) influences the resting La^- levels as well as the metabolic capacity during high-intensity exercise. The monitoring of resting La^- fluctuations may provide a convenient indication of the training cycle-dependent metabolic capacity in athletes.

The Effects of Different Relative Loads in Weight Training on Acceleration and Acceleration from Flying Starts

The purpose of this review was to examine how different relative loads in weight training can improve acceleration over 10 m from a standing or flying start. A systematic review of the literature was undertaken using the following databases: PubMed, MedLine, Google Scholar, and SPORTDiscus. Studies were eligible if they met the following criteria: (1) participants were at least 15 years or older and healthy and injury free, (2) the study included at least one exercise for the lower body with a strength training frequency of at least once a week and included a training period of at least four weeks, and (3) interventions with clear pre- and post-test results on 10 m sprint or 10 m flying start are stated. Non-English-language articles were excluded. Percent change and between-group effect size (ES) were calculated to compare the effects of different training interventions. Forty-nine studies met the inclusion criteria. The results were categorized into four groups: (1) explosive weight training with light loads at 30–60% of 1-RM, (2) explosive weight training with moderate loads at 60–85% of 1-RM, (3) maximal weight training at 85–100% of 1-RM, and (4) hypertrophy training at 60–85% of 1-RM. At 10 m, all methods of weight training demonstrated improvements, and maximal weight training demonstrated the highest results with a large ES, while other approaches varied from very small to moderate ES. Weight training showed little progression with a significantly lower effect on flying start across all training methods, except for one group that trained power cleans (hypertrophy) where progress was large. To improve acceleration over the first 10 m, this review demonstrated maximal weight training as the preferred training method. For athletes with a pre-existing high level of strength, it could be more appropriate to use explosive training with light loads or a combination of the two. To a lesser extent, acceleration from a flying start could be improved using both training methods as well.

Biomarker Changes in Oxygen Metabolism, Acid-Base Status, and Performance after the Off-Season in Well-Trained Cyclists

During the off-season, cyclists reduce their volume and intensity of training in order to recover the body from the high workload during the competitive season. Some studies have examined the effects of the off-season on cardiovascular, metabolic, and performance levels but have not evaluated oxygen metabolism, acid-base status, and electrolytes in cyclists. Therefore, our main objective was to analyze these markers in the off-season period (8 weeks) via finger capillary blood gasometry in well-trained cyclists. We found an increase in oxygen saturation (sO2) and oxyhemoglobin (O2Hb) (p ≤ 0.05) and a decrease in fat oxidation at maximum fat oxidation (FatMax) (p ≤ 0.05). In addition, we observed a decreasing trend of VO2 in the ventilatory threshold 2 (VT2) and maximum oxygen consumption (VO2MAX) (p ≤ 0.06) after the off-season in well-trained cyclists. Negative correlations were found between the pre–post off-season differences in the VO2 at ΔFatMax and ΔHCO3− (bicarbonate ion) and between power generated at the ΔeFTP (functional power threshold) and the ΔVO2MAX with the pH (r ≥ −0.446; p ≤ 0.05). After the off-season period, well-trained cyclists had increased markers of oxygen metabolism, decreased fat oxidation at low exercise intensities, and decreased VO2 at the VT2 and VO2MAX. Relationships were found between changes in the ΔeFTP and VO2MAX with changes in the pH and between the pH and HCO3− with changes in La−.

Effects of Short- and Long-Term Detraining on Maximal Oxygen Uptake in Athletes: A Systematic Review and Meta-Analysis

V̇O2max, a gold standard for evaluating cardiorespiratory fitness, can be enhanced by training and will gradually decrease when training stops. This study, which followed the Cochrane Collaboration guidelines, is aimed at assessing the effect of short- and long-term detraining on trained individuals’ V̇O2max through a systematic review and meta-analysis and performed a subgroup analysis to evaluate the effects of different ages, detraining formats, and training statuses on V̇O2max variation between short- and long-term training cessation. Web of Science, SPORTDiscus, PubMed, and Scopus, four databases, were searched, from which 21 of 3315 potential studies met the inclusion criteria. Significant decreases in V̇O2max were identified after short-term training cessation ( $\text{ES}=-0.62$ [95% CI -0.94; -0.31], $p<0.01$ ; within-group $I^2=35.3\%$ , $\text{Egge}{\text{r}}^{\text{’}}\text{s}\text{test}=-1.22$ , $p=0.335$ ) and long-term training cessation ( $\text{ES}=-1.42$ [95% CI -1.99; -0.84], $p<0.01$ ; within-group $I^2=76.3\%$ , $\text{Egge}{\text{r}}^{\text{’}}\text{s}\text{test}=-3.369$ , $p<0.01$ ), which shows that the detraining effect was found to be larger on V̇O2max in long-term training cessation than in short-term training cessation ( $Q=6.5$ , $p=0.01$ ). However, there was no significant difference regarding V̇O2max change between 30-90 days detraining and larger than 90 days detraining ( $Q=0.54$ , $p=0.46$ ) when conducting subgroup analysis. In addition, younger (<20) individuals showed a greater reduction in V̇O2max after long-term detraining than adult individuals ( $Q=5.9$ , $p=0.05$ ), and athletes with higher trained-state V̇O2max showed a significant decline in V̇O2max after long-term detraining compared with the lower trained-state group ( $Q=4.24$ , $p=0.03$ ). In conclusion, both short- and long-term training cessation have a detrimental effect on V̇O2max, and a greater impact on V̇O2max was found in long-term training cessation compared to short-term training cessation; however, there was no significant change in V̇O2max when the duration of training cessation was more than 30 days. To buffer the detrimental effects of detraining, especially long-term training cessation, performing some physical exercise during training cessation can effectively weaken detraining effects. Thus, to prevent athlete’s V̇O2max from decreasing dramatically from detraining, athletes should continue performing some physical exercise during the cessation of training.

Longitudinal Associations of High-Volume and Vigorous-Intensity Exercise With Hip Fracture Risk in Men

Maintenance of vigorous exercise habits from young to old age is considered protective against hip fractures, but data on fracture risk in lifelong vigorous exercisers are lacking. This longitudinal cohort study examined the hazard of hip fractures in 1844 male former athletes and 1216 population controls and in relation to exercise volume and intensity in later years. Incident hip fractures after age 50 years were identified from hospital discharge register from 1972 to 2015. Exercise and covariate information was obtained from questionnaires administered in 1985, 1995, 2001, and 2008. Analyses were conducted using extended proportional hazards regression model for time-dependent exposures and effects. During the mean ± SD follow-up of 21.6 ± 10.3 years, 62 (3.4%) athletes and 38 (3.1%) controls sustained a hip fracture. Adjusted hazard ratio (HR) indicated no statistically significant difference between athletes and controls (0.84; 95% confidence interval [CI], 0.55-1.29). In subgroup analyses, adjusted HRs for athletes with recent high (≥15 metabolic equivalent hours [MET-h]/week) and low (<15 MET-h/week) exercise volume were 0.83 (95% CI, 0.46-1.48) and 1.04 (95% CI, 0.57-1.87), respectively, compared with controls. The adjusted HR was not statistically significant between athletes with low-intensity exercise (<6 METs) and controls (1.08; 95% CI, 0.62-1.85). Athletes engaging in vigorous-intensity exercise (≥6 METs at least 75 minutes/week) had initially 77% lower hazard rate (adjusted HR 0.23; 95% CI, 0.06-0.86) than controls. However, the HR was time-dependent (adjusted HR 1.04; 95% CI, 1.01-1.07); by age 75 years the HRs for the athletes with vigorous-intensity exercise reached the level of the controls, but after 85 years the HRs for these athletes increased approximately 1.3-fold annually relative to the controls. In conclusion, these data suggest that continuation of vigorous-intensity exercise is associated with lower HR of hip fracture up to old age. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

The pathophysiology of motor fatigue and fatigability in multiple sclerosis

Multiple Sclerosis (MS) is a heterogeneous immune mediated disease of the central nervous system (CNS). Fatigue is one of the most common and disabling symptom of MS. It interferes with daily activities on the level of cognition and motor endurance. Motor fatigue can either result from lesions in cortical networks or motor pathways (“primary fatigue”) or it may be a consequence of detraining with subsequent adaptions of muscle and autonomic function. Programmed exercise interventions are used frequently to increase physical fitness in MS-patients. Studies investigating the effects of training on aerobic capacity, objective endurance and perceived fatigability have yielded heterogenous results, most likely due to the heterogeneity of interventions and patients, but probably also due to the non-uniform pathophysiology of fatigability among MS-patients. The aim of this review is to summarize the current knowledge on the pathophysiology of motor fatigability with special reference to the basic exercise physiology that underlies our understanding of both pathogenesis and treatment interventions.

Effect of exercise training after bariatric surgery: A 5-year follow-up study of a randomized controlled trial

Background and objectives

We previously showed in a 6-month randomized controlled trial that resistance training and protein supplementation after bariatric surgery (Roux-en-Y gastric bypass, RYGB) improved muscle strength without significant effect on weight loss and body composition changes. We performed a 5-year follow-up study in these subjects with the aim 1) to assess the long-term effect of this exercise training intervention and 2) to analyze associations between habitual physical activity (PA) and weight regain at 5 years.

Methods

Fifty-four out of 76 initial participants (follow-up rate of 71%) completed the 5-year follow-up examination (controls, n = 17; protein supplementation, n = 22; protein supplementation and resistance training, n = 15). We measured body weight and composition (DXA), lower-limb strength (leg-press one-repetition maximum) and habitual PA (Actigraph accelerometers and self-report). Weight regain at 5 years was considered low when <10% of 12-month weight loss.

Results

Mean (SD) time elapse since RYGB was 5.7 (0.9) y. At 5 years, weight loss was 32.8 (10.1) kg, with a mean weight regain of 5.4 (SD 5.9) kg compared with the 12-month assessment. Moderate-to-vigorous PA (MVPA) assessed by accelerometry did not change significantly compared with pre-surgery values (+5.2 [SD 21.7] min/d, P = 0.059), and only 4 (8.2%) patients reported participation in resistance training. Muscle strength decreased over time (overall mean [SD]: -49.9 [53.5] kg, respectively, P<0.001), with no statistically significant difference between exercise training intervention groups. An interquartile increase in MVPA levels was positively associated with lower weight regain (OR [95% CI]: 3.27 [1.41;9.86]).

Conclusions

Early postoperative participation in a resistance training protocol after bariatric surgery was not associated with improved muscle strength after 5 years of follow-up; however, increasing physical activity of at least moderate intensity may promote weight maintenance after surgery. PA may therefore play an important role in the long-term management of patients with obesity after undergoing bariatric procedure.

Aerobic capacity of professional soccer players before and after COVID-19 infection

This investigation aimed to assess the aerobic capacity of professional soccer players pre-and post-COVID-19 infection. Twenty-one division-1 elite soccer players (age 24.24 ± 5.75 years, height 178.21 ± 5.44 cm, weight 74.12 ± 5.21 kg) participated in this study. This observational study compared the same players' aerobic capacity pre-, and 60-days post COVID-19 recovery. The statistical analysis demonstrated that the infected players had significantly lower VO_2max values [t₍₂₀₎ = 5.17, p < 0.01, d = 0.613 (medium effect)], and significantly lower VO₂ values at respiratory compensation point (RC) [t₍₂₀₎ = 2.97, p < 0.05, d = 0.39 (small effect)] after recovery. Furthermore, results indicated a significantly lower running time (RT) on the treadmill [t₍₂₀₎ = 4.84, p < 0.01, d = 0.46 (small effect)] when compared to the results that were obtained before they got infected. In addition, velocity at VO_2max (_VVO_2max) was significantly lower [t₍₂₀₎ = 2.34, p < 0.05, d = 0.41 (small effect)] and the heart rate values at ventilatory threshold (VT) [t₍₂₀₎ = −2.79, p < 0.01, d = 0.55 (medium effect)] and RC [t₍₂₀₎ = −3.72, p < 0.01, d = 0.52 (medium effect)] were significantly higher post-recovery. The aforementioned findings indicate that post COVID-19 soccer players may not reach full recovery at two months. Therefore, our results highlight that further adaptations and improvements are needed with regard to aerobic capacity before soccer players return to professional games.

Effects of Respiratory Muscle Strength Training on Respiratory-Related Impairments of Parkinson's Disease

In addition to typical motor dysfunction, Parkinson's disease is also characterized by respiratory-related dysfunction. As a means of rehabilitation, respiratory muscle strength training (RMST) has been applied to restore Parkinson's disease (PD) functions. However, the current clinical value of RMST in the application for PD has not been widely established. This article aims to review the research progress of the application of RMST in PD rehabilitation to provide new sight into respiratory-related impairments management in people with PD.

Analysis of the Sustainability of Long-Term Detraining Caused by COVID-19 Lockdown: Impact on the Maximal Aerobic Speed of Under-16 Soccer Players

This retrospective cohort study aimed to analyze the effect of a 9-week detraining caused by COVID-19 lock-down on the maximal aerobic speed (MAS) of youth soccer players. The study included twenty-two under-16 male players competing at the national league level (15.4 ± 0.7 years old) who were analyzed pre and post the detraining period. The MAS was estimated using the Bronco’s test. Moreover, the self-regulated physical exercise performed by the players during the lockdown was monitored using a questionnaire. Considering the training volume per week, the players were grouped into those working more (>180 min/week) and those working less (<180 min/week) during the lockdown. Within-group changes revealed no significant differences (p = 0.122; d = 0.381) in the group that self-trained less than 180 min/week started (pre-lockdown) at 3.97 ± 0.29 m/s and ended (post-lockdown) at 3.85 ± 0.34 m/s, corresponding to a decrease of 3.02%. For those who self-trained more than 180 min/week during the lockdown, they started with 4.33 ± 0.28 m/s and decreased by 1.62% for 4.26 ± 0.28 m/s (p = 0.319; d = 0.250). The team as a whole (pooled data, all players included) decreased 2.27% from 4.15 ± 0.34 to 4.06 ± 0.37 m/s (p = 0.077; d = 0.321). Between group analysis revealed that the group of players that trained more than 180 min/weeks were significantly better than players working below 180 min/week in both pre-lockdown moment (+9.01%; p = 0.007; d = 1.263) and post-lockdown moment (10.6%; p = 0.006; d = 1.323). Home-based training can be a good strategy to mitigate the detraining effects caused by a lockdown.

Lockdown Duration and Training Intensity Affect Sleep Behavior in an International Sample of 1,454 Elite Athletes

Objective: To investigate the effect of 1) lockdown duration and 2) training intensity on sleep quality and insomnia symptoms in elite athletes.

Methods: 1,454 elite athletes (24.1 ± 6.7 years; 42% female; 41% individual sports) from 40 countries answered a retrospective, cross-sectional, web-based questionnaire relating to their behavioral habits pre- and during- COVID-19 lockdown, including: 1) Pittsburgh sleep quality index (PSQI); 2) Insomnia severity index (ISI); bespoke questions about 3) napping; and 4) training behaviors. The association between dependent (PSQI and ISI) and independent variables (sleep, napping and training behaviors) was determined with multiple regression and is reported as semi-partial correlation coefficient squared (in percentage).

Results: 15% of the sample spent < 1 month, 27% spent 1–2 months and 58% spent > 2 months in lockdown. 29% self-reported maintaining the same training intensity during-lockdown whilst 71% reduced training intensity. PSQI (4.1 ± 2.4 to 5.8 ± 3.1; mean difference (MD): 1.7; 95% confidence interval of the difference (95% CI): 1.6–1.9) and ISI (5.1 ± 4.7 to 7.7 ± 6.4; MD: 2.6; 95% CI: 2.3–2.9) scores were higher during-compared to pre-lockdown, associated (all p < 0.001) with longer sleep onset latency (PSQI: 28%; ISI: 23%), later bedtime (PSQI: 13%; ISI: 14%) and later preferred time of day to train (PSQI: 9%; ISI: 5%) during-lockdown. Those who reduced training intensity during-lockdown showed higher PSQI (p < 0.001; MD: 1.25; 95% CI: 0.87–1.63) and ISI (p < 0.001; MD: 2.5; 95% CI: 1.72–3.27) scores compared to those who maintained training intensity. Although PSQI score was not affected by the lockdown duration, ISI score was higher in athletes who spent > 2 months confined compared to those who spent < 1 month (p < 0.001; MD: 1.28; 95% CI: 0.26–2.3).

Conclusion: Reducing training intensity during the COVID-19-induced lockdown was associated with lower sleep quality and higher insomnia severity in elite athletes. Lockdown duration had further disrupting effects on elite athletes’ sleep behavior. These findings could be of relevance in future lockdown or lockdown-like situations (e.g., prolonged illness, injury, and quarantine after international travel).

Postlockdown Performance in French Swimming Championships

PURPOSE

To measure the proportion of French swimmers that progressed, stagnated, or regressed during the 2020 national championship compared with previous ones.

METHOD

Individual best performances were collected at the French national championships from 2000 to 2020. Yearly proportions of swimmers who improved, stagnated, or regressed in performances were compared with their previous performances.

RESULTS

In 2020, the proportion of swimmers with performance regression has significantly increased (33% vs 17% in 2019). Women showed a higher proportion of performance regression (41%) than men (26%, P < .0001) in 2020. Only 39% of women and 53% of men experienced progression in 2020 (vs 60.8% [3.7%] and 66.7% [5.2%], respectively, in the previous years). Only the 2008 and 2009 championships showed a regression proportion that did not increase with age. The 2010 championship (the year of swimsuits ban) showed a higher proportion of regressing athletes than these previous years. Long-distance events showed higher proportion of performance regression (36.2% [0.5%]) for 400-, 800-, and 1500-m races than for short-distance ones (32.1% [3.2%]; 50-, 100-, and 200-m events). Breaststroke events showed higher regression (42.4%) than other styles (30.5% [2.1%]). Younger swimmers more often improved their performance than older ones (61.9% [8.5%] for swimmers less than 18 y of age vs 20.0% [10.8%] for those 25 y and older).

CONCLUSION

A high proportion of swimmers experienced performance regression during the 2020 French national championships. A higher impact was observed among female, long-distance, and breaststroke swimmers. Eight weeks of lockdown without training may have led to poorer swimming performances.

Physical Exercise for Health and Performance Post-Pandemic COVID-19 Era, a Renewed Emphasis on Public Health

After the period of forced quarantine due to the COVID-19 epidemic, the physiological principle of detraining became more evident than ever [...].

Effects of 3 months of detraining following cardiac rehabilitation in patients with atrial fibrillation

Background

Atrial fibrillation negatively impacts physical fitness and health-related quality of life. We recently showed that 3 months of physiotherapist-led exercise-based cardiac rehabilitation improves physical fitness and muscle function in elderly patients with permanent atrial fibrillation and concomitant diseases. Little is, however, known about the consequences for physical fitness, physical activity level, and health-related quality of life after ending the rehabilitation period.

Methods

Prospective 3 months follow-up study of 38 patients out of 40 eligible (10 women) who, as part of a randomized controlled trial, had completed a 3 months physiotherapist-led cardiac rehabilitation resulting in improved physical fitness,. In the current study, the participants were instructed to refrain from exercise for 3 months after completion of the rehabilitation period. Primary outcome measure was physical fitness measured as highest achieved workload using an exercise tolerance test. Secondary outcome measures were muscle function (muscle endurance tests), physical activity level (questionnaire and accelerometer), and health-related quality of life, (Short Form-36), as in the preceding intervention study. We used the Wilcoxon Signed Rank test to analyse differences between the end of rehabilitation and at follow-up. The effect size was determined using Cohen’s d .

Results

Exercise capacity and exercise time significantly decresead between end of rehabilitation and at follow-up (p < .0001 for both). A significant reduction in shoulder flexion repetitions (p = .006) was observed as well as reduced health-related quality of life in the Short Form-36 dimensions Physical Function (p = .042), Mental Health (p = .030), and Mental Component Score (p = .035). There were, however, no changes regarding objective and subjective physical activity measurements.

Conclusion

In older patients with permanent atrial fibrillation, previously achieved improvements from physiotherapist-led exercise-based cardiac rehabilitation in physical fitness and muscle function were lost, and health-related quality of life was impaired after ending the rehabilitation period. A strategy for conserving improvements after a rehabilitation period is essential.

Changes in Upper-Body Muscular Strength and Power in Paralympic Swimmers: Effects of Training Confinement during the COVID-19 Pandemic

The aim of this case series was to evaluate the effectiveness of a dry-land home-training program conducted during the COVID-19 pandemic period in Paralympic swimmers. Previous evidence showed the importance of muscular strength and power training for Paralympic swimmers due to the positive relationship between severity of impairment, swimming technique and biomechanics parameters. Specifically, we aimed to analyze: (i) the effects of a customized training regime conducted pre, during and post restrictions on upper-body muscular strength and power (one repetition maximum, mean propulsive velocity, and mean relative propulsive power) compared to a regular gym-based program; (ii) the associations between mean propulsive velocity and load during two upper body exercises in order to estimate the one repetition maximum. Four elite Paralympic swimmers were retrospectively analyzed in upper-body muscular strength, mean propulsive velocity and mean relative propulsive power in bench press and lat pull-down exercises at three time points: T0 (prior the Lockdown period), T1 (immediately after the Lockdown confinement), T2 (sixteen weeks after returning to gym training). Our findings suggest a very likely decrement in one repetition maximum, mean propulsive velocity, and mean relative propulsive power during the Lockdown period compared with the T0 period with a subsequent very likely increment in one repetition maximum after returning to gym training (T2) compared with the lockdown period (T0). Conversely, mean relative propulsive power showed an unclear improvement in all athletes in T2 compared with T1. These results were also corroborated by the Friedman’s test followed by the Dunn’s pairwise comparison that mainly showed a decrement from T0 to T1 (p < 0.05). At the same time, it appears that muscle strength and power could be rapidly restored close to the pre-lockdown levels following an adequate training program in the gym, albeit without significance (p > 0.05). Finally, the close relationship between mean propulsive velocity and load in bench press and lat pull-down exercises was also confirmed in para swimming, making a possible estimation of one repetition maximum.

Effects of a 12-Week Detraining Period on Physical Capacity, Power and Speed in Elite Swimmers

This study aims to evaluate the effects of a prolonged transition period (detraining) on the physical capacity, power, and speed parameters of elite swimmers. Fourteen swimmers (seven females and seven males) aged 20.4 ± 1.7 years participated in the study. The athletes were subjected to two rounds of identical tests at 12-week intervals during the detraining period (DP), which consisted of an evaluation of the athletes' body weight and composition, a measurement of the power of their lower limbs (Keiser squat, countermovement jump (CMJ), akimbo countermovement jump (ACMJ)) and upper limbs (Keiser arms) on land, and 20-m swimming using the legs only (Crawl Legs test), arms only (Crawl Arms test), and full stroke (Front Crawl test). An analysis of variance revealed a significant effect of the main factor, Gender, on all the measured parameters, while for the factor Detraining, except for Front Crawl (W) (F = 4.27, p = 0.061), no significant interaction effect (Gender × Detraining) was revealed. Among both the male and the female participants, a reduction in lactate-threshold swimming speed (LT Dmax) and a reduction in swimming speed and power on the Crawl Arms, Crawl Legs, and Front Crawl tests was observed after 12 weeks. There were also statistically significant reductions in ACMJ and CMJ jump height and upper-limb power (Keiser squat) among the female and male swimmers. There were no significant changes in body weight or body composition. The study showed a clear deterioration in results for most of the parameters, both for those measured on land and for those measured in water.

Effect of the Reduction in Training Volume during the COVID-19 Era on Performance in 100-m and 400-m Freestyle Events in Greek Swimming Championships

The COVID-19 pandemic had a profound impact on almost all social activities, including sport participation. Swimming training was greatly reduced during the 2019−2020 and 2020−2021 seasons (by four and two months, respectively), which caused athletes and coaches to worry about performance in championships. The present study investigated the impact of COVID-19 lockdowns on the results of Greek swimming championships in the categories of 13 to 18 years of age during 2020 and 2021. Forty-one coaches were interviewed about the training process (satisfaction, duration of the training season, and daily training swimming distance), and the performance of swimmers in national championships over seven seasons (2014−2021) was analyzed. The duration of the training season and the daily swimming distance, as reported by the coaches, were lower during the 2019−2020 and 2020−2021 seasons, compared to the previous five seasons (p < 0.001). The number of swimmers who achieved qualifying times for the national championships during the COVID-19 era were similar to those in previous years. Comparisons of the times in the 100-m and 400-m freestyle events, in both genders, from 2015 through 2021, showed no significant differences except for the 400-m event in males, in which a lower performance was detected in 2021 compared to 2015 (by 2.7%, p = 0.001). In conclusion, two or four months of detraining during the COVID-19 era had a negative impact on the coaches’ evaluation of the training process, but there was no effect on the number of young swimmers who qualified for the national championships and a negligible effect on swimming performance in 100-m and 400-m freestyle events.

Effects of Football Training and Match-Play on Hamstring Muscle Strength and Passive Hip and Ankle Range of Motion during the Competitive Season

Deficits in hamstring muscle strength and in hip range of motion (ROM) have been considered risk factors for hamstring muscle injuries. However, there is a lack of information on how chronic exposure to regular football training affects hamstring muscle strength and hip ROM. The aim of this study was to examine the longitudinal effect of football training and competition during a complete season on hamstring muscle strength and hip ROM in football players. A total of 26 semi-professional football players underwent measurements of isometric hamstring muscle strength and passive hip flexion/extension, and internal/external hip rotation (IR/ER) ROM during the football season (pre-season, mid-season, end-season). Compared to pre-season, hamstring muscle strength increased in the dominant (+11.1%, p = 0.002) and non-dominant (+10.5%, p = 0.014) limbs in the mid-season. Compared to mid-season, hamstring strength decreased in the dominant (−9.3%, p = 0.034) limb at end-season. Compared to the pre-season, hip extension ROM decreased in mid-season in the dominant (−31.7%, p = 0.007) and non-dominant (−44.1%, p = 0.004) limbs, and further decreased at end-season (−49.0%, p = 0.006 and −68.0%, p < 0.001) for the dominant and non-dominant limbs. Interlimb asymmetry for hip IR ROM increased by 57.8% (p < 0.002) from pre-season to mid-season. In summary, while hamstring muscle strength increased during the first half of the football season in football players, a progressive reduction in hip extension ROM was observed throughout the season. The reduced hip extension ROM suggests a reduced mobility of the hip flexors, e.g., iliopsoas, produced by the continuous practice of football. Consequently, hip-specific stretching and conditioning exercises programs should be implemented during the football season.

Impact of Prolonged Absence of Organized Training on Body Composition, Neuromuscular Performance, and Aerobic Capacity: A Study in Youth Male Soccer Players Exposed to COVID-19 Lockdown

The aim of this study is to examine how physical performance has changed after 15 weeks (109 days) long-term absence of organized training in youth soccer players imposed by the stay at home orders. A total of sixty-eight young male soccer players from different age categories (U15, U16, U17 and U19) voluntarily participated in the prospective cohort study. Body fat percentage (BF%), counter-movement jump (CMJ), 30 m sprint, change-of-direction (COD) and yo-yo intermittent recovery test level-1 (YYIRTL-1) were evaluated twice (before and after the detraining period). Subsequently, 2 × 2 repeated measures ANOVA was used to investigate group and time differences in repeated measurements. A significance level of p < 0.05 was implemented. CV and SWC values were calculated to test the reliability of the tests performed at different times. Statistical analysis was performed using the IBM SPSS statistics software (v.25, IBM, New York, NY, USA). Significant increments in BF%, 30 m sprint, and COD (left and right), and also significant decrements in CMJ and YYIRTL-1, were found after the detraining period. A long-term detraining period due to the stay at home orders has a detrimental effect on body composition, neuromuscular performances, and aerobic capacity in youth soccer players.

Lower-Limb Muscle Contractile Properties, Explosive Power and the Subjective Response of Elite Soccer Players to the COVID-19 Lockdown

The present study examined the effects of the lockdown period on basic anthropometric measures, countermovement jumping performance, skeletal muscle contractile properties derived from tensiomyography (TMG), injury incidence, and self-assessed general well-being in elite soccer players. A total of 266 players were assessed before (PRE) and 32 players were reassessed 11 days after (POST) the COVID-19 period. Significant changes in the TMG parameters were observed POST compared to PRE: contraction time (Tc) increased from 6% to 50% in vastus lateralis [VL] (p = 0.009) and biceps femoris [BF] (p < 0.001), respectively; whereas radial displacement (Dm) increased for 19% in BF (p = 0.036) and 17% in VL (p < 0.001), respectively. Jumping performance remained unchanged from PRE to POST In addition, athletes rated the lockdown period as a positive event and felt psychologically better during the lockdown, primarily because they spent more time with family members and friends. Although there were no differences in any of the variables describing lower limb muscle power following the two-month lockdown, the altered contractile properties of the assessed muscles suggest suboptimal conditioning of the football players.

Effects of Dryland Training During the COVID-19 Lockdown Period on Swimming Performance

Purpose: To examine the effect of dryland training during an 11-week lockdown period due to COVID-19 on swimming performance. Methods: Twelve competitive swimmers performed 50- and 300-m maximum-effort tests in their preferred stroke and 200-, 400-, and four 50-m front crawl sprints (4 × 50 m) before and after the lockdown period. Critical speed as an index of aerobic endurance was calculated using (1) 50-, 300-, and (2) 200-, 400-m tests. Blood lactate concentration was measured after the 400- and 4 × 50-m tests. To evaluate strength-related abilities, the dryland tests included handgrip and shoulder isometric strength. Tethered swimming force was measured during a 10-second sprint. During the lockdown period, dryland training was applied, and the session rating of perceived exertion training (sRPE) load was recorded daily. Results: sRPE training load during the lockdown was decreased by 78% (16%), and critical speed was reduced 4.7% to 4.9% compared to prelockdown period (P < .05). Performance time in 200, 300, and 400 m deteriorated 2.6% to 3.9% (P < .05), while it remained unaltered in 4 × 50- and 50-m tests (P > .05). Tethered force increased 9% (10%) (P < .01), but handgrip and shoulder isometric force remained unaltered (P > .05). Blood lactate concentration decreased 19% (21%) after the 400-m test and was unchanged following the 4 × 50-m tests (P > .05). Conclusions: Performance deterioration in the 200, 300, and 400 m indicates reduced aerobic fitness and impaired technical ability, while strength and repeated-sprint ability were maintained. When a long abstention from swimming training is forced, dryland training may facilitate preservation in short-distance but not middle-distance swimming performance.

The impact of COVID-19 lockdown on professional soccer players' body composition and physical fitness

During the COVID-19 lockdown, professional soccer players ceased their regular team training sessions and were provided with exercise programs to follow independently. This investigation assessed the impact of a 7-week COVID-19 lockdown and home-based individual physical training on professional soccer players’ body composition and physical fitness. The study consisted of nineteen division 1 elite soccer players (age 27.68 ± 5.99 years, height 178.47 ± 5.44 cm) and compared the anthropometric and physical fitness parameters obtained post-transition period to those obtained post-COVID-19 lockdown. The statistical analysis indicated that body fat percentage was significantly higher after the lockdown period [t(18) = -5.59, p < 0.01, d = 0.56]. Furthermore, VO_2max [t(17) = -11.54, p < 0.01, d = 0.57] and running time [t(17) = 3.94, p < 0.01, d = 0.76] values were significantly higher after the COVID-19 lockdown than those obtained after the transition period. In addition, significantly higher level of performance was demonstrated on squat jump [t(18) = -4.10, p < 0.01, d = 0.30], countermovement jump [t(18) = -7.43, p < 0.01, d = 1.11] and sit and reach tests [t(19) = -5.33, p < 0.01, d = 0.32]. Concurrently, lower body strength was indicated to be significantly greater (p < 0.01) following the COVID-19 lockdown. The training protocol provided during the confinement, due to the COVID-19 outbreak, was effective in keeping physical fitness at a significantly higher level compared to the transition period. Coaches and trainers are encouraged to examine the effectiveness of this protocol, as it may help them develop effective periodization programs during the transition period. This protocol may aid in the development of effective periodization programs that require minimal equipment and can be followed in similar situations.

Exercise-Based Injury Prevention in High-Level and Professional Athletes: Narrative Review and Proposed Standard Operating Procedure for Future Lockdown-Like Contexts After COVID-19

In regular times, implementing exercise-based injury prevention programs into the training routine of high-level and professional athletes represents a key and challenging aspect to decrease injury risk. Barriers to implementing such prevention programs have previously been identified such as lack of resources, logistic issues or motivation. The COVID-19 pandemic associated with restrictions on daily life dramatically impacted sports participation from training to competition. It is therefore reasonable to assume that such lockdown-like context has exacerbated the challenge to implement exercise-based injury prevention programs, potentially leading to a greater musculoskeletal injury risk. In this narrative review, recommendations are proposed for building an expertise- and evidence-based Standard Operating Procedure for injury prevention in lockdown-like contexts for high-level and professional athletes. The following recommendations can be provided: (1) assess the global and sport-specific risks in the light of the ongoing cause of isolation; (2) adapt remote training materials and programs; (3) ensure regular quality communication within the staff, between athletes and the staff as well as between athletes; (4) follow the athlete's mental well-being; and (5) plan for a safe return-to-sports as well as for an ongoing monitoring of the load-recovery balance. These key domains should further be addressed to comply with local policies, which are subject to change over time in each individual country. The use of these recommendations may improve the readiness of athletes, coaches, physicians and all sports stakeholders for future lockdown-like contexts.

A Multi-Systems Approach to Human Movement after ACL Reconstruction: The Cardiopulmonary System

The cardiopulmonary system plays a pivotal role in athletic and rehabilitative activities following anterior cruciate ligament reconstruction, along with serving as an important support for the functioning of other physiologic systems including the integumentary, musculoskeletal, and nervous systems. Many competitive sports impose high demands upon the cardiorespiratory system, which requires careful attention and planning from rehabilitation specialists to ensure athletes are adequately prepared to return to sport. Cardiopulmonary function following anterior cruciate ligament reconstruction (ACLR) can be assessed using a variety of methods, depending on stage of healing, training of the clinician, and equipment availability. Reductions in cardiovascular function may influence the selection and dosage of interventions that are not only aimed to address cardiopulmonary impairments, but also deficits experienced in other systems that ultimately work together to achieve goal-directed movement. The purpose of this clinical commentary is to present cardiopulmonary system considerations within a multi-physiologic systems approach to human movement after ACLR, including a clinically relevant review of the cardiopulmonary system, assessment strategies, and modes of cardiopulmonary training to promote effective, efficient movement.

LEVEL OF EVIDENCE

5.