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Frontiers in Sports and Active Living

Frontiers Media SA

Preprints posted in the last 30 days, ranked by how well they match Frontiers in Sports and Active Living's content profile, based on 10 papers previously published here. The average preprint has a 0.01% match score for this journal, so anything above that is already an above-average fit.

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Sharing power: effects of rider ability and position on tandem performance

Smit, A.; van Ewijk, J.; Janssen, I.; Janssen, T. W. J.; Hofmijster, M. J.

2026-03-30 physiology 10.64898/2026.03.25.714296 medRxiv
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ObjectiveTandem cycling requires a coordinated effort between the pilot and the stoker. Previous research suggests that randomly paired tandem cyclists produce lower power output than when cycling solo. This study examined how a cyclists individual ability and their position on the tandem (pilot or stoker) affects pair performance, when partners are either closely matched or differ substantially in solo cycling capacity, as this might be relevant for training and selection. MethodsTwenty-three trained cyclists completed three 10-minute time trials: solo, equal-capacity tandem ([≤]25 W difference in solo performance), and unequal-capacity tandem ([≥]40 W difference). Mean power output, heart rate, cadence, and rating of perceived exertion (RPE) were recorded. Positions (pilot or stoker) were counterbalanced. Linear mixed-effects models assessed effects of capacity and position. ResultsRelative to solo cycling, equal-capacity tandem pairs revealed lower power output (-3.9%), lower heart rate (-2.3%), and lower RPE (-11.5%). Unequal-capacity tandems differed from solo only in heart rate (-2.7%). Stokers produced lower power relative to solo (-5.3%) and relative to pilots (-3.7%) and reported lower RPE relative to solo (-13.9%), while pilots matched their solo power at a lower heart rate (-2.9%). Cadence did not differ across conditions. Total tandem power averaged 95.6% of combined solo power, and differences in partner capacity did not significantly affect combined power output. ConclusionThis study provides the first known experimental data on how partner matching affects individual and combined power output in tandem cycling. Equal- and unequal-capacity tandem pairs showed similar performance. Lower power and RPE among stokers suggest reduced engagement or a redistribution of effort between riders. These findings highlight that effective tandem performance depends on physiological capacity and rider position on the tandem, but not on the difference in capacity between partners.

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Effectiveness of a 12-week multicomponent occupational lifestyle intervention to increase physical activity among Japanese teleworkers: a cluster randomised controlled trial (TELEWORK study)

Kim, J.; Nakata, Y.; Wada, A.; Kanamori, S.; Yoshimoto, T.; Tsukinoki, R.; Umishio, W.; Shiomitsu, T.; Yoshioka, N.; Yoshiba, K.; Gosho, M.; Kai, Y.

2026-03-26 occupational and environmental health 10.64898/2026.03.23.26349125 medRxiv
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BackgroundTeleworking is associated with lifestyle risk factors, such as insufficient physical activity (PA) and increased sedentary time (ST); however, effective interventions tailored to teleworkers are lacking. We aimed to evaluate the effectiveness of a 12-week multicomponent occupational lifestyle intervention on daily step counts among Japanese teleworkers. MethodsThis 12-week, two-arm, parallel-group, cluster randomised controlled trial conducted across 12 clusters in six Japanese companies involved 310 teleworkers (mean age 43.0 years; 72.6% men) randomized to the intervention (6 clusters, n=156) or a waitlist control group (6 clusters, n=154). The multicomponent occupational lifestyle intervention included individual (online lectures, feedback, and email messages), physical (posters and a pop-up), and organizational (encouraging messages from an executive) strategies. The primary outcome was the change in daily step counts, measured using an accelerometer over 14 consecutive days at baseline and at week 12. Analyses were based on the intention-to-treat approach using a generalised estimating equation model. FindingsThe intervention group showed an adjusted mean change in daily step counts of +219 steps (95% confidence interval [CI] -165 to 604), compared with +188 steps (95% CI -183 to 560) in the control group. The adjusted between-group difference was +55 steps (95% CI -550 to 660; p=0.844). No significant effects on the secondary outcomes (ST, light PA, or moderate-to-vigorous PA) were observed. InterpretationThe multicomponent occupational lifestyle intervention did not significantly increase daily step counts among Japanese teleworkers. Therefore, further studies should be done on tailored interventions for teleworkers. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSTeleworking has increased globally, particularly following the coronavirus disease pandemic, and has been associated with reduced physical activity and increased sedentary behaviour, both of which are risk factors for cardiovascular disease. Previous studies have also reported that telework environments may contribute to musculoskeletal and other somatic symptoms. Multicomponent interventions in traditional office settings can effectively increase physical activity and reduce sedentary time. These interventions commonly employ strategies at multiple levels of the social-ecological model, including individual approaches (e.g., lectures or incentives), interpersonal approaches (e.g., team-based activities), environmental modifications (e.g., office rearrangements or sit-stand desks), and organisational support (e.g., leadership encouragement). The applicability of such interventions to teleworking populations remains unclear because teleworkers face distinct challenges such as social isolation, blurred work-life boundaries, and heterogeneous home working environments. These contextual differences highlight the need for interventions specifically tailored to teleworkers. Added value of this studyWe evaluated the effectiveness of a multicomponent occupational lifestyle intervention specifically designed for teleworkers, a population whose work environment differs substantially from traditional office settings. Our findings provide novel evidence that can inform the development of more targeted strategies to promote physical activity in evolving work environments. This study also provides objective measurements of physical activity using accelerometers, enabling detailed evaluation of step counts, sedentary time, and different activity intensities among teleworkers. Additionally, we used daily diaries to distinguish activity patterns across workdays, weekends, teleworking days, and commuting days, providing a nuanced understanding of behavioural patterns in remote work contexts. Implications of all the available evidenceOur findings indicate that low-cost, remotely delivered multicomponent interventions may be insufficient to produce meaningful behavioural change among teleworkers. Similar strategies, including individual, physical, and organisational components, have been effective in traditional workplace interventions; however, their implementation in teleworking environments may not adequately address the specific challenges faced by remote workers. In particular, the lack of strong sociocultural support mechanisms, such as team-based step competitions or workplace champions, may limit engagement and reduce the effectiveness of such programmes. Therefore, further investigation is needed to explore more diverse and targeted intervention strategies, identify the specific needs and behavioural patterns of teleworkers, and apply more precise eligibility criteria to better address heterogeneity within teleworking populations.

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Mental fatigue impairs cycling endurance performance and perception of effort, but not muscle activation

Souron, R.; Sarcher, A.; Lacourpaille, L.; Boulahouche, I.; Richier, C.; Mangin, T.; Gruet, M.; Doron, J.; Jubeau, M.; Pageaux, B.

2026-03-23 physiology 10.64898/2026.03.19.712281 medRxiv
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Mental fatigue is induced by prolonged engagement in cognitively demanding tasks and impairs endurance performance. The neuropsychophysiological mechanisms underlying this decreased performance remain unclear, with suggestion that mental fatigue may disrupt motor command and consequently muscle activation. We aimed to test this hypothesis in a repeated cross-over design study in which 18 participants completed two experimental sessions involving a time-to-exhaustion cycling test at 80% of peak power output. Each cycling task was preceded by 1h of a prolonged Stroop task (Stroop session) or a neutral control task (Control session). Perception of effort and surface electromyography from ten lower-limb muscles of the right leg were recorded at regular intervals during cycling. Mental fatigue was higher in the Stroop compared to the Control session (p = .002). Endurance cycling time was 111 {+/-} 160 s shorter in the Stroop than in the Control session (p = .009). No significant differences in electromyography parameters were observed between Stroop and Control sessions, for any muscle (p > .05). Perception of effort was higher in the Stroop session from the onset of the cycling task (p = .006), and the rate of increase in perception of effort was significantly higher in the Stroop than Control session (p = .031). Our findings do not support the hypothesis that mental fatigue alters motor control or increases central motor command, as no changes in muscle activation were detected. Conversely, our results reinforce the notion that prolonged cognitive engagement impairs endurance performance primarily through an increased perception of effort. Future research should consider combining surface electromyography with more sensitive neurophysiological techniques to investigate potential subtle changes in motor drive during dynamic, whole-body tasks under mental fatigue. Impact statementOur study confirms that mental fatigue induced by prolonged cognitive exertion impairs cycling endurance performance. By combining measurements of perceptual responses and multi-muscle surface EMG during the endurance task, we observed that the decreased endurance performance is related to an increased perceived effort in the presence of mental fatigue, not related to alterations in motor command.

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The impact of hospital discharge on physical activity and sedentary behaviour following orthopaedic trauma: An interrupted time series analysis

Kirk, A.; Kimmel, L.; Lane, T. J.; Dumuid, D.; Ekegren, C.

2026-03-28 rehabilitation medicine and physical therapy 10.64898/2026.03.26.26349468 medRxiv
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Objectives: To determine the impact of discharge home on physical activity and sedentary behaviour following orthopaedic trauma. Design: Observational study. Setting: Acute hospital. Participants: Between October 2022 and January 2024, 31 adult orthopaedic trauma patients were recruited during hospital admission. Participants had either an isolated hip fracture or multi-trauma (i.e., a lower limb fracture, with an upper limb and/or spinal fracture). Interventions: Participants wore two activity monitors (activPAL3 and ActiGraphGT3x) during the final days of an acute hospital admission and the first five days at home. An interrupted time series analysis evaluated changes physical activity variables during the hospital to home transition. Participants were analysed individually using mixed-effects linear regression allowing the intercept to vary by participant. Main outcome measures: Primary outcome was daily steps; secondary outcomes included sedentary time and other activity measures. Results: Daily steps (mean +- SD) were higher at home (4552.4 +- 2639.5) compared to hospital (2597.8 +- 1450.8). Modelled results indicated a 27% increase in daily steps following hospital discharge (exp(beta946;): 1.27, 95% CI: 1.01,1.59, p=0.039) and a sustained improvement at home. No significant differences were observed between hip fracture and multi-trauma participants. Conclusion: Participants recovering from orthopaedic trauma showed a significant increase in daily step count upon discharge home from hospital, highlighting the positive impact of the home environment on activity levels. Further research is warranted to assess the effectiveness of interventions to improve activity levels in hospital (e.g., early intensive therapy) and at home (e.g., immediate home-based physiotherapy) in individuals following orthopaedic trauma.

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Center-of-Mass Work Patterns Reveal a Dissociation Between Gait Organization and Limb-level Mechanical Function in Post-stroke Walking

Hosseini-Yazdi, S.-S.; Fitzsimons, K.; Bertram, J. E.

2026-04-16 rehabilitation medicine and physical therapy 10.64898/2026.04.14.26350877 medRxiv
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Walking speed is widely used to assess gait recovery following stroke, yet it provides limited insight into how walking performance is mechanically organized. This study examined how center of mass (COM) work organization and propulsion-support coupling vary across walking speeds in individuals with post stroke hemiparesis to distinguish recovery of gait organization from recovery of limb level mechanical function. Eleven individuals with post stroke hemiparesis performed treadmill walking across speeds ranging from 0.2 to 0.7 m/s while ground reaction forces were recorded. Limb specific COM power and work were computed using an individual limbs framework, and interlimb asymmetry in net and positive work, along with the propulsion-support ratio (PSR), were quantified. A qualitative transition in gait organization was observed: at lower walking speeds, COM power exhibited a simplified two phase pattern, whereas at higher walking speeds (approximately >=0.5 m/s), a structured four phase COM power pattern emerged, including identifiable push off and preload phases. Despite this recovery of gait organization, interlimb work asymmetry remained elevated and paretic PSR remained reduced across all speeds, indicating persistent limb level mechanical deficits. These findings demonstrate that increases in walking speed and the emergence of typical COM power structure reflect recovery of gait organization rather than restoration of underlying limb level mechanical capacity. Consequently, walking speed alone is insufficient to characterize gait recovery after stroke, and biomechanically informed measures of COM work organization and propulsion-support coupling provide complementary insight by distinguishing organizational recovery from limb-level mechanical recovery.

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Interactive Effects of Biological Maturation and Relative Age Effect on Talent Identification for U16 Elite Soccer Players

Li, X.; Gong, Y.; Jiang, W.; Li, Y.; Zhang, W.; Wang, D.; Wang, H.; LUO, C.

2026-04-06 developmental biology 10.64898/2026.04.02.716019 medRxiv
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This retrospective study aims to explore the interactive effects of biological maturation and relative age effect (RAE) on talent identification. 56 male elite soccer players matched for chronological age (15.08{+/-}0.41 years) were studied. Test items included anthropometry (height, body mass, sitting height, leg length, BMI and Quetelet index), physiology (power, speed, agility, speed endurance and aerobic performance), soccer-specific skills (passing, shooting and dribbling), psychology (achievement motivation, orientation and resilience) and biological maturation (APHV) tests. The test results were analyzed independent sample t-test, Pearson correlation analysis, and stratified regression. Conclusion: Biological maturation significantly influences anthropometry (height, weight and Quetelet index), lower limb explosive, and speed (single-leg jump, standing triple jump, and 30-m sprint) in U16 male elite soccer players in Shanghai. The relative age effect shows no significant impact on talent selection indicators, which is attributed to the accumulated training load effect. The mechanisms of biological maturation and RAE in youth soccer talent selection are distinct and operate independently.

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Acute Milk-Protein Intake Enhances Pupil-Linked Executive Function and Esports Performance During Prolonged Play

Matsui, T.; Takahashi, S.; Funabashi, D.; Ohba, C.; Nakamura, K.

2026-03-26 neuroscience 10.64898/2026.03.23.713804 medRxiv
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Prolonged esports play induces cognitive fatigue that is not fully captured by subjective awareness, motivating practical, non-stimulant nutritional strategies supported by objective physiological markers. We here tested whether acute milk protein intake attenuates fatigue-related physiological responses during prolonged esports play and supports subjective state, executive control, and in-game performance. In a randomized, single-blind (assessor-blind), energy-matched controlled crossover study, 15 healthy young adults with esports experience completed two sessions in which they consumed either a milk protein drink or an energy-matched apple juice control before a 3-h virtual soccer task. Physiological measures included pupillometry during gameplay, salivary cortisol, continuous interstitial glucose monitoring, and heart rate. Subjective ratings (VAS) and executive function (flanker task) were assessed across post-ingestion time points, and in-game performance metrics were aggregated within hourly gameplay blocks. Milk protein intake was associated with a coherent pattern of physiological advantages, including larger pupil diameter during gameplay, smoother interstitial glucose dynamics, and lower salivary cortisol, while heart rate showed time-dependent changes without a clear condition effect. These physiological changes co-occurred with higher enjoyment and lower hunger, improved flanker performance, and condition-dependent improvements in in-game performance, most notably higher shot success rate. Additionally, pupil diameter during gameplay was associated with inhibitory-control efficiency on the flanker task. These findings suggest that acute milk protein intake may serve as a practical, non-stimulant nutritional strategy to sustain physiological state and cognitive-behavioral performance during prolonged esports (virtual soccer) play. Highlights- Prolonged esports play models modern digital cognitive activity and cognitive fatigue. - Acute milk protein intake increases pupil diameter during prolonged esports play. - Interstitial glucose dynamics are smoother and salivary cortisol is lower with milk protein. - Enjoyment increases and hunger decreases during 3 h of virtual soccer play. - Executive function and in-game performance improve, most notably shot success rate.

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Development and validation of a Modular Footwear Setup for testing the isolated biomechanical effects of footwear features

Sarlak, H.; Shakir, K.; Rogati, G.; Sartorato, G.; Leardini, A.; Berti, L.; Caravaggi, P.

2026-03-31 rehabilitation medicine and physical therapy 10.64898/2026.03.30.26349729 medRxiv
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The effects of specific footwear features on biomechanical parameters are often confounded by simultaneous changes in other shoe conditions, making it difficult to identify the isolated effect of material and design properties on relevant biomechanical outcomes. This study aimed to propose a tool, namely the Modular Footwear Setup (MFS), to assess the effects of midsole modifications on lower limb joint kinematics and in-shoe plantar pressure. The MFS uses a micro-hook-and-loop fastening system and a custom alignment device to enable fast, strong, and reliable midsole attachment/detachment to/from the upper. Accuracy and repeatability of the MFS in replicating the biomechanical outcomes of a control shoe featuring the same upper and midsole were tested in 10 healthy participants (5M,5F; age=33.2{+/-}9.2 yrs; BMI=21.5{+/-}2.8 kg/m2). Participants were asked to walk wearing both the MFS and the standard control shoe in three sessions. Kinematics of lower limb joints were measured via inertial measurement units, while capacitive pressure insoles were used to measure in-shoe plantar pressure. Intraclass correlation coefficient (ICC) was used to assess the repeatability of kinematic and pressure measurements between sessions. Statistical Parametric Mapping analysis did not identify significant differences in joint kinematics between conditions. While the MFS exhibited slightly lower peak pressure at the rearfoot, pressure parameters were not statistically different in the other foot regions. The MFS demonstrated good-to-excellent inter-session repeatability (ICC 0.84-0.97) for peak and mean pressure. Participants reported similar levels of comfort and stability in both shoes. The findings of the present study suggest the MFS has the potential to be a reliable and accurate tool for evaluating the effect of midsole features on relevant biomechanical parameters. This modular approach may improve data-driven footwear design by providing a consistent platform for testing the effects of midsole designs and materials across various applications, including therapeutic, safety, and athletic shoes.

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A Field-Side Triage Model for Early Specialist Referral After Acute Lower Extremity Sports Injuries in Young Athletes: Development and Internal Validation

Sakoda, S.; Kumagae, H.; Kawano, K.

2026-03-19 sports medicine 10.64898/2026.03.18.26348754 medRxiv
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ObjectiveTo develop and internally validate a field-side triage model to support early specialist referral decisions in young athletes with acute lower extremity sports injuries, where diagnostic resources are often limited. DesignRetrospective cohort study. SettingSingle-center sports medicine clinic. ParticipantsAthletes aged [≤]22 years presenting with acute lower extremity sports injuries between January 2017 and November 2025. Independent VariablesAge, sex, functional severity, injury site, and injury mechanism assessed at initial presentation. ResultsA total of 2,129 athletes were included, with 276 (13.0%) undergoing surgery. Independent predictors were older age, female sex, greater functional severity, knee involvement, and high-energy deceleration mechanisms. The full model showed good performance (AUC 0.890; Brier score 0.073; calibration slope 1.00), and the simplified model also demonstrated high discrimination (AUC 0.883). Risk stratification showed increasing surgical rates across low-, intermediate-, and high-risk groups. Decision curve analysis demonstrated greater net benefit than treat-all and treat-none strategies across clinically relevant thresholds. ConclusionsA field-side prediction model based on readily obtainable clinical variables demonstrated good performance for identifying young athletes at risk of requiring surgical intervention and may support early specialist referral decisions in resource-limited settings. Clinical RelevanceThis model provides a practical tool for early risk stratification using simple clinical information, supporting timely and appropriate referral decisions in field-side and initial clinical settings.

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Frequent vs single active bouts differentially affect movement behavior and energy balance in adults with overweight/obesity

Santo Andre, H. C.; Roux, E. L.; De Jong, N. P.; Smith, P. R.; Lange, A. H.; Mendez, C.; Zahariev, A.; Mamele, M. L.; Johnson, G.; Pan, Z.; Simon, C.; Bessesen, D. H.; Pinto, A. J.; Bergouignan, A.

2026-04-16 sports medicine 10.64898/2026.04.14.26350871 medRxiv
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Objective: To investigate the effects of breaking up prolonged sedentary behavior (SB) on daily movement behavior and energy balance in adults with overweight/obesity. Methods: Thirty participants (16F/14M; 34.2+-7.3y; 29.5+-3.2kg/m2) were randomized to either BREAK (nine hourly 5-min brisk walking bouts) or a duration-matched intervention, ONE (45-min brisk walking), both performed 5 days/week for 6 weeks. Pre- and post-intervention, daily SB and physical activity (PA; accelerometry), body composition (doubly labeled water [DLW]), total daily energy expenditure (TDEE; DLW), appetite, and fasting leptin were measured. Linear-mixed effects models tested time effects and time-by-group interactions. Results: Only BREAK reduced prolonged SB (-8%; interaction: p=0.043). Both groups shifted SB-PA composition toward greater moderate-to-vigorous PA with proportional reductions in SB and light PA (time: all p<0.012), which were associated with increases in TDEE (+0.67 MJ/d; time: p=0.040). Body and fat mass increased in ONE only (interaction: p=0.061 and p=0.055). No differences were noted in energy intake, appetite, or leptin levels. Conclusions: Spreading short PA bouts throughout the day increases MVPA and TDEE to the same extent as a traditional continuous PA bout. Future studies should investigate whether minor differences in body composition are driven by distinct behavioral/physiological compensations influenced by the daily pattern of PA/SB.

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Cortical activity during preparation and execution of balance recovery behavior in people after mild traumatic brain injury: A preliminary investigation

Palmer, J. A.; Lohse, K.; Fino, P.

2026-03-31 rehabilitation medicine and physical therapy 10.64898/2026.03.30.26349748 medRxiv
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Background and purpose: People after mild traumatic brain injury (mTBI) show persistent deficits in reactive balance. Cortical processes engaged during preparation and execution of balance reactions are reflected in distinct cortical activity signatures that can be measured with electroencephalography (EEG). The purpose of this study was to 1) compare preparatory cortical beta activity and evoked cortical N1 responses during balance recovery in people with mTBI and controls, and 2) explore relationships between preparatory and evoked cortical activity. Methods: Participants (age 21-35 years) with symptomatic mTBI (n=5, 27 +/- 13 days post-injury) and controls (n=5) completed the instrumented and modified push & release tests of reactive balance. Cortical activity was recorded using encephalography (EEG). Main outcome measures were 1) preparatory sensorimotor cortical beta-bust power and duration prior to balance perturbation onset (-1s-0s), and 2) cortical N1 response amplitude and latency during the post-perturbation balance recovery (50-250ms). Results: People with mTBI exhibited lower preparatory beta-burst power compared to controls (p=0.044, g=1.18). During balance recovery, cortical N1 responses occurred earlier in people with mTBI compared to controls (p=0.045, g=3.28). Relationships between preparatory and evoked cortical activity were altered after mTBI compared to controls; people after mTBI with greater beta-burst power and longer duration elicited shorter N1 latencies (r's>0.77, p's<0.010). Discussion and conclusion: The results serve as preliminary, hypothesis-generating observations to guide future research directions investigating neural signatures of reactive balance deficits in people after mTBI. The preparatory brain state before reactive balance recovery should be explored as a potential target for post-mTBI balance rehabilitation.

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The Effects of Different Gait Patterns on Knee Joint Biomechanics and Dynamic Stability during Stair Walking in Healthy Adults

Yi, G.; Duan, L.; Sun, Y.; Wang, D.; Gao, Y.

2026-03-23 biophysics 10.64898/2026.03.19.713073 medRxiv
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ObjectiveTo investigate the effects of different gait patterns on knee joint biomechanics and dynamic stability during stair ascent. MethodsFourteen healthy males were recruited to ascend stairs using two distinct gait patterns: the "single-step" (leading with the same leg) and "cross-step" (alternating legs) strategies. Kinematic and kinetic data were collected synchronously using a Qualisys infrared motion capture system and a Kistler 3D force plate. Dynamic stability was quantified using the Margin of Stability (MOS), and knee joint biomechanics were evaluated using Patellofemoral Joint Stress (PFJS) and other relevant metrics. ResultsThroughout the gait cycle, there was no significant difference in the Medio-Lateral (ML) MOS between the single-step and cross-step patterns (P=0.318). However, in the Anterior-Posterior (AP) direction, the MOS for both patterns remained negative and decreased over time, with the cross-step pattern exhibiting significantly lower AP MOS values than the single-step pattern (P=0.002). At the moment of left foot-off, significant differences were observed in the right knee joint angle, right knee joint moment, net joint moment, effective quadriceps muscle lever arm, Quadriceps Force (QF), the angle between the quadriceps tendon and patellar ligament, Patellofemoral Joint Force (PFJF), patellofemoral joint stress, and patellofemoral contact area (all P<0.001). ConclusionsDuring stair ascent, the cross-step pattern reduces body stability, thereby increasing the risk of backward falls. Furthermore, this pattern increases patellofemoral joint stress, subjecting the knee to greater loading. Therefore, it is recommended to enhance lower limb muscle strength through targeted training to reduce fall risk. Additionally, adopting a more cautious gait strategy (such as the single-step pattern) can help minimize patellofemoral joint loading and mitigate the risk of patellofemoral pain.

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Traditional Physical Practice Participation and Vision-Related Quality of Life in Adolescents: The Serial Mediating Roles of Exercise Self-Efficacy and Visual Function Anomalies

Zhang, X.; Liu, Z.; Long, J.

2026-04-07 scientific communication and education 10.64898/2026.04.04.716449 medRxiv
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PurposeThis study examined the association between traditional physical practice participation and vision-related quality of life among junior secondary school students and tested the mediating roles of exercise self-efficacy and visual function anomalies within a serial mediation framework. MethodsA four-wave time-lagged survey was conducted among 1,579 students in Grades 7-9 from schools implementing traditional physical practice activities. Variables were assessed at two-week intervals. Mediation effects were tested using the bias-corrected percentile bootstrap method with 5,000 resamples. ResultsThe total effect of traditional physical practice participation on vision-related quality of life was significant ({beta} = 0.591, p < .001). After including the mediators, the direct effect remained significant ({beta} = 0.404, 95% CI [0.348, 0.457]), accounting for 68.36% of the total effect. The total indirect effect was significant ({beta} = 0.187, 95% CI [0.160, 0.218]), representing 31.64% of the total effect. The indirect effect via exercise self-efficacy was significant ({beta} = 0.088, 95% CI [0.068, 0.112], 14.89%), as was the indirect effect via visual function anomalies ({beta} = 0.065, 95% CI [0.048, 0.086], 11.00%). The serial mediation pathway through exercise self-efficacy and visual function anomalies was also significant ({beta} = 0.034, 95% CI [0.025, 0.045], 5.75%). All confidence intervals excluded zero, supporting partial mediation. ConclusionTraditional physical practice participation was associated with vision-related quality of life both directly and indirectly through exercise self-efficacy and visual function anomalies, including a significant serial mediation pathway. The findings highlight the combined psychological and functional mechanisms underlying adolescents vision-related quality of life.

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Multimorbidity Patterns and Associated Factors Among Middle-Aged and Older Adults in China: Evidence from the CHARLS Study

Wang, Z.; Skou, S. T.; Chen, Y.; Estill, J.

2026-04-02 geriatric medicine 10.64898/2026.03.31.26349821 medRxiv
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Background: Despite the growing global burden of multimorbidity, the patterns of disease combinations, have not been extensively categorized. We aimed to explore the predictors, health consequences, and patterns of discordant and concordant multimorbidity. Methods: We used the 2018 China Health and Retirement Longitudinal Study (CHARLS), a representative database of adults aged >45 years from China. We conducted logistic regression analyses to assess the likelihood of having discordant (conditions from different disease systems) versus concordant (only cardiometabolic, or only respiratory diseases) multimorbidity, and to compare the health status and healthcare utilization between patients with discordant and concordant multimorbidity. Latent class analysis (LCA) was applied to both the entire sample and to patients with discordant multimorbidity to identify clusters of disease combinations. Results: The sample included 1668 patients with concordant (mainly cardiometabolic), and 7306 patients with discordant, multimorbidity. Female patients, patients living in rural settings, former and current smokers, and patients engaging in high-intensity physical activity, were more likely to have discordant instead of concordant multimorbidity. Depression, limitations in daily activities, poor self-reported health, and frequent healthcare use were more common in patients with discordant than concordant multimorbidity. The LCA identified five clusters when all multimorbid patients were included (cardiometabolic, arthritis-digestive, respiratory, multisystem, and arthritis-hypertension classes), and four clusters when restricted to discordant multimorbidity (digestive, arthritis-cardiometabolic, respiratory, and multisystem classes). Conclusion: Discordant multimorbidity is associated with poorer health and increased use of healthcare. Cardiometabolic diseases, arthritis, and digestive diseases have a central role in defining disease patterns.

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Acute and Lifelong Exercise Modulate the Tumorigenic Potential of Human Lung Cancer Cells and Their Susceptibility to Cisplatin

Soares, C. M. d. S.; Moura, J. P.; Ferreira, L. M. R.; Pedrosa, A.; Filipe, P.; Rama, L.; Teixeira, A. M.; Urbano, A. M.

2026-03-23 cancer biology 10.64898/2026.03.19.713009 medRxiv
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The association between higher levels of physical activity and lower cancer risk and mortality is well established. However, a causal link is yet to be proven. Recent studies showed a decrease in the proliferation rates of cultured human cancer cells when the human serum employed to stimulate them was conditioned by acute exercise. Here, we tested the hypothesis that serum mediates some of the putative benefits of exercise on cancer through alterations to the growth pattern and susceptibility to chemotherapy agents of cancer cells. To this end, human non-small cell lung cancer (NSCLC) cells were exposed to serum from two cohorts that differed significantly on their levels of physical activity and, accordingly, cardiorespiratory fitness, but were otherwise identical (master athletes and non-exercisers), collected before and after an acute exercise intervention. Serum levels of glucose, lipids, albumin, C-reactive protein and cytokines were determined and the impact of the serum responses to acute and lifelong exercise on the above-mentioned parameters were analyzed. We found that acute exercise decreased the cells proliferation rate, yet shortened the cells lag phase after detachment, whereas lifelong exercise had the opposite effects. Significantly, we showed, for the first time, that lifelong exercise increased susceptibility to a chemotherapy agent (cisplatin), which may contribute to the decreased cancer mortality rates found among those who exercise regularly. Similar to the cellular effects, changes to serum cytokine levels - several of them linked to the senescence-associated secretory phenotype - depended on whether serum was conditioned by acute or by chronic exercise. Key pointsChronic exercise increased the in vitro susceptibility of lung cancer cells to cisplatin. Acute and chronic exercise modulated the in vitro tumorigenic potential of lung cancer cells. Effects were mediated by serological changes produced by exercise. Acute and chronic exercise had distinct impacts on serological cytokine levels.

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Trajectories of physical activity components among community-dwelling older adults.

Hoogerheide, B.; Maas, E.; Visser, M.; Hoekstra, T.; Schaap, L.

2026-04-11 rehabilitation medicine and physical therapy 10.64898/2026.04.10.26350593 medRxiv
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Background/Objective: Common measures of physical activity (PA) based on duration and intensity do not fully capture its complexity. Adding additional PA components of muscle strength, mechanical strain, and turning actions, can provide a more complete view of activity behavior. Furthermore, PA behaviors differ between men and women. Therefore, the goal of this study is to identify and cluster similar long-term PA patterns over time for each PA component, examined separately for men and women. Methods: We used data from 4963 participants (52% women; mean age 66 years, SD = 8.6) of the Longitudinal Aging Study Amsterdam (1992 to 2019). PA component scores were assigned to self-reported activities, and Sequence Analysis with Optimal Matching was used to identify and cluster similar activity patterns over a period of 10 years, separately for each component and stratified by sex. Results: PA components varied by sex and displayed a unique mix of trajectories, including predominately low, medium, or high activity, increasing or decreasing patterns, and trajectories characterized by early or late mortality. Importantly, trajectories remained independent, indicating that changes in one PA component were not linked to changes in others. Conclusion: Older men and women follow distinct and independent long term PA trajectories across components, underscoring that PA behaviour cannot be described by a single dimension. Significance/Implications: The observed independence and heterogeneity of trajectories suggest that muscle strength, mechanical strain, and turning actions capture meaningful and distinct aspects of PA that are not reflected by traditional measures alone. Future PA-strategies could incorporate these dimensions and acknowledge sex-specific patterns to better reflect natural movement. The independence of components suggests that future interventions should target multiple dimensions, as changes in one component may not translate to others. Such an approach may support more tailored and sustainable PA interventions in later life.

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Gray matter Volume Modulates the Effect of Acute Physical Activity on Reading Comprehension and Cognitive Load in Adolescents. The Cogni-Action Project

Martinez-Flores, R.; Super, H.; Sanchez-Martinez, J.; Solis-Urra, P.; Ibanez, R.; Herold, F.; Paas, F.; Mavilidi, M.; Zou, L.; Cristi-Montero, C.

2026-04-02 neuroscience 10.64898/2026.03.31.715252 medRxiv
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BackgroundPhysical activity has been associated with better reading comprehension and reduces cognitive load (CL), but the role of brain volume in modulating this relationship remains unclear. Therefore, this study aims to determine whether the gray matter volume in key regions modulates the effects of different physical activity modalities on reading comprehension and associated CL. MethodsThirteen male adolescents (12-13 years). Adolescents with MRI data participated in a randomized cross-over trial comparing three conditions: 1) sedentary behavior (SC, emulating a school class), 2) moderate-intensity continuous training (MICT), and 3) cooperative high-intensity interval training (C-HIIT), with physical activity conditions duration adjusted to match SC energy expenditure. Gray matter volumes were measured in the bilateral hippocampus, left pars opercularis, and the brainstem. CL was assessed via pupil dilation during reading using eye-tracking. Reading comprehension was measured through seven-question multiple-choice tests with expert-validated items. ResultsC-HIIT demonstrated superior effects on both CL and reading comprehension compared to MICT and SC, with significant brain volume modulation effects across all examined regions. Brain volume interactions with physical activity modalities systematically modified the pattern of cognitive responses, with C-HIIT consistently benefiting from these modulations, whereas the effects of MICT were generally attenuated. ConclusionThis study suggests that selecting the appropriate physical activity modality may be relevant for cognitive outcomes during reading in adolescents. C-HIIT yielded lower CL and better reading comprehension, and these effects were not explained by brain volume alone but by its interaction with exercise modality.

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Closed Kinematic Chain Biomechanics and Cycling: Linking Biomechanical Variables to Knee Joint Loading

BAHO VITA, H.; Welegebriel, D. F.

2026-04-01 biophysics 10.64898/2026.03.29.715123 medRxiv
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This study investigates closed kinematic chain biomechanics in cycling with a focus on knee joint loading. Data from 16 cyclists collected on a standardized ergometer were analyzed in OpenSim using inverse dynamics, static optimization, and joint reaction analysis. To keep the pipeline consistent across all subjects, the report summarizes right-knee outputs over a steady-state interval between 120 and 124 s. Peak knee joint moments ranged from 15.79 to 44.85 Nm (mean 30.49 {+/-} 7.66 Nm), while peak resultant knee reaction forces ranged from 1187.61 to 3309.04 N (mean 2317.19 {+/-} 728.19 N). Static optimization showed strong contributions from the rectus femoris and vastus lateralis during power production, with additional stabilization from the biceps femoris long head and gastrocnemius medialis. Mean peak muscle activation was highest for the rectus femoris (0.72 {+/-} 0.19), followed by the biceps femoris long head (0.66 {+/-} 0.20). Mean peak muscle force was highest for the vastus lateralis (1078.1 {+/-} 305.8 N) and rectus femoris (994.1 {+/-} 379.2 N). The results confirm substantial inter-subject variability in knee loading and support the use of personalized training or rehabilitation strategies when cycling is used for performance development or joint recovery.

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Development of an Inventory to Identify Psychosocial Factors Influencing Hand Usage: the CHUC

Soberano, T.; Chang, C.-H.; Marcori, A. J.; Philip, B. A.

2026-04-01 rehabilitation medicine and physical therapy 10.64898/2026.03.26.26347326 medRxiv
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Objective: To develop the first inventory to measure psychosocial concerns about use of the non-preferred hand, toward the long-term goal of identifying the casual factors of left-right hand choices ("hand usage"). Design: Cross-sectional Setting: Online question battery Participants: 181 healthy adults Interventions; Not applicable Main Outcome Measures: Self-reported concerns about emotional and physical consequences of using the non-preferred hand. Results: Emotional and physical consequences reflected internally consistent categories (Cronbach's > 0.9) that were moderately correlated with each other ({rho} = 0.783 p = 0.002). Concerns were activity-dependent in each category ({rho} < 1x10-100). Reliability analysis and principal components analysis were used to reduce the battery to the 51-item Changed Hand Usage Concerns inventory, which encompasses everyday tasks and concerns about physical and emotional consequences of using the non-preferred hand in those tasks. Conclusions: Concerns about emotional vs. physical consequences of non-preferred hand use reflect coherent and internally consistent categories The Changed Hand Usage Concerns inventory allows assessment of psychosocial concerns about usage of the non-preferred hand for future attempts to manipulate hand usage via rehabilitation in patients with unilateral or asymmetric impairment.

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Negative emotional visual stimuli alter specific improvised dance biomechanics in professional dancers

Maracia, B. C. B.; Souza, T. R.; Oliveira, G. S.; Nunes, J. B. P.; dos Santos, C. E. S.; Peixoto, C. B.; Lopes-Silva, J. B.; Nobrega, L. A. O. d. A.; Araujo, P. A. d.; Souza, R. P.; Souza, B. R.

2026-03-20 neuroscience 10.64898/2026.03.18.711707 medRxiv
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Dance is a core form of human-environment interaction and a powerful medium for emotional expression, yet dancers are routinely exposed to environmental affective cues that may shape their movement. We tested whether a negative emotional context induced immediately before improvisation alters dance biomechanics. Twenty professional dancers performed two 3-min improvised dances. Between dances, they viewed either Neutral or Negatively valenced pictures from the International Affective Picture System (IAPS; 2 min 40 s, 5 s per image). Eye tracking verified attention to the visual stream. Mood was assessed at four time points (PT1-PT4) using the Brazilian Mood Scale (BRAMS), and full-body, three-dimensional kinematics were captured at 300 Hz using a 9-camera optoelectronic system (Qualisys) and processed to measure global movement amplitude and expansion. Negative IAPS exposure increased tension, depression, fatigue, and decreased vigor from PT2 to PT3. Biomechanically, the Negative Stimulus dancers showed a significant reduction in global movement amplitude after negative IAPS exposure, with reduced movement amplitude of the body extremities. In contrast, global movement expansion remained unchanged; that is, the extremities were not positioned closer or farther from the pelvis. Neutral images produced no mood change and no measurable modulation of movement amplitude or expansion. Together, these results support the hypothesis that improvised dance carries biomechanical signatures of the dancers current affective state, beyond the intended expressive content, and provide an automated motion-capture workflow for studying emotion-movement coupling in spontaneous dance. HighlightsNegative visual context shifted dancers mood toward negative affect Negative images reduced movement amplitude in improvised dance Movement expansion remained stable despite mood induction Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=113 SRC="FIGDIR/small/711707v1_ufig1.gif" ALT="Figure 1"> View larger version (19K): org.highwire.dtl.DTLVardef@aeaacdorg.highwire.dtl.DTLVardef@14f9bf5org.highwire.dtl.DTLVardef@18805fcorg.highwire.dtl.DTLVardef@1411256_HPS_FORMAT_FIGEXP M_FIG C_FIG