Medicine & Science in Sports & Exercise

BackgroundMeteorological factors such as barometric pressure, humidity, and temperature have been linked to weather-related symptoms in the general population, yet little is known about their influence on athletes daily well-being and performance. Individual variability in weather sensitivity has been reported in biometeorology research, suggesting that only certain individuals exhibit pronounced physiological responses to environmental fluctuations. However, no studies have examined within-person associations between multiple meteorological factors and daily condition or performance in competitive athletes. MethodsCollegiate baseball players were monitored over 10 randomly selected days during July-August 2025. Subjective condition and performance were assessed daily using a 3-point Likert scale (1 = poor, 2 = normal, 3 = good). Barometric pressure, humidity, and temperature were recorded hourly and summarized for each day using mean values, day-to-day changes, daily ranges, and rapid fluctuation indices. For each player, multivariable linear regression models were constructed to examine within-person associations between the three meteorological variables and daily condition or performance. Model fit (R2), regression coefficients ({beta}), and dominant meteorological factors were extracted. ResultsEighty players were included in the condition model and eighty-six in the performance model. High weather sensitivity (R2 [≥] 0.60) was observed in 22.5% of players for condition and 14.0% for performance, whereas low sensitivity (R2 [≤] 0.20) was found in 26.3% and 16.3%, respectively. Temperature was the dominant explanatory factor in more than 80% of players, although subsets showed dominance of barometric pressure or humidity. Directionality varied across individuals: decreases in barometric pressure were associated with worsening conditions in 62.5% of players but improvement in 37.5%; similar bidirectional patterns were observed for humidity and temperature. ConclusionDaily meteorological fluctuations explain a meaningful proportion of within-person variation in condition and performance for a subset of collegiate baseball players. The substantial individual variability and diverse directional responses highlight weather sensitivity as a personalized characteristic rather than a uniform effect. These findings suggest that meteorological factors may represent a relevant contextual variable for daily readiness monitoring in susceptible athletes.

BackgroundAnterior knee pain (AKP) is common in adolescent athletes and encompasses heterogeneous osseous and soft tissue pathologies, yet its developmental mechanisms remain poorly integrated. HypothesisPain-generating tissues within the knee extensor mechanism are redistributed from osseous to soft tissue structures with skeletal maturation. Study DesignRetrospective observational cohort study. Level of EvidenceLevel 3. MethodsA total of 1,595 patients with sports-related knee injuries (2017-2025) were included. Skeletal maturity was determined by proximal tibial physeal status on radiographs, classifying participants into open-physes (n = 707) and closed-physes (n = 888) groups. AKP was classified into bony and non-bony subtypes based on maximal tenderness. Prevalence was compared using odds ratios (ORs) with 95% confidence intervals (CIs). ResultsOverall, 575 patients (36.1%) had AKP. AKP was more prevalent in the open-physes group than in the closed-physes group (60.1% vs 16.9%; OR, 7.4; 95% CI, 5.9-9.3; p < 0.001). Bony AKP showed a marked difference (42.4% vs 3.7%; OR, 19.1; 95% CI, 12.8-28.6; p < 0.001), whereas non-bony AKP showed only a modest difference (17.7% vs 13.2%; OR, 1.4; 95% CI, 1.1-1.9; p = 0.013). ConclusionThe association between AKP and skeletal maturity was primarily driven by bony AKP, supporting structural redistribution of pain-generating tissues during growth. Clinical RelevanceTenderness-based classification may aid identification of tissue-specific vulnerability and inform growth-stage-specific load management.

Background: Quadriceps weakness may reduce sagittal plane shock absorption during landing, shifting load toward the frontal plane and increasing knee abduction moment (KAM), a biomechanical risk factor for anterior cruciate ligament (ACL) injuries. Purpose: The purpose of this study was to evaluate the association between isokinetic quadriceps strength and peak KAM during drop vertical jump landing in adolescent athletes. Study Design: Secondary analysis of previously collected data. Methods: Healthy adolescent athletes completed quadriceps strength testing using an isokinetic dynamometer and a biomechanical assessment during a drop vertical jump task. Quadriceps strength was quantified as peak concentric torque and the peak external KAM was calculated during the landing phase on the dominant limb. Both strength and KAM were normalized to body mass. Linear regression was used to examine the association between normalized quadriceps strength and peak external KAM on the dominant limb. Results: The association between quadriceps strength and peak normalized KAM on the dominant limb was not statistically significant ({beta} = -0.053 (95% CI [-0.137 to 0.030]), F(1,119) = 1.62, R2 = 0.013, p = 0.206). Quadriceps strength explained only 1.3% of the variance in peak KAM, indicating a negligible association between these variables in this cohort. Discussion: Quadriceps strength was not associated with peak normalized KAM during landing, suggesting that frontal-plane knee loading during a drop vertical jump is not meaningfully explained by maximal concentric quadriceps strength alone. KAM appears to be driven more by multi-joint movement strategy and neuromuscular coordination than by the capacity of a single muscle group.

PurposeFemale artistic swimmers successful competitive performance depends on several physical performance factors such as postural control, flexibility, muscle strength, and aerobic endurance. Flexibility is a highly important physical component that can directly impact successful performance. Pilates could be an appealing training modality to artistic swimmers due to the sports reliance on precise body control and synchronized movements. This study aimed to assess the impact of an 8-week Pilates training program on flexibility and sport-specific performance in young female artistic swimmers. MethodsEighteen competitive artistic swimmers aged 13 to 15 years (13.8{+/-}0.8 years) were randomly assigned to an experimental or control group. The experimental group executed a Pilates class, incorporating typical equipment exercises (small Pilates ball and bands), while the control group maintained their regular gym workout routine. Both groups had two training sessions per week for 60 minutes per session. Every athlete was evaluated on their ability to accomplish two basic figures in the water (Ariana, Rio). To evaluate all characteristics, univariate analyses of covariance (ANCOVA) were employed, with initial measurements as covariates and final measures as dependent variables. ResultsFlexibility exercises, splits (P =.028), bridge (P =.003), shoulders (P =.005), and figures (Ariana: P =.001, Rio: P =.003), demonstrated statistically significant differences in favour of the experimental group. However, there was no difference in knee flexibility across the groups (p=0.376). The covariate had a significant impact (p<.05) across all analyses. ConclusionThe findings suggest that Pilates training enhances flexibility and basic figure performance in young female artistic swimmers. Incorporating Pilates into training programs could be beneficial in improving flexibility and overall performance.

ObjectivesDeterminants of functional injury severity in young athletes remain incompletely understood. Conventional assumptions emphasize contact sport participation and skeletal immaturity as major drivers of severe injury; however, severity definitions based on surgery or time loss are strongly influenced by health-care systems and competition contexts. We investigated factors associated with early functional severity after lower-extremity sports injury using a large clinical cohort. MethodsThis cross-sectional observational study analyzed 4,829 lower-extremity sports injury cases in athletes aged [&le;]22 years who presented to a specialized sports injury clinic between January 2017 and November 2025. Severe injury was defined as inability to walk independently at the initial visit. Multivariable logistic regression analysis was performed to evaluate associations between severe injury and age, sex, sport type, injury mechanism, injury location, and physeal status. ResultsSevere injury was most strongly associated with acute injury compared with overuse injury (odds ratio [OR], 31.1; 95% confidence interval [CI], 17.7-54.6; p <.001). Injuries involving the knee and ankle were also significantly associated with severe injury (OR, 2.73; 95% CI, 2.04-3.64; p <.001). Female sex showed a modest independent association (OR, 1.40; 95% CI, 1.06-1.84; p =.017), whereas participation in contact sports, physeal status, and age were not independently associated. ConclusionEarly functional severity after lower-extremity sports injury in young athletes was primarily associated with injury acuity and anatomical involvement of the knee and ankle rather than with sport type or skeletal maturity. These findings challenge conventional exposure-based assumptions and support function-oriented phenotyping for injury surveillance and targeted prevention strategies.

ContextACL injury prevention in young athletes has traditionally relied on a dichotomous classification of contact versus noncontact mechanisms; however, this framework may not adequately capture the movement processes underlying many injuries. ObjectiveTo classify ACL injury mechanisms in athletes aged [&le;]22 years with a specific focus on landing-related movements and to examine their associations with sport contact characteristics and age. DesignRetrospective observational study. SettingSingle sports injury clinic. Patients or Other ParticipantsA total of 151 athletes aged [&le;]22 years (mean age, 17.7 {+/-} 2.1 years) diagnosed with ACL injury between January 2017 and November 2025. Main Outcome Measure(s)ACL injury mechanisms were classified as landing-related without contact (L), landing-related with contact (Lc), or direct contact injury (C). Landing-related injuries (L + Lc) were compared with direct contact injuries. Multivariable logistic regression was used to identify factors associated with landing-related injury. ResultsLanding-related injuries accounted for 123 cases (81.5%), including 88 noncontact and 35 contact-related landing injuries, whereas direct contact injuries occurred in 24 cases (15.9%). Athletes with direct contact injuries were significantly older than those with landing-related injuries (19.2 {+/-} 1.7 vs 17.5 {+/-} 2.5 years, p = 0.03). In multivariable analysis, participation in noncollision sports was strongly associated with landing-related injury (odds ratio [OR] = 9.80; 95% confidence interval [CI] = 3.03-31.5; p < 0.001), whereas increasing age was inversely associated with landing-related injury (OR per year = 0.71; 95% CI = 0.56-0.90). Sex was not independently associated with injury mechanism. ConclusionsMost ACL injuries in athletes aged [&le;]22 years occurred through landing-related mechanisms, regardless of contact. These findings highlight insufficient control of landing and foot contact as a fundamental mechanism of ACL injury in young athletes and support prevention strategies focused on movement quality during sport-specific tasks. Key Points{blacksquare} Most ACL injuries in athletes aged [&le;]22 years occurred during landing or foot contact, regardless of whether external contact was present. {blacksquare}Noncollision sports and younger age were strongly associated with landing-related ACL injury mechanisms. {blacksquare}ACL injury prevention in young athletes should prioritize improving landing and foot contact control rather than focusing solely on contact characteristics.

This study compared the effects of a 25-min nap opportunity and a 10-min non-sleep deep rest (NSDR) condition on perceptual, cognitive, and physical performance in physically active young adults. Sixty participants (26 female, 34 male; 22 {+/-} 4 years) were randomly assigned to one of three groups (nap, NSDR, control; n = 20 each). All groups completed identical assessments immediately, 20 min, and 40 min post-intervention. Mixed-effects models, adjusted for sex, prior-night sleep, and weekly physical activity, revealed a significant Group x Time interaction for sleepiness, fatigue, readiness to perform, and handgrip strength (p < 0.05). At 40 min post-intervention, the nap group reported lower fatigue than control and higher readiness to perform than both control and NSDR (p < 0.05). No significant effects were observed for the NSDR condition on perceptual, cognitive, or physical outcomes (p > 0.05). These findings indicate that a short nap can enhance perceived readiness and reduce fatigue after a brief latency period, whereas NSDR did not elicit significant effects under the present conditions.

ObjectiveTo determine the incidence and transition patterns of local and spatial recurrence among youth athletes presenting with groin pain (GP), anterior knee pain (AKP), and heel pain (HP). DesignRetrospective observational study. SettingSingle sports medicine clinic. ParticipantsYouth athletes who visited the clinic between January 2017 and November 2025 for GP, AKP, or HP. A total of 769 clinical episodes were included. Independent VariablesPain-site transitions and laterality were extracted from electronic medical records. No therapeutic interventions were evaluated. Recurrence patterns were classified as local or spatial and further subclassified into contralateral same-site, adjacent-site, and remote-site recurrence. Main Outcome MeasureTrue recurrence, defined as an episode with at least one prior visit for GP, AKP, or HP within the preceding 12 months. ResultsAmong 769 episodes, 130 episodes (16.9%; 95% confidence interval [CI], 14.4- 19.7) represented true recurrence. Local recurrence accounted for 57 episodes (7.4%; 95% CI, 5.8-9.5), whereas spatial recurrence accounted for 73 episodes (9.5%; 95% CI, 7.6-11.8). Among spatial recurrences, 26 episodes (35.6%) were contralateral same-site, 42 (57.5%) adjacent-site, and 5 (6.8%) remote-site recurrence. Transitions most frequently occurred between GP and AKP and between AKP and HP, whereas direct transitions between GP and HP were uncommon. ConclusionsRecurrence after symptom resolution in youth athletes more often involves spatial transitions to anatomically adjacent sites rather than simple local recurrence. These findings support interpreting recurrence within a whole-body functional framework and may facilitate refined recurrence risk assessment and comprehensive intervention strategies. Clinical RelevanceClinicians should evaluate recurrent pain beyond the symptomatic region, which may improve recurrence prevention and return-to-sport decision-making.

BackgroundEmerging research indicates that light exposure may influence sleep quality. Identifying key light-exposure behaviours associated with poor sleep quality in athletes may allow practitioners to efficiently screen for sleep difficulties and prioritise athletes for further assessment. Translating these findings into a practical screening tool could enhance willingness of high-performance professionals to monitor sleep and light exposure in athletes. HypothesisKey predictor variables identified by feature reduction techniques will lead to higher predictive accuracy in determining which light behaviours are associated with poor sleep quality in athletes. Study DesignCross-sectional study. Level of EvidenceLevel 3. Methods121 athletes from varying competitive levels completed questionnaires, including the Light Exposure Behaviour Assessment (LEBA) and Pittsburgh Sleep Quality Index (PSQI). Poor sleep quality was defined using the PSQI cut-off >5. Least absolute shrinkage and selection operator (LASSO) regression identified light exposure variables from the LEBA questionnaire most strongly associated with good and poor sleep quality in athletes. Three models were compared: a full-variable model (23 items), a factor-specific model (Factor 3: screen/device use), and a feature-reduced model (LASSO-selected items). ResultsPhone use before bed, checking phone/watch during the night, were identified as variables of greatest association with poor sleep quality and used for reduced feature set modelling. On an independent test set, the feature-reduced model achieved area under the curve (AUC) 0.83, sensitivity 0.70, and specificity 0.92. ConclusionsOur findings report that phone-related behaviours before and in bed are associated with a higher likelihood of poor sleep quality. These behaviours, combined with the developed nomogram, provide a preliminary, low-burden screening tool to identify athletes who may be experiencing sleep difficulties. The high specificity indicates that athletes flagged by the tool are likely to have genuine poor sleep quality, warranting further assessment to identify underlying causes and appropriate interventions. Clinical RelevanceEducation and interventions focused on light exposure factors were identified as most influencing sleep quality in a multifaceted athletic population and could be prioritised to optimise sleep quality. The developed sleep quality nomogram may be useful as a decision-making tool to improve sleep monitoring practice among practitioners.

IntroductionFamilial hypercholesterolemia (FH) is a genetic disorder characterized by elevated low-density lipoprotein -cholesterol (LDL-c) levels, increasing early cardiovascular risk. Many patients do not reach LDL-c targets despite treatment. Physical activity and exercise may help by improving cardiorespiratory fitness (CRF), reducing inflammation, and modulating metabolic pathways. This study aims 1) to cross-sectionally evaluate the association of physical activity and CRF with markers of sub-clinical atherosclerosis and a nuclear magnetic resonance-derived metabolomic profile in patients with FH, and 2) to assess the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on CRF (primary outcome), markers of subclinical atherosclerosis, serum biomarkers and metabolomic profiles (secondary outcomes), and to unravel the underlying mechanisms. Methods and analysisFor aim 1, a cross-sectional study will be conducted in approximately 200 patients with FH from Granada and Almeria (Spain). Assessments will include accelerometer-measured physical activity, CRF, markers of subclinical atherosclerosis and metabolomic profiles. For aim 2, a 16-week, parallel-group randomized controlled trial will be conducted with 75 participants assigned to one of three groups: HIIT (4 intervals of 4 minutes at 85-95% of maximal heart rate, 3 days/week), MICT (34 minutes at 69-76% of maximal heart rate, 3 days/week) or usual care. CRF will be assessed using the modified Bruce test. Markers of subclinical atherosclerosis will include vascular inflammation (PET/CT scan), arterial stiffness (Mobil-O-Graph(R) 24h pulse wave monitor), carotid intima-media thickness, and carotid plaque presence (carotid Doppler ultrasound). Metabolomic profiles will be analyzed using nuclear magnetic resonance spectroscopy. Analyses will include correlation and regression models for cross-sectional associations, and linear mixed-effects models for RCT outcomes, following an intention-to-treat approach with additional sensitivity analyses. Ethics and disseminationThe study was approved by the Ethics Committee for Biomedical Research of Granada (ref. 1417-N-23), and findings will be disseminated through peer-reviewed publications, conference presentations, and outreach activities aimed at patients and healthcare professionals. Trial registration numberClinicalTrials.gov ID NCT06833944. Strengths and limitations of this studyO_LIThis is the first study to evaluate the effects of structured exercise in patients with familial hypercholesterolemia, comparing two exercise modalities (high-intensity interval training and moderate-intensity continuous training) and assessing multiple clinically relevant health outcomes (cardiorespiratory fitness, subclinical atherosclerosis, and metabolomic profiles). C_LIO_LIThe study integrates objective measures of physical activity (accelerometry), cardiorespiratory fitness (VO{square}max), vascular imaging (PET/CT, carotid ultrasound, arterial stiffness), and metabolomics, providing a comprehensive assessment of both functional and mechanistic outcomes. C_LIO_LIThe interventions are supervised, individualized, and follow established exercise reporting guidelines (CERT), which enhances safety, adherence, and reproducibility. C_LIO_LIThe intervention duration (16 weeks) and the specific clinical population (aged 18- 70 years, clinically stable, without cardiovascular disease) may limit assessment of long-term effects and generalizability to all patients with familial hypercholesterolemia. C_LIO_LIAlthough some outcomes are directly applicable to clinical or exercise practice, other mechanistic outcomes (PET/CT, metabolomics, and vascular imaging) provide rigorous scientific insight but have lower direct applicability. C_LI

Objectives: Compare Anterior Cruciate Ligament (ACL) Return to Sport after Injury (ACL-RSI) scores over time following ACL reconstruction (ACLR) between male and female patients aged 15 to 25 years with primary ACL injuries and ACL reinjuries. Design: Retrospective cohort design. Setting: Sports physical therapy clinics. Participants: 332 patients aged 15-25 years who underwent ACLR following either primary ACL injury or ACL reinjury, either contralateral or ipsilateral graft reinjury, and had at least one observation of the ACL-RSI. Main Outcome Measures: ACL-RSI score. Results: ACL-RSI scores significantly increased over time post- ACLR (p < .001), males reported significantly higher scores compared to females (p < .001), and patients with contralateral ACL reinjury demonstrated higher scores than those with ipsilateral ACL graft reinjury (p = .006), though there was no difference in scores between patients with primary ACL injury and ACL reinjury. A significant interaction effect of sex and injury status was also observed (p = .009), generally demonstrating that females had lower psychological readiness compared to males across injury statuses. Conclusions: ACL-RSI following ACLR varies based on biological sex and time post-ACLR, though ACL reinjury, independent of the reinjured leg, does not appear to effect scores compared to primary ACL injury.

Background: Psychological readiness to return to sport and subjective knee function are critical outcomes following ACL reconstruction (ACLR), yet they do not always progress in parallel. An athlete may demonstrate high subjective knee function but low psychological readiness, suggesting a mental barrier to return, or conversely, report high readiness despite persistent functional limitations, raising concerns of overconfidence and reinjury risk. Understanding how these domains change together during recovery is essential for identifying mismatches that may require targeted intervention. Purpose: The purpose of this study is to examine the relationship between changes in psychological readiness (ACL-RSI) and subjective knee function (IKDC) from early to late recovery following ACLR. Study Design: Secondary analysis of prospectively collected data. Methods: Athletes (N = 48, Age at ACLR = 17.7 {+/-} 1.8 y) aged 15-25 years who underwent ACLR with an ipsilateral autograft, had a pre-injury MARX score > 8, and completed the ACL-RSI and IKDC questionnaires at 3.5 {+/-} 1 and 7 {+/-} 1 months post-ACLR were included. Percent changes in ACL-RSI and IKDC scores between early and late recovery were calculated. Spearman's rank correlation was used to examine the association between changes in psychological readiness and subjective knee function. Significance was set to p < .05. Results: The mean percent change in ACL-RSI was 40.7 {+/-} 57.1% and the mean percent change in IKDC was 24.8 {+/-} 18.1% from 3.5 {+/-} 1 months to 7 {+/-} 1 months post-ACLR. The percent changes in ACL-RSI and IKDC scores from 3.5 {+/-} 1 months to 7 {+/-} 1 months post-ACLR were moderately correlated ({rho} = 0.350 (95% CI [0.089, 0.584]), p = 0.012). Discussion: The main finding of this study was that subjective knee function and psychological readiness to return to sport changed in parallel from 3.5 to 7 months following ACLR. Clinicians can use this information regarding the concordant progression of psychological readiness to return to sport and subjective knee function to personalize ACL rehabilitation for future patients. Overall, clinicians can understand that if psychological readiness improves, subjective knee function will likely improve over the 3.5- to 7-month post-ACLR time frame, and vice versa. Therefore, focusing on both of these components at multiple time points during the recovery process may be influential to ensure the greatest likelihood of returning to sport in athletes following ACLR.

ContextClinical assessments of landing mechanics often require complex scoring systems or laboratory-based motion analysis, which can limit feasibility in routine practice. A visually based landing-mechanics score centered on a standardized optimal joint-alignment configuration ("Zero Position") may offer a simple, clinically deployable alternative. ObjectiveTo determine the intra- and inter-rater reliability of a landing mechanics score based on standardized optimal joint alignment at the moment of maximal center-of-mass (COM) descent. DesignCross-sectional reliability study. SettingUniversity athletic training facility. Patients or Other ParticipantsNinety healthy male collegiate athletes. Main Outcome MeasuresLanding mechanics were evaluated using frontal- and sagittal-plane video recordings, with scoring performed on the frame corresponding to maximal COM descent. Five criteria reflecting the standardized joint configuration ("Zero Position") were assessed. Intra- and inter-rater reliability were calculated using Cohens kappa coefficients and Kendalls W. ResultsAll five criteria demonstrated moderate to substantial intra-rater reliability and moderate to almost perfect inter-rater reliability. The total landing-mechanics score showed excellent agreement across all comparisons. The scoring system required minimal training and was feasible to implement using standard video recordings. ConclusionsThe landing-mechanics score centered on the Zero Position demonstrated high reliability and strong clinical feasibility. This simple, visually grounded assessment may support routine clinical screening, injury-risk evaluation, and return-to-sport decision-making. Future research should examine its applicability to single-leg landings and sport-specific high-risk movements.

High-impact physical activity delivers musculoskeletal and systemic health benefits yet remains controversial for people with hip or knee arthroplasties due to concerns about implant loading and longevity. This study provides the first three-dimensional kinematic and kinetic characterisation of high-impact tasks in high-functioning adults with total hip arthroplasty (THA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA), compared with healthy controls. High-functioning adults with a joint arthroplasty (THA=11, TKA=4, UKA=3) participated. Healthy comparison data (n=70) were obtained from prior studies adopting the same analytical framework. They completed running, 45{degrees} change of direction (COD), countermovement jumps (CMJs), and unilateral/bilateral hopping. An 8-segment biomechanical model was used to quantify 3D joint angles and internal moments. These were time-normalised and modelled using Generalized Additive Models with covariates for group, age, and task intensity. THA had greater hip adduction angles during running 3.65{degrees} (95%CI 0.73{degrees}, 6.57{degrees}) and COD45 14.12{degrees} (95%CI 3.22{degrees}, 25.02{degrees}), compared to controls. THA participants recruited greater hip extensor moment during loading response in running, propulsion during CMJ, and in unilateral and bilateral hops, compared to controls. People with a TKA and UKA exhibited a greater internal rotation angle during running, without a concomitant increase in moments at initial contact and toe-off, compared to healthy controls. Also, TKA and UKA participants experienced reductions in knee extensor moments across all high-impact tasks, such as a 1.86 to 1.89 Nm/kg reduction during running. High-functioning individuals with a joint arthroplasty can perform demanding tasks, but often through movement strategies that may compromise long-term implant durability.

BackgroundSedentarism is prevalent and associated with poorer mental and physical health. Whether everyday physical activity (PA) maps onto computational decision strategies and brain structure/function in non-elderly adults remains unclear. MethodsSeventy-one healthy adults (39 women; 18-45 years) completed the Multi-Source Interference Task (MSIT) during fMRI. PA was quantified with the short IPAQ and participants were classified as Active or Sedentary. Behavior (RT, accuracy) was analyzed with frequentist models and a hierarchical Bayesian drift-diffusion model (DDM) estimating drift rate (v), boundary separation (), and non-decision time ({tau}). First-level fMRI modeled congruent/incongruent trials; group-level analyses used FLAME1 with cluster-wise FWE correction (z>3.1, p <.05). Structural MRI was processed with FreeSurfer 7.4.1 (cortical thickness, hippocampal subfields); surface-based GLMs tested group and DDM effects. ResultsActive participants responded faster overall; incongruent accuracy showed a speed- accuracy trade-off (accuracy increased with slower RTs), with a significant RT x group interaction. In the DDM, boundary separation () was higher in sedentary individuals (greater caution), whereas drift rate (v) differed by sex (males > females). Structurally, the active group showed larger left hippocampal subfields and thicker cortex in posterior temporal & anterior cingulate regions that are negatively related to . Functionally, boundary-related BOLD modulation encompassed fusiform, posterior cingulate, superior temporal cortex, and SMA; Active > Sedentary contrasts highlighted left occipital and inferior parietal lobe. ConclusionsEveryday PA aligns with lower decision thresholds, select structural advantages, and more efficient task-engaged networks, suggesting PA fosters adaptive, resource-efficient cognitive control. These mechanistic links support PA-based strategies to mitigate risks of sedentarism.

Aims/hypothesisTo investigate the feasibility and preliminary efficacy of a 12-week remotely-delivered exercise snacks (ES) intervention in adults with type 2 diabetes. MethodsInsufficiently active adults with type 2 diabetes (N=69; 46 females; mean age {+/-} SD: 58{+/-}11 years) were randomized to an ES or mobility/stretching comparator group (CON), which involved 4 x 1-min bouts of either vigorous or low intensity exercise, respectively, on [&ge;]5 days/week. The primary outcome was feasibility based on adherence. Secondary outcomes included exercise enjoyment (1-7 scale), rating of perceived exertion (RPE; 0-10 scale), heart rate (HR), hemoglobin A1c (HbA1c), blood biomarkers of cardiometabolic health, 30-second sit-to-stand capacity, grip strength, estimated maximal oxygen uptake, and anthropometrics. ResultsWeekly adherence (estimated marginal mean [95% confidence interval]: 18 bouts [16 to 21] for both groups; P=0.99) and total enjoyment (ES: 4.5 [4.1 to 4.8] vs CON: 4.3 [4.0 to 4.7]; P=0.64) were high and not different between groups. Despite higher RPE (5.7 [5.4 to 6.1]) and peak HR (73 [70 to 77] % of age-predicted HR maximum) in ES vs CON (2.0 [1.7 to 2.4] and 61 [58 to 64] % of age-predicted HR maximum, respectively) (all P<0.001), there were no between-group differences in the change in any secondary outcome (all P>0.05) except for greater sit-to-stand capacity in ES after training (between-group effect estimate [95% confidence interval]: 1.9 repetitions [0.3 to 3.4]; P=0.02). Conclusions/interpretationExercise snacks were feasible to perform in the real-world and improved physical capacity to a greater extent than CON in adults living with type 2 diabetes. Trial registrationClinicalTrials.gov ID: NCT06407245 Research in ContextO_ST_ABSWhat is already known about this subject?C_ST_ABSO_LIExercise snacks ([&le;]1-min bouts of vigorous exercise spaced out across the day) are a time-efficient and practical approach to promote vigorous exercise and break up sedentary time. C_LIO_LIReal-world exercise snack interventions appear feasible for middle-aged and older adults. C_LI What is the key question?O_LIAre 12 weeks of exercise snacks performed in the real-world feasible for insufficiently active adults living with non-insulin treated type 2 diabetes? C_LI What are the new findings?O_LIExercise snacks are feasible for those living with type 2 diabetes to perform unsupervised in the real-world based on high adherence, enjoyment, and participant retention rates. C_LIO_LIExercise snacks improved 30-second sit-to-stand capacity and reduced waist circumference suggesting enhancements in physical capacity and body composition. C_LI How might this impact on clinical practice in the foreseeable future?O_LIExercise snacks could be utilized to help individuals living with type 2 diabetes build a routine or habit of incorporating small amounts of physical activity into their daily lives. C_LIO_LIThe improved physical capacity observed in the current study could contribute to lower fall risk and greater lower body strength in those with type 2 diabetes as they age. C_LI

BACKGROUNDThe recovery from sport-related concussion (SRC) is highly heterogenous, with many individuals experiencing symptoms that persist beyond typical recovery timeframes. The early identification of individuals at risk of prolonged symptoms is therefore critical to inform timely interventions and set realistic recovery expectations. Although acute symptom burden is one predictor of future symptom burden, reliance on self-reported measures may limit objectivity and reduce clinical utility in settings where symptom evaluation may be unreliable. In this prospective cohort study, we evaluated the discriminatory accuracy of the CogState Brief Battery, alone and in combination with the Sport Concussion Assessment Tool (SCAT), to classify Australian football players with SRC from Australian footballers without SRC at 24-hours post-injury/match. Furthermore, we examined whether CogState performance and symptom severity at 24 hours were associated with symptom outcomes at one-week post-injury. Adult amateur Australian football players (n=181) were recruited following SRC (n=109 SRC, 86% male) or after a non-injured match (n=72, 90% male). Participants completed the CogState Brief Battery, SCAT and Rivermead Post Concussion Questionnaire (RPQ) at 24-hours and one-week post-injury or match. Area under the receiver operating characteristic (AUC) analyses quantified the ability of 24-hour CogState task performance and SCAT symptom severity to distinguish SRC from controls. Linear regression models examined associations between CogState performance and symptom severity (SCAT and RPQ), within and across the 24-hour and one-week time points. Additional models evaluated whether combining 24-hour symptom severity assessments with CogState performance improved prediction of one-week symptom burden and symptomatic status. SCAT symptom severity demonstrated excellent discriminatory classification accuracy for SRC versus controls at 24-hours post-injury (AUC [95% CI]: 0.949 [0.916 - 0.981]). CogState task performance showed lower discriminatory accuracy but demonstrated fair classification and prognostic utility (e.g., Identification task AUC [95% CI]: 0.666 [0.582 - 0.750]). CogState performance at 24-hours was significantly associated with overall symptom severity at both 24-hours and one-week, as well as with symptom severity across individual symptom domains. In combined models, 24-hour symptom severity and CogState performance independently contributed to the prediction of symptomatic from asymptomatic individuals at one-week post-SRC (e.g., Identification task AUC [95% CI]: 0.721 [0.606 - 0.835] for classification based on <4 versus [&ge;]4 symptoms). These findings indicate that CogState performance at 24-hours post-SRC may serve as an objective adjunct to subjective symptom-based reporting, supporting both diagnosis and early prognostication in the clinical evaluation of SRC.

ObjectiveTo evaluate the effects of glutamine supplementation combined with an exercise program on isokinetic performance, biochemical parameters, and muscle asymmetry indices in individuals undergoing rehabilitation following ACL reconstruction. DesignA 6-week randomized controlled trial was conducted, assigning participants to either a glutamine supplementation group (ExGln) or a placebo group (ExPla), both undergoing a standardized exercise program. SettingThe study was performed in a sports medicine facility with access to isokinetic testing and biochemical analysis. ParticipantsA total of 30 participants who had undergone ACL reconstruction surgery were included, with 15 in each group. MethodsPeak torque and muscle asymmetry of knee extensors and flexors were assessed via isokinetic testing. Biochemical analyses (glucose, lipid profile, liver enzymes) were conducted pre- and post-intervention. Wilcoxon and Mann-Whitney U tests were used for intra- and intergroup comparisons, respectively. ResultsThe ExGln group showed significant improvements in peak torque for the involved limb extensors (p=0.001) and flexors (p=0.001), as well as reductions in extensor and flexor asymmetry indices (p=0.001 and p=0.018, respectively). Additionally, significant reductions were observed in C-LDL, C-HDL, and triglycerides levels in the ExGln group (p=0.006, p=0.003, and p=0.003, respectively). The intergroup analysis indicated significant differences in alkaline phosphatase levels (p=0.031). No adverse effects were reported. ConclusionGlutamine supplementation combined with a structured exercise program significantly enhanced isokinetic performance and improved biochemical parameters, suggesting a beneficial role in postoperative rehabilitation following ACL reconstruction. Further studies with larger sample sizes are recommended to validate these findings.

Exercise training is a cornerstone of Cardiovascular Rehabilitation (CR) and, as of now, moderate-to-vigorous continuous exercise training (MICT) is the standard. New exercise modalities in the context of CR are constantly being explored to improve patient outcomes. These Canadian Association of Cardiovascular Prevention and Rehabilitation (CACPR) exercise training recommendations provide a synthesis of evidence-informed recommendations from existing documents, including recommendations around High-Intensity Interval training (HIIT). CACPR created a pan-Canadian Exercise Working Group with various knowledge users (e.g., kinesiologists/exercise physiologists, physiotherapists, cardiologists, and patients) with expertise in CR-based exercise, who developed knowledge gap questions related to exercise training based on a literature review and synthesis of all available recommendations. An independent evidence-synthesis team performed a rapid review and meta-analyses to address the questions. The working group used this data to develop relevant recommendations. The final guidelines include 12 recommendations for CR exercise, including nine from previous documents and three new recommendations based on HIIT. The previous recommendations address exercise assessments and prescriptions for CR for various patient profiles. The new recommendations suggest that HIIT can be used to improve exercise capacity in patients with coronary artery disease (CAD), heart failure (HF) or atrial fibrillation. They also state that HIIT is superior to MICT in patients with CAD, that patients with HF should be considered for either HIIT or MICT and that any HIIT interval duration can be used as part of CR. Overall, these recommendations provide guidance for exercise in Canadian CR programs.

BACKGROUNDFall injuries in older adults are devastating and often caused by impaired reactive balance to unexpected trips and slips, which conventional exercise programs do not target. This study examined whether a low-dose perturbation balance training (PBT) program among older adults can improve balance recovery following trips and slips and reduce falls and fall injuries. METHODS111 older adults (65+ years) were randomised into an intervention or control group. The intervention group undertook one weekly PBT session for three weeks on the Trip and Slip Walkway, followed by three-monthly PBT booster sessions over one year, for a total of six sessions. The control group received an educational booklet. Blinded staff assessed laboratory-falls induced by a trip and slip with a safety harness at baseline and one year. Number of falls and fall injuries in daily life were collected weekly for one year. RESULTSCompared to the control group, the intervention group experienced a 26% reduction in laboratory falls at 12 months (RR = 0.74; 95% CI: 0.54, 0.99; P = .040) but not different in number of falls, trip-and slip-encounters in daily life. However, fall-related injuries were reduced by 57% (rate ratio = 0.43; 95% CI: 0.19, 0.94, P = .024) over one year. A reduction in falls occurred within the first three months, with greater benefit among participants who completed at least three training sessions. CONCLUSIONSA low-dose PBT program can improve reactive balance over 12 months and reduced injurious falls by 57%, with benefits likely due to enhanced reactive balance rather than proactive gait strategies. Older adults may require at least three sessions to achieve meaningful fall reduction, with periodic booster sessions to sustain benefits. Incorporating PBT into exercise programs may enhance their efficacy in preventing falls and fall injuries in daily life. Key PointsA low-dose perturbation-based training program (six sessions over 12 months) improved reactive balance at 12 months and reduced injurious falls by 57%. Benefits are likely due to task-specific improvements in reactive balance against trips and slips rather than proactive gait strategies or other risk factors. Incorporating PBT into exercise programs may improve their efficacy in preventing falls and fall injuries in daily life. Why does this paper matter?Falls are the leading cause of injury-related hospitalization and loss of independence in older adults. By targeting reactive balance--an ability neglected by conventional exercise programs--it offers a novel, evidence-based approach to enhance fall prevention and reduce injuries.