Institut für Sport und Sportwissenschaft

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Ehemals Institut für Sport und seine Didaktik

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Persons with multiple sclerosis reveal distinct kynurenine pathway metabolite patterns
(2025-09-18) Kupjetz, Marie; Langeskov-Christensen, Martin; Riemenschneider, Morten; Inerle, Stefan; Ligges, Uwe; Gaemelke, Tobias; Patt, Nadine; Bansi, Jens; Gonzenbach, Roman Rudolf; Reuter, Marcel; Rosenberger, Friederike; Meyer, Tim; McCann, Adrian; Ueland, Per Magne; Eskildsen, Simon Fristed; Nygaard, Mikkel Karl Emil; Joisten, Niklas; Hvid, Lars; Dalgas, Ulrik; Zimmer, Philipp
Background and Objectives Kynurenine pathway (KP) metabolites modulate inflammatory activity and neuronal viability. The consequences of KP imbalance partly resemble the molecular mechanisms of multiple sclerosis (MS). An improved understanding of KP imbalance and its relevance in MS requires holistic approaches beyond single-metabolite investigations. Thus, we aimed to explore the presence of KP metabolite patterns in MS and to evaluate their relevance in relation to participant characteristics and clinical measures. Methods In this multinational cross-sectional analysis, we determined serum concentrations of KP metabolites in persons with MS and healthy individuals using targeted metabolomics (LC-MS/MS). Analyses were conducted between March 24, 2022, and August 9, 2024. The source studies were conducted in Denmark, Germany, and Switzerland. All participants were aged 18 years or older and free of acute or chronic diseases besides MS. Persons with MS had mild to moderate disease severity (Expanded Disability Status Scale [EDSS] score ≤6.5). Following the investigation of individual metabolites, we explored KP metabolite patterns using exploratory factor analysis. Associations between KP metabolite patterns and participant characteristics, MS symptoms, and MRI metrics were investigated using correlation analyses, proportional odds regression, and multiple linear regression. Results The MS cohort included 353 participants (67.1% female) with a mean (SD) age of 46.1 (12.4) years. The mean (SD) EDSS score was 3.1 (1.8). The healthy control (HC) cohort included 111 participants (53.2% female) with a mean (SD) age of 45.7 (16.6) years. Persons with MS showed 2 distinct KP metabolite patterns: an inflammation-driven neurotoxic pattern (NeuroTox) and a neuroprotective pattern (NeuroPro). Greater NeuroTox was associated with a higher EDSS score, older age, and higher body fat percentage. Greater NeuroPro was associated with a lower EDSS score and higher cardiorespiratory fitness. Discussion Using a data-driven approach, we demonstrate the presence of 2 KP metabolite patterns, NeuroTox and NeuroPro, in MS. Greater NeuroTox and lower NeuroPro were both associated with greater disease severity. Future studies need to investigate the KP metabolite patterns across the MS disability spectrum and may use comparable approaches to investigate whether KP imbalance follows similar or disease-specific patterns in diseases other than MS.
Finding the needle in the haystack of isokinetic knee data: Random Forest modelling improves information about ACLR-related deficiencies
(2024-12-22) Nolte, Kevin; Gerharz, Alexander; Jaitner, Thomas; Knicker, Axel J.; Alt, Tobias
The difficulties of rehabilitation after anterior cruciate ligament (ACL) injuries, subsequent return-to-sport (RTS) let alone achieving pre-injury performance, are well known. Isokinetic testing is often used to assess strength capacities during that process. The aim of the present machine learning (ML) approach was to examine which isokinetic data differentiates athletes post ACL reconstruction (ACLR) and healthy controls. Two Random Forest models were trained from data of unilateral concentric and eccentric knee flexor and extensor tests (30°/s, 150°/s) of 366 male (63 post ACLR) as well as 183 female (72 post ACLR) athletes. Via a cross-validation predictive performance was evaluated and the Random Forest showed outstanding results for male (AUC = 0.90, sensitivity = 0.76, specificity = 0.88) and female (AUC = 0.92, sensitivity = 0.85, specificity = 0.89) athletes. The Accumulated Local Effects plot was used to determine the impact of single features on the predictive likelihood. For both male and female athletes, the ten most impactful features either referred to the disadvantageous (injured, non-dominant in control group) leg or to lateral differences. The eccentric hamstring work at 150°/s was identified as the most impactful single parameter. We see potential for improving the RTS process by incorporating and combining measures, which focus on hamstring strength, leg symmetry and contractional work.
Baseline inflammation but not exercise modality impacts exercise-induced kynurenine pathway modulation in persons with multiple sclerosis: secondary results from a randomized controlled trial
(2024-11-11) Kupjetz, Marie; Patt, Nadine; Joisten, Niklas; Ueland, Per Magne; McCann, Adrian; Gonzenbach, Roman; Bansi, Jens; Zimmer, Philipp
Background: The kynurenine pathway (KP) is an important hub in neuroimmune crosstalk that is dysregulated in persons with multiple sclerosis (pwMS) and modulated by exercise in a modality-specific manner. Objectives: To compare changes in the KP metabolite profile of pwMS (1) following combined treatments including either high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT) during a 3-week multimodal rehabilitation, (2) to evaluate exercise response in relation to baseline systemic inflammation, and (3) to investigate associations of kynurenines with physical capacity and clinical outcomes. Methods: For this secondary analysis of a randomized controlled trial, serum concentrations of kynurenines at baseline and after 3 weeks were determined using targeted metabolomics (LC-MS/MS). Exercise-induced changes in the KP metabolite profile according to treatment and baseline systemic inflammation (neutrophil-to-lymphocyte ratio (NLR) <3.12 versus ⩾3.12) were investigated using covariance analyses. Results: Regardless of treatment, concentrations of tryptophan and most kynurenines decreased over time. Quinolinic acid concentration increased (p < .001). Participants with low and high NLR revealed differential exercise-induced changes in concentrations of kynurenines and NLR. The systemic inflammation markers neopterin (p = .015) and NLR (p < .001) decreased in the whole group and in participants with high NLR, respectively. Conclusions: Combined treatments including HIIT or MICT do not differentially modulate the KP metabolite profile, with both reducing concentrations of most kynurenines. Baseline systemic inflammation may impact exercise-induced changes in the KP metabolite profile and anti-inflammatory effects of exercise in pwMS. Trial registration: clinicaltrials.gov (identifier: NCT04356248)
Physical activity levels are positively related to progression-free survival and reduced adverse events in advanced ER+ breast cancer
(2024-10-08) Zimmer, Philipp; Esser, Tobias; Lueftner, Diana; Schuetz, Florian; Baumann, Freerk T.; Rody, Achim; Schneeweiss, Andreas; Hartkopf, Andreas D.; Decker, Thomas; Uleer, Christoph; Stoetzer, Oliver J.; Foerster, Frank; Schmidt, Marcus; Mundhenke, Christoph; Steindorf, Karen; Tesch, Hans; Jackisch, Christian; Fischer, Thomas; Hanson, Sven; Kreuzeder, Julia; Guderian, Gernot; Fasching, Peter A.; Bloch, Wilhelm
Background: Increased levels of physical activity are associated with a reduction of breast cancer mortality, especially in postmenopausal women with positive hormone receptor status. So far, previous observational case–control and cohort studies have focused on associations between overall leisure time physical activity and survival of women with breast cancer in general. Methods: In this multicenter prospective cohort study, conducted in Germany between 30th August 2012 to 29th December 2017, we investigated general physical activity in a homogenous sample of n = 1440 postmenopausal women with advanced (inoperable locally advanced or metastatic), hormone receptor-positive breast cancer receiving the same therapy (everolimus and exemestane). Self-reported physical activity was assessed using the Godin Leisure Time Exercise Questionnaire (GLTEQ) before and every 3 months during treatment. Participants were then classified into “active” and “insufficiently active” to screen their activity behavior the week prior to medical treatment. In addition, changes in physical activity patterns were assessed. Adjusted Cox regression analyses were performed for the activity categories to determine hazard ratios (HR). Besides progression-free survival (PFS), adverse events (AEs), QoL, and fatigue were assessed every 3 months until study termination. Results: Compared to “insufficiently active” patients, “active” individuals indicated a significantly longer PFS (HR: 0.84 [0.74; 0.984], p = .0295). No significant differences were observed for changes of physical activity behavior. Patients who reported to be “active” at baseline revealed significantly fewer AEs compared to “insufficiently” active patients. In detail, both severe and non-severe AEs occurred less frequently in the “active” patients group. In line with that, QoL and fatigue were better in physical “active” patients compared to their insufficient active counterparts at the last post-baseline assessment. Participants who remained or become active indicated less AEs, a higher QoL, and reduced fatigue levels. Conclusions: Physical activity behavior prior to medical treatment might have prognostic value in patients with advanced breast cancer in terms of extending the PFS. Moreover, physical activity before and during treatment may reduce treatment-related side effects and improve patients’ QoL and fatigue. Trial registration: EUPAS9462. Registered 30th October 2012 “retrospectively registered.”
Electromyography of shoulder muscles in individuals without scapular dyskinesis during closed kinetic chain exercises on stable and unstable surfaces
(2024-05-22) Arghadeh, Ramin; Alizadeh, Mohammad Hossein; Minoonejad, Hooman; Sheikhhoseini, Rahman; Asgari, Mojtaba; Jaitner, Thomas
Introduction: Unstable surfaces are commonly utilized to enhance the flexibility of the musculoskeletal system for achieving training or rehabilitation goals. However, their effects on shoulder muscle activation during various push-up (PU) exercises have not been thoroughly investigated. Therefore, the purpose of this study was to synthesize electromyography (EMG) data of shoulder muscles in individuals without scapular dyskinesis performing different PU exercises on both stable and unstable surfaces. Methods: A systematic online search was conducted in electronic databases, including Web of Science, PubMed, Scopus, and Google Scholar, up to January 16, 2024, using predefined sets of keywords. Out of the 1,971 titles and abstracts screened, 80 articles were reviewed in detail by two independent researchers to check the eligibility, of which 28 eligible studies were ultimately included. Following assessment of the quality and risk of bias, the studies were categorized based on exercises and muscle groups, and a meta-analysis using a random-effects model was performed to estimate the overall effect size. Results: The use of unstable surfaces led to a decrease in anterior deltoid activity during PU [P = 0.032; I2 = 91.34%; SMD = −0.630 (95% CI −1.205, −0.055)], an increase in pectoralis major activity during PU [P = 0.006; I2 = 63.72%; SMD = 0.282 (95% CI 0.079, 0.484)], as well as during knee PU [P = 0.018; I2 = 32.29%; SMD = 0.309 (95% CI 0.052, 0.565)], and an increase in triceps brachii activity during PU [P = 0.000; I2 = 85.05%; SMD = 0.813 (95% CI 0.457, 1.168)], knee PU [P = 0.000; I2 = 0.00%; SMD = 0.589 (95% CI 0.288, 0.891)], as well as during push-up plus [P = 0.006; I2 = 13.16%; SMD = 0.563 (95% CI 0.161, 0.965)]. However, the use of unstable surfaces did not show a significant effect on the EMG activity of the pectoralis major during push-up plus [P = 0.312; I2 = 22.82%; SMD = 0.207 (95% CI −0.194, 0.609)]. Conclusions: Unstable surfaces can modulate muscle activity in different PU exercises, while the effects on the targeted muscles depend on the type of exercise. The findings of this review provide a framework based on the level of activity of each shoulder muscle during different PU exercises, which can help coaches, trainers, and sports therapists select the most suitable type of PU for designing training or rehabilitation programs. Particularly, the most suitable exercise for increasing anterior deltoid activity is PU on a stable surface. To concurrently increase activity of the pectoralis major and triceps brachii, adding unstable surfaces under hands during knee PU and standard PU is recommended.
15. Symposium der dvs-Sektion „Sportinformatik & Sporttechnologie“ 2024
(2024) Jaitner, Thomas; Schmidt, Marcus; Sendt, Anna; Bergmann, Jana
Ergonomische Bewertung von rückenunterstützenden Exoskeletten in der Arbeitswelt mittels elektromyographischer und kinematischer Analysen
(2024) Riemer, Julia; Jaitner, Thomas; Witte, Kerstin
In dieser kumulativen Dissertation wurden die biomechanischen Auswirkungen von passiven rückenunterstützenden Exoskeletten (RuEs) mittels elektromyographischer und kinematischer Analysen standardisiert untersucht. Es wurde auf Grundlage einer arbeitswissenschaftlichen Stichprobe bewertet, an welcher Stelle des Bewegungsver-laufes verschiedener Arbeitsbewegungen, RuEs einen starken Einfluss auf den Kör-per ausüben. Dazu wurden zunächst die Voraussetzungen für eine Standardisierung von elektromyographischen Normalisierungskontraktionen mit bewegungsunerfahre-nen Proband:innen geschaffen und der Einfluss von Familiarisierung auf deren Fä-higkeit zur Erzeugung einer maximalen willkürlichen isometrischen Kontraktion unter-sucht. Des Weiteren wurde die Zuverlässigkeit der getroffenen Maßnahmen zu Messstandardisierung abgesichert, indem die tägliche Reproduzierbarkeit standardi-sierter biomechanischer Messungen mit RuEs überprüft wurde. Es zeigte sich in sta-tischer Oberkörpervorbeugung eine starke Einwirkung des RuEs auf den Körper, ge-kennzeichnet durch eine Reduktion der Rückenmuskelaktivität. Eine reduzierte Rü-ckenmuskelaktivität konnte zudem beim Heben festgestellt werden, jedoch mit be-sonders starker Ausprägung zu Beginn der Hebebewegung und nicht zum Zeitpunkt der Lastenhandhabung. Die Ergebnisse weisen außerdem auf einen starken Einfluss des RuE auf die Kinematik der Ober- und Unterschenkel während der Beinschwung-phase des Tragens und Gehens hin. Dies wird durch eine Reduktion des Kniewin-kels, eine verstärkte Beugung im Sprunggelenk sowie eine erhöhte Aktivierung der Unterschenkelmuskulatur charakterisiert. Es wird vermutet, dass die evaluierten Ver-änderungen zu einer erhöhten Belastung der unteren Extremitäten bei komplexen Arbeitsaufgaben führen und langfristig das Risiko von Muskel-Skelett-Erkrankungen in diesen Körperbereichen erhöhen könnten. Gleichzeitig könnten die Bewegungsein-schränkungen durch RuEs in möglichen körperlichen Beschwerden resultieren und so die Bereitschaft der Beschäftigten reduzieren, RuEs am Arbeitsplatz zu nutzen.
Tissue-specific effects of exercise as NAD+-boosting strategy: current knowledge and future perspectives
(2023-01-04) Walzik, David; Jonas, Wiebke; Joisten, Niklas; Belen, Sergen; Wüst, Rob C. I.; Guillemin, Gilles; Zimmer, Philipp
Nicotinamide adenine dinucleotide (NAD+) is an evolutionarily highly conserved coenzyme with multi-faceted cell functions, including energy metabolism, molecular signaling processes, epigenetic regulation, and DNA repair. Since the discovery that lower NAD+ levels are a shared characteristic of various diseases and aging per se, several NAD+-boosting strategies have emerged. Other than pharmacological and nutritional approaches, exercise is thought to restore NAD+ homeostasis through metabolic adaption to chronically recurring states of increased energy demand. In this review we discuss the impact of acute exercise and exercise training on tissue-specific NAD+ metabolism of rodents and humans to highlight the potential value as NAD+-boosting strategy. By interconnecting results from different investigations, we aim to draw attention to tissue-specific alterations in NAD+ metabolism and the associated implications for whole-body NAD+ homeostasis. Acute exercise led to profound alterations of intracellular NAD+ metabolism in various investigations, with the magnitude and direction of changes being strongly dependent on the applied exercise modality, cell type, and investigated animal model or human population. Exercise training elevated NAD+ levels and NAD+ metabolism enzymes in various tissues. Based on these results, we discuss molecular mechanisms that might connect acute exercise-induced disruptions of NAD+/NADH homeostasis to chronic exercise adaptions in NAD+ metabolism. Taking this hypothesis-driven approach, we hope to inspire future research on the molecular mechanisms of exercise as NAD+-modifying lifestyle intervention, thereby elucidating the potential therapeutic value in NAD+-related pathologies.
Predictive modeling of lower extremity injury risk in male elite youth soccer players using least absolute shrinkage and selection operator regression
(2023-01-26) Kolodziej, Mathias; Groll, Andreas; Nolte, Kevin; Willwacher, Steffen; Alt, Tobias; Schmidt, Marcus; Jaitner, Thomas
Purpose: To (1) identify neuromuscular and biomechanical injury risk factors in elite youth soccer players and (2) assess the predictive ability of a machine learning approach. Material and Methods: Fifty-six elite male youth soccer players (age: 17.2 ± 1.1 years; height: 179 ± 8 cm; mass: 70.4 ± 9.2 kg) performed a 3D motion analysis, postural control testing, and strength testing. Non-contact lower extremities injuries were documented throughout 10 months. A least absolute shrinkage and selection operator (LASSO) regression model was used to identify the most important injury predictors. Predictive performance of the LASSO model was determined in a leave-one-out (LOO) prediction competition. Results: Twenty-three non-contact injuries were registered. The LASSO model identified concentric knee extensor peak torque, hip transversal plane moment in the single-leg drop landing task and center of pressure sway in the single-leg stance test as the three most important predictors for injury in that order. The LASSO model was able to predict injury outcomes with a likelihood of 58% and an area under the ROC curve of 0.63 (sensitivity = 35%; specificity = 79%). Conclusion: The three most important variables for predicting the injury outcome suggest the importance of neuromuscular and biomechanical performance measures in elite youth soccer. These preliminary results may have practical implications for future directions in injury risk screening and planning, as well as for the development of customized training programs to counteract intrinsic injury risk factors. However, the poor predictive performance of the final model confirms the challenge of predicting sports injuries, and the model must therefore be evaluated in larger samples.
Intensity- and time-matched acute interval and continuous endurance exercise similarly induce an anti-inflammatory environment in recreationally active runners: focus on PD-1 expression in Tregs and the IL-6/IL-10 axis
(2023-06-19) Proschinger, Sebastian; Schenk, Alexander; Weßels, Inga; Donath, Lars; Rappelt, Ludwig; Metcalfe, Alan J.; Zimmer, Philipp
Purpose Acute exercise elicits a transient anti-inflammatory state during the early recovery period. Since recent studies reported on regimen-specific effects on immune-related humoral factors and cellular subsets, this study compared the effects of intensity- and time-matched acute interval and continuous exercise on peripheral anti-inflammatory cellular and humoral immune parameters with a particular focus on the PD-1 expression in CD4+ regulatory T cells (Tregs). Methods Twenty-four recreationally active runners (age: 29.7 ± 4.3 years, BMI: 22.2 ± 2.4, VO2peak: 56.6 ± 6.4 ml × kg−1 × min−1) participated in this crossover RCT. Each subject conducted a moderate continuous (MCE) and a high-intensity interval exercise (HIIE) session in a counterbalanced design. Blood was drawn before, immediately after, and 1 h after exercise. Treg subsets and levels of PD-1 and Foxp3 were assessed by flow cytometry. Serum levels of IL-10 and IL-6 were quantified by ELISA. Results PD-1 levels on Tregs increased within the recovery period after HIIE (p < .001) and MCE (p < 0.001). Total counts of Tregs (HIIE: p = 0.044; MCE: p = .021), naïve Tregs (HIIE: p < 0.001; MCE: p < 0.001), and PD-1+ effector Tregs (eTregs) (HIIE: p = .002) decreased 1 h after exercise. IL-10 increased 1 h after HIIE (p < 0.001) and MCE (p = 0.018), while IL-6 increased immediately after both HIIE (p = 0.031) and MCE (p = 0.021). Correlations between changes in IL-6 and IL-10 (p = 0.017, r = 0.379) and baseline VO2peak and Treg frequency (p = 0.002, r = 0.660) were identified. Conclusion This is the first study that investigates PD-1 expression in circulating Tregs after acute exercise, revealing an increase in PD-1 levels on eTregs during the early recovery period after intensity- and time-matched HIIE and MCE. Future studies are needed to investigate the PD-1 signalosome in eTregs, together with the expression of key effector molecules (i.e., IL-10, TGF-β, IL-35, CTLA-4) to elucidate PD-1-dependent changes in cellular function. Based on changes in serum cytokines, this study further reveals a regimen-independent establishment of an anti-inflammatory milieu and underpins the role of the IL-6/IL-10 axis.
Development of a new exercise-based approach to target Fatigue in Multiple Sclerosis
(2024) Wolf, Florian Philipp; Zimmer, Philipp; Rauen, Katrin
In a joint decision between stakeholders from research (TU Dortmund University) and clinical practice (Neurological Rehabilitation Center Godeshoehe, Bonn), and considering evidence from the literature, fatigue was identified as a serious and common symptom in persons with multiple sclerosis (pwMS), where exercise might be applied as an efficacious intervention. Therefore, research efforts were directed at the development of an exercise-based fatigue intervention. In summary, publication 1 supported that aerobic training is not the most efficacious exercise type to reduce fatigue in pwMS. Publications 2-5 then developed a new group-based multimodal agility-based exercise training (MAT) framework centered on previously described working mechanisms regarding exercise and fatigue, and quantitatively and qualitatively evaluated the feasibility of conducting a randomized-controlled trial in a clinical inpatient rehabilitation setting to compare the new framework (MAT) with traditional strength and endurance training. Results showed that several changes need to be applied before the evaluation of the study protocol can be continued. Consequently, research can build on these early stage, but important results in the future.
Little associations exist between the three commonly used functional screening tests in collegiate athletes
(2024-06-13) Asgari, Mojtaba; Alizadeh, Mohammad Hossein; Naderi, Mohsen; Abshenas, Ehsan; Sahebozamani, Mansour; Yazdani, Shirin; Nolte, Kevin; Alizadeh, Shahab; Mohammadi, Mohammadreza; Kooroshfard, Negar; Arghadeh, Ramin; Jaitner, Thomas
Although an abundant number of studies have investigated the predictability of the commonly used functional screening tests and despite their popularity and applicability, the relationships between these tests have rarely been studied and have not been well established. This study aimed to examine the potential association between the Functional Movement Screen (FMS), Y Balance Test (YBT), and Landing Error Scoring System (LESS). Six hundred twenty-seven Iranian collegiate athletes (347 males, age = 22.63 ± 4.07, weight = 75.98 ± 13.79, height = 181.99 ± 10.15, BMI = 22.84 ± 3.16; and 280 females, age = 22.22 ± 3.37, weight = 60.63 ± 9.58, height = 166.55 ± 6.49, BMI = 21.81 ± 2.84) participated in this study. Following a 5-min warm-up, each participant underwent a standardized screening battery including the FMS, YBT, and LESS, and the scores were recorded and live coded for the statistical analysis, except for the LESS. The LESS tests were video recorded and scored by one expert examiner using an open-source 2D video analysis software (Kinovea- version 0.9.5), afterwards. The Spearman correlation was utilized as a measure for the correlation, and the Mann‒Whitney U test with a significance level of 0.05 was used to check the differences between male and female athletes. The statistical analysis was performed with RStudio 2023.03.0 using R 4.3.1. A small correlation (0.364) was observed between the FMS composite score and the YBT in male athletes. All other pairwise correlations were negligible among male and female athletes, ranging from − 0.096 to 0.294. Reducing the FMS to the component scores targeting the lower extremities did not alter the correlation to the other screening scores. The median FMS composite score in female athletes was significantly higher than that in males (p < 0.001). Negligible correlations exist between the FMS, LESS, and YBT; they do not measure the same values and therefore are irreplaceable with one another. A combination of these tests as a standardized screening battery may potentially better identify injury-predisposed athletes than the application of each test as a stand-alone screening test. Females outperformed males in the FMS test significantly, so sex must be considered a key variable in the FMS studies. Males had slightly higher LESS scores (median difference = 0.5) than females, but this difference is not clinically meaningful. Future research should continue to explore the relationships between various functional screening tests and identify the most effective combinations for comprehensive assessment in different populations and sports disciplines.
Skaten & Klugschei$en - Wissenschaftliche Perspektiven auf das Skateboarding
(2024-03) Büscher, Benjamin; Karpinski, Sebastian; Stemski, Cara Christina; Thorwarth, Anna
Cycling in primary progressive multiple sclerosis (CYPRO): study protocol for a randomized controlled superiority trial evaluating the effects of high-intensity interval training in persons with primary progressive multiple sclerosis
(2023-04-22) Kupjetz, Marie; Joisten, Niklas; Rademacher, Annette; Gonzenbach, Roman; Bansi, Jens; Zimmer, Philipp
Background: Primary progressive multiple sclerosis (PPMS) is the least prevalent multiple sclerosis (MS) phenotype. For persons with PPMS (pwPPMS), pharmacological treatment options are limited. As a complementary non-pharmacological treatment, endurance training improves the health-related quality of life (HRQoL), numerous MS symptoms, and MS-related performance impediments. High-intensity interval training (HIIT) has been shown to induce superior effects compared to moderate-intensity continuous training (MCT). As current evidence is based on MS samples with mixed phenotypes, generalizability to pwPPMS remains unclear. Methods: CYPRO is a parallel-group, single-center, and single-blind randomized controlled superiority trial evaluating the effects of HIIT compared to MCT in pwPPMS. Sixty-one pwPPMS are randomized (1:1) to perform volume-matched HIIT or MCT sessions on bicycle ergometers two to three times per week in addition to standard rehabilitative care during their three-week inpatient stay at Valens rehabilitation clinic, Switzerland. Standard rehabilitative care comprises endurance and strength training, physiotherapy, and occupational therapy. HIIT sessions include six 90-second intervals at 95% peak heart rate (HRpeak), interspersed by 90-second active breaks with unloaded pedaling, aimed to reach 60%HRpeak. MCT represents the standard treatment at Valens rehabilitation clinic and is performed as continuous cycling at 60%HRpeak for the duration of 26 minutes. The primary outcome is cardiorespiratory fitness, assessed as peak oxygen consumption (V̇O2peak) during cardiopulmonary exercise testing (CPET). Secondary outcomes include peak power output during CPET, walking capacity, cognitive performance, HRQoL, fatigue, anxiety and depressive symptoms, and blood-derived biomarkers (e.g., serum neurofilament light chain, glial fibrillary acidic protein, kynurenine pathway metabolites) related to MS pathophysiology. All outcomes are assessed at baseline and discharge after three weeks. Venous blood sampling is additionally performed immediately and two hours after the first HIIT or MCT session. Discussion: CYPRO will expand current knowledge on symptom management and rehabilitation in MS to the subpopulation of pwPPMS, and will contribute to the exploration of potential disease-modifying effects of endurance training in MS. The superiority design of CYPRO will allow deriving explicit recommendations on endurance training design in pwPPMS that can be readily translated into clinical practice. Trial registration: CYPRO has been prospectively registered at ClinicalTrials.gov on 8 February 2022 (NCT05229861).
Heterogenität der Effekte von Ausdauertraining zur Steigerung der kardiorespiratorischen Fitness bei Personen mit Multipler Sklerose
(2023) Schlagheck, Marit Lea; Zimmer, Philipp; Heesen, Christoph
Körperliches Training gewinnt als nicht-medikamentöse Therapiemaßnahme bei Multipler Sklerose (MS) zunehmend an Bedeutung. Die aktuelle Studienlage zeigt jedoch uneinheitliche Effekte von Ausdauertraining hinsichtlich verschiedener physiologischer, biologischer und patientenzentrierter Endpunkte. Die vorliegende Dissertation untersucht potenzielle Einflussfaktoren auf die Heterogenität der Ergebnisse: (i) die Qualität der Interventionsinhalte und deren Dokumentation, (ii) die Aussagekraft der Ergebnismessung, und (iii) Faktoren der individuellen Trainingsresponse. Die Ergebnisse zeigen, dass fundamentale Trainingsprinzipien in bisherigen Interventionsstudien unzureichend berücksichtigt wurden. Fehlende signifikante Ergebnisse können auf Unzulänglichkeiten in der Trainingsgestaltung zurückzuführen sein, was zu einer Unterschätzung der Effekte von körperlichem Training führt. Nur knapp 50% der untersuchten Studien berichten adäquat über Trainingsinhalte und nur 3% über die Trainingsadhärenz, was die Interpretation und die Reproduzierbarkeit einschränken. Publikation 2 zeigt, dass über 40% der Personen mit MS in stationärer Rehabilitation die allgemeinen Kriterien einer maximalen kardiorespiratorischen Belastung während eines Ausbelastungstests nicht erfüllen. Dies schränkt die Beurteilung des Fitnesszustandes, der Effektivität von Trainingsprogrammen und die Trainingssteuerung ein. Schließlich bestätigen die Ergebnisse der Interventionsstudie in Publikation 3 signifikante Verbesserungen der kardiorespiratorischen Fitness auf Gruppenebene sowohl nach hochintensivem Intervalltraining (HIIT) als auch nach moderat-intensivem kontinuierlichem Training. Auf individueller Ebene profitierten jüngere, weniger fitte Personen, die HIIT durchführten, am meisten von der dreiwöchigen Trainingsintervention. Zusammenfassend zeigen die Ergebnisse der Arbeit, dass die heterogenen Studienergebnisse zu den Effekten von Ausdauertraining bei MS durch Mängel in der Interventionsgestaltung, eine unzureichende Aussagekraft der Ergebnismessung und interindividuelle Unterschiede in der Trainingsresponse beeinflusst werden. Um die Evidenz für körperliches Training mit der Evidenz für medikamentöse Behandlungen vergleichbar zu machen, ist es unerlässlich, dass die Gestaltung und Dokumentation den entsprechenden Standards gleichkommen. Zukünftige Studien sollten optimierte Möglichkeiten zur Beurteilung der kardiorespiratorischen Fitness und zur Trainingssteuerung bei Personen mit MS untersuchen. Darüber hinaus ist es wichtig, Faktoren der individuellen Trainingsresponse zu berücksichtigen, um personalisierte Trainingsansätze zu entwickeln, die den Bedürfnissen der Betroffenen gerecht werden. Die Berücksichtigung dieser Aspekte kann das Verständnis und die Anwendung von Ausdauertraining als therapeutische Maßnahme bei MS verbessern.
Electromyography of scapular stabilizers in people without scapular dyskinesis during push-ups
(2023-12-05) Arghadeh, Ramin; Alizadeh, Mohammad Hossein; Minoonejad, Hooman; Sheikhhoseini, Rahman; Asgari, Mojtaba; Jaitner, Thomas
Background: Push-up (PU) is widely considered an effective exercise to stabilize the scapular, especially if performed on unstable surfaces. However, available studies cover a wide range of exercise variations and differ according to exercise prescription, muscle selection and study design. Therefore, findings are contradictory, and conclusions for a proper application of the PU are difficult to draw. Objective: To synthesize the available literature on the changes in the activity of the periscapular muscles in individuals without scapular dyskinesis while performing different types of PU on unstable surfaces. Search procedure: Four online databases were searched from the earliest publications to 9 August 2023, using predefined keywords. Out of the 2,850 potential references identified in the primary search, 92 studies were reviewed in detail, of which 38 met the inclusion criteria and were included. Methodological quality was evaluated using a standardized form based on the Newcastle‒Ottawa scale for observational studies. Data combination was performed using CMA (v3), and the random-effects model was used to calculate the standardized mean difference (SMD) with a 95% confidence interval (CI). Results: The use of unstable surfaces in people without scapular dyskinesis led to increased activity of the upper trapezius during the PU (p = 0.017; I2 = 84.95%; SMD = 0.425 [95% CI 0.077, 0.773]) and knee PU (p = 0.023; I2 = 70.23%; SMD = 0.474 [95% CI 0.066, 0.882]) exercises and increased activity of the middle trapezius (MT) (p = 0.003; I2 = 64.50%; SMD = 0.672 [95% CI 0.225, 1.119]) and serratus anterior (SA) (p = 0.039; I2 = 4.25%; SMD = 0.216 [95% CI 0.011, 0.420]) muscles during the push-up plus (PUP) exercise. Conclusion: Using an unstable support base during PU does not necessarily increase the activity of all scapular stabilizers. The amount of muscle activity depends on the type of PU other than the type of support base. If an unstable surface is used, PUP exercise appears to be the most effective modality to increase the quality of training, improve performance, and prevent the occurrence of scapular dyskinesis due to the increase in the activity of the MT and SA muscles.
Positive influence of neuromuscular training on knee injury risk factors during cutting and landing tasks in elite youth female handball players
(2022-10-07) Schmidt, Marcus; Nolte, Kevin; Terschluse, Benedikt; Willwacher, Steffen; Jaitner, Thomas
Anterior cruciate ligament (ACL) ruptures are frequent in the age group of 15–19 years, particularly for female athletes. Although injury-prevention programs effectively reduce severe knee injuries, little is known about the underlying mechanisms and changes of biomechanical risk factors. Thus, this study analyzes the effects of a neuromuscular injury-prevention program on biomechanical parameters associated with ACL injuries in elite youth female handball players. In a nonrandomized, controlled intervention study, 19 players allocated to control (n = 12) and intervention (n = 7) group were investigated for single- and double-leg landings as well as unanticipated side-cutting maneuvers before and after a 12-week study period. The lower-extremity motion of the athletes was captured using a three-dimensional motion capture system consisting of 12 infrared cameras. A lower-body marker set of 40 markers together with a rigid body model, including a forefoot, rearfoot, shank, thigh, and pelvis segment in combination with two force plates was used to determine knee joint angles, resultant external joint moments, and vertical ground reaction forces. The two groups did not differ significantly during pretesting. Only the intervention group showed significant improvements in the initial knee abduction angle during single leg landing (p = 0.038: d = 0.518), knee flexion moment during double-leg landings (p = 0.011; d = −1.086), knee abduction moment during single (p = 0.036; d = 0.585) and double-leg landing (p = 0.006; d = 0.944) and side-cutting (p = 0.015;d = 0.561) as well as vertical ground reaction force during double-leg landing (p = 0.004; d = 1.482). Control group demonstrated no significant changes in kinematics and kinetics. However, at postintervention both groups were not significantly different in any of the biomechanical outcomes except for the normalized knee flexion moment of the dominant leg during single-leg landing. This study provides first indications that the implementation of a training intervention with specific neuromuscular exercises has positive impacts on biomechanical risk factors associated with ACL injury risk and, therefore, may help prevent severe knee injuries in elite youth female handball players.
Verletzungsprävention im Nachwuchsleistungsfußball
(2023) Kolodziej, Mathias; Jaitner, Thomas; Groll, Andreas
Die Erforschung von Risikofaktoren für Verletzungen wird sowohl aus theoretischer als auch aus praktischer Perspektive aus zwei Gründen befürwortet: um zu verstehen, warum es zu Ver- letzungen kommt und um vorherzusagen, wer ein Risiko trägt, eine Verletzung zu erleiden. Insbesondere im Nachwuchsleistungsfußball spielt diese präventive Handlungsstrategie eine bedeutsame Rolle, da diese Population durch die Kombination aus einem unreifen muskuloske- lettalen System und dem Belastungsprofil im Fußball besonders anfällig für kontaktlose Verlet- zungen der unteren Extremitäten ist. Jedoch wurden in der bisherigen Forschung zur Verlet- zungsprävention im Nachwuchsleistungsfußball überwiegend Messverfahren verwendet, die im Vergleich zu Goldstandardverfahren keine zufriedenstellenden Testgütekriterien aufweisen und deren Zusammenhang zu Verletzungen bisweilen widersprüchlich oder unbekannt ist. Die Zielstellung dieser kumulativen Dissertation bestand daher in der Identifizierung verletzungsrelevanter Risikofaktoren und ihrer Interaktionen im Nachwuchsleistungsfußball mittels laborbasierter biomechanischer Messverfahren einschließlich der Überprüfung ihrer Fähigkeit zur Verletzungsvorhersage. Die Beantwortung der Frage, warum eine Verletzung auftritt und inwiefern das Zustandekommen einer Verletzung das Ergebnis einer nicht linearen Interaktion zwischen multiplen Risikofaktoren ist, stand am Anfang des Forschungsprogramms. Die Analyse dieses methodischen Ansatzes konnte durch die Erhebung von neuromuskulären und biomechanischen Leistungsparametern einige verletzungsrelevante Risikofaktoren und Risikoprofile identifizieren. Es scheint, dass die Untersuchung der Gleichgewichtsfähigkeit unter statischen und instabilen Bedingungen, der Kraftfähigkeiten der Oberschenkelmuskulatur sowie der Bewegungsmuster bei der einbeinigen Landung und einem Richtungswechsel einen guten Hinweis auf das Verletzungsrisiko bei Nachwuchsleistungsfußballern ermöglicht. Eine aus der Verwendung der Classification and Regression Tree (CART)-Methode resultierende, wissenschaftliche Neuerkenntnis zeigte, dass sowohl neuromuskuläre als auch biomechanische Risikofaktoren in einem komplexen nicht linearen System ihren Einfluss auf das Verletzungsrisiko teilweise verändern, sobald ein weiterer Risikofaktor auftritt und hierarchisch untergeordnet ist. Die Möglichkeit, das Verletzungsrisiko vorherzusagen, unterscheidet sich methodisch von dem Ansatz der Erklä- rung, warum eine Verletzung aufgetreten ist. Aufgrund dieser unterschiedlichen methodischen Herangehensweise hat die prädiktive Modellierung des Verletzungsrisikos das Forschungsprogramm abgeschlossen. Das umfassende laborbasierte Risiko-Screening lieferte eine große Anzahl möglicher Prädiktoren, wodurch die Standardschätzungen der klassischen logistischen Regression oft instabil oder sogar undurch- führbar werden (Fall p > n). Darüber hinaus treten insbesondere dann, wenn auch multiple Interaktionseffekte der Prädiktoren einbezogen werden, Probleme mit Multikollinearität auf. In diesen Situationen werden Regularisierungstechniken und Methoden zur Variablenselektion relevant. Dank der erstmaligen Verwendung der LASSO-Regression zur Verletzungsvorhersage konnte gezeigt werden, dass die Regularisierung mit diesen Problematiken umgehen kann, sodass mithilfe dieses Ansatzes letztlich ein Vorhersagemodell erstellt werden konnte. Eine geringere Kraftfähigkeit der kniestreckenden Muskulatur unter konzentrischer Arbeitsweise, ein höheres Innenrotationsmoment des Hüftgelenks bei der einbeinigen Landung und eine geringer ausgeprägte Gleichgewichtsfähigkeit unter statischen Bedingungen erhöhten das zu er- wartende Verletzungsrisiko, was die Verletzung als multifaktorielles Ereignis unterstreicht. Die schwache Vorhersagekraft des erstellten Modells deutet jedoch auf die Schwierigkeit der Vor- hersage von Verletzungen im Nachwuchsleistungsfußball hin. Nichtsdestotrotz erweitern die Ergebnisse dieses Forschungsprogramms das Wissen über verletzungsrelevante Risikofaktoren und sind ein wertvoller erster Schritt zu einer zuverlässigen Abschätzung des Verletzungsrisikos im Nachwuchsleistungsfußball.
Schwimmen lernen von Kindern und Jugendlichen mit Migrationshintergrund
(2022-04-01) Wolter, Veronique; Sendt, Anna; Jaitner, Thomas
Acute effects of the FIFA11+ and Football+ warm-ups on motor performance. A crossover randomized controlled trial
(2023-04-20) Asgari, Mojtaba; Schmidt, Marcus; Terschluse, Benedikt; Sueck, Maximilian; Jaitner, Thomas
Introduction: Few studies including contradictory results have addressed the acute effects of the 11+ on motor performance, indicating a potentially reduced applicability of the program for warming up before competitions. This study aims to compare the acute effects of a soccer-specific warm-up (Football+) and the 11+ on motor performance. Materials and methods: Thirty-eight volunteer collegiate players (22 males; age = 21.1±1.9 years, height = 1.81± 0.06 m, weight = 73.4± 9.5 kg; 16 females; age = 21.3±1.5 years; height = 1.71± 0.07 m, weight = 67.8± 8.5 kg) underwent the 11+ and the Football+ in a randomized crossover design with a one-week washout. The Football+ starts with a self-estimated 40–50 percent running, followed by dynamic stretching of the hip muscles, shoulder contact, controlled lunge, Copenhagen exercise, and modified Nordic hamstring exercise. The second part involves roughly intensive small-sided games, followed by plyometric and anaerobic exercises in the third part. The warm ups’ effects on performance were determined by a linear sprinting test (20 m), countermovement jump performance (CMJ), Illinois agility (IA), and dribbling speed (DS) tests. Within-subject differences were reported as the means and SD. Pairwise t tests at the significance level of p<0.05 were used to calculate the significant differences. Results: Overall, except for the CMJ (mean = -0.43±3.20 cm, p = 0.21, d = -0.13), significant differences for the 20 m sprint (mean = 0.04±0.10 s, p = 0.005, d = 0.42), IA (mean = 0.65±0.45 s, p = 0.01, d = 1.43), and DS (mean = 0.60±1.58 s, p = 0.012, d = 0.38) were observed. In females, significant differences observed only for IA (mean difference = 0.52±0.42 s, p<0.001, d = 1.24) and DS (mean difference = 1.29±1,77 s, p = 0.005, d = 0.73), with the Football+ showing superiority. In males, significant differences were found only for 20 m sprinting (mean difference = 0.06±0.09, p = 0.005, d = 0.60) and IA (mean difference = 0.74±0.46, p<0.001, d = 1.62), with the Football+ having superiority. Discussion: Although practicable for injury prevention, the 11+ may not optimize acute performance and prepare players for high-intensity physical tasks as well as a well-structured, roughly intensive warm-up. Further gender-specific studies should evaluate the long-term effects of the Football+ on performance and injury prevention.

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