This study examined the frequency of the most demanding scenarios (MDS) during official soccer matches using rolling averages over 1, 5, and 10 min. Forty-two Under-19 players from different positions (central defenders, full-backs, central midfielders, wide midfielders, offensive midfielders, and forwards) were monitored across 27 matches using GPS to track distance covered, high-speed running, sprint distance, accelerations, and decelerations. Intensity thresholds were established based on percentiles (0-25, 25-50, 50-75, 75-100, and ≥100). The main findings suggest that: (i) Peak Demands occur in less than 1% of all time windows and variables for all positions; (ii) Most efforts occur below peak demands, with around 95% for high-speed running and sprint distance, and 85% for accelerations, decelerations, and total distance; (iii) Significant differences in intensity distributions were found between positions, particularly at medium-low and high intensities. Regarding training prescription, relying solely on MDS may be limited, highlighting the need to supplement MDS with other metrics for a comprehensive understanding of match demands. This approach ensures better-informed training programs for soccer players.
The occurrence of peak demand events during soccer matches is infrequent. Therefore, understanding the frequency of efforts below the intensity threshold of the most demanding passages for each playing position and across various analysed variables and periods is of utmost importance.MDS might not be enough for effective soccer training planning. Complementing with additional metrics like GPS, tactical analysis, physiological data and psychological factors is essential for a comprehensive understanding of the game’s demands and tailored training programmes.

BACKGROUND: Gait disturbance is common in older adults with vascular diseases. However, how carotid atherosclerosis affects gait remains poorly understood. The objectives were to investigate the associations between carotid intima-media thickness and specific gait performances and explore the potential role of brain structure in mediating these associations.
METHODS: A cross-sectional analysis of data from the Taizhou Imaging Study was conducted, including 707 individuals who underwent both gait and carotid ultrasound examinations. Gait assessments include the Timed-Up-and-Go test, the Tinetti test, and quantitative gait assessment using a wearable device. Quantitative parameters were summarized into independent gait domains with factor analysis. Magnetic resonance images were obtained on a 3.0-Tesla scanner, and the volumes of fifteen brain regions related to motor function (primary motor, sensorimotor), visuospatial attention (inferior posterior parietal lobules, superior posterior parietal lobules), executive control function (dorsolateral prefrontal cortex, anterior cingulate), memory (hippocampus, entorhinal cortex), motor imagery (precuneus, parahippocampus, posterior cingulated cortex), and balance (basal ganglia: pallidum, putamen, caudate, thalamus) were computed using FreeSurfer and the Desikan-Killiany atlas. Mediation analysis was conducted with carotid intima-media thickness as the predictor and mobility-related brain regions as mediators.
RESULTS: Carotid intima-media thickness was found to be associated with the Timed-Up-and-Go performance (β = 0.129, p = 0.010) as well as gait performances related to pace (β=-0.213, p < 0.001) and symmetry (β = 0.096, p = 0.045). Besides, gait performances were correlated with mobility-related brain regions responsible for motor, visuospatial attention, executive control, memory, and balance (all FDR < 0.05). Notably, significant regions differed depending on the gait outcomes measured. The primary motor (41.9%), sensorimotor (29.3%), visuospatial attention (inferior posterior parietal lobules, superior posterior parietal lobules) (13.8%), entorhinal cortex (36.4%), and motor imagery (precuneus, parahippocampus, posterior cingulated cortex) (27.3%) mediated the association between increased carotid intima-media thickness and poorer Timed-Up-and-Go performance. For the pace domain, the primary motor (37.5%), sensorimotor (25.8%), visuospatial attention (12.3%), entorhinal cortex (20.7%), motor imagery (24.9%), and balance (basal ganglia: pallidum, putamen, caudate, thalamus) (11.6%) acted as mediators.
CONCLUSIONS: Carotid intima-media thickness is associated with gait performances, and mobility-related brain volume mediates these associations. Moreover, the distribution of brain regions regulating mobility varies in the different gait domains. Our study adds value in exploring the underlying mechanisms of gait disturbance in the aging population.

Patellofemoral pain syndrome (PFPS) is a common injury among runners, and it is thought that abnormal lower extremity biomechanics contribute to its development. However, the relationship between biomechanical changes after a marathon and PFPS injury remains limited. This study aims to investigate whether differences in knee and hip kinematics and lower extremity muscle activities exist in recreational runners before and after a marathon. Additionally, it aims to explore the relationship between these biomechanical changes and the development of PFPS injury. 12 recreational runners participated in the study. Kinematics and muscle activities of the lower extremity were recorded during walking (5 km/h) and running (10 km/h) tasks within 24 hours before and within 5 hours after a marathon. After the marathon, there was a significant decrease in peak knee flexion (walking: p = 0.006; running: p = 0.006) and an increase in peak hip internal rotation (walking: p = 0.026; running: p = 0.015) during the stance phase of both walking and running compared to before the marathon. The study demonstrates a decrease in knee flexion and an increase in hip internal rotation during the stance phase of gait tasks after completing a marathon, which may increase the risk of developing PFPS injury.

Evaluating variability and stability using measures for nonlinear dynamics may provide additional insight into the structure of the locomotor system, reflecting the neuromuscular system\'s organization of gait. This is in particular of interest when this system is affected by a respiratory disease and it\'s extrapulmonary manifestations. This study assessed stride-to-stride fluctuations and gait stability in patients with chronic obstructive pulmonary disease (COPD) during a self-paced, treadmill 6-minute walk test (6MWT) and its association with clinical outcomes. In this cross-sectional study, eighty patients with COPD (age 62±7y; forced expiratory volume in first second 56±19%predicted) and 39 healthy older adults (62±7y) were analyzed. Gait parameters including stride-to-stride fluctuations (coefficient of variation (CoV), predictability (sample entropy) and stability (Local Divergence Exponent (LDE)) were calculated over spatiotemporal parameters and center of mass velocity. Independent t-test, Mann-Whitney U test and ANCOVA analyses were conducted. Correlations were calculated between gait parameters, functional mobility using Timed Up and Go Test, and quadriceps muscle strength using dynamometry. Patients walked slower than healthy older adults. After correction for Speed, patients demonstrated increased CoV in stride length (F(1,116) = 5.658, p = 0.019), and increased stride length predictability (F(1,116) = 3.959, p = 0.049). Moderate correlations were found between mediolateral center of mass velocity LDE and normalized maximum peak torque (ρ = -0.549). This study showed that patients with COPD demonstrate alterations in stride length fluctuations even when adjusted for walking speed, highlighting the potential of nonlinear measures to detect alterations in gait function in patients with COPD. Association with clinical outcomes were moderate to weak, indicating that these clinical test are less discriminative for gait alterations.

OBJECTIVE: Patients with cerebral small vessel disease (SVD) show a heterogenous clinical course. The aim of the current study was to investigate the longitudinal course of cognitive and motor function in patients who developed parkinsonism, dementia, both, or none.
METHODS: Participants were from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort study, a prospective cohort of patients with SVD. Parkinsonism and dementia were, respectively, diagnosed according to the UK Parkinson\'s Disease Society brain bank criteria and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for major neurocognitive disorder. Linear and generalized linear mixed-effect analyses were used to study the longitudinal course of motor and cognitive tasks.
RESULTS: After a median follow-up of 12.8 years (interquartile range 10.2-15.3), 132 of 501 (26.3%) participants developed parkinsonism, dementia, or both. Years before diagnosis of these disorders, participants showed distinct clinical trajectories from those who developed none: Participant who developed parkinsonism had an annual percentage of 22% (95% CI 18%-27%) increase in motor part of the Unified Parkinson\'s Disease Rating Scale score. This was significantly higher than the 16% (95% CI 14%-18%) of controls, mainly because of a steep increase in bradykinesia and posture and gait disturbances. When they developed dementia as well, the increase in Timed Up and Go Test time of 0.73 seconds per year (95% CI 0.58-0.87) was significantly higher than the 0.20 seconds per year increase (95% CI 0.16-0.23) of controls. All groups, including the participants who developed parkinsonism without dementia, showed a faster decline in executive function compared with controls: Annual decline in Z-score was -0.07 (95% CI -0.10 to -0.05), -0.09 (95% CI -0.11 to -0.08), and -0.11 (95% CI -0.14 to -0.08) for participants who developed, respectively, parkinsonism, dementia, and both parkinsonism and dementia. These declines were all significantly faster than the annual decline in Z-score of 0.07 (95% CI -0.10 to -0.05) of controls.
CONCLUSIONS: A distinct pattern in deterioration of clinical markers is visible in patients with SVD, years before the diagnosis of parkinsonism and dementia. This knowledge aids early identification of patients with a high risk of developing these disorders.

BACKGROUND: Lower back pain (LBP) arising from lumbar disc herniation (LDH) poses a challenging health issue, often necessitating therapeutic interventions. Bushen Huoxue formula (BSHXF) has proved as a potential treatment option with great clinical effect. However, comprehensive investigations into its efficacy and safety in conjunction with celecoxib for managing LBP from LDH are lacking. The objective of this article is to investigate the efficacy and safety of BSHXF in the management of patients with LBP from LDH.
METHODS: This single center, randomized clinical trial was conducted from March 2023 to September 2023 and all patients suffered from LBP of LDH. Participants were randomly assigned to the BSHXF group (celecoxib and BSHXF) or the control group (celecoxib and placebo). The patients received treatment for 2 weeks. Assessment was conducted before treatment, the last day of the treatment, 4 weeks and 8 weeks after the treatment. Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Roland-Morris Disability Questionnaire (RMDQ), Timed up and go test (TUGT), trunk range of movement (Trunk ROM), Hospital Anxiety and Depression Scale (HADS) were used for the evaluation.
RESULTS: A total of 206 subjects completed treatment, among whom 104 participants were randomized to the BSHXF group and 102 participants were randomized to the control group. There were no significant differences between groups in terms of the observed indicators (P > .05). After treatment, patients in BSHXF group obtained significant lower scores at 2-week, 4-week, 8-week of VAS, ODI, RMDQ, TUGT, Trunk ROM and HADS than the baseline data (P < .05). The ODI score was significantly lower than the control group at 2-week, 4-week, 8-week (2w: 11.30 ± 5.80 vs 14.23 ± 6.33, P < .001; 4w: 10.95 ± 4.93 vs 13.54 ± 6.35, P < .001; 8w: 10.27 ± 5.25 vs 12.84 ± 6.57, P = .002). Similarly, the scores of VAS, RMDQ, TUGT, Trunk ROM scores of the BSHXF group markedly decreased at 2, 4, and 8-week when compared to their control group (P < .05). Furthermore, no significant difference showed up in the score of HADS between the between the BSHXF and the control group after treatment (P > .05).
CONCLUSIONS: This randomized clinical trial found that BSXHF can help significantly improve the clinical outcomes of celecoxib including pain intensity reduction and lumbar function improvement in LBP patients.

OBJECTIVE: Three-dimensional (3D)-CT data is currently insufficient for classifying femoral trochanter fractures. Fracture classification based on fracture stability analysis is helpful to evaluate the prognosis of patients after internal fixation. Currently, there is a lack of fracture classification methods based on 3D-CT images and fracture stability analysis. The aim of this study was to propose a new six-part classification method for intertrochanteric fractures of femur based on 3D-CT images and fracture stability analysis to improve the diagnosis rate of unstable fractures.
METHODS: From January 2009 to December 2019, 320 patients receiving intramedullary nail surgery for femoral intertrochanteric fractures at Chengdu University\'s Affiliated Hospital were studied retrospectively. AO and six-part classifications were undertaken according to the 3D-CT image data of the patients, and the stability rates of two classifications were compared. According to the six-part classification stability criteria, the patients were divided into a stable and an unstable fracture group. The perioperative and follow-up indicators of the two groups were statistically analyzed, and the six-part classification\'s inter-observer and internal reliability was examined.
RESULTS: There were 107 men and 213 females women the 320 patients, with an average age of 79.32 ± 11.26 years and an osteoporosis rate of 55.63% (178/320). The fracture stability rate of 39.69% (127/320) was studied using a six-part classification method. The AO classification fracture stability rate was 42.50% (136/320), with no significant difference (χ2  = 0.523, p = 0.470 > 0.05). There is no statistically significant difference between the two classification techniques in the examination of fracture stability (McNemer difference test p = 0.306 > 0.05; Kappa consistency test p < 0.001). According to the six-part classification, fracture stability and instability group were divided into two groups. The following indicators were compared between the two groups: The surgery time (p = 0.280), fracture reduction quality (p = 0.062); function independent measurement (p = 0.075); timed up and go test (TUG) (p = 0.191), and Parker-Palmer score (p = 0.146). Were as compared according to the six-part classification of stable and unstable fracture groups. Perioperative blood loss (p < 0.001), the Harris score excellent and good rate (p = 0.043), fracture healing time (p < 0.001), and the entire weight-bearing duration (p = 0.002) were statistically significant. The difference in femoral head height (FHH) (p = 0.046), the change in femoral neck shaft angle (p = 0.003), the change in medial cephalic nail length (p = 0.033), and the change in tip-apex distance (TAD) (p = 0.002) were statistically significant compared to the relevant markers of imaging stability. Fracture stability had a substantial influence on Harris ratings at 3, 6, and 12 months following surgery, according to repeated measures analysis of variance (F(1,126)  = 32.604, p < 0.001). The effect of time on the Harris score was similarly significant (F(1.893,238.508)  = 202.771, p < 0.001). The observer intra-observer inter-group correlation coefficient (ICC) value was 0.941 > 0.75, the inter-observer ICC value was 0.921 > 0.75, and the intra-observer and inter-observer reliability were both good.
CONCLUSIONS: The six-part classification of femoral intertrochanteric fractures based on 3D-CT images has broader guiding relevance for femoral intertrochanteric fracture stability analysis. Clinicians will find this classification simpler and more consistent than the AO classification.

UNASSIGNED: No study has yet demonstrated the effect of lower limb gait rehabilitation robot treatment combined with acupuncture on stroke patients.
UNASSIGNED: To explore the effect of acupuncture combined with lower limb gait rehabilitation robot on walking function in patients with hemiplegia after stroke.
UNASSIGNED: Fifty-six patients with hemiplegia after stroke were enrolled and randomly divided into two groups. The control group received regular rehabilitation training and acupuncture therapy; the intervention group was additionally trained by AiWalker-I lower limb gait robot. Both groups received 5 sessions a week for 4 weeks. Walking function parameters were assessed before and after the 4-week treatment.
UNASSIGNED: There was no significant difference in all parameters between the two groups in baseline (P > 0.05). After 4 weeks of treatment, all parameters including the effectiveness of functional ambulation category (FAC), time up and go test (TUGT) time, Wisconsin gait scale (WGS) score, walking spatiotemporal parameters were all significantly improved in both groups with a significant better effect in the intervention group (P < 0.05).
UNASSIGNED: Acupuncture combined with lower limb gait rehabilitation robot training has a positive effect on correction of abnormal gait and improvement of walking ability of hemiplegic patients after stroke.

Objective: To explore the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns. Methods: A randomized controlled trial was conducted. From January 2021 to January 2023, 60 elderly patients with lower limb dysfunction after deep burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. The patients were divided into conventional rehabilitation group (30 cases, 17 males and 13 females, aged (65±3) years) and combined rehabilitation group (30 cases, 16 males and 14 females, aged (64±3) years) according to the random number table. For patients in both groups, the red-light treatment was started after the lower limb wounds healed or when the total area of scattered residual wounds was less than 1% of the total body surface area. After 2 weeks of red-light treatment, the patients in conventional rehabilitation group were given conventional rehabilitation treatments, including joint stretching, resistance, and balance training; in addition to conventional rehabilitation treatments, the patients in combined rehabilitation group were given exercise prescription training based on a progressive mode three times a week, mainly including dumbbell press, Bobath ball horizontal support, and high-level pulldown trainings. The training time for patients in both groups was 12 weeks. Before training (after 2 weeks of red-light treatment) and after 12 weeks of training, the upper limb and lower limb motor functions of the patients were evaluated using the simple Fugl-Meyer scale, the physical fitness of patients was evaluated using the simple physical fitness scale, and the patient\'s risk of falling was evaluated by the time consumed for the timed up and go test. The adverse events of patients that occurred during training were recorded. After 12 weeks of training, a self-designed satisfaction survey was conducted to investigate patients\' satisfaction with the training effect. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney U test, Wilcoxon signed rank test, and chi-square test. Results: Before training, the scores of upper limb and lower limb motor functions of patients between the two groups were similar (P>0.05). After 12 weeks of training, the scores of upper limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -11.42 and -13.67, respectively, P<0.05), but there was no statistically significant difference between the two groups (P>0.05). The score of lower limb motor function of patients in combined rehabilitation group was 28.9±2.6, which was significantly higher than 26.3±2.6 in conventional rehabilitation group (t=-3.90, P<0.05), and the scores of lower limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -4.14 and -6.94, respectively, P<0.05). Before training, the individual and total scores of physical fitness of patients between the two groups were similar (P>0.05). After 12 weeks of training, the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in conventional rehabilitation group and combined rehabilitation group were significantly increased compared with those before training (with Z values of -4.38, -3.55, -3.88, -4.65, -4.58, -4.68, -4.42, and -4.48, respectively, P<0.05), and the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in combined rehabilitation group were significantly increased compared with those in conventional rehabilitation group (with Z values of -3.93, -3.41, -3.19, and -5.33, P<0.05). Before training, the time consumed for the timed up and go test for patient\'s risk of falling in the two groups was close (P>0.05). After 12 weeks of training, the time consumed for the timed up and go test for patient\'s risk of falling in combined rehabilitation group was (28.0±2.1) s, which was significantly shorter than (30.5±1.8) s in conventional rehabilitation group (t=4.94, P<0.05). Moreover, the time consumed for the timed up and go test for patient\'s risk of falling in both conventional rehabilitation group and combined rehabilitation group was significantly shorter than that before training (with t values of 14.80 and 15.86, respectively, P<0.05). During the training period, no adverse events such as muscle tissue strain, edema, or falling occurred in any patient. After 12 weeks of training, the satisfaction score of patients with the training effect in combined rehabilitation group was 13.5±1.2, which was significantly higher than 8.5±1.4 in conventional rehabilitation group (t=21.78, P<0.05). Conclusions: The exercise prescription training based on a progressive mode can significantly promote the recovery of lower limb motor function and physical fitness of elderly patients with lower limb dysfunction after deep burns, and effectively reduce the patient\'s risk of falling without causing adverse events during the training period, resulting in patient\'s high satisfaction with the training effect.
目的： 探讨基于渐进模式的运动处方治疗深度烧伤后下肢功能障碍老年患者的效果。 方法： 采用随机对照试验方法。2021年1月—2023年1月，空军军医大学第一附属医院收治60例符合入选标准的深度烧伤后下肢功能障碍老年患者。将患者按照随机数字表法分为常规康复组［30例，男17例、女13例，年龄（65±3）岁］和联合康复组［30例，男16例、女14例，年龄（64±3）岁］。对2组患者于下肢创面愈合后或散在残余创面总面积<1％体表总面积时，开始进行红光治疗。于红光治疗2周后，对常规康复组患者行关节牵伸、抗阻及平衡训练等常规康复治疗；对联合康复组患者在常规康复治疗基础上进行每周3次的基于渐进模式的运动处方训练，主要包括哑铃推举、Bobath球水平支撑、高位下拉训练等。2组患者训练时间均为12周。于训练前（红光治疗2周后）及训练12周后，采用简易Fugl-Meyer量表评定患者上肢与下肢的运动功能，采用简易体能状况量表评定患者体适能，通过计时-起立行走测试耗时评定患者跌倒风险。记录患者训练期间发生的不良事件；训练12周后，自行设计满意度调查表调查患者对训练效果的满意度。对数据行独立样本t检验、配对样本t检验、Mann-Whitney U检验、Wilcoxon符号秩检验、χ2检验。 结果： 训练前，2组患者上肢与下肢运动功能评分均相近（P>0.05）。训练12周后，常规康复组、联合康复组患者上肢运动功能评分均较训练前明显升高（t值分别为-11.42、-13.67，P<0.05），但2组间比较，差异无统计学意义（P>0.05）；联合康复组患者下肢运动功能评分为（28.9±2.6）分，明显高于常规康复组的（26.3±2.6）分（t=-3.90，P<0.05），且常规康复组、联合康复组患者下肢运动功能评分均较训练前明显升高（t值分别为-4.14、-6.94，P<0.05）。训练前，2组患者体适能各单项评分及总评分均相近（P>0.05）；训练12周后，常规康复组、联合康复组患者体适能中的平衡能力评分、步行速度评分、椅子坐立评分及总评分均较训练前明显升高（Z值分别为-4.38、-3.55、-3.88、-4.65与-4.58、-4.68、-4.42、-4.48，P<0.05），且联合康复组患者体适能中的平衡能力评分、步行速度评分、椅子坐立评分及总评分均明显高于常规康复组（Z值分别为-3.93、-3.41、-3.19、-5.33，P<0.05）。训练前，2组患者针对跌倒风险的计时-起立行走测试耗时相近（P>0.05）。训练12周后，联合康复组患者针对跌倒风险的计时-起立行走测试耗时为（28.0±2.1）s，明显短于常规康复组的（30.5±1.8）s（t=4.94，P<0.05）；且常规康复组、联合康复组患者针对跌倒风险的计时-起立行走测试耗时均较训练前明显缩短（t值分别为14.80、15.86，P<0.05）。所有患者训练期间均未发生肌肉组织拉伤、水肿或跌倒等不良事件。训练12周后，联合康复组患者对治疗效果的满意度评分为（13.5±1.2）分，明显高于常规康复组的（8.5±1.4）分（t=21.78，P<0.05）。 结论： 基于渐进模式的运动处方训练可以明显促进深度烧伤后下肢功能障碍老年患者下肢运动功能、体适能恢复，可有效降低患者跌倒风险，且训练期间不引发不良事件，使得患者对训练效果的满意度较高。.

Older adults become more inactive and frailer with aging. Physical status is closely linked to mental health, but it is unclear which physical indicator is more strongly associated with depressive symptoms in older adults. The present study aimed to compare relationships between self-reported physical activity, physical frailty (muscle mass, muscle strength, and gait ability) and depressive symptoms in community male and female older adults.
A total of 1,180 adults aged 60 years and older were recruited to participate in this study from a Chinese community receiving annual check-up service from September 2018 to May 2019. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ). The Bio-electrical Impedance Analyzer was used to determine the muscle mass. As the indicators of muscle function, grip strength and gait ability were assessed by the dynamometer and Timed Up and Go Test (TUGT), respectively. The 15-item version of Geriatric Depression Scale (GDS-15) was used to examine depressive symptoms. Demographic variables, health status and sleep quality were collected using questionnaire.
11.8% men and 11.9% women reported depressive symptoms. Logistic regression showed that depressive symptoms was associated with low grip strength (OR = 2.42, 95% CI: 1.04-5.63), slow gait ability (OR = 3.60, 95% CI: 1.28-10.13) in older males, and associated with low level of self-reported physical activity (OR = 3.85, 95% CI: 2.00-7.42) in older females. No significant association was found between muscle mass and depressive symptoms.
There were gender differences in the relationship between physical activity, physical frailty, and depressive symptoms. Grip strength and gait ability may be a better indicator of frailty for predicting depressive symptoms in older men while physical activity may be useful in predicting depressive symptoms in older women.