OBJECTIVE: To describe serum irisin and fibroblast growth factor-21 (FGF-21) concentrations in healthy female adolescents with different training activity patterns and their associations with bone mineral properties and metabolic markers.
METHODS: A total of 62 adolescent girls aged 14-18 years were recruited: 22 rhythmic gymnasts, 20 swimmers, and 20 untrained controls. Bone mineral characteristics by dual-energy X-ray absorptiometry, daily energy intake by dietary recall, serum irisin, FGF-21, undercarboxylated osteocalcin, and C-terminal telopeptide of type I collagen were measured in all girls.
RESULTS: Whole body and lumbar spine areal bone mineral density and lumbar spine bone mineral content were higher in the rhythmic gymnasts group compared with swimmers and untrained controls groups (P < .05). Serum irisin, FGF-21, undercarboxylated osteocalcin, and C-terminal telopeptide of type I collagen levels were not significantly different between the groups. In the rhythmic gymnasts group, serum FGF-21 concentration was positively correlated with lumbar spine areal bone mineral density independently of confounding factors (r = .51; P = .027).
CONCLUSIONS: Serum irisin and FGF-21 levels were not different between adolescent eumenorrheic girls with different training activity patterns. FGF-21 was positively associated with lumbar spine areal bone mineral density, which predominantly consists of trabecular bone in adolescent rhythmic gymnasts.

BACKGROUND: Although the superior effectiveness of free-weight over machine-based training has been a traditionally widespread assumption, longitudinal studies comparing these training modalities were scarce and heterogeneous.
OBJECTIVE: This research used the velocity-based method to compare the effects of free-weight and machine-based resistance training on athletic performance and muscle architecture.
METHODS: Thirty-four resistance-trained men participated in an 8-week resistance training program allocated into free-weight (n = 17) or machine-based (n = 17) groups. Training variables (intensity, intraset fatigue, and recovery) were identical for both groups, so they only differed in the use of a barbell or specific machines to execute the full squat, bench press, prone bench pull, and shoulder press exercises. The velocity-based method was implemented to accurately adjust the planned intensity. Analysis of covariance and effect size (ES) statistics were used to compare both training modalities on a comprehensive set of athletic and muscle architecture parameters.
RESULTS: No between-group differences were found for any athletic (p ≥ 0.146) and muscle architecture (p ≥ 0.184) variable. Both training modalities significantly and similarly improved vertical jump (Free-weight: ES ≥ 0.45, p ≤ 0.001; Machine-based: ES ≥ 0.41, p ≤ 0.001) and lower limb anaerobic capacity (Free-weight: ES ≥ 0.39, p ≤ 0.007; Machine-based: ES ≥ 0.31, p ≤ 0.003). Additionally, the machine-based group meaningfully enhanced upper limb anaerobic power (ES = 0.41, p = 0.021), whereas the free-weight group significantly improved the change of direction (ES = -0.54, p = 0.003) and 2/6 balance conditions analyzed (p ≤ 0.012). Changes in sprint capacity (ES ≥ -0.13, p ≥ 0.274), fascicle length, and pennation angle (ES ≤ 0.19, p ≥ 0.129) were not significant for either training modality.
CONCLUSIONS: Adaptations in athletic performance and muscle architecture would not be meaningfully influenced by the resistance modality trained.

The high variability of upper limb motor recovery with robotic training (RT) in subacute stroke underscores the need to explore differences in responses to RT. We explored differences in baseline characteristics and the RT dose between responders (ΔFugl-Meyer Assessment (FMA) score ≥ 9 points; n = 20) and non-responders (n = 16) in people with subacute stroke (mean [SD] poststroke time at baseline, 54 (26) days, baseline FMA score, 23 (17) points) who underwent 16 RT sessions combined with conventional therapies. Baseline characteristics were compared between groups. During RT sessions, the actual practice time (%), number of movements performed, and total distance covered (cm) in assisted and unassisted modalities were compared between groups. At baseline, participant characteristics and FMA scores did not differ between groups. During the RT, non-responders increased practice time (+15%; p = 0.02), performed more movements (+285; p = 0.004), and covered more distance (+4037 cm; p < 10-3), with no difference between physical modalities. In contrast, responders decreased practice time (-21%; p = 0.01) and performed fewer movements (-338; p = 0.03) in the assisted modality while performing more movements (+328; p < 0.05) and covering a greater distance (+4779 cm; p = 0.01) in unassisted modalities. Despite a large amount of motor practice, motor outcomes did not improve in non-responders compared to responders: the difficulty level in RT may have been too low for them. Future studies should combine robot-based parameters to describe the treatment dose, especially in people with severe-to-moderate arm paresis, to optimize the RT and improve the recovery prognosis.

Previous data suggest a correlation between the cross-sectional area of Type II muscle fibers and the degree of non-linearity of the EMG amplitude-force relationship (AFR). In this study we investigated whether the AFR of back muscles could be altered systematically by using different training modalities. We investigated 38 healthy male subjects (aged 19-31 years) who regularly performed either strength or endurance training (ST and ET, n = 13 each) or were physically inactive (controls (C), n = 12). Graded submaximal forces on the back were applied by defined forward tilts in a full-body training device. Surface EMG was measured utilizing a monopolar 4 × 4 quadratic electrode scheme in the lower back area. The polynomial AFR slopes were determined. Between-group tests revealed significant differences for ET vs. ST and C vs. ST comparisons at the medial and caudal electrode positions, but not for ET vs. C. Further, systematic main effects of the \"electrode position\" could be proven for ET and C groups with decreasing x2 coefficients from cranial to caudal and lateral to medial. For ST, there was no systematic main effect of the \"electrode position\". The results point towards training-related changes to the fiber-type composition of muscles in the strength-trained participants, particularly for their paravertebral region.

Olympic sailing is a complex sport where sailors are required to predict and interpret weather conditions while facing high physical and physiological demands. While it is essential for sailors to develop physical and physiological capabilities toward major competition, monitoring training status following the competition is equally important to minimize the magnitude of detraining and facilitate retraining. Despite its long history in the modern Olympics, reports on world-class sailors\' training status and performance characteristics across different periodization phases are currently lacking. This case study aimed to determine the influence of training cessation and subsequent retraining on performance parameters in a world-class female sailor. A 31-year old female sailor, seventh in the Women\'s Sailing 470 medal race in Tokyo 2020, completely stopped training for 4 weeks following the Olympics, and resumed low-intensity training for 3 weeks. Over these 7 weeks, 12.7 and 5.3% reductions were observed in 6 s peak cycling power output and jump height, respectively, with a 4.7% decrease in maximal aerobic power output. Seven weeks of training cessation-retraining period induced clear reductions in explosive power production capacities but less prominent decreases in aerobic capacity. The current findings are likely attributed to the sailor\'s training characteristics during the retraining period.

Lower-limb wearable resistance (WR) provides a specific and targeted overload to the musculature involved in sprint running, however, it is unknown if greater impact forces occur with the additional limb mass. This study compared the contact times and ground reaction force waveforms between sprint running with no load and 2% body mass (BM) shank-positioned WR over 30 m. Fifteen male university-level sprint specialists completed two maximum effort sprints with each condition in a randomized order. Sprint running with shank WR resulted in trivial changes to contact times at 5 m, 10 m, and 20 m (effect size [ES] = <0.20, p > 0.05) and a small, significant increase to contact time at 30 m by 1.94% (ES = 0.25, p = 0.03). Significant differences in ground reaction force between unloaded and shank loaded sprint running were limited to the anterior-posterior direction and occurred between 20% and 30% of ground contact at 10 m, 20 m, and 30 m. Shank WR did not result in greater magnitudes of horizontal or vertical forces during the initial impact portion of ground contact. Practitioners can prescribe shank WR training with loads ≤2% BM without concern for increased risk of injurious impact forces.

BACKGROUND: Whether high-intensity interval training (HIIT) is more efficient than moderate-intensity continuous exercise (MICE) to increase cardiorespiratory fitness in patients with acute coronary syndrome at moderate-to-high cardiovascular risk is controversial. The best approach to guide training intensity remains to be determined.
OBJECTIVE: We aimed to assess intensities achieved with self-tailored HIIT and MICE according to perceived exertion and to compare the effect on cardiorespiratory fitness in patients early after ST-elevation myocardial infarction (STEMI).
METHODS: We included 69 males starting cardiac rehabilitation within 4 weeks after STEMI. After a 3-week run-in phase with MICE, 35 patients were randomised to 9 weeks of HIIT (2×HIIT and 1×MICE per week) and 34 patients to MICE (3×MICE). Training workload for MICE was initially set at the patients\' first ventilatory threshold (VT). HIIT consisted of 4×4-min intervals with a workload above the second VT in high intervals. Training intensity was adjusted weekly to maintain the perceived exertion (Borg score 13-14 for MICE, ≥15 for HIIT). Session duration was 38min in both groups. Peak oxygen consumption (VO2) was measured by cardiopulmonary exercise testing pre- and post-intervention.
RESULTS: Both groups improved peak VO2 (ml/kg/min) (HIIT +1.9, P<0.001; MICE +3.2, P<0.001, Cohen\'s d -0.4), but changes in VO2 were not significantly different between groups (P=0.104). Exercise regimes did not differ between groups in terms of energy expenditure or training time, but perceived exertion was higher with HIIT.
CONCLUSIONS: Self-tailored HIIT was feasible in patients early after STEMI. It was more strenuous but not superior nor more time-efficient than MICE in improving peak VO2. The trial was registered at ClinicalTrial.gov (NCT02627586).

BACKGROUND: Exercise-based cardiac rehabilitation increases peak oxygen uptake (peak VO₂), which is an important predictor of mortality in cardiac patients. However, it remains unclear which exercise characteristics are most effective for improving peak VO₂ in coronary artery disease (CAD) patients. Proof of concept papers comparing Aerobic Interval Training (AIT) and Moderate Continuous Training (MCT) were conducted in small sample sizes and findings were inconsistent and heterogeneous. Therefore, we aimed to compare the effects of AIT and Aerobic Continuous Training (ACT) on peak VO₂, peripheral endothelial function, cardiovascular risk factors, quality of life and safety, in a large multicentre study.
METHODS: Two-hundred CAD patients (LVEF >40%, 90% men, mean age 58.4 ± 9.1 years) were randomized to a supervised 12-week cardiac rehabilitation programme of three weekly sessions of either AIT (90-95% of peak heart rate (HR)) or ACT (70-75% of peak HR) on a bicycle. Primary outcome was peak VO₂; secondary outcomes were peripheral endothelial function, cardiovascular risk factors, quality of life and safety.
RESULTS: Peak VO₂ (ml/kg/min) increased significantly in both groups (AIT 22.7 ± 17.6% versus ACT 20.3 ± 15.3%; p-time<0.001). In addition, flow-mediated dilation (AIT+34.1% (range -69.8 to 646%) versus ACT+7.14% (range -66.7 to 503%); p-time<0.001) quality of life and some other cardiovascular risk factors including resting diastolic blood pressure and HDL-C improved significantly after training. Improvements were equal for both training interventions.
CONCLUSIONS: Contrary to earlier smaller trials, we observed similar improvements in exercise capacity and peripheral endothelial function following AIT and ACT in a large population of CAD patients.

BACKGROUND: Since simulators offer important advantages, they are increasingly used in medical education and medical skills training that require physical actions. A wide variety of simulators have become commercially available. It is of high importance that evidence is provided that training on these simulators can actually improve clinical performance on live patients. Therefore, the aim of this review is to determine the availability of different types of simulators and the evidence of their validation, to offer insight regarding which simulators are suitable to use in the clinical setting as a training modality.
CONCLUSIONS: Four hundred and thirty-three commercially available simulators were found, from which 405 (94%) were physical models. One hundred and thirty validation studies evaluated 35 (8%) commercially available medical simulators for levels of validity ranging from face to predictive validity. Solely simulators that are used for surgical skills training were validated for the highest validity level (predictive validity). Twenty-four (37%) simulators that give objective feedback had been validated. Studies that tested more powerful levels of validity (concurrent and predictive validity) were methodologically stronger than studies that tested more elementary levels of validity (face, content, and construct validity).
CONCLUSIONS: Ninety-three point five percent of the commercially available simulators are not known to be tested for validity. Although the importance of (a high level of) validation depends on the difficulty level of skills training and possible consequences when skills are insufficient, it is advisable for medical professionals, trainees, medical educators, and companies who manufacture medical simulators to critically judge the available medical simulators for proper validation. This way adequate, safe, and affordable medical psychomotor skills training can be achieved.