Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials.

OBJECTIVE: To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. DESIGN: Systematic review and network meta-analysis. METHODS: Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. DATA SOURCES: Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. RESULTS: 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. CONCLUSIONS: Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018118040.

Variations in lower body stiffness during sports-specific tasks in well-trained female athletes.

The present study aimed to assess the differences in leg stiffness and the associated performance variables between athletes from various training backgrounds during tasks relevant to athletic training. Forty-seven female participants (20 nationally identified netballers, 13 high-level endurance athletes and 14 age-matched controls) completed a sprint, anticipated sidestep change of direction and unilateral repetitive hopping task to assess leg stiffness and the relationship of stiffness between the different tasks. Leg stiffness and performance variables were evaluated with a 10-camera motion analysis system and force plate, and leg stiffness was derived through the McMahon and Cheng methodology (1990). Significant differences were evident in leg stiffness, and the contributing performance variables between groups across all assessed tasks (p < 0.001-0.017). Furthermore, results indicated the control group displayed no leg stiffness relationship between the evaluated tasks, while the stiffness relationship between tasks within athletic populations reflected training-specific demands of athletes. The results of this study indicated that the athletic training background of individuals may contribute to inherent leg stiffness differences between groups. Furthermore, the stiffness relationship observed between tasks suggests practitioners should take care in the selection of task used to monitor leg stiffness from a performance or injury risk perspective.

The Validity of a Global Navigation Satellite System for Quantifying Small-Area Team-Sport Movements.

Delaney, JA, Wileman, TM, Perry, NJ, Thornton, HR, Moresi, MP, and Duthie, GM. The validity of a global navigation satellite system for quantifying small-area team-sport movements. J Strength Cond Res 33(6): 1463-1466, 2019-The recent development of global navigation satellite systems (GNSS) has improved the availability and signal strength of surrounding satellites compared with traditional global positioning systems, although their ability to quantify rapid changes in speed may still be limited. This study aimed to evaluate the validity of GNSS to quantify the mean speed (m·s) and acceleration (m·s) of movements typical to team sports. One participant completed 9 periods of 4 minutes of activity, separated by 2-minute rest periods, which involved walking, jogging, and running in a variety of directions and patterns, aimed to simulate a team-sport movement profile. Speed and acceleration were quantified from a 10-Hz GNSS unit and compared with a 10-camera, 3-dimensional motion capture system (VICON), from which the movement of both the participant's center of mass (COM) and the location of the GNSS unit (e.g., C7 vertebrae) were calculated. Practical estimates of speed were associated with small differences from both the criterion COM (effect size; ±90% confidence limits = 0.19-0.25; ± ∼0.21) and criterion C7 (0.14-0.22; ± ∼0.13). The corresponding estimates of acceleration derived from raw data were classified as small (0.16-0.22; ± ∼0.15) and small to moderate (0.25-0.35; ± ∼0.24) for the COM and C7, respectively. Software-exported acceleration values exhibited very large mean bias compared with both criterion measures (-3.81 to -3.77; ± ∼0.24). This study demonstrates that 10-Hz GNSS possess acceptable validity for assessing the average demands of movements typical of team-sports training and competition, although caution is recommended when using software-exported measures of acceleration.

Sex Differences in Physical Fitness Characteristics and Match-Play Demands in Adolescent Netball: Should Male and Female Adolescents Co-compete in Netball?

Tissera, KM, Naughton, GA, Gabbett, TJ, Krause, LM, Moresi, MP, and Benson, AC. Sex differences in physical fitness characteristics and match-play demands in adolescent netball: Should male and female adolescents co-compete in netball? J Strength Cond Res 33(3): 846-856, 2019-Sports participation offers multifaceted benefits, especially during adolescence. However, policies relating to male and female adolescents co-competing in team sports can be prohibitive and lack an evidence base. This study aimed to strengthen evidence on coparticipation of male and female adolescents playing recreational netball. Off-court fitness characteristics (power, speed, agility, and high-speed intermittent running) and match-play performances from global positioning system (GPS) and video analysis were compared in adolescent males (n = 34, mean ± SD, age, 15.2 ± 0.8 years) and females (n = 45, mean ± SD, age, 14.9 ± 0.7 years), with previous recreational netball experience. Independent t-tests showed adolescent men outperforming females in all off-court fitness characteristics (p < 0.001). Two-way analyses of variance explored sex-based interactions in match-play (GPS accelerometer data and notational analyses) and type of competition (mixed-/single-sex formats) in forty-two 7-minute matches. Overall, no differences in match-play performances were found between males and females (p > 0.05). Notational skill-based comparisons showed that male skills were better in mixed- than single-sex matches. Conversely, competition format did not alter skills of females. Despite more netball experience in females and superior off-court fitness characteristics in males, on-court performance differences between males and females were minimal in these recreational adolescent netball players. Coparticipation in netball was not detrimental to the performance of either sex.

Impaired heel to toe progression during gait is related to reduced ankle range of motion in people with Multiple Sclerosis.

BACKGROUND: Gait impairment in people with Multiple Sclerosis results from neurological impairment, muscle weakness and reduced range of motion. Restrictions in passive ankle range of motion can result in abnormal heel-to-toe progression (weight transfer) and inefficient gait patterns in people with Multiple Sclerosis. The purpose of this study was to determine the associations between gait impairment, heel-to-toe progression and ankle range of motion in people with Multiple Sclerosis. METHODS: Twelve participants with Multiple Sclerosis and twelve healthy age-matched participants were assessed. Spatiotemporal parameters of gait and individual footprint data were used to investigate group differences. A pressure sensitive walkway was used to divide each footprint into three phases (contact, mid-stance, propulsive) and calculate the heel-to-toe progression during the stance phase of gait. FINDINGS: Compared to healthy controls, people with Multiple Sclerosis spent relatively less time in contact phase (7.8% vs 25.1%) and more time in the mid stance phase of gait (57.3% vs 33.7%). Inter-limb differences were observed in people with Multiple Sclerosis between the affected and non-affected sides for contact (7.8% vs 15.3%) and mid stance (57.3% and 47.1%) phases. Differences in heel-to-toe progression remained significant after adjusting for walking speed and were correlated with walking distance and ankle range of motion. INTERPRETATION: Impaired heel-to-toe progression was related to poor ankle range of motion in people with Multiple Sclerosis. Heel-to-toe progression provided a sensitive measure for assessing gait impairments that were not detectable using standard spatiotemporal gait parameters.

Lower Body Stiffness Modulation Strategies in Well Trained Female Athletes.

Millett, EL, Moresi, MP, Watsford, ML, Taylor, PG, and Greene, DA. Lower body stiffness modulation strategies in well trained female athletes. J Strength Cond Res 30(10): 2845-2856, 2016-Lower extremity stiffness quantifies the relationship between the amount of leg compression and the external load to which the limb are subjected. This study aimed to assess differences in leg and joint stiffness and the subsequent kinematic and kinetic control mechanisms between athletes from various training backgrounds. Forty-seven female participants (20 nationally identified netballers, 13 high level endurance athletes and 14 age and gender matched controls) completed a maximal unilateral countermovement jump, drop jump and horizontal jump to assess stiffness. Leg stiffness, joint stiffness and associated mechanical parameters were assessed with a 10 camera motion analysis system and force plate. No significant differences were evident for leg stiffness measures between athletic groups for any of the tasks (p = 0.321-0.849). However, differences in joint stiffness and its contribution to leg stiffness, jump performance outcome measures and stiffness control mechanisms were evident between all groups. Practitioners should consider the appropriateness of the task utilised in leg stiffness screening. Inclusion of mechanistic and/or more sports specific tasks may be more appropriate for athletic groups.

The impact of data reduction on the intra-trial reliability of a typical measure of lower limb musculoskeletal stiffness.

Double-leg repeated jumping tasks are commonly used as measures of lower limb stiffness in exercise science research. Within similar stiffness calculations, variation in data-reduction criteria exists. The impact of these varied data-reduction methods on stiffness measures is unknown. Sixteen adolescent female participants from varied physical activity backgrounds performed 15 self-paced, bent-knee continuous jumps (CJb) on two force plates. Leg stiffness was calculated as the ratio of the peak force and the centre of mass displacement for each contact. Using combinations of criteria based on previous literature, 83 data-reduction methods were applied to the raw data. Data reduction suitability was assessed based on intra-trial reliability, the number of participants excluded and the average contacts excluded. Four data-reduction methods were deemed suitable for use with adolescent female populations, with three consecutive contacts within 1 SD of the average jump frequency considered optimal. The average individual stiffness values were not greatly influenced by the data-reduction method; however, for a single participant, a stiffness change of up to 6 kN · m(-1) (30%) was observed. The role and potential impact of data-reduction methods used to evaluate measures of lower limb stiffness during repeated jumping tasks warrants consideration.

Mechanical loading with or without weight-bearing activity: influence on bone strength index in elite female adolescent athletes engaged in water polo, gymnastics, and track-and-field.

Bone health is considered not to benefit from water-based sports because of their weight-supported nature, but available evidence primarily relies on DXA technology. Our purpose was to investigate musculoskeletal health in the upper and lower body in well-trained adolescent female athletes using pQCT and compare these athletes with less-active, age- and sex-matched peers. Bone mineral content, volumetric cortical and trabecular BMD, total and cortical area, and bone strength index were assessed at the distal and proximal tibia and radius in four groups of adolescent females (mean age, 14.9 years) including water polo players (n = 30), gymnasts (n = 25), track-and-field athletes (n = 34), and nonactive controls (n = 28). Water polo players did not show any benefit in bone strength index or muscle size in the lower leg when compared with controls. In contrast, gymnasts showed 60.1 % and 53.4 % greater bone strength index at the distal and proximal tibia, respectively, than nonactive females (p < 0.05). Similarly, track-and-field athletes displayed 33.9 % and 14.7 % greater bone strength index at the distal and proximal tibia, respectively, compared with controls (p < 0.05). In the upper body, water polo players had 31.9 % greater bone strength index at the distal radius, but not the radial shaft, and 15.2 % larger forearm muscle cross-sectional area than controls (p < 0.05). The greatest musculoskeletal benefits in the upper body were found in gymnasts. In conclusion, despite training at an elite level, female water polo players did not show any benefits in musculoskeletal health in the lower leg and only limited benefits in the upper body when compared with nonactive girls.

The assessment of adolescent female athletes using standing and reactive long jumps.

The aim of this study was to evaluate the reliability of two long jump tasks and their ability to predict 10 m sprint performance in elite adolescent female athletes. Eight junior national-level female track and field athletes completed three standing (SLJ) and reactive long jumps (RLJ) on portable force plates, followed by three 10 m sprints. Intra-class correlation coefficients (ICC) and coefficients of variation (CV) were calculated to examine reliability. Linear regression results identified the best predictor of average and best 10 m sprint time from the jump kinematic and kinetic measures. The ICCs and CVs indicated good reliability for the majority of kinetic measures however, better reliability was reported for the SLJ. The SLJ was a good predictor of best and average 10 m sprint time, with average horizontal power the best predictor of performance (best; R2 = 0.751, p = 0.003, Standard Error of Estimate (SEE)% = 2.2 average; R2 = 0.708, p = 0.005, SEE% = 2.5).

Custom formed orthoses in cycling.

To assess the effects of currently used prescribed in-shoe custom foot orthoses (CFOs) on a number of biomechanical variables during the power phase of cycling, including: hip adduction, knee abduction and tibial internal rotation. Before and after cross-over study recording subjects' biomechanical variables with and without their CFOs. Twelve competitive cyclists, currently using prescribed in-shoe CFOs, performed two exercise bouts on a stationary trainer, with 3-dimensional data recorded on an 8 camera Vicon Mx system. 2-way ANOVA statistical analysis of Null vs Orthotic condition, and left leg vs right leg. No systematic effects from the CFOs were seen. A trend towards reduced tibial internal rotation range of movement was found (P<0.072). Significant subject-specific effects from the CFOs were seen (P<0.05). Three distinct patterns of knee movement were observed. All subjects had significant left to right leg differences. CFOs do not produce systematic effects on cycling biomechanics. Significant subject-specific biomechanical effects can be produced by CFOs utilizing rearfoot and/or forefoot wedges. An individualised approach to orthotic prescription, and attention to the forefoot-rearfoot relationship, is recommended.