Exercise Improves Physical Capacity, Cognition, Quality of Life and Promotes Neurotrophic Factors in Patients with Multiple Sclerosis.

Introduction: We aimed to determine the effect of regular exercise on aerobic capacity, strength values, and plasma levels of Nerve Growth Factor (NGF) and Neurotrophin-3 (NT-3) in patients with multiple sclerosis (MS) and investigate its effects on MS symptoms including cognitive impairment, fatigue, balance disorders, and quality of life (QOL). Methods: Forty-three relapsing-remitting MS patients with an Expanded Disability Status Scale (EDSS) score of 4 or less participated in the study. Participants were divided into three groups: aerobic group, strength group, and control group. The patients in the exercise groups had exercise programs three days a week for three months. Aerobic capacity (maximum VO2 value), strength measurements, and balance tests were done, and NGF and NT-3 plasma levels were analyzed in all participants at the beginning and end of the study. Multiple Sclerosis Quality of Life-54 (MSQoL-54), fatigue impact scale, Pittsburgh Sleep Quality Index (PSQI) and, to evaluate cognitive functions, BICAMS scale were applied. Results: Aerobic exercise and strength exercise groups had significant increases in VO2 max, back and leg strength values, and NGF and NT-3 plasma levels (p<0.01). Cognitive functions, fatigue, sleep quality, and QOL significantly improved in the exercise groups (p<0.01). The balance values were also significantly improved in the aerobic group (p<0.01), and althoughimprovement although improvement was observed in the strength group, it was not statistically significant (p>0.05). Conclusions: Our study provides evidence that regular exercise improves quality of life, cognitive functions, fatigue, and sleep quality in MS patients. The levels of NGF and NT-3, which are important factors in neural regeneration and remyelination, were increased post exercise. It can be suggested that exercise may have a potential effect on MS and slow down the disease process with these results.

Vitamin D levels on sports injuries in outdoor and indoor athletes: a cross-sectional study.

OBJECTIVE: Having vitamin D levels within normal limits is important for bone and muscle health and its deficiency may increase the risk of injury. The aim of this cross-sectional study was to investigate whether vitamin D levels are different in indoor and outdoor athletes and its levels increase the risk of injury. MATERIAL AND METHODS: Serum vitamin D levels were measured in Caucasian adolescent athletes, who admitted to the sports medicine polyclinic due to a routine health check or injury. The study was carried out at 38°26' north latitude in Izmir between June and September 2019. After the physical examination of the injured athletes, the diagnoses were made accompanied by the findings obtained by imaging methods in cases of necessity. RESULTS: A total of 256 athletes, including swimmers (n = 87), basketball players (n = 104), and football (n = 65) players aged 13.2 (± 2.2) years, were investigated. The average serum vitamin D (25(OH)D) level in athletes was 29.2 (±10.0) ng/mL (6.0-66.0 ng/mL). Forty-six of all athletes (18%) had vitamin D deficiency, with a mean value of 15.7 (±4.0) ng/mL, and 93 of them (36.3%) had vitamin D deficiency with a mean value of 25.2 (±2.4) ng/mL. While vitamin D levels were significantly higher in football players (32 ng/mL) than in other athletes (p < 0.05), it was similar in basketball players (27 ng/mL) and swimmers (26 ng/mL) (p > 0.05). Vitamin D levels (26 ng/mL) of the injured athletes were significantly lower than those of the non-injured athletes (30 ng/mL) (p = 0.001). Bone injuries were significantly related to Vitamin D levels (p < 0.001) but not with muscle injuries (p > 0.05). CONCLUSION: Frequency of vitamin D deficiency and insufficiency is higher in indoor athletes andis especially associated with risk of bone injuries . In order to examine the effect of vitamin D level on bone mineral density, comprehensive prospective studies are required.

Effects of Long-Duration Home Isolation Linked to the COVID-19 Pandemic on Mental Health of Adolescent Athletes.

PURPOSE: To assess whether adolescent athletes were affected or not in terms of mental health by the long duration at home linked to isolation enforced during the COVID-19 pandemic. METHOD: The study included 940 team athletes, 274 individual athletes, and 131 nonathlete controls aged 12-17 years. Demographic data were obtained with a form including questions about age, sex, sports type, and physical activity status (type, duration, and frequency) during the isolation period. Participants completed the Children's Revised Impact of Event Scale-13, Center for Epidemiological Studies Depression Scale for Children, and State-Trait Anxiety Inventory for Children. RESULTS: Among participants, 88% did not meet the physical activity recommendations for children and adolescents, while 42.8% felt depressed. Depressive symptoms were present in 38.1% of boys and 59.7% of girls, with girls (6.4%) having higher posttraumatic stress symptoms than boys (3.5%). Among athletes, depressive and anxiety symptoms were lower compared with nonathlete controls (P < .01). Posttraumatic stress symptoms were lower among athletes than nonathlete controls for girls (team vs control, P = .006; individual vs control, P = .002) but similar for boys (P > .05). The depression (P = .518), state (P = .866), and trait anxiety (P = .507) symptoms were similar between team athletes and individual athletes. CONCLUSION: Though adolescent athletes' depression, anxiety, and posttraumatic stress symptoms were significantly lower than nonathlete controls, athletes also had high depression levels. These findings show the need to take precautions to protect the psychological health of not only nonathletes, but also athletes in the pandemic period.

The psychological impact of COVID-19 infection on athletes: example of professional male football players.

Objective: The purpose of this study was to evaluate the psychological state of professional male football players who were infected by COVID-19.Method: The Depression Anxiety Stress Scale 21 and Kessler Psychological Distress Scale were sent to players' smartphones by sharing a link to the questionnaire. A total of 523 professional football players aged between 18-38 years from 93 different sports clubs participated in the study. The players were divided into 2 groups according to Sars-COV-2 PCR test results.Results: Depression, anxiety, stress, and psychological distress scores of football players who were infected by COVID-19 were higher compared to players who were not infected by COVID-19 (all p < 0.001). Depression, stress, and psychological distress scores were higher for football players with higher loss of income than players with lower loss of income (p = 0.017, p = 0.007, p = 0.005, respectively). There were significant differences in anxiety, depression, and psychological distress scores in favor of the 18-22-year age group (p = 0.002, p = 0.009, p = 0.004, respectively).Conclusion: COVID-19 infection negatively affects the psychological states of football players. The psychological states of professional football players who were infected by COVID-19 should be monitored closely and psychological support should be provided.

The effect of isolation on athletes' mental health during the COVID-19 pandemic.

OBJECTIVE: We aimed to explore whether the mental health status of professional athletes was affected by the isolation period in which organized sports were suspended due to the COVID-19 pandemic. METHODS: A total of 612 volunteers between the ages of 18-38 enrolled in the study, 418 of them were athletes engaged in team sports or individual sports and 194 of them were non-athletes. Participants completed the Depression - Anxiety - Stress Scale 21 (DASS-21), the Impact of Events Scale-Revised (IES-R) and International Physical Activity Questionnaires (IPAQ). Non-parametric methods were used for comparisons between groups. The presence of a linear relationship was tested with the Spearman Correlation Test. A value of p < 0.05 was accepted statistically significant. RESULTS: A total of 571 participants, 372 males and 199 females, completed the study. Depression and anxiety symptoms were lower in athletes compared to non-athletes (p < 0.05). Depression, anxiety and stress symptoms were similar in team athletes and individual athletes (p = 0.232, p = 0.444, p = 0.116; respectively). The post-traumatic stress symptoms were lower in male team athletes than female team athletes (p = 0.020) and non-athletes (p < 0.001). Depression, anxiety and stress symptoms were found to be similar in men and women (p > 0.05). There was a negative correlation between physical activity level and mental health symptoms (p < 0.05). CONCLUSION: The mental health status of athletes was better than non-athletes, and the positive effect of sport, which was done until the break due to the isolation period, on mental health continued. These findings show that physical activity may help to protect mental health.

Posterior tibial slope as a risk factor for anterior cruciate ligament rupture in soccer players.

Anterior cruciate ligament (ACL) is the primary stabilizer of the knee. An impairment of any of the dynamic or static stability providing factors can lead to overload on the other factors and ultimately to deterioration of knee stability. This can result in anterior tibial translation and rupture of the ACL. The purpose of this study was to examine the influence of tibial slope on ACL injury risk on soccer players. A total of 64 elite soccer players and 45 sedentary controls were included in this longitudinal and controlled study. The angle between the tibial mid-diaphysis line and the line between the anterior and posterior edges of the medial tibial plateau was measured as the tibial slope via lateral radiographs. Individual player exposure, and injuries sustained by the participants were prospectively recorded. Eleven ACL injuries were documented during the study period. Tibial slope was not different between soccer players and sedentary controls. Tibial slope in the dominant and non-dominant legs was greater for the injured players compared to the uninjured players. The difference reached a significant level only for the dominant legs (p < 0.001). While the tibial slopes of the dominant and non-dominant legs were not different on uninjured players (p > 0.05), a higher tibial slope was observed in dominant legs of injured players (p < 0.05). Higher tibial slope on injured soccer players compared to the uninjured ones supports the idea that the tibial slope degree might be an important risk factor for ACL injury. Key pointsDominant legs' tibial slopes of the injured players were significantly higher compared to the uninjured players (p < 0.001).Higher tibial slope was determined in dominant legs compared to the non-dominant side, for the injured players (p = 0.042). Different tibial slope measures in dominant and non-dominant legs might be the result of different loading and/or adaptation patterns in soccer.

The effects of long-term regular exercise on endothelial functions, inflammatory and thrombotic activity in middle-aged, healthy men.

As studying with population carrying no classical cardiovascular risk factors seems to be an advantage in isolating effects of regular exercise on endothelial functions, inflammatory and thrombotic activity; the present study was designed to evaluate the clear effects of long-term regular exercise in middle-aged, healthy men. A total of 32 regularly exercising (three times per week, 12.8 ± 6.8 years) men (Group I, mean age = 53.2 ± 6. 1 yrs) and 32 sex- and age-matched sedentary subjects (Group II, mean age = 51.0 ± 7.7 yrs) were involved in the study. All participants were non-smokers and with no history of hypertension and diabetes. During one day preceding tests, the subjects refrained from training and maintained their normal diet. In all subjects, body mass index (BMI), percentage of body fat (% BF) and maximal oxygen uptake (VO2max) were calculated. Serum uric acid, glucose, HbA1c, lipids, high-sensitive C-reactive protein (hs-CRP), fibrinogen levels, white blood cell (WBC) and platelet count were measured. Resting heart rates and blood pressures were recorded and standard exercise stress test was applied using the modified Bruce protocol. Flow-mediated and nitrate-induced dilatation (FMD and NID) of the brachial artery and carotid intima-media thickness (cIMT) were evaluated as markers of endothelial functions and early atherosclerosis. Mean BMI, % BF, systolic and diastolic blood pressures, WBC and platelet count, HbA1c, total and LDL cholesterol, hs-CRP and fibrinogen levels were similar between the groups. Group I had significantly lower serum glucose, uric acid and triglyceride (p < 0.05, p < 0.005 and p < 0.05, respectively) and higher HDL cholesterol levels (p < 0.0001) than in Group II. FMD values were significantly higher in Group I than in Group II (p < 0.005) while there were no significant differences in NID and cIMT measures between the groups. VO2max and cIMT showed a negative correlation in Group I (r = -0.463, p < 0.0001). Negative correlations also existed between VO2max and fibrinogen levels in both Group I and II (r = -0.355, p < 0.05 and r = -0.436, p < 0.05, respectively). These results are concordant with the concept of favorable effects of regular physical exercise on cardiovascular health based on enhancement of endothelial functions even in subjects who have low cardiovascular risk profile. Key PointsThe present study results suggest that regular exercise is effective on endothelial functions even in subjects who have low risk for cardiovascular disease.Therefore, regular exercise is feasible in improving endothelial functions independently from cardiovascular risk profile.