Can resistance training improve throwing performance in handball players? A Systematic review and meta-analysis.

BACKGROUND: Throwing is one of the most important movement in handball. Throwing performance is crucial for success in handball. OBJECTIVE: Τo investigate the level of evidence for the effect of resistance training (RT) on throwing performance in handball players. METHODS: Systematic searches of Pubmed, Medline complete, Cinahl, Sport Discus and Scopus were undertaken for peer reviewed articles published between 18 March 1995 to 18 March 2023. Randomized, controlled, clinical studies, written in English, aiming to investigate the effect at least one modality of RT on throwing performance (velocity or/and accuracy) in handball players were considered for inclusion in the study. The eligible studies were assessed for methodological quality using the Physical Therapy Evidence Database (PEDRO) scale. The Best Evidence Synthesis (BES) approach was used for synthesizing and reporting the results. Furthermore, the random-effects model was used for the meta-analysis and the Q-statistic was used to test the null hypothesis that all studies in the analysis share a common effect size. RESULTS: One hundred ninety-eight studies were identified, of which 30 were included. A total of 727 handball players (males = 388, females = 292) were included. 28 of the 30 studies were rated as high methodological quality studies (PEDRO score > 70%) while the rest of the studies were rated as moderate methodological quality studies (PEDRO score ≤ 60%). The mean effect size for the effectiveness of resistance training (RT) in improving jumping throw, running throw, and standing throw velocity were 1.128 (95% CI 0.457 - 1.798), 1.756 (95% CI 1.111 - 2.400), and 1.098 (95% CI 0.689 - 1.507) correspondingly. Traditional weight training using barbells in mostly compound lifts yielded the most significant and robust results. Other RT modalities such as elastic bands, medicine balls, core training and ballistic training showed no significant results or positive effects due to the limited number of the studies. CONCLUSION: Strong evidence exists only for the effectiveness of RT using barbells in increasing throwing velocity. In contrast, the remaining RT modalities, while yielding positive results, have limited support due to limited number of studies and the high heterogeneity between studies. Furthermore, there is insufficient evidence to support various forms of RT in increasing throw distance. Finally, medicine ball training and elastic band training demonstrated no benefits in improving throwing accuracy. TRIAL REGISTRATION: PROSPERO ID: CRD42023393574.

Concentric exercise-induced fatigue of the shoulder impairs proprioception but not motor control or performance in healthy young adults.

OBJECTIVES: To investigate the effect of concentric fatigue on proprioception, motor control and performance of the shoulder in healthy young adults. DESIGN: Test-retest experimental design. SETTING: Human performance laboratory. PARTICIPANTS: 20 healthy adults. MAIN OUTCOME MEAUSURE(S): Proprioception was assessed using the joint repositioning sense (JRS) and the threshold to detection of passive movement (TTDPM). Motor control was assessed using the Y-balance Upper Quarter test (YBT-UQ) and performance using the Athletic Shoulder test (ASH test). All tests were conducted before and immediately after fatigue intervention (CON/CON protocol). RESULTS: Following fatigue, absolute angular error (AAE) was significantly increase by 160.27 %. Moreover, there was a significant increase (48.41 %) in TTDPM after fatigue. Furthermore there was no significant differences in motor control and performance before and after fatigue intervention. CONCLUSIONS: Since muscular fatigue negatively affects shoulder proprioception, it is essential to assess proprioception before and after fatigue to detect any dysfunctions that may arise as a result of fatigue. To address these dysfunctions, it is recommended to engage in proprioceptive exercises under situations of fatigue in order to enhance the sensitivity of the mechanoreceptors.

Muscle performance following an acute bout of plyometric training combined with low or high intensity weight exercise.

To determine the time course of performance responses after an acute bout of plyometric exercise combined with high and low intensity weight training, a 3-group (including a control group), repeated-measures design was employed. Changes in performance were monitored through jumping ability by measuring countermovement and squat jumping, and strength performance assessment through isometric and isokinetic testing of knee extensors (at two different velocities). Participants in both experimental groups performed a plyometric protocol consisting of 50 jumps over 50 cm hurdles and 50 drop jumps from a 50 cm plyometric box. Additionally, each group performed two basic weight exercises consisting of leg presses and leg extensions at 90-95% of maximum muscle strength for the high intensity group and 60% of maximum muscle strength for the low intensity group. The results of the study suggest that an acute bout of intense plyometric exercise combined with weight exercise induces time-dependent changes in performance, which are also dependent on the nature of exercise protocol and testing procedures. In conclusion, acute plyometric exercise with weight exercise may induce a substantial decline in jumping performance for as long as 72 hours but not in other forms of muscle strength.

The effect of periodized flywheel training on power of lower limbs.

BACKGROUND: The aim of this study was to compare the effects of semi-squat exercise with a flywheel device and free weights on parameters of physical performance. METHODS: 48 well-trained male athletes were randomly divided into three subject groups (N.=16 each), two training groups (DT and RT) and one control group (CON). The duration of the intervention program was 8 weeks with frequency 2 times per week. Squat (SJ), countermovement (CMJ) and drop jump (DJ) tests were evaluated pre- and postprogram. Additionally, sprint performance in 10 (T10) and 30 meters (T30) was evaluated. The mechanical parameters of semi-squat exercise were analyzed pre- and postintervention program. Specifically, the optimum power load (OPL) and the average power output during semi-squat were evaluated. RESULTS: Statistically significant differences showed on 1RM between RT and CON group (P<0.05). Statistically significant difference in SJ and CMJ were showed between DT and CON group. Also, DT decrease significant the time of 10m and 30m sprint in compare with CON group (P<0.05). These results demonstrate that flywheel training has similar effects with resistance training on power of lower limbs muscles. CONCLUSIONS: Flywheel training can be used as alternative training in periodized programs that aim to enhance sports performance. Finally, these findings can be useful for strength and conditioning coaches to understand the function of flywheel device and the design of resistance training programs.

Young tennis players and balance performance.

The purpose of the present study was to investigate the effect of a tennis training session on the balance performance of young tennis players. The study was conducted on 36 elite tennis players (age 14 +/- 2 years; body mass 55 +/- 6 kg; body height 165 +/- 6 cm; mean +/- SD) participating in the national young tennis championship. Balance performance was assessed before and immediately after a tennis training session (pre-training and post-training, respectively). The balance assessment was performed with 2 different balance boards and the Biodex Stability System. In addition, dynamometric measurements of peak isokinetic moment in the knee flexors and extensors were performed pre and post tennis training session, to quantify the degree of muscle fatigue induced by the tennis training session. One-way analysis of variance with repeated measures was used to test for differences in balance performance and in isokinetic performance between pre and post tennis training session. The data analysis revealed no significant differences (p > 0.05) in balance performance, whereas there were significant differences in knee joint moment production between pre and post tennis training measures. Although the tennis training session of the present study had no significant effect (p > 0.05) on any of the balance performance indicators examined, there was a decline in balance performance, which suggests that different level of fatigue for an extended period (games) will have greater effect on balance performance. It is suggested that a tennis-specific balance exercise program should be included in the tennis training session.

Time course of changes in performance and inflammatory responses after acute plyometric exercise.

The objectives of the present investigation were to study the inflammatory and performance responses after an acute bout of intense plyometric exercise during a prolonged recovery period. Participants were randomly assigned to either an experimental group (P, n = 12) that performed intense plyometric exercises or a control group (C, n = 12) that rested. The delayed onset of muscle soreness (DOMS), knee range of motion (KROM), creatine kinase (CK) and lactate dehydrogenase (LDH) activities, white blood cell count, C reactive protein (CRP), uric acid (UA), cortisol, testosterone, IL-6, IL-1b strength (isometric and isokinetic), and countermovement (CMJ) and static (SJ) jumping performance were measured at rest, immediately postexercise and at 24, 48, 72, 96, and 120 hours of recovery. Lactate was measured at rest and postexercise. Strength remained unchanged throughout recovery, but CMJ and SJ declined (p < 0.05) by 8-20%. P induced a marked rise in DOMS, CK, and LDH (peaked 24-48 hours postexercise) and a KROM decline. An acute-phase inflammatory response consisting of leukocytosis (postexercise and at 24 hours), an IL-6, IL-1b, CRP, and cortisol elevation (during the first 24 hours of recovery) and a delayed increase of UA (peaked at 48 hours) and testosterone (peaked at 72 hours) was observed in P. The results of this investigation indicate that performing an acute bout of intense plyometric exercise may induce a short-term muscle damage and marked but transient inflammatory responses. Jumping performance seems to deteriorate for as long as 72 hours postexercise, whereas strength appears to remain unchanged. The acute-phase inflammatory response after a plyometric exercise protocol appears to follow the same pattern as in other exercise models. These results clearly indicate the need of sufficient recovery between successive plyometric exercise training sessions.

Reproducibility of gait kinematics and kinetics in chronic stroke patients.

BACKGROUND: The search for reliable techniques to assess gait in stroke patients is crucial for the design and follow-up of rehabilitation programs. OBJECTIVE: To assess the reproducibility of kinematic and kinetic gait parameters in chronic stroke patients using a three-dimensional gait analysis system. METHODS: Ten chronic stroke patients were assessed while walking along a 20 m walkway at their natural speed, using a gait analysis system of six infrared cameras and two force plates. Each patient performed 10 gait trials on 2 separate days. Inter-measurement agreement was assessed with the Coefficient of Multiple Correlation, while Root Mean Square Differences were used to quantify the variability of the trials. RESULTS: The majority of kinetics and kinematics showed excellent reproducibility in all patients. Joints' power seemed to be more reliable compared with joints' angle and moment. Most parameters presented greater variability in non-paretic than the paretic leg, while they were less variable in the sagittal compared with the non-sagittal planes. Less than 10 trials were sufficient to obtain excellent reproducibility for most kinematic and kinetic parameters. CONCLUSIONS: The reproducibility of movement assessment through three-dimensional gait analysis appears excellent in chronic stroke patients.

A pilot study of the effects of high-intensity aerobic exercise versus passive interventions on pain, disability, psychological strain, and serum cortisol concentrations in people with chronic low back pain.

BACKGROUND AND PURPOSE: Given the complex nature of chronic pain, the effects of high-intensity aerobic exercise on pain, disability, psychological strain, and serum cortisol concentrations in people with chronic low back pain were investigated. SUBJECTS: Twenty subjects receiving primary health care were randomly allocated into exercise and control groups. METHODS: Subjects in the exercise group received a 12-week, high-intensity aerobic exercise program. Subjects in the control group received 12 weeks of passive modalities without any form of physical activity. RESULTS: Data analysis identified reductions in pain (41%, t(10)=8.51, P<.001), disability (31%, t(10)=7.32, P<.001), and psychological strain (35%, t(10)=7.09, P<.001) in subjects in the exercise group and no changes in subjects in the control group. High-intensity exercise failed to influence serum cortisol concentrations. DISCUSSION AND CONCLUSION: Regular high-intensity aerobic exercise alleviated pain, disability, and psychological strain in subjects with chronic low back pain but did not improve serum cortisol concentrations.

Risk factors for fear of falling in elderly patients with severe knee osteoarthritis before and one year after total knee arthroplasty.

PURPOSE: To evaluate the regression of fear of falling (FOF) and identify its risk factors in patients with severe knee osteoarthritis before and one year after total knee arthroplasty (TKA). METHODS: 11 men and 57 women with a mean age of 73 years and a mean body mass index of 30.36 kg/m2 who had severe (grade 3 or 4) knee osteoarthritis and knee pain of ≥1 year were included. Two weeks before and one year after TKA, patients were asked about their FOF status and falls history. Patients were asked to complete the Physical Activity Scale for the Elderly, Short Form 36 (SF-36), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaires. Clinical performance was assessed using the Berg Balance Scale and Timed Up and Go (TUG) test. RESULTS: Of the 68 patients, 56 (82.4%) had FOF preoperatively and 30 (44.1%) had FOF one year after TKA (p<0.001). The strongest predictors for FOF preoperatively were fallers (odds ratio [OR]=9.83, p=0.028), mental component summary (MCS) score of SF-36 (OR=0.88, p=0.024), and TUG (OR=3.4, p=0.013). The strongest predictors for FOF one year postoperatively were fallers (OR=16.51, p=0.041), patients with ≥2 chronic diseases (OR=17.33, p=0.011), physical function score of WOMAC (OR=1.015, p=0.005), and MCS score of SF-36 (OR=0.86, p=0.015). CONCLUSION: TKA positively affected FOF and gradually reduced the FOF rate over a year period after TKA in an elderly population.

Analyzing the History of Falls in Patients with Severe Knee Osteoarthritis.

BACKGROUND: One out of three adults over the age of 65 years and one out of two over the age of 80 falls annually. Fall risk increases for older adults with severe knee osteoarthritis, a matter that should be further researched. The main purpose of this study was to investigate the history of falls including frequency, mechanism and location of falls, activity during falling and injuries sustained from falls examining at the same time their physical status. The secondary purpose was to determine the effect of age, gender, chronic diseases, social environment, pain elsewhere in the body and components of health related quality of life such as pain, stiffness, physical function, and dynamic stability on falls frequency in older adults aged 65 years and older with severe knee osteoarthritis. METHODS: An observational longitudinal study was conducted on 68 patients (11 males and 57 females) scheduled for total knee replacement due to severe knee osteoarthritis (grade 3 or 4) and knee pain lasting at least one year or more. Patients were personally interviewed for fall history and asked to complete self-administered questionnaires, such as the 36-item Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and physical performance test was performed. RESULTS: The frequency of falls was 63.2% for the past year. The majority of falls took place during walking (89.23%). The main cause of falling was stumbling (41.54%). There was a high rate of injurious falling (29.3%). The time patients needed to complete the physical performance test implied the presence of disability and frailty. The high rates of fall risk, the high disability levels, and the low quality of life were confirmed by questionnaires and the mobility test. CONCLUSIONS: Patients with severe knee osteoarthritis were at greater risk of falling, as compared to healthy older adults. Pain, stiffness, limited physical ability, reduced muscle strength, all consequences of severe knee osteoarthritis, restricted patient's quality of life and increased the fall risk. Therefore, patients with severe knee osteoarthritis should not postpone having total knee replacement, since it was clear that they would face more complicated matters when combining with fractures other serious injuries and disability.

Recovery kinetics of knee flexor and extensor strength after a football match.

We examined the temporal changes of isokinetic strength performance of knee flexor (KF) and extensor (KE) strength after a football match. Players were randomly assigned to a control (N = 14, participated only in measurements and practices) or an experimental group (N = 20, participated also in a football match). Participants trained daily during the two days after the match. Match and training overload was monitored with GPS devices. Venous blood was sampled and muscle damage was assessed pre-match, post-match and at 12 h, 36 h and 60 h post-match. Isometric strength as well as eccentric and concentric peak torque of knee flexors and extensors in both limbs (dominant and non-dominant) were measured on an isokinetic dynamometer at baseline and at 12 h, 36 h and 60 h after the match. Functional (KFecc/KEcon) and conventional (KFcon/KEcon) ratios were then calculated. Only eccentric peak torque of knee flexors declined at 60 h after the match in the control group. In the experimental group: a) isometric strength of knee extensors and knee flexors declined (P<0.05) at 12 h (both limbs) and 36 h (dominant limb only), b) eccentric and concentric peak torque of knee extensors and flexors declined (P<0.05) in both limbs for 36 h at 60°/s and for 60 h at 180°/s with eccentric peak torque of knee flexors demonstrating a greater (P<0.05) reduction than concentric peak torque, c) strength deterioration was greater (P<0.05) at 180°/s and in dominant limb, d) the functional ratio was more sensitive to match-induced fatigue demonstrating a more prolonged decline. Discriminant and regression analysis revealed that strength deterioration and recovery may be related to the amount of eccentric actions performed during the match and athletes' football-specific conditioning. Our data suggest that recovery kinetics of knee flexor and extensor strength after a football match demonstrate strength, limb and velocity specificity and may depend on match physical overload and players' physical conditioning level.

Effects of stabilization exercises on health-related quality of life in women with chronic low back pain.

BACKGROUND: The study examined the effects of a 4-week intensive isometric and isotonic stabilization exercise program on dimensions of health-related quality of life (HRQL) in women with chronic low back pain (CLBP). METHODS: A total of 39 women (27-72 years old) provided data in an experimental study with a 9-month follow-up. Random allocation was undertaken for the two treatment groups out of the 3 groups: isometric stabilization (n = 13), isotonic stabilization (n = 13), and a control group (n = 13) that did not participate in any form of exercise. Health-related quality of life measures using the Short-Form 36 Health Survey were assessed before program initiation, immediately after program termination, and 4 times postintervention for a period of 9 months. RESULTS: The isometric stabilization group displayed large improvements in bodily pain and vitality for women with CLBP attending a 4-week intensive isometric stabilization exercise program. The effects were retained for a period of 9 months after program termination. CONCLUSIONS: Isometric stabilization exercises reduce pain and enhance vitality as dimensions of HRQL among women with chronic low back pain with such effects lasting for at least 9 months.

Typical balance exercises or exergames for balance improvement?

BACKGROUND AND OBJECTIVES: Balance training is an effective intervention to improve static postural sway and balance. The purpose of the present study was to investigate the effectiveness of the Nintendo Wii Fit Plus exercises for improving balance ability in healthy collegiate students in comparison with a typical balance training program. METHODS: Forty students were randomly divided into two groups, a traditional (T group) and a Nintendo Wii group (W group) performed an 8 week balance program. The "W group" used the interactive games as a training method, while the "T group" used an exercise program with mini trampoline and inflatable discs (BOSU). Pre and Post-training participants completed balance assessments. RESULTS: Two-way repeated measures analyses of variance (ANOVAs) were conducted to determine the effect of training program. Analysis of the data illustrated that both training program groups demonstrated an improvement in Total, Anterior-posterior and Medial Lateral Stability Index scores for both limbs. Only at the test performed in the balance board with anterior-posterior motion, the improvement in balance ability was greater in the "T group" than the "W group", when the assessment was performed post-training (p=0.023). CONCLUSIONS: Findings support the effectiveness of using the Nintendo Wii gaming console as a balance training intervention tool.

Oxidative stress and inflammatory responses following an acute bout of isokinetic exercise in obese women with knee osteoarthritis.

BACKGROUND: Obesity is associated with osteoarthritis and it is accompanied by chronic inflammation and elevated oxidative stress. Strengthening-type exercise is used in knee osteoarthritis (KOA) rehabilitation. This study determined how acute isokinetic exercise influences inflammatory responses of obese middle-aged women with KOA. METHODS: Ten obese women with KOA and 10 age/weight-matched controls performed an isokinetic exercise protocol. Assessment of performance (knee extensor/flexor torque), muscle soreness (DOMS), knee flexibility (KJRM), and pain, and blood collection were performed pre-exercise, post-exercise, and at 24h post-exercise. Blood was analyzed for creatine kinase activity (CK), lactate dehydrogenase activity (LDH), CRP, leukocytes, uric acid, IL-6, TBARS, lipid hydroperoxides (LPX), protein carbonyls (PC), oxidized (GSH) and reduced glutathione (GSSG), total antioxidant capacity (TAC), catalase activity, and glutathione peroxidase activity (GPX). RESULTS: Physical function remained unaltered by exercise (only torque at 90°/s decreased at 24h). Exercise increased DOMS throughout recovery but KJRM and pain remained unchanged. CK, LDH, and uric acid increased similarly in both groups. CRP remained unaffected by exercise while IL-6 increased only post-exercise. TBARS, PC, LPH, GSSG, and TAC increased only post-exercise in both groups. GSH and GSH/GSSG declined post-exercise and normalized thereafter. Catalase and GPX increased only in patients post-exercise. CONCLUSION: Isokinetic exercise induces only a mild inflammatory response of very short duration (<24h) without affecting physical function and pain in KOA patients suggesting that moderate strengthening-type exercise may be safe for this patient cohort. These results indicate that KOA patients may be able to receive another exercise stimulus after only 48h. CLINICAL RELEVANCE: Isokinetic exercise produces minimal inflammation and pain in knee osteoarthritis patients, could be performed every 48h during rehabilitation, and up-regulates patients' antioxidant system.

Assessment of patients with neck pain: a review of definitions, selection criteria, and measurement tools.

OBJECTIVE: The purpose of this literature review was to synthesize the existing literature on various definitions, classifications, selection criteria, and outcome measures used in different studies in patients with neck pain. METHODS: A literature search of MEDLINE and CINAHL through September 2008 was performed to gather articles on the reliability, validity, and utility of a wide variety of outcome measurements for neck pain. RESULTS: Different types of definitions appear in the literature based on anatomical location, etiology, severity, and duration of symptoms. Classifications according to severity and duration of pain and the establishment of selection criteria seem to play a crucial role in study designs and in clinical settings to ensure homogeneous groups and effective interventions. A series of objective tests and subjective self-report measures are useful in assessing physical abilities, pain, functional ability, psychosocial well-being, general health status, and quality of life in patients with neck pain. Self-administered questionnaires are commonly used in clinical practice and research projects. CONCLUSIONS: Because of multidimensionality of chronic neck pain, more than just one index may be needed to gain a complete health profile of the patient with neck pain. The instruments chosen should be reliable, valid, and able to evaluate the effects of treatment.

Isolated vs. complex exercise in strengthening the rotator cuff muscle group.

The purpose of this study was to compare 2 different training modes in improving shoulder cuff muscular performance. Thirty-nine participants were randomly assigned into 3 groups: the isolated group exercised using 2-kg dumbbells; the complex group used a protocol with complex exercises; and the control group had no training. All participants trained for 6 weeks (3 times per week) and were evaluated isokinetically before (pretest) and after the training period (posttest). Results showed that the complex group significantly improved their muscular performance, but the isolated group did not, indicating that isolated exercises are only effective when the training goal is to strengthen the weaker muscle group, but they must be replaced by more complex and closed-kinetic exercises in order to obtain considerable improvement of the rotator cuff strength. The authors propose that a strengthening program should start with isolated movements for better stimulation of the weaker muscles and continue with complex exercise for more impressive strengthening.

The effects of high- and moderate-resistance training on muscle function in the elderly.

The purpose of this study was to investigate the effects of a 12-week resistance-training program on muscle strength and mass in older adults. Thirty-three inactive participants (60-74 years old) were assigned to 1 of 3 groups: high-resistance training (HT), moderate-resistance training (MT), and control. After the training period, both HT and MT significantly increased 1-RM body strength, the peak torque of knee extensors and flexors, and the midthigh cross-sectional area of the total muscle. In addition, both HT and MT significantly decreased the abdominal circumference. HT was more effective in increasing 1-RM strength, muscle mass, and peak knee-flexor torque than was MT. These data suggest that muscle strength and mass can be improved in the elderly with both high- and moderate-intensity resistance training, but high-resistance training can lead to greater strength gains and hypertrophy than can moderate-resistance training.