Do all matches require the same effort? Influence of contextual factors on physical demands during official female handball competitions.

Understanding the influence of contextual factors on physical demands is essential to maximize performance in handball. The purpose of this study was to explore and compare the influence of contextual factors (halves of the match, level of the opponent, match outcome and player role) on external load during official matches in women's handball. Twenty-two semi-professional female players from the Spanish 2nd Division were monitored across 13 official home matches. Total distance covered (TDC), high-speed running distance (HSR), high-intensity breaking distance (HIBD), accelerations (ACC), decelerations (DEC) and PlayerLoad (PL) were collected in absolute and relative values (normalized by playing time) using a local positioning system (WIMU PRO, Realtrack Systems S.L., Almería, Spain). HSR, HSR/min and HIBD/min decreased during the second half (p < 0.05; small effects). Regarding the level of the opponent, high-level and middle-level teams elicited higher TDC/min, HIBD/min and PL/min than low-level teams (p < 0.05; small-moderate effects). Additionally, starter players exhibited higher absolute values of external load (TDC, HSR, HIBD, ACC, DEC and PL) compared to non-starters (p < 0.05; moderate-large effects). Match outcome did not affect the physical demands (p > 0.05). The study indicated that halves of the match, level of the opponent, and player role influenced external load experienced by players during official matches; specifically, starter players showed higher absolute values of external load compared to non-starters. This information should be considered in managing load and developing strategies to minimize fatigue and enhance performance during matches.

Biological maturity vs. relative age: Independent impact on physical performance in male and female youth handball players.

Maturity status and relative age are two of the determining factors in talent development. The aim of the study was to analyze the influence of biological maturity status and relative age on physical performance in young male and female handball players. The sample included 48 males (14.11 ± 1.17 years) and 41 females (14.25 ± 1.64 years) players from one Spanish professional handball academy. Anthropometric data (height, sitting height, body mass and self-reported biological parent heights) and physical performance data (CMJ, DJ, 20 m speed, T-test and throwing velocity) were collected. Biological maturity status was determined as the percentage of predicted adult height, while relative age was estimated in birth quartiles based on biennial age grouping (Q1-Q8). The results showed a positive correlation between maturity status and CMJ in male players (p < 0.01). Differences in CMJ performance according to maturity status were identified (p < 0.05), with higher jump heights being recorded especially in early maturing boys (p < 0.01) and first lines and wings (p < 0.05). The variance in CMJ test scores could be explained by the maturity status by 42.90% in U-15 (p < 0.05) and 72.60% in U-16 male players (p < 0.001). By contrast, no differences were found in girls (p > 0.05). Moreover, no relationships were found between relative age and indices of physical performance (p > 0.05). Overall, maturity status had greater impacts on the tests of physical performance than relative age. Stakeholders should monitor the maturity status of young handball players to avoid physical performance biases that do not allow them to develop their sporting potential.

Eating Behavior Disorders and Disordered Eating Habits in Spanish High-Performance Women's Olympic Wrestling Athletes.

Eating disorders (EDs) are a significant health issue in combat sports. This study investigated the differences between the different types of female wrestlers and the frequency at which EDs occur in the elite population, and it also sought to establish which factors are predictors of EDs. This study was comprised of 22 elite, female wrestlers who were selected based on the following inclusion criteria: having previously been the Spanish champion, being part of the Spanish national team, participating in at least one international championship, and having a history of ED. Data collection involved five questionnaires: demographic data, the Eating Attitudes Test-26 (EAT-26), the Bulimic Investigatory Test, the Edinburgh (BITE), the Eating Disorders Inventory (EDI-3), and the Depression, Anxiety, and Stress Scale (DASS-21). The results revealed diverse levels of depression, anxiety, and stress, with BITE scores indicating abnormal eating patterns. Group comparisons exposed significant distinctions in eating behaviors based on competition and training experience. Regression analyses showed competition and training experience as predictors of bulimia severity and symptoms. The study revealed prevalent extreme weight-control practices, including fasting, diuretic and laxative use, and binge eating. This research emphasizes the importance of EDs in Olympic wrestling, urging a comprehensive approach involving education, support, and policy implementation by coaches, health professionals, and sports organizations to prioritize athletes' well-being and discourage unhealthy weight-control practices.

Sex Differences in the Load-Velocity Profiles of Three Different Row Exercises.

This study examined the force-velocity profile differences between men and women in three variations of row exercises. Twenty-eight participants (14 men and 14 women) underwent maximum dynamic strength assessments in the free prone bench row (PBR), bent-over barbell row (BBOR), and Smith machine bent-over row (SMBOR) in a randomized order. Subjects performed a progressive loading test from 30 to 100% of 1-RM (repetition maximum), and the mean propulsive velocity was measured in all attempts. Linear regression analyses were conducted to establish the relationships between the different measures of bar velocity and % 1-RM. The ANOVAs applied to the mean velocity achieved in each % 1-RM tested revealed significantly higher velocity values for loads < 65% 1-RM in SMBOR compared to BBOR (p < 0.05) and higher velocities for loads < 90% 1-RM in SMBOR compared to PBR (p < 0.05) for both sexes. Furthermore, men provided significantly higher velocity values than women (PBR 55-100% 1-RM; BBOR and SMBOR < 85% 1-RM; p < 0.05) and significant differences were found between exercises and sex for 30-40% 1-RM. These results confirm that men have higher velocities at different relative loads (i.e., % 1-RM) compared to women during upper-body rowing exercises.

Contextualizing Evaluation of Performance in Volleyball: Introducing Contextual Individual Contribution Coefficients to Assess Technical Actions.

In this study, we proposed novel metrics for evaluating volleyball technical performance in relation to the action context. To assess each player's relative participation, we also introduced relative contextual coefficients. We analyzed 20 games played by the world's top eight teams during the 2019 FIVB Women's Club World Championship, using Data Volley software and Python programming. We evaluated inter- and intra-observer reliability and used binomial logistic regression models to estimate each variable's probability of having contributed to the team's set win. We calculated estimated confidence intervals, standard errors, and Wald values; and we employed Akaike's and Bayesian criteria to evaluate the model's goodness of fit. We identified optimal cut-off points using receiver operating characteristic curves, and we found that the proposed contextual evaluation coefficients prevented overestimation of a player's technical performance in uneven situations. We addressed the issue in which the winning team may be the one that scored the fewest points, and we were able to predict a team's victory with confidence. The proposed coefficients made multiple technical and contextual aspects of the game easily accessible and comprehensible, offering significant beneficial implications for coaches and players.

Do women and men compete equally on a level playing field? An empirical investigation into the 2021 Olympic shooting competitions.

Due to physical differences between the genders, it is hard to study whether women also vary from men in their competitive drive in sports. The Olympic committee instituted major rule changes in the sport of shooting in the Tokyo Olympic Games (2021), leveling the playing field. We explored performance in a myriad of competitions including newly established mixed-gender doubles events in this unique sport of very limited physical input. Men performed better than women in events which required "dynamic" qualities (following moving targets) but when the competitions were held most constant (rifle shooting with stationary targets indoors) and regardless of distance or posture, women performed equally to men exhibiting seemingly similar competitive drive. The last finding should propel the Olympic committee to fully integrate rifle events. In the broader sense, we find that when the playing field is even, the genders, at least among highly trained selective competitors compete equally.

Emotional Intelligence in Spanish Elite Athletes: Is There a Differential Factor between Sports?

Emotional intelligence is a determinant factor in sports performance. The present study analysed differences in total emotional intelligence and its four dimensions in 2166 Spanish athletes (25.20 ± 10.17 years) from eight sports (volleyball, track and field, shooting, football, basketball, handball, gymnastics, and judo). A total of 1200 men and 966 women answered anonymously using a Google Forms questionnaire sent via WhatsApp about demographics and psychological variables. A Pearson correlation was conducted to assess the age-emotional intelligence relationship. An independent T-test and One-Way ANOVA were carried out to check for age differences between biological sex and sport and a One-Way ANCOVA to determine differences between sports controlled by age. Age differences were observed by sex and sport (p < 0.001). An association was found between age and emotional intelligence dimensions (p < 0.001), except for other's emotional appraisal (p > 0.05). Judo was the sport with the highest levels of regulation of emotions, other's emotional appraisal, use of emotion, and total emotional intelligence (p < 0.05). Generally, emotional intelligence was found to be more developed in individual sports than in team sports, except football. Consequently, psychological skills like emotional intelligence could be critical to achieving high performance, depending on the sport.

Bio-Banding in Handball: Academy Players' Perceptions Based on Maturity Status and Gender.

The purpose of this study was to evaluate young male and female handball players' perceptions of the bio-banding concept. The estimated biological maturity status was assessed in a sample of 46 male and 40 female handball players (aged 14.06±1.40 years), who competed in both an annual age-group and bio-banded tournament. To test the players' perception of bio-banding, a post-competition questionnaire was conducted. A series of ANOVA and one-sample t-tests were used in order to examine the differences in perception between the different maturity groups. An inductive thematic analysis of the qualitative data recorded in the open-ended questions was also carried out. The results showed that early-maturing boys enjoyed the bio-banding tournament more than late-maturing boys (p<0.05). Conversely, no differences were found in girls (p>0.05). Furthermore, discussions were conducted based on the qualitative analysis of the players' written comments regarding their overall experience, finding individual variance in biological maturity may be less relevant in female sports contexts due to gender-related differences. Thus, a greater influence on play and leadership in late maturing boys and early maturing girls, a greater physical challenge in early maturing boys and an opportunity to express themselves technically and tactically in late maturing boys and on-time maturing girls were observed. Therefore, stakeholders must consider the different consequences of bio-banding in order to maximize the athlete's sport development process.

A Systematic Review and Meta-Analysis of the Differences in Mean Propulsive Velocity between Men and Women in Different Exercises.

The purpose of this paper was to conduct a systematic review and meta-analysis of studies examining the differences in the mean propulsive velocities between men and women in the different exercises studied (squat, bench press, inclined bench press and military press). Quality Assessment and Validity Tool for Correlational Studies was used to assess the methodological quality of the included studies. Six studies of good and excellent methodological quality were included. Our meta-analysis compared men and women at the three most significant loads of the force-velocity profile (30, 70 and 90% of 1RM). A total of six studies were included in the systematic review, with a total sample of 249 participants (136 men and 113 women). The results of the main meta-analysis indicated that the mean propulsive velocity is lower in women than men in 30% of 1RM (ES = 1.30 ± 0.30; CI: 0.99-1.60; p < 0.001) and 70% of 1RM (ES = 0.92 ± 0.29; CI: 0.63, 1.21; p < 0.001). In contrast, for the 90% of the 1RM (ES = 0.27 ± 0.27; CI: 0.00, 0.55), we did not find significant differences (p = 0.05). Our results support the notion that prescription of the training load through the same velocity could cause women to receive different stimuli than men.

Should We Use the Men Load-Velocity Profile for Women in Deadlift and Hip Thrust?

Injuries are common in team sports and can impact both team and individual performance. In particular, hamstring strain injuries are some of the most common injuries. Furthermore, hamstring injury ratios, in number of injuries and total absence days, have doubled in the last 21 seasons in professional soccer. Weakness in hip extensor strength has been identified as a risk factor in elite-level sprinters. In addition, strength imbalances of the hamstring muscle group seem to be a common cause of hamstring strain injuries. In this regard, velocity-based training has been proposed to analyze deficits in the force-velocity profile. Previous studies have shown differences between men and women, since there are biomechanical and neuromuscular differences in the lower limbs between sexes. Therefore, the aim of this study was to compare the load-velocity profile between males and females during two of the most important hip extension exercises: the hip thrust and the deadlift. Sixteen men and sixteen women were measured in an incremental loading test following standard procedures for the hip thrust and deadlift exercises. Pearson's correlation (r) was used to measure the strength of the correlation between movement velocity and load (%1RM). The differences in the load-velocity relationship between the men and the women were assessed using a 2 (sex) × 15 (load) repeated-measures ANOVA. The main findings revealed that: (I) the load-velocity relationship was always strong and linear in both exercises (R2 range: 0.88-0.94), (II) men showed higher velocities for light loads (30-50%1RM; effect size: 0.9-0.96) than women for the deadlift, but no significant differences were found for the hip thrust. Based on the results of this study, the load-velocity equations seem to be sex-specific. Therefore, we suggest that using sex-specific equations to analyze deficits in the force-velocity profile would be more effective to control intensity in the deadlift exercise.

Effect of Increasing the Number of Substitutions on Physical Performance during Periods of Congested Fixtures in Football.

(I) This study aimed to evaluate the impact on physical demands induced by FIFA's new rule implemented based on the number of substitutions caused by COVID-19. (II) Sixty-six matches were analysed in peak periods (microcycles of three matches in a week) in the competition period before and after the pandemic. The variables collected were organised by team (22 from LaLigaTM SmartBank 2019-2020) for a total of 132 team records and 1077 player performance reports using a multi-camera tracking system and Mediacoach® software. Physical performance variables were analysed in the first half, second half and whole match, thus determining the individual and collective performances of the team. (III) This study shows how, despite the increase in substitutions allowed with the new rule, physical performance increased in some variables in the congested periods (e.g., total distance run and distance run in the first and second halves). Additionally, the players' physical performance involved in a substitution was greater than it was for players who completed the game. (IV) The new substitution rule helps to maintain and even improve physical performance. This measure could improve intensity levels in both individual and team performance. It could even safeguard the physical integrity of the players by reducing the risk of injury, as fewer players have to play the full match.

Training Conditions and Psychological Health: Eating Behavior Disorders in Spanish High-Performance Women's Olympic Wrestling Athletes-A Qualitative Study.

(1) Background: the aim of this study was to determine the factors that affect the occurrence of behaviors related to possible eating disorders in Spanish high-performance Olympic wrestling athletes. (2) Methods: The sample consisted of 22 elite female wrestlers selected through purposive sampling with inclusion criteria of (i) having been a national champion, (ii) having been part of the Spanish team, and (iii) suffering or having suffered from an eating disorder. The semistructured interviews were conducted online and lasted between 20 and 40 min. A statistical analysis was performed with NVivo10 software. (3) Results: the athletes showed a series of issues grouped into three main themes, which were divided into the following categories-firstly, the reasons why wrestlers lose weight; secondly, the inadequate procedures they use; and, finally, the reference persons involved in the process. (4) Conclusions: The training conditions in high-performance sports have psychological and behavioral effects on wrestlers. Wrestlers have to move down to lower categories; however, they do not take into account how this practice influences their health when using inadequate procedures. Rapid and significant weight loss produces negative effects, especially in the female population, generating an incidence of eating disorders. The information obtained provided elements of interest for reflection on possible solutions to prevent existing eating disorders.

In the Opinion of Elite Volleyball Coaches, How Do Contextual Variables Influence Individual Volleyball Performance in Competitions?

The main objective was to know the elite coaches' opinions regarding the relevance, definition, and importance of volleyball contextual variables to measure individual performance in competition. After performing a literature review, an instrument to gather the opinion of the world's elite volleyball coaches was elaborated by four volleyball specialists. The sample of experts consisted in 20 world's elite volleyball coaches who met at least three experience years in first division or national teams. The instrument collected experts' information on the contextual variables in relation to relevance, definition, and importance. Cronbach's α and Aiken's V coefficient were used to test the reliability and content validity of the contextual variables, respectively. To compare the importance of the contextual variables U de Mann-Whitney and Kruskal-Wallis tests were used. Results showed that opposition level, set period, score difference, results of the previous set, competitive load variables, high level, final periods ≥20, and high load categories were relevant (Aikens V > 0.70). In addition, high level, final period ≥20 and ≥+10, and high load categories were significantly more important (p < 0.05). We conclude that, according to the elite coaches, the contextual variables should not be analyzed separately. Future studies should consider contextual variables dynamically.

COVID-19 Confinement Effects on Game Actions during Competition Restart in Professional Soccer Players.

The main objective of the present study was to compare high-intensity actions in a week of three matches before and after the COVID-19 lockdown. The observational methodology was used. This study analysed 551 professional soccer players from 22 different Spanish teams (LaLiga Smartbank 2019−2020) by a multi-camera tracking system and associated software (Mediacoach®, Spain). Variables of distances per minute and totals, travelled at High Intensity (HIR), Very High Intensity (VHIR), Sprint (HSR), player's maximum speed, average speed, and the number of efforts in VHIR and HSR were analysed in the first and second half of the games, the full match, as well as in relation to the playing position. Players who participated in the same number of matches pre- and post-COVID-19 showed an increase in the total minutes played, p < 0.05, and small decreases in game actions, p < 0.05, with an effect size between 0.21 and 0.45, while players who participated in different number of matches pre- and post-COVID-19 showed a performance decrease, p < 0.05, with a size effect between 0.13 and 0.51; this was evident, particularly, for midfielders, p < 0.05, with a size effect between 0.39 and 0.75. The results seem to show that the playing intensity after COVID-19 confinement did not lead to large performance losses, except for midfielders who were the most involved players and showed a higher decrease in performance. The main findings of this study could provide insight to football coaches for rotations in starting line-ups and game substitutions, so as not to affect the intensity levels of the competitions.

Anthropometric, Physiological, and Psychological Variables That Determine the Elite Pistol Performance of Women.

Shooting is a high-precision sport that depends on many factors to achieve high performance levels. The main objective of this study was to analyze the differences in anthropometric, physiological, and psychological variables by sport level in women air-pistol shooters. Fifteen female pistol shooters, including seven elite national shooters of Iran and eight non-elite shooters, participated in this study. Analyzed variables were grouped into three sections: anthropometric, physiological, and psychological. Anthropometric variables included: height, weight, body mass index, length of leg, arm span, and proportions between variables. Physiological tests include resting heart rate, static and dynamic balance, flexibility, and upper body strength. Additionally, psychological questionnaires of SMS-6 sport motivation, TSCI trait sport-confidence and SSCI state sport-confidence, ACSI-28 athletic coping skills, and SAS sport anxiety scale were used. The Shapiro-Wilks test and independent t-test were used to analyze the data. Effect size and test reliability were calculated using Cohen's d and Cronbach's alpha, respectively. Our results showed that elite shooters have higher values of dynamic balance (Y-test), upper body strength (sit-ups), and intrinsic motivation, and lower resting heart rate than non-elite. However, no differences were found in the anthropometric variables, nor in anxiety or coping skills. We conclude that physiological and psychological workouts should be included in the shooters' training programs to improve their performance.

Optoelectronic analysis of technical factors and performance of elite-level air pistol shooting.

Technical elements are related to shooting performance; however, the importance of each factor regarding performance, especially in elite-level pistol shooters, remains controversial. The objective of this study was to determine the technical factors that influence pistol performance. One elite-level shooter was analysed during the season before the Olympic classification European championship through a total of six competitions (n = 360 shots). Aiming point trajectories were measured with the SCATT optoelectronic system. Variables were classified into six categories: performance; aiming time; stability of hold; aiming accuracy; cleanness of triggering and shooting delta. Principal component analysis, multiple regressions, Pearson correlations and ANOVAs were used to analyse the data. The results showed that five components (aiming time, stability of hold, aiming accuracy, cleanness of triggering and shooting delta) determined a total of 79.68% of the shooting variance. Specifically, aiming accuracy and cleanness of triggering explained up to 25% of the shooting score, with cleanness of triggering serving as the determining factor. Correlations were found among the performance and stability of hold, aiming accuracy, cleanness of triggering and shooting delta. Last, significant differences were found among 8-score, 9-score and 10-score shots. We conclude that while aiming accuracy seems to be related to the performance, cleanness of triggering could be the most critical technical element; furthermore, while stability of hold does not seem to be a determining factor of the score, it could be a general prerequisite to achieve high levels of performance in elite-level air pistol shooters.

Air shooting competition effects on visual skills depending on the sport level.

Olympic shooting is a sport with high demands of accuracy. Minimal visual errors could be related to performance losses. However, not all visual skills have been studied in depth in this sport. The main objectives of this study were to compare differences in shooters' visual skills by level and to analyze the competition effect on them. Sixty-six participants were distributed in three groups (non-athletes, elite and non-elite). Eleven visual variables were tested in four skills groups (visual acuity, heterophoria, accommodation functions and other visual skills). The data were collected through a pre- and post-competition simulation test. The results of the study showed differences between groups by shooting sport level. In general, shooters had higher visual acuity values than non-athletes p < .001 with large size effects (d between 1.01 and 2.35), and elite shooters presented higher values of accommodation than non-elite shooters p < .05 with large size effects (d between 0.88 and 0.97). Furthermore, different visual skills were modified after competition depending on the shooting level. Specifically, visual accommodation skills were only improved in elite shooters. Finally, our study suggests that elite shooters employ different visual strategies or skills to non-elite shooters and that shooting activity is closely related to some specific visual skills. This aspect should be considered by coaches in the design of optimal visual trainings and improve the shooters' performance.Highlights Shooters showed better acuity skills than non-athletes.Shooting activity seems to improve visual acuity skills, binocular visual time and eye-hand coordination in non-elite shooters, and accommodation and eye-hand coordination in elite shooters immediately after the competition simulation.Elite shooters employ different visual strategies or skills to non-elite shooters.Non-dominant eye occlusion may benefit binocular vision recovery by inhibiting aiming action and the use of accommodative flexibility could be related to the QE during the shot.

Prevalence and Impact of the Relative Age Effect on Competition Performance in Swimming: A Systematic Review.

This systematic review aimed to examine the prevalence of the relative age effect (RAE) in swimming and its impact on competition performance according to different types of interacting constraints. A systematic literature search, following the PRISMA guidelines for preparing systematic reviews, was performed through four electronic databases, and nine studies met the inclusion criteria. The quality of the selected studies was evaluated using STROBE, and an average score of 16.2 points was obtained. In these studies, the prevalence of the RAE in swimming was observed in more than half (58.65%) of the participants analysed, and the effect of the RAE was more accentuated in young categories (decreased as age increased and was inverted in older ones) and in male swimmers (double that in female swimmers).The impact of the RAE on competitive performance appeared to be related to the strength demands of the event, as the performance in simultaneous strokes, in shorter events, and of swimmers in the postadolescence period seems to be more affected by the RAE. These results indicate that the RAE in competitive swimming relies on individual and environmental (the swimmer's age group and gender) but also task (the competitive events) determinants or limitations. This should serve as a guide for a more effective design of selection and development procedures for young athletes.

Psychological States and Training Habits during the COVID-19 Pandemic Lockdown in Spanish Basketball Athletes.

The outbreak of the COVID-19 pandemic and the resulting restrictions designed to slow the spread of infection greatly disrupted people's lives. The present study aimed to investigate the impact of lockdown on the psychology, training, and sleep habits of a cohort of basketball players. An online survey involving 169 professional and amateur athletes was conducted using four validated psychological questionnaires (WLEIS-S, POMS, BRS, SMS-II) and a Likert scale to measure the rating of perceived exertion (RPE) and training variables. Gender differences in fatigue (p = 0.022); friendships (p = 0.017); others' emotional appraisal (p < 0.001); and resilience (p = 0.031) were apparent, with higher values for women in all categories bar resilience. Comparisons before and during the lockdown revealed that all participants reduced their RPE (p < 0.001); training days (p = 0.004); and training hours (p < 0.001), and experienced a decline in the quality of sleep (p < 0.001). Sleep hours (p < 0.001) increased during lockdown. The professionals and females maintained their training days (p > 0.05), while the non-professionals and males did not. Psychological states during lockdown were a predictor of the differences in training and recovery variables. In situations where training and competition are limited, it is important to develop plans to maintain physical activity, good quality sleep, and promote greater emotional management and understanding to control negative moods.

Effects of myofascial release or self-myofascial release and control position exercises on lower back pain in idiopathic scoliosis: A systematic review.

BACKGROUND: Idiopathic scoliosis is associated, among others, to muscular imbalance, functional limitations, and the most prevalent, back pain. The treatments usually applied are exercise, bracing or surgery. The objective of corrective exercise is to reduce symptoms and improve functional capacity and quality of life. Myofascial release (MFR) or Self-Myofascial release (SMFR) are manual techniques, intended to restore optimal muscle and fascia length, decrease pain, and improve function. PURPOSE: to analyze the effects of MFR and postural control programs in lower back pain and scoliosis curves. METHODS: A systematic literature review was conducted in high quality databases to identify the existing evidence of the effects of MFR and postural control on reducing back pain and scoliosis curves. RESULTS: Seventeen studies met inclusion criteria. 533 subjects and 94 MFR/SMFR applied interventions lasting one to 24 weeks/sessions were identified. Ten studies used MFR, six SMFR and one mixes techniques. Seven MFR and five SMFR studies shown positive result. One study using MFR and one using SMFR applied also postural control exercises. MFR was useful to reduce back pain in all studies included that aimed in that matter. In addition, 12 studies reported improvements in flexibility and/or stiffness reduction, and two studies observed improvements in postural control and balance. CONCLUSIONS: The combination of MFR and postural control programs might be suitable for reducing scoliosis and back pain. However, due to the reduced number of studies and the relatively small sample sizes used, results may be carefully interpreted, and more studies are needed.