"Who's Got Talent?" Change of Direction, Anthropometric Characteristics and Maturity Offset Differences Between Elite and Sub-Elite Young Soccer Player.

Agility, anthropometrics and maturity-offset have been considered fundamental for talent identification in soccer. The aim of this study is to compare 83 young soccer players (U12) from elite (28) and sub-elite (55) teams, to investigate the influences of anthropometric characteristics and maturation on Change-of-Direction (CoD) with the ball (dribbling) and without the ball. ANCOVA was run to investigate potential differences in Agility T-Test and Shuttle Dribble Test between categories while simultaneously controlling for the effects of anthropometric variables such as Peak Height Velocity (PHV), Weight, and Height. Agility T-Test performance does not significantly differ between the two categories (F-value = 0.537, p > .05). However, the Weight significantly influences the results (F-value = 18.425, p < .001, Eta-Squared = 0.172) and also PHV has a significant impact on them (F-value = 10.099, p < .01, Eta-Squared = 0.094). The Shuttle Dribble Test performance significantly varies between two groups (F-value = 5.207, p < .05, Eta-Squared = 0.057). Only Weight significantly influences this test (F-value = 4.324, p < .05, Eta-Squared = 0.048). Our findings indicate that during the U-12 age period, technical skills emerge as a crucial discriminant factor between elite and sub-elite young soccer players, contrarily to the athletic performance without the ball. In addition, the maturity stage specifically influences the Agility T-Test and Weight is significantly related to lower time to complete both in Agility T-Test and SDT.

How Can Promoting Skeletal Muscle Health and Exercise in Children and Adolescents Prevent Insulin Resistance and Type 2 Diabetes?

Skeletal muscle secretome, through its paracrine and endocrine functions, contributes to the maintenance and regulation of overall physiological health. We conducted a narrative review on the role of skeletal muscle and exercise in maintaining glucose homeostasis, driving insulin resistance (IR), and preventing type 2 diabetes in pediatric populations, especially in the context of overweight and obesity. Myokines such as interleukin (IL)-6, IL-8, and IL-15, as well as irisin, myonectin, and myostatin, appear to play a crucial role in IR. Skeletal muscle can also become a target of obesity-induced and IR-induced inflammation. In the correlation between muscle, IR, and inflammation, the role of infiltration of the immune cells and the microvasculature may also be considered. It remains unclear which exercise approach is the best; however, combining aerobic exercise with resistance training seems to be the most effective strategy for managing IR, with high-intensity activities offering superior metabolic benefits and long-term adherence. Encouraging daily participation in enjoyable and engaging exercise is key for long-term commitment and effective glucose metabolism management. Promoting physical activity in children and adolescents must be a top priority for public health, not only in terms of individual quality of life and well-being but also for community health.

Guidelines How to Integrate Surgery and Targeted Therapy with Biologics for the Treatment of Hidradenitis Suppurativa: Delphi Consensus Statements from an Italian Expert Panel.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent and painful nodules and abscesses in intertriginous skin areas, which can progress to sinus tract formation, tissue destruction, and scarring. HS is highly debilitating and severely impairs the psychological well-being and quality of life of patients. The therapeutic approach to HS is based on medical therapy and surgery. First-line medical therapy includes topical antibiotics, systemic antibiotics, and biologics. Main surgical procedures include deroofing, local excision, and wide local excision. Despite the availability of multiple therapeutic options, the rates of disease recurrence and progression continue to be high. In recent years, the possibility of combining biologic therapy and surgery has raised considerable interest. In a clinical trial, the perioperative use of adalimumab has been associated with greater response rates and improved inflammatory load and pain, with no increased risk of postoperative infectious complications. However, several practical aspects of combined biologic therapy and surgery are poorly defined. In June 2022, nine Italian HS experts convened to address issues related to the integration of biologic therapy and surgery in clinical practice. To this purpose, the experts identified 10 areas of interest based on published evidence and personal experience: (1) patient profiling (diagnostic criteria, disease severity classification, assessment of response to treatment, patient-reported outcomes, comorbidities); (2) tailoring surgery to HS characteristics; (3) wide local excision; (4) presurgery biologic treatment; (5) concomitant biologic and surgical treatments; (6) pre- and postsurgery management; (7) antibiotic systemic therapy; (8) biologic therapy after radical surgery; (9) management of adverse events to biologics; and (10) management of postoperative infectious complications. Consensus between experts was reached using the Estimate-Talk-Estimate method (Delphi Method). The statements were subsequently presented to a panel of 27 HS experts from across Italy, and their agreement was assessed using the UCLA Appropriateness Method. This article presents and discusses the consensus statements.

Is change of direction influenced by motor competencies? A possible response from a MOBAK-based study in Italian schoolchildren.

BACKGROUND: Change of direction (COD) ability requires higher motor control capacity and helps children improve individual motor skills. Likewise, basic motor competencies (BMC) are relevant during child maturation and may interleave with COD ability. This study aimed to investigate the possible individual determinants between the COD ability and the BMC, cognitive skills, and anthropometrics characteristics in Italian primary school children aged 6 to 11. METHODS: Children of both sexes (N.=221) were recruited from primary schools (grade 1 to 5) of Northwestern Italy. COD was assessed by 10×5 m Shuttle Run Test; motor coordination by the Motor Coordination (Motorische Basiskompetenzen, MOBAK) 1-6 test battery, whereas Trail Making Test was used to assess cognitive performance. RESULTS: A stepwise linear regression indicated that motor competencies level - assessed by the MOBAK Test - is the most fitting dimension describing COD performance for girls, with the highest R2 in Grade 5 (SEE=0.56); and the lowest SEE in Grade 5 (SEE=1.44); moreover, for boys the highest in Grade 3 (SEE=0.52) and the lowest SEE in Grade 4 (SEE=1.30). CONCLUSIONS: This study confirms the biunivocal relationship between COD and BMC, and the need for physical education teachers and trainers to stimulate both, during growth.

Poor Motor Competence Affects Functional Capacities and Healthcare in Children and Adolescents with Obesity.

BACKGROUND: From a young age, children learn different motor skills known as fundamental motor skills. The acquisition of these skills is crucial for the future development of context-tailored actions that could improve adherence to physical activity (PA) practice. Motor competence and function deficits have been associated with pediatric obesity. We reviewed the literature data regarding motor competence in pediatrics and impaired motor performance in children and adolescents with obesity. METHODS: We assessed the abstracts of the available literature (n = 110) and reviewed the full texts of potentially relevant articles (n = 65) that were analyzed to provide a critical discussion. RESULTS: Children and adolescents with obesity show impaired motor performance, executive functions, postural control, and motor coordination. Children's age represents a crucial point in the development of motor skills. Early interventions are crucial to preventing declines in motor proficiency and impacting children's PA and overall fitness levels. CONCLUSIONS: To involve children, the PA protocol must be fun and tailored in consideration of several aspects, such as clinical picture, level of physical fitness, and motor skills. A supervised adapted exercise program is useful to personalized PA programs from an early pediatric age.

Unraveling Barriers to a Healthy Lifestyle: Understanding Barriers to Diet and Physical Activity in Patients with Chronic Non-Communicable Diseases.

Although the important contribution of nutrition and physical activity to people's health is known, it is equally well known that there are many barriers to adherence to healthy habits (i.e., of an organizational, economic, and/or psychological nature) experienced by the general population, as well as by people with non-communicable diseases. Knowledge of these barriers seems essential to the implementation of the activities and strategies needed to overcome them. Here, we aim to highlight the most frequent barriers to nutrition and exercise improvement that patients with chronic-degenerative diseases experience. Drawing from the Pubmed database, our analysis includes quantitative or mixed descriptive studies published within the last 10 years, involving adult participants with non-communicable diseases. Barriers of an organizational nature, as well as those of an environmental, economic, or psychological nature, are reported. The study of patients' barriers enables healthcare and non-health professionals, stakeholders, and policymakers to propose truly effective solutions that can help both the general population and those with chronic pathologies to adhere to a healthy lifestyle.

International fitness scale (IFIS): association with motor performance in children with obesity.

Background: Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health; and compared with their normal-weight peers, these individuals tend to have a lower level of self-confidence, and consequently lower physical activity adherence. Due to these self-perceived barriers, the aim of our study was to evaluate the efficacy of an online training program on self-reported physical fitness (SRPF) in children with obesity (OB). Methods: A total of 32 children with OB carried out physical fitness (PF) tests and were asked to complete the International Fitness Enjoyment Scale (IFIS) questionnaire. The physical fitness tests were the Standing Broad Jump (SBJ), the 6-Min Walking Test (6MWT) and the 4 × 10 m sprint test. Children participated in a 3-weekly 60-min training session through Zoom platform. Before the beginning of the training protocol, OB children were compared with normal weight (NW) ones for PF batteries and the IFIS questionnaire. Changes in performances after the training were assessed by paired Student t and Wilcoxon tests. Results: After the online training program children increased their performance in 6MWT (mean difference (MD) = 54.93; p < 0.0001) in SBJ (MD = 10.00; p = 0.0001) and in 4 × 10 m sprint test (MD = -0.78; p < 0.0001). No differences were found in children's physical fitness perception. Discussion: Our study highlighted how a structured online training program can lead to improvements in PF of children with OB. Instead, the lack of differences in SRPF after the training suggests interesting questions to be explored on the aspects linked to self-perception. Therefore, even if our training protocol could not directly improve SRPF in children with obesity, the enhancement of their PF could be a starting point for achieving this result with a longer training period and consequently improve PA participation for children with OB.

Pneumatic Compression Combined with Standard Treatment after Total Hip Arthroplasty and Its Effects on Edema of the Operated Limb and on Physical Outcomes: A Pilot Clinical Randomized Controlled Study.

Total hip arthroplasty (THA) is one of the most successful orthopedic procedures and is highly effective at improving function and quality of life. However, patients commonly experience edema immediately after hospitalization and also after discharge, which can lead to health consequences and a lower quality of life. For these reasons, the aim of this study (NCT05312060) was to evaluate the effectiveness of a specific intermittent leg pneumatic compression on lower limb edema and physical outcomes in patients after total hip arthroplasty, compared to standard conservative treatment. A total of 47 patients were enrolled and randomly allocated into two groups: the pneumatic compression group (PG = 24) and the control group (CG = 23). The CG performed the standard venous thromboembolism therapy, which included pharmacological prophylaxis, compressive stockings, and electrostimulation, while the PG combined pneumatic compression with standard VTE therapy. We evaluated thigh and calf circumferences, knee and ankle ranges of motion, pain, and walking autonomy. Our results showed a greater reduction in thigh and calf circumferences for PG (p < 0.001), while other outcomes were similar for the two groups (p > 0.05). The combination of standard therapy with pneumatic leg compression was more effective at reducing lower limb edema and thigh and calf circumferences than standard treatment. Our results suggest that pressotherapy treatment is a valuable and efficient option for managing lower limb edema after THA.

Exergames to Limit Weight Gain and to Fight Sedentarism in Children and Adolescents with Obesity.

Exergames are defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). The players interact with the game through whole-body movements improving energy expenditure. Exergames may be effective in improving physical and psychological aspects of children and adolescents with obesity. In this narrative review, we synthesized the current evidence regarding the role of exergames in modifying body composition and weight and in promoting changes in sedentary behavior to define the benefits of active video games as useful tools for fighting sedentarism and to outline the future directions of exergaming as a supplementation exercise rather than a replacement in educational programs for pediatric obesity. Data from the literature indicate that exergames may offer an interesting impact on childhood obesity and may be considered a potential strategy for controlling weight gain and body composition, promote PA, and decrease time spent on sedentary behavior in children and adolescents with obesity. However, exergame use also has some limits, such as children's poor self-regulation and poor structuring of exergame use. Therefore, a prudent approach should be maintained, and additional high-quality research is needed to determine if exergames can be effectively used in the treatment of childhood obesity and if new digital media, as a supplementation of exercise rather than a replacement, could be considered to combat sedentary behavior in educational programs for pediatric obesity prevention.

Physical fitness trend after COVID-19 restrictions in Italian school-aged children: a cross-sectional study.

BACKGROUND: Physical fitness (PF) is a marker of health in children. Muscular strength and speed-agility PF components play a crucial role in musculoskeletal development and bone health. The outbreaks of COVID-19 pandemic changed the daily and sports activities in younger increasing sedentary habits with a detrimental effect on PF. We aimed to investigate the impact of COVID-19 restrictions on PF in Italian school-aged children. METHODS: We recruited 286 elementary school children, and they were tested through an internationally validated battery test, which evaluate muscular strength and speed-agility (as a multifactorial performance) prior (2018) and after the outbreak of COVID-19 pandemic (2021). RESULTS: Our results showed a reduction in the lower limb strength (SBJ in boys mean difference (MD) -0.42 m; SBJ in girls MD=-0.20 m; P<0.05) and in the speed-agility ability (10x5 m in boys MD=14.1 s; 10x5 m in girls MD=11.2 s; P<0.05), while the upper limb strength remained steady before and after the restrictions. Specifically, for boys of all ages there was a reduction in lower limb strength and in speed-agility but not in upper limb strength. For girls of all ages there was not a recurrent trend, while for 6-8 girls there was a reduction only speed-agility, for 9-11 girls there was a reduction in lower limb and speed-agility. CONCLUSIONS: Our results could be useful to help teachers and sport specialists to evaluate and improve strength and speed-agility in children. We encourage trainers and sport specialists to implement programs to help children to become more active and healthier during their lifespan.

Piezoelectric ultrasonic debridement as new tool for biofilm removal from orthopedic implants: A study in vitro.

Pulse lavage (PL) debridement is the standard treatment used in Debridement, Antibiotics and Implant Retention (DAIR) for bacterial biofilm removal during acute and early postoperative cases of periprosthetic joint infection (PJI). The failure rate of DAIR is still high due to the inadequacy of PL in removing the biofilm. Ultrasound-based techniques are a well-established tool for PJI diagnosis due to their ability to completely eradicate the biofilm from implant surfaces. Hence, this study investigates the efficiency of a piezoelectric ultrasonic scalpel (PUS) in removing bacterial biofilm from different orthopedic implant materials in vitro and compares the results with PL. Biofilms of methicillin-resistant Staphylococcus aureus strains were grown on titanium alloy (Ti6Al4V ELI), stainless steel (AISI 316L), and ultrahigh molecular weight polyethylene (UHMWPE) disks for 24 h. The disks of each material were divided into three groups: (i) a control group (no lavage/debridement), (ii) a group treated with PL, (iii) a group treated with PUS. The disks were then sonicated for viable cell count to measure the residual biofilm content. Compared to the initial cell count (105 CFU/mL for each material), PL showed a two-log reduction of CFU/mL (p < 0.001 for each material), while for PUS a four-log reduction was found (p < 0.001 for each material). The comparison between the two lavage/debridement displayed a two-log reduction of CFU/mL (p < 0.001 for each material) of PUS compared with PL. Its increased efficiency compared with PL promotes the use of PUS in removing bacterial biofilm from orthopedic implants, suggesting its implementation to improve the success rate of DAIR.

Benefits in Cardiac Function from a Remote Exercise Program in Children with Obesity.

Physical activity (PA) is a crucial factor in preventing and treating obesity and related complications. In this one-arm pre−post longitudinal prospective study, we evaluated the effects of a 12-week online supervised training program on cardiac morphology, function and blood pressure (BP) in children with obesity. The training program consisted of three sessions per week, each lasting 60 min. Advanced echocardiographic imaging (tissue Doppler and longitudinal strain analysis) was used to detect subclinical changes in heart function. Categorical variables were described as counts and percentages; quantitative variables as the mean and standard deviation (SD) as they were normally distributed (Shapiro−Wilks test). Pre−post comparisons were made with a paired t-test. A total of 27/38 (71%) enrolled patients (18M/9F, 11 ± 2 years) completed the training protocol and were considered in the analysis. At baseline, no hypertensive patient was noted; all echocardiographic variables were within the normal range. After training, we observed a significant reduction in BP parameters, including systolic BP values and Z-score, diastolic BP values, centiles and Z-score, and mean arterial pressure (all p < 0.05). Significant variations in echocardiographic interventricular septum (IVSd) thickness (p = 0.011), IVSd Z-score (p = 0.001), left ventricular (LV) end-diastolic diameter (p = 0.045), LV posterior wall thickness Z-score (p = 0.017), and LV global longitudinal strain (p = 0.016) were detected. No differences in LV diastolic function and right ventricular strain were noted. PA plays a decisive role in improving BP control and has benefits on left ventricle systolic function, representing a strategic approach to limit CV risk. Online exercise could be an excellent method of training in children with obesity.

Bone Regeneration Guided by a Magnetized Scaffold in an Ovine Defect Model.

The reconstruction of large segmental defects still represents a critical issue in the orthopedic field. The use of functionalized scaffolds able to create a magnetic environment is a fascinating option to guide the onset of regenerative processes. In the present study, a porous hydroxyapatite scaffold, incorporating superparamagnetic Fe3O4 nanoparticles (MNPs), was implanted in a critical bone defect realized in sheep metatarsus. Superparamagnetic nanoparticles functionalized with hyperbranched poly(epsilon-Lysine) peptides and physically complexed with vascular endothelial growth factor (VEGF) where injected in situ to penetrate the magnetic scaffold. The scaffold was fixed with cylindrical permanent NdFeB magnets implanted proximally, and the magnetic forces generated by the magnets enabled the capture of the injected nanoparticles forming a VEGF gradient in its porosity. After 16 weeks, histomorphometric measurements were performed to quantify bone growth and bone-to-implant contact, while the mechanical properties of regenerated bone via an atomic force microscopy (AFM) analysis were investigated. The results showed increased bone regeneration at the magnetized interface; this regeneration was higher in the VEGF-MNP-treated group, while the nanomechanical behavior of the tissue was similar to the pattern of the magnetic field distribution. This new approach provides insights into the ability of magnetic technologies to stimulate bone formation, improving bone/scaffold interaction.

The Effect of Healthy Lifestyle Strategies on the Management of Insulin Resistance in Children and Adolescents with Obesity: A Narrative Review.

Childhood obesity is characterized by an increased risk of several metabolic derangements including insulin resistance (IR). The strongest recommendations to prevent obesity and related complications are a balanced and adequate diet and practicing physical activity from early childhood. In this review, we propose to present the effects of healthy lifestyle strategies, including physical exercise and dietary approaches, on the management of IR and related metabolic derangements. All types of exercise (aerobic, resistance and combined training) effectively reduce IR in pediatric patients with obesity; it seems that aerobic and combined training stimulate greater improvements in IR compared to resistance training. Balanced normocaloric or hypocaloric dietary approaches are also valid strategies to address IR; it is not possible to assess the long-term impact of varying macronutrients on cardiometabolic risk. The glycemic index/load evaluation is a useful dietary approach to glucose metabolism control. Similarly, they should adopt the principle of the Mediterranean diet. Randomized studies with longer monitoring are needed to define the benefits of nutritional supplementation on IR. Considering that healthy style acquisition could track to later ages, programs of healthy lifestyle starting with children offer a better preventive strategy to preserve metabolic control and children's health.

Self-Perceived Physical Level and Fitness Performance in Children and Adolescents with Inflammatory Bowel Disease.

Background: Inflammatory bowel disease (IBD) patients show a higher risk of developing metabolic and cardiovascular diseases due to the presence of systemic low-grade chronic inflammation. Exercise can improve cardiovascular fitness and modulate the inflammatory processes. We evaluated the physical activity (PA) level and the fitness performance of children and adolescents with IBD. Patients and methods: We considered 54 pediatric patients with IBD (14.6 ± 2.2; 22 M), including CD (n = 27) UC (n = 24) and IBD unclassified (n = 3), and 70 healthy children. In all children, the Physical Activity Questionnaire (PAQ-C) and the International Fitness Enjoyment Scale were self-reported and recorded. Results: PAQ-C showed significant difference in PA levels in patients with IBD compared to controls (p < 0.001). A decrease in general fitness (p = 0.003), cardiorespiratory fitness (p = 0.002), strength (p = 0.01), speed agility (p = 0.003), and flexibility (p = 0.01) were also detected between patients and controls. Speed agility was related to age (p = 0.02) and BMI z-score (p = 0.01), and flexibility to BMI z-score (p = 0.05). We noted a correlation between PA levels and physician global assessment (p = 0.021) and activity disease severity (p = 0.025). Conclusions: A poorer PA level and poor physical competence were found in patients with IBD compared to healthy children and adolescents. Monitored exercise could provide multiple benefits at both physical and psychological levels.

Effects of an Online Supervised Exercise Training in Children with Obesity during the COVID-19 Pandemic.

COVID-19 restrictions have dramatically reduced the active lifestyle and physical activity (PA) levels in the whole population, a situation that can contribute to weight gain and to develop obesity. To improve physical fitness (PF) in children with obesity during COVID-19 restrictions, sport specialists started to deliver physical training through tele-exercise. For these reasons, the aim of this study was to evaluate the effects of a 12-week online supervised training program in children with obesity on different PF components and PA levels. We enrolled a total of 40 Caucasian children (9 F/31 M; aged 11 ± 1.9 years) with obesity. The data collection consisted of a series of anthropometric measures, the PAQ-C questionnaire, and PF tests, valid and reliable tools to assess PF in children. We used a Wilcoxon's t-test and a Student's t-test, as appropriate, to assess the differences before and after the training protocol. A total of 37 patients completed the training protocol and were considered in the analysis. Our results show an improvement in all the PF tests, a reduction in the BMI z-score, the waist circumference, and in the waist-to-height ratio, and an increased PA level. In conclusion, the results of our study show that an online supervised training program is effective to promote PA, improving PF and reducing the BMI z-score in children with obesity.

Self-Declared Physical Activity Levels and Self-Reported Physical Fitness in a Sample of Italian Adolescents during the COVID-19 Pandemic.

Only 20% of children worldwide reach the suggested physical activity (PA) levels, and the COVID-19 restrictions seemed to have worsened this situation. In addition, physical fitness (PF) is a crucial marker of health and combined with PA could predict future health status. The aim of this study was to compare reported PA and PF levels in a sample of Italian adolescents. We administered the International PA Questionnaire and International Fitness Enjoyment Scale to 208 adolescents aged 16.0 ± 1.5 (N = 166 females, 16 ± 2.0 years) recruited from a high school in the province of Milan (Italy). The majority of the subjects were "Minimally active" but reported adequate PF levels. In particular, subjects who reported a "Very good" PF perception, had a lower PA level. The misperception of reported PA and PF from our sample could reduce the future PA level in adolescents and lead to a negative spiral of disengagement in PA. These findings should lead to more attention on and improvements to PA promotion in the adolescent population after the restrictions caused by the COVID-19 pandemic.

Effects of the lockdown period on the mental health of elite athletes during the COVID-19 pandemic: a narrative review.

Purpose: This review aimed to assess the effects of COVID-19 pandemic lockdown on mental health to elite athletes. The emotional background influenced their sport career and was examined by questionnaires. Methods: We included original studies that investigated psychological outcomes in elite athletes during COVID-19 lockdown. Sixteen original studies (n = 4475 participants) were analyzed. Results: The findings showed that COVID-19 has an impact on elite athletes' mental health and was linked with stress, anxiety and psychological distress. The magnitude of the impact was associated with athletes' mood state profile, personality and resilience capacity. Conclusion: The lockdown period impacted also elite athletes' mental health and training routines with augmented anxiety but with fewer consequences than the general population thanks to adequate emotion regulation and coping strategies.

The Temporal Association between Body Characteristics and Speed Performance over Twenty-Five Years in Italian Adolescents.

BACKGROUND: Physical fitness (PF) is positively related to skeletal and metabolic health, and it had an inverse relation with obesity. Adolescents with obesity have the worst performance in PF and speed-agility (SA) that contributes to an augmented risk to develop pathologies. To the best of our knowledge, many studies analyzed the trends of obesity and SA separately, but there is a lack of data about SA ability trends in adolescents with obesity. We aimed to investigate SA trends in children with obesity in the last few decades to define the association between body weight and physical performance. METHODS: We recruited 3.923 Caucasian children across the period 1985-2010 in the same school in Northern Italy, near Milan. Once a year, at the ages of 11-12- and 13-years-old, we collected anthropometric measures and SA performance. We pooled the data into 5-year-period study waves and then stratified our analysis into test-sex-age BMI-z-score specific groups. RESULTS: We reported an undetermined trend across years. The 4×5 m run test significantly decreased in adolescents with overweight/obesity, while we did not report a decline in 30 m and 60 m run tests. CONCLUSIONS: Fitness tests highlighted differences in normal weight compared to overweight/obese children, suggesting that it is crucial to carefully monitor PF capacities through the years.