Breaking boundaries: the transformative role of exercise in managing multiple sclerosis.

Multiple sclerosis (MS) is a prevalent cause of physical disability in adults, with inflammation-induced demyelination and neurodegeneration contributing to its etiology. This comprehensive review explores the multifaceted benefits of exercise in managing MS, including improvements in aerobic capacity, balance, muscle strength, immune and hormonal functions and mood. Various exercise modalities, such as aerobic, resistance, flexibility, and balance training, are discussed, along with tailored protocols for MS patients. Recommended exercise strategies are: aerobic exercise: 2-3x/week; 10-30 minutes (40 %-60 % of maximum heart rate (HRmax), HIIT: 1x/week, five 30-90-second intervals at 90 %-100 % HRmax, Resistance training: 2-3x/week, 5-10 exercises; 1-3 sets for each exercise, 8-15 repetitions/set. The review also examines the impact of exercise on neuroplasticity, cardiovascular responses, cytokine modulation, stress hormone regulation, brain structure, and function and fatigue perception. Emphasizing the importance of exercise in enhancing the quality of life for individuals with MS, the review proposes exercise prescriptions and highlights the promising link between physical activity, brain health, and improved hormonal and immune status in MS patients. This review aims to inform future research and guide clinical practices for effective MS management.

Training strategies of 10,074 athletes from 121 countries based on human development index in early COVID-19 lockdown.

The aim of this study was to investigate relationships between changes in training practices and human development index (HDI) levels, and identify strategies employed by athletes who consistently maintained their training quantity during the first 100 days of the COVID-19 pandemic. A total of 10,074 athletes (5290 amateur and 4787 professional athletes from 121 countries) completed an online survey between 17 May to 5 July 2020. We explored their training practices, including specific questions on training frequency, duration and quantity before and during lockdown (March-June 2020), stratified according to the human development index (HDI): low-medium, high, or very high HDI. During the COVID-19 lockdown, athletes in low-medium HDI countries focused on innovative training. Nevertheless, women and amateur athletes experienced a substantial reduction in training activity. Performance-driven athletes and athletes from higher HDI indexed countries, were likely to have more opportunities to diversify training activities during lockdowns, facilitated by the flexibility to perform training away from home. Factors such as lockdown rules, socioeconomic environment, and training education limited training diversification and approaches, particularly in low-medium and high HDI countries. Athletes (amateurs and professionals) who maintained the quantity of training during lockdown appeared to prioritize basic cardiovascular and strength training, irrespective of HDI level. Modifying training and fitness programs may help mitigate the decrease in training activities during lockdowns. Customized training prescriptions based on gender, performance, and HDI level will assist individuals to effectively perform and maintain training activities during lockdowns, or other challenging (lockdown-like) situations.

Supporting athletes during a challenging situation: recommendations from a global insight of COVID-19 home-based training experience.

BACKGROUND: For athletes, overcoming obstacles in challenging situations like pandemic home training is crucial. Strategies and approaches in this context are not well-documented. Our study aims to investigate such a scenario from a performance standpoint, based on a major global crisis: the COVID-19 pandemic and lockdown. METHODS: This cross-sectional study surveyed athletes without disabilities using online questionnaires (35 languages) from May to July 2020. Questions included aspects of alternative routines, training monitoring, recovery, sleep patterns, injury occurrence/prevention based on structured answers, and an open-ended question on lockdown training experiences. RESULTS: Of the 11,762 athletes from 142 countries, 63% were male, including at World-Class, International, National, State and Recreational levels. During lockdown, 25% athletes used innovative or modern ways to maintain or improve fitness e.g., virtual reality and tracking devices (favoring World-Class level, 30%). Many athletes, regardless of gender (43%) watched video competitions to improve/maintain their mental skills and performance [World-Class (47%) and International (51%)]. Contact frequency between athletes and their coaches was mainly at least once a week (36%), more among higher-level (World-Class/International) than lower-level athletes (27 vs. 16%). Higher-level athletes (≥ 54%) monitored training load and were assisted by their coaches (21%). During lockdown, stretching (67%) was considered one of the primary means of recovery, especially for higher-level athletes (> 70%). Compared to pre-lockdown, about two-thirds of athletes reported "normal" or "improved" sleep quality and quantity, suggesting a low sleep quality pre-lockdown. On average, 40% utilized injury prevention exercises (at least) once a week [World-Class (51%) and International (39%)]. Most injury occurrences during lockdown involved the knee (18%), ankle (16%), and back (9%). Four key themes emerged regarding lockdown experiences: remote training adaptation (e.g., shifting training focus), training creativity (e.g., using household items), performance enhancement opportunities (e.g., refocusing neglected aspects), and mental and motivation challenges. CONCLUSIONS: Both male and female athletes, particularly those of higher levels, displayed some adaptalibity during the COVID-19 lockdown, employing innovative approaches and technology for training. Many athletes implemented load monitoring, recovery, and attentive of injury prevention, while optimizing their sleep quality and quantity. Athletes demonstrated their abilities to navigate challenges, and utilized different coping strategies in response to the lockdown's constraints.

Using artificial intelligence for exercise prescription in personalised health promotion: A critical evaluation of OpenAI's GPT-4 model.

The rise of artificial intelligence (AI) applications in healthcare provides new possibilities for personalized health management. AI-based fitness applications are becoming more common, facilitating the opportunity for individualised exercise prescription. However, the use of AI carries the risk of inadequate expert supervision, and the efficacy and validity of such applications have not been thoroughly investigated, particularly in the context of diverse health conditions. The aim of the study was to critically assess the efficacy of exercise prescriptions generated by OpenAI's Generative Pre-Trained Transformer 4 (GPT-4) model for five example patient profiles with diverse health conditions and fitness goals. Our focus was to assess the model's ability to generate exercise prescriptions based on a singular, initial interaction, akin to a typical user experience. The evaluation was conducted by leading experts in the field of exercise prescription. Five distinct scenarios were formulated, each representing a hypothetical individual with a specific health condition and fitness objective. Upon receiving details of each individual, the GPT-4 model was tasked with generating a 30-day exercise program. These AI-derived exercise programs were subsequently subjected to a thorough evaluation by experts in exercise prescription. The evaluation encompassed adherence to established principles of frequency, intensity, time, and exercise type; integration of perceived exertion levels; consideration for medication intake and the respective medical condition; and the extent of program individualization tailored to each hypothetical profile. The AI model could create general safety-conscious exercise programs for various scenarios. However, the AI-generated exercise prescriptions lacked precision in addressing individual health conditions and goals, often prioritizing excessive safety over the effectiveness of training. The AI-based approach aimed to ensure patient improvement through gradual increases in training load and intensity, but the model's potential to fine-tune its recommendations through ongoing interaction was not fully satisfying. AI technologies, in their current state, can serve as supplemental tools in exercise prescription, particularly in enhancing accessibility for individuals unable to access, often costly, professional advice. However, AI technologies are not yet recommended as a substitute for personalized, progressive, and health condition-specific prescriptions provided by healthcare and fitness professionals. Further research is needed to explore more interactive use of AI models and integration of real-time physiological feedback.

Lighting the way: Exploring diurnal physical performance differences in school-aged visually impaired children and adolescents.

Circadian rhythms play a pivotal role in governing various physiological processes, including physical performance. However, in individuals deprived of light perception, such as the blind, these circadian rhythms face disruption. This study aimed to explore the influence of disturbed circadian rhythms on short-term maximal physical performance in children and adolescents with visual impairment. Forty-five volunteers participated in this study, comprising 17 blind, 13 visually impaired, and 15 sighted participants. The participants underwent a series of tests assessing maximal isometric strength performance across two days. To mitigate the influence of morning session fatigue on the evening results, each participant group performed in two separate testing sessions (i.e. in the morning (7:00 h) and in the evening (17:00 h)) on non-consecutive days in a randomized and counterbalanced setting, with approximately 36 h of recovery time between sessions. To mitigate the impact of inter-individual differences on mean values and to account for the influence of age and sex on the studied variables, data were normalized. The outcomes revealed a significant diurnal variation in maximal isometric strength performance among sighted individuals, with peak performance observed in the evening. This pattern aligns with their well-entrained circadian rhythm. In contrast, blind and visually impaired individuals did not display significant diurnal variation, signaling disrupted circadian rhythms due to the absence of light perception. These findings emphasize the crucial consideration of circadian rhythms in assessments of physical performance, especially among participants with visual impairments.

Exploring Growth, Maturity, and Age as Injury Risk Factors in High-Level Youth Football.

Rapid somatic growth and biological maturity status may affect injury patterns in youth football, yet firm conclusions cannot be drawn from the existing research. We aimed to explore growth velocity, maturity, and age as injury risk factors in 95 academy players (11.9-15.0 years), using anthropometric (height and body mass), maturity (skeletal age), injury, and football exposure data collected prospectively over three seasons (2016/17-2018/19). We compared the relative quality of mixed-effects logistic regression models with growth velocity for 223 growth intervals (average 113 days) included as fixed effects and adjusted for age (chronological or skeletal) plus load (hours/week). Associations were considered practically relevant based on the confidence interval for odds ratios, using thresholds of 0.90 and 1.11 to define small beneficial and harmful effects, respectively. We observed harmful effects of older age on overall (OR: 2.61, 95% CI: 1.15-5.91) and sudden onset (1.98, 1.17-3.37) injury risk. Significant associations (p<0.05) were observed for higher body mass change and greater maturity on sudden onset injuries, and for higher hours/week on gradual onset, bone tissue, and physis injuries. Future studies should include larger samples, monitoring athletes from pre-adolescence through maturation, to enable within-subject analyses and better understand the relationship between growth, maturation, and injuries.

Snus use in football: the threat of a new addiction?

The use of Snus, an oral nicotine pouch, is becoming increasingly common in English professional football. As a nicotine product, Snus raises important questions about health and performance for practitioners. The purpose of this short communication is to explain the current regulatory status of Snus, performance relatedeffects, and associated health outcomes. Further, based on player statements and evidence from the general public, we argue that Snus is used as a coping mechanism to deal with the stressors of professional football. Accordingly, the communication concludes with guidance for club-level multidisciplinary interventions to support player welfare, aimed at reducing Snus use as well as future research recommendations.

A new statistical approach to training load and injury risk: separating the acute from the chronic load.

The relationship between recent (acute) training load relative to long-term (chronic) training load may be associated with sports injury risk. We explored the potential for modelling acute and chronic loads separately to address current statistical methodology limitations. We also determined whether there was any evidence of an interaction in the association between acute and chronic training loads and injury risk in football. A men's Qatar Stars League football cohort (1 465 players, 1 977 injuries), where training load was defined as the number of minutes of activity, and a Norwegian elite U-19 football cohort (81 players, 60 injuries), where training load was defined as the session rating of perceived exertion (sRPE). Mixed logistic regression was run with training load on the current day (acute load) and cumulative past training load estimated by distributed lag non-linear models (chronic load) as independent variables. Injury was the outcome. An interaction between acute and chronic training load was modelled. In both football populations, we observed that the risk of injury on the current day for different values of acute training load was highest for players with low chronic load, followed by high and then medium chronic load. The slopes varied substantially between different levels of chronic training load, indicating an interaction. Modelling acute and chronic loads separately in regression models is a suitable statistical approach for analysing the association between relative training load and injury risk in injury prevention research. Sports scientists should also consider the potential for interactions between acute and chronic load.

Lactate-induced autophagy activation: unraveling the therapeutic impact of high-intensity interval training on insulin resistance in type 2 diabetic rats.

Impaired autophagy is a hallmark of diabetes. The current study proposed to investigate if high intensity interval training (HIIT) induced lactate accumulation could stimulate autophagy in type 2 diabetic male rats. 28 male Wistar rats were randomly assigned into four groups: Healthy Control (CO), Diabetes Control (T2D), Exercise (EX), and Diabetes + Exercise (T2D + EX). Diabetes was induced by feeding high-fat diet and administrating single dose of streptozotocin (35 mg/kg). After becoming diabetic, the animals in the exercise groups (EX and T2D + EX) performed an eight-week HIIT (4-10 interval, 80-100% Vmax, 5 days per week). Serum levels of lactate, glucose and insulin as well as the levels of lactate, pyruvate, lactate transporter monocarboxylate transporter 1 (MCT1), phosphorylated mitogen-activated protein kinases (p-MAP 1 and 2), phosphorylated extracellular signal-regulated protein kinases 1 and 2 (p-ERK 1 and 2), mammalian target of rapamycin (p-mTOR), ribosomal protein S6 kinase beta-1 (p-70S6k), p90 ribosomal S6 kinases (p-90RSK), autophagy related 7 (ATG7), Beclin-1, microtubule-associated protein 1A/1B, and 2A/2B -light chain 3 levels (LC3-I), (LC3- II), (LC3I/LC3II) in soleus muscle were measured. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and serum glucose was lower in T2D + EX compared to T2D group (P < 0.0001). While serum and soleus muscle levels of lactate was not different between T2D and T2D + Ex, the levels of Pyruvate (P < 0.01), MCT1, p-ERK1/2, p-mTOR, p70S6k, P-90RSK, ATG7, LC3-II, and LC3-II/LC3I ratios were higher in T2D + EX compared to T2D group (P < 0.0001). We concluded that eight weeks of high-intensity interval training could activated ERK/P90SRK while inhibiting mTOR/P70S6K signaling pathway in lactate dependent manner. It means increased autophagy which resulted in improve insulin resistance (IR) and reduce blood glucose.

Ramadan intermittent fasting and its association with health-related indices and exercise test performance in athletes and physically active individuals: an overview of systematic reviews.

OBJECTIVE: To systematically review, summarise and appraise findings of published systematic reviews, with/without meta-analyses, examining associations between Ramadan fasting observance (RO), health-related indices and exercise test performances in athletes and physically active individuals. DESIGN: Overview of systematic reviews with assessment of reviews' methodological quality. DATA SOURCES: PubMed, Web of Science, Scopus, Cochrane Database of Systematic Reviews, SPORTDiscus, ProQuest, PsycINFO and SciELO. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Systematic reviews with/without meta-analyses examining associations of RO with health-related indices and exercise performances in athletes and physically active individuals. RESULTS: Fourteen systematic reviews (seven with meta-analyses) of observational studies, with low-to-critically-low methodological quality, were included. Two reviews found associations between RO and decreased sleep duration in athletes and physically active individuals. One review suggested athletes may experience more pronounced reductions in sleep duration than physically active individuals. One review found associations between RO and impaired sleep quality in athletes and physically active individuals. RO was associated with decreased energy, carbohydrate and water intake in adult-aged athletes, but not adolescents. One review suggests RO was associated with athletes' increased feelings of fatigue and decreased vigour. No association was found between RO and athletes' lean mass or haematological indices. RO was unfavourably associated with changes in athletes' performance during high-intensity exercise testing. CONCLUSION: Continuance of training during RO could be associated with athletes' mood state disturbances, decreased sleep duration and performance decline during high-intensity exercise testing, while preserving lean mass. However, careful interpretation is necessary due to the low-to-critically-low methodological quality of the included reviews.

Large-scale sporting events during the COVID-19 pandemic: insights from the FIFA World Cup 2022 in Qatar with an analysis of patterns of COVID-19 metrics.

The 2022 FIFA World Cup (FIFA-WC) held in Qatar presented unique challenges, given the potential for rapid transmission of coronavirus disease 2019 (COVID-19) among over 1.4 million international fans attending the event. This study aimed to investigate the impact of the FIFA-WC 2022 on COVID-19 cases, deaths, and reproduction rate (R0) in Qatar. Additionally, it sought to understand the implications of hosting large-scale events during a pandemic without COVID-19 restrictive measures, providing critical insights for future decision-making. Data from "Our World in Data" were analysed for three distinct periods: one week before the FIFA-WC (week-preWC), the four weeks of the event (week-1WC to week-4WC), and one week after (week-postWC). The results revealed a significant increase in COVID-19 cases during week-3WC and week-4WC (compared to week-preWC) in Qatar, followed by a subsequent decrease during the week-postWC. Notably, Qatar experienced a more pronounced surge in positive cases than the global trend. Regarding COVID-19-related deaths, Qatar's peak occurred during week-2WC, while globally deaths peaked from week-3WC to week-postWC. Nevertheless, Qatar's death toll remained relatively low compared to the global trend throughout the event. The findings highlight that the FIFA-WC 2022 in Qatar demonstrated the feasibility of organizing large-scale sporting events during a pandemic with appropriate measures in place. They emphasize the importance of high vaccination coverage, continuous monitoring, and effective collaboration between event organizers, healthcare authorities, and governments. As such, the event serves as a valuable model for future gatherings, underlining the significance of evidence-based decision-making and comprehensive public health preparedness.

Fractures in professional footballers: 7-years data from 106 team seasons in the Middle East.

Epidemiological studies on fractures in European professional football (soccer) are in abundance. However, such data are lacking in Middle Eastern professional footballers and information on fracture treatment is scarce. The aim of this study is to describe the epidemiology of fractures across seven seasons in Qatar Stars League (QSL) footballers. A prospective study of fractures in professional male footballers over 7 consecutive seasons (2013 to 2020), involving 3255 players and 106 team' seasons. Time loss and injuries and illnesses were recorded using standardised digital tools in accordance with international consensus procedures. Fractures were recorded according to onset mechanism, location, diagnoses, treatment and return to play. A total of 108 players sustained fractures during 638,247 hours of player exposure (88.9% training and 11.1% matches), representing 2.7% of all time-loss injuries. The incidence was 0.17 fractures per 1000 h of exposure (match and training incidence of 0.9 and 0.07 fractures / 1000 h, respectively), equivalent to an average of one fracture per team per season. Fractures mostly occurred in the feet (28.2%), hands (21.1%), shoulders (11.3%) and head (i.e., face) (9.9%). Mean (median) absence was 71 (47 days), with 4.6% refractures. Only 34.3% of the fractures required surgery and nearly all players (98.1%) returned to play at the professional level. Almost all professional football players with fractures return to play at the same competitive level after an average of 10 weeks of absence (mean absence was 71 ± 81 (median: 47, Inter Quartile Range [14-93]) days). One in ten continue to play with symptoms and one in twenty may refracture. Long-term effects of fractures are still unknown.

It Is Time to Play: Acute Effects of Soccer and Sprint Exercise on Attentional Performance, Mood, and Enjoyment in Untrained Male Adolescents.

This study aimed to compare the effects of an acute bout of small-sided soccer game (SSG) and sprint exercise on attention, mood, and enjoyment in untrained adolescent boys. Eighteen adolescent boys aged 13-15 years participated in a counterbalanced order intervention: 1-No-training control condition (CONTROL), 2-SSG (SOCCER), and 3-Repeated sprint (SPRINT) sessions. Before and after the sessions, all participants completed the revised d2-test of attention and a mood assessment (i.e., Brunel mood scale [BRUMS]). Rating of perceived exertion (RPE) and perceived enjoyment (i.e., physical activity enjoyment scale) were evaluated after each session. A 3 × 2 repeated measures analysis of variance with contrast-coded test was used to analyze the data. Attentional test performance increased from pre- to post-exercise intervention for both SOCCER and SPRINT (main effect of Phase, F = 40.81, p < .001, ηp2 = 0.48), compared with the CONTROL. BRUMS scores did not change for any of the interventions. RPE was significantly lower after SOCCER compared with SPRINT (t = 3.05 [3.20-7.18], p < .001, ηp2 = 0.46). SOCCER was perceived to be significantly more enjoyable compared with SPRINT (p = .03) and CONTROL (p < .001). To conclude, an acute bout of exercise based on SOCCER or SPRINT exercise was beneficial for adolescent boys' attention, with significantly better enjoyment reported after the SOCCER session, whereas we did not observe any mood effects.

Impact of COVID-19 lockdown on injury risk in Qatar's professional football.

OBJECTIVES: To compare injury incidence, burden and characteristics between the pre- and post-COVID-19 lockdown periods in Qatari professional football. DESIGN: Prospective cohort study. METHODS: Injury and exposure data for two post-COVID-19 lockdown periods [early post-lockdown period: short-term ~2 months (54 matches) and late post-lockdown period: long-term 8-months (183 matches)] were compared to the benchmark of the same periods from the three previous seasons (2017/18-2019/20). RESULTS: We observed no difference in overall, training or match incidence between early post-lockdown period and the benchmark reference. However, this short-term period resulted in lower burden for overall- (RR 0.80, P < 0.0001), training- (RR 0.73, P < 0.0001) and match-injuries (RR 0.40, P < 0.0001) compared to the benchmark. During late post-lockdown period match injury incidence (RR 0.72, P = 0.0010) and match injury burden (RR 0.69, P < 0.001) were lower than the benchmark. In contrast, both overall- (RR 1.30, P < 0.001) and training-injury burden (RR 1.65, P < 0.001) were higher. A significant increase in adductor strains in both post-lockdown periods was observed. CONCLUSIONS: Immediately after the COVID-19 lockdown (short-term effect), there was no difference in injury incidence but a lower injury burden compared to benchmark. Moreover, the rapid return to competition for the successive season (long-term effect) was associated with a higher overall- and training-injury burden, but a lower match-injury burden compared to the benchmark.