The Role of Physical Exercise as a Therapeutic Tool to Improve Lipedema: A Consensus Statement from the Italian Society of Motor and Sports Sciences (Società Italiana di Scienze Motorie e Sportive, SISMeS) and the Italian Society of Phlebology (Società Italiana di Flebologia, SIF).

PURPOSE OF REVIEW: This consensus statement from the Italian Society of Motor and Sports Sciences (Società Italiana di Scienze Motorie e Sportive, SISMeS) and the Italian Society of Phlebology (Società Italiana di Flebologia, SIF) provides the official view on the role of exercise as a non-pharmacological approach in lipedema. In detail, this consensus statement SISMeS - SIF aims to provide a comprehensive overview of lipedema, focusing, in particular, on the role played by physical exercise (PE) in the management of its clinical features. RECENT FINDINGS: Lipedema is a chronic disease characterized by abnormal fat accumulation. It is often misdiagnosed as obesity, despite presenting distinct pathological mechanisms. Indeed, recent evidence has reported differences in adipose tissue histology, metabolomic profiles, and gene polymorphisms associated with this condition, adding new pieces to the complex puzzle of lipedema pathophysiology. Although by definition lipedema is a condition resistant to diet and PE, the latter emerges for its key role in the management of lipedema, contributing to multiple benefits, including improvements in mitochondrial function, lymphatic drainage, and reduction of inflammation. Various types of exercise, such as aquatic exercises and strength training, have been shown to alleviate symptoms and improve the quality of life of patients with lipedema. However, standardized guidelines for PE prescription and long-term management of patients with lipedema are lacking, highlighting the need for recommendations and further research in this area in order to optimise therapeutic strategies.

Acute effects of prismatic adaptation on penalty kick accuracy and postural control in young soccer players: A pilot study.

Background: Prismatic adaptation (PA) is a visuomotor technique using prismatic glasses that are capable of moving the visual field and to affect the excitability of certain brain areas. The aim of this pilot study was to explore potential acute effects of PA on penalty kick accuracy and postural control in youth soccer players. Methods: In this randomized crossover study, seven young male soccer players performed three PA sessions (rightward PA, r-PA; leftward PA, l-PA; sham PA, s-PA) with a washout period of 1-week between them. Immediately before and after each PA session, penalty kick accuracy and postural control were assessed. Results: We detected an increase in penalty kick accuracy following PA, regardless of the deviation side of the prismatic glasses (F1,5 = 52.15; p = 0.08; ηp2 = 0.981). In detail, our results showed an increase in the penalty kick accuracy toward the right target of the football goal following r-PA and toward the left target of the football goal following l-PA. We detected a significant effect on the sway path length (F2,12 = 10.42; p = 0.002; ηp2 = 0.635) and the sway average speed (F2,12 = 9.17; p = 0.004; ηp2 = 0.605) parameters in the stabilometric test with open eyes following PA, regardless of the deviation side of the prismatic glasses. In detail, our results showed a significant difference in both the stabilometric parameters (p = 0.016 and p = 0.009, respectively) only following l-PA. Conclusion: The findings of this pilot study indicate that PA could positively affect penalty kick accuracy and postural control suggesting that PA could be used as a visual training technique in athletes.

Saliva as a Diagnostic Tool for Early Detection of Exercise-Induced Oxidative Damage in Female Athletes.

Although blood still remains the most commonly utilized medium to detect increased levels of oxidative damage induced by exercise, saliva diagnostics have gained increasing popularity due to their non-invasive nature and athlete-friendly collection process. Given that the contribution of various phases of the menstrual cycle to the levels of oxidative damage may differ, the aim of this study was to evaluate an agreement between salivary and plasmatic levels of lipid peroxidation products in female swimmers in both the follicular (F) and luteal (L) phases of the menstrual cycle at rest and following exercise. Twelve well-trained female swimmers aged 19.6 ± 1.1 years old were examined. We measured diene conjugates (DCs), triene conjugates (TCs), and Schiff bases (SBs) in lipids immediately after their extraction from both saliva and blood plasma. All female swimmers were studied two times each, in the two different phases of one menstrual cycle, before and after high-intensity interval exercise (HIIE). Salivary and plasmatic levels of DCs, TCs, and SBs significantly increased post-exercise compared to pre-exercise, in both the F and L phases. A high positive correlation was observed between the concentrations of DCs, TCs, and SBs in the saliva and blood plasma of participants in the F and L phases, both at rest and following HIIE. Ordinary least products regression analysis indicates that there was no proportional and differential bias in the data. The Bland-Altman method also declares that there was no differential bias, since the line of equality was within the 95% confidence interval of the mean difference between salivary and plasmatic levels of DCs, TCs, and SBs in female swimmers, in both the F and L phases, before and after HIIE. There was also no proportional bias in the Bland-Altman plots. Thus, this is the first study to report a high agreement between the quantifications of DCs, TCs, and SBs in the saliva and blood plasma of female swimmers in both the F and L phases, at rest and following HIIE.

Problems and Opportunities in the use of Bioelectrical Impedance Analysis for Assessing Body Composition During Ketogenic Diets: A Scoping Review.

PURPOSE OF THE REVIEW: The use of bioelectrical impedance analysis (BIA) for monitoring body composition during the ketogenic diet has experienced a rapid surge. This scoping review aimed to assess the validity of procedures applying BIA in the ketogenic diet and to suggest best practices for optimizing its utilization. RECENT FINDINGS: We conducted a systematic scoping review of peer-reviewed literature involving BIA for assessing body composition in individuals adhering to a ketogenic diet. Searches of international databases yielded 1609 unique records, 72 of which met the inclusion criteria and were reviewed. Thirty-five studies used foot-to-hand technology, 34 used standing position technology, while 3 did not declare the technology used. Raw bioelectrical parameters were reported in 21 studies. A total of 196 body mass components were estimated, but predictive equations were reported in only four cases. Most research on BIA during ketogenic diets did not report the equations used for predicting body composition, making it impossible to assess the validity of BIA outputs. Furthermore, the exceedingly low percentage of studies reporting and analyzing raw data makes it challenging to replicate methodologies in future studies, highlighting that BIA is not being utilized to its full potential. There is a need for more precise technology and device characteristics descriptions, full report of raw bioelectrical data, and predictive equations utilized. Moreover, evaluating raw data through vectorial analysis is strongly recommended. Eventually, we suggest best practices to enhance BIA outcomes during ketogenic diets.

Not Only Protein: Dietary Supplements to Optimize the Skeletal Muscle Growth Response to Resistance Training: The Current State of Knowledge.

Regarding skeletal muscle hypertrophy, resistance training and nutrition, the most often discussed and proposed supplements include proteins. Although, the correct amount, quality, and daily distribution of proteins is of paramount importance for skeletal muscle hypertrophy, there are many other nutritional supplements that can help and support the physiological response of skeletal muscle to resistance training in terms of muscle hypertrophy. A healthy muscle environment and a correct whole muscle metabolism response to the stress of training is a prerequisite for the increase in muscle protein synthesis and, therefore, muscle hypertrophy. In this review, we discuss the role of different nutritional supplements such as carbohydrates, vitamins, minerals, creatine, omega-3, polyphenols, and probiotics as a support and complementary factors to the main supplement i.e., protein. The different mechanisms are discussed in the light of recent evidence.

High-standard predictive equations for estimating body composition using bioelectrical impedance analysis: a systematic review.

The appropriate use of predictive equations in estimating body composition through bioelectrical impedance analysis (BIA) depends on the device used and the subject's age, geographical ancestry, healthy status, physical activity level and sex. However, the presence of many isolated predictive equations in the literature makes the correct choice challenging, since the user may not distinguish its appropriateness. Therefore, the present systematic review aimed to classify each predictive equation in accordance with the independent parameters used. Sixty-four studies published between 1988 and 2023 were identified through a systematic search of international electronic databases. We included studies providing predictive equations derived from criterion methods, such as multi-compartment models for fat, fat-free and lean soft mass, dilution techniques for total-body water and extracellular water, total-body potassium for body cell mass, and magnetic resonance imaging or computerized tomography for skeletal muscle mass. The studies were excluded if non-criterion methods were employed or if the developed predictive equations involved mixed populations without specific codes or variables in the regression model. A total of 106 predictive equations were retrieved; 86 predictive equations were based on foot-to-hand and 20 on segmental technology, with no equations used the hand-to-hand and leg-to-leg. Classifying the subject's characteristics, 19 were for underaged, 26 for adults, 19 for athletes, 26 for elderly and 16 for individuals with diseases, encompassing both sexes. Practitioners now have an updated list of predictive equations for assessing body composition using BIA. Researchers are encouraged to generate novel predictive equations for scenarios not covered by the current literature.Registration code in PROSPERO: CRD42023467894.

Common and divergent molecular mechanisms of fasting and ketogenic diets.

Intermittent short-term fasting (ISTF) and ketogenic diets (KDs) exert overlapping but not identical effects on cell metabolism, function, and resilience. Whereas health benefits of KD are largely mediated by the ketone bodies (KBs), ISTF engages additional adaptive physiological responses. KDs act mainly through inhibition of histone deacetylases (HDACs), reduction of oxidative stress, improvement of mitochondria efficiency, and control of inflammation. Mechanisms of action of ISTF include stimulation of autophagy, increased insulin and leptin sensitivity, activation of AMP-activated protein kinase (AMPK), inhibition of the mechanistic target of rapamycin (mTOR) pathway, bolstering mitochondrial resilience, and suppression of oxidative stress and inflammation. Frequent switching between ketogenic and nonketogenic states may optimize health by increasing stress resistance, while also enhancing cell plasticity and functionality.

Relationship between intended force and actual force: comparison between athletes and non-athletes.

This cross-sectional study aimed to investigate whether athletes (ATHL) and non-athletes (NON-ATHL) individuals had similar accuracy in matching intended to actual force during ballistic (BAL) and tonic (TON) isometric contractions. In this cross-sectional study, the subjects were divided into ATHL (n = 20; 22.4 ± 2.3 yrs; 73.2 ± 15.7 kg; 1.76 ± 0.08 m) and NON-ATHL (n = 20; 24.6 ± 2.4 yrs; 68.2 ± 15.0 kg; 1.73 ± 0.1 m) groups. The isometric quadriceps strength was measured with a load cell applied to a custom-built chair. For each condition, subjects performed at first three maximal voluntary isometric contractions (MVIC) as reference. Then, subjects had to match three intended force intensities expressed in percentage of the MVIC (i.e., 25%, 50%, and 75%) without any external feedback. Subjects performed three trials for each force intensity. The accuracy (AC) was calculated as the absolute difference in percentage between the intended and the actual force. A Likert scale was administered for each trial to assess the subjective matching between the intended and the actual force. Statistical analysis showed that the ATHL group was more accurate (p < 0.001) than the NON-ATHL group. In contrast, the AC (p < 0.001) was lower when the force intensities increased independently from the group. Moreover, significantly higher AC (p < 0.001) and lower aggregate Likert scores (p < 0.001) were found in BAL than TON conditions. These results suggest that (i) sports practice could enhance muscle recruitment strategies by increasing the AC in the isometric task; (ii) differences between intended and actual force appeared to be intensity-dependent with lower AC at high force intensities; (iii) different control systems act in modulating BAL and TON contractions.

Keep calm and keep rowing: the psychophysical effects of dragon boat program in breast cancer survivors.

PURPOSE: Dragon Boat discipline has become a popular type of physical exercise among women with breast cancer. The present study aims to investigate the effects of Dragon Boat activity on body composition, physical function, and psychosocial aspects (i.e., body appreciation and quality of life [QoL]) in women operated for breast cancer. METHODS: Thirty-one women (age, 57.88 ± 7.88 years; BMI, 27.86 ± 6.38 kg·m-2) with a previous breast removal surgery were recruited and randomized into two groups: Dragon Boat group (DB, N = 18) or a home-based non-supervised training program (home exercise group; HG, N = 13). All participants underwent body composition, handgrip test, 30-s chair stand test (30CST), 6-min walking test (6MWT), and shoulder mobility measurements at baseline and after 12 weeks of intervention. Participants also filled out the Body Appreciation Scale-2 (BAS-2) and the Short Form Health Survey-12 (SF-12) self-report questionnaires. RESULTS: Dragon Boat activity significantly improved the 30CST (+ 6%, p = .011) and 6MWT performance (+ 30%, p = .011) compared to a home-based non-supervised training program. Moreover, 20% (3/15 women) of women in the DB group obtained a reliable change from pre- to post-intervention in the BAS-2 and in the mental QoL component of the SF-12 (vs 15% and 0% of the HC group). No reliable change emerged for the physical component of the SF-12. CONCLUSION: Dragon Boat activity is efficient to improve lower limb strength in women operated for breast cancer. Furthermore, Dragon Boat activity emerged to improve body appreciation and mental QoL in some of the women assigned to this activity. Importantly, no adverse events were documented during the intervention. TRIAL REGISTRATION: NCT05206526 (10/02/2022).

Polycystic Ovary Syndrome and Alteration of Vocal Function: A Systematic Review and Meta-Analysis.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a common hormonal disorder among young women, correlated with hyperandrogenism. Among the symptoms of PCOS, vocal alterations are quite unknown. Dysphonia may be related to hyperandrogenism, and there is no consensus about its prevalence and the severity of vocal disorders, which can cause noticeable discomfort. METHODS: A systematic review of the literature was conducted. Four studies on PCOS that evaluated the phonatory system were included for a total of 174 patients (96 PCOS, 78 controls), and a meta-analysis on comparable data was performed. RESULTS: Four studies evaluated parameters related to vocal symptomatology, altered audiometric examination, and findings at the laryngoscopy in patients affected by PCOS versus controls. Although the individual studies showed increased incidence of alterations and a tendency to develop speech fatigue in women with PCOS, when the results of studies were pulled in meta-analysis, the overall difference was not statistically significant. The studies themselves were very different from each other; therefore, it is hard to draw any firm conclusions. DISCUSSION: The aim of this study was to assess the prevalence of vocal alterations, the correlation with hyperandrogenism, the quality of life, and the voice changes after starting a therapy for PCOS. The present meta-analysis failed to find any difference in terms of PCOS and control cohort. However, the lack of high-quality studies makes it difficult to draw firm conclusions. New and larger studies or big population program data are therefore warranted.

Relationship between external and internal load indicators and injury using machine learning in professional soccer: a systematic review and meta-analysis.

This study verified the relationship between internal load (IL) and external load (EL) and their association on injury risk (IR) prediction considering machine learning (ML) approaches. Studies were included if: (1) participants were male professional soccer players; (2) carried out for at least 2 sessions, exercises, or competitions; (3) correlated training load (TL) with non-contact injuries; (4) applied ML approaches to predict TL and non-contact injuries. TL included: IL indicators (Rating of Perceived Exertion, RPE; Session-RPE, Heart Rate, HR) and EL indicators (Global Positioning System, GPS variables); the relationship between EL and IL through index, ratio, formula; ML indicators included performance measures, predictive performance of ML methods, measure of feature importance, relevant predictors, outcome variable, predictor variable, data pre-processing, features selection, ML methods. Twenty-five studies were included. Eleven addressed the relationship between EL and IL. Five used EL/IL indexes. Five studies predicted IL indicators. Three studies investigated the association between EL and IL with IR. One study predicted IR using ML. Significant positive correlations were found between S-RPE and total distance (TD) (r = 0.73; 95% CI (0.64 to 0.82)) as well as between S-RPE and player load (PL) (r = 0.76; 95% CI (0.68 to 0.84)). Association between IL and EL and their relationship with injuries were found. RPE, S-RPE, and HR were associated with different EL indicators. A positive relationship between EL and IL indicators and IR was also observed. Moreover, new indexes or ratios (integrating EL and IL) to improve knowledge regarding TL and fitness status were also applied. ML can predict IL indicators (HR and RPE), and IR. The present systematic review was registered in PROSPERO (CRD42021245312).

Athletic bioimpedance-based equations underestimate fat free mass components in male elite soccer players: development and validation of new soccer-specific predictive models.

BACKGROUND: Bioelectrical impedance analysis (BIA) is a rapid and user-friendly technique for assessing body composition in sports. Currently, no sport-specific predictive equations are available, and the utilization of generalized formulas can introduce systematic bias. The objectives of this study were as follows: (i) to develop and validate new predictive models for estimating fat-free mass (FFM) components in male elite soccer players; (ii) to evaluate the accuracy of existing predictive equations. METHODS: A total of 102 male elite soccer players (mean age 24.7 ± 5.7 years), participating in the Italian first league, underwent assessments during the first half of the in-season period and were randomly divided into development and validation groups. Bioelectrical resistance (R) and reactance (Xc), representing the bioimpedance components, were measured using a foot-to-hand BIA device at a single frequency of 50 kHz. Dual-energy X-ray absorptiometry was employed to acquire reference data for FFM, lean soft tissue (LST), and appendicular lean soft tissue (ALST). The validation of the newly developed predictive equations was conducted through regression analysis, Bland-Altman tests, and the area under the curves (AUC) of regression receiver operating characteristic (RROC) curves. RESULTS: Developed models were: FFM = - 7.729 + (body mass × 0.686) + (stature2/R × 0.227) + (Xc × 0.086) + (age × 0.058), R2 = 0.97, Standard error of estimation (SEE) = 1.0 kg; LST = - 8.929 + (body mass × 0.635) + (stature2/R × 0.244) + (Xc × 0.093) + (age × 0.048), R2 = 0.96, SEE = 0.9 kg; ALST = - 24.068 + (body mass × 0.347) + (stature2/R × 0.308) + (Xc × 0.152), R2 = 0.88, SEE = 1.4 kg. Train-test validation, performed on the validation group, revealed that generalized formulas for athletes underestimated all the predicted FFM components (p < 0.01), while the new predictive models showed no mean bias (p > 0.05), with R2 values ranging from 0.83 to 0.91, and no trend (p > 0.05). The AUC scores of the RROC curves indicated an accuracy of 0.92, 0.92, and 0.74 for FFM, LST, and ALST, respectively. CONCLUSIONS: The utilization of generalized predictive equations leads to an underestimation of FFM and ALST in elite soccer players. The newly developed soccer-specific formulas enable valid estimations of body composition while preserving the portability of a field-based method.

Young basketball players have better manual dexterity performance than sportsmen and non-sportsmen of the same age: a cross-sectional study.

Manual dexterity is a key skill in motor development. There are conflicting studies on the influence of sports practice on this skill and on which type of sport trains this ability the most in youth. Manual dexterity is usually assessed with expensive and time-consuming tools not easily available to facilities such as schools or sports clubs. The aim of this study was to assess differences in manual dexterity performance between young basketball players, sportsmen, and non-sportsmen. A further aim was to analyze whether the coin rotation task was a reliable tool for assessing manual dexterity. Based on the characteristics of the sport, we hypothesized that basketball players had better manual dexterity performances. Seventy-eight participants were included in the study and categorized into "basketball", "sports", and "non-sports" groups. Manual dexterity was assessed with the grooved pegboard, the coin rotation task, and the handgrip tests. The basketball group showed better performance in all tests. Significant differences were found between the basketball group and sports group and between the basketball group and non-sport group in the grooved pegboard (p < 0.05) and in the handgrip (p < 0.05) tests. Test-retest reliability of the coin rotation task scores was moderate in the basketball group (ICC2,1 0.63-0.6). Basketball practice could positively influence manual dexterity. The coin rotation task showed an acceptable construct of validity.

Two-Year Outcomes After Minimally Invasive Surfactant Therapy in Preterm Infants: Follow-Up of the OPTIMIST-A Randomized Clinical Trial.

Importance: The long-term effects of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome remain to be definitively clarified. Objective: To examine the effect of MIST on death or neurodevelopmental disability (NDD) at 2 years' corrected age. Design, Setting, and Participants: Follow-up study of a randomized clinical trial with blinding of clinicians and outcome assessors conducted in 33 tertiary-level neonatal intensive care units in 11 countries. The trial included 486 infants with a gestational age of 25 to 28 weeks supported with continuous positive airway pressure (CPAP). Collection of follow-up data at 2 years' corrected age was completed on December 9, 2022. Interventions: Infants assigned to MIST (n = 242) received exogenous surfactant (200 mg/kg poractant alfa) via a thin catheter; those assigned to the control group (n = 244) received sham treatment. Main Outcomes and Measures: The key secondary outcome of death or moderate to severe NDD was assessed at 2 years' corrected age. Other secondary outcomes included components of this composite outcome, as well as hospitalizations for respiratory illness and parent-reported wheezing or breathing difficulty in the first 2 years. Results: Among the 486 infants randomized, 453 had follow-up data available (median gestation, 27.3 weeks; 228 females [50.3%]); data on the key secondary outcome were available in 434 infants. Death or NDD occurred in 78 infants (36.3%) in the MIST group and 79 (36.1%) in the control group (risk difference, 0% [95% CI, -7.6% to 7.7%]; relative risk [RR], 1.0 [95% CI, 0.81-1.24]); components of this outcome did not differ significantly between groups. Secondary respiratory outcomes favored the MIST group. Hospitalization with respiratory illness occurred in 49 infants (25.1%) in the MIST group vs 78 (38.2%) in the control group (RR, 0.66 [95% CI, 0.54-0.81]) and parent-reported wheezing or breathing difficulty in 73 (40.6%) vs 104 (53.6%), respectively (RR, 0.76 [95% CI, 0.63-0.90]). Conclusions and Relevance: In this follow-up study of a randomized clinical trial of preterm infants with respiratory distress syndrome supported with CPAP, MIST compared with sham treatment did not reduce the incidence of death or NDD by 2 years of age. However, infants who received MIST had lower rates of adverse respiratory outcomes during their first 2 years of life. Trial Registration: anzctr.org.au Identifier: ACTRN12611000916943.

The bioelectrical impedance analysis (BIA) international database: aims, scope, and call for data.

BACKGROUND: Bioelectrical impedance analysis (BIA) is a technique widely used for estimating body composition and health-related parameters. The technology is relatively simple, quick, and non-invasive, and is currently used globally in diverse settings, including private clinicians' offices, sports and health clubs, and hospitals, and across a spectrum of age, body weight, and disease states. BIA parameters can be used to estimate body composition (fat, fat-free mass, total-body water and its compartments). Moreover, raw measurements including resistance, reactance, phase angle, and impedance vector length can also be used to track health-related markers, including hydration and malnutrition, and disease-prognostic, athletic and general health status. Body composition shows profound variability in association with age, sex, race and ethnicity, geographic ancestry, lifestyle, and health status. To advance understanding of this variability, we propose to develop a large and diverse multi-country dataset of BIA raw measures and derived body components. The aim of this paper is to describe the 'BIA International Database' project and encourage researchers to join the consortium. METHODS: The Exercise and Health Laboratory of the Faculty of Human Kinetics, University of Lisbon has agreed to host the database using an online portal. At present, the database contains 277,922 measures from individuals ranging from 11 months to 102 years, along with additional data on these participants. CONCLUSION: The BIA International Database represents a key resource for research on body composition.

New bioelectrical impedance vector references and phase angle centile curves in 4,367 adults: The need for an urgent update after 30 years.

BACKGROUND & AIMS: The bioelectrical impedance vector analysis (BIVA) represents a qualitative analysis of body composition. The vector, defined by resistance (R) and reactance (Xc) standardized by stature, can be evaluated compared to the 50%,75%, and 95% tolerance ellipses representative of the reference populations. The tolerance ellipses for healthy adults have been provided in 1995 and were developed by mixing underage, adult, and elderly subjects, possibly misrepresenting the actual adult population. The current multicentric, cross-sectional study aimed to provide new tolerance ellipses specific for the general adult population and as a secondary aim to present centile curves for the bioelectrical phase angle. METHODS: R, Xc, and phase angle were measured in 2137 and 2230 males and females using phase-sensitive foot-to-hand analyzers at 50 kHz. A minimum of 35 subjects were included for each sex and age category from 18 to 65 years. RESULTS: The new mean vectors showed a leftward shift on the R-Xc graph with respect to the former reference values (males: F = 75.3; p < 0.001; females: F = 36.6, p < 0.001). The results provided new 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentile curves for phase angle, identifying time point phases of decrement (males: -0.03° per year at 33.0-51.0 years and -0.05° per year after 51 years; females: -0.03° per year from 37.2 to 57.9 years). CONCLUSIONS: Compared to the original references, the new data are characterized by a different distribution within the R-Xc graph with a higher phase angle. Thirty years after the BIVA invention, the current study presents new tolerance ellipses and phase angle reference values for the adult population.

Effectiveness of Pilates exercise on low back pain: a systematic review with meta-analysis.

PURPOSE: Low back pain is the most frequently reported musculoskeletal disorder and represents one of the highest patient burdens in healthcare. This systematic review and meta-analysis aimed to investigate the effectiveness of Pilates exercise on pain intensity and functional disability caused by low back pain (LBP). MATERIALS AND METHODS: A Systematic review with meta-analysis was conducted. Data sources: MEDLINE-NLM and MEDLINE-EBSCO. We also searched on Scopus Elsevier, Cochrane, DOAJ, SciELO, PEDro, and PLOS ONE databases. Eligibility criteria: randomized controlled trials (RCTs) evaluating LBP in which the primary treatment was based on Pilates exercise compared with no exercise, or non-specific exercise. RESULTS: The search returned 1566 records of which 36 articles were included in the systematic review and 19 in the meta-analysis. Twenty-two studies compared the effects of Pilates exercise vs no exercise and 13 studies examined the effects of Pilates exercise vs non-specific exercise. Analysis showed that Pilates had a positive effect on the perception of LBP vs no exercise. A similar trend occurred with non-specific exercise. CONCLUSIONS: Pilates exercise can decrease LBP compared to no exercise and non-specific exercise. General practitioners should consider Pilates exercise as an effective strategy to manage LBP and counteract the growing health. TRIAL REGISTRATION: PROSPERO registration number: CRD42022308387.IMPLICATIONS FOR REHABILITATIONPilates is a good strategy for improving low back pain and is more effective than other exercise programs or no exercise.Pilates is a safe tool to apply to most of the population with low back pain.Pilates is a non-pharmacological strategy useful for counteracting low back pain.

Sport-specific balance tests account for youth alpine skiers' ranking.

Objective: Alpine skiing requires complex motor skills and fine adjustments to maintain balance in dynamic and challenging conditions. This study aimed to understand whether the balance ability in unspecific (UST) and sport-specific (SST) tasks could depend on the skiers' ranking level. The balance performance of the dominant and non-dominant limbs in the SST was also investigated. Methods: Twenty-five skiers (14.96 ± 1.61 yrs; 1.69 ± 0.69 m; 59.9 ± 9.52 kg) were divided into high-ranking (position < 50) and low-ranking (position > 50) groups. Subjects performed three balance conditions: static (ST), dynamic UST, and dynamic SST. Subjects stood on an unstable board over a force platform during UST. During SST, subjects wore ski boots, grasped ski poles, and each foot was clipped to an unstable board over two force plates. From the center-of-pressure (CoP) trajectory the area of the 95th percentile ellipse and the CoP mean velocity were calculated. Angular displacements were recorded by a 12-camera system, to calculate the full balance (FB), fine (FiB), and gross (GB) balance in UST and SST. Results: Balance control was higher (p < 0.01) in high-ranking than low-ranking skiers only in the SST. Kinematic parameters (i.e., FB, FiB, and GB) showed a higher (p < 0.001) balance performance in SST than UST independently from the group. Dominant and non-dominant limbs motion was similar (Pearson correlation, r = 0.97) in SST independently from the skiers' ranking. Conclusion: High-ranking skiers showed better balance control and performance than low-ranking skiers only when the task was sport-specific. Therefore, we suggest testing balance under sport-specific conditions to discriminate the youth skiers' abilities.

The Effects of Ketogenic Diet on Insulin Sensitivity and Weight Loss, Which Came First: The Chicken or the Egg?

The ketogenic diet (KD) is, nowadays, considered an interesting nutritional approach for weight loss and improvement in insulin resistance. Nevertheless, most of the studies available in the literature do not allow a clear distinction between its effects on insulin sensitivity per se, and the effects of weight loss induced by KDs on insulin sensitivity. In this review, we discuss the scientific evidence on the direct and weight loss mediated effects of KDs on glycemic status in humans, describing the KD's biochemical background and the underlying mechanisms.