Unfolding the role of exercise in the management of sleep disorders.

Sleep disorders are prevalent among the general population and even more in individuals suffering from chronic diseases. Recent data reveal promising effects of physical exercise as a non-pharmacological approach for improving sleep and managing various sleep disorders. However, more studies with proper design and methodology should be conducted in the future to obtain a clearer understanding of the subject. The role of exercise in preventing and improving sleep disorders is probably much higher than what is currently exploited. To fully exploit the potential benefit of physical activity on sleep disorders in the future, it is necessary to identify the relevant tools to assess sleep-wake disorders and establish specific exercise protocols tailored to different sleep disorders. The present manuscript aims to review the literature on the use of exercise in managing selected sleep disorders. Regular exercise, including short-term aerobic activity, resistance training, and mind-body exercises, can effectively improve sleep quality, particularly in cases of insomnia and sleep-disordered breathing. Additionally, increasing evidence supports the effectiveness of aerobic and strength training, and body-mind exercises such as yoga in managing sleep-related movement disorders. Exercise can be a safe, affordable, and efficient tool in enhancing sleep quality and improving sleep disorders. Per se, regular exercise could play an adjuvant role alongside with established therapies, or a valid alternative when the pharmacological approach is limited by side effects, interactions, or inefficacy. More research is needed to define how exercise affects the physiology of sleep, and consequently how to use exercise in patients with sleep disorders.

How to cultivate sustainable physical health and wellness in transplant recipients: the emerging and enduring role of exercise scientists.

PURPOSE OF REVIEW: The aim of the current review is to highlight the importance of exercise training as an important section of transplant recipient rehabilitation process and explain the role of the exercise scientist in the development, implementation, and assessment of the exercise regime. RECENT FINDINGS: Transplant patients face a unique set of challenges in their recovery and rehabilitation process, often requiring a multifaceted approach to address the physical, emotional, and psychological aspects of their condition. Exercise training has emerged as a crucial component in the care of these patients, providing a means to improve functional capacity, enhance quality of life, and mitigate the adverse effects of transplant-related complications. Exercise scientists who are trained to assess patient's physical limitations, develop and deliver personalized exercise programs, and monitor their progress are uniquely positioned to play a crucial role in the treatment of patients with chronic conditions that require exercise training as a mean of improving and maintaining health and quality of life. SUMMARY: Exercise scientists are the appropriate professionals for providing transplant recipients with the recommended exercise training for maintaining and improving their health status as part of the overall plan of long-term care and support.

Emotional Intelligence in Hemodialysis Patients: The Impact of an Intradialytic Exercise Training Program.

The current study aimed to investigate whether there is a relationship between emotional intelligence (EI), functional capacity, fatigue, cognitive function, and quality of life (QoL) in HD patients and to assess the effect of a 9-month intradialytic exercise training program on EI levels. Seventy-eight dialysis patients (50 M/28 F, 60.6 ± 17.2 years) participated in the cross-sectional study. Afterward, a subgroup of 18 patients (15 M/3 F, 56.7 ± 12.3 years) completed a 9-month supervised intradialytic exercise training program (three times weekly). EI was assessed by the Schutte Self Report Emotional Intelligence Test (SSEIT) and the Wong and Law Emotional Intelligence Scale (WLEIS). Functional capacity was assessed by a battery of tests. Sleep quality, depression levels, and daily sleepiness were assessed via validated questionnaires. All assessments were carried out before and after the intervention. A significant positive correlation was found between the WLEIS scores and the physical component summary of the QoL questionnaire. In contrast, the WLEIS scores were negatively associated with general and physical fatigue. The SSEIT scores were positively associated with cognitive function. After nine months of exercise training, only the group with low WLEIS scores improved their EI score significantly compared to the baseline values (98.7 ± 7.0 vs. 73.0 ± 4.0, p = 0.020), while no changes were observed in the medium or high EI groups. In conclusion, patients with higher levels of EI showed increased quality of life and lower levels of fatigue. Patients with low levels of EI are more likely to benefit from an exercise training program compared to their medium- and high-level counterparts.

Chronic exercise effects on overall depression severity and distinct depressive symptoms in older adults: A protocol of a systematic and meta-analytic review.

INTRODUCTION: There is high evidence that chronic exercise benefits overall depression severity in older adults. However, late-life depression is characterized by considerable heterogeneity in clinical manifestation emphasizing the need for more individualized exercise intervention programs. Therefore, the objective of the proposed review is to investigate the effects of chronic exercise on overall depression severity and on different symptoms of depression in randomized controlled trials (RCTs) including older adults with a mean age of at least 60 years, and by considering the moderating effects of intervention characteristics and individual characteristics. METHODS: This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). We will use the Population-Intervention-Comparator-Outcomes-Study design (PICOS) criteria for study inclusion and will search the following database sources for relevant RCTs: Web of Science, Academic Search Complete, CINAHL, APA Psycinfo, SPORTDiscuss, Cochrane. Two independent reviewers will conduct the study selection, data extraction, and quality assessment. Disagreement will be solved by a third reviewer. Primary outcome will be changes in overall depression severity and secondary outcomes will encompass changes in symptoms of depression as defined by the DSM-5, such as sleep quality, fatigue, anxiety, mood, apathy, changes in weight, information processing speed, and executive functions, from baseline until the end of the intervention and to any available intermediary measurement or follow up. Meta-analysis will be undertaken to synthesize the effects of chronic exercise on primary and secondary outcomes. Subgroup analysis will investigate the moderating effects of intervention characteristics (frequency, intensity, duration, type of exercise, cognitive demand, social interactions, exercise supervision, behavioral change techniques, compliance, study design, dropout-rate, type of control group) and individual characteristics (age, sex, education, functional capacity, global cognition, population) on primary and secondary outcomes. Additionally, we plan to assess quality of evidence and publication bias, and to carry out sensitivity analysis. CONCLUSION: The results of the proposed review are anticipated to have a substantial impact on research and clinical practice. On the one hand, the review's conclusions could form the foundation for developing evidence-based recommendations for individualized exercise programs that alleviate depression in older adults. On the other hand, by revealing research gaps, the review results could encourage the formulation of research questions for further RCTs. PROTOCOL REGISTRATION NUMBER: This protocol has been published in the Prospero repository (PROSPERO 2022 CRD42022361418, available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022361418).

Effects of chronic physical exercise on executive functions and episodic memory in clinical and healthy older adult populations: a systematic review and meta-analysis protocol.

BACKGROUND: Executive functions (EFs) and episodic memory are fundamental components of cognition that deteriorate with age and are crucial for independent living. While numerous reviews have explored the effect of exercise on these components in old age, these reviews screened and analyzed selected older adult populations, or specific exercise modes, thus providing only limited answers to the fundamental question on the effect of exercise on cognition in old age. This article describes the protocol for a systematic review and multilevel meta-analytic study aiming at evaluating the effectiveness of different types of chronic exercise in improving and/or maintaining EFs and long-term episodic memory in older adults. METHODS AND ANALYSIS: The study protocol was written in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Several databases will be searched. Randomized controlled trials (RCTs) conducted in older adults aged ≥ 60 years providing any kind of planned, structured, and repetitive exercise interventions, and EFs and/or episodic memory measures as outcomes, published in English in peer-reviewed journals and doctoral dissertations will be included. Two independent reviewers will screen the selected articles, while a third reviewer will resolve possible conflicts. The Cochrane risk-of-bias tool will be used to assess the quality of the studies. Finally, data will be extracted from the selected articles, and the formal method of combining individual data from the selected studies will be applied using a random effect multilevel meta-analysis. The data analysis will be conducted with the metafor package in R. DISCUSSION AND CONCLUSION: This review will synthesize the existing evidence and pinpoint gaps existing in the literature on the effects of exercise on EFs and episodic memory in healthy and unhealthy older adults. Findings from this meta-analysis will help to design effective exercise interventions for older adults to improve and/or maintain EFs and episodic memory. Its results will be useful for many researchers and professionals working with older adults and their families. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022367111.

Exploring the Dynamic Relationship between the Gut Microbiome and Body Composition across the Human Lifespan: A Systematic Review.

This systematic review aimed to identify different gut microbiome profiles across the human lifespan and to correlate such profiles with the body composition. PubMed, Scopus, and Cochrane were searched from inception to March 2022. Sixty studies were included in this systematic review. Overall, the gut microbiome composition in overweight participants exhibited decreased α-diversity, decreased levels of the phylum Bacteroidetes and its taxa, and increased levels of the phylum Firmicutes, its taxa, and the Firmicutes/Bacteroidetes ratio, in comparison to normal-weight participants. Other body composition parameters showed similar correlations. Fat mass and waist circumference were found to correlate positively with the Firmicutes taxa and negatively with the Bacteroidetes taxa. In contrast, lean body mass and muscle mass demonstrated a positive correlation with the Bacteroidetes taxa. Notably, these correlations were more pronounced in athletes than in obese and normal-weight individuals. The composition of the gut microbiome is evidently different in overweight individuals or athletes of all age groups, with the former tending towards decreased Bacteroidetes taxa and increased Firmicutes taxa, while a reversed relationship is observed concerning athletes. Further studies are needed to explore the dynamic relationship between energy intake, body composition, and the gut microbiome across the human lifespan.

The effect of chrono-nutritional manipulation of carbohydrate intake on sleep macrostructure: A randomized controlled trial.

BACKGROUND & AIMS: Over the years, there is a rapid increase in the prevalence of inadequate sleep and its detrimental consequences. Yet, the impact of prolonged nutritional interventions on sleep optimization remains unexplored. To examine the effect of carbohydrate manipulation combined with exercise training on sleep macro-structure. METHODS: Forty-two healthy, trained male volunteers were recruited for this study. The 4-week intervention consisted of three groups: i) Sleep Low-No Carbohydrates (SL-NCHO): participants consumed all their carbohydrate intake at regular intervals prior to evening training, ii) Sleep High-Low Glycemic Index (SH-LGI) and iii) Sleep High-High Glycemic Index (SH-HGI): Carbohydrate intake was spread throughout the day, both prior (60% of total CHO intake) and after evening training (40% of total CHO intake). The SH-LGI and SH-HGI groups differentiated by consuming either LGI or HGI foods in the evening, respectively. Alongside, participants performed a standardized exercise program combining resistance exercise and high-intensity interval training. Participants' sleep macro-structure was assessed with polysomnography, actigraphy, sleep diary, and sleep-wake questionnaires. RESULTS: Objective assessments revealed a substantial time-effect on sleep initiation, duration, and continuity. After the intervention, sleep onset latency decreased (p < 0.001), sleep duration was prolonged (p = 0.006), sleep efficiency increased (p < 0.001), and wake after sleep onset decreased (p = 0.035). Sleep macroarchitecture did not significantly change, while the percentage of REM sleep stage to the total sleep time increased over time (p < 0.01). Consistent with the objective findings, subjects reported improved subjective sleep quality (p = 0.043) and reduced daytime sleepiness (p = 0.047). CONCLUSION: The combination of a personalized dietary plan with exercise training enhances sleep initiation, sleep continuity, sleep duration, REM and N1 sleep stages, independently of carbohydrate type or timing. Lifestyle interventions should be investigated further to promote sleep quality and recovery. REGISTRATION: The trial was registered at clinicaltrials.gov as NCT05464342.

Defining and reporting exercise intensity in interventions for older adults: a modified Delphi process.

BACKGROUND: Many exercise studies, including older adults, do not report all relevant exercise characteristics. Especially the description of exercise intensity is missing and mostly not controlled. This leads to difficulties in interpreting study results and summarizing the evidence in systematic reviews or meta-analyses. Therefore, the aim of the present Delphi study was to gain recommendations about the categorization of exercise intensity and for the conducting and reporting of characteristics in future intervention studies with older adults by experts in exercise science and physiology. METHODS: Two hundred ninety-seven international interdisciplinary participants from an EU COST action were invited to participate in three rounds of online questionnaires in April/May 2023. Up to N = 93 experts participated in each round. Round 1 included open-ended questions to solicit possible recommendations and categorizations for light, moderate, vigorous, and high intensity. In round 2, the experts rated their agreement using Likert scales (1-10) on the revealed categories and recommendations. Clusters with a higher average rating of M = 8.0 were summarized into round 3. In the final round, the results were presented for a final rating of agreement (based on a simple majority > 50%). RESULTS: In round 1 a total of 416 qualitative statements were provided from thirteen questions. From round 1 to round 3, a total of 38 items were excluded, with 205 items retained for the final consensus. In round three 37 participants completed the whole questionnaire. The experts showed overall agreement on the final categorizations with 6.7 to 8.8 out of 10 points on the Likert scale. They also showed broad consensus on the relevance of reporting exercise intensity and the recommendations for future conducting and reporting of study results. However, exercise types such as yoga, balance, and coordination training led to conflicting results for categorization into light or moderate. DISCUSSION AND IMPLICATIONS: The results of the current survey can be used to classify the intensity of exercise and suggest a practical approach that can be adopted by the scientific community and applied when conducting systematic reviews and meta-analysis articles when vital and objective information regarding exercise intensity is lacking from the original article.

The Acute, Combined, and Separate Effects of Cold Hemodialysis and Intradialytic Exercise in Insulin Sensitivity and Glucose Disposal.

Hemodialysis (HD) patients suffer from multiple health problems, including severe insulin resistance. Both cold dialysis and intradialytic exercise training could elicit health benefits; however, it is still unknown whether the combination of those two approaches could enhance overall health. The current study aimed to evaluate the separate and combined acute effects of a single session of cold dialysis and intradialytic exercise in parameters related to insulin sensitivity and glucose disposal. Ten HD patients (57.2 ± 14.9 years) participated in the study. Each patient participated in four different scenarios during HD: a) typical dialysis with dialysate temperature at 37°C (TD), b) cold dialysis with dialysate temperature at 35°C, c) typical HD combined with a single exercise bout, d) cold dialysis combined with a single exercise bout. Glucose disposal and insulin resistance were assessed immediately after the end of the HD session. None of the examined parameters significantly differed between the four scenarios ( p > 0.05). However, slight numerical changes and moderate to high effect size ( d : 0.50-0.85) were observed between TD versus cold dialysis and TD versus TD + exercise in glucose and insulin disposal rates. A single session of cold and TD with intradialytic exercise may provide an "acute" time-efficient stimulus for consecutively improving glucose disposal and insulin sensitivity.

Dietary Supplements and Musculoskeletal Health and Function.

This Special Issue of Nutrients 'Dietary Supplements and Musculoskeletal Health and Function' provides new insights into the use of a wide range of dietary supplements, such as zinc, creatine, Vitamin D, HMB, BCAA, betaine, glucoraphanin, citrulline and collagen, to improve bone and muscle structure and function [...].

The Effects of Zinc and Selenium Co-Supplementation on Resting Metabolic Rate, Thyroid Function, Physical Fitness, and Functional Capacity in Overweight and Obese People under a Hypocaloric Diet: A Randomized, Double-Blind, and Placebo-Controlled Trial.

Evidence of the effectiveness of zinc (Zn) and selenium (Se) on resting metabolic rate (RMR) and physical function parameters in people with overweight and obesity is scarce, while the effects of zinc and selenium on thyroid function and body composition are still a topic of debate and controversy. The aim of this randomized, double-blind, and placebo-controlled trial was to examine the effects of a hypocaloric diet and Se-Zn co-supplementation on RMR, thyroid function, body composition, physical fitness, and functional capacity in overweight or obese individuals. Twenty-eight overweight-obese participants (mean BMI: 29.4 ± 4.7) were randomly allocated (1:1) to the supplementation group (n = 14, 31.1 ± 5.5 yrs, 9 females) and the placebo group (n = 14, 32.1 ± 4.8 yrs, 6 females). The participants received Zn (25 mg of zinc gluconate/day) and Se (200 mcg of L-selenomethionine/day) or placebo tablets containing starch for eight weeks. The participants of both groups followed a hypocaloric diet during the intervention. RMR, thyroid function, body composition, cardiorespiratory fitness (VO2max), and functional capacity (sit-to-stand tests, timed up-and-go test, and handgrip strength) were assessed before and after the intervention. A significant interaction was found between supplementation and time on RMR (p = 0.045), with the intervention group's RMR increasing from 1923 ± 440 to 2364 ± 410 kcal/day. On the other hand, no interaction between supplementation and time on the thyroid function was found (p > 0.05). Regarding the effects of Zn/Se co-administration on Se levels, a significant interaction between supplementation and time on Se levels was detected (p = 0.004). Specifically, the intervention group's Se serum levels were increased from 83.04 ± 13.59 to 119.40 ± 23.93 µg/L. However, Zn serum levels did not change over time (90.61 ± 23.23 to 89.58 ± 10.61 umol/L). Even though all body composition outcomes improved in the intervention group more than placebo at the second measurement, no supplement × time interaction was detected on body composition (p > 0.05). Cardiorespiratory fitness did not change over the intervention. Yet, a main effect of time was found for some functional capacity tests, with both groups improving similarly over the eight-week intervention period (p < 0.05). In contrast, a supplement x group interaction was found in the performance of the timed up-and-go test (TUG) (p = 0.010), with the supplementation group improving more. In conclusion, an eight-week intervention with Zn/Se co-supplementation combined with a hypocaloric diet increased the RMR, TUG performance, and Se levels in overweight and obese people. However, thyroid function, Zn levels, body composition, and the remaining outcomes of exercise performance remained unchanged.

Nine Months of Hybrid Intradialytic Exercise Training Improves Ejection Fraction and Cardiac Autonomic Nervous System Activity.

Cardiovascular disease is the most common cause of death in hemodialysis (HD) patients. Intradialytic aerobic exercise training has a beneficial effect on cardiovascular system function and reduces mortality in HD patients. However, the impact of other forms of exercise on the cardiovascular system, such as hybrid exercise, is not clear. Briefly, hybrid exercise combines aerobic and strength training in the same session. The present study examined whether hybrid intradialytic exercise has long-term benefits on left ventricular function and structure and the autonomous nervous system in HD patients. In this single-group design, efficacy-based intervention, twelve stable HD patients (10M/2F, 56 ± 19 years) participated in a nine-month-long hybrid intradialytic training program. Both echocardiographic assessments of left ventricular function and structure and heart rate variability (HRV) were assessed pre, during and after the end of the HD session at baseline and after the nine-month intervention. Ejection Fraction (EF), both assessed before and at the end of the HD session, appeared to be significantly improved after the intervention period compared to the baseline values (48.7 ± 11.1 vs. 58.8 ± 6.5, p = 0.046 and 50.0 ± 13.4 vs. 56.1 ± 3.4, p = 0.054 respectively). Regarding HRV assessment, hybrid exercise training increased LF and decreased HF (p < 0.05). Both conventional Doppler and tissue Doppler imaging indices of diastolic function did not change after the intervention period (p > 0.05). In conclusion, long-term intradialytic hybrid exercise training was an effective non-pharmacological approach to improving EF and the cardiac autonomous nervous system in HD patients. Such exercise training programs could be incorporated into HD units to improve the patients' cardiovascular health.

The Effects of Zinc and Selenium Supplementation on Body Composition and Thyroid Function in Individuals with Overweight or Obesity: A Systematic Review.

People with obesity have been found to have lower zinc (Zn) and selenium (Se) circulatory levels and abnormal thyroid function than people with normal weight. Studies about the effects of Zn and Se supplementation on body composition and thyroid function of overweight-obese people showed inconsistent results. A systematic review of randomized controlled trials was conducted to determine the effects of Ζn supplementation, Se supplementation, and their combination on body composition and thyroid function of individuals with overweight or obesity. Databases of PubMed, ScienceDirect, and Cochrane, were searched from inception to February 27, 2022, to identify relevant articles. For the assessment of the methodological quality of the studies, the Jadad scale was used. After screening the articles, thirteen studies were finally included and were analyzed using the strength of the evidence approach. Regarding the effectiveness of Zn supplementation on body composition, moderate evidence was found, while the effects of Se were found to be mixed. Zn supplementation was found to affect the thyroid function of people with overweight or obesity by increasing their free triiodothyronine (FT3) levels. However, this result is based only on one study among hypothyroid patients. At this point, the effectiveness of Zn, Se, and their combination, on the body composition and the thyroid function of people with overweight or obesity cannot safely be determined because of the controversial results, small number, and the limitations of the identified studies. The results of this systematic review must be interpreted with caution due to the limitations detected.

Effect of Tribulus terrestris L. supplementation on Exercise-Induced Oxidative Stress and Delayed Onset Muscle Soreness Markers: A Pilot Study.

Tribulus terrestris L. contains compounds with antioxidant and anti-inflammatory properties, but its effects on exercise-induced oxidative stress and inflammatory responses are unclear. The aim of this study was to examine whether Tribulus terrestris L. supplementation can attenuate oxidative stress and inflammatory responses to acute aerobic exercise and improve DOMS. In a randomized, double-blind, crossover design study, thirteen healthy men received either a daily supplement of Tribulus terrestris L. or a placebo for 4 weeks (2-week wash-out period between trials). Before and after the supplementation periods, participants performed an exercise test to exhaustion (75% VO2max). DOMS, thigh girth, and knee joint range of motion (KJRM) were assessed before and after the exercise (2, 24, and 48 h). Blood samples were analyzed for reduced (GSH) and oxidized (GSSG) glutathione, GSH/GSSG ratio, protein carbonyls, total antioxidant capacity, creatine kinase activity, white blood cell count, and TBARS. Acute exercise to exhaustion induced inflammatory responses and changed the blood redox status in both Tribulus and Placebo groups (p < 0.050). Tribulus terrestris L. improved GSH fall (p = 0.005), GSSG rise (p = 0.001) and maintained a higher level of GSH/GSSG ratio at the 2 h point (p = 0.034). TBARS were lowered, protein carbonyls, creatine kinase activity, and white blood cell count elevation diminished significantly (p < 0.050). Tribulus terrestris L. administration did not affect DOMS, thigh girth, or KJRM (p > 0.050). 4-weeks of Tribulus terrestris L. supplementation effectively attenuates oxidative stress responses but cannot improve DOMS.

Prevalence and Determinants of Restless Legs Syndrome (Willis-Ekbom Disease) in an Older Greek Population.

OBJECTIVES: The present study aimed to explore the descriptive and analytic epidemiology of restless legs syndrome (RLS) in the older Greek population, with a specific focus on lifestyle indicators. METHODS: Baseline data from the randomly selected non-demented older participants of the population-based HELIAD cohort were analyzed. Multivariable binary logistic regression with RLS diagnosis as the dichotomous dependent outcome was performed. Demographic, socioeconomic, anthropometric, dietary, sleep-related and psychological parameters, physical activity, use of psychoactive substances and personal medical history were investigated for potential associations. RESULTS: A total of 133 from the eligible sample of 1,838 participants were diagnosed with RLS. The mean age-sex standardized prevalence of RLS among the elderly was estimated at 6.1% (95%CI = 5.0-7.2), with a female (8.0%, 95%CI = 6.4-9.6) to male (3.7%, 95%CI = 2.4-5.1) ratio of 2.1. The prevalence of RLS peaked during the 8th decade of life and diminished thereafter. The positive associations of RLS with female sex [OR = 2.06, 95%CI = (1.19-3.57)], anxiety levels [assessed by the 22-point HADS scale, OR = 1.08, 95%CI = (1.03-1.13)] and traumatic brain injury [OR = 2.22, 95%CI = (1.37-3.62)] were reproduced. Good sleep quality was related to 55% [95%CI~(24-83%)] lower odds of having RLS in comparison with both poor and moderate quality. Adherence to the Mediterranean dietary pattern [assessed by a 55-point scale, OR = 1.06, 95%CI = (1.01-1.11)], and low daily energy intake [low-moderate vs. low: OR = 0.45, 95%CI = (0.26-0.79)]; [moderate-high vs. low: OR = 0.69, 95%CI = (0.40-1.22)]; [high vs. low: OR = 0.31, 95%CI = (0.13-0.69)] were related to RLS for the first time. CONCLUSIONS: More emphasis should be placed on the dietary-nutritional aspects of RLS.

Risk factors for shoulder injuries in handball: systematic review.

BACKGROUND: Handball is a sport with a high number of severe injuries. The shoulder is one of the most commonly injured joints, with an average prevalence of 17-41%. OBJECTIVE: The primary aim is to identify the most significant risk factors related to shoulder injuries in handball. The secondary aim is to propose recommendations based on the available evidence concerning potential injury prevention strategies. METHODS: Systematic searches of PubMed, MEDLINE, CINAHL, Proquest, SPORTDiscus, Web of Science, EMBASE, and Scopus were undertaken for peer reviewed articles published between 15 July 1995 and 15 July 2019. The same search strategy was repeated on 24 April 2022. Prospective cohort studies, written in English and published in a journal with a peer-review process aiming to investigate at least one modifiable or/and a non-modifiable potential risk factor for shoulder injuries, specifically in handball players, were included. Only papers published after 1995 were included. The methodological quality of the eligible studies was assessed using the modified version of the Downs and Black Checklist. The Best Evidence Synthesis (BES) approach was used for synthesizing and reporting the results. RESULTS: 1849 studies were identified, of which 8 were included. A total of 2536 (males = 1354, females = 1182) participants of which 2522 were handball athletes, were included. Four of the eight studies were rated as high methodological quality studies (> 85%) while the rest were rated as medium (50-85%). The risk factors for shoulder injuries in handball identified in the studies were strength imbalances (n = 6), glenohumeral range of motion (ROM) imbalances (n = 5), scapular dyskinesis (n = 5), incorrect dosage of training load (n = 2), previous injury (n = 1), sex (n = 2), player's position, school grade, playing level (n = 1), altered shoulder joint position sense (n = 1). CONCLUSION: Overall, from all the risk factors evaluated, there was strong evidence that the weakness of the shoulder external rotator muscles and the female sex increase the probability of shoulder injury in handball athletes. Nevertheless, the evidence for the other risk factors was moderate due to the methodological quality and the limited number of studies. PROTOCOL REGISTRATION: PROSPERO ID: CRD42020138233.

The Addition of High-Load Resistance Exercises to a High-Intensity Functional Training Program Elicits Further Improvements in Body Composition and Strength: A Randomized Trial.

The current study aimed to examine the effects of adding specific high-load resistance exercises to a high-intensity functional training (HIFT) program on healthy adults' physical fitness and body composition. Twenty recreationally active volunteers (30 ± 4 y, 12 females, 8 males) were randomly assigned to either a HIFT-control (HIFT-C, n = 10) or HIFT-power (HIFT-P, n = 10) group and trained three times per week for eight weeks. The HIFT-C protocol included four rounds of an 8-exercise circuit (30:15 s work: rest, 2 min rest after the second round). The exercises used were clean-and-press, box jump, TRX chest press, wall ball throws, burpees, repeated 10 m sprints, sumo squat-and-upright row, and abdominal crunches. The HIFT-P-group replaced TRX chest press with bench press and squat-and-upright row with squat, both at an intensity of 80% 1 RM. Before and after the intervention, participants underwent an evaluation of body composition, cardiorespiratory fitness, vertical jump, 1 RM bench press, and the maximum number of abdominal crunches in 1 min. In both groups, cardiorespiratory fitness, squat jump, countermovement jump, bench press 1 RM, and percent body fat improved significantly after the intervention (p < 0.050), while a trend towards significant time x group interaction was found for bench press 1 RM (p = 0.076), indicating a superiority of HIFT-P over HIFT-C. Muscle mass significantly increased by 3.3% in the HIFT-P group, while abdominal muscle endurance improved by 16.2% in the HIFT-C group (p < 0.050). Short-term HIFT resulted in improvements in whole-body cardiorespiratory and neuromuscular fitness and reduction of body fat. The addition of high-load resistance exercises was well tolerated and resulted in increased muscle mass and upper body maximal strength. HIFT-P programs can be suitable for individuals seeking to enhance muscle mass and physical fitness in a short time.