Modification and refinement of three-dimensional reconstruction to estimate body volume from a simulated single-camera image.

Objective: Body volumes (BV) are used for calculating body composition to perform obesity assessments. Conventional BV estimation techniques, such as underwater weighing, can be difficult to apply. Advanced machine learning techniques enable multiple obesity-related body measurements to be obtained using a single-camera image; however, the accuracy of BV calculated using these techniques is unknown. This study aims to adapt and evaluate a machine learning technique, synthetic training for real accurate pose and shape (STRAPS), to estimate BV. Methods: The machine learning technique, STRAPS, was applied to generate three-dimensional (3D) models from simulated two-dimensional (2D) images; these 3D models were then scaled with body stature and BV were estimated using regression models corrected for body mass. A commercial 3D scan dataset with a wide range of participants (n = 4318) was used to compare reference and estimated BV data. Results: The developed methods estimated BV with small relative standard errors of estimation (<7%) although performance varied when applied to different groups. The BV estimated for people with body mass index (BMI) < 30 kg/m2 (1.9% for males and 1.8% for females) were more accurate than for people with BMI ≥ 30 kg/m2 (6.9% for males and 2.4% for females). Conclusions: The developed method can be used for females and males with BMI < 30 kg/m2 in BV estimation and could be used for obesity assessments at home or clinic settings.

Understanding the Needs and Priorities of People Living with Persistent Pain and Long-Term Musculoskeletal Conditions during the COVID-19 Pandemic-A Public Involvement Project.

BACKGROUND: Critiques of public involvement (PI) are associated with failing to be inclusive of under-represented groups, and this leads to research that fails to include a diversity of perspectives. AIM: The aim of this PI project was to understand the experiences and priorities of people from three seldom-heard groups whose musculoskeletal pain may have been exacerbated or treatment delayed due to COVID-19. Engaging representatives to report diverse experiences was important, given the goal of developing further research into personalised and integrated care and addressing population health concerns about access and self-management for people with musculoskeletal pain. METHODS: The project was approved via Sheffield Hallam University Ethics but was exempt from further HRA approval. A literature review was conducted, followed by informal individual and group discussions involving professionals and people with lived experience of (a) fibromyalgia pain, (b) those waiting for elective surgery and (c) experts associated with the care home sector. Findings from the literature review were combined with the insights from the public involvement. Resulting narratives were developed to highlight the challenges associated with persistent pain and informed the creation of consensus statements on the priorities for service improvement and future research. The consensus statements were shared and refined with input from an expert steering group. RESULTS: The narratives describe pain as a uniformly difficult experience to share with professionals; it is described as exhausting, frustrating and socially limiting. Pain leads to exclusion from routine daily activities and often resigns people to feeling and being unwell. In all cases, there are concerns about accessing and improving services and critical issues associated with optimising physical activity, functional wellbeing and managing polypharmacy. Exercise and/or mobilisation are important and commonly used self-management strategies, but opportunity and advice about safe methods are variable. Services should focus on personalised care, including self-management support and medication management, so that people's views and needs are heard and validated by health professionals. CONCLUSIONS: More research is needed to explore the most effective pain management strategies, and public involvement is important to shape the most relevant research questions. Health and care systems evaluation is also needed to address the scale of the population health need. The pandemic appears to have highlighted pre-existing shortcomings in holistic pain management.

"I Want to Create So Much Stimulus That Adaptation Goes Through the Roof": High-Performance Strength Coaches' Perceptions of Planned Overreaching.

Functional overreaching (FOR) occurs when athletes experience improved athletic capabilities in the days and weeks following short-term periods of increased training demand. However, prolonged high training demand with insufficient recovery may also lead to non-functional overreaching (NFOR) or the overtraining syndrome (OTS). The aim of this research was to explore strength coaches' perceptions and experiences of planned overreaching (POR); short-term periods of increased training demand designed to improve athletic performance. Fourteen high-performance strength coaches (weightlifting; n = 5, powerlifting; n = 4, sprinting; n = 2, throws; n = 2, jumps; n = 1) participated in semistructured interviews. Reflexive thematic analysis identified 3 themes: creating enough challenge, training prescription, and questioning the risk to reward. POR was implemented for a 7 to 14 day training cycle and facilitated through increased daily/weekly training volume and/or training intensity. Participants implemented POR in the weeks (~5-8 weeks) preceding competition to allow sufficient time for performance restoration and improvement to occur. Short-term decreased performance capacity, both during and in the days to weeks following training, was an anticipated by-product of POR, and at times used as a benchmark to confirm that training demand was sufficiently challenging. Some participants chose not to implement POR due to a lack of knowledge, confidence, and/or perceived increased risk of athlete training maladaptation. Additionally, this research highlights the potential dichotomy between POR protocols used by strength coaches to enhance athletic performance and those used for the purpose of inducing training maladaptation for diagnostic identification.

COVID-19 and the long-term cardio-respiratory and metabolic health complications.

Severe acute respiratory syndrome coronavirus type-2 (SARS-CoV-2) transmission continues to impact people globally. Whilst the acute symptoms and management strategies are well documented, millions of people globally are experiencing a prolonged and debilitating symptom profile that is reported to last months and even years. COVID-19 is a multi-system disease however the magnitude of the effects and its associated legacy is presently not well understood. Early reports indicate that multidisciplinary approaches between clinical and non-clinical entities are needed to provide effective and rehabilitative patient support pathways and restore pre-COVID-19 quality of life and functional status. Accordingly, this review provides a summary of the impact on cardiovascular, inflammatory, respiratory, and musculoskeletal function following an acute COVID-19 infection along with the prolonged effects of long-COVID.

Assessing the Acceptability of a Co-Produced Long COVID Intervention in an Underserved Community in the UK.

BACKGROUND: The COVID-19 pandemic has disproportionately affected people from more deprived communities. The experience of Long COVID is similarly distributed but very few investigations have concentrated on the needs of this population. The aim of this project was to co-produce an acceptable intervention for people with Long COVID living in communities recognised as more deprived. METHODS: The intervention was based on a multi-disciplinary team using approaches from sport and exercise medicine and functional rehabilitation. The co-production process was undertaken with a stakeholder advisory group and patient public involvement representation. This study identified participants by postcode and the indices of multiple deprivation (IMD); recruitment and engagement were supported by an existing health and wellbeing service. A virtual 'clinic' was offered with a team of professional practitioners who met participants three times each; to directly consider their needs and offer structured advice. The acceptability of the intervention was based on the individual's participation and their completion of the intervention. RESULTS: Ten participants were recruited with eight completing the intervention. The partnership with an existing community health and wellbeing service was deemed to be an important way of reaching participants. Two men and six women ages ranging from 38 to 73 were involved and their needs were commonly associated with fatigue, anxiety and depression with overall de-conditioning. None reported serious hardship associated with the pandemic although most were in self-employment/part-time employment or were not working due to retirement or ill-health. Two older participants lived alone, and others were single parents and had considerable challenges associated with managing a household alongside their Long COVID difficulties. CONCLUSIONS: This paper presents the needs and perspectives of eight individuals involved in the process and discusses the needs and preferences of the group in relation to their support for self- managed recovery from Long COVID.

Agreement between methods and terminology used to assess the kinematics of the Nordic hamstring exercise.

The Nordic hamstring exercise (NHE) is employed as a component of preventative training programmes to minimise hamstring strain injury risk. Variation in the methods and terminology used to assess the NHE makes comparison between studies difficult. We aimed to compare the utility of kinetic and kinematic metrics by comparing several collected concurrently. 18 male recreational rugby union participants completed 3 bilateral NHE repetitions on a hamstring device equipped with in-line strain gauge load cells, integrated with a 3-dimensional motion tracking system. Mean break-point angle occurred after the angle at first acceleration (121.5 ± 10.4° vs. 119.2 ± 7.1°) whereas break-torque angle (BTA) occurred later in the NHE action (126.0 ± 9.8°) showing highest correlation to the angle at greatest acceleration (123.9 ± 7.9°, r = 0.85). Future research should consider movement quality as the angular velocity of the knee joint at BTA demonstrated large variation (range = 3.6-93.4 deg·s1), with high intrasubject variability of relative trunk-to-thigh angle at peak-torque (range = 0.4-44.7°). This study proposes standardisation of methods and terminology used to define the NHE. Measuring BTA is recommended to represent the point at which hamstring muscle failure occurs, specific to the proposed injury mechanism during high-speed running.

"Is It Overtraining or Just Work Ethic?": Coaches' Perceptions of Overtraining in High-Performance Strength Sports.

Optimal physical performance is achieved through the careful manipulation of training and recovery. Short-term increases in training demand can induce functional overreaching (FOR) that can lead to improved physical capabilities, whereas nonfunctional overreaching (NFOR) or the overtraining syndrome (OTS) occur when high training-demand is applied for extensive periods with limited recovery. To date, little is known about the OTS in strength sports, particularly from the perspective of the strength sport coach. Fourteen high-performance strength sport coaches from a range of strength sports (weightlifting; n = 5, powerlifting; n = 4, sprinting; n = 2, throws; n = 2, jumps; n = 1) participated in semistructured interviews (mean duration 57; SD = 10 min) to discuss their experiences of the OTS. Reflexive thematic analysis resulted in the identification of four higher order themes: definitions, symptoms, recovery and experiences and observations. Additional subthemes were created to facilitate organisation and presentation of data, and to aid both cohesiveness of reporting and publicising of results. Participants provided varied and sometimes dichotomous perceptions of the OTS and proposed a multifactorial profile of diagnostic symptoms. Prevalence of OTS within strength sports was considered low, with the majority of participants not observing or experiencing long-term reductions in performance with their athletes.

The Relationship Between Neuromuscular Function and the W' in Elite Cyclists.

PURPOSE: To assess the association between the W' and measures of neuromuscular function relating to the capacity of skeletal muscle to produce force in a group of elite cyclists. METHODS: Twenty-two athletes specializing in a range of disciplines and competing internationally volunteered to participate. Athletes completed assessments of maximum voluntary torque (MVT), voluntary activation, and isometric maximum voluntary contraction to measure rate of torque development (RTD). This was followed by assessment of peak power output (PPO) and 3-, 5-, and 12-minute time trials to determine critical power. Pearson correlation was used to examine associations with critical power and W'. Goodness of fit was calculated, and significant relationships were included in a linear stepwise regression model. RESULTS: Significant positive relationships were evident between W' and MVT (r = .82), PPO (r = .70), and RTD at 200 milliseconds (r = .59) but not with RTD at 50 milliseconds and voluntary activation. Correlations were also observed between critical power and RTD at 200 milliseconds and MVT (r = .54 and r = .51, respectively) but not with PPO, voluntary activation, or RTD at 50 milliseconds. The regression analysis found that 87% of the variability in W' (F1,18 = 68.75; P < .001) was explained by 2 variables: MVT (81%) and PPO (6%). CONCLUSIONS: It is likely that muscle size and strength, as opposed to neural factors, contribute meaningfully to W'. These data can be used to establish training methods to enhance W' to improve cycling performance in well-trained athletes.

Development of a Novel Nordic Hamstring Exercise Device to Measure and Modify the Knee Flexors' Torque-Length Relationship.

The Nordic hamstring exercise (NHE) has been shown to reduce hamstring injury risk when employed in training programs. This study investigates a novel device to modify the NHE torque-length relationship of the knee flexors, as targeting the hamstrings at a more extended length may have benefits for hamstring strain injury prevention and rehabilitation. Eighteen recreational male participants completed three bilateral NHE repetitions at a conventional 0° flat position, a 10° incline, and a 10° decline slope on a novel device (HALHAM°). Measures of peak torque and break-torque angle explored the effect of inclination on the knee flexors' length-tension relationship. Relative thigh-to-trunk angle and angular velocity of the knee joint were used to assess influence of inclination on technique and exercise quality. Break-torque angle increased when performed at an incline (134.1 ± 8.6°) compared to both the decline (112.1 ± 8.3°, p <0.0001, g = 2.599) and standard flat NHE positions (126.0 ± 9.8°, p = 0.0002, g = 0.885). Despite this, altering inclination did not affect eccentric knee flexor peak torque (decline = 132.0 ± 63.1 Nm, flat = 149.7 ± 70.1 Nm, incline = 148.9 ± 64.9 Nm, F = 0.952, p = 0.389), angular velocity of the knee joint at break-torque angle (decline = 23.8 ± 14.4°, flat = 29.2 ± 22.6°, incline = 24.5 ± 22.6°, F = 0.880, p = 0.418) or relative thigh-to-trunk angle at break-torque angle (decline = 20.4 ± 10.4°, flat = 16.7 ± 10.8°, incline = 20.2 ± 11.2°, F = 1.597, p = 0.207). The report recommends the use of arbitrary metrics such as break-torque angle that can be replicated practically in the field by practitioners to assess proxy muscle length changes i.e., the angular range over which the torque can be produced. Inclination of the Nordic hamstring exercise leads to hamstring muscle failure at longer muscle lengths without reductions in the maximal force exuded by the muscle. Therefore, the NHE performed on an incline may be a more effective training intervention, specific to the proposed mechanism of hamstring strain injury during sprinting that occurs whilst the muscle is rapidly lengthening. Using a graded training intervention through the inclinations could aid gradual return-to-play rehabilitation.

A flow resistive inspiratory muscle training mask worn during high-intensity interval training does not improve 5 km running time-trial performance.

PURPOSE: There is little evidence of the ergogenic effect of flow-resistive masks worn during exercise. We compared a flow-resistive face mask (MASK) worn during high-intensity interval training (HIIT) against pressure threshold loading inspiratory muscle training (IMT). METHODS: 23 participants (13 males) completed a 5 km time trial and six weeks of HIIT (3 sessions weekly). HIIT (n = 8) consisted of repeated work (2 min) at the speed equivalent to 95% [Formula: see text]O2 peak with equal rest. Repetitions were incremental (six in weeks 1, 2 and 6, eight in weeks 3 and 4 and ten in week 5). Participants were allocated to one of three training groups. MASK (n = 8) wore a flow-resistive mask during all sessions. The IMT group (n = 8) completed 2 × 30 breaths daily at 50% maximum inspiratory pressure (PImax). A control group (CON, n = 7) completed HIIT only. Following HIIT, participants completed two 5 km time trials, the first matched identically to pre-intervention trial (ISO time), and a self-paced effort. RESULTS: Time trial performance was improved in all groups (MASK 3.1 ± 1.7%, IMT, 5.7 ± 1.5% and CON 2.6 ± 1.0%, p < 0.05). IMT improved greater than MASK and CON (p = 0.004). Post intervention, PImax and diaphragm thickness were improved in IMT only (32% and 9.5%, respectively, p = 0.003 and 0.024). CONCLUSION: A flow-resistive mask worn during HIIT provides no benefit to 5 km performance when compared to HIIT only. Supplementing HIIT with IMT improves respiratory muscle strength, morphology and performance greater than HIIT alone.

Mechanical and morphological determinants of peak power output in elite cyclists.

Mechanical peak power output (PPO) is a determinant of performance in sprint cycling. The purpose of this study was to examine the relationship between PPO and putative physiological determinants of PPO in elite cyclists, and to compare sprint performance between elite sprint and endurance cyclists. Thirty-five elite cyclists (18 endurance; 17 sprint) performed duplicate sprint cycling laboratory tests to establish PPO and its mechanical components. Quadriceps femoris (QVOL ) and hamstring muscle volume (HAMVOL ) were assessed with MRI, vastus lateralis pennation angle (PθVL ) and fascicle length (FLVL ) were determined with ultrasound imaging, and neuromuscular activation of three muscles was assessed using EMG at PPO during sprint cycling. For the whole cohort, there was a wide variability in PPO (range 775-2025 W) with very large, positive, bivariate relationships between PPO and QVOL (r = .87), HAMVOL (r = .71), and PθVL (r = .81). Step-wise multiple regression analysis revealed that 87% of the variability in PPO between cyclists was explained by two variables QVOL (76%) and PθVL (11%). The sprint cyclists had greater PPO (+61%; P < .001 vs endurance), larger QVOL (P < .001), and BFVOL (P < .001) as well as more pennate vastus lateralis muscles (P < .001). These findings emphasize the importance of quadriceps muscle morphology for sprint cycling events.