Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials.

OBJECTIVE: To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. DESIGN: Systematic review and network meta-analysis. METHODS: Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. DATA SOURCES: Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. RESULTS: 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. CONCLUSIONS: Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018118040.

The effects of aerobic and resistance exercise on blood pressure in uncomplicated and at risk pregnancies: A systematic review and meta-analysis.

BACKGROUND: Regular exercise performed during pregnancy has been shown to reduce the risk of developing perinatal gestational hypertensive conditions. Further evidence on the exact parameters of exercise needed to explain these beneficial responses is required, within both uncomplicated and at-risk pregnancies. OBJECTIVE: The aim of this systematic review and meta-analysis was to investigate the effects of aerobic and resistance exercise on blood pressure during pregnancy. DESIGN: Systematic review and meta-analysis. DATA SOURCES AND METHODS: An online search of six search engines was conducted up to February 2023. Randomized controlled trials, quasi-experimental, cohort, and longitudinal studies were included. Studies included an acute exercise bout or intervention of land-based aerobic and/or resistance exercise during any trimester in uncomplicated and at-risk pregnancies. Outcomes included mean arterial pressure (MAP), or systolic blood pressure (SBP) and diastolic blood pressure (DBP). RESULTS: Following the removal of duplicates, 1538 articles were screened with 59 studies meeting the inclusion criteria for the review (randomized controlled trials (RCTs) n = 34, clinical trials n = 19, cohort n = 5 and cross-sectional n = 2), and 21 studies included in the meta-analysis. A random effects model was used with mean difference calculated in mmHg. Overall, there were no statistically significant effects of exercise on resting blood pressure (BP) outcomes in pregnant women with normal blood pressure compared to control/usual care populations following intervention (SBP mean diff -1.54 mmHg (favours intervention), p = 0.38; DBP mean diff -2.25 mmHg (favours intervention), p = 0.1; MAP mean diff -1.75 mmHg (favours intervention), p = 0.31). In at-risk pregnant women, both aerobic and combination exercise significantly reduced BP outcomes compared to control (SBP mean diff -3.91 mmHg, p < 0.01; DBP mean diff -2.9 mmHg, p = 0.01; MAP mean diff -2.38 mmHg, p = 0.01). Twenty-seven studies reported an acute increase in SBP and DBP during aerobic exercise, with no difference found between uncomplicated and at-risk pregnancies. CONCLUSIONS: Compared to usual care, aerobic and/or resistance exercise performed throughout uncomplicated pregnancy had no influence on blood pressure. Pregnant women with no diagnosed complications should be encouraged to exercise regularly due to the multitude of known benefits. In women who are at risk of, or diagnosed, with gestational hypertensive conditions during pregnancy, moderate to vigorous exercise during pregnancy improves blood pressure outcomes. Higher risk pregnancies may reduce their risk of future cardiovascular complications through regular exercise training during pregnancy. REGISTRATION: CRD42020159998.

Longitudinal association of physical activity during pregnancy with maternal and infant outcomes: Findings from the Australian longitudinal study of women's health.

BACKGROUND: Physical activity has known benefits during pregnancy; however, the optimum volume of physical activity through the different stages of pregnancy is not well known. OBJECTIVES: The aims of this study were to investigate the associations of physical activity volume in pregnant women in each trimester of pregnancy with maternal and infant outcomes. DESIGN: The study involved 1657 pregnant women from the Australian Longitudinal Study on Women's Health, who completed surveys from 2006 to 2012 (aged 28-39 years). METHODS: Women reported being in either the first, second or third trimester of pregnancy. Women were grouped into four groups according to their self-reported physical activity during pregnancy: (1) Nil (0-<33.3 MET.min/week), (2) Low (33.3-<500 MET.min/week), (3) Moderate (500-<1000 MET.min/week) and (4) High (⩾1000 MET.min/week). Women who reported their physical activity during pregnancy completed a survey within three years after the birth, relating to outcomes associated with pregnancy and childbirth (gestational diabetes, hypertension, and antenatal depression and anxiety) and infant outcomes (birthweight and prematurity). RESULTS: There was no association of physical activity in any trimester with infant birthweight, prematurity, gestational diabetes, hypertension or antenatal depression. Antenatal anxiety was less prevalent in women who reported low (1.7%) or moderate (1.1%) physical activity than in those who reported no activity (4.7%; p = 0.01). CONCLUSION: Different amounts of physical activity during pregnancy were not associated with the measured adverse health outcomes. However, low and moderate amounts of physical activity were associated with reduced incidence of antenatal anxiety.

What are the odds? Identifying factors related to competitive success in powerlifting.

BACKGROUND: The ability for athletes to gain a competitive advantage over their opponents is well recognised. At times, this advantage may be considered a marginal gain. However, in the context of competition, marginal advantages may be the difference between winning and losing. This investigation explores how competition factors influence the odds of competitive success (i.e. winning) in powerlifting (PL) to assist athletes and coaches in achieving a competitive advantage. METHODS: A cross-sectional, retrospective analysis of competition data from raw/classic, Australian powerlifting competitions 2010-2019 was conducted. Data included 10,599 competition entries (males: n = 6567 [62%], females: n = 4032 [38%]). Independent t-tests were used to compare continuous data between sexes or winners and non-winners at an event. Cohen's d and the 95% confidence interval (d [95% CI]) were calculated. Univariate odds of winning an event based on independent variables (age [irrespective of category], sex, body weight and weight of first lift attempt [regardless of success]), were assessed by separate simple logistic regression. RESULTS: When compared to males, the odds of winning for females were 50% greater (OR [95% CI] 1.500 [1.384, 1.625]; P < 0.001). Athletes who had larger first lift attempts (Squat: + 7.0 kg P < 0.001, Bench Press: + 3.2 kg P < 0.001, and Deadlift: + 6.1 kg P < 0.001and competed for a longer period (winners: 401 vs non-winners: 304 days, P < 0.001) had an increased likelihood winning. Age was associated with increased odds of success for males (OR [95% CI] 1.014 [1.009, 1.019], P < 0.001) per additional year of age for males, but not females (P = 0.509). CONCLUSIONS: Multiple factors appear to contribute to the likelihood of winning a PL competition. These results may help coaches to develop competition and training strategies that optimise athletes' likelihood of competitive success in PL.

Long-Term Adaptations in the Squat, Bench Press, and Deadlift: Assessing Strength Gain in Powerlifting Athletes.

PURPOSE: Understanding strength changes with resistance training is important in human performance. It also enables better understanding into the expected magnitude of strength increase and factors that influence this change over time. METHODS: Squat, bench press, and deadlift scores were collated from 407 powerlifting meets (n = 1896 unique competitors: ~625 females, ~1270 males) between 2003 and 2018. Absolute (in kilograms) and relative starting strength (in kilograms per body weight) for each lift type was expressed for both sexes. Maximum and overall strength gain per day and per year (in kilograms) was calculated by comparing first and final, or maximum scores for each lift, respectively, and considered based on strength quartile classification. Paired and independent t-tests compared strength changes from baseline and between sexes. One-way ANOVAs compared strength changes between quartiles. Pearson correlations assessed relationships between strength changes over time, and baseline strength, number of competitions, and total days competing. RESULTS: Maximum strength adaptations were greater for squat (20.2-25.4 kg·yr-1) and deadlift (18.1-21.1 kg·yr-1) compared with bench press (10.5-12.8 kg·yr-1, P ≤ 0.001). However, the change in absolute (all lifts: P = 0.247-0.379) and relative strength (all lifts: P = 0.641-0.821) did not differ between sexes. For females, maximum strength gain per day did not differ by quartile (all lifts: P = 0.091-0.746), nor did overall strength gain per day (P = 0.151-0.575). Conversely, males in the fourth quartile generally displayed lower maximum and overall strength gain per day. CONCLUSIONS: These findings show differences in strength gain between upper- and lower-body lifts, but not sex differences in the change in strength. In line with previous research, the strongest males likely gain strength more slowly than weaker counterparts. Professionals should consider this information in the training, assessment, and long-term benchmarking of athletes whose sports require a focus on muscular strength.

Impacts of squat attempt weight selection and success on powerlifting performance.

BACKGROUND: To date, there is no evidence to support the optimal competition strategy for success in powerlifting competitions. The purpose of this study was to analyze powerlifting (PL) competition data to assess the relationship between squat attempts, the success of each lift attempt, and weight increase between attempts, with winning. METHODS: The analysis from 'raw' Powerlifting Australia sanctioned competitions held between 2008 and 2019 included 10,672 individual competition entries (males: N.=6617, females: N.=4055). We reported Cohen's d, statistical significance, 95% confidence intervals and the univariate odds of winning an event. Factors were assessed by separate simple logistic regression and reported as an odds ratio. RESULTS: Overall, first squat attempt weight for those who won was on average 7.0 kg greater (P<0.001, d=0.14 [0.10, 0.18]) than for non-winners. In the total sample, athletes selected opening attempts which were an average of 92% of their achieved maximum on the day with 93.5% of competitors improving on this weight in subsequent attempts. Winners had a 0.5 kg (P<0.001, d=0.10 [0.06, 0.14]) greater absolute increase in weight between first and second lift attempts than non-winners. Overall, ~68% of winners successfully lifted their third attempt weight compared to ~64% of non-winners (P<0.001). CONCLUSIONS: A powerlifting athlete's odds of winning a competition overall are significantly increased by selecting a larger opening squat attempt weight than competitors and completing the attempt successfully. The opening squat may be one of the most important lifts during competition.

Nuclear factor (erythroid-derived 2)-like 2 (Nrf2) and exercise.

Chronic metabolic health diseases are increasing worldwide placing strain on healthcare systems and importantly, impacting individuals' quality of life. It is well established that many chronic diseases are associated with inflammation and oxidative stress. Exercise is a known strategy to manage and treat inflammation in animals and humans. Understanding the mechanisms which cause acute and chronic changes to systems via various exercise protocols may provide insights into how we can better clinically manage patients with inflammatory and oxidative stress associated diseases. Nrf2 is a basic leucine transcription factor which regulates the expression of antioxidant proteins to protect against damage caused by electrophilic or oxidative stress. The aim of this narrative review is to provide an overview of the literature which has investigated the relationship between acute and chronic exercise training and Nrf2 protein, mRNA and Nrf2-ARE binding activity. This narrative review presents analysis of twenty-nine articles presenting studies using animals and humans. Findings from animal models suggest that exercise increases all molecular aspects of the Nrf2-ARE pathway in all tissues studied. It was noted that there seems to be an age-related decline in Nrf2 protein upregulation with exercise training. In humans, however, there is a lack of evidence to support this claim.

Long-Term Strength Adaptation: A 15-Year Analysis of Powerlifting Athletes.

Latella, C, Teo, W-P, Spathis, J, and van den Hoek, D. Long-term strength adaptation: A 15-year analysis of powerlifting athletes. J Strength Cond Res 34(9): 2412-2418, 2020-Strength is a fundamental component of athletic performance and development. This investigation examined the long-term strength development of powerlifting (PL) athletes. The rate of strength gain/day was assessed in 1897 PL athletes (F = 626, M = 1,271) over a 15-year period (2003-2018). Independent T-tests explored sex differences in baseline absolute (kg) and relative strength (kg·body mass [bm]) recorded from the first competition, and strength gain/day (kg·d). Analyses based on initial strength quartiles were conducted using one-way analysis of variances with significance set at p < 0.05. Bivariate correlational analysis tested for relationships between strength gain/day and baseline strength, the number of competitions, and mean days between competitions. Males had greater absolute (M: 513.3 ± 99.8 kg, F: 289.4 ± 55.7 kg, p < 0.001) and relative (M: 5.89 ± 1.04 kg·bm, F: 4.27 ± 0.85 kg·bm, p < 0.001) strength at baseline. Overall, strength gain/day (F: 0.12 ± 0.69 kg·d, M: 0.15 ± 0.44 kg·d, p = 0.318) was similar between sexes. However, the strongest males showed a lower rate of strength improvement (0.102 kg·d) compared with least strong males (0.211 kg·d), p = 0.010. No differences were observed across quartiles for females. Correlational analyses revealed significant but weak negative relationships between strength gain/day and the mean days between competitions for females (r = -0.120, p = 0.003) and males (r = -0.190, p < 0.001). Similar relationships were observed for baseline strength (r = -0.073, p = 0.009) and the number of competitions (r = -0.111, p < 0.001) for males. The results suggest similar strength adaptation between sexes. The strongest males improve more slowly, possibly due to a ceiling effect. Collectively, the findings provide novel evidence of real-world long-term strength adaptations that may be particularly useful to understand athlete development, to aid periodized programming, and to benchmark strength over time.

Effect of Competition Frequency on Strength Performance of Powerlifting Athletes.

Pearson, J, Spathis, JG, van den Hoek, DJ, Owen, PJ, Weakley, J, and Latella, C. Effect of competition frequency on strength performance of powerlifting athletes. J Strength Cond Res 34(5): 1213-1219, 2020-Powerlifting (PL) requires athletes to achieve the highest possible "total" weight lifted across squat, bench press, and deadlift. Athletes compete multiple times per year; however, it is not well understood how often PL athletes should compete to facilitate maximal strength performance. This study investigated the effect of competition frequency on strength (relative and absolute) in PL athletes over a 12-month period. Results across all male (n = 563, mean ± SD; age; 28 ± 10 years, body mass; 89.3 ± 19.3 kg) and female (n = 437, age; 31 ± 11 years, body mass; 70.1 ± 15.8 kg) PL athletes were collated. Total competition scores were used to calculate absolute and relative strength for each competition. Linear mixed models with random effects, and effect sizes ± 95% confidence intervals compared competition frequency and total score for (a) all, (b) male, and (c) female competition entries, respectively. The association between total score at each competition was assessed with Pearson's correlation coefficient for the same independent variables. Results demonstrate greater absolute strength at competition 2 for all athletes (5.1%: p = 0.043: d = 0.16) and males (2.9%: p = 0.049: d = 0.15). For females, absolute strength was greater at competition 5 compared to 1 (12.0%: p = 0.001: d = 0.65) and 2 (9.6%: p = 0.007: d = 0.50). Weak positive correlations for relative strength and number of times competed for males were evident between competitions 1 to 4 (r = 0.070-0.085, p = 0.003-0.043). For females, 3 competitions weakly correlated with absolute strength (r = 0.106, p = 0.016). PL athletes who compete multiple times per year are more likely to achieve higher totals; however, there is an upper limit to the number of competitions (4 per year) that seem to allow a performance increase.

Guidelines for the delivery and monitoring of high intensity interval training in clinical populations.

High intensity interval training (HIIT) is now recognized in international clinical-based exercise guidelines as an appropriate and beneficial adjunct to moderate intensity continuous training. HIIT involves alternating periods of high intensity aerobic exercise with light recovery exercise or no exercise, allowing for greater physiological stimulus and adaptation than moderate intensity continuous training (MICT) for cardiorespiratory fitness and other cardiometabolic processes. However, there is no universal criteria or framework for the prescription and monitoring of HIIT in clinical populations, and safety concerns remain a common barrier for implementing HIIT as standard care. Historically, exercise intensity has been prescribed using heart rate (HR) targets derived from either a predicted maximal HR (HRmax) or from an attempt to objectively measure HRmax. However, using this approach alone has a number of limitations. Here we provide guidelines to improve the delivery of HIIT in cardiometabolic populations using 1) a framework for HIIT prescription using a combination of objective and subjective measures of exercise intensity, and 2) clinical considerations for assessment and monitoring to maximize patient safety. The framework involves an individualized step-by-step process to calculate, validate, and calibrate HR target zones for HIIT training to allow for appropriate workload prescription and progression. We strongly recommend this framework be used in future clinical trials investigating HIIT.

A battery of strength tests for evidence-based classification in Para swimming.

This study examined the validity of isometric strength tests for evidence-based classification in Para swimming. Thirty non-disabled participants and forty-two Para swimmers with physical impairment completed an isometric strength test battery designed to explain activity limitation in the freestyle discipline. Measures pertaining to dominant and non-dominant limb strength and symmetry were derived from four strength tests that were found to be reliable in a cohort of non-disabled participants (ICC = 0.85-0.97; CV = 6.4-9.1%). Para swimmers had lower scores in strength tests compared with non-disabled participants (d = 0.14-1.00) and the strength test battery successfully classified 95% of Para swimmers with physical impairment using random forest algorithm. Most of the strength measures had low to moderate correlations (r = 0.32 to 0.53; p ≤ 0.05) with maximal freestyle swim speed in Para swimmers. Although, fewer correlations were found when Para swimmers with hypertonia or impaired muscle power were analysed independently, highlighting the impairment-specific nature of activity limitation in Para swimming. Collectively, the strength test battery has utility in Para swimming classification to infer loss of strength in Para swimmers, guide minimum eligibility criteria, and to define the impact that strength impairment has on Para swimming performance.

Classifying motor coordination impairment in Para swimmers with brain injury.

OBJECTIVES: The International Paralympic Committee has mandated that International Sport Federations develop sport-specific classification systems that are evidence-based. This study examined the predictive and convergent validity of instrumented tapping tasks to classify motor coordination impairments in Para swimming. DESIGN: Cross-sectional. METHODS: Thirty non-disabled participants and twenty-one Para swimmers with brain injury completed several instrumented tapping tasks as an assessment of upper and lower limb motor coordination. Para swimmers also completed a maximal freestyle swim to obtain a performance measure. The predictive and convergent validity of instrumented tapping tasks was examined by establishing differences in test measures between participants with and without brain injury and defining the strength of association between test measures and maximal freestyle swim speed in Para swimmers, respectively. RESULTS: Random forest successfully classified 96% of participants with and without brain injury using test measures derived from instrumented tapping tasks. Most test measures had moderate to high correlations (r=0.54 to 0.72; p<0.01) with maximal freestyle swim speed and collectively explained up to 72% of the variance in maximal freestyle swim performance in Para swimmers with brain injury. CONCLUSIONS: The results of this study evidence the predictive and convergent validity of instrumented tapping tasks to classify motor coordination impairments in Para swimmers with brain injury. These tests can be included in revised Para swimming classification to improve the objectivity and transparency in determining athlete eligibility and sport class for these Para athletes.

Establishing the reliability of a novel battery of range of motion tests to enable evidence-based classification in Para Swimming.

OBJECTIVES: To evaluate the reliability of swimming-specific range of movement tests developed in order to permit evidenced-based classification in the sport of para swimming. DESIGN: Test-retest intra- and inter-examiner reliability. SETTING: International Swimming training camps and university exercise science departments. PARTICIPANTS: 42 non-disabled participants (mean age 23.2 years) and 24 Para swimmers (mean age 28.5 years). MAIN OUTCOME MEASURES: Intra- and inter-examiner reliability of a battery of novel active range of motion tests. RESULTS: Good to excellent intra-examiner reliability was found for the majority (32/34) of tests in non-disabled participants (ICC = 0.85-0.98). SEM values ranged from 1.18° to 6.11°. Similarly, good to excellent inter-examiner reliability was found for the majority (35/42) of tests in non-disabled participants (ICC = 0.85-0.98). SEM values range from 0.73° to 6.52°. Para swimmers exhibited significantly reduced range of motion compared to non-disabled participants. CONCLUSIONS: The large majority of ROM tests included in this novel battery were reliable both within and between examiners in non-disabled participants. The tests were found to differentiate between non-disabled participants and Para swimmers with hypertonia or impaired muscle power.

How Much Do Range of Movement and Coordination Affect Paralympic Sprint Performance?

INTRODUCTION: Development of evidence-based methods of paralympic classification requires research quantifying the relative strength of association between ratio-scaled measures of impairment and sports performance. To date, no such research has been conducted. The purpose of this study was to quantify the extent to which range of movement (ROM) and coordination affect running performance in runners with and without brain impairment. METHODS: Participants were 41 male runners, 13 with brain impairments (RBI) and 28 nondisabled (NDR). All participants completed a maximal 60-m sprint as well as a novel battery of five lower limb ROM tests and three lower limb coordination tests. RESULTS: In the coordination tests, RBI showed significantly slower mean movement times compared to NDR on all measures (e.g., 0.54 s ± 0.12 s vs 0.34 s ± 0.05 s). Runners with brain impairments had significantly lower range of movement on five of ten measures (e.g., 25.9° ± 5.4° vs 37.0° ± 6.0°) and had significantly slower acceleration (0-15 m) (3.2 s ± 0.3 s vs 2.8 s ± 0.2 s) and top speed (30-60 m) (4.3 s ± 0.6 s vs 3.8 s ± 0.3 s). Five ROM measures significantly correlated with sprint performance in RBI and did not significantly correlate with sprint performance in NDR, satisfying convergent and divergent validity criteria. These individual tests explained 38% to 58% of the variance in sprint performance in RBI. CONCLUSION: This is the first study to quantify the extent to which eligible impairments affect performance in a paralympic sport. Five of the ROM measures significantly affected sprint performance in RBI and were deemed valid for the purposes of classifying impairments in classes T35-T38. This study is an important methodological step toward development of evidence-based methods of classifying impairments in classes T35-T38 and provides practical methodological guidance to researchers in this field.

Reliability and validity of a talent identification test battery for seated and standing Paralympic throws.

Paralympic throwing events for athletes with physical impairments comprise seated and standing javelin, shot put, discus and seated club throwing. Identification of talented throwers would enable prediction of future success and promote participation; however, a valid and reliable talent identification battery for Paralympic throwing has not been reported. This study evaluates the reliability and validity of a talent identification battery for Paralympic throws. Participants were non-disabled so that impairment would not confound analyses, and results would provide an indication of normative performance. Twenty-eight non-disabled participants (13 M; 15 F) aged 23.6 years (±5.44) performed five kinematically distinct criterion throws (three seated, two standing) and nine talent identification tests (three anthropometric, six motor); 23 were tested a second time to evaluate test-retest reliability. Talent identification test-retest reliability was evaluated using Intra-class Correlation Coefficient (ICC) and Bland-Altman plots (Limits of Agreement). Spearman's correlation assessed strength of association between criterion throws and talent identification tests. Reliability was generally acceptable (mean ICC = 0.89), but two seated talent identification tests require more extensive familiarisation. Correlation strength (mean rs = 0.76) indicated that the talent identification tests can be used to validly identify individuals with competitively advantageous attributes for each of the five kinematically distinct throwing activities. Results facilitate further research in this understudied area.