Cross-sectional area and fat infiltration of the lumbar spine muscles in patients with back disorders: a deep learning-based big data analysis.

PURPOSE: Validated deep learning models represent a valuable option to perform large-scale research studies aiming to evaluate muscle quality and quantity of paravertebral lumbar muscles at the population level. This study aimed to assess lumbar spine muscle cross-sectional area (CSA) and fat infiltration (FI) in a large cohort of subjects with back disorders through a validated deep learning model. METHODS: T2 axial MRI images of 4434 patients (n = 2609 females, n = 1825 males; mean age: 56.7 ± 16.8) with back disorders, such as fracture, spine surgery or herniation, were retrospectively collected from a clinical database and automatically segmented. CSA, expressed as the ratio between total muscle area (TMA) and the vertebral body area (VBA), and FI, in percentages, of psoas major, quadratus lumborum, erector spinae, and multifidus were analyzed as primary outcomes. RESULTS: Male subjects had significantly higher CSA (6.8 ± 1.7 vs. 5.9 ± 1.5 TMA/VBA; p < 0.001) and lower FI (21.9 ± 8.3% vs. 15.0 ± 7.3%; p < 0.001) than females. Multifidus had more FI (27.2 ± 10.6%; p < 0.001) than erector spinae (22.2 ± 9.7%), quadratus lumborum (17.5 ± 7.0%) and psoas (13.7 ± 5.8%) whereas CSA was higher in erector spinae than other lumbar muscles. A high positive correlation between age and total FI was detected (rs = 0.73; p < 0.001) whereas a negligible negative correlation between total CSA and age was observed (rs = - 0.24; p < 0.001). Subjects with fractures had lower CSA and higher FI compared to those with herniations, surgery and with no clear pathological conditions. CONCLUSION: CSA and FI values of paravertebral muscles vary a lot in accordance with subjects' sex, age and clinical conditions. Given also the large inter-muscle differences in CSA and FI, the choice of muscles needs to be considered with attention by spine surgeons or physiotherapists when investigating changes in lumbar muscle morphology in clinical practice.

Effectiveness of Telemedicine for Musculoskeletal Disorders: Umbrella Review.

BACKGROUND: Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence on multiple clinical outcomes remains unclear. OBJECTIVE: We aimed to summarize the available evidence from SRs on telemedicine for musculoskeletal disorders. METHODS: We conducted an umbrella review of SRs with and without meta-analysis by searching PubMed and EMBASE up to July 25, 2022, for SRs of randomized controlled trials assessing telemedicine. We collected any kind of patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), and objective measures, including direct and indirect costs. We assessed the methodological quality with the AMSTAR 2 tool (A Measurement Tool to Assess systematic Reviews 2). Findings were reported qualitatively. RESULTS: Overall, 35 SRs published between 2015 and 2022 were included. Most reviews (n=24, 69%) were rated as critically low quality by AMSTAR 2. The majority of reviews assessed "telerehabilitation" (n=29) in patients with osteoarthritis (n=13) using PROMs (n=142 outcomes mapped with n=60 meta-analyses). A substantive body of evidence from meta-analyses found telemedicine to be beneficial or equal in terms of PROMs compared to conventional care (n=57 meta-analyses). Meta-analyses showed no differences between groups in PREMs (n=4), while objectives measures (ie, "physical function") were mainly in favor of telemedicine or showed no difference (9/13). All SRs showed notably lower costs for telemedicine compared to in-person visits. CONCLUSIONS: Telemedicine can provide more accessible health care with noninferior results for various clinical outcomes in comparison with conventional care. The assessment of telemedicine is largely represented by PROMs, with some gaps for PREMs, objective measures, and costs. TRIAL REGISTRATION: PROSPERO CRD42022347366; https://osf.io/pxedm/.

Sleep Characteristics, Magnetic Resonance Imaging- and Dual-Energy X-Ray Absorptiometry-Based Morphological Parameters, Muscle Strength, and Risk of Falls in Sedentary Older Subjects.

BACKGROUND: The aims of this cross-sectional study were to (a) assess actigraphy-based sleep parameters (total sample and gender differences), (b) assess differences in morphological parameters and physical function between short- versus normal-sleepers and poor- versus good-sleepers, and (c) assess the possible correlations between sleep variables and morphological and physical function parameters in older subjects. METHODS: This study enrolled 42 healthy older participants (60-80 years). Participants completed the following clinical evaluations: (1) whole-body dual-energy X-ray absorptiometry to assess the appendicular skeletal muscle mass index; (2) magnetic resonance imaging acquisition to determine the cross-sectional muscle area of thigh muscles and intermuscular adipose tissue; (3) risk of fall assessment through the mini-Balance Evaluation Systems Test; (4) strength assessment: (a) chair stand test and (b) handgrip strength test; (5) sleep monitoring by actigraphy to assess total sleep time, sleep efficiency, wake after sleep onset, sleep latency, fragmentation index, mobile time, and subjective sleep quality. RESULTS: 31.0% of subjects were short-sleepers (total sleep time < 6 hr), 19.1% were poor-sleepers (sleep efficiency < 85%), and gender differences were detected in mobile time (males: 15.8 ± 6.0 and females: 13.4 ± 6.8; p < .001) and fragmentation index (males: 35.3 ± 14.3 and females: 29.6 ± 14.6; p < .001); no significant differences were observed between groups (short- vs. normal-sleepers and poor- vs. good-sleepers) in morphological and physical function variables; correlation analysis showed that sleep latency negatively correlated with Mini-Balance Evaluation Systems Test (r = -.352; p = .022) and a positive correlation was detected between cross-sectional muscle area and mobile time (r = .349, p = .023). CONCLUSION: No differences were observed in morphological and function parameters between good- versus poor-sleepers, those subjects with worse sleep onset latency (i.e., longer time to fall asleep) registered higher for risk of fall. The potential role of sleep in the physiological mechanisms of muscular aging must be explored through cross-sectional cohort studies with a larger population.

How do patients sleep after orthopaedic surgery? Changes in objective sleep parameters and pain in hospitalized patients undergoing hip and knee arthroplasty.

PURPOSE: The aim of this observational cohort study was to assess actigraphy-based sleep characteristics and pain scores in patients undergoing knee or hip joint replacement and hospitalized for ten days after surgery. METHODS: N=20 subjects (mean age: 64.0±10.39 years old) wore the Actiwatch 2 actigraph (Philips Respironics, USA) to record sleep parameters for 11 consecutive days. Subjective scores of pain, by a visual analog scale (VAS), were constantly monitored and the following evaluation time points were considered for the analysis: pre-surgery (PRE), the first (POST1), the fourth (POST4), and the tenth day (POST10) after surgery. RESULTS: Sleep quantity and timing parameters did not differ from PRE to POST10, during the hospitalization whereas sleep efficiency and immobility time significantly decreased at POST1 compared to PRE by 10.8% (p=0.003; ES: 0.9, moderate) and 9.4% (p=0.005; ES: 0.86, moderate) respectively, and sleep latency increased by 18.7 min (+320%) at POST1 compared to PRE (p=0.046; ES: 0.70, moderate). Overall, all sleep quality parameters showed a trend of constant improvement from POST1 to POST10. VAS scores were higher in the first day post-surgery (4.58 ± 2.46; p=0.0011 and ES: 1.40, large) compared to POST10 (1.68 ± 1.58). During the time, mean VAS showed significant negative correlations with mean sleep efficiency (r = -0.71; p=0.021). CONCLUSION: Sleep quantity and timing parameters were stable during the entire hospitalization whereas sleep quality parameters significantly worsened the first night after surgery compared to the pre-surgery night. High scores of pain were associated with lower overall sleep quality.

Comparison between magnetic resonance imaging and electrical impedance myography for evaluating lumbar skeletal muscle composition.

BACKGROUND: To compare electrical impedance myography (EIM) and MRI in assessing lumbar skeletal muscle composition. METHODS: One hundred forty-one patients (78 females, mean age 57 ± 19 years) were prospectively enrolled and underwent lumbar spine MRI, EIM with Skulpt®, and clinical evaluation including the questionnaire SARC-F. MRIs were reviewed to assess the Goutallier score of paravertebral muscles at L3 level and to calculate the cross sectional area (CSA) of both psoas, quadratus lumborum, erector spinae, and multifidus muscles on a single axial slice at L3 level, in order to calculate the skeletal muscle index (SMI=CSA/height2). We tested the correlation between EIM-derived parameters [body fat percentage (BF%) and muscle quality] and body mass index (BMI), Goutallier score (1-4), SMI, and SARC-F scores (0-10) using the Pearson correlation coefficient. The strength of association was considered large (0.5 to 1.0), medium (0.3 to 0.5), small (0.1 to 0.3). RESULTS: Pearson's correlation coefficient showed small (0.26) but significant (p < 0.01) positive correlation between BF% obtained with EIM and Goutallier score. Small negative correlation (- 0.22, p < 0.01) was found between EIM muscle quality and Goutallier Score. Large negative correlation (- 0.56, p < 0.01) was found between SMI and Goutallier Score, while SMI showed small negative correlation with SARC-F (- 0.29, p < 0.01). Medium positive correlation was found between Goutallier Score and SARC-F (0.41, p < 0.01). BMI showed medium positive correlation with SMI (r = 0.369, p < 0.01) and small correlation with EIM muscle quality (r = - 0.291, p < 0.05) and BF% (r = 0.227, p < 0.05). We found a substantial increase of the strength of associations of BF% and muscle quality with Goutallier in the 18-40 years (r = 0.485 and r = - 0.401, respectively) and in the 41-70 years group (r = 0.448 and r = - 0.365, respectively). CONCLUSIONS: Muscle quality and BF% measured by EIM device showed only small strength of correlation with other quantitative parameters for assessing muscle mass and fat infiltration. Interesting results have been found in younger patients, but Skulpt Chisel™ should be applied cautiously to assess lumbar skeletal muscle composition. This point deserves further investigation and other studies are warranted. TRIAL REGISTRATION: The registration number of this study is 107/INT/2019.

Appendicular Muscle Mass, Thigh Intermuscular Fat Infiltration, and Risk of Fall in Postmenopausal Osteoporotic Elder Women.

BACKGROUND: The association between the quantity and composition of skeletal muscle and the decline in physical function in elderly is poorly understood. Therefore, the primary aim of this cross-over study was to investigate the association between thigh intermuscular adipose tissue (IMAT) infiltration, appendicular muscle mass, and risk of fall in postmenopausal osteoporotic elder women. Second, we examined the differences in muscle mass, IMAT, and risk of fall in the same sample of older subjects after being classified as sarcopenic or nonsarcopenic on the basis of the dual-energy X-ray absorptiometry (DXA)-based Appendicular Skeletal Muscle Mass Index (ASMMI). METHODS: Twenty-nine subjects (age: 72.4 ± 6.8; BMI: 23.0 ± 3.3; and T-score: -2.7 ± 0.2) completed the following clinical evaluations: (1) whole-body DXA to assess the ASMMI; (2) magnetic resonance to determine the cross-sectional muscle area (CSA) and IMAT of thigh muscles, expressed both in absolute (IMATabs) and relative (IMATrel) values; and (3) risk of fall assessment through the OAK system (Khymeia, Noventa Padovana, Italy). The existence of a correlation between the risk of fall (OAK scores, an automated version of the Brief-BESTest) and the clinical parameters (ASMMI, CSA, IMATrel, and IMATabs) was tested by the Pearson's correlation index while data homogeneity between sarcopenic and nonsarcopenic subjects was tested through unpaired Student t tests or with the Mann-Whitney rank test. Effect sizes (ES) were used to determine the magnitude of the effect for all significant outcomes. RESULTS: Eleven subjects were classified as sarcopenic and 18 as nonsarcopenic based on their ASMMI (cutoff value: 5.5 kg/m2). A positive correlation between OAK and CSA was observed (r2 = 0.19; p = 0.033), whereas a negative correlation between OAK and IMATrel was detected (r2 = 0.27; p = 0.009). No correlations were observed between OAK and ASMMI and between ASMMI and IMATrel. Sarcopenic subjects showed significantly lower weight (p = 0.002; ES = 1.30, large), BMI (p = 0.0003; ES = 1.82, large), CSA (p = 0.010; ES = 1.17, moderate), and IMATabs (p = 0.022; ES = 1.63, large) than nonsarcopenic individuals, whereas OAK scores and IMATrel were similar between groups. DISCUSSION/CONCLUSION: Increased IMAT and lower CSA in the thigh muscles are associated with higher risk of fall while ASMMI, a value of appendicular muscle mass, was not associated with physical performance in older adults.

Direct superior approach versus posterolateral approach in total hip arthroplasty: a randomized controlled trial on early outcomes on gait, risk of fall, clinical and self-reported measurements.

Background and purpose - Several surgical approaches are used in primary total hip arthroplasty (THA). In this randomized controlled trial we compared gait, risk of fall, self-reported and clinical measurements between subjects after direct superior approach (DSA) versus posterolateral approach (PL) for THA.Patients and methods - Participants with DSA (n = 22; age 74 [SD 8.9]) and PL (n = 23; age 72 [7.7]) underwent gait analysis, risk of fall assessment and Timed Up and Go Test (TUG) before (PRE), 1 month (T1) and 3 months after (T3) surgery. Data on bleeding and surgical time was collected.Results - DSA resulted in longer surgical times (90 [14] vs. 77 [20] min) but lower blood loss (149 [66] vs. 225 [125] mL) than PL. DSA had lower risk of fall at T3 compared with T1 and higher TUG scores at T3 compared with T1 and PRE. PL improved balance at T3 compared with T1 and PRE. Spatiotemporal gait parameters improved over time for both DSA and PL with no inter-group differences, whereas DSA, regarding hip rotation range of motion, showed lower values at T3 and T1 compared with PRE and, furthermore, this group had lower values at T1 and T3 compared with PL. All foregoing comparisons are statistically signficant (p < 0.05)Interpretation - DSA showed longer surgical time and lower blood loss compared with PL and early improvements in TUG, spatiotemporal, and kinematic gait parameters, highlighting rapid muscle strength recovery.

Are elite track and field athletes on track? The impact of COVID-19 outbreak on sleep behavior and training characteristics.

The Covid-19 outbreak forced many governments to enter a nationwide lockdown. The aim of this study was to evaluate, by means of a survey, changes in sleep parameters and physical activity characteristics of elite track and field athletes in three periods: before the lockdown (T0), during the lockdown (09th March - 03rd May 2020, T1) and the first month after the lockdown (T2). This study was conducted from May 2020 to June 2020 and data were collected using an offline survey with 89 elite track and field athletes (mean age: 24.7 ± 5.4; n = 43 males; n = 46 females). The survey consisted of demographic data and questions on physical activity and sleep behavior at T0, T1 and T2. Athletes reported lower sleep quality scores at T1 compared to T0 and T2 (p < 0.0001) and registered delayed bedtime, wake-up time and longer sleep latency during the lockdown compared to pre-lockdown and post-lockdown whereas no changes in total sleep time were reported. No inter-group differences were detected in sleep characteristics between short- and long-term disciplines and between genders. The weekly training volume decreased from 16.1 ± 5.7 hours at T0 to 10.7 ± 5.7 hours at T1 (p < 0.0001) whereas no significant differences were detected in training volume during the lockdown in relation to the square footage of the house (p = 0.309). Alcohol (p = 0.136) and caffeine intake (p = 0.990) and use of electronic devices (p = 0.317) were similar pre-, during, and post-lockdown. The unprecedented circumstances of the Covid-19 pandemic had negative impacts on the Italian track and field athletes' sleep and training volumes.

Differences in GPS variables according to playing formations and playing positions in U19 male soccer players.

The aims of this study were 1) to investigate Global Positioning System (GPS)-based match physical performance according to players' playing position in three different playing formations (4-4-2, 3-5-2, 4-3-3) and 2) to analyse the differences in match performance between 1st and 2nd half. Twenty-three U19 elite male soccer players (age: 18 ± 1 year, height: 1.80 ± 0.04 m, body mass: 70.65 ± 6.02 kg), categorized as Central Back (CB, n = 5), Full Back (FB, n = 4), Central Midfielders (CM, n = 4), Wingers (W, n = 3), Strikers (S, n = 7), were monitored using 10 Hz GPS during 31 competitive matches. The results showed that FB and W always had the highest very high-speed running distance and number of sprints in all playing formations. Significant decrease in all GPS variables was observed in the 2nd half of the match for all playing positions. Strength coaches should adopt specific training regimes in accordance with players' playing position.

Imaging of sarcopenia: old evidence and new insights.

To date, sarcopenia is considered a patient-specific imaging biomarker able to predict clinical outcomes. Several imaging modalities, including dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance (MR), and ultrasound (US), can be used to assess muscle mass and quality and to achieve the diagnosis of sarcopenia. With different extent, all these modalities can provide quantitative data, being thus reproducible and comparable over time. DXA is the one most commonly used in clinical practice, with the advantages of being accurate and widely available, and also being the only radiological tool with accepted cutoff values to diagnose sarcopenia. CT and MR are considered the reference standards, allowing the evaluation of muscle quality and fatty infiltration, but their application is so far mostly limited to research. US has been always regarded as a minor tool in sarcopenia and has never gained enough space. To date, CT is probably the easiest and most promising modality, although limited by the long time needed for muscle segmentation. Also, the absence of validated thresholds for CT measurements of myosteatosis requires that future studies should focus on this point. Radiologists have the great potential of becoming pivotal in the context of sarcopenia. We highly master imaging modalities and know perfectly how to apply them to different organs and clinical scenarios. Similarly, radiologists should master the culture of sarcopenia, and its clinical aspects and relevant implications for patient care. The medical and scientific radiological community should promote specific educational course to spread awareness among professionals. KEY POINTS: • DXA is an accurate, reproducible, and widely available imaging modality to evaluate body composition, being the most commonly used radiological tool to diagnose sarcopenia in clinical practice • CT and MR are the gold standard imaging modalities to assess muscle mass and quality, but no clear cutoff values have been reported to identify sarcopenia, limiting the application of these modalities to research purposes • US has shown to be accurate in the evaluation of muscle trophism, especially in the thigh, but its current application in sarcopenia is limited.

Outcomes of lateral unicompartmental knee arthroplasty in post-traumatic osteoarthritis, a retrospective comparative study.

PURPOSE: We asked whether the clinical and radiographic outcomes and survivorship after unicompartmental knee arthroplasty (UKA) for osteoarthritis (OA) consequent to lateral tibial plateau fracture were comparable with those obtained after lateral UKA for primary OA. METHODS: A total of 13 patients receiving lateral UKA for OA secondary to tibial plateau fracture (post-traumatic UKA, P-UKA) were compared with 13 patients who underwent lateral UKA for primary OA (OA-UKA). Patients were matched for age at surgery, gender, body mass index, and follow-up length. Pre- and post-operative clinical and radiographic assessments included clinical (KSS-c) and functional (KSS-f) Knee Society Score, Hip-Knee-Ankle (HKA) angle, and signs of osteolysis. RESULTS: Mean follow-up was similar in both groups: 9.9 ± 4.6 years for P-UKA and 9.3 ± 2.4 years for OA-UKA. The two way ANOVA procedure followed by the Bonferroni multiple comparisons test highlighted a baseline difference in KSS-c with P-UKA having greater scores than OA-UKA (+ 12; p < 0.05) and both groups showed large improvements in KSS-c (p < 0.001), KSS-f (p < 0.001), and HKA angle (p < 0.001) at follow-up. The nine year prosthesis survival rate, tested by the Kaplan-Meier methods, was 92% in both groups. CONCLUSION: Lateral UKA for OA secondary to tibial plateau fracture was efficient in restoring joint function, improving clinical results, and correcting lower limb alignment. Clinical outcomes and nine year survivorship did not differ from lateral UKA for primary OA. Consequently, lateral UKA should be considered a valid option in treating lateral posttraumatic OA in carefully selected patients. TRIAL REGISTRATION NUMBER: ( clinicaltrials.gov ) NCT04198389.

Are two different speed endurance training protocols able to affect the concentration of serum cortisol in response to a shuttle run test in soccer players?

Soccer involves multiple high-intensity physical, technical and tactical actions; as result of this, soccer training must include high-intensity exercises, which can act as a stimulus to the hypothalamus pituitary-adrenal axis, resulting in a significant increase in circulating cortisol levels. This study examined the effect of 4 weeks of Speed Endurance Maintenance (SEM) and Speed Endurance Production (SEP) on the serum cortisol concentration in response to a 5-meter multiple shuttle run test (5-m MST) in young elite soccer players. Fifteen soccer players were divided to SEM (n = 7) or SEP (n = 8) training group. Blood drawings were performed four times: before and after the 5-m MST at baseline (T1a, T1b) and at follow-up (T2a, T2b). Both training regimes determined a cortisol secretion following the 5-m MST at both baseline and follow-up. Data on delta values highlighted that SEP had greater values than SEM at baseline and registered a significant decrease at the follow-up. This difference is probably due to the lack of specific speed endurance training for players of SEP group prior to the beginning of the protocol. The physiological mechanisms behind the observed biological differences should be deeply investigated.

Acute sleep hygiene strategy improves objective sleep latency following a late-evening soccer-specific training session: A randomized controlled trial.

The aim of this study was to evaluate the effects of sleep hygiene (SH) education on sleep quality in soccer players after a late-evening small-sided-game (SSG) training session. Twenty-nine non-professional players were recruited and allocated to either an experimental group (EG, n = 17) that received SH education, or a control group (CG, n = 12). SSG consisted of 3 × 4 min in a 4vs4, with 3 min of recovery and was performed at 8.00 p.m. Sleep quality was monitored via actigraphy and sleep diary entries before (PRE) and two nights after (POST1, POST2) the SSG. Sleep latency (SL) differed between the two groups at POST1 (4.9 ± 5.4 vs. 15.5 ± 16.1 for EG and CG, respectively; p = 0.017, effect size [ES] = 2.0); SL values were lower at POST1 compared to PRE for the EG (-47%; p = 0.021, ES = 0.6). Subjective sleep quality was better in the EG than the CG at POST1 (8.6 ± 1.0 vs. 7.1 ± 2.0 for EG and CG, respectively; p = 0.016, ES = 0.9) with a significant improvement over PRE-values (+11.0%, p = 0.004, ES = 0.8). Although SL and subjective sleep quality did not decrease significantly from POST1 to POST2 values at POST2 no longer differed significantly form baseline and, hence, indicate that observed effects may be short-lasting. No other objective sleep indices were influenced by late-evening training or SH practices implemented by the EG. Soccer players may benefit from acute SH strategies to reduce the time to sleep onset after late-evening training sessions.

The Role of the Molecular Clock in Promoting Skeletal Muscle Growth and Protecting against Sarcopenia.

The circadian clock has a critical role in many physiological functions of skeletal muscle and is essential to fully understand the precise underlying mechanisms involved in these complex interactions. The importance of circadian expression for structure, function and metabolism of skeletal muscle is clear when observing the muscle phenotype in models of molecular clock disruption. Presently, the maintenance of circadian rhythms is emerging as an important new factor in human health, with disruptions linked to ageing, as well as to the development of many chronic diseases, including sarcopenia. Therefore, the aim of this review is to present the latest findings demonstrating how circadian rhythms in skeletal muscle are important for maintenance of the cellular physiology, metabolism and function of skeletal muscle. Moreover, we will present the current knowledge about the tissue-specific functions of the molecular clock in skeletal muscle.

Actigraphy-based Sleep Parameters and Rest-activity Circadian Rhythm in a Young Scoliotic Patient Treated with Rigid Bracing: A Case Study.

The correct expression of circadian rhythmicity, together with a good sleep behavior, are key factors for the body homeostasis. Rest-activity circadian rhythms (RARs) are involved in the control of the sleep-wake cycle and altered RARs could lead to a compromised health status. Therefore, we aimed to investigate the existence of RAR and to study actigraphy-based sleep behavior in a 14-year-old male patient affected by severe idiopathic scoliosis and treated with a rigid brace 23 hours per day. RAR and sleep parameters were studied through actigraphy for seven consecutive days in July 2018. The mean cosinor analysis revealed the presence of a significant RAR (p < 0.001), specifically: the percentage of rhythm was 23.4%, the mean MESOR was 84.6 Activity Count (AC), the amplitude registered a mean value of 74.4 AC's, and the acrophase occurred at 17:56 h. The subject reached a good sleep quantity: 507.9 ± 30.2 minutes of Time in Bed with a mean Total Sleep Time of 450.7 ± 20.1 minutes; Similarly, Sleep Efficiency was equal to 83.3 ± 7.2% and the Fragmentation Index was 27.3 ± 12.8%. We observed that both RAR and sleep behavior had normal trends in a 14-year-old patient treated with a rigid brace for a severe adolescent idiopathic scoliosis (AIS). Improved assessment of sleep in routine clinical practice can help to identify and manage health-related problems that could potentially affect some clinical outcomes, such as pain, mood state, and recovery process.

Effects of an 8-Week Body-Weight Neuromuscular Training on Dynamic Balance and Vertical Jump Performances in Elite Junior Skiing Athletes: A Randomized Controlled Trial.

Vitale, JA, La Torre, A, Banfi, G, and Bonato, M. Effects of an 8-week body-weight neuromuscular training on dynamic balance and vertical jump performances in elite junior skiing athletes: a randomized controlled trial. J Strength Cond Res 32(4): 911-920, 2018-The aim of the present randomized controlled trial was to evaluate the effects of an 8-week neuromuscular training program focused on core stability, plyometric, and body-weight strengthening exercises on dynamic postural control and vertical jump performance in elite junior skiers. Twenty-four Italian elite junior male skiers were recruited and randomized to either an experimental group (EG), performing neuromuscular warm-up exercises, (EG; n = 12; age 18 ± 1 years; body mass 66 ± 21 kg; height 1.70 ± 0.1 m) or a control group (CG) involved in a standard warm-up (CG; n = 12; age 18 ± 1 years; body mass 62 ± 14 kg; height 1.73 ± 0.1 m). lower quarter Y-Balance Test (YBT), countermovement jump (CMJ), and drop jump (DJ) at baseline (PRE) and at the end (POST) of the experimental procedures were performed. No significant differences between EG and CG were observed at baseline. Results showed that EG achieved positive effects from PRE to POST measures in the anterior, posteromedial, posterolateral directions, and composite score of YBT for both lower limbs, whereas no significant differences were detected for CG. Furthermore, 2-way analysis of variance with Bonferroni's multiple comparisons test did not reveal any significant differences in CMJ and DJ for both EG and CG. The inclusion of an 8-week neuromuscular warm-up program led to positive effects in dynamic balance ability but not in vertical jump performance in elite junior skiers. Neuromuscular training may be an effective intervention to specifically increase lower limb joint awareness and postural control.

The effect of two different speed endurance training protocols on a multiple shuttle run performance in young elite male soccer players.

There is not enough evidence on the impact of different speed endurance training regimes on footballers' ability to perform multiple shuttle run performance. This study examined the effect of 4 weeks of speed endurance maintenance (SEM) and speed endurance production (SEP) training on the 5-meter multiple shuttle run test (5-m MST) performance in young elite soccer players. A parallel two-groups, longitudinal design was used. Fifteen players were divided to either SEM (8 repetitions of 20-s all-out sprint interspersed with 40 s of recovery) or SEP (8 repetitions of 20-s all-out bout interspersed with 120 s of recovery) training group. SEM improved the ability to tolerate fatigue and maintained the performance development during the 5-m MST while SEP increased only the 1st sprint showing, simultaneously, an increased fatigue index and performance decrement. The selection of which training regimes to prioritize should be based on the players' characteristics and individual game requirements Abbreviations: SEP: Speed Endurance Production; SEM: Speed Endurance Maintenance; PRE: Baseline; POST: End of experimental protocol; 5-m MST: 5-meters Multiple Shuttle Run Test; TD: Total Distance; FI: Fatigue Index; MSTdec: Percentage Decrement Score; BMI: Body Mass Index.

Acute Modification of Cardiac Autonomic Function of High-Intensity Interval Training in Collegiate Male Soccer Players with Different Chronotype: A Cross-Over Study.

The purpose of this study was to evaluate if the time of the day (8.00 a.m. vs 8.00 p.m.) and chronotype could influence autonomic cardiac control in soccer players in relation to an acute session of high-intensity interval training. The morningness-eveningness questionnaire was administered to recruit Morning-type and Evening-type collegiate male soccer players. Therefore, 24 players (12 Morning-types and 12 Evening-types) were randomly assigned, to either morning (n = 12; age 23 ± 3 years; height 1.75 ± 0.07 m; body mass 73 ± 10 kg; weekly training volume 8 2 hours), or evening (n = 12; age 21 ± 3 years; height 1.76 ± 0.05 m; body mass 75 ± 11 kg; weekly training volume 8 ± 3 hours) training. Heart Rate Variability vagal and sympatho/vagal indices were calculated in time, frequency and complexity domains at rest, before, after 12 and 24 hours of high-intensity interval training. Before evening training session, a higher resting heart rate was observed which was determined by a marked parasympathetic withdrawal with a sympathetic predominance. Moreover, Evening-type subjects during morning training session, present a significant higher heart rate that corresponded to significant higher vagal indices with a significant lower parasympathetic tone that returned to the rest values after 24 hours of the cessation of high-intensity interval training exercise. On the contrary, Morning-type subjects did not reveal any significant differences with Evening-Type subjects during evening high-intensity interval training session. Stress response of high-intensity interval training is influenced by both the time of the day and by the chronotype. Understanding the Heart Rate Variability response to high-intensity interval training can be an additional important procedure for evaluating of cardiovascular recovery in soccer players. Moreover, these results suggest that an athlete's chronotype should be taken into account when scheduling a high-intensity interval training exercise.

Physical Attributes and NFL Combine Performance Tests Between Italian National League and American Football Players: A Comparative Study.

Vitale, JA, Caumo, A, Roveda, E, Montaruli, A, La Torre, A, Battaglini, CL, and Carandente, F. Physical attributes and NFL Combine performance tests between Italian National League and American football players: a comparative study. J Strength Cond Res 30(10): 2802-2808, 2016-The purpose of this study was to examine anthropometric measurements and the results of a battery of performance tests administered during the National Football League (NFL) Combine between American football players who were declared eligible to participate in the NFL Combine and football players of a top Italian team (Rhinos Milan). Participants (N = 50) were categorized by position into 1 of 3 groups based on playing position: skill players (SP) included wide receivers, cornerbacks, free safeties, strong safeties, and running backs; big skill players (BSP) consisted of fullbacks, linebackers, tight ends, and defensive ends; lineman (LM) included centers, offensive guards, offensive tackles, and defensive tackles. A 1-way analysis of variance followed by the Tukey-Kramer post hoc test was used for comparisons between Italian players by playing position. Ninety-five percent CIs were used for comparisons between American and Italian football for the NFL Combine performance tests. Significant differences for all the variables between the 3 playing categories were observed among the Italian players; LM had higher anthropometric and body composition values than SP (p < 0.001) and BSP (p < 0.001), whereas LM performed significantly worse in the physical tests, except for the 225-lb bench press test when compared with SP (p < 0.002). American football players presented significantly higher anthropometric values and test performance scores when compared with Italian players. Administrators of professional football teams in Italy need to improve the player's physical attributes, so the gap that currently exists between American and Italian players can be reduced, which could significantly improve the quality of American football in Italy.

THE EFFECT OF CHRONOTYPE ON PSYCHOPHYSIOLOGICAL RESPONSES DURING AEROBIC SELF-PACED EXERCISES.

It was hypothesized that an individual's chronotype might influence the response to physical activity at a given time of day. This study aimed to analyze the psychophysiological responses during a walking task at different times of day in individuals with different chronotypes. 46 students (M age=24.8 yr., SD=7.2) filled in the Morningness-Eveningness Questionnaire to determine chronotypes. Heart rate, walking time, and the rating of perceived exertion (RPE) were measured during two self-paced walking sessions: one in the morning (08:30) and one in the afternoon (15:30). A multivariate analysis of variance found a significant interaction between chronotype and time of day. The post hoc analysis showed a significant difference for RPE in the morning session, with evening types reporing a higher RPE compared with the morning types. The chronotype and the time of day when a physical task is undertaken can influence the RPE response, although it might not influence physiological or performance parameters. This has to be taken into account, because it can affect test reliability as well as possibly have a negative influence on the affective responses to a given task.