Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 42 appraisals
PloS one
Does delayed exercise-based priming improve subsequent athletic performance? A systematic review and multilevel meta-analysis.
This systematic review and multilevel meta-analysis examined whether delayed exercise-based priming improves subsequent athletic performance. Following PRISMA 2020 principles, 3,095 records were identified; after removing 1,107 duplicates, 1,988 unique records were screened, 212 full-text reports were assessed, 186 reports were excluded at eligibility, and 26 studies were included. Eighteen studies contributed 46 effect sizes to the quantitative synthesis. Risk of bias was assessed with RoB 2 principles calibrated for crossover exercise trials, and certainty was evaluated using GRADE. A three-level random-effects model showed a small positive average effect of delayed priming on subsequent performance (g = 0.232, 95% CI [0.092, 0.372], p = .002), with cluster-robust inference supporting the same conclusion (p = .004). The prediction interval crossed zero (-0.265 to 0.730), and the overall certainty of evidence was low. Delayed exercise-based priming can be used as a practical competition-day strategy when embedded in planned preparation windows, although protocol selection and athlete response should be checked in training before competition use.
31 July 2026
Read appraisal →PloS one
Systematic review and meta-analysis of the acute effects of self-selected rest intervals on exercise performance maintenance, lactate levels, and heart rate.
BACKGROUND: Rest interval duration is a key variable in exercise prescription, influencing both performance and physiological responses. Traditional training typically employs fixed rest intervals; however, this approach may not adequately reflect individual variability in recovery needs. Recently, self-selected rest intervals-based on individual perception-have gained attention as a potential strategy for more precise load regulation. Nevertheless, current evidence regarding their effects on exercise performance, heart rate, and blood lactate remains inconsistent. METHODS: This study followed PRISMA guidelines and conducted a systematic search of Web of Science, PubMed, Cochrane Library, and Embase from database inception to March 20, 2026. Acute experimental studies comparing self-selected and fixed rest intervals were included. A three-level random-effects meta-analysis was performed to account for dependency among multiple effect sizes. Subgroup analyses, meta-regression, and sensitivity analyses were conducted to explore potential moderators and assess robustness. RESULTS: Sixteen studies (k = 16) involving 281 participants were included. No significant overall difference was observed between self-selected and fixed rest intervals for exercise performance (g = 0.27, 95% CI [-0.14, 0.69], p = 0.29), with substantial between-study heterogeneity. After removing outliers, a small but significant effect favoring self-selected rest intervals was identified (g = 0.20, 95% CI [0.08, 0.33], p < 0.01). No significant differences were observed for heart rate (g = 0.002, p = 0.98) or blood lactate (g = -0.20, p = 0.36). CONCLUSION: Self-selected and fixed rest intervals produce comparable effects on exercise performance and physiological responses. However, self-selected rest intervals may confer a small advantage in maintaining performance under specific conditions. These findings should be interpreted with caution due to sensitivity to outliers and study heterogeneity.
25 July 2026
Read appraisal →Scandinavian journal of pain
Exercise prescription and monitoring of heart rate parameters in people with chronic pain: a systematic review
INTRODUCTION: Chronic pain affects over 50 million adults in the United States and is associated with autonomic nervous system dysfunction assessed through measurements of heart rate variability (HRV). While exercise has been shown to improve HRV in healthy individuals, the effects of different exercise protocols in chronic pain populations on HRV remain underexplored. CONTENT: The purpose of this systematic review investigated how exercise interventions influence HRV and pain in individuals with chronic pain. A literature search was conducted in accordance with PRISMA guidelines across four electronic databases. Six randomized controlled trials met the inclusion criteria and were critically appraised for methodological quality. Studies were included if they involved an exercise intervention and reported HRV. If pain was assessed, it was included as an outcome measure. SUMMARY AND OUTLOOK: Six randomized controlled trials were identified with 283 participants. All studies measured HRV, while four reported pain outcomes. Five studies reported significant improvements in HRV following exercise interventions (p <0.05), while findings related to pain outcomes were mixed. Methodological reporting of HRV procedures was generally insufficient. Due to heterogeneity across studies, it remains unclear whether exercise improves pain or HRV sufficiently. While pain outcomes are commonly reported, HRV is the only measure specific to \autonomic function, and its reliability as a clinical metric in individuals with chronic pain remains uncertain. Limited research across diverse chronic conditions, sexes, and methodological approaches restricts generalizability. This highlights the need for greater methodological rigor and broader inclusion to strengthen the use of HRV metrics in chronic pain populations.
25 July 2026
Read appraisal →PloS one
Hamstring strength assessment methods in sport: A systematic review and meta-analysis of post-activity strength decrements, asymmetry benchmarks, and measurement reliability.
Hamstring strain injuries (HSI) represent one of the most prevalent and recurrent injuries in sport, making reliable strength assessment essential for neuromuscular monitoring in athletic populations. Despite the breadth of available testing modalities, no comprehensive synthesis of assessment methods, their reliability, post-activity strength responses, or normative asymmetry values has been undertaken. This systematic review and meta-analysis aims to evaluate the reliability of hamstring strength assessment methods, quantify the time-course of strength decrements following competition, establish normative inter-limb asymmetry benchmarks, and identify gaps to guide future assessment practices. PubMed, Scopus, SPORTDiscus, and Web of Science were searched from inception to November 1, 2025 following PRISMA guidelines. Methodological quality was assessed using a modified version of the Downs and Black checklist. A total of 161 studies were included in qualitative synthesis and 106 in quantitative analysis. Isokinetic dynamometry was the most frequently used modality, followed by force platform assessments and Nordic hamstring-based devices, with a clear upward trend in field-based testing observed after 2010. Multiple modalities demonstrate good reliability, sensitivity to post-activity fatigue, and comparable patterns to detect inter-limb asymmetries, supporting their use across varied applied settings. Hamstring strength deficits persisted for 24-72 hours following on-field activity, identifying a critical vulnerability window during congested schedules. Minor inter-limb asymmetries of approximately 3-4% appear normative and should not be considered clinically meaningful in isolation. Practitioners should establish individualized baselines and integrate routine monitoring with evidence-based recovery strategies to mitigate HSI risk throughout competitive seasons.
23 July 2026
Read appraisal →Medicine
Effect of physical exercise on executive function in individuals with substance use disorder: A systematic review and meta-analysis
BACKGROUND: The increasing number of individuals with substance use disorder (SUD) has a serious impact on individuals, families, and society. As a complementary therapy, physical exercise has been used in the rehabilitation of individuals with SUD. This study systematically aimed to evaluate the effect of physical exercise interventions on enhancing executive function in individuals with SUD. METHODS: Electronic databases were searched, covering the period from their inception to December 26, 2024. The Cochrane Risk of Bias Assessment Tool was utilized to assess the methodological quality of the included literature. Data were extracted from study graphs using GetData Graph Digitizer 2.26, and Stata 17.0 was also employed to conduct analysis. Grading of recommendations assessment, development and evaluation pro was utilized to evaluate the quality of evidence of outcome indicators. RESULTS: Nine studies, encompassing 752 participants, were included in the analysis. Compared with the control group, physical exercise improved inhibition (Hedges's g = 0.47, 95% CI: 0.29 to 0.65, P < .001) and working memory (Hedges's g = 0.42, 95% CI: 0.16 to 0.69, P = .002), but did not significantly affect cognitive flexibility (Hedges's g = 0.51, 95% CI: -0.22 to 1.24, P = .170). Subgroup analysis revealed that physical exercise with single time of 46 to 60 minutes (Hedges's g = 0.39, 95% CI: 0.05 to 0.73, P = .024), 5 times per week (Hedges's g = 0.45, 95% CI: 0.07 to 0.83, P = .020), duration of 8 weeks (Hedges's g = 0.46, 95% CI: 0.14 to 0.77, P = .004) may improve working memory in individuals with SUD (these subgroup findings are exploratory and should be interpreted as hypothesis-generating). CONCLUSION: Evidence from this study suggests physical exercise may enhance inhibition and working memory in individuals with SUD. However, the improvement in cognitive flexibility requires further investigation in future studies.
19 July 2026
Read appraisal →Analytical methods : advancing methods and applications
Microfluidic-electrochemical sweat patches for athletes: monitoring lactate, electrolytes, and hydration status
Wearable biochemical sensing is shifting sports physiology from intermittent laboratory sampling toward continuous, in situ readouts during training and competition. This review analyzes skin conformal systems that integrate capillary driven fluid routing, flexible sensor arrays, and wireless readout to capture dynamic changes in eccrine secretions relevant to performance management. We compare microchannel layouts that enable controlled filling, time resolved sampling, and evaporation suppression, and we discuss how material selection governs comfort and analytical fidelity, highlighting tradeoffs among polydimethylsiloxane, polyurethane, and polyethylene terephthalate substrates and their compatibility with scalable fabrication. Manufacturing pathways are assessed from soft lithography to laser cutting, three dimensional printing, and roll to roll processing for high throughput multilayer assembly. For transduction, we summarize enzymatic amperometric schemes based on lactate oxidase with hydrogen peroxide detection, including sensitivity, response time, and oxygen dependence, and we contrast these with emerging non enzymatic catalysts. We then detail potentiometric ion selective electrodes for sodium and potassium, focusing on ion selective membrane chemistry, solid state reference electrodes, Nernstian response, and dominant error sources such as drift and biofouling. System integration challenges, including chemical and electrical cross talk in multiplexed layouts, are linked to microfluidic isolation strategies and multiplexed electronics. Finally, we appraise validation practice, emphasizing the debated sweat to blood relationship, the need for synchronized comparative protocols, and the role of data analytics and machine learning for personalization, drift compensation, and prediction of thermoregulatory strain. Remaining barriers include long term stability, adhesion under motion, manufacturability, and regulatory evidence requirements in real world settings. Across these topics, the review emphasizes technology-specific limitations, engineering translation metrics, and realistic breakthrough directions rather than treating wearable sweat patches as a mature plug-and-play platform.
27 June 2026
Read appraisal →Journal of the International Society of Sports Nutrition
Caffeine makes a splash: a systematic review and multilevel meta-analysis exploring the effects of caffeine intake on swimming performance.
BACKGROUND: Evidence for acute caffeine supplementation in swimming remains inconsistent across reviews, likely due to between-study heterogeneity and methodological differences. METHODS: Five databases were searched for randomized placebo-controlled crossover trials exploring the effects of caffeine on swimming performance in competitive swimmers. Performance outcomes were pooled as standardized mean differences (SMD; Hedges' g), with time outcomes sign-reversed so that positive values indicated improved performance. Dependence among multiple outcomes within studies was addressed using three-level random-effects models (REML). As a supplementary, interpretable metric, log ratios of means (lnRoM) were meta-analysed and expressed as percentage change. Post-exercise blood lactate (mmol/L) was pooled as mean differences (MD). Risk of bias was assessed using RoB 2 and certainty of evidence using GRADE. Prespecified exploratory moderator analyses examined potential effect modification (dose, timing, distance, administration form, stroke, gender, and athlete level). RESULTS: Thirteen studies were included (144 men and 48 women), which contributed 28 performance effect sizes. Caffeine improved swimming performance (SMD = 0.57, 95% CI: 0.20 to 0.94; p = 0.005), corresponding to a +1.71% improvement in lnRoM (95% CI: +1.01% to +2.41%; p < 0.001). Heterogeneity was substantial (I²total = 64.7%) and primarily between studies. Eight studies contributed 24 blood lactate effect sizes. In the meta-analysis, caffeine increased post-test lactate (MD = 0.85 mmol/L, 95% CI: 0.22 to 1.49; p = 0.016) with high heterogeneity (I²total = 76.5%). Exploratory moderator analyses suggested a possible dose-related pattern for swimming performance, with larger pooled effects at ≥6 mg/kg (SMD = 0.95, 95% CI: 0.52 to 1.38) than at <6 mg/kg (SMD = 0.22, 95% CI: -0.15 to 0.60; p difference = 0.017). Other performance moderators did not show clear between-subgroup differences. For lactate, exploratory subgroup analyses suggested larger increases in freestyle and short-distance events, although these patterns were more sensitive to modelling assumptions and should be interpreted cautiously. CONCLUSION: Acute caffeine ingestion confers a moderate ergogenic benefit for swimming performance (SMD = 0.57, 1.7% improvement) and is associated with higher post-test blood lactate (MD = 0.85 mmol/L). Dose (≥6 mg/kg) may be associated with larger performance benefits, whereas lactate responses appear more pronounced in freestyle and shorter events. However, these subgroup findings are hypothesis-generating and require exploration.
22 June 2026
Read appraisal →Brain research
BDNF relates to prefrontal cortex activity in the context of physical exercise
Exercise has been shown to support brain health, cognitive function, and increase levels of brain-derived neurotrophic factor (BDNF). While BDNF is known to support the central nervous system through improved brain metabolism, vasculature, neurotransmission and synaptic plasticity, the association between exercise-induced changes in BDNF concentrations and exercise-related cognitive improvements is still unclear. This study investigated the relationship between exercise-induced changes in plasma BDNF (pBDNF) and serum BDNF (sBDNF), and haemodynamic indicators of prefrontal cortex function in sedentary adults. Participants (n = 23, female = 7) were randomized into intervention (12-week cycling programme) and control groups (no intervention). Participants completed V̇O2max tests to assess changes in fitness. pBDNF and sBDNF were measured pre- and post-V̇O2max testing, and a battery of executive function and memory tasks were also conducted, alongside functional near-infrared spectroscopy (fNIRS) to assess haemodynamic changes in the prefrontal cortex activity. Changes were assessed using the correlation-based signal improvement (CBSI) method. Results indicated that participants in the exercise intervention group did not show increased levels of resting-state s/pBDNF levels at the end of the intervention; however, they did exhibit a significant exercise-induced increase in sBDNF at week 12. This increase was correlated with changes in V̇O2max. Higher pBDNF levels and exercise-induced sBDNF were associated with a decrease in CBSI values in the frontopolar, dorsolateral and orbitofrontal prefrontal cortex during attention and inhibition tasks, but not during the memory task. These results suggest that increasing physical fitness can enhance BDNF transcription in response to acute bouts of exercise. This might, in turn, play a part in the modulation of neural function during executive tasks after acute exercise.
15 June 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Feasibility and acceptability of ExerciseGuideUK for those living with and beyond lung cancer: a mixed methods study
PURPOSE: Digital health interventions offer promise for addressing unmet needs in individuals living with and beyond lung cancer (LWBLC). ExerciseGuideUK, a personalised, web-based exercise platform, was developed for those LWBLC. This study aimed to evaluate ExerciseGuideUK. METHODS: Participants were recruited from Hull University Teaching Hospital and used ExerciseGuideUK over eight weeks. Feasibility and acceptability were assessed using quantitative measures, including the System Usability Scale, structured questionnaires, and qualitative interviews (guided by the Theoretical Framework of Acceptability). A novel mixed-methods integration approach called the Pillar Integration process (PIP) was used to integrate quantitative and qualitative findings on feasibility, engagement, barriers, and adaptation potential. RESULTS: Eighteen participants (mean age 65 ± 14.42y) enrolled. Recruitment and retention rates were 30.5% and 77%, respectively. Notably, 25.4% of those screened were excluded due to digital access issues, including some participants who owned smartphones, suggesting limited digital literacy. Among those who participated, acceptability, usability, and engagement were high. Valued features included goal-setting tools, breathlessness management strategies, and personalised exercise prescriptions. Barriers included treatment side effects, work responsibilities, and low confidence with technology. CONCLUSION: ExerciseGuideUK showed moderate feasibility and high acceptability among users. This is the first known application of PIP in the context of lung cancer, exercise, and digital health. The PIP facilitated a comprehensive understanding of feasibility and acceptability, guiding informed adaptations by users. The PIP warrants further testing and refinement in relation to optimising digital intervention design that promotes equitable, patient-centred care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05121259.
14 June 2026
Read appraisal →Annals of medicine
Predicting major adverse cardiovascular and cerebrovascular events in chronic heart failure: a machine learning study
BACKGROUND: Heart failure (HF) is a clinical syndrome characterized by impaired cardiac diastolic and systolic function due to structural or functional damage to the myocardium. HF represents the end-stage manifestation of many cardiac diseases. Therefore, early identification of high-risk patients is crucial. This study aims to utilize machine learning (ML) methods to develop and validate a model to predict major adverse cardiovascular and cerebrovascular events (MACCE) in patients with HF and identify its key predictive features. METHODS: This study is a retrospective cohort study. We enrolled a total of 271 patients, who were divided into training and testing sets. Baseline data, including cardiopulmonary exercise testing (CPET) parameters and laboratory tests, were collected for all participants. Based on the presence or absence of MACCE during follow-up, they were categorized into a No-event group and MACCE group. We developed seven ML models to predict the incidence of MACCE in patients with chronic heart failure (CHF) using CPET parameters. The predictive performance of these models was systematically compared, and model interpretability was evaluated using Shapley Additive exPlanations (SHAP). Subsequently, retaining only those with HF with preserved ejection fraction (HFpEF) for a sensitivity analysis. Additionally, a subgroup analysis was conducted between No-event group and Worsening HF (WHF) group. RESULTS: We used Boruta feature selection, four important predictive features were identified. Among the ML models constructed with these features, the Categorical Boosting (CatBoost) model demonstrated the best performance. SHAP analysis was applied to interpret the optimal model, revealing that lower values of heart rate recovery at 1 min (HRR1), as well as a higher carbon dioxide ventilation equivalent slope (VE/VCO2 slope), were associated with higher SHAP values-indicating greater importance in predicting adverse outcomes. CONCLUSION: HRR1 and VE/VCO2 slope can serve as independent predictors for the incidence of MACCE in patients with CHF. Both impaired HRR1 and an elevated VE/VCO2 slope serve as significant independent predictors of MACCE in the CHF population.HRR1 is an independent predictor of WHF in patients with CHF.
14 June 2026
Read appraisal →PloS one
Effects of a school-based ACT program on motivation, physical activity participation, motor competence, and physical performance in physically inactive female adolescent students
Adolescents face internal barriers like low self-confidence and psychological discomfort that limit physical activity. Adolescence offers a key window to enhance intrinsic motivation. Acceptance and Commitment Therapy (ACT) may effectively improve physical activity and motor competence through psychological flexibility and value-based behavior. This study examined the effects of an ACT-based intervention on physical activity participation, motivation, motor competence, and physical fitness in physically inactive adolescent girls. A randomized controlled trial involved 132 inactive girls aged 13-18, randomly assigned to either an ACT intervention or a control group. Intervention included seven sessions targeting six core ACT processes. Pre-and post-intervention assessments used standardized questionnaires and tests for physical activity participation, motivation, physical activity, motor competence, and fitness. ACT group showed significant improvements in intrinsic motivation, identified regulation, autonomy, and reduced amotivation and external regulation (p ≤ 0.05). Introjected regulation did not show a significant change (p > 0.05). Physical activity participation and fitness performance also improved significantly, along with both perceived and actual motor competence (p ≤ 0.05). ACT-based intervention effectively enhanced motivation, physical activity engagement, motor competence, and fitness. These findings support integrating ACT into school or community programs to promote sustainable physical activity habits in adolescent girls.
13 June 2026
Read appraisal →Behavioural brain research
Function-specific repetitive transcranial magnetic stimulation enhances motor strategy adaptation when combined with motor practice.
Effective motor strategy adaptation is essential for both high-performance sports and neurorehabilitation. Repetitive transcranial magnetic stimulation (rTMS) can modulate brain function; however, its efficacy may depend on the specificity of the stimulation targets. This study investigated whether function-specific rTMS, guided by fMRI-defined activation during motor imagery, enhances motor strategy adaptation. Forty-six healthy adults were randomized into three groups: function-specific rTMS, hotspot rTMS, and a no-stimulation control. All participants received identical motor imagery and physical practice in the backward glide shot put. Kinematic and resting-state functional magnetic resonance imaging (rs-fMRI) data were collected before and after the 7-day intervention, and functional connectivity (FC) was analyzed. Results showed that function-specific rTMS led to significantly greater improvements in trunk angle during the glide phase, a critical biomechanical parameter. FC between the right inferior frontal gyrus (IFG) and primary sensorimotor cortex increased significantly in this group and was positively correlated with kinematic improvements. These findings demonstrate that rTMS targeting task-relevant brain regions enhances motor strategy adaptation via mechanisms involving FC associated with motor performance, highlighting its potential for optimizing motor learning in both athletic and clinical populations.
7 June 2026
Read appraisal →Behavioural brain research
Effects of anodal transcranial direct current stimulation on athletic performance among elite athletes: A systematic review and meta-analysis
BACKGROUND: Non-invasive brain stimulation techniques, such as transcranial direct current stimulation (tDCS), have been proposed as promising approaches for enhancing motor performance. However, evidence regarding their effects on different domains of athletic performance in elite athletes remains inconclusive. OBJECTIVE: This study aims to quantify the effects of anodal tDCS on athletic performance in elite athletes, compared with a sham condition. METHODS: A comprehensive search of six electronic databases (PubMed, Web of Science, SportDiscus, ECSCO, Embase, and the Cochrane Library) was conducted to identify randomized clinical trials (RCTs). Standardized mean differences (SMDs) based on post-intervention scores were pooled using random-effects models to estimate pooled effect sizes. Subgroup analyses were performed to examine potential moderating variables. Study quality and risk of bias were evaluated using the Cochrane Risk of Bias Tool. RESULTS: A total of 18 studies involving 259 elite athletes were included in the analysis. The results indicated that anodal tDCS had a moderate but significant overall effect on athletic performance in elite athletes (SMD = 0.57, 95% CI [0.39, 0.75], p < 0.01), although moderate heterogeneity was observed ( I²= 51.38%). Subgroup analyses revealed significant domain-specific variability: the effects were strongest in sport-specific performance (SMD = 0.79, 95% CI [0.51, 1.08], p < 0.01) and physical fitness (SMD = 0.58, p < 0.01), whereas the effects on recovery (SMD = 0.17, p = 0.65) and psychological variables (SMD = 0.38, p = 0.09) were negligible and non-significant. Additionally, the M1 area was found to be the most effective cortical target. CONCLUSIONS: Our findings provide evidence that anodal tDCS is a promising tool for enhancing performance in elite athletes, but its effectiveness is highly domain-dependent. It is particularly potent for improving sport-specific skills and physical fitness, while its role in accelerating recovery remains unsupported. Coaches and practitioners should consider these domain-specific variations and the ceiling effect of elite populations when designing tDCS interventions.
7 June 2026
Read appraisal →European journal of nutrition
Microencapsulated docosahexaenoic acid increases the Omega-3 Index and attenuates the physiological impact of eccentric exercise in physically trained adults: a 12-week double-blind placebo-controlled trial
PURPOSE: This study investigated the effects of docosahexaenoic acid (DHA) supplementation on delayed onset muscle soreness (DOMS), physical function, and inflammation following eccentric exercise-induced muscle damage in physically trained male and female adults (training ≥ 5d/wk). METHODS: Thirty-eight participants (12 Control, 26 DHA) completed a 12-week double-blind, placebo-controlled matched-pair trial. The Control group received high-oleic acid tablets. The DHA group received 715 mg/d of microencapsulated DHA tablets. Participants performed eccentric cycling at weeks 0 and 12, with assessments conducted pre-exercise, 0-h, 24-h, and 48-h post-exercise. The primary outcomes were DOMS (visual analogue scale) and the Omega-3 Index (O3I) (estimated by finger-stick dry blood spot). Secondary outcomes included neuromuscular function and inflammatory cytokines. RESULTS: O3I was not different between groups at week 0 but was elevated in the DHA group (∆2.43%, [95% CI; 2.10, 2.77], P < 0.001) and between Control at week 12 (P < 0.001). DOMS was lower at 24-h and 48-h post-exercise in the DHA group and between Control at week 12 (P < 0.01). At week 12, jump height and peak vertical force improved at 48-h post-exercise in the DHA group (P < 0.05), resulting in moderate (d = 0.60) and small (d = 0.32) effect sizes for 48-h post-exercise area under the curve (AUC) between groups, respectively. There were interaction effects for 48-h post-exercise AUC of IL-6 (P = 0.049), TNF-α (P = 0.010), and IL-10 (P = 0.026). CONCLUSION: A dietary achievable dose of DHA elevated the O3I and reduced DOMS in physically trained adults. These outcomes support protracted intake of DHA to attenuate the physiological impact of eccentric exercise and promote recovery.
31 May 2026
Read appraisal →Medicine
Effect of aerobic exercise of different intensity on articular cartilage metabolism in patients with knee osteoarthritis: A randomized controlled trial
BACKGROUND: Osteoarthritis (OA) of the knee is a leading cause of disability worldwide, yet optimal exercise intensity for cartilage protection remains unclear. This randomized controlled trial investigated dose-response effects of aerobic exercise intensity on cartilage metabolism, clinical symptoms, and structural outcomes in knee OA patients. METHODS: One hundred twenty participants with knee OA (Kellgren-Lawrence grade 2-3) were randomly assigned to low-intensity (50-60% heart rate reserve [HRR]), moderate-intensity (60-70% HRR), high-intensity (70-80% HRR) treadmill walking or stationary cycling, or a control group for 12 weeks (3 sessions/week). Heart rate was continuously monitored using Polar H10 chest-strap monitors. Primary outcomes were serum C-terminal telopeptide of type II collagen and cartilage oligomeric matrix protein levels. Secondary outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Visual Analog Scale (VAS) pain, 6-minute walk test, and magnetic resonance imaging-assessed cartilage morphology. Data were analyzed using mixed-model repeated measures analysis of variance with IBM SPSS Statistics version 26.0 (IBM Corp.). RESULTS: The high-intensity group demonstrated the greatest reductions in C-terminal telopeptide of type II collagen (-28.5%, P < .001) and cartilage oligomeric matrix protein (-22.3%, P < .001), the largest improvements in WOMAC scores (-45.3%, P < .001) and VAS pain (-52.5%, P < .001), and the greatest increases in cartilage thickness (+4.2%) and volume (+3.8%). A significant dose-response relationship was confirmed (group × time interaction: F (3108) = 4.82, P = .003). Among participants in the high-intensity group, 73% achieved the minimal clinically important differences (MCID) for WOMAC total score and 80% achieved the MCID for VAS pain. The 6-minute walk test improvement in the high-intensity group (71 m) exceeded the established MCID of 26 m. No serious adverse events were reported; minor events (transient knee pain exacerbation and delayed-onset muscle soreness) resolved spontaneously within 48 to 72 hours. CONCLUSIONS: Appropriately prescribed high-intensity aerobic exercise safely and effectively improved cartilage metabolism, alleviated symptoms, and enhanced functional capacity in knee OA patients. These findings support revising current conservative exercise recommendations upward when tolerable.
31 May 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Exercise effects on cognitive function and molecular markers in post-stroke patients with cognitive impairment: a systematic review and meta-analysis
INTRODUCTION: Exercise may improve cognitive function in stroke survivors. However, no study has yet examined the most effective exercise modalities and associated changes in biomarkers. This study aims to investigate the effects of different exercise types on cognitive function and biomarker trends, providing evidence-based guidance for early rehabilitation interventions. METHODS: Data from randomized controlled trials were collected from January 1, 2000, to March 6, 2025, using medical subject headings combined with free-text terms from PubMed, Cochrane Library, Embase, Wanfang, CNKI, CSTJ, and the China Medical Information Database. The Cochrane Risk of Bias Tool was used to assess the quality of the studies. Review Manager version 5.4.1 was employed to conduct all statistical syntheses. RESULTS: The forty-four original studies involving 4,450 patients with PSCI(Post-stroke cognitive impairment) were analyzed. Subgroup analysis by exercise intervention type revealed larger effect sizes when combining aerobic exercise with other task-based interventions(cognitive-motor dual-tasking and functional motor training) [SMD = 1.18, 95% CI (0.68, 1.68)]. Patients also showed improvements in motor function [MD = 13.98, 95% CI (10.06, 17.89)] and activities of daily living [MD = 16.78, 95% CI (12.97, 20.58)]. Concerning molecular biomarkers, serum levels of brain-derived neurotrophic factor (BDNF), glutathione (GSH), and neuron-specific enolase (NSE) increased significantly, whereas interleukin-6 (IL-6) levels decreased notably in PSCI patients following exercise therapy. CONCLUSION: Structured exercise effectively improves cognitive recovery, motor skills, and daily functioning in patients with PSCI. These clinical gains are accompanied by favorable peripheral biomarker modulations, characterized by significantly increased serum BDNF and GSH, as well as markedly decreased IL-6 levels.
28 May 2026
Read appraisal →Journal of the International Society of Sports Nutrition
The effect of probiotic and synbiotic supplementation on sleep parameters in exercised population: a systematic review and synthesis without meta-analysis (SWiM) of randomized controlled trials
BACKGROUND: Sleep is crucial for recovery and optimal performance in athletes; however, poor sleep is common during periods of intensive training or competition. The microbiota-gut-brain axis suggests probiotics and synbiotics could modulate sleep, but evidence in exercised populations is limited. OBJECTIVE: To systematically review randomized controlled trials (RCTs) assessing the effects of probiotic and synbiotic supplementation on sleep in exercised populations, using a Synthesis Without Meta-analysis (SWiM) approach. METHODS: PubMed, Scopus, Web of Science, and ProQuest were searched up to September 2025. Eligible studies were RCTs including exercised individuals, testing probiotics or synbiotics, and reporting sleep outcomes. Data extraction, risk of bias assessment (RoB 2), and narrative synthesis followed SWiM guidelines. RESULTS: Six RCTs (n = 180) were included: four probiotic and two synbiotic interventions lasting 4-17 weeks. Populations included athletes from multiple sports across four continents. Nine of twelve primary sleep outcomes favored supplementation, with significant effects for probiotics (combined p < 0.01) and synbiotics (p < 0.001). Benefits were most consistent for subjective sleep quality and, in some cases, sleep latency. Secondary outcomes showed occasional reductions in stress, anxiety, and fatigue. CONCLUSION: Probiotic and synbiotic supplementation may improve sleep in exercised populations, especially perceived quality and latency. Evidence supports cautious, adjunctive use, but larger, standardized trials are needed to confirm effects.PROSPERO registration number: CRD420251151264.
26 May 2026
Read appraisal →Circulation journal : official journal of the Japanese Circulation Society
Smaller Right Ventricle Results in Poorer Exercise Performance in Young Patients With Repaired Tetralogy of Fallot
BACKGROUND: Severe right ventricular (RV) dilatation and exercise intolerance are considered indications for pulmonary valve replacement in surgically repaired tetralogy of Fallot (rTOF). METHODS AND RESULTS: Cardiopulmonary exercise testing (CPET) and cardiac magnetic resonance (CMR) were performed in rTOF patients with pulmonary insufficiency (PI). Oxygen pulse (OP), calculated as oxygen consumption (V̇O2)/heart rate, was used as a surrogate of stroke volume (SV). Correlations between CPET and CMR measures were investigated. In all, 37 patients (mean [±SD] age 17±5 years; 14 males) were examined. Peak V̇O2/kg was approximately 70% of predicted value. The pulmonary regurgitant fraction (PRF) was 28.3±13.4%. Body surface area (BSA)-indexed RV end-diastolic volume (RVEDVi) and RVSV (RVSVi) were 127±28 and 65±16 mL/m2, respectively. RV and left ventricular (LV) ejection fractions were 50.3±7.8% and 59.1±6.1%, respectively. A strong positive correlation was noted between RV end-diastolic volume and RVSV (P<0.0001), RVSV and LVSV (P<0.0001), and RVEDVi and peak OP/BSA (P=0.0004). Larger RVEDVi was correlated with better exercise performance, whereas smaller RVEDVi was correlated with worse exercise performance. RVEDVi was larger in male than female rTOF patients despite comparable PRF, RVSVi, LVEDVi, and BSA-indexed LVSV. CONCLUSIONS: A smaller RV was associated with worse exercise performance, indicating exercise intolerance is independent of RV dilatation in young rTOF with PI and represents a unique pathological entity responsible for reduced exercise performance.
25 May 2026
Read appraisal →Medicine
Effect of a sports-medicine-guided football program on physical fitness in adolescents: A controlled school-based trial
Integrating artificial intelligence (AI) with sports medicine principles into school-based physical education may enhance physical fitness and reduce injury risk among adolescents. This study aimed to evaluate whether a 10-week sports-medicine-guided football curriculum augmented with explainable machine-learning feedback produces greater improvements in physical fitness and injury-prevention outcomes than a standard physical-education curriculum. A total of 195 healthy junior high school students (mean age 14.1 ± 0.7 years) participated in a controlled school-based intervention and were allocated to either an AI-supported sports-medicine curriculum (intervention) or a standard curriculum (control). Physical fitness outcomes, including lung capacity, estimated maximal oxygen uptake (VO2max), sprint performance, standing long jump, and middle-distance running performance (800 m girls/1000 m boys), were assessed before and after the 10-week program. Outcomes were analyzed using 2-way mixed analysis of variance to test Group × Time interactions. Injury risk prediction was supported by an explainable machine-learning ensemble model (CatBoost + Gradient Boosting) interpreted using SHAPley Additive explanations. Significant Group × Time interactions were observed for lung capacity (P < .01) and VO2max (P < .01), indicating greater improvements in the intervention group compared with controls. The intervention group also demonstrated superior improvements in sprint performance, middle-distance running, and lower-limb power (P < .05), while no significant between-group differences were observed for upper-body strength (P > .05). A school-based football curriculum integrating sports-medicine principles with explainable AI-driven feedback leads to significantly greater improvements in key physical-fitness outcomes than a standard physical-education curriculum. This approach directly supports individualized training adaptation and injury-risk awareness, offering a scalable model for enhancing adolescent health and safety in school physical education.
25 May 2026
Read appraisal →Medicine
The effects of electroacupuncture and the Otago Exercise Program in older adults with sarcopenia: A randomized controlled study
BACKGROUND: The aim of this study was to investigate the effects of a combination of electroacupuncture (EA) and the Otago Exercise Program (OEP) for sarcopenia in older individuals and provide treatment recommendations for this patient population. METHODS: In this assessor-blinded randomized controlled trial, 120 older patients with sarcopenia were randomly divided into an OEP group (n = 58) and an EA + OEP group (n = 62). The OEP group received OEP 5 times/week, with each session lasting 30 minutes, for a duration of 12 weeks. In addition to OEP treatment, the EA + OEP group was treated with EA at ST31, ST32, GB34 and ST36 for 30 minutes 3 times/week for 12 weeks. The appendicular skeletal muscle mass-height index (ASM/H2) was the primary outcome. The secondary outcomes included grip strength, 4-m gait speed and 6-min walk distance. Outcomes were measured before initiation and at 6 and 12 weeks after initiation. RESULTS: Significant differences in ASM/H2, grip strength, 4-m gait speed and 6-min walk distance were detected between the 2 groups at week 12, whereas no differences were detected at weeks 0 and 6. In the EA + OEP group, as the treatment time increased, ASM/H2, grip strength, 4-m gait speed and 6-min walk distance increased significantly. In the OEP group, as the treatment time increased, no significant difference was found in ASM/H2, whereas grip strength, 4-m gait speed and 6-min walk distance increased significantly (P < .05). CONCLUSION: In older patients with sarcopenia, EA + OEP was associated with increased skeletal muscle mass, but no such effect was found for OEP alone. Moreover, EA + OEP was superior to OEP alone in terms of improving muscle strength and walking ability. EA + OEP may be considered an effective treatment for sarcopenia in older adults.
25 May 2026
Read appraisal →PloS one
A randomised crossover trial comparing photobiomodulation therapy with other recovery strategies in CrossFit athletes
BACKGROUND: This study compared the effects of different therapeutic modalities on recovery following the workout of the day (WOD) in CrossFit athletes, focusing on reducing muscle damage and improving functional performance. METHODS: In a randomised, controlled, crossover design, twelve CrossFit athletes underwent four post-WOD recovery interventions across four weeks: passive recovery (PR), intermittent pneumatic compression (IPC), extracorporeal shock wave therapy (ESWT), and photobiomodulation therapy combined with a static magnetic field (PBMT-sMF). Assessments were conducted at baseline, and at 1, 24, and 48 hours post-WOD. The primary outcome was vertical jump performance (countermovement jump [CMJ] height) at 1-hour post-WOD; secondary outcomes included lactate dehydrogenase (LDH) levels, superoxide dismutase (SOD) and catalase (CAT) activity, thiobarbituric acid reactive substances (TBARS), carbonylated proteins, perceived exertion, and intervention satisfaction. RESULTS: There was no significant difference between interventions in CMJ height at 1-hour post-WOD. In contrast, PBMT-sMF outperformed the other interventions in the secondary outcomes. PBMT-sMF significantly improved CMJ height at 24 and 48 hours compared with PR (p < 0.05) and led to greater reductions in LDH at both time points (p < 0.05 and p < 0.001, respectively). PBMT-sMF also produced lower TBARS and carbonylated protein levels, with higher CAT and SOD activities at 24 and 48 hours (p < 0.05 and p < 0.0001, respectively). CAT and SOD activities were also significantly elevated at 1 hour post-WOD compared with PR (p < 0.05). CONCLUSIONS: PBMT-sMF may be an effective recovery strategy for CrossFit athletes, with its benefits possibly related to the modulation of oxidative stress as an underlying mechanism. TRIAL REGISTRATION: Trial registration number: NCT06628609.
24 May 2026
Read appraisal →Archives of women's mental health
Multidimensional psychological and neurophysiological effects of moderate- and low-intensity exercise on pregnant women: an integrative systematic review and Bayesian framework network meta-analysis
BACKGROUND: Pregnancy-related mental health disorders are an increasingly important global public health concern. Exercise interventions have gained attention as safe, non-pharmacological strategies for improving maternal psychological and neurophysiological well-being. However, comparative evidence regarding different exercise modalities and intensities remains limited. OBJECTIVE: This study aimed to systematically evaluate and rank the effects of different prenatal exercise modalities and compare moderate- versus low-intensity exercise protocols on maternal mental health and neurophysiological outcomes during pregnancy. METHODS: A Bayesian network meta-analysis was conducted following PRISMA-NMA guidelines. PubMed, Embase, Cochrane Central, and PsycINFO were systematically searched. Thirty-six randomized controlled trials involving 4,577 pregnant participants were included. Methodological quality was assessed using the Cochrane RoB 2.0 tool. Treatment effects were ranked using the surface under the cumulative ranking curve method. RESULTS: Moderate-intensity aerobic training showed the strongest effect on reducing prenatal depression, with a SUCRA value of 0.89. Yoga-based interventions were particularly effective for anxiety reduction, with a SUCRA value of 0.76, and ranked second in the overall outcome evaluation, with a SUCRA value of 0.82. Neurophysiological findings indicated that yoga showed the greatest benefit for cortisol regulation, whereas aquatic exercise demonstrated distinctive anti-inflammatory effects. Subgroup analyses suggested that moderate-intensity exercise tended to produce greater reductions in depression, while low-intensity exercise showed comparable or superior effects on anxiety and cortisol modulation. Meta-regression further indicated that interventions conducted three times per week and lasting more than 12 weeks were associated with larger effect sizes. The certainty of evidence ranged from moderate to high across primary comparisons. CONCLUSION: This network meta-analysis provides a preliminary evidence hierarchy for prenatal exercise interventions. Moderate-intensity aerobic exercise may be most beneficial for reducing prenatal depression, while yoga appears particularly suitable for anxiety and cortisol regulation. These findings offer clinicians a reference framework for individualized prenatal exercise recommendations and support the integration of exercise into maternal mental healthcare.
16 May 2026
Read appraisal →Thorax
Measurement properties of the sit-to-stand test in community-dwelling people with chronic obstructive pulmonary disease: a COSMIN systematic review
BACKGROUND: The sit-to-stand (STS) test can assess physical function in people with chronic obstructive pulmonary disease (COPD); however, there are multiple versions. No study has used current guidelines to assess the measurement properties of the STS tests in people with COPD. METHODS: We conducted a systematic review using current COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Full text peer-reviewed publications were included if they assessed the measurement properties (validity, reliability and/or responsiveness) of at least one STS test among community-dwelling people with COPD. We searched six databases and imported results into Covidence where title/abstract screening and full text selection was completed independently and in duplicate. Extraction was conducted independently and in duplicate using the COSMIN extraction file. We assessed study risk of bias (very good, adequate, doubtful or inadequate), measurement property quality (sufficient, indeterminate or insufficient) and overall certainty of evidence (high, moderate, low or very low) using the COSMIN recommended tools. RESULTS: We assessed 2577 titles/abstracts and 102 full texts for inclusion; 30 publications met eligibility. Seven unique STS tests were located with the most common being the 1 min STS test (n=14, 39%), 5-repetition STS test (n=10, 28%) and the 30 s STS test (n=8, 22%). Where assessed, reliability was sufficient for the 1 min, the 5-repetition and the 30 s STS tests. Only the 1 min STS test had high-quality evidence of sufficient construct validity, while the 30 s STS test was the sole test with at least moderate quality evidence of sufficient responsiveness. CONCLUSIONS: The 1 min STS test has the most robust measurement properties for cross-sectional assessments while the 30 s STS test is more robust to assess change.
16 May 2026
Read appraisal →PloS one
Effects of β-alanine supplementation on kickboxing-specific anaerobic performance, neuromuscular power, and strength endurance: A randomized, double-blind, placebo-controlled trial
β-Alanine (BA) elevates skeletal muscle carnosine and may improve repeated high-intensity performance; however, evidence in kickboxing is limited. This study investigated the effects of 4-week BA supplementation on sport-specific kickboxing anaerobic performance, neuromuscular power, and strength endurance in trained male kickboxers. Twenty-eight athletes were randomly assigned to BA (6.4 g·day ⁻ ¹; n = 14) or placebo (n = 14) in a double-blind, placebo-controlled design. Pre- and post-intervention assessments included the Kickboxing Anaerobic Speed Test (KAST₁-₅, KASTbest, KASTtotal, Performance Decrement Index [PDI]), neuromuscular power (countermovement jump [CMJ], squat jump [SJ]), and strength endurance tests (push-up, pull-up). Baseline differences were tested via t-tests, effect sizes calculated according to Hedges' g formula. Group × time effects were analyzed using two-way repeated-measures ANOVA with partial eta squared (ηp²) effect sizes. Baseline measures were comparable (all p > 0.05). After supplementation, no significant group × time interactions emerged for CMJ (p = 0.148), SJ (p = 0.717), KAST₁-₅ (all p > 0.05), KASTbest (p = 0.071), or PDI (p = 0.454). However significant improvements were observed in the BA group for KASTtotal (F(1,26) = 14.49, p < 0.001, ηp² = 0.358), push-ups (F(1,26) = 5.89, p = 0.023, ηp² = 0.185), and pull-ups (F(1,26) = 9.79, p = 0.004, ηp² = 0.274). Four weeks of BA supplementation enhanced total anaerobic performance (KASTtotal) and upper-body strength endurance (push-up, pull-up), while no significant changes were observed in neuromuscular jump performance (CMJ, SJ). BA appears to be a practical ergogenic aid for improving repeated-effort and strength-endurance capacity in kickboxing. Clinical trial registration ClinicalTrials.gov (NCT07319052).
15 May 2026
Read appraisal →PloS one
Oral carbohydrate sensing enhances prefrontal cortex oxygenation, reduces perceived exertion, and improves high-intensity cycling performance: A randomized crossover trial
PURPOSE: Carbohydrate mouth rinsing (CHO-MR) and music listening (MUS) are non-metabolic interventions proposed to attenuate cognitive and perceptual fatigue during exercise. However, their comparative effects on prefrontal cortical oxygenation, executive function, and perceived exertion during high-intensity endurance performance remain unclear. This study examined the effects of CHO-MR and MUS on dorsolateral prefrontal cortex (DLPFC) oxygenation, cognitive performance, perceived exertion, and cycling performance during a 4-km time trial (TT). METHODS: Eleven trained cyclists (7 men, 4 women) completed a randomized, single-blind, crossover trial under three conditions: CHO-MR, MUS (120 beats/min), and placebo mouth rinse (PLA). Bilateral DLPFC oxygenation was assessed using functional near-infrared spectroscopy at rest, during Stroop testing, post-intervention, and post-TT. Stroop performance, rating of perceived exertion (RPE); every 500 m, completion time, power output, heart rate, and blood lactate were measured. Outcomes were analyzed using generalized estimating equations adjusted for period, sequence, and first-order carryover effects with robust standard errors. RESULTS: CHO-MR increased bilateral DLPFC oxygenation compared with MUS and PLA at post-intervention and post-TT time points (p < 0.05), with no differences at rest or baseline. Stroop performance was superior in CHO-MR relative to MUS and PLA following the TT (p < 0.001), without between-condition differences at earlier assessments. RPE was lower in CHO-MR than PLA across all intervals (p ≤ 0.01) and lower than MUS at mid-trial distances (p < 0.05). CHO-MR resulted in faster completion times, greater mean power output, and higher mean speed compared with MUS and/or PLA (p < 0.05), whereas peak power, heart rate, and blood lactate did not differ among conditions. Pooled change-score analyses demonstrated positive associations between bilateral ΔDLPFC oxygenation (p < 0.001) and between ΔDLPFC oxygenation and ΔStroop performance (p < 0.05). CONCLUSION: CHO-MR enhances bilateral DLPFC oxygenation, preserves executive function, and reduces perceived exertion during high-intensity endurance exercise, translating into improved performance without detectable peripheral metabolic alterations. These findings support a central neurocognitive mechanism underlying the ergogenic effects of oral carbohydrate sensing. TRIAL REGISTRATION: ClinicalTrials.gov NCT07099807.
14 May 2026
Read appraisal →Journal of the International Society of Sports Nutrition
Post-activation performance enhancement (PAPE) and taurine combination improves anaerobic performance in highly trained wrestlers: a double-blind, randomized, crossover study
BACKGROUND: PAPE is a physiological phenomenon that temporarily enhances muscular strength and responsiveness following high-intensity muscle activity. This study aimed to investigate the acute effects of a PAPE protocol combined with taurine supplementation on anaerobic performance, blood lactate levels, and neuromuscular fatigue in highly trained male wrestlers. METHODS: Twenty elite male wrestlers participated in a double-blind, crossover design comprising three separate sessions: (i) control with no supplementation or PAPE protocol (CON), (ii) PAPE protocol with placebo (PAPE*PLA), and (iii) PAPE protocol with taurine supplementation (PAPE*TAU). In the PAPE*PLA and PAPE*TAU conditions, participants completed 3 sets of 8 repetitions of squat and hip thrust exercises at 85% of their one-repetition maximum. Either a taurine supplement or a sucrose placebo was administered 60 minutes before the protocol. Five minutes after the PAPE protocol, the Wingate anaerobic power (WanT) test was conducted, while CMJ tests were performed before (CMJ-pre), immediately after (CMJ-post), and five minutes following (CMJ-post-5) the WanT. RESULTS: The PAPE*TAU condition resulted in significantly higher peak power output (16.76% increase; p = 0.048) and power relative to body mass (22.24% increase; p = 0.028) compared to PAPE*PLA and CON. Additionally, post-test blood lactate levels were significantly lower in the PAPE*TAU condition (p < 0.05), and CMJ performance was significantly better post-exercise (p < 0.05), indicating reduced neuromuscular fatigue. CONCLUSION: In conclusion, the combination of the PAPE protocol with taurine supplementation enhances anaerobic performance, supports neuromuscular function, and promotes metabolic recovery following high-intensity exercise. These findings suggest a synergistic effect that may benefit athletes engaged in explosive and anaerobic sports such as wrestling.
13 May 2026
Read appraisal →Journal of the International Society of Sports Nutrition
Carbohydrate supplementation for endurance exercise in the heat: a systematic review with practical recommendations
BACKGROUND AND OBJECTIVES: Endurance exercise performance is impaired by heat stress. Although the mechanisms are not yet fully understood, heat-induced increases in glycogenolysis may play a role. Therefore, carbohydrate supplementation recommendations may differ for endurance exercise in hot environments. This systematic review aims to investigate the efficacy of carbohydrate supplementation for endurance performance in hot environments. METHODS: Electronic databases, including PubMed, the Cochrane Library, MEDLINE, and SPORTDiscus were searched through to April 14, 2026 for studies evaluating endurance performance outcomes under heat stress in response to carbohydrate supplementation. Studies were included if the participants were healthy, aged 18-65 years, and at least recreationally active. A hot environment was defined as an ambient temperature >23 °C. Studies were required to involve an endurance-based and continuous exercise protocol lasting >30 min and a direct performance measure. This cutoff was selected based on evidence indicating glycogen stress at ~40 min under heat stress. In total, 3151 records were identified, and nine randomized, crossover studies met the inclusion criteria. Risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias. Primary outcomes (endurance performance and carbohydrate oxidation rates) and secondary outcomes (including gastrointestinal symptoms, thermoregulation, and hydration markers) were extracted. Mean carbohydrate intake rates were calculated, and a narrative synthesis was performed. RESULTS: Mean carbohydrate ingestion rates ranged between 14 and 140 g·h-1, and the exercise trial duration ranged between ~50 and 152 min. Carbohydrate supplementation resulted in equivocal benefits to endurance performance: five studies found significant (p < 0.05) positive effects for carbohydrates (increases of 13.4%-19.3% in time to exhaustion and 3.3%-12.7% in time trial), and four studies found no significant effects. Although nonsignificant, three studies reported average improvements of 6.7%-11.6%, which may be meaningful in elite athletes. Most studies reported no differences in the respiratory exchange ratio between trials, indicating a preferential reliance on glycogen, which is in line with the literature. Carbohydrate ingestion during exercise in the heat did not influence markers of hydration, thermoregulation, or fatigue compared with placebo. Given that prior research shows gastrointestinal symptoms is common in endurance events in hot environments, the absence of symptom investigations in seven out of nine studies reviewed has important implications for interpreting findings. Overall, the results suggest that carbohydrate intake may not reduce glycogen breakdown during endurance performance in heat. Future research should help to better understand the underlying reasons, including any moderating effects of gastrointestinal distress. CONCLUSIONS: Carbohydrate intake during endurance exercise in the heat does not consistently improve exercise performance. Athletes may focus on maintaining hydration during exercise and practice gut-training, based on the wider literature. Future studies should fill the gaps in research, namely, the measurement of gastrointestinal symptoms, the mechanisms of exogenous carbohydrate use in heat, and different modes of exercise, including running, to enable the development of robust, evidence-based recommendations.
12 May 2026
Read appraisal →ChemistryOpen
Ionic Hydrogel Triboelectric Sensor for Real-Time Swimming Kinematics Monitoring and Stroke Recognition
Recently, wearable sports electronics have attracted increasing attention for their potential to enable continuous motion tracking and energy-autonomous operation in complex athletic environments. In this work, we present a flexible triboelectric nanogenerator (PAC-TENG) constructed from a PVA/Ala/CaCl2 ionic hydrogel electrode and a compliant silicone triboelectric layer. The PAC hydrogel provides high stretchability, stable ionic conductivity, and strong deformation tolerance, while the silicone surface ensures efficient and repeatable charge generation. Benefiting from this synergistic design, the PAC-TENG achieves excellent electrical outputs, including a peak voltage of 472.9 V, a short-circuit current of 37.1 µA, and a transferred charge of 104.1 nC, along with high power density under matched load. The device exhibits strong sensitivity to bending angle, applied force, and motion frequency, enabling accurate perception of human biomechanics. When mounted on swimming-related joints, the PAC-TENG can reliably monitor stroke patterns and detect abnormal motion signals, highlighting its promise for self-powered aquatic sports analytics and intelligent safety monitoring.
6 May 2026
Read appraisal →Sports health
Evaluation of Exertional Sweat Loss Estimates in Wearable Technology
BACKGROUND: Wearable technology shows promise for monitoring exertional sweat loss, yet its accuracy requires evaluation. This study evaluated the accuracy of 2 commercially available smartwatches for estimating sweat loss compared with gold standard methods. HYPOTHESIS: Sweat loss values measured via wearable technology will be determined accurate compared with gold standard methods. STUDY DESIGN: Cross-sectional. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 111 participants (age, 40 ± 14 years; height, 171.0 ± 8.9 cm; body mass, 70.8 ± 14.7 kg; VO2max, 46.8 ± 8.7 ml/kg/min) completed up to 4 running trials under varying conditions (indoor/outdoor, distances from 2.5 km to 20 km, and interval runs). Sweat loss estimates from each smartwatch were compared with criterion measurements based on change in nude body mass pre- and postexercise. Validity statistics included tests for error (mean absolute error [MAE], mean absolute percentage error [MAPE]), linearity (Lin's concordance correlation coefficient [CCC], Pearson's [r], and Deming regression), equivalence (CI for difference in means), and Bland-Altman plots for bias assessment. Stratified analyses by sex, weight, and fitness category were also completed, along with a chi-square test of independence. RESULTS: Both devices demonstrated acceptable overall correlation (CCC range, 0.71 to 0.90) but substantial errors in estimating exertional sweat loss (MAPE range, 25.38% to 33.21%). Stratified analyses yielded similar results, with no additional analyses meeting the combined validity thresholds. CONCLUSION: Wearable devices offer a promising and convenient tool for general sweat loss tracking but lack the precision to replace laboratory methods for hydration management. Traditional methods remain essential for the most accurate measurements. CLINICAL RELEVANCE: Wearable devices provide an accessible option for sweat loss monitoring. This study highlights their potential for general tracking while emphasizing the need for laboratory methods when accuracy is critical, ensuring better guidance for hydration strategies in sports performance and health applications.
4 May 2026
Read appraisal →PloS one
Short-duration phase-change material cryotherapy selectively enhances early neuromuscular and perceptual recovery.
The purpose of this study was to examine whether short-duration phase-change material cooling (PCM) applied at different temperatures influences acute recovery following fatigue induced by stretch-shortening cycle exercise (SSC). Sixty-four physically active participants were randomly assigned to 5°C, 10°C, or 15°C PCM cryotherapy group or a passive recovery control group. After completing a SSC fatigue protocol, participants underwent a 15-minute PCM intervention, and peak torque (PT), mean power, rate of force development (RFD), countermovement jump (CMJ) performance, Rating of perceived exertion (RPE), modified endurance ratio (MER), vastus lateralis (VL) and Rectus Femoris (RF) stiffness were assessed immediately after fatigue (Imm-fatigue), immediately after PCM cryotherapy (Imm-PCM), and 60 minutes post PCM cryotherapy (Post60-PCM). Mean power and RFD were significantly greater in PCM groups compared with the control group at Imm-PCM (P ≤ 0.01), with mean power remaining elevated in the 15°C PCM group at post-60-PCM (P ≤ 0.05). RPE was significantly lower in all PCM groups at Imm-PCM and post60-PCM compared with control (P ≤ 0.01). No between-group differences were observed for PT, CMJ, MER, or muscle stiffness, and no temperature-dependent effects were detected within the 5-15 °C. These findings indicate that 15-minute PCM cryotherapy selectively accelerates early-phase neuromuscular and perceptual recovery without affecting maximal strength, endurance capacity, or passive muscle mechanical properties. From an applied perspective, PCM cryotherapy may be an effective strategy to enhance explosive performance and perceived readiness during short recovery intervals in training or competition settings.
27 Apr 2026
Read appraisal →Annals of medicine
Artificial intelligence and wearable sensors in sports injury risk prediction: current status and future perspectives.
BACKGROUND: Artificial intelligence (AI) and wearable sensors are increasingly reshaping sports injury risk prediction by enabling continuous, individualized, and data-driven assessment. DISCUSSION: This review summarizes recent advances in wearable technologies - including inertial measurement units (IMUs), electromyography (EMG), physiological monitors, and flexible electronics - and their use in capturing biomechanical, physiological, and psycho-physiological indicators relevant to injury risk. Deep learning (DL) models, particularly those capable of temporal and multimodal fusion, have shown promise in predicting injuries such as anterior cruciate ligament (ACL) tears, muscle fatigue, and stress fractures. Through representative applications and mechanism-informed analysis, we highlight the growing role of interpretable AI, real-time feedback, and behavior-integrated predictive systems. CONCLUSIONS: Key challenges remain, including data heterogeneity, limited generalizability, compliance issues, and privacy concerns. Future directions point toward personalized modeling, explainable systems, federated learning, and digital twin frameworks. Together, these advancements mark a shift toward proactive, intelligent injury prevention across athletic and clinical settings.
24 Apr 2026
Read appraisal →European journal of preventive cardiology
A comprehensive analysis of the impact of high-intensity interval vs. moderate-intensity continuous training on global and regional myocardial function in patients early after acute myocardial infarction: the STRAICT randomized controlled trial
AIMS: This study aims to compare the effect of moderate-intensity continuous training (MICT) vs. isovolumic high-intensity interval training (HIIT) on left ventricular (LV) myocardial function early post-acute myocardial infarction (AMI). Training-induced changes were analysed at both global and segmental levels using advanced deformation echocardiographic imaging techniques. METHODS AND RESULTS: One hundred AMI patients were randomly assigned to participate in an 8-week training programme comprising either MICT (n = 50) or isovolumic HIIT (n = 50), starting within 6 weeks post-AMI. Before and after cardiac rehabilitation (CR), we carried out a comprehensive and detailed evaluation of myocardial function, including measurements of LV longitudinal strain (LS) and circumferential strain and torsional mechanics, LV myocardial work (MW) and mechanical dispersion [post-systolic shortenings (PSS)] indexes, and atrial strains. Mixed models were used to evaluate the effect of MICT and HIIT on speckle-tracking echocardiography parameter. Both MICT and HIIT resulted in a similar improvement in the amplitude and timing of LV LS (time effect P < 0.001 in each case), as depicted by the comparable increase in global LS [HIIT: -0.82%, 95% confidence interval (CI): -0.19/-61; MICT: -1.11%, 95% CI: -1.17/-0.51; time ∗ group P = 0.71], MW index and efficiency, constructive MW, and reduction in the number of PSS and wasted MW (time ∗ group P > 0.12 in each case) in the two groups. These improvements were observed in all myocardial territories, regardless of previous ischaemic risk status (culprit vessel-by-time-by-group interactions, P > 0.60 in each case). Circumferential strains remained unchanged in both groups while there was a trend (time ∗ group P = 0.04) for LV torsion to decrease for MICT (P = 0.06) and increase for HIIT (P = 0.36) after CR. Left atrial strains during the reservoir and conduit phases improved (time effect P < 0.05) similarly in MICT vs. HIIT (time ∗ group P > 0.54). V̇O2peak (P < 0.001) and quality of life (P < 0.001) improved equally in MICT and HIIT after CR. CONCLUSION: Early supervised exercise-based CR, whether using MICT or isovolumic HIIT, improves longitudinal myocardial function in both culprit and non-culprit territories after AMI. Exercise-based cardiac rehabilitation (CR) is an effective strategy for reducing cardiovascular morbidity and mortality in patients after a myocardial infarction (MI). While moderate-intensity continuous training (MICT) has been the traditional form of aerobic exercise in CR, high-intensity interval training (HIIT) is gaining popularity due to its demonstrated feasibility, safety, and potential superiority in improving physical fitness. The impact of CR on heart function after MI is not well understood. It is still unclear whether HIIT is more effective than MICT for improving heart function. This uncertainty is due to limitations in previous studies, such as differences in total workload realized, which is an important factor in CR. It is also unclear whether different types of exercise training have different effects on parts of the heart that were damaged due to reduced blood flow during the heart attack compared with the areas that were not affected. This study aims to fill these gaps by comparing HIIT and equal-volume MICT using advanced echocardiographic imaging techniques to evaluate overall and regional heart function, focusing on both affected and unaffected areas of the heart. We found thatExercise-based CR initiated early after the heart attack effectively improves cardiac function, with HIIT as effective as isovolumic MICT.These improvements were observed equally with both MICT and HIIT across all areas of the heart, confirming its ability to functionally recover even in regions previously impacted by reduced blood flow.
24 Apr 2026
Read appraisal →Journal of the International Society of Sports Nutrition
Soccer pass performance following caffeine intake with deliberate or maintenance practice
BACKGROUND: The impact of caffeine on strength and endurance performance is well acknowledged, yet its influence on skill performance remains contentious. A potential scenario in which caffeine augments the efficacy of practice could be useful for sports brokers who diligently pursue every nuance to enhance performance. Therefore, the primary objective of this study was to examine the impact of 3 mg·kg-1 of caffeinated coffee intake combined with deliberate (DP) or maintenance practice (MP) on passing performance in adolescent football players. The study also discusses how DP and MP affect passing accuracy without considering caffeine or placebo conditions, as well as how athletes perceive DP and MP and whether caffeine supplementation influences these perceptions. METHODS: Fourteen adolescent male football players (14.07 ± 0.26 years; 174.28 ± 3.12 cm; 57.21 ± 8.40 kg) participated in a double-blind, randomized, counterbalanced, and crossover research design. For the experimental protocols, each participant visited an artificial turf pitch on four occasions, separated by 48 h. They received 3 mg·kg-1 of caffeine sourced from coffee with DP (1), caffeinated coffee intake with MP (2), decaffeinated coffee with DP (3), and decaffeinated coffee with MP (4). Upon concluding the practice regimes, the athletes promptly expressed their evaluations of the practice on a scale of 1-10. The Loughborough Soccer Passing Test (LSPT), the One-Touch Passing Test (OTPT), and the Long Passing Test (LPT) were administered to evaluate participants' passing proficiency at both the beginning and end of each session. RESULTS: There was no difference in LSPT, OTPT, or LPT values following caffeine (CAF) and placebo (PLA) supplementation after DP or MP. Regardless of CAF-PLA conditions, although both practices improve the LSPT original time, penalty time, and performance time, only MP increases the LPT score (21.9%; p = 0.03). Caffeine also has no additional modifier effect on practice perceptions. DP is considered more mentally challenging than MP (4.18 ± 2.3 & 1.9 ± 1.2; p > 0.05), but both practices are similar in terms of relevancy, enjoyment, and physicality. CONCLUSION: 3 mg·kg-1 of caffeinated coffee has no additional effects on DP or MP for passing performance. Regardless of CAF or PLA intake, both practices improve short-term passing, yet only MP appears effective for enhancing long-term passing in players with average technical ability. Accordingly, coaches may consider incorporating these strategies into pre-match warm-ups or structured training programs. Moreover, CAF did not influence players' perceptions of the training sessions, particularly when physical demand was minimal. Similarly, when comparing DP and MP, athletes reported similar perceptions, suggesting that the practical application of DP in field-based settings may diverge from its original theoretical framework. Further research needs to clarify how DP principles are implemented and perceived in real-world practice.
23 Apr 2026
Read appraisal →Journal of the International Society of Sports Nutrition
Effects of eight weeks of eicosapentaenoic acid and medium-chain triacylglycerol structured lipid intake on EPA/AA ratio and muscle performance in young men
BACKGROUND: Structured triglycerides (STGs), in which eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are esterified with medium-chain triglycerides (MCTs), have demonstrated greater bioavailability and potential benefits in improving endurance and reducing post-exercise strength loss compared with physical mixtures (PMs) of EPA and MCTs. However, it remains unclear whether STGs have superior effects on blood EPA levels and muscular endurance and fatigue. This study compared the effects of 8-week STG and PM intake on blood EPA levels, muscular endurance, and fatigue following resistance exercise. METHODS: Twenty-eight healthy young men were randomly assigned to an STG group (n = 15) or a PM group (n = 13) in a double-blind, parallel-group, active comparator trial. Participants consumed 4,560 mg/day of the test oil (600 mg EPA, 260 mg DHA) for 8 weeks. After the intervention, the participants performed four sets of leg extensions to exhaustion at 40% of their body weight. Muscular endurance was assessed by the number of repetitions, and fatigue was evaluated by changes in maximal voluntary contraction, range of motion, thigh circumference, muscle thickness, echo intensity, and jump performance. RESULTS: The STG group showed a significantly greater increase in the serum EPA/arachidonic acid (AA) ratio compared with the PM group. However, no significant differences were found between groups in repetition counts or fatigue-related measures. CONCLUSION: Eight weeks of STG supplementation improved the blood EPA/AA ratio more than a PM, but did not yield superior effects on muscle endurance or fatigue.
18 Apr 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Effects of Abdominal Bracing Versus Abdominal Hollowing on Abdominal Muscle Thickness and Activation During Static and Dynamic Trunk Stabilization Tasks in Healthy Adults
BACKGROUND Abdominal hollowing selectively targets deep abdominal muscles, whereas abdominal bracing emphasizes global activation of the superficial musculature. This study aimed to compare the effects of abdominal bracing and abdominal hollowing on abdominal muscle thickness and activation during trunk stabilization tasks in healthy adults. MATERIAL AND METHODS Eighteen healthy adults (9 males, 9 females) participated in a randomized crossover study. Abdominal bracing and hollowing were performed in random order with a 1-week wash-out period. Muscle thickness of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) were measured using ultrasound imaging. Surface electromyography assessed activation of the RA, EO, and IO during a static hook-lying position and a dynamic supine toe-tap task. RESULTS RA thickness was greater during bracing than hollowing (10.07±1.55 mm vs 9.22±1.46 mm, p=0.032), whereas IO and TrA thicknesses were greater during hollowing (IO: 8.65±3.18 mm vs 6.63±2.14 mm; TrA: 4.08±1.23 mm vs 2.41±0.80 mm, both p<0.05), representing an approximately 31% increase in TrA thickness. During the static task, activation of the RA, EO, and IO was higher during hollowing (p<0.05), whereas no significant differences were observed during the dynamic task. CONCLUSIONS Abdominal hollowing preferentially enhances deep muscle activation during low-load static conditions, whereas abdominal bracing promotes global muscular engagement. With increasing task demands, stabilization strategies converge, indicating task-dependent neuromuscular coordination.
18 Apr 2026
Read appraisal →Carbohydrate polymers
Multifunctional conductive hydrogel based on carboxymethyl cellulose/oxidized sodium alginate for machine learning-guided sports training
Multifunctional hydrogels have shown great promise in advanced wearable sensing technologies; however, their performance under real-world sweaty and dynamic conditions remains a significant challenge. In this study, a highly conductive and adhesive hydrogel was developed using poly(AM-co-AA), carboxymethyl cellulose (CMC), oxidized sodium alginate (OSA), and polydopamine-modified carbon nanotubes (PDA-CNT). Featuring a dual dynamic cross-linking system based on reversible Schiff base bonds and strong hydrogen bonding, the hydrogel demonstrates high mechanical toughness (2416 kJ/m3), excellent stretchability (1829%), and stable electrical conductivity (1.5 S/m). It exhibits outstanding sweat resistance, maintaining strong adhesion and reliable sensing performance even during intense physical activities, along with high fatigue resistance over 10,000 deformation cycles, enabling long-term reliable monitoring. As a highly sensitive strain sensor, it offers multi-range gauge factors (up to 2.53) and accurately captures human motion and physiological signals without interference from sweat or motion artifacts. When integrated with machine learning algorithms, the sensor achieves a validation accuracy of 98.75%, providing real-time feedback on movement techniques and supporting personalized training optimization. Furthermore, the hydrogel demonstrates significant antibacterial properties and good biocompatibility, making it an ideal candidate for next-generation wearable electronic devices suited for long-term athletic training and high-sweat environments.
17 Apr 2026
Read appraisal →Journal of the International Society of Sports Nutrition
Effects of race distance and probiotics intervention on kidney, muscle, and gut injury and inflammation biomarker responses during running.
INTRODUCTION: Prolonged intense physical activity, such as long-distance running, may lead to systemic inflammation and cause organ injury, particularly to the kidneys. This study aimed to assess the impact of trail race running on kidney and muscle injury and gut inflammation biomarkers, and the potential mitigating effects of Lactiplantibacillus plantarum 299v (Lp299v) supplementation. METHODS: This randomized, double-blind, placebo-controlled study included 34 participants who completed 42 races, ranging from 20 to 164 km. Participants were divided into two groups, receiving either 40 bn CFU Lp299v or a placebo for 4 weeks before the race. Urine and fecal samples were collected pre- and post-race (immediately after, morning after and 24 h after the race) to measure biomarkers of muscle and kidney injury, and gut inflammation. Principal component analysis was used to create a single tubular kidney injury biomarker component variable (TKIBC1) positively associated with five separate tubular kidney injury biomarkers (MCP-1, KIM-1, GST-π, clusterin, and calbindin) at the three post-race time points. RESULTS: Running led to increased tubular and glomerular kidney injury markers, increased levels of fecal calprotectin, and, in some cases, elevated urine myoglobin levels. These effects were more pronounced in races ≥107 km (ultradistance). While Lp299v supplementation did not significantly influence TKIBC1, it was associated with a protective effect against gut inflammation. CONCLUSION: These findings suggest that prolonged intense exercise induces kidney and muscle injury as well as gut inflammation, with more severe effects observed in ultra-distance running. Lp299v may have some protective effects, particularly against gut inflammation, but further studies are needed to confirm these findings and explore the underlying mechanisms linking gut health and kidney injury during extreme physical exertion.
16 Apr 2026
Read appraisal →PloS one
Effect of different velocity loss thresholds during a resistance training program on jump and sprint performances in trained female athletes
This study aimed to explore the effects of velocity-based resistance training (VBT) using different velocity loss (VL) thresholds on jump and sprint performance in trained female athletes. Fifteen college-level female basketball players completed an 8-week VBT program (2 sessions/week), involving parallel back squats performed at a target mean propulsive velocity of 0.7 m/s. Participants were randomly assigned to two groups: VL10% (n = 8) and VL20% (n = 7), where training sets were terminated when the target velocity-loss threshold was exceeded for the second time within the same set. Performance tests, including one-repetition maximum (1RM), squat jump (SJ), countermovement jump (CMJ), and 20-m sprint (SP20) with split times recorded at 5 m (SP5) and 10 m (SP10), were conducted pre- and post-intervention. The VL10% group showed significant improvements in SJ (p = 0.048, d = 1.30), SP10 (p = 0.004, d = 0.62), SP20 (p = 0.002, d = 0.67), and 1RM (p = 0.002, d = 0.29). The VL20% group also showed improvements in SP10 (p = 0.004, d = 0.42), SP20 (p = 0.002, d = 0.56), and 1RM (p = 0.002, d = 0.62), although SJ did not significantly improve. Despite no significant interaction effects, effect sizes suggest possible differences that require verification in adequately powered trials. VBT using low VL thresholds may be useful for maintaining movement velocity with lower training volume; however, between-group differences were not statistically significant and CMJ did not show clear improvement. Larger-scale studies are needed to confirm these trends.
14 Apr 2026
Read appraisal →PloS one
Effects of complex training on jump performance and neuromuscular activation in volleyball athletes: A controlled study
This study examined the integrated effects of complex training combining barbell back squats (BBS) and drop jumps (DJ) on jump performance and concentric-phase neuromuscular activation in volleyball athletes. In a randomized controlled design, twenty male volleyball athletes were allocated to an intervention group (IG, n = 10) or a control group (CG, n = 10). The IG completed an 8-week, twice-weekly complex training protocol (BBS followed by DJ), with loads progressively adjusted according to individual 1RM values, whereas the CG performed an intensity-matched BBS protocol. Primary outcomes were countermovement jump (CMJ) and approach jump (AJ) height and propulsion impulse (expressed in BW·s), while concentric-phase integrated electromyography (iEMG) and root mean square (RMS) amplitude were secondary outcomes. The results showed that, compared with the CG, the IG exhibited greater improvements in both CMJ and AJ height (CMJ: Δ = 6.13 vs 2.65 cm; AJ: Δ = 7.28 vs 2.78 cm; both p < 0.05). In addition, gains in propulsion impulse were larger in the IG (CMJ: Δ = 0.06 vs 0.02 BW·s; AJ: Δ = 0.08 vs 0.03 BW·s; both p < 0.05). Furthermore, electromyography revealed task-specific recruitment patterns: under BBS, the quadriceps and tibialis anterior showed higher iEMG and RMS values, whereas under DJ the lateral and medial heads of the gastrocnemius were more strongly activated, indicating complementary effects across key lower-limb muscle groups. Taken together, these findings indicate that an 8-week BBS-DJ complex program, compared with resistance training alone, is more effective in improving jump performance and propulsion impulse and in optimizing task-specific concentric activation patterns of the lower-limb musculature in volleyball athletes, and may serve as a feasible and evidence-based prescription for volleyball-specific conditioning.
12 Apr 2026
Read appraisal →Blood pressure
Effects of whole-body vibration training on resting blood pressure in adults: a systematic review and meta-analysis of randomised controlled trials
OBJECTIVE: To investigate the effect of whole‑body vibration training (WBVT) on resting blood pressure (BP) in adults and its moderating factors through a meta‑analysis. METHODS: PubMed, Cochrane Library, Embase, and Web of Science were systematically searched up to 2 December 2025, with systolic BP (SBP) and diastolic BP (DBP) as the primary outcomes. Using Stata 17.0 software, effect sizes were pooled with a random‑effects model, and results were reported as weighted mean differences (WMDs) with 95% confidence intervals. RESULTS: This meta-analysis included 14 randomised controlled trials (RCTs) involving 490 adult participants. WBVT significantly reduced SBP (WMD = -6.57 mmHg, 95% CI [-8.84, -4.29]; p < 0.01) and DBP (WMD = -3.01 mmHg, 95% CI [-4.32, -1.71]; p < 0.01) in adults. Subgroup analyses showed greater BP reduction in individuals with higher baseline BP (SBP: -11.34 mmHg [95% CI: -13.45, -9.23]; p < 0.01; DBP: -6.15 mmHg [95% CI: -7.46, -4.83]; p < 0.01) and in those who were overweight or obese (SBP: -8.99 mmHg [95% CI: -11.18, -6.80]; p < 0.01; DBP: -3.98 mmHg [95% CI: -5.17, -2.78]; p < 0.01). Interventions using combined movement patterns also yielded more pronounced effects (SBP: -7.12 mmHg [95% CI: -9.73, -4.51]; p < 0.01; DBP: -3.30 mmHg [95% CI: -5.61, -0.79]; p < 0.01). CONCLUSION: WBVT significantly reduced resting BP in adults, particularly effective in those with higher baseline BP, overweight/obese, or using combined exercise protocols, but further high-quality RCTs are needed. This meta-analysis demonstrates that WBVT significantly reduces resting BP in adults, with an average reduction of 6.57 mmHg in SBP and 3.01 mmHg in DBP. Subgroup antihypertensialyses further revealed that the anve effect was more pronounced in individuals with elevated baseline BP (SBP ≥130 mmHg or DBP ≥80 mmHg) and in those who were overweight or obese (BMI ≥25 kg/m2). Additionally, training protocols incorporating compound movements, such as squats combined with heel raises, were superior to those using simple standing postures. These findings hold clear clinical significance. The magnitude of BP reduction achieved by WBVT, particularly the approximate 6.57 mmHg decrease in SBP, is expected to translate into a significant reduction in cardiovascular risk. Prior evidence indicates that for every 5 mmHg reduction in SBP, the risk of major cardiovascular events decreases by approximately 10%. Therefore, WBVT provides an effective, safe, and promising non-pharmacological adjunctive management strategy for adults, especially for higher-risk groups (e.g. individuals with hypertension or those who are overweight/obese) and for those who have difficulty engaging in traditional exercise.
9 Apr 2026
Read appraisal →PloS one
Effects of virtual reality training on racket sports performance: A systematic review and meta-analysis of controlled trials
BACKGROUND: Virtual reality (VR) interventions are increasingly used in racket sports, and quantitative evidence is emerging. PURPOSE: To synthesise controlled trials examining the effects of VR-based training on racket sports performance outcomes. METHODS: A systematic search of five databases (PubMed, Web of Science, Scopus, SPORTDiscus, PsycINFO) up to 15 August 2025 was conducted following PRISMA 2020 guidelines. Eligible studies were controlled trials (randomised or non-randomised) comparing VR-based training (immersive or exergaming) with non-VR controls in tennis or table tennis players. Risk of bias was assessed using Cochrane RoB 2 (randomised) and ROBINS-I (non-randomised). Standardised mean differences (Hedges' g) were pooled using a random-effects model with Paule-Mandel τ² and Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment. The protocol was registered (PROSPERO CRD420251132325). RESULTS: Six controlled trials(total N = 426; analysed N = 401) were included. The pooled meta-analysis indicated a moderate overall effect favouring VR (Hedges' g = 0.78; HKSJ 95% CI [0.41, 1.15]), with moderate heterogeneity (I² = 52%). The 95% prediction interval was [-0.01, 1.57], which spans the null effect, indicating that in some future populations or settings VR training may not yield a meaningful performance advantage. One trial investigated perceptual-cognitive VR training (Anguera et al., 2025), showing a substantial but imprecise effect (g = 0.81, 95% CI [-0.05, 1.67]). As only a single study was available, this evidence is presented descriptively rather than meta-analytically. A subgroup examination of five physically engaging VR interventions found a similarly large effect (*g* = 0.78, 95% CI [0.31, 1.25]) despite considerable heterogeneity (I² = 62%). CONCLUSION: According to six controlled trials, VR training was associated with average performance enhancements in racket sports; however, the 95% prediction interval [-0.01, 1.57] encompasses the null effect, indicating that a future study could plausibly show no benefit. Due to the limited evidence base (k = 6), significant heterogeneity (I² = 52%), and considerable statistical uncertainty, the existing evidence does not allow for definitive conclusions regarding the efficacy of VR. The current findings should be regarded as a preliminary signal rather than confirmation of effectiveness. Larger, more methodologically robust RCTs with standardised outcomes are needed before definitive recommendations can be made.
7 Apr 2026
Read appraisal →Circulation
Wearable-Derived Training Load and Coronary Atherosclerosis in Middle-Aged and Older Athletes and Physically Active Controls: A New Perspective From the Master@Heart Study
BACKGROUND: Middle-aged and older endurance athletes have increased prevalence of coronary artery disease (CAD) on coronary computed tomography angiography compared with healthy controls, despite similarly low cardiovascular risk. Previous studies relied on self-reported data to quantify training load (TL), which poorly correlates with objective wearable-derived TL and may bias outcomes. The effect of objective TL on CAD risk remains unknown. METHODS: In this observational, cross-sectional analysis of the Master@Heart study, 222 men (median age, 54 [49-59] years) were included: 77 lifelong athletes, 98 late-onset athletes, and 47 controls. TL was assessed using objective wearable-derived training duration and intensity (12 consecutive months), as well as self-reported training measures. Coronary computed tomography angiography-derived CAD prevalence was compared across TL quartiles (Q) using a global unadjusted chi-square test and logistic regression, adjusted for cardiovascular risk factors and years of endurance exercise, to estimate odds ratios between Q4 and Q1. In addition, adjusted logistic regression models were fitted with continuous TL, using smoothing splines to capture potential nonlinear associations. RESULTS: Across quartiles of objective Edwards training impulse (training duration × heart rate-weighted intensity), unadjusted global differences were observed for ≥1 plaque (P<0.001), coronary artery calcification (CAC)>0 (P=0.002), and CAC>100 (P=0.012). Q4 participants had significantly higher adjusted odds of ≥1 plaque (odds ratio, 5.85; 95% CI, 2.33-14.71), CAC>0 (odds ratio, 5.03; 95% CI, 2.04-12.35), and CAC>100 (odds ratio, 3.50; 95% CI, 1.22-10.00) versus Q1. Similar associations were found for objective training duration, whereas no clear associations were observed for relative time spent in high-intensity zones. In continuous analyses, Edwards training impulse and objective training duration showed significant positive associations with ≥1 plaque and CAC>100 (P<0.05), whereas self-reported training duration was only significantly associated with CAC>100 (P<0.05). Metabolic equivalent of task-minutes per week based on self-reported TL was not associated with CAD (P>0.05). CONCLUSIONS: High training duration (hours/week), particularly when combined with cumulative high-intensity TL (Edwards training impulse), was independently associated with increased prevalence of subclinical CAD in middle-aged and older athletes and physically active controls. Exercise intensity alone, in the absence of high duration, was not clearly linked to CAD. These findings underscore the potential of objectively measured TL for understanding associations with subclinical CAD in endurance athletes. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03711539.
7 Apr 2026
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