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1.  Concurrent validity of the Gyko inertial sensor system for the assessment of vertical jump height in female sub-elite youth soccer players 
Background
The aim of the present study was to verify concurrent validity of the Gyko inertial sensor system for the assessment of vertical jump height.
Methods
Nineteen female sub-elite youth soccer players (mean age: 14.7 ± 0.6 years) performed three trials of countermovement (CMJ) and squat jumps (SJ), respectively. Maximal vertical jump height was simultaneously quantified with the Gyko system, a Kistler force-plate (i.e., gold standard), and another criterion device that is frequently used in the field, the Optojump system.
Results
Compared to the force-plate, the Gyko system determined significant systematic bias for mean CMJ (−0.66 cm, p < 0.01, d = 1.41) and mean SJ (−0.91 cm, p < 0.01, d = 1.69) height. Random bias was ± 3.2 cm for CMJ and ± 4.0 cm for SJ height and intraclass correlation coefficients (ICCs) were “excellent” (ICC = 0.87 for CMJ and 0.81 for SJ). Compared to the Optojump device, the Gyko system detected a significant systematic bias for mean CMJ (0.55 cm, p < 0.05, d = 0.94) but not for mean SJ (0.39 cm) height. Random bias was ± 3.3 cm for CMJ and ± 4.2 cm for SJ height and ICC values were “excellent” (ICC = 0.86 for CMJ and 0.82 for SJ).
Conclusion
Consequently, apparatus specific regression equations were provided to estimate true vertical jump height for the Kistler force-plate and the Optojump device from Gyko-derived data. Our findings indicate that the Gyko system cannot be used interchangeably with a Kistler force-plate and the Optojump device in trained individuals. It is suggested that practitioners apply the correction equations to estimate vertical jump height for the force-plate and the Optojump system from Gyko-derived data.
doi:10.1186/s13102-016-0061-x
PMCID: PMC5106793  PMID: 27895923
Countermovement jump; Squat jump; Accelerometer; Lower-extremity muscle power; Athlete testing; Field test
5.  Effects and dose–response relationships of resistance training on physical performance in youth athletes: a systematic review and meta-analysis 
British Journal of Sports Medicine  2016;50(13):781-795.
Objectives
To quantify age, sex, sport and training type-specific effects of resistance training on physical performance, and to characterise dose–response relationships of resistance training parameters that could maximise gains in physical performance in youth athletes.
Design
Systematic review and meta-analysis of intervention studies.
Data sources
Studies were identified by systematic literature search in the databases PubMed and Web of Science (1985–2015). Weighted mean standardised mean differences (SMDwm) were calculated using random-effects models.
Eligibility criteria for selecting studies
Only studies with an active control group were included if these investigated the effects of resistance training in youth athletes (6–18 years) and tested at least one physical performance measure.
Results
43 studies met the inclusion criteria. Our analyses revealed moderate effects of resistance training on muscle strength and vertical jump performance (SMDwm 0.8–1.09), and small effects on linear sprint, agility and sport-specific performance (SMDwm 0.58–0.75). Effects were moderated by sex and resistance training type. Independently computed dose–response relationships for resistance training parameters revealed that a training period of >23 weeks, 5 sets/exercise, 6–8 repetitions/set, a training intensity of 80–89% of 1 repetition maximum (RM), and 3–4 min rest between sets were most effective to improve muscle strength (SMDwm 2.09–3.40).
Summary/conclusions
Resistance training is an effective method to enhance muscle strength and jump performance in youth athletes, moderated by sex and resistance training type. Dose–response relationships for key training parameters indicate that youth coaches should primarily implement resistance training programmes with fewer repetitions and higher intensities to improve physical performance measures of youth athletes.
doi:10.1136/bjsports-2015-095497
PMCID: PMC4941165  PMID: 26851290
Strength; Weight lifting; Children; Adolescent; Physical fitness
6.  Effects of Resistance Training in Youth Athletes on Muscular Fitness and Athletic Performance: A Conceptual Model for Long-Term Athlete Development 
During the stages of long-term athlete development (LTAD), resistance training (RT) is an important means for (i) stimulating athletic development, (ii) tolerating the demands of long-term training and competition, and (iii) inducing long-term health promoting effects that are robust over time and track into adulthood. However, there is a gap in the literature with regards to optimal RT methods during LTAD and how RT is linked to biological age. Thus, the aims of this scoping review were (i) to describe and discuss the effects of RT on muscular fitness and athletic performance in youth athletes, (ii) to introduce a conceptual model on how to appropriately implement different types of RT within LTAD stages, and (iii) to identify research gaps from the existing literature by deducing implications for future research. In general, RT produced small-to-moderate effects on muscular fitness and athletic performance in youth athletes with muscular strength showing the largest improvement. Free weight, complex, and plyometric training appear to be well-suited to improve muscular fitness and athletic performance. In addition, balance training appears to be an important preparatory (facilitating) training program during all stages of LTAD but particularly during the early stages. As youth athletes become more mature, specificity, and intensity of RT methods increase. This scoping review identified research gaps that are summarized in the following and that should be addressed in future studies: (i) to elucidate the influence of gender and biological age on the adaptive potential following RT in youth athletes (especially in females), (ii) to describe RT protocols in more detail (i.e., always report stress and strain-based parameters), and (iii) to examine neuromuscular and tendomuscular adaptations following RT in youth athletes.
doi:10.3389/fphys.2016.00164
PMCID: PMC4861005  PMID: 27242538
weight lifting; children; adolescents; physical fitness; muscle strength; muscle power; muscular endurance
7.  Neural Correlates of Dual-Task Walking: Effects of Cognitive versus Motor Interference in Young Adults 
Neural Plasticity  2016;2016:8032180.
Walking while concurrently performing cognitive and/or motor interference tasks is the norm rather than the exception during everyday life and there is evidence from behavioral studies that it negatively affects human locomotion. However, there is hardly any information available regarding the underlying neural correlates of single- and dual-task walking. We had 12 young adults (23.8 ± 2.8 years) walk while concurrently performing a cognitive interference (CI) or a motor interference (MI) task. Simultaneously, neural activation in frontal, central, and parietal brain areas was registered using a mobile EEG system. Results showed that the MI task but not the CI task affected walking performance in terms of significantly decreased gait velocity and stride length and significantly increased stride time and tempo-spatial variability. Average activity in alpha and beta frequencies was significantly modulated during both CI and MI walking conditions in frontal and central brain regions, indicating an increased cognitive load during dual-task walking. Our results suggest that impaired motor performance during dual-task walking is mirrored in neural activation patterns of the brain. This finding is in line with established cognitive theories arguing that dual-task situations overstrain cognitive capabilities resulting in motor performance decrements.
doi:10.1155/2016/8032180
PMCID: PMC4855015  PMID: 27200192
8.  Effects of conditioning hops on drop jump and sprint performance: a randomized crossover pilot study in elite athletes 
Background
It has previously been shown that conditioning activities consisting of repetitive hops have the potential to induce better drop jump (DJ) performance in recreationally active individuals. In the present pilot study, we investigated whether repetitive conditioning hops can also increase reactive jump and sprint performance in sprint-trained elite athletes competing at an international level.
Methods
Jump and sprint performances of 5 athletes were randomly assessed under 2 conditions. The control condition (CON) comprised 8 DJs and 4 trials of 30-m sprints. The intervention condition (HOP) consisted of 10 maximal repetitive two-legged hops that were conducted 10 s prior to each single DJ and sprint trial. DJ performance was analyzed using a one-dimensional ground reaction force plate. Step length (SL), contact time (CT), and sprint time (ST) during the 30-m sprints were recorded using an opto-electronic measurement system.
Results
Following the conditioning activity, DJ height and external DJ peak power were both significantly increased by 11 % compared to the control condition. All other variables did not show any significant differences between HOP and CON.
Conclusions
In the present pilot study, we were able to demonstrate large improvements in DJ performance even in sprint-trained elite athletes following a conditioning activity consisting of maximal two-legged repetitive hops. This strengthens the hypothesis that plyometric conditioning exercises can induce performance enhancements in elite athletes that are even greater than those observed in recreationally active athletes.. In addition, it appears that the transfer of these effects to other stretch-shortening cycle activities is limited, as we did not observe any changes in sprint performance following the plyometric conditioning activity.
doi:10.1186/s13102-016-0027-z
PMCID: PMC4734887  PMID: 26835128
Post-activation potentiation; Performance gains; Reactive movement; Plyometric exercise
9.  Postural Control in Dual-Task Situations: Does Whole-Body Fatigue Matter? 
PLoS ONE  2016;11(1):e0147392.
Postural control is important to cope with demands of everyday life. It has been shown that both attentional demand (i.e., cognitive processing) and fatigue affect postural control in young adults. However, their combined effect is still unresolved. Therefore, we investigated the effects of fatigue on single- (ST) and dual-task (DT) postural control. Twenty young subjects (age: 23.7 ± 2.7) performed an all-out incremental treadmill protocol. After each completed stage, one-legged-stance performance on a force platform under ST (i.e., one-legged-stance only) and DT conditions (i.e., one-legged-stance while subtracting serial 3s) was registered. On a second test day, subjects conducted the same balance tasks for the control condition (i.e., non-fatigued). Results showed that heart rate, lactate, and ventilation increased following fatigue (all p < 0.001; d = 4.2–21). Postural sway and sway velocity increased during DT compared to ST (all p < 0.001; d = 1.9–2.0) and fatigued compared to non-fatigued condition (all p < 0.001; d = 3.3–4.2). In addition, postural control deteriorated with each completed stage during the treadmill protocol (all p < 0.01; d = 1.9–3.3). The addition of an attention-demanding interference task did not further impede one-legged-stance performance. Although both additional attentional demand and physical fatigue affected postural control in healthy young adults, there was no evidence for an overadditive effect (i.e., fatigue-related performance decrements in postural control were similar under ST and DT conditions). Thus, attentional resources were sufficient to cope with the DT situations in the fatigue condition of this experiment.
doi:10.1371/journal.pone.0147392
PMCID: PMC4721871  PMID: 26796320
11.  Physical Fitness Percentiles of German Children Aged 9–12 Years: Findings from a Longitudinal Study 
PLoS ONE  2015;10(11):e0142393.
Background
Generating percentile values is helpful for the identification of children with specific fitness characteristics (i.e., low or high fitness level) to set appropriate fitness goals (i.e., fitness/health promotion and/or long-term youth athlete development). Thus, the aim of this longitudinal study was to assess physical fitness development in healthy children aged 9–12 years and to compute sex- and age-specific percentile values.
Methods
Two-hundred and forty children (88 girls, 152 boys) participated in this study and were tested for their physical fitness. Physical fitness was assessed using the 50-m sprint test (i.e., speed), the 1-kg ball push test, the triple hop test (i.e., upper- and lower- extremity muscular power), the stand-and-reach test (i.e., flexibility), the star run test (i.e., agility), and the 9-min run test (i.e., endurance). Age- and sex-specific percentile values (i.e., P10 to P90) were generated using the Lambda, Mu, and Sigma method. Adjusted (for change in body weight, height, and baseline performance) age- and sex-differences as well as the interactions thereof were expressed by calculating effect sizes (Cohen’s d).
Results
Significant main effects of Age were detected for all physical fitness tests (d = 0.40–1.34), whereas significant main effects of Sex were found for upper-extremity muscular power (d = 0.55), flexibility (d = 0.81), agility (d = 0.44), and endurance (d = 0.32) only. Further, significant Sex by Age interactions were observed for upper-extremity muscular power (d = 0.36), flexibility (d = 0.61), and agility (d = 0.27) in favor of girls. Both, linear and curvilinear shaped curves were found for percentile values across the fitness tests. Accelerated (curvilinear) improvements were observed for upper-extremity muscular power (boys: 10–11 yrs; girls: 9–11 yrs), agility (boys: 9–10 yrs; girls: 9–11 yrs), and endurance (boys: 9–10 yrs; girls: 9–10 yrs). Tabulated percentiles for the 9-min run test indicated that running distances between 1,407–1,507 m, 1,479–1,597 m, 1,423–1,654 m, and 1,433–1,666 m in 9- to 12-year-old boys and 1,262–1,362 m, 1,329–1,434 m, 1,392–1,501 m, and 1,415–1,526 m in 9- to 12-year-old girls correspond to a “medium” fitness level (i.e., P40 to P60) in this population.
Conclusions
The observed differences in physical fitness development between boys and girls illustrate that age- and sex-specific maturational processes might have an impact on the fitness status of healthy children. Our statistical analyses revealed linear (e.g., lower-extremity muscular power) and curvilinear (e.g., agility) models of fitness improvement with age which is indicative of timed and capacity-specific fitness development pattern during childhood. Lastly, the provided age- and sex-specific percentile values can be used by coaches for talent identification and by teachers for rating/grading of children’s motor performance.
doi:10.1371/journal.pone.0142393
PMCID: PMC4636306  PMID: 26544848
12.  Dose–Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis 
Sports Medicine (Auckland, N.z.)  2015;45(12):1693-1720.
Background
Resistance training (RT) is an intervention frequently used to improve muscle strength and morphology in old age. However, evidence-based, dose–response relationships regarding specific RT variables (e.g., training period, frequency, intensity, volume) are unclear in healthy old adults.
Objectives
The aims of this systematic review and meta-analysis were to determine the general effects of RT on measures of muscle strength and morphology and to provide dose–response relationships of RT variables through an analysis of randomized controlled trials (RCTs) that could improve muscle strength and morphology in healthy old adults.
Data Sources
A computerized, systematic literature search was performed in the electronic databases PubMed, Web of Science, and The Cochrane Library from January 1984 up to June 2015 to identify all RCTs related to RT in healthy old adults.
Study Eligibility Criteria
The initial search identified 506 studies, with a final yield of 25 studies. Only RCTs that examined the effects of RT in adults with a mean age of 65 and older were included. The 25 studies quantified at least one measure of muscle strength or morphology and sufficiently described training variables (e.g., training period, frequency, volume, intensity).
Study Appraisal and Synthesis Methods
We quantified the overall effects of RT on measures of muscle strength and morphology by computing weighted between-subject standardized mean differences (SMDbs) between intervention and control groups. We analyzed the data for the main outcomes of one-repetition maximum (1RM), maximum voluntary contraction under isometric conditions (MVC), and muscle morphology (i.e., cross-sectional area or volume or thickness of muscles) and assessed the methodological study quality by Physiotherapy Evidence Database (PEDro) scale. Heterogeneity between studies was assessed using I2 and χ2 statistics. A random effects meta-regression was calculated to explain the influence of key training variables on the effectiveness of RT in terms of muscle strength and morphology. For meta-regression, training variables were divided into the following subcategories: volume, intensity, and rest. In addition to meta-regression, dose–response relationships were calculated independently for single training variables (e.g., training frequency).
Results
RT improved muscle strength substantially (mean SMDbs = 1.57; 25 studies), but had small effects on measures of muscle morphology (mean SMDbs = 0.42; nine studies). Specifically, RT produced large effects in both 1RM of upper (mean SMDbs = 1.61; 11 studies) and lower (mean SMDbs = 1.76; 19 studies) extremities and a medium effect in MVC of lower (mean SMDbs = 0.76; four studies) extremities. Results of the meta-regression revealed that the variables “training period” (p = 0.04) and “intensity” (p < 0.01) as well as “total time under tension” (p < 0.01) had significant effects on muscle strength, with the largest effect sizes for the longest training periods (mean SMDbs = 2.34; 50–53 weeks), intensities of 70–79 % of the 1RM (mean SMDbs = 1.89), and total time under tension of 6.0 s (mean SMDbs = 3.61). A tendency towards significance was found for rest in between sets (p = 0.06), with 60 s showing the largest effect on muscle strength (mean SMDbs = 4.68; two studies). We also determined the independent effects of the remaining training variables on muscle strength. The following independently computed training variables are most effective in improving measures of muscle strength: a training frequency of two sessions per week (mean SMDbs = 2.13), a training volume of two to three sets per exercise (mean SMDbs = 2.99), seven to nine repetitions per set (mean SMDbs = 1.98), and a rest of 4.0 s between repetitions (SMDbs = 3.72). With regard to measures of muscle morphology, the small number of identified studies allowed us to calculate meta-regression for the subcategory training volume only. No single training volume variable significantly predicted RT effects on measures of muscle morphology. Additional training variables were independently computed to detect the largest effect for the single training variable. A training period of 50–53 weeks, a training frequency of three sessions per week, a training volume of two to three sets per exercise, seven to nine repetitions per set, a training intensity from 51 to 69 % of the 1RM, a total time under tension of 6.0 s, a rest of 120 s between sets, and a rest of 2.5 s between repetitions turned out to be most effective.
Limitations
The current results must be interpreted with caution because of the poor overall methodological study quality (mean PEDro score 4.6 points) and the considerable large heterogeneity (I2 = 80 %, χ2 = 163.1, df = 32, p < 0.01) for muscle strength. In terms of muscle morphology, our search identified nine studies only, which is why we consider our findings preliminary. While we were able to determine a dose–response relationship based on specific individual training variables with respect to muscle strength and morphology, it was not possible to ascertain any potential interactions between these variables. We recognize the limitation that the results may not represent one general dose–response relationship.
Conclusions
This systematic literature review and meta-analysis confirmed the effectiveness of RT on specific measures of upper and lower extremity muscle strength and muscle morphology in healthy old adults. In addition, we were able to extract dose–response relationships for key training variables (i.e., volume, intensity, rest), informing clinicians and practitioners to design effective RTs for muscle strength and morphology. Training period, intensity, time under tension, and rest in between sets play an important role in improving muscle strength and morphology and should be implemented in exercise training programs targeting healthy old adults. Still, further research is needed to reveal optimal dose–response relationships following RT in healthy as well as mobility limited and/or frail old adults.
doi:10.1007/s40279-015-0385-9
PMCID: PMC4656698  PMID: 26420238
13.  Associations Between Measures of Balance and Lower-Extremity Muscle Strength/Power in Healthy Individuals Across the Lifespan: A Systematic Review and Meta-Analysis 
Sports Medicine (Auckland, N.z.)  2015;45(12):1671-1692.
Background
It has frequently been reported that balance and lower-extremity muscle strength/power are associated with sports-related and everyday activities. Knowledge about the relationship between balance, strength, and power are important for the identification of at-risk individuals because deficits in these neuromuscular components are associated with an increased risk of sustaining injuries and falls. In addition, this knowledge is of high relevance for the development of specifically tailored health and skill-related exercise programs.
Objectives
The objectives of this systematic literature review and meta-analysis were to characterize and, if possible, quantify associations between variables of balance and lower-extremity muscle strength/power in healthy individuals across the lifespan.
Data Sources
A computerized systematic literature search was performed in the electronic databases PubMed, Web of Science, and SPORTDiscus up to March 2015 to capture all relevant articles.
Study Eligibility Criteria
A systematic approach was used to evaluate the 996 articles identified for initial review. Studies were included only if they investigated healthy individuals aged ≥6 years and tested at least one measure of static steady-state balance (e.g., center of pressure [CoP] displacement during one-legged stance), dynamic steady-state balance (e.g., gait speed), proactive balance (e.g., distance in the functional-reach-test), or reactive balance (e.g., CoP displacement during perturbed one-legged stance), and one measure of maximal strength (e.g., maximum voluntary contraction), explosive force (e.g., rate of force development), or muscle power (e.g., jump height). In total, 37 studies met the inclusionary criteria for review.
Study Appraisal and Synthesis Methods
The included studies were coded for the following criteria: age (i.e., children: 6–12 years, adolescents: 13–18 years, young adults: 19–44 years, middle-aged adults: 45–64 years, old adults: ≥65 years), sex (i.e., female, male), and test modality/outcome (i.e., test for the assessment of balance, strength, and power). Studies with athletes, patients, and/or people with diseases were excluded. Pearson’s correlation coefficients were extracted, transformed (i.e., Fisher’s z-transformed rz value), aggregated (i.e., weighted mean rz value), back-transformed to r values, classified according to their magnitude (i.e., small: r ≤ 0.69, medium: r ≤ 0.89, large: r ≥ 0.90), and, if possible, statistically compared. Heterogeneity between studies was assessed using I2 and Chi-squared (χ2) statistics.
Results
Three studies examined associations between balance and lower-extremity muscle strength/power in children, one study in adolescents, nine studies in young adults, three studies in middle-aged adults, and 23 studies in old adults. Overall, small-sized associations were found between variables of balance and lower-extremity muscle strength/power, irrespective of the age group considered. In addition, small-sized but significantly larger correlation coefficients were found between measures of dynamic steady-state balance and maximal strength in children (r = 0.57) compared with young (r = 0.09, z = 3.30, p = 0.001) and old adults (r = 0.35, z = 2.94, p = 0.002) as well as in old compared with young adults (z = 1.95, p = 0.03).
Limitations
Even though the reported results provided further insight into the associations between measures of balance and lower-extremity muscle strength/power, they did not allow us to deduce cause and effect relations. Further, the investigated associations could be biased by other variables such as joint flexibility, muscle mass, and/or auditory/visual acuity.
Conclusions
Our systematic review and meta-analysis showed predominately small-sized correlations between measures of balance and lower-extremity muscle strength/power in children, adolescents, and young, middle-aged, and old adults. This indicates that these neuromuscular components are independent of each other and should therefore be tested and trained complementarily across the lifespan. Significantly larger but still small-sized associations were found between measures of dynamic steady-state balance and maximal strength in children compared with young and old adults as well as in old compared with young adults. These findings imply that age/maturation may have an impact on the association of selected components of balance and lower-extremity muscle strength.
doi:10.1007/s40279-015-0390-z
PMCID: PMC4656701  PMID: 26412212
14.  Exercise to Improve Mobility in Healthy Aging 
Sports Medicine (Auckland, N.z.)  2015;45(12):1625-1626.
doi:10.1007/s40279-015-0405-9
PMCID: PMC4656693  PMID: 26400695
15.  Effects of Strength Training Using Unstable Surfaces on Strength, Power and Balance Performance Across the Lifespan: A Systematic Review and Meta-analysis 
Sports Medicine (Auckland, N.z.)  2015;45:1645-1669.
Background
The effectiveness of strength training on unstable surfaces (STU) versus stable surfaces (STS) or a control condition (CON; i.e. no training or regular training only) for strength, power and balance performance across the lifespan has not yet been investigated in a systematic review and meta-analysis.
Objective
The aims of this systematic review and meta-analysis were to determine the general effects of STU versus STS or CON on muscle strength, power and balance in healthy individuals across the lifespan and to investigate whether performance changes following STU are age specific.
Data Sources
A computerized systematic literature search was performed in the electronic databases PubMed and Web of Science from January 1984 up to February 2015.
Study Eligibility Criteria
Initially, 209 articles were identified for review. Only controlled trials were included if they investigated STU in healthy individuals and tested at least one measure of maximal strength, strength endurance, muscle power, or static/dynamic balance. In total, 22 studies met the inclusion criteria.
Study Appraisal and Synthesis Methods
The included studies were coded for the following criteria: age, sex, training status, training modality, exercise and test modality. Effect size measures included within-subject standardized mean differences (SMDw) and weighted between-subject standardized mean differences (SMDb). Heterogeneity between studies was assessed using I2 and χ2 statistics. The methodological quality of each study was assessed using the Physiotherapy Evidence Database (PEDro) Scale.
Results
Our search failed to identify studies that examined the effects of STU versus STS or CON in children and middle-aged adults. However, four studies were identified that investigated the effects of STU versus CON or STS in adolescents, 15 studies were identified in young adults and three studies were identified in old adults. Compared with CON, STU produced medium effects on maximal strength in young adults and no effects to medium effects in old adults. In addition, large effects were detected on strength endurance in adolescents and in young adults; in old adults, a small effect was found. With regard to muscle power, medium effects were observed in young adults and small effects were observed in old adults. Further, large effects were found for static and dynamic balance in old adults, but only a small effect was found for dynamic balance in young adults. The comparison of STU and STS revealed inconsistent results as indicated by training-induced changes in favour of STU, as well as STS. Small to medium effects were found for maximal strength in adolescents in favour of STS, and small effects were found in young adults in favour of STU. With regard to strength endurance, large effects were found in adolescents in favour of STS and small effects were found in favour of STU. Additionally, we detected small effects in young adults in favour of STU. In terms of muscle power, no effects were observed in adolescents but medium effects were found in favour of STS in young adults. With regard to balance, small effects were detected in adolescents for static and dynamic balance in favour of STU. In young adults, small effects were found for static balance in favour of STS. With regard to dynamic balance, the analysis revealed small effects in young adults in favour of STU.
Limitations
The quality of the included studies was rather low, with mean PEDro scores of 5.8, 4.0 and 5.0 for studies including adolescents, young adults and old adults, respectively. Further, trivial to considerable heterogeneity between studies (i.e. 0 % ≤ I2 ≤ 96 %) was detected.
Conclusions
Compared with CON, STU is effective in improving muscle strength, power and balance in adolescents, young adults and old adults. However, inconsistent results were particularly found in adolescents and young adults when the specific effects of STU were compared with those of STS. We conclude that the performance of STU compared with STS has limited extra effects on muscle strength, power and balance performance in healthy adolescents and young adults. Given that our systematic search did not identify studies that examined the effects of STU versus STS in children, middle-aged adults and old adults, further research of high methodological quality is needed to determine whether there are additive effects of STU as compared with STS in those age groups.
doi:10.1007/s40279-015-0384-x
PMCID: PMC4656700  PMID: 26359066
16.  Effects of Balance Training on Balance Performance in Healthy Older Adults: A Systematic Review and Meta-analysis 
Sports Medicine (Auckland, N.z.)  2015;45:1721-1738.
Background
The effects of balance training (BT) in older adults on proxies of postural control and mobility are well documented in the literature. However, evidence-based dose–response relationships in BT modalities (i.e., training period, training frequency, training volume) have not yet been established in healthy older adults.
Objectives
The objectives of this systematic literature review and meta-analysis are to quantify BT intervention effects and to additionally characterize dose–response relationships of BT modalities (e.g., training period, training frequency) through the analysis of randomized controlled trials (RCTs) that could maximize improvements in balance performance in healthy community-dwelling older adults.
Data Sources
A computerized systematic literature search was performed in the electronic databases PubMed and Web of Science from January 1985 up to January 2015 to capture all articles related to BT in healthy old community-dwelling adults.
Study Eligibility Criteria
A systematic approach was used to evaluate the 345 articles identified for initial review. Only RCTs were included if they investigated BT in healthy community-dwelling adults aged ≥65 years and tested at least one behavioral balance performance outcome (e.g., center of pressure displacements during single-leg stance). In total, 23 studies met the inclusionary criteria for review.
Study Appraisal and Synthesis Methods
Weighted mean standardized mean differences between subjects (SMDbs) of the intervention-induced adaptations in balance performance were calculated using a random-effects model and tested for an overall intervention effect relative to passive controls. The included studies were coded for the following criteria: training modalities (i.e., training period, training frequency, training volume) and balance outcomes [static/dynamic steady-state (i.e., maintaining a steady position during standing and walking), proactive balance (i.e., anticipation of a predicted perturbation), reactive balance (i.e., compensation of an unpredicted perturbation) as well as balance test batteries (i.e., combined testing of different balance components as for example the Berg Balance Scale)]. Heterogeneity between studies was assessed using I2 and Chi2-statistics. The methodological quality of each study was tested by means of the Physiotherapy Evidence Database (PEDro) Scale.
Results
Weighted mean SMDbs showed that BT is an effective means to improve static steady-state (mean SMDbs = 0.51), dynamic steady-state (mean SMDbs = 0.44), proactive (mean SMDbs = 1.73), and reactive balance (mean SMDbs = 1.01) as well as the performance in balance test batteries (mean SMDbs = 1.52) in healthy older adults. Our analyses regarding dose–response relationships in BT revealed that a training period of 11–12 weeks (mean SMDbs= 1.26), a frequency of three training sessions per week (mean SMDbs= 1.20), a total number of 36–40 training sessions (mean SMDbs = 1.39), a duration of a single training session of 31–45 min (mean SMDbs = 1.19), and a total duration of 91–120 min of BT per week (mean SMDbs = 1.93) of the applied training modalities is most effective in improving overall balance performance. However, it has to be noted that effect sizes for the respective training modalities were computed independently (i.e., modality specific). Because of the small number of studies that reported detailed information on training volume (i.e., number of exercises per training session, number of sets and/or repetitions per exercise, duration of single-balance exercises) dose–response relationships were not computed for these parameters.
Limitations
The present findings have to be interpreted with caution because we indirectly compared dose–response relationships across studies using SMDbs and not in a single controlled study as it is difficult to separate the impact of a single training modality (e.g., training frequency) from that of the others. Moreover, the quality of the included studies was rather limited with a mean PEDro score of 5 and the heterogeneity between studies was considerable (i.e., I2 = 76–92 %).
Conclusions
Our detailed analyses revealed that BT is an effective means to improve proxies of static/dynamic steady-state, proactive, and reactive balance as well as performance in balance test batteries in healthy older adults. Furthermore, we were able to establish effective BT modalities to improve balance performance in healthy older adults. Thus, practitioners and therapists are advised to consult the identified dose–response relationships of this systematic literature review and meta-analysis. However, further research of high methodologic quality is needed to determine (1) dose–response relationships of BT in terms of detailed information on training volume (e.g., number of exercises per training session) and (2) a feasible and effective method to regulate training intensity in BT.
doi:10.1007/s40279-015-0375-y
PMCID: PMC4656699  PMID: 26325622
17.  Effects of Three Types of Exercise Interventions on Healthy Old Adults’ Gait Speed: A Systematic Review and Meta-Analysis 
Sports Medicine (Auckland, N.z.)  2015;45:1627-1643.
Background
Habitual walking speed predicts many clinical conditions later in life, but it declines with age. However, which particular exercise intervention can minimize the age-related gait speed loss is unclear.
Purpose
Our objective was to determine the effects of strength, power, coordination, and multimodal exercise training on healthy old adults’ habitual and fast gait speed.
Methods
We performed a computerized systematic literature search in PubMed and Web of Knowledge from January 1984 up to December 2014. Search terms included ‘Resistance training’, ‘power training’, ‘coordination training’, ‘multimodal training’, and ‘gait speed (outcome term). Inclusion criteria were articles available in full text, publication period over past 30 years, human species, journal articles, clinical trials, randomized controlled trials, English as publication language, and subject age ≥65 years. The methodological quality of all eligible intervention studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. We computed weighted average standardized mean differences of the intervention-induced adaptations in gait speed using a random-effects model and tested for overall and individual intervention effects relative to no-exercise controls.
Results
A total of 42 studies (mean PEDro score of 5.0 ± 1.2) were included in the analyses (2495 healthy old adults; age 74.2 years [64.4–82.7]; body mass 69.9 ± 4.9 kg, height 1.64 ± 0.05 m, body mass index 26.4 ± 1.9 kg/m2, and gait speed 1.22 ± 0.18 m/s). The search identified only one power training study, therefore the subsequent analyses focused only on the effects of resistance, coordination, and multimodal training on gait speed. The three types of intervention improved gait speed in the three experimental groups combined (n = 1297) by 0.10 m/s (±0.12) or 8.4 % (±9.7), with a large effect size (ES) of 0.84. Resistance (24 studies; n = 613; 0.11 m/s; 9.3 %; ES: 0.84), coordination (eight studies, n = 198; 0.09 m/s; 7.6 %; ES: 0.76), and multimodal training (19 studies; n = 486; 0.09 m/s; 8.4 %, ES: 0.86) increased gait speed statistically and similarly.
Conclusions
Commonly used exercise interventions can functionally and clinically increase habitual and fast gait speed and help slow the loss of gait speed or delay its onset.
Electronic supplementary material
The online version of this article (doi:10.1007/s40279-015-0371-2) contains supplementary material, which is available to authorized users.
doi:10.1007/s40279-015-0371-2
PMCID: PMC4656792  PMID: 26286449
18.  Small and inconsistent effects of whole body vibration on athletic performance: a systematic review and meta-analysis 
European Journal of Applied Physiology  2015;115(8):1605-1625.
Purpose
We quantified the acute and chronic effects of whole body vibration on athletic performance or its proxy measures in competitive and/or elite athletes.
Methods
Systematic literature review and meta-analysis.
Results
Whole body vibration combined with exercise had an overall 0.3 % acute effect on maximal voluntary leg force (−6.4 %, effect size = −0.43, 1 study), leg power (4.7 %, weighted mean effect size = 0.30, 6 studies), flexibility (4.6 %, effect size = −0.12 to 0.22, 2 studies), and athletic performance (−1.9 %, weighted mean effect size = 0.26, 6 studies) in 191 (103 male, 88 female) athletes representing eight sports (overall effect size = 0.28). Whole body vibration combined with exercise had an overall 10.2 % chronic effect on maximal voluntary leg force (14.6 %, weighted mean effect size = 0.44, 5 studies), leg power (10.7 %, weighted mean effect size = 0.42, 9 studies), flexibility (16.5 %, effect size = 0.57 to 0.61, 2 studies), and athletic performance (−1.2 %, weighted mean effect size = 0.45, 5 studies) in 437 (169 male, 268 female) athletes (overall effect size = 0.44).
Conclusions
Whole body vibration has small and inconsistent acute and chronic effects on athletic performance in competitive and/or elite athletes. These findings lead to the hypothesis that neuromuscular adaptive processes following whole body vibration are not specific enough to enhance athletic performance. Thus, other types of exercise programs (e.g., resistance training) are recommended if the goal is to improve athletic performance.
doi:10.1007/s00421-015-3194-9
PMCID: PMC4503864  PMID: 26037127
Exercise; Muscle; Force; Power; Skill; Reflex; Endocrine; Metabolism
19.  Effects of Heavy-Resistance Strength and Balance Training on Unilateral and Bilateral Leg Strength Performance in Old Adults 
PLoS ONE  2015;10(2):e0118535.
The term “bilateral deficit” (BLD) has been used to describe a reduction in performance during bilateral contractions when compared to the sum of identical unilateral contractions. In old age, maximal isometric force production (MIF) decreases and BLD increases indicating the need for training interventions to mitigate this impact in seniors. In a cross-sectional approach, we examined age-related differences in MIF and BLD in young (age: 20–30 years) and old adults (age: >65 years). In addition, a randomized-controlled trial was conducted to investigate training-specific effects of resistance vs. balance training on MIF and BLD of the leg extensors in old adults. Subjects were randomly assigned to resistance training (n = 19), balance training (n = 14), or a control group (n = 20). Bilateral heavy-resistance training for the lower extremities was performed for 13 weeks (3 × / week) at 80% of the one repetition maximum. Balance training was conducted using predominately unilateral exercises on wobble boards, soft mats, and uneven surfaces for the same duration. Pre- and post-tests included uni- and bilateral measurements of maximal isometric leg extension force. At baseline, young subjects outperformed older adults in uni- and bilateral MIF (all p < .001; d = 2.61–3.37) and in measures of BLD (p < .001; d = 2.04). We also found significant increases in uni- and bilateral MIF after resistance training (all p < .001, d = 1.8-5.7) and balance training (all p < .05, d = 1.3-3.2). In addition, BLD decreased following resistance (p < .001, d = 3.4) and balance training (p < .001, d = 2.6). It can be concluded that both training regimens resulted in increased MIF and decreased BLD of the leg extensors (HRT-group more than BAL-group), almost reaching the levels of young adults.
doi:10.1371/journal.pone.0118535
PMCID: PMC4335049  PMID: 25695770
20.  Association of dual-task walking performance and leg muscle quality in healthy children 
BMC Pediatrics  2015;15(1):2.
Background
Previous literature mainly introduced cognitive functions to explain performance decrements in dual-task walking, i.e., changes in dual-task locomotion are attributed to limited cognitive information processing capacities. In this study, we enlarge existing literature and investigate whether leg muscular capacity plays an additional role in children’s dual-task walking performance.
Methods
To this end, we had prepubescent children (mean age: 8.7 ± 0.5 years, age range: 7–9 years) walk in single task (ST) and while concurrently conducting an arithmetic subtraction task (DT). Additionally, leg lean tissue mass was assessed.
Results
Findings show that both, boys and girls, significantly decrease their gait velocity (f = 0.73), stride length (f = 0.62) and cadence (f = 0.68) and increase the variability thereof (f = 0.20-0.63) during DT compared to ST. Furthermore, stepwise regressions indicate that leg lean tissue mass is closely associated with step time and the variability thereof during DT (R2 = 0.44, p = 0.009). These associations between gait measures and leg lean tissue mass could not be observed for ST (R2 = 0.17, p = 0.19).
Conclusion
We were able to show a potential link between leg muscular capacities and DT walking performance in children. We interpret these findings as evidence that higher leg muscle mass in children may mitigate the impact of a cognitive interference task on DT walking performance by inducing enhanced gait stability.
doi:10.1186/s12887-015-0317-8
PMCID: PMC4325950  PMID: 25652949
Gait; Cognitive interference; Body composition; Muscle mass; Children
21.  Effects of core strength training using stable versus unstable surfaces on physical fitness in adolescents: a randomized controlled trial 
Background
It has been demonstrated that core strength training is an effective means to enhance trunk muscle strength (TMS) and proxies of physical fitness in youth. Of note, cross-sectional studies revealed that the inclusion of unstable elements in core strengthening exercises produced increases in trunk muscle activity and thus provide potential extra training stimuli for performance enhancement. Thus, utilizing unstable surfaces during core strength training may even produce larger performance gains. However, the effects of core strength training using unstable surfaces are unresolved in youth. This randomized controlled study specifically investigated the effects of core strength training performed on stable surfaces (CSTS) compared to unstable surfaces (CSTU) on physical fitness in school-aged children.
Methods
Twenty-seven (14 girls, 13 boys) healthy subjects (mean age: 14 ± 1 years, age range: 13–15 years) were randomly assigned to a CSTS (n = 13) or a CSTU (n = 14) group. Both training programs lasted 6 weeks (2 sessions/week) and included frontal, dorsal, and lateral core exercises. During CSTU, these exercises were conducted on unstable surfaces (e.g., TOGU© DYNAIR CUSSIONS, THERA-BAND© STABILITY TRAINER).
Results
Significant main effects of Time (pre vs. post) were observed for the TMS tests (8-22%, f = 0.47-0.76), the jumping sideways test (4-5%, f = 1.07), and the Y balance test (2-3%, f = 0.46-0.49). Trends towards significance were found for the standing long jump test (1-3%, f = 0.39) and the stand-and-reach test (0-2%, f = 0.39). We could not detect any significant main effects of Group. Significant Time x Group interactions were detected for the stand-and-reach test in favour of the CSTU group (2%, f = 0.54).
Conclusions
Core strength training resulted in significant increases in proxies of physical fitness in adolescents. However, CSTU as compared to CSTS had only limited additional effects (i.e., stand-and-reach test). Consequently, if the goal of training is to enhance physical fitness, then CSTU has limited advantages over CSTS.
Trial registration
ClinicalTrials.gov Identifier: NCT02290457 Registered 13 November 2014.
doi:10.1186/2052-1847-6-40
PMCID: PMC4290805  PMID: 25584193
Resistance training; Trunk muscle strength; Physical fitness
22.  Metastability in plyometric training on unstable surfaces: a pilot study 
Background
In the past, plyometric training (PT) has been predominantly performed on stable surfaces. The purpose of this pilot study was to examine effects of a 7-week lower body PT on stable vs. unstable surfaces. This type of exercise condition may be denoted as metastable equilibrium.
Methods
Thirty-three physically active male sport science students (age: 24.1 ± 3.8 years) were randomly assigned to a PT group (n = 13) exercising on stable (STAB) and a PT group (n = 20) on unstable surfaces (INST). Both groups trained countermovement jumps, drop jumps, and practiced a hurdle jump course. In addition, high bar squats were performed. Physical fitness tests on stable surfaces (hexagonal obstacle test, countermovement jump, hurdle drop jump, left-right hop, dynamic and static balance tests, and leg extension strength) were used to examine the training effects.
Results
Significant main effects of time (ANOVA) were found for the countermovement jump, hurdle drop jump, hexagonal test, dynamic balance, and leg extension strength. A significant interaction of time and training mode was detected for the countermovement jump in favor of the INST group. No significant improvements were evident for either group in the left-right hop and in the static balance test.
Conclusions
These results show that lower body PT on unstable surfaces is a safe and efficient way to improve physical performance on stable surfaces.
doi:10.1186/2052-1847-6-30
PMCID: PMC4118276  PMID: 25089202
Instability resistance training; Stretch-shortening cycle; Physical fitness test; Balance training
23.  Effect of living area and sports club participation on physical fitness in children: a 4 year longitudinal study 
BMC Public Health  2014;14:499.
Background
Cross-sectional studies detected associations between physical fitness, living area, and sports participation in children. Yet, their scientific value is limited because the identification of cause-and-effect relationships is not possible. In a longitudinal approach, we examined the effects of living area and sports club participation on physical fitness development in primary school children from classes 3 to 6.
Methods
One-hundred and seventy-two children (age: 9–12 years; sex: 69 girls, 103 boys) were tested for their physical fitness (i.e., endurance [9-min run], speed [50-m sprint], lower- [triple hop] and upper-extremity muscle strength [1-kg ball push], flexibility [stand-and-reach], and coordination [star coordination run]). Living area (i.e., urban or rural) and sports club participation were assessed using parent questionnaire.
Results
Over the 4 year study period, urban compared to rural children showed significantly better performance development for upper- (p = 0.009, ES = 0.16) and lower-extremity strength (p < 0.001, ES = 0.22). Further, significantly better performance development were found for endurance (p = 0.08, ES = 0.19) and lower-extremity strength (p = 0.024, ES = 0.23) for children continuously participating in sports clubs compared to their non-participating peers.
Conclusions
Our findings suggest that sport club programs with appealing arrangements appear to represent a good means to promote physical fitness in children living in rural areas.
doi:10.1186/1471-2458-14-499
PMCID: PMC4049502  PMID: 24886425
Motor performance; Youth; Primary school; Maturation
24.  A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial 
BMC Geriatrics  2013;13:105.
Background
With increasing age neuromuscular deficits (e.g., sarcopenia) may result in impaired physical performance and an increased risk for falls. Prominent intrinsic fall-risk factors are age-related decreases in balance and strength / power performance as well as cognitive decline. Additional studies are needed to develop specifically tailored exercise programs for older adults that can easily be implemented into clinical practice. Thus, the objective of the present trial is to assess the effects of a fall prevention program that was developed by an interdisciplinary expert panel on measures of balance, strength / power, body composition, cognition, psychosocial well-being, and falls self-efficacy in healthy older adults. Additionally, the time-related effects of detraining are tested.
Methods/Design
Healthy old people (n = 54) between the age of 65 to 80 years will participate in this trial. The testing protocol comprises tests for the assessment of static / dynamic steady-state balance (i.e., Sharpened Romberg Test, instrumented gait analysis), proactive balance (i.e., Functional Reach Test; Timed Up and Go Test), reactive balance (i.e., perturbation test during bipedal stance; Push and Release Test), strength (i.e., hand grip strength test; Chair Stand Test), and power (i.e., Stair Climb Power Test; countermovement jump). Further, body composition will be analysed using a bioelectrical impedance analysis system. In addition, questionnaires for the assessment of psychosocial (i.e., World Health Organisation Quality of Life Assessment-Bref), cognitive (i.e., Mini Mental State Examination), and fall risk determinants (i.e., Fall Efficacy Scale – International) will be included in the study protocol. Participants will be randomized into two intervention groups or the control / waiting group. After baseline measures, participants in the intervention groups will conduct a 12-week balance and strength / power exercise intervention 3 times per week, with each training session lasting 30 min. (actual training time). One intervention group will complete an extensive supervised training program, while the other intervention group will complete a short version ('3 times 3’) that is home-based and controlled by weekly phone calls. Post-tests will be conducted right after the intervention period. Additionally, detraining effects will be measured 12 weeks after program cessation. The control group / waiting group will not participate in any specific intervention during the experimental period, but will receive the extensive supervised program after the experimental period.
Discussion
It is expected that particularly the supervised combination of balance and strength / power training will improve performance in variables of balance, strength / power, body composition, cognitive function, psychosocial well-being, and falls self-efficacy of older adults. In addition, information regarding fall risk assessment, dose–response-relations, detraining effects, and supervision of training will be provided. Further, training-induced health-relevant changes, such as improved performance in activities of daily living, cognitive function, and quality of life, as well as a reduced risk for falls may help to lower costs in the health care system. Finally, practitioners, therapists, and instructors will be provided with a scientifically evaluated feasible, safe, and easy-to-administer exercise program for fall prevention.
Trial registration
ClinicalTrials.gov Identifier: NCT01906034
doi:10.1186/1471-2318-13-105
PMCID: PMC3852637  PMID: 24106864
Seniors; Fall risk assessment; Resistance training; Postural stability
25.  Alteration of synergistic muscle activity following neuromuscular electrical stimulation of one muscle 
Brain and Behavior  2012;2(5):640-646.
The aim of the study was to determine muscle activation of the m. triceps surae during maximal voluntary contractions (MVCs) following neuromuscular electrical stimulation (NMES) of the m. gastrocnemius lateralis (GL). The participants (n = 10) performed three MVC during pretest, posttest, and recovery, respectively. Subsequent to the pretest, the GL was stimulated by NMES. During MVC, force and surface electromyography (EMG) of the GL, m. gastrocnemius medialis (GM), and m. soleus (SOL) were measured. NMES of GL induced no significant decline (3%) in force. EMG activity of the GL decreased significantly to 81% (P < 0.05), whereas EMG activity of the synergistic SOL increased to 112% (P < 0.01). The GM (103%, P = 1.00) remained unaltered. Decreased EMG activity in the GL was most likely caused by failure of the electrical propagation at its muscle fiber membrane. The decline of EMG activity in GL was compensated by increased EMG activity of SOL during MVC. It is suggested that these compensatory effects are caused by central contributions induced by NMES.
doi:10.1002/brb3.87
PMCID: PMC3489816  PMID: 23139909
Neuromuscular control; NMES; synergistic muscles; triceps surae

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