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Journal: Scandinavian journal of medicine & science in sports


This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson’s disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.

Concepts: Osteoporosis, Medicine, Hypertension, Diabetes mellitus type 2, Diabetes mellitus, Obesity, Cystic fibrosis, Aging-associated diseases


The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis were randomized to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load progressive strength training (the strength group) performed every second day. High-load strength training consisted of unilateral heel raises with a towel inserted under the toes. Primary outcome was the foot function index (FFI) at 3 months. Additional follow-ups were performed at 1, 6, and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI that was 29 points lower [95% confidence interval (CI): 6-52, P = 0.016] compared with the stretch group. At 1, 6, and 12 months, there were no differences between groups (P > 0.34). At 12 months, the FFI was 22 points (95% CI: 9-36) in the strength group and 16 points (95% CI: 0-32) in the stretch group. There were no differences in any of the secondary outcomes. A simple progressive exercise protocol, performed every second day, resulted in superior self-reported outcome after 3 months compared with plantar-specific stretching. High-load strength training may aid in a quicker reduction in pain and improvements in function.

Concepts: Improve, Randomized controlled trial, Physical exercise, Exercise, Strength training, Outcome, Stretching, Plantar fasciitis


Hip adductor injuries are frequent in football, and players with low adductor strength appear to be at increased risk of injury. High adductor muscle activity has been shown in the Copenhagen Adduction exercise (CA); however, an associated strength gain has not been investigated. This study aims to examine the eccentric hip adduction strength (EHAD) gain using the CA in-season. Two U-19 sub-elite football teams, including 24 football players, were randomized to either an 8-week supervised progressive training program in addition to the usual training (intervention) or to continue training as usual (control). EHAD, eccentric hip abduction strength (EHAB), and side-bridge endurance were measured using reliable test procedures at baseline and follow-up by a blinded tester. There was a significant interaction between group and time on EHAD, EHAB, and EHAD/EHAB ratio (P < 0.025). The intervention group demonstrated a 35.7% increase in EHAD (P < 0.001); a 20.3% increase in EHAB (P = 0.003), and 12.3% increase in EHAD/EHAB ratio (P = 0.019). No significant within-group differences were found in the control group (P > 0.335). Compliance was 91.25%, and median muscle soreness ranged from 0 to 2. The CA implemented in-season with an 8-week progressive training program elicited a large significant increase in EHAD, EHAB, and EHAD/EHAB ratio.

Concepts: Randomized controlled trial, Hip, Abduction, Adduction, Gracilis muscle, Muscles of the hip, Adductor muscles of the hip


The purpose of this study was to compare the effects of 10 weeks of effort-matched short intervals (SI; n = 9) or long intervals (LI; n = 7) in cyclists. The high-intensity interval sessions (HIT) were performed twice a week interspersed with low-intensity training. There were no differences between groups at pretest. There were no differences between groups in total volume of both HIT and low-intensity training. The SI group achieved a larger relative improvement in VO2max than the LI group (8.7% ± 5.0% vs 2.6% ± 5.2%), respectively, P ≤ 0.05). Mean effect size (ES) of the relative improvement in all measured parameters, including performance measured as mean power output during 30-s all-out, 5-min all-out, and 40-min all-out tests revealed a moderate-to-large effect of SI training vs LI training (ES range was 0.86-1.54). These results suggest that the present SI protocol induces superior training adaptations on both the high-power region and lower power region of cyclists' power profile compared with the present LI protocol.

Concepts: Present, Time, Medical statistics, Statistical significance, Odds ratio, Effect size, Jacob Cohen, Equal temperament


The purpose of this study was to assess the effect of resistance training cessation on strength performance through a meta-analysis. Seven databases were searched from which 103 of 284 potential studies met inclusion criteria. Training status, sex, age, and the duration of training cessation were used as moderators. Standardized mean difference (SMD) in muscular performance was calculated and weighted by the inverse of variance to calculate an overall effect and its 95% confidence interval (CI). Results indicated a detrimental effect of resistance training cessation on all components of muscular performance: [submaximal strength; SMD (95% CI) = -0.62 (-0.80 to -0.45), P < 0.01], [maximal force; SMD (95% CI) = -0.46 (-0.54 to -0.37), P < 0.01], [maximal power; SMD (95% CI) = -0.20 (-0.28 to -0.13), P < 0.01]. A dose-response relationship between the amplitude of SMD and the duration of training cessation was identified. The effect of resistance training cessation was found to be larger in older people (> 65 years old). The effect was also larger in inactive people for maximal force and maximal power when compared with recreational athletes. Resistance training cessation decreases all components of muscular strength. The magnitude of the effect differs according to training status, age or the duration of training cessation.

Concepts: Old age, Probability theory, Strength training, Normal distribution, Effect size, Standard deviation, Isometric exercise, Dose-response relationship


Little is known about health variables and if these variables could increase the risk of injuries among adolescent elite athletes. The primary aim was to present overall data on self-perceived stress, nutrition intake, self-esteem, and sleep, as well as gender and age differences, on two occasions among adolescent elite athletes. A secondary aim was to study these health variables as potential risk factors on injury incidence. A questionnaire was e-mailed to 340 adolescent elite athletes on two occasions during a single school year: autumn semester and spring semester. The results show that during autumn semester, the recommended intake of fruits, vegetables, and fish was not met for 20%, 39%, and 43% of the adolescent elite athletes, respectively. The recommended amount of sleep during weekdays was not obtained by 19%. Multiple logistic regression showed that athletes sleeping more than 8 h of sleep during weekdays reduced the odds of injury with 61% (OR, 0.39; 95% CI, 0.16-0.99) and athletes reaching the recommended nutrition intake reduced the odds with 64% (OR, 0.36; 95% CI, 0.14-0.91). Our findings suggest that nutrition intake and sleep volume are of importance in understanding injury incidence.

Concepts: Regression analysis, Logistic regression, Health, Epidemiology, Nutrition, High school, Healthy diet, Academic term


The purpose of this study was to compare the effects of two different methods of organizing endurance training in trained cyclists during a 12-week preparation period. One group of cyclists performed block periodization (BP; n = 8), wherein every fourth week constituted five sessions of high-intensity aerobic training (HIT), followed by 3 weeks of one HIT session. Another group performed a more traditional organization (TRAD; n = 7), with 12 weeks of two weekly HIT sessions. The HIT was interspersed with low-intensity training (LIT) so that similar total volumes of both HIT and LIT were performed in the two groups. BP achieved a larger relative improvement in VO(2max) than TRAD (8.8 ± 5.9% vs 3.7 ± 2.9%, respectively, P < 0.05) and a tendency toward larger increase in power output at 2 mmol/L [la(-) ] (22 ± 14% vs 10 ± 7%, respectively, P = 0.054). Mean effect size (ES) of the relative improvement in VO(2max) , power output at 2 mmol/L [la(-) ], hemoglobin mass, and mean power output during 40-min all-out trial revealed moderate superior effects of BP compared with TRAD training (ES range was 0.62-1.12). The present study suggests that BP of endurance training has superior effects on several endurance and performance indices compared with TRAD.

Concepts: Effect, Training, Performance, Effect size, Aerobic exercise, Play, Periodization, Endurance training


The purpose of this study was to evaluate the effects of a 4-week familiarization to simulated barefoot running (SBR) on running economy (RE) when compared with shod running. Fifteen trained male runners (age: 24 ± 4 years; stature: 177.2 ± 6.21 cm; mass: 67.99 ± 7.36 kg and VO(2max) 70.2 ± 5.2 mL/kg/min) were recruited. Subjects completed two RE tests, 24 h apart, in a random order, in both the SBR and shod condition (pretest) at 11 km/h and 13 km/h. Oxygen uptake, heart rate, stride frequency, and foot strike patterns were measured in both conditions. Subjects then completed a 4-week familiarization period of SBR, before repeating the two RE tests (post-test). At pretest, there was no significant difference in RE between SBR and shod running (P = 0.463), but following the 4-week familiarization period, RE significantly improved by 6.9% in the SBR condition compared with shod running (46.4 ± 0.9 vs 43.2 ± 1.2 mL/kg/min; P = 0.011). A significant improvement in RE was observed in the SBR condition (8.09%) between the pretest and post-test (47.0 ± 1.2 vs 43.2 ± 1.2 mL/kg/min; P = 0.002). RE improved in the SBR condition as a result of familiarization, and became significantly lower in SBR compared with shod running.

Concepts: Better, Improve, Barefoot running


Achilles tendon rupture is a frequent injury with an increasing incidence. Until now, there is no consensus regarding optimal treatment. The aim of this review was to illuminate and summarize randomized controlled trials comparing surgical and non-surgical treatment of Achilles tendon ruptures during the last 10 years. Seven articles were found and they were all acceptable according to international quality assessment guidelines. Primary outcomes were re-ruptures, other complications, and functional outcomes. There was no significant difference in re-ruptures between the two treatments, but a tendency to favoring surgical treatment. Further, one study found an increased risk of soft-tissue-related complications after surgery. Patient satisfaction and time to return to work were significantly different in favor of surgery in one study, and there was also better functional outcome after surgery in some studies. These seven studies indicate that surgical patients have a faster rehabilitation. However, the differences between surgical and non-surgical treatment appear to be subtle and it could mean that rehabilitation is more important, rather than the actual initial treatment. Therefore, further studies will be needed in regard to understanding the interplay between acute surgical or non-surgical treatment, and the rehabilitation regimen for the overall outcome after Achilles tendon ruptures.

Concepts: Randomized controlled trial, Tendon, Achilles tendon, Tendinosis, Achilles tendon rupture


This study examined the influence of muscle deoxygenation and reoxygenation on repeated-sprint performance via manipulation of O(2) delivery. Fourteen team-sport players performed 10 10-s sprints (30-s recovery) under normoxic (NM: F(I) O(2) 0.21) and acute hypoxic (HY: F(I) O(2) 0.13) conditions in a randomized, single-blind fashion and crossover design. Mechanical work was calculated and arterial O(2) saturation (S(p) O(2) ) was estimated via pulse oximetry for every sprint. Muscle deoxyhemoglobin concentration ([HHb]) was monitored continuously by near-infrared spectroscopy. Differences between NM and HY data were analyzed for practical significance using magnitude-based inferences. HY reduced S(p) O(2) (-10.7 ± 1.9%, with chances to observe a higher/similar/lower value in HY of 0/0/100%) and mechanical work (-8.2 ± 2.1%; 0/0/100%). Muscle deoxygenation increased during sprints in both environments, but was almost certainly higher in HY (12.5 ± 3.1%, 100/0/0%). Between-sprint muscle reoxygenation was likely more attenuated in HY (-11.1 ± 11.9%; 2/7/91%). The impairment in mechanical work in HY was very largely correlated with HY-induced attenuation in muscle reoxygenation (r = 0.78, 90% confidence limits: 0.49; 0.91). Repeated-sprint performance is related, in part, to muscle reoxygenation capacity during recovery periods. These results extend previous findings that muscle O(2) availability is important for prolonged repeated-sprint performance, in particular when the exercise is taken in hypoxia.

Concepts: Energy, Crossover study, Hypoxia, Statistical inference, Vastus lateralis muscle, Work, Pulse oximetry, Pulse oximeter