Med Sci Sports Exerc [JOURNAL]
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200 papers
Exercise Training Reduces Cerebrovascular Impedance in Patients with Amnestic Mild Cognitive Impairment: A 1-Year Randomized Controlled Trial.
Sugawara J, Tarumi T, Tomoto T … +3 more , Pasha E, Cullum CM, Zhang R
Med Sci Sports Exerc · 2026 May · PMID 41538307 · Full text
INTRODUCTION: In patients with amnestic mild cognitive impairment (aMCI), cerebrovascular impedance modulus ( Z ) was higher than in cognitively normal peers, which is associated with brain hypoperfusion. While 1 yr of m...
INTRODUCTION: In patients with amnestic mild cognitive impairment (aMCI), cerebrovascular impedance modulus ( Z ) was higher than in cognitively normal peers, which is associated with brain hypoperfusion. While 1 yr of moderate-to-vigorous aerobic exercise training (AET) reduced Z in cognitively normal older adults, the effects of AET on aMCI remain unknown. METHODS: Seventy patients with aMCI were randomized into 1 yr of AET ( N = 31) or stretching and toning (SAT, N = 39). At baseline, midpoint (6 months), and trial completion (12 months), Z was assessed using transfer function analysis between carotid arterial pressure and cerebral blood flow (CBF) velocity measured simultaneously via applanation tonometry and transcranial Doppler in the middle cerebral artery, respectively. Total CBF was measured as the sum of the bilateral internal carotid and vertebral arterial flow via duplex ultrasonography. RESULTS: The AET group exhibited gradual, significant reductions in Z at 6 months ( P = 0.008 vs baseline) and 12 months ( P < 0.001 vs baseline; P < 0.001 vs 6 months). In the SAT group, although Z decreased during the first 6 months ( P < 0.001 vs baseline), it was maintained over the following 6 months. Repeated-measures correlation analyses revealed inverse relationships between Z and total CBF as well as cerebrovascular conductance in the AET group ( rrm = -0.503, P = 0.008; rrm = -0.404, P = 0.037, respectively), but not in the SAT group. In exploratory sex-stratified analyses, women exhibited continued reductions in Z across 12 months regardless of training modality, whereas men demonstrated a plateau after 6 months. CONCLUSIONS: These findings suggest that in patients with aMCI, AET reduces Z , which is associated with higher brain perfusion and cerebrovascular conductance. Sex-stratified analyses further suggested that women may experience greater improvements in Z than men across 1 yr of training.
Energetics of Underwater Swimming in Apnea - Corrigendum.
Vinetti G, Taboni A, Fagoni N … +3 more , Tam E, Lundby C, Ferretti G
Med Sci Sports Exerc · 2026 Feb · PMID 41529153 · Publisher ↗
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The Adolescent Athlete and the Team Physician: A Consensus Statement. 2025 Update.
Putukian M, Leclere LE, Herring SA … +12 more , Benjamin HJ, Bennett CH, Boyajian-O'Neill L, Callender SS, Day M, Finnoff JT, Franks R, Jayanthi N, Magnes SA, Matuszak J, Roach R, Statuta SM
Med Sci Sports Exerc · 2026 Feb · PMID 41529152 · Publisher ↗
Team physicians may be called upon to treat adolescent athletes, defined in this document as those in the range of 12-18 yr of age. Many are involved in school-based, intramural, or specialized sports participation and/o...
Team physicians may be called upon to treat adolescent athletes, defined in this document as those in the range of 12-18 yr of age. Many are involved in school-based, intramural, or specialized sports participation and/or training, potentially resulting in injury and/or illness. Specialized treatments may be necessary due to growth and development of the adolescent. Additionally, psychological factors in this age group may play an important role in sports participation, emotional well-being, and injury rehabilitation. While many children younger than 12 yr of age are active in sports participation, their medical and musculoskeletal concerns are not included in the scope of this consensus statement. The healthcare team must stay educated and knowledgeable regarding potential challenges to individuals participating safely in sport. All healthcare professionals should provide quality care, free from discrimination and specific to the needs of every unique individual. Ensuring access to care, fostering welcoming sporting environments, and recognizing the distinct challenges faced by underrepresented populations will reduce healthcare disparities and improve safe participation across all sports.
Dynamics of the Power-Duration Relationship during Intermittent Team Sports Exercise.
Black MI, Lewis JA, Liu Y … +4 more , Altuna A, Vanhatalo A, Kirby BS, Jones AM
Med Sci Sports Exerc · 2026 May · PMID 41430780 · Publisher ↗
PURPOSE: To 1) determine whether critical power (CP), W' and W' reconstitution kinetics (W' REC ) are altered by high-intensity team-sport specific intermittent exercise; 2) examine the accuracy with which W' balance (W'...
PURPOSE: To 1) determine whether critical power (CP), W' and W' reconstitution kinetics (W' REC ) are altered by high-intensity team-sport specific intermittent exercise; 2) examine the accuracy with which W' balance (W' BAL ) is estimated by the W' BAL model; 3) examine whether physiological variables assessed during ramp incremental exercise and the 3-min all-out test, explain exercise-induced changes in the power-duration relationship. METHODS: CP, W', and W' REC were determined during a repeated all-out test, which comprised a 3-min all-out test and a 2-min all-out test, separated by 90 s, in 13 recreationally active team-sport players. The test was performed in a rested condition (control) and immediately following a 40-min (40-IST) and 80-min (80-IST) intermittent sprint test. RESULTS: CP assessed after the 40-IST (222 ± 57 W) and 80-IST (213 ± 49 W) were not different from control (222 ± 52 W; P > 0.05). W' REC was also not significantly different from control (0.08 ± 0.02 kJ·s -2 ) after the 40-IST (0.07 ± 0.02 kJ·s -2 ) or 80-IST (0.07 ± 0.02 kJ·s -2 ; P > 0.05). W' was lower than control (13.5 ± 4.0 kJ) after the 40-IST (10.1 ± 4.0 kJ) and 80-IST (9.1 ± 3.5 kJ) (both P < 0.05). After the 40-IST, W' BAL was not significantly different from the value predicted from the W' BAL model (10.9 ± 2.4 kJ; P > 0.05), but W' BAL was overestimated by the model following the 80-IST (10.7 ± 2.6 kJ; P < 0.05). There were considerable interindividual differences in the changes in the power-duration relationship following exercise, which were not related to physiological variables assessed in the control condition. CONCLUSIONS: CP and W' REC are not altered after intermittent exercise, but W' is decreased, with considerable heterogeneity in the changes in the power-duration relationship between individuals. These results have important implications for the application of the W' BAL model to describe intermittent exercise performance.
Mechanics and Energetics of Cycling with Unilateral Transtibial Amputation: Effects of Prosthetic Effective Leg Length and Prosthesis Type.
Allen SP, Grabowski AM
Med Sci Sports Exerc · 2026 May · PMID 41430779 · Publisher ↗
INTRODUCTION: Cyclists with unilateral transtibial amputation (TTA) exhibit kinematic and kinetic asymmetries between their affected and unaffected sides that may influence efficiency. Altering bicycle geometry such as c...
INTRODUCTION: Cyclists with unilateral transtibial amputation (TTA) exhibit kinematic and kinetic asymmetries between their affected and unaffected sides that may influence efficiency. Altering bicycle geometry such as changing prosthetic effective leg length and/or using a cycling-specific prosthesis (CSP) could reduce asymmetries and improve cycling performance. PURPOSE: We determined the biomechanical and metabolic effects of different prosthetic effective leg lengths with two types of prostheses on lower limb joint kinematics and kinetics, asymmetry, and net efficiency in cyclists with TTA. METHODS: Twelve participants with TTA rode at 1.5 W kg -1 with their standard prosthetic effective leg length and +5, +10, and +15 mm using a daily-use prosthesis and CSP. RESULTS: A prosthetic effective leg length of +15 mm decreased the average knee joint angle by 3° for both prosthesis types ( P = 0.02), but did not alter kinematic or kinetic asymmetries, or net efficiency. However, use of a CSP versus daily-use prosthesis increased average knee joint angle of the affected side by 12.5° and decreased knee angle asymmetry from 11% to 3%. There were no changes to joint or crank power asymmetry, but net efficiency improved from 21.4% using a daily-use prosthesis to 22.3% using a CSP. CONCLUSIONS: Cyclists with a TTA can increase prosthetic effective leg length in a daily-use prosthesis or CSP up to 15 mm without affecting performance. However, use of a CSP decreases knee angle asymmetry and improves efficiency compared with a daily-use prosthesis. CSPs may shift knee extensor muscles into a more favorable region of the force-length relationship for producing force more economically. These findings can be used to inform bicycle and prosthesis designs that may encourage individuals with a TTA to increase exercise and sport participation.
Measuring the Effects of the Commonest Exercise Programs on Subjective Fatigue in People with Multiple Sclerosis: A Randomized Effectiveness Trial.
Boi A, Morrone M, Martinez G … +9 more , Ventura L, Meloni M, Natale D, Cugusi L, Oneto C, Sechi E, Aiello E, Deriu F, Manca A
Med Sci Sports Exerc · 2026 May · PMID 41430777 · Publisher ↗
PURPOSE: To test and compare the effects of the four most common exercise-based interventions employed to manage subjective fatigue and functional impairments due to multiple sclerosis. METHODS: Persons with multiple scl...
PURPOSE: To test and compare the effects of the four most common exercise-based interventions employed to manage subjective fatigue and functional impairments due to multiple sclerosis. METHODS: Persons with multiple sclerosis complaining of fatigue as a main symptom were enrolled. After a comprehensive baseline assessment evaluating subjective fatigue impact and severity (primary endpoints), quality of life, cardiorespiratory performance, and mobility and motor-functional outcomes, participants were randomly assigned to an 8-wk intervention consisting of strength training (ST) or aerobic training (AT) or strength + aerobic (Combo) or global rehabilitation (Rehab). RESULTS: Sixty-two mildly-moderately disabled PwMS (median Expanded Disability Status Scale 3.5 ± 1.6; age 46.6 ± 11.8 yr; 75% women) completed the study. No adverse events were reported. Between-group comparisons did not detect significant differences among groups. Considering training-induced effects separately for each group, AT showed the largest reduction in the Fatigue Severity Score (-18.8%; -0.81 points [pts], confidence interval [CI]: -1.53, -0.09, P = 0.03), followed by ST (-16.8%; -0.84 pts, CI: -1.56, -0.12, P = 0.02). Fatigue impact assessed by Modified Fatigue Impact Scale was significantly reduced after AT (-35.3%; -12.44 pts, CI: -19.00, -5.87, P < 0.01), followed by Combo (-33.8%; -13.36 pts; CI: -20.38, -6.34, P < 0.01) and Rehab (-26.2%; -8.18 pts; CI: -16.10, -0.26, P = 0.04). Regarding motor-functional outcomes, beyond the expected training-specific effects (e.g., muscle strength gains after ST, increased cardiorespiratory fitness after AT), comfortable and fastest walking speed increased significantly after Rehab (+0.16 m·s -1 , CI: 0.08, 0.23, P < 0.01; +0.22 m·s -1 , CI: 0.11, 0.329, P < 0.01, respectively) exceeding established thresholds for clinically important changes. Also, the increased distance covered in 6 min was found to exceed clinically important thresholds after ST (+55 m, CI: 9.15, 101.02, P = 0.02) and Combo (+62 m, CI: 14.04, 109.13, P = 0.01). CONCLUSIONS: Although the superiority of one treatment over the others has yet to be claimed, and all interventions proved beneficial to reduce fatigue impact, only AT and ST reduced both fatigue severity and impact, with the former intervention associated with the largest within-group effect sizes. When testing the effects of interventions on mobility outcomes, AT led to the largest improvements, followed by Combo.
Mediating Effects of Fitness and Motor Competence on Children's Executive Functions: Findings from the Learning to Lead Cluster Randomized Controlled Trial.
Bao R, Wade L, Leahy AA … +5 more , Beauchamp MR, Diallo TMO, Smith JJ, Hillman CH, Lubans DR
Med Sci Sports Exerc · 2026 May · PMID 41430739 · Publisher ↗
PURPOSE: The aim of this study was to examine the mediating effects of cardiorespiratory and muscular fitness (the fitness hypothesis) and motor competence (the skill acquisition hypothesis) on executive functions among...
PURPOSE: The aim of this study was to examine the mediating effects of cardiorespiratory and muscular fitness (the fitness hypothesis) and motor competence (the skill acquisition hypothesis) on executive functions among children participating in the Learning to Lead fundamental movement skills intervention. METHODS: We conducted a two-arm cluster randomized controlled trial in 20 primary schools in New South Wales, Australia ( N = 946). Ten schools were allocated to the intervention condition and ten to the wait-list control condition. Children in the intervention condition participated in 12 × 30-min peer-led fundamental movement skill sessions over a 10-wk period. Cardiorespiratory fitness, muscular fitness, motor competence, inhibition, and cognitive flexibility were assessed at baseline and postintervention. The preregistered mediation analysis was conducted at the individual level within a structural equation modeling framework, using cluster-robust standard errors (SEs), to account for nonindependence of observations at the classroom level. RESULTS: None of the mediation effects were statistically significant. The intervention significantly improved inhibition ( β = 0.125, SE = 0.054, P = 0.021) but not cognitive flexibility ( β = 0.013, SE = 0.068, P = 0.845). The intervention improved cardiorespiratory fitness ( β = 0.14, SE = 0.051, P = 0.007) but not muscular fitness ( β = -0.02, SE = 0.062, P = 0.707) or motor competence ( β = 0.04, SE = 0.076, P = 0.568). Muscular fitness was associated with inhibition ( β = 0.13, SE = 0.035, P < 0.001), and motor competence was associated with inhibition ( β = 0.08, SE = 0.034, P = 0.017) and cognitive flexibility ( β = 0.12, SE = 0.030, P < 0.001) at postintervention. CONCLUSIONS: Changes in fitness and motor competence did not mediate the effect of the intervention on children's executive functions. However, the significant associations between mediators and executive functions offer partial support for both the "fitness" and "skill acquisition" hypotheses, suggesting their potential importance for children's cognitive development.
Trimodal Prehabilitation with Supervised Exercise during Neoadjuvant Chemotherapy in Localized Pancreatic Cancer.
Romero-Elías M, García-González D, Esteban Bosque I … +6 more , Suarez Blazquez V, Vielba EJ, Méndez-Otero M, Pueyo Rabanal A, Cea Soriano M, Ruiz-Casado A
Med Sci Sports Exerc · 2026 May · PMID 41430738 · Publisher ↗
BACKGROUND: Pancreatic cancer (PC) is highly lethal, with surgery as the only curative option, but significant postoperative morbidity. Prehabilitation shows promise in other cancers, yet no trials have examined supervis...
BACKGROUND: Pancreatic cancer (PC) is highly lethal, with surgery as the only curative option, but significant postoperative morbidity. Prehabilitation shows promise in other cancers, yet no trials have examined supervised exercise during neoadjuvant chemotherapy in PC. OBJECTIVES: The primary objective was to evaluate recruitment and adherence to a trimodal prehabilitation program during neoadjuvant chemotherapy in patients with nonmetastatic PC. Secondary aims included assessing changes in physical condition, fatigue, quality of life (QoL), and some biomarkers. METHODS: A prospective single-center study recruited adults diagnosed with nonmetastatic PC scheduled for chemotherapy. Inclusion criteria were ECOG- performance status 0-2 and the ability to perform the one mile walk test. The intervention involved supervised exercise, respiratory muscle training, nutritional counseling, and psychological support. Primary outcomes were recruitment (10 patients/yr) and adherence (≥70% of exercise, nutrition, or psychological sessions). Secondary outcomes included cardiorespiratory fitness (six-mine walking test, mile time walk test, estimated VO 2 peak), muscular strength (sit-to-stand test and handgrip), global QoL (EORTC QLQ-C30), fatigue (PERFORM and FACIT), and body composition (body mass index). RESULTS: Among 35 screened patients, 14 completed the prehabilitation program, and 12 underwent surgery (in 30 months). Ten patients were recruited in 12 months. Adherence was acceptable across all components, with physical training achieving 100% attendance. Significant improvements were observed in respiratory capacity ( P = 0.000), gait speed ( P = 0.001), estimated VO 2 peak ( P = 0.002), six-mile walking test ( P = 0.021), one-mile walk test ( P = 0.000), sit-to-stand test ( P = 0.000), body mass index ( P = 0.047), fatigue PERFORM ( P = 0.023), FACIT ( P = 0.000), and QoL ( P = 0.017). CONCLUSIONS: Trimodal prehabilitation during neoadjuvant chemotherapy in PC can be implemented and may be associated with clinically meaningful improvements in physical fitness, fatigue, and QoL. Multicenter randomized controlled trials are warranted to determine their impact on postoperative outcomes.
Opposing Effects of Dietary Nitrate on Muscle Contractile Function in Fast and Slow Human Muscles.
Zoughaib WS, Fry MJ, Singhal A … +2 more , Hoffman RL, Coggan AR
Med Sci Sports Exerc · 2026 May · PMID 41430736 · Publisher ↗
PURPOSE: Increasing nitric oxide bioavailability via nitrate (NO 3- ) ingestion enhances muscle contractility, which may be due to phosphorylation of the regulatory light chain of myosin. If so, there should be an intera...
PURPOSE: Increasing nitric oxide bioavailability via nitrate (NO 3- ) ingestion enhances muscle contractility, which may be due to phosphorylation of the regulatory light chain of myosin. If so, there should be an interaction between NO 3- supplementation and post activation twitch potentiation, which acts via the same pathway. METHODS: A double-blind, placebo-controlled, randomized crossover study was conducted to determine the influence of dietary NO 3- on the contractile properties of the triceps brachii (60%-70% fast-twitch, or type II) and triceps surae (60%-70% slow-twitch, or type I) muscles of healthy young men ( n = 14). Participants were studied after acute ingestion of 2.2 mL/kg of beetroot juice either containing or lacking 200 µmol/kg of NO 3- , with neuromuscular electrical stimulation used to determine muscle function. RESULTS: NO 3- supplementation did not alter unpotentiated or potentiated peak twitch torque or the maximal rates of torque development or relaxation in either muscle group. On the other hand, NO 3- ingestion resulted in significant changes in the torque-frequency relationship of both the triceps brachii ( P = 0.019) and the triceps surae ( P < 0.001). This was due to a leftward shift of this sigmoidal relationship in the triceps brachii, but a rightward shift in the triceps surae. CONCLUSIONS: We conclude that dietary NO 3- has opposing effects on the contractile properties of fast and slow human muscles, which could be due to differential changes in Ca 2+ sensitivity. However, potentiation was unaltered, suggesting that this occurs independently of changes in regulatory light chain phosphorylation. Additional research will be required to determine the underlying biochemical mechanisms.
A Natural Experiment of Childhood Lifestyle on Emotional Distress Outcomes Using a Birth Cohort of Typically Developing Children.
Imbeault A, Morizot J, Pagani LS
Med Sci Sports Exerc · 2026 May · PMID 41399195 · Publisher ↗
PURPOSE: Many youngsters have an unhealthy lifestyle. This raises risks of emotional distress (i.e., depressive and anxiety symptoms). Conversely, those with emotional distress are also at risk of having an unhealthy lif...
PURPOSE: Many youngsters have an unhealthy lifestyle. This raises risks of emotional distress (i.e., depressive and anxiety symptoms). Conversely, those with emotional distress are also at risk of having an unhealthy lifestyle. We aim to examine the association between emotional distress and lifestyle in children. METHODS: Data were from the Quebec Longitudinal Study of Child Development, which was collected in Quebec province, Canada. Lifestyle and emotional distress were assessed by questionnaires completed by mothers, teachers, and children at ages 8 ( N = 1451, 52% girls), 10 ( N = 1334), and 12 years ( N = 1355). Latent profile analysis was used to derive lifestyle profiles. Logistic regression and mean difference analysis were conducted to test the associations between emotional distress and lifestyle profiles. RESULTS: At age 10 years, four profiles were found: healthy (43 %); fair (38 %); inactive (15 %); and sedentary (4 %). Children in the sedentary lifestyle profile had significantly more depressive symptoms at age 12 years compared with the healthy lifestyle profiles (mean difference [MD] = -1.618, 95% confidence interval [CI] = -2.841 to -0.396, P = 0.009), the fair lifestyle profile (MD = -1.399, 95% CI = -2.629 to -0.170, P = 0.03), and the inactive lifestyle profile (MD = -1.609, 95% CI = -2.966 to -0.253, P = 0.02). Effect sizes were large (respectively d = 1.13, d = 0.97, and d = 1.12). CONCLUSIONS: Parents and schools should provide more opportunities for extracurricular physical activity from an early age. The study would have benefited from including distinct types of sport and electronic devices instead of aggregated variables to evaluate differential associations with emotional distress.
Acute Severe Hypoxia Impacts Whole-Body Fat Oxidation and Muscle Desaturation Kinetics During Exercise: Intensity Matters.
Garcia J, Allender P, Malatesta D
Med Sci Sports Exerc · 2026 May · PMID 41399010 · Publisher ↗
PURPOSE: The aim of this study was to investigate the effects of acute exposure to severe normobaric hypoxia versus normoxia on whole-body fat oxidation and muscle desaturation kinetics over a wide range of identical rel...
PURPOSE: The aim of this study was to investigate the effects of acute exposure to severe normobaric hypoxia versus normoxia on whole-body fat oxidation and muscle desaturation kinetics over a wide range of identical relative and absolute intensities. METHODS: Thirteen active men performed 1) two maximal incremental tests to determine maximal oxygen uptake ( ) in normobaric hypoxia (FiO 2 = 13.2%, 3740 m) and normoxia (FiO 2 = 20.7%, 375 m), and 2) two submaximal graded tests, after overnight fasting, to assess fat oxidation and muscle desaturation kinetics as a function of exercise intensity in each condition. Fat oxidation kinetics were measured using indirect calorimetry and characterized using a sinusoidal model. Vastus lateralis desaturation kinetics were measured using near-infrared spectroscopy and the tissue saturation index (TSI), and modeled through a double linear model. RESULTS: Compared with the relative (% ) or absolute (% ) exercise intensity, absolute fat oxidation rates (g·min -1 ) were significantly higher in hypoxia than in normoxia, ranging from 55% to 85% ( P ≤ 0.023) and from 35% to 60% ( P ≤ 0.027), respectively. TSI was lower in hypoxia than in normoxia when compared at relative or absolute exercise intensity ( P ≤ 0.004), and muscle desaturation reached a maximal level only in hypoxia at high exercise intensity ( P ≤ 0.014). CONCLUSIONS: Compared with normoxia, acute exposure to severe normobaric hypoxia enhanced fat oxidation pathways during moderate-to-high relative and low-to-moderate absolute exercise intensities while allowing greater and maximal muscle desaturation. These findings highlight the relevance of considering both relative and absolute intensities when comparing fat oxidation during exercise in hypoxia and normoxia and suggest that maximal muscle desaturation is not a limiting factor for fat oxidation during exercise.
Physical Activity Trajectories in the First Year following ACL Reconstruction and Links to Early Markers of Osteoarthritis Development.
Büttner C, Thoma L, Lisee C … +6 more , Lee H, Arbeeva L, Favoreto N, Spang J, Li X, Pietrosimone B
Med Sci Sports Exerc · 2026 May · PMID 41398991 · Publisher ↗
UNLABELLED: Time spent in moderate-to-vigorous physical activity (MVPA) is linked to biomarkers associated with knee osteoarthritis development following anterior cruciate ligament reconstruction (ACLR). It remains uncle...
UNLABELLED: Time spent in moderate-to-vigorous physical activity (MVPA) is linked to biomarkers associated with knee osteoarthritis development following anterior cruciate ligament reconstruction (ACLR). It remains unclear whether distinct MVPA trajectories exhibited during the first 12 months post-ACLR are linked to early markers of knee osteoarthritis. PURPOSE: To identify distinct MVPA trajectories between 2 and 12 months post-ACLR and compare tibiofemoral articular cartilage composition changes and patient-reported outcomes (PROs) between trajectory groups. METHODS: Device-measured MVPA was collected at 2, 4, 6, and 12 months post-ACLR in individuals with ACLR. MVPA trajectories were identified using group-based trajectory modeling. Cartilage composition was measured preoperatively and at 12 months post-ACLR using change in T1ρ (ΔT1ρ) magnetic resonance imaging relaxation times in the lateral (lateral femoral condyle [LFC], lateral tibia) and medial (medial femoral condyle, medial tibia) femoral and tibial compartments. The Knee Injury and Osteoarthritis Outcomes Score (KOOS) was used to assess PROs preoperatively and at 2, 4, 6, and 12 months post-ACLR. Differences in KOOS subscale scores and ΔT1ρ were compared between MVPA trajectory groups. RESULTS: We identified a consistent MVPA (74.5%) and a high-increasing MVPA trajectory (25.5%). The high-increasing trajectory group engaged in more MVPA at all time points compared with the consistent group. The high-increasing trajectory group demonstrated greater ΔT1ρ in the LFC (i.e., deleterious changes in cartilage composition, P = 0.006) and higher KOOS sport compared with the consistent MVPA group ( P = 0.037). CONCLUSIONS: Individuals between 2 and 12 months post-ACLR most commonly engage in the consistent MVPA trajectory. The high-increasing MVPA trajectory group demonstrated worsening LFC cartilage composition. These data indicate that high MVPA in the first 12 months post-ACLR may be linked to deleterious knee tissue changes but not worse PROs.
Is Exercise-Induced Lactate Accumulation Associated with Changes in Acylated Ghrelin? A Systematic Review and Individual Participant Data Meta-Analysis.
McCarthy SF, Tucker JAL, Hazell TJ
Med Sci Sports Exerc · 2026 May · PMID 41398985 · Publisher ↗
INTRODUCTION: Lactate has been proposed to suppress the release and activation of the orexigenic peptide acylated ghrelin, though no study has synthesized available evidence from acute exercise trials. PURPOSE: To determ...
INTRODUCTION: Lactate has been proposed to suppress the release and activation of the orexigenic peptide acylated ghrelin, though no study has synthesized available evidence from acute exercise trials. PURPOSE: To determine if exercise-induced lactate accumulation predicts and/or is associated with changes in acylated ghrelin. METHODS: A systematic search strategy was developed and conducted in four databases for studies exploring changes in acylated ghrelin and lactate during acute exercise interventions. Using Covidence, studies were identified and included if participants were between the ages of 18 and 65 years, healthy (absence of medical condition or disease), conducted an acute exercise trial, and measured both acylated ghrelin and lactate pre and postexercise. Corresponding authors of eligible studies were contacted for individual data, and linear mixed-effect models were fitted and repeated measures correlations were conducted to determine if change in (Δ) lactate predicts and/or was associated with Δ acylated ghrelin and acylated ghrelin incremental area under the curve (iAUC). RESULTS: Twelve data sets (169 participants) were included in the Δ acylated ghrelin analysis and nine data sets (105 participants) were included in the acylated ghrelin iAUC analysis. There was a significant effect of Δ lactate for both Δ acylated ghrelin (β = -8.1, standard error = 1.1, P < 0.001) and Δ acylated ghrelin iAUC (β = -698, standard error = 69, P < 0.001) and Δ lactate had a negative correlation with both outcomes (r m = -0.41, P < 0.001; and r m = -0.59, P < 0.001). CONCLUSIONS: Overall, this study suggests that exercise-induced lactate accumulation significantly affects Δ acylated ghrelin and acylated ghrelin iAUC and is negatively associated, suggesting that greater exercise-induced lactate accumulation would be associated with the suppression of ghrelin.
Time Required for the Restitution of Extra Initial Force in Fast Motor Units of the Rat Medial Gastrocnemius Muscle.
Drzymała-Celichowska H, Majerczak J, Kryściak K … +2 more , Celichowski J, Zoladz JA
Med Sci Sports Exerc · 2026 May · PMID 41398628 · Publisher ↗
INTRODUCTION: During tetanic contractions of fast motor units (MUs), an early increase in force (boost) is followed by a slight decline to a plateau (sag). This boost is present at the onset of activity but disappears du...
INTRODUCTION: During tetanic contractions of fast motor units (MUs), an early increase in force (boost) is followed by a slight decline to a plateau (sag). This boost is present at the onset of activity but disappears during rhythmically repeated contractions at short intervals; however, it may be restituted after a period of rest. Nevertheless, the background of the boost, especially the minimum time required to restore this effect, is unknown, and the present study aimed to address this gap. METHODS: The functional isolation of a single MU was achieved by splitting the L5 or L4 ventral roots into thin filaments, which were electrically stimulated with rectangular electrical pulses. We recorded a series of three 504-ms tetanic contractions (triplets) evoked at 35 Hz repeated once per second, with the boost visible in the first tetanus. The triplets were evoked at progressively shorter time intervals, ranging from 90 to 2 s. RESULTS: The boost in successive triplets reduced when the intervals became critically short. The reduction of boost was estimated by the decrease in sag amplitude following the peak force associated with the boost. In fast fatigue-resistant MUs, the sag amplitude decreased by 25% at an average interval of 29.80 s and by 50% at an interval of 16.84 s. For fast fatigable MUs, the interval required to restitute the studied effect was longer: a 25% reduction in sag corresponded to an interval of 82.29 s, and a 50% reduction corresponded to 54.07 s. CONCLUSIONS: The results suggest that the physiological basis for the restitution of initial force (boost) is the kinetics of muscle energy status recovery following initial exercise.
A Whole-Body Exercise Test to Assess Cardiorespiratory Fitness across the Stroke Recovery Continuum.
Moncion K, Rodrigues L, DE Las Heras B … +7 more , Wiley E, Sikorska K, Cristini J, Allison EY, Eng JJ, Tang A, Roig M
Med Sci Sports Exerc · 2026 May · PMID 41398627 · Publisher ↗
BACKGROUND: Accurate assessment of cardiorespiratory fitness is a critical component of cardiopulmonary exercise testing (CPET) and prescription for people with stroke. However, post-stroke disability and neuromuscular i...
BACKGROUND: Accurate assessment of cardiorespiratory fitness is a critical component of cardiopulmonary exercise testing (CPET) and prescription for people with stroke. However, post-stroke disability and neuromuscular impairments are common and may disproportionately affect females throughout the continuum of recovery. There is a need to evaluate alternative whole-body CPET protocols and to characterize the sex-specific CPET responses throughout the continuum of stroke recovery. PURPOSE: To characterize the sex-specific CPET responses on a whole-body recumbent stepper CPET using American College of Sports Medicine (ACSM) criteria in people with subacute (7-90 d) and chronic (≥6-60 months) stroke. METHODS: Participants underwent a whole-body recumbent stepper symptom-limited CPET. Each CPET was assessed for ventilatory threshold (VT), peak oxygen uptake ( ) and ACSM maximal oxygen uptake criteria, including respiratory exchange ratio ≥1.10; plateau, heart rate (HR) within 10 beats of HRmax, and ratings of perceived exertion (RPE) ≥17/20 or ≥7/10. Sex differences by stroke chronicity were evaluated via t tests, rank-sum tests, χ 2 , or Fisher exact tests. RESULTS: In total, 145 participants underwent a symptom-limited CPET. In subacute stroke ( n = 69), no sex differences were found for VT or ( P > 0.05), but females were more likely to achieve a plateau ( P = 0.002). In chronic stroke ( n = 76), no sex differences were observed for VT or criteria ( P > 0.05), but females had lower ( P = 0.002). Irrespective of sex, achieving the RPE ( n = 41 subacute [61%], n = 38 chronic [54%]) or respiratory exchange ratio criteria ( n = 28 subacute [41%], n = 39 [51%]) was the most commonly met ACSM criteria. CONCLUSIONS: This whole-body CPET protocol is appropriate for eliciting peak and maximal efforts in people post-stroke; however, clinicians should consider biological sex and stroke chronicity.
Rating of Perceived Exertion as Prescription Tool to Maximize Oxygen Uptake Response during High-Intensity Interval Training.
Bok D, Turk E, Gulin J … +2 more , Rakovac M, Foster C
Med Sci Sports Exerc · 2026 May · PMID 41398624 · Publisher ↗
PURPOSE: The aims of the study were to 1) investigate the prescriptive validity of Borg's category-ratio 10 rating of perceived exertion (RPE) scale for high-intensity interval training (HIIT) using the criterion of accu...
PURPOSE: The aims of the study were to 1) investigate the prescriptive validity of Borg's category-ratio 10 rating of perceived exertion (RPE) scale for high-intensity interval training (HIIT) using the criterion of accumulated time ≥90% of maximal oxygen uptake (VO 2max ), 2) determine the optimal RPE category for HIIT prescription, and 3) analyze the physiological responses to RPE-prescribed HIIT sessions. METHODS: Seventeen (12 male) current and former physical education students (age: 24.2 ± 5 years, height: 181.3 ± 7.3, weight: 77.5 ± 12.2 kg; % body fat: 14.3 ± 4.3%) volunteered to participate in the study. Within four visits, separated by at least 48 hours, the participants performed a maximal incremental exercise test and three HIIT sessions. The HIIT sessions included three 3-minute intervals prescribed at RPE 6, 7, or 8, interspersed with 2-minute passive rest. RESULTS: Time ≥90% VO 2max and ≥90% maximal heart rate as well as mean and peak running speed, heart rate, VO 2 , respiratory frequency, peak minute ventilation (V E ), and blood lactate were all significantly lower in HIIT RPE6 compared with HIIT RPE7 and HIIT RPE8 , while there were no significant differences between HIIT RPE7 and HIIT RPE8 . Mean V E was significantly different between all three HIIT sessions, indicating the validity of RPE for HIIT prescription. CONCLUSIONS: RPE can be used to effectively prescribe long format HIIT sessions. RPE 7 appears to be an optimal prescription category as HIIT RPE7 elicited similar cardiovascular and metabolic responses to HIIT RPE8 but with lower ventilatory stress. V E appeared to be the main perceptual cue for the regulation of running speed, while VO 2 was mainly governed by the dynamics of running speed adjustments during HIIT intervals.
Sex-Specific Lean Mass Changes during Marine Corps Officer Candidates School and Associations with Physical Health, Performance, and Military Readiness.
Koltun KJ, Forse JN, Feigel ED … +7 more , Tiede D, Kargl CK, Steele EJ, Bird MB, Lovalekar M, Martin BJ, Nindl BC
Med Sci Sports Exerc · 2026 May · PMID 41398623 · Publisher ↗
UNLABELLED: Individuals participating in military training are subject to physical training that can affect body mass and composition in a manner that may be dependent on sex and relate to physical health and performance...
UNLABELLED: Individuals participating in military training are subject to physical training that can affect body mass and composition in a manner that may be dependent on sex and relate to physical health and performance. PURPOSE: This investigation compared changes in body composition between sexes during Marine Corps Officer Candidates School, and explored potential associations with physical health, performance, and military readiness outcomes. METHODS: At the onset of training, 55 officer candidates ( n = 27 female) completed body composition analyses and 28 ( n = 11 female) completed posttesting. Two-way mixed measures analyses of variance compared changes over time between sexes, and Pearson or Spearman correlations examined associations among changes in body composition and performance outcomes. RESULTS: After training, lean mass ( P = 0.002, 7%) increased in female but not male candidates. Body fat percentage ( P = 0.013) decreased to a greater extent in female ( P < 0.001, -33%) than in male ( P < 0.001, -26%) candidates. Reductions in body mass and fat mass were similar between sexes. Change in body mass was negatively associated with change in physical fitness test score ( P = 0.038, r = -0.401), such that greater reductions in body mass would be associated with greater improvements in test score. Positive associations between change in body mass, body mass index, and lean mass ( P ≤ 0.040, r ≥ 0.414) with change in countermovement jump absolute force were observed. Increased lean mass was associated with reduced C-reactive protein concentration ( P = 0.004, ρ = -0.675). CONCLUSIONS: Reductions in fat mass and body mass as well as sex-specific changes in lean mass were demonstrated. Lean mass may also be beneficial for maintaining physical performance and health during military training.
Improved Glycemic Control in Adults with Type 2 Diabetes Is More Strongly Associated with Exercise Duration than with Volume, Frequency, or Consistency.
Low JL, Hesketh K, Falkenhain K … +8 more , Jung ME, Singer J, Jones CA, Russon C, Cocks M, McManus A, Little JP, MOTIVATE T2D Team
Med Sci Sports Exerc · 2026 May · PMID 41398622 · Publisher ↗
PURPOSE: Exercise interventions play a pivotal role in managing type 2 diabetes (T2D), yielding significant benefits in glycemic control. Despite the recognized role of exercise duration, volume, frequency, and consisten...
PURPOSE: Exercise interventions play a pivotal role in managing type 2 diabetes (T2D), yielding significant benefits in glycemic control. Despite the recognized role of exercise duration, volume, frequency, and consistency, the literature remains discrepant on which exerts the greatest effect. The purpose of this secondary analysis was to determine the relationship between exercise duration, volume, frequency, and consistency and markers of glycemic control (HbA1c and continuous glucose monitoring metrics) following a 26-wk mHealth intervention. METHODS: Inactive adults with newly diagnosed (<2 yr) T2D ( n = 58) completed blood and 14-day continuous glucose monitoring testing before and after a 26-wk personalized exercise intervention. Raw exercise data from fitness watches were extracted for each session. Duration, volume, frequency, and consistency were calculated for the full intervention and for the first 13 wk (greater support) and last 13 wk (reduced support). RESULTS: Average session duration (57 ± 36 min) significantly predicted HbA1c (β = -0.23 [0.07], P = 0.002), 24-h mean glucose (β = -0.03 [0.01], P = 0.01), and glycemic variability (standard deviation; β = -0.01 [0.0], P = 0.003; Beta coefficients are reported with standard errors). Total exercise time during the first 13 wk (2931 ± 3362 min) also predicted HbA1c (β = -0.001 [0.0], P = 0.01), mean glucose (β = -0.002 [0.0], P = 0.01), and glycemic variability (β = -0.005 [0.0], P = 0.03). No other exercise metrics significantly predicted outcomes. CONCLUSIONS: Average session duration and exercise time accumulated early in the intervention were the only significant predictors of improvements in HbA1c, mean glucose, and glucose variability. These findings suggest that promoting increased exercise duration, independent of type or intensity, may improve glycemic control among individuals with newly diagnosed T2D. TRIAL REGISTRATION: ClinicalTrials.gov NCT04653532.
Longitudinal Bidirectional Associations between Physical Activity and Cognitive Ability in Older Adults across the United Kingdom, United States, and China.
Zhang X, Zhao J, Zhao B … +1 more , Li X
Med Sci Sports Exerc · 2026 Apr · PMID 41392396 · Publisher ↗
PURPOSE: Physical activity (PA) has been linked to better cognitive ability (CA), but the bidirectionality of this association and the role of activity intensity remain unclear. We aimed to examine bidirectional longitud...
PURPOSE: Physical activity (PA) has been linked to better cognitive ability (CA), but the bidirectionality of this association and the role of activity intensity remain unclear. We aimed to examine bidirectional longitudinal associations between PA and CA across three national cohorts. METHODS: We used harmonized data from three population-based aging studies: the English Longitudinal Study of Ageing, the US Health and Retirement Study, and the China Health and Retirement Longitudinal Study (CHARLS). Participants aged ≥50 years with three waves of data were included ( n = 15,120). PA was categorized by intensity (light, moderate, and vigorous) and self-reported at baseline and follow-up. CA was assessed via composite scores of memory, orientation, and numeracy. We applied linear mixed-effects models to estimate longitudinal bidirectional associations between PA (PA intensity) and CA, adjusting for sociodemographic and health-related covariates. RESULTS: In English Longitudinal Study of Ageing cohort, we observed modest but statistically significant bidirectional associations between PA and CA. In CHARLS cohort, the CA-PA association attenuated to nonsignificance after adjusting for chronic conditions, while the US Health and Retirement Study cohort showed similar patterns to CHARLS. Notably, moderate-intensity PA showed the most consistent longitudinal associations with subsequent cognitive outcomes across all cohorts (β = 0.024, P = 0.001). Evidence for reverse association was also observed across all cohorts (β = 0.016, P = 0.017). No systematic moderation by gender or baseline age was detected. Results were broadly comparable across cohorts, despite differences in measurement and cultural context. CONCLUSIONS: Regular moderate-intensity PA may support cognitive health in later life, and cognitive function may in turn influence ongoing engagement in moderate PA. These findings underscore the value of the reciprocal benefits of moderate PA as cognitive health strategies in aging populations.
Single-leg Landing Coordination Variability and Second Injury in Young Athletes after Primary Anterior Cruciate Ligament Reconstruction.
Perry JA, Kronenberg JM, Thomas SM … +3 more , Paterno MV, Siston RA, Schmitt LC
Med Sci Sports Exerc · 2026 Apr · PMID 41349576 · Publisher ↗
PURPOSE: Young, active individuals who undergo anterior cruciate ligament (ACL) reconstruction (ACLR) after an ACL injury often experience suboptimal outcomes, including a high risk of second ACL injury. Coupling angle v...
PURPOSE: Young, active individuals who undergo anterior cruciate ligament (ACL) reconstruction (ACLR) after an ACL injury often experience suboptimal outcomes, including a high risk of second ACL injury. Coupling angle variability has been used previously to investigate the interactions between joints and their relative coordination, but it has not yet been used to investigate the future risk of subsequent ACL injury during dynamic tasks post-ACLR. As such, the purpose of this work was to examine the relationship between coordination variability and second ACL injury outcomes in young athletes after primary ACLR, along with uninjured controls. METHODS: This article represents a secondary analysis from a larger parent study that included motion capture data at the time of return to sports and second ACL injury incidences over a 2-yr period after return to sports in young athletes post-ACLR. We utilized kinematic data during landing to calculate coordination variability with a modified vector coding technique. For this analysis, coordination variability during the landing phase of a single-leg landing task was compared among three groups: uninjured control participants (CTRL), participants with ACLR that did not sustain a subsequent second ACL injury (ACL1), and participants with ACLR that sustained a second ACL injury (ACL2). RESULTS: On the uninvolved limb, CTRL demonstrated lower coordination variability compared with ACL1 and ACL2. On the involved limb, CTRL demonstrated the lowest coordination variability, and ACL2 demonstrated the highest coordination variability of the three groups. CONCLUSIONS: The higher coordination variability seen in the ACLR groups suggests lower consistency of movement strategies. Additional research is needed to further investigate how coordination variability may impact subsequent injury risk after primary ACLR.
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