Journal of Functional Morphology and Kinesiology

14 pages, 424 KB

Open AccessArticle

Running Speed and Mental Toughness: Effects on Change-of-Direction Speed in Police Students

by Ranko Rajović, Nenad Koropanovski, Filip Kukić, Igor Radošević, Miloš Milošević and Milivoj Dopsaj

J. Funct. Morphol. Kinesiol. 2026, 11(3), 268; https://doi.org/10.3390/jfmk11030268 - 8 Jul 2026

Abstract

Objectives: Effective operational functioning within the tactical domain requires a high integration of physical and psychological capacities under stressful conditions. This study investigated the impact of physical exertion at varying intensities (anaerobic and aerobic running) on subsequent change-of-direction speed (CODS) performance among [...] Read more.

Objectives: Effective operational functioning within the tactical domain requires a high integration of physical and psychological capacities under stressful conditions. This study investigated the impact of physical exertion at varying intensities (anaerobic and aerobic running) on subsequent change-of-direction speed (CODS) performance among police students, while evaluating the role of mental toughness (MT) and biological sex. Methods: Thirty police students (36.7% female) completed running protocols at different intensities (300-yard shuttle run and 2.4 km Cooper test), immediately followed by the Illinois Agility Test (IAT) to assess CODS performance. Mental toughness was evaluated using the Mental Toughness Index (MTI). Repeated-measures ANOVA and ANCOVA were used to analyze the main and interaction effects. Results: Initial repeated-measures ANOVA revealed that increasing running intensities significantly degraded CODS performance, demonstrating large main effects for both the anaerobic (F = 56.70, p < 0.001, η²_p = 0.661) and aerobic (F = 47.50, p < 0.001, η²_p = 0.621) protocols. After introducing mean-centered MT as a covariate, the main effect of Running Speed remained highly significant in both the anaerobic (F = 57.52, p < 0.001, η²_p = 0.673) and aerobic (F = 46.01, p < 0.001, η²_p = 0.622) models, with no significant univariate interaction effects involving MT or sex on the rate of decline. Mixed ANCOVA showed a significant main effect of sex on absolute IAT times under both anaerobic and aerobic conditions, with males consistently outperforming females. No significant differences in baseline MT scores were observed between sexes (p = 0.507). Conclusions: The findings demonstrate that physical fatigue robustly impairs CODS performance at a parallel rate for both male and female police students. Mental toughness does not neutralize the physiological rate of performance decline under acute fatigue. Practical training programs should integrate physical and psychological conditioning scenarios, while workload management protocols can be uniformly applied across biological sexes. Full article

(This article belongs to the Special Issue Tactical Athlete Health and Performance, 2nd Edition)

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14 pages, 1236 KB

Open AccessArticle

Reliability of Electrical Threshold Testing for Assessing Sensory, Motor and Pain Thresholds: An Exploratory Study in Active Subjects

by Izarbe Ríos-Asín, Elena Bueno-Gracia, Isabel Albarova-Corral, Pilar Pardos-Aguilella, Gianluca Ciuffreda and Miguel Malo-Urriés

J. Funct. Morphol. Kinesiol. 2026, 11(3), 267; https://doi.org/10.3390/jfmk11030267 - 7 Jul 2026

Abstract

Background: Sensorimotor impairments are common following sports injuries. Electrical Threshold Testing (ETT) is a promising quantitative sensory testing (QST) tool that allows the assessment of sensory deficits, motor recruitment, and pain perception. Although various protocols have been proposed, direct comparisons between studies [...] Read more.

Background: Sensorimotor impairments are common following sports injuries. Electrical Threshold Testing (ETT) is a promising quantitative sensory testing (QST) tool that allows the assessment of sensory deficits, motor recruitment, and pain perception. Although various protocols have been proposed, direct comparisons between studies and protocols remain difficult due to methodological inconsistencies, particularly regarding the number of measurements used, which significantly affect reliability. The main objective was to determine the number of trials required to obtain reliable measurements of electrical sensory threshold (EST), electrical motor threshold (EMT), and electrical pain threshold (EPT) in terms of both intra- and interday reliability. Methods: In this repeated-measures study, 14 active participants underwent three electrical stimulation protocols (sensory, motor, and pain) and performed five measurements per threshold. Averages of 1 to 5 measurements were analyzed using intraclass correlation coefficients (ICCs). Results: For EST, averaging multiple trials yielded good-to-excellent intra- and interday reliability (ICCs = 0.778–0.964). For EMT, intraday reliability was excellent (ICCs > 0.928), but interday stability remained moderate depending on the performed test. For EPT, intraday reliability was good to excellent (ICCs = 0.812–0.957), whereas interday stability (ICCs > 0.782) required averaging at least three trials. Single-trial assessments provided insufficient precision across all thresholds. Conclusions: Implementing a standardized protocol of three-averaged trials, including EST, EMT and EPT, appears to be an optimal, reliable, and time-efficient balance for clinical settings. These findings may contribute to ETT standardization in active populations, enhancing clinical efficiency, and supporting its use as a reliable tool for assessing sensorimotor impairments and monitoring treatment outcomes. Full article

(This article belongs to the Special Issue Posture and Neuromuscular Plasticity: Clinical and Instrumental Assessment in Sport and Disease Populations)

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14 pages, 5849 KB

Open AccessOpinion

A Persistent Misconception About Hip Rotation Torques During Elastic Band Sidestepping

by Heiliane de Brito Fontana, Walter Herzog, Felipe Neumann, Heron Baptista de Oliveira Medeiros, Marcio Nunes, Vitor Guarda Munari and Josiel Gomes Ribeiro

J. Funct. Morphol. Kinesiol. 2026, 11(3), 266; https://doi.org/10.3390/jfmk11030266 - 6 Jul 2026

Abstract

Resisted sidestepping is widely implemented in rehabilitation and strength training, and exercise prescription is often guided by recommendations based on surface electromyography (EMG) patterns and intuitive assumptions about how elastic-band placement and posture influence hip loading. EMG provides valuable insight into neuromuscular strategies, [...] Read more.

Resisted sidestepping is widely implemented in rehabilitation and strength training, and exercise prescription is often guided by recommendations based on surface electromyography (EMG) patterns and intuitive assumptions about how elastic-band placement and posture influence hip loading. EMG provides valuable insight into neuromuscular strategies, but it does not, by itself, specify the direction or magnitude of joint-level mechanical demand. In this opinion article, we argue that exercise prescription is strengthened when EMG findings are interpreted within a joint-kinetic framework, in which the net external joint moment, calculated via inverse dynamics, defines the mechanical demand imposed by the task. Using resisted sidestepping as the central example and drawing on previously published three-dimensional inverse-dynamics findings, we address a common misconception that placing an elastic band around the forefeet necessarily imposes an external hip moment toward medial rotation that can help target “hip lateral rotator” muscles. Available inverse-dynamics evidence indicates that, under typical execution with slight hip and knee flexion, forefoot-band sidestepping imposes a resultant external hip moment toward lateral rotation, thereby requiring a net internal muscular moment toward medial rotation to maintain alignment and perform the task. We further highlight that posture and resistance configuration modulate how demand is distributed across joint movement planes. Specifically, band placement alters the moment arms of the elastic resistance relative to different hip joint axes and therefore influences how changes in band stiffness are translated into transverse- and frontal-plane hip loading. Thus, band placement, posture, and resistance magnitude should be selected according to the intended joint-level loading objective rather than inferred from EMG patterns alone. Although illustrated with sidestepping, this reasoning is relevant to many resistance and rehabilitation exercises in which EMG-only interpretations, without consideration of external forces and joint kinetics, may lead to incomplete or incorrect inferences about joint loading and musculoskeletal function. Full article

(This article belongs to the Section Kinesiology and Biomechanics)

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24 pages, 2900 KB

Open AccessReview

Exercise-Induced Coronary Remodeling and the Atherosclerotic Paradox in Endurance Athletes: Toward a Unified Mechanobiological Framework

by Nardi Tetaj, Andrea Segreti, Michele Pelullo, Camilla Rossi, Alberto Spagnolo, Virginia Ligorio, Aurora Ferro, Antonio Emanuele Lentini, Teresa Trunfio, Martina Ciancio, Chiara Fossati, Fabio Pigozzi and Francesco Grigioni

J. Funct. Morphol. Kinesiol. 2026, 11(3), 265; https://doi.org/10.3390/jfmk11030265 - 4 Jul 2026

Abstract

Regular endurance exercise is consistently associated with lower cardiovascular mortality, a favorable cardiometabolic profile, and superior cardiorespiratory fitness. However, coronary imaging studies in master endurance athletes have raised a clinically relevant paradox: despite a low burden of conventional risk factors, some athletes—particularly older [...] Read more.

Regular endurance exercise is consistently associated with lower cardiovascular mortality, a favorable cardiometabolic profile, and superior cardiorespiratory fitness. However, coronary imaging studies in master endurance athletes have raised a clinically relevant paradox: despite a low burden of conventional risk factors, some athletes—particularly older men with high lifetime exercise exposure—show a greater prevalence of coronary artery calcium and subclinical coronary plaque than sedentary or less active controls. This observation has challenged the long-standing assumption that high-volume endurance exercise is uniformly protective against coronary artery disease. A binary interpretation of this literature is inadequate. Coronary flow reserve and ischemic threshold may remain adequate in some athletes, although this concept is supported by limited functional and outcome data. Based on experimental vascular biology and indirect human evidence, repetitive high-flow states during endurance exercise generate sustained laminar shear stress, cyclic wall strain, and marked increases in coronary blood flow, thereby activating endothelial mechanotransduction pathways and influencing vascular smooth muscle cell behavior, extracellular matrix remodeling, and calcification biology. These adaptations may culminate in positive arterial remodeling, luminal enlargement, and, in some individuals, a predominantly calcified plaque phenotype. Importantly, structural remodeling does not necessarily equate to functional impairment. In selected athletes, when outward remodeling and endothelial responsiveness are preserved, coronary flow reserve and ischemic threshold may remain adequate, although this concept remains supported by limited functional and outcome data. This narrative review integrates the clinical imaging literature with current concepts in vascular mechanobiology to propose that coronary remodeling in endurance athletes exists along an adaptive–maladaptive continuum shaped by cumulative exercise load, aging, sex, conventional risk factors, and biological susceptibility. This framework may help clinicians interpret CAC/CCTA findings in athletes more appropriately and avoid equating plaque burden with equivalent functional or prognostic significance. Full article

(This article belongs to the Special Issue Exercise Interventions in Cardiovascular Health)

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13 pages, 4791 KB

Open AccessBrief Report

Latent Factor Structure of Dynamic Postural Control and Ankle Mobility in Young Female Volleyball Players During Single-Leg Tasks: A Pilot Study

by Koichi Moriguchi, Kuniaki Moridera, Tomoki Noguchi, Nariyuki Mura, Toshiaki Sato and Hiroshi Katoh

J. Funct. Morphol. Kinesiol. 2026, 11(3), 264; https://doi.org/10.3390/jfmk11030264 - 1 Jul 2026

Abstract

Background: This study aimed to explore the relationships among different indices and the underlying latent structure of dynamic postural control in young female volleyball players. It used factor analysis of indices from stabilogram diffusion analysis (SDA), the modified Star Excursion Balance Test (mSEBT), [...] Read more.

Background: This study aimed to explore the relationships among different indices and the underlying latent structure of dynamic postural control in young female volleyball players. It used factor analysis of indices from stabilogram diffusion analysis (SDA), the modified Star Excursion Balance Test (mSEBT), and the Weight-Bearing Lunge Test (WBLT) to generate hypotheses regarding the relationships among these measures. Methods: In total, 34 female middle- and high-school volleyball players participated in this study. The SDA was performed using center-of-pressure (COP) data obtained during a single-leg vertical jump landing task, and the critical point (CP) was calculated. Lower-limb reach distances in the anterior (ANT), posteromedial (PM), and posterolateral (PL) directions were measured using the modified mSEBT. In addition, hallux-to-wall distance (HWD) was measured using the WBLT. Exploratory factor analysis was conducted to examine the latent factor structure among these indices. Results: The Kaiser–Meyer–Olkin value was 0.63, and Bartlett’s test of sphericity had significant results (p < 0.001). Considering the factor retention decision and the study’s theoretical framework, a two-factor solution was adopted for factor analysis, yielding a cumulative explained variance of 79.77%. Factor 1 had high factor loadings for the ANT, PM, and PL directions. Meanwhile, factor 2 showed high factor loadings for CP and HWD. Conclusions: Factor 1 reflected the spatial dynamic balance ability associated with the mSEBT and may be related to it. Moreover, factor 2 may indicate the temporal characteristics of COP variability assessed via the SDA and based on ankle mobility-related characteristics. However, because this was an exploratory pilot study with a small sample size, the findings should be considered as preliminary hypotheses. Full article

(This article belongs to the Special Issue Posture, Balance, and Gait: Assessment Techniques and Rehabilitation Strategies—2nd Edition)

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15 pages, 941 KB

Open AccessArticle

Relation Between Anaerobic Power and Competitive Performance in Paralympic Powerlifting Athletes: A Cross-Sectional Study

by Carolina Oliveira de Carvalho, Felipe J. Aidar, Vanessa Carla Monteiro Pinto, Paulo Moreira Silva Dantas, Gilmara Gomes de Assis, Jonathas Helber Souza Santos, João Pedro de Macêdo Barros, Júlio César Medeiros Alves, Paulo Francisco de Almeida-Neto, Luis Leitão and Breno Guilherme de Araújo Tinoco Cabral

J. Funct. Morphol. Kinesiol. 2026, 11(3), 263; https://doi.org/10.3390/jfmk11030263 - 1 Jul 2026

Abstract

Background: Paralympic powerlifting requires high upper-limb force production within a short time frame, making anaerobic power a potentially relevant physiological component associated with competitive performance. This study aimed to analyze the associations between biodynamic variables and competitive performance in Paralympic powerlifting athletes. [...] Read more.

Background: Paralympic powerlifting requires high upper-limb force production within a short time frame, making anaerobic power a potentially relevant physiological component associated with competitive performance. This study aimed to analyze the associations between biodynamic variables and competitive performance in Paralympic powerlifting athletes. Methods: A cross-sectional study was conducted with 13 elite Paralympic powerlifters. Body composition was assessed using DXA. Arm isometric strength was measured by the handgrip test, dynamic strength by the medicine ball throw, and anaerobic power by an upper-limb-adapted Wingate test. Competitive performance was determined based on the official ranking position in the Brazilian Paralympic Powerlifting Championship. Results: Significant correlations were observed between all anaerobic power variables and competitive performance: relative mean power (r = −0.864; p < 0.001), mean power (r = −0.804; p = 0.003), relative peak power (r = −0.766; p = 0.006), and peak power (r = −0.791; p = 0.004). Additionally, total lean mass and left-hand grip strength showed significant associations with maximum competition lift in exploratory linear regression analyses. Conclusions: Upper-limb anaerobic power showed strong associations with competitive performance indicators in Paralympic powerlifting athletes. Furthermore, lean mass and upper-limb isometric strength showed significant associations with maximum competition lift, supporting the multifactorial nature of competitive performance in Paralympic powerlifting. These findings suggest the potential relevance of integrating power-, strength-, and body composition-oriented assessments and interventions into the training process of elite Paralympic powerlifters. Full article

(This article belongs to the Section Athletic Training and Human Performance)

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13 pages, 2557 KB

Open AccessArticle

The Effects of External Lower Limb Weight or Pressure Application on Human Knee Joint Proprioception in Resting and Fatigue Conditions: A Randomized Trial

by Elmina-Eleftheria Roditi, Themistoklis Tsatalas, Giorgos K. Sakkas, Ioanna Giannopoulou, Yiannis Koutedakis, Giannis Giakas and Christina Karatzaferi

J. Funct. Morphol. Kinesiol. 2026, 11(3), 262; https://doi.org/10.3390/jfmk11030262 - 30 Jun 2026

Abstract

Objectives: Knee proprioception is affected by many biomechanical and physiological factors. Often, during training, rehabilitation, or specific sport requirements, weight or pressure is applied to the foot. However, it is not clear if such applications affect knee proprioceptive acuity. This study examined [...] Read more.

Objectives: Knee proprioception is affected by many biomechanical and physiological factors. Often, during training, rehabilitation, or specific sport requirements, weight or pressure is applied to the foot. However, it is not clear if such applications affect knee proprioceptive acuity. This study examined whether the application of an external weight (3 kg) or of pressure (120 mmHg) at a level above the ankle joint would affect knee proprioception in an open kinematic chain movement in resting or fatigue conditions. Methods: Participants included active young men (n = 7) and women (n = 15), aged 21–34 years, without prior knee injury. Women were tested in their follicular phase. An isokinetic dynamometer was used to evaluate knee joint repositioning. Three knee angles were targeted (30°, 45°, 60°) before and after localized muscle fatigue. A three-way ANOVA analysis with repeated measures and one independent variable (gender) was performed. Results: Analysis showed that ankle weight application positively influenced knee joint proprioceptive acuity resulting in an overall reduction in knee joint angular error for both genders, with the “corrective” effect most evident at 45° and 60° knee joint angles (p < 0.05), whether in the rested or fatigued state. The application of pressure however improved knee proprioceptive performance in men (p < 0.05), in both the rest and fatigue states, but not in women (ns tendency). Conclusions: Application of a small weight at the ankle level significantly improved proprioceptive knee joint acuity. These findings may have wider applicability by allowing the development of specific preventive measures towards safeguarding weaker and/or less resilient players. Full article

(This article belongs to the Special Issue 10th Anniversary of JFMK: Advances in Athletic Training and Human Performance)

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10 pages, 806 KB

Open AccessArticle

Relationship Between Echo-Intensity Bands of the Vastus Lateralis and Rectus Femoris Muscles and Torque Parameters of Knee Extensors in Soccer Players

by Maria Rita dos Santos Lara, Silas Nery de Oliveira, Luiz Henrique Rufino Batista, Silvio Assis de Oliveira-Junior, Eduardo Feijó da Rocha, Rodolfo André Dellagrana and Mateus Rossato

J. Funct. Morphol. Kinesiol. 2026, 11(3), 261; https://doi.org/10.3390/jfmk11030261 - 30 Jun 2026

Abstract

Background: Echo intensity (EI) derived from ultrasound imaging is widely used to assess muscle quality and has been proposed as a potential indicator of neuromuscular performance. Recently, EI band analysis has been suggested as an alternative approach to provide additional information beyond [...] Read more.

Background: Echo intensity (EI) derived from ultrasound imaging is widely used to assess muscle quality and has been proposed as a potential indicator of neuromuscular performance. Recently, EI band analysis has been suggested as an alternative approach to provide additional information beyond mean EI. However, evidence linking EI bands to functional outcomes remains limited. Methods: Forty-eight male soccer players (26.2 ± 3.6 years) underwent ultrasound assessment of the vastus lateralis (VL) and rectus femoris (RF) muscles. EI was analyzed as mean values and as pixel distribution across five bands (0–50, 51–100, 101–150, 151–200, and 201–255 A.U.), with correction for subcutaneous adipose thickness. Knee extensor peak concentric torque and total work were assessed using isokinetic dynamometry at 60°/s. Generalized linear regression models were used to examine associations between EI variables and mechanical outcomes. Results: No significant differences were observed between limbs for EI mean or EI band distribution in either muscle. The 0–50 A.U. band exhibited the highest pixel percentage for both VL and RF. Mean EI of the RF was negatively associated with peak torque (β = −4.10; 95% CI: −7.35 to −0.86) and total work (β = −3.89; 95% CI: −6.34 to −1.45) of the right knee extensors. No significant associations were found for EI bands or for any EI variables of the VL muscle. In male soccer players, mean EI of the rectus femoris, but not EI band distribution, is associated with knee extensor torque and work output. Conclusions: These findings suggest that mean EI remains a more informative indicator of muscle quality related to strength performance than band-based EI analysis in this athletic population. Full article

(This article belongs to the Section Kinesiology and Biomechanics)

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25 pages, 3292 KB

Open AccessArticle

Injury Patterns in Portuguese Under-23 and Senior Rink Hockey Athletes: A Retrospective Cross-Sectional Study

by Sofia Sacadura, Ricardo Maia Ferreira, Maria Paula Pacheco and Rui Soles Gonçalves

J. Funct. Morphol. Kinesiol. 2026, 11(3), 260; https://doi.org/10.3390/jfmk11030260 - 29 Jun 2026

Abstract

Background: Rink Hockey is a high-intensity contact sport with growing participation in Portugal, yet epidemiological data on injuries among senior and under-23 practitioners remain scarce. This study aimed to retrospectively describe self-reported injury occurrence, injury characteristics, and potential associations with demographic and sport-related [...] Read more.

Background: Rink Hockey is a high-intensity contact sport with growing participation in Portugal, yet epidemiological data on injuries among senior and under-23 practitioners remain scarce. This study aimed to retrospectively describe self-reported injury occurrence, injury characteristics, and potential associations with demographic and sport-related variables among Portuguese Rink Hockey athletes. Methods: A retrospective, cross-sectional, self-reported e-survey was conducted among federated Portuguese Rink Hockey practitioners (under-23 and senior categories) during the 2024/2025 season. The questionnaire included 53 closed-ended items on sociodemographics, sport participation, equipment, training loads, and injury history. Injury prevalence, incidence rate, mean injuries per athlete, and associations were analyzed. Results: Among 181 respondents (68.5% male; age 22.3 ± 4.3 years; experience 15.8 ± 5.0 years), 89 (49.2%) reported at least one injury (mean 2.6 ± 2.7 injuries/athlete in the total sample; 3.3 ± 3.1 per injured athlete). Estimated incidence was 3.9 ± 5.9 injuries/1000 h (total sample) and 7.9 ± 6.2/1000 h (injured athletes). The knee (19.1%) was the most common injury localization, and muscular injuries (25.8%) were the most frequent type. Most injuries occurred during matches (46.0%), with contact with another player (27.0%) during offensive transition (40.4%) in areas surrounding the goal (57.3%) being the most frequently reported circumstances. Older and female athletes reported a higher injury prevalence than younger and males counterparts (66.7% vs. 33.3% [p = 0.042; ES = 0.174] and 61.4% vs. 43.5% [p = 0.026; ES = 0.166], respectively). Injury occurrence was positively associated with age (r = 0.262–0.158, p ≤ 0.05) and playing experience (r = 0.157, p ≤ 0.05). However, greater playing experience was associated with lower odds of joint injury (11–15 years: OR = 0.116, 95% CI [0.019; 0.695], p = 0.018; 16–19 years: OR = 0.116, 95% CI [0.019; 0.695], p = 0.018; and ≥20 years: OR = 0.056, 95% CI [0.006; 0.534], p = 0.012). Conclusions: Portuguese Rink Hockey practitioners exhibit a high injury burden, predominantly affecting the knee, with muscle injuries and contact/overuse mechanisms as major contributors. Age, sex, and experience were associated with injury occurrence. These findings may support the incorporation of targeted prevention strategies into multidisciplinary support teams. Full article

(This article belongs to the Special Issue From Injury to Recovery: Rehabilitation Strategies for Athletes)

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17 pages, 1752 KB

Open AccessReview

Movement Retraining and Peak Landing Force, a Modifiable Anterior Cruciate Ligament Injury Risk Marker, in Athletes: A Systematic Review and Meta-Analysis for Primary Prevention

by Taeseok Choi, Hanshin Jeong, Yohan Uhm and Yoonhwan Kim

J. Funct. Morphol. Kinesiol. 2026, 11(3), 259; https://doi.org/10.3390/jfmk11030259 - 29 Jun 2026

Abstract

Background: Non-contact anterior cruciate ligament (ACL) injury is common and disabling, often requiring reconstruction and predisposing individuals to early post-traumatic osteoarthritis, making scalable, exercise-based prevention a clinical and public health priority. Excessive peak vertical ground reaction force (vGRF) during landing is a [...] Read more.

Background: Non-contact anterior cruciate ligament (ACL) injury is common and disabling, often requiring reconstruction and predisposing individuals to early post-traumatic osteoarthritis, making scalable, exercise-based prevention a clinical and public health priority. Excessive peak vertical ground reaction force (vGRF) during landing is a modifiable biomechanical risk marker for ACL injury, although whether reducing it lowers injury incidence is unproven. We evaluated the effect of movement retraining on peak vGRF during landing in pivot-sport athletes and general athletic populations. Methods: MEDLINE (PubMed), Embase, and the Cochrane Central Register of Controlled Trials were searched from inception through to 25 May 2026. Two reviewers independently screened records and extracted data. Random-effects meta-analyses (DerSimonian–Laird) used Hedges’ g; risk of bias was assessed with RoB 2 and certainty with GRADE. The protocol was registered in PROSPERO (CRD42025116119). Results: Nine comparisons from eight randomised controlled trials (292 participants) were included. Movement retraining significantly reduced peak vGRF (Hedges’ g = −0.94, 95% CI −1.34 to −0.54; I² = 63%), with larger effects in general athletic populations (g = −1.50) than in pivot-sport athletes (g = −0.66; subgroup difference p = 0.005). Knee flexion angle at initial contact showed a non-significant increasing trend (g = 0.48; p = 0.18). Certainty of evidence (GRADE) was low. Conclusions: Movement retraining was associated with a reduction in peak vGRF during landing, a surrogate biomechanical marker for ACL injury, on the basis of low-certainty evidence with substantial heterogeneity (I² = 63%). A subgroup difference favouring general over pivot-sport athletes was observed but is exploratory, resting on only three general-athletic comparisons. Because no included trial measured injury incidence, whether these biomechanical changes reduce ACL injury is unknown, and the findings should be regarded as hypothesis-generating. Full article

(This article belongs to the Section Functional Anatomy and Musculoskeletal System)

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23 pages, 3081 KB

Open AccessArticle

Optimizing Intermittent Hypoxic–Hyperoxic Training for Safety and Feasibility: An Exploratory Pilot Study

by Manuel Marzola, Tommaso Antonio Giacon, Simona Mrakic-Sposta, Costantino Balestra, Alessandra Vezzoli, Stefano Zappalà, Simona Stimolo, Michele Lazzari, Katia Battista, Margherita Bortolato, Giulia D’Amico and Gerardo Bosco

J. Funct. Morphol. Kinesiol. 2026, 11(3), 258; https://doi.org/10.3390/jfmk11030258 - 29 Jun 2026

Abstract

Background: Intermittent Hypoxic–Hyperoxic Training (IHHT) induces physiological adaptations. While its efficacy in athletic performance remains debated, IHHT improves health markers in pathological and geriatric populations. This Exploratory Pilot Study aimed to explore the safety and feasibility of two IHHT protocols through preliminary responses. [...] Read more.

Background: Intermittent Hypoxic–Hyperoxic Training (IHHT) induces physiological adaptations. While its efficacy in athletic performance remains debated, IHHT improves health markers in pathological and geriatric populations. This Exploratory Pilot Study aimed to explore the safety and feasibility of two IHHT protocols through preliminary responses. Methods: Twelve healthy volunteers completed a 4-week intervention (two sessions/week, 45 min/session) combining IHHT simultaneously during low-intensity exercise. The study compared a Training Group (TG: 30 min hypoxia, 7.5 min normoxia, 7.5 min hyperoxia) with a Conditioning Group (CG: 15 min hypoxia, 22.5 min normoxia, 7.5 min hyperoxia). Outcomes assessed included cardiorespiratory parameters, Acute Mountain Sickness symptoms, Perceived Exertion, a comprehensive biochemical panel, systemic inflammation, oxidative stress, and renal status. Results: Both protocols were well-tolerated. The TG exhibited significantly greater oxygen desaturation than the CG (p = 0.048). Moreover, the CG demonstrated a significantly attenuated increase in Interleukin-6 (p = 0.021) compared to the TG. Additionally, preliminary variations highlighted an interesting reduction in lipid parameters (TC, LDL, and Apo A1/B ratios) in both groups, although these did not reach statistical significance after FDR correction. Conclusions: While both protocols proved feasible and safe, a more balanced hyperoxic-to-hypoxic exposure (CG) showed better acute physiological tolerability, attenuating cardiovascular strain and mitigating systemic pro-inflammatory responses compared to the unbalanced exposure (TG). Finally, the preliminary variations observed in lipid parameters provide a rationale that warrants further controlled investigations. Full article

(This article belongs to the Special Issue 10th Anniversary of JFMK: Advances in Physical Exercise for Health Promotion)

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14 pages, 1028 KB

Open AccessArticle

Biological Maturation and Physical Performance in Youth Football: Associations Across Professional and Non-Professional Environments

by Manuel Amore, Maria Francesca Piacentini, Vincenzo Sorgente, Francesco Sera and Diego Minciacchi

J. Funct. Morphol. Kinesiol. 2026, 11(3), 257; https://doi.org/10.3390/jfmk11030257 - 29 Jun 2026

Abstract

Background: Biological maturation is a major determinant of physical performance in youth football, although the previous evidence suggests that training context may influence maturation–performance associations. This study investigated the association between biological maturation and physical performance in youth football players from professional [...] Read more.

Background: Biological maturation is a major determinant of physical performance in youth football, although the previous evidence suggests that training context may influence maturation–performance associations. This study investigated the association between biological maturation and physical performance in youth football players from professional and non-professional settings. Methods: A total of 302 male football players (Under-10 to Under-14) from a professional academy (n = 122) and non-professional clubs (n = 180) participated. Biological maturation was estimated using maturity offset and age at peak height velocity (aPHV). Physical performance was assessed through standing broad jump, T-test agility, and sit-and-reach tests. General Linear Models and stratified correlation analyses were used to examine the interaction between maturation, age category, and training environment. Relative age distribution was also described. Results: Professional academy players demonstrated superior explosive power, agility, and flexibility across most age categories compared with non-professional players. Significant associations between biological maturation and physical performance were observed mainly in the non-professional environment, particularly for agility and explosive power, whereas few significant relationships emerged in the professional academy. Significant interactions between training environment, age category, and maturation status were found for all performance measures, with the strongest effect observed for agility. A relative age effect emerged only in the older professional categories. Conclusions: Associations between biological maturation and physical performance differed according to training environment in youth football players. Stronger maturation–performance relationships were generally observed in non-professional settings, whereas weaker associations emerged in the professional academy. However, due to the cross-sectional design and the likely interdependence between maturation, selection, and training exposure, causal interpretations cannot be inferred. Full article

(This article belongs to the Special Issue Integrative Perspectives on Functional Morphology, Performance and Injury Prevention in Soccer)

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15 pages, 1230 KB

Open AccessArticle

Concurrent and Construct Validity of the Diagnoform^® Kid Physical Fitness Test Battery in Primary School Children

by Alexis Barbry, Jérémy Coquart, Caroline Verhoeven and Malgorzata Klass

J. Funct. Morphol. Kinesiol. 2026, 11(3), 256; https://doi.org/10.3390/jfmk11030256 - 27 Jun 2026

Abstract

Background: Physical Fitness (PF) is an important health marker that should be regularly monitored with simple, time-efficient test batteries such as Diagnoform^® Kid. However, its validity remains insufficiently evaluated. Therefore, this cross-sectional study examined its concurrent and construct validity against a [...] Read more.

Background: Physical Fitness (PF) is an important health marker that should be regularly monitored with simple, time-efficient test batteries such as Diagnoform^® Kid. However, its validity remains insufficiently evaluated. Therefore, this cross-sectional study examined its concurrent and construct validity against a battery of established reference tests. Methods: 184 children were grouped by age (6–7, 8–9 and 10–11 years). The Diagnoform^® and reference batteries assessed identical PF components using the following tests: 6-min shuttle run-walk vs. reduced Cooper for cardiorespiratory fitness, hopscotch vs. quadrant jump for agility, standing broad jump with vs. without execution instructions for power, 5-s sprint vs. 20-m sprint for speed, and simplified fingertip-to-floor vs. sit-and-reach for flexibility. Concurrent validity was examined using bivariate correlations, and construct validity through responsiveness to age and sex. Results: Corresponding tests were significantly correlated for all PF components (p < 0.001), except for agility at 10–11 years (p = 0.094). Agility showed moderate correlations in the younger groups (r = −0.45 to −0.67). Correlations were strong for cardiorespiratory fitness and flexibility (r ≥ 0.70). For power and speed, correlations ranged from moderate (power: r ≥ 0.61 at 6–7 and 8–9 years; speed: r = 0.58 at 6–7 years) to strong (power: r ≥ 0.83 at 10–11 years; speed: r ≥ 0.70 at 8–9 and 10–11 years). Age and sex influenced performances in both batteries, except for agility (no sex effect observed) and flexibility (sex effect observed in both batteries, whereas an age effect was found only for boys on the reference test). Conclusions: Despite slightly lower responsiveness of the simplified fingertip-to-floor test to age, findings support the concurrent and construct validity of the Diagnoform^® Kid tests. Full article

(This article belongs to the Special Issue 10th Anniversary of JFMK: Advances in Physical Exercise for Health Promotion)

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17 pages, 10996 KB

Open AccessArticle

Feasibility and Biomechanical Effects of Dynamic Neuromuscular Stabilization Training During Stair Negotiation in Middle-Aged Women with Knee Osteoarthritis: A Randomized Controlled Pilot Study

by Hyun Ju Kim, Shu Ho Kang, Young Joo Cha and Il Bong Park

J. Funct. Morphol. Kinesiol. 2026, 11(3), 255; https://doi.org/10.3390/jfmk11030255 - 27 Jun 2026

Abstract

Background: Knee osteoarthritis (KOA) alters the performance of daily activities, such as stair negotiation, by compromising lateral stability and neuromuscular control. This pilot study aimed to evaluate the feasibility of a 10-week Dynamic Neuromuscular Stabilization (DNS) program and to explore its preliminary [...] Read more.

Background: Knee osteoarthritis (KOA) alters the performance of daily activities, such as stair negotiation, by compromising lateral stability and neuromuscular control. This pilot study aimed to evaluate the feasibility of a 10-week Dynamic Neuromuscular Stabilization (DNS) program and to explore its preliminary biomechanical effects during stair ascent and descent in middle-aged women with KOA. Methods: Twenty-six participants were randomly assigned to a DNS group (n = 13) or a control group (n = 13). The DNS group completed a 10-week intervention (twice weekly). Feasibility was assessed via recruitment, retention, and adherence. Primary outcomes were mediolateral (ML) center of pressure (COP) parameters, while secondary outcomes included anteroposterior (AP) COP parameters and lower limb range of motion (ROM). Effect sizes (η²_p) were estimated using 3D motion analysis and force plates. Results: The intervention showed high potential feasibility, with 100% recruitment and retention rates and 98.5% compliance. No adverse events occurred. Large effect sizes were observed for reduced ML COP velocity (ascent: η²_p = 0.79; descent: η²_p = 0.62) and RMS (descent: η²_p =0.16). Secondary outcomes, including AP COP parameters and joint ROM (increased sagittal flexion and decreased coronal instability), also demonstrated large effect sizes. Conclusions: This pilot study suggests that progressive DNS training appears to be feasible and safe for patients with KOA. The preliminary effect sizes observed in COP control and lower kinetic chain mechanics may serve as useful foundational data for designing future adequately powered clinical trials to further examine the efficacy and underlying biomechanical mechanisms of DNS training. Full article

(This article belongs to the Section Kinesiology and Biomechanics)

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10 pages, 240 KB

Open AccessArticle

Sex-Specific Associations Between Physical Activity, LDL Cholesterol, and Functional Performance in a Real-World Primary Care Population: A Cross-Sectional Study

by Peter Marián Kalanin

J. Funct. Morphol. Kinesiol. 2026, 11(3), 254; https://doi.org/10.3390/jfmk11030254 - 27 Jun 2026

Cited by 1

Abstract

Background: Physical activity (PA) is associated with cardiometabolic health and functional performance, yet sex-specific evidence from real-world primary care populations remains limited. Objective: This study evaluated whether associations between self-reported PA categories and LDL-C concentrations and Timed Up and Go (TUG) [...] Read more.

Background: Physical activity (PA) is associated with cardiometabolic health and functional performance, yet sex-specific evidence from real-world primary care populations remains limited. Objective: This study evaluated whether associations between self-reported PA categories and LDL-C concentrations and Timed Up and Go (TUG) functional performance differed between males and females in a real-world primary care cohort. Methods: This cross-sectional observational study included 863 adult primary care patients (424 males, 439 females). PA was categorized as low, moderate, or high based on World Health Organization recommendations. LDL-C and TUG were assessed as primary outcomes. Sex-stratified analyses included one-way ANOVA with Bonferroni post hoc comparisons and multivariable linear regression adjusted for age, BMI, arterial hypertension (AH), and diabetes mellitus (DM). An interaction term (PA × sex) was included to formally test for sex modification. Results: Males and females did not differ significantly in age, BMI, LDL-C, TUG, AH prevalence, DM prevalence, or PA distribution (all p > 0.05). Higher PA categories were associated with lower LDL-C in both males (ANOVA F = 13.03, p < 0.001) and females (ANOVA F = 14.92, p < 0.001), and with better TUG performance in both males (F = 44.21, p < 0.001) and females (F = 36.09, p < 0.001). In multivariable regression, PA was the strongest independent predictor of both LDL-C (males: β = −0.301, p < 0.001; females: β = −0.323, p < 0.001) and TUG performance (males: β = −1.235, p < 0.001; females: β = −1.170, p < 0.001) in both sexes. The interaction term (PA × sex) was not statistically significant for either LDL-C (p = 0.804) or TUG (p = 0.944), indicating no significant sex modification of the PA–outcome associations. Conclusions: The associations between self-reported PA and both LDL-C concentrations and TUG functional performance were consistent across sexes in this real-world primary care cohort. These findings support the clinical relevance of routine PA assessment as a sex-independent indicator of cardiometabolic risk and functional health in primary care. Because of the cross-sectional design, causality cannot be established. Full article

(This article belongs to the Special Issue 10th Anniversary of JFMK: Advances in Physical Exercise for Health Promotion)

14 pages, 661 KB

Open AccessProtocol

Quality of Basic Cardiopulmonary Resuscitation of Adults at Medium and High Altitudes, with and Without Conditioning: Study Protocol

by Joseba Rabanales-Sotos, Sonia Piñero-Sáez, Ángel López-González, Francisco García-Alcaraz, Jesús López-Torres-Hidalgo, Carmen María Guerrero-Agenjo, Jaime López-Tendero and Vicente Ferrer-López

J. Funct. Morphol. Kinesiol. 2026, 11(3), 253; https://doi.org/10.3390/jfmk11030253 - 27 Jun 2026

Abstract

Background: Performing and maintaining high-altitude cardiopulmonary resuscitation (CPR) could pose a significant physical challenge for rescuers. The objective of this study is to analyse the effects of reducing the oxygen fraction at altitudes of 3000 m and 5000 m above sea level [...] Read more.

Background: Performing and maintaining high-altitude cardiopulmonary resuscitation (CPR) could pose a significant physical challenge for rescuers. The objective of this study is to analyse the effects of reducing the oxygen fraction at altitudes of 3000 m and 5000 m above sea level (asl), with and without conditioning to hypoxia, on the quality of resuscitation performed in adults. Methods: An analytical before–after study in which 56 students with a Degree in Nursing between 18 and 30 years old perform 10 min of resuscitation on a mannequin at different altitudes (670, 3000 and 5000 m asl) will be carried out. Subsequently completing an intermittent hypoxia conditioning programme, the participants will perform the resuscitation manoeuvres at previously referenced altitudes. Sociodemographics, CPR quality, self-perception CPR, adequate anthropometric data, physical condition, blood tests, oxygenation in muscular tissue, biceps, brachii and erector spinae, subjective perception of effort, anxiety levels and quality of resuscitation will be measured in all participants at different altitudes. Discussion: Although CPR is a submaximal effort manoeuvre, it is subject to being performed by anyone without motor disabilities. Our study will also provide evidence as to whether this characteristic continues to hold true in a hostile environment such as medium and high altitudes. Our study aims to demonstrate that the improvement in physical performance and recovery capacity induced by intermittent hypoxia conditioning programmes increases the quality of CPR in prolonged cardiac arrests and in adverse conditions, such as at high altitudes. The proposed study will contribute as a novelty to the estimation of the influence of high altitudes and conditioning on performing basic CPR manoeuvres. If the hypothesis turns out to be true, recommendations about the practice of moderate-intensity physical exercise could be incorporated into the CPR guidelines as one of the important aspects in the training of rescuers to conduct CPR. Full article

(This article belongs to the Section Physical Exercise for Health Promotion)

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13 pages, 1651 KB

Open AccessArticle

Association Between Posterior Ankle Soft Tissue Properties and Deep Squatting Ability After Ankle Fracture Surgery: A Cross-Sectional Study

by Hayato Miyasaka, Bungo Ebihara, Makoto Takahashi, Takashi Fukaya, Koichi Iwai, Shigeki Kubota and Hirotaka Mutsuzaki

J. Funct. Morphol. Kinesiol. 2026, 11(3), 252; https://doi.org/10.3390/jfmk11030252 - 26 Jun 2026

Abstract

Background: Deep squatting is essential for daily activities and sports; however, it is often limited after ankle fracture surgery, and the contributions of posterior ankle soft tissues, including the soleus muscle (SOL), Achilles tendon (AT), flexor hallucis longus muscle (FHL), and Kager’s [...] Read more.

Background: Deep squatting is essential for daily activities and sports; however, it is often limited after ankle fracture surgery, and the contributions of posterior ankle soft tissues, including the soleus muscle (SOL), Achilles tendon (AT), flexor hallucis longus muscle (FHL), and Kager’s fat pad (KFP), to this limitation remain unclear. This study aimed to determine the relationship between posterior ankle soft tissue properties (including stiffness and echo intensity [EI]) and deep squatting ability after ankle fracture surgery. Methods: This cross-sectional study included 53 patients (49.5 ± 16.1 years, 26 men) who underwent ankle fracture surgery. We measured the shear modulus of the SOL and AT, and the EI of the FHL and Kager’s fat pad; ankle range of motion and strength were evaluated. Deep squatting ability was also assessed. Multiple regression and receiver operating characteristic (ROC) analyses were performed to identify predictors of squatting limitation and evaluate discriminative performance. Results: Participants with a deep squatting limitation showed a higher shear modulus in the SOL and AT and higher EI in the FHL compared with those without limitations. SOL and AT shear modulus and FHL EI were significant independent predictors of ankle dorsiflexion angle during deep squatting. ROC analysis showed good discriminative ability for SOL shear modulus and AT shear modulus and modest discriminative ability for FHL EI. Conclusions: Increased stiffness and EI of the SOL, AT, and FHL were associated with reduced deep squatting ability after ankle fracture surgery. Targeted assessment and interventions addressing these tissues may improve postoperative function. Full article

(This article belongs to the Section Functional Anatomy and Musculoskeletal System)

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18 pages, 13222 KB

Open AccessArticle

Clinical and Radiographic Outcomes of Cementless Total Hip Arthroplasty for Osteoarthritis Secondary to Developmental Dysplasia of the Hip: A Retrospective Study with Minimum 12-Month Follow-Up

by Francesco Liuzza, Pierfrancesco Pirri, Gianluca Serra, Andrea Aureli, Fernando De Maio, Pasquale Farsetti and Giuseppe Rovere

J. Funct. Morphol. Kinesiol. 2026, 11(3), 251; https://doi.org/10.3390/jfmk11030251 - 26 Jun 2026

Abstract

Background: Developmental dysplasia of the hip (DDH) is one of the leading causes of secondary hip osteoarthritis and frequently results in severe anatomical alterations that make total hip arthroplasty (THA) technically demanding. Restoration of hip biomechanics, limb length, and joint stability remains challenging, [...] Read more.

Background: Developmental dysplasia of the hip (DDH) is one of the leading causes of secondary hip osteoarthritis and frequently results in severe anatomical alterations that make total hip arthroplasty (THA) technically demanding. Restoration of hip biomechanics, limb length, and joint stability remains challenging, particularly in patients with moderate-to-severe dysplasia. Objective: To evaluate the clinical and radiographic outcomes of cementless total hip arthroplasty combined with soft-tissue balancing, with or without acetabular reconstruction using autologous femoral head graft, in patients affected by osteoarthritis secondary to DDH. Methods: A retrospective single-center case series was conducted on eight female patients (mean age 53.9 ± 14.6 years; range 33–80 years) who underwent primary cementless THA for DDH-related osteoarthritis between 2019 and 2025. Clinical outcomes were assessed using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-36 (SF-36). Radiographic evaluation included implant positioning, osteolysis, heterotopic ossification, bone graft incorporation, and leg-length discrepancy. Data normality was assessed using the Shapiro–Wilk test. Preoperative and postoperative outcomes were compared using paired Student’s t-test and confirmed with the Wilcoxon signed-rank test. Implant survival and revision-free status were recorded throughout the follow-up period. Results: At a minimum follow-up of 12 months (range 12 months–6 years), significant improvements were observed in all clinical outcome measures. Mean HHS increased from 49.3 ± 2.5 preoperatively to 90.4 ± 2.7 postoperatively (p < 0.001), while mean WOMAC decreased from 53.5 ± 5.6 to 7.4 ± 3.3 (p < 0.001). Mean SF-36 improved from 47.2 ± 3.8 to 89.9 ± 3.2 (p < 0.001). Wilcoxon analysis confirmed the statistical significance of these findings (all p = 0.0078). Radiographic assessment demonstrated satisfactory implant positioning and stable fixation in all patients, with no evidence of osteolysis or implant loosening. Minor complications included one intraoperative periprosthetic femoral fracture treated successfully with cerclage wiring, two cases of Brooker grade I–II heterotopic ossification, and one case of minimal graft resorption without clinical consequences. No revision procedures were recorded during follow-up, and implant survival was 100%. Conclusions: Cementless THA combined with selective soft-tissue balancing provides excellent clinical, functional, and radiographic outcomes in patients with osteoarthritis secondary to DDH. This approach significantly improves hip function and quality of life while ensuring stable implant fixation, low complication rates, and excellent mid-term implant survival. Full article

(This article belongs to the Special Issue Advances in Hip and Knee Arthroplasty)

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16 pages, 297 KB

Open AccessArticle

Anthropometric and Physical Performance Reference Values in Young Handball Players Aged 9–15 Years: A Cross-Sectional Study Using Percentile Profiling and Factorial ANOVA

by Samir Krichen, Chirine Aouichaoui, Hamada Chaari, Liwa Masmoudi, Yousri Elghoul, Monia Zaouali, Wajdi Dardouri, Hamdi Chtourou, Yassine Trabelsi and Mohamed Zouch

J. Funct. Morphol. Kinesiol. 2026, 11(3), 250; https://doi.org/10.3390/jfmk11030250 - 26 Jun 2026

Abstract

Background: Reference values may assist practitioners in interpreting anthropometric and physical performance profiles in youth handball players within comparable sporting contexts. This study aimed to establish sex- and competitive-age-specific anthropometric and physical performance reference values for Tunisian youth handball players aged 9–15 [...] Read more.

Background: Reference values may assist practitioners in interpreting anthropometric and physical performance profiles in youth handball players within comparable sporting contexts. This study aimed to establish sex- and competitive-age-specific anthropometric and physical performance reference values for Tunisian youth handball players aged 9–15 years and to examine differences by sex and competitive age category. Methods: A total of 370 competitive youth handball players participated in this cross-sectional study (182 boys and 188 girls; U11, n = 130; U13, n = 158; U15, n = 82). Participants had at least two years of structured handball training. Assessment included body size, body composition, flexibility, squat jump, countermovement jump, 3 kg medicine ball throw, horizontal jumps, and handgrip strength. Sex, competitive age category, and sex × age category effects were examined using two-way ANOVA, with Bonferroni-adjusted post-hoc comparisons applied when appropriate. Effect sizes were reported as partial eta squared. Percentile values were calculated. Significance was set at p < 0.05. Results: Boys demonstrated higher values than girls in squat jump, (η_p² = 0.099), countermovement jump (η_p² = 0.097), medicine ball throw (η_p² = 0.202), and both dominant (η_p² = 0.073) and non-dominant handgrip strength (η_p² = 0.048, p < 0.001). Additionally, older age categories showed higher scores on all these tests (p < 0.001). Sex- and competitive-age-category-specific percentile values were established. Conclusions: The established reference values may support descriptive benchmarking and training/monitoring among comparable Tunisian youth handball players. However, these values should not be interpreted as maturity-adjusted standards or general population norms. Full article

(This article belongs to the Special Issue 10th Anniversary of JFMK: Advances in Athletic Training and Human Performance)

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