Search Results (335)

Background: Obesity management is evolving with the integration of dual GIP/GLP-1 receptor agonists (Tirzepatide) into comprehensive Digital Weight-Loss Services (DWLSs). This model leverages virtual, app-based multidisciplinary care (MDT) to deliver continuous, supervised treatment, distinguishing it from traditional, intermittent clinic-based care. While clinical trials demonstrate high efficacy, real-world data are necessary to evaluate long-term adherence and identify predictive markers for patient persistence in these scalable care models. Specifically, there is a knowledge gap regarding the specific behavioral factors that govern 12-month persistence in these comprehensive, medicated DWLS settings. This study retrospectively assessed the 12-month effectiveness and adherence of a Tirzepatide-supported DWLS and identified demographic, clinical, and behavioral predictors of weight loss and program attrition. Methods: Data from 19,693 patients enrolled in the Juniper UK DWLS were analyzed. Adherence was defined by a minimum of 10 medication orders and 12-month weight submission. Weight loss in the full cohort was evaluated using the Last Observation Carried Forward (LOCF) method. Binary logistic and multiple linear regression models identified predictors of adherence and weight loss, respectively, using a comprehensive set of demographic, clinical (e.g., BMI, comorbidities), and behavioral variables. Results: The 12-month adherence rate was 27%. The adherent sub-cohort (n = 5322) achieved a mean weight loss of 22.60 (±7.46) percent, compared to 13.62 (±10.85) percent in the full cohort (LOCF). This difference in 12-month mean weight loss was statistically significant (p < 0.001). Consistent weekly weight tracking and health coach communication were the strongest positive predictors of long-term adherence and weight loss. Conversely, hyper-engagement, specifically intensive tracking frequency and high weight loss velocity in the first month, was a significant inverse predictor of 12-month adherence. Reporting side effects was positively correlated with adherence, suggesting a reporting bias among engaged patients. Conclusions: The DWLS model facilitates the maximum therapeutic effectiveness for adherent patients. However, patient persistence remains the primary translational challenge. As consistent weekly engagement (tracking, coaching) is the strongest predictor of success, clinical strategies should prioritize promoting sustainable, moderate behavioral pacing (i.e., emphasizing consistent weekly engagement over intensive daily tracking and rapid early weight loss) to mitigate attrition risk and optimize the public health effectiveness of medicated DWLSs. Full article

Objectives: This study aimed to investigate the skating force–velocity (F–V) mechanical characteristics of trained youth ice hockey players at different stages of their maturational development. Methods: A total of 52 male trained ice hockey players (14.6 ± 1.4 years) from U13, U15, U17, and U18 competitive teams of the same hockey program were classified into three maturation groups—Pre-, Mid-, and Post-peak height velocity (PHV). Participants performed two 40 m maximal skating efforts while velocity data were collected using a radar device to derive F–V parameters (e.g., theoretical maximal force (F₀), velocity (V₀), power (P_max), and related metrics). The maturation offset was computed using the following formula: Maturity offset = −8.128741 + (0.0070346 · (Chronological age · Sitting height)). Results: Results revealed significant effects of puberty on most performance variables (F_(2,49) = [5.58, 31.72]; p ≤ 0.07; η² = [0.19, 0.56]). Differences in acceleration (0–10 m time) and F₀ improved markedly between Mid- and Post-PHV stages (|d| = [1.38, 1.92]), while V0 and maximal sprint velocity (30–40 m time) improved constantly across maturation stages (|d| = [1.03, 1.99]). Conclusions: This is the first study to provide reference skating F–V profile values across puberty in trained youth male ice hockey players. Coaches and practitioners are encouraged to prioritize acceleration and skating technique early during puberty to maximize velocity development and emphasize strength development after reaching peak height velocity. Conclusions should be considered with care as the Pre-PHV group was small (n = 5) and the used F–V method remains to be validated on ice. Full article

This study compared the external [movement load (ML)] and internal [rating of perceived exertion (RPE), mean and peak heart rate (HRmean, HRpeak)] loads, performance and enjoyment between time-matched (~12 min) traditional (TRAD) and small-sided game (SSG) warm-ups in youth basketball players. Using a counterbalanced crossover design, 24 male players (16.0 ± 0.1 years) performed both warm-up types after reporting fatigue (ROF) and completing an 8 min standardized pre-warm-up. Before and after each warm-up, players completed 20 m sprint and countermovement jump (CMJ) tests; enjoyment (ENJ) was assessed post-warm-up. No significant differences were found between warm-ups for ROF (p = 0.053), RPE (p = 0.259), or HRmean (p = 0.053). However, SSG induced a higher HRpeak than TRAD (p = 0.001), while ML was greater in TRAD (p < 0.001). No interaction, time effect, or typology effect emerged for performance in sprinting and change of direction, although CMJ was higher after TRAD (p = 0.047). Enjoyment did not differ significantly (p = 0.066), although with a large effect size (r = 0.612). The greater ML in TRAD may reflect more dynamic basketball actions compared with SSG, which emphasized static tasks (e.g., screening, boxing out) yet produced higher HRpeak. Coaches may consider SSG warm-ups to replicate game-specific conditions while controlling the external load and maintaining adequate physiological preparation. Full article

Introduction: Nutrition plays a fundamental role in sports performance by influencing energy availability, recovery, and training adaptation. In recent years, different dietary strategies have gained popularity among athletes, although the evidence supporting their efficacy is inconsistent. Objective: This consensus document, developed under the auspices of the Spanish Society of Nutrition, aims to provide a critical overview of the most relevant nutritional strategies currently used in sports and to offer evidence-based practical recommendations for both professional and recreational athletes, coaches, and health professionals. Methods: A narrative review was conducted following standardized scientific procedures by a multidisciplinary panel of experts. The analyzed strategies included high-carbohydrate, low-carbohydrate, ketogenic, intermittent fasting, plant-based, Paleolithic, and carbohydrate periodization diets. Each strategy was assessed based on its physiological rationale, evidence of performance in endurance, strength/power, sprint, aesthetic, weight category, and team sports, practical applications, and potential risks. Results: The available evidence shows that no single dietary strategy can be universally recommended for all athletes. High carbohydrate availability remains the most consistent approach for sustaining performance in endurance and high-intensity efforts. Low-carbohydrate and ketogenic diets enhance fat oxidation but often compromise exercise economy at competitive intensity levels. Intermittent fasting may improve body composition and metabolic health; however, it requires careful adaptation. Well-planned plant-based diets can support performance, although attention to certain nutrients (e.g., B12, iron, and omega-3) is essential. Paleolithic diets improve metabolic parameters but show limited direct evidence of athletic performance. Carbohydrate periodization is a promising tool for combining metabolic adaptations with competitive demands. Conclusions: Nutritional strategies should be individualized according to the athlete’s sport, training phase, and personal context. Professional guidance is crucial for minimizing risks and optimizing benefits. Further well-designed, long-term studies on athletes are needed to resolve the current controversies. Full article

Background: Healthcare burnout is pervasive, necessitating more efforts to reduce it. Objective: To evaluate the effectiveness of well-being leadership training in reducing healthcare burnout. Design: The Clinician Wellness Council (CWC) leadership training consisted of 15 months of educational and small group sessions (September 2023–November 2024) with pre–post-training burnout survey comparison. Setting: Primary and specialty departments across a Pacific Northwest community-based hospital system. Participants comprised 22 clinicians from primary and specialty departments. Participants identified an intervention group where they would focus their leadership efforts. Those groups contained 549 clinicians, and 5439 non-intervention clinicians were controls. Intervention: Well-being leadership training. Measures: The Maslach Burnout Inventory (MBI) and the turnover intent questions before and after training. Results: Of the 22 CWC participants, 15 (68%) completed the surveys before and after training. Burnout reduction was seen (47% to 13%; p = 0.0253), primarily driven by decreased emotional exhaustion (EE). Among 549 intervention group clinicians, 173 completed both surveys compared to 359 of 5439 clinicians in the control group. Intervention practitioners (N = 173) showed reductions in EE items (e.g., feeling burnout, working too hard, working with people is stressful) and turnover intent. Multivariable regression analyses showed that EE reductions were associated with co-workers’ intent to leave. Limitations: We obtained pre- and post-training MBI measures on a subset of the intervention group co-workers rather than a majority. Conclusions: Participation in a well-being leadership training program consisting of education, coaching, and community building reduced burnout, increased confidence to improve their workplace, and their leadership decreased co-worker EE and turnover intent. This training creates a blueprint for reducing burnout in clinician leaders and co-workers. Primary Funding Source: A PPMC foundation grant sponsored 10 local participants. Central division funding came from system and local funds. Participants received $1000/month training reimbursement. Full article

The contemporary volatile business environment demands a shift from directive oversight to developmental leadership, given the complexity and rapid technological advancement characterizing modern workplaces. The Coaching Leadership Style (CLS) has emerged as a critical approach, linking extensively to enhanced employee engagement, performance, innovation, and psychological safety. However, the mechanisms by which coaching behaviors create these outcomes, especially the foundational element of safety, remain under-specified. Existing leadership research often lacks a replicable, mechanistic, and neurobiologically grounded model. This conceptual paper bridges this gap by integrating leadership science with interpersonal neurobiology. We propose Polyvagal Theory (PVT), a framework explaining the neurophysiology of safety and connection, as the missing mechanism that explains the effectiveness of CLS. We argue that the relational cues of a coaching leader (e.g., vocal prosody, attuned listening) are non-consciously detected via neuroception, shaping an employee’s autonomic state. We propose that these cues create physiological safety, which is the biological prerequisite that enables the interpersonal risk-taking and voice behaviors that constitute psychological safety. We then operationalize this synthesis by embedding PVT principles within the established 5E Coaching Model (Engage, Explore, Explain, Execute, Evaluate), offering a practical, state-aware framework for leaders. This paper contributes a testable, micro-to-macro pathway from leader autonomic co-regulation to team-level high-performance outcomes. Full article

An integrated physiological model would be useful for monitoring internal load in functional fitness, including formats like CrossFit and Hyrox. Traditional performance metrics often neglect internal strain, energy system engagement, and neuromuscular fatigue, central to these modalities. Oxygen uptake kinetics, metabolic profiling, heart rate and heart rate variability monitoring, and neuromuscular fatigue assessment can be employed for load monitoring. Breath-by-breath oxygen uptake analysis characterizes aerobic activation and recovery. Metabolic stress is estimated via indirect calorimetry and capillary blood lactate to quantify oxidative, glycolytic, and phosphagen contributions. Heart rate is tracked continuously to assess session intensity, while heart rate variability provides insights into autonomic recovery. Neuromuscular fatigue can be assessed via countermovement jump performance, offering sensitive measures of recovery and training tolerance. Portable tools such as the Cosmed K5™, Lactate Pro 2, heart rate sensors, and force platforms support real-time monitoring in training and competitions. Rather than advocating for the continuous use of advanced tools, the model promotes strategic integration of high-precision methods for research, and practical, low-cost alternatives (e.g., heart rate monitoring, session rating of perceived exertion, or jump analysis apps) for day-to-day coaching. This approach enables early detection of maladaptation, supports individualized training adjustments, and improves safety and performance outcomes. Ultimately, this framework bridges physiological science and real-world practice, providing value across both applied and research settings. Full article

Background: As cardiovascular medicine advances rapidly, the integration of artificial intelligence (AI) has garnered increasing attention. Although AI has been widely adopted in diagnostics, risk prediction, and decision support, its application in exercise-based cardiovascular rehabilitation is still limited, representing a new and promising research frontier. Objective: This scoping review aimed to identify and analyze original studies that have applied AI to exercise-based interventions designed to improve cardiovascular outcomes. Methods: Following the PRISMA-ScR guidelines, PubMed, Scopus, Web of Science, Embase, and IEEE Xplore were searched for articles published between January 2015 and August 2025. Eligible studies were peer-reviewed by human research employing AI (machine learning or deep learning) to deliver, adapt, or monitor an exercise intervention with cardiovascular outcomes. Reviews, diagnostic-only studies, protocols without data, and animal studies were excluded. Non-original works (reviews, protocols), animal studies, and purely diagnostic applications were excluded, ensuring a strict focus on AI applied within exercise interventions. Data extraction focused on study design, AI method, exercise modality, outcomes, and findings. Results: From 2183 records, nine studies met the inclusion criteria (two RCTs, feasibility pilots, and validation studies). Designs included feasibility pilots, randomized controlled trials (RCTs), and validation studies. AI applications encompassed adaptive step goals, reinforcement learning for engagement, coaching apps, machine learning–based exercise prescription, and continuous monitoring (e.g., VO₂ estimation). These AI methods, such as machine learning and reinforcement learning, were used to personalize exercise interventions and improve cardiovascular outcomes. Reported outcomes included blood pressure reduction, improved adherence, increased daily steps, improvement in VO₂max, continuous physiological monitoring, and enhanced diagnostic accuracy. Conclusions: Findings demonstrate that AI has the potential to significantly enhance cardiovascular rehabilitation. It can personalize exercise prescriptions, enhance adherence, and facilitate safe monitoring in home settings. However, the evidence base remains preliminary, with very few RCTs and substantial methodological heterogeneity. Future research must prioritize large-scale clinical trials, explainable AI, and equitable implementation strategies to ensure clinical translation. Full article

This study examined child outcomes for five minimally verbal (or non-speaking) autistic preschoolers who participated in cascading coaching programs in which naturalistic developmental behavioral intervention (NDBI) techniques were taught to graduate student clinicians and Hispanic caregivers (three who primarily spoke English, and two who spoke Spanish). While prior studies reported on adult participant outcomes, this study analyzed child multimodal communication outcomes, using multiple baselines/probes single case experimental designs across contexts. Neurodiversity-affirming and culturally responsive principles were embedded within the intervention procedures. Following the introduction of a coached NDBI, all five children (three who received the intervention in English and two who received the intervention in Spanish) demonstrated increased use of (a) the total targeted communicative responses and (b) the targeted unprompted communicative responses, across both student clinician-led and caregiver-led play sessions. The Tau-U effect size measures revealed large-to-very large effects across all of the variables. Overall, higher rates of communication responses were observed during student clinician-led sessions than in caregiver-led sessions. Additionally, behavioral coding of the multimodal response forms (e.g., gestures, aided augmentative and alternative communication, signs, vocal words) using the Communication Matrix revealed that the children used a variety of response topographies during the intervention sessions beyond their preferred communication mode (e.g., signs for three participants). Four of the five children used symbolic communication forms consistently across both caregiver and student clinician-led sessions. Importantly, adults’ reinforcement of pre-symbolic or less advanced communication forms during the intervention did not inhibit the use of more advanced forms. Full article

Quality Physical Education (QPE) is crucial, yet its delivery at the primary level is often challenged by generalist teachers’ inadequate preparedness, a deficit that collaborative tandem teaching can address. This study compared the perceived preparedness of 618 generalist teachers with varied tandem teaching experience in Slovakia and North Macedonia, examining differences linked to the structural model type. Data were collected via a questionnaire assessing self-perceived preparedness across 11 PE domains and the need for continuous professional development. A Chi-square test compared responses between the Slovakian model (rotational sports coaches, co-teaching 1 of 3 weekly lessons) and the North Macedonian model (consistent PE teachers, co-teaching all 3 weekly lessons). Generalist teachers in both countries reported overall high preparedness, but a significant deficiency was identified in working with children with diverse learning needs (p < 0.01). North Macedonian teachers, who experience a long-term partnership with a dedicated PE teacher in all weekly PE lessons, reported being significantly better prepared across most domains (e.g., selection of equipment, p = 0.000) than Slovakian teachers, who utilize short, rotational partnerships in 1 of 3 weekly lessons. The findings suggest that the structure of the tandem teaching model is a key factor in enhancing generalist teachers’ preparedness and professional growth in QPE. Full article

Routine Early Intervention services are an ideal context to evaluate parent-mediated intervention (PMI) delivery. While effectiveness research suggests that receiving manualized PMIs positively affects caregivers’ learning and use of intervention strategies, the impact of other aspects of delivery, such as PMI adaptation, on caregiver engagement and learning is less clear. The current study aimed to address this gap by closely characterizing the delivery and associated outcomes of an autism PMI, Project ImPACT, within an Early Intervention (EI) Part C system. In total, 21 EI providers and 23 caregivers of children with social communication delays participated. Following training in Project ImPACT, the providers submitted videos of their Project ImPACT sessions as part of routine service delivery. The sessions were behaviorally coded for Project ImPACT coaching fidelity and instances in which Project ImPACT was adapted. After each session, the caregivers rated their participatory engagement and therapeutic alliance. Before and immediately following the intervention, the caregivers also completed measures of their self-efficacy and their child’s social communication skills, and their use of Project ImPACT strategies (i.e., fidelity) was behaviorally coded. The results demonstrated that EI providers’ Project ImPACT coaching fidelity was not related to caregiver ratings of therapeutic alliance or participatory engagement at the session level. Augmenting Project ImPACT sessions was associated with higher caregiver ratings of therapeutic alliance but not with participatory engagement. Although provider coaching fidelity was not associated with changes in caregiver ratings of self-efficacy, it was associated with caregiver use of Project ImPACT strategies focused on teaching their children new skills. There was no association between provider fidelity and caregiver report of child social communication outcomes. The current study highlights the complicated relationship between the delivery of autism PMIs and caregiver-reported outcomes. The findings highlight the value of holistic delivery models that support adaptations in response to child- and family-level factors. Full article

Background: This study employed a markerless motion capture system to quantify the external game load of elite 3 × 3 basketball players and evaluated its association with game performance. Methods: Twenty-four female 3 × 3 basketball games from the 2024 Paris Olympic Games were analyzed, involving 32 players from eight national teams. A markerless motion capture system was used to collect six categories of external load metrics during games, and 22 types of technical statistics were gathered to determine performance. Collected data were standardized according to live game time (min⁻¹). Repeated-measures correlation analysis was applied to examine the relationships between external load and performance, while mixed-effects models were used to compare external load differences between better- and worse-performing groups (classified by Player Value). Results: The correlations between external load and performance indicators were trivial to small. Accelerations (ACC) were significantly associated with the greatest number of performance indicators (e.g., points, rebounds, 1-point made, key assists), while rebounds were significantly correlated with the largest number of external load metrics (e.g., total distance, low-intensity active distance, high-intensity active distance); however, all correlations remained at the small level (r = 0.16–0.24). No significant differences in external load were observed between players of differing performance groups (p > 0.05). Conclusions: In elite 3 × 3 basketball, external load reflects players’ involvement and effort rather than serving as a primary determinant of game performance. This study provides new empirical evidence on the characteristics of 3 × 3 basketball, suggesting that coaches and strength and conditioning practitioners should adopt a comprehensive perspective when evaluating performance, with external load being more suitable for training regulation and fatigue monitoring. Full article

Background/Objective: Understanding the training effect in high-level running is important for performance optimization and injury prevention. This includes awareness of how different running surface types (e.g., hard versus soft) may modify biomechanics. Recent studies have demonstrated that deep learning algorithms, such as convolutional neural networks (CNNs), can accurately classify human activity collected via body-worn sensors. To date, no study has assessed optimal signal type, sensor location, and model architecture to classify running surfaces. This study aimed to determine which combination of signal type, sensor location, and CNN architecture would yield the highest accuracy in classifying grass and asphalt surfaces using inertial measurement unit (IMU) sensors. Methods: Running data were collected from forty participants (27.4 years + 7.8 SD, 10.5 ± 7.3 SD years of running) with a full-body IMU system (head, sternum, pelvis, upper legs, lower legs, feet, and arms) on grass and asphalt outdoor surfaces. Performance (accuracy) for signal type (acceleration and angular velocity), sensor configuration (full body, lower body, pelvis, and feet), and CNN model architecture was tested for this specific task. Moreover, the effect of preprocessing steps (separating into running cycles and amplitude normalization) and two different data splitting protocols (leave-n-subject-out and subject-dependent split) was evaluated. Results: In general, acceleration signals improved classification results compared to angular velocity (3.8%). Moreover, the foot sensor configuration had the best performance-to-number of sensor ratio (95.5% accuracy). Finally, separating trials into gait cycles and not normalizing the raw signals improved accuracy by approximately 28%. Conclusion: This analysis sheds light on the important parameters to consider when developing machine learning classifiers in the human activity recognition field. A surface classification tool could provide useful quantitative feedback to athletes and coaches in terms of running technique effort on varied terrain surfaces, improve training personalization, prevent injuries, and improve performance. Full article

Objective: Mental fatigue (MF) worsens soccer performance. Further knowledge is needed to understand MF’s effects on soccer players and its underlying mechanisms. Our aim was to analyze the subjective, objective, and neural MF-related outcomes induced by different type of tasks. Methods: A randomized crossover experimental design with repeated measures was used. Thirteen amateur soccer players (M_age = 23 ± 5.43) completed three conditions: cognitive (30 min. Stroop.), physical (30 min. cycling), or combined (30 min. Stroop while cycling). Ratings of mental fatigue (measured via the Visual Analogue Scale), electroencephalographical signals (electroencephalography), and psychomotor performance (Brief-Psychomotor Vigilance Test) were measured pre- and post-condition. Soccer-related decision-making (TacticUP^® test) was assessed post-condition. Results: Linear Mixed Models analysis revealed increments in perceived mental fatigue in all conditions, especially cognitive (p = 0.004) and combined (p < 0.0001) conditions. Psychomotor performance worsened, especially for cognitive (p = 0.039) and combined (p = 0.009) conditions. The Individual Alpha Peak Frequency was lower after the cognitive task (p = 0.040) and compared with the physical task (p = 0.021). The Alpha midline power increased after the cognitive task in the central-frontal (p = 0.047) and central-posterior brain regions (p = 0.043). Conclusions: Cognitive and combined conditions were found to be more mentally demanding and fatiguing than single physical tasks. This was also reflected by an impaired reaction time. Based on the neural activity recorded, the performance impairments caused by mental fatigue were caused by reduced brain readiness (i.e., a lower Alpha Peak Frequency). However, non-significant changes were found in soccer-related decision-making. Coaches should consider the type of training tasks they recommend in light of their different effects on mental fatigue and performance. Full article

A cascading coaching model was used to teach bilingual speech-language pathology (SLP) graduate student clinicians and Spanish-speaking caregivers to implement naturalistic developmental behavioral intervention (NDBI) techniques with autistic preschoolers. Two triads (each consisting of a graduate student clinician, a minimally vocal child diagnosed with autism, and a caregiver) participated in the study. Following the cascading approach, a lead instructor (with limited Spanish conversational skills) coached bilingual student clinicians (in English) to apply culturally adapted NDBI with child participants. Following additional instruction in coaching, student clinicians coached caregivers in Spanish. Effects were evaluated using a multiple methods approach consisting of multiple probes across participants single case experimental design and a qualitative analysis of semi-structured interviews with adult participants. All adult participants increased their use of targeted NDBI skills including elicitation techniques (creating communication temptations, using wait time, and prompting) and response techniques (reinforcing children’s communication with natural consequences and providing a contextually relevant vocal model), demonstrating large to very large effect sizes. Although qualitative findings indicated areas for improvement (e.g., additional Spanish supports for clinicians), thematic analysis revealed additional benefits in terms of positive changes across adult learning, behavior, and perspectives; child communication; and child-caregiver relationships. Full article