Influence of Dynamic Balance on Jumping-Based Asymmetries in Team Sport: A between-Sports Comparison in Basketball and Handball Athletes

The aims of the present study were to analyze mobility, dynamic balance and lower-limb strength and the prevalence of asymmetry according to the type of sport and assess the association between inter-limb asymmetry and sports performance. A total of 23 basketball and 25 handball players performed a test battery consisting of functional movements and a jump test. Inter-limb asymmetry was calculated using a standard percentage difference equation. A between-groups comparison analysis was carried out, and Pearson’s correlation coefficients (r) were calculated to establish a relationship between asymmetries and physical performance. The results found athletes in different sports to exhibit different performance in functional movements and the jump test, but no bilateral asymmetries. The reactive strength index (RSI) and stiffness asymmetries were significantly associated with the anterior reach Y-balance test (YBT) (r = -0.412; p < 0.01 and r = -0.359; p < 0.05, respectively), and the unilateral triple hop test (THTU) was negatively correlated to anterior reach, posterior lateral reach YBT and YBT composite YBT (r = -0.341 to -0.377; p < 0.05). These findings suggest that the asymmetries exhibited important dispersion not dependent upon the type of sport but on each individual and the applied test. In addition, asymmetry in anterior direction YBT showed the strongest association to the rest of the sports performance variables

Recomendaciones de experto sobre el bloqueo de la interleucina 6 en pacientes con artritis reumatoide

[Abstract] Objective: To draft recommendations on interleukin 6 (IL-6) blockade in rheumatoid arthritis (RA), based on best evidence and experience. Methods: A group of 10 experts on IL-6 blockade in RA was selected. The 2 coordinators formulated 23 questions about IL-6 blockade (indications, efficacy, safety, etc.). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (Medline, EMBASE and the Cochrane Library were searched). Two different reviewers selected the articles. Evidence tables were created. At the same time, European League Against Rheumatism and American College of Rheumatology abstracts were evaluated. Based on this evidence, the coordinators proposed preliminary recommendations that the experts discussed and voted on in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Centre for Evidence Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no). Results: The 8 preliminary recommendations were accepted after the Delphi process. They covered aspects such as the use of these therapies in monotherapy, in combination, in patients with refractory disease or intolerant patients, response evaluation, optimization and risk management. Conclusions: The manuscript aims to solve frequently asked questions and aid in decision making strategies when treating RA patients with IL-6 blockade.[Resumen] Objetivo. Generar recomendaciones sobre el bloqueo de la interleucina 6 (IL-6) en pacientes con artritis reumatoide (AR), basadas en la mejor evidencia y experiencia. Métodos. Se seleccionó a 10 expertos reumatólogos en el manejo de los inhibidores de la IL-6. Los 2 coordinadores generaron 23 preguntas sobre el bloqueo de la IL-6 en la AR (perfiles de indicación, eficacia, seguridad, etc.) para ser contestadas mediante una revisión sistemática de la literatura. Con base en las preguntas se definieron los criterios de inclusión y exclusión, y las estrategias de búsqueda (para interrogar Medline, Embase y la Cochrane Library). Dos revisores seleccionaron los artículos resultantes de la búsqueda. Se generaron tablas de evidencia. Paralelamente, se evaluaron abstracts de congresos de EULAR y ACR. Con toda esta evidencia los coordinadores propusieron 8 recomendaciones preliminares que se evaluaron, discutieron y votaron en una reunión de grupo nominal con el resto de los expertos. Para cada recomendación se estableció el nivel de evidencia y grado de recomendación, y el grado de acuerdo mediante un Delphi. Se definió acuerdo si al menos el 80% de los participantes contestaban sí a la recomendación (sí o no). Resultados. Las 8 recomendaciones preliminares se aceptaron tras el Delphi. Abarcan aspectos como su uso en monoterapia, en combinación, en pacientes refractarios o intolerantes, la evaluación de su respuesta, la optimización o la gestión del riesgo. Conclusiones. Este documento pretende resolver algunos interrogantes clínicos habituales y facilitar la toma de decisiones con el bloqueo de la IL-6 en el manejo de la AR

Documento de expertos sobre el uso de terapia combinada de metotrexato con terapias biológicas o terapias dirigidas a pacientes con artritis reumatoide

We aimed to develop recommendations for the management of methotrexate (MTX) when considering the combination with biological (b) or targeted synthetic (ts) disease modifying drugs (DMARDs) in rheumatoid arthritis (RA). Methods: Eleven experts on RA were selected. Two coordinators formulated 13 questions about the combination therapy of MTX with bDMARDs or tsDMARDs. A systematic review was conducted to answer the questions. Inclusion and exclusion criteria were established as well as the search strategies (Medline, Embase and the Cochrane Library were searched up to January 2019). Two reviewers selected the articles and collected data. Simultaneously, EULAR and ACR meeting abstracts were evaluated. Based on this evidence, the coordinators proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation was established using the Oxford Center for Evidence Based Medicine and the level of agreement with a Delphi. Agreement was established if at least 80% of the experts voted ‘yes’ (yes/no). Results: The systematic review retrieved 513 citations of which 61 were finally included. A total of 10 recommendations were generated, voted and accepted. The level of agreement was very high in all of them and it was achieved in the first Delphi round. Final recommendations cover aspects such as the optimal MTX dosage, tapering strategy or patients’ risk management. Conclusions: This document is intended to help clinicians solve usual clinical questions and facilitate decision making when treating RA patients with MTX in combination with bDMARDs or tsDMARDsDesarrollar recomendaciones sobre el uso de metotrexato (MTX) en combinación con medicamentos modificadores de la enfermedad (DMARD) biológicos (b) o sintéticos específicos (ts) en la artritis reumatoide (AR). Se seleccionaron 11 expertos en AR. Dos coordinadores formularon 13 preguntas sobre la terapia combinada de MTX con bDMARD o tsDMARD. Se realizó una revisión sistemática para responder las preguntas. Se establecieron criterios de inclusión y exclusión, así como las estrategias de búsqueda (se realizaron búsquedas en Medline, Embase y la Biblioteca Cochrane hasta enero de 2019). Dos revisores seleccionaron los artículos y recopilaron datos. Simultáneamente, se evaluaron los resúmenes de las reuniones EULAR y ACR. Con base en esta evidencia, los coordinadores propusieron recomendaciones preliminares que los expertos discutieron y votaron en una reunión de grupo nominal. El nivel de evidencia y el grado de recomendación se establecieron utilizando el Centro de Oxford para Medicina Basada en Evidencia y el nivel de acuerdo con un Delphi. El acuerdo se estableció si al menos el 80% de los expertos votaron «sí» (sí/no). La revisión sistemática recuperó 513 citas, de las cuales finalmente se incluyeron 61. Se generaron, votaron y aceptaron un total de 10 recomendaciones. El nivel de acuerdo fue muy alto en todas ellas y se logró en la primera ronda de Delphi. Las recomendaciones finales cubren aspectos como la dosis óptima de MTX, la estrategia de reducción o la gestión del riesgo de los pacientes. Este documento está destinado a ayudar a los médicos a resolver preguntas clínicas habituales y facilitar la toma de decisiones al tratar a pacientes con AR con MTX, en combinación con bDMARD o tsDMAR

Longitudinal analysis of blood DNA methylation identifies mechanisms of response to tumor necrosis factor inhibitor therapy in rheumatoid arthritis

[Abstract] Background: Rheumatoid arthritis (RA) is a chronic, immune-mediated inflammatory disease of the joints that has been associated with variation in the peripheral blood methylome. In this study, we aim to identify epigenetic variation that is associated with the response to tumor necrosis factor inhibitor (TNFi) therapy. Methods: Peripheral blood genome-wide DNA methylation profiles were analyzed in a discovery cohort of 62 RA patients at baseline and at week 12 of TNFi therapy. DNA methylation of individual CpG sites and enrichment of biological pathways were evaluated for their association with drug response. Using a novel cell deconvolution approach, altered DNA methylation associated with TNFi response was also tested in the six main immune cell types in blood. Validation of the results was performed in an independent longitudinal cohort of 60 RA patients. Findings: Treatment with TNFi was associated with significant longitudinal peripheral blood methylation changes in biological pathways related to RA (FDR<0.05). 139 biological functions were modified by therapy, with methylation levels changing systematically towards a signature similar to that of healthy controls. Differences in the methylation profile of T cell activation and differentiation, GTPase-mediated signaling, and actin filament organization pathways were associated with the clinical response to therapy. Cell type deconvolution analysis identified CpG sites in CD4+T, NK, neutrophils and monocytes that were significantly associated with the response to TNFi. Interpretation: Our results show that treatment with TNFi restores homeostatic blood methylation in RA. The clinical response to TNFi is associated to methylation variation in specific biological pathways, and it involves cells from both the innate and adaptive immune systems

Lipoprotein(A) Concentrations In Rheumatoid Arthritis On Biologic Therapy: Results From The Cardiovascular In Rheumatology [Carma] Study Project

Background Plasma concentrations of lipoprotein (a) (Lp(a)), a lipoprotein with atherogenic and thrombogenic properties, have a strong genetic basis, although high concentrations of Lp(a) have also been reported in the context of inflammation, as in rheumatoid arthritis (RA). Few studies evaluate the impact of biologic therapies (BT) on Lp(a) in RA, taking into account that with these new therapies a better control of inflammation is achieved. Objective The aim of the study was to evaluate the plasma concentrations of Lp(a) in Spanish RA patients on BT attending rheumatology outpatient clinics. Methods Baseline analysis of the CARdiovascular in rheuMAtology project, a 10-year prospective study, evaluating the risk of cardiovascular events in RA and other forms of inflammatory arthritis. RA patients were classified according to treatment: no biologic, anti-tumor necrosis factor, anti-interleukin-6 receptor tocilizumab (TCZ), and other biologic (rituximab or abatacept). A model of linear multivariate regression was built in which the dependent variable was Lp(a) concentration and the explanatory variable was BT. The model was adjusted for confounding factors. Results Seven hundred and seventy-five RA patients were analyzed. Plasma concentrations of total cholesterol and triglyceride were significantly higher in TCZ-treated patients. Nevertheless, no significant difference in the atherogenic index between TCZ-treated patients and patients without BT was found. After adjusting for confounding factors, patients with BT had lower concentrations of Lp(a) than those without BT; however, only TCZ-treated patients achieved statistically significant differences (?: ?0.303, 95% confidence interval: ?0.558 to ?0.047; P = .02). Conclusions RA patients treated with TCZ show lower plasma concentrations of Lp(a) compared with patients without BT.This project has been supported by an unrestricted grant from Abbvie, Spain. The design, analysis, interpretation of results, and preparation of the article have been done independently of Abbvie. Dr González-Gay's studies have been supported by grants from “Fondo de Investigaciones Sanitarias” PI06/0024, PS09/00748, and PI12/00060 and RD12/0009/0013 (RIER) from “Instituto de Salud Carlos III” (ISCIII) (Spain)

Mediation Effect of Age Category on the Relationship between Body Composition and the Physical Fitness Profile in Youth Handball Players

The aims of the present study were (1) to determine the di erences in body composition and the physical and physiological profile of handball youths across age categories, and (2) to analyze the mediation e ect of di erent categories on the relationship between lean mass or fat mass and specific physical handball capacities. Fifty-four young handball players aged 13 to 18 were assigned to U14 (13- and 14-year-olds), U16 (15- and 16-year-olds), and U18 (17- and 18-year-olds). Body composition was measured using multi-frequency bioelectrical impedance (Inbody®, 230). Handball physical fitness was assessed using handgrip force, jumping tests (squat jump, countermovement jump, countermovement jump with aimed arms), a 30-m sprint, a change-of-direction test (T-half agility test and modified Illinois test), and a Yo-Yo intermittent recovery test level 1. Simple mediation analysis was performed to analyze whether the category mediated the relationship between lean mass or fat mass and physical capacities. No significant di erences were observed according to category for the majority of the measured parameters, except for height, lean body mass, and arm span. Lean body mass increased significantly as player category increased (p < 0.05; D = 4.66–9.38; e ect size (ES) = 0.96–1.92). The increase in handball category enhanced the majority of the physical capacities evaluated; however, these di erences were reduced between the U16 vs. U18 categories. The indirect mediation e ect suggests that handball category mediated the relationship between lean mass and upper and lower strength, velocity, agility, and cardiorespiratory fitness. In contrast, an indirect e ect suggests that category mediated the relationship between fat mass only in agility and cardiorespiratory fitness. We conclude that U18s showed better body composition parameters, as well as better physical performance scores. Handball category clearly mediated the relationship between body composition through lean mass and fat mass and the physiological profile in handball youth, but lean mass proved to be more relevant when mediating physical performance

Decisive Factors for a Greater Performance in the Change of Direction and Its Angulation in Male Basketball Players

A study was made to initially evaluate whether the age category directly could influence anthropometric measurements, functional movement tests, linear sprint (30 m) and strength. Moreover, and as the main purpose, this study aimed to examine the relationship between the time execution and angles in di erent changes of direction (COD) test with the analyzed sport performance variables. A total sample of 23 basketball players (age: 17.5 2.42 years; height: 184.6 6.68 cm; body weight: 78.09 11.9 kg). Between-groups’ comparison explored the di erences between basketball categories (Junior, n = 12; Senior, n = 11). The COD variables were divided by the time execution into low responders (LR) and high responders (HR) to establish comparisons between groups related to COD time execution. Pearson’s correlation coe cient was used to establish correlations between di erent CODs and sport performance variables. The results showed a greater influence of age category upon COD performance, especially when the cutting angle was sharper (7.05% [Confidence limits (CL) 90%: 2.33; 11.99]; Quantitative chances (QC) 0/2/98), in which athletes need greater application of strength. Moreover, the sharper the angle or the larger the number of cuts made, the greater the relationship with the vertical force–velocity profile (-42.39 [CL 90%: -57.37; -22.16]; QC 100/0/0%). Thus, the usefulness of the f–v profile to implement training programs that optimize the f–v imbalance and the improvement of the COD performance in basketball players is suggested

Efectos de la intervención desde terapia ocupacional sobre la percepción del dolor crónico y la calidad de vida en pacientes con artritis reumatoide

Objectives: To determine if an occupational therapy based intervention focused on performance reorganization on patients with rheumatoid arthritis reduces pain and improves self-efficacy and quality of life. Material and methods: Randomized controlled intervention study through a group program of seven occupational therapy sessions, conducted in five weeks. Results: We found an improvement in self-efficacy (p<0,001) and quality of life scores (p = 0,001, p = 0,08), as well as pain intensity MPQ (McGill Pain Questionnaire) measures, although the values collected with VAS (visual analogue scale) maintained over time. Conclusions: The program was effective in changing the studied variables, although a new study with a larger sample is required.Objetivos: determinar si una propuesta de intervención experimental desarrollada desde el campo de trabajo de la terapia ocupacional, dirigida a la reestructuración del desempeño ocupacional en pacientes con artritis reumatoide, reduce los niveles de dolor percibidos y mejora la autoeficacia y la calidad de vida de los mismos. Esta intervención se llevó a cabo de forma grupal, utilizando modelos de formación y enseñanza de estrategias a los pacientes. Material y método: estudio de intervención controlado aleatorizado de un programa grupal de terapia ocupacional de siete sesiones, de dos horas cada una, realizadas en cinco semanas. Resultados: se detectó una mejora en las puntuaciones de autoeficacia (p < 0,001) y de calidad de vida (p = 0,001; p = 0,08), así como de las puntuaciones de intensidad de dolor medidas con MPQ (McGill Pain Questionnaire), aunque los valores recogidos con EVA (escala visual analógica) se mantienen en el tiempo. Conclusiones: el programa resultó eficaz en la modificación de las variables estudiadas, apreciándose cambios significativos tanto en intensidad de dolor, como en los valores referidos a autoeficacia y calidad de vida. Es recomendable repetir el trabajo con una muestra mayor que permita obtener datos más consistentes

La relación de la actividad física sobre la imagen corporal en mujeres postparto

The perception of body image is usually affected in the different stages of a woman's life. The practice of physical exercise would be related to an improvement in the perception of body image, so it is important to investigate how the practice of physical exercise affects body image in the postpartum stage, since at this stage the perception is usually more negative . For this purpose, an online questionnaire was designed, consisting of socio-demographic questions, the International Physical Activity Questionnaire and the Body Shape Questionnaire. The sample consisted of 80 Spanish women, aged between 23 and 42 years, who were mothers in 2020 and 2021. The results show that the Body Mass Index is positively and significantly associated with body dissatisfaction.  However, in relation to physical exercise, the results showed an inverse relationship. The women with the highest body dissatisfaction were those with the highest Body Mass Index and the highest level of physical activity, with Body Mass Index being the variable that most explained body dissatisfaction.La percepción de la imagen corporal suele verse afectada en las diferentes etapas de la vida de la mujer. La práctica de ejercicio físico está relacionada con una mejora de la percepción de la imagen corporal, por lo que resulta importante investigar para conocer cómo afecta la práctica de ejercicio físico a la imagen corporal en la etapa postparto, ya que en esta etapa la percepción suele ser más negativa. Para ello, se diseñó un cuestionario en línea compuesto por cuestiones sociodemográficas, se evaluó el nivel de actividad física a través del International Physical Activity Questionnaire y la satisfacción corporal a través del Body Shape Questionnaire. La muestra ha sido compuesta por 80 mujeres españolas, de edades comprendidas entre 23 y 42 años que han sido madres en los años 2020 y 2021. Los resultados muestran que el Índice de Masa Corporal está asociado positiva y significativamente con la insatisfacción corporal. Sin embargo, en relación con el ejercicio físico, los resultados mostraron una relación inversa a la esperada. Aquellas mujeres que presentaban mayor insatisfacción corporal fueron las que más Índice de Masa Corporal tenía y más práctica de actividad física realizaban, siendo el Índice de Masa Corpora la variable que más explicaba la insatisfacción corporal