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The Cochrane Database of Systematic... Mar 2018Survivors of critical illness often experience a multitude of problems that begin in the intensive care unit (ICU) or present and continue after discharge. These can... (Review)
Review
BACKGROUND
Survivors of critical illness often experience a multitude of problems that begin in the intensive care unit (ICU) or present and continue after discharge. These can include muscle weakness, cognitive impairments, psychological difficulties, reduced physical function such as in activities of daily living (ADLs), and decreased quality of life. Early interventions such as mobilizations or active exercise, or both, may diminish the impact of the sequelae of critical illness.
OBJECTIVES
To assess the effects of early intervention (mobilization or active exercise), commenced in the ICU, provided to critically ill adults either during or after the mechanical ventilation period, compared with delayed exercise or usual care, on improving physical function or performance, muscle strength and health-related quality of life.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase and CINAHL. We searched conference proceedings, reference lists of retrieved articles, databases of trial registries and contacted experts in the field on 31 August 2017. We did not impose restrictions on language or location of publications.
SELECTION CRITERIA
We included all randomized controlled trials (RCTs) or quasi-RCTs that compared early intervention (mobilization or active exercise, or both), delivered in the ICU, with delayed exercise or usual care delivered to critically ill adults either during or after the mechanical ventilation period in the ICU.
DATA COLLECTION AND ANALYSIS
Two researchers independently screened titles and abstracts and assessed full-text articles against the inclusion criteria of this review. We resolved any disagreement through discussion with a third review author as required. We presented data descriptively using mean differences or medians, risk ratios and 95% confidence intervals. A meta-analysis was not possible due to the heterogeneity of the included studies. We assessed the quality of evidence with GRADE.
MAIN RESULTS
We included four RCTs (a total of 690 participants), in this review. Participants were adults who were mechanically ventilated in a general, medical or surgical ICU, with mean or median age in the studies ranging from 56 to 62 years. Admitting diagnoses in three of the four studies were indicative of critical illness, while participants in the fourth study had undergone cardiac surgery. Three studies included range-of-motion exercises, bed mobility activities, transfers and ambulation. The fourth study involved only upper limb exercises. Included studies were at high risk of performance bias, as they were not blinded to participants and personnel, and two of four did not blind outcome assessors. Three of four studies reported only on those participants who completed the study, with high rates of dropout. The description of intervention type, dose, intensity and frequency in the standard care control group was poor in two of four studies.Three studies (a total of 454 participants) reported at least one measure of physical function. One study (104 participants) reported low-quality evidence of beneficial effects in the intervention group on return to independent functional status at hospital discharge (59% versus 35%, risk ratio (RR) 1.71, 95% confidence interval (CI) 1.11 to 2.64); the absolute effect is that 246 more people (95% CI 38 to 567) per 1000 would attain independent functional status when provided with early mobilization. The effects on physical functioning are uncertain for a range measures: Barthel Index scores (early mobilization: median 75 control: versus 55, low quality evidence), number of ADLs achieved at ICU (median of 3 versus 0, low quality evidence) or at hospital discharge (median of 6 versus 4, low quality evidence). The effects of early mobilization on physical function measured at ICU discharge are uncertain, as measured by the Acute Care Index of Function (ACIF) (early mobilization mean: 61.1 versus control: 55, mean difference (MD) 6.10, 95% CI -11.85 to 24.05, low quality evidence) and the Physical Function ICU Test (PFIT) score (5.6 versus 5.4, MD 0.20, 95% CI -0.98 to 1.38, low quality evidence). There is low quality evidence that early mobilization may have little or no effect on physical function measured by the Short Physical Performance Battery score at ICU discharge from one study of 184 participants (mean 1.6 in the intervention group versus 1.9 in usual care, MD -0.30, 95% CI -1.10 to 0.50), or at hospital discharge (MD 0, 95% CI -1.00 to 0.90). The fourth study, which examined postoperative cardiac surgery patients did not measure physical function as an outcome.Adverse effects were reported across the four studies but we could not combine the data. Our certainty in the risk of adverse events with either mobilization strategy is low due to the low rate of events. One study reported that in the intervention group one out of 49 participants (2%) experienced oxygen desaturation less than 80% and one of 49 (2%) had accidental dislodgement of the radial catheter. This study also found cessation of therapy due to participant instability occurred in 19 of 498 (4%) of the intervention sessions. In another study five of 101 (5%) participants in the intervention group and five of 109 (4.6%) participants in the control group had postoperative pulmonary complications deemed to be unrelated to intervention. A third study found one of 150 participants in the intervention group had an episode of asymptomatic bradycardia, but completed the exercise session. The fourth study reported no adverse events.
AUTHORS' CONCLUSIONS
There is insufficient evidence on the effect of early mobilization of critically ill people in the ICU on physical function or performance, adverse events, muscle strength and health-related quality of life at this time. The four studies awaiting classification, and the three ongoing studies may alter the conclusions of the review once these results are available. We assessed that there is currently low-quality evidence for the effect of early mobilization of critically ill adults in the ICU due to small sample sizes, lack of blinding of participants and personnel, variation in the interventions and outcomes used to measure their effect and inadequate descriptions of the interventions delivered as usual care in the studies included in this Cochrane Review.
Topics: Activities of Daily Living; Adult; Critical Illness; Early Ambulation; Exercise; Humans; Intensive Care Units; Muscle Strength; Quality of Life; Randomized Controlled Trials as Topic; Respiration, Artificial
PubMed: 29582429
DOI: 10.1002/14651858.CD010754.pub2 -
Nutrients Mar 2018The increasing recognition of sarcopenia, the age-related loss of skeletal muscle mass and function (muscle strength and physical performance), as a determinant of poor... (Review)
Review
The increasing recognition of sarcopenia, the age-related loss of skeletal muscle mass and function (muscle strength and physical performance), as a determinant of poor health in older age, has emphasized the importance of understanding more about its aetiology to inform strategies both for preventing and treating this condition. There is growing interest in the effects of modifiable factors such as diet; some nutrients have been studied but less is known about the influence of overall diet quality on sarcopenia. We conducted a systematic review of the literature examining the relationship between diet quality and the individual components of sarcopenia, i.e., muscle mass, muscle strength and physical performance, and the overall risk of sarcopenia, among older adults. We identified 23 studies that met review inclusion criteria. The studies were diverse in terms of the design, setting, measures of diet quality, and outcome measurements. A small body of evidence suggested a relationship between "healthier" diets and better muscle mass outcomes. There was limited and inconsistent evidence for a link between "healthier" diets and lower risk of declines in muscle strength. There was strong and consistent observational evidence for a link between "healthier" diets and lower risk of declines in physical performance. There was a small body of cross-sectional evidence showing an association between "healthier" diets and lower risk of sarcopenia. This review provides observational evidence to support the benefits of diets of higher quality for physical performance among older adults. Findings for the other outcomes considered suggest some benefits, although the evidence is either limited in its extent (sarcopenia) or inconsistent/weak in its nature (muscle mass, muscle strength). Further studies are needed to assess the potential of whole-diet interventions for the prevention and management of sarcopenia.
Topics: Age Factors; Aged; Aging; Diet; Diet, Healthy; Female; Humans; Male; Middle Aged; Muscle Strength; Muscle, Skeletal; Nutritional Status; Nutritive Value; Protective Factors; Risk Factors; Risk Reduction Behavior; Sarcopenia
PubMed: 29510572
DOI: 10.3390/nu10030308 -
Sports Medicine (Auckland, N.Z.) Oct 2022Whole muscle hypertrophy does not appear to be negatively affected by concurrent aerobic and strength training compared to strength training alone. However, there are... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Whole muscle hypertrophy does not appear to be negatively affected by concurrent aerobic and strength training compared to strength training alone. However, there are contradictions in the literature regarding the effects of concurrent training on hypertrophy at the myofiber level.
OBJECTIVE
The current study aimed to systematically examine the extent to which concurrent aerobic and strength training, compared with strength training alone, influences type I and type II muscle fiber size adaptations. We also conducted subgroup analyses to examine the effects of the type of aerobic training, training modality, exercise order, training frequency, age, and training status.
DESIGN
A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [PROSPERO: CRD42020203777]. The registered protocol was modified to include only muscle fiber hypertrophy as an outcome.
DATA SOURCES
PubMed/MEDLINE, ISI Web of Science, Embase, CINAHL, SPORTDiscus, and Scopus were systematically searched on 12 August, 2020, and updated on 15 March, 2021.
ELIGIBILITY CRITERIA
Population: healthy adults of any sex and age; intervention: supervised, concurrent aerobic and strength training of at least 4 weeks; comparison: identical strength training prescription, with no aerobic training; and outcome: muscle fiber hypertrophy.
RESULTS
A total of 15 studies were included. The estimated standardized mean difference based on the random-effects model was - 0.23 (95% confidence interval [CI] - 0.46 to - 0.00, p = 0.050) for overall muscle fiber hypertrophy. The standardized mean differences were - 0.34 (95% CI - 0.72 to 0.04, p = 0.078) and - 0.13 (95% CI - 0.39 to 0.12, p = 0.315) for type I and type II fiber hypertrophy, respectively. A negative effect of concurrent training was observed for type I fibers when aerobic training was performed by running but not cycling (standardized mean difference - 0.81, 95% CI - 1.26 to - 0.36). None of the other subgroup analyses (i.e., based on concurrent training frequency, training status, training modality, and training order of same-session training) revealed any differences between groups.
CONCLUSIONS
In contrast to previous findings on whole muscle hypertrophy, the present results suggest that concurrent aerobic and strength training may have a small negative effect on fiber hypertrophy compared with strength training alone. Preliminary evidence suggests that this interference effect may be more pronounced when aerobic training is performed by running compared with cycling, at least for type I fibers.
Topics: Adult; Humans; Hypertrophy; Infant; Infant, Newborn; Muscle Fibers, Skeletal; Muscle Strength; Muscle, Skeletal; Resistance Training
PubMed: 35476184
DOI: 10.1007/s40279-022-01688-x -
Journal of the American Medical... Aug 2023This systematic review aims to reevaluate the role of minerals on muscle mass, muscle strength, physical performance, and the prevalence of sarcopenia in... (Review)
Review
OBJECTIVE
This systematic review aims to reevaluate the role of minerals on muscle mass, muscle strength, physical performance, and the prevalence of sarcopenia in community-dwelling and institutionalized older adults.
DESIGN
Systematic review.
SETTING AND PARTICIPANTS
In March 2022, a systematic search was performed in PubMed, Scopus, and Web of Sciences using predefined search terms. Original studies on dietary mineral intake or mineral serum blood concentrations on muscle mass, muscle strength, and physical performance or the prevalence of sarcopenia in older adults (average age ≥65 years) were included.
METHODS
Eligibility screening and data extraction was performed by 2 independent reviewers. Quality assessment was performed with the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Risk of bias was evaluated using the Risk Of Bias In Non-randomized Studies-of Exposure (ROBINS-E) tool.
RESULTS
From the 15,622 identified articles, a total of 45 studies were included in the review, mainly being cross-sectional and observational studies. Moderate quality of evidence showed that selenium (n = 8) and magnesium (n = 7) were significantly associated with muscle mass, strength, and physical performance as well as the prevalence of sarcopenia. For calcium and zinc, no association could be found. For potassium, iron, sodium, and phosphorus, the association with sarcopenic outcomes remains unclear as not enough studies could be included or were nonconclusive (low quality of evidence).
CONCLUSIONS AND IMPLICATIONS
This systematic review shows a potential role for selenium and magnesium on the prevention and treatment of sarcopenia in older adults. More randomized controlled trials are warranted to determine the impact of minerals on sarcopenia in older adults.
Topics: Humans; Aged; Sarcopenia; Magnesium; Selenium; Cross-Sectional Studies; Muscle Strength
PubMed: 37355247
DOI: 10.1016/j.jamda.2023.05.017 -
International Journal of Environmental... Aug 2019Volleyball is considered a very explosive and fast-paced sport in which plyometric training is widely used. Our purpose was to review the effects of plyometric training...
Volleyball is considered a very explosive and fast-paced sport in which plyometric training is widely used. Our purpose was to review the effects of plyometric training on volleyball players' performance. A systematic search was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using PubMed, SciELO, SPORTDiscus, Medline, Scopus, Academic Search Complete, CINAHL and Web Science for articles published no later than December 2018. Any criteria were imposed for the included sample. The search focus was on interventional studies in which athletes underwent a plyometric program. To the 1831 articles found, another five were added, identified through other sources. Duplicated files were removed, titles and abstracts were screened, which left 21 remaining studies for extensive analysis. Results showed that the vertical jump (15 studies) was the major ability studied in plyometric training interventions, followed by strength (four studies), horizontal jump (four studies), flexibility (four studies) and agility/speed (three studies). In addition, it was observed that young (under 18 years old) female athletes were the most studied. The included studies indicated that plyometric training seems to increase vertical jump performance, strength, horizontal jump performance, flexibility and agility/speed in volleyball players. However, more studies are needed to better understand the benefits of plyometric training in volleyball players' performance.
Topics: Athletes; Cohort Studies; Humans; Muscle Strength; Plyometric Exercise; Randomized Controlled Trials as Topic; Volleyball
PubMed: 31426481
DOI: 10.3390/ijerph16162960 -
Journal of Applied Physiology... Jul 2021Muscle atrophy and decline in muscle strength appear very rapidly with prolonged disuse or mechanical unloading after acute hospitalization or experimental bed rest. The...
Muscle atrophy and decline in muscle strength appear very rapidly with prolonged disuse or mechanical unloading after acute hospitalization or experimental bed rest. The current study analyzed data from short-, medium-, and long-term bed rest (5-120 days) in a pooled sample of 318 healthy adults and modeled the mathematical relationship between muscle strength decline and atrophy. The results show a logarithmic disuse-induced loss of strength and muscle atrophy of the weight-bearing knee extensor muscles. The greatest rate of muscle strength decline and atrophy occurred in the earliest stages of bed rest, plateauing later, and likely contributed to the rapid neuromuscular loss of function in the early period. In addition, during the first 2 wk of bed rest, muscle strength decline is much faster than muscle atrophy: on , the ratio of muscle atrophy to strength decline as a function of bed rest duration is 4.2, falls to 2.4 on , and stabilizes to a value of 1.9 after ∼35 days of bed rest. Positive regression revealed that ∼79% of the muscle strength loss may be explained by muscle atrophy, while the remaining is most likely due to alterations in single fiber mechanical properties, excitation-contraction coupling, fiber architecture, tendon stiffness, muscle denervation, neuromuscular junction damage, and supraspinal changes. Future studies should focus on neural factors as well as muscular factors independent of atrophy (single fiber excitability and mechanical properties, architectural factors) and on the role of extracellular matrix changes. Bed rest results in nonuniform loss of isometric muscle strength and atrophy over time, where the magnitude of change was greater for muscle strength than for atrophy. Future research should focus on the loss of muscle function and the underlying mechanisms, which will aid in the development of countermeasures to mitigate or prevent the decline in neuromuscular efficiency. Our study contributes to the characterization of muscle loss and weakness processes reflected by a logarithmic decline in muscle strength induced by chronic bed rest. Acute short-term hospitalization (≤5 days) associated with periods of disuse/immobilization/prolonged time in the supine position in the hospital bed is sufficient to significantly decrease muscle mass and size and induce functional changes related to weakness in maximal muscle strength. By bringing together integrated evaluation of muscle structure and function, this work identifies that 79% of the loss in muscle strength can be explained by muscle atrophy, leaving 21% of the functional loss unexplained. The outcomes of this study should be considered in the development of daily countermeasures for preserving neuromuscular integrity as well as preconditioning interventions to be implemented before clinical bed rest or chronic gravitational unloading (e.g., spaceflights).
Topics: Adult; Bed Rest; Humans; Muscle Strength; Muscle, Skeletal; Muscular Atrophy; Neuromuscular Junction
PubMed: 33703945
DOI: 10.1152/japplphysiol.00363.2020 -
Journal of Rehabilitation Medicine Jan 2022To evaluate the effects and safety of exercise training, and to determine the most effective exercise intervention for people with Duchenne muscular dystrophy.... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effects and safety of exercise training, and to determine the most effective exercise intervention for people with Duchenne muscular dystrophy. Exercise training was compared with no training, placebo or alternative exercise training. Primary outcomes were functioning and health-related quality of life. Secondary outcomes were muscular strength, endurance and lung function. Data sources: A systematic literature search was conducted in Medline, EMBASE, CINAHL, Cochrane Central, PEDro and Scopus. Study selection and data extraction: Screening, data extraction, risk of bias and quality assessment were carried out. Risk of bias was assessed using the Cochrane Collaborations risk of bias tools. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.
DATA SYNTHESIS
Twelve studies with 282 participants were included. A narrative synthesis showed limited or no improvements in functioning compared with controls. Health-related quality of life was assessed in only 1 study. A meta-analysis showed a significant difference in muscular strength and endurance in favour of exercise training compared with no training and placebo. However, the certainty of evidence was very low.
CONCLUSION
Exercise training may be beneficial in Duchenne muscular dystrophy, but the evidence remains uncertain. Further research is needed on exercise training to promote functioning and health-related quality of life in Duchenne muscular dystrophy.
Topics: Exercise; Humans; Muscle Strength; Muscular Dystrophy, Duchenne; Quality of Life
PubMed: 35642324
DOI: 10.2340/jrm.v53.985 -
Sports Medicine (Auckland, N.Z.) Jul 2022Weightlifting training (WLT) is commonly used to improve strength, power and speed in athletes. However, to date, WLT studies have either not compared training effects... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Weightlifting training (WLT) is commonly used to improve strength, power and speed in athletes. However, to date, WLT studies have either not compared training effects against those of other training methods, or been limited by small sample sizes, which are issues that can be resolved by pooling studies in a meta-analysis. Therefore, the objective of this systematic review with meta-analysis was to evaluate the effects of WLT compared with traditional resistance training (TRT), plyometric training (PLYO) and/or control (CON) on strength, power and speed.
METHODS
The systematic review included peer-reviewed articles that employed a WLT intervention, a comparison group (i.e. TRT, PLYO, CON), and a measure of strength, power and/or speed. Means and standard deviations of outcomes were converted to Hedges' g effect sizes using an inverse variance random-effects model to generate a weighted mean effect size (ES).
RESULTS
Sixteen studies were included in the analysis, comprising 427 participants. Data indicated that when compared with TRT, WLT resulted in greater improvements in weightlifting load lifted (4 studies, p = 0.02, g = 1.35; 95% CI 0.20-2.51) and countermovement jump (CMJ) height (9 studies, p = 0.00, g = 0.95; 95% CI 0.04-1.87). There was also a large effect in terms of linear sprint speed (4 studies, p = 0.13, g = 1.04; 95% CI - 0.03 to 2.39) and change of direction speed (CODS) (2 studies, p = 0.36, g = 1.21; 95% CI - 1.41 to 3.83); however, this was not significant. Interpretation of these findings should acknowledge the high heterogeneity across the included studies and potential risk of bias. WLT and PLYO resulted in similar improvements in speed, power and strength as demonstrated by negligible to moderate, non-significant effects in favour of WLT for improvements in linear sprint speed (4 studies, p = 0.35, g = 0.20; 95% CI - 0.23 to 0.63), CODS (3 studies, p = 0.52, g = 0.17; 95% CI - 0.35 to 0.68), CMJ (6 studies, p = 0.09, g = 0.31; 95% CI - 0.05 to 0.67), squat jump performance (5 studies, p = 0.08, g = 0.34; 95% CI - 0.04 to 0.73) and strength (4 studies, p = 0.20, g = 0.69; 95% CI - 0.37 to 1.75).
CONCLUSION
Overall, these findings support the notion that if the training goal is to improve strength, power and speed, supplementary weightlifting training may be advantageous for athletic development. Whilst WLT and PLYO may result in similar improvements, WLT can elicit additional benefits above that of TRT, resulting in greater improvements in weightlifting and jumping performance.
Topics: Athletes; Athletic Performance; Humans; Muscle Strength; Plyometric Exercise; Resistance Training; Weight Lifting
PubMed: 35025093
DOI: 10.1007/s40279-021-01627-2 -
Medicine Jan 2015Strength training has, in recent years, been shown to be beneficial for people with Parkinson disease and multiple sclerosis. Consensus regarding its utility for these... (Meta-Analysis)
Meta-Analysis Review
Strength training has, in recent years, been shown to be beneficial for people with Parkinson disease and multiple sclerosis. Consensus regarding its utility for these disorders nevertheless remains contentious among healthcare professionals. Greater clarity is required, especially in regards to the type and magnitude of effects as well as the response differences to strength training between individuals with Parkinson disease or multiple sclerosis. This study examines the effects, magnitude of those effects, and response differences to strength training between patients with Parkinson disease or multiple sclerosis. A comprehensive search of electronic databases including Physiotherapy Evidence Database scale, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL was conducted from inception to July 2014. English articles investigating the effect of strength training for individuals with neurodegenerative disorders were selected. Strength training trials that met the inclusion criteria were found for individuals with Parkinson disease or multiple sclerosis. Individuals with Parkinson disease or multiple sclerosis were included in the study. Strength training interventions included traditional (free weights/machine exercises) and nontraditional programs (eccentric cycling). Included articles were critically appraised using the Physiotherapy Evidence Database scale. Of the 507 articles retrieved, only 20 articles met the inclusion criteria. Of these, 14 were randomized and 6 were nonrandomized controlled articles in Parkinson disease or multiple sclerosis. Six randomized and 2 nonrandomized controlled articles originated from 3 trials and were subsequently pooled for systematic analysis. Strength training was found to significantly improve muscle strength in people with Parkinson disease (15%-83.2%) and multiple sclerosis (4.5%-36%). Significant improvements in mobility (11.4%) and disease progression were also reported in people with Parkinson disease after strength training. Furthermore, significant improvements in fatigue (8.2%), functional capacity (21.5%), quality of life (8.3%), power (17.6%), and electromyography activity (24.4%) were found in individuals with multiple sclerosis after strength training. The limitations of the study were the heterogeneity of interventions and study outcomes in Parkinson disease and multiple sclerosis trials. Strength training is useful for increasing muscle strength in Parkinson disease and to a lesser extent multiple sclerosis.
Topics: Biomarkers; Disease Progression; Electromyography; Fatigue; Glutathione Peroxidase; Humans; Hydrogen Peroxide; Malondialdehyde; Mobility Limitation; Multiple Sclerosis; Muscle Strength; Parkinson Disease; Postural Balance; Quality of Life; Resistance Training; Superoxide Dismutase
PubMed: 25634170
DOI: 10.1097/MD.0000000000000411 -
Sports Health 2016Lateral ankle ligamentous sprain (LAS) is one of the most common injuries in recreational activities and competitive sports. Many studies have attempted to determine... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Lateral ankle ligamentous sprain (LAS) is one of the most common injuries in recreational activities and competitive sports. Many studies have attempted to determine whether there are certain intrinsic factors that can predict LAS. However, no consensus has been reached on the predictive intrinsic factors.
OBJECTIVE
To identify the intrinsic risk factors of LAS by meta-analysis from data in randomized control trials and prospective cohort studies.
DATA SOURCES
A systematic computerized literature search of MEDLINE, CINAHL, ScienceDirect, SPORTDiscus, and Cochrane Register of Clinical Trials was performed.
STUDY SELECTION
A computerized literature search from inception to January 2015 resulted in 1133 studies of the LAS intrinsic risk factors written in English.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 4.
DATA EXTRACTION
The modified quality index was used to assess the quality of the design of the papers and the standardized mean difference was used as an index to pool included study outcomes.
RESULTS
Eight articles were included in this systematic review. Meta-analysis results showed that body mass index, slow eccentric inversion strength, fast concentric plantar flexion strength, passive inversion joint position sense, and peroneus brevis reaction time correlated with LAS.
CONCLUSION
Body mass index, slow eccentric inversion strength, fast concentric plantar flexion strength, passive inversion joint position sense, and the reaction time of the peroneus brevis were associated with significantly increased risk of LAS.
Topics: Ankle Injuries; Ankle Joint; Body Mass Index; Humans; Lateral Ligament, Ankle; Muscle Strength; Posture; Proprioception; Range of Motion, Articular; Reaction Time; Risk Factors; Sprains and Strains
PubMed: 26711693
DOI: 10.1177/1941738115623775