Constantin Sufaru

Background: Psychological determinants are increasingly recognized as central contributors to both performance decline and recovery in competitive sport; however, contemporary evidence integrating injury-related and non-injury performance contexts remains fragmented. Objective: This systematic review synthesized empirical evidence (2016–2025) examining psychological determinants associated with return to sport (RTS), reinjury risk, burnout, injury incidence, and performance decline among competitive athletes. Methods: Conducted in accordance with PRISMA 2020 guidelines, a systematic search of PubMed, Scopus, Web of Science, and SPORTDiscus identified peer-reviewed studies published between January 2016 and December 2025. Eligibility criteria were defined using a PICO framework. Prospective cohort studies, longitudinal multi-wave investigations, one randomized controlled trial, matched cohort studies, diary-based designs, and injury-related observational studies were included. Due to heterogeneity in constructs and outcomes, findings were synthesized narratively. Results: Fourteen studies met the inclusion criteria, including prospective cohort studies, multi-wave longitudinal designs, one randomized controlled trial, one matched cohort study, and a diary-based investigation. Seven independent cohorts examined psychological readiness using the Anterior Cruciate Ligament—Return to Sport after Injury scale (ACL-RSI) in athletes with anterior cruciate ligament (ACL) injuries (sample sizes ranging from n = 39 to n = 384), consistently demonstrating that higher readiness predicted successful RTS at 6–24 months, while two prospective studies reported contrasting associations with second ACL injury risk. Four longitudinal studies (n = 93–491) showed that increased burnout and controlled motivation predicted performance decline and dropout trajectories, whereas higher resilience and mental toughness reduced burnout progression. One seasonal longitudinal study (n = 21) linked elevated cognitive anxiety and mood disturbance to increased injury incidence. Conclusion: Psychological determinants operate across deterioration and restoration pathways. Psychological readiness shows the strongest predictive consistency for RTS, while burnout, motivational climate, and resilience significantly shape long-term performance sustainability and injury-related outcomes.

Background: Musculoskeletal disorders (MSDs) are a major contributor to global disability. Exercise-based rehabilitation is widely recommended as first-line management; however, in clinical practice, it is frequently combined with adjunct therapeutic modalities, and the incremental effectiveness of these approaches remains unclear. The present review addressed the research question: Do adjunct modalities provide additional benefits beyond exercise-based rehabilitation alone in individuals with musculoskeletal disorders? Methods: This systematic review was conducted according to PRISMA 2020 guidelines and prospectively registered in the PROSPERO database (registration number CRD420261309183). Electronic searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials to identify controlled clinical trials evaluating exercise-based rehabilitation delivered alone or combined with adjunct modalities. Outcomes included pain, functional disability, physical performance, strength, structural or imaging-based measures, biomechanical variables, injury risk, and work-related outcomes. Due to methodological heterogeneity across studies, a structured narrative and tabular synthesis were performed. Results: Twenty-one controlled clinical trials were included, encompassing tendinopathies (n = 7), knee osteoarthritis (n = 5), post-ACL reconstruction (n = 2), chronic spinal pain (n = 3), sarcopenia (n = 2), low bone mass (n = 2), and occupational musculoskeletal conditions (n = 1), with sample sizes ranging from 22 to 823 participants. Pain outcomes were reported in 18 studies (86%) and functional outcomes in 16 studies (76%). Exercise-based rehabilitation consistently produced clinically meaningful improvements across studies, whereas adjunct modalities demonstrated short-term advantages in a limited number of trials but rarely showed sustained long-term superiority. Conclusions: Evidence from controlled clinical trials indicates that exercise-based rehabilitation is an effective primary intervention for improving pain, functional capacity, and physical performance across diverse musculoskeletal conditions. Adjunct modalities may provide condition-specific or short-term benefits but do not consistently enhance long-term outcomes beyond structured exercise programs.

Background/Objectives: Exercise-induced fatigue is a fundamental component of running performance and training, yet it is also implicated in altered movement mechanics and increased injury risk. While numerous studies have examined fatigue-related biomechanical changes during running, findings remain fragmented across biomechanical domains and fatigue modalities. The purpose of this systematic review was to synthesize contemporary evidence on the effects of fatigue on lower-limb biomechanics during running and to interpret the potential injury relevance of these adaptations. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science for original empirical studies published between January 2010 and December 2025. Eligible studies involved human participants performing running or running-related tasks, applied an explicit fatigue protocol, and reported quantitative lower-limb biomechanical outcomes. Study selection followed PRISMA 2020 guidelines. Data extraction included participant characteristics, fatigue protocols, biomechanical measures, instrumentation, and key findings. Methodological quality was assessed using the Cochrane Risk of Bias 2 (RoB-2) tool. Due to substantial methodological heterogeneity, findings were synthesized narratively. Results: Twenty-four studies met the inclusion criteria. Across studies, fatigue consistently altered spatiotemporal parameters, joint kinematic and kinetic variables, spring-mass behavior, impact loading, coordination variability, neuromuscular output, and inter-limb symmetry. Common adaptations included increased ground contact time, reduced ankle joint power and stiffness, increased joint range of motion, elevated impact loading, and greater movement variability. These changes reflected reduced mechanical efficiency and a redistribution of mechanical load from distal to proximal joints, particularly toward the knee and hip. Similar fatigue-related biomechanical patterns were observed in both laboratory-based and real-world endurance running conditions. Conclusions: Exercise-induced fatigue produces systematic and injury-relevant alterations in lower-limb biomechanics during running. These adaptations may preserve short-term performance but create mechanical conditions associated with increased susceptibility to overuse and non-contact injuries. Integrating fatigue-aware biomechanical assessment, neuromuscular conditioning, and individualized load management strategies may help mitigate adverse fatigue-related adaptations.

Background and Study Aim. Basketball is characterized by high-intensity, intermittent efforts that require rapid transitions between aerobic and anaerobic metabolism. Monitoring physiological responses across training intensities is essential to optimize conditioning strategies, manage workloads, and improve player performance. The purpose of this study was to determine the effect of training with differentiated intensity on the complex cardiovascular and respiratory responses of female basketball players. Material and Methods. Thirty-two female university-level basketball players (age: 24.1 ± 3.4 years; height: 156.4 ± 6.2 cm) with ≥5 years of structured training participated. Four controlled training conditions were randomized: mostly aerobic, mixed aerobic–anaerobic, anaerobic glycolytic, and anaerobic alactate drills. Heart rate (HR) was continuously monitored using the Sunfox Spandan Pro electrocardiography (ECG) system. Expired gases were analyzed via Douglas bags and a calibrated gas meter to determine oxygen consumption (VO₂), carbon dioxide production (VCO₂), pulmonary ventilation (VE), oxygen pulse, and oxygen debt. Data were analyzed using repeated measures analysis of variance (ANOVA), multivariate analysis of variance (MANOVA), Bonferroni post-hoc tests, Pearson correlations, intraclass correlation coefficients (ICC), and linear regression modeling. Results. Progressive increases in VO₂, HR, VE, and oxygen debt were observed from aerobic to anaerobic glycolytic drills (p < 0.001). Effect sizes were medium to large (η² = 0.39–0.52). Post-hoc analysis revealed significantly greater VO₂ and HR during anaerobic glycolytic drills compared to aerobic and mixed drills (Cohen’s d > 0.80). MANOVA confirmed significant multivariate differences (Wilks’ Lambda = 0.42, p < 0.001). VO₂ correlated strongly with HR (r = 0.81) and VE (r = 0.76). Regression modeling indicated that HR and VE explained 68% of VO₂ variance, while ICCs (>0.85) confirmed measurement reliability. Conclusions. Controlled basketball drills elicit distinct physiological responses depending on intensity. Anaerobic glycolytic efforts produce the highest demands. HR and VE provide reliable predictors of VO₂ and offer practical tools for field-based monitoring. However, the controlled design may not fully capture the unpredictability of live competition. This highlights the need for complementary training approaches that integrate situational and tactical elements.

(1) Background: The aim of this study was to conduct a systematic literature review and meta-analysis on the effects of virtual reality (VR) and traditional (TR) physical activity programs, analyzing their impact on the physical, health, and cognitive aspects of participants. The study sought to identify the advantages and limitations of both methods, taking into account previous research and potential areas for future studies. (2) Methods: The study protocol for this systematic review was registered at the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY202530015). The review followed PRISMA guidelines, and studies were selected based on their relevance to the research objectives using the PICOS model criteria. The authors applied a meta-analysis in addition to a systematic review to further ensure the accuracy of the results. Primary outcomes included physical and cognitive performance, while secondary outcomes encompassed participant perceptions and psychological effects. (3) Results: The findings indicate that VR training significantly enhances flexibility, motivation, and cognitive abilities, particularly in populations with limited access to traditional exercise methods. The most pronounced effects were observed in programs lasting 8 to 12 weeks with a moderate to high intensity. In contrast, TR showed superiority in developing strength, endurance, and cardiorespiratory functions. (4) Conclusions: VR offers significant benefits as an adjunct or alternative to TR, especially for individuals with limited resources or physical accessibility. However, variations in methodological approaches, short program durations, and sample heterogeneity highlight the need for further longitudinal research. Standardizing VR training duration and intensity is essential to ensure consistent and reliable outcomes.

(1) Background: The relationship between physical activity (PA) and mental health remains a topic of significant interest, particularly in populations recovering from COVID-19. This study aimed to examine the differences in PA levels and mental health parameters (anxiety, depression, and stress) across sex and age groups following COVID-19 recovery; (2) Methods: The sample of participants (n = 288) was selected using a random sampling method and consisted of participants of different ages and both sexes. Participants’ self-reported PA was assessed using the International Physical Activity Questionnaire (IPAQ), while the Depression, Anxiety, and Stress Scale (DASS) was used to measure negative emotional states. The influence of COVID-19 recovery on PA and mental health (depression, anxiety, stress) was analyzed using MANOVA and follow-up univariate tests by age and sex. Statistical significance was set at p < 0.05, with SPSS (v23.0) used for data analysis; (3) Results: A statistically significant difference was observed between the initial and final measurements in PA levels (Wilk’s Lambda = 0.95; p = 0.000) and mental health (Wilk’s Lambda = 0.96; p = 0.000) with older individuals—particularly women—demonstrating improved PA levels and better mental health outcomes. In contrast, younger women exhibited a decline in both domains, with increased anxiety, depression, and stress symptoms. While younger men showed increased PA, their mental health parameters were slightly elevated, though still within normal ranges; (4) Conclusions: Our findings suggest that older individuals were better adapted to post-COVID challenges due to maturity and life experience, while younger populations may require additional support. The study underscored the complexity of the PA–mental health relationship and highlighted the need for further research, particularly among younger individuals recovering from COVID-19.

INPLASY202530015 Comparing Virtual and Traditional Physical Activity Programs: Systematic Review Keywords: Effectiveness; Virtual Training; Digital Exercise; Online Fitness; Influence. Read and dow…

Introduction and objective: The study focused on identifying the differences regarding the implementation of a program that uses Fitlight technology and targets the development of simple and reactive repetitive speed in manual and bilateral manual executions. Methodology: There were 311 subjects in the study, including 243 student-athletes (handball, basketball, and volleyball) and 65 recreational subjects (control group). Study phasing: initial testing; implementing a 6-week experimental program using the Fitlight technology to improve manual, repetitive speed; final testing. Study tests: the Tapping the plates test-unilateral execution with the dominant hand (TP_dominant hand), the random reactive plate touching test_unilateral execution with the dominant hand (TPR_dominant hand), Touching the plates test- bilateral execution (TP_bilateral), Test Touching the plates bilateral execution-random reactive (TPR_bilateral). Results: The ANOVA analysis highlighted significant differences between the male and female groups, respectively, for all four versions of the Tapping Plate Test, for p<0.05. While analyzing the results of the male/female sports game groups, the most significant differences in progress were recorded in TP_dominant hand between Volleyball-Basketball with 0.179/0.126 executions; TPR_ dominant hand between Volleyball-Basketball -0.126/0.086 executions; TP_bilateral between Volleyball-Basketball -0.154/-0.173 executions; bilateral TPR_ between Volleyball-Handball -0.016/-0.033 executions. Analyzing the study results, we found that the control group recorded lower results than all the experimental groups. Conclusions: The Fitlight technology positively impacted the environment of simple and reactive repetitive speed as part of practicing an experimental program of specific exercises adapted to team sports games.

(1) Background: The objective of this systematic review was to collect relevant data in the available contemporary studies about sports injuries of basketball players and explain differences in sports injuries relative to gender, location, sport, and position on the court; (2) Methods: The papers were searched digitally using PubMed, MEDLINE, ERIC, Google Scholar, and ScienceDirect databases, from 1990 to 2024; (3) Results: The most frequent severe injuries for both genders are knee and ankle injuries and the most frequent forms of injury are ankle sprain and ligament strain. The most frequent injuries occur during running and after contact with the ball. Shooting guards sustain the highest injury rate followed by centers and point guards, while guards have the highest rate of adductor muscle injury; and (4) Conclusions: Studies indicate that ankle and knee injuries are prevalent among basketball players, with ankle sprains being particularly prevalent. Knee injuries are more common in female basketball players, including ACL injuries. Various factors contribute to injuries, including the biomechanics of jumping, landing, sudden changes in direction, and the physical demands placed on the body during the game.

Background: Understanding the relationship between teachers’ physical activity (PA) and quality of life (QoL), which is impacted by work-related stress, could help develop guidelines for improvement. The purpose of this study was to investigate the impact of physical activity on high school teachers’ quality of life and the differences in QoL and PA between male and female teachers. Methods: The sample consisted of 499 respondents (193 men and 306 women), all working in the educational system. The International Physical Activity Questionnaire (short form) was used for PA assessment, and the WHOQoL questionnaire to measure QoL. Results: Physical health and Psychological health domains were areas where male teachers scored better (p < 0.01, both), while female teachers had higher scores in Social relationships domain (p < 0.05). Regression analysis showed that PA affects Physical health: Sig. = 0.056; Psychological health: Sig. = 0.000; Social relationships: Sig. = 0.001; Environment: Sig. = 0.021 in men, and Physical health (Sig. = 0.009) and Psychological health (Sig. = 0.039) in women. Conclusions: The findings of this study allow us to conclude that, whereas female teachers’ PA primarily impacts their physical and psychological domain, male teachers’ PA has an impact on their overall QoL.