Adrián Feria-Madueño

Background: Physical exercise involving simultaneous cognitive demands, including dance-based exergames, has shown moderate effects on executive function. Immersive virtual reality (VR) may enhance these effects by increasing presence and frontal cortical activation; however, evidence in youth integrating objective neurophysiological measures remains limited and methodologically heterogeneous. Objective: This study aims to examine the acute and chronic effects of an immersive VR dance exergame, considered as an integrated package of immersion, interactivity, and real-time performance feedback, compared with a matched video-guided screen-based exercise condition (comparator condition [CS]), on inhibitory control as the primary outcome, and on frontal cortical activity, perceived self-efficacy, affective state, and physiological response as mechanistic or secondary outcomes. Methods: This protocol reports 2 methodologically independent studies, covered by a single prospective trial registration that describes both, in young adults aged 18 to 30 years: an acute randomized crossover study with up to 40 participants, and a 10-week 2-arm randomized controlled trial with a target sample of 64 participants and 3 sessions per week. In the VR condition, participants will play Beat Saber using Meta Quest 2 headsets. In the CS, they will follow a prerecorded video of the same playlist, matched for songs, tempo, movement sequence, difficulty, transition periods, and session duration. The primary outcome is the Stroop interference index. The confirmatory neurophysiological end point is absolute frontal theta power (4-7 Hz) averaged across F3, F4, AF3, and AF4 during the color-word interference condition. Secondary and exploratory outcomes include additional spectral measures, perceived self-efficacy, affective state, heart rate and percentage of heart rate reserve, rating of perceived exertion, wrist accelerometry, presence, cybersickness, enjoyment, and expectations. Assessments are conducted before and after each session in the acute study and at baseline, midpoint, postintervention, and 4-week follow-up in the chronic study. Linear mixed models accounting for period, sequence, participant, and the within-session pre/post structure will be used, with a prespecified hierarchy of confirmatory and exploratory analyses and false discovery rate correction applied within defined families. Results: Recruitment is expected to begin in October 2026, with data collection completed by December 2027 and first results available by June 2028. No participants had been enrolled at submission. Conclusions: This protocol presents a controlled experimental design to examine the effects of immersive VR exergaming, compared with matched video-guided screen-based exercise, on neurocognitive, psychological, and physiological outcomes. Incorporating immersion-related variables may help clarify the mechanisms underlying VR-based exercise and inform future technology-supported interventions in exercise and cognitive health. Trial Registration: ISRCTN Registry ISRCTN15563829; https://www.isrctn.com/ISRCTN15563829 International Registered Report Identifier (IRRID): PRR1-10.2196/105801

Objective: To characterize sagittal-plane lower-limb kinematics during a standardized single-leg landing task and to compare landing mechanics between male and female athletes. Methods: One hundred and sixty-two athletes (75% males, 25% females) performed three single-leg landings from a 30-cm platform. Two-dimensional photogrammetric analysis was used to evaluate trunk, hip, knee and ankle kinematics at initial ground contact and at maximum knee flexion. Variables included knee flexion at initial contact and maximum knee flexion, hip flexion, trunk inclination, ankle position and ankle dorsiflexion range of motion. Independent t-tests were used to examine sex-related differences. Results: Athletes landed with a mean knee angle of 145.89 ± 6.24° at initial contact and reached a maximum knee flexion angle of 116.72 ± 9.71°. Mean hip flexion increased from 10.02 ± 1.82° to 20.98 ± 1.38°, while trunk position changed from 102.94 ± 3.23° at initial contact to 59.33 ± 2.60° at maximum knee flexion. Ankle dorsiflexion range of motion during landing was 41.54 ± 4.32°. No significant differences were observed between males and females for any of the kinematic variables analysed (p > 0.05). Conclusions: Single-leg landing is characterized by coordinated sagittal-plane motion of the trunk, hip, knee and ankle. The absence of sex-related differences suggests that male and female athletes adopt similar landing strategies under standardized conditions. These findings support the use of an integrated biomechanical approach when assessing landing mechanics and may provide reference values for injury prevention, movement screening and rehabilitation programmes.

Anterior cruciate ligament (ACL) injuries remain a critical burden in professional football, resulting in prolonged absence and high economic costs. While physical demands have increased, traditional epidemiological surveillance relies on manual data extraction, which is resource-intensive and subjective. Large Language Models (LLMs) offer a potential solution for automated screening, but their reliability in sports medicine remains largely unexplored. This study aimed to: (1) update the epidemiology of ACL injuries in the Spanish First Division (LaLiga) over six consecutive seasons (2019/2020–2024/2025) and (2) validate the accuracy of an AI-assisted screening approach using ChatGPT compared to manual data extraction. A retrospective observational study was conducted using publicly available sources. Manual screening by external investigators (gold standard) was compared against an AI-assisted workflow based on a structured prompt-engineering framework. Analyses focused on injury frequency, mechanism, return-to-play (RTP) time, recurrence rates, and AI case-detection sensitivity. A total of 56 ACL injuries were identified in 52 players. Findings revealed a predominance in defenders (41.1%), a high prevalence of non-contact mechanisms (67.9%), and a median RTP of 280 days. Notably, the match-to-training injury ratio was 1.8–1, a significantly narrower gap than historical records. The recurrence rate was 17.9%, with 70% of cases occurring in the contralateral knee. Methodologically, the AI model exhibited a learning curve: 44.4% sensitivity in the initial refinement season (2019/2020), which progressed to a sustained 100% sensitivity across the following five seasons (2020–2025). ACL injury incidence in LaLiga remains stable, but the narrowing match-to-training ratio suggests that modern training intensities are reaching competitive levels of biomechanical stress. LLMs, once optimized through prompt engineering, provide a highly reliable and scalable tool for near real-time epidemiological surveillance, representing a methodological milestone in sports medicine research.

BACKGROUND Physical exercise involving simultaneous cognitive demands, including dance-based exergames, has shown moderate effects on executive function. Immersive virtual reality (VR) may enhance these effects by increasing presence and frontal cortical activation; however, evidence in youth integrating objective neurophysiological measures remains limited and methodologically heterogeneous. OBJECTIVE This study aims to examine the acute and chronic effects of an immersive VR dance exergame, considered as an integrated package of immersion, interactivity, and real-time performance feedback, compared with a matched video-guided screen-based exercise condition (comparator condition [CS]), on inhibitory control as the primary outcome, and on frontal cortical activity, perceived self-efficacy, affective state, and physiological response as mechanistic or secondary outcomes. METHODS This protocol reports 2 methodologically independent studies, covered by a single prospective trial registration that describes both, in young adults aged 18 to 30 years: an acute randomized crossover study with up to 40 participants, and a 10-week 2-arm randomized controlled trial with a target sample of 64 participants and 3 sessions per week. In the VR condition, participants will play Beat Saber using Meta Quest 2 headsets. In the CS, they will follow a prerecorded video of the same playlist, matched for songs, tempo, movement sequence, difficulty, transition periods, and session duration. The primary outcome is the Stroop interference index. The confirmatory neurophysiological end point is absolute frontal theta power (4-7 Hz) averaged across F3, F4, AF3, and AF4 during the color-word interference condition. Secondary and exploratory outcomes include additional spectral measures, perceived self-efficacy, affective state, heart rate and percentage of heart rate reserve, rating of perceived exertion, wrist accelerometry, presence, cybersickness, enjoyment, and expectations. Assessments are conducted before and after each session in the acute study and at baseline, midpoint, postintervention, and 4-week follow-up in the chronic study. Linear mixed models accounting for period, sequence, participant, and the within-session pre/post structure will be used, with a prespecified hierarchy of confirmatory and exploratory analyses and false discovery rate correction applied within defined families. RESULTS Recruitment is expected to begin in October 2026, with data collection completed by December 2027 and first results available by June 2028. No participants had been enrolled at submission. CONCLUSIONS This protocol presents a controlled experimental design to examine the effects of immersive VR exergaming, compared with matched video-guided screen-based exercise, on neurocognitive, psychological, and physiological outcomes. Incorporating immersion-related variables may help clarify the mechanisms underlying VR-based exercise and inform future technology-supported interventions in exercise and cognitive health. CLINICALTRIAL ISRCTN Registry ISRCTN15563829; https://www.isrctn.com/ISRCTN15563829 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/105801

To examine the associations of objectively measured sedentary behavior and ambulatory activity with circulating 25-hydroxyvitamin D (25(OH)D) concentrations, this cross-sectional study analyzed baseline data from physically inactive postmenopausal women within 10 years of menopause onset and with vitamin D deficiency (25(OH)D n = 88). Physical activity and sedentary behavior were evaluated under free-living conditions using a wrist-worn triaxial accelerometer (Fitbit Versa 3) worn continuously for 7 consecutive days. Participants were stratified into tertiles of daily step count and sedentary time within the vitamin D–deficient subgroup. Differences in serum 25(OH)D concentrations across tertiles were examined using Kruskal–Wallis tests with Bonferroni-corrected Mann–Whitney post hoc comparisons when appropriate, and associations between continuous variables were assessed using Spearman correlation. No significant differences in serum 25(OH)D concentrations were observed across tertiles of daily step count (Kruskal–Wallis, p = 0.23), and daily step count was not correlated with 25(OH)D concentrations (Spearman’s ρ ≈ 0, p = 0.52). In contrast, serum 25(OH)D concentrations differed significantly across sedentary-time tertiles (Kruskal–Wallis, p < 0.05), with lower levels observed in women in the highest compared with the lowest sedentary tertile (Bonferroni-corrected p < 0.05). Consistently, sedentary time showed a modest but statistically significant inverse association with circulating 25(OH)D concentrations (Spearman’s ρ = −0.28, p = 0.010). In vitamin D–deficient postmenopausal women in early post menopause, objectively measured sedentary behavior, but not ambulatory activity volume, was associated with lower serum vitamin D concentrations. These findings suggest that sedentary behavior may be associated with lower vitamin D concentrations in this specific subgroup, highlighting the potential relevance of sedentary patterns as a behavioral correlate warranting further investigation.

Adolescents and young adults with intellectual and developmental disabilities (IDs) experience disproportionately low physical activity and high sedentary time yet remain insufficiently served by scalable and cognitively accessible health-enhancing physical activity (HEPA) programmes. This study reports proof-of-concept evidence for IDHEApp, a co-designed, gamified mobile health (mHealth) intervention integrated with a wearable activity tracker to promote physical activity in cognitively diverse users. We conducted an 8-week, convergent mixed-methods pilot randomised controlled trial across two European community IDs services (Rome, Italy; Rijeka, Croatia). Sixty adolescents and young adults were randomised (1:1) to an intervention arm (IDHEApp with Fitbit-enabled feedback and gamified step challenges) or a control arm (Fitbit monitoring plus usual routines). Quantitative outcomes were derived from wearable data (primary: daily step count; secondary: activity intensity and posture-related indicators) and analysed as exploratory behavioural signals using ANCOVA adjusted for baseline values. Qualitative data were obtained through two-phase focus groups (pre-implementation formative assessment and post-implementation technology exposure) with adolescents and young adults and caregivers and examined using reflexive thematic analysis. The intervention was technically feasible to deploy in real-world service settings at both sites. The strongest between-group signal was observed for daily steps (+2068 steps/day; p < 0.001), whereas activity-intensity and posture metrics demonstrated smaller and less consistent patterns. Thematic findings suggested that simple, non-competitive gamification (step goals, points, badges) was readily understood and perceived as motivating, supporting sustained engagement; however, technical barriers (Bluetooth pairing, synchronisation, device charging) increased reliance on caregiver support. Collectively, these findings indicate that IDHEApp is a promising mobile–wearable ecosystem to support HEPA in adolescents and young adults with IDs and justify further optimisation to enhance technical robustness, reduce caregiver burden, and evaluate effectiveness over longer follow-up periods.

Knee injuries remain prevalent in sports involving landing tasks, particularly among non-professional athletes. Sex-specific neuromuscular strategies during landing may contribute to different joint stabilization patterns. The aim of this study was to examine sex-related differences in thigh muscle activation and hamstrings-to-quadriceps (H/Q) co-activation during standardized single-leg landings in recreational athletes. A total of 162 physically active participants (25% women) performed a single-leg drop landing from 30 cm. Surface electromyography was recorded from the rectus femoris and biceps femoris and normalized to maximal voluntary contraction (MVC). Muscle activation was analyzed across early post-contact time windows (50, 100, 150, and 200 ms). Between-sex comparisons were conducted using independent t-tests with Bonferroni correction (α = 0.0033). At the group level, quadriceps activation exceeded hamstrings under MVC-normalized conditions, whereas during the early post-contact phase hamstring activation was slightly higher, with H/Q ratios close to unity. Men showed greater quadriceps activation than women at 50 ms post-contact, which remained significant after correction. Other sex differences did not reach the adjusted significance threshold. No significant sex differences were observed for hamstring activation. Recreational single-leg landings are characterized by high early-phase thigh activation with balanced H/Q ratios. These findings suggest that early neuromuscular responses and sex-specific activation patterns should be considered when designing injury prevention and neuromuscular training programs, particularly those targeting rapid muscle coordination during the initial phase of landing.

Introduction: The relationship between external workload and injury risk in elite football remains controversial. While acute increases in workload have traditionally been associated with injury occurrence, recent evidence suggests that universal workload thresholds may not adequately capture the multifactorial nature of sports injuries. Objective: To investigate whether football injuries are preceded by specific patterns of GPS-derived external load, with particular emphasis on high-speed running (HSR), sprint exposure, maximum speed, and acute:chronic workload ratios (ACWR). Methods: A retrospective observational study analysed 270 GPS-derived training and match records from eight male professional football players who sustained 11 injuries during the 2024–2025 season. External load variables recorded during the 0–7 days preceding each injury were compared with those recorded during the preceding 8–28-day period. Generalized estimating equations (GEE), event-level ACWR analyses, receiver operating characteristic (ROC) analyses, and temporal trend analyses were performed. Results: No generalized increase in external workload was observed during the 0–7 days preceding injury. Total distance did not differ significantly between the 0–7 and 8–28-day windows (p = .229), whereas relative distance was significantly lower during the 0–7-day window (p = .015). No significant differences were observed for HSR, sprint count, or maximum speed. At the event level, ACWR values >1.25 were observed for HSR in four of 11 injury events and for sprint exposure in five of 11 events, whereas no such increases were observed for total distance or maximum speed. GPS-derived variables showed limited ability to discriminate between the two pre-injury windows, with oriented AUC values ranging from 0.52 to 0.58. Conclusions: Injury events were not consistently preceded by elevated absolute external workloads. Although some events were preceded by relative increases in HSR and sprint exposure, the absence of comparable non-injury control periods prevents determining whether these patterns were specific to periods preceding injury. These findings support the exploratory use of individualized monitoring to contextualize fluctuations in high-intensity locomotor exposure, rather than the use of universal workload thresholds or isolated GPS-derived variables as injury-prediction tools.

Despite the high incidence of knee injuries reported in non-professional sports, the implementation of specific training programmes aimed at mitigating the kinematic and kinetic factors associated with these injuries remains limited. To determine the effects of a tailored exercise programme on kinematic and kinetic variables during side-cutting activities. Fifty-seven physically active participants were randomised into control group (CG; n: 28) that received no intervention, and an experimental group (EG; n: 29), that performed an individualised exercise programme that included a combination of strength, neuromuscular, proprioceptive, eccentric training and whole-body vibration (WBV) exercises. Knee, hip and trunk angles, vertical ground reaction force (VGRF), force in the antero-posterior (AP) and medio-lateral (ML) axes, acceleration, contact time and impulse were assessed during three types of side-cutting, two open manoeuvres (30º and 45º - SC₃₀ and SC₄₅ -respectively) and one closed manoeuvre (45º - SC_45cl-). After the 12-week intervention, EG participants had lower knee extension during all side-cuttings, shorter contact time and lower acceleration, VGRF and impulse compared to CG during side-cutting manoeuvres. A tailored exercise programme could be an effective neuromuscular and biomechanical strategy to reduce risk factors for knee injury in healthy, physically active young people.

Systematically, this study assessed the impact of digital technologies, including social media, on health, diet, and sports, amid rising concerns and acknowledged benefits. We performed a comprehensive review of literature spanning 20 years, up to June 2024, focusing on interventions targeted at youth aged 14-29. Our initial database search identified 8,278 articles. After removing duplicates and those that failed to meet inclusion criteria, 307 articles underwent a rigorous blinded peer review process, ultimately resulted in 29 studies for synthesis. Our analysis concludes the dual impact of digital technologies on youth: although they highlight the positive potential in colouring youth health behaviors, often linked to sports, nutrition, and active lifestyles, they also pose risks due to the unregulated and misleading content, emphasizing the necessity for enhanced digital literacy and critical engagement with content. In this context, five major theme highlight this paradoxical impact together: 1) Increasing awareness, knowledge and self-efficacy, 2) Hazards, misinformation, and credibility, 3) Attitudes and behavior change, 4) Social comparison, and 5) Product promotion. Eventually, we draw attention to the urgent need for regulations and systematic content verification to protect youth from misinformation and to strengthen the credibility, trustworthiness and effectiveness of health, diet and sport related content on these technologies.