Gamification in physical education is an active methodology that fosters student engagement. However, few studies have examined its influences based on the types of elements in gamification. This study analyzed and compared the effects of these factors on motivation, future physical activity intention and basic psychological needs. The intervention was conducted with secondary school students in Spain during 8 physical education sessions in different schools. The 209 participants were divided into 3 groups: a control group (CG), a group where intrinsic gamification elements predominated (InMG), and another where extrinsic elements predominated (ExMG). Participants completed the questionnaires before and after the intervention. The results revealed a significant time × group interaction effect for perceived competence (p = .023) and future physical activity intention (p = .02). Although these interactions did not derive from statistically significant post-hoc pairwise comparisons, descriptive trends revealed a tendency toward an increase in perceived competence for both the ExMG and InMG, and a specific upward tendency for future physical activity intention only within the InMG. No significant effects were observed for the remaining motivational regulations, which remained stable across all conditions. In conclusion, the findings delineate the specific and nuanced impacts of the two evaluated gamification profiles. While both the InMG and ExMG frameworks were associated with a descriptive tendency toward a slight improvement in students' perceived competence compared to the CG, the InMG profile suggested a possible descriptive advantage in fostering intentions for future physical practice that requires further confirmation.

There is limited knowledge of the relationship between gestational age and physical activity assessed by accelerometers in population-based cohort studies. We examined how gestational age predicts physical activity among adolescents and adults. Data from 12 896 participants (13-52 years) with physical activity assessed by two tri-axial accelerometers for seven days in the population-based Trøndelag Health Study (HUNT Study) were linked to the Medical Birth Registry of Norway. Metabolic equivalent of task (MET) min/day and min/day in total, moderate to vigorous, and light physical activity were calculated. Effects of gestational age (in weeks) and birth weight (in grams) on physical activity were modelled using fractional polynomials and linear regression. Gestational age predicted MET min/day in light physical activity (B = 1.53, 95% CI: 0.02 to 3.07) in the total sample, especially among females (B = 2.14, 95% CI: 0.33 to 3.93), and in total physical activity among adolescents (B = 2.44, 95% CI: 0.16 to 4.88). Gestational age predicted min/day in total physical activity in the total sample (B = 0.99, 95% CI: 0.07 to 1.90), among females (B = 1.25, 95% CI: 0.11 to 2.40) and adolescents (B = 1.06, 95% CI: 0.02 to 2.12). There were no non-linear or linear effects of birth weight on physical activity. Shorter gestation predicted less physical activity in the total sample, among females, and in adolescents. The associations with total physical activity are by and large consistent with previous observations that individuals born preterm with very low birth weight have lower rates of physical activity.

Small diameter unmyelinated (group IV) and myelinated (group III) muscle afferents transmit action potentials to signal muscle pain and the exercise pressor reflex (EPR). The EPR helps to drive the cardiovascular response to exercise. µ- (µOR), δ- (δOR), and κ- (κOR) opioid receptors (OR) have been shown to be expressed by dorsal root ganglia (DRG) neurons, but only peripheral µOR activation has been shown to inhibit the EPR mediated by group IV afferents. To determine if this results from differential OR expression, we identified group IV neurons in DRG and axons in gastrocnemius muscles from both male and female rats, and used immunocytochemistry to compare the expression of µOR, δOR, and κOR. We show that µOR labeling was more frequently observed in group IV somata and axons vs. δOR or κOR. OR axonal labeling was lower than somata labeling, particularly for δOR & κOR. There were no significant differences in OR staining between male and female animals. The relatively high µOR axonal expression suggests that µOR are selectively transported to the peripheral group IV axons and can explain the selective effect of µOR agonists to inhibit group IV afferent activity that generates the EPR and muscle pain.

Machine learning is central to modern science, industry, and policy, yet its predictive power often comes at the cost of transparency: We rarely know which input features drive a model's predictions. Without such understanding, researchers cannot draw reliable conclusions, practitioners cannot ensure fairness or accountability, and policymakers cannot trust or govern model-based decisions. Existing tools for assessing feature influence are limited; most lack statistical guarantees, and many require costly retraining or surrogate modeling, making them impractical for large modern models. We introduce AICO (Add-In COvariates), a broadly applicable framework that turns model interpretability into an efficient statistical exercise. AICO tests whether each feature contributes to predictive performance by masking its information and measuring the resulting change. The method provides exact, finite-sample feature [Formula: see text]-values and CIs for feature importance through a simple, nonasymptotic hypothesis testing procedure. It requires no retraining, surrogate modeling, or distributional assumptions, making it feasible for large-scale algorithms. In both controlled experiments and real applications, from credit scoring to mortgage-behavior prediction, AICO identifies variables that contribute to model behavior, providing a scalable and statistically principled path toward transparent and trustworthy machine learning.

Background/Objectives: Sarcopenia is a common public health problem in older adults and is associated with an increased risk of morbidity and mortality, particularly in institutionalized populations. This study aimed to determine the prevalence of sarcopenia in institutionalized older adults, assess the adequacy of protein intake in terms of quantity and quality, and identify factors associated with its presence. Methods: An observational, analytical, cross-sectional study was conducted in three institutional care homes in Loja canton, Ecuador, between 2024 and 2025. A total of 44 older adults aged ≥65 years were included. Sarcopenia was diagnosed according to the EWGSOP2 criteria, and protein intake was assessed using the direct food-weighing method over three days. Descriptive, comparative, and binary logistic regression analyses were performed. Results: The prevalence of confirmed and severe sarcopenia was 61.3%. Severe sarcopenia was more frequent in men, whereas probable sarcopenia was more frequent in women. Participants with sarcopenia presented with lower skeletal muscle mass, skeletal muscle index, and muscle strength. Protein intake was generally insufficient compared with international recommendations, although protein quality was predominantly high or very high. Higher skeletal muscle mass and higher body mass index were independently associated with a lower likelihood of sarcopenia. Conclusions: Sarcopenia in institutionalized older adults appears to be more closely associated with body composition and overall nutritional status than with protein quantity or quality alone. These findings support a comprehensive approach to the prevention and management of sarcopenia that combines adequate nutrition with tailored physical exercise interventions.

Background: Gastroesophageal reflux and exercise-induced bronchoconstriction (EIB) commonly coexist with asthma, but the effect of exercise on reflux remains unclear. We aimed to assess the prevalence of abnormal impedance-detected acid exposure in children with partially controlled or uncontrolled asthma, its association with EIB, and changes in reflux parameters after an exercise challenge test (ECT). Methods: Thirty patients aged 7-18 years underwent spirometry, treadmill ECT, and 48 h multichannel intraluminal impedance-pH monitoring. EIB was defined as a ≥10% fall in FEV1, and abnormal acid exposure as impedance-detected acid reflux lasting ≥1.2% of recording time. Results: Abnormal acid exposure was identified in 14/30 patients (46.7%), whereas EIB occurred in 6/30 (20.0%), with no significant association between them. The absolute number of reflux episodes was higher after ECT in the count-based analysis (43.0 [35.2-69.8] vs. 33.5 [21.2-54.5], p = 0.006); however, this finding was not confirmed after normalization to analyzable recording time in a sensitivity analysis. Overweight or obesity was present in 9 patients (30.0%) and correlated positively with acid exposure. BMI-for-age z-score correlated positively with acid exposure (ρ = 0.41, p = 0.025), but these findings did not remain significant after correction for multiple testing. Conclusions: Using the prespecified acid-exposure criterion, abnormal acid exposure was frequently identified in this cohort. No statistically significant association with EIB was demonstrated; however, the small number of EIB events limits definitive conclusions. The higher absolute post-ECT reflux episode count was not confirmed in a rate-based sensitivity analysis, and a causal effect of exercise on reflux cannot be established.

Swenson, AG, Smith, CD, Cavallero, NJ, Romero, GA, Pritchard, N, Bullock, GS, Miles, CM, Mihalik, JP, Urban, JE, and Stitzel, JD. Physical performance and head impact exposure in boys' youth ice hockey. J Strength Cond Res XX(X): 000-000, 2026-Evidence suggests that physical performance influences head acceleration event (HAE) exposure in collision sports, especially in youth populations undergoing physical and neuromuscular development. Concern surrounding negative effects of HAE exposure highlights a need to better understand individual-level factors that may increase propensity for HAEs. Therefore, this study evaluated relationships between physical performance and HAE exposure in youth ice hockey. Athletes from one 14U (n = 10) and one 16U (n = 7) ice hockey teams completed on-ice and off-ice assessments at a preseason hockey performance combine event and wore custom instrumented mouthpieces measuring HAE frequency and magnitude across their respective seasons. Outcomes were per-player cumulative HAE magnitudes, HAE rates, and percentage of HAEs with direct head contact. Linear regressions adjusted for age division, body mass index (BMI), and position evaluated relationships between physical performance and HAE exposure. Athletes experienced 1,027 total HAEs. Multiple physical performance measures for both on- and off-ice tasks were significantly associated with HAE exposure metrics, though the strength and direction of these relationships varied by task. Relationships were additionally modified by age division, BMI, and position. Skating speed tasks yielded the strongest associations for on-ice tasks, with faster Reed skate times associated with reductions in cumulative game HAE magnitudes. For off-ice tasks, vertical jump height was associated with lower cumulative game HAE magnitudes and reduced rates of direct head contact across all sessions. Findings may be of interest to coaches and athletic trainers for injury risk management and ultimately present early opportunities for the development of physical performance-based strategies to reduce HAE exposure.

Parkinson's disease (PD) involves progressive basal ganglia dysfunction, with hyperexcitability of striatal indirect-pathway D2 medium spiny neurons (D2-MSNs) linked to motor impairment. Neuromotor rehabilitation is an important therapy, but its efficacy varies across interventions. This thematic review examines eleven rehabilitative strategies for PD, spanning forced and voluntary exercise (FE and VE respectively), non-invasive brain stimulation (rTMS, tDCS), and technology-based approaches such as exoskeletons, augmented reality, and dual-task training, within a framework distinguishing striatal recalibration from compensation via alternative motor networks. To formalize this distinction, a Bayesian ranking framework combines neurobiological plausibility with clinical evidence quality, identifying three functional clusters: a high-recalibration cluster (FE, p ≈ 0.80; LSVT BIG, p ≈ 0.62), an intermediate-uncertainty cluster (rTMS, HIIT, tDCS, treadmill, resistance training, Tai Chi/dance; 0.40-0.56), and a bypass/compensatory cluster (augmented reality, exoskeletons, dual-task training; p ≤ 0.33). This distinction between direct modulation of basal ganglia circuitry and recruitment of alternative motor networks, including the lateral premotor cortex, parieto-premotor circuits, and cerebello-thalamo-cortical pathways, supports a precision rehabilitation approach in PD.

Obesity is a heterogeneous chronic disease involving dysregulated energy intake and expenditure. Dopamine (DA) has traditionally been recognized as a key regulator of reward-driven feeding. However, accumulating evidence indicates that its functions extend beyond hedonic eating. This review examines the central and peripheral actions of DA in obesity. It focuses on neuronal and receptor diversity, DA-related circuits, metabolic interactions, and responses to anti-obesity interventions.

Children with Fontan circulation (FC) rely on passive blood flow to the lungs and require optimal lung function [1, 2]. Singing has been shown to increase exercise capacity, improve lung function and enhance quality of life (QoL) in adults and in rare studies of children with non-cardiac disease [7-9]. Singing as an intervention has not been studied in children with FC. A feasibility program of in-person and online singing and breathing instruction was developed and trialed by the Bienen School of Music and the Heart Center of the Ann & Robert H. Lurie Children's Hospital of Chicago. Pre- and post-intervention measures of exercise capacity, respiratory muscle strength, and QoL assessments were conducted before and after 8 weeks of singing instruction. This study provided 30 min of private voice instruction and 60 min of group instruction/week for eight weeks. In-person instruction was supported by an asynchronous on-line program of singing and breathing exercises performed independently several days per week between in-person sessions. The program was safe and feasible. 14 children aged 8-16 years completed the study with an 89% attendance rate and 27.5% homework completion rate. Post-intervention assessments demonstrated improvements in 3 breathing measures (single breath counting, sustained ah, and Twinkle Twinkle task) p < 0.005. Improvements occurred in patient self-report of depression (p < 0.05) and parent proxy reports of school function (p = 0.04), depression (p = 0.03) and anxiety (p = 0.02) and patient wellbeing p < 0.01. There was no improvement in spirometry or 6MWT. The program was well received by both children and parents. Our findings support the feasibility and acceptability of singing as an adjunct intervention for FC patients. Further investigation of these findings in a larger, longer trial is warranted.