Research

Background: Tibial plateau fractures (TPF) are complex injuries that may lead to long-term functional deficits despite surgical management. This study aims to evaluate gait biomechanics in patients with severe tibial plateau fractures (Schatzker VI) treated with circular external fixation Methods: Eighteen patients (mean age 46.3 ± 12.9 years; 19.8 months median follow up) underwent a fully instrumented three-dimensional gait analysis (3DGA), isokinetic strength testing of knee extensors and flexors, and completed self-reported outcomes for quality of life (EQ-5D) and knee-specific function (KOOS). An age- and sex-matched control group (n = 36) served as reference. Results: While only subtle kinematic asymmetries were observed between the healthy and affected limbs, knee excursion in the operated limb was significantly reduced during stance (Δ = -2°, p = 0.039). Joints’ kinematics showed overall mild deviations, with no major angular deficits except from the hip and ankle joints. In contrast, kinetic impairments were evident. Ankle plantarflexion moment was reduced by 13.6 % in the operated limb compared to controls (p < 0.001, d = 1.08), and forward propulsive ground reaction force (GRF) was 5.5 % body mass lower (p < 0.001, d = 1.30). The second vertical GRF peak was also significantly diminished (-11.4 % body mass, p < 0.001, d = 1.03). The healthy limb exhibited milder but consistent kinetic alterations. Isokinetic testing revealed significant strength asymmetries, especially reduced quadriceps torque in the operated limb. EQ-5D and KOOS scores were significantly below normative values, though only moderately associated with gait metrics. Conclusion: These findings highlight persistent kinetic impairments months after injury, emphasizing the need for comprehensive lower-limb evaluation and targeted rehabilitation programs that extent beyond the injured joint alone.
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Skouras, A. Z., Papagiannis, G., Zafeiris, I., Soucacos, F., Triantafyllou, A., Tsolakis, C., Koulalis, D., & Koulouvaris, P. Gait & Posture, 2026

This study explores how social actors account for psychosocial barriers to healthcare access. Interviews with 17 residents in remote regions of Greece and 12 professionals employed by Mobile Medical Units were analyzed using the tools and concepts of critical discursive social psychology. Analysis indicated that, oriented to different accountability concerns, residents tended to attribute reluctance to seek medical help to structural barriers, while professionals leaned toward psychological and individual-centered explanations. Findings also highlighted the construction of living in hard-to-reach areas as both a “cure” and a “curse” for residents’ capacity to achieve a healthy status, representing remote communities as both enhancing solidarity and social support and as promoting stigmatization against illness and social isolation. Building upon prior discourse-oriented approaches in health psychology, the study seeks to exemplify how a discursive and rhetorically oriented research agenda can be employed to explore how health inequalities are enacted and (re)produced in social interactions.
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Vergouli, E. S., Figgou, L., Koulouvaris, P., & Scarmeas, N. Journal of Health Psychology, 2025

Platelets play a central role in primary hemostasis and arterial thrombosis, and accumulating evidence suggests that physical exercise can modulate platelet function. Acute vigorous or exhaustive bouts commonly produce transient thrombocytosis, enhanced aggregation and degranulation (e.g., P-selectin, β-TG, and PF4), increased thromboxane generation, and short-lived shifts toward hypercoagulability; these responses seem to scale with exercise intensity, adrenergic drive, and shear stress and may be amplified in untrained or high-risk individuals. By contrast, repeated training across modalities (aerobic, resistance, and high-intensity interval) generally lowers resting platelet reactivity, augments endothelial nitric oxide (NO) bioavailability, improves redox balance, and strengthens fibrinolytic capacity. These favorable adaptations may diminish with detraining, suggesting that the platelet-modulating effects of exercise are dynamic and contingent on consistent training exposure. In this review, we examine the association between platelet function and distinct exercise modalities, including aerobic, resistance, and high-intensity training, influence. We compare exercise modalities, intensities, and fitness states and consider major methodological sources of heterogeneity (assay selection, sampling timing, exercise prescription, and inter-individual variability) that complicate interpretation. Clinically, regularly performed, appropriately progressed exercise appears net favorable for hemostatic balance, whereas unaccustomed extreme exertion in high-risk individuals should be approached with preparation and caution. Better-standardized protocols and biomarker-informed trials are needed to refine exercise prescriptions for reducing thrombotic risk.
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Skouras, A. Z., Tsantes, A. G., & Koulouvaris, P. Seminars in Thrombosis and Hemostasis, 2025

Purpose: Bone mineral measurements and their association with peak impact and sport-specific, persistent muscle loads were examined in 10 elite artistic swimmers age 15-19 years. Methods: Bone mineral density (BMD) and bone mineral content (BMC) of total body, total body less head, spine, and dominant and nondominant limbs were assessed by dual-energy X-ray absorptiometry. Peak ground-reaction forces of 2 dry jumps (countermovement jump and frog jump) were measured on a force plate. Peak forces applied during in-water exercises (vertical scull, barracuda push, and kick pull) were measured. Results: On average, artistic swimmers’ total-body BMD (1.12 [0.08] g/cm2) was similar to values reported for young swimmers and nonathletic females, and total-body BMC (2359 [399] g) was higher than previously reported in race swimmers. Based on previously published reference curves, 9 out of 10 artistic swimmers had total-body less head BMD and BMC at or above the 90th percentile, with average to above average z scores and height-adjusted z scores for their age. Countermovement jump and frog jump exhibited moderate peak ground-reaction forces (2.61 [0.46] and 1.93 [0.42] N/kg, respectively). In water, greater force was exerted in kick pull (60.4 [4.8] N) compared with vertical skull (45.5 [6.4] N) and barracuda push (40.6 [4.8] N). Bone measurements were correlated with the peak ground-reaction forces exerted in both dry jumps (r = .61-.83, P ≤ .05) and the peak force output of the in-water exercises (r = .63-.80, P ≤ .05). Conclusion: These results imply robust bone health among artistic swimmers, partially associated with the high muscle forces regularly applied during their sport-specific training that seem to counteract the low-impact nature of the sport.
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Skouras, A. Z., Koulouvaris, P., Tsekouras, Y., Antonakis-Karamintzas, D., Goutseva, A., Tsolakis, C., & Klentrou, P. International Journal of Sports Physiology and Performance, 2025

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Skouras, A. Z., & Koulouvaris, P. Research and Practice in Thrombosis and Haemostasis, 2025

Physical activity (PA) is widely recognized as a therapeutic intervention for numerous non-communicable diseases. This study assessed Greek medical students’ knowledge and education on PA across seven medical schools. A structured questionnaire was distributed electronically to all medical schools across Greece, with 135 students responding (67.4% female). Among respondents, 78.5% reported being taught about PA benefits, and 77.8% felt prepared to discuss them with patients. However, 30.2% had received less than two hours of formal PA education. Only 25.2% were aware of the World Health Organization (WHO) and Greek Central Board of Health (KESY) recommendations, while 81.5% expressed the need for additional education on PA and its role in health. Students who were taught about PA were more likely to address exercise physiology (42.5% vs. 17.2%, p = 0.013, OR = 16.4), cardiopulmonary exercise testing (52.8% vs. 24.1%; p = 0.006, OR = 3.5), and PA benefits (89.6% vs. 34.5%; p < 0.001, OR = 3.5). Although most medical students have been taught about PA’s health benefits, only a small proportion have sufficient knowledge for effective prescription.
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Kyriakoulakou, E., Skouras, A. Z., Tsolakis, C., Koulouvaris, P., & Philippou, A. Behavioral Sciences, 2025

Purpose: This study aimed to cross-culturally adapt the second version of the Oslo Sports Trauma Research Center Questionnaires on Overuse Injuries (OSTRC-O2) and Health Problems (OSTRC-H2) into Greek. Materials and Methods: The questionnaires were translated using the back-translation method in accordance with international guidelines. The OSTRC-O2 was administered to 56 female volleyball players, focusing on shoulder injuries, while the OSTRC-H2 was delivered to 52 adolescent and young adult male and female volleyball and soccer players. Validity was assessed through content validity (Content Validity Index – CVI), face validity (using additional questions on comprehensibility, difficulty, relevance, and completeness), and concurrent validity (correlations between the OSTRC-O2 severity score and the numeric pain rating scale [NPRS], as well as between the OSTRC-H2 severity score with days of time loss [DL] and NPRS). Reliability was evaluated using internal consistency (Cronbach’s α) and the test-retest method (intraclass correlation coefficient – ICC). The study was conducted for a two-week period and the test-retest was performed with a two-day interval. Results: Twenty-three athletes (41%) reported shoulder problems using the OSTRC-O2, while 28 injury events and 5 cases of illness were reported with the OSTRC-H2. Face and content validity were excellent (CVI = 0.925 and 0.975 for OSTRC-O2 and OSTRC-H2). A strong correlation was observed between the OSTRC-O2 severity score and the NPRS (ρ = 0.819, p < 0.001), while the OSTRC-H2 severity score demonstrated significant correlations with both the NPRS (ρ = 0.72, p < 0.001) and days of time loss (ρ = 0.625, p < 0.001). Both questionnaires demonstrated excellent reliability and internal consistency, with the OSTRC-O2 showing an ICC of 0.90 (95% CI: 0.82–0.94) and Cronbach’s alpha of 0.84, and the OSTRC-H2 showing an ICC of 0.93 (95% CI: 0.89–0.97) and Cronbach’s alpha of 0.93. Conclusions: The Greek versions of the OSTRC questionnaires are valid and reliable tools for injury surveillance among Greek volleyball and soccer players.
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Antonopoulos, K., Skouras, A. Z., Melissaridou, D. E., Papagiannis, G. I., Triantafyllou, A., Antonakis-Karamintzas, D., Papitsi, F., Tsolakis, C., Savvidou, O., Papagelopoulos, P. J., & Koulouvaris, P. International Journal of Sports Science & Coaching, 2025

Background: Over the past several decades, soccer has undergone significant evolution, reflected by increasing physical demands and distinct anthropometric characteristics among elite players worldwide. This study examines long-term trends in anthropometric and physiological characteristics of professional soccer players of Greece first division from 1981 to 2013. Methods: A repeated cross-sectional study was conducted, analyzing data from 850 male players, aged 18-40, competing in Greece’s top soccer league. Participants were divided into five groups based on evaluation periods (1981-1989, 1990-1995, 2000-2004, 2005-2010, and 2011-2013). Anthropometric measurements included height, body mass, and body fat percentage, while physiological assessments included maximal oxygen uptake (V̇O<inf>2max</inf>), minute ventilation (VE), anaerobic power (Wingate Test), and vertical jump height (countermovement jump, CMJ). Data were analyzed using non-parametric statistical tests, with correlations assessed and adjusted for anthropometrics. Results: Over time, significant increases were observed in height (η2=0.089, P<0.001), V̇O<inf>2max</inf> (η2=0.281, P<0.001), anaerobic power output (η2=0.732, P<0.001), and CMJ height (η2=0.160, P<0.001), while body fat percentage declined significantly (η2=0.085, P<0.001) from 1981 to 2013. Positive correlations were found between V̇O<inf>2max</inf>, anaerobic power, and CMJ performance. Conclusions: The observed improvements in anthropometric and physiological characteristics among Greek soccer players reflect the increased physical demands of modern soccer over a period of about 30 years. Increased aerobic and anaerobic capacities, along with improved body composition, indicate the impact of advancements in training and selection practices. Future research should investigate how various training practices and individual internal and external factors affect performance outcomes.
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Antonakis-Karamintzas, D., Skouras, A. Z., Poulos, S., Pavlou, K. N., Behrakis, P. K., Vassiliou, M. P., Balabinis, C. P., Tsolakis, C., Christogeorgos, P., & Koulouvaris, P. The Journal of Sports Medicine and Physical Fitness, 2025

Cardiopulmonary resuscitation (CPR) is a vital skill for healthcare professionals, crucial in life-saving situations. More than 80% of cardiac arrest cases occur out of hospital. As the demand for competent CPR practitioners grows, the effectiveness of training methods becomes increasingly important, especially for undergraduate students preparing to enter the healthcare field. The primary objective of our study is to investigate the effectiveness of simulation-based teaching methods and by integrating innovative technologies, such as the OMNI2 simulator, to enhance practitioners’ performance and to improve the precision and objectivity of CPR instruction. A cohort of 144 undergraduate students from the Nursing School Department of the National Kapodistrian University of Athens participated in an 8 h Basic Life Support Seminar. It consisted of a 5 h theoretical instruction followed by 3 h of practical training using the OMNI2 simulator. Each student was tasked to identify cardiac arrest and to perform two cycles of CPR according to the 2021 guidelines. Metrics, including total session time, cycles performed, compression-to-ventilation ratio, compression depth, compressions and ventilations per minute, full recoil, peak inspiratory pressure, and ventilation duration, were measured and compared against the simulator’s preset targets. Statistically significant differences (p < 0.05) were observed for all outcomes. In conclusion, while simulation-based teaching has conventionally been proven effective for CPR proficiency, real-time data collected in this study reveal a disparity between anticipated and actual performance. Our research underscores the necessity of refining instructional methods to enhance skill acquisition, potentially leading to improved patient outcomes in the future.
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Alevrogianni, F., Korompeli, A., Triantafyllou, C., Katsoulas, T., Koulouvaris, P., & Myrianthefs, P. International Medical Education, 2025

Total hip arthroplasty (THA) is a preferred treatment for primary osteoarthritis (OA) or secondary degenerative arthropathy due to developmental hip dysplasia (DDH). Gait analysis is considered a gold standard for evaluating post-arthroplasty walking patterns. This study compared post-THA spatiotemporal gait parameters (SGPs) between OA and DDH patients and explored correlations with demographic and clinical variables. Thirty patients (15 per group) were recorded during gait and their SGPs were analyzed. Functionality was evaluated with the Oxford Hip Score (OHS). The OA patients were significantly older than DDH patients (p < 0.005). Significant and moderate to strong were the correlations between SGPs, age, and four items of the OHS concerning hip pain and activities of daily life (0.31 < Pearson’s r < 0.51 all p < 0.05). Following THA, both groups exhibited similar levels of the examined gait parameters. Post-arthroplasty SGPs and OHS correlations indicate limitations in certain activities. Given the absence of pre-operative data and the correlation between age and SGPs and OHS, ANCOVA testing revealed that age adjusts OHS and SGP values, while pre-operative diagnosis has no main effect. These findings indicate that hip OA or DDH do not affect postoperative SGPs and patients’ functionality. Future studies should examine both kinematic and kinetic data to better evaluate the post-THA gait patterns of OA and DDH patients.
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Stasi, S., Papagiannis, G., Triantafyllou, A., Papagelopoulos, P., & Koulouvaris, P. Journal of Functional Morphology and Kinesiology, 2024

Training load monitoring is a common practice in sports medicine for supporting athletes’ health and performance. Despite progress in exercise oncology research for breast cancer patients, training load monitoring is underutilized. This study retrospectively investigated the relationship between maintained training load within a defined range and physical and health outcomes of ten breast cancer patients during active anticancer treatment who underwent a 12-week exercise program. Intervention consisted of endurance and resistance training, three times a week, with each session lasting 30-45 min. Assessments were conducted at baseline, 6 and 12 weeks after enrollment, evaluating physical function (6-min walk test-6MWT, and sit-to-stand), muscle strength, body composition, sleep quality (Pittsburgh Sleep Quality Index-Pittsburgh Sleep Quality Index), quality of life (EORTC-QLQ-C30), heart rate variability and physical activity levels (International Physical Activity Questionnaire-International Physical Activity Questionnaire). The Physiological Cost Index/Energy Expenditure Index (PCI/EEI) was estimated using the 6MWT and Heart rate. Training load monitoring was performed by session rating of perceived exertion (sRPE, relative intensity multiplying with session duration). Acute-to-Chronic Workload Ratio (ACWR) (7:28, rolling average) was calculated accordingly. Analyses were performed within-subjects across time points and between-subjects, comparing those who maintained from weeks 6-12 an ACWR of 0.8-1.3 with those who did not. Adherence rates were similar between groups. Physical function improved in the total sample with large effect sizes (Δ6MWT = 56.5 m [95%CI: 6-100 m], effect size [w] = 0.52, p = 0.006; ΔSit-to-Stand = 1.5 [95%CI: 1-5], effect size [w] = 0.681, p < 0.001), demonstrating greater changes in patients with higher ACWR. Sleep quality improvements were higher in the appropriate ACWR group (p = 0.016). A positive correlation was demonstrated between global health status and 6MWT change from baseline to 12 weeks (ρ = 0.689, p = 0.04). Despite a small sample size, patients maintaining sufficient relative training load presented greater physical fitness and sleep quality improvements. Thus, training load monitoring may enhance exercise program benefits in breast cancer patients under active treatment.
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Skouras, A. Z., Antonakis-Karamintzas, D., Tsolakis, C., & Koulouvaris, P. Frontiers in Physiology, 2024

Background: Total hip arthroplasty (THA) is one of the most cost-effective and successful procedures in orthopedics. However, assessing the post-operative range of motion (ROM) remains a challenge due to the limitations of traditional measurement methods. This study aimed to evaluate hip and spine ROM post-operatively and single-leg balance, using a single-camera markerless motion capture system, and compare outcomes with pre-operative ROM and with an age-matched healthy control group. Methods: An interventional study was conducted from January 2018 to December 2021. Twenty patients with hip osteoarthritis underwent THA and were assessed using a single-camera markerless system (Kinetisense software). Measurements were taken one month pre-operatively and one year post-operatively. Results: Significant improvements were observed in hip and lumbar spine ROM variables after THA. The most notable enhancements were in hip and spinal flexion. Compared to the control group, the THA group showed minor deficits in hip ROM, particularly in external rotation. Single-leg balance demonstrated improved stability post-operatively. Conclusions: The single-camera markerless motion capture system offers a promising alternative for assessing hip and lumbar spine ROM, presenting potential advantages over manual goniometry and traditional 3D motion capture systems. Using this system for the evaluation of patients after THA, it seems that THA significantly enhances hip and lumbar spine ROM. Future research should focus on validating the accuracy of markerless systems.
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Roustemis, A. G., Gavriil, P., Skouras, A. Z., Melissaridou, D., Sioutis, S., Trikoupis, I., Karampikas, V., Avgerinos, K., Altsitzioglou, P., Koulouvaris, P., Papagelopoulos, P. J., & Savvidou, O. Cureus, 2024

Classical ballet dancers are exposed daily to physically demanding movements. Among these, the Grand Plié stands out for its biomechanical complexity, particularly the stress applied to the knee joint. This study investigates the knee kinematics of healthy professional classical ballet dancers performing the Grand Plié. Twenty dancers were evaluated with a motion analysis system using a marker-based protocol. Before measurements, the self-reported Global Knee Functional Assessment Scale was delivered for the knees’ functional ability, and the passive range of knee motion was also assessed. The average score on the Global Knee Functional Assessment Scale was 94.65 ± 5.92. During a complete circle of the Grand Plié movement, executed from the upright position, the average maximum internal rotation of the knee joint was 30.28° ± 6.16°, with a simultaneous knee flexion of 134.98° ± 4.62°. This internal rotation observed during knee flexion exceeds the typical range of motion for the joint, suggesting a potential risk for knee injuries, such as meniscal tears. The findings provide an opportunity for future kinematic analysis research, focusing on the movement of the Grand Plié and other common ballet maneuvers. These data have the potential to yield valuable information about the knee kinematics concerning meniscus damage.
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Fotaki, A., Triantafyllou, A., Koulouvaris, P., Skouras, A. Z., Stasinopoulos, D., Gkrilias, P., Kyriakidou, M., Stasi, S., Antonakis-Karamintzas, D., Tsolakis, C., Savvidou, O., & Papagiannis, G. Sports, 2024

The purpose of the study was to examine the effects of dry-land strength endurance (SE) and maximum strength (MS) sessions on next-day swimming performance. Eight swimmers (age: 18.6 ± 2.9 years) performed evening training sessions (19:00-19:40), including: (i) SE (2 × 15 – 20 repetitions, 50% of 1-RM), (ii) MS (2 × 5 repetitions, 90% of 1-RM), (iii) control (CON: no dry-land training). All sessions were followed by a 90-min swimming training (20:00-21:30). Medicine ball throw and countermovement jump, free countermovement jump and squat jump were evaluated before and after the dry-land training session and 12 h later, before a 100-m front crawl sprint (next day at 8:30 a.m.). Performance time, RPE, blood lactate and biomechanical variables in 100-m sprint were no different between conditions (time, MS: 64.70 ± 7.35, SE: 63.81 ± 7.29, CON: 64.52 ± 7.71 s, p > 0.05). Jump height was not changed before and after dry-land and before the 100-m sprint in all conditions (p > 0.05). Medicine ball throw was lower in MS compared to CON before the 100-m sprint (MS: 4.44 ± 1.11, vs. CON: 4.66 ± 1.21 m, p < 0.05). Upper-body but not lower- body muscle function may be affected by MS training. However, performance in a 100-m test is not affected by dry-land training performed 12 h earlier.
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Tsoltos, A., Arsoniadis, G., Tsolakis, C., Koulouvaris, P., Simeonidis, T., Chatzigiannakis, A., & Toubekis, A. Journal of Functional Morphology and Kinesiology, 2023

Aim of the study was to compare the isometric strength of flexors and extensors trunk muscles between male and female elite adolescent athletes of different age and training experience. Absolute and relative trunk muscle isometric peak extension (PTE) and flexion (PTF) torque, as well as flexion/extension (F/E) ratio were evaluated in 388 elite adolescent athletes 188 males (Age: 15.4±1.8 years, Body height: 175.5±11.2 cm, Body mass: 68.8±14.5 kg, BMI: 22.1±0.3 kg/m2) and 207 females (Age: 15.1±1.6 years, Body height: 166.8±7.8 cm, Body mass: 60.8±8.4 kg and BMI: 21.8±0.4 kg/m2). Participants were assigned into seven different groups according to their sport specialisation (oars-paddle, swimming, contact-combat, team, racket, winter and mixed other sports). Significant effect of age (η2: 0.077-0.112, p < 0.05), gender (η2: 0.020-0.077; p < 0.05) and sport category factors (η2: 0.057-0.154. p < 0.005) for absolute/relative PTE, PTF and F/E ratio was found. The highest values were observed in contact-combat and the lowest in mixed other sports groups. F/E ratio significantly differs between the age groups, especially in female athletes. The present data suggest that TMSs and F/E ratio are highly affected by age, gender and sports specialisation in high level trained adolescents.
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Tsolakis, C., Simeonidis, T., Georginis, P., Cherouveim, E., Methenitis, S., & Koulouvaris, P. Sports Biomechanics, 2023

Purpose: The Covid-19 restriction exposed most athletes to insufficient training stimuli leading to detraining. This study investigated whether a home-based exercise training program could preserve body composition and exercise performance in young high-level kayak athletes during Covid-19 restriction. Methods: Seventeen healthy young high-level kayak athletes (10 males and 7 females), aged 14.7 ± 1 yrs, participated in this study. A 7-week home-based training program was followed during Covid-19 restriction. Baseline measurements were assessed 4 weeks before Covid-19 pandemic and ended on 4 May 2020. Body composition, flexibility, isometric muscle trunk strength (Biodex), anaerobic power (30-s all-out trial), and aerobic capacity (4-min maximal test) were evaluated. Personal daily loads and wellness details were collected with AthleteMonitoring.com software. Results: Home-based exercise training program was effective to improve flexibility (9.20 ± 2.85%) and lean body mass (3.96 ± 0.89%), to maintain muscle strength, anaerobic power, body mass, and body fat percentage but insufficient to maintain aerobic capacity (- 8.96 ± 2.49%). Conclusion: The findings of the present study potentially highlight the importance of the implementation of such a program to minimize the detraining effect on young athletes during periods of movement restriction caused by pandemics.
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Tsolakis, C., Cherouveim, E. D., Viliotis, A., Simeonidis, T., Skouras, A., & Koulouvaris, P. Sport Sciences for Health, 2023

Lumbar muscle atrophy, diminished strength, stamina, and increased fatigability have been associated with chronic nonspecific low back pain (LBP). When evaluating patients with LBP, trunk or core stability, provided by the performance and coordination of trunk muscles, appears to be essential. Several clinical tests have been developed to identify deficiencies in trunk performance, demonstrating high levels of validity and reproducibility. The most frequently prescribed tests for assessing the core body muscles are the prone plank bridge test (PBT), the side bridge test (SBT), and the supine bridge test (SUBT). However, quantitative assessments of the kinematics of the lumbar spine during their execution have not yet been conducted. The purpose of our study was to provide objective biomechanical data for the assessment of LBP patients. The lumbar spine ranges of motion of 22 healthy subjects (Group A) and 25 patients diagnosed with chronic LBP (Group B) were measured using two inertial measurement units during the execution of the PBT, SUBT, and SBT. Statistically significant differences between the two groups were found in all three tests’ kinematic patterns. This quantitative assessment of lumbar spine motion transforms the three bridge tests into an objective biomechanical diagnostic tool for LPBs that may be used to assess the efficacy of applied rehabilitation programs.
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Triantafyllou, A., Papagiannis, G., Stasi, S., Gkrilias, P., Kyriakidou, M., Kampouroglou, E., Skouras, A. Z., Tsolakis, C., Georgoudis, G., Savvidou, O., Papagelopoulos, P., & Koulouvaris, P. Bioengineering, 2023

Hip fractures are a major health concern, particularly for older adults, as they can reduce life quality, mobility loss, and even death. Current evidence reveals that early intervention is recommended for endurance in patients with hip fractures. To our knowledge, preoperative exercise intervention in patients with hip fractures remains poorly researched, and no study has yet applied aerobic exercise preoperatively. This study aims to investigate the short-term benefits of a supervised preoperative aerobic moderate-intensity interval training (MIIT) program and the added effect of an 8-week postoperative MIIT aerobic exercise program with a portable upper extremity cycle ergometer. The work-to-recovery ratio will be 1-to-1, consisting of 120 s for each bout and four and eight rounds for the pre- and postoperative programs, respectively. The preoperative program will be delivered twice a day. A parallel group, single-blinded, randomized controlled trial (RCT) was planned to be conducted with 58 patients each in the intervention and control groups. This study has two primary purposes. First, to study the effect of a preoperative aerobic exercise program with a portable upper extremity cycle ergometer on immediate postoperative mobility. Second, to investigate the additional effect of an 8-week postoperative aerobic exercise program with a portable upper extremity cycle ergometer on the walking distance at eight weeks after surgery. This study also has several secondary objectives, such as ameliorating surgical and keeping hemostatic balance throughout exercise. This study may expand our knowledge of preoperative exercise effectiveness in hip fracture patients and enhance the current literature about early intervention benefits.
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Skouras, A. Z., Antonakis-Karamintzas, D., Tsolakis, C., Tsantes, A. E., Kourlaba, G., Zafeiris, I., Soucacos, F., Papagiannis, G., Triantafyllou, A., Houhoula, D., Savvidou, O., & Koulouvaris, P. Biomedicines, 2023

Hemostatic balance refers to the dynamic balance between blood clot formation (coagulation), blood clot dissolution (fibrinolysis), anticoagulation, and innate immunity. Although regular habitual exercise may lower the incidence of cardiovascular diseases (CVD) by improving an individual’s hemostatic profile at rest and during exertion, vigorous exercise may increase the risk of sudden cardiac death and venous thromboembolism (VTE). This literature review aims to investigate the hemostatic system’s acute and chronic adaptive responses to different types of exercise in healthy and patient populations. Compared to athletes, sedentary healthy individuals demonstrate similar post-exercise responses in platelet function and coagulatory and fibrinolytic potential. However, hemostatic adaptations of patients with chronic diseases in regular training is a promising field. Despite the increased risk of thrombotic events during an acute bout of vigorous exercise, regular exposure to high-intensity exercise might desensitize exercise-induced platelet aggregation, moderate coagulatory parameters, and up-regulate fibrinolytic potential via increasing tissue plasminogen activator (tPA) and decreasing plasminogen activator inhibitor (PAI-1) response. Future research might focus on combining different types of exercise, manipulating each training characteristic (frequency, intensity, time, and volume), or investigating the minimal exercise dosage required to maintain hemostatic balance, especially in patients with various health conditions.
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Skouras, A. Z., Antonakis-Karamintzas, D., Tsantes, A. G., Triantafyllou, A., Papagiannis, G., Tsolakis, C., & Koulouvaris, P. Sports, 2023

Background: The Arm Care Screen was developed to detect musculoskeletal limitations that could affect performance or even increase the risk for shoulder injuries in overhead athletes. This study aimed to assess the discriminant validity of the modified Arm Care Screen in overhead athletes. Methods: Sixty-two overhead athletes (mean age: 24.5 ± 4.2 years) were recruited. The athletes underwent a comprehensive Arm Care Screen evaluation, including reciprocal shoulder mobility, total body rotation, lower body diagonal reach, and rotary stability assessments. Ten different musculoskeletal measurements were independently measured by two physical therapists. Results: The modified Arm Care Screen showed moderate to strong associations (phi values ranged from 0.273 to 0.905) with the respective musculoskeletal range of motion and balance measurements. Sensitivity ranged from 81.25% to 88.57%, indicating a high true positive rate, and specificity ranged from 43.75% to 94.44%, indicating a moderate to strong positive rate. Positive and negative likelihood ratios ranged from 1.48 to 15.92 and 0.12 to 0.38, respectively. The positive and negative predictive value ranged from 58.14% to 92% and from 73.68% to 93.18%, respectively. The accuracy of the modified ACS ranged from 62.90% to 91.94%. Conclusion: The modified Arm Care Screen demonstrated promising diagnostic accuracy in identifying significant movement restrictions.
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Paraskevopoulos, E., Kottaridis, F. M., Moutzouri, M., Koumantakis, G. A., Antonakis-Karamintzas, D., Tsolakis, C., Koulouvaris, P., Christakou, A., & Papandreou, M. Healthcare, 2023 

This study aimed to investigate the relationship of body mass index (BMI) with muscle and cardiorespiratory fitness in children living within rural areas (regional unit of West Attica) in Greece. Participants included 399 students (187 boys, 212 girls), ages 8-12 years old, and were evaluated in physical performance tests. The point prevalence of overweight and obesity was 21.39% and 26.20% in boys, and 19.90% and 23.79% in girls. Significant differences were observed in all physical performance tests (handgrip, long jump, shuttle run, trunk flexors, and extensors endurance) between normal weight and obese participants. BMI was positively correlated with handgrip (r = 0.442-0.462, p < 0.001). There was a negative association with long jump (r = -0.206, p < 0.001), 20 m shuttle run (r = -0.394, p < 0.001), trunk flexors (r = -0.403, p < 0.001) and trunk extensors endurance (r = -0.280, p < 0.001). The regression analysis showed that 20-30% of the overall variation for physical performance assessments could be accounted for by BMI, age, and sex. With the exception of the long jump and the endurance of the trunk extensors, BMI alone may explain more than 10% of the outcome of most tests. This study highlights the determinant of BMI on muscle and cardiorespiratory fitness. The management of obesity should begin early in childhood to prevent adult chronic cardiovascular and metabolic diseases.
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Tsolakis, C., Cherouveim, E. D., Skouras, A. Z., Antonakis-Karamintzas, D., Czvekus, C., Halvatsiotis, P., Savvidou, O., & Koulouvaris, P. International Journal of Environmental Research and Public Health, 2022

Background/objective: Aetiology and significance of exercise-induced troponin release remains a contentious issue. We investigated the effect of a 28 km mountain run on cardiac troponin I (cTnI), in relation to training, performance, nutritional, biochemical and echocardiography variables, in a group of 25 recreational male master athletes. Material and methods: A comprehensive list of variables related with nutrition, training, performance and echocardiography, was collected pre- and post-race. Twenty-four months later, outcomes regarding cardiovascular events were obtained. Results: Serum cTnI values were increased after the race, with mean values rising from 7.2 ± 2.2 (before) to 80.0 ± 33.2 ng/L (post race), (p < 0.001) and 23/25(92%) exceeding Upper Reference limit (50 ng/L). Echocardiography did not reveal significant alterations, or correlations with cTnI values. The percentage difference in hs-cTnI concentrations pre- and post-race correlated positively with age, race-induced changes of selected muscle damage indices, resistance training volume and negatively with endurance capacity and training volume (r: -0.727 to 0.725, p < 0.05). All athletes reported no cardiovascular event during the 24-month period post-race. Conclusion: cTnI elevation induced by a 28 km mountain running race was not correlated with echocardiographic, nutritional parameters and was less pronounced in athletes with larger endurance training history, in contrast with resistance training and age.
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Stavroulakis, G., Methenitis, S., Koutroulis, G., Xanthis, D., Cherouveim, E., Kroupis, C., Anastasiadis, G., Ketselidi, K., Vlachopoulou, E., Tsolakis, C., & Koulouvaris, P. Biomarkers, 2022

Q-angle represents the resultant force vector of the quadriceps and patellar tendons acting on the patella. An increased Q-angle has been considered a risk factor for many disorders and injuries. This literature review challenges the clinical value of static Q-angle and recommends a more dynamic movement evaluation for making clinical decisions. Although there are many articles about static Q-angle, few have assessed the value of dynamic Q-angle. We searched Scopus and PubMed (until September 2021) to identify and summarize English-language articles evaluating static and dynamic Q-angle, including articles for dynamic knee valgus (DKV) and frontal plane projection angle. We also used textbooks and articles from references to related articles. Although static Q-angle measurement is used systematically in clinical practice for critical clinical decisions, its interpretation and clinical translation present fundamental and intractable limitations. To date, it is acceptable that mechanisms that cause patellofemoral pain and athletic injuries have a stronger correlation with dynamic loading conditions. Dynamic Q-angle has the following three dynamic elements: frontal plane (hip adduction, knee abduction), transverse plane (hip internal rotation and tibia external rotation), and patella behavior. Measuring one out of three elements (frontal plane) illustrates only one-third of this concept. Static Q-angle lacks biomechanical meaning and utility for dynamic activities. Although DKV is accompanied by hip and tibia rotation, it remains a frontal plane measurement, which provides no information about the transverse plane and patella movement. However, given the acceptable reliability and the better differentiation capability, DKV assessment is recommended in clinical practice.
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Skouras, A. Z., Kanellopoulos, A. K., Stasi, S., Triantafyllou, A., Koulouvaris, P., Papagiannis, G., & Papathanasiou, G. Cureus, 2022

Introduction: Water polo is a competitive team sport played in the water between two teams of seven players each. Water polo players must have swimming speed, strong abdominal and back muscles, and strong shoulder muscles to cope with this sport’s special conditions. In this study, we investigate the possible association of shoulder and trunk muscle systems in adolescent water polo athletes of high demands. Materials and methods: The research included 42 water polo players aged 14-16, who train regularly for at least five years, six times a week, and participate in national championships and national teams. The athletes were evaluated on the strength and torque of these muscular systems using the isokinetic dynamometer Biodex System 4 Pro (Biodex Medical Systems, Inc, Shirley, NY). The correlation of the results was done using the statistical package SPSS 21. Results: The correlations revealed statistically significant differences in trunk extension in combination with the shoulder external/internal rotation ratio. Also, most of the correlations occurred between the trunk and non-dominant limb of the athletes and, more often, in the female athletes. Furthermore, for the hand grip, the male athletes showed a greater difference in strength between the dominant and the non-dominant member than female athletes. Finally, the evaluation of the trunk extension/flexion ratio and external/internal rotation ratio for the shoulder joint showed that many athletes are outside the normal range and need targeted strengthening. Conclusion: The negative correlation coefficient between trunk extension/flexion and shoulder external/internal rotation indicates that the trunk extension mechanism helps for better internal rotation of the shoulder. Therefore, water polo players should focus on the training of the stretching mechanism of the trunk and also give weight to achieving a balance between the competing muscular systems of the trunk and the shoulder. Thus, athletes can maximize their skills and, at the same time, protect themselves from injuries.
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Sioutis, S., Zygogiannis, K., Papakonstantinou, M. E., Zafeiris, I., Soucacos, F., Altsitzioglou, P., Skouras, A., Karamintzas, D., Tsolakis, C., & Koulouvaris, P. Cureus, 2022

Background: Volleyball players as overhead athletes have the highest risk of developing scapular dyskinesis. The kinetic chain exercise-approach has gained a lot of attention because of its claims to provide an improved motor control and scapular kinematics. A form of cross exercise, known as mirror therapy, may enhance the effects of a kinetic-chain-approach on scapular posture, upper and lower limb performance. The aim of this study was to investigate the adjunctive benefits of mirror cross education in a kinetic chain approach, in volleyball athletes with SD. Methods: Thirty-nine professional volleyball athletes were randomly assigned to three groups of 13 each, two experimental, the mirror cross education and kinetic chain approach, and one control. Both experimental groups performed a kinetic chain approach program, however, the mirror cross education group performed the exercise program with the addition of two mirrors that allowed athletes to observe their opposite non-dyskinetic scapula. Scapular posture asymmetries in cm, the Y-Balance and the Upper-Quarter Y-Balance after normalizing by limb length the reach distance in each direction, were assessed before and after performing each intervention for 6 weeks. Results: 3×2 two-way Mixed ANOVAs detected significant interactions on scapular posture (P=0.001) on both experimental groups when compared with the control. The Y-Balance and the Upper Quarter Y-Balance scores at both mirror cross education and kinetic chain approach groups showed significant differences when compared with the control (P<0.05). Overall, variables showed significant superiority of the mirror cross education group. Conclusions: The Mirror-Cross-Education demonstrated significant effects in scapular posture and in the functional balance tests of volleyball athletes with scapular dyskinesis.
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Paraskevopoulos, E., Simeonidis, T., Tsolakis, C., Koulouvaris, P., & Papandreou, M. The Journal of Sports Medicine and Physical Fitness, 2022

This study aimed to explore the importance of aerobic capacity and nutrition on 28-km mountain running performance and race-induced changes in body composition and biochemical blood indices, in recreational master athletes of different performance levels. Twenty male master runners (age: 44.6 ± 7.7 years) were divided into two groups, slower and faster runners, according to their race performance. Maximum oxygen uptake ( V ˙ O 2 max ) , velocity at V ˙ O 2 max ( v V ˙ O 2 max ) , oxygen consumption ( V ˙ O 2 Thr ) , and velocity ( v V ˙ O 2 Thr ) during the second ventilatory threshold were evaluated. Nutrition was assessed for one week before and during the race. Body composition was evaluated, and blood samples were collected before and 3 h after the race. Slower runners exhibited a greater reduction in lean body mass and greater changes in all muscle damage/inflammation/metabolism blood indices than the faster runners (η² = 0.201–0.927; p < 0.05). When all the participants were assessed as one group (n = 20), significant correlations were found between ( v V ˙ O 2 max , vVO2Thr, race time, energy intake, expenditure, carbohydrate, protein intakes, and post-race changes in body composition and blood markers (r: −0.825–0.824; p < 0.05). The strongest determinants were ( v V ˙ O 2 max and vVO2Thr, while energy intake, expenditure, carbohydrate, and protein intakes seemed to be the weakest determinants of race performance and race-induced changes in body composition and blood indices. The results suggest that race-induced changes in body composition and blood indices are determined mainly by master runners’ race performance and endurance capacity and to a lesser extent by nutrition. However, it seems that carbohydrate and protein intakes have equal importance.
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Methenitis, S., Cherouveim, E. D., Kroupis, C., Tsantes, A., Ketselidi, K., Vlachopoulou, E., Stavroulakis, G., Mavrogenis, A., Tsolakis, C., & Koulouvaris, P. International Journal of Sports Science & Coaching, 2022

The aim of this study was to develop accurate, reliable, and reproductive equations for the prediction of maximum oxygen uptake (𝑉𝑂 ) in male and female high-level adolescent rowers. This study included two parts. In the first part, 𝑉𝑂 was evaluated in 106 male and 83 female high-level adolescent rowers during an incremental step test (IRT) on a rowing ergometer, and stepwise multiple regression analyses were used for the development of new equations. In the second part, these equations were tested in 26 new high-level adolescent rowers of the same age and anthropometrical characteristics (boys: 15.27 ± 2.70 yrs and 15.34 ± 2.80 yrs; 72.37 ± 10.96 kg and 70.96 ± 10.65 kg; girls: 15.00 ± 2.11 yrs and 15.94 ± 2.71 yrs; 62.50 ± 7.14 kg and 63.41 ± 6.72 kg for parts 1 and 2, respectively; p > 0.05). 𝑉𝑂 was predicted from the combination of lean body mass (LBM) and the distance covered during the last 4 min stage of the IRT (boys: r2 = 0.715, F = 68.74, p = 0.001; girls: r2 = 0.769, F = 57.81, p = 0.001). In the second part, no significant differences were identified when the new equations were tested against measured 𝑉𝑂 (boys: 3971.15 ± 713.38 mL·min−1 vs. 3915.83 ± 704.43 mL·min−1; girls: 3272.75 ± 551.46 mL·min−1 vs. 3308.94 ± 557.59 mL·min−1 for measured and predicted values, respectively; p > 0.05). In conclusion, 𝑉𝑂 of high-level adolescent rowers can be predicted with high accuracy, reliability, and repeatability using simple and easily evaluated anthropometric and performance variables.
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Cherouveim, E. D., Methenitis, S. K., Simeonidis, T., Georginis, P., Tsekouras, Y. E., Biskitzi, C., Tsolakis, C., & Koulouvaris, P. Journal of Human Kinetics, 2022

The aim was to investigate the potential differences in muscle (vastus lateralis) and cerebral (prefrontal cortex) oxygenation levels as well as in the number of repetitions and total work output between isokinetic eccentric and concentric exercise at a moderate relative intensity until exhaustion. Ten recreationally active young men underwent two isokinetic exercise sessions either concentric or eccentric, one on each randomly selected leg. The protocols were performed at 60°/s and an intensity corresponding to 60% of the maximal voluntary contraction (MVC) of each contraction type. Concentric torque was significantly lower compared to eccentric torque in both peak values and at values corresponding to 60% of MVC [230 ± 18 Nm vs. 276 ± 19 Nm (P = .014) and 137 ± 12 Nm vs. 168 ± 11 Nm, respectively (P = .010)]. The participants performed 40% more contractions during eccentric compared to concentric exercise [122 ± 15 vs. 78 ± 7, respectively]. No differences were found in the levels of oxyhaemoglobin, deoxyhemoglobin, total haemoglobin and tissue saturation index when eccentric and eccentric exercise regimes were compared (all P > .05). Our results demonstrate that eccentric exercise of moderate intensity leads to greater resistance to fatigue and more work output compared to concentric exercise, despite the comparable muscle and cerebral oxygenation levels.
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Cherouveim, E. D., Margaritelis, N. V., Koulouvaris, P., Tsolakis, C., Malliou, V. J., Chatzinikolaou, P. N., Franchi, M. V., Porcelli, S., Kyparos, A., Vrabas, I. S., Geladas, N. D., Nikolaidis, M. G., & Paschalis, V. Journal of Sports Sciences, 2022

The aim of this study was to compare the vertical peak force (PF) generated during the isometric mid-thigh pull (IMTP) and isometric squat (ISqT) performed at the same knee and hip angles. Fourteen elite track and field athletes performed 3 maximal efforts of isometric IMTP and ISqT tests. The vertical PF was measured by a force platform (Kistler 9290CD, AG Winterthur, Switzerland). Our findings revealed significant higher PF and relative PF during ISqT than IMTP (Mean difference: 953 ± 224 N, p < 0.001, d = 1.62 and 14.6 ± 2.4 N·kg-1 , p < 0.001, d = 3.8, respectively). The results of this study suggest that ISqT may be more appropriate testing procedure for identifying athletes’ maximum isometric strength capacities in elite track and field athletes.
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Stavridis, I., Fragkoulis, E., Tsopanidou, A., Economou, T., Tsolakis, C., Koulouvaris, P., & Paradisis, G. ISBS Proceedings Archive, 2021

The aim of the present study was to study the effects of cycling and pure concentric and pure eccentric high-intensity interval exercise (HIIE) on skeletal muscle (i.e., vastus lateralis) and cerebral oxygenation. Twelve healthy males (n = 12, age 26 ± 1 yr, body mass 78 ± 2 kg, height 176 ± 2 cm, body fat 17 ± 1% of body mass) performed, in a random order, cycling exercise and isokinetic concentric and eccentric exercise. The isokinetic exercises were performed on each randomly selected leg. The muscle and the cerebral oxygenation were assessed by measuring oxyhemoglobin, deoxyhemoglobin, total hemoglobin, and tissue saturation index. During the cycling exercise, participants performed seven sets of seven seconds maximal intensity using a load equal to 7.5% of their body mass while, during isokinetic concentric and eccentric exercise, they were performed seven sets of five maximal muscle contractions. In all conditions, a 15 s rest was adopted between sets. The cycling HIIE caused greater fatigue (i.e., greater decline in fatigue index) compared to pure concentric and pure eccentric isokinetic exercise. Muscle oxygenation was significantly reduced during HIIE in the three exercise modes, with no difference between them. Cerebral oxygenation was affected only marginally during cycling exercise, while no difference was observed between conditions. It is concluded that a greater volume of either concentric or eccentric isokinetic maximal intensity exercise is needed to cause exhaustion which, in turn, may cause greater alterations in skeletal muscle and cerebral oxygenation.
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Perentis, P. A., Cherouveim, E. D., Malliou, V. J., Margaritelis, N. V., Chatzinikolaou, P. N., Koulouvaris, P., Tsolakis, C., Nikolaidis, M. G., Geladas, N. D., & Paschalis, V. Journal of Functional Morphology and Kinesiology, 2021

Context: Volleyball players have shown to be at an increased risk of developing scapular dyskinesis. The kinetic chain exercise approach has gained a lot of attention because of its claims to provide an improved motor control and scapular kinematics. A form of cross exercise, known as mirror therapy, may enhance the effects of a kinetic chain exercise approach in throwing performance. Objective: To examine the effects of mirror cross exercise (MCE), based on a kinetic chain exercise approach in the throwing performance of volleyball athletes with scapular dyskinesis. Design: Randomized controlled trial. Setting: Biomechanics laboratory. Methods: 39 volleyball players with scapular dyskinesis were randomly allocated into 3 groups. The first group completed a 6-week kinetic chain approach (KCA group), the second group completed a kinetic chain exercise approach program in addition to MCE group, and the control group followed only their regular training program. Before and after delivering both interventions, throwing accuracy, speed, and force were determined while measuring the ground reaction forces of the drive leg during throwing. Two-way mixed analysis of variance investigated the effects of intervention and time and their interaction. Results: The results showed intervention × time statistically significant interactions for throwing accuracy, speed, and force for the MCE and the KCA groups. Over the 6-week training period, the MCE and the KCA groups showed significant improvements in throwing accuracy (P < .01) and speed (P < .01), while the ground reaction forces did not change (P > .05). Throwing force increased significantly in the MCE group (P = .01). Between-group comparison showed statistically significant improvements in the throwing accuracy for the MCE and KCA groups against the control group (P < .01) at posttesting. The MCE demonstrated superior results over the KCA in the aforementioned measures. Conclusions: This study suggests that the addition of MCE in a KCA program enhances energy transfer throughout the distal and proximal segments, thus improving kinetic chain recruitment and potentially preventing shoulder pathology.
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Paraskevopoulos, E., Simeonidis, T., Tsolakis, C., Koulouvaris, P., & Papandreou, M. Journal of Sport Rehabilitation, 2021

Background: Data about lower extremities’ strength and power asymmetries in fencers, and their relationships to fencing performance are limited and inconsistent. Objective: The aim of the present study was to investigate asymmetries, between dominant (D) and non-dom (ND) legs of elite young male and female fencers, in relation to performance in fencing specific tests. Methods: Anthropometric characteristics, unilateral vertical-horizontal jumping, isokinetic strength, lunge and step lunge performances were evaluated in 16 male and 22 female elite fencers. Results: Significant differences between genders were found for all anthropometric measurements (
0.05). No significant bilateral asymmetries and gender x laterality effects were observed ( 0.05). Fencing performance was negatively correlated with the D leg’s flexion/extension (F/E) ratio at 300/s (r: 0.564 to 0.619, 0.05). In addition, D leg’s F/E ratio at 300/s was positively related to lung peak velocity and power in female fencers (r: 0.562–0.649; 0.05). Finally, only in female fencers, unilateral triple hop distance was significantly related to lung peak velocity and power (r: 0.442–0.500; 0.05). Conclusions: The results of the present study suggest that the differential activation/movement pattern of the D and ND leg muscles do not lead to anatomical, dynamic and functional lower extremities asymmetries.
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Drakoulaki, V., Kontochristopoulos, N., Methenitis, S., Simeonidis, T., Cherouveim, E., Koulouvaris, P., Savvidou, O., & Tsolakis, C. Isokinetics and Exercise Science, 2021

The unprecedented situation of Covid-19 which resulted in the closure of schools, enforced the educational community worldwide to find alternative ways to design the learning process. In special education the challenges are greater due to the need of individualized learning in 1:1 base, physical prompt, visual support and direct reinforcement. Nowadays, the internet services, like remote learning and teletherapy, could be an alternative and effective method of providing virtual intervention services using either well known video conferencing platforms, or more specialized ones. However, while such platforms hold great promise, there are few research studies that discuss the design decisions of the remote learning services and the most effective learning model that could be offered to children with Special Education Needs (SEN). The goal of this paper is to present a case study where SEN teachers and therapists applied a remote learning approach using an innovative online education gaming platform in combination with a video conferencing platform during the period of school closures due to Covid-19. Thirteen (13) children from three special schools participated in the study, with the majority having the autism diagnosis. The positive effects of this remote learning approach are discussed with the focus remaining on autism population.
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Aloizou, V., Chasiotou, T., Retalis, S., Daviotis, T., & Koulouvaris, P. Educational Media International, 2021

The aim of this study was to examine the relationship between the mechanical characteristics of the horizontal and vertical Force-velocity (F-v) profile as well as the performance variables of the sprinting and jumping testing procedures. Twenty high-level sprinters performed two maximal sprints and squat jumps against multiple external loads. Our main findings revealed very large correlations for maximal mechanical power output (Pmax) (r=0.72), as well as for performance variables between the sprinting and jumping tasks (r=-0.81) and large correlations for maximal velocity (V0) (r=0.66). The maximal force (F0) and the slope of the F-v relationship (F-v slope) were not significantly correlated between both tasks. These results suggest that both testing procedures should be performed in order to gain a deeper insight into the maximal mechanical properties and function of the lower-body muscles in high-level sprinters.
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Stavridis, I., Tsopanidou, A., Tsolakis, C., Zacharogiannis, E., Koulouvaris, P., & Paradisis, G. ISBS Proceedings Archive, 2020

Background: The most common sports activities leading to menisci injuries are tennis, jogging, gymnastics, and dancing. Menisci injuries in dancers most frequently occur due to rotational forces applied to the knee. Objectives: Since dancers’ movement is of great biomechanical and rehabilitation interest, the purpose of this review is to explore the biomechanical approach of this issue as well as to identify any gap to this process and propose corresponding assessments. A literature review search database of Pubmed, Medline, EMBASE, AMED, Scopus, Google Scholar, and CINAHL was conducted using relevant keywords and phrases. Major Findings: The most common dance movement that can cause meniscus injury, is the grand plie, because of the excessive range of motion combined to compressive forces and axial rotations that occur during the execution of the movement.
Conclusions: A complete three-dimensional kinematic assessment of the lower limb joints from dynamic grand plies or in intermidiate positions of the legs has not been made. Thus, further research has to be done with the use of optoelectronic cameras and force plates, to accurately identify weather excessive knee rotation range of motion or moments could lead in medial or/and lateral meniscus tear during the grand plie.
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Fotaki, A., Triantafyllou, A., Papagiannis, G., Stasi, S., Papathanasiou, G., Savvidou, O., Tsolakis, C., & Koulouvaris, P. Physical Therapy Reviews, 2020

Introduction: Despite the differentiation of anthropometric and physiological demands according to the technical and tactical requirements of each playing positionin adults, only few studies have examined this issue in young female volleyball players. Thus, the aim of this study was to investigate the effects of playing positions and age on anthropometric characteristics and exercise performance in young female volleyball players. Material and Methods: A total of 389 healthy females (n = 389, 14.2 ± 5.5 years old, body mass of 57.05 ± 9.48 kg, height of 1.67 ± 0.07 m, and body mass index of 20.28 ± 2.76), who are high-level volleyball players, volunteered to participate in this study. Participants were divided into six groups according to their playing position [i.e., setters (n = 66), outside-hitters (n = 125), middle blockers (n = 66), opposites (n = 37), liberos (n = 25), and without a specific position (n = 70)] and into two age groups [i.e., 13 (AG13, n = 127) and 14 (AG14, n = 262) years old]. All athletes were assessed for anthropometric characteristics and physical performance. Specifically, athletes completed overhead medicine ball throw (MBT), standing long jump (LJ), countermovement jump (CMJ), spike jump (SJ), flexibility, agility T-test, and sit-ups (SU) trials. Results: There was a significant difference (p < 0.05) among playing positions in terms of anthropometrics and exercise performance. Specifically, volleyball players without a specific playing position had a smaller body morphology and lower exercise performance (in MBT, LJ, CMJ, SJ, SRT, AT, and UP) compared to other playing positions. However, physiological characteristics were similar (p>0.05) among volleyball players with specific playing positions. Regarding age, there was a significant effect on exercise performance, and the mean values of LJ, CMJ, SPJ, MBT, and agility test were higher in olderathletes than in younger ones; whereas sit-ups values were higher in younger players than in older ones. Significant correlations were observed between jumping ability and anthropometric characteristics. Conclusion: The results of this study can be used as reference values duringthe talent selection process to provide specific playing position data for this age-group category.The lack of physiological differences among playing positions confirms that anthropometric characteristics can be an adequate identification factor for the primary talent selection for this age group.
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Cherouveim, E., Tsolakis, C., Ntozis, C., Apostolidis, N., Gkountas, K., & Koulouvaris, P. Journal of Physical Education and Sport, 2020

The aim of this study was to investigate sport specific correlates of fencing performance, in both young male and female fencers. all assessments (anthropometry, arm strength, leg power, flexibility, fencing movement reaction times in visual stimuli velocity of arm extension, lunge velocity, step and lunge velocity and fencing specific agility test) were conducted on 9 males and 13 female young fencers 13.4±0.85 years old (mean age ± standard deviation). relationships were examined by calculating Pearson’s product moment correlation coefficient (r). a stepwise multiple linear regression was used to identify the best predictors of fencing performance. Females were found to have more body fat and higher BMI values compared to males. Males outperformed females in all leg power tests, while females were more flexible than males. Moreover males were faster in arm velocity, step-lunge velocity and change of direction velocity compared to females. anthropometric parameters were not correlated to fencing performance. long jump and squat jump were the best predictors of step and lunge velocity and change of direction velocity, respectively. The integration of power exercises in both the horizontal and vertical plane is recommended as regular regimen in physical condition protocols in order to optimize the fencing performance in young fencers.
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Tsolakis, C., Tsekouras, Y. E., Daviotis, T., Koulouvaris, P., & Papaggelopoulos, P. Biology of Exercise, 2018

Introduction: Obesity has become one of the major health risks in childhood, significantly affecting children’s health and physical fitness. Although the marked increase of obesity in urban areas is well established, evidence is limited in remote and isolated areas with adverse socioeconomic features. The aim of this study was to examine the prevalence of obesity and its association with physical performance indices in young school-aged children living in 18 remote and isolated Greek islands. Methods: Four hundred and sixty-three children (244 boys, 219 girls), aged 5-12 years underwent a series of physical fitness tests including 20 m sprint, standing long jump, 1 kg medicine ball throw, agility T-test and sit-and-reach test. Age and gender BMI cut-off points were determined according to World Health Organisation (WHO) norms. Results: The prevalence of obesity was 23.8% and 13.2% for boys and girls, respectively. A negative body mass index (BMI) main effect was observed for weight-bearing activities, such as 20 m sprint (F=6.21, p=0.000, &eta;2=0.041) and standing long jump (F=11.369, p=0.000, &eta;2=0.074), while medicine ball throw was positively correlated with BMI in children aged 9-12 years. Conclusion: The results of this study confirmed previous findings on obesity prevalence in Greece. A negative association was also found between BMI and physical fitness indices and, in particular, in weight-bearing activities. It is critical to establish physical education interventions and physical fitness programs at schools, aiming to increase motivation for physical activity participation.
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Koulouvaris, P., Tsolakis, C., Tsekouras, Y. E., Donti, O., & Papagelopoulos, P. J. Rural and Remote Health, 2018