Objective To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. Design Systematic review and network meta-analysis. Methods Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. Data sources Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. Eligibility criteria for selecting studies Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. Results 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges’ g −0.62, 95% credible interval −0.80 to −0.45), yoga (n=1047, κ=33, g −0.55, −0.73 to −0.36), strength training (n=643, κ=22, g −0.49, −0.69 to −0.29), mixed aerobic exercises (n=1286, κ=51, g −0.43, −0.61 to −0.24), and tai chi or qigong (n=343, κ=12, g −0.42, −0.65 to −0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. Conclusions Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. Systematic review registration PROSPERO CRD42018118040.

Accelerometry is the method of choice for objectively assessing physical activity in older adults. Many studies have used an accelerometer count cut point corresponding to 3 metabolic equivalents (METs) derived in young adults during treadmill walking and running with a resting metabolic rate (RMR) assumed at 3.5 mL · kg−1 · min−1 (corresponding to 1 MET). RMR is lower in older adults; therefore, their 3 MET level occurs at a lower absolute energy expenditure making the cut point derived from young adults inappropriate for this population. The few studies determining older adult specific moderate-to-vigorous intensity physical activity (MVPA) cut points had methodological limitations, such as not measuring RMR and using treadmill walking. This study determined a MVPA hip-worn accelerometer cut point for older adults using measured RMR and overground walking. Following determination of RMR, 45 older adults (mean age 70.2 ± 7 years, range 60–87.6 years) undertook an outdoor, overground walking protocol with accelerometer count and energy expenditure determined at five walking speeds. Mean RMR was 2.8 ± 0.6 mL · kg−1 · min−1. The MVPA cut points (95% CI) determined using linear mixed models were: vertical axis 1013 (734, 1292) counts · min−1; vector magnitude 1924 (1657, 2192) counts · min−1; and walking speed 2.5 (2.2, 2.8) km · hr−1. High levels of inter-individual variability in cut points were found. These MVPA accelerometer and speed cut points for walking, the most popular physical activity in older adults, were lower than those for younger adults. Using cut points determined in younger adults for older adult population studies is likely to underestimate time spent engaged in MVPA. In addition, prescription of walking speed based on the adult cut point is likely to result in older adults working at a higher intensity than intended.

Powerlifting (PL) is characterised by the ability to generate maximal force. However, an understanding of the factors affecting strength in PL athletes is poorly understood. Therefore, competition data were analysed from 1368 individuals during 2017. Relative strength was compared for the squat (SQ), bench press (BP) and deadlift (DL) between age groups (Sub-junior [SJ], Junior [JU], Open [OP], and Masters’ I-IV [M1-M4]), weight classes (females; 47 kg, 52 kg, 57 kg, 63 kg, 72 kg, 84 kg and + 84 kg and males; 59 kg, 66 kg, 74 kg, 83 kg, 93 kg, 105 kg, 120 kg, + 120 kg) and between sexes. The results showed that relative strength was greater for males across all lifts (P < 0.001). Relative strength tended to decrease with increasing body mass for males (SQ, BP and DL: P < 0.001, R² = 0.9306–0.9763) and females (SQ, BP and DL: P < 0.001, R² = 0.9485–0.9802), and with increasing age for males (SQ, BP and DL: P < 0.001, R² = 0.4742–0.6729), and females (SQ: P < 0.001, BP: P = 0.002 and DL: P = 0.001, R² = 0.0844–0.3705), respectively. The findings offer important information regarding factors that affect strength performance in athletes. Coaches should consider the factors influencing strength when developing resistance training programmes or in longer term athletic development for powerlifters and other strength based sports.

Latella, C, van den Hoek, D, and Teo, WP. Differences in strength performance between novice and elite athletes: Evidence from powerlifters. J Strength Cond Res 33(7S): S103–S112, 2019—Strength forms an integral part of many sports. In particular, powerlifting success is determined solely by maximal strength, providing a unique opportunity to investigate the differences and potential factors influencing novice and elite competitors. We evaluated performance from 2,137 competitors between local (LOC), national (NAT), and international (INT) competitions. Results were analyzed by using the total (TOT) competition score within weight classes and age categories. Cohen's d effect sizes and 95% confidence intervals were used to detect differences within categories between LOC, NAT, and INT competitions. The coefficient of variation (CV) was used to determine the absolute variability. A moderate to large increase in performance was observed for all weight classes between LOC and NAT (men; d = 0.76, women; d = 1.09). No meaningful differences were observed between LOC and NAT, and NAT and INT when compared using age. No meaningful differences were observed between NAT to INT competitions when compared using weight classes. The CV was not different across competition level (CV = 17.4–22.9%) categories. Several internal (athlete) and external (environmental) factors are likely to explain these findings. Therefore, factors such as training experience, performance variability, body composition, anthropometric characteristics, and competition pressure that may influence strength performance should also be considered in both training phases and during competition. Collectively, the results offer novel information regarding the difference in strength performance between novice, subelite, and elite strength athletes. Strength and conditioning professionals should consider these factors when working with various athletes where maximal strength is an important determinant of success.

Strength assessment and comparison to normative values are an important benchmarking tool in human health and performance. However, population specific normative data are several decades old, lack information about adolescent and adult strength levels and are not representative of the strength levels of strength trained individuals. The purpose of this study was to develop contemporary strength norms for the squat, bench press, and deadlift using powerlifters competing in un-equipped, drug-tested competitions. Retrospective cross-sectional analysis. Retrospective data from global drug-tested, unequipped powerlifting competitions were collated with 809,986 samples (571,650 males, 238,336 females) included. Strength was assessed according to sex, United Nations age classifications, and competitive powerlifting weight class. Strength was expressed relatively (ratio of weight lifted/bodyweight) and computed for the 10th-90th percentile for each of the above categories. Relative strength was greatest for young adults (18-35 years; 90th percentile for squat [male: 2.83 × bodyweight, female: 2.26], bench press [male: 1.95, female: 1.35], deadlift [male: 3.25, female: 2.66]) before declining thereafter for all three exercises. Although lower than their younger counterparts, very old adults (>80 years) had 90th percentile data for the squat of male: 1.72 and female: 1.01, bench press: male: 1.31 and female: 0.92, and deadlift: male: 2.30 and female: 1.68. These findings provide a comprehensive, accurate and precise representation of strength for drug-tested, unequipped powerlifters in each category and serve as a point of reference for other trained population groups. To facilitate uptake and ease of comparison, we have developed a freely available online tool (www.thestrengthinitiative.com).

Pearson, J, Spathis, JG, van den Hoek, DJ, Owen, PJ, Weakley, J, and Latella, C. Effect of competition frequency on strength performance of powerlifting athletes. J Strength Cond Res 34(5): 1213–1219, 2020—Powerlifting (PL) requires athletes to achieve the highest possible “total” weight lifted across squat, bench press, and deadlift. Athletes compete multiple times per year; however, it is not well understood how often PL athletes should compete to facilitate maximal strength performance. This study investigated the effect of competition frequency on strength (relative and absolute) in PL athletes over a 12-month period. Results across all male (n = 563, mean ± SD; age; 28 ± 10 years, body mass; 89.3 ± 19.3 kg) and female (n = 437, age; 31 ± 11 years, body mass; 70.1 ± 15.8 kg) PL athletes were collated. Total competition scores were used to calculate absolute and relative strength for each competition. Linear mixed models with random effects, and effect sizes ± 95% confidence intervals compared competition frequency and total score for (a) all, (b) male, and (c) female competition entries, respectively. The association between total score at each competition was assessed with Pearson's correlation coefficient for the same independent variables. Results demonstrate greater absolute strength at competition 2 for all athletes (5.1%: p = 0.043: d = 0.16) and males (2.9%: p = 0.049: d = 0.15). For females, absolute strength was greater at competition 5 compared to 1 (12.0%: p = 0.001: d = 0.65) and 2 (9.6%: p = 0.007: d = 0.50). Weak positive correlations for relative strength and number of times competed for males were evident between competitions 1 to 4 (r ² = 0.070–0.085, p = 0.003–0.043). For females, 3 competitions weakly correlated with absolute strength (r ² = 0.106, p = 0.016). PL athletes who compete multiple times per year are more likely to achieve higher totals; however, there is an upper limit to the number of competitions (4 per year) that seem to allow a performance increase.