14 2023 1 AnnaleSKinesiologiae UDK / UDC 796.01:612 | Annales Kinesiologiae 14, 2023, 1, pp. 1–90 | ISSN 2232-2620 8, 2017, 1 A nnaleSK inesiologiae AnnaleSKinesiologiae UDK / UDC 796.01:612 | Annales Kinesiologiae 8, 2017, 1, pp. 1–64 | ISSN 2232-2620 AnnaleSKinesiologiae UDK / UDC 796.01:612 | Annales Kinesiologiae 14, 2023, 1, pp. 1–90 | ISSN 2232-2620 Koper 2023 ISSN 2232-2620 UDK/UDC 796.01:612 Volume 14, Year 2023, Number 1 ISSN (online ed.) 2335-4240 Editor in Chief / Glavni in odgovorni urednik: Rado Pišot Editors / Uredniki in urednice: Peter Čerče, Petra Dolenc, Mitja Gerževič, Mihaela Jurdana, Uroš Marušič, Cecil J. W. Meulenberg, Nina Mohorko, Armin Paravlić, Saša Pišot, Matej Plevnik, Boštjan Šimunič Editorial Board / Uredniški odbor: Guglielmo Antonutto (Ita), Bojan Borštner (Slo), Andrej Čretnik (Slo), Natale Gaspare de Santo (Ita), Nandu Goswami (Aut), Jay R. Hoffman (USA), Anita Hökelmann (Ger), Aleš Holobar (Slo), Peter Kokol (Slo), Stefano Lazzer (Ita), Zlatko Matjačić (Slo), Zoran Milanović (Srb), Ivana Milovanović (Srb), Jurij Planinšec (Slo), Pietro Enrico di Prampero (Ita), Carlo Reggiani (Ita), Vesna Štemberger (Slo), Matjaž Vogrin (Slo), Jernej Završnik (Slo), Milan Žvan (Slo) Technical Editors / Tehnični urednik in urednica: Peter Čerče, Alenka Obid Language Editors / Lektorji in lektorice: Jezikovna Zadruga Soglasnik (an.), Nina Novak (sl.) Translation / Prevod: Jezikovna Zadruga Soglasnik (an./sl.) Graphic Design of the Cover / Oblikovanje naslovnice: Mateja Oblak Typesetting / Stavek: Alenka Obid Publisher / Izdajatelj: Science and Research Centre Koper, Annales ZRS / Znanstveno-raziskovalno središče Koper, Annales ZRS Journal secretary contact / Sedež: Annales Kinesiologiae, Science and Research Centre Koper, Garibaldijeva 1, SI-6000 Koper/Capodistria tel.: +386 5 663-77-00; fax: +386 5 663-77-10 E-mail: annaleskin@zrs-kp.si Home page: http://ojs.zrs-kp.si/index.php/AK Printing / Tisk: Grafika 3000 d.o.o. Quantity / Naklada: 250 copies per issue Financial support / Finančna podpora: The publishing of this journal is supported by the Foundation for Financing Sport Organisations in the Republic of Slovenia and the Slovenian Research and Innovation Agency. Izdajo revije sofinancirata Fundacija za financiranje športnih organizacij v Republiki Sloveniji in Javna agencija za znanstvenoraziskovalno in inovacijsko dejavnost Republike Slovenije. Journal abbreviation: Ann. Kinesiol. Annales Kinesiologiae is an international journal published twice a year. Annual subscriptions (2 issues in English language) are available for 25 eur, and a single issue is available for 15 eur. For students 20% discount applies upon presenting an international valid student ID. Subscription requests can be send to: annaleskin@zrs-kp.si TABLE OF CONTENTS Cécil Meulenberg: ................................................................................................... Editorial Uvodnik Tamara Ilić, Doroteja Rančić, Stefan Stojanović, Ismail Ilbak: ......................... Health Aspects of Aerobic Interval Training in the Rehabilitation of Patients With Cardiovascular Diseases: A Systematic Review Zdravstveni vidiki aerobnega intervalnega treninga pri rehabilitaciji pacientov s srčno-žilnimi boleznimi: sistematični pregled Nikolina Alerić, Ana Penjak, Hrvoje Karninčić: .................................................. Attitudes Towards Exercise Content on Social Media and the Choice of Fitness Trainer Odnos do vsebin v družbenih medijih, povezanih s telesno vadbo, in izbira trenerja fitnesa Tatjana Tomažič, Bojana Filej, Nadja Plazar: ...................................................... Development and Preliminary Validation of the Scale of Factors Which Influence Decisionmaking of the Elderly to Take Part in Physical Exercise Programs Razvoj in preliminarno preverjanje lestvice dejavnikov pri odločanju starejših za vadbo Janez Konjar, Živa Arko: ................................................................................... Physical Therapy of Rotator Cuff Injuries of Olympic Weightlifters – Systematic Literature Review Fizioterapija po poškodbah rotatorne manšete pri olimpijskih dvigalcih uteži – sistematični pregled literature REVIEWS AND REPORTS OCENE IN POROČILA Saša Pišot: ................................................................................................................ 19th Conference of the European Association for Sociology of Sport “Transitioning Sport – Transitioning European Societies” 19. konferenca Evropskega združenja za sociologijo športa (EASS) »Šport na prehodu – evropske družbe na prehodu« 1 5 19 37 57 81 Uroš Marušič, Tisa Hodnik, Manca Peskar: ........................................................ Neuroscience of Movement – Exploring the Dynamics of the Human Brain in Motion Neuroscience of Movement – Exploring the Dynamics of the Human Brain in Motion Guidelines for authors .............................................................................................. Navodila avtorjem 83 87 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 1 EDITORIAL Welcome to the first issue of volume 14 of Annales Kinesiologiae for the publishing year of 2023, which truly reflects the interdisciplinary scientific re- search and quality of life outcomes that the wider field of kinesiology research can contribute to. The first contribution, a review article, investigates whether aerobic interval training has positive health benefits for cardiovascular patients. Based on 15 selected studies, it concludes that ten to sixteen weeks of moderate or high- intensity training two to three times per week has positive effects for elderly cardiovascular patients. These recommendations are in line with previously published guidelines, as well as very useful for planning general quality fitness programmes. The next contribution, an original scientific article, aims to investigate whether gender differences influence gym-goers’ choice of fitness trainer and can determine and explain social media exercise content. The developed ques- tionnaire was tested on 50 gym-goers from which a myriad of complex con- clusions concerning gym-clients’ attitudes can be drawn. Furthermore, these results could support the planning of social media exercises and client-friendly content. The second scientific article reports on the development and validation of a scale that reflects the decision-making by the elderly on taking part in organized physical exercise programmes. The scale was tested on 1777 people aged over 60 years and consists of four factors with 27 statements, explaining 43% of the variability. The scale will be a helpful tool assisting in the planning and promo- tion of organized physical activity interventions for older people. The final contribution and second review paper investigates the best reha- bilitation process for Olympic weightlifters with rotator cuff injuries, drawing recommendations from 16 research papers. As these injuries are usually quite complex, the results indicate how effective rehabilitation can be prepared based on a well-planned combination of applied physiotherapy, specific methods and duration. In addition, our editorial team offers two reports on recent events that they were part of: the European Association for the Sociology of Sport held a con- ference in Budapest at the end of May and beginning of June; and in Piran, the Third TwinBrain Summer School »Neuroscience of Movement – Exploring the Dynamics of the Human Brain in Motion« was organized in June. 2 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Altogether, the studies in this issue of Annales Kinesiologiae offer useful information and tools that can aid in preparing for successful lifestyle/rehabili- tation interventions for various populations, including the elderly, injured and diseased persons. Scientific collections like this are a good way for the multidisciplinary field of kinesiology to contribute to improving the quality of life, and something the editorial team certainly hopes to continue to offer in the future. Cécil Meulenberg, PhD, Editor ANNALES KINESIOLOGIAE • 14 • 2023 • 1 3 UVODNIK Spoštovane bralke in bralci, vabimo vas k branju prve številke 14. letni- ka Annales Kinesiologiae z letnico izida 2023, vsebina katere resnično izraža interdisciplinarno znanstveno raziskovanje in rezultate na področju kakovosti življenja, h katerim lahko prispeva širše področje kinezioloških raziskav. V prvem prispevku, preglednem članku, avtorji raziskujejo, ali aerobni in- tervalni trening pozitivno učinkuje na zdravje bolnikov s srčno-žilnimi obo- lenji. Na podlagi 15 izbranih raziskav je bilo ugotovljeno, da ima od dva- do trikrat tedenska zmerno ali visoko intenzivna vadba, ki se izvaja od deset do šestnajst tednov, pozitivne učinke na starejše srčno-žilne bolnike. Ta priporo- čila se večinoma skladajo s predhodno objavljenimi smernicami, prav tako so zelo koristna za načrtovanje splošnih kakovostnih programov telesne pripra- vljenosti. V naslednjem prispevku, izvirnem znanstvenem članku, avtorji raziskujejo, ali razlike med spoloma vplivajo na izbiro trenerja za fitnes pri obiskovalcih te- lovadnic ter ali lahko določijo in pojasnijo vsebino vadbe v družbenih medijih. Vprašalnik, ustvarjen za to raziskavo, je izpolnilo 50 obiskovalcev fitnesa. Iz dobljenih rezultatov je mogoče izpeljati nešteto kompleksnih ugotovitev glede odnosa strank do fitnesa. Še bolj so ti rezultati gotovo lahko v pomoč pri načrto- vanju vadbe v družbenih medijih in pri oblikovanju strankam prijaznih vsebin. Drugi znanstveni članek poroča o razvoju in potrditvi lestvice, ki izraža od- ločanje starejših za udeležbo v organiziranih programih telesne vadbe. Lestvica je bila preizkušena med 1777 osebami, starejšimi od 60 let, in je sestavljena iz štirih dejavnikov s 27 trditvami, ki pojasnjujejo 43 % variabilnosti. Lestvica bo koristno orodje za pomoč pri načrtovanju in spodbujanju priporočene organizi- rane telesne dejavnosti za starejše osebe.. V zadnjem prispevku, ki je drugi pregledni članek v tej številki revije, po- skušajo avtorji ugotoviti, kateri je najboljši rehabilitacijski postopek za olim- pijske dvigalce uteži s poškodbo rotatorne manšete, pri čemer so priporočila povzeta iz 16 raziskovalnih člankov. Čeprav so te poškodbe običajno precej kompleksne, rezultati kažejo, da je učinkovito rehabilitacijo mogoče pripraviti z dobro načrtovano kombinacijo uporabne fizioterapije, specifičnih metod in njihovega trajanja. Poleg tega je naša uredniška ekipa pripravila tudi poročili o nedavnih do- godkih, ki se jih je udeležila. Konec maja in v začetku junija je v Budimpešti potekala konferenca Evropskega združenja za sociologijo športa (EASS), juni- ja pa je bila v Piranu organizirana tretja poletna šola TwinBrain »Neuroscience of Movement – Exploring the Dynamics of the Human Brain in Motion«. 4 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Raziskave v tej številki revije Annales Kinesiologiae ponujajo koristne in- formacije in orodja, ki lahko pomagajo pri pripravi uspešnih posegov na podro- čju življenjskega sloga/rehabilitacije pri različnih skupinah prebivalstva –sta- rejših, poškodovanih in bolnih osebah. Znanstvene vsebine, kot so predstavljene v tej številki revije, potrjujejo, da lahko multidisciplinarno področje kineziologije prispeva k boljši kakovosti ži- vljenja, uredniška ekipa pa vsekakor upa, da jih bo ponujala tudi v prihodnosti. dr. Cécil Meulenberg, urednik ANNALES KINESIOLOGIAE • 14 • 2023 • 1 5 HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING IN THE REHABILITATION OF PATIENTS WITH CARDIOVASCULAR DISEASES: A SYSTEMATIC REVIEW Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK2 1Faculty of Sport and Physical Education, University of Niš 2 İnönü University, Institute of Health Sciences, Malatya, Türkiye Corresponding author: Tamara ILIĆ Faculty of Sport and Physical Education, University of Niš Čarnojevića 10a, 18000 Niš, Serbia Telephone number: +381644481191 Email: tamarailic.fsfv@gmail.com ABSTRACT Purpose: The aim of this study was to review the literature analyzing the effects of aerobic interval training in the rehabilitation of cardiovascular patients. Methods: Research data was collected considering the inclusion and exclusion cri- teria of the research studies published in English. In order for the study to be included in the analysis, it had to meet the following criteria: year of publication (2004–2022), respondents were people with cardiovascular disease, and the studies included in this review must contain data on disease, training programme and outcomes. Papers with- out full texts available and systematic review studies were excluded. The first search identified 71 articles. In the initial assessment carried out in accordance with the inclu- sion and exclusion criteria, 15 articles were found suitable and were included in the study, while 20 studies were excluded for being duplicates, 28 studies excluded for not having the full text available and eight for non-compliance. Results: The reviewed materials indicate that aerobic interval training has an im- pact on VO2 max, functional abilities, VO2 peak and functional capacity in the reha- bilitation of cardiovascular diseases, especially in the elderly. The duration of the pro- gramme in most studies has a similar time range from 10 to 16 weeks. The programmes that showed the best effects are related to aerobic interval training, from 2 to 3 times per week with moderate (50–60% of VO2 max) or high intensity (80–90% of VO2 max). Review article DOI: https://doi.org/10.35469/ak.2023.390 received: 2023-05-04 UDC: 796.015:616.1-052 6 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Conclusion: Studies indicate that properly dosed physical activity contributes to a better lifestyle for people with cardiovascular diseases. All 15 studies showed positive effects of aerobic interval training in cardiovascular disease rehabilitation. Keywords: aerobic exercise, interval training, rehabilitation, cardiovascular dis- eases ZDRAVSTVENI VIDIKI AEROBNEGA INTERVALNEGA TRENINGA PRI REHABILITACIJI PACIENTOV S SRČNO-ŽILNIMI BOLEZNIMI: SISTEMATIČNI PREGLED IZVLEČEK Namen: Namen raziskave je pripraviti pregled literature, v kateri so analizirani učinki aerobnega intervalnega treninga na rehabilitacijo pacientov s srčno-žilnimi boleznimi. Metode: Podatki o raziskavah so bili zbrani ob upoštevanju meril za vključitev in izključitev, in sicer za raziskave, objavljene v angleškem jeziku. V analizo so bile vključene raziskave, ki so izpolnjevale naslednja merila: objavljene so bile med let- oma 2004 in 2022, anketiranci so bili ljudje s srčno-žilnimi boleznimi, poleg tega so raziskave vključevale tudi podatke o bolezni, programu treninga in rezultatih. Po drugi strani v analizo niso bili vključeni raziskave, katerih besedilo ni bilo v celoti dosto- pno, in sistematični pregledi raziskav. S prvim iskanjem je bilo najdenih 71 člankov. V začetno oceno je bilo v skladu z merili za vključitev in izključitev vključenih 15 člankov, medtem ko je bilo 20 raziskav izključenih, ker so bile podvojene, 28 raziskav je izključenih, ker ni bilo na voljo celotnega besedila, osem pa jih je bilo izključenih zaradi neskladnosti. Rezultati: Pregledana gradiva kažejo, da aerobni intervalni trening vpliva na mak- simalno aerobno moč (VO2 max), funkcionalne sposobnosti, najvišjo vrednost porabe kisika (VO2 peak) in funkcionalne zmogljivosti pri rehabilitaciji v primeru srčno-žilnih bolezni, zlasti pri starejših. V večini raziskav programi trajajo od 10 do 16 tednov. Tisti, ki so se izkazali za najučinkovitejše, so povezani z aerobnim intervalnim treningom in se izvajajo od 2- do 3-krat tedensko z zmerno (50–60 % vrednosti VO2 max) ali visoko intenzivnostjo (80–90 % vrednosti VO2 max). Zaključek: Raziskave kažejo, da ustrezna količina telesne dejavnosti prispeva k boljšemu življenjskemu slogu oseb s srčno-žilnimi boleznimi. Vseh 15 raziskav je pokazalo pozitivne učinke aerobnega intervalnega treninga pri rehabilitaciji v primeru srčno-žilnih bolezni. Ključne besede: aerobn, intervalni trening, rehabilitacija, srčno-žilne bolezni 7 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 INTRODUCTION Cardiovascular disease (CVD) remains the leading cause of mortality world- wide and in Europe (Lozano et al., 2012). It is estimated that 13 million deaths worldwide are caused by CVD. In Europe, more than 80% of all CVD mortality occurs in developing countries. Both mortality and disability caused by CVD remain extremely high and thereby CVD is still the leading somatic cause of loss of productivity (Van Camp, 2014). Exercise-based cardiac rehabilitation has been established as a beneficial treatment approach for patients with cardio- vascular diseases (CVDs). However, optimal exercise characteristics that elicit the most favourable effects for CVD patients are still a matter of controversy (Vanhees, Rauch, Piepoli, & van Buuren, 2012). The “traditional” approach to prescribing exercise intensity for cardiac re- habilitation is between 60–80% of VO2 max, resulting in an average increase of 20% of VO2 max. Intensity appears to be a significant predictor of rehabilitation programme efficacy, as higher intensity leads to greater improvements in VO2 max, even after adjusting for other training-related variables (Rankin, Rankin, MacIntyre, & Hillis, 2012). However, higher intensity is difficult to sustain over a longer period; therefore, Mezzani et al. (2013) suggest an interval structure that refers to shorter exercise sessions with high to severe intensity (60–95% of VO2 max) with duration from 3 to 20 minutes. Several studies have demonstrated the beneficial effects of physical activ- ity in the prevention, treatment and rehabilitation of cardiovascular diseases (Scrutino, Bellotto, Lagioia, & Passantino, 2005; Secco, Paffenberger, & Lee, 2000; Šuščević et al., 2011). Physical activity was not previously recognized as having a significant impact on the prevention and rehabilitation of CVDs. How- ever, in recent years, significant changes have occurred due to the emergence of strong evidence of the effectiveness of primary and secondary prevention (Fletcher et al., 2013). It has been established that physical activity has a pow- erful and beneficial effect on human health, particularly in the pathogenesis of diseases that make up metabolic syndrome, including CVDs (Ades & Coello, 2000). Physical activity is part of a multifactorial concept that, in addition to reducing risk factors, lifestyle changes and therapy, leads to a reduction in car- diovascular risk (Šuščević et al., 2011). In contrast, physical inactivity is one of the main risk factors and causes two million deaths annually (Petković-Košćal, Damjanov, Jevtović, Jovanović & Pantović, 2007). Considering previous studies, there is a need for further and more detailed analysis of the implementation of aerobic interval training in the rehabilita- tion of patients with cardiovascular disease. Although there are many studies 8 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 investigating aerobic interval training in the rehabilitation of CVDs, to be able to draw a conclusion on this topic there is a need for a systematic review of studies that employ different structures, intensity and frequency of this kind of training in practice. Research in this direction will make it possible to obtain in- formation about health aspects of aerobic interval training in the rehabilitation of CVD patients. Therefore, the aim of this study was to review the literature analyzing the effects of aerobic interval training in the rehabilitation of cardio- vascular patients. METHODS This research was designed using the systematic review technique. Research data was collected considering the inclusion and exclusion criteria of the re- search published, as a result of a search made by using the keywords “aerobic, interval, training, rehabilitation, cardiovascular diseases” in English. The search string was related to aerobic interval training with the following combination of keywords used in all databases: “aerobic interval training” AND “rehabilita- tion” AND “cardiovascular diseases”. The search was performed on the Web of Science, Google Scholar and PubMed databases. In accordance with the Pre- ferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic review of the available literature was undertaken (Mo- her et al., 2009) (Figure 1.). The first search identified 71 articles. In the initial assessment carried out in accordance with the inclusion and exclusion criteria, 15 articles were found suitable and were included in the study, while 56 stud- ies were excluded. In order for a study to be included in the analysis, it had to meet the following criteria: year of publication (2004–2022), respondents were people with cardiovascular disease, and the studies included in this review must contain data on disease, the training programme and outcomes. Papers without the full text available and systematic review studies were excluded. References from all papers were reviewed in order to find more studies that deal with a topic that is interesting and related to our review paper. 9 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 In cl ud ed A na ly si s Id en tifi ca tio n Articles identified through database searching n=71 Articles (duplicates) removed n=20 Articles included in systematic review n=15 Excluded (no full text available) n=28 Eliminated articles for non-compliance to including criteria n=8 Articles analyzed n=51 Full text articles assessed for eligibility n=23 E lig ib ili ty Figure 1. PRISMA flow chart of the article selection process 10 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 RESULTS In this part, 15 original scientific studies will be presented on the topic of the influence of physical activity on the arterial blood pressure of the elderly in Table 1. The number of respondents did not vary much from study to study, where the lowest number of respondents (21) was seen in the study (Rognmo, Het- land, Helgerud, Hoff, & Slørdahl, 2004), while the highest number of respond- ents (200) was seen in the study (Conraads et al., 2015). The studies had either only male or only female population, except for study (Papathanasiou et al., 2020), which contained a mixed population. The age range did not vary much in the studies (mostly between 53–65 years), while the youngest population was seen in the study of Lee, Tsai, Oh and Brooks (2018), where there were respondents aged 30. All research studies had the same goal, examination of the impact of aerobic interval training (AIT) in the rehabilitation of cardiovascular disease (CVD) patients. The reviewed materials indicate that aerobic interval training has numerous health aspects in the rehabilitation of cardiovascular dis- eases, especially in the elderly. The duration of the programme in most studies had a similar time range from 10 to 16 weeks, and the programmes that showed the best effects are related to aerobic interval training, from 2 to 3 times a week with moderate (50–60% of VO2 max) or high intensity (80–90% of VO2 max). 11 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 Ta bl e 1. S ys te m at ic re vi ew o f t he st ud ie s А ut ho rs Pa rt ic ip an ts Pu rp os e Ty pe o f p hy si ca l a ct iv ity (i nt en si ty a nd fr eq ue nc y) R es ul ts R og nm o et a l. (2 00 4) n= 21 (М ) ag e 57 .1 ±5 .1 (C VD ) Th e in flu en ce o f di ffe re nt in te ns iti es o f A IT in th e re ha bi lit at io n of C V D s. Su pe rv is ed tr ea dm ill w al ki ng w as p er fo rm ed at h ig h in te ns ity (8 0- 90 % V O 2 p ea k) o r m od er at e in te ns ity (5 0- 60 % V O 2 p ea k) th re e tim es a w ee k fo r 1 0 w ee ks . V O 2 p ea k 17 .9 % ↑ in th e hi gh -in te ns ity gr ou p an d 7. 9% ↑ in th e m od er at e- in te ns ity gr ou p (p =0 .0 74 ) Sm ar t & W St ee le (2 01 2) n= 23 (M ) ag e 66 ±7 (C on ge st iv e he ar t f ai lu re ) H ea lth a sp ec ts o f A IT in th e re ha bi lit at io n of co ng es tiv e he ar t d is ea se Th e pa rti ci pa nt s w er e di vi de d in to tw o gr ou ps . T he se g ro up s c om pl et ed 1 6 w ee ks o f st at io na ry c yc lin g at 7 0% V O 2 m ax th re e tim es a w ee k fo r 3 0 m in ut es c on tin uo us ly o r 6 0 m in ut es (6 0s ec w or k: 6 0s ec re st ). V O 2 m ax g ro up o ne : 13 % ↑ (p = 0 .1 2) ; g ro up tw o 21 % ↑ (p =0 .0 3) . R an ki n et a l. (2 01 2) n= 31 (F ) a ge 6 3± 2 (M en op au se w ith C VD ) Ex am in at io n of th e he al th a sp ec ts o f A IT in th e re ha bi lit at io n of C V D in w om en Su pe rv is ed tr ea dm ill w al ki ng w as p er fo rm ed at h ig h in te ns ity (7 5- 85 % V O 2 p ea k) o r m od er at e in te ns ity (4 5- 55 % V O 2 p ea k) th re e tim es a w ee k fo r 1 0 w ee ks . H ig h- in te ns ity A IT sh ow ed th at V O 2 m ax ↑ (1 2% ; p =0 .0 85 ) M ad ss en e t a l. (2 01 4) n= 36 (М ) ag e 50 -6 3. 5 (C VD ) Th e eff ec ts o f t w o ty pe s o f t ra in in g on th e re ha bi lit at io n of co ro na ry h ea rt di se as e A IT (i nt er va ls a t ≈ 90 % o f m ax im um h ea rt ra te ) o r M C T (c on tin uo us e xe rc is e at ≈ 70 % of m ax im um h ea rt ra te ) w er e pe rf or m ed th re e tim es a w ee k fo r 1 2 w ee ks a fte r t he im pl an ta tio n of a n in tra co ro na ry st en t. A IT ↑ 13 .2 % (p =0 .0 5) M C T↑ 1 2. 7% (p =0 .0 5) . K im e t a l. (2 01 5) n= 28 (F ) A ge 6 1± 8 (A cu te m yo ca rd ia l in fa rc tio n) T he h ea lth a sp ec ts o f A IT in a cu te m yo ca rd ia l in fa rc tio ns in o ld er w om en A IT a t 8 5- 95 % in te ns ity o r M C T at 7 0- 85 % in te ns ity , t hr ee d ay s a w ee k fo r s ix w ee ks in a ca rd ia c re ha bi lit at io n cl in ic . A IT V O 2 p ea k↑ 2 2. 16 % (p = 0 .0 21 ) M C T V O 2 p ea k 8. 7% (p =0 .0 21 ) 12 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 А ut ho rs Pa rt ic ip an ts Pu rp os e Ty pe o f p hy si ca l a ct iv ity (i nt en si ty a nd fr eq ue nc y) R es ul ts C ar do zo e t a l. (2 01 5) n= 71 (M ) A ge 5 6± 12 (C VD ) Th e he al th a sp ec ts o f A IT in th e re ha bi lit at io n of C V D EG p er fo rm ed 3 0 m in ut es o f c on tin uo us ae ro bi c ex er ci se a t 7 0- 75 % o f m ax im um he ar t r at e (H R m ax ), w hi le H II T pe rf or m ed 30 -m in ut e se ss io ns d iv id ed in to 2 -m in ut e al te rn at in g at ta ck s a t 6 0% /9 0% H R m ax (t hr ee tim es a w ee k fo r 1 6 w ee ks ). V O 2 m ax ↑ 22 .5 % (p <0 .0 5) C on ra ad s e t al . ( 20 15 ) n= 20 0 (М ) A ge 5 8. 4± 9. 1 (C or on ar y ar te ry di se as e) Ex am in e th e eff ec ts o f A IT in th e re ha bi lit at io n of C V D A su pe rv is ed 1 2- w ee k ca rd ia c re ha bi lit at io n pr og ra m m e of th re e w ee kl y se ss io ns o r A IT (9 0- 95 % o f p ea k he ar t r at e) o r M C T (7 0- 75 % of p ea k he ar t r at e) o n a bi cy cl e. V O 2 m ax ↑( A IT 22 .7 ±1 7. 6% v er su s M C T 20 .3 ±1 5. 3% ). p< 0. 05 Ja ur eg ui za r et al . ( 20 16 ) n= 72 (М ) ag e 52 -6 7 (I sc ha em ic h ea rt di se as e) Ex am in e th e he al th as pe ct s o f A IT in th e re ha bi lit at io n of C H D A su pe rv is ed 8 -w ee k ca rd ia c re ha bi lit at io n pr og ra m m e of th re e w ee kl y se ss io ns o r A IT (8 0- 90 % o f p ea k he ar t r at e (H R )) o n a bi cy cl e. V O 2 m ax ↑ 21 % (p <0 .0 5) U lb ri ch e t a l. (2 01 6) n= 22 (М ) A ge 5 3. 8± 8 (C hr on ic h ea rt di se as e) H ea lth a sp ec ts o f A IT in pa rti ci pa nt s w ith c hr on ic he ar t d is ea se Th e pa rti ci pa nt s u nd er w en t 1 2 w ee ks o f su pe rv is ed a er ob ic tr ai ni ng , l as tin g 60 m in ut es , t hr ee ti m es a w ee k (6 0- 70 % ) A IT V O 2 m ax ↑ V O 2 pe ak ↑ 20 .7 % (p <0 .0 1) A nd er so n et al . ( 20 16 ) n= 31 (F ) A ge 5 9. 9± 11 .1 (C or on ar y ar te ry di se as e) Th e he al th a sp ec ts o f H II T w er e in ve st ig at ed in th e re ha bi lit at io n of C V D in o ld er w om en w ith c or on ar y ar te ry di se as e. A er ob ic in te rv al tr ai ni ng o n a bi cy cl e er go m et er fo r 1 6 w ee ks , t hr ee ti m es a w ee k fo r 4 5- 60 m in ut es , w ith a m od el o f l in ea r pe rio di za tio n an d gr ad ua l i nc re as e ev er y fo ur w ee ks a t 6 0- 70 % V O 2 p ea k. A IT V O 2 p ea k↑ 2 0. 8% (p <0 .0 5) 13 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 А ut ho rs Pa rt ic ip an ts Pu rp os e Ty pe o f p hy si ca l a ct iv ity (i nt en si ty a nd fr eq ue nc y) R es ul ts L ee e t a l. (2 01 8) n= 72 A ge 3 0- 50 (C VD ) Ex am in e th e im pa ct of A IT o n C V D re ha bi lit at io n A er ob ic in te rv al tr ai ni ng o n a st at io na ry bi cy cl e fo r 6 0 m in ut es , t hr ee ti m es a w ee k at 50 -7 5% o f m ax im um h ea rt ra te , f or 1 0 w ee ks . V O 2 p ea k↑ (p <0 .0 01 ); re du ce d th e fr eq ue nc y of C V D b y 3. 13 % . L ee e t a l. (2 01 9) n= 31 (F ) A ge 6 8. 2± 9. 2 (M en op au se w ith co ro na ry a rt er y di se as e) Ex am in e th e im pa ct o f A IT o n th e re ha bi lit at io n of c or on ar y ar te ry di se as e Fo ur in te rv al s o f f ou r m in ut es a t 9 0- 95 % o f m ax im um h ea rt ra te , t hr ee ti m es a w ee k + pl us tw ic e a w ee k fo r 8 w ee ks . V O 2 m ax ↑ 22 .5 6% (p <0 .0 5) Si lv ei ra e t a l. (2 02 0) n= 34 (F ) A ge 6 0± 9 (C VD ) In ve st ig at e th e be ne fit s of H II T in o ld er w om en w ith C V D A c lin ic al tr ia l w ith e xe rc is e th re e da ys a w ee k fo r 1 2 w ee ks w as c on du ct ed . P at ie nt s w ith C V D w er e ra nd om ly a ss ig ne d to hi gh -in te ns ity in te rv al tr ai ni ng o r m od er at e co nt in uo us tr ai ni ng . V O 2 p ea k↑ : H II T 22 % (p <0 .0 5) : M C T 11 % (p <0 .0 5) . Pa pa th an as io u et a l. (2 02 0) n= 12 0 (M +F ) A ge 6 3. 73 ±6 .6 8 (C VD ) E xa m in e th e he al th as pe ct s o f H II T in th e re ha bi lit at io n of C V D in th e ol de r p op ul at io n Pa rti ci pa nt s w er e en co ur ag ed to p ed al a t a fr eq ue nc y of 6 5- 80 re vo lu tio ns p er m in ut e (r pm ). Th e ex er ci se e nd ed w he n th e pe da l fr eq ue nc y dr op pe d be lo w 4 0 rp m a nd th e pa rti ci pa nt s w er e ex ha us te d. T hr ee ti m es p er w ee k fo r 1 6 w ee ks . H II T↑ (p <0 .0 01 )in th e re ha bi lit at io n of C V D in e ld er ly p ar tic ip an ts L iu e t a l. (2 02 2) n= 24 (F ) A ge 6 4. 2± 4. 2 (C VD ) Ex am in in g th e he al th as pe ct s o f H II T in th e re ha bi lit at io n of C V D Su pe rv is ed tr ea dm ill w al ki ng w as p er fo rm ed at h ig h- in te ns ity (8 0- 90 % V O 2 p ea k) o r m od er at e- in te ns ity (5 0- 60 % V O 2 p ea k) th re e tim es p er w ee k fo r 2 0 w ee ks . H II T↑ V O 2 p ea k (2 1. 3% ; p <0 .0 5) ; L eg en d: ↑ - im pr ov em en t; C VD – c ar di ov as cu la r d is ea se s; A IT – a er ob ic in te rv al tr ai ni ng ; H II T – hi gh -in te ns ity in te rv al tr ai ni ng ; М – m al e; F – fe m al e; n - nu m be r o f p ar tic ip an ts ; Е G – e xp er im en ta l g ro up . 14 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 DISCUSSION The aim of the study was to perform a literature review of studies examining the health aspects of aerobic interval training for the rehabilitation of cardio- vascular patients. The cardiorespiratory endurance of CVD patients improved in all studies that examined the effects of high- and moderate-intensity interval training, whereas high-intensity interval training produces greater cardiorespi- ratory adaptations, related to VO2 max, than moderate-intensity interval train- ing, according to the data (Table 1). Most of the studies presented in Table 1 investigated the impact of high- and moderate-intensity aerobic interval training on CVD patients (Rognmo et al., 2004; Rankin et al., 2012; Madssen et al., 2014; Kim, Choi, & Lim, 2015; Cardozo, Oliveira, & Farinatti, 2015; Conraads et al., 2015; Donelli da Silveira et al., 2020; Liu, Liu, Ji, Dai, & Han, 2022). Some studies showed that high- intensity interval training, ranging from 80–95% HRmax, induced significant improvements in VO2 max ranging from 13–22% after a 6- (Kim et al., 2015), 10–12- (Rognmo et al., 2004; Rankin et al., 2012; Madssen et al., 2014; Con- raads et al., 2015; Donelli da Silveira et al., 2020) and 16–20- (Cardozo et al., 2015; Liu et al., 2022) week experimental programme. Since all the studies showed significant cardiorespiratory adaptations it can be noted that the inten- sity variable plays crucial role in achieving those adaptations. However, it is worth mentioning that the studies presented in this paragraph also compared high- and moderate-intensity exercises. Considering the cardiorespiratory ad- aptations of moderate-intensity groups, improvements in VO2 max ranged from 8–20% after a 6- (Kim et al., 2015), 10–12- (Rognmo et al., 2004; Rankin et al., 2012; Madssen et al., 2014; Conraads et al., 2015; Donelli da Silveira et al., 2020) and 16–20- (Cardozo et al., 2015; Liu et al., 2022) week experimental programme. Both high- and moderate-intensity exercise programme showed significant improvements in VO2 max, although high-intensity interval training seemed to induce a slightly higher increment in cardiorespiratory indications than moderate training in CVDs patients. Some of the studies examined only the impact of moderate-intensity aerobic interval training on CVD patients (Smart & Steele, 2012; Ulbrich et al., 2016; Anderson et al., 2016; Lee et al., 2018; Papathanasiou et al., 2020). The inten- sity in most of these studies ranges from 55–75% HRmax inducing a significant impact on VO2 max of around of 20% after 10–12 (Ulbrich et al., 2016; Lee et al., 2018) and 16 (Smart & Steele, 2012; Anderson et al., 2016; Papathana- siou et al., 2020) weeks of moderate-intensity exercise. Since all of the studies showed improvements on the health aspects of aerobic interval training, it can 15 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 be seen that moderate-intensity training can also be used in rehabilitation with CVD patients. A few studies investigated only the effect of high-intensity aerobic interval training on CVD patients (Jaureguizar et al., 2016; Lee, Tsai, Brooks, & Oh, 2019). In these studies the intensity ranged from 80–95% of HRmax that affect- ed the improvement of VO2 max 21–22% for 8 weeks (Jaureguizar et al., 2016; Lee et al., 2019). Both of the studies showed that this type of high-intensity interval training can be used to benefiting aspects of health in the rehabilitation of CVD patients. All of the studies, that investigated the effects of high- and moderate-inten- sity interval training showed positive improvements of cardiorespiratory endur- ance in CVD patients. However, based on the data shown (Table 1), it can be noted that high-intensity interval training has a slightly better effect on cardi- orespiratory adaptations, regarding VO2 max, compared to moderate-intensity interval training. Limitations of the study This study has potential limitations. Firstly, the study’s inclusion and exclu- sion criteria, which were quite restrictive, likely reduced the amount of litera- ture retrieved. Secondly, only articles published in English were included in this systematic review. CONCLUSION The aim of this study was to systematize the literature that examines the health aspects of aerobic interval training in the rehabilitation of cardiovascular patients. In conclusion, this study showed that both high- and moderate-inten- sity interval training are valid interventions in cardiovascular rehabilitation, positively inducing cardiorespiratory adaptations. However, when comparing the data of the analyzed studies, we concluded that high-intensity interval train- ing contributes slightly more to the health aspects regarding cardiorespiratory adaptations than moderate-intensity training does. 16 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Acknowledgement All authors equally contributed in preparation of this manuscript. Conflict of interest The authors declare that there is no conflict of interest. Future research For future research, we recommend the inclusion of a larger number of stud- ies in the systematic review. REFERENCES Ades, P. A., & Coello, C. E. (2000). Effects of exercise and cardiac rehabilitation on cardiovascular outcomes. Medical Clinics of North America, 84(1), 251-265. https://doi.org/10.1016/S0025-7125(05)70217-0 Anderson, L., Thompson, D. R., Oldridge, N., Zwisler, A. D., Rees, K., Martin, N., & Taylor, R. S. (2016). Exercise-based cardiac rehabilitation for coronary heart disease. Journal of the American College of Cardiology, 67(1), 1–12. https://doi. org/10.1002/14651858.CD001800.pub3 Cardozo, G. G., Oliveira, R. B., & Farinatti, P. T. (2015). Effects of high intensity interval versus moderate continuous training on markers of ventilatory and cardiac efficiency in coronary heart disease patients. Scientific World Journal, 15, Article 192479. https://doi.org/10.1155/2015/192479 Conraads, V. M., Pattyn, N., De Maeyer, C., Beckers, P. J., Coeckelberghs, E., Cor- nelissen, V. A., ... & Vanhees, L. (2015). Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the SAINTEX-CAD study. International Journal of Cardiology, 179, 203- 210. https://doi.org/10.1016/j.ijcard.2014.10.155 Donelli da Silveira, A., Beust de Lima, J., da Silva Piardi, D., dos Santos Macedo, D., Zanini, M., Nery, R., ... & Stein, R. (2020). High-intensity interval training is effec- tive and superior to moderate continuous training in patients with heart failure with preserved ejection fraction: a randomized clinical trial. European Journal of Preven- tive Cardiology, 27(16), 1733-1743. https://doi.org/10.1177/2047487319901206 Fletcher, G. F., Ades, P. A., Kligfield, P., Arena, R., Balady, G. J., Bittner, V. A., ... & Williams, M. A. (2013). Exercise standards for testing and training: a scien- 17 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 tific statement from the American Heart Association. Circulation, 128(8), 873-934. https://doi.org/10.1161/CIR.0b013e31829b5b44 Jaureguizar, K. V., Vicente-Campos, D., Bautista, L. R., de la Peña, C. H., Gómez, M. J. A., Rueda, M. J. C., & Mahillo, I. F. (2016). Effect of high-intensity interval versus continuous exercise training on functional capacity and quality of life in patients with coronary artery disease: a randomized clinical trial. Journal of Cardio- pulmonary Rehabilitation and Prevention, 36(2), 96-105. https://doi.org/10.1097/ HCR.0000000000000156 Kim, C., Choi, H. E., & Lim, M. H. (2015). Effect of high interval training in acute myocardial infarction patients with drug-eluting stent. American Journal of Physical Medicine & Rehabilitation, 94(10S), 879-886. https://doi.org/10.1097/ PHM.0000000000000290 Lee, L. S., Tsai, M. C., Brooks, D., & Oh, P. I. (2019). Randomised controlled trial in women with coronary artery disease investigating the effects of aerobic interval training exercise in cardiac rehabilitation. BMJ Open Sport & Exercise Medicine, 5(1), e000589. https://doi.org/10.1136/bmjsem-2019-000589 Lee, L. S., Tsai, M. C., Oh, P. I., & Brooks, D. (2018). The effectiveness of progres- sive aerobic interval training in cardiac rehabilitation. Medicine & Science in Sports & Exercise, 50(5), 881-888. https://doi.org/10.1249/MSS.0000000000001526 Liu, H., Liu, F., Ji, H., Dai, Z., & Han, W. (2022). A bibliometric analysis of high- intensity interval training in cardiac rehabilitation. International Journal of Envi- ronmental Research and Public Health, 19(21), 13745. https://doi.org/10.3390/ ijerph192113745 Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., & Aboyans, V. (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lan- cet, 380(9859), 2095-2128. https://doi.org/10.1016/S0140-6736(12)61728-0 Madssen, E., Moholdt, T., Videm, V., Wisløff, U., Hegbom, K., & Wiseth, R. (2014). Coronary atheroma regression and plaque characteristics assessed by grayscale and radiofrequency intravascular ultrasound after aerobic exercise. The Ameri- can Journal of Cardiology, 114(10), 1504-1511. https://doi.org/10.1016/j.amj- card.2014.08.012 Mezzani, A., Hamm, L. F., Jones, A. M., McBride, P. E., Moholdt, T., Stone, J. A., … Williams, M. A. (2013). Aerobic exercise intensity assessment and prescrip- tion in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation. European Journal of Preventive Cardiology, 20(3), 442-467. https://doi.org/10.1177/2047487312460484 Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & PRISMA Group*. (2009). Pre- ferred reporting items for systematic reviews and meta-analyses: the PRISMA state- ment. Annals of Internal Medicine, 151(4), 264-269. https://doi.org/10.7326/0003- 4819-151-4-200908180-00135 Papathanasiou, J. V., Petrov, I., Tokmakova, M. P., Dimitrova, D. D., Spasov, L., Dzhafer, N. S., ... & Foti, C. (2020). Group-based cardiac rehabilitation interven- tions. A challenge for physical and rehabilitation medicine physicians: a randomized controlled trial. European Journal of Physical and Rehabilitation Medicine, 56(4), 479–488. https://doi.org/10.23736/S1973-9087.20.06013-X 18 Tamara ILIĆ1, Doroteja RANČIĆ1, Stefan STOJANOVIĆ1, Ismail ILBAK: HEALTH ASPECTS OF AEROBIC INTERVAL TRAINING ..., 5–18 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Petković-Košćal, M., Dajmanov, V., Jevtović, I., Jovanović, M., & Pantović, V. (2007). Fizička aktivnost i modifikacija stila života u prevenciji šećerne bolesti [Physical activity and lifestyle modification in the prevention of diabetes]. Zdravs- tvena zaštita, 36(2),35-51. Rankin, A. J., Rankin, A. C., MacIntyre, P., & Hillis, W. S. (2012). Walk or run? Is high-intensity exercise more effective than moderate-intensity exercise at re- ducing cardiovascular risk? Scottish Medical Journal, 57(2), 99-102. https://doi. org/10.1258/smj.2011.011284 Rognmo, Ø., Hetland, E., Helgerud, J., Hoff, J., & Slørdahl, S. A. (2004). High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease. European Journal of Preventive Cardiology, 11(3), 216-222. https://doi.org/10.1097/01. hjr.0000131677.96762.0c Scrutino, D., Bellotto, F., Lagioia, R., & Passantino, A. (2005). Physical activity for coronary heart disease: Cardioprotective mechanisms and effects on prognosis. Monaldi Archives for Chest Disease, 64(2), 77‒87. https://doi.org/10.4081/monal- di.2005.591 Secco, H., Paffenberger, R., & Lee I. (2000). Physical activity and coronary heart dis- ease in men: The Harvard Alumni Health Study. Circulation, 102, 975‒980. https:// doi.org/10.1161/01.CIR.102.9.975 Smart, N. A., & Steele, M. (2012). A comparison of 16 weeks of continuous vs inter- mittent exercise training in chronic heart failure patients. Congest Heart Failure, 18(4), 205-211. https://doi.org/10.1111/j.1751-7133.2011.00274.x Šuščević, D., Obradović, Z., Dragosavljević, Š., Sekulić, T., Dragić, S., Baroš, I., … Mrđa, V. (2011). Uticaj organizovane fizičke aktivnosti na antropometrijske mjere i fizične faktore [The influence of organized physical activity on anthropometric measures and physical factors]. Glasnik Antropološkog društva Srbije, 46, 331-338. Ulbrich, A. Z., Angarten, V. G., Netto, A. S., Sties, S. W., Bündchen, D. C., de Mara, L. … de Carvalho, T. (2016). Comparative effects of high intensity interval training versus moderate intensity continuous training on quality of life in patients with heart failure. Clinical Trials and Regulatory Science in Cardiology, 13, 21-28. https://doi.org/10.1016/j.ctrsc.2015.11.005 Van Camp, G. (2014). Cardiovascular disease prevention. Acta Clinica Belgica, 69(6), 407–411. https://doi.org/10.1179/2295333714Y.0000000069 Vanhees, L., Rauch. B., Piepoli, M., & van Buuren, F. (2012). Importance of characteristics and modalities of physical activity and exercise in the manage- ment of cardiovascular health in individuals with cardiovascular disease (Part III). European Journal of Preventive Cardiology, 19(6), 1333-1356. https://doi. org/10.1177/1741826711430926 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 19 Original scientific article DOI: https://doi.org/10.35469/ak.2023.424 received: 2023-11-17 UDC: 796.035:316.472 ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA AND THE CHOICE OF FITNESS TRAINER Nikolina ALERIĆ1, Ana PENJAK1, Hrvoje KARNINČIĆ1 1Faculty of Kinesiology, University of Split, Croatia Corresponding author: Ana PENJAK 1Faculty of Kinesiology, University of Split Teslina 6, HR-21000 Split, Croatia Telephone: +385 21 302 440 Email: ana.penjak@kifst.eu ABSTRACT The aim of this study was to: a) investigate and determine gender differences to- wards factors influencing gym-goers’ choice of fitness trainer; and b) to identify and explain gender differences in gym-goers’ attitudes towards social media exercise con- tents (SMEC). For this purpose, a questionnaire was created. The study was conducted on a sample of 50 gym-goers (N1=13 male and N2=37 female), all attending a gym in Split, Croatia. The variable sample consisted of five groups of variables. Test-retest overlap was performed to determine the reliability (88.20%) of the questionnaire. The results showed that the affirmative attitudes were statistically significant in contrast to the non-affirmative attitudes (Wilcoxon Matched Pairs Test, T=250.00, Z=3.60, p<0.001). In addition, male gym-goers generally have a significantly more affirmati- ve attitude towards SMEC than female gym-goers (Mann-Whitney U-test, U=119.50, Z=–2.68, p=0.007). Furthermore, there are gender differences in choosing a fitness trainer based on their appearance; but there are no gender differences in the attitude towards the number of fitness trainers’ followers on social media as an indicator of tru- stworthiness. As this study was specifically concerned with the attitudes of gym-goers, future studies should focus on sports professionals and their attitudes toward this topic. Keywords: social media, attitudes, fitness trainer, exercise, gender 20 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 ODNOS DO VSEBIN V DRUŽBENIH MEDIJIH, POVEZANIH S TELESNO VADBO, IN IZBIRA TRENERJA FITNESA IZVLEČEK Cilj raziskave je bil: a) proučiti in opredeliti razlike med spoloma v dejavnikih, ki vplivajo na odločitev obiskovalcev fitnesa o izbiri trenerja, ter b) ugotoviti in razloži- ti razlike med spoloma v odnosu obiskovalcev fitnesa do vsebin v družbenih medijih, povezanih s telesno vadbo. V ta namen smo na novo zasnovali vprašalnik. Raziskavo smo izvedli na vzorcu 50 oseb (N1 = 13 moških, N2 = 37 žensk), ki obiskujejo fitnes v Splitu. Vzorec spremenljivk je bil sestavljen iz petih skupin spremenljivk. Izvedli smo test ponovljivosti, s katerim smo določili zanesljivost (88,20 %) vprašalnika. Rezultati so pokazali statistično pomembnost afirmativnih odnosov v nasprotju z neafirmativnimi (Wilcoxonov test ekvivalentnih parov, T = 250,00, Z = 3,60, p < 0,001). Poleg tega je bil odnos moških obiskovalcev fitnesa do vsebin v družbenih medijih, povezanih s telesno vadbo, veliko bolj afirmativen kot odnos obiskovalk (Mann-Whitneyjev U test, U = 119,50, Z = -2,68, p = 0,007). Med spoloma so bile razlike tudi pri izbiri trenerja fitnesa na podlagi njegovega videza, ni pa bilo razlik med spoloma v odnosu do števila sledilcev, ki jih ima trener v družbenih medijih, kot kazalnika njegove verodostojnosti. Ta raziskava zajema samo obiskovalce fitnesa, zato bi se morale prihodnje raziskave osredotočiti na poklicne športnike in njihov odnos do te teme. Ključne besede: družbeni mediji, odnos, trener fitnesa, vadba, spol 21 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 INTRODUCTION Over the last twenty years, technology has not only changed the way we live but also the way we work. This has led to a sedentary lifestyle, less physical work and the emergence of modern diseases (WHO, 2021; European Commis- sion, 2021). As online access to information does not require users to have any prior kno- wledge or knowledge of a programming language (Norman, 2012), people have easier and cheaper access than before (Chou, Hunt, Beckjord, Moser & Hesse, 2009; Hanson et al., 2011; Ralph, Berglas, Schwartz & Brindis, 2011; Selkie, Benson & Moreno, 2011; Usher, 2011). For example, statistical data indicate that 61% of American adults use the Internet to find information about sports and health every day, while 39% look for the same information on social media (Fox & Jones, 2018); 22% of healthcare professionals in Norway use Facebook as a source of health information, while 45% of healthcare professionals in Norway and Sweden use LinkedIn for the same purpose (Teodoro & Naaman, 2013); and 30% of the world’s population uses social media as a medium of interaction every day (Regan, 2015). Due to its efficiency and convenience, social media as a global phenomenon has become an indispensable means of communication today: a channel for the instant exchange of information, opinions, and attitudes shared by all genera- tions worldwide (Ratinger, 2017; Stanojević, 2011; Akbari, Huc, Liqiangb & Chua, 2018). Even more, its use is not only a common medium to emphasize one’s interests or hobbies but also a medium to share knowledge and opportu- nities in various fields and for various purposes in our daily lives: from its use in health and educational professions (Mani, Uma, John & Mieminen, 2023; Zaintal & Rahmat, 2020) to its impact on consumers’ purchase intention, wor- kers’ creativity (Arora, Rana & Prashar, 2023; Zhang, Wang & Chen, 2023) and even as a tool to promote the career prospects of female academics in countries where women’s career prospects are not as promising as men’s (Sarwar, Imran, Akhtar & Fatima, 2023). Furthermore, when browsing online profiles, people are subject to trends im- posed by social media, whether consciously or unconsciously. One such trend concerns the profiles of fitness trainers and their social media exercise content (SMEC). The idea of taking care of one’s health, combined with daily posts of exercises, healthy eating, and various ways to become physically active, has led to the emergence of this modern trend that has taken on an important, even invasive, role in contemporary life. In other words, Facebook and Instagram, as the most popular social media in terms of followers, have enabled fitness 22 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 trainers to publish such content and reach a large audience through pictures, videos and motivational posts (Stanojević, 2011; Kaplan & Haenlein, 2010). In addition, today’s gym-goers have become more demanding and require more information and expertise than what they receive in a gym (McCall, 2015). Nu- merous studies have highlighted the positive impact of SMEC on its users. In addition to the ability to publish daily online exercise videos and motivational posts, fitness trainers who post on social media represent an important ‘digital type of health communicator that could influence health behavior’ (Durau, Di- ehl & Terlutter, 2022: 2). Tracking the influence of SMEC and fitness trainers on social media shows that they increase users’ awareness of the importance of physical activity, healthy eating and good fitness, and increase physical activity among both men and women (Durau, Diehl & Terlutter, 2022). Social media platforms that expose SMEC provide the opportunity to reach a larger number of people in a timely manner and draw their attention to their posts and/or blogs where they disseminate information about a healthy lifestyle on a daily basis; it represents a valuable source of useful and correct information about health and sports (Adams, 2010a; Adams, 2010b); it brings profit to the influencers of social media fitness trainers as they use these platforms to promote themselves and their products in addition to all the aspects mentioned above (Grbavac & Grbavac, 2014; Teodoro & Naaman, 2013). However, some studies have also highlighted the negative aspects of SMEC use. Moorhead et al. (2013), for example, lists 12 negative aspects of SMEC. One of these is the inability to control the trustworthiness of the source of content posted on social media, highlighting the potential harm that can result from blindly following SMEC. Given all this, and the fact that there is no way to control the accuracy of SMEC, the question arises: can users trust the SMEC they see, to what extent can they trust it, and how should they choose which influences from SMEC or fitness trainers to follow? Based on these arguments, we hypothesize the following: H1: Users tend to be indecisive when choosing their fitness trainer on social media; H2: There are differences between males and females in terms of affirmative attitudes towards exercise via social media; H3: There are statistically significant differences between males and fema- les in terms of non-affirmative attitudes towards sports on social media. Thus, this study aims to: a) investigate and determine gender differences towards factors influencing gym-goers’ choice of fitness trainer; b) identify and explain the gender differences in gym-goers’ attitudes towards SMEC. 23 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 METHODS Procedure and participants The sample consisted of a total of 50 gym-goers (N1=13 male (26%) and N2=37 female (74%)), all attending a gym in Split, Croatia (see Table 1 for a detailed description of the sample). All of the participants were annual gym members who exercised individually and not in groups programs. As there were no previously developed and validated measurement instru- ments, a new measurement instrument (questionnaire with five questions) was constructed for data collection. The survey was conducted in May 2018. The questionnaire was anonymous and all participants were informed in writing that their participation was voluntary. The given time limit was ten minutes. The questionnaire was written in Croatian. It was handed out in paper. The questionnaire consisted of five items: 1) Demographic variables (gen- der, age, height, weight and body mass index (BMI)); 2) Exercise habits (how often do they exercise, do they participate in any type of group workout); 3) Sources of knowledge about exercise (education, gym, social media, online ar- ticles or scientific sports literature); 4) Choice of social media platforms as a so- urce of information about exercise (Facebook, Instagram, Twitter or YouTube); 5) 13 variables on attitudes towards SMEC (7 affirmative attitude variables, 4 non-affirmative attitude variables and 2 variables of a neutral character). Affirmative attitudes were as follows: “I follow sports-content posts on the Internet and social media”; “Social media play an important role in the fitness industry”; “I often visit personal fitness trainers’ sites and their sports content posts on the Internet and social media”; “I trust personal fitness trainers’ posts on the Internet and social media”; ‘Personal fitness trainers’ posts on the Inter- net and social media motivate me”; “Exercising according to fitness trainers’ posts on the Internet and social media is the most practical way of exercising”; “Personal trainers’ posts on the Internet and social media have had a positive impact on the importance of exercising”. Non-affirmative attitudes were as fol- lows: “People who cannot afford any other type of exercising, exercise using personal fitness trainers’ posts on the Internet and social media”; “One cannot exercise using personal fitness trainers’ posts on the Internet and social media without any prior knowledge”; “I have a hard time finding adequate personal fitness trainers’ posts on the Internet and social media for my exercises”; “I do not exercise using personal fitness trainers’ posts on the internet and social me- dia, but via their posts I have enriched my knowledge on exercising”. Neutral attitudes were as follows: “I choose personal fitness trainers on the Internet and 24 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 social media according to their looks”; “The number of followers is a good quality sign of personal fitness trainers’ posts on the Internet and social media”. All questions that could be answered quantitatively were asked on a 5-point Likert scale (1=strongly agree, 2=agree, 3=neither agree nor disagree, 4=disa- gree, and 5=strongly disagree). The test-retest overlap was calculated (88.20%) to determine the reliabili- ty of the measurement instrument (questionnaire). This confirms the validity of the newly constructed questionnaire. Descriptive statistics (mean, standard deviation, minimum and maximum score, median, mode, and frequency of mode) were used to describe the variables of the sample and to determine the differences between the affirmative and non-affirmative variables. Frequency, percentage and mode were calculated for the questions describing the sample. The Wilcoxon matched-pairs test was used to determine the differences bet- ween affirmative and non-affirmative attitudes. The Mann-Whitney U test was used to determine differences in attitudes between male and female. Data were analysed using the statistical software package Statistics 14.0. (TIBCO Softwa- re Inc. (2020)). RESULTS Table 1 shows that non-affirmative attitudes statistically prevail (p<0.001) and that male users have more affirmative attitudes than female users (p=0.007). Table 2 shows that, based on the results gained from the total sample, the majority of users exercise mostly 3 times per week or 3-5 times per week. Table 3 shows that, based on the results gained from the total sample, gym- goers say they have gained their knowledge of exercises and fitness mostly from the gym and less from SMEC. Table 4 shows that Instagram (46%) is the most popular platform for gaining information on exercises; Twitter (30%) is the second most popular platform, Facebook (22%) comes in third place and YouTube (2%) is the least popular platform for gaining information on exercises. Table 5 shows the results of the gym-goers answers for each of 12 variables regarding all three attitudes. Variable 1 has the highest frequency in males, in females, and in all groups together. 25 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 Table 1: Descriptive statistical parameters (mean, standard deviation, minimal and maximal result) for sample description and affirmative and non-affirmative attitudes regarding exercising using contents published online and on social media All groups Female Male Variable AS ± SD MIN/MAX AS ± SD MIN/ MAX AS ± SD MIN/ MAX Age 58.44±8.99 17.00/ 54.00 28.62 ±9.64 17.00/ 54.00 27.92 ±7.09 19.00/ 43.00 Body height 174.72 ±6.15 165.00/ 191.00 172.11 ±4.43 165.00/ 183.00 182.15 ±3.85 178.00/ 191.00 Body weight 70.60 ±12.14 51.00/ 97.00 66.19 ±8.47 51.00/ 96.00 86.00 ±6.28 76.00/ 97.00 BMI 23.02±3.02 18.21/ 31.71 22.01 ±2.73 18.21/ 31.71 26.91 ±2.73 23.20/ 28.41 Affirmative 2.69±0.54† 1.71/ 4.43 2.55 ±0.42* 1.71/3.43 3.08 ±0.68* 1.86/ 4.43 Non- affirmative 3.30 ±0.74† 2.00/ 5.00 3.40 ±0.70 2.00/5.00 3.03 ±0.81 2.00/ 5.00 Legend: †Statistically significant difference between affirmative and non-affirmative on the total sample (Wilcoxon Matched Pairs Test, T=250.00, Z=3.60, p<0.001); *Statistically significant difference between females and males in affirmative attitudes (Mann-Whitney U test, U=119.50, Z=-2.68, p=0.007) Table 2: Descriptive statistical parameters (frequency, percentage, and mode) for the variable ‘Exercise habits of gym-goers’ All groups I exercise f % Daily 4.00 8.00 3-5 times per weekw 21.00 42.00 3 times per week 22.00* 44.00* 2 times per week 3.00 6.00 Never 0.00 0.00 Legend: *mode; f - frequency; % - percentage 26 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Table 3: Descriptive statistical parameters (frequency, percentage, and mode) for the variable ‘Source of knowledge about exercise’ All groups I gained my knowledge on exercises f % Throughout my education 6.00 12.00 In a gym 31.00* 62.00* Via social media 10.00 20.00 Via online articles 2.00 4.00 From scientific sports literature 1.00 2.00 Legend: *mode; f - frequency; % - percentage Table 4: Descriptive statistical parameters (frequency, percentage and mode) for the variable ‘Choice of social media platforms as a source of information about exercising’ All groups As a source of information about exercising, I use: f % Facebook 11.00 22.00 Instagram 23.00* 46.00* Twitter 15.00 30.00 YouTube 1.00 2.00 Legend: *mode; f - frequency; % - percentage Graph 1 shows that for males the answers vary from ‘Strongly agree’ to ‘Strongly disagree’ while, for females, answers vary from ‘Agree’ to ‘Disagree’. Graph 2 shows that the answers ‘Nor agree nor disagree’ dominate; females were more likely to answer ‘Disagree’ than males, and males were more likely to answer ‘Strongly disagree’ than females. 27 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 Graph 1: Percentages of answers to the neutral attitude: ‘I choose personal fitness trainers on the Internet and social networks according to their looks’ Graph 2: Percentages of individual responses to the neutral attitude: ‘The number of followers is a good indicator of a fitness trainer’s quality as well as the quality of their posts on the Internet and social networks’ 28 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Ta bl e 5: D es cr ip tiv e st at is tic al p ar am et er s (m ed ia n, m od e, a nd fr eq ue nc y of m od e- F m od e) fo r 12 v ar ia bl es o n th e po si tiv e an d ne ga tiv e at tit ud es A ll gr ou ps Fe m al e M al e Va ri ab le M ed ia n M od e F m od e M ed ia n M od e F m od e M ed ia n M od e F m od e Affirmative attitudes 1 st ro ng ly a gr ee st ro ng ly a gr ee 40 st ro ng ly a gr ee st ro ng ly a gr ee 30 st ro ng ly a gr ee st ro ng ly a gr ee 10 2 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 19 ag re e ne ith er a gr ee no r d is ag re e 17 di sa gr ee di sa gr ee 4 3 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 19 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 13 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 6 4 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 16 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 13 di sa gr ee st ro ng ly di sa gr ee 5 5 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 19 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 12 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 7 6 ag re e ag re e 19 ag re e ag re e 16 ne ith er a gr ee no r d is ag re e st ro ng ly di sa gr ee 4 Non-affirmative attitudes 7 di sa gr ee di sa gr ee 20 ag re e st ro ng ly di sa gr ee 15 di sa gr ee di sa gr ee 7 8 ne ith er a gr ee no r d is ag re e ag re e 14 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 12 st ro ng ly a gr ee st ro ng ly a gr ee 7 9 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 15 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 13 ne ith er a gr ee no r d is ag re e st ro ng ly a gr ee 5 10 ag re e ag re e 17 ag re e ag re e 12 ag re e ag re e 5 29 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 A ll gr ou ps Fe m al e M al e Va ri ab le M ed ia n M od e F m od e M ed ia n M od e F m od e M ed ia n M od e F m od e Neutral attitudes 11 ne ith er a gr ee no r d is ag re e M ul tip le 11 ne ith er a gr ee no r d is ag re e M ul tip le 9 ne ith er a gr ee no r d is ag re e st ro ng ly ag re e 4 12 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 17 ne ith er a gr ee no r d is ag re e ne ith er a gr ee no r d is ag re e 12 ne ith er a gr ee no r d is ag re e M ul tip le 5 Le ge nd : M ed ia n; m od e; f m od e- fr eq ue nc y Va ria bl es : 1 -‘ So ci al m ed ia p la y an im po rta nt ro le in th e fit ne ss in du st ry ’; 2- ‘I o fte n vi si t p er so na l fi tn es s t ra in er s’ si te s a nd th ei r s po rts c on te nt p os ts o n th e I nt er ne t a nd so ci al m ed ia ’; 3- ‘I tr us t p er so na l fi tn es s t ra in er s’ po st s o n th e I nt er ne t a nd so ci al m ed ia ’; 4- ‘P er so na l fi tn es s t ra in er s’ po st s o n th e I nt er ne t an d so ci al m ed ia m ot iv at e m e’ ; 5 -‘ Ex er ci si ng th an ks to fi tn es s t ra in er s’ po st s o n th e In te rn et a nd so ci al m ed ia is th e m os t p ra ct ic al w ay o f e xe rc is in g’ ; 6- ‘P er so na l t ra in er s’ po st s o n th e I nt er ne t a nd so ci al m ed ia h av e h ad a po si tiv e i m pa ct o n th e i m po rta nc e o f e xe rc is in g’ ; 7 -‘ Pe op le w ho ca nn ot aff or d an y ot he r t yp e of e xe rc is in g, e xe rc is e us in g pe rs on al fi tn es s t ra in er s’ po st s o n th e In te rn et a nd so ci al m ed ia ’; 8- ; ‘ O ne c an no t e xe rc is e us in g pe rs on al fi tn es s tra in er s’ po st s o n th e In te rn et a nd so ci al m ed ia w ith ou t a ny p rio r k no w le dg e’ ; 9 -‘ I h av e a ha rd ti m e fin di ng a de qu at e pe rs on al fi tn es s t ra in er s’ po st s o n th e In te rn et a nd so ci al m ed ia fo r m y ex er ci si ng ’; 10 -‘ I d o no t e xe rc is e us in g pe rs on al fi tn es s t ra in er s’ po st s o n th e In te rn et a nd so ci al m ed ia b ut v ia th ei r po st s I h av e en ric he d m y kn ow le dg e on e xe rc is in g’ ; 1 1- ‘I p re fe r c ho os in g pe rs on al fi tn es s tra in er s on th e In te rn et a nd s oc ia l m ed ia a cc or di ng to th ei r lo ok s’ ; 1 2- ‘T he n um be r o f f ol lo w er s i s a g oo d qu al ity si gn o f p er so na l fi tn es s t ra in er s’ po st s o n th e In te rn et a nd so ci al m ed ia ’ 30 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 DISCUSSION Firstly, based on the obtained results, we can confirm that non-affirmati- ve attitudes towards SMEC dominate (Affirmative 2.69±0.54; Non-affirmative 3.30±0.74). There can be many reasons for this. For example, you do not need to have any license or diploma to post any type of content related to exercise; there is no form of control or review of the content published on the Internet; it seems that people can post whatever they want as long as the content is not pornographic or discriminatory. On the one hand, it is necessary to protect chil- dren and young people, but, on the other hand, it encroaches on freedom of speech (Ružić, 2008). Furthermore, if we compare the results regarding gender differences, we notice that male users are significantly more affirmative than female. A higher percentage of males play sports, so we can assume that they have more knowledge on this topic, i.e. it would be logical for males to be more critical of the content. Secondly, although the gym-goers say that most of their gained knowledge comes from the gym, probably from fitness trainers working at the gym, still, when using social media as their source of information, users prefer using In- stagram. It comes as no surprise that Instagram is the platform that is curren- tly the trendiest and, as such, the most used by athletes as a platform to post their content. Research has shown that females in elite sports are more likely to post pictures on Instagram, but that males get more attention and comments (Geurin-Eagleman & Burch, 2016). Instagram is a network used by athletes for self-promotion (Smith & Sanderson, 2015; Li, Scott, Naraine & Ruihley, 2021), while social networks are used a lot in sports and by the sports industry and fans, in general (Shahzad, Bajwa, Hussain & Naz, 2021; Anagnostopoulos, Parganas, Chadwick & Fenton, 2018; Calvio, 2013). In addition, studies show that everyday exposure to social media awakens an individual’s creativity and innovation making its user’s profile a reflection of their identity (Kušić, 2010). In other words, if we have acknowledged the im- pact of social media on and in our daily lives, as well as the fact that we use and buy many of the products advertised online, then the issues regarding a fitness trainer’s appearance as a determining factor and the number of their followers as an indicator of their trustworthiness, comes as no surprise. The results indicate that for males, a fitness trainers’ appearance is not the prime reason for following them. The same goes for females who, based on their answers that varied from ‘Agree’ to ‘Disagree’, also state that the appea- rance does not have the expected impact on the determining choice of fitness trainer. This may be, as Soekmawati et al. (2022) explain in their research, in 31 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 direct relationship between gym-users’ age and gender. In other words, they confirmed that the gym-users who said they were influenced by appearance and weight management motives were more likely to identify with physically attractive fitness trainers. Based on the age of our sample (young adults), we believe that extrinsic motives, such as physical appearance, do not seem to motivate them (at least as our small sample is concerned). This is rather a sur- prise since we know that today a lot of young people spend a lot of time trying to look physically attractive and more like some famous social media persona (Jiotsa, Naccache, Duval, Rocher & Grall-Bronnec, 2021; Fardouly, Pinkus & Vartanian 2017; Choukas-Bradley, Nesi, Widman & Higgins, 2019). The se- cond statement, based on the prevailing answers, ‘Nor agree nor disagree’, in- forms us that the number of fitness trainer followers and the quality of their po- sts do not stand as an indicator of their quality and trustworthiness. The reason might be that gym-goers are aware of the complexity of fitness coaching as a profession, i.e. they might believe that, in addition to theoretical and practical knowledge, fitness trainers should master several other professional, scientific and teaching skills (Marković, Marković & Metikoš, 2006). Or, since it has not yet been regulated anywhere, we cannot avoid the question regarding the type of competencies needed for an individual who posts or owns such SMEC. Limitations of the study The fundamental limitation of this study is the rather small and unbalanced sample. The inclusion of a larger sample, perhaps consisting of professional athletes, would complement the available data and provide a more complete picture of the attitudes towards the issues addressed. As the data analysis was conducted in a local gym, further research is needed to generalise the current findings on a more national and international level. Finally, it would be intere- sting if the future studies would do a qualitative research based on which we would get direct answers regarding the issue. CONCLUSION Social media platforms in general have become the most popular means for users to create, share, and receive all kinds of information/content on a daily basis. In this context, many social media users share content about physical 32 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 activity, nutrition, fitness activities and sports, consciously or unconsciously influencing the attitudes of a large number of their users. Based on the results of this case study, we can confirm hypothesis H1, which states that respondents are statistically significantly more likely to be non-af- firmative towards SMEC. We can also confirm hypothesis H2, according to which there are statistically significant differences between males and females in affirmative attitudes towards exercising via the Internet and social media. Finally, we can reject hypothesis H3, as there were no confirmed statistically significant differences between males and females in non-affirmative attitudes towards exercise via the Internet and social networks. In conclusion, we can summarise that females tend to choose a fitness trainer based on their appearan- ce more often than males and that the number of followers does not play a role in the decision to follow a fitness trainer’s social media profile. We, therefore, conclude that this study contributes to a better understanding of how gender differentiated users can be motivated to engage in physical ac- tivity by fitness trainers on social media, i.e. it provides insights into how the use of social media related to sports and fitness can influence users’ attitudes towards choosing specific SMEC. Also, we believe that repeating the same stu- dy, after the COVID-19 pandemic, would show significantly stronger results in favour of using SMEC precisely due to the type of exercise and physical contact that was (not) allowed during the pandemic. REFERENCES Adams, S. A. (2010a). Blog-based applications and health information: two case stu- dies that illustrate important questions for Consumer Health Informatics (CHI) re- search. International Journal of Medical Informatics, 79(6), e89–96. https://doi. org/10.1016/j.ijmedinf.2008.06.009. Adams, S. A. (2010b). Revisiting the online health information reliability debate in the wake of “web 2.0”: an inter-disciplinary literature and website review. Inter- national Journal of Medical Informatics, 79(6), 391-400. https://doi.org/10.1016/j. ijmedinf.2010.01.006. Akbari, M., Huc, H., Liqiangb, N. & Chua, T. (2018). From Tweets to Wellness: Wellness Event Detection from Twitter Streams. Retrieved from http://www.aaai. org/ocs/index.php/AAAI/AAAI16/paper/download/11931/11568. Anagnostopoulos, C., Parganas, P., Chadwick, S. & Fenton, A. (2018). Branding in pictures: using Instagram as a brand management tool in professional team sport organisations. European Sport Management Quarterly, 18(4), 413-438. https://doi. org/10.1080/16184742.2017.1410202. 33 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 Arora, N., Rana, M., & Prashar, S. (2023). How does social media impact consu- mers’ sustainable purchase intention? Review of Marketing Science, 21(1), 143-168. https://doi.org/10.1515/roms-2022-0072. Chou, W. Y., Hunt, Y. M., Beckjord, E. B., Moser, R. P., & Hesse, B. W. (2009). So- cial media use in the United States: implications for health communication. Journal of Medical Internet Research, 11(4), e48. https://doi.org/10.2196/jmir.1249. Choukas-Bradley, S., Nesi, J., Widman, L., & Higgins, M. K. (2019). Camera-rea- dy: Young women’s appearance-related social media consciousness. Psychology of Popular Media Culture, 8(4), 473-481. https://doi.org/10.1037/ppm0000196. Clavio, G. (2013). Emerging social media and applications in sport. In P. M. Peder- sen (Ed.), Routledge handbook of sport communication (pp. 259-268). London and New York: Routledge, Taylor and Francis group. Durau, J., Diehl, S., & Terlutter, R. (2022). Motivate me to exercise with you: the effects of social media fitness infulencers on users’ intentions to engage in physical activity and the role of user gender. Digital Health, 8, 1-17. https://doi. org/10.1177/20552076221102769. European Commission. Special Eurobarometer 472. Report. (2021). Sport and physical activity: survey requested by the European commission, directorate-ge- neral for education, youth, sport and culture and co-ordinated by the directorate- -general for communication. Retrived from http://ec.europa.eu/commfrontoffice/ publicopinion/index.cfm/ResultDoc/download/DocumentKy/82432. Fardouly, J., Pinkus, R. T., & Vartanian, L. R. (2017). The impact of appearan- ce comparisons made through social media, traditional media, and in person in women’s everyday lives. Body Image, 20, 31-39. https://doi.org/10.1016/j.bo- dyim.2016.11.002. Fox, S., & Jones, S. (2018). The Social Life of Health Information. Retrieved from https://www.pewresearch.org/short-reads/2014/01/15/the-social-life-of-health-in- formation/. Geurin-Eagleman, A. N., & Burch, L. M. (2016). Communicating via photographs: A gendered analysis of Olympic athletes’ visual self-presentation on Instagram. Sport management review, 19(2), 133-145. https://doi.org/10.1016/j.smr.2015.03.002. Grbavac, J., & Grbavac, V. (2014). Pojava društvenih mreža kao globalnog komuni- kacijskog fenomena [The emergence of social networks as a global communication phenomenon]. Media, culture and public relations, 5(2), 206-219. Hanson, C., West, J., Neiger, B., Thackeray, R., Barnes, M., & McIntyre, E. (2011). Use and acceptance of social media among health educators. American Journal of Health Education, 42(4), 197-204. https://doi.org/10.1080/19325037.2011.105991 88. Jiotsa, B., Naccache, B., Duval, M., Rocher, B., & Grall-Bronnec, M. (2021). Social media use and body image disorders: association between frequency of comparing one’s own physical appearance to that of people being followed on social media and body dissatisfaction and drive for thinness. International Journal of Environmental Research and Public Health, 18(6), 2880. https://doi.org/10.3390/ijerph18062880. Kaplan, A. M., & Haenlein M. (2010). Users of the world, unite! The challenges and opportunities of social media. Business Horizons, 53(1), 59-68. https://doi. org/10.1016/j.bushor.2009.09.003. 34 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Kušić, S. (2010). Online društvene mreže i društveno umrežavanje [Online social net- works and social networking]. Život i škola, 24(2), 103-125. Li, B., Scott, O. K., Naraine, M. L., & Ruihley, B. J. (2021). Tell me a story: Ex- ploring elite female athletes’ self-presentation via an analysis of Instagram stories. Journal of Interactive Advertising, 21(2), 108-120. https://doi.org/10.1080/152520 19.2020.1837038. Mani, S. A., Uma, E., John, J., & Nieminen, P. (2023). Perceptions of professional social media interaction with patients and faculty members – a comparative survey among dental students from Malaysia and Finland. BMC Medical Education, 23, 384. https://doi.org/10.1186/s12909-023-04359-1. Marković, G., Marković, M., & Metikoš, B. (2006). Što uspješan fitness trener treba znati [What should experienced fitness trainers know?]. In V. Findak (Ed.), Kvali- teta rada u područjima edukacije, sporta i sportske rekreacije, pp. 466-469. Rovinj: Hrvatski kineziološki savez. McCall, P. (2015). 10 fitness trends to look out for in 2016. Retrived from http://bit. ly/2c0Y9cg. Moorhead, S. A., Hazlett, D. E., Harrison, L., Carroll, J. K., Irwin, A., & Hoving, C. (2013). A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication. Journal of Medical Inter- net Research, 15(4), e85. https://doi.org/10.2196/jmir.1933. Norman, C. D. (2012). Social media and health promotion. Global health promotion, 19(849), 3-6. Ralph, L. J., Berglas, N. F., Schwartz, S. L., & Brindis, C. D. (2011). Finding teens in their space: Using social networking sites to connect youth to sexual health ser- vices. Sexuality Research and Social Policy, 8(1), 38-49. https://doi.org/10.1007/ S13178-011-0043-4. Rattinger, M. (2017). Aktivnosti i društvene mreže u slobodnom vremenu mlađih tinejdžera [Activities and social networks in younger teenagers’ free time]. Školski vjesnik: časopis za pedagogijsku teoriju i praksu, 66(2), 222-237. Regan, K. (2015). 10 Amazing Social Media Growth Stats From 2015. Social Media Today. Retrieved from https://www.socialmediatoday.com/social-networks/kadie- regan/2015-08-10/10-amazing-social-media-growth-stats-2015. Ružić, N. (2008). Zakonska ograničenja ili sloboda izražavanja na internetu? [Legal restrictions or freedom of expression on the internet?] MediAnali: međunarodni znanstveni časopis za pitanja medija, novinarstva, masovnog komuniciranja i odnosa s javnostima, 2(4), 101-111. Sarwar, A., Imran, M. K., Akhtar, N., & Fatima, T. (2023). Does social media usage boost career prospects of women: an exploratory study in the academia. Kybernetes, 52(6), 2061-2091. https://doi.org/10.1108/K-04-2021-0294. Selkie, E. M., Benson, M., & Moreno M. (2011). Adolescents’ views regarding uses of social networking websites and text messaging for adolescent sexual health edu- cation. American Journal of Health Education, 42(4), 205-212. https://doi.org/10.1 080/19325037.2011.10599189. Shahzad, N., Bajwa, M. J., Hussain, G., & Naz, T. (2021). Social media marketing in sports and using social media platforms for sports fan engagement. Journal of Contemporary Issues in Business and Government, 27(5), 2812-2822. 35 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Nikolina ALERIĆ, Ana PENJAK, Hrvoje KARNINČIĆ: ATTITUDES TOWARDS EXERCISE CONTENT ON SOCIAL MEDIA ..., 19–35 Smith, L. R., & Sanderson, J. (2015). I’m going to Instagram it! An analysis of athlete self-presentation on Instagram. Journal of Broadcasting & Electronic Media, 59(2), 342-358. https://doi.org/10.1080/08838151.2015.1029125. Soekmawati, N. R. J., Victor, V., & Pei Kian, T. (2022). Gym-goers’ self-identifica- tion with physically attractive fitness trainers and intention to exercise. Behavioral Sciences, 12(5), 158. https://doi.org/10.3390/bs12050158. Stanojević, M. (2011). Marketing na društvenim mrežama [Marketing on social me- dia]. MediAnali: međunarodni znanstveni časopis za pitanja medija, novinarstva, masovnog komuniciranja i odnosa s javnostima, 5(10), 165-180. Teodoro, R., & Naaman, M. (2013). Fitter with Twitter: understanding personal health and fitness activity in social media. Proceedings of the International AAAI Con- ference on Web and Social Media, 7(1), 611-620. https://doi.org/10.1609/icwsm. v7i1.14417. Usher, W. (2011). Types of social media (Web 2.0) used by Australian allied health professionals to deliver early twenty-first-century practice promotion and health care. Social Work in Health Care, 50(4), 305-329. https://doi.org/10.1080/009813 89.2010.534317. Vuletić, S., Jeličić, A. & Karačić, S. (2015). Bioethical aspects of internet. Diacoven- sia: teološki prilozi, 22(4), 525-558. Zainal, Z., & Rahmat, N. H. (2020). Social media and its influence on vocabulary and language learning: a case study. European Journal of Education Studies, 7(11), 1-18. https://doi.org/10.46827/ejes.v7i11.3331. Zhang, H., Wang, M., & Chen, A. (2023). Empirical investigation of how social me- dia usage enhances employee creativity: the role of knowledge management behav- ior. Behavioral Sciences, 13, 601. https://doi.org/10.3390/bs13070601. World Health Organization. (2021). Physical activity. Retrived from http://www. who.int/news-room/fact-sheets/detail/physical-activity. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 37 Original scientific article DOI: https://doi.org/10.35469/ak.2023.421 received: 2023-11-07 UDC: 796.035:613.98 DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS WHICH INFLUENCE DECISION- MAKING OF THE ELDERLY TO TAKE PART IN PHYSICAL EXERCISE PROGRAMS Tatjana TOMAŽIČ1, Bojana FILEJ1, Nadja PLAZAR1 1Alma Mater Europaea – ECM, Department of Social Gerontology Corresponding author: Tatjana TOMAŽIČ Department of Social Gerontology, Alma Mater Europaea – ECM, Slovenska ulica 17, 2000 Maribor, Slovenia e-mail: tatjana.tomazic.majstor@gmail.com ABSTRACT Regular physical activity and exercise are beneficial for both physical and mental health. However, in the elderly, the level of physical activity they partake in is consist- ently inadequate. Recognizing the need to enhance the participation of the elderly in organized physical exercise and understanding the factors which influence their deci- sion-making becomes pivotal. The purpose of this study was to develop a measurement instrument, specifically a scale, to identify these factors and evaluate its psychometric properties. First, the statements were formulated, which was followed by content as- sessment by a panel of experts. In the process of scale validation, its internal consist- ency, stability, correlations between the variables, and factor structure were also evalu- ated. The scale was tested on a sample of 1777 participants engaged in guided physical exercise at the School of Health Association (društvo Šola zdravja), all aged 60 years or more. The exploratory factor analysis yielded a four-factor model with 27 state- ments which explained 42.9% of variability. The results indicated weak, but statistically significant correlations between the factors and an acceptable level of internal consist- ency and stability of the entire scale. This scale, developed to establish the factors that influence the decision-making of the elderly to take part in organized physical exercise, represents a valid and reliable measurement instrument, which can be beneficial in the planning and promotion of organized physical exercise programs for the elderly. Keywords: physical exercise, quantitative methodology, elderly, social gerontology 38 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 RAZVOJ IN PRELIMINARNO PREVERJANJE LESTVICE DEJAVNIKOV PRI ODLOČANJU STAREJŠIH ZA VADBO IZVLEČEK Redna gibalna dejavnost in vadba koristita fizičnemu in duševnemu zdravju, vendar so starejši večinoma premalo gibalno dejavni. Za povečanje deleža starejših pri orga- niziranih gibalnih vadbah je ključno poznavanje dejavnikov, ki vplivajo na njihovo od- ločitev za vključitev v vadbo. Namen raziskave je bil razviti merski instrument – lestvico za ugotavljanje dejavnikov, ki vplivajo na odločitev starejših za vključitev v organizi- rano gibalno vadbo – in oceniti njegove psihometrične lastnosti. Najprej so bile obli- kovane trditve, ki so jih vsebinsko ocenili strokovnjaki ekspertnega panela. V procesu validacije lestvice so se preverjale tudi notranja konsistentnost, stabilnost, povezanost spremenljivk in struktura dejavnikov. Lestvica je bila testirana pri 1777 udeležencih vadbe v društvu Šola zdravja, starih 60 let ali več. Eksploratorna analiza dejavnikov je podala model s štirimi dejavniki (27 trditvami), ki pojasnjujejo 42,9 % variabilno- sti. Rezultati kažejo tudi šibke, toda statistično značilne povezanosti med dejavniki ter sprejemljivo notranjo konsistentnost in stabilnost celotne lestvice. Ustvarjena lestvica za ugotavljanje dejavnikov, ki vplivajo na odločitev starejših za vključitev v organizi- rano gibalno vadbo, je veljaven in zanesljiv merski instrument, ki je lahko koristen pri načrtovanju in promociji programov organiziranih gibalnih vadb za starejše. Ključne besede: gibalna vadba, kvantitativna metodologija, starejši, socialna ge- rontologija ANNALES KINESIOLOGIAE • 14 • 2023 • 1 39 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 INTRODUCTION The global population is aging and, in the coming decades, many coun- tries including Slovenia will face serious challenges in the fields of public healthcare systems, pensions, and social security (Zubiashvil & Zubiashvil, 2021). In 2022, 21.1% of the population of Slovenia were aged 65 years or more, and according to data from the EUROPOP2023 population projections, this percentage is expected to increase to 30.2% by 2050 (Statistical Office of the Republic of Slovenia, 2023). This shifting age structure forces countries to conduct research on how to preserve and enhance the health and well-being of the elderly, ultimately prolonging their independence and reducing the costs associated with healthcare and social services (van Baal, Hoogendoorn & Fis- cher, 2016; Wang et al., 2019). To maintain health and prevent premature morbidity and mortality, regular physical activity and exercise are of particular importance (Langhammer, Ber- gland & Rydwik, 2018; Winett & Ogletree, 2019). Their benefits have been well-documented in the prevention and management of chronic diseases, such as cardiovascular diseases (Coats et al., 2017; Tonet et al., 2018; Singam, Fine & Fleg, 2020; Ciumărnean et al., 2022; Vilela de Sousa et al., 2023), type 2 dia- betes (Colberg et al., 2016; Pan et al., 2018) and some cancers (Ahn et al., 2020; Sanchez-Bayona et al., 2021; Trinh et al., 2021). Additionally, regular physical activity and exercise have been associated with improvements in emotional, psychological, and social well-being, as well as mental health, and cognitive functions (Lee et al., 2015; Langhammer et al., 2018; Yamasaki, 2023). Despite compelling evidence that regular physical activity and exercise sig- nificantly contribute to maintaining independence and improving quality of life in old age (Langhammer et al., 2018; Wang et al., 2019), there exists a notable shortfall in the percentage of elderly individuals who meet the recommended guidelines of at least 150 minutes of moderate physical activity per week (Var- gas, 2020). Therefore, the promotion of physical activity among the elderly constitutes an important public health objective, which should receive greater attention (Nielsen et al., 2014; Langhammer et al., 2018). In the pursuit of formulating effective measures to increase the level of physical activity among the elderly, an in-depth understanding of the factors in- fluencing their decision-making to engage in physical activity is crucial (Niels- en et al., 2014; Chen, While & Hicks, 2015). Nevertheless, the results of stud- ies conducted among the elderly across various cultures cannot be indiscrimi- nately generalized. The factors influencing their decision-making to engage in physical activity within the context of a specific cultural and social community 40 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 necessitate focused investigation (Buman, Daphna Yasova & Giacobbi, 2010; Apaydin Kaya et al., 2013; Capalb, O’Halloran & Liamputtong, 2014; Dėdelė, Chebotarova & Miškinytė, 2022). Since there are no well-established tools in Slovenia to identify such factors, the primary objective of the article was to introduce a measurement instrument designed to assess the factors influencing elderly individuals’ decisions to participate in organized physical exercise, and to validate its psychometric properties. METHODS This study was part of a larger quantitative study of the factors which influ- enced the decision-making of elderly inhabitants of Slovenia to participate in regularly scheduled organized physical exercise throughout an entire year. The study’s objective was in compliance with the recommendations of the World Health Organization, which suggest at least 150 minutes of moderate-intensity exercise a week for the elderly to maintain their health (World Health Organi- zation, 2010). Several psychometric tests were employed to assess the instru- ment’s validity and reliability. Process for developing a measurement instrument Drawing upon an extensive review of prior research into the factors influ- encing the decision-making of the elderly to engage in physical activity (Stathi, McKenna & Fox, 2010; Lee & Hung, 2011; Sims-Gould, Miran-Khan, Haggis & Liu-Ambrose, 2012; Capalb et al., 2014; Nielsen et al., 2014; Chen et al., 2015; de Guzman, Jatulan & Jimenez, 2015; Yamakita, Kanamori, Kondo & Kondo, 2015) and a smaller qualitative study done among the members of the Ljubljana-Dravlje and Ljubljana-Vič groups of the School of Health Associa- tion, a set of 36 statements was created to establish the factors which influence the participation of the elderly in organized physical exercise. Assessment of these statements was based on a 5-point Likert scale, with responses ranging from 5 (I completely agree) to 1 (I completely disagree). ANNALES KINESIOLOGIAE • 14 • 2023 • 1 41 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 Evaluating the content validity of the scale To determine the suitability of the scale designed to identify the factors in- fluencing the decision-making of elderly individuals to participate in organized physical exercise, a panel of experts from the field assessed the formulated statements. To assess content validity, members of the expert panel rated the statements on two dimensions: (1) relevance, using the following scale 4 ‒ very relevant, 3 ‒ somewhat relevant, 2 ‒ revision is essential, and 1 ‒ irrelevant; and (2) clarity, using the following scale 1 ‒ not clear, 2 ‒ needs some revision, and 3 ‒ very clear. When evaluating the content validity index, the number of experts who rat- ed each statement as 3 (somewhat relevant) or 4 (very relevant) was divided by the total number of experts in the panel. This ratio, which was calculated for each individual statement, represents its content validity according to the method described by Polit and Beck (2006). The same two authors also stated that an individual statement is acceptable if its sum total is at least 0.83 for six to eight experts, reflecting good content validity. Furthermore, the Fleiss Kappa (κ) coefficient was calculated, which deter- mines the level of agreement above random chance. Values of the Fleiss Kappa coefficient above 0.74 are considered excellent, those between 0.60 and 0.74 are good, and those between 0.40 and 0.59 are fair (Tang, Hu, Zhang, Wu & He, 2015). Evaluation of the construct validity of the scale Construct validity was evaluated using exploratory factor analysis which enables the condensation of extensive data into a more manageable and com- prehensible datasets (Tavakol & Wetzel, 2020). Exploratory factor analysis is used to collate interdependent variables into descriptive categories and to clas- sify profiles into types with similar properties. In addition, factor analysis can be used to simplify the complexity of correlations between the variables and to predict correlations (Field, 2009). The suitability of data for factor analysis was evaluated using the Kaiser-Meyer-Olkin (KMO) index and Bartlett’s test of sphericity. Data is deemed suitable if the KMO index is at least 0.5. If Bartlett’s test of sphericity does not show statistical significance (p ≥ 0.05), this means that the correlation matrix does not show a satisfactory correlation between the variables measuring an individual construct (Field, 2009). In the data analysis, 42 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 only variables with an eigenvalue of communalities (percentage of total vari- ance in the variable) greater than 0.4 were considered relevant. Evaluation of reliability of the scale The reliability of the scale was assessed by analyzing its internal consist- ency and stability. Internal consistency was assessed using the Cronbach’s al- pha coefficient (α), whereby 0.60 was used as the threshold value. While this value is considered suboptimal, it remains acceptable (Morgan, Cleave-Hogg, DeSousa & Tarshis, 2004; Kachooei et al., 2015). The threshold value of 0.60 was also applied when evaluating reliability with the split-half method for ana- lyzing the stability of the variables using Guttman’s coefficient and Spearman- Brown’s coefficient. Sample description The expert panel tasked with evaluating the content validity of the scale‘s statements consisted of six experts, five women and one man between the ages of 40 and 75, and having a master’s degree or doctorate of science. The panel’s diverse expertise included social gerontology, sociology and extensive experi- ence in healthcare education. Their collective experience provided a compre- hensive understanding of the various aspects of social activities relevant to the focus of the scale. Evaluation of validity and reliability based on the expert ratings was per- formed on a sample of participants retrieved from the physical exercise pro- gram organized by the School of Health Association of Slovenia. This program comprises 30 minutes of morning exercise done in accordance with the “1000 movements” method (Grishin, 2012). It is led by trained volunteers who are members of the association and is available free of charge every day (except Sundays and holidays) in open air public areas. The research data were obtained on a sample of 1777 respondents between 60 and 92 years of age. The average age of the respondents was 69.5 years (SD = 6.2). In terms of gender structure, women prevailed in the sample (88.7%), while based on their residence the re- spondents were mostly from urban areas (65.1%). The respondents came from all statistical regions of Slovenia, except the Pomurje and Zasavje regions. The levels of education ranged from unfinished primary school to doctorate of sci- ence, and most of them had a secondary school level of education (39.4%). In ANNALES KINESIOLOGIAE • 14 • 2023 • 1 43 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 terms of household income, most respondents stated that they were just getting by with their income (50.3%), 8.4% of the respondents found it difficult or ex- tremely difficult to survive on their income, and the rest of them stated that they were able to live comfortably on their income. Data collection and processing Data collection was done in line with the Helsinki Declaration and took place from June to October 2017. Formal approval from the ethics committee was not sought as the research method did not involve any interventions or sensitive personal data. The participants were thoroughly informed about the study and their voluntary participation. In addition, the study was conducted in accordance with general ethical principles, including anonymity and confi- dentiality, as well as respect for the autonomy and dignity of all participants. The first author joined several training groups and upon completing the exercises she invited the participants to join the study, guaranteeing anonym- ity and protection of the collected data. Since it was not possible to visit all of the groups, some of the participants were recruited by the group leaders using the same approach described above. The participants were given the questionnaires and asked to fill them out at home and return them back to the group leader. All of the leaders then forwarded the collected questionnaires to the first author by mail using envelopes equipped with stamps and properly addressed. Data were analyzed using the IBM SPSS software, Version 29.0 (SPSS Inc., Chicago, IL, US). To determine the psychometric properties of the scale to establish the factors influencing the decision-making of the elderly to take part in organized physical exercise, the following statistical analyses were done: descriptive statistics (frequency distribution, the lowest and highest data values, the mean and standard deviations), Cronbach’s alpha coefficient to establish internal consistency, Guttman’s and Spearman-Brown’s coeffi- cients for analyzing the stability of the variables, exploratory factor analysis for evaluating the factor structure and Pearson’s correlation coefficient to de- termine the correlation between the variables. 44 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 RESULTS A total of 2579 questionnaires were distributed and 1966 of those were re- turned, which means that the response rate was 76.2%. Questionnaires of the participants younger than 60 years of age and of those who did not provide the year of birth were excluded from further analysis. The statistical analysis thus comprised 1777 or 68.9% of all distributed questionnaires. Content validity of the scale The expert panel members assessed all 36 formulated statements of the scale as relevant and clear. Therefore, no statement was excluded on the basis of content validity analysis. The content validity indices for the statements were satisfactory and rated between 0.83 and 1.00 for relevance, and between 0.83 and 1.00 for clarity. To reduce the possibility of random agreement between the expert panel’s members, the level of their agreement was calculated using the Fleiss Kappa coefficient. The value of this coefficient showed a good agree- ment between expert assessments (κ = 0.71; 95% confidence interval from 2.98 to 4.08; p < 0.001). The results for the Fleiss Kappa coefficient for individual statements of the scale ranged between 0.67 and 1.00. Construct validity of the scale The evaluation of the scale’s validity to establish the factors that affect the decision-making of the elderly to take part in organized physical exercise was done on the basis of an exploratory factor analysis. The suitability of data for factor analysis was first verified using the KMO index and Bartlett’s test of sphericity. Analysis of the interdependence between the variables showed that the use of factor analysis was reasonable, which was confirmed by the KMO index and Bartlett’s test of sphericity (KMO = 0.702; Bartlett’s test of spheric- ity χ2 = 5165.895, df = 496, p < 0.001). It follows from the obtained results that the correlation matrix demonstrated satisfactory correlations between the vari- ables measuring individual constructs. In the data analysis, we used those vari- ables which had an eigenvalue of communality higher than 0.4. For this reason, 9 statements were excluded from further analysis because they did not meet the inclusion criteria. The final scale for determining the factors that influence ANNALES KINESIOLOGIAE • 14 • 2023 • 1 45 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 the decision-making of the elderly to participate in organized physical exercise thus consisted of 27 statements. Table 1 shows these 27 statements and the respective factor loadings which range from 0.402 to 0.791. Factor 1, Exercise Characteristics, was comprised of 8 statements with factor loadings ranging from 0.498 to 0.647. Factor 2, So- cial Aspect, was comprised of 4 statements with factor loadings ranging from 0.603 to 0.788. Factor 3, Health Problems, was comprised of 7 statements with factor loadings ranging from 0.483 to 0.785, and Factor 4, Improvement in Psy- chophysical Well-Being, was comprised of 8 statements with factor loadings ranging from 0.402 to 0.791. Using this four-factor model, 42.9% of variability can be explained. Factor 1 had the highest eigenvalue of variability of 14.3 %, followed by Factor 2 with 10.7%, Factor 3 with 9.6%, and Factor 4 with 8.3%. Table 1 also shows the content validity index of individual statements from the viewpoint of relevance. Regarding clarity, all expert panel members as- sessed all of the 27 statements of the final scale to establish the factors that influence the decision-making of the elderly to participate in organized physical exercise as very clear (1.00). A quartile-based scoring system was also determined. Using the scale, the respondents were able to achieve between 27 and 135 points. Considering the factors that influence the participation of the elderly in organized physical ex- ercise, scoring was done as follows: low influence (from 27 to 53 points), mod- erately low influence (from 54 to 81 points), moderately high influence (from 82 to 108 points), and high influence (from 109 to 135 points). The sum of all results leading to the final score on the scale was quite low among the respond- ents and indicated a moderately low influence of the factors on the decision- making of the elderly to participate in organized physical exercise ( = 65.00; SD = 12.189; 95% confidence interval [64.43; 65.57]; p < 0.001) (Table 2). As part of validating the measurement model, the correlation coefficients between the factors were also stated. The results showed that the correlations between the factors were low/weak, as they ranged from 0.216 to 0.300. All correlations were statistically significant at p < 0.001 (Table 3). 46 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Ta bl e 1: A ss es sm en t s ca le to e st ab lis h th e fa ct or s w hi ch in flu en ce th e pa rt ic ip at io n of th e el de rl y in o rg an iz ed p hy si - ca l e xe rc is e S ta te m en ts Fa ct or lo ad in gs M ea n sc or e (S D ) I- C V I (R ) Fa ct or 1 I c ho se to ex er ci se at th e S ch oo l o f H ea lth A ss oc ia tio n be ca us e i t i s d on e i n a s ta nd in g po si tio n. 0. 64 7 2. 16 (1 .5 92 ) 0. 83 I c ho se to ex er ci se at th e S ch oo l o f H ea lth A ss oc ia tio n be ca us e i t l as ts o nl y 30 m in ut es . 0. 62 7 2. 31 (1 .6 89 ) 1. 00 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n be ca us e it ta ke s pl ac e in th e m or ni ng s. 0. 62 5 3. 43 (1 .6 46 ) 1. 00 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n be ca us e it is a va ila bl e se ve ra l tim es a w ee k. 0. 58 2 2. 85 (1 .8 12 ) 1. 00 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n be ca us e it is p er fo rm ed in a gr ou p. 0. 53 4 2. 93 (1 .8 99 ) 1. 00 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n be ca us e it ta ke s pl ac e in th e op en a ir. 0. 50 8 3. 92 (1 .4 96 ) 0. 83 I c ho se to ex er ci se at th e S ch oo l o f H ea lth A ss oc ia tio n be ca us e i t i s c lo se to m y ho m e. 0. 49 9 3. 74 (1 .5 49 ) 0. 83 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n be ca us e it do es n ot re qu ire a ny sp ec ia l s po rts e qu ip m en t. 0. 49 8 2. 39 (1 .6 55 ) 0. 83 Fa ct or 2 I c ho se to a tte nd th e ex er ci si ng a ct iv iti es a t t he S ch oo l o f H ea lth A ss oc ia tio n be ca us e I m is s t he c om pa ny o f o th er p eo pl e. 0. 78 8 1. 72 (1 .4 38 ) 0. 83 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n to fe el le ss lo ne ly . 0. 76 4 1. 82 (1 .5 52 ) 0. 83 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n be ca us e I a m d ep re ss ed . 0. 61 7 1. 35 (0 .7 53 ) 1. 00 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n to fe el le ss sa d. 0. 60 3 1. 25 (0 .9 07 ) 0. 83 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 47 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 St at em en ts Fa ct or lo ad in gs M ea n sc or e (S D ) I- C V I (R ) Fa ct or 3 I ch os e to e xe rc is e at t he S ch oo l of H ea lth A ss oc ia tio n be ca us e I ha ve e le va te d ch ol es te ro l l ev el s. 0. 78 5 2. 33 (1 .7 34 ) 1. 00 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n be ca us e I h av e di ab et es . 0. 75 9 1. 39 (1 .1 18 ) 1. 00 I ch os e to e xe rc is e at t he S ch oo l of H ea lth A ss oc ia tio n be ca us e I ha ve b re at hi ng pr ob le m s. 0. 67 8 1. 59 (1 .1 86 ) 0. 83 I c ho se to ex er ci se at th e S ch oo l o f H ea lth A ss oc ia tio n be ca us e I h av e a ca rd io va sc ul ar di se as e. 0. 51 2 1. 98 (1 .5 32 ) 0. 83 I ch os e to e xe rc is e at t he S ch oo l of H ea lth A ss oc ia tio n be ca us e I ha ve s to m ac h pr ob le m s o r i nd ig es tio n. 0. 50 6 1. 69 (1 .2 92 ) 0. 83 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n be ca us e I h av e ca nc er . 0. 49 7 1. 19 (0 .7 38 ) 1. 00 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n be ca us e I h av e os te op or os is . 0. 48 3 1. 80 (1 .3 90 ) 0. 83 Fa ct or 4 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n to im pr ov e m y m ob ili ty . 0. 79 1 4. 27 (1 .5 08 ) 1. 00 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n fo r g re at er w el l-b ei ng . 0. 62 0 4. 44 (0 .6 49 ) 1. 00 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n fo r b et te r p hy si ca l fi tn es s. 0. 47 3 3. 88 (1 .4 63 ) 0. 83 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n to im pr ov e m y ba la nc e. 0. 46 1 2. 44 (1 .8 82 ) 1. 00 I ch os e to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n be ca us e I ha ve p ai n in m y m us cl es o r j oi nt s. 0. 45 8 2. 46 (1 .8 88 ) 0. 83 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n to im pr ov e m y sl ee p. 0. 44 3 1. 37 (1 .1 10 ) 1. 00 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n to lo se w ei gh t. 0. 40 5 1. 32 (1 .0 44 ) 0. 83 I c ho se to e xe rc is e at th e Sc ho ol o f H ea lth A ss oc ia tio n to m ai nt ai n m y he al th . 0. 40 2 3. 35 (1 .8 93 ) 1. 00 Le ge nd : F ac to r 1 ‒ Ex er ci se C ha ra ct er ist ic s; Fa ct or 2 ‒ So ci al A sp ec t; Fa ct or 3 ‒ H ea lth P ro bl em s; Fa ct or 4 ‒ Im pr ov em en t i n Ps yc ho ph ys ic al W el l-B ei ng ; SD  ‒  st an da rd d ev ia tio n; S co re s b as ed o n le ve l o f a gr ee m en t: Fr om 5 ‒ C om pl et el y ag re e to 1 ‒ C om pl et el y di sa gr ee ; I -C V I ( R) ‒ St at em en ts C on te nt V al id ity In de x (R el ev an ce ) 48 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Table 2: Scores on the scale to establish the factors which influence the partici- pation of the elderly in organized physical exercise Factors  SD 95% confidence interval p value Lower limit Upper limit Exercise Characteristics 21.89 6.788 21.58 22.21 < 0.001 Social Aspect 6.14 3.025 6.00 6.28 < 0.001 Health Problems 11.98 4.016 11.79 12.16 < 0.001 Improvement in Psychophysical Well- Being 23.18 4.844 22.96 23.41 < 0.001 Assessment scale to establish the factors which influence the decision- making of the elderly to participate in organized physical exercise 65.00 12.189 64.43 65.57 < 0.001 Legend:  ‒ mean value; SD ‒ standard deviation Table 3: Correlation matrix for factors of the scale ‒ Pearson’s correlation coefficient Factors 1 2 3 4 Exercise Characteristics - 0.216** 0.266** 0.300** Social Aspect 0.216** - 0.256** 0.243** Health Problems 0.266** 0.256** - 0.288** Improvement in Psychophysical Well-Being 0.300** 0.243** 0.288** - Legend: ** Correlation is statistically significant at 0.01 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 49 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 Evaluation of reliability of the scale The reliability evaluation to establish the factors that influence the deci- sion-making of the elderly to enroll in organized physical exercise was done using reliability and stability testing. Cronbach’s alpha coefficient, Guttman’s split-half coefficient, and Spearman-Brown’s coefficient were calculated for the scale as a whole (Table 4). The results showed reliability and stability along the entire scale (> 0.600). Table 4: Reliability evaluation of the scale to establish the factors which influ- ence the participation of the elderly in organized physical exercise Construct n Cronbach’s α coefficient Guttman’s split-half coefficient Spearman- Brown’s coefficient Assessment scale to establish the factors which influence the participation of the elderly in organized physical exercise 27 0.642 0.670 0.649 Legend: n ‒ total number of statements within the scale DISCUSSION The purpose of the study was to develop a scale comprising of factors that influence the decision-making of the elderly to enroll in organized physical exercise lasting 30 minutes per session five or six days a week, and to perform its psychometric validation. The retention of all 36 initial statements after expert validation emphasizes their relevance and appropriateness in capturing the different aspects of deci- sion-making in this population. This comprehensive inclusion, which meets the content validity criteria of Polit and Beck (2006), emphasizes the depth and breadth of the factors considered in our study. The exploratory factor analysis, which was crucial for refining the scale, re- vealed interesting findings. The exclusion of 9 statements due to their insufficient variability suggests that certain anticipated factors may not play as significant a 50 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 role in the decision-making process as originally assumed. This refinement result- ed in a more focused four-factor model that reveals the complexity and multidi- mensionality of the decision-making process in the elderly in relation to physical exercise. The weak but statistically significant correlations between these factors suggest a nuanced interplay rather than strong, direct relationships. This subtlety in the relationships between the different factors provides a more complex under- standing of how the elderly weigh up different considerations when deciding to participate in organized physical exercise programs. The scale to establish the factors that influence the decision-making of the elderly to enroll in organized physical exercise clearly identified four main fac- tors that are crucial for planning organized physical exercise for the elderly in Slovenia. The first factor refers to the Exercise Characteristics and is related to the way the exercises are done, the duration of exercise, the timing of exercise, the frequency of exercise, the form of exercise, the place of exercise, and the need to use sports equipment. Other authors have also reported that the characteristics of organized physical exercise, such as access to the exercise area, the time and place of exercise, the intensity and form of exercise, and the prices of exercise programs, are important for the elderly when deciding to participate in a physical exercise program (Bethancourt, Rosenberg, Beatty & Arterburn, 2014; de Guz- man et al., 2015; Levasseur et al., 2015; Shaikh & Dandekar, 2019). The second factor, i.e. Social Aspect, is related to the enrolment of the el- derly in organized physical exercise programs as a means to counteract feelings of loneliness, depression, and sadness. Aging encompasses not only biological changes, but also important psychological and social shifts (Cannon, 2015). These are often associated with alterations in socio-economic status, loss of employment, spouse or friends, and an increasing dependence on the assistance of others. Moreover, cognitive and mental capacities tend to decline with age (Johnson, Barrera & Yochim, 2018; June & Marty, 2018; Woodhead, 2018). Given these multifaceted challenges, it becomes advantageous for the elderly to have access to and participate in organized group physical exercise programs. The results of studies have shown that the elderly do not take part in such pro- grams solely to maintain or improve their physical health, but also to socialize with other people of similar age (Devereux-Fitzgerald, Powell, Dewhurst & French, 2016; Pels & Kleinert, 2016; Franke, Sims-Gould, Nettlefold, Ottoni & McKay, 2021). There is also an increasing amount of evidence in support of the mental and cognitive benefits for the elderly derived from participating in programs involving regular physical exercise (Windle, 2014; Lee et al., 2015; Yamasaki, 2023). ANNALES KINESIOLOGIAE • 14 • 2023 • 1 51 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 The third factor, i.e. Health Problems, comprises statements on various health problems reported by the respondents. This factor is particularly com- plex as there are different views in the literature on how health perceptions influence physical activity in the elderly. On the one hand, some studies have found that poor health can actually motivate the elderly to increase the level of their physical activity (Stathi et al., 2010; Patel, Schofield, Kolt & Keogh, 2013; Midlöv, Leijon, Sundquist, Sundquist & Johansson, 2014). These authors suggest that health problems may serve as a wake-up call that prompts the el- derly to exercise more in order to manage or alleviate their health problems. On the other hand, a number of studies argue that negative self-rated health tends to be associated with lower levels of physical activity in the elderly (Moschny, Platen, Klaaßen-Mielke, Trampisch & Hinrichs, 2011; Chen et al., 2015; Yam- akita et al., 2015; Aro, Agbo & Omole, 2018). This perspective implies that the elderly who perceive their health to be poor are less likely to engage in physical activity, possibly out of concern about exacerbating their health problems or a general sense of incapacity. When designing exercise programs, it is advisable to consider the health problems and diseases of the elderly. Awareness of these conditions is crucial as the etiology of such health problems may necessitate adaptations in the exercise program. The last factor of the scale to establish the factors that influence the deci- sion-making of the elderly to participate in organized physical exercise com- bines statements that refer to improvement in psychophysical well-being. This is demonstrated by improvements in mobility, overall well-being, fitness levels, balance, pain reduction, sleep quality, loss of excess weight, and maintenance of health. Our findings are consistent with other studies (Bethancourt et al., 2014; Capalb et al., 2014; Nielsen et al., 2014; Tumanova, 2019; Yarmoham- madi, Saadati, Ghaffari & Ramezankhani, 2019; Pedersen, Hansen & Elmose- Østerlund, 2021). When designing physical exercise programs, it is important to understand the reasons that motivate the elderly to participate in the organ- ized physical exercise program. With this knowledge, exercises programs might become better tailored to the needs of the elderly. Aligning physical exercise programs with the values and needs of the elderly enhances the likelihood of their sustained commitment to the organized physical exercise program. In addition to substantiating the validity of the scale in elucidating the factors influencing the decision-making of the elderly to participate in organized physi- cal exercise, the study also verified its commendable reliability and stability. The study was conducted on a representative sample of the elderly taking part in physical exercises at the School of Health Association, although the use of stratified random sampling instead of convenience sampling should be con- 52 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 sidered in future studies. Limitations of the study may arise from unequal gen- der representation and omission of certain statistical regions of Slovenia. Some limitations might also be associated with the subjective nature of participants’ personal experiences. While the four-factor model exhibited satisfactory psychometric proper- ties, it might not have comprehensively addressed the entire scope of the fac- tors influencing the participation of the elderly in organized physical exercise. Therefore, a suggestion for future studies is to expand the scale’s statements, perform confirmatory factor analysis and test-retest analysis on a new sample of respondents. Furthermore, assessing the cultural sensitivity of the scale and performing intercultural adjustment would contribute to a better understand- ing of the factors influencing the decision-making of the elderly to take part in organized physical exercise. CONCLUSION This study focused on the development and initial psychometric validation of a scale. It identified factors that influence decision-making of the elderly to take part in organized physical exercise programs. The resulting novel meas- urement instrument comprises four factors and 27 statements. It can help pro- fessionals, public and non-governmental institutions, organizations and asso- ciations in the planning and promotion of organized physical exercise programs for the elderly. REFERENCES Ahn, S. J., Kim, J. H., Chun, M., Yoon, W. S., Rim, C. H., Yang, D. S., … Lee, D. S. (2020). Physical activity status in relation to quality of life and dietary habits in breast cancer survivors: subset analyses of KROG 14-09 nationwide questionnaire study, Quality of Life Research, 29(12), 3353–3361. https://doi.org/0.1007/s11136- 020-02585-4. Apaydin Kaya, Ç., Turan, N., Ozfirat, N., Ozel, S., Sezgin, S., Kucuk, V., … Ay, P. (2013). Investigation of reliability and validity of the Turkish version of the participa- tion motivation questionnaire for older adults (PMQOA). International Journal of Ac- ademic Research, 5(5), 363–368. https://doi.org/10.7813/2075-4124.2013/5-5/B.56. Aro, A. A., Agbo, S., & Omole, O. B. (2018). Factors influencing regular physical exercise among the elderly in residential care facilities in a South African health district. African Journal of Primary Health Care & Family Medicine, 10(1), 1–6. https://doi.org/10.4102/phcfm.v10i1.1493. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 53 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 Bethancourt, H. J., Rosenberg, D. E., Beatty, T., & Arterburn, D. E. (2014). Barri- ers to and facilitators of physical activity program use among older adults. Clinical Medicine & Research, 12(1/2), 10–20. https://doi.org/10.3121/cmr.2013.1171. Buman, M. P., Daphna Yasova, L., & Giacobbi, P. R. Jr. (2010). Descriptive and narrative reports of barriers and motivators to physical activity and sedentary older adults. Psychology of Sport and Exercise, 11(3), 223–230. https://doi.org/10.1016/j. psychsport.2010.02.002. Cannon, M. L. (2015). What is aging? Disease-a-Month, 61(11), 454–459. https://doi. org/10.1016/j.disamonth.2015.09.002. Capalb, D. J., O’Halloran, P., & Liamputtong, P. (2014). Why older people en- gage in physical activity: an exploratory study of participants in a community-based walking program. Australian Journal of Primary Health, 20(1), 74–78. https://doi. org/10.1071/PY12090. Chen, Y., While, A. E., & Hicks, A. (2015). Physical activity among older people liv- ing alone in Shanghai, China. Health Education Journal, 74(2), 156–167. https:// doi.org/10.1177/0017896914523943. Ciumărnean, L., Milaciu, M. V., Negrean, V., Orasan, O. H., Vesa, S. C., Salagean, O., … Vlaicu, S. I. (2022). Cardiovascular risk factors and physical activity for the prevention of cardiovascular diseases in the elderly. International Journal of Environmental Research and Public Health, 19(207), 1–16. https://doi.org/10.3390/ ijerph19010207. Coats, A. J. S., Forman, D. E., Haykowsky, M., Kitzman, D. W., McNeil, A., Camp- bell, T. S., & Arena, R. (2017). Physical function and exercise training in older patients with heart failure. Nature Reviews Cardiology, 14(9), 550-559. https://doi. org/10.1038/nrcardio.2017.70. Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., … Tate, D. F. (2016). Activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(11), 2065–2079. https://doi. org/10.2337/dc16-1728. de Guzman, A. B., Jatulan, E. H. M., & Jimenez, J. A. C. A. (2015). Explicating physical activity preferences of community-dwelling filipino elderly in urban and rural settings: a conjoint analysis. Educational Gerontology, 41(4), 251–266. htt- ps://doi.org/10.1080/03601277.2014.954492. Dėdelė, A., Chebotarova, Y., & Miškinytė, A. (2022). Motivations and barriers to- wards optimal physical activity level: A community-based assessment of 28 EU countries. Preventive medicine, 164(November), 1–7. https://doi.org/10.1016/j. ypmed.2022.107336. Devereux-Fitzgerald, A., Powell, R., Dewhurst, A., & French, D. P. (2016). The ac- ceptability of physical activity interventions to older adults: A systematic review and meta-synthesis. Social Science & Medicine, 158, 14–23. https://doi.org/10.1016/j. socscimed.2016.04.006. Field, A. (2009). Discovering statistics using SPSS. Los Angeles (USA): SAGE Pub- lications Ltd. Franke, T., Sims-Gould, J., Nettlefold, l., Ottoni, C., & McKay, H. A. (2021). “It makes me feel not so alone”: features of the Choose to Move physical activity in- tervention that reduce loneliness in older adults. BMC Public Health, 21(1), 1–15. https://doi.org/10.1186/s12889-021-10363-1. 54 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Grishin, N. (2012). Metoda - 1000 gibov [The 1000 movements method]. Ljubljana (Slovenia): samozaložba. Johnson, S. F., Barrera, K., & Yochim, B. P. (2018). Cognition and aging. In B. P. Yochim & E. L. Woodhead (Eds.), Psychology of Aging: A Biopsychosocial Per- spective (pp. 157–175). New York: Springer Publishing Company. June, A., & Marty, M. A. (2018). Death and the Dying Process, Bereavement, and Wid- owhood. In B. P. Yochim & E. L. Woodhead (Eds.), Psychology of Aging: A Biopsy- chosocial Perspective (pp. 273–298). New York: Springer Publishing Company. Kachooei, A. R., Ebrahimzadeh, M. H., Salimi, E., Razi, S., Erfani-Sayyar, R., & Salehi, M. (2015). Short Form-McGill Pain Questionnaire-2 (SF-MPQ-2): A cross- cultural adaptation and validation study of the Persian version in patients with knee osteoarthritis. Archives of Bone and Joint Surgery, 3(1), 45–50. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322125/. Langhammer, B., Bergland, A., & Rydwik, E. (2018). The importance of physical activity exercise among older people. BioMed Research International, 2018, 1–3. https://doi.org/10.1155/2018/7856823. Lee, Y. J., & Hung, W. L. (2011). The relationship between exercise participation and well-being of the retired elderly. Aging & Mental Health, 15(7), 873–881. https:// doi.org/10.1080/13607863.2011.569486. Lee, Y., Kim, J., Han, E. S., Chae, S., Ryu, M., Ahn, K. H., & Park, E. J. (2015). Changes in physical activity and cognitive decline in older adults living in the com- munity. Age, 37(2), 1–10. https://doi.org/10.1007/s11357-015-9759-z. Levasseur, M., Généreux, M., Bruneau, J.-F., Vanasse, A., Chabot, É. Beaulac, C., & Bédard, M.-M. (2015). Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: results from a scoping study. BMC Public Health, 15(1), 1–19. https:// doi.org/10.1186/s12889-015-1824-0. Midlöv, P., Leijon, M., Sundquist, J., Sundquist, K., & Johansson, S.-E. (2014). The longitudinal exercise trend among older Swedes aged 53–84 years – a 16-year follow-up study. BMC Public Health, 14(1), 40–53. https://doi.org/10.1186/1471- 2458-14-1327. Morgan, P. J., Cleave-Hogg, D., DeSousa S., & Tarshis, J. (2004). High-Fidelity patient simulation: validation of performance checklists. British Journal of Anaes- thesia, 92(3), 388–392. https://doi.org/10.1093/bja/aeh081. Moschny, A., Platen, P., Klaaßen-Mielke, R., Trampisch, U., & Hinrichs, T. (2011). Barriers to physical activity in older adults in Germany: a cross-sectional study. In- ternational Journal of Behavioral Nutrition and Physical Activity, 8, 1–10. https:// doi.org/10.1186/1479-5868-8-121. Nielsen, G., Wikman, J. M., Jensen, C. J., Schmidt, J. F., Gliemann, L., & An- dersen, T. R. (2014). Health promotion: The impact of beliefs of health benefits, social relations and enjoyment on exercise continuation. Scandinavian Journal of Medicine & Science in Sports, 24 (Supplement 1), 66–75. https://doi.org/10.1111/ sms.12275. Pan, B., Ge, L., Xun, Y., Chen, Y., Gao, C., Han, X., … Tian, J. (2018). Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 15(1), 1–14. https://doi.org/10.1186/s12966-018-0703-3. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 55 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 Patel, A., Schofield, G. M., Kolt, G. S., & Keogh, J. W. L. (2013). Perceived barriers, benefits, and motives for physical activity: two primary-care physical activity pre- scription programs. Journal of Aging and Physical Activity, 21(1), 85–99. https:// doi.org/10.1123/japa.21.1.85. Pedersen, M. R. L., Hansen, A. F., & Elmose-Østerlund, K. (2021). Motives and barriers related to physical activity and sport across social backgrounds: implica- tions for health promotion. International Journal of Environmental Research and Public Health, 18(11), 1–16. https://doi.org/10.3390/ijerph18115810. Pels, F., & Kleinert J. (2016). Loneliness and physical activity: A systematic review. International Review of Sport and Exercise Psychology, 9(1), 231–260. https://doi. org/10.1080/1750984X.2016.1177849. Polit, D. F., & Beck, C. T. (2006). The content validity index: are you sure you know what’s being reported? critique and recommendations. Research in Nursing & Health, 29(5), 489–497. https://doi.org/10.1002/nur.20147. Sanchez-Bayona, R., Gardeazabal, I., Romanos-Nanclares, A., Fernandez-Lazaro, C. I., Alvarez-Alvarez, I., Ruiz-Canela, M., … Toledo, E. (2021). Leisure-time physical activity, sedentary behavior, and risk of breast cancer: Results from the SUN (‘Seguimiento Universidad De Navarra’) project. Preventive Medicine, 148, 1–8. https://doi.org/10.1016/j.ypmed.2021.106535. Shaikh, A. A., & Dandekar, S. P. (2019). Perceived benefits and barriers to exercise among physically active and non-active elderly people. Disability, CBR & Inclusive Development, 30(2), 73–83. Retrieved from https://dcidj.uog.edu.et/index.php/up- j-dcbrid/article/view/332. Sims-Gould, J., Miran-Khan, K., Haggis, C., & Liu-Ambrose, T. (2012). Timing, experience, benefits, and barriers: older women’s uptake and adherence to an exer- cise program. Activities, Adaptation & Aging, 36(4), 280–296. https://doi.org/10.10 80/01924788.2012.729188. Singam, N. S. V., Fine, C., & Fleg J. L. (2020). Cardiac changes associated with vas- cular aging. Clinical Cardiology, 43(2), 92–98. https://doi.org/10.1002/clc.23313. Stathi, A., McKenna J., & Fox, K. R. (2010). Processes associated with participation and adherence to a 12-month exercise programme for adults aged 70 and older. Journal of Health Psychology, 15(6), 838–847. https://doi.org/10.1177/1359105309357090. Statistical Office of the Republic of Slovenia (2023). Projekcije prebivalstva EU- ROPOP2023 - demografska bilanca in izbrani kazalniki, Slovenija, 2022–2100 [EUROPOP2023 population projections – demographic balance and selected in- dicators, Slovenia, 2022–2100]. Retrieved from https://pxweb.stat.si/SiStatData/ pxweb/sl/Data/Data/05U3019S.px/. Tang, W., Hu, J., Zhang, H., Wu, P., & He, H. (2015). Kappa coefficient: a popular measure of rater agreement. Shanghai Archives of Psychiatry, 27(1), 62–67. https:// doi.org/10.11919/j.issn.1002-0829.215010. Tavakol, M., & Wetzel, A. (2020). Factor Analysis: a means for theory and instrument development in support of construct validity. International Journal of Medical Edu- cation, 11, 245–247. https://doi.org/10.5116/ijme.5f96.0f4a. Tonet, E., Vitali, F., Serenelli, M., Bugani, G., Ruggiero, R., Biscaglia, S., … Sella, G. (2018). Physical activity intervention for elderly patients with reduced physical performance after acute coronary syndrome (HULK study): rationale and design of 56 Tatjana TOMAŽIČ, Bojana FILEJ, Nadja PLAZAR: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SCALE OF FACTORS ..., 37–56 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 a randomized clinical trial. BMC Cardiovascular Disorders, 18(1), 1–9. https://doi. org/10.1186/s12872-018-0839-8. Trinh, L., Kramer, A. F., Rowland, K., Strom, D. A., Wong, J. N., & McAuley, E. (2021). A pilot feasibility randomized controlled trial adding behavioral coun- seling to supervised physical activity in prostate cancer survivors: behavior change in prostate cancer survivors trial (BOOST). Journal of Behavioral Medicine, 44(2), 172–186. https://doi.org/10.1007/s10865-020-00185-8. Tumanova, B. (2019). Physical activity and older adults. Trakia Journal of Sciences, 17 (Supplement 1), 692–695. https://doi.org/10.15547/tjs.2019.s.01.113. van Baal, P. H. M., Hoogendoorn, M., & Fischer, A. (2016). Preventing demen- tia by promoting physical activity and the long-term impact on health and social care expenditures. Preventive Medicine, 85, 78–83. https://doi.org/10.1016/j. ypmed.2016.01.013. Vargas, N. (2020). Physical Activity and Function in the Elderly. New York (USA): Nova Medicine and Health. Vilela de Sousa, T., Cavalcante, A. M. R. Z., Lima, N. X., Souza, J. S., Sousa, A. L. L., Brasil, V. V. … Silveira, E. A. (2023). Cardiovascular risk factors in the elderly: a 10-year follow-up survival analysis. European Journal of Cardiovascular Nurs- ing, 22(1), 43-52. https://doi.org/10.1093/eurjcn/zvac040. Wang, B., Wu, Y., Zhang, T., Han, J., Sun, W., & Yu, L. (2019). Effect of physical activity on independent living ability among community-dwelling elderly in urban areas of Liaoning Province in China: A population-based study. BMJ Open 9(10), 1–8. https://doi.org/10.1136/bmjopen-2018-023543. Windle, G. (2014). Exercise, physical activity and mental well-being in later life. Reviews in Clinical Gerontology, 24(4), 319–325. https://doi.org/10.1017/ S0959259814000173. Winett, R. A., & Ogletree A. M. (2019). Evidence-based, high-intensity exercise and physical activity for compressing morbidity in older adults: a narrative review. In- novation in Aging, 3(4), 1–15. https://doi.org/10.1093/geroni/igz020. Woodhead, E. L. (2018). Personality and Emotional Development. In B. P. Yochim & E. L. Woodhead (Eds.), Psychology of Aging: A Biopsychosocial Perspective (pp. 111–134). New York: Springer Publishing Company. World Health Organization. (2010). Global Recommendations on Physical Activity for Health. Geneva (Switzerland): World Health Organization. Yamakita, M., Kanamori, S., Kondo, N., & Kondo, K. (2015). Correlates of regular participation in sports groups among Japanese older adults: JAGES cross-sectional study. PLoS ONE, 10(10), 1–18. https://doi.org/10.1371/journal.pone.0141638. Yamasaki, T. (2023). Preventive strategies for cognitive decline and dementia: benefits of aerobic physical activity, especially open-skill exercise. Brain Sciences, 13(3), 1–13. https://doi.org/10.3390/brainsci13030521. Yarmohammadi, S., Saadati, H. M., Ghaffari, M., & Ramezankhani, A. (2019). A systematic review of barriers and motivators to physical activity in elderly adults in Iran and worldwide. Epidemiology and Health, 41, 1–11. https://doi.org/10.4178/ epih.e2019049. Zubiashvili, T., & Zubiashvili, N. (2021). Population aging – a global challenge. Eco- forum Journal, 10(2). Retrieved from http://ecoforumjournal.ro/index.php/eco/ar- ticle/viewFile/1248/754. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 57 Review article DOI: https://doi.org/10.35469/ak.2023.392 received: 2023-06-06 UDC: 796.88:615.8 PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS – A SYSTEMATIC LITERATURE REVIEW Janez KONJAR1, Živa ARKO2 1Basketball Club Ratiopharm Ulm, Deutschland 2Alma Mater Europaea – ECM, Department of Physiotherapy, Maribor, Slovenia Corresponding author: Janez KONJAR Kolenčeva pot 15, 1241 Kamnik Telephone: +386 51 668 797 E-mail: konjar15@gmail.com ABSTRACT From an injury-rate standpoint, Olympic weightlifting is a relatively safe sport. Despite that, a large number of repetitions, the ballistic nature of the lifts and the high forces sustained by the shoulder joint during their execution can lead to shoulder inju- ries, specifically rotator cuff injuries. The purpose of this paper was to investigate the scientifically proven physiotherapy methods and what their indications are when deal- ing with rotator cuff injuries of Olympic weightlifters. A qualitative literature review method was used, and the following online databases were included: PubMed, Scopus, Wiley, and PEDro in ResearchGate. The keywords in the literature search were: rotator cuff, shoulder, injury, physiotherapy, sport, weight- lifting and Olympic weightlifting. The final analysis included fully published and ac- cessible research papers in English from 2012 onwards, focusing on the physiotherapy of rotator cuff injuries. In total, 16 research papers were included in the final review. Management of rota- tor cuff injuries is a complex process, especially in sports with overhead movements. We found that the success and effectiveness of the physiotherapy process can be im- proved through a proper combination of kinesiotherapy, physical agent modalities, manual methods and other forms of therapy. The choice of the specific methods and their duration depends on the pathology of the individual injury. Further research focusing on Olympic weightlifting is needed to 58 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 create precise and conclusive guidelines for rehabilitation, especially for sport specific phases occurring later in the rehabilitation process. Keywords: Olympic weightlifting, rotator cuff, rehabilitation, injuries, physiotherapy. FIZIOTERAPIJA PO POŠKODBAH ROTATORNE MANŠETE PRI OLIMPIJSKIH DVIGALCIH UTEŽI – SISTEMATIČNI PREGLED LITERATURE POVZETEK Olimpijsko dviganje uteži je z vidika pogostnosti poškodb relativno varen šport. Kljub temu veliko število ponovitev, balistična narava športa in visoka sila na ramenski sklep lahko povzročijo poškodbe ramena, še posebej rotatorne manšete. Namen tega dela je s pregledom literature raziskati, katere fizioterapevtske metode so dokazano učinkovite in kakšne so njihove indikacije za obravnavo posameznih tipov poškodb rotatorne manšete pri olimpijskih dvigalcih uteži. V kvalitativni pregled literature so bile vključene te podatkovne baze: PubMed, Scopus, Wiley, PEDro in ResearchGate. Ključne besede pri iskanju literature so bile: »Rotator cuff«, »Shoulder«, »Injury«, »Physiotherapy«, »Sport«, »Weigltlifting« in »Olympic Weightlifting«. V končno raziskavo smo vključili v celoti objavljene in do- stopne raziskave v angleškem jeziku, ki so bile objavljene od leta 2012 in neposredno raziskujejo fizioterapevtsko rehabilitacijo poškodb rotatorne manšete. V končno analizo je bilo vključenih 16 raziskav. Obravnava poškodb rotatorne man- šete je kompleksen proces, še posebej kadar gre za športe z aktivnostmi nad glavo. Ugotovili smo, da je izboljšanje uspešnosti rehabilitacije omenjenih poškodb mogoče doseči s pravilno kombinacijo kinezioterapije, fizičnih dejavnikov, manualnih in drugih metod obravnave. Izbira posameznih metod in njihovo trajanje sta odvisna od patologije posamezne poškodbe. Jasno je, da so za izoblikovanje natančnih smernic celotne rehabilitacije, predvsem v poznejših športno specifičnih fazah, potrebne raziskave usmerjene samo v dvigalce uteži. Ključne besede: olimpijsko dviganje uteži, rotatorna manšeta, rehabilitacija, po- škodbe, fizioterapija. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 59 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 INTRODUCTION Olympic weightlifting is often misinterpreted as a very dangerous sport. While it is true that athletes in this sport are constantly lifting relatively heavy weights, this alone cannot be the reason to label a sport as dangerous. This is clear if we consider that the execution, volume and intensity of the sessions and movements in this sport can be often tracked and managed better than for example in team sports. Aasa, Svartholm, Andersson and Berglund (2017) con- cluded that the injury rate in weightlifting is between 2.4 to 3.3 injuries/1000 hours of training. We can compare this to American football where the injury rate is much higher at 9.3 injuries/1000 hours of training or even 35.9 inju- ries/1000 hours of competition (Hootman, Dick & Agel, 2007). Even when comparing these numbers to the injury rate of 3.57 injuries/1000 hours of expo- sure to non-contact sports like track and field (Jacobsson et al., 2013), Olympic weightlifting is a relatively safe sport. Researchers found that the most injured anatomical regions within weight- lifting were the lower back, shoulder and knee joints (Calhoon & Fry, 1999; Raske & Norlin, 2002). In terms of the severity and nature of those injuries, we found conflicting results. Calhoon and Fry (1999) found that most of the injuries to the mentioned regions required less than one day of missed training, suggesting that most of the injuries and associated pain were minor. On the other hand, Raske and Norlin (2002) reported the injuries to be more severe, requiring more than one month to recover. For comparison, the majority of track and field injuries were severe, requiring more than three weeks of missed training (Jacobsson et al., 2013). The most common diagnosis was tendinitis, muscle spasms, muscle tears and ligament tears (Calhoon & Fry, 1999). Since Olympic weightlifting includes ballistic movements with weight overhead, athletes can be expected to be at a higher risk for subacromial impin- gement (Page, 2011; Escalante, 2016). This is in line with claims that repetitive lifting overhead presents a certain risk for soft tissue shoulder injuries (Van der Wall et al., 1999; Raske & Norlin, 2002; Bedi, 2011). Escalante (2016) and Gross, Brenner, Esformes and Sonzogni (1993) claim that the primary reason for risk with those movements is increased stress on the inferior glenohume- ral ligament while the upper extremity is abducted and externally rotated. The required catch and stabilization of the weight overhead in the end shoulder range of motion and the involvement of shoulder musculature practically thro- ughout the whole Olympic lifts are also important risk factors to consider (Ser- rano, 2020). 60 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 During the lift-off, the first pull and transition phases of snatch and clean shoulder muscles are contracting primarily isometrically. During the explosive second pull and turnover phases, they are contracting concentrically, as they do during the drive phase of the jerk. Lastly, the greatest shoulder musculature isometric force requirements are present during the catch phase of the snatch and jerk. The required dynamic glenohumeral stability and humeral head cen- tralization during those phases depend primarily on the rotator cuff muscles and the long head of the musculus biceps brachii (Serrano, 2020). Any limitations or deficiencies in shoulder range of motion and passive or active stability may compromise the technical execution of the lifts and contribute to or lead to injuries (Henoch, 2017). When assessing a patient with shoulder pain, the first goal should be to determine the underlying cause of the pain. This is usually performed through a combination of an interview, palpation, diagnostic imaging, pain-provoking and range of motion tests. Treatment plans and physiotherapeutic methods sho- uld be based on that information (Ristori et al., 2018; Serrano, 2020). One of the primary goals of diagnostics is determining whether the pain is specific or non-specific and if surgical treatment is needed. Additional assessments of shoulder stability, thoracic mobility and scapula movement all provide physi- otherapists with additional crucial information that should be used to guide interventions (Moser 2014; Panagiotopoulos & Crowther, 2019) When dealing with the majority of specific rotator cuff injuries, researchers suggest starting with conservative treatment and opting for surgery only when conservative treatment fails (Ryösä et al., 2017; Nazari, MacDermid, Bryant & Athwal, 2019; Millett, Wilcox, O’Holleran & Warner, 2006). Ristori et al. (2018) suggested that both diagnostic imaging and pain-provoking tests should be interpreted only in association with functional activity and pain. The main reasons for this are the often large discrepancies found between diagnostic re- sults, actual functional limitations and pain. In the past authors proposed similar models of rotator cuff rehabilitation. The main difference between the 3-phase post-operative (Sgroi & Cilenti, 2018) model proposed for the general population and the 4-phase (Millett et al., 2006) or 5-phase (Serrano, 2020) models for athletes, is that the latter two usually last longer as they define sport specific phases. Cools et al. (2021) emphasized the importance of a comprehensive return to sports protocol for athletes, which should be able to detect and correct possible asymmetries in shoulder range of motion, stability and strength. Today we have a good amount of clinical research on effective physiothera- peutic modalities for rotator cuff treatment. There is however virtually no cli- ANNALES KINESIOLOGIAE • 14 • 2023 • 1 61 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 nical research specifically done on Olympic weightlifters. The 5-phase model proposed by Serrano (2020) is a rare work that focuses on collecting existing research and knowledge on rotator cuff injuries and forming rehabilitation gui- delines specifically for Olympic weightlifters. The goal of our work was to focus primarily on the role of the physiothera- pist in the process of the aforementioned rehabilitation. We wanted to highlight clinically proven effective physiotherapeutic interventions and how they could be used specifically for the rehabilitation of Olympic weightlifters with rotator cuff injuries. METHODS We systematically reviewed the literature using a systematic qualitative lit- erature review method. Data was extracted from the online databases PubMed, Scopus, Wiley, PEDro, and ReserchGate during the period between 25 May 2022 and 3 June 2022. In conjunction with the operator AND and/or OR, the following keywords were used: rotator cuff, shoulder, injury, physiotherapy, sport, weightlifting and Olympic weightlifting. Articles were first evaluated based on title, followed by the abstract, then a quick full-text overview and lastly based on the inclusion and exclusion cri- teria. The inclusion criteria were: i) fully accessible clinical studies, ii) fully written in the English language, iii) published after 2012, and iv) investigating physiotherapeutic interventions during the rehabilitation of rotator cuffs. The exclusion criteria were: i) meta-analysis, systematic literature reviews and case studies, ii) studies investigating the efficiency of pharmaceutical interventions, iii) choosing between operative and conservative treatment, iv) entirely home- based unsupervised kinesiotherapy, v) research in which all subjects were older than 50 years or the average age was higher than 55 years were also excluded. Microsoft Office Excel 2016 (Microsoft Corporation, New York, USA) was used to collect and present the summary of the results with tables. The search process and the final selection of articles were performed using the PRISMA 2020 guidelines (Page et al., 2021). Additionally, we used additional filters when searching the databases as shown in Table 1. 62 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Table 1: Additional search filters applied in the online databases Database Search filters PubMed Articles published between 2012 and 2022, randomized control studies and clinical trials Scopus English articles published between 2012 and 2022 Wiley Articles published between 2012 and 2022 PEDro PEDro grade at least 5/10 and articles published after 2012 ReserchGate Not able to choose additional search filters within the database RESULTS The initial search in databases returned 1302 hits. After applying additional search parameters from Table 1, the search results included 248 hits. Next, after reviewing the titles and abstracts we narrowed our search to 49 studies. Lastly, we eliminated duplicates and read the full articles. After reviewing the content, we eliminated an additional 33 articles and thus analyzed 16 relevant studies. The systematic review process is presented in Figure 1. A total of 724 individuals with rotator cuff injuries were included in the analyzed studies. Out of the 16 studies, 14 provided information on partici- pants’ gender, with women representing a slightly larger share (54%). The du- ration of the studies varied from one week up to a year. Most of the studies, their eligibility requirements and the period between checkups were in line with the following differentiation based on the length of the symptoms (Koç et al., 2020): – Acute pain: symptoms lasting less than 6 weeks – Sub-acute pain: symptoms lasting between 6–12 weeks – Chronic pain: symptoms lasting more than 12 weeks Chronic injuries were the most researched within our sample. Seven studies investigated exclusively chronic rotator cuff injuries, while six other studies also included them among others. Sub-acute injuries were exclusively investi- gated within one study while they were included among others in eight other studies. There was no research focusing exclusively on acute injuries, but they were part of six mixed studies. Only one of the studies specifically defined that all of the patients underwent surgical intervention. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 63 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 Figure 1: Systematic review process 64 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Ta bl e 2: S um m ar y of th e in cl ud ed a rt ic le s a nd re su lts A ut ho r( s) a nd ye ar o f p ub l. A rt ic le ti tle R es ea rc h sa m pl e A rt ic le ty pe R es ul ts D e O liv ei ra e t al . ( 20 20 ) K in es io ta pi ng fo r t he R eh ab ili ta tio n of R ot at or C uff -R el at ed S ho ul de r Pa in 52 p eo pl e (2 2 fe m al es a nd 3 0 m al es ) w ith p ai n, re st ric te d ra ng e of m ot io n, a nd fu nc tio n as a re su lt of a ro ta to r c uff pa th ol og y. R an do m iz ed cl in ic al tr ia l B ot h in th e m ed iu m - a nd lo ng -te rm , t he ad di tio n of k in es io ta pi ng to 6 -w ee k- lo ng k in es io th er ap y di d no t r es ul t i n a st at is tic al ly si gn ifi ca nt e ffe ct o n re du ci ng pa in a nd im pr ov in g R O M in th e sh ou ld er jo in t. Pa rle e t a l. (2 01 7) A cu te ro ta to r c uff te nd in op at hy : d oe s ic e, lo w lo ad is om et ric ex er ci se , o r a c om bi na tio n of th e tw o pr od uc e an an al ga es ic e ffe ct ? 20 p eo pl e (1 3 fe m al es a nd 7 m al es ) w ith u ni la te ra l s ho ul de r pa in p er si st in g le ss th an 12 w ee ks . A ll su bj ec ts h ad ul tra so un d- co nfi rm ed ro ta to r cu ff te nd in os is o r b ur si tis . R an do m iz ed cl in ic al tr ia l A st at is tic al ly si gn ifi ca nt sh or t-t er m eff ec t o n re du ci ng p ai n an d im pr ov in g fu nc tio n of th e sh ou ld er jo in t. Th e co m bi na tio n of b ot h m et ho ds w as n ot fo un d ad va nt ag eo us . B ou dr ea u et a l. (2 01 9) Th e A dd iti on o f G le no hu m er al A dd uc to r C oa ct iv at io n to a R ot at or C uff E xe rc is e Pr og ra m fo r R ot at or C uff Te nd in op at hy 42 p eo pl e (2 2 fe m al es a nd 20 m al es ) w ith c on fir m ed ro ta to r c uff te nd in op at hy a nd sy m pt om s p er si st in g lo ng er th an a m on th . P ai nf ul a rc , p ai n w ith re si st ed is om et ric e xt er na l ro ta tio n an d ab du ct io n. R an do m iz ed cl in ic al tr ia l N o st at is tic al ly si gn ifi ca nt im pr ov em en t in sh ou ld er fu nc tio n an d pa in re du ct io n af te r 6 w ee ks o f a dd iti on al g le no hu m er al ad du ct or c oa ct iv at io n. G ua n et a l. 20 20 D ec re as ed S yn ov ia l Fl ui d B io m ar ke rs L ev el s A re A ss oc ia te d w ith R eh ab ili ta tio n of F un ct io n an d Pa in in R ot at or C uff Te ar P at ie nt s F ol lo w in g El ec tro ac up un ct ur e Th er ap y 54 p eo pl e (3 8 fe m al es a nd 1 6 m al es ) w ith a sm al l t o m ed iu m - si ze d ro ta to r c uff ru pt ur e an d at le as t 6 m on th s o f c on se rv at iv e tre at m en t. R an do m iz ed cl in ic al tr ia l Sy no vi al fl ui d bi om ar ke rs le ve ls a re re lia bl e in di ca to rs o f a su cc es sf ul re ha bi lit at io n. E le ct ro ac up un ct ur e th er ap y is a n eff ec tiv e co ns er va tiv e m et ho d de liv er in g a re du ct io n of in fla m m at or y cy to ki ne s, pa in a nd im pr ov in g sh ou ld er fu nc tio n. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 65 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 A ut ho r( s) a nd ye ar o f p ub l. A rt ic le ti tle R es ea rc h sa m pl e A rt ic le ty pe R es ul ts M ut h et a l. 20 12 Th e eff ec ts o f t ho ra ci c sp in e m an ip ul at io n in su bj ec ts w ith si gn s o f ro ta to r c uff te nd in op at hy 30 p eo pl e (1 4 fe m al es a nd 1 6 m al es ) w ith si gn s o f r ot at or te nd in op at hy a nd sy m pt om s w hi ch la st ed o n av er ag e fo r 4 ,2 m on th s. Pr im ar ily hi gh -le ve l a th le te s f ro m di sc ip lin es in vo lv in g ov er he ad m ov em en ts . La bo ra to ry co nt ro lle d tri al N o st at is tic al ly si gn ifi ca nt e ffe ct o n sc ap ul ar k in em at ic s, w ith th e ex ce pt io n of sl ig ht ly sm al le r s ca pu la r l at er al ro ta tio n. St at is tic al ly si gn ifi ca nt h ig he r a ct iv at io n of th e m id dl e m us cu lu s t ra pe zi us , p ai n re du ct io n, a nd im pr ov in g th e fu nc tio n 7- 10 d ay s a fte r t he m an ip ul at io n. Zh an g et a l. 20 20 In flu en ce o f S ca pu la Tr ai ni ng E xe rc is es o n Sh ou ld er Jo in t F un ct io n A fte r S ur ge ry fo r R ot at or C uff In ju ry 46 p eo pl e (2 0 fe m al es a nd 2 6 m al es ) a fte r t he a rth ro sc op ic su rg er y of p ar tia l o r f ul l th ic kn es s t ea r o f t he ro ta to r cu ff. R an do m iz ed cl in ic al tr ia l A c om bi na tio n of tr ad iti on al ph ys io th er ap y an d sp ec ifi c sc ap ul ar ex er ci se s i s e ffe ct iv e in re du ci ng th e dy sf un ct io ns a fte r t he su rg er y. A fte r 6 w ee ks sp ec ifi c sc ap ul ar e xe rc is es h av e a st at is tic al ly si gn ifi ca nt e ffe ct o n re du ci ng sh ou ld er p ai n, im pr ov in g R O M a nd fu nc tio n. A fte r 1 2 w ee ks th e po si tiv e eff ec t o f t ho se e xe rc is es is a ls o se en o n m us cl e st re ng th te st in g. M en ek , Ta ra kc i, & A lg un 2 01 9 Th e eff ec t o f M ul lig an m ob ili za tio n on p ai n an d lif e qu al ity o f pa tie nt s w ith R ot at or c uff sy nd ro m e 30 p eo pl e (1 2 fe m al es a nd 1 8 m al es ) w ith p ar tia l r ot at or c uff ru pt ur e, a cu te sy m pt om s, an d w ith ou t s ur gi ca l t re at m en t. R an do m iz ed cl in ic al tr ia l 6- w ee k- lo ng tr ea tm en t p ro to co l w ith M ul lig an m ob ili za tio n re su lts in a st at is tic al ly si gn ifi ca nt p ai n re du ct io n, im pr ov in g fu nc tio n an d R O M . Fr as sa ni to e t a l. 20 18 Eff ec tiv en es s o f Ex tra co rp or ea l S ho ck W av e Th er ap y an d ki ne si o ta pi ng in c al ci fic te nd in op at hy o f t he sh ou ld er 42 p eo pl e (2 6 fe m al es a nd 1 6 m al es ) w ith d ia gn os ed c al ci fic ro ta to r c uff te nd in op at hy , a nd fu nc tio na l i ss ue s p er si st in g at le as t 2 w ee ks . R an do m iz ed cl in ic al tr ia l Th e ad di tio n of k in es io ta pi ng to ex tra co rp or ea l s ho ck w av e th er ap y ad ds to p ai n an d in fla m m at io n re du ct io n in th e sh or t t er m . T hi s a dd iti on th us p ot en tia lly he lp s t o re du ce th e re ha bi lit at io n tim e. 66 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 A ut ho r( s) a nd ye ar o f p ub l. A rt ic le ti tle R es ea rc h sa m pl e A rt ic le ty pe R es ul ts A kb ab a et a l. 20 19 Th e eff ec tiv en es s o f tri gg er p oi nt tr ea tm en t i n ro ta to r c uff p at ho lo gy 41 p eo pl e w ith d ia gn os ed pa rti al ro ta to r c uff te ar , a t l ea st 3 ac tiv e sh ou ld er tr ig ge r-p oi nt s, an d sy m pt om s p er si st in g at le as t 3 m on th s. R an do m iz ed cl in ic al tr ia l A dd iti on al tr ig ge r-p oi nt tr ea tm en t d oe s no t r es ul t i n st at is tic al ly si gn ifi ca nt im pr ov em en t o f r eh ab ili ta tio n ou tc om es . K lü te r e t a l. 20 18 El ec tro m ag ne tic tra ns du ct io n th er ap y an d sh oc kw av e th er ap y in 8 6 pa tie nt s w ith ro ta to r c uff te nd in op at hy 86 p eo pl e (4 5 fe m al es a nd 4 1 m al es ) w ith d ia gn os ed ro ta to r cu ff te nd in op at hy , s ym pt om s la st in g at le as t 3 m on th s, pa in gr ad ed a t l ea st 5 o n a VA S sc al e, a nd fa ile d pr ev io us co ns er va tiv e tre at m en t. R an do m iz ed cl in ic al tr ia l A c om bi na tio n of e le ct ro m ag ne tic tra ns du ct io n th er ap y an d sh oc kw av e th er ap y ha s a st at is tic al ly si gn ifi ca nt su pe rio r e ffe ct o n pa in re du ct io n an d im pr ov in g fu nc tio n th an sh oc kw av e th er ap y on ly . T hi s w as th e ca se 6 , 1 2, a nd 24 w ee ks a fte r t he la st th er ap y. Li e t a l. 20 21 Eff ec tiv en es s o f Fo cu se d Sh oc kw av e Th er ap y ve rs us R ad ia l Sh oc kw av e Th er ap y fo r N on ca lc ifi c R ot at or C uff Te nd in op at hi es 46 p eo pl e (2 5 fe m al es in 1 9 m al es ) w ith M R I- di ag no se d no n- ca lc ifi c ro ta to r c uff te nd in op at hy w ith ou t r up tu re . Su bj ec ts h ad sy m pt om s l as tin g at le as t 3 m on th s, re st ric te d R O M , p ai n w ith o ve rh ea d m ov em en ts a nd g ra de d th ei r pa in w ith a t l ea st 5 o n a VA S sc al e. R an do m iz ed cl in ic al tr ia l N o st at is tic al ly si gn ifi ca nt d iff er en ce in pa in re du ct io n w ith in 2 4 w ee ks o f t he in te rv en tio n be tw ee n fo cu se d an d ra di al sh oc kw av e th er ap y. F oc us ed sh oc kw av e th er ap y re su lts in su pe rio r l on ge r-t er m pa in re du ct io n. K oç e t a l. 20 20 D oe s b al ne ot he ra py pr ov id e ad di tiv e eff ec ts to p hy si ca l th er ap y in p at ie nt s w ith su ba cu te su pr as pi na tu s te nd in op at hy ? 90 p eo pl e (5 3 fe m al es a nd 3 7 m al es ) w ith M R I d ia gn os ed un ila te ra l s ub -a cu te u ni la te ra l te nd in op at hy o f m us cu lu s Su pr as pi na tu s, at le as t o ne po si tiv e pa in -p ro vo ca tiv e te st an d fu ll R O M . R an do m iz ed cl in ic al tr ia l A st at is tic al ly si gn ifi ca nt im pr ov em en t o f sh ou ld er R O M , f un ct io n, g rip st re ng th , qu al ity o f l ife a nd p ai n re du ct io n w ith th e ad di tio n of b al ne ot he ra py to th e tra di tio na l p hy si ot he ra py p ro to co l. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 67 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 A ut ho r( s) a nd ye ar o f p ub l. A rt ic le ti tle R es ea rc h sa m pl e A rt ic le ty pe R es ul ts El so da ny e t a l. 20 18 Lo ng -T er m E ffe ct o f Pu ls ed N d: YA G L as er in th e Tr ea tm en t o f Pa tie nt s w ith R ot at or C uff Te nd in op at hy 60 p eo pl e w ith d ia gn os ed ro ta to r c uff te nd in op at hy , p ai n pe rs is tin g fo r o ve r 3 m on th s, an d po si tiv e pa in p ro vo ca tiv e te st s t ha t i nd ic at e ro ta to r c uff pa th ol og y. S ub je ct s w er e al so de al in g w ith im pa ire d sh ou ld er ab du ct io n, in te rn al a nd e xt er na l ro ta tio n R O M . R an do m iz ed cl in ic al tr ia l R eh ab ili ta tio n pr og ra m c om bi ni ng H IL T an d ex er ci se in te rv en tio n pr og ra m w as m or e eff ec tiv e in re st or in g sh ou ld er fu nc tio n, R O M , a nd re du ci ng p ai n th an ex er ci se in te rv en tio n pr og ra m a lo ne . C ar lis i e t a l. 20 18 Fo cu se d ex tra co rp or ea l sh oc k w av e th er ap y co m bi ne d w ith su pe rv is ed ec ce nt ric tr ai ni ng fo r su pr as pi na tu s c al ci fic te nd in op at hy 22 p eo pl e (1 4 fe m al es a nd 8 m al es ) w ith sh ou ld er p ai n pe rs is tin g fo r m or e th an 6 w ee ks , c lin ic al si gn s o f s ub - ac ro m ia l i m pi ng em en t, an d fu ll pa ss iv e R O M . A ll of th e su bj ec ts a ls o ha d a co nfi rm ed ca lc ifi c te nd in op at hy o f t he su pr as pi na tu s t en do n. R an do m iz ed cl in ic al tr ia l Fo cu se d ex tra co rp or ea l s ho ck w av e th er ap y is a n eff ec tiv e m et ho d fo r re du ci ng sh ou ld er p ai n an d im pr ov in g fu nc tio n. A dd iti on al sh ou ld er a bd uc to r ec ce nt ric e xe rc is e pr ot oc ol d oe s no t p ro vi de st at is tic al ly si gn ifi ca nt im pr ov em en t i n tre at m en t o ut co m es co m pa re d to fo cu se d ex tra co rp or ea l s ho ck w av e th er ap y al on e. C ho u et a l. 20 18 C om pa ra tiv e ou tc om es o f ex tra co rp or ea l s ho ck w av e th er ap y fo r s ho ul de r te nd in iti s o r p ar tia l t ea rs of th e ro ta to r c uff in at hl et es a nd n on -a th le te s 35 p eo pl e (1 9 fe m al es a nd 1 6 m al es ). 13 p ro fe ss io na l a th le te s an d 22 n on -a th le te s, di ag no se d an d sy m pt om at ic c hr on ic ro ta to r c uff te nd in iti s, w ith o r w ith ou t r up tu re , a nd p re vi ou sl y fa ile d co ns er va tiv e tre at m en t. R et ro sp ec tiv e st ud y Ex tra co rp or ea l s ho ck w av e th er ap y is eff ec tiv e bo th fo r a th le te s a nd n on - at hl et es . I ts u se sh ou ld b e co ns id er ed fo r at hl et es w ith lo ng -la st in g te nd in iti s o r pa rti al ly to rn ro ta to r c uff b ef or e op tin g fo r a rth ro sc op y. C oş ku n et a l. 20 18 Eff ec tiv en es s o f K in es io lo gi c Ta pe A pp lic at io n in R ot at or C uff In ju rie s 30 p eo pl e (1 3 fe m al es a nd 1 7 m al es ) w ith ro ta to r c uff in ju ry , ei th er te nd in iti s o r a cu te in ju ry w ith p er si st en t p ai n, re du ce d R O M a nd a ss oc ia te d re du ce d lif e qu al ity . R an do m iz ed cl in ic al tr ia l Th e ad di tio n of k in es io ta pi ng to tra di tio na l p hy si ot he ra py m et ho ds re su lts in su pe rio r p ai n, in fla m m at io n an d re ha bi lit at io n tim e re du ct io n. It a ls o en ab le s b et te r i m pr ov em en ts in R O M an d sh ou ld er fu nc tio n co m pa re d to o nl y tra di tio na l p hy si ot he ra py in te rv en tio ns . 68 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 DISCUSSION Evaluation and diagnostics Reviewed studies analyzed symptoms differently both at the beginning and during check-ups. This indicates that there is a lack of consensus on how to screen patients with potential rotator cuff pathology (Ristori et al., 2018). De- spite that, all of the researchers used a combination of different questionnaires about the pain and function of the shoulder joint. Eleven studies used the Visual Analogue Scale (VAS), while the Numeric Rating Scale (NRC) was the second most commonly used. Concerning functional assessment, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was the most common, with a full version in seven pieces of research and a shortened version used within two more. The second most commonly used was the Constant-Murley Score (CMS). Nine out of sixteen included studies used different physiotherapeutic asses- sments to test the active and passive range of motion (ROM), muscle strength and function. Among those, the passive range of motion assessment was the most commonly used in six studies. Half of the studies also used pain-provo- king tests to confirm rotator cuff pathology, but only one study used those tests during control check-ups. Half of the research also included at least one dia- gnostic imaging method, with magnetic resonance imaging (MRI) used within seven, ultrasound within six and X-ray within three studies. We believe that the basic assessment of injured Olympic weightlifters sho- uld not be significantly different than that of the general population and should focus on diagnosing the underlying mechanisms of pain. This includes the in- terview with the athlete, diagnostic imaging, pain-provoking testing, passive and/or active ROM assessment, and function and pain assessment. Based on that information the therapist should be able to determine if the pain is the result of the rotator cuff symptomatic and what would be the appropriate course of action. A physiotherapist has to consider how long and how severe is the pain, and especially how it affects the function and performance. It is crucial to look at an individual’s training load and plan to identify possible injury-contributing factors. Physiotherapists must thus collaborate closely with the coach and at- hlete to modify both training load and activities to ensure alignment with the rehabilitation plan. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 69 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 Physical Agent Modalities Some authors have included similar physical agent modalities in the “tradi- tional physiotherapy” for rotator cuff injuries (Zhang et al., 2020; Menek, Ta- rakci & Algun 2019; Koç et al., 2020; Coşkun et al., 2018). Those models con- sisted of ultrasound, cryotherapy or thermotherapy and transcutaneous electri- cal nerve stimulation (TENS). Cryotherapy as a modality seems to be primarily suitable for acute and subacute injuries. Parle, Riddiford-Harland, Howitt & Lewis (2017) found that cryopak is an effective method for reducing pain sen- sation and improving the function of the shoulder joint when dealing with non- traumatic acute or subacute pain. Zhang et al. (2020) found that a combination of 5 to 20 minutes of cryotherapy within the first four weeks after the operation and 5 to 10 minutes of moving method ultrasound therapy with the dosage of 1.5–2.5 W/cm2 between the 4th and 12th week is effective in reducing the pain and improving the function of the shoulder joint after the arthroscopic surgery. Similarly, Menek et al. (2019) observed significant improvements in function and reduction of pain after 6 weeks of using a combination of cryotherapy, 6-minute ultrasound therapy at a frequency of 1.5 MHz and TENS at a frequen- cy of 100 Hz after partial rotator cuff tears. Koç et al. (2020), using the same parameters for the ultrasound and 20-minute TENS at a frequency of 60–80 Hz for three weeks also demonstrated pain reduction and improved function in patients suffering from subacute supraspinatus tendinopathy. A similar protocol with a 20-minute TENS and 10-minute ultrasound therapy at 1.5 MHz frequen- cy was also successfully used for a week by Coşkun et al. (2018) with patients dealing with various rotator cuff injuries. Interventions in all of the mentioned studies were carried out at least five times per week. We should emphasize that the “traditional physiotherapy” model always included some form of kinesi- otherapy. Most of the studies also indicate that even though the improvements with “traditional physiotherapy” are significant, it can be expected that combi- ning those methods with other physiotherapeutic modalities leads to superior patient outcomes. Elsodany, Alayat, Ali & Khaprani (2018) found that for the treatment of ro- tator cuff tendinopathy high-intensity laser therapy (HILT) combined with exer- cises provides superior results in terms of pain reduction, increasing shoulder ROM and function compared to performing exercises alone. Chou et al. (2018) found that one to two sessions of extracorporeal shockwave therapy (ESWT) enabled all 13 included overhead athletes to return to a competitive level within 3 months after the intervention. 3000 impulses of the shockwave at 0.32 mJ/mm2 energy flux density were applied to the affected shoulder under ultrasonographic 70 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 guidance during the sessions. The inclusion criteria in this study were an at least three-month-long unsuccessful conservative treatment. The recurrence rate was quite high at 62% though, much higher than the 18% observed in the non-athlete group, which shows the importance of comprehensive sport-specific phases of rehabilitation. Carlisi et al. (2018) found that three focused ESWT sessions with 1-week breaks in between were effective in terms of reducing shoulder pain and improving joint function in individuals dealing with sub-acute or chronic pain resulting from supraspinatus calcific tendinopathy. The amount of energy influx during a single therapy was lower, 0.15 mJ/mm2 applied with 1700 impulses. Four sessions with focused ESWT, 3000 impulses at 0.09 ± 0.018 mJ/mm2 ener- gy flux density applied, and a 5-to-9-day break between them, have been proven more successful in the treatment of non-calcific supraspinatus tendinopathy than a protocol with radial ESWT (Li et al., 2021). Three ESWT sessions with 2000 impulses at 0.32 mJ/mm2 energy flux density within two weeks also resulted in shoulder pain reduction and function improvements within a group of patients with non-calcific rotator cuff tendinopathy. Combining ESWT therapy with 8 sessions of electromagnetic transduction therapy within 4 weeks resulted in superior results. Each electromagnetic trans- duction therapy treatment lasted 20 minutes at 80 mT, with an impulse fre- quency of 3 Hz and a discharge voltage of 30 KV (Klüter et al., 2018). Chou et al. (2018) and Klüter et al. (2018) also monitored long-term ESWT results and both concluded that the improvements are greater in the long-term. Manual methods Adding 12 sessions of rotator cuff myofascial trigger-point release to stan- dard conservative treatment does not significantly improve outcomes of the patients with symptomatic rotator cuff ruptures (Akbaba et al., 2019). The addi- tion of Mulligan mobilization to all 30 sessions of “traditional physiotherapy” within six weeks results in superior outcomes. Menek et al. (2019) observed both pain reduction, an increase in shoulder ROM and an improvement of sho- ulder function after the described addition of an approximately 20-minute-long protocol of Mulligan mobilization. Muth, Barbe, Lauer and McClure (2012) found that a single intervention of thoracic spine and cervicothoracic junction manipulation is effective for reducing pain and improving shoulder function in patients with chronic rotator cuff pathology. Manipulation resulted in improve- ments both immediately after and 7–10 days after the intervention. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 71 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 Exercise interventions Different combinations of passive, active, actively assisted and range of mo- tion exercises were used. The addition of scapular mobilization, stabilization and surrounding musculature strengthening to the standard physiotherapeutic protocol results in superior outcomes 12 weeks after the surgical repair of parti- al rotator cuff tears (Zhang et al., 2020). In this study, active exercises for surro- unding joints and corresponding musculature were applied to all patients a day after the operation, while Codman pendulum exercises were introduced after a week. Four weeks after the surgery, actively-assisted exercises were introduced and after six weeks exercises in a closed kinetic chain. Similar exercise proto- cols including pendulum exercises, actively-assisted exercises, strengthening and ROM exercises were used in other included studies emphasizing conserva- tive treatment (Menek et al., 2019; Elsodany et al., 2018). Both of those studies concluded that another physiotherapy method, specifically Mulligan mobiliza- tion or HILT, results in additional improvements in shoulder function and pain reduction for patients with rotator cuff tendinopathy. De Oliveira, de Fontenay, Bouyer Desmeule, and Roy (2020) concluded that individualized six-week ki- nesiotherapy with an emphasis on sensorimotor control, strengthening and edu- cation significantly improves ROM, and function and reduces pain associated with the symptomatic rotator cuff. This was evident not only in the short- and mid-term, but also in the long-term. Some studies also defined the number of sets and repetitions executed in the respected protocols. All used three sets of 10 repetitions (Carlisi et al., 2018; Menek et al., 2019; Boudreau, Gaudreault, Roy, Bédard & Balg, 2019), while Carlisi et al. (2018) additionally defined a progressive number of sets and repe- titions at the initial two weeks. Carlisi et al. (2018) and Boudreau et al. (2019) stated that mild pain (<4 on the VAS scale) was allowed during the performance of the exercises. Parle et al. (2017) found that isometric exercises (10–20 second holds in three to five series, executed daily) are a viable and effective short-term option to reduce acute or subacute shoulder pain as a result of rotator cuff tendino- pathy. Boudreau et al. (2019) found a 6-week-long intervention of strengthe- ning exercises focusing on m. serratus anterior, m. trapezius and rotator cuff muscles result in reduced movement pain, while the pain at rest and shoulder function do not improve significantly. Additional strengthening of glenohume- ral adductors in this study also did not contribute to better outcomes. Carlisi et al. (2018) also found no benefits with the addition of eccentric shoulder ab- 72 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 ductor training for calcific supraspinatus tendinopathy during a 9-week-long treatment protocol combined with ESWT. Other physiotherapeutic interventions and methods The addition of balneotherapy to the “traditional physiotherapy” model is effective for patients with subacute supraspinatus tendinopathy. Koç et al. (2020) found it improves ROM, pain reduction, and shoulder function. Guan et al. (2020) found improvements in shoulder function and reduced inflammation with the addition of Electroacupuncture Therapy to “traditional physiotherapy” twice per week. The 6-week, 3-day-per-week intervention was carried out on a population with full-thickness rotator cuff tears, with failed six months of conservative treatment. Kinesiotaping is also a potentially applicable method for symptomatic rota- tor cuff injury treatment. A 1-week-long addition of kinesiology tape results in improved function and pain reduction compared to “traditional physiotherapy” only (Coşkun et al., 2018). The authors of this study pointed to enhanced senso- rimotor and proprioceptor effects as the likely mechanisms for those improve- ments. Frassanito, Cavalieri, Maestri and Felicetti (2018) found that the ad- dition of kinesiotaping reduces the required rotator cuff calcific tendinopathy treatment response time compared to when using only ESWT. The improve- ments of kinesiology tape addition were seen both in short- and medium-term outcome results. During their 6-week long study, De Oliveira et al. (2020) found that adding kinesiotaping to the established rehabilitation program with an emphasis on sensorimotor training does not provide superior medium- or long-term outcomes for individuals with rotator cuff-related shoulder pain. The study identified the greater influence of exercise and the absence of a more de- tailed diagnosis as possible reasons for those results. Guidelines for rotator cuff injury treatment for Olympic Weightlifters While we can conclude that “traditional physiotherapy” is suitable for ad- dressing the majority of rotator cuff injuries, physiotherapists should use addi- tional methods to improve outcomes. This is vital with Olympic weightlifters, whose primary goal is usually to return to training as soon as possible after sustaining an injury. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 73 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 Kinesiotaping and thoracic spine mobilization are two easily applied me- thods that may improve treatment outcomes of a wide range of rotator cuff pathologies. Mulligan mobilization can be added if the individual is dealing with a partial rotator cuff tear, while electroacupuncture may be more suitable for small to medium full-thickness tears. ESWT seems to be a very effective method for addressing sub-acute and especially chronic rotator cuff tendinopathies, and its effectiveness can be en- hanced with the addition of electromagnetic transduction therapy. HILT and balneotherapy are other methods that can be utilized for chronic pathologies if ESWT is not available. We believe that comprehensive exercise intervention is an essential part of any shoulder rotator cuff injury rehabilitation, but is especially crucial for Olym- pic weightlifters. A suitable exercise program should be based on the results of the initial diagnostic testing which should provide information about shoulder ROM, stability and both periscapular and rotator cuff muscle strength imbalan- ces and deficits. Even minimal, 1–2 millimetres of uncontrolled shoulder joint translation can result in pain and shoulder symptomatic (Horsley & Ashworth, 2016). Addressing found deficits should thus be the physiotherapist’s priori- ty along with methods for reducing pain, inflammation and swelling (Weiss, Wang, Hendel, Buzzerio & Rodeo, 2018). Any possible exercise technique flaws that may be connected with the symptoms should also be identified and addressed in collaboration with coa- ches, while the activities that cause the pain should be discontinued or at least modified (Escalante, 2016). Additionally, an examination of possible spikes in weightlifters’ training loads should also be performed as those correlate with injury incidence (Jones, Griffiths & Mellalieu, 2017). If the shoulder pain is severe and accompanied by any kind of functional im- pairment or if the primary interventions failed to solve the issues within a short period, more detailed imaging diagnostics should be prioritized. It is crucial to assess if the pain is associated with structural rotator cuff damage, which would warrant a larger modification of the training plan. Determining if the continua- tion of the specific overhead activities presents a risk for further complications or more severe injury is also warranted. Based on the diagnosis, utilizing the appropriate combination of the aforementioned physiotherapeutic methods is vital for the most effective rehabilitation. Lastly, if surgical treatment is chosen to treat the rotator cuff injury, physi- otherapists can improve functional outcomes by adding scapular training exer- cises to “traditional physiotherapy” protocols within the first 12 weeks after the injury (Zhang et al., 2020). Based on multiple sources, Serrano (2020) recom- 74 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 mends introducing basic overhead activities approximately 16–20 weeks and more weightlifting-specific activities approximately 20–26 weeks after the sur- gery. It should be emphasized that the exact timeline for these activities should be tailored to each individual’s progression and capabilities. CONCLUSIONS With appropriate diagnostic tests and an optimal combination of physio- therapeutic methods, the rehabilitation effects of acute, sub-acute, and chronic rotator cuff injuries can be improved. While “traditional physiotherapy” in- volving kinesiotherapy coupled with ultrasound, TENS and cryotherapy or thermotherapy is effective, the addition of ESWT or Mulligan mobilization re- sults in superior outcomes for chronic and sub-acute rotator cuff pathologies. Furthermore, combining ESWT with electromagnetic transduction therapy and kinesiotaping seems to provide additional benefits. Early-stage shoulder injury rehabilitation of Olympic weightlifters may not be significantly different from that for the general population. Shoulder ROM, rotator cuff and periscapular musculature strengthening are all critical for later more sport-specific stages of rehabilitation, during which gradual exercise and training load progression are crucial for returning to full weightlifting training. The main limitation of this work is that practical research on physical the- rapy protocols specifically for Olympic weightlifters dealing with rotator cuff injuries is very limited. This must be considered especially when interpreting the results and deciding on optimal physiotherapeutic interventions in later, more sport-specific stages of the rehabilitation process. We believe that future research on rotator cuff injury rehabilitation in Olym- pic weightlifting should focus on effective sport-specific late-rehabilitation stage protocols and long-term post-operative rehabilitation protocols. Lastly, defining a unified approach with comprehensive diagnostic testing, both for guiding the progressions through phases of rehabilitation and identifying sport- -specific issues and pain within the shoulder joint is essential. This enables practitioners and coaches to better understand and identify the rotator cuff inju- ry risk factors that may originate from the training process itself. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 75 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 REFERENCES Aasa, U., Svartholm, I., Andersson, F., & Berglund, L. (2017). Injuries among weightlifters and powerlifters: a systematic review. British Journal of Sports Medi- cine, 51(4), 211–220. https://doi.org/10.1136/bjsports-2016-096037. Akbaba, Y. A., Mutlu, E. K., Altun, S., Turkmen, E., Birinci, T., & Celik, D. (2019). The effectiveness of trigger point treatment in rotator cuff pathology: A randomized controlled double-blind study. Journal of Back and Musculoskeletal Rehabilitation, 32(3), 519–527. https://doi.org/10.3233/BMR-181306. Bedi, G. (2011). Shoulder injury in athletes. Journal of Clinical Orthopaedics and Trauma, 2(2), 85-92. https://doi.org/10.1016/S0976-5662(11)60050-7. Boudreau, N., Gaudreault, N., Roy, J. S., Bédard, S., & Balg, F. (2019). The addi- tion of glenohumeral adductor coactivation to a rotator cuff exercise program for rotator cuff tendinopathy: a single-blind randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy, 49(3), 126–135. https://doi.org/10.2519/ jospt.2019.8240. Calhoon, G., & Fry, A. C. (1999). Injury rates and profiles of elite competitive weight- lifters. Journal of Athletic Training, 34(3), 232–238. Retrieved from https://www. ncbi.nlm.nih.gov/pmc/articles/PMC1322916/pdf/jathtrain00007-0016.pdf. Carlisi, E., Lisi, C., Dall’angelo, A., Monteleone, S., Nola, V., Tinelli, C., & Toffola, E. D. (2018). Focused extracorporeal shock wave therapy combined with super- vised eccentric training for supraspinatus calcific tendinopathy. European Journal of Physical and Rehabilitation Medicine, 54(1), 41–47. https://doi.org/10.23736/ S1973-9087.16.04299-4. Chou, W.-Y., Wang, C.-J., Wu, K.-T., Yang, Y.-J., Cheng, J.-H., & Wang, S.-W. (2018). Comparative outcomes of extracorporeal shockwave therapy for shoulder tendinitis or partial tears of the rotator cuff in athletes and non-athletes: Retrospec- tive study. International Journal of Surgery, 51, 184–190. https://doi.org/10.1016/j. ijsu.2018.01.036. Cools, A. M., Maenhout, A. G., Vanderstukken F., Declève P., Johansson F. R., & Borms D. (2021). The challenge of the sporting shoulder: From injury prevention through sport-specific rehabilitation toward return to play. Annals of Physical and Rehabilitation Medicine, 64(4), 1-8. https://doi.org/10.1016/j.rehab.2020.03.009. Coşkun, R., Alptekin, H. K., Aksoy, B., Reyhan, A. C., Dereli, E. E., & Alptekin, J. Ö. (2018). Effectiveness of kinesiologic tape application in rotator cuff injuries. International Journal of Physiotherapy, 5(5), 156–161. https://doi.org/10.15621/ ijphy/2018/v5i5/177433. De Oliveira, F. C. L., de Fontenay, B.P., Bouyer, L. J., Desmeule, F., & Roy, J-S. (2020). Kinesiotaping for the Rehabilitation of rotator cuff-related shoul- der pain: a randomized clinical trial. Sports Health, 13(2), 161–172. https://doi. org/10.1177/1941738120944254. Elsodany, A. M., Alayat, M. S. M., Ali, M. M. E., & Khaprani, H. M. (2018). Long- -term effect of pulsed Nd:YAG laser in the treatment of patients with rotator cuff tendinopathy: a randomized controlled trial. Photomedicine and Laser Surgery, 36(9), 506–513. https://doi.org/10.1089/pho.2018.4476. 76 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Escalante, G. (2016). Exercise modification strategies to prevent and train around sho- ulder pain. Strength and Conditioning Journal, 39(3), 1. https://doi.org/10.1519/ SSC.0000000000000259. Frassanito, P., Cavalieri, C., Maestri, R., & Felicetti, G. (2018). Effectiveness of Extracorporeal Shock Wave Therapy and kinesio taping in calcific tendinopathy of the shoulder: a randomized controlled trial., European Journal of Physical and Rehabilitation Medicine, 54(3), 333–340. https://doi.org/10.23736/S1973- 9087.17.04749-9. Gross, M. L., Brenner, S. L., Esformes I., & Sonzogni J. J. (1993). Anterior shoul- der instability in weight lifters. The American Journal of Sports Medicine, 21(4), 599–603. https://doi.org/10.1177/036354659302100419. Guan, J., Geng, W.-Q., Li, Y., Liu, G.-Y., Ding L.-B., Liu Y.-J., … Zheng, X.-F. (2020). Decreased synovial fluid biomarkers levels are associated with rehabilita- tion of function and pain in rotator cuff tear patients following electroacupuncture therapy. Medical Science Monitor, 26(e923240), 1–10. https://doi.org/10.12659/ MSM.923240. Henoch, Q. (2017). Weightlifting movement assessment & optimization. Fallbrook (USA): Catalyst Athletics, Inc. Hootman, J. M., Dick, R., & Agel, J. (2007). Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. Journal of Athletic Training, 42(2), 311–319. Retrieved from https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC1941297/. Horsley, I., & Ashworth, B. (2016). The athletic shoulder and Rehabilitation. In J. David & L. Daniel (Eds.), Sports Injury Prevention (pp. 259-273). New York: Rout- ledge. Jacobsson J., Timpka, T., Kowalski, J., Nilsson, S., Ekberg, J., Dahlström, Ö., & Renström P.A. (2013). Injury patterns in Swedish elite athletics: annual incidence, injury types, and risk factors. British Journal of Sports Medicine, 47(15), 941–952. https://doi.org/10.1136/bjsports-2012-091651. Jones, C. M., Griffiths P. C., & Mellalieu S. D. (2017). Training load and fatigue marker associations with injury and illness: a systematic review of longitudinal stud- ies. Sports medicine, 47(5), 943–974. https://doi.org/10.1007/s40279-016-0619-5. Klüter, T., Krath, A., Stukenberg, M., Gollwitzer, H., Harrasser, N., Knobloch, K., … Gerdesmeyer, L. (2018). Electromagnetic transduction therapy and shockwave therapy in 86 patients with rotator cuff tendinopathy: A prospective randomized controlled trial. Electromagnetic Biology and Medicine, 37(4), 175–183. https://doi. org/10.1080/15368378.2018.1499030. Koç, C., Kurt, E. E., Koçak, F. A., Erdem, H. R., & Konar, N. M. (2020). Does balneotherapy provide additive effects to physical therapy in patients with subacute supraspinatus tendinopathy? A randomized, controlled, single-blind study. Interna- tional Journal of Biometeorology, 65(2), 301–310. https://doi.org/10.1007/s00484- 020-02032-6. Li, C., Li, Z., Shi, L., Wang, P., Gao, F., & Sun, W. (2021). Effectiveness of focused shockwave therapy versus radial shockwave therapy for noncalcific rotator cuff ten- dinopathies: a randomized clinical trial. BioMed Research International, 2021, 1–9. https://doi.org/10.1155/2021/6687094. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 77 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 Menek, B., Tarakci, D., & Algun, C. Z. (2019). The effect of Mulligan mobilization on pain and life quality of patients with Rotator cuff syndrome: A randomized con- trolled trial. Journal of Back and Musculoskeletal Rehabilitation, 32(1), 171–178. https://doi.org/10.3233/BMR-181230. Millett, P., Wilcox, R. B., O’Holleran, J. D., & Warner J. J. B. (2006). Rehabilitation of the Rotator Cuff: An Evaluation-Based Approach. Journal of the American Acade- my of Orthopaedic Surgeons, 14(11), 599–609. https://doi.org/10.5435/00124635- 200610000-00002. Moser, J. (2014). Physiotherapy assessment of patients with rotator cuff pathology. Shoulder & Elbow, 6(3), 222-232. https://doi.org/10.1177/1758573214535910. Muth, S., Barbe, M. F., Lauer, R., & McClure, P. W. (2012). The effects of tho- racic spine manipulation in subjects with signs of rotator cuff tendinopathy. Jo- urnal of Orthopaedic & Sports Physical Therapy, 42(12), 1005–1016. https://doi. org/10.2519/jospt.2012.4142 Nazari, G., MacDermid, J. C., Bryant, D., & Athwal, G. S. (2019). The effectiveness of surgical vs conservative interventions on pain and function in patients with sho- ulder impingement syndrome. A systematic review and meta-analysis. PLoS ONE, 14(5), 1-22. https://doi.org/10.1371/journal.pone.0216961. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372, 1–9. https://doi.org/10.1136/bmj.n71. Page, P. (2011). Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. International Journal Sports Physical Therapy, 6(1), 51–58. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105366/. Panagiotopoulos, A. C., & Crowther, I. M. (2019). Scapular Dyskinesia, the forgot- ten culprit of shoulder pain, and how to rehabilitate. SICOT-J, 5(29), 1–6. https:// doi.org/10.1051/sicotj/2019029. Parle, P. J., Riddiford-Harland, D. L., Howitt, C. D., & Lewis, J. S. (2017). Acute rotator cuff tendinopathy: does ice, low load isometric exercise, or a combination of the two produce an analgaesic effect? British Journal of Sports Medicine, 51(3), 208–209. https://doi.org/10.1136/bjsports-2016-096107. Raske, Å., & Norlin R. (2002). Injury incidence and prevalence among elite weight and power lifters. The American Journal of Sports Medicine, 30(2), 248–256. https://doi.org/10.1177%2F03635465020300021701. Ristori, D., Miele, S., Rossettini, G., Monaldi, E., Arceri, D., & Testa, M. (2018). Towards an integrated clinical framework for patient with shoulder pain. Archives of Physiotherapy, 8(7), 1–11. https://doi.org/10.1186/s40945-018-0050-3. Ryösä, A., Laimi, K., Äärimaa, V, Lehtimäki, K., Kukkonen, J., & Saltychev, M. (2017). Surgery or conservative treatment for rotator cuff tear: a meta-analysis. Dis- ability and Rehabilitation, 39(14), 1357–1363. https://doi.org/10.1080/09638288.2 016.1198431. Serrano, B. A. (2020). Rotator cuff pathology in olympic weightlifting: a comprehen- sive review of incidence, diagnosis, management, and rehabilitation. (Doctoral dis- sertation, Selinus University, Faculty of Natural Health Sciences). Retrieved from https://www.uniselinus.education/sites/default/files/2021-06/Tesi%20Serrano.pdf. 78 Janez KONJAR, Živa ARKO: PHYSICAL THERAPY OF ROTATOR CUFF INJURIES OF OLYMPIC WEIGHTLIFTERS .., 57–78 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Sgroi, T. A., & Cilenti, M. (2018). Rotator cuff repair: post-operative rehabilitation concepts. Current Reviews in Musculoskeletal Medicine, 11(1), 86–91. https://doi. org/10.1007/s12178-018-9462-7. Van der Wall, H., McLaughlin, A., Bruce, W., Frater, C. J., Kannangara, S., & Murray, I. P. (1999). Scintigraphic patterns of injury in amateur weight lifters. Clinical Nuclear Medicine, 24(12), 915–920. https://doi.org/10.1097/00003072- 199912000-00001. Weiss, L. J., Wang, D., Hendel, M., Buzzerio, P., & Rodeo, S. A. (2018). Manage- ment of rotator cuff injuries in the elite athlete. Current Reviews in Musculoskeletal Medicine, 11(1), 102–112. https://doi.org/10.1007/s12178-018-9464-5. Zhang, M., Zhou, J., Zhang, Y., Zhang, X., Chen, J., & Chen, W. (2020). Influence of scapula training exercises on shoulder joint function after surgery for rotator cuff injury. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 26, 1–7. https://doi.org/10.12659/MSM.925758. REPORTS AND REVIEWS POROČILA IN OCENE ANNALES KINESIOLOGIAE • 14 • 2023 • 1 81 REPORTS AND REVIEWS/POROČILA IN OCENE, 81–86 19th CONFERENCE OF THE EUROPEAN ASSOCIATION FOR SOCIOLOGY OF SPORT “TRANSITIONING SPORT – TRANSITIONING EUROPEAN SOCIETIES” Budapest, Hungary, 29 May–2 June 2023 The 2023 EASS conference was held in the picturesque city of Budapest and at the Hungarian University of Sport Science with over 120 participants and 110 conference papers. Presentations in 32 parallel sessions, with more than a hundred contributions from delegates, focused on a range of different topics, with an emphasis on diversity and health. Several sessions focused on specific social groups, analysis of sport and gender, and many presentations yet explored and assessed the effects of Covid-19 on various aspects of sport. Two keynote speakers presented recent findings on social media and the me- diatization of doping. On Wednesday, we heard Prof. Dunja Antunović from the University of Minnesota present “What is Still ‘New’ about Social Media? The Importance of Sociology of Sport in Research on Mediatization.” The other keynote was by Prof. Andrea Petroczi, who brought a critical and interdiscipli- nary perspective to her own research in the field of doping, outlining how this very problem arises from the modern sports landscape, where a wide range of factors and stakeholders in elite sports keep the solution to the doping problem opaque. At the end of the week, the Young Researcher Award was given to Fed- erico Genovesi from Ulster University for his paper entitled “Spaces of football and belonging for people seeking asylum: Resisting policy-imposed liminality in Italy”. There was also an honourable mention for the paper “Listening to boxing hearts and beats: Analysing boxing (through) soundscapes” by Kristina Orszaghova. While the days were filled with presentations and talks, the afternoons were spent in social activities. A wide range of cultural activities provided opportuni- ties to relax, connect with colleagues, and learn about the history of Budapest and Hungary. To summarize, it is clear that new interdisciplinary and multimodal thinking is needed to address a problem that is so embedded and entrenched in the sports system. In line with this message, we are looking forward to the next EASS conference in Spain, hosted by the European University of Madrid. Saša Pišot 82 REPORTS AND REVIEWS/POROČILA IN OCENE, 81–86 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 19. KONFERENCA EVROPSKEGA ZDRUŽENJA ZA SOCIOLOGIJO ŠPORTA (EASS) »ŠPORT NA PREHODU – EVROPSKE DRUŽBE NA PREHODU« Budimpešta, Madžarska, 29. maj–2. junij 2023 Konferenca EASS 2023 je potekala v slikoviti Budimpešti in na madžarski univerzi za vede o športu. Sodelovalo je več kot 120 udeležencev, ki so pred- stavili 110 konferenčnih prispevkov. Predstavitve so potekale v 32 vzporednih sekcijah, udeleženci pa so v prispevkih obravnavali različne teme s poudarkom na raznolikosti in zdravju. Več sekcij je bilo posvečenih posebnim družbenim skupinam, analizi športa in spola, številni prispevki pa so še vedno predstavljali raziskave o covidu-19 in učinkih tega na šport. Na dveh plenarnih predstavitvah smo se seznanili z najnovejšimi ugotovi- tvami o družbenih medijih in mediatizaciji dopinga. V sredo smo prisluhnili profesorici Dunji Antunović z univerze v Minnesoti, ki je predstavila prispevek Kaj je še »novega« v družbenih medijih? Pomen sociologije športa pri razisko- vanju mediatizacije. Drugo predavanje je imela prof. Andrea Petroczi, ki je v predstavitvi svojega področja raziskovanja vnesla kritično in interdisciplinarno perspektivo problema dopinga v sodobnem športnem okolju, kjer zaradi števil- nih dejavnikov in deležnikov v vrhunskem športu, rešitev problema še vedno ostaja nerazjasnjena. Ob koncu tedna je nagrado za mlade raziskovalce prejel Federico Genovesi z univerze Ulster za prispevek Prostori nogometa in pripadnosti v Italiji: od- por prosilcev za azil proti liminaliteti z udeležbo v solidarnostnem množičnem športu (nogometu). Častno pohvalo je prejel tudi prispevek Kristine Orszag- hove Poslušanje src in utripov boksa: Analiza boksa (skozi) zvočne pokrajine. Medtem ko so bili dnevi napolnjeni s predstavitvami in predavanji, so bili popoldnevi in večeri namenjeni družabnim dejavnostim. Številne kulturne pri- reditve so ponudile priložnosti za sprostitev, povezovanje s kolegi ter spozna- vanje zgodovine Budimpešte in Madžarske. Če povzamem, je jasno, da bo v prihodnje potrebno interdisciplinarno in multimodalno razmišljanje za reševanje problemov, ki so tako močno zasidrani in zakoreninjeni v športnem sistemu. Zato se tudi veselimo naslednje konferen- ce EASS v Španiji, ki jo bo gostila evropska univerza v Madridu. Saša Pišot ANNALES KINESIOLOGIAE • 14 • 2023 • 1 83 REPORTS AND REVIEWS/POROČILA IN OCENE, 81–86 NEUROSCIENCE OF MOVEMENT – EXPLORING THE DYNAMICS OF THE HUMAN BRAIN IN MOTION TwinBrain Summer School 3.0, Piran, Slovenia 19–24 June 2023 Our daily lives are filled with automatic actions, and although we often re- spond effortlessly, our brains are engaged in numerous intricate processes. It is only when we (re)learn certain cognitive-motor tasks, such as maintaining balance while skiing or surfing, or even grasping a spoon after a stroke, that we realize the true difficulty involved. Conversely, we are aware of various pro- gressive neurodegenerative diseases that hinder the smooth execution of eve- ryday tasks. The study of brain dynamics during routine movements, such as walking, balancing or acquiring new motor-cognitive skills, poses a significant challenge for neuroscience. The TwinBrain Summer School 3.0 hosted an international team of experts who shared the latest neuroscience discoveries in movement-related topics and explored how brain imaging technology contributes to understanding brain function and disease development. Advancements in wireless and portable technologies have extended experimentation into real-life scenarios, reflecting everyday experiences. The distinguished experts from Slovenia, Germany, Bel- gium, Italy, Luxembourg, the Netherlands, France, Switzerland and the USA presented cutting-edge developments in Mobile Brain/Body Imaging (MoBI). Professor Dr Nico Bohnen, MD, a renowned radiology and neurology ex- pert from the University of Michigan, delivered the keynote speech for this year’s summer school. With a dedicated career focused on Parkinson’s disease research and treatment, which affects over 8.5 million people worldwide, Prof. Dr Bohnen strives to discover innovative approaches that enhance the inde- pendence and quality life of individuals with Parkinson’s disease and the el- derly population. His lecture, held on Tuesday, 20 June 2023, at the town hall of the Municipality of Piran, revolved around the neurobiological basis of walk- ing and balance problems in Parkinson’s disease. Utilizing positron emission tomography (PET) to explore metabolic and biochemical brain processes, he presented the mechanisms underlying the disease’s development and progres- sion, along with novel treatment approaches for more effective and holistic patient care. The final instalment of the TwinBrain Summer School series, known as TwinBrain Summer School 3.0, was held in Piran, Slovenia, from 19–24 June 2023. This event was the culmination of the TwinBrain H2020 project: 84 REPORTS AND REVIEWS/POROČILA IN OCENE, 81–86 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 TwinBrain – TWINning the BRAIN with machine learning for neuro-mus- cular efficiency European Commission: HORIZON 2020. WIDESPREAD-05-2020 – Twin- ning Grant agreement ID: 952401 The Community Research and Development Information Service (CORDIS): https://cordis.europa.eu/project/id/952401 TwinBrain partner institutions: Znanstveno-raziskovalno središče Koper (Slovenia), Technische Universität Berlin (Germany), Université de Genève (Switzerland), Università degli Studi di Trieste (Italy) Principal Investigator: Uroš Marušič, PhD Project duration: 1 November 2020 – 31 October 2023 Overall budget: €900k Uroš Marušič, Tisa Hodnik, Manca Peskar ANNALES KINESIOLOGIAE • 14 • 2023 • 1 85 REPORTS AND REVIEWS/POROČILA IN OCENE, 81–86 NEUROSCIENCE OF MOVEMENT – EXPLORING THE DYNAMICS OF THE HUMAN BRAIN IN MOTION Poletna šola TwinBrain 3.0, Piran, Slovenija, 19.–24. junij 2023 Naš vsakdan je napolnjen z avtomatiziranimi dejanji, in čeprav se nanje pogosto odzovemo, ne da bi ob tem občutili napor, so naši možgani neprestano vpeti v številne zapletene procese. Šele ko se (ponovno) naučimo določenih kognitivno-motoričnih nalog, kot je ohranjanje ravnotežja med smučanjem ali surfanjem ali držanje žlice po možganski kapi, spoznamo resnično zahtevnost izvajanja takih nalog. Kljub temu se zavedamo, da številne progresivne nevro- degenerativne bolezni neprestano ovirajo nemoteno opravljanje vsakdanjih na- log. Raziskovanje možganskega delovanja med rutinskimi opravili, kot so hoja, ohranjanje ravnotežja in pridobivanje novih kognitivno-motoričnih veščin, je pomemben izziv za nevroznanost. Poletna šola TwinBrain 3.0 je gostila mednarodno ekipo strokovnjakov, ki je delila najnovejša odkritja s področja nevroznanosti s poudarkom na temah, povezanih z gibanjem, ter raziskovala, kako tehnologija slikanja možganov pri- speva k razumevanju delovanja teh in razvoju bolezni. Napredki v brezžični in prenosni tehnologi so omogočili eksperimentiranje v dejanskih okoliščinah, ki izražajo vsakodnevne izkušnje. Izjemni strokovnjaki iz Slovenije, Nemčije, Belgije, Italije, Luksemburga, Nizozemske, Francije, Švice in ZDA so pred- stavili najnovejše dosežke na področju mobilnega slikanja možganov in telesa (Mobile Brain/Body Imaging – MoBI). Slavnostni govornik letošnje poletne šole je bil profesor dr. Nico Bohnen, dr. med., priznan strokovnjak za radiologijo in nevrologijo z univerze v Michi- ganu. V svoji dolgoletni karieri se predano posveča raziskovanju in zdravljenju Parkinsonove bolezni, ki prizadene več kot 8,5 milijona ljudi po vsem svetu. Prizadeva si odkriti inovativne pristope, ki izboljšujejo neodvisnost in kako- vost življenja posameznikov s Parkinsonovo boleznijo in starejše populacije. Njegovo predavanje, ki je potekalo v torek, 20. junija 2023, v mestni hiši Ob- čine Piran, je osvetljevalo nevrobiološke osnove težav pri hoji in ravnotežju pri Parkinsonovi bolezni. Predstavljene mehanizme, ki sovpadajo z razvojem in napredovanjem bolezni, ter nove pristope k zdravljenju za bolj učinkovito in celostno oskrbo pacientov odkriva s pomočjo pozitronske emisijske tomogra- fije (PET). 86 REPORTS AND REVIEWS/POROČILA IN OCENE, 81–86 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Tretja in zadnja izmed poletnih šol TwinBrain, znana kot TwinBrain Sum- mer School 3.0, je potekala v Piranu v Sloveniji med 19. in 24. junijem 2023. Ta dogodek je bil vrhunec projekta TwinBrain H2020: TwinBrain – TWINning the BRAIN with machine learning for neuro-muscu- lar efficiency European Commission: HORIZON 2020. WIDESPREAD-05-2020 – Twin- ning Grant agreement ID: 952401 The Community Research and Development Information Service (COR- DIS): https://cordis.europa.eu/project/id/952401 TwinBrain partner institutions: Znanstveno-raziskovalno središče Koper (Slovenia), Technische Universität Berlin (Germany), Université de Genève (Switzerland), Università degli Studi di Trieste (Italy) Principal Investigator: Uroš Marušič, PhD Project duration: November 1, 2020 – October 31, 2023 Overall budget: 900k € Uroš Marušič, Tisa Hodnik, Manca Peskar ANNALES KINESIOLOGIAE • 14 • 2023 • 1 87 GUIDELINES FOR AUTHORS, 87–90 GUIDELINES FOR AUTHORS 1. Aim and scope of the journal: Annales Kinesiologiae is an international interdisciplinary journal covering kinesiology and its related areas. It combines fields and topics directed towards the study and research of human movement, physical activity, exercise and sport in the context of human life style and influences of specific environments. The journal publishes original scientific articles, review articles, technical notes and reports. 2. General policy of Annales Kinesiologiae Annales Kinesiologiae pursues the multi-disciplinary aims and nature of Kinesiology with the main goal to promote high standards of scientific research. a) Reviewing: Each manuscript, meeting the technical standards and falling within the aims and scope of the journal, will be subjected to a double-blind peer-review by two reviewers. Authors can propose up to two reviewers for revision of their work and also up to two reviewers they would like to avoid. The referees are chosen by the Editors. Assessments by the referees will be presented anonymously to the author and will be returned to the author for correction. The corrected copy of the manuscript, with the list of corrections on a separate page, should be returned to the responsible Editor. b) Permissions: Authors wishing to include figures, tables, or text passages that have been published elsewhere, are required to obtain permission from the copyright owner(s) and to include evidence that such permission has been granted when submitting their manuscript. Any material received without such evidence it will be assumed that the authors hold the copyright. c) Copyright agreement: Submitting the article through the OJS (Open Journal System), the corresponding author will be asked to accept the terms of the copyright agreement. The aforementioned agreement is effective if and when the article submitted to be published in Annales Kinesiologiae is accepted. 3. Manuscript preparation a) Language and style: The language of Annales Kinesiologiae is USA English. The authors are responsible for the language, grammar, and style of the manuscript, which need to meet the criteria defined in the guidelines for authors. Manuscripts are required to follow a scientific style style. The journal will be printed in grayscale. b) The length of the manuscript should not exceed 36,000 characters (excluding spaces). Text formatting: It is required to use the automatic page numbering function to number the pages. Times New Roman font size 12 is recommended, with double spacing between lines. Use the table function, not spreadsheets, to make tables. Use an equation editor for equations. Finally, all lines need to be number, were the first line of a pages is assigned line number 1. c) Miscellaneous: Whenever possible, use the SI units (Système international d’unités). 88 GUIDELINES FOR AUTHORS, 87–90 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 d) The title page should include the title of the article (no more than 85 characters, including spaces), full names of the author(s) and affiliations (institution name and address) of each author; linked to each author using superscript numbers, as well as the corresponding author’s full name, telephone, and e-mail address. e) The authors are obliged to prepare two abstracts – one short abstract in English and one (translated) in Slovene language. For foreign authors translation of the abstract into Slovene will be provided. The content of the abstract should be structured into the following sections: purpose, methods, results, and conclusions. It should only contain the information that appears in the main text, and should not contain reference to figures, tables and citations published in the main text. The abstract is limited to 250 words. f) Under the abstract a maximum of 6 appropriate Keywords shall be given in English and in Slovene. For foreign authors the translation of the key words into Slovene will be provided. g) The main text should include the following sections: Introduction, Methods, Results, Discussion, Conclusions, Acknowledgement (optional), and References. Individual parts of the text can form sub-sections. h) Each table should be submitted on a separate page in a Word document after the Reference section. Tables should be double-spaced. Each table shall have a brief caption; explanatory matter should be in the footnotes below the table. Abbreviations used in the tables must be consistent with those used in the main text and figures. Definitions of symbols should be listed in the order of appearance, determined by reading horizontally across the table and should be identified by standard symbols. All tables should be numbered consecutively Table 1, etc. The preferred location of the table in the main text should be indicated preferably in a style as follows: *** Table 1 somewhere here ***. i). Captions are required for all figures and shall appear on a separate manuscript page, under the table captions. Each figure should be saved as a separate file without captions and named as Figure 1, etc. Files should be submitted in *.tif or *.jpg format. The minimum figure dimensions should be 17x20 cm and a resolution of at least 300 dpi. Combinations of photo and line art should be saved at 600–900 dpi. Text (symbols, letters, and numbers) should be between 8 and 12 points, with consistent spacing and alignment. Font type may be Serif (Times Roman) or Sans Serif (Arial). Any extra white or black space surrounding the image should be cropped. Ensure that participant-identifying information (i.e., faces, names, or any other identifying features) should be omitted. Each figure should be saved as a separate file without captions and named as Figure 1, etc. The preferred location of the figure in the main text should be indicated preferably in a style as follows: *** Figure 1 somewhere here ***. ANNALES KINESIOLOGIAE • 14 • 2023 • 1 89 GUIDELINES FOR AUTHORS, 87–90 j) References The journal uses the Harvard reference system (Publication Manual of the American Psycho- logical Association, 6th ed., 2010), see also: https://www.apastyle.org). The list of references should only include work cited in the main text and being published or accepted for publication. Personal communications and unpublished works should only be mentioned in the text. Referen- ces should be complete and contain up to seven authors. If the author is unknown, start with the title of the work. If you are citing work that is in print but has not yet been published, state all the data and instead of the publication year write „in print“. Reference list entries should be alphabetized by the last name of the first author of each work. Titles of references written in languages other than English should be additionally translated into English and enclosed within square brackets. Full titles of journals are required (no abbreviati- ons). Where available, DOI numbers should be provided in the form of a resolvable URL https:// doi.org/10.1037/rmh0000008. Examples of reference citation in the text One author: This research spans many disciplines (Enoka, 1994) or Enoka (1994) had con- cluded... Two authors: This result was later contradicted (Greene & Roberts, 2005) or Greene and Roberts (2005) pointed out... Three to six authors: a) first citation: Šimunič, Pišot and Rittweger (2009) had found... or (Šimunič, Pišot & Rit- tweger, 2009) b) Second citation: Šimunič et al. (2009) or (Šimunič et al., 2009) Seven or more authors: Only the first author is cited: Di Prampero et al. (2008) or (Di Prampero et al., 2008). Several authors for the same statement with separation by using a semicolon: (Biolo et al., 2008; Plazar & Pišot, 2009) Examples of reference list: The style of referencing should follow the examples below: Books Latash, M. L. (2008). Neurophysiologic basis of movement. Campaign (USA): Human Ki- netic. Journal articles Marušič, U., Meeusen, R., Pišot, R., & Kavcic, V. (2014). The brain in micro- and hyper- gravity : the effects of changing gravity on the brain electrocortical activity. European journal of sport science, 14(8), 813–822. https://doi.org/10.1080/17461391.2014.908959 90 GUIDELINES FOR AUTHORS, 87–90 ANNALES KINESIOLOGIAE • 14 • 2023 • 1 Šimunič, B., Koren, K., Rittweger, J., Lazzer, S., Reggiani, C., Rejc, E., … Degens, H. (2019). Tensiomyography detects early hallmarks of bed-rest-induced atrophy before changes in muscle architecture. Journal of applied physiology, 126(4), 815–822. https://doi.org/10.1152/ japplphysiol.00880.2018 Book chapters Šimunič, B., Pišot, R., Mekjavić, I. B., Kounalakis, S. N. & Eiken, O. (2008). Orthostatic intolerance after microgravity exposures. In R. Pišot, I. B. Mekjavić, & B. Šimunič (Eds.), The effects of simulated weightlessness on the human organism (pp. 71–78). Koper: University of Primorska, Scientific and research centre of Koper, Publishing house Annales. Rossi, T., & Cassidy, T. (in press). Teachers’ knowledge and knowledgeable teachers in physical education. In C. Hardy, & M. Mawer (Eds.), Learning and teaching in physical educati- on. London (UK): Falmer Press. Conference proceeding contributions Volmut, T., Dolenc, P., Šetina, T., Pišot, R. & Šimunič, B. (2008). Objectively measures physical activity in girls and boys before and after long summer vacations. In V. Štemberger, R. Pišot, & K. Rupret (Eds.) Proceedings of 5th International Symposium A Child in Motion “The physical education related to the qualitative education” (pp. 496–501). Koper: University of Primorska, Faculty of Education Koper, Science and research centre of Koper; Ljubljana: University of Ljubljana, Faculty of Education. Škof, B., Cecić Erpić, S., Zabukovec, V., & Boben, D. (2002). Pupils‘ attitudes toward endurance sports activities. In D. Prot, & F. Prot (Eds.), Kinesiology – new perspectives, 3rd International scientific conference (pp. 137–140), Opatija: University of Zagreb, Faculty of Ki- nesiology. 4. Manuscript submission The article should be submitted via online Open Journal Systems application, which is open source journal management and publishing software at http://ojs.zrs-kp.si/index.php/AK/ about/submissions. All the communication process with authors proceeds via Open Journal System and e-mail. 5. For additional information regarding article publication, please do not hesitate to contact the secretary of Annales Kinesiologiae. ISSN 1318-0185ISSN 2232-2620 A nnaleSK inesiologiae