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    Eccentric Isokinetic Rehabilitation for Chronic Lateral Epicondylitis in Female Swimmers: A Randomized Controlled Trial of Bilateral Neuromuscular Adaptations and Functional Performance
    (MDPI, 2026) Dhahbi, Wissem; Ghouili, Hatem; Ceylan, Halil Ibrahim; Adhadhi, Nessrine; Bchini, Souhail; Bessifi, Manel; Hammami, Nadhir
    Background and Objectives: This study investigated the efficacy of eccentric isokinetic muscle strengthening versus passive motion protocols on neuromuscular function and performance capacity in female swimmers with chronic lateral epicondylitis. Materials and Methods: Twenty-five swimmers (age 46.1 +/- 3.1 years) with lateral epicondylitis exceeding three months' duration completed a randomized controlled trial comparing eccentric training in Controlled Active Motion mode (experimental group (EG), n = 13) against passive motion in Continuous Passive Motion mode (control group (CG), n = 12). Both groups performed 18 supervised sessions over six weeks (60 degrees/s angular velocity, progressive loading 1-12 sets & times; 5 repetitions). Bilateral concentric peak torque of elbow extensors and flexors constituted the primary outcomes. Secondary measures included push-up performance, explosive power assessed by the Seated Medicine Ball Chest Push Test, and goniometric range of motion. Linear mixed-effects models and analysis of covariance with baseline adjustment were employed. Results: Eccentric training produced side-specific strength adaptations in elbow flexors (confirmed interaction: F-1,F-23 = 8.56, p = 0.008, eta(2)(p) = 0.271), with the experimental group demonstrating balanced bilateral gains, whereas the control group exhibited asymmetric responses favoring the non-dominant limb. EG demonstrated superior functional gains: push-up repetitions increased 4.15 +/- 1.77 versus 2.17 +/- 1.27 in CG (adjusted difference = 3.21 repetitions, 95% CI [1.52, 4.90], p = 0.001, d = 1.31), while explosive power improved 0.32 +/- 0.09 m versus 0.10 +/- 0.06 m (adjusted difference = 0.35 m, 95% CI [0.25, 0.45], p < 0.001, d = 1.20). Range of motion remained unchanged across groups (all p > 0.65). Conclusions: Eccentric isokinetic strengthening confers substantial advantages over passive motion protocols for restoring upper-body muscular endurance and ballistic force production in swimmers with lateral epicondylitis, supporting its integration into rehabilitation frameworks for the management of tendinopathy.
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    Network comparison methods detect temporal reorganization of psychophysiological integration invisible to conventional univariate analysis: Proof-of-concept using lunar-phase-timed measurements in elite athletes
    (Taylor & Francis Inc, 2026) Yousfi, Narimen; Dhahbi, Wissem; Ghouili, Hatem; Mejri, Mohamed Arbi; Bessifi, Manel; Ceylan, Halil Ibrahim; Chamari, Karim
    Field studies using conventional univariate methods fail to detect physiological rhythms (melatonin, cortisol, sleep architecture) that are consistently documented under laboratory-controlled conditions, suggesting that temporal factors operate on systemic organization rather than isolated metrics. Network analysis quantifies conditional dependencies among variables simultaneously, enabling the detection of organizational changes independent of mean-level shifts. As an exploratory proof-of-concept, this study examines whether network comparison methods detect temporal reorganization of psychophysiological integration invisible to conventional repeated-measures analysis in elite athletes; no confirmatory causal inference is drawn. Twelve elite male athletes completed psychophysiological assessments (mood states, subjective well-being, neurocognitive performance, postural control, intermittent endurance) at three lunar phases (New Moon, First Quarter, Full Moon) in a counterbalanced design. Conventional repeated-measures ANOVA detected no temporal effects on isolated variables (all F < 2.87, p > 0.05, eta(2)p < 0.21). Network comparison revealed marked organizational differences: New Moon versus Full Moon networks exhibited distinct architecture (M = 0.31, padj = 0.008) and connectivity (S = 8.42, padj = 0.029). Centrality systematically redistributed from capacity and well-being constructs (New Moon: vigour z = 1.82) to recovery markers (Full Moon: stress z = 2.13). Twelve connections differed significantly, including enhanced stress-confusion coupling (Delta r = +0.39, p = 0.003). This proof-of-concept demonstrates that temporal measurements can exhibit systemic reorganization despite stable component means, resolving apparent contradictions between laboratory-detected physiological rhythms and field-based null findings. Temporal control measurements and multi-cycle replication are required to definitively attribute observed reorganization to lunar periodicity rather than generic temporal variation.
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    Ramadan intermittent fasting alters cardiac autonomic modulation, neuromuscular performance, and recovery in adolescent tennis players: a within-subject repeated-measures design
    (Taylor & Francis Ltd, 2026) Lakhdar, Nadia; Landolsi, Mounir; Ghouili, Hatem; Ceylan, Halil Ibrahim; Ceylan, Nagihan Burcak; Muntean, Raul Ioan; Dergaa, Ismail
    Background: Tennis requires repeated high-intensity efforts with brief recovery periods, placing significant demands on cardiac autonomic regulation and neuromuscular performance. Ramadan intermittent fasting alters sleep, nutrition, and hydration patterns, potentially affecting match responses, particularly in adolescents. Methods: Sixteen male International Tennis Federation (ITF) junior players completed a within-subject repeated-measures study during mid-Ramadan and 15 days post-Ramadan. Each performed a standardized two-set outdoor match under both conditions. Heart rate variability (HRV), countermovement jump (CMJ), blood glucose, hydration markers, and rating of perceived exertion were assessed at baseline (T0), between sets (T1), and post-match (T2). Sleepiness, chronotype, fatigue, and recovery were evaluated via validated questionnaires. Results: Match play reduced lnRMSSD (p < 0.001, eta p(2 )= 0.775) and increased LF/HF (p < 0.001, eta p(2)= 0.234), indicating sympathetic dominance. During Ramadan, parasympathetic activity was lower (p < 0.001, eta p(2)= 0.269), and CMJ performance was reduced (p = 0.010, eta p(2)= 0.085). Blood glucose showed a Period & times; Set interaction (p = 0.020,eta p(2) = 0.114). Sleepiness, fatigue, and perceived recovery were significantly impaired (p < 0.001). Conclusion: Ramadan intermittent fasting reduces vagal activity and impairs neuromuscular performance in adolescent tennis players. HRV-guided training, optimized nutrition, and sleep management may help mitigate these effects.