Preparticipation examinations (PPE) are frequently used to evaluate eligibility for competitive sports in adolescent athletes. Nevertheless, the effectiveness of these examinations is under debate since costs are high and its validity is discussed controversial.
To analyse medical findings and consequences in adolescent athletes prior to admission to a sports school.
In 733 adolescent athletes (318 girls, 415 boys, age 12.3±0.4, 16 sports disciplines), history and clinical examination (musculoskeletal, cardiovascular, general medicine) was performed to evaluate eligibility. PPE was completed by determination of blood parameters, ECG at rest and during ergometry, echocardiography and x-rays and ultrasonography if indicated. Eligibility was either approved or rated with restriction. Recommendations for therapy and/or prevention were given to the athletes and their parents.
Historical (h) and clinical (c) findings (eg, pain, verified pathologies) were more frequent regarding the musculoskeletal system (h:120, 16.4%; c:247, 33.7%) compared to cardiovascular (h:9, 1.2%; c:23, 3.1%) or general medicine findings (h:116, 15.8%; c:71, 9.7%). ECG at rest was moderately abnormal in 46 (6.3%) and severely abnormal in 25 athletes (3.4%). Exercise ECG was suspicious in 25 athletes (3.4%). Relevant echocardiographic abnormalities were found in 17 athletes (2.3%). In 52 of 358 cases (14.5%), x-rays led to diagnosis (eg, Spondylolisthesis). Eligibility was temporarily restricted in 41 athletes (5.6%). Three athletes (0.4%) had to be excluded from competitive sports. Therapy (eg, physiotherapy, medication) and/or prevention (sensorimotor training, vaccination) recommendations were deduced due to musculoskeletal (t:n=76,10.3%;p: n=71,9.8%) and general medicine findings (t:n=80, 10.9%; p:n=104, 14.1%).
Eligibility for competitive sports is restricted in only 5.5% of adolescent athletes at age 12. Eligibility refusals are rare. However, recommendations for therapy and prevention are frequent, mainly regarding the musculoskeletal system. In spite of time and cost consumption, adolescent preparticipation before entering a career in high-performance sports is supported.
Paralympic athletes can be categorised in different groups, each requiring a particular approach with regard to medical care: athletes with loss of limb or limb deficiency (eg, amputation), athletes with loss of muscle power (eg, spinal cord injury, postpoliomyelitis, spina bifida), athletes with coordination problems (eg, hypertonia, ataxia, or athetosis as clinically manifested in, for example, cerebral palsy), athletes with visual impairment and athletes with intellectual...]]>
To assess and summarise the economic evidence regarding diagnostic tests, treatment and prevention for lateral ankle sprains.
Potential studies were identified from electronic databases and trial registries and by scanning reference lists. Risk of bias and methodological quality were evaluated. Two independent reviewers screened, assessed studies and extracted data. Data were synthesised descriptively due to study heterogeneity.
A total of 230 records were identified; 10 studies were included. Five studies conducted a full economic evaluation and five studies involved cost analyses. Lack of blinding was the main risk of bias. The methodological quality of the full economic evaluations was fairly good. Valuation of costs, measurement of outcomes and sensitivity analysis were points for improvement. Single studies showed that the Ottawa ankle rules (OAR) was cost effective for diagnosing lateral ankle sprains in the emergency setting compared with existing hospital protocols; acute treatment with anti-inflammatory medication and the plaster cast for severe sprains appeared cost effective; and neuromuscular training was cost effective in preventing ankle re-injury.
Results of this current systematic review supplements the evidence provided by reviews of effectiveness. There is evidence to support the implementation of OAR in the emergency setting, the use of anti-inflammatory medication and the plaster cast in the acute phase, and the prescription of neuromuscular exercises to prevent re-injury. Although the evidence is limited due to the low number of studies, shortcomings in methodological quality and small sample sizes, the findings may be used to inform clinical practice and practice guidelines.
Evidence for specific effects of acupuncture that are clinically relevant remains contentious. When compared with no treatment, acupuncture is effective.
To assess the injury incidence in elite handball, and if gender and previous injuries are risk factors for new injuries.
Cohort study of 517 male and female elite handball players (age groups under (u)16, u-18 and senior). Participants completed a web survey establishing injury history, demographic information and sports experience, and provided weekly reports of time-loss injuries and handball exposure for 31 weeks by short message service text messaging (SMS). Injuries were further classified by telephone interview.
The weekly response rate ranged from 85% to 90% illustrating the promise of the SMS system as a tool in injury surveillance. Of 448 reported injuries, 165 injuries (37%) were overuse injuries and 283 (63%) traumatic injuries. Knee (19%) and ankle (29%) were the most common traumatic injuries. The injury incidence during match play was 23.5 (95% CI 17.8 to 30.4), 15.1 (95% CI 9.7 to 22.2), 11.1 (95% CI 7.0 to 16.6) injuries per 1000 match hours among senior, u-18 and u-16 players, respectively. U-18 male players had an overall 1.76 (95% CI 1.10 to 2.80) times higher risk of injury compared to females. Having had two or more previous injuries causing absence from handball for more than 4 weeks increased the risk of new injury in the u-16 group (IRR: 1.79 (95% CI 1.03 to 3.11)–2.23 (95% CI 1.22 to 4.10)).
The incidence of time-loss injuries in elite handball was higher during match play than previously reported in recreational handball. Previous injuries were a risk factor for new injuries among u-16 players. Male players had a significant higher injury rate in the u-18 group.
It is believed that Scotland has been inhabited for over 12 000 years. These early settlers were hunter-gatherers, sustaining regular physical activity in their search for food. Scots take pride in their proud history of innovation and invention. To medicine, we have contributed penicillin, insulin and the ECG. Scots also contributed the three best friends of the couch potato; the telephone, the refrigerator and the television, unwittingly sowing the seeds for one of the biggest public health challenges of the 21st century: physical inactivity.
Steven Blair's research has shown that low cardiorespiratory fitness is responsible for the largest attributable fraction of all-cause mortality.
Paralympic athletes can be categorised in different groups, each requiring a particular approach with regard to medical care: athletes with loss of limb or limb deficiency (eg, amputation), athletes with loss of muscle power (eg, spinal cord injury, postpoliomyelitis, spina bifida), athletes with coordination problems (eg, hypertonia, ataxia, or athetosis as clinically manifested in, for example, cerebral palsy), athletes with visual impairment and athletes with intellectual...]]>
Illness accounts for a significant proportion of consultations with a team physician travelling with elite athletes.
To determine the incidence, type, cause and consequences of illness in Rugby Union players participating in a 16-week tournament.
8 teams participating in the 2010 Super 14 Rugby tournament
A cohort of 259 elite rugby players from eight teams was recruited.
All players were followed daily over the 16-week competition period (22 676 player days). Each day, team physicians completed an illness log with 100% compliance. Information included the daily squad size and illness details including system affected, final diagnosis, type and onset of symptoms, training/match days lost and suspected cause.
Incidence of illness (illness per 1000 player days).
The incidence of illness in the cohort was 20.7/1000 player days (95% CI 18.5 to 23.1) with the highest incidence of illness in the respiratory system (6.4: 95% CI 5.5 to 7.3), gastrointestinal system (5.6: 95% CI 4.9 to 6.6) and the skin and subcutaneous tissue (4.6; 95% CI 4.0 to 5.4). Infections accounted for 54.5% of all illness and 26.1% of illness resulted in time loss of ≥1 day. In over 50% of illnesses, symptoms were present for ≥1 day before being reported to the team physician.
Infective illness involving the respiratory tract and gastrointestinal tract together with dermatological illness was common in elite rugby players participating in this international tournament. A delay in reporting of symptoms >24 h could have important clinical implications in player medical care.
An 11-year-old high-level competitive female gymnast presented with back pain. Approximately 10 months earlier, she experienced acute pain in the (thoracic-lumbar) mid-spine during a training camp, on the uneven bar. She reported no acute trauma. The pain was located at the paravertebral right side and was provoked by rotation movements to the right. Night-time pain existed. She went to a physiotherapist, who at physical examination found a movement with typical local fixation in the spine (paradox movement). There were no neurological symptoms. The pain was mainly felt when her posture changed from anterior flexion to extension of the spine and with rotation to the right. At this first presentation of symptoms, she trained 20 h a week.
Although physiotherapy, manual therapy and a period of rest slightly improved the situation, a setback occurred after another intensive training camp, now with continuous pain, increasing during jumping (like dismounts from the...]]>
One approach that could be used to transfer the learnings...]]>
While this is true, we would do well to recall that the earliest studies of physical activity epidemiology relied primarily on measures of occupational physical activity, and that this field of research has now turned full circle, as outlined in our earlier review paper (from early roots in occupational sitting, through aerobic fitness training, then moderate-intensity physical activity, to a contemporary perspective on the balance between activity and inactivity in different domains of everyday life).
Concussion is common in contact sports such as boxing. Diagnosis of concussion depends on symptom report or recognition of clinical features, and true incidence may be underestimated. Persistent morbidity is a possible risk of repeated or unrecognised concussion. This study aimed to evaluate pre and postbout cognitive performance in motivated amateur boxers in order to detect objective evidence of unrecognised cognitive impairment suggestive of concussive injury.
The study employed a prospective and observational design. Participants were amateur boxers who won at least one bout in a single elimination competition. Optimal preparticipation performance using a computerised cognitive assessment tool (CCAT, Axon Sports) and no significant deterioration in cognitive performance within 24 h postbout were required to compete. All boxers were screened for clinical evidence of concussion by a ringside physician.
Of approximately 200 competing boxers, 96 were eligible having won at least one of the total 160 bouts. Mean age was 21.3 (SD 1.9) years (range 18.5–29.7). Of these, 17 (10.6%) failed their first postbout CCAT, with 12 (71%) passing a repeat test. Of the five remaining boxers, there were two boxers (1.3% of bouts) not suspected of a concussion after their bouts, who showed evolving slowing in cognitive performance typical of a concussion.
Cognitive impairment, as detected by subtle deterioration in reaction time measures, can occur in amateur boxers postbout that is not recognised at ringside. Although the vast majority of bouts were conducted safely, unrecognised injury may occur and be detectable using objective computerised cognitive assessment.
Determine if balance and technique training (BTT) implemented adjunct to normal Australian football (AF) training reduces external knee loading during sidestepping. Additionally, the authors determined if an athlete's knee joint kinematics and kinetics change over a season of AF.
Eight amateur-level AF clubs (n=1,001 males) volunteered to participate in either 28 weeks of BTT or a ‘sham’ training (ST) adjunct to their normal preseason and regular training. A subset of 34 athletes (BTT, n=20; ST, n=14) were recruited for biomechanical testing in weeks 1–7 and 18–25 of the 28-week training intervention. During biomechanical testing, participants completed a series running, preplanned (PpSS) and unplanned sidestepping (UnSS) tasks. A linear mixed model (α=0.05) was used to determine if knee kinematics and peak moments during PpSS and UnSS were influenced by BTT and/or a season of AF.
Both training groups significantly (p=0.025) decreased their peak internal-rotation knee moments during PpSS, and significantly (p=0.022) increased their peak valgus knee moments during UnSS following their respective training interventions.
BTT was not effective in changing an athlete's knee joint biomechanics during sidestepping when conducted in ‘real-world’ training environments. Following normal AF training, the players had different changes to their knee joint biomechanics during both preplanned and unplanned sidestepping. When performing an unplanned sidestepping task in the latter half of a playing season, athletes are at an increased risk of ACL injury. The authors therefore recommend both sidestepping tasks are performed during biomechanical testing when assessing the effectiveness of prophylactic training protocols.
To evaluate if pelvic or hip width predisposed women to developing greater trochanteric pain syndrome (GTPS).
Prospective case control study.
Four groups were included in the study: those gluteal tendon reconstructions (n=31, GTR), those with conservatively managed GTPS (n=29), those with hip osteoarthritis (n=20, OA) and 22 asymptomatic participants (ASC).
Anterior-posterior pelvic x-rays were evaluated for femoral neck shaft angle; acetabular index, and width at the lateral acetabulum, and the superior and lateral aspects of the greater trochanter. Body mass index, and waist, hip and greater trochanter girth were measured. Data were analysed using a one-way analysis of variance (ANOVA; posthoc Scheffe analysis), then multivariate analysis.
The GTR group had a lower femoral neck shaft angle than the other groups (p=0.007). The OR (95% CI) of having a neck shaft angle of less than 134°, relative to the ASC group: GTR=3.33 (1.26 to 8.85); GTPS=1.4 (0.52 to 3.75); OA=0.85 (0.28 to 2.61). The OR of GTR relative to GTPS was 2.4 (1.01 to 5.6). No group difference was found for acetabular or greater trochanter width. Greater trochanter girth produced the only anthropometric group difference (mean (95% CI) in cm) GTR=103.8 (100.3 to 107.3), GTPS=105.9 (100.2 to 111.6), OA=100.3 (97.7 to 103.9), ASC=99.1 (94.7 to 103.5), (ANOVA: p=0.036). Multivariate analysis confirmed adiposity is associated with GTPS.
A lower neck shaft angle is a risk factor for, and adiposity is associated with, GTPS in women.
‘23 1/2 hours: what is the single most important thing you can do for your health?’
Infraspinatus syndrome (IS) results from injury to the suprascapular nerve. For reasons that are poorly understood, volleyball players are at greater risk of developing IS than are athletes who compete in other overhead sports. Differences between the shoulder kinematics of volleyball-related overhead skills and those skills demanded by other overhead sports might explain the pronounced prevalence of IS among volleyball athletes.
Observational, laboratory-based, cross-sectional study.
The American Sports Medicine Institute.
Fourteen healthy female Division 1 collegiate volleyball athletes.
Upper limb biomechanics of 14 healthy female Division 1 collegiate volleyball athletes while spiking and serving were quantified, then compared to the results from data previously obtained from female baseball pitchers and tennis players.
Although the general movement pattern at the shoulder girdle is qualitatively similar for the upper limb skills required by a variety of overhead sports, volleyball spiking and serving result in greater shoulder abduction and horizontal adduction at the moment of ball contact/release than do baseball pitching or tennis serving.
The authors suggest that the unique scapular mechanics which permit the extreme shoulder abduction and horizontal adduction that characterise volleyball spiking and serving place anatomically predisposed volleyball athletes at increased risk for developing cumulative traction-related injury to the suprascapular nerve at the level of the spinoglenoid notch.
To determine the incidence and characteristics of newly incurred injuries and illnesses during international Athletics Championships, by improving the medical surveillance coverage, in order to determine future prevention strategies.
Prospective recording of newly occurred injuries and illnesses.
13th International Association of Athletics Federations World Championships in Athletics 2011 in Daegu, Korea.
National team and Local Organising Committee physicians; and 1851 registered athletes.
Incidence and characteristics of newly incurred injuries and illnesses.
82% of athletes were covered by medical teams participating with a response rate of 94%. A total of 249 injuries were reported, representing an incidence of 134.5 injuries per 1000 registered athletes, and 119 (48%) resulted in time loss from sport. A total of 185 injuries affected the lower limb (74%). Hamstring strain was the main diagnosis and 67% resulted in absence from sport. Overuse (n=148; 59%) was the predominant cause. A total of 126 illnesses were reported, signifying an incidence of 68.1 per 1000 registered athletes. Upper respiratory tract infection was the most common reported diagnosis (18%), followed by exercise-induced dehydration (12%), and gastroenteritis/diarrhoea (10%). The highest incidences of injuries were found in combined events and middle and long-distance events, and of illness in race walking events.
During elite Athletics World Championships, 135 injuries, 60 time-loss injuries and 68 illnesses per 1000 registered athletes were reported. Higher risks of injuries were found in combined events and long-distance runs. Preventive interventions should focus on overuse injuries and hamstring strains, decreasing the risk of transmission of infectious diseases, appropriate event scheduling and heat acclimatisation.
Reduced flexibility has been documented in athletes with lower limb injury, however, stretching has limited evidence of effectiveness in preventing injury or reducing the risk of recurrence. In contrast, it has been proposed that eccentric training can improve strength and reduce the risk of injury, and facilitate increased muscle flexibility via sarcomerogenesis.
This systematic review was undertaken to examine the evidence that eccentric training has demonstrated effectiveness as a means of improving lower limb flexibility.
Six electronic databases were systematically searched by two independent reviewers to identify randomised clinical trials comparing the effectiveness of eccentric training to either a different intervention, or a no-intervention control group. Studies evaluating flexibility using both joint range of motion (ROM) and muscle fascicle length (FL) were included. Six studies met the inclusion/exclusion criteria, and were appraised using the PEDro scale. Differences in the muscles studied, and the outcome measures used, did not allow for pooled analysis.
There was consistent, strong evidence from all six trials in three different muscle groups that eccentric training can improve lower limb flexibility, as assessed using either joint ROM or muscle FL.
The results support the hypothesis that eccentric training is an effective method of increasing lower limb flexibility. Further research is required to compare the increased flexibility obtained after eccentric training to that obtained with static stretching and other exercise interventions.
Physical activity could benefit drug users' physiological and mental health. Previous research has suggested that physical activity levels change when drug users enter prison.
Twenty-five class A drug users who were new to prison answered physical activity and drug use cross-sectional questionnaires, took a submaximal fitness test and wore a pedometer for 1 week.
Participants' mean aerobic capacity was estimated as 49 mls O2/kg/min (±12 SD). Their mean self-reported walking distance outside of prison was 4.67 miles on an average day (±4.14 SD). Pedometer data suggest they walked a mean of 1.8 miles/day in prison.
Many class A drug users entering prison had high levels of fitness and physical activity before admission, often gained from walking. Walking activity reduced when they entered prison, posing a challenge to maintaining healthy activity levels.
The ‘single-item measure’ was developed as a short self-report tool for assessing physical activity. The aim of this study was to test the criterion validity of the single-item measure against accelerometry.
Participants (n=66, 65% female, age: 39±11 years) wore an accelerometer (ActiGraph GT3X) over a 7-day period and on day 8, completed the single-item measure. The number of days of ≥30 min of accelerometer-determined moderate to vigorous intensity physical activity (MVPA) were calculated using two approaches; first by including all minutes of MVPA and second by including only MVPA accumulated in bouts of ≥10 min (counts/min ≥1952). Associations between the single-item measure and accelerometer were examined using Spearman correlations and 95% limits of agreement. Percent agreement and statistic were used to assess agreement between the tools in classifying participants as sufficiently/insufficiently active.
Correlations between the number of days of ≥30 min MVPA recorded by the single-item and accelerometer ranged from 0.46 to 0.57. Participants underreported their activity on the single-item measure (–1.59 days) when compared with all objectively measured MVPA, but stronger congruence was observed when compared with MVPA accumulated in bouts of ≥10 min (0.38 days). Overall agreement between the single-item and accelerometry in classifying participants as sufficiently/insufficiently active was 58% (k=0.23, 95% CI 0.05 to 0.41) when including all MVPA and 76% (k=0.39, 95% CI 0.14 to 0.64) when including activity undertaken in bouts of ≥10 min.
The single-item measure is a valid screening tool to determine whether respondents are sufficiently active to benefit their health.
Shoulder injuries in rugby players are common, but the mechanisms of injury are less well understood. This study aims to elucidate common mechanisms of injury and identify the patterns of injury they produce.
Twenty-four elite rugby players, referred to the senior author for diagnosis and management of shoulder injuries, were selected. Videos of the injuries were independently reviewed by rugby-medical experts to describe the mechanisms of injury. The mechanisms reported were collated and analysed to determine the level of agreement between reviewers and conclude an overall description of injury mechanisms.
The authors identified three mechanisms of shoulder injury from the video analysis. These are the ‘Try-Scorer’, characterised by hyperflexion of the outstretched arm such as when scoring a try; the ‘Tackler’, extension of the abducted arm behind the player while tackling; and the ‘Direct Impact’, a direct blow to the arm or shoulder when held by the side in neutral or slight adduction. The Try Scorer and Tackler mechanisms both involve a levering force on the glenohumeral joint (GHJ). These mechanisms predominantly cause GHJ dislocation, with Bankart, reverse Bankart and superior labrum anterior–posterior tears. The Try-Scorer Mechanism also caused the majority (83%) of rotator cuff tears. The Direct Hit mechanism resulted in GHJ dislocation and labral injury in 37.5% of players and was most likely to cause acromioclavicular joint dislocation and scapula fractures, injuries that were not seen with the other mechanisms.
Greater understanding of the mechanisms involved in rugby shoulder injury is useful in understanding the pathological injuries, guiding treatment and rehabilitation and aiding the development of injury-prevention methods.
"Those who cannot remember the past are condemned to repeat it". George...]]>
To provide sex- and age-specific normative values for health-related fitness of 9–17-year-old Australians.
A systematic literature search was undertaken to identify peer-reviewed studies reporting health-related fitness data on Australian children since 1985—the year of the last national fitness survey. Only data on reasonably representative s amples of apparently healthy (free from known disease or injury) 9–17-year-old Australians, who were tested using field tests of health-related fitness, were included. Both raw and pseudo data (generated using Monte Carlo simulation) were combined with sex- and age-specific normative centile values generated using the Lambda Mu and Sigma (LMS) method. Sex- and age-related differences were expressed as standardised effect sizes.
Normative values were displayed as tabulated percentiles and as smoothed centile curves for nine health-related fitness tests based on a dataset comprising 85347 test performances. Boys typically scored higher than girls on cardiovascular endurance, muscular strength, muscular endurance, speed and power tests, but lower on the flexibility test. The magnitude of the age-related changes was generally larger for boys than for girls, especially during the teenage years.
This study provides the most up-to-date sex- and age-specific normative centile values for the health-related fitness of Australian children that can be used as benchmark values for health and fitness screening and surveillance systems.
The use of medication in professional football has previously been shown to defy clinical guidelines.
Physicians of the teams who participated at the 2010 FIFA World Cup provided the list of medications used by each player within the 72 h preceding every match.
During the tournament 71.7% of all players took medication, and 60.3% (444 of 736 players) took painkilling agents at least once. Over a third of players (39.0%) took a painkilling agent before every game. More medications were used during the finals than during the qualifying round of matches (pool games) (0.87±0.09 vs 0.77±0.03, p<0.01). Players from North and South America took almost twice the number of medications than did players from other continents (1.18±0.08 vs 0.64±0.03; p<0.01).
The use of medication reported by the team physicians in international football competition is increasing. Systematic use – medication for every match – appeared to be the norm in certain teams. This has implications for player health. These data encourage efforts to better understand, and to address, this potential disastrous practice in professional sports.
Epidemiological work suggests that the prominence of suicides in sport is actually quite predictable. Sport is dominated by young men and studies show a 4:1 ratio...]]>
Participation in organised or volitional sport and exercise programmes can contribute to daily physical activity quotas. However, our recent population-based research measuring lifetime physical activity produced an unexpected finding – sporting activity formed a small fraction of overall physical activity compared with occupational and household activity (
Historically, epidemiological studies primarily based physical activity estimates on occupation. These data were gender biased...]]>
Severe cervical spine injury in Rugby Union (Rugby) exerts a major impact on the individual who sustains the injury and on the broader society. Since the late 1970s, authors of rugby case report studies have postulated that the underlying mechanism of cervical spine injury is hyperflexion of the neck. However, this is in conflict with findings from more recent experimental studies. These have shown that it is more likely that the majority of cervical spine injuries occur due to buckling of the cervical spinal column.
To investigate the primary mechanism of cervical spine injury in Rugby.
A comprehensive and systematic review of the literature was undertaken. Six key factors were identified and subsequently used to investigate the two principally postulated mechanisms of cervical spine injury: hyperflexion and buckling.
Facet dislocations, in particular bilateral facet dislocations, were identified as the most common types of cervical spine injury in Rugby. Trauma occurred most often at lower cervical spinal levels, notably the C4/5 and C5/6 motion segments. Experimental studies demonstrate that bilateral facet dislocations occurring at the lower cervical spinal levels are primarily produced via buckling.
Our analysis of key factors for cervical spine injury in Rugby shows that it is unlikely that the majority of injuries occur after hyperflexion of the neck. It appears more likely that they are the result of buckling of the cervical spinal column.
To investigate the evolution of anthropometric characteristics in World Cup rugby players and identify elements associated with performance.
Age, weight and height were collected for 2692 World Cup rugby players as well as rankings in each World Cup, and collective experience of winners, finalists, semifinalists and quarter finalists in comparison to the rest of the competitors. Anthropometric parameters were compared according to age and position (back and forwards).
From 1987 to 2007, forwards and backs have become heavier by 6.63 and 6.68 kg and taller by 0.61 and 1.09 cm, respectively. The collective experience of the forwards' pack is a value increasing with the final ranking attained, as well as the weight of forwards and the height of backs.
For all Rugby World Cups, the highest performing teams have the tallest backs and heaviest forwards with the highest percentage of collective experience.
To verify if in male elite junior soccer players a minimum 1-month performance decrease is accompanied by a mood profile and hormone levels typical of non-functional over-reaching (NFOR).
A prospective case-control study using a monthly performance monitor with a standardised field test to detect the performance changes. Players with a performance decrease lasting at least 1 month were compared with control players without a performance decrease on mood scores and pre-exercise and postexercise levels of stress hormones.
Sporting field and sports medical laboratory.
Ninety-four young elite soccer players were monitored during the 2006–2008 seasons. Twenty-one players were invited to the laboratory, seven of whom showed a significant performance decrease.
Performance change over time, scores on the profile of mood states and premaximal and postmaximal exercise serum levels of adrenocorticotropic hormone (ACTH), growth hormone (GH) and cortisol.
Players with a performance decrease showed psychological and hormonal changes typical of the non-functional state of over-reaching. Scores were higher on depression and anger, whereas the resting GH levels and ACTH levels after maximal exercise were reduced. ACTH and GH were capable of classifying all but one player correctly as either NFOR or control.
Performance-related criteria in field tests are capable of identifying players with worsened mood and adaptations of the endocrine system that fit the definition of NFOR. Performance, mood and hormone levels may therefore be considered as valid instruments to diagnose NFOR in young elite soccer players.
Regular aerobic exercise prevents and reverses arterial stiffening, but the association between resistance training and arterial stiffness is unclear.
This study was performed to conduct a systematic review and meta-analysis of randomised controlled clinical trials (RCTs) assessing the associations between resistance training and changes in arterial stiffness.
MEDLINE and SPORTDiscus databases were searched from January 1980 through to April 2011. RCTs evaluating the ability of resistance training to increase arterial stiffness in comparison with a control group were included in the meta-analysis. Two independent reviewers extracted data and assessed the quality of the included studies. Data from 185 reports of eight RCTs (193 participants) were included. Pooled mean differences in arterial stiffness indices (carotid arterial β stiffness and pulse wave velocity (PWV)) between intervention and control groups were calculated using a random-effects model.
The overall association of resistance training versus control with relative changes in carotid β index or PWV (eight studies; 193 participants) was 10.7% (95% CI 3.4% to 18.0%; I2, 89%; heterogeneity, p<0.001). Five studies indicated that resistance training in young subjects (n=115) was significantly associated with an increase in stiffness index of 14.3% (95% CI 8.5% to 20.1%; I2, 71%; heterogeneity, p<0.001) compared with controls. However, three studies showed that resistance training in middle-aged subjects (n=78) was not associated with changes in arterial stiffness. In addition, although high-intensity resistance training (n=87) was significantly associated with an increase in stiffness of 11.6%, moderate-intensity resistance training (n=106) showed no such association.
High-intensity resistance training is associated with increased arterial stiffness in young subjects with low baseline levels of arterial stiffness.
Acute ankle sprains are usually managed functionally, with advice to undertake progressive weight-bearing and walking. Mechanical loading is an important modular of tissue repair; therefore, the clinical effectiveness of walking after ankle sprain may be dose dependent. The intensity, magnitude and duration of load associated with current functional treatments for ankle sprain are unclear.
To describe physical activity (PA) in the first week after ankle sprain and to compare results with a healthy control group.
Participants (16–65 years) with an acute ankle sprain were randomised into two groups (standard or exercise). Both groups were advised to apply ice and compression, and walk within the limits of pain. The exercise group undertook additional therapeutic exercises. PA was measured using an activPAL accelerometer, worn for 7 days after injury. Comparisons were made with a non-injured control group.
The standard group were significantly less active (1.2±0.4 h activity/day; 5621±2294 steps/day) than the exercise (1.7±0.7 h/day, p=0.04; 7886±3075 steps/day, p=0.03) and non-injured control groups (1.7±0.4 h/day, p=0.02; 8844±2185 steps/day, p=0.002). Also, compared with the non-injured control group, the standard and exercise groups spent less time in moderate (38.3±12.7 min/day vs 14.5±11.4 min/day, p=0.001 and 22.5±15.9 min/day, p=0.003) and high-intensity activity (4.1±6.9 min/day vs 0.1±0.1 min/day, p=0.001 and 0.62±1.0 min/day p=0.005).
PA patterns are reduced in the first week after ankle sprain, which is partly ameliorated with addition of therapeutic exercises. This study represents the first step towards developing evidence-based walking prescription after acute ankle sprain.
Strategies to promote physical activity may be more successful if they reflect people's interests.
To explore physical activity contexts preferred by three adult groups at risk of inactivity: older adults, those with low income and those with high body mass index (BMI).
Cross-sectional data were from a mail survey of 7873 adults aged 42–67 years. Respondents indicated the extent of disagreement or agreement with a preference for each of 14 contexts relating to format (eg, vigorous), location (eg, outdoors) and social setting (eg, done alone). Data were analysed using multilevel multinomial logistic regression. Adjusted OR and 95% CI are reported.
Those aged 60–67 (vs 42–49) years had significantly higher odds to prefer activities with people of same age, and significantly lower odds to prefer activities that are at a fixed time with scheduled sessions, competitive, team-based or vigorous. Adults with low (vs high) income had significantly higher odds to prefer activities that are low cost, not just about exercise, team-based, supervised, skill-based or that can be done alone, and significantly lower odds to prefer vigorous or outdoor activities. Adults with BMI 30+ (vs<25) had significantly higher odds to prefer activities that are supervised, with people the same sex, team-based, with people the same age, or at a fixed time with scheduled sessions.
These three groups had distinct preferences for how, where and with whom the physical activity is done. This information could be used by those who promote, design, deliver and evaluate physical activity opportunities.
Since the first publication on proximal metatarsal V fractures by Jones in 1902,
The purpose of this study was to evaluate the treatment strategies of the different proximal metatarsal V fractures (avulsion, Jones and stress fractures,
This evaluation is based on a critical overview of the current literature combined...]]>
Regular physical activity is associated with reduced risk of mortality in middle-aged adults; however, associations between physical activity and mortality in older people have been less well studied. The objective of this study was to compare relationships between physical activity and mortality in older women and men.
The prospective cohort design involved 7080 women aged 70–75 years and 11 668 men aged 65–83 years at baseline, from two Australian cohorts – the Australian Longitudinal Study on Women's Health and the Health in Men Study. Self-reported low, moderate and vigorous intensity physical activity, socio-demographic, behavioural and health characteristics were assessed in relation to all-cause mortality from the National Death Index from 1996 to 2009; the median follow-up of 10.4 (women) and 11.5 (men) years.
There were 1807 (25.5%) and 4705 (40.3%) deaths in women and men, respectively. After adjustment for behavioural risk factors, demographic variables and self-reported health at baseline, there was an inverse dose – response relationship between physical activity and all-cause mortality. Compared with women and men who reported no activity, there were statistically significant lower hazard ratios for women who reported any activity and for men who reported activities equivalent to at least 300 metabolic equivalent.min/week. Risk reductions were 30–50% greater in women than in men in every physical activity category.
Physical activity is inversely associated with all-cause mortality in older men and women. The relationship is stronger in women than in men, and there are benefits from even low levels of activity.
The clinical assessment of chronic proximal hamstring tendinopathy (PHT) in athletes is a challenge to sports medicine. To be able to compare the results of research and treatments, the methods used to diagnose and evaluate PHT must be clearly defined and reproducible.
To assess the reliability and validity of three pain provocation tests used for the diagnosis of PHT.
Ninety-two athletes with (N=46) and without (N=46) PHT were examined by one physician and two physiotherapists, who were trained in the examination techniques before the study. The examiners were blinded to the symptoms and identity of the athletes. The three pain provocation tests examined were the Puranen–Orava, bent-knee stretch and modified bent-knee stretch tests. Intraclass correlation coefficients (ICCs) based on the repeated measures analysis of variance were used to analyse the intraexaminer and interexaminer reliability, while sensitivity, specificity, predictive values and likelihood ratios were used to determine the validity of the three tests.
The ICC values in all three tests revealed a high correlation (range 0.82 to 0.88) for the interexaminer reliability and a high-to-very high correlation (range 0.87 to 0.93) for the intraexaminer reliability. All three tests displayed a moderate-to-high validity, with the highest degree of validity being yielded by the modified bent-knee stretch test.
All three pain provocation tests proved to be of potential value in assessing chronic PHT in athletes. However, we recommend that they be used in conjunction with other objective measures, such as MRI.
Playing a sport or a musical instrument is presumed to improve motor ability. One would therefore predict that children who play a sport or music are better at motor imagery tasks, which rely on an intact cortical proprioceptive representation and precise motor planning, than children who do not. The authors tested this prediction.
This study involved an online questionnaire and then a motor imagery task. The task measured the reaction time (RT) and the accuracy for left/right-hand judgements in children aged 5 to 17 years. Forty pictured hands (20 left), held in various positions and rotated zero, 90°, 180° or 270°, were displayed on a screen. Participants indicated whether the displayed hands were left or right by pressing keys on a keyboard.
Fifty-seven children (30 boys; mean±SD age=10±3.3 years) participated. The mean±SD RT was 3015.4±1330.0 ms and the accuracy was 73.9±16.6%. There was no difference in RT between children who played sport, music, neither or both (four-level one-way analysis of variance, p=0.85). There was no difference in accuracy between groups either (Kruskal–Wallis, p=0.46). In a secondary analysis, participants whose parents rated them as being ‘clumsy’ were no slower (n.s.) but were about 25% less accurate than those rated coordinated or very coordinated (p<0.05).
The authors conclude against the intuitively sensible and widely held view that participation in a sport or music is associated with better cortical proprioceptive representation and motor planning. Secondary analyses suggest that parent-rated clumsiness is negatively related to motor imagery performance.
Physiological cardiac adaptation in athletes is influenced by body surface area, gender, age, training intensity and sport type. This study assesses the influence of sport category and provides a physiological reference for sport category and gender.
Three hundred and eighty-one subjects (mean age 25±5 years, range 18 to 39 years; 61% men) underwent cardiac MRI and ECG: 114 healthy non-athletes (≤3 training h/week) and 267 healthy elite athletes (mean 17±6.6 training h/week). Athletes performed low-dynamic high-static (LD-HS, n=42), high-dynamic low-static (HD-LS, n=144) or high-dynamic high-static sports (HD-HS, n=81).
Left ventricular (LV) end-diastolic volume (EDV) index (ml/m2) for non-athletes/LD-HS/HD-LS/HD-HS, respectively, was 101/107/122/129 in men and 90/103/106/111 in women. LV end-diastolic mass (EDM) index (g/m2) for non-athletes/LD-HS/HD-LS/HD-HS was, respectively, 47/49/57/69 for men and 34/38/42/51 for women. Left or right ventricular EDV ratios were alike in all groups. LV EDV/EDM ratios were similar in non-athletes/LD-HS/HD-LS athletes, and only lower in HD-HS athletes, disproving selective ventricular wall thickening in LD-HS athletes. Multivariate linear regression demonstrated HD-LS and HD-HS sport category coefficients (p<0.01) larger than those of training hours, gender and age (LV EDV/EDM coefficients for sport category LD-HS 6/0.75, HD-LS 16/7, HD-HS 21/17). ECG abnormalities were most frequent in HD-HS athletes and in male subjects.
This study demonstrates a balanced cardiac adaptation with preserved ratios of LV/right ventricular volume (in all sport categories) and LV volume/wall mass (in LD-HS and HD-LS sports). Sport category has a strong impact on cardiac adaptation. HD-HS sports show the largest changes, whereas LD-HS sports show dimensions similar to non-athletes.
Arthroscopy is increasingly used to improve pain and function in athletes with hip joint pathology. Surgical techniques have evolved to utilise arthroscopic femoral osteoplasty to address potential morphological contributors to pathology.
Investigate pain and function outcomes following hip arthroscopy with and without femoral osteoplasty in individuals with intra-articular hip pathology.
Systematic review.
A comprehensive search strategy identified studies that evaluated the outcome over at least 3 months following arthroscopy for intra-articular hip pathology, using patient-reported outcomes of pain and/or function. Methodological quality was evaluated (Downs and Black scale), and effect sizes calculated when sufficient data were available.
Twenty-nine studies of moderate methodological quality were included. Of 16 studies investigating arthroscopy alone, two studies showed large effects (3.12–5.46) at 1–2 years. Pain reduction and functional improvement (median 47%) were consistently reported by the remaining 14 studies up to 10 years postsurgery. Of 15 studies investigating arthroscopy with osteoplasty, nine papers showed mostly large effects (0.78–2.93) over 6–28 months. Adverse events were minimal (7% of participants, 12 studies, predominantly transient neuropraxia (83%)).
Current evidence indicates that hip arthroscopy can significantly reduce pain and improve function in patients with intra-articular hip pathology. While benefits of arthroscopy alone can persist up to 10 years postsurgery, effects of osteoplasty beyond 3 years need to be established. Future studies should investigate rehabilitation in this population, and the impact of surgery on development of osteoarthritis.
To investigate the level of translation of the Australian Rugby Union ‘Mayday’ safety procedure into practice among community rugby union coaches in New South Wales (Australia).
All registered coaches of senior community rugby union teams in five zones/associations in the north-eastern region of the state were invited to complete a short online questionnaire at the end of the 2010 rugby season. The questionnaire was designed around the five RE-AIMdimensions and assessed: Reach, perceived Effectiveness, Adoption, Implementation and Maintenance of the Mayday procedure.
Seventy (39%) coaches participated. There was a high level of awareness of the Mayday procedure, and most coaches believed it was effective in preventing injuries. The majority reported training their players in the procedure, although training was generally infrequent. Coaches were confident that their own players could implement the procedure appropriately if required to do so, but less confident that other teams or referees could do so. Barriers to providing training included not enough players at training, players not taking training seriously and technical difficulties (eg, verbalisation of instructions for physical tasks).
The findings suggest that the translation of the Mayday ‘policy’ could be improved by building individual coach, and club or zone organisational capacity by ensuring that coaches have the resources and skills in ‘how’ to train their players to complement their existing knowledge on ‘what’ to train them; setting expectations that encourage coaches to provide regular training for players; and regular monitoring of player competency to perform the procedure appropriately.
To obtain data regarding admissions of U19 rugby players to spinal injury units in Great Britain and Ireland and to compare this with a recent peak in presentation in Scotland. To assess the current state of data collection and subsequent analysis of serious neck injuries. To analyse the mechanism of injury in this group of at-risk players.
Retrospective case series.
Spinal injury units in Great Britain and Ireland.
Annual frequency of serious neck injuries. Analysis of injury types, neurological deficit and mechanism of injury.
36 Injuries were recorded. 10 Of these occurred in Scotland since 1996 of which six have occurred in the past 4 years. This compared with 14 in Ireland over the same period. 12 Cases were traced in England and Wales since 2000; records were not available before this date. No prospective collation of data is performed by the home unions and inconsistency of data collection exists. The mean age was 16.2 years. 16 Of the 36 admissions had complete neurological loss, 9 had incomplete neurological injury and 11 had cervical column injury without spinal cord damage. The mechanism of injury was tackle in 17 (47%), scrum in 13 (36%), two each due to the maul and collision, and one each due to a kick and a ruck. Some degree of spinal cord injury occurred in 92% of scrum injuries (61% complete) and 53% of tackle injuries (29% complete).
U19 rugby players continue to sustain serious neck injuries necessitating admission to spinal injury units with a low but persistent frequency. The recent rate of admission in Scotland is disproportionately high when the respective estimated playing populations are considered. While more injuries were sustained in the tackle, spinal cord injury was significantly more common in neck injury sustained in the scrum (p<0.001). No register of catastrophic neck injuries exists despite repeated calls over the past three decades, and a study such as this has not been reported before. Data collection of this serious category of injury is incomplete and very variable across the home unions, as a consequence a large proportion of the serious neck injuries that have occurred in U19 players over the past 14 years have not been analysed. Rigorous data collection and analysis have to be established so that problem areas of the game such as scrum engagement and the tackle can be made safer.
To describe the risk factors associated with injuries resulting from physical education (PE), leisure time physical activity (leisure time PA) and sports in 9–12-year-old children.
Prospective cohort study.
Primary schools.
Nine hundred and ninety-five children aged 9–12 years.
Injuries occurring during either PE class, leisure time PA or sports, and caused the child to at least stop the current activity were recorded prospectively. Individual weekly exposure was estimated from baseline and follow-up questionnaires. Potential risk factors were gender, age, socioeconomic status, ethnicity, habitual level of PA, body mass index and a motor fitness. A multivariate Cox proportional hazard regression model was developed, accounting for clustering within schools.
Gender, age and level of PA were independent significant risk factors for injury. Different modalities of PA had different injury risk factors. Most importantly, the low levels of habitual PA significantly increased injury risk.
The children at highest injury risk are the target audience of the contemporary PA promotion efforts. PA promotion should also focus on injury prevention.
A history of ankle injury is known to be associated with an increased risk of future injuries. Prevention of a first-time injury to an ankle will also prevent subsequent re-injury; yet these participants are often overlooked in reports of preventive testing. Determining the functional deficits which promote injury risk in all ankles, through studies inclusive of previously injured and never injured ankles, will enable training to be directed at improving known deficits in all sports participants.
To review studies investigating the measurement of intrinsic functions in healthy ankles and assess their predictive value for injury.
Systematic review and meta-analysis of journal articles from selected electronic databases. Using all papers that included sufficient data for extraction in any paradigm, the authors pooled results for measures of strength, postural control, proprioception, muscle reaction time in response to perturbation, range of movement and ligament stability.
Thirteen papers were found with adequate data reporting to allow calculation of pooled standardised mean difference (SMD) or pooled RR. The following are all associated with an increased risk of ankle injury: higher postural sway (SMD=0.693, 95% CI=0.151 to 1.235, p=0.012), being in the lower postural stability group (RR=2.06, 95% CI=1.364 to 3.111, p=0.001), lower inversion proprioception (0.573, 0.244 to 0.902, <0.001), higher concentric plantar flexion strength at faster speeds (0.372, 0.092 to 0.652, 0.009) and lower eccentric eversion strength at slower speeds (0.337, 0.117 to 0.557, 0.003).
There is a set of intrinsic functional and structural ankle deficits associated with significantly increased risk of ankle injury. These findings will enable clinicians and sports trainers to measure and train specific deficits in sports people for the prevention of ankle injury.
It is important to examine how childhood physical activity is related to adult physical activity in order to best tailor physical activity-promotion strategies. The time- and resource-intensive nature of studies spanning childhood into adulthood means the understanding of physical activity trajectories over this time span is limited. This study aimed to determine whether childhood domain-specific physical activities predict domain-specific physical activity 20 years later in adulthood, and whether age and sex play a role in these trajectories.
In 1985, 6412 children of age 9–15 years self-reported frequency and duration of discretionary sport and exercise (leisure activity), transport activity, school sport and physical education (PE) in the past week and number of sports played in the past year. In 2004–2006, 2201 of these participants (aged 26–36 years) completed the long International Physical Activity Questionnaire and/or wore a Yamax pedometer. Analyses included partial correlation coefficients and log-binomial regression.
Childhood and adult activity were weakly correlated (r=–0.08–0.14). Total weekly physical activity in childhood did not predict adult activity. School PE predicted adult total weekly physical activity and daily steps (older females), while school sport demonstrated inconsistent associations. Leisure and transport activity in childhood predicted adult leisure activity among younger males and older females, respectively. Childhood past year sport participation positively predicted adult physical activity (younger males and older females).
Despite modest associations between childhood and adult physical activity that varied by domain, age and sex, promoting a range of physical activities to children of all ages is warranted.
Initial power output declines significantly during exercise in hot conditions on attaining a rapid increase in skin temperature when exercise commences. It is unclear whether this initial reduced power is mediated consciously, through thermal perceptual cues, or is a subconscious process. The authors tested the hypothesis that improved thermal perception (feeling cooler and more comfortable) in the absence of a change in thermal state (ie, similar deep-body and skin temperatures between spray conditions) would alter pacing and 40 km cycling time trial (TT) performance.
Eleven trained participants (mean (SD): age 30 (8.1) years; height 1.78 (0.06) m; mass 76.0 (8.3) kg) completed three 40 km cycling TTs in standardised conditions (32°C, 50% RH) with thermal perception altered prior to exercise by application of cold-receptor-activating menthol spray (MENTHOL SPRAY), in contrast to a separate control spray (CONTROL SPRAY) and no spray control (CON). Thermal perception, perceived exertion, thermal responses and cycling TT performance were measured.
MENTHOL SPRAY induced feelings of coolness and improved thermal comfort before and during exercise. Skin temperature profile at the start of exercise was similar between sprays (CON-SPRAY 33.3 (1.1)°C and MENTHOL SPRAY 33.4 (0.4)°C, but different to CON 34.5 (0.5)°C), but there was no difference in the pacing strategy adopted. There was no performance benefit using MENTHOL SPRAY; cycling TT completion time for CON is 71.58 (6.21) min, for CON-SPRAY is 70.94 (6.06) min and for MENTHOL SPRAY is 71.04 (5.47) min.
The hypothesis is rejected. Thermal perception is not a primary driver of early pacing during 40 km cycling TT in hot conditions in trained participants.
To compare new versus recurrent concussions with respect to constellation of symptoms, symptom severity, symptom resolution; evaluate potential subset differences with respect to gender and sport; and to compare mechanisms and activities associated with new versus recurrent concussions.
Sports-related injury and exposure data were collected for nine sports from 2005 to 2010 from 100 nationally representative US high schools.
Nationally, an estimated 732,805 concussions occurred. Of these reported concussions, 13.2% were recurrent. The rate of new concussions was 22.2 per 100,000 athletic exposures while the rate of recurrent concussions was 3.1 per 100,000 athletic exposures (RR 7.23, 95% CI 6.39 to 8.17, p<0.001). While 0.6% of new concussion symptoms took >1 month to resolve, 6.5% of recurrent concussion symptoms took >1 month to resolve (IPR 10.35; 95% CI 4.62 to 23.16; p<0.001). Loss of consciousness was reported more often with recurrent (7.7%) than new concussions (4.4%) (IPR 1.76; 95% CI 1.02 to 3.03; p=0.043). A greater proportion of athletes sustaining recurrent concussions returned to play in >3 weeks (7.5%) or were medically disqualified (16.2%) than athletes sustaining new concussions (3.8%; IPR 1.95; 95% CI 1.01 to 3.77; p=0.047 and 2.9%; IPR 5.58; 95% CI 3.50 to 8.88; p<0.001, respectively). The majority of new and recurrent concussions resulted from contact with another person (73.4% and 77.9%, respectively).
Athletes sustaining recurrent concussions had longer symptom resolution times, were kept out of play longer and reported loss of consciousness more frequently than athletes sustaining new concussions. With the possibility of long-term impairment and other negative sequelae, proper management and prevention of concussions at the high school level is imperative.
Currently, there is no consensus regarding the optimal management for patients following an Achilles tendon rupture. To allow comparisons between different treatments, a universally accepted outcome measure is required. However, there are currently a range of these reported within the literature.
To recommend the most suitable patient-reported outcome measure for the assessment of patients following an Achilles tendon rupture, based on a systematic review of first what is currently used and second evidence of validity.
The electronic databases MEDLINE, EMBASE and AMED were searched up to September 2010. Predefined inclusion and exclusion criteria were applied to identify what outcome measures are reported in the literature. Aspects of validity were defined and a checklist used to determine which aspects have been evaluated.
Twenty-one outcome measures in 50 research papers were identified. The most commonly used was the American Orthopaedic Foot and Ankle Society hind-foot score. Of the 21 outcome measures, only 4 cited independent validation data. Of these four, only the ‘Achilles tendon Total Rupture Score’ reported evidence to support multiple facets of validity, as defined by a predetermined criteria checklist.
The Achilles tendon Total Rupture Score was identified as the only outcome measure which has demonstrated multiple facets of validity for use in this patient group. However, even this tool has limitations. Researchers should be aware of the limitations of the available outcome measurement tools and check on their validity before use in clinical research.
Structured, regular exercise is recommended to improve health outcomes. Exercise takes many forms and varies in type, intensity, duration and frequency. The authors used the example of exercise for chronic health conditions to examine how exercise programmes are described and summarised in systematic reviews.
Two independent reviewers conducted a review of exercise reporting practices using the evidence of exercise effects for chronic conditions as the source material. Inclusion criteria: systematic reviews that summarised the effects of exercise programmes for adults with chronic health conditions. Exclusion criteria: reviews of studies of children and adolescent populations, and non-English publications.
Seventy-three reviews were included. Data on sample size, number of included trials, interventions, comparisons, programme characteristics, exercise components, author conclusions and recommendations were extracted. Seventy-one per cent of reviews reported being unable to adequately describe the exercise programmes, because the required information was not reported in included trials. Using key exercise descriptors from the included reviews, the authors developed criteria for reporting to a level that enables replication.
All included reviews recommended better and standardised reporting. Incomplete exercise programme descriptions limit confidence in the accurate replication of effective interventions and limits critical appraisal of interventions when conflicting outcomes are reported. The evaluation and implementation of physical activity and exercise research would be facilitated if exercise programmes are comprehensively described. The authors propose that systematic reviews/meta-analysis and clinical application of the outcomes of exercise therapy research would be enhanced if authors used an exercise reporting grid that includes a detailed description of the programme components.
Reported data for injuries sustained by jockeys in thoroughbred horse racing vary greatly. While the range of abilities and types of racing may account for some variation, the variations result mainly from differences in the definitions and methodologies employed in the studies.
The British Horseracing Authority (BHA) facilitated a meeting of experts from the four leading horse racing countries in Europe. Using an approach adopted by the previous consensus groups addressing sports injuries, issues related to definitions, methodology and implementation were discussed and voted on by the group during a structured one-day meeting. Following this meeting, two members of the consensus group produced a draft document, based on the group discussions, which was circulated for review; two revisions were prepared before the final consensus statement was produced.
The definition of injury and the criteria for recording the severity and nature of injuries are proposed for use in future epidemiological studies of...]]>
Although most experts agree that preparticipation screening is important to prevent sudden cardiac death in sport, only a few reports have been published on the feasibility of its practical implementation.
The football associations participating in the U-17 and U-20 Women's World Cups 2010 were asked to perform a standardised precompetition medical assessment (PCMA) of their players (in total 672).
Compliance with the requirement for performing the PCMA was high among all teams, particularly from African, Asian and Central/South American countries. No relevant abnormal findings in personal history and clinical cardiological examination were reported. Athletic ECG patterns were frequent, but very few findings were considered to require further investigation. All players were declared as eligible to play.
Based on the demonstrated feasibility of performing a comprehensive PCMA in elite female youth players, the Fédération Internationale de Football Association (FIFA) Executive Committee decided to make the PCMA a compulsory requirement for all FIFA competitions.
Gastrointestinal (GI) symptoms during exercise may be caused by GI ischaemia. The authors report their experience with the diagnostic protocol and management of athletes with symptomatic exercise-induced GI ischaemia. The value of prolonged exercise tonometry in the diagnostic protocol of these patients was evaluated.
Patients referred for GI symptoms during physical exercise underwent a standardised diagnostic protocol, including prolonged exercise tonometry. Indicators of GI ischaemia, as measured by tonometry, were related to the presence of symptoms during the exercise test (S+ and S– tests) and exercise intensity.
12 athletes were specifically referred for GI symptoms during exercise (five males and seven females; median age 29 years (range 15–46 years)). Type of sport was cycling, long-distance running and triathlon. Median duration of symptoms was 32 months (range 7–240 months). Splanchnic artery stenosis was found in one athlete. GI ischaemia was found in six athletes during submaximal exercise. All athletes had gastric and jejunal ischaemia during maximum intensity exercise. No significant difference was found in gastric and jejunal Pco2 or gradients between S+ and S– tests during any phase of the exercise protocol. In S+ tests, but not in S– tests, a significant correlation between lactate and gastric gradient was found. In S+ tests, the regression coefficients of gradients were higher than those in S– tests. Treatment advice aimed at limiting GI ischaemia were successful in reducing complaints in the majority of the athletes.
GI ischaemia was present in all athletes during maximum intensity exercise and in 50% during submaximal exercise. Athletes with GI symptoms had higher gastric gradients per mmol/l increase in lactate, suggesting an increased susceptibility for the development of ischaemia during exercise. Treatment advice aimed at limiting GI ischaemia helped the majority of the referred athletes to reduce their complaints. Our results suggest an important role for GI ischaemia in the pathophysiology of their complaints.
The adductor muscles are implicated in the pathogenesis of groin strain, but the proximal morphology of this muscle group is poorly defined. The purpose of this study was to investigate the detailed anatomy of the entheses and proximal musculotendinous junctions (MTJs) of adductor longus (AL), adductor brevis (AB) and gracilis.
The adductors were dissected bilaterally in 10 embalmed cadavers (7 females, mean age at death 79 years (range 57–93 years)), focusing on the type of enthesis, and architecture of the proximal tendons and MTJs. Histology was used to determine if the entheses contained fibrocartilage and to semiquantitatively assess the vascularity of each proximal tendon.
All entheses were fibrocartilaginous. The proximal tendons of AB and gracilis were fused, forming a common tendinous insertion in all specimens. AL and AB both contained extensive intramuscular tendons of variable length (AL 11.1 ± 1.5 cm; AB 5.4 ± 1.1 cm); this has not been recorded previously. The vascularity of AL and AB tendons decreased significantly towards the enthesis (p < 0.05), and their entheses were significantly less vascular than that of gracilis (p < 0.05).
The proximal anatomy of AL, AB and gracilis is more complex than previously described. The arrangement and fusion of these muscles, their fibrocartilaginous entheses and differences in vascularity of their proximal tendons may be important anatomical considerations in the pathogenesis and pattern of adductor-related groin pain.
First-aid is a recommended injury prevention and risk management strategy in community sport; however, little is known about the sport-specific competencies required by first-aid providers.
To achieve expert consensus on the competencies required by community Australian Football (community-AF) sports trainers.
A three-round online Delphi process.
Community-AF.
16 Australian sports first-aid and community-AF experts.
Rating of competencies as either ‘essential’, ‘expected’, ‘ideal’ or ‘not required’.
After Round 3, 47 of the 77 (61%) competencies were endorsed as ‘essential’ or ‘expected’ for a sports trainer to effectively perform the activities required to the standards expected at a community-AF club by ≥75% of experts. These competencies covered: the role of the sports trainer; the responsibilities of the sports trainer; emergency management; injury and illness assessment and immediate management; taping; and injury prevention and risk management. Four competencies (5%) were endorsed as ‘ideal’ or ‘not required’ by ≥85% of experts and were excluded from further consideration. The 26 competencies where consensus was not reached were retained as second-tier, optional competencies.
Sports trainers are important members of on-field first-aid teams, providing support to both injured players and other sports medicine professionals. The competencies identified in this study provide the basis of a proposed two-tiered community-AF–specific sports trainer education structure that can be implemented by the peak sports body. This includes six mandatory modules, relating to the ‘required’ competencies, and a further six optional modules covering competencies on which consensus was not reached.
The communication of injury risk in rugby and other sports is underdeveloped and parents, children and coaches need to be better informed about risk.
A Poisson distribution was used to transform population based incidence of injury into average probabilities of injury to individual players.
The incidence of injury in schoolboy rugby matches range from 7 to 129.8 injuries per 1000 player-hours; these rates translate to average probabilities of injury to a player of between 12% and 90% over a season.
Incidence of injury and average probabilities of injury over a season should be published together in all future epidemiological studies on school rugby and other sports. More research is required on informing and communicating injury risks to parents, staff and children and how it affects monitoring, decision making and prevention strategies.
The aim of this systematic review was to investigate the perceived barriers and facilitators to physical activity among children with disability.
10 electronic databases were searched from the earliest time available to September 2010 to identify relevant articles. Articles were included if they examined the barriers or facilitators to physical activity for children with disability and were written in English. Articles were excluded if they included children with an acute, transient or chronic medical condition, examined sedentary leisure activities, or societal participation in general. Two reviewers independently assessed the search yields, extracted the data and assessed trial quality. Data were analysed descriptively.
14 articles met the inclusion criteria. Barriers included lack of knowledge and skills, the child's preferences, fear, parental behaviour, negative attitudes to disability, inadequate facilities, lack of transport, programmes and staff capacity, and cost. Facilitators included the child's desire to be active, practising skills, involvement of peers, family support, accessible facilities, proximity of location, better opportunities, skilled staff and information.
Personal, social, environmental, and policy and programme-related barriers and facilitators influence the amount of activity children with disability undertake. The barriers to physical activity have been studied more comprehensively than the facilitators.
The influence of an exercise programme performed by healthy pregnant women on maternal glucose tolerance was studied.
A physical activity (PA, land/aquatic activities) programme during the entire pregnancy (three sessions per week) was conducted by a qualified instructor. 83 healthy pregnant women were randomly assigned to either an exercise group (EG, n=40) or a control (CG, n=43) group. 50 g maternal glucose screen (MGS), maternal weight gain and several pregnancy outcomes were recorded.
Significant differences were found between study groups on the 50 g MGS. Values corresponding to the EG (103.8±20.4 mg/dl) were better than those of the CG (126.9±29.5 mg/dl), p=0.000. In addition, no differences in maternal weight gain and no cases of gestational diabetes in EG versus 3 in CG (7%) (p>0.05) were found.
A moderate PA programme performed during pregnancy improves levels of maternal glucose tolerance.
The aim of this study was to examine the effect of three different doses of aerobic exercise training (corresponding to approximately 50%, 100% and 150% of the National Institutes of Health consensus guidelines) on endothelial function in sedentary obese postmenopausal women with elevated blood pressure. Aerobic exercise training improves endothelial function in individuals with cardiovascular risk; however, it is unknown whether these adaptations occur in a dose-dependent manner.
Obese postmenopausal women (n=155) with elevated blood pressure (systolic blood pressure between 120 and 159.0 mm Hg) were randomly assigned to one of four groups: 4, 8 or 12 kilocalories per kilogram of energy expenditure per week (kcal/kg/week) or a non-exercise control group for 6 months. Endothelial function was assessed via flow-mediated dilation (FMD) at baseline and post-intervention.
After exercise training, there was a similar improvement (1.02–1.5%) in FMD in all three exercise groups (p<0.05) compared with control (–0.5%). Change in FMD after exercise training was significantly correlated with FMD at baseline (r= –0.35, p<0.001). Post hoc analyses found a significant improvement in FMD in exercisers (all exercise groups combined) with endothelial dysfunction (FMD < 5.5%) at baseline (1.8%, 95% CI: 1.17 to 2.38; p<0.001) compared with exercisers with normal endothelial function (FMD ≥ 5.5%) (–1.2%; 95% CI: –1.17 to 0.69; p=0.60).
Aerobic exercise training was associated with improved FMD in postmenopausal women with elevated blood pressure. In addition, exercise training may be more efficacious in improving endothelial function in postmenopausal women with endothelial dysfunction than individuals with normal endothelial function at baseline.
Connective tissues of the musculoskeletal system (eg, bones, tendons, ligaments, cartilage, menisci, muscles) are a diverse family of tissues essential for movement and mobility. Like most families, they share some distinctive features: they are matrix-rich tissues with relatively few cells that function well in mechanically active environments. This is despite the fact that their environments can be quite...]]>
Few prospective studies have examined predictors of change in specific physical activity (PA) behaviours in different ethnic groups.
To assess predictors of change in sports participation in Latino and non-Latino 5–8 year-old children in San Diego, California.
Average sports participation frequency (days/week) was assessed by validated parent-report at baseline (Nov 2006–May 2008) and 1 year later in 541 children (45.0% male, 41.1% Latino; mean±SD age: 6.6±0.7 years) taking part in an obesity prevention study (Project MOVE). Biological (sex, age, Body Mass Index z-score), socio-cultural (ethnicity, income, care giver education), parental (PA rules, PA encouragement) and environmental factors (home PA equipment, PA location) were assessed at baseline. Associations between change in sports participation and potential predictors were studied using multilevel linear regression stratified by Latino ethnicity, adjusted for sex, baseline sport participation, study condition and recruitment area.
Sports participation increased over 1 year (mean change: +0.5 days; p<0.001) and change was similar for boys and girls (p=0.95), but Latino children showed a greater increase (p=0.03). The number of locations used for PA (p=0.024) and the total frequency of PA location use (p=0.018) were positively associated with increased sports participation among Latinos. No predictors were identified for non-Latino children.
Only factors relating to PA location were identified as predictors of change in sports participation for Latino children. Interventions targeting specific PA behaviours such as sports participation may need to consider PA locations for Latino children and be tailored for specific ethnic groups.
Fasting of short duration or intermittent nature has little or no effect on the health or performance of most athletes, and an overnight fast of 8–12 h is normal for the majority of the population. However, where fasting prevents the athlete from following guidelines for optimum nutrition before, during or after exercise, there may be effects on both health and performance. Even small effects on performance may be sufficient...]]>
Prolonged television (TV) viewing time is unfavourably associated with mortality outcomes, particularly for cardiovascular disease, but the impact on life expectancy has not been quantified. The authors estimate the extent to which TV viewing time reduces life expectancy in Australia, 2008.
The authors constructed a life table model that incorporates a previously reported mortality risk associated with TV time. Data were from the Australian Bureau of Statistics and the Australian Diabetes, Obesity and Lifestyle Study, a national population-based observational survey that started in 1999–2000. The authors modelled impacts of changes in population average TV viewing time on life expectancy at birth.
The amount of TV viewed in Australia in 2008 reduced life expectancy at birth by 1.8 years (95% uncertainty interval (UI): 8.4 days to 3.7 years) for men and 1.5 years (95% UI: 6.8 days to 3.1 years) for women. Compared with persons who watch no TV, those who spend a lifetime average of 6 h/day watching TV can expect to live 4.8 years (95% UI: 11 days to 10.4 years) less. On average, every single hour of TV viewed after the age of 25 reduces the viewer's life expectancy by 21.8 (95% UI: 0.3–44.7) min. This study is limited by the low precision with which the relationship between TV viewing time and mortality is currently known.
TV viewing time may be associated with a loss of life that is comparable to other major chronic disease risk factors such as physical inactivity and obesity.
To investigate associations between deep abdominal muscle activation and long-term pain outcome in chronic non-specific low back pain (LBP).
Recruitment of transversus abdominis and obliquus internus abdominis during the abdominal drawing-in manoeuvre was recorded by B-mode ultrasound and anticipatory onset of deep abdominal muscle activity with M-mode ultrasound. Recordings were done before and after 8 weeks with guided exercises for 109 patients with chronic non-specific LBP. Pain was assessed with a numeric rating scale (0–10) before and 1 year after intervention. Associations between muscle activation and long-term pain were examined by multiple linear and logistic regression methods.
Participants with a combination of low baseline lateral slide in transversus abdominis and increased slide after intervention had better odds for long-term clinically important pain reduction (≥2 points on the numeric rating scale) compared with participants with small baseline slide and no improvement in slide (OR 14.70, 95% CI 2.41 to 89.56). There were no associations between contraction thickness ratios in transversus abdominis or obliquus internus abdominis and pain at 1-year follow-up. Transversus abdominis lateral slide before intervention was marginally associated with a lower OR for clinically important improvement in pain at 1-year follow-up (OR 0.76, 95% CI 0.62 to 0.93). Delayed onset of the abdominal muscles after the intervention period was weakly associated with higher long-term pain.
Improved transversus abdominis lateral slide among participants with low baseline slide was associated with clinically important long-term pain reduction. High baseline slide and delayed onset of abdominal muscles after the intervention period were weakly associated with higher pain at 1-year follow-up.
The study was preregistered in ClinicalTrials.gov with identifier NCT00201513.
To review the efficacy of resistance training (RT) as a therapeutic modality in various musculoskeletal conditions.
Systematic review.
Data from 1545 rehabilitation patients who had participated in structured RT programmes were included into the review. The total number of patients was composed of separate musculoskeletal conditions—chronic low back pain (CLBP) (549), tendinopathy (299), knee osteoarthritis (433), anterior cruciate ligament reconstruction (189) and hip replacement surgery (75).
Evidence suggests that RT can increase muscle strength, reduce pain and improve functional ability in patients suffering from CLBP, knee osteoarthritis, and chronic tendinopathy and those under recovery after hip replacement surgery.
RT can be used successfully as a therapeutic modality in several musculoskeletal conditions, especially those of a chronic variety. Although the exact application of training intensity and volume for maximal therapeutic effects is still unclear, it appears that RT guidelines, which have proven effective in a healthy population, can also be successfully applied in a rehabilitation context.
There is a risk of concussion when playing rugby union. Appropriate management of concussion includes compliance with the return-to-play regulations of the sports body for reducing the likelihood of premature return-to-play by injured players.
To describe the proportion of rugby union players who comply with the sports body's regulations on returning to play postconcussion.
Prospective cohort study.
1958 community rugby union players (aged 15–48 years) in Sydney (Australia) were recruited from schoolboy, grade and suburban competitions and followed over ≥1 playing seasons. Club doctors/physiotherapists/coaches or trained injury recorders who attended the game reported players who sustained a concussion. Concussed players were followed up over a 3-month period and the dates when they returned to play (including either a game or training session) were recorded, as well as any return-to-play advice they received.
187 players sustained ≥1 concussion throughout the follow-up. The median number of days before players returned to play (competition game play or training) following concussion was 3 (range 1–84). Most players (78%) did not receive return-to-play advice postconcussion, and of those who received correct advice, all failed to comply with the 3-week stand-down regulation.
The paucity of return-to-play advice received by community rugby union players postconcussion and the high level of non-compliance with return-to-play regulations highlight the need for better dissemination and implementation of the return-to-play regulations and improved understanding of the underlying causes of why players do not adhere to return-to-play practices.
Research supports the use of exercise to improve quality of life and reduce the side effects of breast cancer treatment, such as fatigue and decreased aerobic capacity. Previously published reviews have focused on reporting the outcomes of exercise interventions, but have not critically examined the exercise prescriptions. The purpose of this review is to evaluate the application of the principles of exercise training in the exercise prescriptions reported in intervention studies for breast cancer survivors.
Databases were searched for randomised controlled trials of exercise in women diagnosed with breast cancer. Data were extracted to evaluate the application of the principles of exercise training, the reporting of the components of the exercise prescription and the reporting of adherence to the exercise prescription.
Of the 29 papers included, none applied all principles of exercise training. Specificity was applied by 64%, progression by 41%, overload by 31%, initial values by 62% and diminishing returns and reversibility by 7% of trials. No study reported all components of the exercise prescription.
The application of the principles of exercise training varied greatly, and reporting of the exercise prescribed and completed was incomplete. When principles of exercise training are applied to the development of exercise protocols, there is greater confidence that non-significant findings reflect lack of efficacy of exercise rather than deficiencies in the prescription. Incomplete reporting of the exercise prescription and adherence to the prescription limits the reproducibility of the intervention, and the ability to determine the dose of exercise received by participants.
To investigate the longitudinal changes in children's recess and lunchtime physical activity levels and in the contribution of recess and lunchtime to daily physical activity levels over 5 years among 5–6- and 10–12-year olds.
Data were drawn from two longitudinal studies that were conducted in metropolitan Melbourne, Australia. Boys and girls (n=2782) aged 5–6 years and 10–12 years participated in baseline (T0) measures. Physical activity (n=2490) was measured every 60 s for eight consecutive days using hip-mounted accelerometry. Subsequent measurements were taken at 3-year (T1; n=773) and 5-year (T2; n=634) follow-up. Physical activity intensities were derived using age-adjusted cut-points. Sedentary time was defined as 100 counts/min. Longitudinal data were analysed using three-level (time, child, school) multilevel analyses, stratified by sex and cohort, and adjusted for potential confounding variables.
Significant decreases in recess and lunchtime moderate and vigorous physical activity were observed (p<0.001), with larger decreases occurring in the older cohort. Associated increases were observed in sedentary time over time (p<0.01). Although the contribution of recess to daily moderate intensity physical activity increased in the younger cohort over time (p<0.001), significant decreases were observed in the older cohort (p<0.001).
Physical activity levels during recess and lunchtime decreased in both cohorts over time. Decreases in the contribution of recess and lunchtime to older children's daily physical activity were also observed. Interventions are needed in both primary and secondary schools to promote physical activity levels during recess and lunchtime, particularly during the early years of secondary school.
The aim of this study was to examine the association between time spent in sedentary leisure and physical activity level in mid-aged men and women.
Data were from the 2007 HABITAT study in Brisbane, Australia. A mail survey sent to 17 000 adults (40–65 years) provided 11 037 responses (68.5%), and 9121 (82.6%) were analysed. Sedentary leisure was quantified as hours/day spent sitting watching television, in home computer use, in general leisure, and overall, on a usual week and weekend day. Physical activity level (no activity, low, recommended, high, very high) included walking, moderate and vigorous activity combined into a measure of MET.min/week. Data were analysed separately for men and women using multilevel multinomial logistic regression with adjustment for sociodemographic and health variables.
The only significant negative associations were between watching television on a week day and high activity in men (0.91; 0.83–0.98), and home computer use on a weekend day and very high activity in men (0.89; 0.81–0.98). For both men and women, there were significant positive associations between overall sedentary leisure time on a week day and very high activity (men: 1.07, 1.02–1.13; women: 1.10, 1.04–1.16), home computer use on a week day and very high activity (men: 1.11, 1.01–1.22; women: 1.15, 1.04–1.27) and general leisure on a week day and most activity levels.
Sedentary leisure is mainly independent of physical activity and does not preclude meeting physical activity recommendations.
The internet plays an important role in the dissemination of health information to the general public. Information on orthopaedic sports medicine websites has been shown to be of a varying standard, and to date there has been no evaluation of the overall quality of concussion-related websites.
A four-stage methodological sampling technique was used to identify concussion-related websites. Websites were assessed for the presence of a quality standard (the HONcode), their adherence to current expert concussion knowledge using a custom-developed concussion checklist ('CONcheck'), and their readability using the established Flesch Reading Ease (FRE) and Flesch–Kincaid Grade Level (FKGL).
43 Websites were identified from the search strategy with the majority (70%) not HONcode certified. A wide distribution of scores was seen for the CONcheck (0–22), FRE (16.3–77.4) and FKGL (6–17.8). Statistical analysis using independent t tests between websites with the HONcode and websites without the HONcode showed no significant differences between the two groups for CONcheck (t41=0.571, p=0.571), FRE (t41=0.808, p=0.424) and FKGL(t41=–0.964, p=0.341) scores.
The variability in the standard of concussion-related websites highlights the need for sports medicine website providers to consider the delivery, content and readability of information to the public.
Although adolescent motor awkwardness and increased injury susceptibility have often been speculated and researched, studies regarding adolescent regressions in motor control have yielded inconsistent conclusions. Thus, the relationship between adolescent maturation and injury risk remains unclear. The purpose of this study was to systematically review the literature relative to two questions: (1) Which sensorimotor mechanisms are not fully mature by the time children reach adolescence? and (2) Is adolescence a period when children exhibit delays or regressions in sensorimotor mechanisms?
Systematic searches for keywords were performed in February 2010 using PubMed MEDLINE (from 1966), CINAHL (from 1982) and SPORTDiscus (from 1985) databases. Articles were reviewed relative to predetermined criteria, and the methodological quality of each included study was assessed.
The search identified 2304 studies, of which 33 studies met the inclusion criteria. All 33 identified studies provided results associated with Question 1, 6 of which also yielded results pertaining to Question 2. The search results indicated that many aspects of sensorimotor function continue to mature throughout adolescence, and at least some children experience delays or regressions in at least some sensorimotor mechanisms. The results also exposed several significant weaknesses in our knowledge base.
The identified knowledge gaps are critical barriers because they hinder methods for identifying children at high risk and diminish the efficacy of targeted prevention programmes. Implications regarding research on adolescent injury risk are discussed and recommendations for future research such as improved methodological designs and integration of non-linear analyses are provided.