Method: A cross-sectional questionnaire-based survey investigated the opinions of the above professionals from three primary care trusts and associated hospitals in London and Birmingham.

Results: With a 50% response rate (n=226), 93% (208/224) of participants felt there was a role for SEM in the NHS. 56% (124/223) agreed this role should be in both primary and secondary care. 64% (136/212) of participants felt that their practice would benefit from the input of a SEM physician and 95% (191/202) would consider referring patients to SEM services. 74% (165/222) agreed SEM should have a public health role and 63% (140/222) believed these responsibilities should be evenly balanced with the treatment of sports injuries. Despite the emphasis on public health work from SEM policy makers, none of the SEM registrars selected public health as an important training area. 31% (44/140) of participants felt that a lack of education in the medical profession regarding SEM represented the greatest hindrance to its development in the NHS.

Conclusion: Several areas of agreement were demonstrated across the specialties, many of which matched the views of policy makers. This study involved participants from a range of cognate disciplines, and was the first to investigate this issue since SEM was recognised as a specialty in 2005.

Objective: To investigate whether a home exercise programme is more successful than a supervised exercise programme in treating patients with LET.

Methods: Patients with unilateral LET for at least four weeks were included in this trial. They were sequentially allocated to receive five times a week for 12 weeks either a home exercise programme or a supervised exercise programme. The exercise programme consisted of slow progressive eccentric exercises of wrist extensors and static stretching of the extensor carpi radialis brevis tendon. Outcome measures were pain using a visual analogue scale and function using a visual analogue scale and the pain free grip strength. Patients were evaluated at baseline, at the end of treatment (week 12), and three months (week 24) after the end of treatment.

Results: Seventy patients met the inclusion criteria. At the end of treatment there was a decline in pain and a rise in function in both groups compared with baseline (p<0.0005, paired t test). There were significant differences in the reduction of pain and the improvement of function between the groups at the end of treatment and at the three month follow up and the supervised exercise programme produced the largest effect (p<0.0005, independent t test).

Conclusions: Supervised exercise programme is superior to home exercise programme to reduce pain and improve function in patients with LET at the end of the treatment and at the follow up. Further research is needed to confirm our results.

Methods: Twenty-one patients with back pain and 14 controls completed two tasks, each involving two trials of 40 images: a left/right hand judgement task, which was used as a control task, and the left/right trunk rotation judgement task. Two (task) x three (group: bilateral back pain, unilateral back pain, control) ANOVAs were undertaken on mean RT and accuracy.

Results: RT was similar across participants and tasks (n.s.). Accuracy was not. Patients with bilateral back pain made more mistakes on the left/right trunk rotation task than patients with unilateral back pain did, who in turn made more mistakes on that task than controls did (Body Part x Group interaction; p<0.001). The mean (95% confidence interval) accuracy for left/right trunk rotation judgements was 53.4% (44.5 – 62.3%) for bilateral back pain patients, 67.2% (60.2 – 74.1%) for unilateral back pain patients and 87% (75 – 98%) for control participants. This pattern was not observed on the left/right hand judgement task, on which all three groups made correct judgements about 83% of the time (n.s.).

Discussion: Chronic back pain is associated with disruption of the working body schema of the trunk. This might be an important contributor to motor control abnormalities seen in this population.

Hypothesis: Polyurethane foam orthoses adapted to subject’s barefoot plantar pressure distribution are an effective treatment option for chronic overuse injuries in runners.

Design: Prospective, randomised, controlled clinical trial.

Intervention: 51 patients with running injuries were treated with custom-made, semi-rigid running shoe orthoses for 8 weeks. 48 served as a randomised control group that continued regular training activity without any treatment.

Main outcome measures: Evaluation was made by the validated pain questionnaire subjective pain rating scale (SES), the pain disability index (PDI) and a comfort index in the orthoses group (ICI).

Results: There were statistically significant differences between orthoses and control group at 8 weeks for PDI (mean difference 3.2 (95% CI 0.9 to 5.5) and SES (6.6 (2.6 to 10.6)). The orthoses patients reported a rising wearing comfort (ICI pre 69/100, ICI post 83/100) which was most pronounced in the first four weeks (ICI 80.4/100).

Conclusion: Customised polyurethane running shoe orthoses are an effective conservative therapy strategy for chronic running injuries with high comfort and acceptance of injured runners.

Devise and implement evidence based guidelines for the prevention and management of travellers’ diarrhoea (TD), and establish the incidence of TD during an elite sporting trip to India.

Long term Italian experience has provided evidence that preparticipation screening in competitive athletes with 12-lead ECG, history and physical examination, is effective in identifying potentially lethal cardiovascular diseases. However, it’s not being routinely practised in other countries.

To determine whether the provision of comparative performance feedback during 4 km track cycling affects completion time.

This review shows that sports-related violence, including hazing, brawling, and foul play, occurs among youth athletes of all ages and in a variety of different sports. The few studies to address this issue have all acknowledged the dangers of sports-related violence; however, no incident tracking method has been developed. Future research must provide accurate national estimates of the incidence of sports-related violence among youth, identify associated risk factors, evaluate preventive interventions, and identify effective methods of distributing and implementing evidence-based interventions. Monitoring the magnitude and distribution of the burden of sports-related violence and building the scientific infrastructure necessary to support the development and widespread application of effective sports-related prevention interventions are essential first steps toward a reduction in the incidence of sports-related violence.

Impaired biomechanics and neuromuscular control have been suggested as probable links to female sex bias in the onset of patellofemoral pain syndrome (PFPS). There are limited objective, clinical measures for assessment of impaired biomechanics and neuromuscular control. The primary objective of this investigation was to examine sex differences in vertical ground reaction force (vGRF) and force loading rate in young athletes performing maximum, repeated vertical single-leg hops (RVSH). We hypothesized that females would demonstrate greater vGRF and force loading rate than males and females would show inter-limb differences in force attenuation.

It is unclear whether hormone profiles obtained in two consecutive months are consistent within females. We prospectively examined month to month consistency in daily, nadir, peak and mean hormone concentrations during the early follicular and luteal phases in recreationally active, young eumenorrheic females.

Seventeen male participants (age 33.5 ± 6.5 years [46-26 yrs], body mass 80 ± 9.2 kg [100-63 kg], height 1.81 ± 0.06 m [1.93-1.70 m]) ran a marathon to investigate the relationship between systolic function (using cardiac magnetic resonance; CMR) and diastolic function (using echocardiography) against biomarkers of cardiac damage.

Physical inactivity has been associated with significant increases in disease morbidity and mortality. This study assessed the association between physical activity and 1) healthcare resource utilizations and 2) healthcare resource utilization costs.

To examine the effect of a multi-factorial lifestyle intervention on five-year change in physical activity and to explore whether length of education had an impact on the effect of the intervention.

To examine the use of food supplements and pharmaceutical preparations by elite Paralympic athletes.

To assess whether a rule change introduced in the Australian Football League (AFL) prior to the start of the 2005 season, to limit the run-up of ruckmen at the centre bounce, has been successful in reducing the incidence of knee posterior cruciate ligament (PCL) injuries.

Both mean power output and the distribution of the available energy over the race, i.e. pacing strategy, are critical factors in performance. The purpose of this study was to determine the relative importance of both pacing strategy and mean power output to performance.

Athletes are trained to choose the pace which is perceived to be correct during a specific effort, such as the 1500-m speed skating competition. The purpose of the present study was to ‘override’ self-paced performance by instructing athletes to execute a theoretically optimal pacing profile.

Eccentric hip adduction and abduction strength plays an important role in the treatment and prevention of groin injuries in soccer players. Lower extremity strength deficits of less than 10% on the injured side, compared to the uninjured side has been suggested as the clinical milestone before returning to sport following injury.

Analyse risk factors in alpine skiing.

This paper provides an overview of the epidemiology of women’s rugby league injuries requiring medical treatment and associated costs in New Zealand.

We examined whether increasing peak aerobic capacity for walking (VO_2peak) by interval walking training (IWT) is closely linked with decreasing the indices of lifestyle-related diseases in middle-aged and older people.

The aim of this study was to investigate the cumulative effects of prolonged intensive training and rapid weight loss on immunological parameters and anti-oxidation activity of elite male Taiwanese Taekwondo athletes.

To classify Paralympic athletes, classifiers use test batteries to obtain an objective, pre-competition estimate of an athlete’s training level. We evaluated five tests to determine which combination explained the maximum variance in running performance in a non-disabled population. A non-disabled sample was required to permit psychometric evaluation of the tests without the confounding influence of impairment, and to provide an indication of normative performance.

Objective: Firstly, we wanted to look for appropriate closed kinetic chain exercises to restore intramuscular imbalance between upper trapezius (UT) and serratus anterior (SA) in overhead athletes. Secondly, we wanted to determine the influence of using diagonal pattern muscle recruitment during knee push up plus (KPP) exercises on scapular EMG activity.

Design: Single group repeated-measures design.

Setting: Controlled laboratory study.

Participants: Thirty-two physically active individuals in good general health, who did not have a history of neck and/ or shoulder injury or surgery, nor participated in high level overhead sports or performed upper limb strength training for more than 5 hours per week.

Interventions: Subjects performed the standard KPP and 6 variations.

Main outcome measurements: Electromyographic activity of the 3 trapezius parts and the SA.

Results: Four exercises with a low UT/SA can be selected for rehabilitation of intramuscular balance: standard KPP, KPP with homolateral leg extension, KPP with a wobble board and homolateral leg extension, and one handed KPP. The use of a wobble board during KPP exercises and performance on one hand has no influence on SA EMG activity.

Heterolateral leg extension during KPP stimulates LT activity, while homolateral leg extension stimulates SA activity.

Conclusions: In case of intramuscular scapular imbalance, some exercises are preferable over others because of their low UT/SA ratio. The use of a kinetic chain approach during KPP exercises influences scapular muscle activity.

We assessed the effects of maternal physical activity level on several fetal haemodynamics parameters such as pulsatility index of the fetal middle cerebral (MCA-PI) and umbilical artery (UA-PI), and cerebral to fetal ratio (CPR), as well as on fetal heart rate (FHR) responses to one-bout of moderate exercise (20-min cycle-ergometry at ~60% of age-predicted maximum heart rate) during the third pregnancy trimester. We studied 26 sedentary and 26 physically active gravidae aged 29(3) and 30(2) years respectively. Maternal exercise did not have a deleterious effect on fetal haemodynamics (particularly, CPR remained within normal limits with exercise). Overall, maternal training status did not influence the fetal cardiovascular variables we studied.

Objective: To examine the concurrent validity of the Technogym Active Key accelerometer against objective and subjective Physical Activity (PA) measures.

Design: Randomized, cross-sectional design with two phases. The laboratory phase compared the Active Key with the ActiGraph GT1M and the Yamax SW200 Digiwalker pedometer during treadmill graded walking increasing speed each minute. The free-living phase compared the Active Key with the ActiGraph, Digiwalker, Bouchard Activity Recall (BAR), and Global PA Questionnaire (GPAQ) for seven continuous days. Data were analyzed using Spearman rank-order correlation coefficients for all comparisons.

Setting: Laboratory and free-living phases.

Participants: Sixteen participants randomly stratified from 41 eligible respondents by sex (n=8 male; n=8 female) and PA levels (n=4 low), (n=8 middle), and (n=4 high active).

Intervention: N/A.

Main outcome measurements: N/A.

Results: There was a strong association between the Active Key and the ActiGraph accelerometer during controlled graded treadmill walking (r = 0.91, p < 0.01) and in free-living settings (r = 0.73 to 0.76 for light to vigorous PA, respectively, p < 0.01). No associations were observed between the Active Key and the BAR and GPAQ. (p > 0.05).

Conclusions: The Active Key has a high concurrent validity with the ActiGraph accelerometer to detect PA in both controlled laboratory and free living settings.

The pacing strategy may be defined as the process in which the total energy expenditure during exercise is regulated on a moment-to-moment basis in order to insure that the exercise bout can be completed in a minimum time and without a catastrophic biological failure. Experienced athletes develop a stable template of the power outputs they are able to sustain for different durations of exercise but it is not known how they originally develop this template nor how that template changes with training and experience. Whilst it is understood that the athlete’s physiological state makes an important contribution to this process, there has been much less interest in the contribution that the athlete’s emotional status makes.

The aim of this review is to evaluate the literature of physiological, neurophysiological and perceptual responses during exercise in order to propose a complex model interpretation of this process which may be a critical factor determining success in middle and long duration sporting competitions.

We describe unconscious/physiological and conscious/emotional mechanisms of control, the focus of which are to insure that exercise terminates before catastrophic failure occurs in any bodily system.

We suggest that training sessions teach the athlete to select optimal pacing strategies, by associating a level of emotion with the ability to maintain that pace for exercise of different durations. That pacing strategy is then adopted in future events.

Finally, we propose novel perspectives to maximize performance and to avoid overtraining by paying attention also to the emotional state in training process.

Objective: To compare the effectiveness and cost-effectiveness of eccentric loading exercises (ELE) with prolotherapy injections used singly and in combination for painful Achilles tendinosis.

Design: A single-blinded randomised clinical trial. The primary outcome measure was the VISA-A questionnaire with a minimum clinically important change (MCIC) of 20 points on a 100 point scale.

Setting: Five Australian private primary care centres.

Participants: 43 patients with painful mid-portion Achilles tendinosis commenced and 40 completed the treatment protocols.

Interventions: Participants were randomised to a 12 week program of ELE (n=15), or prolotherapy injections of hypertonic glucose with lignocaine alongside the affected tendon (n=14) or combined treatment (n=14).

Main outcome measurements: VISA-A, pain, stiffness and limitation of activity scores and treatment costs were assessed prospectively over 12 months.

Results: At 12 months, the proportions of participants achieving the MCIC for VISA-A scores were 73% for ELE, 79% for prolotherapy and 86% for combined treatment. Mean (95% CI) increases in VISA-A scores at 12 months were 23.7 (15.6 to 31.9) for ELE, 27.5 (12.8 to 42.2) for prolotherapy and 41.1 (29.3 to 52.9) for combined treatment. At 6 weeks and 12 months, these increases were significantly less for ELE than for combined treatment. Compared with ELE, reductions in stiffness and limitation of activity occurred earlier with prolotherapy and reductions in pain, stiffness and limitation of activity occurred earlier with combined treatment. Combined treatment had the lowest incremental cost per additional responder (AU$1539) compared with ELE.

Conclusions: For Achilles tendinosis, prolotherapy and particularly ELE combined with prolotherapy give more rapid improvements in symptoms than ELE alone but long term VISA-A scores are similar.

Background: Novel treatment interventions are advancing rapidly in the management of hip and groin disability, in the physically active young to middle-aged population.

Objective: To recommend the most suitable patient-reported outcome questionnaires for the assessment of hip and groin disability based on a systematic review of evidence of validity, reliability and responsiveness of these instruments.

Methods: MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO, SportsDiscus and Web of Science, were all searched up to January 2009. Two reviewers independently rated measurement properties of the patient-reported outcome questionnaires in the included studies, according to a standardised criteria list.

Results: The computerized search identified 2737 publications. Forty-one publications investigating measurement properties of patient-reported outcome questionnaires assessing hip or groin disability were included in the study. Twelve different questionnaires designed for patients with hip disability and one questionnaire for patients with groin disability were identified. Hip dysfunction and Osteoarthritis Outcome Score (HOOS) contains adequate measurement qualities to evaluate patients with hip osteoarthritis or total hip replacement. Hip Outcome Score (HOS) is the best available questionnaire for evaluating hip arthroscopy, but the Inguinal Pain Questionnaire (IPQ), the only identified questionnaire evaluating groin disability, does not contain adequate measurement qualities.

Conclusions: HOOS is recommended for evaluating patients with hip osteoarthritis undergoing non-surgical treatment and surgical interventions such as total hip replacement. HOS is recommended for evaluating patients undergoing hip arthroscopy. Current and new patient-reported outcome questionnaires should also be evaluated in younger patients (age<50) with hip and/or groin disability, including both surgical and non-surgical patients.

Objective: To summarize the best available evidence to determine if facial protection reduces head injury in ice hockey.

Data sources: MEDLINE and Cochrane databases through January 2009.

Review methods: Utilizing terms: "head injuries," "craniocerebral trauma [MeSH]", "head injuries, closed [MeSH]", head injuries, penetrating [MeSH]", "face mask", "face shield", "visor", and "hockey", twenty-four articles were identified through our systematic literature search. Of these, six studies met inclusion criteria. Three independent reviewers reviewed the articles. The study results and generated conclusions were extracted and agreed upon.

Results: Studies reviewed suggest that facial protection reduces overall head injuries in ice hockey. Facial protection showed statistically significant (p<0.05) reduction in the number and type of facial injuries. In studies evaluating full facial protection versus half facial protection, full facial protection offered a significantly higher level of protection against facial injuries and lacerations than half facial protection (RR 2.31, CI 1.53-3.48). There was no significant difference in the rate of concussion (RR 0.97, CI 0.61-1.54) or neck injury (CI 0.43-3.16) between full and partial protection. However, in those that sustained concussion players with full facial protection returned to practice or games sooner than players with partial facial protection (1.7 sessions, CI 1.32-2.18).

Conclusions: There is good evidence to support that full facial protection reduces the number and risk of overall head and facial injuries in ice hockey compared to both partial facial protection and no facial protection. Partial facial protection, while not as protective as full facial protection, appears to offer more risk reduction than no protection at all.

Objective: To report sex- and age-specific physical fitness levels in European adolescents.

Methods: A sample of 3456 adolescents aged 12.5 to 17.49 y from ten European cities in Austria, Belgium, France, Germany, Greece (an inland city and an island city), Hungary, Italy, Spain and Sweden, was assessed in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study between 2006 and 2008. Muscular fitness, speed/agility, flexibility and cardiorespiratory fitness were assessed using 9 different fitness tests: handgrip, bent arm hang, standing broad jump, Bosco jumps (squat jump, counter movement jump and Abalakov jump), 4x10m shuttle run, back-saver sit and reach, and 20m shuttle run tests.

Results: Sex- and age-specific normative values for physical fitness in the European adolescents were derived using the LMS statistical method, and expressed as tabulated percentiles from 10 to 100 and as smoothed centile curves (P₅, P₂₅, P₅₀, P₇₅, and P₉₅). The figures showed greater physical fitness in the boys, except for the flexibility test, and a trend towards increased physical fitness in the boys as their age increased, whereas the fitness levels in the girls were more stable across ages.

Conclusions: The normative values hereby provided will enable evaluation and correct interpretation of European adolescents’ fitness status.

Objective: To examine the association of health-related physical fitness with total and central body fat in adolescents.

Subjects/Methods: The present cross-sectional study comprises 363 Spanish adolescents (186 females) aged 12.5-17.5 years. We assessed fitness by the 20m shuttle run test (cardiorespiratory fitness); the handgrip strength, the standing broad jump and the Abalakov tests (muscular strength); and the 4x10m shuttle run test (speed- agility). Total body fat was measured by DXA, BodPod, and sum of 6 skinfolds, and central body fat was measured by DXA at three regions (R1, R2, and R3), and waist circumference.

Results: The Abalakov, the standing broad jump, the 4x10m shuttle run, and the 20m shuttle run tests were negatively associated with all markers of total and central body fat in both males and females after controlling for age, pubertal status and objectively assessed physical activity (P<0.01). Handgrip strength test was positively associated with waist circumference (P<0.01).

Conclusions: Both lower body muscular strength and cardiorespiratory fitness are negatively and consistently associated with total and central body fat in adolescents, whereas levels of upper body muscular strength were superior in adolescents with higher levels of central body fat.

Objective: to collect medical data on women’s boxing.

Design: Cross-sectional and longitudinal study.

Setting: Medical examinations requested by Italian laws.

Participants: A retrospective study was conducted on all female boxing competitions in Italy from April 2001 to December 2007. Sixty-one amateur female boxers were evaluated longitudinally.

Interventions: Retrospective study: all pre-/post-match medical reports were analyzed. Prospective study: Breast, gynaecologic, brain, eyes, ear, nose and throat examinations were carried out.

Main outcome measurements: Retrospective study: any injury assessed before/after the match. Prospective study: health problems which could be related to boxing activity.

Results: Retrospective study: data from 5600 examinations were collected. Pre-competition, a medical problem was recorded in 3 athletes (1 conjunctiva hyperemia, 1 zygomatic bruise, 1 eyelid hematoma). Post-competition, 51/2800 medical checks showed mild common injuries, such as, soft tissue facial lesions, epistaxis, and hand-wrist problems. Only one concussion was recorded with hospitalization (for a thorough evaluation). Another athlete was hospitalized for a nasal fracture. Prospective study: 2 fibroadenomas, 3 ovarian cysts, and 1 intramural uterine myoma were diagnosed. In 4 boxers non-specific electroencephalographic abnormalities were detected however with a normal brain MRI in 3 (the 4th is still waiting for the radiologic procedure). Nasal septum deviation was common (42.6%) and a transmissive hypoacusia was observed in 2 athletes. No major eye injuries were reported.

Conclusions: Female boxing seems to be a safe sport with a very low incidence of events requiring hospitalization. No specific diseases in female boxers could be observed, in particular regarding the breast and reproductive system.

Objective: Objectives of this study were to investigate children’s physical activity patterns to gain comparisons between home and school, and to determine whether the current physical activity guidelines of 60 minutes of moderate to vigorous physical activity (MVPA) daily were being met.

Methods: Participants were recruited from two New Zealand primary schools (60 children, mean ± SD: age: 8.3 ± 0.7 years). Physical activity was measured for seven consecutive days using Actigraph accelerometers. Total activity and average counts were determined for: school playtime, after school and weekends. Differences between average counts for these intervals were compared using the t statistic. Time and percentage of time spent were categorised into the activity thresholds: sedentary (<100); light (101-299); moderate (3000-5200); vigorous (>5200). Total activity for each day was also determined.

Results: No child met the recommended 60 minutes of MVPA daily during the investigation. Compared to school play time, activity counts were lower by: 36% (CI = 25 to 45.5%, p<.001, ES = -1.29) after school; 50.1% (CI = 37 to 60.5%, p<.001, ES = -2.01) Saturday; 57.4% (CI = 46.3 to 66.3%, p<.001, ES = -2.47) Sunday. Mean results showed children spent 91-96% of their time engaged in light or sedentary activities. Even during school playtime, where children were most active, only eight out of eighty minutes were spent engaged in MVPA.

Conclusions: This study found activity levels were considerably lower than the recommended guidelines, and children were more active during school play time, compared to after school and weekends.

Objective: To establish cardiac MRI reference values for atrial adaptation to training in endurance athletes in comparison to matched non-athletes. Additionally, to study the relationship of atrial size to ventricular and annular size and valvular function. Design: Cross-sectional study. Participants: 180 healthy persons aged 18-39 years (41% women): 60 elite endurance athletes (exercising > 18 hours/week), 60 regular endurance athletes (9-18 hours/week), and 60 age and gender matched non-athletes (exercising ≤ 3 hours/week) underwent cardiac MRI. Quantitative atrial dimensions and volumes, indexed for body surface area, were compared to ventricular and annular dimensions. Regurgitant fractions of all four valves and peak velocities of mitral and tricuspid valves were also assessed. Results: Body surface area corrected right and left atrial volumes and diameters were significantly larger for athletes compared to non-athletes (P<0.05–<0.0005). Ventricular, annular, and atrial ratios remained constant for all groups suggesting balanced adaptation to exercise training. E/A ratios remained statistically unchanged in all groups. Regurgitant fractions of the four cardiac valves were all mild (≤ 15%) and not significantly different in athletes compared to non-athletes. Conclusions: Atrial remodelling in endurance athletes may be regarded as a balanced physiological adaptation to exercise training with preservation of valvular function.

Objective: To investigate the effect of all-out cycling test duration on indices of power, anaerobic lactic energy metabolism, perceived exertion and mood.

Methods: Nine physically active males undertook 4 all-out cycling tests of 5, 15, 30 or 45 s from seated stationary start on an ergometer fit with power cranks. Subjects completed a Profile of Mood States (POMs) questionnaire prior to each test and indicated perceived exertion immediately post-test (Borg 6-20 scale). Indices of anaerobic lactic metabolism were determined from blood lactate concentrations.

Results: Pacing strategy was apparent in the 45 s tests with lower peak (p<0.01) and mean power in the initial 10 s compared to the 5 and 15 s tests (p<0.05). The first 15 s of the 30 and 45 s tests revealed lower fatigue indexes compared to the 15 s tests (p<0.05) indicating some pacing in the 30 s tests. Perceived exertion increased with duration, with no difference between the 15 and 30 s tests (p>0.05). Extravascal lactate generation (reflecting exercising muscle lactate production) explained 59% of the variance in perceived exertion. There was no effect of knowledge of test duration on mood states or total mood disturbance (p>0.05).

Conclusions: An all-out pacing strategy was apparent for at least up to 15 s, with indicators of dampened power in both 30 and 45 s sprints. Reduced power at the start of all-out long duration sprints support a central control of at least initial pacing strategy.

This study tested the hypotheses that: 1) secondary criteria (RER, heart rate, blood lactate) traditionally used to verify the determination of VO_2max in children can result in the acceptance of a ‘sub-maximal’ VO_2max or falsely reject a ‘true’ VO_2max; and 2) the VO_2peak recorded during a ramp test in children is comparable to the VO_2peak achieved during supra-maximal testing. Thirteen children (9-10 y) completed a ramp cycle test to exhaustion to determine their VO_2peak. After 15 min recovery, the participants performed a supra-maximal cycle test to exhaustion at 105% of their ramp test peak power. Compared to the VO_2peak during the ramp test, a significantly lower VO₂ was recorded at an RER of 1.00 (1.293 L•min^-1 [SD 0.265] vs. 1.681 L•min^-1 [SD 0.295], P<0.001, n=12), and at a heart rate of 195 beats•min^-1 (1.556 L•min^-1 [SD 0.265] vs. 1.721 L•min^-1 [SD 0.318], P<0.001, n=10) and at 85% of age predicted maximum (1.345 L•min^-1 [SD 0.228] vs. 1.690 L•min^-1 [SD 0.284], P<0.001, n=13). Supra-maximal testing yielded a VO_2peak that was not significantly different from the ramp test (1.615 L•min^-1 [SD 0.307] vs. 1.690 L•min^-1 [SD 0.284], P=0.090, respectively). The use of secondary criteria to verify a maximal effort in young people during ramp cycling exercise may result in the acceptance of a ‘sub-maximal’ VO_2max. As supra-maximal testing elicits a VO_2peak similar to the ramp protocol, thus satisfying the plateau criterion, the use of such tests are recommended as the appropriate method of confirming a ‘true’ VO_2max with children.

Endurance exercise training produces multiple cardiac adaptations including changes in electrophysiological function that may make endurance trained athletes more vulnerable to atrial fibrillation (AF). This possible association is not recognized by many practicing cardiologists and sports physicians. Consequently, we performed a literature review to examine the relationship between atrial fibrillation and endurance exercise training among athletes. PubMed was searched from January 1960 through December 2008 to identify articles examining the relationship between endurance exercise training and AF.

Evidence suggests that athletes are at increased risk for development of AF. Possible factors increasing AF in this population include increased parasympathetic tone, reduced sympathetic tone, increased atrial size, and increased inflammation.

Suggested management of AF in athletes should follow similar principles to those used to manage AF in the general population.

Objective: To asses if three-dimensional imaging of the Achilles tendon by Ultrasonographic Tissue Characterisation (UTC) can differentiate between symptomatic and asymptomatic tendons.

Design: Case-control study.

Setting: Sports medical department of The Hague medical centre.

Patients: Twenty-six tendons from patients with chronic midportion Achilles tendinopathy were included. The "matched" control group consisted of 26 asymptomatic tendons.

Interventions: Symptomatic and asymptomatic tendons were scanned using the UTC-procedure. One researcher performed the ultrasonographic data-collection. These blinded data were randomised and outcome measures were determined by two independent observers.

Main outcome measurements: The raw ultrasonographic images were analysed with a custom-designed algorithm that quantifies the three-dimensional stability of echopatterns, qua intensity and distribution over contiguous transverse images. This three-dimensional stability was related to tendon structure in previous studies. UTC categorizes four different echo-types that represent: I) highly stable; II) medium stable; III) highly variable and IV) constantly low intensity and variable distribution. The percentages of echo-types were calculated and the maximum tendon-thickness was measured. Finally, the inter-observer reliability of UTC was determined.

Results: Symptomatic tendons showed less pixels in echo-types I and II than asymptomatic tendons (51.5% versus 76.6%, p<0.001), thus less three-dimensional stability of the echopattern. The mean maximum tendon thickness was 9.2 mm in the symptomatic group and 6.8 mm in the asymptomatic group (p<0.001). The Intra-class Correlation Coefficient (ICC) for the inter-observer reliability of determining the echo-types I+II was 0.95. The ICC for tendon thickness was 0.84.

Conclusion: UTC can quantitatively evaluate tendon structure and thereby discriminate symptomatic and asymptomatic tendons. As such UTC might be useful to monitor treatment protocols.

Objectives: To investigate the value for money of strategies to prevent falls in older adults living in the community.

Design: Systematic review of peer reviewed journal articles reporting an economic evaluation of a falls prevention intervention as part of a randomised controlled trial, a controlled trial, or using an analytic model. We searched MEDLINE, PUBMED, EMBASE, and NHS EED databases to identify cost effectiveness, cost utility, and cost benefit studies from 1945 through July 2008.

Setting: Not applicable.

Patients: Not applicable.

Intervention: Not applicable.

Main outcome measures: Our primary outcome measure was incremental cost-effectiveness, cost-utility and cost-benefit ratios in the reported currency and in pounds sterling at 2008 prices. We assessed the quality of the studies using two instruments: 1) an economic evaluation checklist developed by Drummond and colleagues and 2) the Quality of Health Economic Studies instrument.

Results: Nine studies meeting our inclusion criteria included eight cost-effectiveness analyses, one cost-utility and one cost-benefit analysis. Three effective falls prevention strategies were cost saving in a subgroup of participants: (i) an individually customised multifactorial programme in those with four or more of the eight targeted fall risk factors, (ii) the home based Otago Exercise Programme in people ≥80 years, and (iii) a home safety programme in the subgroup with a previous fall. These three findings were from six studies that scored ≥75% on the Quality of Health Economic Studies instrument.

Conclusions: Best value for money came from effective single factor interventions such as the Otago Exercise Programme which was cost saving in adults 80 years and older. This programme has broad applicability and therefore warrants health policy decision makers' close scrutiny.

Objective: To determine the level of awareness regarding nonsteroidal anti-inflammatory drugs (NSAIDs), and the prevalence and reasons for their consumption among athletes competing at the 2008 Brazil Ironman Triathlon (3,8-km swim, 180-km cycle, and 42,2-km run).

Design: Survey study.

Setting: 2008 Brazil Ironman Triathlon, Florianópolis, Brazil, May 2008.

Participants: Three hundred and twenty-seven of the 1250 athletes competing at the 2008 Brazil Ironman Triathlon were enrolled in the study.

Main outcome measures: Athletes answered a questionnaire about NSAID effects and consumption at the bike check out or awards lunch.

Results: One hundred ninety-six (59.9%) athletes reported using NSAIDs in the previous three months; of these, 25.5% (n=50), 17.9% (n=35) and 47.4% (n=93) consumed NSAIDs the day before, immediately before and during the race, respectively. Among NSAID users, 48.5% (n=95) consumed them without medical prescription. The main reason given for NSAID consumption in the previous three months was the treatment of injuries, while the main reason given for consuming NSAIDs during the race was pain prevention. Despite anti-inflammatory and analgesic effects, most athletes were unaware of the effects of NSAIDs, and the only adverse effects known by most athletes were the gastrointestinal complications.

Conclusions: This study found a high prevalence of NSAID consumption, limited awareness of the effects of them and a high rate of non-prescribed use. It is suggested that long distance triathlon events include in their programmes educational devices – like talks or folders – about NSAID use and effects.

Objective: There is lack of evidence to show the role of exercise intensity in the prevention of cancer mortality since no previous studies have shown this relation. Thus, we assessed the relationship of leisure-time physical activity with cancer mortality.

Methods: Participants were from a population-based sample of 2560 men from Eastern Finland with no history of cancer at baseline. Physical activity was assessed using the 12-Month Leisure-Time Physical Activity Questionnaire. During an average follow-up of 16.7 years, a total of 181 cancer related deaths occurred.

Results: An increase of 1.2 METs (one standard deviation in metabolic equivalents) in the mean intensity of leisure-time physical activity was related to a decrease (RR=0.85, 95 % CI 0.72 to 0.99) in cancer mortality mainly due to lung and gastrointestinal cancers, after adjustment for age, examination year, alcohol consumption, smoking, body mass index, and energy, fibre and fat intake. Men with leisure-time physical activity of more than 5.2 METs (highest quartile) had a lower (RR=0.63, 95 % CI 0.40 to 0.99) cancer mortality compared with men whose mean intensity of physical activity was less than 3.7 METs (lowest quartile). The mean intensity of physical activity was related to the risk of cancer death among men who exercised at least 30 minutes per day on average.

Conclusions: This prospective study indicates that the mean intensity of leisure-time physical activity is inversely associated with the risk of premature death from cancer in men.

Objective: To assess the independent and joint associations between self-reported physical activity (PA) and objectively measured cardiorespiratory fitness (CRF) from a maximal treadmill exercise test and the development of type 2 diabetes mellitus in a large cohort of men.

Methods: Participants for the current analysis were 23,444 men aged 20 to 85 years free of cardiovascular disease (CVD), cancer, or diabetes at baseline. Incident diabetes were identified from mail-back surveys. Cox regression analysis was used to estimate hazard ratios (HRs), 95% confidence intervals (CIs), and diabetes incidence rates (per 10,000 man-years) according to exposure categories.

Results: During an average 18 years of follow-up, 589 incident cases of diabetes were identified. After adjusting for age, examination year, survey response pattern, BMI, smoking, drinking, fasting glucose, chronic diseases, and family history of CVD or diabetes, the walking/jogging/running (WJR) and sport/fitness groups had a 40% and 28% lower risk of developing diabetes compared with the sedentary men, respectively (both P < 0.05). For CRF, diabetes incidence rates were 31.9, 14.5, and 6.5 for low, moderate, and high fitness groups, respectively. After adjustment for the above covariables, moderate and high CRF had a 38% and 63% lower risk of developing diabetes compared with low CRF group (P trend < 0.0001).

Conclusion: Our findings showed lower risk of developing diabetes for men who participated in a WJR program or sport/fitness activity, compared to those who were sedentary. Higher levels of fitness were associated with an inverse gradient of incident diabetes.

Statistical analysis of professional football (soccer) is leading to the conclusion that the team medical staff may be substantially undervalued in the market. Statistically, a player's value is a product of his 'skill' and 'durability' (percentage of games he is available to play). The team medical staff is probably more relevant to the second factor than is realised.

Objective: Quality of reporting in congress abstracts is likely to influence clinical decision making.

Hypothesis: The quality of reporting in sports injury prevention abstracts has increased over the last three years as did the amount of randomised-controlled trialsrandomized controlled trials (RCT).

Methods: 154 abstracts from the 2005 and 186 abstracts from 2008 World Conferences on Sports Injury Prevention in Norway were analysed.

Main outcome measures: Scores of 17 CONSORT criteria for RCT, or 22 STROBE criteria for observational studies were determined.

Results: Improvement in reporting was evident in RCT (CONSORT score 5.8±0.9 vs. 8.6±2.9, p=0.001, CI -4.29 to -1.43) as well as for observational studies (STROBE score 7.9±1.6 vs. 9.9±1.7, p<0.001, CI -2.34 to -1.53) between 2005 and 2008. RCTs were published in 9.1% in 2005 vs. 10.2% in 2008 (p=0.727). RCT demonstrated a significant improvement in main outcome (0% vs. 57.9%, p <0.001). For observational studies significant improvement was reported in rationale (53.5% vs. 98.2% p<0.001), objectives (82.2% vs. 95.1% p=0.012), study design (25.2% vs. 65% p<0.001), setting (43.7% vs. 65.6% p=0.002), variables (20.7% vs. 74.2% p<0.001), participants (0.7% vs. 10.4%, p=0.001), and funding (0% vs. 5.5% p=0.006).

Conclusion: While the percentage of published RCTs in abstracts at the World Congress of Sports Injury Prevention remained unchanged, improvement in reporting of abstracts was evident from 2005 to 2008 determined by CONSORT/STROBE criteria. However, substantial and comprehensive use of the CONSORT and STROBE criteria might further increase the quality of reporting of sports injury conference abstracts in the future and should be endorsed.

Objective: To prospectively determine gait-related risk factors for lower leg overuse injury (LLOI).

Design: A prospective cohort study.

Setting: Male and female recruits from a start-to-run (STR) program during a 10-week training period.

Participants: One hundred thirty one healthy subjects (20 men and 111 women), without a history of any lower-leg complaint, participated in the study.

Interventions: Before the start of the 10-week STR program, plantar force measurements during running were performed. During STR, lower leg injuries were diagnosed and registered by a sports physician.

Main outcome measurements: Plantar force measurements during running were performed using a footscan pressure plate (RsScan International).

Results: During the STR, 27 subjects (5 male and 22 female) developed a LLOI. Logistic regression analysis revealed that subjects who developed a LLOI had a significantly more laterally directed force distribution at first metatarsal contact and forefoot flat, a more laterally directed force displacement in the forefoot contact phase, foot flat phase and at heel-off. These subjects also had a delayed change of the center of force (COF) at forefoot flat, a higher force and loading underneath the lateral border of the foot, and a significantly higher directed force displacement of the COF at forefoot flat.

Conclusions: These findings suggest that a less pronated heel strike and a more laterally directed roll-off can be considered as risk factors for LLOI. Clinically, the results of this study can be considered important in identifying persons at risk for LLOI.

Objective: The purpose of this study was to determine the reliability and predictive value of performance parameters measured by a new novel submaximal cycle protocol, on peak power and endurance cycling performance in well-trained cyclists.

Methods: Seventeen well-trained competitive male road racing cyclists completed four peak power output tests (PPO) and four 40-km time trials (40-km TT). Before each test all cyclists performed a novel submaximal cycle test (LSCT). Parameters associated with performance such as power, speed, cadence and rate of perceived exertion (RPE) were measured during the 3 stages of the test when cyclists rode at workloads coinciding with fixed predetermined heart rates. Heart rate recovery (HRR) was measured after the last stage of the test.

Results: Parameters measured during the second and third stage of the LSCT were highly reliable (Intraclass correlation range: R=0.85–1.00) with low typical error of measurements (TEM-range: 1.3–4.4%). Good relationships were found between the LSCT and cycling performance measured by the PPO and 40-km TT tests. Mean power had stronger relationships with measures of cycling performance during the second (r = 0.80-0.89) and third stage (r = 0.91-0.94) of the LSCT than HRR (r = 0.55-0.68).

Conclusions: The LSCT is a reliable novel test which is able to predict peak and endurance cycling performance from submaximal power, RPE and HRR in well-trained cyclists. As these parameters are able to detect meaningful changes more accurately than VO2max, the LSCT has the potential to monitor cycling performance with more precision than other current existing submaximal cycle protocols.

Objective: To investigate whether a six-month neuromuscular warm-up programme could improve muscle power, balance, speed, and agility.

Design: Cluster randomised controlled study.

Setting: 27 top level female floorball teams in Finland.

Participants: 222 players (mean age 24 years) – 119 in the intervention group and 103 in the control group were followed up for one league season (six months).

Intervention: A neuromuscular warm-up programme included sports specific running technique, balance, jumping, and strengthening exercises. The teams were advised to use the programme 1-3 times per week through the league season. One training session took approximately 25 minutes.

Main outcome measures: Performance tests were assessed before and after the six-month intervention including static jump, countermovement jump, jumping over a bar, standing on a bar, and figure-of-eight running.

Results: At six months, we found statistically significant between-groups differences in two outcome parameters: jumping over a bar (number of jumps in 15 sec), and standing on a bar (number of balance losses in 60 sec). Mean between-groups difference in the former was 2.3 jumps (95% CI 0.8 to 3.8, p=0.003) favouring the intervention group, and in the latter -0.4 balance losses (95% CI -0.8 to 0.0, p=0.050), again in the favour of the intervention group.

Conclusion: A neuromuscular warm-up programme improved the floorball players’ sideways jumping speed and static balance. The exercises were also safe to perform and can thus be recommended for weekly training of floorball players.

Trial registration: The International Standard Randomised Controlled Trial Register, the registration number ISRCTN26550281.

Objectives: To assess how much competitive sport contributes to sudden cardiac death (SCD) in young athletes and the impact on population health if this group were to be screened in the UK.

Methods: Using reported and imputed incidence rates of SCD in athletes and non-athletes and false negative and false positive test rates reported in three key Italian screening studies, we calculate: the population and attributable risk fractions of SCD in young athletes and the total population (athletes and non-athletes) aged 12-35 before and after screening; the number of athletes needed to screen to prevent one SCD (NNS); and the sensitivity and specificity of screening with ECG. Using these parameters we developed a decision-tree model based on the UK population age 12-35 to estimate the annual number of SCDs, the expected number of screening and diagnostic tests, the number of athletes disqualified from competitive sport per SCD prevented.

Results: Participation in competitive athletics contributes to 81.9% (62.4–91.6%) of SCD in athletes, but only 26.6% (-20.3–55.8%) in the total population. After screening, the contribution in the total population falls to 7.2% (-10.7–22.4%). The NNS is 38,151 (20,534–267,380). A UK screening programme would result in 1,520,021 young athletes being screened, with 140,361 referred for diagnosis. Of an expected 196 SCDs per year, 40 (6–74) would be prevented. For every life saved, 791 athletes would be disqualified.

Conclusions: The impact of screening on reducing SCD in young athletes is only modest, and would be achieved with significant harms to population health.

Objective: A decreased range of motion of the hip joint is known to predispose to athletic groin injury. Femoroacetabular impingement (FAI) of the hip leads to a reduced range of motion (ROM). This study examined the prevalence of radiological signs of FAI in patients presenting with long-standing adductor related groin pain (LSARGP).

Design: Prospective case series.

Setting: Outpatient sports medicine department.

Patients: 34 athletes with LSARGP defined as; pain on palpation of the proximal insertion of adductor muscle and a painful resisted adduction test.

Assessment: A clinician blinded to the results of the radiological assessment performed a physical examination: iliopsoas length, hip ROM and anterior hip impingement test.

Antero-posterior pelvic radiographs were examined by a second blinded clinician for the presence of: pistol grip deformity, centrum-collum-diaphyseal angle, femoral head neck ratio, coxa profunda, protrusio acetabuli, lateral centre edge angle, acetabular index and cross over sign.

Results: The prevalence of radiological signs of FAI was 94% (64/68). The mean number of radiological signs in hips with LSARGP was 1.84 (range 0-4, SD 1.05) and 1.96 (range 0-5, SD1.12) in asymptomatic groins (P = 0.95).

The anterior hip impingement test was positive in nine cases. There was no relationship with the number of radiological signs (p=0.95). There was no correlation between hip ROM and the number of radiological signs (p=0.37).

Conclusion: Radiological signs of FAI are frequently observed in patients presenting with LSARGP. Clinicians should be aware of this fact and the possible lack of correlation when assessing athletes with groin pain.

Objective: To investigate the risk between throwing workload and upper limb injury in elite cricketers.

Design: Prospective cohort study.

Setting: Elite Australian cricket.

Participants: Twenty-eight male adult cricketers, aged 18 – 32 years.

Assessment of risk factors: Daily throwing workload and injury were prospectively monitored over the 2007-8 cricket season. Risk ratios were calculated to describe the association between throwing workload and injury.

Main outcome measurement: Upper limb injury associated with throwing.

Results: Seven (25%) players sustained an injury during the season. Injured players threw approximately 40 more throws per week (p=0.004) and 12.5 more throws per throwing day (p=0.061) than uninjured players. Players were at significantly increased risk of injury if they completed more than 75 throws per week (RR = 1.73, 95%CI = 1.03, 2.92) and there was a trend towards increased risk if they completed more than 40 throws per throwing day (RR = 1.41, 95%CI = 0.88, 2.26). Injured players also completed more throws and had more throwing days (and consequently less rest days) in the week prior to injury, as compared with the rest of their season preceding that point.

Conclusion: An increased throwing workload is a risk factor for the development of upper limb injury in elite cricketers. Investigation of the kinematics of throwing in elite cricketers would complement this study and further research is required to develop detailed throwing workload guidelines for cricketers across a range of ages.

Background: Exercise-associated hyponatraemia (EAH) is a potentially fatal cause of collapse in endurance exercise. It is understood to be a dilutional hyponatraemia caused by an increase of total body water relative to the amount of exchangeable sodium stores. Fourteen runners presented to one London hospital with symptomatic EAH several hours after finishing the 2003 London Marathon and more recently, a young male runner died from the complications of severe EAH after crossing the finish line of the London Marathon.

Objectives: To determine the incidence of EAH in runners in the London Marathon.

Method: Volunteers were recruited at race registration where they were weighed, had blood tests and completed a demographic and experience questionnaire. Weights, blood tests and a fluid intake questionnaire were repeated after the finish. Blood was analysed on-site using hand-held i-STAT blood analysers.

Results: Of the 88 volunteers, 11 (12.5%) developed asymptomatic hyponatraemia (serum sodium 128-134mmol/l). They consumed more fluid (p<0.001) and gained more weight (p<0.001) than did those without hyponatraemia.

Conclusion: A significant proportion (12.5%) of healthy volunteers developed asymptomatic hyponatraemia running a marathon in cool conditions. On average, these runners consumed more fluid and gained more weight than did non-hyponatraemic runners although fluid intake was not related to weight gain in this study. Four of the eleven hyponatraemic runners lost weight over the course of the marathon, strengthening the case for an additional factor, such as inappropriate anti-diuretic hormone release during exercise, in the development of EAH.

Alzheimer’s disease (AD) is the most common neurological disorder associated with ageing, and has a global prevalence of 6% in people over the age of 65.1 It is also the most common cause of dementia, accounting for 50-60% of all cases.2 The increase in life expectancy of the world population is expected to translate into many more cases of dementia – it is estimated that 1 in 85 persons worldwide will be affected by AD in 2050.3 Clearly Alzheimer’s disease is a major public health problem.

Background: Topical glyceryl trinitrate treatment has previously demonstrated short-term efficacy in the treatment of lateral epicondylosis. No long term follow up has been performed.

Hypothesis: Benefits from topical gylceryl trinitrate persist five years after cessation of therapy.

Study design: Prospective comparative study.

Methods: A follow up study of 58 patients treated with 6 months of topical glyceryl trinitrate or placebo, combined with a tendon rehabilitation program, was performed 5 years after discontinuation of therapy. Assessment included patient rated pain scores, clinically assessed lateral epicondylar and proximal common extensor tendon tenderness, hand-held dynamometer measurement of resisted 3rd finger metacarpophalangeal extension with a fully extended elbow (Maudsley’s test) and wrist extensor tendon mean peak force using a modified chair pick-up test (ORI-TETS).

Results: Patients in both the glyceryl trinitrate group and those in the placebo group had significant improvements in symptoms, clinical signs and provocative functional tests compared with baseline week 0 measures. Glyceryl trinitrate did not offer any additional clinical benefit over a standard tendon rehabilitation program at five years.

Conclusion: While glyceryl trinitrate appears to offer short term benefits up to 6 months in the treatment of lateral epicondylosis, at five years there does not appear to be significant clinical benefits when compared with patients undertaking a standard tendon rehabilitation program alone. This is in contrast to findings of continued benefits at long term follow up described in the literature for patients with Achilles tendinopathy treated with glyceryl trinitrate.

Background: Voluntary lumbo-pelvic control is compromised in patients with back pain. Loss of proprioceptive acuity is one contributor to decreased control. Several reasons for decreased proprioceptive acuity have been proposed, but the integrity of cortical body maps has been overlooked. We investigated whether tactile acuity, a clear clinical signature of primary sensory cortex organisation, relates to lumbopelvic control in people with back pain.

Methods: Forty-five patients with back pain and 45 age and gender matched healthy controls participated in this cross sectional study. Tactile acuity at the back was assessed using two-point discrimination (TPD) threshold in vertical and horizontal directions. Voluntary motor control was assessed using an established battery of clinical tests.

Results: Patients performed worse on the voluntary lumbopelvic tasks than healthy controls did (p<0.001). TPD threshold was larger in patients (mean ± SD = 61mm ± 13mm) than in healthy controls (44mm ± 10mm). Moreover, larger TPD threshold was positively related to worse performance on the voluntary lumbopelvic tasks (Pearsons r= 0.49; p<0.001).

Discussion: Tactile acuity, a clear clinical signature of primary sensory cortex organisation, relates to voluntary lumbopelvic control. This relationship raises the possibility that the former contributes to the latter, in which case training tactile acuity may aid recovery and assist in achieving normal motor performance after back injury.

We compared allele and genotype frequencies of the ADRB1 Arg389Gly [rs1801253], ADRB2 Gly16Arg [rs1042713] and Gln27Glu [rs1042714], and ADRB3 Trp64Arg [rs4994] variations in the following three groups of Spanish (Caucasian) men: (i) world-class endurance athletes (E; runners and cyclists, N=100), (ii) elite power athletes (P; sprinters, jumpers and throwers, N=53) and (iii) non-athletic controls (C; N=100). We did not observe significant differences in genotype and allele distributions among the study groups except for the ADRB3 Trp64Arg polymorphism in E vs C (27% vs 8% of carriers of the Arg allele in E and C, P<0.001; frequency of the minor Arg (C) allele of 14% vs 4% in E and C, P=0.001). Heterozigosity for the ADRB3 Trp64Arg polymorphism seems to be associated with elite endurance performance, while other variants of the ß-adrenergic receptors’ genes do not seem to influence top-level sports performance significantly, at least in athletes of Spanish origin.

Objective: To study the injury characteristics in professional football and to follow the variation of injury incidence during a match, during a season and over consecutive seasons.

Design: Prospective cohort study where teams were followed for seven consecutive seasons. Team medical staff recorded individual player exposure and time-loss injuries from 2001 to 2008.

Setting: European professional men’s football.

Participants: The first team squads of 23 teams selected by UEFA as belonging to the 50 best European teams.

Main outcome measurement: Injury incidence.

Results: 4,483 injuries occurred during 566,000 hours of exposure, giving an injury incidence of 8.0 injuries/1,000 hours. The injury incidence during matches was higher than in training (27.5 v 4.1, p<0.0001). A player sustained on average 2.0 injuries per season and a team with typically 25 players can thus expect about 50 injuries each season. The single most common injury subtype was thigh strain, representing 17% of all injuries. Re-injuries constituted 12% of all injuries and they caused longer absences than non re-injuries (24 v 18 days, p<0.0001). The incidence of match injuries showed an increasing injury tendency over time in both the first and second halves (p<0.0001). Traumatic injuries and hamstring strains were more frequent during the competitive season, while overuse injuries were common during the pre-season. Training and match injury incidences were stable over the period with no significant differences between seasons.

Conclusions: The training and match injury incidences were stable over seven seasons. The risk of injury increased with time in each half of matches.

Acute and chronic (overuse) musculoskeletal soft tissues injuries are common as a result of sports and occupational related physical activities. These injuries have no single cause -- instead, they result from a complex interaction of intrinsic and extrinsic factors which include genetic factors. Specific genetic elements have been identified for certain soft tissue injuries and I will summarise those in this editorial. I also explore the possible clinical implications of including genetic risk factors in multifactorial models developed to understand the molecular mechanisms of musculoskeletal soft tissue injuries.

Objectives: In this study, the objective was to evaluate the validity and reliability of the Turkish version of the Victorian Institute of Sports Assessment – Achilles (VISA-A) questionnaire for patients with Achilles tendnopathy.

Design: Fifty-five patients with a diagnosis of Achilles tendinopathy and fifty five healthy subjects were included in the study. VISA-A questionnaire were translated and culturally adapted into Turkish language. The final Turkish version, the VISA-A Turkish version (VISA-A-Tr) was tested for reliability on healthy individuals and patients. Tests for internal consistency, validity and structure were performed on 55 patients.

Results: The VISA-A-Tr showed good test-retest reliability (Pearson's r = 0.99, p<0.001). There was no statistically significant difference between the scores of the first, second and third tests in both healthy individuals and patients.

The patients with Achilles tendinopathy had a significantly lower score (p < 0.001) compared with the healthy individuals. The mean VISA-A-Tr score was 52.9±13.6 (range 24–72) for the patients and 97.1±1.5 (range 95–100) for the healthy individuals.

The internal consistency of the scale (Cronbach’s alpha coefficient) was 0.66. The VISA-A-Tr score correlated significantly with another tendon grading system (Spearman's r = -0.86; p < 0.001). There was a significant correlation with the physical domain of the quality of life assessment tool (WHOQOL-BREF) (Spearman's r= +0.37; p < 0.01).

Conclusion: The Turkish version of the VISA-A is a valid and reliable tool for evaluating the severity of the Achilles tendinopathy.

Background and objectives: The determination of the carbon isotope ratio in androgen metabolites has been previously shown to be a reliable, direct method to detect testosterone misuse in the context of antidoping testing. Here, we examine the variability in the 13C/12C ratios in urinary steroids in a widely heterogeneous cohort of professional soccer players residing in different countries (Argentina, Italy, Japan, South-Africa, Switzerland and Uganda).

Method: Carbon isotope ratios of selected androgens in urine specimens were determined using gas chromatography/combustion/isotope ratio mass spectrometry (GC-C-IRMS).

Results: Urinary steroids in Italian and Swiss populations were found to be enriched in 13C relative to other groups, reflecting higher consumption of C3 plants in these two countries. Importantly, detection criteria based on the difference in the carbon isotope ratio of androsterone and pregnanediol for each population were found to be well below the established threshold value for positive cases.

Conclusion: The results obtained with the tested diet groups highlight the importance of adapting the criteria if one wishes to increase the sensitivity of exogenous testosterone detection. In addition, confirmatory tests might be rendered more efficient by combining isotope ratio mass spectrometry with refined interpretation criteria for positivity and subject-based profiling of steroids.

Objective: To determine the effects of stretching before and after physical activity on risks of injury and soreness in a community population.

Design: Internet-based pragmatic randomised trial conducted between January 2008 and January 2009.

Setting: International.

Participants: 2,377 adults who regularly participated in physical activity.

Interventions: Participants in the stretch group were asked to perform 30-second static stretches of 7 lower limb and trunk muscle groups before and after physical activity for 12 weeks. Participants in the control group were asked not to stretch.

Main outcome measurements: Participants provided weekly on-line reports of outcomes over 12 weeks. Primary outcomes were any injury to the lower limb or back, and bothersome soreness of the legs, buttocks or back. Injury to muscles, ligaments and tendons was a secondary outcome.

Results: Stretching did not produce clinically important or statistically significant reductions in all-injury risk (HR = 0.97, 95% CI 0.84 to 1.13), but did reduce the risk of experiencing bothersome soreness (mean risk of bothersome soreness in a week was 24.6% in the stretch group and 32.3% in the control group; OR = 0.69, 95% CI 0.59 to 0.82). Stretching reduced the risk of injuries to muscles, ligaments and tendons (incidence rate of 0.66 injuries per person-year in the stretch group and 0.88 injuries per person-year in the control group; HR = 0.75, 95% CI 0.59 to 0.96).

Conclusion: Stretching before and after physical activity does not appreciably reduce all-injury risk, but probably reduces the risk of some injuries, and does reduce the risk of bothersome soreness.

Trial registration: anzctr.org.au 12608000044325.

Objective: To assess the accuracy of a pedometer (manufactured by Silva) currently being used as part of a national programme to promote physical activity in the UK.

Methods: Laboratory study: 68 participants (age 19.2±2.7 years, BMI 22.5±3.3 kg/m²) wore 2 Silva pedometers (over the right and left hips) whilst walking on a motorised treadmill at 2, 2.5, 3, 3.5 and 4mph. Pedometer step counts were compared with actual steps counted. Free-living study: 134 participants (age 36.4±18.1 years, BMI 26.3±5.1 kg/m²) wore one Silva pedometer, one New-Lifestyles NL-1000 pedometer and an ActiGraph GT1M accelerometer (the criterion) during waking hours for one day. Step counts registered by the Silva and NL-1000 pedometers were compared to ActiGraph step counts. Percent error of the pedometers were compared across normal-weight (n=58), overweight (n=45) and obese (n=31) participants.

Results: Laboratory study: Across the speeds tested percent error in steps ranged from 6.7 (4mph) – 46.9% (2mph). Free-living study: Overall percent errors of the Silva and NL-1000 pedometers relative to the criterion were 36.3% and 9% respectively. Significant differences in percent error of the Silva pedometer were observed across BMI groups (normal-weight 21%, overweight 40.2%, obese 59.2%, P<0.001).

Conclusion: The findings suggest the Silva pedometer is unacceptably inaccurate for activity promotion purposes particularly in overweight and obese adults. Pedometers are an excellent tool for activity promotion however the use of inexpensive, untested pedometers is not recommended as they will lead to user frustration, low intervention compliance, and adverse reaction to the instrument, potentially impacting future public health campaigns.

Objective: There is a need for a measure of physical activity that assesses low, basic and high-intensity activities suitable for use in ageing research including falls prevention trials. We aimed to perform a formal validation of the Incidental and Planned Activity Questionnaire (IPAQ) by investigating its overall structure and measurement properties.

Design: Cross-sectional survey.

Setting: Community sample.

Participants: 500 older people (mean age: 77.4 years, SD: 6.08).

Main outcome measures: The IPAQ was administered as part of a longer assessment in two different postal self-completion formats; one for estimating physical activity during the last week (IPAQ-W) and one for estimating average weekly physical activity over the past three months (IPAQ-WA). Test–retest reliability was assessed by re-administration of the instruments one week later in a sub-sample of 80 respondents.

Results: Both IPAQ versions had good measurement properties, but overall the IPAQ-WA performed better than the IPAQ-W. Rasch analyses indicated the IPAQ-WA had an excellent overall fit. Analysis of the internal structure supported the unidimensionality of the scale with an acceptable internal consistency. The content representation of the items revealed three categories (low, moderate and high levels of physical activity), with a good contribution of items by threshold. The IPAQ-WA had excellent test–retest reliability, ICC=0.87) and was able to discriminate differences in physical activity levels between groups differentiated by sex, age, and fall risk factors.

Conclusions: the IPAQ has excellent psychometric properties and assesses the level of physical activity relating to both basic and more demanding activities. Further research is required to confirm sensitivity to change.

Objectives: Although motor control exercises have been shown to be effective in the management of low back pain (LBP) the mechanism of action is unclear. The current study investigated the relationship between ability to recruit transversus abdominis and clinical outcomes of participants in a clinical trial.

Methods: Ultrasonography was used to assess the ability to recruit transversus abdominis in a nested design: a sample of 34 participants with chronic low back pain was recruited from participants in a randomised controlled trial comparing efficacy of motor control exercise, general exercise and spinal manipulative therapy. Perceived recovery, function, disability and pain were also assessed.

Results: Participants with chronic LBP receiving motor control exercise had greater improvement in recruitment of transversus abdominis (7.8%) than participants receiving general exercise (4.9% reduction) or spinal manipulative therapy (3.7% reduction). The effect of motor control exercise on pain reduction was greater in participants who had a poor ability to recruit transversus abdominis at baseline. There was a significant, moderate correlation between improved recruitment of transversus abdominis and reduction in disability (r= -0.35; 95%CI 0.02 to 0.62).

Conclusion: These data provide some support for the hypothesised mechanism of action of motor control exercise and suggest that the treatment may be more effective in those with a poor ability to recruit transversus abdominis.

Objective: 1) To determine, using magnetic resonance imaging (MRI), the cross sectional area (CSA) of the psoas major (PM) muscle across multiple vertebral levels, 2) to examine any asymmetry of the PM muscle and investigate the consistency across vertebral levels, and 3) to determine whether a relationship exists between low back pain (LBP) and size or asymmetry of the PM muscle among elite Australian Rules football (AFL) players.

Design: Observational cross-sectional study.

Setting: Assessments and MRI examinations were carried out in a hospital setting.

Participants: Thirty-one male elite AFL players aged between 20 and 32 years of age participated in the study.

Risk factors: The independent factors in the study were asymmetry (coded as ipsilateral or contralateral to kicking leg) and group (current LBP versus no current LBP).

Main outcome measurements: The dependent variable in the study was the CSA of the PM muscle.

Results: The PM muscle was larger on the side of the dominant kicking leg at all four vertebral levels measured (F=7.28, P=0.012). Participants who reported current LBP had larger PM muscles than the remainder of the players (F=4.63, P=0.041).

Conclusion: Additional investigation into the underlying mechanisms of the observed differences in PM muscle size could help to develop treatment and rehabilitation programs aimed at reducing the incidence of LBP among AFL players. Furthermore, asymmetry of the PM muscle was observed at multiple vertebral levels and therefore future studies may only need to take single level measurements to assess for asymmetry.

A code of ethics for sports physicians needs to be clear, appropriate and practically useful to clinicians in everyday circumstances and those that may be difficult or contentious. For a code of ethics to be so apposite requires that it be based on the actual ethical concerns of this group. This article uses the recent experience of rewriting the code of ethics for the Australasian College of Sports Physicians, describing the process and challenges that arose, and providing suggestions for other code writers in this field.

The objective was to show the superiority of Comfrey root extract ointment (Kytta-Salbe® f; Merck Selbstmedikation GmbH) to placebo ointment in patients with acute upper or low back pain. The study was conducted as a double-blind, multi-centre, randomised clinical trial with parallel group design over a period of 5 ± 1 days. The patients (n = 120, mean age 36.9 years) were treated with verum or placebo ointment three times a day, 4 g ointment per application. The trial included four visits.

The primary efficacy variable was the area-under-the-curve (AUC) of the Visual Analogue Scale (VAS) on active standardised movement values at visits 1 to 4. The secondary efficacy variables were back pain at rest using assessment by patient on VAS, pressure algometry (pain-time curve; AUC over 5 days), global assessment of efficacy by the patient and the investigator, consumption of analgesic medication, and functional impairment measured with the Oswestry Disability Index.

There was a significant treatment difference between Comfrey extract and placebo regarding the primary variable. In the course of the trial the pain intensity on active standardised movement decreased on average (medians) about 95.2 % in the verum group and 37.8 % in the placebo group. The results of this clinical trial were clear-cut and consistent across all primary and secondary efficacy variables. Comfrey root extract showed a remarkably potent and clical relevant effect in reducing acute back pain. For the first time, also a fast acting effect of the ointment (1 hour) has been witnessed.

Home advantage in the summer Olympic Games is well known. What is not so well known is that countries that host the Olympic Games perform better in the games prior to, and following the games where they were hosts.

Objective: To model/quantify the significance associated with these ‘hosting’ effects and to explain the likely causes of Great Britain’s improved medals haul in Beijing, while looking at implications for London 2012 and beyond.

Results: Using all hosting cities/countries since the Second World War and analysing the number of medals awarded to competitors as a binomial proportion (p) response variable within a logit model, we identified a significant increase in the probability/odds of a country obtaining a medal in the Olympic games prior to, during and after hosting the Olympics.

Conclusions: Funding appears to be an important factor when explaining these findings. Almost all countries that have been awarded the games post World War 2, would appear to have invested heavily in sport prior to being awarded the games. A second factor in Great Britain’s success is the legacy of hosting the Commonwealth Games in 2002 (a post-hosting games effect) that undoubtedly provided an infrastructure that benefited, in particular, cycling. Whether the IOC either consciously or subconsciously take these factors into account is unclear when awarding the games to a city. What is clear is that based on these findings, Great Britain’s prospects of maintaining the Olympic success achieved in Beijing is likely to continue to London 2012 and beyond.

Objective: To test whether there is an association of social class (im)mobility in childhood and adulthood with absolute rates of adult participation in sport and exercise.

Design: Secondary analysis of the 2003 Scottish Health Survey.

Participants: 2770 Scottish men and women aged 35 to 54.

Results: The highest age adjusted rate of sport and exercise was seen amongst those who were in the highest social class in both childhood and adulthood (62.8%) while those in the lowest social class at both stages had the lowest rate at 25.8%, 37% points lower. This gap was wider than if the assessment of participation had been based solely on childhood or adult social class. The upwardly mobile had a higher rate than their class of origin in childhood but a lower rate than their class of destination in adulthood. The downwardly mobile had a lower rate than their class of origin but a higher rate than their class of destination.

Conclusion: There are major absolute differences in participation in sport and exercise associated with social class (im)mobility that will be important to understand in order to improve population health and to reduce health inequalities.

Background: Anterior cruciate ligament (ACL) ruptures are among the most severe musculoskeletal soft tissue injuries. However, the exact mechanisms which cause these acute injuries are unknown. Recently, sequence variants within two genes, namely COL1A1 and COL5A1, which code for the 1 chains of types I and V collagen respectively, were shown to be associated with ACL ruptures. Type XII collagen, similarly to types I and V collagen, is a structural component of the ligament fibril and is encoded by a single gene, COL12A1.

Objective: The aim of this study was to investigate whether sequence variants within COL12A1 are associated with ACL ruptures.

Methods: One hundred and twenty nine (38 female) participants with clinically and surgically diagnosed ACL ruptures, as well as 216 (83 female) physically active controls subjects (CON) without any history of ACL injury were included in this case-control genetic association study. All participants were genotyped for the AluI and BsrI restriction fragment length polymorphisms (RFLPs) within COL12A1.

Results: The AA genotype of the COL12A1 AluI RFLP was significantly over-represented in the female (OR=2.4, 95% CI 1.0 - 5.5, p=0.048), but not male (p=0.359) ACL participants. There were no genotype differences between the ACL and CON group for the BsrI RFLP.

Conclusion: The COL12A1 AluI RFLP is associated with ACL ruptures in females. The results suggest that females with an AA genotype are at increased risk of ACL ruptures. These initial genetic-association studies should be explored further and, if repeated, incorporated into multifactorial models developed to identify predisposed individuals.

Emerging evidence supports a link between neighborhood built environment and physical activity. Systematic methodologies for characterizing neighborhood built environment are needed that take advantage of available population information such as Census-level demographics. Based on transportation and urban planning literatures, an integrated index for operationalizing walkability using parcel-level information is proposed. Validity of the walkability index is examined through travel surveys among areas examined in the Neighborhood Quality of Life Study, a study investigating built environment correlates of adults’ physical activity.

Iit is a great time to be involved in British sport following the remarkable performances of Team GB in the recent Beijing Olympic Games. You do not need to be reminded, although the rest of world must be, that in the 1996 Atlanta Olympics, United Kingdom athletes, not yet Team GB, garnered just one medal. To progress in 12 years to the current situation in which your Olympic athletes won more than 40 medals is an achievement equalled perhaps only by Australia and East Germany in the recent past. Indeed the evidence I observe and the mood I have encountered suggests that the world has yet to see the peak of this British Olympic success; that Team GB has the capacity to improve yet further. In the years to come it will become apparent that however remarkable was your team’s performance in the Beijing Olympics, it was relatively pedestrian compared to what lies ahead at your London Olympic Games and beyond.

Objectives: This study determined the effects of temporal changes in unanticipated pre-landing stimuli on lower limb biomechanics and the impact of sex and limb dominance on these variables during single leg landings. We hypothesized that reductions in the time of pre-landing unanticipated stimuli, female sex, and the non-dominant limb would significantly increase high-risk landing biomechanics during unanticipated jump landings.

Methods: Twenty-six subjects (13 male and 13 female) had initial contact (IC) and peak stance (0% - 50%) phase (PS) lower limb joint kinematics and kinetics quantified during anticipated (AN) and unanticipated (UN) single leg (left and right) landings. Post landing jump direction was governed via one of two randomly ordered light stimuli, presented either prior to initiation of the jump (AN), or 600 ms (UN1), 500 ms (UN2) or 400 ms (UN3) immediately prior to ground contact.

Results: Statistically significant (p < 0.05) differences in IC hip posture and PS hip and knee internal rotation moments occurred in unanticipated compared to anticipated landings. Differences were not observed, however, among unanticipated conditions for any biomechanical comparisons. Significant (p < 0.05) differences in specific IC and PS hip and knee postures and loads occurred between sexes and limbs. Neither of these factors, however, influenced movement condition effects.

Conclusion: Unanticipated landings induce modifications in landing biomechanics that may increase ACL injury risk in both men and women. These modifications, however, do not appear overly sensitive to the timing of the unanticipated stimulus, at least within a temporal range affording a successful movement response. Expanding unanticipated training to include even shorter stimulus-response times may promote the additional central control adaptations necessary to maneuver safely within the random sports setting.

Objective: To investigate how experience and feedback influence pacing and performance during time trial cycling.

Design: Twenty-nine cyclists performed three 20 km cycling time trials using a Computrainer. The first two time trials (TT1 & TT2) were performed either i) without any performance feedback (n=10), ii) with accurate performance feedback (n=10) or, iii) with false feedback showing speed to be 5% greater than actual speed (n=9). All participants received full feedback during the third time trial (TT3) and their performance and pacing data was compared against TT2.

Results: Completion time, average power and average speed did not change among the false feedback group but their pacing strategy did change as indicated by a lower average cadence, 89.2(5.2) vs. 96.4(6.8) rpm, p<0.05, and higher power during the first 5 km (SMD=39, 36, 36, 27 and 27 W for 1–5 km respectively). Pacing changed among the blind feedback group indicated by a faster completion time, 35.9(3.1) vs. 36.8(4.4) min, p<0.05, and power increases during the final 5 km (SMD=14, 13, 18, 23 & 53 W for 16-20 km respectively). No performance or pacing changes were observed among the accurate feedback group.

Conclusions: Pacing is influenced by and interaction between feedback and previous experience. Conscious cognitive processes that lead to RPE and pacing appear to be influenced by previous experience.

The objective of this systematic review was to comprehensively study the criterion-related validity of the existing field-based fitness tests used in children and adolescents. The studies were scored according to the number of subjects, description of the study population and statistical analysis. Each study was classified as high, low and very low quality. Three levels of evidence were constructed: Strong evidence, when consistent findings were observed in ≥3 high-quality studies; moderate evidence, when consistent findings were observed in 2 high-quality studies; and limited evidence when consistency of findings and/or the number of studies did not achieve the criteria for moderate. The results of 73 studies (50 of high-quality) addressing the criterion-related validity of field-based fitness tests in children and adolescents indicate that: There is strong evidence indicating that the 20m shuttle run test is a valid test to estimate cardiorespiratory fitness; handgrip strength test is a valid measure of musculoskeletal fitness; skinfold thickness and body mass index are good estimates of body composition, and waist circumference is a valid measure to estimate central body fat. We found moderate evidence that the 1-mile run/walk test is a valid test to estimate cardiorespiratory fitness. A large number of other field-based fitness tests presented limited evidence, mainly due to a limited number of studies (1 for each test). The results of the present systematic review should be interpreted with caution due to the substantial lack of consistency in reporting and designing the existing validity studies.

Background: Musculoskeletal disorders of the shoulder are extremely common, with reports of prevalence ranging from 1 in 3 people experiencing shoulder pain at some stage of their lives to approximately half the population experiencing at least one episode of shoulder pain annually. Pathology of the soft tissues of the shoulder including the musculotendinous rotator cuff and subacromial bursa are a principle cause of pain and suffering. Competing theories have been proposed to explain the pathoaetiology of rotator cuff pathology at specific stages and presentations of the condition. This review proposes a model to describe the continuum of the rotator cuff pathology from asymptomatic tendon through full thickness rotator cuff tears.

Conclusions: The pathoaetiology of rotator cuff failure is multifactorial and results from a combination of intrinsic, extrinsic and environmental factors. Profound changes within the subacromial bursa are strongly related to the pathology and resulting symptoms. Recently a new and generic model detailing the continuum of tendon pathology has been proposed. This model is relevant for the rotator cuff and provides a framework to stage the continuity of rotator cuff disease. Furthermore, it provides a structure to identify the substantial deficiencies in our knowledge base and areas where research would improve our understanding of the pathological and repair process, together with assessment and management. The strength of this model adapted for the rotator cuff tendons will be tested in its ability to incorporate and adapt to emerging research.

Background: There are still questions concerning the mechanisms of development of chronic pain and impaired function of tendons (tendinosis). Aspects that are known to occur are cell proliferation, angiogenesis and altered blood flow regulation. Neuropeptide NPY (NPY) is widely distributed in the body and has powerful effects in relation to these processes. NPY has its effects via the G-protein-coupled Y receptors. There is no information concerning the presence or absence of NPY receptors in Achilles tendons or other tendons.

Objective: To clarify the expression patterns of the NPY receptors Y1 and Y2 in normal and tendinosis Achilles tendons of man.

Methods: Immunohistochemical methods were used. Examination on NPY was carried out in parallel.

Results: The tenocytes showed strong immunoreactions for the Y1 receptor. The immunoreactions were more intense in the tenocytes of the tendinosis tendons than in those of the non-tendinosis tendons. The rounded/oval tenocytes typically seen in tendinosis tendons exhibited marked Y1 receptor reactions on their exterior. Pronounced Y1 reactions were seen in the smooth muscle of the arterioles of both tendinosis and non-tendinosis tendons. No reactions for the Y2 receptor were noted. NPY was detected in nerve fascicles and in the perivascular innervation.

Conclusions: The present study shows that there is a morphologic correlate for the occurrence of pronounced NPY effects via the Y1 receptor in both tenocytes, this especially being a fact for tendinosis tendons, and blood vessel walls in the Achilles tendon. The findings are of particular interest as NPY is known to have proliferative, angiogenic and blood vessel regulating effects. The effects of targeting the Y1 receptor in tendinosis is an interesting task to be further evaluated.

Objective: To determine the serum triglycerides and total serum cholesterol levels in patients with rotator cuff tear.

Design: Frequency-matched case-control study.

Setting: University Teaching Hospital.

Participants: The study included 240 subjects who were operated at our institution. Group 1 included 120 patients (45 men and 75 women; mean age: 64.86 years, range 40 to 83) who underwent arthroscopic repair of a rotator cuff tear. Group 2 (control group) included 120 patients (45 men and 75 women; mean age: 63.91 years, range 38 to 78) who underwent arthroscopic meniscectomy for a meniscal tear, and had no evidence of shoulder pathology. These patients were frequency-matched by age (within 3 years) and gender with patients of Group 1.

Main outcome measure: Measurement of serum triglyceride and total cholesterol concentrations.

Results: When comparing the two groups, there was no difference either in serum triglyceride concentration or total serum cholesterol concentration.

Conclusions: There appears to not be an association between serum triglyceride concentration and total serum cholesterol concentration and rotator cuff tears.

Objective: This study examined the neuromuscular responses to 60 min of self-paced high intensity exercise punctuated with 6 x 1 min "all-out" sprints at 10 min intervals in moderate (19.8 ± 0.3° C) and warm (33.2 ± 0.1°C), humid (~ 64% relative humidity) conditions with either complete hydration (CF) or without hydration (NF).

Design: Seven subjects (mean ± SE; age 20.6 ± 1.1 yr, mass 73.8 ± 4.5 kg, peak power 288 ± 11.3 W) performed the time trial on four separate occasions which were differentiated by ambient temperature and fluid ingestion. For each sprint interval, distance, power output and electromyographic (EMG) data from the rectus femoris and vastus lateralis muscles were recorded.

Results: The NF trials resulted in a reduction in body mass for the moderate and warm conditions of 1.7% and 2.1%, respectively. Final rectal temperatures were not different among conditions (~ 38.7 °C). Total body sweating was higher in the warm condition (19.1 – 21.3 mL/kg/h) compared with the moderate condition (16.1 – 16.5 mL/kg/h; P < 0.05). Neither fluid ingestion nor ambient temperature altered total distance cycled for any of the trials (range 30.1 – 32.6 km). The normalised iEMG (as % maximal voluntary contraction) when compared with the first sprint increased from sprint three for the rectus femoris muscle in both NF and CF but decreased for vastus lateralis muscle. However, the mean percentile frequency shift increased for both vastus lateralis and rectus femoris muscles in both NF and CF.

Objective: To compile histologic and imaging research detailing the microvascularity of the rotator cuff and determine the clinical application of these findings for clinicians.

Methods: A computer-assisted literature search of MEDLINE (1966 to September 2008) using keywords related to blood flow to the shoulder and limited to humans and English language. A hand search was also performed by three of the authors.

Results: Nineteen studies met inclusion and exclusion criteria.

Conclusions: The relationship between the variables of vascularity, age and degeneration remains unclear. However, recent studies with stronger design and better technology support the fact that increased vascularity is a normal response to smaller tears but that as tear size increases, the healing response fails and decreased vascularity is observed. Also, impingement may cause hypovascularity. Further, these studies support the possibility that people without symptoms may have normal blood flow even with aging. Finally, exercise may increase blood flow to the rotator cuff. These findings have both surgical and rehabilitation implications.

Background and objectives: Urinary steroid profiling is used in doping controls to detect testosterone abuse. A testosterone over epitestosterone (T/E) ratio exceeding 4.0 is considered as suspicious of testosterone administration, irrespectively of individual heterogeneous factors such as the athlete’s ethnicity. A deletion polymorphism in the UGT2B17 gene was demonstrated to account for a significant part of the inter-individual variability in the T/E between Caucasians and Asians. Here, we examined the variability of urinary steroid profiles in a widely heterogeneous cohort of professional soccer players. Method: The steroid profile of 57 Africans, 32 Asians, 50 Caucasians and 32 Hispanics was determined by gas chromatography-mass spectrometry. Results: Significant differences have been observed between all ethnic groups. After estimation of the prevalence of the UGT2B17 deletion/deletion genotype (African:22%; Asian:81%; Caucasian:10%; Hispanic:7%), ethnic-specific thresholds were developed for a specificity of 99% for the T/E (African:5.6; Asian:3.8; Caucasian:5.7; Hispanic:5.8). Finally, another polymorphism could be hypothesized in Asians based on specific concentrations ratio of 5a-/5b-androstane-3a,17b-diol in urine. Conclusion: These results demonstrate that a unique and nonspecific threshold to evidence testosterone misuse is not fit for purpose. An athlete's endocrinological passport consisting of a longitudinal follow-up together with the ethnicity and/or the genotype would strongly enhance the detection of testosterone abuse. Finally, additional genotyping studies should be undertaken to determine if the remaining unexplained disparities have an environmental or a genetic origin.

In Europe, participation in physical activity has been growing among people of all ages. Thus, there is an increasing demand for care relating to ‘sports medicine’ and this has promoted the development of specialised sports physicians. Sports medicine involves a wide range of professionals with functions of taking care of active population, recreational and competitive athletes upon different aspects: curative, rehabilitative and preventive. In the light of an higher demand of expertise and sport-specific burden of knowledge, such as a further development of the phenomenon doping with all the related moral, legal and health implications, the sport physician has to deal with a complex picture. As a result, the need to provide prevention at all levels has become one of the most important objectives of sports medicine. This article aims to give a brief overview of the state of the art of this specialty in Europe and to describe definitions, scopes and educational perspectives of the Sport Medicine Specialty Training Core Curriculum to be adopted in the E.U.

Objective: A multi-factorial combination of predictors may increase ACL injury risk in athletes. The objective of this twin case series was to examine these risk factors to identify commonalities in risk factors that predisposed female fraternal twins to ACL injury.

Methods: Female twins in high-risk sports were prospectively measured prior to an injury for neuromuscular control using 3-dimensional motion analysis during landing, hamstrings and quadriceps muscular strength on a dynamometer and joint laxity suing a modified Beighton Horan index and a Compu-KT arthrometer. Intraoperative measures of femoral intercondylar notch width were recorded during ACL reconstruction.

Findings: Abduction angles were increased at one knee in both of the twin sister athletes relative to uninjured controls both at initial contact and at maximum displacement during landing. The twin female athletes that went on to ACL injury also demonstrated decreased peak knee flexion motion at both knees than uninjured females during landing. The twin athletes also had increased joint laxity and decreased hamstrings to quadriceps (H/Q) torque ratios compared to controls. Femoral intercondylar notch widths were also below the control mean in the twin siblings.

Conclusions: Prescreened mature female twins that subsequently suffered ACL injury demonstrated multiple potential risk factors including: increased knee abduction angles, decreased knee flexion angles, increased general joint laxity, decreased H/Q ratios and femoral intercondylar notch width.

Sports and health practitioners responsible for the management of injured athletes are routinely required to make decisions regarding the timing of exercise progression, commencement of functional activities, and return to competitive play. Such decision-making might be enhanced by adoption of an outcomes-based approach to treatment progression, where patients must achieve specific outcomes prior to proceeding to more advanced levels of activity. However, outcome measures are infrequently incorporated into routine practice. A possible reason for this lack of use is that practitioners may feel insufficiently familiar with how to evaluate a measure’s suitability.

Using illustrative examples from the field of ACL rehabilitation, this critical review provides a comprehensive, yet user-friendly, guide to selecting outcome measures for use with active populations. A series of questions are presented for consideration when selecting a measure: Is the measure appropriate for the intended use? (Appropriateness); Is the measure acceptable to patients? (Acceptability); Is it feasible to use the measure? (Feasibility); Does the measure provide meaningful results? (Interpretability); Does the measure provide reproducible values? (Reliability); Does the measure assess what it is supposed to assess? (Validity); Can the measure detect change? (Responsiveness); Do substantial proportions of patients achieve the worst or best scores? (Floor and Ceiling Effects); Is the measure structured and scored correctly? (Dimensionality and Internal Consistency); Has the measure been tested with the types of patients with whom it will be used? (Sample Characteristics). Evaluation of the measure using these questions will assist practitioners in making their judgements.

Objective: To analyse the secular trends in aerobic fitness and its determinants (BMI and leisure physical activity) in adolescents.

Design: Cross-sectional population-based studies in 1976 and 2001.

Setting: Finland.

Participants: A stratified random sample of Finnish 13- to18-year-old pupils was studied in 1976 (N= 717; 384 boys and 333 girls) and in 2001 (N=558; 305 boys and 253 girls).

Main outcome measures: Aerobic fitness was measured with a 2000 m (for boys) and 1500 m (for girls) running test and participants’ weight and height were measured. Self-reported weekly frequency of leisure time physical activity of at least 30 min duration and regularity of participation in organized sport were obtained by questionnaire. Identical methods were used in 1976 and 2001.

Results:Running time was longer in 1976 compared to 2001 in both boys (56 sec; p<.001) and girls (29 sec; p<.001). In the linear regression analysis BMI and participation in leisure time physical activity explained more of the variance in aerobic fitness in 2001 than in 1976 in both boys and girls.

Conclusions: Aerobic fitness of school-aged children deteriorated between the measurement points. BMI and organized leisure time physical activity explained aerobic fitness better in 2001 than in 1976. An increase in overweight and obesity was associated with the decrease in aerobic fitness. Although the importance of organized leisure-time physical activity to fitness increased, it is possible that the decrease in overall physical activity between 1976 and 2001 contributed most to the decrease in the level of aerobic fitness.

There has been increasing recognition of the need for effectiveness research within the real-world intervention context of community sport. This is important because, even if interventions have been shown to be efficacious in controlled trials, if they are not also widely adopted and sustained, then it is unlikely that they will have a public health impact. There is very little information about how to best conduct such studies but application of health promotion frameworks, such as the RE-AIM framework, to evaluate the public health impact of interventions could potentially help to understand the implementation context. Care needs to be taken when directly applying the RE-AIM framework, however, because the definitions for each of its dimensions will depend on the level/s the intervention is targeted at. This paper provides a novel extension to the RE-AIM framework (the RE-AIM Sports Setting Matrix [RE-AIM SSM]) that accounts for the fact that many sports injury interventions need to be targeted at multiple levels of sports delivery. Accordingly, the RE-AIM components also need to be measured across all tiers of possible influence on the rate of uptake and effectiveness. Specific examples are given for coach-delivered exercise-training interventions. The RE-AIM SSM is specific to the community sports setting implementation context and could be used to guide the delivery of future sports safety, and other health promotion, interventions in this area.

Background: Asthma is frequent in elite athletes and clinical studies in athletes have found increased airway inflammation.

Objective: To investigate asthma-like symptoms, airway inflammation, airway reactivity (AR) to mannitol and use of asthma medication in Danish elite athletes.

Methods: The study group consisted of 54 elite athletes (19 with physician-diagnosed asthma), 22 non-athletes with physician-diagnosed asthma (steroid naïve for 4 weeks before the examination), and 35 non-athletes without asthma; all aged 18-35 years. Examinations (one day): questionnaires, exhaled nitric oxide (eNO), spirometry, skin prick test, AR to mannitol and blood samples. Induced sputum was done in subjects with asthma.

Results: We found no difference in values for eNO, AR and atopy between 42 elite athletes with and 12 without asthma-like symptoms (NS). Elite athletes with physician-diagnosed asthma had less AR (Response Dose Ratio 0.02 (0.004) vs. 0.08 (0.018) p < 0.01) and fewer sputum eosinophils (0.8% (0-4.8) vs. 6.0% (0-18.5), p < 0.01) than non-athletes with physician-diagnosed asthma. Use of asthma medication was similar in the two groups (NS). Forty-two elite athletes had asthma-like symptoms but only 12 had evidence of current asthma. Elite athletes without asthma had asthma-like symptoms more frequently than non-athletes without asthma (68.6% vs. 25.7%, p < 0.001).

Conclusion: Asthma-like symptoms in elite athletes are not necessarily associated with classic features of asthma and alone should not give a diagnosis of asthma. More studies are needed to further investigate if and how the asthma phenotype of elite athletes differs from that of classical asthma.

Two studies from South Africa and one from Sweden have suggested that the rare TT genotype of the functional Sp1 binding site polymorphism within intron 1 of the COL1A1 gene is associated with cruciate ligament ruptures, shoulder dislocations and Achilles tendon ruptures. Similar genotype distributions were reported for the control and the injury groups in all three studies. In this report, the data from these studies were combined and analyzed. The main findings are that the TT genotype, when compared to the control group (4.1%, n=24 of 581), was significantly under-represented in 1) the cruciate ligament ruptures group (0.3%, n=1 of 350, OR=15.0, 95% CI 2.0 to 111.7, P=0.0002), 2) the combined cruciate ligament ruptures and shoulder dislocations group (0.4% TT genotype, n=2 of 476, OR=10.2, 95% CI 2.4 to 43.4, P<0.0001), and 3) the combined ligament and tendon ruptures group (0.4% TT genotype, n=2 of 517, OR=11.1, 95% CI 2.6 to 47.2, P<0.0001). Although these data should be interpreted with caution due to the low frequency of this rare genotype, this combined analysis indicates that the TT genotype appears to be protective against acute soft tissue ruptures. We propose that this sequence variant is the first genetic element to be incorporated into multifactorial models predicting the acute soft tissue ruptures.

Objective: Ultrasound imaging has revealed distinct types of gray-scale abnormalities in both the patellar and Achilles tendons, including diffusely thickened tendons and tendons containing a hypoechoic region. The relationship between these gray-scale abnormalities and their clinical relevance is unknown. This study investigated the temporal sequence in gray-scale abnormlities as well as the relationship between gray-scale abnormalities, Doppler flow and pain.

Methods: Patellar tendon pain (single leg decline squat test) and ultrasound imaging (gray-scale [normal, diffuse thickening, hypoechoic], presence of Doppler flow) were assessed bilaterally among 58 volleyball players at monthly intervals during a five month season. The probability of transition between the gray-scale ultrasound groups was calculated for each month and totalled over the season (prospective) and the relationship between these groups and the presence and intensity of pain and the presence of Doppler flow were investigated (cross-sectional).

Results: Tendons with normal US were more likely to transition to diffuse thickening than to a hypoechoic region. Tendons containing a hypoechoic region were more likely to transition to diffusely thickening rather than to a normal US appearance. Hypoechoic regions were more likely to be painful (59%) and contain Doppler flow (42%) than tendons with diffuse thickening (pain in 43% and Doppler flow in 6%).

Conclusions: The transitions identified between normal, diffusely thickened tendons and those containing a hypoechoic region suggests that these gray-scale ultrasound changes may represent different phases of tendon pathology. Tendons containing a hypoechoic region are more likely to be painful and contain Doppler flow than diffusely thickened tendons.

Background: Participation in regular exercise and athletic activities across the lifespan is encouraged to maintain the cardiovascular system, the musculoskeletal system (muscle and bone integrity), and general well being. Prior to menopause there is an increased risk for ACL injuries, while there is increased risk of joint diseases such as knee osteoarthritis after menopause. While there is a paucity of data available regarding alterations in individual connective tissues of the knee in humans, it is possible to assess changes occurring in experimental models following surgical menopause.

Objective: To assess changes in cell metabolism which occur in the MCL, ACL, PT, lateral and medial menisci, tibial and femoral articular cartilage, and the synovium after surgical menopause in an experimental model system.

Methods: Panels of rabbits were subjected to ovariohysterectomy or sham operations and RNA from each tissue assessed for collagen, proteoglycan, proteinase, growth factor, sex hormone receptor and inflammatory mediator mRNA levels by RT-PCR.

Results: Unique alterations in cell metabolism were detected two months post-surgical menopause and the pattern of significant changes was tissue-specific (number of mRNA species altered, extent of the changes, elevation /depression of the changes).

Conclusions: Changes in cell metabolism may alter the set point for the tissues of the knee and subsequently, the functioning of the knee after menopause. Such changes may contribute to increased risk for injury and/or degenerative conditions. Further studies in pre- and post-menopausal women athletes may also shed light on whether the present findings can be extrapolated to human populations.

Background: Left ventricular hypertrophy (LVH) is often observed in athletes which should be differentiated from hypertrophic cardiomyopathy (HCM). The aim of the study was to explore the functional changes measured using tissue Doppler imaging (TDI) deformation analysis in athletes fulfilling LVH criteria participating in different endurance sports.

Methods: Healthy controls (n=62, 58% men) and endurance athletes (n=120, 62% men) aged 18 to 40 years were prospectively enrolled and underwent both standard echocardiography as well as TDI. Longitudinal TDI derived strain and strain-rate (SR) were calculated in the septal and posterior wall in three segments. LVH was defined as an LVmass of >132 g/m2 in men and >109 g/m2 in women.

Results: Echocardiographic LVH was observed in 33 athletes (67% men). LVmass was significantly increased in both athlete groups (102.6±16.0 and 135.7±15.9 g/m2 vs. 88.0±16.5 in controls, p<0.001). Diastolic parameters were not significantly different between groups. Athletes with LVH showed no significant difference in strain and SR values in any segment of the septal or posterior wall compared to controls or those without LVH. A weak but significant correlation (also after multivariate analysis) was found for septal wall thickness and LVmass in peak systolic strain (r=0.26, p<0.01 and 0.23, p<0.01) and SR (r=0.27, p<0.01 and 0.29, p<0.01). Nevertheless, strain and SR values were still within normal limits in all athletes.

Conclusion: Athletes with LVH overall show normal deformation values in the LV. Our data suggest that a moderate reduction in regional septal deformation should not be considered as pathological when evaluating the endurance athlete with echocardiographic LVH of unknown origin.

Background: Athlete’s heart as an adaptation to long-time and intensive endurance training shows considerable individual differences. Genetic polymorphisms in the cardiologic relevant insulin-like growth factor 1 (IGF1) signalling pathway seem to have an essential influence on the extent of physiological hypertrophy.

Objective: Analysis of polymorphisms in the genes of IGF1, IGF1 receptor (IGF1R) and the negative regulator of the cardiac IGF1 signalling pathway, myostatin (MSTN), and their relation to left ventricular mass (LVM) of endurance athletes.

Methods: In 110 elite endurance athletes or athletes with a high amount of endurance training (75 males and 35 females) and 27 male controls, which were examined by echocardiographic imaging methods and ergometric exercise-testing, the genotypes of a cytosine-adenine repeat polymorphism in the promoter region of the IGF1 gene and a G/A substitution at position 3174 in the IGF1R gene were determined. Additionally, a mutation screen of the MSTN gene was performed.

Results: The polymorphisms in the IGF1 and the IGF1R gene showed a significant relation to the LVM for male (IGF1: p=0.003; IGF1R: p=0.01), but not for female athletes. The same applies to a previously unnoticed polymorphism in the 1. intron of the MSTN gene, whose deletion allele (AAA -> AA) appears to increase the myostatic effect (p=0.015). Moreover, combinations of the polymorphisms showed significant synergistic effects on the LVM of the male athletes.

Conclusions: Our results argue for the importance of polymorphisms in the IGF1 signalling pathway in combination with MSTN on the variant degree of physiological hypertrophy of male athletes.

Objectives: To describe the incidence and severity of injuries resulting from physical education, sports, and leisure time physical activity (PA) in 10-12 year old children.

Design: Prospective cohort study

Setting: Primary schools

Participants: 995 children aged 10-12y.

Interventions: Individual weekly exposure was estimated from baseline and follow-up questionnaires. Exposure to physical education (PE) classes was equal in all schools. An injury was recorded if it occurred during either PE class, leisure time PA, or sports, and caused the child to at least stop the current activity. Injuries were reported within one week of injury onset.

Main outcome measures: Injury incidence density Results: During the school-year a total of 119 injuries were reported by 104 children, resulting in an overall injury incidence density (ID) of 0.48 per 1,000 hours of exposure (95%CI: 0.38-0.57). Injury ID was lowest for leisure time PA, followed by PE and sports respectively. Of all injuries, 40% required medical treatment and 14% resulted in one or more days of absence from regular school activities. In general for girls a higher injury ID was reported than for boys, mainly caused by a twofold higher risk during leisure time PA.

Conclusions: Next to specific areas of preventive interest it was found that in this specific age group, girls require special attention as they seem to be at higher injury risk than boys.

The purpose of this editorial/leader is to highlight the importance of encouraging patients with chronic obstructive pulmonary disease (COPD) to participate in a programme of resistance training (RT). COPD is a respiratory condition, which not only affects the pulmonary system but it also has systemic effects on the peripheral skeletal muscles. The systemic effects alter the structure and function of the skeletal muscles, which leads to muscle weakness, loss of muscle mass and poor health related quality of life (HRQoL). In the past, aerobic training has been recommended to counteract the deleterious effects of COPD. However, evidence suggests that RT, which exerts or resists an external force (weight machines and free weights) will improve muscular strength, lean leg mass and HRQoL in COPD patients.

Objective: To ascertain the epidemiology of ankle injuries in elite youth football.

Design: Retrospective analysis of prospectively collected injury data from English Football Association Academies.

Setting: Forty-one FA Football Academies, between 1998 and 2006.

Participants: For the complete seasons studied, a total of 14776 players were registered from U9 to the U16 age category – a mean of 2463 players per year. All ankle injuries of sufficient severity to miss 48 hours or more training were studied - 2563 injuries in total.

Main outcome measurements: The incidence and burden of ankle injuries in this population, and factors associated with injury.

Results: There was a mean incidence of one ankle injury per player per year, and a mean of 20 training days and 2 matches were missed per ankle injury. Increased injury rates were seen in older players, in competition and later in each half of match time. Peaks in injury were seen early in the season and after the winter break. In competition, more injuries were associated with a contact situation than in training. Eighty-eight injuries (3.4%) required a lay-off of three months or more and in 18 (0.7%) cases, the player failed to return to training. In total, 52290 training days and 5182 match appearances were lost through ankle injury. The majority of injuries were sprains, but more severe injuries occurred accounted for 3.9% of the total.

Conclusions: Ankle injuries are common in young football players, and are often severe, with prolonged loss of training time. This has potential far reaching implications, both on and off the field.

Objective: To develop a clinical prediction rule to identify patients with patellofemoral pain (PFP) who are more likely to benefit from foot orthoses.

Design: Post-hoc analysis of one treatment arm of a randomised clinical trial.

Setting: Single centre trial in a community setting in Brisbane, Australia.

Participants: 42 participants (mean age 27.9 years) with a clinical diagnosis of PFP (median duration 36 months).

Interventions: Foot orthoses fitted by a physiotherapist.

Main outcome measures: Five-point global improvement scale at 12-week follow-up, dichotomised with marked improvement equalling success.

Results: Potential predictor variables identified by univariate analyses were age, height, pain severity, Anterior Knee Pain Scale score, Functional Index Questionnaire score, foot morphometry (arch height ratio, mid foot width difference from non-weight bearing to weight bearing), and overall orthoses comfort. Parsimonious fitting of these variables to a model that explained success with orthoses identified the following: age (> 25 years), height (< 165 centimetres), worst pain visual analogue scale (< 53.25 millimetres) and a difference in mid-foot width from non-weight bearing to weight bearing (> 10.96 millimetres). The pre-test success rate of 40% increased to 86% if the patient exhibited three of these variables (positive likelihood ratio 8.8 (95% confidence interval 1.2 to 66.9)).

Conclusion: Post-hoc analysis identified age, height, pain severity and mid foot morphometry as possible predictors of successful treatment of PFP with foot orthoses, thereby providing practitioners with information for prescribing foot orthoses in PFP and stimulating further research. Trial registration Australian Clinical Trials Registry ACTRN012605000463673 ClinicalTrials.gov NCT00118521

Objective: To determine if non-elite athletes undertaking short duration running exercise adjacent to a busy roadway experience increased blood levels of common pollutant volatile organic compounds (BTEX; benzene, toluene, ethyl benzene, xylene).

Design and Setting: The study was observational in design. Participants (9 males/1 female non-elite athletes) ran for 20 minutes, near a busy roadway along a 100 m defined course at their own pace. Blood levels of BTEX were determined both pre- and post-exercise by SPME-GC-MS. Environmental BTEX levels were determined by passive adsorption samplers.

Results: Subjects completed a mean (range) distance of 4.4 (3.4-5.2) km over 20 minutes [4.5(3.8-5.9) min/km pace], with a mean (SD) exercise intensity of 93 (2.3)% HRmax, and mean (SD) ventilation significantly elevated compared to resting levels [86.2 (2.3) versus 8.7 (0.9) l/min; p<0.001]. Mean (SD) environmental levels (time weighted average) were determined as 53.1 (4.2), 428 (83), and 80.0 (3.7) µg/m3 for toluene, ethylbenzene and xylenes respectively, while benzene was below the detectable limit due to the short exposure period. Significant increases in blood BTEX levels were observed in runners between pre- and post-exercise for toluene (mean increase of 1.4 ng/ml; p=0.002), ethylbenzene (0.7 ng/ml; p=0.0003), m/p-xylene (2.0 ng/ml; p=0.004), and o-xylene (1.1 ng/ml; p=0.002), however, no change was observed for benzene.

Conclusions: Blood BTEX levels are increased during high intensity exercise such as running undertaken in areas with BTEX pollution, even with a short duration of exercise. This may have health implications for runners who regularly exercise near roadways.

Background: Although high prevalence of anterior cruciate ligament injuries (ACL) in judokas has been reported, events preceding the injury have hardly been researched.

Objective: To determine the common situation and mechanism of the ACL injury in judo.

Methods: We investigated 43 cases of ACL injuries which had occurred during judo competition or practice. We used questionnaires with interviews conducted by one certified athletic trainer who has 20-year judo experience to obtain information regarding the situation and mechanism in which the ACL injury occurred.

Results: The number of the ACL injuries when the subject's grip style was different from the style of the opponent (i.e. kenka-yotsu style) (28 cases) was significantly greater than when the subject's grip style was the same as that of the opponent (i.e. ai-yotsu style)(15 cases)(P<0.001). The number of the ACL injury was significantly higher when the subject was attacked by the opponent than when counterattacked or when attempting the attack (P<0.001). In addition, being attacked with osoto-gari was revealed as the leading cause of the ACL injury incidence among the subjects (16.8%). Conclusions: Grip styles may be associated with the ACL injury occurrence in judo. In addition, direct contact due to the opponent's attack may be a common mechanism of the ACL injuries in judo.

Objective: To assess the influence of a 12-week training program on plasmatic levels of allantoin, an in vivo marker for oxidative stress, in adolescents with Down syndrome. This finding would be of great interest since oxidative damage has been proposed as a pathogenic mechanism of several pathologies in this population.

Materials: To get this goal, thirty-one male adolescents with Down syndrome (16.3±1.1 years; 155.2±5.7 cm; 70.8±4.5 kg) performed a 12-week training program, 3 sessions per week, consisting of warm up (15 min) followed by a main part (20-35 min [increasing 5 minutes each three weeks]) at a work intensity of 60-75% of peak heart rate (increasing a 5% each three weeks) and by a cool-down period (10 min). According to previous studies, it should be emphasized maximal heart rate for individuals with Down syndrome was predicted by the equation HRmax=194.5–[0.56 age]. Control group included 7 age, sex and BMI-matched adolescents with trisomy 21 that did not perform any training program. The levels uric acid and allantoin were assayed in plasma by HPLC. This protocol was approved by an Institutional Ethic Committee.

Results: When compared to baseline, plasmatic levels of allantoin were decreased significantly (22.09±1.62 vs 18.74±1.38 micromol/l; p<0.001) after being exercised. Further allantoin/uric acid ratio was decreased significantly (0.071±0.006 vs. 0.059±0.004; p<0.05). On the contrary, no changes were reported in controls.

Conclusion: A 12-week aerobic program reduced significantly oxidative damage expressed in terms of plasmatic allantoin content in adolescents with Down syndrome. Further studies on this topic are required.

There has recently been an increased emergence of research on the maltreatment of athletes in sport. It is suggested that research may play a particularly salient role with respect to athlete protection initiatives. However, as it stands, current research in this area is limited by a lack of consistency in definitions. The purpose of the paper, therefore, is to propose a conceptual framework of maltreatment in sport to be used among research practitioners. More specifically, a conceptual model of the different categories, constructs and constituents of maltreatment in sport is proposed. Sport-specific examples of the various maltreatments are outlined. Current literature is reviewed, and recommendations are made for future research.

Purpose: Physical fitness may confer protection from thrombosis however exercise induced platelet activation may be involved in the triggering of acute vascular events. This study aimed to assess haemostatic responses to acute exercise in trained and sedentary middle aged subjects.

Methods: 21 1st class Scottish football referees and 15 sedentary controls performed a treadmill exercise test. Blood sampling was performed pre, immediately post and 30 minutes post exercise. Samples were analysed for platelet count, Prothrombin time (PT), Activated Partial Thromboplastin Time (APTT), and serum fibrinogen. Platelet activation was assessed using flow cytometry with CD62 (p- Selectin) and antifibrinogen antibodies at rest and in response to ADP and epinephrine.

Results: Mean VO2 max (mls/kg/min) achieved was 47.23 (5.02) in the referees and 30.1(5.2) in the sedentary controls. Total platelet count (x10 -9/l) increased immediately post exercise (228.2(40.5), 278.6 (48.9), p=0.001) remaining elevated at 30 minutes in both groups. APTT(s) was reduced immediately post exercise (32.15(3.1), 29.7(3.94) p=0.001) with further reduction seen at 30 minutes (32.15 (3.1), 28.4(3.31), p=0.001). In the referees, % CD62 expression increased immediately post exercise (0.688(0.52), 1.42(1.3) p=0.008). % Anti-fibrinogen expression increased post exercise (5.19 (4.31), 13.01 (14.24) p=0.017) with a further increase seen at 30 minutes (5.19 (4.31), 20.47(26.8) p=0.02). Similar trends were seen in the sedentary controls.

Conclusion: In contrast to previous studies in young athletes, this study suggests that in an older athletic population, physical fitness does not protect against the prothrombotic effects of exercise and that the potential risks persist well into the recovery period. Our data would suggest that during a football match when referees achieve around 80% of peak VO2,(23) they may be at risk of significant platelet activation. They are a population at increased risk of cardiac events in view of increased age therefore prophylactic platelet inhibition should be considered in this group after appropriate screening and risk stratification.

We report on a series of patients who were diagnosed as having had a transient LATERAL patellar dislocation by MRI. The images were reviewed with specific reference to the medial collateral ligament (MCL), a heretofore undescribed concomitant injury.

Eighty patients were diagnosed on MRI as having had transient LATERAL patellar dislocation. Their mean age was 23.9+/-7.5 years. Forty patients (50.0%) had co existent MCL injuries. These injuries were classified as grade 1 (n=20), grade 2 (n=17), and grade 3 (n=3).

These results suggest that MCL injury commonly accompanies transient LATERAL patella dislocation, most likely due to a shared valgus injury. It appears to occur more commonly in male patients and if unidentified may explain both delayed recovery and persistent morbidity in more severe cases. In this setting, without specifically excluding co-existent MCL injury, the current vogue for early rehabilitation should be adopted with caution.

Background: There is a lack of effective intervention strategies that promote physical activity (PA) in school children. Furthermore, there is a gap between PA intervention research and the delivery of programmes in practice. Evaluation studies seldomly lead to adaptations in interventions which are subsequently evaluated on a wider scale implementation. The stepwise development and study of JUMP-in aims to add knowledge to better understand how, when and for whom intervention effects (or lack of effects) occur.

Methods: This paper describes the stepwise development of JUMP-in, a Dutch school based multi- level intervention programme, aimed at the promotion of PA behaviour in 6 to 12-year-old children. JUMP-in incorporates education, sports, care and policy components. JUMP-in consists of six programme components:

1. Pupil Follow Up Monitoring System;

2. School sports clubs;

3. In-class exercises with "The Class Moves!";

4. Personal workbook "This is the way you move!";

5. Parental Information services;

6. Extra lessons physical education, Motor Remedial Teaching and extra care.

The process- and effect outcomes of a pilot study were translated into an improved programme and intervention organisation, using the RE-AIM framework (Reach, Efficacy, Adoption, Implementation and Maintenance). This paper presents the process and results of the application of this framework, which resulted in a wide-scale implementation of JUMP-in.

Results: The application of the RE-AIM framework resulted in challenges and remedies for an improved JUMP-in intervention. The remedies required changes at three different levels: 1. the content of the programme components; 2. the organisation and programme management; and 3. the evaluation design.

Conclusions: Considering factors that determine the impact of PA interventions in 'real life' is of great importance. The RE-AIM framework appeared to be a useful guide in which process- and effect outcomes could be translated into an improved programme content and organisation.

Objective: Evaluate several biomechanical factors of the head during a sparring session and their link to cognitive function.

Design: Instrumented Boxing Headgear (IBH) was used for data collection during 4-two minute sparring sessions. Neurocognitive assessment was measured using the ImPACT© Concussion management software. A baseline neurocognitive test was obtained from each athlete prior to sparring; two additional tests were obtained and compared to the baseline.

Setting: Male and female amateur boxers.

Participants: Data were collected from 30 male and 30 female amateur boxers.

Main Outcome Measurements: Head accelerations (translational and rotational), injury severity indexes (Head Injury Criteria (HIC) and Gadd Severity Index (GSI)), and cognitive function scores.

Results: Peak translational and rotational acceleration values were 191 g and 17,156 rad/s2, respectively, for males and 184 g and 13,113 rad/s2, respectively, for females. The peak HIC and GSI values for males were 1,652 and 2,292, respectively, and for females were 1,079 and 1,487, respectively. There was no significant difference in the neurocognitive scores between genders. A decrease was exhibited in the delayed memory post bout scores. All other scores either increased or did not significantly decrease when compared to the baseline.

Conclusions: The majority of impacts experienced by both genders were under the threshold for mild head injury. There was a statistically significant difference between peak translational and rotational acceleration, HIC, and GSI when comparing genders. When analyzing cognitive functions there was no statistical difference between genders.

Background: Validation of instruments used to measure physical activity patterns are essential when attempting to assess the effectiveness of physical activity interventions.

Objectives: To assess the validity of two self-report physical activity questionnaires on a representative sample of New Zealand adults.

Methods: Seventy adults aged 18-65 years from around Christchurch, New Zealand were required to wear an ActiGraph GT1M accelerometer during all waking hours for seven consecutive days. Immediately following the 7-day accelerometer period participants were required to complete the long forms of both the New Zealand Physical Activity Questionnaire (NZPAQ-LF) and the International Physical Activity Questionnaire (IPAQ-LF).

Results: Both the NZPAQ-LF and the IPAQ-LF questionnaires showed small to moderate correlations to Actigraph data for time spent in moderate-intensity physical activity (r = 0.19 – 0.30), and total physical activity (sum of moderate and vigorous-intensity physical activity r = 0.30 – 0.32). Compared to the Actigraph data both self-report questionnaires tended to overestimate activity levels by ~ 165%. Total physical activity levels gathered from both questionnaires were strongly correlated to each other (r = 0.79) and showed good levels of agreement in the Bland-Altman plots.

Conclusions: We found the long forms of the NZPAQ and IPAQ had acceptable validity when detecting participant’s ability to meet activity guidelines based on exercise duration, but a significant amount of over-estimation was evident. This presents a need for both instruments to be further developed and tested in order to increase validity.

Objective: To investigate the diagnostic accuracy of commonly used signs of dehydration in marathon runners.

Design: The diagnostic accuracy of 5 clinical signs/symptoms thought to indicate dehydration (altered skin turgor, dry oral mucous membranes, sunken eyes, an inability to spit and the sensation of thirst) was assessed by comparing the presence of these markers with the criterion standard of body weight change over a marathon footrace.

Setting: 2006 Auckland Marathon.

Participants: 606 competitors in the full marathon.

Assessment: Body weight was measured before and immediately after the marathon. The 5 clinical signs/symptoms were assessed immediately after the marathon.

Main outcome measures: Diagnostic accuracy of clinical signs/symptoms to detect dehydration greater than 3% of body weight.

Results: 606 complete data sets were obtained. Three clinical signs were associated with greater percentage weight loss: sunken eyes (mean percentage weight loss with symptom 2.6% (standard deviation 1.5), without 2.3% (1.5)); decreased skin turgor (with 3.0% (1.4), without 2.3% (1.5)) and the sensation of thirst (with 2.5% (1.5), without 2.3% (1.5) ). The ability to spit and dry oral mucous membranes were unrelated to percentage weight loss. No sign/symptoms showed acceptably high validity for detecting a weight loss equal to or greater than 3% of body weight.

Conclusions: The five parameters (decreased skin turgor, sensation of thirst, sunken eyes, inability to spit and dry mucous membranes) tested in this study did not precisely identify runners with total weight loss >3% at the end of a marathon.

Objective: To investigate the regulation of blood pressure in response to an orthostatic challenge in athletes running a marathon.

Methods: Ten experienced male runners (mean ± SD age 29 ± 4 years) were tested on the day prior to the 2004 London Marathon, and again immediately post-race (race time 210 ± 36 min). In addition, 6 of the subjects were re-tested 24 hours post-race. During each examination, systolic arterial blood pressure (SBP), heart rate (HR) were measured, and stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were estimated via arterial transmural pressure waveforms during 3 min in a supine position and then during 3 min of upright, unsupported standing. Data were averaged over 20 s epochs, and the final 20 s of each posture were compared pre- and post-race via repeated measures 2-way ANOVA.

Results: Pre-race SBP in standing increased only moderately when compared to supine values (2 ± 9 mmHg, P>0.05). This was accompanied by an increase in HR (13 ± 7 beats.min-1, P<0.05), and as well as a decrease in SV (16 ± 9 ml, P<0.05). However there was little change in CO (-0.13 ± 0.97 l.min-1, P>0.05) or TPR (0.047 ± 0.280 MU, P>0.05). Post-race SBP significantly decreased from supine to standing (-15 ± 20 mmHg, P<0.05). The change in SBP was accompanied an increase in HR (19 "b 6 beats.min-1, P<0.05), a reduction in SV (26 ± 14 ml, P<0.05) and CO (-1.02 ± 1.39 l.min-1, P=0.05). Post-race there was no change in TPR (0.366 ± 0.607 MU, P>0.05) upon standing. The orthostatic adjustments in SBP, HR and CO were greater than at pre-race (P<0.05). The post-race orthostatic challenge resulted in only one subject experiencing presyncopal symptoms. At 24 hr post-race cardiovascular responses to an orthostatic challenge mirrored those at pre-race.

Conclusions: A drop in systolic blood pressure upon orthostatic challenge after prolonged exercise appears to result from an uncompensated decrease in SV and resultant CO during standing.

Background: The International Olympic Committee–Medical Commission (IOC-MC) accepts a number of bronchial provocation tests for the diagnosis of exercise-induced bronchoconstriction (EIB) in elite athletes, none of which have been studied in elite swimmers. With the suggestion of a different pathogenesis involved in the development of EIB in swimmers, there is a possibility that the recommended test for EIB in elite athletes, the eucapnic voluntary hyperpnoea (EVH) challenge, may be missing the diagnosis in elite swimmers.

Objective: The aim of this study was to assess the effectiveness of the EVH challenge, the field swim challenge and the laboratory cycle challenge in the diagnosis of EIB in elite swimmers.

Design: 33 elite swimmers were evaluated on separate days for the presence of EIB using 3 different bronchial provocation challenge tests: an 8 minute field swim challenge. 6 minute laboratory EVH challenge, an 8 minute laboratory cycle challenge.

Main Outcome Measurements: Change in Forced Expiratory Volume in 1 second (FEV1) pre and post test protocol. A fall in FEV1 from baseline of ≥ 10% post challenge was diagnostic of EIB.

Results: Only 1 of the 33 subjects (3%) had a positive field swim challenge with a fall in FEV1 of 16% from baseline. Eighteen of the 33 subjects (55%) had a positive EVH challenge, with a mean fall in FEV1 of 20.4 ± 11.7% from baseline. Four of the subjects (12%) had a positive laboratory cycle challenge, with a mean fall in FEV1 of 14.8 ± 4.7% from baseline. Only one of the 33 subjects was positive to all 3 challenges.

Conclusions: These results suggest that the EVH challenge is a highly sensitive challenge for identifying EIB in elite swimmers, in contrast to the laboratory and field based exercise challenge tests which significantly underdiagnose the condition. The EVH challenge, a well established and standardized test for EIB in elite winter and summer land based athletes, should thus be used for the diagnosis of EIB in elite swimmers, as recommended by the IOC-MC.

OBJECTIVE: To examine the association between fitness, BMI, and neutrophil, lymphocyte, monocyte, basophil, and eosinophil concentrations in apparently healthy, nonsmoking men.

DESIGN: Cross-sectional study of 452 men from the Aerobics Center Longitudinal Study examining the resting concentration of white blood cell subfractions across fitness (maximal METS during a treadmill exercise test) and fatness (BMI) categories after adjusting for age.

RESULTS: Fitness was inversely associated with all WBC subfraction concentrations. After further adjusting for BMI, only total WBC, neutrophil, and basophil concentrations remained significantly associated with fitness. BMI was directly associated with total WBC, neutrophil, lymphocyte, monocyte, and basophil concentrations and when fitness was added to the model, only monocytes lost significance.

CONCLUSION: Fitness (inversely) and fatness (directly) are associated with WBC subfraction populations.

Objectives: To evaluate the feasibility, acceptability and effects of a Tai Chi and Qigong exercise program in adults with elevated blood glucose. Design, Setting, and Participants: A single group pre-post feasibility trial with 11 participants (3 male and 8 female; aged 42-65 years) with elevated blood glucose. Invervention: Participants attended Tai Chi and Qigong exercise training for 1 to 1.5 hours, 3 times per week for 12 weeks, and were encouraged to practice the exercises at home. Main Outcome Measures: Indicators of metabolic syndrome (body mass index[BMI], waist circumference, blood pressure, fasting blood glucose, triglycerides, HDL-cholesterol), glucose control (HbA1c, fasting insulin and insulin resistance [HOMA]), health-related quality of life; stress and depressive symptoms. Results: There was good adherence and high acceptability. There were significant improvements in four of the seven indicators of metabolic syndrome including BMI (mean difference -1.05, p<0.001), waist circumference (-2.80 cm, p<0.05), and systolic (-11.64 mm Hg, p<0.01) and diastolic blood pressure (-9.73 mm Hg , p<0.001), as well as in HbA1c (-0.32 %, p<0.01), insulin resistance (-0.53, p<0.05), stress (-2.27, p<0.05), depressive symptoms (-3.60, p<0.05), and the SF-36 mental health summary score (5.13, p<0.05) and sub-scales for general health (19.00, p<0.01), mental health (10.55, p<0.01) and vitality (23.18, p<0.05. Conclusions: The program was feasible and acceptable and participants showed improvements in metabolic and psychological variables. A larger controlled trial is now needed to confirm these promising preliminary results.

Leptin and adiponectin represent two newly discovered adipose tissue derived hormones; that are both associated in health status and in glucose and free fatty acid metabolisms. Moreover, acute and chronic exercises affect body composition, carbohydrate and lipid metabolisms. It is thus interesting to evaluate the effects of physical exercise and training on leptin and adiponectin levels. It seems that leptin concentration is not modified after short-term exercise (<60 minutes) or exercise that generates an energy expenditure lower than 800 kcal. Leptin levels decreases after long-term exercise (≥60 min) that stimulates FFA release, or after exercise that generates energy expenditure higher than 800 kcal. Adiponectin concentration presents a delayed increase (30 min) after short-term intense exercise (<60 min) performed by trained athletes. For adiponectin, limited data suggests that adiponectin concentration presents a delayed increase (30 min) after short-term intense exercise (<60 min) performed by trained athletes. It seems that, adiponectin concentrations do not change in response to long-term exercise (≥60 min). Short-term training (<12 weeks) and long-term training (≥12 weeks) present contrasting results regarding leptin and adiponectin. Most training studies which improve fitness levels and affect body composition, could decrease leptin and increase adiponectin concentrations.

Objective: The study examined whether the addition of a night splint to eccentric exercises is beneficial for functional outcome in chronic mid-portion Achilles tendinopathy.

Design: One-year follow-up of a randomised controlled single blinded clinical trial.

Setting: Sports medicine department in a general hospital.

Patients: 58 patients (70 tendons) were included.

Interventions: All patients completed a 12-week heavy load eccentric training programme. One group received a night splint in addition to eccentric exercises.

Main outcome measurements: Outcome scores were: Victorian Institute of Sport Assessment – Achilles (VISA-A) score, subjective patient satisfaction and neovascularisation score measured with Power Doppler Ultrasonography.

Results: For both groups the VISA-A score increased significantly (from 50 to 76 (P < 0.01) in the eccentric group and from 49 to 78 (P < 0.01) in the night splint group). No significant differences in VISA-A score were found between the groups from baseline to one year (P = 0.32). Presence of neovessels at baseline did not predict change in VISA-A score after one year in the whole group (P = 0.71).

Conclusion: Eccentric exercises with or without a night splint improved functional outcome at one-year follow-up. At follow-up there was no significant difference in clinical outcome when a night splint was used in addition to an eccentric exercise program. Between three months and one year follow-up, a continuing increase in VISA-A score was found. Assessment of the neovascularisation score with PDU at baseline has no prognostic value on long-term clinical outcome.

Objectives: We examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options provide optimal pain relief with rapid return to sport and prevention of symptom reoccurrence.

Methods: Three databases-MEDLINE, Cochrane Database of Systematic Reviews and CINAHL were searched using the OVID interface for all years between 1985 and May 2008. References were analyzed from included studies and additional relevant articles were obtained for inclusion. Inclusion criteria included: 1) humans only, (2) subjects had no apparent risk factors for development of osteitis pubis or osteomyelitis of the pubic symphysis other than athletic involvement, (3) both physical exam findings and diagnostic imaging were used to confirm either diagnosis, and (4) a definitive treatment strategy was identifiable for management of osteitis pubis or osteomyelitis of the pubic symphysis. In total, 25 articles were included in the review.

Results: There were no randomized controlled trials (RCTs) identified with our search strategy.

195 athletes were diagnosed with osteitis pubis (186 males, 9 females) and treated with either conservative measures/physical therapy, local injection with corticosteroids and/or local anesthetic, dextrose prolotherapy, surgery or antibiotic therapy. Six case reports/series described conservative treatment measures (physical therapy, rest, NSAIDs). Four case series explored the use of corticosteroid injections in treatment. One case series described the use of dextrose prolotherapy as a treatment modality. Six case series described various surgical techniques (pubic symphysis curettage, polypropylene mesh placement, and pubic bone stabilization) in treatment. Ten case reports/series (10 subjects) outlined antibiotic treatment of osteomyelitis of the pubic symphysis.

Conclusions: The current medical literature shows only level 4 evidence for the treatment of osteitis pubis in twenty-four case reports/series in athletes. Without any direct comparison of treatment modalities it is difficult to determine which individual treatment option is the most efficacious. Further study comparing the different treatment options is necessary to determine which modality provides the fastest return to sport.

Objectives: To evaluate the prevalence of urinary stress incontinence (USI) in menstruating women practicing recreational sport activity, to detect specific sports with a stronger association with UI, and to evaluate risk factors possibly related to this condition. Design: Epidemiological study Setting: Non competitive sport organizations in the province of Varese - Italy. Participants: 679 women in fertile age, practicing recreational sport activity. Intervention: Anonymous questionnaire on UI. Main outcome measurements: The questionnaire included questions about patients’ general characteristics, occurrence of UI in relation to sport or daily general activities, time of onset of this condition, frequency of leakage episodes, correlation of incontinence with types of movements or sports, subjective impression of being limited in such occasions and/or necessity to modify the type of sport. Results: UI was reported by 101 women (14.9%). Of them, 32 (31.7%) complained of UI only during sport activity, 48 (47.5%) only during daily life and 21 (20.8%) in both circumstances. BMI and parity were significantly associated with the risk of urinary incontinence. Looking at the different sport activities, the higher rate of incontinent women was found in basketball (16.6%), athletics (15%), and tennis or squash (11%). 10.4% of women abandoned their favourite sport, due to stress UI, and a further 20% limited the way they practiced their favourite sport to reduce leakage episodes. Conclusions: Female UI affects a relevant proportion of young women practicing non-competitive sport activity; it can cause abandon of the type of sport or limitation in its practice.

Objective: To determine the effects of vibration therapy on delayed onset muscle soreness (DOMS) and associated inflammatory markers after downhill running.

Methods: Twenty nine male recreational runners (33 ± 8 yr, VO2peak 57 ± 6 ml•kg-1•min-1) completed a 40 minute downhill run, and were randomly allocated to a Vibration Therapy group or Control group. For 5 days post-run, the VT group underwent once-daily sessions of vibration therapy on the upper and lower legs. DOMS was assessed pre-run and for 5 days post-run by visual analog scale. Immune cell subsets and plasma inflammatory markers were assessed pre-run, post-run, 24 and 120 h post-run by full differential cell count, and by enzyme-linked immunosorbent assay and enzyme immunoassay, respectively. Data were analysed as percent-change from pre-run (ANOVA) and the magnitude of the treatment effect (Cohen's effect size statistics).

Results: Vibration therapy significantly reduced calf pain 96 h post-run (-50%; ± 40%, 90%Confidence Limits), and gluteal pain 96 (-50%; ± 40%) h and 120 h post-run (-30%; ± 30%); decreased IL-6 24 h (-46%; ±31%) and 120 h post-run (-65%; ±30%); substantially decreased histamine 24 h (-40%; ±50%) and 120 h post-run (-37%; ±48%); substantially increased neutrophils (8.6%; ±8.1%) and significantly decreased lymphocytes (-17%; ±12%) 24 h post-run. There were no clear substantial effects of vibration therapy on other leukocyte subsets and inflammatory markers.

Conclusion: Vibration therapy reduces muscle soreness and IL-6. It may stimulate lymphocyte and neutrophil responses, and be a useful modality in treating muscle inflammation.

Background: Lateral scapular slide test (LSST) quantitatively measures the distance between thoracic spine (T7) and inferior angle of scapula.

Objective: To measure intra rater reliability, inter rater reliability and diagnostic accuracy of LSST by using the caliper.

Methods: Three measurements of each test position were obtained bilaterally. ICC (2,1), 95% confidence interval and 2SEMs were calculated for intra-rater and inter-rater reliability of the absolute scapular distance. Sensitivity, specificity, positive and negative likelihood ratios were determined.

Results: Twenty-seven people with and thirty people without shoulder pain participated. The mean age and standard deviation (SD) for the participant was 47.7 years (SD= 11.6) and 33.5 years (SD= 11.7) respectively. The ICCs for intra-rater reliability were high. A range of poor to good ICCs found for inter-rater reliability. The 2SEMs ranged from 4.6 to 7.9 mm for intra-rater reliability and from 6.8 to 13.4 mm for inter-rater reliability for people with shoulder pain. Positive and negative likelihood ratios from 0.94 to 1.22 and 0.21 to 2.5 respectively were demonstrated.

Conclusion: LSST did not show a consistent high reliability. The diagnostic accuracy of the LSST was low, which questions the clinical importance of the tests outcomes.

Objective: To identify behavioural and social correlates of objectively-measured sedentary time in young people.

Design: Cross-sectional analysis of data from the European Youth Heart Study (EYHS).

Setting: Schools in Denmark, Estonia, Portugal and Norway.

Participants: Invited using a two-stage cluster sampling procedure. Analyses include 2107 children (9-10 years) and adolescents (14-15 years).

Assessment of independent variables: Seven behavioral and 15 social variables assessed by parental and computerized child questionnaires.

Main outcome measure: Sedentary activity as assessed by accelerometry (10-minute blocks at <200 counts/minute). Analyses were stratified by country and interactions with grade and gender were investigated.

Results: Adolescents were more sedentary than children (335.4 (SD: 90.4) vs. 217.2 (SD: 75.6) minutes/day, p<0.001). Patterns of associations differed across countries. High computer use and no television viewing before school in Norway, and being sedentary during school-breaks in Estonia were positively associated with sedentary time. No behavioural variables were associated with sedentary time in the Danish and Portuguese models. Socioeconomic position was positively associated with sedentary time in Portugal and Estonia, father¡¦s body mass index negatively in the Estonian model. Norwegian participants with a games console at home and Portuguese participants with a television in their bedroom were more sedentary.

Conclusions: A single strategy aimed at reducing sedentary behaviour is unlikely to be effective across Europe as the target populations and behaviours of focus differ between countries. Targeting high socioeconomic groups in Portugal and Estonia or focusing on reducing computer use in Norway might be effective intervention strategies to reduce overall sedentary time.

The parallel response of sweat rate and urine production to changes in plasma osmolality and volume support a role for arginine vasopressin (AVP) as the main endocrine regulator of both excretions. Ten moderately trained runners completed both a maximal test to exhaustion and a steady-state run on a motorized treadmill, one week apart. Sweat, urine and serum sodium concentrations ([Na+]) were evaluated in association with the plasma concentrations of cytokines, neurohypophyseal and natriuretic peptides, and adrenal steroid hormones. When data from both the high intensity and steady state runs were combined, significant linear correlations were noted between: sweat [Na+] versus post-exercise urine [Na+] (r = 0.80; p<0.001), post-exercise serum [Na+] versus both post-exercise urine [Na+] (r = 0.56; p<0.05) and sweat [Na+] (r = 0.64; p<0.01) and post-exercise urine [Na+] versus post-exercise plasma arginine vasopressin concentration ([AVP]P) (r = 0.48; p<0.05). A significant positive correlation was noted between post-exercise [AVP]P and sweat [Na+] during the steady-state condition only (r = 0.66; p<0.05). These correlations suggest that changes in serum [Na+] during exercise may evoke corresponding changes in sweat and urine [Na+], which are likely regulated coordinately by changes in [AVP]P to preserve body fluid homeostasis.

Background: Tendinopathy commonly occurs in tendons with large in vivo loading demands like the Achilles tendon (AT) and supraspinatus tendon (SST). In addition to differences in their local anatomic environment, these tendons are designed for different loading requirements because of the muscles to which they attach, with the AT experiencing higher loads than the SST. One possible factor in the progression of tendinopathy is the interplay between mechanical loading and the regulation of enzymes that degrade the extracellular matrix (matrix metalloproteinases: MMPs) and their inhibitors (tissue inhibitor of metalloprotienases: TIMPs). Thus, overuse injuries may have different biological consequences in tendons designed for different in vivo loading demands.

Aim: To investigate the tendon-specific regulation of MMP-13, MMP-3, and TIMP-2 expression in rat AT and SST exposed to two different mechanical environments.

Methods: Rat AT and SST were exposed to stress-deprivation (i.e. detached from attachments) and intermittent cyclic hydrostatic compression (with attachments intact). Levels of MMP-13, MMP-3 and TIMP-2 mRNA were evaluated in time-zero control, attached, stress-deprived and "compressed" tendons.

Results: Stress-deprivation led to elevated expression of MMP-13, MMP-3 and TIMP-2 in both tendons, although the magnitude of the increase was greater for the SST than the AT. Intermittent cyclic hydrostatic compression of attached tendons increased expression of MMP-13 in the SST, but not the AT.

Conclusions: The results of this study suggest that stress-deprivation may be one contributor to the progression of tendinopathy in AT and SST, where the tendon designed for the lower in vivo loading demand (SST) was the most affected by a change in mechanical loading. The unique up-regulation of MMP-13 with hydrostatic compression supports the impingement injury theory for rotator cuff tears.

We compared genotype frequencies of several polymorphisms that are candidates to influence sports performance (i.e., ACTN3 R577X, ACE ID, PPARGC1A Gly482Ser, AMPD1 C34T, CKMM 985bp/1170bp and GDF8 [myostatin] K153R) in 123 non-athletic controls, 50 professional cyclists, 52 Olympic-class runners and 39 World-class rowers (medalists in the World championships, lightweight category). We did not find significant differences in genotype distributions among the groups except for the ACE gene -that is, lower (P<0.05) proportion of II in rowers (10.3%) than in the total subject population (22.3%). In summary, sports performance is likely polygenic with the combined effect of hundreds of genetic variants, one possibly being the ACE ID polymorphism (at least in the sports studied here) but many others remain to be identified.

The electrocardiographic patterns of type I and type II second-degree AV block during sinus rhythm describe the behavior of the PR intervals (in sinus rhythm) in sequences (with at least 2 consecutive conducted PR intervals) where a single P wave fails to conduct to the ventricles.¹ Unfortunately the diagnosis of Mobitz type II second-degree AV block continues to be an important clinical problem because the standard definitions of second-degree AV block are often misinterpreted.¹ The literature is replete with cases of type I second-degree AV block labeled as type II block and similar errors have crept into the sports literature with claims that narrow QRS type II AV block can also occur in otherwise healthy young athletes^2-7 and less commonly after exercise in the form of vasovagal syncope.⁸ (Table I). These reports of type II block in athletes provided either no electrocardiograms or misdiagnosed ones. Furthermore, when stated, the definitions of type II block were inappropriate. The occurrence of type II block in young athletes is counterintuitive because it would imply serious disease of the His-Purkinje system and an absolute indication for a permanent pacemaker regardless of symptoms.¹ We were unable to find a single case of precisely documented type II block in young athletes. Yet, many review articles continue to list type II block as one of the manifestations of the athlete's heart.^9-12 Accurate diagnosis of type II block in athletes is critical and will affect treatment recommendations. Based on these considerations there is a need for reviewing the pitfalls surrounding the diagnosis of type II block with emphasis on how errors can be avoided by strict adherence to definitions.

Objective: Determine if asymmetry relative to the preferred kicking leg exists for the psoas and quadratus lumborum muscles among elite Australian Football League (AFL) players.

Design: AFL players were assessed at 3 time points from 2005-2007 (start of pre-season, end of season and end of pre-season training). Magnetic Resonance Imaging (MRI) was used to determine the cross-sectional areas (CSAs) of the psoas and quadratus lumborum (QL) muscles at the L4-5 vertebral level (psoas) and the L3-4 vertebral level (QL).

Setting: MRI was performed in a hospital setting.

Participants: 54 professional AFL players were eligible to participate in this study. The number of subjects at each of the 3 time points was 36 for Time 1 (T1 Nov 2005), 31 for Time 2 (T2 Aug 06) and 43 for Time 3 (T3 Feb/Mar 07).

Risk Factors: The repeated measures factor in the analyses was ‘asymmetry’, defined as ‘ipsilateral’ or ‘contralateral’ to preferred kicking leg. Number of injuries (coded as 0, 1, 2 or more) was also included as a risk factor.

Main Outcome Measurements: The dependent variables were the CSAs of the psoas and QL muscles.

Results: At all 3 time points, the CSA of the psoas muscle was significantly greater ipsilateral to the kicking leg, while the CSA of the QL muscle was significantly greater on the side contralateral to the kicking leg. Asymmetry in muscle size was not related to number of injuries.

Conclusions: Asymmetry of the psoas and the quadratus lumborum muscle exists in elite AFL players.

Objective: The purpose of the present study was to conduct a process analysis of the effects of personality on physical activity intention and behaviour using the Theory of Planned Behaviour (TPB).

Design: Prospective study design with data collected by means of two questionnaires.

Methods: Data were obtained by means of two questionnaires, the initial questionnaire measured demographic characteristics, TPB constructs, physical activity intention and personality. The two week follow up questionnaire assessed self-report physical activity behaviour. A number of regression analysis were undertaken to identify the relationship between the variables and to determine mediation effects of the TPB constructs.

Patients: A random sample of individuals with Type II Diabetes was selected from the Diabetes Australia (Queensland) membership database. A total of 74 complete data sets were obtained.

Results: Intention explained 28 percent of the variance in physical activity behaviour. Attitude, subjective norm and PBC explained 73 percent of variance in physical activity intention. Attitude and PBC mediated the relationship between conscientiousness and physical activity intention.

Conclusions: These results provide preliminary evidence that targeting constructs proximal to the behaviour (attitudes and PBC) may be effective in overcoming inherent qualities such as personality in order to produce physical activity behaviour change within this sample population.

Background: sCD40L is a powerful marker of cardiovascular risk. Exercise is known to decrease cardiovascular risk, but the impact of ultra-endurance exercise on sCD40L responses is unknown.

Objective: To examine the relationship between ultra-endurance exercise in trained athletes and levels of sCD40L and its natural ligand sCD40.

Design: Control-trial, cross-over design, exercise intervention study of sCD40L and sCD40 levels.

Setting: Outdoor exercise and laboratory testing, single centre study, School of Physical Education, University of Otago, New Zealand.

Participants: Nine trained ultra-endurance athletes.

Interventions: Athletes exercised (cycled and jogged) for 17 of 24 hours. Venous blood was sampled at baseline and serially throughout exercise and 24 and 48 hours after exercise. The athletes completed a 24-hour control trial on a separate occasion, in randomised order.

Main outcome measurements: Mean levels of sCD40L and sCD40 during exercise and rest with 95% confidence intervals.

Results: sCD40L levels dropped steadily from baseline (median 4128 pg/ml) to a measured nadir at 24 hours following exercise (median 1409 pg/ml) (p= 0.01). The levels had started to rise again by 48 hours after exercise. When measured as a group, sCD40L levels remained constant during a control rest period. sCD40 levels remained constant on both exercise and control days.

Conclusion: Ultra-endurance exercise lowers the levels of the cardiovascular risk marker sCD40L in athletes. These results raise the possibility that exercise induced changes in sCD40L may provide one of the mechanisms by which exercise lowers cardiovascular risk.

Objective: To examine factors associated with tackles in rugby union and to assess their impact on the risk of injury.

Design: 2-season (2003/2004 and 2005/2006) prospective cohort design with video analysis.

Setting: 13 English Premiership clubs.

Participants: 645 players.

Main outcome measure: Relative risk (95% confidence interval) calculated by comparing the frequency of occurrence of risk factors in a cohort of players injured during tackles with their frequency of occurrence in tackles in general play.

Risk factors: Playing position; player’s speed, impact force, head position, head/neck flexion and body region struck in the tackle; sequence, direction and type of tackle; and location and type of injury.

Results: High speed going into the tackle, high impact force, collisions and contact with a player’s head/neck were identified as significant (p<0.01) risk factors for ball carriers and tacklers. Midfield backs were significantly (p<0.01) more prone to injury when tackling than other players. Relatively few tacklers were penalised by referees for collision tackles (general play: 2.0%; injured players: 3.3%) and tackles above the line of the shoulder (general play: 5.9%; injured players: 16.7%).

Conclusions: Advice in national and international injury prevention programmes for reducing the risk of injury in tackles is strongly supported by the results obtained from this study. These programmes should be reviewed, however, to provide specific advice for each type of tackle. Stricter implementation of the Laws of Rugby relating to collisions and tackles above the line of the shoulder may reduce the number of head/neck injuries sustained by ball carriers.

Objective: The functional 577R allele of the -actinin-3 (ACTN3) gene has been reported to be associated with elite power athlete status, while the nonfunctional 577XX genotype (predicts an -actinin-3 deficient phenotype) has been hypothesized as providing some sort of advantage for endurance athletes. In the present study we examined the distribution of ACTN3 genotypes and alleles in Russian endurance-oriented athletes and looked for association between ACTN3 genotypes and the competition results of rowers.

Methods: The study involved 456 Russian endurance-oriented athletes of regional or national competitive standard. ACTN3 genotype and allele frequencies were compared to 1,211 controls. The data from the Russian Cup Rowing Tournament were used to search for possible association between the ACTN3 genotype and the long-distance (~~ 6 km) rowing results of 54 athletes. DNA was extracted from mouthwash samples. Genotyping for the R577X variant was performed by PCR and restriction enzyme digestion.

Results: The frequencies of the ACTN3 577XX genotype (5.7% vs. 14.5%; P < 0.0001) and 577X allele (33.2% vs. 39.0%; P = 0.0025) were significantly lower in endurance-oriented athletes compared to the controls, and none of the highly elite athletes had the 577XX genotype. Furthermore, male rowers with ACTN3 577RR genotype showed better results (1339 ± 11 s) in long-distance rowing than carriers of 577RX (1386 ± 12 s) or 577XX (1402 ± 10 s) genotypes (P=0.016).

Conclusion: Our data show that the ACTN3 577X allele is underrepresented in Russian endurance athletes and is associated with the rowers’ competition results.

Objective: To describe injury incidence and association with type and volume of training in international rowers.

Design: A prospective cohort design was used over a 12 month period.

Patients: 20 international rowers who were competing as part of the Irish Amateur rowing Union squad system.

Methods: The rowers were interviewed monthly and data was collected regarding their training and competition exposure as well as their injury experience.

Results: A mean injury rate of 3.67 per 1000 exposure hours was reported with a total of 44 injuries reported in a 12 month period. The mean number of injuries sustained per athlete was 2.2 (1.24) over the 12 month period. The area where the greatest number of injuries were reported was the lumbar spine (31.82% of total injuries, 95% CI, 20-50) (Figure 2) followed by the knee (15.91% of total injuries, 95% CI, 10-30) and the cervical spine (11.36% of total injuries, 95% CI, 5-24). Half of the injuries (22 injuries, 50% of total reported injuries) were to the spine. (2 = 30.8, df = 9, P = 0.0003). Ergometer training load was the most significantly associated with injury risk (r = 0.68, P = 0.01).

Conclusion: International rowers are at higher risk of injury than most non-contact sports and some contact sports. The high risk of lumbar spine injury and the significant association of high volume of ergometer training merit further research to reduce time and competition lost to injury.

Objective: To investigate early clinical predictors of time to return to competition and of recurrence following hamstring strain.

Design: Prospective observational study.

Setting: Elite level of Australian Football competition.

Participants: 59 players who suffered a hamstring strain in 2002 season.

Predictors: Clinical assessment by a physiotherapist and questionnaire.

Main outcome measures: Time taken to return to play and recurrence of hamstring injury within 3 weeks.

Results: Players taking more than one day to walk pain-free were significantly more likely to take longer than three weeks to return to competition (AOR 4.0; 95% CI 1.3, 12.6; p=0.018). Nine players (15.2%) experienced an injury recurrence; all involving the biceps femoris. Recurrence was more likely in players who reported a hamstring injury in past 12 months (AOR 19.6; 95% CI: 1.5, 261.0; p=0.025).

Conclusion: Time to walk pain-free and previous hamstring injury are predictors of time to return to competition and recurrence, respectively, and should be included in a clinical assessment to aid in prognosis.

Objective: To study if a two bout exercise protocol can be used to make an objective, immediately available distinction between non-functional overreaching (NFO) and overtraining syndrome (OTS).

Design: Underperforming athletes who were diagnosed with the suspicion of NFO or OTS were included in the study. Recovery of the athletes was monitored by a sports physician to retrospectively distinguish NFO from OTS.

Setting: Sports medicine laboratory.

Participants: Ten underperforming athletes started and completed the protocol. Five athletes were retrospectively diagnosed with NFO and five were diagnosed with OTS.

Interventions: A two bout maximal exercise protocol was used to measure physical performance and stress induced hormonal reactions.

Main outcome measurements: Exercise duration, heart rate and blood lactate concentration were measured at the end of both exercise tests. Venous concentrations cortisol, adrenocorticotrophic hormone (ACTH), prolactin and growth hormone were measured both before and after both exercise tests.

Results: Maximal blood lactate concentration was lower in OTS compared to NFO, while resting concentrations of cortisol, ACTH and prolactin concentrations were higher. However, sensitivity of these measures was low. The ACTH and prolactin reactions to the second exercise bout were much higher in NFO athletes compared to OTS and showed the highest sensitivity for making the distinction.

Objective: To determine the relative accuracy during treadmill walking and motor vehicle travel of the ActivPAL^TM, PALlite^TM and Digi-Walker^TM accelerometers.

Methods: Forty healthy volunteers wearing all accelerometers undertook either five treadmill walks (n=20) at speeds ranging between 0.6–1.4m/s or a 15min motor vehicle journey (n=20). Step counts recorded by each accelerometer were compared to the actual step count determined by video analysis (treadmill walking) or to an actual step count of zero (motor vehicle). Mean percentage measurement error was calculated and compared between devices by one-way ANOVA and Student's t-test.

Results: For treadmill walking, the measurement error was lowest for the ActivPAL, with no significant differences between the ActivPAL and the PALlite monitors. The measurement error was significantly higher for the Digi-Walker at speeds of ≤1m/s. During vehicle travel erroneous steps were recorded by the PALlite (254 steps) and Digi-Walker (25 steps), but not the AcitvPAL monitor (0 steps).

Conclusions: The ActivPAL accelerometer accurately measures step count over a range of walking speeds and, unlike the other accelerometers tested, is not falsely triggered by motor vehicle travel.

Objective: The osseous ankle configuration (tibiotalar sector, talar radius and height) has been discovered as intrinsic risk factor for chronic ankle instability (CAI). These measurements were done on lateral radiographs only. The aim of this study was to measure osseous characteristics in the frontal plane and further lateral values.

Design: Case control study, Level III.

Setting: Radiological measurement of frontal and lateral radiographs by one independent, blinded radiologist using a digital DICOM/PACS system.

Patients: A group of 52 patients with CAI was compared to an age- and gender-matched control group of 52 healthy subjects.

Main Outcome Measurements: In the frontal plane: the depth of the talar curvature (froCu), the lateral and medial malleolar length. In the lateral plane: the position of the center of rotation to the tibial axis (TibCOR) and the lateral tibial surface angle (TLS).

Results: The froCu was deeper in patients with CAI (1.8±1mm) than in healthy subjects (1.0±0.4mm; P<0.05). The TibCOR was more anterior in patients with CAI (2.4±1.9mm) than in healthy subjects (1.5±2.2mm; P<0.05). The distance from the fibular tip to the center of rotation was smaller in patients with CAI (3.5±3.4mm) than in healthy subjects (6.5±3.3mm; P<0.05). The TLS, the length of the lateral and medial ankle were not significantly different.

Conclusions: This study supports that the osseous joint configuration is an intrinsic risk factor for CAI. It could be shown that CAI is characterized by a deeper frontal curvature of the talus and a more anterior position of the talus to the tibia.

Background: Tennis elbow is a tendinopathy affecting the upper extremity. Recent studies have shown high sensitivity for ultrasound (US) examination and high specificity for colour Doppler (CD) examination. There are no mid- or long-term follow-up investigations of the tendon structure and blood flow using these techniques.

Objective: To use US and CD to study structure and blood flow in the extensor origin in patients with tennis elbow treated with intra-tendinous injections.

Design: Follow-up study.

Setting: Sports Medicine Unit, Umeå University.

Patients: Twenty-five patients (twenty-eight elbows), age 46 years (27-66), treated with intratendinous injections due to chronic pain from tennis elbow.

Method: US- and CD-examination of the extensor origin was carried out at inclusion and at follow-up 2 years after intratendinous injection treatment with polidocanol and/or a local anaesthetic.

Main outcome measurements: US (structure) and CD (blood flow) findings.

Results: All patients had structural tendon changes and high blood flow at inclusion when given the injection treatment. At the 2-year follow up, structural tendon changes were seen in 20/28 elbows and high blood flow was seen in 4/28 elbows. The majority of patients with a good clinical result after treatment had no visible blood flow (17/20), but the structural changes showed no relation to a good result (13/20 remaining changes).

Conclusions: Doppler findings, but not structure, might be related to the clinical result after intra-tendinous injection treatment of tennis elbow.

Objective: To evaluate the osmotic and non-osmotic regulation of arginine vasopressin (AVP) during endurance cycling

Design: observational study

Setting: 109 km cycle race

Participants: 33 cyclists

Interventions: none

Main Outcome Measurements: plasma sodium concentration ([Na+]), plasma volume (PV) and plasma AVP concentration ([AVP]p)

Results: A 4-fold increase in [AVP]p occurred despite a 2 mmol/L decrease in plasma [Na+] combined with only modest (5%) plasma volume contraction. A significant inverse correlation was noted between [AVP]p Ä versus urine osmolality Ä (r=-0.41; p<0.05) while non-significant inverse correlations were noted between [AVP]p versus both plasma [Na+] Ä and % PV Ä. Four cyclists finished the race with asymptomatic hyponatraemia. The only significant difference between the entire cohort with this subset of athletes was post-race plasma [Na+] (137.7 vs. 133.5 mmol/L; p<0.001) and plasma [Na+] Ä (-1.9 vs. -5.1 mmol/L; p<0.05). The mean pre-race [AVP]p of these four cyclists was just below the minimum detectable limit (0.3 pg/mL) and increased marginally (0.4 pg/mL) despite the decline in plasma [Na+].

Conclusions: Non-osmotic AVP secretion overshadowed the osmotic regulation of [AVP]p during competitive cycling. The modest decrease in plasma volume was not the primary non-osmotic stimulus to AVP. Partial suppression of AVP occurred in four (12%) cyclists who developed hyponatraemia during five hours of riding. Therefore, these results confirm that non-osmotic AVP secretion and EAH does, in fact, occur in cyclists participating in a 109 km cycle race. However, the stimuli to AVP is likely different between cycling versus running.

Background: For a given subject, time in moderate to very vigorous intensity physical activity (MVPA) varies substantially among physical activity monitors.

Objective: The primary objective of the present study was to determine whether time in MVPA recorded with SenseWear^TM Pro2 Armband (Armband), ActiGraph, ikcal and ActiReg® is different compared to indirect calorimetry. The secondary objective was to determine whether these activity monitors estimate energy expenditure different compared to indirect calorimetry.

Material and methods: Fourteen men and six women wore the activity monitors and a portable oxygen analyzer for 120 minutes doing a variety of activities of different intensities. Resting metabolic rate (RMR) was measured with indirect calorimetry. The cut off points defining moderate, vigorous and very vigorous intensity were 3, 6 and 9 times RMR.

Results: Armband and ActiGraph overestimated time in MVPA by 2.9 and 2.5% and ikcal and ActiReg® underestimated time in MVPA by 11.6 and 98.7%, respectively. ActiReg® (p=0.004) and ActiGraph (p=0.007) underestimated energy expenditure in MVPA and all monitors underestimated total energy expenditure (by 5 to 21%). Conclusions: Recorded time in MVPA and energy expenditure varies substantially among physical activity monitors. Thus, when comparing physical activity level among studies, it is essential to know the type of physical activity monitor being used.

Objective: To study trends in general practitioners’ knowledge, confidence, and practices in promoting physical activity to patients over a ten year period (1997-2007). Design: Repeated cross sectional population survey. Setting: General practice in New South Wales (Australia). Participants: 646 (40%), 747 (53%), and 511 (64%) general practitioners that were registered in a selection of urban and rural divisions in New South Wales participated in 2007, 2000, and 1997, respectively. Main outcome measures: Self report questionnaire on the general practitioner’s knowledge, confidence, role perception, attendance of continuous professional development, and counselling practice with regard to promoting physical activity in their patients. Results: The majority of general practitioners felt confident in giving physical activity advice and saw it as their role to do so. The proportion of general practitioners with high confidence and role perception increased between 1997 and 2000 (p< 0.001) but remained unchanged thereafter. In 1997, general practitioners were 0.54 times less likely (95%CI 0.42 to 0.69, p< 0.001) to discuss physical activity with more than 10 patients per week than general practitioners in 2007. However, the percentage of new patients that were asked about their physical activity did not change over the last decade. Conclusions: Most increases in the proportion of general practitioners reporting high knowledge, role perception, and confidence in giving physical activity advice to patients occurred between 1997 and 2000, and remained unchanged thereafter. In 2007, general practitioners appeared to give more physical activity advice, but Australian general practice is not yet living up to its potential with regard to physical activity promotion.

Objectives: To compare serum levels of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) between patients with a history of Achilles tendon rupture and blood donor controls, and to relate MMPs and TIMPs to mechanical properties of the tendons during healing.

Methods: More than three years after injury, we measured serum levels of MMP-1, -2, -3, -7, -8, -9 and -13 and TIMP-1 and -2 in eight patients who had suffered Achilles tendon rupture. Twelve blood donors served as controls. During the early phase of healing, the tendon modulus of elasticity was calculated from radiostereometric data and tendon cross-sectional area.

Results: Patients with a history of Achilles tendon rupture had increased levels of MMP-2 (median difference (m.d.) 10 %; p = 0.01), MMP-7 (m.d. 15 %; p = 0.02) and TIMP-2 (m.d. 36%; p = 0.02), as compared to controls. Levels of MMP-7, measured three years after injury, correlated inversely to tendon modulus of elasticity (rs = -0.83; p = 0.02), and positively to tendon elongation (rs = 0.74; p = 0.05) during the early phase of healing. There was a trend towards positive correlation between MMP-7 and cross-sectional area during the early phase of healing (rs = 0.67; p = 0.08).

Conclusions: Patients with a history of Achilles tendon rupture appear to have elevated levels of MMP-2, MMP-7 and TIMP-2 in serum. These pilot data support the view that the MMP-TIMP system is involved in tendinopathy and suggest that disturbances in proteolytic control might be generalised.

Objective Measuring physical activity is a key part of studying its health effects. Questionnaires and pedometers each have weaknesses but are the cheapest and easiest to use measurement methods for large scale studies. We examined their capacity to detect expected associations between physical activity and a range of surrogate health measures.

Design Cross sectional analysis of 669 community dwelling participants (mean age 63.3 ± 7.7 years) who completed the Physical Activity Scale for the Elderly "PASE" questionnaire and, within 2 weeks, wore a pedometer for seven days.

Results PASE score and step count were only poorly correlated, r=0.37 in women, r= 0.30 in men. Of 12 expected associations examined between activity and surrogate markers of health, ten were detected as statistically significant by step counts but only 3 by PASE scores. Significant associations in the expected direction were found between step counts and high density lipoprotein, body mass index (BMI), waist circumference (WC), waist hip ratio (WHR), blood glucose level, white cell count, and fibrinogen. There was no association with either systolic or diastolic blood pressure. The association between PASE score and these markers was detected as significant only for BMI and WC in women, and WHR in both sexes. Associations were stronger for steps multiplied by stride length than for raw step count.

Conclusions Pedometer derived step counts are a more valid measurement of overall physical activity in this sample than PASE score. Researchers should use objective measures of physical activity whenever possible.

Objectives: To develop a profile of direct catastrophic injuries in international styles of wrestling and to describe possible risk factors.

Design: Survey and retrospective review

Setting: Catastrophic injuries which occurred in wrestling clubs in Iran from July 1998 to June 2005 were identified by contacting several sources. The cases were retrospectively reviewed.

Results: The injuries included were 29 direct injuries (fatalities: 12, non-fatal: 11, and serious: 6).The injury rate was: 1.99 direct catastrophic injuries /100,000 wrestlers/year. The majority of direct injuries occurred during training sessions, with a trend toward more injuries in the low- and middle-weight classes and those who were competing at high performance and experience levels. The takedown position, especially for the attacking wrestler who faces a counter attack, was the most common activity at the time of injury. A list of risk factors was suggested of which ‘performing the wrestling maneuver incorrectly’, ‘inappropriate management of the injury’, ‘lack of the coach supervision’, ‘mat problems’ and ‘lack of restraining the wrestlers in a precarious position’ were the most common risk factors.

Conclusions: Catastrophic wrestling injuries are rare and preventable. Coaches have an essential role in the prevention of these injuries.

Background: There is considerable evidence that respiratory muscle training improves pulmonary function, quality of life and exercise performance in healthy athletic populations. The benefits for wheelchair athletes are less well understood. Therefore, the present study examined the influence of inspiratory muscle training (IMT) upon respiratory function and repetitive propulsive sprint performance in wheelchair basketball players.

Methods: Using a placebo-controlled design, 16 wheelchair athletes were divided to an experimental (IMT; n=8) or placebo (sham-IMT; n=8) group based upon selective grouping criteria. The IMT group performed 30 dynamic breaths, twice daily at a resistance equivalent to 50% Maximum Inspiratory Pressure (MIP) and the sham-IMT group performed 60 slow breaths once a day at 15% MIP for a period of 6 weeks.

Results: The IMT group improved both MIP and MEP (17%, 23% respectively; p ≤0.03). Similar improvements were noted for the sham-IMT group with 23% and 33% from base-line for MIP and MEP respectively (p ≤0.03). There were no significant changes in pulmonary function at rest and any of the performance parameters associated with the repetitive sprint test (sprint and recovery times, HRpeak and peak blood lactate concentration). Reported experiences of using the IMT training device suggested ‘less breathlessness’ and ‘less tightness in the chest during the training’

Conclusions: Although there was no improvement in sprint performance, participants in both the IMT and sham-IMT reported an improved respiratory muscle function and quality of life.

BACKGROUND: The core components of physical activity, cardiovascular endurance, muscular strength, balance, and flexibility, can provide many health benefits and potentially slow declines associated with aging. National health authorities have widely promoted aerobic exercise message to the public, although the promotion of resistance training has received far less attention.

OBJECTIVES: The primary aim of this research was to assess the prevalence of resistance training in a sample of adults living in regional Australia.

DESIGN: A Computer -Assisted -Telephone-Interview (CATI) survey (n=1230) conducted by Population Research Laboratory at Central Queensland University performed a survey of Queensland adults in October-November 2006. Respondents were asked to report the frequency with which they engaged in resistance training.

PARTICIPANTS: Respondents were 18 years of age or older that could be contacted by direct-dialled, land-based telephone service. A telephone database using a computer program to select, with replacement, a simple random sample of phone numbers selected respondents.

RESULTS: Almost 14% of the population did some form of gym-based resistance training in the week prior to the survey. There was a significant (p<0.05) reduction in participation levels with age. Participation was highest amongst the youngest 18-34 year olds (23.8%) steadily declining with age to a low of 7% in the 55 years and older age group. There was no significant association between genders and participation in resistance training.

CONCLUSIONS: The findings underscore the need to increase overall education on the benefits of resistance training with an emphasis among targeted adult populations to increase participation in resistance training.

ABSTRACT

Objective

To identify the presence and severity of External Auditory Canal Exostoses (EACE) in a group of white water kayakers related to the duration and intensity of kayaking and the number of ear infections reported.

Design

A community based volunteer cross sectional study was completed with 92 kayakers (69 male, 23 female, mean (SD) age 29.3 (8.72) years) and 65 control volunteers (37 male, 28 female, mean (SD) age 36.9 (14.9) years). Following exclusions 269 individual ears were examined (154 kayaker, 115 control). Participants completed a questionnaire and underwent otoscopic examination. Main outcome measures were the presence and severity of EACE, the duration and frequency of kayaking and self-reported ear infections. Exclusion criteria included other cold water exposure, known ear pathology or poor visualisation of the auditory canal.

Results

The findings demonstrate that 69.5% of kayaker ears and 1.7% of the control group were found to have EACE. Severity of EACE was significantly associated with the duration (p<0.01) and frequency (p<0.05) of kayaking with 90.6% of kayakers that had participated for over 10 years having evidence of EACE. A significant relationship also existed between the number of self-reported ear infections and the severity of EACE (p<0.01).

Conclusion

There is a positive relationship between the duration and frequency of white water kayaking and the presence and severity of EACE and associated ear infections.

Background: regular intensive physical activity is associated with nonpathological changes in cardiac morphology. Differential diagnosis with arrhythmogenic right ventricular cardiomyopathy (ARVC) constitutes a not infrequent problem, especially in athletes showing ventricular arrhythmias with left bundle branch block morphology.

Aim of the study: to assess the different clinical and non invasive instrumental features of subjects affected by ARVC and of athletes. Methods: three groups of subjects (40 ARVC patients, 40 athletes and 40 controls, mean age 27+/- 9 yrs) were examined with family and personal history, physical examination, 12-lead ECG, 24 hour ECG, signal-averaged ECG and 2D-and Doppler echocardiography.

Results: 12-lead ECG was abnormal in 62% of ARVC pts vs 7.5% of athletes and 2.5% of controls (p<0.0001). Ventricular arrhythmias and late potentials were present in 70% and 55 % of ARVC subjects, respectively (vs 5% of athletes and 7.5% of controls, p<0.0001). Left ventricular parietal wall thickness and left ventricular-end diastolic diameters were significantly higher in athletes. Moreover right ventricular (RV) outflow tract, measured on parasternal long axis and at the level of aortic root, was significantly larger in ARVC patients (33.6±4.7 mm vs 29.1±3.4 mm and 35.6±6.8 mm vs 30.1±2.9 mm, p<0.0001) and RV fractional shortening and ejection fraction were significantly lower in ARVC patients compared to athletes (40±7.9% vs 44+/-±10%, p=0.05 and 52.9±8% vs 59.9±4.5%, p<0.0001). A thickened moderator band was found to be present in similar percentage in ARVC patients and athletes.

Conclusion: an accurate clinical and instrumental non invasive evaluation including echocardiography as imaging technique allows to distinguish RV alterations typical of ARVC from those detected in athletes as a consequence of intensive physical activity.

Occasional piece - no abstract

Educational article no abstract

Background: Pre-cooling has been shown to enhance performance in repeated sprint exercise in able-bodied subjects in a hot environment. Spinal cord injury causes thermoregulatory impairment with a detrimental effect on performance. This study assessed whether cooling strategies prior to and during exercise in the heat enhances sprint performance in tetraplegic athletes.

Methods: Eight male tetraplegic athletes performed arm crank intermittent exercise in the heat (32.0 ± 0.1°C, humidity 50 ± 0.1%) for a maximum of 60 min or until exhaustion. Trials involved a no cooling control (CON), pre-cooling (PRE) or cooling during exercise (DUR). Each intermittent sprint protocol consisted of varied periods of passive rest, maximal sprinting and active recovery.

Results: Both PRE and DUR cooling strategies improved the ability of the athletes to repeatedly perform high intensity sprints, with times to exhaustion (TTE) of 47.2 ±10.8 and 52.8 ±5.8 min respectively (P < 0.05). During the CON trial athletes demonstrated a reduction in the total number of sprints they were able to perform (18.13 ± 4.8 sprints; 36.2 ±9.6 min). Core temperature was significantly higher for CON (37.3 ± 0.3°C) when compared to both PRE and DUR (36.5 ± 0.6°C and 37.0 ± 0.5°C respectively; P < 0.01). Ratings of perceived exertion and thermal sensation upon exhaustion or completion were not different.

Conclusions: Tetraplegic athletes should use a pre-cooling or during exercise cooling strategy when performing intermittent sprint exercise in hot conditions to improve performance.

Objective: To examine whether physical activity is independently associated with direct health care costs in community-dwelling older adults with multiple chronic conditions.

Design: Cross-sectional analysis.

Setting: Research laboratory.

Participants: Two hundred and nine community-dwelling men and women volunteers aged 65 years and older with chronic conditions.

Intervention: None.

Main Outcome Measures: Primary dependent variable was direct health care costs incurred in the previous three months. Participants completed the Health Resource Utilization (HRU) questionnaire. To estimate HRU, direct costs in the previous three months were calculated using the third party payer perspective of the British Columbia Ministry of Health, deemed representative of the Canadian health care system costs. For medications, we used the Retail Pharmacy Dispensed prescription cost tables. Primary independent variables were: 1) self-report current level of physical activity as assessed by the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD); and 2) general balance and mobility as assessed by the National Institute on Aging Balance Scale.

Results: The mean number of chronic conditions per participant was six. Current level of physical activity was independently and inversely associated with HRU. Age, gender, number of chronic conditions, global cognitive function, body mass index, and general balance and mobility together accounted for 24.3% of the total variance. Adding PASIPD score resulted in an R-square change of 3.3% and significantly improved the model. The total variance accounted by the final model was 27.6%.

Conclusions: Physical activity promotion may reduce health care costs in older adults with chronic conditions.

Objective: To assess the hydration status of amateur cyclists who voluntarily adjusted their fluid intake to environmental conditions in a three-day, 248 km mountain bike (MTB) race

Design: Prospective observational field study.

Setting: Sani2C MTB Race, KwaZulu-Natal, South Africa, 2006.

Participants: 18 randomly selected amateur, male MTB cyclists

Main Outcome Measures: Reported usual fluid intake, environmental conditions, voluntary fluid intake, urine voided, changes in body mass, serum osmolality (SO), sodium concentration [Na⁺], and urinary specific gravity (Usg) during each stage (S).

Results: Dry bulb temperature (adjusted for windchill) ranged from 6 - 21.4°C during S1, S2 & S3. While 77.8 % (n =14) of subjects reported a usual intake of >750 ml. hr^-1 in previous MTB events, mean (±SEM) fluid intake in this race ranged from 341 (±32) ml. hr^-1 during S1 to 551 (±56) ml. hr^-1 during S3. Changes in mean body mass ranged between -0.99 and -2.02 % during the three stages. Mean SO and serum [Na⁺] ranged between 292 (±0.73) and 298 mosm.kg^-1 and 137 (±0.35) and 140 (±0.42) meq., respectively, during the three-day period, while Usg remained ≤1.025.

Conclusion: Ad libitum fluid intake during the 2006 Sani2C MTB Race which took place in unexpectedly cold environmental conditions, was slightly below current recommendations and substantially lower than the usual reported fluid intake of subjects. Changes in body mass, SO, serum [Na⁺] and Usg were not clinically significant, indicating that adequate an hydration status was maintained during the multi-day MTB cycle race.

This study examined the effect of a 5-min cold water immersion (CWI; 14°C) recovery intervention on repeated cycling performance in the heat. Ten male cyclists performed two bouts of a 25-min constant paced (254±22W) cycling session (CP) followed by a 4-km time trial (TT) in hot conditions (35°C, 40% relative humidity). The two bouts were separated by either 15-min of seated recovery in the heat (CON), or the same condition with 5-min CWI (5th-10th min), in a counterbalanced cross-over design (CP1TT1 -> CWI or CON -> CP2TT2). Rectal temperature (T^re) was measured immediately before and after both the CP sessions and 4 km TTs. Cycling economy and VO₂ were measured during the CP sessions and the average power output (PO) and completion times (CT) were recorded for each TT. Compared with CON, T^re was significantly lower (0.5±0.4°C) in CWI before CP2 until the end of TT2. However, the increase in T^re (0.5±0.2°C) during CP2 was not significantly different between conditions. During TT2, PO was significantly greater in CWI (327.9 ± 55.7 W) compared with CON (288.0 ± 58.8 W), leading to a faster CT in CWI (6.1 ± 0.3 s) compared with CON (6.4 ± 0.5 s). Economy and VO₂ were not influence by the CWI recovery intervention. In conclusion, 5-min CWI recovery significantly lowered T^re and maintained endurance performance during subsequent high-intensity exercise. These data indicate that repeated exercise performance in heat may be improved when a short period of CWI is applied during the recovery period.

Objective: The potential of currently available padded soccer goalkeeper shorts to prevent hip injuries sustained in side jumps was investigated.

Design: Within the scope of this study a survey among professional and amateur goalkeepers, trainers as well as the medical staff was performed. In addition commercially available shorts were impact-tested using an artificial hip model. The results were compared to requirements established for hip protectors for elderly.

Results: As results of the survey it was found that contusions and abrasions were observed most often for all players. Fractures and arthritis were only reported by amateur players, whereas bursitis was more frequently observed by professional players. Amateurs have a significantly higher risk of injury than professional players and the higher injury risk during training is significantly higher compared to the injury risk during a match. No difference of the injury risk was found between goalkeepers wearing padded shorts and those who did not. Impact tests indicated a wide range of performance of the currently available products. The padded shorts generally reduce impact forces, but mostly perform poorly. Only shorts that were made of visco-elastic foam fulfilled the basic requirements requested for hip protectors for elderly.

Conclusions: The quality of most of the currently available goalkeeper shorts needs to be improved in order to effectively prevent hip injury sustained in side jumps.

Background and aims: The validity of five brands of cycle ergometers was evaluated by the comparison of the VO₂ requirements at different displayed power.

Methods and results: Five physically active males performed a continuous incremental exercise test on five ergometers (Ergomeca, Lifecycle, Monark, Polar S710 and Computrainer). The latter was also compared with a standard dynamometer in order to associate VO₂ values with the real power. Every test started by 5-min warm up on the same cycle-ergometer (Ergomeca) at 100 W to make sure that the VO₂ differences do not come from VO₂ measurement error. Only last minute steady state VO₂ values of each 2-min stage were used for the VO₂/Watt curve. Large differences (5 to 10 ml kg-1 min-1) at the same displayed power indicate inaccuracy of displayed power output (PO). Using corrected power values from the dynamometer revealed that for the same VO₂ the Computrainer underestimates PO by ~30 W between 100 and 300 W while the Lifecycle overestimate it by 3 to 53 W from 100 to 300 W. The Monark and Polar S710 underestimate PO by 15 W and the Ergomeca by ~5 W.

Conclusion: Inaccuracies between -10 to 18% in displayed PO of various cycle ergometers, question their interchangeability.

Objective: To evaluate the impact of regular training on left ventricle morphology in a group of Bicuspid aortic valve ( BAV ) athletes, considering BAV as a common congenital cardiac condition which is normally compatible with sports activity in the presence of mild aortic regurgitation.

Design: A group of competitive athletes with BAV was followed with a yearly standard echocardiographic examination for five years .

Setting: Sport Medicine Centre, University of Florence, Pre-Partecipation Protocol Study.

Participants: A group of 88 consecutive athletes diagnosed with BAV was followed from January to December 1999 and 30 of these completed a 5-year follow-up. They were compared with a group of 56 athletes with a normal tricuspid valve (TAV).

Results: BAV athletes showed significant progressive increase in left ventricular dimensions and aortic diameters at four levels .The values were within the range of the general and non-athletic BAV populations. In TAV athletes, the aortic and left ventricle dimensions did not increase significantly and remained within physiological range.

Conclusions: Left ventricular measurements in competitive BAV athletes maintain the normal range; there is however a significant progressive increase in the BAV group as compared with the TAV one. Our results are in agreement with data obtained in previous studies on the non-athletic BAV population . Sports activity does not have an additional effect on cardiac morphology in athletes with asymptomatic BAV associated with mild regurgitation, for at least five years.

Objective: To investigate the effects of Difflam^TM Forte Anti-inflammatory Throat Spray on the incidence of upper respiratory symptoms (URS) and inflammatory responses following a half-marathon race. Design and Setting: Double-blind placebo-controlled randomised trial conducted in association with a half-marathon event.

Participants: Forty-five well-trained half-marathon runners

Interventions: Difflam^TM Forte Anti-inflammatory Throat Spray (n=25) or Placebo (n=20) throat sprays were self-administered three times daily for one week prior to and two weeks following the race.

Main outcome measures: Self-reported respiratory symptoms; plasma prostaglandin E2, myeloperoxidase, Interleukin (IL)-6, IL-8, IL-10 and IL-1 receptor antagonist (IL-1ra) concentrations; and salivary myeloperoxidase and IL-6 concentrations.

Results: All subjects completed the intervention without reporting any adverse events. The proportion of athletes reporting URS was not substantially different between Difflam (52%) and Placebo (56%) groups (p=0.82). However, symptom severity scores were ~30% lower during Difflam^TM Forte Anti-inflammatory Throat Spray treatment (7.4 ± 8.2 versus 9.9 ± 11.7 arbitrary units). Post-exercise responses in plasma inflammatory markers did not differ substantially between Difflam and Placebo groups. Post-race increases in salivary myeloperoxidase (~63%; trivial to moderate difference; p=0.13) and salivary IL-6 (~50%; trivial to moderate difference; p=0.25) were greater in the Difflam group.

Conclusions: Prophylactic use of the Difflam^TM Forte Anti-inflammatory Throat Spray reduced the severity, but not the frequency of upper respiratory symptoms among half-marathon runners. Post-race increases in systemic inflammatory markers were not altered by Difflam^TM Forte Anti-inflammatory Throat Spray use, but markers of local inflammation (salivary myeloperoxidase and IL-6) were augmented in the Difflam compared with the Placebo group.

Background: Animal models for the study of tendinopathy and bone-tendon (B-T) junction repair have been established in the past for sports medicine research. As healing at B-T junction is difficult and sometime with delay in healing, establishing a delayed B-T healing experimental model is therefore essential to study efficacy of potential biophysical and biological interventions for treatment of B-T junction healing.

Objective: We hypothesized that a delay in B-T healing could be modeled by shielding the B-T healing interface for the initial few weeks.

Methods: Using an established partial patellectomy model in rabbits, the B-T healing interface was shielded with a latex slice for the first 4 postoperative weeks in mature female rabbits. The characteristics of delay in B-T repair (n=10) were compared with controls (n=10) were evaluated at 8 and 12 postoperative weeks.

Results: Radiology showed consistent delay in osteogenesis at healing interface in all samples in the delayed healing group, with new bone size of only 25.8% and 50.1% of the control groups at week 8 and 12, respectively. Bone mineral density was 56.0% lower in the delayed healing group at week 8, but this difference diminished at week 12. The quality of B-T healing was poor in the delayed healing group, with 22.9% and 24.2% lower failure load than the control group at week 8 and week 12, respectively. The healing quality was also echoed by histological findings.

Conclusions: A delayed B-T healing experimental model was established for the first time for future sports medicine research.

Objective: To examine the amplitude and time distribution of power output in a variety of competitive cycling events through the use of a new mathematical analysis; exposure variation analysis (EVA).

Design: Descriptive field study

Setting: Various professional road cycling events, including; a 5 day - 8 stage tour race, a one day World Cup event and the Australian National Individual Time Trial Championships.

Participants: Nine elite female cyclists (mean ± SD: mass = 57.8 ± 3.4 kg, height = 167.3 ± 2.8cm, VO_2peak = 63.2 ± 5.2 mL^.kg^-1.min^-1).

Interventions: None.

Main Outcome Measurements: The examination of the variation in power output and the quantification of the total time and acute time spent at various exercise intensities during competitive professional cycling. Pre-defined levels of exercise intensity that elicited first ventilation threshold, second ventilation threshold and maximal aerobic power were determined from a graded exercise test performed prior to the events and compared with power output during each event.

Results: Exposure variation analysis exposed that power output during the time trial was highly variable (EVA_SD = 2.81 ± 0.33) but more evenly distributed than the circuit/criterium (4.23 ± 0.31) and road race events (4.81 ± 0.96).

Conclusion: Exposure variation analysis may be useful for illustrating variations in the amplitude and time distribution of power output during cycling events. The specific race format influenced not only the overall time spent in various power bands, but also the acute time spent at these exercise intensities.

Background Several studies have revealed that the Masai, pastoralists in Tanzania, have low rates of coronary heart disease (CHD) despite a diet high in saturated fat. It has also been suggested that they may be genetically protected. Recent studies detailing other potential protective factors, however, are lacking.

Methods A cross-sectional investigation of 985 Tanzanians men and women (130 Masai, 371 rural Bantu and 484 urban Bantu) with mean age 46.0 [SD 9.3]. Anthropometric measures, blood pressure, serum lipids, and the reported dietary pattern and physical activity level were assessed.

Results Eighty two percents of Masai subjects reported a high fat/low carbohydrate intake, whereas 77% of the rural Bantu subjects reported a low fat/high carbohydrate intake, and a high fat/high carbohydrate intake was the main dietary pattern of the urban Bantu group as reported by 55%. The most conspicuous finding for the Masai was the extremely high energy expenditure, corresponding to 2565 kcal/day over basal requirements, compared to 1500 kcal/day in the rural and 891 kcal/day for the urban Bantu. Mean body mass index among the Masai was lower than among the rural and urban Bantu. Mean systolic blood pressure of the Masai was also lower compared to their rural and urban Bantu counterparts. The Masai revealed a favourable lipid profile.

Conclusion The potentially atherogenic diet among the Masai was not reflected in serum lipids and was offset probably by very high energy expenditure levels and low body weight.

Key terms: Masai, Bantu, energy expenditure, diet, cardiovascular disease.

The central fatigue hypothesis describes a possible link between the neurotransmitter, 5-hydroxytryptamine (5-HT), plasma tryptophan and branched chain amino acids concentration and exercise-induced fatigue. Recent investigations studied 5-HT receptors and neuroendocrine "challenge" tests, using prolactin release as an indirect measure of 5-HT activity. The present study combined the original hypothesis about the role of amino acids in increasing brain 5-HT with a neuroendocrine challenge test on elite athletes diagnosed with unexplained, underperformance syndrome (UUPS). There was an apparent increased sensitivity of 5-HT receptors in athletes with UUPS compared with fit, well-trained controls, as measured via increased prolactin release following a bolus dose of m-chlorophenylpiperazine, a 5-HT agonist. No changes were observed in plasma amino acid concentrations in either group. There is evidence that well-trained athletes have a reduced sensitivity of 5-HT receptors. The present study suggests that this adaptation may be lost in athletes with UUPS: this might explain some of their observed symptoms.

Objective: To clarify whether sickle cell trait (SCT) carriers (SCT group) present a specific post-exercise inflammatory response to repeated and strenuous exercise.

Design: The patterns of inflammatory markers in response to repeated heavy exercise were investigated in SCT carriers (SCT group: 8 men, 20.0 ± 0.7 yrs) and subjects with normal haemoglobin (CONT group: 7 men, 20.6 ± 0.7 yrs). The exercise consisted of three successive maximal ramp exercise tests, interspaced with 10 minutes of recovery, and accomplished at room temperature. Blood was sampled at rest (TR), at the end of each of the three tests (T1, T2, T3), and during the immediate (T1h, T2h) and late (T24h, T48h) recovery periods. Standard haematological parameters and plasma levels of cytokines (TNF-, IL-6) and adhesion molecules (sL-selectin, sP-selectin, sVCAM-1, sICAM-1) were measured.

Results: In both groups, the three successive maximal exercise bouts prompted an inflammatory response (i.e., white blood cells and IL-6 levels increased in response to exercise). sICAM-1 and sVCAM-1 levels did not change during or after exercise and presented no difference between groups. However, during exercise, sL-selectin and sP-selectin kinetics differed between groups: sL-selectin increased earlier in SCT group than in CONT group, and sP-selectin statistically increased only in SCT group.

Conclusion: Although the data do not indicate an extended exercise inflammatory response in SCT carriers, a specific activation of the L and P-selectins was observed. Further studies are needed to determine whether the selectins¡¦ changes are evidence of greater risk for SCT carriers during physical exercise in specific conditions or an indication of a protective mechanism mediated by the shedding process of adhesion molecules.

Objective: To investigate structure, blood flow and thickness in the Achilles tendon related to tendon-loading activity.

Design: Examination by ultrasound (US) and colour Doppler (CD) immediately before and after one hour of floor-ball matchplay.

Setting: Sports Medicine Unit, Umeå University, Sweden.

Participants: Thirty-six Achilles tendons in 18 middle-aged (mean 39 years) recreational male floor-ball players.

Main outcome measurements: Structure and high blood flow (HBF)/neovessels (NV) in the tendons were registered. Tendon thickness was measured 3 cm and 4.5 cm above the upper calcaneus, and at the thickest part of the tendon.

Results: The US examination showed that 11/36 tendons (30.5%) in nine individuals had structural changes before, and after, the floor-ball match. In 7/36 tendons (five with structural changes) there were HBF/NV before, and after, the match. In six of these seven tendons the blood flow was higher after than before the match. In three more tendons (two with structural changes) there were HBF/NV after, but not before, the match. After the match, mean tendon thickness had decreased significantly in both normal tendons and tendons with structural changes at the 3 cm level (6.0+1.0mm to 5.8+0.9mm;p<0.019), at the 4.5 cm level (5.7+1.1mm to 5.5+1.0mm;p<0.044), and at the thickest part (6.6+1.1mm to 6.3+1.2mm;p<0.000).

Conclusions: In about 1/3 of the tendons there were structural changes, about half of those tendons also had HBF/NV, that was higher after, than before, the match. Mean tendon thickness in both normal tendons and tendons with structural changes had decreased significantly after a one-hour floor-ball match.

We conducted a prospective observational study comparing salivary lactoferrin and lysozyme concentration over five months (chronic changes) in elite rowers (n=17, mean age 24.3 ± 4.0y) with sedentary individuals (controls) (n=18, mean age = 27.2 ± 7.1 y) and a graded exercise test to exhaustion (acute changes) with a cohort of elite rowers (n=11, mean age 24.7 ± 4.1). Magnitudes of differences and changes were interpreted as a standardized (Cohen’s) effect size (ES). Lactoferrin concentration in the observational study was approximately 60% lower in rowers than control subjects at baseline (7.9 ± 1.2 µg.ml-1 mean ± SEM, 19.4 ± 5.6 µg.ml-1, P=0.05, ES=0.68, ‘moderate’) and at the midpoint of the season (6.4 ± 1.4 µg.ml-1 mean ± SEM, 21.5 ± 4.2 µg.ml-1, P=0.001, ES=0.89, ‘moderate’). The concentration of lactoferrin at the end of the study was not statistically significant (P=0.1) between the groups. There was no significant difference between rowers and control subjects in lysozyme concentration during the study. There was a 50% increase in the concentration of lactoferrin (P=0.05, ES=1.04, ‘moderate’) and 55% increase in lysozyme (P=0.01, ES=3.0, ‘very large’) from pre-exercise to exhaustion in the graded exercise session. Lower concentrations of these proteins may be indicative of an impairment of innate protection of the upper respiratory tract. Increased salivary lactoferrin and lysozyme concentration following exhaustive exercise may be due to a transient activation response that increases protection in the immediate post exercise period.

Objectives: The six-minute walk test (6MWT) is a frequently used indicator of functional exercise capacity. The goals of this study were to compare the six-minute walk performance of three paediatric patient groups with that of healthy peers, to assess differences between published reference values and to investigate which anthropometric characteristics best predict six-minute walk performance.

Methods: Forty-seven children with haemophilia (mean ± SD age 12.5 ± 2.9), forty-four with juvenile idiopathic arthritis (JIA) (mean ± SD age 9.3 ± 2.2) and twenty-two with spina bifida (SB) (mean ± SD age 10.3 ± 3.1) were included. Subjects performed a 6MWT and the distance walked (6MWD) was compared with published reference values.

Results: The haemophilia, JIA, and SB patients respectively achieved 90-92%, 72-75% and 60-62% of predicted walking distances. There were significant associations between 6MWD and age, height and weight in the haemophilia group and 6MWD and height in the JIA group. None of the anthropometric variables was significantly related to 6MWD in the SB group. All anthropometric variables were strongly correlated with walking distance-body weight product (6Mwork) in all groups. Height explained 24% (haemophilia) and 11% (JIA) of the variance in 6MWD and 84% (haemophilia), 78% (JIA) and 73% (SB) of the variance in 6Mwork.

Conclusions: Walking distances of children with haemophilia, JIA and SB are significantly reduced compared to healthy references. Walking distance-body weight product seems to be a better outcome measure of the 6MWT compared to distance walked alone. Height is the best predictor of 6MWD and 6Mwork.

Objective: The aim of the study was to evaluate the influence of various anatomical and biomechanical factors on the ability to detect the magnitude of elbow extension during the cricket bowling action, with either the naked eye or from conventional two-dimensional video footage.

Design: Descriptive study Setting: One male bowler who had a large "carrying angle" was studied by means of a 3-dimensional biomechanical analysis using the Vicon MX13 motion analysis system when bowling at match pace. Photographs were taken from various angles during the bowling delivery action to illustrate factors influencing the visual appearance of an illegal delivery.

Main Outcome Measures: The influence of extension of the elbow joint and the elbow’s anatomically fixed position, known as the "carrying angle", on the visual perception of an illegal ("thrown") delivery were the main outcome measures.

Results: The elbow joint rotates about 90° as a result of humeral rotation during the movement of shoulder circumduction produced by the bowler’s delivery action. This causes the plane in which the elbow joint moves to change throughout the delivery action. This movement will also vary between bowlers. The movement of elbow planar flexion/extension can be viewed only when the viewer’s eyes are at exactly 90° to the plane of elbow joint movement. Thus a cricket umpire wishing to detect elbow extension during the bowler’s delivery action would need continuously to change his viewing position as the bowler’s arm moved from the horizontal to the vertical position at ball release. We show that by viewing the action from only one position, the umpire will be confused by the illusion of a "throw" produced by a large "carrying angle" in some bowlers.

Conclusion: It is impossible for an umpire conclusively to cite a bowler for an illegal action based only on naked eye observation. To do this the umpire would need to be in at least three different positions throughout a single delivery. Similarly video footage shot from at least three different angles during the bowler’s delivery action would need to be viewed by the match referee. By viewing the delivery from only one position, the visual illusion of a "throw" will be created by the presence of a large "carrying angle".

Background: New Zealand children’s health and fitness performance is declining over time, but whether this change is due to deterioration in all children’s health and fitness performance, or can be attributed to just a certain portion of the population is unknown.

Objectives: To track secular trends and distributional changes in health-and performance-related fitness components among New Zealand primary school children aged 10 to 14 years between 1991 and 2003.

Methods: Health-and performance-related fitness parameters including height, weight, body mass index (BMI), flexibility, standing broad jump, 4 x 9m agility run, abdominal curl-ups, and 550-m run were collected up to twice a year from 3306 children (10-14 years) from one New Zealand school between 1991 and 2003.

Results: Over the twelve year period boys’ weight increased by 4.5 kg (95% confidence limits CL = 2.7-6.2 kg or 0.8% per year) and girls’ by 3.9 kg (CL = 2.0 – 5.9 kg or 0.7% per year). Mean BMI increased by 0.12 kg.m-2 (0.6%) and 0.11 kg.m-2 (0.5%) per year for boys and girls respectively. Children’s 550-m run performance declined by 1.5% and 1.7% per year for boys and girls respectively. Little difference existed between children located in the highest performing and leanest percentiles in 1991 and 2003, but for children in the poorest performing and fattest percentiles, their results were substantially worse in 2003.

Conclusions: These results suggest that the deterioration in the health-and performance-related fitness components of New Zealand 10-14 year-olds is not homogeneous but skewed towards those children who are the heaviest and perform worst in fitness tests.

Purpose: This study examined the effects of variable- and constant-intensity cycling on muscle glycogen depletion patterns and subsequent running economy.

Methods: Nine male triathletes (VO₂max = 67.7 ± 4.9 mL•kg-1•min-1) completed 60 min of cycling at a constant power (CON) or variable intensity (VAR) followed by a treadmill run to determine running economy.

Results: During CON, there was greater glycogen depletion in the type I fibers compared to type II (0.08 ± 0.04 vs. 0.02 ± 0.01 optical density units (OD); P<0.05), while during VAR there was greater glycogen depletion in the type II fibers compared to type I (0.06 ± 0.03 vs. 0.03 ± 0.02 OD; P<0.05). The variation in muscle glycogen depletion patterns was not associated with the detriment in running economy, which was not significantly different between conditions (52.1 vs 52.8 mL•kg-1•min-1). There was a strong correlation between total muscle glycogen depletion and the change in running VO₂ (r = 0.73; P<0.05) when the data from both trials were combined. There was also a negative correlation between type I fiber percentage and glycogen depletion within type II fibers during CON (r = -0.85, P<0.05).

Conclusion: The results demonstrate that the decrease in running economy, subsequent to 60 min of cycling, is not affected by the cycling strategy employed. While different glycogen depletion patterns in the type I and II fibres were observed between conditions, total glycogen depletion may be more important to subsequent running economy. The percentage of type I fibers was associated with the glycogen depletion pattern during constant-load, but not variable-intensity exercise.

Objective: To determine the incidence and to identify gender-specific predictors of Running-Related Injury (RRI) among a group of recreational runners training for a four-mile running event.

Design: Prospective cohort study.

Methods: Several potential risk factors were prospectively measured in 629 novice and recreational runners. They were observed during an eight-week training period for any running-related musculoskeletal injuries of the lower limbs and back. A running-related injury was defined as any musculoskeletal pain of the lower limb or back causing a restriction of running for at least one day.

Results: At least one RRI was reported by 25.9% of the runners during the eight-week observation period. The incidence of RRI was 30.1 (95% confidence interval (CI) 25.4–34.7) per 1,000 hours of running exposure. Multivariate Cox regression showed that male participants were more prone to sustain a running-related injury than female participants (HR 1.4; 95% CI 1.0–2.0). No prior running experience was the most important risk factor in male (HR 2.6; 95% CI 1.2–5.5) and female (HR 2.1; 95% CI 1.2–3.7) participants.

Conclusions: The incidence of running-related injuries in recreational runners preparing for a four-mile running event is substantially high. Male and female participants have different risk profiles. Furthermore, the findings suggest that novice runners are the most availed by preventive interventions for RRI.

Background/Hypothesis: Shoulder pain in elite swimmers is common and its pathogenesis is uncertain.

Hypothesis/Study Design: We used a cross-sectional study design to test Jobe’s hypothesis that repetitive forceful swimming leads to shoulder laxity which in turn leads to impingement pain.

Methods: Eighty young elite swimmers (13-25 years of age) completed questionnaires on their swimming training, pain, and shoulder function. They were given a standardized clinical shoulder examination, and tested for glenohumeral joint laxity using a non-invasive electronic laxometer. 52/80 swimmers also attended for shoulder magnetic resonance imaging (MRI).

Results: 73/80 (91%) swimmers reported shoulder pain. Most (84%) had a positive impingement sign and 69% of those examined with MRI had supraspinatus tendinopathy. The impingement sign and MRI-determined supraspinatus tendinopathy correlated strongly (rs=0.49, p<0.00001). Increased tendon thickness correlated with supraspinatus tendinopathy (rs=0.37, p<0.01). Laxity correlated weakly with impingement pain (rs=0.23, p<0.05) and was not associated with supraspinatus tendinopathy (rs=0.14, p=0.32). The number of hours swum/week (rs=0.39, p<0.005) and weekly mileage (rs=0.34, p=0.01) both correlated significantly with supraspinatus tendinopathy. Swimming stroke preference did not.

Conclusions: These data indicate: (1) supraspinatus tendinopathy is the major cause of shoulder pain in elite swimmers; (2) this tendinopathy is induced by large amounts of swimming training; and (3) shoulder laxity per se has only a minimal association with shoulder impingement in elite swimmers. These findings are consistent with animal and tissue culture findings which support an alternate hypothesis: the intensity and duration of load to tendon fibers and cells causes tendinopathy, impingement, and shoulder pain.

Objectives: To explore the feasibility of conducting a 10-week home-based physical activity (PA) program and to evaluate the changes in insulin sensitivity commensurate with the program in obese young people.

Design: Open-labelled intervention

Setting: Home-based intervention with clinical assessments at a tertiary paediatric hospital. Subjects 18 obese (BMI>International Obesity Task Force age and sex-specific cut-offs) children and adolescents (8-18 years, 11 girls/7 boys) were recruited. 15 participants (9 girls/6 boys, mean±SE age 11.8±0.6 years, BMI-SDS 3.5±0.1, 6 prepubertal / 9 pubertal) completed the intervention. Intervention The program comprised biweekly home-visits over 10 weeks with personalized plans implemented aiming to increase moderate-intensity PA. Pedometers and physical activity diaries were used as self-monitoring tools. The goals were to a) teach participants behavioural skills related to adopting and maintaining an active lifestyle and b) increase daily participation in PA.

Outcome measures: Mean steps per day were assessed. Insulin sensitivity (S_I) assessed by the Frequently Sampled Intravenous Glucose Tolerance Test (FSIGT) and other components of the insulin resistance syndrome were measured.

Results: Mean steps per day increased significantly from 10,363±927 (baseline) to 13,013±1131 (week 10) (p<0.05). S_I was also significantly increased despite no change in BMI-SDS and remained so after an additional 10-weeks follow-up.

Conclusions: The results suggest that such a home-based PA program is feasible. Insulin sensitivity improved without changes in BMI. More rigorous evaluations of such programs are warranted.

Objective: To identify a seat pressure threshold that corresponds to significant compression of the perineum.

Design: Quasiexperimental crossover.

Setting: Radiology department of a hospital.

Participants: A convenience sample of 6 male recreational cyclists.

Intervention: Compression of the corpus spongiosum and corpora cavernosa of the perineum without bicycle seat pressure (0) and at 10%, 40%, and 80% of the mean bicycling pressure was assessed using MRI. Seat pressure was applied using a custom loading device designed to replicate seat pressure recorded during stationary bicycling.

Outcome Measure: Diameter measurements of the cavernous spaces at the point of peak compression.

Results: The mean diameter values for the corpus spongiosum in the unloaded and 10% of load conditions were 105% and 172% greater than the 40% and 80% loaded conditions, respectively (P = 0.002-0.004). Similarly, the corpora cavernosa values for the unloaded and 10% of max load conditions were 115% and 175% greater than the 40% and 80% loaded conditions, respectively (P = 0.001-0.0001).

Conclusions: From our data it may be suggested that substantial compression of the perineal cavernous spaces occurs with total seat pressure values of less than 40% of typical seat loads.

Objective: To examine the associations between physical activity (PA) and abdominal adiposity, as measured by waist circumference (WC), in children and adolescents, and to test whether cardiovascular fitness (CVF) modifies these associations.

Methods: PA components were measured by accelerometry in 1075 individuals aged 9 or 15 y. CVF was measured by a maximal cycling test. Self-reported maternal educational level, body mass index, children's birth weight and television viewing were used as confounders.

Results: Linear regression did not show any association between the PA variables and WC, after controlling for sex, age and height. When stratifying by CVF level (low/high), time spent at vigorous PA was inversely associated with WC (P<0.05) in the low CVF group. Unexpectedly, in the high CVF group, the PA variables were positively associated with WC (P<0.05). In both groups, the results were unchanged after controlling for the confounders. CVF was inversely associated with WC, after controlling for all PA variables (P<0.01) and confounders (P<0.01).

Conclusion: CVF is inversely associated with abdominal adiposity and seems to modify the associations between PA and abdominal adiposity. In low fit children and adolescents, time spent in vigorous PA seems to be the key component linked to abdominal adiposity. This finding should be considered in further development of lifestyle intervention strategies. The results found in the high fit group need to be confirmed.

Objectives: The Activity Watch 200 (AW200) is a new device which calculates energy expenditure (EE) based on movement detection. We aimed to validate EE measured by this device against indirect calorimetry (IC) and to assess the reproducibility of AW200 measurements.

Design: EE was assessed during a 9.7 km hike. Twenty 35-45 year old men (10) and women (10), and 11 50-55 year old men (5) and women (6) were tested. One in five subjects of each age and sex matched group was equipped with a portable metabograph (Oxycon Mobil) for IC measurements. Data were collected every 30 minutes during the hike and IC was extrapolated for the remaining 4 other subjects of the group.

Results: During the total hike there was a high correlation between EE obtained from the AW200 and the IC calculation (r=0.987, P<0.001). Identical values of EE were calculated by both methods during the first 90min of the hike. However, EE calculated by the AW200 at 120min and at the end of the hike was lower (P<0.05). Bland-Altman analysis showed limits of agreements between 105 and 279 kJ after 30min and 120min, respectively. EE measured by the AW200 was well correlated with IC measurements and limits of agreement between devices are below 10% of the measured values for hike durations longer than 60min.

Conclusion: The AW200 appears to be a very useful and accurate device for measuring EE during exercise in recreational hikers and provides a useful tool for keeping track of personal energy expenditure.

OBJECTIVE: Whole body vibration has been recently suggested as an alternative form of exercise. The aim of the study was to analyse the acute effects of a single session of whole body vibration exercise on anabolic hormones in aged individuals.

DESIGN: A Randomised cross-over trial design was used.

SETTINGS: Geriatrics department, Hospital.

PARTICIPANTS: Twenty subjects (9 males and 11 females; median age 70 years (range 66 to 85 years) volunteered in the experiment.

INTERVENTIONS: isometric squat on a platform with vibration (V) or no vibration (C) conditions.

MAIN OUTCOME MEASUREMENTS: Plasma Cortisol, Testosterone, Growth Hormone, and IGF-1 were measured before, after, 1h and 2h after the interventions.

REPORTS: A significant difference between treatments (P<.001) and a time by treatment interaction (P<.05) was found in IGF-1 levels. Cortisol levels were shown not to be significantly different between treatments (P=0.43) but a difference over time (P<.001) and a time x treatment interaction (P<.05) were identified. No significant differences were identified in GH and Testosterone levels.

CONCLUSIONS: the results of our study suggest that 5 minutes of WBV exercise characterised by static squat with a frequency of 30Hz can be performed by elderly individuals without apparent signs of stress and/or fatigue. Furthermore, the results of the study showed that WBV produced an acute increase in the circulating levels IGF-1 and cortisol greater than that observed following the same exercise protocol conducted without vibration.

Objectives: Regular physical activity is thought to be associated with better mental health, although there is lack of consensus regarding the optimal amount and type of activity to achieve these benefits. We examined the association between mental health and physical activity behaviours among a representative sample of men and women from the Scottish Health Surveys. Methods: Self reported physical activity was measured and the General Health Questionnaire (GHQ-12) was administered in order to obtain information on current mental health. Participants were 19 842 men and women. We calculated risk estimates per category of physical activity sessions per week using logistic regression models. Results: Psychological distress (based on a score of 4 or more on the GHQ-12) was evident in 3200 participants. Any form of daily physical activity was associated with a lower risk of psychological distress after adjustment for age, gender, social economic group, marital status, body mass index, long standing illness, smoking, and survey year (OR = 0.59, 95% CI, 0.52-0.66, P < 0.001). A dose-response relationship was apparent, with moderate reductions in psychological distress with less frequent activity (OR = 0.67, 0.61-0.75). Different types of activities including domestic (housework and gardening), walking, and sports were all independently associated with lower odds of psychological distress, although the strongest effects were observed for sports (OR=0.67, 0.54-0.82). Conclusion: Mental health benefits were observed at a minimal level of at least 20 minutes per week of any physical activity, although a dose-response pattern was demonstrated with greater risk reduction for activity at a higher volume and/or intensity.

Objective: To determine whether prolotherapy is effective in the treatment of deficient load transfer of the SIJ.

Design: A prospective descriptive study.

Setting: Authors’ private practice.

Participants:25 patients who consented to treatment and attended for at least one follow up visit and assessment.

Study period:From April 2004 to July 2007.

Intervention:Three injections of hypertonic dextrose solution into the dorsal interosseous ligament of the affected SIJ, under CT control, six weeks apart.

Main outcome measures: Quebec Back Pain Disability Scale, Roland Morris 24, Roland Morris 24 Multiform questionnaires and clinical examination by two authors independently. Clinical tests include active straight leg raise, sacroiliac joint glide, Stork (Gillet), stance phase and posterior pelvic pain provocation tests.

Results: All patients included in this study attended for at least one follow up visit at 3, 12 or 24 months. The number of patients at follow up decreased at 12 and 24 months. Functional questionnaires demonstrated significant improvements for those followed up at 3, 12 and 24 months (p < 0.05). Clinical scores showed significant improvement from commencement to three, 12 and 24 months (p < 0.001).

Conclusions:This descriptive study of prolotherapy in private practice has shown positive clinical outcomes for the 76% of patients who attended the 3 months and 12 months’ follow up visits and for the 32% of patients who attended follow up visits at 24 months. Similar results were found in the Questionnaires (Q, RM and RMM) at 3, 12 and 24 months. The findings of this study warrant further research.

Trial registration Written informed consent was obtained from all participants in the trial. This was conducted as a practice quality assurance project, and as such did not require ethics approval or trial registration.

Objective: This study investigated the hypothesis that tennis players with scapular dyskinesia present a smaller subacromial space than non-athletes. Additionally, the correlation between the size of the subacromial space and abnormalities in scapular movement during arm abduction was investigated.

Design: Cross sectional study.

Participants: A total of 53 elite tennis players and 20 control subjects were enrolled in the study. Participation was restricted to elite-level, junior tennis players who had no current shoulder pain or history of shoulder injuries.

Intervention: Each individual was examined for scapular dyskinesia by a single physician and by ultrasound, with the results analyzed in a blind fashion by a single radiologist.

Results: 43.4% of the tennis players and 20% of control subjects presented scapular dyskinesia. Of the 106 shoulders evaluated, 39.6% of tennis players and 10% of control subjects presented scapular dyskinesia in the clinical examination (p=0.005). Ultrasonographic measurements demonstrated that tennis players presented statistically smaller subacromial spaces compared to control subjects (p<0.001). A decrease in the subacromial space was observed in tennis players when the shoulder was raised from zero to 60° of abduction. However, dyskinesia-afflicted athletes demonstrated a significantly greater decrease following this movement (19,3 mm versus 13.8mm, p=0.002).

Conclusion: This study demonstrated that tennis players with scapular dyskinesia present a smaller subacromial space than control subjects. Additionally, when the shoulder was analyzed dynamically, moving from neutral abduction to 60° of elevation, the tennis players with scapular dyskinesia presented a greater reduction in the subacromial space compared to unaffected athletes.

Objective: To investigate the prevalence of abnormalities in the cervical spine of asymptomatic professional rugby players using both static and dynamic magnetic resonance imaging (MRI) in order to improve the detection of abnormalities and prevention of related injuries.

Design: Prospective observational study. Setting: French professional rugby union clubs, between 2002 and 2006.

Participants: 206 elite male adult players.

Intervention: Static sagittal T2 and axial T2* FSE, and dynamic sagittal SSFSE weighted MRI scans of the C2-C7 region were examined for the presence of abnormalities. Participants’ spines were in supine neutral position for the static protocol but were allowed complete flexibility in a sagittal plane for the dynamic protocol.

Main outcome measurements: The medulla-to-canal ratio (MCR) was measured at every vertebral disc level for both MRI methods. When observed, anatomical abnormalities were categorised.

Results: Anatomical abnormalities mainly consisted of degenerative discopathy and were most frequently observed in players aged 21 years and older, as well as in players whose MCR was abnormally high based on medical expertise. Most MCRs that were initially assessed as intermediate with static MRI were subsequently assessed as abnormal with dynamic MRI assessment.

Conclusions:Since dynamic MRI is more accurate than static techniques in examining the cervical spine, it contributes substantially to identifying the risk of spinal injuries in professional rugby players, and when used in association with clinical assessment, can assist in preventing spinal injury.

Title: Head, face and neck injury in youth rugby: incidence and risk factors.

Objectives: To determine the incidence of head, neck and facial injuries in youth rugby and assess associated risk factors.

Design: Data were extracted from a cluster randomised controlled trial of headgear with the football teams as the unit of randomisation. No effects were observed for headgear use on injury rates and the data were pooled.

Setting: General school and club based community competitive youth rugby in the 2002 and 2003 seasons.

Participants: Young male rugby union football players participating in under 13, under 15, under 18 and under 21 years competitions. 82 teams participated in year one and 87 in year two.

Main Outcome Measures: Injury rates for: all body regions combined, head, neck and face calculated for game and missed game injuries.

Results: 554 head, face and neck injuries were recorded within a total of 28,902 hours of rugby game exposure. Level of play and player position were related to injury risk. Younger players had the lowest rates of injury; forwards, especially the front row had the highest rate of neck injury; and, inside backs had the highest rate of injuries causing the player to miss a game. Contact events, including the scrum and tackle, were the main events leading to injury.

Conclusion: Injury prevention must focus on the tackle and scrum.

Abstract

Background

Anterior knee tendon problems are seldom reported in badminton players although the game is obviously stressful to the lower extremities.

Hypotheses

Painful anterior knee tendons are common among elite badminton players. The anterior knee tendons exhibit colour Doppler activity. This activity increases after match. Painful tendons have more Doppler activity than tendons without pain.

Study design

Cohort study

Methods

Seventy-two elite badminton players were interviewed about training, pain and injuries. The subjects were scanned with high-end ultrasound equipment. Colour Doppler was used to examine tendons of 64 players before match and 46 after match. Intratendinous colour Doppler flow was measured as colour fraction. The tendon complex was divided into three loci; the quadriceps tendon, the proximal patellar tendon and the insertion on the tibial tuberosity.

Results

Interview: Of the 72 players, 62 players had complaints from 86 tendons in the lower extremity. Of these 86 tendons, 48 were the anterior knee tendons. Ultrasound: At baseline, the majority of players (87%), had colour Doppler flow in at least one scanning position. After match the percentage of the knee complexes involved, did not change. Colour fraction increased significantly in the dominant leg at the tibial tuberosity, single players had a significantly higher colour fraction after match at the tibial tuberosity and in the patellar tendon both before and after match. Painful tendons had highest colour Doppler activity.

Conclusions

Most elite badminton players suffered from pain in the anterior knee tendons and most had intratendinous Doppler activity both before and after match. High levels of Doppler activity were associated with self-reported ongoing pain.

Objective: To evaluate the prevalence of X-rays changes in the proximal humerus growth plate of 21 young pitchers.

Design: Case Series

Setting: This study was conducted at the Department of Orthopedics and Traumatology, ABC Faculty of Medicine, Santo Andre, SP –Brazil. Terciary institution.

Patients: We studied 21 male adolescent baseball pitchers with mean age 14.5 years selected from the Brazilian National Team.

Interventions: The patients were submited to X rays evaluations of the shoulders

Main Outcome Measuraments: The patients shoulders X rays were studied to look for changes in the proximal humeral groth plate and correlated to clinical findings.

Results: Fourteen athletes (66%) had radiographic changes in the proximal humerus growth plate. Nine of these 14 cases (64%) where the observers found radiographic changes did not complain of pain. We also observed that in only 11 cases there was a correlation between the clinical and radiographic evaluations.

Conclusion: We concluded that radiographic change in the proximal humerus growth plate was found in 66% of the cases and that no significant correlation was found with the clinical evaluation. A presence of widening of the growth plate of the proximal humerus of young pitchers’ dominant shoulder can occur even in asymptomatic athletes. Probably this widening represents the evolution, in the future, to a greater retroversion of their dominant shoulders.

There is no abstract as this is a letter to the editor

Objectives. The purpose of the present investigation was to examine the relationship between inter-instrument differences in regard to the daily number of steps with the intensity distribution of daily physical activity in younger and older adults.

Methods. Seventeen younger individuals and 28 elderly individuals wore two pedometers (Lifecorder, (LC) and EC-200, (YM)) simultaneously for seven days, in order to determine the number of steps each took. Furthermore, LC determined the time spent in light, moderate and vigorous physical activity, corresponding to <3 METs, 3 to 6 METs and >6 METs, respectively.

Results. The LC detected a significantly larger number of steps than YM (p< 0.001), yet there was a strong relationship between the two measurements (r= 0.962, p<0.001). The inter-device difference with the number of steps significantly decreased in inactive elderly individuals in comparison to the active elderly and younger individuals, and it was also significantly negatively correlated with the time spent in light intensity physical activity (r=0.523, p<0.01).

Conclusion. These results suggested that the inter-device difference with the number of step significantly decreased in the elderly due to the greater length of the time spent in light intensity physical activity.

From December 12-14, 2007, UK Sport held a think tank on "muscle strains" in London. This brought together many of UK Sport’s top sports medicine clinicians along with three invited international experts. Many issues of muscle strains were discussed over the three days, but the aspect which attracted the most attention was the early management of strains in the elite athlete. A consensus summary of conclusions on this specific topic from the think tank is presented here.

Breath-hold diving (BHD) is both a recreational activity, performed by thousands of enthusiasts in Europe, and a high-performance competitive sport. Several "disciplines" exist, of which the "no-limits" category is the most spectacular: using a specially designed heavy "sled", divers descend to extreme depths on a cable, and then re-ascend using an inflatable balloon, on a single breath. The current world record for un-assisted descent stands at more than 200 meters of depth. Equalising air pressure in the paranasal sinuses and middle ear cavities is a necessity during descent to avoid barotraumas. However, this requires active insufflations of precious air, which is thus unavailable in the pulmonary system. We describe a diver who, by training, is capable of allowing passive flooding of the sinuses and middle ear with (sea) water during descent, by suppressing protective (parasympathetic) reflexes during this process. Using this technique, he performed a series of extreme depth breath-hold dives in June 2005, descending to 209 meters of sea water on one breath of air.

Objective: To evaluate the ability of a probiotic Lactobacillus fermentum VRI 003 (PCC) to enhance the mucosal immune system of elite athletes.

Design and Setting: A double-blind, placebo-controlled, cross-over trial was conducted over a four-month period of winter training.

Participants: 20 healthy elite male distance runners.

Interventions: PCC was given at a daily dose of 1.2x10^10 as a freeze dried powder in gelatin capsules. Placebo capsules contained an inert excipient.

Main Outcome Measures: Treadmill performance (monthly), mucosal and systemic immunity (monthly), training (daily), and illness (daily) were assessed. Serum cytokine levels, salivary IgA levels and incidence, duration and severity of respiratory tract infections.

Results: Subjects reported less than half the number of days of respiratory symptoms during PCC treatment (30 d) compared with placebo (72 d, p=0.00006). Illness severity was also lower for episodes occurring during the PCC treatment (p=0.06). There were no significant differences in the mean change in salivary IgA and IgA1 levels, or in interleukin IL-4 and interleukin-12 levels, between treatments. However, PCC treatment elicited a two-fold (p=0.07) greater change in whole-blood culture interferon gamma (IFN-fx) compared with placebo. There were no substantial changes in running performance measures over the study period.

Conclusions: Prophylactic administration of PCC was associated with a substantial reduction in the number of days and severity of respiratory illness in a cohort of highly trained distance runners. Maintenance of IFN-fx] levels may be one mechanism underpinning the positive clinical outcomes.

Objective: Contrasting to posterior tibial tendon lesions, dislocations of the posterior tibial tendon are thought to be "extremely rare". Diagnostic criteria for this condition have not yet been established.

Methods: A systematic literature review revealed 61 published cases with posterior tibial tendon dislocation in 36 reports, including eight (12 patients) in French and five (seven patients) in German language. We add one more case, which was complicated by a longitudinal tibial tendon tear and a lateral talar dome osteochondral lesion. 59 cases were descriptively analyzed regarding initial injury, subjective symptoms, clinical presentation and findings on different imaging modalities. Treatment and outcome was additionally evaluated.

Results: 58.5% of the initial injuries were induced by sport. Initially most cases were misdiagnosed (53.1%). 35.6% of the patients felt a recurrent snapping phenomenon at the medial ankle. Physical examination exhibited a cordlike structure over the medial malleolus in 58.6%, a posterior tibial tendon (sub)luxation could be provocated in 54.2%. MRI, ultrasound and plain radiography (medial malleolar chip fracture) detected specific findings in 75.0%, 66.7%, and 14.7%, respectively. Surgery was done in 83.1% of the patients using varying techniques. The authors judged the treatment result as excellent or asymptomatic in 80%, as good in 12% and as fair or moderate in 8% of the patients.

Conclusions: Posterior tibial tendon dislocation occurs more frequent as it was previously thought. Misdiagnosis can be avoided, if the surgeon is aware of the condition and combines findings from history, physical investigation and imaging modalities.

No abstract

Objectives: To clarify the effects of high intensity and high frequency long-term/chronic training on neutrophil function and serum level of myogenic enzymes in male university judoists. Methods: The subjects were 24 male university judoists who had stopped judo training for six months and had restarted their training. The following parameters were examined before and after a 2 h unified exercise loading (UEL) at the beginning of the restarted quotidian training (pre-training) and at two months, four months, and six months thereafter: myogenic enzymes, neutrophil and leukocyte counts, and neutrophil phagocytic activity (PA) and oxidative burst activity as a measure of reactive oxygen species (ROS) production capability. Results: Myogenic enzymes that were measured after UEL at all four points significantly increased and neutrophil counts significantly increased after UEL at the pre-training, two- and four-month points, but these changes became smaller from the two-month point. PA significantly decreased after UEL at the pre-training and two-month points, but no change was seen at the four- and six-month points. On the other hand, no change in ROS production per cell after UEL was seen at the pre-training point, but it significantly increased after UEL at the two-, four- and six-month points. Furthermore, there were no significant differences in the changing rates at the three last assessment points. Conclusion: The changing rate of the levels of UEL-mediated myogenic enzymes, neutrophil mobilization and neutrophil function was seen to decrease during daily training at the two- and four-month-assessments: these may comprise at least some of the long-term training effects.

Purpose: To study the effects of 8 wk creatine monohydrate (CrM) supplementation on blood and urinary clinical health markers in soccer players.

Methods: 14 soccer players were randomly assigned in a double-blinded fashion to Cre (N = 7) or Pla (N = 7) group. Cre group ingested 15 g/d of CrM during 7 d, and 3 g/d for the remaining 49 d, whereas the Pla group ingested maltodextrin following the same protocol. Soccer-specific training was performed during the study. Total body mass was determined and blood and urine samples were analized for metabolic, hepatic, renal and muscular function markers, before and after supplementation.

Results: A gain of total body mass was observed after CrM intake, not with placebo. Blood and urinary markers remained within normal reference values. There were no significant changes in renal and hepatic markers after CrM intake. However, total CK activity significantly increased, and uric acid level tended to decrease after CrM use. Likewise, serum glucose decreased in the Cre group following supplementation. No significant differences in urine parameters were found in either group after supplementation.

Conclusions: 8 wk of CrM supplementation had no negative effect on blood and urinary clinical health markers in soccer players. Properties of CrM may, however, be associated with an increase in CK activity, improving the efficiency for ATP resynthesis, phenomenon indirectly confirmed by the decreasing tendency in uric acid concentration. Furthermore, CrM seems to slightly influence glucoregulation in trained subjects.

We report the case of a 35-year-old male bodybuilder who was found to have a hepatocellular carcinoma arising in a pre-existing hepatic adenoma following recreational anabolic steroid use. Given the widespread use of recreational anabolic steroids we highlight another potentially life-threatening complication in addition to the more commonly recognised hepatic adenoma. To our knowledge, malignant transformation to HCC from a pre-existing hepatic adenoma confirmed by immuno-histochemical study has previously not been reported. We conclude by recommending further study to implement screening programs to identify high risk individuals.

Background: It is well documented that heat acclimation of 6 or more sessions of at least 60 min duration prolongs the time to exhaustion during endurance walking, cycling and running in the heat. However, this type of acclimation is not specific to team sport activity and the effect of acclimation on prolonged high intensity intermittent running has not yet been investigated.

Objective: To assess the impact of an intermittent acclimation protocol on distance run during team sport activity.

Methods: The impact of 4 short heat acclimation sessions (30 - 45 min of the Loughborough Intermittent Shuttle Test; LIST) on high-intensity intermittent running capacity (LIST) in the heat (30°C, 27% RH), was examined. Seventeen female well-trained games players were split into 3 groups; an acclimation group (30°C, 24% RH), a moderate training group (18°C, 41% RH), and a control group who did not complete any training between the main trials (pre- and post-acclimation). The pre- (A) and post-acclimation (B) trials were separated by 28 days to control for menstrual phase and verified using hormonal analysis. The 4 acclimation or moderate training sessions utilising the LIST were completed with one or two rest days interspersed between each session in a 10-day period prior to the post-acclimation trial (B).

Results: In the post-acclimation trial distance run was increased by 33% in the acclimation group (A: 7703 ± 1401 vs B: 10215 ± 1746m; interaction group x trial P<0.05), but was unchanged in the moderate and control groups. The acclimation group had a lower rectal temperature (interaction group x trial x time P<0.01) due to a lower rate of rise, and an increase in thermal comfort [1] after acclimation (End A: 7 ± 2 vs 6 ± 2; interaction group x trial P<0.01). There was no difference in serum progesterone, aldosterone or cortisol concentrations following acclimation or between groups.

Conclusion: Four 30-45 min sessions of intermittent exercise induced acclimation, and resulted in an improvement in intermittent running exercise capacity in female games players. A lower rectal temperature and a concomitant rise in thermal comfort may be partly responsible for the improvement in exercise capacity.