Factor analysis on the performance of elite male fencing athletes

BACKGROUND

We analyzed how stress and heart rate variability affect the performance of male fencing athletes expected to compete in various international events representing Korea.

METHODS

This study included 72 fencing athletes who participated in training and competition from January 2020 to December 2023. The stress was analyzed using the Sports Competition Anxiety Test (SCAT). Heart rate variability (HRV) was measured using an autonomous neurodiagnostic device (SA-6000). Heart rate variability measurement items were time domain analysis (heart rate, standard deviation of NN interval, and root mean square of the successful differences) and frequency domain analysis (total power, low frequency, and low frequency/high-frequency ratio). All athletes were classified into two categories: victory (high performance) and defeat (low performance) groups in the recent national championships.

RESULTS

In SCAT, there was no significant difference between high and low performance. After comparing HRV, it was found that there is a significant difference in heart rates (P=0.030) and low frequency/high-frequency ratio (P=0.006) between high and low performance. heart rates and low-frequency/high-frequency ratio during the high performance were observed to be higher than during low performance.

CONCLUSIONS

In our study, we found that SCAT does not affect performance, while HRV has been shown to have an impact on performance. These findings can be valuable for coaches and athletes in developing strategies to improve performance results, particularly for elite male fencing athletes.

The impact of concurrent training in team sports and soccer

Team sports players are frequently required to integrate multiple physical components, including strength and endurance capacity, to maximize their performance during both training and competitions. The combination of strength and endurance within a periodized program is known as concurrent training. Recently, concurrent training has emerged as an innovative method to enhance both muscular strength and aerobic performance, tailored to the specific requirements and diverse nature of each sport. However, concurrent training may induce excessive fatigue and compromise performance potentiation, depending on training prescription parameters. This distinction between the interference effect and performance enhancement presents a complex challenge for any team sports system. Consequently, the objective of this review was to scrutinize the efficacy, practical application, and methodological aspects of concurrent training. Additionally, it aims to elucidate strategies to mitigate the complexities associated with the interference effect, thereby optimizing the benefits of concurrent training modality for team sports, emphasizing soccer. The major findings indicate that concurrent training can improve strength and endurance qualities in athletes, but under certain conditions, it can also interfere with adaptations. Appropriate programming strategies, such as proper sequencing, scheduling, volume, intensity, and recovery, can help mitigate these negative effects. Additionally, whereas more experienced athletes display greater proficiency in executing concurrent training programs, younger players, particularly those under 14, tend to experience minimal interference effects from this training approach, making it well-suited for their development. Overall, concurrent training has been demonstrated as an effective and efficient method for improving strength and endurance performance in team sports players.

[Online resources for ankle sprains : A German language web analysis]

BACKGROUND

With the Internet as the main source of information for health content, the quality of websites with medical information is of high importance.

OBJECTIVE

This study analysed 250 websites on acute ankle sprain (ASD), one of the most common musculoskeletal disorders, for their quality and readability. Based on the results, a guide for patients was created.

METHOD

The quality of the websites was assessed using a 25-item content score and the EQIP36 score for medical information material. The reading level could be determined using the Flesch-Kincaid index and the calculated readability. The best three websites were evaluated in a user survey.

RESULTS

Of the 250 websites recorded 77 were included in the study. The quality of these varied significantly, with none achieving the maximum score. Sources in the healthcare system showed higher quality, while commercially influenced sites were below average in terms of completeness of content. Only 14% of the websites reached the recommended reading level. A significant negative correlation was found between completeness of content and readability. The user survey showed a mixed level of satisfaction and participants with previous medical knowledge were more critical than laypersons.

CONCLUSION

Online resources about ASD are suboptimal and differ considerably. Deficiencies in content, readability and structure were identified, which limit the effective use by patients. Health information publishers should work harder to improve the comprehensibility and quality of the information provided.

The Influence of Resistance Training on Joint Flexibility in Healthy Adults: A Systematic Review, Meta-analysis, and Meta-regression

ABSTRACT

Favro, F, Roma, E, Gobbo, S, Bullo, V, Di Blasio, A, Cugusi, L, and Bergamin, M. The influence of resistance training on joint flexibility in healthy adults: A systematic review, meta-analysis, and meta-regression. J Strength Cond Res 39(3): 386-397, 2025-Joint flexibility is a key component of physical fitness. Despite the large body of evidence regarding the effectiveness of muscle stretching exercises, little is known about the effect of resistance training on flexibility. A systematic search was conducted on 9 academic search instruments; inclusion criteria were as follows: healthy adult participants (age ≥18 years); resistance training intervention (duration ≥4 weeks); at least one flexibility outcome. Risk of bias was assessed using the RoB-2 and ROBINS-I tools. A 3-level meta-analysis was conducted, with multiple outcomes nested within each study. A moderator analysis was conducted by fitting a meta-regression model. Significance level was set at p < 0.05. We included 36 studies (1,469 participants). None of the included papers resulted at a low risk of bias. The pooled effect size for resistance training on flexibility was g = 0.6325, with 95% CI: 0.4762 to 0.7888 ( p < 0.0001). There was a substantial amount of heterogeneity between studies. Exercise intensity was a significant moderator ( p < 0.0225, high vs low), based on 129 and unique effect sizes, and sex ( p = 0.0429). Activity level and age were nonsignificant moderators. Resistance training could be implemented as a strategy to improve joint flexibility, with high-intensity protocols resulting in a magnified effect. However, the high overall risk of bias and substantial heterogeneity limit our ability to draw definitive conclusions.

Do floating toes relate with the ability to perform the deep squat test among baseball players with throwing injury?

Relationship between ability to perform the deep squat test (DST) and floating toes among baseball players with disabled throwing shoulder/elbow was retrospectively investigated. Players performed the DST by fully squatting while having their arms crossed in front of their chest without lifting the heel off the floor or falling backwards. Floating toes were evaluated if all the toes were in contact with the mat or not. The relationship between ability to perform the DST and prevalence of floating toes was statistically analysed. Sixty-three players (69.2%) were unable to perform the DST. Floating toes were observed in 74 players (81.3%). Players with inability to perform the DST had significantly higher prevalence of floating toes (58 players, 92.1%), compared with those who were able to perform the test (16 players, 57.1%) (p < 0.001). Floating toes may relate with inability to perform the DST among baseball players with disabled throwing shoulder/elbow.

Anterior Cruciate Ligament Injury Does Not Increase the Risk for a Future Concussion: A Unidirectional Phenomenon

CONTEXT

Epidemiological studies have shown an increased risk of musculoskeletal injury after concussion. The purpose of this study was to determine whether the reverse relationship exists, specifically whether there is an increased risk of concussion after an anterior cruciate ligament (ACL) injury in a population-based cohort.

DESIGN

Retrospective cohort.

METHODS

The Rochester Epidemiology Project was searched between 2000 and 2017 for International Classification of Diseases, 9th and 10th Revision codes relevant to the diagnosis and treatment of concussion and ACL tear. A total of 1294 unique patients with acute, isolated ACL tears and no previous history of concussion were identified. Medical records for cases were reviewed to confirm ACL tear diagnosis and to determine history of concussion after the ACL injury. Cases were matched by age, sex, and Rochester Epidemiology Project availability to patients without an ACL tear (1:3 match), resulting in 3882 controls. Medical records of matched control patients were reviewed to rule out history of ACL injury. The hazard ratio of concussion injury following an ACL injury was determined.

RESULTS

Nine patients with an ACL injury suffered concussion up to 3 years after the ACL injury. The rate of concussion was no different between ACL-injured cases (0.7%) compared with matched controls with no ACL injury (1.2%), which corresponded to a hazard ratio of 0.55 (95% confidence interval, 0.3-1.1; P = .10).

CONCLUSIONS

Based on the current evidence, there does not appear to be a significant association between ACL injury and subsequent concussion, which suggests that a concussion uniquely affects the risk of future subsequent musculoskeletal injury.

Lack of effects of acute exercise intensity on mnemonic discrimination

The hippocampus is thought to support episodic memory by pattern separation, thereby supporting the ability to discriminate high similarity items. Past research evaluating whether acute exercise can improve mnemonic discrimination of high similarity items is mixed. The present experiment attempts to extend these prior mixed findings by evaluating the effects of multiple exercise intensities on hippocampal-dependent, mnemonic discrimination and memory performance. Fifty-seven young adults completed a three-condition (control, moderate-intensity, and vigorous-intensity), within-subjects crossover pretest-posttest comparison. We observed no effects of acute exercise on recognition memory or mnemonic discrimination. We discuss the implications of these null findings with the broader literature by discussing the complexity of this potential exercise-mnemonic discrimination relationship, including the unique role of exercise intensity, differences in the level of processing (e.g., conceptual vs. perceptual), and unique brain regions involved in mnemonic discrimination.

Impact of Lifting Straps on the Relationship Between Maximum Repetitions to Failure and Lifting Velocity During the Prone Bench Pull Exercise

BACKGROUND

Fastest mean (MVfastest) and peak (PVfastest) velocity of the set have been proposed to predict the maximum number of repetitions to failure (RTF) during the Smith machine prone bench pull (PBP) exercise.

HYPOTHESIS

Goodness-of-fit would be higher for individualized compared with generalized RTF-velocity relationships and comparable for both execution equipment conditions (with or without straps), and the MVfastest and PVfastest associated with each RTF would be comparable between execution equipment and prediction methods (multiple- vs 2-point method).

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

After determining the PBP 1-repetition maximum (1RM), 20 resistance-trained male athletes performed 2 sessions randomly, with and without lifting straps, consisting of single sets to failure against the same load sequence (60% to 80% to 70% 1RM). Generalized (pooling data from all subjects) and individualized (separately for each subject using multiple-point or 2-point methods) RTF-velocity relationships were constructed.

RESULTS

Individualized RTF-velocity relationships were always stronger than generalized RFT-velocity relationships, but comparable with (MVfastest: r2 = 0.87-0.99]; PVfastest: r2 = 0.88-1.00]) and without (MVfastest: r2 = 0.82-1.00; PVfastest: r2 = 0.89-0.99]) lifting straps. The velocity values associated with each RTF were comparable between execution equipment (P ≥ 0.22), but higher for the multiple-point compared with the 2-point method (P < 0.01).

CONCLUSION

The use of lifting straps during the Smith machine PBP exercise does not affect the goodness-of-fit of the RTF-velocity relationships or the velocity values associated with different RTFs. However, caution should be exercised when using different methods.

CLINICAL RELEVANCE

The benefits of the RTF-velocity relationships can be extrapolated when using lifting straps, and the 2-point method can also be used as a quick and more fatigue-free procedure. Nevertheless, it is imperative for coaches to ensure that these relationships are reflective of fatigue experienced during training.

Nutritional Strategies for Optimizing Health, Sports Performance, and Recovery for Female Athletes and Other Physically Active Women: A Systematic Review

CONTEXT

Despite the progress toward gender equality in events like the Olympic Games and other institutionalized competitions, and the rising number of women engaging in physical exercise programs, scientific studies focused on establishing specific nutritional recommendations for female athletes and other physically active women are scarce.

OBJECTIVE

This systematic review aimed to compile the scientific evidence available for addressing the question "What dietary strategies, including dietary and supplementation approaches, can improve sports performance, recovery, and health status in female athletes and other physically active women?"

DATA SOURCES

The Pubmed, Web of Science, and Scopus databases were searched.

DATA EXTRACTION

The review process involved a comprehensive search strategy using keywords connected by Boolean connectors. Data extracted from the selected studies included information on the number of participants and their characteristics related to sport practice, age, and menstrual function.

DATA ANALYSIS

A total of 71 studies were included in this review: 17 focused on the analysis of dietary manipulation, and 54 focused on the effects of dietary supplementation. The total sample size was 1654 participants (32.5% categorized as competitive athletes, 30.7% as highly/moderately trained, and 37.2% as physically active/recreational athletes). The risk of bias was considered moderate, mainly for reasons such as a lack of access to the study protocol, insufficient description of how the hormonal phase during the menstrual cycle was controlled for, inadequate dietary control during the intervention, or a lack of blinding of the researchers.

CONCLUSION

Diets with high carbohydrate (CHO) content enhance performance in activities that induce muscle glycogen depletion. In addition, pre-exercise meals with a high glycemic index or rich in CHOs increase CHO metabolism. Ingestion of 5-6 protein meals interspersed throughout the day, with each intake exceeding 25 g of protein favors anabolism of muscle proteins. Dietary supplements taken to enhance performance, such as caffeine, nitric oxide precursors, β-alanine, and certain sport foods supplements (such as CHOs, proteins, or their combination, and micronutrients in cases of nutritional deficiencies), may positively influence sports performance and/or the health status of female athletes and other physically active women.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD480674.

Physiologic readiness and subjective workload of performing operations: A prospective observational study of attending and trainee surgeons

Physical health and perceived workload are determinants of career satisfaction and longevity for surgeons. The aim of this prospective observational study was to determine if biometric indicators of physical recovery among surgeons are associated with perceived workload during operations. The primary outcome was whether there was an association between surgeon self-assessment and a physiologic recovery score based on heart rate variability measured with a wearable biometric sensor. These associations were evaluated through mixed-effects regression models. Of the 66 participants, 29 were attending surgeons and 37 were surgical trainees across multiple surgical subspecialities. There was no association between recovery score and perceived workload for either trainees or attendings. Differences in self-assessment scores were identified between trainees based on gender and years in training, as well as for attendings based on years in practice. Additionally, recovery scores were higher for both junior trainees and attendings compared to their senior counterparts. These findings underscore the importance of awareness of differences in experience among surgeons and may reveal targets for improvement in performance and career satisfaction.

Malate or Not? Acute Effects of L-Citrulline Versus Citrulline Malate on Neuromuscular Performance in Young, Trained Adults: A Randomized, Double-Blind, Placebo-Controlled Crossover Trial

L-citrulline (CIT) supplementation seems to improve resistance training performance; yet, whether malate has additive ergogenic effects when combined with CIT is unknown. This randomized, double-blind, placebo-controlled crossover trial aimed to compare the acute effects of CIT versus citrulline malate (CMA) supplementation on neuromuscular performance and exertion and emotional perceptions in young, trained men and women. 43 (21 women; 24.2 ± 3.7 years) participants ingested a placebo, CIT (5.3 g of CIT), or CMA (5.3 g of CIT, 2.7 g of malate) 45 min before three experimental sessions in a counterbalanced manner. We evaluated the upper and lower limb maximal neuromuscular and ballistic performance through the two-point method and countermovement jump. Strength-endurance was assessed across three sets of 10 repetitions in the squat and bench press exercises. Exertion and emotional perceptions were evaluated before and after the assessment and during the strength-endurance assessment. CIT and CMA supplementation did not enhance maximal neuromuscular performance (all p ≥ .061, ηp2≤.066), or ballistic strength (all p ≥ .348, ηp2≤.025). Neither CIT nor CMA supplementation improved strength-endurance as observed in the total number of repetitions (all p ≥ .590, ηp2≤.013), repetitions before reaching velocity loss threshold (all p ≥ .623, ηp2≤.010), mean velocity (all p ≥ .792, ηp2≤.004), mean velocity decline (all p ≥ .293, ηp2≤.029), and mean velocity maintenance (all p ≥ .393 ηp2≤.022), or exertion and emotional perceptions (both p ≥ .306, ηp2≤.028). In conclusion, CIT and CMA supplementation may not increase the neuromuscular performance during low- to moderate-volume resistance training sessions in young, trained adults. This trial was registered at ClinicalTrials.gov (No. NCT05183893).

Fatigue-induced modifications to trunk and lower-limb coordination mode during drop vertical jump and sidestep cutting tasks in female handball athletes

BACKGROUND

Examining movement patterns in athletic activities is crucial for understanding the mechanisms and contributing factors linked to lower limb injuries, with the knee joint being particularly vulnerable in team sports like handball.

RESEARCH QUESTION

How does a handball-specific fatigue protocol affect trunk-knee and hip-knee intersegmental coordination during the drop vertical jump (DVJ) and sidestep cutting maneuver (SCM) in handball players?

METHODS

Twenty female handball athletes participated, performing three trials of each task before and after undergoing the fatigue protocol. Using a motion capture system, the trunk, hip, and knee joint angles were recorded in all three planes and time-normalized to 100 % of the stance phase. A vector coding technique evaluated coordination nodes.

RESULTS

This study indicated significant post-fatigue alterations in coordination modes, especially in the sagittal plane for DVJ and SCM tasks. There was an increase in knee phase modes and a decrease in in-phase modes for hip-knee coordination during the DVJ task, with transverse plane coordination being affected only in the SCM task. Movement variability decreased in the frontal and transverse planes post-fatigue, suggesting a neuromuscular strategy to simplify task execution.

SIGNIFICANCE

Fatigue's significant impact on movement coordination and variability. It demonstrates the importance of considering the specificity of the task performed when setting up injury prevention training to mitigate the negative effects of fatigue and reduce the risk of injuries.

How do neuromuscular characteristics of the peroneal muscles differ in adults with and without chronic ankle instability? A systematic review with meta-analysis

BACKGROUND

Chronic ankle instability (CAI) has been associated with neuromuscular control dysfunction, particularly of the peroneal musculature.

RESEARCH QUESTION

How do neuromuscular characteristics of the peroneal muscles, including corticospinal excitability, strength, proprioception (force sense) and electromyographic measures differ in individuals with CAI compared to healthy control counterparts aged 18-45?

METHODS

A systematic review with meta-analysis was conducted by retrieving relevant articles from electronic databases including EBSCOhost (CINAHL Complete, AMED, SPORTDiscus), Ovid (MEDLINE, Embase), Web of Science, Scopus and Cochrane Library as well as Grey literature sources. The eligibility and methodological quality of the included case-control and cross-sectional studies were assessed by two reviewers. The random effects model and the standard mean difference with a 95 % confidence interval were utilised to calculate pooled estimates of the overall effect size.

RESULTS

Of the total 13,670 studies retrieved, 42 were included in the systematic review. Of these, 25 were eligible for the meta-analyses. Two of the meta-analyses, each consisting of two studies, showed less evertor force sense accuracy at 10 % (d=0.50, p = 0.03) and 20 % of maximum voluntary isometric contraction (d=1.14, p < 0.00001) in individuals with CAI than the control group. In addition, another meta-analysis of two studies showed that the CAI population had longer peroneus longus latency (d=1.69, p < 0.0001) than the control group during single-leg landing inversion perturbation test under unexpected conditions.

SIGNIFICANCE

Individuals with CAI showed specific sensorimotor impairments in evertor force sense accuracy and peroneus longus latency, which may indicate that neuromuscular dysfunction of the peroneal muscles is associated with the underlying mechanisms of the CAI pathogenesis. However, the meta-analyses are limited by the inclusion of only two studies with small sample sizes. Therefore, these findings should be cautiously interpreted, and further research is required to validate them.

Why Do You Focus on the Acetabular Labral Tear? You Can't See the Forest for the Trees

The advent of higher-quality imaging has brought increased attention to the understanding and implications of commonly observed hip morphology and pathology. Many patients and even physicians like to focus on the presence of an acetabular labral tear when one is present on magnetic resonance imaging, despite the limitations of magnetic resonance imaging in identifying labral tears. Furthermore, recent studies have shown normal variations of the acetabular labrum, as well as a high prevalence of labral tears in both symptomatic and asymptomatic individuals. For patients electing to undergo surgical treatment of a labral tear, addressing the underlying pathology is imperative. Ignoring the primary pathology (e.g., femoroacetabular impingement or hip dysplasia) risks the formation of a new labral tear after initial surgical management. This comprehensive approach ensures that the primary cause of the labral tear is treated, thereby reducing the likelihood of recurrence and improving patient outcomes. Although the labrum is highly innervated, making labral tears a direct cause of hip pain in affected patients, we should not be setting our focus on the labral tear itself. Focusing solely on the labral pathology may set up our patients for failure by overlooking the underlying anatomic issues that precipitate these tears. Addressing the root cause, such as correcting femoroacetabular impingement and/or hip dysplasia, is crucial for effective treatment. By correcting these anatomic factors, we can prevent future labral damage and provide more comprehensive and lasting relief for our patients. Ignoring the primary anatomic issues risks recurrent tears and ongoing pain, highlighting the need for a holistic approach to treatment.

The Effect of Proximity-To-Failure on Perceptual Responses to Resistance Training

Perceptual responses may influence how much pleasure or displeasure an individual experiences during or following resistance training (RT). Resistance-trained males (n = 12) and females (n = 6) completed an 8-week intervention involving two RT sessions per week. The lower limbs of each participant were randomised to perform the leg press and leg extension exercises either to (i) momentary muscular failure (FAIL) or (ii) a perceived 2-RIR and 1-RIR, respectively, for the entire intervention. In weeks one, four, and eight, post-set ratings of perceived discomfort (RPD), and post-session ratings of perceived exertion (RPE) and general feelings via feeling scale (FS) were measured. Data were analysed with Bayesian mixed-effect models. When averaged over all time points measured, results showed slightly greater RPD for FAIL [5.1 (HDI: 4.2-6.0); pd = 100%] versus RIR [4.1 (HDI: 3.2-5.1); pd = 100%], greater RPE for FAIL [5.4 (HDI: 4.6-6.3); pd = 100%] versus RIR [4.3 (HDI: 3.5-5.1); pd = 100%], and more positive general feelings for RIR [1.2 (HDI: 0.7-1.8); pd = 100%] versus FAIL [0.3 (HDI: -0.3 to 0.8); pd = 86%]. Overall, assessing perceptual responses may help inform RIR prescription to promote desired outcomes whilst limiting negative feelings that may compromise long-term adherence.

Prevalence and associated risk factors of anxiety-induced sleep disturbance: Sex-stratified comparison among school-going adolescents in Paraguay

OBJECTIVES

This study aimed to assess the prevalence and correlates of anxiety-induced sleep disturbance (AISD) in Paraguayan adolescents through sex-stratified analysis.

METHODS

This study used the cross-sectional data from Paraguay's 2017 Global School-Based Student Health Survey (GSHS). A total of 3149 in-school adolescents (12-17 years; 51.2 % female) were included in the final analysis. Anxiety-induced sleep disturbance (AISD) was evaluated using the survey question: "During the past 12 months, how often have you been so anxious about something that you could not sleep at night?" Participants could respond on a scale from 1 (never) to 5 (always). For analysis, responses were categorized as follows: "never/rarely/occasionally" indicated no AISD, while "often/always" indicated the presence of AISD. Age-adjusted univariate and multiple logistic analyses were used to determine the correlates of AISD. Regression analysis findings were presented using adjusted odds ratios (AOR) and 95 % confidence intervals (CI), with a p-value <0.05.

RESULTS

The overall prevalence of AISD was 9.5 % among the respondents, significantly higher in girls (12 %) than boys (6.7 %). Loneliness, suicidal ideation, not attending physical education classes, and sitting activities were significantly associated with respondents' AISD. In both sexes, those with loneliness and those who had suicidal ideation were more likely to suffer from AISD than their counterparts. Among girls, those who did not attend physical education class and those who engaged in sedentary activities for three hours or more had significantly higher odds of AISD than boys.

CONCLUSION

This study found differences in patterns of significant associations between risk factors of AISD for boys and girls. Therefore, different sex-based strategies are recommended to reduce the prevalence of AISD among adolescents in Paraguay.

Interrupting sitting with moderate-intensity physical activity breaks improves cognitive processing speed in adults with overweight and obesity: Findings from the SITLess pilot randomized crossover trial

INTRODUCTION

Prolonged sitting can acutely reduce working memory (WM) in individuals with overweight and obesity (OW/OB) who show executive function deficits. Interrupting prolonged sitting with brief PA bouts may counter these effects. However, the benefits of such interventions on behavioral and neuroelectric indices of WM and whether neurocognitive responses are associated with postprandial glycemic responses in young and middle-aged adults with OW/OB remain unknown. To address this gap, this study examined the acute effects of interrupting three-hour prolonged sitting every 30 min with 3.5-min moderate-intensity physical activity (MPA) bouts (MPA + SIT condition) relative to sedentary social interaction condition (SOC + SIT) on behavioral measures of WM and the P3b component of event-related potentials (ERP) in young and middle-aged adults with OW/OB.

METHOD

Nineteen adults with OW/OB (63 % females; 29.9 ± 7.5 years; BMI = 30.0 ± 3.64 kg*m-2) were included in the SITLess pilot randomized crossover trial. Choice RT and WM were measured before, after, and four times during each condition with 1- and 2-back letter tasks. They were expressed as the incremental area under the curve (iAUC). Choice RT was expressed as d-prime, target, and nontarget accuracy, and RT on the 1-back and nontarget RT on the 2-back task. WM was expressed as d-prime, target accuracy, and RT on the 2-back task. The amplitude of the P3b-ERP component was used to measure attentional resource allocation during both tasks; the P3b-ERP fractional area latency measured cognitive processing before and after each condition. Two-hour postprandial glycemic responses (expressed as iAUC) were measured using an oral glucose tolerance test (OGTT). Time (pre, post) x Condition (MPA + SIT vs. SOC + SIT) interactions and the main effect of Condition (iAUCs) were tested using Linear Mixed Models.

RESULTS

No significant intervention effects on glucose were noted (p = 0.74). Compared to SOC + SIT, MPA + SIT resulted in shorter 1-back target P3b latency (F(1, 17.0) = 5.14, p = 0.037; Mdiff = -9.77, SE = 4.31 ms, 95%CI: -18.9, -0.68) at post-test. No effects on behavioral measures were noted (ps ≥ 0.06). However, the between-condition difference in 1-back P3b latency correlated positively with the between-condition difference in RTs on 1-back;shorter P3b latency was related to shorter RTs in the MPA + SIT relative to SOC + SIT (r = 0.65 and 0.55 for target and nontarget trials, ps ≤ 0.02).

CONCLUSION

Interrupting sitting with short MPA bouts can enhance some aspects of cognitive processing in adults with OW/OB. Future studies are needed to better understand behavioral responses to interrupting prolonged sitting with MPA bouts and the underlying mechanisms.

Foot sole two-point discrimination is not associated with dynamic standing balance in healthy adults

[Purpose] To evaluate the association between foot sole two-point discrimination and dynamic standing balance. [Participants and Methods] This cross-sectional, observational study included 50 healthy adults. Participants were made to stand on a firm or foam surface with eyes open or closed, and the center of pressure length was measured for static standing balance and limits of stability for dynamic standing balance. Two-point discrimination and muscle strength were assessed using the two-point discrimination test and toe grip strength, respectively. We then analyzed the association with sensory-motor assessment and standing balance. [Results] Significant differences were observed for almost all factors between static and dynamic standing balance. Two-point discrimination was associated with static standing balance, and muscle strength was associated with dynamic standing balance on a firm floor. There was no significant association between two-point discrimination and dynamic standing balance. [Conclusion] These results indicate that foot sole two-point discrimination is not directly associated with dynamic standing balance in healthy adults. Therefore, postural stability must be evaluated considering the specific floor surfaces and sensory conditions in clinical situations, and assessment of dynamic standing balance based only on two-point discrimination should be avoided.

Effects of static and dynamic stretching techniques on muscle function

[Purpose] To examine the effects of a combination of static stretching (SS) and dynamic stretching (DS) on muscle function. [Participants and Methods] There were 32 healthy male participants. The hamstrings were the target muscles. Flexibility was measured using the straight leg raise test and muscle output was measured using a manual muscle force meter. The two measurements were compared before and after stretching, and between the group that first performed SS and the group that first performed DS. [Results] Flexibility improved significantly after stretching compared to the level before stretching when either SS or DS was performed first. However, there were no significant differences in muscle output or in between-group comparisons for any indicator. [Conclusion] There were no differences between the stretching techniques, suggesting that either combination of stretching may improve flexibility but with little effect on muscle output.

Treatment of obesity in spinal cord injury with tirzepatide: a case report

INTRODUCTION

Individuals with spinal cord injury (SCI) experience alterations in metabolism that result in increased central obesity, insulin resistance, and dyslipidemia placing them at elevated risk for developing cardiometabolic disease (CMD). Increased exercise and dietary modifications are the primary interventions for preventing CMD. However, people with SCI face unique challenges that prevent them from increasing their physical activity and easily modifying their nutritional intake. Tirzepatide is a medication that has been approved by the Food and Drug Administration to be used in conjunction with lifestyle changes to treat obesity in adults with type 2 diabetes mellitus.

CASE PRESENTATION

A male in his 40's with C6 American Spinal Injury Association Impairment Scale B SCI 15 years prior with a body mass index of 32 presented to his primary care provider for treatment of obesity. He previously worked with multiple dietitians and increased his physical activity to lose weight. Despite these interventions, he was unable to reduce his weight. He was started on tirzepatide. After 3 months of treatment, he lost 31 pounds and saw improvements in his lipid profile. The only adverse effect reported was heartburn.

DISCUSSION

The metabolic dysfunction associated with SCI and barriers to adequate exercise for weight loss place individuals with SCI at increased risk for obesity and developing CMD. Tirzepatide may be an effective adjunct therapy to lifestyle interventions to help prevent CMD in those with SCI. Further research is indicated to examine the long-term efficacy, benefits, and adverse effects that may be associated with tirzepatide.

The Effect of Heart Rate Variability Biofeedback on Recovery After Aerobic Exercise

Recovery is a critical factor in athletic performance, and accelerating this process is essential to enable athletes to perform more effectively in both training load and competitive performance. After exercise, immediate recovery is potentially helpful for investigating autonomic activity levels, as they are definable with heart rate variability (HRV). The purpose of this study was to examine the effect of ten sessions of HRV-Biofeedback (HRV-BF) training on recovery process parameters after the aerobic performance. In this study, twenty-four soccer players aged 18-24 volunteered to participate. The athletes who met the research criteria were divided into an experimental group (n = 12) and a control group (n = 12). Each participant's height, weight, BMI, body fat percentage, and aerobic capacity were measured before and after the 10-session intervention. The experimental group participated in a 10-session HRV-BF training and soccer training program, while the control group only participated in a 10-session soccer training program. Aerobic capacity tests were then applied again to experimental and control group participants. The effect of biofeedback on the three HRV parameters during the 5-minute acute recovery period after the test was investigated. The results showed that regularly applied HRV-BF training can significantly shorten the HRV recovery parameter after exercise. Specifically, the athletes who performed HRV-BF training demonstrated faster cardiovascular recovery after aerobic exercise. This suggests that implementing HRV-BF training for athletes can significantly accelerate their recovery processes during and after competitions. Given recent technological advancements, it is promising to consider adding HRV-BF training to stress management interventions, particularly in relation to physiological stress indicators.

Postural control strategies in individuals with and without chronic ankle instability during the reach phase of the posteromedial direction of the star excursion balance test

OBJECTIVE

To compare center of mass (COM) and center of pressure (COP) displacement, joint angles, and muscle activity for the ankle, knee, and hip during the posteromedial (PM) reach direction of the Star Excursion Balance Test between individuals with chronic ankle instability (CAI) and healthy individuals.

DESIGN

Cross-sectional Study.

SETTING

Biomechanics laboratory.

PARTICIPANTS

Fifteen individuals with CAI (age: 20.0 ± 1.2 y) and 20 healthy individuals (age: 20.6 ± 0.8 y).

MAIN OUTCOME MEASURES

The maximum reach distance (MRD). The COM and COP displacement, and ankle, knee, and hip joint angles of the stance limb during the PM reach task measured via a 3D motion analysis system. Electromyography (EMG) was also recorded during the task from the tibialis anterior (TA), soleus, peroneus longus, vastus medialis (VM), biceps femoris, and gluteus medius muscles.

RESULTS

MRD of the CAI group was shorter than the healthy group (P = 0.005). The CAI group showed higher COM positioning (P = 0.007), less knee flexion (P = 0.009), and lower muscle activity in TA (P = 0.04), and VM (P = 0.007) during performance of the PM reach as compared to the healthy group.

CONCLUSIONS

These findings suggest that individuals with CAI demonstrate altered postural control strategies during PM reach performance, likely contributing to a shorter MRD.

Link Between Ferritin, Vitamin D, Performance, and Eating Attitudes in Female Athletes

Iron and vitamin D deficiencies can affect athletes' health and performance. However, the epidemiology and associated risk factors remain unclear. Forty-three elite female athletics athletes (20.2±1.9 years) were included. A survey regarding the training schedule and Eating Attitudes Test-26, body composition, bone mineral density, and serum 25-hydroxyvitamin D (25(OH)D) and ferritin levels were assessed. Mean serum 25(OH)D and ferritin levels were 25.2±5.5 ng/mL and 29.0±13.2 ng/mL, respectively, and 83.7% and 41.9% of athletes had vitamin D and ferritin insufficiency, respectively. Serum 25(OH)D level was negatively correlated with the number of rest days per week (Coefficient,-6.19; 95% confidence interval [CI],-9.82--2.57; p=0.002), and serum ferritin level was negatively correlated with body mass index (Coefficient,-3.87; 95% CI,-7.57--0.16; p=0.041). Performance levels were positively correlated with serum vitamin D levels (Coefficients, 7.25; 95% CI, 0.25-14.25; p=0.043) and negatively correlated with EAT-26 scores (Coefficient,-7.30; 95% CI,-12.61--1.98; p=0.009) and body fat percentage (Coefficient,-13.26; 95% CI,-24.66--1.86; p=0.025). Vitamin D and ferritin insufficiencies are prevalent among Japanese female athletics athletes. Serum vitamin D level was related to performance level.

Impact of exercise intervention with or without curcumin supplementation on body fat composition, glucose, and lipid metabolism in obese adults: A meta-analysis

This study was carried out to systematically review and evaluate the influence of exercise with and without curcumin on body fat composition, glucose, and lipid metabolism in obese adults. Search for eligible studies through four databases, and then proceed with screening. The inclusion criteria are as follows: (1) obese adults; (2) randomized controlled trial (RCT); (3) classified the exercise intervention with curcumin supplementation as the exercise with curcumin (CU) group and without curcumin supplementation as the exercise without curcumin (EX) group; (4) Conducted pre- and post-training assessments, which include body fat composition, glucose and lipid metabolism parameters. Use the Cochrane bias risk assessment tool to evaluate the quality of the selected study. Select standardized mean difference (SMD) as the appropriate effect scale index, and use Revman 5.4 software to analyze the mean difference of the selected article data with a 95% confidence interval (CI). A total of seven studies fulfilled the inclusion criteria and were selected for the meta-analysis. The included studies involved 72 males and 111 females, where 94 belonged to the EX group and 89 from the CU group. The CU group benefited more from the reduced Fat% (SMD, 2.18 [0.12, 4.24], p < 0.05, I2 = 0%, p for heterogeneity = 0.98) than the EX group. The study demonstrated that the combined exercise intervention with curcumin supplementation significantly reduced Fat% in obese adults compared with exercise without supplementing curcumin.

A tackler correctly adhering to the tackle instruction in a front-on, one-on-one torso tackle alters the peak inertial head kinematics of the ball carrier but not the tackler

OBJECTIVES

To evaluate if the tackler correctly adhering, or not, to four different instructions of legal front-on one-on-one torso tackles altered the tackler and/or ball carrier peak inertial head kinematics.

DESIGN

Controlled laboratory study.

METHODS

Fifteen rugby-code players measured with three-dimensional optoelectronic motion capture performed two tackle instructions from the Australian National Rugby League coaching manual on under (Dominant National Rugby League) and over (Smother National Rugby League) the ball tackles, and two novel variants of these (under, Dominant, Torso Stick; over, Smother, Pop, Lock). A series of mixed general linear models identified if the tackler adhering (n = 455), or not (n = 139) to the tackle instructions altered peak inertial head kinematics.

RESULTS

The tackler's peak inertial head kinematics did not significantly change whether or not they adhered to each of the tackle instructions. When the tackler did adhere to the instructions, the ball carrier sustained a lower peak inertial head kinematics (p < 0.01) in the Smother National Rugby League tackle but higher peak inertial head kinematics in the Smother, Pop, Lock.

CONCLUSIONS

The ball carriers' inertial head kinematics but not the tacklers were increased when the tackler adhered to this study's variants of the over and under the ball tackle instructions, suggesting that the tacklers were more effective in their tackle performance than the traditional tackle instructions when adhering to the tackle instruction. Greater adherence to the under the ball instructions suggests that the over the ball instruction is a more challenging technique to learn.

Comparison of the efficacy of the modified internal brace and the arthroscopic Broström-Gould procedure for chronic lateral ankle instability

PURPOSE

To compare the efficacy of an internal brace and the arthroscopic Broström-Gould procedure for chronic lateral ankle instability (CLAI).

METHODS

The clinical data of 71 patients who were diagnosed with chronic lateral ankle instability between May 2020 and May 2022 were retrospectively analyzed. The American Orthopedic Foot and Ankle Society (AOFAS) scale, Foot and Ankle Ability Measure (FAAM), and Visual Analogue Scale (VAS) were used to assess clinical outcomes.

RESULTS

A total of 59 patients were followed up for a mean of 21 months (range, 16-24 months). Thirty-seven patients underwent the modified Broström-Gould (IB) procedure, and twenty-two patients underwent the arthroscopic Broström-Gould (ABG) procedure. The mean postoperative VAS score (P = 0.790), AOFAS score (P = 0.252), FAAM daily activity score (P = 0.983), and FAAM for sports activity score (P = 0.379) were not significantly different between the ABG and IB groups at the final follow-up. However, the FAAM sports score was better in the internal brace group than in the arthroscopy group at the 1-year postoperative follow-up (P = 0.025).

CONCLUSION

Patients treated with an internal brace recovered faster than those who underwent the arthroscopic ABG procedure. However, no other significant differences were observed between the two methods.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

The effectiveness of foam rolling with and without vibration and static stretching on range of motion, muscle strength and proprioception of the ankle joint in adults with chronic ankle instability

BACKGROUND

People with chronic ankle instability (CAI) have insufficient ankle dorsiflexion range of motion (DFROM) and decreases proprioception and muscle strength. Foam roller with and without vibration as a warm-up intervention may have benefits for healthy populations, but the effect on applied to injured individuals is still lacking, especially in CAI. Therefore, we aimed to compare the acute effects of three warm-up interventions, including vibration foam rolling (VR), foam rolling (FR), and static stretching (SS) in adults with CAI.

METHODS

This study was a randomized, counterbalanced crossover trial. Eligible sixteen adults with CAI received all three interventions (VR, FR, and SS) in unilateral CAI leg in a randomized order. Each intervention included 6 sets, 30 s each, targeting the ankle dorsiflexors and plantarflexors, with a 30-s rest time in between. Ankle dorsiflexion range of motion (DFROM), muscle strength, and ankle proprioception were measured before and immediately after each intervention.

RESULTS

VR significantly improved ankle DFROM and muscle strength by over 30% compared to the pre-intervention, whereas FR improved DFROM by 23.68%, and SS did not improve DFROM. Additionally, VR was more significantly effective than SS in improving ankle DFROM and maximal strength. The ankle joint repositioning error angle did not have significantly different.

CONCLUSIONS

Our results suggest that VR and FR interventions may be incorporated into warm-ups for adults with CAI to improve ankle DFROM. Furthermore, VR offers additional benefits in increasing muscle strength, especially compared to SS.

Evaluating the Biomechanical Effects and Real-World Usability of a Novel Ankle Exo for Runners

Achilles tendon overuse injuries are common for long-distance runners. Ankle exos (exoskeletons and exosuits) are wearable devices that can reduce Achilles tendon loading and could potentially aid in the rehabilitation or prevention of these injuries by helping to mitigate and control tissue loading. However, most ankle exos are confined to controlled lab testing and are not practical to use in real-world running. Here, we present the design of an unpowered ankle exo aimed at reducing the load on the Achilles tendon during running while also overcoming key usability challenges for runners outside the lab. We fabricated a 500-gram ankle exo prototype that attaches to the outside of a running shoe. We then evaluated the reliability, acceptability, transparency during swing phase, and offloading assistance provided during treadmill and outdoor running tests. We found that the exo prototype reliably assisted 95-99% of running steps during indoor and outdoor tests, was deemed acceptable by more than 80% of runners in terms of comfort and feel, and did not impede natural ankle dorsiflexion during leg swing for 86% of runners. During indoor tests, the exo reduced peak Achilles tendon loads for most participants during running; however, reductions varied considerably, between near zero and 12%, depending on the participant, condition (speed and slope) and the precise tendon load metric used. This next-generation ankle exo concept could open new possibilities for longitudinal and real-world research on runners, or when transitioning into the return-to-sport phase after an Achilles tendon injury.

Reliability of the Wii balance board for static and dynamic balance assessment in total knee arthroplasty patients

PURPOSE

Poor performance in practicing balance tasks is partly caused by the changes in the knee function and balance control activities following total knee arthroplasty (TKA). The purpose of this study was to determine the test-retest reliability of the static and dynamic balance measures using Wii Balance Board (WBB) in patients after TKA.

DESIGN

Thirty-one TKA patients (6 males, 27 females, mean age 55 ± 5.3 years) were involved in the study. They performed four standing balance trials on a WBB on two occasions, with an interval of 3-7 days apart. Double leg stance and functional reach task with opened and closed eyes were assessed in four trials. Extracted center of pressure (COP) measures collected included: mean velocity, medio-lateral displacement, antero-posterior displacement, and area. Intraclass correlation coefficients (ICC), standard error of measure (SEM), minimal detectable change (MDC) and Bland-Altman plots were calculated to show the reliability of COP measures.

RESULTS

ICCs ranged from 0.51 to 0.86 for the four trials indicating moderate-to-good reliability. Just the medio-lateral displacement in double leg open eyes condition showed weak reliability (ICC = 0.29). The highest and lowest ICC values (0.86, 0.29) were obtained for COP medio-lateral displacement in double leg open eyes condition and medio-lateral displacement in double leg close eyes condition measures, respectively. SEM (0.03-5.93) and MDC (0.09-16.45) range scores varied. Bland-Altman plots revealed no significant difference between two trials in both opened and closed eyed conditions, indicating strong agreement between assessments.

CONCLUSION

These findings suggest that the WBB was a reliable tool for assessing static and dynamic balance tests in TKA patients, making it as a suitable tool for standing balance assessment in clinical settings.

Cross-sectional and longitudinal associations between physical activity and intrinsic capacity in healthy older adults from the MAPT study

BACKGROUND

The construct of intrinsic capacity (IC) has been recently developed with the aim of assessing and monitoring life-long individuals' functional trajectories. Physical activity (PA) is recognized for its benefits on health but its associations with IC remain less investigated. We explored the cross-sectional and longitudinal associations of PA with IC in non-demented older adults.

METHODS

Eight hundred and thirty-seven males and females aged 70 years and over, were included in the present work. IC and its domains (mobility, vitality, cognition, psychology and sensory) were assessed over 2 years and converted to a 0-100 scale. Participants were categorized into 5 PA groups (0-29; 30-499; 500-999; 1000-1999; and 2000+ MET-min/week) using questionnaires. The associations between PA and IC variables (all reflected and square-root-transformed) observed over 2 years were examined using mixed-effect linear regressions.

FINDINGS

Over the 2-year follow-up, ordinal PA was associated with higher scores in IC (B = -0.066, SE = 0.015, p < .001) In addition, compared to the inactive group, most of the active groups had a slower decline in IC (B30-499 MET-min/week = -0.196, SE = 0.078; B500-999 MET-min/week = -0.208, SE = 0.076; B1000-1999 MET-min/week = -0.165, SE = 0.073; B2000+MET-min/week = -0.187, SE = 0.074; all p < .05). Subdomain analyses revealed that these associations were driven by mobility, vitality and psychological domain.

INTERPRETATION

This study suggests that PA may help preventing IC decline, especially mobility, vitality, and psychology in older adults.

Effect of physical exercise training on neural activity during working memory in major depressive disorder

BACKGROUND

Deficits in working memory (WM) are common in patients with Major Depression Disorder (MDD). Previous research mainly in healthy adults indicated that physical exercise training may improve cognitive functions by stimulating neuronal plasticity particularly in hippocampal structures. Thus, the goal of this functional Magnetic Resonance Imaging (fMRI) study was to examine alterations in neuronal activity during a WM task and to investigate changes in brain volume and functioning following a physical exercise training in patients with MDD with a specific focus on hippocampal structures.

METHODS

86 (39 female) MDD outpatients (average age 37.3), diagnosed by clinical psychologists, were randomly assigned to one of three groups for a 12-week intervention: High intensity exercise training (HEX), low intensity exercise training (LEX) or waiting list control group (WL). An n-back task (with WM loads of 0, 1, 2, and 3) during fMRI was conducted before and after interventions/waiting period.

RESULTS

Both exercise groups showed better performance and shorter reaction times at higher WM loads after 12-weeks of physical exercise training. Specifically in the HEX, we found an improvement in physical fitness and an increase in neural activation in the left hippocampus as compared to the WL following the exercise training. Training-related structural volume changes in gray matter or hippocampus were not detected.

CONCLUSIONS

Our results partly support the hypothesis that physical exercise training positively affects WM functions by improving neuronal plasticity in hippocampal regions. Exercise training seems to be a promising intervention to improve deficient WM performance in patients with MDD.

CLINICAL TRIALS REGISTRATION NAME

Neurobiological correlates and mechanisms of the augmentation of psychotherapy with endurance exercise in mild to moderate depression - SPeED, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00008869, DRKS00008869.

The Physical Activity Health Paradox in Type 2 Diabetes

INTRODUCTION

The physical activity health paradox refers to the contrasting associations of leisure-time physical activity and occupational physical activity with cardiovascular disease, but whether this applies to Type 2 diabetes risk is unknown. This study aimed to investigate the physical activity health paradox and age-specific Type 2 diabetes.

METHODS

Working adults (N=5,866) in Denmark aged 30-60 years enrolled in the Inter99 cohort at baseline in 1999 were followed in a Diabetes Register. Incidence rates of Type 2 diabetes as a function of age, sex, and separate and combined levels of self-reported occupational physical activity and leisure-time physical activity were modeled using Poisson regression, adjusting for relevant covariates in separate analyses (2024).

RESULTS

Moderate/vigorous leisure-time physical activity was associated with lower risk of Type 2 diabetes than light (rate ratio=0.63, 95% CI=0.46, 0.85). Strenuous occupational physical activity was associated with a slightly higher risk of Type 2 diabetes than moderate occupational physical activity, but the association diminished adjusted for covariates (rate ratio=1.12, 95% CI=0.79, 1.58). Sedentary leisure-time physical activity combined with any level of occupational physical activity was associated with higher risk of Type 2 diabetes than light leisure-time physical activity/moderate occupational physical activity combined (e.g., sedentary leisure-time physical activity and demanding occupational physical activity) (rate ratio=1.68, 95% CI=1.14, 2.48). Moderate/vigorous leisure-time physical activity combined with any level of occupational physical activity was associated with lower risk of Type 2 diabetes (e.g., moderate/vigorous leisure-time physical activity and moderate occupational physical activity) (rate ratio=0.6, 95% CI=0.39, 0.92).

CONCLUSIONS

Leisure-time physical activity lowered the risk of Type 2 diabetes regardless of the level of occupational physical activity, whereas no similar beneficial effects were found for occupational physical activity level. The differential effects of occupational physical activity and leisure-time physical activity on Type 2 diabetes suggest that the paradox may also exist in Type 2 diabetes.

Epidemiology of paediatric winter sports-related injuries in France: The WINTRAUMA-1 retrospective cohort study

AIM

To describe the epidemiology of injuries related to winter sports in patients younger than 15 years in France.

METHODS

We conducted a retrospective observational multicentre cohort study of patients younger than 15 years who were seen by mountain-community general practitioners for winter-sports injuries in 1999-2022.

RESULTS

Of the 108 619 patients (mean age, 11.4 ± 2.8 years), 76 724 (70.6%), 26 186 (24.1%) and 2132 (2.0%) were injured while skiing, snowboarding and sledding, respectively. Helmet use was noted in 50 164 (46.2%) patients and increased over time but remained low among sledders. A collision was the mechanism in 12.3% of patients overall and 32.1% of sledders. The most common injuries overall were wrist fractures (48.5%), head and trunk injuries (42.3%), and anterior cruciate ligament (ACL) tears (23.7%), with wrist fractures being more common in beginners (24.7%) and head/trunk injuries and ACL tears in advanced participants (18.3% and 2.6%, respectively). Only 3699 (3.4%) patients were admitted after the general-practitioner visit, notably for leg or ankle fractures (9.5%).

CONCLUSION

Winter sports-related injuries vary according to age, sex, skill level and sport. Admission rates are low but might be further decreased by better prevention. Protective measures should be tailored to each sport and individual.

Comparative lipidomic profiling in adolescents with obesity and adolescents with type 1 diabetes

OBJECTIVE

Both adolescents with obesity and those with type 1 diabetes (T1D) exhibit alterations in lipid profiles, but direct comparisons are limited. Comparing lipidomic profiles between obese individuals and those with T1D is crucial for identifying specific metabolic markers, informing tailored interventions, and advancing precision medicine strategies for these distinct populations. The aim of the study was to compare lipidomic profiles between adolescents with obesity and those with T1D, and to analyze associations between metabolites and clinical parameters.

METHODS

We included 156 adolescents aged 11-18 years (59.6% girls) from the HEPAFIT (n=114, obesity) and Diactive-1 Cohort (n=42, T1D) studies. Clinical measures included anthropometrics, body composition, lipids, liver enzymes, glucose, and HbA1c. Lipidomic analysis of 277 serum/plasma metabolites used UHPLC-MS.

RESULTS

Distinct lipid profiles were seen, with higher diglycerides, triglycerides, and certain phosphatidylinositols in the obesity group, while phosphatidylcholines, phosphatidylethanolamines, cholesterol esters, sphingomyelins, and ceramides were elevated in T1D. Triglycerides acyl chain lengths and saturation levels also varied. Multivariate analysis identified seven metabolites -PC(O-18:1/18:1), PC(O-18:1/22:4), PE(O-16:0/18:1), PE(18:2e/22:6), PC(40:1), PC(O-22:1/20:4), and PE(P-18:0/18:1)- significantly associated with clinical parameters.

CONCLUSIONS

Distinct lipid profiles were observed among adolescents with obesity and T1D in the study, emphasizing the importance of understanding specific metabolite associations with clinical parameters for more precise health management.

Artificial neural networks' estimations of lower-limb kinetics in sidestepping: Comparison of full-body vs. lower-body landmark sets

Artificial neural networks (ANNs) offers potential for obtaining kinetics in non-laboratory. This study compared the estimation performance for ground reaction forces (GRF) and lower-limb joint moments during sidestepping between ANNs fed with full-body and lower-body landmarks. 71 male college soccer athletes executed sidestepping while three-dimensional kinematics and kinetics were collected to calculate joint moments by inverse dynamic. To estimate GRF and lower-limb joint moments, coordinates of 18 full-body (the full-body landmarks ANN) and 11 lower-limb body landmarks (the lower-body landmarks ANN) were respectively used as inputs in ANNs. Estimation performance was evaluated using the coefficient of multiple correlations, root mean square error (RMSE), and normalized RMSE (nRMSE) between estimated and measured results. A Wilcoxon signed-rank test determined the difference in estimation performance between the two types of ANNs. Statistical parametric mapping determined the difference between the estimated and measured curves. The lower-body landmarks ANN showed lower error for sagittal knee moments (RMSE: p < 0.001; nRMSE: p < 0.001), but higher error for sagittal hip (RMSE: p = 0.015) and ankle moments (RMSE: p = 0.001; nRMSE: p = 0.001). Significant differences between the lower-body landmarks ANN estimates and measurement curves were found in anterior-posterior GRF (10-12 %, p = 0.013), vertical GRF (5-15 %, p < 0.001), and hip transverse moment (1 %, p = 0.017). No significant differences were found in the estimated and measured GRF peaks. The ANN only using lower-body landmarks as inputs could accurately estimate GRF and lower-limb joint moments during sidestepping, with better performance for knee moments, while ANN using full-body landmarks performs better for hip and ankle moments.

The Effect of the Menstrual Cycle on Energy Intake: A Systematic Review and Meta-analysis

CONTEXT

Energy intake may differ across the menstrual cycle, with some studies identifying greater energy intake in the luteal phase (LP) compared with the follicular phase (FP) and others finding no clear differences. To date, no study has systematically synthesized the available data to draw more definite conclusions while considering any methodological inconsistencies between studies.

OBJECTIVE

The aim was to conduct a systematic review/meta-analysis in an effort to determine if there are differences in energy intake between the FP and LP.

DATA SOURCES

A systematic search strategy was developed and the search was conducted in 5 databases for studies that investigated any changes in energy intake across menstrual phases.

DATA EXTRACTION

Using Covidence, studies were identified and included if they contained individuals between the ages of 18 and 45 years, maintained an average body mass index (BMI) of 18.5-25 kg/m2, had no history of disordered eating, and included energy intake and menstrual cycle measurements in the FP and LP.

DATA ANALYSIS

Effect sizes were calculated for each study and a random-effects model was used to pool the results of each study.

RESULTS

Fifteen datasets were included consisting of 330 female participants with a mean age of 26 ± 4 years and mean BMI of 22.4 ± 2.3 kg/m2. Overall, there was a statistically significant difference (standardized mean difference = 0.69; P = .039) with increased energy intake in the LP compared with the FP (crude 168 kcal⋅d-1 average difference between phases).

CONCLUSION

Energy intake was found to be greater in the LP compared with the FP, providing insight into the effect of the menstrual cycle on energy intake. However, there were repeated methodological inconsistencies and future work should strive to utilize best practices for both energy intake measurement and menstrual phase specification.

Physiological Responses of Elite Cheerleaders During Training and Simulated Competition Routines

PURPOSE

Competitive cheerleading (cheersport) is a physically demanding sport; however, there is a lack of information regarding its acute physiological responses during training or competition in these athletes. Thus, this study aimed to investigate these responses during both training sessions and simulated cheerleading competition routines (full-outs) among elite cheersport athletes.

METHODS

Six Coed and 10 All Girl elite cheerleaders were included in this study. Countermovement-jump (CMJ) height and blood lactate concentration were measured prepractice, after warm-up, after a full-out, and at the end of the training session. Heart rate (HR) was monitored throughout all the sessions. One-way analysis of variance was used to analyze changes over time.

RESULTS

Most of the training time (51%-68%) was spent between 50% and 69% maximum HR. Only 3% to 4% was spent above 90% HRmax. During full-outs, most of the time (67%-80%), HR was ≥80% maximum HR. The blood lactate concentration was significantly elevated post-full-out (6.4 [1.6] mmol/L) compared with pretraining and post-warm-up (P < .001). In addition, blood lactate concentration was higher after training (3.4 [2.2] mmol/L) compared with prepractice and post-warm-up (P ≤ .025). CMJ height did not change over time (P ≤ .268).

CONCLUSION

Cheersport training leads to a low overall metabolic demand but is interspersed with short, high-intensity "intervals." The highest intensities were achieved during full-outs, indicating the anaerobic nature of competition routines. Therefore, cheerleaders should train both the aerobic and the anaerobic systems to increase recovery capacity between drills and to maximize anaerobic power during competition.

Technical Stroke Regulations Discriminate Pacing Effectiveness During a 5-km Indoor Pool Race

PURPOSE

To investigate technical regulation mechanisms of long-distance swimmers that differentiate optimal pacing strategies and the underlying kinematic parameters.

METHODS

Twenty-one national and international swimmers were equipped with a sacrum-worn inertial measurement unit performed during 5000-m indoor French championships. Percentage of critical swimming speed (CSS), stroke rate, stroke length, jerk cost, stroke index, and mechanical proficiency score were computed by lap. Athletes were divided into groups of pacing effectiveness based on optimal potential performance level (OPPL)-optimal (nearOPPL) and suboptimal (farOPPL)-using functional clustering of percentage of the CSS. Race sections were analyzed with a change-in-slope detection method. Common stroke-regulation abilities and deviations by pacing groups were profiled by fitting hierarchical generalized additive models between mechanical variables and laps.

RESULTS

The 2 clusters were discriminated by percentage of the CSS sustainment (P < .01). Optimal performers showed a +41.4% more stable pacing (2 race sections vs 3 for farOPPL) and a +36.7% higher end spurt, with a trend combining higher overall stroke rate (P = .08) with lower jerk cost (P = .17). Functional profiles showed that maintaining a higher stroke length and stroke index in a fatigued state, rather than overall values, allows the swinner to reach OPPL (P < .001). High regulation of mechanical proficiency score across the race, in line with pacing expectations of particular race sections, is a game changer to sustain CSS (P < .001).

CONCLUSIONS

Specific profiles of stroke regulations, regarding tradeoff between stroke smoothness and resultant speed, lead to optimal pacing during the 5000-m. The results of this study enhance the technical understanding of optimal pacing in long-distance pool races for coaches and swimmers.

Effects of Bilateral and Unilateral Plyometric Training on Physical Performance in Male Postpubertal Basketball Players

PURPOSE

The aim of this study was to analyze the effects of bilateral and unilateral plyometric-training (PT) programs on jumping, sprinting, and change-of-direction (COD) ability in male postpubertal basketball players.

METHODS

Forty-three young male basketball players (14.2 [1.2] y), from 4 squads belonging to an elite basketball club, were randomly assigned to 1 of 3 groups: (1) bilateral PT group (BG), (2) unilateral PT group (UG), and (3) control group (CG). The experimental groups followed a PT program twice weekly for 6 weeks, with BG and UG performing 2- and 1-legged jumps, respectively. Both groups completed the same number of vertical, horizontal, cyclic, and acyclic jumps. Pretraining and posttraining measurements included (1) countermovement jump (CMJ), (2) unilateral CMJ (CMJL and CMJR), (3) horizontal jump (HJ), (4) unilateral HJ (HJL and HJR), (5) straight-line sprint in 20 m (T20), and (6) V-Cut COD test (V-Cut).

RESULTS

CMJ, CMJL, and CMJR were significantly improved by BG and UG (P < .001), while CG did not change. Both the BG and the UG improved their performance significantly (P < .01) in HJL and HJR, but only BG significantly increased (P < .05) HJ and showed significantly greater improvements than CG. Furthermore, only BG improved V-Cut performance (P = .03). Neither group increased T20. CG did not improve in any tests.

CONCLUSIONS

BG enhances single-leg and double-leg jump performance in vertical and horizontal directions, as well as COD ability. In contrast, an equivalent volume of unilateral PT only improves vertical jumps and unilateral HJs.

Epidemiology of injuries and illnesses among female cricketers in Bangladesh's first-class cricket: a retrospective analysis (2015-2021)

This retrospective study aimed to examine the incidence, types, and patterns of injuries and illnesses among female cricketers in the first-class cricket of Bangladesh between 2015 and 2021. The study was conducted with 250 female cricket players aged 14-28 who had experienced injuries. Participants completed a structured questionnaire that gathered information on injury type, frequency, recurrence, treatment methods, and post-injury performance. Logistic regression analysis was employed to assess the relationship between injury risk and key variables, including playing position (batter, bowler, or fielder), weekly workload (hours spent in training/competition), and injury context (occurring during matches or practice). Descriptive statistics were used to summarize injury patterns and recovery outcomes, while odds ratios (OR) with 95% confidence intervals (CI) were calculated to identify significant predictors of injury risk. Of the participants, 75.2% experienced new injuries, while 24.8% reported chronic injuries. The most common injury sites were the knee/leg (24%) and shoulder (20%). Recurrence was high, with 56% experiencing 5-6 injury recurrences, and 68% reported multiple injuries over their careers. Physiotherapy was the primary treatment, used by 52% of participants, and 76% of players returned to competition post-injury. However, only 8% regained their pre-injury performance levels. Logistic regression revealed that bowlers had a significantly higher injury risk (OR = 2.12, p = 0.055), while high workloads (21+ hours/week) were also associated with increased injury risk (OR = 1.42, p = 0.112), though not statistically significant. The findings highlight the prevalence of injuries in female cricket, particularly in bowlers and those with high workloads. Physiotherapy was effective in promoting recovery, but a significant portion of athletes did not regain their pre-injury performance levels. Comprehensive injury prevention programs, tailored rehabilitation, and ongoing education on injury management are essential to mitigate risks and enhance player recovery.

Association between sex steroid hormones and α-klotho: Results from the NHANES 2013-2016 and Mendelian randomization study

PURPOSE

This study aimed to explore the association and causal links between sex steroid hormones and the anti-aging protein α-Klotho, extending to investigate the mediation effects of potential mediators.

METHODS

Based on data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016, this study performed weighted multivariable-adjusted logistic regression to evaluate the association between sex steroid hormones and α-Klotho. Then, utilizing summary data from genome-wide association studies (GWAS), a bidirectional two-sample Mendelian randomization (MR) was conducted to assess the causal relationship between sex steroid hormones and α-Klotho. Finally, mediation analysis was conducted to delineate the influence of five identified potential mediators on the sex steroid hormones-α-Klotho association.

RESULTS

In men, significant positive correlations with α-Klotho were consistent across both unadjusted and fully adjusted models for total testosterone (TT), bio-available testosterone (Bio-T), estradiol (E2) and sex hormone-binding globulin (SHBG) (Model 3: TT: β = 3.54, 95 % CI: 1.63-5.44, P = 0.0003; Bio-T: β = 1.74, 95 % CI: 0.73-2.74, P = 0.0007; E2: β = 0.25, 95 % CI: 0.11-0.38, P = 0.0003; SHBG: β = 0.95, 95 % CI: 0.63-1.27, P < 0.0001); In premenopausal women, we detected a potential nonlinear relationship between TT levels and α-Klotho, with α-Klotho levels rising to a peak at a TT level of 72.2 ng/mL, after which they declined. Furthermore, results from MR analyses reaffirmed positive associations of TT and Bio-T with α-Klotho in men (TT: β = 3.54, 95 % CI: 1.63-5.44, P = 0.0003; Bio-T: β = 1.74, 95 % CI: 0.73-2.74, P = 0.0007). Finally, significant mediation effects were observed for uric acid (β = 0.27, 95 % CI: 0.15-0.67, P < 0.0001) and creatinine (β = 0.05, 95 % CI: 0.01-0.16, P = 0.0060), accounting for 26.7 % and 5.23 % of the total mediation effect, respectively.

CONCLUSION

In conclusion, our results demonstrate that both TT and Bio-T enhance the expression of α-Klotho in men. The positive association observed may be partly mediated by uric acid and creatinine.

The effects of caffeine mouth rinsing on selective attention as a function of different caffeine concentrations and perceived taste intensity in recreationally active males at rest: a randomized placebo-controlled cross-over trial

RATIONALE

The effect of caffeine mouth rinsing (CAF-MR) on cognitive performance has not been thoroughly investigated.

OBJECTIVES

To evaluate the effects of different concentrations of CAF-MR on selective attention in relation to perceived taste intensity.

METHODS

A total of 30 healthy and recreationally active male subjects were included in this randomized, double-blind, placebo-controlled crossover trial. Interventions included MR for 20 s at rest with three different caffeine solutions (0.24% [60 mg/25 mL], 0.6% [150 mg/25 mL], and 1.2% [300 mg/25 mL]), MR with 25 mL water (placebo), and no MR (control). Data on Victoria Stroop Test (VST) and the perceived taste intensity were recorded at five sessions.

RESULTS

CAF-MR-300 mg intervention significantly decreased completion time (from 62.93 ± 19.07 to 57.01 ± 16.74 s, p = 0.002 in Part D), while CAF-MR-150 mg intervention significantly decreased number of errors in Part D (7.00 ± 6.21 vs. 5.63 ± 5.76, p = 0.04) and Part C (8.77 ± 8.80 vs. 7.10 ± 7.11, p = 0.02). Perceived difficulty was significantly decreased both after CAF-MR with 150 mg (5.57 ± 1.65 vs. 4.77 ± 1.98, p = 0.006) and 300 mg (5.95 ± 1.77vs. 4.67 ± 1.96, p < 0.001). Perceived taste intensity for 300 mg of caffeine was negatively correlated with completion time (r: ranged, 0.37 to 0.46, p ranged, 0.045 to 0.009) after 300 mg, 150 mg (p ranged, 0.04 to 0.005) and placebo (p ranged 0.044 to 0.03) interventions.

CONCLUSIONS

This study is the first to demonstrate that CAF-MR shows dose-dependent effects on selective attention in healthy recreational males, such as improved speed (for 300 mg caffeine), reduced error rate (for 150 mg caffeine) and decrease in perceived difficulty (for 150 and 300 mg caffeine).

Antioxidant capacity and athletic condition of endurance horses undergoing nutraceutical supplementation

Endurance is an equestrian discipline that primarily relies on aerobic metabolism. Intense aerobic exercise produces reactive oxygen species due to an imbalance between oxidant and antioxidant substances, known as oxidative stress, which may reduce athletic performance. This study evaluated the effects of a feed supplement containing natural antioxidants and omega-3 fatty acids on the blood antioxidant activity and the athletic condition of endurance horses undergoing an exercise test. Twelve Arabian endurance horses were randomly assigned to treatment or control groups. At T0, blood lactate, whole blood and red blood cells (RBC) antioxidant capacity were assessed. The horses performed an exercise test with heart rate monitoring. After 30 min, blood lactate, antioxidant capacity and serum creatine kinase (CK) were measured. The treatment group received the dietary supplement for 21 days, while controls maintained their diet. Then, the protocol was repeated (T1). Variables were compared within and between groups through two-way ANOVA and post-hoc tests. Significant time*group effects were observed for serum CK (p = 0.026), RBC antioxidant capacity at rest (p = 0.034) and post-exercise (p = 0.019). At T1, in treatment group, CK was lower than controls (p = 0.006), while RBC antioxidant capacity increased at rest (p = 0.037) and after exercise (p = 0.006) compared to T0. The dietary supplement showed efficacy in enhancing RBC antioxidant capacity, and it could be beneficial for horses engaged in intense aerobic exercise.

Conditioning of Motor Evoked Responses After Anterior Cruciate Ligament Reconstruction: Effects of Stimulus Intensity

BACKGROUND

Operant conditioning of motor evoked torque (MEPTORQUE) can directly target the corticospinal pathway in patients with anterior cruciate ligament (ACL) reconstruction. However, it remains unclear whether operant conditioning can elicit short-term improvements in corticospinal excitability and whether these improvements are influenced by stimulus intensity.

HYPOTHESIS

Quadriceps MEPTORQUE responses can be upconditioned in a single session and will elicit short-term adaptations in corticospinal excitability, with higher stimulus intensities eliciting greater effects.

STUDY DESIGN

Randomized controlled laboratory study.

LEVEL OF EVIDENCE

Level 2.

METHODS

Thirty-six participants were assessed during a single session of an operant conditioning protocol. Participants were randomized into 1 of 3 groups for stimulus intensity used during operant conditioning based on the participant's active motor threshold (AMT: 100%, 120%, and 140%). Quadriceps MEPTORQUE amplitude was evaluated during a block of control transcranial magnetic stimulation trials (CTRL) to establish baseline corticospinal excitability, and 3 blocks of conditioning trials (COND) during which participants trained to upcondition their MEPTORQUE. MEPTORQUE recruitment curves were collected to evaluate the effect of operant conditioning on acute corticospinal adaptations.

RESULTS

Participants with ACL reconstruction could upcondition their MEPTORQUE in a single session (P < 0.01; CTRL, 17.27 ± 1.28; COND, 21.35 ± 1.28 [mean ± standard error [SE] in N·m]), but this ability was not influenced by the stimulus intensity used during training (P = 0.84). Furthermore, significant improvements in corticospinal excitability were observed (P = 0.05; PRE, 687.91 ± 50.15; POST, 761.08 ± 50.15 [mean ± SE in N·m %AMT]), but stimulus intensity did not influence corticospinal adaptations (P = 0.67).

CONCLUSION

Operant conditioning can elicit short-term neural adaptations in ACL-reconstructed patients. Future operant conditioning paradigms may effectively use any of the 3 stimulus intensities studied herein.

CLINICAL RELEVANCE

Operant conditioning may be a feasible approach to improve corticospinal excitability after ACL reconstruction.

Impact of resistance and endurance exercise training on femoral artery function: sex differences in humans

Exercise has direct and indirect anti-atherogenic impacts on arterial function and health in humans. Few studies have directly compared the impacts of different commonly adopted exercise approaches on femoral artery function. We hypothesized that, owing to its direct impact via sustained increases in shear stress, endurance (END) training would have larger impacts on arterial diameter and function than resistance (RES) training. Thirty-nine young, healthy participants (age 26.9 ± 6.2 years, 22♀) completed 12 weeks of both RES and END training in random order, separated by a 12 week washout. Resting femoral artery diameter and flow-mediated dilatation (FMD) were collected before and after each exercise intervention. END training was associated with an increase in both FMD (Δ1.61 ± 3.09%, P = 0.005) and resting diameter (Δ0.15 ± 0.29 mm, P = 0.004). Neither resting diameter nor FMD increased following RES. However, sex difference analysis revealed that males increased FMD following RES (Δ2.21 ± 3.76%, P = 0.015), whereas no RES change was evident for females. Following END, both males and females increased FMD (♂, Δ1.11 ± 1.65%; ♀, Δ1.88 ± 3.67%; both P = 0.025), with males also showing an increase in resting arterial diameter following END (Δ0.23 ± 0.2 mm, P < 0.001). Group data revealed that END has greater impacts than RES on femoral artery diameter and flow-mediated functional responses, which are endothelium mediated and nitric oxide dependent. Males exhibit beneficial impacts in response to both END and RES, whereas females respond predominantly to END. Our findings suggest that arterial adaptation to exercise might be influenced by exercise modality and sex. KEY POINTS: Exercise has anti-atherogenic effects and lowers the risk of cardiovascular diseases. This is mediated, in part, by the direct haemodynamic impacts of exercise on arterial function, structure and health. Different modalities of exercise have distinct effects on arterial haemodynamics, but few studies have directly compared, within subjects and using a cross-over design of trial, the relative impacts of distinct forms of exercise training on arterial adaptation. In this study, endurance training increased baseline femoral artery diameter and flow-mediated dilatation, which is endothelium dependent and mediated by nitric oxide. Resistance training had a beneficial but lesser impact. Females and males were responsive to endurance training, but only males responded positively to resistance training in this study. These results show that changing the training mode modifies training-induced arterial adaptation; this has implications for the optimization of exercise prescription for individual benefit.

Return to Golf After Hip Arthroscopy: A Systematic Review of the Literature

CONTEXT

Patients experiencing pain from femoral acetabular impingement and considering hip arthroscopy may be concerned about their timeline to resume activities they enjoy, such as golf.

OBJECTIVE

The purpose of this study was to review current literature on return-to-play data after hip arthroscopy and to provide clinicians with data to set proper expectations with patients.

DATA SOURCES

The following terms were used to search PubMed and Embase electronic databases on October 18, 2023: hip, arthroscopy, arthroscopic, golf.

STUDY SELECTION

Studies were included if they were in the English language, of Level 1 to 4 evidence, and contained data specific to golfers undergoing hip arthroscopy. Studies were excluded if they did not designate participants as golfers or did not specify return-to-play data. Editorials, case reports, and review articles were excluded. Screening was completed by 2 authors in a blind and duplicate manner.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level II.

DATA EXTRACTION

The following datapoints were extracted from each study: hip pathology and arthroscopic procedure data; number of players returning to golf and time from surgery to return; outcome score(s); and rehabilitation details. Descriptive statistics were calculated using Comprehensive Meta-Analysis software.

RESULTS

The search returned 400 studies, of which 4 were included for analysis. Of these 4 studies, 2 specified return-to-play time. Of 95 golfers, 90 (94.7%) returned to golf successfully after arthroscopic hip surgery. Subjective and objective outcome scores improved postoperatively, including an increased average drive distance.

CONCLUSION

Return to golf after hip arthroscopy is highly probable, with approximately 95% of patients throughout literature returning to play. A mean return time of 4.7 months for professional golfers and 7.2 months for amateurs, alongside improved subjective outcomes and performance metrics postsurgery, suggest patients can expect a relatively quick return to the course with similar or improved performance.

[Health literacy and health behaviour-insights into a developing field of research and action for public health]

The research and action field of health literacy and health behaviour is increasingly differentiating. General health literacy is established and focuses on population-based studies. Specific health literacy for health behaviour offers topic-related starting points for interventions and public health strategies.There are various concepts, definitions and measurement instruments for general health literacy and specific health literacy in the areas of nutrition and physical activity. These differ in terms of the levels of action and areas of application of health literacy.Most studies show a positive association between health literacy and various health behaviours. Higher health literacy is more often associated with improved health-promoting behaviour. This applies to both general as well as specific health literacy regarding nutrition and exercise (physical activity). Some studies found no correlation for certain behaviours, while others only found correlations for certain groups, which may be due to the different measuring instruments and research contexts. This points to the importance of always considering the interaction between behaviour and circumstances in order to improve the fit between the individual and the everyday demands of dealing with health information.The behavioural and cultural insights (BCI) approach can provide insights into how to promote health literacy with regard to various health behaviours, individual barriers and facilitators that arise from life circumstances and conditions, and that take social practice into account. BCI and health literacy complement each other and have the potential to make strategies for improving health behaviour more effective and targeted.

Return to Play, Performance, and Earnings Analysis After Lumbar Disc Herniation in National Hockey League Players

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

Professional hockey players have a high incidence of lumbar disc herniations (LDH). The purpose of this study was to determine the impact of LDH on the performance and financial earnings of National Hockey League (NHL) players.

METHODS

NHL players who sustained a LDH were retrospectively reviewed utilizing an online database and a 2:1 matched control cohort. Player performance and game usage was compared at one- and three-season(s) pre- and post-injury season within the cohorts. Injured and matched players were divided into 3 groups based on the player's adjusted index season salary.

RESULTS

A total of 181 players were included, with 62 LDH players matched to 119 healthy controls. Return to play after LDH was 79%. The LDH cohort had fewer seasons played throughout their career compared to the matched group (12.5 ± 4.3 vs 14.2 ± 3.8; P = .031). At 1 season post-index, the LDH cohort had significantly fewer goals per 60 and points per 60 when compared to pre-index. At 3 seasons post-index, the LDH cohort exhibited a significant decline in time-on-ice per game played, goals per 60, and points per 60 compared to pre-index.

CONCLUSION

The majority of NHL players who sustained a LDH returned to play (79%) but had shorter careers overall and decreased performance outcomes when compared to matched cohorts at both 1 and 3 seasons post-injury.

Factors Influencing Length of Care in Physical Therapy After Pediatric and Adolescent Concussion

CONTEXT

Social determinants of health including insurance type, income, race, and ethnicity have been shown to influence the utilization of physical therapy and recovery after an orthopedic injury. The influence of social determinants of health on the utilization of physical therapy and recovery from concussion is not well understood.

DESIGN

Prospective observational registry study in a specialty concussion program.

METHODS

Patients diagnosed with a concussion using the Postconcussion Symptom Inventory and the visio-vestibular examination (VVE) who were also referred to physical therapy were included. The main outcomes of interest were the number of days from referral to initial physical therapy evaluation and the number of physical therapy visits completed. Information related to patients' age, race, ethnicity, sex, insurance type, and Child Opportunity Index was extracted from the registry. Multivariate and univariate regressions were used to assess the associations of each sociodemographic characteristic with the outcomes.

RESULTS

A total of 341 patients diagnosed with concussion between January 2017 and December 2023 met inclusion criteria. The average age was 14.77, and 64% were female. Patients' age, race, ethnicity, insurance type, and Child Opportunity Index were not associated with days to evaluation or length of care in physical therapy. Higher PCSI scores in children under 12 years (coefficient: 0.17, 95% CI, 0.06-0.29) and female sex (coefficient: 1.2, 95% CI, 0.26-2.1) were associated with a longer course of care in physical therapy. Patients with an abnormal VVE score had on average 2.1 more physical therapy visits than those with a normal VVE score (coefficient: 2.1, 95% CI, 0.73-3.5).

CONCLUSIONS

Higher PCSI scores in children, female sex, and higher VVE scores in general predicted a longer course of care in physical therapy. Implementation of a clinical care pathway for concussion care using the PCSI and the VVE may be one strategy to help mitigate systemic factors that might otherwise negatively influence access to physical therapy.