Periodization and physical therapy: Bridging the gap between training and rehabilitation

Bridging, Mapping, and Addressing Research Gaps in Health Sciences: The Naqvi-Gabr Research Gap Framework

Innovations pertaining to the ever-evolving needs of the medical and healthcare sciences remain constant. This creates a gap between the rationalized needs of the study and the proposed research question. However, classifying, identifying, and addressing these research gaps require a systematic and precise structured map. Using the Medical Subject Heading (MeSH) terms "Research Gaps" AND "Healthcare" AND "Framework" in MEDLINE, Scopus, and CINAHL databases with the filters yielded no relevant literature. Therefore, this review aims to fill this practical and clinical knowledge gap by developing the Naqvi-Gabr Research Gap Framework through critical synthesis based on extensive research on medical and healthcare research gaps. Fourteen research gaps are distributed for allocation as per the healthcare delivery system approach: developing new treatments or prevention strategies, improving diagnostic tools and techniques, addressing health disparities, and improving access to healthcare services. This structured framework determines the strategic mapping of research gaps corresponding to the nature of the research. The identification and classification of the appropriate research gap led to precise and concise conclusions corresponding to the research process proposed in this study. Hence, the Naqvi-Gabr Research Gap Framework is a valuable tool for determining the potential application of gaps by researchers, policymakers, and other stakeholders with a productive address.

Strength training as a dynamical model of motor learning

This paper outlines a framework for strength training as a dynamical model of perceptual-motor learning. We show, with emphasis on fixed-point attractor dynamics, that strength training can be mapped to the general dynamical principles of motor learning that arise from the constraints on action, including the distribution of practice/training. The time scales of the respective dynamics of performance change (increment and decrement) in discrete strength training and motor learning tasks reveal superposition of exponential functions in fixed-point dynamics, but distinctive attractor and parameter dynamics in oscillatory limit cycle and more continuous tasks, together with unique timescales to process influences (including practice, learning, strength, fitness, fatigue, warm-up decrement). Increments and decrements of strength can be viewed within a dynamical model of change in motor performance that reflects the integration of practice and training processes at multiple levels of learning and skill development.

Level of knowledge of sports coaches and physical education teachers in physical therapy

The topic of physical therapy has concerned widely among the developed scholarly works but little in the developing context, thus this study pursues to explore the role of level of knowledge of both sports and physical education teachers in the area of physical therapy in context of Jeddah, Saudi Arabia. The study was a descriptive in its nature and through using the questionnaire, the data collected from Jeddah City in Saudi Arabia for further perceptions in this topic. A total of 98 participants involved in this study, and the results showed the majority of the participants had adequate knowledge about the important role and potential benefits of the physical therapy in their workplaces. The implications provided of this study indicate the need to integrate the training sessions of the physical therapy into sports events and activities to avoid injuries and improve rehabilitation and treatment of these injuries once occurred. For further exploration of this issue a larger with different sample is needed to fulfill the research gaps in this field.

Readaptación deportiva y retorno deportivo en el alto rendimiento. Del laboratorio al campo de juego: Una revisión de la literatura

Introducción En la actualidad, la readaptación deportiva se conoce como un proceso dinámico a nivel estructural y funcional de elementos del movimiento corporal humano tales como la caracterización de cualidades físicas, sinergias articulares y musculares, eficiencia y eficacia del movimiento y potencialización de habilidades funcionales para el deporte de alto rendimiento después de una lesión deportiva Metodología revisión de la literatura basados en los criterios PRISMA donde se hizo la búsqueda en las principales bases de datos tales como: Pubmed, Ebsco, Medline, Scopus, Science Direct con los siguientes terminos DeCS: Return to sport, Performance, sports, Return to training, Return to play, Rehabilitation, sports idioma de evidencia inglés, español, portugués, catalán y francés Resultados se pudo obtener la información de 74 artículos donde se estableció que el proceso de readaptación deportiva se basa en pilares específicos tales como movimiento, patrones funcionales, control de carga, monitorización, criterios de seguimiento por fase que permiten desarrollar un retorno exitoso al alto rendimiento deportivo. Conclusión la readaptación deportiva es un proceso que permite tomar decisiones basados en un proceso sistematizado generando la evolución del concepto de readaptador deportivo como un pilar esencial en el trabajo en el deporte de alto rendimiento en cualquier disciplina deportiva.   PALABRAS CLAVE: Return to Sport, Performance, sports, Return to training, Return to play

Comparative study on the efficiency of motor rehabilitation of the lower limbs using a stationary horizontal bicycle versus a standard therapeutic program

Abstract: The purpose of the present study is to compare the efficiency of two physiother-apeutic programs for rehabilitation of the lower limbs, one using a stationary bicycle and the other one being a standard program, targeting muscle imbalance deficit. Subjects are outpatients - the control group (C n=5), 58.67 ± 11.67 years, received a standard rehabilita-tion program, and the experimental group (E n=5), 56.67 ± 12.14 years, received a pro-posed rehabilitation program implying a stationary bicycle. Equipment used is for muscle imbalances – sensor attached to bicycle pedals, for joint testing – goniometer, for heart rate smart watch, pain assessment – VAS numeric scale, and for perceived effort Borg scale. The rehabilitation program including the stationary horizontal bicycle obtained better re-sults in terms of pain control (T-Test p C/E=.004/.001 and Wilcoxon p C/E=.039/.041) and the correction of muscular imbalances (T-Test p C/E=.003/.000, r= .990/.997) related to the lower limbs, with the mention that both programs recorded statistically significant results regarding functionality. HR values for the control group and experimental group < THR values, aerobic conditioning with the submaximal effort being essential for rehabilitation. Both programs maintained the same perceived level of effort with an average of 3.6 Borg- moderate effort, respectively mild-moderate dyspnea. Keywords: rehabilitation; lower limbs; stationary bicycle; muscle imbalance; pedal sensor; ana-log value; heart rate (HR); target heart rate (THR).

Beurteilung des neuromuskulären Funktionszustands bei Berufssportlern

In den letzten Jahren wurden bedeutende Fortschritte in den chirurgischen Techniken, der postoperativen Rehabilitation und der Identifizierung von Risikofaktoren für eine zweite Verletzung des vorderen Kreuzbands (VKB) gemacht. Dies führte jedoch nicht zu einer Verringerung des sekundären VKB-Verletzungsrisikos. Die Wiederherstellung der anatomischen (operative Rekonstruktion) und anschließend insbesondere der trainingsbedingten funktionellen Stabilität sollte eine grundlegende Voraussetzung für die Rückkehr zu Pivot-Sportarten nach einer VKB-Verletzung sein. Das VKB hat eine bedeutende Rolle bei der Kniepropriozeption mit der Konsequenz einer eingeschränkten sensomotorischen Regulation im Verletzungsfall. Das Perturbationstraining stellt eine große Herausforderung in der spätrehabilitativen Phase nach VKB-Rekonstruktion dar. Die Diagnostik der Muskelaktivierung im Rehabilitationsverlauf nach VKB-Rekonstruktion hat deshalb eine enorme Bedeutung. Mit der entwickelten Software können Charakteristika der motorischen Einheiten knieführender Muskeln zeitnah objektiviert und somit eine mögliche Überlastung bei hochreaktivem Perturbationstraining im Rahmen der spätrehabilitativen Phase nach VKB-Rekonstruktion vermieden werden.

Monitorización y periodización del rendimiento desde la fisioterapia deportiva ¿Hacia dónde vamos?

RESUMEN Introducción El concepto de monitorización y periodización es un visión que se ha desarrollado en la última década, donde se busca que se pueda tener un control de la carga interna y externa en los deportistas de distintas disciplinas deportivas producidas por el proceso de interacción con variables de prescripción de ejercicio que causan modificaciones a nivel fisiológico, bioquímico, biomecanico, muscular, neuromuscular  ocasionando la tensión en los subsistemas del movimiento corporal humano generando adaptaciones especificas ante una carga determinada la cual puede ser medida mediante el uso de tecnología especifica o test indirectos Metodología Revisión de la literatura con la combinación de palabras clave como Monitoring, Performance, sports training load, Periodization en bases de datos como Pubmed, Ebsco, Medline, Scopus, Science Direct Resultados se pudo identificar 65 artículos que referencian la existencia  de herramientas tecnológicas para realizar un proceso de monitorización y periodización desde la rehabilitación , prevención, control de carga, recuperación y readaptación deportiva que permiten la generación de datos estadísticos y crear perfiles desde cada área de actuación del fisioterapeuta deportivo. Conclusión la fisioterapia es una profesión encargada de muchos procesos deportivos que deben ser monitorizados y generen datos que permitan estandarizar procesos, crear perfiles de seguimiento específicos para facilitar la toma de decisiones desde el equipo biomédico e investigaciones en el deporte de alto rendimiento fusionando la practica con la evidencia científica.

Prevention and Treatment of Sports Injuries and Rehabilitative Physical Training of Wushu Athletes

This paper is aimed at exploring the characteristics of research on prevention and treatment of sports injuries and rehabilitation physical training of Wushu athletes. It also considers the application of rehabilitation physical training in the rehabilitation of Wushu athletes. By searching literature, conducting questionnaires, and combining mathematical statistics, it studies the injury prevention and rehabilitation training of Wushu athletes. This paper chooses the level of first class and above of sports, and a total of 50 elite male and female Wushu athletes were systematically trained as subjects of study. Athletes, aged 15 to 20 years, were trained for 2 to 5 years, 35 male athletes and 15 female athletes. Different from traditional rehabilitation therapy, athletes' physical rehabilitation training is also different from traditional sports rehabilitation treatment. By evaluating the physical condition of athletes, the causes of sports injuries were analyzed, to formulate special rehabilitation training programs and carry out athletes' rehabilitation training targeted and purposeful. Record the experimental data and analyze the experimental results. The experimental results show that physical rehabilitation training can make athletes avoid the influence of unsafe factors of sports injury, improve the safety of training, and effectively prevent sports injury. The experimental results show that physical rehabilitation training combined with rehabilitation medicine has obvious advantages, which can make Wushu athletes recover quickly without sequelae.

A Fitness-Fatigue Model of Performance in Peripheral Artery Disease: Predicted and Measured Effects of a Pain-Free Exercise Program

Banister impulse-response (IR) model estimates the performance in response to the training impulses (TRIMPs). In 100 patients with peripheral artery disease (PAD), we tested by an IR model the predictability of the effects of a 6-month structured home-based exercise program. The daily TRIMPs obtained from prescribed walking speed, relative intensity and time of exercise determined the fitness-fatigue components of performance. The estimated performance values, calculated from the baseline 6-min and pain-free walking distance (6MWD and PFWD, respectively) were compared with values measured at visits through regression models. Interval pain-free walking at controlled speed prescribed during circa-monthly hospital visits (5 ± 1) was safely performed at home with good adherence (92% of scheduled sessions, 144 ± 25 km walked in 50 ± 8 training hours). The mean TRIMP rose throughout the program from 276 to 601 a.u. The measured 6MWD and PFWD values increased (+33 m and +121 m, respectively) showing a good fit with those estimated by the IR model (6MWD: R² 0.81; PFWD: R² 0.68) and very good correspondence (correlation coefficients: 0.91 to 0.95), without sex differences. The decay of performance without training was estimated at 18 ± 3 weeks. In PAD, an IR model predicted the walking performance following a pain-free exercise program. IR models may contribute to design and verify personalized training programs.

What conservative interventions improve bite function in those with temporomandibular disorders? A systematic review using self-reported and physical measures

BACKGROUND

Bite is an important function of the human stomatognathic system. Despite this, it is commonly impaired in temporomandibular disorder (TMD) populations. The aim of this review is to evaluate the effectiveness of conservative interventions on self-reported and physical measures of bite function in individuals with TMD.

METHODS

This review was performed in compliance with PRISMA guidelines. An electronic search was performed on databases including Pubmed, CINAHL, Embase, and Cochrane Central. Inclusion criteria were journal articles evaluating the effect of any non-pharmacological conservative interventions on bite function in participants diagnosed with TMD. Risk of bias for individual studies was assessed using the Cochrane risk-of-bias v2 tool, and the NIH NHLBI pre-post tool. Data was synthesised based on outcome measures of bite function, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Eleven studies were eligible for this review. Interventions included splinting, photobiomodulation, needling, exercise, manual therapy, and patient education; which were evaluated using mastication-related pain, self-reported chewing difficulty, and bite force/endurance outcome measures. Findings suggested manual therapy, needling, oral splinting, exercise and PBM interventions may improve bite function in TMD, although confidence in cumulative evidence ranged from moderate to very low. There was no evidence that patient education improved bite function.

CONCLUSION

Conservative interventions may be helpful to address bite-related impairments associated with TMD, although further research is needed to improve the quality of evidence and direct clinical guidelines.

Comprehensive Rehabilitation of the Athlete: A Specific and Purposeful Approach

There is a need to improve the quality of rehabilitation in sports medicine to return athletes to optimal function safely and quickly, reducing the risk of reinjury. This paper describes a planning paradigm to guide clinical reasoning during individual treatment sessions and a model for planning the rehabilitation program from acute injury to return to play. The design of a rehabilitation program should be a collaborative, team effort, and accounting for the specific needs of the athlete. As the athlete progresses from acute injury management all the way back to full competition, the rehabilitation professional emphasizes the components of pain management, motion, motor control, and force production in varying degrees based upon phases of tissue healing and the athlete's response. Utilizing high-value, evidence-based treatments maximize both the effectiveness and efficiency of rehabilitation to restore and improve upon preinjury levels of physical performance.

Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues, and Inadequate Outcomes

Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.

Is resistance training intensity adequately prescribed to meet the demands of returning to sport following anterior cruciate ligament repair? A systematic review

Objective

To identify, critique and synthesise the research findings that evaluate the use of resistance training (RT) programmes on return to sport outcome measures for people following ACL repair (ACLR).

Design and data sources

This systematic review included a comprehensive search of electronic databases (EBSCO health databases (CINAHL, MEDLINE, SPORTDiscus), Scopus and Pedro) performed in June 2020 and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies were appraised using the Downs and Black checklist.

Eligibility criteria

Randomised and non-randomised controlled trials, longitudinal cohort studies and case series were considered for inclusion where an adequate description of the RT intervention was provided as a part of the study's ACLR rehabilitation protocol. Articles that did not include outcome measures related to return to sport criteria were excluded.

Results

Eleven articles met the inclusion criteria and were subjected to appraisal and data extraction. Study quality ranged from poor to excellent. RT intensity varied considerably among studies (between 5% and >80% of one repetition maximum). Only one identified study specifically investigated the effect of a low-intensity versus high-intensity RT protocol. The majority of studies reported participant outcomes that would not meet commonly used return to sport criteria.

Conclusion

There appears to be considerable variation in the intensity of RT prescribed in research for people following ACLR. Furthermore, in most of the identified studies, RT protocols promoted muscle endurance and hypertrophy without progressing to strength or power-based RT. The findings of this review provide insight into potential factors limiting returning to sport and contributing to reinjury for people following ACLR.

Frequency of Injury and Illness in the Final 4 Weeks before a Trail Running Competition

We aimed to (i) determine self-reported injury and illness frequency in trail runners 4 weeks preceding competition; (ii) compare athletes with and without injury/illness by sex, age, body mass index (BMI) and competition distance; (iii) describe mechanism of injury, anatomical region (injury)/organ system (illness) involved, consequences of injury on preparation and self-perception of injury severity; (iv) compare anatomical region (injury) and organ system (illness) by sex. A total of 654 trail runners (age 36.2, IQR 30.6-43.0; 36.9% females) participated in this retrospective cross-sectional study by completing a self-reported questionnaire. Injury and illness frequency rates were 31.3% (n = 205, CI: 27.7-35.0%) and 22.3% (n = 146, CI: 19.1-25.7%), respectively. No significant difference was found between injured vs. non-injured or ill vs. non-ill study participants by sex, age, BMI and competition distance. Regarding injuries, gradual onset (41.6%) and knee (33.2%) were the most indicated mechanism and anatomical region of injury. At least 85.4% of trail runners changed their training following injury and 79% indicated that their injury would affect their competition performance. Regarding illness, the respiratory tract was the most frequent organ system involved (82.9%). Male and female participants reported similar proportions of anatomical regions (injury) and organ systems (illness) affected. These results could help to generate education strategies and appropriate medical support before and during these competitions.

Periodization: Variation in the Definition and Discrepancies in Study Design

Over the past several decades, periodization has been widely accepted as the gold standard of training theory. Within the literature, there are numerous definitions for periodization, which makes it difficult to study. When examining the proposed definitions and related studies on periodization, problems arise in the following domains: (1) periodization has been proposed to serve as the macro-management of the training process concerning the annual plan, yet research on long-term effects is scarce; (2) periodization and programming are being used interchangeably in research; and (3) training is not periodized alongside other stressors such as sport (i.e., only resistance training is being performed without the inclusion of sport). Overall, the state of the literature suggests that the inability to define periodization makes the statement of its superiority difficult to experimentally test. This paper discusses the proposed definitions of periodization and the study designs which have been employed to examine the concept.

Periodization in Anterior Cruciate Ligament Rehabilitation: A Novel Framework

More than 250,000 anterior cruciate ligament (ACL) injuries occur each year in the USA, and approximately 65% of these injuries undergo reconstructive surgery. Appropriate rehabilitation after ACL reconstruction can yield predictably good outcomes, with return to previous levels of activity and high knee function. At present, periodization is used at all levels of sports training. Whether conceptualized and directed by coaches, or by athletes themselves, competitors structure their training in a cyclic fashion, enabling athletes to best realize their performance goals. In practical application, sport physical therapists use periodization: postoperative "protocols" serve as rudimentary forms of periodization, albeit implemented over shorter time frames than that typically employed in preparation for competition. An ACL injury should not be considered a "simple" musculoskeletal pathology with only local mechanical or motor dysfunctions. Together with the psychological trauma and reduction in physical capacity, there is a cascade of events, including neurological insult to the central nervous system and reduction in afferences to the sensorimotor system. Rehabilitation should consider all these issues, and periodization would allow to better define and to plan aims and objectives to return athletes to their sport. Technological resources including advanced neuroimaging methods, virtual reality for injury risk screening and return to sport assessment, and interactive artificial reality-based neuromuscular training methods offer new approaches and tools to address this important biomedical problem. The cost and availability of many of these technologies will continue to decrease, providing greater availability, scientific rigor, and ultimately, utility for cost-effective and data-driven assessments.

Effects of Different Types of Exercise on Bone Mineral Density in Postmenopausal Women: A Systematic Review and Meta-analysis

In this sub-analysis of a comprehensive meta-analysis, we aimed to determine the effect of different types of exercise on (areal) bone mineral density (BMD) in postmenopausal women. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) with at least one exercise and one control group, (c) intervention ≥ 6 months, (d) BMD assessments at lumbar spine (LS), femoral neck (FN) or total hip (TH), (e) in postmenopausal women. Eight electronic databases were scanned without language restrictions up to March 2019. The present subgroup analysis was conducted as a mixed-effect meta-analysis with "type of exercise" as the moderator. The 84 eligible exercise groups were classified into (a) weight bearing (WB, n = 30) exercise, (b) (dynamic) resistance exercise (DRT, n = 18), (c) mixed WB&DRT interventions (n = 36). Outcome measures were standardized mean differences (SMD) for BMD-changes at LS, FN and TH. All types of exercise significantly affect BMD at LS, FN and TH. SMD for LS average 0.40 (95% CI 0.15-0.65) for DRT, SMD 0.26 (0.03-0.49) for WB and SMD 0.42 (0.23-0.61) for WB&DRT. SMD for FN were 0.27 (0.09-0.45) for DRT, 0.37 (0.12-0.62) for WB and 0.35 (0.19-0.51) for WB&DRT. Lastly, SMD for TH changes were 0.51 (0.28-0.74) for DRT, 0.40 (0.21-0.58) for WB and 0.34 (0.14-0.53) for WB&DRT. In summary, we provided further evidence for the favorable effect of exercise on BMD largely independent of the type of exercise. However, in order to generate dedicated exercise recommendations or exercise guideline, meta-analyses might be a too rough tool.

Effects of dynamic resistance exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis with special emphasis on exercise parameters

This systematic review and meta-analysis set out to determine the effect of dynamic resistance exercise (DRT) on areal bone mineral density (aBMD) in postmenopausal women and derive evidence-based recommendations for optimized training protocols. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) of isolated DRT with at least one exercise and one control group, (c) with intervention durations ≥ 6 months, (d) aBMD assessments at lumbar spine or proximal femur, (e) in cohorts of postmenopausal women. We searched eight electronic databases up to March 2019 without language restrictions. The meta-analysis was performed using a random-effects model. Standardized mean differences (SMD) for BMD changes at lumbar spine (LS), femoral neck (FN), and total hip (TH) were defined as outcome measures. Moderators of the exercise effects, i.e., "intervention length," "type of DRT," "training frequency," "exercise intensity," and "exercise volume," were addressed by sub-group analyses. The study was registered in the international prospective register of systematic reviews (PROSPERO) under ID: CRD42018095097. Seventeen articles with 20 exercise and 18 control groups were eligible. SMD average is 0.54 (95% CI 0.22-0.87) for LS-BMD, 0.22 (0.07-0.38) for FN-BMD, and 0.48 (0.22-0.75) for TH-BMD changes (all p ≤ 0.015). While sub-group analysis for FN-BMD revealed no differences within categories of moderators, lower training frequency (< 2 sessions/week) resulted in significantly higher BMD changes at LS and TH compared to higher training frequency (≥ 2 sessions/week). Additionally, free weight training was significantly superior to DRT devices for improving TH-BMD. This work provided further evidence for significant, albeit only low-moderate, effects of DRT on LS-, FN-, and TH-BMD. Unfortunately, sub-analysis results did not allow meaningful exercise recommendations to be derived. This systematic review and meta-analysis observed a significant low-moderate effect of dynamic resistance exercise on bone mineral density changes in postmenopausal women. However, sub-group analyses focusing on exercise characteristics found no results that enable the derivation of meaningful exercise recommendations in the area of exercise and osteoporosis prevention or therapy.

Peak Match Demands in Young Basketball Players: Approach and Applications

Background: The aim of this study is to describe the peak match demands and compare them with average demands in basketball players, from an external load point of view, using different time windows. Another objective is to determine whether there are differences between positions and to provide an approach for practical applications. Methods: During this observational study, each player wore a micro technology device. We collected data from 12 male basketball players (mean ± SD: age 17.56 ± 0.67 years, height 196.17 ± 6.71 cm, body mass 90.83 ± 11.16 kg) during eight games. We analyzed intervals for different time windows using rolling averages (ROLL) to determine the peak match demands for Player Load. A separate one-way analysis of variance (ANOVA) was used to identify statistically significant differences between playing positions across different intense periods. Results: Separate one-way ANOVAs revealed statistically significant differences between 1 min, 5 min, 10 min, and full game periods for Player Load, F (3,168) = 231.80, η_p² = 0.76, large, p < 0.001. It is worth noting that guards produced a statistically significantly higher Player Load in 5 min (p < 0.01, η_p² = −0.69, moderate), 10 min (p < 0.001, η_p² = −0.90, moderate), and full game (p < 0.001, η_p² = −0.96, moderate) periods than forwards. Conclusions: The main finding is that there are significant differences between the most intense moments of a game and the average demands. This means that understanding game demands using averages drastically underestimates the peak demands of the game. This approach helps coaches and fitness coaches to prepare athletes for the most demanding periods of the game and present potential practical applications that could be implemented during training and rehabilitation sessions.

Alternative scapular stabilization exercises to target strength, endurance and function of shoulders in tetraplegia: A prospective non-controlled intervention study

OBJECTIVE

Scapular stabilization exercises (SSE) are well-established for the able-bodies. The aim of the current study is to access the potential benefits of SSE on isometric internal and external rotator strength, endurance and function of the shoulder in persons with tetraplegia, throughout a 12-week exercise program consisting of five resisted movements with elastic bands.

DESIGN

Prospective non-controlled intervention study.

SETTING/PARTICIPANTS/INTERVENTIONS

A convenience sample of 17 subjects (age, 40.0±10.0 years old) with SCI was recruited from the University Hospital at the State University of Campinas (UNICAMP) from March 2015 to February 2016. They performed 5-resisted-SSE for 12 weeks, using Thera-band® elastic bands. Four evaluations were required: Baseline1, Baseline2, 6W and 12W.

OUTCOME MEASURES

The dependent variables were isometric internal and external rotation strength, flexion and abduction endurance and the Disabilities of the Arm, Shoulder and Hand (DASH) score.

RESULTS

Isometric external rotation strength and flexion endurance increased after SSE and were classified as "clinically relevant" using minimal importance difference (MID). Abduction endurance increased but it was classified as "not clinically relevant". DASH score reported no significant differences but it was classified as "potentially clinically relevant". Correlations were observed among time since injury and endurance improvements.

CONCLUSION

This study demonstrated that specific training of the scapula muscles shows a benefit for shoulder strength, endurance and function of the shoulder in subjects with tetraplegia and should be part of the rehabilitation program. Besides, the SSE can be performed by subjects with tetraplegia themselves on a regular basis.

An Integrated, Multifactorial Approach to Periodization for Optimal Performance in Individual and Team Sports

Sports periodization has traditionally focused on the exercise aspect of athletic preparation, while neglecting the integration of other elements that can impact an athlete's readiness for peak competition performances. Integrated periodization allows the coordinated inclusion of multiple training components best suited for a given training phase into an athlete's program. The aim of this article is to review the available evidence underpinning integrated periodization, focusing on exercise training, recovery, nutrition, psychological skills, and skill acquisition as key factors by which athletic preparation can be periodized. The periodization of heat and altitude adaptation, body composition, and physical therapy is also considered. Despite recent criticism, various methods of exercise training periodization can contribute to performance enhancement in a variety of elite individual and team sports, such as soccer. In the latter, both physical and strategic periodization are useful tools for managing the heavy travel schedule, fatigue, and injuries that occur throughout a competitive season. Recovery interventions should be periodized (ie, withheld or emphasized) to influence acute and chronic training adaptation and performance. Nutrient intake and timing in relation to exercise and as part of the periodization of an athlete's training and competition calendar can also promote physiological adaptations and performance capacity. Psychological skills are a central component of athletic performance, and their periodization should cater to each athlete's individual needs and the needs of the team. Skill acquisition can also be integrated into an athlete's periodized training program to make a significant contribution to competition performance.

The use of periodized exercise prescription in rehabilitation: a systematic scoping review of literature

OBJECTIVE

To describe the use of periodized exercise prescription with patients in the context of rehabilitation.

DATA SOURCE

The following databases were searched: The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, CINAHL, ScienceDirect, PEDro, Web of Science, SPORTDiscus, SAGE and Google Scholar. Databases were searched from inception to March 2018.

RESULTS

The literature search yielded 1772 articles with 1755 being excluded leaving 17 articles in total for the full review. Methodological quality and internal validity of the included papers were lacking. The included studies failed to indicate in which phase rehabilitation had occurred. Programme structure relating to the use of a familiarization phase, sequencing of exercises and structuring of specific phases (i.e. macrocycle, mesocycle and microcycle) was not present and lacked consistency across the board.

CONCLUSION

Periodization models of exercise prescription are being used within a variety of population groups in the rehabilitation setting. Integration of periodization principles into a rehabilitation programme still however remains a challenge. Although there is a lack of consistency with regard to the structure and implementation of a periodized model of exercise prescription in the rehabilitation context, it seems to be an alternative way in which to prescribe exercise within the rehabilitation setting.

Return to competition after an Achilles tendon rupture using both on and off the field load monitoring as guidance: A case report of a top-level soccer player

OBJECTIVES

To describe the Return to competition after Achilles Tendon rupture (ATR) in an elite soccer player.

DESIGN

Case report.

SETTING

Return to sport (RTS) of a professional soccer player who suffered an ATR during a match. The RTS phase started 15 weeks after surgery and specific on-field activities were gradually introduced. Criteria used to monitor the transition through the different phases were strength and endurance of the calf muscle and ability to sustain specific on-field training loads (TL) monitored with Global Positioning System and heart-rate system. TLs were weekly compared to pre-injury values to evaluate recovery and to prescribe future sessions.

PARTICIPANT

A 39-year-old (height 178 cm, weight 75 kg) elite soccer defender player, playing in Italian Serie-A league.

RESULTS

Days of absence were lower compared to a cohort presented in UEFA study (119 versus 161 ± 65 days, respectively). External-TL and Internal-TL were organized to gradually increase during RTS and resulted in higher values prior to return to competition compared to pre-injury values. Concentric plantar flexion peak torque increased till 9th months after surgery.

CONCLUSIONS

Monitoring of the field activities allowed comparison with pre-injury values and provided a useful and functional criteria to pass return to team activity and competition.

Eccentric Exercise Program Design: A Periodization Model for Rehabilitation Applications

The applied use of eccentric muscle actions for physical rehabilitation may utilize the framework of periodization. This approach may facilitate the safe introduction of eccentric exercise and appropriate management of the workload progression. The purpose of this data-driven Hypothesis and Theory paper is to present a periodization model for isokinetic eccentric strengthening of older adults in an outpatient rehabilitation setting. Exemplar and group data are used to describe the initial eccentric exercise prescription, structured familiarization procedures, workload progression algorithm, and feasibility of the exercise regimen. Twenty-four men (61.8 ± 6.3 years of age) completed a 12-week isokinetic eccentric strengthening regimen involving the knee extensors. Feasibility and safety of the regimen was evaluated using serial visual analog scale (VAS, 0–10) values for self-reported pain, and examining changes in the magnitude of mean eccentric power as a function of movement velocity. Motor learning associated with the familiarization sessions was characterized through torque-time curve analysis. Total work was analyzed to identify relative training plateaus or diminished exercise capacity during the progressive phase of the macrocycle. Variability in the mean repetition interval decreased from 68 to 12% during the familiarization phase of the macrocycle. The mean VAS values were 2.9 ± 2.7 at the start of the regimen and 2.6 ± 2.9 following 12 weeks of eccentric strength training. During the progressive phase of the macrocycle, exercise workload increased from 70% of the estimated eccentric peak torque to 141% and total work increased by 185% during this training phase. The slope of the total work performed across the progressive phase of the macrocycle ranged from −5.5 to 29.6, with the lowest slope values occurring during microcycles 8 and 11. Also, mean power generation increased by 25% when eccentric isokinetic velocity increased from 60 to 90° s⁻¹ while maintaining the same workload target. The periodization model used in this study for eccentric exercise familiarization and workload progression was feasible and safe to implement within an outpatient rehabilitation setting. Cyclic implementation of higher eccentric movement velocities, and the addition of active recovery periods, are featured in the proposed theoretical periodization model for isokinetic eccentric strengthening.