Under the Gun: Percussive Massage Therapy and Physical and Perceptual Recovery in Active Adults

CONTEXT

Handheld percussive massage devices (ie, massage guns) are a relatively new and under-researched recovery tool. These tools are intended to increase range of motion and reduce muscle soreness by delivering targeted vibration to soft tissues. Empirical knowledge about the potential influence of these devices on perceptual recovery and the recovery of performance characteristics after exercise is scarce.

OBJECTIVE

To investigate the effect of a 5-minute massage gun application, using a commercially available device, on physical and perceptual recovery after a strenuous bout of lower body exercise.

DESIGN

Controlled laboratory study.

SETTING

Physiology laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 65 active young adults (age = 21.3 ± 1.4 years; age range = 18-30 years; 34 women: height = 165.8 ± 6.1 cm, mass = 66.0 ± 7.4 kg; 31 men: height = 181.1 ± 6.0 cm, mass = 81.5 ± 11.8 kg).

INTERVENTION(S)

Participants applied a massage gun on the calf muscles of 1 leg after strenuous exercise (massage gun recovery group) for 5 minutes and used no recovery intervention on the other leg (control group).

MAIN OUTCOME MEASURE(S)

Ankle range of motion, calf circumference, isometric strength, calf endurance, and perceived muscle soreness measures were collected at baseline and at various points after lower body exercise.

RESULTS

No significant group × time interactions were recorded for any of the performance or perceptual measures (P values > .05). Effect sizes were mostly unclear, except for a small increase in perceived muscle soreness in the massage gun recovery group compared with the control group immediately (d = -0.35) and 4 hours (d = -0.48) postrecovery.

CONCLUSIONS

Massage guns appeared to have little effect on physical measures when applied for 5 minutes immediately after strenuous calf exercise. Given the small increase in muscle soreness up to 4 hours after their use, caution is recommended when using massage guns immediately after strenuous lower body exercise.

The test-retest reliability of physiological and perceptual responses during treadmill load carriage

PURPOSE

Understanding the test-retest reliability of physiological responses to load carriage influences the interpretation of those results. The aim of this study was to determine the test-retest reliability of physiological measures during loaded treadmill walking at 5.5 km h-1 using the MetaMax 3B.

METHODS

Fifteen Australian Army soldiers (9 male, 6 female) repeated two 12-min bouts of treadmill walking at 5.5 km h-1 in both a 7.2 kg Control condition (MetaMax 3B, replica rifle) and a 23.2 kg Patrol condition (Control condition plus vest) across three sessions, separated by one week. Expired respiratory gases and heart rate were continuously collected, with the final 3 min of data analysed. Ratings of Perceived Exertion and Omnibus-Resistance Exercise Scale were taken following each trial. Reliability was quantified by coefficient of variation (CV), intra-class correlation coefficients (ICC), smallest worthwhile change (SWC), and standard error of the measurement.

RESULTS

Metabolic and cardiovascular variables were highly reliable (≤ 5% CV; excellent-moderate ICC), while the respiratory variables demonstrated moderate reliability (< 8% CV; good-moderate ICC) across both conditions. Perceptual ratings had poorer reliability during the Control condition (12-45% CV; poor ICC) than the Patrol condition (7-16% CV; good ICC).

CONCLUSIONS

The test-retest reliability of metabolic and cardiovascular variables was high and relatively consistent during load carriage. Respiratory responses demonstrated moderate test-retest reliability; however, as the SWC differed with load carriage tasks, such data should be interpreted independently across loads. Perceptual measures demonstrated poor to moderate reliability during load carriage, and it is recommended that they only be employed as secondary measures.

Physiological, perceptual, and biomechanical differences between treadmill and overground walking in healthy adults: A systematic review and meta-analysis

This systematic review and meta-analysis aims to compare physiological, perceptual and biomechanical outcomes between walking on a treadmill and overground surfaces. Five databases (CINAHL, EMBASE, MEDLINE, SPORTDiscus, Web of Science) were searched until September 2022. Included studies needed to be a crossover design comparing biomechanical, physiological, or perceptual measures between motorised-treadmill and overground walking in healthy adults (18-65 years) walking at the same speed (<5% difference). The quality of studies were assessed using a modified Downs and Black Quality Index. Meta-analyses were performed to determine standardised mean difference ± 95% confidence intervals for all main outcome measures. Fifty-five studies were included with 1,005 participants. Relative oxygen consumption (standardised mean difference [95% confidence interval] 0.38 [0.14,0.63]) and cadence (0.22 [0.06,0.38]) are higher during treadmill walking. Whereas stride length (-0.36 [-0.62,-0.11]) and step length (-0.52 [-0.98,-0.06]) are lower during treadmill walking. Most kinetic variables are different between surfaces. The oxygen consumption, spatiotemporal and kinetic differences on the treadmill may be an attempt to increase stability due to the lack of control, discomfort and familiarity on the treadmill. Treadmill construction including surface stiffness and motor power are likely additional constraints that need to be considered and require investigation. This research was supported by an Australian Government Research Training Program (RTP) scholarship. Protocol registration is CRD42020208002 (PROSPERO International Prospective Register of Systematic Reviews) in October 2020.

Peak movement and impact characteristics of different training methods in professional rugby union

The purpose of this study was to compare the peak periods (1- to 6-minute epochs) for three different training methods (game-based training - GBT; small-sided games - SSG; and conditioning training - CT) in elite male rugby union (RU) players. The peak movement (m·min^-1) and impact (impact·min^-1) characteristics of 42 players during in-season training were assessed. When comparing between training methods, SSG drills produced the greatest peak movement characteristics for all time epochs (1-minute average peak periods - SSG 195 m·min^-1, GBT 160 m·min^-1, and CT 144 m·min^-1). The peak impact characteristics performed during training were 1-2 impact·min^-1 for a 1-minute period and then decreased as the time period increased for all training methods. The greatest distribution of training time occurred at 30-39% (SSG and CT) and 40-49% (GBT) of peak movement intensity, with less than 5% of training performed at or above 80% peak intensity across all drill types. Findings from the current study show that the peak movement periods (m·min^-1) in RU training from all three training methods match or exceed those which are previously reported in peak gameplay, yet their ability to replicate peak impact characteristics is questionable.

Contextual Factors Influencing Physical Activity and Technical Performance in Australian Football League Women's Competition Match-Play

ABSTRACT

Leabeater, A, Clarke, A, and Sullivan, C. Contextual factors influencing physical activity and technical performance in AFLW competition match-play. J Strength Cond Res 37(1): 194-199, 2023-The purpose of this study was to examine the influence of contextual factors on physical activity and technical match performance during Australian Football League Women's (AFLW) competition match-play. The study was of a retrospective longitudinal design and used physical activity and technical data collected from female Australian Football players (n = 49) from 1 team during 23 AFLW competition games over 3 seasons. A three-level linear mixed model was constructed to investigate the influence of different contextual factors (match-related variables) on relative total distance (TD), relative high-speed running (HSR) distance, and ranking points during AFLW match-play. The results showed that from season 1 to season 3, relative TD increased by 2.0 m·min-1 (ES: 0.06 [-0.04 to 0.16], p < 0.05) and relative HSR increased by 4.1 m·min-1 (ES: 0.22 [0.14-0.31], p < 0.001). Interstate matches were associated with a reduction of 5.1 m·min-1 per match in TD (ES: -0.21 [-0.30 to -0.12], p < 0.001) and 2.5 m·min-1 in HSR distance (ES: -0.22 [-0.31 to -0.13], p < 0.001). Total disposals were associated with a 0.23 m·minute-1 reduction in HSR for that player (ES: -0.13 [-0.22 to 0.04], p < 0.01). Match margin was the only contextual factor to influence ranking points/min (0.007 AU·min-1, ES: 0.30 [0.21-0.38], p < 0.001). In conclusion, this study shows that player physical activity may be reduced during interstate AFLW matches; the average HSR has increased since the start of the AFLW competition and may reflect increasing match activity profiles, and players have a greater rate of accumulation of ranking points when the score difference is greater.

Association Between Position-Specific Impact and Movement Characteristics of Professional Rugby Union Players During Game Play

ABSTRACT

Peek, RJ, Carey, DL, Middleton, KJ, Gastin, PB, and Clarke, AC. Association between position-specific impact and movement characteristics of professional rugby union players during game play. J Strength Cond Res 37(1): 161-166, 2023-The aim of this study was to understand the association between impact and movement characteristics during whole game and peak 1- to 10-minute rolling windows in professional rugby union. Maximal impact (impacts·min-1) and corresponding running (m·min-1) characteristics as well as maximal running (m·min-1) and corresponding impact (impacts·min-1) characteristics were obtained for 160 athletes from 4 teams across the 2018 and 2019 Super Rugby seasons. A linear mixed-effects model reported a positive association between whole-game running and impacts, where greater impact characteristics corresponded with greater running characteristics. The average 1-minute peak running characteristics (150-160 m·min-1) typically occurred when no impacts occurred. The average 1-minute peak impact characteristics (4-6 impacts·min-1) corresponded with an average relative distance of 90-100 m·min-1. Worst case scenario observed impact characteristics as large as 15 impacts·min-1 with a corresponding relative distance of 140 m·min-1. When training for peak period characteristics, running may be completed in isolation; however, peak impacts often occur in conjunction with moderate to high running movements. Given running and impact characteristics can appear concurrently within game play, this highlights the need to train them accordingly. As such, when prescribing training drills to replicate the peak characteristics in rugby union, consideration should be taken for both running and impact characteristics.

Comparing tibial accelerations between delivery and follow-through foot strikes in cricket pace bowling

Foot strikes of the pace-bowling delivery stride produce large ground reaction forces, which may be linked to injury, yet the biomechanics of the follow-through are unknown. This study assessed tibial accelerations across the delivery and follow-through foot strikes in pace bowlers and evaluated relationships between these measures and five common pace-bowling intensity metrics. Fifteen sub-elite male pace bowlers performed deliveries at warm-up, match, and maximal intensities. Tibial accelerations were measured using tibial-mounted inertial measurement units and recorded at back- and front-foot initial and re-contacts. A trunk-worn global navigation satellite system unit measured PlayerLoad™, run-up speed, and distance. Ball speed and perceived exertion measures were also recorded. A linear mixed model showed statistical significance of prescribed intensities (p < .001) and foot strike for tibial acceleration (p < .001). Tibial accelerations showed positive increases with changes in prescribed intensity (p < .05). The greatest magnitude of tibial acceleration was found at back foot re-contact (mean ± SD; 1139 ± 319 m/s2). Repeated-measures correlations of tibial acceleration between foot contacts were weak (r = 0.2-0.4). The greatest magnitude of tibial acceleration reported at back foot re-contact may have implications for injury incidence, representing an important avenue for future pace bowling research.

Assessment of Physical, Technical, and Tactical Analysis in the Australian Football League: A Systematic Review

Background

Elite Australian Football (AF) match-play requires proficiency in physical, technical, and tactical elements. However, when analysing player movement practitioners commonly exclude technical and tactical considerations, failing to recognise the multifactorial nature of AF match-play and providing little context into the movement requirements of the players.

Objectives

This systematic review aimed to identify the physical, technical, and tactical requirements of the Australian Football League (AFL) and to highlight the importance of integrating data from multiple sources when analysing player output.

Methods

A systematic search of electronic databases (CINAHL, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted from January 2009 to June 2022. Keywords relating to physical, technical, and tactical match requirements were used.

Results

Forty-eight studies met the inclusion criteria. In isolation, physical requirements were the most analysed construct within the AFL (n = 17), followed by technical (n = 9) and then tactical (n = 6). Thirteen studies integrated physical and technical elements, one study integrated technical and tactical elements, one study integrated physical and tactical elements, and one study integrated all three elements. Movement analysis centred around average ‘whole’ match requirements, whereas technical and tactical match analyses focused on key performance indicators of match performance.

Conclusion

While the physical requirements of the AFL have been well documented, there is little understanding of how player technical output and various team tactics influence player movement requirements. Knowledge of how the elements of AF match-play interact with one another could enhance our understanding of match performance and provide a greater resource for training prescription.

Validity and between-unit agreement of commercially-available linear position transducer and inertial sensor devices during loaded countermovement jumps

To assess the validity and between-unit agreement of velocity monitoring devices during incrementally-loaded countermovement jumps (CMJ), 16 males (24.0 ± 3.5 yr) completed 12 CMJs on a force plate (FP). Performance variables were collected through two linear position transducers (GymAware [GA]) and four accelerometer-based devices (two PUSH units, two Bar Sensei units). Pearson correlations (r) and coefficients of variation (CV) demonstrated strong to very-strong relationships (r = 0.60-0.88) and poor agreement (CV = 11.7-25.3%) between FP and GA, and moderate to very-strong relationships (r = 0.31-0.81) and poor agreement (CV = 10.1-24.2%) between FP and PUSH. Between-unit comparisons demonstrated moderate to very-strong relationships (r = 0.50-0.88) with poor agreement (CV = 10.8-26.6%) for GA, and very weak to very-strong relationships (r = 0.01-0.87) with moderate to poor agreement (CV = 9.1-24.1%) for PUSH. Bar Sensei units were excluded from analyses. Loaded CMJ data collected with either device displayed poor agreement with a FP. Velocity monitoring devices demonstrate poor validity across all loads; however, GA demonstrated strong between-unit agreement. A FP should be utilised to accurately assess CMJ performance at all times.

Effects of concussion on technical performance in professional Australian Football

There is limited research on the on-field performance of previously concussed athletes. The aim of this exploratory study was to investigate athlete technical performance pre- and post-concussion in Australian Football. Using publicly available data, male athletes who sustained a concussion during the 2016-19 professional Australian Football League seasons were analysed across five games pre- and post-concussion (concussion events n=41, age 25.4 ± 3.5 years; control n=39, age 25.2 ± 3.6 years). Mean technical performance metrics (goals, time-on-ground percentage, kicks, ground ball and disposal efficiency, contested marks) over the five games pre- and post-concussion, as well as within-athlete performance variability measures (standard deviation and coefficient of variation) were analysed. Results showed no significant group-by-time interactions, nor effect of time (pre-post) for any technical performance metric. Similarly, the within-athlete standard deviation and coefficient of variation of technical performance metrics showed no group-by-time interaction, nor effect for time. This retrospective study has shown that athlete performance averaged over five games is not affected post-concussion in elite men's Australian Football. Further prospective studies controlling for contextual match factors based on opposition and environmental conditions may be required to identify potential in-game technical performance changes following return-to-play from concussion.

Staff and patient experience of the implementation and delivery of a virtual health care home monitoring service for COVID-19 in Melbourne, Australia

BACKGROUND

Provision of virtual health care (VHC) home monitoring for patients who are experiencing mild to moderate COVID-19 illness is emerging as a central strategy for reducing pressure on acute health systems. Understanding the enablers and challenges in implementation and delivery of these programs is important for future implementation and re-design. The aim of this study was to explore the perspectives of staff involved with the implementation and delivery, and the experience of patients managed by, a VHC monitoring service in Melbourne, Australia during the COVID-19 pandemic.

METHODS

A descriptive qualitative approach informed by naturalist inquiry was used. Staff interviews were analysed using the Consolidated Framework for Implementation Research (CFIR). Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses as they related to the CFIR. Finally, data from the interviews and patient experience were triangulated to see if patient experience validated data from staff interviews.

RESULTS

All 15 staff were interviewed, and 271 patients were surveyed (42%). A total of four final overarching themes emerged: service implementation enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths. 19 subthemes aligned with 18 CFIR constructs from staff and patient data.

CONCLUSION

Rapid implementation was enabled through shared resources, dividing implementation tasks between senior personnel, engaging furloughed healthcare staff in design and delivery, and having a flexible approach that allowed for ongoing improvements. Benefits for patients included early identification of COVID-19 deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges were the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.

Investigating the Psychophysiological Response to Grade One Muscular Injuries in Professional Australian Football Athletes

The purpose of this study was to examine Australian Football athletes' responses to a grade one muscular injury from a psychophysiological perspective to understand the strength of the association between stress, optimism, and cortisol. Forty-five players listed with one professional Australian Football club volunteered for this study. Inclusion criteria consisted of sustaining a muscular injury during the course of the season with four-weeks predicted recovery time (as diagnosed by club medical staff, n=9). The control group were age, position, and career history matched players from the same sample. Players were also matched for their personality (10-item Big Five Personality Inventory) and fluid intelligence (Raven's Standard Progressive Matrices). Injured players and matched controls completed perceived stress and optimism measures (paper-based questions) as well as salivary cortisol testing once per week for four weeks. Significant increases in cortisol (p=0.015) and perceived stress (p<0.001) were observed in injured players, along with a reduction in optimism (p<0.001) returning by week 4. A significant positive correlation was found between perceived stress and cortisol (r= 0.426), and significant negative correlations observed between optimism and cortisol r= -0.257 and perceived stress r= -0.391. This study showed that athletes were significantly stressed and less optimistic during the first two-weeks of recovery compared to matched controls. While not statistically significant, large effects observed in cortisol and stress in the week prior to returning to competition in the injured group suggest these results demonstrate that a multi-modality approach can improve understanding of psychophysiological stress following a grade one muscular injury in Australian Football athletes.

Possession chain factors influence movement demands in elite Australian football match-play

Contemporary analysis of physical activity in Australian Football (AF) is typically presented as a total measure and independent of game context, which is not representative of how the game is played and/or assessed by coaches. This study examines the activity profile of individual possession chains and determines the influence that field position, initial chain state, and possession phase have on these activity characteristics in men's AF.Global positioning system data were attained from 35 players in 13 matches across the 2019 Australian Football League season. Matches were coded into different possession phases, initial field location of the ball, and initial chain state. Mixed models were built to observe the influence of field position and initial chain state for each possession phase.Less TD and HSR distance were covered during attacking chains in the forward 50 and attacking midfield, while defensive chains covered less TD and HSR in the defensive 50 and defensive midfield (p < 0.001). Significant main effects for possession phase and initial chain state were observed for TD and HSR. TD and HSR were higher during attacking chains, while chains beginning from a stoppage were lower than intercept and kick-ins (p < 0.001).Overall, the most intense moments of the game appear similar across all possession phases when field location is accounted for and that transitioning the ball quickly from the defensive end of the field results in greater physical activity. These findings can be used for prescription and monitoring of training drills specific to AF requirements.

The AFLW draft combine: Seasonal changes and relationships to draft success

This study aimed to identify seasonal changes in AFLW Draft Combine assessments, examine the physical and anthropometric assessments associated with draft outcome and investigate the presence of a relative age effect. Three seasons (2017-2019) of the AFLW Draft Combine assessment data were obtained (n = 131). Testing data between seasons were examined using a MANOVA. A factor analysis using principal components (identifying speed, lower body power, aerobic capacity, and anthropometry) was conducted prior to the construction of a binary logistic regression model. Speed (including 5, 10 and 20 m sprint times) significantly contributed to the binary logistic regression model discriminating drafted and non-drafted players (p = 0.040). A significant main effect of season was reported (p ≤ 0.01) with post-hoc tests confirming 5, 10 and 20 m sprint times were faster in the 2018 AFLW Draft Combine compared with the 2017 AFLW Draft Combine. No relative age effect was observed in this dataset. Overall, the 20 m sprint test showed the greatest difference between drafted and non-drafted players, while speed (collectively) was the greatest predictor of draft outcome. This data provides insight into the physical qualities of prospective players that were associated with selection to the AFLW competition in its first 3 years.

Objective assessment of fast bowling delivery intensity in amateur male cricketers

Wearable microtechnology is effective in detecting fast deliveries in cricket, however methods to quantify delivery intensity have not been established. This study aimed to investigate the utility of wearable sensors in quantifying cricket fast bowling intensity.Fifteen sub-elite male fast bowlers performed deliveries at warm-up, match, and maximal intensities. A principal component analysis resulted in the selection of perceived exertion and seven variables of bowling exertion derived from trunk- (PlayerLoad™, trunk flexion velocity, trunk forward rotation velocity) and tibia-mounted (tibial acceleration at back foot contact, front foot contact, back foot re-contact and front foot re-contact) inertial measurement units for further analysis. Repeated measures ANOVAs were used to investigate the effect of intensity on outcome variables. Significant main effects of intensity and large effect sizes were identified for all variables (p < .05, n_p² > 0.14). Measures from the match and maximal conditions were significantly larger compared with the warm-up condition (P_holm < .05). No differences were observed between the match and maximal conditions (p > .05). Inertial measurement metrics can distinguish between a warm-up effort and both match and maximal fast bowling delivery intensity. These devices provide a unique, time-efficient approach to cricket fast bowling exertion quantification.

Evolving peak period, match movement, and performance demands in elite women's Australian football

OBJECTIVES

Given the dearth of research available on the elite women's Australian football (AFLW) competition, this study aimed to observe the position-specific peak movement demands of AFLW players and assess whether any seasonal changes have occurred in movement- or performance-based metrics over the initial three years of competition.

DESIGN

Observational longitudinal design.

METHODS

Data were collected on one team across the initial three seasons of the AFLW competition. Global position system units were used to obtain the movement demands while performance metrics were obtained from an external statistical provider. Peak movement demands were determined using a rolling period analysis of 1-10 min durations. Mixed models were used to assess the influence of season and position on movement- and performance-based metrics.

RESULTS

Peak period high speed running (HSR, >14.4 km/h), but not total distance (TD), differed between playing positions, with midfielders covering the greatest peak period movements (p < 0.01). No seasonal changes were observed for peak periods of TD or HSR for any positions. Various mean running movements observed seasonal changes and positional differences (p < 0.01), albeit with small effect sizes. No performance-based metric differed by position. Seasonal changes were observed for handballs and uncontested possessions only (p < 0.01), with trivial effect sizes.

CONCLUSIONS

The small differences in on-field movement patterns and performance characteristics of AFLW players observed across seasons and between positional groups gives confidence that practitioners can continue to prescribe whole team rather than position-specific movement and technical training. External factors such as modification to competition structure and rules, or a change in team focus, may mask developments in this competition and warrants continued investigation.

Descriptive Analysis of a Telephone Based Community Monitoring Service for COVID-19

The coronavirus disease (COVID-19) pandemic has required health services to rapidly respond to the needs of people diagnosed with the virus. Over 80% of people diagnosed with COVID-19 experience a mild illness and there is a need for community management to support these people in their home. In this paper we present, a telephone based COVID-19 community monitoring service developed in an Australian public health network, and we describe the rapid implementation of the service and the demographic and clinical characteristics of those enrolled. A retrospective mixed methods evaluation of the COVID-19 community monitoring service using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Eight hundred and fifty COVID-19 positive patients were enrolled, 54% female, 45% male, mean age 34 years SD 17. Four hundred and nine (48%) patients were born outside Australia. Among the 850 patients, 305 (36%) were classified as having a high risk of serious illness from COVID-19. The most prevalent risk factors were cardiovascular disease (37%), lung disease (30%) and age over 60 years (26%). The most common reported ongoing symptoms were fatigue (55%), breathing issues (26%) and mental health issues such as low mood (19%). There were no deaths in patients that participated in the service. The process of risk stratification undertaken with telephone triage was effective in determining risk of prolonged illness from COVID-19. Telephone monitoring by trained health professionals has a strong potential in the effective management of patients with a mild COVID-19 illness.

Treadmill load carriage overestimates energy expenditure of overground load carriage

This study compared physiological and biomechanical responses between treadmill and overground load carriage. Thirty adults completed six 10-minute walking trials across three loads (0, 20, and 40% body mass) and two surfaces (treadmill and overground). Relative oxygen consumption was significantly greater on the treadmill for 20% (1.54 ± 0.20 mL⋅kg^-1⋅min^-1) and 40% loads (1.08 ± 0.20 mL⋅kg^-1⋅min^-1). All other physiological and perceptual responses were significantly higher in the treadmill condition and with increases in load. Stance time was longer (0%: 0.05 s; 20%: 0.02 s, 40%: 0.05 s, p < 0.001) and cadence was lower (0%: 1 step·min^-1; 20%: 2 steps·min^-1; 40%: 3 steps·min^-1, p < 0.05) on the treadmill. Peak lower limb joint angles were similar between surfaces except for ankle plantar flexion, which was 8˚ greater on the treadmill. The physiological responses to treadmill-based load carriage are generally not transferable to overground load carriage and caution must be taken when conducting treadmill-based load carriage research to inform operational-based scenarios. Practitioner Summary: Literature is limited when comparing the physiological and biomechanical responses to treadmill and overground load carriage. Using a repeated measures design, it was shown that although walking kinematics are generally similar between surfaces, there was a greater physiological demand while carrying a load on a treadmill when compared with overground. Abbreviations: BM: body mass; e.g: for example; HR: heart rate; HR_max: heart rate maximum; Hz: hertz; kg: kilograms; km·h^-1: kilometres per hour; L⋅min^-1: litres per minute; m: metres; MD: mean difference; mL·kg^-1·min^-1: millilitres per kilogram per minute; mL⋅min^-1: millilitres per minute; η²p: partial-eta squared; OG: overground; RPE: rating of perceived exertion; s: seconds; SD: standard deviation; SE: standard error; steps·min^-1: steps per minute; TM: treadmill; V̇CO₂: volume of carbon dioxide; V̇E: ventilation; V̇O₂: volume of oxygen; V̇O_2max: maximum volume of oxygen; y: years.

Hormonal Contraceptive Use in Football Codes in Australia

The recent launch of the new National elite women's football competitions in Australia has seen a 20-50% increase in grassroots female participation. With the growing participation across grassroots to elite competitions, understanding the health of female athletes should be prioritized. In elite level athletes, hormonal contraceptive (HC) use is common (~50%), however, little is known about the prevalence and reasons for use and disuse of HC in elite female football athletes. As such, the impact of HC use is often not considered when monitoring the health of female footballers. This study involved a subset of data collected as part of a larger questionnaire investigating menstrual cycle function, hormonal contraception use, and the interaction with training load volume and perceived performance in elite female football code athletes. A total of 177 participants completed the questionnaire across three football codes within Australia (rugby league, rugby union/sevens, Australian football). One third (n = 58) of athletes were currently using HC, predominately in the form of an oral contraceptive pill (OC, n = 47). Reasons for use included: to avoid pregnancy (71%); to control/regulate cycle (38%); and to reduce menstrual pain (36%). However, most athletes using an OC (89%) could not identify the type of pill used (e.g., mono-, bi-, or triphasic). The main reason for disuse was due to the negative side effects (n = 23), such as mood swings, weight gain, and depression/anxiety. Comparing HC users and non-users, there were no statistical differences in the number of reported menstrual symptoms, use of medication to relieve menstrual pain, or frequency for needing to adapt training due to their menstrual cycle (p > 0.05). Since most athletes were unaware of the type of OC they used, female football athletes require further education about the different types of HC, and specifically OC, available to them. Similarities in the symptoms experienced, pain management, and training adaptation requirements between groups suggests that HC use may not have the intended outcome for certain athletes. As such, greater awareness of athlete's personal experiences with the menstrual cycle, how HC may influence their experience, and acknowledgment of non-pharmacological methods to help manage menstrual cycle related symptoms are warranted.

No physiological or biomechanical sex-by-load interactions during treadmill-based load carriage

This study investigated whether physiological demand or gait mechanics differ between sexes during treadmill load carriage. Female (n = 15) and male (n = 15) military recruit-type participants with no load carriage experience completed three 10-minute walking trials at a self-selected speed with increasing relative body-borne loads (0%, 20%, and 40% body weight). A range of cardiorespiratory, perceptual and biomechanical variables were measured. Self-selected walking speed was similar between sexes (4.6-4.8 km·h^-1, p > .05) and there were no significant sex-by-load interactions for any variables. Absolute VO₂ and VCO₂ were greater in males (difference 175-178 mL·min^-1, p < .001), however, when relative to body mass, VO₂ was similar between sexes (p > .05). Across all loads, cadence was 7 ± 2 steps·min^-1 faster (p = .004) and stance time was 0.06 ± 0.02 s shorter (p = .013) in females. Increasing load resulted in greater physiological demand, cadence, % stance time, and step length (p < .05). Practitioner summary: Literature comparing physiological and biomechanical variables between sexes during load carriage is scarce. Physiological and biomechanical sex differences were limited to relative measures associated with physical size (height and mass). Future research may pool male and female participants when conducting trials up to ten minutes in length. Abbreviations: BW: body weight; COM: centre of mass; HR: heart rate; HR_max: maximum heart rate; RER: respiratory exchange ratio; RPE: rating of perceived exertion; VCO₂: volume of carbon dioxide; VE: ventilation; VO₂: volume of oxygen; VO_2max: maximum volume of oxygen.

Physical demands and technical performance in Australian Football League Women's (AFLW) competition match-play

OBJECTIVES

To compare positional differences in the physical and technical demands of Australian Football League Women's (AFLW) match-play. A secondary aim was to examine the time course changes in activity profiles during AFLW match-play.

DESIGN

Longitudinal observational study.

METHODS

Global positioning system data were collected from 26 players (6 positional groups) from the same club during seven AFLW matches. Absolute and relative physical performance data were categorised into total distance, high-speed running (>14.4kmh^-1, HSR), very high-speed running (>18.0kmh^-1, VHSR), and sprinting distance (>20.0kmh^-1, Sprint). Technical performance data was obtained from a commercial statistics provider. A mixed model analysis was used to examine differences between positional groups and playing quarters.

RESULTS

Absolute measures of running performance did not differ between position groups. Relative total distance was moderately greater (ES=∼0.80, p<0.05) for midfielders, small backs and small forwards (125-128mmin^-1) than tall backs and tall forwards (102-107mmin^-1). Relative HSR distance was greater (ES=∼0.73) for midfielders and small backs (∼28mmin^-1) than tall backs (17mmin^-1). Analysis of technical performance indicators showed: midfielders and small forwards had the most inside 50s; tall backs had the highest number of rebound 50s; tall forwards scored more goals; while midfielders made more tackles (p<0.05). All relative running performance measures were reduced in the fourth quarter when compared to the first and second quarters (ES=0.32-0.77).

CONCLUSIONS

These data can be used as benchmarks for temporal analysis of AFLW match demands and assist in developing specific training strategies.

Iron monitoring of male and female rugby sevens players over an international season

BACKGROUND

Given the likely influence that high training loads, contact-induced hemolysis and female-specific requirements have on the incidence of iron deficiency, characterizing the direction and magnitude of fluctuations in iron status over an international season is important for managing player health and physical performance in rugby sevens.

METHODS

Australian national male (N.=27) and female (N.=23) rugby sevens players undertook blood tests at pre-season, mid-season, and end-season. Hemoglobin (Hb), hematocrit (Hct), ferritin, transferrin and transferrin saturation were quantified. Female athletes also reported oral contraceptive use and a subset (N.=7) provided 7-day food diaries to quantify iron intake.

RESULTS

Male players typically had a three-fold higher ferritin concentration than females. Pre-season ferritin concentrations in male (151±66 µg/L) and female (51±24 µg/L) players declined substantially (~20%) by mid-season but recovered by end-season. Over the season 23% of female players were classified as iron deficient (ferritin <30 µg/L) and prescribed supplementation. The greatest incidence of iron deficiency in female players occurred mid-season (30%). Oral contraception and dietary iron intake had an unclear influence on female players' ferritin concentration, while age was largely positively correlated (r=0.66±~0.33).

CONCLUSIONS

Given the relatively low ferritin concentrations evident in female rugby sevens players, and the potential for a further decline midway through a season when physical load may be at its highest, 6-monthly hematological reviews are suggested in combination with dietary management. Annual screening may be beneficial for male players, with further monitoring only when clinically indicated.

PO-31 - Circulating tumour cells and hypercoagulability: a lethal relationship in metastatic breast cancer

INTRODUCTION

Circulating tumour cells (CTCs) are a marker of poor prognosis and are associated with increased risk of venous thromboembolism in metastatic breast cancer.

AIM

We aimed to correlate presence of CTCs and markers of hyper-coagulability (D-dimer, fibrinogen and thrombin-antithrombin [TAT]) with survival in metastatic breast cancer.

MATERIALS AND METHODS

In a prospective study, enumeration of CTCs (CellSearch) and D-dimer, fibrinogen and TAT (ELISA) were measured at a single timepoint in 50 MBC (median age 59, range 36-82) patients undergoing active treatment. Survival data was determined at a median follow-up of 366days (range 58-986).

RESULTS

To date, 25 patients have died (median survival 566days, range 135-978). CTCs (>1/7.5ml) were identified in 13 patients (range 2-31) and were associated with increased markers of hypercoagulability [D-dimer: median 1814 (IQR 2700) vs 755 (IQR 735) ng/ml, p=0.004; fibrinogen: median 4.2 (IQR 1.9) vs 3.2 (1.3) g/l, p=0.05; TAT: median 6.2(IQR 6.3) vs 4.7 (5.2) ng/ml, p=0.1]. CTCs were associated with visceral compared to just bony metastases (p=0.03) and their presence was associated with a trend for reduced survival (295days (CI: 0-652) vs 737days (CI: 186-1288), p=0.1). There was no correlation between CTCs /markers of hypercoagulability and age, oestrogen receptor, progesterone receptor or Her2 status. D-dimer, fibrinogen and TAT all inversely correlated with survival and were all significantly higher in patients dying within 1year (D-dimer: 1098 (IQR 1122) vs 723 (IQR 735) ng/ml, p=0.03; fibrinogen: 4.4 (1.1) vs 3.2 (0.8) g/l, p=0.004; TAT: 8.1 (6.3) vs 4.7(3.1) ng/ml, p=0.03 [analysis excludes patients with <1year follow-up, n=13]). D-dimer >1,500ng/ml was associated with significantly reduced survival (295days [CI: 0-615] vs 836days [404-1267], p=0.05). On Cox regression, D-dimer, but not fibrinogen or TAT was associated with an increased risk of death (HR 1.3 per 1,000ng/ml D-dimer, p=0.07).

CONCLUSIONS

The correlation between CTCs, hypercoagulability and reduced survival in metastatic breast cancer suggests a possible role for the coagulation system in supporting tumour cell metastasis and is therefore a potential therapeutic target.

Hepatosplenic T-cell lymphoma, immunosuppressive agents and biologicals: what are the risks?

We present three cases of the rare hepatosplenic T-cell lymphoma (HSTCL); two patients suffering from Crohn disease who developed HSTCL on azathioprine without exposure to biologicals, and a third patient who had psoriasis treated using etanercept, cyclosporine and methotrexate. The evidence for an association between HSTCL and immunosuppressive drugs and biologicals is reviewed. We argue for improved pharmacovigilance processes to help determine the benefit to risk ratios for the use of these and other new agents.

Effect of proton pump inhibitors on markers of risk for high-grade dysplasia and oesophageal cancer in Barrett's oesophagus

BACKGROUND

It has been shown that the presence on diagnosis of endoscopic macroscopic markers indicates a high-risk group for Barrett's oesophagus.

AIM

To determine whether proton pump inhibitor therapy prior to diagnosis of Barrett's oesophagus influences markers for risk development of subsequent high-grade dysplasia/adenocarcinoma.

METHODS

A review of all patients with Barrett's oesophagus entering a surveillance programme was undertaken. Five hundred and two patients diagnosed with Barrett's oesophagus were assessed on diagnosis for endoscopic macroscopic markers or low-grade dysplasia. Subsequent development of high-grade dysplasia/adenocarcinoma was documented. The relationship between the initiation of proton pump inhibitor therapy prior to the diagnosis of BE and the presence of macroscopic markers or low-grade dysplasia at entry was determined.

RESULTS

Fourteen patients developed high-grade dysplasia/adenocarcinoma during surveillance. Patients who entered without prior proton pump inhibitor therapy were 3.4 times (95% CI: 1.98-5.85) more likely to have a macroscopic marker or low-grade dysplasia than those patients already on a proton pump inhibitor.

CONCLUSIONS

Use of proton pump inhibitor therapy prior to diagnosis of Barrett's oesophagus significantly reduced the presence of markers used to stratify patient risk. Widespread use of proton pump inhibitors will confound surveillance strategies for patients with Barrett's oesophagus based on entry characteristics but is justified because of the lower risk of neoplastic progression.

Autoimmune hepatobiliary disease in trisomy 21

Two patients with abnormal liver biochemistry are presented with hepatobiliary disorders rarely described in trisomy 21. The first was considered to have primary sclerosing cholangitis (PSC) and Crohn's disease. Liver biochemistry was normal after six months' treatment with ursodeoxycholic acid and diarrhea resolved after sulfasalazine. The second patient had autoimmune hepatitis that responded to immunosuppression. Autoimmune hepatobiliary disorders, highlighted by this report, occur in trisomy 21 but are rare. A high index of suspicion for these potentially treatable disorders is required.

Tuberous sclerosis complex and Wolff-Parkinson-White syndrome

This report highlights the association between tuberous sclerosis and Wolff-Parkinson-White syndrome. Ten patients with concurrent diagnoses of Wolff-Parkinson-White syndrome and tuberous sclerosis were identified. Wolff-Parkinson-White syndrome presented early in life, nine cases being diagnosed in the first year. Eight of the 10 cases were male. In eight cases, the syndrome was associated with supraventricular tachycardias, and in nine with cardiac rhabdomyomata. One child died from cardiac failure secondary to obstruction of the left ventricular outflow tract by a rhabdomyoma. Five of nine survivors showed resolution of Wolff-Parkinson-White syndrome on follow up. The accessory pathway was localised in nine patients from surface electrocardiograms: six children had left sided pathways and three had right sided pathways.

A function for the integrin alpha6beta4 in the invasive properties of colorectal carcinoma cells

Expression of the integrin alpha6beta4, a receptor for the laminin family of matrix proteins, has been correlated with the progression and metastatic potential of several different tumors, including colorectal carcinoma. For this reason, defining the mechanistic contribution of alpha6beta4 to the aggressive behavior of colorectal and other carcinoma cells is an issue of timely importance for cancer biology. In the present study, we sought to gain insight into the function of alpha6beta4 in colorectal carcinoma cells by studying the behavior of clone A cells, which express high surface levels of this integrin, and by restoring alpha6beta4 expression in RKO cells, a beta4-deficient rectal carcinoma cell line. The data obtained reveal that alpha6beta4 expression increases the adhesive strength of these cells on laminin-1 matrices, although it does not increase their ability to migrate on such matrices. The RKO/beta4 transfectants were considerably more spread on Matrigel, laminin-1, and collagen I than the mock transfectants and displayed numerous extensions suggestive of pseudopodia. More importantly, we discovered that expression of alpha6beta4 facilitates the ability of colorectal carcinoma cells to invade both Matrigel and collagen I matrices. The alpha6beta4-dependent increases in adhesion and invasion, as well as the observed morphological changes, required an intact beta4 cytoplasmic domain. These data argue for a ligand-independent role for alpha6beta4 in promoting cell invasion, and they have important implications for the involvement of this integrin in colorectal carcinoma progression.

Ulnar nerve palsy following fractures of the distal radius: clinical and anatomical studies

We report three cases of progressive ulnar nerve palsy following fractures of the distal radius. One was an open injury and one involved dorsal displacement of the nerve through a dislocated distal radio-ulnar joint. All were associated with dense scar tissue formation around the nerve. Early surgical decompression was successful in all cases. An anatomical study indicated that the relative immunity of the nerve to injury in this region may be due to its greater excursion and mobility compared with the median nerve.

Nurses as role models and health educators

This paper focuses on the role of the nurse as both a role model and as a health educator and examines some key areas where tension between these two appear to exist. The context is the changing British National Health Service and the expectations of both the providers of the care and the consumers. The concept of the nurse as a role model for health is explored: the use of the term 'role' and its implications for nurses; what being a role model might mean for nurses and some of the stresses which living up to these role models might impose; the extra burden of an implied healthy role model and the expectations which are placed on nurses from both within and outwith the profession. Communication theory and the view of the nurse as a 'credible source' may add to these pressures and this paper tries to offer to nurses an alternative standpoint from which they may begin to tackle their health promotion/education activities. The traditional role of the nurse as a health educator is examined and a variety of options are offered to encourage nurses to consider their approach to dealing with clients within the context of health education. Some different models of education which are more suitable for the flexible approach which is required for health education are outlined. The paper closes with some discussion points which suggest that self-awareness and personal developments may be among the most important qualities which nurses need to be effective health educators.

Effects of cimetidine on the healing of benign gastric ulcers

A prospective double-blind trial was undertaken to determine whether treatment with cimetidine influenced the healing of gastric ulcers in New Zealand patients. Ulcer size and healing was assessed by endoscopic examination. Of the 30 patients who completed the trial, 15 were given cimetidine and 15 placebo. At six weeks, 60% of the patients on cimetidine had healed their ulcers, whereas only 20% of those on the placebo had healed ulcers (P < 0.05). Fewer patients taking cimetidine required antacids for symptom control than those on placebo treatment (P < 0.05). The study confirmed that cimetidine treatment accelerates the healing of gastric ulcers.

Fibresigmoidoscopy: technique of choice?

A study was undertaken to determine the practicality of replacing rigid sigmoidoscopy with flexible fibresigmoidoscopy. A total of 388 examinations were performed and complete examination was possible in 79% of patients in less than 10 minutes. Abnormalities were found in 18% of patients; colorectal polyps and tumours were identified in 11% of patients. No complications occurred and the investigation was well tolerated. Fibresigmoidoscopy is a practical, safe procedure for routine use in the outpatient setting and has several advantages over rigid sigmoidoscopy.

Tissue distribution of orally administered bismuth in the rat

1. A colloidal bismuth preparation, tripotassium dicitrato-bismuthate, was given (172 mg/kg body weight, 6/7 days) to 10 laboratory rats for 14 months. Bismuth was measured by atomic absorption spectrometry in various tissues and the pattern of distribution studied. 2. Bismuth was present in kidney lung, spleen, liver, brain, heart and skeletal muscles, in descending order of abundance. Haematological data, renal and liver function tests were normal in the bismuth-treated group. 3. The data suggested that chronic ingestion of bismuth in large doses in rats results in absorption and binding to tissues. Absorbed bismuth probably crosses the blood-brain barrier.

Prolonged ileus following gastroscopy--a case report

A patient who developed signs of acute bowel obstruction following upper intestinal endoscopy is described. Relations of endoscopy to the symptoms and therapeutic measures are discussed.

Liver biopsy--an outpatient procedure

Experience with 67 liver biopsies performed on outpatients has been retrospectively analysed. One serious complication was encountered but would not have been detected earlier even had the patient been retained in hospital for 48 hours. The results suggest that liver biopsy can be performed on many outpatients with safety.

Per endoscopic sphincterotomy: a minimum trauma technique for the removal of retained common bile duct stones

Drainage of the biliary tree and removal of retained common bile duct stones can be achieved by performing a sphincterotomy of the ampulla of Vater using a diathermy sphincterotome directed through a fibre-optic endoscope. The procedure was successfully performed on two patients considered unfit for abdominal surgery. It is a useful method in selected patients to release stones retained in the common bile duct after cholecystectomy.