Evaluating the Variability Between 20-m Multistage Fitness Test Estimating Equations in Law Enforcement Recruits

ABSTRACT

Campbell, P, Maupin, D, Lockie, RG, Dawes, JJ, Simas, V, Canetti, E, Schram, B, and Orr, R. Evaluating the variability between 20-m multistage fitness test estimating equations in law enforcement recruits. J Strength Cond Res 38(4): 742-748, 2024-The 20-m multistage fitness test (20MSFT) is commonly used by law enforcement agencies to measure aerobic fitness and to estimate maximal aerobic consumption (V̇ o2 max). These measures are an important occupational variable with aerobic fitness levels linked to employment status, occupational performance, and long-term health in law enforcement officers. There are a multitude of predictive equations used to provide an estimate of V̇ o2 max, with the extent of variability in the estimated V̇ o2 max currently unknown in this population. This has consequences for comparisons between, and across, differing agencies, and in capabilities of deriving normative data. The aim of this investigation was to compare the variability in estimated V̇ o2 max scores derived from different 20MSFT predictive equations. The 20-m multistage fitness test data from 1,094 law enforcement recruits (male n = 741, 25.2 ± 6.3 years; female: n = 353, 25.6 ± 5.6 years) from a single agency were retrospectively analyzed. The 20MSFT scores were transformed into estimated V̇ o2 max scores using 6 different predictive equations. Significance was set at p < 0.05. Results demonstrated significantly different V̇ o2 max scores between each predictive equation ( p < 0.001; d = 0.25-1.53) and between male and female recruits ( p < 0.001, r = 0.55). All estimated V̇ o2 max equations showed small to very strong correlations with each other ( p < 0.001; r = 0.32-0.99). The findings indicate considerable dispersion of V̇ o2 max scores when using differing equations, suggesting raw 20MSFT variables (e.g., shuttles or distance completed) should be preferred to measure and apply results from aerobic fitness tests if standardized approaches are not developed within law enforcement.

Determining the Changes in Law Enforcement Recruit Aerobic Fitness Using the 2.4-km Run and 20-m Multistage Fitness Test. Does the Type of Test Matter?

ABSTRACT

Campbell, P, Maupin, D, Lockie, RG, Dawes, JJ, Simas, V, Canetti, E, Schram, B, and Orr, R. Determining the changes in law enforcement recruit aerobic fitness using the 2.4-km run and 20-m multistage fitness test. Does the type of test matter? J Strength Cond Res XX(X): 000-000, 2023-Aerobic fitness is linked with academy graduation, employment, and the long-term health of law enforcement officers and is often used as a training outcome. However, different tests can be used, and aerobic improvements may differ according to the test used. The aim of this study was to determine whether recruits improved to a greater extent in 1 aerobic test compared with the other. Retrospective data from 5 law enforcement recruit cohorts (males = 741; females = 353) who underwent 18 weeks of academy training were analyzed. Initial 20-m multistage fitness test (20MSFT) and 2.4-km run assessments were completed during weeks 4 and 5 of training, with final testing completed during weeks 16 and 17, respectively. A repeated-measures analysis of variance (p < 0.05) with a Bonferroni post hoc analysis determined changes in aerobic fitness in the 20MSFT and 2.4-km run between male and female recruits. A mean difference of 9.27 (95% confidence intervals [CI] 14.8-10.9; d = 0.63; p < 0.001) shuttle increase in 20MSFT performance and 20.1 (95% CI 16.0-24.2; d = 0.49; p < 0.001) second improvement in 2.4-km run time were demonstrated when averaged across sex, yielding a larger performance improvement for the 20MSFT compared with the 2.4-km run. Conversely, there was a smaller magnitude of change in aerobic fitness between male recruits and female recruits for the 20MSFT (d = 0.47) compared with the 2.4-km run (d = 0.50). The findings indicate that current academy training results in improvements to aerobic fitness and to a greater magnitude in the 20MSFT compared with the 2.4-km run. These results may affect policy considerations for law enforcement agencies regarding aerobic test selection.

Exploring mental health approaches and curriculum in physiotherapy: an Australasian perspective

BACKGROUND

Exposure to mental health problems are becoming increasingly more frequent within physiotherapy. Physiotherapists recognize the need for a biopsychosocial approach, however their knowledge, assessment, and treatment skills specific to mental health problems requires further research.

PURPOSE

To profile the level of education and perception of education that physiotherapists have acquired specific to mental health problems; and to profile an understanding of the current practice of physiotherapists specific to mental health problems.

METHODS

An online survey addressed the aims of the study and collected data from physiotherapists in Australia and New Zealand (open between 20th of October 2022 to the 20th of March 2023).

RESULTS

139 respondents were included in the analysis. Physiotherapists had a perception that a significantly greater amount of coursework related to mental health needed to be included within their initial degree compared to what they received (mean difference of 20.0%, 95% CI: 17.5 to 22.5). This trend was evident irrespective of the degree level or the year of graduation. Higher perceived knowledge of anxiety (MD of 11.4, p = 0.001, ES: 0.5) and depression (MD of 11.8, p = 0.001, ES: 0.5) was evident in outpatient care physiotherapists. Lack of perceived knowledge is a reason for whether an assessment or treatment strategy is used with patients experiencing a mental health problem. Motivational interviewing and mindfulness were the most frequently used psychologically based techniques.

CONCLUSION

This study reveals the need to increase the amount of mental health and psychologically based techniques within Physiotherapy curriculum.

An Examination of Subjective and Objective Measures of Stress in Tactical Populations: A Scoping Review

Persons working in tactical occupations are often exposed to high-stress situations. If this stress is to be measured, an understanding of the stress outcomes used in these occupations is needed. The aim of this review was to capture and critically appraise research investigating subjective and objective outcome measures of physiological stress in tactical occupations. Several literature databases (PubMed, EMBASE, EBsco) were searched using key search words and terms. Studies meeting inclusion criteria were critically evaluated and scored by two authors using the Joanne Briggs Institute (JBI) critical appraisal tool. Of 17,171 articles, 42 studies were retained. The Cohen's Kappa agreement between authors was 0.829 with a mean JBI Score of included studies of 8.1/9 ± 0.37 points. Multiple subjective and objective measures were assessed during a variety of high-stress tasks and environments across different occupations, including police officers, emergency service personnel, firefighters, and soldiers in the military. Common objective outcomes measures were heart rate, cortisol, and body temperature, and subjective measures were ratings of perceived exertion, and the Self Trait Anxiety Inventory. Often used in combination (i.e., subjective and objective), these outcome measures can be used to monitor stressors faced by tactical personnel undergoing on-the-job training.

Injury rates in female and male military personnel: a systematic review and meta-analysis

Background

An effective military force is required to be agile, capable, efficient, and potent. Injuries to military personnel interrupt active-duty service and can detract from overall capability. These injuries are associated with a high individual and organizational burden, with lost work time and financial costs—all problematic for the ongoing functioning of a military force. Injury control strategies have therefore been described as force multipliers. Female personnel form an integral part of any modern defence force, but little research has examined their specific experiences of injury, to inform targeted injury control efforts. The aim of this review was to identify and synthesise findings from studies of injury rates and patterns in female military personnel, comparing them to those of male personnel.

Methods

A systematic search was conducted for studies which compared injury rates between the sexes at any stage of military service, from basic training through to deployment. Databases searched included PUBMED, CINAHL and Medline through OVID. Methodological quality of eligible articles was assessed using the Critical Appraisal Skills Program (CASP), and AXIS tools and data were extracted, synthesized, and, where possible, underwent meta-analysis.

Results

Of 2287 identified studies, a total of 25 studies were eligible and included. Methodological quality ranged from 60% up to a perfect score of 100%, with an average of 82% across all studies. Relative risks for injuries (reported as RR [95%CI]) to females when compared to males were 2.10 [1.89–2.33] during basic training, 1.70 [1.33–2.17] during officer training, and 1.23 [1.05–1.43] post initial training. After adjustment for differences between the sexes in average fitness levels (2-mile run time), there was no longer a significant difference in injury rates (adjusted RR: 0.95 [0.86–1.05]). Female personnel tended to make bigger improvements in their fitness during basic training than males and tended to report their injuries more frequently and sooner than males.

Conclusion

While this review found a higher rate of reported injuries in female military personnel when compared to male personnel, differences between the sexes in average fitness levels and injury reporting behaviours may largely explain this rate difference. The difference in rates of reported injuries was greatest during basic training, and reduced thereafter, possibly due in part to a reduced difference in fitness between the sexes or increased opportunity to self-determine workloads relative to fitness levels.

The Effects of Early Physiotherapy Treatment on Musculoskeletal Injury Outcomes in Military Personnel: A Narrative Review

The risks and incidence rates of musculoskeletal injuries among military personnel are high, and the importance of physiotherapy in treating these injuries is well established. However, what is less clear is whether the timing of commencement of physiotherapy treatment affects musculoskeletal injury outcomes in military personnel. This lack of clarity is exacerbated by the known underreporting of injuries among military personnel, and the resulting self-management of musculoskeletal injuries using analgesics, non-steroidal anti-inflammatories and other means. This narrative review was designed to identify and synthesize current evidence regarding the effects of timing of physiotherapy treatment on musculoskeletal injury outcomes, focusing on potential benefits of early versus typical or delayed commencement of physiotherapy treatment. Overall, current evidence suggests early physiotherapy treatment of musculoskeletal injuries offers distinct advantages over typical or delayed commencement of physiotherapy treatment in military settings. Specifically, it appears early treatment expedites recovery in early phases following injury onset and benefits longer term mental health and well-being. It may also reduce the need for more invasive and costly health care interventions and enable earlier return to training and operational service. Importantly, a cultural shift within military contexts to ensure early reporting of musculoskeletal injuries is required if the benefits of early commencement of physiotherapy treatment are to be achieved.

The influence of education in decision making concerning athlete’s return to sport following a concussion injury: A systematic review

Objectives

Concussions have emerged as one of the most prevalent and controversial injuries sustained within the sporting context. The objective of this review was to determine the influence that education has on decision making concerning athlete’s return to sport following a concussion injury and if the risk is worth it in the eyes of the athletes.

Study design

Systematic review.

Methods

A rapid literature review was performed in PubMed, CINAHL, SPORTDiscus, Embase and Web of Science looking for articles that discussed concussions and any three of the four following search terms: (a) decision making, (b) education/knowledge, (c) sport/return to sport and (d) risk.

Results

Sixteen of 1243 articles were included in this review based on eligibility criteria. Ten were cohort studies, four were cross-sectional studies and two were qualitative research. There was a good agreement between the authors for all studies when determining risk of bias, presenting a Cohen’s κ of 0.901 (95% CI, 0.834, 0.968), p <  0.001.

Conclusion

Education can make a difference in athlete’s decision making process to return to sport; however, their awareness of the health risks that they put themselves in by returning to sport too soon is clouded by other external and internal factors. What is not fully understood is why do they put themselves at this risk? Further studies should explore athletes’ risk aversion behaviour and how it impacts their decision to return to sport following a concussion.

The Relationship Between Acute: Chronic Workload Ratios and Injury Risk in Sports: A Systematic Review

PURPOSE

Low injury rates have previously been correlated with sporting team success, highlighting the importance of injury prevention programs. Recent methods, such as acute:chronic workload ratios (ACWR) have been developed in an attempt to predict and manage injury risk; however, the relation between these methods and injury risk is unclear. The aim of this systematic review was to identify and synthesize the key findings of studies that have investigated the relationship between ACWR and injury risk.

METHODS

Included studies were critically appraised using the Downs and Black checklist, and a level of evidence was determined. Relevant data were extracted, tabulated, and synthesized.

RESULTS

Twenty-seven studies were included for review and ranged in percentage quality scores from 48.2% to 64.3%. Almost perfect interrater agreement (κ = 0.885) existed between raters. This review found a high variability between studies with different variables studied (total distance versus high speed running), as well as differences between ratios analyzed (1.50-1.80 versus ≥1.50), and reference groups (a reference group of 0.80-1.20 versus ≤0.85).

CONCLUSION

Considering the high variability, it appears that utilizing ACWR for external (eg, total distance) and internal (eg, heart rate) loads may be related to injury risk. Calculating ACWR using exponentially weighted moving averages may potentially result in a more sensitive measure. There also appears to be a trend towards the ratios of 0.80-1.30 demonstrating the lowest risk of injury. However, there may be issues with the ACWR method that must be addressed before it is confidently used to mitigate injury risk. Utilizing standardized approaches will allow for more objective conclusions to be drawn across multiple populations.

Risk factors for development of lower limb osteoarthritis in physically demanding occupations: A narrative umbrella review

Objectives

Osteoarthritis (OA) is a common disorder which affects the joints. As relationships between occupational factors and lower limb OA have been widely studied in systematic reviews, the aim of this umbrella review was to synthesize their key findings in the risk factors for development of lower limb OA.

Methods

A systematic search was conducted using the databases PUBMED, Cumulative Index of Nursing and Allied Health Literature, and Elton B Stevens Company to identify reviews examining associations between lower limb OA and occupational tasks. These reviews were rated for their methodological quality before key data were extracted and synthesized.

Results

Sixteen reviews were found, seven pertained to the knee, four to the hip, two to a variety of joints, and three to both the hip and knee. One was deemed to be of high methodological quality, one of critically low methodological quality, and the others of moderate methodological quality. The reviews found moderate to good evidence for heavy occupational lifting to be associated with an increased risk of OA at the knee and the hip. Kneeling, squatting, and climbing, previous injuries to joints, being overweight and obese were also predictive of lower limb OA.

Conclusion

Occupations which involve heavy physical workloads increase the risk of developing lower limb OA. Heavy lifting, squatting, knee bending, kneeling, and climbing may all increase the risk of developing OA in both the knees and hips. Efforts to reduce exposure to these tasks, reducing joint injuries, optimizing bodyweight may reduce the risks of lower limb OA for occupations which are physically demanding.

A Comparison of Two Commercial Swim Bench Ergometers in Determining Maximal Aerobic Power and Correlation to a Paddle Test in a Recreational Surfing Cohort

The recent addition of surfing to the Tokyo 2020 Olympic Games has fueled a surge in commercial and research interest in understanding the physiological demands of the sport. However, studies specific to maximal aerobic testing of surfers are scarce. Therefore, the primary aim of this study was to compare two commercially available swim bench (SWB) ergometers in the determination of maximal aerobic capacity in recreational surfers. A secondary aim was to correlate (independent of one another) the two ergometer findings of VO2peak to the time taken to complete a water-based 400-m paddle test. This cross-sectional study consisted of 17 recreational surfers aged between 18-58 years. Participants were randomized to either the SwimFast ergometer or VASA ergometer and tested for maximal aerobic capacity, followed by a 400-m paddle test. There were no significant differences between the two SWB ergometers in the determination of relative VO2peak (mean difference 0.33 mL/kg/min; 95% CI -1.24-1.90; p = 0.66). Correlations between VO2peak obtained from maximal paddling effort on the SwimFast and the VASA and the 400-m paddle test (total time (s)) showed a negative significant correlation r = -0.819, p = 0.024; r = -0.818, p = 0.024, respectively. Results suggest that either ergometer (SwimFast or VASA) can be used to determine peak aerobic capacity within a recreational surfing cohort. The significant correlation of the two SWB ergometers and the 400-m paddle test suggest that the 400-m paddle test may be a suitable field-based method of determining aerobic capability. Collectively, these preliminary findings provide initial evidence for similarities in VO2peak on two commercial ergometers and their correlations with a field-based test. However, further research is needed with a larger sample size and inclusive of competitive surfers to provide robust findings which can be generalized to the surfing population.

Monocyte Subsets in Atherosclerosis and Modification with Exercise in Humans

Atherosclerosis is a progressive pathological remodeling of the arteries and one of its hallmarks is the presence of chronic inflammation. Notably, there is an increased proportion and activation state of specific monocyte subsets in systemic blood circulation. Monocyte subsets have distinct contributions to the formation, progression, and destabilization of the atherosclerotic plaque. Strong clinical and epidemiological studies show that regular aerobic exercise mitigates the progression of cardiovascular disease. In fact, aerobic fitness is a powerful predictor of cardiovascular mortality in adults, independent of traditional risk factors such as hypertension and hyperlipidemia. Acute bouts and chronic exercise training modulate monocyte behavior, ranging from their recruitment from the bone marrow or marginal pool, to tissue margination and functional changes in cytokine and chemokine production. Such modulation could reflect a potential mechanism for the cardio-protective effect of exercise on atherosclerosis. This review summarizes the current knowledge of monocyte subsets and highlights what is known about their responses to exercise.