Modelling the relationships between volume, intensity and injury-risk in professional rugby league players

OBJECTIVE

This study aimed to: (a) identify the association between external-workloads and injury-risk in the subsequent week; and (b) understand the effectiveness of workload variables in establishing injury-risk.

DESIGN

Retrospective cohort study.

METHODS

Workload and injury data (soft-tissue) were collected from forty-eight professional male rugby league players. Load variables included duration (min), total distance (m), relative distance (mmin^-1), high speed distance ([m]>20kmh^-1), very-high speed distance ([m]>25kmh^-1), acceleration and deceleration efforts (count) and PlayerLoad (Arbitrary Unit: AU). Cumulative two-, three- and four-weekly loads; Acute:Chronic Workload Ratio (ACWR); Mean-Standard Deviation Workload Ratio (MSWR) and strain values were calculated and divided into three equally-sized bins (low, moderate and high). Generalised Estimating Equations analysed relationships between workload variables and injury probability in the subsequent week.

RESULTS

Injury-risk increased alongside increases in the ACWR for duration, total distance and PlayerLoad. Conversely, injury-risk decreased (Area Under Curve: 0.569-0.585) with increases in the four-weekly duration, total distance, accelerations, decelerations and PlayerLoad. For relative distance, high four-weekly workloads (high: >60mmin^-1) demonstrated a positive association with injury-risk, whilst high two-weekly loads (high: >82 mmin^-1) were negatively associated.

CONCLUSIONS

A range of external workload metrics and summary statistics demonstrate either positive or negative associations with injury-risk status. Such findings provide the framework for the development of decision-support systems in which external workload metrics (e.g. total or high speed distance) can be uniquely and routinely monitored across a range of summary statistics (i.e. cumulative weekly loads and ACWR) in order to optimise player performance and welfare.

Characterizing problematic hypoglycaemia: iterative design and preliminary psychometric validation of the Hypoglycaemia Awareness Questionnaire (HypoA-Q)

AIMS

To design and conduct preliminary validation of a measure of hypoglycaemia awareness and problematic hypoglycaemia, the Hypoglycaemia Awareness Questionnaire.

METHODS

Exploratory and cognitive debriefing interviews were conducted with 17 adults (nine of whom were women) with Type 1 diabetes (mean ± sd age 48 ± 10 years). Questionnaire items were modified in consultation with diabetologists/psychologists. Psychometric validation was undertaken using data from 120 adults (53 women) with Type 1 diabetes (mean ± sd age 44 ± 16 years; 50% with clinically diagnosed impaired awareness of hypoglycaemia), who completed the following questionnaires: the Hypoglycaemia Awareness Questionnaire, the Gold score, the Clarke questionnaire and the Problem Areas in Diabetes questionnaire.

RESULTS

Iterative design resulted in 33 items eliciting responses about awareness of hypoglycaemia when awake/asleep and hypoglycaemia frequency, severity and impact (healthcare utilization). Psychometric analysis identified three subscales reflecting 'impaired awareness', 'symptom level' and 'symptom frequency'. Convergent validity was indicated by strong correlations between the 'impaired awareness' subscale and existing measures of awareness: (Gold: rs =0.75, P < 0.01; Clarke: rs =0.76, P < 0.01). Divergent validity was indicated by weaker correlations with diabetes-related distress (Problem Areas in Diabetes: rs =0.25, P < 0.01) and HbA1c (rs =-0.05, non-significant). The 'impaired awareness' subscale and other items discriminated between those with impaired and intact awareness (Gold score). The 'impaired awareness' subscale and other items contributed significantly to models explaining the occurrence of severe hypoglycaemia and hypoglycaemia when asleep.

CONCLUSIONS

This preliminary validation shows the Hypoglycaemia Awareness Questionnaire has robust face and content validity; satisfactory structure; internal reliability; convergent, divergent and known groups validity. The impaired awareness subscale and other items contribute significantly to models explaining recall of severe and nocturnal hypoglycaemia. Prospective validation, including determination of a threshold to identify impaired awareness, is now warranted.

Diabetes and driving

The principal safety concern for driving for people treated with insulin or insulin secretagogues is hypoglycaemia, which impairs driving performance. Other complications, such as those causing visual impairment and peripheral neuropathy, are also relevant to medical fitness to drive. Case control studies have suggested that drivers with diabetes pose a modestly increased but acceptable and measurable risk of motor vehicle accidents compared to non-diabetic drivers, but many studies are limited and of poor quality. Factors which have been shown to increase driving risk include previous episodes of severe hypoglycaemia, previous hypoglycaemia while driving, strict glycaemic control (lower HbA1c) and absence of blood glucose monitoring before driving. Impaired awareness of hypoglycaemia may be counteracted by frequent blood glucose testing. The European Union Third directive on driving (2006) has necessitated changes in statutory regulations for driving licences for people with diabetes in all European States, including the UK. Stricter criteria have been introduced for Group 1 vehicle licences while those for Group 2 licences have been relaxed. Insulin-treated drivers can now apply to drive Group 2 vehicles, but in the UK must meet very strict criteria and be assessed by an independent specialist to be issued with a 1-year licence.

Differences in the kinematics of the baseball swing between hitters of varying skill

PURPOSE

The aim of this study was to determine differences in bat swing kinematics in baseball hitters of varying ability.

METHODS

Kinematic data for the upper and lower body were collected from 20 trained male baseball players (22.3 ± 5.3 yr, 1.82 ± 0.07 m, 83.5 ± 10.9 kg), using three-dimensional computerized motion-analysis techniques. Participants were ranked before testing based on a novel coach's rating scale and seasonal batting average. They were subsequently separated into a relatively high-caliber group of hitters (n = 10) and a relatively low-caliber group of hitters (n = 10) for comparison. Importantly, the two groups were significantly different in terms of coach's rating (P < 0.01) and batting average (P < 0.05).

RESULTS

The results showed a significant difference in maximum bat swing velocity (P < 0.05) with high-caliber hitters having a higher velocity (36.8 m · s) in comparison with relatively low-caliber hitters (33.8 m · s). Lead elbow maximum angular velocity was significantly higher (35.9%) among relatively high-caliber hitters (P < 0.05). Angular velocity of the hip segment approached significance between the groups (P = 0.056). High-caliber hitters also had a right knee angle of 106° at ball contact, which was significantly (P < 0.05) higher than that of relatively low-caliber hitters (100°). There were no between-group differences for wrist and linear hip joint velocities at ball contact.

CONCLUSIONS

It was established that bat swing velocity is a key characteristic of the baseball swing when identifying skill level and performance between hitters. In addition, high-caliber hitters display greater lead elbow maximum angular velocity possibly because of achieving a higher angular hip segment velocity early in the swing. It is noted that although these attributes differentiate hitters of varying skill level, future research should examine whether developing these characteristics in players of lower ability improves batting performance.