Context: General screening methods for athletes are limited. This study aims to analyze the reliability and validity of the Japanese version of the athlete sleep screening questionnaire. Methods: In total, 111 female collegiate athletes completed the initial test and retest. The independent variables included the kind of sports of the participants and their athletic level, grade (freshman, sophomore, junior, and senior), and age. The reliability of the questionnaire was assessed using Cronbach’s alpha and intraclass correlation coefficients. Athletes competing in team sports and individual sports were compared to evaluate for differences. Results: A total of 38.7% of athletes had moderate to severe sleep difficulty score. Their Cronbach’s alpha for test and retest were .34 and .44, respectively. The intraclass correlation coefficient indicated sufficient internal consistency and test–retest validity. The mean sleep difficulty scores were 7.0 (2.3) and 6.5 (2.1) for test and retest, but no significant difference was observed between the individual and team sport athletes. Results of multivariable regression analysis revealed that having sleep and performance issues during travel was related to sleep difficulty scores (Coef 1.44, P < .01). Conclusions: Athletes of all levels have sleep disorders. The Japanese version of athlete sleep screening questionnaire has been validated with sufficient test–retest validity but has poor internal consistency. Thus, although Japanese version of the athlete sleep screening questionnaire is an appropriate questionnaire for assessing sleep disorders in athletes whose primary language is Japanese, future research is needed to optimize the questionnaire accounting for cultural variation.
Athlete Sleep Screening Questionnaire in Japanese: Adaptation and Validation Study
Yuka Tsukahara, Satoshi Kodama, Saaya Kikuchi, and Carly Day
The Effect of a Synthetic-Grass Sport Surface on Physiology and Perception During Intermittent Exercise in Hot Conditions
Gurpreet Singh, Kyle J.M. Bennett, Hannah McGuigan, Scott G. Goddard, and Christopher J. Stevens
Purpose: The current study aimed to determine the effect of a synthetic-grass sport surface on core body temperature, skin temperature, heart rate, thermal sensation, thermal comfort, and rating of perceived exertion (RPE) during intermittent exercise in hot conditions. Methods: Using a randomized crossover design, 13 trained/developmental team-sport athletes completed two 50-minute standardized intermittent running protocols on a synthetic and a natural-grass surface, on separate days (control-condition air temperature 32.6 °C [1.3 °C], relative humidity 43.2% [5.3%]). Results: Final skin temperature was significantly higher on synthetic compared with natural grass at the calf (40.1 °C [2.5 °C] vs 33.4 °C [0.6 °C]; P < .001), shoulder (36.6 °C [1.7 °C] vs 33.7 °C [0.7 °C]; P < .001), and chest (33.2 °C [1.1 °C] vs 31.8 °C [1.2 °C]; P = .02). Thermal sensation (median: 2.3; interquartile range [0.5] vs 2.2 [0.5], P = .03) and sweat rate (1.5 [0.4] L·h−1 vs 1.2 [0.3] L·h−1; P = .02) were also significantly higher on synthetic grass. While final core body temperature was significantly higher on the natural than synthetic grass (38.4 °C [0.3 °C] vs 38.2 °C [0.4 °C]), there were no significant differences in delta core temperature, as well as heart rate, thermal comfort, or RPE. Conclusions: Higher skin temperatures, thermal sensation, and sweat rates suggest that exercising on synthetic grass in hot conditions may increase some markers of heat strain during exercise. However, delta core body temperature, heart rate, thermal comfort, and RPE remained unaffected.
The Efficacy of Ischemic Preconditioning on Handgrip Strength and Strength Endurance in Para-Athletes With Spinal-Cord Injury: A Pilot Study
Lexi Kasofsky, Rebecca Cross, Dallin Tavoian, and Jason Siegler
Purpose: This pilot study investigated the functional outcomes after ischemic preconditioning (IPC) in high-level para-athletes with spinal-cord injury. Methods: Nine athletes completed 2 handgrip exercise trials (an isometric hold to failure at 60% maximal voluntary contraction [ISO] and a progressive, intermittent handgrip to failure [INT]), preceded by either IPC (220 mm Hg) or sham (20 mm Hg) for six 5-minute periods, in a repeated-measures, crossover design. Results: Although small performance improvements in time to task failure were observed in the ISO (∼5%) and INT (∼8%) IPC conditions, which are similar to those reported elsewhere, no statistical influence was observed (ISO–IPC, 74.2 [32.6] s; SHAM, 70.7 [27.2] s; P = .73; INT–IPC, 426.0 [80.1] s; SHAM, 392.2 [42.5] s; P = .35). Fatigue was evident in the forearm muscle force (maximal voluntary contraction) ISO (mean decline of 178.1 [76.0] N [95% CI, −10.4 to 366.7 N]; P < .05) and INT (mean decline of 182.2 [72.5] N [95% CI, 34.5–329.8 N]; P < .05) trials but not different between treatments (P > .95). Conclusions: Although small performance improvements in time to task failure were observed, the findings of the present data set suggest that acute bouts of IPC do not meaningfully influence fatigue during handgrip exercise in para-athletes with spinal-cord injury.
Longitudinal Associations Between Physical Activity and Sleep Duration in Infants and Toddlers
Agnes G. Bucko, Bridget Armstrong, Kerry L. McIver, Alexander C. McLain, and Russell R. Pate
Purpose: This study examined longitudinal associations between average physical activity (PA) levels in children and their sleep duration, and whether changes in PA levels are associated with their sleep duration. Methods: Data were collected on 108 children at 4 time points: when children were 6, 12, 18, and 24 months of age (44% female, 50% Non-Hispanic White). PA was assessed using accelerometry. Children’s daytime, nighttime, and 24-hour sleep duration were measured with actigraphy. Linear mixed model analyses estimated the associations between average PA levels over time and changes in PA over time, treating each sleep duration variable as an outcome in separate linear mixed model analyses. Results: Children with higher total PA levels slept less during the day compared with children with lower total PA levels over the 2-year period. The strength of the relationship between a child’s PA levels and their 24-hour sleep duration decreased as they approached 24 months of age. Conclusions: The results suggest that while PA may be developmentally beneficial overall, it appears that its relationship with sleep duration is not clinically relevant in very young children.
Minimizing Redislocation Rates and Restoring Function After Patella Dislocation: A Critically Appraised Topic
Matthew Senese and Veronika Smith
Clinical Scenario: Patella dislocation is a common knee injury resulting in decreased function, increased knee pain, and a higher risk of recurrent patella dislocation. Patients with patella instability are treated surgically or conservatively with physical therapy to minimize redislocation risk and restore function. Clinical Question: In individuals with a patella dislocation, how does treatment (conservative therapy versus medial patellofemoral ligament [MPFL] surgery) affect redislocation rates and patient-perceived function? Summary of Key Findings: This critically appraised topic included 3 studies assessing outcomes in individuals with patella instability treated with MPFL surgery or conservative management. Outcomes included comparing redislocation rates and Kujala scale perceived knee function between participant groups. Surgery included MPFL reconstruction (MPFL-R) in 1 randomized controlled trial and 1 prospective controlled trial and MPFL repair in another randomized controlled trial. Conservative treatment included physical therapy and bracing. All 3 studies demonstrated significantly lower redislocation rates in individuals managed with surgery versus conservative treatment. Reported knee function was significantly higher in the MPFL-R group compared with individuals conservatively managed at 2-year follow-up but not at 1 year. No significant difference in knee function was present between individuals receiving MPFL repair or conservative management at a 2-year follow-up. Clinical Bottom Line: There is moderate-level evidence to support a significant decrease in patella redislocation rates in individuals managed with MPFL surgery compared with conservative treatment. The reviewed studies suggest a significant improvement in patient-perceived knee function at 2 years following MPFL-R but no difference at 1 year following MPFL-R or 2 years after MPFL repair. Strength of Recommendations: Grade B evidence supports lower patella redislocation rates with MPFL surgery compared with nonsurgical treatment. Furthermore, this evidence suggests a potential benefit in perceived knee function 2 years after MPFL-R compared with conservative management.
Training-Load Management Ambiguities and Weak Logic: Creating Potential Consequences in Sport Training and Performance
Stephen West, Ian Shrier, Franco M. Impellizzeri, Jo Clubb, Patrick Ward, and Garrett Bullock
Background: The optimization of athlete training load is not a new concept; however in recent years, the concept of “load management” is one of the most widely studied and divisive topics in sports science and medicine. Purpose: Discuss the challenges faced by sports when utilizing training load monitoring and management, with a specific focus on the use of data to inform load management guidelines and policies/mandates, their consequences, and how we move this field forward. Challenges: While guidelines can theoretically help protect athletes, overzealous and overcautious guidelines may restrict an athlete’s preparedness, negatively influence performance, and increase injury risk. Poor methods, wrong interpretation of study findings, and faulty logic do not allow for systematic scientific evaluations to inform guidelines. Practical Solutions: Guidelines and mandates should be developed through a systematic research process with stronger research designs and clear research questions. Collaborating with statistical and epidemiological experts is essential. Implementing open science principles and sharing all sports training load data increase transparency and allow for more rapid and valid advancements in knowledge. Practitioners should incorporate multiple data streams and consider individual athlete responses, rather than applying broad guidelines based on average data. Conclusion: Many current training load guidelines and mandates in sports come from good intentions; however, they are arbitrary without sound knowledge of the underlying scientific principles or methods. Common sense guidelines are helpful when there is sparse literature, but they should be careful to avoid arbitrarily choosing findings from weak research. Without precise scientific inquiries, implementing training load interventions or guidelines can have negative implications.
Challenges and Future Directions for Promoting Intersectional Quantitative Studies in Physical Activity Research
Mari Sone, Teatske M. Altenburg, and Mai J.M. ChinAPaw
Understanding health inequalities is essential for improving social justice. Intersectionality refers to a theoretical framework for studying the intersection of multiple social categorizations that create unique experiences and related social inequalities. Currently, the majority of the intersectional studies in the physical activity field have a qualitative design; thus, there is a need for quantitative intersectional studies. This commentary aims to explore primary obstacles impeding intersectional quantitative research and provide recommendations for overcoming these obstacles in physical activity research. In the commentary, we discuss that the lack of accessibility of large-scale and diverse data sets, and suboptimal social categorizations and intersectionality-related questions may contribute to the scarcity of intersectional quantitative research in the field. To facilitate intersectional quantitative analyses, we advocate for making large-scale data sets accessible for intersectional secondary analyses, diverse sampling, standardizing questions and categories related to intersectionality, promoting inclusive research designs and methods, and using the appropriate questions and social categorization that reflect the distinct experiences of each subgroup. By addressing these challenges, researchers may gain new insights into health disparities, making physical activity research more inclusive and contributing to more equitable health outcomes.
A Holistic Way to Understand the Determinants of Physical Activity in Urban New South Wales, Australia: A Codesigned Systems Mapping Project
Mengyun Luo, Binh Nguyen, Tracy Nau, Simon K. Chiu, Adrian Bauman, Louise Freebairn, William Bellew, Lucie Rychetnik, David T. Burns, Elizabeth A. Calleja, Lucy Corbett, Jennifer L. Kent, David R. Lubans, Anthony D. Okely, Catherine Sherrington, Anne Tiedemann, and Ding Ding
Background: To meet the World Health Organization goal of reducing physical inactivity by 15% by 2030, a multisectoral system approach is urgently needed to promote physical activity (PA). We report the process of and findings from a codesigned systems mapping project to present determinants of PA in the context of urban New South Wales, Australia. Methods: A participatory conceptual mapping workshop was held in May 2023 with 19 participants working in education, transportation, urban planning, community, health, and sport and recreation. Initial maps were developed and refined using online feedback from the participants. Interviews were conducted with 10 additional policymakers from relevant sectors to further refine the maps. Results: Two systems maps were cocreated, identifying over 100 variables influencing PA and their interconnections. Five settings emerged from the adults’ map—social and community, policy, built environment and transportation, health care, and workplace—and 4 for the young people’s map—family, school, transportation, and community and environment. The maps share similarities, such as regarding potential drivers within the transportation, community, and built environment sectors; however, the young people’s map has a specific focus on the school setting and the adults’ map on workplace and health care settings. Interviews with policymakers provided further unique insights into understanding and intervening in the PA system. Conclusions: This codesigned participatory systems mapping process, supplemented by stakeholder interviews, provided a unique opportunity to bring together stakeholders across sectors to understand the complexity within the PA system and begin to identify leverage points for tackling physical inactivity in New South Wales.
Navigating Virtual Collisions: Insights Into Perception–Action Differences in Children and Young Adults Using a Head-On Avoidance Task
Megan Hammill, Victoria Rapos, and Michael Cinelli
Children tend to make more last-minute locomotor adjustments than adults when avoiding stationary obstacles. The purpose of this study was to compare avoidance behaviors of middle-aged children (10–12 years old) with young adults during a head-on collision course with an approaching virtual pedestrian. Participants were immersed in a virtual environment and completed a perceptual decision-making task in which they had to respond to the future direction of an approaching virtual pedestrian once they disappeared. Following the perceptual task, participants walked along an 8-m pathway toward a goal, while avoiding a collision with a virtual pedestrian who approached along the midline than veered toward the left, right, or continued walking straight. Results revealed that children were able to correctly predict the future directions of the virtual pedestrian similar to adults, albeit at a slower response time (0.55 s vs. 0.33 s). During the action task, children initiated a deviation in their travel path later (i.e., closer to the virtual pedestrian) compared to adults (1.65 s vs. 1.52 s). Children were also more variable in their onset of deviation and time-to-contact. Although children appear to have developed adult-like perceptual abilities and can avoid an approaching virtual pedestrian, children employ riskier avoidance strategies and are highly variable, suggesting middle-aged children are still fine-tuning their perception-action system.
Validating the Use of Continuous Glucose Monitors With Nondiabetic Recreational Runners
Lesley J. Mason, Timothy Hartwig, and David Greene
Purpose: Continuous glucose monitors (CGMs) are becoming increasingly popular among endurance athletes despite unconfirmed accuracy. We assessed the concurrent validity of the FreeStyle Libre 2 worn on 2 different sites at rest, during steady-state running, and postprandial. Methods: Thirteen nondiabetic, well-trained recreational runners (age = 40 [8] y, maximal aerobic oxygen consumption = 46.1 [6.4] mL·kg–1·min–1) wore a CGM on the upper arm and chest while treadmill running for 30, 60, and 90 minutes at intensities corresponding to 50%, 60%, and 70% of maximal aerobic oxygen consumption, respectively. Glucose was measured by manually scanning CGMs and obtaining a finger-prick capillary blood glucose sample. Mean absolute relative difference, time in range, and continuous glucose Clarke error grid analysis were used to compare paired CGM and blood glucose readings. Results: Across all intensities of steady-state running, we found a mean absolute relative difference of 13.8 (10.9) for the arm and 11.4 (9.0) for the chest. The coefficient of variation exceeded 70%. Approximately 47% of arm and 50% of chest paired glucose measurements had an absolute difference ≤10%. Continuous glucose Clarke error grid analysis indicated 99.8% (arm) and 99.6% (chest) CGM data fell in clinically acceptable zones A and B. Time-in-range analysis showed reduced accuracy at lower glucose levels. However, CGMs accurately detected trends in mean glucose readings over time. Conclusions: CGMs are not valid for point glucose monitoring but appear to be valid for monitoring glucose trends during steady-state exercise. Accuracy is similar for arm and chest. Further research is needed to determine whether CGMs can detect important events such as hypoglycemia during exercise.
