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Karlee Burns, Ryan Tierney, and Jane McDevitt

Clinical Question: In individuals with posttraumatic headache following concussion, what impact does medication have? Clinical Bottom Line: Prescription medications may be beneficial for those suffering posttraumatic headache following concussion by decreasing headache symptoms and improving cognitive function, though long-term outcomes were similar between those taking and not taking medications.

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Paul A. Cacolice and Corinne M. Ebbs

Clinical Question: What is the effect of CT intervention on the stress and arousal levels of undergraduate students? Clinical Bottom Line: There is Level A–B evidence showing that the use of therapy dogs decreases stress and elevates arousal in female undergraduate students, with little evidence available for other populations.

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Claudio Quagliarotti, Matteo Cortesi, Giorgio Gatta, Marco Bonifazi, Paola Zamparo, Roberto Baldassarre, Veronica Vleck, and Maria Francesca Piacentini

Purpose : Although wearing a wetsuit while swimming, when permitted, is primarily for safety reasons (ie, to protect against hypothermia), changes in buoyancy, biomechanics, and exercise performance have been reported. This narrative review covers the benefits of different wetsuit models on performance in swimming and triathlon. Methods : A computer search of online databases was conducted to locate relevant published research until March 2021. After the screening process, 17 studies were selected for analysis. Results : Most of the selected studies involved pool swimmers or triathletes completing short or middle distances in a pool while using a full or a long sleeveless wetsuit. Swimming with wetsuit elicited significant improvements in performance (maximum 11%), mainly by decreasing drag and energy cost, by increasing buoyancy, and by affecting technique. Different rates of change in each factor were found according to swimming ability and wetsuit model. In addition, wearing a wetsuit was often rated as uncomfortable by athletes. Conclusions : Although improvement in swimming performance by wearing a wetsuit has been reported in the literature, the amplitude of the improvement remains questionable. The enhancement in swimming performance is attributable merely to improvements in propulsion proficiency and buoyancy, as well as a reduction in drag. The extent to which athletes are familiar with the use of a wetsuit, their swimming ability, and the wetsuit model may play important roles in this improvement. More studies simulating competition and comparing elite versus nonelite athletes are needed.

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Yasuki Sekiguchi, Courteney L. Benjamin, Samantha O. Dion, Ciara N. Manning, Jeb F. Struder, Erin E. Dierickx, Margaret C. Morrissey, Erica M. Filep, and Douglas J. Casa

The purpose of this study was to examine the effect of heat acclimation (HA) on thirst levels, sweat rate, and percentage of body mass loss (%BML), and changes in fluid intake factors throughout HA induction. Twenty-eight male endurance athletes (mean ± SD; age, 35 ± 12 years; body mass, 73.0 ± 8.9 kg; maximal oxygen consumption, 57.4 ± 6.8 ml·kg−1·min−1) completed 60 min of exercise in a euhydrated state at 58.9 ± 2.3% velocity of maximal oxygen consumption in the heat (ambient temperature, 35.0 ± 1.3 °C; relative humidity, 48.0 ± 1.3%) prior to and following HA where thirst levels, sweat rate, and %BML were measured. Then, participants performed 5 days of HA while held at hyperthermia (38.50–39.75 °C) for 60 min with fluid provided ad libitum. Sweat volume, %BML, thirst levels, and fluid intake were measured for each session. Thirst levels were significantly lower following HA (pre, 4 ± 1; post, 3 ± 1, p < .001). Sweat rate (pre, 1.76 ± 0.42 L/hr; post, 2.00 ± 0.60 L/hr, p = .039) and %BML (pre, 2.66 ± 0.53%; post, 2.98 ± 0.83%, p = .049) were significantly greater following HA. During HA, thirst levels decreased (Day 1, 4 ± 1; Day 2, 3 ± 2; Day 3, 3 ± 2; Day 4, 3 ± 1; Day 5, 3 ± 1; p < .001). However, sweat volume (Day 1, 2.34 ± 0.67 L; Day 2, 2.49 ± 0.58 L; Day 3, 2.67 ± 0.63 L; Day 4, 2.74 ± 0.61 L; Day 5, 2.74 ± 0.91 L; p = .010) and fluid intake (Day 1, 1.20 ± 0.45 L; Day 2, 1.52 ± 0.58 L; Day 3, 1.69 ± 0.63 L; Day 4, 1.65 ± 0.58 L; Day 5, 1.74 ± 0.51 L; p < .001) increased. In conclusion, thirst levels were lower following HA even though sweat rate and %BML were higher. Thirst levels decreased while sweat volume and fluid intake increased during HA induction. Thus, HA should be one of the factors to consider when planning hydration strategies.

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Michael A. Hemphill, Emily M. Janke, Santos Flores, and Barrie Gordon

Purpose: The purpose of this study was to explore the issues of conflict and harm in physical education within a school recognized for its exemplary restorative practices. Method: A single case study approach was employed to examine one restorative school in Wellington, New Zealand. The school was purposely selected to participate in this study based on its recognition for exemplary restorative practices. Participants included physical educators (n = 11), administrators (n = 4), and students (n = 25). Data sources included interviews, observations, and reflection documents. Data were analyzed using a collaborative qualitative approach. Results: Three qualitative themes described the context of restorative school physical education, types of harm that occurred, and how physical educators were positioned as central figures in creating a context where harm was addressed. Discussion: This study provides insights into restorative practices and has implications for teaching social and emotional learning skills.

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Sofía Pereira-García, Elena López-Cañada, and Agnes Elling-Machartzki

Purpose: The lesbian, gay, bisexual, transgender/transsexual, and queer/questioning students normally occupy a marginalized and at-risk position in classes and especially in physical education. In this paper, the authors explore the ways in which queer tango can contribute to counteracting heteronormativity and opening up students to new interactions and identifications through the performance of different gender performances in Physical Education and Sport Tertiary Education. Method: A queer tango session was carried out with 111 university students (91 men and 19 women aged 19–22 years). Data were obtained from interviews, video records, and open questionnaires about the practice. Results: The findings reveal that the performance of dance roles that are contrary to the heteronormative order reinforced both heteronormativity and queer embodiments in Physical Education and Sport Tertiary Education. Conclusion: An isolated activity is not enough, and more queer pedagogical practices should be introduced in order to make meaningful changes to mainstream students’ ideology and behaviors.

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Nick Dobson

Clinical Scenario: Resistance training (RT) programs promote skeletal muscle hypertrophy through the progressive physiological stress applied to an individual. Currently, the vast majority of studies regarding the hypertrophic response to RT have focused on either sedentary or untrained individuals. This critically appraised topic focuses on the hypertrophic response to high- and low-load RT in resistance-trained men. Clinical Question: In experienced male weightlifters, does high-load RT lead to greater increases in muscle mass than low-load RT? Summary of Key Findings: Six studies met the inclusion criteria, while 4 studies were included in the analysis. Each of the 4 studies showed that low-load RT elicited hypertrophic gains similar to high-load RT when sets were taken to failure. Three of the studies were not volume equated, indicating a dose–response relationship between training volume-load and skeletal muscle hypertrophy. One of the studies was volume equated, indicating that skeletal muscle hypertrophy could be achieved at levels comparable to those observed in high-load protocols as a result of high levels of metabolic stress and the concomitant recruitment of high-threshold motor units that can occur during fatiguing contractions. Clinical Bottom Line: Evidence suggests that low-load training produces hypertrophic gains similar to those observed in high-load RT protocols when sets are taken to failure in resistance-trained men. Strength of Recommendation: There is moderate to strong evidence to suggest that low-load RT elicits hypertrophic gains similar to those observed in high-load RT protocols when sets are taken to failure in resistance-trained men.

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Dong Ha Kim, Heewon Kang, and Seunghyun Yoo

Walking promotes active aging; however, walking prevalence changes among older adults by age and environmental conditions remain unclear. Age-period-cohort (APC) differences in walking trends among Korean older adults were examined. Data included adults aged ≥ 65 years (n = 592,235) from the nationally representative Korean Community Health Survey. Regional units examined were metropolitan cities, small- and medium-sized cities, and rural areas. Environment-stratified APC modeling was applied for walking prevalence (walking days/time during the past week). From 2008 to 2017, the walking prevalence gap between regional units widened. Decreasing trends were most apparent in rural areas, including by birth year. In all areas, walking decreased with increased age. No distinct period effects were found. Each effect’s magnitude was larger in rural areas than cities. Differential APC effects by environmental conditions likely influence walking prevalence changes among older adults. Walking promotion for older adults should consider APC effects and environmental conditions.

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Mansi Gaitonde, Shannon Jones, Courtney McCracken, Matthew E. Ferguson, Erik Michelfelder, Ritu Sachdeva, and William Border

Background: Elevated left ventricular outflow tract (LVOT) gradients during exercise can occur in patients with hypertrophic cardiomyopathy (HCM) as well as in athletes and normal controls. The authors’ staged exercise protocol calls for imaging at rest and during each stage of exercise to evaluate the mechanism of LVOT obstruction at each stage. They investigated whether this staged approach helps differentiate HCM from athletes and normal controls. Methods: They reviewed pediatric exercise stress echocardiograms completed between January 2009 and October 2017 at their center and identified those with gene-positive HCM, athlete’s heart, and normal controls. Children with inducible obstruction (those with no LVOT gradient at rest who developed a LVOT peak gradient > 25 mm Hg during exercise) were included. LVOT peak gradient, velocity time integral, acceleration time, and deceleration time were measured at rest, submaximal stages, and peak exercise. Results: Compared with athletes, HCM patients had significantly higher LVOT peak gradients at rest (P = .019), stage 1 of exercise (P = .002), and peak exercise (P = .051), as well as a significantly higher change in LVOT peak gradient from rest to stage 1 (P = .016) and from rest to peak (P = .038). The acceleration time/deceleration time ratio of the LVOT Doppler was significantly lower in HCM patients compared with normal controls at peak exercise. Conclusions: The HCM patients who develop elevated LVOT gradients at peak exercise typically manifest early obstruction in the submaximal stages of exercise, which helps to differentiate them from athletes and normal controls.

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Pankaja Desai, Shannon Halloway, Klodian Dhana, Yanyu Zhang, Thomas Holland, Puja Agarwal, Christopher N. Ford, Carlos Mendes de Leon, Denis A. Evans, and Martha C. Morris

This study examined the relationship between walking and cognitive function among Chicago Health and Aging Project participants. Data collection occurred during six 3-year cycles, of which Cycles 4–6 were used for this specific analysis. Information was obtained regarding walking frequency and duration, demographics, chronic conditions, cognitive activities, apolipoprotein E4, physical function, and cognitive function (global and domains). A composite walking measure was developed and categorized as follows: no walking, ≤105 min/week, and >105 min/week. Mixed-effects regression analyses tested associations between walking and global cognitive function, episodic memory, and perceptual speed. The sample consisted of 4,320 participants (African American/Black: 65%; female: 65%; mean education: 13 years; mean age: 75 years). Composite or total walking had a statistically significant association with global cognitive function and perceptual speed, after adjustments were made.