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Daniel Miner and Brent Harper

Context: The Buffalo Concussion Treadmill Test (BCTT) is a standard assessment of exercise tolerance utilized for exercise prescription following concussion and to inform decisions regarding return to play. One limitation of the BCTT is that interpretation of test results is dependent on individuals’ self-report of symptom exacerbation with exertion. Symptoms following concussion are significantly underreported or unreported. Combining objective neurocognitive assessment with exercise tolerance testing may enable clinicians to objectively identify those requiring further assessment or rehabilitation before return to play. The purpose of this study was to investigate how performance on a neurocognitive assessment battery is affected by provocative exercise testing. Design: Prospective cohort study, pretest/posttest. Methods: A total of 30 participants included 13 women (43.3%), age 23.4 (1.93) years, height 173.56 (10) cm, weight 77.35 (16.3) kg, and 11 (36.7%) with history of concussion. All participants completed a neurocognitive assessment battery, including the Stroop Test and standardized assessments of working memory, attention, and information processing speed/accuracy in single-task (seated position) and dual-task conditions (walking on a treadmill at 2.0 miles per hour). The neurocognitive assessment battery was performed at baseline and after the standard BCTT test protocol. Results: BCTT: Average percentage of heart rate maximum (%HRmax) = 93.97% (4.8%); average maximum rating of perceived exertion = 18.6 (1.5). Time-based performance in single-task and dual-task conditions significantly improved from baseline (P < .05) following maximal exercise testing on the BCTT for the following neurocognitive assessments: concentration-reverse digits, Stroop congruent, and Stroop incongruent. Conclusions: Healthy participants demonstrated improvements across multiple domains of neurocognitive performance following the exercise tolerance testing on the BCTT. Understanding normal responses in neurocognitive performance for healthy individuals following exercise tolerance testing may allow clinicians to more objectively monitor the trajectory of recovery following sports-related concussion.

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Kannan Singaravelu Jaganathan, Karen A. Sullivan, Sally Kinmond, Sara Berndt, Steve Street, Catherine Haden, Jaimi Greenslade, Katie McMahon, Gary Mitchell, and Graham Kerr

Context: Exercise rehabilitation for postconcussion symptoms (PCS) has shown some benefits in adolescent athletes; but a synthesis of evidence on exercise per se has been lacking. Objective: This systematic review aimed to determine if unimodal exercise interventions are useful to treat PCS and if so, to identify a set of clearly defined and effective exercise parameters for further research. Evidence Acquisition: Relevant health databases and clinical trial registries were searched from inception to June 2022. The searches used a combination of subject headings and keywords related to mild traumatic brain injury (mTBI), PCSs, and exercise. Two independent reviewers screened and appraised the literature. The Cochrane Collaboration’s Risk of Bias-2 tool for randomized controlled trials was used to assess methodological quality of studies. Evidence Synthesis: Seven studies were included in the review. Four studies were assessed to have a low overall risk of bias, 2 with low risk and 1 with some concerns. Participants in the studies comprised mostly adolescents with sports-related concussion. The review found exercise to be more beneficial than control conditions in 2 studies investigating acute PCS and 2 studies investigating persistent PCS. Within-group differences showing symptom improvement over time were observed in all 7 studies. In general, the review found support for programmatic exercise that commences after an initial period of rest for 24 to 48 hours. Recommendations for exercise parameters that can be explored in subsequent research include progressive aerobic exercise starting from 10 to 15 minutes at least 4 times a week, at a starting intensity of 50% HR of the subsymptom threshold, with length of program depending on recovery. Conclusion: The evidence in support of exercise rehabilitation for PCSs is moderate based on the small pool of eligible studies. Further research can be guided by the exercise parameters identified in this review.

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Siobhan K. Fitzpatrick and Janine V. Olthuis

American student-athletes (SAs) are at heightened risk for hazardous alcohol consumption compared with their nonathlete peers. However, little is known about this risk or the influence of psychosocial predictors on drinking behavior among Canadian SAs. This study compared rates of alcohol use across Canadian SAs and nonathletes and investigated whether the use of athlete-specific psychosocial predictors can improve the prediction of alcohol use outcomes in SAs. Participants (179 varsity athletes and 366 nonathletes) completed anonymous self-report questionnaires. Results suggest that Canadian athletes are at a heightened risk for experiencing alcohol-related problems compared with nonathletes, with general psychosocial predictors explaining the majority of variance in SA alcohol use. However, and quite notably, athlete-specific positive reinforcement motives predicted SA binge drinking. This research provides some of the first evidence of drinking-related problems among Canadian SAs and supports the potential use of preventative efforts to help SAs develop safe strategies for alcohol use.

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Fırat Tan, Hande Guney-Deniz, Gulcan Harput, Burak Ulusoy, Gürhan Dönmez, John Nyland, and Mahmut N. Doral

Context: The study purpose was to compare the ankle muscle activation and dynamic ankle joint stability of subjects who underwent endoscopy-assisted Achilles tendon repair (ATR; at ≥ 2 y postsurgery) with age, gender, and activity level-matched healthy control group subjects. Design: Prospective, cross-sectional study. All functional tests were performed on the involved ankle of the ATR group, and at the matched side of healthy age, gender, and activity-level control group subjects. Methods: Fifteen men in each group were evaluated for medial and lateral gastrocnemius, soleus, tibialis anterior, and peroneus longus muscle activation during modified star excursion balance test and heel-rise test performance. The weight-bearing lunge test (ankle dorsiflexion) and heel-rise test distance (ankle plantar flexion) also determined weight-bearing, active ankle mobility magnitudes. The Achilles Tendon Total Rupture Score and Foot and Ankle Outcome Score provided patient-reported outcome perceptions specific to Achilles tendon rupture and comprehensive foot and ankle symptoms and function, respectively. Results: Medial (P = .005) and lateral (P = .012) gastrocnemius displayed greater activation amplitudes in the ATR group during the star excursion balance test, and peroneus longus displayed greater activation amplitudes during the heel-rise test (P = .006). The star excursion balance test reach distance was comparable between groups. Active weight-bearing ankle plantar flexion (heel-rise test) and dorsiflexion (weight-bearing lunge test) mobility magnitudes were lower in the ATR group. Conclusions: Subjects who underwent endoscopy-assisted percutaneous ATR had reduced active weight-bearing ankle dorsiflexion and plantar flexion mobility magnitudes and greater gastrocnemius and peroneus longus neuromuscular activation when performing the same tasks as healthy control group subjects. As surgical approaches evolve to less invasive, soft tissue preserving methods with less tissue morbidity and faster healing, rehabilitation approaches may likewise need to evolve. Level of Evidence: Level III.

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Emily H. Gabriel and Cameron J. Powden

Identification of factors which may influence participation in exercise-related injury prevention programs within Reserve Officers’ Training Corps (ROTC) cadets is an important step in improving adoption and adherence rates. Therefore, the purpose of the study was to identify factors associated with intention to participate in an exercise-related injury prevention program within ROTC cadets. Theory of planned behavior scale perceived benefits (B = 3.65, η2 = .36, p = .001) and Health Belief Model Scale perceived benefits (B = 3.46, η2 = .31, p = .01) had a large positive association with intention to participate. Theory of planned behavior scale perceived barriers (B = −2.28, η2 = .37, p = .001) had a large negative association with intention to participate. Implementation strategies for exercise-related injury prevention programs may need to focus on the benefits and barriers of participation to increase adoption and adherence.

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Russell L. Muir

Athletic trainers frequently make decisions under uncertain conditions leading to the use of decisional shortcuts (heuristics). Heuristics can be useful decisional tools, but their use gives rise to predictable cognitive errors (cognitive bias), which can lead to diagnostic and injury management errors. This study assessed athletic trainers’ understanding of these topics and explored their presence in athletic training education. Few participants were taught about heuristics (11.6%) and cognitive bias (24.1%), although those taught about heuristics demonstrated greater understanding of both topics. To improve clinical efficacy and patient outcomes, athletic trainers should seek educational opportunities related to heuristics and cognitive bias.

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Lindsey E. Slavin, Tess M. Palmateer, Trent A. Petrie, and E. Whitney G. Moore

The onset of COVID-19 and cancellation of collegiate sports may have exacerbated student-athletes’ psychological distress. Within a national sample of collegiate athletes (N = 5,755; 66.7% women), we determined how gender and race related to rates of depression, stress, and counseling use at the beginning of the pandemic (April/May 2020). Overall, 26.5% (n = 1,526) and 10.6% (n = 612) endorsed clinical levels of depression and stress, respectively; 25.1% (n = 1,443) and 69.7% (n = 4,014) reported subclinical levels. Few athletes (2.3%–17.1%) reported counseling use before or after the onset of COVID-19; those who did reported higher levels of depression and stress than those who never sought services. The female athletes reported higher rates of depression, stress, and counseling use than the male athletes. There were no race effects. Athletic departments must address their student-athletes’ psychological distress by facilitating a higher use of mental health services.

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Martin Alfuth, Pia Joana Franke, Jonas Klemp, and Axel Johannes Knicker

Context: After anterior cruciate ligament reconstruction (ACLR), long-term functional deficiencies can occur, with controversial results reported when comparing women and men. Dynamic balance and unilateral hop test performance are considered important indicators for the risk of reinjury of the lower extremity. Although both sexes seem to have a similar risk to experience a second anterior cruciate ligament injury, sex-specific differences of dynamic balance and unilateral hop performance in handball players following ACLR are unknown. Objective: To compare dynamic balance and unilateral hop performance between women and men handball players at least 6 months after ACLR. Design: Cross-sectional pilot study. Participants: Ten women (27.6 [4.5] y) and 10 men (26.5 [3.1] y) handball players 6 to 16 months after ACLR. Outcome Measures: Dynamic balance and unilateral hop performance were assessed using the Y-Balance Test and the Single-Leg Hop for Distance Test. Results: Women players demonstrated significantly better results in the anterior direction of the Y-Balance Test for both legs compared with men players. Hop performance was not significantly different between sexes. Conclusion: Dynamic balance and single-leg hop performance seem not to differ between women and men handball players 6 to 16 months after ACLR. The difference between sexes in the anterior reach direction of the Y-Balance Test should be considered small, rather than representing a true difference.

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Rodrigo Rodrigues Gomes Costa, Matt Laurent, Frederico Ribeiro Neto, Luis Felipe Castelli Correa de Campos, and Ciro Winckler

Context: One of the primary training variables, although often overlooked, is recovery level achieved before starting subsequent training sessions. To find a more practical measurement that is consonant with the daily training routine, the Perceived Recovery Status (PRS) scale is proposed. In this perspective, the present study aimed to translate and culturally adapt the PRS scale into Brazilian Portuguese. Design: This was a clinical measurement. Methods: The cross-cultural translation was performed according to guidelines. Linguistic validation consisted of 5 stages: forward translation, translation synthesis, back translation, analysis of inconsistencies, and cognitive debriefing. Results: During forward translation, different interpretations were obtained from the 2 translators (versions V1 and V2). Supported by an expert committee, a combined version (V3) was obtained from V1 and V2. During back translation, different interpretations were obtained from the 2 translators (versions V4 and V5). Discrepancies, applicability, and cultural equivalence were documented and analyzed by the expert committee participating in the cross-cultural translation procedure. During the cognitive debriefing, a group of 5 Brazilian people from the general population were asked to participate in a cognitive debriefing to assess the comprehensibility of the translated items. Conclusions: The PRS was translated and culturally adapted to Brazilian Portuguese (PRS-Brasil).