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Mohammad Siahpush, Trish D. Levan, Minh N. Nguyen, Brandon L. Grimm, Athena K. Ramos, Tzeyu L. Michaud and Patrik L. Johansson

Background: The mortality benefits of meeting the US federal guidelines for physical activity, which includes recommendations for both aerobic and muscle-strengthening activities, have never been examined among smokers. Our aim was to investigate the association between reporting to meet the guidelines and all-cause, cancer, cardiovascular disease, and respiratory disease mortality among smokers. Methods: We pooled data from the 1998–2009 National Health Interview Survey, which were linked to records in the National Death Index (n = 68,706). Hazard ratios (HR) were computed to estimate the effect of meeting the physical activity guidelines on mortality. Results: Smokers who reported meeting the guidelines for physical activity had 29% lower risk of all-cause mortality (HR: 0.71; 95% confidence interval [CI], 0.62–0.81), 46% lower risk of mortality from cardiovascular disease (HR: 0.54; 95% CI, 0.39–0.76), and 26% lower risk of mortality from cancer (HR: 0.74; 95% CI, 0.59–0.93), compared with those who reported meeting neither the aerobic nor the muscle-strengthening recommendations of the guidelines. Meeting the aerobic recommendation of the guidelines was associated with a 42% decline in that risk (HR: 0.58; 95% CI, 0.44–0.77). Conclusion: Smokers who adhere to physical activity guidelines show a significant reduction in mortality.

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Christina M. Patch, Caterina G. Roman, Terry L. Conway, Ralph B. Taylor, Kavita A. Gavand, Brian E. Saelens, Marc A. Adams, Kelli L. Cain, Jessa K. Engelberg, Lauren Mayes, Scott C. Roesch and James F. Sallis

Background: A common hypothesis is that crime is a major barrier to physical activity, but research does not consistently support this assumption. This article advances research on crime-related safety and physical activity by developing a multilevel conceptual framework and reliable measures applicable across age groups. Methods: Criminologists and physical activity researchers collaborated to develop a conceptual framework. Survey development involved qualitative data collection and resulted in 155 items and 26 scales. Intraclass correlation coefficients (ICCs) were computed to assess test–retest reliability in a subsample of participants (N = 176). Analyses were conducted separately by age groups. Results: Test–retest reliability for most scales (63 of 104 ICCs across 4 age groups) was “excellent” or “good” (ICC ≥ .60) and only 18 ICCs were “poor” (ICC < .40). Reliability varied by age group. Adolescents (aged 12–17 y) had ICCs above the .40 threshold for 21 of 26 scales (81%). Young adults (aged 18–39 y) and middle-aged adults (aged 40–65 y) had ICCs above .40 for 24 (92%) and 23 (88%) scales, respectively. Older adults (aged 66 y and older) had ICCs above .40 for 18 of 26 scales (69%). Conclusions: The conceptual framework and reliable measures can be used to clarify the inconclusive relationships between crime-related safety and physical activity.

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Mhairi K. MacLean and Daniel P. Ferris

The authors tested 4 young healthy subjects walking with a powered knee exoskeleton to determine if it could reduce the metabolic cost of locomotion. Subjects walked with a backpack loaded and unloaded, on a treadmill with inclinations of 0° and 15°, and outdoors with varied natural terrain. Participants walked at a self-selected speed (average 1.0 m/s) for all conditions, except incline treadmill walking (average 0.5 m/s). The authors hypothesized that the knee exoskeleton would reduce the metabolic cost of walking uphill and with a load compared with walking without the exoskeleton. The knee exoskeleton reduced metabolic cost by 4.2% in the 15° incline with the backpack load. All other conditions had an increase in metabolic cost when using the knee exoskeleton compared with not using the exoskeleton. There was more variation in metabolic cost over the outdoor walking course with the knee exoskeleton than without it. Our findings indicate that powered assistance at the knee is more likely to decrease the metabolic cost of walking in uphill conditions and during loaded walking rather than in level conditions without a backpack load. Differences in positive mechanical work demand at the knee for varying conditions may explain the differences in metabolic benefit from the exoskeleton.

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Angela Maria Hoyos-Quintero and Herney Andrés García-Perdomo

Objective: To evaluate the relationship between biologico-demographical, sociocultural, and environmental factors and the performance of physical activity in early childhood. Methodology: A systematic search was carried out of the databases MEDLINE, EMBASE, CENTRAL, and LILACS, as well as Google Scholar, Open Grey,, DARE, PROSPERO, Health Technology Assessment, and the World Health Organization International Clinical Trials Registry Platform, from their first records to June 2018. The selection criteria were previously defined with respect to population age and article theme. No meta-analyses were carried out due to the heterogeneity of the studies. Results: The percentage of moderate to vigorous physical activity runs between 3% and 47%. Environmental and sociocultural factors were identified as exerting a greater influence on children’s physical activity in early childhood, with the environmental factors being, according to almost all the study authors, the greater of the two. Conclusions: According to the studies included in this research project, the factors identified as associated with moderate to vigorous physical activity are environmental (play in open spaces) and sociocultural (the role of the family and the physical activity of the mother). The evidence is not strong enough to conclude that biologico-demographic factors are significantly influential in the physical activity at this age.

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Ítalo R. Lemes, Rômulo A. Fernandes, Bruna C. Turi-Lynch, Jamile S. Codogno, Luana C. de Morais, Kelly A.K. Koyama and Henrique L. Monteiro

Background: Metabolic syndrome (MetS) is a combination of risk factors for cardiovascular disease and type 2 diabetes mellitus. The prevalence of MetS worldwide is increasing. There is no study investigating the economic burden of MetS, especially in developing countries, on medication-related expenditure. The aim of this study was to investigate the association of medication-related expenditures with MetS and to explore how physical activity (PA) may influence this association. Methods: A total of 620 participants, 50 years or older, randomly selected in the city of Bauru, Brazil. Participants were followed from 2010 to 2014, and data on health care expenditure were collected annually. PA questionnaire was applied at baseline, 2 (2012), and 4 (2014) years later. Results: Mean age was 64.7 (95% confidence interval, 64.1–65.3). MetS was associated with higher medication expenditure related to diseases of the circulatory (P <.01) and endocrine (P <.01) systems. MetS explained 17.2% of medication-related expenditures, whereas PA slightly attenuated this association, explaining 1.1% of all health care costs. Conclusion: This study demonstrates that MetS has a significant burden on health care expenditures among adults, whereas PA seems to affect this phenomenon significantly, but in low magnitude.

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Mindi Fisher, Ryan Tierney, Anne Russ and Jamie Mansell

Clinical Question: In concussed patients, will having attention deficit hyperactivity disorder (ADHD) or learning difficulties (LD) versus not having ADHD or LD cause higher symptom severity scores or invalid baseline protocols? Clinical Bottom Line: Research supports the concept that there is a difference at baseline for individuals with ADHD and/or LD compared with those who do not.

Open access

David M. Shaw, Fabrice Merien, Andrea Braakhuis, Daniel Plews, Paul Laursen and Deborah K. Dulson

This study investigated the effect of the racemic β-hydroxybutyrate (βHB) precursor, R,S-1,3-butanediol (BD), on time-trial (TT) performance and tolerability. A repeated-measures, randomized, crossover study was conducted in nine trained male cyclists (age, 26.7 ± 5.2 years; body mass, 69.6 ± 8.4 kg; height, 1.82 ± 0.09 m; body mass index, 21.2 ± 1.5 kg/m2; VO2peak,63.9 ± 2.5 ml·kg−1·min−1; W max, 389.3 ± 50.4 W). Participants ingested 0.35 g/kg of BD or placebo 30 min before and 60 min during 85 min of steady-state exercise, which preceded a ∼25- to 35-min TT (i.e., 7 kJ/kg). The ingestion of BD increased blood D-βHB concentration throughout exercise (0.44–0.79 mmol/L) compared with placebo (0.11–0.16 mmol/L; all p < .001), which peaked 1 hr following the TT (1.38 ± 0.35 vs. 0.34 ± 0.24 mmol/L; p < .001). Serum glucose and blood lactate concentrations were not different between trials (all p > .05). BD ingestion increased oxygen consumption and carbon dioxide production after 20 min of steady-state exercise (p = .002 and p = .032, respectively); however, no further effects on cardiorespiratory parameters were observed. Within the BD trial, moderate to severe gastrointestinal symptoms were reported in five participants, and low levels of dizziness, nausea, and euphoria were reported in two participants. However, this had no effect on TT duration (placebo, 28.5 ± 3.6 min; BD, 28.7 ± 3.2 min; p = .62) and average power output (placebo, 290.1 ± 53.7 W; BD, 286.4 ± 45.9 W; p = .50). These results suggest that BD has no benefit for endurance performance.

Open access

Brittany M. Ingram, Melissa C. Kay, Christina B. Vander Vegt and Johna K. Register-Mihalik

Clinical Scenario: Current studies have identified body checking as the most common cause of sports-related concussion in ice hockey across all divisions and levels. As a result, many hockey organizations, particularly in youth sports, have implemented rules making body checking to the head, face, and/or neck illegal. Such a rule, in Canada, makes age 13 the first age in which individuals can engage in body checking. Despite these changes, effectiveness of their implementation on the incidence of concussion in Canadian male youth ice hockey players remains unclear. Clinical Question: What is the effect of body checking policy changes on concussion incidence in male youth ice hockey players? Summary of Key Findings: Of the 3 included studies, 2 studies reported a decrease in the incidence of concussion once a body checking policy change was implemented. The third study showed an increase; however, it is important to note that this may be due, in part, to increased awareness leading to better reporting of injuries. Clinical Bottom Line: Current evidence supports a relationship between body checking policy implementation and decreased concussion incidence; however, more research is needed to understand the long-term implications of policy change and the effects in other leagues. In addition, further data are needed to differentiate between increased concussion incidence resulting from concussion education efforts that may improve disclosure and increased concussion incidence as a direct result of policy changes. Strength of Recommendation: Grade B evidence exists that policy changes regarding body checking decrease concussion incidence in male youth ice hockey players.

Open access

Corey P. Ochs, Melissa C. Kay and Johna K. Register-Mihalik

Clinical Scenario: Collision sports are often at higher risk of concussion due to the physical nature and style of play. Typically, initial clinical recovery occurs within 7 to 10 days; however, even this time frame may result in significant time lost from play. Little has been done in previous research to analyze how individual game performance may be affected upon return to play postconcussion. Focused Clinical Question: Upon return-to-play clearance, how does sport-related concussion affect game performance of professional athletes in collision sports? Summary of Key Findings: All 3 studies included found no significant change in individual performance of professional collision-sport athletes upon returning to play from concussive injury. One of the studies indicated that there was no difference in performance for NFL athletes who did not miss a single game (returned within 7 d) and those who missed at least 1 game. One study indicated that although there was no change in performance of NFL players upon returning to play from sustained concussion, there was a decline in performance in the 2 weeks before the diagnosed injury and appearing on the injury report. The final study indicated that there was no difference in performance or style of play of NHL athletes who missed time due to concussive injury when compared with athletes who missed games for a noninjury factor. Clinical Bottom Line: There was no change in performance upon return from concussive injury suggesting that players appear to be acutely recovered from the respective concussion before returning to play. This suggests that current policies and management properly evaluate and treat concussed athletes of these professional sports. Strength of Recommendation: Grade C evidence exists that there is no change in individual game performance in professional collision-sport athletes before and after suffering a concussion.