Don Hellison (1938–2018) was a leader and trailblazer in sport and physical education pedagogy. Early in his career, he was an advocate for humanistic physical education. His engaged approach to scholarship culminated in the development of the Teaching Personal and Social Responsibility (TPSR) model, which is now recognized as a best practice for promoting social and emotional learning in physical education. The TPSR model has also been widely applied in the field of sport-based youth development. This is the introduction to the special issue devoted to Don’s life and legacy. It provides opening comments from the guest editors and a brief overview of the articles in the special issue.
Paul M. Wright and David Walsh
Jordan Bettleyon and Thomas W. Kaminski
Clinical Scenario: Low-level laser therapy (LLLT) is a controversial topic for its use in athletic recovery, mainly due to inconsistency in research regarding the application of LLLT. Articles on LLLT have assessed its effectiveness in untrained humans through pain scales, functional scales, and blood draws, and it has been found capable in nonathletic rehabilitative use. The controversy lies with LLLT in the recovering athlete. Not only do athletes need to perform at high levels, but each sport is unique in the metabolic demands placed on the athletes’ bodies. This modality can alter chemical mediators of the inflammatory process, specifically blood lactate (BL) and creatine kinase (CK). During soccer contests, it is a common problem for athletes to have an average CK level of 800 U/L and BL of 8 mmol·L, increasing delayed-onset muscle soreness and fatigue. Micro-CK level elevation is associated with cellular membrane damage, localized hypoxia, and electrolyte imbalances, hindering the recovery process. Clinical Question: Does LLLT decrease muscle-damaging mediators effecting player fatigue and delayed-onset muscle soreness after performance in soccer athletes versus sham treatment? Summary of Key Findings: In 3 studies, preperformance, postperformance, or preperformance and postperformance LLLT was performed and evaluated BL (2 of 3) and CK (2 of 3). In each article, BL and CK showed a significant decrease (P < .05) when performed either preperformance or postperformance versus the control group. The greatest decrease in these mediators was noticed when postperformance laser therapy was performed. Clinical Bottom Line: LLLT at 10, 30, or 50 J performed at a minimum of 2 locations on the rectus femoris, vastus lateralis, and vastus medialis bilaterally for 10 seconds each is significant in decreasing blood serum levels of BL and CK when performed postexercise. Strength of Recommendations: All 3 articles obtained a Physiotherapy Evidence Database score of ≥8/10.
Xin He, Hio Teng Leong, On Yue Lau, Michael Tim-Yun Ong and Patrick Shu-Hang Yung
Context: Altered lower-limb biomechanics have been observed during landing task in patients with anterior cruciate ligament reconstruction (ACLR), which increases the risk of secondary anterior cruciate ligament injury. However, the alteration in neuromuscular activity of the lower-extremity during landing task is not clear. Objective: To compare the muscle activity pattern assessed by electromyography between the involved limb of patients with ACLR and the contralateral limb or control limb of matched healthy subjects during landing task. Evidence Acquisition: Database of PubMed, Ovid, Scopus, and Web of Science from the inception of the databases until July 2019, using a combination of keywords and their variations: (anterior cruciate ligament OR ACL) AND (electromyography OR EMG) AND (landing OR land). Studies that assessed lower-extremity muscle activity patterns during landing task in patients with ACLR and compared them either with the contralateral side or healthy controls were included. Evidence Synthesis: Of the 21 studies, 16 studies reported altered muscle activity pattern during landing tasks when compared with either the healthy controls or the contralateral side. For the specific muscle activity patterns, the majority of the studies showed no significant difference in reactive muscle activity, and comparisons across studies revealed a possible trend toward the early onset of quadriceps and hamstring activity and increased cocontraction of the involved limb. There are inconsistent findings regarding the alteration in muscle timing and preparatory muscle activity. Conclusions: Patients with ACLR displayed an altered muscle activity pattern during landing tasks, even though they were considered to be capable for sport return. Nevertheless, a firm conclusion could not be drawn due to great heterogeneity in the subject selection and study methods.
Christopher J. Burcal, Sunghoon Chung, Madison L. Johnston and Adam B. Rosen
Background: Region-specific patient-reported outcomes (PROs) are commonly used in rehabilitation medicine. Digital versions of PROs may be implemented into electronic medical records and are also commonly used in research, but the validity of this method of administration (MOA) must be established. Purpose: To determine the agreement between and compare the test–retest reliability of a paper version (FAAM-P) and digital version (FAAM-D) of the Foot and Ankle Ability Measure (FAAM). Study Design: Randomized, nonblinded, crossover observational study. Methods: A total of 90 adults were randomized to complete the FAAM-P or FAAM-D first, and then completed the second MOA (first day [D1]). The FAAM-D was a digital adaptation of both FAAM-P subscales on Qualtrics. Identical test procedures were completed 1 week later (D2). Data were removed if a participant scored 100% on both MOA, reported injury between D1 and D2, or did not complete both MOA. Agreement was assessed on 46 participants between the 2 MOA using intraclass correlation coefficients (ICC) at D1. There was good-to-excellent test–retest reliability for the FAAM activities of daily living. Results: The authors observed good agreement between the FAAM-P and FAAM-D for the activities of daily living (ICC = .88) and sport scales (ICC = .87). Test–retest reliability was good-to-excellent for the FAAM activities of daily living (FAAM-P: ICC = .87; FAAM-D: ICC = .89) and sport (FAAM-P: ICC = .71; FAAM-D: ICC = .91). Conclusions: The MOA does not appear to affect the responses on the FAAM; however, the authors observed slightly higher reliability on the FAAM-D. The FAAM-D is sufficient to be used for generating practice-based evidence in rehabilitation medicine.
Jillian J. Haszard, Kim Meredith-Jones, Victoria Farmer, Sheila Williams, Barbara Galland and Rachael Taylor
Although 24-hour time-use data are increasingly being examined in relation to indices of health, consensus has yet to be reached about the best way to present estimates from compositional analyses. This analysis explored the impact of different presentations of results when assessing the relationship between 24-hour time-use and body mass index (BMI) z-score using compositional analysis of 5-day actigraphy data in 742 children. First it was found that reallocating non-wear time to day-time components only (sedentary behavior, light physical activity, and moderate-to-vigorous physical activity [MVPA]) before normalization to 24 hours provided stronger estimates with BMI z-score than simply removing non-wear time before normalization. Estimates for sleep time were substantially affected, where associations with BMI z-score nearly doubled (mean difference [95% CI] in BMI z-score for 10% longer sleep were −0.20 [−0.32, −0.08] compared to −0.11 [−0.23, 0.002]). Presenting estimates in terms of a greater number of minutes in a component, relative to all others, showed MVPA to be the strongest predictor of BMI z-score, while estimates in terms of the proportion of minutes showed sleep to be the strongest predictor. Both presentations have value. However, presentations in terms of one-to-one “substitutions” of time may need careful interpretation due to the uneven distribution of time in each component. In conclusion, when analyzing relationships between 24-hour time-use and health outcomes, non-wear time and presentation of estimates can impact final conclusions. As a result, the current understanding of the importance of sleep for child health may be underestimated.
Stephanie Field, Jeff Crane, Patti-Jean Naylor and Viviene Temple
Children who underestimate their physical abilities have lower motivation, higher anxiety, and lack of understanding as to why they may be succeeding or struggling in sports settings, which can result in withdrawal from physical activities. Theoretically, middle childhood is a time when perceptions of physical competence (PPC) become more accurate as children develop the cognitive capacity to interpret new sources of feedback and develop a realistic sense of their physical abilities. The purpose of this study was to investigate the extent to which accuracy of PPC changed from grade 2 to grade 4. Participants were 238 boys and girls (M age = 7.8 yrs) from eight participating elementary schools in Victoria, British Columbia, Canada. The Test of Gross Motor Development–Second Edition was used to assess motor skills. PPC were assessed using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (for grade 2) and the Self-Perception Profile for Children (for grades 3 and 4). Results revealed that participants who underestimated or overestimated their physical competence in grade 2 saw an improvement in accuracy, and, by grade 4, had similar accuracy scores to their peers who were considered ‘accurate’ estimators. These results reinforce theory that suggests PPC become more accurate in middle childhood.
Mayrena I. Hernandez, Kevin M. Biese, Dan A. Schaefer, Eric G. Post, David R. Bell and M. Alison Brooks
Context: Sport specialization among youth athletes has been associated with increased risk of overuse injuries. Previous research demonstrates that children perceive specialization to be beneficial in making their high school team and receiving athletic college scholarships. Previous research demonstrates that parents play a significant role in their child’s sport experience. However, it is unknown if parents and children answer questions related to specialization factors in a similar manner. Objective: To evaluate the beliefs of youth athletes and parents on factors related to sport specialization and evaluate the level of agreement between dyads on sports specialization. Design: Cross-sectional. Setting: Online and paper surveys. Patients or Other Participants: Aim 1: 1998 participants (993 children and 1005 parents). Aim 2: 77 paired parent–child dyads. Interventions: Self-administered survey. Main Outcome Measures: The responses were summarized via frequency and proportions (%). Chi-squares were calculated between parent and child responses. Kappa coefficients were calculated for dyads to determine level of agreement. Sport specialization was classified using a common 3-point scale. Results: The parents were more concerned about risk of injury in sports compared with children (P < .001, χ2 = 231.4; parent: extremely: 7.1%; child: extremely: 3.7%). However, children were more likely to believe that specialization was associated with their chances of obtaining an athletic college scholarship compared with parents (P < .001, χ2 = 201.6; parent: very/extremely likely: 13.7%; child: very/extremely likely: 15.8%). Dyad subanalysis indicated a moderate level of agreement for “quitting other sports to focus on one sport” (κ = .50) and a low level of agreement for “identifying a primary sport” (κ = .30) and “training >8 months per year in primary sport” (κ = .32). Conclusions: Parents and youth athletes had differing beliefs on the factors related to sport specialization. Dyad analysis shows that parents and children answer sport specialization classification questions differently. Health care providers should be aware of these differences, and messaging should be individualized to the audience.
Theodore Kent Kessinger, Bridget Melton, Theresa Miyashita and Greg Ryan
Clinical Scenario: Manipulation of exercise variables in resistance training (RT) is an important component in the development of muscular strength, power, and hypertrophy. Currently, most research centers on untrained or recreationally trained subjects. This critically appraised topic focuses on studies that center on the well-trained subject with regard to frequency of training. Clinical Question: In well-trained male subjects, is there an association between RT frequency and the development of muscular strength and hypertrophy? Summary of Key Findings: Four studies met the inclusion criteria and were included for analysis. All studies showed that lower-frequency training could elicit muscular strength and hypertrophy increases. One study suggested that a higher frequency compared with a lower frequency may provide a slight benefit to hypertrophic development. One study reported a greater level of delayed onset muscle soreness with lower frequency training. The 4 studies demonstrate support for the clinical question. Clinical Bottom Line: Current evidence suggests that lower-frequency RT produces equal to greater improvements on muscular strength and hypertrophy in comparison to higher-frequency RT when volume is equated. The evidence is particularly convincing when lower-frequency RT is associated with a total-body training protocol in well-trained male subjects. Strength of Recommendation: There is moderate-to-strong evidence to suggest that lower-frequency RT, when volume is equated, will produce equal to greater improvements on muscular strength and hypertrophy in comparison to higher-frequency RT.
Mustafa Sarkar and Nathan K. Hilton
Although there is burgeoning research on resilience in elite athletes, there has been no empirical investigation of resilience in elite coaches. The purpose of this study was to explore psychological resilience in world-class coaches and how they develop resilience in athletes. A longitudinal qualitative design was adopted due to the dynamic and temporal nature of resilience. Five Olympic medal–winning coaches (four males and one female) were interviewed twice over a 12-month swimming season. Reflexive thematic analysis was employed to analyze the data. Findings revealed 14 higher order themes, which were categorized into the following three general dimensions: coach stressors (managing the Olympic environment, preparation for major events, coach personal well-being, directing an organization); coach protective factors (progressive coaching, coaching support network, maintaining work/life balance, secure working environment, durable motivation, effective decision making); and enhancing resilience in athletes (developing a strong coach–athlete relationship, creating a facilitative environment, developing a resilience process, athlete individual factors). The results are presented to demonstrate the interplay between coach stressors and protective factors over time, which offers an original and significant contribution to the resilience literature by providing a unique insight into the dynamic and temporal nature of resilience in Olympic medal–winning coaches.