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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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Brice T. Cleland and Sheila Schindler-Ivens

Background: Prior work indicates that pedaling-related brain activation is lower in people with stroke than in controls. We asked whether this observation could be explained by between-group differences in volitional motor commands and pedaling performance. Methods: Individuals with and without stroke performed passive and volitional pedaling while brain activation was recorded with functional magnetic resonance imaging. The passive condition eliminated motor commands to pedal and minimized between-group differences in pedaling performance. Volume, intensity, and laterality of brain activation were compared across conditions and groups. Results: There were no significant effects of condition and no Group × Condition interactions for any measure of brain activation. Only 53% of subjects could minimize muscle activity for passive pedaling. Conclusions: Altered motor commands and pedaling performance are unlikely to account for reduced pedaling-related brain activation poststroke. Instead, this phenomenon may be due to functional or structural brain changes. Passive pedaling can be difficult to achieve and may require inhibition of excitatory descending drive.

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Jenny H. Conviser, Amanda Schlitzer Tierney and Riley Nickols

It is estimated that 1.6 million people in the United States are currently diagnosed with an eating disorder. Eating disorders (EDs) have high rates of morbidity and mortality and remain the most severe mental illness. Unfortunately, rates of EDs and disordered eating behaviors (DEBs) among athletes appear to be increasing. In this study, authors summarize ED-related risks that pose compromises in psychological and social functioning, medical health, and overall quality of life. The importance of early detection and formal evaluation in preserving the athlete’s health, well-being and sustaining successful sport participation, and performance are highlighted. Athlete-specific factors, which challenge the ease and accuracy of ED detection and assessment, are noted. The recommended components of effective ED assessment are identified, including use of self-report measures and clinical interviews conducted by ED certified and licensed professionals. The importance of being well informed in tenets of ED awareness, prevention and supporting early detection, and referral for formal ED assessment are noted. Conclusions reflect the vital roles that both the multidisciplinary sport personnel and the sport environment/culture play in reducing the serious health risks of DEBs and EDs. Each is needed to protect an athlete’s well-being while fostering safe and successful sport participation.

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Laura K. Fewell, Riley Nickols, Amanda Schlitzer Tierney and Cheri A. Levinson

The current study tested if athlete patients differed from non-athlete patients in measures of eating disorder (ED) and related pathology. Athlete (n = 91 in Study 1; n = 39 in Study 2) and non-athlete (n = 76 in Study 1; n = 26 in Study 2) patients completed self-report measures, and body mass index (BMI) was calculated. Athlete patients had significantly lower ED symptomatology and depression than non-athlete patients (ps < .05). ED impairment, worry, psychosocial functioning, BMI, obsessive-compulsiveness, and compulsive exercise did not significantly differ between groups (ps > .08). Greater ED symptomatology was associated with higher psychosocial functioning among athlete patients and higher obsessive-compulsive symptoms and compulsive exercise among non-athlete patients. This is a novel study comparing ED symptomatology and related measures of mental health in athlete and non-athlete patients engaged in residential or partial hospitalization ED treatment. Future research should further investigate how participation in high-level sport impacts the presentation, treatment, and outcome of individuals with EDs.

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Jenny H. Conviser, Amanda Schlitzer Tierney and Riley Nickols

Eating disorders (EDs) and disordered-eating behaviors (DEBs), pose a high risk of morbidity and mortality, threatening physical health, emotional health, and overall quality of life. Unfortunately, among athletes, prevalence rates continue to increase. This document summarizes the challenges of establishing and navigating the multidisciplinary care needed to effectively treat EDs and DEBs among athletes. The benefits of timely and frequent communication within the multidisciplinary treatment team (MDTT) are emphasized and discussed. Authors advise who should be selected as members of the MDTT and suggest that all personnel, including athletic coaches, athletic trainers, physical therapists, and certified fitness professionals be ED-informed and ED-sensitive. Vital components of care are noted including use of a variety of evidence-based psychotherapeutic modalities, interventions which target emotional regulation, and prioritize values based compassionate care. Authors caution that performance decrements and medical/physiological changes are not always easily observable in individuals with EDs and DEBs and therefore, attuned, consistent, and ongoing monitoring is needed. Consensus regarding previously established parameters for return to play and careful titration of physical activity throughout the ED recovery process are suggested as important for preserving health, preventing re-injury, or relapse and facilitating successful return to sport participation.

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Laura K. Fewell, Riley Nickols, Amanda Schlitzer Tierney and Cheri A. Levinson

Understanding the unique needs of athletes who undergo eating disorder (ED) treatment is sorely needed. This study explores changes of strength and power in athlete (n = 21) and non-athlete (n = 36) patients from intake to discharge. Maximal oxygen consumption, vertical jump, push-ups, hand grip strength, and body mass index (in anorexia nervosa; AN) were measured among treatment center patients. The number of push-ups and hand grip strength were significantly improved upon discharge in the full sample (ps < .005) and in AN only (ps < .001). Body mass index was also significantly higher in AN (p < .001). Maximal oxygen consumption and vertical jump did not significantly improve between admission and discharge in either group (ps > .40). This study is the first to investigate measures of strength in athletes engaged in intensive eating disorder treatment and indicates the need to address the psychological mindset around physical activity using exercise education as part of a comprehensive program. Recommendations for incorporating exercise into an intensive ED treatment center are also provided.

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Ken Pitetti, Ruth Ann Miller and E. Michael Loovis

Male youth (8–18 years) with intellectual disability (ID) demonstrate motor proficiency below age-related competence capacities for typically developing youth. Whether below-criteria motor proficiency also exists for females with ID is not known. The purpose of this study was to determine if sex-specific differences exist in motor proficiency for youth with ID. The Bruininks-Oseretsky Test of Motor Proficiency was used to measure motor proficiency: six items for upper limb coordination, seven items for balance, and six items for bilateral coordination. One hundred and seventy-two (172) males and 85 females with ID but without Down syndrome were divided into five age groups for comparative purposes: 8–10, 11–12, 13–14, 15–16, and 17–21 years. Males scored sufficiently higher than females to suggest that sex data should not be combined to established Bruininks-Oseretsky Test of Motor Proficiency standards for upper limb coordination, balance, and bilateral coordination subtests.

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Zachary R. Weber, Divya Srinivasan and Julie N. Côté

The objectives of this study were to assess the sex-specific relationships between motor and sensory adaptations to repetitive arm motion–induced neck/shoulder fatigue, and to measure how additional sensory stimulation affects these adaptations. Twenty-three participants performed two sessions of a repetitive pointing task until scoring 8 on the Borg CR10 scale for neck/shoulder exertion or for a maximum of 45 min, with and without sensory stimulation (i.e., light touch) applied on the fatiguing shoulder. Just before reaching the task termination criteria, all participants showed changes in mean and variability of arm joint angles and experienced a fivefold increase in anterior deltoid sensory threshold in the stimulus-present condition. Women with the greatest increases in anterior deltoid sensory thresholds demonstrated the greatest increases in shoulder variability (r = .66), whereas men with the greatest increases in upper-trapezius sensory thresholds demonstrated the greatest changes in shoulder angle (r = −.60) and coordination (r = .65) variability. Thus, sensory stimulation had no influence on time to termination but affected how men and women differently adapted, suggesting sex differences in sensorimotor fatigue response mechanisms.

Open access

Karin Lobenius-Palmér, Birgitta Sjöqvist, Anita Hurtig-Wennlöf and Lars-Olov Lundqvist

This study compared accelerometer-assessed habitual physical activity (PA), sedentary time, and meeting PA recommendations among 102 youth with disabilities (7–20 years) in four subgroups—physical/visual impairments, intellectual disability, autism spectrum disorders, and hearing impairment—and 800 youth with typical development (8–16 years). Low proportions of youth with disabilities met PA recommendations, and they generally were less physically active and more sedentary than youth with typical development. The hearing impairment and autism spectrum disorder groups were the most and least physically active, respectively. Older age and to some extent female sex were related to less PA and more sedentary time. Considering the suboptimal levels of PA in youth with disabilities, effective interventions directed at factors associated with PA among them are needed.

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Kelly P. Arbour-Nicitopoulos, Viviane Grassmann, Krystn Orr, Amy C. McPherson, Guy E. Faulkner and F. Virginia Wright

The objective of this study was to comprehensively evaluate inclusive out-of-school time physical activity programs for children/youth with physical disabilities. A search of the published literature was conducted and augmented by international expertise. A quality appraisal was conducted; only studies with quality ratings ≥60% informed our best practice recommendations. Seventeen studies were included using qualitative (n = 9), quantitative (n = 5), or mixed (n = 3) designs. Programs had a diversity of age groups, group sizes, and durations. Most programs were recreational level, involving both genders. Rehabilitation staff were the most common leaders. Outcomes focused on social skills/relationships, physical skill development, and psychological well-being, with overall positive effects shown in these areas. The best practice recommendations are consistent with an abilities-based approach emphasizing common group goals and interests; cooperative activities; mastery-oriented, individualized instruction; and developmentally appropriate, challenging activities. Results indicate that inclusive out-of-school time physical activity programs are important for positive psychosocial and physical skill development of children/youth with physical disabilities.