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Ryota Ashizawa, Kazuma Yamashita, Koki Take, Kengo Okawara, Eri Mochizuki, Asuka Sakamoto, and Yoshinobu Yoshimoto

The purpose of this single-masked randomized clinical trial was to examine whether nonleisure-time physical activity guidance (NLTPAG) improves physical activity levels in patients after minor ischemic stroke. Patients who had been hospitalized for minor ischemic stroke in an acute care hospital (National Health Institute Stroke Scale ≤ 5) were randomized to either an NLTPAG group (n = 17) or a leisure-time physical activity guidance group (n = 16). NLTPAG focused on reducing sedentary behavior and increasing the frequency of walking for shopping and household activities to improve physical activity levels in daily life. Physical activity levels significantly improved only in participants in the NLTPAG group (initial assessment: metabolic equivalents of task = 12.6; final assessment: metabolic equivalents of task = 14.8; p = .035, r = .51). These results suggest that NLTPAG may be effective for improving physical activity levels in patients after minor ischemic stroke.

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T.N. Kirk, Justin A. Haegele, and Xihe Zhu

The purpose of this inquiry was to examine the relationship between barriers to physical activity, expectancy-value variables, and physical activity engagement among adults with visual impairments. Using a descriptive correlational approach, a sample of 214 adults with visual impairments (M age = 43.14, SD = 13.67) completed questionnaires pertaining to barriers to physical activity, expectancy-value beliefs about physical activity, and physical activity engagement. Data were analyzed via correlation and hierarchical regression. The final regression model explained 20.30% of variance in physical activity (p < .001). Intrinsic value (β = 0.26, p = .01) and expectancy beliefs (β = 0.33, p < .001) each emerged as significant predictors of physical activity engagement, which suggests that expectancy-value theory may have some utility for investigating the physical activity engagement of individuals with visual impairments. However, the lack of significant contribution of other variables such as attainment and utility values, as well as barriers factors, underscores the need for additional research in this area.

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Samuel C. Fischer, Darren Q. Calley, and John H. Hollman

Clinical Scenario : Low back pain is a common condition for the general population with 29% of adults having low back pain within the last 3 months. A deadlift is described as a free weight exercise in which a barbell is lifted from the floor in a continuous motion by extending the knees and hips. For those without low back pain, the deadlift was found to have the highest muscle activation of paraspinal musculature compared with other exercises. There are a limited number of studies that investigate the usefulness of incorporating deadlifts as part of a rehabilitation program for low back pain. Clinical Question: For those who live with low back pain, is an exercise routine that includes a deadlift a viable treatment option to improve pain and/or function? Summary of Key Findings: The literature search yielded 3 total studies meeting the inclusion and exclusion criteria: 1 randomized control trial, 1 secondary analysis of a randomized control trial, and 1 cohort study. Exercise programs that include deadlifts can yield improvements in both pain and function for those living with low back pain but were not found to be more beneficial than low load motor control exercises. Those with lower pain levels and higher baseline lumbar extension strength may be most appropriate to participate in an exercise program that includes deadlifts. Further research is needed to compare exercise programs that include deadlifts to other interventions for those living with low back pain. Clinical Bottom Line: There is minimal evidence that exercise programs that included deadlifts are a clinically effective option for the treatment of low back pain for both pain scores and functional outcome measures. Strength of Recommendation: Level B evidence exists that exercise programs that include deadlifts are a clinically effective option for the treatment of low back pain for both pain scores and functional outcome measures.

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Scott Benson Street, Matthew Rawlins, and Jason Miller

Clinical Scenario: Ankle fractures are a frequent occurrence, and they carry the potential for syndesmosis injury. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Presently, the gold standard for treating an ankle syndesmosis injury is to insert a metallic screw through the fibula and into the tibia. This technique requires a second intervention to remove the hardware, but also carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope, has gained popularity in treating ankle syndesmosis injuries. The TightRope involves inserting Fiberwire® through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. Clinical Question: In patients suffering from ankle syndesmosis injuries, is the Tightrope ankle syndesmosis fixation system more effective than conventional screw fixation at improving return to work, pain, and patient-reported outcome measures? Summary of Key Findings: Five studies were selected to be critically appraised. The PEDro checklist was used to score 2 randomized control trials, and the Downs & Black checklist was used to score the cohort study on methodology and consistency. Two systematic reviews were also appraised. All 5 articles demonstrated support for using the TightRope fixation. Clinical Bottom Line: There is moderate evidence to support the use of the TightRope syndesmosis fixation system, as it provides both clinician- and patient-reported outcomes that are similar to those using the conventional metallic screw, with a shortened time to recover and return to activity. Strength of Recommendation: Grade A evidence exists in support of using the TightRope fixation system in place of the metallic screw following ankle syndesmosis injury.

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Tomoko Aoki and Koji Kadota

The present study examined the effects of daily activities of the hands on finger motor function in older adults. Maximum tapping frequency with each finger during single-finger tapping and alternate movements of index–middle, middle–ring, and ring–little finger pairs during double-finger tapping were compared between older adults who used their hands actively in their daily lives and those who did not. The active participants had significantly faster tapping rates for the ring finger in the single-finger tapping and the middle–ring finger pair in the double-finger tapping than did the inactive participants. Thus, daily activity of the hands in older adults could be effective at preventing the loss of dynamic motor function in individual fingers, especially with greater difficulty in movement, resulting from the degeneration with age.

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Alexandre Nehring, Thiago Teixeira Serafim, Elisa Raulino Silva, Fábio Sprada de Menezes, Nicola Maffulli, Luciana Sayuri Sanada, and Rodrigo Okubo

Context: Myofascial self-release is performed using a roller to exert pressure on the soft tissues and to promote effects similar to those of traditional massage. However, there is no standardization regarding its application, mainly in relation to time. Objective: To evaluate the effects of myofascial self-release with a rigid roller on range of motion (ROM), pressure pain threshold (PPT), and hamstring strength in asymptomatic individuals following 2 different times of intervention. Design: Randomized, controlled, blind, clinical trial comparing preintervention and immediately postintervention within 2 groups. Setting: Institutional physiotherapy clinic. Participants: A total of 40 university students (18–30 y), who had no symptoms, participated. Intervention: Foam roller for 30 seconds and 2 minutes for group 2. Main Outcome Measures: Hamstring PPT, knee-extension ROM, and peak knee-flexion torque measured before and immediately after the intervention. Results: Both groups experienced a statistically significant increase in ROM compared with baseline (30 s and 2 min for group 2 P < .024). There were no statistically significant differences comparing peak knee-flexion torque or PPT. Conclusions: Hamstring myofascial self-release using a roller for 30 seconds or 2 minutes produced an increase in ROM in healthy individuals. PPT and peak knee-flexion isometric torque showed no effects.

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Gemma N. Parry, Lee C. Herrington, Ian G. Horsley, and Ian Gatt

Context: Maximal power describes the ability to immediately produce power with the maximal velocity at the point of release, impact, and/or take off—the greater an athlete’s ability to produce maximal power, the greater the improvement of athletic performance. In reference to boxing performance, regular consistent production of high muscular power during punching is considered an essential prerequisite. Despite the importance of upper limb power to athletic performance, presently, there is no gold standard test for upper limb force development performance. Objective: To investigate the test–retest reliability of the force plate–derived measures of countermovement push-up in elite boxers. Design: Test–retest design. Setting: High Performance Olympic Training Center. Participants: Eighteen elite Olympic boxers (age = 23 [3] y; height = 1.68 [0.39] m; body mass = 70.0 [17] kg). Intervention: Participants performed 5 repetitions of countermovement push-up trials on FD4000 Forcedeck dual force platforms on 2 separate test occasions 7 days apart. Main Outcome Measures: Peak force, mean force, flight time, rate of force development, impulse, and vertical stiffness of the bilateral and unilateral limbs from the force–time curve. Results: No significant differences between the 2 trial occasions for any of the derived bilateral or unilateral performance measures. Intraclass correlation coefficients indicated moderate to high reliability for performance parameters (intraclass correlation coefficients = .68–.98) and low coefficient of variation (3%–10%) apart from vertical stiffness (coefficient of variation = 16.5%–25%). Mean force demonstrated the greatest reliability (coefficient of variation = 3%). In contrast, no significant differences (P < .001) were noted between left and right limbs (P = .005–.791), or between orthodox or southpaw boxing styles (P = .19–.95). Conclusion: Force platform–derived kinetic bilateral and unilateral parameters of countermovement push-up are reliable measures of upper limb power performance in elite-level boxers; results suggest unilateral differences within the bilateral condition are not the norm for an elite boxing cohort.

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Nilüfer Kablan, Nuray Alaca, and Yaşar Tatar

Context: Fast and adequate recovery after exercise and activity is important for increasing performance and preventing injuries. Inadequate recovery usually causes changes in the biomechanical and viscoelastic properties of the muscle. Objective: To compare the immediate effect of petrissage massage (PM) and manual lymph drainage (MLD) following submaximal exercise on the biomechanical and viscoelastic properties of the rectus femoris muscle in healthy women. Design: Cross-sectional, repeated-measures. Setting: Marmara University. Participants: 18 healthy female students. Intervention(s): Following the submaximal quadriceps strengthening exercise performed in 3 sets of 8 repetitions with intensity of 75% of 1 maximum repetition, participants’ right leg received a 5-minute PM (PM group) and the contralateral leg received a 5-minute MLD application (MLD group). Main Outcome Measures: Skin temperature was measured using P45 thermographic thermal camera (Flir System; ThermaCAM, Danderyd, Sweden), and muscle tone, biomechanical, and viscoelastic features were measured with a myometer (Myoton AS, Tallinn, Estonia) at baseline, immediately postexercise, post-PM/MLD application, and 10 minutes postexercise. Results: In the PM group, the tonus (P = .002) and stiffness (P < .001) values measured after the massage and at the end of the 10-minute resting period were found to be statistically different than those measured right after the exercise (P < .05). Relaxation time and creep values at all measurement times were significantly different (P < .05). In the MLD group, it was observed the tonus (P < .001), stiffness (P = .025), and relaxation time (P < .01) values decreased significantly after the MLD compared with the values measured after the exercise; however, the creep value was found to be significantly different in all measurements (P < .05). Conclusion: PM and MLD reduce passive tissue stiffness and improve the extent of muscle extensibility over time against the muscle tensile strength. PM and MLD are therapeutic methods that can be used to support tissue recovery after exercise and prevent injuries.

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Matías Henríquez, Aitor Iturricastillo, Arturo González-Olguín, Felipe Herrera, Sonny Riquelme, and Raul Reina

This study compared physical performance in a group of international cerebral palsy football players during two formats of small-sided games (SSGs) and performance in a simulated game (SG) according to players’ sport classes (FT1, FT2, and FT3). Internal load (heart rate and rating of perceived exertion) and external load (total distance, distance covered at different velocities, maximum speed reached, acceleration, and deceleration) were obtained with global positioning system devices during two formats of SSGs (2-a-side/SSG2 and 4-a-side/SSG4) and an SG (7-a-side). SSG2 demands faster actions compared with SSG4/SG, and significant differences and large effect sizes were found in the distance covered in Speed Zones 5 (16.0−17.9 km/hr) and 6 (>18.0 km/hr; p < .05; .35<ηp2<.50, large). Lower moderate accelerations and decelerations per minute in SSG4/SG compared with SSG2 were also found (p < .01; .77<ηp2<.81, large). In the SSG2 task, the FT3 players reached maximum speeds, covered more distance at the highest intensities, and performed more moderate/high accelerations/decelerations and more sprints compared with FT1 and FT2 players (p < .05; −0.85 < d g < −4.64, large). The SSG2 task could be the best option for discriminating physical demands in important variables for cerebral palsy football performance between classes FT3 versus FT1/FT2.