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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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Joseph O.C. Coyne, Aaron J. Coutts, Robert U. Newton, and G. Gregory Haff

Purpose: To investigate the relationships between internal and external training load (TL) metrics with elite international women’s basketball performance. Methods: Sessional ratings of perceived exertion, PlayerLoad/minute, and training duration were collected from 13 elite international-level female basketball athletes (age 29.0 [3.7] y, stature 186.0 [9.8] cm, body mass 77.9 [11.6] kg) during the 18 weeks prior to the International Basketball Federation Olympic qualifying event for the 2016 Rio Olympic Games. Training stress balance, differential load, and the training efficiency index were calculated with 3 different smoothing methods. These TL metrics and their change in the last 21 days prior to competition were examined for their relationship to competition performance as coach ratings of performance. Results: For a number of TL variables, there were consistent significant small to moderate correlations with performance and significant small to large differences between successful and unsuccessful performances. However, these differences were only evident for external TL when using exponentially weighted moving averages to calculate TL. The variable that seemed most sensitive to performance was the change in training efficiency index in the last 21 days prior to competition (performance r = .47–.56, P < .001 and difference between successful and unsuccessful performance P < .001, f2 = 0.305–0.431). Conclusions: Internal and external TL variables were correlated with performance and distinguished between successful and unsuccessful performances among the same players during international women’s basketball games. Manipulating TL in the last 3 weeks prior to competition may be worthwhile for basketball players’ performance, especially in internal TL.

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Anis Aloulou, Francois Duforez, Damien Léger, Quentin De Larochelambert, and Mathieu Nedelec

Purpose: To evaluate the effects of sporting activities, training loads, and athletes’ characteristics on sleep among high-level adolescent athletes, in a controlled training and academic environment. Methods: A total of 128 high-level adolescent athletes (age = 15.2 [2.0] y), across 9 different sports, completed common sleep questionnaires and were monitored daily (7.3 [2.7] d) during a typical in-season training period. Sleep was analyzed using actigraphy and sleep diaries, whereas training load was evaluated using the session rating of perceived exertion, and muscle soreness and general fatigue were reported with the aid of visual analog scales. Separate linear mixed-effects models were fitted, including the athlete as a random effect and the following variables as fixed effects: the sport practiced (categorical predictor), daily training load, age, and sex. Different models were used to compare sleep variables among sports and to assess the influence of training load, age, and sex. Results: The mean total sleep time was 7.1 (0.7) hours. Swimmers presented increased sleep fragmentation, training loads, perceived muscle soreness, and general fatigue compared with athletes who engaged in other sports. Independent of any sport-specific effects, a higher daily training load induced an earlier bedtime and reduced total sleep time and perceived sleep quality, with higher sleep fragmentation. Moreover, female athletes experienced increased total sleep time and worse sleep quality in response to stress compared with those in males. Conclusion: In a controlled training and academic environment, high-level adolescent athletes did not achieve the recommended sleep duration. Impaired sleep quality and quantity could be partially explained by increased training loads.

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Xiang Yao, Christopher Curtis, Anthony Turner, Chris Bishop, Alex Austerberry, and Shyam Chavda

Rugby union (RU) is a field-based team sport with a large number of high-intensity actions such as sprinting, change of direction, tackling, scrummaging, rucking, and mauling. Competitive success in female RU has previously been related to anthropometric and physical characteristics, and with the recent introduction of professionalism in female rugby, characterizing such physical attributes may provide insight into selection and training processes. Purpose: To identify anthropometric and physical characteristics of competitive female RU players and differences between playing positions. Methods: Twenty-two players were recruited from the top tier of female RU in the United Kingdom during the 2018–2019 Premiership season. Players were split into forwards and backs and underwent body composition testing via dual-X-ray absorptiometry and physical characteristic tests (10- and 20-m speed, 1-repetition-maximum bench press and squat, countermovement jump, drop jump, isometric midthigh pull, and 1200-m shuttle). Results: Moderate to large significant differences between playing positions in both anthropometric and physical characteristics were found (P < .01). Forwards displayed greater body mass (P = .03), fat mass (P = .01), and absolute upper-body strength (P = .03), whereas backs demonstrated superior countermovement jump height (P = .01), drop jump height (P = .01), greater reactive strength (P = .03), and speed (P = .03). Conclusion: These findings provide practitioners with a greater understanding of anthropometric and physical characteristics of professional female RU players.

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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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Manuel Matzka, Christoph Zinner, Philipp Kunz, Hans-Christer Holmberg, and Billy Sperlich

Purpose: (1) To compare various physiological indicators of performance during a 5 × 1500-m incremental kayak test performed on an ergometer and on-water and (2) to analyze the relationships between these indicators and the actual competition performance of elite sprint kayakers, aiming to provide information to coaches for evaluating and planning training on-water. Methods: A total of 14 male and female German elite sprint kayakers performed an incremental test both on an ergometer and on-water. The tissue saturation index of the musculus (m.) biceps brachii, oxygen consumption, ratings of perceived exertion, and levels of blood lactate were measured and compared with actual racing times. In addition, power output was monitored during ergometer testing only. Results: Oxygen consumption during the fourth (P = .02; d = 0.32) and final (fifth; P < .001; d = 0.32) steps of incremental testing was higher on-water than on the ergometer. The tissue saturation index of the m. biceps brachii was approximately 21% higher at the end of the ergometer test (P = .002; d = 1.14). During the second (P = .01; d = 0.78), third (P = .005; d = 0.93), and fourth stages (P = .005; d = 1.02), the ratings of perceived exertion for ergometer kayaking was higher. During the final step, power output was most closely correlated to 200- (r = .88), 500- (r = .93), and 1000-m (r = .86) racing times (all Ps < .01). Conclusions: During high-intensity kayaking on an ergometer or on-water, the oxygen consumption and tissue saturation index of the m. biceps brachii differ. Furthermore, at moderate to submaximal intensities, the ratings of perceived exertion were higher for ergometer than for on-water kayaking. Finally, of all parameters assessed, the power output during ergometer kayaking exhibited the strongest correlation with actual racing performance.

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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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Bethany Northeast and Tom Clifford

This systematic review and meta-analysis examined the effects of creatine supplementation on recovery from exercise-induced muscle damage, and is reported according to the PRISMA guidelines. MEDLINE and SPORTDiscus were searched for articles from inception until April 2020. Inclusion criteria were adult participants (≥18 years); creatine provided before and/or after exercise versus a noncreatine comparator; measurement of muscle function recovery, muscle soreness, inflammation, myocellular protein efflux, oxidative stress; range of motion; randomized controlled trials in humans. Thirteen studies (totaling 278 participants; 235 males and 43 females; age range 20–60 years) were deemed eligible for analysis. Data extraction was performed independently by both authors. The Cochrane Collaboration Risk of Bias Tool was used to critically appraise the studies; forest plots were generated with random-effects model and standardized mean differences. Creatine supplementation did not alter muscle strength, muscle soreness, range of motion, or inflammation at each of the five follow-up times after exercise (<30 min, 24, 48, 72, and 96 hr; p > .05). Creatine attenuated creatine kinase activity at 48-hr postexercise (standardized mean difference: −1.06; 95% confidence interval [−1.97, −0.14]; p = .02) but at no other time points. High (I2; >75%) and significant (Chi2; p < .01) heterogeneity was identified for all outcome measures at various follow-up times. In conclusion, creatine supplementation does not accelerate recovery following exercise-induced muscle damage; however, well-controlled studies with higher sample sizes are warranted to verify these conclusions. Systematic review registration (PROSPERO CRD42020178735).

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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.