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Jian Chen, Bruce Oddson and Heather C. Gilbert

Context: Symptom checklist in Sport Concussion Assessment Tool has been widely used in preseason assessment and in concussion diagnosis, but the impact of prior concussions on the graded symptoms after a new concussion has not been evaluated. Objective: This study was undertaken to examine reported symptoms associated with recurrent concussions using data of a comprehensive survey among athletes. Design: Retrospective survey and cross-sectional study. Setting: College athletes. Participants: Student athletes who sustained one or more concussions. Main Outcome Measures: Concussion history and graded symptoms of the most recent concussion at time of the survey were surveyed. The impact of prior concussions was examined over symptoms and aggregated symptoms. Results: Multiple concussions were associated with greater reporting of individual symptoms related to emotion and physical symptoms of sensitivity to light and noise: more emotional (z = 2.3, P = .02); sadness (z = 2.4, P = .02); nervousness (z = 2.4, P = .02); irritability (z = 3.6, P = .01); sensitivity to light (z = 2.6, P = .01); and sensitivity to noise (z = 2.4, P = .04). The composite scores of emotional symptom and sensitivity symptom clusters were significantly higher: t = 2.68 (P < .01) and t = 3.35 (P < .01), respectively. Conclusions: The significant rises in emotional and sensitivity symptoms may be an important additive effect of concussive injury. Closer attention should be given to these symptom clusters when evaluating concussion injury and recovery.

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Nick Dobbin, Jamie Highton, Samantha L. Moss and Craig Twist

Purpose: To assess whether a standardized testing battery can differentiate anthropometric and physical qualities between youth, academy, and senior rugby league players and determine the discriminant validity of the battery. Methods: A total of 729 rugby league players from multiple clubs in England categorized as youth (n = 235), academy (n = 362), and senior (n = 132) players completed a standardized testing battery that included the assessment of anthropometric and physical characteristics during preseason. Data were analyzed using magnitude-based inferences and discriminant analysis. Results: Academy players were most likely taller and heavier than youth players (effect size [ES] = 0.64–1.21), with possibly to most likely superior countermovement jump, medicine-ball throw, and prone Yo-Yo Intermittent Recovery Test Level 1 (Yo-Yo IR1) performance (ES = 0.23–1.00). Senior players were likely to most likely taller and heavier (ES = 0.32–1.84), with possibly to most likely superior 10- and 20-m sprint times, countermovement jump, change of direction, medicine-ball throw, and prone Yo-Yo IR1 than youth and academy players (ES = −0.60 to 2.06). The magnitude of difference appeared to be influenced by playing position. For the most part, the battery possessed discriminant validity with an accuracy of 72.2%. Conclusion: The standardized testing battery differentiates anthropometric and physical qualities of youth, academy, and senior players as a group and, in most instances, within positional groups. Furthermore, the battery is able to discriminate between playing standards with good accuracy and might be included in future assessments and rugby league talent identification.

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Francisco J. Amaro-Gahete, Lucas Jurado-Fasoli, Alejandro R. Triviño, Guillermo Sanchez-Delgado, Alejandro De-la-O, Jørn W. Helge and Jonatan R. Ruiz

Purpose: To analyze the diurnal variation of maximal fat oxidation (MFO) and the intensity that elicits MFO (Fatmax) in trained male athletes. Methods: A total of 12 endurance-trained male athletes age 24.7 (4.1) y participated in the study. The authors measured MFO, Fatmax, maximum oxygen uptake (VO2max), and VO2 percentage at ventilatory threshold 2 with a graded exercise protocol performed on 2 days separated by 1 wk. One test was performed in the morning and the other in the afternoon. The authors assessed the participants’ chronotype using the HÖME questionnaire. Results: MFO and Fatmax were greater in the afternoon than in the morning (Δ = 13%, P < .001 and Δ = 6%, P = .001, respectively), whereas there were similar VO2max and ventilatory threshold 2 in the morning, than in the afternoon test (Δ = 0.2%, P = .158 and Δ = 7%, P = .650, respectively). There was a strong positive association between VO2max and MFO in both morning and afternoon assessments (R 2 = .783, P = .001 and R 2 = .663, P < .001, respectively). Similarly, there was a positive association between VO2max and Fatmax in both morning and afternoon assessments (R 2 = .406, P = .024 and R 2 = .414, P = .026, respectively). Conclusion: MFO and Fatmax may partially explain some of the observed diurnal variation in the performance of endurance sports.

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Zachary McCarver, Shelby Anderson, Justine Vosloo and Sebastian Harenberg

The purpose of the present study was to explore diversity characteristics and experiences of discrimination in certified mental-performance consultants (CMPCs). The results of a questionnaire (N = 260) indicated that CMPCs remain a rather homogeneous population (>80% White, heterosexual, and able-bodied). Female and non-White consultants were significantly more likely to experience discrimination in the field. The findings indicate that minorities remain underrepresented among CMPCs. In addition, the profession is in need of interventional strategies to prevent experiences of discrimination in applied sport psychology.

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Sarah Edney, Tim Olds, Jillian Ryan, Ronald Plotnikoff, Corneel Vandelanotte, Rachel Curtis and Carol Maher

Background: Homophily is the tendency to associate with friends similar to ourselves. This study explored the effects of homophily on team formation in a physical activity challenge in which “captains” signed up their Facebook friends to form teams. Methods: This study assessed whether participants (n = 430) were more similar to their teammates than to nonteammates with regard to age, sex, education level, body mass index, self-reported and objectively measured physical activity, and negative emotional states; and whether captains were more similar to their own teammates than to nonteammates. Variability indices were calculated for each team, and a hypothetical variability index, representing that which would result from randomly assembled teams, was also calculated. Results: Within-team variability was less than that for random teams for all outcomes except education level and depression, with differences (SDs) ranging from +0.15 (self-reported physical activity) to +0.47 (age) (P < .001 to P = .001). Captains were similar to their teammates except in regard to age, with captains being 2.6 years younger (P = .003). Conclusions: Results support hypotheses that self-selected teams are likely to contain individuals with similar characteristics, highlighting potential to leverage team-based health interventions to target specific populations by instructing individuals with risk characteristics to form teams to help change behavior.

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; Wmax, 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.

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Francesco Campa, Federico Spiga and Stefania Toselli

Context: Poor functional movement patterns negatively affect the ability to perform fundamental movements with precision and efficiency, increasing injury risk in athletes. Objectives: To examine the effect of a 20-week corrective exercise program during the competitive season on functional movement patterns in youth elite male soccer players. Design: Cohort study. Setting: Team facilities. Participants: Sixty-five youth elite male soccer players (age: 15.89 [0.53] y; weight: 67.42 [6.78] kg; and stature: 175.20 [6.34] cm). Of the 4 teams, 2 were randomly selected to take part in the corrective program. Thus, the players were placed into 2 groups: corrective exercise program and control group. Intervention: Corrective exercise program. Main Outcome Measures: Functional Movement Screen (FMS) was used to assess the presence of dysfunctional, asymmetrical, and painful movements in the players before and after the intervention period. In addition to considering the FMS total score (FMStotal), we separated the screen into 3 parts: FMSmove, FMSflex, and FMSstab. A repeated-measures analysis of variance was conducted to determine the effectiveness of the training program on FMS scores. The chi-square test was performed to determine whether there were significant changes in the frequencies of asymmetric and dysfunctional movements after 20 weeks. Results: No athlete experienced severe injuries during the intervention period. There was a significant group by time interaction (P < .01) for FMStotal, FMSmove, and FMSstab, in which only the corrective exercise program increased their scores after the intervention period (P < .05). A chi-square analysis showed a significant (P < .05) decrease in asymmetric and dysfunctional movements at the follow-up in corrective exercise program, whereas these changes were not observed in the control group. Conclusions: Youth elite soccer players demonstrate a high prevalence of asymmetric movements during FMS testing, but their functional movement patterns can be improved during the competitive season following a specific corrective exercise program.

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.

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Yuri Alberto Freire, Geovani de Araújo Dantas de Macêdo, Rodrigo Alberto Vieira Browne, Luiz Fernando Farias-Junior, Ágnes Denise de Lima Bezerra, Ana Paula Trussardi Fayh, José Cazuza de Farias Júnior, Kevin F. Boreskie, Todd A. Duhamel and Eduardo Caldas Costa

Background: This study analyzed the effect of walking breaks or low-volume high-intensity interval exercise (LV-HIIE) on markers of metabolic syndrome relative to a day of prolonged sitting. Methods: Twenty-five adults with excess body fat participated in this crossover trial: (1) 10-hour sitting day (SIT), (2) LV-HIIE followed by a sitting day (EX+SIT), and (3) sitting day with 5-minute walking breaks for every 20 minutes (SIT+WB). Glucose and blood pressure (BP) were measured before and 1 hour after 4 meals and 2 hours after lunch. Triglycerides were measured at baseline, 2, and 3.5 hours after lunch. Generalized mixed models were used to identify differences in the area under the curve (AUC) of BP and incremental AUC (iAUC) of glucose and triglycerides among the sessions. Results: iAUC-glucose was lower in SIT+WB than SIT (β = −35.3 mg/dL·10 h; 95% confidence interval, −52.5 to −8.2). AUC-diastolic BP was lower in SIT+WB than SIT (β = −14.1 mm Hg·10 h; 95% confidence interval, −26.5 to −1.6) and EX+SIT (β = −14.5 mm Hg·10 h; 95% confidence interval, −26.9 to −2.1). There were no differences in triglycerides and systolic BP levels among the sessions. Conclusion: Adults with excess body fat present lower glucose and diastolic BP during a day with breaks in sitting time compared with a prolonged sitting day with or without an LV-HIIE session.

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.