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Robert S. Thiebaud, Takashi Abe, Jeremy P. Loenneke, Tyler Garcia, Yohan Shirazi and Ross McArthur

Context: Blood flow restriction (BFR) increases muscle size and strength when combined with low loads, but various methods are used to produce this stimulus. It is unclear how using elastic knee wraps can impact acute muscular responses compared with using nylon cuffs, where the pressure can be standardized. Objective: Investigate how elastic knee wraps compare with nylon cuffs and high-load (HL)/low-load (LL) resistance exercise. Design: A randomized cross-over experimental design using 6 conditions combined with unilateral knee extension. Setting: Human Performance Laboratory. Participants: A total of 9 healthy participants (males = 7 and females = 2) and had an average age of 22 (4) years. Intervention: LL (30% of 1-repetition maximum [1-RM]), HL (70% 1-RM), BFR at 40% of arterial occlusion pressure (BFR-LOW), BFR at 80% of arterial occlusion pressure (BFR-HIGH), elastic knee wraps stretched by 2 in (PRACTICAL-LOW), and elastic knee wraps stretched to a new length equivalent to 85% of thigh circumference (PRACTICAL-HIGH). BFR and practical conditions used 30% 1-RM. Main Outcome Measures: Muscle thickness, maximum voluntary isometric contraction, and electromyography amplitude. Bayesian statistics evaluated differences in changes between conditions using the Bayes factor (BF10), and median and 95% credible intervals were reported from the posterior distribution. Results: Total repetitions completed were greater for BFR-LOW versus PRACTICAL-HIGH (BF10 = 3.2, 48.6 vs 44 repetitions) and greater for PRACTICAL-LOW versus BFR-HIGH (BF10 = 717, 51.8 vs 36.3 repetitions). Greater decreases in changes in maximum voluntary isometric contraction were found in PRACTICAL-HIGH versus HL (BF10 = 1035, ∼103 N) and LL (BF10 = 45, ∼66 N). No differences in changes in muscle thickness were found between LL versus PRACTICAL-LOW/PRACTICAL-HIGH conditions (BF10 = 0.32). Greater changes in electromyography amplitude were also found for BFR-LOW versus PRACTICAL-HIGH condition (BF10 = 6.13, ∼12%), but no differences were noted between the other BFR conditions. Conclusions: Overall, elastic knee wraps produce a more fatiguing stimulus than LL or HL conditions and might be used as an alternative to pneumatic cuffs that are traditionally used for BFR exercise.

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Karen McCormack

Women’s experiences in largely male sporting worlds often include marginalization and patronizing attitudes that can make participants unwelcome. Yet some women describe positive, liberating experiences in these sports. How do these women negotiate a largely male sport? What strategies do they employ to craft supportive communities? Based on interviews with 60 mountain bikers and email correspondence with an additional 98 bikers, along with results from a global survey of over 2,300 bikers, this paper examines women’s strategies for creating communities in which they can fully participate. The research uncovers the important role of communication technologies. While media practices can promote the celebration of risk-taking and aggression, they also provide a platform for talking back and building an alternative, supportive community.

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Brian W. Wiese, Kevin Miller and Eduardo Godoy

A 19-year-old African-American male Division I collegiate American football player with no prior history of shoulder injury presented with right shoulder pain after making a tackle during a game. He was initially diagnosed with a rotator cuff strain with potential underlying labral pathology. Subsequent magnetic resonance imaging arthrogram showed no labral tearing, though a Buford complex was identified. A Buford complex is a normal anatomical labral variant where the anterior labrum is absent and the middle glenohumeral ligament is “cord-like” in structure. This case was managed conservatively since surgical intervention is only recommended if there is a secondary pathology to the shoulder (e.g., type II superior labrum anterior to posterior [SLAP] lesions). Clinicians should be aware of Buford complexes because they can predispose athletes to secondary injuries and can be managed successfully with a conservative rehabilitation approach in the absence of secondary pathology.

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Devajyoti Deka

This research examined the effect of pre–post differences in walking duration, health, and weight on retirees’ long-term quality of life (QoL). It used data from a 2018 randomized mail survey of 483 suburban New Jersey retirees. Ordinary least squares and three-stage least squares models were used. The analysis showed that changes in walking duration during the first 2 years of retirement are directly associated with health change, health change has an effect on long-term QoL, and weight variation of 10 lb or more has an effect on health change and long-term QoL. Although QoL peaks for the sample of retirees at around age 75, people whose average walking duration increased, health improved, and weight did not increase substantially after retirement continued to experience high QoL for a longer time. The results show that people can achieve high long-term QoL by choosing an active lifestyle when transitioning to retirement.

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Timothy A. Kulpa, Jamie Mansell, Anne Russ and Ryan Tierney

Context: Patients who do not fully recover from a concussion in 7–14 days may require an impairment-based rehabilitation program. Recent evidence indicates improved outcomes with active rehabilitation compared to passive physical and cognitive rest. Clinical Question: In patients with persistent symptoms (greater than 4 weeks) following concussion, how does aerobic exercise affect postconcussion symptoms? Clinical Bottom Line: There is moderate and sufficient SORT Level B evidence to support the inclusion of subsymptom threshold (SST) exercise in the multimodal treatment plan for patients suffering from persistent symptoms after concussion. All five included studies reported moderate to very large effects ranging from d = 0.72 to d = 10.64 in reducing symptoms after the implementation of SST aerobic exercise. Additionally, two studies also identified moderate and very large effects (d = 0.77, d = 2.56) favoring aerobic exercise over stretching interventions. These results indicate that this treatment has potential clinical utility and is a viable option to reduce symptoms in patients with postconcussion syndrome and persistent symptoms following concussion.

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Fatemeh Ehsani, Rozita Hedayati, Rasool Bagheri and Shapour Jaberzadeh

Context: Chronic low back pain (CLBP) often presents with a dysfunction in deep abdominal muscles activity during standing tasks. Although some studies indicated that deep abdominal muscle activity improved during some functional tasks following stabilization exercise (SE), there is no study to evaluate the effect of SE on lateral abdominal muscles thickness during standing postural tasks. Objective: The purpose of this study was (1) to evaluate the lateral abdominal muscles thickness in the participants with CLBP while standing on a balance board and (2) to compare the effects of SE and a general exercise (GE) program on the lateral muscles thickness changes. Methods: This was a between-groups, triple-blinded randomized controlled trial design. In total, 40 females with CLBP were randomly assigned into 2 groups:  GE (control group) and supervised progressive SE (experimental group). Diagnostic ultrasound imaging was used before and after the intervention to measure lateral abdominal muscles thickness during standing on 2 different levels of platform in the Biodex Balance System. Visual analog scale and Roland–Morris Disability Questionnaire were used to evaluate changes in pain intensity and disability. Results: The results indicated significant increases in transverse abdominis muscle thickness during all standing tasks (P = .02) and significant decreases in pain intensity and disability following SE intervention (P < .001). However, the lateral abdominal muscle thicknesses were not changed after GE intervention while standing postural tasks (P > .05). The GE group revealed only significant decreases in pain intensity after intervention (P = .03). Conclusion: Supervised progressive SE improved the activity of deep abdominal muscles in standing postural tasks in the patients with CLBP.

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Shane Pill, Brendon Hyndman, Brendan SueSee and John Williams

Purpose: The research applies a multidisciplinary perspective to create knowledge and insight about the opportunities that digital game design principles offer to physical education (PE) pedagogy. Methods: Data were initially collected through an appreciative inquiry (AI). AI offers an alternative research perspective to critical theory that has dominated the investigation of the work of PE teachers. This study uniquely used AI with a narrative approach and multidisciplinary analysis to examine two teachers’ use of digital game design pedagogy in PE. Results: It was found that the teachers were motivated to use digital game design principles to provide students with means to solve problems, manage learning motivations, evaluate progress, and gain control over their learning in ways that are not normally associated with the common PE method. Conclusion: The two examples provided illustrate the generative potential of AI research combined with a multidisciplinary perspective directed at examples of pedagogical change in PE.

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Risto Marttinen, Dillon Landi, Dario Novak and Stephen Silverman

Purpose: We aimed to identify, categorize, and analyze published peer-reviewed research on teaching in physical education between July 1994 and December 2015. Methods: An exhaustive search was conducted on three databases (Education Resources Information Center, PE Index, and Web of Science), which produced 18,966 abstracts that were reduced to 1,023 articles that met the inclusion criteria through a review of abstracts and titles, and the second review of full papers. Articles were coded independently for numerous aspects of the research method by three coders, with multiple checks for interobserver agreement, all of which were above .85 interobserver agreement. Results: There was a great increase in the number of articles, methodological diversity, and research focus compared with a previous analysis. Research was published in 183 journals and by researchers in 45 different countries. Challenges in maintaining quality over quantity and the growth of the field are discussed. Conclusion: Research on teaching in physical education has grown greatly, and the field has matured.

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Erik A. Wikstrom, Kyeongtak Song, Kimmery Migel and Chris J. Hass

Aberrant loading is a mechanism by which individuals with chronic ankle instability (CAI) may negatively impact cartilage health and therefore long-term health outcomes. We aimed to quantify walking vertical ground reaction force (vGRF) component differences between those with and without CAI. Participants (n = 36) walked barefoot overground at a self-selected comfortable pace. Normalized peak vGRF, time to peak vGRF, and normalized loading rate were calculated. Higher normalized loading rates (CAI: 5.69 ± 0.62 N/BW/s; controls: 5.30 ± 0.44 N/BW/s, p = .034) and less time to peak vGRF (CAI: 1.48 ± 0.18 s; controls: 1.62 ± 0.16 s, p = .018) were observed in those with CAI. In conclusion, those with CAI demonstrate a higher normalized loading rate and less time to peak vGRF compared to controls.

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Chi-Whan Choi, Jung-Wan Koo and Yeon-Gyu Jeong

Context: The modified side-bridge exercise is designed for some special situations in which it is impossible to tolerate the compressive load on the side supported during the side bridge, such as in the older people with a hip or knee replacement and even in athletes with shoulder pain. Objectives: To examine the effects of 3 modified side-bridge exercises on the spinal stability muscles compared with traditional side-bridge (TSB) exercises for healthy men. Design: The effects of different exercises on the muscle activities of the external oblique (EO), internal oblique (IO), and quadratus lumborum (QL) during TSB exercise, both legs lift on side lying (BLLS), torso lift on a 45° bench while side lying (TLBS), and wall side bridge (WSB) were analyzed with the 1-way repeated-measures analysis of variance. Setting: This study was conducted in a university hospital laboratory. Participants: A total of 20 healthy men were recruited for this study. Interventions: The participants performed TSB, BLLS, TLBS, and WSB in a random order. Main Outcome Measures: Surface electromyography measured the muscle activity of the EO, IO, and QL. A 1-way repeated-measures analysis of variance assessed the statistical significance of the EO, IO, and QL muscle activity. When there was a significant difference, a Bonferroni adjustment was performed. Results: BLLS and TLBS showed similar effects to TSB in the EO, IO, and QL muscle activity, whereas WSB showed significantly less QL muscle activity than TSB (P < .05). Moreover, TLBS was significantly greater in the muscle activity of QL and EO than WSB (P < .05). Conclusion: BLLS and TLBS may be effective rehabilitation techniques to activate EO, IO, and QL in patients who are unable to perform TSB as spine stability exercises.