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Michelle A. Sandrey

Clinical Question: Is there sufficient evidence to determine which low back instability tests should be incorporated into a stabilization classification exam for athletes? Clinical Bottom Line: There is moderate level 2 evidence to include, but not to use in isolation, the prone instability test along with other instability tests in a stabilization classification exam.

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Pedro L. Valenzuela, Javier S. Morales, Adrián Castillo-García and Alejandro Lucia

Purpose: To determine the acute effects of ketone supplementation on exercise performance (primary outcome) and physiological and perceptual responses to exercise (secondary outcomes). Methods: A systematic search was conducted in PubMed, Web of Science, and SPORTDiscus (since inception to July 21, 2019) to find randomized controlled trials assessing the effects of acute ketone supplementation compared with a drink containing no ketones (ie, control intervention). The standardized mean difference (Hedges g) between interventions and 95% confidence interval (CI) were computed using a random-effects model. Results: Thirteen studies met all inclusion criteria. No significant differences were observed between interventions for overall exercise performance (Hedges g = −0.05; 95% CI, −0.30 to 0.20; P = .68). Subanalyses revealed no differences between interventions when analyzing endurance time-trial performance (g = −0.04; 95% CI, −0.35 to 0.28; P = .82) or when assessing the separate effects of supplements containing ketone esters (g = −0.07; 95% CI, −0.38 to 0.24; P = .66) or salts (g = −0.02; 95% CI, −0.45 to 0.41; P = .93). All studies reported increases in plasma ketone concentration after acute ketone supplementation, but no consistent effects were reported on the metabolic (plasma lactate and glucose levels), respiratory (respiratory exchange ratio, oxygen uptake, and ventilatory rate), cardiovascular (heart rate), or perceptual responses to exercise (rating of perceived exertion). Conclusions: The present findings suggest that ketone supplementation exerts no clear influence on exercise performance (from sprints to events lasting up to ∼50 min) or metabolic, respiratory, cardiovascular, or perceptual responses to exercise. More research is needed to elucidate if this strategy could provide ergogenic effects on other exercise types (eg, ultraendurance exercise).

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Brian Tyo, Rebecca Spataro-Kearns and David R. Bassett Jr.

Purpose: The purpose of this study was twofold: (1) to determine if the Digi-Walker SW-200 (SW-200), New Lifestyles NL-2000 (NL-2000), and Omron HJ-303 (HJ-303) yield similar daily step counts compared to the StepWatch-3; and (2) to determine if pedometer error is influenced by adiposity and/or stepping rate in African American women. Methods: 60 participants (28.0 ± 9.8 y) wore the devices for three weekdays. ANOVAs were performed to determine if body mass index (BMI) and device were related to steps per day, and to determine if BMI and device were related to error. Stepwise linear regressions were performed to determine which variables contributed to pedometer error. Results: StepWatch-3 counted significantly more steps than all other devices within each BMI category (p < .01). The NL-2000 had significantly less error in the normal (−13.4%) and overweight (−14.9%) groups compared to the SW-200 (−26.2% and −33.3%) and HJ-303 (−32.5% ad −31.5%) (p < .05). The SW-200 had significantly more error in the obese group (−50.7%) compared to the NL-2000 (−17.1%) and HJ-303 (−26.0%) (p < .05). NL-2000 error was not related to any variables while the SW-200 error was related to waist circumference (WC) and the HJ-303 error was related to percentage of slow steps. Conclusion: In African American women adiposity is more strongly related to more pedometer error in a device using a spring-levered mechanism (SW-200). Accumulating steps at a slow rate is related to more pedometer error when using a device with a step filter (HJ-303).

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Carl Foster, Jos J. de Koning, Christian Thiel, Bram Versteeg, Daniel A. Boullosa, Daniel Bok and John P. Porcari

Background: Pacing studies suggest the distribution of effort for optimizing performance. Cross-sectional studies of 1-mile world records (WRs) suggest that WR progression includes a smaller coefficient of variation of velocity. Purpose: This study evaluates whether intraindividual pacing used by elite runners to break their own WR (1 mile, 5 km, and 10 km) is related to the evolution of pacing strategy. We provide supportive data from analysis in subelite runners. Methods: Men’s WR performances (with 400-m or 1-km splits) in 1 mile, 5 km, and 10 km were retrieved from the IAAF database (from 1924 to present). Data were analyzed relative to pacing pattern when a runner improved their own WR. Similar analyses are presented for 10-km performance in subelite runners before and after intensified training. Results: WR performance was improved in 1 mile (mean [SD]: 3:59.4 [11.2] to 3:57.2 [8.6]), 5 km (13:27 [0:33] to 13:21 [0:33]), and 10 km (28:35 [1:27] to 28:21 [1:21]). The average coefficient of variation did not change in the 1 mile (3.4% [1.8%] to 3.6% [1.6%]), 5 km (2.4% [0.9%] to 2.2% [0.8%]), or 10 km (1.4% [0.1%] to 1.5% [0.6%]) with improved WR. When velocity was normalized to the percentage mean velocity for each race, the pacing pattern was almost identical. Very similar patterns were observed in subelite runners in the 10 km. When time improved from 49:20 (5:30) to 45:56 (4:58), normalized velocity was similar, terminal RPE increased (8.4 [1.6] to 9.1 [0.8]), coefficient of variation was unchanged (4.4% [1.1%] to 4.8% [2.1%]), and VO2max increased (49.8 [7.4] to 55.3 [8.8] mL·min−1·kg−1). Conclusion: The results suggest that when runners break their own best performances, they employ the same pacing pattern, which is different from when WRs are improved in cross-sectional data.

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Steven Salaga, Scott Tainsky and Michael Mondello

The authors demonstrate that betting market outcomes are a statistically significant and economically relevant driver of local market television viewership in the National Basketball Association. Ratings are higher when the local market team covers the point spread and when point spread outcome uncertainty is increased. They further illustrate that point spread market outcomes have a larger relative impact on viewership in less-popular games and when the local market team is expected to perform poorly. This suggests wagering market access serves as insurance to the league and its franchises against reduced viewership in games that are less appealing to consumers. The results assess the degree to which wagering interest has driven past revenues as well as how the legalization of sports wagering may influence future revenues.

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David Morawetz, Tobias Dünnwald, Martin Faulhaber, Hannes Gatterer, Lukas Höllrigl, Christian Raschner and Wolfgang Schobersberger

Background: The altering effects of hypoxia on aerobic/anaerobic performance are well documented and form the basis of this study. Application of hyperoxic gases (inspiratory fraction of oxygen [FiO2] > 0.2095) prior to competition or training (hyperoxic preconditioning) can compensate for the negative influence of acute hypoxia. Purpose: To investigate whether oxygen supplementation immediately prior to exercise (FiO2 = 1.0) improves all-out exercise performance in normobaric hypoxia (3500 m) in highly skilled skiers. Methods: In this single-blind, randomized, crossover study, 17 subjects performed a 60-second constant-load, all-out test in a normobaric hypoxic chamber. After a short period of adaptation to hypoxia (60 min), they received either pure oxygen or chamber air for 5 minutes prior to the all-out test (hyperoxic preconditioning vs nonhyperoxic preconditioning). Capillary blood was collected 3 times, and muscle oxygenation was assessed with near-infrared spectroscopy. Results: Absolute and relative peak power (P = .073 vs P = .103) as well as mean power (P = .330 vs P = .569) did not significantly differ after the hyperoxic preconditioning phase. PaO2 increased from 51.3 (3) to 451.9 (89.0) mm Hg, and SaO2 increased from 88.2% (1.7%) to 100% (0.2%) and dropped to 83.8% (4.2%) after the all-out test. Deoxygenation (P = .700) and reoxygenation rates (P = .185) did not significantly differ for both preconditioned settings. Conclusions: Therefore, the authors conclude that hyperoxic preconditioning did not enhance 60-second all-out exercise performance in acute hypoxia (3500 m).

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Erik Sesbreno, Gary Slater, Margo Mountjoy and Stuart D.R. Galloway

The monitoring of body composition is common in sports given the association with performance. Surface anthropometry is often preferred when monitoring changes for its convenience, practicality, and portability. However, anthropometry does not provide valid estimates of absolute lean tissue in elite athletes. The aim of this investigation was to develop anthropometric models for estimating fat-free mass (FFM) and skeletal muscle mass (SMM) using an accepted reference physique assessment technique. Sixty-four athletes across 18 sports underwent surface anthropometry and dual-energy X-ray absorptiometry (DXA) assessment. Anthropometric models for estimating FFM and SMM were developed using forward selection multiple linear regression analysis and contrasted against previously developed equations. Most anthropometric models under review performed poorly compared with DXA. However, models derived from athletic populations such as the Withers equation demonstrated a stronger correlation with DXA estimates of FFM (r = .98). Equations that incorporated skinfolds with limb girths were more effective at explaining the variance in DXA estimates of lean tissue (Sesbreno FFM [R2 = .94] and Lee SMM [R2 = .94] models). The Sesbreno equation could be useful for estimating absolute indices of lean tissue across a range of physiques if an accepted option like DXA is inaccessible. Future work should explore the validity of the Sesbreno model across a broader range of physiques common to athletic populations.

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Jessica Ross and Peter D. MacIntyre

Flow is a desirable state of consciousness and absorption in an optimally challenging activity. Prior research has investigated individual differences in flow. The present study investigates flow by contrasting physical versus mental activities, using a mixed-methods, sequential explanatory design. The sample from the quantitative phase included 205 undergraduate university students assessed on measures of personality, difficulties in emotion regulation, and flow. The big-five traits intellect and conscientiousness, as well as the emotion regulation subscale “lack of emotional clarity” predicted flow during mental activities, but unexpectedly no variables significantly predicted physical flow activities. The second phase used semi-structured interviews with 10 participants. Analyses of the interviews helped further explain the statistical findings, revealing four main themes: role of stress, source of guilt, presence of others, and satisfaction and fulfillment. We conclude that flow is especially relevant in physical activities which have advantages over mental activities in opportunities to experience flow.

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Ignacio Perez-Pozuelo, Thomas White, Kate Westgate, Katrien Wijndaele, Nicholas J. Wareham and Soren Brage

Background: Wrist-worn accelerometry is the commonest objective method for measuring physical activity in large-scale epidemiological studies. Research-grade devices capture raw triaxial acceleration which, in addition to quantifying movement, facilitates assessment of orientation relative to gravity. No population-based study has yet described the interrelationship and variation of these features by time and personal characteristics. Methods: 2,043 United Kingdom adults (35–65 years) wore an accelerometer on the non-dominant wrist and a chest-mounted combined heart-rate-and-movement sensor for 7 days free-living. From raw (60 Hz) wrist acceleration, we derived movement (non-gravity acceleration) and pitch and roll (forearm) angles relative to gravity. We inferred physical activity energy expenditure (PAEE) from combined sensing and sedentary time from approximate horizontal arm angle coupled with low movement. Results: Movement differences by time-of-day and day-of-week were associated with forearm angles; more movement in downward forearm positions. Mean (SD) movement was similar between sexes ∼31 (42) mg, despite higher PAEE in men. Women spent longer with the forearm pitched >0°, above horizontal (53% vs 36%), and less time at <0° (37% vs 53%). Diurnal pitch was 2.5–5° above and 0–7.5°below horizontal during night and daytime, respectively; corresponding roll angles were ∼0° (hand flat) and ∼20° (thumb-up). Differences were more pronounced in younger participants. All diurnal profiles indicated later wake-times on weekends. Daytime pitch was closer to horizontal on weekdays; roll was similar. Sedentary time was higher (17 vs 15 hours/day) in obese vs normal-weight individuals. Conclusions: More movement occurred in forearm positions below horizontal, commensurate with activities including walking. Findings suggest time-specific population differences in behaviors by age, sex, and BMI.

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Liam Sayer, Nidia Rodriguez-Sanchez, Paola Rodriguez-Giustiniani, Christopher Irwin, Danielle McCartney, Gregory R. Cox, Stuart D.R. Galloway and Ben Desbrow

This study investigated the effect of drinking rate on fluid retention of milk and water following exercise-induced dehydration. In Part A, 12 male participants lost 1.9% ± 0.3% body mass through cycle exercise on four occasions. Following exercise, plain water or low-fat milk equal to the volume of sweat lost during exercise was provided. Beverages were ingested over 30 or 90 min, resulting in four beverage treatments: water 30 min, water 90 min, milk 30 min, and milk 90 min. In Part B, 12 participants (nine males and three females) lost 2.0% ± 0.3% body mass through cycle exercise on four occasions. Following exercise, plain water equal to the volume of sweat lost during exercise was provided. Water was ingested over 15 min (DR15), 45 min (DR45), or 90 min (DR90), with either DR15 or DR45 repeated. In both trials, nude body mass, urine volume, urine specific gravity and osmolality, plasma osmolality, and subjective ratings of gastrointestinal symptoms were obtained preexercise and every hour for 3 hr after the onset of drinking. In Part A, no effect of drinking rate was observed on the proportion of fluid retained, but milk retention was greater (p < .01) than water (water 30 min: 57% ± 16%, water 90 min: 60% ± 20%, milk 30 min: 83% ± 6%, and milk 90 min: 85% ± 7%). In Part B, fluid retention was greater in DR90 (57% ± 13%) than DR15 (50% ± 11%, p < .05), but this was within test–retest variation determined from the repeated trials (coefficient of variation: 17%). Within the range of drinking rates investigated the nutrient composition of a beverage has a more pronounced impact on fluid retention than the ingestion rate.