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Gary Allen, Kristy Smith, Brady Tripp, Jason Zaremski and Seth Smith

We present a case of a 17-year-old White male high school American football player who was diagnosed with an anomalous left coronary artery arising from the right coronary sinus after experiencing dizziness, near-syncope, and altered mental status during a football practice. The symptoms were recognized by an on-site certified athletic trainer who activated emergency medical response. After unremarkable initial emergency evaluation, referral to a sports cardiologist unveiled an anomalous left coronary artery arising from the right coronary sinus on echocardiogram. After surgical correction and rehabilitation, the patient was able to return to exercise activity. Anomalous coronary arteries are the second most common cause of autopsy-positive episodes of sudden cardiac death among athletes and are rarely recognized with abnormal electrocardiogram (EKG) findings prior to events. This case highlights the importance of prompt recognition, evaluation, and treatment of athletes with cardiac symptoms, and contributes to an ongoing discussion on whether echocardiograms should be considered in preparticipation evaluations.

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Kelly Cornett, Katherine Bray-Simons, Heather M. Devlin, Sunil Iyengar, Patricia Moore Shaffer and Janet E. Fulton

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Simon A. Rogers, Peter Hassmén, Alexandra H. Roberts, Alison Alcock, Wendy L. Gilleard and John S. Warmenhoven

Purpose: A novel 4-task Athlete Introductory Movement Screen was developed and tested to provide an appropriate and reliable movement screening tool for youth sport practitioners. Methods: The overhead squat, lunge, push-up, and a prone brace with shoulder touches were selected based on previous assessments. A total of 28 mixed-sport junior athletes (18 boys and 10 girls; mean age = 15.7 [1.8] y) completed screening after viewing standardized demonstration videos. Athletes were filmed performing 8 repetitions of each task and assessed retrospectively by 2 independent raters using a 3-point scale. The primary rater reassessed the footage 3 weeks later. A subgroup (n = 11) repeated the screening 7 days later, and a further 8 athletes were reassessed 6 months later. Intraclass correlation coefficients (ICC), typical error (TE), coefficient of variation (CV%), and weighted kappa (k) were used in reliability analysis. Results: For the Athlete Introductory Movement Screen 4-task sum score, intrarater reliability was high (ICC = .97; CV = 2.8%), whereas interrater reliability was good (intraclass correlation coefficient = .88; CV = 5.6%). There was a range of agreement from fair to almost perfect (k = .31–.89) between raters across individual movements. A 7-day and 6-month test–retest held good reliability and acceptable CVs (≤ 10%) for sum scores. Conclusion: The 4-task Athlete Introductory Movement Screen appears to be a reliable tool for profiling emerging athletes. Reliability was strongest within the same rater; it was lower, yet acceptable, between 2 raters. Scores can provide an overview of appropriate movement competencies, helping practitioners assess training interventions in the athlete development pathway.

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Rachael L. Thurecht and Fiona E. Pelly

This study aimed to develop and refine an Athlete Food Choice Questionnaire (AFCQ) to determine the key factors influencing food choice in an international cohort of athletes. A questionnaire that contained 84 items on a 5-point frequency scale was developed for this study. Athletes at the 2017 Universiade, in Taiwan, were invited to participate. Principal component analysis was utilized to identify key factors and to refine the questionnaire. Completed questionnaires were received from 156 athletes from 31 countries and 17 sports. The principal component analysis extracted 36 items organized into nine factors explaining 68.0% of variation. The nine factors were as follows: nutritional attributes of the food, emotional influences, food and health awareness, influence of others, usual eating practices, weight control, food values and beliefs, sensory appeal, and performance. The overall Kaiser–Meyer–Olkin measure was 0.75, the Bartlett test of sphericity was statistically significant, χ2(666) =2,536.50, p < .001, and all of the communalities remained >0.5. Intercorrelations were detected between performance and both nutritional attributes of the food and weight control. The price of food, convenience, and situational influences did not form part of the factorial structure. This research resulted in an AFCQ that includes factors specific to athletic performance and the sporting environment. The AFCQ will enable researchers and sports dietitians to better tailor nutrition education and dietary interventions to suit the individual or team. The next phase will test the accuracy and reliability of the AFCQ both during and outside of competition. The AFCQ is a useful tool to assist with management of performance nutrition for athletes.

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Nancy D. Groh and Greggory M. Hundt

Self-efficacy shares a causal relationship with performance. Few studies have examined self-efficacy in relationship to athletic training and instead limit themselves to areas focused on the musculoskeletal system. The purpose of this study was to develop and validate a scale for measuring athletic trainer self-efficacy in the assessment and diagnosis of medical conditions and illness. A principal component analysis yielded 19 items that loaded on three factors. The analysis resulted in acceptable levels of correlation (KMO = .93; Bartlett x2 = 2152.58, df = 171, p < .001) and internal consistency (α = .943). This scale demonstrates both validity and reliability.

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Louise Capling, Janelle A. Gifford, Kathryn L. Beck, Victoria M. Flood, Gary J. Slater, Gareth S. Denyer and Helen T. O’Connor

Food-based diet indices provide a practical, rapid, and inexpensive way of evaluating dietary intake. Rather than nutrients, diet indices assess the intake of whole foods and dietary patterns, and compare these with nutrition guidelines. An athlete-specific diet index would offer an efficient and practical way to assess the quality of athletes’ diets, guide nutrition interventions, and focus sport nutrition support. This study describes the development and validation of an Athlete Diet Index (ADI). Item development was informed by a review of existing diet indices, relevant literature, and in-depth focus groups with 20 sports nutritionists (median of 11 years’ professional experience) from four elite athlete sporting institutes. Focus group data were analyzed (NVivo 11 Pro; QSR International Pty. Ltd., 2017, Melbourne, Australia), and key themes were identified to guide the development of athlete-relevant items. A modified Delphi survey in a subgroup of sports nutritionists (n = 9) supported item content validation. Pilot testing with athletes (n = 15) subsequently informed face validity. The final ADI (n = 68 items) was categorized into three sections. Section A (n = 45 items) evaluated usual intake, special diets or intolerances, dietary habits, and culinary skills. Section B (n = 15 items) assessed training load, nutrition supporting training, and sports supplement use. Section C (n = 8 items) captured the demographic details, sporting type, and caliber. All of the athletes reported the ADI as easy (40%) or very easy (60% of participants) to use and rated the tool as relevant (37%) or very relevant (63% of participants) to athletes. Further evaluation of the ADI, including the development of a scoring matrix and validation compared with established dietary methodology, is warranted.

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Daniel P. Joaquim, Claudia R. Juzwiak and Ciro Winckler

This study aimed to assess the diet quality of Brazilian Paralympic track-and-field team sprinters and its variation between days. All sprinters (n = 28) were invited, and 20 (13 men and seven women) accepted the invitation consisting of 13 athletes with visual impairment, four with cerebral palsy, and three with limb deficiency. The dietary intake was recorded by photographic register on four consecutive days, and diet quality was determined using a revised version of the Healthy Eating Index for the Brazilian population. Physical activity was assessed using an accelerometer, and metabolic unit information was used to classify exercise intensity. Variance Analysis Model and Bonferroni multiple comparisons were used to assess relationships between variables. The correlations between variables used Pearson linear correlation coefficient. The results show that revised version of the Healthy Eating Index score was classified as “needs to be modified” for all athletes. The maximum score for the components “Whole fruits,” “Total vegetables,” and “Dark green and orange vegetables and legumes” was achieved by 23.1% and 14.3%, 7.7% and 14.3%, and 46.2% and 57.8% of male and female athletes, respectively. Only 38.5% of the male athletes achieved the maximum score for the “Total cereal” component. Female athletes achieved higher scores than male athletes for the “Milk and dairy products” component (p = .03). Intake of whole grain cereals, dairy products, vegetables, and whole fruits needs modifications to improve adequate intake of vitamins and antioxidants, highlighting the need of continuous actions of nutrition education for this population.

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Joseph O.C. Coyne, Sophia Nimphius, Robert U. Newton and G. Gregory Haff

Purpose: Criticisms of the acute to chronic workload ratio (ACWR) have been that the mathematical coupling inherent in the traditional calculation of the ACWR results in a spurious correlation. The purposes of this commentary are (1) to examine how mathematical coupling causes spurious correlations and (2) to use a case study from actual monitoring data to determine how mathematical coupling affects the ACWR. Methods: Training and competition workload (TL) data were obtained from international-level open-skill (basketball) and closed-skill (weightlifting) athletes before their respective qualifying tournaments for the 2016 Olympic Games. Correlations between acute TL, chronic TL, and the ACWR as coupled/uncoupled variations were examined. These variables were also compared using both rolling averages and exponentially weighted moving averages to account for any potential benefits of one calculation method over another. Results: Although there were some significant differences between coupled and uncoupled chronic TL and ACWR data, the effect sizes of these differences were almost all trivial (g = 0.04–0.21). Correlations ranged from r = .55 to .76, .17 to .53, and .88 to .99 for acute to chronic TL, acute to uncoupled chronic TL, and ACWR to uncoupled ACWR, respectively. Conclusions: There may be low risk of mathematical coupling causing spurious correlations in the TL–injury-risk relationship. Varying levels of correlation seem to exist naturally between acute and chronic TL variables regardless of coupling. The trivial to small effect sizes and large to nearly perfect correlations between coupled and uncoupled AWCRs also imply that mathematical coupling may have little effect on either calculation method, if practitioners choose to apply the ACWR for TL monitoring purposes.

Open access

Artur Direito, Joseph J. Murphy, Matthew Mclaughlin, Jacqueline Mair, Kelly Mackenzie, Masamitsu Kamada, Rachel Sutherland, Shannon Montgomery, Trevor Shilton and on behalf of the ISPAH Early Career Network

Increasing population levels of physical activity (PA) can assist in achieving the United Nations sustainable development goals, benefiting multiple sectors and contributing to global prosperity. Practices and policies to increase PA levels exist at the subnational, national, and international levels. In 2018, the World Health Organization launched the first Global Action Plan on Physical Activity (GAPPA). The GAPPA provides guidance through a framework of effective and feasible policy actions for increasing PA, and requires engagement and advocacy from a wide spectrum of stakeholders for successful implementation of the proposed actions. Early career professionals, including researchers, practitioners, and policymakers, can play a major role with helping “all people being regularly active” by contributing to 4 overarching areas: (1) generation—of evidence, (2) dissemination—of key messages and evidence, (3) implementation—of the evidence-based actions proposed in the GAPPA, and (4) contributing to advocacy for robust national action plans on PA. The contribution of early career professionals can be achieved through 5 pathways: (1) research, (2) workplace/practice, (3) business, (4) policy, and (5) professional and public opinion. Recommendations of how early career professionals can contribute to the generation, dissemination, and implementation of the evidence and actions proposed by the GAPPA are provided.