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Robin S. Vealey, Nick Galli and Robert J. Harmison

In this commentary, we respond to Scherzer and Reel’s concerns over the Certified Mental Performance Consultant® (CMPC®) certification program requirements, particularly the certification exam. A reframing is suggested, in which the exam and recertification requirements are viewed as exciting historical milestones and an opportunity for individual professional growth as opposed to a personal inconvenience. In addition, some historical context and rationale for specific aspects of the CMPC certification program are provided, including the rationale for the CMPC credential.

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Emily Kroshus, Sara P.D. Chrisman, David Coppel and Stanley Herring

This study sought to identify factors that influence whether coaches support athletes struggling with depression and anxiety. Participants were U.S. public high school coaches who completed a written survey assessing their experiences, attitudes, and behaviors related to student-athlete mental health (n = 190 coaches, 92% response rate). Around two-thirds of coaches were concerned about mental health issues among the students they coached. They were more likely to extend help to a struggling athlete if they were aware of their school’s mental health plan and had greater confidence related to helping, including feeling confident in their ability to identify symptoms of mental health disorders. Mental health professionals, including sport psychologists who work with or consult with coaches, are well positioned to help provide coaches with the education necessary to be able to support and encourage care seeking by athletes who are struggling with anxiety or depression.

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Drue Stapleton

Clinical Question: Does the published literature support the use of composite FMS score to predict work-related musculoskeletal disorders (WMSD) in emergency service personnel (ESP)? Clinical Bottom Line: There is conflicting evidence of the usefulness of composite FMS score to predict WMSD in emergency service personnel.

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Mark A. Sutherlin, L. Colby Mangum, Jay Hertel, Susan A. Saliba and Joseph M. Hart

Ultrasound imaging has been used to assess muscle function of deeper muscles and to compare individuals with and without low back pain. These measures may be influenced by numerous factors requiring normalization for these comparisons. The purpose of this study was to assess anthropometric normalization variables with muscle thickness of the transversus abdominis and lumbar multifidus across multiple ultrasound testing positions. Numerous anthropometric variables were correlated with muscle thickness. Mass, body mass index, and height times mass show the best promise for normalization, but were not consistent for the transversus abdominis and lumbar multifidus muscles. Normalization strategies should be considered when comparing between groups.

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Mindi Fisher, Ryan Tierney, Anne Russ and Jamie Mansell

Clinical Question: In concussed patients, will having attention deficit hyperactivity disorder (ADHD) or learning difficulties (LD) versus not having ADHD or LD cause higher symptom severity scores or invalid baseline protocols? Clinical Bottom Line: Research supports the concept that there is a difference at baseline for individuals with ADHD and/or LD compared with those who do not.

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Dennis van Erck, Eric J. Wenker, Koen Levels, Carl Foster, Jos J. de Koning and Dionne A. Noordhof

Background: Although cyclists often compete at altitude, the effect of altitude on gross efficiency (GE) remains inconclusive. Purpose: To investigate the effect of altitude on GE at the same relative exercise intensity and at the same absolute power output (PO) and to determine the effect of altitude on the change in GE during high-intensity exercise. Methods: Twenty-one trained men performed 3 maximal incremental tests and 5 GE tests at sea level, 1500 m, and 2500 m of acute simulated altitude. The GE tests at altitude were performed once at the same relative exercise intensity and once at the same absolute PO as at sea level. Results: Altitude resulted in an unclear effect at 1500 m (−3.8%; ±3.3% [90% confidence limit]) and most likely negative effect at 2500 m (−6.3%; ±1.7%) on pre-GE, when determined at the same relative exercise intensity. When pre-GE was determined at the same absolute PO, unclear differences in GE were found (−1.5%; ±2.6% at 1500 m; −1.7%; ±2.4% at 2500 m). The effect of altitude on the decrease in GE during high-intensity exercise was unclear when determined at the same relative exercise intensity (−0.4%; ±2.8% at 1500 m; −0.7%; ±1.9% at 2500 m). When GE was determined at the same absolute PO, altitude resulted in a substantially smaller decrease in GE (2.8%; ±2.4% at 1500 m; 5.5%; ±2.9% at 2500 m). Conclusion: The lower GE found at altitude when exercise is performed at the same relative exercise intensity is mainly caused by the lower PO at which cyclists exercise.

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Kasper Salin, Mikko Huhtiniemi, Anthony Watt, Harto Hakonen and Timo Jaakkola

Background: This study examined the distribution of objectively measured physical activity (PA) and sedentary time of fifth-grade students during school, leisure time, and physical education (PE) classes. Demographic, anthropometric, and PA data were collected from 17 representative Finnish schools. Methods: To estimate the PA and sedentary time, participants (N = 592) wore wGT3X-BT ActiGraphs for 7 consecutive days. Comparisons were made between genders and different BMI groups. Results: From the study sample, 43.7% met the moderate to vigorous PA (MVPA) guidelines. Participants spent 62.2% of the day sedentary and 8.2% in moderate and vigorous activities. Boys performed more MVPA than girls, and girls were more sedentary during school days. Boys had more MVPA than girls in leisure time, but there were no differences in sedentary time. However, an examination of PA assessed during PE classes revealed no differences between boys and girls. Normal-weight boys engaged in more MVPA than overweight and obese boys. No differences were found for girls. Conclusions: The PA levels differ between different BMI groups in leisure time and during school but not during PE lessons. PA for overweight children should be targeted and compulsory PE time should be increased to achieve the PA guidelines.

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Frederico Ribeiro Neto, Rodrigo Rodrigues Gomes Costa, Ricardo Tanhoffer, Martim Bottaro and Rodrigo Luiz Carregaro

Context: Strength training is one of the most common interventions employed to increase functional independence during rehabilitation of individuals with spinal cord injury (SCI). However, in the literature, different results have been reported in terms of strength modifications after a SCI compared with a control group (CG). Objective: This study aimed to verify whether discriminant analysis using relative and absolute strength is able to discriminate individuals with different levels of SCI from a CG and to compare strength values of men with different levels of SCI with a CG. Design: Cross-sectional study. Setting: Rehabilitation hospital setting. Participants: A total of 36 individuals with SCI stratified in tetraplegia (TP; C6–C8), high paraplegia (HP; T1–T6), and low paraplegia (LP; T7–L2), and 12 matched control subjects were enrolled in the study. Main Outcome Measures: The subjects performed a maximum strength test of elbow extension/flexion and also shoulder abduction/adduction and flexion/extension in an isokinetic dynamometer. Discriminant analysis was carried out to identify which strength variables would be able to discriminate the TP, HP, or LP groups from the CG. A 1-way analysis of variance was performed to compare peak torque and agonist/antagonist ratio means. Results: Shoulder adduction, followed by elbow extension peak torque, was the best variable for discriminating the TP group from the CG (function coefficients: −0.056 and 0.051, respectively, Wilks Λ = 0.41, P ≤ .05). There were no significant differences between the HP group, LP group, and CG. Conclusions: The strength similarity of the paraplegic groups and the CG should not be extrapolated for activities of daily living or sports. The TP group demonstrated lower peak torque for all movements than the CG.

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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.