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Bryan Holtzman, Adam S. Tenforde, Allyson L. Parziale and Kathryn E. Ackerman

This study’s objective was to identify differences in risk for low energy availability and athletic clearance level by comparing scores on Female Athlete Triad Cumulative Risk Assessment (Triad CRA) and Relative Energy Deficiency in Sport Clinical Assessment Tool (RED-S CAT). A total of 1,000 female athletes aged 15–30 years participating in ≥4 hr of physical activity/week for the previous ≥6 months completed an extensive survey assessing health, athletic history, family disease history, and specific Triad/RED-S risk factors. Retrospective chart review ascertained laboratory and bone mineral density measures. Triad CRA and RED-S CAT were used to assign each athlete’s risk level (low, moderate, and high), and case-by-case comparison measured the level of agreement between the tools. We hypothesized that the tools would generally agree on low-risk athletes and that the tools would be less aligned in the specific elevated risk level (moderate or high). Most of the sample was assigned moderate or high risk for Triad CRA and RED-S CAT (Triad: 54.7% moderate and 7.9% high; RED-S: 63.2% moderate and 33.0% high). The tools agreed on risk for 55.5% of athletes. Agreement increased to 64.3% when only athletes with bone mineral density measurements were considered. In conclusion, Triad CRA and RED-S CAT provide consensus on the majority of athletes at elevated (moderate or high) risk for low energy availability, but have less agreement on the specific risk level assigned.

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Ian M. Greenlund, Piersan E. Suriano, Steven J. Elmer, Jason R. Carter and John J. Durocher

Background: Sedentary activity and sitting for at least 10 hours per day can increase the risk for cardiovascular disease by more than 60%. Use of standing desks may decrease sedentary time and improve cardiovascular health. Acute standing lowers pulse wave velocity (PWV), but chronic effects remain unknown. The purpose of this study was to determine the effect of chronic standing desk use on arterial stiffness versus seated controls. Methods: A total of 48 adults participated in this study. Twenty-four participants qualified as seated desk users (age 41 [10] y, body mass index 25 [4] kg/m2) and 24 as standing desk users (age 45 [12] y, body mass index 25 [5] kg/m2). Arterial stiffness was assessed as PWV within the aorta, arm, and leg. Results: Carotid–femoral PWV (cfPWV) was not different between seated (6.6 [1.3] m/s) and standing (6.9 [1.3] m/s) groups (P = .47). Similarly, there were no differences in arm or leg PWV between groups (P = .13 and P = .66, respectively). A secondary analysis of traditional factors of age and aerobic fitness revealed significant differences in cfPWV in seated and standing desk participants. Age also significantly influenced cfPWV across conditions. Conclusions: Standing for >50% of a workday did not affect PWV. Consistent with previous research, fitness and age are important modulators of arterial stiffness.

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Zakariya Nawasreh, David Logerstedt, Adam Marmon and Lynn Snyder-Mackler

Context: Manual perturbation training improves knee functional performance and mitigates abnormal gait in patients with anterior cruciate ligament (ACL) rupture. However, manual perturbation training is time- and labor-intensive for therapists. Objective: To investigate whether perturbation training administered using a mechanical device can provide effects similar to manual training on clinical measures and knee biomechanics after ACL rupture. Design: Prospective cohort (therapeutic) study. A 2 × 2 analysis of variance was used for statistical analysis. Setting: A clinical and biomechanical laboratory. Patients: Eighteen level I/II patients with acute ACL ruptures participated in this preliminary study. Intervention: Nine patients received mechanical perturbation training on an automated mechanical device (mechanical group), and 9 patients received manual perturbation training (manual group). Outcome Measures: Patients completed performance-based testing (quadriceps strength and single-legged hop tests), patient-reported questionnaires (Knee Outcome Survey-Activities of Daily Living Scale, Global Rating Score, and International Knee Documentation Committee 2000), and 3-dimensional gait analysis before (pretesting) and after (posttesting) training. Results: There was no significant group-by-time interaction found for all measures (P ≥ .18). Main effects of time were found for International Knee Documentation Committee 2000 (pretesting: 69.10 [10.95], posttesting: 75.14 [7.19]), knee excursion during weight-acceptance (pretesting: 16.01° [3.99°]; posttesting: 17.28° [3.99°]) and midstance (pretesting: 14.78° [4.13°]; posttesting: 16.92° [4.53°]) and external knee-flexion moment (pretesting: 0.43 [0.11] N m/kg/m; posttesting: 0.48 [0.11] N m/kg/m) (P ≤ .04). After accounting for pretesting groups’ differences, the mechanical group scored significantly higher on triple hops (mechanical: 96.73% [6.65%]; manual: 84.97% [6.83%]) and 6-m timed hops (mechanical: 102.07% [9.50%]; manual: 91.21 [9.42%]) (P ≤ .047) compared with manual group. Conclusion: The clinical significance of this study is the mechanical perturbation training produced effects similar to manual training, with both training methods were equally  effective at improving patients’ perception of knee function and increasing knee excursion and external flexion moment during walking after acute ACL rupture. Mechanical perturbation training is a potential treatment to improve patients’ functional and biomechanical outcomes after ACL rupture.

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Bruno P. Melo, Débora A. Guariglia, Rafael E. Pedro, Dennis A. Bertolini, Solange de Paula Ramos, Sidney B. Peres and Solange M. Franzói de Moraes

Background: Combined exercise (CE) has been recommended for individuals living with HIV/AIDS (ILWHA) under antiretroviral therapy. However, depending on the intensity and duration, physical exercise may occasionally increase inflammatory parameters and reduce immunological responses that if not reversed, cause health injury specifically in this population. Information about immunological and hormonal responses after CE in ILWHA has not been completely elucidated. Therefore, the aim is to verify the acute effects of CE on cortisol, testosterone, immunoglobulin A, and pro-inflammatory and anti-inflammatory cytokines over 24 hours in ILWHA. Methods: Noninfected individuals and ILWHA undergone 5 sessions of CE prior to the acute assessment session. Seventy-two hours after the last session, the subjects were submitted to one session of CE (aerobic exercise: 25 min at 60–70% reserve heart rate and resistance exercise: 3 sets of 15 maximum repetitions of 6 exercises). Saliva samples were collected before, immediately, 6 and 24 hours after CE. Results: CE reduced cortisol (6 h: 2.54 [0.58] vs 0.65 [0.22] pg·mL−1; P = .02), increased testosterone (all moments) and immunoglobulin A levels (24 h: 255.3 [44.7] vs 349.2 [41.9] μm·mL−1; P = .01) without significant difference in cytokines levels in ILWHA. Conclusion: CE modulates cortisol, testosterone, and immunoglobulin A levels without the change in immunological parameters in ILWHA.

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Ching T. Lye, Swarup Mukherjee and Stephen F. Burns

This study examined if plant sterols and walking reduce postprandial triacylglycerol (TAG) concentrations in Chinese men with elevated body mass index (≥ 23.5 kg/m2). Fifteen Chinese men (mean [SD]: age = 25 [3] years and body mass index = 26.2 [1.5] kg/m2] completed four 10-day trials in random order with a 7- to 10-day washout between trials: (a) daily consumption of a control margarine while sedentary (C-S), (b) daily consumption of margarine containing 2 g/day of plant sterols while sedentary (PS-S), (c) daily consumption of a control margarine with 30-min daily walking (C-W), and (d) daily consumption of margarine containing 2 g/day of plant sterols with 30-min daily walking (PS-W). On Day 11 of each trial, postprandial TAG was measured after a high-fat milkshake. The 5-hr total area under the TAG curve was 22%, 25%, and 12% lower on PS-W (mean [SD]: 8.9 [4.3] mmol·5 hr/L) than C-S (11.4 [4.5] mmol·5 hr/L; p = .005; d = 0.56), PS-S (11.9 [4.9] mmol·5 hr/L; p = .004; d = 0.67), and C-W (10.1 [4.4] mmol·5 hr/L; p = .044; d = 0.27) trials, respectively. Similarly, 5-hr incremental area for PS-W (4.5 [2.7] mmol·5 hr/L) was 31%, 32%, and 18% lower than C-S (6.6 [3.3] mmol·5 hr/L; p = .005; d = 0.62), PS-S (6.6 [3.4] mmol·5 hr/L; p = .004; d = 0.64), and C-W (5.5 [2.8] mmol·5 hr/L; p = .032; d = 0.29). Ten days of daily plant sterol intake combined with walking presents an intervention strategy to lower postprandial TAG in Chinese men with elevated body mass index.

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Jessica Ferreira, André Bebiano, Daniel Raro, João Martins and Anabela G. Silva

Context: Sliding and tensioning neural mobilization are used to restore normal function of the nervous system, but they impose different stresses on it. Particularly, sliding induces greater nerve excursion than tensioning. Conceivably, they might impact nervous system function differently. Objective: To compare the effects of tensioning neural mobilization versus sliding neural mobilization of the dominant lower limb on static postural control and hop testing. Design: Randomized, parallel and double blinded trial. Setting/Participants: Thirty-seven football players. Intervention(s): Participants were randomized into 2 groups: sliding neural mobilization (n = 18) or tensioning neural mobilization (n = 19) targeting the tibial nerve. Main Outcome Measures: Static postural sway was assessed with a force plate and functional performance with hop tests. Measurements were taken at baseline, after the intervention, and at 30-minute follow-up. Results: There was a significant effect of time for the center of pressure total displacement and velocity (P < .05), for the single-leg hop test (P < .05), the 6-m timed hop test (P < .05), and the cross-over hop test (P < .05), but no significant effect of the intervention. Conclusions: Sliding and tensioning neural mobilization improved postural control and hop testing in football players, and improvements remained 30 minutes after the intervention. Additional research examining the influence of neural mobilization on sensory motor impairments, postural control, and functional performance is needed.

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Alireza Derakhshani, Amir Letafatkar and Zohre Khosrokiani

Context: Scapular downward rotation syndrome (SDRS) is an impaired alignment that causes shoulder and neck pain. Interventions may lead to the reduction of pain intensity and joint position error (JPE) and improved range of motion (ROM). Objective: To evaluate the effects of 6-week Scapular Upward Rotation and Elevation Exercises (SUREE) with and without visual feedback on pain, ROM, and JPE in people with SDRS. Study Design: Randomized control trial. Setting: Institutional practice. Participants: Forty-two young and active subjects (22.61 [1.80] y; 27 males and 15 females) with unilateral SDRS randomly assigned into 3 groups (2 intervention groups and 1 control group). Interventions: SUREE without and with visual feedback programs. Main Outcome Measures: Pain, neck-flexion and rotation ROMs, and JPE were measured using visual analog scale (score), double inclinometer method, universal goniometer method (degrees), and a dual digital inclinometer (degrees), respectively, before and after interventions. Results: The results showed statistically significant changes within the experimental groups in all variables except for the neck rotation ROM in the SUREE intervention without visual feedback (P < .05). However, there were no changes in the control group before and after the interventions in all dependent variables (P < .05). Also, there were no significant differences between both experimental groups concerning all dependent variables except for the rotation ROM (P < .05). Conclusion: The results suggest that the 6-week SUREE with and without visual feedback programs result in decreased neck pain and improved flexion ROM and JPE during active neck motions in subjects with unilateral SDRS. However, the 6-week SUREE with visual feedback may improve the neck rotation ROM in subjects with unilateral SDRS. However, further studies are needed to confirm the results of this study.

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Akira Asada and Yong Jae Ko

Sport socialization research has revealed that a community is one of the most influential socializing agents. However, little is known about which aspects of a community promote sport socialization and how it occurs. In the current research, we identified and conceptualized two key factors characterizing sports teams’ fan communities, relative size and entitativity, and discussed how these factors influence sport socialization and its outcomes. First, we developed the model of community influence on sport socialization to depict the effects of relative size and entitativity on people’s perceptions and behaviors at the initial stage of their sport socialization. Second, we proposed the model of community influence on the outcomes of sport socialization, which explains how relative size and entitativity contribute to the outcomes of sport socialization.

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Michael Girdwood, Liam West, David Connell and Peter Brukner

Context: Muscle injuries of the hip stabilizers are considered rare in sport. Objective: This report presents a previously unreported case of a contact injury resulting in acute strain of quadratus femoris, obturator externus, and inferior gemellus in an amateur Australian rules football player. Design: Level 4—case report. Case Presentation: A player was tackled ipsilateral to the injured leg, while in hip flexion in a lunged position. The case describes the diagnostic process, initial management, and return to play for this athlete. Results: Following rehabilitation, the player was able to return to sport at 8 weeks without ongoing issues. Conclusions: A literature search for sports-related contact injuries to either muscle returned only one result. All other documented cases of injury to these muscle groups are confined to noncontact mechanisms or delayed presentations. Despite conventional teaching, the action of the deep external rotators of the hip appears to be positionally dependent. Knowledge of this type of injury and mechanism may be useful for future clinical reasoning and differential diagnosis in patients with this type of presentation.