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Volume 34 (2024): Issue 4 (Jul 2024)

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Volume 38 (2024): Issue 4 (Jul 2024)

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Volume 43 (2024): Issue 3 (Jul 2024)

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Aerobic Exercise as an Intervention for Mild Traumatic Brain Injury: A Critically Appraised Topic

Makayla Florez, Erin Roberge, and Jennifer Ostrowski

Clinical Scenario: As of 2020, the lifetime prevalence of at least one self-reported concussion is 24.6%. Athletic trainers in all settings work with patients who are at risk of sustaining a concussion or mild traumatic brain injury (mTBI) and developing persistent postconcussive symptoms. Aerobic exercise is emerging as an intervention for decreasing symptoms in patients who have sustained mTBI; however, the majority of research has been performed on pediatric patients. It is of interest whether aerobic exercise is an effective intervention for adult patients with mTBI. Focused Clinical Question: In adults who have sustained mTBI, does traditional therapy decrease symptoms more than aerobic exercise? Summary of Search: A systematic search of 4 databases was performed to answer this question. Three randomized controlled trials were identified that compared aerobic exercise to traditional therapy, which consists of physical and cognitive rest. Two studies found no significant differences in symptoms between the 2 groups while 1 study found decreased symptoms in the aerobic exercise group. Clinical Bottom Line: The current evidence is clear that there is no decrease in mTBI symptoms with traditional therapy as compared with aerobic exercise, with 1 study showing decreased symptoms with aerobic exercise. Strength of Evidence: Based on the Center for Evidence-Based Medicine grades of evidence, the clinical bottom line is based on grade A evidence.

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Analzying Dual-Task Paradigms to Improve Postconcussion Assessment and Management

Diana Robertson, Landon B. Lempke, and Robert C. Lynall

Context: Dual-task (simultaneous cognitive–motor activities) assessments have been adapted into reliable and valid clinical concussion measures. However, abundant motor and cognitive variations leave researchers and clinicians uncertain about which combinations elicit the intended dual-task effect. Our objective was to examine differences between commonly employed dual-task motor and cognitive combinations among healthy, college-aged individuals. Design: Cross-sectional laboratory study. Methods: Twenty participants (age: 21.3 [2.4] y; height: 176.0 [9.1] cm; mass: 76.0 [16.4] kg; 20% with concussion history) completed 4 motor tasks (gait, tandem gait, single-leg balance, and tandem balance) under 5 cognitive conditions (single task, subtraction, month reversal, spelling backward, and visual Stroop) in a research laboratory. The motor performance outcomes were spatiotemporal variables for gait and tandem gait and center of pressure path length (in centimeters) for single-leg and tandem balance. Cognitive outcomes were response rate (responses/second) and cognitive accuracy. We used separate repeated-measures analyses of variance for each motor and cognitive outcome with post hoc Tukey t tests. Results: Gait velocity, gait stride length, and tandem gait velocity demonstrated significant cognitive–motor interactions (P’s < .001) such that all dual-task conditions resulted in varyingly slower or shorter movement than single task. Conversely, single-leg balance (P = .627) and tandem balance (P = .434) center of pressure path length did not significantly differ among the dual-task cognitive conditions or relative to single task. Statistically significant cognitive–motor interactions were observed only for spelling backward accuracy (P = .004) and response rates for spelling backward, month reversal, and visual Stroop (P’s < .001) such that worse accuracy, but faster response rates, occurred during motor tasks. Conclusions: Gait and tandem gait motor tasks accompanied with spelling backward or subtraction cognitive tasks demonstrated consistently strong dual-task effects and, therefore, may be the best suited for clinical and research use following concussion.

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Defining Worst-Case-Scenario Thresholds in Soccer: Intensity Versus Volume

Mauro Mandorino and Mathieu Lacome

Purpose: This study aimed to enhance the understanding of soccer match peak demands by describing worst-case scenario (WCS) and time spent above 80% and 90% of the WCS for total distance (TD) and high-speed running (HSR). The investigation considered playing level (first team vs under-19 [U19] team) and playing position (center backs, fullbacks, midfielders, and forwards) to assess how WCS and the time spent above specific thresholds vary across different populations. Methods: Data from 31 players in a professional Italian soccer club were collected during the 2022–23 season. Microtechnology devices tracked physical activity during matches. Players were categorized by position, and WCS was determined using rolling averages over a 1-minute period. Time spent above 80% and 90% of WCS for TD and HSR was calculated. Results: The U19 team exhibited higher HSR WCS compared with the first team (∼63 m·min−1 vs ∼56 m·min−1). Midfielders recorded the highest TD WCS (∼208 m·min−1), and forwards exhibited the highest HSR WCS (∼70 m·min−1). The first team spent significantly more time above 80% (∼6 min) and 90% (∼1 min) of TD WCS. Midfielders spent significantly more time above the 80% (∼7 min) of TD WCS, while forwards above the 80% (∼2 min) of HSR WCS. Conclusions: The study emphasizes that WCS used alone may not sufficiently capture real match intensity. Considering the time spent above specific thresholds provides additional insights (ie, between-levels differences and position). Practitioners should consider both WCS and time spent above thresholds for individualized training prescriptions, reflecting differences in playing roles.

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Effectiveness of Percutaneous Needle Electrolysis to Reduce Pain in Tendinopathies: A Systematic Review With Meta-Analysis

Matheus Hissa Lourenço Ferreira, Guilherme Augusto Santos Araujo, and Blanca De-La-Cruz-Torrez

Context: Tendon injuries are common disorders in both workers and athletes, potentially impacting performance in both conditions. This is why the search for effective treatments is continuing. Objective(s): The objective of this study was to analyze whether the ultrasound-guided percutaneous needle electrolysis technique may be considered a procedure to reduce pain caused by tendinosis. Evidence Acquisition: The search strategy included the PubMed, SCOPUS, CINAHL, Physiotherapy Evidence Database, SciELO, and ScienceDirect up to the date of February 25, 2024. Randomized clinical trials that assessed pain caused by tendinosis using the Visual Analog Scale and Numeric Rating Scale were included. The studies were evaluated for quality using the Cochrane Risk of Bias 2, and the evidence strength was assessed by the GRADEpro GDT. Evidence Synthesis: Out of the 534 studies found, 8 were included in the review. A random-effects meta-analysis and standardized mean differences (SMD) were conducted. The ultrasound-guided percutaneous needle electrolysis proved to be effective in reducing pain caused by tendinosis in the overall outcome (SMD = −0.97; 95% CI, −1.26 to −0.68; I 2  = 58%; low certainty of evidence) and in the short-term (SMD = −0.83, 95% CI, −1.29 to −0.38; I 2  = 65%; low certainty of evidence), midterm (SMD = −1.28; 95% CI, −1.65 to −0.91; I 2  = 0%; moderate certainty of evidence), and long-term (SMD = −0.94; 95% CI, −1.62 to −0.26; I 2  = 71%; low certainty of evidence) subgroups. Conclusion(s): The application of the ultrasound-guided percutaneous needle electrolysis technique for reducing pain caused by tendinosis appears to be effective. However, due to the heterogeneity found (partially explained), more studies are needed to define the appropriate dosimetry, specific populations that may benefit more from the technique, and possible adverse events.

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Erratum. Injury Prediction in Competitive Runners With Machine Learning

International Journal of Sports Physiology and Performance

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Gender Differences in Students’ Moderate to Vigorous Physical Activity Levels During Primary School Physical Education Lessons: A Systematic Review and Meta-Analysis

Diego Arenas, Josep Vidal-Conti, and Adrià Muntaner-Mas

Purpose: We aimed to determine gender differences in students’ moderate to vigorous physical activity (MVPA) levels measured in primary school by accelerometry. Methods: Our systematic search (PROSPERO: CRD42023422799) was developed using four electronic databases (from January 2013 to December 22, 2023). Our meta-analysis was conducted based on a random-effects model. Results: The search yielded 6255 manuscripts. Only 24 manuscripts were included in the systematic review, reporting 7550 participants. Finally, 19 manuscripts were meta-analyzed. Our analyses indicated that the mean percentages (95% confidence interval) of MVPA in primary school physical education lessons were 28.75 ± 13.75 for boys and 25.99 ± 12.35 for girls. In addition, the mean minutes (95% confidence interval) were 13.75 ± 9.91 for boys and 12.15 ± 8.88 for girls. Students failed to meet the 50% recommendation of MVPA lesson time. Conclusion: Boys spend significantly more time in MVPA than girls during PE lessons in primary school. The findings show the need for methodological changes in physical education to reduce this gender gap.

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Head Game: Mental Health in Sports Media

Mahdi Latififard