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Darin A. Padua and Stephen W. Marshall

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Catherine J. Vladutiu, Kelly R. Evenson and Stephen W. Marshall

Background:

Although physical activity can provide health benefits to pregnant women, population-based research on the circumstances surrounding injuries from physical activity during pregnancy is lacking.

Methods:

Physical activity and subsequent injuries among a cohort of 1469 pregnant women in North Carolina were examined prospectively from the third phase of the Pregnancy, Infection, and Nutrition Study between 2001 and 2005. Chi-square analyses were used to compare distributions of maternal characteristics among women who sustained injuries from physical activity and women who reported no injuries during pregnancy. Injury incidence rates were calculated.

Results:

Few pregnant women (N = 34) reported a physical activity-related injury during pregnancy. The rates of physical activity-related and exercise-related injuries during pregnancy were 3.2 per 1000 physical activity hours and 4.1 per 1000 exercise hours, respectively. The most common types of injuries were bruises or scrapes (55%). Among all injuries, 33% resulted from exercise and 67% resulted from nonexercise physical activities. Sixty-four percent of all injuries were due to falls.

Conclusions:

The incidence of injury from physical activity was low during pregnancy. Women should continue to be encouraged to maintain involvement in physical activity during pregnancy, while being aware of the potential for injury, particularly falls, from these activities.

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Yvonne M. Golightly, Stephen W. Marshall, Leigh F. Callahan and Kevin Guskiewicz

Background:

Injury has been identified as a potential risk factor for osteoarthritis. However, no previous study has addressed playing-career injuries and subsequent osteoarthritis in a large sample of former athletes. The purpose of this study was to describe the prevalence and determinants of arthritis and osteoarthritis in retired professional football players.

Methods:

Self-reported arthritis prevalence and retrospectively-recalled injury history were examined in a cross-sectional survey of 2,538 retired football players.

Results:

Football players reported a high incidence of injury from their professional playing days (52.8% reported knee injuries, 74.1% reported ligament/tendon injuries, and 14.2% reported anterior cruciate ligament tears). For those under 60 years, 40.6% of retired NFL players reported arthritis, compared with 11.7% of U.S. males (prevalence ratio =3.5, 95%CI: 3.3 to 3.7). Within the retired NFL player cohort, osteoarthritis was more prevalent in those with a history of knee injury (prevalence ratio = 1.7, 95%CI: 1.5 to 1.9) and ligament/tendon injury (prevalence ratio = 1.6, 95%CI: 1.4 to 1.9).

Conclusions:

In males under the age of 60, arthritis is over 3 times more prevalent in retired NFL players than in the general U.S. population. This excess of early-onset arthritis may be due to the high incidence of injury in football.

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Darin A. Padua, Michelle C. Boling, Lindsay J. DiStefano, James A. Onate, Anthony I. Beutler and Stephen W. Marshall

Context:

There is a need for reliable clinical assessment tools that can be used to identify individuals who may be at risk for injury. The Landing Error Scoring System (LESS) is a reliable and valid clinical assessment tool that was developed to identify individuals at risk for lower extremity injuries. One limitation of this tool is that it cannot be assessed in real time and requires the use of video cameras.

Objective:

To determine the interrater reliability of a real-time version of the LESS, the LESS-RT.

Design:

Reliability study.

Setting:

Controlled research laboratory.

Participants:

43 healthy volunteers (24 women, 19 men) between the ages of 18 and 23.

Intervention:

The LESS-RT evaluates 10 jump-landing characteristics that may predispose an individual to lower extremity injuries. Two sets of raters used the LESS-RT to evaluate participants as they performed 4 trials of a jump-landing task.

Main Outcome Measures:

Intraclass correlation coefficient (ICC2,1) values for the final composite score of the LESS-RT were calculated to assess interrater reliability of the LESS-RT.

Results:

Interrater reliability (ICC2,1) for the LESS-RT ranged from .72 to .81 with standard error of measurements ranging from .69 to .79.

Conclusions:

The LESS-RT is a quick, easy, and reliable clinical assessment tool that may be used by clinicians to identify individuals who may be at risk for lower extremity injuries.

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Elizabeth F. Teel, Stephen W. Marshall, L. Gregory Appelbaum, Claudio L. Battaglini, Kevin A. Carneiro, Kevin M. Guskiewicz, Johna K. Register-Mihalik and Jason P. Mihalik

Context: Concussion management is moving from passive rest strategies to active interventions, including aerobic exercise therapy. Little information is available regarding the feasibility and adherence of these programs. Objectives: To determine whether an aerobic exercise training program intended for rehabilitation in people with concussion is feasible. Healthy, nonconcussed subjects were studied in this phase 1 trial. Design: Phase 1 parallel-group, randomized controlled trial in a sample of healthy (nonconcussed), recreationally active university students. Setting: Laboratory. Patients: 40 healthy university students. Methods: Participants were equally randomized to acute concussion therapy intervention (ACTIVE) training or nontraining groups. All participants completed maximal cardiopulmonary exercise tests on a stationary cycle ergometer at 2 test sessions approximately 14 days apart. During this 2-week study period, ACTIVE training participants completed six 30-minute cycling sessions, progressing from 60% to 80% of the participant’s individualized maximal oxygen consumption. A subset of participants (NACTIVE = 12, Nnontraining = 11) wore physical activity monitors throughout the 2-week study period. Main Outcomes Measures: Study protocol and randomization effectiveness, exercise safety and adherence, and progressive intensity of the ACTIVE training procedures. Results: No adverse events occurred during any exercise sessions. Twelve ACTIVE training participants (60%) completed all training sessions, and every participant completed at least 4 sessions. Heart rate increased throughout the training period (P < .001), but symptom changes and training adherence remained stable despite the progressively increasing workload. ACTIVE training participants completed approximately 30 additional minutes of physical activity on training sessions days, although that was not statistically significant (P = .20). Conclusions: University-aged students were adherent to the ACTIVE training protocol. Future research should investigate the safety and feasibility of aerobic training programs in acutely concussed individuals to determine their appropriateness as a clinical rehabilitation strategy.