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William M. Adams, Yuri Hosokawa, Robert A. Huggins, Stephanie M. Mazerolle, and Douglas J. Casa


Evidence-based best practices for the recognition and treatment of exertional heat stroke (EHS) indicate that rectal thermometry and immediate, aggressive cooling via cold-water immersion ensure survival from this medical condition. However, little is known about the recovery, medical follow-up, and return to activity after an athlete has suffered EHS.


To highlight the transfer of evidenced-based research into clinical practice by chronicling the treatment, recovery, and return to activity of a runner who suffered an EHS during a warm-weather road race.


Case study.


Warm-weather road race.


53-y-old recreationally active man.


A runner’s treatment, recovery, and return to activity from EHS and 2014 Falmouth Road Race performance.

Main Outcomes:

Runner’s perceptions and experiences with EHS, body temperature, heart rate, hydration status, exercise intensity.


The runner successfully completed the 2014 Falmouth Road Race without incident of EHS. Four dominant themes emerged from the data: predisposing factors, ideal treatment, lack of medical follow-up, and patient education. The first theme identified 3 predisposing factors that contributed to the runner’s EHS: hydration, sleep loss, and lack of heat acclimatization. The runner received ideal treatment using evidence-based best practices. A lack of long-term medical care following the EHS with no guidance on the runner’s return to full activity was observed. The runner knew very little about EHS before the 2013 race, which drove him to seek knowledge as to why he suffered EHS. Using this newly learned information, he successfully completed the 2014 Falmouth Road Race without incident.


This case supports prior literature examining the factors that predispose individuals to EHS. Although evidence-based best practices regarding prompt recognition and treatment of EHS ensure survival, this case highlights the lack of medical follow-up and physician-guided return to activity after EHS.

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Semyon M. Slobounov, Robert Simon, Wayne Sebastianelli, Angela Carlson, and William E. Buckley

A variety of assessment devices have been developed for scientific investigation on human movement that can also be used to assess the progress of a rehabilitation program. The present investigation was undertaken to show how this technology can be combined with the most aggressive type of medical intervention and rehabilitation. Advanced technology was used to assess the physical rehabilitation parameters of active range of motion (AROM) and sport-specific functional progression for an Olympic-caliber diver who had bilateral wrist problems. AROM was measured for both wrists using a Flock of Birds motion-tracking device, and functional progression was assessed with an Advanced Mechanical Technology Inc. force platform for measuring the center of pressure (CP) area. The results of the treatment were clinically favorable, with an increase in AROM and a decrease in the CP area for functional motor control. The technology provided useful information about the progress of a rehabilitation program.

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Alireza Esmaeili, Andrew M. Stewart, William G. Hopkins, George P. Elias, and Robert J. Aughey


Detrimental changes in tendon structure increase the risk of tendinopathies. The aim of this study was to investigate the influence of individual internal and external training loads and leg dominance on changes in the Achilles and patellar tendon structure.


The internal structure of the Achilles and patellar tendons of both limbs of 26 elite Australian footballers was assessed using ultrasound tissue characterization at the beginning and the end of an 18-wk preseason. Linear-regression analysis was used to estimate the effects of training load on changes in the proportion of aligned and intact tendon bundles for each side. Standardization and magnitude-based inferences were used to interpret the findings.


Possibly to very likely small increases in the proportion of aligned and intact tendon bundles occurred in the dominant Achilles (initial value 81.1%; change, ±90% confidence limits 1.6%, ±1.0%), nondominant Achilles (80.8%; 0.9%, ±1.0%), dominant patellar (75.8%; 1.5%, ±1.5%), and nondominant patellar (76.8%; 2.7%, ±1.4%) tendons. Measures of training load had inconsistent effects on changes in tendon structure; eg, there were possibly to likely small positive effects on the structure of the nondominant Achilles tendon, likely small negative effects on the dominant Achilles tendon, and predominantly no clear effects on the patellar tendons.


The small and inconsistent effects of training load are indicative of the role of recovery between tendon-overloading (training) sessions and the multivariate nature of the tendon response to load, with leg dominance a possible influencing factor.

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Darin A. Padua, Kevin M. Guskiewicz, William E. Prentice, Robert E. Schneider, and Edgar W. Shields


To determine whether select shoulder exercises influence shoulder-rotation strength, active angle reproduction (AAR), single-arm dynamic stability, and functional throwing performance in healthy individuals.






54, randomly placed in 4 training groups.


Four 5-week training protocols.

Main Outcome Measures:

Average shoulder-rotation torque, AAR, single-arm dynamic stability, and functional throwing performance.


Repeated-measures ANOVAs revealed a significant group-by-test interaction for average torque (P > .05). Post hoc analyses revealed significantly increased average torque in the open kinetic chain and proprioceptive neuromuscular facilitation (PNF) groups after training. AAR and sway velocity were not affected in any of the groups (P > .05), but functional performance revealed a significant group-by-test interaction (P < .05). Post hoc analysis demonstrated that the PNF group significantly improved after training (P < .05).


Shoulder strength can be improved in healthy individuals, but improvements depend on the exercise performed. Shoulder proprioception and neuromuscular control were unchanged in all groups, but functional performance improved in the PNF group

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Samuel T. Howe, Robert J. Aughey, William G. Hopkins, and Andrew M. Stewart

Purpose: Can power law models accurately predict the peak intensities of rugby competition as a function of time? Methods: Match movement data were collected from 30 elite and 30 subelite rugby union athletes across competitive seasons, using wearable Global Navigation Satellite Systems and accelerometers. Each athlete’s peak rolling mean value of each measure (mean speed, metabolic power, and PlayerLoad) for 8 durations between 5 seconds and 10 minutes was predicted by the duration with 4 power law (log–log) models, one for forwards and backs in each half of a typical match. Results: The log of peak exercise intensity and exercise duration (5–600 s) displayed strong linear relationships (R 2 = .967–.993) across all 3 measures. Rugby backs had greater predicted intensities for shorter durations than forwards, but their intensities declined at a steeper rate as duration increased. Random prediction errors for mean speed, metabolic power, and PlayerLoad were 5% to 6%, 7% to 9%, and 8% to 10% (moderate to large), respectively, for elite players. Systematic prediction errors across the range of durations were trivial to small for elite players, underestimating intensities for shorter (5–10 s) and longer (300–600 s) durations by 2% to 4% and overestimating 20- to 120-second intensities by 2% to 3%. Random and systematic errors were slightly greater for subelites compared to elites, with ranges of 4% to 12% and 2% to 5%, respectively. Conclusions: Peak intensities of professional rugby union matches can be predicted with adequate precision (trivial to small errors) for prescribing training drills of a given duration, irrespective of playing position, match half, level of competition, or measure of exercise intensity. However, practitioners should be aware of the substantial (moderate to large) prediction errors at the level of the individual player.

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Nigel R. Green, William M. Roberts, Dwayne Sheehan, and Richard J. Keegan

Physical literacy is creating significant interest worldwide due to its holistic nature and the potential it has to impact on people’s lives. It is underpinning many physical education programs, coaching strategies, health initiatives, and policymakers’ decisions. However, the complex philosophical and holistic nature of the concept has meant that methods used to chart/assess/measure progress have been very much dependent on the pedagogues interpretation of the concept. This paper will provide a review of current practices and issues related to charting/assessing/measuring progress of an individual’s journey. It will go on to highlight considerations that, we suggest, should be made by any organization developing methods to chart/assess/measure progress.

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Brendan H. Lazarus, William G. Hopkins, Andrew M. Stewart, and Robert J. Aughey

Effects of fixture and team characteristics on match outcome in elite Australian football were quantified using data accessed at for 5109 matches for seasons 2000 to 2013. Aspects of each match included number of days’ break between matches (≤7 d vs ≥8 d), location (home vs away), travel status (travel vs no travel), and differences between opposing teams’ mean age, body mass, and height (expressed as quintiles). A logistic-regression version of the generalized mixed linear model estimated each effect, which was assessed with magnitude-based inference using 1 extra win or loss in every 10 matches as the smallest important change. For every 10 matches played, the effects were days’ break, 0.1 ± 0.3 (90% CL) wins; playing away, 1.5 ± 0.6 losses; traveling, 0.7 ± 0.6 losses; and being in the oldest, heaviest, or shortest, quintile, 1.9 ± 0.4, 1.3 ± 0.4, and 0.4 ± 0.4 wins, respectively. The effects of age and body-mass difference were not reduced substantially when adjusted for each other. All effects were clear, mostly at the 99% level. The effects of playing away, travel, and age difference were not unexpected, but the trivial effect of days’ break and the advantage of a heavier team will challenge current notions about balancing training with recovery and about team selection.

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Semyon M. Slobounov, Shannon T. Poole, Robert F. Simon, Elena S. Slobounov, Jill A. Bush, Wayne Sebastianelli, and William Kraemer

Assessment and enhancement of joint position sense is an inexact science at best. Anew method of evaluating and improving this sense using motion-tracking technology that incorporates computer visualization graphics was examined. Injured and healthy subjects were evaluated for their abilities to determine shoulder joint position, after abduction, in two tasks. The first was active reproduction of a passively placed angle. The second was visual reproduction of such an angle. A training protocol was added to determine the effectiveness of proprioceptive training in conjunction with 3-D visualization techniques. The primary findings were (a) a significant difference (p = .05) in the level of joint position sense in injured vs. healthy subjects; (b) significantly less accurate reproduction of larger shoulder abduction vs. the smaller movement in the active reproduction task; (c) significantly greater ability to accurately reproduce angles actively vs. visually; and (d) that proprioception training using 3-D visualization techniques significantly increased active and visual reproductions of passively placed angles.

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Antonio Bernabe-Ortiz, Rodrigo M. Carrillo-Larco, Robert H. Gilman, Liam Smeeth, William Checkley, and J. Jaime Miranda

Background: The long-term health association of the leisure-time and transport-related physical activity domains of the International Physical Activity Questionnaire have not been established in Latin American settings. The authors aimed to quantify the 7-year all-cause mortality risk associated with levels of leisure-time and transport-related physical activity. Methods: Ongoing prospective cohort study conducted in 4 sites in Peru. People ≥35 years were randomly selected from the general population in each study site. The exposures were leisure-time and transport-related physical activity (International Physical Activity Questionnaire) at baseline. The outcome was all-cause mortality based on information retrieved from national records. Cox regression and sensitivity analyses were conducted. Results: There were 3601 people (mean age 55.8 y, 51.5% women). Greater levels of physical activity were associated with lower risk of all-cause mortality, an observation confirmed in sensitivity analyses. Compared with those with low levels of physical activity, leisure-time (≥500 metabolic equivalent of task minutes per week) and transport-related (500–1499 and ≥1500 metabolic equivalent of task minutes per week) physical activity were associated with 70% (95% confidence interval, 3%–90%), 43% (95% confidence interval, 18%–61%), and 42% (95% confidence interval, 8%–63%) lower all-cause mortality, respectively. Conclusions: Greater levels of leisure-time and transport-related physical activity were associated with a strong reduction in the risk of all-cause mortality across different geographical sites.

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Tinker D. Murray, Jack Ransone, William C. Lockett, and Robert M. Markus Jr.

Column-editor : Joseph J. Piccininni