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  • Author: William M. Roberts x
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William M. Adams, Yuri Hosokawa, Robert A. Huggins, Stephanie M. Mazerolle and Douglas J. Casa

Context:

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.

Objective:

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.

Design:

Case study.

Setting:

Warm-weather road race.

Participant:

53-y-old recreationally active man.

Intervention:

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.

Results:

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.

Conclusions:

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

Objective:

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.

Design:

Pretest–posttest.

Setting:

Laboratory.

Participants:

54, randomly placed in 4 training groups.

Intervention:

Four 5-week training protocols.

Main Outcome Measures:

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

Results:

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).

Conclusions:

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

Purpose:

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.

Methods:

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.

Results:

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.

Conclusion:

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

Column-editor : Joseph J. Piccininni

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J. Jaime Miranda, Rodrigo M. Carrillo-Larco, Robert H Gilman, Jose L. Avilez, Liam Smeeth, William Checkley, Antonio Bernabe-Ortiz and the CRONICAS Cohort Study Group

Background:

Physical inactivity and sedentary behaviors have been linked with impaired health outcomes. Establishing the physical inactivity profiles of a given population is needed to establish program targets and to contribute to international monitoring efforts. We report the prevalence of, and explore sociodemographical and built environment factors associated with physical inactivity in 4 resource-limited settings in Peru: rural Puno, urban Puno, Pampas de San Juan de Miraflores (urban), and Tumbes (semiurban).

Methods:

Cross-sectional analysis of the CRONICAS Cohort Study’s baseline assessment. Outcomes of interest were physical inactivity of leisure time (<600 MET-min/week) and transport-related physical activity (not reporting walking or cycling trips) domains of the IPAQ, as well as watching TV, as a proxy of sedentarism (≥2 hours per day). Exposures included demographic factors and perceptions about neighborhood’s safety. Associations were explored using Poisson regression models with robust standard errors. Prevalence ratios (PR) and 95% confidence intervals (95% CI) are presented.

Results:

Data from 3593 individuals were included: 48.5% males, mean age 55.1 (SD: 12.7) years. Physical inactivity was present at rates of 93.7% (95% CI 93.0%–94.5%) and 9.3% (95% CI 8.3%–10.2%) within the leisure time and transport domains, respectively. In addition, 41.7% (95% CI 40.1%–43.3%) of participants reported watching TV for more than 2 hours per day. Rates varied according to study settings (P < .001). In multivariable analysis, being from rural settings was associated with 3% higher prevalence of leisure time physical inactivity relative to highly urban Lima. The pattern was different for transport-related physical inactivity: both Puno sites had around 75% to 50% lower prevalence of physical inactivity. Too much traffic was associated with higher levels of transport-related physical inactivity (PR = 1.24; 95% CI 1.01–1.54).

Conclusions:

Our study showed high levels of inactivity and marked contrasting patterns by rural/urban sites. These findings highlight the need to generate synergies to expand nationwide physical activity surveillance systems.

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William J. Kraemer, N. Travis Triplett, Andrew C. Fry, L. Perry koziris, Jeffrey E. Bauer, James M. Lynch, Tim McConnell, Robert U. Newton, Scott E. Gordon, Richard C. Nelson and Howard G. Knuttgen

The purpose of this study was to provide an in-depth sports medicine profile of women college tennis players and determine the relationships among an array of performance and clinical variables. Thirty-eight non-resistance-trained women from NCAA Divisions I and III collegiate tennis teams participated. A comprehensive battery of performance tests was conducted on each subject, including measurements of dynamic, isometric, and isokinetic strength; joint laxity and flexibility; speed; agility; power and power endurance; peak oxygen consumption; body composition; and ball velocities of the serve, forehand, and backhand. It was found that no single variable strongly explains tennis performance. The low amount of shared variance of strength measures with ball velocities suggests that tennis skills play a large role in producing peak ball velocities in this group. Due to the large range observed in profiled variables, individual evaluation is needed for clinical and conditioning recommendations.