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Cecilia Winberg, Gunilla Carlsson, Christina Brogårdh and Jan Lexell

Maintaining regular physical activity (PA) can be challenging for persons with late effects of polio. This qualitative study of ambulatory persons with late effects of polio explored their perceptions of PA, as well as facilitators of and barriers to PA. Semistructured interviews were conducted with 15 persons and analyzed with content analysis using the International Classification of Functioning, Disability and Health (ICF) as a framework. The participants described positive perceptions of PA and its health benefits. PA was used to prevent further decline in functioning, and the type and frequency of activities had changed over time. Past experiences and personal characteristics impacted PA. Support from close relatives, knowledgeable health care professionals, mobility devices, and accessible environments facilitated PA, whereas impairments, inaccessible environments, and cold weather were the main barriers. To perform PA regularly, persons with late effects of polio may benefit from individualized advice based on their disability and personal and environmental factors.

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Michael B. Hudson

It can be challenging deciding how to resolve personal and professional dilemmas, and the dilemmas that athletic trainers and athletic therapists experience are no different, if not more complex, than the dilemmas other health care professionals experience. The moral behaviors individuals demonstrate with these dilemmas come from their experiences; however, moral beliefs may not always coincide with professional obligations and ethics. The purpose of this article is to examine factors that influence decision making for athletic trainers and athletic therapists to identify and describe policies for guiding moral behaviors in the workplace. These key policies include education in ethical decision making, developing a workplace code of conduct, communicating policies regarding professional behaviors, appraising accepted values and behaviors in the workplace, and investigating possible ethical violations and applying appropriate sanctions.

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Ross E. Andersen and John M. Jakicic

The aim of this review is to provide a scientific update on the current guidelines for both health and weight management. There has been confusion among health professionals as to which physical activity guidelines should be used to help various specific populations adopt more active lifestyles. We first review the history of the physical activity guidelines. Using the physical activity guidelines in clinical practice is also explored. We also describe common barriers to physical that overweight individuals report and we discuss when it is appropriate for a health care professional to seek a referral from an exercise scientist to help sedentary adults increase their levels of activity. It is important for individuals who care for overweight patients and sedentary adults to understand the current physical guidelines and how these guidelines can be worked into clinical practice.

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Troy R. Garrett and Peter J. Neibert

Clinical Scenario:

Injury to the plantar fascia, whether acute or chronic, is common among many populations. A conventional multiple-treatment approach is commonly administered by health care providers, consisting of controlling inflammation, managing pain, and promoting healing. Frequently, the initial treatment for plantar fasciitis is targeted at increasing dorsiflexion range of motion by stretching the gastroc-soleus musculature. It has been theorized that inflexibility of the gastroc-soleus complex can lead to excessive pronation and overcompensation of the plantar fascia at the first metatarsal phalangeal joint, therefore increasing the stress at the medial calcaneal insertion. Therefore, it is deemed that gastrocnemius–soleus stretches are a beneficial treatment in the initial stage of a plantar fasciitis treatment or rehabilitation program.

Focused Clinical Question:

Is a gastrocnemius–soleus stretching program, as a stand-alone treatment variable, effective in the treatment of plantar fasciitis?

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Ulrika Olsson Möller, Jimmie Kristensson, Patrik Midlöv, Charlotte Ekdahl and Ulf Jakobsson

Objectives:

To investigate the effects of a home-based one-year case management intervention in older people with functional dependency and repeated contact with the health care services on self-reported falls and self-reported injurious falls.

Methods:

The study was a randomized controlled trial with repeated follow-ups. The sample (n = 153) was consecutively and randomly assigned to the intervention group (n = 80, mean age = 81.4 [SD 5.9]) or control group (n = 73, mean age = 81.6 [SD 6.8]). The intervention group received a case management intervention which comprised monthly home visits during 12 months by nurses and physiotherapists employing a multifactorial preventive approach.

Results:

In the intervention group, 96 falls occurred during the intervention period compared with 85 falls in the control group (p = .900). There were 40 and 38 injurious falls (p = .669) in the intervention and control groups, respectively.

Conclusions:

This home-based case management intervention was not able to prevent falls or injurious falls.

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Christian C. Evans and Sandra L. Cassady

Objective:

To describe the underlying conditions that predispose athletes to sudden cardiac death (SCD) and review signs and symptoms that indicate an athlete is at risk.

Data Sources:

MEDLINE, the Los Angeles Times and Triathlon Times archives, and other sources identified in the references of articles initially located therein. A total of 43 references were included.

Conclusions:

Most cases of SCD in younger athletes (≤35 years) are attributable to multiple hereditary conditions, with familial hyper-trophic cardiomyopathy being the primary cause, whereas the major cause of SCD in older athletes (>35 years) is coronary artery disease. Health-care professionals evaluating athletes should pay particular attention to past medical and family history. Items in an athlete’s screening that suggest increased risk include a history of chest pain, syncope, excessive shortness of breath, irregular heart rate or murmur, or a history of SCD in an immediate family member.

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Lisa M. Stobierski, Shirleeah D. Fayson, Lindsay M. Minthorn, Tamara C. Valovich McLeod and Cailee E. Welch

Clinical Scenario:

Injuries are inevitable in the physically active population. As a part of preventive medicine, health care professionals often seek clinical tools that can be used in real time to identify factors that may predispose individuals to these injuries. The Functional Movement Screen (FMS), a clinical tool consisting of 7 individual tasks, has been reported as useful in identifying individuals in various populations that may be susceptible to musculoskeletal injuries. If factors that may predispose physically active individuals to injury could be identified before participation, clinicians may be able to develop a training plan based on FMS scores, which could potentially decrease the likelihood of injury and overall time missed from physical activities. However, in order for a screening tool to be used clinically, it must demonstrate acceptable reliability.

Focused Clinical Question:

Are clinicians reliable at scoring the FMS, in real time, to assess movement patterns of physically active individuals?

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Jacquelyn Allen Collinson

Despite a growing body of research on the sociology of time and, analogously, on the sociology of sport, to date there has been relatively little sports literature that takes time as the focus of the analysis. Given the centrality of time as a feature of most sports, this would seem a curious lacuna. The primary aims of this article are to contribute new perspectives on the subjective experience of sporting injury and to analyze some of the temporal dimensions of sporting “injury time” and subsequent rehabilitation. The article is based on data derived from a 2-year autoethnographic research project on 2 middle/long-distance runners, and concludes with some indicative comments regarding the need for sports physiotherapists and other health-care practitioners to take into account the subjective temporal dimension of injury and rehabilitative processes.

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Andrew T. Kaczynski and Karla A. Henderson

Background:

The purpose of this study was to review reported associations between parks and recreation settings (PRSs) as features of the built environment and various functions and intensities of physical activity (PA).

Methods:

By searching 4 major databases for the years 1998 to 2005, 50 articles were uncovered that reported quantitative relationships between PRSs and PA.

Results:

Most articles showed some significant positive relationships between PRSs and PA. PRSs were more likely to be positively associated with PA for exercise or utilitarian functions than for recreational PA. Mixed results were observed for the associations between PRSs and both moderate and vigorous PA, but PRSs were commonly associated with walking.

Conclusions:

The studies indicated links between PRSs and PA and provided evidence for the contributions parks and recreation makes as part of the “health care” system within communities. Because of the ubiquity of PRSs and their potential contributions to active living, these relationships merit further exploration.

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James F. Sallis and Kevin Patrick

The International Consensus Conference on Physical Activity Guidelines for Adolescents convened to review the effects of physical activity on the health of adolescents, to establish age-appropriate physical activity guidelines, and to consider how these guidelines might be implemented in primary health care settings. Thirty-four invited experts and representatives of scientific, medical, and governmental organizations established two main guidelines. First, all adolescents should be physically active daily or nearly every day as part of their lifestyles. Second, adolescents should engage in three or more sessions per week of activities that last 20 min or more and that require moderate to vigorous levels of exertion. Available data suggest that the vast majority of U.S. adolescents meet the first guideline, but only about two thirds of boys and one half of girls meet the second guideline. Physical activity has important effects on the health of adolescents, and the promotion of regular physical activity should be a priority for physicians and other health professionals.