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Scott O. McDoniel

With the number of individuals becoming overweight or obese, health care professionals are in need of accurate, reliable, and convenient tools to help personalize weight-loss programs. Recently, a new handheld indirect calorimeter (i.e., MedGem/BodyGem; also know as “Gem”) was introduced as a convenient way to assess resting metabolic rate (RMR) to determine daily energy needs. Several validation and comparison studies were conducted to determine whether the Gem device is accurate and reliable, and results from these studies are mixed. Fourteen human studies (12 adult, 2 pediatric) were conducted, and 12 met the established criteria for this review. In all Douglas-bag (DB; n = 4) validation studies, the Gem device was not significantly different than the DB (mean difference adult ±1%, pediatric ±1%). The intra class reliability of the Gem ranged from 0.97 to 0.98, and the interclass reliability to the DB ranged from 0.91 to 0.97. Although few (n = 2) studies have demonstrated that the Gem device measures RMR significantly lower (–8.2% to 15.1%) than traditional metabolic carts, it performs very comparably (RMR values 0.1–4.0%, interclass reliability 0.76–0.92) to traditional metabolic carts in most (n = 6) of the comparison studies. Based on these data, the Gem device is a valid and reliable indirect calorimeter for energy assessment in most adults and children.

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Robert M. Kaplan, Alison K. Herrmann, James T. Morrison, Laura F. DeFina and James R. Morrow Jr.

Background:

Despite benefits of physical activity (PA), exercise is also associated with risks. Musculoskeletal injury (MSI) risk increases with exercise frequency/intensity. MSI is associated with costs including medical care and time lost from work.

Purpose:

To evaluate the economic costs associated with PA-related MSIs in community-dwelling women.

Method:

Participants included 909 women in the Women’s Injury Study reporting PA behaviors and MSI incidence weekly via the Internet for up to 3 years (mean follow-up 1.89 years). Participants provided consent to obtain health records. Costs were estimated by medical records and self-reports of medical care. Components included physician visits, medical facility contacts, medication costs, and missed work.

Results:

Of 909 participants, 243 reported 323 episodes of expenditure or contact with the health care system associated with PA. Total costs of episodes ranged from $0–$18,934. Modal cost was $0 (mean = $433 ± $1670). Costs were positively skewed with nearly all participants reporting no or very low costs.

Conclusions:

About 1 in 4 community-dwelling women who are physically active experienced a PA-related MSI. The majority of injuries were minor, and large expenses associated with MSI were rare. The long-term health benefits and costs savings resulting from PA likely outweigh the minor costs associated with MSI from a physically-active lifestyle.

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Jessica R. Edler, Kenneth E. Games, Lindsey E. Eberman and Leamor Kahanov

The tibial plateau is a critical load-bearing surface in humans. Although tibial plateau fractures represent only 1% of all fractures, proper management by all members of the health care team, including athletic trainers, physicians, and physical therapists, is required for successful patient outcomes. A 14-year-old national-level competitive female diver injured her right knee during the precompetition warm-up period. Upon evaluation by an athletic trainer, the patient was referred for imaging and examination by a physician. She was seen by an orthopedic surgeon for consultation. The patient elected for a surgical repair of the tibial plateau fracture. Following surgery she underwent an 11-week comprehensive therapeutic exercise program with athletic trainers and physical therapists. The patient’s return-to-play progression included dry land activities, platform diving, 1-m springboard diving, and 3-m springboard diving. The patient has successfully returned to competitive diving. Proper identification of tibial fractures can be difficult considering their low occurrence in youth and their similar clinical presentation to more common youth injuries such as anterior cruciate ligament ruptures. Clinicians providing immediate on-site medical care should be thorough in their clinical exam including palpation and axial loading of the joint.

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Christina Tsitsimpikou, Nastasia Chrisostomou, Peter Papalexis, Konstantinos Tsarouhas, Aristidis Tsatsakis and Athanasios Jamurtas

Although the use of nutritional supplements by professional athletes and the benefits thereof have been extensively studied, information on recreational athletes’ use of supplements is limited. This study investigated the consumption of nutritional supplements, source of information and supply of supplements, and level of awareness with regard to the relevant legislation among individuals who undertake regular exercise in Athens, Greece. A closed-ended, anonymous questionnaire was answered by 329 subjects (180 men, 149 women), age 30.6 ± 12.1 yr, from 11 randomly selected gym centers. Preparations declared as anabolic agents by the users were submitted to a gas chromatographic analyzer coupled to a mass spectrometric detector. Consumption of nutritional supplements was reported by 41% of the study population, with proteins/amino acids and vitamins being the most popular. Age (r = .456, p = .035), sex (χ2 = 14.1, df = 1, p < .001), level of education (χ2 = 14.1, df = 3, p < .001), and profession (χ2 = 11.4, df = 4, p = .022) were associated with the subjects’ decision to consume nutritional supplements. Most (67.1%) purchased products from health food stores. Only 17.1% had consulted a physician or nutritionist, and one third were aware of the relevant legislation. Two preparations were detected containing synthetic anabolic steroids not stated on the label. In conclusion, use of nutritional supplements was common among recreational athletes in Athens, Greece. A low level of awareness and low involvement of health care professionals as sources of information and supply were observed.

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Roy J. Shephard

The Journal of Physical Activity and Health seems likely to develop as a vehicle for practical, evidence-based answers to problems concerning physical activity and health, issues that have important implications for public health policy. There is strong epidemiological evidence for an association between the regular practice of physical activity and preventive or therapeutic benefit in a wide range of chronic health conditions,1-4 and already many professional groups have been eager to pre¬pare position statements, indicating their assessments of an appropriate minimum weekly dose of physical activity to maintain health.5 Unfortunately, there have been substantial discrepancies between successive recommendations, and uncertainties in the message are one probable factor, limiting its acceptance by both the general public and immediate health-care providers.6,7 The purpose of this brief commentary is to suggest some areas of investigation that would help in formulating a clear and consistent message. Topics discussed include the desired health outcome, the shape of the dose–response relationship, the impact of confounding variables, the quality of the evidence accepted, the basis for shaping the message, and the need for multiple messages.

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Brent C. Mangus

The number of wheelchair-bound athletes training for and competing in local, state, national, and international sporting events increases every year. As participation increases, sports injuries associated with the training and competition of these athletes also increase. Medical attention for wheelchair athletes during training and competition should be provided by competent professionals. However, even with competent professionals providing medical attention to wheelchair athletes, injuries do occur. Typical injuries experienced by the wheelchair-bound athlete include carpal tunnel syndrome, various shoulder problems, numerous problems with the hands, and lacerations, abrasions, and contusions to all parts of the body. The ability of the wheelchair athlete to thermoregulate his or her own body is also an area of concern for those providing health care during practice and competition. More researchers are studying injuries and injury rates to the wheelchair athlete, and the body of literature in this area is becoming larger. Future research can begin to document the effects of strength training, nutrition, various conditioning strategies, the biomechanics of the wheelchair motion, and the psychological impact of athletic injuries. Although some physiological factors have been studied, many remain to be addressed in an effort to shed light on the injuries experienced by wheelchair athletes.

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Barry D. McPherson

With the aging of the population, an increasing sex ratio of women to men, the potential for increased disability-free life expectancy, and increasing health-care costs, health promotion and physical activity personnel engaged in research, policy, or practice need a full understanding of the physical, cultural, and social context in which consecutive age cohorts move through life. This paper integrates research information from health promotion, the physical activity sciences, social gerontology, and demography; it is divided into six sections focusing on demographic and cultural diversity, the cultural meaning of physical activity, active lifestyles, catalysts and barriers to the emergence of an active older population, and promoting lifelong active living. Employing a macro (societal) rather than a micro (individual) level of analysis, the paper emphasizes that aging is a lifelong social process leading to diverse lifestyles in middle and later adulthood, that there is considerable heterogeneity in physical and social experiences and capacities within and between age cohorts, and that aging is a women’s issue, particularly with respect to health and activity promotion.

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Colleen A. Cuthbert, Kathryn King-Shier, Dean Ruether, Dianne M. Tapp and S. Nicole Culos-Reed

Background:

Family caregivers are an important health care resource and represent a significant proportion of Canadian and US populations. Family caregivers suffer physical and psychological health problems because of being in the caregiver role. Interventions to support caregiver health, including physical activity (PA), are slow to be investigated and translated into practice.

Purpose:

To examine the evidence for PA interventions in caregivers and determine factors hampering the uptake of this evidence into practice.

Methods:

A systematic review and evaluation of internal and external validity using the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework was conducted. Randomized controlled trials or pretest/posttest studies of PA interventions were included.

Results:

Fourteen studies were published between 1997 and 2015. Methodological quality of studies and risk of bias was variable. External validity criteria were often not reported. Mean reporting levels were 1) reach, 53%; 2) efficacy/effectiveness, 73%; 3) adoption, 18%; 4) implementation, 48%; and 5) maintenance, 2%.

Conclusions:

The lack of reporting of components of internal and external validity hinders the integration of caregiver PA interventions into clinical or community settings. Researchers should focus on standardized outcomes, accepted reporting criteria, and balancing factors of internal and external validity, to advance the state of the science.

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James L. Farnsworth, Youngdeok Kim and Minsoo Kang

Background:

Disruptive sleeping patterns have been linked to serious medical conditions. Regular physical activity (PA) has a positive impact on health; however, few research have investigated the relationships between PA, body mass index (BMI), sedentary behaviors (SB), and sleep disorders (SD).

Methods:

Data from the 2005–2006 NHANES were analyzed for this study. Participants (N = 2989; mean age = 50.44 years) were grouped based upon responses to SD questions. Accelerometers were used to measure the average time spent in moderate or vigorous physical activity (MVPA) and SB. Multinomial logistic regression analyses were used to examine the associations between PA, SB, and SD after controlling for covariates and to explore potential moderation effects among common risk factors and the main study variables.

Results:

Among middle-aged adults, PA was significantly associated with SD [Wald χ2 (8) = 22.21; P < .001]. Furthermore, among adults in the highest tertile of SB, PA was significantly associated with SD [Wald χ2 (8) = 32.29; P < .001].

Conclusions:

These results indicate that middle-aged adults who are less active may have increased likelihoods of SD. It is important for health care professionals to continue developing methods for increasing PA to decrease the risk of SD.

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Anna Melin, Monica Klungland Torstveit, Louise Burke, Saul Marks and Jorunn Sundgot-Borgen

Disordered eating behavior (DE) and eating disorders (EDs) are of great concern because of their associations with physical and mental health risks and, in the case of athletes, impaired performance. The syndrome originally known as the Female Athlete Triad, which focused on the interaction of energy availability, reproductive function, and bone health in female athletes, has recently been expanded to recognize that Relative Energy Deficiency in Sport (RED-S) has a broader range of negative effects on body systems with functional impairments in both male and female athletes. Athletes in leanness-demanding sports have an increased risk for RED-S and for developing EDs/DE. Special risk factors in aquatic sports related to weight and body composition management include the wearing of skimpy and tight-fitting bathing suits, and in the case of diving and synchronized swimming, the involvement of subjective judgments of performance. The reported prevalence of DE and EDs in athletic populations, including athletes from aquatic sports, ranges from 18 to 45% in female athletes and from 0 to 28% in male athletes. To prevent EDs, aquatic athletes should practice healthy eating behavior at all periods of development pathway, and coaches and members of the athletes’ health care team should be able to recognize early symptoms indicating risk for energy deficiency, DE, and EDs. Coaches and leaders must accept that DE/EDs can be a problem in aquatic disciplines and that openness regarding this challenge is important.