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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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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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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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Eric Emmanuel Coris, Stephen Walz, Jeff Konin and Michele Pescasio

Context:

Heat illness is the third leading cause of death in athletics and a leading cause of morbidity and mortality in exercising athletes. Once faced with a case of heat related illness, severe or mild, the health care professional is often faced with the question of when to reactivate the athlete for competitive sport. Resuming activity without modifying risk factors could lead to recurrence of heat related illness of similar or greater severity. Also, having had heat illness in and of itself may be a risk factor for future heat related illness. The decision to return the athlete and the process of risk reduction is complex and requires input from all of the components of the team. Involving the entire sports medicine team often allows for the safest, most successful return to play strategy. Care must be taken once the athlete does begin to return to activity to allow for re-acclimatization to exercise in the heat prior to resumption particularly following a long convalescent period after more severe heat related illness.

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Cora Lynn Craig

Background:

Low levels of physical activity (PA) and fitness have long been a government concern in Canada; however, more than half of adults are inactive. This article examines factors influencing policy development and implementation using Canadian PA policy as a case study.

Methods:

Current and historical PA policy documents were amassed from a literature review, audit of government and non government websites and from requests to government officials in each jurisdiction directly responsible for PA. These were analyzed to determine policy content, results, barriers, and success factors.

Results:

The national focus for PA policy in Canada has devolved to a multilevel system that meets most established criteria for successful strategies. Earlier PA targets have been met; however, the prevalence of PA decreased from 2005 to 2007. Annual per capita savings in health care associated with achieving the earlier target is estimated at $6.15 per capita, yet a fraction of that is directed to promoting PA.

Conclusion:

Evidenced-based strategies that address multiple policy agendas using sector-specific approaches are needed. Sustained high-level commitment is required; advocacy grounded in metrics and science is needed to increase the profile of the issue and increase the commitments to PA policies in Canada and internationally.

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Robert Carter III, Samuel N. Cheuvront and Michael N. Sawka

Objectives:

We report our observations on one soldier with abnormal hyperthermia during exercise in the heat compared with prior exercise and following acute local (non-febrile) infection. Also, we report on 994 heat stroke hospitalizations in the U.S. Army. It is known that prior infection is a risk factor for heat illness and some of the 37 heat stroke deaths cited infections (eg, pneumonia, influenza) in the medical records.

Results:

This case report illustrates complete recovery from abnormal hyperthermia, which occurred in a laboratory setting during mild, low intensity exercise. In a field setting, this case may have resulted in serious heat illness. As with most of the heat stroke cases, rapid medical attention (ie, cooling and rehydration) and the age group (19 to 26) that represents majority of the heatstroke cases in U.S. Army are likely factors that contribute successful treatment of heatstroke in the field environment.

Conclusions:

We conclude that acute inflammatory response can augment the hyperthermia of exercise and possibly increase heat illness susceptibility. Furthermore, it is important for health care providers of soldiers and athletes to monitor acute local infections due to the potential thermoregulatory consequences during exercise in the heat.

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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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Stefan C. Garcia, Jeffrey J. Dueweke and Christopher L. Mendias

Context: Manual isometric muscle testing is a common clinical technique used to assess muscle strength. To provide the most accurate data for the test, the muscle being assessed should be at a length in which it produces maximum force. However, there is tremendous variability in the recommended positions and joint angles used to conduct these tests, with few apparent objective data used to position the joint such that muscle-force production is greatest. Objective: To use validated anatomically and biomechanically based musculoskeletal models to identify the optimal joint positions in which to perform manual isometric testing. Design: In silico analysis. Main outcome measure: The joint position which produces maximum muscle force for 49 major limb and trunk muscles. Results: The optimal joint position for performing a manual isometric test was determined. Conclusion: Using objective anatomical models that take into account the force-length properties of muscles, the authors identified joint positions in which net muscle-force production was predicted to be maximal. This data can help health care providers to better assess muscle function when manual isometric strength tests are performed.

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Kevin Patrick, Michael Pratt and Robert E. Sallis

Background:

Healthcare professionals are influential sources of health information and guidance for people of all ages. However healthcare providers do not routinely address physical activity (PA). Engaging health professionals in a national plan for physical activity will depend upon whether proven strategies can be found to promote PA within clinical settings.

Methods:

The literature on promoting PA in healthcare settings was reviewed, as were recommendations from healthcare organizations and evidence-gathering entities about whether and how PA should be promoted in healthcare.

Key recommendations:

Evidence is mixed about whether interventions based in healthcare settings and offered by healthcare providers can improve PA behaviors in patients. Brief stand-alone counseling by physicians has not been shown to be efficacious, but office-based screening and advice to be active, followed by telephone or community support for PA has proven effective in creating lasting PA behavior improvement. Healthcare delivery models that optimize the organization of services across clinical and community resources may be very compatible with PA promotion in health care. Because of the importance of PA to health, healthcare providers are encouraged to consider adding PA as a vital sign for each medical visit for individuals aged 6 years and older.