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Cora Lynn Craig


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.


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.


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.


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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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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Janet Simon and Matt Donahue

Clinical Scenario:

Ankle taping and bracing are commonly used to reduce the risk of sports-related ankle sprains. Mechanical- and neuromuscular-control facilitation has been the focus of their effectiveness. Another potential advantage to using ankle taping or bracing is an increased sense of confidence, stability, and reassurance that the individual may experience when performing a dynamic-balance activity. Since ankle sprains are one of the most common sport-related injuries treated by clinicians, treatment and prevention of these injuries is a priority for many health care providers. However, the psychological effects of taping or bracing on athletes are still unknown. Researchers have described athletes’ emotional responses and psychological reactions after athletic injuries. However, athlete reactions related to adhesive taping or bracing are limited. There is anecdotal evidence showing that football players stated they would tape a body part even if it was not injured as part of a superstitious pregame ritual. Therefore, the purpose of this article was to determine if individuals who have had their ankle taped or braced experience an increased sense of confidence, stability, or reassurance when performing a dynamic-balance activity.

Focused Clinical Question:

Does ankle taping or bracing create an increased sense of confidence, stability, and reassurance when performing dynamic-balance activity in physically active people?

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Derek T. Smith, Stacey Judge, Ashley Malone, Rebecca C. Moynes, Jason Conviser and James S. Skinner

Reduced strength, balance, and functional independence diminish quality of life and increase health care costs. Sixty adults (82.2 ± 4.9 years) were randomized to a control or three 12-week intervention groups: bioDensity (bD); Power Plate (PP) whole-body vibration (WBV); or bD+PP. bD involved one weekly 5-s maximal contraction of four muscle groups. PP involved two 5-min WBV sessions. Primary outcomes were strength, balance, and Functional Independence Measure (FIM). No groups differed initially. Strength significantly increased 22–51% for three muscle groups in bD and bD+PP (P < .001), with no changes in control and PP. Balance significantly improved in PP and bD+PP but not in control or bD. bD, PP, and bD+PP differentially improved FIM self-care and mobility. Strength improvements from weekly 5-min sessions of bD may impart health/clinical benefits. Balance and leg strength improvements suggest WBV beneficially impacts fall risk and incidence. Improved FIM scores are encouraging and justify larger controlled trials on bD and bD+PP efficacy.

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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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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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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.

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Kim D. Lu, Krikor Manoukian, Shlomit Radom-Aizik, Dan M. Cooper and Stanley P. Galant

Obesity increases the risk of asthma throughout life but the underlying mechanisms linking these all too common threats to child health are poorly understood. Acute bouts of exercise, aerobic fitness, and levels of physical activity clearly play a role in the pathogenesis and/or management of both childhood obesity and asthma. Moreover, both obesity and physical inactivity are associated with asthma symptoms and response to therapy (a particularly challenging feature of obesity-related asthma). In this article, we review current understandings of the link between physical activity, aerobic fitness and the asthma-obesity link in children and adolescents (e.g., the impact of chronic low-grade inflammation, lung mechanics, and direct effects of metabolic health on the lung). Gaps in our knowledge regarding the physiological mechanisms linking asthma, obesity and exercise are often compounded by imprecise estimations of adiposity and challenges of assessing aerobic fitness in children. Addressing these gaps could lead to practical interventions and clinical approaches that could mitigate the profound health care crisis of the increasing comorbidity of asthma, physical inactivity, and obesity in children.

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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.