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Alex Antonio Florindo, Evelyn Fabiana Costa, Thiago Herick Sa, Taynã Ishii dos Santos, Marília Velardi and Douglas Roque Andrade


The aim of this study was to describe a methodology for training to provide counseling on physical activity among community health workers working within primary healthcare in Brazil.


This was an intervention study conducted with 65 community health workers in the Ermelino Matarazzo district in the São Paulo, Brazil (30 in intervention group). The intervention group received a course of 12 hours (with 4 meetings of 3 hours each in 1 month) that aimed to improve their knowledge and be autonomous with regard to promoting physical activity. For data analysis, focus groups and questionnaires on knowledge and perceptions regarding physical activity were used.


The average attendance for the 4 meetings was 29 workers (93% of total). There was an improvement in knowledge on physical activity recommendations in comparison with the control (P = .03), and qualitative results revealed that the professionals appreciated the learned content, valued its application based on knowledge construction and felt secure about promoting physical activity. This was seen through high adherence levels and construction collective of proposal for home visits for physical activity promotion.


The training was effective in improving knowledge and attitudes toward counseling on physical activity among community health workers.

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Anne-Marie Elbe, Svein Barene, Katharina Strahler, Peter Krustrup and Andreas Holtermann

Flow is a rewarding psychological state that motivates individuals to repeat activities. This study explored healthcare workers’ flow experiences during a workplace exercise intervention. Seventy-nine females were assigned to either a 12-week football or Zumba exercise intervention and their flow experiences were assessed at the beginning, midway and at the end of the intervention. The results showed that both intervention groups experienced medium levels of flow and an increase in flow values over time. A significant positive correlation between experiencing flow midway through the intervention and adherence to regular physical activity 18 weeks after the end of the intervention was found. Furthermore, repeated measures throughout the intervention period showed a significantly different development of flow values over time for the adherers and nonadherers. Flow therefore may be of importance for adherence to regular workplace physical activity. Future research needs to investigate the importance of flow in other physical activity settings, especially also for male participants.

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Rebecca A. Schlaff, Claudia Holzman, Lanay M. Mudd, Karin A. Pfeiffer and James M. Pivarnik


Little is known about how leisure-time physical activity (LTPA) influences gestational weight gain (GWG) among body mass index (BMI) categories. The purpose of this study was to examine the relationship between pregnancy LTPA and the proportion of normal, overweight, and obese women who meet GWG recommendations.


Participants included 449 subcohort women from the Pregnancy Outcomes and Community Health (POUCH) study. LTPA was collapsed into 3 categories [(None, < 7.5 kcal/kg/wk (low), ≥ 7.5 kcal/kg/wk (recommended)]. GWG was categorized according to IOM recommendations (low, recommended, or excess). Chi-square and logistic regression analyses were used to evaluate relationships among LTPA, BMI, and GWG.


Overweight women were more likely to have high GWG vs. normal weight women (OR = 2.3, 95% CI 1.3–4.0). Obese women were more likely to experience low GWG (OR = 7.3, 95% CI 3.6–15.1; vs. normal and overweight women) or excess GWG (OR = 3.5, 95% CI 1.9–6.5; vs. normal weight women). LTPA did not vary by prepregnancy BMI category (P = .55) and was not related to GWG in any prepregnancy BMI category (P = .78).


Regardless of prepregnancy BMI, LTPA did not affect a woman’s GWG according to IOM recommendations. Results may be due to LTPA not differing among BMI categories.

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Glenn E. Cashman


It has been postulated that subjects with weak hip abductors and external rotators may demonstrate increased knee valgus, which may in turn raise risk of injury to the lower extremity. Recent studies have explored the potential link between hip strength and knee kinematics, but there has not yet been a review of this literature.


To conduct a systematic review assessing the potential link between hip-abductor or external-rotator strength and knee-valgus kinematics during dynamic activities in asymptomatic subjects.

Evidence Acquisition:

An online computer search was conducted in early February 2011. Databases included Medline, EMBASE, CINAHL, SPORTDiscus, and Google Scholar. Inclusion criteria were English language, asymptomatic subjects, dynamometric hip-strength assessment, single or multicamera kinematic analysis, and statistical analysis of the link between hip strength and knee valgus via correlations or tests of differences. Data were extracted concerning subject characteristics, study design, strength measures, kinematic measures, subject tasks, and findings with regard to correlations or group differences.

Evidence Synthesis:

Eleven studies were selected for review, 4 of which found evidence that subjects with weak hip abductors or external rotators demonstrated increased knee valgus, and 1 study found a correlation to the contrary.


There is a small amount of evidence that healthy subjects with weak hip abductors and perhaps weak external rotators demonstrate increased knee valgus. However, due to the variation in methodology and lack of agreement between studies, it is not possible to make any definitive conclusions or clinical recommendations based on the results of this review. Further research is needed.

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Gil Rodas, Lourdes Osaba, David Arteta, Ricard Pruna, Dolors Fernández and Alejandro Lucia

Purpose: The authors investigated the association between risk of tendinopathies and genetic markers in professional team sports. Methods: The authors studied 363 (mean [SD]; 25 [6] y, 89% male) elite players (soccer, futsal, basketball, handball, and roller hockey) from a top-level European team (FC Barcelona, Spain). Of 363, 55% (cases) had experienced 1+ episodes of tendinopathy during 2008–2018 and 45% (controls) remained injury free. The authors first examined the association between single-nucleotide polymorphisms (SNPs) and tendinopathy risk in a hypothesis-free case-control genome-wide association study (495,837 SNPs) with additional target analysis of 58 SNPs that are potential candidates to influence tendinopathy risk based on the literature. Thereafter, the authors augmented the SNP set by performing synthetic variant imputation (1,419,369 SNPs) and then used machine learning-based multivariate modeling (support vector machine and random forest) to build a reliable predictive model. Results: Suggestive association (P < 10−5) was found for rs11154027 (gap junction alpha 1), rs4362400 (vesicle amine transport 1-like), and rs10263021 (contactin-associated protein-like 2). Carriage of 1+ variant alleles for rs11154027 (odds ratio = 2.11; 95% confidence interval, 1.07–4.19, P = 1.01 × 10−6) or rs4362400 (odds ratio = 1.98; 95% confidence interval, 1.05–3.73, P = 9.6 × 10−6) was associated with a higher risk of tendinopathy, whereas an opposite effect was found for rs10263021 (odds ratio = 0.42; 95% confidence interval, 0.20–0.91], P = 4.5 × 10−6). In the modeling approach, one of the most robust SNPs was rs10477683 in the fibrillin 2 gene encoding fibrillin 2, a component of connective tissue microfibrils involved in elastic fiber assembly. Conclusions : The authors have identified previously undescribed genetic predictors of tendinopathy in elite team sports athletes, notably rs11154027, rs4362400, and rs10263021.

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D. Enette Larson-Meyer, Kathleen Woolf and Louise Burke

Nutrition assessment is a necessary first step in advising athletes on dietary strategies that include dietary supplementation, and in evaluating the effectiveness of supplementation regimens. Although dietary assessment is the cornerstone component of the nutrition assessment process, it should be performed within the context of a complete assessment that includes collection/evaluation of anthropometric, biochemical, clinical, and environmental data. Collection of dietary intake data can be challenging, with the potential for significant error of validity and reliability, which include inherent errors of the collection methodology, coding of data by dietitians, estimation of nutrient composition using nutrient food tables and/or dietary software programs, and expression of data relative to reference standards including eating guidance systems, macronutrient guidelines for athletes, and recommended dietary allowances. Limitations in methodologies used to complete anthropometric assessment and biochemical analysis also exist, as reference norms for the athlete are not well established and practical and reliable biomarkers are not available for all nutrients. A clinical assessment collected from history information and the nutrition-focused physical exam may help identify overt nutrient deficiencies but may be unremarkable in the well-trained athlete. Assessment of potential food-drug interactions and environmental components further helps make appropriate dietary and supplement recommendations. Overall, the assessment process can help the athlete understand that supplement intake cannot make up for poor food choices and an inadequate diet, while a healthy diet helps ensure maximal benefit from supplementation. Establishment of reference norms specifically for well-trained athletes for the nutrition assessment process is a future research priority.

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Gregory Knell, Henry S. Brown, Kelley P. Gabriel, Casey P. Durand, Kerem Shuval, Deborah Salvo and Harold W. Kohl III

walking spaces. 1 Of particular interest is the economic value of sidewalk infrastructure, that is, could sidewalks promote increased physical activity to the extent it offsets the cost of the sidewalk improvements through reductions in health care expenditures? This question could best be answered by

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Nicole J. Chimera, Monica R. Lininger and Meghan Warren

that exercise, while necessary for overall health and wellness, 3 does pose a risk for injury. 4 Unlike sanctioned intercollegiate and high school sports, injuries during recreational sports are less clear and the risk is probably underestimated due to lack of access to health care personnel during

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Katie J. Lyman, Michael McCrone, Thomas A. Hanson, Christopher D. Mellinger and Kara Gange

Cryotherapy is a common therapy used by allied health care professionals to treat orthopedic injuries 1 and to manage acute musculoskeletal injuries. 2 Purported benefits of cryotherapy include minimizing inflammation, edema, hypoxic injury, and soft-tissue damage, as well as reducing muscle