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Jordan Milsom, Paulo Barreira, Darren J. Burgess, Zafar Iqbal and James P. Morton

The onset of injury and subsequent period of immobilization and disuse present major challenges to maintenance of skeletal muscle mass and function. Although the characteristics of immobilization-induced muscle atrophy are well documented in laboratory studies, comparable data from elite athletes in free-living conditions are not readily available. We present a 6-month case-study account from a professional soccer player of the English Premier League characterizing rates of muscle atrophy and hypertrophy (as assessed by DXA) during immobilization and rehabilitation after ACL injury. During 8 weeks of inactivity and immobilization, where the athlete adhered to a low carbohydrate-high protein diet, total body mass decreased by 5 kg attributable to 5.8 kg loss and 0.8 kg gain in lean and fat mass, respectively. Changes in whole-body lean mass was attributable to comparable relative decreases in the trunk (12%, 3.8 kg) and immobilized limb (13%, 1.4 kg) whereas the nonimmobilized limb exhibited smaller declines (7%, 0.8 kg). In Weeks 8 to 24, the athlete adhered to a moderate carbohydrate-high protein diet combined with structured resistance and field based training for both the lower and upper-body that resulted in whole-body muscle hypertrophy (varying from 0.5 to 1 kg per week). Regional hypertrophy was particularly pronounced in the trunk and nonimmobilized limb during weeks 8 to 12 (2.6 kg) and 13 to 16 (1.3 kg), respectively, whereas the previously immobilized limb exhibited slower but progressive increases in lean mass from Week 12 to 24 (1.2 kg). The athlete presented after the totality of the injured period with an improved anthropometrical and physical profile.

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Margaret McGladrey, Angela Carman, Christy Nuetzman and Nicole Peritore

, where these agencies may be geographically dispersed. This brief report presents a case study of a public health practice effort to increase physical activity among individuals and communities using Extension as a backbone support organization. We contend that the collective impact model is a useful

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Luana Farias de Oliveira, Bryan Saunders and Guilherme Giannini Artioli

, body mass index: 24 kg/m 2 ) volunteered for this case study after being informed about the discomforts and risks, and provided written consent. The participant was 2 years postgastric bypass surgery (presurgery BM: 178.0 kg, body mass index: 46 kg/m 2 ), maintaining approximately 30 mL of stomach. The

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Ian N. Bezodis, David G. Kerwin, Stephen-Mark Cooper and Aki I.T. Salo

and healthy for the duration of data collection and reported no recent injuries. We adopted an observational, multiple-participant case study design. Table 1 Participant Information Participant Age, y Event,m EventPB, s Stature, m Mass,kg A1 29 100 9.98 1.76 75.0 A2 23 100 10.30 1.73 76.3 A3 18 100 10

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Karen Reid

Flatwater kayaking requires upper-body muscle strength and a lean body composition. This case study describes a nutrition intervention with a 19-year-old male elite sprint kayaker to increase muscle mass and improve recovery posttraining. Before the intervention, average daily energy intake was 13.6 ± 2.5 MJ (M ± SD; protein, 1.8 g/kg; carbohydrate, 3.6 g/kg), and the athlete was unable to eat sufficient food to meet the energy demands of training. During the 18-month intervention period, the athlete’s daily energy intake increased to 22.1 ± 3.8 MJ (protein, 3.2 g/kg; carbohydrate, 7.7 g/kg) by including milk-based drinks pre- and posttraining and before bed and an additional carbohydrate-based snack midmorning. This simple dietary intervention, along with a structured strength and conditioning program, resulted in an increase of 10 kg body mass with minimal change in body fat percentage. Adequate vitamin D status was maintained without the need for supplementation during the intervention period. In addition, the athlete reported the milk-based drinks and carbohydrate snacks were easy to consume, and no adverse side effects were experienced. This was the first time the athlete was able to maintain weight during intensive phases of the training cycle.

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Matthew Weston, Warren Gregson, Carlo Castagna, Simon Breivik, Franco M. Impellizzeri and Ric J. Lovell

Athlete case studies have often focused on the training outcome and not the training process. Consequently, there is a dearth of information detailing longitudinal training protocols, yet it is the combined assessment of both outcome and process that enhances the interpretation of physical test data. We were provided with a unique opportunity to assess the training load, physical match performance, and physiological fitness of an elite soccer referee from the referee’s final season before attaining full-time, professional status (2002) until the season when he refereed the 2010 UEFA Champions League and FIFA World Cup finals. An increased focus on on-field speed and gym-based strength training was observed toward the end of the study period and longitudinal match data showed a tendency for decreased total distances but an increased intensity of movements. Laboratory assessments demonstrated that VO2max remained stable (52.3 vs 50.8 mL-kg–1-min–1), whereas running speed at the lactate threshold (14.0 vs 12.0 km-h-1) and running economy (37.3 vs 43.4 mLkg–1min–1) both improved in 2010 compared with 2002.

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Ronald Davis, Charlotte Sanborn, David Nichols, David M. Bazett-Jones and Eric L. Dugan

Bone mineral density (BMD) loss is a medical concern for individuals with spinal cord injury (SCI). Concerns related to osteoporosis have lead researchers to use various interventions to address BMD loss within this population. Whole body vibration (WBV) has been reported to improve BMD for postmenopausal women and suggested for SCI. The purpose of this case study was to identify the effects of WBV on BMD for an individual with SCI. There were three progressive phases (standing only, partial standing, and combined stand with vibration), each lasting 10 weeks. Using the least significant change calculation, significant positive changes in BMD were reported at the trunk (0.46 g/cm2) and spine (.093 g/cm2) for phase 3 only. Increases in leg lean tissue mass and reduction in total body fat were noted in all three phases.

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Jason D. Vescovi and Jaci L. VanHeest

This observational case study examined the association of inter- and intraday energy intake and exercise energy expenditure with bone health, menstrual status and hematological factors in a female triathlete. The study spanned 7 months whereby energy intake and exercise energy expenditure were monitored three times (13 d); 16 blood samples were taken, urinary hormones were assessed for 3 months, and bone mineral density was measured twice. Energy availability tended to be sustained below 30 kcal/kg FFM/d and intraday energy intake patterns were often “back-loaded” with approximately 46% of energy consumed after 6 p.m. Most triiodothyronine values were low (1.1–1.2nmol/L) and supportive of reduced energy availability. The athlete had suppressed estradiol (105.1 ± 71.7pmol/L) and progesterone (1.79 ±1.19nmol/L) concentrations as well as urinary sex-steroid metabolites during the entire monitoring period. Lumbar spine (L1-L4) bone mineral density was low (age-matched Z-score −1.4 to −1.5). Despite these health related maladies the athlete was able to perform typical weekly training loads (swim: 30–40 km, bike: 120–300 km, run 45–70 km) and was competitive as indicated by her continued improvement in ITU World Ranking during and beyond the assessment period. There is a delicate balance between health and performance that can become blurred especially for endurance athletes. Education (athletes, coaches, parents) and continued monitoring of specific indicators will enable evidence-based recommendations to be provided and help reduced the risk of health related issues while maximizing performance gains. Future research needs to longitudinally examine how performance on standardized tests in each discipline (e.g., 800-m swim, 20-km time trial, 5-km run) is impacted when aspects of the female athlete triad are present.

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Shaina Riciputi, Meghan H. McDonough and Sarah Ullrich-French

Physical activity–based positive youth development (PYD) programs often aim to foster character development. This study examined youth perspectives of character development curricula and the impact these activities have on their lives within and beyond the program. This case study examined youth from low-income families in a physical activity–based summer PYD program that integrated one character concept (respect, caring, responsibility, trust) in each of 4 weeks. Participants (N = 24) included a cross section of age, gender, ethnicity, and past program experience. Semi-structured interviews were analyzed using inductive thematic analysis and constant comparative methods. Thirteen themes were grouped in four categories: building highquality reciprocal relationships; intrapersonal improvement; moral reasoning and understanding; and rejection, resistance, and compliance. The findings provide participant-centered guidance for understanding youth personal and social development through physical activity in ways that are meaningful to participants, which is particularly needed for youth in low-income communities with limited youth programming.

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Benjamin G. Serpell, Joshua Strahorn, Carmen Colomer, Andrew McKune, Christian Cook and Kate Pumpa

University of Canberra human research ethics committee. This was a group case study in a professional rugby club from Australia. Testing occurred across 2 days (48 h and 24 h prior to a match) on 2 occasions (week 1 and week 2; weeks were consecutive). During both weeks, participants completed an SPS