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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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Faye Prior, Margaret Coffey, Anna Robins and Penny Cook

Background: Exercise referral schemes (ERSs) support inactive adults, who have chronic health conditions, to become physically active. Uncertainty exists regarding the effectiveness of ERSs, with few studies evaluating their long-term impact. The aims of this study were to evaluate the long-term impact (12 mo) of participation in an ERS on self-reported physical activity (PA) and a range of health-related outcomes. Methods: Data were analyzed for participants of a 24-week ERS who attended a week 52 follow-up between July 2015 and 2017. PA and health-related outcomes collected at weeks 1, 24, and 52 were analyzed using the Friedman test and Wilcoxon signed-ranks test. Results: A total of 273 participants attended the week 52 follow-up. Self-reported PA significantly increased by a median of 636 MET minutes at week 52. There were also significant improvements in body mass index, systolic blood pressure, mental well-being, and health-related quality of life. Conclusions: For every 8 participants referred to this 24-week ERS, 1 participant went on to show long-term improvements in at least 1 health indicator. The evidence base requires further long-term evaluations to confirm these findings across a range of ERS providers. Changes in self-reported PA would be supported by the inclusion of device-based measurment of PA.

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Michael Joch, Mathias Hegele, Heiko Maurer, Hermann Müller and Lisa K. Maurer

Motor learning can be monitored by observing the development of neural correlates of error processing. Among these neural correlates, the error- and feedback-related negativity (Ne/ERN and FRN) represent error processing mechanisms. While the Ne/ERN is more related to error prediction, the FRN is found after an error is manifested. The questions the current study strives to answer are: What information is needed by the system to make error predictions and how is this represented by the Ne/ERN and FRN in a complex motor task? We reduced the information and increased the difficulty level for the prediction in a semivirtual throwing task and found no Ne/ERN but a large FRN when the action result was finally observed (hitting or missing a target). We assume that uncertainty for error prediction was too high (either due to insufficient information or due to lacking prerequisites for prediction), such that error processing had to be mainly based on feedback. The finding is in line with the reinforcement theory of learning, after which Ne/ERN and FRN should behave complementary.

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Marj Moodie, Michelle M. Haby, Boyd Swinburn and Robert Carter

Background:

To assess from a societal perspective the cost-effectiveness of a school program to increase active transport in 10- to 11-year-old Australian children as an obesity prevention measure.

Methods:

The TravelSMART Schools Curriculum program was modeled nationally for 2001 in terms of its impact on Body Mass Index (BMI) and Disability-Adjusted Life Years (DALYs) measured against current practice. Cost offsets and DALY benefits were modeled until the eligible cohort reached age 100 or died. The intervention was qualitatively assessed against second stage filter criteria (‘equity,’ ‘strength of evidence,’ ‘acceptability to stakeholders,’ ‘feasibility of implementation,’ ‘sustainability,’ and ‘side-effects’) given their potential impact on funding decisions.

Results:

The modeled intervention reached 267,700 children and cost $AUD13.3M (95% uncertainty interval [UI] $6.9M; $22.8M) per year. It resulted in an incremental saving of 890 (95%UI −540; 2,900) BMI units, which translated to 95 (95% UI −40; 230) DALYs and a net cost per DALY saved of $AUD117,000 (95% UI dominated; $1.06M).

Conclusions:

The intervention was not cost-effective as an obesity prevention measure under base-run modeling assumptions. The attribution of some costs to nonobesity objectives would be justified given the program’s multiple benefits. Cost-effectiveness would be further improved by considering the wider school community impacts.

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Gary R. Gray

This study was conducted to determine the reasons that influence the decision to settle a personal injury lawsuit rather than proceed to court for a trial. Additionally, this study compared plaintiff attorneys’ and insurance company attorneys’ reasons for settlement in personal injury lawsuits to determine whether there are significant differences between the two groups. Subjects, 28 plaintiff attorneys and 57 insurance company attorneys, rated the importance of or degree of agreement with 77 statements related to their decision to settle or to recommend settlement. T tests revealed significant differences between the two groups on 31 of the 77 items. Among all 85 attorneys, the top four reasons for settlement were (a) if the opposing attorney offers realistic settlement figures, a jury trial will offer more risk than advantage; (b) settlements are an attractive alternative to a trial partly because of the high costs of litigation; (c) in deciding whether to settle, attorneys attempt to determine the probable verdict in light of the evidence; and (d) attorneys attempt to determine the value of an immediate settlement compared to the uncertainty of a trial.

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Xavier Ohl, Pierre-Yves Lagacé, Fabien Billuart, Olivier Gagey, Wafa Skalli and Nicola Hagemeister

A robust and reproducible scapular coordinate system is necessary to study scapulothoracic kinematics. The coordinate system recommended by the ISB (International Society of Biomechanics) is difficult to apply in studies using medical imaging, which mostly use a glenoid-centered coordinate system. The aim of this study was to assess the robustness of a glenoid-centered coordinate system compared with the ISB coordinate system, and to study the reproducibility of this coordinate system measure during abduction. A Monte-Carlo analysis was performed to test the robustness of the two coordinate systems. This method enabled the variability of the orientation of the coordinate system to be assessed in a laboratory setting. A reproducibility study of the glenoid-centered coordinate system in the thorax reference frame was performed during abduction in the scapular plane using a low-dose stereoradiography system. We showed that the glenoid-centered coordinate system was slightly more robust than the ISB-recommended coordinate system. Most reproducible rotation was upward/downward rotation (x axis) and most reproducible translation was along the Y axis (superior-inferior translation). In conclusion, the glenoid-centered coordinate system can be used with confidence for scapular kinematics analysis. The uncertainty of the measures derived from our technique is acceptable compared with that reported in the literature. Functional quantitative analysis of the scapulothoracic joint is possible with this method.

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Paul G. Montgomery and Will G. Hopkins

Australian Football is an intense team sport played over ~120 min on a weekly basis. To determine the effects of game and training load on muscle soreness and the time frame of soreness dissipation, 64 elite Australian Football players (age 23.8 ± 1.8 y, height 183.9 ± 3.8 cm, weight 83.2 ± 5.0 kg; mean ± SD) recorded perceptions of muscle soreness, game intensity, and training intensity on scales of 1–10 on most mornings for up to 3 competition seasons. Playing and training times were also recorded in minutes. Data were analyzed with a mixed linear model, and magnitudes of effects on soreness were evaluated by standardization. All effects had acceptably low uncertainty. Game and training-session loads were 790 ± 182 and 229 ± 98 intensity-minutes (mean ± SD), respectively. General muscle soreness was 4.6 ± 1.1 units on d 1 postgame and fell to 1.9 ± 1.0 by d 6. There was a small increase in general muscle soreness (0.22 ± 0.07–0.50 ± 0.13 units) in the 3 d after high-load games relative to low-load games. Other soreness responses showed similar timelines and magnitudes of change. Training sessions made only small contributions to soreness over the 3 d after each session. Practitioners should be aware of these responses when planning weekly training and recovery programs, as it appears that game-related soreness dissipates after 3 d regardless of game load and increased training loads in the following week produce only small increases in soreness.

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Danny O’Brien and Trevor Slack

The organizational field that constitutes English rugby union has undergone substantial change since 1995. This paper builds on earlier work by O’Brien and Slack (2003a) that established that a shift from an amateur to a professional dominant logic in English rugby union took place between 1995 and 2000. Utilizing ideas about institutional logics, isomorphism, and diffusion, the current paper explores how this shift in logics actually evolved. Data from 43 interviews with key individuals in English rugby union form the main data source for the study. The results show that isomorphic change in accord with a new professional logic diffused throughout the field by way of three distinct diffusion patterns: status driven, bandwagon, and eventually, the social learning of adaptive responses. An initial period of high uncertainty, intense competitive pressures, and sustained financial crises resulted in unrestrained mimesis in the first two seasons of the professional era. However, this gave way in the third season to increased interorganizational linkages, coalition building, and political activity that promoted normative and coercive pressures for a consolidation of the game’s infrastructure and future development.

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Thomas Gotschi

Background:

Promoting bicycling has great potential to increase overall physical activity; however, significant uncertainty exists with regard to the amount and effectiveness of investment needed for infrastructure. The objective of this study is to assess how costs of Portland’s past and planned investments in bicycling relate to health and other benefits.

Methods:

Costs of investment plans are compared with 2 types of monetized health benefits, health care cost savings and value of statistical life savings. Levels of bicycling are estimated using past trends, future mode share goals, and a traffic demand model.

Results:

By 2040, investments in the range of $138 to $605 million will result in health care cost savings of $388 to $594 million, fuel savings of $143 to $218 million, and savings in value of statistical lives of $7 to $12 billion. The benefit-cost ratios for health care and fuel savings are between 3.8 and 1.2 to 1, and an order of magnitude larger when value of statistical lives is used.

Conclusions:

This first of its kind cost-benefit analysis of investments in bicycling in a US city shows that such efforts are cost-effective, even when only a limited selection of benefits is considered.

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Caroline Barelle, Anne Ruby and Michel Tavernier

Aerodynamic properties are one of the factors that determine speed performance in Alpine skiing. Many studies have examined the consequences of this factor in downhill skiing, and the impact of postural modifications on speed is now well established. To date, only wind tunnel tests have enabled one to measure aerodynamic drag values (a major component of the aerodynamic force in Alpine skiing). Yet such tests are incompatible with the constraints of a regular and accurate follow-up of training programs. The present study proposes an experimental model that permits one to determine a skier's aerodynamic drag coefficient (SCx) based on posture. Experimental SCx measurements made in a wind tunnel are matched with the skier's postural parameters. The accuracy of the model was determined by comparing calculated drag values with measurements observed in a wind tunnel for different postures. For postures corresponding to an optimal aerodynamic penetration (speed position), the uncertainty was 13%. Although this model does not permit an accurate comparison between two skiers, it does satisfactorily account for variations observed in the aerodynamic drag of the same skier in different postures. During Alpine ski training sessions and races, this model may help coaches assess the gain or loss in time induced by modifications in aerodynamic drag corresponding to different postures. It may also be used in other sports to help determine whether the aerodynamic force has a significant impact on performance.