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.
Faye Prior, Margaret Coffey, Anna Robins and Penny Cook
Marj Moodie, Michelle M. Haby, Boyd Swinburn and Robert Carter
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.
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.
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).
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.
Ceyda Mumcu and Kimberly Mahoney
When individuals need to make a decision, they often face alternatives and some uncertainty. Identifying alternatives and anticipating outcomes in a systematic way provides value in better decision-making. Decision trees help to clarify the choices, risks, monetary gains, and other information involved in the decision. As a result, managers can make an informed decision when choosing the alternative that provides the best net gain and whether the net gain is worthwhile to pursue. As such, this case presents a scenario in which the sport marketing manager of the local sports commission is working with the convention center to bring a sporting event to the city in order to enhance the city’s image and generate positive economic impact. The manager is faced with evaluating three alternatives (Event A, Event B, or neither) and making a recommendation to the sports commission and convention center executives regarding which event to pursue, if any. This case provides an opportunity for students to practice using this strategic management tool to assist in systematic decision-making while investigating the event bidding process.
Scott J. Montain, Samuel N. Cheuvront and Henry C. Lukaski
Uncertainty exists regarding the effect of sustained sweating on sweat mineral-element composition.
To determine the effect of multiple hours of exercise-heat stress on sweat mineral concentrations.
Seven heat-acclimated subjects (6 males, 1 female) completed 5 × 60 min of treadmill exercise (1.56 m/s, 2% grade) with 20 min rest between exercise periods in 2 weather conditions (27 °C, 40% relative humidity, 1 m/s and 35 °C, 30%, 1 m/s). Sweat was collected from a sweat-collection pouch attached to the upper back during exercise bouts 1, 3, and 5. Mineral elements were determined by using inductively coupled plasma-emission spectrography.
At 27 °C, sweat sodium (863  µg/mL; mean [SD]), potassium (222  µg/mL), calcium (16 ) µg/mL), magnesium (1265  ng/mL), and copper (80  ng/mL) remained similar to baseline over 7 h of exercise-heat stress, whereas sweat zinc declined 42–45% after the initial hour of exercise-heat stress (Ex1 = 655 , Ex3 = 382 , Ex5 = 355  µg/mL, P < 0.05). Similar outcomes were observed for sweat zinc at 35 °C when sweat rates were higher. Sweat rate had no effect on sweat trace-element composition.
Sweat sodium, potassium, and calcium losses during multiple hours of sustained sweating can be predicted from initial sweat composition. Estimates of sweat zinc losses, however, will be overestimated if sweat zinc conservation is not accounted for in sweat zinc-loss estimates.
Chris McGlory and James P. Morton
The aim of this study was to determine the effects of postexercise ingestion of different-molecular-weight glucose polymer solutions on subsequent high-intensity interval-running capacity. In a repeated-measures design, 6 men ran for 60 min in the morning at 70% VO2max. Immediately post- and at 1 and 2 hr postexercise, participants consumed a 15% low-molecular-weight (LMW) or high-molecular-weight (HMW) carbohydrate solution, at a rate of 1.2 g of carbohydrate/kg body mass, or an equivalent volume of flavored water (WAT). After recovery, participants performed repeated 1-min intervals at 90% VO2max interspersed with 1 min active recovery (walking) until volitional exhaustion. Throughout the 3-hr recovery period, plasma glucose concentrations were higher (p = .002) during the HMW and LMW conditions than with WAT (M 7.0 ± 0.8, 7.5 ± 1.0, and 5.6 ± 0.2 mmol/L, respectively), although there was no difference (p = .723) between HMW and LMW conditions. Exercise capacity was 13 (43 ± 10 min; 95% CI for differences: 8–18; p = .001) and 11 min (41 ± 9 min; 95% CI for differences; 2–18: p = .016) longer with HMW and LMW solutions, respectively, than with WAT (30 ± 9 min). There was no substantial difference (2 min; 95% CI for differences: –5 to 10; p = .709) in exercise capacity between LMW and HMW solutions. Although this magnitude of difference is most likely trivial in nature, the uncertainty allows for a possible small substantial enhancement of physiological significance, and further research is required to clarify the true nature of the effect.
Taija Finni and Paavo V. Komi
During dynamic activities it is difficult to assess in vivo length changes in human tendon and aponeurosis. The present study compared the outcome of two methods during unilateral squat jump and drop jump performances of four volunteers. Tendinous tissue elongation of vastus lateralis muscle was estimated using either (a) direct measurement of in vivo fascicle length change and muscletendon length estimation (kinematic method), or (b) prediction using a quadratic force function in combination with direct tendon force measurement (force method). In the kinematic method the most critical measures contributing to the 10% uncertainty were the fascicle angle and fraction of the estimated fascicle length. The force method was most sensitive to resting length, with 1% error margin. Both methods predicted the same pattern of tendinous elongation because of the monotonic force/length relationship. The magnitude of length change, however, differed considerably between both methods. Based on the force method, the changes were only 20% (absolute values) or 30% (strain values) of those obtained with the kinematic method. On average, the maximum strains were 5% with the force method and 15% with the kinematic method. This difference can be explained by the fact that the kinematic method characterizes not only the changes in tendon length but also includes aponeurosis strain along the muscle belly. In addition, the kinematic method may be affected by non-uniform distribution of fascicle length change along the length of the muscle. When applying either method for estimating the patterns of tendon and tendinous tissue length changes during human locomotion, the given methodological considerations should be acknowledged.
Christos K. Argus, Nicholas D. Gill, Justin W.L. Keogh, Michael R. McGuigan and Will G. Hopkins
There is little literature comparing contrast training programs typically performed by team-sport athletes within a competitive phase. We compared the effects of two contrast training programs on a range of measures in high-level rugby union players during the competition season.
The programs consisted of a higher volume-load (strength-power) or lower volume-load (speed-power) resistance training; each included a tapering of loading (higher force early in the week, higher velocity later in the week) and was performed twice a week for 4 wk. Eighteen players were assessed for peak power during a bodyweight countermovement jump (BWCMJ), bodyweight squat jump (BWSJ), 50 kg countermovement jump (50CMJ), 50 kg squat jump (50SJ), broad jump (BJ), and reactive strength index (RSI; jump height divided by contact time during a depth jump). Players were then randomized to either training group and were reassessed following the intervention. Inferences were based on uncertainty in outcomes relative to thresholds for standardized changes.
There were small between-group differences in favor of strength-power training for mean changes in the 50CMJ (8%; 90% confidence limits, ±8%), 50SJ (8%; ±10%), and BJ (2%; ±3%). Differences between groups for BWCMJ, BWSJ, and reactive strength index were unclear. For most measures there were smaller individual differences in changes with strength-power training.
Our findings suggest that high-level rugby union athletes should be exposed to higher volume-load contrast training which includes one heavy lifting session each week for larger and more uniform adaptation to occur in explosive power throughout a competitive phase of the season.
Kyle R. Barnes, Will G. Hopkins, Michael R. McGuigan and Andrew E. Kilding
Runners use uphill running as a movement-specific form of resistance training to enhance performance. However, the optimal parameters for prescribing intervals are unknown. The authors adopted a dose-response design to investigate the effects of various uphill interval-training programs on physiological and performance measures.
Twenty well-trained runners performed an incremental treadmill test to determine aerobic and biomechanical measures, a series of jumps on a force plate to determine neuromuscular measures, and a 5-km time trial. Runners were then randomly assigned to 1 of 5 uphill interval-training programs. After 6 wk all tests were repeated. To identify the optimal training program for each measure, each runner’s percentage change was modeled as a quadratic function of the rank order of the intensity of training. Uncertainty in the optimal training and in the corresponding effect on the given measure was estimated as 90% confidence limits using bootstrapping.
There was no clear optimum for time-trial performance, and the mean improvement over all intensities was 2.0% (confidence limits ±0.6%). The highest intensity was clearly optimal for running economy (improvement of 2.4% ± 1.4%) and for all neuromuscular measures, whereas other aerobic measures were optimal near the middle intensity. There were no consistent optima for biomechanical measures.
These findings support anecdotal reports for incorporating uphill interval training in the training programs of distance runners to improve physiological parameters relevant to running performance. Until more data are obtained, runners can assume that any form of high-intensity uphill interval training will benefit 5-km time-trial performance.
Damien Moore, Tania Pizzari, Jodie McClelland and Adam I. Semciw
Context: Many different rehabilitation exercises have been recommended in the literature to target the gluteus medius (GMed) muscle based mainly on single-electrode, surface electromyography (EMG) measures. With the GMed consisting of 3 structurally and functionally independent segments, there is uncertainty on whether these exercises will target the individual segments effectively. Objective: To measure individual GMed segmental activity during 6 common, lower-limb rehabilitation exercises in healthy young adults, and determine if there are significant differences between the exercises for each segment. Method: With fine-wire EMG electrodes inserted into the anterior, middle, and posterior segments of the GMed muscle, 10 healthy young adults performed 6 common, lower-limb rehabilitation exercises. Main Outcome Measures: Recorded EMG activity was normalized, then reported and compared with median activity for each of the GMed segments across the 6 exercises. Results: For the anterior GMed segment, high activity was recorded for the single-leg squat (48% maximum voluntary isometric contraction [MVIC]), the single-leg bridge (44% MVIC), and the resisted hip abduction–extension exercise (41% MVIC). No exercises recorded high activity for the middle GMed segment, but for the posterior GMed segment very high activity was recorded by the resisted hip abduction–extension exercise (69% MVIC), and high activity was generated by the single-leg squat (48% MVIC) and side-lie hip abduction (43% MVIC). For each of the GMed segments, there were significant differences (P < .05) in the median EMG activity levels between some of the exercises and the side-lie clam with large effect sizes favoring these exercises over the side-lie clam. Conclusions: Open-chain hip abduction and single-limb support exercises appear to be effective options for recruiting the individual GMed segments with selection dependent on individual requirements. However, the side-lie clam does not appear to be effective at recruiting the GMed segments, particularly the anterior and middle segments.
Adriana V. Savescu, Mark L. Latash and Vladimir M. Zatsiorsky
This article proposes a technique to calculate the coefficient of friction for the fingertip– object interface. Twelve subjects (6 males and 6 females) participated in two experiments. During the first experiment (the imposed displacement method), a 3-D force sensor was moved horizontally while the subjects applied a specified normal force (4 N, 8 N, 12 N) on the surface of a sensor covered with different materials (sandpaper, cotton, rayon, polyester, and silk).The normal force and the tangential force (i.e., the force due to the sensor motion) were recorded. The coefficient of friction (µd) was calculated as the ratio between the tangential force and the normal force. In the second experiment (the beginning slip method), a small instrumented object was gripped between the index finger and the thumb, held stationary in the air, and then allowed to drop. The weight (200 g, 500 g, and 1,000 g) and the surface (sandpaper, cotton, rayon, polyester, and silk) in contact with the digits varied across trials. The same sensor as in the first experiment was used to record the normal force (in a horizontal direction) and the tangential force (in the vertical direction). The slip force (i.e., the minimal normal force or grip force necessary to prevent slipping) was estimated as the force at the moment when the object just began to slip. The coefficient of friction was calculated as the ratio between the tangential force and the slip force. The results show that (1) the imposed displacement method is reliable; (2) except sandpaper, for all other materials the coefficient of friction did not depend on the normal force; (3) the skin–sandpaper coefficient of friction was the highest µd = 0.96 ± 0.09 (for 4-N normal force) and the skin–rayon rayon coefficient of friction was the smallest µd = 0.36 ± 0.10; (4) no significant difference between the coefficients of friction determined with the imposed displacement method and the beginning slip method was observed. We view the imposed displacement technique as having an advantage as compared with the beginning slip method, which is more cumbersome (e.g., dropped object should be protected from impacts) and prone to subjective errors owing to the uncertainty in determining the instance of the slip initiation (i.e., impeding sliding).