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Emma V. Richardson, Sarah Blaylock, Elizabeth Barstow, Matthew Fifolt and Robert W. Motl

recent observations that persons with MS actively seek information about exercise and diet for managing MS through a health care provider (HCP) ( Motl et al., 2017 ). HCPs are trusted by patients and viewed as credible messengers of exercise ( Letts et al., 2011 , Smith, Tomasone, Latimer

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Brianne L. Foulon, Valérie Lemay, Victoria Ainsworth and Kathleen A. Martin Ginis

The purpose of this study was to determine preferences of people with spinal cord injury (SCI) and health care professionals (HCP) regarding the content and format of a SCI physical activity guide to support recently released SCI physical activity guidelines. Seventy-eight people with SCI and 80 HCP completed a survey questionnaire. Participants with SCI identified desired content items and their preferences for format. HCP rated the helpfulness of content items to prescribe physical activity. All content items were rated favorably by participants with SCI and useful by HCP. The risks and benefits of activity and inactivity, and strategies for becoming more active, were rated high by both samples. Photographs and separate information for those with paraplegia versus tetraplegia were strongly endorsed. These data were used to guide the development of an SCI physical activity guide to enhance the uptake of physical activity guidelines for people with SCI. The guide was publically released November 11, 2011.

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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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Øyvind F. Standal, Tor Erik H. Nyquist and Hanne H. Mong

for Research Data and given the necessary ethical approval before institutions and participants were contacted. Institutions and Participants Six institutions were recruited based on the criteria that they were (a) delivering rehabilitation services in the national specialist health care services 1

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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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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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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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Courtney W. Hess, Stacy L. Gnacinski and Barbara B. Meyer

injury (e.g., fear of reinjury or reinjury anxiety; Walker, Thatcher, & Lavallee, 2010 ). Although it is not possible to fully elucidate the reasons for these suboptimal outcomes, researchers have pointed to a variety of institutional (e.g., models of health care, insurance limitations, inconsistent

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Brent C. Mangus

The number of wheelchair-bound athletes training for and competing in local, state, national, and international sporting events increases every year. As participation increases, sports injuries associated with the training and competition of these athletes also increase. Medical attention for wheelchair athletes during training and competition should be provided by competent professionals. However, even with competent professionals providing medical attention to wheelchair athletes, injuries do occur. Typical injuries experienced by the wheelchair-bound athlete include carpal tunnel syndrome, various shoulder problems, numerous problems with the hands, and lacerations, abrasions, and contusions to all parts of the body. The ability of the wheelchair athlete to thermoregulate his or her own body is also an area of concern for those providing health care during practice and competition. More researchers are studying injuries and injury rates to the wheelchair athlete, and the body of literature in this area is becoming larger. Future research can begin to document the effects of strength training, nutrition, various conditioning strategies, the biomechanics of the wheelchair motion, and the psychological impact of athletic injuries. Although some physiological factors have been studied, many remain to be addressed in an effort to shed light on the injuries experienced by wheelchair athletes.