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Roy J. Shephard

During the 1970s, the U.S. policy of requiring a negative exercise stress test for all adults >35 years old proved expensive. It also discouraged exercise adoption, was ineffective in detecting high-risk individuals, and led to much iatrogenic disease. In the age range of 15–69 years, a better alternative is triage, based on responses to the revised Physical Activity Readiness Questionnaire (PAR-Q), supplemented by considerations of age and cardiac risk factors. But most people older than 70 years have one or more clinical conditions; in this age group, any potential system of triage excludes an excessive proportion of potential exercisers and thus does not appear warranted. An increase in habitual physical activity increases quality-adjusted life span, and it might also enhance total longevity. Restriction of physical activity remains advisable in a few individuals, but they are already under medical care. The one small group who need medical clearance includes those who decide to prepare themselves for some high-performance event. They are highly motivated, and their activity will not be discouraged by the need for a careful clinical examination.

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Victoria Kochick, Aaron M. Sinnott, Shawn R. Eagle, Indira R. Bricker, Michael W. Collins, Anne Mucha, Christopher Connaboy, and Anthony P. Kontos

The determination of an athletes’ readiness to return to play (RTP) after sport-related concussion (SRC) remains a significant health concern for scientific and medical communities. 1 , 2 Medical clearance to RTP should constitute a multifaceted clinical assessment of neurocognitive, vestibular

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Dino G. Costanzo, David M. Rustico, and Linda S. Pescatello

The preparedness of community facilities offering exercise programs to older adults is unknown. On-site evaluations were conducted by trained professionals to assess compliance of community older adult exercise programs with fitness-industry standards. Fourteen facilities were evaluated whose clientele (N = 2,172) were predominantly White (98%) women (87%) over 75 years of age (66%). Few of the 14 facilities required exercise participants to complete preactivity health questionnaires (n = 5), 3 administered informed consents, and none adhered to a medical-clearance policy. Only 2 facilities had defined emergency policies, and none conducted emergency drills. One site conducted exercise programs with instructors trained in cardiopulmonary resuscitation. Professionally certified exercise instructors leading all exercise programs were observed in 1 facility. Most facilities evaluated were noncompliant with existing professional health and fitness standards. The practicality of imposing such standards on community exercise programs for older adult requires further examination.

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Kelly A. Fiala and Donna M. Ritenour

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Cyril Besson, Kenny Guex, Laurent Schmitt, Boris Gojanovic, and Vincent Gremeaux

the successful health and performance management of a mildly symptomatic COVID-19 infection in an elite sprinter through the prism of TL and HRV monitoring. He was able to set 2 personal bests 1 month later. Alongside medical clearance for RTPa, those metrics were used as key points for training

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Steven Nagib and Shelley W. Linens

outcome measure was medical clearance for activity; therefore, there were 2 populations within each (treatment and control) group 84 out of 114 patients admitted for VRT at a specialty clinic received a customized VRT plan and had at least 1 visit with a trained clinician VRT plans included: gaze

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Lisa K. Sharp, Marian L. Fitzgibbon, and Linda Schiffer


Despite the increased health risks for obese Black women, relatively little research has explored physical activity and nutrition interventions for these women. This article describes the recruitment strategies used in a program designed specifically for obese Black women.


Recruitment of Black women age 30 to 65 years with body mass indices between 30 kg/m2 and 50 kg/m2 was completed using in-person recruitment and flyers within 2 miles of the intervention site along with mass e-mails within the sponsoring university system. Medical clearance from a physician was an eligibility requirement because of Institutional Review Board safety concerns.


Of the 690 women who were screened, 213 (31%) were eligible and randomized. The most common reason for exclusion was failure to return a medical clearance form (n = 167, 39% of ineligible). Different rates of efficiency were noted across recruitment approaches.


Black women were successfully recruited using in-person community recruitment, e-mail, and community flyers within close proximity to the intervention site. Careful consideration should be given to the advantages and disadvantages of various recruitment strategies that might not generalize across studies.

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Ryan D. Henke, Savana M. Kettner, Stephanie M. Jensen, Augustus C.K. Greife, and Christopher J. Durall

intended to noticeably raise HR. Stretching was progressed each week. Participants completed a weekly BCTT during clinic visits. Outcome measure(s) Symptom severity and exacerbation per PCSS. Time (in days) to medical clearance. Time (in days) to recovery from initial visit. Return to baseline symptoms per

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Kyoungyoun Park, Thomas Ksiazek, and Bernadette Olson

once a week by a single-study treatment physiotherapist for 8 wk or until the time of medical clearance to return to sport. Treatment received by both groups includes nonprovocative ROM exercises, stretching, and postural education; standard concussion protocol was also followed, including rest until

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Kelly M. Cheever, Jane McDevitt, and Jacqueline Phillips

; highlight the role physiotherapy assessment and treatment of cervical spine following SRC Including cervical and vestibular physical therapy decreases time to medical clearance to return to sport in patients with persistent symptoms of neck dysfunction such as neck pain, dizziness, and/or headaches