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Pier Paolo Mariani, Luca Laudani, Jacopo E. Rocchi, Arrigo Giombini, and Andrea Macaluso

proprioception and muscular strength, are defined as prehabilitation. The preoperative phase may be useful to reduce the risk of postoperative complications and to improve a successful return to high-level activity. Many studies have confirmed these effects in the long term after surgery with better quadriceps

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Linda Linton, Morag Barr, and Stephanie Valentin

available on running, thus making it paradoxical for runners to select the most appropriate approach. Prehabilitation (prehab) provides a multifactorial approach incorporating both exercises and educational methods to reduce likelihood of injury 14 and may reach a wider spectrum of runners with variable

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Efthymios Papadopoulos, Priya Brahmbhatt, Shabbir M.H. Alibhai, George A. Tomlinson, Andrew G. Matthew, Michael Nesbitt, Jennifer M. Jones, Ian Randall, Daniel Sellers, Antonio Finelli, Neil Fleshner, and Daniel Santa Mina

has been shown to improve cardiovascular fitness in patients with cancer prior to treatment, 26 including patients prior to PCa surgery. 27 However, it is important to dinstiguish that prehabilitation studies 26 , 27 involved vigorous intensities of structured and repetitive exercise interventions

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Adam Jones, Chris Brogden, Richard Page, Ben Langley, and Matt Greig

cleat with short, circular (not blades), molded (nonreplaceable) hard rubber studs evenly distributed across the entire outsole. The test battery comprised drills designed to reflect the mechanism of ankle sprain injury and was consistent with the prehabilitation work regularly performed by the

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Nathan H. Parker, Rebecca E. Lee, Daniel P. O’Connor, An Ngo-Huang, Maria Q.B. Petzel, Keri Schadler, Xuemei Wang, Lianchun Xiao, David Fogelman, Richard Simpson, Jason B. Fleming, Jeffrey E. Lee, Ching-Wei D. Tzeng, Sunil K. Sahai, Karen Basen-Engquist, and Matthew H.G. Katz

Background: Physical activity and exercise appear to benefit patients receiving preoperative treatment for cancer. Supports and barriers must be considered to increase compliance with home-based exercise prescriptions in this setting. Such influences have not been previously examined. Methods: The authors used quantitative and qualitative methods to examine potential physical activity influences among patients who were prescribed home-based aerobic and strengthening exercises concurrent with preoperative chemotherapy or chemoradiation for pancreatic cancer. Physical activity was measured using exercise logs and accelerometers. Social support for exercise and perceived neighborhood walkability were measured using validated surveys. Relationships between influences and physical activity were evaluated using linear regression analyses and qualitative interviews. Results: Fifty patients received treatment for a mean of 16 (9) weeks prior to planned surgical resection. Social support from friends and neighborhood esthetics were positively associated with physical activity (P < .05). In interviews, patients confirmed the importance of these influences and cited encouragement from health care providers and desire to complete and recover from treatment as additional motivators. Conclusions: Interpersonal and environmental motivators of exercise and physical activity must be considered in the design of future home-based exercise interventions designed for patients receiving preoperative therapy for cancer.

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Alexandre Moreira, Johann C. Bilsborough, Courtney J. Sullivan, Michael Cianciosi, Marcelo Saldanha Aoki, and Aaron J. Coutts


To examine the training periodization of an elite Australian Football team during different phases of the season.


Training-load data were collected during 22 wk of preseason and 23 wk of in-season training. Training load was measured using the session rating of perceived exertion (session-RPE) for all training sessions and matches from 44 professional Australian Football players from the same team. Training intensity was divided into 3 zones based on session-RPE (low, <4; moderate, >4 AU and <7 AU; and high, >7 AU). Training load and intensity were analyzed according to the type of training session completed.


Higher training load and session duration were undertaken for all types of training sessions during the preseason than in-season (P < .05), with the exception of “other” training (ie, re/prehabilitation training, cross-training, and recovery activities). Training load and intensity were higher during the preseason, with the exception of games, where greater load and intensity were observed during the in-season. The overall distribution of training intensity was similar between phases with the majority of training performed at moderate or high intensity.


The current findings may allow coaches and scientists to better understand the characteristics of Australian Football periodization, which in turn may aid in developing optimal training programs. The results also indicate that a polarized training-intensity distribution that has been reported in elite endurance athletes does not occur in professional Australian Football.

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Jenny L. Toonstra, Dana Howell, Robert A. English, Christian Lattermann, and Carl G. Mattacola

Context: Patient expectations have been shown to be a major predictor of outcomes. Fulfilled expectations have been linked to increased patient satisfaction and rehabilitation adherence. Expectations may be influenced by a variety of factors, including patient characteristics, preoperative function, or disease characteristics. It is currently unknown what factors may influence patient expectations prior to cartilage repair of the knee, and to what degree. Furthermore, understanding the importance and values of those expectations for recovery using mixed methods has not previously been conducted in this patient population. The purpose of this mixed methods study is to examine and explore the relationships between patient expectations and functional outcome in patients undergoing cartilage repair of the knee. Design: A mixed methods design was used. Methods: Twenty-one patients scheduled to undergo cartilage repair of the knee were included. Participants completed the Hospital for Special Surgery Knee Surgery Expectations Survey and the Knee Injury and Osteoarthritis Outcome Score at their preoperative visit. Knee Injury and Osteoarthritis Outcome Scores were also obtained at 3 and 6 months postsurgery. A selected sample of 6 participants participated in semi-structured interviews 6 months postsurgery. Pearson correlation coefficients were used to determine relationships between expectations and functional outcome. Results: Patients have moderate expectations for recovery, and these expectations were positively associated with preoperative pain, activities of daily living, and quality of life. Expectations also correlated with symptoms 3 months postsurgery, but there were no other significant correlations between preoperative expectations and postoperative function in the short term. Four qualitative themes emerged as participants described how previous recovery experiences shaped their expectations. Conclusions: Formalized patient and caregiver education, prehabilitation, and the use of psychological skills during rehabilitation may help to manage patient expectations and provide more focused and individualized care, thus improving outcomes.

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Matt Greig, Hannah Emmerson, and John McCreadie

Context: Contemporary developments in Global Positioning System (GPS) technology present a means of quantifying mechanical loading in a clinical environment with high ecological validity. However, applications to date have typically focused on performance rather than rehabilitation. Objective: To examine the efficacy of GPS microtechnology in quantifying the progression of loading during functional rehabilitation from ankle sprain injury, given the prevalence of reinjury and need for quantifiable monitoring. Furthermore, to examine the influence of unit placement on the clinical interpretation of loading during specific functional rehabilitation drills. Design: Repeated measures. Setting: University athletic facilities. Participants: Twenty-two female intermittent team sports players. Intervention: All players completed a battery of 5 drills (anterior hop, inversion hop, eversion hop, diagonal hop, and diagonal hurdle hop) designed to reflect the mechanism of ankle sprain injury, and progress functional challenge and loading. Main Outcome Measures: GPS-mounted accelerometers quantified uniaxial PlayerLoad for each drill, with units placed at C7 and the tibia. Main effects for drill type and GPS location were investigated. Results: There was a significant main effect for drill type (P < .001) in the mediolateral (η 2 = .436), anteroposterior (η 2 = .480), and vertical planes (η 2 = .516). The diagonal hurdle hop elicited significantly greater load than all other drills, highlighting a nonlinear progression of load. Only the mediolateral load showed evidence of progressive increase in loading. PlayerLoad was significantly greater at the tibia than at C7 for all drills, and in all planes (P < .001, η 2 ≥ .662). Furthermore, the tibia placement was more sensitive to between-drill changes in mediolateral load than the C7 placement. Conclusions: The placement of the GPS unit is imperative to clinical interpretation, with both magnitude and sensitivity influenced by the unit location. GPS does provide efficacy in quantifying multiplanar loading during (p)rehabilitation, in a field or clinical setting, with potential in extending GPS analyses (beyond performance metrics) to functional injury rehabilitation and prevention.

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Jay R. Ebert, Kate E. Webster, Peter K. Edwards, Brendan K. Joss, Peter D’Alessandro, Greg Janes, and Peter Annear

educational process. It was interesting to note that 38% of surgeons felt that there was no benefit in preoperative rehabilitation. The reasons for the relative lack of interest in “prehabilitation” are no doubt multi-factorial as dictated by the surgeon and the patient. From the patient’s perspective, they

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Chris Brogden, Kelly Marrin, Richard Page, and Matt Greig

of movement screening is fundamental to the subsequent design of prehabilitation and injury management strategies. Circadian rhythm is a term used to describe variations in many human physiological variables 8 and factors influencing athletic performance, relative to time of day. 9 , 10 It has been