Progressing On-Court Rehabilitation After Injury: The Control-Chaos Continuum Adapted to Basketball.

BACKGROUND: Sport-specific training is an integral component of returning to sport following injury. Frameworks designed to guide sport-specific rehabilitation need to integrate and adapt to the specific context of elite sport. The control-chaos continuum (CCC) is a flexible framework originally designed for on-pitch rehabilitation in elite football (soccer). The concepts underpinning the CCC transfer to other elite sport rehabilitation environments. CLINICAL QUESTION: How can practitioners and clinicians transfer the CCC to elite basketball, to support planning and return to sport? On-court rehabilitation is a critical sport-specific rehabilitation component of return to sport, yet there are no frameworks to guide practitioners when planning and delivering on-court rehabilitation. KEY RESULTS: Based on our experience working in the National Basketball Association, we report how the CCC framework can apply to elite basketball. We focus on the design and delivery of progressive training in the presence of injury in this basketball-specific edition of the CCC. Given the challenges when quantifying "load" in basketball, we encourage practitioners and clinicians to consider the qualitative aspects of performance such as skill, sport-specific movement, contact, and decision making. CLINICAL APPLICATION: The 5-phase framework describes training progression from high control, a return to on-court running, to high chaos, a return to "live" unrestricted basketball. The model can be adapted to both short- and long-term injuries based on injury and progression criteria. Strength and power "diagnostics" can be strategically implemented to enhance decision making throughout the return to sport continuum. J Orthop Sports Phys Ther 2023;53(9):1-12. Epub: 9 August 2023. doi:10.2519/jospt.2023.11981.

Fitness Changes in Adolescent Girls Following In-School Combined Aerobic and Resistance Exercise: Interaction With Birthweight.

PURPOSE: To assess the efficacy of a supervised in-school combined resistance and aerobic training program in adolescent girls and investigate whether responses differ according to birthweight. METHODS: Participants (girls aged 13-17 y) were randomized either to an intervention replacing physical education (PE) classes with 2 × 60-minute training sessions per week (n = 58) or to a control group that continued to attend 2 × 60 minutes per week of curriculum PE (n = 41). We measured muscular fitness (handgrip, standing long jump, and sit-ups), cardiorespiratory fitness (20-m shuttle run), skinfolds, and lean body mass preintervention and postintervention and determined effect size (Hedge's g) differences between changes in these measures. We also compared changes within lower (<3000 g) and normal birthweight intervention and PE control subgroups. RESULTS: The intervention group showed greater improvements in all the fitness measures and lean body mass (g = 0.22-0.48) and lower skinfold increases (g = 0.41) than PE controls. Within the intervention group, improvements in all fitness measures were larger in lower birthweight (g = 0.53-0.94) than in normal birthweight girls (g = 0.02-0.39). CONCLUSION: Replacing curriculum PE with supervised training improved muscular and cardiorespiratory fitness and body composition outcomes in adolescent females. Our findings suggest an enhanced adaptive response to training in participants with lower birthweight which warrants further investigation.

The SIMAC study: A randomized controlled trial to compare the effects of resistance training and aerobic training on the fitness and body composition of Colombian adolescents.

The aim of this study was to evaluate the impact on muscle strength, aerobic fitness and body composition, of replacing the physical education (PE) class of Colombian adolescents with resistance or aerobic training. 120 tanner stage 3 adolescents attending a state school were randomized to resistance training, aerobic training, or a control group who continued to attend a weekly 2- hour PE class for 16 weeks. The resistance training and aerobic training groups participated in twice weekly supervised after-school exercise sessions of < 1 hour instead of their PE class. Sum of skinfolds, lean body mass (bioelectrical impedance analysis), muscular strength (6 repetition maximum (RM)) bench press, lateral pulldown and leg press) and estimated cardiorespiratory fitness (multistage 20 meter shuttle run) were assessed at pre and post intervention. Complete data were available for n = 40 of the resistance training group, n = 40 of the aerobic training group and n = 30 PE (controls). Resistance training attenuated increases in sum of skinfolds compared with controls (d = 0.27, [0.09-0.36]). We found no significant effect on lean body mass. Resistance training produced a positive effect on muscle strength compared with both controls (d = 0.66 [.49-.86]) and aerobic training (d = 0.55[0.28-0.67]). There was a positive effect of resistance training on cardiorespiratory fitness compared with controls (d = 0.04 [-0.10-0.12]) but not compared with aerobic training (d = 0.24 [0.10-0.36]). Replacing a 2-hour PE class with two 1 hour resistance training sessions attenuated gains in subcutaneous adiposity, and enhanced muscle strength and aerobic fitness development in Colombian youth, based on a median attendance of approximately 1 session a week. Further research to assess whether adequate stimuli for the development of muscular fitness exists within current physical education provision is warranted.

Facilitadores y barreras percibidos en la práctica de la actividad física en adolescentes escolarizados en Piedecuesta (Santander), en 2016: análisis cualitativo / Perceived facilitators and barriers to physical activity in adolescents in Piedecuesta (Santander), in 2016: qualitative analysis / Facilitadores e barreiras evidentes na prática da atividade física nos adolescentes em idade escolar em Piedecuesta Santander, em 2016: Análise qualitativa

Resumen Objetivo: Describir la percepción que tienen adolescentes escolarizados entre 12 y 16 años, en Piedecuesta (Santander), en 2016, sobre los facilitadores y las barreras que influyen en la práctica de la actividad física. Metodología: Análisis cualitativo desde un enfoque fenomenológico, con la participación de 20 adolescentes escolarizados que, mediante entrevistas semiestructuradas y un grupo focal, conversaron sobre la práctica, los beneficios, los entornos y la influencia y la compañía en relación con la actividad física, para identificar barreras y facilitadores. Resultados: La práctica de la actividad física se limitaba a las clases de educación física en la mayoría de los casos. El compañero principal en la práctica extracurricular era el padre del mismo sexo. La actividad física representaba una oportunidad para el disfrute, mejorar la salud física y mental, así como la contextura corporal, y para romper con la rutina diaria. La falta de tiempo por compromisos académicos fue la razón principal para no realizar actividad física. Los lugares públicos no siempre estaban disponibles, a menudo no se consideraban seguros. En la escuela, el espacio y las instalaciones eran inadecuados, y el uso estaba restringido. Conclusiones: La escuela es un punto de convergencia importante para la práctica de la actividad física, lo que sugiere la necesidad de fortalecer el plan de estudios al respecto; este entorno es un facilitador potencial para aumentar el nivel de actividad física en adolescentes. También se percibe como barrera, dado que la práctica interfiere con las actividades académicas. Las mejoras en la seguridad y el atractivo estético en el entorno comunitario se visibilizan como un facilitador para promover la actividad física.

Abstract Objective: Describe the perception of adolescents aged between 12 and 16 years, in Piedecuesta (Santander), in 2016, about the facilitators and barriers that influence physical activity. Methodology: Qualitative analysis from a phenomenological approach, with the participation of 20 adolescents who talked about the practice, benefits, environments, influence and company in connection with physical activity , to identify barriers and facilitators, through semi-structured interviews and a focus group. Results: Physical activity was limited to physical education classes in most cases. The main companion in extracurricular physical activity was the parent of the same sex. Physical activity represented an opportunity for enjoyment, improvement of physical and mental health, as well as body composition, and to have a break in their daily routine. Lack of time due to academic commitments was the main reason for not doing physical activity. Public places were not always available and they were often not considered to be safe. Space and facilities at school were inadequate, and their use was restricted.. Conclusions: The school is an important point of convergence for doing physical activity, suggesting the need to strengthen the curriculum in this respect; this environment is a potential facilitator to increasing the level of physical activity in adolescents. It can also be seen as a barrier, given that the practice interferes with academic activities. Improvements in safety and aesthetic appeal in the surrounding community are seen as a facilitator to promoting physical activity.

Resumo Objetivo: Descrever a percepção que os adolescentes entre 12 e 17 anos de Piedecuesta em Santander, tiveram em 2016 sobre os facilitadores e as barreiras que influenciaram na prática da atividade física. Metodologia: Análise qualitativa partindo de um foco fenomenológico, com a participação de 20 adolescentes em idade escolar que, através de entrevistas semiestruturadas e um grupo focal, conversaram sobre a prática, os benefícios, os entornos, a influência e o acompanhamento relacionados com a atividade física, para identificar barreiras e facilitadores. Resultados: Na maioria dos casos, a prática da atividade física limitava-se às aulas de educação física. O companheiro principal na prática extracurricular era o genitor ou genitora do mesmo sexo. A atividade física representava uma oportunidade para disfrutar, melhorar a saúde física e mental, além da estrutura corporal e para sair da rotina diária. A falta de tempo devido às responsabilidades escolares foi a principal razão para não realizarem atividade física. Os lugares públicos nem sempre estavam disponíveis e geralmente não são considerados seguros. Na escola, o espaço e as instalações eram inadequados e o uso estava restrito. Conclusões: A escola é um importante ponto de convergência para a prática da atividade física, o que determina a necessidade de fortalecer o currículo relacionado; esse ambiente é um facilitador potencial para aumentar o nível de atividade física nos adolescentes. Também se percebe como barreira, já que a prática interfere com as atividades escolares. As melhorias na segurança e um espaço comunitário mais atraente do ponto de vista estético são determinantes como facilitadores para a promoção da atividade física.

The Relationship between Socioeconomic Status, Family Income, and Measures of Muscular and Cardiorespiratory Fitness in Colombian Schoolchildren.

OBJECTIVE: To determine the associations between socioeconomic status (SES) and physical fitness in a sample of Colombian youth. STUDY DESIGN: Prueba SER is cross-sectional survey of schoolchildren in Bogota, Colombia. Mass, stature, muscular fitness (standing long-jump, handgrip), and cardiorespiratory fitness (20-m shuttle run) were measured in 52?187 schoolchildren 14-16 years of age. Area-level SES was categorized from 1 (very low) to 4 (high) and parent-reported family income was categorized as low, middle, or high. RESULTS: Converting measures into z scores showed stature, muscular, and cardiorespiratory fitness were significantly (z?=?0.3-0.7) below European values. Children in the mid- and high SES groups jumped significantly further than groups with very low SES. Differences were independent of sex but became nonsignificant when adjusted for anthropometric differences. Participants in the mid-SES and high-SES groups had better handgrip scores when adjusted for body dimension. There were, however, no significant between-group differences in cardiorespiratory fitness, which was strongly clustered by school and significantly greater in students from private schools. CONCLUSIONS: Area-level SES is associated with measures of muscular fitness in Colombian schoolchildren. These associations were largely explained by the large differences in body dimensions observed between SES groups. When area-level SES is considered, there was no evidence that family income influenced fitness. The clustering of outcomes reaffirms the potential importance of schools and area-level factors in promoting fitness through opportunities for physical activity. Interventions implemented in schools, can improve academic attainment; a factor likely to be important in promoting the social mobility of children from poorer families.

Sociodemographic factors related to handgrip strength in children and adolescents in a middle income country: The SALUS study.

OBJECTIVE: To determine sociodemographic factors associated with handgrip (HG) strength in a representative sample of children and adolescents from a middle income country. METHODS: We evaluated youth between the ages of 8 and 17 from a representative sample of individuals from the Department of Santander, Colombia. Anthropometric measures, HG strength, and self-reported physical activity were assessed, and parents/guardians completed sociodemographic questionnairres. Multinomial logistic regression models were used to estimate the association between sociodemographic and anthropometric characteristics and tertiles of relative HG strength. We also produced centile data for raw HG strength using quantile regression. RESULTS: 1,691 young people were evaluated. HG strength increased with age, and was higher in males than females in all age groups. Lower HG strength was associated with indicators of higher socioeconomic status, such as living in an urban area, residence in higher social strata neighborhoods, parent/guardian with secondary education or higher, higher household income, and membership in health insurance schemes. In addition, low HG strength was associated with lower physical activity levels and higher waist-to-hip ratio. In a fully adjusted regression model, all factors remained significant except for health insurance, household income, and physical activity level. CONCLUSIONS: While age and gender specific HG strength values were substantially lower than contemporary data from high income countries, we found that within this middle income population indicators of higher socioeconomic status were associated with lower HG strength. This analysis also suggests that in countries undergoing rapid nutrition transition, improvements in socioeconomic conditions may be accompanied by reduction in muscle strength.

Is myopia another clinical manifestation of insulin resistance?

Myopia is a multifactorial visual refraction disease, in which the light rays from distant objects are focused in front of retina, causing blurry vision. Myopic eyes are characterized by an increased corneal curvature and/or ocular axial length. The prevalence of myopia has increased in recent decades, a trend that cannot be attributed exclusively to genetic factors. Low and middle income countries have a higher burden of refractive error, which we propose could be a consequence of a shorter exposure time to a westernized lifestyle, a phenomenon that may also explain the rapid increase in cardiometabolic diseases, such as diabetes, among those populations. We suggest that interactions between genetic, epigenetic and a rapidly changing environment are also involved in myopia onset and progression. Furthermore, we discuss several possible mechanisms by which insulin resistance may promote abnormal ocular growth and myopia to support the hypothesis that insulin resistance and hyperinsulinemia are involved in its pathogenesis, providing a link between trends in myopia and those of cardiometabolic diseases. There is evidence that insulin have direct ocular growth promoting effects as well an indirect effect via the induction of insulin-like growth factors leading to decreases insulin-like growth factor-binding protein, also implicated in ocular growth.

Neck circumference as a predictor of metabolic syndrome, insulin resistance and low-grade systemic inflammation in children: the ACFIES study.

BACKGROUND: The current study aims to evaluate the association between neck circumference (NC) and several cardio-metabolic risk factors, to compare it with well-established anthropometric indices, and to determine the cut-off point value of NC for predicting children at increased risk of metabolic syndrome, insulin resistance and low-grade systemic inflammation. METHODS: A total of 669 school children, aged 8-14, were recruited. Demographic, clinical, anthropometric and biochemical data from all patients were collected. Correlations between cardio-metabolic risk factors and NC and other anthropometric variables were evaluated using the Spearman's correlation coefficient. Multiple linear regression analysis was applied to further examine these associations. We then determined by receiver operating characteristic (ROC) analyses the optimal cut-off for NC for identifying children with elevated cardio-metabolic risk. RESULTS: NC was positively associated with fasting plasma glucose and triglycerides (p = 0.001 for all), and systolic and diastolic blood pressure, C-reactive protein, insulin and HOMA-IR (p < 0.001 for all), and negatively with HDL-C (p = 0.001). Whereas, other anthropometric indices were associated with fewer risk factors. CONCLUSIONS: NC could be used as clinically relevant and easy to implement indicator of cardio-metabolic risk in children.

Influence of football match time-motion parameters on recovery time course of muscle damage and jump ability.

We analysed the time course of recovery of creatine kinase (CK) and countermovement jump (CMJ) parameters after a football match, and correlations between changes in these variables and match time-motion parameters (GPS-accelerometry) in 15 U-19 elite male players. Plasma CK and CMJ height (CMJH), average concentric force (CMJCON) and average eccentric force (CMJECC) were assessed 2 h before and 30 min, 24 h and 48 h post-match. There were substantially higher CK levels 30 min, 24 h and 48 h (ES: 0.43, 0.62, 0.40, respectively), post-match. CMJECC (ES: -0.38), CMJH (ES: -0.35) decreased 30 min post, CMJCON (ES: -0.35), CMJECC (ES: -0.35) and CMJH (ES: -1.35) decreased 24 h post, and CMJCON (ES: -0.41) and CMJH (ES: -0.53) decreased 48 h post. We found correlations between distance covered at velocities ≤21 km · h(-1) and changes in CK at 24 h (r = 0.56) and at 48 h (r = 0.54) and correlations between CK and distance covered >14 km · h(-1) (r = 0.50), accelerations (r = 0.48), and decelerations (r = 0.58) at 48 h. Changes in CMJCON 30 min and 24 h post (both r = -0.68) correlated with impacts >7.1·G. Decelerations >2 m · s(-)(2) correlated with changes CMJCON (r = -0.49) at 48 h and CMJECC (r = -0.47) at 30 min. Our results suggest that match GPS-accelerometry parameters may predict muscle damage and changes in components of neuromuscular performance immediately and 24-48 h post-match.

The impact of the FIFA 11+ training program on injury prevention in football players: a systematic review.

The FIFA 11+ is a simple, and easy to implement, sports injury prevention program comprising a warm up of 10 conditioning exercises. The aim of this systematic review was to evaluate the impact of the FIFA 11+ on injury incidence, compliance and cost effectiveness when implemented among football players. MEDLINE, EMBASE and Scopus databases were searched using the search terms "FIFA 11+", "football", "soccer", "injury prevention", and "The 11". The titles and abstracts were screened by two independent reviewers and the data were filtered by one reviewer using a standardized extraction form and thereafter checked by another one. The risk of bias and the methodological quality of the studies were evaluated through the PEDro score and Critical Appraisal Skills Programme (CASP). A total of 911 studies were identified, of which 12 met the inclusion criteria of the review. The FIFA 11+ has demonstrated how a simple exercise program completed as part of warm-up can decrease the incidence of injuries in amateur football players. In general, considerable reductions in the number of injured players, ranging between 30% and 70%, have been observed among the teams that implemented the FIFA 11+. In addition, players with high compliance to the FIFA 11+ program had an estimated risk reduction of all injuries by 35% and show significant improvements in components of neuromuscular and motor performance when participating in structured warm-up sessions at least 1.5 times/week. Most studies had high methodological quality and a low risk of bias. Given the large number of people who play football at amateur level and the detrimental impact of sports injuries on a personal and societal level, the FIFA 11+ can be considered as a fundamental tool to minimize the risks of participation in a sport with substantial health benefits.

Low muscle strength is associated with metabolic risk factors in Colombian children: the ACFIES study.

PURPOSE: In youth, poor cardiorespiratory and muscular strength are associated with elevated metabolic risk factors. However, studies examining associations between strength and risk factors have been done exclusively in high income countries, and largely in Caucasian cohorts. The aim of this study was to assess these interactions in schoolchildren in Colombia, a middle income Latin American country. METHODS: We measured body mass index, body composition, handgrip strength (HG), cardiorespiratory fitness (CRF) and metabolic risk factors in 669 low-middle socioeconomic status Colombian schoolchildren (mean age 11.52±1.13, 47% female). Associations between HG, CRF and metabolic risk factors were evaluated. RESULTS: HG and CRF were inversely associated with blood pressure, HOMA index and a composite metabolic risk score (p<0.001 for all) and HG was also inversely associated with triglycerides and C-reactive protein (CRP) (both p<0.05). Associations between HG and risk factors were marginally weakened after adjusting for CRF, while associations between CRF and these factors were substantially weakened after adjusting for HG. Linear regression analyses showed inverse associations between HG and systolic BP (ß = -0.101; p = 0.047), diastolic BP (ß = -0.241; p> = 0.001), HOMA (ß = -0.164; p = 0.005), triglycerides (ß = -0.583; p = 0.026) and CRP (ß = -0.183; p = 0.037) but not glucose (p = 0.698) or HDL cholesterol (p = 0.132). The odds ratios for having clustered risk in the weakest quartile compared with the strongest quartile were 3.0 (95% confidence interval: 1.81-4.95). CONCLUSIONS: In Colombian schoolchildren both poorer handgrip strength/kg body mass and cardiorespiratory fitness were associated with a worse metabolic risk profile. Associations were stronger and more consistent between handgrip and risk factors than between cardiorespiratory fitness and these risk factors. Our findings indicate the addition of handgrip dynamometry to non-invasive youth health surveillance programs would improve the accuracy of the assessment of cardio-metabolic health.

Anthropometric characteristics and physical performance of colombian elite male wrestlers.

BACKGROUND: Wrestling was an important part of the ancient Olympic Games and is still one of the most popular events of the modern Olympic Games. Studies indicate that general physiologic profile of successful wrestlers is high anaerobic power and capacity, muscular strength, above average aerobic power, exceptional flexibility, fat free mass, and a mesomorphic somatotype. OBJECTIVES: The objective of the present study was to evaluate anthropometric characteristics and physical performance of elite male wrestlers. PATIENTS AND METHODS: The Colombian Wrestling Team was evaluated while in preparation for the Olympic Games (n = 21; age, 27.9 ± 6.7 years). Athletes were tested on anthropometric and fitness parameters: body composition, somatotype distribution according to Heath-Carter, aerobic capacity, vertical jump, and anaerobic power. RESULTS: The evaluations showed a mean body fat percentage of 13.6% ± 3.0% (95% CI, 12.2%-15%), muscle mass of 46.4% ± 2.2% (95% CI, 45.4%-47.4%), Ponderal index of 41.0 ± 1.8 (95% CI, 40.2-41.8), body adiposity index (BAI) 25.1 ± 3.6 (95% CI, 23.5-26.8), and somatotype distribution mesomorphic-ectomorph (5.3-1.6-3.8). Mean aerobic capacity was 45.9 ± 6.6 mL/kg/min (95% CI, 42.8-48.9), vertical jump was 36.4 ± 6.6 cm (95% CI, 11.8-16.6), and anaerobic power was 92.6 ± 19.5 kg/s (95% CI, 83.7-101.5). CONCLUSIONS: These results provided a profile of elite wrestlers that could be used as training targets for developing athletes. The results may also provide information for training and tactical planning.

Inflammation and hypertension: are there regional differences?

Hypertension is a chronic disease with global prevalence and incidence rapidly increasing in low and medium income countries. The surveillance of cardiovascular risk factors, such as hypertension, is a global health priority in order to estimate the burden and trends, to appropriately direct resources, and to measure the effect of interventions. We propose here that the adoption of Western lifestyles in low and middle incomes countries has dramatically increased the prevalence of abdominal obesity, which is the main source of proinflammatory cytokines, and that the vascular systemic inflammation produced by adipose tissue contributes to the development of hypertension. The concentration of proinflammatory cytokines is higher in the Latin American population than that reported in developed countries, suggesting a higher susceptibility to develop systemic low-degree inflammation at a given level of abdominal obesity. These particularities are important to be considered when planning resources for health care programs. Moreover, studying these singularities may provide a better understanding of the causes of the burden of cardiovascular risk factors and the remarkable variability in the prevalence of these medical conditions within and between countries.