Physical activity and health in Chinese children and adolescents: expert consensus statement (2020).

China is experiencing significant public health challenges related to social and demographic transitions and lifestyle transformations following unprecedented economic reforms four decades ago. Of particular public health concern is the fourfold increase in overweight and obesity rates in the nation's youth population, coupled with the low prevalence of adolescents meeting recommended levels of physical activity. Improving the overall health of China's more than 170 million children and adolescents has become a national priority. However, advancing nationwide health initiatives and physical activity promotion in this population has been hampered by the lack of a population-specific and culturally relevant consensus on recommendations for achieving these ends. To address this deficiency and inform policies to achieve Healthy China 2030 goals, a panel of Chinese experts, complemented by international professionals, developed this consensus statement. The consensus was achieved through an iterative process that began with a literature search from electronic databases; in-depth reviews, conducted by a steering committee, of the resulting articles; and panel group evaluations and discussions in the form of email correspondence, conference calls and written communications. Ultimately, the panel agreed on 10 major themes with strong scientific evidence that, in children and adolescents aged 6-17, participating in moderate to vigorous physical activities led to multiple positive health outcomes. Our consensus statement also (1) highlights major challenges in promoting physical activity, (2) identifies future research that addresses current knowledge gaps, and (3) provides recommendations for teachers, education experts, parents and policymakers for promoting physical activity among Chinese school-aged children and adolescents. This consensus statement aligns with international efforts to develop global physical activity guidelines to promote physical activity and health and prevent lifestyle-related diseases in children and adolescents. More importantly, it provides a foundation for developing culturally appropriate and effective physical activity interventions, health promotion strategies and policy initiatives to improve the health of Chinese children and adolescents.

Epidemiology of time-loss injuries in international fencing: a prospective, 5-year analysis of Fédération Internationale d'Escrime competitions.

OBJECTIVES: The study aimed to determine the risk of time-loss injuries in international fencing and to characterise their type, location, severity and mechanism. Variations in risk associated with sex and discipline categories are also examined. METHODS: Data on participation and withdrawal due to injury from 809 competitions comprising the major events of the 2010-2014 seasons (inclusive) for the Fédération Internationale d'Escrime were compiled from official results. Athletes who withdrew due to injury sustained in each competition were contacted individually to obtain follow-up information including time lost from fencing participation (practice/competition) and sequelae. RESULTS: A total of 176 injuries were recorded from 637 776 athlete exposures (AEs) in 85 686 participants (men=47 869; women=37 817) over the study period, for an overall incidence of 0.28/1000 AEs (95% CI 0.24 to 0.32). Men had significantly greater risk than women (RR=1.42, 95% CI 1.05 to 1.94); épée had a significantly lower risk than foil or sabre (RR=0.52, 95% CI 0.35 to 0.76; RR=0.47, 95% CI 0.32 to 0.69, respectively). The majority of injuries were sprains (40.8%) and strains (20.1%), which occurred in the lower extremities (72.4%); ankle sprains were the most common specific injury (25.3%). Intrinsic effort of the fencer (non-contact injury) was the most common mechanism related to a time-loss injury (47.1% of cases). The overall median time loss was 4 weeks; 32.1% of the injuries involved 2 weeks or less away from fencing participation. CONCLUSION: The data indicate that the risk of time-loss injury in international fencing is very low and primarily involves sprains and strains in the lower extremity.

Preventing penetrating hand injuries in sabre fencing: an application and critique of the van Mechelen model by the Fédération Internationale d'Escrime.

BACKGROUND/AIM: To address the unusual phenomenon of unbroken blades causing penetrating hand injuries in sabre fencing by applying the van Mechelen model of the 'sequence of prevention'. METHODS: Cases were collected from three surveillance systems and snowball sampling, and examined for potential aetiological factors. Presumed contributing factors were evaluated against the available evidence to compile a viable list for change. Determining a prevention strategy was guided by the philosophy of developing an approach that was most likely to produce a meaningful reduction in these injuries with the least disruption to the current norms of competitive sabre fencing. RESULTS: Nine factors which contributed, either individually or in some combination, to these injuries were grouped under three headings relating to: (1) the nature of modern sabre fencing, (2) the design of the sabre blade and (3) the vulnerability of the hand. Changes to the design and integrity of sabre gloves were selected as the most feasible option and new standards were introduced as compulsory in international competitions from 1 April 2014. The effect of this change is now being monitored via available surveillance systems. CONCLUSIONS: The van Mechelen model is a useful framework for sports federations to apply to reduce injury risk, even for rare injuries. However, this research model has limitations in guiding the realities of sometimes competing interests among the scientific, political, financial and technical aspects of injury prevention interventions.

So much research, so little application: Barriers to dissemination and practical implementation of Tai Ji Quan.

Despite the large number of articles published in the medical literature advocating the use of Tai Ji Quan for a wide variety of health-related outcomes, there has been little systematic broad-scale implementation of these programs. It may be argued that the lack of funding from organizations capable of implementing and overseeing large-scale programs, such as governmental health agencies or national non-governmental organizations concerned with healthcare for older adults, is to blame. However, the evidence these organizations need to justify underwriting such programs is in short supply because of conflicting priorities and standards related to determining the efficacy and effectiveness of Tai Ji Quan. Establishing efficacy through acceptable designs such as randomized controlled trials involves strict protocols to ensure meaningful internal validity but different approaches are needed to demonstrate meaningful effectiveness (external validity) outside the study setting. By examining the quality, quantity, and relative proportions of the randomized controlled trials, systematic reviews, and dissemination studies reported in the medical literature, this paper highlights the disparity in emphasis between efficacy and effectiveness research that has impeded the development of a cohesive literature on Tai Ji Quan and concludes that until more researchers develop a systematic, long-range commitment to investigating its health-related benefits, the research related will remain fractured and sporadic, limiting the incentive of large funding agencies to support its wide-spread use.

Getting to the point: injury patterns and medical care in competitive fencing.

Modern competitive fencing, consisting of the three disciplines of foil, epee, and sabre, has experienced a rapid growth in participation across all age groups in the USA in the past decade. Unfortunately, because of media sensationalism and a lack of well-designed epidemiological studies, there are significant misconceptions regarding both the incidence and types of injuries presented in fencing. Recent research has indicated that the rate of time-loss injuries in competitive fencing is very low and the majority of these injuries are lower extremity sprains and strains, typical of ballistic, change-of-direction sports. However, most medical assistance in fencing is for minor (nontime-loss) soft tissue injuries (blisters, contusions, abrasions). Although extremely rare, significant fencing-specific injuries, such as lacerations and punctures, occur. Medical personnel dealing with fencing competitions need to be aware of the potential for catastrophic or fatal wounds.

Built environment, adiposity, and physical activity in adults aged 50-75.

BACKGROUND: Few studies have investigated the built environment and its association with health-especially excess adiposity-and physical activity in the immediate pre-Baby Boom/early-Baby Boom generations, soon to be the dominant demographic in the U.S. The purpose of this study was to examine this relationship. METHODS: This study used a cross-sectional, multilevel design with neighborhoods as the primary sampling unit (PSU). Residents (N=1221; aged 50-75) were recruited from 120 neighborhoods in Portland OR. The independent variables at the PSU level involved GIS-derived measures of land-use mix, distribution of fast-food outlets, street connectivity, access to public transportation, and green and open spaces. Dependent variables included resident-level measures of excess adiposity (BMI>or=25), three walking activities, and physical activity. Data were collected in 2006-2007 and analyzed in 2007. RESULTS: Each unit (i.e., 10%) increase in land-use mix was associated with a 25% reduction in the prevalence of overweight/obesity. However, a 1-SD increase in the density of fast-food outlets was associated with a 7% increase in overweight/obesity. Higher mixed-use land was positively associated with all three types of walking activities and the meeting of physical activity recommendations. Neighborhoods with high street connectivity, high density of public transit stations, and green and open spaces were related in varying degrees to walking and the meeting of physical activity recommendations. The analyses adjusted for neighborhood- and resident-level sociodemographic characteristics. CONCLUSIONS: Findings suggest the need for public health and city planning officials to address modifiable neighborhood-level, built-environment characteristics to create more livable residential communities aimed at both addressing factors that may influence unhealthy eating and promoting active, healthy lifestyles in this rapidly growing population.

Tai Chi and falls prevention in older people.

BACKGROUND: Considerable research evidence has been accumulated since 1990 that practicing Tai Chi can ameliorate multiple characteristics in older adults that place them at increased risk of falling, including poor balance, loss of strength, limited flexibility, and fear of falling. However, relatively few studies have directly examined the influence of Tai Chi practice on falls in this population. RESULTS: Nine randomized controlled trials utilizing Tai Chi (n = 6), or Tai Chi-inspired exercise (n = 3), were published between 1996 and July, 2007. The studies varied considerably on study settings, participant characteristics, sample size, type of Tai Chi intervention, length of intervention and quality of the study design. Of the six studies that used Tai Chi forms, three showed significant improvement in fall-related outcomes. One study using Tai Chi-inspired exercise also had a significant fall-related outcome. CONCLUSION: Despite the evidence demonstrating the beneficial influence of Tai Chi practice on known risk factors for falling in older adults, evidence indicating an actual impact on falls-related outcomes is equivocal. More large-scale, longitudinal studies with consistent intervention parameters and clinically meaningful outcome variables are needed to a clarify the role of Tai Chi in effective falls prevention programs. The recent development of a standardized, research-to-practice Tai Chi falls prevention program may be an important step in this process.

Incidence and characteristics of time-loss injuries in competitive fencing: a prospective, 5-year study of national competitions.

OBJECTIVE: To estimate the incidence of time-loss injuries in competitive fencing and to characterize these injuries regarding type and location. DESIGN: A 5-year prospective study. SETTING: Data were collected at all national events organized by the U.S. Fencing Association (USFA) during the 2001-2006 seasons. PARTICIPANTS: A total of 78,223 male and female competitors, ranging in age from 8 to above 70, participated in various events in the targeted competitions. METHODS: Experienced certified athletic trainers (ATC) evaluated and documented all incidents that resulted in withdrawal from competition. Exposure data [athlete exposures (AE)] were calculated from the number of bouts completed in each competition. MAIN OUTCOME MEASURES: Rate of time-loss injury was calculated per 1000AE. Frequency distributions for types and locations of injuries were used to characterize time-loss injuries. RESULTS: One hundred eighty-four time-loss injuries were reported during the study, for an overall rate of 0.3 per 1000 AE (95% CI: 0.26-0.35). Of these, 26.1% were recorded as strains and 25.5% were identified as sprains. The knee was the most frequently injured location (19.6%), followed by the thigh (15.2%) and the ankle (13%). Overall, 60% of the injuries were in the lower extremities. CONCLUSIONS: The rate of time-loss injury in competitive fencing is low. Although there are differences in the distribution of types and location of time-loss injuries by sex and discipline, the predominant characteristics (sprain/strain in the lower extremities) are similar to other sports with ballistic action in stop-start, rapid change-of-direction activity.

Basketball injuries.

OBJECTIVE: To identify and quantify, to the best extent possible from the existing literature, injury characteristics and factors (risk; protective) associated with injury in young basketball players. DATA SOURCES: Database searches principally involving Medline and SportDiscus. In addition, web-based searching and filtering of the reference lists of papers found in the preliminary searches were utilized. MAIN RESULTS: Few well-controlled studies of this population have been conducted. However, from the information available: basketball is the most frequent cause of sports-related emergency department visits for youth and adolescents; the risk of being injured in a game is greater than for practice; girls are more likely to be injured than boys, especially with knee and ankle injuries and the knee injuries are more likely to be severe; acute injuries are more common than chronic; strains/sprains are the most common types of injuries but overall time loss is minimal, indicating that the majority of pediatric basketball injuries are minor (less than 7 days away from activity). Intervention studies show that: mouthguards reduce orofacial/dental injuries; mouthguard use can be increased in young players; neuromuscular training can reduce the incidence of knee injuries in female participants; postural sway is related to risk of ankle injury. CONCLUSIONS: The current state of epidemiological research involving youth and adolescent basketball injuries is poor. With an increasing number of young participants, in situations ranging from informal play and physical education classes to organized community and school teams, the need for comprehensive and authoritative information on risk and protective factors is significant.