Testing in Intermittent Sports-Importance for Training and Performance Optimization in Adult Athletes.

ABSTRACT: Performance in intermittent sports relies on the interplay between multiple physiological systems determining the capacity to perform short explosive efforts as well as repeated intense actions with limited recovery over the course of an entire game. Testing should reflect these demands to allow for sport- and position-specific capacity analyses that eventually may translate into optimized training and improved performance. This may include individual load management and optimized training prescription, intensity targeting for specific positions or individual athletes, as well as benchmarking for monitoring of training progression and enhanced engagement of athletes. This review provides an overview of available tests in different exercise domains identified as relevant (from assessment of single explosive actions to intermittent endurance capacity), forming the basis for recommendations on how to compose a comprehensive yet feasible test battery that may be integrated into the seasonal competition and training plan. The test procedures should cover the performance spectrum of relevance for the individual athlete-also in team sports to account for positional differences. We emphasize the benefits of sport-specific tests, highlight parameters of importance for test standardization, and discuss how the applied test battery may be supplemented with secondary tests directed toward specific energy systems to allow for more in-depth analyses when required (e.g., in terms of an underperforming athlete). The synergy between testing and tracking of match performance (utilizing time-motion or global positioning systems) is highlighted, and although tracking cannot substitute for testing, combining the tools may provide a comprehensive overview of the physiological demands and performance during competition contextualized to the athletes' maximal exercise capacity.

Unsupervised Machine Learning in Countermovement Jump and Isometric Mid-Thigh Pull Performance Produces Distinct Combat and Physical Fitness Clusters in Male and Female U.S. Marine Corps Recruits.

INTRODUCTION: Several challenges face the U.S. Marine Corps (USMC) and other services in their efforts to design recruit training to augment warfighter mobility and resilience in both male and female recruits as part of an integrated model. Strength and power underpin many of the physical competencies required to meet the occupational demands one might face in military. As the military considers adopting force plate technology to assess indices of strength and power, an opportunity presents itself for the use of machine learning on large datasets to deduce the relevance of variables related to performance and injury risk. The primary aim of this study was to determine whether cluster analysis on baseline strength and power data derived from countermovement jump (CMJ) and isometric mid-thigh pull (IMTP) adequately partitions men and women entering recruit training into distinct performance clusters. The secondary aim of this study is then to assess the between-cluster frequencies of musculoskeletal injury (MSKI). MATERIALS AND METHODS: Five hundred and sixty-five males (n = 386) and females (n = 179) at the Marine Corps Recruit Depots located at Parris Island and San Diego were enrolled in the study. Recruits performed CMJ and IMTP tests at the onset of training. Injury data were collected via medical chart review. Combat fitness test (CFT) and physical fitness test (PFT) results were provided to the study team by the USMC. A k-means cluster analysis was performed on CMJ relative peak power, IMTP relative peak force, and dynamic strength index. Independent sample t-tests and Cohen's d effect sizes assessed between-cluster differences in CFT and PFT performance. Differences in cumulative incidence of lower extremity %MSKIs were analyzed using Fisher's exact test. Relative risk and 95% confidence intervals (CIs) were also calculated. RESULTS: The overall effects of cluster designation on CMJ and IMTP outcomes ranged from moderate (relative peak power: d = -0.68, 95% CI, -0.85 to -0.51) to large (relative peak force: d = -1.69, 95% CI, -1.88 to -1.49; dynamic strength index: d = 1.20, 95% CI, 1.02-1.38), indicating acceptable k-means cluster partitioning. Independent sample t-tests revealed that both men and women in cluster 2 (C2) significantly outperformed those in cluster 1 (C1) in all events of the CFT and PFT (P < .05). The overall and within-gender effect of cluster designation on both CFT and PFT performance ranged from small (d > 0.2) to moderate (d > 0.5). Men in C2, the high-performing cluster, demonstrated a significantly lower incidence of ankle MSKI (P = .04, RR = 0.2, 95% CI, 0.1-1.0). No other between-cluster differences in MSKI were statistically significant. CONCLUSIONS: Our results indicate that strength and power metrics derived from force plate tests effectively partition USMC male and female recruits into distinct performance clusters with relevance to tactical and physical fitness using k-means clustering. These data support the potential for expanded use of force plates in assessing readiness in a cohort of men and women entering USMC recruit training. The ability to pre-emptively identify high and low performers in the CFT and PFT can aid in leadership developing frameworks for tailoring training to enhance combat and physical fitness with benchmark values of strength and power.

A single trial of the five-repetition sit-to-stand test provides adequate measures in community-dwelling older adults: A cross-sectional study.

PURPOSE: To investigate whether the number of trials would affect the results of the Five-Repetition Sit-to-Stand Test (5STSt) and its measurement properties in community-dwelling older adults. METHODS: Three trials of the 5STSt, after familiarization, were performed by 50 older adults (69.9 ± 5.5 years). The one-way ANOVA was used to compare the number of trials of the 5STSt (the first trial, the best trial, the mean of two trials, and the mean of three trials). Intraclass Correlation Coefficient (ICC) was calculated to investigate inter-rater and test-retest reliabilities, and SEM and MDC95% were also calculated. The magnitude of the correlations was classified as very low≤0.25; low = 0.26-0.49; moderate = 0.50-0.69; high = 0.70-0.89; and very high = 0.90-1.00. (α = 0.05). RESULTS: The values provided by different numbers of trials were similar in session-1 (F = 1.315; p = 0.271), as well as in session-2 (F = 0.668; p = 0.574). Inter-rater and test-retest reliabilities were significant and classified as moderate to high for all number of trials (0.63

Deep squat test - Functional movement Screen: Convergent validity and ability to discriminate subjects with different levels of joint mobility.

BACKGROUND: Functional Movement Screen (FMS) is an important tool in the assessment of exercise practice. Assuming FMS lacks precise validity for assessing postural deficits, further research is needed to assess whether it is a sufficiently precise tool for analysing joint mobility. Research aims were to evaluate: convergent validity of Deep Squat (DS) - one of FMS tests - regarding joint mobility, using data from a three-dimensional motion analysis as a comparable method; DS's ability to discriminate between subjects with different joint mobility levels. METHODS: Sixty subjects were selected (23.6 ± 3.8 years). DS was performed according to FMS guidelines. Subjects' performance in frontal and sagittal planes was recorded by two video cameras and subsequently scored by two FMS-certified evaluators. Three-dimensional motion analyses of DS were acquired by a Vicon Motion Capture System (200 Hz). Ten trials were acquired for each subject. Ankle, knee, hip, and shoulder angular positions in sagittal plane were determined from the FullBody PlugInGait model. Spearman's coefficient examined the correlation between angular positions and DS score. Kruskal-Wallis test was used to assess the DS ability to discriminate between subjects with different joint mobility levels by comparing different scores. RESULTS: Negligible to moderate correlations were found between DS score and angular positions (-0.5 < r < 0.5). Only shoulder angular positions showed differences between score "1" and "2" (p < 0.05). Shoulder and hip angular positions showed no differences between score "2" and "3" (p < 0.05). CONCLUSIONS: DS yielded low convergent validity regarding joint mobility and did not show the ability to discriminate between subjects with different joint mobility levels.

Difference in badminton-specific endurance evaluated by a newly developed on-court test between competitive levels: A pilot study of female players.

We developed a test to evaluate badminton-specific endurance. The study included 10 female badminton players. Five participants were ranked in Japan's top 100 national rankings (ranked), whereas the others were unranked (unranked). Participants reacted quickly with badminton-specific steps from the base center to the four sensors at each corner of a singles badminton court. On each set, they reacted eight times to randomized instructions at stage-specific intervals (1.2, 1.0, and 0.8 s for stages 1, 2, and 3, respectively), which were performed six times with a rest of 20 s in each stage (8 movements × 6 sets × 3 stages). On a different day, participants ran on a treadmill as a comparative test. Blood lactate concentration (BLa) was measured on each test. In the badminton-specific test, ranked participants had lower BLa (4.2 ± 1.7 mM vs. 6.3 ± 3.1 mM), with medium or large effect sizes. The average reach time to sensors was shorter in ranked participants (1.56 ± 0.03 s vs. 1.62 ± 0.07 s), with medium or large effect sizes. BLa was similar between groups, with trivial or small effect sizes in the running test. These results suggest that the newly developed test can evaluate badminton-specific endurance.

The psychometric properties of the Six-Spot Step Test - a systematic review using the COSMIN guidelines.

OBJECTIVE: Accurate and reliable balance measures are important for prescribing fall prevention treatments and monitoring their effectiveness. Thus, we aimed to systematically review the psychometric properties of the Six-Spot Step Test, an increasingly used measure of dynamic balance. DATA SOURCES: A literature search using the free-text term "Six-Spot Step Test" was performed on 12 February 2024, in Medline, Embase, Rehabilitation & Sports Medicine and SPORTDiscus. Eligibility criteria were adults aged 18 or more, trials evaluating the psychometric properties of the Six-Spot Step Test, and English-language articles. Conference abstracts were excluded. REVIEW METHODS: Two investigators screened and selected data independently and assessed the methodological quality and evidence using the COSMIN Risk of Bias checklist and modified GRADE approach. One investigator extracted study characteristics such as design, population and psychometric properties. RESULTS: Of the 159 articles identified, 16, evaluating multiple measurement properties, were included in the final analysis. A total of 1319 people participated, including people affected by Stroke, multiple sclerosis, Parkison's disease, chronic inflammatory polyneuropathy and older adults with balance problems. Eight articles assessing reliability (n = 618, intraclass correlations coefficient ≥0.7, minimal detectable change = 22%) and 12 construct validity (n = 1082, 83% true hypothesis, area under the curve >0.7) exhibited sufficient methodological quality with high-level evidence, while two studies (n = 167) examining responsiveness showed very low evidence. CONCLUSION: Apart from responsiveness, robust evidence supports the reliability and validity of the Six-Spot Step Test for assessing dynamic balance in a specific group of individuals with neurological diseases and older adults. Further, it is considered feasible for clinical use.

The test-retest reliability of physiological and perceptual responses during treadmill load carriage.

PURPOSE: Understanding the test-retest reliability of physiological responses to load carriage influences the interpretation of those results. The aim of this study was to determine the test-retest reliability of physiological measures during loaded treadmill walking at 5.5 km h-1 using the MetaMax 3B. METHODS: Fifteen Australian Army soldiers (9 male, 6 female) repeated two 12-min bouts of treadmill walking at 5.5 km h-1 in both a 7.2 kg Control condition (MetaMax 3B, replica rifle) and a 23.2 kg Patrol condition (Control condition plus vest) across three sessions, separated by one week. Expired respiratory gases and heart rate were continuously collected, with the final 3 min of data analysed. Ratings of Perceived Exertion and Omnibus-Resistance Exercise Scale were taken following each trial. Reliability was quantified by coefficient of variation (CV), intra-class correlation coefficients (ICC), smallest worthwhile change (SWC), and standard error of the measurement. RESULTS: Metabolic and cardiovascular variables were highly reliable (≤ 5% CV; excellent-moderate ICC), while the respiratory variables demonstrated moderate reliability (< 8% CV; good-moderate ICC) across both conditions. Perceptual ratings had poorer reliability during the Control condition (12-45% CV; poor ICC) than the Patrol condition (7-16% CV; good ICC). CONCLUSIONS: The test-retest reliability of metabolic and cardiovascular variables was high and relatively consistent during load carriage. Respiratory responses demonstrated moderate test-retest reliability; however, as the SWC differed with load carriage tasks, such data should be interpreted independently across loads. Perceptual measures demonstrated poor to moderate reliability during load carriage, and it is recommended that they only be employed as secondary measures.

Reference values for estimated VO2max by two submaximal cycle tests: the Åstrand-test and the Ekblom-Bak test.

AIMS: Submaximal tests estimating VO2max have inherent biases; hence, using VO2max estimations from the same test is essential for reducing this bias. This study aimed to establish sex- and age-specific reference values for estimated VO2max using the Åstrand-test (Å-test) and the Ekblom-Bak test (EB-test). We also assessed the effects of age, exercise level, and BMI on VO2max estimations. METHODS: We included men and women (20-69 years) from the Swedish working population participating in Health Profile Assessments between 2010 and 2020. Excluding those on heart rate-affecting medicines and smokers, n = 263,374 for the Å-test and n = 95,043 for the EB-test were included. VO2max reference values were based on percentiles 10, 25, 40, 60, 75, and 90 for both sexes across 5-year age groups. RESULTS: Estimated absolute and relative VO2max were for men 3.11 L/min and 36.9 mL/min/kg using the Å-test, and 3.58 L/min and 42.4 mL/min/kg using the EB-test. For women, estimated absolute and relative VO2max were 2.48 L/min and 36.6 mL/min/kg using the Å-test, and 2.41 L/min and 35.5 mL/min/kg using the EB-test. Higher age (negative), higher exercise level (positive), and higher BMI (negative) were associated with estimated VO2max using both tests. However, explained variance by exercise on estimated VO2max was low, 10% for the Å-test and 8% for the EB-test, and moderate for BMI, 23% and 29%. CONCLUSION: We present reference values for estimated VO2max from two submaximal cycle tests. Age, exercise, and BMI influenced estimated VO2max. These references can be valuable in clinical evaluations using the same submaximal tests.

Exercise duration: Independent effects on acute physiologic responses and the need for an individualized prescription.

An individualization of exercise prescription is implemented mainly in terms of intensity but not for duration. To survey the need for an individualized exercise duration prescription, we investigated acute physiologic responses during constant-load exercise of maximal duration (tmax ) and determined so-called duration thresholds. Differences between absolute (min) and relative terms (% tmax ) of exercise duration were analyzed. Healthy young and trained male and female participants (n = 11) performed an incremental exercise test and one tmax constant-load exercise test at a target intensity of 10% of maximal power output below the second lactate turn point (LTP2 ). Blood lactate, heart rate, and spirometric data were measured during all tests. tmax was markedly different across subjects (69.6 ± 14.8 min; range: 40-90 min). However, distinct duration phases separated by duration thresholds (DTh) were found in most measured variables. These duration thresholds (except DTh1) were significantly related to tmax (DTh2: r2  = 0.90, p < 0.0001; DTh3: r2  = 0.98, p < 0.0001) and showed substantial interindividual differences if expressed in absolute terms (DTh2: 24.8 ± 6.0 min; DTh3: 47.4 ± 10.6 min) but not in relative terms (DTh2: 35.4 ± 2.7% tmax ; DTh3: 67.9 ± 2.4% tmax ). Our data showed that (1) maximal duration was individually different despite the same relative intensity, (2) duration thresholds that were related to tmax could be determined in most measured variables, and (3) duration thresholds were comparable between subjects if expressed in relative terms. We therefore conclude that duration needs to be concerned as an independent variable of exercise prescription.

Updated Reference Standards for Cardiorespiratory Fitness Measured with Cardiopulmonary Exercise Testing: Data from the Fitness Registry and the Importance of Exercise National Database (FRIEND).

OBJECTIVE: To provide updated reference standards for cardiorespiratory fitness (CRF) for the United States derived from cardiopulmonary exercise (CPX) testing when using a treadmill or cycle ergometer. PATIENTS AND METHODS: Thirty-four laboratories in the United States contributed data to the Fitness Registry and the Importance of Exercise National Database. Analysis included 22,379 tests (16,278 treadmill and 6101 cycle ergometer) conducted between January 1, 1968, through March 31, 2021, from apparently healthy adults (aged 20 to 89 years). Percentiles of peak oxygen consumption for men and women were determined for each decade from 20 through 89 years of age for treadmill and cycle exercise modes, as well as when defining maximal effort as respiratory exchange ratio (RER) greater than or equal to 1.0 or RER greater than or equal to 1.1. RESULTS: For both men and women, the 50th percentile scores for each exercise mode decreased with age and were higher in men across all age groups and higher for treadmill compared with cycle CPX. The average rate of decline per decade over a 6-decade period was 13.5%, 4.0 mLO2·kg-1·min-1 for treadmill CPX and 16.4%, 4.3 mLO2·kg-1·min-1 for cycle CPX. Observationally, the mean peak oxygen consumption was similar whether using an RER criterion of greater than or equal to 1.0 or greater than or equal to 1.1 across the different test modes, ages, and for both sexes. The updated reference standards for treadmill CPX were 1.5 - 4.6 mLO2·kg-1·min-1 lower compared with the previous 2015 standards whereas the updated cycling standards were generally comparable to the original 2017 standards. CONCLUSION: These updated cardiorespiratory fitness reference standards improve the representativeness of the US population compared with the original standards.

Examining the repeatability of a novel test to measure exertional dyspnoea in chronic obstructive pulmonary disease.

BACKGROUND: Exertional dyspnoea(ED) is a hallmark of chronic obstructive pulmonary disease(COPD). We examined the repeatability and face validity of the end-exercise ED(EDend) response during the Dyspnoea Challenge and compared those to the six-minute walk test (6MWT) in COPD. METHODS: Twenty-six individuals with COPD(13 Females, age:69 ± 5.5yrs, FEV1:63.4 ± 11.9 %) completed 2 × 6MWTs and 4 x Dyspnoea Challenges on three occasions. The challenge consisted of a two-minute treadmill walk at 80 % of 6MWT speed(3.9 ± 0.5 km·hr-1) at either a low(LIDC:5.3 ± 2%) or high angle of incline(HIDC:9.5 ± 3%). Dyspnoea(0-10 scale), heart rate(HR) and oxygen saturation(SpO2) were monitored continuously. RESULTS: Mean 6MWT distance was 488 ± 58 m. End-exercise ED and HR were higher in the HIDC(EDend 6.2 ± 2.0; HR: 123 ± 17beats·min-1) compared to the LIDC(EDend 4.2 ± 2.0; HR: 119 ± 15beats·min-1) and the 6MWT(EDend 4.3 ± 2.0; HR: 115 ± 16beats·min-1)(P < 0.01). SpO2 was not different between 6MWT, LIDC or HIDC(P = 0.34). The intraclass correlation coefficient(ICC) for each intensity was excellent (HIDC, ICC = 0.88, LIDC, ICC = 0.93, P < 0.001) with neither reporting bias(HIDC, P = 0.63; LIDC, P = 0.94). CONCLUSIONS: The Dyspnoea Challenge is a simple measure of ED that appears to have both repeatability and face validity. With further optimisation, this test may enhance the field-based clinical assessment of ED.

Utility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients.

Cardiopulmonary exercise testing (CPET) guidelines recommend analysis of the oxygen (O2 ) pulse for a late exercise plateau in evaluation for obstructive coronary artery disease (OCAD). However, whether this O2 pulse trajectory is within the range of normal has been debated, and the diagnostic performance of the O2 pulse for OCAD in physically fit individuals, in whom V˙O2 may be more likely to plateau, has not been evaluated. Using prospectively collected data from a sports cardiology program, patients were identified who were free of other cardiac disease and underwent clinically-indicated CPET within 90 days of invasive or computed tomography coronary angiography. The diagnostic performance of quantitative O2 pulse metrics (late exercise slope, proportional change in slope during late exercise) and qualitative assessment for O2 pulse plateau to predict OCAD was assessed. Among 104 patients (age:56 ± 12 years, 30% female, peak V˙O2 119 ± 34% predicted), the diagnostic performance for OCAD (n = 24,23%) was poor for both quantitative and qualitative metrics reflecting an O2 pulse plateau (late exercise slope: AUC = 0.55, sensitivity = 68%, specificity = 41%; proportional change in slope: AUC = 0.55, sensitivity = 91%, specificity = 18%; visual plateau/decline: AUC = 0.51, sensitivity = 33%, specificity = 67%). When O2 pulse parameters were added to the electrocardiogram, the change in AUC was minimal (-0.01 to +0.02, p ≥ 0.05). Those patients without OCAD with a plateau or decline in O2 pulse were fitter than those with linear augmentation (peak V˙O2 133 ± 31% vs. 114 ± 36% predicted, p < 0.05) and had a longer exercise ramp time (9.5 ± 3.2 vs. 8.0 ± 2.5 min, p < 0.05). Overall, a plateau in O2 pulse was not a useful predictor of OCAD in a physically fit population, indicating that the O2 pulse should be integrated with other CPET parameters and may reflect a physiologic limitation of stroke volume and/or O2 extraction during intense exercise.

Making Cardiopulmonary Exercise Testing Interpretable for Clinicians.

ABSTRACT: Cardiopulmonary exercise testing (CPET) is a dynamic clinical tool for determining the cause for a person's exercise limitation. CPET provides clinicians with fundamental knowledge of the coupling of external to internal respiration (oxygen and carbon dioxide) during exercise. Subtle perturbations in CPET parameters can differentiate exercise responses among individual patients and disease states. However, perhaps because of the challenges in interpretation given the amount and complexity of data obtained, CPET is underused. In this article, we review fundamental concepts in CPET data interpretation and visualization. We also discuss future directions for how to best use CPET results to guide clinical care. Finally, we share a novel three-dimensional graphical platform for CPET data that simplifies conceptualization of organ system-specific (cardiac, pulmonary, and skeletal muscle) exercise limitations. Our goal is to make CPET testing more accessible to the general medical provider and make the test of greater use in the medical toolbox.

Comparison of constant load exercise intensity for verification of maximal oxygen uptake following a graded exercise test in older adults.

Maximal oxygen uptake (VO2 max) declines with advancing age and is a predictor of morbidity and mortality risk. The purpose here was to assess the utility of constant load tests performed either above or below peak work rate obtained from a graded exercise test for verification of VO2 max in older adults. Twenty-two healthy older adults (9M, 13F, 67 ± 6 years, BMI: 26.3 ± 5.1 kg·m-2 ) participated in the study. Participants were asked to complete two experimental trials in a randomized, counterbalanced cross-over design. Both trials (cycle ergometer) consisted of (1) an identical graded exercise test (ramp) and (2) a constant load test at either 85% (CL85; n = 22) or 110% (CL110; n = 20) of the peak work rate achieved during the associated ramp (performed 10-min post ramp). No significant differences were observed for peak VO2 (L·min-1 ) between CL85 (1.86 ± 0.72; p = 0.679) or CL110 (1.79 ± 0.73; p = 0.200) and the associated ramp (Ramp85, 1.85 ± 0.73; Ramp110, 1.85 ± 0.57). Using the study participant's mean coefficient of variation in peak VO2 between the two identical ramp tests (2.9%) to compare individual differences between constant load tests and the associated ramp revealed 19/22 (86%) of participants achieved a peak VO2 during CL85 that was similar or higher versus the ramp, while only 13/20 (65%) of participants achieved a peak VO2 during CL110 that was similar or higher versus the ramp. These data indicate that if a verification of VO2 max is warranted when testing older adults, a constant load effort at 85% of ramp peak power may be more likely to verify VO2 max as compared to an effort at 110% of ramp peak power.

Safety and feasibility of symptom-limited cardiopulmonary exercise test using the modified Naughton protocol in children with cerebral palsy: An observational study.

ABSTRACT: Variables derived from the cardiopulmonary exercise test (CPX) provide objective information regarding the exercise capacity of children with cerebral palsy (CP), which can be used as the basis for exercise recommendations. Performing maximal CPX might not be appropriate, safe, or practical for children with CP. In the present study, the safety and feasibility of symptom-limited CPX using the modified Naughton protocol, a submaximal protocol, were investigated in children with CP, Gross Motor Function Classification System (GMFCS) level I or II. The present study included 40 children aged 6 to 12 years with CP who underwent symptom-limited CPX. CPX was performed to measure cardiopulmonary fitness using a treadmill with a modified Naughton protocol. Motor capacity was assessed using the Gross Motor Function Measure (GMFM), Pediatric Balance Scale (PBS), Timed Up and Go (TUG) test, and 6-minute walk test. Thirty-seven children with CP successfully completed testing without any adverse events during or immediately after CPX (dropout rate 7.5%). The reason for test termination was dyspnea (51.4%) or leg fatigue (48.6%). Based on the respiratory exchange ratio (RER), 21 of 37 (56.8%) children chose premature termination. The relationship between the reason for test termination and RER was not statistically significant (Spearman rho = 0.082, P = .631). CPX exercise time was strongly correlated with GMFM (Spearman rho = 0.714) and moderate correlation with PBS (Spearman rho = 0.690) and TUG (Spearman rho = 0.537). Peak oxygen uptake during CPX showed a weak correlation with GMFM and a moderate correlation with PBS. This study revealed that symptom-limited CPX using the modified Naughton protocol was safe and feasible for children with CP and GMFCS level I or II.

US School-Based Physical Fitness Assessments and Data Dissemination.

BACKGROUND: Low physical fitness (PF) levels during childhood affect healthy growth and development, and increase the risk of cardiovascular diseases. Physical education standards exist for nearly all states in the United States, but evaluation of PF in youth has yet to be systematic, reproducible, and harmonized. The purpose of this project was to describe publicly available data of school-based PF testing (SB-PFT). METHODS: A list of state-mandated SB-PFT programs published by SHAPE 2016 was confirmed by contacting appropriate authorities. SB-PFT data were obtained through each state's department of education. RESULTS: Sixteen states mandate SB-PFT, with 10 states providing publicly available data; 92% to 100% of states perform the pacer/mile, curl-up, and push-up; 54.2% to 78.5% of elementary and 44% to 66.5% of high-school youth are in the "healthy fitness zone" for aerobic capacity. CONCLUSIONS: SB-PFT provided PF data in children across the United States. The variability and inconsistency in reporting and in the values, however, raises questions about the current status of SB-PFT data and its utility in assessing PF in children. The critical nature of PF assessments is highlighted in the current COVID-19 pandemic, during which physical education has been curtailed, and emerging data demonstrate worsening of the already low levels of PF in youth.

Drop Jump? Single-Leg Squat? Not if You Aim to Predict Anterior Cruciate Ligament Injury From Real-Time Clinical Assessment: A Prospective Cohort Study Involving 880 Elite Female Athletes.

OBJECTIVE: To determine whether visually assessed performances of the single-leg squat (SLS) and vertical drop jump (VDJ) were associated with future noncontact anterior cruciate ligament (ACL) injury. DESIGN: Prognostic accuracy cohort study. METHODS: Elite female handball and football (soccer) athletes (n = 880) were tested from 2007 to 2014 and tracked through 2015. Trained physical therapists visually rated each leg during a SLS and overall control during a VDJ. Receiver operating characteristic curve, Pearson chi-square, and logistic regression analyses were used to determine the prognostic accuracy of the 2 screening tests. RESULTS: Sixty-five noncontact ACL injuries occurred during the follow-up period. Fourteen percent of athletes who sustained an ACL injury had poor SLS performance, compared to 17% of the noninjured athletes (P = .52 and .67 for hip and knee ratings, respectively). Side-to-side asymmetry in the SLS was not different between injured and noninjured athletes (P = .10 and .99 for hip and knee asymmetry, respectively). Twenty-one percent of athletes who sustained an ACL injury had a poor VDJ rating, compared to 27% of the noninjured athletes (P = .09). Furthermore, area under the curve values ranged from 0.43 to 0.54 for the SLS and VDJ, demonstrating no to poor prognostic accuracy. CONCLUSION: Neither SLS nor VDJ test performance distinguished between athletes who sustained a subsequent noncontact ACL injury and those who did not. J Orthop Sports Phys Ther 2021;51(7):372-378. doi:10.2519/jospt.2021.10170.

Short Physical Performance Battery: Response to Pulmonary Rehabilitation and Minimal Important Difference Estimates in Patients With Chronic Obstructive Pulmonary Disease.

OBJECTIVE: To determine the response to a pulmonary rehabilitation (PR) program and minimal important differences (MIDs) for the Short Physical Performance Battery (SPPB) subtests and SPPB summary score in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Retrospective analysis using distribution- and anchor-based methods. SETTING: PR center in the Netherlands including a comprehensive 40-session 8-week inpatient or 14-week outpatient program. PARTICIPANTS: A total of 632 patients with COPD (age, 65±8y; 50% male; forced expiratory volume in the first second=43% [interquartile range, 30%-60%] predicted). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Baseline and post-PR results of the SPPB, consisting of 3 balance standing tests, 4-meter gait speed (4MGS), and 5-repetition sit-to-stand (5STS). The chosen anchors were the 6-Minute Walk Test and COPD Assessment Test. Patients were stratified according to their SPPB summary scores into low-performance, moderate-performance, and high-performance groups. RESULTS: 5STS (∆=-1.14 [-4.20 to -0.93]s) and SPPB summary score (∆=1 [0-2] points) improved after PR in patients with COPD. In patients with a low performance at baseline, balance tandem and 4MGS significantly increased as well. Based on distribution-based calculations, the MID estimates ranged between 2.19 and 6.33 seconds for 5STS and 0.83 to 0.96 points for SPPB summary score. CONCLUSIONS: The 5STS and SPPB summary score are both responsive to PR in patients with COPD. The balance tandem test and 4MGS are only responsive to PR in patients with COPD with a low performance at baseline. Based on distribution-based calculations, an MID estimate of 1 point for the SPPB summary score is recommended in patients with COPD. Future research is needed to confirm MID estimates for SPPB in different centers.

Cardiopulmonary exercise testing during the COVID-19 pandemic.

The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has presented a global public health emergency. Although predominantly a pandemic of acute respiratory disease, corona virus infectious disease-19 (COVID-19) results in multi-organ damage that impairs cardiopulmonary (CP) function and reduces cardiorespiratory fitness. Superimposed on the CP consequences of COVID-19 is a marked reduction in physical activity that exacerbates CP disease (CPD) risk. CP exercise testing (CPET) is routinely used in clinical practice to diagnose CPD and assess prognosis; assess cardiovascular safety for rehabilitation; and delineate the physiological contributors to exercise intolerance and exertional fatigue. As such, CPET plays an important role in clinical assessments of convalescent COVID-19 patients as well as research aimed at understanding the long-term health effects of SARS-CoV-2 infection. However, due to the ventilatory expired gas analysis involved with CPET, the procedure is considered an aerosol generating procedure. Therefore, extra precautions should be taken by health care providers and exercise physiologists performing these tests. This paper provides recommendations for CPET testing during the COVID-19 pandemic. These recommendations include indications for CPET; pre-screening assessments; precautions required for testing; and suggested decontamination protocols. These safety recommendations are aimed at preventing SARS-CoV-2 transmission during CPET.