Comparing return to play protocols after sports-related concussion among international sporting organisations.

BACKGROUND: Return to play (RTP) protocols are an important part of recovery management following a sport-related concussion (SRC) and can prevent athletes from returning to competition too early and thereby avoid prolonged recovery times. To assist sporting organizations in the development of RTP guidelines, the Concussion in Sports Group (CISG) provides scientific-based recommendations for the management of SRC in its consensus statement on concussion in sport. OBJECTIVES: This study investigates commonalities and differences among current RTP protocols of international sporting organizations and examines the implementation of the most recent CISG recommendations. METHODS: Concussion guidelines and medical rules of 12 international sporting organizations from contact, collision and combat sports were accessed via the organizations websites and compared regarding the management of SRC and the RTP decision. RESULTS: Only six of the included organizations developed and published their own concussion guidelines, which included an RTP protocol on their website. The number of steps until RTP was similar across the different protocols. Each protocol required at least one medical examination before clearing an athlete to RTP. A high variation among organizations was found for initial resting period after injury, the implementation of sport-specific training drills and the time needed to complete the protocol before returning to competition. At the date of this study (9 September 2023), none of the accessible RTP protocols were updated to include the latest version of the CISG consensus statement. CONCLUSION: To improve the safety of athletes after a head injury, sporting organizations should develop sport-specific guidelines according to the latest CISG consensus statement, and this should be updated regularly. Implementation is especially important in combat sports, where there is a high incidence of head injury. Thus, there is a requirement for the most up-to-date concussion management protocols in these sports.

An Artificial Intelligence Exercise Coaching Mobile App: Development and Randomized Controlled Trial to Verify Its Effectiveness in Posture Correction.

BACKGROUND: Insufficient physical activity due to social distancing and suppressed outdoor activities increases vulnerability to diseases like cardiovascular diseases, sarcopenia, and severe COVID-19. While bodyweight exercises, such as squats, effectively boost physical activity, incorrect postures risk abnormal muscle activation joint strain, leading to ineffective sessions or even injuries. Avoiding incorrect postures is challenging for novices without expert guidance. Existing solutions for remote coaching and computer-assisted posture correction often prove costly or inefficient. OBJECTIVE: This study aimed to use deep neural networks to develop a personal workout assistant that offers feedback on squat postures using only mobile devices-smartphones and tablets. Deep learning mimicked experts' visual assessments of proper exercise postures. The effectiveness of the mobile app was evaluated by comparing it with exercise videos, a popular at-home workout choice. METHODS: Twenty participants were recruited without squat exercise experience and divided into an experimental group (EXP) with 10 individuals aged 21.90 (SD 2.18) years and a mean BMI of 20.75 (SD 2.11) and a control group (CTL) with 10 individuals aged 22.60 (SD 1.95) years and a mean BMI of 18.72 (SD 1.23) using randomized controlled trials. A data set with over 20,000 squat videos annotated by experts was created and a deep learning model was trained using pose estimation and video classification to analyze the workout postures. Subsequently, a mobile workout assistant app, Home Alone Exercise, was developed, and a 2-week interventional study, in which the EXP used the app while the CTL only followed workout videos, showed how the app helps people improve squat exercise. RESULTS: The EXP significantly improved their squat postures evaluated by the app after 2 weeks (Pre: 0.20 vs Mid: 4.20 vs Post: 8.00, P=.001), whereas the CTL (without the app) showed no significant change in squat posture (Pre: 0.70 vs Mid: 1.30 vs Post: 3.80, P=.13). Significant differences were observed in the left (Pre: 75.06 vs Mid: 76.24 vs Post: 63.13, P=.02) and right (Pre: 71.99 vs Mid: 76.68 vs Post: 62.82, P=.03) knee joint angles in the EXP before and after exercise, with no significant effect found for the CTL in the left (Pre: 73.27 vs Mid: 74.05 vs Post: 70.70, P=.68) and right (Pre: 70.82 vs Mid: 74.02 vs Post: 70.23, P=.61) knee joint angles. CONCLUSIONS: EXP participants trained with the app experienced faster improvement and learned more nuanced details of the squat exercise. The proposed mobile app, offering cost-effective self-discovery feedback, effectively taught users about squat exercises without expensive in-person trainer sessions. TRIAL REGISTRATION: Clinical Research Information Service KCT0008178 (retrospectively registered); https://cris.nih.go.kr/cris/search/detailSearch.do/24006.

Applying Gamification Principles and Therapeutic Movement Sequences to Design an Interactive Physical Activity Game: Development Study.

BACKGROUND: Depression is a severe illness that has accelerated with the spread of COVID-19 and associated lockdowns. As a result, reported physical activity has substantially decreased, further increasing depressive symptoms. OBJECTIVE: This study aims to explain the use of gamification principles to develop content for an interactive physical activity game for depression based on clinically proven depression diagnostic criteria. METHODS: We discuss related work in this field, the game design framework, the users' depression severity, how we customize the contents accordingly, the gradual progression of the game to match exercise principles, and user flow optimization. RESULTS: We provide a brief description of each of the games developed, including instructions on how to play and design aspects for flow, audio, and visual feedback methods. Exergames (interactive physical activity-based games) stimulate certain physical fitness factors such as improving reaction time, endurance, cardiovascular fitness, and flexibility. In addition, the game difficulty progresses based on various factors, such as the user's performance for successful completion, reaction time, movement speed, and stimulated larger joint range of motions. Cognitive aspects are included, as the user has to memorize particular movement sequences. CONCLUSIONS: Mental health issues are linked to behavior and movement; therefore, future physical activity-based interactive games may provide excellent stimulation for inducing user flow, while physical activity can help train various physical fitness factors linked to depression.

Functional Reaction Times of a Simulated Blocking Test among Para Taekwondo Athletes.

Para taekwondo is a combat sport martial art that requires fast reaction times for successful defense during fighting. The current classification system is based on the function and the effective length of the upper limbs, which affects the athlete's ability to block. Therefore, this study aimed to investigate the differences between the different classes in the athlete's ability to block and move around the ring. A total of 87 Para taekwondo (K42, K43, and K44) athletes' data were analyzed. Each participant engaged in the blocking reaction time test in a fighting stance with the left leg in front, the right leg in front, and the legs parallel in random order. A foot-stepping reaction test was performed to anlyze how the athletes moved in various directions. The results indicated no significant differences between the classes for the lower body foot stepping reaction times and the upper body blocking performance times. The stimulated blocking time of the Para taekwondo athletes ranged from 0.79 to 0.97 s Furthermore, the neurological group (0.86 ± 0.09 s) was significantly slower than the amputation/dysmelia group (0.81 ± 0.07 s). We thus concluded that the neurologically impaired athletes were disadvantaged and therefore belonged in a separate class.

Injury and Illness in World Taekwondo Junior Athletes: An Epidemiological Study.

Taekwondo has been reported to be one of the most injurious sports in the summer Olympics, however, there is a dearth of data about injury profiles for junior athletes. Therefore, we aimed to identify the incidence and profiles of the injuries and illnesses that occurred during the 2018 World Taekwondo Junior Championships and recorded using an online system. Among the 889 athletes, 67 injuries and four illnesses were reported, corresponding to an overall clinical incidence of 7.5 injuries (95% confidence interval [CI]: 5.7-9.3) and 0.5 illnesses (0.1-0.9) per 100 athletes. The most frequent injuries were lower extremity injuries (n = 33, 3.71% of all athletes), mostly in the foot/toe (n = 11, 1.2% of athletes), followed by head and trunk injuries, mostly in the face (n = 14, 1.6% of athletes), and upper extremity injuries, mostly in the fingers (n = 6, 0.7% of athlete). Contusions (n = 37, 4.2% of athlete) were the most frequent injury type, followed by ligament ruptures/sprains and laceration. The most common injury mechanism was contact during an opponent attack (n = 51, 5.7% of athlete). Three mild concussions none resulted in time loss (none required hospital transfer or had prolonged recovery). The respiratory system was the most affected by illness, with pain and fever as symptoms. Environmental factors were the most common cause of illness. This study shows that 7.5 per 100 athletes (38.5/1000 athlete-exposures and 6.9/1000 min-exposures) had new or recurrent injuries, whereas 0.5 per 100 athletes experienced illness. In conclusion, the data shows male athletes reported more injuries than females and the most common cause of injury was due to contact between athletes. Contusions, ligament rupture/sprains, laceration and fractures to the lower extremities, head, and trunk were the most common injury. Knowing these injury profiles of junior taekwondo athletes can help taekwondo stakeholders, especially medical staff to prepare accordingly to ensure the safety of the athletes.

Investigating the influence of Taekwondo body protectors size on shock absorption.

OBJECTIVE: This study aims to compare and analyze the difference of impact force attenuation according to size and impact location on a Taekwondo body protector. METHODS: Body protectors sized 1 to 5, were impact tested by equipment based on the specifications in the European standard manual (EN 13277-1, 3). The impactor release heights were set to match impact energies of 3 and 15 J. The impactor was made from a 2.5 kg cylindrically cut piece of aluminum. Each body protector was impacted 10 times at the two impact energies and two locations. The differences in performance for each body protector size were compared using a two-way analysis of variance with a significance level of p< 005. The effect sizes were investigated using a partial eta squared value (η2). RESULTS: The significant mean differences between the body protector size and impact area (p< 005) and the average impact time of impact strengths 3 and 15 J were 0.0017 and 0.0012 s, respectively In addition, when an impact strength of 15 J was applied, the maximum resulting impact force exceeded 2000 N for both locations on all sizes. Furthermore, at an impact strength of 3 J size 3 significantly reduced the impact force more than the other sizes; however, size 1 showed the greatest shock absorption at an impact of 15 J. CONCLUSION: The results of this study show that the shock absorption of body protectors does not increase according to size; i.e., a larger body protector does not reduce the impact load more effectively. To improve safety performance, we recommend a maximum impact force of 2000 N or less for all body protectors.

Safety Evaluation of Protective Equipment for the Forearm, Shin, Hand and Foot in Taekwondo.

The objective of the study was to evaluate and compare different brands of forearm, shin, hand and foot protective equipment used in Taekwondo. The most popular brands of large forearm, shin, hand and foot protectors (D®, A®, K ®), approved by the World Taekwondo and Korean Taekwondo Association, were examined. A drop test was used to test the protective equipment using impact levels of 3J, 9J, 12J and 15J for the forearm and shin guards, and 3J and 9J for the hand and foot protectors. The protective equipment was hit ten times from each of the designated drop heights. The drop test is described in the European standards manual of protective equipment for martial arts (SRPS EN 13277-2). The maximum force (MF) and impulse were lowest for brand K® (2610.3 ± 1474.1 N), and brand A® (9.6 ± 3.1 Ns), respectively, for the forearm guards; for brand A® (2053.4 ± 1267.1 N) and brand K® (9.8 ± 3.5 Ns), respectively, for the shin guards; for brand K® (4486.5 ± 1718.4 N), and brand A® (6.3 ± 1.1 Ns), respectively for the hand protectors; and for brand A® (3733.7 ± 2465.3 N), and brand D® (6.8 ± 0.6 Ns), respectively, for the foot protectors. For the forearm guard brand and impact level, there was a significant interaction effect for the MF (F=42.44, η2=.677, p <0.001) and impulse (F = 33.97, η2 = 0.626, p <0.001). Based on the MF, brand K® performed the best for the forearm guards and hand protectors, and brand A®, for the shin guards and foot protectors. The best results for the impulse were for brand A® (forearm guards and hand protectors), brand K® (shin guards) and brand D® (foot protectors).

Evaluation of skin-mounted sensor for head impact measurement.

The requirement to measure the number and severity of head impacts in sports has led to the development of many wearable sensors. The objective of this study was to determine the reliability and accuracy of a wearable head impact sensor: xPatch, X2Biosystems, Inc. The skin-mounted sensor, xPatch, was fixed onto a Hybrid III headform and dropped using an impact test rig. A total of 400 impacts were performed, ranging from 20g to 200g linear acceleration, and impact velocities of 1.2 - 3.9 m/s. During each impact, the peak linear acceleration, angular velocity and angular acceleration were recorded and compared to the reference calibrated data. Impacts were also recorded using a high-speed video camera. The results show that the linear acceleration recorded by the xPatch during frontal and side impacts had errors of up to 24% when compared to the referenced data. The angular velocity and angular acceleration had substantially larger errors of up to 47.5% and 57%, respectively. The location of the impact had a significant effect on the results: if the impact was to the side of the head, the device on that side may have an error of up to 71%, thus highlighting the importance of device location. All impacts were recorded using two separate xPatches and, in certain cases, the difference in angular velocity between the devices was 43%. In conclusion, the xPatch can be useful for identifying impacts and recording linear accelerations during front and side impacts, but the rotational velocity and acceleration data need to be interpreted with caution.

Can 24 weeks strength training reduce feelings of depression and increase neurotransmitter in elderly females?

BACKGROUND: Geriatric depression is common due to the high rate of chronic diseases suffered by the older population. There is a well-established effect of exercise on one's wellbeing, however, for the elderly females there is dearth in research addressing exercise and its effect on their neurotransmitters and depression score. Therefore, this study aimed to investigate the effects of 24 weeks of the Growing Stronger program on neurotransmitter and depression of older women. METHODS: Twenty-one older women, aged between 67 and 81, participated in this study. The participants were randomly assigned into a strength exercise (n = 11) and control group (n = 10) (age 76.40 ±â€¯3.27, height 152.77 ±â€¯5.63 kg, Weight 52.35 ±â€¯2.86Kg, BMI 22.50 ±â€¯1.88). The strength exercise group (age 76.10 ±â€¯3.85, height 151.14 ±â€¯5.42 kg, Weight 54.74 ±â€¯6.73Kg, BMI 23.96 ±â€¯2.70) participated for 50-80 min a day three times per week for a total of 24 weeks. All participants had their height, weight, blood testing and depression score tested before and after the training program. Two-way ANOVA with effect sizes was used to identify differences between times in each group and the statistical significance was set at 0.05. RESULTS: In neurotransmitter factor, serotonin, dopamine, epinephrine, and norepinephrine significantly decreased in the strength exercise group but not for the control group. Notably, one participant whose serotonin level was lower than normal range before the exercise program showed normal level in serotonin after the program. In depression factor, there were no significant differences for both the strength exercise group and control group. CONCLUSION: The results suggest that the effect of strength exercise on neurotransmitter and depression score remain unclear, but highlight the need for future studies investigating the relationship between strength training and depression.

Case Study of Mental Skills Training for a Taekwondo Olympian.

The purpose of this study was to identify the effect of systematic mental skills training (MST) for a taekwondo gold medallist. Based on MST of other sports, this programme was designed for a single subject who competed in the Olympics. The Korean test of performance strategies, Sport Attributional Style in Korean Athletes, and a few sessions of interviews were applied to investigate the effect of MST. The pre and post-test mean scores of both the Korean test of performance strategies and Sport Attributional Style in Korean Athletes were compared. Interviews recorded the athlete's psychological characteristics. Excluding the 'activation' variable, all of the psychological skills, e.g. self-talk (4.25-5), emotional control (3.75-4.5), automaticity (3.75-4.25), goal setting (4.5-5), imagery (4.25-5), negative thinking (3.25-4.75), anxiety management (4.5-5), and physical and mental condition (4.5-5) improved. MST is believed to have helped the athlete succeed.

Effects of Aqua Aerobic Therapy Exercise for Older Adults on Muscular Strength, Agility and Balance to Prevent Falling during Gait.

[Purpose] The purpose of the present study was to examine the effects of an aqua aerobic therapy exercise for older adults on biomechanical and physiological factors affecting gait. [Subjects] A total of 15 subjects participated in this study and they were randomly divided into the experimental and the control group. [Methods] Physiological variables, leg strength, power and flexibility, and biomechanical variables, both kinematic and kinetic, were measured before and after the aqua aerobic therapy exercise. Each subject was instructed to walk along an elevated walkway and during the trials a trapdoor opened at random to create a 10 cm falling perturbation. Full body motion and kinetics was gathered during the gait. [Results] There were significant reductions in body weight, and body fat mass, and stride time after the perturbation. Significant increases in leg strength corresponded to the maximum joint moment of the landing leg showing that the subjects' ability for recovery of balance after the perturbation improved. [Conclusion] As the results showed significant improvements in gait pattern and recovery time after perturbed gait, we conclude that aqua aerobic therapy is an effective exercise method for training older adults to reduce their risk of falling.

Competition injuries in taekwondo: a literature review and suggestions for prevention and surveillance.

OBJECTIVE: To review competition injuries in taekwondo and use this information to develop recommendations to reduce the number and severity of injuries in taekwondo competition. METHODS: The available literature was searched for prospective studies on taekwondo injuries in adult athletes. An injury was defined as any circumstance for which the athlete sought the assistance of the on-site medical personnel. Injury rates were expressed per athlete-exposures (A-E) and 95% CIs calculated. RESULTS: Total injury rates for elite men varied from 20.6/1000 A-E (95% CI 11.8 to 29.3) to 139.5/1000 A-E (95% CI 94.0 to 185.1). For elite women, the rates varied from 25.3/1000 A-E (95% CI 3.1 to 47.4) to 105.5/1000 A-E (95% CI 89.8 to 121.1). About one-third of all injuries (29.6%) in the men were to the head and neck region, while almost half of the injuries (44.5%) were to the lower extremities. In women, 15.2% of injuries were to the head and neck and 53.1% to the lower extremities. The vast majority of all injuries were contusions (42.7% in the men and 62.7% in the women). Point estimates of rates of head injuries and concussions were found to be higher in taekwondo than in other contact sports such as football (soccer) and American gridiron football. Time-loss injury rates in the men varied from 6.9/1000 A-E (95% CI 1.8 to 11.9) to 33.6/1000 A-E (95% CI 18.9 to 48.3). In the women, they varied from 2.4/1000 A-E (95% CI 2.3 to 7.2) to 23.0/1000 A-E (95% CI 15.7 to 30.4). The turning kick was most often involved in causing injury: 56.9% of all injuries in the men and 49.8% in the women. Lack of blocking skills was identified as one of the main injury mechanisms. CONCLUSIONS: Rule changes should be considered and it is recommended that governing bodies employ qualified medical personnel. Establishing an ongoing injury surveillance system in taekwondo should be the first priority.