Physiological adaptations of active postmenopausal women and matched men to the multi-day Sardinia Selvaggio Blu wild trek: a gender-comparative pilot study.

PURPOSE: To evaluate the effects of wild trekking by examining, in postmenopausal women, the physiological adaptations to an intensive 5-day wild trek and comparing their responses to those displayed by a group of men of comparable age, training status and mountaineering skills. METHODS: Six healthy, active postmenopausal women in their sixth decade of life participated in the study. Six men of comparable age and training status were also enrolled for gender-based comparisons. The participants traversed the Selvaggio Blu wild trek (Sardinia, Italy) completing a total of 56 km, for an overall height differential of 14,301 m. During all 5-day trek, subjects were supervised by two alpine guides. Changes in body composition, cardiorespiratory fitness, and metabolic patterns of energy expenditure were evaluated before and after the intervention. RESULTS: Total energy expenditure during the trek was significantly higher (p = 0.03) in women (12.88 ± 3.37 kcal/h/kg) than men (9.27 ± 0.89 kcal/h/kg). Extracellular (ECW) and intracellular water (ICW) increased significantly following the trek only in women (ECW: - 3.8%; p = 0.01; ICW: + 3.4%; p = 0.01). The same applied to fat-free mass (+ 5.6%; p = 0.006), fat mass (- 20.4%; p = 0.006), skeletal muscle mass (+ 9.5%; p = 0.007), and appendicular muscle mass (+ 7.3%; p = 0.002). Peak VO2/kg (+ 9.4%; p = 0.05) and fat oxidation (at 80 W: + 26.96%; p = 0.04; at 100 W: + 40.95%; p = 0.02; at 120 W: + 83.02%; p = 0.01) were found increased only in women, although no concurrent changes in partial pressure of end-tidal CO2 (PETCO2) was observed. CONCLUSIONS: In postmenopausal women, a 5-day, intensive and physically/technically demanding outdoor trekking activity led to significant and potentially relevant changes in body composition, energy balance and metabolism that are generally attained following quite longer periods of training.

Musculoskeletal injuries during trail sports: Sex- and age-specific analyses over 20 years from a national injury database.

INTRODUCTION: Musculoskeletal (MSK) injuries in US trail sports are understudied as trail sport popularity grows. This study describes MSK injury patterns among hikers, trail runners, and mountain bikers from 2002 through 2021 and investigates MSK injury trends acquired during mountain sports. METHODS: The National Electronic Injury Surveillance System (NEISS) was used to identify US emergency department (ED) patients from 2002-2021 (inclusive) who endured MSK injuries during hiking, trail running, or mountain biking. Injury rates and national estimates were calculated across demographics. RESULTS: 9835 injuries were included (48.4% male, 51.6% female). Injuries increased over time, with 1213 from 2002-2005 versus 2417 from 2018-2021. No sex differences existed before 2010, after which female injury rates exceeded those of males. The following findings were statistically significant, with P<0.05: females endured more fractures and strains/sprains; males endured more lacerations; concussions and head injuries were higher among those <18 y; dislocations and strains/sprains were higher for 18 to 65 y; fractures were higher for >65 y; <18 y had high mountain-biking and low running rates; 18 to 65 y had high running rates; and >65 y had low biking and running rates. Although all diagnoses increased in number over time, no significant differences existed in the proportion of any given diagnosis relative to total injuries. CONCLUSIONS: MSK injuries during trail sports have increased since 2002. Males endured more injuries until 2009, after which females endured more. Significant sex and age differences were found regarding injury diagnosis and body parts. Further studies are needed to confirm these trends and their causes.

Altered trunk-pelvis kinematics during load carriage with a compliant versus a rigid system.

Load carriage is a key component of hiking and military activity. The design of the load carriage system (LCS) could influence performance and injury risk. This study aimed to compare a traditional and a compliant LCS during walking and a step-up task to quantify differences in oxygen consumption and trunk-pelvis kinematics. Fourteen participants completed the tasks whilst carrying 16 kg in a rigid and a compliant LCS. There were no differences in oxygen consumption between conditions during either task (p > 0.05). There was significantly greater trunk-pelvis axial rotation (p = 0.041) and lateral flexion (p = 0.001) range of motion when carrying the compliant LCS during walking, and significantly greater trunk-pelvis lateral flexion range of motion during the step-up task (p = 0.003). Carrying 16 kg in a compliant load carriage system results in greater lateral flexion range of motion than a traditional, rigid system, without influencing oxygen uptake.

Carrying 16 kg in a compliant load carriage system during walking and a step-up task allows greater lateral flexion range of motion than a traditional, rigid system without influencing oxygen consumption.

Trucks versus treks: The relative influence of motorized versus nonmotorized recreation on a mammal community.

Outdoor recreation is increasing rapidly on public lands, with potential consequences for wildlife communities. Recreation can induce shifts in wildlife activity and habitat use, but responses vary widely even within the same species, suggesting mitigating factors that remain poorly understood. Both the type of recreation-motorized or nonmotorized-and the distance of wildlife from human disturbance may be important in developing a general understanding of recreation impacts on wildlife and making more informed management decisions. We conducted a camera-trapping survey in the Colville National Forest (CNF) of northeastern Washington in the summers of 2019 and 2020. We collected ~11,000 trap nights of spatially extensive data on nine mid-large mammalian species, simultaneously recording the presence and activity patterns of motorized (primarily vehicles on roads) and nonmotorized (primarily hikers on trails) recreation and wildlife both along trails and roads and off trails and off roads (away from most recreation). We used diel overlap analysis, time lag analysis, and single-season single-species occupancy modeling to examine the impact of recreation on the focal species. Species temporally avoided recreationists either by shifting to more nocturnal hours or delaying return to recently used recreation sites. Most species also responded spatially by altering the use or the intensity of use of camera sites due to recreation, although both positive and negative associations with recreation were documented. Species responded to nonmotorized recreation (e.g., hikers on trails) more often than motorized recreation (e.g., vehicles on roads). Most effects of recreation extended off the trail or road, although in three instances the spatiotemporal response of species to recreation along trails/roads disappeared a short distance away from those features. Our work suggests that a better understanding of landscape-scale impacts of recreation, including fitness consequences, will require additional work to disentangle the effects of different types of recreation and estimate the effective distance at which wildlife responds. Moreover, these results suggest that quiet, nonconsumptive recreation may warrant increased attention from land managers given its potential to influence the spatiotemporal ecology of numerous species.

Habitat visibility affects the behavioral response of a large herbivore to human disturbance in forest landscapes.

Wildlife can perceive humans as predators and human disturbance, whether lethal (e.g., hunting) or non-lethal (e.g., hiking, biking, and skiing), triggers antipredator behavior among prey. Visibility is the property that relates habitat structure to accessibility of visual information that allows animals to detect predators and evaluate predation risk. Thus, the visibility of a habitat (hereafter referred to as habitat visibility) for prey species alters the perceived risk of predation and therefore has a strong influence on their antipredator behavior. Yet, knowledge of how habitat visibility affects the response of animals to different types of human disturbance is limited, partly, because it is challenging to measure habitat visibility for animals at a fine spatial scale over a landscape, particularly in highly heterogeneous landscapes (e.g., forests). In this study, we employed a newly described approach that combines terrestrial and airborne LiDAR to contiguously measure fine-scale habitat visibility in a forested landscape. We applied the LiDAR-derived habitat visibility to examine how habitat visibility in forests affects the summer space use of 20 GPS-collared female red deer (Cervus elaphus) modeled with integrated step-selection functions in the Bavarian Forest National Park, Germany when exposed to various types of human disturbance including recreational activities, forest roads, hiking trails, and hunting. We found that red deer in our study area avoided areas with higher all types of human disturbance, especially during daylight hours. Furthermore, habitat visibility significantly modified the use of space by red deer in response to human recreational activities, forest roads, and hiking trails, but not to the hunting area. Red deer tended to tolerate a higher intensity of human recreational activities and to use areas closer to forest roads or hiking trails when they have lower habitat visibility (i.e., more cover). Our findings highlight the importance of considering visual perception when studying the response of wild animals to human disturbance. We emphasize the potential to mitigate negative consequences of human disturbance on wildlife, through measures such as maintaining vegetative buffers around recreational infrastructure (e.g., roads and skiing tracks) in order to reduce habitat visibility around areas frequented by humans.

Influence of blistering lesions on foot functionality in hikers.

BACKGROUND: Friction blisters are formed by abrasion from frictional forces on the upper layer of the epidermis and can make physical activity an uncomfortable experience. To our knowledge, no previous studies have considered how these injuries affect the functionality of the foot. For this reason, the main aim of this study was to evaluate foot function in hikers, with or without blisters. MATERIAL AND METHODS: This case-control study examined 298 hikers who walked the Camino de Santiago long-distance trail (in northern Spain); 207 had one or more blistering foot lesions and 91 had no blisters. Sociodemographic and clinical variables were collected, and the number of blisters and their locations on the foot were recorded. All participants self-completed the Foot Function Index (FFI) questionnaire, in their native language. RESULTS: Pain and disability were significantly greater among the hikers with blisters (pain p=<0.001; disability p = 0.015). However, there were no significant differences in the limitation of physical activity between those with blisters (case group) and the control group (p = 0.144). Neither was there any correlation between the number of blisters and pain, disability or limitation of activity. However, the location of the lesion did influence foot functionality. Blisters on the metatarsal heads were more limiting and caused greater pain (right foot p = 0.009; left foot p = 0.017), greater disability (right foot p = 0.005; left foot p = 0.005), greater limitation of activity (on right foot p = 0.012) and more loss of foot functionality (right foot p = 0.002; left foot p = 0.007). CONCLUSION: The hikers with blisters experienced reduced foot functionality in terms of pain and disability. The number of blisters was not related to foot functionality. Blisters located on the metatarsal heads caused the greatest increase in pain, disability and limitation of activity.

Half-Life Extension and Biodistribution Modulation of Biotherapeutics via Red Blood Cell Hitch-Hiking with Novel Anti-Band 3 Single-Domain Antibodies.

Small therapeutic proteins are receiving increased interest as therapeutic drugs; however, their clinical success has been limited due to their rapid elimination. Here, we report a half-life extension strategy via strategy via red blood cell red blood cell (RBC) hitch-hiking. This manuscript details the development and characterization of novel anti-RBC single-domain antibodies (sdAbs), their genetic fusion to therapeutic antibody fragments (TAF) as bispecific fusion constructs, and their influence on TAF pharmacokinetics and biodistribution. Several sdAbs specific to the band 3 antigen were generated via phage-display technology. Binding affinity to RBCs was assessed via flow cytometry. Affinity maturation via random mutagenesis was carried out to improve the binding affinity of the sdAbs. Bi-specific constructs were generated by fusing the anti-RBC sdAbs with anti-tissue necrosis factor alpha (TNF-α) TAF via the use of a glycine-serine flexible linker, and assessments for binding were performed via enzyme-linked immunosorbent assay and flow cytometry. Pharmacokinetics of anti-RBC sdAbs and fusion constructs were evaluated following intravenous bolus dosing in mice at a 1 mg/kg dose. Two RBC-binding sdAbs, RB12 and RE8, were developed. These two clones showed high binding affinity to human RBC with an estimated KD of 17.7 nM and 23.6 nM and low binding affinity to mouse RBC with an estimated KD of 335 nM and 528 nM for RB12 and RE8, respectively. Two derivative sdAbs, RMA1, and RMC1, with higher affinities against mouse RBC, were generated via affinity maturation (KD of 66.9 nM and 30.3 nM, respectively). Pharmacokinetic investigations in mice demonstrated prolonged circulation half-life of an anti-RBC-TNF-α bispecific construct (75 h) compared to a non-RBC binding control (1.3 h). In summary, the developed anti-RBC sdAbs and fusion constructs have demonstrated high affinity in vitro, and sufficient half-life extension in vivo.

Effects of mountain biking versus hiking on trails under different environmental conditions.

Recreational use of nature areas is increasing worldwide. All trail-based activities have a certain degradation effect on vegetation and soil, and conflicts between conservation values and recreation may occur. Controversy still exists regarding the relative impact of mountain bikers compared to hikers on trails. In this study, we manipulated the use intensity from hikers and mountain bikers on existing, natural-surfaced trails, and investigated effects of increased use and the relative importance of mountain biking on trail degradation. In two study sites, two trails were selected, one designated for hiking and one for biking. Passes were counted with TRAFx counters. The proportion of mountain bikers on the designated biking trails was on average 47%, and on the hiking trails 13%. Trail width and depth were recorded at permanently marked transects repeatedly throughout the growing season, and analyzed with linear mixed models as a function of number of passes, proportion of bikers and environmental conditions along the trail. Trail width, both the core trail without vegetation and the total area influenced by trampling and biking, showed on average small, but highly variable increases with enhanced use. Trail widening occurred particularly in moist parts, and trail width increased more when a larger proportion of the passes was mountain bikers. Trail depth did not change much throughout the study period, suggesting that the soils along the trails were already compacted and to a limited degree prone to soil movement and subsequent soil loss. Our study shows that on-trail use by hikers and mountain bikers have relatively limited overall effects in terms of trail widening and deepening, but that effects depend highly on environmental conditions; enhanced use of trails in wet areas is likely to result in greater trail degradation, and more so if a large proportion of the users are mountain bikers. Management and maintenance of trails, in terms of re-routing or trail surface hardening, could thus be necessary to avoid negative impacts of increased use. For such management actions to be successful, they need to be targeted towards the actual user groups and the natural conditions in the area.

Survey of Musculoskeletal Injuries, Prehike Conditioning, and On-Trail Injury Prevention Strategies Self-Reported by Long-Distance Hikers on the Appalachian Trail.

INTRODUCTION: Studies show that 40 to 60% of long-distance hikers on the Appalachian Trail experience musculoskeletal (MSK) injuries, but these studies are over a decade old. The increasing popularity of hiking and injury prevention advances warrant re-evaluation of injury patterns. We sought to determine the frequency of self-reported MSK injuries in long-distance hikers on the Appalachian Trail and associations with prehike conditioning and on-trail injury prevention strategies. METHODS: The Appalachian Trail Conservancy surveys registered hikers annually. Our orthopedic team added 10 questions specific to MSK injury, training, and equipment to the 2018 to 2019 electronic, cross-sectional Appalachian Trail Conservancy survey. Descriptive statistics and frequencies were calculated. Categorical variables were compared using χ2 analysis. Correlations were performed for associations between training and gear and MSK injury. Logistic regression assessed the effect of training on MSK injury. Statistical significance was set at P<0.05. RESULTS: Of 1295 respondents (52% response rate), 61% (n=791) reported MSK complaints; 28% (n=363) reported overuse/chronic MSK injuries, and 18% (n=238) reported acute injuries. MSK complaints resulted in 11% (n=147) stopping their hike. Respondents who did not train (13%, n=168) were significantly more likely to report an MSK injury (odds ratio 2.82; 95% CI 1.92-4.24; P<0.001). Strength training, stretch/yoga, and endurance training were associated with less injury (all P<0.001). Stabilizing footwear and poles/sticks were associated with fewer MSK complaints (all P<0.001). CONCLUSIONS: Prehike training and hiking gear correlate with fewer injuries. Further research is warranted to elucidate whether promoting injury prevention strategies can reduce MSK injuries among long-distance hikers.

Recent kuru-induced female gene flow disrupted the coevolution of genes and languages in the Papua New Guinea highlands.

OBJECTIVES: The island of New Guinea was settled by modern human over 50,000 years ago, and is currently characterized by a complex landscape and contains one-seventh of the world's languages. The Eastern Highlands of New Guinea were also the home to the devastating prion disease called kuru that primarily affected Fore-speaking populations, with some 68% of cases involving adult females. We characterized the mitochondrial DNA (mtDNA) diversity of highlanders from Papua New Guinea (PNG) to: (a) gain insight into the coevolution of genes and languages in situ over mountainous landscapes; and (b) evaluate the recent influence of kuru mortality on the pattern of female gene flow. MATERIALS AND METHODS: We sequenced the mtDNA hypervariable segment 1 of 870 individuals from the Eastern and Southern Highlands of PNG using serums collected in the 1950s to 1960s. These highlanders were selected from villages representing 15 linguistic groups within the Trans-New Guinea phylum. Genetic, linguistic, and geographic distances were calculated separately and correlations among those distance matrices were assessed using the Mantel test. RESULTS: Geographic, genetic, and linguistic patterns were independently correlated with each other (p < .05). Increased mtDNA diversity in kuru-affected populations and low Fst estimates between kuru-affected linguistic groups were observed. DISCUSSION: In general, the genetic structure among the Highland populations was shaped by both geography and language, and language is a good predictor of mtDNA affinity in the PNG Highlands. High kuru female mortality increased female gene flow locally, disrupting coevolutionary pattern among genes, languages, and geography.

Medical Care During Mountain Rescue in King County, Washington, from 2004 to 2017.

INTRODUCTION: Seattle Mountain Rescue (SMR) is a nonprofit, volunteer organization that provides mountain rescue services in King County, Washington. This study analyzed the medical care provided by SMR over 14 y to understand the challenges in patient care in the region and to perform data collection and monitoring. METHODS: A retrospective review of mission reports submitted from 2004 to 2017 was conducted. Date, location, demographics, activity, callout reason, chief complaint, treatments provided, extraction means, and helicopter utilization were analyzed. Data are presented as mean±SD, with range as appropriate, unless otherwise noted. Linear regression was used to estimate changes in mission volume over time. RESULTS: There were 552 missions involving 756 subjects during the study period. Mission totals increased by 4 (95% CI 2-6, P<0.001) per year. Four locations accounted for 38% of mission volume. Subject age was 36±18 y, and 59% of subjects were male. The most common activity leading to rescue was hiking (80%). Injuries or illness precipitated 58% of callouts, whereas lost, stranded, or overdue subjects comprised 40%. For subjects requiring medical treatment, 81% involved a traumatic injury, 64% were packaged in a litter, and 35% required splinting. CONCLUSIONS: The frequency of mountain rescue missions in King County, Washington, has increased in the past 14 y, with traumatic injuries most frequently requiring medical care. Missing data were common in most categories, and nonstandardized reports challenged research efforts. This study provides a baseline for future research and data collection and adds to the literature regarding the medical care provided during mountain rescue incidents.

Prevalence and risk factors associated with the formation of dermal lesions on the foot during hiking.

BACKGROUND: The aim of this study is to assess the prevalence of blisters on the foot during hiking and the factors associated with this condition. MATERIAL AND METHODS: A cross-sectional observational comparative study was conducted of 315 patients treated at two hostels, located on the Way of Saint James, in northern Spain. The study participants were interviewed and clinically examined to obtain sociodemographic and clinical variables. The variables recorded concerned the type of terrain covered (asphalt or dirt trails), the weight carried (backpack), the footwear used (weight, type, impermeability), the type of socks worn and the hydration of the skin obtained. The inclusion criteria were at least 18 years and to walk at least 20 km in the last five days. RESULTS: 74% (n = 233) of the hikers presented a bullous lesion on the foot after completing several stages of hiking. The most frequent locations were the first or second metatarsal head and the fifth toe. Logistic regression showed that risk factors for the appearance of blistering were the number of kilometres walked on asphalt (p = .001 [95% CI (1.019-1.064)]) and having wet socks at the end of the day (p = . 006 [95% CI (1.286-4.479)]). The protective factors identified were walking on a dirt, grass or gravel surface (p < .001 [95% CI (0.982- 0.995)]) and using customised plantar orthoses (p = .001 [95% CI (0.085) - 0.512)]). CONCLUSIONS: The type of terrain is a determining factor in the appearance of blisters. Walking on a dirt trail reduces the risk. Using custom made insoles and controlling humidity are other factors that should be considered as preventive measures.

Wilderness Falls: An Analysis and Comparison of Rock Climbers and Nonclimbers.

BACKGROUND: Wilderness travel and rock climbing are increasingly popular. Urban falls from height have been reported from trauma centers; however, there have been no trauma center reports of rock climbing or wilderness falls (WFs) in the United States. We sought to describe the injury pattern of WF and to determine whether rock climbers represent a distinct pattern of injury. MATERIALS AND METHODS: The trauma database from our level 1 trauma center was queried from 1/1/06 to 12/31/16 for the diagnosis of "fall from cliff" (ICD9: e884.1, ICD10: w15.xx). Demographics, injury characteristics, and trauma center care were analyzed. Data were analyzed using two sample unequal variance T-tests, two sample Z-tests for proportions, and Fisher's exact tests. RESULTS: One hundred fifty-one falls were analyzed (40 climbers, 111 nonclimbers). WF victims were predominantly male (79%), moderately injured (mean injury severity score = 13.2), frequently intoxicated (34%), and fell from an average of 43 feet (7-200 ft). The most frequent injures were soft tissue (55%), spine (50%), head (43%), lower extremity (38%), and chest (39%). Climbers were younger, more often sustained upper extremity and soft tissue injuries, more often flown from the scene, injured during daytime, and were better insured. Helmet use was rare (one climber and one nonclimber). There were 3 (2%) deaths, including one climber. CONCLUSIONS: WFs have a distinct injury pattern and demographic and occur from a height greater than twice those reported in urban falls. Rock climbing falls involve another distinct demographic and pattern of injury. Injury prevention strategies may include helmet use and avoiding nighttime wilderness travel and drug/alcohol use.

Green exercise and mg-ca-SO4 thermal balneotherapy for the treatment of non-specific chronic low back pain: a randomized controlled clinical trial.

BACKGROUND: Non-specific chronic low back pain (nscLBP) has a high socio-economic relevance due to its high incidence, prevalence and associated costs. Therefore, it is essential to evaluate effective therapeutic strategies. This study examines the effects of moderate mountain exercise and spa therapy on orthopedic and psychophysiological parameters. Based on a three-armed randomized controlled trial, guided mountain hiking tours and balneotherapy in thermal water were compared to a control group. METHODS: Eighty patients with diagnosed nscLBP were separated into three groups: The two intervention groups GE (green exercise) and GEBT (green exercise and balneotherapy) undertook daily mountain hiking tours, whereas the GEBT group got an additional treatment with baths in Mg-Ca-SO4 thermal water. The third group (CO) received no intervention. GE and GEBT group were treated for 6 days; all groups were followed up for 120 days. RESULTS: Compared to GE and CO group, the GEBT treatment showed significant improvements of pain, some orthopedic parameters, health-related quality of life and mental well-being in patients with nscLBP. CONCLUSIONS: The results of this study confirmed a benefit of mountain hiking combined with Mg-Ca-SO4 spa therapy as a multimodal treatment of patients with nscLBP. Further studies should focus on long-term-effects of this therapeutic approach. TRIAL REGISTRATION: ISRCTN, ISRCTN99926592 . Registered 06. July 2018 - Retrospectively registered.

Observational Study of Grand Canyon Rim-to-Rim Day Hikers: Determining Behavior Patterns to Aid in Preventive Search and Rescue Efforts.

INTRODUCTION: Grand Canyon National Park has seen an increase in visitors traversing the canyon from rim to rim (R2R) in a single day. R2R hikers travel over 33.8 km (21 mi) over 3300 m (11,000 ft) of elevation change and endure large temperature changes. Grand Canyon emergency medical service providers provide emergency medical services to over 1100 visitors annually. Direct guidance by Preventive Search and Rescue rangers has improved safety. The objective of this study was to examine visitors attempting an R2R traverse and to enhance PSAR rangers' anticipatory guidance. METHODS: We conducted an observational study of R2R hikers in the spring and fall of 2015. Hikers consented to study inclusion and were interviewed at the starting trailhead, canyon bottom, and exit trailhead. We performed a survey and collected biometric data. RESULTS: We enrolled 617 visitors with a median age of 43 y (interquartile range [IQR] 33-53); 65% were male and 46% had hiked the R2R a median number of 3 times previously (IQR 2-7). Hydration strategies included water bottle only (20%), hydration bladder only (31%), and both water bottle and hydration bladder (48%). R2R crossers had an average start time of 0530 (SD 1.3 h) and median crossing time of 11.9 h (IQR 10.7-13.3). Crossing time and self-reported fatigue were negatively correlated with prior R2R experience (P=0.02). CONCLUSIONS: Crossing R2R in a day is hazardous and associated with risk of injury and illness. The results of this study can be used by Preventive Search and Rescue to reduce these risks by educating hikers.

The effects of a 3-month controlled hiking programme on the functional abilities of patients following total knee arthroplasty: a prospective, randomized trial.

PURPOSE AND HYPOTHESIS: Improvements in pain, function and sports activity are the main goals of patients following total knee arthroplasty (TKA). Participation in sports has become an increasingly important contributor to patients' quality of life (QoL). Hiking is one of the most popular summer activities among elderly people in alpine regions. Consequently, this randomized controlled trial investigates the impact of a 3-month guided hiking programme on patients' functional abilities and QoL following TKA. It was hypothesized that patients who participate in this programme would demonstrate improvements in functional and QoL parameters compared with a control group. METHODS: Forty-eight TKA patients were included and randomized into either the intervention group (IG; n = 25) or the control group (CG; n = 23). The IG participated in a 3-month hiking programme (2-3 times a week), whereas the CG performed activities of daily living. The stair climb test (SCT), QoL questionnaires and isokinetic force measurements were completed at three time points (i.e. pre-test, post-test, retention-test). ANOVAs for repeated measurements were conducted for the SCT results. The Friedman test and the Mann-Whitney U test were performed for the QoL parameters. RESULTS: After the 3-month hiking programme, the IG achieved faster overall walking times on the SCT. The time decreased from 4.3 ± 0.6 s (pre-test) to 3.6 ± 0.4 s (post-test) for the stair ascent (p = 0.060) and from 3.6 ± 0.6 s (pre-test) to 3.2 ± 0.5 s (post-test) for the stair descent (p = 0.036). The IG showed significant improvement on some of the subscales of the Knee Injury and Osteoarthritis Outcome Score from pre-test to retention-test (p < 0.01). In the CG, no significant changes were observed (n.s.). CONCLUSIONS: The results indicate moderate improvement in the functional abilities and QoL of TKA patients who participated in a 3-month guided hiking programme compared with the patients in the CG. Hiking did not have any acute detrimental effects on the TKA patients during this study period. LEVEL OF EVIDENCE: II.

The efficacy of combined educational and site management actions in reducing off-trail hiking in an urban-proximate protected area.

Park and protected area managers are tasked with protecting natural environments, a particularly daunting challenge in heavily visited urban-proximate areas where flora and fauna are already stressed by external threats. In this study, an adaptive management approach was taken to reduce extensive off-trail hiking along a popular trail through an ecologically diverse and significant area in the Chesapeake and Ohio National Historical Park near Washington DC. Substantial amounts of off-trail hiking there had created an extensive 16.1 km network of informal (visitor-created) trails on a 39 ha island in the Potomac Gorge. A research design with additive treatments integrating educational and site management actions was applied and evaluated using self-reported behavior from an on-site visitor survey and unobtrusive observations of off-trail hiking behavior at two locations along the trail. Study treatments included: 1) trailhead educational signs developed using attribution theory and injunctive-proscriptive wording, 2) symbolic "no hiking" prompter signs attached to logs placed across all informal trails, 3) placement of concealing leaf litter and small branches along initial sections of informal trails, 4) restoration work on selected trails with low fencing, and 5) contact with a trail steward to personally communicate the trailhead sign information. The final, most comprehensive treatment reduced visitor-reported intentional off-trail hiking from 70.3% to 43.0%. Direct observations documented reduction in off-trail hiking from 25.9% to 2.0%. The educational message and site management actions both contributed to the decline in off-trail travel and the two evaluation methods enhanced our ability to describe the efficacy of the different treatments in reducing off-trail travel.

Pulmonary Injury from Waterproofing Spray During a Hike.

A 48-year-old man developed general fatigue, dyspnea, and fever at an altitude of 1562 m from the morning of the first day of a 3-day hike. Despite pharyngeal discomfort and mild general fatigue, he felt that the symptoms were not sufficient to abandon his plan. He usually required 1.5 hours to reach Tokusawa (6.4 km from the starting point at an altitude of 1500 m), but this time he required 2.5 hours and slept briefly upon arrival at Tokusawa due to extreme fatigue and respiratory discomfort. His symptoms became aggravated, so he presented at a mountain clinic with oxygen saturation at 80% and body temperature of 37.6ºC. He was diagnosed with hypoxemia due to pneumonia and/or other disease(s) and was evacuated to a hospital where a chest computed tomography scan revealed ground glass opacity and infiltrative shadows. He was treated for pneumonia, but another doctor discovered during follow-up that the patient had sprayed 300 mL of a waterproofing aerosol on mountain equipment in a nonventilated, enclosed area of his home on the night before starting out on the hike. Therefore, waterproofing spray was considered to have caused pulmonary damage. Self-reporting or appropriate questionnaires are the only means of identifying this type of injury. The differential diagnosis of pulmonary problems in an outdoor setting should include toxic aerosol exposure from waterproofing spray.

Isometric quadriceps strength determines sailing performance and neuromuscular fatigue during an upwind sailing emulation.

This study investigates the physiological responses to upwind sailing on a laser emulation ergometer and analyses the components of the physical profile that determine the physiological responses related to sailing level. Ten male high-level laser sailors performed an upwind sailing test, incremental cycling test and quadriceps strength test. During the upwind sailing test, heart rate (HR), oxygen uptake, ventilation, respiratory exchange ratio, rating of perceived exertion (RPE) and lactate concentration were measured, combined with near-infrared spectroscopy (NIRS) and electromyography (EMG) registration of the M. Vastus lateralis. Repeated measures ANOVA showed for the cardio-respiratory, metabolic and muscles responses (mean power frequency [MPF], root mean square [RMS], deoxy[Hb+Mb]) during the upwind sailing test an initial significant increase followed by a stabilisation, despite a constant increase in RPE. Stepwise regression analysis showed that better sailing level was for 46.5% predicted by lower MPF decrease. Lower MPF decrease was for 57.8% predicted by a higher maximal isometric quadriceps strength. In conclusion, this study indicates that higher sailing level was mainly determined by a lower rate of neuromuscular fatigue during the upwind sailing test (as indicated by MPF decrease). Additionally, the level of neuromuscular fatigue was mainly determined by higher maximal isometric quadriceps strength stressing the importance of resistance training in the planning of training.