Force and Neuromuscular Responses During a Handgrip Hold to Failure Anchored to a Moderate Perceptual Intensity in Males.

OBJECTIVES: The current study investigated performance fatigability (PF) and time course of changes in force, electromyographic amplitude (EMG AMP) and frequency (EMG MPF), and neuromuscular efficiency (NME) during a sustained, isometric, handgrip hold to failure (HTF) using the rating of perceived exertion (RPE)-Clamp Model. METHODS: Twelve males performed a handgrip HTF anchored to RPE=5. The time to task failure (Tlim), force (N), EMG AMP and MPF, and NME (normalized force/ normalized EMG AMP) were recorded. Analyses included a paired samples t-test for PF at an alpha of p<0.05, 1-way repeated measures ANOVA across time and post-hoc t-tests (p<0.0025) for force, EMG AMP and MPF, and NME responses. RESULTS: The PF (pre- to post- maximal force % decline) was 38.2±11.5%. There were decreases in responses, relative to 0% Tlim, from 40% to 100% Tlim (force), at 30%, 60%, and 100% Tlim (EMG AMP), from 10% to 100% Tlim(EMP MPF), and from 50% to 65%, and 80% to 100% Tlim (NME) (p<0.0025). CONCLUSIONS: The RPE-Clamp Model in this study demonstrated that pacing strategies may be influenced by the integration of anticipatory, feedforward, and feedback mechanisms, and provided insights into the relationship between neuromuscular and perceptual responses, and actual force generating capacity.

Comparison of Force, Neuromuscular, and Metabolic Responses During Sustained, Isometric Handgrip Holds to Failure Anchored to Low and High Perceptual Intensities in Men: An Exploratory Study.

ABSTRACT: Kwak, M, Succi, PJ, Benitez, B, Mitchinson, C, Samaan, MA, Abel, MG, and Bergstrom, HC. Comparison of force, neuromuscular, and metabolic responses during sustained, isometric handgrip holds to failure anchored to low and high perceptual intensities in men: An exploratory study. J Strength Cond Res 38(8): e405-e416, 2024-This study examined the responses of force alterations, relative to critical force (CF), neuromuscular parameters, and muscle oxygenation (SmO2) for isometric handgrip holds to failure (HTF) anchored to ratings of perceived exertion (RPE) of 3 and 7. Twelve men completed pre-maximal voluntary isometric contractions (pre-MVIC), submaximal HTF at 4 percentages of pre-MVIC, HTF at RPE = 3 and 7, and post-MVIC. Mechanomyograpic (MMG) signals and SmO2 were recorded during the RPE HTF. Analyses included paired-samples t-tests and repeated-measures ANOVAs at an alpha level of p ≤ 0.05. Time to task failure was not different between RPE 3 (478.7 ± 196.6 s) and RPE 7 (495.8 ± 173.8 s). Performance fatigability (PF) and MMG amplitude (AMP) were greater for RPE 7 (PF: 37.9 ± 12.9%; MMG AMP: 15.7 ± 7.4% MVIC) than RPE 3 (PF: 30.0 ± 14.5%; MMG AMP: 10.2 ± 6.5% MVIC), but MMG mean power frequency (MPF) was greater for RPE 3 (146.2 ± 31.1% MVIC) than RPE 7 (128.8 ± 23.0% MVIC). There were RPE-dependent decreases in force (p ≤ 0.01) across 3 discernable phases during the HTF. There were decreases in MMG AMP across time for both RPEs, but there were no significant changes in MMG MPF or SmO2. There were overall similar motor unit control strategies and local metabolic demand between RPEs. The majority of the HTF performed below CF at RPE 3 and 7 indicated CF did not reflect the highest sustainable force. When prescribing isometric exercise anchored to RPE, practitioners should be aware of the magnitude of force loss and relative intensity of the task to be sure desired training loads are met.

Posterior cervical spinal fusion in the pediatric population using modern adult instrumentation - clinical outcome and safety.

PURPOSE: Traditionally, less rigid fixation techniques have been applied to the pediatric cervical spine. There is a lack of long-term outcome data for rigid fixation techniques. The purpose of this study was to define the clinical outcome and safety of posterior instrumented fusion in the pediatric population using adult posterior instrumentation. METHODS: A multicenter, retrospective review of pediatric patients who underwent posterior cervical fusion using a 3.5 mm posterior cervical system for any indication was performed. Outcome parameters included complications, revision and fusion rates, operative time (OR), blood loss, and postoperative neurologic status. Outcomes were compared between patient groups (posterior only versus anterior/posterior approach, short versus intermediate versus long fusion, and between different etiologies) using Mann-Whitney and chi-square test. RESULTS: Seventy-nine patients with a mean age of 9.9 years and mean follow-up of 2.8 years were included. At baseline 44 (56%) had an abnormal neurologic exam. Congenital deformities and basilar invagination were the most common indications for surgery. Posterior-only surgery was performed in 71 (90%) cases; mean number of levels fused was 4 (range 1-15). Overall, 4 (5%) operative complications and 4 (5%) revisions were reported at an average postoperative time of 2.6 years. Neurologic status remained unchanged in 74%, improved in 23%, and worsened in 3%. When comparing outcome measures between the various groups, 2 significant differences were found: OR was longer in the anterior/posterior approach group and decline of neuro status was more frequent in the long fusion group. CONCLUSION: Posterior cervical fusion with an adult 3.5 mm posterior cervical system was safe in this cohort of 79 pediatric patients irrespective of surgical technique, fusion length, and etiology, resulting in a high fusion and low complication/revision rate.

Evaluation of Work Efficiency in Structural Firefighters.

ABSTRACT: Langford, EL, Bergstrom, HC, Lanham, S, Eastman, AQ, Best, S, Ma, X, Mason, MR, and Abel, MG. Evaluation of work efficiency in structural firefighters. J Strength Cond Res 37(12): 2457-2466, 2023-To perform occupational tasks safely and effectively, firefighters (FF) must work quickly and consume air provided by the self-contained breathing apparatus (SCBA) efficiently. However, most literature only factors work rate into performance, neglecting the inherent time limitation imposed by the SCBA. The purpose of this article was to (a) evaluate the reliability and variability in a "work efficiency" (WE) performance metric reflective of both work rate and air consumption; (b) explore the relationship between WE and established measures of metabolic strain; and (c) identify fitness, anthropometric, and demographic correlates of WE. About 79 structural FF completed an air consumption drill while breathing through an SCBA. Self-paced work duration and air consumption were entered into the WE equation. A subsample of FF (n = 44) completed another randomized trial while breathing through a portable gas analyzer. Anthropometric and fitness data were collected separately. Correlations were performed between WE vs. fitness, anthropometric, demographic, and metabolic outcomes. Multiple linear regression was used to identify the strongest predictors of WE. WE was reliable (intraclass correlation coefficient = 0.71) and yielded inter-FF variability {0.79 ± 0.25 ([lb·in-2·min]-1) × 104; coefficient of variation = 31.6%}. WE was positively correlated to oxygen consumption (V̇O2) (L·minute-1, mL·kg-1·minute-1) and tidal volume and negatively correlated to V̇E/V̇O2 and respiratory frequency. Height, upper-body endurance, and aerobic endurance were identified as the strongest predictors of WE (adjusted R2 = 0.59, RMSE = 0.16). WE is a reliable and occupationally relevant method to assess FF performance because it accounts for work rate and air consumption. Firefighters may enhance WE through a training intervention focused on improving metabolic tolerance, upper-body endurance, and aerobic endurance.

Responses to Exercise at the Critical Heart Rate vs. the Power Output Associated With the Critical Heart Rate.

ABSTRACT: Succi, PJ, Dinyer-McNeely, TK, Voskuil, CC, Abel, MG, Clasey, JL, and Bergstrom, HC. Responses to exercise at the critical heart rate vs. the power output associated with the critical heart rate. J Strength Cond Res 37(12): 2362-2372, 2023-This study examined the physiological (volume of oxygen consumption [V̇ o2 ], heart rate [HR], power output [PO], respiration rate [RR], muscle oxygen saturation [%SmO 2 ]), neuromuscular (electromyographic and mechanomyographic amplitude [EMG AMP and MMG AMP] and mean power frequency [EMG MPF and MMG MPF]), and perceptual (rating of perceived exertion [RPE]) responses during exercise anchored at the critical heart rate (CHR) vs. the PO associated with CHR (PCHR). Nine subjects (mean ± SD ; age = 26 ± 3 years) performed a graded exercise test and 4 constant PO trials to exhaustion at 85-100% of peak PO (PP) to derive CHR and PCHR on a cycle ergometer. Responses were recorded during trials at CHR (173 ± 9 b·min -1 , time to exhaustion [T Lim ] = 45.5 ± 20.2 minutes) and PCHR (198 ± 58 W, T Lim = 21.0 ± 17.8 minutes) and normalized to their respective values at PP in 10% intervals. There were significant ( p ≤ 0.05) mode (CHR vs. PCHR) × time (10%-100% T Lim ) interactions for all variables ( p < 0.001-0.036) except MMG AMP ( p > 0.05). Post hoc analyses indicated differences across time for CHR V̇ o2 (%change = -22 ± 16%), PCHR V̇ o2 (19 ± 5%), CHR RR (24 ± 23%), PCHR RR (45 ± 14%), CHR PO (-33 ± 11%), PCHR HR (22 ± 5%), CHR RPE (22 ± 14%), PCHR RPE (39 ± 6%), CHR %SmO 2 (41 ± 33%), PCHR %SmO 2 (-18 ± 40%), CHR EMG AMP (-13 ± 15%), PCHR EMG AMP (13 ± 13%), CHR EMG MPF (9 ± 8%), CHR MMG MPF (7 ± 11%), and PCHR MMG MPF (-3 ± 14%). The critical heart rate was more sustainable than PCHR but required adjustments in PO which traversed intensity domains and caused dissociations of the responses previously observed in exercise anchored to PO. These dissociations indicated the demands to exercise varied with anchoring scheme and provides an important consideration for practitioners prescribing endurance exercise.

The Acute Effect of High-Intensity Resistance Training on Subsequent Firefighter Performance.

ABSTRACT: Mason, MR, Heebner, NR, Abt, JP, Bergstrom, HC, Shapiro, R, Langford, EL, and Abel, MG. The acute effect of high-intensity resistance training on subsequent firefighter performance. J Strength Cond Res 37(7): 1507-1514, 2023-High-intensity resistance training (HIRT) is commonly performed by structural firefighters on duty to enhance occupational readiness. However, exercise-induced fatigue may negatively impact subsequent occupational performance. Therefore, the purpose of this study was to assess the acute effect of HIRT on subsequent occupational physical ability in structural firefighters and to determine the time course of recovery. Seven resistance-trained male firefighters performed a timed maximal effort simulated fireground test (SFGT) in 3 randomized conditions: baseline (SFGT baseline ), 10 minutes post HIRT (SFGT 10min ), and 60 minutes post HIRT (SFGT 60min ). Work efficiency and air depletion were assessed during the SFGT. The timed HIRT session consisted of a standardized set of exercises using absolute training loads. Repeated measures analysis of variance and minimal difference (MD) analysis assessed group and individual effects between the conditions, respectively. The level of significance was set at p < 0.05. SFGT 10min completion time was greater than SFGT baseline (430 ± 137 vs. 297 ± 69 seconds, p < 0.01), with no difference between SFGT baseline and SFGT 60min (297 ± 69 vs. 326 ± 89 seconds, p = 0.08). The MD analysis indicated that all firefighters' SFGT 10min times exceeded the MD (±26.4 seconds) compared with SFGT baseline . However, 43% of firefighters still exceeded the MD at SFGT 60min . Air depletion during SFGT 10min was greater than that during SFGT baseline (2,786 ± 488 vs. 2,186 ± 276 lb·in -2 , p = 0.02), with no difference between SFGT baseline and SFGT 60min ( p = 0.25). Work efficiency during SFGT 10min was 40% lower than that during SFGT baseline ( p < 0.01), with no difference between SFGT baseline and SFGT 60min ( p = 0.25). These findings indicate that an acute bout of HIRT decreases multiple descriptors of firefighters' occupational performance 10 minutes post exercise with varied responses at 60 minutes post exercise.

The Effect of Tactical Tasks and Gear on Muscle Activation of SWAT Officers.

ABSTRACT: Keeler, JM, Pohl, MB, Bergstrom, HC, Thomas, JM, and Abel, MG. The effect of tactical tasks and gear on muscle activation of SWAT officers. J Strength Cond Res 36(1): 238-244, 2022-Special Weapons and Tactics (SWAT) officers perform a variety of tactical operations while wearing tactical gear. Load carriage has been shown to alter muscle activation in the torso and is also associated with lower back pain, which is a prevalent musculoskeletal injury suffered by SWAT Officers. The purpose of this study was to quantify the effect of tactical gear on muscle activation of torso musculature while performing occupational tasks. Twenty male SWAT Officers (age: 34.7 ± 4.5 years; height: 1.79 ± 0.1 m; body mass: 91.5 ± 17.3 kg) performed 4 tasks (standing, rifle walk, sitting, and shield walk) with and without gear (mass of gear: 13.8 ± 1.9 kg). Mean electromyographic amplitude was evaluated bilaterally for the erector spinae, rectus abdominis, and external oblique muscles during the trials and expressed relative to maximal voluntary isometric contraction (MVIC). Addition of gear significantly increased erector spinae mean muscle activation during the rifle walk task (mean delta: +0.16%). However, no differences in muscle activation were identified for any other muscles between gear conditions (effect size ≤ 0.15). The shield walk produced the highest mean activation for each muscle during different tasks. The dynamic tasks yielded (0.24-4.18% MVIC) greater muscle activation levels than sitting and standing tasks. Despite minimal increases in muscle activation levels with the addition of gear, load carriage is known to increase the risk of acute and chronic injury. Collectively, these findings indicate that SWAT Officers should perform most skills without gear during tactical training to simulate task-specific movement patterns but reduce the risk of musculoskeletal injury.

Gait biofeedback and impairment-based rehabilitation for chronic ankle instability.

Our purpose was to analyze the effects of 4 weeks of visual gait biofeedback (GBF) and impairment-based rehabilitation on gait biomechanics and patient-reported outcomes (PROs) in individuals with chronic ankle instability (CAI). Twenty-seven individuals with CAI participated in this randomized controlled trial (14 received no biofeedback (NBF), 13 received GBF). Both groups received 8 sessions of impairment-based rehabilitation. The GBF group received visual biofeedback to reduce ankle frontal plane angle at initial contact (IC) during treadmill walking. The NBF group walked for equal time during rehabilitation but without biofeedback. Dependent variables included three-dimensional kinematics and kinetics at the ankle, knee, and hip, electromyography amplitudes of 4 lower extremity muscles (tibialis anterior, fibularis longus, medial gastrocnemius, and gluteus medius), and PROs (Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL), FAAM-Sport, Tampa Scale of Kinesiophobia (TSK), and Global Rating of Change (GROC)). The GBF group significantly decreased ankle inversion at IC (MD:-7.3º, g = 1.6) and throughout the entire stride cycle (peak inversion: MD:-5.9º, g = 1.2). The NBF group did not have significantly altered gait biomechanics. The groups were significantly different after rehabilitation for the FAAM-ADL (GBF: 97.1 ± 2.3%, NBF: 92.0 ± 5.7%), TSK (GBF: 29.7 ± 3.7, NBF: 34.9 ± 5.8), and GROC (GBF: 5.5 ± 1.0, NBF:3.9 ± 2.0) with the GBF group showing greater improvements than the NBF group. There were no significant differences between groups for kinetics or electromyography measures. The GBF group successfully decreased ankle inversion angle and had greater improvements in PROs after intervention compared to the NBF group. Impairment-based rehabilitation combined with visual biofeedback during gait training is recommended for individuals with CAI.

Efficacy and Safety of the Telestroke Drip-And-Stay Model: A Systematic Review and Meta-Analysis.

OBJECTIVES: To compare outcomes between two models of acute ischemic stroke care. Namely 1) "drip-and-stay", i.e. IV tissue plasminogen activator (tPA) administered at a spoke hospital in a telestroke network, with the patient remaining at the spoke, versus 2) "drip-and-ship", i.e. tPA administered at a spoke hospital with subsequent patient transfer to a hub hospital, and 3) "hub", i.e. tPA and subsequent treatment at a hub hospital. MATERIALS AND METHODS: We performed a systematic review and meta-analysis according to PRISMA guidelines. Literature searches of MEDLINE, Embase, and Cochrane from inception-October 2019 included randomized control trials and observational cohort studies comparing the drip-and-stay model to hub and drip-and-ship models. Outcomes of interest were functional independence (modified Rankin Scale ≤ 1), symptomatic intracranial hemorrhage (sICH), mortality, and length of stay. Pooled effect estimates were calculated using a fixed-effects meta-analysis and random-effects Bayesian meta-analysis. Non-inferiority was calculated using a fixed-margin method. RESULTS: Of 2806 unique records identified, 10 studies, totaling 4,164 patients, fulfilled the eligibility criteria. Meta-analysis found no significant difference in functional outcomes (mRS0-1) (6 studies, RR=1.09, 95%CI 0.98-1.22, p=0.123), sICH (8 studies, RR=0.98, 95%CI 0.64-1.51, p=0.942), or 90-day mortality (5 studies, RR=0.98, 95%CI 0.73-1.32, p=0.911, respectively) between patients treated in a drip-and-stay model compared to patients treated in drip-and-ship or hub models. There was no significant heterogeneity in these outcomes. Drip-and-stay outcomes (mRS 0-1, sICH) were non-inferior when compared to the combined group. CONCLUSIONS: Our findings indicate that drip-and-stay is non-inferior to current models of drip-and-ship or hub stroke care, and may be as safe and as effective as either.

Effect of a Law Enforcement Academy Training Program on Validated Fitness Outcomes of Cadets.

ABSTRACT: Martinez, GJ and Abel, MG. Effect of a law enforcement academy training program on validated fitness outcomes of cadets. J Strength Cond Res 35(4): 955-962, 2021-The purpose of this investigation was to assess the efficacy of a law enforcement training program on physical fitness outcomes in police cadets. A convenience sample of 138 male and 8 female police cadets participated in a 23-week law enforcement training academy with validated fitness assessments conducted at entrance, midpoint, and exit from the academy. Demographic, anthropometric, and fitness data (i.e., 1.5-mile run, 1 repetition maximum bench press, sit-up repetitions, push-up repetitions, and 300-m run) were retrospectively collected. Analysis of variance was used to identify the influence of training on fitness outcomes over time and between cadet subgroup stratifications. Statistical significance for this study was set at p ≤ 0.05. All cadet subgroups (specialty-stratified and sex-stratified cohorts) exceeded the validated fitness standards on academy entrance and exit (p ≤ 0.01). The entire cohort significantly improved all fitness outcomes throughout the training program. Furthermore, improvements in all fitness outcomes were significantly greater from entrance to midpoint (4.4-35.7%, p ≤ 0.001) vs. midpoint to exit (1.2-15.4%, p < 0.05). Specifically, there were greater relative improvements in push-ups and sit-ups (57.5 and 28.7%, respectively; p < 0.001) compared with bench press (13.8%, p < 0.001), 300-m run (5.8%, p < 0.001), and 1.5-mile run (12.1%, p < 0.001). Regarding female cadets, the average relative improvement in fitness outcomes from entrance to exit assessments was superior compared to male counterparts for all fitness tests except sit-ups. Moreover, the specialty cadets produced lower 1.5-mile run times than nonspecialty cadets throughout the academy. Overall, the academy improved occupationally relevant fitness outcomes, with greater improvements occurring earlier in the academy.

Methodological Considerations for the Determination of the Critical Load for the Deadlift.

ABSTRACT: Moss, AC, Dinyer, TK, Abel, MG, and Bergstrom, HC. Methodological considerations for the determination of the critical load for the deadlift. J Strength Cond Res 35(2S): S31-S37, 2021-This study determined whether performance method during conventional deadlifting affects critical load (CL) estimates derived from the linear work limit (Wlim) vs. repetitions relationship. Eleven subjects completed 1-repetition maximum (1RM) deadlift testing followed by separate visits, to determine the number of repetitions to failure at 50, 60, 70, and 80% 1RM for both reset (RS) and touch-and-go (TG) methods. The CL was the slope of the line of total work completed (load [kg] × repetitions) vs. total repetitions for 4 intensities (50-80% 1RM). The number of repetitions to failure were determined at CLRS and CLTG. The kg values and repetitions to failure at CLRS and CLTG, and total repetitions at each intensity (50-80%) for each method (RS and TG) were compared. There were no significant mean differences (±SD) in kg values (-0.4 ± 7.9 kg, range = -8.8 to 17 kg, p = 0.856), %1RM (-1.2 ± 5.6%, p = 0.510), or total repetitions completed (2.8 ± 15.7 reps, range = -15 to 37 reps, p = 0.565) for CLRS and CLTG. These findings indicated that performance method did not affect mean estimation of CL or number of repetitions completed at submaximal loads. Thus, the estimates of CL from the modeling of total work vs. repetitions were relatively robust to variations in deadlifting methodologies. However, individual variability (range of scores) in kg values and repetition to failure at CLRS and CLTG indicated that deadlifting methods may differ in anatomical region of fatigue. The CL is an individually derived threshold that may be used to examine and describe performance capabilities.

Prolonged Postoperative Intubation After Spinal Fusion in Cerebral Palsy: Are There Modifiable Risk Factors and Associated Consequences?

BACKGROUND: Instrumented spinal fusion is performed to correct severe spinal deformity that commonly complicates cerebral palsy (CP). Prolonged intubation (PI) is a common perioperative complication, though little is known about the risk factors and consequences of this phenomenon. QUESTIONS/PURPOSES: The purpose of this study was to determine (1) the preoperative and intraoperative risk factors associated with PI after spine surgery for CP; (2) the perioperative and postoperative complications associated with PI; and (3) any long-term impacts of PI with respect to health-related quality of life. PATIENTS AND METHODS: A retrospective case-control analysis of prospectively collected, multicenter data was performed on patients with Gross Motor Function Classification System (GMFCS) 4 or 5 CP who underwent instrumented spinal fusion. Patients extubated on postoperative day (POD) 0 were in the early extubation (EE) cohort and those extubated on POD 3 or later were in the PI cohort. Comparisons were made between PI and EE groups with respect to several preoperative and intraoperative variables to identify risk factors for PI. Multivariate logistic regression was performed to identify independent predictors of this outcome. The postoperative hospital course, rate of complications, and health-related quality of life at 2 years were also compared. RESULTS: This study included 217 patients (52% male individuals; mean age, 14.0±2.8 y) who underwent spinal fusion for CP. In this cohort, 52 patients (24%) had EE and 58 patients (27%) had PI. There were several independent predictors of PI including history of pneumonia [odds ratio (OR), 6.2; 95% confidence interval (CI), 1.6-24.3; P=0.01], estimated blood loss of >3000 mL (OR, 16.5; 95% CI, 2.0-134; P=0.01), weight of <37 kg (OR, 6.4; 95% CI, 1.5-27.1), and Child Health Index of Life with Disabilities (CPCHILD) Communication and Social Interaction score of <15 (OR, 10.8; 95% CI, 1.1-107.3; P=0.04). In addition, PI was associated with a higher rate of perioperative and postoperative respiratory (P<0.001), cardiovascular (P=0.014), gastrointestinal (P<0.001), and surgical site (0.027) complications, in addition to prolonged hospitalization (P<0.001) and intensive care unit stay (P<0.001). CONCLUSIONS: Surgeons should seek to optimize nutritional status and pulmonary function, and minimize blood loss in patients with CP to decrease the risk of PI after spinal fusion. Efforts should be made to extubate patients on POD 0 to decrease the risk of complications associated with PI.

Improving Health-related Quality of Life for Patients With Nonambulatory Cerebral Palsy: Who Stands to Gain From Scoliosis Surgery?

INTRODUCTION: It is unclear what factors influence health-related quality of life (HRQOL) in neuromuscular scoliosis. The aim of this study was to evaluate which factors are associated with an improvement in an HRQOL after spinal fusion surgery for nonambulatory patients with cerebral palsy (CP). METHODS: A total of 157 patients with nonambulatory CP (Gross Motor Function Classification System IV and V) with a minimum of 2-year follow-up after PSF were identified from a prospective multicenter registry. Radiographs and quality of life were evaluated preoperatively and 2 years postoperatively. Quality of life was evaluated using the validated Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire. Patients who had an increase of 10 points or greater from baseline CPCHILD scores were considered to have meaningful improvement at 2 years postoperatively. 10 points was chosen as a threshold for meaningful improvement based on differences between Gross Motor Function Classification System IV and V patients reported during the development of the CPCHILD. Perioperative demographic, clinical, and radiographic variables were analyzed to determine predicators for meaningful improvement by univariate and multivariate regression analysis. RESULTS: A total of 36.3% (57/157) of the patients reported meaningful improvement in CPCHILD scores at 2 years postoperatively. Preoperative radiographic parameters, postoperative radiographic parameters, and deformity correction did not differ significantly between groups. Patients who experienced meaningful improvement from surgery had significantly lower preoperative total CHPILD scores (43.8 vs. 55.2, P<0.001). On backwards conditional binary logistic regression, only the preoperative comfort, emotions, and behavior domain of the CPCHILD was predictive of meaningful improvement after surgery (P≤0.001). CONCLUSION: Analysis of 157 CP patients revealed a meaningful improvement in an HRQOL in 36.3% of the patients. These patients tended to have lower preoperative HRQOL, suggesting more "room for improvement" from surgery. A lower score within the comfort, emotions, and behavior domain of the CPCHILD was predictive of meaningful improvement after surgery. Radiographic parameters of deformity or curve correction were not associated with meaningful improvement after surgery. LEVEL OF EVIDENCE: Level II-retrospective review of prospectively collected data.

The Influence of Age on Firefighter Combat Challenge Performance and Exercise Training Habits.

Saari, AI, Renz, G, Davis, P, and Abel, MG. The influence of age on firefighter combat challenge performance and exercise training habits. J Strength Cond Res 34(9): 2500-2506, 2020-The primary purpose of this study was to compare older vs. younger physically trained structural firefighters' performance in an international firefighter physical ability competition (Scott Firefighter Combat Challenge) and their engagement in physical training. Secondarily, firefighters' perceived importance of fitness characteristics to perform occupational tasks was evaluated. Sixty-four trained male firefighters' completed a timed occupationally specific competition course and a survey to assess exercise habits and perceived importance of fitness characteristics to perform fireground tasks. Firefighters were stratified into younger (<37 years; n = 34) and older (≥37 years; n = 30) cohorts based on the sample's median age. Independent samples t-tests were used to analyze differences in outcome measures between younger and older cohorts. It took older firefighters 8.8% longer to complete the course compared with younger firefighters (p = 0.029). Both groups reported similar training frequencies of cardiovascular (CV) training (Younger: 4.1 ± 1.7 vs. Older: 3.6 ± 1.5 session·wk, p = 0.203) and strength training (Younger: 3.6 ± 1.2 vs. Older 3.2 ± 1.4 session·wk, p = 0.274). Furthermore, there was no difference in weekly training load for CV (p = 0.663) or strength training (p = 0.898) activities between the cohorts. On average, firefighters indicated that all fitness characteristics were at least somewhat important for occupational performance. Occupationally relevant competition performance among a sample of fit firefighters was lower in older firefighters compared with younger firefighters, despite similar self-reported training volume and intensity. Practitioners may expect age-related decreases in occupational performance despite performing similar amounts of physical training.

The Effect of Personal Protective Equipment on Firefighter Occupational Performance.

Lesniak, AY, Bergstrom, HC, Clasey, JL, Stromberg, AJ, and Abel, MG. The effect of personal protective equipment on firefighter occupational performance. J Strength Cond Res 34(8): 2165-2172, 2020-The purpose of this study was to evaluate the effects of load carriage (LC) and LC plus respirator use (LC + self-contained breathing apparatus [SCBA]) on firefighters' work capacity to enhance our understanding of occupational demands. Twenty-one male structural firefighter recruits (age: 28.6 ± 4.3 years; height: 178.6 ± 7.2 cm; body mass: 94.1 ± 15.4 kg; body fat: 22.9 ± 6.1%) participated. Occupational performance was assessed by time to complete a simulated fire ground test (SFGT). After 2 familiarization trials, recruits performed the following SFGT conditions in a randomized order: PT (physical training clothes), LC only, and LC + SCBA. To describe within-group differences between SFGT conditions, relative difference scores were calculated as follows: % difference = ([experimental trial outcome - PT trial outcome]/PT trial outcome) × 100. Statistical differences between conditions were assessed with repeated-measures analysis of variance. The level of significance was set p < 0.01. Time to complete the LC + SCBA trial (345.9 ± 43.7 seconds; p < 0.001) and LC-only trial (331.2 ± 39.3 seconds; p < 0.001) were significantly greater than the PT trial (241.0 ± 33.3 seconds). Post-SFGT rating of perceived exertion was higher in the LC + SCBA trial (6.7 ± 1.7) and LC trial (6.4 ± 1.5) compared with the PT trial (4.7 ± 1.8; p < 0.001). Heart rate and lactate measures were similar across conditions (p = 0.488; p = 0.287). Personal protective equipment (PPE) significantly decreases the work capacity and increases the perceived effort of occupational tasks. Thus, these findings describe the additional physical demands produced by PPE and indicate that performance of firefighting tasks in an unloaded condition does not reflect work capacity in a bona fide condition.

Construct Validity, Test-Retest Reliability, and Repeatability of Performance Variables Using a Flywheel Resistance Training Device.

Bollinger, LM, Brantley, JT, Tarlton, JK, Baker, PA, Seay, RF, and Abel, MG. Construct validity, test-retest reliability, and repeatability of performance variables using a flywheel resistance training device. J Strength Cond Res 34(11): 3149-3156, 2020-Power production is highly associated with physical performance; however, the ability to quantitatively measure power output during resistance exercise is lacking. The purpose of this study was to determine the validity and test-retest reliability of flywheel-based performance testing. Twelve young, resistance trained subjects completed 2 bouts of resistance exercise using a flywheel resistance training device (Exxentric kbox 4 Pro). Each session consisted of 3 sets of 3 exercise (bent-over row, Romanian deadlift, and biceps curl) with varying moments of inertia (0.050, 0.075, and 0.100 kg·m, respectively) in random order. Each set consisted of 5 maximal effort repetitions with 3-minute recovery between sets. Average power, peak concentric and eccentric power, average force, average speed, and total work for each set were recorded. Regression analysis revealed a near-perfect relationship between measured and predicted power, force, and work at given workloads. Pearson's r between trials 1 and 2 revealed good (≥0.70) to excellent (≥0.90) test-retest reliability for all outcomes with the exception of peak eccentric power for biceps curls (r = 0.69), which narrowly missed the cutoff for acceptable reliability. Bland-Altman plots revealed small (approximately 5-15%), but statistically significant bias between the 2 trials for some measures. Coefficient of repeatability for all outcomes was relatively high, indicating poor repeatability. Flywheel-based performance testing provides valid data. However, reliability varies between individual lifts and specific outcomes. Given the poor repeatability between trials, it is likely that subjects who are unaccustomed to this modality may require multiple testing sessions or a thorough familiarization period to ensure accurate measures of power, force, speed, and work during flywheel-based performance testing.

Effects of Curcumin and Fenugreek Soluble Fiber on the Physical Working Capacity at the Fatigue Threshold, Peak Oxygen Consumption, and Time to Exhaustion.

Herrick, LP, Goh, J, Menke, W, Campbell, MS, Fleenor, BS, Abel, MG, and Bergstrom, HC. Effects of curcumin and fenugreek soluble fiber on the physical working capacity at the fatigue threshold, peak oxygen consumption, and time to exhaustion. J Strength Cond Res 34(12): 3346-3355, 2020-The purpose of this study was to examine the effects of curcumin in combination with fenugreek soluble fiber (CUR + FEN) or fenugreek soluble fiber alone (FEN) on the neuromuscular fatigue threshold (PWCFT), peak oxygen consumption (V˙o2peak), and time to exhaustion (Tlim) on a graded exercise test (GXT), in untrained subjects. The PWCFT estimates the highest power output that can be maintained without evidence of neuromuscular fatigue. Forty-seven untrained, college-aged subjects were randomly assigned to one of 3 supplementation groups; placebo (PLA, n = 15), CUR + FEN (500 mg·d, n = 18), or FEN (300 mg·d, n = 14). The subjects completed a maximal GXT on a cycle ergometer to determine the PWCFT, V˙o2peak, and Tlim before (PRE) and after (POST) 28 days of daily supplementation. Surface electromyographic signals were recorded from a bipolar electrode arrangement on the vastus lateralis of the right leg during each test. Separate one-way analysis of covariances were used to determine if there were between-group differences for adjusted POST-PWCFT, POST-V˙o2peak, and POST-Tlim values, covaried for the respective PRE-test scores. The adjusted POST-PWCFT for the CUR + FEN group (mean ± SD: 196 ± 58 W) was greater (p = 0.016) than the PLA group (168 ± 49 W) but the FEN group (185 ± 32 W) was not different from the CUR + FEN or PLA groups (p > 0.05). There were no differences for adjusted POST-V˙o2peak (p = 0.612) or POST-Tlim (p = 0.508) among the groups. These findings suggested curcumin combined with fenugreek soluble fiber might delay neuromuscular fatigue.

Muscular and Neural Contributions to Postactivation Potentiation.

Wallace, BJ, Shapiro, R, Wallace, KL, Abel, MG, and Symons, TB. Muscular and neural contributions to postactivation potentiation. J Strength Cond Res 33(3): 615-625, 2019-This study's purpose was to explain the relationship between muscle factors (twitch potentiation [TP]) and neural factors (reflex potentiation) contributing to total postactivation potentiation (PAP) that couples these. The tibial nerve of 15 participants were stimulated intermittently for 20 minutes at supramaximal (Mmax) and submaximal (Hmax) intensities on separate days under 2 conditions: (a) rest (Control) and (b) after a 10-second plantarflexion maximum voluntary isometric contraction (MVIC). Isometric twitch torque and rate of force development (RFD) as well as soleus and gastrocnemius electromyographic values were analyzed. Torque and RFD TP were significantly greater 10 and 30 seconds after MVIC vs. Control. Postactivation potentiation of torque and RFD at Hmax were highest at 3 and 4.5 minutes after MVIC, respectively, with RFD significantly elevated. Electromyographic values were not different between conditions. Twitch potentiation significantly contributed to PAP at the following time points: 20 seconds, Hmax peak, and 20 minutes after MVIC (torque: R = 0.54, 0.76, and 0.70; RFD: R = 0.46, 0.59, and 0.53). The soleus significantly contributed to PAP torque at 20 seconds and 20 minutes after MVIC, and to PAP RFD at 20 seconds, 4.5 minutes, and 20 minutes (torque: R = 0.26 and 0.34, p ≤ 0.05; RFD: R = 0.65, 0.52, and 0.41). The gastrocnemius did not significantly contribute to PAP. Both muscle and neural factors play a significant role in PAP, and neural factors may play a more prominent role in RFD potentiation than torque potentiation.

Effect of Impairment-Based Rehabilitation on Lower Leg Muscle Volumes and Strength in Patients With Chronic Ankle Instability: A Preliminary Study.

Context: Patients with chronic ankle instability (CAI) have demonstrated atrophy of foot and ankle musculature and deficits in ankle strength. The effect of rehabilitation on muscle morphology and ankle strength has not previously been investigated in patients with CAI. Objective: Our objective was to analyze the effect of impairment-based rehabilitation on intrinsic and extrinsic foot and ankle muscle volumes and strength in patients with CAI. Design: Controlled laboratory study. Setting: Laboratory. Patients: Five young adults with CAI. Intervention: Twelve sessions of supervised impairment-based rehabilitation that included range of motion, strength, balance, and functional exercises. Main Outcome Measures: Measures of extrinsic and intrinsic foot muscle volume and ankle strength measured before and after 4 weeks of supervised rehabilitation. Novel fast-acquisition magnetic resonance imaging was used to scan from above the femoral condyles through the entire foot. The perimeter of each muscle was outlined on each axial slice and then the 2-dimensional area was multiplied by the slice thickness (5 mm) to calculate muscle volume. Plantar flexion, dorsiflexion, inversion, and eversion isometric strength were measured using a hand-held dynamometer. Results: Rehabilitation resulted in hypertrophy of all extrinsic foot muscles except for the flexor hallucis longus and peroneals. Large improvements were seen in inversion, eversion, and plantar flexion strength following rehabilitation. Effect sizes for significant differences following rehabilitation were all large and ranged from 1.54 to 3.35. No significant differences were identified for intrinsic foot muscle volumes. Conclusion: Preliminary results suggest that impairment-based rehabilitation for CAI can induce hypertrophy of extrinsic foot and ankle musculature with corresponding increases in ankle strength.

Effect of Load Carriage on Tactical Performance in Special Weapons and Tactics Operators.

Thomas, JM, Pohl, MB, Shapiro, R, Keeler, J, and Abel, MG. Effect of load carriage on tactical performance in special weapons and tactics operators. J Strength Cond Res 32(2): 554-564, 2018-Special weapons and tactics (SWAT) operators are specially trained personnel that are required to carry equipment to perform high-risk tasks. Given the need to carry this equipment, it is important to understand the potentially deleterious effect that the additional load may have on tactical performance. Furthermore, it is important to identify physical fitness characteristics that are associated with the potential decrement in performance. Therefore, the purpose of this study was to evaluate the effect of load carriage on tactical physical ability and marksmanship and to identify fitness characteristics associated with any decrement in performance. Twelve male SWAT operators were timed while performing a simulated tactical test (STT) on a live firing range with (loaded condition) and without equipment (unloaded condition). A battery of physical fitness assessments were used to assess anaerobic and aerobic power, muscular endurance, strength, agility, and flexibility. Paired-samples t-tests were used to identify differences between STT conditions, and bivariate correlations were used to determine relationships between STT and fitness outcomes. Time to complete the STT in the loaded condition increased by 7.8% compared with the unloaded condition (p < 0.001). Nine of the 13 STT tasks were performed significantly slower in the loaded condition. Fatigue index (r = 0.64) and V[Combining Dot Above]O2peak (r = -0.62) were associated with the decrement in the overall STT time. Marksmanship was not different between load carriage conditions (p = 0.816). These findings indicate that resistance to anaerobic fatigue and aerobic power are related to the decrement in tactical performance produced by load carriage.