The International Olympic Committee framework on fairness, inclusion and nondiscrimination on the basis of gender identity and sex variations does not protect fairness for female athletes.

The International Olympic Committee (IOC) recently published a framework on fairness, inclusion, and nondiscrimination on the basis of gender identity and sex variations. Although we appreciate the IOC's recognition of the role of sports science and medicine in policy development, we disagree with the assertion that the IOC framework is consistent with existing scientific and medical evidence and question its recommendations for implementation. Testosterone exposure during male development results in physical differences between male and female bodies; this process underpins male athletic advantage in muscle mass, strength and power, and endurance and aerobic capacity. The IOC's "no presumption of advantage" principle disregards this reality. Studies show that transgender women (male-born individuals who identify as women) with suppressed testosterone retain muscle mass, strength, and other physical advantages compared to females; male performance advantage cannot be eliminated with testosterone suppression. The IOC's concept of "meaningful competition" is flawed because fairness of category does not hinge on closely matched performances. The female category ensures fair competition for female athletes by excluding male advantages. Case-by-case testing for transgender women may lead to stigmatization and cannot be robustly managed in practice. We argue that eligibility criteria for female competition must consider male development rather than relying on current testosterone levels. Female athletes should be recognized as the key stakeholders in the consultation and decision-making processes. We urge the IOC to reevaluate the recommendations of their Framework to include a comprehensive understanding of the biological advantages of male development to ensure fairness and safety in female sports.

Hip and Knee Osteoarthritis, Not Nonsteroidal Anti-Inflammatory Drugs, are Linked to Cardiac Disease.

BACKGROUND: In 2005, the Food and Drug Administration placed a black-box warning (the most stringent warning for drugs) on all nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) stating that these agents may cause heart attacks and/or strokes. No level I evidence demonstrates that nonselective NSAIDs increase cardiovascular risk. An alternative hypothesis is that hip and knee osteoarthritis (OA) indirectly causes cardiovascular disease (CVD) through decreased activity and NSAIDs are correlated with CVD as an arthritis treatment. METHODS: Systematic reviews were conducted to find observational studies evaluating the association of hip and/or knee OA, CVD, activity, walking, and step counts. The systematic review found studies correlating hip and/or knee OA and CVD morbidity incidence (n = 2); CVD morbidity prevalence (n = 6); odds ratios, relative risks, or hazard ratios of CVD morbidity (n = 11); relative risk, standardized mortality ratios, or hazard ratios of CVD mortality (n = 14); and all-cause mortality hazard ratios associated with NSAID use (n = 3). RESULTS: Hip OA (5 studies), knee OA (9 studies), and hip and knee OA (6 studies) are linked to an increased risk of CVD morbidity and mortality. Cardiac risk increases with validated disability scores, use of walking aids, walking difficulties, longer follow-up times, younger ages of OA onset, numbers of joints involved, and OA severities. No study linked NSAID use to cardiac disease. CONCLUSIONS: All studies with more than 10-year follow-up linked cardiac disease with hip and knee OA. No study linked nonselective NSAID use to CVD. The Food and Drug Administration should reconsider the black-box warnings on naproxen, ibuprofen, and celecoxib.

How much water is in a mouthful, and how many mouthfuls should I drink? A laboratory exercise to help students understand developing a hydration plan.

Preventing impairments in athletic performance is an important concept for students that are preparing for careers that involve working with athletes. Gaining hands on, laboratory-based experience in measuring exercise induced dehydration can help students understand how to help athletes prevent dehydration induced impairment in performance. This article describes a laboratory exercise for junior and senior students in a sports nutrition class, in which the students measure changes in body mass (as a measure of dehydration) due to 40 min of moderate-intensity exercise and 40 min of vigorous-intensity exercise. The students also measure how much water is in a mouthful from a sports bottle and from a drinking fountain. The students then calculate how many mouthfuls are necessary to replace exercise induced fluid losses. This laboratory exercise has been well received by students and has improved performance on the test regarding hydration.

Online quizzes promote inconsistent improvements on in-class test performance in introductory anatomy and physiology.

Review quizzes can provide students with feedback and assist in the preparation for in-class tests, but students often do not voluntarily use self-testing resources. The purpose of the present study was to evaluate if taking a mandatory online review quiz alters performance on subsequent in-class tests. During two semesters of a single-semester introductory anatomy and physiology course, students were required to complete brief online quizzes after each textbook chapter had been covered during lecture as well as the day before an in-class test. During the next two semesters, students were not required to take the online review quizzes. Overall scores on chapter specific in-class tests were higher (P < 0.05) during the semesters in which students took online review quizzes (82.9 ± 14.3%) compared with when they did not (78.7 ± 15.5%), but all in-class tests were not improved. Scores on comprehensive midterm examinations were higher (83.0 ± 12.9% vs. 78.9 ± 13.7%, P < 0.05) but not on final examinations (72.4 ± 13.8% vs. 71.8 ± 14.0%) between those with online review quizzes and those without, respectively. Overall scores on in-class tests and comprehensive examinations were higher (P < 0.05) during the semesters in which students took online review quizzes (83.4 ± 16.8%) compared with when they did not (80.3 ± 17.6%). These data suggest that an online review quiz taken the day before an in-class test increases performance on some in-class tests. However, online review quizzes taken after completion of each chapter do not consistently enhance performance on comprehensive examinations.

Validity of HydraTrend reagent strips for the assessment of hydration status.

Hydration is used by athletic governing organizations for weight class eligibility. The measurement of urine specific gravity (USG) as a measure of hydration by reagent strips is a controversial issue. The purpose of this study was to determine the validity of HydraTrend reagent strips that facilitate the correction of USG for alkaline urine samples against refractometry for the assessment of USG. Fifty-one participants (33 males, age = 22.3 ± 1.3 years; 18 females, age = 22.4 ± 1.2 years) provided 84 urine samples. The samples were tested for USG using refractometry and reagent strips and for pH using reagent strips and a digital pH meter. Strong correlation coefficients were found between refractometry and reagent strips for USG (rs(82) = 0.812, p < 0.01) and between reagent strips and pH meter for pH (rs(82) = 0.939, p < 0.01). It was observed that false negative results for National Collegiate Athletic Association (NCAA) requirements (fail refractometry with USG >1.020, pass reagent strips with USG ≤1.020) occurred 39% (33/84) of the time and false negative results for National Federation of State High School Association (NFHS) requirements (fail refractometry with USG >1.025, pass reagent strips with USG ≤1.025) occurred 14% (12/84) of the time. There were no false positives (pass refractometry and fail reagent strips) for NCAA or NFHS requirements. These data show that refractometry and reagent strips have strong positive correlations. However, the risk of a false negative result leading to incorrect certification of euhydration status outweighs the benefits of the HydraTrend reagent strips for the measurement of USG.

Rescuers may vary their side of approach to a casualty without impact on cardiopulmonary resuscitation performance.

AIM: To determine whether cardiopulmonary resuscitation (CPR) performance is influenced by a rescuer's preferred side of approach. METHODS: Eighty-three first-year healthcare students were enrolled in a prospective randomised crossover study comparing chest compression quality during uninterrupted chest compression CPR after approach from both their preferred and non-preferred sides. RESULTS: Chest compression quality was not dependent on rescuers' sidedness preference; neither mean compression rate and depth nor hand positioning differed between sides of approach. CONCLUSIONS: No link exists between the side from which a rescuer approaches, or prefers to approach, a casualty and chest compression quality.

Implementation of a Community-Based Mind-Body (Tae-Bo) Physical Activity Programme on Health-Related Physical Fitness in Rural Black Overweight and Obese Women with Manifest Risk Factors for Multimorbidity.

Non-communicable diseases (NCDs) are the leading cause of death globally, particularly impacting low- and middle-income countries and rural dwellers. Therefore, this programme aimed to investigate if a community-based mind-body PA programme implemented in a low-resource setting could improve health-related physical fitness outcomes. Black overweight or obese adult women (25 ± 4.7 years) with a body mass index (BMI) > 25 kg·m-2 recruited from a rural settlement in South Africa with manifest risk factors for multimorbidity were assigned to a 10-week waiting-to-treat non-exercising control group (n = 65) or a community-based mind-body programme (n = 60) consisting of 45-60 min, thrice-weekly Tae-Bo. The intervention resulted in significant (p ≤ 0.05) improvements in body weight (p = 0.043), BMI (p = 0.037), and waist (p = 0.031) and hip circumferences (p = 0.040). Flexibility was found to be significantly increased at mid- and post-programme (p = 0.033 and p = 0.025, respectively) as was static balance (mid: p = 0.022; post: p = 0.019), hand grip strength (mid: p = 0.034; post: p = 0.029), sit-up performance (mid: p = 0.021; post: p = 0.018), and cardiorespiratory endurance (mid: p = 0.017; post: p = 0.011). No significant change was found in sum of skinfolds following the programme (p = 0.057). Such a community-based mind-body programme presents an opportunity to level health inequalities and positively improve health-related physical fitness in low-resource communities irrespective of the underlying barriers to participation.

Coaching, Separate from Mentoring, May Provide Skill Acquisition, Improved Well-Being, and Career Advancement in Orthopaedic Surgery: AOA Critical Issues.

ABSTRACT: Coaching is separate from mentoring, and can include life coaching, skills coaching, and behavior coaching. Life coaching can focus on purpose, work-life balance, well-being, and career path. Skills coaching encourages mastery and promotes autonomy. Behavior coaching may be mandated for a disruptive surgeon. Coaching has been shown to reduce burnout and promote well-being and can potentially advance a surgeon's career trajectory and leadership skills.

Thermal Nerve Radiofrequency Ablation for the Nonsurgical Treatment of Knee Osteoarthritis: A Systematic Literature Review.

BACKGROUND: There are roughly 14 million adults in the United States presenting with symptomatic osteoarthritis (OA) of the knee. Nerve radiofrequency ablation (RFA) is a nonsurgical procedure for the management of knee OA symptoms, and no previous systematic review has been performed comparing geniculate nerve RFA to other nonsurgical treatments. QUESTIONS/PURPOSES: (1) How does geniculate nerve RFA compare with other nonsurgical modalities for patients with knee OA about pain, function, quality of life, and composite scores? and (2) How does geniculate nerve RFA compare with other nonsurgical modalities for patients with knee OA about adverse events (AEs)? METHODS: A systematic literature review was conducted within PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to identify all studies from 1966 to 2019 evaluating the relative effectiveness of geniculate nerve thermal (heated or cooled) RFA compared with other nonsurgical treatments for knee OA. Two independent abstractors reviewed and analyzed the literature including comparators such as intra-articular (IA) corticosteroids, IA hyaluronic acid, NSAIDs, acetaminophen (paracetamol), and control/sham procedures. Inclusion was based on the following criteria: English language, human subjects, symptomatic knee OA, and patient-reported outcomes. RESULTS: Five high-quality and two moderate-quality randomized controlled trials (RCTs) met the inclusion criteria for this review. The results showed consistent agreement across all RCTs in favor of geniculate nerve thermal RFA use for nonsurgical treatment of knee OA. One high-quality RCT and one moderate-quality RCT found geniculate nerve RFA to provide statistically significant outcome improvement compared with control or sham procedures regarding pain, function, quality of life, and composite scores. When compared with IA corticosteroids and hyaluronic acid, geniculate nerve RFA also provided notable improvement in pain, function, and composite scores (visual analog scale, Western Ontario, and McMaster Universities Arthritis Index, and Oxford Knee Score). RFA was markedly favored for all pain and composite outcomes (Western Ontario and McMaster Universities Arthritis Index and visual analog scale). The included RCTs did not report any serious AEs related to geniculate nerve RFA. DISCUSSION: These results demonstrate geniculate nerve thermal RFA to be a superior nonsurgical treatment of knee OA compared with NSAIDs and IA corticosteroid injections. None of the RCTs reported any serious AEs with geniculate nerve thermal RFA, as opposed to known cardiovascular, gastrointestinal, and renal AEs for NSAIDs and accelerated cartilage loss and periprosthetic infection risk for IA corticosteroid injections. LEVEL OF EVIDENCE: Level I.

Comparison of energy expenditure on a treadmill vs. an elliptical device at a self-selected exercise intensity.

Treadmills (TM) and elliptical devices (EL) are popular forms of exercise equipment. The differences in the training stimulus presented by TM or EL are unknown. The purpose of this investigation was to evaluate oxygen consumption, energy expenditure, and heart rate on a TM or EL when persons exercise at the same perceived level of exertion. After measuring peak oxygen uptake (VO2peak) in 9 male and 9 female untrained college-aged participants, the subjects performed 2 separate 15-minute submaximal exercise tests on the TM and EL at a rating of perceived exertion (RPE) of 12-13. VO2peak was higher (p<0.05) in the males (48.6+/-1.5 vs. 45.2+/-1.6 ml/kg/min) than the females (41.7+/-1.8 vs. 38.8+/-2.2 ml/kg/min) for both TM and EL (means+/-standard error of the mean; for TM vs. EL respectively), but there were no differences in the measured VO2peak between TM or EL. During submaximal exercise there were no differences in RPE between TM and EL. Total oxygen consumption was higher (p<0.05) in males (30.8+/-2.2 vs. 34.9+/-2.2 L) than females (24.1+/-1.8 vs. 26.9+/-1.7 L) but did not differ between TM and EL. Energy expenditure was not different between TM (569+/-110 J) or EL (636+/-120 kJ). Heart rate was higher (p<0.05) on the EL (164+/-16 beats/min) compared to the TM (145+/-15 beats/min). When subjects exercise at the same RPE on TM or EL, oxygen consumption and energy expenditure are similar in spite of a higher heart rate on the EL. These data indicate that during cross training or noncompetition-specific exercise, an elliptical device is an acceptable alternative to a treadmill.

Oxygen consumption, heart rate, and blood lactate responses to an acute bout of plyometric depth jumps in college-aged men and women.

Although plyometrics are widely used in athletic conditioning, the acute physiologic responses to plyometrics have not been described. The purpose of this study was to investigate the oxygen consumption, heart rate, and blood lactate responses to a single session of plyometric depth jumps. Twenty recreationally trained college-aged subjects (10 men, 10 women) participated in a single session of 8 sets of 10 box depth jumps from a height of 0.8 m with 3 minutes of passive recovery between each set. Plyometric depth jumping elicited 82.5 +/- 3.1% and 77.8 +/- 3.1% of the measured maximal oxygen consumption (O2max) for women and men, respectively, with no difference in oxygen consumption in ml/kg/min or percent O2max between sexes or sets. Heart rate significantly increased (p < 0.05) from 68.1 +/- 2.9 beatsxmin-1 at rest to 169.6 +/- 1.2 beatsxmin-1 during depth jumping. Sets 5 to 8 elicited a higher (p < 0.05) heart rate (173.3 +/- 1.3 beatsxmin-1) than sets 1 to 4 (164.6 +/- 1.8 beatsxmin-1). Women exhibited a higher heart rate (p < 0.05) during sets 1 and 2 (169.9 +/- 2.8 beatsxmin-1) than men (150.7 +/- 4.4 beatsxmin-1). The blood lactate concentrations were significantly (p < 0.05) increased above resting throughout all sets (1.0 +/- 0.2 mmolxL-1 compared with 2.9 +/- 0.1 mmolxL-1), with no differences between sexes or sets. Plyometric depth jumping significantly increased oxygen consumption, heart rate, and blood lactate in both men and women, but no significant difference was found between the sexes. Plyometric depth jumping from a height of 0.8 m has similar energy system requirements to what Wilmore and Costill termed "Aerobic Power" training, which should enhance O2max, lactate tolerance, oxidative enzymes, and lactate threshold.

Management of Surgical Site Infections.

The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria for the Management of Surgical Site Infections (SSIs) (website: http://www.orthoguidelines.org/go/auc/default.cfm?auc_id=225018&actionxm=Terms). Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Appropriate Use Criteria for the Management of SSIs were derived by identifying clinical indications typical of patients commonly presenting with a SSI in clinical practice. These indications were most often parameters observable by the clinician, including symptoms and diagnostic tests. The 264 patient scenarios and nine treatments were developed by the writing panel, which consisted of a group of clinicians who are specialists in this Appropriate Use Criteria topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a nine-point scale to designate a treatment as appropriate (median rating, seven to nine), may be appropriate (median rating, four to six), or rarely appropriate (median rating, one to three).

Comparison of resistance and concurrent resistance and endurance training regimes in the development of strength.

Resistance and endurance training are often performed concurrently in most exercise programs and in rehabilitative settings in an attempt to acquire gains in more than 1 physiologic system. However, it has been proposed that by simultaneously performing these 2 modes of exercise training, the strength gains achieved by resistance training alone may be impaired. Thus, the aim of this study was to compare the effects of 16 weeks of resistance training and concurrent resistance and endurance training on muscular strength development in 38 sedentary, apparently healthy males (25 yr +/- 8 mo). Subjects were age-matched and randomly assigned to either a control (Con) group (n = 12), resistance training (Res) group (n = 13), or concurrent resistance and endurance training (Com) group (n = 13). After 16 weeks, no changes were found in the strength of the subjects in the Con group. Resistance training and concurrent resistance and endurance training significantly (p < or = 0.05) improved strength in all of the 8 prescribed exercises. The data also indicated that 16 weeks of concurrent resistance training and endurance training was as effective in eliciting improvements in strength as resistance training alone in previously sedentary males. As such, concurrent resistance and endurance training does not impede muscular strength gains and can be prescribed simultaneously for the development of strength in sedentary, apparently healthy males and thus may invoke all the physiologic adaptations of resistance and endurance training at once.

A fitness screening model for increasing fitness assessment and research experiences in undergraduate exercise science students.

When students analyze and present original data they have collected, and hence have a cultivated sense of curiosity about the data, student learning is enhanced. It is often difficult to provide students an opportunity to practice their skills, use their knowledge, and gain research experiences during a typical course laboratory. This article describes a model of an out-of-classroom experience during which undergraduate exercise science students provide a free health and fitness screening to the campus community. Although some evidence of the effectiveness of this experience is presented, this is not a detailed evaluation of either the service or learning benefits of the fitness screening. Working in small learning groups in the classroom, students develop hypotheses about the health and fitness of the population to be screened. Then, as part of the health and fitness screening, participants are evaluated for muscular strength, aerobic fitness, body composition, blood pressure, physical activity, and blood cholesterol levels. Students then analyze the data collected during the screening, accept or reject their hypotheses based on statistical analyses of the data, and make in-class presentations of their findings. This learning experience has been used successfully to illustrate the levels of obesity, hypercholesterolemia, and lack of physical fitness in the campus community as well as provide an opportunity for students to use statistical procedures to analyze data. It has also provided students with an opportunity to practice fitness assessment and interpersonal skills that will enhance their future careers.

Self-reported dietary intake following endurance, resistance and concurrent endurance and resistance training.

With regards to obesity-related disease the impact of exercise training on health depends on the ability of exercise to promote a negative energy balance. Exercise's effect on promoting a negative energy balance is more likely to occur if exercise can induce a favourable dietary intake such as a reduced relative fat content in the diet. As such, the aim of this study was to evaluate and compare the effectiveness of aerobic training, weight training and concurrent aerobic and weight training on self-reported dietary intake. The effects of 16 weeks of aerobic (n = 12), weight (n = 13) and concurrent aerobic and weight training (n = 13) on self-reported dietary intakes were compared in previously sedentary males using the computer-based Dietary Manager(®) software programme. Only the concurrent aerobic and weight training group showed significant (p ≤ 0.05) reductions in total kilocalories, carbohydrates, proteins and fats consumed while the aerobic training group showed significant reductions in fat intake at the completion of the experimental period (before: 91.0 ± 42.1g versus after: 77.1 ± 62.1g). However, no changes were observed in self-reported dietary intake in the weight training or non-exercising control groups. It is concluded that concurrent aerobic and weight training is the most effective mode of exercise at promoting a favourable improvement in self-reported dietary intake in the short term. This finding provides support for efforts to promote increases in overall physical activity in an attempt to modify the patterns of dietary intake. Key pointsConcurrent aerobic and weight training can significantly reduce the amount of total kilocalories, carbohydrates, proteins and fats consumed.Aerobic training can significantly reduce fat intake.Weight training resulted in no changes in dietary intake.Concurrent aerobic and weight training is the most effective mode of exercise at promoting a favourable improvement in self-reported dietary intake.

Discrepancy between training, competition and laboratory measures of maximum heart rate in NCAA division 2 distance runners.

A percentage of either measured or predicted maximum heart rate is commonly used to prescribe and measure exercise intensity. However, maximum heart rate in athletes may be greater during competition or training than during laboratory exercise testing. Thus, the aim of the present investigation was to determine if endurance-trained runners train and compete at or above laboratory measures of 'maximum' heart rate. Maximum heart rates were measured utilising a treadmill graded exercise test (GXT) in a laboratory setting using 10 female and 10 male National Collegiate Athletic Association (NCAA) division 2 cross-country and distance event track athletes. Maximum training and competition heart rates were measured during a high-intensity interval training day (TR HR) and during competition (COMP HR) at an NCAA meet. TR HR (207 ± 5.0 b·min(-1); means ± SEM) and COMP HR (206 ± 4 b·min(-1)) were significantly (p < 0.05) higher than maximum heart rates obtained during the GXT (194 ± 2 b·min(-1)). The heart rate at the ventilatory threshold measured in the laboratory occurred at 83.3 ± 2.5% of the heart rate at VO2 max with no differences between the men and women. However, the heart rate at the ventilatory threshold measured in the laboratory was only 77% of the maximal COMP HR or TR HR. In order to optimize training-induced adaptation, training intensity for NCAA division 2 distance event runners should not be based on laboratory assessment of maximum heart rate, but instead on maximum heart rate obtained either during training or during competition. Key pointsA percentage of maximum heart rate is commonly used to prescribe and measure exercise intensity. However, maximum heart rate may be greater during competition or training than during laboratory exercise testing.Heart rates during training and competition were significantly higher than maximum heart rates obtained during laboratory exercise testing.To optimize training-induced adaptation, training intensity for NCAA division 2 distance event runners should not be based on laboratory assessment of maximum heart rate, but instead on maximum heart rate measure obtained either during training or during competition.