Post-injury fear-avoidance and confidence in readiness to return to sport in Irish collegiate athletes.

Fear avoidance and low confidence in their ability to return to sport can impede athletes' subsequent recovery and return to sport. This study aimed to identify fear avoidance and confidence in readiness to return to sport following injury in Irish collegiate athletes. Male (416) and female (256) athletes from 24 field-sport teams at one university were prospectively followed for one season. The Athlete Fear Avoidance Questionnaire (AFAQ) and pain on the Visual Analogue Scale was completed following a time-loss injury. Prior to return to sport, participants completed the AFAQ and the Injury Psychological Readiness to Return to Sport (I-PRRS). We recorded 179 injuries. Fear avoidance was evident post-injury (21.8 ± 6.7), and the mean total I-PRRS score was 48.4 ± 8.9. Those with severe injuries presented with higher fear avoidance and lower confidence. Higher pain was associated with greater fear avoidance following injury (r = 0.32, p < 0.0001), prior to return to sport (r = 0.38, p < 0.0001), and with lower confidence (r = -0.27, p < 0.0001).   Low confidence and fear avoidance was identified, particularly in those with a severe injury or high pain levels. Identifying, and providing psychosocial support to athletes experiencing, these issues is recommended.

Can Directed Compliant Running Reduce the Magnitude of Variables Associated With the Development of Running Injuries?

ABSTRACT: Ó Catháin, CP, Richter, C, and Moran, K. Can directed compliant running reduce the magnitude of variables associated with the development of running injuries? J Strength Cond Res 36(3): 772-780, 2022-Running is one of the most popular modes of activity worldwide and provides numerous health benefits. However, impact forces associated with the foot contacting the ground have been implicated in the development of running related injuries. As such, previous studies have used various methods to alter running to reduce the magnitude of these impact forces. However, it is unclear what kinematic changes facilitate this reduced loading or how loading further up the body changes. In this study, verbal direction was used to teach subjects to run with a more compliant running technique. Kinetic and kinematics characteristics of each subjects "normal" running technique and new "compliant technique" were measured in a fatigued and unfatigued state. Energy expenditure of each running style was also measured. Verbally directed compliant running significantly decreased (17%) vertical ground reaction force impact peaks, sacral (41%) and head (28%) impact accelerations, and increased energy expenditure (21%), in comparison with normal running. Findings suggest that verbally directed compliant running may reduce the magnitude of variables associated with the development of running injuries.

Principal Component Analysis of the Biomechanical Factors Associated With Performance During Cutting.

ABSTRACT: Welch, N, Richter, C, Franklyn-Miller, A, and Moran, K. Principal component analysis of the biomechanical factors associated with performance during cutting. J Strength Cond Res 35(6): 1715-1723, 2021-The main aim of the current study was to investigate the relationship between kinematic variables in cutting and performance outcome across different angled cuts through the use of principal component analysis and permutation testing. Twenty-five male intercounty Gaelic football players (23.5 ± 4.2 years, 183 ± 6 cm, and 83 ± 6.9 kg) participated in the study. Three-dimensional motion capture was used to perform a biomechanical analysis of 110 and 45° cutting tasks. Principal component analysis and permutation testing revealed one principal component within the 45° cut (r = 0.26) and 2 principal components within the 110° (r = 0.66 and 0.27) cut that consistently correlated with performance outcome. Within the 45° cut, the identified principal component was interpreted as relating to performance cues of maintaining a low center of mass during the concentric phase, using a shorter ground contact time, resisting a reduction in lateral center of mass to ankle and knee distance in the eccentric phase, and using faster and larger extensions of the hip and knee. Within the 110° cut, the first identified principal component was interpreted as relating to performance cues of maintaining a low center of mass during the concentric phase, using a shorter ground contact time, resisting a reduction in lateral center of mass to ankle and knee distance in the eccentric phase, and resisting hip flexion then using hip extension. The second principal component was interpreted as relating to a performance cue of leaning in the direction of the cut.

Principal Component Analysis of the Associations Between Kinetic Variables in Cutting and Jumping, and Cutting Performance Outcome.

ABSTRACT: Welch, N, Richter, C, Moran, K, and Franklyn-Miller, A. Principal component analysis of the associations between kinetic variables in cutting and jumping, and cutting performance outcome. J Strength Cond Res 35(7): 1848-1855, 2021-The primary aim of this study was to determine which features within the ground reaction force (GRF) trace during cutting are related to performance outcome in different angled cuts. The secondary aim was to understand the relationship between GRF features in a series of maximum strength, explosive strength, and reactive strength tests, and cutting performance outcome. Twenty-five male intercounty Gaelic football players (23.5 ± 4.2 years, 183 ± 6 cm, and 83 ± 6.9 kg) participated in the study. Subjects completed 110 and 45° cutting tasks, single leg squat jumps, drop landings, drop jumps, and isometric midthigh pulls. A principal component (PC) analysis and simulation approach were applied to the data and correlations between PCs and cutting performance outcome measured. Lower vertical to horizontal impulse ratios (r = -0.70 to -0.46) in both cuts and greater forces over the first 50 ms of ground contact (r = -0.44) in the 110° cut correlated with enhanced cutting performance outcomes. Greater reactive strength index and height in the drop jump (r = -0.51 and -0.54) and greater impulses over the first 25 ms of ground contact in the drop landing (r = 0.49 and 0.70) correlated with enhanced cutting performance outcomes. These results highlight the importance of greater horizontal and rapid force production in cutting and greater reactive strength qualities to enhance cutting performance.

The Effect of Hip Extension and Nordic Hamstring Exercise Protocols on Hamstring Strength: A Randomized Controlled Trial.

ABSTRACT: Whyte, EF, Heneghan, B, Feely, K, Moran, KA, and O'Connor, S. The effect of hip extension and Nordic hamstring exercise protocols on hamstring strength: A randomized controlled trial. J Strength Cond Res 35(10): 2682-2689, 2021-Lower and between-limb asymmetrical eccentric hamstring isokinetic strength may be associated with hamstring injuries, which mainly affect the biceps femoris. The 45° hip extension exercise (HEE) strengthens the hamstrings in the lengthened position where the biceps femoris experiences greatest loading during high-speed running. However, the effect of an HEE program on eccentric hamstring isokinetic strength has not been investigated or compared with the Nordic Hamstring Exercise (NHE) program. Twenty-four male, varsity, Gaelic footballers (22.4 ± 2.7 years; 182.1 ± 6.0 cm; 84.4 ± 7.9 kg) were randomly allocated to an HEE or NHE 4-week program. Isokinetic (60°·s-1) eccentric peak torque, functional hamstring-to-quadriceps ratio, and between-limb eccentric strength (absolute and percentage) asymmetries were recorded before and after intervention. Muscle soreness scores were reported after exercise using a visual analogue scale. A mixed between-within analysis of variance investigated group (HEE vs. NHE) by time (pre vs. post) interaction effects, and any main effects. An independent-samples t-test compared muscle soreness scores between the NHE and HEE groups. No interaction or group main effects were found. Main effects for time were observed on dominant and nondominant limbs for eccentric peak torque (p < 0.001, η2 = 0.21, p = 0.01, η2 = 0.51, respectively) and functional hamstring quadriceps ratio (p = 0.03, η2 = 0.59, p < 0.0001, η2 = 0.26, respectively). There were no main effects for time between-limb eccentric peak torque or percentage asymmetries (p = 0.41, η2 = 0.03, p = 0.20, η2 = 0.07, respectively), or differences in muscle soreness scores (p > 0.05). A 4-week HEE program increases eccentric hamstring isokinetic strength similar to a NHE program, which may be useful as part of a hamstring injury prevention program.

Feasibility, Acceptability, and Clinical Effectiveness of a Technology-Enabled Cardiac Rehabilitation Platform (Physical Activity Toward Health-I): Randomized Controlled Trial.

BACKGROUND: Cardiac rehabilitation (CR) is highly effective as secondary prevention for cardiovascular diseases (CVDs). Uptake of CR remains suboptimal (30% of eligible patients), and long-term adherence to a physically active lifestyle is even lower. Innovative strategies are needed to counteract this phenomenon. OBJECTIVE: The Physical Activity Toward Health (PATHway) system was developed to provide a comprehensive, remotely monitored, home-based CR program for CVD patients. The PATHway-I study aimed to investigate its feasibility and clinical efficacy during phase III CR. METHODS: Participants were randomized on a 1:1 basis to the PATHway (PW) intervention group or usual care (UC) control group in a single-blind, multicenter, randomized controlled pilot trial. Outcomes were assessed at completion of phase II CR and 6-month follow-up. The primary outcome was physical activity (PA; Actigraph GT9X link). Secondary outcomes included measures of physical fitness, modifiable cardiovascular risk factors, endothelial function, intima-media thickness of the common carotid artery, and quality of life. System usability and patients' experiences were evaluated only in PW. A mixed-model analysis of variance with Bonferroni adjustment was used to analyze between-group effects over time. Missing values were handled by means of an intention-to-treat analysis. Statistical significance was set at a 2-sided alpha level of .05. Data are reported as mean (SD). RESULTS: A convenience sample of 120 CVD patients (mean 61.4 years, SD 13.5 years; 22 women) was included. The PATHway system was deployed in the homes of 60 participants. System use decreased over time and system usability was average with a score of 65.7 (SD 19.7; range 5-100). Moderate-to-vigorous intensity PA increased in PW (PW: 127 [SD 58] min to 141 [SD 69] min, UC: 146 [SD 66] min to 143 [SD 71] min; Pinteraction=.04; effect size of 0.42), while diastolic blood pressure (PW: 79 [SD 11] mmHg to 79 [SD 10] mmHg, UC: 78 [SD 9] mmHg to 83 [SD 10] mmHg; Pinteraction=.004; effect size of -0.49) and cardiovascular risk score (PW: 15.9% [SD 10.4%] to 15.5% [SD 10.5%], UC: 14.5 [SD 9.7%] to 15.7% [SD 10.9%]; Pinteraction=.004; effect size of -0.36) remained constant, but deteriorated in UC. CONCLUSIONS: This pilot study demonstrated the feasibility and acceptability of a technology-enabled, remotely monitored, home-based CR program. Although clinical effectiveness was demonstrated, several challenges were identified that could influence the adoption of PATHway. TRIAL REGISTRATION: ClinicalTrials.gov NCT02717806; https://clinicaltrials.gov/ct2/show/NCT02717806. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2017-016781.

Recognition and Repetition Counting for Local Muscular Endurance Exercises in Exercise-Based Rehabilitation: A Comparative Study Using Artificial Intelligence Models.

Exercise-based cardiac rehabilitation requires patients to perform a set of certain prescribed exercises a specific number of times. Local muscular endurance exercises are an important part of the rehabilitation program. Automatic exercise recognition and repetition counting, from wearable sensor data, is an important technology to enable patients to perform exercises independently in remote settings, e.g., their own home. In this paper, we first report on a comparison of traditional approaches to exercise recognition and repetition counting (supervised ML and peak detection) with Convolutional Neural Networks (CNNs). We investigated CNN models based on the AlexNet architecture and found that the performance was better than the traditional approaches, for exercise recognition (overall F1-score of 97.18%) and repetition counting (±1 error among 90% observed sets). To the best of our knowledge, our approach of using a single CNN method for both recognition and repetition counting is novel. Also, we make the INSIGHT-LME dataset publicly available to encourage further research.

Can a Standardized Visual Assessment of Squatting Technique and Core Stability Predict Injury?

O'Connor, S, McCaffrey, N, Whyte, EF, and Moran, KA. Can a standardized visual assessment of squatting technique and core stability predict injury? J Strength Cond Res 34(1): 26-36, 2020-This study examined whether a standardized visual assessment of squatting technique and core stability can predict injury. Male adolescent and collegiate Gaelic players (n = 627) were assessed using the alternative core/trunk stability push-up test and a developed scoring system for the overhead squat and single-leg squat (SLS) that examined both overall impression and segmental criteria. A single summative score from the overall impression scores of all 3 tests was calculated. Sustained injuries were examined over a season. Results indicated that the single summative score did not predict those that sustained a lower-extremity injury, trunk injury, or whole-body injury, and receiver operating characteristic curves were also unable to generate an optimal cutoff point for prediction. When segmental criteria were included in multivariate analyses, the tests were able to predict whole-body injury (p < 0.0001) and lower-extremity injury (p < 0.0001). However, although specificity was high (80.6%, 76.5%), sensitivity of the models was low (40.2%, 44.2%). The most common score was "good" for the overhead squat (46.4%) and SLS (47.6%), and "good" and "excellent" for the alternative core stability push-up test (33.5%, 49.1%), with "poor" core stability increasing the odds of sustaining a lower-extremity injury (odds ratio = 1.52 [0.92-2.51]). The findings suggest that although segmental scoring could be incorporated by strength and conditioning coaches and clinicians, they should be used predominantly as a preliminary screening tool to highlight players requiring a more thorough assessment.

How actual motor competence and perceived motor competence influence motor-skill engagement of a novel cycling task.

In early childhood, factors that contribute to motor-skill engagement (MSE) are unknown. Our aim was to explore the relationships between actual and perceived motor competence and their influences on MSE on a balance bike (bike with no pedals). A secondary aim was to investigate whether MSE had an effect on ability on a balance bike. This study comprised of 45 children (29% female) aged 4.5 ± 0.5 years. MSE was assessed using distance travelled on a balance bike over an 8-week period. Actual motor competence was assessed using the Movement Assessment Battery for Children, second edition. Perceived motor competence was assessed using the Pictorial Scale of Perceived Movement Skill Competence. Ability on a balance bike was measured using timed trials on a specifically designed track. Pearson product-moment correlations were used to assess relationships between actual and perceived motor competence and ability on a balance bike. Linear regressions were used to examine whether actual or perceived motor competence or ability on a balance bike predicted MSE. Repeated measures ANOVA was used to examine whether there was a difference in ability on a balance bike between three MSE groups over 8 weeks. No relationships were found, and none of the variables predicted MSE. There was a significant difference between the MSE groups on ability on a balance bike over time (P = 0.019). Investigating the contributors to MSE on a novel cycling task during early childhood provides knowledge to ensure children are given the best opportunities for practice and acquisition of skills.

Is Poor Hamstring Flexibility a Risk Factor for Hamstring Injury in Gaelic Games?

CONTEXT: Hamstring injuries are a leading cause of injury in Gaelic games. Hamstring flexibility as a risk factor for hamstring injury has not yet been examined prospectively in Gaelic games. OBJECTIVE: To examine whether hamstring flexibility, using the modified active knee extension (AKE) test, and previous injury are risk factors for hamstring injury in Gaelic players and to generate population-specific AKE cutoff points. DESIGN: Prospective cohort study. SETTING: School and colleges. Patients (or Other Participants): Adolescent and collegiate Gaelic footballers and hurlers (n = 570). INTERVENTION(S): The modified AKE test was completed at preseason, and hamstring injuries were assessed over the course of one season. Any previous hamstring injuries were noted in those who presented with a hamstring injury. MAIN OUTCOME MEASURES: Bilateral AKE scores and between-leg asymmetries were recorded. Receiver operating characteristic curves were implemented to generate cutoff points specific to Gaelic players. Univariate and backward stepwise logistic regression analyses were completed to predict hamstring injuries, hamstring injuries on the dominant leg, and hamstring injuries on the nondominant leg. RESULTS: Mean flexibility of 64.2° (12.3°) and 64.1° (12.4°) was noted on the dominant and nondominant leg, respectively. Receiver operating characteristic curves generated a cutoff point of < 65° in the AKE on the nondominant leg only. When controlled for age, AKE on the nondominant leg was the only predictor variable left in the multivariate model (odds ratio = 1.03) and significantly predicted hamstring injury (χ2 = 9.20, P = .01). However, the sensitivity was 0% and predicted the same amount of cases as the null model. It was not possible to generate a significant model for hamstring injuries on the dominant leg (P > .05), and no variables generated a P value < .20 in the univariate analysis on the nondominant leg. CONCLUSIONS: Poor flexibility noted in the AKE test during preseason screening and previous injury were unable to predict those at risk of sustaining a hamstring strain in Gaelic games with adequate sensitivity.

Electronic Health Physical Activity Behavior Change Intervention to Self-Manage Cardiovascular Disease: Qualitative Exploration of Patient and Health Professional Requirements.

BACKGROUND: Cardiovascular diseases are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation. Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based cardiac rehabilitation programs is low, with community-based cardiac rehabilitation rates and individual long-term exercise maintenance even lower. Home-based cardiac rehabilitation programs have been shown to be equally effective in clinical and health-related quality of life outcomes and yet are not readily available. OBJECTIVE: Given the potential that home-based cardiac rehabilitation programs have, it is important to explore how to appropriately design any such intervention in conjunction with key stakeholders. The aim of this study was to engage with individuals with cardiovascular disease and other professionals within the health ecosystem to (1) understand the personal, social, and physical factors that inhibit or promote their capacity to engage with physical activity and (2) explore their technology competencies, needs, and wants in relation to an eHealth intervention. METHODS: Fifty-four semistructured interviews were conducted across two countries. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Barriers to the implementation of PATHway were also explored specifically in relation to physical capability and safety as well as technology readiness and further mapped onto the COM-B model for future intervention design. RESULTS: Key recommendations included collection of patient data and use of measurements, harnessing hospital based social connections, and advice to utilize a patient-centered approach with personalization and tailoring to facilitate optimal engagement. CONCLUSIONS: In summary, a multifaceted, personalizable intervention with an inclusively designed interface was deemed desirable for use among cardiovascular disease patients both by end users and key stakeholders. In-depth understanding of core needs of the population can aid intervention development and acceptability.

Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients.

BACKGROUND: Clinical assessments and rehabilitation in athletic groin pain (AGP) have focused on specific anatomical structures and uniplanar impairments rather than whole body movement. OBJECTIVE: To examine the effectiveness of rehabilitation that targeted intersegmental control in patients with AGP and to investigate post rehabilitation changes in cutting biomechanics. METHODS: Two hundred and five patients with AGP were rehabilitated focusing on clinical assessment of intersegmental control, linear running and change of direction mechanics in this prospective case series. Hip and Groin Outcome Score (HAGOS) was the primary outcome measure. Secondary measures included pain-free return to play rates and times, pain provocation on squeeze tests and three-dimensional (3D) biomechanical analysis during a 110° cutting manoeuvre. RESULTS: Following rehabilitation, patients demonstrated clinically relevant improvements in HAGOS scores (effect size (ES): 0.6-1.7). 73% of patients returned to play pain-free at a mean of 9.9 weeks (±3.5). Squeeze test values also improved (ES: 0.49-0.68). Repeat 3D analysis of the cutting movement demonstrated reductions in ipsilateral trunk side flexion (ES: 0.79) and increased pelvic rotation in the direction of travel (ES: 0.76). Changes to variables associated with improved cutting performance: greater centre of mass translation in the direction of travel relative to centre of pressure (ES: 0.4), reduced knee flexion angle (ES: 0.3) and increased ankle plantar flexor moment (ES: 0.48) were also noted. CONCLUSIONS: Rehabilitation focused on intersegmental control was associated with improved HAGOS scores, high rates of pain-free return to sporting participation and biomechanical changes associated with improved cutting performance across a range of anatomical diagnoses seen in AGP.

The effect of high intensity exercise and anticipation on trunk and lower limb biomechanics during a crossover cutting manoeuvre.

We investigated the effects of high intensity, intermittent exercise (HIIP) and anticipation on trunk, pelvic and lower limb biomechanics during a crossover cutting manoeuvre. Twenty-eight male, varsity athletes performed crossover cutting manoeuvres in anticipated and unanticipated conditions pre- and post-HIIP. Kinematic and kinetic variables were captured using a motion analysis system. Statistical parametric mapping (repeated-measures ANOVA) was used to identify differences in biomechanical patterns. Results demonstrated that both unanticipation and fatigue (HIIP) altered the biomechanics of the crossover cutting manoeuvre, whereas no interactions effects were observed. Unanticipation resulted in less trunk and pelvic side flexion in the direction of cut (d = 0.70 - 0.79). This led to increased hip abductor and external rotator moments and increased knee extensor and valgus moments with small effects (d = 0.24-0.42), potentially increasing ACL strain. The HIIP resulted in trivial to small effects only with a decrease in internal knee rotator and extensor moment and decreased knee power absorption (d = 0.35), reducing potential ACL strain. The effect of trunk and hip control exercises in unanticipated conditions on the crossover cutting manoeuvre should be investigated with a view to refining ACL injury prevention programmes.

Investigation of the Effects of High-Intensity, Intermittent Exercise and Unanticipation on Trunk and Lower Limb Biomechanics During a Side-Cutting Maneuver Using Statistical Parametric Mapping.

Whyte, EF, Richter, C, O'Connor, S, and Moran, KA. Investigation of the effects of high-intensity, intermittent exercise and unanticipation on trunk and lower limb biomechanics during a side-cutting maneuver using statistical parametric mapping. J Strength Cond Res 32(6): 1583-1593, 2018-Anterior cruciate ligament (ACL) injuries frequently occur during side-cutting maneuvers when fatigued or reacting to the sporting environment. Trunk and hip biomechanics are proposed to influence ACL loading during these activities. However, the effects of fatigue and unanticipation on the biomechanics of the kinetic chain may be limited by traditional discrete point analysis. We recruited 28 male, varsity, Gaelic footballers (21.7 ± 2.2 years; 178.7 ± 14.6 m; 81.8 ± 11.4 kg) to perform anticipated and unanticipated side-cutting maneuvers before and after a high-intensity, intermittent exercise protocol (HIIP). Statistical parametric mapping (repeated-measures analysis of varience) identified differences in phases of trunk and stance leg biomechanics during weight acceptance. Unanticipation resulted in less trunk flexion (p < 0.001) and greater side flexion away from the direction of cut (p < 0.001). This led to smaller (internal) knee flexor and greater (internal) knee extensor (p = 0.002-0.007), hip adductor (p = 0.005), and hip external rotator (p = 0.007) moments. The HIIP resulted in increased trunk flexion (p < 0.001) and side flexion away from the direction of cut (p = 0.038), resulting in smaller (internal) knee extensor moments (p = 0.006). One interaction effect was noted demonstrating greater hip extensor moments in the unanticipated condition post-HIIP (p = 0.025). Results demonstrate that unanticipation resulted in trunk kinematics considered an ACL injury risk factor. A subsequent increase in frontal and transverse plane hip loading and sagittal plane knee loading was observed, which may increase ACL strain. Conversely, HIIP-induced trunk kinematic alterations resulted in reduced sagittal plane knee and subsequent ACL loading. Therefore, adequate hip and knee control is important during unanticipated side-cutting maneuvers.

Behavior Change Techniques in Physical Activity eHealth Interventions for People With Cardiovascular Disease: Systematic Review.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of premature death and disability in Europe, accounting for 4 million deaths per year and costing the European Union economy almost €196 billion annually. There is strong evidence to suggest that exercise-based secondary rehabilitation programs can decrease the mortality risk and improve health among patients with CVD. Theory-informed use of behavior change techniques (BCTs) is important in the design of cardiac rehabilitation programs aimed at changing cardiovascular risk factors. Electronic health (eHealth) is the use of information and communication technologies (ICTs) for health. This emerging area of health care has the ability to enhance self-management of chronic disease by making health care more accessible, affordable, and available to the public. However, evidence-based information on the use of BCTs in eHealth interventions is limited, and particularly so, for individuals living with CVD. OBJECTIVE: The aim of this systematic review was to assess the application of BCTs in eHealth interventions designed to increase physical activity (PA) in CVD populations. METHODS: A total of 7 electronic databases, including EBSCOhost (MEDLINE, PsycINFO, Academic Search Complete, SPORTDiscus with Full Text, and CINAHL Complete), Scopus, and Web of Science (Core Collection) were searched. Two authors independently reviewed references using the software package Covidence (Veritas Health Innovation). The reviewers met to resolve any discrepancies, with a third independent reviewer acting as an arbitrator when required. Following this, data were extracted from the papers that met the inclusion criteria. Bias assessment of the studies was carried out using the Cochrane Collaboration's tool for assessing the risk of bias within Covidence; this was followed by a narrative synthesis. RESULTS: Out of the 987 studies that were identified, 14 were included in the review. An additional 9 studies were added following a hand search of review paper references. The average number of BCTs used across the 23 studies was 7.2 (range 1-19). The top three most frequently used BCTs included information about health consequences (78%, 18/23), goal setting (behavior; 74%, 17/23), and joint third, self-monitoring of behavior and social support (practical) were included in 11 studies (48%, 11/23) each. CONCLUSIONS: This systematic review is the first to investigate the use of BCTs in PA eHealth interventions specifically designed for people with CVD. This research will have clear implications for health care policy and research by outlining the BCTs used in eHealth interventions for chronic illnesses, in particular CVD, thereby providing clear foundations for further research and developments in the area.

Kinetic changes during a six-week minimal footwear and gait-retraining intervention in runners.

An evaluation of a six-week Combined minimal footwear transition and gait-retraining combination vs. gait retraining only on impact characteristics and leg stiffness. Twenty-four trained male runners were randomly assigned to either (1) Minimalist footwear transition Combined with gait-retraining over a six-week period ("Combined" group; n = 12) examined in both footwear, or (2) a gait-retraining group only with no minimalist footwear exposure ("Control"; n = 12). Participants were assessed for loading rate, impact peak, vertical, knee and ankle stiffness, and foot-strike using 3D and kinetic analysis. Loading rate was significantly higher in the Combined group in minimal shoes in pre-tests compared to a Control (P ≤ 0.001), reduced significantly in the Combined group over time (P ≤ 0.001), and was not different to the Control group in post-tests (P = 0.16). The impact peak (P = 0.056) and ankle stiffness reduced in both groups (P = 0.006). Loading rate and vertical stiffness was higher in minimalist footwear than conventional running shoes both pre (P ≤ 0.001) and post (P = 0.046) the intervention. There has a higher tendency to non-rearfoot strike in both interventions, but more acute changes in the minimalist footwear. A Combined intervention can potentially reduce impact variables. However, higher loading rate initially in minimalist footwear may increase the risk of injury in this condition.

Automated detection of atrial fibrillation using R-R intervals and multivariate-based classification.

Automated detection of AF from the electrocardiogram (ECG) still remains a challenge. In this study, we investigated two multivariate-based classification techniques, Random Forests (RF) and k-nearest neighbor (k-nn), for improved automated detection of AF from the ECG. We have compiled a new database from ECG data taken from existing sources. R-R intervals were then analyzed using four previously described R-R irregularity measurements: (1) the coefficient of sample entropy (CoSEn), (2) the coefficient of variance (CV), (3) root mean square of the successive differences (RMSSD), and (4) median absolute deviation (MAD). Using outputs from all four R-R irregularity measurements, RF and k-nn models were trained. RF classification improved AF detection over CoSEn with overall specificity of 80.1% vs. 98.3% and positive predictive value of 51.8% vs. 92.1% with a reduction in sensitivity, 97.6% vs. 92.8%. k-nn also improved specificity and PPV over CoSEn; however, the sensitivity of this approach was considerably reduced (68.0%).

Cardiac patients show high interest in technology enabled cardiovascular rehabilitation.

BACKGROUND: Cardiac rehabilitation (CR) can slow or reverse the progression of cardiovascular disease (CVD). However, uptake of community-based CR is very low. E-cardiology, e-health and technology solutions for physical activity uptake and monitoring have evolved rapidly and have potential in CVD management. However, it is unclear what the current technology usage is of CVD patients, and their needs and interests for technology enabled CR. METHODS: A technology usage questionnaire was developed and completed by patients from a supervised ambulatory CR program and an adult congenital heart disease clinic and from two community-based CR programs. Results were described and related with age, gender and educational level by Spearman correlations. RESULTS: Of 310 patients, 298 patients (77 % male; mean age 61,7 ± 14,5 years) completed at least 25 questions of the survey and were included in the analysis (completion rate 96 %). Most (97 %) patients had a mobile phone and used the internet (91 %). Heart rate monitors were used by 35 % and 68 % reported to find heart rate monitoring important when exercising at home. Physical activity monitoring was reported by 12 % of the respondents. Respondents were interested in CR support through internet (77 %) and mobile phone (68 %). Many patients reported interest in game-based CR (67 %) and virtual rehabilitation (58 %). At least medium interest in technology enabled CR was reported by 75 % of the patients. Interest decreased with increasing age (r = -0.16; p = 0.005). CONCLUSIONS: CVD patients show interest for technology enabled home-based CR. Our results could guide the design of a technology-based, virtual CR intervention.

The novel use of a SenseCam and accelerometer to validate training load and training information in a self-recall training diary.

Self-recall training diaries are a frequently used tool to quantify training load and training information. While accelerometers are predominantly used to validate training diaries, they are unable to validate contextual training information. Thus this study aimed to examine the novel use of data fusion from a wearable camera device (SenseCam) and accelerometer to validate a self-recall training diary. Thirty participants filled in a training diary for 1 day while simultaneously wearing a SenseCam and accelerometer. The training diary was validated using Bland-Altman plots, Spearman's rank-order correlation, percentage agreement and κ measure of agreement between the diary and the SenseCam and accelerometer. The results demonstrated overall agreement, and no bias, between the training diary and the accelerometer for training intensity, and the SenseCam for duration of activity and travel time. A positive correlation was found for duration (r = 0.82, P < 0.001) and intensity (r = 0.67, P < 0.001). Hundred per cent agreement was found between the SenseCam and training diary for activity, training surface and footwear (κ = 1, P < 0.0001), with a lower agreement noted for sports played (97.3%, κ = 0.91, P < 0.0001). The self-recall training diary was found to be a valid measure of capturing training load and training information using the combined wearable camera device and accelerometer.

The Number of Trials Required to Obtain a Representative Movement Pattern During a Hurdle Hop Exercise.

When reporting a subject's mean movement pattern, it is important to ensure that reported values are representative of the subject's typical movement. While previous studies have used the mean of 3 trials, scientific justification of this number is lacking. One approach is to determine statistically how many trials are required to achieve a representative mean. This study compared 4 methods of calculating the number of trials required in a hopping movement to achieve a representative mean. Fifteen males completed 15 trials of a lateral hurdle hop. Range of motion at the trunk, pelvis, hip, knee, and ankle, in addition to peak moments for the latter 3 joints were examined. The number of trials required was computed using a peak intraclass correlation coefficient method, sequential analysis with a bandwidth of acceptable variance in the mean, and a novel method based on the standard error of measurement (SEMind). The number of trials required across all variables ranged from 2 to 12 depending on method, joint, and anatomical plane. The authors advocate the SEMind method as it demonstrated fewer limitations than the other methods. Using the SEMind, the required number of trials for a representative mean during the lateral hurdle hop is 6.