Neurobehavioral consequences of repetitive head impacts in Para swimming: A case report.

Para swimmers with limb deficiency are faced with the particular situation that they must use their head to finish each competition by a hit to the wall. Repetitive head impacts may impair behavioral and brain functions. We therefore investigated neurobehavioral functions of a Para swimmer with dysmelia before and after repetitive head impacts (T1) and without (T2). Average head impact at T1 constituted 13.6 g with a mean impact force of 6689.9 N. Behavioral and brain functions decreased from pre to post at T1 but not at T2. Para swimmers with limb deficiency are therefore affected from the same consequences onto brain health that are observed after repeated sport-related concussions.

A novel method to guide classification of para swimmers with limb deficiency.

The International Paralympic Committee has directed International Federations that govern Para sports to develop evidence-based classification systems. This study defined the impact of limb deficiency impairment on 100 m freestyle performance to guide an evidence-based classification system in Para Swimming, which will be implemented following the 2020 Tokyo Paralympic games. Impairment data and competitive race performances of 90 international swimmers with limb deficiency were collected. Ensemble partial least squares regression established the relationship between relative limb length measures and competitive 100 m freestyle performance. The model explained 80% of the variance in 100 m freestyle performance and found hand length and forearm length to be the most important predictors of performance. Based on the results of this model, Para swimmers were clustered into four-, five-, six-, and seven-class structures using nonparametric kernel density estimations. The validity of these classification structures, and effectiveness against the current classification system, were examined by establishing within-class variations in 100 m freestyle performance and differences between adjacent classes. The derived classification structures were found to be more effective than current classification based on these criteria. This study provides a novel method that can be used to improve the objectivity and transparency of decision-making in Para sport classification. Expert consensus from experienced coaches, Para swimmers, classifiers, and sport science and medicine personnel will benefit the translation of these findings into a revised classification system that is accepted by the Para swimming community.

High incidence of injury at the Sochi 2014 Winter Paralympic Games: a prospective cohort study of 6564 athlete days.

OBJECTIVE: To describe the epidemiology of injuries at the Sochi 2014 Winter Paralympic Games. METHODS: A total of 547 athletes from 45 countries were monitored daily for 12 days during the Sochi 2014 Winter Paralympic Games (6564 athlete days). Daily injury data were obtained from teams with their own medical support (32 teams, 510 athletes) and teams without their own medical support (13 teams, 37 athletes) through electronic data capturing systems. RESULTS: There were 174 total injuries reported, with an injury incidence rate (IR) of 26.5 per 1000 athlete days (95% CI 22.7% to 30.8%). There was a significantly higher IR recorded in alpine skiing/snowboarding (IR of 41.1 (95% CI 33.7% to 49.6%) p=0.0001) compared to cross-country skiing/biathlon, ice sledge hockey or wheelchair curling. Injuries in the shoulder region were the highest single-joint IR (IR of 6.4 (95% CI 4.6% to 8.6%)), although total upper and lower body IR were similar (IR 8.5 vs 8.4 (95% CI 6.4% to 11.1%)). Furthermore, the IR of acute injuries was significantly higher than other types of injury onset (IR of 17.8 (95% CI 14.7% to 21.4%)). CONCLUSIONS: In a Winter Paralympic Games setting, athletes report higher injury incidence than do Olympic athletes or athletes in a Summer Paralympic Games setting. The highest incidence of injury was reported in the alpine skiing/snowboarding sporting category. There was a similar incidence of injury in the upper and lower limbs. The joint with the greatest rate of injury reported was the shoulder joint. Our data can inform injury prevention programmes and policy considerations regarding athlete safety in future Winter Paralympic Games.

The incidence and patterns of illness at the Sochi 2014 Winter Paralympic Games: a prospective cohort study of 6564 athlete days.

OBJECTIVE: To describe the epidemiology of illness at the Sochi 2014 Winter Paralympic Games. METHODS: A total of 547 athletes from 45 countries were monitored daily for 12 days over the Sochi 2014 Winter Paralympic Games (6564 athlete days). Illness data were obtained daily from teams without their own medical support (13 teams, 37 athletes) and teams with their own medical support (32 teams, 510 athletes) through electronic data capturing systems. RESULTS: The total number of illnesses reported was 123, with an illness incidence rate (IR) of 18.7 per 1000 athlete days (95% CI 15.1% to 23.2%). The highest IR was reported for wheelchair curling (IR of 20.0 (95% CI 10.1% to 39.6%)). Illnesses in the respiratory system (IR of 5.6 (95% CI 3.8% to 8.0%)), eye and adnexa (IR of 2.7 (95% CI 1.7% to 4.4%)) and digestive system (IR of 2.4 (95% CI 1.4% to 4.2%)) were the most common. Older athletes (35-63 years) had a significantly higher IR than younger athletes (14-25 years, p=0.049). CONCLUSIONS: The results of this study indicate that Paralympic athletes report higher illness incidence rates compared to Olympic athletes at similar competitions. The highest rates of illness were reported for the respiratory and digestive systems, eye and adnexa, respectively. Thus, the results of this study form a basis for the identification of physiological systems at higher risk of illness, which can in turn inform illness prevention and management programmes with eventual policy change to promote athlete safety in future editions of the Winter Paralympic Games.

The epidemiology of injuries in powerlifting at the London 2012 Paralympic Games: An analysis of 1411 athlete-days.

Sport injury epidemiology has received increased recognition as a field of sport medicine research that can improve the health and safety of athletes. Injuries among Paralympic powerlifters have not previously been systematically studied. The purpose of this prospective cohort study was to characterize injuries among Paralympic powerlifters. Athletes competing in the sport of powerlifting were followed over the 7-day competition period of the 2012 London Paralympic Games. The main outcome measurements were injury incidence rate (IR; number of injuries per 1000 athlete-days) and injury incidence proportion (IP; injuries per 100 athletes). A total of 38 injuries among 163 powerlifters were documented. The overall IR was 33.3 injuries/1000 athlete-days (95% CI 24.0-42.6) and the overall IP was 23.3 injuries per 100 athletes (95% CI 16.8-29.8). The majority of injuries were chronic overuse injuries (61%). The most commonly injured anatomical region was the shoulder/clavicle (32% of all injuries), followed by the chest (13%) and elbow (13%). The information obtained in this study opens the door for future study into the mechanisms and details of injuries into powerlifters with physical impairments.

Physical fitness profile of elite athletes with intellectual disability.

UNLABELLED: The aim of this study was to investigate the physical fitness profile of high-performance athletes with intellectual disability (ID) in comparison with able-bodied individuals. METHODS: Participants were 231 male and 82 female athletes. All evaluations were done using the EUROFIT physical fitness test. RESULTS: In comparison with population data, both male and female athletes with ID score better for flexibility and upper body muscle endurance, but have similar or lower values for running speed, speed of limb movement, and strength measures. Compared with age-matched physical education students, male athletes with ID score better for running speed and flexibility, and worse for strength. Female athletes with ID score not different from able-bodied individuals for flexibility, running speed, and upper body muscle endurance, but worse for strength measures. Athletes with ID also have poorer cardio respiratory endurance capacity compared with sportive peers without ID. Furthermore, male athletes have a more differentiated profile depending upon their sports discipline, compared with female athletes. CONCLUSION: It can be concluded that high-performance athletes with ID reach physical fitness levels that are equal to or lower than those of able-bodied sportive counterparts. Further research should investigate the importance of reduced muscle strength to be the limiting factor.

Assessing the additional impact of fitness training in depressed psychiatric patients receiving multifaceted treatment: a replicated single-subject design.

PURPOSE: Exercise has been put forward as a therapeutic means for the treatment of clinical depression. METHODS: In this study, 29 patients, all with diagnosed with mood disorder, completed daily measurements of depression and physical well-being during periods ranging from 77 to 436 days (M = 146.5). Fitness training was added to the treatment after a period and changes before (A-phase) and after (B-phase) the implementation of this training were the subject of investigation. Data were analysed by means of randomization tests with an AB-design and time-series analysis. Replication of the findings was investigated using Fisher's multiplicative method. RESULTS: Adding fitness training to the treatment of clinical depression does not systematically lead to changes in self-reported feelings of depression on top of benefits that may be due to other treatments. CONCLUSIONS: Since the present findings are not in agreement with previous studies, the absence of statistically significant changes in self-reported feelings of depression is discussed within the complexity of the 'exercise - depression' relationship in inpatient populations. These included the severity of their depression, the potential ceiling effect of a multifaceted treatment programme and the initial increase in depression due to the confrontational nature of the intervention.

Evaluation of cardio-respiratory fitness and perceived exertion for patients with depressive and anxiety disorders: a study on reliability.

PURPOSE: The implementation of a physical reconditioning programme for patients with depressive and/or anxiety disorders requires a thorough evaluation of the physical fitness and the perceived exertion during exercise. This implies the use of reliable and clinically useful instruments. The present study examined the reliability of the Franz ergocycle test, as measure for cardio-respiratory fitness, and the Borg Category Ratio 10 Scale, as measure for subject-perceived exertion. METHOD: Sixty-eight hospitalized patients performed test and re-test of the Franz ergocycle test and the Borg CR 10 Scale with a between interval of 1 week. RESULTS: The Physical Work Capacity 130 and the Physical Work Capacity 150, determined by the Franz ergocycle test, had a proper to good test-re-test reliability (r ranged from 0.74 to 0.90). The Borg Category Ratio 10 Scale had a moderate reliability (r ranged from 0.42 to 0.82). CONCLUSIONS: The Franz ergocycle test seems to be a reasonable reliable instrument for measuring physical work capacity of these patients. Possible explanations for the simply moderate reliability of the Borg Category Ratio 10 Scale could be the low level of physical activity prior to hospitalization, and the depressive and anxiety symptoms that might influence the perceived exertion.

The effectiveness of two psychomotor therapy programmes on physical fitness and physical self-concept in nonpsychotic psychiatric patients: a randomized controlled trial.

OBJECTIVE: To compare the changes in cardiorespiratory and muscular fitness, and the changes in physical self-concept after participation in one of two psychomotor therapy programmes in a sample group of psychiatric patients. To study the relationship between the changes in physical fitness and the changes in physical self-concept. DESIGN: Randomized controlled parallel-group trial with repeated measures. SETTING: Three treatment units of a university psychiatric hospital in Belgium. SUBJECTS: One hundred and ninety-nine patients with severe symptoms of depression and/or anxiety, and/or personality disorders. INTERVENTIONS: A general programme of psychomotor therapy, consisting of different forms of physical exercises and relaxation training, and a personalized psychomotor fitness programme, consisting of aerobic and resistance training. These programmes were followed three times a week for a period of 16 weeks. OUTCOME MEASURES: The maximum dynamic strength, the strength endurance, physical work capacity at 60% and 80% of the estimated maximal heart rate reserve, and the physical self-concept by means of the Dutch version of the Physical Self-Perception Profile. RESULTS: After eight weeks, both groups exhibited an improvement in muscular fitness (both p-values < 0.0001), but only the psychomotor fitness group had improved in cardiorespiratory fitness (p < 0.01). After 16 weeks, the patients in the general programme of psychomotor therapy had not increased in cardiorespiratory fitness. At the end of the 16-week programmes, both groups showed a more positive physical self-concept (p from 0.01 to < 0.0001). However, these improvements were not related to the progress in physical fitness. CONCLUSIONS: The main difference in the effectiveness of the two programmes was the increase in cardiorespiratory fitness in the psychomotor fitness group. The gains in fitness did not play an essential role in the enhancement of physical self-concept.

Changes in psychological well-being in female patients with clinically diagnosed depression: an exploratory approach in a therapeutic setting.

The objective of this exploratory one-group pretest-posttest study was to evaluate the nature of psychological change in inward depressed psychiatric patients attending multi-disciplinary treatment, including physical activity, designed to improve mental well-being. Female depressed psychiatric patients (n = 51) were examined before and after this programme over a period of 3 months. The following psychological parameters were assessed: depression, anxiety, global self-esteem, and physical self-perceptions. Depressed patients demonstrated statistically significant improvements in depression, anxiety, global self-esteem and physical self-worth (t(50) ranging from -3.76 to 4.65, all p < 0.007; ES ranging from 0.53 to -0.65). Changes in depression and anxiety displayed a strong negative correlation with changes in global self-esteem, and those changes are independent of the initial severity of the depressive symptoms ( F(2,48) ranging from 0.03 to 0.70, n.s.). Patients with greater improvement in physical self-perceptions reported greater improvement anxious symptoms then patients who did not improve. Consequently, within the limitations of the research design it can be concluded that the programme appeared successful in improving psychological well-being in female depressed patients. Results also provide preliminary insight into the potential role of the physical self in recovery.

Improvements in physical fitness of non-psychotic psychiatric patients following psychomotor therapy programs.

AIM: To investigate the changes in physical fitness after participation in 1 of 2 psychomotor therapy programs in a sample group of non-psychotic psychiatric patients. EXPERIMENTAL DESIGN: randomized controlled parallel group trial with follow-up measures after 8 weeks and after 16 weeks. SETTING: 3 treatment units of a university psychiatric hospital in Belgium. PATIENTS: 141 (51 males, 90 females) patients with severe depressive and/or anxious symptoms, and/or personality disorders. INTERVENTIONS: patients followed a personalized psychomotor fitness program (PF), consisting of aerobic and resistance training, or a general program of psychomotor therapy (GPMT), consisting of different forms of physical exercises and relaxation training. MEASURES: the maximum dynamic strength, the strength endurance and physical work capacity at 60% and 80% of the estimated maximal heart rate reserve. RESULTS: After 8 weeks it was observed that the PF group enhanced in all parameters of cardio-respiratory as well as muscular fitness; the GPMT group had improved in 7 out of the 9 muscular fitness measurements. At the end of the 16 weeks, both groups had shown an improvement in all of the muscular fitness parameters, but only the PF group had increased in cardio-respiratory fitness. CONCLUSION: In order to improve both muscular and cardio-respiratory fitness in these patients, a balanced personalized training program, which includes aerobic and resistance training, is necessary during a period of at least 8 weeks. The less specific GPMT, when followed for a period of 16 weeks, is sufficient for improving muscular fitness and for maintaining cardio-respiratory fitness.