Relative leg press strength relates to activity energy expenditure in older women: Implications for exercise prescription.

Limited work has evaluated how leg press strength (LPS), relative to body mass (i.e., rLPS), affects heart rate (HR) responses during activities of daily living. Such information would prove useful by informing a specific level of rLPS needed to promote independent mobility and physical activity. Secondary analyses were performed on baseline measures of 76 untrained older (65 ± 4 y) women. After familiarization, one-repetition maximum leg press was converted to rLPS by dividing the external load lifted (kg) by body mass (BM). Participants were stratified according to percentile of age-group norms of rLPS: ≤50 % (low, ≤0.99 kg/BM, n = 15), 51-89 % (middle, 1.0-1.31 kg/BM, n = 31), and ≥90 % (high, ≥1.32 kg/BM, n = 30). HR was measured at rest and during laboratory-based tasks including fixed-speed (0.89 m·s-1) non-graded treadmill walking, graded (2.5 %) treadmill walking, and stair stepping. Maximal oxygen uptake (V̇O2max) was measured via indirect calorimetry. Doubly labeled water was used to quantify activity energy expenditure (AEE) over a 14-d period. Relative LPS per group were: 0.85 ± 0.12 (low), 1.16 ± 0.09 (middle), and 1.55 ± 0.25 (high) (p < 0.001). Significant between-group differences in HR emerged during both walking tasks and stair stepping - with the high rLPS group having the lowest HR. AEE between-group comparisons did not yield statistical significance (p = 0.084), however, rLPS correlated with AEE (r = 0.234, p = 0.042) and V̇O2max (r = 0.430, p < 0.001). Such findings suggest a higher rLPS attenuates HR for weight-bearing activities while also demonstrating a significant, albeit modest, positive link to AEE among older women. This information may be especially relevant for informing thresholds of rLPS linked to mobility and functional independence in older women.

A Novel Approach to Assessment of Perceptual-Motor Efficiency and Training-Induced Improvement in the Performance Capabilities of Elite Athletes.

Standard clinical assessments of mild traumatic brain injury are inadequate to detect subtle abnormalities that can be revealed by sophisticated diagnostic technology. An association has been observed between sport-related concussion (SRC) and subsequent musculoskeletal injury, but the underlying neurophysiological mechanism is not currently understood. A cohort of 16 elite athletes (10 male, 6 female), which included nine individuals who reported a history of SRC (5 male, 4 female) that occurred between 4 months and 8 years earlier, volunteered to participate in a 12-session program for assessment and training of perceptual-motor efficiency. Performance metrics derived from single- and dual-task whole-body lateral and diagonal reactive movements to virtual reality targets in left and right directions were analyzed separately and combined in various ways to create composite representations of global function. Intra-individual variability across performance domains demonstrated very good SRC history classification accuracy for the earliest 3-session phase of the program (Reaction Time Dispersion AUC = 0.841; Deceleration Dispersion AUC = 0.810; Reaction Time Discrepancy AUC = 0.825, Deceleration Discrepancy AUC = 0.794). Good earliest phase discrimination was also found for Composite Asymmetry between left and right movement directions (AUC = 0.778) and Excursion Average distance beyond the minimal body displacement necessary for virtual target deactivation (AUC = 0.730). Sensitivity derived from Youden's Index for the 6 global factors ranged from 67 to 89% and an identical specificity value of 86% for all of them. Median values demonstrated substantial improvement from the first 3-session phase to the last 3-session phase for Composite Asymmetry and Excursion Average. The results suggest that a Composite Asymmetry value ≥ 0.15 and an Excursion Average value ≥ 7 m, provide reasonable qualitative approximations for clinical identification of suboptimal perceptual-motor performance. Despite acknowledged study limitations, the findings support a hypothesized relationship between whole-body reactive agility performance and functional connectivity among brain networks subserving sensory perception, cognitive decision-making, and motor execution. A complex systems approach appears to perform better than traditional data analysis methods for detection of subtle perceptual-motor impairment, which has the potential to advance both clinical management of SRC and training for performance enhancement.

Exercise load monitoring: integrated approaches to advance the individualisation of exercise oncology.

Whether slowing disease progression or combatting the ills of advancing age, the extensive utility of exercise training has contributed to the outright declaration by the American College of Sports Medicine that 'exercise is medicine'. Consistent with general framework of adaptation, the advantages of exercise training are indiscriminate-benefitting even the most susceptible clinical populations. Still, the benefit of exercise training presupposes healthy adaptation wherein progressive overload matches sufficient recovery. Indeed, a difference exists between healthy adaptation and non-functional over-reaching (ie, when internal/external load exceeds recovery capacity)-a difference that may be blurred by cancer treatment and/or comorbidity. Recent advances in smartwatches make them ideally suited to non-invasively monitor the physiological stresses to exercise training. Resolving whether individuals are successfully adapting to exercise training via load monitoring bears clinical and practical relevance. While behaviour-change research aims to identify positive constructs of exercise adherence, further attention is needed to uncover how to optimise exercise prescription among cancer populations. Herein, we briefly discuss the constituents of exercise load monitoring, present examples of internal and external load and consider how such practices can be applied to cancer populations.

Resumption of Sport at the United States Olympic and Paralympic Training Facilities During the COVID-19 Pandemic.

In this brief report, we describe the safety of reopening US Olympic and Paralympic Training facilities (USOPTFs) during the coronavirus disease 2019 (COVID-19) pandemic from July 2020 through October 2020. We evaluated the prevalence of COVID-19 infection at the time of reentry and cardiopulmonary sequelae of COVID-19 in elite athletes. All athletes returning to a USOPTF were required to go through a reentry protocol consisting of an electronic health history, a 6-day quarantine including twice-daily symptom surveys, COVID-19 polymerase chain reaction and antibody testing, physical examination, 12-lead electrocardiogram, high-sensitivity cardiac troponin I, and pulmonary function testing. Athletes with current or prior COVID-19 infection also underwent an echocardiogram, cardiology consultation, and additional testing as indicated. All athletes followed rigorous infection prevention measures and minimized contact with the outside community following reentry. At the time of this report, 301 athletes completed the reentry protocol among which 14 (4.7%) tested positive for active (positive polymerase chain reaction test, n = 3) or prior (positive antibody test, n = 11) COVID-19 infection. During the study period, this cohort accrued 14,916 days living and training at USOPTFs. Only one (0.3%) athlete was subsequently diagnosed with a new COVID-19 infection. No cardiopulmonary pathology attributable to COVID-19 was detected. Our findings suggest that residential elite athlete training facilities can successfully resume activity during the COVID-19 pandemic when strict reentry and infection prevention measures are followed. Dissemination of our reentry quarantine and screening protocols with COVID-19 mitigation measures may assist the global sports and medical community develop best practices for reopening of similar training centers.

Upper-Extremity Perceptual-Motor Training Improves Whole-Body Reactive Agility Among Elite Athletes With History of Sport-Related Concussion.

CONTEXT: Sport-related concussion (SRC) elevates risk for subsequent injury, which may relate to impaired perceptual-motor processes that are potentially modifiable. OBJECTIVE: To assess a possible upper-extremity (UE) training effect on whole-body (WB) reactive agility performance among elite athletes with history of SRC (HxSRC) and without such history of SRC. DESIGN: Cohort study. SETTING: Residential training center. PARTICIPANTS: Elite athletes (12 males and 8 females), including 10 HxSRC and 10 without such history of SRC. INTERVENTION: One-minute training sessions completed 2 to 3 times per week over a 3-week period involved verbal identification of center arrow direction for 10 incongruent and 10 congruent flanker test trials with simultaneous reaching responses to deactivate illuminated buttons. MAIN OUTCOME MEASURES: Pretraining and posttraining assessments of UE and WB reactive responses included flanker test conflict effect (incongruent minus congruent reaction time) and WB lateral average asymmetry derived from reaction time, speed, acceleration, and deceleration in opposite directions. Discrimination was assessed by receiver operating characteristic analysis, and training effect was assessed by repeated-measures analysis of variance. RESULTS: Pretraining discrimination between HxSRC and without such history of SRC was greatest for conflict effect ≥80 milliseconds and WB lateral average asymmetry ≥18%. Each athlete completed 6 training sessions, which improved UE mean reaction time from 767 to 646 milliseconds (P < .001) and reduced mean conflict effect from 96 to 53 milliseconds (P = .039). A significant group × trial interaction was evident for WB lateral average asymmetry (P = .004), which was reduced from 24.3% to 12.5% among those with HxSRC. CONCLUSIONS: Suboptimal perceptual-motor performance may represent a subtle long-term effect of concussion that is modifiable through UE training, which appears to improve WB reactive capabilities.

Protecting the world's finest athletes: periodic health evaluation practices of the top performing National Olympic Committees from the 2016 Rio or 2018 PyeongChang Olympic Games.

AIM: To describe the periodic health evaluation (PHE) practices of the top performing National Olympic Committees (NOCs). METHODS: We sent a survey to NOCs finishing in the top 8 for medal count at the 2016 Rio Olympic Games or 2018 PyeongChang Olympic Games. The survey included four sections: (1) PHE staff composition and roles, (2) beliefs regarding the PHE, (3) a ranking of risk factors for future injury and (4) details on the elements of the PHE. RESULTS: All 14 NOCs with top 8 finishes at the 2016 Rio Olympic Games or 2018 PyeongChang Olympic Games completed the survey. NOCs included a median of seven staff specialties in the PHE, with physicians and physiotherapists having the highest level of involvement. There was agreement that PHEs are effective in identifying current health conditions (13/14) and that athletes should receive individualised action plans after their PHE (14/14), but less agreement (6/14) that PHEs can predict future injury. The practices of NOCs were diverse and often specific to the athlete population being tested, but always included the patient's health history, laboratory studies, cardiovascular screening and assessments of movement capacity. The top three risk factors for future injury were thought to be previous injury, age and training experience. CONCLUSIONS: Among the top performing NOCs, the PHE is a comprehensive, multidisciplinary process aimed to identify existing conditions and provide baseline health and performance profiles in the event of future injury. Research linking PHEs to injury prevention is needed.

Expanding the screening toolbox to promote athlete health: how the US Olympic & Paralympic Committee screened for health problems in 940 elite athletes.

AIM: To assess the value of including validated screening tools for allergies, anxiety, depression, sleep apnoea and sleep quality into an electronic patient health history questionnaire. METHODS: In this descriptive study, we reviewed electronic medical records of Olympic and Paralympic athletes who completed health screenings, which included validated screens for allergies (Allergy Questionnaire for Athletes), anxiety (General Anxiety Disorder-2), depression (Patient Health Questionaire-2), sleep apnoea (Berlin Questionnaire) and sleep quality (Pittsburgh Sleep Quality Index), using established criteria for a positive screen. We report the prevalence of positive tests and the associations between positive screening tools. RESULTS: A total of 683 Olympic and 257 Paralympic athletes (462 male, 478 female) completed the health history between May and September of 2019. At least one positive screen was reported by 37% of athletes training for the Olympics and 48% of athletes training for the Paralympics. More than 20% of all athletes screened positive for allergies and poor sleep quality. Athletes training for the Paralympics had a significantly higher percentage of positive screens for anxiety, depression, poor sleep quality and sleep apnoea risk. Females had significantly more positive screens for allergy and poor sleep quality. CONCLUSIONS: The addition of standardised screening tools to an electronic health history resulted in the identification of potential mental health, sleep and allergy problems in both Olympic and Paralympic athletes. Strong associations between mental health and sleep disorders suggest these problems should be considered together in health screening programmes.

The Value of the Patient History in the Periodic Health Evaluation: Patient Interviews Capture 4 Times More Injuries Than Electronic Questionnaires.

OBJECTIVE: To assess the value of the patient interview and electronic questionnaire methods of health history data collection in elite athletes. DESIGN: Cohort study. METHODS: A retrospective chart review compared health history data collected by questionnaire and by interview in a cohort of 142 athletes who participated in a periodic health evaluation at the US Olympic & Paralympic Training Center sports medicine clinic. The main outcome measure was number of injuries reported by either interview or written questionnaire. RESULTS: Six hundred twenty-six injuries were reported by interview and 157 by questionnaire. The mean ± SD number of injuries reported per participant was 4.4 ± 4.2 by interview and 1.1 ± 1.3 by questionnaire (difference, 3.3; P<.001). Capture rate by method was similar across sexes and for both Olympic and Paralympic athletes. More injuries were reported by interview than by questionnaire for all injury categories, except for concussions and surgeries. CONCLUSION: Patient interviews capture 4 times as many past or current injuries than electronic questionnaires in athletes training for the Olympic and Paralympic Games. Questionnaires provide incomplete health history information in this patient population. J Orthop Sports Phys Ther 2021;51(1):46-51. Epub 11 Dec 2020. doi:10.2519/jospt.2021.9821.

Concussion History and Neuromechanical Responsiveness Asymmetry.

CONTEXT: Detection of subtle changes in brain sensorimotor processes may enable clinicians to identify athletes who would derive the greatest benefit from interventions designed to reduce the risk for future injury and progressive neurologic or musculoskeletal dysfunction. OBJECTIVE: To develop a generalizable statistical model for identifying athletes who possess subtle alterations in sensorimotor processes that may be due to previous concussion. DESIGN: Cross-sectional study. SETTING: Residential Olympic Training Center sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS: A primary cohort of 35 elite athletes and a secondary cohort of 40 elite athletes who performed identical tests the preceding year. INTERVENTION(S): Two upper extremity tests of visual-motor reaction time and 2 tests of whole-body reactive agility were administered. The whole-body tests required lateral or diagonal responses to virtual-reality targets, which provided measures of reaction time, speed, acceleration, and deceleration. MAIN OUTCOME MEASURE(S): Sport-related concussion history, which was reported by 54% (n = 19) of the athletes in the primary cohort and 45% (n = 18) of the athletes in the secondary cohort. RESULTS: Univariable analyses identified 12 strong predictors of sport-related concussion history, which we combined to create a composite metric with maximum predictive value. Composite lateral asymmetry for whole-body reactive movements and persisting effects of previous musculoskeletal injury yielded a logistic regression model with exceptionally good discrimination (area under the curve = 0.845) and calibration (predicted-observed probabilities within 7 subgroups: r = 0.959, P = .001). Application of the derived model to compatible data acquired from another cohort of elite athletes demonstrated very good discrimination (area under the curve = 0.772) and calibration (within 8 subgroups: r = 0.849, P = .008). CONCLUSIONS: Asymmetry in whole-body reactive movement capabilities may be a manifestation of a subtle abnormality in the functional connectivity of brain networks that might be relevant to previously reported associations between sport-related concussion history and musculoskeletal injury occurrence.

How New Technology Is Improving Physical Therapy.

PURPOSE OF REVIEW: As rehabilitation patient volume across the age spectrum increases and reimbursement rates decrease, clinicians are forced to produce favorable outcomes with limited resources and time. The purpose of this review is to highlight new technologies being utilized to improve standardization and outcomes for patients rehabilitating orthopedic injuries ranging from sports medicine to trauma to joint arthroplasty. RECENT FINDINGS: A proliferation of new technologies in rehabilitation has recently occurred with the hope of improved outcomes, better patient compliance and safety, and return to athletic performance. These include technologies applied directly to the patient such as exoskeletons and instrumented insoles to extrinsic applications such as biofeedback and personalized reference charts. Well-structured randomized trials are ongoing centered around the efficacy and safety of these new technologies to help guide clinical necessity and appropriate application. We present a range of new technologies that may assist a diverse population of orthopedic conditions. Many of these interventions are already supported by level 1 evidence and appear safe and feasible for most clinical settings.

Improved reporting of overuse injuries and health problems in sport: an update of the Oslo Sport Trauma Research Center questionnaires.

In 2013, the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) was developed to record the magnitude, symptoms and consequences of overuse injuries in sport. Shortly afterwards, a modified version of the OSTRC-O was developed to capture all types of injuries and illnesses-The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H). Since then, users from a range of research and clinical environments have identified areas in which these questionnaires may be improved. Therefore, the structure and content of the questionnaires was reviewed by an international panel consisting of the original developers, other user groups and experts in sports epidemiology and applied statistical methodology. Following a review panel meeting in October 2017, several changes were made to the questionnaires, including minor wording alterations, changes to the content of one question and the addition of questionnaire logic. In this paper, we present the updated versions of the questionnaires (OSTRC-O2 and OSTRC-H2), assess the likely impact of the updates on future data collection and discuss practical issues related to application of the questionnaires. We believe this update will improve respondent adherence and improve the quality of collected data.

Serum ferritin distribution in elite athletes.

OBJECTIVES: It is not uncommon for athletes to be diagnosed with iron deficiency, yet there remains uncertainty whether the prevalence of suboptimal iron status in elite athletes differs from the normal population or warrants routine screening. The purpose of this study is to describe the distribution of serum ferritin (SF) in a cohort of elite athletes. DESIGN: Retrospective cohort study. METHODS: Electronic health records of 1085 elite adult athletes (570 women, 515 men) from 2012-2017 were examined retrospectively. SF values were compared to published normal population data. The proportion of athletes meeting criterion values for iron deficiency or initiation of treatment was examined. RESULTS: SF distributions in male athletes were significantly lower than normal males aged 20 to <24yrs. (χ2 28.8, p<0.001) and aged 24 to <28yrs. (χ2 91.9, p<0.001). SF status was similar in female athletes and normal women aged 20 to <24yrs. (χ2 9.5, p>0.05) or aged 24 to <28yrs. (χ2 11.5, p>0.05). Using 35ng/ml as the criterion value for stage one iron deficiency, 15% of male athletes and 52% of female athletes displayed suboptimal iron status. CONCLUSIONS: Male athletes have a significantly lower population distribution of SF values as compared to normative data on healthy males, with 15% of male athletes having suboptimal SF status. The distribution of SF values in elite female athletes did not differ from population values, however approximately half women athletes were iron deficient. These data suggest that iron screening should be considered in both male and female athlete populations.

Close encounters of the US kind: illness and injury among US athletes at the PyeongChang 2018 Winter Olympic Games.

AIM: To describe injury and illness incidence during the 2018 Winter Olympic Games (WOG) by Team USA. METHODS: A descriptive observational study. We used registered Team USA Olympic athletes' electronic medical records to review preparticipation health histories and medical encounters immediately prior to and throughout the 2018 WOG. Medical encounters were defined as all medical services provided by a healthcare provider, including evaluation, treatment and prophylactic services. All medical conditions were described according to International Olympic Committee injury and illness reporting criteria. RESULTS: Team USA included 134 men and 108 women, aged 18-39 years, who represented 17 sport federations. The 47 Team USA medical staff documented 1744 medical encounters on 242 registered athletes (7.2 medical encounters per athlete). Forty-seven illnesses (194.2/1000 athletes) and 32 time loss injuries (132.2/1000 athletes) were recorded during the Games. CONCLUSIONS: An injury surveillance programme consisting of an electronic preparticipation health history and surveillance of medical encounters during the WOG was used to describe the health status of Team USA. We noted limitations to the surveillance process that can be addressed at future events.

Survey of Income Comparison: General Practice and Sports Certified Doctors of Chiropractic.

OBJECTIVE: The purpose of this study was to determine whether there are differences in reported gross billings and collections between doctors of chiropractic who have obtained a certificate of additional qualification (CAQ) in sports medicine compared with those without a CAQ in sports medicine. METHODS: A cross-sectional study was conducted. An e-mail invitation to participate in an anonymous survey was sent to doctors of chiropractic who hold active certifications with the American Chiropractic Board of Sports Physicians. The respondents were provided a link to a web-based survey that was constructed with similar questions to a national chiropractic survey issued by Chiropractic Economics (CE) for the same year (2015). RESULTS: Three hundred forty-nine sports medicine CAQ doctors of chiropractic responded (23.8% response rate) in comparison to 719 CE respondents. The CAQ respondents averaged $722 983 in gross billings (9.8% response rate) compared with $539 046 by CE respondents. Sports medicine CAQ doctors of chiropractic averaged $452 376 in gross collections (10.4% response rate) compared with $348 773 by CE respondents. CONCLUSION: An analysis of these 2 surveys illustrates that CAQ respondents report higher total annual gross billings and collections than the CE respondents. Improving study methodology may improve response rates and garner a more accurate representation of any differences between doctors of chiropractic with and without CAQs.

Detection of Persisting Concussion Effects on Neuromechanical Responsiveness.

PURPOSE: Assessment of various indices of neuromechanical responsiveness for association with concussion history. METHODS: An observational cohort study included 48 elite athletes (34 males: 23.8 ± 4.4 yr; 14 females: 25.4 ± 4.5 yr) who performed visuomotor reaction time (VMRT) tests involving rapid manual contact with illuminated target buttons that included two dual-task conditions: 1) simultaneous oral recitation of scrolling text (VMRT+ST) and 2) simultaneous verbal responses to identify the right or left direction indicated by the center arrow of the Eriksen flanker test (VMRT+FT). A whole-body reactive agility (WBRA) test requiring side-shuffle movements in response to visual targets was used to assess reaction time, speed, acceleration, and deceleration. RESULTS: Concussion occurrence at 2.0 ± 2.3 yr before testing was reported by 21 athletes. Strong univariable associations were found for VMRT+FT left minus right difference ≥15 ms (odds ratio [OR], 7.14), VMRT+ST outer two-ring to inner three-ring ratio ≥1.28 (OR, 4.58), and WBRA speed asymmetry ≥7.7% (OR, 4.67). A large VMRT+FT by VMRT+ST interaction effect was identified (OR, 25.00). Recursive partitioning identified a three-way VMRT+FT by VMRT+ST by WBRA interaction that had 100% positive predictive value for identification of athletes with concussion history, whereas negative status on all three factors had 90% negative predictive value. CONCLUSIONS: Performance on dual-task VMRT tests and the WBRA test identified neuromechanical responsiveness deficiencies among elite athletes who reported a history of concussion.

Subspine Hip Impingement: An Unusual Cause of Hip Pain in an Elite Weightlifter.

Anterior hip pain can be difficult to diagnose due to the many pathologies and overlapping pain patterns that exist in the hip region. Clinical findings of pain at the anterior inferior iliac spine with passive hip flexion, proximal quadriceps pain and weakness, and painful impingement tests of the hip may be indicative of subspine hip impingement. This report describes the diagnosis and treatment of anterior hip pain, including subspine impingement and femoroacetabular impingement in an elite weightlifter. This case also describes how with the correct diagnosis and treatment, the athlete returned to play to her previous level of sport 11 months after a complex hip injury.

Sports injury and illness epidemiology during the 2014 Youth Olympic Games: United States Olympic Team Surveillance.

BACKGROUND: To describe injury and illness incidence from the US Youth Olympic Team during the 2014 Youth Olympic Games (YOG). METHODS: Electronic health records of Team USA athletes registered for the YOG were reviewed for patient encounters during the 2014 YOG. Medical encounters were defined as all medical services provided by a healthcare provider including evaluation, treatment and prophylactic services. All medical conditions were categorised by IOC Injury and Illness reporting criteria. RESULTS: Team USA was comprised of 48 male and 46 female athletes, aged of 14-18 years, representing 20 sports. There were 346 total medical encounters among 54 of the 94 registered athletes for a rate of 3.7 medical encounters per athlete. A total of 40 injuries were recorded (14 time loss injuries, 26 non-time loss) and 20 illnesses. This equates to 43% of athletes sustaining an injury, and 21% sustaining an illness, with a frequency of 426 injuries and 213 illnesses per 1000 registered athletes. The most commonly involved body regions for time loss injuries were the knee (21%) and ankle (12%). Time loss injuries most frequently occurred in competition (71%) and the most common type of injury was a ligament sprain (43%). The most common illnesses were respiratory (35%) and dermatological conditions (30%). CONCLUSIONS: The rates of injury, illness and medical encounters per athlete were greater than in previous reports of medical service provisions at youth Olympic-level sporting events.