Evidence-Based Corrective Exercise Intervention for Forward Head Posture in Adolescents and Young Adults Without Musculoskeletal Pathology: A Critically Appraised Topic.

CLINICAL SCENARIO: Habitual overuse of cellphones is on the rise among adolescents and young adults. Those who maintain a flexed neck posture when using a cellphone for extended periods possess an elevated risk for developing forward head posture (FHP). Chronic FHP can lead to painful medical disorders affecting the head, neck, and shoulders. Both stretching and strengthening exercises are advocated interventions to address this postural abnormality; however, due to a wide range of corrective exercise programming in the literature, the decision for which exercises to prescribe for this condition can be challenging for clinicians. CLINICAL QUESTION: For adolescents and young adults without musculoskeletal pathology, what are the most frequent stretching and strengthening exercises incorporated into effective FHP intervention programs supported by current randomized control trials? SUMMARY OF KEY FINDINGS: A combined total of 5 stretches and 8 strengthening exercises were identified across 3 studies of level 1b evidence that successfully impacted FHP using a combined stretching and strengthening corrective exercise intervention. The supine chin tuck and a sternocleidomastoid stretch were utilized in all 3 studies, while scapular retraction and a pectoralis stretch were included in 2 of the 3 studies. CLINICAL BOTTOM LINE: Based on the results of this appraisal, the most frequent stretches and strengthening exercises incorporated into effective FHP intervention programs supported by current randomized control trials focused on adolescents or young adults without musculoskeletal pathology include a sternocleidomastoid stretch, pectoralis stretch, the supine chin tuck, and scapular retraction. STRENGTH OF RECOMMENDATION: There is "Good" to "Excellent" evidence from 3 level 1b randomized control trials to support the inclusion of a sternocleidomastoid stretch, pectoralis stretch, the supine chin tuck, and scapular retraction exercises into a corrective exercise program to address forward head posture.

The Effectiveness of a Physical Activity Educational Campaign in a Rural Obstetrics and Gynecology Office.

Objectives The objective of this study was to evaluate the effectiveness of an early intervention health education campaign to positively influence physical activity (PA) knowledge, intention, and performance among prenatal women and women of reproductive age. Methods This study employed a quantitative, quasi-experimental, control-group comparison design with nonprobability sampling methodology. Implemented in rural healthcare settings located in the Southeastern portion of the United States, participants included prenatal patients and patients of reproductive age (n = 325) from two separate obstetrics and gynecology (OB/GYN) offices. While the intervention group was solicited from an OB/GYN office where the information-based health education campaign was implemented, the comparison group was solicited from a comparable OB/GYN office that did not implement the health education campaign. Results The women exposed to the PA health education campaign were significantly more likely to report that PA information was provided at their physician's office, scored higher on PA knowledge, and were more likely to meet the guidelines for vigorous PA and strength training (p < 0.05). Conclusions Physical activity educational campaigns are a cost effective intervention that can be implemented in healthcare settings to promote maternal and child health.

Evaluation of the Craniovertebral Angle in Standing versus Sitting Positions in Young Adults with and without Severe Forward Head Posture.

The purpose of this study was to examine the effects of standing versus sitting body position on the craniovertebral angle (CVA) in young adults without pathology; and to investigate whether mean differences between positional CVA measures in subjects with severe forward head posture (FHP) are distinct from age-matched controls with normal head posture. Ninety-eight young adults (68 women, 30 men) without pathology (OVERALL; n = 98) volunteered for the study; those with CVA > 53° were also included in a normal posture group (NORM; n = 14); those with CVA < 45° were also included in a severe FHP group (SEV; n = 15). CVA assessments were conducted in standing and sitting. Mean difference comparison of change in mean CVA between conditions revealed significantly (p < 0.05) higher CVA values in standing condition (OVERALL: 50.0 ± 5.2°; NORM: 56.6 ± 2.7°; SEV: 41.2 ± 3.2°) compared to sitting condition (OVERALL: 47.8 ± 5.7°; NORM: 55.9 ± 2.8°; SEV: 39.0 ± 4.0°). Mean difference comparison of between-group change in mean CVA between conditions revealed greater CVA change (p < 0.05) in the SEV group (2.2 ± 2.1°) versus the NORM group (0.8 ± 1.2°). Sitting CVA values may be lower (indicating greater FHP) than standing CVA values in young adults. Differences between standing and sitting CVA measures may be greater in young adults with severe FHP compared to peers with normal head posture. Study findings support standing as a standardized body position for CVA assessment in young adults without pathology.

Strengthening First Responders' Coaching Proficiency through a Peer Fitness Leader Workshop: A Preliminary Efficacy Trial.

First responders require physical fitness to perform dangerous tasks in unpredictable environments. To promote physical fitness among first responders, many agencies use a peer fitness leader (PFL) approach; however, resources for the fitness, wellness, and health of PFLs are often minimal. This study's purpose was to investigate the effectiveness of a training workshop to increase PFL's training knowledge and coaching comfort (CC). Thirty-six PFLs (Experience: 14.6 ± 9.1 yrs; Age: 41.0 ± 9.8 yrs; BMI: 28.9 ± 7.0 kg·m-2) attended a one-day workshop. Paired samples t-tests assessed for differences between baseline and post-assessment knowledge scores. Pearson correlations described the bivariate relationship between baseline and post-assessment knowledge scores. Wilcoxon's Signed Rank Test determined associations between baseline and post-workshop CC variables. Spearman's Rho correlations described bivariate relationships between baseline and post-assessment values for each CC category. Kendall's Rank correlations investigated relationships between knowledge scores and total perceived CC for pre- and post-workshops. Statistical significance was set at p < 0.05. Results indicated an improvement from the baseline knowledge score (6.08 ± 1.46 points) and post-workshop knowledge score (7.03 ± 0.94 points); (t (25) = 3.85; p < 0.001). Similar trends were observed for all CC measures (Z > -3.42; p < 0.001). Differences were not observed between pre-workshop total CC and knowledge scores (τ = -0.03; p = 0.81) or following workshop completion (τ = -0.04; p = 0.76). Participants demonstrated varying exercise knowledge and CC, highlighting inconsistencies in exercise standards within first responder occupations. This investigation suggests the proposed pedagogy design may be a solution for agencies with limited budgets.

Measuring exercise self-efficacy in pregnant women: psychometric properties of the pregnancy-exercise self-efficacy scale (P-ESES).

BACKGROUND AND PURPOSE: This study assessed the psychometric properties of a modified self-efficacy scale-the Pregnancy-Exercise Self-Efficacy Scale (P-ESES). METHODS: Pregnant women completed the P-ESES and physical activity questionnaires (N = 88). RESULTS: Internal consistency was confirmed by Cronbach's alpha (alpha = 0.838) and equal-length Spearman-Brown (alpha = 8.22). Squared multiple correlation coefficients were calculated showing 9 of 10 items with values greater than the desired .5. A nonrotated exploratory principal components analysis confirmed the same 9 of 10 items loaded on a single factor, accounting for 46.1% of the variance. Each item had an acceptable load value of .40 or higher. CONCLUSIONS: Initial testing of the P-ESES confirmed validity and reliability with the exception of 1 item from the original measure: "Exercising without physician approval".

Running-Related Overuse Injuries and Their Relationship with Run and Resistance Training Characteristics in Adult Recreational Runners: A Cross-Sectional Study.

This study aimed to characterize running-related injuries (RRIs), explore their relationship with run and resistance training (RT) parameters, and identify perceived prevention measures among adult recreational runners. An anonymous online survey was designed and distributed via social media and email. Data were analyzed with chi-square, t-test, or analysis of variance (ANOVA), with significance accepted at p ≤ 0.05. Data from 616 participants (76.8% female, age: 42.3 ± 10.5 y) were analyzed. Most runners (84.4%) had an injury history, with 44.6% experiencing one in the past year. The most common RRI sites included the foot/ankle (30.9%) and knee (22.2%). RRI prevalence was higher in those running >19 miles weekly (48.4%, p = 0.05), but there were no differences based on RT participation status. Among those using RT, relatively more RRIs were observed in runners who trained the hip musculature (50.3%, p = 0.005) and did not include the upper body (61.6%, p < 0.001). A disproportionately high RRI prevalence was found for several of the other risk-reduction strategies. RRIs remain a substantial problem, particularly around the ankle/foot and knee. Higher run volume and performance motives were positively associated with RRIs. Most runners incorporated RRI risk-reduction techniques, with over half using RT. The current study did not determine whether preventative strategies were implemented before or after injury; therefore, prospective studies controlling for previous injuries are required to evaluate the effectiveness of RT in preventing future RRIs.

The Effects of Postural Education or Corrective Exercise on the Craniovertebral Angle in Young Adults with Forward Head Posture: A Randomized Controlled Trial.

The purpose of this study was to compare the effects of three different intervention strategies, postural education (PE) and two corrective exercise programs (CEPs), on the craniovertebral angle (CVA) in young adults with forward head posture (FHP). A prospective four-arm parallel randomized controlled trial with repeated measures was performed. Seventy-nine healthy young adults (55 women, 24 men; mean age: 20.08 ± 2.19 years) with FHP were randomized into four groups: PE group, self-myofascial release + stretching group (SMRS), self-myofascial release + stretching + strengthening group (SMRSS), and a control group (CG). Participant CVA (°) was assessed before and after a 4-week intervention. Seventy-two participants completed the trial. Mean difference comparisons of within-group change in mean CVA revealed an increase in the PE (MD = 3.1, p < .01), SMRS (MD = 3.8, p < .01), and SMRSS (MD = 4.4, p < .01) groups. Mean difference comparison of between-group change in mean CVA supported greater CVA change in the SMRS and SMRSS groups compared to the CG (F(3, 68) = 5.26, p < .01, η2 = .188). All three interventions appear to be effective techniques for improving FHP in young adults, however CEPs may provide superior outcomes than PE alone. A 4-week CEP consisting of self-myofascial release + stretching may yield similar CVA enhancements as a CEP consisting of self-myofascial release + stretching + strengthening. Study findings can assist fitness professionals in designing evidence-based FHP intervention programs for young adults.

Physical Profile of Air Force Special Warfare Trainees.

Physical fitness testing in the military is commonly used to assess whether service members are physically capable of performing the diverse physical tasks that may be required for their job. Body composition can influence an individual's ability to physically perform. This study aimed to analyze the general physical profile of U.S. Air Force (USAF) special warfare candidates by assessing body composition results and physical assessment scores collected over the past four years. Male candidates (n = 1036) were 18.2 years to 39.5 years of age (M = 23.5, SD = 3.9) and weighed 78.8 kg (SD = 8.3) with a BMI of 25.0 (SD = 2.0) at 11.8% body fat (SD = 3.3) as measured using bioelectrical impedance. Body composition and fitness scores were similar to those noted in U.S. Navy special warfare candidates as well as individuals in other elite tactical units. These results highlight the normative body composition profile of individuals assessing for advanced military career fields.

Fitness Policies Within the Fire Service: A Pilot Investigation of Exercise Adherence on Fitness Outcomes Among Rural Firefighters.

The purpose of this study was to investigate the adherence to departmental fitness policies and to evaluate the impact of on-duty firefighters' adherence to fitness outcomes. This cross-sectional designed study utilized a convenience sample of 40 career firefighters from one department in rural southeast Georgia. Onsite gym attendance logs were recorded during a 10-month period. Firefighters were classified as lowest (0-16 sessions), low (17-30 sessions), moderate (31-44 sessions), or high (45+ sessions) adherence for analyses based on gym attendance. The fitness outcomes were retrieved from required annual fitness testing, including measurements of muscular strength (1RMest leg press and 1RMest bench press), muscular endurance (pushup), muscle power (vertical jump), cardiovascular fitness (submaximal treadmill), mobility (functional movement screen), and flexibility (shoulder elevation). Only 12.5% (n = 5) of firefighters complied with the department's fitness policy of a minimum 75% adherence rate. Furthermore, there were significant differences (P ≤ .05) between various muscular strength, endurance, and flexibility between adherence rates. This study indicated that firefighters that complied more with the fitness policies were more physically fit than those that did not. Considerations should be made to promote and enforce departmental fitness policies to ensure that firefighters can physically perform their responsibilities.

The Relationship Between Physical Mobility and Firefighter Occupational Task Performance.

Firefighters work in a dangerous profession with high injury rates. Mobility dysfunction in firefighters may impact performance and contribute to injury. The Functional Movement Screen (FMS) is commonly used to evaluate individuals for mobility dysfunction and compensatory movements. The purpose of this study was to identify if mobility is related to firefighters' occupational task performance. This was a retrospective study assessing 29 career firefighters using FMS and occupational performance task scores. Statistical analyses consisted of a multiple linear regression assessing predictors on occupational task performance, and 21 point-biserial correlations ran to assess the relationship between each individual predictor and occupational task performance. Of the 21 point-biserial correlations, four were found to be significant, indicating a relationship between the FMS and occupational task performance. Inline Lunge L had a negative correlation with occupational task time and was statistically significant (rpb = -0.46, p = 0.012); Inline Lunge R had a negative correlation of moderate strength (rpb = -0.583, p = 0.001), Inline Lunge Combined had a negative correlation of moderate strength (rpb = -0.523, p = 0.004), and Shoulder Mobility L had a negative correlation of moderate strength (rpb = -0.445, p = 0.016). This study determined that the Inline Lunge component of the FMS may be a key element in occupational task performance.

The Impact of Gloves and Occupational Tasks on Handgrip Strength in Structural Firefighters.

Adequate handgrip strength (HGS) is important to safely perform fireground tasks. However, there is limited research describing the deleterious impact of glove use and fatigue from occupational tasks on HGS. Therefore, the aims of this investigation were to quantify the impact of glove use and occupational tasks on HGS, to explore the relationship between HGS versus the glove and task-induced decrement in HGS, and to evaluate the relationship between HGS and decrement in HGS versus occupational performance. Fourteen (Male: n = 13) career structural firefighters (Age: 35.5 ± 7.2 yr) performed a maximal isometric HGS assessment with and without gloves before and immediately following completion of a simulated fireground test (SFGT). General linear model with written contrast was used to identify significant differences in HGS between conditions. Pearson Correlations were used to describe bivariate relationships between the decrements in HGS and occupational task times. Significance was set at p < 0.05. There were significant main effects indicating that gloves, performing occupational tasks, and their combined effects decreased HGS (p < 0.001 for all). There were strong inverse relationships between baseline (barehanded) HGS versus the decrement in HGS from donning gloves (r = -0.82, p < 0.001) and from performing occupational tasks with gloves (r = -0.61, p = 0.021). Baseline HGS and the decrement in HGS due to wearing gloves and performing occupational tasks were not correlated to the timed completion of occupational tasks (p ≥ 0.27). These findings suggest that the use of regulation fire gloves and work-induced fatigue reduces HGS and these decrements are related to HGS. Practitioners are encouraged to utilize training strategies to optimize HGS among structural firefighters.

Associations Between Health Status, Training Level, Motivations for Exercise, and Supplement Use Among Recreational Runners.

Dietary supplement use continues to increase, with athlete use surpassing non-athlete utilization. Most research has been conducted on dietary supplement use in elite or collegiate-level athletes. This study investigated supplement use in adult recreational runners and determined relationships between supplement use and participants' training volume, motivations for exercise, self-reported health status, and reasons for using dietary supplements. Participants (n = 283) were recruited for this cross-sectional study via a convenience sampling method. Participants completed an electronic questionnaire using Likert-scale response options. Correlations between the aggregate variables of health status, training level, exercise motivation, reasons for using supplements, and supplement use were calculated using bivariate Pearson correlation analysis. There was a positive correlation between the variables exercise motivation and supplement use (r = 0.267, n = 276, p = 0.01), and between variables influencing reasons for using dietary supplements and reported supplement use was also found (r = 0.425, n = 276, p = 0.01). There was no correlation between health status and supplement use (r = 0.043, n = 275, p = 0.476), or between training level and supplement use (r = 0.00, n = 275, p = 0.994). This study demonstrated a positive correlation between runners' supplement use and motivations for exercising and reasons for consuming supplements. A significant relationship was not found between supplement use and participants' health status or supplement use and runners' training volume. This finding contrasts with previous research in supplement use in the athlete population, which largely reports increased dietary supplement use with increased training volume.

Cardiorespiratory Fitness Is Inversely Associated With Aortic Arterial Stiffness in Firefighters.

OBJECTIVES: The aim of this study was to determine whether cardiorespiratory fitness (CRF), expressed as VO 2 max (mL/kg/min), is associated with resting AS (carotid-femoral pulse wave velocity [cf-PWV]) and the AS response to simulated fire suppression activities in firefighters. METHODS: In firefighters (n = 20, 34 ± 8 years), AS was determined using cf-PWV (m/s) before and after a fire simulation exercise. VO 2 max was determined using a standard treadmill protocol. Linear regression models, adjusted for body fat percentage, are reported as unstandardized (b) and standardized (ß) betas (effect sizes). RESULTS: H1: there was a moderate (ie, ß = 0.5-0.8), inverse association between cf-PWV and VO 2 max (b = -0.80; 95% confidence interval [CI], -0.14 to -0.02; ß = 0.71). H2: there was a moderate, positive association between ∆cf-PWV and VO 2 max (b = 0.05; 95% CI, 0.00-0.10; ß = 0.62). CONCLUSIONS: These findings indicate that CRF may protect against arterial stiffening in firefighters.

The Influence of Education on the Nutritional Knowledge of Certified Fitness Professionals.

The American Fitness Industry has seen progressive success with recent increases in facility memberships and annual revenues of fitness centers. The number of fitness trainers and instructors in the United States has persisted this growth and is projected to grow over the next decade. However, only a few known studies have investigated the nutritional education of fitness professionals. This preliminary study explores the education and knowledge among certified fitness professions (CFPs) in the United States. A cross-sectional, descriptive survey design was utilized with a convenience sample of 120 female participants from the United States who were associated with a major fitness newsletter. The average age of the participants was 48.51 years (SD 12), and they had 14.85 years of experience (SD 10.16) and worked an average of 22.04 hours per week (SD 16.78). Most of the participants had some kind of college degree (96.2%) and held a group fitness certification (76.6%) or personal training certification (47.5%). Those with a nutrition certification were found to have significantly higher nutrition knowledge test scores on the 21 question test (18.2 ± 2.0 correct to 17.1 ± 1.9, p=0.04). Additionally, it is revealed that CFPs use the internet as a primary source for nutritional information and was the most frequently used source of nutrition information accessed. This pilot study suggests a more in-depth study would be beneficial to solidify the current results and could allow for more investigation into whether or not completion of nutrition coursework within formal earned degrees by CFPs positively influences their nutritional knowledge.

The Effect of Timing and Type of Exercise on the Quality of Sleep in Trained Individuals.

Sleep is an extremely important component for overall health and for a well-balanced training program. Recent studies have highlighted the interaction between sleep, recovery, and performance in elite and recreational athletes alike. Exercise has been known to affect the quality of sleep, nevertheless the impact is not well understood in the current research, particularly the effects of exercise timing and intensity on sleep quality. The purpose of this study was to understand if exercise timing and intensity significantly impact sleep quality among recreational exercisers. The participants involved were recreational exercisers who were self-grouped into an AM or PM exercise group. They participated in a seven-day quantitative, quasi-experimental, exploratory study wearing an Actigraph watch. The participant's intensity was also self-grouped into moderate intensity or high intensity based on criteria cut points. Data was analyzed using a factorial ANOVA to examine if there was a significant difference between exercise timing and intensity on sleep quality of the participants. There were no significant differences in sleep quality in either the time group (AM vs PM) or the intensity group (MOD vs VIG) within the four measures of sleep that were looked at throughout this study; total sleep time, sleep onset latency, sleep efficiency % and wake after sleep onset (TST, SOL, SE, and WASO). Results within both, the AM and PM group and the MOD and VIG group, results showed no significant differences. These results conclude that neither exercise intensity or timing had an effect on sleep quality.

Qualitative Assessment of Barriers and Ideal Wellness Programming Among Rural Firefighters.

OBJECTIVE: The purpose of this study was to determine and assess the perceived physical and psychosocial barriers to, and the constitution of, ideal health and wellness programming among rural firefighters. METHODS: Open-ended, semi-structured interviews were conducted and recorded on 40 rural, structural firefighters. Responses to each question were qualitatively analyzed to determine themes. RESULTS: Several themes emerged in regards to the physical and psychosocial stressors of the profession. Three themes emerged relating to the self-perceived barriers to overall health and wellness. There was also agreement in the components of an "ideal" workplace health and wellness program to help overcome perceived barriers. CONCLUSIONS: The themes that emerged from the interviews with this population are similar to firefighters who work in a more urban area. This indicates that the stressors and barriers firefighters face may be occupation, and not location, driven.

Health-related behaviors and technology usage among college students.

OBJECTIVE: To examine associations between technology usage and specific health factors among college students. METHODS: The research employed was a quantitative, descriptive, cross-sectional design; undergraduate students enrolled in spring 2012 general health education courses were recruited to participate. To explore college students' specific technology usage and health-related behaviors, a 28-item questionnaire was utilized. RESULTS: Statistical significant differences of technology usage were found between 3 of the 4 health-related behaviors under study (BMI, sleep, and nutrition) (p < .05). CONCLUSION: As technology usage continues to evolve within the college student population, health professionals need to understand its implications on health behaviors.

Influence of age, sex, and race on college students' exercise motivation of physical activity.

OBJECTIVE: The authors examined differences in exercise motivation between age, sex, and race for college students. PARTICIPANTS: Students from 156 sections of physical activity classes at a midsize university were recruited (n = 2,199; 1,081 men, 1,118 women) in 2005-2006 and volunteered to complete the Exercise Motivation Inventory. METHODS: Quantitative, cross-sectional descriptive research design was employed. RESULTS: Significant differences were found in 3 of 14 exercise motivational subscales by age (affiliation, health pressures, and ill health avoidance) (p < .05). Males were motivated by intrinsic factors (strength, competition, and challenge) (p < .05) and females by extrinsic factors (ie, weight management and appearance) (p < .05); only 2 subscales proved not to be significant by sex. Race differences provided 8 significant differences by exercise motivations (p < .05). CONCLUSIONS: Significant differences for exercise motivations in college-aged population by demographics were documented. Understanding these differences is important for college health professionals for programming strategies and promoting physical activity.