Sports Medicine

Sports Medicine

Comment on “Biological Background of Block Periodized Endurance Training: A Review”

01-09-2019 – J Kiely,C Pickering,I Halperin


Reply to Kiely et al.: Comment on: “Biological Background of Block Periodized Endurance Training: A Review”

01-09-2019 – VB Issurin


Causal Mediation Analysis Could Resolve Whether Training-Induced Increases in Muscle Strength are Mediated by Muscle Hypertrophy

01-09-2019 – JL Nuzzo,HT Finn,RD Herbert


Abstract Resistance training increases muscle size (i.e., causes hypertrophy) and muscle strength, particularly in untrained individuals. Hypertrophy is widely believed to be one of the mechanisms (i.e., a mediator) by which resistance training increases strength. However, some researchers have questioned whether training-induced hypertrophy causes increases in strength. One approach to resolving this issue has been to use correlations between training-induced changes in muscle size and strength to infer the effect of hypertrophy on strength. This is problematic because correlations between changes in muscle size and strength may be confounded (i.e., correlation is not causation). Another approach has involved randomizing participants to different volumes of exercise to create different levels of hypertrophy and then comparing the strength increases associated with different levels of hypertrophy. This approach is also problematic because the unit of randomization is exercise volume rather than hypertrophy, and the potential for confounding remains. Thus, a new approach is needed to determine the extent to which hypertrophy increases muscle strength. Here, we introduce resistance training researchers to causal mediation analysis and recommend that it be used to resolve the current debate. Causal mediation analysis potentially provides an unconfounded estimate of the effect of a mediating variable (hypertrophy) on an outcome (strength). This analysis is supplemented by causal maps that help conceptualize research questions and identify potential confounders. In addition to resolving the debate on hypertrophy, causal mediation analysis can be used to answer a host of other questions about mechanisms in the health sciences.

Effects of Exercise Compression Stockings on Anterior Muscle Compartment Pressure and Oxygenation During Running: A Randomized Crossover Trial Conducted in Healthy Recreational Runners

01-09-2019 – K Rennerfelt,S Lindorsson,H Brisby,A Baranto,Q Zhang

Journal Article

Abstract Background Exercise compression garments have increased in popularity among athletes at all levels during the last 10 years. However, the scientific grounds for this are unclear. The purpose of the present study was to examine the effect of wearing exercise compression stockings (CS) on the anterior compartment pressure, oxygenation of the tibialis anterior muscle, and early blood biomarkers change for muscle damage during a 10-km treadmill run in healthy subjects. Methods Twenty healthy subjects completed two identical treadmill runs, with or without CS. The subjects were randomized regarding the order in which the sessions were performed. Intramuscular pressure (IMP) and muscle oxygenation in the one leg were continuously measured before, during, and after running sessions. Blood samples were collected just before and directly after these sessions and analyzed for myoglobin and creatine kinase concentrations. Results The use of CS during running resulted in significantly higher IMP (by 22 ± 3.1 mm
Hg on average) and lower tissue oxygenation index (by 11 ± 1.8%) compared to running without CS (p < 0.001). In addition, the Δ change in median serum myoglobin concentration measured before and after running was significantly higher when CS were used: 58 (9‒210) µg/L as compared to 38 (0‒196) µg/L with no CS (p = 0.04). No difference in post-running early serum creatine kinase concentration was observed between using CS and not using CS. Conclusion Wearing exercise CS during and following a 10-km treadmill run elevated IMP and reduced muscle tissue oxygenation in the anterior compartment of healthy runners. Furthermore, the use of exercise CS did not prevent early exercise-induced muscle damage, as measured by serum biomarkers.

Physiological Impact and Clinical Relevance of Passive Exercise/Movement

01-09-2019 – JD Trinity,RS Richardson

Journal Article, Review

Abstract Passive exercise/movement has a long history in both medicine and physiology. Early clinical applications of passive exercise/movement utilized pneumatic and direct limb compression to stimulate the vasculature and evoke changes in blood flow to avoid complications brought about by stasis and vascular disease. Over the last 50 years, passive exercise/movement has continued to progress and has provided physiologists with a reductionist approach to mechanistically examine the cardiorespiratory, hyperemic, and afferent responses to movement without the confounding influence of metabolism that accompanies active exercise. This review, in addition to providing an historical perspective, focuses on the recent advancements utilizing passive leg movement, and how the hyperemic response at the onset of this passive movement has evolved from a method to evaluate the central and peripheral regulation of blood flow during exercise to an innovative and promising tool to assess vascular function. As an assessment of vascular function, passive leg movement is relatively simple to perform and provides a nitric oxide-dependent evaluation of endothelial function across the lifespan that is sensitive to changes in activity/fitness and disease state (heart failure, peripheral artery disease, sepsis). The continual refinement and characterization of passive leg movement are aimed at improving our understanding of blood flow regulation and the development of a clinically ready approach to predict and monitor the progression of cardiovascular disease.

Role of Physical Activity and Sedentary Behavior in the Mental Health of Preschoolers, Children and Adolescents: A Systematic Review and Meta-Analysis

01-09-2019 – M Rodriguez-Ayllon,C Cadenas-Sánchez,F Estévez-López,NE Muñoz,J Mora-Gonzalez,JH Migueles,P Molina-García,H Henriksson,A Mena-Molina,V Martínez-Vizcaíno,A Catena,M Löf,KI Erickson,DR Lubans,FB Ortega,I Esteban-Cornejo

Journal Article, Review

Abstract Background Evidence suggests that participation in physical activity may support young people’s current and future mental health. Although previous reviews have examined the relationship between physical activity and a range of mental health outcomes in children and adolescents, due to the large increase in published studies there is a need for an update and quantitative synthesis of effects. Objectives The objectives of this study were to determine the effect of physical activity interventions on mental health outcomes by conducting a systematic review and meta-analysis, and to systematically synthesize the observational evidence (both longitudinal and cross-sectional studies) regarding the associations between physical activity and sedentary behavior and mental health in preschoolers (2–5 years of age), children (6–11 years of age) and adolescents (12–18 years of age). Methods A systematic search of the PubMed and Web of Science electronic databases was performed from January 2013 to April 2018, by two independent researchers. Meta-analyses were performed to examine the effect of physical activity on mental health outcomes in randomized controlled trials (RCTs) and non-RCTs (i.e. quasi-experimental studies). A narrative synthesis of observational studies was conducted. Studies were included if they included physical activity or sedentary behavior data and at least one psychological ill-being (i.e. depression, anxiety, stress or negative affect) or psychological well-being (i.e. self-esteem, self-concept, self-efficacy, self-image, positive affect, optimism, happiness and satisfaction with life) outcome in preschoolers, children or adolescents. Results A total of 114 original articles met all the eligibility criteria and were included in the review (4 RCTs, 14 non-RCTs, 28 prospective longitudinal studies and 68 cross-sectional studies). Of the 18 intervention studies, 12 (3 RCTs and 9 non-RCTs) were included in the meta-analysis. There was a small but significant overall effect of physical activity on mental health in children and adolescents aged 6–18 years (effect size 0.173, 95% confidence interval 0.106–0.239, p < 0.001, percentage of total variability attributed to between-study heterogeneity I2 = 11.3%). When the analyses were performed separately for children and adolescents, the results were significant for adolescents but not for children. Longitudinal and cross-sectional studies demonstrated significant associations between physical activity and lower levels of psychological ill-being (i.e. depression, stress, negative affect, and total psychological distress) and greater psychological well-being (i.e. self-image, satisfaction with life and happiness, and psychological well-being). Furthermore, significant associations were found between greater amounts of sedentary behavior and both increased psychological ill-being (i.e. depression) and lower psychological well-being (i.e. satisfaction with life and happiness) in children and adolescents. Evidence on preschoolers was nearly non-existent. Conclusions Findings from the meta-analysis suggest that physical activity interventions can improve adolescents’ mental health, but additional studies are needed to confirm the effects of physical activity on children’s mental health. Findings from observational studies suggest that promoting physical activity and decreasing sedentary behavior might protect mental health in children and adolescents. PROSPERO Registration Number: CRD42017060373.

Methodological Issues in Soccer Talent Identification Research

01-09-2019 – TLG Bergkamp,ASM Niessen,RJR den Hartigh,WGP Frencken,RR Meijer

Journal Article

Abstract Talent identification research in soccer comprises the prediction of elite soccer performance. While many studies in this field have aimed to empirically relate performance characteristics to subsequent soccer success, a critical evaluation of the methodology of these studies has mostly been absent in the literature. In this position paper, we discuss advantages and limitations of the design, validity, and utility of current soccer talent identification research. Specifically, we draw on principles from selection psychology that can contribute to best practices in the context of making selection decisions across domains. Based on an extensive search of the soccer literature, we identify four methodological issues from this framework that are relevant for talent identification research, i.e. (1) the operationalization of criterion variables (the performance to be predicted) as performance levels; (2) the focus on isolated performance indicators as predictors of soccer performance; (3) the effects of range restriction on the predictive validity of predictors used in talent identification; and (4) the effect of the base rate on the utility of talent identification procedures. Based on these four issues, we highlight opportunities and challenges for future soccer talent identification studies that may contribute to developing evidence-based selection procedures. We suggest for future research to consider the use of individual soccer criterion measures, to adopt representative, high-fidelity predictors of soccer performance, and to take restriction of range and the base rate into account.

Running Biomechanics in Individuals with Anterior Cruciate Ligament Reconstruction: A Systematic Review

01-09-2019 – B Pairot-de-Fontenay,RW Willy,ARC Elias,RL Mizner,MO Dubé,JS Roy

Journal Article, Review

Abstract Background A return to running after anterior cruciate ligament reconstruction (ACL-R) is critical to the clinical success of any cutting and pivoting athlete who wishes to return to sport. Knowledge of specific alterations during running after ACL-R is required to optimise rehabilitation for improving outcomes and long-term disability. Objective The objective of this systematic review was to summarise kinematic, kinetic and muscle activation data during running after ACL-R and the intrinsic factors (e.g. surgical technique and strength asymmetries) affecting running biomechanics. Methods MEDLINE, EMBASE, SPORTDiscus and CINAHL databases were searched from inception to 10 December, 2018. The search identified studies comparing kinematic, kinetic or muscle activation data during running between the involved limb and contralateral or control limbs. Studies analysing the effect of intrinsic factors in the ACL-R group were also included. Risk of bias was assessed, qualitative and quantitative analyses performed, and levels of evidence determined. Results A total of 1993 papers were identified and 25 were included for analysis. Pooled analyses reported a deficit of knee flexion motion and internal knee extension moment, compared with both contralateral or control limbs, during the stance phase of running from 3 months to 5 years after ACL-R (strong evidence). Inconsistent results were found for both peak vertical ground reaction force and impact forces after ACL-R. Patellofemoral and tibiofemoral joint contact forces differed from both contralateral or control limbs up until at least 2.5 years after ACL-R and moderate evidence indicated no difference for muscle activations during moderate speed running. Quadriceps and hamstring strength asymmetries, and knee function, but not surgical techniques, were likely to be associated with both knee kinematics and kinetics during running after ACL-R. Conclusion After ACL-R, knee flexion motion and internal knee extension moment are the most affected variables and are consistently smaller in the injured limb during running when pooling evidence. Clinicians should be aware that these deficits do not appear to resolve with time and, thus, specific clinical interventions may be needed to reduce long-term disability. Systematic review registration Registered in PROSPERO 2017, CRD42017077130.

The Role of Hypernetworks as a Multilevel Methodology for Modelling and Understanding Dynamics of Team Sports Performance

01-09-2019 – J Ribeiro,K Davids,D Araújo,P Silva,J Ramos,R Lopes,J Garganta

Journal Article

Abstract Despite its importance in many academic fields, traditional scientific methodologies struggle to cope with analysis of interactions in many complex adaptive systems, including team sports. Inherent features of such systems (e.g. emergent behaviours) require a more holistic approach to measurement and analysis for understanding system properties. Complexity sciences encompass a holistic approach to research on collective adaptive systems, which integrates concepts and tools from other theories and methods (e.g. ecological dynamics and social network analysis) to explain functioning of such systems in their natural environments. Multilevel networks and hypernetworks comprise novel and potent methodological tools for assessing team dynamics at more sophisticated levels of analysis, increasing their potential to impact on competitive performance in team sports. Here, we discuss how concepts and tools derived from studies of multilevel networks and hypernetworks have the potential for revealing key properties of sports teams as complex, adaptive social systems. This type of analysis can provide valuable information on team performance, which can be used by coaches, sport scientists and performance analysts for enhancing practice and training. We examine the relevance of network sciences, as a sub-discipline of complexity sciences, for studying the dynamics of relational structures of sports teams during practice and competition. Specifically, we explore the benefits of implementing multilevel networks, in contrast to traditional network techniques, highlighting future research possibilities. We conclude by recommending methods for enhancing the applicability of hypernetworks in analysing team dynamics at multiple levels.

Your Personal Motivator is with You: A Systematic Review of Mobile Phone Applications Aiming at Increasing Physical Activity

01-09-2019 – M Hosseinpour,R Terlutter

Journal Article, Review

Abstract Background Literature shows mixed evidence about the power of mobile phone applications to foster physical activity. A systematic integration that offers insights into which mobile phone application techniques can or cannot foster physical activity is lacking, as is a theoretical integration of current research. Objectives We performed a systematic review guided by a theoretical framework focusing on effects that certain mobile phone application techniques have on physical activity, to improve our understanding of what techniques are more or less effective. Methods We identified articles by searching EBSCO Business Source Complete, Science Direct, Psyc
INFO, Springer, PLo
S ONE, Taylor and Francis, IEEE, Social Science Citation Index, Science Citation Index Expanded, PUBMED, MEDLINE, and Google Scholar. We considered articles if (1) they referred to the use of mobile phone applications to promote physical activity; (2) their methodological approach allowed one to derive appropriate results (e.g., intervention-based approach, observational study); (3) they were published in peer-reviewed journals or conference proceedings; and (4) they were written in English. The literature search resulted in 41 usable studies. Meta-synthesis and vote counting were applied to analyze these studies. Results Based on the ratio of supportive versus non-supportive evidence in both the qualitative and the quantitative studies, we propose the following descending rank order for the effectiveness of application techniques to foster physical activity. This is tentative in nature because the current overall small body of literature made coming to definite conclusions difficult: (1) feedback, (2) goal setting and its sub-forms, (3) competition, social sharing with familiar users in both segregated and social network groups, and (4) social sharing with strangers in segregated groups, reward, and social sharing with strangers in social network groups. Rewards in particular provided mixed results, and social sharing with strangers in segregated and social network groups seemed rather ineffective but may work under special conditions that need to be identified in additional research. One limitation of our study was that our results are mostly derived from qualitative studies, since quantitative studies are underrepresented in the field. Conclusion Several mobile phone application techniques were identified that have the potential to foster physical activity, whereas others were identified that are unlikely to increase physical activity. Major avenues for future research include more theoretical development and more quantitative studies, among others.

The Biomechanics of the Track and Field Sprint Start: A Narrative Review

01-09-2019 – NE Bezodis,S Willwacher,AIT Salo

Journal Article, Review

Abstract The start from blocks is a fundamental component of all track and field sprint events (≤ 400 m). This narrative review focusses on biomechanical aspects of the block phase and the subsequent first flight and stance phases. We discuss specific features of technique and how they may be important for a high level of performance during the start. The need to appropriately quantify performance is discussed first; external power has recently become more frequently adopted because it provides a single measure that appropriately accounts for the requirement to increase horizontal velocity as much as possible in as little time as possible. In the “set” position, a relatively wide range of body configurations are adopted by sprinters irrespective of their ability level, and between-sprinter differences in these general positions do not appear to be directly associated with block phase performance. Greater average force production during the push against the blocks, especially from the rear leg and particularly the hip, appears to be important for performance. Immediately after exiting the blocks, shorter first flight durations and longer first stance durations (allowing more time to generate propulsive force) are found in sprinters of a higher performance level. During the first stance phase, the ankle and knee both appear to play an important role in energy generation, and higher levels of performance may be associated with a stiffer ankle joint and the ability to extend the knee throughout stance. However, the role of the sprinter’s body configuration at touchdown remains unclear, and the roles of strength and anatomy in these associations between technique and performance also remain largely unexplored. Other aspects such as the sex, age and performance level of the studied sprinters, as well as issues with measurement and comparisons with athletes with amputations, are also briefly considered.

Factors Influencing the Relationship Between the Functional Movement Screen and Injury Risk in Sporting Populations: A Systematic Review and Meta-analysis

01-09-2019 – E Moore,S Chalmers,S Milanese,JT Fuller

Journal Article, Review

Abstract Background Studies investigating the association between the Functional Movement Screen (FMS) and sports injury risk have reported mixed results across a range of athlete populations. Objectives The purpose of this systematic review was to identify whether athlete age, sex, sport type, injury definition and mechanism contribute to the variable findings. Study design Systematic review and meta-analysis. Methods A systematic search was conducted in October 2018 using PubMed, EBSCOhost, Scopus, Em
Base and Web of Science databases. Studies were included if they were peer reviewed and published in English language, included athletes from any competition level, performed the FMS at baseline to determine risk groups based on FMS composite score, asymmetry or pain, and prospectively observed injury incidence during training and competition. Study eligibility assessment and data extraction was performed by two reviewers. Random effects meta-analyses were used to determine odds ratio (OR), sensitivity and specificity with 95% confidence intervals. Sub-group analyses were based on athlete age, sex, sport type, injury definition, and injury mechanism. Results Twenty-nine studies were included in the FMS composite score meta-analysis. There was a smaller effect for junior (OR = 1.03 0.67–1.59; p = 0.881) compared to senior athletes (OR = 1.80 1.17–2.78; p = 0.008) and for male (OR = 1.79 1.08–2.96; p = 0.024) compared to female (OR = 1.92 0.43–8.56; p = 0.392) athletes. FMS composite scores were most likely to be associated with increased injury risk in rugby (OR = 5.92 1.67–20.92; p = 0.006), and to a lesser extent American football (OR = 4.41 0.94–20.61; p = 0.059) and ice hockey (OR = 3.70 0.89–15.42; p = 0.072), compared to other sports. Specificity values were higher than sensitivity values for FMS composite score. Eleven studies were included in the FMS asymmetry meta-analysis with insufficient study numbers to generate sport type subgroups. There was a larger effect for senior (OR = 1.78 1.16–2.73; p = 0.008) compared to junior athletes (OR = 1.21 0.75–1.96; p = 0.432). Sensitivity values were higher than specificity values for FMS asymmetry. For all FMS outcomes, there were minimal differences across injury definitions and mechanisms. Only four studies provided information about FMS pain and injury risk. There was a smaller effect for senior athletes (OR = 1.28 0.33–4.96; p = 0.723) compared to junior athletes (OR = 1.71 1.16–2.50; p = 0.006). Specificity values were higher than sensitivity values for FMS pain. Conclusion Athlete age, sex and sport type explained some of the variable findings of FMS prospective injury-risk studies. FMS composite scores and asymmetry were more useful for estimating injury risk in senior compared to junior athletes. Effect sizes tended to be small except for FMS composite scores in rugby, ice hockey and American football athletes. Protocol registration CRD42018092916.

Effectiveness of Education Interventions Designed to Improve Nutrition Knowledge in Athletes: A Systematic Review

02-08-2019 – R Tam,KL Beck,MM Manore,J Gifford,VM Flood,H O’Connor

Journal Article, Review

Abstract Background A range of nutrition education strategies are used to assist athletes to improve nutrition knowledge. Evaluation of nutrition education interventions guides the delivery of efficacious nutrition education for athletes. Aim Our aim was to systematically review sport/general nutrition education interventions delivered to athletes, and to evaluate their effectiveness. Methods A search was conducted using terms related to nutrition knowledge, athletes, education, and intervention. Included studies had to be conducted in athletes (all calibres), use a scored nutrition knowledge assessment tool, and measure knowledge before and after a nutrition education intervention. Peer-reviewed and unpublished theses were included. Results Thirty-two manuscripts (randomised controlled trial, n = 13; single-arm pre/post design, n = 19) met the inclusion criteria. Participants (n = 2180; mean age 17.4 ± 1.7 years) were mostly female (66.1%), university-level (56.3%) athletes based in the US (75%). Comparison of different education methods was limited since the majority of interventions (n = 28/36, 77.8%) used face-to-face education. Most intervention conditions (n = 19) had a total contact time of < 300 min (5 h). The majority of interventions (n = 30, 85.7%) reported significant knowledge improvement, with a mean increase of 16.1 ± 0.7% (mean effect size 1.72; range 0.4–17.1). Only 15.6% of studies used well-validated knowledge assessment tools (more than three types of validity or reliability testing). Conclusions Most interventions reported a significant improvement in nutrition knowledge. Unfortunately, the wide range of knowledge assessment tools with limited validation, and the predominant use of face-to-face interventions, prohibits identification of the most effective modality and dose for nutrition education in athletes.

Correction to: Pulmonary and Respiratory Muscle Function in Response to Marathon and Ultra-Marathon Running: A Review

01-08-2019 – NB Tiller

Published Erratum

On page 8, in the left-hand column, third paragraph, lines 9–13 which previously read:

Comment on: “Revised Approach to the Role of Fatigue in Anterior Cruciate Ligament Injury Prevention: A Systematic Review with Meta-analyses”

01-08-2019 – A Koller,W Schobersberger


Reply to Koller and Schobersberger: Comment on: “Revised Approach to the Role of Fatigue in Anterior Cruciate Ligament Injury Prevention: A Systematic Review with Meta‐analyses”

01-08-2019 – A Benjaminse,KE Webster,A Gokeler


Exercise Recommendations for Women with Polycystic Ovary Syndrome: Is the Evidence Enough?

01-08-2019 – NK Stepto,RK Patten,EC Tassone,ML Misso,L Brennan,J Boyle,RA Boyle,CL Harrison,AL Hirschberg,K Marsh,A Moreno-Asso,L Redman,M Thondan,C Wijeyaratne,HJ Teede,LJ Moran

Journal Article

Abstract In this opinion piece, we summarize, discuss implications of implementation, and critically evaluate our 2018 evidence-based guideline recommendations for exercise and physical activity in women with polycystic ovary syndrome (PCOS). We developed recommendations as part of a larger international guideline development project. The overall guideline scope and priorities were informed by extensive health professional and consumer engagement. The lifestyle guideline development group responsible for the exercise recommendations included experts in endocrinology, exercise physiology, gynecology, dietetics, and obstetrics, alongside consumers. Extensive online communications and two face-to-face meetings addressed five prioritized clinical questions related to lifestyle, including the role of exercise as therapy for women with PCOS. The guideline recommendations were formulated based on one narrative and two evidence-based reviews, before consensus voting within the guideline panel. The development process was in accordance with the Appraisal of Guidelines for Research and Evaluation (AGREE) II, and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework to assess evidence quality, desirable and undesirable consequences, feasibility, acceptability, cost, implementation, and recommendation strength. Given the evidence for exercise as therapy in PCOS being of low quality, a consensus recommendation was made based on current exercise guidelines for the general population. Women with PCOS and clinicians are forced to adopt generic approaches when recommending exercise therapy that perpetuates clinical management with pharmacological solutions. The current status of evidence highlights the need for greater international co-operation between researchers and funding agencies to address key clinical knowledge gaps around exercise therapy in PCOS to generate evidence for appropriate, scalable, and sustainable best practice approaches.

The Mediating Effect of Pupils’ Physical Fitness on the Relationship Between Family Socioeconomic Status and Academic Achievement in a Danish School Cohort

01-08-2019 – MP Andersen,L Valeri,L Starkopf,RN Mortensen,M Sessa,KH Kragholm,H Vardinghus-Nielsen,H Bøggild,T Lange,C Torp-Pedersen

Journal Article

Abstract Introduction Family socioeconomic status influences pupils’ academic achievements, and studies have established positive associations between physical fitness and academic achievements. However, whether physical fitness mediates the relationship remains unknown. Objective We investigated if pupils’ physical fitness mediates the pathway between family socioeconomic status and academic achievement using causal inference-based mediation analysis. Methods This study included 527 girls and 552 boys between 13 and 15 years of age from the Danish municipality of Aalborg. Physical fitness was measured through VO2max tests in 2010 and demographic data were obtained from nationwide registers. Family socioeconomic status was classified into four levels ranging from 1 to 4, where level 1 represents the lowest and level 4 the highest based on either family income or education. Results Controlling for sex, ethnicity, age, and parents’ cohabitation status, all total effects display higher academic achievement with increased family socioeconomic status. Splitting the effects, the direct effects reveal the existence of other pathways not involving physical fitness. The indirect effects established physical fitness as a mediator showing that pupils from family socioeconomic status levels one, three, and four changes grade by − 0.13 95% confidence interval (CI) − 0.26, − 0.01, 0.07 (95% CI 0.00, 0.14), and 0.24 (95% CI 0.14, 0.34), respectively, compared to socioeconomic status level two. The corresponding proportions mediated are 18% (95% CI 1, 57), 6% (95 CI 0, 13), and 12% (95% CI 7, 18) when family socioeconomic status is based on education. Classifying family socioeconomic status on income, pupils from family socioeconomic status levels one, three, and four show grade changes of − 0.07 (95% CI − 0.16, 0.02), 0.22 (95% CI 0.13, 0.32), and 0.26 (95% CI 0.15, 0.37), respectively, compared to socioeconomic status level two. The corresponding proportions mediated are 12% (95% CI − 6, 41), 30% (95% CI 16, 54), and 20% (95% CI 12, 32). Conclusion In conclusion, pupils’ physical fitness partially mediated the pathway between family socioeconomic status and academic achievement.

Physical Activity Intolerance and Cardiorespiratory Dysfunction in Patients with Moderate-to-Severe Traumatic Brain Injury

01-08-2019 – RN Hamel,JM Smoliga

Journal Article, Review

Abstract Moderate-to-severe traumatic brain injury (TBI) is a chronic health condition with multi-systemic effects. Survivors face significant long-term functional limitations, including physical activity intolerance and disordered sleep. Persistent cardiorespiratory dysfunction is a potentially modifiable yet often overlooked major contributor to the alarmingly high long-term morbidity and mortality rates in these patients. This narrative review was developed through systematic and non-systematic searches for research relating cardiorespiratory function to moderate-to-severe TBI. The literature reveals patients who have survived moderate-to-severe TBI have ~ 25–35% reduction in maximal aerobic capacity 6–18 months post-injury, resting pulmonary capacity parameters that are reduced 25–40% for weeks to years post-injury, increased sedentary behavior, and elevated risk of cardiorespiratory-related morbidity and mortality. Synthesis of data from other patient populations reveals that cardiorespiratory dysfunction is likely a consequence of ventilator-induced diaphragmatic dysfunction (VIDD), which is not currently addressed in TBI management. Thus, cardiopulmonary exercise testing should be routinely performed in this patient population and those with cardiorespiratory deficits should be further evaluated for diaphragmatic dysfunction. Lack of targeted treatment for underlying cardiorespiratory dysfunction, including VIDD, likely contributes to physical activity intolerance and poor functional outcomes in these patients. Interventional studies have demonstrated that short-term exercise training programs are effective in patients with moderate-to-severe TBI, though improvement is variable. Inspiratory muscle training is beneficial in other patient populations with diaphragmatic dysfunction, and may be valuable for patients with TBI who have been mechanically ventilated. Thus, clinicians with expertise in cardiorespiratory fitness assessment and exercise training interventions should be included in patient management for individuals with moderate-to-severe TBI.

Can Resistance Training Improve Upper Limb Postural Tremor, Force Steadiness and Dexterity in Older Adults? A Systematic Review

01-08-2019 – JWL Keogh,S O’Reilly,E O’Brien,S Morrison,JJ Kavanagh

Journal Article, Review

Abstract Background The ageing process and several health conditions may increase tremor and reduce force steadiness and dexterity, which can severely impact on function and quality of life. Resistance training can evoke a range of neuromuscular adaptions that may significantly reduce tremor and/or increase force steadiness and/or dexterity in older adults, irrespective of their health condition. Objectives The objective of this study was to systematically review the literature to determine if a minimum of 4 weeks’ resistance training can reduce postural tremor and improve force steadiness and/or dexterity in older adults, defined as aged 65 years and over. Methods An electronic search using Ovid, CINAHL, SPORTDiscus and EMBASE was performed. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Results Fourteen studies met the eligibility criteria, including six randomised controlled trials and two quasi-randomised controlled trials. All eight studies that recruited healthy older adults reported significant reductions in postural tremor and/or improvements in force steadiness and dexterity. Five out of seven studies that examined older adults with a particular health condition reported some improvements in force steadiness and/or dexterity. Specifically, significant benefits were observed for older adults with chronic obstructive pulmonary disease and essential tremor; however, small or no changes were observed for individuals with osteoarthritis or stroke. Conclusions Resistance training is a non-pharmacological treatment that can reduce tremor and improve force steadiness and dexterity in a variety of older adult populations. Future research should employ randomised controlled trials with larger sample sizes, better describe training programme methods, and align exercise prescription to current recommendations for older adults.