Showing papers in "British Journal of Sports Medicine in 2008"

Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials.

Abstract: Objective To review the published literature on the effectiveness of interventions to promote physical activity in children and adolescents. Design Systematic review. Data sources Literature search using PubMed, SCOPUS, Psychlit, Ovid Medline, Sportdiscus, and Embase up to December 2006. Review methods Two independent reviewers assessed studies against the following inclusion criteria: controlled trial, comparison of intervention to promote physical activity with no intervention control condition, participants younger than 18 years, and reported statistical analyses of a physical activity outcome measure. Levels of evidence, accounting for methodological quality, were assessed for three types of intervention, five settings, and three target populations. Results The literature search identified 57 studies: 33 aimed at children and 24 at adolescents. Twenty four studies were of high methodological quality, including 13 studies in children. Interventions that were found to be effective achieved increases ranging from an additional 2.6 minutes of physical education related physical activity to 283 minutes per week of overall physical activity. Among children, limited evidence for an effect was found for interventions targeting children from low socioeconomic populations, and environmental interventions. Strong evidence was found that school based interventions with involvement of the family or community and multicomponent interventions can increase physical activity in adolescents. Conclusion Some evidence was found for potentially effective strategies to increase children's levels of physical activity. For adolescents, multicomponent interventions and interventions that included both school and family or community involvement have the potential to make important differences to levels of physical activity and should be promoted. A lack of high quality evaluations hampers conclusions concerning effectiveness, especially among children.

Non-contact ACL injuries in female athletes: An International Olympic Committee current concepts statement

Abstract: The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the "knee over toe position" when cutting.

Too much sitting: a novel and important predictor of chronic disease risk?

Abstract: Research on physical activity and health has pointed clearly to increasing the time that adults spend doing moderate to vigorous intensity activities: 30 minutes a day is generally recommended However, recent evidence underlines the importance of also focusing on sedentary behaviours—the high volumes of time that adults spend sitting in their remaining “non-exercise” waking hours We provide a brief overview of recent evidence for the distinct relationships between ‘too much sitting’ and biomarkers of metabolic health and, thus, with increased risk of type 2 diabetes, cardiovascular disease and other prevalent chronic health problems Particular concerns for this new field include the challenges of changing sedentary behaviours in the context of ubiquitous environmental and social drivers of sitting time; examining the effects of interventions for reducing or breaking-up sitting time and identifying the most relevant implications for clinical and public health practice Increasing participation in leisure time physical activity (LTPA) in adult populations is a central tenet of strategies for preventing major chronic diseases (type 2 diabetes, cardiovascular disease, breast and colon cancer) and obesity in developed and developing nations1 2 To date, clinical practice, community programmes, mass-media campaigns and population strategies have focused mainly on encouraging and supporting individuals to be more active, largely during discretionary or leisure time, but more recently (and to a lesser extent) also in travel time2 While these approaches have met with some success, our recent body of work has identified sedentary behaviour (time spent sitting) as a novel and potentially important risk factor for the development of chronic disease Even if people meet the current recommendation of 30 minutes of physical activity on most days each week, there may be significant adverse metabolic and health effects from prolonged …

Aerobic exercise effects on cognitive and neural plasticity in older adults

Abstract: Older adults frequently experience cognitive deficits accompanied by deterioration of brain tissue and function in a number of cortical and subcortical regions. Because of this common finding and the increasing ageing population in many countries throughout the world, there is an increasing interest in assessing the possibility that partaking in or changing certain lifestyles could prevent or reverse cognitive and neural decay in older adults. In this review we critically evaluate and summarise the cross-sectional and longitudinal studies that assess the impact of aerobic exercise and fitness on cognitive performance, brain volume, and brain function in older adults with and without dementia. We argue that 6 months of moderate levels of aerobic activity are sufficient to produce significant improvements in cognitive function with the most dramatic effects occurring on measures of executive control. These improvements are accompanied by altered brain activity measures and increases in prefrontal and temporal grey matter volume that translate into a more efficient and effective neural system. Brain deterioration and cognitive decline are considered common characteristics of ageing. However, it is clear that not everyone experiences senescence at the same rate or to the same degree. Individual differences in the quality of cognitive and brain function in old age suggest that deterioration and decay are neither ubiquitous nor inevitable characteristics of ageing. This begs the following question: what are the factors that explain some of the individual differences in old age, allowing some people to retain cognitive and brain function, while pushing others into a trajectory of decline and decay? In addition to determining individual difference factors, recent interventions demonstrate that cognitive and brain deterioration is not unalterable and that the older adult brain retains some plasticity that can be taken advantage of in order to reverse deterioration and decay that may already be manifest. In …

Walking and primary prevention: a meta-analysis of prospective cohort studies

Abstract: Objective: To quantify the association between walking and the risk of cardiovascular disease (CVD) and all-cause mortality in healthy men and women. Data sources: Medline, Cochrane Database of Systematic Reviews, and Web of Science databases were searched to May 2007. Study selection: Prospective epidemiological studies of walking and CVD and all-cause mortality. Results: 18 prospective studies were included in the overall analysis, which incorporated 459 833 participants free from CVD at baseline with 19 249 cases at follow-up. From the meta-analysis the pooled hazard ratio of CVD in the highest walking category compared with the lowest was 0.69, (95% CI 0.61 to 0.77, p Conclusions: The results suggest walking is inversely associated with clinical disease endpoints and largely support the current guidelines for physical activity. The mechanisms that mediate this relationship remain largely unknown and should be the focus of future research.

Physical activity habits of doctors and medical students influence their counselling practices

Abstract: Doctors are well positioned to provide physical activity (PA) counselling to patients. They are a respected source of health-related information and can provide continuing preventive counselling feedback and follow-up; they may have ethical obligations to prescribe PA. Several barriers to PA counselling exist, including insufficient training and motivation of doctors and improvable, personal PA habits. Rates of exercise counselling by doctors remain low; only 34% of US adults report exercise counselling at their last medical visit. In view of this gap, one of the US health objectives for 2010 is increasing the proportion of patients appropriately counselled about health behaviours, including exercise/PA. Research shows that clinical providers who themselves act on the advice they give provide better counselling and motivation of their patients to adopt such health advice. In summary, there is compelling evidence that the health of doctors matters and that doctors' own PA practices influence their clinical attitudes towards PA. Medical schools need to increase the proportion of students adopting and maintaining regular PA habits to increase the rates and quality of future PA counselling delivered by doctors.

Injury surveillance in multi-sport events: the International Olympic Committee approach

Abstract: Background: The protection of athletes’ health by preventing injuries is an important task for international sports federations. Standardised injury surveillance provides not only important epidemiological information, but also directions for injury prevention, and the opportunity for monitoring long-term changes in the frequency and circumstances of injury. Numerous studies have evaluated sports injuries during the season, but few have focused on injuries during major sport events such as World Championships, World Cups or the Olympic Games. Objectives: To provide an injury surveillance system for multi-sports tournaments, using the 2008 Olympic Games in Beijing as an example. Methods: A group of experienced researchers reviewed existing injury report systems and developed a scientific sound and concise injury surveillance system for large multi-sport events. Results: The injury report system for multi-sport events is based on an established system for team sports tournaments and has proved feasible for individual sports during the International Association of Athletics Federations World Championships in Athletics 2007. The most important principles and advantages of the system are comprehensive definition of injury, injury report by the physician responsible for the athlete, a single-page report of all injuries, and daily report irrespective of whether or not an injury occurred. Implementation of the injury surveillance system, all definitions, the report form, and the analysis of data are described in detail to enable other researchers to implement the injury surveillance system in any sports tournament. Conclusion: The injury surveillance system has been accepted by experienced team physicians and shown to be feasible for single-sport and multi-sport events. It can be modified depending on the specific objectives of a certain sport or research question; however, a standardised use of injury definition, report forms and methodology will ensure the comparability of results.

Physical activity and breast cancer risk: impact of timing, type and dose of activity and population subgroup effects

Abstract: Objective: To review (1) the epidemiological literature on physical activity and the risk of breast cancer, examining the effect of the different parameters of activity and effect modification within different population subgroups; and (2) the biological mechanisms whereby physical activity may influence the risk of breast cancer. Methods: A review of all published literature to September 2007 was conducted using online databases; 34 case-control and 28 cohort studies were included. The impact of the different parameters of physical activity on the association between activity and the risk of breast cancer was examined by considering the type of activity performed, the timing of activity over the life course and the intensity of activity. Effect modification of this association by menopausal status, body mass index (BMI), racial group, family history of breast cancer, hormone receptor status, energy intake and parity were also considered. Results: Evidence for a risk reduction associated with increased physical activity was found in 47 (76%) of 62 studies included in this review with an average risk decrease of 25–30%. A dose-response effect existed in 28 of 33 studies. Stronger decreases in risk were observed for recreational activity, lifetime or later life activity, vigorous activity, among postmenopausal women, women with normal BMI, non-white racial groups, those with hormone receptor negative tumours, women without a family history of breast cancer and parous women. Conclusions: The effect of physical activity on the risk of breast cancer is stronger in specific population subgroups and for certain parameters of activity that need to be further explored in future intervention trials.

Exercise is medicine and physicians need to prescribe it

Abstract: The three major factors that influence our health and longevity are genetics, the environment and behaviour. Because we have very little control over genetic factors, it is critical that we focus on the environmental and behavioural factors we can control to improve health. Whereas great strides have been made in reducing the environmental factors influencing disease, such as through vaccinations, hygiene and safety regulations, little has been done to target behavioural factors such as physical inactivity. It is tragic that so little has been done to address the one major factor affecting our health and longevity that is almost entirely under our control. At this point in time, I believe physical inactivity has become the greatest public health problem of our time and finding a way to get patients more active is absolutely critical to improving health and longevity in the 21st century. The beneficial relationship between exercise and health has been well known dating back to the 5th century BC, when Hippocrates said that “Eating alone will not keep a man well; he must also take exercise. For food and exercise… work together to produce health”.1 This relationship has been further defined by years of scientific research that shows a clear correlation between physical activity and health status. That is, those individuals who maintain an active and fit way of life live longer and healthier lives than those who do not. This association between physical activity and health persists in virtually every subgroup of the population, regardless of age, sex, race or environmental condition.2 There is clear scientific evidence proving the benefit of regular physical activity on both the primary and secondary prevention of diabetes, hypertension, cancer (particularly breast and colon cancer), depression, osteoporosis and dementia. Furthermore, regular physical activity has been shown to be essential in …

Growth factor delivery methods in the management of sports injuries: the state of play

Abstract: In recent years there have been rapid developments in the use of growth factors for accelerated healing of injury. Growth factors have been used in maxillo-facial and plastic surgery with success and the technology is now being developed for orthopaedics and sports medicine applications. Growth factors mediate the biological processes necessary for repair of soft tissues such as muscle, tendon and ligament following acute traumatic or overuse injury, and animal studies have demonstrated clear benefits in terms of accelerated healing. There are various ways of delivering higher doses of growth factors to injured tissue, but each has in common a reliance on release of growth factors from blood platelets. Platelets contain growth factors in their α-granules (insulin-like growth factor-1, basic fibroblast growth factor, platelet-derived growth factor, epidermal growth factor, vascular endothelial growth factor, transforming growth factor-β1) and these are released upon injection at the site of an injury. Three commonly utilised techniques are known as platelet-rich plasma, autologous blood injections and autologous conditioned serum. Each of these techniques has been studied clinically in humans to a very limited degree so far, but results are promising in terms of earlier return to play following muscle and particularly tendon injury. The use of growth factors in sports medicine is restricted under the terms of the World Anti-Doping Agency (WADA) anti-doping code, particularly because of concerns regarding the insulin-like growth factor-1 content of such preparations, and the potential for abuse as performance-enhancing agents. The basic science and clinical trials related to the technology are reviewed, and the use of such agents in relation to the WADA code is discussed.

Prevention in the first place: schools a setting for action on physical inactivity

Abstract: Promoting physical activity has become a priority because of its role in preventing childhood obesity and chronic disease. Ecological approaches that recognise the interaction between individuals and the settings in which they spend their time are currently at the forefront of public health action. Schools have been identified as a key setting for health promotion. An overview of the literature addressed the promotion of physical activity in schools and showed that school-based strategies (elementary or high school) that utilised classroom-based education only did not increase physical activity levels; one notable exception was screen time interventions. Although evidence is sparse, active school models and environmental strategies (interventions that change policy and practice) appear to promote physical activity in elementary schools effectively. There is also strong evidence to support multicomponent models in high schools, particularly models that incorporate a family and community component. An emerging trend is to involve youth in the development and implementation of interventions. In the context of childhood obesity and sedentary lifestyles, modest increases in physical activity levels in school-based trials are important. School initiatives must be supported and reinforced in other community settings. Health professionals play a key role as champions in the community, based on their influence and credibility. Health professionals can lend support to school-based efforts by asking about and emphasising the importance of physical activity with patients, encouraging family-based activities, supporting local schools to adopt an "active school" approach and advocating for support to sustain evidence-based and promising physical activity models within schools.

Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomised controlled trial

Abstract: Objective: To examine the effects of aerobic exercise or vitamin B supplementation on cognitive function in older adults with mild cognitive impairment (MCI). Design: Randomised placebo-controlled trial. Setting: General community. Participants: Community-dwelling adults aged 70-80 with MCI. Interventions : The 152 participants were randomly assigned to two interventions: (1) a twice-weekly, group-based, moderate-intensity walking programme (WP, n = 77) or a low-intensity placebo activity programme (n = 75) for one year; and (2) daily vitamin pill containing 5 mg folic acid, 0.4 mg vitamin B-12, 50 mg vitamin B-6 (FA/B12/B6, n = 78) or placebo pill (n = 74) for one year. Outcome measures: Cognitive function, measured with neuropsychological tests at baseline and after six and 12 months. Results: Median session attendance at the exercise programmes (25th-75th percentile) was 63% (2%-81%) and median compliance with taking pills (25th-75th percentile) was 100% (99%-100%). Gender was an effect modifier. Intention-to-treat analysis revealed no main intervention effect for either intervention. In women in the WP, attention (Stroop combination task) improved by 0.3 seconds (p = 0.04) and memory (auditory verbal learning test) by 0.04 words (p = 0.06) with each percentage increase in session attendance. In men attending at least 75% of the sessions, the WP improved memory (β 1.5 (95% CI: 0.1 to 3.0) words). Conclusion: The walking programme and/or FA/B12/B6 supplementation were not effective in improving cognition within one year. The walking programme, however, was efficacious in improving memory in men and memory and attention in women with better adherence. Trial registration: International Standard Randomised Controlled Trial Number Register, 19227688, http://www.controlled-trials.com/isrctn/. Chemicals / CAS: Folic Acid, 59-30-3; Vitamin B 12, 68-19-9; Vitamin B 6, 8059-24-3

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain

Abstract: OBJECTIVE: To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain. DESIGN: Factorial randomised trial. Setting 64 general practices in England. PARTICIPANTS: 579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups were randomised to exercise prescription. INTERVENTIONS: Normal care (control), six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling. MAIN OUTCOME MEASURES: Roland Morris disability score (number of activities impaired by pain) and number of days in pain. RESULTS: Exercise and lessons in the Alexander technique, but not massage, remained effective at one year (compared with control Roland disability score 8.1: massage -0.58, 95% confidence interval -1.94 to 0.77, six lessons -1.40, -2.77 to -0.03, 24 lessons -3.4, -4.76 to -2.03, and exercise -1.29, -2.25 to -0.34). Exercise after six lessons achieved 72% of the effect of 24 lessons alone (Roland disability score -2.98 and -4.14, respectively). Number of days with back pain in the past four weeks were lower after lessons (compared with control median 21 days: 24 lessons -18, six lessons -10, massage -7) and quality of life improved significantly. No significant harms were reported. CONCLUSIONS: One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons.

Physical activity and maintaining physical function in older adults

Abstract: Older Americans, the most rapidly growing age group, are the least physically active1 and generate the highest healthcare expenditures.2 For example, older persons who were functionally dependent accounted for 46% of the healthcare expenditures, but only made up 20% of the older adult population.3 Additionally, they spent $5000 more per year than people who remained independent. Physical activity (PA) may play an important role in maintaining health and physical function while reducing the healthcare burden.4 Recommendations for PA began in 1975 with the American College of Sports Medicine’s (ACSM) guidelines for exercise testing and prescription. While little space was devoted to PA in older adults, likely due to the limited amount of research, today a wealth of literature is available touting its benefits. Throughout the past two decades many obstacles to adopting PA, a safe and effective modality for improving physical capacity in older adults, have been overcome. Many questions still remain; the one which we attempt to address in this brief review is whether PA can maintain physical function in older adults. Physical activity has a myriad of effects that stem from physiological adaptations that may transfer to improvements in clinical outcomes such as reducing the risk of falls.5 The purpose of this article is to briefly review the current literature regarding whether PA can help maintain physical function in older adults and offer some suggestions for clinicians wanting to improve physical function with PA. As illustrated in fig 1, individuals who begin a regular PA programme early in life and maintain this over the years will likely have high physical performance throughout the lifespan, although a decline in physical function is inevitable. Potentially more clinically relevant is whether a PA programme can set a person on a different trajectory over time (see …

MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain

Abstract: Objectives: To determine if asymmetry of trunk muscles and deficits of motor control exist among elite cricketers with and without low back pain (LBP). Design: Single-blinded observational quasi-experimental design study Setting: Assessments were conducted in a hospital setting. Participants: Among a total eligible sample of 26 male elite cricketers (mean age 21.2 (SD 2.0) years), selected to attend a national training camp, 21 participated in the study. Risk factors: The independent variables were ‘group’ (LBP or asymptomatic) and ‘cricket position’ (fast bowler versus the rest of the squad). Main outcome measurements: The dependent variables were the cross-sectional areas (CSA) of the quadratus lumborum (QL), lumbar erector spinae plus multifidus (LES + M) and psoas muscles, the thickness of the internal oblique (IO) and transversus abdominis (TrA) muscles, and the amount of lateral slide of the anterior abdominal fascia. Results: The QL and LES + M muscles were larger ipsilateral to the dominant arm. In the subgroup of fast bowlers with LBP, the asymmetry in the QL muscle was the greatest. The IO muscle was larger on the side contralateral to the dominant arm. No difference between sides was found for the psoas and TrA muscles. Cricketers with LBP showed a reduced ability to draw in the abdominal wall and contract the TrA muscle independently of the other abdominal muscles. Conclusions: This study provides new insights into trunk muscle size and function in elite cricketers, and evidence of impaired motor control in elite cricketers with LBP. Rehabilitation using a motor control approach has been shown to be effective for subjects with LBP, and this may also benefit elite cricketers.

The risk for a cruciate ligament injury of the knee in adolescents and young adults: a population-based cohort study of 46 500 people with a 9 year follow-up

Abstract: Objectives: The knee joint is the most common site for injury among younger people, the injury often resulting in expensive (surgical) treatment, long-term rehabilitation and permanent functional impairment and disability. Methods: We investigated the incidence and risk factors for a major knee-ligament injury in an adolescent Finnish population. A population-based cohort of 46 472 adolescents was followed for an average of 9 years. All patients hospitalised with the diagnosis of anterior or posterior cruciate ligament injury (ACL or PCL injury) were included in the analysis. Results: 265 (0.6%) people (194 male and 71 female subjects) from the total cohort of 46 472 were treated for a cruciate ligament injury of the knee during the follow-up period, giving an injury incidence of 60.9 (95% CI 53.6 to 68.2) per 100 000 person-years. When the socioeconomic, health and lifestyle background variables were taken into account, the adjusted hazard ratio for a cruciate ligament injury of the knee was 8.5 (95% CI 4.3 to 16.4) for female and 4.0 (95% CI 2.7 to 6.1) for male subjects who participated in organised sports ⩾4 times/week. Conclusions: The general risk for a cruciate ligament injury of the knee is relatively low among adolescents and young adults, but participation in organised sports increases the risk significantly. The risk is especially high in active young women. Preventive measures should be adopted to decrease the short-term and long-term burden of these severe injuries.

International Rugby Board Rugby World Cup 2007 injury surveillance study

Abstract: Objective: to determine the incidence, nature and causes of injuries sustained during the International Rugby Board (IRB) Rugby World Cup 2007. Design: Pospective, whole-population survey. Population: 626 international rugby players representing 20 teams competing at the IRB Rugby World Cup 2007 in France. Methods: The survey followed the international consensus procedures for studies of injuries in rugby union; the main outcome measures were incidence of match and training injuries (number of injuries/1000 player hours), severity (days absence), location, type and cause of injury. Results: the incidence of injuries was 83.9/1000 player-match hours (forwards 84.0; backs 83.7) and 3.5/1000 player-training hours (forwards 3.5; backs 3.6). The average severity of injuries was 14.7 days (forwards 14.0; backs 15.5) during matches and 17.8 (forwards 15.9; backs 19.8) during training. Lower limb muscle and ligament injuries were the main injuries during both matches and training. Most injuries were sustained in the tackle during matches and in full-contact skills activities during training. Conclusions: This study shows the application of the methodology described in the international consensus statement on injury surveillance studies in rugby union and provides benchmark values for the incidence, severity, nature and causes of match and training injuries sustained during the IRB Rugby World Cup.

Physical activity interventions for cancer survivors

Abstract: Obesity and a sedentary lifestyle are highly prevalent in cancer survivors, and a growing number of publications have shown statistically and clinically significant associations between low levels of physical activity, obesity and cancer recurrence and death. Adoption and maintenance of physical activity is a difficult challenge for healthy adults, and is likely to be even more difficult after a cancer diagnosis. More effective strategies to increase physical activity in cancer survivors should be explored. The purpose of this paper is to (1) provide a rationale for physical activity interventions and programmes for cancer survivors, and (2) discuss successful approaches to adopting and maintaining physical activity to meet evidence based recommendations and ultimately improve cancer survival and overall survival. Since a majority of cancer survivors are not currently participating in recommended levels of physical activity, resulting in greater disease risk and health care costs, targeted exercise therapy has the potential to benefit a large number of cancer survivors. Cancer survivors should seek out the opportunities that exist towards being physically active, and oncologists should also become aware of the benefits of exercise, assist their patients by endorsing existing physical activity guidelines, and refer their patients to certified cancer exercise trainers.

Energy expenditure in adolescents playing new generation computer games

Abstract: Objective To compare the energy expenditure of adolescents when playing sedentary and new generation active computer games. Design Cross sectional comparison of four computer games. Setting Research laboratories. Participants Six boys and fi ve girls aged 13-15 years. Procedure Participants were fi tted with a monitoring device validated to predict energy expenditure. They played four computer games for 15 minutes each. One of the games was sedentary (XBOX 360) and the other three were active (Wii Sports). Main outcome measure Predicted energy expenditure, compared using repeated measures analysis of variance. Results Mean (standard deviation) predicted energy expenditure when playing Wii Sports bowling (190.6 (22.2) kJ/kg/min), tennis (202.5 (31.5) kJ/kg/min), and boxing (198.1 (33.9) kJ/kg/min) was signifi cantly greater than when playing sedentary games (125.5 (13.7) kJ/kg/min) (P<0.001). Predicted energy expenditure was at least 65.1 (95% confi dence interval 47.3 to 82.9) kJ/kg/min greater when playing active rather than sedentary games. Conclusions Playing new generation active computer games uses signifi cantly more energy than playing sedentary computer games but not as much energy as playing the sport itself. The energy used when playing active Wii Sports games was not of high enough intensity to contribute towards the recommended daily amount of exercise in children.

New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study

Abstract: New regimen for eccentric calf muscle training in patients with chronic insertional Achilles tendinopathy : results of a pilot-study

Is heart rate a convenient tool to monitor over-reaching? A systematic review of the literature

Abstract: Objective: A meta-analysis was conducted on the effect of overload training on resting HR, submaximal and maximal exercise HR (HR), and heart rate variability (HRV), to determine whether these measures can be used as valid markers of over-reaching. Methods: Six databases were searched using relevant terms and strategies. Criteria for study inclusion were: participants had to be competitive athletes, an increased training load intervention had to be used, and all necessary data to calculate effect sizes had to be available. An arbitrary limit of 2 weeks was chosen to make the distinction between short-term and long-term interventions. Dependent variables were HR and HRV (during supine rest). Standardised mean differences (SMD) in HR or HRV before and after interventions were calculated, and weighted according to the within-group heterogeneity to develop an overall effect. Results: In these competitive athletes, short-term interventions resulted in a moderate increase in both resting HR (SMD = 0.55; p = 0.01) and low frequency/ high frequency ratio (SMD = 0.52; p = 0.02), and a moderate decrease in maximal HR (SMD = 20.75; p = 0.01). Long-term interventions resulted in a small decrease in HR during submaximal (SMD = 20.38; p = 0.006) and maximal exercise (SMD = 20.33; p = 0.007), without alteration of resting values. Conclusion: The small to moderate amplitude of these alterations limits their clinical usefulness, as expected differences may fall within the day-to-day variability of these markers. Consequently, correct interpretation of HR or HRV fluctuations during the training process requires the comparison with other signs and symptoms of overreaching to be meaningful.

Temporal trends in adults’ sports participation patterns in England between 1997 and 2006: the Health Survey for England

Abstract: Objective: To examine temporal trends in participation in sport and exercise activities in England between 1997 and 2006 while taking into account wider societal changes. Design: A series of annual cross-sectional surveys. Setting and participants: Nationally representative samples of men (n = 27 217) and women (n = 33 721) aged ⩾16 years. Main outcome measures: Any (more than once every 4 weeks) and regular (more than once a week) participation in overall sport and exercise and a number of sport and exercise groupings (eg cycling, swimming, gym and fitness club-based activities (G/FC), racquet sports). Time point (1997/98, 2003/04, 2006) was the main dependent variable. Results: Age-standardised overall regular participation changed from 40.8% in 1997/98 to 41.2% in 2006 for men (multivariable-adjusted participation OR = 1.11 in 2006, 95% CI 1.03 to 1.19, p Conclusions: Sports and exercise participation in England has changed between 1997 and 2006 as the result of increases among middle-aged and older adults and decreases among young men. There are no signs that the participation gap between less and more advantaged population groups is narrowing.

After-school Interventions to Increase Physical Activity among Youth

Abstract: Most children and adolescents do not meet the recommended 60 minutes or more of moderate to vigorous physical activity per day. One attractive approach to increasing physical activity in young people is providing activity through structured after-school programmes. This paper provides a review of the scientific literature on the effects of after-school programmes on physical activity in children and adolescents. After-school physical activity interventions provided mixed results; some increased children's physical activity, others did not. Although after-school programmes have the potential to help children and adolescents engage in regular, enjoyable physical activity, the research on these programmes is limited and, in some cases, methodologically weak. Additional, well-controlled studies are needed to identify the components of after-school programmes that promote physical activity and to determine the level of activity that can be attained when children and adolescents participate in these programmes.

Patellofemoral pain syndrome: a review on the associated neuromuscular deficits and current treatment options

Abstract: Background: Patellofemoral pain syndrome (PFPS) is a common clinical presentation. Various neuromuscular factors have been reported to contribute to its aetiology. Study design: Systematic review Methods: A literature search was carried out from 1998 up to December 2007. Eligible studies were those that: (1) examined the effects of hip strengthening in subjects with PFPS; (2) examined the effects of physiotherapy treatment aimed at restoring muscle balance between the vastus medialis oblique (VMO) and vastus lateralis (VL) in subjects with PFPS; (3) examined the effect of taping on electromyogram (EMG) muscle amplitude in subjects with PFPS; and (4) compared the effects of open versus closed kinetic chain exercises in the treatment of subjects with PFPS. Results and conclusion: No randomised controlled trials exist to support the use of hip joint strengthening in subjects with PFPS. Physiotherapy treatment programmes appear to be an efficacious method of improving quadriceps muscle imbalances. Further studies are required to determine the true efficacy of therapeutic patellar taping. Both open and closed kinetic chain exercises are appropriate forms of treatment for subjects with PFPS.

Efficacy of personal symptom and family history questionnaires when screening for inherited cardiac pathologies? The role of electrocardiography.

Abstract: Aims: This study sought to confirm the efficacy of using resting 12-lead ECG alongside personal symptom and family history questionnaires and physical examination when screening for diseases with the potential to cause sudden cardiac death in the young. Methods and results: 1074 national and international junior athletes (mean age 15.8 (SD 0.7) years, range 10 to 27) and 1646 physically active schoolchildren (16.1 (SD 2.1) years, range 14 to 20) were screened using personal and family history questionnaires, physical examination and resting 12-lead ECG. Nine participants with a positive diagnosis of a disease associated with sudden cardiac death were identified. None of the participants diagnosed with a disease associated with sudden cardiac death were symptomatic or had a family history of note. Conclusion : Family history and personal symptom questionnaires alone are inadequate to identify people with diseases associated with sudden cardiac death. Use of the 12-lead ECG is essential when screening for cardiac pathology in the young.

Exercise and cognition in older adults: is there a role for resistance training programmes?

Abstract: In recent years, there has been a strong interest in physical activity as a primary behavioural prevention strategy against cognitive decline. A number of large prospective cohort studies have highlighted the protective role of regular physical activity in lowering the risk of cognitive impairment and dementia. The majority of prospective intervention studies of exercise and cognition to date have focused on aerobic-based exercise training. These studies highlight that aerobic-based exercise training enhances both brain structure and function. However, it has been suggested that other types of exercise training, such as resistance training, may also benefit cognition. The purpose of this brief review is to examine the evidence regarding resistance training and cognitive benefits. Three recent randomized exercise trials involving resistance training among seniors provide evidence that resistance training may have cognitive benefits. Resistance training may prevent cognitive decline among seniors via mechanisms involving IGF-1 and homocysteine. A side benefit of resistance training, albeit a very important one, is its established role in reducing morbidity among seniors. Resistance training specifically moderates the development of sarcopenia. The multifactorial deleterious sequelae of sarcopenia include increased falls and fracture risk as well as physical disability. Thus, clinicians should consider encouraging their clients to undertake both aerobic-based exercise training and resistance training not only for ‘physical health’ but also because of the almost certain benefits for ‘brain health’.

A comparative study of whole body vibration training and conventional training on knee proprioception and postural stability after anterior cruciate ligament reconstruction

Abstract: Objective: To compare the effect of a whole body vibration training (WBVT) programme with a conventional training (CT) programme on knee proprioception and postural stability after anterior cruciate ligament (ACL) reconstruction. Methods: Twenty athletes with unilateral ACL reconstruction were randomly assigned to the WBVT or CT group; all participants received 12 sessions of WBVT or conventional training. Absolute error in joint repositioning for two target angles (30° and 60°) was measured with the Biodex dynamometer; bilateral dynamic postural stability (anteroposterior, mediolateral and overall stability indices) was measured with the Biodex Stability System pre-intervention and post-intervention. Results: The improvement in postural stability in the WBVT group was significantly greater than that in the CT group (p⩽0.05). The p values of the changing scores of open overall, open anteroposterior, open mediolateral, closed overall, closed anteroposterior and closed mediolateral stability indices were 0.002, 0.010, 0.0001, 0.001, 0.0001 and 0.046, respectively. In addition, there were significant differences in all averages of absolute angular error at 60° and 30° between the WBVT and CT groups in both knees (p = 0.001 in healthy knees and p = 0.001 and p = 0.0001 in reconstructed knees), apart from the healthy knees at the 30° target position, which was not significant (p = 0.131). Conclusions: Whole body vibration training improved proprioception and balance in athletes with reconstructed ACL.

How do i measure physical activity in my patients? Questionnaires and objective methods

Abstract: How do healthcare providers know if their patients are getting enough physical activity to promote good health and to reduce their risks of chronic diseases and injury? The first step is to identify the patient's current level of physical activity using questionnaires and/or motion sensors. Questionnaires assess activity levels by having patients answer a set of questions about the types and amounts of activity performed at some time in the past. Motion sensors assess physical activity by patients wearing a small monitoring device that records their body movement as it occurs. If a provider is interested in determining a patient's caloric energy expenditure, he/she can apply statistical regression models to the questionnaire and motion sensor data to estimate kilocalories. If more precise measures of energy expenditure are desired, a provider can use the isotopic doubly labelled water method to estimate kilocalories; however, this method is costly and is impractical in non-research clinical settings.

Screening the athlete???s shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology

Abstract: Chronic shoulder pain and dysfunction are common complaints among overhead athletes seeking care from physical medicine and rehabilitation Impingement is a frequently described pathological condition in the overhead athlete Impingement symptoms may be the result of rotator cuff pathology, shoulder instability, scapular dyskinesis or muscle dysfunction, biceps pathology, SLAP lesions and chronic stiffness of the posterior capsule At present, numerous different shoulder tests have been described in literature and discussed with respect to their individual diagnostic accuracy However, in view of the number of shoulder tests, it is often a challenge for the clinician to select the appropriate tests for diagnosing the underlying pathology The purpose of this paper is to present and discuss a clinical algorithm which may be used in the early detection of the underlying causes of impingement symptoms In this algorithm, a specific chronology and selection of diagnostic tests may offer the clinician a guideline in his physical examination of the athlete with shoulder pain

Effective prevention of sports injuries: a model integrating efficacy, efficiency, compliance and risk-taking behaviour

Abstract: In 1992 van Mechelen et al published a "sequence of prevention model" based on a four-step process. This model has been widely used to implement preventive measures in response to sports injuries. However, the execution of this model has been shown to lack validity in determining the success of a preventive measure. A modified model has therefore been proposed which incorporates additional steps that enable the inclusion of external factors with a significant effect on the outcome of a prevention intervention. This expansion of van Mechelen's model leads to a more global model in which the compliance level and risk-taking behaviour of the individual and the assessment of efficiency of the stakeholders have a key influence on the preventive measure. This model gives a better insight into the different processes in injury prevention that can be used by clinicians, coaches and managers to decide whether to implement a preventive measure programme.