Research and Publications - Department of Kinesiology

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Acute Exercise and Oxidative Stress: CrossFit (TM) vs. Treadmill Bout
(Sciendo, 2015) Kliszczewicz, Brian; Quindry, C. John; Blessing, L. Daniel; Oliver, D. Gretchen; Esco, R. Michael; Taylor, J. Kyle; Kennesaw State University; Auburn University; University of Alabama Tuscaloosa
CrossFit (TM), a popular high-intensity training modality, has been the subject of scrutiny, with concerns of elevated risk of injury and health. Despite these concerns empirical evidence regarding physiologic stresses including acute oxidative stress is lacking. Therefore, the purpose of this investigation was to examine the acute redox response to a CrossFit (TM) bout. Furthermore, these findings were compared to a high-intensity treadmill bout as a point of reference. Ten males 26.4 +/- 2.7 yrs having three or more months of CrossFit (TM) experience participated in the present study. Blood plasma was collected at four time points: Pre-exercise (PRE), immediately-post-exercise (IPE), 1 hr-post (1-HP) and 2 hr-post (2-HP), to examine oxidative damage and antioxidant capacity. Regarding plasma oxidative damage, CrossFit (TM) and Treadmill elicited a time-dependent increase of lipid peroxides 1-HP (CrossFit (TM)=+143%, Treadmill=+115%) and 2-HP (CrossFit (TM) =+256%, Treadmill+167%). Protein Carbonyls were increased IPE in CF only (+5%), while a time-dependent decrease occurred 1-HP (CrossFit (TM)=-16%, Treadmill=-8%) and 2-HP (CF=-16%, TM=-1%) compared to IPE. Regarding antioxidant capacity, Ferric Reducing Antioxidant Power also demonstrated a time-dependent increase within CrossFit (TM) and Treadmill: IPE (CrossFit (TM)=+25%, Treadmill=+17%), 1-HP (CrossFit (TM)=+26%, Treadmill=+4.8%), 2-HP (CrossFit (TM)=+20%, Treadmill=+12%). Total Enzymatic Antioxidant Capacity showed a time-dependent decrease in IPE (CrossFit (TM)=-10%, Treadmill=-12%), 1-HP (CrossFit (TM)=-12%, Treadmill=-6%), 2-HP (CrossFit (TM)=-7%, Treadmill=11%). No trial-dependent differences were observed in any biomarker of oxidative stress. The CrossFit (TM) bout elicited an acute blood oxidative stress response comparable to a traditional bout of high-intensity treadmill running. Results also confirm that exercise intensity and the time course of exercise recovery influence oxidative responses.
Tracking Changes in Maximal Oxygen Consumption with the Heart Rate Index in Female Collegiate Soccer Players
(Sciendo, 2014) Esco, Michael R.; Snarr, Ronald L.; Flatt, Andrew; Leatherwood, Matthew; Whittaker, Adam; University of Alabama Tuscaloosa; Auburn University
The purpose of this study was to determine if the HRindex Method (VO2max = [6 x HRindex - 5] x 3.5, where HRindex = HRmax/HRrest) was accurate for tracking changes in VO2max following 8-weeks of endurance training among collegiate female soccer players. Predicted VO2max via the HRindex Method and observed VO2max from a maximal exercise test on a treadmill were determined for a group of female soccer athletes (n = 15) before and following an 8-week endurance training protocol. The predicted (pVO(2max)) and observed (aVO(2max)) values were compared at baseline and within 1-week post-training. Change values (i.e., the difference between pre to post) for each variable were also determined and compared. There was a significant difference between aVO(2max) before (43.2 +/- 2.8 ml.kg.min(-1)) and following (46.2 +/- 2.1 ml.kg.min(-1)) the 8-week training program (p < 0.05). However, pVO(2max) did not significantly change following training (pre = 43.4 +/- 4.6 ml.kg.min(-1), post = 42.9 +/- 4.1 ml.kg.min(-1), p = 0.53). Furthermore, the correlation between the change in aVO(2max) and the change in pVO(2max) was trivial and non-significant (r = 0.30, p = 0.28). The HRindex Method does not appear to be suitable for predicting changes in VO2max following 8-weeks of endurance training in female collegiate soccer players.
Electromyographical Comparison of a Traditional, Suspension Device, and Towel Pull-Up
(De Gruyter, 2017) Snarr, Ronald L.; Hallmark, Ashleigh V.; Casey, Jason C.; Esco, Michael R.; Georgia Southern University; University of Alabama Tuscaloosa
Strengthening muscles of the back may have various implications for improving functions of daily living, aiding in the transfer of power in throwing, and assist in injury prevention of the shoulder complex. While several versions of the pull-up exist, there is currently no literature comparing their differences. The purpose of this investigation was to compare the electromyographical activity of the latissimus dorsi, posterior deltoid, middle trapezius, and biceps brachii while performing three variations of the pull-up. Resistance-trained men and women (n = 15, age = 24.87 +/- 6.52 years) participated in this study by performing traditional pull-ups, suspension device pull-ups, and towel pull-ups in a randomized fashion. Each pull-up was performed for three repetitions with a 1.5 biacromial grip-width for each participant. Normalized (%MVC) electromyographical values were recorded for each muscle group during each pull-up variation. No significant differences existed within the latissimus dorsi, biceps brachii or posterior deltoid between any of the exercises. For the middle trapezius, towel pull-ups provided significantly lower muscle activity than the traditional pull-up, while no differences between suspension pull-ups and the other variations occurred. In conclusion, only one muscular difference existed between the exercise variations and all versions examined provided electromyographical values, determined by current literature, to invoke a sufficient stimulus to promote increases in muscle strength and hypertrophy. Although further research is needed, practitioners can be confident when programming any of the movement variations examined when attempting to elicit adaptations of muscular strength and hypertrophy.
Adequacy of the Ultra-Short-Term HRV to Assess Adaptive Processes in Youth Female Basketball Players
(Sciendo, 2017) Nakamura, Fabio Y.; Pereira, Lucas A.; Abad, Cesar C. Cal; Cruz, Igor F.; Flatt, Andrew A.; Esco, Michael R.; Loturco, Irineu; Universidade Estadual de Londrina; University of Alabama Tuscaloosa
Heart rate variability has been widely used to monitor athletes' cardiac autonomic control changes induced by training and competition, and recently shorter recording times have been sought to improve its practicality. The aim of this study was to test the agreement between the (ultra-short-term) natural log of the root-mean-square difference of successive normal RR intervals (lnRMSSD - measured in only 1 min post-1 min stabilization) and the criterion lnRMSSD (measured in the last 5 min out of 10 min of recording) in young female basketball players. Furthermore, the correlation between training induced delta change in the ultra-short-term lnRMSSD and the criterion lnRMSSD was calculated. Seventeen players were assessed at rest pre-and post-eight weeks of training. Trivial effect sizes (-0.03 in the pre-and 0.10 in the post-treatment) were found in the comparison between the ultra-short-term lnRMSSD (3.29 +/- 0.45 and 3.49 +/- 0.35 ms, in the pre-and post-, respectively) and the criterion lnRMSSD (3.30 +/- 0.40 and 3.45 +/- 0.41 ms, in the pre-and post-, respectively) (intraclass correlation coefficient = 0.95 and 0.93). In both cases, the response to training was significant, with Pearson's correlation of 0.82 between the delta changes of the ultra-short-term lnRMSSD and the criterion lnRMSSD. In conclusion, the lnRMSSD can be calculated within only 2 min of data acquisition (the 1(st) min discarded) in young female basketball players, with the ultra-short-term measure presenting similar sensitivity to training effects as the standard criterion measure.
Balance, Basic Anthropometrics and Performance in Young Alpine Skiers; Longitudinal Analysis of the Associations During Two Competitive Seasons
(Sciendo, 2017) Lesnik, Blaz; Sekulic, Damir; Supej, Matej; Esco, Michael R.; Zvan, Milan; University of Ljubljana; University of Split; University of Alabama Tuscaloosa
Balance is hypothesized to be important in alpine skiing, while it is known that balance depends on anthropometric indices. The aim of this investigation was to explore the association between balance, anthropometrics and skiing-results over two competitive seasons among youth alpine-skiers. Eighty-one skiers (40 females) participated in this study. The participants were tested twice over two competitive seasons: when they were 12-13 years old (U14) and when they were 14-15 years old (U16). The variables consisted of anthropometrics (body height and body mass) and three balance indexes (medio-lateral-, anterio-posterior- and overall-stability-index). Additionally, skiing results in U14 and U16 were evaluated. The balance status did not change significantly over the observed period of time regardless of the significant changes in body mass and height. The relationships between balance and skiing results were higher in the U14 (Pearson's r = 0.45-0.54) than in the U16 (Pearson's r = 0.05-0.28). The relationships between anthropometrics and competitive results were generally stronger in girls (Pearson's r = 0.39-0.88) than in boys (Pearson's r = 0.26-0.58). After clustering athletes into three achievement groups on a basis of their competitive performance, discriminant canonical analysis showed that relationships between balance and skiing results decreased, while the relationships between anthropometrics and skiing results increased over the two observed seasons. This study highlighted the importance of balance in youth alpine skiing in the age range of 11-14 years.
Field-Based Performance Tests Are Related to Body Fat Percentage and Fat-Free Mass, But Not Body Mass Index, in Youth Soccer Players
(MDPI, 2018) Esco, Michael R.; Fedewa, Michael, V; Cicone, Zackary S.; Sinelnikov, Oleg A.; Sekulic, Damir; Holmes, Clifton J.; University of Alabama Tuscaloosa; University of Split
The primary aim of this study was to determine the association between body composition and performance outcomes in youth soccer players. Twenty-five competitive male youth soccer players (age = 13.7 +/- 0.8 years, height = 167.4 +/- 9.7 cm, weight = 57.6 +/- 12.1 kg) volunteered to participate in this study. Height and weight were used to calculate body mass index (BMI). Body fat percentage (BF%) and fat-free mass (FFM) were determined with dual-energy X-ray absorptiometry. Each athlete performed the Pacer test, vertical jump, and t-test drill. Participants were predominantly normal weight (20.4 +/- 2.7 kg.m(-2)). The body composition results were 20.3 +/- 4.9% for BF% and 46.5 +/- 8.7 kg for FFM. The results of the performance tests indicated a mean standard deviation (SD) of 1418 +/- 332 m for Pacer, 57.2 +/- 7.4 cm for vertical jump, 11.6 +/- 0.7 s for t-test. Body mass index was not associated with any performance measure (r = 0.02 to -0.21, all p > 0.05). Body fat percentage was associated with the Pacer, vertical jump, and t-test (r = -0.62, -0.57, 0.61, respectively; all p < 0.01) and remained after accounting for BMI. Fat-free mass was only significantly related to t-test (r = -0.43, p < 0.01). However, after controlling for BMI, FFM was related to all three performance tests. Body fat percentage and FFM are associated with performance in youth soccer players, with stronger relationships reported in the former metric. The findings highlight the need for accurate body composition measurements as part of an assessment battery in young athletes.
Association between Subjective Indicators of Recovery Status and Heart Rate Variability among Divison-1 Sprint-Swimmers
(MDPI, 2018) Flatt, Andrew A.; Esco, Michael R.; Nakamura, Fabio Y.; University of Alabama Tuscaloosa; G d'Annunzio University of Chieti-Pescara; James Cook University
Heart rate variability (HRV) is a physiological marker of training adaptation among athletes. However, HRV interpretation is challenging when assessed in isolation due to its sensitivity to various training and non-training-related factors. The purpose of this study was to determine the association between athlete-self report measures of recovery (ASRM) and HRV throughout a preparatory training period. Ultra-short natural logarithm of the root mean square of successive differences (LnRMSSD) and subjective ratings of sleep quality, fatigue, muscle soreness, stress and mood were acquired daily for 4 weeks among Division-1 sprint-swimmers (n = 17 males). ASRM were converted to z-scores and classified as average (z-score -0.5-0.5), better than average (z-score > 0.5) or worse than average (z-score < -0.5). Linear mixed models were used to evaluate differences in LnRMSSD based on ASRM classifications. LnRMSSD was higher (p < 0.05) when perceived sleep quality, fatigue, stress and mood were better than average versus worse than average. Within-subject correlations revealed that 15 of 17 subjects demonstrated at least one relationship (p < 0.05) between LnRMSSD and ASRM variables. Changes in HRV may be the result of non-training related factors and thus practitioners are encouraged to include subjective measures to facilitate targeted interventions to support training adaptations.
Heart Rate Variability Responses to an Undulating Resistance Training Program in Free-Living Conditions: A Case Study in a Collegiate Athlete
(MDPI, 2018) Holmes, Clifton J.; Wind, Stefanie A.; Esco, Michael R.; University of Alabama Tuscaloosa
The purpose of this case study was to evaluate the response in heart rate variability via the parasympathetically-mediated metric of the log-transformed root mean square of successive R-R interval differences (lnRMSSD) to weekly variations in total volume-load (TVL) during an 18-week periodized strength training program in a competitive collegiate hockey athlete. The program consisted of three 60-90 min full-body exercise sessions per week with at least 24-h of rest between each session. Daily lnRMSSD measurements were taken immediately after waking using a validated smartphone application and the pulse-wave finger sensor. The weekly lnRMSSD values were calculated as the mean (lnRMSSD(MEAN)) and the coefficient of variation (lnRMSSD(CV)). A Pearson's bivariate correlation of lnRMSSD(MEAN) and TVL revealed no statistically significant correlation between the two variables; TVL (r = -0.105, p = 0.678). However, significant correlations were found between 1nRMSSD(CV) and both total load (TL) (r = -0.591, p = 0.013) and total volume (TV) (r = 0.765, p < 0.001). Additionally, weekly ratings of perceived exertion (RPE) mean values were statistically significantly correlated to TVL, r = 0.853, p < 0.001. It was concluded that lnRMSSD(CV) increased or decreased proportionally to an increase or decrease in TVL during the periodized resistance training program with TV being the strongest, independent indicator of these changes.
Daily Heart Rate Variability before and after Concussion in an American College Football Player
(MDPI, 2019) Flatt, Andrew A.; Wilkerson, Gary B.; Allen, Jeff R.; Keith, Clay M.; Esco, Michael R.; University of Alabama Tuscaloosa; University of Tennessee at Chattanooga
This case report demonstrates the effects of sport-related concussion (SRC) on heart rate variability (HRV) in an American college football player. Daily measures of resting, ultra-short natural logarithm of the root mean square of successive differences (LnRMSSD), subjective wellbeing, and Player Load were obtained each training day throughout a 4-week spring camp and 4 weeks of preseason training. SRC occurred within the first 2 weeks of the preseason. During spring camp and preseason pre-SRC, the athlete demonstrated minimal day-to-day fluctuations in LnRMSSD, which increased post-SRC (LnRMSSD coefficient of variation pre-SRC 3.1%, post-SRC = 5.8%). Moderate decrements in daily-averaged LnRMSSD were observed post-SRC relative to pre-SRC (Effect Size +/- 90% Confidence Interval = -1.12 +/- 0.80), and the 7-day rolling average fell below the smallest worthwhile change for the remainder of the preseason. LnRMSSD responses to SRC appeared similar to trends associated with stress and training fatigue. Therefore, performance and sports medicine staff should maintain regular communication regarding player injury and fatigue status so that HRV can be interpreted in the appropriate context. Detection and monitoring of autonomic dysregulation post-SRC may require near-daily assessment, as LnRMSSD showed greater daily fluctuations rather than chronic suppression following the head injury.
Risks of Heat Illness in Athletes With Spinal Cord Injury: Current Evidence and Needs
(Frontiers, 2020) Zhang, Yang; Bishop, Phillip A.; University of Alabama Tuscaloosa
Heart Rate Variability and Stress Recovery Responses during a Training Camp in Elite Young Canoe Sprint Athletes
(MDPI, 2019) Coelho, Andre B.; Nakamura, Fabio Y.; Morgado, Micaela C.; Holmes, Clifton J.; Di Baldassarre, Angela; Esco, Michael R.; Rama, Luis M.; Universidade de Coimbra; G d'Annunzio University of Chieti-Pescara; James Cook University; Universidade do Porto; University of Alabama Tuscaloosa
Training camps are typical in elite Canoeing preparation, during which, the care to assure adaptation to avoid undesired fatigue is not always present. This study aimed identifying a specific sex response in perceived training loads, recovery and stress balance, and cardiac autonomic responses. Twenty-one elite athletes (11 males and 10 females) of the Portuguese Canoeing National team participated in the investigation. The daily HRV (lnRMSSD) was monitored. The (RESTQ-52) questionnaire was used to access the recovery and stress state. The 10-day training camp was composed of two consecutive 5-day periods (P1 and P2). Data analyses were performed using confidence limits, effect size, and magnitude-based inference. In the females, Session rating of perceived exertion (sRPE), lnRMSSD, and its coefficient of variation did not change between P1 and P2. However, in males, lnRMSSD showed a small reduction from P1 to P2. Also, sRPE was higher in males over the training period, with a possibly small difference at P2. Regarding RESTQ-52, total stress most likely increased with large and very large differences in males and moderate differences in females during the training period. Male canoeists undertook higher perceived training loads than females, with a consequent higher level of total perceived stress and lnRMSSD during a 10-day training camp.
Acute Effects of a Perturbation-Based Balance Training on Cognitive Performance in Healthy Older Adults: A Pilot Study
(Frontiers, 2021) Martelli, Dario; Kang, Jiyeon; Aprigliano, Federica; Staudinger, Ursula M.; Agrawal, Sunil K.; University of Alabama Tuscaloosa; State University of New York (SUNY) Buffalo; Scuola Superiore Sant'Anna; Columbia University
Aging is accompanied by an alteration in the capacity to ambulate, react to external balance perturbations, and resolve cognitive tasks. Perturbation-based balance training has been used to induce adaptations of gait stability and reduce fall risk. The compensatory reactions generated in response to external perturbations depend on the activation of specific neural structures. This suggests that training balance recovery reactions should show acute cognitive training effects. This study aims to investigate whether exposure to repeated balance perturbations while walking can produce acute aftereffects that improve proactive and reactive strategies to control gait stability and cognitive performance in healthy older adults. It is expected that an adaptation of the recovery reactions would be associated with increased selective attention and information processing speed. Twenty-eight healthy older adults were assigned to either an Experimental (EG) or a Control Group (CG). The protocol was divided in 2 days. During the first visit, all participants completed the Symbol Digit Modalities Test (SDMT) and the Trail Making Test (TMT). During the second visit, a cable-driven robot was used to apply waist-pull perturbations while walking on a treadmill. The EG was trained with multidirectional perturbations of increasing intensity. The CG walked for a comparable amount of time with cables on, but without experiencing perturbations. Before and after the training, all participants were exposed to diagonal waist-pull perturbations. Changes in gait stability were evaluated by comparing the distance between the heel of the leading leg and the extrapolated Center of Mass (Heel-XCoM Distance-HXD) at perturbation onset (PON) and first compensatory heel strike (CHS). Finally, the cables were removed, and participants completed the SDMT and the TMT again. Results showed that only the EG adapted the gait stability (p < 0.001) in reaction to diagonal perturbations and showed improved performance in the SDMT (p < 0.001). This study provides the first evidence that a single session of perturbation-based balance training produce acute aftereffects in terms of increased cognitive performance and gait stability in healthy older adults. Future studies will include measures of functional activation of the cerebral cortex and examine whether a multi-session training will demonstrate chronic effects.
Outdoor Walking Speeds of Apparently Healthy Adults: A Systematic Review and Meta-analysis
(Adis, 2021) Murtagh, Elaine M.; Mair, Jacqueline L.; Aguiar, Elroy; Tudor-Locke, Catrine; Murphy, Marie H.; University of Limerick; University of Alabama Tuscaloosa; University of North Carolina; University of North Carolina Charlotte; Ulster University
Background Walking outdoors can be used by many individuals to meet public health guidelines for moderate-to-vigorous-intensity physical activity. The speed at which adults walk may be a proxy for intensity. Traditional estimates of indoor walking speed are unlikely to reflect self-selected usual or other instructed paces of outdoor walking speed. Objective To inform estimates of pace-based walking speed of apparently healthy adults in outdoor settings. Methods We searched four electronic databases for articles published in English between January 1970 and March 2019. Studies that reported walking speed (m/s), cadence (steps/min), or intensity (mL/kg/min) of ambulatory, apparently healthy, and community-dwelling adults (> 18 years) were included. Walking speed categories were defined according to the description provided in each study. Meta-analysis was used to synthesise speed, cadence, and intensity data by slow, usual, medium, fast, and maximal pace (where reported). Results Thirty-five studies, representing 14,015 participants (6808 women, 5135 men, and 2072 sex not specified), were identified. The mean (95% CI) walking speed for slow, usual, medium, fast, and maximal pace was 0.82 (0.77-0.86), 1.31 (1.27-1.35), 1.47 (1.44-1.49), 1.72 (1.64-1.81), and 1.62 (1.45-1.79) m/s, respectively. Mean cadence (95% CI) for usual and fast paces were 116.65 (114.95-118.35) and 126.75 (121.87-131.63) steps/min, respectively. The mean oxygen consumption (95% CI) for the usual and medium paces was 11.97 (11.69-12.25) and 13.34 (12.94-13.73) mL/kg/min, respectively. Conclusion These findings provide greater clarity with regard to how various indicators of enacted walking pace, speed, and intensity overlap and how each can be best communicated in the real-world setting to optimise health-related outcomes. Pace-based instructions can be used to support walking in outdoor settings within public health guidelines.
Reliability and accuracy of ultrasound image analyses completed manually versus an automated tool
(PeerJ, 2022) Wohlgemuth, Kealey J.; Blue, Malia N. M.; Mota, Jacob A.; University of Alabama Tuscaloosa; University of North Carolina; University of North Carolina Chapel Hill
Analysis of Brightness-mode ultrasound-captured fascicle angle (FA) and fascicle length (FL) can be completed manually with computer-based programs or by automated programs. Insufficient data exists regarding reliability and accuracy of automated tools. Therefore, the purpose of this study was to determine the test-retest reliability of automatic and manual ultrasound analyses, while determining accuracy of the automatic tool against the manual equivalent. Twenty-three participants (mean +/- SD; age = 24 +/- 4 years; height = 172.2 +/- 10.5 cm; body mass = 73.1 +/- 16.1 kg) completed one laboratory visit consisting of two trials where vastus lateralis muscle architecture was assessed with ultrasound. Images were taken at both lower (10 MHz) and higher frequency (12 MHz). Images were analyzed manually in an open-source imaging program and automatically using a separate open-source macro function. Test-retest reliability statistics were calculated for automatic and manual analyses. Accuracy was determined with validity statistics and were calculated for automatic analyses. The results show that manual ultrasound analyses for FA and FL for both lower and higher frequency displayed good reliability (ICC2,1 = 0.75-0.86). However, automatic ultrasound analyses for FA and FL revealed moderate reliability (ICC2,1 = 0.61-0.72) for the lower frequency images and poor reliability (ICC2,1 = 0.16-0.27) for higher frequency images. When assessed against manual techniques, automatic analyses presented greater total error (TE) and standard error of the estimate (SEE) for FA at lower frequency (constant error (CE) = -3.91 degrees, TE = 5.57 degrees, SEE = 3.45 degrees) than higher (CE = -2.78 degrees, TE = -4.54 degrees, SEE = 2.45 degrees). For FL, the higher frequency error (CE = 0.92 cm, TE = 2.12 cm, SEE = 1.15 cm) was similar to lower frequency error (CE = 1.98 cm, TE = 3.66 cm, SEE = 1.57 cm). The findings overall show that manual analyses had good reliability and low absolute error, while demonstrating the automated counterpart had poor to moderate reliability and large errors in analyses. These findings may be impactful as they highlight the good reliability and low error associated with manually analyzed ultrasound images and validate a novel automatic tool for analyzing ultrasound images. Future work should focus on improving reliability and decreasing error in automated image analysis tools. Automated tools are promising for the field as they eliminate biases between analysts and may be more time efficient than manual techniques.
Achieving Consensus Through a Modified Delphi Technique to Create the Post-concussion Collegiate Return-to-Learn Protocol
(Adis, 2023) Memmini, Allyssa K.; Popovich, Michael J.; Schuyten, Kristen H.; Herring, Stanley A.; Scott, Katie L.; Clugston, James R.; Choe, Meeryo C.; Bailey, Christopher M.; Brooks, M. Alison; Anderson, Scott A.; McCrea, Michael A.; Kontos, Anthony P.; Wallace, Jessica S.; Mihalik, Johna K. Register; Kasamatsu, Tricia M.; McLeod, Tamara Valovich; Rawlins, Michelle L. Weber; Snedden, Traci R.; Kaplan, Matthew; Akani, Briana; Orr, La'Joya C. L.; Hasson, Rebecca E.; Rifat, Sami F.; Broglio, Steven P.; University of New Mexico; University of Michigan; University of Washington; University of Washington Seattle; University of Florida; University of California Los Angeles; University of California Los Angeles Medical Center; David Geffen School of Medicine at UCLA; University of Wisconsin Madison; University of Oklahoma - Norman; Medical College of Wisconsin; University of Pittsburgh; University of Alabama Tuscaloosa; University of North Carolina; University of North Carolina Chapel Hill; California State University Fullerton; A.T. Still University of Health Sciences; San Diego State University; Cleveland Clinic Foundation
Background Sport-related concussions (SRCs) affect millions of adolescents and young adults annually in the USA; however, current SRC consensus statements provide limited guidance on academic support for students within higher education. Objective To generate consensus on appropriate academic recommendations for clinicians, students, and academic stakeholders to support university students during their recovery. Methods Panelists participated in three stages of a modified Delphi procedure: the first stage included a series of open-ended questions after reviewing a literature review on post-SRC return-to-learn (RTL) in higher education; the second stage asked panelists to anonymously rate the recommendations developed through the first Delphi stage using a 9-point scale; and the final stage offered panelists the opportunity to change their responses and/or provide feedback based on the group's overall ratings. Results Twenty-two panelists including clinicians, concussion researchers, and academic stakeholders (54.5% female) from 15 institutions and/or healthcare systems participated in a modified Delphi procedure. A total of 42 statements were developed after round one. Following the next two rounds, 27 statements achieved consensus amongst the panel resulting in the four-stage Post-Concussion Collegiate RTL Protocol. Conclusion There are several unique challenges when assisting university students back to the classroom after SRC. Explicit guidelines on when to seek additional medical care (e.g., if they are experiencing worsening or persistent symptoms) and how to approach their instructor(s) regarding academic support may help the student self-advocate. Findings from the present study address barriers and provide a framework for universities to facilitate a multidisciplinary approach amongst medical and academic stakeholders.
The modulatory role of cannabis use in subconcussive neural injury
(Cell Press, 2023) Kalbfell, Rachel M.; Rettke, Devin J.; Mackie, Ken; Ejima, Keisuke; Harezlak, Jaroslaw; Alexander, Isabella L.; Wager-Miller, Jim; Johnson, Blair D.; Newman, Sharlene D.; Kawata, Keisuke; Indiana University Bloomington; Washington University (WUSTL); Saint Louis University; Nanyang Technological University & National Institute of Education (NIE) Singapore; Nanyang Technological University; University of Alabama Tuscaloosa
Cannabis use has become popular among athletes, many of whom are exposed to repetitive subconcussive head impacts. We aimed to test whether chronic cannabis use would be neuroprotective or exacerbating against acute subconcus-sive head impacts. This trial included 43 adult soccer players (Cannabis group using cannabis at least once a week for the past 6 months, n = 24; non-cannabis control group, n = 19). Twenty soccer headings, induced by our controlled head-ing model, significantly impaired ocular-motor function, but the degrees of im-pairments were less in the cannabis group compared to controls. The control group significantly increased its serum S100B level after heading, whereas no change was observed in the cannabis group. There was no group difference in serum neurofilament light levels at any time point. Our data suggest that chronic cannabis use may be associated with an enhancement of oculomotor functional resiliency and suppression of the neuroinflammatory response following 20 soc-cer headings.
Sweat gland density and response during high-intensity exercise in athletes with spinal cord injuries
(Institute of Sports, 2015) Pritchett, R. C.; Al-Nawaiseh, A. M.; Pritchett, K. K.; Nethery, V; Bishop, P. A.; Green, J. M.; Central Washington University; Hashemite University; University of Alabama Tuscaloosa
Sweat production is crucial for thermoregulation. However, sweating can be problematic for individuals with spinal cord injuries (SCI), as they display a blunting of sudomotor and vasomotor responses below the level of the injury. Sweat gland density and eccrine gland metabolism in SCI are not well understood. Consequently, this study examined sweat lactate (S-LA) (reflective of sweat gland metabolism), active sweat gland density (SGD), and sweat output per gland (S/G) in 7 SCI athletes and 8 able-bodied (AB) controls matched for arm ergometry VO(2)peak. A sweat collection device was positioned on the upper scapular and medial calf of each subject just prior to the beginning of the trial, with iodine sweat gland density patches positioned on the upper scapular and medial calf. Participants were tested on a ramp protocol (7 min per stage, 20 W increase per stage) in a common exercise environment (21 +/- 1 degrees C, 45-65% relative humidity). An independent t-test revealed lower (p< 0.05) SGD (upper scapular) for SCI (22.3 +/- 14.8 glands.cm(-2)) vs. AB. (41.0 +/- 8.1 glands.cm(-2)). However, there was no significant difference for S/G between groups. S-LA was significantly greater (p< 0.05) during the second exercise stage for SCI (11.5 +/- 10.9 mmol.l(-1)) vs. AB (26.8 +/- 11.07 mmol.l(-1)). These findings suggest that SCI athletes had less active sweat glands compared to the AB group, but the sweat response was similar (SLA, S/G) between AB and SCI athletes. The results suggest similar interglandular metabolic activity irrespective of overall sweat rate.
A Comparison of Energy Expenditure Estimation of Several Physical Activity Monitors
(Lippincott Williams & Wilkins, 2013) Dannecker, Kathryn L.; Sazonova, Nadezhda A.; Melanson, Edward L.; Sazonov, Edward S.; Browning, Raymond C.; Colorado State University; University of Alabama Tuscaloosa; University of Colorado Denver
Introduction: Accurately and precisely estimating free-living energy expenditure (EE) is important for monitoring energy balance and quantifying physical activity. Recently, single and multisensor devices have been developed that can classify physical activities, potentially resulting in improved estimates of EE. Purpose: This study aimed to determine the validity of EE estimation of a footwear-based physical activity monitor and to compare this validity against a variety of research and consumer physical activity monitors. Methods: Nineteen healthy young adults (10 men, 9 women) completed a 4-h stay in a room calorimeter. Participants wore a footwear-based physical activity monitor as well as Actical, ActiGraph, IDEEA, DirectLife, and Fitbit devices. Each individual performed a series of postures/activities. We developed models to estimate EE from the footwear-based device, and we used the manufacturer's software to estimate EE for all other devices. Results: Estimated EE using the shoe-based device was not significantly different than measured EE (mean T SE; 476 T 20 vs 478 +/- 18 kcal, respectively) and had a root-mean-square error of 29.6 kcal (6.2%). The IDEEA and the DirectLlife estimates of EE were not significantly different than the measured EE, but the ActiGraph and the Fitbit devices significantly underestimated EE. Root-mean-square errors were 93.5 (19%), 62.1 kcal (14%), 88.2 kcal (18%), 136.6 kcal (27%), 130.1 kcal (26%), and 143.2 kcal (28%) for Actical, DirectLife, IDEEA, ActiGraph, and Fitbit, respectively. Conclusions: The shoe-based physical activity monitor provides a valid estimate of EE, whereas the other physical activity monitors tested have a wide range of validity when estimating EE. Our results also demonstrate that estimating EE based on classification of physical activities can be more accurate and precise than estimating EE based on total physical activity.
The Epidemiology of Deltoid Ligament Sprains in 25 National Collegiate Athletic Association Sports, 2009-2010 Through 2014-2015 Academic Years
(National Athletic Trainers' Association, 2017) Kopec, Thomas J.; Hibberd, Elizabeth E.; Roos, Karen G.; Djoko, Aristarque; Dompier, Thomas P.; Kerr, Zachary Y.; Samford University; University of Alabama Tuscaloosa; University of North Carolina; University of North Carolina Chapel Hill; University of North Carolina School of Medicine
Context: Deltoid ligament sprains among collegiate studentathletes have not been extensively investigated. Research regarding the mechanisms, participation-restriction time, and recurrence of deltoid ligament sprains in collegiate studentathletes is lacking. Objective: To describe the epidemiology of deltoid ligament sprains in 25 National Collegiate Athletic Association championship sports. Design: Descriptive epidemiology study. Setting: National Collegiate Athletic Association Injury Surveillance Program. Main Outcome Measure(s): We analyzed deltoid ligament sprains recorded in the Injury Surveillance Program for the 2009-2010 through 2014-2015 academic years. Deltoid ligament sprain injury rates, rate ratios, and injury proportion ratios with 95% confidence intervals (CIs) were reported. Results: During the study period, 380 deltoid ligament sprains were reported, resulting in a combined injury rate of 0.79/10 000 athlete-exposures (AEs; 95% CI = 0.71, 0.87). Most deltoid ligament sprains occurred in practices (54.2%, n = 206). However, the competition injury rate was higher than the practice injury rate (rate ratio = 3.74; 95% CI = 3.06, 4.57). The highest deltoid ligament sprain rates were in women's gymnastics (2.30/10 000 AEs; 95% CI = 1.05, 3.55), men's soccer (1.73/10 000 AEs; 95% CI = 1.14, 2.32), women's soccer (1.61/10 000 AEs; 95% CI = 1.13, 2.09), and men's football (1.40/10 000 AEs; 95% CI = 1.18, 1.62). Nearly half of all deltoid ligament sprains (49.7%, n = 189) were due to player contact, and 39.5% (n = 150) were non-time-loss injuries (ie, participation restricted for less than 24 hours). Only 8.2% (n = 31) of deltoid ligament sprains were recurrent. Conclusions: The highest deltoid ligament sprain rates were in women's gymnastics, men's and women's soccer, and men's football. However, the rate for women's gymnastics was imprecise (ie, the CI was wide), highlighting the need for further surveillance of deltoid ligament sprains in the sport. Most deltoid ligament sprains were due to player contact. Future researchers should assess interventions that may prevent deltoid ligament sprains.
Epidemiology of National Collegiate Athletic Association men's and women's swimming and diving injuries from 2009/2010 to 2013/2014
(BMJ, 2015) Kerr, Zachary Y.; Baugh, Christine M.; Hibberd, Elizabeth E.; Snook, Erin M.; Hayden, Ross; Dompier, Thomas P.; Harvard University; Boston Children's Hospital; University of Alabama Tuscaloosa
Background Recent injury data for collegiate-level swimming and diving are limited. This study describes the epidemiology of men's and women's swimming and diving injuries reported by the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) during the 2009/2010 to 2013/2014 academic years. Methods Injuries and athlete-exposure (AE) data reported within 9 men's and 13 women's swimming and diving programmes were analysed. Injury rates, injury rate ratios (IRR), and injury proportions by body site, diagnosis and mechanism were reported with 95% CIs. Results The ISP captured 149 and 208 injuries for men's and women's swimming and diving, respectively, leading to injury rates of 1.54/1000 and 1.71/1000 AEs. Among females, divers had a higher injury rate (2.49/1000 AEs) than swimmers (1.63/1000 AEs; IRR=1.53; 95% CI 1.07 to 2.19). Injury rates for male divers (1.94/1000 AEs) and swimmers (1.48/1000 AEs) did not differ (IRR=1.33; 95% CI 0.85 to 2.31). Most injuries occurred to the shoulder, resulted in strains and were classified as overuse or non-contact. Female swimmers had a higher overuse injury rate (1.04/1000 AEs) than male swimmers (0.66/1000 AEs; IRR=1.58; 95% CI 1.14 to 2.19). Overuse injury rates for female divers (0.54/1000 AEs) and male divers (0.46/1000 AEs) did not differ (IRR= 1.16; 95% CI 0.40 to 3.34). Injury rates in 2012/2013-2013/2014 were lower than those in 2009/2010-2011/2012 for women's swimming (IRR= 0.70; 95% CI 0.52 to 0.95) and diving (IRR= 0.56; 95% CI 0.30 to 1.08), respectively. No time trends existed for men's swimmers or divers. Conclusions Shoulder, strain and overuse injuries were common in collegiate men's and women's swimming and diving. Female swimmers were more likely to suffer an overuse injury than male swimmers. In addition, divers may have higher injury rates than swimmers, although small reported numbers warrant additional research.

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