Professor Carlton Cooke

Introduction Femoroacetabular impingement (FAI) is a recognised cause of pain and disability in athletes. The purpose of this study is to report the clinical outcomes in soccer athletes following hip arthroscopic surgery for FAI. Methods Soccer players were undergoing hip arthroscopy for symptomatic FAI. Demographic data, radiographic features of FAI and operative findings were recorded. The time to return to play soccer and their level of playing were documented. Athletes completed a patient satisfaction questionnaire, a visual analogue scale for pain (VAS for pain), the modified Harris Hip Score (mHHS) and Sports-score from the Hip Osteoarthritis Outcome Score (HOOS) pre and postoperatively. Results We included 50 soccer players with a mean age at the time of operation 26 (16-47, SD 7.8). Ten players underwent bilateral hip arthroscopy with a mean interval between the two operations 6.4 months (2-16, SD 2). The mean follow-up was 3.6 years (SD 14.09). During clinical examination all the athletes had anterior impingement test positive and log-roll test was negative to all. All of the athletes had FAI with 53 hips (88.3%) of mixed-type impingement. Labral repair was performed in 54 hips (90%) and in 10 hips (16.6%) os acetabulae was present. The status of the acetabular articular cartilage according to Outerbridge classification was of grade 4 in 22 hips and of grade 4 on femoral head in 4 hips. Three patients required re-operation for division of adhesions. Forty-seven players (94%) returned to play at the same level but two athletes elected not to return to play because of ageing and one player abandoned soccer following spinal surgery. The players returned to their pre-injury level to play at a mean of 14 weeks (8-54, SD 9.6). The mean patient satisfaction was 9.01 and the mean VAS scale for pain decreased considerably from 7.06 preop to 0.75. The mean mHHS (from 65.55 to 93.72) and sports-score (from 54.67 to 92.93) were improved for both groups. Conclusion This study demonstrates that arthroscopic treatment for FAI and associated intra-articular pathology in soccer players provides a significant clinical improvement and allows athletes to return to play promptly at the same level.

ABSTRACT: Aims: To assess test-retest reliability of both food photography and food diary methods and validity of these data against known values derived from food labels. Methods: Test-retest reliability analyses of food diary and food photography were compared using single foodstuffs using intra-class correlation coefficients, coefficients of variation and limits of agreement. For food diaries, 24-h test-retest reliability was also examined. Validity was assessed against weighed analyses. As part of habitual intake, a single foodstuff (randomly allocated from 14 common foods) were consumed by 26 participants over 24-h. On two occasions (14 days apart), single-blind dietary analyses allowed estimation of foodstuff-specific energy and macronutrient content, and 24-h intakes. Results: For food diaries, test-retest reliability was acceptable (weight, energy, carbohydrate, protein, fat: all intraclass correlation coefficients >0.990, coefficient of variation percentage: <0.1%, limits of agreements: <0.1 to <0.1, p>0.05, effect size: <0.01). For food photography, test-retest reliability was acceptable for weight, energy, carbohydrate, and protein (all intraclass correlation coefficients >0.898, coefficient of variation percentage: 3.6% - 6.2%, limits of agreements: 1.1 to – 44.9, effect size: 0.01 – 0.12). Food photography validity was worse than food diaries for all variables (percentage difference: 8.8% - 15.3%, coefficient of variation percentage: 7.5% - 13.8%, all; p≤0.05, effect size: 0.001 – 0.11). Conclusions: Greater reliability and validity occurred in food diaries versus food photography; findings which may suggest that using food photography may lead to an under-estimation of energy and macronutrient content, which may have implications for dietary interventions and nutritional strategies.

The association of lifestyle factors and biochemical variables with plasma viscosity was examined in a sample of middle-aged males of high social status. Analyses were performed on a subsample of men that had relevant rheological and biochemical variables determined during a preventive medical assessment conducted between 1992 and 1996. Among 622 subjects (64 smokers), measures of physical activity or predicted VO(2max) and adiposity (sum of subcutaneous skinfolds) were the lifestyle factors significantly associated with plasma viscosity (both P < 0.001). Among the biochemical variables, serum total protein and plasma fibrinogen concentrations accounted for most of the explained variability in plasma viscosity within subjects (combined adjusted r

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Introduction: Cold exposure and load carriage is an understudied area. Most research shows that VO2max is generally unaffected by cold exposure, however the majority of research suggests that sub-maximal O2 consumption increases for a given workload [1]. This pilot study assessed the effects of cold on load carriage. Methods: 4 male participants (age: 21.8 ± 3.4 years, height: 182.5 ±5.0 cm, weight: 77.8 ± 13.5 kg) completed a walking protocol of ~1 hour in a range of different ambient temperatures within an environmental chamber (20 °C, 10 °C, 5 °C, 0 °C, -5 °C and -10 °C). Humidity was controlled at ~50% while altitude was 0 m (20.95% FiO2). Participants wore shorts and t-shirt for all trials. The protocol included a 15 minute rest period, unloaded walking at 4 km.hr-1 for 4 minutes at 0% and 10% gradient. The same workloads were repeated loaded (18 kg) after a 5 minute rest. Heart rate returned to resting levels before each exercise section to ensure prior activity did not influence findings. Unloaded walking was then repeated. Expired air was collected and analysed using a Cortex 3B Metalyzer (Germany). Statistical analysis was performed using SPSS version 22, with significance denoted by p < 0.05. Results: Table ​Table1 shows a significant increase in VO2 with load (p = 0.019). At all workloads, significant increases in VO2 were associated with decreasing temperature (p = 0.048). ΔVO2 values suggest that the effect of loading was consistent, regardless of ambient temperature (p = 0.997). When comparing the first unloaded exercise bout with the second, VO2 for 20 °C, 10 °C and 5 °C was similar, whereas at 0 °C and below, VO2 was higher in the second unloaded bout, but this interaction was not significant (p = 0.158).

Aim: The aim of the present study was to assess the validity of jump height (h), absolute (VPOWERABS) and relative to body mass (VPOWERREL) performance indices when elicited of a modified 30 s Bosco vertical jump test (VJT) based on the absolute (WPOWERABS) and relative (WPOWERREL) power values of a 30 s Wingate test (WAnT). Methods: Nineteen physical education students with mean ± SD age 21±3 y, body mass 73.8±7 kg and height 1.8±0.06 m performed a 30 s VJT on a force plate and a 30 s WAnT on a Monark cycle ergometer. Performance data were expressed in W and W.kg-1 of body mass for WPOWERABS and WPOWERREL; in cm, W and W.kg-1 for h, VPOWERABS and VPOWERREL, respectively. The performance indices' values were expressed as means and SDs of the 30 s duration of both tests, as well as in 4 time intervals of 7.5 s (0-7.5 s, 7.5-15 s, 15-22.5 s, and 22.5-30 s). Results: WPOWERABS and h were significantly (P<0.05) correlated in the 4 time intervals (0-7.5 s: r=0.51; 7.5-15 s: r=0.36; 15-22.5 s: r=0.39) and in the overall duration of the test (0-30 s: r=0.38). Significant correlation was also revealed between VPOWERABS and WPOWERABS, but only for the interval 0-7.5 s (r=0.48). Conclusion: A 30 s VJT is valid against a 30 s WAnT only when h is used as performance indices. The selection of the appropriate unit of measurement is important for assessing effort distribution in maximum effort tests of short duration.

This study aimed to determine the effects of different acute creatine loadings (ACRL) on repeated cycle sprints. Twenty-eight active subjects divided into the control (n=7) and the experimental (n=21) group. The exercise protocol comprised three 30s Anaerobic Wingate Tests (AWT) interspersed with six minutes recovery, without any supplements ingested and following placebo and creatine ingestion, according to each ACRL (40g, 100g and 135g throughout a four-day period). Blood and urinary creatine levels were also determined from the experimental group for each ACRL. Protein intake (across all groups) was held constant during the study. There were no changes in protein intake or performance of the control group. For the experimental group creatine supplementation produced significant (p<0.01) increases in body mass (82.5 ± 1.4kg pre vs 82.9 ± 1.2kg post), blood (0.21 ± 0.04mmol·l-1 pre vs 2.24 ± 0.98mmol·l-1 post), and urinary creatine (0.23 ± 0.09mmol·l-1 pre vs 4.29 ± 1.98mmol·l-1 post). No significant differences were found between the non-supplement and placebo condition. Creatine supplementation produced an average improvement of 0.7%, 11.8% and 11.1% for the 40g, 100g and 135g ACRL respectively. However, statistics revealed significant (p<0.01) differences only for the 100g and 135g ACRL. Mean ± SD values for the 100g ACRL for mean and minimum power were 612 ± 180W placebo vs 693 ± 221W creatine and 381 ± 35W placebo vs 415 ± 11W creatine accordingly. For the 135g ACRL the respective performance values were 722 ± 215W placebo vs 810 ± 240W creatine and 405 ± 59W placebo vs 436 ± 30W creatine. These data indicate that a 100g compared to 40g ACRL produces a greater potentiation of performance whilst, greater quantities of creatine ingestion (135g ACRL) can not provide a greater benefit.

Professor Carlton Cooke joined Leeds Met in 1990, whilst working as a principal investigator on the pioneering Allied Dunbar National Fitness Survey. He became a Reader in 1993 and Carnegie Professor of Sport and Exercise Science in 1998, followed by his appointment in 2004 as Associate Dean and Head of the School of Sport, Exercise & Physical Education. His research interests range from physiological and biomechanical aspects of high level sports performance to physical activity, exercise and health in adults and children. Pro-Vice-Chancellor Professor Sally Brown said: "The University is delighted to recognise Carlton Cooke's work over many years as a researcher, research supervisor, research champion and advocate of research to support teaching by his appointment as Director of Research for the University."

This study assessed changes in kinetics from unloaded walking associated with load carriage using both a traditional and a new rucksack design that incorporates front balance pockets (AARN). Nine subjects walked at 3(±0.05) km.h

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The purpose of this study was to assess the energy expenditure associated with load carriage using both a traditional rucksack and a new rucksack design, the AARN rucksack, which incorporates front balance pockets. Nine volunteers walked at 3 km h

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Waist circumference 'action levels' have been recommended as a screening tool for overweight/obesity and associated metabolic risk factors. The use of waist circumference action levels in identifying need for weight management and higher metabolic risk was evaluated in 541 consecutive coronary artery disease patient referrals (85 female) to a long-term maintenance, community-based cardiac rehabilitation programme. Recommended waist circumference action levels identified overweight and obese patients (body mass index (BMI ≥ 25.0 kg·m

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Purpose: The relationship of both self-reported leisure time physical activity (LTPA) and predicted maximum oxygen consumption (V̇O(2max)) with plasma viscosity and hematocrit (Hct) concentration was examined within a cross-sectional sample of employed middle-aged men. Methods: Analyses were performed on a subsample of nonsmoking men who completed a preventive medical assessment between 1992-1996. Results: Among nonsmokers the mean age-adjusted levels of plasma viscosity (N = 590) and Hct concentration (N = 632) were significantly lower with higher Physical Activity Index (PAI) categories (P = 0.001 and P = 0.01, respectively). Following adjustment for conventional IHD risk factors and blood leukocyte count, a significant inverse relationship remained for Hct (P = 0.044) but not plasma viscosity. Mean age-adjusted plasma viscosity and Hct concentration also showed a significant decrease with higher quartiles of predicted V̇O(2max) (mL·kg

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The association between both plasma viscosity and fibrinogen concentration with clustering of metabolic risk markers was examined within a cross-sectional study of employed middle-aged men. Analyses were performed on a subsample of 629 non-smokers (46.7 ± 7.8 years) without diabetes. The effect of obesity and cardiorespiratory fitness on these haemorheological parameters and their association with the metabolic syndrome was also investigated. The cohort was grouped by the number of metabolic markers present. Metabolic markers included high-density lipoprotein-cholesterol (< 1.13 mmol/l), triglycerides (≥ 1.805 mmol/l), glucose (≥ 5.5 mmol/l) and diastolic blood pressure (≥ 90 mmHg). The age-adjusted odds ratio for hyperviscosity (≥ 1.67 mPa/s) was 2.08 [95% confidence interval (CI), 1.06- 4.05; P = 0.031] for the subjects with the metabolic syndrome (three or more metabolic markers) when compared with those with no metabolic abnormalities. The comparable age-adjusted odds ratio for hyperfibrinogenaemia (≥ 3.47 g/l) was non-significantly higher at 1.69 (95% CI, 0.87-3.27; P = 0.119). The mean age-adjusted plasma viscosity level and the prevalence of hyperviscosity increased significantly from 1.629 to 1.692 mPa/s (P = 0.0005) and from 21.0 to 36.0% with accumulating metabolic markers (P = 0.006). Plasma viscosity and fibrinogen concentration both increased with higher quartiles of skinfolds (P = 0.003 and P = 0.01, respectively) following adjustment for age, lipids and leucocyte count. Plasma viscosity was also significantly lower with higher levels of predicted maximum oxygen consumption (V̇(O2max)) (P = 0.0005). The odds ratio for hyperviscosity in subjects with the metabolic syndrome as compared with those with no metabolic markers was attenuated following adjustment for age, sum of skinfolds and predicted maximum oxygen consumption (V̇(O2max)) (1.44; 95% CI, 0.72-2.90; P = 0.307). These cross-sectional results suggest that plasma viscosity is associated with increased clustering of metabolic markers in middle-aged men of high socio-economic status. Obesity and poor cardiorespiratory fitness may be important in the development of haemorheological abnormalities associated with the metabolic syndrome. (C) 2000 Lippincott Williams and Wilkins.

Purpose: The relationship of both leisure time physical activity and predicted maximum oxygen consumption (VO2(max)) with plasma fibrinogen concentration was examined within a cohort of employed middle-aged men. Methods: Analyses were performed on a subsample of 635 nonsmoking men (46.7 ± 7.7 yr) who completed a preventive medical assessment between 1992 and 1996. Results: Among nonsmokers, mean age-adjusted fibrinogen concentration decreased significantly with higher physical activity index (PAI) categories and quartiles of predicted VO2(max) (mL · kg

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The aim is to quantify the physiological cost of head-load carriage and to examine the 'free ride' hypothesis for head-load carriage in groups of women differing in their experience of head-loading. Twenty-four Xhosa women [13 experienced head-loaders (EXP), 11 with no experience of head-loading (NON)] attempted to carry loads of up to 70% of body mass on both their heads and backs whilst walking on a treadmill at a self-selected walking speed. Expired air was collected throughout. In a second study nine women, members of the British Territorial Army, carried similar loads, again at a self-selected speed. Maximum load carried was greater for the back than the head (54.7 +/- 15.1 vs. 40.8 +/- 13.2% BM, P < 0.0005). Considering study one, head-loading required a greater oxygen rate than back-loading (10.1 +/- 2.6 vs. 8.8 +/- 2.3 ml kg bodymass(-1) min(-1), P = 0.043, for loads 10-25% BM) regardless of previous head-loading experience (P = 0.333). Percentage changes in oxygen consumption associated with head-loading were greater than the proportional load added in both studies but were smaller than the added load for the lighter loads carried on the back in study 1. All other physiological variables were consistent with changes in oxygen consumption. The data provides no support for the 'free ride' hypothesis for head-loading although there is some evidence of energy saving mechanisms for back-loading at low speed/load combinations. Investigating the large individual variation in response may help in identifying combinations of factors that contribute to improved economy.

The purpose of this study was to compare the subjective perceptual responses to both head-loading and back-loading in a group of Xhosa women. Thirty two women were divided into three groups based on their experience of head-loading and walked on a treadmill on two occasions, head-loading and back-loading, at a self selected walking speed for 4 min with a variety of loads until pain or discomfort caused the test to be terminated or a load of 70% body mass was successfully carried. After each workload there was a 1 min rest period during which the women indicated feelings of pain or discomfort in particular areas of the body via visual analogue scales. At the end of each test the women were asked to complete further questionnaires relating to pain and discomfort and on completion of the second test were also asked to compare the two loading conditions. Finally the women were interviewed to establish their history of load carriage and associated pain and discomfort. The data indicate that whilst back-loading was generally associated with more areas of discomfort than head-loading, the pain and discomfort in the neck associated with head-loading was the predominant factor in the termination of tests and that this was independent of head-loading experience. This early termination meant that, on average, the women could carry greater loads on their backs than on their heads. The study suggests that further work needs to be carried out to establish viable alternatives to head-loading for rural dwellers in Africa.

The aim of this study was to determine whether 4 weeks of inspiratory muscle training (IMT) would be accompanied by alteration in cardiopulmonary fitness as assessed through moderate intensity oxygen uptake (V̇O2) kinetics and maximal aerobic power (V̇O2max). Eighteen healthy males agreed to participate in the study [training group (Tra) n = 10, control group (Con) n = 8]. Measurements of spirometry and maximal static inspiratory mouth pressure (PImax) were taken pre- and post-training in addition to: (1) an incremental test to volitional exhaustion, (2) three square-wave transitions from walking to running at a moderate intensity (80% ventilatory threshold) and (3) a maximal aerobic constant-load running test to volitional fatigue for the determination of time to exhaustion (Tlim). Training was performed using an inspiratory muscle trainer (Powerbreathe). There were no significant differences in spirometry either between the two groups or when comparing the post- to pre-training results within each group. Mean PImax increased significantly in Tra (P < 0.01) and showed a trend for improvement (P < 0.08) in Con. Post-training Tlim was significantly extended in both Tra [232.4 (22.8) s and 242.8 (20.1) s] (P < 0.01) and Con [224.5 (19.6) and 233.5 (12.7) s] (P < 0.05). Post-training Tlim was significantly extended in Tra compared to Con (P < 0.05). In conclusion, the most plausible explanation for the stability in V̇O2 kinetics and V̇O2max following IMT is that it is due to insufficient whole-body stress to elicit either central or peripheral cardiopulmonary adaptation. The extension of post-training Tlim suggests that IMT might be useful as a stratagem for producing greater volumes of endurance work at high ventilatory loads, which in turn could improve cardiopulmonary fitness. © Springer-Verlag 2004.

Purpose – Domain and sub-domain physical self-perceptions have been associated with adolescent moderate intensity physical activity although the association with different types of adolescent moderate intensity physical activity remains unclear. This study seeks to examine the relationship between personal self-perceptions and adolescent sport/exercise and lifestyle moderate intensity physical activity frequency. Design/methodology/approach – A total of 122, 13-to-14 year-old, English adolescents from Leeds, West Yorkshire (58 boys and 64 girls) had their personal self-perceptions, sport/exercise and lifestyle moderate intensity physical activity assessed. Findings – No significant positive relationships were found between boys' personal self-perceptions and lifestyle moderate intensity physical activity. However, a range of weak (r = 0.34-0.42) but significant relationships (p < 0.01) were found between personal self perceptions and boys' sport/exercise frequency. In contrast, only perceptions of strength competence were significantly related to girls' sport/exercise frequencies (r = 0.28; p < 0.05), while all personal self perceptions scales were significantly related to girls' lifestyle moderate intensity physical activity (r = 0.26-0.32; p < 0.05). Research limitations/implications – The use of correlation analyses by this study placed limitations on the extent to which cause-effect relationships were established. Furthermore, girls' sport/exercise was poorly distributed, which may have led to the non-significant relationship found between this activity type and personal self-perceptions. The presence of a significant relationship between these two variables should therefore not be discounted. Originality/value – This study seems to be the first to investigate and identify variations in the personal self-perceptions – moderate intensity physical activity relationship relative to activity type. Although more research is required, findings have implications for practitioners aiming to tailor physical activity interventions to this group and researchers aiming to match specific correlates to different types of adolescent physical activity.

Although contrasting evidence exists in the literature as to the economy of head-loading, there is a notion that head-loading is an extremely economical method of load carriage. This has become known as the 'free ride' hypothesis and, although untested, it is widely accepted. The purpose of this study was to test the 'free ride' hypothesis for head-load carriage among African women by comparing the relative economy of head-loading and back-loading. Twenty-four Xhosa women walked on a level treadmill, attempting to carry loads of between 10% and 70% of their body mass (BM) using both a backpack and a head basket. All 24 women carried at least 25% of their BM in both conditions. The relative economy of load carriage was calculated for loads of 10% to 25% of BM. Results indicated that the 'free ride' was not a generalisable phenomenon, with both methods realising economy scores close to unity (1.04 ± 0.19 and 0.97 ± 0.15 for head-loading and back-loading, respectively). The results did, however, reveal significant individual differences in economy scores and it is suggested that analysis of such individual differences in future may well be instructive in understanding mechanisms associated with greater economy in load carriage. © 2010. The Authors.

This study aimed to determine the effects of different acute creatine loadings (ACRL) on repeated cycle sprints. Twenty-eight active subjects divided into the control (n=7) and the experimental (n=21) group. The exercise protocol comprised three 30s Anaerobic Wingate Tests (AWT) interspersed with six minutes recovery, without any supplements ingested and following placebo and creatine ingestion, according to each ACRL (40g, 100g and 135g throughout a four-day period). Blood and urinary creatine levels were also determined from the experimental group for each ACRL. Protein intake (across all groups) was held constant during the study. There were no changes in protein intake or performance of the control group. For the experimental group creatine supplementation produced significant (p<0.01) increases in body mass (82.5 ± 1.4kg pre vs 82.9 ± 1.2kg post), blood (0.21 ± 0.04mmol·l-1 pre vs 2.24 ± 0.98mmol·l-1 post), and urinary creatine (0.23 ± 0.09mmol·l-1 pre vs 4.29 ± 1.98mmol·l-1 post). No significant differences were found between the non-supplement and placebo condition. Creatine supplementation produced an average improvement of 0.7%, 11.8% and 11.1% for the 40g, 100g and 135g ACRL respectively. However, statistics revealed significant (p<0.01) differences only for the 100g and 135g ACRL. Mean ± SD values for the 100g ACRL for mean and minimum power were 612 ± 180W placebo vs 693 ± 221W creatine and 381 ± 35W placebo vs 415 ± 11W creatine accordingly. For the 135g ACRL the respective performance values were 722 ± 215W placebo vs 810 ± 240W creatine and 405 ± 59W placebo vs 436 ± 30W creatine. These data indicate that a 100g compared to 40g ACRL produces a greater potentiation of performance whilst, greater quantities of creatine ingestion (135g ACRL) can not provide a greater benefit.

Few studies have examined the effects of retirement from sports involving regular, high impact and weight bearing activity on bone mass. This cross-sectional study compared total body and regional areal bone mineral density (aBMD, g/cm2) within female former gymnasts and women who had never participated in structured sport or exercise, and explored relations between aBMD of these former gymnasts and their duration of retirement. Eighteen sedentary female former gymnasts (GYM) and 18 sedentary controls (CON) were recruited. GYM displayed a broad range of duration of retirement (3–12 years) and a wide age range (20–32 years). GYM and CON were paired individually to match for age, body mass and stature. GYM had commenced training at least 3 years pre-menarche and had trained post-menarche for 2 or more years. They had trained continuously for 5–12 years and had retired between age 14 and 22 years. Measurements of aBMD and body composition were made using dual energy X-ray absorptiometry (DXA). Group mean values of physical and skeletal characteristics were compared using paired t-tests. Linear regression was used to explore possible relations of aBMD within GYM to duration of retirement. GYM displayed a higher aBMD than CON at all measurement sites, which ranged in magnitude from 6% for the total body (P=0.004), to 11% for the total femur (P=0.006). Elevations of aBMD within GYM equated to T-scores ranging from +0.8 (arms) to +1.7 (legs). There were no differences in body composition or age of menarche between groups, although 11 of 18 GYM reported a history of irregular menses. There was no significant decline of aBMD with increasing duration of retirement in GYM. The results suggested that an elevated bone mass in female former gymnasts was retained during early adulthood, in spite of a cessation of training for up to 12 years.

In order to identify risk factors (e.g. physical inactivity, dietary composition) associated with blood pressure within a given population, it is necessary to adjust for differences in known associations (e.g. age, body weight) using a method such as the analysis of covariance. However, the blood pressure results from the Allied Dunbar National Fitness Survey (ADNFS) were found to be non-linear with age, positively skewed (with heteroscedastic errors) and therefore non-normally distributed. Hence, before valid inferences can be drawn from such data, there is a clear need to formulate an appropriate model for blood pressure that will overcome these undesirable characteristics. A multiplicative model (with allometric body size components) was proposed and fitted to the ADNFS blood pressure results. After a logarithmic transformation the parsimonious solution was able to confirm the association with BMI, the non-linear changes with age, and overcome the heteroscedastic and positively skewed errors, i.e. the residuals from the fitted log-linear models for both systolic and diastolic blood pressure were symmetric and normally distributed. Other factors were found to make a significant additional contribution to the prediction of blood pressure. Cyclists, participants in vigorous physical activity and those subjects who consumed more fresh fruit, rice or pasta, and wine were found to have significantly lower mean levels of blood pressure. Indeed, the gap in blood pressure between participants and non-participants in vigorous physical activity increased further with age. However, subjects who drank more beer tended to have significantly higher mean levels of blood pressure. Thus, by developing an appropriate model for arterial blood pressure, some well known, and some less well known, associations with arterial blood pressure have been identified. The results suggest that physical activity and other lifestyle factors may protect against hypertension.

The aim of this study was to identify the kinematic and postural characteristics associated with sprint running on uphill and downhill slopes of 3° and on a horizontal surface. Eight male physical education students were filmed while sprinting maximally on an uphill-downhill platform under each of three conditions: (a) uphill at 3°, (b) downhill at 3° and (c) horizontal. Running speed, step rate, step length, step time, contact time, flight time and selected postural characteristics of the step cycle were analysed. Running speed was 9.2% faster (P < 0.05) during downhill and 3.0% slower (P < 0.05) during uphill compared with horizontal sprint running. During downhill and uphill sprint running, step length was the main contributor to the observed changes in running speed. It increased by 7.1% (P < 0.05) for downhill sprint running and was associated with significant changes in posture at touchdown and take-off. During uphill sprint running, step length decreased by 5.2% (P < 0.05), which was associated with significant changes in posture and reduced flight distance. Given the interaction between the acute changes in step length and posture when sprinting on a sloping surface, our findings suggest that such changes in posture may detract from the specificity of training on such surfaces. The chronic effects of training on such slopes on the kinematics and posture of horizontal sprint running are currently unclear.

Aerobic and anaerobic performance of the upper body (UB) and lower body (LB) were assessed by arm cranking and treadmill tests respectively in a comparison of national (N) and international (I) male gymnasts. Force velocity and Wingate tests were performed using cycle ergometers for both arms and legs. In spite of a significant difference in training volume (4-12 vs. 27-34 h · wk-1 for N and I, respectively), there was no significant difference between N and I in aerobic and anaerobic performance. Upper body and LB maximal oxygen uptake (Vo2max) values were 34.44 ± 4.62 and 48.64 ± 4.63 ml middot; kg-1 middot; min-1 vs. 33.39 ± 4.77 and 49.49 ± 5.47 ml middot; kg-1 middot; min-1 respectively, for N and I. Both N and I had a high lactic threshold (LT), at 76 and 82% of Vo2max, respectively. Values for UB and LB force velocity (9.75 ± 1.12 and 15.07 ± 4.25 vs. 10.63 ± 0.95 and 15.87 ± 1.25 W · kg-1) and Wingate power output (10.43 ± 0.74 and 10.98 ± 3.06 vs. 9.58 ± 0.60 and 13.46 ± 1.34 W · kg-1) were also consistent for N and I. These findings confirm the consistency of Vo2max values presented for gymnasts in the last 4 decades, together with an increase in peak power values. Consistent values for aerobic and anaerobic performance suggest that the significant difference in training volume is related to other aspects of performance that distinguish N from I gymnasts. Modern gymnastics training at N and I levels is characterized by a focus on relative strength and peak power. In the present study, the high LT is a reflection of the importance of strength training, which is consistent with research for sports such as wrestling.

The aim of this study was to examine the effects of sprint running training on sloping surfaces (3[degrees]) on selected kinematic and physiological variables. Thirty-five sport and physical education students were randomized into 4 training groups (uphill-downhill, downhill, uphill, and horizontal) and a control group, with 7 participants in each group. Pre- and posttraining tests were performed to examine the effects of 6 weeks of training on the maximum running speed at 35 m, step rate, step length, step time, contact time, eccentric and concentric phase of contact time, flight time, selected posture characteristics of the step cycle, and peak anaerobic power performance. Maximum running speed and step rate were increased significantly (p < 0.05) in a 35-m running test after training by 0.29 m[middle dot]s-1 (3.5%) and 0.14 Hz (3.4%) for the combined uphill-downhill group and by 0.09 m[middle dot]s-1 (1.1%) and 0.03 Hz (2.4%) for the downhill group, whereas flight time shortened only for the combined uphill-downhill training group by 6 milliseconds (4.3%). There were no significant changes in the horizontal and control groups. Overall, the posture characteristics and the peak anaerobic power performance did not change with training. It can be suggested that the novel combined uphill-downhill training method is significantly more effective in improving the maximum running velocity at 35 m and the associated horizontal kinematic characteristics of sprint running than the other training methods are.

The multi-stage 20-m shuttle run fitness test (20mMSFT) is a popular field test which is widely used to measure aerobic fitness by predicting maximum oxygen uptake (VO2max) and performance. However, the velocity at which VO2max occurs (vVO2max) is a better indicator of performance than VO2max, and can be used to explain inter-individual differences in performance that VO2max cannot. It has been reported as a better predictor for running performance and it can be used to monitor athletes' training for predicting optimal training intensity. This study investigated the validity and suitability of predicting VO2max and vVO2max of adult subjects on the basis of the performance of the 20mMST. Forty eight (25 male and 23 female) physical education students performed, in random order, a laboratory based continuous horizontal treadmill test to determine VO2max, vVO2max and a 20mMST, with an interval of 3 days between each test. The results revealed significant correlations between the number of shuttles in the 20mMSFT and directly determined VO2max (r = 0.87, p<0.05) and vVO2max (r = 0.93, p<0.05). The equation for prediction of VO2max was y = 0.0276x + 27.504, whereas for vVO2max it was y = 0.0937x + 6.890. It can be concluded that the 20mMSFT can accurately predict VO2max and vVO2max and this field test can provide useful information regarding aerobic fitness of adults. The predicted vVO2max can be used in monitoring athletes, especially in determining optimal training intensity.

To understand the energy balance of international female rugby sevens (R7s) players in applied environments, this study estimated the energy intakes (EI) and total daily estimated energy expenditures (TDEE) during a five-day training camp (TRAIN) and phase of competition preparation (COMP) of equal duration. Tri-axial accelerometer devices were worn throughout both scenarios to estimate TDEE, whereas EI was estimated via self-reported food diaries. Energy deficits of -47% (TDEETRAIN: 14.6 ± 1.6 MJ·day-1, EITRAIN: 7.7 ± 0.9 MJ·day-1, p ≤ 0.001, d = 5.1) and -50% (TDEECOMP: 15.5 ± 1.6 MJ·day-1, EICOMP: 7.7 ± 1.0 MJ·day-1, p ≤ 0.001, d = 5.7) were observed throughout TRAIN (n = 11; age: 25 ± 4 years, height: 170 ± 6 cm, weight: 71 ± 7 kg) and COMP (n = 8; age: 25 ± 3 years, height: 172 ± 5 cm, weight: 72 ± 6 kg), respectively. Carbohydrate intakes were below the lower range of sports nutrition recommendations in both TRAIN (-62%; 2.3 ± 0.3 g·kg-1 BM, p ≤ 0.001) and COMP (-60%; 2.4 ± 0.5 g·kg-1 BM, p ≤ 0.001). For protein (TRAIN: 1.7 ± 0.4 g·kg-1 BM, COMP: 1.5 ± 0.1 g·kg-1 BM), intakes met the lower range of recommendations. Fat intake exceeded recommendations of the percentage of total EI (COMP: 39 ± 5%). Accordingly, the dietary strategies of international female R7s players may warrant optimization, as carbohydrate and fat intakes were less than optimal when compared to current performance-based sports nutrition guidelines.

PURPOSE: The relationship of both physical activity and predicted maximum oxygen consumption (VO2max) with the clustering of metabolic risk factors associated with the metabolic syndrome (MS) was examined within 711 employed middle-aged (46.9 +/- 7.8 yr) men. METHODS: Metabolic markers included fasting glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure, and BMI, defined by highest risk quintiles or clinically relevant risk thresholds. RESULTS: The prevalence and age-adjusted odds ratios of all MS clusters were inversely graded across both higher physical activity index (PAI) and cardiorespiratory fitness (CRF) categories. The age-adjusted odds ratio for the clustering of clinically relevant metabolic markers was 0.60 (95% CI 0.22-1.22) for subjects in the occasional/light PAI, 0.32 (95% CI 0.12-0.82) for the moderate/moderately vigorous PAI, and 0.13 (95% CI 0.02-1.02) for the vigorous PAI when compared with subjects in the sedentary PAI (P < 0.05 for trend). The corresponding age-adjusted odds ratio was 0.28 (95% CI 0.14-0.57) for subjects in the moderate fitness category and 0.12 (95% CI 0.05-0.32) for the highest fitness category compared with those in the lowest fitness category (P < 0.001 for trend). Higher levels of physical activity or CRF were also associated with significantly lower age-adjusted odds ratios for the MS after exclusion of obesity in the MS definition. CONCLUSION:Overall, these cross-sectional results suggest that higher physical activity and predicted VO2max levels are associated with a decreased clustering of risk factors associated with the MS in middle-aged men of higher social class.

Background: Reference data for the body composition values of female athletes are limited to very few sports, with female Rugby Union players having mostly been omitted from such analyses.Methods: Using dual energy X-ray absorptiometry (DXA) scans, this study assessed the body composition profiles (body mass, bone mineral content; BMC, fat mass; FM, lean mass; LM, bone mineral density; BMD) of 15 competitive female Rugby Union players before and after the 2018/19 competitive season. Total competitive match-play minutes were also recorded for each player.Results: Body mass (73.7 ± 9.6 kg vs 74.9 ± 10.2 kg, p ≤ 0.05, d = 0.13) and BMC (3.2 ± 0.4 kg vs 3.3 ± 0.4 kg, p ≤ 0.05, d = 0.15) increased pre- to post-season for all players. Conversely, FM (21.0 ± 8.8 kg), LM (50.7 ± 3.9 kg), and BMD (1.31 ± 0.06 g·cm−2) were similar between time-points (all p > .05). Accounting for position, body mass (rpartial(12) = 0.196), FM (rpartial(12) = −0.013), LM (rpartial(12) = 0.351), BMD (rpartial(12) = 0.168) and BMC (rpartial(12) = −0.204) showed no correlation (all p > .05) against match-play minutes.Conclusion: The demands of the competitive season influenced specific body composition indices (i.e., body mass, BMC) in female Rugby Union players; a finding which was unrelated to the number of minutes played in matches. While the causes of such differences remain unclear, practitioners should be cognizant of the body composition changes occurring throughout a female Rugby Union competitive season and, where necessary, consider modifying variables associated with adaptation and recovery accordingly.

Aim: The aim of the present study was to assess the validity of jump height (h), absolute (VPOWERABS) and relative to body mass (VPOWERREL) performance indices when elicited of a modified 30 s Bosco vertical jump test (VJT) based on the absolute (WPOWERABS) and relative (WPOWERREL) power values of a 30 s Wingate test (WAnT). Methods: Nineteen physical education students with mean ± SD age 21±3 y, body mass 73.8±7 kg and height 1.8±0.06 m performed a 30 s VJT on a force plate and a 30 s WAnT on a Monark cycle ergometer. Performance data were expressed in W and W.kg-1 of body mass for WPOWERABS and WPOWERREL; in cm, W and W.kg-1 for h, VPOWERABS and VPOWERREL, respectively. The performance indices' values were expressed as means and SDs of the 30 s duration of both tests, as well as in 4 time intervals of 7.5 s (0-7.5 s, 7.5-15 s, 15-22.5 s, and 22.5-30 s). Results: WPOWERABS and h were significantly (P<0.05) correlated in the 4 time intervals (0-7.5 s: r=0.51; 7.5-15 s: r=0.36; 15-22.5 s: r=0.39) and in the overall duration of the test (0-30 s: r=0.38). Significant correlation was also revealed between VPOWERABS and WPOWERABS, but only for the interval 0-7.5 s (r=0.48). Conclusion: A 30 s VJT is valid against a 30 s WAnT only when h is used as performance indices. The selection of the appropriate unit of measurement is important for assessing effort distribution in maximum effort tests of short duration.

Purpose: To link annual changes of bone mineral density (BMD) over 12 consecutive years to pharmacological intervention and to fluctuations of body mass and body composition in an amenorrheic athlete. Methods: BMD of the lumbar spine (LS) and total proximal femur (PF) were measured using dual energy x-ray absorptiometry (DXA), every 11-13 months between ages 24.8 and 36.9 yr. Body composition was assessed every 3-4 yr from a whole body DXA scan. Body mass was recorded every 3 months. For the first 5 yr of study, the subject used oral contraceptives (OC). For the subsequent 7 yr, she used estradiol skin patches (EP) with oral norethisterone. Results: The first DXA scan (age 24.8 yr) revealed a low BMD at both LS and PF, with T-scores of -1.4 and -2.8, respectively. During the next 5 yr, while adhering to OC, the BMD of her LS and PF declined by 9.8% and 12.1%, respectively. Concomitantly, her body mass fell from 45.1 to 41.4 kg, her body mass index (BMI) from 16.4 to 15.0 kg·m-2, and her percent body fat from 8.3 to <4.0%. While treated with EP and norethisterone (age 29.8-33.5 yr), her LS BMD gradually increased by 9.4%, despite a further 0.8 kg decline of body mass. From age 33.8 to 36.9 yr, voluntary weight gain (2-3 kg·yr-1; total: 8.1 kg) was accompanied by an increase of her PF BMD (16.9%), with no further increase at the LS. Conclusion: Changes of BMD at the total proximal femur reflected changes of body mass in this subject. At the lumbar spine, BMD declined with weight loss but increased in association with transdermal estradiol treatment in the absence of weight gain. The female athlete triad is a syndrome of disordered eating, amenorrhea, and osteoporosis that has been documented in women training for sports in which there is an emphasis on a low body mass, such as distance running (25). Certain metabolic features of this syndrome resemble those of anorexia nervosa and are characteristic of protracted energy restriction (6,25). Despite the potential for physical activity to enhance or protect bone mass (20,27,31), this beneficial effect may be counteracted by a negative energy balance, a low body mass, and associated endocrine disturbances (26,34,38,39). Furthermore, it is well established that only those activities that involve load bearing and/or high-impact movements provide an osteogenic stimulus (20,27,31). This stimulus is localized to the bones that are specifically stressed by the activity (20,27,31) and is therefore unlikely to protect the entire skeleton from the systemic effects of energy restriction and a low body mass. Decrements of bone mass in women with the female athlete triad have been shown to be positively related to the duration of their menstrual disturbance (23,26,28). To date, prospective studies of bone mineral density (BMD) in women with the female athlete triad have been short term (<2 yr) and have shown that bone loss continues, or fails to increase, while a low body mass and amenorrhea persist (8,18,35). However, weight gain may be accompanied by significant increments of BMD, particularly if there is an associated resumption of menses (8,18,35). There have been few controlled trials that have investigated the efficacy of combined estrogen and progestogen treatment for the protection of bone mass in young, active women with a low body mass and amenorrhea (10,12,14,19,22), and the majority have shown no beneficial effect. We report here annual changes of BMD within the lumbar spine and total proximal femur over a 12-yr period (24.8-36.9 yr) in a female athlete with a history of energy-restricting behavior dating back to childhood. All measurements of BMD were made on GE/Lunar absorptiometers operating in the same scan mode. Three different absorptiometers were used throughout the study, with a change of machine after the first five scans and the subsequent four scans. Before measurement with a different absorptiometer, a cross-calibration procedure was undertaken to enable accurate comparisons to be made. To prevent drift in measurements made by the same absorptiometer over time, the machine was subjected to a daily quality assurance and a weekly quality control procedure as recommended by the manufacturers. Accompanying measures of body mass and composition, physical activity, and selected hormone concentrations, in conjunction with sex hormone treatment, are discussed.

Complex training is the method of coupling heavy and light loads into an organized sequence with the aim of facilitating postactivation potentiation. Anecdotal evidence has supported the use of complex training sequences, but scientific studies investigating the effects of sequencing isometric loads with dynamic muscle actions have been limited. The purpose of this study was to examine the effects of a preconditioning sequence of maximal isometric knee extensions on performance standards in selected dynamic whole-body exercise. Fourteen track and field athletes (23 6 5.7 years; 71.53 6 6.93 kg; 172.6 6 5.8 cm) were randomly assessed in selected whole-body exercises (drop and countermovement jumps, 5-second cycle sprint, knee extension) following a sequence of maximal voluntary isometric contractions (MVC; 3 repetitions of 3 seconds or 3 repetitions of 5 seconds) or in the absence of prior loading (control). Electromyographic (EMG) assessments of muscle activity were also made during the knee extension assessment. Significant (p # 0.05) increases in jump height (5.03%), maximal force (4.94%), and acceleration impulse (9.49%) were observed in the drop jump following 3 repetitions of 3-second MVC only. Knee extension maximal torque was also significantly increased (6.12%) following the 3-second MVC. No significant changes in countermovement jump or cycle sprint measures were observed for any of the experimental conditions. Though adaptations were found, changes in EMG activity were not significantly different for any of the experimental conditions. These data indicate that performing a sequence of repeated maximal isometric knee extensions (3 repetitions of 3 seconds) prior to selected dynamic exercise (#0.25 seconds) may have favorable effects on performance beyond standards achieved without prior heavy loading.

The purpose of this study was to compare the kinetic responses associated with ground reaction force measurements to both head-loading and back-loading in a group of Xhosa women. Altogether, 16 women were divided into two groups based on their experience of head-loading. They walked over a force plate in three conditions: unloaded or carrying 20 kg in either a backpack or on their head. The most striking finding was that there was no difference in kinetic response to head-loading as a consequence of previous experience. Considering the differences between the load carriage methods, most changes were consistent with increasing load. Head-loading was, however, associated with a shorter contact time, smaller thrust maximum and greater vertical force minimum than back-loading. Both loading conditions differed from unloaded walking for a number of temporal variables associated with the ground contact phase, e.g. vertical impact peak was delayed whilst vertical thrust maximum occurred earlier. Statement of Relevance: Consideration of the kinetics of head and back load carriage in African women is important from a health and safety perspective, providing an understanding of the mechanical adaptations associated with both forms of load carriage for a group of people for whom such load carriage is a daily necessity. © 2011 Taylor & Francis.

Purpose. To explore relationships between load carriage economy and the kinematics and kinetics of load carriage using both a backpack (BP) and a double pack (DP). Basic procedures. Nine participants walked on a treadmill at gradients of between 27% downhill and 20% uphill, and over a force plate on level ground, at a speed of 3 km.h-1. Expired air was collected throughout the treadmill experiment and all experiments were filmed for subsequent biomechanical analysis. The relative economy of load carriage was expressed in terms of the Extra Load Index (ELI). Main findings. There was a tendency for the double pack system to be associated with better economy than the BP. The double pack system provoked significantly less forward lean than the backpack and the horizontal displacement of the CoM was also smaller for the double pack system and both of these factors were strongly related to economy. There was, however, a greater range of motion of the trunk in the DP condition and this was also associated with improved economy. Conclusions. The results suggest that the DP was associated with smaller perturbations in gait than the BP and that this represents an advantage in terms of economy. In particular freedom of movement of the trunk in the sagittal plane may be an important consideration in the efficiency of load carriage systems.

Energy Balance, Bone Turnover, and Skeletal Health in Physically Active Individuals. Med. Sci. Sports Exerc., Vol. 36, No. 8, pp. 1372-1381, 2004. Over the past 20 years, there have been a growing number of reports of low bone mineral density (BMD) or premature bone loss in individuals with a high physical activity level. These skeletal problems have been documented mainly in underweight women with amenorrhea and have often been linked to a sex hormone deficiency. However, sex hormone treatment has been shown to have limited efficacy for the prevention or treatment of low BMD in such women. Studies of bone turnover in women with sustained exercise-associated amenorrhea using metabolic markers of osteoblast activities and collagen synthesis have demonstrated an apparent reduction of bone formation that is associated with a low body mass index (BMI) and with endocrine disturbances that are characteristic of energy deficit. Comparable metabolic and endocrine disturbances have been observed in anorexic women that reverse with weight gain. Furthermore, increases of BMD accompany weight gain in both groups of women, even without a return of menses. Collectively, these observations suggest an important link between energy balance and the balance of bone turnover in women with exercise and/or diet-associated amenorrhea. Although there have been few studies that have explored relations between bone turnover, BMD, and energy balance in physically active men, there is evidence for a link between reduced bone formation and an abrupt, short-term energy deficit. Interestingly, the presence of low BMD in physically active men has not been associated with a sex hormone deficiency. This review evaluates the evidence that underlies the hypothesis that an energy deficit is instrumental in the disturbance of bone turnover that has been observed in physically active individuals.

The drag flick is important in field hockey as it gives a greater opportunity to score a goal at penalty corners than hitting does. However, there is a lack of scientific research conducted on this technique. The purpose of this research was therefore to undertake a technique analysis of the drag flick. Given the paucity of research 10 field hockey coaches were recruited to synthesise expert opinions using a consensus-based, modified three-stage Delphi poll, comprising initial interviews and subsequent questionnaires. 28 physical and technical attributes were agreed and informed the biomechanical analyses. The four corners of the goal were agreed as the preferential target areas along with ball accuracy as the overall performance criterion. Twelve mixed ability field hockey players (8 male and 4 female) (age 24.25 ± 4.83 years, height 1.75 ± 0.09 m and mass 77.29 ± 17.44 kg) were then recruited to perform 60 drag flick trials at a 1 m2 target positioned in a standard field hockey goal at a distance of 14.63 m. The trials were split into three conditions: Self-selected target area, performance criterion ball accuracy; self-selected target area, ball velocity; and prescribed target area, ball accuracy. Three-dimensional kinematic data was recorded from a motion analysis system using a 15-segment model to compute performance and technique variables. An analysis of the full time series of kinematic data was completed to determine the core movement strategy of the drag flick technique. The main findings showed that the task constraint of accuracy altered the kinematic sequencing of players from a throw like pattern to more of a push like pattern. The left and right hip and shoulder ab-/adduction and left and right elbow and wrist flex/-extension are the key joint angles which contribute to the core of the drag flick technique. A dimensional reduction technique (PCA) was then applied to the same data to decompose the complex, but highly redundant set of postures into a comprehensible number of uncorrelated variables. Each of these variables represented multisegmented movements, which could be visualized. The main findings were that the left and right flex-/extension of the wrists are key to drag flick technique, in addition to the lowering of the thorax. Also the lower body kinematics explain greater variance compared with the shoulder and elbow joints, as they dominate the principal components, accounting for most of the variance. Although further work is required, this research has enhanced the understanding of the technique of the field hockey drag flick, particularly with respect to the core movement strategy.

Product Description Whether you’re an experienced mountaineer, a hardened climber, or about to embark on your first expedition, nothing is more critical than anticipating, understanding, and preparing for the adversities and accomplishments that await you and your team. In Mountaineering: Training and Preparation, Carlton Cooke, Dave Bunting, and John O’Hara, along with the members of the British Army Everest West Ridge Expedition team and sport and exercise scientists from Leeds Metropolitan University, share their insights, experiences, and expertise on these aspects of mountaineering: •Selecting the right team for each expedition •Physical conditioning and training programs to ensure success •Nutritional strategies for your training and expeditions •Team safety, climbing precautions, and first aid •Preparing for and surviving in extreme conditions From the technical aspects of a climb to the leadership and teamwork skills so essential to success, this comprehensive guide covers all of the essentials for a safe and successful expedition. Mountaineering: Training and Preparation is must-read for every mountaineer. Read it before your next expedition. Contents Part I Planning and Team Selection Chapter 1 Logistics and Planning Chapter 2 Team Selection Chapter 3 Preparation Chapter 4 Equipment Chapter 5 First Aid, Travel, and Acclimatisation Part II Conditioning and Nutrition for Expeditions Chapter 6 Fitness and Training Chapter 7 Endurance Training Chapter 8 Strength and Power Training Chapter 9 Nutrition for Training Chapter 10 Nutrition for Expeditions Part III Expedition Leadership and Psychology Chapter 11 Psychological Skills in the Outdoors Chapter 12 Resilience Chapter 13 Leadership

This paper addresses two questions. Firstly, do inequalities of opportunity exist between the general population and adults with mild and moderate learning disabilities to lead a physically active lifestyle? Secondly, should the provision of equivalent opportunities be considered a human right? For the learning disability population the right to opportunities to be physically active can be divided into primary and secondary rights, the former is the right to opportunities, the latter is whether and how the opportunities are taken up. The principle of distributive justice gives people with a learning disability the same right as others to be physically active. Realisation of such a right would bring the potential for tangible health benefits. This review suggests that care in the community is insufficiently resourced to provide adequately beyond basic needs and that significant inequalities do exist between the general and learning disability populations in relations to opportunities and choices to be physically active.

Purpose: Whilst the health benefits associated with regular physical activity are well known, little objective evidence exists regarding the activity profiles of adults with mild and moderate learning disabilities. The aims of the present study were to establish 7 day physical activity profiles for 24 adults with mild and moderate learning disabilities and to compare them with the general population and current Department of Health recommendations for physical activity. Method: A descriptive study was used, based on interviews with 24 adults with learning disabilities (mean age 34 years) triangulated by daytime and residential care workers. Participants volunteered from two residential homes and one social education centre (SEC) in a city in the North of England. Results: The physical activity profiles show that the participants led sedentary lifestyles that were more exaggerated than those of the general population. Twenty-two participants (93%) performed significantly less than the minimum daily levels of physical activity recommended by the Department of Health. Conclusions: Few adults with learning disabilities can choose to walk to work, go for a run or visit the local swimming pool without adequate support. This study suggests that there may not be enough moderate or vigorous physical activity choices available in day and residential care settings to empower adults with mild and moderate learning disabilities to meet the minimum recommendations of the Department of Health. Hence some people with learning disabilities have no alternatives to a sedentary lifestyle and the health risks associated with physical inactivity.

One hundred and ninety-four children enrolled in a summer weight loss camp program (64 boys and 130 girls, aged 12.6 ± 2.5 years) and were assessed for body mass and stature on arrival. One hundred and fourteen subjects were assessed for waist circumference, with a subgroup of 14 boys assessed on 8 skinfold thicknesses, 9 circumference measures, and a self-paced walk test to evaluate aerobic performance. A further group of 40 girls were assessed on 3 psychometric variables (self concept, body esteem, and body cathexis). During the camp (located in Massachusetts, U.S.), diet was restricted to 1,400 kcal · day−1, with a daily prescription of structured fun-type, skill-based physical activities and regular behavioral and educational sessions. Paired t tests showed highly significant improvements (p < .001) in all variables comparing pre and post intervention measures. The improvements in body composition, aerobic performance, and psychometric variables suggest that the camp program was successful in reducing significant risk factors in children’s health.

Levels of overweight and obesity in children continue to increase despite recognition within the public health agenda, growing levels of media attention, and public debate. Of course the negative physical, psychological, and social consequences of obesity are of major concern to those people involved in tackling this condition. At this time the prevention of obesity is considered the primary objective in efforts to tackle this problem on a national scale (Department of Health, 2004; Institute of Medicine, 2004). However, given the current levels of obesity such a strategy will on average exclude the one in three children that are already overweight to such a degree that their health will be negatively affected. This is a concern given that this group represents a sizable proportion of the population and they are likely to require greater healthcare support in the medium and long term (Haslam, Sattar, & Lean, 2006). Daviglus et al. (2004) concluded that “overweight/ obesity in young adulthood and middle age has long term adverse consequences for health care costs in older age” (p. 2743) with annual health care costs averaging $6,244 for normal weight, $7,653 for overweight, $9,612 for obese and $12,432 for severely obese women. Arter-burn, Maciejewski, and Tsevat (2005) have also contributed to this evidence, suggesting healthcare expenditures were 81 percent higher for the morbidly obese than normal weight individuals—equating to more than $11 billion in 2000. Such evidence demonstrates the need for the development and delivery of a range of initiatives to combat this growing epidemic.

Childhood obesity is rapidly increasing, with few effective interventions currently available. It is therefore prudent to establish the efficacy of a range of possible intervention options. Sixty-five obese children were enrolled in the program and compared with 42 normal-weight children. They were assessed for a range of anthropometric, fitness, and metabolic variables (subsample n=10). Children in the intervention group participated in a range of recreational activities including six one-hour skill-based fun-type activities, moderate dietary restriction, and three weekly educational sessions. Significant group by time interactions on all measures showed that the campers improved all variables compared to their normal-weight peers. In addition, paired t-tests showed significant (p < 0.05) improvements in several of the metabolic variables. The program was successful in achieving significant improvements in indicators of health and well-being, whereas such changes were not found in the free-living comparison group. Follow-up studies are currently underway to assess the longer-term impact of this program. Keywords: obesity, weight-loss camp, children, exercise therapy, recreational therapy, diet, behavior modification

Introduction Adductor injuries are a common problem in football resulting in days of absence from sports and in high reinjury rate. Acute avulsion of the adductor longus through its fibrocartilagenous enthesis is an uncommon injury. The purpose of this study is to highlight the injury of the adductor longus at its enthesis, be it complete or partially avulsed, and to report the functional outcome and return to play following surgical treatment. Materials and Methods We included footballers who presented with an acute injury of the adductor longus origin. Demographic data, clinical examination, strength testing measurements, imaging features and level of sports were recorded. Athletes were assessed for pain using a visual analogue scale. The time and the level to return to play football following selective partial adductor release (for partial avulsion with minimal displacement) (2) or adductor longus reattachment (for complete avulsion) (1) were documented. Results We included 58 out of 73 football players with acute adductor injury; 43 were professional players with a mean age at the time of operation 25 (18-36, SD 4.7) and 15 were non-professional with a mean age 38 (23-48, SD 7.3). There were 32 professional and nine non-professional footballers with complete avulsion, 11 professional and six non-professional with partial avulsion with minimal displacement. Previous history of adductor enthesopathy was noted in 31 professional of which 21 had undergone more than two corticosteroid injections and in seven non-professional, all of them had undergone corticosteroid injections. The mean VAS scale for pain was decreased and adductor strength was increased considerably. All of the athletes returned to play football but one player with incomplete tear at 8 weeks sustained a complete avulsion and underwent surgical reattachment. The footballers with reattachment returned to full training at a mean 11.75 weeks (SD 6.5) and returned to play at a median 13 weeks (IQR 8). The footballers with selective partial adductor release returned to full training at a mean 6.4 weeks (SD 2.07) and returned to play at a median 8 weeks (IQR 4). Conclusion This study demonstrates that acute avulsion of the adductor longus should be treated taking into account the degree and type of injury. Surgical treatment be it reattachment of the enthesis or selective partial adductor release provides a significant clinical improvement and allows athletes to return to play promptly and at the same level. References 1. Dimitrakopoulou A., Schilders EM., Talbot JC., Bismil Q.Acute avulsion of the fibrocartilage origin of the adductor longus in professional soccer players: a report of two cases. Clin J Sport Med. 2008;18(2):167-169. 2. Schilders E, Dimitrakopoulou A., Cooke M., Bismil Q., Cooke C. Effectiveness of a Selective Partial Adductor Release for Chronic Adductor-Related Groin Pain in Professional Athletes. Am J Sports Med 2013;41(3):603-7

Introduction: Life expectancy has increased and elderly people have the desire to live an active lifestyle with participation in sports. Hip arthroscopy has not yet been established as standard treatment in this group of patients. The purpose of this study is to assess the outcomes after hip arthroscopy for FAI in patients aged over 50, as well as to report the factors that can lead to conversion to a hip replacement. Methods: Prospectively collected data were retrieved from our database in patients aged 50 years or older undergoing hip arthroscopic surgery for FAI and disabling pain. Demographics, clinical examination, imaging signs of impingement and operative findings were recorded. Patients completed MHHS pre and postoperatively and patients’ satisfaction. Factors that may indicate a conversion to a hip replacement were statistically analysed. Results: We included 149 patients (163 hips) with a mean age 56.7 years (50 -80). There were 75 males and 74 females. Median follow-up was 19 months. All patients had signs of FAI on radiographs and osteoarthritic changes 0-3 according to Tonnis classification. Hip replacement was required in 12 patients (8.05%). The MHHS improved from mean 57.14 (26-96)preoperatively to 79.24 (28-100) postoperatively. The mean patients’ satisfaction was 85 (0-100). Statistically hip arthroscopy was significantly more likely to fail in patients who were older at the time of surgery (OR=1.09, p=0.05). Patients were also significantly more likely to progress to a hip replacement with poor acetabular articular cartilage (OR=2.59, p=0.05) and with severe cartilage changes on the femoral head (OR=6.63, p=0.008). It was significantly more likely for patients with a higher age at the time of surgery to undergo a labral resection (OR=1.09, p=0.007). The group of patients who underwent a labral resection was significantly more likely to need a hip replacement when compared with the group of patients who had a labral repair (OR=10.67, p=0.028). Patients with lateral sourcil height less than <2mm were significantly more likely to undergo a total hip replacement ((OR=9.11, p=0.05). Conclusion: In patients with FAI aged 50 years or older good results can be achieved with therapeutic hip arthroscopy and with low conversion to a hip replacement. Factors that can lead to a failure of hip arthroscopy are >2mm joint space, labral resection, higher age and severe osteoarthritic changes, especially on the femoral head.

Introduction Acetabular rim ossicles known as os acetabuli are considered as unfused secondary centres of ossification or fatigue fractures caused by overload. Competitive athletes subject their hips to a significant amount of stress and therefore make them more prone to hip injuries. The purpose of this study is to assess the presence of os acetabuli in athletes undergoing hip arthroscopy and to report its prevalence for different type of sports. Methods A mixed group of athletes were assessed following hip arthroscopy for femoro acetabular impingement (FAI) and associated pathology. Clinical examination, radiographic features and operative findings were documented. The level and type of sports were recorded and categorized according to their movement required per sport in predictable and unpredictable movements. The return to sports was also mentioned. Results From our database we retrieved 378 athletes from different type of sports treated for FAI. Imaging modalities showed the presence of os acetabulae in 30 athletes. There were 139 (36.7%) athletes with predictable movements during their sport; golf 34 (24.4%) athletes, in cycling were 64 (46%), dressage were 13 (9.3%) and ballet 28 (20.14%). In this group of predictable movements were found 3 athletes with os acetabuli: 2 in cycling (3.1%) and 1 in golf (2.9%). There were 239 (63.2%) athletes in sports with unpredictable movements; in soccer 177 (74%) athletes, rugby 42 (17.5%) and cricket 20 (8.3%). In this group 27 athletes had the presence of os acetabuli: soccer 21 (11.8%), rugby 5 (11.5%) and cricket 1 (5%). Conclusion This study demonstrates a higher prevalence of os acetabuli in sports with unpredictable movements such as soccer, rugby and cricket compared to those sports with predictable movements such as golf, cycling, dressage and ballet. It is not unreasonable then in sports to refer to it as a rim fracture rather than as os acetabulae.

Résultats suivants arthroscopie de la hanche pour conflit fémoroacétabulaire chez les patients plus de 50 ans d' âge Introduction Life expectancy has increased and elderly people have the desire to live an active lifestyle with participation in sports. Hip arthroscopy has not yet been established as standard treatment in this group of patients. The purpose of this study is to assess the outcomes after hip arthroscopy for FAI in patients aged over 50, as well as to report the factors that can lead to conversion to a hip replacement. Methods Prospectively collected data were retrieved from our database in patients aged 50 years or older undergoing hip arthroscopic surgery for FAI and disabling pain. Demographics, clinical examination, imaging signs of impingement and operative findings were recorded. Patients completed MHHS pre and postoperatively and patients’ satisfaction. Factors that may indicate a conversion to a hip replacement were statistically analysed. Results We included 149 patients (163 hips) with a mean age 56.7 years (50 -80). There were 75 males and 74 females. Median follow-up was 19 months. All patients had signs of FAI on radiographs and osteoarthritic changes 0-3 according to Tonnis classification. Hip replacement was required in 12 patients (8.05%). The MHHS improved from mean 57.14 (26-96)preoperatively to 79.24 (28-100) postoperatively. The mean patients’ satisfaction was 85 (0-100). Statistically hip arthroscopy was significantly more likely to fail in patients who were older at the time of surgery (OR=1.09, p=0.05). Patients were also significantly more likely to progress to a hip replacement with poor acetabular articular cartilage (OR=2.59, p=0.05) and with severe cartilage changes on the femoral head (OR=6.63, p=0.008). It was significantly more likely for patients with a higher age at the time of surgery to undergo a labral resection (OR=1.09, p=0.007). The group of patients who underwent a labral resection was significantly more likely to need a hip replacement when compared with the group of patients who had a labral repair (OR=10.67, p=0.028). Patients with lateral sourcil height less than <2mm were significantly more likely to undergo a total hip replacement ((OR=9.11, p=0.05). Conclusion In patients with FAI aged 50 years or older good results can be achieved with therapeutic hip arthroscopy and with low conversion to a hip replacement. Factors that can lead to a failure of hip arthroscopy are >2mm joint space, labral resection, higher age and severe osteoarthritic changes, especially on the femoral head.

Introduction The painful groin is a challenging entity. The complexity of groin anatomy, the similarity of symptoms for different pathologies that may co-exist may lead to a diagnostic dilemma and delays in treatment. The purpose of the study is to determine the prevalence of adductor enthesopathy in patients require arthroscopic surgery for treatment of femoroacetabular impingement (FAI) and to evaluate the results of treatment for both of these disorders. Methods Prospectively collected data were retrieved to identify patients with both symptomatic FAI and adductor enthesopathy at the time of presentation. Demographics, clinical examination, imaging signs of hip impingement and adductor enthesopathy were recorded. Isometric strength testing of the adductors and abductors was measured in both legs using a handheld dynamometer. Patients completed the modified Harris hip score (MHHS) pre and postoperatively and pain was evaluated on a visual analog scale (VAS). Results From our database of 1135 patients were included 38 (3.34%) patients with 44 hips. There were 31 males and 7 females with a mean age 36.8 years (20-63, SD 11.6). Mean follow-up was 27.7 months (SD 19.7). Pubic cleft injections were carried out in 37 (84.09%) hips and 20 (45.4%) hips underwent selective partial adductor release. All of the patients (100%) underwent hip arthroscopic surgery for FAI. Maximum improvement in strength was observed at two months postoperatively both on the operated and non-operated side compared to preoperative strength. The MHHS improved from mean 60 (21-74, SD 16.2) preoperatively to 79 (30-100, SD 17.6) postoperatively and VAS for pain from 6.9 (SD 1.7) to 2.8 (SD 2.6). Conclusion When FAI and adductor enthesopathy are present then both pathologies should be addressed simultaneously or in a staged manner to optimize the postoperative outcomes. Pubic cleft injections and selective partial adductor release are valuable therapeutic procedures in patients treated for symptomatic FAI.

Introduction Femoroacetabular impingement (FAI) is a recognised cause of pain and disability in athletes. The purpose of this study is to report the clinical outcomes in soccer athletes following hip arthroscopic surgery for FAI. Methods Soccer players were undergoing hip arthroscopy for symptomatic FAI. Demographic data, radiographic features of FAI and operative findings were recorded. The time to return to play soccer and their level of playing were documented. Athletes completed a patient satisfaction questionnaire, a visual analogue scale for pain (VAS for pain), the modified Harris Hip Score (mHHS) and Sports-score from the Hip Osteoarthritis Outcome Score (HOOS) pre and postoperatively. Results We included 50 soccer players with a mean age at the time of operation 26 (16-47, SD 7.8). Ten players underwent bilateral hip arthroscopy with a mean interval between the two operations 6.4 months (2-16, SD 2). The mean follow-up was 3.6 years (SD 14.09). During clinical examination all the athletes had anterior impingement test positive and log-roll test was negative to all. All of the athletes had FAI with 53 hips (88.3%) of mixed-type impingement. Labral repair was performed in 54 hips (90%) and in 10 hips (16.6%) os acetabulae was present. The status of the acetabular articular cartilage according to Outerbridge classification was of grade 4 in 22 hips and of grade 4 on femoral head in 4 hips. Three patients required re-operation for division of adhesions. Forty-seven players (94%) returned to play at the same level but two athletes elected not to return to play because of ageing and one player abandoned soccer following spinal surgery. The players returned to their pre-injury level to play at a mean of 14 weeks (8-54, SD 9.6). The mean patient satisfaction was 9.01 and the mean VAS scale for pain decreased considerably from 7.06 preop to 0.75. The mean mHHS (from 65.55 to 93.72) and sports-score (from 54.67 to 92.93) were improved for both groups. Conclusion This study demonstrates that arthroscopic treatment for FAI and associated intra-articular pathology in soccer players provides a significant clinical improvement and allows athletes to return to play promptly at the same level.

Introduction Acetabular rim ossicles known as os acetabuli are considered as unfused secondary centres of ossification or fatigue fractures caused by overload. Competitive athletes subject their hips to a significant amount of stress and therefore make them more prone to hip injuries. The purpose of this study is to detect the presence of os acetabuli in soccer and to report its prevalence. Methods Athletes were assessed following hip arthroscopy for femoroacetabular impingement (FAI) and associated pathology. Clinical examination, radiographic features, operative findings and the return to sports were documented. The presence of os acetabuli in soccer was recorded and its prevalence in comparison with other sports was calculated. Results From our database we retrieved 378 athletes treated for FAI. The sports were categorized according to their movement required per sport in predictable and unpredictable movements. There were 139 (36.7%) athletes from sports with predictable movements (golf, cycling, dressage, ballet) and 239 (63.2%) athletes with unpredictable movements (soccer, rugby, cricket). Imaging modalities showed the presence of os acetabulae in 30 athletes. In sports with predictable movements were found only 3 athletes (2.15%) with os acetabuli and in sports with unpredictable movements 27 athletes (11.29%) had the presence of os acetabuli. Specifically in soccer there were 177 (74%) players with 21 (11.8%) had the presence of os acetabuli. Conclusion This study demonstrates that os acetabulae is present in sports with most unpredictable and uncoordinated movements compared to sports require smooth and predictable movements. The higher prevalence of os acetabulae seems to be in soccer compared to other sports. This suggests that might be said in soccer as a rim fracture rather than os acetabulae.

Introduction Chronic adductor enthesopathy is a cause of groin pain in athletes. When conservative treatment fails and long-standing adductor-related pain becomes debilitating for the athletes operative treatment should be considered. Methods: Professional soccer players with chronic adductor enthesopathy were included in this study. Patients with femoroacetabular impingement or coexisting sports’ hernia were excluded. They were assessed in a standard way for adductor dysfunction and underwent a specifically designed magnetic resonance imaging groin study protocol. Pain and functional improvement were assessed with visual analog scale (VAS) for pain and time to return to sport. Results: We treated 36 athletes (nine players having bilateral symptoms) with a selective partial adductor release. The duration of symptoms was 9.7 months (2-36, SD 8.4) and the average follow-up was 41 months (24-72, SD 13.2). The VAS scale for pain was improved from 5.7 (3-8, SD 1.08) preoperatively to 0.1 (0-1, SD 0.31) postoperatively. All of them (100%) returned to their pre-injury level of sport after an average of 9.3 weeks (4-24, SD 4.9). Conclusion: A selective partial adductor longus release provides excellent pain relief for chronic adductor enthesopathy and promptly return to the pre-injury level of competition in soccer players.

Introduction Adductor pain is a common finding in soccer players. However, when femoroacetabular impingement (FAI) is present it can be difficult to differentiate between hip-related adductor pain and adductor-related groin pain. We hypothesize that isometric strength testing of the adductors/abductors can be a useful tool. Materials and Methods We assessed athletes, predominantly soccer players, with unilateral adductor pain and divided them in two groups; Group I: Hip-related adductor pain. Inclusion criteria: FAI, adductor pain alleviated with a hip injection. Patients with co-existing conditions such sports hernia and adductor enthesopathy were excluded. Group II: Adductor-related groin pain. Inclusion criteria: adductor enthesopathy, adductor pain alleviated with a pubic cleft injection. Patients with associated FAI, sports hernia and acute onset of symptoms were excluded. A handheld dynamometer (Microfet 2) was used for isometric strength testing. Both groups were assessed for the difference in adductor strength in symptomatic/asymptomatic side, and the ratio of adductor/abductor strength. For statistical analysis: a Kolmogorov-Smirnov test, an independent t-test and ANOVA. Results In our database 28 athletes fulfilled the criteria to be included in group I. The athletes (12 football players) with hip-related adductor pain, had a mean age of 36 years. Group II contained 20 athletes (17 football players: 15 professional and 2 recreational) with adductor-related groin pain, with a mean age of 28.6 years. Athletes in group I were weaker on the symptomatic side and the difference in adductor strength between the symptomatic/asymptomatic side was 3.71 % (SD 13.06). In Group II athletes adductors were 28.4% (SD 20.3) weaker on the symptomatic side. There was a significant difference (p<0.01) in adductor strength difference between group I and II. The ratio of adductor/abductor strength in Group I was 0.93 on the symptomatic and 0.92 on the asymptomatic side and in Group II was 0.67 and 0.95 respectively. There was a significant difference in adductor/ abductor strength ratio (p<0.01) between groups. Conclusion This study demonstrates successfully how isometric strength testing can help to differentiate between the two types of adductor pain; the hip-related adductor pain and the adductor-related groin pain. The data suggest that higher adductor strength on the symptomatic side occurs in patients with hip-related adductor pain.

Introduction Pubalgia is a known cause of groin pain in athletes and represent a challenging entity in diagnosis and treatment. The complexity of the groin anatomy and the overlapped symptoms from different pathologies that may co-exist leading to chronic lower abdominal pain and disability in athletes. The purpose of this study is to report the clinical outcomes together with a new surgical technique and to determine if athletes could return to the same high level of performance promptly. Materials and Methods We included professional footballers who presented with chronic groin pain, pubalgia, pain resistant to non-operative treatment. Patients with associate sports’ hernia (or inguinal disruption), osteitis pubis, adductor enthesopathy or hip pathology were excluded. Demographic data and type of sports were noted. Medical history, clinical examination of the lower abdomen, groin and hip joint, imaging investigation and strength testing measurements were recorded. All athletes were assessed for pain using a visual analogue scale and if they returned to sports at the same level as preoperatively. Results We assessed 18 footballers; 13 were professional and five were non-professional. All of them were males with a mean age 28 (SD 7.6) years old. All of the athletes (100%) had constant pain during acceleration and some of them while striking a ball. The pain was localised on suprapubic area radiating to midline 2-3 cm below the umbilicus (linea alba) and adductors area affecting their level of performance. Duration of symptoms was 7.46 months (SD 6.8, 2-24 months). Seven athletes had a pubic cleft injection (2,3) prior to the surgery with short-term partially improvement of symptoms. All athletes (100%) underwent bilateral pyramidalis muscle release and rectus abdominis fascioplasty (1). The pain was improved and ranged from 0 to 3 postoperatively. All of the patients (100%) returned to full training at a mean of 8.3 weeks (SD 1.49, 6-12 weeks) and at their previous level of sporting activity 12 weeks post surgery but one athlete elected to stop playing due to ageing. Conclusions Pyramidalis muscle may cause long-standing pubalgia in footballers leading to disability and potential career-ending for the athlete. A bilateral pyramidalis muscle release associated with rectus abdominis fascioplasty is a promising technique when prior non-operative treatment has failed. Athletes have a prompt recovery and return to the same level of sports with this technique. References 1. Martens MA, Hansen L, Mulier JC. Adductor tendinitis and musculus rectus abdominis tendopathy. Am J Sports Med. 1987;15(4):353-356. 2. Schilders E, Bismil Q, Robinson P et al. Adductor-related groin pain in competitive athletes: role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am 2007; 89: 2173-2178. 3. Schilders E, Talbot JC, Robinson P, Dimitrakopoulou A et al. Adductor-related groin pain in recreational athletes: role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am 2009; 91: 2455-2460.

An increased Tonnis angle correlates with poorer surgical outcomes in patients with acetabular dysplasia receiving arthroscopic treatment for labral tears. Introduction: Labral tears are a common finding in patients with acetabular dysplasia. Currently, the role of arthroscopic treatment and the factors that might influence the outcome of labral treatment are still uncertain. The aim of this study is to assess if the size of the Tonnis angle influences the clinical outcomes in patients with acetabular dysplasia receiving arthroscopic treatment for labral tears. Methods: From prospective collected data were retrieved 30 patients with acetabular dysplasia and an associated labral tear treated with hip arthroscopy. Inclusion criteria were centre edge (CE) angle < 25, Tonnis grade 0, lateral sourcil height ≥2mm. The Tonnis angle was measured. Intraoperative findings were recorded and the type of labral treatment: resection or repair. Patients were assessed using a 100 point Modified Harris Hip Score (MHHS) pre- and post-operatively after an average of 2 years. A linear regression model was used to assess the relation of the difference in MHHS (preop-postop) and the Tonnis angle (explanatory variable). A linear regression model was also fitted within each of the treatment groups separately. Results: There were 30 patients; 23 females and 7 males (mean age 37  years, range 23-51) were assessed pre-operatively and at 2-year-follow-up. The average CE angle was 21 degrees (range 15-24).  The average Tonnis angle was 13.8 degrees (6-25). Eleven patients had a labral debridement and 19 patients a labral repair. Our study demonstrates a significant (p=0.0013) relation between the reduction in MHHS score difference (preop-postop) as the Tonnis angle increases. Conclusion: This study demonstrates that in patients with dysplasia who received arthroscopic treatment for labral tears, the surgical outcome (MHHS) is depending on the Tonnis angle. Patients with an increased Tonnis angle, independent of the type of treatment, have a poorer outcome and possibly, a different treatment option should be considered.

Title: Hip arthroscopy for femoroacetabular impingement in professional and non-professional footballers and time to return to play. Introduction: Femoroacetabular impingement (FAI) with associated intra-articular hip pathologies is a recognised cause of pain and disability in athletes. The purpose of this study is to report the clinical outcomes and time to return to play football between professional and non-professional athletes following hip arthroscopic surgery for femoroacetabular impingement (FAI). Methods: Football players were undergoing hip arthroscopy for symptomatic FAI. Demographic data, radiographic features of FAI and operative findings were recorded. The time to return to play soccer and their level of playing were documented. Athletes completed a patient satisfaction questionnaire, a visual analogue scale for pain (VAS for pain), the modified Harris Hip Score (mHHS) and Sports-score from the Hip Osteoarthritis Outcome Score (HOOS) pre and postoperatively after an average of 3.6 years. For tatistical analysis a Cox proportional hazards model was used to examine whether professional or non-professional footballers were more likely to return faster to soccer at the same level. Results: We included 50 soccer players (60 hips); 29 were professional players (36 hips) with a mean age at the time of operation 22.3 (16-35, SD 5.18) and 21 were non-professional (24 hips) with a mean age 31.6 (17-47, SD 7.78). The mean follow-up was 43.1 months (SD 14.09). Two non-professional athletes (2 hips) did not return to play because of ageing and one professional (2 hips) because of spinal surgery. For professional footballers the mean patient satisfaction was 9.2 and for non-professional footballers was 8.75. The mean VAS scale for pain decreased considerably from 7.3 preop to 0.38 postoperatively for professional and from 6.5 preop to 1.29 postoperatively for non-professional athletes. The mean mHHS, sports-score were improved for both groups.                                 Professional footballers returned to their pre-injury level to play at a mean of 13.26 weeks (8-22, SD 2.95) and non-professional at a mean 23.3 weeks (8-54, SD 12.7).                                                                   Statistical analysis showed that the hazard ratio was 1.99 (p-value 0.016) suggesting that the professional players were about twice as likely to return to play football faster, at the same level than non-professional athletes. Conclusion: This study demonstrates that arthroscopic treatment for FAI and associated intra-articular pathology in football players provides a significant clinical improvement and allows athletes to return to play at the same level. Professional football players are significantly more likely to return to play football faster compared to non-professional athletes.

PURPOSE: Evidence shows that those with a learning disability are typically amongst the most inactive and sedentary members of the population, yet few studies have focused on the determinants of physical activity. The aim of the present study was to establish whether a group of 24 adults with mild and moderate learning disabilities receive adequate support to be able to make choices to lead a physically active lifestyle. METHOD: A descriptive study was used based on interviews with 24 adults with learning disabilities (mean age of 34 years) triangulated by day time and residential care workers. Participants volunteered from two residential homes and one social education centre (SEC) in a city in the North of England. RESULTS: The participants face a set of primary barriers that prevent them from having a choice to adopt the Department of Health's recommendations for physical activity. Identified barriers included: unclear policy guidelines in residential and day service provision together with resourcing, transport and staffing constraints; participant income and expenditure; and limited options for physically active community leisure. CONCLUSIONS: These are barriers that are widely acknowledged and understood by day and residential staff and participants in the study, but are arguably poorly understood by policy makers, health promotion agencies, commissioners and providers of learning disability services. The current lack of resources and inadequately specified responsibilities associated with community care deny many people with learning disabilities real choices to live a physically active healthy lifestyle.

Poster

Physical inactivity as a risk factor for coronary artery disease is comparable with the other three primary risk factors (hypertension, hypercholesterolemia and smoking history), but is significantly more prevalent. Evidence shows that people with learning disabilities are typically amongst the most inactive and sedentary members of the population, yet few studies have explained why. The aim of the present study was to establish whether adults with learning disabilities receive adequate support to be able to make choices to lead a physically active lifestyle. Participants volunteered from two residential homes and one social education centre in two cities in the north of England. Interviews were conducted with 24 adults with mild or moderate learning disabilities (mean age of 34 years). The interviews were recorded and transcribed and the content was analysed. An emerging theme was barriers to exercise, which were subsequently subdivided into primary and secondary barriers. Identified secondary barriers included: differences in how `ordinary living principles' were interpreted by day and residential carers; parental influence; arguments associated with integrated versus segregated leisure provision; and what is meant by `age appropriateness'.

Although the influence of weight-bearing activity on bone mass has been widely investigated in white women, few studies have been conducted in black, African populations. We investigated bone mineral density (BMD) in black South African women, with and without a history of load-carrying on the head. We also investigated whether load carrying may offer protection against low BMD in users of injectable progestin contraception (IPC). Participants were 32 black, South African women (22.4 ± 3.2 years). Load carrying history was determined by questionnaire and interview; participants were grouped as load carriers (LC; n = 18) or non-load carriers (NLC; n = 14). Ten women were using IPC and 6 were load-carriers. Total body (TB), lumbar spine (LS) and total hip (H) BMD were measured by dual energy X-ray absorptiometry. There were no differences in BMD between LC and NLC, and after controlling for age and BMI using two-tailed partial correlations. IPC users had lower BMD at all sites compared to non-IPC users (p < 0.05) and there were no associations between load carrying and BMD in this group. When IPC users were excluded from analysis, LC had higher LS BMD than NLC (p < 0.005). Correlations were found between the weight of load carried and LS BMD (r = 0.743, p < 0.005), and between years of load carrying and LS and TB BMD (r = 0.563, r = 0.538, respectively; both p < 0.05). Load carrying on the head may offer osteogenic benefits to the spine but these benefits did not appear in women using IPC. © The Japanese Society for Bone and Mineral Research and Springer 2009.

This study assessed the effect of incorrect calculation of power output measurement on the ergogenic properties of creatine. Fifteen males performed repeated Wingate anaerobic tests, under baseline, placebo, and creatine conditions. Statistics showed significant differences (p < 0.05) following creatine-supplemented conditions compared with placebo conditions, whereas no significant differences existed between the baseline and placebo conditions. However, the performance enhancement effect of creatine became significant only when the corrected (for the inertia of the flywheel) method was employed for measuring peak and minimum power. Mean (�SD) values across all cycle sprints for placebo versus creatine were 1033 100 W versus 1130 95 W for peak power and 385 78 W versus 427 70 W for minimum power. No significant differences were shown using the uncorrected method for peak power (756 97 W versus 786 88�W) and minimum power 440 64 W pre versus 452 65 W post). In conclusion, the present study suggests that the potentiating effect of creatine might be underestimated if the inertial effects of the flywheel are not considered in power output determination.

In professional academy rugby league (RL) players, this two-part study examined; A) the within- and between-day reliability of isometric mid-thigh pulls (IMTP), countermovement jumps (CMJ), and a wellness questionnaire (n = 11), and B) profiled the responses with acceptable reliability (no between-trial differences and between-day coefficient of variation (CV) ≤10% and intraclass correlation coefficient (ICC) ≥0.8) for 120 h (baseline: -3, +24, +48, +72, +96, +120 h) following RL match-play (n = 10). In part A, force at 200, and 250 ms, and peak force (PF) demonstrated acceptable within- (CV%: 3.67-8.41%, ICC: 0.89-0.93) and between-day (CV%: 4.34-8.62%, ICC: 0.87-0.92) reliability for IMTP. Most CMJ variables demonstrated acceptable within-day reliability (CV%: 3.03-7.34%, ICC: 0.82-0.98), but only six (i.e., flight-time, PF, peak power (PP), relative PP, velocity at take-off (VTO), jump-height (JH)) showed acceptable between-day reliability (CV%: 2.56-6.79%, ICC: 0.83-0.91). Only total wellness demonstrated acceptable between-day reliability (CV%: 7.05%, ICC: 0.90) from the questionnaire. In part B, reductions of 4.75% and 9.23% (vs. baseline; 2.54 m∙s-1; 0.33 m) occurred at +24 h for CMJ VTO, and JH, respectively. Acceptable reliability was observed in some, but not all, variables and the magnitude and time-course of post-match responses were test and variable specific. Practitioners should therefore be mindful of the influence that the choice of recovery monitoring tool may have upon the practical interpretation of the data.

To minimize underperformance, injury, and illness, and to enhance readiness for training and match-play, post-match responses are commonly monitored within professional rugby. As no clear consensus exists regarding the magnitude and duration of post-match recovery, this review summarized the literature (17 studies yielded from literature searching/screening) reporting neuromuscular (countermovement jump [CMJ], peak power output [PP], and flight time [FT]), biochemical (creatine kinase [CK]) or endocrine (cortisol [C] and testosterone [T] concentrations), and subjective (wellness questionnaire and muscle soreness) indices after rugby match-play. For neuromuscular responses (11 studies), reductions in PP <31.5% occurred <30 minutes after match, returning to baseline within 48-72 hours. Post-match reductions in FT of <4% recovered after 48 hours. For biochemical and endocrine responses (14 studies), increases in CK, ranging from 120 to 451%, peaked between 12 and 24 hours, returning to baseline within 72 hours of match-play. Initial increases of <298% in C and reductions in T concentrations (<44%) returned to pre-match values within 48-72 hours. Mood disturbances (6 studies) required 48-72 hours to normalize after peak decrements of <65% at 24 hours. This review highlights that 72 hours were needed to restore perturbations in neuromuscular, biochemical and endocrine, and subjective/perceptual responses after competitive rugby match-play. Notably, only 4 studies reported responses in more ecologically valid scenarios (i.e., those in which regular training and recovery strategies were used) while also reporting detailed match demands. A lack of research focusing on youth players was also evident, as only 3 studies profiled post-match responses in younger athletes. Deeper insight regarding post-match responses in ecologically valid scenarios is therefore required.

Purpose: This study examined the effects of sprint running training on sloping surfaces (3°) on selected kinematic and physiological variables. Methods: Fifty-four sport and physical education students were randomly allocated to one of two training groups (combined uphill–downhill [U+D] and horizontal (H)) and a control group (C). Pre- and posttraining tests were performed to examine the effects of 8 wk of training on the maximum running speed (MRS), step rate, step length, step time, contact time, eccentric and concentric phase of contact time (EP, CP), flight time, selected posture characteristics of the step cycle, and 6-s maximal cycle sprint test. Results: MRS, step rate, contact time, and step time were improved significantly in a 35-m sprint test for the U+D group (P < .01) after training by 4.3%, 4.3%, −5.1%, and −3.9% respectively, whereas the H group showed smaller improvements, (1.7% (P < .05), 1.2% (P < .01), 1.7% (P < .01), and 1.2% (P < .01) respectively). There were no significant changes in the C group. The posture characteristics and the peak anaerobic power (AWT) performance did not change with training in any of the groups. Conclusion: The U+D training method was significantly more effective in improving MRS and the kinematic characteristics of sprint running than a traditional horizontal training method.

This study examined the effects of an 8-week uphill-downhill sprint training programme on the force generation capacity of leg muscles. Twenty-four university students were randomly allocated to one of two training groups (combined uphill-downhill and horizontal) and a control group. The combined training method produced significant improvements in maximal isometric force (7.1%) and rate of force production (approximate to 25%) of the knee flexor muscles (p<0.05). The combined training was also significantly more effective in improving the maximum sprinting speed (5.9%, p<0.05) and associated kinematic variables. In particular, the propulsive phase of contact decreased significantly by 17% (p<0.05) indicating a link between the improved rate of force production during the isometric test and the rate of production of propulsive forces during sprinting. The increased capacity of the leg flexor muscles to generate force appears to contribute to the improvement of sprinting speed perhaps due to a more efficient muscle function during the support phase of the stride.

The determinants of energy saving phenomena reported for load carried on the head, back and in a doublepack remain unclear. This study compared the energetic, kinematic and kinetic responses to head (H), back (B) and doublepack (DP) loading. Fifteen volunteers walked on an instrumented treadmill at 3 km.h-1 with 0, 3, 12 and 20 kg in each loading method. Whole body motion, ground reaction forces (GRF) and metabolic cost were measured. H was less economical than B (p = 0.014) and DP (p = 0.010). H was also associated with increased step length (p = 0.045), decreased cadence (p = 0.001), greater trunk (p < 0.001) and hip (p < 0.001) extension and greater minimum vertical GRF (p = 0.001) than B and DP. In conclusion, no energy saving was found for head- or back-loading but economy may be improved with methods that cause smaller perturbations from unloaded walking. Practitioner summary: Energy saving phenomena have been reported for load carried on the head, back and in a doublepack, yet the determinants are unclear. This study shows that smaller perturbations from unloaded to loaded walking are associated with improved economy for certain load carriage conditions, such as the doublepack.

Equivocal findings exist for the economy associated with load carried close to the body's centre of mass. Individual variation could explain some of the equivocal findings. This research aimed to examine the extent of individual variation in loaded walking economy. Eighteen females carried load on the back, head and split between the front and back. Individual variation in relative load carriage economy (ELI) was primarily assessed using standard deviation, coefficients of variation (CV) and intraclass correlation coefficients (ICC). There was large inter-individual variation in ELI values with highest mean CV's of 16%, 12% and 10% for head-, back- and combined front and back-loading. Mean ELI values were not significantly different between methods. The large amount of individual variation found here suggests future load carriage research should account for individual variation, particularly when considering sample size and when making inferences on the economy associated with different types of load carriage using group mean data.

It has been suggested that freedom of movement in the trunk could influence load carriage economy. This study aimed to compare the economy and sagittal plane trunk movements associated with three load carriage methods that constrain posture differently. Eighteen females walked at 3 km.h-1 with loads of 0, 3, 6, 9, 12, 15 and 20 kg carried on the back, back/front and head. Load carriage economy was assessed using the Extra Load Index (ELI). Change in sagittal plane trunk forward lean and trunk angle excursion from unloaded to loaded walking were assessed. Results show no difference in economy between methods (p = 0.483), despite differences in the change in trunk forward lean (p = 0.001) and trunk angle excursion (p = 0.021) from unloaded to loaded walking. We conclude that economy is not different among the three methods of load carriage, despite significant differences in sagittal plane trunk movements.

Inspiratory muscle training (IMT) and functional IMT (IMTF: exercise-specific IMT activities) has been unsuccessful in reducing respiratory muscle fatigue following load carriage. IMTF did not include load carriage specific exercises. Fifteen participants split into two groups (training and control) walked 6 km loaded (18.2 kg) at speeds representing ∼50%V̇O2max in cold-hypoxia. The walk was completed at baseline; post 4 weeks IMT and 4 weeks IMTF (five exercises engaging core muscles, three involved load). The training group completed IMT and IMTF at a higher maximal inspiratory pressure (Pimax) than controls. Improvements in Pimax were greater in the training group post-IMT (20.4%, p = .025) and post-IMTF (29.1%, p = .050) compared to controls. Respiratory muscle fatigue was unchanged (p = .643). No other physiological or subjective measures were improved by IMT or IMTF. Both IMT and IMTF increased the strength of respiratory muscles pre-and-post a 6 km loaded walk in cold-hypoxia. Practitioner Summary: To explore the interaction between inspiratory muscle training (IMT), load carriage and environment, this study investigated 4 weeks IMT and 4 weeks functional IMT on respiratory muscle strength and fatigue. Functional IMT improved inspiratory muscle strength pre-and-post a loaded walk in cold-hypoxia but had no more effect than IMT alone. Abbreviations: ANOVA: analysis of variance; BF: breathing frequency; CON: control group; EELV: end-expiratory lung volume; EXP: experimental group; FEV1: forced expiratory volume in one second; FiO2: fraction of inspired oxygen; FVC: forced vital capacity; HR: heart rate; IMT: inspiratory muscle training; IMTF: functional inspiratory muscle training; Pemax: maximal expiratory pressure; Pimax: maximal inspiratory pressure; RMF: respiratory muscle fatigue; RPE: rate of perceived exertion; RWU: respiratory muscle warm-up; SaO2: arterial oxygen saturation; SpO2: peripheral oxygen saturation; V̇E: minute ventilation; V̇O2: rate of oxygen uptake.

This study examined the effects of sprint running training on sloping surfaces (3°) in experienced sprinters using selected kinematic variables. Twelve experienced sprinters were randomly allocated to two training groups (combined uphill–downhill and horizontal). Pre- and post-training tests were performed to examine the effects of six weeks of training on maximum running speed, step rate, step length, step time, contact time, braking and propulsive phase of contact time, flight time and selected postural characteristics during a step cycle in the final steps of a 35m sprint test. In the combined uphill–downhill training group, maximum running speed was substantially greater (from 9.08 ± 0.90 m s-1 to 9.51 ± 0.62 m s-1; p <0.05) after training by 4.8%; step rate, contact time, step time and concentric phase was not modified. There were no significant changes in maximal speed or sprint kinematics in the horizontal training group. Overall, the posture characteristics did not change with training. The combined uphill–downhill training method was substantially more effective in improving the maximum running speed in experienced sprinters than a traditional horizontal training method.

Background: This study explored the experiences of university employees recruited to a 10-week randomized controlled trial (n = 64). The trial compared “walking routes” with “walking-while-working” on daily step totals, showing that, compared with controls, interventions resulted in around 1000 extra steps per day. Methods: A subsample of 15 academic and administrative employees from intervention groups completed interviews at the end of intervention. Interviews were transcribed verbatim and subject to inductive coding within the major themes of benefits/positives and problems/barriers. Findings: Both interventions benefited employee health and work productivity but were difficult to implement in the workplace. Involvement in walking routes was challenged by the difficulties of managing time pressures, and individuals assigned to walking-while-working had to deal with local management subcultures favoring physical presence and inactivity. Conclusions: Findings highlight the need for further research, advocate the value of walking at work, and provide insights into the challenges that face staff in workplace interventions.

The aim of the study was to evaluate the cardiorespiratory fitness, levels of obesity, daily levels of physical activity and barriers to a physically active lifestyle in a group of 24 adults with mild and moderate learning disabilities (aged 23–47 years, mean age 34). The efficacy of two community-based exercise intervention programmes for the group was also evaluated. The results showed that overall 50% of the men and 70% of the women were overweight, of whom 57% of the men and 100% of the women were obese. Mean cardiorespiratory fitness levels were 20% to 28% lower for the men and 42% lower for the women compared with average values for the general population. Physical activity profiles indicated that 22 of the participants were below recognised minimum levels of physical activity. Barriers to physical activity specific to the learning disability population included transport needs, staffing ratios, financial resources and unclear policy guidelines for day and residential service provision.

Objective Using a randomised control trial design, this study assessed the impact of two walking interventions, on the work day step counts and health of UK academic and administrative, university employees. Method A convenience sample of 58 women (age 42 ± 10 years) and 6 men (age 40 ± 11 years) completed baseline and intervention measures for step counts, % body fat, waist circumference and systolic/diastolic blood pressure, during a ten-week period (October to December, 2005). Before intervention, baseline step counts (five working days) were used to randomly allocate participants to a control (maintain normal behaviour, n = 22) and two treatment groups (“walking routes”, n = 21; “walking in tasks”, n = 21). Intervention effects were evaluated by calculating differences between pre-intervention and intervention data. A one-way ANOVA analysed significant differences between groups. Results A significant intervention effect (p < 0.002) was found for step counts, with mean differences indicating a decrease in steps for the control group (− 767 steps/day) and increases in the “walking routes” (+ 926 steps/day) and “walking in tasks” (+ 997 steps/day) groups. Small, non-significant changes were found in % body fat, waist circumference and blood pressure. Conclusions Findings have implications for work-based physical activity promotion and the development of walking interventions within the completion of work-based tasks.

The efficacy of a multimodal recovery strategy implemented within 4 hours of rugby league (RL) training was investigated using repeated-measures, randomized, crossover methods in 10 professional academy RL players (age: 17 ± 1 years). Following standardized training (5,383 m covered, 350-m high-speed running, 28 repeated high-intensity efforts, 24 collisions), players completed a multimodal recovery (REC) strategy (i.e., ∼640 kcal meal + ∼1,285 kcal snacks or drinks, cold-water immersion, sleep hygiene recommendations) or control (i.e., ∼640 kcal meal: CONT) practices. Isometric mid-thigh pulls (IMTP), countermovement jumps (CMJ), and wellness questionnaires were completed before (−3 hours) and after (+24, +48 hours) training. The recovery strategy influenced IMTP peak force (p = 0.026), but between-trial differences were undetectable. No other between-trial effects (all p > 0.05) were seen for IMTP, CMJ, or wellness variables. Training-induced reductions in CMJ peak power (−4 ± 6% vs baseline: 4,878 ± 642 W) at +24 hours (p = 0.016) dissipated by +48 hours. Fatigue and lower-body soreness reduced by 16 ± 19% (p = 0.01) and 32 ± 44% (p = 0.024) at +48 hours versus +24 hours, respectively. Relative to CONT (i.e., posttraining nutrition), the effects of a single bout of recovery practices appeared limited when implemented after RL-specific training. Therefore, when training included limited collisions, balanced postexercise meals appeared equally effective relative to a multimodal recovery strategy. Transient changes in performance and wellness variables after training may have implications for practitioners. Consecutive training sessions, including a high frequency and intensity of eccentric muscle actions, should be carefully planned, especially near match-play.

Abstract

Strategies that enhance the acquisition of bone mass may be protective against osteoporosis. BMD was compared in 20 artistic gymnasts (10 boys; 10 girls) and 20 untrained children ages 7-8 years. Higher regional values of BMD were observed in female gymnasts than untrained girls. If retained to adulthood, this higher BMD may protect skeletal integrity in later life.

Strategies that enhance the acquisition of bone mass in children may assist with the prevention of osteoporosis. This study explored the effects of regular high-impact and weight-bearing activity before the age of 7 years on total and regional bone mineral density (BMD). Twenty artistic gymnasts (10 boys and 10 girls) and 20 untrained children, 7-8 years of age, were recruited. The untrained children were matched to gymnasts by sex, height, weight, and age. Female gymnasts trained 8-10 h per week and had trained regularly for 3-4 years. Male gymnasts trained 4-6 h per week and had trained for 1-2 years. Measurements of bone mineral density were made using DXA for total body BMD (TBBMD); lumbar spine, both areal (aSBMD) and volumetric (vSBMD); total spine; pelvis; arms; and legs. Significant mean differences (8-10%) in aSBMD, vSBMD, arm BMD, and TBBMD were observed between female gymnasts and untrained girls (p &lt; 0.05: aSBMD, vSBMD, and TBBMD body mass (BM); p &lt; 0.01: arm BMD). A nonsignificant trend toward a higher TBBMD/BM and arm BMD was observed in male gymnasts compared with untrained boys. Trends toward a higher BMD within the pelvis, legs, and total spine were also observed in gymnasts. There were no differences in total and regional BMD between untrained boys and untrained girls. The results suggest that gymnastics training before the age of 7 years enhances the acquisition of bone mass at selected skeletal sites. The magnitude of this enhancement seems to be linked to the cumulative volume of such training. If retained during adolescence and young adulthood, a surfeit of bone acquired through high-impact and weight-bearing activity in early childhood may protect skeletal integrity in later life.

This chapter contains sections titled: Introduction Physical activity and exercise, what is the difference? Current physical activity behaviour and guidelines The importance of physical activity to health Energy expenditure Exercise tolerance and cardiorespiratory fitness in overweight and obese adults and children Guidelines for exercise and activity prescription (including practical issues of clinical management for diabetics and the obese) Research evidence on the role of physical activity in the prevention and treatment of obesity and type 2 diabetes Physical activity and the behavioural treatment of obesity Linking research and practice Summary References Introduction Physical activity and exercise, what is the difference? Current physical activity behaviour and guidelines The importance of physical activity to health Energy expenditure Exercise tolerance and cardiorespiratory fitness in overweight and obese adults and children Guidelines for exercise and activity prescription (including practical issues of clinical management for diabetics and the obese) Research evidence on the role of physical activity in the prevention and treatment of obesity and type 2 diabetes Physical activity and the behavioural treatment of obesity Linking research and practice Summary References

The Extra Load Index (ELI) has been proposed as a suitable method of assessing the relative economy of load carriage systems. The purpose of this study was to determine, based on empirical evidence, that the ELI can accommodate variations in both body composition and added load. In total, 30 women walked carrying loads of up to 70% body mass at self-selected walking speeds whilst expired air was collected. In addition, each of the women had body composition assessed via dual energy X-ray absorptiometry. Results show that the ELI is independent of body composition variables, the magnitude of additional loads and the speed of progression. Consequently, it is suggested that it represents an appropriate method of comparing load carriage systems in both scientific and commercial arenas. STATEMENT OF RELEVANCE: This paper demonstrates that ELI is independent of body composition, added load and speed and is therefore an appropriate method to generalise comparisons of load carriage systems. It has the advantage of being easily understood by manufacturers and consumers whilst retaining appropriate scientific precision.

This study examined the relationships between selected kinematic and physiological parameters and their influence on performance during incremental exercise in elite swimmers competing at the international level. Eleven men and ten women (all specialized in 200-m events) performed an incremental 7 × 200-m test in their specialized stroke. Stroke rate (SR), stroke length (SL), velocity (V), and blood lactate concentration (BLa) were measured for each 200 m. In addition to the cross-sectional group design, the longitudinal performance of a male swimmer was evaluated by 4 tests during a period of 20 weeks. Stroke rate increased and SL decreased with V, regardless of the age, stroke, or gender of the swimmer. Statistically significant correlations were found between SR and V (p < 0.01; r = 0.66 to 0.99), SR and SL (p < 0.01; r = -0.78 to -0.99), SL and V (except for women's freestyle and breaststroke) (p < 0.01; r = -0.67 to -0.98), and BLa and V (p < 0.01; r = 0.7 to 0.96). Changes in SR and SL were not affected by changes in BLa. Similar velocities were produced with different combinations of SR and SL. The fastest times reached in the test were generally slower than expected, and the performance in the test was not associated with competition performance. The case study revealed similar results to those of the group. The test used in this study was informative with respect to identifying the most economical and effective stroke kinematics combination for slow to submaximal velocities. It is possible that the swimming speeds were not maximal in the final 200-m swim because of cumulative fatigue, which is a major limitation for assessing race pace. An additional test that produces velocities similar to those used in competitions would be more useful for the purpose of providing optimal kinematic information specific to racing speeds, which would facilitate performance improvement through regular monitoring in training.

The purpose of the study was to examine the effect of creatine (Cr) supplementation on anaerobic performance when ingesting creatine and carbohydrates (CHO) together. Twenty male physical education students comprised the two experimental (CR and CRCHO) and one control (CON) groups of the study. All groups performed three 30 s anaerobic Wingate tests (AWTs) interspersed with 6 minutes of recovery. The CR group (n = 7) ingested 5 g of Cr 5 times per day for 4 days. Subjects in the CRCHO group (n = 6) ingested the same quantity but additionally after each 5 g dose of Cr consumed 500 ml of a commercially available energy drink containing 100 g of simple sugars. Over all three AWTs average mean power improved significantly compared to baseline for the CR group (5.51%) but not for the CRCHO group (3.06%). Mean power for the second AWT was improved following the acute loading for the CR group only (4.54%) and for the third AWT for both CR (8.49%) and CRCHO (5.75%) groups. Over all three AWTs a significant change was recorded in average peak power following the acute loading for the CR group (8.26%) but not for the CRCHO group (4.11%). Peak power was significantly improved following the loading only for the CR group during the third AWT (19.79%). No changes in AWT performance were recorded for the CON group after intervention. The findings of the present study suggest that ingesting creatine together with carbohydrates will not further improve performance compared to the ingestion of creatine only.

BACKGROUND: Interventions designed to increase workplace physical activity may not automatically reduce high volumes of sitting, a behaviour independently linked to chronic diseases such as obesity and type II diabetes. This study compared the impact two different walking strategies had on step counts and reported sitting times. METHODS: Participants were white-collar university employees (n = 179; age 41.3 +/- 10.1 years; 141 women), who volunteered and undertook a standardised ten-week intervention at three sites. Pre-intervention step counts (Yamax SW-200) and self-reported sitting times were measured over five consecutive workdays. Using pre-intervention step counts, employees at each site were randomly allocated to a control group (n = 60; maintain normal behaviour), a route-based walking group (n = 60; at least 10 minutes sustained walking each workday) or an incidental walking group (n = 59; walking in workday tasks). Workday step counts and reported sitting times were re-assessed at the beginning, mid- and endpoint of intervention and group mean+/- SD steps/day and reported sitting times for pre-intervention and intervention measurement points compared using a mixed factorial ANOVA; paired sample-t-tests were used for follow-up, simple effect analyses. RESULTS: A significant interactive effect (F = 3.5; p < 0.003) was found between group and step counts. Daily steps for controls decreased over the intervention period (-391 steps/day) and increased for route (968 steps/day; t = 3.9, p < 0.000) and incidental (699 steps/day; t = 2.5, p < 0.014) groups. There were no significant changes for reported sitting times, but average values did decrease relative to the control (routes group = 7 minutes/day; incidental group = 15 minutes/day). Reductions were most evident for the incidental group in the first week of intervention, where reported sitting decreased by an average of 21 minutes/day (t = 1.9; p < 0.057). CONCLUSION: Compared to controls, both route and incidental walking increased physical activity in white-collar employees. Our data suggests that workplace walking, particularly through incidental movement, also has the potential to decrease employee sitting times, but there is a need for on-going research using concurrent and objective measures of sitting, standing and walking.

Surfing is described as an intermittent exercise that comprises bouts of high intensity exercise interspersed with periods of low intensity activity and rest, utilising both the upper body during paddling and the lower body during surfing. The short-term supplementation of creatine has been reported to improve maximal power, strength and work performed during repetitive sprint performance (Williams et al., 1999: Creatine the power supplement. Leeds: Human Kinetics).This study assessed the effect of short-term(20 g day71 for 5 days) creatine supplementation on body composition, repeated upper body anaerobic power and competition performance in club level surfers. Following institutional ethical approval, seventeen club level male surfers (mean: age 23.06, s¼4.21 years, stature 79.68, s¼9.92 cm) underwent a randomised, double blind, placebo controlled, cross-over design study. Testing comprised assessmentof body mass and total body water using bioelectrical impedance analysis, a repeated upper body Wingate (5615 s) with active recovery (120 s) and passive recovery (105 s), based on time motion analysis of competitive surfing (Mendez-Villanueva et al., 2003: Journal of Science and Medicine in Sport, 23, 70–74). Competition performance was assessed by rank in competition and number of waves caught per heat. Participants were tested at baseline and randomly assigned to creatine and placebo groups, receiving 20 g day71 for 5 days of creatine monohydrate (CMH) or placebo (polyethylene glycol – PEG). Testing was repeated following supplementation. Participants then underwent a 4 week wash-out period before the groups were reversed and testing repeated. Table I shows an insignificant increase in body mass (0.32 kg) and total body water (0.59 kg) following 5 days of creatine loading. Oral creatine supplementation also had no significant effect on repeated upper body anaerobic peak power (22.00 W increase) and average power (10.37 W increase) supporting the findings of Green et al., (2001: Journal of Strength and Conditioning Research, 15, 36–41) using a similar study design with physically active men. There was no significant effect on competitive performance in terms of ranking or number of waves ridden. These results may be due to the acute effects of the variable surfing conditions during the study period on physiological condition of the participants affecting performance in all tests.

Surfing is a high intensity intermittent exercise which in recent years has experienced a rapid increase in participation rates and growing professionalism amongst competitive athletes. Studies in a variety of sports have indicated that, unless one has a distinctive and specific body form suitable to the sport, there is little likelihood of success in top class performance (Lowdon, 1980: Australian Journal of Sports Medicine 12, 34–39). The aim of this study was to investigate the relationship between anthropometric measures and national ranking in male high performance junior British surfers. Following institutional ethical approval and the completion of parental informed consent (children giving assent) high performance male surfers (N¼16, age¼mean 15.61, s¼1.06 years) participated in anthropometric measures of stature, body mass, skinfolds (Tricep, subscapular, biceps, iliac crest, supraspinale, abdominal, front thigh and medial calf), girths (arm flexed and tensed, waist, gluteal and calf) and breadths (humerus and femur). All measures were taken in accordance with the guidelines of the International Society for the Advancement of Kinanthropometry (ISAK). These were used to calculate body mass index, waist to hip ratio and body fat percentage using the equation of Yuhasz (1975: Physical fitness manual. London: University of Western Ontario). A correlation analysis was performed using SPSS for Windows (V.15) between the measured physiological variables and the numerical national ranking of the subjects. Significant (P50.05) correlations were found with Illiac Crest skinfold measurement r¼0.52 (R2¼0.27) and body fat percentage r¼0.60 (R2¼0.36). Thus the coefficient’s of determination for these measures suggest that the iliac crest skinfold measure can explain 27% of the variance in ranking and body fat percentage explains 36% of the variance within the sample used. No other significant correlations were found. The results suggest that within this age group body fatness may be conducive to surfing performance. This is supported by Felder et al (1998: International Journal of Sport Nutrition, 8(1), 36–48) and Lowdon (1980: Australian Journal of Sports Medicine 12,34–39) who theorised that increased body fat may well protect the surfer from the cold and wet environment in which they perform.

Purpose. The objective of this study was to determine the relationships of peak oxygen uptake ( VÌO2peak), power at VÌO2peak and power at the anaerobic threshold (AT) with national ranking in a sample of British high performance junior surfers. Methods. Eighteen male surfers (aged 15.4 ± 1.4 years) from the British Junior Surfing team were tested for VÌO2peak and AT using an adapted kayak ergometer; national ranking was used to indicate performance level. The AT was identified as the point at which VÌE/VÌO2 started to rise without a concomitant increase in VÌE/VÌCO2. Spearman's rank (rs) and partial correlations (rp) controlling for age were used to identify the relationships between the physiological variables and national ranking. Results. Mean VÌO2peak was 3.1 ± 0.5 l · min

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The aim of this study was to evaluate the anthropometric profiles of male surfers and to investigate the relationship of these measures with performance and ability. Following institutional ethical approval, 79 male surfers underwent anthropometric assessment. These surfers composed of three sub-groups of professional (n=17; age: 34.12, s =3.81 years, stature: 177.28, s =6.29 cm; body mass: 78.57, s =7.17 kg), junior national level (n=15; age: 15.61, s =1.06 years, stature: 173.86, s =5.72 cm; body mass: 63.27, s =7.17 kg) and intermediate level surfers (n=47; age: 22.47, s =2.80 years, stature: 179.90, s =5.41; body mass: 77.83, s =9.43 kg). The mean somatotype values for the different groups of surfers were found to be 2.48, 5.00 and 1.03 for the professional surfers; 2.18, 3.72 and 3.24 for the junior national surfers and 2.79, 3.57 and 2.42 for the intermediate surfers. Professional surfers were significantly (P < 0.01) more mesomorphic and less ectomorphic than intermediate level surfers. Significant correlations were observed between endomorphy (r = −0.399, P < 0.01), sum of six skinfolds (r = −0.341, P < 0.05), and body fat percentage (r = −0.380, P < 0.01) and the rating of ability among the intermediate group of surfers. Across all participants, the rating of surfer ability was significantly correlated with endomorphy (r = −0.366, P≤0.01), mesomorphy (r = 0.442, P < 0.01), sum of six skinfolds (r = −0.274, P < 0.05) and body fat percentage (r = −0.268, P < 0.05). Findings suggest that the levels of adiposity and muscularity may influence the potential for progression between intermediate and professional-level surfing performance.

This study investigated the effects of wave conditions on performance and the physiological responses of surfers. After institutional ethical approval 39 recreational surfers participated in 60 surfing sessions where performance and physiological response were measured using global positioning system (GPS) heart rate monitors. Using GPS, the percentage time spent in surfing activity categories was on average 41.6, 47.0, 8.1, and 3.1% for waiting, paddling, riding, and miscellaneous activities, respectively. Ability level of the surfers, wave size, and wave period are significantly associated with the physiological, ride, and performance parameters during surfing. As the ability level of the surfers increases there is a reduction in the relative exercise intensity (e.g., average heart rate as a percentage of laboratory maximum, rpartial = -0.412, p < 0.01) which is in contrast to increases in performance parameters (e.g., maximum ride speed (0.454, p < 0.01). As the wave size increased there were reductions in physiological demand (e.g., total energy expenditure rpartial = -0.351, p ≤ 0.05) but increases in ride speed and distance measures (e.g., the maximum ride speed, 0.454, p < 0.01). As the wave period increased there were increases in intensity (e.g., average heart rate as a percentage of laboratory maximum, rp = 0.490, p < 0.01) and increases in ride speed and distance measures (e.g., the maximum ride speed, rpartial = 0.371, p < 0.01). This original study is the first to show that wave parameters and surfer ability are significantly associated with the physiological response and performance characteristics of surfing.

The systems, models and programmes designed to identify and provide for the development of talented young people in sport continue to evolve in their complexity and comprehensiveness, often driven by national interests of doing well in sport. The influences of the approach developed in the German Democratic Republic still remain, with a continued focus on the physical determinants of performance in sport. However, such influences are now complemented by due consideration for the holistic development of young people who happen to be talented in sport. As a field of enquiry talent identification and development demands a multidisciplinary approach and those that work directly with young people require a sound interdisciplinary understanding of the key disciplinary contributions. Selection for performance with a focus on the immediate or short term goals and aspirations of important others are still too often confused with talent identification and development. In contrast, some of the most comprehensive examples of talent identification and development programmes in sport analyse the performer's activity from end to start (ie, they start from an accessible result and work backwards in terms of understanding the processes of preparation and development that are the required building blocks in order to get an individual young performer to their accessible endpoint). This presentation will draw on a range of theoretical and disciplinary perspectives, as well as providing some examples from sport, to identify the contemporary issues in talent identification and development of concern to those who plan and practice it, but mostly importantly for those young people that experience it.

The purpose of this investigation was to evaluate the postactivation potentiation (PAP) effects of both dynamic and isometric maximum voluntary contractions (MVCs) on sprint and jump performance and establish whether PAP methods could be used effectively in warm up protocols for soccer players. Twelve male soccer players performed 4 warm up protocols in a cross-over, randomized, and counterbalanced design. In addition to a control warm up, subjects performed deadlift (5 repetitions at 5 repetitions maximum), tuck jump (5 repetitions), and isometric MVC knee extensions (3 repetitions for 3 s) as PAP treatments in an otherwise identical warm up protocol. After each treatment, the subjects underwent 3 10 m and 20 m sprints 4, 5, and 6 minutes post-warm up and 3 vertical jumps (VJ) at 7, 8, and 9 minutes post-warm up. Repeated measures analysis of variance showed no significant differences in the first 10 m (p = 0.258) and 20 m (p = 0.253) sprint and VJ (p = 0.703) performance and the average 10 m (p = 0.215), 20 m (p = 0.388), and VJ (p = 0.529) performance between conditions. There were also no significant differences in performance responses between the strongest and weakest subjects, but large variations in individual responses were found between the subjects. The findings suggest that there was no significant group PAP effect on sprint and jump performance after dynamic and isometric MVCs compared with a control warm up protocol. However, the large variation in individual responses (-7.1% to +8.2%) suggests PAP should be considered on an individual basis. Factors such as method, volume, load, recovery, and interindividual variability of PAP must be considered in the practical application of PAP and the rigorous research design of future studies to evaluate the potential for performance enhancement.

The systems, models and programmes designed to identify and provide for the development of talented young people in sport continue to evolve in their complexity and comprehensiveness, often driven by national interests of doing well in sport. The influences of the approach developed in the German Democratic Republic still remain, with a continued focus on the physical determinants of performance in sport. However, such influences are now complemented by due consideration for the holistic development of young people who happen to be talented in sport. As a field of enquiry talent identification and development demands a multidisciplinary approach and those that work directly with young people require a sound interdisciplinary understanding of the key disciplinary contributions. Selection for performance with a focus on the immediate or short term goals and aspirations of important others are still too often confused with talent identification and development. In contrast, some of the most comprehensive examples of talent identification and development programmes in sport analyse the performer's activity from end to start (ie, they start from an accessible result and work backwards in terms of understanding the processes of preparation and development that are the required building blocks in order to get an individual young performer to their accessible endpoint). This presentation will draw on a range of theoretical and disciplinary perspectives, as well as providing some examples from sport, to identify the contemporary issues in talent identification and development of concern to those who plan and practice it, but mostly importantly for those young people that experience it.

Smoking is a leading cause of preventable morbidity and mortality globally. During the COVID-19 pandemic, Smoking Cessation (SC) services faced many challenges, including lockdown and social distancing restrictions. Consequently, SC services had to adapt to the challenges in different ways or halt delivery. This research evaluated the impact of COVID-19 on the delivery and outcomes of SC services. This was achieved by comparing service delivery and outcomes pre-COVID-19 and during the pandemic and drawing insights for the delivery of SC services post-pandemic. Secondary analysis was performed on the data of 11,533 participants who attended the One Life Suffolk (OLS) SC services pre- and during the COVID-19 pandemic. A total of 4923 and 6610 participants attended SC services pre-COVID-19 and during COVID-19 respectively. Fifty-four percent of participants achieved quit status at week-4 while attending the SC services during the COVID-19 pandemic, compared with 46% pre-COVID-19, (X2(1) = 38.2, p-value<0.001). Participants who attended the SC services during the COVID-19 period were 1.7 times more likely to achieve quit status at week-4 than pre-COVID-19. However, the proportion of participants lost-to-follow-up (LTF) was significantly higher during the COVID-19 period (11%) compared to pre-COVID-19 (7%), (X2(1) = 51.4, p-value <0.001). There was an increased participation and quit rate during the pandemic for modified, remotely delivered SC services indicating successful delivery of remote services during the pandemic. Although switching from face-to-face to online helped some smokers to access the service at a time of motivational readiness, despite the COVID-19 restrictions, some smokers could not access or use some aspects of the remote delivery due to a lack of internet access, poor digital literacy, no peer support and no commitment to a group during face-to-face sessions, contributing to an increased rate of LTF. Posing a major challenge to SC services delivery, COVID-19 compelled OLS SC services to adapt and be more innovative in their delivery. SC services need to continue to evolve and adapt by applying the lessons learnt during the pandemic in terms of flexibility and person-centered delivery given what did and did not work well for different demographics within the population.

The characterisation of bone geometry in male and female athletes may increase our understanding of how physical loading may enhance bone strength in both sexes. This study investigated sexual dimorphism in hip geometry of athletes and age- and sex-matched non-athletes. Dual energy X-ray absorptiometry of the left proximal femur was performed in 62 male (n = 31; 30.2 ± 4.6 years) and female (n = 31; 27.9 ± 5.2 years) competitive endurance runners, and 36 male (n = 18; 28.7 ± 5.8 years) and female (n = 18; 29.1 ± 5.3 years) non-athletes. The hip structural analysis programme determined areal bone mineral density (aBMD), bone area (BA), hip axis length, cross-sectional area (CSA), and cross-sectional moment of inertia (CSMI) of the femoral neck. Strength indices were derived from the femoral strength index (FSI) (Yoshikawa et al., J Bone Miner Res 9:1053–1064, 1994). Despite similar size-adjusted aBMD, sexual dimorphism was apparent for BA, CSA and CSMI, with superior values in men compared to women (P < 0.01). FSI was greater in male and female athletes than non-athletes (P < 0.01). From all groups, results in male athletes inferred greatest resistance to axial (CSA) and bending loads (FSI). Estimates of bone strength (FSI) were greater in female athletes than male and female non-athletes, supporting the osteogenic value of regular loading of the hip.

The aim of the study was to compare the effects of high and low concentration carbohydrate (CHO) solutions on the endurance performance of recreational, male soccer players consumed prior to and during intense, intermittent exercise. Methods: Seven participants consumed four different fluids using a randomised double blind procedure, an 8% carbohydrate electrolyte solution (2.5% galactose and 5.5% glucose polymer) (8% CES), a 2.5% carbohydrate (2.5% galactose) electrolyte solution (2.5% CES), an electrolyte solution (E) and water (W). A further three participants acted as controls by consuming E only on four occasions. We used the Loughborough Intermittent Shuttle Test (LIST) to simulate the intense, intermittent nature of a soccer match. The LIST protocol consists of two parts: Part A required walking, jogging and sprinting, utilising a 20 m shuttle procedure, for 75 min, recovering for 3 min every 15 min. Part B required participants to perform intermittent running to exhaustion, alternating between 55% and 95% of their predicted maximal oxygen uptake. Each beverage was administered immediately prior to exercise (5 ml · kg-1) and every 15 min thereafter (2 ml · kg-1) until the conclusion of Part A. Results: The performance run times for Part B (mean ± SD) were 16.3 ± 1.5 min (8% CES), 11.1 ± 1.2 min (2.5% CES), 10.0 ± 1.0 min (E) and 9.3 ± 0.9 min (W). The 8% CES beverage produced a significantly greater time to exhaustion (Part B) than the other drinks (5.0 ± 1.5 min, P<0.05). Conclusions: A high CHO concentration formulation (8% CES) is associated with a significant increase in endurance performance during intense, intermittent exercise in recreational, male soccer players.

BACKGROUND: Increasing body mass index, cholesterol and body fat are associated with a better prognosis in patients with left ventricular systolic dysfunction (LVSD). Beta-blocker usage is associated with changes in body composition and increased body fat. The present study investigated 12-month changes in body composition in patients with LVSD initiated on beta-blocker therapy. METHODS: The relation between beta-blocker use and body composition was evaluated in 91 patients (75% male) with LVSD. Body composition was assessed by bioelectrical impedance. RESULTS: Seventeen patients died during the study period. There was no statistical difference among beta-blocker usage, beta-blocker type, or changes in body fat, basal metabolic rate, impedance, fat-free mass, fat mass and total body water. There were no significant differences between any of these measures and beta-blocker usage. CONCLUSION: After 12 months, changes in body composition were not found to be influenced by initiation of beta-blocker therapy in patients with LVSD.

Background The 6 min walk test (6-MWT) is a simple and popular test for evaluating functional status in patients with chronic heart failure (CHF). However, the prognostic value of the 6-MWT in a large, representative sample of CHF patients, and in patients with different degrees of left ventricular systolic dysfunction (LVSD) remains unclear. Methods and results Of an initial population of 1592 patients, 212 died representing a crude death rate of 13.3%. In surviving patients, the median time to follow-up period was 36.6 months [inter-quartile range (IQR) 28–45 months]. Five variables remained independent predictors of all-cause mortality; decreasing 6-MWT distance, self-perceived signs of breathlessness at night (SOBAN), beta-blocker usage, elevated log NT-proBNP, and reduced haemoglobin concentration. We also dichotomized our analysis by LVSD status (≤mild LVSD or >mild LVSD). For patients with >mild LVSD, 6-MWT remained an important prognostic indicator but not in patients with ≤mild LVSD. Conclusion The 6-MWT is an important independent predictor of mortality in CHF patients, and this was especially evident in patients with >mild LVSD. The 6-MWT provides little prognostic utility in patients with ≤mild LVSD. While log NT-proBNP was the most potent independent predictor, an additive prognostic effect was evident with the additional selection of 6-MWT. Patients' self-perceived symptoms, especially SOBAN was an independent predictor of mortality in our patients.

The six-minute walk test (6-MWT) is widely used to assess functional status in patients with chronic heart failure (CHF). The aims of the present study were: (1) to compare metabolic gas exchange during the 6-MWT in older patients with left ventricular systolic dysfunction (LVSD) and in breathless patients with no major structural heart disease (MSHD); (2) to determine the exercise intensity of the 6-MWT relative to peak oxygen uptake; (3) to establish the accuracy and reproducibility of the Metamax 3B ergospirometer during an incremental workload. Twenty four older patients with LVSD (19 male; age 76 +/- 5 years; BMI 27 +/- 4), and 18 patients with no MSHD (12 male; age 75 +/- 8 years; BMI 27 +/- 4) attended on consecutive days at the same time. Patients completed a 6-MWT with metabolic gas exchange measurements using the Metamax 3B portable ergospirometer, and an incremental cycle ergometry test using both the Metamax 3B and Oxycon Pro metabolic cart. Patients returned and performed a second 6-MWT and an incremental treadmill test, metabolic gas exchange was measured with the Metamax 3B. In patients with LVSD, the 6-MWT was performed at a higher fraction of maximal exercise capacity (p = 0.02). The 6-MWT was performed below the anaerobic threshold in patients with LVSD (83 %) and in patients with no MSHD (61 %). The Metamax 3B showed satisfactory to high accuracy at 10 W and 20 W in patients with LVSD (r = 0.77 - 0.97, p < 0.05), and no MSHD (r = 0.76 - 0.94, p < 0.05). Metabolic gas exchange variables measured during the 6-MWT showed satisfactory to high day-to-day reproducibility in patients with LVSD (ICC = 0.75 - 0.98), but a higher variability was evident in participants with no MSHD (ICC = 0.62 - 0.97). The Metamax 3B portable ergospirometer is an accurate and reproducible device during submaximal, fixed rate exercise in older patients with LVSD and no MSHD. In elderly patients with LVSD and no MSHD, the 6-MWT should not be considered a maximal test of exercise capacity but rather a test of submaximal exercise performance. Our study demonstrates that the 6-MWT takes place at a higher proportion of peak oxygen uptake in patients with LVSD compared to those with no MSHD, and may be one reason why fatigue is a more prominent symptom in these patients.

Objectives: To generate insights into the personal meaning and value of an inclusive adventurous training and adapted sport course for military personnel who have experienced physical disability as a result of injuries sustained during active service. Design: Narrative storytelling approach based on collaboratively written creative nonfictions. Method: First-person stories were constructed with two male soldiers on the basis of informal interviews and conversations across five days of a residential adventure training and sport course. Results: The stories portray the personal benefits, meaning, and value of adventurous training and sport by illuminating each individual's experiences since injury/trauma, his experiences while on the course, and how these interact to shape psychological wellbeing and future life horizons. They reveal a complex interplay between physical, psychological, and social disability among some military personnel. Conclusions: The story as analysis expands current understanding of the psychological effects of physical activity for injured military personnel through: (i) providing an alternative analytical approach; (ii) revealing subjectivities, personal meaning, and biographical connections to generate a holistic understanding of the individual; (iii) preserving the complexity and ambiguity that characterize lived experience to support plural understandings; (iv) sharing an embodied representation as an ethical act of witnessing another's life. We suggest these kinds of understandings are necessary for physical activity practitioners who wish to support military personnel who have sustained a disability.

We investigated the effect of an acute creatine loading (25 g per day for 4 days) and longer-term creatine supplementation (5 g of creatine or 5 g of placebo per day for 2 months) on the performance of 22 elite swimmers during maximal interval sessions. After the acute creatine loading, the mean of the average interval swim times for all swimmers (n = 22) improved (44.3 +/- 16.5 s before vs 43.7 +/- 16.3 s after supplementation; P ≪ 0.01). Three of the 22 swimmers did not respond positively to supplementation. After 2 months of longer term creatine supplementation or placebo,neither group showed a significant change in swimming performance (38.7 +/-13.5 s before vs 38.7 +/- 14.1 s after for the creatine group; 48.7 +/- 18.0 s before vs 48.7 +/- 18.1 s after for the placebo group). We conclude that, in elite swimmers, 4 days of acute creatine loading improves swimming performance significantly when assessed by maximal interval sessions. However, longer-term supplementation for 2 months (5 g of creatine per day) did not benefit significantly the creatine group compared with the placebo group.

Introduction and Purpose A recent MRI study defined the different types of PLAC injuries (Table 1) and noted that Adductor Longus Avulsions are seldom isolated, being most commonly associated with injuries to the Pyramidalis and Pectineus. Mechanisms of injury of the Adductor Longus and PLAC differ between different sports. The aim of the study was to examine the hypothesis that the prevalence of the type of PLAC injury is dependent on the type of sport. Materials and Methods Retrospective study. The PLAC injury database in our institution was interrogated using the following inclusion criteria: acute post traumatic PLAC injury; PLAC injury score (type 1-6); type of sport, n>3 per sport. The distribution of PLAC injury types across sports was examined alongside the incidence of associated partial Pectineus tears. Hypotheses were tested using Chi-square test, effect size using Cramer’s V. Results 257 athletes fulfilled the inclusion criteria. The experimental hypothesis, that the type of PLAC injury is dependent on the type of sport is accepted and is significant across all sports. (X2 (30, 257) = 63.7 (LR), p = 0.0003; small effect size (Cramer’s V = 0.232)). Football (n=188, 73%) with (n=128, 50%) professional, Rugby (n=43, 17%), Racket sports (n=11, 4%), professional Ice Hockey (n=5, 2%), Martial Arts (n=6, 2%), Water Skiing (n=4, 2%). The occurrence of a partial Pectineus Avulsion is also significant across all sports (X2 (3, 192) = 10.2, p = 0.017;small effect size (Cramer’s V = 0.230)). Associated Pectineus Avulsions were: Football (24%), Rugby (44%), Martial Arts and Water Skiing (100%). Conclusion The study confirms different PLAC injury patterns across different sports, including a considerable variation in the prevalence of associated Pectineus injuries. This is clinically relevant and important knowledge to facilitate accurate MRI assessment of these injuries, and appropriate planning of surgical treatment. Type 1 Complete fibrocartilage (FC) avulsion–Pyramidalis separated from Adductor Longus–intact Pectineus Type 2 Complete FC avulsion–Pyramidalis separated from Adductor Longus–partial Pectineus tear Type 3 Complete FC avulsion–Pyramidalis connected to Adductor Longus–intact Pectineus Type 4 Complete FC avulsion–Pyramidalis connected to Adductor Longus–partial Pectineus tear Type 5 Complete FC avulsion–Pyramidalis partially separated from Adductor Longus–partial Pectineus tear Type 6 Partial FC avulsion–Pyramidalis connected to Adductor Longus–intact Pectineus Table 1: Types of PLAC injuries PLAC TYPE Total Football Professional Football Rugby Racket Sports Ice Hockey Martial Arts Water Skiing Type 1 67(25) 8(14) 40(31) 12(28) 7(64) 0 0 0 Type 2 45(18) 12(20) 19(15) 7(16) 0 0 4(66) 3(75) Type 3 63 (24) 15(25) 36(28) 8(19) 2(18) 2(40) 0 0 Type 4 21 (8) 2(3) 9(7) 7(16) 0 1(20) 1(17) 1(25) Type 5 9(4) 1(2) 2(2) 5(12) 0 0 1(17) 0 Type 6 52 (21) 22(36) 22(17) 4(9) 2(18) 2(40) 0 0 Total 257 60 128 43 11 5 6 4 Table 2: Frequency of PLAC type by sport (integers in brackets are percentages)

Introduction and Purpose An imaging classification for Pyramidalis-Anterior Pubic Ligament-Adductor Longus Complex (PLAC) injuries has recently been described. The objective of this study was to assess intra-and inter-observer agreement on MRI PLAC injury classification and make comparisons with surgical findings. Methods: Retrospective study The PLAC injury database in our institution was interrogated using the following inclusion criteria: Acute post-traumatic PLAC injury, dedicated MRI protocol, complete Adductor Longus (AL) Avulsion, surgical PLAC repair 2017-2020. Two expert musculoskeletal radiologists, blinded for demographic and clinical data, scored the MRI scans twice in a 6-week interval. Both MRI and surgical findings were scored for type of PLAC injury (1-5), injury to Pectineus and Lacunar Ligament (LL). Cohen’s weighted and unweighted Kappa were used to calculate intra- and inter-rater agreement for scoring the MRI scan and to calculate agreement between each radiologist with the surgical findings. Results: 80 athletes fulfilled the inclusion criteria. Main sports were Football (n=36, 45%), Rugby (n=21, 26%), Other (n=23, 29%). Surgical findings: The Pyramidalis was present in (n=76, 95%). AL was separated from Pyramidalis (n=44, 55.0%), in continuity (n=35, 43.8%). The AL was displaced in (n=55, 68.8%) and in situ in (n=25, 31.2%). LL injury (n=41, 51.2%). Partial Pectineus Avulsion (n=39, 48.8%). Scoring PLAC injury type, the intraobserver weighted Kappa score was 1 for both radiologists, the interobserver weighted Kappa score 0.98. The weighted Kappa score for MRI/Surgical correlation for PLAC injury type was 0.96 for first scorer and 0.98 for the second. Conclusion This original study established excellent correlations between MRI and surgical findings in AL/PLAC injuries. There was an almost perfect intra- and inter-observer agreement on the PLAC injury type diagnosis. A dedicated MRI groin study protocol is a reliable method to accurately diagnose PLAC injury, assess the different anatomical structures and facilitate effective planning for surgical treatment. Type 1 Complete fibrocartilage (FC) avulsion–Pyramidalis separated from Adductor Longus–intact Pectineus Type 2 Complete FC avulsion–Pyramidalis separated from Adductor Longus–partial Pectineus tear Type 3 Complete FC avulsion–Pyramidalis connected to Adductor Longus–intact Pectineus Type 4 Complete FC avulsion–Pyramidalis connected to Adductor Longus–partial Pectineus tear Type 5 Complete FC avulsion–Pyramidalis partially separated from Adductor Longus–partial Pectineus tear Type 6 Partial FC avulsion–Pyramidalis connected to Adductor Longus–intact Pectineus Table 1 Types of PLAC injuries Interobserver agreement Kappa unweighted Kappa weighted lower estimate upper lower estimate upper Type of PLAC 0.95 0.98 1.00 0.98 0.98 0.98 Pyramidalis 1 1 1 1 1 1 Pyramidalis oedema 0.74 0.85 0.96 0.73 0.73 0.73 Pyramidalis-AL separation 1 1 1 1 1 1 Partially/complete 0.9 0.96 1.0 0.9 0.9 0.9 Lacunar ligament injury 0.75 0.87 0.98 0.75 0.87 0.98 Partial pectineus avulsion 1 1 1 1 1 1 Table 2: interobserver agreement between radiologist for the first score

Introduction and purpose: To date, Proximal Adductor Longus Avulsions and Pyramidalis-Anterior Pubic Ligament-Adductor Longus Complex (PLAC) injuries are reported uniquely in male athletes. This study compared the Symphyseal anatomy of males and females to establish whether anatomical variations could account for the observed sex difference in occurrence of PLAC injuries, and aid MRI image interpretation. Methods: The anterior Symphyseal area was systematically dissected in six female and eight male fresh-frozen cadavers to examine PLAC and Rectus Abdominis (RA), and their anatomical relationship. The level of agreement for the observers was measured using the Bland and Altman method. Results: A PLAC was found in all specimens. The RA was found to have both an external and internal tendon (IT) in 100% of male and 66.6 % of female cadavers. The small bias of -0.17% + 3.58% in the mean of differences in the percentage width of the total RA insertion between the two scorers was not significant (paired t test, P>0.05). In males the IT of RA decussates with the contralateral tendon and runs deep to the Anterior Pubic ligament (APL), to insert caudally. In females the IT of the RA tendon, when present, by contrast inserts cranial to the deep portion of the APL, and does not interlace with the IT from the contralateral side (Figure 1 and 2). Conclusions: The PLAC is present in both sexes and therefore does not account for the difference in occurrence of proximal adductor avulsions. However, in males the IT runs deep to the APL forming a pulley system which can be disrupted with forced abduction of the leg. The absence of this pulley system in women and the parallel orientation of the internal tendons of the RA is protective against PLAC injuries, and allows widening of the pubic symphysis during pregnancy and childbirth.

Objectives: Proximal adductor longus avulsions and pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) injuries are reported uniquely in male athletes and appear underreported in female athletes. The aim of the study is to investigate potential variations in the symphyseal anatomy between males and females which could account for the difference in occurrence of PLAC injuries, and aid MRI image interpretation. Methods: Approval was obtained from our institution’s Local Research and Ethics Committee. A layered dissection of the soft tissues of the anterior symphyseal area was performed on six female and eight male fresh-frozen cadavers to systematically investigate anatomical structures of the anterior pubic area, namely the pyramidalis muscles and the rectus abdominis, and their anatomical relationship with the adductor longus. The ratio between the internal tendon (IT) and total width (TW) of the rectus abdominis was calculated independently by 2 observers. The level of agreement between the observers was measured using the Bland and Altman method. Results: A PLAC was found in all specimens. The rectus abdominis was found to have both an external and internal tendon in 100% of the male and 66.6 % of the female cadavers. The mean IT/TW ratio was 40.1% (25.8%-59.2%) in males and 38.0% (31.6%-48.9%) in females. The small bias of -0.17%, as shown by the mean of differences between the two scorers’ percentages was not significant (paired t test, P>0.05). In males the internal tendon of rectus abdominis decussates with the contralateral tendon and runs deep to the anterior pubic ligament, to insert caudally. In females the internal tendon of the rectus abdominis tendon, when present, by contrast inserts cranial to the deep portion of the anterior pubic ligament, caudally to the pelvic ridge. It does not interlace with the internal tendon from the contralateral side. Female anterior symphyseal anatomy (Pyramidalis removed) Male anterior symphyseal anatomy (Pyramidalis removed) Conclusions: The PLAC is present in both males and females and therefore does not account for the difference in occurrence of proximal adductor avulsions. When present, the relative width of the internal tendon of the rectus abdominis is similar for both genders. However, in males the internal tendon runs deep to the anterior pubic ligament forming a pulley system. With abduction and extension of the leg, the internal tendon can cause a disruption of the anterior pubic ligament and adductor longus fibrocartilage which can account for the higher incidence of adductor avulsions/ PLAC injuries in male athletes. The absence of this pulley system in women and the parallel orientation of the internal tendons of the rectus abdominis is protective against PLAC injuries, and also allows widening of the pubic symphysis during pregnancy and childbirth.

Currently there is no consensus on the most appropriate management of Adductor Longus Avulsions and selection of athletes for operative or non-operative treatment. An MRI study identified 6 types of injury to the Pyramidalis-Anterior Pubic Ligament- Adductor Longus Complex (PLAC) following Adductor Longus Avulsions, often associated with partial Pectineus Avulsions. Alternate hypothesis: the distribution of PLAC injuries associated with Adductor Avulsions is different in athletes with failed conservative treatment compared to athletes with successful conservative or surgical treatment. Methods The PLAC injury database was examined at our institution for the following inclusion criteria: High level or Professional Athletes, PLAC injury score type 1-6 (Table 1), with further division into: Group A: Failure of non-operative treatment (> 44 days after index injury), completion of structured rehabilitation program Group B: Successful non-operative or surgical treatment (<20 days of the index injury). Hypotheses were tested using Chi-square, effect size Cramer’s V and post hoc cell differences using Bonferroni adjustment (p< 0.004). Results: Group A (n=120), Group B (n=109) Most common PLAC types found in group A were type 3 and 6 (Table1), n=39 (33%) and n=40 (33%) respectively. Most common types found in group B were type 1 and 3, n=37 (34%) and n=21 (19%) respectively. Overall, PLAC type distribution and groups were dependent (X2 (5, 229) = 26, p = 0.00009; moderate effect size (Cramer’s V = 0.304)). The variation between frequency of type 1 and 6 injuries between the groups reflected the significant cell differences between observed and expected values (p=0.0002 and p=0.0001 respectively). Conclusion Variability exists in PLAC injury patterns between athletes who had successful conservative or surgical management compared to athletes who had failed conservative treatment. This original study can help to select the appropriate treatment for PLAC injuries associated with Adductor Avulsions. Type 1 Complete fibrocartilage (FC) avulsion–Pyramidalis separated from Adductor Longus–intact Pectineus Type 2 Complete FC avulsion–Pyramidalis separated from Adductor Longus–partial Pectineus tear Type 3 Complete FC avulsion–Pyramidalis connected to Adductor Longus–intact Pectineus Type 4 Complete FC avulsion–Pyramidalis connected to Adductor Longus–partial Pectineus tear Type 5 Complete FC avulsion–Pyramidalis partially separated from Adductor Longus–partial Pectineus tear Type 6 Partial FC avulsion–Pyramidalis connected to Adductor Longus–intact Pectineus Table 1: Types of PLAC injuries Type 1 2 3 4 5 6 Group A 120 16 (13%) 16 (13%) 39 (33%) 6 (5%) 3 (3%) 40 (33%) Group B 82+27 30 +7 (34%) 18 +1 (18%) 15+6 (19%) 8+1 (8%) 5+2 (6%) 6+10 (15%) Table 2: Distribution of PLAC injury types between Group A (failed non-operative treatment) and Group B (successful surgical or non-operative treatment)

The Anterior Pubic ligament spans the Symphyseal joint and forms part of the Pyramidalis-Anterior Pubic Ligament-Adductor Longus Complex (PLAC). A recent MRI study demonstrated that anterior Pubic ligament (APL) tears of the bridging part are often associated with PLAC injuries and Pectineus injuries. No cases have previously been reported of isolated APL tears in professional football. The aim of this study is to desccribe this new entity, detail the clinical symptoms and MRI findings. Material and Methods Our PLAC database was interrogated for APL tears. Adductor Longus avulsions, partial or complete, were excluded. Demographics, type of sport and level were recorded. The mechanism of injury, clinical presentation and MRI findings were evaluated. All athletes in our clinic presenting with acute groin pain are imaged using a specific MRI protocol. Results Four professional Football players fulfilled the inclusion criteria (average age 24 years (21-28)). Injury occurred when two players did the splits and two were taking a penalty. All players felt a pop and developed severe immediate pubic related groin pain. None of the players could continue playing. Clinically there was exquisite pain on palpation of the Symphyseal joint. One player had a feeling of unstable pubic bones. All had reduced adductor strength bilaterally (Table 1). The MRI showed a typical APL ligament tear where it bridges the Symphyseal joint (Figure 1). Three of the four players had previous MRI imaging which did not demonstrate the APL tear. Time between injury and diagnosis was 28-388 days. Conclusion Isolated APL tears are a newly reported cause of Pubic-related groin pain. Players who feel a pop and develop severe post traumatic Pubic pain should routinely have a dedicated MRI groin protocol. Axial oblique images through the Symphyseal area, thinly sliced, are essential to diagnose this condition which is easily missed with incorrect MRI protocols. Age injury mechanism Pain location ADD R ABD R ADD L ABD L ADD/ABD R ADD/ABD L 28 split Pubis/Perineal 13 36 11 30 0.36 0.36 25 split Pubis/Adductor 19 33 21 27 0.57 0.77 25 Penalty kick Pubis/Adductor 12 18 15 23 0.66 0.65 21 Penalty kick Pubis/Adductor 26 34 27 33 0.76 0.82 Table 1: Clinical presentation of anterior pubic ligament tear. Strength measurements of Adductors and Abductors in pounds (Microfet) and as a ratio (ADD = adduction; ABD = abduction). Figure 1: T2 axial oblique: yellow arrow demonstrates anterior pubic ligament tear.

Background: It is recommended that process evaluations of implementation fidelity become an integral part of the conduct of all digital health behaviour intervention research. The current study evaluated implementation fidelity of an Integrated Healthy Lifestyle Service (IHLS) during the COVID-19 lockdown. Methods: A pragmatic sample of 167 online surveys were conducted across IHLS staff (n= 44) and clients (n= 123). Results: A positive degree of online implementation fidelity was demonstrated during the COVID-19 lockdown for IHLS staff and clients alike across the key themes of integration, training, support, session delivery and content, and health benefits. Mixed degrees of online implementation fidelity were noted across the key themes of key performance indicators (KPIs), client engagement, and perceived competence. Lessons learned show that incorporating a bottom-up approach to information dissemination and rapid feedback from commissioners through to ground level staff, in particular in relation to KPI targets, is necessary for ensuring that programme targets are fully understood and agreed upon. The majority of IHLS clients were able to access and engage with online IHLS sessions successfully. Conclusion: This process evaluation represents one of the first efforts to document how an ongoing IHLS was adapted as a result of the COVID-19 pandemic. In the context of behavioural health interventions, the ubiquity of digital technologies and their adoption into day-to-day life translates into greater potential reach than traditional interventions, and consequently, greater potential for positive public health impact.

The association of both leisure-time physical activity and obesity with lipoprotein-lipids and composite atherogenic markers were examined within a cross-sectional study of middle-aged men of higher socioeconomic status. Analyses were performed on a subsample (n=629) of non-smoking, non-diabetic men (46.7±7.8 years) who completed a preventive medical assessment between 1992 and 1996. Mean adjusted (age, body mass index (BMI), sum of skinfolds, fasting glucose, and logarithmic alcohol consumption) levels of high-density lipoprotein-cholesterol (HDL-C) were significantly higher, and logarithmic triglycerides significantly lower, with higher physical activity index (PAI) categories (both P<0.0001). Significantly lower adjusted mean ratios of both total cholesterol to HDL-C (TC:HDL-C), and logarithmic triglycerides to HDL-C (TG:HDL-C) with higher PAI were evident following adjustment for the above covariates (P=0.005 and P<0.0001). Age-adjusted non-HDL-C (total cholesterol minus HDL-C) decreased significantly with higher PAI categories, but was not significantly lower following covariate adjustment (P=0.150). On stepwise multiple regression, logarithmic physical activity score and BMI explained 9.5-14% of the variance in the TC:HDL-C and TG:HDL-C ratios in models including age, body mass, sum of skinfolds, fasting glucose and logarithmic alcohol consumption. Age, sum of skinfolds and logarithmic alcohol consumption were significant predictors of non-HDL-C (r2=8.0%). These findings emphasise the importance of both physical activity and obesity in predicting lipoprotein-lipid risk markers.

Aims: Reported health behavior change intervention attrition rates vary considerably, from 10% to more than 80%, depending on the type and setting of the treatment programme. A better understanding of the determinants of programme adherence are required. Between March and August 2020, a convenience sample of 44 individual telephone interviews, as well as 42 online Qualtrics surveys took place. The aim was to explore perceived barriers, facilitators and opportunities for participation, sustained participation as well as initial non-participation to better understand reasons for attrition in online delivery during the COVID-19 lockdown amongst vulnerable and under-served groups within an Integrated Healthy Lifestyle Service (IHLS). Methods: This resulted in a total of 86 (33 male) individuals comprising intervention clients, including children and young people (CYP) (n=16), manual workers (n=7), Black, Asian or Minority Ethnic (BAME) (n=19), physical disability (n=8), learning disability (n=6), and those from areas of high deprivation (n=19), as well as IHLS practitioners (n=11). Results: The study revealed that more resources and support are needed for BAME, manual worker, learning disability, and high deprivation sub-groups in order to reduce attrition rates. Specifically, a lack of technological equipment and competence of using such equipment was identified as key barriers to initial and sustained attendance among these vulnerable and under-served sub-groups during the COVID-19 lockdown. Conclusion: The pattern of differences in attrition during the COVID-19 lockdown suggests that further research is required to explore how best to ensure online health behavior change offers are scalable and accessible to all. Keywords: Attrition; Behavior Change; Community Intervention; COVID-19; Digital Intervention; Health Promotion

Objective Identifying community physical activity interventions that facilitate increases in moderate physical activity (MPA) is important in meeting targets set in government health policy. This study evaluated community interventions that aimed to increase levels of MPA. Intervention themes included exercise referral, classes and groups, peermentoring, motivational interviewing, campaigns and directories, outdoor activity and training physical activity leaders. Design Longitudinal, pre-intervention and intervention assessments occurred between 2004 and 2006. Setting Recruitment of 10,433 people from ten sites located in areas of high health need across England. Method Demographic data were collected by questionnaire, with seven-day, population-specific self-reports assessing pre-intervention and intervention MPA. Using guidelines for young people and adults, MPA MET-minutes/week were used to assign participants to four MPA categories (sedentary, lightly, moderately and highly active) at pre-intervention and intervention phases. Cross-tabulation established movement between three change categories (reversal, stability and progression). Results From nine sites, 5324 people engaged in the evaluation, and a sub-sample of 998 provided demographic and 1022 self-report baseline and intervention data (i.e. completers) for a typical week’s physical activity participation. Of completers who were sedentary or lightly active at pre-intervention, 58.5 per cent achieved recommended physical activity guidelines. 80.9 per cent who were sedentary at pre-intervention reported as lightly, moderately or highly active at intervention. Conclusions Completers increased overall activity levels, including those sedentary and lightly active at pre-intervention who increased levels to recommended guidelines.

BACKGROUND: While respiratory muscle fatigue is present following load carriage activity at sea level, the effect of environmental conditions on respiratory strength while undertaking load carriage is unknown. METHODS: The effect of thoracic load carriage during walks (5.5 km) in four environments [(thermo-neutral sea level (SL), −10°C (C), 4300 m (H) and 4300 m at −10°C (HC)] was evaluated on respiratory muscle fatigue. Ten subjects completed eight self-paced randomized treadmill walks comprising a variety of gradients, unloaded and loaded (18.2 kg), across the four environments. Respiratory muscle strength was measured via maximal inspiratory pressure (PImax) and expiratory pressure (PEmax) assessments. RESULTS: Submaximal walking in HC elicited respiratory muscle fatigue when compared to SL. Inspiratory muscle fatigue was independent of load. The relative change in PImax from baseline was significantly greater in HC compared to SL (9.6% vs. 1.3%). PEmax showed a significant reduction during HC (−22.3 cmH2O, −14.4%) when compared to the other three environments. CONCLUSION: These results highlight the need to focus on respiratory muscle strength in preparation for exercise in cold hypoxic conditions.

A sprint kayaking specific deterministic model was used to identify key performance related technique factors using data from 12 international-level kayakers. There was large variability in the strength of the between-factor relationships across the group. The pull phase was split into 3 components with the 1st phase contributing the most to increases in boat velocity and the 3rd phase causing a decrease in velocity. The propulsive impulse had the largest influence on velocity, but the magnitude of the impact was moderated by blade slip. Large propulsive impulses in the 3rd phase of the pull were associated with larger decreases in velocity. The results show that the model can be used to identify key technique factors on an individual level, although the use of the model should be confirmed on additional kayakers before being used in an applied setting by practitioners.

Purpose The purpose of this experiment was to evaluate the effect of load carriage in a range of temperatures to establish the interaction between cold exposure, the magnitude of change from unloaded to loaded walking and gradient. Methods Eleven participants (19-27 years) provided written informed consent before performing six randomly ordered walking trials in six temperatures (20°C, 10°C, 5°C, 0°C, -5°C and -10°C). Trials involved two unloaded walking bouts before and after loaded walking (18.2 kg) at 4 km.hr⁻¹, on 0% and 10% gradients in 4 minute bouts. Results The change in absolute oxygen consumption (V̇O₂) from the first unloaded bout to loaded walking was similar across all six temperatures. When repeating the second unloaded bout, V̇O₂ at both -5°C and-10°C was greater compared to the first. At -10°C, V̇O₂ was increased from 1.60 ± 0.30 L.min⁻¹ to 1.89 ± 0.51 L.min⁻¹. Regardless of temperature, gradient had a greater effect on V̇O₂ and heart rate (HR) than backpack load. HR was unaffected by temperature. Stride length (SL) decreased with decreasing temperature but trunk forward lean was greater during cold exposure. Conclusion Decreased ambient temperature did not influence the magnitude of change in V̇O₂ from unloaded to loaded walking. However, in cold temperatures, V̇O₂ was significantly higher than in warm conditions. The increased V̇O₂ in colder temperatures at the same exercise intensity is predicted to ultimately lead to earlier onset of fatigue and cessation of exercise. These results highlight the need to consider both appropriate clothing and fitness during cold exposure.

OBJECTIVE: To assess the long-term effects of a multidisciplinary approach involving structured fun-type skill learning physical activities in the treatment of obese and overweight children. DESIGN: A longitudinal investigation incorporating repeated measurements before and after the 8 week intervention and after the 44 week follow-up period. METHODS: The camp programme (Massachusetts, USA) utilised structured fun-based skill learning physical activities, moderate dietary restriction and behaviour modification. The primary aims of the intervention were to reduce body mass and promote the maintenance of the reduction in body mass using an alternative to standard exercise prescription. SUBJECTS: One-hundred and ninety-four children (64 boys and 130 girls, aged 12.6±2.5y) enrolled at a summer weight loss camp, of which 102 children (38 boys and 64 girls aged 13.6±2.4y) returned 1y later. MEASUREMENTS: On commencement of the programme all children were assessed for body mass and stature. At follow-up, data was available on 102 subjects for body mass and stature. RESULTS: Over the 8 week intervention significant reductions (P=0.00) in body mass were obtained. During the 44 week follow-up significant increases (P= 0.00) were noted in body mass, body mass index (BMI) and stature, but as expected there were large variations in the responses. One year after the initial measures had been taken mean body mass and BMI were lower than at the start of the intervention, BMI significantly so (week 0, 32.9 ± 7.4 kg/m

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Background: The development of effective and sustainable childhood obesity treatment programmes is a public health priority. This pilot study evaluated the effectiveness of a local community collaboration (local council & local health care provider) in delivering a community based childhood obesity intervention following comprehensive training from our group. Methods: The Saturday morning intervention was delivered each week for a total of 12 weeks in a local secondary school. The family-based programme consisted of physical activity, nutrition and physical activity education, and behaviour modification. BMI, body composition, waist circumference, and aerobic fitness were assessed before and after the intervention. Statistical analysis was performed on an intention to treat basis. Results: Seventeen children (10 girls and 7 boys, aged 12.8±1.8 years) and at least one parent/carer per child were recruited to the programme, which had a mean attendance of 76.9% (± 22.9). Significant improvements (paired t test, P<0.05) were observed in BMI (-0.65±0.88 kg.m-2), BMI SD (-0.08±0.13 units), waist circumference (-2.47±4.73 cm), and predicted VO2 max from a one mile walk (6.05±9.19 ml.kg.-1min -1), while body fat percentage was maintained (-0.04±2.0%). Conclusion: The delivery of a childhood obesity intervention by a local community collaboration produced significant improvements in a variety of health variables. Such improvements, in combination with regular participant attendance and positive feedback from the local community collaboration regarding the training and delivery processes, suggest the current intervention to be effective. This community based approach is currently being delivered in several locations in the UK.

This book provides students and scholars with a fail-safe guide to the key concepts in the field of Sport & Exercise Science.

The objective of the present study was to investigate the accuracy of percent body fat (%fat) estimates from dual-energy X-ray absorptiometry, air-displacement plethysmography (ADP), and total body water (TBW) against a criterion four-compartment (4C) model in overweight and obese children. A volunteer sample of 30 children (18 male and 12 female), age of (mean ± SD) 14.10 ± 1.83 yr, body mass index of 31.6 ± 5.5 kg/m, and %fat (4C model) of 41.2 ± 8.2%, was assessed. Body density measurements were converted to %fat estimates by using the general equation of Siri (ADPSiri) (Siri WE. Techniques for Measuring Body Composition. 1961) and the age- and gender-specific constants of Lohman (ADPLoh) (Lohman TG. Exercise and Sport Sciences Reviews. 1986). TBW measurements were converted to %fat estimates by assuming that water accounts for 73% of fat-free mass (TBW73) and by utilizing the age- and gender-specific water contents of Lohman (TBWLoh). All estimates of %fat were highly correlated with those of the 4C model ( r ≥ 0.95, P < 0.001; SE ≤ 2.14). For %fat, the total error and mean difference ± 95% limits of agreement compared with the 4C model were 2.50, 1.8 ± 3.5 (ADPSiri); 1.82, -0.04 ± 3.6 (ADPLoh); 2.86, -2.0 ± 4.1 (TBW73); 1.90, -0.3 ± 3.8 (TBWLoh); and 2.74, 1.9 ± 4.0 DXA (dual-energy X-ray absorptiometry), respectively. In conclusion, in overweight and obese children, ADPLoh and TBWLoh were the most accurate methods of measuring %fat compared with a 4C model. However, all methods under consideration produced similar limits of agreement.

Abstract

Objective: To compare percentage body fat (percentage fat) estimates from DXA and air displacement plethysmography (ADP) in overweight and obese children.

Research Methods and Procedures: Sixty‐nine children (49 boys and 20 girls) 14.0 ± 1.65 years of age, with a BMI of 31.3 ± 5.6 kg/m2 and a percentage fat (DXA) of 42.5 ± 8.4%, participated in the study. ADP body fat content was estimated from body density (Db) using equations devised by Siri (ADPSiri) and Lohman (ADPLoh).

Results: ADP estimates of percentage fat were highly correlated with those of DXA in both male and female subjects (r = 0.90 to 0.93, all p < 0.001; standard error of estimate = 2.50% to 3.39%). Compared with DXA estimates, ADPSiri and ADPLoh produced significantly (p < 0.01) lower estimates of mean body fat content in boys (−2.85% and −4.64%, respectively) and girls (−2.95% and −5.15%, respectively). Agreement between ADP and DXA methods was further examined using the total error and methods of Bland and Altman. Total error ranged from 4.46% to 6.38% in both male and female subjects. The 95% limits of agreement were relatively similar for all percentage fat estimates, ranging from ±6.73% to ±7.94%.

Discussion: In this study, conversion of Db using the Siri equation led to mean percentage fat estimates that agreed better with those determined by DXA compared with the Lohman equations. However, relatively high limits of agreement using either equation resulted in percentage fat estimates that were not interchangeable with percentage fat determined by DXA.

Objective. The evidence base for child obesity treatment is weak. Children's weight-loss camps, despite their popularity, have not been properly evaluated. This study evaluated the effectiveness of a residential weight-loss camp program for overweight and obese children. Methods. A total of 185 overweight children (mean age: 13.9 years) enrolled in 1 of 4 consecutive programs between 1999 and 2002 (intervention group) were compared with 94 children of similar ages who were not camp attendees, ie, 38 overweight children and 56 normal-weight children. The intervention group attended a 6-week (maximum) summer residential weight-loss camp. The program included a daily schedule of six 1-hour, skill-based, fun, physical activity sessions, moderate dietary restriction, and group-based educational sessions. All children were assessed for body weight, height, and other anthropometric measures, blood pressure, aerobic fitness, self-esteem, and selected sports skills. Results. Campers, who stayed for a mean of 29 days, lost 6.0 kg, reduced their BMI by 2.4 units, and reduced their BMI SD scores by 0.28. Fat mass decreased significantly (from 42.7 to 37.1 kg), whereas fat-free mass did not change. In contrast, both comparison groups gained weight during this period. Camp attendees also showed significant improvements in blood pressure, aerobic fitness, and self-esteem. Longer durations of stay were associated with greater improvements in outcomes. Conclusions. In the short term at least, this weight-loss program was effective across a range of health outcomes. Ongoing research is examining the maintenance of these improvements. Future research should investigate whether benefits can be generalized across weight-loss camps and how the intervention can be adapted to nonresidential, term-time settings.

Objective: To evaluate the accuracy of percentage body fat (%fat) estimates from air displacement plethysmography (ADP) against an increasingly recognised criterion method, dual-energy X-ray absorptiometry (DXA), in young adolescents. Design: Cross-sectional evaluation. Setting: Leeds General Infirmary, Centre for Bone and Body Composition Research, Leeds, UK. Subjects: In all, 28 adolescents (12 males and 16 females), age (mean±s.d.) 14.9±0.5y, body mass index 21.2±2.9 kg/m

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OBJECTIVES: To examine the validity of body composition estimates obtained using foot-to-foot bio-electrical impedance analysis (BIA) in overweight and obese children by comparison to a reference four-compartment model (4-CM). SUBJECTS/METHODS: 38 males: age (mean +/- sd) 13.6 +/- 1.3 years, body mass index 30.3 +/- 6.0 kg.m(-2) and 14 females: age 14.7 +/- 2.2 years, body mass index 32.4 +/- 5.7 kg.m(-2) participated in the study. Estimates of fat-free mass (FFM), fat mass (FM) and percentage body fat (PBF) obtained using a Tanita model TBF-310 and a 4-CM (derived from body mass, body volume, total body water and total body bone mineral measurements) were compared using bias and 95% limits of agreement (Tanita minus 4-CM estimates). RESULTS: Body composition estimates obtained with the Tanita TBF-310 were not significantly different from 4-CM assessments: for all subjects combined the bias was -0.7kg for FM, 0.7kg for FFM and -1.3% for PBF. However, the 95% limits of agreement were substantial for individual children: males, up to +/-9.3kg for FFM and FM and +/-11.0% for PBF; females, up to +/-5.5kg for FFM and FM and +/-6.5% for PBF. CONCLUSIONS: The Tanita TBF-310 foot-to-foot BIA body composition analyser with the manufacturer's prediction equations is not recommended for application to individual children who are overweight and obese although it may be of use for obtaining group mean values.

Background: Current UK policy in relation to the influence of the ‘food environment’ on childhood obesity appears to be driven largely on assumptions or speculations because empirical evidence is lacking and findings from studies are inconsistent. The aim of this study was to investigate the number of food outlets and the proximity of food outlets in the same sample of children, without solely focusing on fast food. Methods: Cross sectional study over 3 years (n = 13,291 data aggregated). Body mass index (BMI) was calculated for each participant, overweight and obesity were defined as having a BMI >85th (sBMI 1.04) and 95th (sBMI 1.64) percentiles respectively (UK90 growth charts). Home and school neighbourhoods were defined as circular buffers with a 2 km Euclidean radius, centred on these locations. Commuting routes were calculated using the shortest straight line distance, with a 2 km buffer to capture varying routes. Data on food outlet locations was sourced from Leeds City Council covering the study area and mapped against postcode. Food outlets were categorised into three groups, supermarkets, takeaway and retail. Proximity to the nearest food outlet in the home and school environmental domain was also investigated. Age, gender, ethnicity and deprivation (IDACI) were included as covariates in all models. Results: There is no evidence of an association between the number of food outlets and childhood obesity in any of these environments; Home Q4 vs. Q1 OR = 1.11 (95% CI = 0.95-1.30); School Q4 vs. Q1 OR = 1.00 (95% CI 0.87 – 1.16); commute Q4 vs. Q1 OR = 0.1.00 (95% CI 0.83 – 1.20). Similarly there is no evidence of an association between the proximity to the nearest food outlet and childhood obesity in the home (OR = 0.77 [95% CI = 0.61 – 0.98]) or the school (OR = 1.01 [95% CI 0.84 – 1.23]) environment. Conclusions: This study provides little support for the notion that exposure to food outlets in the home, school and commuting neighbourhoods increase the risk of obesity in children. It seems that the evidence is not well placed to support Governmental interventions/recommendations currently being proposed and that policy makers should approach policies designed to limit food outlets with caution.

Objective: With growing concerns to establish the value for returns on public health investment, there is a need to identify cost-effective physical activity interventions. This study measured change in moderate physical activity (MPA) in seven community-based intervention types, costs and cost-effectiveness of the interventions, and possible explanations for cost variation. Design: Between 2004 and 2006, pre- and post-intervention assessments identified demographics and MPA levels, and quarterly interviews with intervention managers identified key implementation costs. Setting: Nine sites across the UK. Method: MPA was collected using self-report measures. MPA categories (sedentary, lightly, moderately, highly active) were assigned at pre- and post-intervention. Differences between pre- and post-intervention scores identified MPA change (median metabolic equivalent (MET)-minutes/week) in completers. Cost, attendance and activity data were combined to estimate the average monthly implementation cost, cost per participant attending interventions, and the cost per completer improving MPA category. An economic model was built to estimate the cost per Quality Adjusted Life Year (QALY) gained and potential savings to the National Health Service (NHS). Results: Demographics (n = 984) show that those who engaged with the interventions were predominantly white, British older females. In completers (N = 1,051), 37.9 per cent improved at least one MPA category. The cost per completer improving MPA category ranged from c£260 to c£2,786 (N = 1000). The cost per QALY gained from intervention types ranged from c£47 to c£509, which was below the £20,000 threshold implicit in National Institute for Health and Clinical Excellence (NICE) decisions. Future cost savings to the NHS per intervention participant ranged from c£769 to c£4,891. In the case of each of the interventions, this saving per participant exceeds the implementation cost per participant, which ranged from c£55 to c£3,420 (N = 6940). Conclusions: MPA interventions are cost-effective. Key Words: community interventions • cost-effectiveness • healthcare savings • physical activity

The potential for imprecision in the estimation of hydration status from changes in body mass has been outlined previously but the equations derived from these derivations appear inconsistent. Reconciliation of body mass loss in terms of sweat loss and effective body water loss is possible from specific equation sets provided that gains and losses of both body mass and water used in the derivation of sweat loss and to derive effective body water loss are in inclusive equation sets. This is obligatory so that mass and water changes as quantifiable determinants are consistent with both internal processes and external gains and losses. Thus, body mass loss, substrate oxidation, metabolic water, and all the terms used in simultaneous equation sets have to be reconciled not only as identical variables but mathematically balance exactly. The revised equation for effective body water loss given here is different from that originally proposed. Metabolic water is part of body mass loss corrected for substrate oxidation, fluid ingestion, and respiratory water to derive sweat loss and it may not be justified to also include water associated with glycogen as releasable bound water. Accordingly, our calculated effective body water loss is substantially a greater loss than originally supposed but clearly still less than the simple balance between mass loss and fluid ingested.

The addition of carbohydrate (CHO) to an acute creatine (Cr) loading regimen has been shown to increase muscle total creatine content significantly beyond that achieved through creatine loading alone. However, the potential ergogenic effects of combined Cr and CHO loading have not been assessed. The purpose of this study was to compare swimming performance, assessed as mean swimming velocity over repeated maximal intervals, in high-performance swimmers before and after an acute loading regimen of either creatine alone (Cr) or combined creatine and carbohydrate (Cr + CHO). Ten swimmers (mean ± SD of age and body mass: 17.8 ± 1.8 years and 72.3 ± 6.8 kg, respectively) of international caliber were recruited and were randomized to 1 of 2 groups. Each swimmer ingested five 5 g doses of creatine for 4 days, with the Cr + CHO group also ingesting ∼100 g of simple CHO 30 minutes after each dose of creatine. Performance was measured on 5 separate occasions: twice at "baseline" (prior to intervention, to assess the repeatability of the performance test), within 48 hours after intervention, and then 2 and 4 weeks later. All subjects swam faster after either dietary loading regimen (p < 0.01, both regimens); however, there was no difference in the extent of improvement of performance between groups. In addition, all swimmers continued to produce faster swim times for up to 4 weeks after intervention. Our findings suggest that no performance advantage was gained from the addition of carbohydrate to a creatine-loading regimen in these high-caliber swimmers. © 2005 National Strength & Conditioning Association.

Objective: Using a randomised control trial design, this study assessed the impact of two walking interventions, on the work day step counts and health of UK academic and administrative, university employees. Method: A convenience sample of 58 women (age 42 ± 10 years) and 6 men (age 40 ± 11 years) completed baseline and intervention measures for step counts, % body fat, waist circumference and systolic/diastolic blood pressure, during a ten-week period (October to December, 2005). Before intervention, baseline step counts (five working days) were used to randomly allocate participants to a control (maintain normal behaviour, n = 22) and two treatment groups (“walking routes”, n = 21; “walking in tasks”, n = 21). Intervention effects were evaluated by calculating differences between pre-intervention and intervention data. A one-way ANOVA analysed significant differences between groups. Results: A significant intervention effect (p < 0.002) was found for step counts, with mean differences indicating a decrease in steps for the control group (− 767 steps/day) and increases in the “walking routes” (+ 926 steps/day) and “walking in tasks” (+ 997 steps/day) groups. Small, non-significant changes were found in % body fat, waist circumference and blood pressure. Conclusions: Findings have implications for work-based physical activity promotion and the development of walking interventions within the completion of work-based tasks.

This study evaluated the effects of the pre-exercise (30 minutes) ingestion of galactose (Gal) or glucose (Glu) on endurance capacity as well as glycemic and insulinemic responses. Ten trained male cyclists completed 3 randomized high-intensity cycling endurance tests. Thirty minutes before each trial, cyclists ingested 1 L of either 40 g of glucose, 40 g of galactose, or a placebo in a double-blind manner. The protocol comprised 20 minutes of progressive incremental exercise (70-85% maximal power output [Wmax]); ten 90-second bouts at 90% Wmax, separated by 180 seconds at 55% Wmax; and 90% Wmax until exhaustion. Blood samples were drawn throughout the protocol. Times to exhaustion were longer with Gal (68.7 ± 10.2 minutes, p = 0.005) compared with Glu (58.5 ± 24.9 minutes), with neither being different to placebo (63.9 ± 16.2 minutes). Twenty-eight minutes after Glu consumption, plasma glucose and serum insulin concentrations were higher than with Gal and placebo (p < 0.001). After the initial 20 minutes of exercise, plasma glucose concentrations increased to a relative hyperglycemia during the Gal and placebo, compared with Glu condition. Higher plasma glucose concentrations during exercise, and the attenuated serum insulin response at rest, may explain the significantly longer times to exhaustion produced by Gal compared with Glu. However, neither carbohydrate treatment produced significantly longer times to exhaustion than placebo, suggesting that the pre-exercise ingestion of galactose and glucose alone is not sufficient to support this type of endurance performance.

In talent identification research, most studies have taken a cross-sectional rather than longitudinal approach. However, to improve understanding of factors that contribute to expert performance players should be monitored over a prolonged period (Williams & Reilly, 2000: Journal of Sports Sciences, 18, 657–667). The purpose of this study was to identify whether anthropometric and physiological characteristics could discriminate between selection levels when measured longitudinally over a 2-year period in junior Rugby League With institutional ethics approval, 683 Regional selected players completed an anthropometric and physiological battery of tests between 2005 and 2008. Players that were retained at Regional (n=26 age mean 13.60, s=0.27 years) and National (n=13 age mean 13.54, s=0.29 years) levels for three consecutive years were used for analysis. A repeated measures ANOVA was used to examine group differences between selection level (i.e. Regional and National) together with differences in characteristics over time. Findings demonstrate that differences between sum of four skinfolds and V_ O2max, measured by the multi-stage fitness test, exist between Regionaland National retained players which are maintained over a 2-year period with National players outperforming Regional players, however, speed improves at different rates. Although further longitudinal research is required, this study demonstrates that skinfold and V_ O2max measures do discriminate between Regional and National players over a 2-year period, even though such measurements are not used as part of the selection process in junior Rugby League.

In talent identification research, most studies have taken a cross-sectional rather than longitudinal approach. However, to improve understanding of factors that contribute to expert performance players should be monitored over a prolonged period (Williams & Reilly, 2000: Journal of Sports Sciences, 18, 657–667). The purpose of this study was to identify whether anthropometric and physiological characteristics could discriminate between selection levels when measured longitudinally over a 2-year period in junior Rugby League With institutional ethics approval, 683 Regional selected players completed an anthropometric and physiological battery of tests between 2005 and 2008. Players that were retained at Regional (n=26 age mean 13.60, s=0.27 years) and National (n=13 age mean 13.54, s=0.29 years) levels for three consecutive years were used for analysis. A repeated measures ANOVA was used to examine group differences between selection level (i.e. Regional and National) together with differences in characteristics over time. Findings demonstrate that differences between sum of four skinfolds and V_ O2max, measured by the multi-stage fitness test, exist between Regionaland National retained players which are maintained over a 2-year period with National players outperforming Regional players, however, speed improves at different rates. Although further longitudinal research is required, this study demonstrates that skinfold and V_ O2max measures do discriminate between Regional and National players over a 2-year period, even though such measurements are not used as part of the selection process in junior Rugby League.

Relative age effects (RAEs), reflecting observed inequalities in participation and attainment as a result of annual age-grouping policies in youth sport, are common in most team sports. The aims of this study were to determine if and when RAEs become apparent in Rugby League, determine how influential variables (e.g., gender) lead and clarify whether player retention at junior representative levels can explain persistent RAEs. Player data were collected for the male and female community games ranging from Under 7s to Senior (N=15,060) levels, junior representative selections (i.e., Regional) and professional players (N=298). Chi-square analyses found significant (P<0.05) uneven birth date distributions beginning at the earliest stages of the game and throughout into senior professionals. In junior representative selections, 47.0% of Regional and 55.7% of National representative players were born in Quartile 1, with RAE risk increasing with performance level. Gender and nationality were also found to moderate RAE risk. When tracking representative juniors, over 50% were retained for similar competition the following season. Findings clearly demonstrate that RAEs exist throughout Rugby League with early selection, performance level and retention processes, appearing to be key contributing factors responsible for RAE persistence.

The present study examined relationships between anthropometric, physiological and selection characteristics of junior (N=683; aged 13–16) representative Rugby League players who underwent a battery of tests (e.g., height; O2max) as part of a national talent development program. Considerate of playing position (categorised as ‘Outside-Backs’, ‘Pivots’, ‘Props’, ‘Backrow’), ‘Props’ were more likely to be the relatively oldest and most mature. However, MANCOVA – with chronological age and maturation controlled – also identified that ‘Props’ were the worst performing on physiological tests. To add, physiological characteristics did not differ according to relative age. Findings suggest that relationships between anthropometric and physiological characteristics are not consistent with biases in selection, which raises issues regarding identification for immediate and long-term player selection and development.

Relative Age Effects (RAEs), reflecting observed inequalities in participation and selection as a result of annual age-grouping, are a common problem in most team sports (e.g. soccer; Musch & Grondin, 2001: Developmental Review, 21, 147– 167). In junior representative Rugby League, RAEs increase with each performance level with coaches preferentially selecting taller, heavier and earlier maturing players. However, the effect of playing position on RAEs is not clear with limited data available as to whether maturational differences exist between playing positions in youth sport. Therefore the purpose of this study was to examine the RAE and maturational status amongst playing positions in high performance junior Rugby League players. With institutional ethics approval, 683 regionally (e.g. Yorkshire) selected players (Age mean 14.57, s¼0.83 years) underwent anthropometric testing between 2005 and 2007. Birth date, playing position,height, sitting height and body mass were obtained, and age at Peak Height Velocity (PHV) calculated (Mirwald et al., 2002: Medicine and Science in Sport and Exercise, 34, 689–694) for each player. Player’s birth dates were recoded by quartile (e.g. Q1¼September–November, Q2¼December–February, etc.) with playing position categorised into one of four subgroups (‘‘Outside-Backs’’, ‘‘Halves and Hookers’’, ‘‘Props’’ and ‘‘Backrowers’’). Chi square analysis identified significant uneven birth date distributions (w2¼236.36, P50.01) for all Regional players and each playing position. Odds ratio (OR) and 95% Confidence Intervals (CI) identified increased risk of selection (Q1 v Q4 OR: 13.39, 95% CI: 4.32–41.53) for the ‘‘Prop’’ position, with 82.9% of ‘‘Props’’ born in the first half of the selection year. One way analysis of variance identified significant (P50.01) differences in maturity, height and body mass between positions with ‘‘Props’’ and ‘‘Backrowers’’ significantly taller, heavier and earlier maturing than the ‘‘Outside-Backs’’ and ‘‘Halves and Hookers’’. Whilst recognising the physical demands of Rugby League, findings demonstrate that player selection at junior representative levels is significantly biased towards the relatively older player, with ‘‘Props’’ and ‘‘Backrowers’’ older, earlier maturing, taller and heavier than ‘‘Outside-Backs’’ and ‘‘Halves and Hookers’’. Thus, younger and later maturing junior players, especially ‘‘Props’’ and ‘‘Backrowers’’, may be disadvantaged in selection to Regional squads due to a lack of physical development, highlighting issues related to differences between selection for current performance and talent identification and development.

This study evaluated the development of anthropometric and fitness characteristics of 3 individual adolescent junior rugby league players and compared their characteristics with a cross-sectional population matched by age and skill level. Cross-sectional anthropometric and fitness assessments were conducted on 1,172 players selected to the Rugby Football League's talent development program (i.e., the Player Performance Pathway) between 2005 and 2008. Three players of differing relative age, maturational status, and playing position were measured and tracked once per year on 3 occasions (Under 13s, 14s, 15s age categories) and compared against the cross-sectional population. Results demonstrated that the later maturing players increased height (player 1 = 9.2%; player 2 = 7.8%) and a number of fitness characteristics (e.g., 60-m speed-player 1 = -14.9%; player 2 = -9.9%) more than the earlier maturing player (player 3-Height = 2.0%, 60-m sprint = -0.7%) over the 2-year period. The variation in the development of anthropometric and fitness characteristics between the 3 players highlights the importance of longitudinally monitoring individual characteristics during adolescence to assess the dynamic changes in growth, maturation, and fitness. Findings showcase the limitations of short-term performance assessments at one-off time points within annual-age categories, instead of advocating individual development and progression tracking without deselection. Coaches should consider using an individual approach, comparing data with population averages, to assist in the prescription of appropriate training and lifestyle interventions to aid the development of junior athletes.

OBJECTIVES: The current study provided a longitudinal evaluation of the anthropometric and fitness characteristics in junior rugby league players across three annual-age categories (i.e., under 13s, 14s and 15s) considering playing position and selection level. DESIGN: Longitudinal design. METHODS: Eighty-one junior rugby league players selected to a talent development programme were tracked over a two year period. Anthropometric (height, sitting height, body mass and sum of four skinfolds) and fitness (lower and upper body power, speed, change of direction speed and maximal aerobic power) characteristics were measured on three occasions (i.e., under 13s, 14s and 15s). Repeated measures multivariate analysis of variance (MANOVA) and multivariate analysis of covariance (MANCOVA; controlling chronological and maturational age) analysed changes across annual-age categories in relation to playing position and selection level. RESULTS: Findings identified significant improvements in anthropometric and fitness characteristics across annual-age categories (p<0.001). MANOVA and MANCOVA analysis identified significant overall effects for playing position (p<0.001) and selection level (p<0.05) throughout the two year period. Interactions between playing position and time were identified for height, vertical jump and estimated V˙O2max (p<0.05). Selection level by time interactions were identified for 20m, 30m and 60m sprint (p<0.05). CONCLUSIONS: This study demonstrates the improvement of anthropometric and fitness characteristics within junior representative rugby league players. Interactive effects for playing position and selection level by time highlight the variation in the development of characteristics that occur during adolescence. Tracking the progression of characteristics longitudinally during adolescence, instead of at one-off time points, may assist selection and/or performance assessments within rugby league and other youth sport contexts.

Relative age effects (RAEs)—observed inequalities in participation and attainment as a result of annual age-grouping policies in youth sport—are a common problem in many sports (e.g., soccer; see Musch & Grondin, 2001). Maturational and selection mechanisms appear Symposia S15 to account for these birth-date discrepancies; however understanding how they manifest and operate—even in physically dependent sports (e.g., Rugby League)—is not clear. The purpose of this study was to examine birth date distribution, physical maturity, height, and body mass in regionally and nationally selected UK junior Rugby League players. Between 2005 and 2007, birth date, height, sitting height, and body mass were collected and age at peak height velocity (PHV) calculated (Mirwald et al., 2002) in 12- to 16-year-old players involved in the UK’s Rugby Football League National (n = 208) and Regional (n = 473) performance pathways. Chi-square analyses identified significant uneven birth date distributions, with 54% of National (χ 2 = 107.2, p < 0.0001) and 47% of Regional players (χ 2 = 140.9, p < 0.0001) born in the first quartile (i.e., Sept to Nov) alone. Related to height, 95% of National and 92% of Regional players were taller than the age-matched 50th percentile of UK reference values. And similarly, 97% of National and 96% of Regional players were above the UK’s age-matched 50th percentile for body mass. National (13.52 ± 0.58) and Regional (13.62 ± 0.6) players’ age at PHV also occurred significantly (p < 0.0001) earlier than UK reference values (Billewicz et al., 1981) of 14.1 ± 1.0 years. Although recognizing the physical demands of Rugby league, findings suggest that talent selection is overwhelmingly biased toward the relatively older, taller, heavier, and earlier maturing youngster within an annual cohort. Thus, younger and later maturing junior rugby league players are disadvantaged in selection to the performance pathway due to a lack of physical development.

This study longitudinally evaluated whether maturation and relative age interact with time during adolescence to differentially affect the development of anthropometric and fitness characteristics in junior rugby league players. Anthropometric and fitness characteristics of 81 junior players selected into the UK Rugby Football League's talent identification and development process were assessed over three consecutive occasions (i.e., under-13s, -14s, -15s). Players were grouped and compared in relation to maturational status (i.e., early, average, late) and relative age quartile (i.e., quartile 1). Repeated measures multivariate analysis of variance identified significant (P < 0.001) overall main effects for maturation group, relative age quartile and importantly a maturation group by time interaction. Findings showed that the early-maturing group had the greatest anthropometric characteristics and medicine ball throw across the three occasions. However, the late-maturing group increased their height (early = 5.0 cm, late = 10.3 cm), medicine ball throw and 60-m sprint (early = -0.46 s, late = -0.85 s) the most throughout the 2-year period. Early (de)selection policies currently applied in talent identification and development programs are questionable when performance-related variables are tracked longitudinally. During adolescence, maturation status alongside relative age should be considered and controlled for when assessing athlete potential for future progression.

Athlete development through adolescence can vary greatly because of maturational processes. For example, variation can be observed in anthropometric and fitness measures with later maturing individuals "catching up" their earlier maturing peers at later time points. This study examined a methodological issue concerning how best to assess anthropometric and fitness change (i.e., "across age categories" or "per year") relative to an age and skill-matched population (N = 1,172). Furthermore, it examined changes in anthropometric and fitness characteristics in 3 cases of youth rugby league players (aged 13-15) across a 2-year period. Findings identified the "per year" method as generating less deviated z-scores across anthropometric and fitness measures (e.g., mean change p < 0.001), suggesting less substantial change in case players relative to the population. When applied to additional players, z-score and radar graphs showed developmental variability and longitudinal change. The possibility of a "later maturing player" increasing anthropometric (e.g., height: player 4 = 3.3 cm; player 5 = 13.2 cm; and player 6 = 15.7 cm) and fitness (e.g., 30-m sprint: player 4 = -0.18 s, player 5 = -0.46 s, and player 6 = -0.59 s) characteristics compared with early maturing players was confirmed. Findings affirm the potential for variable and changing trajectories in adolescent athletes. Practical implications advocate a long-term inclusive tracking approach of athletes, the avoidance of (de)selection, and the reduction of a performance emphasis in adolescent stages of sport systems.

The purpose of the study was to assess the validity and inter-bike reliability of 10 Wattbike cycle ergometers, and to assess the test–retest reliability of one Wattbike. Power outputs from 100 to 1000 W were applied using a motorised calibration rig (LODE) at cadences of 70, 90, 110 and 130 rev · min−1, which created nineteen different intensities for comparison. Significant relationships (P < 0.01, r2 = 0.99) were found between each of the Wattbikes and the LODE. Each Wattbike was found to be valid and reliable and had good inter-bike agreement. Within-bike mean differences ranged from 0.0 W to 8.1 W at 300 W and 3.3 W to 19.3 W at 600 W. When taking into account the manufacturers stated measurement error for the LODE (2%), the mean differences were less than 2%. Comparisons between Wattbikes at each of the nineteen intensities gave differences from 0.6 to 25.5 W at intensities of 152 W and 983 W, respectively. There was no significant difference (P > 0.05) between the measures of power recorded in the test–retest condition. The data suggest that the Wattbike is an accurate and reliable tool for training and performance assessments, with data between Wattbikes being able to be used interchangeably.

Introduction: Few studies have objectively assessed the physiological demands of cricket, particularly during first class matches. An understanding of the specific physiological demands placed on players during match play is useful for setting individual training programmes. Exercise intensity relates to the physical demands of an activity and heart rate (HR) measurement during match play is a convenient way of objectively assessing exercise intensity. Purpose: This study aimed to quantify the exercise intensity of batting in first class cricket and determine any differences in responses between 50 and 20 over formats. Method: Using the Activio Team System, the HR of 5 first-class county batsmen was monitored during competitive 50 and 20 over games. To help identify the factors affecting batting intensity, batting statistics were recorded along with post-match feedback from the batsmen. Findings: HR ranged between 139-154 beats∙min-1 in the 50-over format and 149-167 beats∙min-1 in the 20-over format. The relative time spent in high (>85% HRmax), moderate (70-85% HRmax) and low-intensity (<70% HRmax) HR zones was 19.7 ± 6.9%, 62.6 ± 2.5%, 21.5 ± 7.2% for 50-over cricket and 53.1 ± 24.2%, 44.9 ± 24.2% and 1.35 ± 0.1% during 20-over cricket. During 20-over cricket, batsmen spent significantly more time in high intensity HR zones (p=0.021) and significantly less time in low-intensity HR zones (p=0.015) than during 50-over cricket. The HR when repeatedly scoring runs from running (164-181 beats∙min-1) and hitting 4’s and 6’s (160-177 beats∙min-1) was consistently greater than the HR during low-scoring (145-162 beats∙min-1) or predominantly stationary periods (142-158 beats∙min-1). Discussion: 50-over innings are mainly of low-moderate intensity interspersed with high-intensity periods. Whilst 20-over innings are often much shorter, significantly more time is spent at higher exercise intensities due to shorter and less frequent recovery opportunities. Greater contributions are therefore likely from anaerobic energy systems and repeated sprint ability may be important. Based on the high between and within-subject variability, batting intensity as reflected by measurement of HR, is dependent on the game format, the match situation and the individual. Typical Twenty-20 innings were calculated as lasting 46 ± 0.12 mins on average. Whilst such periods are relatively short compared with other intermittent sports, considerable physical fitness is required to perform consistently within the tight domestic schedule. Based on the HR data, combined net and conditioning sessions can be developed and tailored towards the specific game format in order to facilitate specific adaptations towards batting match play.

To advance our understanding of talent identification and development (TID), it is valuable to retrospectively trace athletes’ long-term career progression (Vaeyens et al., 2008, Journal of Sports Sciences, 38, 703–714). However, research monitoring athletes’ career progression through TID programmes into professional sport is limited, and no study has assessed career outcomes based on a retrospective longitudinally tracked sample. Therefore, the purpose of this study was to retrospectively compare the anthropometric and performance characteristics of junior rugby league players consecutively selected to a TID programme over 3 years (Under 13s, 14s and 15s) in relation to their longterm career progression. With local institutional ethics approval, former junior rugby league players were grouped according to their long-term career progression level (i.e., amateur, n = 12; academy, n = 24; professional, n = 15). All players undertook anthropometric (height, body mass, sum of four skinfolds), maturational (age at peak height velocity) and performance (vertical jump, medicine ball chest throw, 10–60 m sprint, agility 505 and estimated V?O2max via the multistage fitness test) assessments at the Under 13–15 age categories. A repeated measures multivariate analysis of variance identified overall significant effects for time (P < 0.001; ?2 = 1.00), career level (P = 0.005; ?2 = 0.48) and career level × time (P = 0.049; ?2 = 0.73). More specifically, univariate analysis identified differences at the junior age groups between career levels for chronological age (P = 0.002; ?2 = 0.24) and estimated V? O2max (P = 0.006; ?2 = 0.19), with professional players significantly younger than academy players and professional players having higher estimated V? O2max compared to amateur players. Significant interactions for career level × time were apparent for sitting height (P = 0.049; ?2 = 0.11), body mass (P = 0.05; ?2 = 0.09), 10-m sprint (P = 0.023; ?2 = 0.11) and 20-m sprint (P = 0.018; ?2 = 0.12). Greater increases in sitting height and body mass were observed for professional compared to amateur players. For sprint speed, greater improvements in performance were observed in amateur and professional compared to academy players. This study demonstrates, based on group responses, that future professional players selected to a TID programme were younger with a greater V? O2max and increased sitting height and body mass more than amateur players over a 2-year period (Under 13s-–15s). Such findings demonstrate that age and size advantages commonly observed in TID research within adolescent athletes may not be sensitive indicators to correctly identify future career progression. It is recommended that the evaluation of adolescent athletes within TID programmes should incorporate monitoring the development of anthropometric and performance characteristics over time instead of (de)selecting players using one-off assessments.

PURPOSE: To explore the psychosocial outcomes of an inclusive adapted sport and adventurous training course that aims to support the rehabilitation and personal development of military personnel who have sustained physical and/or psychological disability. METHOD: Narrative life story interviews were conducted with 11 men aged 20-43 taking part in one of the 5-day courses. A thematic narrative analysis was conducted, focusing on accounts that provided insights into personally meaningful psychosocial outcomes of the course. FINDINGS: We identified six themes, falling into two distinct clusters. "Bringing me back to myself" was achieved through the themes of (1) returning to activity, (2) rediscovering a sense of purpose, and (3) reconnecting to others. "New rooms to explore" was realised through (4) experiencing new activities, (5) being valued/respected/cared for and (6) being inspired by other people. CONCLUSION: Involvement in the course stimulated a balance of present- and future-oriented psychosocial outcomes through which participants both recreated aspects of themselves that had been lost through injury/trauma and moved forward with their lives as a result of new horizons of possibility. IMPLICATIONS FOR REHABILITATION: This 5-day inclusive adapted sport and adventurous training course offered meaningful psychosocial outcomes among military personnel who had experienced physical and/or psychological disability. The course helped participants recover aspects of their previous life and self through becoming physically active again, rediscovering a sense of purpose and reconnecting to others. Participants describe a broadening of life horizons as a result of the course, through new activities, being valued/respected/cared for, and being inspired by other people.

Loading of the skeleton is important for the development of a functionally and mechanically appropriate bone structure, and can be achieved through impact exercise. Proximal femur cross-sectional geometry was assessed in the male athletes (n = 55) representing gymnastics, endurance running and swimming, and non-athletic controls (n = 22). Dual energy X-ray absorptiometry (iDXA, GE Healthcare, UK) measurements of the total body (for body composition) and the left proximal femur were obtained. Advanced hip structural analysis (AHA) was utilised to determine the areal bone mineral density (aBMD), hip axis length (HAL), cross-sectional area (CSA), cross-sectional moment of inertia (CSMI) and the femoral strength index (FSI). Gymnasts and runners had greater age, height and weight adjusted aBMD than in swimmers and controls (p < 0.05). Gymnasts and runners had greater resistance to axial loads (CSA) and the runners had increased resistance against bending forces (CSMI) compared to swimmers and controls (p < 0.01). Controls had a lower FSI compared to gymnasts and runners (1.4 vs. 1.8 and 2.1, respectively, p < 0.005). Lean mass correlated with aBMD, CSA and FSI (r = 0.365-0.457, p < 0.01), particularly in controls (r = 0.657-0.759, p < 0.005). Skeletal loading through the gymnastics and running appears to confer a superior bone geometrical advantage in the young adult men. The importance of lean body mass appears to be of particular significance for non-athletes. Further characterisation of the bone structural advantages associated with different sports would be of value to inform the strategies directed at maximising bone strength and thus, preventing fracture.

Labral tears are commonly associated with femoroacetabular impingement. We reviewed 151 patients (156 hips) with femoroacetabular impingement and labral tears who had been treated arthroscopically. These were subdivided into those who had undergone a labral repair (group 1) and those who had undergone resection of the labrum (group 2). In order to ensure the groups were suitably matched for comparison of treatment effects, patients with advanced degenerative changes (Tönnis grade > 2, lateral sourcil height < 2 mm and Outerbridge grade 4 changes in the weight-bearing area of the femoral head) were excluded, leaving 96 patients (101 hips) in the study. At a mean follow-up of 2.44 years (2 to 4), the mean modified Harris hip score in the labral repair group (group 1, 69 hips) improved from 60.2 (24 to 85) pre-operatively to 93.6 (55 to 100), and in the labral resection group (group 2, 32 hips) from 62.8 (29 to 96) pre-operatively to 88.8 (35 to 100). The mean modified Harris hip score in the labral repair group was 7.3 points greater than in the resection group (p = 0.036, 95% confidence interval 0.51 to 14.09). Labral detachments were found more frequently in the labral repair group and labral flap tears in the resection group. No patient in our study group required a subsequent hip replacement during the period of follow-up. This study shows that patients without advanced degenerative changes in the hip can achieve significant improvement in their symptoms after arthroscopic treatment of femoroacetabular impingement. Where appropriate, labral repair provides a superior result to labral resection.

OBJECTIVE: It has been suggested that childhood obesity is inversely associated with deprivation, such that the prevalence is higher in more deprived groups. However, comparatively few studies actually use an area-level measure of deprivation, limiting the scope to assess trends in the association with obesity for this indicator. Furthermore, most assume a linear relationship. Therefore, the aim of this study was to investigate associations between area-level deprivation and three measures of adiposity in children: body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). DESIGN: This is a cross-sectional study in which data were collected on three occasions a year apart (2005-2007). SUBJECTS: Data were available for 13,333 children, typically aged 11-12 years, from 37 schools and 542 lower super-output areas (LSOAs). MEASURES: Stature, mass and WC. Obesity was defined as a BMI and WC exceeding the 95th centile according to British reference data. WHtR exceeding 0.5 defined obesity. The Index of Multiple Deprivation affecting children (IDACI) was used to determine area-level deprivation. RESULTS: Considerable differences in the prevalence of obesity exist between the three different measures. However, for all measures of adiposity the highest probability of being classified as obese is in the middle of the IDACI range. This relationship is more marked in girls, such that the probability of being obese for girls living in areas at the two extremes of deprivation is around half that at the peak, occurring in the middle. CONCLUSION: These data confirm the high prevalence of obesity in children and suggest that the relationship between obesity and residential area-level deprivation is not linear. This is contrary to the 'deprivation theory' and questions the current understanding and interpretation of the relationship between obesity and deprivation in children. These results could help make informed decisions at the local level.

Research suggests that there has been a leveling off in obesity prevalence occurring in the child population. However, a concern with the evidence base is that all of the studies have relied upon the use of BMI. The purpose of this study was to compare waist circumference (WC), BMI, and waist-to-height ratio (WHtR) data in three different sample of children (total number: 14,697) typically aged 11–12 years. Obesity prevalence defined by BMI did not change significantly between measurement years (2005 boys 20.6%, girls 18.0%; 2006 boys 19.3%, girls 17.3%; 2007 boys 19.8%, girls 16.4%). Obesity prevalence defined by WC was considerably higher especially, in girls (2005 boys 26.3%, girls 35.6%; 2006 boys 20.3%, girls 28.2%; 2007 boys 22.1%, girls 30.1%). The prevalence of children defined as “at risk” according to WHtR (2005 boys 23.3%, girls 21.1%; 2006 boys 16.7%, girls 15.6%; 2007 boys 17.6%, girls 17.2%) was found to be between obesity prevalence, estimated using BMI and WC. This data are the most up to date collection that includes BMI and WC in three large samples of children and clearly demonstrates inconsistencies between different measurements based on current classification systems. There is a need to understand the relationship between BMI and WC, with growth and health risk to establish a consistent public health message that is easily understood by the public

Objective: The purpose of this study was to examine the prevalence of obesity over time in the same individuals comparing body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR). Study design: Five year longitudinal repeated measures study (2005–2010). Children were aged 11–12 (Y7) years at baseline and measurements were repeated at age 13–14 (Y9) years and 15–16 (Y11) years. Methods: WC and BMI measurements were carried out by the same person over the five years and raw values were expressed as standard deviation scores (sBMI and sWC) against the growth reference used for British children. Results: Mean sWC measurements were higher than mean sBMI measurements for both sexes and at all assessment occasions and sWC measurements were consistently high in girls compared to boys. Y7 sWC = 0.792 [95% confidence interval (CI) 0.675–0.908], Y9 sWC = 0.818 (95%CI 0.709–0.928), Y11 sWC = 0.943 (95%CI 0.827–1.06) for boys; Y7 sWC = 0.843 (0.697–0.989), Y9 sWC = 1.52 (95%CI 1.38–0.67), Y11 sWC = 1.89 (95%CI 1.79–2.04) for girls. Y7 sBMI = 0.445 (95%CI 0.315–0.575), Y9 sBMI = 0.314 (95%CI 0.189–0.438), Y11 sBMI = 0.196 (95%CI 0.054–0.337) for boys; Y7 sBMI = 0.353 (0.227–0.479), Y9 sBMI = 0.343 (95%CI 0.208–0.478), Y11 sBMI = 0.256 (95%CI 0.102–0.409) for girls. The estimated prevalence of obesity defined by BMI decreased in boys (18%, 12% and 10% in Y 7, 9 and 11 respectively) and girls (14%, 15% and 11% in Y 7, 9 and 11). In contrast, the prevalence estimated by WC increased sharply (boys; 13%, 19% and 23%; girls, 20%, 46% and 60%). Conclusion: Central adiposity, measured by WC is increasing alongside a stabilization in BMI. Children appear to be getting fatter and the additional adiposity is being stored centrally which is not detected by BMI. These substantial increases in WC are a serious concern, especially in girls.

BACKGROUND: The Battle Back Centre offers a bespoke, Self Determination Theory-oriented adapted sport and adventurous training programme centred on experiential learning and reflection to support the recovery of military personnel. AIM: To identify the short-term impact of participation in the programme on positive mental health and psychological need satisfaction. METHOD: Participants were 978 wounded, injured and sick (WIS) personnel classified as: Wounded (battle casualties), Injured (non-battle casualties) and Sick (mental/physical illness). Participants completed the Basic Need Satisfaction in General Scale (Gagné, 2003) and Warwick and Edinburgh Mental Well Being Scale (Tennant et al. 2006) on arrival and course completion. RESULTS: All measures of positive mental health and psychological need satisfaction showed statistically significant increases, with a large effect size, from baseline to course completion (mean ± SD change in positive mental health, competence, autonomy and relatedness were 7.19 ± 9.61, 0.46 ± 0.9, 0.27 ± 0.84, 0.26 ± 0.86, respectively, p < 0.05). While the average magnitude of the intervention effect for positive mental health (16%) is comparable or greater than other reported interventions, changes were achieved in a shorter time. CONCLUSION: Findings highlight the positive short-term effect adapted sport and adventurous activities have for WIS personnel. DECLARATION OF INTEREST: Work supported by The Royal British Legion.

Contemporary guidelines for young people advocate both a sustained and accumulative approach to moderate-to-vigorous physical activity (MVPA) participation. In order to investigate the behavioural significance of applying these approaches, this study assessed if differences in adolescent MVPA occurred when either a sustained or accumulated criterion was adopted. Using heart rate thresholds indicative of intensity, the physical activity of 25 adolescents was assessed by monitoring heart rate over 3 days. Results indicated that differences in MVPA participation did exist when different approaches were used, in that the majority of adolescents were active with respect to an accumulated criterion yet inactive with respect to a sustained criterion. Such a disparity may be due to accumulative MVPA being more characteristic of young people's natural activity behaviour. Such findings have strong implications for practitioners seeking to counter young people's inactivity, in that the application of an accumulative approach may be more effective at initiating and establishing an habitual activity behaviour than that of a sustained approach.

PURPOSE: Adductor longus injuries are complex. The conflict between views in the recent literature and various nineteenth-century anatomy books regarding symphyseal and perisymphyseal anatomy can lead to difficulties in MRI interpretation and treatment decisions. The aim of the study is to systematically investigate the pyramidalis muscle and its anatomical connections with adductor longus and rectus abdominis, to elucidate injury patterns occurring with adductor avulsions. METHODS: A layered dissection of the soft tissues of the anterior symphyseal area was performed on seven fresh-frozen male cadavers. The dimensions of the pyramidalis muscle were measured and anatomical connections with adductor longus, rectus abdominis and aponeuroses examined. RESULTS: The pyramidalis is the only abdominal muscle anterior to the pubic bone and was found bilaterally in all specimens. It arises from the pubic crest and anterior pubic ligament and attaches to the linea alba on the medial border. The proximal adductor longus attaches to the pubic crest and anterior pubic ligament. The anterior pubic ligament is also a fascial anchor point connecting the lower anterior abdominal aponeurosis and fascia lata. The rectus abdominis, however, is not attached to the adductor longus; its lateral tendon attaches to the cranial border of the pubis; and its slender internal tendon attaches inferiorly to the symphysis with fascia lata and gracilis. CONCLUSION: The study demonstrates a strong direct connection between the pyramidalis muscle and adductor longus tendon via the anterior pubic ligament, and it introduces the new anatomical concept of the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC). Knowledge of these anatomical relationships should be employed to aid in image interpretation and treatment planning with proximal adductor avulsions. In particular, MRI imaging should be employed for all proximal adductor longus avulsions to assess the integrity of the PLAC.

Background: Prevalence of the metabolic syndrome has risen in children from 4.2% to 6.4% in 8 years (Duncan et al., 2004). Given this and the evidence that dietary modification and physical activity can favourably modify cardiovascular risk factors, the current study assessed the impact of an 8-week residential weight loss camp intervention on various biochemical and body composition variables. Methods: Fifty-one overweight and obese children (19 boys and 32 girls), mean age of 14.4 ± 2.0 years, BMI of 33.7 ± 7.2 kg/m2 and waist circumference of 95.5 ± 13.3 cm were resident at the camp intervention. Body composition and a range of biochemical variables were measured before and after the intervention (mean stay 31 ± 13 days). Results: Significant reductions (P < 0.001) were observed in all body composition variables, with BMI and waist circumference reduced by 5.6% and 5%, respectively. Significant reductions (P < 0.01) were observed for all biochemical variables except adiponectin. The following changes were achieved, T-C/HDL-c ratio (3.54 ± 0.76 pre to 2.99 ± 0.64 post), triglycerides (1.06 ± 0.41 mmol/L pre to 0.83 ± 0.32 mmol/L post), HOMA-IR (measure of insulin resistance) (3.46 ± 2.27 pre to 2.72 ± 1.77 post), C-reactive protein (measure of inflammation) (3.06 ± 2.79 mg/L pre to 1.71 ± 2.06 mg/L post), and leptin (125.0 ± 69.3 ng/mL pre to 55.7 ± 50.5 ng/mL post). Conclusion: Our programme achieved significant improvements in a variety of bio-chemical and body composition variables in a matter of weeks. This demonstrates the potential of this form of intervention for acute improvements. Further research is required to investigate the durability of these effects and the relationship with morbidity and premature mortality in adulthood.

Background: Adductor avulsions are complex injuries often involving multiple structures, as indicated by several magnetic resonance imaging (MRI) studies. However, no studies have compared MRI assessments using a dedicated groin protocol with surgical findings. Hypothesis: It was hypothesized that MRI assessments using a dedicated groin protocol would correlate closely with surgical findings, applicable to both experienced and novice users of the pyramidalis–anterior pubic ligament–adductor longus complex (PLAC) classification. Study Design: Case series; Level of evidence, 4. Methods: This retrospective study analyzed 161 athletes who underwent MRI using a dedicated groin protocol, followed by surgical repair of the PLAC. Two musculoskeletal radiologists—1 experienced (rater A) and 1 inexperienced (rater B) in the use of the PLAC classification—independently assessed the MRI scans twice, 6 weeks apart, using a structured 3-step protocol to evaluate (1) adductor longus fibrocartilage (intact, partially avulsed, or completely avulsed), (2) pyramidalis separation from adductor longus (intact, partially separated, or completely separated), and (3) pectineus status (intact or partially avulsed). Agreement between MRI and surgical findings was evaluated using a PLAC injury classification (types 1-5), with intra- and interobserver reliability measured by Cohen kappa. Results: Among the 161 athletes, 93 played soccer, of whom 69 were professional. All athletes exhibited complete fibrocartilage avulsion, with 83 athletes (52%) showing adductor longus separation from the pyramidalis. Isolated adductor longus avulsions (PLAC type 1) were observed in only 36 athletes (22%). The interobserver kappa score between MRI assessments and surgical findings was 0.942 for rater A and 0.858 for rater B. Intraobserver ratings were 0.967 for rater A and 0.875 for rater B. Both inter- and intraobserver scores indicated almost perfect agreement. In combination, these statistical findings support the validity, reliability, and applicability of the MRI protocol using the PLAC classification system for 2 users with varying levels of experience. Conclusion: Adductor avulsions were rarely isolated, typically involving multiple muscles. The PLAC classification effectively captured the complexity of these injuries. When used in conjunction with a dedicated MRI protocol, the PLAC classification demonstrated almost perfect agreement and concordance with surgical findings. Together, the PLAC classification and MRI protocol offered a more comprehensive and accurate representation of patients’ clinical and radiological features and provided valuable guidance for surgical planning.

Aim: Small dense LDL particles are associated with an increased risk of coronary heart disease and are prevalent in obesity related dyslipidaemia. This study evaluated the effect of weight loss in nine children (BMI 33.4 +/- 8.4 kg.m(-2) and age 15.1 +/- 2.9 years) on LDL peak particle size, and cholesterol concentrations within particular LDL sub-fractions. Methods: Each child undertook fan based physical activity, dietary restriction and modification and lifestyle education classes in a residential summer weight loss intervention. Blood was drawn before and after intervention and LDL heterogeneity measured by ultracentrifugation. Results: The mean change in body weight were -6.8 +/- 4.9 kg, BMI units -2.5 +/- 1.4 kg.m(-2), and waist circumference -6.3 +/- 6.3 cm (all p < 0.01). Absolute LDL-c concentration reduced from 106.2 mg/dL to 88.3 mg/dL (p < 0.01). The cholesterol contained within the small dense LDL sub-fraction (LDL-c M) reduced from 54.1 mg/dL to 40.4 mg/dL (p < 0.01). Peak particle density decreased from 1.041g/mL to 1.035g/mL (p < 0.01). At pre intervention 50.9% of absolute cholesterol was within LDL-c M particles, changing to 46.2%. Conclusion: Mean weight loss of -6.8 +/- 4.9 kg lowers absolute LDL-c and the cholesterol specifically within LDL-c III particles. LDL peak particle size increased and a degree of LDL particle remodelling occurred. These favourable adaptations, accrued in a matter of 4 weeks, maybe associated with a reduction in CHD risk.

This study evaluated the effects of inspiratory muscle training (IMT) on inspiratory muscle fatigue (IMF) and physiological and perceptual responses during trekking-specific exercise. An 8-week IMT program was completed by 21 males (age 32.4 ± 9.61 years, VO2peak 58.8 ± 6.75 mL/kg/min) randomised within matched pairs to either the IMT group (n = 11) or the placebo group [(P), n = 9]. Twice daily, participants completed 30 (IMT) or 60 (P) inspiratory efforts using a Powerbreathe initially set at a resistance of 50% (IMT) or used at 15% (P) of maximal inspiratory pressure (MIP) throughout. A loaded (12.5 kg) 39-minute incremental walking protocol (3–5 km/hour and 1–15% gradient) was completed in normobaric hypoxia (PIO2 = 110 mmHg, 3000 m) before and after training. MIP increased from 164 to 188 cmH2O (18%) and from 161 to 171 cmH2O (6%) in the IMT and P groups (P = 0.02). The 95% CI for IMT showed a significant improvement in MIP (5.21±43.33 cmH2O), but not for P. IMF during exercise (MIP) was*5%, showing no training effect for either IMT or P (P = 0.23). Rating of perceived exertion (RPE) was consistently reduced (*1) throughout exercise following training for IMT, but not for P (P = 0.03). The mean blood lactate concentration during exercise was significantly reduced by 0.26 and 0.15 mmol/L in IMT and P (P = 0.00), with no differences between groups (P = 0.34). Rating of dyspnoea during exercise decreased (*0.4) following IMT but increased (*0.3) following P (P = 0.01). IMT may attenuate the increased physiological and perceived exercise stress experienced during normobaric hypoxia, which may benefit moderate altitude expeditions

The effects of inspiratory muscle training (IMT) were evaluated at rest and during exercise in normobaric hypoxia (NH) and then an 11-day trek to 5300m. A 7-week IMT program was completed by 6 females and 3 males (age 34.8 ± 10.0 years) randomized to IMT (n = 4) or placebo [P (n = 5)]. A Powerbreathe was initially set at a resistance of 50% (IMT) or used at 15%ofmaximal inspiratory pressure (MIP) throughout (P). A self-paced walking test was completed before and after training at PIO2 = 104.1mmHg, 3440m (NH1); PIO2 = 85.9 mmHg, 4930m (NH2); and at 3440m during the trek (HH). Exercise data were interpolated to 4.8 km/hour to evaluate training effects. Patterns of change suggest possible benefits of IMT, but due to small group sizes and variability, these trends are not significant. MIP increased by 6% and 4% following IMT and P. Pulse oxygen saturation (SaO2) during exercise in NH2 increased by*4% following IMT, with no change in P. Decreases in resting SaO2 during the expedition (4930m) were attenuated in IMT (85.0 ± 3.61%) compared to P (80.0 ± 5.87%). Comparisons between NH1 exercise post-training and HH showed a decrease in perceived dyspnoea and effort in IMT ( - 0.3 and - 0.7) but an increase in P ( + 0.7 and + 2.6). Nonsignificant trends within the data suggest that the altitude-induced decrease in resting and exercise SaO2 and intensified perceived effort and dyspnoea during exercise were attenuated following IMT. However, further research is required to establish any beneficial effect of IMT.

This study evaluated the influence of annual-age category, relative age, playing position, anthropometry and fitness on the career attainment outcomes of junior rugby league players originally selected to a talent identification and development (TID) programme. Junior rugby league players (N=580) were grouped retrospectively according to their career attainment level (i.e., amateur, academy and professional). Anthropometric (height, sitting height, body mass, sum of four skinfolds), maturational (age at peak height velocity) and fitness (power, speed, change of direction speed, estimated ) characteristics were assessed at the Under 13s, 14s and 15s annual-age categories. Relative age (Q2=8.5% vs. Q4=25.5%) and playing position (Pivots=19.5% vs. Props=5.8%) influenced the percentage of players attaining professional status. Anthropometry and fitness had a significant effect on career attainment at the Under 14 (p=0.002, η2=0.16) and 15 (p=0.01, η2=0.12) annual-age categories. Findings at the Under 14s showed future professional players were significantly later maturing compared to academy and amateur players. Findings suggest that relative age, playing position, anthropometry and fitness can influence the career attainment of junior rugby league players. TID programmes within rugby league, and other related team sports, should be aware and acknowledge the factors influencing long-term career attainment, and not delimit development opportunities during early adolescence.

Research examining the factors influencing selection within talented junior Rugby League players is limited. The aims of this study were firstly to determine whether differences existed for anthropometric and performance characteristics between regional and national selection in high performance UK junior Rugby League players, and secondly to identify variables that discriminated between these selection levels. Regional representative (n=1172) selected junior players (aged 13-16 years) undertook an anthropometric and fitness testing battery with players split according to selection level (i.e., national, regional). MANCOVA analyses, with age and maturation controlled, identified national players as having lower sum of 4 skinfolds scores compared to regional players, and also performed significantly better on all physical tests. Stepwise discriminant analysis identified that estimated maximum oxygen uptake (VO2max), chronological age, body mass, 20 m sprint, height, sum of 4 skinfolds and sitting height discriminated between selection levels, accounting for 28.7% of the variance. This discriminant analysis corresponded to an overall predictive accuracy of 63.3% for all players. These results indicate that performance characteristics differed between selection levels in junior Rugby League players. However, the small magnitude of difference between selection levels suggests that physical qualities only partially explain higher representative selection. The monitoring and evaluation of such variables, alongside game related performance characteristics, provides greater knowledge and understanding about the processes and consequences of selection, training and performance in youth sport.

The use of global positioning systems (GPS) technology within referees of any sport is limited. Therefore, the purpose of the current study was to evaluate the movement and physiological demands of professional rugby league referees using GPS tracking analysis. Time-motion analysis was undertaken on 8 referees using 5-Hz GPS devices and heart rate monitors throughout a series of Super League matches. 44 data sets were obtained with results identifying similar total distance covered between first and second half periods with a significant (P=0.004) reduction in the number of high velocity efforts performed between 5.51-7.0 m.s-1 (1st=21±8, 2nd=18±8). Mean distance covered from greatest to least distance, was 3 717±432 m, 3 009±402 m, 1 411±231 m, 395±133 m and 120±97 m for the following 5 absolute velocity classifications, respectively; 0.51-2.0 m.s-1; 2.1-4.0 m.s-1: 4.01-5.5 m.s-1; 5.51-7.0 m.s-1; <7.01 m.s-1. Heart rate was significantly (P<0.001) greater in the first (85.5±3.4% maxHR) compared to the second (82.9±3.8% maxHR) half. This highlights the intermittent nature of rugby league refereeing, consisting of low velocity activity interspersed with high velocity efforts and frequent changes of velocity. Training should incorporate interval training interspersing high velocity efforts of varying distances with low velocity activity while trying to achieve average heart rates of ~ 84% maxHR to replicate the physiological demands.

The current study retrospectively investigated the differences in anthropometric and fitness characteristics of junior rugby league players selected onto a talent identification and development (TID) programme between long-term career progression levels (i.e., amateur, academy, professional).

The effects of inspiratory muscle training (IMT) were evaluated at rest and during exercise in normobaric hypoxia (NH) and then an 11-day trek to 5300m. A 7-week IMT program was completed by 6 females and 3 males (age 34.8 ± 10.0 years) randomized to IMT (n = 4) or placebo [P (n = 5)]. A Powerbreathe was initially set at a resistance of 50% (IMT) or used at 15% of maximal inspiratory pressure (MIP) throughout (P). A self-paced walking test was completed before and after training at PIO2 = 104.1mmHg, 3440m (NH1); PIO2 = 85.9 mmHg, 4930m (NH2); and at 3440m during the trek (HH). Exercise data were interpolated to 4.8 km/hour to evaluate training effects. Patterns of change suggest possible benefits of IMT, but due to small group sizes and variability, these trends are not significant. MIP increased by 6% and 4% following IMT and P. Pulse oxygen saturation (SaO2) during exercise in NH2 increased by*4% following IMT, with no change in P. Decreases in resting SaO2 during the expedition (4930m) were attenuated in IMT (85.0 ± 3.61%) compared to P (80.0 ± 5.87%). Comparisons between NH1 exercise post-training and HH showed a decrease in perceived dyspnoea and effort in IMT ( - 0.3 and - 0.7) but an increase in P ( + 0.7 and + 2.6). Nonsignificant trends within the data suggest that the altitude-induced decrease in resting and exercise SaO2 and intensified perceived effort and dyspnoea during exercise were attenuated following IMT. However, further research is required to establish any beneficial effect of IMT.

This study evaluated the effects of inspiratory muscle training (IMT) on inspiratory muscle fatigue (IMF) and physiological and perceptual responses during trekking-specific exercise. An 8-week IMT program was completed by 21 males (age 32.4 – 9.61 years, VO2peak 58.8 – 6.75 mL/kg/min) randomised within matched pairs to either the IMT group (n = 11) or the placebo group [(P), n = 9]. Twice daily, participants completed 30 (IMT) or 60 (P) inspiratory efforts using a Powerbreathe initially set at a resistance of 50% (IMT) or used at 15% (P) of maximal inspiratory pressure (MIP) throughout. A loaded (12.5 kg) 39-minute incremental walking protocol (3–5 km/hour and 1–15% gradient) was completed in normobaric hypoxia (PIO2 = 110 mmHg, 3000 m) before and after training. MIP increased from 164 to 188 cmH2O (18%) and from 161 to 171 cmH2O (6%) in the IMT and P groups (P = 0.02). The 95% CI for IMT showed a significant improvement in MIP (5.21–43.33 cmH2O), but not for P. IMF during exercise (MIP) was ~5%, showing no training effect for either IMT or P (P = 0.23). Rating of perceived exertion (RPE) was consistently reduced (~1) throughout exercise following training for IMT, but not for P (P = 0.03). The mean blood lactate concentration during exercise was significantly reduced by 0.26 and 0.15 mmol/L in IMT and P (P = 0.00), with no differences between groups (P = 0.34). Rating of dyspnea during exercise decreased (~0.4) following IMT but increased (~0.3) following P (P = 0.01). IMT may attenuate the increased physiological and perceived exercise stress experienced during normobaric hypoxia, which may benefit moderate altitude expeditions.

Abstract

Objective: To evaluate the effect of a high‐protein diet on anthropometry, body composition, subjective appetite, and mood sensations in overweight and obese children attending a residential weight‐loss camp.

Research Methods and Procedures: Children (120; BMI, 33.1 ± 5.5 kg/m2; age, 14.2 ± 1.9 years) were randomly assigned to either a standard or high‐protein diet group (15% vs. 22.5% protein, respectively). All children were assessed at baseline and at the end of the camp for anthropometry, body composition, blood pressure, biochemical variables (n = 27), and subjective appetite and mood sensations (n = 50).

Results: Attendance at the weight‐loss camp resulted in significant improvements in most measures. Campers lost 5.5 ± 2.9 kg in body weight (p < 0.001) and 3.8 ± 5.4 kg in fat mass (p < 0.001) and reduced their BMI standard deviation score by 0.27 ± 0.1 (p < 0.001) and their waist circumference by 6.6 ± 2.8 cm (p < 0.001). Subjective sensations of hunger increased significantly over the camp duration, but no other changes in appetite or mood were observed. There were no significant differences between the two diets on any physical or subjective measures.

Discussion: Weight‐loss camps are effective in assisting children to lose weight and improve on a range of health outcomes, independently of the protein content of the diet. The implications of an increase in hunger associated with weight loss needs to be considered. Further work is warranted to investigate whether higher levels of dietary protein are feasible or effective in longer‐term weight‐loss interventions of this type.

This study assessed the reproducibility of performance and selected metabolic variables during a variable high-intensity endurance cycling test. 8 trained male cyclists (age: 35.9 ± 7.7 years, maximal oxygen uptake: 54.3 ± 3.9 mL·kg - 1·min - 1) completed 4 high-intensity cycling tests, performed in consecutive weeks. The protocol comprised: 20 min of progressive incremental exercise, where the power output was increased by 5% maximal workload (Wmax) every 5 min from 70% Wmax to 85% Wmax; ten 90 s bouts at 90% Wmax, separated by 180 s at 55% Wmax; 90% Wmax until volitional exhaustion. Blood samples were drawn and heart rate was monitored throughout the protocol. There was no significant order effect between trials for time to exhaustion (mean: 4 113.0 ± 60.8 s) or total distance covered (mean: 4 6126.2 ± 1 968.7 m). Total time to exhaustion and total distance covered showed very high reliability with a mean coefficient of variation (CV) of 1.6% (95% Confidence Intervals (CI) 0.0 ± 124.3 s) and CV of 2.2% (95% CI 0.0 ± 1904.9 m), respectively. Variability in plasma glucose concentrations across the time points was very small (CV 0.46-4.3%, mean 95% CI 0.0 ± 0.33 to 0.0 ± 0.94 mmol·L - 1). Plasma lactate concentrations showed no test order effect. The reliability of performance and metabolic variables makes this protocol a valid test to evaluate nutritional interventions in endurance cycling.

It is important to employ training practices that ensure that fire-fighter instructors work in an environment which does not provoke unacceptable rises in core temperature (>38°C). PURPOSE: To assess the effects of a two-day fire-behaviour training (FBT) course on the core temperature (Tc) of fire-fighter instructors in order to establish whether current training practices ensure a safe working environment. METHODS: Eleven males (mean±sd age 38.3±4.3 yr, body mass 88.5±12.7 kg and stature 177.8±5.3 cm) from two regional training centres completed three days of standard FBT, wearing full protective clothing and breathing apparatus. Two consecutive days (HOT1 and HOT2, mean ambient temperature of 12.7°C) each consisted of a morning and an afternoon heat exposure (approximately 30 minutes in duration). The third day was a control (NORM), without heat exposure (mean Tc of 19.3 °C). Tc was measured at baseline (BASE) and at the start and end of the two exposures (PRE-AM, POST-AM and PRE-PM, POST-PM respectively) for each subject using a telemetry pill (HQ Inc, USA). RESULTS: There was a different pattern of Tc response over the two HOT days compared with the NORM day due to the significant increase in Tc associated with each of the heat exposures (p<0.01, PRE to POST, Table 1). Mean Tc did not reach 38°C, but in 10 out of 44 individual exposures subjects had a T above 38°C post heat exposure. In contrast, baseline T for the three days was not significantly different and showed a consistent significant increase to PRE-AM values (p<0.01, BASE to PRE-AM, Table 1) associated with the wearing of protective clothing and morning activities. The mean (±sd) unit temperatures of the HOT and NORM days were 160.2 (±89.3) and 27.6 (±8.4) °C respectively. CONCLUSION: The physiological strain experienced due to heat exposure in firefighter instructors resulted in a significant increase in Tc above that experienced during similar physical exertion with no heat exposure. While mean Tc did not reach 38°C, defined as an acceptable limit for work, Tc did rise above 38°C after approximately 1 in 4 individual heat exposures.

This study aimed to evaluate the weight loss and hunger motivation effects of an energy-restricted high-protein (HP) diet in overweight and obese children. In total, 95 overweight and obese children attended an 8-week (maximum) program of physical activity, reduced-energy intake, and behavior change education. Children were randomly assigned to one of two isoenergetic diets (standard (SP): 15% protein; HP: 25% protein), based on individually estimated energy requirements. Anthropometry and body composition were assessed at the start and end of the program and appetite and mood ratings completed on the first 3 consecutive weekdays of each week children attended camp. The HP diet had no greater effect on weight loss, body composition, or changes in appetite or mood when compared to the SP diet. Overall, campers lost 5.2 3.0 kg in body weight and reduced their BMI standard deviation score (sds) by 0.25. Ratings of desire to eat increased significantly over the duration of the intervention, irrespective of diet. This is the third time we have reported an increase in hunger motivation in weight-loss campers and replicates our previous failure to block this with a higher protein diet. Further work is warranted into the management of hunger motivation as a result of negative energy balance.

The hydration status of rugby league players during competitive home match play was assessed throughout the 2008 Super League season. Fourteen players from 2 Super League clubs were monitored (72 observations). On arrival, 2 h prior to kick off, following normal prematch routines, players' body mass were measured following a urine void. Prematch fluid intake, urine output, and osmolality were assessed until kick off, with additional measurements at half time. Fluid intake was also monitored during match play for club B only, and final measurements of variables were made at the end of the match. Mean body mass loss per match was 1.28 ± 0.7 kg (club A, 1.15 kg; club B, 1.40 kg), which would equate to an average level of dehydration of 1.31% (mass loss, assumed to be water loss, expressed as a percentage of body mass), with considerable intra-individual coefficient of variation (CV, 47%). Mean fluid intake for club B was 0.64 ± 0.5 L during match play, while fluid loss was 2.0 ± 0.7 L, with considerable intra-individual CV (51% and 34%, respectively). Mean urine osmolality was 396 ± 252 mosm·kg-1 on arrival, 237 ± 177 mosm·kg-1 prematch, 315 ± 133 mosm·kg-1 at half time, and 489 ± 150 mosm·kg-1 postmatch. Body mass losses were primarily a consequence of body fluid losses not being completely balanced by fluid intake. Furthermore, these data show that there is large inter- and intra-individual variability of hydration across matches, highlighting the need for future assessment of individual relevance.

Bissas, A, Paradisis, GP, Nicholson, G, Walker, J, Hanley, B, Havenetidis, K, and Cooke, CB. Development and maintenance of sprint training adaptations: an uphill-downhill study. J Strength Cond Res XX(X): 000-000, 2020-We examined the development of performance adaptations resulting from an uphill-downhill training program and monitored the decline of adaptations during detraining. Twenty-eight men were randomly assigned to 1 of 2 sprint training groups who trained 3 times per week for 6 weeks and a control group (C). The uphill-downhill group (U+D) trained on an 80-m platform with 3° slopes, whereas the horizontal (H) group trained on flat track. Subjects were tested for maximal running speed (MRS), associated kinematics, and leg strength before and after training, with U+D subjects also tested after weeks 2 and 4 of training, and after a 3-week detraining period. The U+D group increased their MRS by 3.7% (from 8.75 ± 0.72 to 9.07 ± 0.64 m·s, p < 0.05), their stride rate by 3.1% (from 4.21 ± 0.21 to 4.34 ± 0.18 Hz, p < 0.05), and their knee extensors' maximum isometric force by 21% (from 2,242 ± 489 to 2,712 ± 498 N, p < 0.05) after training. The time course of changes showed declines for weeks 1-4 (1.4-5.1%), but an ascending trend of improvement compensated all losses by the end of week 6 (p < 0.05). During detraining, no decreases occurred. No changes were observed for the H and C groups. The minimum period to produce positive effects was 6 weeks, with a very good standard of performance maintained 3 weeks after training. U+D training will prove useful for all athletes requiring fast adaptations, and it can fit into training mesocycles because of its low time demands.

Background: UK levels of overweight and obesity in children are high and continue to increase (Health Survey of England 2004). Recently alternative methods to determine prevalence of overweight and obesity have gained recognition and been made available. Therefore this study was undertaken using three accepted methods for determining prevalence of overweight and obesity in a large sample of 11 year old children. Methods: 4711 children were assessed in 33 schools in Leeds, UK. All children were assessed for stature, body mass, waist circumference, % body fat and selected sports performance tests. Overweight and obesity was recognised using each of the three anthropometric measures (BMI, Waist circumference and % body fat) above the 85th percentile for age and gender. Results: Overweight and obesity prevalence was high with BMI, Waist circumference and % body fat mean prevalence being 34.4%, 47.9% and 25.2% respectively. Of concern was the high variability between schools, with the variation being 22.8% – 42.3% (BMI), 22.5% – 72.8% (waist circumference) and 16.4% - 36.9%% (Body fat). Conclusion: These data show that levels of childhood obesity are high in comparison to the 27.7% reported in the Health Survey of England (2004) and that there is high variation between schools in a large UK city. These findings provide strong evidence and information for targeted action in the form of both prevention and treatment for this population.

Background: In 2004 the UK Government, within the Choosing Health White Paper, outlined a target ‘To halt, by 2010, the year on year increase in obesity among children under 11 in the context of a broader strategy to tackle obesity in the population as a whole’. In order to justify action there is a need to highlight the scale of the problem. In addition, further analysis comparing differences between schools is important to identify where appropriate resources/support should be provided. Methods: During 2005 BMI measurements were obtained in 2425 boys and 2267 girls, aged 11.6±0.3y, from 33 out of 40 schools in Leeds, UK. Standardized values were calculated using National Centile Charts and overweight and obesity prevalence defined at the 85th and 95th centiles, respectively. Results: Overall UK BMI centile charts identified 33.5% of children overweight and obese compared to the 27.7% prevalence reported in the Health Survey of England (2003) for children aged 9–11y. When the data were analysed by school the prevalence of overweight and obesity varied from 23.0% to 42.9%, with 3 schools less than 30% and 4 schools higher than 40%. Conclusion: These data should be of major concern given the increasing trend in an age group extremely close to that the government has prioritised. In addition, it is clear that there was large variability in the prevalence of overweight and obesity according to school. The upper prevalence values are particularly high and demonstrate the scale of the problem in children attending specific schools.

Objective: The aim of the present study was to compare percentage body fat (PF) estimates using bioelectrical impedance analysis (BIA) with that determined by air displacement plethysmography in overweight and obese children. Methods: All participants had standardised BMI values >85th centile according to National Centile Charts. 302 males: age 13.9±1.7 y, BMI 32.8±6.6 kg.m-2, PF ADP 40.8±9.6 %, and 354 females: age 14.5±1.8 y, BMI 33.8±6.2 kg.m-2, PF ADP 44.2±7.2 %, were assessed. BIA PF estimates were obtained at 50 kHz using a foot-plate system device (Tanita TBF-310) and the inbuilt manufacturer prediction equations. ADP PF measurements were obtained using the child-specific thoracic gas volume prediction equations of Fields (2004) and the age and gender-specific body density conversion equations of Lohman (1989). Results: BIA estimates of PF were significantly correlated with those of ADP (males r=0.80, females r=0.68; both P<0.001). BIA significantly underestimated mean PF compared to ADP (males -3.6 %, females -1.7 %; both P<0.001). According to the methods of Bland and Altman, the ±95 % limits of agreement were slightly higher in males (±12.0 %) than females (±10.4 %). Further, correlation on the Bland and Altman plots revealed a significant bias as a function of increasing PF in females (r = - 0.45; P<0.001). Conclusion: On an individual basis there may be large discrepancies between BIA and ADP PF estimates. Results from devices are therefore not interchangeable in overweight and obese children.

Purpose: To evaluate the movement and physiological demands of the Australasian National Rugby League (NRL) referees, officiating with a ‘two referee’ (i.e., ‘lead’ and ‘pocket’) system and to compare the demands of the lead referee and pocket referees. Methods: 10 Hz global positioning system devices were used to obtain 86 data sets (‘lead’, n=41; ‘pocket’, n=45) on 19 NRL referees. Total distance, relative distance covered and heart rate per half and across match-play was examined within and between referees using t-tests. Distance, time and number of movement 'efforts' were examined in six velocity classifications (i.e., standing <0.5; walking 0.51–2.0; jogging 2.01-4.0; running 4.01-5.5; high speed running 5.51-7.0; sprinting > 7.0 m.s-1) using ANOVA. Cohen's d effect sizes were reported. Results: There were no significant differences between the ‘lead’ and ‘pocket’ referee for any movement or physiological variable. There was an overall significant (large; very large) effect for distance (% distance) and time (% time) (P < 0.001) between each velocity classification for both the ‘lead’ and ‘pocket’ referee. Both roles covered the largest distance and number of efforts at velocities between 0.51–2.0 m.s-1 and 2.01-72 4.0 m.s-1, which were interspersed with efforts >5.51 m.s-1. Conclusions: Findings highlight the intermittent nature of rugby league refereeing, but show that there were no differences in the movement and physiological demands of the two refereeing roles. Findings are valuable for those responsible for the preparation, training and conditioning of NRL referees, and to ensure training prepares for and simulates match demands.

The purpose of this study was to evaluate the annual and long-term (i.e., 4 years) development of anthropometric and physical characteristics in academy (16-20 years) rugby league players. Players were assessed at the start of preseason over a 6-year period and were required to be assessed on consecutive years to be included in the study (Under 16-17, n = 35; Under 17-18, n = 44; Under 18-19, n = 35; Under 19-20, n = 16). A subset of 15 players were assessed for long-term changes over 4 years (Under 16-19). Anthropometric (height, body mass, sum of 4 skinfolds) and physical (10- and 20-m sprint, 10-m momentum, vertical jump, yo-yo intermittent recovery test level 1, 1 repetition maximum [1RM] squat, bench press, and prone row) assessments were collected. Paired t-tests and repeated measures analysis of variance demonstrated significant annual (e.g., body mass, U16 = 76.4 ± 8.4, U17 = 81.3 ± 8.3 kg; p < 0.001, d = 0.59) and long-term (e.g., vertical jump, Under 16 = 44.1 ± 3.8, Under 19 = 52.1 ± 5.3 cm; p < 0.001, d = 1.74) changes in anthropometric and physical characteristics. Greater percentage changes were identified between the Under 16-17 age categories compared with the other ages (e.g., 1RM squat, U16-17 = 22.5 ± 19.5 vs. U18-19 = 4.8 ± 6.4%). Findings demonstrate the annual and long-term development of anthropometric and physical characteristics in academy rugby league players establishing greater changes occur at younger ages upon the commencement of a structured training program within an academy. Coaches should understand the long-term development of physical characteristics and use longitudinal methods for monitoring and evaluating player performance and development.