American College Of Sports Medicine Research Articles

Physical Activity and Nonalcoholic Fatty Liver Disease: A Roundtable Statement from the American College of Sports Medicine.

Although physical activity (PA) is crucial in the prevention and clinical management of nonalcoholic fatty liver disease, most individuals with this chronic disease are inactive and do not achieve recommended amounts of PA. There is a robust and consistent body of evidence highlighting the benefit of participating in regular PA, including a reduction in liver fat and improvement in body composition, cardiorespiratory fitness, vascular biology, and health-related quality of life. Importantly, the benefits of regular PA can be seen without clinically significant weight loss. At least 150 min of moderate or 75 min of vigorous intensity PA are recommended weekly for all patients with nonalcoholic fatty liver disease, including those with compensated cirrhosis. If a formal exercise training program is prescribed, aerobic exercise with the addition of resistance training is preferred. In this roundtable document, the benefits of PA are discussed, along with recommendations for 1) PA assessment and screening; 2) how best to advise, counsel, and prescribe regular PA; and 3) when to refer to an exercise specialist.

Return to Sport in Middle-aged and Older Athletes After Unicompartmental Knee Arthroplasty at a Mean 10-Year Follow-up: Radiographic and Clinical Outcomes

Background: Return to sport is essential information when an athlete contemplates surgical intervention. Young athletes, <30 years of age, may undergo complex cartilage procedures or femoral/tibial osteotomies to successfully treat single-compartment knee osteoarthritis. Unicompartmental knee arthroplasty (UKA) may offer an attractive alternative option to middle-aged/older athletes with timely return to the same sport without a lengthy rehabilitation. Purpose: The purpose of this study was to determine if athletes are able to return to the same level of vigorous and moderate sports after fixed-bearing intramedullary nonrobotic UKA and the specific sports activities that these athletes continued to participate in at a minimum of 5 years. We hypothesized that UKA in the appropriately selected middle-aged/older athlete would yield high return to sport after UKA with high patient satisfaction. We also hypothesized that UKA would allow athletes to return to their sports of choice. Study Design: Cohort study; Level of evidence, 3. Methods: We identified 245 patients who underwent a UKA by a single surgeon between 2003 and 2017. Athletes were included if they participated in vigorous or moderate sports, as defined by the American College of Sports Medicine, and had minimum 5-year follow-up. The primary outcome was return to vigorous or moderate sports after UKA. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living score, KOOS Sport and Recreation score, Lysholm score, Patient Acceptable Symptom State (PASS) analysis, and radiographic analysis. Results: An overall 169 athletes met the inclusion criteria and were evaluated for return to sports. A total of 98% (165/169) returned to vigorous or moderate sports participation. The mean ± SD time to return to sport was 5.2 ± 2.3 months in the 39- to 50-year-old cohort, 5.8 ± 3.2 months in athletes aged 51 to 64 years, and 5.2 ± 3.0 months in athletes aged ≥65 years. A total of 143 athletes had minimum 5-year clinical and radiographic follow-up (mean, 10 years; range, 5-19 years). Maintenance of vigorous and moderate sport was seen in 99% (142/143) of athletes at a mean 10 years. In athletes who participated in vigorous sports, the mean Lysholm score was 85 ± 17, and 83% reached the PASS for KOOS Sport and Recreation. Radiographic analysis revealed no evidence of implant loosening (ie, subsidence, radiolucency) or osteolysis, and limb alignment and posterior slope of the implant were within normal limits. Conclusion: Athletes returned to sport at a mean 5 months after UKA implantation, with 98% (165/169) participating in vigorous or moderate sports. UKA is recommended as an alternative procedure in middle-aged and older athletes with single-compartment osteoarthritis who are contemplating a return to vigorous or moderate sport.

Association of Abdominal Endurance with Body Mass Index and Playing Hours in Collegiate Cricket Players: An Observational Study

Objective: To find the association between abdominal endurance, Body Mass Index and playing hours in collegiate cricket players. Study design: Observational study. Settings: Uka Tarsadia University, Bardoli, Gujarat, India. Participants: 101 collegiate male cricket players with ages ranging from 18-24 years. Outcome measures: The abdominal endurance of all the players were assessed using the American College of Sports Medicine (ACSM) Curl-up test. Body mass index (BMI) and the number of playing hours per week were recorded as the other outcome measures. Results: The players exhibited excellent abdominal endurance. Pearson coefficient correlation test was used to assess the association of abdominal endurance with BMI and playing hours. The results showed that there was no association between abdominal endurance with BMI. However, there was a significant correlation found between abdominal endurance and plying hours in collegiate cricket players. Conclusion: It is concluded from the present study that abdominal endurance is associated with plying hours. Hence, for enhancing abdominal endurance one should consider increasing the playing hours, so as to improve overall performance. Also, the results showed that abdominal endurance is independent of BMI. KEY WORDS: Abdominal Endurance, Body Mass Index, Cricket, Sports Medicine, Crurl-Up Test.

Do we need to rethink the determination of exercise-related energy expenditure in cardiac telerehabilitation interventions?

The American College of Sports Medicine determined the energy consumption of daily activities and sports. Cardiac telerehabilitation (CTR) requires knowing how much energy people consume in daily life outside of cardiac rehabilitation activities. Therefore, we have investigated if the estimated values are valid in CTR. Data from two studies were incorporated. The first study measured ventilatory threshold (VT)1, VT2, and peak exercise on cardiopulmonary exercise testing (CPET) collected from 272 cardiac (risk) patients and compared them to the estimated oxygen consumption (VO2) at low-to-moderate-intense exercise (3-6 metabolic equivalents [METs]). Next, a patient-tailored application was developed to support CTR using these estimated values, and the intervention (the second study) was conducted with 24 coronary artery disease patients using this application during a CTR intervention. In the first study, VO2 at VT1, VT2 and peak exercise corresponded to 3.2 [2.8, 3.8], 4.3 [3.8, 5.3], and 5.4 [4.5, 6.2] METs, which are significantly different from the estimated VO2 at low-to-moderate-intense exercise, especially lower in older, obese, female, and post-myocardial infarction/heart failure patients. These VO2 varied considerably between patients. The telerehabilitation study did not show significant progress in peak VO2, but using the application's estimated target, 97.2% of the patients achieved their weekly target, which is a significant overestimate. The estimated and observed exercise-related energy expenditures by CPET were significantly different, resulting in an overestimation of the exercise done by the patients at home. The results can have a significant impact on the quantification of exercise dose during (tele)rehabilitation programs.

The Wide Grip Tubing Row Exercise

Peter Ronai, M.S., FACSM, ACSM-CEP, ACSM-EP, EIM-III, CSCS, is a clinical professor of Exercise Science in the Department of Physical Therapy and Human Movement Sciences at Sacred Heart University in Fairfield, Connecticut. He is a fellow of the American College of Sports Medicine (ACSM) and an associate editor of ACSM's Health & Fitness Journal®and writes the Do It Right column. He is a member of the ACSM Committee on Certification and Registry Boards (CCRB). His articles and presentations address tips, tools, and resources exercise professionals can use to better serve their clients and patients. Disclosure: The author declares no conflict of interest and does not have any financial disclosures.

Relationship between performance, heart rate variability and clinical symptoms in elite football: A case study

Introduction&#x0D; Matches and high-intensity training put important load on elite football players, which may result in performance decrease and physiological alterations (Meeusen et al., 2013).&#x0D; Positive correlations between heart rate variability (HRV) athletic performance have been reported (Buchheit et al., 2012) but the measurements were not related to match performance. Studies investigating the relationship between HRV and in-match performance data are scarce and none identified typologies of fatigue (Schmitt et al., 2015).&#x0D; This is a case study of one elite football player that showed a typical autonomic dysfunction corresponding to a fatigue state with associated clinical symptoms.&#x0D; Methods&#x0D; A male elite football player playing in French Ligue 1 and continental competitions recorded his beat-to-beat heart rate (Polar H10) during an orthostatic test (5 min supine followed by 5 min standing) systematically 2 days before every match during a series of 8 matches at the rate of 1 match/week. These recordings allowed the assessment of mean heart rate (HR), power spectrum in the low- and high-frequency bands (LF and HF). During each match a GNSS sensor (Vector S7, Catapult) allowed the recording of total distance, acceleration/deceleration above 2m/s. Moreover, the number of passes, passes to the final thirty meters and number of duels and duels won were quantified by video analysis.&#x0D; Results&#x0D; The player played the entirety of the 8 games mostly as a midfielder and sometimes as a left back. Heart rate in the supine position was inversely correlated to the number of passes and successful passes to final third (R = -0.67, p &lt; 0.05) whilst LF in the standing position was correlated to the duels and duels won (R = 0.75, p &lt; 0.05). In addition, log(HF) was correlated to the number of acceleration during the match whilst log(LF) was correlated with the total distance ran. The player displayed on several occasions a fatigue profile characterized by a parasympathetic hypertonia in the standing position, which ultimately resulted in the player fainting on the pitch.&#x0D; Discussion/Conclusion&#x0D; HRV during an orthostatic test two days before a match could be useful in identifying fatigue profiles associated with decreased performances and clinical symptoms. Such methods should be used on an entire season and entire squad to better characterize the fatigue profiles in elite football and may help better adapt training sessions.&#x0D; References&#x0D; Buchheit, M., Simpson, M. B., Al Haddad, H., Bourdon, P. C., &amp; Mendez-Villanueva, A. (2012). Monitoring changes in physical performance with heart rate measures in young soccer players. European Jopurnal of Applied Physiology, 112, 711–723. https://doi.org/10.1007/s00421-011-2014-0&#x0D; Meeusen, R., Duclos, M., Foster, C., Fry, A., Gleeson, M., Nieman, D., Raglin, J., Rietjens, G., Steinacker, J., &amp; Urhausen, A. (2013). Prevention, diagnosis, and treatment of the overtraining syndrome: Joint consensus statement of the European College of Sport Science and the American College of Sports Medicine. Medicine &amp; Science in Sports &amp; Exercise, 45(1), 186–205. https://doi.org/10.1249/mss.0b013e318279a10a&#x0D; Schmitt, L., Regnard, J., Parmentier, A. L., Mauny, F., Mourot, L., Coulmy, N., &amp; Millet, G. P. (2015). Typology of “Fatigue” by heart rate variability analysis in elite nordic-skiers. International Journal of Sports Medicine, 36(12), 999–1007. https://doi.org/10.1055/s-0035-1548885

Do five screening tools identify the same number of runners who require pre-exercise medical clearance? SAFER XXXIV

ABSTRACT Objectives Currently, there are five international screening tools that are recommended to identify individuals who require pre-exercise medical clearance to reduce the risk of medical encounters during exercise. Therefore, the aim was to determine the percentage of race entrants who are advised to obtain pre-exercise medical clearance and the observed agreement between these five different international pre-exercise medical screening tools. Methods In all, 76,654 race entrants from the Two Oceans Marathon (2012–2015) that completed an online pre-race screening questionnaire. Five pre-exercise medical screening tools (American Heart Association (AHA), pre-2015 American College of Sport Medicine (ACSM), post-2015 ACSM, Physical Activity Readiness Questionnaire (PAR-Q), and the European Association of Cardiovascular Prevention and Rehabilitation (EACPR)) were retrospectively applied to all participants. The % (95%CI) race entrants requiring medical clearance identified by each tool and the observed agreement between tools (%) was determined. Results The % entrants requiring medical clearance varied from 6.7% to 33.9% between the five tools: EACPR (33.9%; 33.5–34.3); pre-2015 ACSM (33.9%; 33.5–34.3); PAR-Q (23.2%; 22.9–23.6); AHA (10.0%; 9.7–10.2); post-2015 ACSM (6.7%; 6.5–6.9). The observed agreement was highest between the pre-2015 ACSM and EACPR (35.4%), for pre-2015 ACSM and PAR-Q (24.8%), PAR-Q and EACPR (24.8%), and lowest between the post-2015 ACSM and AHA (4.1%). Conclusion The percentage of race entrants identified to seek medical clearance (and observed agreement) varied considerably between pre-exercise medical screening tools. Further research should determine which tool has the best predictive ability in identifying those at higher risk of medical encounters during exercise.

Wet Bulb Globe Temperature: Indicating Extreme Heat Risk on a Global Grid.

The Wet Bulb Globe Temperature (WBGT) is an international standard heat index used by the health, industrial, sports, and climate sectors to assess thermal comfort during heat extremes. Observations of its components, the globe and the wet bulb temperature (WBT), are however sparse. Therefore WBGT is difficult to derive, making it common to rely on approximations, such as the ones developed by Liljegren etal. (2008, https://doi.org/10.1080/15459620802310770, ) and by the American College of Sports Medicine ( ). In this study, a global data set is created by implementing an updated WBGT method using ECMWF ERA5 gridded meteorological variables and is evaluated against existing WBGT methods. The new method, , uses globe temperature calculated using mean radiant temperature and is found to be accurate in comparison to across three heatwave case studies. In addition, it is found that is not an adequate approximation of WBGT. Our new method is a candidate for a global forecasting early warning system.

Influence of Aerobic Exercise on Appetite-Regulating Hormones, Ghrelin-o-Acyltransferase and Perceived Hunger in Normal Weight and Obese Adults

Background: Obesity is a major public health issue in the United States (U.S.), affecting an estimated 78 million US adults. Aerobic exercise (AE) is recommended by the American College of Sports Medicine to prevent and treat obesity, yet the effects of AE on circulating hunger hormones including acylated ghrelin and its biological catalyst, ghrelin o-acyltransferase (GOAT) are less known. Objectives: We investigated the effects of AE on circulating concentrations of appetite regulating hormones and GOAT in a pilot sample of adults classified with normal weight (NW) and obese (OB) body weight status. Methods: Using a quasi-experimental design, nine adults with NW (n=4, body mass index [BMI] = 21.3±1.2 kg/m2) and OB (n=5, BMI = 38.9±6.2 kg/m2) body weight status completed a preliminary health/fitness assessment. Participants returned to the laboratory on three separate occasions, separated by ≥ 48 hours to perform cycle exercise at 30% and 60% oxygen uptake reserve (VO2R) or a seated control session with no exercise for 40 min. Fifteen mL of blood was taken pre-and-post exercise and control and were assayed in duplicate. Nonparametric procedures determined whether mean rank differences existed between NW and OB for acylated ghrelin, leptin, insulin, and GOAT in response to exercise and control. Alpha levels were set a priori to p 0.05. Results: Significant mean rank reductions were found in GOAT after compared to before AE and control for NW and OB (p.05). Significant mean rank differences were found in acylated ghrelin after compared to before performing AE at 60% VO2R in NW and OB (p.05); however, differences were not observed between NW and OB (p.05). Conclusions: Our findings reveal the first available data regarding the effects of AE on GOAT, with NW and OB experiencing equivocal changes pre-to-post AE at 60% VO2R, and in response to a seated control session.

Prediction of Maximal Oxygen Consumption in Cycle Ergometry in Competitive Cyclists.

Models for predicting maximal oxygen consumption (VO2max) in average adults might not be suitable for athletes, especially for competitive cyclists who can have significantly higher VO2max than normally active people. The aim of this study was to develop a clinically applicable equation for predicting VO2max during cycle ergometry in competitive cyclists and to compare its accuracy to the traditional American College of Sports Medicine (ACSM) equation. Maximal cycle ergometry tests were performed in 496 male and 84 female competitive cyclists. Six predictors were initially used to model the prediction equation (power output, body weight, body height, fat mass, fat-free mass and age). Power output and body weight were the most important parameters in the model predicting VO2max. Three new equations were derived: for male (VO2max = 0.10 × PO - 0.60 × BW + 64.21), female cyclists (0.13 × PO - 0.83 × BW + 64.02) and the non-gender-specific formula (0.12 × PO - 0.65 × BW + 59.78). The ACSM underestimated VO2max in men by 7.32 mL/min/kg (11.54%), in women by 8.24 mL/min/kg (15.04%) and in all participants by 7.45 mL/min/kg (11.99%), compared to the new equation that underestimated VO2max in men by 0.12 mL/min/kg (0.19%) and in all participants by 0.65 mL/min/kg (1.04%). In female cyclists, the new equation had no relative bias. We recommend that medicine and sports practitioners adapt our proposed equations when working with competitive cyclists. Our findings demonstrate the need to evaluate prediction models for other athletes with a special focus on disciplines that demand high aerobic capacity.

The ACSM American Fitness Index: Using Data to Identify Opportunities to Support Physical Activity

ABSTRACT Since 2008, the American College of Sports Medicine (ACSM) American Fitness Index program has provided data, materials, resources, and connections to help city officials, public health professionals, and community-based organizations assess the fitness of their residents, identify opportunities to improve health outcomes, and enable physically active lifestyles. The purpose of this article was to describe the development and methods used to create the annual scores and rankings for the Fitness Index. Fitness Index indicators were originally selected by ACSM content experts and other nationally recognized fitness experts who understood the importance of community assets to improve health behaviors and outcomes. Indicator values for the 100 largest US cities were gathered from reputable, regularly updated, publicly available data sources. Indicator values for the cities were ranked, weighted, and combined into a personal health subscore, a community/environment subscore, and a total score that were then ranked from the most fit (rank 1) to least fit (rank 100) cities. Fitness Index indicators are reviewed by ACSM content experts and updated annually to ensure the Fitness Index stays true to its goal. Strengths of the Fitness Index include the use of multiple indicators related to the health and behaviors of residents as well as community assets and policies. Some data limitations for the Fitness Index include sample variability from year to year, use of self-reported survey data with well-known biases and variability, and lack of availability of important data indicators. The annual summary report suggests how these rankings and data can be translated into action within cities. Additional resources for the American Fitness Index, including an interactive tool that allows comparison of indicator values among cities, are available online.

The Influence of Pregestational Body Mass Index and Physical Activity Patterns on Maternal, Delivery, and Newborn Outcomes in a Sample of Portuguese Pregnant Women: A Retrospective Cohort Study

Introduction: There is a linear association between pregestational body mass index (BMI) and almost all adverse pregnancy outcomes. Pregnancy is “a window of opportunities” in terms of changing behavior and improving awareness of healthy living. The proper assessment of physical activity levels, during pregnancy, determines trends, health benefits, and their effects over time. This study aims to describe maternal physical activity levels, stratified by pregestational BMI, verify the accomplishment of physical activity recommendations in pregnant women, and correlate pregestational BMI and physical activity accomplishment with maternal, delivery, and neonatal parameters. Methods: A retrospective cohort study was carried out with 103 pregnant women. Physical activity levels were evaluated using a questionnaire and accelerometry. Pregestational BMI was obtained through the Quetelet formula and used the American College of Sports Medicine’s guidelines were used to determine physical activity accomplishment levels. Continuous data were presented as mean and standard deviation and categorical data as numbers and percentages. The F test was used to examine the differences between groups. Results: Pregnant women in the sample spent 42.9% of their time on household activities, and for pregnant women with obesity, 91.5% of the time was spent on sedentary activities. Women with normative BMI had higher levels of moderate-intensity activities. Only 15.8% of participants with obesity reached the international recommendations for physical activity practice and women who accomplished physical activity recommendations gained less weight during pregnancy. A high percentage of pre-obesity and obese pregnant women exceeded the recommendations for gestational weight gain and the gestational diabetes prevalence was higher in the obesity group (p = 0.03 between groups). Regarding delivery and neonatal parameters (Apgar score 1st, Apgar score 5th, birth weight, length and head circumference), no statistical differences were found when adjusted to a gestational week at birth, between BMI (p = 0.58; p = 0.18; p = 0.60; p = 0.34; p = 0.34, respectively) or physical activity (p = 0.12; p = 0.15; p = 0.83; p = 0.70; p = 0.70, respectively) groups. Conclusion: Pregnant women with obesity, exhibit high levels of sedentary behavior, a high prevalence of gestational diabetes, and exceed recommended gestational weight gain. Healthcare professionals have a crucial role in promoting regular physical activity and lifestyle changes before and during pregnancy.

Health and fitness trends in Southern Europe for 2023: A cross-sectional survey.

The physical activity, exercise and wellness sector is rapidly growing and seems to be an exciting field for business and professional development with great potential globally. The purpose of this observational and cross-sectional study was to determine the most popular health and fitness trends in Southern Europe for the first time, including data from Italy, Spain, Portugal, Greece and Cyprus, and to investigate any potential differences in this area compared to the Pan-European and global fitness trends for 2023. A national online survey was conducted in five Southern European countries, using the methodology of similar regional and worldwide surveys conducted by the American College of Sports Medicine since 2007. In total, a web-based questionnaire was sent to 19,887 professionals who worked in the Southern European physical activity, exercise and wellness sector. A total of 2645 responses were collected from five national surveys with an overall mean response rate of 13.3%. The ten most important fitness trends in Southern Europe for 2023 were personal training, licensure for fitness professionals, exercise is medicine, employing certified fitness professionals, functional fitness training, small group training, high-intensity interval training, fitness programs for older adults, post-rehabilitation classes and body weight training. The present findings are aligned with those reported for the European and worldwide fitness trends.

Exercise &amp; Sports Science Australia (ESSA) updated Position Statement on exercise and physical activity for people with hip/knee osteoarthritis

This Position Statement is an update to the existing statement. It is intended for all health practitioners who manage people with hip/knee osteoarthritis. It synthesises the most recent evidence (with a focus on clinical guidelines and systematic reviews) for exercise in people with hip/knee osteoarthritis, and provides guidance to practitioners about how best to implement exercise in clinical practice. Clinical practice guidelines for hip/knee osteoarthritis advocate physical activity and exercise as fundamental core components of evidence-based management. Research evidence indicates that exercise can reduce joint pain, increase physical function, and improve quality of life in hip/knee osteoarthritis, and that a range of exercise types (both supervised and unsupervised) may be beneficial. Exercise dosage should be guided by the principles of the American College of Sports Medicine. As people with osteoarthritis experience many barriers to exercise, practitioners should take an active role in monitoring and promoting adherence to exercise in order to optimise therapeutic benefits.

Health and fitness trends in Iran for 2024: A cross-sectional study.

The health and fitness sector is evolving and appears to be an important field not only for consumers but also for gym operators/managers, exercise professionals, training providers and educators with great potential worldwide. Our aim of this cross-sectional survey was to investigate the most attractive health and fitness trends in Iran for the first time and to observe any potential differences with the recent results reported in other regions. A national online survey was conducted, using the methodology of similar international surveys conducted by the American College of Sports Medicine since 2007. In total, a web-based questionnaire was sent to 7158 professionals who worked in the Iranian health and fitness industry. A total of 408 responses were collected with a response rate of 5.7%. The 10 most important health and fitness trends in Iran for 2024 were strength training with free weights, exercise for weight loss, group training, low-cost and budget gyms, dance-based workouts, outdoor activities, Pilates, bodyweight training, core training and aquatic exercise. The present findings are not fully aligned with those reported for the top health and fitness trends internationally, showing that trends related to technology and health are not yet popular nationwide. Such outcomes may support all industry stakeholders with making important business decisions, professional development opportunities and innovative concepts to enhance customer engagement through positive exercise experiences.

Assessing Performing Artists in Medical and Health Practice - The Dancers, Instrumentalists, Vocalists, and Actors Screening Protocol.

Training in the performing arts exposes individuals to often extreme physical and psychological demands, which are linked to high occupational injury rates. The intense demands of performing artists have been likened to those of sport athletes. However, distinct differences in these demands necessitate specialized approaches to the health care of performing artists. Through the Athletes and the Arts collaboration, the American College of Sports Medicine and Performing Arts Medicine Association identified that the creation of a specialized preparticipation screening tool for performing artists would likely enhance health care for performing artists significantly. Based on a thorough review of established assessments and an extensive consultation process with domain experts, a consensus best-practice screening tool was developed: the Dancer, Instrumentalist, Vocalist, Actor (DIVA) Preparticipation Screening. This screening tool is modeled on the athletic preparticipation examination (PPE) in its structure and 30-min target duration. However, DIVA diverges considerably from the PPE in its content to address the specific risks and needs of performing artists. In particular, screening questions and physical examination procedures focus strongly on musculoskeletal injuries and mental health conditions, in response to the preponderance and interactions of these conditions appearing in performing artists. The DIVA tool presented is intended as a "living tool," which can be modified in the future to include new effective assessment techniques as appropriate. Training in the DIVA preparticipation physical examination is included as a core component of the essentials of performing arts medicine continuing education course described in detail in a companion manuscript in this issue.

Athletes and the Arts and Performing Arts Medicine: Leveraging Sports Medical Expertise to Improve the Care of Performing Artists.

Athletes and the Arts and Performing Arts Medicine: Leveraging Sports Medical Expertise to Improve the Care of Performing Artists.

An Intensive Continuing Education Course to Enhance Care of the Performing Arts Athlete: The "Essentials of Performing Arts Medicine".

Abstract A new continuing education course from Performing Arts Medicine Association and American College of Sports Medicine enables sports medical health professionals to better care for performing artists. High occupational injury rates have been reported in performing artists, yet the quality of preventive and clinical care remains highly variable. Through the Athletes and the Arts collaboration, The Performing Arts Medicine Association, and the American College of Sports Medicine identified that health care practitioners’ existing expertise should be enhanced to address the complex psychophysical needs of performing artists. In response, a 2-d continuing education course, “The Essentials of Performing Arts Medicine” (EOPAM), was developed and has been delivered at least annually since 2016. This course has been well-received by 149 physicians and 240 allied health professionals to date (average ratings, ≥3.5/5 from 2018 to present), with course quality significantly improved by a transition to online delivery in 2020 (average ratings ≥4.5/5; P &lt; 0.01). Accordingly, EOPAM demonstrates that a brief continuing education course can enhance health professionals’ understanding of the unique needs and demands of performing artists, addressing a key barrier to improved care.

Efficacy of Bilateral Lower-Limb Training Over Unilateral Lower-Limb Training To Reeducate Balance and Walking in Post-Stroke Survivors: A Randomized Clinical Trial.

Background and objective While designing the rehabilitation regime of a hemiplegic patient, most physiotherapists focus on the affected/hemiparetic side. The less affected/unaffected side remains unused and loses its properties, i.e., muscle strength, girth, balance, and gait, thus causing deconditioning effects in patients' overall rehabilitation. To enhance the recovery process, the focus should be drawn to training both sides equally to fasten the recovery process. The rationale behind designing this study was to maintain the integrity of the unaffected side along with rehabilitation of the affected side in hemiplegic patients. Many proven studies focus on bimanual upper-limb training in post-stroke survivors, but there is a lack of literature regarding the same in the lower limbs. This clinical trial was designed to study the effect of bilateral lower-limb training over unilateral lower-limb training on balance and walking in post-stroke survivors. Methods 40 hemiplegic patients were selected and randomly divided into two groups: Group A (unilateral training group (UTG)) and Group B (bilateral training group (BTG)). Patients in Group A underwent approach-oriented training using the motor relearning program (MRP) and proprioceptive neuromuscular facilitation (PNF) for the affected side, while those in Group B underwent strength training for the lower-limb muscles using DeLorme's principle for the unaffected side and approach-oriented training using the MRP and PNF for the affected side for a period of six weeks, five days per week. A strengthening regimen was designed for the unaffected side, considering the frequency, intensity, time, and type (FITTs) principle provided by the American College of Sports Medicine (ACSM). The static and dynamic balance along with gait parameters were measured using the functional reach test (FRT), one-leg stance test (OLST), Berg balance scale (BBS), Dynamic Gait Index (DGI), gait parameters (stride length, gait velocity, and cadence), and Brunnstrom recovery stages (BRS) at the baseline and post rehabilitation. Results Both groups significantly improved following therapy (p<0.05). Group B showed more significant results both statistically and clinically. The enhancement in the FRT (2.25, p<0.03), OLST (5.12. p<0.0001), BBS (0.68, p<0.020), and DGI(1.70, p<0.030) scores indicated improvement in static and dynamic balance in the two groups. Patients showed improvement in the stereotyped sequence of movements indicating recovery on the BRS (4.62, p<0.0001). The overall gait parameters in patients, i.e., gait velocity (6.78, p<0.0001), stride length (3.59, p<0.001) and cadence (6.15, p<0.0001), improved post rehabilitation. Conclusion The results of this study showed that the BTG had positive impacts on the postural balance and walking capacities of subacute hemiparetic stroke patients, promoting early recovery in comparison to the UTG. This study also helped to design a strengthening protocol for the unaffected side according to DeLorme's principle in line with the FITTs principle.

Cardiorespiratory fitness estimations and their ability to predict all-cause mortality in patients with cardiovascular disease

BackgroundIn cardiac rehabilitation programs, cardiorespiratory fitness is commonly estimated (eCRF) from the maximum workload achieved on a graded exercise test. This study compared four well-established eCRF equations in their ability to predict mortality in patients with cardiovascular disease (CVD). MethodsA total of 7269 individuals with CVD were studied (81% male; age 59.4 ± 10.3yr). eCRF was calculated using equations from the American College of Sports Medicine, Bruce et al., the Fitness Registry and the Importance of Exercise International Database, and McConnell and Clark. The eCRF from each equation was compared with a RMANOVA. Cox proportional hazard models assessed the relationship between the eCRF equations and mortality risk. The predictive ability of the models was compared using the concordance index. ResultsThere were 284 deaths (85% male) over a follow-up period of 5.8 ± 2.8yr. Although differences in eCRF were observed between each equation (P < 0.05), the eCRF from each of the four equations was predictive of mortality (P < 0.05). The concordance index values for each of the models were the same (0.77) indicating similar predictive performance. ConclusionsThe four well-established eCRF equations did not differ in their ability to predict mortality in patients with CVD, indicating any could be used for this purpose. However, the differences in eCRF from each of the equations suggest potential differences in their ability to guide clinical care and should be the focus of future research.