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Ice hockey players are susceptible to COVID-19 because of close contact and poor arena ventilation. Preventive strategies include reducing arena crowding, practice strategies that reduce clustering of players, at-home rapid tests, symptom screening, and face mask or vaccine recommendations for spectators, coaches, and players. Face masks have little effect on physiological responses or performance and reduce COVID-19 transmission, but shifts should be shortened later in periods to reduce perceived exertion and players should be encouraged to assume a classic "hockey stance" when puck handling to improve peripheral vision. These strategies are important to prevent cancelation of practices or games, which have important physical and psychological benefits., Competing Interests: No conflicts of interest to declare

This systematic review examined the effect of Pilates on health-related outcomes in individuals with increased fracture risk to inform the 2021 Clinical Practice Guidelines for Management of Osteoporosis and Fracture Prevention in Canada. Seven electronic databases were searched to December 2020. Studies of Pilates in men and postmenopausal women aged ≥50 years with low bone mineral density (BMD), history of fragility fracture, or moderate-high risk of fragility fracture were included. Two reviewers independently screened studies and performed risk of bias assessment. Of 7286 records and 504 full-text articles, 5 studies were included, encompassing data from 143 participants (99% female). Data were insufficient for meta-analyses. There is low-certainty evidence that Pilates improved physical functioning and health-related quality of life. The effect of Pilates on falls and BMD is uncertain. No evidence was available for the effect of Pilates on mortality, fractures, or adverse events. Overall, Pilates may improve physical functioning and quality of life. Evidence of benefits relative to harms of Pilates in people with increased fracture risk, particularly males, is limited. PROSPERO registration: CRD42019122685. Novelty: Pilates may improve physical functioning and quality of life in women with osteoporosis. Evidence of the effect of Pilates on BMD, falls, fractures, or adverse events is limited.

We summarized the effects of yoga on health-related outcomes and adverse events in men and postmenopausal women ≥50 years-old at increased risk of fracture, to inform the updated Osteoporosis Canada clinical practice guidelines. Six databases were searched for observational studies, randomized controlled trials and case series. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation handbook. Nine studies were included and reported using narrative syntheses due to the limited available evidence. Overall, the available evidence was of very low certainty. There was no effect of yoga on health-related quality of life in randomized trials. Effects on other health-related outcomes were mixed or not available in the literature. Five studies reported no adverse events directly related to the study intervention, and 2 studies did not report whether adverse events occurred. However, 2 case series reported vertebral fractures related to yoga participation, possibly due to excessive spinal flexion. Due to the limited and very low certainty evidence, guideline developers will need to draw indirect evidence from yoga studies among middle aged or older adults that are not at fracture risk. PROSPERO: CRD42019124898. Novelty: Evidence in general was of very low certainty. Yoga had no effect on health-related quality of life in randomized trials. Evidence was mixed or unavailable for other outcomes. Case studies reported yoga poses involving spinal flexion coincided with incidents of vertebral compression fracture among older adults with increased fracture risk.

Face masks are promoted for preventing spread of viruses; however, wearing a mask during exercise might increase CO 2 rebreathing, decrease arterial oxygenation, and decrease exercise performance. A systematic review and meta-analysis was conducted on the impact of wearing a mask during exercise. Data sources included SPORTDiscus, PubMed, and Medline. Eligibility criteria included all study designs comparing surgical, N95, or cloth masks to a no mask condition during any type of exercise where exercise performance and/or physiological parameters were evaluated. Healthy and clinical participants were included. Mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals were calculated and pooled effects assessed. Twenty-two studies involving 1573 participants (620 females, 953 males) were included. Surgical, or N95 masks did not impact exercise performance (SMD -0.05 [-0.16, 0.07] and -0.16 [-0.54, 0.22], respectively) but increased ratings of perceived exertion (SMD 0.33 [0.09, 0.58] and 0.61 [0.23, 0.99]) and dyspnea (SMD 0.6 [0.3, 0.9] for all masks). End-tidal CO 2 (MD 3.3 [1.0, 5.6] and 3.7 [3.0, 4.4] mm Hg), and heart rate (MD 2 [0,4] beats/min with N95 masks) slightly increased. Face masks can be worn during exercise with no influences on performance and minimal impacts on physiological variables. PROSPERO registration: CRD42020224988. Novelty: Face masks can be worn during exercise with no impacts on performance and minimal impacts on physiological variables.

Newcomers are often healthy when they arrive in Canada, yet experience health declines shortly thereafter, possibly due to lifestyle changes. As part of the Healthy Immigrant Children study, this mixed-methods study aims to analyze possible predictors of physical activity among 300 newcomer children, and explore their lived experiences using a sub-sample of 19 parents and 24 service providers. Data collection involved questionnaires concerning socioeconomic status and physical activity, anthropometric measurements, and in-depth interviews. Participants aged 5 years and older largely met physical activity recommendations (82.9%), while none of the 3-4-year-olds did. Males were more active than females, especially among older ages. Many participants engaged in too much screen time (53.4-90.0%). Age and income predicted physical activity among males, while parents' education level was the only significant predictor among females. Barriers to physical activity included: recreational physical activity being an unfamiliar concept, gender limitations, financial resources, safety concerns, and children's preference for screen time. Schools played a central role in newcomer children's health by providing accessible opportunities for physical activity. Newcomer families preferred to have their children involved in culturally relevant physical activities. Given the growing newcomer population, it is important to support active lifestyle practices among them. Novelty: About 83% of newcomer children aged 5 years and older met physical activity recommendations, while none of the 3-4-year-olds did. Age and income predicted males' physical activity, while parents' education level predicted females' physical activity. Schools provide accessible opportunities for newcomer children to engage in physical activity.

University students are a vulnerable group for poor dietary intake, insufficient physical activity and sedentary behaviour. The purpose of this study was to examine the impact of coronavirus disease (COVID-19) on university students' dietary intake, physical activity, and sedentary behaviour. Participants were students ( n = 125) from the Universities of Saskatchewan and Regina. An online questionnaire was administered retrospectively (for prepandemic) and prospectively (during the pandemic) to examine students' dietary intake, physical activity, and sedentary behaviour. Overall, nutrient and caloric intakes were significantly reduced ( p < 0.05) during the pandemic, and alcohol intake increased ( p = 0.03). Before the pandemic, 16% and 54% of the participants were meeting the Canadian 24-Hour Movement Guidelines for Adults (18-64 years) of 150 min of moderate-vigorous physical activity and 8 h or less of sedentary activity, respectively. Only 10% met the guidelines for physical activity while 30% met the guidelines for sedentary behaviour during the pandemic. The minutes per week spent engaging in moderate to vigorous physical activity during the pandemic decreased by approximately 20% ( p < 0.001). The hours spent in sedentary activities increased by 3 h per day ( p < 0.001). Our findings confirm that during the pandemic, students' inadequate dietary intake, high alcohol consumption, low physical activity, and high sedentary behaviour were significantly compounded. Novelty: During COVID-19, the nutrient and caloric intakes of university students decreased, and alcohol intake increased significantly. University students' physical activity levels decreased, and sedentary activity increased significantly during COVID-19. During COVID-19 students did not engage in sufficient physical activity to offset the increased sedentary behaviour.

This Horizons is part of a series that identifies key, forward-thinking research questions and challenges that need to be addressed. Specifically, this Horizons paper discusses research in nutritional supplements and nutraceuticals for health, physical activity, and performance, and is the product of a discussion by an expert panel that took place in January 2018 prior to the Canadian Nutrition Society Thematic Conference "Advances in Sport Nutrition from Daily Living to High Performance Sport". The objective of this Horizons paper was to identify core considerations for future studies for this research area, and how scientists can be leaders in the field to ensure the best quality science is available for decision makers. It is strongly recommended that the various elements highlighted throughout this Horizons paper will increase the awareness of the significant before-, during-, and after-research due-diligence required to produce research of the highest quality. While it is recognized that many scientists will not be able to meet all of these aspects, it is nonetheless important to consider the points outlined and to recognize that those elements that are not met in studies may be significant limitations. Highlights Research questions that are hypothesis-driven are the strongest, and when combined with careful planning of the study, the result will often be of the best quality. Studies with a strong experimental design help discern between evidence-based findings and those that have not been substantiated.

It has been speculated that resting muscle mechanical activity, also known as minor tremor, microvibration, and thermoregulatory tonus, has evolved to maintain core temperature in homeotherms, and may play a role in nonshivering thermogenesis. This experiment was done to determine whether resting muscle mechanical activity increases with decreasing ambient temperature. We cooled 20 healthy, human, resting, supine subjects from an ambient temperature of 40° to 12 °C over 65 min. Core temperature, midquadriceps mechanomyography, surface electromyography, and oxygen consumption (VO2) were recorded. Resting muscle mechanical and electrical activity in the absence of shivering increased significantly at temperatures below 21.5 °C. Women defended core temperature more effectively than men, and showed increased resting muscle activity earlier than men. Metabolism measured by VO2 correlated with resting muscle mechanical activity (R = 0.65; p = 0.01). Resting muscle mechanical activity may have evolved, in part, to maintain core temperature in the face of mild cooling.

We systematically reviewed the safety of physical activity (PA) for people with arthritis, osteoporosis, and low back pain. We searched PubMed, MEDLINE, Sport Discus, and the Cochrane Central Register of Controlled Trials (1966 through March 2008) for relevant articles on PA and adverse events. A total of 111 articles met our inclusion criteria. The incidence for adverse events during PA was 3.4%-11% (0.06%-2.4% serious adverse events) and included increased joint pain, fracture, and back pain for those with arthritis, osteoporosis, and low back pain, respectively. Recommendations were based on the Appraisal of Guidelines for Research and Evaluation, which applies Levels of Evidence based on type of study ranging from high-quality randomized controlled trials (Level 1) to anecdotal evidence (Level 4) and Grades from A (strong) to C (weak). Our main recommendations are that (i) arthritic patients with highly progressed forms of disease should avoid heavy load-bearing activities, but should participate in non-weight-bearing activities (Level 2, Grade A); and (ii) patients with osteoporosis should avoid trunk flexion (Level 2, Grade A) and powerful twisting of the trunk (Level 3, Grade C); (iii) patients with acute low back pain can safely do preference-based PA (i.e., PA that does not induce pain), including low back extension and flexion (Level 2, Grade B); (iv) arthritic patients with stable disease without progressive joint damage and patients with stable osteoporosis or low back pain can safely perform a variety of progressive aerobic or resistance-training PAs (Level 2, Grades A and B). Overall, the adverse event incidence from reviewed studies was low. PA can safely be done by most individuals with musculoskeletal conditions.

A randomized double-blind placebo controlled study design was used to assess the effects of flaxseed lignan complex supplementation during exercise training on a metabolic syndrome composite score and osteoporosis risk in older adults. A total of 100 subjects (>or=50 years) were randomized to receive flaxseed lignan (543 mg.day-1 in a 4050 mg complex) or placebo while completing a 6 month walking program (30-60 min.day-1, 5-6 days.week-1). Fasting serum glucose, triacylglycerol (TAG), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, total cholesterol, interleukin-6, and tumor necrosis factor-alpha were measured every 2 months, while body composition, bone mineral density, and resting blood pressure were assessed at baseline and at 6 months. A composite Z score of 6 risk factors for metabolic syndrome (fasting glucose, HDL cholesterol, TAG, abdominal adiposity, blood pressure, and inflammatory cytokines) was calculated at baseline and at 6 months. Men taking placebo increased metabolic syndrome composite Z score (p < 0.05), but there were no changes in the other groups. A significant group x sex x time interaction was noted for TAG (p = 0.017) and diastolic blood pressure (p = 0.046), with men taking flaxseed lignan decreasing diastolic blood pressure relative to men taking placebo, and men taking placebo increasing TAG relative to men taking flax lignan. There were no differences between groups for change in bone measures, body composition, lipoproteins, or cytokines. Males taking the flaxseed lignan complex reduced metabolic syndrome score relative to men taking placebo, but a similar trend was not seen in females. Flaxseed lignan had no effect on bone mineral density or content, body composition, lipoproteins, glucose, or inflammation.

Increased inflammation with aging has been linked to sarcopenia. The purpose of this study was to evaluate the effects of supplementing older adults with alpha-linolenic acid (ALA) during a resistance training program, based on the hypothesis that ALA decreases the plasma concentration of the inflammatory cytokine tumor necrosis factor (TNF)-alpha and interleukin (IL)-6, which in turn would improve muscle size and strength. Fifty-one older adults (65.4 +/- 0.8 years) were randomized to receive ALA in flax oil (~14 g.day-1) or placebo for 12 weeks while completing a resistance training program (3 days a week). Subjects were evaluated at baseline and after 12 weeks for muscle thickness of knee and elbow flexors and extensors (B-mode ultrasound), muscle strength (1 repetition maximum), body composition (dual energy X-ray absorptiometry), and concentrations of TNF-alpha and IL-6. Males supplementing with ALA decreased IL-6 concentration over the 12 weeks (62 +/- 36% decrease; p = 0.003), with no other changes in inflammatory cytokines. Chest and leg press strength, lean tissue mass, muscle thickness, hip bone mineral content and density, and total bone mineral content significantly increased, and percent fat and total body mass decreased with training (p < 0.05), with the only benefit of ALA being a significantly greater increase in knee flexor muscle thickness in males (p < 0.05). Total-body bone mineral density improved in the placebo group, with no change in the ALA group (p = 0.05). ALA supplementation lowers the IL-6 concentration in older men but not women, but had minimal effect on muscle mass and strength during resistance training.

High doses of ibuprofen have been shown to inhibit muscle protein synthesis after a bout of resistance exercise. We determined the effect of a moderate dose of ibuprofen (400 mg x d(-1)) consumed on a daily basis after resistance training on muscle hypertrophy and strength. Twelve males and 6 females (approximately 24 years of age) trained their right and left biceps on alternate days (6 sets of 4-10 repetitions), 5 d x week(-1), for 6 weeks. In a counter-balanced, double-blind design, they were randomized to receive 400 mg x d(-1) ibuprofen immediately after training their left or right arm, and a placebo after training the opposite arm the following day. Before- and after-training muscle thickness of both biceps was measured using ultrasound and 1 repetition maximum (1 RM) arm curl strength was determined on both arms. Subjects rated their muscle soreness daily. There were time main effects for muscle thickness and strength (p < 0.01). Ibuprofen consumption had no effect on muscle hypertrophy (muscle thickness of biceps for arm receiving ibuprofen: pre 3.63 +/- 0.14, post 3.92 +/- 0.15 cm; and placebo: pre 3.62 +/- 0.15, post 3.90 +/- 0.15 cm) and strength (1 RM of arm receiving ibuprofen: pre 18.6 +/- 2.8, post 23.4 +/- 3.5 kg; and placebo: pre 18.8 +/- 2.8, post 22.8 +/- 3.4 kg). Muscle soreness was elevated during the first week of training only, but was not different between the ibuprofen and placebo arm. We conclude that a moderate dose of ibuprofen ingested after repeated resistance training sessions does not impair muscle hypertrophy or strength and does not affect ratings of muscle soreness.

Muscle loss with age has a negative effect on strength and functional independence. Age-related loss of muscle is the result of decreased muscle fiber number and size, which are functions of altered hormonal status, physical inactivity, and variations in nutritional intake. Resistance training has a positive effect on muscle mass and strength in the elderly. Studies of protein or creatine supplementation for increasing muscle mass and strength in older individuals are equivocal. The timing of nutritional supplementation may be more important than the absolute daily intake of supplements. Protein or creatine ingestion proximate to resistance-training sessions may be more beneficial for increasing muscle mass and strength than ingestion of protein or creatine at other times of the day, possibly because of increased blood flow and therefore increased transport of amino acids and creatine to skeletal muscle.

Exercise has a beneficial effect on bone, possibly by stimulating estrogen receptor alpha. Because estrogen up-regulates this receptor, estrogen therapy combined with exercise training may be optimal for increasing bone mineral density. Studies combining estrogen therapy and exercise training in postmenopausal women show mixed results, but indicate that the combination of interventions may be more effective for increasing bone mass than either intervention alone. Plant-like estrogens (i.e phytoestrogens such as soy isoflavones) may act as weak estrogen agonists or antagonists, have small beneficial effects on bone, and may interact with exercise for increasing bone mineral density. Phytoestrogen derived from flaxseed (flax lignans) has not been evaluated as extensively as soy isoflavones and thus its effect on bone is difficult to determine. Estrogen or soy isoflavones given to postmenopausal women results in a small increase in lean tissue mass that may be mediated through estrogen receptor alpha on muscle or through decreased inflammation.

Rugby union football requires muscular strength and endurance, as well as aerobic endurance. Creatine supplementation may enhance muscular performance, but it is unclear if it would interfere with aerobic endurance during running because of increased body mass. The purpose of this study was to determine if creatine supplementation during 8 weeks of a season of rugby union football can increase muscular performance, without negatively affecting aerobic endurance. Rugby union football players were randomized to receive 0.1 g.kg(-1).d(-1) creatine monohydrate (n=9) or placebo (n=9) during 8 weeks of the rugby season. Players practiced twice per week for approximately 2 h per session and played one 80 min game per week. Before and after the 8 weeks, players were measured for body composition (air displacement plethysmography), muscular endurance (number of repetitions at 75% of one repetition maximum (1 RM) for bench press and leg press), and aerobic endurance (Leger shuttle-run test with 1 min stages of progressively increasing speed). There were time main effects for body mass (-0.7+/-0.4 kg; p=0.05), fat mass (-1.9+/-0.8 kg; p<0.05), and a trend for an increase in lean tissue mass (+1.2+/-0.5 kg; p=0.07), with no differences between groups. The group receiving creatine supplementation had a greater increase in the number of repetitions for combined bench press and leg press tests compared with the placebo group (+5.8+/-1.4 vs. +0.9+/-2.0 repetitions; p<0.05). There were no changes in either group for aerobic endurance. Creatine supplementation during a rugby union football season is effective for increasing muscular endurance, but has no effect on body composition or aerobic endurance.