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Hill, MW, Roberts, M, Price, MJ, and Kay, AD. Effects of flywheel training with eccentric overload on standing balance, mobility, physical function, muscle thickness, and muscle quality in older adults. J Strength Cond Res 36(11): 3190-3199, 2022-This study investigated the effects of a 6-week eccentric overload flywheel training program on vastus lateralis (VL) and gastrocnemius medialis (GM) muscle thickness and muscle quality (echo intensity), mobility (Timed Up and Go [TUG]), physical function (sit-to-stand), and balance (postural sway) performance. Nineteen subjects were assigned to either a flywheel training group ( n = 11, age = 66.4 ± 5.2 years) or a control group ( n = 8, age = 65.9 ± 3.8 years). The flywheel group underwent twice weekly squat and calf raise exercises for 6 weeks with outcome measures assessed before and after training or a time-matched control period. Throughout the training, subjects were instructed to contract as fast as possible with maximal effort during the concentric phase and to maximally resist the pull during the eccentric phase. The alpha value was a priori set at p0.05. Statistically significant ( p0.05) mean ( SD ) increases in right and left VL (7.6-9.6 ± 7.7-9.8%) and GM (8.6-8.7 ± 6.4-11.5%) muscle thickness and a reduction in VL (10.2-11.3 ± 5.9-7.9%) and GM (11.7-11.9 ± 5.6-9.6%) echo intensity were accompanied by faster TUG time (13.7 ± 7.0%) improved sit-to-stand performance (17.8-23.5 ± 7.6 - 13.4%) and reduced postural sway (29.7-42.3 ± 13.2-24.2%) after 6 weeks of flywheel training. There were no differences in any outcome measures between the treatment and control group at baseline ( p0.05). Overall, we observed substantial gains in muscle thickness and muscle quality, in addition to enhanced physical function, balance, and mobility performance among older adults after flywheel training, which may have important implications for preserving the functional capacity of older adults.

Objectives Provide normative values for cervical range of motion and describe trends in school age rugby union players. Design Cross-sectional study. Setting National 3 level club. Participants 59 school age rugby union players across under 8 (n = 8), under 9 (n = 9), under 10 (n = 15), under 13 (n = 13) and under 15 (n = 15) categories. Main outcome measures Cervical range of motion using a cervical range of motion device (CROM) to determine values for active range of motion. Results This study established mean ranges of motion for each age group. Pooled mean ranges with standard deviations for each direction were, flexion 66° (±11), extension 73° (±17), left rotation 69° (±9), right rotation 74° (±10), left lateral flexion 53° (±10) and right lateral flexion 49° (±12). No statistically significant differences were observed between the age groups, however, downward trends in lateral flexion were observed as age increased. School age rugby players had greater range of motion than senior playing counterparts. Conclusions No statistically significant differences in ranges of motion were observed between the age groups of under 8 through to under 15. However, downward trends in some ranges of motion highlight the need for age specific monitoring for potential adaptations to continued playing and comparison to age matched non-rugby players. Inclusion of other risk factors such as head re-positioning sense should also be evaluated to help guide injury risk reduction strategies.

Environmental heat stress can negatively impact health, work capacity, and athletic performance and potentially to lead to life-threatening consequences if not mitigated. With the upcoming Toyko Olympic games to be held during anticipated warm ambient temperatures (up to 29°C), and with spectators potentially spending long durations of time outdoors, certain populations of persons with impaired thermoregulatory capacity will be at higher risk of heat-related illness from passive heat stress. Persons with spinal cord injury (SCI) are one of these groups as a result of a decentralized sympathetic nervous system, which leaves them with impairment in convective and evaporative cooling via vasodilation and sweating, respectively. This review summarizes (1) thermoregulatory physiological responses of persons with SCI under passive heat stress: the effect of level and completeness of injury; (2) the impact of passive heat stress on quality of life (QOL), outdoor participation, behavioral thermoregulation, and cognition; (3) recommendations and education for clinicians providing health care for persons with SCI; and (4) suggestions of future directions for exploring the gaps in the literature on passive heat stress in persons with SCI. This article aims to equip consumers with SCI and health-care professionals with the most up-to-date knowledge on passive heat stress responses in persons with SCI, so that their attendance at the Olympic games can be done with maximal safety and enjoyment.

The purpose of this study was to assess the association between muscle thickness and echo intensity of the knee extensors and ankle plantarflexors with postural sway, mobility and physical function in older adults. Twenty-one older men and women (age; 69.9 ± 4.3 years) were assessed for postural sway (centre of pressure movement), mobility (i.e. Timed-Up and-Go-test [TUG]), physical function (i.e. 5 times sit-to-stand [STS]), and ultrasound derived measures of muscle thickness and echo intensity of the vastus lateralis (VL) and gastrocnemius medialis (GM). Significant inverse correlations were observed between VL and GM thickness with TUG (r = −0.432 to −0.492) and STS (r = −0.473 to −0.596). Significant positive correlations were observed between VL and GM echo intensity with TUG (r = 0.459 to 0.518) and STS (r = 0.481 to 0.635). Significant positive correlations were also detected between GM echo intensity and anteroposterior sway (r = 0.451 to 0.534). Two key findings emerged from the present experiment. First, this study provides novel evidence that ankle plantarflexor echo intensity, but not thickness, was associated with anteroposterior postural sway among older adults. Second, we provide new evidence that muscle thickness and echo intensity of the knee extensors and uniquely, the ankle plantarflexors, presented with similar magnitude associations with TUG and STS performance in older adults.

Transient symptoms of muscle damage emanating from unaccustomed eccentric exercise can adversely affect muscle function and potentially increase the risk of falling for several days. Therefore, the aims of the present study were to investigate the shorter- and longer-lasting temporal characteristics of muscle fatigue and damage induced by level (i.e., concentrically biased contractions) or downhill (i.e., eccentrically biased contractions) walking on postural, physical, and muscular functions in older people. Nineteen participants were matched in pairs for sex, age and self-selected walking speed and allocated to a level (n = 10, age = 72.3 ± 2.9 years) or downhill (n = 9, age = 72.1 ± 2.2 years) walking group. Postural sway, muscle torque and power, physical function (5× and 60 s sit-to-stand; STS), and mobility (Timed-Up-and-Go; TUG) were evaluated at baseline (pre-exercise), 1 min, 15 min, 30 min, 24 h, and 48 h after 30 min of level (0% gradient) or downhill (−10% gradient) walking on a treadmill. Following downhill walking, postural sway (+66 to 256%), TUG (+29%), 60 s STS (+29%), five times STS (−25%) and concentric power (−33%) did not change at 1–30 min post exercise, but were significantly different (p < 0.05) at 24 and48 h post-exercise when compared to baseline (p < 0.05). Muscle torque decreased immediately after downhill walking and remained impaired at 48 h post-exercise (−27 to −38%). Immediately following level walking there was an increase in postural sway (+52 to +98%), slower TUG performance (+29%), fewer STS cycles in 60 s (−23%), slower time to reach five STS cycles (+20%) and impaired muscle torque (−23%) and power (−19%) which returned to baseline 30-min after exercise cessation (p > 0.05). These findings have established for the first time distinct impairment profiles between concentric and eccentric exercise. Muscle damage emanating from eccentrically biased exercise can lead to muscle weakness, postural instability and impaired physical function persisting for several days, possibly endangering older adult’s safety during activities of daily living by increasing the risk of falls.

Background Ankle fractures are one of the most common fractures in adults aged 20–65 years. The British Orthopaedic Association (BOA) and British Orthopaedic Foot and Ankle Society (BOFAS) jointly produced Standards for Trauma (BOAST) BOAST 12, with the aim of reducing morbidity by standardising care of these injuries. The primary aim of the AUGMENT study was to determine the extent and clinical effect of variation from BOAST 12. Methods AUGMENT was a multi-centre prospective trainee led audit of consecutive patients presenting with an ankle fracture within a four-week period. Data were collected on patient demographics, comorbidities, management and 12-week outcome. The BOAST 12 standards were divided into four subgroups; documentation, imaging, management and follow-up. Percentage compliance with each subgroup was analysed. A multivariate logistic regression analysis was used to determine impact of overall compliance on likelihood of discharge in follow-up period. Findings 971 patients were included across 52 sites. The overall rate of BOAST 12 compliance was 41.7%. Variations in practice were observed in clinical documentation, especially of neurovascular status, (40.7%) and VTE assessment (61.5%). Patient management compliance with all 16 of the BOAST 12 standards was associated with a higher rate of discharge during the 12-week follow-up period (p = 0.005). Conclusion AUGMENT has demonstrated that the management of ankle fractures is variable across the UK. Over half of patients had aspects of their care that were not BOAST 12 compliant. When compliance was observed, it was associated with earlier discharge from orthopaedic care.

Holding asymmetrical loads in the hands is common during many daily and occupational activities which, depending on the load mass, may alter postural stability. The purpose of this study was to determine the effect of load magnitude held asymmetrically in the hand on postural sway in older people. Eighteen healthy older adults (age 65.9 ± 5.7 years) were assessed in the following conditions; (1) standing without an external load (0%), (2) standing while holding a grocery bag containing 5%, (3) 10% and (4) 20% body mass in the dominant hand. The total displacement of the centre of pressure (COP) in the anteroposterior and mediolateral directions (cm), mean COP velocity (cm s−1) and COP area (cm2) were used to indirectly assess postural sway. The COP area (R 2 = 0.96), anteroposterior (R 2 = 0.85) and mediolateral (R 2 = 0.84) COP displacement increased linearly with additional load. The 20% load condition elicited the greatest increase in postural sway (d = 2.1–3.6) compared to 0%, while the 5% load had no effects on sway (P ≥ 0.05). In contrast, the mean COP velocity decreased by similar amounts when holding a load at 5% (d = 1.6), 10% (d = 1.4) and 20% (d = 1.5) body mass, compared to 0% (all P

This study examined postural sway in children in eyes open (EO) and eyes closed (EC) conditions, controlling for body mass index (BMI) and physical activity (PA). Sixty two children (aged 8–11years) underwent sway assessment using computerized posturography from which 95% ellipse sway area, anterior/posterior (AP) sway, medial/lateral (ML) sway displacement and sway velocity were assessed. Six trials were performed alternatively in EO and EC. BMI (kg/m2) was determined from height and mass. PA was determined using sealed pedometry. AP amplitude (p = .038), ML amplitude (p = .001), 95% ellipse (p = .0001), and sway velocity (p = .012) were higher in EC compared with EO conditions. BMI and PA were not significant as covariates. None of the sway variables were significantly related to PA. However, sway velocity during EO (p = .0001) and EC (p = .0001) was significantly related to BMI. These results indicate that sway is poorer when vision is removed, that BMI influences sway velocity, but that pedometer-assessed PA was not associated with postural sway.

Objectives: Athletes with high level spinal cord injuries (tetraplegia) are under greater thermal strain during exercise than the able-bodied. The purpose of this study was to investigate the effectiveness of pre-cooling using an ice vest and the combination of pre-cooling and cooling during play using water sprays in athletes with tetraplegia.\ud \ud Design: Counter-balanced, cross-over design.\ud \ud Methods: Eight wheelchair rugby players with tetraplegia completed a 60 min intermittent sprint protocol (ISP) on a wheelchair ergometer in 20.2 °C ± 0.2 °C and 33.0% ± 3.1% relative humidity. The ISP was conducted on three occasions; no cooling (NC), pre-cooling with an ice vest (P) and pre-cooling with an ice vest and water sprays between quarters (PW). Gastrointestinal (Tgi) temperature, mean skin temperature (Tsk) and perceptual responses were measured throughout.\ud \ud Results: At the end of pre-cooling, the change in Tgi was not significantly different between conditions (P > 0.05) but the change in Tsk was significantly greater in P and PW compared to NC (P < 0.001). The change in Tgi over the ISP was significantly lower in PW and P compared to NC (P < 0.05), whilst the change in Tsk was lower in PW compared to P and NC (P < 0.05). Cooling had no effect on performance or perceptual responses (P > 0.05).\ud \ud Conclusions: Water spraying between quarters combined with pre-cooling using an ice vest lowers thermal strain to a greater degree than pre-cooling only in athletes with tetraplegia, but has no effect on simulated wheelchair rugby performance or perceptual responses.

Persons without spinal cord injury (SCI) physiologically acclimate between seven to fourteen consecutive days of exercise in the heat. Decreased resting and exercise core temperature, decreased heart rate, increased plasma volume and increased thermal comfort during exercise are changes consistent with heat acclimation. Autonomic dysfunction after SCI impairs heat dissipation through sweating and vasodilation. The purpose of this study is to determine if seven consecutive days of exercise in the heat would result in physiologic changes consistent with heat acclimation in persons with SCI. Ten persons with SCI divided into two groups: tetraplegia (n=5) and paraplegia (n=5) exercised in 35°C using an arm ergometer at 50% Wpeak for 30min followed by 15min rest. This protocol was repeated over seven consecutive days. Heart rate (HR), skin temperature, aural temperature (Taur), rate of perceived exertion (RPE), rate of perceived thermal strain (RPTS), and plasma volume (PV) were measured throughout the protocol. There were no significant differences in resting Taur exercise Taur, mean skin temperature, HR, PV, RPE or RPTS over the 7 days for either the tetraplegic or paraplegic group. Participants with SCI did not demonstrate the ability to dissipate heat more efficiently over 7 days of exercise at 35°C. The lack of heat acclimation seen in persons with SCI has implications for the athlete and non-athlete alike. For the SCI athlete, inability to acclimate will impair performance and endurance especially in warm environments, compared to the person without SCI. For the SCI non-athlete, there is a greater risk of heat-related illness in warm environments that can negatively affect participation in outdoor activities and thus quality of life.

Presented in this infographic is a summary of studies investigating the thermoregulatory impairment of athletes with a spinal cord injury during real-world sporting scenarios. The infographic depicts the heightened thermal strain experienced by athletes with tetraplegia (high level lesions), both compared to athletes with paraplegia (low level lesions) and within the sport of wheelchair rugby. In addition to the cooling interventions presented, the infographic highlights the significant need for appropriate interventions to reduce the risk of overheating and potential performance decrements. This infographic was field tested with those who work within a wheelchair sports environment, ranging from practitioners, researchers, athletes with an SCI and sports clinicians. The experimental studies were also designed in consultation with the wheelchair rugby coaches and players.

Objective To investigate manual therapist's knowledge and beliefs of working with Transplantee Athletes (TxA) at Transplant Games. Design On-line questionnaire. Participants Thirty present and previous members of Transplant Sport ‘therapy team’ (age; 35 ± 14 years, 24 female). Main outcome measures Questions concerned demographics and general information on the background of the therapists. Closed questions with rating statements concerning beliefs when treating TxA and open questions asking for advice the participants would give to colleagues and further information they would like to have available to them. Results TxA were thought to be a vulnerable group of athletes requiring special precautions and considerations. Two areas of information evolved: “general advice for TxA management” and “specific advice for therapists”. General advice was to understand TxAs and be vigilant with hygiene. Specific therapy advice was to avoid grade V manipulations and care with taping and massage, because of complications resulting from side effects of long-term medication. Conclusion There appears to be a lack of research-based evidence to guide practitioners in their management of TxAs. Generic, good advice is now available from experienced practitioners however there is a paucity of research evidence to support this. Thus, there is a potential danger of being overcautious in approaches to treatment which ultimately may impact on athletic performance.

Physiological responses to arm and leg-cycling are different, which may influence psychological and biological mechanisms that influence post-exercise cognitive performance. The aim of this study was to determine the effects of maximal and submaximal (absolute and relative intensity matched) arm and leg-cycling on executive function. Thirteen males (age, 24.7 ± 5.0 years) initially undertook two incremental exercise tests to volitional exhaustion for arm-cycling (82 ± 18 W) and leg-cycling (243 ± 52 W) for the determination of maximal power output. Participants subsequently performed three 20-min constant load exercise trials: (1) arm-cycling at 50% of the ergometer-specific maximal power output (41 ± 9 W), (2) leg-cycling at 50% of the ergometer-specific maximal power output (122 ± 26 W), and (3) leg-cycling at the same absolute power output as the submaximal arm-cycling trial (41 ± 9 W). An executive function task was completed before, immediately after and 15-min after each exercise test. Exhaustive leg-cycling increased reaction time (p < 0.05, d = 1.17), while reaction time reduced following exhaustive arm-cycling (p < 0.05, d = -0.62). Improvements in reaction time were found after acute relative intensity arm (p < 0.05, d = -0.76) and leg-cycling (p < 0.05, d = -0.73), but not following leg-cycling at the same absolute intensity as arm-cycling (p > 0.05). Improvements in reaction time following arm-cycling were maintained for at least 15-min post exercise (p = 0.008, d = -0.73). Arm and leg-cycling performed at the same relative intensity elicit comparable improvements in cognitive performance. These findings suggest that individuals restricted to arm exercise possess a similar capacity to elicit an exercise-induced cognitive performance benefit.

© 2016 Informa UK Limited, trading as Taylor & Francis Group The purpose of this study was to compare arm–leg coordination and kinematics during 100 m breaststroke in 26 (8 female; 18 male) specialist breaststroke swimmers. Laps were recorded using three 50-Hz underwater cameras. Heart rate and blood lactate were measured pre- and post-swim. Arm–leg coordination was defined using coordination phases describing continuity between recovery and propulsive phases of upper and lower limbs: coordination phase 1 (time between end of leg kick and start of the arm pull phases); and coordination phase 2 (time between end of arm pull and start of leg kick phases). Duration of stroke phases, coordination phases, swim velocity, stroke length (SL), stroke rate (SR) and stroke index (SI) were analysed during the last three strokes of each lap that were unaffected by turning or finishing. Significant changes in velocity, SI and SL (P

The purpose of this study was to investigate whether high-intensity cycling training leads to adapted responses of balance performance in response to exercise-induced muscle fatigue. Eighteen healthy adults were assigned to either 3-weeks (n = 8, age 20.1 ± 2.6 years, height 177 ± 5 cm, mass 73.6 ± 5.1 kg) or 6-weeks (n = 10, age 24.3 ± 5.8 years, height 179 ± 6 cm, mass 81.0 ± 15.8 kg) of high-intensity training (HIT) on a cycle ergometer. The centre of pressure (COP) displacement in the anteroposterior (COPAP) direction and COP path length (COPL) were measured before and after the first and final high-intensity training sessions. Pre-training, exercise-induced fatigue elicited an increase in COPAP (3-weeks; p = 0.001, 6-weeks; p = 0.001) and COPL (3-weeks; p = 0.002, 6-weeks; p = 0.001) returning to pre-exercise levels within 10-min of recovery. Following 3-weeks of training, significant increases in COPAP (p = 0.001) and COPL (p = 0.002) were observed post-fatigue, returning to pre-exercise levels after 15-min of recovery. After 6-weeks of training no significant increases in sway (COPAP; p = 0.212, COPL; p = 0.998) were observed following exercise-induced fatigue. In summary, 3 weeks of HIT resulted in longer recovery times following fatigue compared to pre-training assessments. After 6 weeks of HIT, postural sway following fatigue was attenuated. These results indicate that HIT could be included in injury prevention programmes, however, caution should be taken during early stages of the overreaching process.

This study evaluated the effects of ingesting sodium bicarbonate (NaHCO3) or caffeine individually or in combination on high-intensity cycling capacity. In a counterbalanced, crossover design, 13 healthy, noncycling trained males (age: 21 ± 3 years, height: 178 ± 6 cm, body mass: 76 ± 12 kg, peak power output (Wpeak): 230 ± 34 W, peak oxygen uptake: 46 ± 8 mL·kg−1·min−1) performed a graded incremental exercise test, 2 familiarisation trials, and 4 experimental trials. Trials consisted of cycling to volitional exhaustion at 100% Wpeak (TLIM) 60 min after ingesting a solution containing either (i) 0.3 g·kg−1 body mass sodium bicarbonate (BIC), (ii) 5 mg·kg−1 body mass caffeine plus 0.1 g·kg−1 body mass sodium chloride (CAF), (iii) 0.3 g·kg−1 body mass sodium bicarbonate plus 5 mg·kg−1 body mass caffeine (BIC-CAF), or (iv) 0.1 g·kg−1 body mass sodium chloride (PLA). Experimental solutions were administered double-blind. Pre-exercise, at the end of exercise, and 5-min postexercise blood pH, base excess, and bicarbonate ion concentration ([HCO3−]) were significantly elevated for BIC and BIC-CAF compared with CAF and PLA. TLIM (median; interquartile range) was significantly greater for CAF (399; 350–415 s; P = 0.039; r = 0.6) and BIC-CAF (367; 333–402 s; P = 0.028; r = 0.6) compared with BIC (313: 284–448 s) although not compared with PLA (358; 290–433 s; P = 0.249, r = 0.3 and P = 0.099 and r = 0.5, respectively). There were no differences between PLA and BIC (P = 0.196; r = 0.4) or between CAF and BIC-CAF (P = 0.753; r = 0.1). Relatively large inter- and intra-individual variation was observed when comparing treatments and therefore an individual approach to supplementation appears warranted.

The purpose of the present study was to quantify differences in lower extremity reach performance, static posturography and gait outcomes between young (20-39 years), middle-aged (40-59 years) and older (60-79 years) adults using identical tests and parameters. This was a cross-sectional study with three parallel groups (young [20-39 years] vs. intermediate [40-59 years] vs. older [60-79 years] adults). In a randomised order each participant completed: (i) static posturography, (ii) lower extremity reach performance, and (iii) gait assessment. Changes in balance between age groups were analysed using analysis of variance (ANOVA). Additionally, correlational analysis was used to identify relationships between age and outcome measures. Centre of pressure (COP) movement was greater in older compared to intermediate-aged (d = 0.50-2.40) and young (d = 0.54-2.61) adults (p 0.001). Reduced lower extremity reach distance was found in older compared to intermediate-aged (d = 1.28-3.60) and young (d = 2.09-3.87) adults (p 0.001), while young adults demonstrated greater reach distances than intermediate (d = 0.64-1.74) aged adults (p 0.001). Correlational analysis revealed moderate to strong positive correlations between age across the adult life span (20-79 years) for all COP metrics and lower extremity reach outcomes. When correlational analyses were performed only in the young and middle-aged groups (20-59 years), coefficients were weak and not significant for the COP, but remained moderate for lower extremity reach performance. Lower extremity reach performance reveals earlier age-related declines in postural stability that are not evident during quiet standing tasks of varying difficulty. These findings should contribute to the early identification of potential balance deficits in those where balance problems do not yet exist, which will assist clinical decision making with respect to timely implementation of fall prevention strategies.

BACKGROUND The purpose of this study was to determine the cardiorespiratory demands of standing and wheelchair (seated) fencing in a group of able-bodied fencers during simulated competitive bouts. METHODS Participants were ten male able-bodied fencers of regional level with previous training experience in wheelchair fencing. After a standardized warm-up, participants performed two series of simulated competitive epee bouts (5 and 15 touches) in a random order, either while standing or while sitting in a wheelchair. Expired gas was analyzed for oxygen consumption (VO2) and respiratory exchange ratio (RER) and heart rate were continually monitored. Energy expenditure (EE) was subsequently calculated. RESULTS VO2, HR and EE peak responses were greater during standing than seated fencing (P

Nevin, JP, Smith, P, Waldron, M, Patterson, S, Price, M, Hunt, A, and Blagrove, R. Efficacy of an 8-week concurrent strength and endurance training program on hand cycling performance. J Strength Cond Res 32(7): 1861-1868, 2018-The aim of this study was to investigate the effects of an 8-week concurrent strength and endurance training program in comparison with endurance training only on several key determinants of hand cycling performance. Five H4 and 5 H3 classified hand cyclists with at least 1 year's hand cycling training history consented to participate in the study. Subjects underwent a battery of tests to establish body mass, body composition, V[Combining Dot Above]O2peak, maximum aerobic power, gross mechanical efficiency (GME), maximal upper-body strength, and 30-km time-trial performance. Subjects were matched into pairs based on 30-km time-trial performance and randomly allocated to either a concurrent strength and endurance or endurance training only, intervention group. After an 8-week training program based on a conjugated block periodization model, subjects completed a second battery of tests. A mixed model, 2-way analysis of variance revealed no significant changes between groups. However, the calculation of effect sizes (ESs) revealed that both groups demonstrated a positive improvement in most physiological and performance measures with subjects in the concurrent group demonstrating a greater magnitude of improvement in body composition (ES -0.80 vs. -0.22), maximal aerobic power (ES 0.97 vs. 0.28), GME (ES 0.87 vs. 0.63), bench press 1 repetition maximum (1RM) (ES 0.53 vs. 0.33), seated row 1RM (ES 1.42 vs. 0.43), and 30-km time-trial performance (ES -0.66 vs. -0.30). In comparison with endurance training only, an 8-week concurrent training intervention based on a conjugated block periodization model seems to be a more effective training regime for improving the performance capabilities of hand cyclists.

Spinal cord injury results in physiologic adaptations affecting heat production (reduced muscle mass) and heat dissipation (blood redistribution and reduced sweating capacity below the level of lesion). However, it is the balance between these factors which determines whether heat balance is achieved. Core temperature estimates are generally consistent with those for the able-bodied, with cooler values reported in some instances. More notable differences are demonstrated through cooler lower-body skin temperatures at rest and a loss of anticipatory control during exposure to heat and cold when compared to the able-bodied. During exercise in cool conditions persons with paraplegia demonstrate similar body temperature responses as for the able-bodied but retain heat during recovery. Persons with tetraplegia demonstrate continual increases in core temperature and thus thermal imbalance along with greater heat retention. During exercise in the heat, athletes with paraplegia appear to be able to regulate body temperature to a similar extent as the able-bodied. Those with tetraplegia again show thermal imbalance but to a much greater extent than in the cold. Future work should focus upon specific sweating responses and adaptations following spinal cord injury, the effects of completeness of lesion, perceptual responses to environmental challenges, and how these translate to undertaking activities of daily living.

The purpose of this study was to investigate the effects of holding external loads on postural sway during upright stance across age decades. Sixty-five healthy adults (females, n = 35), aged 18-80 years were assessed in four conditions; (1) standing without holding a load, holding a load corresponding to 5% body mass in the (2) left hand, (3) right hand and (4) both hands. The centre of pressure (COP) path length and anteroposterior and mediolateral COP displacement were used to indirectly assess postural sway. External loading elicited reductions in COP measures of postural sway in older age groups only (P 0.05). No changes were observed in younger or intermediate aged adults (P 0.05). Holding external loads during standing is relevant to many activities of daily living (i.e. holding groceries). The reduction in postural sway may suggest this type of loading has a stabilising effect during quiet standing among older adults.

The purpose of this study was to determine whether a player’s physical impairment or activity profile was related to the amount of thermal strain experienced during wheelchair rugby match play. 17 elite wheelchair rugby players played a competitive match, whilst activity profiles, measures of core and skin temperature, heart rate and perceptual responses were taken. Players were divided into 2 groups depending on their physical impairment: players with a cervical spinal cord injury, (n=10) or non-spinal related physical impairment (n=7). Total distance was lower (4 842±324 vs. 5 541±316 m, p

SUMMARYPelvic inflammatory disease (PID) and more specifically salpingitis (visually confirmed inflammation) is the primary cause of tubal factor infertility and is an important risk factor for ectopic pregnancy. The risk of these outcomes increases following repeated episodes of PID. We developed a homogenous discrete-time Markov model for the distribution of PID history in the UK. We used a Bayesian framework to fully propagate parameter uncertainty into the model outputs. We estimated the model parameters from routine data, prospective studies, and other sources. We estimated that for women aged 35–44 years, 33·6% and 16·1% have experienced at least one episode of PID and salpingitis, respectively (diagnosed or not) and 10·7% have experienced one salpingitis and no further PID episodes, 3·7% one salpingitis and one further PID episode, and 1·7% one salpingitis and ⩾2 further PID episodes. Results are consistent with numerous external data sources, but not all. Studies of the proportion of PID that is diagnosed, and the proportion of PIDs that are salpingitis together with the severity distribution in different diagnostic settings and of overlap between routine data sources of PID would be valuable.

Age-predicted maximal heart rate (HRMAX ) equations are commonly used for the purpose of prescribing exercise regimens, as criteria for achieving maximal exertion and for diagnostic exercise testing. Despite the growing popularity of upper body exercise in both healthy and clinical settings, no recommendations are available for exercise modes using the smaller upper body muscle mass. The purpose of this study was to determine how well commonly used age-adjusted prediction equations for HRMAX estimate actual HRMAX for upper body exercise in healthy young and older adults. A total of 30 young (age: 20 ± 2 years, height: 171·9 ± 32·8 cm, mass: 77·7 ± 12·6 kg) and 20 elderly adults (age: 66 ± 6 years, height: 162 ± 8·1 cm, mass: 65·3 ± 12·3 kg) undertook maximal incremental exercise tests on a conventional arm crank ergometer. Age-adjusted maximal heart rate was calculated using prediction equations based on leg exercise and compared with measured HRMAX data for the arms. Maximal HR for arm exercise was significantly overpredicted compared with age-adjusted prediction equations in both young and older adults. Subtracting 10-20 beats min(-1) from conventional prediction equations provides a reasonable estimate of HRMAX for upper body exercise in healthy older and younger adults.

This study examined the acute effects of NaHCO3 ingestion on repetitions to failure and rating of perceived exertion in the back squat and bench press in trained men. Eight resistance-trained men took part in this double-blind, randomized crossover experimental study whereby they ingested NaHCO3 (0.3 g·kg(-1) body mass) or placebo (sodium chloride NaCl: 0.045 g·kg(-1) body mass) solution 60 minutes before completing a bout of resistance exercise (3 sets of bench press and back squat exercise to failure at an intensity of 80% 1 repetition maximum). Experimental conditions were separated by at least 48 hours. Participants completed more repetitions to failure in the back squat after NaHCO3 ingestion (p = 0.04) but not for bench press (p = 0.679). Mean ± SD of total repetitions was 31.3 ± 15.3 and 24.6 ± 16.2 for back squat and 28.7 ± 12.2 and 26.7 ± 10.2 for bench press in NaHCO3 and placebo conditions, respectively. Repetitions to failure decreased as set increased for the back squat and bench press (p = 0.001, both). Rating of perceived exertion significantly increased with set for the back squat and bench press (p = 0.002, both). There was no significant change in blood lactate across time or between conditions. There were however treatment × time interactions for blood pH (p = 0.014) and blood HCO3 concentration (p = 0.001). After ingestion, blood pH and HCO3 (p = 0.008) concentrations were greater for the NaHCO3 condition compared with the placebo condition (p < 0.001). The results of this study suggest that sodium bicarbonate ingestion can enhance resistance exercise performance using a repetition to failure protocol in the first exercise in a resistance exercise session.

Ten healthy, non-cycling trained males (age: 21.2 ± 2.2 years, body mass: 75.9 ± 13.4 kg, height: 178 ± 6 cm, [Vdot]O2PEAK: 46 ± 10 ml · kg(-1) · min(-1)) performed a graded incremental exercise test, two familiarisation trials and six experimental trials. Experimental trials consisted of cycling to volitional exhaustion at 100%, 110% and 120% WPEAK, 60 min after ingesting either 0.3 g · kg(-1) body mass sodium bicarbonate (NaHCO3) or 0.1 g · kg(-1) body mass sodium chloride (placebo). NaHCO3 ingestion increased cycling capacity by 17% at 100% WPEAK (327 vs. 383 s; P = 0.02) although not at 110% WPEAK (249 vs. 254 s; P = 0.66) or 120% WPEAK (170 vs. 175 s; P = 0.60; placebo and NaHCO3 respectively). Heart rate (P = 0.02), blood lactate (P = 0.001), pH (P0.001), [HCO3 (-)], (P0.001), and base excess (P0.001) were greater in all NaHCO3 trials. NaHCO3 attenuated localised ratings of perceived exertion (RPEL) to a greater extent than placebo only at 100% WPEAK (P0.02). Ratings of abdominal discomfort and gut fullness were mild but higher for NaHCO3. NaHCO3 ingestion significantly improves continuous constant load cycling at 100% WPEAK due to, in part, attenuation of RPEL.

This study examined the effects of elevated buffer capacity [~32 mM HCO3 −] through administration of sodium bicarbonate (NaHCO3) on maximally stimulated isolated mouse soleus (SOL) and extensor digitorum longus (EDL) muscles undergoing cyclical length changes at 37 °C. The elevated buffering capacity was of an equivalent level to that achieved in humans with acute oral supplementation. We evaluated the acute effects of elevated [HCO3 −] on (1) maximal acute power output (PO) and (2) time to fatigue to 60 % of maximum control PO (TLIM60), the level of decline in muscle PO observed in humans undertaking similar exercise, using the work loop technique. Acute PO was on average 7.0 ± 4.8 % greater for NaHCO3-treated EDL muscles (P

Introduction Asynchronous arm-cranking performed at high cadences elicits greater cardiorespiratory responses compared to low cadences. This has been attributed to increased postural demand and locomotor–respiratory coupling (LRC), and yet, this has not been empirically tested. This study aimed to assess the effects of cadence on cardiorespiratory responses and LRC during upper-body exercise. Methods Eight recreationally-active men performed arm-cranking exercise at moderate and severe intensities that were separated by 10 min of rest. At each intensity, participants exercised for 4 min at each of three cadences (50, 70, and 90 rev min−1) in a random order, with 4 min rest-periods applied in-between cadences. Exercise measures included LRC via whole- and half-integer ratios, cardiorespiratory function, perceptions of effort (RPE and dyspnoea), and diaphragm EMG using an oesophageal catheter. Results The prevalence of LRC during moderate exercise was highest at 70 vs. 50 rev min−1 (27 ± 10 vs. 13 ± 9%, p = 0.000) and during severe exercise at 90 vs. 50 rev min−1 (24 ± 7 vs. 18 ± 5%, p = 0.034), with a shorter inspiratory time and higher mean inspiratory flow (p

Background Previous studies of death during law enforcement restraint have focused on lying restraint positions; this study extends this work to seated restraint positions. Methods Lung function in a standing control position was compared with lung function in seated positions using 40 volunteers. [Figure: see text][Figure: see text][Figure: see text] Results No significant reduction in lung function was detected in an upright seated position. When participants were leant forward while seated, significant reductions in lung function occurred. The application of restraint holds in the seated, leant forward position resulted in a non-significant further reduction in lung function. Reductions in lung function were greater in those participants with higher body mass index (BMI). Conclusions Seated restraint positions with the person leant forward may increase the risk of harm or death during prolonged restraint. The risk will be further increased where the person exhibits higher BMI.

We examined the effects of concomitant increases in crank rate and power output on incremental arm crank ergometry. Ten healthy males undertook three incremental upper body exercise tests to volitional exhaustion. The first test determined peak minute power. The subsequent tests involved arm cranking at an initial workload of 40% peak minute power with further increases of 10% peak minute power every 2 min. One involved a constant crank rate of 70 rev · min(-1), the other an initial crank rate of 50 rev · min(-1) increasing by 10 rev · min(-1) every 2 min. Fingertip capillary blood samples were analysed for blood lactate at rest and exhaustion. Local (working muscles) and cardiorespiratory ratings of perceived exertion (RPE) were recorded at the end of each exercise stage. Heart rate and expired gas were monitored continuously. No differences were observed in peak physiological responses or peak minute power achieved during either protocol. Blood lactate concentration tended to be greater for the constant crank rate protocol (P = 0.06). Test duration was shorter for the increasing than for the constant crank rate protocol. The relationship between local RPE and heart rate differed between tests. The results of this study show that increasing cadence during incremental arm crank ergometry provides a valid assessment of peak responses over a shorter duration but alters the heart rate-local RPE relationship.

During upper body exercise the vascular adaptations of the leg have been reported to play an important thermoregulatory role. This study examined the effect of exercise intensity on thermoregulation during upper body exercise. Nine healthy male participants undertook an incremental exercise test on an arm crank ergometer to determine peak power (W peak ). The participants performed four experimental trials involving 5 minutes of arm exercise at either 45, 60, 75, or 90% Wpeak (70 rev.min -1 ) followed by 30 minutes of passive recovery. Aural and skin temperatures, upper arm and calf heat fl ow were recorded. Calf volume was measured during exercise using plethysmography. During exercise at 45, 60, 75 and 90% W peak calf volume decreased (P

Resting energy expenditure of persons with a spinal cord injury (SCI) is generally lower than that seen in able-bodied (AB) individuals due to the reduced amounts of muscle mass and sympathetic nervous system available. However, outside of clinical studies, much less data is available regarding athletes with an SCI. In order to predict the energy expenditure of persons with SCI, the generation and validation of prediction equations in relation to specific levels of SCI and training status are required. Specific prediction equations for the SCI would enable a quick and accurate estimate of energy requirements. When compared with the equivalent AB individuals, sports energy expenditure is generally reduced in SCI with values representing 30-75% of AB values. The lowest energy expenditure values are observed for sports involving athletes with tetraplegia and where the sport is a static version of that undertaken by the AB, such as fencing. As with AB sports there is a lack of SCI data for true competition situations due to methodological constraints. However, where energy expenditure during field tests are predicted from laboratory-based protocols, wheelchair ergometry is likely to be the most appropriate exercise mode. The physiological and metabolic responses of persons with SCI are similar to those for AB athletes, but at lower absolute levels. However, the underlying mechanisms pertaining to substrate utilization appear to differ between the AB and SCI. Carbohydrate feeding has been shown to improve endurance performance in athletes with generally low levels of SCI, but no data have been reported for mid to high levels of SCI or for sport-specific tests of an intermittent nature. Further research within the areas reviewed may help to bridge the gap between what is known regarding AB athletes and athletes with SCI (and other disabilities) during exercise and also the gap between clinical practice and performance.

Purpose:Individuals with a spinal-cord injury have impaired thermoregulatory control due to a loss of sudomotor and vasomotor effectors below the lesion level. Thus, individuals with high-level lesions (tetraplegia) possess greater thermoregulatory impairment than individuals with lower-level lesions (paraplegia). Previous research has not reflected the intermittent nature and modality of wheelchair court sports or replicated typical environmental temperatures. Hence, the purpose of this study was to investigate the thermoregulatory responses of athletes with tetraplegia and paraplegia during an intermittent-sprint protocol (ISP) and recovery in cool conditions.Methods:Sixteen wheelchair athletes, 8 with tetraplegia (TP, body mass 65.2 ± 4.4 kg) and 8 with paraplegia (body mass 68.1 ± 12.3 kg), completed a 60-min ISP in 20.6°C ± 0.1°C, 39.6% ± 0.8% relative humidity on a wheelchair ergometer, followed by 15 min of passive recovery. Core temperature (Tcore) and mean (Tsk) and individual skin temperatures were measured throughout.Results:Similar external work (P = .70, ES = 0.20) yet a greater Tcore (P < .05, ES = 2.27) and Tsk (P < .05, ES = 1.50) response was demonstrated by TP during the ISP.Conclusions:Despite similar external work, a marked increase in Tcore in TP during exercise and recovery signifies that thermoregulatory differences between the groups were predominantly due to differences in heat loss. Further increases in thermal strain were not prevented by the active and passive recovery between maximal-effort bouts of the ISP, as Tcore continually increased throughout the protocol in TP.

Ice vest pre-cooling has been show to lower rectal tem- perature during intermittent exercise in hot conditions but only after 40 min of exercise [1]. The authors sug- gested that the ice vest may have initiated a strong local cutaneous vasoconstrictor response reducing skin blood flow [2] and thus the cooling potential, until increases in body temperature and skin blood flow occurred later in exercise. Therefore, the purpose of this study was to determine whether ice vest pre-cooling reduces skin blood flow during intermittent exercise in the heat com- pared to a no cooling control.

Athletes with tetraplegia (spinal cord injury at the cervical region of the spinal cord) are at a greater risk of heat illness than their able-bodied counterparts, due to the loss of sweating capacity and vasomotor control below the lesion level. Commercially available ice vests worn prior to exercise (pre-cooling) have received considerable interest in the able-bodied athletic population eliciting varying results in performance, and physiological and thermoregulatory responses. However, limited research has been conducted in thermoregulatory impaired athletes with tetraplegia. Anecdotally water spraying the face and torso is commonly used by these athletes during breaks in play, though the effectiveness of this method has not been established. The purpose of this study was to investigate the effects of pre-cooling using an ice vest and the combination of pre-cooling and cooling during play using water sprays on simulated wheelchair rugby performance in athletes with tetraplegia.

This study examined coincidence anticipation timing (CAT) performance at slow and fast stimulus speeds before, during, and after an acute bout of walking in adults aged 60–76 years. Results from a series of repeated measures ANOVAs indicated significant rest versus exercise × stimulus speed × time interactions for absolute and variable errors (bothP=0.0001) whereby absolute and variable error scores, when stimulus speed was slow, improved as the duration of exercise increased. When stimulus speed was fast there were significantly greater absolute and variable errors at 18 minutes of the walking bout. There was also greater error at 18 minutes during walking compared to rest. These results suggest that, in a task involving walking and CAT, stimulus speeds plays an important role; specifically walking (exercise) enhances CAT performance at slow stimulus speeds but reduces CAT performance at fast stimulus speeds. The implications are that in everyday situations, where events require dual-task responses to be made at different speeds, for example, walking on the pavement whilst avoiding a crowd, compared to crossing a busy road, an understanding of how different stimulus speeds influence dual-task performance is extremely important, particularly in the older adult population.

The increased participation in wheelchair sports in conjunction with environmental challenges posed by the most recent Paralympic venues has stimulated interest into the study of thermoregulation of wheelchair users. This area is particularly pertinent for the spinal cord injured as there is a loss of vasomotor and sudomotor effectors below the level of spinal lesion. Studies within this area have examined a range of environmental conditions, exercise modes and subject populations. During exercise in cool conditions (15-25 degrees C), trained paraplegic individuals (thoracic or lumbar spinal lesions) appear to be at no greater risk of thermal injury than trained able-bodied individuals, although greater heat storage for a given metabolic rate is evident. In warm conditions (25-40 degrees C), trained subjects again demonstrate similar core temperature responses to the able-bodied for a given relative exercise load but elicit increased heat storage within the lower body and reduced whole-body sweat rates, increasing the risk of heat injury. The few studies examining a wide range of lesion levels have noted that, for paraplegic individuals where heat production is matched by available sweating capacity, excessive heat strain may be offset. Studies relating to tetraplegic subjects (cervical spinal lesions) are fewer in number but have consistently shown this population to elicit much faster rates of core and skin temperature increase and thermal imbalance in both cool and warm conditions than paraplegic individuals. These responses are due to the complete absence or severely reduced sweating capacity in tetraplegic subjects. During continuous exercise protocols, the main thermal stressor for tetraplegic subjects appears to be environmental heat gain, whereas during an intermittent-type exercise protocol it appears to be metabolic heat production. Fluid losses during exercise and heat retention during passive recovery from exercise are related to lesion level. Future research is recommended to focus on the specific role of absolute and relative metabolic rates, sweating responses, training status and more sport- and vocation-specific exercise protocols.

Current evidence suggests that acute bouts of lower limb exercise elicits a number of adverse effects on both sensory and motor components of postural control. The effects of acute exercise on quiet standing balance while concurrently performing an attentional task remains equivocal. This study aimed to compare the alterations in postural control and attentional demands elicited by upper and lower limb exercise. Twelve healthy young males (mean ± SD age, 22.2 ± 3.2 years) were examined on six separate occasions. The first two visits determined maximal aerobic fitness on an arm crank ergometer (ACE) and cycle ergometer (CYC). Subsequently, participant’s postural sway was assessed during single- (ST) and dual-task (DT) conditions before and immediately after moderate- and high-intensity exercise engaging the upper or lower body musculature. The order of the four exercise tests was counterbalanced. The centre of pressure displacement in the anteroposterior (COPAP) and mediolateral (COPML) directions and the COP path length (COPL) were computed using a force platform. A time × mode interaction was observed for COPAP (ST; p = 0.011, DT; p = 0.018) and COPML (ST; p = 0.001). CYC elicited large (ES; 1.6–2.0) increases in COPAP and COPML, but there were no differences between aerobic and anaerobic tests (p > 0.05). The effect of cognitive load appeared to increase sway in the frontal plane following anaerobic CYC (p = 0.001) but not ACE (p < 0.05). Exercise has different effects on frontal and sagittal plane sway following different cognitive loads. In particular, COPML was increased at the cost of maintaining attentional performance following exercise.

This study examined the effects of variations in crank rate on physiological responses during submaximal arm ergometry. Fifteen non-specifically trained male subjects volunteered to participate in this study. Each subject undertook a discontinuous arm crank ergometry test (30, 50, 70, 90 W) on three separate occasions using crank rates of 50, 70, and 90 rev.min(-1). Respiratory parameters and heart rate were continuously monitored. An 80-microL capillary blood sample was obtained immediately following each exercise bout for the determination of whole blood lactate. Measures of efficiency were calculated using specific caloric equivalents of oxygen consumption (V(O2)). Heart rate was lowest (p0.05) at 30, 50, and 70 W using 50 rev.min(-1). Values of gross and net efficiency tended to be higher (p0.05) using 50 rev.min (-1) at the lower absolute workloads, but no differences (p0.05) were observed between the three crank rates at 90 W. No differences (p0.05) were observed between crank rates for delta efficiency. This study confirms that variations in crank rate can influence gross and net values of V(O2) and exercise efficiency at low absolute workloads, but crank rate ceases to be an influential factor at moderate workloads. Further research is required to identify the specific mechanisms underpinning the observations reported in the present study relating to the interaction between crank rate, workload, and exercise efficiency during arm crank ergometry.

The present study examined the impact of two exercise protocols on the attainment of peak physiological responses during arm crank ergometry (ACE). Fourteen physically active, although non-specifically trained male subjects completed two V.O (2) peak tests using an electrically braked arm ergometer (Lode Angio, Groningen, Netherlands). The tests consisted of a stepwise or rampwise increase in external workload. The order of tests was randomised and each test was separated by at least two days. Respiratory data were collected continuously using an on-line gas analysis system with sample time set at 30 s. Fingertip capillary blood samples ( approximately 20 microL) were collected at volitional exhaustion and at minute intervals for 7 min of passive recovery for the determination of peak whole blood lactate concentration. Time on the test (T (lim); s), peak minute power (PMP; W), and total work done (TWD; kJ) were also recorded. In addition to determining systematic bias using separate independent t-tests, the level of agreement was also examined by way of calculating the 95 % limits of agreement. Sub-maximal values of V.O (2), V.E, and HR were similar (p > 0.05) between test when the amount of external work completed was taken into consideration. There was no systematic bias (p > 0.05) for mean (+/- s) peak values of V.O (2) (3.12 [0.37] vs. 3.04 [0.38] L . min (-1)) or any other parameter between the step and ramp tests, respectively. Mean values of T (lim), PMP, and TWD were also similar (p > 0.05) between tests. However, the level of agreement for peak values of all test parameters was low. It is therefore concluded that while either test can be considered as being suitable for the purpose of eliciting V.O (2) peak and other physiological responses using ACE, they should not be used interchangeably for the purpose of assessing parameters linked to the aerobic capacity of the upper-body.

The thermoregulatory responses of upper-body trained athletes were examined at rest, during prolonged arm crank exercise and recovery in cool (21.5 +/- 0.9 degrees C, 43.9 +/- 10.1% relative humidity; mean +/- s) and warm (31.5 +/- 0.6 degrees C, 48.9 +/- 8.4% relative humidity) conditions. Aural temperature increased from rest by 0.7 +/- 0.7 degrees C (P0.05) during exercise in cool conditions and by 1.6 +/- 0.7 degrees C during exercise in warm conditions (P0.05). During exercise in cool conditions, calf skin temperature decreased (1.5 +/- 1.3 degrees C), whereas an increase was observed during exercise in warm conditions (3.0 +/- 1.7 degrees C). Lower-body skin temperatures tended to increase by greater amounts than upper-body skin temperatures during exercise in warm conditions. No differences were observed in blood lactate, heart rate or respiratory exchange ratio responses between conditions. Perceived exertion at 45 min of exercise was greater than that reported at 5 min of exercise during the cool trial (P0.05), whereas during exercise in the warm trial the rating of perceived exertion increased from initial values by 30 min (P0.05). Heat storage, body mass losses and fluid consumption were greater during exercise in warm conditions (7.06 +/- 2.25 J x g(-1) x degrees C(-1), 1.3 +/- 0.5 kg and 1,038 +/- 356 ml, respectively) than in cool conditions (1.35 +/- 0.23 J x g(-1) x degrees C(-1), 0.8 +/- 0.2 kg and 530 +/- 284 ml, respectively; P0.05). The results of this study indicate that the increasing thermal strain with constant thermal stress in warm conditions is due to heat storage within the lower body. These results may aid in understanding thermoregulatory control mechanisms of populations with a thermoregulatory dysfunction, such as those with spinal cord injuries.

The aim of this study was to determine the aerobic contribution to upper body and lower body Wingate Anaerobic tests (WAnT). Eight nonspecifically trained males volunteered to take part in this study. Participants undertook incremental exercise tests for peak oxygen uptake and two 30-s WAnT (habituation and experimental) for both the upper and lower body. The resistive loadings used were 0.040 and 0.075 kg·kg body mass−1, respectively. Peak power output (PPO) and mean power output (MPO) were calculated for each WAnT. The aerobic contribution of each WAnT was assessed using breath by breath expired gas analysis. Peak oxygen uptake was lower for the upper body when compared with the lower body (P = 0.001). Similarly, PPO and MPO were greater for the lower body (both P < 0.001). Absolute oxygen uptake during the upper body WAnT was lower than for the lower body (P = 0.013), whereas relative oxygen uptake (% peak oxygen uptake) was similar (P = 0.997). The mean aerobic contribution for the upper body WAnT (43.5% ± 29.3%) was greater than for the lower body (29.4% ± 15.8%; P < 0.001). The greater aerobic contribution to the WAnT observed for the upper body in comparison with the lower body is likely due to methodological differences in upper and lower body WAnT protocols and potentially differences in anaerobic power production and exercise efficiency. The results of this study suggest that differences may exist for the aerobic contribution of upper and lower body Wingate anaerobic tests.

Cooling strategies that help prevent a reduction in exercise capacity whilst exercising in the heat have received considerable research interest over the past 3 decades, especially in the lead up to a relatively hot Olympic and Paralympic Games. Progressing into the next Olympic/Paralympic cycle, the host, Rio de Janeiro, could again present an environmental challenge for competing athletes. Despite the interest and vast array of research into cooling strategies for the able-bodied athlete, less is known regarding the application of these cooling strategies in the thermoregulatory impaired spinal cord injured (SCI) athletic population. Individuals with a spinal cord injury (SCI) have a reduced afferent input to the thermoregulatory centre and a loss of both sweating capacity and vasomotor control below the level of the spinal cord lesion. The magnitude of this thermoregulatory impairment is proportional to the level of the lesion. For instance, individuals with high-level lesions (tetraplegia) are at a greater risk of heat illness than individuals with lower-level lesions (paraplegia) at a given exercise intensity. Therefore, cooling strategies may be highly beneficial in this population group, even in moderate ambient conditions (~21 °C). This review was undertaken to examine the scientific literature that addresses the application of cooling strategies in individuals with an SCI. Each method is discussed in regards to the practical issues associated with the method and the potential underlying mechanism. For instance, site-specific cooling would be more suitable for an athlete with an SCI than whole body water immersion, due to the practical difficulties of administering this method in this population group. From the studies reviewed, wearing an ice vest during intermittent sprint exercise has been shown to decrease thermal strain and improve performance. These garments have also been shown to be effective during exercise in the able-bodied. Drawing on additional findings from the able-bodied literature, the combination of methods used prior to and during exercise and/or during rest periods/half-time may increase the effectiveness of a strategy. However, due to the paucity of research involving athletes with an SCI, it is difficult to establish an optimal cooling strategy. Future studies are needed to ensure that research outcomes can be translated into meaningful performance enhancements by investigating cooling strategies under the constraints of actual competition. Cooling strategies that meet the demands of intermittent wheelchair sports need to be identified, with particular attention to the logistics of the sport.

Older adults are increasingly being encouraged to exercise but this may lead to muscle fatigue, which can adversely affect postural stability. Few studies have investigated the effects of upper body exercise on postural sway in groups at risk of falling, such as the elderly. The purpose of this study was to compare the effects arm crank ergometry (ACE), cycle ergometry (CE) and treadmill walking (TM) on postural sway in healthy older females. In addition, this study sought to determine the time necessary to recover postural control after exercise. A total of nine healthy older females participated in this study. Participants stood on a force platform to assess postural sway which was measured by displacement of the centre of pressure before and after six separate exercise trials. Each participant completed three incremental exercise tests to 85% of individual's theoretical maximal heart rate (HRMAX) for ACE, CE and TM. Subsequent tests involved 20-min of ACE, CE and TM exercise at a relative workload corresponding to 50% of each individual's predetermined heart rate reserve (HRE). Post fatigue effects and postural control recovery were measured at different times after exercise (1, 3, 5, 10, 15 and 30-min). None of the participants exhibited impaired postural stability after ACE. In contrast, CE and TM elicited significant post exercise balance impairments, which lasted for ∼ 10 min post exercise. We provide evidence of an exercise mode which does not elicit post exercise balance impairments. Older adults should exercise caution immediately following exercise engaging the lower limbs to avoid fall risk.

STUDY DESIGN Single trial, two factor repeated measures design. SETTING England, Cheshire. OBJECTIVES To examine the thermoregulatory responses of able-bodied (AB) athletes, paraplegic (PA) athletes and a tetraplegic (TP) athlete at rest, during prolonged upper body exercise and recovery. METHODS Exercise was performed on a Monark cycle ergometer (Ergomedic 814E) adapted for arm exercise at 60% VO2 peak for 60 min in cool conditions ('normal' laboratory temperature; 21.5+/-1.7 degrees C and 47+/-7.8% relative humidity). Aural and skin temperatures were continually monitored. RESULTS Mean (+/-S.D.) peak oxygen uptake values were greater (P

Purpose: The smaller muscle mass of the upper body compared to the lower body may elicit a smaller thermoregulatory stimulus during exercise and thus produce novel training induced thermoregulatory adaptations. Therefore, the principal aim of the study was to examine the effect of arm training on thermoregulatory responses during submaximal exercise. Methods: Thirteen healthy male participants (Mean ±SD age 27.8 ±5.0yrs, body mass 74.8 ±9.5kg) took part in 8 weeks of arm crank ergometry training. Thermoregulatory and calf blood flow responses were measured during 30 minutes of arm cranking at 60% peak power (Wpeak) pre, and post training and post training at the same absolute intensity as pre training. Core temperature and skin temperatures were measured, along with heat flow at the calf, thigh, upper arm and chest. Calf blood flow using venous occlusion plethysmography was performed pre and post exercise and calf volume was determined during exercise. Results: The upper body training reduced aural temperature (0.1 ±0.3oC) and heat storage (0.3 ±0.2 J.g-1) at a given power output as a result of increased whole body sweating and heat flow. Arm crank training produced a smaller change in calf volume post training at the same absolute exercise intensity (-1.2 ±0.8% compared to -2.2 ±0.9% pre training; P

This study examined the effects of combined glucose and sodium bicarbonate ingestion prior to intermittent exercise. Ninemales (mean ± s age 25.4 ± 6.6 years, body mass 78.8 ± 12.0 kg, maximal oxygen uptake (VO2 max)) 47.0 ± 7 ml · kg · min(-1)) undertook 4 × 45 min intermittent cycling trials including 15 × 10 s sprints one hour after ingesting placebo (PLA), glucose (CHO), sodium bicarbonate (NaHCO3) or a combined CHO and NaHCO3 solution (COMB). Post ingestion blood pH (7.45 ± 0.03, 7.46 ± 0.03, 7.32 ± 0.05, 7.32 ± 0.01) and bicarbonate (30.3 ± 2.1, 30.7 ± 1.8, 24.2 ± 1.2, 24.0 ± 1.8 mmol · l(-1)) were greater for NaHCO3 and COMB when compared to PLA and CHO, remaining elevated throughout exercise (main effect for trial; P0.05). Blood lactate concentration was greatest throughout exercise for NaHCO3 and COMB (main effect for trial; P0.05). Blood glucose concentration was greatest 15 min post-ingestion for CHO followed by COMB, NaHCO3 and PLA (7.13 ± 0.60, 5.58 ± 0.75, 4.51 ± 0.56, 4.46 ± 0.59 mmol · l(-1), respectively; P0.05). Gastrointestinal distress was lower during COMB compared to NaHCO3 at 15 min post-ingestion (P0.05). No differences were observed for sprint performance between trials (P = 1.00). The results of this study suggest that a combined CHO and NaHCO3 beverage reduced gastrointestinal distress and CHO availability but did not improve performance. Although there was no effect on performance an investigation of the effects in more highly trained individuals may be warranted.

The purpose of this study was to determine the effects of sodium bicarbonate (NaHCO3) ingestion on intermittent running and subsequent performance. Eight healthy men volunteered to take part in the study. One hour after the ingestion of either NaHCO(3) or placebo (sodium chloride; NaCl) participants undertook 20 x 24-second runs on a motorized treadmill at the velocity eliciting maximal oxygen uptake (100% v-VO(2)max). After sprint 20 participants performed a run to volitional exhaustion at 120% v-VO(2)max. Capillary blood samples for blood pH, bicarbonate ([HCO(3)]), and lactate ([Bla]) concentration were taken pre and postingestion, every fifth sprint and after the performance run. After ingestion of NaHCO(3), blood [HCO(3)] increased from resting values (p0.05), and the increase in pH approached significance. Blood [HCO(3)(-)] continually decreased throughout intermittent exercise (p0.05) and decreased further after performance in both trials (p0.05). [Bla] was similar in both trials throughout intermittent exercise but was greater at exhaustion for NaHCO(3) (main effect for trial; p0.05). There was no significant difference in performance of the group between trials (78 +/- 22 and 75 +/- 22 seconds for NaHCO(3) and NaCl, respectively). The intercept of the relationships between [Bla] and [HCO(3)(-)] and between [Bla] and pH was greater during NaHCO(3) (p0.05), whereas the relationship between pH and [HCO(3)(-)] was unchanged (p0.05). The results of this study suggest that the ingestion of NaHCO(3) before intermittent type exercise was sufficient to induce metabolic alkalosis but did not significantly affect performance. However, because significant individual variations in performance were observed, an individual approach to bicarbonate ingestion is recommended based on the intensity and duration of the required performance.