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Turnout, or external rotation of the lower limbs, is an integral part of classical ballet technique. Contributions of lower limb structures to turnout can be separated into HER (hip external rotation) and NHCTO (non-hip contributions to turnout). This study aimed to review systematically methods used to measure turnout in dance medicine and science research, thereby updating the literature since the Champion and Chatfield review of 2008. CINAHL, EMBASE, PubMed, and Web of Science were searched in January 2018 by two independent reviewers. Peer-reviewed studies measuring turnout in dance were included, except those published prior to March 23, 2006, as that was the last date of publication included in the previous review. Abstracts, theses, and editorials were excluded. From each study, study design, population (sample size, sex, age, genre of dance, and level of training), details of the protocol used, and result of turnout measurement were extracted, as well as reliability data. All included studies were assessed for risk of bias, using either Newcastle-Ottawa scale, AXIS tool, or PEDro scale as appropriate for each study design. A total of 41 studies met the inclusion criteria. Twenty-eight studies measured HER, nine measured NCHTO, and 22 measured total turnout (TTO). An increased number of studies investigated TTO (N = 22; N = 4 passive TTO) and NHCTO (N = 9) since 2006. All studies scored above half the points attainable from their respective tools. Results suggest HER remains the most common protocol for measuring turnout (N = 28), despite the fact it disregards input from structures below the hip. It is concluded that researchers should focus on quality of reporting of protocols to ensure repeatability and facilitate comparison of results. Future studies should include absolute reliability and validity testing of all currently used protocols so that standardization can be fully achieved.

Football players are at risk of overuse injuries, discomfort and decreased performance due to the boot design and repetitive plantar loading of the sport. However, there is no agreement of normativ...

Objectives: To investigate the biomechanics of Ukemi in relation to head and neck injury in adult judokas with varying skill sets. Design: Narrative systematic review. Methods: An extensive literature search was performed using PubMed, Google Scholar, Science direct and EMBASE from inception to April 2021. Studies were included if they: (1) reported biomechanical analysis of judo throws and Ukemi; (2) were on adult judoka populations; (3) discussed injury related to judo technique. The included studies were assessed for risk of bias using a five-part modified STROBE checklist. A narrative synthesis was performed due to the heterogeneity of included studies. Results: 173 titles and abstracts were screened with 16 studies (158 judokas, 9 of which were female) included. All studies used 3D biomechanical analysis to assess Ukemi. Ukemi implementation produced reduced kinematic data in comparison to direct occipital contact, which was always below the injury threshold. Analysis of lower limb and trunk kinematics revealed variances in Ukemi between novice and experienced judoka. Whilst no significant differences were seen in neck flexion angles, hip, knee and trunk angle time plots revealed greater extension angles in experienced judokas. Conclusions: Ukemi is essential in preventing head and neck injuries; however, technique differs between experienced and novice judoka. Larger flexion angles of the hip, knee and trunk are seen in novice judoka, which correlate with increased kinematic data. The association of greater neck muscle strength with improved Ukemi is weak. However, a negative correlation was established between fatigue and breakfall skill by one study.

ObjectiveAn e-learning resource (MEdic GAming, MEGA) was developed based on the contents of the Faculty of Sports and Exercise Medicine exercise prescription booklet. This study aimed to (i) explore medical students’ perspectives of physical activity promotion and e-learning and (ii) investigate medical students’ response to the design, content and usability of the MEGA e-learning resource.DesignQualitative think-aloud interview study.SettingA London medical school.Participants19 undergraduate medical students were interviewed using the think-aloud method while using the e-learning resource concurrently.ResultsIn general, medical students felt current education on physical activity is inadequate and held a strong desire for more teaching on exercise medicine. Students believed the MEGA e-learning resource addressed a gap in their knowledge on physical activity but noted e-learning should not replace face-to-face teaching and suggested physical activity education would be best delivered through a blended learning approach. Students felt such an approach would allow better opportunity to practice physical activity counselling skills with patients while on clinical placement. Students’ motivation to engage with the MEGA e-learning resource was positively impacted by aesthetically appealing design and interactive gamification elements such as self-assessment quizzes and visual progress tracking.ConclusionMedical students value the role of physical activity in health but are disappointed by the lack of teaching within the current medical curriculum. E-learning resources, such as MEGA, which contain interactive features are a viable means to integrate physical activity into the undergraduate curriculum but should be supplemented by the opportunity to practice physical activity counselling in-person.

BackgroundAt present education on exercise medicine and physical activity (PA) promotion does not feature heavily within the medical curriculum.ObjectivesThe purpose of this study was to test the feasibility of a self-directed educational tool (Faculty of Sports and Exercise Medicine (FSEM) exercise prescription booklet) on medical students’ understanding of PA in disease management.MethodsStudents from 22 UK medical schools were invited to complete a brief online questionnaire before and after being provided access to the FSEM exercise prescription booklet.ResultsA total of 205 students responded to the open invitation to participate. At baseline 59% of students agreed that PA promotion was an important part of a doctor’s job with 86% agreeing that PA was important in the prevention of disease. However, confidence to prescribe PA and knowledge of chief medical officer’s adult PA guidelines was low. Following use of the FSEM booklet students’ (n=53) knowledge of PA guidelines and confidence to advise patients about PA significantly improved (pConclusionSelf-guided educational tools have the potential to improve the exercise prescription skills of undergraduate medical students. Future research should compare different methods of delivering education on PA within medical schools to determine the most effective means of integrating PA into the curriculum.

BACKGROUND: The circus arts involve a high degree of acrobatic, athletic, and aesthetic ability with extreme physical demands placed on performers. An understanding of the injury profile is required to guide prevention. AIM: To provide the first systematic review to enhance understanding of circus-related injuries and to provide a foundation for future preventative intervention. METHODS: MEDLINE, Scopus, and Web of Science were searched from conception to March 2016 using key search terms relating to circus artists and injury. Studies were limited to English-language human studies and included all levels and ages of circus artists. Risk of bias was assessed using a novel seven-item checklist based on the STROBE statement. RESULTS: Eight studies of varying design, populations, outcomes, and quality were analysed. Results suggest that the injury rate is relatively low among professional circus artists at 7.37 to 9.27/1,000 artist exposures. The spine and ankle are frequently injured, and most injuries are to soft tissue structures. In the professional setting, injuries appear minor, resulting in few treatments, few missed or altered performances, and a low risk of re-injury. CONCLUSIONS: The spine and ankle should be targeted for preventative interventions in circus artists due to their high frequency of injury. The heterogeneity of studies included in this review highlights the need for consistency within future research, particularly in terms of injury definition and outcome measurements.

Objectives Systematically review shoulder injury prevalence, proportion, rate, type, onset, severity, mechanism, risk factors in female artistic gymnasts. Methods PubMed, Web of Science, Scopus, Cochrane Library were searched on 7/01/2017. Original studies reporting data for female artistic gymnasts only, of any age or level were included. Quality assessment was undertaken using Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results Fifteen observational studies were included. Thirteen were poor/fair quality. Shoulder injury prevalence (0%–86.9%) was higher in international (29.2%) versus national (20%) gymnasts. As a proportion of all injuries, shoulder injuries made up 4.2%–7.5%. Rates (0.35–5.7/1000 athlete exposures) were greater during practice (5.0/1000) than competition (2.4/1000). Multidirectional instability (33.8%, 37.7%) and musculotendinous injury (26.6%–90.9%) were the most common injury. In four studies 66.2%–100% of total shoulder injuries were acute onset. Most (59.3%) shoulder injuries were minor, 7.4% required surgery and 80% caused symptoms post-retirement. Asymmetric bars were the most frequent mechanism of shoulder injury. One study reported excessive shoulder stretching, hyperlaxity and instability as significant (p Conclusions Shoulder injuries are a problem among female artistic gymnasts. Interventional studies reporting age and competition level-specific data may guide prevention strategy implementation.

Objectives To investigate the effects of vitamin D supplementation on muscle strength in healthy individuals. Design A systematic review with meta-analysis. Methods In October 2013 a computerised literature search of three databases (PubMed, Web of Knowledge and Scopus) was performed. Included in the review were controlled and randomised controlled trials, published in English, which measured muscle strength and serum vitamin D concentration in participants 18–40 years old. References of identified articles were then cross-checked and citations scanned for additional articles. Quality was assessed using the PEDro scale. Muscle strength and vitamin D levels were extracted for a meta-analysis on upper and lower limb strength with standardised mean differences calculated to analyse effect. Results Six randomised controlled trials and one controlled trial were identified and quality assessment showed all seven trials were of ‘good quality'. Data was extracted from 310 adults, 67% female, with mean ages ranging from 21.5 to 31.5 years. Trials lasted from 4 weeks to 6 months and dosages differed from 4000IU per day to 60,000IU per week. Upper and lower limb muscle strength had a standardised mean difference of 0.32 (95% CI=0.10, 0.54) and 0.32 (95% CI=0.01, 0.63) respectively, suggesting vitamin D supplementation significantly increased muscle strength in the experimental group for upper ( P =0.005) and lower limbs ( P =0.04). Conclusions Vitamin D supplementation increases upper and lower limb strength. Further research should focus on its effect on muscle power, endurance and maximal strength.

Background No investigation has analysed the RWL approaches since new rules by the International Judo Federation (IJF) regarding weigh-ins have been implemented in international competitions in 2014. The current study analyses the prevalence, most common methods and knowledge surrounding the effects of rapid weight loss (RWL) amongst adult UK judo athletes. Additionally, it examines differences in rapid weight loss behaviour (RWLB) between gender, weight-class, competitive level, age RWL began and "high"/"low" knowledge athletes. Methods A previously validated questionnaire developed to assess RWL in judo athletes was modified by adding a knowledge section and revalidated for content. The questionnaire provided a RWLB score (higher score equated to more aggressive RWL) and a knowledge score (out of 10). 256 athletes (189 males and 66 females, aged 18-67 years) completed the questionnaire between February and April 2015. Unpaired t test, one-way ANOVA-tests and Chi-squared tests were used to test differences of mean RWLB scores and prevalence between groups. Results The prevalence of RWL was 84%. The most common methods of RWL were increased exercise and decreased food/fluid intake. The mean knowledge score was 6.2±2.8, with most incorrect answers regarding physiological effects of RWL. No significant differences in RWLB scores were found between gender, "high"/"low" knowledge athletes or weight-classes. Statistically significant differences in RWLB scores were found between different competitive levels (p=0.014) and age RWL began (p

Video analysis has become a useful tool in the preparation for sport performance and its use has highlighted the diff erent physiological demands of seemingly similar sports and play- ing positions. The aim of the current study was to examine the performance diff erences between classical ballet and contemporary dance. In total 93 dance performances (48 ballet and 45 con- temporary) were analysed for exercise inten- sity, changes in direction and specifi c discrete skills (e. g., jumps, lifts). Results revealed signifi - cant diff erences between the 2 dance forms for exercise intensity (p < 0.001), changes in direc- tion (p < 0.001) and discrete skills (p < 0.05) with gender diff erences noted in the latter (p < 0.05). Ballet was characterised by longer periods at rest (38 s.min − 1 ) and high to very high exercise intensities (9 s.min − 1 ), whilst contemporary dance featured more continuous moderate exercise intensities (27 s.min − 1 ). These diff erences have implications on the energy systems utilised during perform- ance with ballet potentially stressing the anaer- obic system more than contemporary dance. The observed high rates in the discrete skills in ballet (5 jumps.min − 1 ; 2 lifts.min − 1 ) can cause local muscular damage, particularly in relatively weaker individuals. In conclusion, classical bal- let and contemporary dance performances are as signifi cantly diff erent in the underlying physical demands placed on their performers as the artis- tic aspects of the choreography.

To date, the effects of body composition on injury occurrence and healing times in dancers have received limited scientific attention. The aim of the current study was to determine possible associations between somatotype, percent body fat, and self-reported injury characteristics in dance students. Forty-two full-time ballet students (11 male, 31 female) from two vocational dance schools volunteered for the study. The Heath-Carter protocol and Siri equation were adopted to calculate somatotype and percent body fat (%BF), respectively. Injury types, together with the time taken to recover from injury, were assessed using a recall injury questionnaire. Results revealed that the sample was classified as balanced-mesomorph somatotype (endomorphy – mesomorphy – ectomorphy = 3.4±0.9 – 3.9±1.4 – 3.2±1.2). Ectomorphy was a strong predictor of the number of acute injuries sustained (F1,36 = 5.4, p = 0.026); these parameters also revealed a significant negative correlation (r = –0.37, p = 0.016). Significant negative correlations were observed between the dancers’ total time off due to injury and %BF (r = –0.31, p = 0.048) and between the total time off resulting from acute injury and both %BF (r = –0.32, p = 0.04) and ectomorphy (r = –0.42, p = 0.005). The number of overuse injuries sustained and time off due to overuse injury also were correlated with mesomorphy (r = –0.38, p = 0.015 and r = –0.33, p = 0.032, respectively). It was concluded that high ectomorphy ratings, low %BF values, and low mesomorphy ratings are linked to injury. More relevant research is required on dancers from different genres.

Jumping plays an integral part of ballet performance and this study examines some of the ballet dancer's characteristics that influence jump height. Forty-nine dancers (M = 21; F = 28) completed a series of tests that included two footed vertical jump height, single leg vertical jump height and anthropometric measurements. Supplemental training history and company position were also recorded. Statistical analysis (ANCOVA and MANOVA) indicated males had a greater vertical jump height than females (p < 0.01) and soloist and first artists had significantly greater vertical jump height than principals and artists for both male and females (p < 0.05). Anthropometric data indicated males having significantly larger leg girths than females. Males and females had no significant bilateral differences in girth measurements though male artists had significantly smaller thighs and calves than the other seniority levels (p < 0.05). Supplemental training did not influence jump height in this study's population though males carried out significantly more weight training (p < 0.01) and females more aerobic training (p < 0.05). When jump height was analyzed in relation to cross-sectional area of the calf and thigh, there was no gender difference (p > 0.05). These results corroborate to previous research and also provide greater insight on how anthropometric and choreographic factors potentially influence vertical jump height in ballet dancers. The ineffective influence of supplemental training on vertical jump height needs greater examination. How other training regimens could influence jump height in dancers needs to be examined.

Within aesthetic sports such as figure skating and rhythmic gymnastics, physical fitness has been shown to have positive benefits on performance outcomes. Presently the link between physical fitness and aesthetic contemporary dance performance has not been demonstrated within an intervention study. In this study, 24 females engaged in contemporary dance (age 27 ± 5.9 yrs; height 165.3 ± 4.8 cm; weight 59.2 ± 7.6 kg) were recruited and randomly assigned to either an exercise (n = 12) or a control group (n = 12). Three dancers withdrew during the study. The intervention group completed a 6-week conditioning programme comprising two 1-hr sessions of circuit and vibration training per week. The circuit training focused on local muscular endurance and aerobic conditioning and vibration training protocol concentrated on power. Repeated measures ANOVA revealed significant increases for the conditioning group in lower body muscular power (11%), upper body muscular endurance (22%), aerobic fitness (11%), and aesthetic competence (12%) (p0.05). The control group reported decreases in all the fitness parameters with the exception of aerobic fitness as well as a decrease in aesthetic competence (7%). A 6-week circuit and vibration training programme, which supplemented normal dance commitments, revealed significant increases in selected fitness components and a concomitant increase in aesthetic competence in contemporary professional and student dancers.

Research has indicated that classical ballet dancers tend to have lower fitness levels and increased injury rates compared to other athletes with similar workloads. The aim of the current study was to examine the effects of a specifically tailored fitness training programme on the incidence of injury and the aesthetic quality of performance of classical ballet dancers compared to a control group. Proficiency in performance was evaluated at the beginning and end of the intervention period for both groups through a 4-min dance sequence using previously ratified marking criteria. The intervention group (n = 8) partook in a weekly 1-hr training session that included aerobic interval training, circuit training, and whole body vibration. All dancers' performance proficiency scores increased from pre-intervention testing to post-intervention. The intervention group's overall performance scores demonstrated a significantly greater increase (p = 0.03) than the equivalent for the control group. It was concluded that supplementary fitness training has a positive effect on aspects related to aesthetic dance performance as studied herein; further research is recommended on a larger and more varied sample. Practical applications from this study suggest that supplemental training should be part of a ballet dancer's regime, and minimal intervention time is required to have observable effects.

Passive smoking may be implicated in the development of cardiovascular disease (CVD) in children because of their partially developed physiological systems. The aim of the present systematic paper is to investigate whether passive smoking is associated with factors that influence the development of CVD in children. Data sources included Medline, Cochrane Library, Cumulative Index to Nursing & Allied Health (CINAHL) research database, Google Scholar, Excerpta Medica database (EMBASE), the 2006 Office of the Surgeon General's report, and the 2005 report from the California Environmental Protection Agency. We identified a total of 42 relevant articles (i.e., 30 reviews and 12 observational). Results revealed that passive smoking may be implicated in deteriorating cardiovascular status in children in terms of unfavorable high-density lipoprotein levels and deteriorated vascular function.

The physical demands imposed on contemporary dancers by choreographers and performance schedules make their physical fitness just as important to them as skill development. Nevertheless, it remains to be confirmed which physical fitness components are associated with aesthetic competence. The aim of this study was to: 1. replicate and test a novel aesthetic competence tool for reliability, and 2. investigate the association between selected physical fitness components and aesthetic competence by using this new tool. Seventeen volunteers underwent a series of physical fitness tests (body composition, flexibility, muscular power and endurance, and aerobic capacity) and aesthetic competence assessments (seven individual criteria commonly used by selected dance companies). Inter-rater reliability of the aesthetic competence tool was very high (r = 0.96). There were significant correlations between the aesthetic competence score and jump ability and push-ups (r = 0.55 and r = 0.55, respectively). Stepwise backward multiple regression analysis revealed that the best predictor of aesthetic competence was push-ups (R(2) = 0.30, p = 0.03). Univariate analyses also revealed that the interaction of push-ups and jump ability improved the prediction power of aesthetic competence (R(2) = 0.44, p = 0.004). It is concluded that upper body muscular endurance and jump ability best predict aesthetic competence of the present sample of contemporary dancers. Further research is required to investigate the contribution of other components of aesthetic competence, including upper body strength, lower body muscular endurance, general coordination, and static and dynamic balance.

Video analysis of classical ballet to date has been largely limited to examining the artistic elements of choreography. The aim this study was to employ a method of video analysis to describe the physiological demands of classical ballet performance and to examine differences between artists, soloists, and principal dancers. Forty-eight performances [male = 24, female = 24; artists (corps de ballet) = 16, soloists =16, principals =16] were analyzed in four fields: work intensity, body movement, partner work, and number of transitory movements occurring per minute. Statistical analysis revealed significant differences between ranks in two intensity bands: time at rest (p < 0.05) and time performing at moderate intensity (p < 0.05), with soloists and principals resting for 75.2 ± 15.1% and 53 ± 24.1% of the total performance, respectively (p < 0.05). Principals also spent a significantly greater percentage of time at moderate intensity than both soloists and artists (p < 0.05). Significant differences between males and females (p < 0.05) were seen in the number of lifting and supporting movements performed. It was concluded that classical ballet is an intermittent form of exercise, utilizing both aerobic and anaerobic energy systems, a finding that supports previous studies. The demands of the performances analyzed varied according to role. Therefore, it was also concluded that video analysis can help provide a basis for rank-specific supplemental training.

Within aesthetic sports such as figure skating and rhythmic gymnastics, physical fitness has been shown to have positive benefits on performance outcomes. Presently the link between physical fitness and aesthetic contemporary dance performance has not been demonstrated within an intervention study. In this study, 24 females engaged in contemporary dance (age 27 ± 5.9 yrs; height 165.3 ± 4.8 cm; weight 59.2 ± 7.6 kg) were recruited and randomly assigned to either an exercise (n = 12) or a control group (n = 12). Three dancers withdrew during the study. The intervention group completed a 6-week conditioning programme comprising two 1-hr sessions of circuit and vibration training per week. The circuit training focused on local muscular endurance and aerobic conditioning and vibration training protocol concentrated on power. Repeated measures ANOVA revealed significant increases for the conditioning group in lower body muscular power (11%), upper body muscular endurance (22%), aerobic fitness (11%), and aesthetic competence (12%) (p < 0.05). The control group reported decreases in all the fitness parameters with the exception of aerobic fitness as well as a decrease in aesthetic competence (7%). A 6-week circuit and vibration training programme, which supplemented normal dance commitments, revealed significant increases in selected fitness components and a concomitant increase in aesthetic competence in contemporary professional and student dancers.

Limited data are available on whether different physical fitness levels are associated with injury severity in contemporary dancers. The aim of this study was to investigate this association in female dancers. Five professional contemporary dancers and 11 dance students in pre-professional training volunteered (n = 16). All participants underwent selected fitness assessments (anthropometry, flexibility, muscular power and endurance, aerobic capacity) and completed a seven-item recall questionnaire about their last 12-month injury history. Pearson's coefficients detected significant negative correlations between the total number of days off due to injuries and standing vertical jump (r = –0.66; p = 0.014). Backward regression analysis also revealed that days off due to injuries was best predicted from standing vertical jump performance (p = 0.014). Results suggest that a reduced level of lower body muscular power is associated with increased severity of injuries in female contemporary dancers. More research using appropriate methodological designs, such as sample size calculations and randomization and the use of contemporary dance movements only, is needed to investigate the effects of physical fitness levels on injury severity in contemporary dance.