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Definitive radiotherapy for locally-advanced node-positive cervical cancer confers significant toxicity to pelvic organs including small bowel. Gross nodal disease exhibits significant shrinkage during radiotherapy (RT), and yet conventional RT does not account for this change. We evaluated the reduction in absorbed bowel dose using various adaptive radiotherapy (ART) schedules.We obtained 130 evaluable scans (computed tomography (CT) simulation and 25 cone beam CT scans per patient) of 5 patients who had received definitive external beam RT for lymph node positive cervical cancer over 5 weeks daily. Using a single universal volumetric modulated arc therapy (VMAT) plan with predefined optimization priorities, we created adapted RT plans in 4 schedules: Daily, Weekly, Twice, and NoAdapt. The in silico (computer modeled) patients were treated to 45 Gy to primary cervical disease with a simultaneous integrated boost (SIB) to involved lymph nodes to 55 Gy. We evaluated dose metrics including D2cc, D15cc, and V45 to determine the impact of adapted RT schedules on bowel sparing. Statistical tests included Student's t, ANOVA, and Spearman's rank correlation.The quantity of reduced bowel dose was significantly associated with the chosen planning schedule in all evaluated metrics, and was proportional to the frequency of adaptive RT with significant moderate-to-strong monotonicity. Both D2cc and D15cc were reduced an average of 2.7 Gy using Daily replanning compared to a non-adapted approach. A minimally-adapted strategy of only two replans also confers a significant dosimetric benefit over a non-adapted approach. Reduced standard deviations of D2cc and V45 bowel doses over the treatment courses were significantly associated with the choice of planning schedule with strong monotonicity.All adaptive RT schedules evaluated confer significant dosimetric advantages in bowel sparing over a conventional non-adapted technique, with greater sparing seen with more frequent replanning schedules. These findings warrant future trials of adaptive radiotherapy for pelvic malignancies.

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.

Rating of perceived exertion (RPE) is a reliable method of assessing exercise intensity during isolated arm and leg cycling. The aim of this study was to assess the validity and reproducibility of perceptually regulated exercise responses during combined arm + leg cycling. Twelve males (age; 24.6 ± 5.3 years, height; 1.81 ± 0.7 m, mass; 83.1 ± 8.4 kg) initially undertook incremental exercise tests to volitional exhaustion for arm cycling (133 ± 14 W) and leg cycling (253 ± 32 W). On three subsequent occasions, participants undertook combined arm + leg cycling trials using two modified Monark ergometers involving three bouts of exercise at RPE 9, 13 and 17, in that order. Heart rate (HR), oxygen uptake ( $$\dot{V}{\text{O}}_{{2}}$$ ) and pulmonary ventilation ( $$\dot{V}_{{\text{E}}}$$ ) were recorded continuously. No significant differences were observed for HR (P = 0.086), $$\dot{V}{\text{O}}_{{2}}$$ (P = 0.525) and $$\dot{V}_{{\text{E}}}$$ (P = 0.899) between trials, whilst significant differences were observed between each level of RPE (all P

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 aim of this study was to determine the physiological demands of epee fencing performance. Eight elite male epee fencers competed in a competition consisting of 7 Poule and 7 Direct Elimination ...

Adults with a very tall stature (above the 97th percentile for height) encounter challenges with engagement in everyday occupations. Conversely, work-related opportunities and benefits for ...

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.

This study compared cardiorespiratory and perceptual responses to exercise using self-regulated and imposed power outputs distributed between the arms and legs. Ten males (age 21.7 ± 3.4 years) initially undertook incremental arm-crank ergometry (ACE) and cycle ergometry (CYC) tests to volitional exhaustion to determine peak power output (Wpeak). Two subsequent tests involved 20-min combined arm–leg ergometry (ALE) trials, using imposed and self-regulated protocols, both of which aimed to elicit an exercising heart rate of 160 beats min−1. During the imposed trial, arm and leg intensity were set at 40% of each ergometer-specific Wpeak. During the self-regulated trial, participants were asked to self-regulate cadence and resistance to achieve the target heart rate. Heart rate (HR), oxygen uptake ( $$\dot {V}{{\text{O}}_{\text{2}}}$$ ), pulmonary ventilation ( $${\dot {V}_{\text{E}}}$$ ), and ratings of perceived exertion (RPE) were recorded continuously. As expected, there were no differences between imposed and self-regulated trials for HR, $$\dot {V}{{\text{O}}_{\text{2}}}$$ , and $${\dot {V}_{\text{E}}}$$ (all P ≥ 0.05). However, central RPE and local RPE for the arms were lower during self-regulated compared imposed trials (P ≤ 0.05). Lower RPE during the self-regulated trial was related to preferential adjustments in how the arms (33 ± 5% Wpeak) and legs (46 ± 5% Wpeak) contributed to the exercise intensity. This study demonstrates that despite similar metabolic and cardiovascular strain elicited by imposed and self-regulated ALE, the latter was perceived to be less strenuous, which is related to participants doing more work with the legs and less work with the arms to achieve the target intensity.

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.

Secondary schools across England and Wales understand the importance of offering young people the opportunity to experience activity-based trips. One of these fundamental trips is the ski trip which enables young people to experience new challenges and adventure. However, within England and Wales, skiing is an atypical activity due to the lack of accessibility to the slopes. Consequently, it is vital to effectively prepare young people for skiing to promote enjoyment and reduce the likelihood of injury. The purpose of this study was to explore the current practices in the preparation of school ski trips within England and Wales. An electronic survey was administered to secondary schools across England and Wales with 270 completed responses of schools which organise ski trips. Analysis revealed that there were no significant differences (p > 0.05) across the regions with information being shared with parents prior to the ski trip. Young people are informed on similar information prior to and during...

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.

The aim of the study was to determine whether climatic limits for achieving heat balance at rest are affected by spinal cord injury (SCI). Twenty-three men [8 able-bodied (AB), 8 with paraplegia (PP), and 7 with tetraplegia (TP)] rested in 37°C and 20% relative humidity (RH) for 20 min. With the ambient temperature held constant, RH was increased by 5% every 7 min, until gastrointestinal temperature (Tgi) showed a clear inflection or increased by >1°C. Tgi, skin temperatures, perceptual responses, and metabolic energy expenditure were measured throughout. Metabolic heat production [AB: 123 (21) W, PP: 111 (15) W, TP: 103 (29) W; means (SD)] and required rate of evaporative cooling for heat balance [Ereq; AB: 113 (20) W, PP: 107 (17) W, TP: 106 (29) W] were similar between groups ( P = 0.22 and P = 0.79). Compared with AB, greater increases in Tgi were observed in TP ( P = 0.01), with notable increases in mean skin temperature (Tsk) for TP and PP ( P = 0.01). A Tgi inflection point was demonstrated by seven AB, only three of eight PP, and no TP. Despite metabolic heat production (and Ereq) being similar between groups, evaporative heat loss was not large enough to obtain heat balance in TP, linked to a shortfall in evaporative cooling potential. Although PP possess a greater sweating capacity, the continual increase in Tgi and Tsk in most PP, although lower than for TP, implies that latent heat loss for PP is also insufficient to attain heat balance. NEW & NOTEWORTHY In the absence of convective heat loss, at temperatures around 37°C evaporative heat loss is insufficient to attain heat balance at rest in individuals with paraplegia and tetraplegia. This finding was directly linked to a shortfall in evaporative cooling potential compared with required evaporative cooling. In this environment, individuals with both paraplegia and tetraplegia cannot subjectively determine the magnitude of their thermal strain; thus perceptual responses should not be relied upon for this population group.

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.

International sporting competitions, including the Paralympic Games, are increasingly being held in hot and/or humid environmental conditions. Thus, a greater emphasis is being placed on preparing athletes for the potentially challenging environmental conditions of the host cities, such as the upcoming Games in Tokyo in 2020. However, evidence-based practices are limited for the impairment groups that are eligible to compete in Paralympic sport. This review aims to provide an overview of heat-related issues for Paralympic athletes alongside current recommendations to reduce thermal strain and technological advancements in the lead up to the Tokyo 2020 Paralympic Games. When competing in challenging environmental conditions, a number of factors may contribute to an athlete's predisposition to heightened thermal strain. These include the characteristics of the sport itself (type, intensity, duration, modality, and environmental conditions), the complexity and severity of the impairment and classification of the athlete. For heat vulnerable Paralympic athletes, strategies such as the implementation of cooling methods and heat acclimation can be used to combat the increase in heat strain. At an organizational level, regulations and specific heat policies should be considered for several Paralympic sports. Both the utilization of individual strategies and specific heat health policies should be employed to ensure that Paralympics athletes' health and sporting performance are not negatively affected during the competition in the heat at the Tokyo 2020 Paralympic Games.

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.

The aim of the current study was to determine if unstimulated saliva flow (measured in μl min-1 ) is affected by different durations of sample collection and by temperatures of mouthrinse water used before sample collection. In randomized order, participants provided 10 samples of unstimulated saliva at time points ranging from 1 to 6 min after rinsing with different temperatures of water (10, 20, and 30°C). Data were analysed by one-way anova with post-hoc tests. Test-retest reliability was assessed using Bland-Altman plots and correlation coefficients. A larger volume of saliva was obtained over a longer collection time. No significant difference in saliva flow rate was observed between collection times [mean: 364 (95% CI: 332-397) μl min-1 ]. Although rinsing with different temperatures of mouthrinse water resulted in no significant difference in saliva flow rates as a result of the mouthrinse water temperatures, 60% of the participants had a higher saliva flow rate after rinsing with mouthrinse water at a temperature of 10°C compared with mouthrinse water at 20 and 30°C, suggesting large individual variation (range: 24-420 μl min-1 ). These findings provide justification for using saliva collection times of 1-6 min during sampling of unstimulated saliva. The large individual variations in saliva flow rate in response to different mouthrinse water temperatures suggest that standardization, control, and reporting of mouthrinse water temperature is warranted.

© 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.

The aims were to undertake a movement analysis of a simulated epee fencing competition and to develop and validate a laboratory based protocol (LAB). Seven male club epee fencers undertook a simula...

The switch from an outcrossing mode of mating enforced by self-incompatibility to self-fertility in the Arabidopsis thaliana lineage was associated with mutations that inactivated one or both of the two genes that comprise the self-incompatibility (SI) specificity-determining S-locus haplotype, the S-locus receptor kinase (SRK) and the S-locus cysteine-rich (SCR) genes, as well as unlinked modifier loci required for SI. All analyzed A. thaliana S-locus haplotypes belong to the SA, SB, or SC haplotypic groups. Of these three, the SC haplotype is the least well characterized. Its SRKC gene can encode a complete open-reading frame, although no functional data are available, while its SCRC sequences have not been isolated. As a result, it is not known what mutations were associated with inactivation of this haplotype. Here, we report on our analysis of the Lz-0 accession and the characterization of its highly rearranged SC haplotype. We describe the isolation of its SCRC gene as well as the subsequent isolation of SCRC sequences from other SC-containing accessions and from the A. lyrata S36 haplotype, which is the functional equivalent of the A. thaliana SC haplotype. By performing transformation experiments using chimeric SRK and SCR genes constructed with SC- and S36-derived sequences, we show that the SRKC and SCRC genes of Lz-0 and at least a few other SC-containing accessions are nonfunctional, despite SCRC encoding a functional full-length protein. We identify the probable mutations that caused the inactivation of these genes and discuss our results in the context of mechanisms of S-locus inactivation in A. thaliana.

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