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Introduction: The relationship between the percentage of a fatiguing ambulatory task completed and rating of perceived exertion (RPE) appears to be linear and scalar, with a relatively narrow “window.” Recent evidence has suggested that a similar relationship may exist for muscularly demanding tasks. Methods: To determine whether muscularly demanding tasks fit within this “ambulatory window,” we tested resistance-trained athletes performing bench press and leg press with different loadings predicted to allow 5, 10, 20, and 30 repetitions and measured RPE (category ratio scale) at the end of the concentric action for each repetition. Results: There was a regular, and strongly linear, pattern of growth of RPE for both bench press (r = .89) and leg press (r = .90) during the tasks that allowed 5.2 (1.2), 11.6 (1.9), 22.7 (2.0), and 30.8 (3.2) repetitions for bench press and 5.5 (1.5), 11.4 (1.6), 20.2 (3.0), and 32.4 (4.2) repetitions for leg press, respectively. Conclusions: The path of the RPE growth versus percentage task fit within the window evident for ambulatory tasks. The results suggest that the RPE versus percentage task completed relationship is scalar, relatively linear, and apparently independent of exercise mode.

Kildow, AR, Wright, G, Reh, RM, Jaime, S, and Doberstein, S. Can monitoring training load deter performance drop-off during off-season training in Division III American football players? J Strength Cond Res 33(7): 1745-1754, 2019-The primary aim of this observational investigation was to monitor performance of Division III American football players during off-season training while the secondary aim was to investigate differences in training adaptations between linemen and nonline players. Twenty-three subjects from the university's football team were recruited from an Exercise Science 100 conditioning class to participate in a 15-week off-season training program. Phase I consisted of concurrent strength and speed/endurance training (3-4 d·wk) for 7 weeks. Phase II consisted of strength training and spring football practice (3-4 d·wk) for 4 weeks. Countermovement jump, estimated one repetition maximum (1RM) bench press and back squat, 505 change of direction (COD), repeated 30-yard anaerobic sprint test (RAST), and body mass were all measured Pre, Mid, and Post training program. Two-way analysis of variance with repeated measures revealed no significant interaction between linemen and nonline players for all performance variables (p > 0.05). Over the course of the study, RSAT % decrement, 505 COD times, and estimated 1RM performance for bench and squat significantly improved (p ≤ 0.05). No significant changes were detected in CMJ, RSAT best time, or body mass. Results indicate that linemen and non-line players did not respond significantly different to the present training program. The 15-week training program produced improvements in COD skill, speed, anaerobic capacity, and muscular strength. Furthermore, all performance changes were maintained through the end of the study. Data from this study indicate that monitoring training load can give feedback to help augment performance and prevent performance decrements during the off-season.

During competitive events, the pacing strategy depends upon how an athlete feels at a specific moment and the distance remaining. It may be expressed as the Hazard Score (HS) with momentary HS being shown to provide a measure of the likelihood of changing power output (PO) within an event and summated HS as a marker of how difficult an event is likely to be perceived to be. This study aimed to manipulate time trial (TT) starting strategies to establish whether the summated HS, as opposed to momentary HS, will improve understanding of performance during a simulated cycling competition. Seven subjects (peak PO: 286 ± 49.7 W) performed two practice 10-km cycling TTs followed by three 10-km TTs with imposed PO (±5% of mean PO achieved during second practice TT and a self-paced TT). PO, rating of perceived exertion (RPE), lactate, heart rate (HR), HS, summated HS, session RPE (sRPE) were collected. Finishing time and mean PO for self-paced (time: 17.51 ± 1.41 min, PO: 234 ± 62.6 W), fast-start (time: 17.72 ± 1.87 min, PO: 230 ± 62.0 W), and slow-start (time: 17.77 ± 1.74 min, PO: 230 ± 62.7) TT were not different. There was a significant interaction between each secondary outcome variable (PO, RPE, lactate, HR, HS, and summated HS) for starting strategy and distance. The evolution of HS reflected the imposed starting strategy, with a reduction in PO following a fast-start, an increased PO following a slow-start with similar HS during the last part of all TTs. The summated HS was strongly correlated with the sRPE of the TTs (r = 0.88). The summated HS was higher with a fast start, indicating greater effort, with limited time advantage. Thus, the HS appears to regulate both PO within a TT, but also the overall impression of the difficulty of a TT.

Although cycling class intensity can be modified by changing interval intensity sequencing, it has not been established whether the intensity order can alter physiological and perceptual responses. Therefore, this study aimed to determine the effects of interval intensity sequencing on energy expenditure (EE), physiological markers, and perceptual responses during indoor cycling. Healthy volunteers (10 males = 20.0 ± 0.8years; 8 females = 21.3 ± 2.7years) completed three randomly ordered interval bouts (mixed pyramid—MP, ascending intervals—AI, descending intervals—DI) including three 3-min work bouts at 50%, 75%, and 100% of peak power output (PPO) and three 3-min recovery periods at 25% PPO. Heart rate (HR) and oxygen consumption (VO2) were expressed as percentages of maximal HR (%HRmax) and VO2 (%VO2max). EE was computed for both the work bout and for the 5-min recovery period. Session Rating of Perceived Exertion (sRPE) and Exercise Enjoyment Scale (EES) were recorded. No differences emerged for % HRmax (MP = 73.3 ± 6.1%; AI = 72.1 ± 4.9%; DI = 71.8 ± 4.5%), % VO2max (MP = 51.8 ± 4.6%; AI = 51.4 ± 3.9%; DI = 51.3 ± 4.5%), EE (MP = 277.5 ± 39.9 kcal; AI = 275.8 ± 39.4 kcal; DI = 274.9 ± 42.1 kcal), EES (MP = 4.9 ± 1.0; AI = 5.3 ± 1.1; DI = 4.9 ± 0.9), and sRPE (MP = 4.9 ± 1.0; AI = 5.3 ± 1.1; DI = 4.9 ± 0.9). EE during recovery was significantly (p < 0.005) lower after DI (11.9 ± 3.2 kcal) with respect to MP (13.2 ± 2.5 kcal) and AI (13.3 ± 2.5 kcal). Although lower EE was observed during recovery in DI, interval intensity sequencing does not affect overall EE, physiological markers, and perceptual responses.

Walking tests, such as the 6-min walk test (6MWT), are popular methods of estimating peak oxygen uptake (VO2peak) in clinical populations. However, the strength of the distance vs. VO2peak relationship is not strong, and there are no equations for estimating ventilatory threshold (VT), which is important for training prescription and prognosis. Since the 6MWT is often limited by walking mechanics, prediction equations that include simple additional predictors, such as the terminal rating of perceived exertion (RPE), hold the potential for improving the prediction of VO2max and VT. Therefore, this study was designed to develop equations for predicting VO2peak and VT from performance during the 6MWT, on the basis of walking performance and terminal RPE. Clinically stable patients in a cardiac rehabilitation program (N = 63) performed the 6MWT according to the American Thoracic Society guidelines. At the end of each walk, the subject provided their terminal RPE on a 6–20 Borg scale. Each patient also performed a maximal incremental treadmill test with respiratory gas exchange to measure VO2peak and VT. There was a good correlation between VO2peak and 6MWT distance (r = 0.80) which was improved by adding the terminal RPE in a multiple regression formula (6MWT + RPE, R2 = 0.71, standard error of estimate, SEE = 1.3 Metabolic Equivalents (METs). The VT was also well correlated with walking performance, 6MWT distance (r = 0.80), and was improved by the addition of terminal RPE (6MWT + RPE, R2 = 0.69, SEE = 0.95 METs). The addition of terminal RPE to 6MWT distance improved the prediction of maximal METs and METs at VT, which may have practical applications for exercise prescription.

Jagim, AR, Dominy, TA, Camic, CL, Wright, G, Doberstein, S, Jones, MT, and Oliver, JM. Acute effects of the elevation training mask on strength performance in recreational weightlifters. J Strength Cond Res 32(2): 482-489, 2018-The Elevation Training Mask 2.0 (ETM) is a novel device that purportedly simulates altitude training. The purpose of this study was to investigate the acute effects of the ETM on resistance exercise performance, metabolic stress markers, and ratings of mental fatigue. Twenty male recreational weight lifters completed 2 training sessions of back squat and bench press (6 sets of 10 repetitions at 85% of 5-repetition maximum and seventh set to failure) as well as a maximal effort sprint test (18% body mass) with the mask (ETM) and without the mask (NM). Training evaluation included baseline and postexercise blood lactate and oxygen saturation measures. Performance evaluation included peak and average velocity bar velocity, total volume load, total work, total repetitions completed, and sprint performance. Adverse side effects were reported in 12% (n = 3) of participants, which included feelings of light headedness, anxiety, and discomfort. No differences were found in repetitions or total workload in back squat (p = 0.07) or bench press (p = 0.08) between conditions. A lower peak velocity was identified during the back squat, bench press, and sprint test in the ETM condition (p = 0.04). Blood lactate values were lower after bench press and sprint during the ETM condition (p < 0.001). Significantly lower ratings of alertness and focus for task were found after squat, bench press, and sprint test in the ETM condition compared with the NM condition (p < 0.001). Wearing the ETM during bouts of resistance training did not hinder the ability to achieve desired training volumes during the resistance training session. However, wearing the ETM does seem to attenuate the ability to maintain working velocity during training bouts and negatively influence ratings of alertness and focus for task.

Although maximal incremental exercise tests (GXT) are the gold standard for outcome assessment and exercise proscription, they are not widely available in either fitness or clinical exercise programs. This study compared the prediction of VO2max in healthy, sedentary volunteers using a non-exercise prediction (Matthews, Heil, Freedson & Pastides, 1999), RPE extrapolation to 19 & 20 (Eston, Lambrick, Sheppard & Parfitt, 2008) and the Rockport Walking Test (RWT)(Kline et al, 1987) and of VT using the Talk Test (Foster et al., 2018) and RPE @ 13,14,15. Subjects performed treadmill GXT with gas exchange, submaximal treadmill with RPE and Talk Test, the RWT and the Matthews non-exercise estimation. All methods provided reasonable estimates of both VO2max and VT, with correlations >0.75 and SEE ~1 MET. VO2max was best estimated with extrapolation to RPE=19. VT was observed intermediate between the Last Positive & Equivocal stages of the TT and between RPE 13 & 14. Non-maximal evaluation, and even non-exercise equations can be used as a substitude for maximal GXT with gas exchange to make reasonable estimates of both VO2max and VT.

ObjectiveTo provide certified athletic trainers (ATs) with recommendations and guidelines for the immediate management of patients with joint dislocations.BackgroundOne of the primary responsibilities of ATs is to provide immediate injury care for active individuals. Although ATs are confronted with managing patients who have many kinds of injuries, the onsite management of a joint dislocation presents challenges in evaluation and immediate treatment. The critical concern in managing a dislocation is deciding when a joint can be reduced onsite and when the patient should be splinted and transported for reduction to be performed in the hospital or medical setting. Factors that influence the decision-making process include the following: whether the AT possesses a documented protocol that is supported by his or her supervising physician(s), employer documents, and respective state regulations; the AT's qualifications and experience; the dislocated joint; whether the dislocation is first time or recurrent; the patient's age and general health; and whether associated injuries are present.RecommendationsThese guidelines are intended to provide considerations for the initial care of specific joint dislocations. They are not intended to represent the standard of care and should not be interpreted as a standard of care for therapeutic or legal discussion.

High intensity interval training (HIIT) has become an increasingly popular form of exercise due to its potentially large effects on exercise capacity and small time requirement. This study compared the effects of two HIIT protocols vs steady-state training on aerobic and anaerobic capacity following 8-weeks of training. Fifty-five untrained college-aged subjects were randomly assigned to three training groups (3x weekly). Steady-state (n = 19) exercised (cycle ergometer) 20 minutes at 90% of ventilatory threshold (VT). Tabata (n = 21) completed eight intervals of 20s at 170% VO2max/10s rest. Meyer (n = 15) completed 13 sets of 30s (20 min) @ 100% PVO2 max/ 60s recovery, average PO = 90% VT. Each subject did 24 training sessions during 8 weeks. Results: There were significant (p < 0.05) increases in VO2max (+19, +18 and +18%) and PPO (+17, +24 and +14%) for each training group, as well as significant increases in peak (+8, + 9 and +5%) & mean (+4, +7 and +6%) power during Wingate testing, but no significant differences between groups. Measures of the enjoyment of the training program indicated that the Tabata protocol was significantly less enjoyable (p < 0.05) than the steady state and Meyer protocols, and that the enjoyment of all protocols declined (p < 0.05) across the duration of the study. The results suggest that although HIIT protocols are time efficient, they are not superior to conventional exercise training in sedentary young adults.

Background The use of dietary supplements to improve performance is becoming increasingly popular among athletes and fitness enthusiasts. Unfortunately, there is a tremendous lack of research being done regarding female athletes and the use of sport supplements. The purpose of this study was to examine the acute effects of multi-ingredient pre-workout supplement (MIPS) ingestion on resting metabolism and exercise performance in recreationally-active females. Methods Fifteen recreationally-active females participated in a randomized, double-blind, placebo controlled study. Subjects completed baseline, and two experimental testing sessions in a cross-over design fashion. Experimental testing included assessment of resting energy expenditure (REE), heart rate, and blood pressure following the ingestion of a MIPS or placebo. Subjects also completed a repetition to failure test for the back squat (BS) and bench press (BP) at 85% of their 5-repetition maximum followed by the assessment of anaerobic power using a counter-movement vertical jump test and a sprint test on a force-treadmill. Subjective measurements of energy, focus, and fatigue were also assessed using a 5-point Likert scale. Separate repeated measures analysis of variance (ANOVA) were used to assess differences in REE, cardiovascular responses, and subjective markers between conditions. Performance data were analyzed using paired Student’s T-tests. Results A significant main effect for condition was observed for REE (p = 0.021) and diastolic blood pressure (p = 0.011) following ingestion of the MIPS. The supplement condition resulted in a greater number of BP repetitions to failure and total work completed during treadmill test (p = 0.039) compared to placebo (p = 0.037). A significant condition x time interaction for focus was observed with the supplement treatment exhibiting improved focus at 80-min post ingestion (p = 0.046). Conclusions Consumption of a MIPS increased resting metabolism following a single dose accompanied by an increase in diastolic blood pressure. Furthermore, acute MIPS ingestion improved upper body muscular endurance and anaerobic capacity while improving feelings of focus following high-intensity exercise in recreationally active females.

Exercise intensity is traditionally prescribed using %HRmax, %HRR, %VO2max, or %VO2R. Recently, the Talk Test (TT) has been proposed as an alternative method to guide exercise intensity. However, it is unknown if prescribing exercise intensity solely using the TT can provoke training responses that are comparable to traditional guidelines. This study compared the responses to training using either the TT or %HRR. Forty-four subjects (17 males and 27 females: age=20.4±3.02 years; body height=170.5±9.79 cm; body weight=71.9±13.63 kg) completed an incremental maximal cycle ergometer test, were stratified by VO2max and gender, and randomly assigned to training groups guided by either %HRR (n=20) or the TT (n=24). Both groups completed 40-minute training sessions three days per week for 10 weeks. In the HRR group, exercise intensity was targeted (per ACSM guidelines) at 40-59% HRR for weeks 1-4, 50-59% HRR for weeks 5-8, and 60-79% HRR for weeks 9-10. In the TT group, exercise intensity was targeted at the highest power output (PO) that still allowed for comfortable speech. Changes in VO2max, peak power output (PPO), VO2 at ventilatory threshold (VT), and PO at VT were compared between the groups using two-way ANOVA with repeated measures. There were significant (p0.05) interaction effect. Guiding exercise prescription using the TT is a simple and effective method for prescribing exercise intensity and elicits improvements in exercise performance that are comparable to the traditional %HRR guidelines.

The rating of perceived exertion (RPE) normally grows as a scalar function of relative competitive distance, suggesting that it may translate between the brain and body relative to managing fatigue during time-trial exercise. In nonstandard pacing situations, a reciprocal relationship between RPE and power output (PO) would be predicted.Purpose:To determine whether PO would decrease when RPE was forced above the normal growth curve during a cycle time trial.Methods:Well-trained cyclists performed randomly ordered 10-km cycle time trials. In CONTROL they rode at their own best pace throughout. In BURST, they made a 1-km “burst” at the 4-km mark and then finished as rapidly as possible.Results:CONTROL was significantly (P < .05) faster than BURST (16:36 vs 17:00 min). During CONTROL, responses between 4 and 5 km were PO, 240 W; RPE, 5–6; and blood lactate [HLa], 8–9 mmol/L. During BURST PO increased to 282 W, then fell to 220 W after the burst and remained below CONTROL until the end spurt (9 km). RPE increased to 9 during the burst but returned to the normal RPE growth pattern by 6 km; [HLa] increased to ~13 mmol/L after the burst and remained elevated throughout the remainder of the trial.Conclusions:The reciprocal behavior of RPE and PO after BURST supports the hypothesis that RPE translates between the brain and the body during heavy exercise. However, the continuing reduction of PO after the burst, even after RPE returned to its normal growth pattern, suggests that PO is regulated in a more complex manner than reflected solely by RPE.

Recent research has shown that beta-alanine (BA) supplementation can increase intramuscular carnosine levels. Carnosine is an intramuscular buffer, and it has been linked to improvements in performance, specifically during bouts of high-intensity exercise that are likely limited by muscle acidosis. Therefore, the purpose of this study was to examine the effect of BA supplementation on sprint endurance at 2 different supramaximal intensities. Twenty-one anaerobically trained (rugby players [n = 4], wrestlers [n = 11], and recreationally strength trained athletes [n = 6]) college-aged men participated in a double-blind, placebo controlled study. The subjects performed an incremental VO2max test and 2 sprint to exhaustion tests set at 115 and 140% of their VO2max on a motorized treadmill before (PRE) and after (POST) a 5-week supplementation period. During this time, the subjects ingested either a BA supplement or placebo (PLA) with meals. The subjects ingested 4 g·d(-1) of BA or PLA during the first week and 6 g·d(-1) the following 4 weeks. Capillary blood samples were taken before and after each sprint to determine blood lactate response to the sprint exercise. No significant group (BA, PLA) × intensity (115%, 140%; p = 0.60), group by time (PRE, POST; p = 0.72), or group × intensity × time (p = 0.74) interactions were observed for time to exhaustion. In addition, similar nonsignificant observations were made for lactate response to the sprints (group × intensity, p = 0.43; group × time, p = 0.33, group × intensity × time, p = 0.56). From the results of this study, it was concluded that beta-alanine supplementation did not have a significant effect on sprint endurance at supramaximal intensities.

The dipeptide carnosine has been shown to contribute to the buffer capacity of hydrogen ions (H) during intense exercise. Increasing skeletal muscle carnosine levels through beta-alanine (BA) supplementation has been shown to maintain acid-base balance, delay fatigue, and improve exercise performance. We designed this study to examine the effect of 5 weeks of BA supplementation on repeat high-intensity sprint performance. Nineteen, physically active, college men were divided into 2 groups (control [C], n = 10 or BA, n = 9). We performed double-blind placebo-controlled study where subjects ingested 4 g per day during the first week and 6 g per day over the next 4 weeks of a placebo (rice flour) or a BA supplement. Subjects completed 2 sets of 5 5-second sprints with 45-second recovery separated by 2 minutes of active recovery. All tests were conducted on a non-motorized treadmill against a resistance of 15% of the participant's body weight. We recorded horizontal power (HP) of the running sprint. Post-exercise capillary blood samples were analyzed for lactate to determine the metabolic demands. There were no significant between-group differences (p > 0.05) in HPpeak or HPmean for the repeat sprint protocol. No significant between-group differences were found for performance decrement (% fatigue) for HPpeak or HPmean. In addition, no significant interactions were observed. Post-exercise blood lactate values were similar pre and post supplementation in both groups. The results of this study clearly indicate that 5 weeks of BA supplementation provides no benefit for repeat sprint performance.

The purpose was to determine if cold whirlpool treatment decreases functional performance equally regardless of gender. A secondary aim was to determine if there is a gradual increase in functional performance across time. Twenty-one college-aged subjects volunteered to participate in this study and were required to perform four measures of functional performance including: counter movement vertical jump, T-test, 36.58-meter dash (40-yard), and active range of motion of the ankle. Participants were treated with a 20 minute, 10 degree Celsius cold whirlpool following the pre-test of a given functional performance measure. Participants demonstrated significant decreases in counter movement vertical jump, T-test, and 40-yard dash performance immediately following treatment. Vertical jump performance remained impaired for at least 32 minutes. While both the T-test and 40-yard dash were affected for 7 and 22 minutes post- treatment, respectively. Participants also demonstrated significant decreases in peak power and average power immediately after and for 32 minutes post-treatment. Dorsiflexion was significantly decreased 7 and 12 minutes following treatment. There were no differences for plantar flexion, inversion, or eversion. These data suggest functional performance was affected immediately following and for up to 32 minutes after cold whirlpool treatment. It was also evident that there is a gradual performance increase for each measure of functional performance across time. Therefore, the consequences should be carefully considered before returning athletes to activity following cold whirlpool treatment

RATIONALE Heart rate (HR) and oxygen consumption (VO(2)) are indicators of the intensity of exercise. Handrail support has been shown, during maximal treadmill testing, to blunt HR and VO(2) responses at a particular speed and grade, resulting in an increased treadmill time and overprediction in aerobic capacity. OBJECTIVES This study was designed to determine if handrail support would similarly blunt HR and VO(2) responses during steady-state treadmill exercise at intensities typical of exercise training. METHODS Healthy volunteers (age, 38-60 years; N = 10) performed maximal treadmill exercise to define VO2max (35.4 +/- 6.5 mL kg(-1) min(-1)) and ventilatory threshold (26.4 +/- 5.8 mL kg(-1) min(-1)). They also performed 3 random steady-state exercise bouts including free arm swing, handrail support-resting, and handrail support-gripping (HRS-G). Each test consisted of three 5-minute stages with intensity levels corresponding to 75%, 85%, and 95% of the speed and grade at ventilatory threshold. RESULTS There were significant (P < .05) differences in HR and VO2 at the 75%, 85%, and 95% ventilatory thresholds in HRS-G (108, 114, and 121 beats min and 17.2, 18.0, and 20.6 mL kg min, respectively) versus handrail support-resting (114, 126, and 137 beats min and 19.5, 21.8, and 23.9 mL kg min, respectively) and HRS-G versus free arm swing (120, 130, and 142 beats min and 20.3, 22.8, and 26.1 mL kg min, respectively). Rating of perceived exertion was significantly (P < .05) different between HRS-G (1.8, 2.4, and 3.1) and free arm swing (2.2, 2.9, and 3.6) at all intensities and between HRS-G (2.4 and 3.1, respectively) and handrail support-resting (3 and 3.7, respectively) at the 85% and 95% ventilatory thresholds. CONCLUSION Gripping and, to a lesser degree, resting the hands on the handrails during steady-state treadmill walking will blunt responses during exercise training and may result in less predictable exercise program.

Objective: To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1–T2 disc herniation. Background: A 23-year-old male collegiate wrestler injured his neck in a wrestling tournament match and experienced pain, weakness, and numbness in his left upper extremity. He completed that match and 1 additional match that day with mild symptoms. Evaluation by a certified athletic trainer 6 days postinjury showed radiculopathy in the C7 distribution of his left upper extremity. He was evaluated further by the team physician, a primary care physician, and a neurosurgeon. Differential Diagnosis: Cervical spine injury, stinger/burner, peripheral nerve injury, spinal cord injury, thoracic outlet syndrome, brachial plexus radiculopathy. Treatment: The patient initially underwent nonoperative management with ice, heat, massage, electrical stimulation, shortwave diathermy, and nonsteroidal anti-inflammatory drugs without symptom resolution. Cervical spine radiographs were negative for bony pathologic conditions. Magnetic resonance imaging showed evidence of T1–T2 disc herniation. The patient underwent surgery to resolve the symptoms and enable him to participate for the remainder of the wrestling season. Uniqueness: Whereas brachial plexus radiculopathy commonly is seen in collision sports, a postfixed brachial plexus in which the T2 nerve root has substantial contribution to the innervation of the upper extremity is a rare anatomic variation with which many health care providers are unfamiliar. Conclusions: The injury sustained by the wrestler appeared to be C7 radiculopathy due to a brachial plexus traction injury. However, it ultimately was diagnosed as radiculopathy due to a T1–T2 thoracic intervertebral disc herniation causing impingement of a postfixed brachial plexus and required surgical intervention. Athletic trainers and physicians need to be aware of the anatomic variations of the brachial plexus when evaluating and caring for patients with suspected brachial plexus radiculopathies.

Purpose Correlative data have suggested that the Talk Test (TT) may be a surrogate of the ventilatory threshold (VT). This study examined manipulations of either the VT or exercise protocol to test the hypothesis that the TT and VT are related in a robust way, adequate for exercise prescription. Methods Healthy young adults participated in 4 independent series of experiments designed to decrease (blood donation) or increase (training) VT, or to systematically vary the exercise intensity above and below VT. These interventions were matched to responses of the TT. Results The changes in the exercise intensity at VT and at the last positive stage of the TT matched each other following both blood donation and training. When exercise intensity was varied above and below VT, the predicted ability to speak was well matched to observations of the TT. Predictive errors biased toward passing the TT when exercise intensity was greater than VT. The time required for the result of TT to become negative when exercise intensity was more than VT, decreased with increasing intensity but averaged more than the 2 minutes that has been used in previous studies. Conclusions This study confirms the robust relationship between VT and the TT during various interventions and suggests that the TT is suitable for exercise prescription.

Context: Various techniques have been described for assessing conditions that cause pain at the patellofemoral (PF) joint. The Clarke sign is one such test, but the diagnostic value of this test in assessing chondromalacia patella is unknown.Objective: To (1) investigate the diagnostic value of the Clarke sign in assessing the presence of chondromalacia patella using arthroscopic examination of the PF joint as the “gold standard,” and (2) provide a historical perspective of the Clarke sign as a clinical diagnostic test.Design: Validation study.Setting: All patients of one of the investigators who had knee pain or injuries unrelated to the patellofemoral joint and were scheduled for arthroscopic surgery were recruited for this study.Patients or Other Participants: A total of 106 otherwise healthy individuals with no history of patellofemoral pain or dysfunction volunteered.Main Outcome Measure(s): The Clarke sign was performed on the surgical knee by a single investigator in the clinic before surgery. A positive test was indicated by the presence of pain sufficient to prevent the patient from maintaining a quadriceps muscle contraction against manual resistance for longer than 2 seconds. The preoperative result was compared with visual evidence of chondromalacia patella during arthroscopy.Results: Sensitivity was 0.39, specificity was 0.67, likelihood ratio for a positive test was 1.18, likelihood ratio for a negative test was 0.91, positive predictive value was 0.25, and negative predictive value was 0.80.Conclusions: Diagnostic validity values for the use of the Clarke sign in assessing chondromalacia patella were unsatisfactory, supporting suggestions that it has poor diagnostic value as a clinical examination technique. Additionally, an extensive search of the available literature for the Clarke sign reveals multiple problems with the test, causing significant confusion for clinicians. Therefore, the use of the Clarke sign as a routine part of a knee examination is not beneficial, and its use should be discontinued.

Objective: To present the unique case of a collegiate swimmer who experienced nearly 9 months of unresolved rib pain.Background: A 20-year-old collegiate swimmer was jumping up and down, warming up before a race, when she experienced pain in the area of her left lower rib cage. She completed the event and 2 additional events that day with moderate discomfort. The athlete was evaluated by a certified athletic trainer 3 days postinjury and followed up over the next 9 months with the team physician, a chiropractor, a nonsurgical sports medicine physician, and a thoracic surgeon.Differential Diagnosis: Intercostal strain, oblique strain, fractured rib, somatic dysfunction, hepatosplenic conditions, pleuritic chest pain, slipping rib syndrome.Treatment: The athlete underwent 4 months of conservative treatment (eg, activity modification, ice, ultrasound, hot packs, nonsteroidal anti-inflammatory drugs) after the injury, independently sought chiropractic intervention (12 treatments) 4 to 6 months postinjury, was referred to physical therapy (10 visits) by a nonsurgical sports medicine physician 6 to 8 months postinjury, and finally underwent surgical intervention 9 months after the onset of the initial symptoms.Uniqueness: Slipping rib syndrome was first described in 1919. However, many health care professionals who are involved with diagnosing and treating athletes and active individuals (eg, athletic trainers, physicians) are relatively unfamiliar with this musculoskeletal condition.Conclusions: It is important for clinicians and team physicians to familiarize themselves with and consider the diagnosis of slipping rib syndrome when assessing and managing individuals with persistent abdominal and/or thoracic pain.

This study was conducted to monitor the training patterns throughout a basketball season in order to determine if a relationship exists between the physical stress of practice and the occurrence of injuries and illnesses in NCAA Division III athletes. Subjects consisted of college women (n = 12) ranging in age from 18 to 22 years. A certified athletic trainer distributed a questionnaire following each practice, including 2 weeks of preseason, documenting the presence of injury, illness, or both, relative to the intensity and duration of practice. Training load, training monotony, and training strain were computed using the session rate of perceived exertion scale method. An increase in injuries occurred during times of increased training loads, particularly during the first 2 weeks of formal practice, and immediately subsequent to the holidays. The temporal relationship between training load and injury suggests a causative link (p < 0.01; r = 0.675). The present data suggest that the periodization pattern of basketball training may be linked to the likelihood of illness/injury.