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PubMed2005

Nutritional status of endurance athletes: what is the available information?

Nutritional status is a critical determinant of athletic performance. We question whether currently available studies can give adequate information on nutritional status of endurance athletes. This paper is a critical review of articles published from 1989 to 2003 that investigate nutritional status of endurance athletes. The terms, "nutrition", "diet", or "nutrient", were combined with "endurance athletes" to perform Medline and Pubmed electronic database searches. Two inclusion criteria were considered: (a) study subjects should be adults and (b) articles should report gender-specific values for total energy expenditure and intake of energy, macro and micronutrient from food. Only seven studies fulfilled inclusion criteria. In general, the conclusions of these studies are that endurance athletes have negative energy balance, low intake of carbohydrate, adequate to high intake of protein, and high intake of fat. A critical discussion of the articles' data on vitamins, minerals and trace elements adequacy is conducted using insights and methodology proposed by the newly published assessment and interpretation of Dietary Reference Intakes (DRIs). The studies evaluated give an inappropriate evaluation of the prevalence of adequacy/inadequacy of micronutrient intake among endurance athletes. In this work we indicate potential limitations of existing nutritional data, which reflects the misconceptions found in published literature on nutritional group evaluation. This review stresses the need for a comprehensive and well-conducted nutrition assessment planning to fulfill the existing gap in reliable information about micronutrient adequacy of endurance athletes.

Adult↗
PubMed1992

Educational effects of interscholastic athletic participation on African-American and Hispanic youth.

This study examined the educational effects of interscholastic athletic participation on a national, stratified, probability sample of African-American and Hispanic boys and girls drawn from the High School and Beyond Study (U.S. Department of Education, 1987). This two-year longitudinal analysis was based on questionnaire data from 3,686 minority youth who were sophomores in 1980 and seniors in 1982. The independent variable was athletic participation, and the dependent variables included senior year popularity, extracurricular involvement, grades, achievement test performance, dropout rates, and educational expectations. The control variables were socioeconomic status, school location, and sophomore measures of the dependent variables. In general, athletic participation enhanced popularity and contributed to greater involvement in extracurricular activities. Sports participation was generally unrelated to grades and standardized test scores. Depending on school location (i.e., urban, suburban, rural), athletic participation was significantly related to lower dropout rates for some minority youth. High school athletic participation was unrelated to educational expectations in the senior year. These findings show that high school athletic participation was a social resource for many minority youth, but only a modest academic resource for others. Equally clear, however, is the fact that not all racial or ethnic groups reap the same benefits from sport. More importantly, these findings strongly suggest that high school sport should only be considered one of many institutional forces converging in the lives of American minority youth. To assign sport more significance than these findings call for is to run the risk of oversimplifying and trivializing the very complex psychosocial processes which attend high school athletic participation.

Achievement↗
PubMedDate not supplied

Competing perspectives during organizational socialization on the role of certified athletic trainers in high school settings.

CONTEXT: When certified athletic trainers (ATCs) enter a workplace, their potential for professional effectiveness is affected by a number of factors, including the individual's ability to put acquired knowledge, skills, and attitudes into practice. This ability may be influenced by the preconceived attitudes and expectations of athletes, athletes' parents, athletic directors, physical therapists, physicians, and coaches. OBJECTIVE: To examine the perspectives of high school coaches and ATCs toward the ATC's role in the high school setting by looking at 3 questions: (1) What are coaches' expectations of ATCs during different phases of a sport season? (2) What do ATCs perceive their role to be during different phases of a season? and (3) How do coaches' expectations compare with ATCs' expectations? DESIGN: Qualitative research design involving semistructured interviews. SETTING: High schools. PATIENTS OR OTHER PARTICIPANTS: Twenty high school varsity basketball coaches from 10 high schools in 2 states and the ATCs assigned to these teams. MAIN OUTCOME MEASURE(S): For the coaches, 12 questions focused on 3 specific areas: (1) the athletic training services they received as high school basketball coaches, (2) each coach's expectations of the ATC with whom he or she was working during various phases of the season, and (3) coaches' levels of satisfaction with the athletic training services provided to their team. For the ATCs, 17 questions focused on 3 areas: (1) the ATC's background, (2) the ATC's perceived duties at different phases of the basketball season and his or her relationship with the coach, and (3) other school factors that enhanced or interfered with the ATC's ability to perform duties. RESULTS: Three themes emerged. Coaches had limited knowledge and understanding of ATCs' qualifications, training, professional preparation, and previous experience. Coaches simply expected ATCs to be available to complement their roles. Positive communication was identified as a critical component to a good coach-ATC relationship. CONCLUSIONS: Although all participants valued good communication, poor communication appeared to limit ATCs' contributions to player performance beyond simple availability. Coaches must be educated by ATCs to ensure they are receiving qualified athletic training support.

Journal Article↗
PubMed2005

Sudden cardiac death due to physical exercise in male competitive athletes. A report of six cases.

In the period of 30 years, i.e. from 1973 to 2002, we noticed in Croatia 6 sudden and unexpected cardiac deaths in male athletes during or after training. Two were soccer players, 2 athletic runners, one was a rugby player and one was a basketball player. All of them were without cardiovascular symptoms. At the forensic autopsy, the first athlete, aged 29, had chronic myocarditis and thickened left ventricular wall of 15 mm. The second, aged 21, had an acute myocardial infarction of the posterior wall with normal coronaries and thickened left ventricular wall of 15 mm. The third aged 17, had hypoplastic right coronary artery and narrowed ascending aorta, suppurant tonsillitis and subacute myocarditis. Two athletes, aged 29 and 15, had hypertrophic cardiomyopathy and normal coronaries, and one dilated aorta. The sixth, aged 24, had arrhythmogenic cardiomyopathy of the right ventricle. All the 6 athletes died suddenly, obviously because of malignant ventricular arrhythmias. In Croatia the death rate among athletes reached 0.15/100 000, in others who practice exercise reached 0.74/100,000 and the difference is highly significant (c2=14.487, Poisson rates=3.81, P=0.00014) and in physicians-specialists reached 33.6/100,000. Preventive medical examinations are essential, especially in athletes before physical exercise, as are other investigations in every case suspicious of heart disease, including electrocardiogram (ECG), stress ECG, echocardiography and stress-echocardiography and other findings if indicated. Physical exercise is contraindicated in acute respiratory infection: in 2 of those cases had been a cause of death as a trigger.

Adolescent↗
PubMed1992

A survey of athletic medicine outreach programs in wisconsin.

In 1985, Sherman (21) reported a lack of organized and supervised health care for athletes in southern Wisconsin high schools and proposed that outreach athletic trainer services could help fill this gap. In order to determine the extent to which outreach programs are providing athletic training services, in January 1990, I surveyed 30 athletic medicine outreach services in Wisconsin to observe the frequency and scope of care being provided. Twenty-six surveys were returned. Results indicated that: (1) nearly half the high schools in Wisconsin subscribe to an outreach service; (2) outreach visits vary per individual school/service agreements, but average 2.5 visits per week, 2 hours per visit; (3) generally, outreach services furnish medical coverage to community athletic events as well as provide a source of continuing education programs for local coaches and administrators; (4) fees for services vary per contract, with nearly one-third of the respondents operating on a "no fee" volunteer basis; (5) nearly two-thirds of the outreach services emanate from a physical therapy department; and (6) 88% of services employ certified athletic trainers to provide outreach care. Outreach services appear as the mode of choice for providing athletic medicine in Wisconsin. Although some care is better than none, the quality and comprehensiveness of this care requires further investigation.

Journal Article↗
PubMed1992

A national survey of athletic trainer roles and responsibilities in the allied clinical setting.

Data collected from a survey instrument mailed to all 188 NATA-approved allied clinical setting directors were analyzed to assess the current levels of professional preparation as related to the NATA competencies, job roles, and responsibilities of certified athletic trainers in the allied clinical setting. The topics examined included specific roles and responsibilities of certified athletic trainers currently employed in an allied clinical setting. A response rate of 70.5% was obtained. Skills and services provided by the clinical ATC rated as very important were: evaluation, prevention, and rehabilitation/reconditioning of athletic injuries. Competency regarding recognition and evaluation received the highest relative importance score, which is consistent with the findings of the 1982 NATA Role Delineation Study and the 1991 NATA Validation Study. Educational preparation through NATA-approved curriculums had the highest importance in professional preparation for a career in athletic training. The data indicated that educational emphasis for athletic training students interested in employment in the nontraditional setting has diverged from the guidelines established in the 1982 Role Delineation Study. The results of this study suggest that students preparing for a career in a nontraditional (clinical) setting should focus on developing skills in athletic injury evaluation, rehabilitation and reconditioning, and prevention. While these results support findings of the 1982 Role Delineation Study, additional research is needed to address the levels of professional preparation as related to the NATA competencies, job roles, and responsibilities of the clinical athletic trainer.

Journal Article↗
PubMed1994

Athletic Medical Insurance Practices at NCAA Division I Institutions.

As the cost of athletic medical insurance continues to rise, athletic departments are searching for ways to continue to provide quality insurance coverage while keeping costs contained. There are few published articles dealing with the specific topic of the daily operations of maintaining an athletic medical insurance program. We sent an 18-item questionnaire to the 295 active NCAA Division I head athletic trainers to ascertain the current trends in athletic medical insurance. Of these, 207 (70%) responded. Of the respondents, 85% were primarily responsible for the administration of their athletic department's insurance coverage, although they had received no formal training in insurance management. Most athletic departments carry secondary policies and many report having a deductible. A wide range of insurance coverage and premiums were reported.

Journal Article↗
PubMed1995

Legislative funding of athletic training positions in public secondary schools.

In 1991, approximately 21 000 student athletes were actively participating in organized athletics in Hawaii's 61 (38 public and 23 private) secondary schools. Of the 61 schools, only 5 (all private) employed full-time, NATABOC-certified athletic trainers (ATCs) to facilitate the sports health care of their respective student athletes. In an attempt to convince the state legislature that providing funding to hire ATCs was a primary health and safety issue in the state, a community-based educational platform was established and a twofold needs-assessment study was implemented statewide. The educational platform was aimed at parents, coaches, athletic directors, and school administrators. The needs-assessment studies consisted of a 30-question survey on the current practices of sports health care and a year-long injury surveillance survey within the 38 public secondary schools. There were significant differences between the public and private schools with respect to the practice of sports health care. The public school student athletes demonstrated a normative incidence of injury rate. These findings definitively quantified and qualified the need to hire ATCs in the public secondary schools. In July of 1993, the State of Hawaii funded a 2-year athletic training pilot program for approximately $1.2 million, following an extensive lobbying effort and media campaign.

Journal Article↗
PubMed1996

Wound care management: proper protocol differs from athletic trainers' perceptions.

As research techniques in wound care management improve, treatment protocols for the care of wounds must also change to ensure safe and optimal healing. In this study, I surveyed current practices of athletic trainers regarding the care of athletic wounds and compared the findings to current literature. I contacted 501 athletic trainers, including all NATA curricular undergraduate directors. Overall response rate was 58%; 78% of the athletic trainers from the curricular schools responded. Wet-to-dry, irrigation, and soaks were the three most common methods used to debride and cleanse a wound. Povidone-iodine (Betadine) and hydrogen peroxide were the two most popular cleansing agents. Conventional gauze was the primary dressing used by 67% of the athletic trainers, while 20% of those surveyed used occlusive dressings. Although povidone-iodine and hydrogen peroxide are commonly used, both are toxic to cells involved in the wound-healing process and delay healing. Research indicates that the best method of cleansing and debriding a wound is to irrigate it with saline. Occlusive dressings have a lower infection rate, are viral barriers, and are associated with faster wound healing and less pain than gauze dressings. Athletic trainers need to assess their wound care protocols so that they give the best possible care to their athletes.

Journal Article↗
PubMed1996

Academic preparation of athletic trainers as counselors.

Athletic trainers have assumed several roles and responsibilities over the years, but perhaps there is no more important role than that of a counselor. Are they prepared to do so? One hundred and thirty-two modified Revised Wylie Inventories were mailed to college/university athletic trainers to examine their educational preparation and experiences with counseling in various areas. Most athletic trainers surveyed reported that they were predominantly counseling in the areas of injury prevention, injury rehabilitation, and nutrition, and felt academically prepared to do so. However, it was reported that preparation to counsel in other less common areas (eg, family matters, financial matters, etc) was not adequately addressed in academic programs. The athletic trainers surveyed sought continuing education in order to meet the other counseling needs of student-athletes. Although they used several psychological referral services, it was apparent that most athletic trainers frequently served as counselors on many nonorthopedic topics. We suggest that athletic training educators consider incorporating both academic knowledge and clinical experience in a wider variety of counseling areas into their curricula.

Journal Article↗
PubMed1996

Anabolic-androgenic steroid use among california community college student-athletes.

OBJECTIVE: To determine the incidence of anabolic- androgenic steroid use among a sample of community college student-athletes; also, to compare various aspects of users and nonusers, as well as to describe usage patterns. DESIGN AND SETTING: A survey following random stratified cluster sampling techniques was administered to 10 California community colleges. SUBJECTS: A group of 1,185 male and female student- athletes. MEASUREMENTS: An anonymous 27-item, valid, and reliable questionnaire was administered surveying anabolic-androgenic steroid use and usage patterns. RESULTS: Of all student-athletes sampled, 3.3% were anabolic -androgenic steroid users. Gender-specific incidence rates were 4.2% for males and 1.2% for females. Anabolic- androgenic steroid users tended to be older males, usually in their second year of college. The users were more often minorities. Users believed that they were knowledgeable about anabolic-androgenic steroids, and that the rates of usage were higher than reported. Their sources of steroid information were often lifting partners and fellow athletes. Use of these drugs was most often in cycles (mean of 6.7 weeks) and was frequently done using multiple anabolic-androgenic steroids at a time. The average number of cycles completed was 2.9. A wide variety of steroids were used by the student-athletes, of which most were obtained from illegal sources. CONCLUSIONS: Anabolic-androgenic steroid use among Califonia community college student-athletes were similar to other previous research studies involving high school and university student-athletes.

Journal Article↗
PubMed1998

Pneumomediastinum in a female track and field athlete: a case report.

OBJECTIVE: To present the case of an elite female track and field athlete who suffered a pneumomediastinum resulting from a Valsalva maneuver performed while throwing the javelin. BACKGROUND: Episodes of chest pain and labored breathing in athletes may be alarming. Accurate, early diagnosis is enhanced by an awareness of those relatively rare conditions that may cause these symptoms. DIFFERENTIAL DIAGNOSIS: Bronchial injury/fracture, retropharyngeal abscess, acute pulmonary disease, pneumomediastinum, pneumothorax, cardiac disease, allergic reaction. TREATMENT: The athlete was given intravenous morphine for pain, prescribed oral pain medication, and restricted from strenuous activity for 6 weeks. Aerobic exercise was allowed after pain and air in the neck subsided, which was estimated at 1 week postinjury. UNIQUENESS: This is a rarely reported case of a pneumomediastinum in a female and a track and field athlete. CONCLUSIONS: Medical personnel must be aware of the possibility of pneumomediastinum in track and field athletes and in female athletes and must be knowledgeable in the followup care and the safe return of the athlete to activity.

Journal Article↗
PubMed1998

Sexual harassment: a concern for the athletic trainer.

OBJECTIVE: Sexual harassment is a vital social issue that affects the business community, educational institutions, and personnel in the U.S. military. Addressing sexual harassment in the athletic training clinical setting is an important issue for the athletic training professional. Athletic trainers need to understand the complex definitions of sexual harassment and how to identify and handle claims of sexual harassment in order to prevent sexual harassment from occurring and to prevent civil lawsuits of alleged sexual harassment. BACKGROUND: Professional journals, legal textbooks, policy handbooks, unpublished findings from the NATA Women in Athletic Training Committee report, and current news media sources were used to gain a greater understanding of this social problem. DESCRIPTION: To make the athletic trainer aware of this important social issue and to offer suggestions for the athletic training staff to aid in preventing problems of sexual harassment. CLINICAL ADVANTAGES: This article provides definitions and examples of sexual harassment, discussion of policy development, and suggestions for ways to eliminate sexual harassment in the athletic training environment.

Journal Article↗
PubMed2000

An examination of stress and burnout in certified athletic trainers at division I-a universities.

OBJECTIVE: A growing body of knowledge indicates that too much stress can negatively influence psychological and physical health. A model proposed by Smith to explore personal and situational variables, stress appraisal, and burnout has led to significant understanding of burnout of individuals working in service professions. We examined the relationship of hardiness, social support, and work-related issues relevant to athletic trainers to perceived stress and the relationship of perceived stress to burnout. DESIGN AND SETTING: Correlational analyses were performed to examine the relationships predicted by Smith's model. In addition, we conducted stepwise multiple regression analyses to assess the relative contributions of the personal and situational variables to perceived stress and to examine the relative impact of perceived stress on 3 burnout factors (emotional exhaustion, personal accomplishment, and depersonalization). SUBJECTS: One hundred eighteen certified athletic trainers working in National Collegiate Athletic Association Division I-A intercollegiate settings that maintain a football program. MEASUREMENTS: We assessed personal and situational variables using the Hardiness Test, the Social Support Questionnaire, and the Athletic Training Issues Survey, adapted for this study. The Perceived Stress Scale was used to assess stress appraisal, and the Maslach Burnout Inventory was used to assess 3 dimensions of burnout. RESULTS: Our results were in support of Smith's theoretical model of stress and burnout. Athletic trainers who scored lower on hardiness and social support and higher on athletic training issues tended to have higher levels of perceived stress. Furthermore, higher perceived stress scores were related to higher emotional exhaustion and depersonalization and lower levels of personal accomplishment. CONCLUSIONS: Our findings examining burnout in Division I athletic trainers were similar to those of other studies investigating coaches and coach-teachers and in support of Smith's theoretical model of stress and burnout.

Journal Article↗
PubMed2000

Pain assessment in journal of athletic training articles 1992-1998: implications for improving research and practice.

OBJECTIVE: To examine, evaluate, and summarize the techniques used to assess pain in all the Original Research articles published in the Journal of Athletic Training from 1992 through 1998. A second objective was to determine whether any of the Original Research investigations that did not assess pain were on topics that included a pain component. A third purpose was to make recommendations for assessing pain in a clinical athletic training setting. DATA SOURCES: Every Original Research article published from 1992 through 1998 was reviewed independently by 2 of the authors to determine whether a pain assessment was included in the investigation and, if so, to evaluate the pain assessment technique used. DATA SYNTHESIS: A total of 23 (12.5%) of the 184 Original Research articles included some type of pain assessment. Most of these articles addressed the topics of delayed-onset muscle pain (43.5%), knee pain (17.4%), or pain resulting from cryotherapeutic procedures (17.4%). Most of the articles that included some type of pain measurement focused on the assessment of pain intensity using a category scale (17/23, 73.9%). In a substantial percentage of studies, a pain assessment tool that either lacked published supportive validity evidence (8/23, 34.8%) or was poorly constructed (because pain affect and pain intensity were confounded within a single scale) (7/23, 30.4%) was used. In a small number of articles on a topic directly relevant to pain (4/184, 2.2%), pain was not assessed, even though it could have provided useful information. CONCLUSIONS/RECOMMENDATIONS: Pain is a construct of interest to those conducting athletic training research. Pain measures were included in approximately 1 of every 8 Original Research articles published in the Journal of Athletic Training. However, investigators have too frequently measured pain in a limited fashion, often focusing only on pain intensity. Measuring other components of pain could provide additional opportunities for learning more about the relationships between pain and athletic training procedures. We recommend that athletic trainers involved in research, as well as those engaged in clinical practice, consider systematically employing valid, multidimensional measures of pain to better understand the relationships between pain and athletic training outcomes.

Journal Article↗
PubMed2000

Evaluation of a screening test for female college athletes with eating disorders and disordered eating.

OBJECTIVE: To develop a screening test to detect female college athletes with eating disorders/disordered eating (ED/ DE). No validated eating disorder screening tests specifically for athletes have been available. DESIGN AND SETTING: In this cross-sectional study, subjects from a large midwestern university completed 3 objective tests and a structured diagnostic interview. MEASUREMENTS: A new test, developed and pilot tested by the researchers (Athletic Milieu Direct Questionnaire, AMDQ), and 2 tests normed for the general population (Eating Disorder Inventory-2, Bulimia Test-Revised) were used to identify ED/DE athletes. A structured, validated, diagnostic interview (Eating Disorder Examination, version 12.OD) was used to determine which test was most effective in screening female college athletes. SUBJECTS: Subjects included 149 female athletes, ages 18 to 25 years, from 11 Division I and select club sports. RESULTS: ED/DE subjects (35%) were found in almost every sport. Of the ED/DE subjects, 65% exhibited disordered eating, 25% were bulimic, 8% were classified as eating disordered not otherwise specified (NOS), and 2% were anorexic. The AMDQ more accurately identified ED/DE than any test or combination of items. The AMDQ produced superior results on 7 of 9 epidemiologic analyses; sensitivity was 80% and specificity was 77%, meaning that it correctly classified approximately 4 of every 5 persons who were truly exhibiting an eating disorder or disordered eating. CONCLUSIONS: We recommend that the AMDQ subsets, which met statistical criteria, be used to screen for ED/DE to enable early identification of athletes at the disordered eating or NOS stage and to initiate interventions before the disorder progresses.

Journal Article↗
PubMed2001

Herbal supplements: considerations for the athletic trainer.

OBJECTIVE: To examine common herbal supplements, explore potential risks associated with herbal use, and provide recommendations to the athletic trainer regarding patient care issues. DATA SOURCES: We searched MEDLINE, SPORT Discus, CINAHL, and Academic Search Elite databases 1990-2000 using the key words herbals, regulation, supplements, toxicity, and adulteration. DATA SYNTHESIS: The use of herbal products continues to grow. While the origins of some medications and herbal supplements are similar, clinical testing and understanding of most herbal remedies is lacking. Some herbal products may prove useful in an athletic setting; however, current United States Food and Drug Administration (FDA) regulations do not ensure safe and effective products. A descriptive review focusing on specific considerations for the athletic trainer is provided. CONCLUSIONS/RECOMMENDATIONS: Despite their increasing tendency to seek natural therapies, athletes need to be aware that "natural" does not equal "safe." Athletes are entitled to know that most herbs are not proven safe or effective under current FDA standards. The athletic trainer must be able to provide honest, unbiased information when educating athletes regarding herbal supplements.

Journal Article↗
PubMed2006

[ECG and 24-hour ECG findings in athletes of static and dynamic disciplines].

UNLABELLED: Endurance sports are associated with structural and functional changes in the myocardium. Physiologic changes representing cardiac adaptation to training are termed "athletic heart". THE AIM: We compared the incidence of arrhythmias and conduction abnormalities in athletes of static and dynamic sports using resting and 24 hour electrocardiography. We also studied the effect of physiologic left ventricular hypertrophy on the incidence of arrhythmias and conduction abnormalities in athletes, as well as of training duration on electrocardiographic parameters. MATERIAL AND METHODS: We enrolled 40 male athletes of static and 40 of dynamic sports, as well as 30 normally active males. A 12-lead resting ECG, 24 hour ECG, and echocardiography were done. RESULTS: The resting heart reate in athletes was significantly slower (p < 0.0001). No intervals longer than 3s, bundle branch or atrioventricular blocks were disclosed. The finding of left ventricular bypertrophy and training duration had no significant effect on the presence and number of supraventricular and ventricular arrhythmias or blocks. CONCLUSION: Resting ECG, echocardiography, and 24 hour ECG provide valuable cardiologic information in athletes. The heart rate was slower in all athletes and the PQ interval was longer as compared with controls. No serious arrhythmias or conduction abnormalities were noted. The duration of training and the presence of myocardial hypertrophy had no effect on electrocardiographic parameters.

Adult↗