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PubMed2000

Cardiovascular screening of student athletes.

Each year, a number of children and adolescents die suddenly from cardiac problems that are associated with a small subgroup of disorders and high-risk behaviors. While sudden cardiac death in any child or adolescent is distressing, it can be particularly devastating when it occurs in a seemingly healthy young athlete. Although uncommon in competitive sports, sudden death is a catastrophe that physicians who care for athletes should attempt to prevent. To prevent the occurrence of sudden death or cardiovascular disease progression in young athletes, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine and American Osteopathic Academy of Sports Medicine have developed or endorsed recommendations for cardiovascular screening of student athletes as part of a comprehensive sports preparticipation physical evaluation (PPE). Knowledge and understanding of these recommendations can help physicians make informed decisions about the eligibility of an athlete to participate in a particular sport and encourage development of a more uniform PPE screening process.

Adolescent↗
PubMed2001

Detection of recombinant human erythropoietin abuse in athletes utilizing markers of altered erythropoiesis.

BACKGROUND AND OBJECTIVES: The detection of recombinant human erythropoietin (r-HuEPO) abuse by athletes remains problematic. The main aim of this study was to demonstrate that the five indirect markers of altered erythropoiesis identified in our earlier work were reliable evidence of current or recently discontinued r-HuEPO use. A subsidiary aim was to refine weightings of the five markers in the initial model using a much larger data set than in the pilot study. A final aim was to verify that the hematologic response to r-HuEPO did not differ between Caucasian and Asiatic subjects. DESIGN AND METHODS: Recreational athletes resident in Sydney, Australia (Sydney, n = 49; 16 women, 33 men) or Beijing, China (Beijing, n=24; 12 women, 12 men) were randomly assigned to r-HuEPO or placebo groups prior to a 25 day administration phase. Injections of r-HuEPO (or saline) were administered double-blind at a dose of 50 IU/kg three times per week, with oral iron (105 mg) or placebo supplements taken daily by all subjects. Blood profiles were monitored during and for 4 weeks after drug administration for hematocrit (Hct), reticulocyte hematocrit (RetHct), percent macrocytes (%Macro), serum erythropoietin (EPO) and soluble transferrin receptor (sTfr), since we had previously shown that these five variables were indicative of r-HuEPO use. RESULTS: The changes in Hct, RetHct, %Macro, EPO and sTfr in the Sydney trial were qualitatively very similar to the changes noted in our previous administration trial involving recreational athletes of similar genetic origin. Statistical models developed from Fisher's discriminant analysis were able to categorize the user and placebo groups correctly. The same hematologic response was demonstrated in Beijing athletes also administered r-HuEPO. INTERPRETATION AND CONCLUSIONS: This paper confirms that r-HuEPO administration causes a predictable and reproducible hematologic response. These markers are disturbed both during and for several weeks following r-HuEPO administration. This work establishes an indirect blood test which offers a useful means of detecting and deterring r-HuEPO abuse. Ethnicity did not influence the markers identified as being able to detect athletes who abuse r-HuEPO.

Adult↗
PubMed2001

Pushing the envelope. Case studies on how fast you can and cannot return the elite athlete to running.

When treating an elite athlete, a physician always must keep in mind the status of the athlete in training, upcoming sports events, and the athlete's financial status. If the treatment requires the athlete to withdraw from regular training or sports events, a modified training program should be considered. This modified training must be balanced with returning the athlete back to full form and keeping him or her physically fit.

Adolescent↗
PubMed2001

The relationship of self-concept and perceived athletic competence to physical activity level and gender among Turkish early adolescents.

The purpose of this study was to examine the self-concept and perceived athletic competence of Turkish early adolescents in relation to physical activity level and gender. Self-concept was assessed using the Piers-Harris Children's Self-Concept Scale, and perceived athletic competence was assessed by means of the Athletic Competence subscale of Harter's Self-Perception Profile for Children. In addition, the Weekly Activity Checklist was used for assessing physical activity level. Males and females were assigned to low and high physical activity level groups based on their mean scores. Multivariate analysis of variance revealed significant main effects for gender and physical activity level, but there was no significant gender by physical activity interaction. Univariate analysis demonstrated a significant main effect for physical activity level on perceived athletic competence but not global self-concept. In addition, univariate analysis did not reveal a significant difference in either global self-concept or perceived athletic competence with respect to gender.

Adolescent↗
PubMed2002

Special olympics, special athletes, special needs?

Based upon the current study, the review of the literature, and our experience, the preparticipation physical examination for Special Olympics is an opportunity for physicians of all specialties to assist and encourage a group of athletes with special physical and emotional characteristics not found in other athletes. The physician should review the medical condition of the athlete (including prescribed medications and their potential side effects), the physical demands of the proposed activity, and the presence of volunteers to assist the athlete when necessary. Full or limited participation should be recommended in most cases. "No participation" should only apply to unstable medical conditions or situations that would place the athlete at risk for injury despite activity modification and close supervision.

Adolescent↗
PubMed2002

Evaluation of the BOD POD for estimating percent fat in female college athletes.

The purpose of this investigation was to examine the accuracy of percent body fat (%BF) estimates obtained by air displacement plethysmography (ADP) using the BOD POD Body Composition System compared with hydrostatic weighing (HW) in a group of female college athletes (n = 80). In addition, %BF estimates by skinfold measures (SF) were also obtained for comparison. A lean subset (n = 39) of the sample was also examined. Mean %BF estimated for the entire sample by ADP (21.2 +/- 5.9%) was significantly greater than that determined by HW (19.4 +/- 6.4%) and SF (18.8 +/- 5.5%). Results from the lean subset also revealed that %BF determined by ADP (17.1 +/- 3.7%) was significantly higher than %BF estimates by HW (14.3 +/- 2.8%) and SF (15.2 +/- 3.2%). The regression equation for the entire sample (%BF HW = 0.937%BF ADP - 0.452, r(2) = 0.73, standard error of estimates (SEE) = 3.34) did not differ from the line of identity. In contrast, the line of identity differed significantly from the regression equation for the lean subset of female athletes (%BF HW = 0.48%BF ADP + 6.115, r(2) = 0.41, SEE = 2.18). The results of this investigation indicate that ADP significantly overestimated %BF by 8% in female athletes and by 16% for a leaner subset of the sample compared with HW. It appears that %BF estimates by SF may be more accurate than those obtained by ADP for female college athletes, regardless of body composition. Coaches and trainers evaluating body composition should consider the use of SF before ADP when measuring %BF in female college athletes. Sports scientists should continue to examine the possible gender and body composition bias for ADP.

Adult↗
PubMed2001

Management of Cerebral Concussion in Sports: The Athletic Trainer's Perspective.

OBJECTIVE: To present a new approach in the evaluation and management of concussion from the athletic trainer's perspective. BACKGROUND: The evaluation and management of concussion continues to be a controversial topic among sports medicine professionals. Inconsistent management, lack of objective data, and confusion concerning assessment techniques may lead to inappropriate decisions regarding when to return an athlete to competition after concussion. In this article, we provide recommendations and considerations for the certified athletic trainer in the management of concussion. We also present a quantifiable assessment technique that provides more information on which return-to-play decisions can be made; this technique can be used during the initial sideline examination as well as during subsequent follow-up examinations. RECOMMENDATIONS: Certified athletic trainers and team physicians should consistently use appropriate grading scales. Assessment of concussion should include a symptom checklist, the Balance Error Scoring System, and the Standardized Assessment of Concussion, and the results should be compared with the athlete's normal baseline scores. Follow-up neuropsychological and postural stability testing is recommended. Return-to-play decisions should be based on the grade of concussion, scores on objective tests, and presence of concussive symptoms during exertional activities.

Journal Article↗
PubMed2001

Selection and Evaluation Guidelines for Clinical Education Settings in Athletic Training.

OBJECTIVE: To develop and test standards and associated criteria for the selection and evaluation of a clinical education setting in athletic training. DESIGN AND SETTING: A previously validated set of 20 standards for physical therapy clinical education settings, the associated criteria, and 2 related evaluation forms were systematically judged, revised, and adapted through a survey process. SUBJECTS: Program directors, clinical instructors, and students involved with athletic training clinical education from 28 athletic training education programs approved by the National Athletic Trainers' Association or accredited by the Commission on Accreditation of Allied Health Education Programs. MEASUREMENTS: We tabulated respondents' critiques and ratings by type of respondent. Items were judged as to whether they were relevant, practical, and suggestive of high-quality clinical education settings. RESULTS: We accepted a final set of 12 standards and 31 associated criteria to measure these standards. The student form lists 23 criteria relevant to these accepted standards. The accepted standards include the following: learning environment, program planning, ethical standards, administrative support, and Setting Coordinator of Clinical Education. CONCLUSIONS: The 12 standards, criteria, and related forms developed in this research project should be used as guidelines rather than as minimal requirements. They could be helpful in forming an impression not only about a particular clinical setting but also about the requirements of clinical education in general. Further research should include evaluating and comparing perceptions between sexes and among ethnic groups concerning their clinical education experiences. Also, standards and criteria for clinical instruction in athletic training should be systematically developed.

Journal Article↗
PubMed2002

Qualitative Research Applications in Athletic Training.

OBJECTIVE: To explain the ethnographic, phenomenologic, and grounded theory approaches to qualitative research and to describe how these approaches can be applied to contemporary topics related to athletic training education. BACKGROUND: Athletic training education has recently experienced an increase in the use of qualitative methods, and various qualitative approaches are viable for answering many questions related to athletic training education. Ethnography focuses on describing a culture or subculture. Phenomenology focuses on the meaning of lived human experience. Grounded theory focuses on developing theory related to social processes. Each approach is contextual and attempts to facilitate insight and understanding related to the human condition. DESCRIPTION: We provide an in-depth discussion of each of the selected qualitative approaches and explain the focus and unique data-collection and data-analysis strategies and identify the distinctive outcomes of each approach. Each research approach has a distinct purpose, and the specific application is driven by the questions asked. We also identify questions that are amenable to a specific method. APPLICATIONS: To better understand the interactive nature of education and learning, athletic training researchers are beginning to ask questions that require information to be gathered about meaning, contexts, culture, and processes. Such questions are best answered through the use of qualitative research methods that most commonly include ethnography, phenomenology, and grounded theory. In order for athletic training professionals to gain the most from the research conducted, it is essential that they have an understanding of the theoretic underpinnings of these methods and when each should be used.

Journal Article↗
PubMed2002

Athletic Training Clinical Instructors as Situational Leaders.

OBJECTIVE: To present Situational Leadership as a model that can be implemented by clinical instructors during clinical education. Effective leadership occurs when the leadership style is matched with the observed followers' characteristics. Effective leaders anticipate and assess change and adapt quickly and grow with the change, all while leading followers to do the same. As athletic training students' levels of readiness change, clinical instructors also need to transform their leadership styles and strategies to match the students' ever-changing observed needs in different situations. DATA SOURCES: CINAHL (1982-2002), MEDLINE (1990-2001), SPORT Discus (1949-2002), ERIC (1966-2002), and Internet Web sites were searched. Search terms included leadership, situational leadership, clinical instructors and leadership, teachers as leaders, and clinical education. DATA SYNTHESIS: Situational Leadership is presented as a leadership model to be used by clinical instructors while teaching and supervising athletic training students in the clinical setting. This model can be implemented to improve the clinical-education process. Situational leaders, eg, clinical instructors, must have the flexibility and range of skills to vary their leadership styles to match the challenges that occur while teaching athletic training students. CONCLUSIONS/RECOMMENDATIONS: This leadership style causes the leader to carry a substantial responsibility to lead while giving power away. Communication is one of the most important leadership skills to develop to become an effective leader. It is imperative for the future of the profession that certified athletic trainers continue to develop effective leadership skills to address the changing times in education and expectations of the athletic training profession.

Journal Article↗
PubMed1992

Feeding the ultraendurance athlete: practical tips and a case study.

With the rising popularity of ultradistance sports events lasting from 6 to 24 hours or multiple days, athletes are consulting registered dietitians for specialized dietary advice. Many dietitians, however, lack experience with these types of events. This article provides basic guidelines ffor fueling the ultradistance athlete. The goals are to maintain normal hydration and blood glucose levels, which can be done by enforcing programmed drinking (approximately 250 to 500 mL/15 minutes, depending on the athlete's sweat rate and environmental temperature) and programmed eating (1 to 1.5 + g of carbohydrate per kilogram of body weight per hour, depending on the athlete's acceptance of and tolerance to solid and/or liquid foods during exercise). Athletes who compete longer than 6 to 8 hours should consume adequate electrolytes, particularly sodium (approximately 1 g/hour) through either sports drinks or foods. These guidelines are applied to a case study of the 1991 women's winner of the Race Across America, a 2,930-mile biking event.

Bicycling↗
PubMed1977

[Heart diagnosis using M-mode-echocardiography. Continuous registration of the left ventricular transversal internal diameter. III. Measurements on highly trained athletes (author's transl)].

"Relative Cross-sectional area Differences" (RCD) and "Relative Velocities of Contraction" (RVC) permit a differentiation between normal subjects and patients with different degrees of myocardial failure, as previously described. Important determinants of the parameters RCD and RVC are changed, if ventricular volume and stroke volume increase and heart rate decreases, as is commonly observed in athletes. Examinations were performed at rest and after exercise on 31 athletes and 33 untrained normal subjects. Ventricular volumes were clearly increased in athletes. RCD, however, which is an equivalent to the ejection fraction, showed only slight alterations with physical training. RVC was obviously not changed by athletic training. After exercise athletes showed a significant increase in RCD. In untrained subjects only small changes in RCD were observed. In conclusion, the results show that RCD and RVC can quantitatively assess the degree of myocardial failure in cases of left ventricular dilatation without having to take into account the patients' degree of physical training.

Adolescent↗
PubMed2003

[Iron deficiency and anemia in female athletes--causes and risks].

Iron deficiency is probably the most common nutrient deficiency in the western world. Low levels of iron in the body are caused by several mechanisms, and become symptomatic with the onset of iron deficiency anemia. Athletes are a special group with additional reasons for iron or blood loss, such as plasma expansion, increase perspiration, 'foot strike hemolysis, and occasionally--malnutrition. Female athletes have yet another source of blood loss--menstruation. However, the most common cause for low hemoglobin levels in an athlete is dilutional pseudoanemia, which is caused by exercise-induced fluid retention. Athletes are more sensitive to the effects of anemia and iron deficiency, as exercise performance depends on maximal oxygen carrying capacity to the active muscle, and efficient oxygen utilization. Iron deficiency without anemia can also reduce athletic performance. Diagnosis is ultimately made by a blood count and red blood cell parameters, with ferritin serving as an index of body iron stores. Treatment requires iron supplements, as it is nearly impossible to refill the iron stores through diet alone.

Anemia, Iron-Deficiency↗
PubMed2003

[A noninvasive method for measuring and evaluating cardiac reserve of athletes].

Phonocardiogram exercise testing(PCGET) is a recently developed method for evaluating cardiac contractility and the cardiac reserve of patients with heart disease and of healthy subjects. In order to test the reliability of PCGET method in physical sport, the present author conducted a clinical study. The ratio of the amplitude of the first heart sound after PCGET to that recorded at rest was defined as an indicator, i.e. cardiac contractility reserve index (CCRI). PCGET was performed on 30 athletes and 30 non-athletes. The results showed that the average of CCRI was 10.139 +/- 2.631 in 30 athletes and 6.612 +/- 3.104 in 30 non-athletes. There was a significant difference between CCRI of the two groups (P < 0.01). Thus, PCGET might be a noninvasive, convenient and inexpensive technique to evaluate the cardiac reserve quantitatively for athletes.

Adolescent↗
PubMed2003

Ground Reaction Forces Among Gymnasts and Recreational Athletes in Drop Landings.

OBJECTIVE: To compare vertical ground reaction forces among gymnasts and recreational athletes during drop landings from 30-, 60-, and 90-cm heights. DESIGN AND SETTING: Two subject groups, intercollegiate gymnasts and college-aged recreational athletes, participated in this study. Subjects completed 10 landing trials onto a force platform at each height. SUBJECTS: Ten female competitive gymnasts (height = 1.57 +/- 0.02 m, mass = 55.4 +/- 7.3 kg) and 10 female recreational athletes (height = 1.63 +/- 0.06 m, mass = 59.6 +/- 4.9 kg) volunteered for this study. MEASUREMENTS: Measurements of first peak-force magnitude (F1), time to F1 (T1), impulse to F1, second peak-force magnitude (F2), time to F2 (T2), and impulse to F2 were compiled to describe the ground reaction force profile for each trial at 30-, 60-, and 90-cm platform heights. A 2 x 3 (group x height) mixed-factors analysis of variance was calculated for each of the 6 variables. RESULTS: The group-by-height interaction was significant for F1, F2, and impulse to F2. Tukey post hoc analyses revealed significantly higher values for the gymnasts than for the recreational athletes at 60- and 90-cm heights for F1 and F2 magnitudes. Differences between groups for T1, T2, impulse to F1, and impulse to F2 were not statistically significant at any height. CONCLUSIONS: Drop landings performed by female gymnasts at 60- and 90-cm heights exhibited higher vertical ground reaction forces than drop landings performed by female recreational athletes. High ground reaction forces experienced by gymnasts during landings may contribute to the incidence of lower extremity injuries.

Journal Article↗
PubMed1992

The athlete's heart. Historical perspectives.

Even an athlete's heart may be affected by clinical conditions. Regarding the extreme performances of the athlete's heart in training and competition, even conditions that might be harmless in sedentary people can be fatal for the athlete. Looking back on the history of the athlete's heart, some common mistakes in its assessment can be avoided that might harm the athlete on the misinterpretation of adaptational phenomena or the trivialization of clinical conditions.

Adaptation, Physiological↗
PubMed1992

Maximal aerobic power in cerebral palsied wheelchair athletes: validity and reliability.

This study examined the validity and reliability of maximal aerobic power (VO2max) during wheelchair ergometry (WE) in wheelchair athletes with cerebral palsy. Six class 3 and class 4 male athletes with cerebral palsy completed two graded exercise tests to volitional fatigue on a wheelchair ergometer mounted on frictionless rollers. Four athletes were also able to complete two tests of bicycle ergometry (BE). Although the reliability coefficients for the VO2max during the two exercise modes were high (.89 and .93 for the WE and BE tests, respectively), the validity coefficients for this variable (ie, the correlations between WE and BE) were poor (.31 and -.24 for trials 1 and 2, respectively). Examination of the individual data indicated that athletes who used wheelchairs as their primary mode of ambulation had higher VO2max values during WE; whereas, those who used canes or no aids for daily ambulation had higher values on BE. Because of the specificity of the, VO2max response, it is recommended that the primary mode of ambulation be considered when deciding on the testing mode for evaluating the cardiorespiratory fitness of athletes with cerebral palsy.

Adult↗
PubMed2004

The angiotensin converting enzyme I/D polymorphism in Turkish athletes and sedentary controls.

The angiotensin converting enzyme (ACE) gene is located on human chromosome 17 expressing three genotypes within the intron 16 of the related gene structure. These genotypes are classified as I and D alleles which are termed as insertion and deletion, respectively. This study was carried out to identify possible relationships between the insertion/deletion (I/D) polymorphisms and athletic performance in Turkish athletes. To be able to determine these relationships, eighty healthy athletes and eighty healthy sedentary controls were genotyped for the ACE I/D polymorphism at gene level. According to the results obtained, we found significant difference on ACE I/D polymorphism in between athletes and healthy controls (x2 = 7.32, df = 2, P = 0.026). This result supports the association in ACE genotype in Turkish athletes, suggesting that this might be a genetic factor influencing the physical performance.

Adult↗