A Systematic Review on the Biomechanics of Breakfall Technique (Ukemi) in Relation to Injury in Judo within the Adult Judoka Population.

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

Whole-body vibration decreases delayed onset muscle soreness following eccentric exercise in elite hockey players: a randomised controlled trial.

BACKGROUND: Delayed onset muscle soreness (DOMS) is a common non-structural muscle injury which can disrupt training and impair performance in elite athletes. Vibration therapy reduces inflammation and improves neuromuscular efficiency, leading to reductions in pain and stiffness, and may be effective for the prevention or treatment of DOMS. However, the effect of whole-body vibration (WBV) used after sport in elite athletes has not been reported. METHODS: A randomised, controlled trial was performed. Participants were elite (national or international level) hockey players and underwent an eccentric exercise protocol previously shown to produce clinical DOMS. After exercise, one group underwent static stretching with WBV therapy, and the other performed stretching only. Baseline and serial post-exercise pain scores and measurements of quadriceps tightness were obtained. RESULTS: Eleven participants were recruited into each study arm. There were no significant differences in baseline group characteristics. Participants receiving WBV had significant reductions in both pain (p = 0.04) and quadriceps tightness (p = 0.02) compared with stretching only. CONCLUSIONS: Post-exercise WBV is effective in elite hockey players to reduce DOMS after eccentric exercise. Elite athletes in multi-sprint sports are at risk of DOMS during training and competition, and its reduction could contribute to reduced injury risk and improved performance. This treatment modality is favourable because it can be incorporated with minimal disruption into the recovery section of existing training regimes. These findings may also be extrapolated to other multi-sprint sports.

Usability testing of an e-learning resource designed to improve medical students' physical activity prescription skills: a qualitative think-aloud study.

OBJECTIVE: An e-learning resource (MEdic GAming, MEGA) was developed based on the contents of the Faculty of Sports and Exercise Medicine exercise prescription booklet. This study aimed to (i) explore medical students' perspectives of physical activity promotion and e-learning and (ii) investigate medical students' response to the design, content and usability of the MEGA e-learning resource. DESIGN: Qualitative think-aloud interview study. SETTING: A London medical school. PARTICIPANTS: 19 undergraduate medical students were interviewed using the think-aloud method while using the e-learning resource concurrently. RESULTS: In general, medical students felt current education on physical activity is inadequate and held a strong desire for more teaching on exercise medicine. Students believed the MEGA e-learning resource addressed a gap in their knowledge on physical activity but noted e-learning should not replace face-to-face teaching and suggested physical activity education would be best delivered through a blended learning approach. Students felt such an approach would allow better opportunity to practice physical activity counselling skills with patients while on clinical placement. Students' motivation to engage with the MEGA e-learning resource was positively impacted by aesthetically appealing design and interactive gamification elements such as self-assessment quizzes and visual progress tracking. CONCLUSION: Medical students value the role of physical activity in health but are disappointed by the lack of teaching within the current medical curriculum. E-learning resources, such as MEGA, which contain interactive features are a viable means to integrate physical activity into the undergraduate curriculum but should be supplemented by the opportunity to practice physical activity counselling in-person.

An Updated Systematic Review of Turnout Position Assessment Protocols Used in Dance Medicine and Science Research.

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

Integrating physical activity promotion into UK medical school curricula: testing the feasibility of an educational tool developed by the Faculty of Sports and Exercise Medicine.

BACKGROUND: At present education on exercise medicine and physical activity (PA) promotion does not feature heavily within the medical curriculum. OBJECTIVES: The purpose of this study was to test the feasibility of a self-directed educational tool (Faculty of Sports and Exercise Medicine (FSEM) exercise prescription booklet) on medical students' understanding of PA in disease management. METHODS: Students from 22 UK medical schools were invited to complete a brief online questionnaire before and after being provided access to the FSEM exercise prescription booklet. RESULTS: A total of 205 students responded to the open invitation to participate. At baseline 59% of students agreed that PA promotion was an important part of a doctor's job with 86% agreeing that PA was important in the prevention of disease. However, confidence to prescribe PA and knowledge of chief medical officer's adult PA guidelines was low. Following use of the FSEM booklet students' (n=53) knowledge of PA guidelines and confidence to advise patients about PA significantly improved (p<0.05). Correct response answers to case scenarios covering PA in disease management (specifically osteoarthritis and cancer) also improved (32% and 44% increase, respectively, p<0.01). CONCLUSION: Self-guided educational tools have the potential to improve the exercise prescription skills of undergraduate medical students. Future research should compare different methods of delivering education on PA within medical schools to determine the most effective means of integrating PA into the curriculum.

A systematic review of shoulder injury prevalence, proportion, rate, type, onset, severity, mechanism and risk factors in female artistic gymnasts.

OBJECTIVES: Systematically review shoulder injury prevalence, proportion, rate, type, onset, severity, mechanism, risk factors in female artistic gymnasts. METHODS: PubMed, Web of Science, Scopus, Cochrane Library were searched on 7/01/2017. Original studies reporting data for female artistic gymnasts only, of any age or level were included. Quality assessment was undertaken using Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: Fifteen observational studies were included. Thirteen were poor/fair quality. Shoulder injury prevalence (0%-86.9%) was higher in international (29.2%) versus national (20%) gymnasts. As a proportion of all injuries, shoulder injuries made up 4.2%-7.5%. Rates (0.35-5.7/1000 athlete exposures) were greater during practice (5.0/1000) than competition (2.4/1000). Multidirectional instability (33.8%, 37.7%) and musculotendinous injury (26.6%-90.9%) were the most common injury. In four studies 66.2%-100% of total shoulder injuries were acute onset. Most (59.3%) shoulder injuries were minor, 7.4% required surgery and 80% caused symptoms post-retirement. Asymmetric bars were the most frequent mechanism of shoulder injury. One study reported excessive shoulder stretching, hyperlaxity and instability as significant (p < 0.001) potential risk factors. CONCLUSIONS: Shoulder injuries are a problem among female artistic gymnasts. Interventional studies reporting age and competition level-specific data may guide prevention strategy implementation.

Prevalence, techniques and knowledge of rapid weight loss amongst adult british judo athletes: a questionnaire based study.

BACKGROUND: No investigation has analysed the RWL approaches since new rules by the International Judo Federation (IJF) regarding weigh-ins have been implemented in international competitions in 2014. The current study analyses the prevalence, most common methods and knowledge surrounding the effects of rapid weight loss (RWL) amongst adult UK judo athletes. Additionally, it examines differences in rapid weight loss behaviour (RWLB) between gender, weight-class, competitive level, age RWL began and "high"/"low" knowledge athletes. METHODS: A previously validated questionnaire developed to assess RWL in judo athletes was modified by adding a knowledge section and revalidated for content. The questionnaire provided a RWLB score (higher score equated to more aggressive RWL) and a knowledge score (out of 10). 256 athletes (189 males and 66 females, aged 18-67 years) completed the questionnaire between February and April 2015. Unpaired t test, one-way ANOVA-tests and Chi-squared tests were used to test differences of mean RWLB scores and prevalence between groups. RESULTS: The prevalence of RWL was 84%. The most common methods of RWL were increased exercise and decreased food/fluid intake. The mean knowledge score was 6.2±2.8, with most incorrect answers regarding physiological effects of RWL. No significant differences in RWLB scores were found between gender, "high"/"low" knowledge athletes or weight-classes. Statistically significant differences in RWLB scores were found between different competitive levels (p=0.014) and age RWL began (p<0.01) in males but not in females. CONCLUSION: RWL is highly prevalent in the UK adult judo population and athletes have moderate knowledge surrounding its effects. In males, RWLB is most aggressive in elite level athletes and those that began RWL at a younger age. Therefore, updated rulings to target elite and youth level athletes should be implemented to reduce dangerous RWL. LEVEL OF EVIDENCE: IV.

Effects of vitamin D supplementation on upper and lower body muscle strength levels in healthy individuals. A systematic review with meta-analysis.

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

Early signs of osteoarthritis in professional ballet dancers: a preliminary study.

OBJECTIVE: To investigate a cohort of professional ballet dancers for evidence of early signs of osteoarthritis (OA). DESIGN: One radiologist and 1 orthopedic surgeon specialized in musculoskeletal disorders analyzed magnetic resonance imaging scans independently. SETTING: University Teaching Hospital. PARTICIPANTS: Fifteen professional ballet dancers (4 males and 11 females; age range, 19-36 years) experiencing chronic pain in the hip, knee, spine, ankle, or foot joints. MAIN OUTCOME MEASURES: Presence of osteophytes, subchondral sclerosis, joint space narrowing, cysts, and bone marrow changes; the Kellgren and Lawrence scale was used to quantify the knee OA. RESULTS: In the knee, there was thinning and irregularity of the articular cartilage over the medial femoral condyle and bone marrow changes within the lateral femoral condyle. In the hip, there was a loss of joint space and a frayed labrum with deep recess. The first metatarsophalangeal joint showed evidence of osteophytic development. CONCLUSIONS: Early signs of OA, in different joints, were present in a small but highly selected cohort of professional ballet dancers. In future, prospective studies among a number of ballet companies should control for medical and natural history alongside the visual analysis of images and plain radiographs to confirm these preliminary results.

Effects of supplemental training on fitness and aesthetic competence parameters in contemporary dance: a randomised controlled trial.

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

Development, validity, and reliability of a ballet-specific aerobic fitness test.

The aim of this study was to develop and assess the reliability and validity of a multi-stage, ballet-specific aerobic fitness test to be used in a dance studio setting. The test consists of five stages, each four minutes long, that increase in intensity. It uses classical ballet movement of an intermediate-level of difficulty, thus emphasizing physiological demand rather than skill. The demand of each stage was determined by calculating the mean oxygen uptake during its final minute using a portable gas analyser. After an initial familiarization period, eight female subjects performed the test twice within seven days. The results showed significant differences in oxygen consumption between stages (p < 0.001), but not between trials. Pearson correlation co-efficients produced a very good linear relationship between trials (r = 0.998, p < 0.001). Bland-Altman reliability analysis revealed the 95% limits of agreement to be ± 6.2 ml·kg(-1)·min(-1), showing good agreement between trials. The oxygen uptake in our subjects equated positively to previous estimates for class and performance, confirming validity. It was concluded that the test is suitable for use among classical ballet dancers, with many possible applications.

Do increases in selected fitness parameters affect the aesthetic aspects of classical ballet performance?

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

Passive smoking and the development of cardiovascular disease in children: a systematic review.

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

Does physical fitness affect injury occurrence and time loss due to injury in elite vocational ballet students?

Most ballet dancers will suffer at least one injury a year. There are numerous causes of injury in dance, and while many investigators have documented risk factors such as anatomical characteristics, past medical history, menstrual history, dance experience, length of dance training, fatigue, and stress, risk factors related to body characteristics and nutrient intake, levels of conditioning, or physical fitness parameters have only recently received the same amount of attention. The aim of the present study was, therefore, to investigate correlations between ballet injury and body fat percentage, active and passive flexibility, lower limb power, upper body and core endurance, and aerobic capacity. Low levels of aerobic fitness were significantly associated with many of the injuries sustained over a 15-week period (r=.590, p=0.034), and body fat percentage was significantly associated with the length of time a dancer was forced to modify activity due to injury (r=-.614, p=0.026). This information may be of benefit to dancers, teachers, physical therapists and physicians in dance schools and companies when formulating strategies to prevent injury.

The demands of a working day among female professional ballet dancers.

Professional classical ballet dancers typically face long working days, and many complain of fatigue, particularly as a possible cause of injury. However, little information exists regarding the true physiological demands on dancers. The aim of the present study was therefore to ascertain the daily workload of professional female ballet dancers in terms of work intensity and rest data. Information regarding a single "work day" was obtained from 51 female dancers in one company using a multiple accelerometer. Data were examined for the amount of time spent at work intensities measured in metabolic equivalents (METS)deemed sedentary, low, moderate, and high, and the length of each period at rest. Results indicated significant differences between dancer rankings (corps de ballet, first artist, soloist, and principal) for mean exercise intensity and the percentage of time spent at sedentary intensity (< 3 METS), moderate intensity (3-6 METS) (p < 0.005), and vigorous intensity (6-9 METS) (p < 0.05). The ratios of time spent below 1.5 METS versus time spent above 1.5 METS ("rest" vs. "work") were also significantly different (p < 0.001) between rankings. When rest periods throughout the working day were analyzed, 90% of dancers were found to spend less than 60 consecutive minutes resting at any one time; for 33.3% of dancers this was less than 20 minutes. Results also revealed significant differences (p < 0.05) between dancer rankings for the greatest amount of rest at any one time during the day. It was concluded that female professional classical ballet dancers' ranking in their companies should be considered in devising work-rest schedules to help them to avoid fatigue and resultant injuries.

Association between selected physical fitness parameters and esthetic competence in contemporary dancers.

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

Video analysis of classical ballet performance.

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