Effects of foot intensive rehabilitation (FIRE) on clinical outcomes for patients with chronic ankle instability: a randomized controlled trial protocol.

BACKGROUND: Lateral ankle sprains account for a large proportion of musculoskeletal injuries among civilians and military service members, with up to 40% of patients developing chronic ankle instability (CAI). Although foot function is compromised in patients with CAI, these impairments are not routinely addressed by current standard of care (SOC) rehabilitation protocols, potentially limiting their effectiveness. The purpose of this randomized controlled trial is to determine if a Foot Intensive REhabilitation (FIRE) protocol is more effective compared to SOC rehabilitation for patients with CAI. METHODS: This study will use a three-site, single-blind, randomized controlled trial design with data collected over four data collection points (baseline and post-intervention with 6-, 12-, and 24-month follow-ups) to assess variables related to recurrent injury, sensorimotor function, and self-reported function. A total of 150 CAI patients (50 per site) will be randomly assigned to one of two rehabilitation groups (FIRE or SOC). Rehabilitation will consist of a 6-week intervention composed of supervised and home exercises. Patients assigned to SOC will complete exercises focused on ankle strengthening, balance training, and range of motion, while patients assigned to FIRE will complete a modified SOC program along with additional exercises focused on intrinsic foot muscle activation, dynamic foot stability, and plantar cutaneous stimulation. DISCUSSION: The overall goal of this trial is to compare the effectiveness of a FIRE program versus a SOC program on near- and long-term functional outcomes in patients with CAI. We hypothesize the FIRE program will reduce the occurrence of future ankle sprains and ankle giving way episodes while creating clinically relevant improvements in sensorimotor function and self-reported disability beyond the SOC program alone. This study will also provide longitudinal outcome findings for both FIRE and SOC for up to two years. Enhancing the current SOC for CAI will improve the ability of rehabilitation to reduce subsequent ankle injuries, diminish CAI-related impairments, and improve patient-oriented measures of health, which are critical for the immediate and long-term health of civilians and service members with this condition. Trial Registration Clinicaltrials.gov Registry: NCT #NCT04493645 (7/29/20).

Metformin to Augment Strength Training Effective Response in Seniors (MASTERS): study protocol for a randomized controlled trial.

BACKGROUND: Muscle mass and strength are strong determinants of a person's quality of life and functional independence with advancing age. While resistance training is the most effective intervention to combat age-associated muscle atrophy (sarcopenia), the ability of older adults to increase muscle mass and strength in response to training is blunted and highly variable. Thus, finding novel ways to complement resistance training to improve muscle response and ultimately quality of life among older individuals is critical. The purpose of this study is to determine whether a commonly prescribed medication called metformin can be repurposed to improve the response to resistance exercise training by altering the muscle tissue inflammatory environment. METHODS/DESIGN: Individuals aged 65 and older are participating in a two-site, randomized, double-blind, placebo-controlled trial testing the effects of metformin or placebo on muscle size, strength, and physical function when combined with a progressive resistance training program. Participants consume 1700 mg of metformin per day or placebo for 2 weeks before engaging in a 14-week progressive resistance training regimen, with continued metformin or placebo. Participants are then monitored post-training to determine if the group taking metformin derived greater overall benefit from training in terms of muscle mass and strength gains than those on placebo. Muscle biopsies are taken from the vastus lateralis at three time points to assess individual cellular and molecular adaptations to resistance training and also changes in response to metformin. DISCUSSION: The response of aged muscles to a resistance training program does not always result in a positive outcome; some individuals even experience a loss in muscle mass following resistance training. Thus, adjuvant therapies, including pharmacological ones, are required to optimize response to training in those who do not respond and may be at increased risk of frailty. This is the first known metformin repurposing trial in non-diseased individuals, aimed specifically at the resistance exercise "non-responder" phenotype present in the aging population. The overall goal of this trial is to determine if combined exercise-metformin intervention therapy will benefit older individuals by promoting muscle hypertrophy and strength gains, thereby maintaining functional independence. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02308228 . Registered on 25 November 2014.

Cardiorespiratory fitness modifies the relationship between myocardial function and cerebral blood flow in older adults.

A growing body of evidence indicates that cardiorespiratory fitness attenuates some age-related cerebral declines. However, little is known about the role that myocardial function plays in this relationship. Brain regions with high resting metabolic rates, such as the default mode network (DMN), may be especially vulnerable to age-related declines in myocardial functions affecting cerebral blood flow (CBF). This study explored the relationship between a measure of myocardial mechanics, global longitudinal strain (GLS), and CBF to the DMN. In addition, we explored how cardiorespiratory affects this relationship. Participants were 30 older adults between the ages of 59 and 69 (mean age=63.73years, SD=2.8). Results indicated that superior cardiorespiratory fitness and myocardial mechanics were positively associated with DMN CBF. Moreover, results of a mediation analysis revealed that the relationship between GLS and DMN CBF was accounted for by individual differences in fitness. Findings suggest that benefits of healthy heart function to brain function are modified by fitness.

A journey through heart valve surgery.

It is evident that valvular surgeries have made countless advances since the first valve surgery in 1925 when Dr Henry Souttar operated on a woman with mitral stenosis. Patients in the 21st century have a better chance of surviving as a result of these advances. In addition to providing high-quality health care to patients, educating patients and their families regarding the disease processes, symptoms, diagnosis, types of valve surgeries, different approaches, complications, nonsurgical care, recovery, and lifestyle changes is an instrumental component to a successful recovery.

Personal food systems of male collegiate football players: a grounded theory investigation.

CONTEXT: Factors that affect food choices include the physical and social environments, quality, quantity, perceived healthfulness, and convenience. The personal food choice process was defined as the procedures used by athletes for making food choices, including the weighing and balancing of activities of daily life, physical well-being, convenience, monetary resources, and social relationships. OBJECTIVE: To develop a theoretical model explaining the personal food choice processes of collegiate football players. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Division II football program. PATIENTS OR OTHER PARTICIPANTS: Fifteen football players were purposefully sampled to represent various positions, years of athletic eligibility, and ethnic backgrounds. DATA COLLECTION AND ANALYSIS: For text data collection, we used predetermined, open-ended questions. Data were analyzed using the constant comparison method. The athletes' words were used to label and describe their interactions and experiences with the food choice process. Member checks and an external audit were conducted by a qualitative methodologist and a nutrition specialist, and the findings were triangulated with the current literature to ensure trustworthiness of the text data. RESULTS: Time was the core category and yielded a cyclic graphic of a theoretical model for the food choice system. Planning hydration, macronutrient strategies, snacks, and healthful food choices emerged as themes. CONCLUSIONS: The athletes planned meals and snacks around their academic and athletic schedules while attempting to consume foods identified as healthful. Healthful foods were generally lower in fat but high in preferred macronutrients. High-protein foods were the players' primary goal; carbohydrate consumption was secondary. The athletes had established plans to maintain hydration. Professionals may use these findings to implement educational programs on food choices for football players.

Alcohol consumption behaviors among athletic training students at accredited athletic training education programs in the mid-america athletic trainers' association.

CONTEXT: Alcohol consumption among college students has been evaluated at many levels, but assessment of alcohol consumption among collegiate athletic training students has not been substantially reviewed. Understanding the alcohol use of this college-age group adds to the overall literature on alcohol consumption of the college student population. OBJECTIVE: To assess the prevalence of hazardous and harmful alcohol consumption behaviors in collegiate athletic training students using the Alcohol Use Disorders Identification Test (AUDIT). DESIGN: A cross-sectional survey using the AUDIT. SETTING: The AUDIT questionnaire was sent to the program directors of all Commission on Accreditation of Allied Health Education Programs-accredited athletic training education programs in the Mid-America Athletic Trainers' Association. PATIENTS OR OTHER PARTICIPANTS: Fourteen of the 35 athletic training education programs agreed to take part in the study, yielding a 40% response rate. Three hundred and forty-eight of the 946 athletic training students (36%) solicited agreed to participate. MAIN OUTCOME MEASURE(S): Maximum score on the AUDIT out of a possible score of 40. RESULTS: The mean AUDIT score for the sample was 7.47, with an SD of 5.69. Thirty-seven percent of participants demonstrated an AUDIT score of 9 or above. Nearly 18% of participants reported having 6 or more drinks at one sitting on a weekly basis. CONCLUSIONS: It is difficult to compare athletic training students' alcohol consumption with that of other student groups. The greater percentage of athletic training students does not drink in excess on a frequent basis.