Headpulse Biometric Measures Following Concussion in Young Adult Athletes.

Importance: Concussions are common in sports. Return-to-play protocols can be enhanced by objective biometrics. Objective: To characterize temporal changes of headpulse, a digital biometric, in athletes with sports-related concussion; to explore the association of unstructured physical activity with headpulse changes. Design, Setting, and Participants: This cohort study included headpulse measurements from players in the highest level of amateur Australian Rules Football in South Australia. Analysis included feasibility and validation phases, with the feasibility cohort recruited between August 5, 2021, and September 10, 2021, and the validation cohort recruited between May 5, 2022, and September 3, 2022. Data were analyzed October 2022 through January 2023. Interventions: Cranial accelerometry detected micromovements of the head following cardiac contraction (what we have described as "headpulse"). Headpulse was serially recorded for 1 month in concussed individuals. Main Outcomes and Measures: Headpulse waveforms underwent frequency transformation analysis per prespecified algorithm. Result Z scores were calculated. Headpulse Z scores exceeding 2 (2 SDs from control means) met an abnormality threshold. Headpulse sensitivity, timing, and duration of change were determined. Results: A total of 59 control and 43 concussed individuals (44 total concussions; 1 control also concussed, 1 concussed individual injured twice) provided headpulse measurements. The feasibility cohort (all male) included 17 control (median [IQR] age, 23 [19-28] years) and 15 concussed individuals (median [IQR] age, 21 [19-23] years). The validation cohort included 25 female (median [IQR] age, 21 [20-22] years) and 17 male (median [IQR] age, 26 [23-29] years) control individuals, and 8 female (median [IQR] age, 28 [20-31] years) and 20 male (median [IQR] age, 21 [19-23] years) concussed individuals. Headpulse reached abnormality threshold in 26 of 32 concussed individuals (81%; 9% on day 0, 50% by day 2, 90% by day 14). Headpulse alterations lasted 14 days longer than symptoms and were exacerbated by return-to-play or unsupervised physical activity. Conclusions and Relevance: In this study of 101 amateur Australian Rules Football athletes, the digital headpulse biometric was evaluated in 44 sports-related concussions. Compared with controls, new headpulse changes occurred after concussion; this objective metric may complement return-to-play protocols.

Association Between Centralization and Outcome for Children Admitted to Intensive Care in Australia and New Zealand: A Population-Based Cohort Study.

OBJECTIVES: To describe regional differences and change over time in the degree of centralization of pediatric intensive care in Australia and New Zealand (ANZ) and to compare the characteristics and ICU mortality of children admitted to specialist PICUs and general ICUs (GICUs). DESIGN: A retrospective cohort study using registry data for two epochs of ICU admissions, 2003-2005 and 2016-2018. SETTING: Population-based study in ANZ. PATIENTS: A total of 43,256 admissions of children aged younger than 16 years admitted to an ICU in ANZ were included. Infants aged younger than 28 days without cardiac conditions were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was risk-adjusted ICU mortality. Logistic regression was used to investigate the association of mortality with the exposure to ICU type, epoch, and their interaction. Compared with children admitted to GICUs, children admitted to PICUs were younger (median 25 vs 47 mo; p < 0.01) and stayed longer in ICU (median 1.6 vs 1.0 d; p < 0.01). For the study overall, 93% of admissions in Australia were to PICUs whereas in New Zealand only 63% of admissions were to PICUs. The adjusted odds of death in epoch 2 relative to epoch 1 decreased (adjusted odds ratio [AOR], 0.50; 95% CI, 0.42-0.59). There was an interaction between unit type and epoch with increased odds of death associated with care in a GICU in epoch 2 (AOR, 1.63; 95% CI, 1.05-2.53 for all admissions; 1.73, CI, 1.002-3.00 for high-risk admissions). CONCLUSIONS: Risk-adjusted mortality of children admitted to specialist PICUs decreased over a study period of 14 years; however, a similar association between time and outcome was not observed in high-risk children admitted to GICUs. The results support the continued use of a centralized model of delivering intensive care for critically ill children.

Physiological Response Differences between Run and Cycle High Intensity Interval Training Program in Recreational Middle Age Female Runners.

The aim of this investigation was to compare the changes in endurance running performance and physiological variables after a four-week period of high intensity interval training (HIIT) in either running or cycling in female athletes. Fourteen recreational female runners (age = 42 10 yr, height = 1.67 0.06 m, body mass = 61.6 10.4 kg, body mass index (BMI) = 22.2 3.4 kg.m-2) were randomly allocated to one of two HIIT training groups: running (HIITrun) or cycling (HIITbike). Each group performed two HIIT sessions per week for 4 weeks, which consisted of 6 x 2 min at 95% of maximal heart rate (HRmax) and 4 x 1 min all out efforts. Maximal oxygen consumption (VO2max) in treadmill running increased significantly after the HIITrun (p < 0.01, ES = 0.6) but remained unchanged in HIITbike. However, HIITbike improved average velocity in a 10 km running time trial (TTrun) (p < 0.05, ES = -0.4), whereas, no changes were found for the HIITrun group. Analysing the first and last HIIT sessions, for HIITrun only the average rate of perceived exertion (RPEav) increased significantly, whereas, performance variables such as average heart rate (HRav) and average pace (paceav) remained unchanged. HIITbike enhanced significantly the average speed of HIIT sets (speedav) and the peak power output (PPO) of the session, as well as, the RPEav and delayed onset muscle soreness immediately after HIIT session (DOMSpost) were increased significantly. A regime of HIIT in cycling may evoke increases in female recreational runners' power, which may be related with improvements in a 10 km TTrun independent of changes in aerobic capacity. This may be advantageous in order to avoid overuse running related injuries.

A scoping review of interventions using accelerometers to measure physical activity or sedentary behaviour during hospitalization.

OBJECTIVE: To identify interventions using wearable accelerometers to measure physical activity and/or sedentary behaviour in adults during hospitalization for an acute medical/surgical condition. DATA SOURCES: Four databases were searched in August 2019 (MEDLINE, CINAHL, Scopus, EMBASE). REVIEW METHODS: Studies were selected if they described an intervention in adults with a medical/surgical condition, and concurrently reported an accelerometer-derived measure of physical activity and/or sedentary behaviour while participants were admitted. Items were screened for eligibility in duplicate. Included studies were synthesized to describe intervention types, feasibility and potential effectiveness. RESULTS: Twenty-two studies were included, reporting on 3357 participants (2040 with accelerometer data). Identified types of interventions were: pre-habilitation (n = 2) exercise (n = 3), patient behaviour change with self-monitoring (n = 6), models of care (n = 5), implementing system change (n = 2), surgical technique (n = 2) patients wearing day clothes (n = 1) and education about activity in hospital (n = 1). Of 16 studies that reported intervention effects on physical activity, 11 reported a favourable impact including studies of: pre-habilitation, self-monitoring (accelerometry or an activity whiteboard), physiotherapy, an early mobility bundle, minimally invasive surgery, an education booklet and by implementing system change. Of the six studies that reported intervention effects on sedentary behaviour, there was a favourable impact with an activity whiteboard, models of care and an education booklet. CONCLUSION: Accelerometer-derived measures of physical activity and/or sedentary behaviour have been used to describe sample characteristics and intervention effects in studies of hospitalized adults. Interventions may involve a range of health professionals, but less is known about sedentary behaviour in this setting.

Feasibility of population screening tests to establish a healthy ageing trajectory.

OBJECTIVES: There are no agreed comprehensive tests for age-related changes to physical, emotional, mental and social functioning. Research into declining function focuses on those 75 years and older and little is known about age-related changes in younger people. The aims of this project were (1) to ascertain a comprehensive test battery that could underpin community-based health screening programmes for people aged 40-75 years and pilot both (2) community-based recruitment and (3) the utility, acceptability, response burden and logistics. METHODS: A total of 11 databases were searched using a broad range of relevant terms. An identified comprehensive, recent, high-quality systematic review of screening instruments for detection of early functional decline for community-dwelling older people identified many relevant tools; however, not all body systems were addressed. Therefore, lower hierarchy papers identified in the rapid review were included and expert panel consultation was conducted before the final test battery was agreed. Broad networks were developed in one Australian city to aid pilot recruitment of community-dwellers 40-75 years. Recruitment and testing processes were validated using feasibility testing with 12 volunteers. RESULTS: The test battery captured (1) online self-reports of demographics, health status, sleep quality, distress, diet, physical activity, oral health, frailty and continence; and (2) objective tests of anthropometry; mobility; lung function; dexterity; flexibility, strength and stability; hearing; balance; cognition and memory; foot sensation; and reaction time. Recruitment and testing processes were found to be feasible. CONCLUSION: This screening approach may provide new knowledge on healthy ageing in younger people.

Comparison of Reduced-Volume High-Intensity Interval Training and High-Volume Training on Endurance Performance in Triathletes.

PURPOSE: To investigate changes in physiological and performance variables in triathletes following a 4-wk period of reduced training volume and increased training intensity. METHODS: Sixteen moderately trained triathletes were randomly allocated to 2 groups: a control (CON) group, which followed their usual training, or a high-intensity interval training (HIIT) group, which completed 2 HIIT sessions per week during 4 wk of reduced training volume Results: Maximal oxygen consumption (VO2max) increased significantly in the HIIT group (P = .03, d = 0.5) but remained unchanged in the CON group. Cycling power at first and second ventilatory thresholds increased significantly in the HIIT subjects (P = .03, d = 1.0) and was unchanged in the CON participants (P = .57). During the simulated triathlon test, pretest-posttest cycling times and average power were unchanged in both groups (P > .05). No significant interactive effects between groups were observed for running time (P = .50). CONCLUSION: After a 4-wk HIIT program, VO2max and power at first and second ventilatory thresholds were found to have increased significantly while cycling and running performance were unchanged, despite an overall reduction in training time. In the present study, performance was only shown to improve with usual (high-volume) training. Summarizing, in order to improve running or cycling performances, high-volume training programs are highly recommended.

Agreement between pre-exercise screening questionnaires completed online versus face-to-face.

OBJECTIVES: To investigate the levels of agreement between self-reported responses to the Adult Pre-exercise Screening System (APSS) questionnaire using online versus face-to-face (F2F) modalities. DESIGN: Convenience sample of adults completing a pre-exercise screening questionnaire using different modalities. METHODS: Adult volunteers (n = 94) were recruited to complete the APSS using both online and F2F modalities. Participants were provided a URL link to an online APSS questionnaire then followed-up the next day in a F2F interview. Objective health risk factors were also measured. Comparisons between responses were undertaken using kappa and correlation statistics to determine levels of agreement. RESULTS: The levels of agreement between online versus F2F responses for the seven compulsory Stage 1 questions (known diseases and signs and/or symptoms of disease) were >94% (kappa = 0.644-0.794). Response comparisons for Stage 2 questions on health risk factors were also generally high (>82% agreement) but there were larger differences between reported and measured risk factors in Stage 3. CONCLUSIONS: Levels of agreement between the Stage 1 responses were substantial and support the use of this online option for pre-exercise screening. There were larger differences between self-reported and objectively measured health risk factors in Stages 2 and 3.

A preliminary investigation of the Partners in Health scale measurement properties in patients with end stage renal disease.

End-stage renal disease (ESRD) is becoming more prevalent in Australia. As a result, strategies to improve quality of life when living with ESRD are becoming increasingly important. The Flinders Program has been developed to help support and increase the self-management capacity of people living with chronic disease. The Partners in Health (PIH) scale is a self-management capacity assessment tool, which is an integral element of the Flinders Program. The primary aim of this study was to investigate the preliminary measurement properties of the PIH scale within the ESRD population. Forty participants took part in the study, which involved survey assessments at baseline and follow up and a semi-structured interview. Results indicated that the PIH scale had good internal reliability (α=0.85), moderate test-retest reliability (r=0.33) and face validity in ESRD patients. Areas for improving the instrument or data collection process were identified through qualitative interviews, and implications are discussed specific to ESRD patients.

Changes in Physical Activity Behaviour and Health Risk Factors Following a Randomised Controlled Pilot Workplace Exercise Intervention.

BACKGROUND: Declining physical activity (PA) and associated health risk factors are well established. Workplace strategies to increase PA may be beneficial to ameliorate extensive sedentary behavior. This study assessed the effectiveness of two PA interventions in workplace settings. METHODS: Interventions were conducted over 40 days targeting insufficiently active (<150 min/wk PA) and/or obese (BMI ≥ 30 kg/m2) adults; participants were randomly allocated to instructor-led exercise sessions either after-work (n = 25) or in-work (n = 23) with a 60 minPA/day common goal, or a wait-listed control group (n = 23). The programme commenced with low-moderate physical activities and progressed to high intensity game style activities by week six. Adherence and compliance were determined using both objective measures of daily PA time from HR monitors and self-report responses to PA questionnaires. Cardiovascular and metabolic risk factors were measured pre- and post-intervention. Changes across the study were analysed using Chi square and repeat-measures ANOVA. RESULTS: Adherence rates (completed pre and post-testing) were not different between groups (76.0 vs 65.2%). Compliance for the instructor-led sessions was higher for the after-work group (70.4% vs 26.4%, respectively). Increased total PA and aerobic fitness, and decreased weight in both intervention groups were found relative to controls. The after-work group undertook more vigorous PA, and had greater weight loss and fasting blood glucose improvement, relative to in-work participants and controls. CONCLUSIONS: These workplace interventions resulted in rapid and dramatic increases in PA behaviour and important health benefits. Short, in-work PA sessions were less efficacious than longer after-work sessions.

Impact of stretching on the performance and injury risk of long-distance runners.

Stretching, either prior to exercise or at the end, or both, is typically carried out by all individuals undertaking sporting activity whether they be elite or recreational athletes. The many forms of stretching available to the athlete, either passive or active, have long been thought to improve performance, decrease injury and generally be advantageous to the athlete. This review examines the current state of the literature and evaluates what athletes can and should do with respect to this controversial topic.

Effects of Short-Term Physical Activity Interventions on Simple and Choice Response Times.

Objective. Response time (RT) is important for health and human performance and provides insight into cognitive processes. It deteriorates with age, is associated with chronic physical activity (PA), and improves with PA interventions. We investigated associations between the amount and type of PA undertaken and the rate of change in RT for low-active adults across the age range 18-63 yr. Methods. Insufficiently active adults were assigned to either a walking (n = 263) or higher-intensity (n = 380) exercise program conducted over 40 days. Active controls were also recruited (n = 135). Simple response time (SRT) and choice response time (CRT) were measured before and after the intervention and at 3-, 6-, and 12-month follow-up. Results. SRT and CRT slowed across the age range; however, habitually active participants at baseline had significantly faster CRT (p < 0.05). The interventions increased weekly PA with corresponding increases in physical fitness. These changes were mirrored in faster CRT across the study for both intervention groups (p < 0.05). No changes were found for SRT. Conclusions. Both PA interventions resulted in improvements in CRT among adults starting from a low activity base. These improvements were relatively rapid and occurred in both interventions despite large differences in exercise volume, type, and intensity. There were no effects on SRT in either intervention.

Adherence, Compliance, and Health Risk Factor Changes following Short-Term Physical Activity Interventions.

BACKGROUND: Low physical activity (PA) levels are associated with poor health risk factor profiles. Intervention strategies to increase PA and quantify the rate and magnitude of change in risk factors are important. METHODS: Interventions were conducted over 40 days to increase PA in 736 insufficiently active (<150 min/wk PA) participants using either a pedometer or instructor-led group protocol. There were a further 135 active participants as controls. Major cardiovascular and metabolic risk factors, including fitness parameters, were measured before and after intervention. RESULTS: Adherence to the interventions was higher for the group versus pedometer participants (87.1% versus 79.8%) and compliance rates for achieving sufficient levels of PA (≥150 min/wk) were also higher for the group participants (95.8% versus 77.6%). Total weekly PA patterns increased by 300 and 435 minutes, for the pedometer and group participants, respectively. Improvements were found for waist girth, total cholesterol, aerobic fitness, and flexibility relative to controls. The change in vigorous PA, but not moderate PA, was a significant predictor of the change in eight of 11 risk factor variables measured. CONCLUSIONS: Rapid and dramatic increases in PA among previously insufficiently active adults can result in important health benefits.

Exercise training improves fasting glucose control.

PURPOSE: Numerous studies have measured changes in fasting blood glucose (FBG) levels in response to physical activity (PA) interventions. While studies involving clinical populations such as type 2 diabetics typically report significant reductions, most others report no change in FBG. This study investigated changes in FBG in apparently healthy adults following a PA intervention. METHODS: We measured fingertip samples for FBG pre and post a 40-day PA program in 575 insufficiently active adults. The PA goal was at least 30 minutes of moderate exercise daily, and there was 73% compliance. RESULTS: A PA questionnaire showed the average level of activity was 69 ± 46 min/wk preintervention, and this increased to 635 ± 458 min/wk postintervention. When the change in FBG was regressed against baseline FBG levels, there was a significant negative relationship (y = 2.623 - 0.471 × x; r = 0.472; P < 0.0001). The regression line showed, on average, subjects with low pre-study glucose levels had increased FBG while those with high levels had reductions in FBG. CONCLUSION: It appears that the body's response to PA training is to upregulate glucose control, which is reflected in tighter FBG levels around a physiological set point (5.6 mmol/L, in the present study). Regulation of blood glucose is a complex neuroendocrine process with numerous organs involved, but it was not possible in the present study to determine which of these regulatory steps are involved in exercise-induced changes of FBG.

A comparison of two short-term intensive physical activity interventions: methodological considerations.

BACKGROUND: Increases in chronic illness due to sedentary lifestyles and poor metabolic fitness have led to numerous intervention strategies to promote physical activity (PA). This paper describes the methodological strategies of two short-term PA interventions. Outcome measures reported are PA adherence and compliance rates during the intervention and at 3, 6 and 12-month follow-up. METHODS: The 40-day interventions were: a pedometer-based walking program (n = 251) and a group-based intensive program (n = 148). There was also an active control group (n = 135). Intervention subjects were prescribed PA each day and required to record all activity sessions (pedometer steps or energy expenditure from heart rate monitors). RESULTS: Compliance (≥ 150 min/wk PA) was highest post-intervention (81.1% and 64.5% for the group and pedometer subjects, respectively) and then progressively decreased across the 12-month follow-up period (final compliance rates were 53.5% and 46.6%, respectively) although they remained significantly higher than pre-intervention rates (zero %). There was significantly higher adherence to 6 months (75.0% and 64.9%), and compliance to 3 months (64.9% and 51.0%), for group versus pedometer subjects. The active control group maintained the highest adherence and compliance rates across the study. CONCLUSIONS: The group-based program resulted in higher adherence and compliance rates post-intervention although both types of interventions showed long-term effectiveness to increase activity patterns.

Position statement on physical activity and exercise intensity terminology.

The terminology used for monitoring and promoting physical activity and exercise among health and fitness professionals varies considerably. There is a large array of descriptor terms reported in the literature and used in day-to-day practice and this inconsistency can be confusing for clients and practitioners alike. The variation in terminology also makes it difficult to track changes in activity patterns over time and across studies. There are also a range of objective and relative intensity cut-offs used to describe the same intensity descriptors. This position statement addresses the question of standardisation of physical activity and exercise intensity terminology and makes recommendations that should assist those undertaking research and prescribing physical activity/exercise as well as those clients who are receiving professional guidance.

Glucose control, organ failure, and mortality in pediatric intensive care.

OBJECTIVE: In ventilated children, to determine the prevalence of hyperglycemia, establish whether it is associated with organ failure, and document glycemic control practices in Australasian pediatric intensive care units (PICUs). DESIGN: Prospective inception cohort study. SETTING: All nine specialist PICUs in Australia and New Zealand. PATIENTS: Children ventilated > 12 hrs excluding those with diabetic ketoacidosis, on home ventilation, undergoing active cardiopulmonary resuscitation on admission, or with do-not-resuscitate orders. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All blood glucose measurements for up to 14 days, clinical and laboratory values needed to calculate Paediatric Logistic Organ Dysfunction (PELOD) scores, and insulin use were recorded in 409 patients. Fifty percent of glucose measurements were > 6.1 mmol/L, with 89% of patients having peak values > 6.1 mmol/L. The median time to peak blood glucose was 7 hrs. Hyperglycemia was defined by area under the glucose-time curve > 6.1 mmol/L above the sample median. Thirteen percent of hyperglycemic subjects died vs. 3% of nonhyperglycemic subjects. There was an independent association between hyperglycemia and a PELOD score > or = 10 (odds ratio 3.41, 95% confidence interval 1.91-6.10) and death (odds ratio 3.31, 95% confidence interval 1.26-7.7). Early hyperglycemia, defined using only glucose data in the first 48 hrs, was also associated with these outcomes but not with PELOD > or = 10 after day 2 or with worsening PELOD after day 1. Five percent of patients received insulin. CONCLUSIONS: Hyperglycemia is common in PICUs, occurs early, and is independently associated with organ failure and death. However, early hyperglycemia is not associated with later or worsening organ failure. Australasian PICUs seldom use insulin.

The application of risk-adjusted control charts using the Paediatric Index of Mortality 2 for monitoring paediatric intensive care performance in Australia and New Zealand.

OBJECTIVE: To assess the applicability of risk-adjusted sequential control charts using the Paediatric Index of Mortality version 2 for monitoring of the quality of paediatric intensive care. DESIGN: Observational study. SETTING: A registry of patient admissions to paediatric intensive care units (PICUs) in Australia and New Zealand. PATIENTS: A total of 10,710 patients admitted to eight PICUs during a 24-month period. MEASUREMENTS AND RESULTS: A series of risk-adjusted control charts was created for each PICU. Modified sequential probability ratio tests were used to test the hypothesis that the PICUs being monitored were 'out of control', where loss of control was arbitrarily defined as the odds of death exceeding twice the odds of dying as estimated by PIM2. In 24 months of monitoring, there was one alarm signal, suggesting the odds of deaths had doubled, and there was one signal, in another PICU, suggesting the odds of death had halved. CONCLUSIONS: The major advantage of risk-adjusted sequential control charts is that the technique allows unit performance to be monitored continuously over time, rather than intermittently, with the aim of rapidly detecting a change in performance as soon as possible after it occurs. This technique is suitable for continuously screening for a change in outcome within a PICU over time and complements other methods of monitoring the quality of paediatric intensive care.

Automated external defibrillators in the Australian fitness industry.

Sudden cardiac arrest (SCA) occurs in many thousands of Australians each year. Scientific evidence shows an increased survival rate for individuals who receive electrical defibrillation in the first few minutes after SCA. In the last decade automated (rhythm-detecting) external defibrillators (AEDs) have become available that are portable and affordable. Although still relatively rare, there is still the potential that SCA may occur when a person undertakes physical activity. Consequently, health/fitness centres are increasingly recognised as higher risk sites that may benefit from placement of AEDs. There are no laws in Australia requiring health/fitness centres to install AEDs. However, several international and professional organisations have "strongly encouraged" larger centres to install AEDs. Guidelines and algorithms are presented to help estimate the risk of SCA in fitness centres. Fitness centre placement is particularly important if the clientele is older or has a 'high-risk' profile, for example, clients with cardiovascular, respiratory or metabolic disease. International negligence case law and duty of care principles suggests the standard of care required in health/fitness centres may be increasing. Therefore, it may be prudent to install AEDs in larger centres and those in which higher risk groups are physically active.