Updated reliability and normative values for the standing heel-rise test in healthy adults.

OBJECTIVES: The heel-rise test is used to assess the strength and endurance of the plantar flexors in everyday clinical practice. However, several factors may affect outcomes, including sex, age, body mass index and activity level. The aims of this study were to revisit the reliability and normative values of this test, and establish normative equations accounting for several factors. DESIGN: Cross-sectional observational study with test-retest. SETTING: Community. PARTICIPANTS: Volunteers (n=566, age 20 to 81 years). INTERVENTIONS: Subjects performed single-legged heel rises to fatigue, standing on a 10° incline, once on each leg. A subset of subjects (n=32) repeated the test 1 week later. Reliability was quantified using intraclass (ICC) correlation coefficients and Bland-Altman plots {mean difference [95% limits of agreement (LOA)]}, whereas the impact of sex, age, body mass index and activity level on the number of heel rises was determined using non-parametric regression models. RESULTS: The test showed excellent reliability (ICC=1.0 right leg, 1.0 left leg), with mean between-day differences in the total number of heel-rise repetitions of 0.2 (95% LOA -6.2 to 6.5) and 0.1 (95% LOA -6.1 to 6.2) for right and left legs, respectively. Overall, males completed more repetitions than females (median 24 vs 21). However, older females (age >60years) outperformed older males. According to the model, younger males with higher activity levels can complete the most heel rises. CONCLUSIONS: The heel-rise test is highly reliable. The regression models herein can be employed by clinicians to evaluate the outcomes of heel-rise tests of individuals against a comparable normative population.

Physical exercise ameliorates deficits induced by traumatic brain injury.

The extent and depth of traumatic brain injury (TBI) remains a major determining factor together with the type of structural insult and its location, whether mild, moderate or severe, as well as the distribution and magnitude of inflammation and loss of cerebrovascular integrity, and the eventual efficacy of intervention. The influence of exercise intervention in TBI is multiple, ranging from anti-apoptotic effects to the augmentation of neuroplasticity. Physical exercise diminishes cerebral inflammation by elevating factors and agents involved in immunomodulatory function, and buttresses glial cell, cerebrovascular, and blood-brain barrier intactness. It provides unique non-pharmacologic intervention that incorporate different physical activity regimes, whether dynamic or static, endurance or resistance. Physical training regimes ought necessarily to be adapted to the specific demands of diagnosis, type and degree of injury and prognosis for individuals who have suffered TBI.

Self-related health, physical activity and musculoskeletal complaints in Swedish high school students.

AIM: There is a positive correlation between physical activity and health. The aim of this study was to describe self-related health, sports, level of physical activity and possible musculoskeletal complaints among Swedish high school students and to analyze whether there were any differences in these aspects between gender and students from different high school programs. METHODS: A questionnaire was distributed and a total of 1,090 high school students answered it (468 males, 622 females), aged 16-26 years. RESULTS: Students from theoretical programs reported better self-related health than students from practical programs. Females from practical programs reported poorer self-related health than other students. Physically active students reported better self-related health than less physically active students. Fifty-seven percent reported to be physically active in sport. Students from practical programs were less physically active than those from theoretical programs. Females from the practical programs were the least active ones. Fifty percent of the students reported complaints; the percentage was higher among females. There was no difference between students from theoretical and practical programs in terms of reporting complaints. Back and knee complaints were the most common ones. CONCLUSION: According to these results it would be advisable for adolescents to be stimulated to participate in physical activity in order to increase the possibility of a healthy life.

Physical activity, health, BMI and body complaints in high school students.

AIM: Children and adolescents in the industrial world are becoming less physically active and are adopting a sedentary lifestyle in front of computers and TV. The aim of the present investigation was to determine self-related health, physical activity, prevalence of overweight and body complaints in high school students in Norway, and to compare students in academic programs with those in vocational programs. METHODS: Seven hundred and two high school students aged 16-19 years were included in the study. A questionnaire was completed in three high schools and included questions about weight and height, health, physical activity, type of physical activity/sport, intensity, possible injuries or complaints during the last three months. RESULTS: Twenty three percent of the students suffers from overweight/obesity are at risk of being overweight. Males reported better health than females (P<0.02). Sixty-six percent of the study group reported body complaints during the last three months, a higher number of females than males (P=0.001). Students in vocational programs reported poorer self-related health than those in academic programs and the males reported better self-related health generally than females. Furthermore, there were a higher level of prevalence of overweight students in vocational programs than academic programs (P=0.039). CONCLUSION: It is important to make it easy for school children and adolescents to do physical activity at school and during leisure time in order to prevent overweight and obesity as well as chronic diseases later in life.

Young elite cross-country skiers and low back pain-A 5-year study.

OBJECTIVES: To evaluate possible changes in spinal curvature over a period of 5 years of an elite cross-country skiing squad, and to study whether there are any differences in this respect between individuals who report low back pain and those how do not. PARTICIPANTS: Fifteen young cross-country skiers (M age=13.6±0.9) participated voluntarily throughout the entire study period. MAIN OUTCOME MEASURES: Debrunner's kyphometer was used for measuring the difference between thoracic kyphosis and lumbar lordosis of the spine. All subjects also answered a questionnaire including questions about ski-related low back pain, the amount of ski training, and participation in other sports. RESULTS: The results at the end of the 5-year period comprise data from 15 skiers (M age=18.5±0.9 years). The relationship between thoracic kyphosis and lumbar lordosis increased from 3.5° to 13.1°, respectively (p=0.0001). Of the 15 elite cross-country skiers, seven reported low back pain at the 5-year examination. At the 5-year follow-up, skiers with low back pain showed significantly higher relationship between thoracic kyphosis and lumbar lordosis than did those skiers without low back pain, 18.2° and 10.5°, respectively (p=0.035). Of the eight elite cross-country skiers without low back pain, seven were also involved in other sports (p=0.005). CONCLUSIONS: Based on these findings, our advice is that adolescent cross-country skiers also should participate in other physical activities besides cross-country skiing.

Self-reported health, physical activity and prevalence of complaints in elite cross-country skiers and matched controls.

AIM: The purpose of this study was to compare physical health, physical activity and location for possible symptoms in high school students with cross-country skiers of the same age from ski high schools. Another aim was to study back pain with regards to influence on skiing. METHODS: The subjects studied were: 92% (n=120) of all Swedish cross-country skiers at ski high schools and 68% (n=993) of regular high school students from the North part of Sweden answered a reliable questionnaire (r=1) with regards to health, physical activity and location of possible symptoms/injuries during the last 3 months. Furthermore, the skiers answered questions on possible ski related back pain. RESULTS: All skiers were active also in other sports compared with 26% of the controls and at considerably higher levels of physical effort than the controls; 92% of the skiers and 76% of the controls described themselves as healthy, meaning ''very good'' or ''good'' (P=0.0001); 55% of the skiers and 64% of the controls reported recent symptoms (P=0.06); 47% of the skiers reported previous or present complaints of back pain, mainly low back pain, which could be relieved by changing body position from a flexed to a more extended one while skiing, and 77% reported their back pain to disappear during rest. CONCLUSIONS: These results show the need for encouraging regular high school students to participate in sport. It also shows the importance of introducing preventative strategies regarding back pain to long-distance cross-country skiers, who are exposed to a prolonged flexed position of their back.

The effect of pre-season dance training on physical indices and back pain in elite cross-country skiers: a prospective controlled intervention study.

OBJECTIVE: To evaluate the effect of pre-season dance training on back pain, joint mobility, and muscle flexibility, and on speed and agility in elite cross-country skiers. METHODS: 26 skiers participated (mean (SD) age, 19 (3.9) years). An intervention group (n = 16) had 12 weeks of dance training; a control group (n = 10) did not dance; otherwise both groups followed a similar pre-season physical training programme. Joint mobility and muscle flexibility of the spine, hip, and ankle were measured. Two sports related functional tests (slalom and hurdle) were also done. All measurements/tests were carried out before and after the dancing period. RESULTS: Four (of six) subjects from the intervention group who initially complained of ski related back pain did not report back pain after the dance training; the three subjects with back pain from the control group were unchanged. At study onset the intervention group had a slightly impaired range of motion in the spine compared with the control group. After dance training, there was a better relation between kyphosis of the thoracic spine and lordosis of the lumbar spine, and a 7.1 degrees increase in hip flexion with the knee extended (p = 0.02). In the control group hip extension decreased by 0.08 m on average (p = 0.01). No positive effects of dance training on sports related functional tests were observed. CONCLUSIONS: Preseason dance training improved the range of hip motion and joint mobility and the flexibility of the spine. These improvements might explain the reduction in ski related back pain in the intervention group.

The effect of dance training on joint mobility, muscle flexibility, speed and agility in young cross-country skiers--a prospective controlled intervention study.

We evaluated a short-term (3 months) and a long-term (8 months) effect of dance training on joint mobility and muscle flexibility of the spine, hip and ankle and on speed and agility in young cross-country skiers. Twenty elite cross-country skiers - aged 12-15 years - participated in the study. Five males and five females received dance training (intervention group) and five males and five females did not dance (reference group). Joint mobility and muscle flexibility of the spine, hip and ankle joints were measured using a goniometer, a kyphometer, a measuring tape and a ruler. Two sports-related functional tests - the slalom-test and the hurdle-test - were also performed. These measurements/tests were performed before the start of the dancing period and after 3 and 8 months. The subjects from the intervention group increased their speed with 0.3 s after 3 (P = 0.05) and 8 months (P = 0.02), respectively, when measured with the slalom-test. They also improved their speed and agility according to the hurdle-test after 3 months with 0.8 s (P = 0.000) and 8 months with 0.6 s (P = 0.01). Furthermore, they increased flexion-extension of the thoracic spine with 7.5 degrees after 3 months (P = 0.05) and with 9 degrees degrees after 8 months (P = 0.03) and lateral flexion of the spine with 0.04 m (P = 0.005) and 0.03 m (P = 0.02) after 3 and 8 months, respectively. The reference group was impaired or unchanged in the studied parameters after both 3 and 8 months. We conclude that dance training has a positive effect on speed and agility and on joint mobility and muscle flexibility in flexion-extension and lateral flexion of the spine in young cross-country skiers.

Reliability of sports related functional tests with emphasis on speed and agility in young athletes.

The aim of the present investigation was to test the reliability of two sports related functional tests, a speed test (slalom-test) and an agility test (hurdle-test). Eleven athletes aged 11 years (8 boys, 3 girls) participated voluntarily in the study. All subjects completed four different test sessions for both the slalom-test and the hurdle-test using six standard track hurdles placed at 2-m intervals along a 12-m length of track. There were no significant differences between testing sessions for either the slalom-test (P=0.99) or the hurdle-test (P=0.96), showing no systematic variation between test times. The intraclass correlation coefficients were 0.96 and 0.90 respectively, indicating a good reliability. We conclude that the slalom-test and the hurdle-test are reliable sports related functional tests for measuring speed and agility in groups of young athletic individuals.

Mobility, muscular strength and endurance in the cervical spine in Swedish Air Force pilots.

PURPOSE: Muscle strength, endurance and range of movement of the cervical spine in a group of Swedish Air Force jet pilots (AF) and in a reference group of conscripts doing their military service (RG) were compared. METHODS: We tested 30 (AF) 24-42 yr and 33 (RG) 19-22 yr. A questionnaire was used to document complaints. Maximum voluntary isometric muscle strength of the flexor and extensor muscles of the cervical spine and sub-maximum isometric endurance in the flexor and extensor muscles were measured. RESULTS: Eleven AF (37%) and four RG (12%) had experienced discomfort in the neck within the previous year. The pilots' flexor and extensor muscle strength (47 Nm and 65 Nm) was superior to that of the conscripts (36 Nm and 59 Nm) (p = 0.0001, p = < 0.05, respectively). However, the RG group had greater isometric endurance in the flexor muscles than AF (p = < 0.05) and greater neck rotation (p = <0.005). There was no difference between the two groups in the other variables. CONCLUSION: Differences between the groups with regard to muscle strength and endurance might depend on variations in work-related physical muscle strain, and/or differences in fiber composition in the muscles, which might be reflected by pilot selection procedures.