Enhanced ventricular-arterial coupling during a 2-year physical activity programme in patients with rheumatoid arthritis: a prospective substudy of the physical activity in rheumatoid arthritis 2010 trial.

OBJECTIVE: To establish how guided physical activity in patients with rheumatoid arthritis (RA) without known cardiovascular disease affected vascular and cardiac function, and how these two entities were prospectively interconnected in this patient group. METHODS: Prospective substudy of 29 participants in the Physical Activity in RA (PARA) 2010 trial. All subjects were examined at baseline, at year 1 and 2 with measures of pulse wave velocity and arterial augmentation index, as well as echocardiographic evaluation of diastolic parameters and ventricular-arterial coupling. Muscle strength and aerobic exercise capacity were assessed at baseline and yearly. All participants performed physiotherapist-guided aerobic and muscle strength exercise during 2 years and were reminded through SMS to report physical activity progress. RESULTS: This cohort of patients with RA exhibited increased vascular stiffness despite normal blood pressure. At baseline, lower muscle strength was associated with increased vascular stiffness (ß = 0.68; P = 0.004), whereas lower aerobic working capacity was associated with left ventricular diastolic dysfunction (ß = 0.85; P = 0.03). There was a significant positive correlation between vascular stiffness and diastolic dysfunction at baseline (R2  = 0.64) and for the changes in those parameters observed during 2 years of guided physical activity. Finally, a significant improvement in ventricular-arterial coupling was observed after exercise (P < 0.001). CONCLUSION: These results indicate that although differentially associated with physical capacity parameters, improved vascular stiffness and improved diastolic dysfunction are interrelated, and that an optimization of the ventricular-arterial coupling may contribute to the beneficial effects of physical activity in patients with RA.

Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective.

Many risk factors for injury are presented in the literature, few of those are however consistent and the majority is associated with adult and not adolescent elite athletes. The aim was to identify risk factors for injury in adolescent elite athletes, by applying a biopsychosocial approach. A total of 496 adolescent elite athletes (age range 15-19), participating in 16 different sports, were monitored repeatedly over 52 weeks using a valid questionnaire about injuries, training exposure, sleep, stress, nutrition, and competence-based self-esteem. Univariate and multiple Cox regression analyses were used to calculate hazard ratios (HR) for risk factors for first reported injury. The main finding was that an increase in training load, training intensity, and at the same time decreasing the sleep volume resulted in a higher risk for injury compared to no change in these variables (HR 2.25, 95% CI, 1.46-3.45, P<.01), which was the strongest risk factor identified. In addition, an increase by one score of competence-based self-esteem increased the hazard for injury with 1.02 (HR 95% CI, 1.00-1.04, P=.01). Based on the multiple Cox regression analysis, an athlete having the identified risk factors (Risk Index, competence-based self-esteem), with an average competence-based self-esteem score, had more than a threefold increased risk for injury (HR 3.35), compared to an athlete with a low competence-based self-esteem and no change in sleep or training volume. Our findings confirm injury occurrence as a result of multiple risk factors interacting in complex ways.

Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes.

Little is known about health variables and if these variables could increase the risk of injuries among adolescent elite athletes. The primary aim was to present overall data on self-perceived stress, nutrition intake, self-esteem, and sleep, as well as gender and age differences, on two occasions among adolescent elite athletes. A secondary aim was to study these health variables as potential risk factors on injury incidence. A questionnaire was e-mailed to 340 adolescent elite athletes on two occasions during a single school year: autumn semester and spring semester. The results show that during autumn semester, the recommended intake of fruits, vegetables, and fish was not met for 20%, 39%, and 43% of the adolescent elite athletes, respectively. The recommended amount of sleep during weekdays was not obtained by 19%. Multiple logistic regression showed that athletes sleeping more than 8 h of sleep during weekdays reduced the odds of injury with 61% (OR, 0.39; 95% CI, 0.16-0.99) and athletes reaching the recommended nutrition intake reduced the odds with 64% (OR, 0.36; 95% CI, 0.14-0.91). Our findings suggest that nutrition intake and sleep volume are of importance in understanding injury incidence.

Expression of sex steroid hormone receptors in human skeletal muscle during the menstrual cycle.

AIM: Variations in sex hormone levels during the menstrual cycle may affect neuromuscular performance and the risk of sustaining musculoskeletal injury in women. The aim of this study was to investigate mRNA and protein levels for sex steroid hormone receptors in skeletal muscle in three distinct phases of the menstrual cycle. METHODS: Fifteen, healthy women with regular menstrual cycles participated in the study. Muscle biopsies from the vastus lateralis were obtained in three hormonally verified phases of the menstrual cycle for each individual, that is the follicular phase, the ovulatory phase and the luteal phase. mRNA and protein levels of oestrogen (ERα and ERß), progesterone (PR) and androgen (AR) receptors were analysed. RESULTS: There was an overall significant variation in mRNA and protein levels of ERα and PR across the menstrual cycle. mRNA and protein levels of ERα were highest in the follicular phase when oestradiol levels were low, whereas protein levels of PR were highest in the luteal phase when progesterone levels were high. mRNA levels of PR were highest in the ovulatory phase. No significant variation in AR levels was detected across the menstrual cycle. ERß levels were very low in all three phases of the menstrual cycle. CONCLUSION: Significant variations in mRNA and protein levels of ERα and PR were detected in skeletal muscle during three confirmed phases of the menstrual cycle. These results may have an impact on effects of muscular training and sports injuries in women.

Enhancing meaningful learning and self-efficacy through collaboration between dental hygienist and physiotherapist students - a scholarship project.

INTRODUCTION: Within the field of Dental Hygiene (DH) and Physiotherapy (PT), students are taught to use an evidence-based approach. Educators need to consider the nature of evidence-based practice from the perspective of content knowledge and learning strategies. Such effort to seek best available evidence and to apply a systematic and scholarly approach to teaching and learning is called scholarship of teaching and learning. OBJECTIVES: To evaluate the application of the scholarship model including an evidence-based approach to enhance meaningful learning and self-efficacy among DH and PT students. METHODS: Based on the research on student learning, three central theories were identified (constructivism, meaningful learning and self-efficacy). These were applied in our context to support learner engagement and the application of prior knowledge in a new situation. The DH students performed an oral health examination on the PT students, and the PT students performed an individual health test on the DH students; both groups used motivational interviewing. Documentation of student's learning experience was carried out through seminars and questionnaires. RESULTS: The students were overall satisfied with the learning experience. Most appreciated are that it reflected a 'real' professional situation and that it also reinforced important learning from their seminars. CONCLUSION: The scholarship model made the teachers aware of the importance of evidence-based teaching. Furthermore, the indicators for meaningful learning and increased self-efficacy were high, and the students became more engaged by practising in a real situation, more aware of other health professions and reflected about tacit knowledge.

Ankle-joint mobility and standing squat posture in elite junior cross-country skiers. A pilot study.

AIM: Skating technique in cross-country skiing is a complex multi-joint movement with kinematics comparable to those of the standing squat exercise where any restricted joint mobility in the lower extremity-chain may change the movement pattern. The aim of this pilot study was to investigate the effect of ankle mobility on trunk posture during squat exercise in cross-country skiers. METHODS: Seven elite junior cross-country skiers (age range 17-19 years) performed two different standing squats, one with hands on hips and one with arms extended above the head. The squats were recorded on video and analyzed in selected positions: 90 degrees and maximal knee flexion. Segment angles for shank and trunk were calculated from anatomical references relative to vertical/horizontal orientation in space. Recordings from passive ankle dorsiflexion were correlated with 1) trunk flexion, and 2) angle index (trunk flexion relative to shank angle). RESULTS: Reduced ankle dorsiflexion was moderately associated with increased trunk flexion with hands on hips (r=-0.51 to -0.57), and arms above head (r=-0.61 to -0.64). Further, reduced dorsiflexion was also moderately associated with decreased angle index with hands on hip (r=0.60 to 0.67) but highly associated with decreased angle index with arms above head (r=0.75 to 0.76). CONCLUSION: The results imply that reduced ankle dorsal mobility is related to decreased angle index as well as increased trunk flexion during squat exercise, thus indicating the relevance of good ankle joint mobility for appropriate upper-body posture during squat exercise.

Pilot study of female high school basketball players' anterior cruciate ligament injury knowledge, attitudes, and practices.

An anterior cruciate ligament (ACL) injury prevention program was evaluated. One hundred and thirteen female high school varsity and junior varsity basketball players and 12 coaches participated in an 8-week educational and skills program. Demographic and injury history data were collected. At pre-intervention and at the end of season, knowledge, attitudes, and practices about ACL risk and injury prevention were assessed via questionnaires, and frequency of two-footed landings were videotaped during games. Univariate statistics described the sample. Paired t-tests evaluated the program's impact. Cronbach's alpha, correlations, and kappa statistics assessed the validity and reliability of questionnaires and video analysis. Of the 113 players, 74 completed the study. The players' mean age was 16.25 years (SD=1.07; range=14.2-18.8). Baseline knowledge score was 57.2%, practice 58.4%, and attitude 73.5%. The mean baseline knowledge score of the 12 coaches (mean age=40.8 years; SD=10.3; range=26.9-56.3) was 68.7%. Players' knowledge about ACL injury prevention improved (t=2.57; P<0.01). No changes in attitudes toward injury prevention were found (t(diff)=1.88; P<0.06). Inter-rater reliability of two-footed landings observed was acceptable (kappa=0.72). Videotape analyses revealed a 5.5% increase in landing performance (t(diff)=9.6; P<0.0001). The program increased knowledge about ACL injury risk and improved player's landing skills.

The influence of premenstrual symptoms on postural balance and kinesthesia during the menstrual cycle.

Recent studies have indicated an increased incidence of female athletic injuries during the luteal phase and the first days of the menstrual period. The purpose of this study was to investigate whether postural sway and knee-joint kinesthesia very during the menstrual cycle, and whether premenstrual syndrome (PMS) influences postural balance and kinesthesia. A total of 13 subjects with regular menstrual cycles participated in the study. Postural sway and kinesthesia were measured in the early follicular phase, in the ovulation phase and in the mid-luteal phase. Postural sway was measured with an ankle disc placed on a Statometer, and kinesthesia was measured with a specially designed device. Menstrual cycle phases were determined by sex hormone analyses in serum and by luteinizing hormone (LH) detection in urine. The diagnosis of PMS was made prospectively using validated daily symptom ratings. Eight of 13 women were classified as having PMS. These women had a significantly greater postural sway (p = 0.002) and a greater threshold for detection of passive motion in the knee joints (p = 0.05) than women without PMS. A tendency (p = 0.06) towards greater postural sway in the mid-luteal phase was detected among women with PMS. This may explain the finding of an increased incidence of athletic injuries in the luteal phase, reported previously.