Protocol for a feasibility randomized controlled trial of gentle yoga in older patients discharged from phase II cardiac rehabilitation.

Background: Physical activity (PA) is essential following an acute cardiac event. Cardiac rehabilitation (CR) is commonly prescribed, and PA after CR is recommended. Because of age-related changes in functional ability and multi-comorbidity, many older cardiac patients struggle to continue performing PA at home after CR. Depressive symptoms and anxiety are prevalent in cardiac patients and associated with poor self-care, including lack of daily PA. Yoga has been demonstrated to improve psychological and physical health outcomes in cardiac patients, but it is unknown whether yoga, modified for older CR patients - Gentle Yoga - is beneficial in managing psychological distress and maintaining PA following phase II CR. Our specific aims are to:1) determine the feasibility and acceptability of a modified gentle yoga intervention delivered via video conferencing for older cardiac patients; 2) compare, at 3-month follow-up, the effects and determine effect sizes of a gentle yoga intervention versus control on psychological health and physical health. Methods: We are conducting a 2-group (intervention versus control) randomized controlled pilot study. The intervention is a 12-week gentle yoga program delivered via video conference. Short-term effects will be evaluated at 3-month. Conclusion: This study is designed to be suited for older cardiac patients who would not have access to supervised PA opportunities after facility-based CR to enhance PA. This study will provide data about the feasibility and acceptability of the protocol for older cardiac patients and will offer effect sizes to determine sample size for a fully powered randomized controlled trial.

The Influence of Emergency Call Volume on Occupational Workload and Sleep Quality in Urban Firefighters.

OBJECTIVE: To determine the impact of emergency call volume on exertion, autonomic activity, and sleep among urban structural firefighters. METHODS: Thirty-four firefighters wore a wrist-based monitor to track sleep and autonomic parameters and rated their level of perceived exertion (RPE) and subjective sleepiness after a 24-hour shift. Predictive variables included total run time and total run time after 11:59 PM. RESULTS: Total run time and sleep duration accounted for RPE and subjective sleepiness; while total run time and total run time after 11:59 PM accounted for sleep durations on-duty. CONCLUSIONS: The current results suggest emergency call volume is associated with indicators of exertion and sleep. As such, call volume tracking is an important consideration for departments to ensure personnel readiness and wellness and provide a method of tracking the occupational demands experienced by firefighters on-duty.

Relationships Among Baseline Concussion Balance Test and Gaze Stability Test Scores in Division-I Collegiate Athletes.

CONTEXT: Sports-related concussions are commonly occurring injuries as a result of sports and recreation that may cause alterations in brain functioning. It is important to be able to evaluate the impact of these injuries on function to manage the injury recovery and ensure recovery. Recent literature suggests the use of objective evaluation strategies in a multifaceted approach to evaluate and manage these injuries. It is important to understand the relationships between the assessments and how best to utilize each assessment. The purpose of this study was to investigate if relationships exist between measures of vestibular function at baseline in assessments that may be used following sports-related concussions. Additionally, a secondary purpose was to determine if self-reported symptoms were related to performance on the assessments. This study aimed to identify if these assessments measured independent functions of the vestibulo-ocular reflex or if some redundancy existed among the assessment strategies. DESIGN: A cross-sectional study design was used in a cohort of collegiate athletes ages 18-24. METHODS: Participants completed demographics questionnaires, the Post-Concussion Symptom Scale, Gaze Stabilization Test, and Concussion Balance Test. Spearman rho correlations were used to examine the relationships between the measures. RESULTS: One hundred and thirty-five collegiate athletes (82 males and 53 females) were included, representative of 3 sports (cheerleading, soccer, and football) with a mean age of 19.77 (1.42) years old. There were weak to moderate, significant relationships between measures of Gaze Stabilization Test and Concussion Balance Test errors (r = .20-.31, P = .001-.03). CONCLUSIONS: The direction of these relationships indicated that greater Concussion Balance Test errors were associated with greater Gaze Stabilization Test performance. These relationships may be attributed to the difficulty created by the foam conditions and the integration of more complex sensory tasks required to maintain balance during the more difficult conditions.

Etiology of Exercise Injuries in Firefighters: A Healthcare Practitioners' Perspective.

The purpose of this study was to query healthcare practitioners (HCPs) who treat firefighter injuries to identify risk factors and mechanisms associated with musculoskeletal injuries during exercise. A phenomenological design was utilized to understand the experiences of HCPs while treating firefighters' musculoskeletal injuries due to exercise. Semi-structured interviews were conducted with 14 HCPs. Two interviews were pilot-tested with HCPs to ensure reliability and validity. Interviews were transcribed and uploaded to a qualitative analysis software program. Although the study inquired about injuries incurred by any exercise modality (e.g., endurance and resistance training), injuries induced during resistance training were prominent among HCPs as resistance training emerged as a primary exercise injury mechanism. HCPs indicated that the back and shoulder were prevalent anatomical exercise injury locations. Risk factors for exercise injuries included age, immobility, movement proficiency, and factors associated with fatigue. Exercise injury mechanisms included poor resistance training technique and overexertion. These findings could guide exercise program design, use of movement assessments, and the identification of other countermeasures to decrease the risk of resistance training exercise injuries among firefighters.

The effect of extended shift work on autonomic function in occupational settings: A systematic review and meta-analysis.

OBJECTIVE: To examine the effect of 24-h shift work on autonomic nervous system function via heart rate variability (HRV) methodologies. METHODS: Electronic databases (indexed in either PubMed, MEDLINE, CINAHL, SPORTDiscus, or OpenDissertations) were searched from January 1964 to March 2023. A modified Downs and Black checklist was used for assessing methodological quality and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the quality of evidence. Study design, study population, study sample, shift work description, and assessment of HRV metrics and methods were extracted from each study. FINDINGS: A total of 58 478 study articles were identified, of which 12 articles met inclusion criteria. Sample sizes varied from eight to 60 participants, with the ratio of low- to high-frequency HRV (LF/HF) as the most common frequency-domain variable reported. Of the nine included studies that observed LF/HF, three (33.3%) demonstrated a significant increase after 24-h shift work. Moreover, of the five studies that reported HF, two (40%) noted a significant decrease after 24-h shift work. When observing risk of bias, two (16.6%) studies were low quality, five (41.7%) were moderate quality, and five (41.7%) were high quality. INTERPRETATION: There were inconsistent findings demonstrating an effect of 24-h shift work on autonomic function, with a suggested shift away from parasympathetic dominance. Discrepancies in HRV methodologies, such as the duration of recordings and hardware used for measurement, may have contributed to the disparity in findings. In addition, differences in roles and responsibilities across occupations may explain the incongruence in findings across studies.

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).

The Acute Effect of High-Intensity Resistance Training on Subsequent Firefighter Performance.

ABSTRACT: Mason, MR, Heebner, NR, Abt, JP, Bergstrom, HC, Shapiro, R, Langford, EL, and Abel, MG. The acute effect of high-intensity resistance training on subsequent firefighter performance. J Strength Cond Res 37(7): 1507-1514, 2023-High-intensity resistance training (HIRT) is commonly performed by structural firefighters on duty to enhance occupational readiness. However, exercise-induced fatigue may negatively impact subsequent occupational performance. Therefore, the purpose of this study was to assess the acute effect of HIRT on subsequent occupational physical ability in structural firefighters and to determine the time course of recovery. Seven resistance-trained male firefighters performed a timed maximal effort simulated fireground test (SFGT) in 3 randomized conditions: baseline (SFGT baseline ), 10 minutes post HIRT (SFGT 10min ), and 60 minutes post HIRT (SFGT 60min ). Work efficiency and air depletion were assessed during the SFGT. The timed HIRT session consisted of a standardized set of exercises using absolute training loads. Repeated measures analysis of variance and minimal difference (MD) analysis assessed group and individual effects between the conditions, respectively. The level of significance was set at p < 0.05. SFGT 10min completion time was greater than SFGT baseline (430 ± 137 vs. 297 ± 69 seconds, p < 0.01), with no difference between SFGT baseline and SFGT 60min (297 ± 69 vs. 326 ± 89 seconds, p = 0.08). The MD analysis indicated that all firefighters' SFGT 10min times exceeded the MD (±26.4 seconds) compared with SFGT baseline . However, 43% of firefighters still exceeded the MD at SFGT 60min . Air depletion during SFGT 10min was greater than that during SFGT baseline (2,786 ± 488 vs. 2,186 ± 276 lb·in -2 , p = 0.02), with no difference between SFGT baseline and SFGT 60min ( p = 0.25). Work efficiency during SFGT 10min was 40% lower than that during SFGT baseline ( p < 0.01), with no difference between SFGT baseline and SFGT 60min ( p = 0.25). These findings indicate that an acute bout of HIRT decreases multiple descriptors of firefighters' occupational performance 10 minutes post exercise with varied responses at 60 minutes post exercise.

Computerized Cognitive Function Does Not Correlate With Choice Reaction Time During a Hopping Task.

CONTEXT: Cognitive performance has been shown to be associated with musculoskeletal injury risk. Cognitive assessments are often administered in controlled environments despite sport settings challenging cognition in uncontrolled, less predictable environments. Cognitive assessments should be representative of sport demands; thus, integrating motor with cognitive assessments may be more clinically relevant. Accordingly, the purpose of this research was to investigate the relationship between tablet-based cognitive tests and choice reaction time during a hopping task. DESIGN: Cross-sectional. METHODS: A total of 20 healthy participants volunteered to participate. Participants completed 3 tablet-based cognitive assessments. Average raw response time and fully corrected scores were used for analysis. In addition, participants completed a choice reaction hopping task to capture neuromuscular-cognitive reaction time. Participants completed a forward hop over a hurdle, landing on a single limb. Light sensors were utilized for the choice reaction component to capture reaction time in seconds, cue them when to hop, and indicate the landing limb. The relationship between the tablet-based cognitive assessments and reaction time during a hopping task was examined with Pearson correlations (α = .05). RESULTS: The choice reaction time from the hop task had a negligible correlation (r = -.20-.07) to the fully corrected tablet-based cognitive tests. The choice reaction time from the hop task had a negligible correlation (r = .02) to the average response time of the Pattern Comparison Processing Speed Test and a low correlation (r = .34-.36) to the Dimensional Change Card Sort Test and Flanker Inhibitory Control and Attention Test. CONCLUSIONS: This study determined that tablet-based cognitive assessments had trivial relationships to choice reaction time during a hopping task. This research has implications as clinicians aim to evaluate and analyze cognitive performance. Although reaction time was a critical component of all the assessments in this study, an individual's performance on a tablet-based assessment does not indicate performance during a functional reaction time assessment.

Comparisons and Intercorrelations of Physical Performance Variables of Operational Preparedness in Special Operations Forces.

INTRODUCTION: Marine Forces Special Operations Command (MARSOC) deploys teams of operators (OP) and enablers (EN) to accomplish special operations missions. OP and EN are required to train and deploy together to accomplish these missions; however, they have different training and selection pipelines. Advanced strength and conditioning training strategies are applied to both OP and EN to enhance physical preparedness; however, it is unclear how the selection pipeline of these two personnel types affects overall physical preparedness and the relationships between performance variables. The purpose of this study is to gain a greater understanding of the relationships of a wide array of physical preparedness variables in OP and EN in an effort to streamline testing and training strategies. MATERIALS AND METHODS: For this study, 155 male (82 OP, 73 EN) MARSOC personnel (age: 29.5 ± 4.9 years, mass: 87.9 ± 11.1 kg, height: 1.79 ± 0.07 m) completed a physical preparedness assessment that included a DEXA assessment of body composition (BF%), 27.4 m sprint (30 yd), countermovement jump (VJ), 5-10-5 pro-agility (Agility), medicine ball toss (UBP), isometric mid-thigh pull (IMTP), and a 30 second (AnC) and 5 minute (AC) non-motorized treadmill run. Independent samples t tests, Mann-Whitney U tests, and Spearman's Rank correlations were used to compare variables between OP and EN. RESULTS: OP demonstrated greater VJ, UBP, IMTP, AnC, and AC (P < 0.05); and significantly lower BF% and agility time (P < 0.05). Measurements of mass, height, body mass index, and 30 yd were not significantly different (P > 0.05). Weak to moderate correlations were seen between anthropometric and performance variables. OP and EN demonstrated similar correlations for most performance and anthropometric variables. CONCLUSIONS: These results suggest that MARSOC OP demonstrate better physical preparedness over EN, while similar trends are observed between performance variables. Tests with moderate to high correlations may be removed from the protocol to account for testing time constraints. Height, weight, and BF% variables are poorly correlated with performance, particularly in OP, questioning their value in physical performance assessments in this population.

Slower visuomotor reaction time in division-I collegiate athletes with a history of ankle sprain.

The purpose of this study was to compare visuomotor reaction time (VMRT) in collegiate athletes based on ankle sprain history. Participants included athletes with ankle sprain history (n = 18) and athletes with no ankle sprain history (n = 33). Participants completed an upper-extremity VMRT task which was comprised of eight wireless light-emitting diode sensors. The difference between reaction time (sec) and the number of "Hits" and "Misses" were compared between groups. The ankle sprain history group had significantly slower VMRT compared to the no ankle sprain history group with moderate effect sizes. However, there was no difference in the number of "Hits" or "Misses" between groups, despite observing moderate effect sizes. This result suggests that VMRT may be a potential target for prevention and rehabilitation strategies in individuals with ankle sprains. However, further research is needed to better understand the role of VMRT on the risk of ankle sprains.

No pain, no gain: The military overtraining hypothesis of musculoskeletal stress and injury.

The purpose of this manuscript is to present a model of military overtraining and subsequent injury, discharge, and disability. Military training and combat operations are physically and physiologically demanding, placing great strain on the musculoskeletal system of warfighters. Non-battle musculoskeletal injuries (MSKI) are common and present a serious threat to operational readiness in today's military. MSKI risk stratification and prevention are an active area of research and is steeped in the background of sports science. Here, a model is proposed that incorporates the theory of General Adaptation Syndrome to describe how military training stressors may exceed that of training in traditional athletics and may induce sub-optimal training stressors. Positive feedback loops are discussed to explain how military overtraining (MOT) creates a system of ever-increasing stressors that can only be fully understood in the greater context of all environmental factors leading to overtraining. The Military Overtraining Hypothesis (MOTH) is proposed as a model that encapsulates the elevated MSKI risk in combat arms and other operational military personnel as an effort to broaden understanding of multifactorial military MSKI etiologies and as a tool for researchers and commanders to contextualize MSKI research and risk mitigation interventions.

Pain Early After Anterior Cruciate Ligament Reconstruction is Associated With 6-Month Loading Mechanics During Running.

BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) results in persistent altered knee biomechanics, but contributing factors such as pain or patient function, leading to the altered loading, are unknown. HYPOTHESIS: Individuals with worse self-reported pain after ACLR would have poorer biomechanics during running, and poor loading mechanics would be present in the ACLR limb compared with contralateral and control limbs. STUDY DESIGN: Cohort pilot study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 20 patients after ACLR (age, 18.4 ± 2.7 years; height, 1.7 ± 0.1 m; mass, 84.2 ± 19.4 kg) completed visual analog scale and Knee Injury and Osteoarthritis Outcomes Score (KOOS) at 1 and 6 months postsurgery. At 6 months postsurgery, patients underwent biomechanical testing during running. A total of 20 control individuals also completed running biomechanical analyses. Associations between patient outcomes and biomechanics were conducted, and differences in running biomechanics between groups were analyzed. RESULTS: KOOS pain score 1 month after surgery was associated with peak ACLR knee abduction moment (R2 = 0.35;P = 0.01). At 6-months, KOOS sport score was related to peak abduction moment in the ACLR limb (R2 = 0.23; P = 0.05). For change scores, the improvement in pain scores related to ACLR limb peak knee abduction moment (R2 = 0.55; P = 0.001). The ACLR limb had lower knee excursion, extension moments, and ground-reaction forces compared with the uninvolved and control limb. The uninvolved limb also had higher ground-reaction forces compared with the ACLR limb and control limb. CONCLUSION: These results suggest that patient-reported outcomes 1 and 6 months after surgery are associated with running mechanics 6 months after ACLR. Further, the underloading present in the ACLR limb and overloading in the uninvolved limb indicates greater need for running rehabilitation after ACLR. CLINICAL RELEVANCE: Understanding pain and how it may be linked to movement dysfunction is important for improving long-term outcomes.

The influence of cognitive tasks on sensory organization test performance / A influência das tarefas cognitivas no desempenho do teste de organização sensorial

Abstract Introduction: Many static postural tasks requiring vestibular contributions are completed while dual- tasking. Objective: We investigated the influence of dual-tasks on sensory integration for postural control and cognitive performance during the sensory organization test and examined the relationship between cognitive function and dual-task cost during the sensory organization test. Methods: Twenty adults completed single and dual-task versions of the six conditions of the sensory organization test were completed during two visits separated by one week. A subset of 13 participants completed three National Institute of Health (NIH)-toolbox cognitive tests including the Flanker inhibitory control and attention test, dimensional change card sort test and pattern comparison processing speed test. Wilcoxon signed rank tests were used to compare postural sway during single and dual-task sensory organization test. Friedman's test, with pairwise comparison post-hoc tests, was used to compare single task serial subtraction performance to the 6 dual-task sensory organization test conditions. Spearman's correlation coefficients were used to assess the relationship between cognitive performance on NIH-toolbox test and postural and cognitive dual-task cost during the sensory organization test. Results: Performing a cognitive dual-task during the sensory organization test resulted in a significant increase in postural sway during condition 1 (Z = −3.26, p = 0.001, ES = 0.73), condition 3 (Z = −2.53, p = 0.012, ES = 0.56), and condition 6 (Z = −2.02, p = 0.044, ES = 0.45). Subtraction performance significantly decreased in during condition 6 (Z = −2.479, p = 0.011, ES = 0.55) compared to single-task. The dimensional change card sort test demonstrated moderate correlations with dual-task cost of serial subtraction performance in condition 5 (dimensional change card sort test: r = −0.62, p = 0.02) and condition 6 (dimensional change card sort test: r= −0.56, p = 0.04). Pattern comparison processing speed test scores were significantly correlated with dual-task cost of postural control during condition 2. Conclusion: Performing a cognitive task during the sensory organization test resulted in significantly increased postural sway during three conditions, particularly during visual environment manipulation oppose to vestibular and somatosensory manipulation. Cognitive performance decreased during the most complex sensory organization test condition. Additionally, we found participants with poorer executive function had greater dual-task cost during more complex sensory integration demands.

Resumo Introdução: Muitas tarefas posturais estáticas que requerem contribuições vestibulares são feitas durante a dupla tarefa. Objetivo: Investigamos a influência da dupla tarefa na integração sensorial para o controle postural e desempenho cognitivo durante o teste de organização sensorial e examinamos a relação entre a função cognitiva e o custo da dupla tarefa durante o teste de organização sensorial. Método: Vinte adultos completaram versões da tarefa única e dupla tarefa das seis condições do teste de organização sensorial, que foram concluídas em duas consultas com um intervalo de uma semana. Um subgrupo de 13 participantes completou três testes cognitivos do NIH-toolbox, inclusive o flanker inhibitory control and attention test, dimensional change card sort test e o pattern comparison processing speed test .O teste de postos sinalizados de Wilcoxon foi usado para comparar a oscilação postural durante o teste de organização sensorial de tarefa única e dupla. O teste de Friedman, com testes post hoc de comparação pareada, foi usado para comparar o desempenho da subtração em série de tarefa única para as 6 condições do teste de organização sensorial de dupla tarefa. Os coeficientes de correlação de Spearman foram usados para avaliar a relação entre o desempenho cognitivo no teste NIH-toolbox e o custo da dupla tarefa postural e cognitivo durante o teste de organização sensorial. Resultados: A feitura de uma dupla tarefa cognitiva durante o teste de organização sensorial resultou em um aumento significativo na oscilação postural durante a condição 1 (Z = -3,26, p = 0,001, TE = 0,73), condição 3 (Z = -2,53, p = 0,012, TE = 0,56) e condição 6 (Z = -2,02, p = 0,044, TE = 0,45). O desempenho de subtração diminuiu significativamente durante a condição 6 (Z =-2,479, p = 0,011, TE = 0,55) em comparação com a tarefa única. O dimensional change card sort test demonstrou correlações moderadas com o custo da dupla tarefa de desempenho de subtração em série na condição 5 (dimensional change card sort test: r=-0,62, p = 0,02) e condição 6 (dimensional change card sort test: r = -0,56, p = 0,04). Os escores do pattern comparison processing speed test foram significativamente correlacionados com o custo da dupla tarefa do controle postural durante a condição 2. Conclusão: A feitura de uma tarefa cognitiva durante o teste de organização sensorial resultou em um aumento significativo na oscilação postural em três condições, principalmente durante a manipulação do ambiente visual em oposição à manipulação vestibular e somatossensorial. O desempenho cognitivo diminuiu durante a condição de teste de organização sensorial mais complexa. Além disso, observamos que os participantes com função executiva pior apresentaram maior custo da dupla tarefa durante demandas de integração sensorial mais complexas.

A Pilot Study Comparing Two Measures of Perceived Health Services Access Among Military Veterans With Musculoskeletal Injuries and Mental Health Conditions.

INTRODUCTION: Service members endure a number of musculoskeletal injuries (MSIs) during service (e.g., ankle sprains and chronic back pain). Musculoskeletal injuries can reduce engagement in physical activity after military service and contribute to a sedentary lifestyle that diminishes physical health and elevates the risk for psychological distress including suicide-related behaviors. Yet, little is known about barriers and facilitators to accessing care in veterans with co-occurring MSI and mental health conditions. The purpose of this study was to pilot two brief measures of barriers and facilitators to rehabilitation and mental health services in military veterans with musculoskeletal and mental health conditions. Self-report tools vary in their response formats in ways that can impact usability, data quality, and completeness. We examine two response styles (i.e., checklist vs. thermometer) for two health services (mental health and rehabilitation) to determine usability, patterns in item endorsement, and veteran preference. MATERIALS AND METHODS: Barriers and facilitators informed by the Fortney Veterans Healthcare Access model were assessed by veterans (n = 31) on the newly developed 22-item, paper-and-pencil scale with separate ratings for mental health and rehabilitation services. All participants completed scales with both response styles and the order of administration was randomized (i.e., either the checklist first or the thermometer-style response first). Data also included self-reported demographics, musculoskeletal and mental health diagnoses, health-related quality of life, physical activity levels, mental health symptoms, suicide risk, and coronavirus disease of 2019 pandemic-related stress. RESULTS: Veterans reported no differences in ease of use across response formats; however, 83.9% (n = 26) preferred the checklist style, with only 3.22% (n = 1) preferring the thermometer format. Checklist items also resulted in less missing data (i.e., range 0.00%-6.45%) than the thermometer-style option (i.e., range 6.45%-61.30%). On the checklist, total number of perceived barriers was low for mental health and rehabilitation services (i.e., M = 1.58 and M = 1.61, respectively). Distance to care and problems related to symptoms were the most frequently identified barriers for both services. Facilitators outnumbered barriers for mental and rehabilitation services, and nearness of the clinic/hospital was the top-rated facilitator for both. On the thermometer, the perceived strength of each mental health (M = 39.37) and rehabilitation (M = 39.81) service barrier was moderate (0-100 scale), while the average perceived strength of each mental health (M = 61.66) and rehabilitation service (M = 61.84) facilitator was higher. Associations between barrier and facilitator scores with mental and physical health indicators were small with exceptions. For instance, suicide attempt likelihood was positively correlated with rehabilitation services barriers; mental health burden was positively associated with both barriers and facilitators. CONCLUSIONS: Results of this pilot comparing two measurement approaches identified actionable next steps. Brief barriers and facilitators checklists were viable for veteran ratings across type of health. The thermometer-based tool captured the perceived strength of barriers and facilitators but yielded problematic rates of missing data in its current form and was not preferred by veterans.

Combined driving: task-specific position impacts grip strength of equestrian athletes.

BACKGROUND: Loss of hand strength is a predictor of mortality in aging populations. Despite reliance on the hands to participate in equestrian driving activity, no existing studies focus on associations of hand strength to athletic performance. Therefore, this study 1) established baseline handgrip of equestrian combined drivers in standing and task-specific positions, 2) determined endurance of task-specific handgrip, 3) compared handgrip strength to normative data, and 4) evaluated associations of handgrip and equestrian-specific variables. METHODS: There were 51 combined drivers (9 males, 42 females) ages 21-78 who completed a survey, standing handgrip, and grip strength and endurance in a task-specific position. Sixty-three percent of participants were 50 years or older. The dynamometer grip bar was normalized by hand size for standing tests; to duplicate sport-specific tasks, the bar was set to the closest setting. Significances were determined at p < 0.05. RESULTS: Drivers with more than 30 years of experience demonstrated highest summed standing (73.1 ± 5.2 kg) and summed sitting (59.9 ± 6.3 kg) grip strength. Females 60-years and older had greater handgrip endurance (Χ2 = 8.323, df = 2, p = .0156) in non-dominant (left) hands. Males (60%) reported more cold weather fatigue than females. Glove wearing was associated with bilateral endurance balance; a higher proportion of endurance balance between dominant and non-dominant (49% high-high and 29% low-low; Χ2 = 11.047, df = 1, p = .0009) was realized. There were no associations of handgrip and prior injury. CONCLUSIONS: Our results have implications in understanding task-specific and normative grip strengths in aging equestrian populations. Bilateral balance in handgrip strength and endurance is important particularly in maintaining strength in non-dominant hands over time. Equestrian driving sport promotes greater endurance in older females. Strength can be improved by participating in combined driving, and engagement in this sport over several years' benefits hand strength over time. This cohort of equestrian participants provides evidence that participating in hand-specific activities promotes greater strength, which has been previously shown to improve aging outcomes.

The influence of cognitive tasks on sensory organization test performance.

INTRODUCTION: Many static postural tasks requiring vestibular contributions are completed while dual- tasking. OBJECTIVE: We investigated the influence of dual-tasks on sensory integration for postural control and cognitive performance during the sensory organization test and examined the relationship between cognitive function and dual-task cost during the sensory organization test. METHODS: Twenty adults completed single and dual-task versions of the six conditions of the sensory organization test were completed during two visits separated by one week. A subset of 13 participants completed three National Institute of Health (NIH)-toolbox cognitive tests including the Flanker inhibitory control and attention test, dimensional change card sort test and pattern comparison processing speed test. Wilcoxon signed rank tests were used to compare postural sway during single and dual-task sensory organization test. Friedman's test, with pairwise comparison post-hoc tests, was used to compare single task serial subtraction performance to the 6 dual-task sensory organization test conditions. Spearman's correlation coefficients were used to assess the relationship between cognitive performance on NIH-toolbox test and postural and cognitive dual-task cost during the sensory organization test. RESULTS: Performing a cognitive dual-task during the sensory organization test resulted in a significant increase in postural sway during condition 1 (Z=-3.26, p=0.001, ES=0.73), condition 3 (Z=-2.53, p=0.012, ES=0.56), and condition 6 (Z=-2.02, p=0.044, ES=0.45). Subtraction performance significantly decreased in during condition 6 (Z=-2.479, p=0.011, ES=0.55) compared to single-task. The dimensional change card sort test demonstrated moderate correlations with dual-task cost of serial subtraction performance in condition 5 (dimensional change card sort test: r=-0.62, p=0.02) and condition 6 (dimensional change card sort test: r=-0.56, p=0.04). Pattern comparison processing speed test scores were significantly correlated with dual-task cost of postural control during condition 2. CONCLUSION: Performing a cognitive task during the sensory organization test resulted in significantly increased postural sway during three conditions, particularly during visual environment manipulation oppose to vestibular and somatosensory manipulation. Cognitive performance decreased during the most complex sensory organization test condition. Additionally, we found participants with poorer executive function had greater dual-task cost during more complex sensory integration demands.

Training Strategies Maintain Performance Characteristics in Marines Selected for Marine Forces Special Operations Individualized Training Course.

INTRODUCTION: Marines must complete an intensive Assessment and Selection (A&S) course before becoming a U.S. Marine Forces Special Operations Command (MARSOC) Raider. Following selection, marines are given training recommendations designed to maintain performance characteristics deemed relevant to successfully complete a rigorous 9-month Individualized Training Course (ITC). However, training strategies are individually implemented by the marine, and the time between the two courses is highly irregular, ranging between 2 months and 24 months based on operational factors related to military occupational specialty (MOS). The purpose of this study was to evaluate changes in performance between the completion of A&S and the start of ITC and to examine if the duration between courses and previous MOS influenced changes in performance. MATERIALS AND METHODS: Body fat percentage (BF%), anaerobic power (AP), anaerobic capacity (AC), aerobic capacity (VO2max), knee flexion (KF), knee extension (KE), trunk extension (TE), and trunk flexion (TF) isokinetic strength were collected on 38 marines (age: 25.1 ± 2.7 years, height: 1.77 ± 0.05 m, mass: 83.2 ± 7.7 kg, Post-A&S to ITC start: 204.1 ± 68.4 days) following A&S and directly before ITC. RESULTS: Pre-ITC students had significantly greater mass (P = .002), BF% (P = .000), and AP (P = .039). There were no significant changes in AC (P = .170), VO2max (P = .259), KF (P = .400), KE (P = .320), TE (P = .178), and TF (P = .643). There was no significant relationship between performance outcomes and time between courses and previous MOS. CONCLUSION: Current training strategies appear effective at addressing performance deficits that occur as a result of A&S, while maintaining high levels of KF, KE, TE, TF, AC, and VO2max. However, pre-ITC students still exhibited AP deficits compared to active marine raiders, so forthcoming programming may benefit from an increased emphasis on AP. Assessment of additional selectees at these timepoints, as well as students before A&S may provide valuable information to MARSOC human performance specialists to develop programing, ultimately leading to a higher ITC graduation rate, increased force readiness, and decreased financial burden forcewide.

Specificity of isokinetic assessment in noncontact knee injury prevention screening: A novel assessment procedure with relationships between variables in amateur adult agility-sport athletes.

OBJECTIVES: To present a new knee isokinetic assessment procedure linked to noncontact knee injury mechanisms and examine correlations between variables relevant to noncontact knee injury prevention screening (peak torque [PT, Nm], time-to-peak torque [TTPT, ms], angle-of-peak torque [APT, °], mean PT [MPT, Nm]). DESIGN: Cross-sectional. SETTING: Sports medicine laboratory. PARTICIPANTS: Thirty-four agility-sport athletes (male/female n = 18/16, age 24.1 ± 3.5yr, height 171.8 ± 9.6 cm, mass 70.6 ± 12 kg). MAIN OUTCOME MEASURES: Pearson's/Spearman's correlation (r/rs), coefficient of determination (r2/rs2). RESULTS: Most correlations were statistically non-significant or statistically-significant with only weak-to-moderate coefficients. For both knee extension and flexion, PT and MPT were significantly and strongly correlated (r = 0.99, r2 = 0.98, p = 0.001). Graphical analyses revealed two datapoint clusters for knee flexion TTPT and APT. One cluster indicated some participants could generate knee flexor PT rapidly (<150 ms) at low knee flexion angles (<45°) and the other cluster indicated that other participants could not (>200 ms, >50°). CONCLUSIONS: In this study, most isokinetic variables represented distinct knee neuromuscular characteristics. For both knee extension and flexion, only PT or MPT need be used to represent isokinetic maximal strength. Knee flexion TTPT and APT may have utility in noncontact knee injury prevention screening with amateur adult agility-sport athletes.

Asymmetrical Loading Patterns in Military Personnel With a History of Self-Reported Low Back Pain.

BACKGROUND: Servicemembers are required to operate at high levels despite experiencing common injuries such as chronic low back pain. Continuing high levels of activity while compensating for pain may increase the risk of musculoskeletal injuries. As such, the purpose of this project was to determine if servicemembers with chronic low back pain have reduced lower extremity performance, and if they use alternate strategies to complete a functional performance task as compared to healthy servicemembers. METHODS: Of a total of 46 male United States Marine Corps Forces Special Operations Command (MARSOC) personnel, 23 individuals who suffered from chronic low back pain (age = 28.6 ± 4.4 years, weight = 84.2 ± 6.8 kg) and 23 healthy controls (age = 27.9 ± 3.8 years, weight = 83.8 ± 7.7 kg) completed a stop jump task. In this task, three-dimensional biomechanics were measured, and lower extremity and trunk strength were assessed. RESULTS: The low back pain group exhibited higher vertical ground reaction force impulse on the dominant limb (0.26% body weight [BW]/s), compared to the nondominant limb (0.25% BW/s, p = .036). The control group demonstrated relationships between jump height and strength in both limbs (dominant: r = 0.436, p = .043; nondominant: r = 0.571, p = .006), whereas the low back pain group demonstrated relationships between jump height and dominant limb knee work (r = 0.470, p = .027) and ankle work (r = 0.447, p = .037). CONCLUSIONS: This study demonstrates that active-duty MARSOC personnel with a history of low back pain reach similar levels of jump height during a counter movement jump, as compared to those without a history of low back pain. However, the asymmetries displayed by the low back pain group suggest an alternate strategy to reaching similar jump heights as compared to healthy individuals.