Corridor and real-time 6-minute walk tests in healthy young adults: A randomized cross-over study.

Objective: Cardiopulmonary endurance is important for comfortably participating in activities of daily living. Exercise tests, such as the 6-minute walk test (6MWT), are commonly used to evaluate cardiopulmonary endurance. We investigated the effects of the Gait Real-Time Analysis Interactive Lab (GRAIL)- and corridor-based 6MWTs on functional performance. Methods: Thirty healthy men were randomly divided into two groups. Group A participants performed a corridor-based 6MWT, followed by a washout period (1 h). Subsequently, they performed the GRAIL-based 6MWT. Group B participants performed the tests in the reverse order of that performed by Group A participants. Results: The corridor-based 6MWT resulted in significantly higher 6MW distance and 6MW speed than the GRAIL-based 6MWT. No significant differences were observed between the two groups in any of the following secondary outcomes: systolic blood pressure, diastolic blood pressure, oxygen saturation, heart rate, dyspnea, and overall fatigue. A strong positive correlation was observed between the 6MW distance and 6MW speed. Conclusion: The corridor- and GRAIL-based 6MWT should not be used interchangeably.

The effectiveness of the Copenhagen adduction exercise on improving eccentric hip adduction strength among soccer players with groin injury: a randomized controlled trial.

INTRODUCTION: Groin injuries are common in soccer players and often involve adductor muscle strains. The Copenhagen Adduction Exercise (CAE) is a targeted intervention whose effectiveness in rehabilitation for these injuries warrants investigation. OBJECTIVE: To investigate the impact of a rehabilitation program, which includes the CAE, on eccentric hip adduction (EHAD) strength, hip joint range of motion (ROM), self-reported disability, and pain among soccer players with adductor-related groin pain. It was hypothesized that the addition of CAE to the rehabilitation program would yield greater improvements. METHODS: Employing a randomized controlled trial with a two-group parallel design, thirty male soccer players with a mean age of 26.4 ± 3.9 years were randomized into an intervention group (IG) including CAE (n = 15) and a control group (CG) without CAE (n = 15), based on a power analysis to ensure 80% power to detect significant differences. Both groups engaged in their respective rehabilitation programs twice a week for eight weeks. The primary outcome measured was EHAD strength, while secondary outcomes included hip joint ROM, self-reported disability measured by the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain levels. RESULTS: Significant improvements within groups were observed across all measures (p < 0.001). The IG demonstrated a greater increase in EHAD strength (Mean Difference [MD] = 0.49 Nm/kg, 95% Confidence Interval [CI] [0.31, 0.66]), a more pronounced reduction in pain (MD = -1.60, 95% CI [-2.18, -1.02]), and betterment in all HAGOS subscale scores compared to the CG. There were no significant between-group differences in hip joint ROM. CONCLUSION: Incorporating the CAE into rehabilitation programs significantly improves EHAD strength, decreases pain scores, and reduces self-reported disability in soccer players with adductor-related groin pain. REGISTRATION: ClinicalTrials.gov identifier: NCT05589623.

A comparison of the range of motion and dynamic stability of the ankle joint of athletes with an ankle sprain as compared to healthy controls: A cross-sectional study.

Background: Ankle sprains are the most common lower-leg musculoskeletal injuries, frequently occurring among athletes and other physical activity individuals. The objective of this study was to compare the ankle range of motion and dynamic stability of healthy and injured athletes for their dominant and nondominant legs. Methods: A cross-sectional study design was selected to investigate this study with 32 male soccer players with average age: 22.6 ± 3.3 years, weight: 69.6 ± 5.7 kg, height: 176.8 ± 5.32 cm, with a history of a lateral ankle sprain on the dominant leg for the past 2 years. Ankle range of motion was determined using dorsiflexion and plantar flexion by a goniometer. The dynamic stability was determined using the SWAY medical system. An independent t-test was used to study the differences between healthy and injured groups and between dominant and nondominant legs for dynamic stability, dorsiflexion, and plantar flexion range. Results: There were higher significant differences for dynamic stability in healthy participants than in injured participants for their dominant (P = 0.001) and nondominant (P = 0.001) legs. There were significant differences in dynamic stability in the dominant and nondominant leg (healthy [P = 0.033] and injured [P = 0.000] participants). The dominant leg shows higher dynamic stability in healthy group, whereas nondominant leg shows higher dynamic stability in the injured group. Conclusion: The study found significant differences between the injured and sound legs. The injured dominant and nondominant leg revealed a striking disparity in the ankle range of motion. Therefore, the study demonstrated that ankle sprain causes due to less stability of the ankle joint, which limits ankle movements.

Correlation of ankle dorsiflexion range of motion with lower-limb kinetic chain function and hop test performance in healthy male recreational athletes.

Background: The study aims to identify the correlation of ankle dorsiflexion range-of-motion (ADROM) (with its related gastrocnemius and soleus extensibility) with lower-limb kinetic chain function and hop test performance in young healthy recreational athletes. Methods: Twenty-one young male healthy recreational athletes were tested for ADROM, gastrocnemius and soleus extensibility, lower-limb kinetic chain function with the closed kinetic chain lower extremity stability test (CKCLEST) and hop test performance with the single-leg hop for distance test (SHDT) and side hop test (SHT). Results: There was a positive significant (rho = 0.514, 95% CI [0.092-0.779], P < 0.01) correlation between the dominant lower-limb weight-bearing/closed-chain ADROM (that represented the soleus extensibility) and the CKCLEST. There were no significant correlations between the study performance-based tests and open-chain ADROM (P > 0.05). Conclusion: The CKCLEST is positively and significantly correlated with SHT and weight-bearing ADROM with knee flexion (and its related soleus extensibility) which suggests comparability among them. Open-chain ADROM has a negligible and non-significant correlation with the readings of this study performance-based tests suggesting that it is probably not an essential construct of their execution. To the best of our knowledge, this study is the first to investigate these correlations.

Dry needling in the management of tendinopathy: A systematic review of randomized control trials.

INTRODUCTION: The objective of the study is to evaluate the best available evidence on the effectiveness of DN in the management of tendinopathy. METHODS: Seven randomized control trials were selected following an electronic search in PubMed, Web of Science, Scopus, and SPORTDiscus databases. To be included in the current systematic review, the study had to be an RCT conducted on human participants, which investigated the effect of the DN technique on the management of tendinopathies. Only studies in the English language published in peer-reviewed journals between 1999 and 2020 were included. The methodological quality of the studies was assessed using the PEDro scale. RESULTS: The PEDro score of the studies ranged from 5 to 9 with a mean score of 6.7 ± 1.2 (mean ± SD). A total of 357 participants were enrolled in the seven included studies, which were on greater trochanteric pain syndrome, lateral epicondylitis, supraspinatus tendinopathy and Achilles tendinopathy. DN was compared with various interventions, including platelet-rich plasma injection, autologous blood injection and non-steroidal anti-inflammatory medication. All the selected studies reported a significant positive effect of DN on pain intensity and other outcome measures, such as patient-specific functional score, disability index, range of motion and health-related quality of life. CONCLUSION: The results indicate that DN appears to be as effective as other treatment methods at relieving pain and other symptoms of tendinopathy immediately after treatment and up to 6 months. DN can be considered among the many options available for the management of tendinopathy.

Role of kinetic chain in sports performance and injury risk: a narrative review.

The kinetic chain refers to the body's intricate coordination of various segments to perform a specific activity involving precise positioning, timing, and speed. This process is based on task-oriented and activity-specific pre-programmed muscle activation patterns enhanced by repeated practice. It demands muscular eccentric strength, joint flexibility, and musculotendinous elastic energy storage. The body core (lumbopelvic-hip complex) forms the kinetic chains' central point of activities in most sports because it facilitates load transfers to and from the limbs. The kinetic chain relationship with fascia, peripheral nerves, and tensegrity is fundamental to holistic human body movements. The kinetic chain function demands neuromuscular, sensorimotor, and neurocognitive control. Any blockage or defect in the kinetic chain can develop compensatory patterns, high demands on distal parts, and overuse and overload injuries. Taking a holistic approach and evaluating the integrity of the kinetic chain in athletes can significantly enhance efforts to improve sports performance and mitigate injury risk.

Analysis of the Anaerobic Power Output, Dynamic Stability, Lower Limb Strength, and Power of Elite Soccer Players Based on Their Field Position.

Soccer players require a high degree of aerobic and anaerobic fitness to perform well throughout the game as per their position in the field. This study aimed to investigate the differences in anaerobic power output, dynamic stability, lower limb strength, and power among elite soccer players based on their field position. A cross-sectional population of 96 elite soccer players with average age 23.10 ± 4.35 years, weight 69.99 ± 9.71 kg, height 174.84 ± 6.64 cm, and body mass index 22.84 ± 2.39 kg/m2 from various soccer clubs in Saudi Arabia was tested for their anaerobic power output, dynamic stability, lower limb strength, and power performance. All the participants have more than 4 years of experience in competitive soccer events. Tests included a measure of single-leg vertical jump, star excursion balance test, and single-leg triple hop test for distance. The players were divided into four groups (goalkeepers, defenders, midfielders, and attackers) based on their self-reported position on the field. One-way ANOVA was used to determine the differences between all variables according to the players' position. In addition, partial eta-squared (ηp2) was used to report effect sizes. The results revealed significant differences between positions in the anaerobic power output (p = 0.012, ηp2 = 0.312), dynamic stability {Anterior (p = 0.004, ηp2 = 0.235), Anteromedial (p = 0.007, ηp2 = 0.622), Anterolateral (p = 0.011, ηp2 = 0.114)}, and lower limb strength, and power (p = 0.008, ηp2 = 0.421). At the same time, goalkeepers' performance was significantly superior to midfielders (p = 0.006) in the anaerobic power output. In addition, lower limb strength and power was significantly higher (p = 0.004) for goalkeepers than for midfielders, with a similar trend in dynamic stability (p = 0.007). These results exhibited differences in anaerobic power output, dynamic stability, lower limb strength, and power performance based on the players' positions. The investigation may assist the practitioner in designing training programs for the players according to their position for performance improvement.

Determining the hip joint isokinetic muscle strength and range of motion of professional soccer players based on their field position.

Background: Soccer players' physical and physiological demands vary based on their field position. Although the hip joint has an important role in soccer, little information is available about the strength and flexibility of the hip joint based on player positions. Therefore, this study aims to investigate the differences in muscle strength and flexibility of the hip joint of professional soccer players based on their field position. Methods: Ninety-six professional soccer players from Saudi Arabia were divided into four groups (goalkeepers, defenders, midfielders, and attackers), with 24 participants in each group based on their field position. The Modified Thomas test was used to measure the hip extension range of motion (ROM), and muscle strength was assessed by an Isokinetic dynamometer. Results: There were no statistically significant differences in the isokinetic strength at the hip joint movements between goalkeepers, defenders, midfielders, and attackers (p ≥ 0.05). At the same time, there was a significant difference between groups in the hip extension ROM (p ≤ 0.05). according to different player positions. Post hoc tests reported significant differences between goalkeepers and defenders (p ≤ 0.05), midfielders (p ≤ 0.05), and attackers p ≤ 0.05). At the same time, there were no significant differences between defenders and midfielders (p ≥ 0.05), defenders and attackers (p ≥ 0.05), and midfielders and attackers (p ≥ 0.05). Conclusion: Even though there was no significant difference in isokinetic strength, there was a significant difference in hip extension ROM among players based on field position. This study may help coaches and trainers to recognize the strengths and weaknesses of players and design training programs to rectify the weaker components and improve players' performance in different playing positions.

Glenohumeral internal rotation deficit in volleyball players with and without a history of shoulder pain.

This study aimed to investigate physiological and pathological Glenohumeral Internal Rotation Deficit (GIRD) in volleyball players with and without a history of shoulder pain. Volleyball players with a history of shoulder pain (n = 18) and without a history of shoulder pain (n = 18), who were matched in age, weight, height, BMI, years of experience and frequency of practice were recruited for this cross-sectional study. Shoulder internal and external rotation Range of Motion (ROM) was measured for the dominant and non-dominant shoulders of each participant using a digital inclinometer. Measurements of GIRD, External Rotation Gain (ERG), and Total Range of Motion (TROM) were calculated. There were significantly higher degrees of GIRD in the pain group (15.65°) than the no-pain group (9.06°) (p=0.004) and significantly higher differences in the TROM in the pain group (16.17°) than the no-pain group (10.17°) (p=0.007). There was no correlation between the level of pain and the presented ROM adaptations. The study showed that for volleyball players, pathological GIRD should be defined at 10-18° degrees of GIRD that are accompanied by differences in the TROM that exceeds 8°.

Efficacy of Core Training in Swimming Performance and Neuromuscular Parameters of Young Swimmers: A Randomised Control Trial.

Background: This study aimed to investigate the efficacy of core training in the swimming performance and neuromuscular properties of young swimmers. Methods: Eighteen healthy male swimmers (age: 13 ± 2 years, height: 159.6 ± 14.5 cm, weight: 48.7 ± 12.4 kg) were recruited from the Public Authority for Sports swimming pool in Dammam and randomly assigned to the experimental and control groups. The experimental group performed a six-week core-training program consisting of seven exercises (three times/week) with regular swimming training. The control group maintained its regular training. Swimming performance and neuromuscular parameters were measured pre- and post-interventions. Results: The experimental group benefitted from the intervention in terms of the 50 m swim time (−1.4 s; 95% confidence interval −2.4 to −0.5) compared with the control group. The experimental group also showed improved swimming velocity (+0.1 m.s−1), stroke rate (−2.8 cycle.min−1), stroke length (+0.2 m.cycle−1), stroke index (+0.4 m2·s−1), total strokes (−2.9 strokes), and contraction time for erector spinae (ES; −1.5 ms), latissimus dorsi (LD; −7 ms), and external obliques (EO; −1.9 ms). Maximal displacement ES (DM-ES) (+3.3 mm), LD (0.5 mm), and EO (+2.2 mm) were compared with the baseline values for the experimental group, and TC-ES (5.8 ms), LD (3.7 ms), EO (2.5 ms), DM-ES (0.2 mm), LD (−4.1 mm), and EO (−1.0 mm) were compared with the baseline values for the control group. The intergroup comparison was statistically significant (p < 0.05; DM-ES p > 0.05). Conclusion: The results indicate that a six-week core-training program with regular swimming training improved the neuromuscular properties and the 50 m freestyle swim performance of the experimental group compared with the control group.

Patellar Tendinopathy-Does Injection Therapy Have a Role? A Systematic Review of Randomised Control Trials.

Injection treatment is one of the most widely used methods for the conservative management of patellar tendinopathy. The objective of this systematic review was to synthesise data from randomised control trails on the effectiveness of various injections used in the management of patellar tendinopathy. An electronic search was conducted in the Web of Science, Scopus, PubMed, and SPORTDiscus databases. To be included in the current systematic review, the study had to be an RCT conducted on human participants that investigated the effect of at least one injection treatment on the management of patellar tendinopathy. Selected studies were required to report either patient-reported outcomes or biological and clinical markers of the tendon healing. The methodological quality of the studies was appraised using the revised Cochrane risk of bias tool for RCTs (RoB 2.0). Nine RCTs on seven types of injections were included in this review, with an overall positive outcome. Pain intensity was measured in all the studies. The VISA P score was the most used outcome measure (n = 8). A wide variety of interventions were compared with injection therapy, including eccentric training, extracorporeal shockwave, and arthroscopy. It can be concluded that the injection treatments can produce promising results in the management of patellar tendinopathy. However, because of the limited number of studies and the disparities in the study populations and protocols, it is not possible to make a firm conclusion on the efficacy of these injection methods, and these results should be inferred with care.

Virtual reality environment training effect on dynamic and static stability among athletes from random intermittent dynamic type sports / Efeito do treinamento do ambiente de realidade virtual na estabilidade dinâmica entre atletas de esportes do tipo dinâmico aleatório e intermitente

ABSTRACT This study aims to investigate the aftereffect of a six-week virtual reality environment training on dynamic and static postural stability in athletes participating in random intermittent dynamic type sports. The pretest and posttest study designs were chosen to conduct this study. Twenty-four male athletes were selected for the study. Participants participated in a six-week virtual reality environment training program three times a week for a session of forty-five minutes. The virtual reality environment was created using CAREN's integrated virtual reality system with Motek's D-flow application. The postural stability was assessed using a stadiometer. Assessments were performed before and after six weeks of training. A paired sample t-test was used to determine differences between pretest and posttest outcome measures. The improvement can be seen as an effect of virtual reality environment training intervention. Statistically significant differences were observed between pretest and posttest for dynamic and static anteroposterior and mediolateral postural stability at 20 and 40 levels of difficulty. The virtual reality environment training helps to improve performance by assessing and optimizing the training load in the process of improving the performance of athletes participating in random intermittent dynamic type sports.

RESUMO Este estudo tem como objetivo investigar o efeito colateral de um treinamento em ambiente de realidade virtual de seis semanas na estabilidade postural dinâmica e estática em atletas que participam de esportes do tipo dinâmico intermitente aleatório. Os desenhos de estudo pré-teste e pós-teste foram escolhidos para conduzir este estudo. Vinte e quatro atletas do sexo masculino foram selecionados para o estudo. Os participantes participaram de um programa de treinamento em ambiente de realidade virtual de seis semanas, três vezes por semana, durante uma sessão de quarenta e cinco minutos. O ambiente de realidade virtual foi criado usando o sistema de realidade virtual integrado da CAREN com o aplicativo D-flow da Motek. A estabilidade postural foi avaliada por meio de um estadiômetro. As avaliações foram realizadas antes e após seis semanas de treinamento. Um teste t de amostra emparelhada foi usado para determinar as diferenças entre as medidas de resultados pré e pós-teste. A melhoria pode ser vista como um efeito da intervenção de treinamento em ambiente de realidade virtual. Diferenças estatisticamente significativas foram observadas entre o pré e pós-teste para estabilidade postural anteroposterior e mediolateral dinâmica e estática em 20 e 40 níveis de dificuldade. O treinamento em ambiente de realidade virtual ajuda a melhorar o desempenho, avaliando e otimizando a carga de treinamento no processo de melhoria do desempenho de atletas que participam de esportes do tipo dinâmico intermitente aleatório.

Reliability and validity of smartphone applications to measure the spinal range of motion: A systematic review.

Introduction: The objective of this study is to conduct a systematic review on the reliability and validity of various smartphone applications for spinal range of motion (ROM) measurements.Methods: Eleven studies were selected following an electronic search of PubMed, CINAHAL, Medline, Embase and SPORTDiscus. Quality appraisals of selected studies were conducted using a standardized appraisal tool.Results: Most studies demonstrated a good intra- and inter-rater reliability, as well as validity in more than 50% of joint movements. At the same time, relative reliability/validity outcomes (e.g. interclass correlation co-efficient) were stronger than absolute reliability/validity outcomes (e.g. mean differences, limits of agreement). Spinal rotation movement showed less reliability and validity when compared to other spinal movements.ConclusionsːResult of the study supports the use of smartphone applications for ROM measurements of spinal joints. However, we cannot advocate the most appropriate application for spinal ROM measurement or suggest which application is superior to all others. As clinicians have multiple options in selecting applications, it is recommended they use applications that have proven reliable and valid for that particular joint. Data from this study provides clinicians with evidence-based research on smartphone devices for measuring spinal joint ROM in clinical settings.

Comparison of instability resistance training, traditional resistance training and plyometric training on athletic performance parameters.

OBJECTIVES: The objective of the study was to compare traditional resistance, instability resistance, and plyometric training methods on measures of athletic performance in healthy subjects. METHODS: Sixty five healthy, physically active male students were randomly assigned to the following groups: traditional resistance training (RT, n=22), instability training (IT, n=22), and plyometric training (PLY, n=21).Athletic performance parameters were assessed pre- and post-training using chair squat test, standing stork test, shuttle run test, t-test, and vertical jump test. RESULTS: General linear univariate model with baseline as covariate (ANCOVA) was used for analyzing the change in outcome from baseline to post-treatment. Statistically significant improvement was observed in all the athletic performance parameters in all three groups after seven weeks of training (p-value<0.05). The highest change in chair squat test was reported for RT compared to IT (p-value<0.001) and PLY (p-value<0.001). The change in standing stork test among the IT group was substantially higher than that among RT (p-value=0.007) but did not significantly differ from that among the PLY (p-value=0.27). No statistically significant difference was observed in post-test values of vertical jump test among three groups. The highest change in t-test and shuttle run test was reported for PLY compared to IT (p-value<0.001) and RT (p-value<0.001). CONCLUSIONS: Based on the findings of this study, it is suggested that IT and PLY can be included with traditional RT to improve various aspects of athletic performance in healthy physically active individuals. The current study will give an insight to athletes, coaches, and trainers regarding utilization of appropriate training methods in enhancing athletic performance. However, further research is required to establish the effectiveness.

Comparison of plantar loading patterns on natural grass and artificial turf during various athletic activities.

BACKGROUND: This study aimed to investigate the differences in plantar pressure during various athletic activities on natural grass and artificial turf. METHODS: Twenty-one athletes were fitted with properly sized soccer shoes and corresponding F-Scan system insoles and performed walking, running, vertical jumping and cutting activities to the right and left sides on both natural and artificial turf. RESULTS: There were no statistically significant differences between natural grass and artificial turf in peak pressure, maximum force and force-time integral during all the athletic activities (P˃0.05). On both turfs, the highest peak pressure and maximum force values occurred during running and cutting to the right, and the highest force-time integral value occurred during cutting to the right. There were no statistically significant differences between the two turfs in peak pressure in the various anatomical regions during any of the athletic activities (P˃0.05). The peak pressure was the highest on the first metatarsal and the hallux during all five activities. A clinically meaningful difference between the surfaces in peak pressure on the second to fifth metatarsals was found during walking, indicating more loading on artificial turf than on natural grass. There was more loading on artificial turf than on natural grass during cutting left and at hallux and third toe on natural grass during cutting right. However, these differences were not statistically significant (P˃0.05). CONCLUSIONS: The results of this study suggest that it is important to limit or prevent athletes from undertaking certain activities that increase the risk of re-injury during rehabilitation.

Rehabilitation of patellar tendinopathy.

Patellar tendinopathy is a common musculoskeletal disorder characterized by progressive activity-related anterior knee pain and patellar tendon dysfunction. It is highly prevalent in sports which involve running and jumping. Various treatment methods are used in the management of PT including rest, activity modification, anti-inflammatory medication, injection therapies, taping, eccentric exercises, extra corporeal shock wave therapy, percutaneous electrolysis, and surgery. Even though various treatment options are available for patellar tendinopathy, no single method has proven to result in a consistent and near complete recovery in patients. Conservative management is considered to be the first line of treatment. This study presents an overview of the current practice about the management of patellar tendinopathy with an emphasis on rehabilitation. This review can act as a guide to sports medicine and rehabilitation professionals' decision making in the management of this disorder.

Effects of Neuromuscular Fatigue on Eccentric Strength and Electromechanical Delay of the Knee Flexors: The Role of Training Status.

Purpose: To examine the effects of fatiguing isometric contractions on maximal eccentric strength and electromechanical delay (EMD) of the knee flexors in healthy young adults of different training status. Methods: Seventy-five male participants (27.7 ± 5.0 years) were enrolled in this study and allocated to three experimental groups according to their training status: athletes (ATH, n = 25), physically active adults (ACT, n = 25), and sedentary participants (SED, n = 25). The fatigue protocol comprised intermittent isometric knee flexions (6-s contraction, 4-s rest) at 60% of the maximum voluntary contraction until failure. Pre- and post-fatigue, maximal eccentric knee flexor strength and EMDs of the biceps femoris, semimembranosus, and semitendinosus muscles were assessed during maximal eccentric knee flexor actions at 60, 180, and 300°/s angular velocity. An analysis of covariance was computed with baseline (unfatigued) data included as a covariate. Results: Significant and large-sized main effects of group (p ≤ 0.017, 0.87 ≤ d ≤ 3.69) and/or angular velocity (p < 0.001, d = 1.81) were observed. Post hoc tests indicated that regardless of angular velocity, maximal eccentric knee flexor strength was lower and EMD was longer in SED compared with ATH and ACT (p ≤ 0.025, 0.76 ≤ d ≤ 1.82) and in ACT compared with ATH (p = ≤0.025, 0.76 ≤ d ≤ 1.82). Additionally, EMD at post-test was significantly longer at 300°/s compared with 60 and 180°/s (p < 0.001, 2.95 ≤ d ≤ 4.64) and at 180°/s compared with 60°/s (p < 0.001, d = 2.56), irrespective of training status. Conclusion: The main outcomes revealed significantly higher maximal eccentric strength and shorter eccentric EMDs of knee flexors in individuals with higher training status (i.e., athletes) following fatiguing exercises. Therefore, higher training status is associated with better neuromuscular functioning (i.e., strength, EMD) of the hamstring muscles in fatigued condition. Future longitudinal studies are needed to substantiate the clinical relevance of these findings.

Translation and validation of the stroke specific quality of life scale into Arabic.

BACKGROUND: There is a need to validate one of the specific stroke quality of life (QOL) scales into Arabic. OBJECTIVE: To translate and validate the stroke specific quality of life (SSQOL) into Arabic. METHODS: The SSQOL was translated into Arabic (SSQOL-A) according to a forward/backward translation protocol. 147 first time stroke survivors and 60 healthy subjects were recruited. Cronbach's α was used to measure internal consistency, test-retest reliability was measured by intraclass correlation coefficient (ICC). Acceptability was established by studying floor and ceiling effects. A linear correlation between SSQOL-A and the Short Form 36, the Beck Depression Inventory II, the Barthel Index and the National Institutes of Health Stroke Scale was done to assess construct validity. Discriminant and convergent validity were evaluated by correlating item to scale of each of the domains using Pearson correlation (rp). RESULTS: The SSQOL-A has shown good internal consistency (Cronbach's α  = 0.78-0.94) and test-retest reliability (ICC = 0.77-0.94). It has also shown acceptable construct validity (r2 = 0.06-0.55). Item to scale correlation showed acceptable convergent (0.76-0.98) and discriminant (0.12-0.53) validity. Mann-Whitney U test showed the ability of the SSQOL-A to differentiate between stroke survivors and healthy participants QOL. CONCLUSIONS: SSQOL-A has good validity and reliability for patients with mild to moderate stroke.

Cardio respiratory response: Validation of new modifications of Bruce protocol for exercise testing and training in elite Saudi triathlon and soccer players.

The Bruce protocol is the traditional method used to assess maximal fitness level, although it may have limitations, such as its short duration and large work rate increases, with very high levels of exertion that consist of speed/incline combinations. Modifications have been added to elicit similar maximal fitness achievements. The authors of this experimental trial have proposed a new treadmill protocol that allows optimal test duration in conjunction with peak oxygen consumption 'VO2max', and with appropriate patient comfort and safety during both exercise testing and training. SUBJECTS: Twenty-two elite Saudi players, comprising eleven Saudi triathlon athletes, and eleven Saudi elite soccer players, BMI, body fat mass percentage, body fat free mass percentage. cardiovascular parameter; including, absolute and relative "VO2max" as well as maximal heart rate "HR max", were assessed during a graded treadmill running modified protocol, using a Quark Cardio Pulmonary Exercise Testing Unit (CPET). RESULTS: Descriptive statistics were used to obtain the anthropometric characteristics, including comparisons between the means, independent sample T-test and a regression analysis, to test the association of the protocol duration and the corresponding, dependent variables. CONCLUSIONS CLINICAL RELEVANCE: It is often difficult to achieve a high cardiorespiratory response, VO2max, without an association to high values of HR max, and peak perceived exertion. This may lead to cardiovascular risk. Our new modifications can provide a practical, valid alternative protocol to be used comfortably both during exercise testing and training, rather than performance testing only, to achieve high VO2max with minimal cardiovascular stress.