Clinical Report: Land-Based Versus Pool-Based Exercise for People Awaiting Joint Replacement Surgery of the Hip or Knee: Results of a Randomized Controlled Trial

Background: Individuals with either knee or hip osteoarthritis are at risk of experiencing pain and developing functional limitations (Bennell 2005). In many cases, to alleviate pain and improve one\u27s quality of life, an individual may require a total joint replacement. Despite advances in surgical technique and joint replacement hardware, surgical procedures are not without risk. Conservative treatments, including therapeutic exercise programmes, may improve a patient\u27s status while avoiding the potential risks associated with surgery (pain, medication utilisation, long bouts of rehabilitation, and/ or death). Researchers have demonstrated that some patients may experience improvements in pain and functional abilities after participating in either land-based or aquatic-based exercise programmes (Maurer et al 1999, Hinman et al 2007). However, according to Gill et al (2009), there is paucity of literature addressing post-exercise outcomes in individuals who are scheduled for either hip or knee joint replacement surgery. Aim: To assess self-reported and performance-based functional measures in individuals (who were scheduled to have either a hip or knee joint replacement) after the completion of either a land-based or pool-based exercise programme. Methods: The authors implemented a randomised controlled trial, allocating subjects to either the land-based (n=40) or pool-based (n=42) exercise programme, stratified by the involved joint. Subjects were recruited from a waiting list of patients who were scheduled for either a knee replacement or hip replacement. Each exercise session was performed for one hour over a total period of 12 sessions (2 times a week for 6 weeks). In addition, the authors instructed the subjects to exercise 3 days a week at home (for 30 minutes each session) performing a combination of walking, stationary bicycling, and/or other exercises they performed in class. Self-reported function (as measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), performance-based outcomes (50-foot timed walk and 30-second chair stand test), and psychosocial status (SF-36 MCS) measures were collected prior to treatment, at the end of the 6-week training session, and finally two months later. These data were collected by a blinded assessor. Additionally, daily pre- and post-exercise pain levels were recorded during each session. Results: The authors reported that both pool-based and land-based exercise programmes were effective in reducing pain and increasing function in patients with a diagnosis of either knee or hip arthritis. However, there were no differences between groups for WOMAC pain (p = .614), WOMAC function (p = .739), 50-foot timed walk test p = .173), the 30-second chair stand test (p = .179), or the SF-36 MCS (p = .205). Those who participated in the land-based programme experienced improvements in pain at both assessment periods (p = .000; .015) whereas the participants in the pool-based programme only demonstrated improvements at the first assessment (p = .011; .431). Both groups demonstrated significant functional improvements at the first testing session for performance-based tests as well as demonstrating significant improvement in WOMAC function scores and the 30-second chair stand test at the final assessment session. Those who participated in the pool-based programme experienced a significantly lower daily pain score (p = .005) when compared to those in the land-based programme. Conclusion: The authors report that both training programmes may lead to positive functional outcomes in individuals who are awaiting a joint replacement surgery. In addition, the authors report that those who participated in the pool programme may tolerate the treatment with less post-exercise pain

Point/Counterpoint: Are Specific Spine Stabilization Exercises Necessary for Athletes?

The issue of spine stabilization has received considerable attention in recent years; although there are many proponents for specific training of spinal musculature, there is debate as to whether it is beneficial and required for athletes

Core Stabilization Exercise Prescription, Part I: Current Concepts in Assessment and Intervention

Context: Injury to the low back can cause significant pain and dysfunction, which can affect an athlete’s performance and result in time lost from sport. A common conservative treatment is therapeutic core stabilization exercises, which can address pain and musculoskeletal dysfunction in patients with low back pathology. Evidence Acquisition: MEDLINE and CINAHL were searched (from 1966 to March 2013) to identify relevant research. Keywords and keyword combinations searched included motor control exercise, segmental stabilization, core stabilization, transversus abdominis, multifidi, and low back pain. Results: There are 2 popular rehabilitation strategies to assess core function and promote core stabilization. Each has been developed based on biomechanical models of lumbar segmental stability and observed motor control dysfunction in patients with low back pain. Conclusion: Controversy exists among clinical and research groups as to the optimal strategy for an athlete with low back pain

Core Stabilization Exercise Prescription, Part 2: A Systematic Review of Motor Control and General (Global) Exercise Rehabilitation Approaches for Patients with Low Back Pain

Context: Therapeutic exercises are frequently prescribed to patients with low back pain. Numerous exercise programs for patients with low back pain have been described. Many of these treatment programs are based on 1 of 2 popular rehabilitation strategies: a motor control exercise approach or a general exercise approach. Data Sources: PubMed clinical queries from 1966 to March 2013 for keyword combinations including motor control exercise, core stability exercise, therapeutic exercise, general exercise, global exercise, local exercise, transversus abdominis, segmental stabilization, and low back pain. Study Selection: Randomized controlled trials that assessed the effects of a motor control exercise approach, a general exercise approach, or both for patients with low back pain that were published in scientific peer-reviewed journals. Data Extraction: Included studies underwent appraisal for exercise intervention and outcomes. Results: Fifteen studies were identified (8, motor control exercise approach without general exercise comparison; 7, general exercise approach with or without motor control exercise approach comparison). Current evidence suggests that exercise interventions may be effective at reducing pain or disability in patients with low back pain. Conclusion: Stabilization exercises for patients with low back pain may help to decrease pain and disability. It may not be necessary to prescribe exercises purported to restore motor control of specific muscles

Preseason Functional Test Scores are Associated with Future Sports Injury in Female Collegiate Athletes

Brumitt, J, Heiderscheit, B, Manske, R, Niemuth, PE, Mattocks, A, and Rauh, MJ. Preseason functional test scores are associated with future sports injury in female collegiate athletes. J Strength Cond Res 32(6): 1692–1701, 2018—Recent prospective cohort studies have reported preseason functional performance test (FPT) measures and associations with future risk of injury; however, the findings associated with these studies have been equivocal. The purpose of this study was to determine the ability of a battery of FPTs as a preseason screening tool to identify female Division III (D III) collegiate athletes who may be at risk for a noncontact time-loss injury to the lower quadrant (LQ = low back and lower extremities). One hundred six female D III athletes were recruited for this study. Athletes performed 3 FPTs: standing long jump (SLJ), single-leg hop (SLH) for distance, and the lower extremity functional test (LEFT). Time-loss sport-related injuries were tracked during the season. Thirty-two (24 initial and 8 subsequent) time-loss LQ injuries were sustained during the study. Ten of the 24 initial injuries occurred at the thigh and knee. At-risk athletes with suboptimal FPT measures (SLJ #79% ht; (B) SLH #64% ht; LEFT $118 seconds) had significantly greater rates of initial (7.2 per 1,000 athletic exposures [AEs]) and total (7.6 per 1,000 AEs) time-loss thigh or knee injuries than the referent group (0.9 per 1,000 AEs; 1.0 per 1,000 AEs, respectively). At-risk athletes were 9 times more likely to experience a thigh or knee injury (odds ratio [OR] = 9.7, confidence interval [CI]: 2.3–39.9; p = 0.002) than athletes in the referent group. At-risk athletes with a history of LQ sports injury and lower off-season training habits had an 18-fold increased risk of a time-loss thigh or knee injury during the season (adjusted OR = 18.7, CI: 3.0–118.1; p = 0.002). This battery of FPTs appears useful as a tool for identifying female D III athletes at risk of an LQ injury, especially to the thigh or knee region

Training Toys ... Bells, Ropes, and Balls - Oh My!

Participation in regular moderate-to-vigorous physical activity often decreases with increasing age (16), and among people who do exercise, long-term adherence often is a challenge because of various factors including lack of enjoyment, intrinsic motivation, or social support; poor environment; inconvenience; fear of injury; and health-related issues. During the past decade, general fitness professionals and personal trainers have incorporated numerous adjunct modalities (‘‘toys’’) to ‘‘break up’’ the rigors of fitness training and as a means to introduce some diversion and goal-specific activities. Three popular modalities are kettlebells, battling ropes, and medicine balls. This article briefly reviews each device and presents some applications for their use in the fitness setting

Lower Extremity Functional Tests and Risk of Injury in Division III Collegiate Athletes

Purpose/Background: Functional tests have been used primarily to assess an athlete’s fitness or readiness to return to sport. The purpose of this prospective cohort study was to determine the ability of the standing long jump (SLJ) test, the single-leg hop (SLH) for distance test, and the lower extremity functional test (LEFT) as preseason screening tools to identify collegiate athletes who may be at increased risk for a time-loss sports-related low back or lower extremity injury. Methods: A total of 193 Division III athletes from 15 university teams (110 females, age 19.1 ± 1.1 y; 83 males, age 19.5 ± 1.3 y) were tested prior to their sports seasons. Athletes performed the functional tests in the following sequence: SLJ, SLH, LEFT. The athletes were then prospectively followed during their sports season for occurrence of low back or LE injury. Results: Female athletes who completed the LEFT in 118 s were 6 times more likely (OR=6.4, 95% CI: 1.3, 31.7) to sustain a thigh or knee injury. Male athletes who completed the LEFT in 100 s were more likely to experience a time-loss injury to the low back or LE (OR=3.2, 95% CI: 1.1, 9.5) or a foot or ankle injury (OR=6.7, 95% CI: 1.5, 29.7) than male athletes who completed the LEFT in 101 s or more. Female athletes with a greater than 10% side-to-side asymmetry between SLH distances had a 4-fold increase in foot or ankle injury (cut point: \u3e10%; OR=4.4, 95% CI: 1.2, 15.4). Male athletes with SLH distances (either leg) at least 75% of their height had at least a 3-fold increase (OR=3.6, 95% CI: 1.2, 11.2 for the right LE; OR=3.6, 95% CI: 1.2, 11.2 for left LE) in low back or LE injury. Conclusions: The LEFT and the SLH tests appear useful in identifying Division III athletes at risk for a low back or lower extremity sports injury. Thus, these tests warrant further consideration as preparticipatory screening examination tools for sport injury in this population. Clinical Relevance: The single-leg hop for distance and the lower extremity functional test, when administered to Division III athletes during the preseason, may help identify those at risk for a time-loss low back or lower extremity injury

The Lower-Extremity Functional Test and Lower-Quadrant Injury in NCAA Division III Athletes: A Descriptive and Epidemiologic Report

Context: The Lower-Extremity Functional Test (LEFT) has been used to assess readiness to return to sport after a lower extremity injury. Current recommendations suggest that women should complete the LEFT in 135 s (average; range 120-150 s) and men should complete the test in 100 s (average; range 90-125 s). However, these estimates are based on limited data and may not be reflective of college athletes. Thus, additional assessment, including normative data, of the LEFT in sport populations is warranted. Objective: To examine LEFT times based on descriptive information and off-season training habits in NCAA Division III (Dill) athletes. In addition, this study prospectively examined the LEFT’S ability to discriminate sport-related injury occurrence. Design: Descriptive epidemiology. Setting: Dill university. Subjects: 189 Dill college athletes (106 women, 83 men) from 15 teams. Main Outcome Measures: LEFT times, preseason questionnaire, and time-loss injuries during the sport season. Results: Men completed the LEFT (105 ± 9 s) significantly faster than their female counterparts (117 ± 10 s) (P \u3c .0001). Female athletes who reported \u3e3-5 h/wk of plyometric training during the off-season had significantly slower LEFT scores than those who performed \u3c3 h/wk of plyometric training (P - -03). The overall incidence of a lower-quadrant (LQ) time-loss injury for female athletes was 4.5/1000 athletic exposures (AEs) and 3.7/1000 AEs for male athletes. Female athletes with slower LEFT scores (\u3e118 s) experienced a higher rate of LQ time-loss injuries than those with faster LEFT scores (\u3c117 s) (P = .03). Conclusion: Only off-season plyometric training practices seem to affect LEFT score times among female athletes. Women with slower LEFT scores are more likely to be injured than those with faster LEFT scores. Injury rates in men were not influenced by performance on the LEFT

Context-Aware User Authentication – Supporting Proximity-Based Login in Pervasive Computing

Abstract. This paper explores computer security in pervasive computing with focus on user authentication. We present the concept of Proximity-Based User Authentication, as a usability-wise ideal for UbiComp systems. We present a context-aware user authentication protocol, which (1) uses a JavaCard for identi-fication and cryptographic calculations, (2) uses a context-awareness system for verifying the user’s location, and (3) implements a security fall-back strategy. We analyze the security of this protocol and discuss the tradeoff between usabil-ity and security. We also present our current implementation of the protocol and discuss future work.