The role of upper body biomechanics in elite racewalkers

The aim of this study was to analyze the link between the upper and lower body during racewalking. Fifteen male and 16 female racewalkers were recorded in a laboratory as they racewalked at speeds equivalent to their 20-km personal records [men: 1:23:12 (±2:45); women: 1:34:18 (±5:15)]; a single representative trial was chosen from each athlete for analysis and averaged data analyzed. Spatial variables (e.g., stride length) were normalized to stature and referred to as ratios. None of the peak upper body joint angles were associated with speed (p < 0.05) and there were no correlations between pelvic motion and speed, but a medium relationship was observed between peak pelvic external rotation (right pelvis rotated backwards) and stride length ratio (r = 0.37). Greater peak shoulder extension was associated with lower stride frequencies (r = −0.47) and longer swing times (r = 0.41), whereas peak elbow flexion had medium associations with flight time (r = −0.44). Latissimus dorsi was the most active muscle at toe-off during peak shoulder flexion; by contrast, pectoralis major increased in activity just before initial contact, concurrent with peak shoulder extension. Consistent but relatively low rectus abdominis and external oblique activation was present throughout the stride, but increased in preparation for initial contact during late swing. The movements of the pelvic girdle were important for optimizing spatiotemporal variables, showing that this exaggerated movement allows for greater stride lengths. Racewalkers should note however that a larger range of shoulder swing movements was found to be associated with lower stride frequency, and smaller elbow angles with increased flight time, which could be indicative of faster walking but can also lead to visible loss of contact. Coaches should remember that racewalking is an endurance event and development of resistance to fatigue might be more important than strength development

Reporting the whole story : Analysis of the 'out-of-scope' questions from the James Lind Alliance Teenage and Young Adult Cancer Priority Setting Partnership Survey

OBJECTIVE: We conducted a UK-wide survey to identify the top 10 research questions for young people's cancer. We conducted secondary analysis of questions submitted, which were 'out-of-scope' of the original survey aim. We sought to disseminate these questions, to inform practice, policy and the development of potential interventions to support young people with cancer. DESIGN: James Lind Alliance Priority Setting Partnership. PARTICIPANTS: Young people aged 13-24 with a current/previous cancer diagnosis, their families/friends/partners and professionals who work with this population. METHODS: Eight hundred and fifty-five potential research questions were submitted, and 326 were classified as 'out-of-scope'. These questions, along with 49 'free-text' comments, were analysed using thematic analysis. RESULTS: The 375 out-of-scope questions and comments were submitted by: 68 young people, 81 family members/partners/friends and 42 professionals. Ten overarching themes were identified: diagnostic experience; communication; coordination of care; information needs and lack of information; service provision; long-term effects and aftercare support; family support; financial impact; end-of life care; and research methods and current research. CONCLUSIONS: The need to tailor services, information and communication is a striking thread evidenced across the 'out-of-scope' questions. Gaps in information highlight implications for practice in revisiting information needs throughout the cancer trajectory. We must advocate for specialist care for young people and promote the research priorities and these findings to funding bodies, charities, young people and health and social care policymakers, in order to generate an evidence base to inform effective interventions across the cancer trajectory and improve outcomes. PATIENT/PUBLIC CONTRIBUTIONS: Patients and carers were equal stakeholders throughout

Urban meadows as an alternative to short mown grassland: Effects of composition and height on biodiversity

There are increasing calls to provide greenspace in urban areas, yet the ecological quality, as well as quantity, of greenspace is important. Short mown grassland designed for recreational use is the dominant form of urban greenspace in temperate regions but requires considerable maintenance and typically provides limited habitat value for most taxa. Alternatives are increasingly proposed, but the biodiversity potential of these is not well understood. In a replicated experiment across six public urban greenspaces we used nine different perennial meadow plantings to quantify the relative roles of floristic diversity and height of sown meadows on the richness and composition of three taxonomic groups – plants, invertebrates and soil microbes. We found that all meadow treatments were colonised by plant species not sown in the plots, suggesting that establishing sown meadows does not preclude further locally determined grassland development if management is appropriate. Colonising species were rarer in taller and more diverse plots, indicating competition may limit invasion rates. Urban meadow treatments contained invertebrate and microbial communities that differed from mown grassland. Invertebrate taxa responded to changes in both height and richness of meadow vegetation, but most orders were more abundant where vegetation height was longer than mown grassland. Order richness also increased in longer vegetation and Coleoptera family richness increased with plant diversity in summer. Microbial community composition seems sensitive to plant species composition at the soil surface (0–10 cm), but in deeper soils (11–20 cm) community variation was most responsive to plant height, with bacteria and fungi responding differently. In addition to improving local residents’ satisfaction, native perennial meadow plantings can produce biologically diverse grasslands that support richer and more abundant invertebrate communities, and restructured plant, invertebrate and soil microbial communities compared with short mown grassland. Our results suggest that diversification of urban greenspace by planting urban meadows in place of some mown amenity grassland is likely to generate substantial biodiversity benefits, with a mosaic of meadow types likely to maximise such benefits

Research priorities for young people with cancer : a UK priority setting partnership with the James Lind Alliance

OBJECTIVES: To conduct a UK-wide survey of young people who have experienced cancer, carers and professionals, to identify and prioritise research questions to inform decisions of research funders and support the case for research with this unique cancer population. DESIGN: James Lind Alliance Priority Setting Partnership. SETTING: UK health service and community. METHODS: A steering group oversaw the initiative and partner organisations were recruited. Unanswered questions were collected in an online survey. Evidence searching verified uncertainties. An interim survey was used to rank questions prior to a final prioritisation workshop. PARTICIPANTS: Young people aged 13-24 years with a current or previous cancer diagnosis, their families, friends, partners and professionals who work with this population. RESULTS: Two hundred and ninety-two respondents submitted 855 potential questions. Following a refining process and removal of 'out of scope' questions, 208 unique questions remained. Systematic evidence checking identified seven answered questions and 16 were the subject of ongoing studies. The interim survey was completed by 174 participants. The top 30 questions were prioritised at a workshop attended by 25 young people, parents and multidisciplinary professionals. The top three priorities are: (1) What psychological support package improves psychological well-being, social functioning and mental health during and after treatment? (2) What interventions, including self-care, can reduce or reverse adverse short-term and long-term effects of cancer treatment? (3) What are the best strategies to improve access to clinical trials? The remaining questions reflect the complete cancer pathway: new therapies, life after cancer, support, education/employment, relapse and end-of-life care. CONCLUSIONS: We have identified shared research priorities for young people with cancer using a rigorous, person-centred approach involving stakeholders typically not involved in setting the research agenda. The breadth of priorities suggest future research should focus on holistic and psychosocial care delivery as well as traditional drug/biology research

Using the AR-V7 biomarker to determine treatment in metastatic castrate resistant prostate cancer, a feasibility randomised control trial, conclusions from the VARIANT trial [version 2; peer review: 2 approved]

Background: Prostate cancer is the most commonly diagnosed malignancy in the UK. Castrate resistant prostate cancer (CRPC) can be difficult to manage with response to next generation hormonal treatment variable. AR-V7 is a protein biomarker that can be used to predict response to treatment and potentially better inform management in these patients. Our aim was to establish the feasibility of conducting a definitive randomised controlled trial comparing the clinical utility of AR-V7 biomarker assay in personalising treatments for patients with metastatic CRPC within the United Kingdom (UK) National Health Service (NHS).  Due to a number of issues the trial was not completed successfully, we aim to discuss and share lessons learned herein. Methods: We conducted a randomised, open, feasibility trial, which aimed to recruit 70 adult men with metastatic CRPC within three secondary care NHS trusts in the UK to be run over an 18-month period. Participants were randomised to personalised treatment based on AR-V7 status (intervention) or standard care (control). The primary outcome was feasibility, which included: recruitment rate, retention and compliance. Additionally, a baseline prevalence of AR-V7 expression was to be estimated. Results: Fourteen participants were screened and 12 randomised with six into each arm over a nine-month period. Reliability issues with the AR-V7 assay meant prevalence was not estimated. Due to limited recruitment the study did not complete to target. Conclusions: Whilst the trial did not complete to target, we have ascertained that men with advanced cancer are willing to take part in trials utilising biomarker guided treatment. A number of issues were identified that serve as important learning points in future clinical trials

The Effect of Habitual Walking in Minimalist Footwear on Dynamic Balance and Lower Limb Strength

Recent evidence suggests that habitual walking in minimalist shoes leads to reductions in knee loading in osteoarthritic women (Shakoor et al. 2013), and increased muscular strength and flexion in the metatarsophalangeal joints (Potthast et al. 2005) compared to traditional shoes. Further understanding of the benefits of habitual walking in minimalist footwear within clinical populations is warranted to establish potential beneficial effects on a range of conditions. The purpose of this study was to examine the chronic effect of minimalist footwear on measures of dynamic balance and strength of lower limb musculature. Fifteen healthy adult males voluntarily participated in the study (age 30.4 ± 9.4 yr) and were assigned into an intervention (IG; n=7) or control group (CG; n=8). The IG performed an 8 wk accommodation period of wearing minimalist footwear (2.5 mm sole thickness; Feelmax Osma 2) for at least 6 h.d-1 for 5 d.wk-1. Dynamic balance was assessed bilaterally using the Y-Balance Test (YBT) in 3 directions (anterior, posteromedial and posterolateral). Maximum voluntary isokinetic strength was measured for ankle plantarflexion and dorsiflexion (Humac Norm).Leg length and height were significantly correlated to reach distance in the anterior direction in the YBT (p > 0.05); excursion distances were normalised to participant’s leg length (Gribble & Hertel, 2003). Post-test analysis revealed an increase in the YBT in all directions for both groups; however only the anterior excursion distance in the left leg for the IG (p = 0.003) and the right leg for the CG (p =0.007) were significant. The IG had an increase in maximal eccentric plantarflexion in the left foot (18%; p = 0.021; see Fig 1); there was also a non-significant increase in concentric plantarflexion strength in both the right (45.8%, p = 0.146) and left foot (21.6%, p = 0.116). No improvement in lower limb strength was observed in the CG. There was also an inverse relationship between the percentage change for the IG in left foot anterior excursion distance and right concentric dorsiflexion strength (r = -0.87; p = 0.025). The findings suggest that habitual walking in minimalist footwear resulted in functional improvements in lower limb strength, however this did not translate into consistent improvements in dynamic balance

The Spatio-Temporal Differences Between Gait Parameters from 8 Weeks Minimalist Footwear Habituation: A Comparison of Three Footwear Conditions

Introduction Preventing injury in the athletic population is of interest; one suggested technique to achieve this is to modify the gait pattern, which can potentially be attained by barefoot running (Murphy et al. 2013). Manufacturers have now developed minimalist shoes to alleviate the obvious surface hazards that are present while barefoot (Willy & Davies 2013). To date, this intermediate option, that is now readily available, has received limited scientific investigation regarding the effects the footwear may have on spatio-temporal gait parameters, particularly after prolonged habitual wear. Methods Participants (healthy adult males n=15) were randomly allocated to a control or intervention group. The intervention group were provided with a pair of minimalist shoes (Feelmax) to be worn at least 6 hrs a d, 5 d a wk, over an 8 wk habituation period. Spatio-temporal data were obtained both before and after the 8 wk period for all participants. A 16 camera 3D motion capture system (Vicon) and analysed (Vicon BodyBuilder) were utilised. The Statistical Package for the Social Science (SPSS) was used for the statistical data analysis. All spatio-temporal parameters of gait were compared for each trial. Results Complete statistical analysis is pending. The gait parameters to be reported include, but are not limited to; stride length, stride frequency, cadence, step time, stride time, swing time, and stance time. Discussion After the 8 week intervention period, a tendency for alterations in spatio-temporal gait parameters was observed. Bonacci et al. (2013) did not find any kinematic differences between the minimalist shoe and other shod conditions tested. Additionally Willy & Davies (2013) also reported no changes in spatio-temporal gait parameters when compared with the standard running shoe. The dissimilarity in results of previous work, and the present study may be caused by different habituation periods utilised between each investigation. Only a 10 min (Willy & Davies 2013), and a 10 d (Bonacci et al. 2013) habituation period were utilised in comparison to the 8 week period prescribed here. This may suggest a 10 d habituation period is not long enough to modify gait pattern, and therefore prevent injury. Squadron & Gallozi (2009) observed a reduced sagital plane ankle and knee angle just before foot strike while adopting a minimalist shoe. However, the participants of this study were habitual barefoot runners. Therefore, the modification in spatio-temporal gait parameters may be due to the long term barefoot running adaption, and not to the immediate effect of wearing minimalist footwear. References Bonacci, J., Saunders, U., Hicks, A., Rantalain, T., Vicenzino, T. & Spratford, W. (2013). Br J Sports Med. 47 (6), 387-392. Murphy, K., Curry, E. & Matzkin, E. (2013). Sports Med. 43 (11), 1131-1138. Squadrone, R. & Gallozzi, C. (2009). J Sports Med Phys Fitness. 49 (1), 6-13. Will, W. & Davies, S. (2013). Med Scie Sports Excerc. 46 (2), 318-323

Muscoskeletal and Spatio-temporal Gait Changes in Walking After an Eight Weeks Minimalist Footwear Intervention

INTRODUCTION Manufacturers have now developed minimalist shoes to alleviate the obvious surface hazards that are present while barefoot (Willy & Davies). To date, the minimalist footwear option, that is now readily available, has received limited scientific investigation concerning chronic wear. This intermediate option has inspired many to transition to minimalist footwear or go barefoot through the use of training programs (Warne et al. 2013). Most training interventions regarding the transition to barefoot running commence with walking, yet no scientific rational exists for this decision. Therefore the aim of this study was to compare spatio-temporal walking gait parameters, and peak musculoskeletal torque values of the ankle joint after an 8 week minimalist footwear habituation period. METHODS Fourteen healthy male participants were randomly allocated to a control (CG) or intervention group (IG). The IG were provided with a pair of minimalist shoes (2.5 mm sole thickness; Feelmax Osma 2, Feelmax®) to be worn ≥6 hrs a day, 5 days a week over an 8 wk habituation period. Spatio-temporal and lower limb strength data were obtained both before and after the 8 wk period for all participants, in three different footwear conditions, barefoot, minimalist shoe, and traditional shoe. A 16 camera 3D motion capture system (Vicon) was used to collect data, which was subsequently processed and modelled analysed (Workstation, Bodybuilder, Vicon). Peak musculoskeletal torque values of the ankle joint were assessed through isokinetic dynamometry (Humac Norm Isokinetic dynamometer). Five repetitions of bilateral concentric and eccentric strength assessments were made during ankle plantar flexion and ankle dorsiflexion. Paired t-tests were utilised to determine group differences between baseline and post intervention spatio-temporal, and isokinetic force measures. Pearson’s correlation coefficient was used to assess relationships between the spatio-temporal and strength data. RESULTS The IG had an increase in stride length (4.2%; p = 0.44), and walking speed (5.2%; p = 0.04) during the barefoot condition. There was a similar increase in barefoot stride length observed in the CG (3.65%; p = 0.11). However, only the IG showed an improvement in eccentric plantar flexion strength of the left limb (18%; p = 0.021). No improvement in lower limb strength was observed in the CG. DISCUSSION Participants in the IG walked faster due to an increased stride length, as these spatiotemporal parameters are interrelated. This increase in stride length following the intervention differs to previous reports concerning barefoot gait during running (Kaplan 2014). This may be due to the extended time period the participants habituated to the footwear, or that the footwear worn was considerably more minimal than footwear investigated elsewhere. As significant differences were only observed in the barefoot condition, it can be suggested that the minimalist shoe worn during the 8 week period acted as a suitable transition to barefoot walking. Small improvements in peak torque values suggest that habitual walking in minimalist footwear resulted in increased lower limb strength. CONCLUSION To conclude, significant differences in gait parameters were only observed in the barefoot condition. This would suggest the minimalist shoe acted as a suitable training device for those transitioning to barefoot running. REFERENCES Kaplan, Y. (2014). Barefoot versus shoe running: from the past to the present. The Physician and sportsmedicine. 42 (1): 30-35. Warne, J., Kilduff, S., Gregan, B., Nevill, A., Moran, K., & Warrington, G. (2013). A 4Ǧweek instructed minimalist running transition and gaitǦretraining changes plantar pressure and force. Scandinavian journal of medicine & science in sports. Willy, R. & Davis, I. (2013). Kinematic and kinetic comparison of running in standard and minimalist shoes. Applied Sciences. 46 (2): 318-323