Exercise-Related Transient Abdominal Pain

Exercise-related transient abdominal pain (ETAP), commonly referred to as “stitch”, is an ailment well known in many sporting activities. It is especially prevalent in activities that involve repetitive torso movement with the torso in an extended position, such as running and horse riding. Approximately 70% of runners report experiencing the pain in the past year and in a single running event approximately one in five participants can be expected to suffer the condition. ETAP is a well-localized pain that is most common in the lateral aspects of the mid abdomen along the costal border, although it may occur in any region of the abdomen. It may also be related to shoulder tip pain, which is the referred site from tissue innervated by the phrenic nerve. ETAP tends to be sharp or stabbing when severe, and cramping, aching, or pulling when less intense. The condition is exacerbated by the postprandial state, with hypertonic beverages being particularly provocative. ETAP is most common in the young but is unrelated to sex or body type. Well-trained athletes are not immune from the condition, although they may experience it less frequently. Several theories have been presented to explain the mechanism responsible for the pain including: ischemia of the diaphragm; stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament; aggravation of the spinal nerves; and irritation of the parietal peritoneum. Of these theories, irritation of the parietal peritoneum best explains the features of ETAP, however, further investigations are required. Strategies for managing the pain are largely anecdotal, especially given its etiology remains to be fully elucidated. Commonly purported prevention strategies include: avoiding large volumes of food and beverages for at least two hours prior to exercise, especially hypertonic compounds; improving posture, especially in the thoracic region; and supporting the abdominal organs by improving core strength or wearing a supportive broad belt. Techniques for gaining relief from the pain during an episode are equivocal. This article presents a contemporary understanding of ETAP, which historically has received little research attention but over the past 15 years has been more carefully studied

Analysis of Time Course Changes in the Cardiovascular Response to Head-Up Tilt in Fighter Pilots

Fighter pilots are exposed to significant levels of +Gz acceleration on a frequent occupational basis (Newman & Callister, 1999). There is an emerging body of experimental research that suggest that they physiologically adapt to this frequent +Gz exposure (Convertino, 1998; Newman & Callister, 2008, 2009; Newman et al, 1998, 2000). Our previous work has shown that fighter pilots are able to maintain their cariovascular function to a much greater extent than non-pilots when exposed to an orthostatic stimulus such as head-up tilt(Newman & Callister, 2008, 2009; Newman et al, 1998, 2000)

Efficacy of manual therapy treatments for people with cervicogenic dizziness and pain : Protocol of a randomised controlled trial

BACKGROUND: Cervicogenic dizziness is a disabling condition characterised by postural unsteadiness that is aggravated by cervical spine movements and associated with a painful and/or stiff neck. Two manual therapy treatments (Mulligan’s Sustained Natural Apophyseal Glides (SNAGs) and Maitland’s passive joint mobilisations) are used by physiotherapists to treat this condition but there is little evidence from randomised controlled trials to support their use. The aim of this study is to conduct a randomised controlled trial to compare these two forms of manual therapy (Mulligan glides and Maitland mobilisations) to each other and to a placebo in reducing symptoms of cervicogenic dizziness in the longer term and to conduct an economic evaluation of the interventions. METHODS: Participants with symptoms of dizziness described as imbalance, together with a painful and/or stiff neck will be recruited via media releases, advertisements and mail-outs to medical practitioners in the Hunter region of NSW, Australia. Potential participants will be screened by a physiotherapist and a neurologist to rule out other causes of their dizziness. Once diagnosed with cervciogenic dizziness, 90 participants will be randomly allocated to one of three groups: Maitland mobilisations plus range-of-motion exercises, Mulligan SNAGs plus self-SNAG exercises or placebo. Participants will receive two to six treatments over six weeks. The trial will have unblinded treatment but blinded outcome assessments. Assessments will occur at baseline, post-treatment, six weeks, 12 weeks, six months and 12 months post treatment. The primary outcome will be intensity of dizziness. Other outcome measures will be frequency of dizziness, disability, intensity of cervical pain, cervical range of motion, balance, head repositioning, adverse effects and treatment satisfaction. Economic outcomes will also be collected. DISCUSSION: This paper describes the methods for a randomised controlled trial to evaluate the effectiveness of two manual therapy techniques in the treatment of people with cervicogenic dizziness for which there is limited established evidence-based treatment. TRIAL REGISTRATION: ACTRN1261100007390

The Feasibility of a Telehealth Exercise Program Aimed at Increasing Cardiorespiratory Fitness for People After Stroke

Background: Accessing suitable fitness programs post-stroke is difficult for many. The feasibility of telehealth delivery has not been previously reported.Objectives: To assess the feasibility of, and level of satisfaction with home-based telehealth-supervised aerobic exercise training post-stroke.Methods: Twenty-one ambulant participants (?3 months post-stroke) participated in a home-based telehealth-supervised aerobic exercise program (3 d/week, moderate-vigorous intensity, 8-weeks) and provided feedback via questionnaire postintervention. Session details, technical issues, and adverse events were also recorded.Results: Feasibility was high (83% of volunteers met telehealth eligibility criteria, 85% of sessions were conducted by telehealth, and 95% of participants rated usability favourably). Ninety-five percent enjoyed telehealth exercise sessions and would recommend them to others. The preferred telehealth exercise program parameters were: frequency 3 d/week, duration 20-30 min/session, program length 6-12 weeks.Conclusion: The telehealth delivery of exercise sessions to people after stroke appear

Going their own way-male recreational runners and running-related injuries : a qualitative thematic analysis

Objective Recreational running is one of the most common physical leisure activities worldwide and is associated with high rates of running related injury (RRI). Little is known of the perceptions of male recreational runners regarding the aetiology and management of RRI. Design Utilising an interpretive phenomenological analysis framework, qualitative data was gathered from participants via interview, and reflexive thematic analysis was used to develop insights into the experiences and perceptions of the participants in relation to RRI. Materials and methods Two focus groups with a total of six (mean age 37.8 ± 9.5 years, 16.5 ± 13.1 years running experience) male recreational runners were used to obtain data regarding their understanding of RRI causation, prevention and management. Interviews were evaluated using a sixphase reflexive thematic analysis approach to generate and interpret themes within the data. Results Three themes (Mind, Body and Education) were identified by the analysis as critical to RRI avoidance. Mind refers to the self-understanding and self-management of personal limits required for RRI prevention. Body reflects a degree of physical conditioning necessary for injury free running, while Education indicates an understanding of how to correctly structure a running program. When viewed together these themes can be seen to form an 'internal locus of injury' model which highlights the runners' beliefs that RRI are related to their decisions regarding training and running, and that avoidance of injury lies within their personal control. Conclusion Recreational runners rely on self-management, in preference to professional advice, to manage training loads, fitness and RRI. Health care professionals involved with this population may consider the use of online resources, a preferred option of runners, to assist runners to build their knowledge base and support their development to experienced runners

Injury incidence, characteristics and timing in amateur male rugby union: A prospective cohort study

Rugby union has a high incidence of match injuries. However, there is limited information regarding the incidence and characteristics of match injuries in male amateur players. In particular, there is a lack of information regarding injury rates per match quarter. Investigating this may inform injury prevention strategies. The aim is to determine whether the rate and characteristics of injury vary with match quarter in male amateur rugby union players, regardless of whether the injury resulted in time loss from play. This prospective cohort study recorded and examined the number and characteristics of injuries during match quarters across a season of amateur rugby union. Team match exposure was recorded. Injuries were recorded by a team physiotherapist consistent with Rugby Injury Consensus Group guidelines. Matches were divided into quarters for data analysis, and statistical significance was determined using Chi-square analysis. 127 players sustained 207 injuries across 18 games. The injury incidence was 164 injuries/1000 match hours. There was a significant (p<0.001) difference in the number of injuries between match quarters, with the greatest number in the fourth, followed by the second, third, and first quarter. Forwards had a statistically significant higher rate of injury between quarters. Injury incidence in amateur rugby is higher than previously reported. Injury rates in amateur male rugby increase at the end of each match half, peaking in the fourth quarter. These findings contribute to the understanding of the aetiology of injury in amateur rugby union

Biomechanical and musculoskeletal measurements as risk factors for running-related injury in non-elite runners : a systematic review and meta-analysis of prospective studies

Background: Running-related injury (RRI) is highly prevalent among recreational runners and is a key barrier to participation. Atypical lower limb alignment and mechanical function have been proposed to play a role in development of lower extremity injury. The purpose of this study was to investigate relationships between incidence of running related injury (RRI) in non-elite runners with biomechanical and musculoskeletal variables. Methods: A systematic review and meta-analysis of prospective studies. Published research indexed in MEDLINE, EMBASE, CINAHL, SPORTDiscus, AMED, and The Cochrane library until 13th January 2021, grey literature, and reference lists of included studies were screened to identify prospective studies of non-elite adult runners that measured a relationship between biomechanical or musculoskeletal measures and incidence of RRI. Results: Thirty studies (3404 runners), testing over 100 discrete biomechanical and musculoskeletal risk factors for RRI, were included. Nineteen studies were pooled in twenty-fve separate meta-analyses. Meta-analysis of four studies detected signifcantly less knee extension strength among runners who developed a RRI (SMD−0.19, 95% CI−0.36 to−0.02, p=0.03), though this may not be clinically important. A meta-analysis of two studies detected signifcantly lower hip adduction velocity among runners who developed a RRI (MD−12.80, 95% CI−25.22 to−0.38, p=0.04). Remaining meta-analyses found no signifcant relationship between biomechanical or musculoskeletal variables and RRI. Conclusion: This systematic review and meta-analysis found the currently available literature does not generally support biomechanical or musculoskeletal measures as risk factors for RRI in non-elite runners. While meta-analysis fndings for knee extension strength and hip adduction velocity as risk factors for RRI were statistically signifcant, the associated trivial to small efects sizes suggest these fndings should be treated with caution. Until further evidence emerges, recommendations for injury prevention in non-elite runners cannot be made based on biomechanical and musculoskeletal measurements alon

Healthy Body Healthy Mind: Trialling an exercise intervention for reducing depression in youth with major depressive disorder

Introduction: Major Depressive Disorder (MDD) has high prevalence among adolescents and young adults but evidence of any effective treatments is limited. Exercise as an effective treatment for adults has some support but studies in younger populations are lacking. MDD is associated with inflammation and exercise may contribute to reductions in inflammatory marker levels. Therefore the aim of this study was to investigate the feasibility and preliminary efficacy of brief motivational interviewing (MI) plus 12-weeks exercise training as a treatment for MDD in youth. Methods: Youth (15-25 years) with MDD were recruited to participate in a prospective trial investigating exercise as treatment for MDD. Twenty-six participants were screened (telephone then clinical psychology diagnosis) and 13 (9 females) were eligible (MDD from SCID, no psychotic illness, not pregnant, no physical barriers to exercise, not suicidal, no major eating disorder) to participate. Participants completed assessments at baseline and after 12 weeks training, which included questionnaires: the Beck Depression Inventory (BDI-II); blood samples for analysis of inflammatory biomarkers; and fitness measures: VO2max, YMCA bench press test, and a seated horizontal leg press endurance test. Prior to commencing the training program, participants engaged in a motivational interview with a psychologist to enhance engagement with the program. IL-6 was measured by ELISA. The exercise program consisted of small group trainer-led supervised exercise (resistance and endurance) training 3 times a week (1h per session) for 12 weeks, and encouragement to do at least 30min of physical activity on other days. Paired t-tests were used to determine changes from baseline and correlations used to explore relationships between changes in depression scores, training attendance and fitness levels. Results: 12 participants (mean±SD, aged 20.7±1.7 y) completed 12-week assessments; one withdrew due to family issues. Attendance at training averaged 66±25% of sessions; 3 participants completed less than 40% of training sessions. At baseline all participants met the criteria for MDD; at 12 weeks only 2 still met the criteria; depression severity (BDI-II) decreased (p\u3c0.001) from 32±9 to12±10. Aerobic fitness levels did not change with training. YMCA bench press repetitions increased (p\u3c0.001) from 20±11 to 27±11. IL-6 decreased (p\u3c0.05) from 1.39±0.78 to 0.73±0.80 pg.mL-1. Changes in depression symptom scores were significantly correlated (p\u3c0.05) with attendance (r=0.32), improvements in bench press endurance (r=0.65) and changes in IL-6 (r=0.34). Changes in IL-6 were also correlated with attendance (r=0.60) Conclusion: Exercise training is a feasible and potentially effective intervention for MDD in youth and reductions in depression severity are associated with reductions in IL-6

Relationship between body composition, inflammation and lung function in overweight and obese asthma

Background: The obese-asthma phenotype is not well defined. The aim of this study was to examine both mechanical and inflammatory influences, by comparing lung function with body composition and airway inflammation in overweight and obese asthma. Methods: Overweight and obese (BMI 28-40 kg/m2) adults with asthma (n = 44) completed lung function assessment and underwent full-body dual energy x-ray absorptiometry. Venous blood samples and induced sputum were analysed for inflammatory markers. Results: In females, android and thoracic fat tissue and total body lean tissue were inversely correlated with expiratory reserve volume (ERV). Conversely in males, fat tissue was not correlated with lung function, however there was a positive association between android and thoracic lean tissue and ERV. Lower body (gynoid and leg) lean tissue was positively associated with sputum %neutrophils in females, while leptin was positively associated with android and thoracic fat tissue in males. Conclusions: This study suggests that both body composition and inflammation independently affect lung function, with distinct differences between males and females. Lean tissue exacerbates the obese-asthma phenotype in females and the mechanism responsible for this finding warrants further investigation

The ‘Healthy Dads, Healthy Kids’ community effectiveness trial: study protocol of a community-based healthy lifestyle program for fathers and their children

Background: The \u27Healthy Dads, Healthy Kids\u27 program was designed to help overweight fathers lose weight and positively influence the health behaviors of their children. The aim of the current study was to evaluate the previously established program in a community setting, in a large effectiveness trial. Methods/Design: The Healthy Dads, Healthy Kids community trial consists of three stages: (i) Stage 1 - program refinement and resource development (ii) Stage 2 - community randomized controlled trial (iii) Stage 3 - community effectiveness trial. The program will be evaluated in five Local Government Areas in the Hunter Valley Region of NSW, Australia. For the community randomized controlled trial, 50 overweight/obese men (aged 18-65 years) from one Local Government Area with a child aged between 5-12 years of age will be recruited. Families will be randomized to either the program or a 6-month wait-list control group. Fathers and their children will be assessed at baseline, post-intervention (3-months) and 6-months. Inclusion criteria are: body mass index 25-40 kg/m2; no participation in other weight loss programs during the study; pass a health-screening questionnaire; and access to a computer with Internet facilities. In the community trial, the program will be evaluated using a non-randomized, prospective design in five Local Government Areas. The exclusion criteria is body mass index \u3c 25 kg/m2 or lack of doctor\u27s approval. Measures will be collected at baseline, 3-, 6- and 12-months. The program involves fathers attending seven face-to-face group sessions (three with children) over 3-months. Measures: The primary outcome is fathers\u27 weight. Secondary outcomes for both fathers and children include: waist circumference, blood pressure, resting heart rate, physical activity, sedentary behaviors and dietary intake. Father-only measures include portion size, alcohol consumption, parenting for physical activity and nutrition and parental engagement. Process evaluation will determine the fidelity, dose (delivered and received), reach, recruitment and context of the program. Discussion: As a unique approach to reducing obesity prevalence in men and improving lifestyle behaviours in children, our findings will provide important evidence relating to the translation of Healthy Dads, Healthy Kids, which will enable it to be delivered on a larger scale