Thursday-Abstracts

Thursday, May 30, 2013 

S176 Vol. 45 No. 5 Supplement 

C-15 Thematic Poster - Diet, Exercise, and 

Glycemic Response 

May 30, 2013, 8:00 AM - 10:00 AM 

Room: 104 

983 Chair: Jill A. Kanaley, FACSM. University of Missouri, 

Columbia, MO. 

(No relationships reported) 

984 Board #1 May 30, 8:00 AM - 10:00 AM 

Effect of a high Protein Breakfast on Glycemic Control in 

Individuals with Type 2 diabetes 

Young-Min Park, Timothy D. Heden, Ying Liu, Lauryn M. 

Nyhoff, Heather J. Leidy, John P. Thyfault, Jill A. Kanaley, 

FACSM. University of Missouri, Columbia, MO. 


Considerable research has focused on carbohydrate (CHO) content of the breakfast 

meal on the second meal effect, but very little research has focused on protein-rich 

breakfast meals in individuals with type 2 diabetes (T2D). 

PurPOsE: To determine whether a high protein breakfast provides better glycemic 

control following both the breakfast and lunch meal compared to a high CHO 

breakfast. 

METhOds: Seven subjects with T2D completed two, 7-day conditions in random 

order in which they consumed either a 500 kcal high protein (PRO: 40% CHO, 40% 

protein, 20% fat) or high CHO (CHO: 65% CHO, 15% protein, 20% fat) breakfast 

for 6 days of acclimatization. On the 7th day, they underwent mixed meal testing in 

which they consumed the respective breakfast followed by a standard lunch meal (500 

kcal, 65% CHO, 15% protein, 20% fat). Blood samples were collected over the 9-h 

period and analyzed for glucose, insulin, c-peptide, and glucagon. The area under the 

curve (AUC) for the 4-h post-breakfast and -lunch was used to quantify and compare 

postprandial responses between conditions. 

rEsuLTs: The glucose AUC was not significantly different between conditions for 

either meal. The condition x meal effect for the insulin AUC approached significance 

(p=0.058), such that there was a slightly greater insulin AUC after the lunch meal in 

the PRO compared to the CHO (PRO +31% vs. CHO +12%). The c-peptide AUC after 

the lunch meal was greater compared to the breakfast meal (+12%, p

Official Journal of the American College of Sports Medicine 

oxidation were calculated using stoichiometric equations (Frayn, 1983) with the 

assumption that urinary nitrogen was negligible. 

rEsuLTs: Paired t test showed that mean (pre 2.27±0.6 V post 1.73±0.62 g.min-1) 

rate of CHO metabolism during submaximal runs was significantly lower (p0.05). 

CONCLusIONs: The results of this study indicate that a 4 weeks dietary intervention 

with LGI CHO may lower the rate of CHO without 

altering other cardiorespiratory parameters and the energy cost of exercise. 

988 Board #5 May 30, 8:00 AM - 10:00 AM 

Glycemic response after Exercise and Ingestion Of dextrose 

In Type 2 diabetics 

Gisela Arsa1 , Laila J. Lima2 , Daisy M. Santos3 , Wesley S. 

Almeida2 , Carmen Sg Campbell2 , Herbert G. Simões2 . 1Federal University of Mato Grosso, Cuiabá - MT, Brazil. 2Catholic University of Brasilia, Brasília - DF, Brazil. 3Federal University 

of Minas Gerais, Belo Horizonte - MG, Brazil. 


PurPOsE: The presence of type 2 diabetes (T2D) increases the risk of developing 

coronary arterial diseases. This study aimed was to determine if exercise prior to 

dextrose intake minimizes the increase in blood glucose. 

METhOds: Nine DB2 individuals (54.9 ± 1.8 years, 30.7 ± 1.9 kg·m2-1 , 5.5 ± 1.3 

years diagnostic T2D) underwent one session comprising twenty minutes of exercise 

(EX) at moderate intensity (workload corresponding to 90% of Lactate Threshold) 

on a cycle ergometer, and a control session (CT) in randomized order. After the 

exercise or control period the individuals remained seated for 135 min. At 45 

minutes of post-exercise recovery (R0), a dextrose solution (DS; 0.5g/kg) was 

administered and blood glucose levels were monitored every fifteen minutes for 

90 min. Repeated measures ANOVA and t-test were used for comparisons within and 

between sessions, respectively. 

rEsuLTs: Blood glucose increased (p 0.05). 

CONCLusIONs: Thus, increases in blood glucose after a DS ingestion has not been 

minimized by prior exercise.Supported by CAPES/PROCAD grant 0216054. 

989 Board #6 May 30, 8:00 AM - 10:00 AM 

Comparing Interval and Continuous Exercise on Glycemic 

Control, affect, Enjoyment and Preference in Inactive Obese 

adults 

Amy E. Wright, Mary E. Jung, Wendi L. Wright, Michelle 

Sawatsky, Jonathan P. Little. University of British Columbia, 

Kelowna, BC, Canada. 


Exercise improves glycemic control, yet comparisons between acute high-intensity 

interval training (HIT) and continuous moderate-intensity exercise (CMI) are limited. 

There is also limited research comparing affective and enjoyment responses to these 

two exercise modalities. 

PurPOsE: To examine the acute effects of HIT versus CMI on glycemic control, 

in-task exercise affect, enjoyment, and preference. 

METhOds: Ten inactive adults (n=8 female, 41±3 yrs, 36±2 kg/m 2 ) completed 

one bout of HIT and CMI, separated by seven days in a randomized counterbalanced 

fashion. HIT consisted of 10 x 1-min cycling intervals eliciting ~90% maximal 

heart rate (HR max ) separated by 1-min recovery. CMI was matched for total work 

output and involved 30 minutes of steady-state cycling at ~65% HR max . Exercise was 

performed two hours after a standardized breakfast. Feeling Scale (FS), rating of 

perceived exertion (RPE) and HR were recorded at 20%, 50% and 90% of exercise 

bout completion. Exercise enjoyment was assessed immediately post-exercise. Upon 

Vol. 45 No. 5 Supplement S177 

completion of the study, preference for HIT or CMI was assessed. Individualized diets 

were provided 24-hr before and after each exercise bout. Blood glucose (BG) levels 

for 24-hr following HIT and CMI were measured using continuous glucose monitoring 

(CGM) and comparisons were made to a non-exercise control day under identical diet 

conditions. 

rEsuLTs: Mean 24-hr BG was unaffected by either exercise modality (p>0.05). 

However, AUC for breakfast on the following day was significantly reduced following 

HIT (p=0.01) but not CMI. Similarly, pre-to-post meal glucose spikes for dinner 

(p



regular physical activity and healthy eating behaviors. One outcome of the program is 

maximal aerobic capacity. The purpose of this study was to determine the relationship 

between predicted and measured peak oxygen consumption (VO 2 peak) in overweight 

and obese breast cancer survivors. 

METhOds: To date, 23 women (mean age 53.6 yrs) who were at least 12 months 

after completion of treatment for hormone-receptor negative breast cancer with a BMI 

> 25 (mean 31.3 kg/m 2 ) have been enrolled into the study. At baseline, all women 

underwent full cardiopulmonary exercise testing to volitional maximal levels using 

a modified Balke treadmill protocol with measured expired gas analysis. Measured 

VO 2 peak was compared to VO 2 peak predicted from standard equations utilizing 

treadmill speed and grade. A t-test was performed to determine difference and 

significance was set at p < 0.05. 

rEsuLTs: At baseline, mean measured VO 2 peak was 19.9 ml/kg/min (SD = 4.9), 

which was significantly (p


exercise training at 60 minutes a day; 3 days per week. The intervention consisted of 

progressive cardiovascular and whole-body strength training. Participants were then 

reassessed following the intervention. 

rEsuLTs: There were significant increases in pre to post VO2peak[[Unsupported 

Character - Codename ]] (19.1 to 23.4 mL·kg-1·min-1; p=.006), chest press (50.3 

to 62.0 lbs.; p=.016), and leg press (143.2 to 190.8 lbs.; p=.000). CRF significantly 

decreased (4.37 to 2.97; p=.006) from pre to post exercise. A negative correlation was 

observed between CRF and leg press (p= .07, r= -.430) and VO2peak (p = .36, r= 

-.23), however, a positive correlation was seen with chest press (p=.55, r= .15). This 

suggests that lower body exercises may have a greater effect on the reduction of CRF 

than cardiovascular fitness. 

CONCLusIONs: Cancer treatment-related side-effects lengthen the recovery process 

post treatment for cancer survivors. The results of this study demonstrate that exercise 

interventions increase strength and cardiovascular fitness while decreasing CRF. 

Cardiovascular fitness and lower body strength correlate with a reduction in CRF. 

Lower body strength was shown to have a higher correlation with decreased CRF than 

upper body strength or cardiovascular fitness. Therefore, rehabilitation programs for 

cancer survivors with a goal of reducing CRF should incorporate lower body strength 

training. 

997 Board #7 May 30, 8:00 AM - 10:00 AM 

Moderate Intensity acute aerobic Exercise Effect on Natural 

Killer Cell Counts in Breast Cancer survivors 

Claudio Battaglini, Elizabeth Evans, Robert McMurray, FACSM, 

Scott Randell, Hyman Muss, A.C. Hackney, FACSM. University 

of North Carolina at Chapel Hill, Chapel Hill, NC. 


Current research examining the effect of acute aerobic exercise on immune responses 

in cancer survivors is limited. 

PurPOsE: To examine the effect of one acute bout of aerobic exercise on natural 

killer (NK) cell counts in breast cancer survivors (BCS) and healthy controls (C). 

METhOds: Participants included 9 women who had completed major treatments 

for Stage I-III invasive breast cancer within 3-6 months of enrollment and 9 sedentary 

women without a history of cancer. Subjects completed a 30-minute bout of exercise 

on the cycle ergometer at 60% of VO2peak. Blood samples were taken pre-exercise, 

immediately post-exercise, 2 hours post-exercise, and 24 hours post-exercise. 

Complete blood counts were obtained at each time point. Proportions of lymphocytes 

that carry the NK cell phenotype (CD3-CD16+CD56+) were obtained via flow 

cytometric analysis. NK cell counts were compared between groups across time points 

using a 2x4 mixed model ANOVA. 

rEsuLTs: NK cell counts rose significantly from pre-exercise to immediately postexercise 

in both the BCS and C groups (70.3 ± 37.9 cells/μL to 214.3 ± 132.0 cells/ 

μL, p = 0.003 and 108.9 ± 51.7 cells/μL to 357.5 ± 171.1 cells/μL, p = 0.001). At 2 

hours post-exercise, NK cell counts tended to remain elevated in the BCS group (92.1 

± 62.4 cells/μL) relative to pre-exercise (p = 0.096). At 24 hours post-exercise, NK cell 

counts also tended to be elevated in the BCS group (106.3 ± 66.8 cells/μL, p = 0.052) 

and in the C group (142.3 ± 74.6, p = 0.097) relative to pre-exercise. When comparing 

between groups, NK cell counts were somewhat lower in the BCS group compared to 

the C group pre-exercise (p = 0.09) and immediately post-exercise (p = 0.064). 

CONCLusIONs: Although some lower in NK cell counts, recent BCS seem to 

exhibit a normal NK cell response to acute moderate intensity aerobic exercise as 

compared with similar women without a history of cancer. 

Supported by UNC Lineberger Comprehensive Cancer Center and Petro Kulynych 

Foundation 

998 Board #8 May 30, 8:00 AM - 10:00 AM 

The utility of Exercise or Pharmacological stress in 

Identifying Cardiac damage in Breast Cancer survivors 

Amy A. Kirkham, Kristin L. Campbell. University of British 

Columbia, Vancouver, BC, Canada. 


The addition of myocardial stress to cardiac imaging techniques may increase 

sensitivity in identifying breast cancer treatment (BCT) related cardiac damage. 

PurPOsE: To systematically review whether cardiac imaging with exercise or 

pharmacologic stress (SI) can better identify cardiac damage in breast cancer survivors 

(BCS) than imaging at rest (RI). 

METhOds: Medline, Embase and CINAHL were searched using (breast cancer) 

AND (keywords related to cardiac imaging) AND (keywords related to cardiotoxic 

BCT or related cardiac issues). All experimental or observational studies including ≥2 

cardiac imaging techniques/parameters and BCS only, were searched to identify studies 

that used both SI and RI. Studies were also excluded if they did not report the SI data 

for ≥10 BCS or included cancer treatments no longer used for BCS. Ten studies were 

included in the review and relevant data extracted. The results of SI were compared to 

those of RI, and each study was labeled as “no benefit,” “some benefit,” or “benefit,” 

based on whether the SI identified cardiac damage that was not detected by the RI. 

rEsuLTs: Overall, 3 studies showed “no benefit”, 2 showed “some benefit” and 

5 showed a “benefit” of SI over RI. The use of exercise or pharmacologicals to 


induce myocardial stress was evenly split amongst the studies showing “benefit” 

or “some benefit” (1 study used both). Six of the 7 studies showing at least some 

benefit were long-term follow-up (LTFU) studies of 34 months to 18 years posttreatment 

(chemotherapy and/or radiation), and the other followed patients through 

chemotherapy up to 18 months later. All of the studies with LTFU of radiation 

treatment (n=5) (some included chemotherapy as well), showed at least some benefit of 

SI over RI, with the exception of one study reporting no damage with SI or RI. These 

studies all used myocardial perfusion imaging (MPI) techniques. Other techniques 

showing the benefit of SI were echocardiography (n=2, 1 during and 1 LTFU to 

chemotherapy) and ECG (n=2, both LTFU to radiation and/or chemotherapy). 

CONCLusIONs: MPI with exercise or pharmacological stress appears to be 

beneficial for detection of cardiac damage in LTFU to radiation treatment for breast 

cancer. Both ECG and echocardiography with stress merit further research to 

determine their utility in identifying BCT-induced cardiac damage. 

C-17 Thematic Poster - Perceptual and Cognitive 

Response to Heat Exposure 

May 30, 2013, 8:00 AM - 10:00 AM 

Room: 207 

999 Chair: Alan Utter, FACSM. Appalachian State University, 

Boone, NC. 


1000 Board #1 May 30, 8:00 AM - 10:00 AM 

skin Temperature and heart rate Estimate Physiological 

strain during Exercise In The heat 

John Cuddy1 , Mark Buller2 , Walter Hailes1 , Brent Ruby, 

FACSM1 . 1The University of Montana, Missoula, MT. 2US Army 

Research Institute of Environmental Medicine, Natick, MA. 


Skin temperature and heart rate have previously been used to predict physiological 

strain during exercise in the heat. 

PurPOsE: To evaluate the previously developed physiological strain index model 

using heart rate and skin temperature to provide further insight into the detection and 

estimation of thermal and physiological heat strain indices. A secondary aim was to 

characterize individuals who excel in their performance in the heat compared to those 

who perform poorly. 

METhOds: 56 male participants (22 ± 3 yrs, 181 ± 9 cm, 81 ± 12 kg, 4.2 ± 0.6 

L•min-1) completed the study. Participants completed 2 trials using a randomized, 

counterbalanced cross-over design in a temperature and humidity controlled 

environmental chamber in ambient conditions of 43.3°C and 40% relative humidity, 

and 15.5°C and 40% humidity. Core and skin temperature, along with heart rate and 

physiological strain index, were continually monitored during exercise. Additionally, 

participants completed a United States Marine Corps (USMC) physical fitness test. 

rEsuLTs: Based on the highest PSI achieved during the 90 minute walk, 23 

participants were classified in the “At Risk” group while 33 participants were classified 

in the “Not at Risk” group. The logistic regression model exhibited 4 false positives and 

1 false negative at the 40% decision boundary. The “Not at Risk” group had higher body 

weight (84 ± 13 vs. 77 ± 10 kg, respectively) and fat free mass (71 ± 9 vs. 64 ± 8 kg, 

respectively) compared to the “At Risk” group, p



perceived exertion and thermal comfort. Although the PeSI may be useful in the field 

when HR/Tc are unavailable, previous research has found discrepancies between the 

indexes. 

PurPOsE: To assess the correspondence between PSI and PeSI under two 

environmental conditions. 

METhOds: Participants (n=18) completed a heat tolerance test (HTT; 40°C/40%RH) 

and thermoneutral tolerance test (TTT; 20°C/40%RH) by walking at 5km/h, 2% grade 

for 120 min; they provided ratings for PeSI every 20min. Percent body fat (skinfold 

analysis), VO2max (maximal aerobic power test) were measured and sweat rate (SW), 

Max HTT/TTT HR and Tc were assessed during the tests. Data were analyzed first by 

correlating all PeSI/PSI values across time points for HTT/TTT. Then we correlated 

max PeSI/PSI for HTT alone. Lastly, participants were grouped by calculating PSI- 

PeSI discrepancies during HTT into poor (Pest: Max PSI - max PeSI > 1) vs. good 

(Gest: Max PSI - max PeSI ≤ 1) estimators. 

rEsuLTs: Combining 247 PeSI ratings, the PeSI correlated with PSI (r = 0.51). 

As expected, PeSI and PSI values were lower during TTT than HTT, but the strength 

of the relation between PSI and PeSI did not differ by test. The most common PeSI 

values were -1 to 3, and corresponded with these average PSI values: PeSI = -1, PSI 

of 2.1±1.1; PeSI: 0, PSI 2.1±1.1 / PeSI 1, PSI 1 2.6±1.1 / PeSI: 2, PSI 3.1±1.3 / PeSI: 

3, PSI 2.9±1.3. HTT max PeSI (3.4±1.3) did not correlate with max PSI (4.6±1.5) (r 

= 0.37, p = 0.13). Individuals categorized as Pest (n=9) had significantly higher HTT 

max Tc (38.2±0.3 vs 37.7±0.4C, p < 0.01) and max HR (140.1±11.8 vs 113.8 ±21.0) as 

compared to Gest; HTT max PeSI, TTT values, %body fat, VO2 max did not differ by 

estimator group. 

dIsCussION: Across temp conditions under a mild exercise challenge, PeSI 

correlated with PSI. However PeSI values did not map onto the same PSI values. 

Participants who were poor at estimating their heat strain had higher HR and Tc 

responses to HTT. Future work might focus on accurately assessing thermal comfort in 

addition to perceived exertion prior to environmental exposure. 

1002 Board #3 May 30, 8:00 AM - 10:00 AM 

Perceptual responses in Predicting Physiological Measures 

of heat stress While Wearing Three Work Clothing 

Ensembles 

Rebecca M. Lopez, Jason Martuscello, Candi D. Ashley, Eric 

Coris. University of South Florida, Tampa, FL. (Sponsor: 

Douglas J. Casa, FACSM) 


Protective equipment is commonly used in athletic, military and occupational settings. 

Despite its effectiveness in protecting individuals from collisions or harmful chemicals 

and environments, protective clothing can unintentionally lead to uncompensable heat 

stress. Adequately assessing an individual’s physiological state may be difficult due to 

stressful environments, protective clothing, or other obstacles. 

PurPOsE: To investigate the efficacy of using a modified Environmental Symptoms 

Questionnaire (ESQ) and thirst (TST) and thermal (THM) responses in predicting body 

temperature (TGI) while wearing 3 ensembles. 

METhOds: Fifteen healthy subjects (8 males; 7 females; 24.1 ± 4.7 yr, 76.0 ± 19.2 

kg, 170.9 ± 9.3 cm, BSA 1.87 ± 0.26 m2) volunteered in a crossover, randomized 

design study. Subjects first completed a familiarization heat stress trial (HST) in 

shorts and t-shirt then in WORK (135 g m-2 cotton shirt and 270 g m-2 cotton pants), 

WATER (water-barrier, vapor-permeable coverall; NexGen), and VAPOR (vaporbarrier 

coverall; Tyvek). HST consisted of treadmill walking in 35 oC and 50% RH at 

160 w/m2 for 120 min or until volitional exhaustion or TGI reached 39 oC. Data were 

analyzed using a repeated measures 2-way (ensembles x time) ANOVA. The grouped 

Pearson product moment correlation was used to analyze relationships between TGI 

and perceptual measures. 

rEsuLTs: TGI in VAPOR (38.57 ± 0.12 oC) was greater at finish than WORK (37.72 

± 0.09 oC; p = .001), and WATER (37.64 ± 0.16 oC; p = .001). Trial time for VAPOR 

(91.4 ± 7.7 min) was shorter than all other trials (F1,14= 13.811, p = .002). Significant 

correlations were found between TGI and ESQ at 30-min (r = .26, p = .042), 60-min 

(r = .41, p = .042), 90-min (r = .26, p = .05), and finish (r = .34, p = .008). Significant 

correlations between TGI and TST were found at 90-min (r = .29, p = .032) and finish 

(r = .28, p= .031), while relationships between TGI and THM were found at 60-min (r 

= .56, p = .000) and finish (r = .33, p = .010). 

CONCLusION: Positive relationships between TGI and perceptual measures and 

ESQ indicate a potential use for these measures as prevention tools when working in 

the heat with various work ensembles. Although physiological measures of heat strain 

should supersede perceptual measures, the modified ESQ and other measures can help 

ensure workplace safety and health. 

MEDICINE & SCIENCE IN SPORTS & EXERCISE ® 

1003 Board #4 May 30, 8:00 AM - 10:00 AM 

The Effect of ad Libitum hydration on Cognitive Function 

Following Exercise in the heat 

Matthew T. Wittbrodt1 , Christopher C. Cheatham1 , Ross A. 

Sherman2 , YuanLong Liu1 . 1Western Michigan University, 

Kalamazoo, MI. 2Grand Valley State University, Allendale, MI. 

(Sponsor: Mindy Millard-Stafford, FACSM) 


Cognitive decrements are reported with dehydration of ≥ 2% body mass (BM). Since 

ad libitum hydration (AL) may fail to fully replace sweat loss during exercise in a 

hot environment and result in dehydration, the influence of AL on cognitive function 

following exercise is unclear. 

PurPOsE: To quantify the effect of an AL strategy on physiological responses and 

post-exercise cognitive function following exercise in the heat. 

METhOds: Twelve unacclimatized and recreationally active males (22.2 ± 2.4 yr) 

completed three 50 min cycling tests (60% VO2peak) in the heat (32 °C; 65% RH) 

with three hydration strategies: no fluid (NF), AL, and full fluid replacement to match 

sweat loss during NF (FR). Physiological responses were examined every 5 min. A 

cognitive battery assessing working memory, pattern recognition, perceptual speed, 

sustained attention, visual search and scanning speed, and executive function was 

administered pre- and post-exercise. 

rEsuLTs: Fluid loss during NF was greater than AL and FR (NF: -1.5 ± 0.6; AL: -0.3 

± 0.8; FR: -0.1 ± 0.3 % Body Mass; p < 0.001). Greater increases in core temperature, 

mean skin temperature, heart rate, rating of perceived exertion, and thermal sensation 

were observed after 35-50 min with NF compared to AL and FR (p < 0.05). No 

differences in cognitive measures were observed between hydration strategies but 

overall mean response time decreased (p < 0.05) in post- vs. pre-exercise measures for 

perceptual speed, working memory, and pattern recognition. 

CONCLusIONs: AL was as effective in mitigating thermoregulatory strain as FR 

and both were better than NF. Cognitive function was not impaired with or without 

fluid replacement but improved following moderate intensity exercise in the heat. 

1004 Board #5 May 30, 8:00 AM - 10:00 AM 

Effects of relative humidity on Thermoregulation and 

Perception during Low Intensity Exercise in the heat 

Nicole E. Moyen, Carolyn L.V. Ellis, Anthony B. Ciccone, 

Taylor S. Thurston, Kristen C. Cochrane, Lee E. Brown, 

FACSM, Jared W. Coburn, FACSM, Daniel A. Judelson, 

FACSM. California State University, Fullerton, Fullerton, CA. 


Limited research demonstrates increasing relative humidity (RH) impairs high intensity 

exercise performance in hot environments. As some athletes, military personnel, 

and day laborers work extended hours in hot humid climates, investigating RH’s 

independent effects during prolonged, low intensity exercise also merits attention. 

PurPOsE: To study how RH affected thermoregulation and perception during low 

intensity exercise in the heat. 

METhOds: Thirteen healthy male recreational exercisers (age = 23 ± 2 y, mass = 

83.1 ± 13.3 kg, height = 179.9 ± 5.9 cm, VO2max = 55.6 ± 7.3 ml/kg/min, body fat = 

12.6 ± 4.4%) walked for 90 min at 35% VO2max in 35 °C, completing trials at 40% 

RH (40RH), 55% RH (55RH), 70% RH (70RH), and 85% RH (85RH). Investigators 

obtained 1) heart rate, rectal temperature (Tre), skin temperatures, rating of perceived 

exertion, thermal sensation, thirst sensation, and environmental conditions every five 

min, 2) pulmonary ventilation and oxygen consumption every 25 min, and 3) pre and 

post nude body masses. 

rEsuLTs: No differences existed between 40RH and 55RH or between 70RH and 

85RH in sweat rate (40RH = 0.79 ± 0.21 L/h, 55RH = 0.83 ± 0.22 L/h, 70RH = 0.97 

± 0.29 L/h, 85RH = 1.07 ± 0.40 L/h) or hydration state (40RH = -0.61 ± 0.43%, 55RH 

= -0.62 ± 0.36%, 70RH = -0.93 ± 0.46%, 85RH = -0.98 ± 0.56%), but the higher RH 

trials elicited significantly greater sweat rate and percent hypohydration than the lower 

RH trials. Incremental RH increases caused non-linear increases in Tre such that: 1) 

40RH and 55RH equaled throughout trials, 2) 70RH exceeded 40RH and 55RH from 

35-90 min, and 3) 85RH exceeded all other trials from 40-90 min. Increases in Tre 

subsequently appeared to catalyze changes in skin temperatures, heart rate, pulmonary 

ventilation, oxygen consumption, rating of perceived exertion, and thermal sensation, 

which demonstrated similar patterns as Tre with minor temporal variations. Thirst 

behaved differently, with 85RH exceeding all other trials after 40 min and no other 

differences among trials. 

CONCLusIONs: In these conditions, a RH threshold for sufficient evaporative heat 

loss plausibly occurred between 55-70% RH and at a Tre of ~37.7 ± 0.3 °C. Exceeding 

this RH threshold overwhelmed thermoregulatory abilities, resulting in potentially 

dangerous physiological stress and higher perceptual ratings. 

ACSM May 28 - June 1, 2013 Indianapolis, Indiana


C-18 Thematic Poster - Resistance Training 

May 30, 2013, 8:00 AM - 10:00 AM 

Room: 208 

1005 Chair: Matthew J. Delmonico. University of Rhode Island, 

Kingston, RI. 


1006 Board #1 May 30, 8:00 AM - 10:00 AM 

The Effect Of high-speed Power Training On Peak Power 

Production In Older adults 

Stephen P. Sayers, Gibson Kyle. University of Missouri - 

Columbia, Columbia, MO. 


PurPOsE:The production of muscle power requires both force and velocity, and 

maximizing the velocity component of power is critical to maintaining safety in 

older adults. For example, sufficient high-speed power could help move the lower 

limb quickly to stabilize the body and prevent a fall. The purpose of this study was to 

examine whether resistance training (RT) at high speed reduced the external resistance 

(and increased the velocity) at which peak power is produced. 

METhOds: 72 older adults (22m, 50f; Age=70.6±7.3yrs) participated in a lower 

extremity leg press RT program for 12 weeks. Participants were randomized to highspeed 

power training at 40% one-repetition maximum (1RM) (HSPT: n=25; 3 x 12-14 

reps), slow-speed strength training at 80%1RM (SSST: n=25; 3 x 8-10 reps) or control 

(CON: n=22; stretching) 3 times/week for 12 weeks. Leg press 1RM, Peak power (PP; 

the highest value obtained from 40%-90% 1RM) and the corresponding peak power 

velocity [PPV] and peak power force [PPF] were obtained at baseline and 12 weeks. 

A 3 x 2 repeated measures ANOVA was used to compare changes from baseline to 12 

weeks. Statistical significance was accepted at p



training session of each week by multiplying sets, repetitions, and weight lifted. Blood 

was drawn at pre- and post-training and 30 minutes prior to each strength training 

session to analyze the time course of changes in testosterone and cortisol levels. TV 

was analyzed using a 2x6 (group x time) repeated measures ANOVA, while hormonal 

response was analyzed using a 2x8. Significance was set at p


rEsuLTs: The muscule strength of 3 groups subjects have significantly 

improved (p



1018 Board #4 May 30, 8:00 AM - 10:00 AM 

Effects Of stair Climbing Training On Balance, Gait, 

strength and submaximal Endurance In healthy seniors 

Lars Donath, Lukas Zahner, Ralf Roth, Martin Zwingli, Philipp 

Steiner, Oliver Faude. University of Basel, Basel, Switzerland. 


Stair climbing has been shown to induce a health-relevant additional energy 

expenditure and increase leg strength as well as maximal oxygen uptake in young 

adults. Data on effects of regular stair climbing on selected fall-risk factors in seniors 

are lacking. 

PurPOsE: To examine the effects of a guided stair-climbing intervention on balance, 

gait, strength and submaximal endurance in seniors with particular emphasis on 

differences between a 1- and 2-step ascending strategy. 

METhOds: 48 healthy seniors were randomly assigned (strata: age, gender, BMI) 

to either a 1-step strategy (INT1), a 2-step strategy (INT2) or a control group (CON). 

Nine seniors dropped out (health complaints, insufficient training compliance). Thus, 

39 seniors (females: n=22, males: n=17; age: 70.5 (SD 5.1) y; BMI: 25.8 (3.1) kg/m2) 

completed the 8-week training intervention (3 sessions per week, attendance 83%). 

The amount of stairs climbed per session progressively increased from 256 to 640 

stairs. The overall climbed altitude (INT1: 1659 (349) m, INT2: 1556 (235) m, p=0.38) 

and total vertical work (INT1: 1144 (290) kJ, INT2: 1126 (201) kJ, p=0.85) was 

similar for both groups. We assessed standing balance, spatio-temporal gait, maximal 

and explosive strength as well as submaximal endurance before and after the training 

period. 

rEsuLTs: We found a large effect for center-of-pressure path length displacement 

during right leg stance (np²=0.14, p=0.10, INT1: -14%; INT2: -9%, CON: +1%). 

Spatio-temporal gait parameters did not relevantly change. Large effects in favor of 

INT1 and INT2 were present for peak force during leg press (np²=0.16, p=0.04) as well 

as rate of torque development during right leg plantar flexion (np²=0.14, p=0.06). We 

found relevant decreases in heart rate (p=0.04, np²=0.16; INT1: -8 min-1, INT2: -10 

min-1, CON: -1 min-1), perceived exertion (p=0.01, np²=0.22; INT1: -1.2 (10-point 

Borg scale), INT2: -2.5, CON: +0.2) and lactate concentration (p=0.06, np²=0.14; 

INT1: -0.4 mmol/L, INT2: -0.5 mmol/L, CON: +0.1 mmol/L) during submaximal 

uphill (8% inclination) walking. 

CONCLusION: Independent of the ascending strategy, a guided stair climbing 

intervention beneficially affects cardio-metabolic endurance and selected strength 

parameters. The transfer to standing balance and gait characteristics seems restricted. 

1019 Board #5 May 30, 8:00 AM - 10:00 AM 

Physical Function In Nursing home residents as a Function 

Of Grip strength and Gender 

Sandra M. Matsudo 1 , Rafael Mancini 1 , Timoteo L. Araujo 1 , 

Vagner Raso 2 , Victor KR Matsudo 1 . 1 CELAFISCS, São Caetano 

do Sul, Brazil. 2 2 Bandeirante University of Sao Paulo, 

UNIBAN, 3 UNOESTE, São Caetano do Sul, Brazil. 


PURPOSE To examine relationships between body composition and functional 

capacity according to grip strength and gender in nursing home residents. 

METHOD We measured body composition (body mass and body mass index), physical 

function (body balance, chair rise during 30 seconds, flexibility, time to up and go test 

[TUGT] and usual walking [WALK]) and grip strength in 147 nursing home residents 

(male [N=59], age equals to 71.5 ± 1.2 years-old and BMI equals to 24.9 ± 0.6 kg•m2; 

female [N=88], age equals to 76.1 ± 1.5 years-old and BMI equals to 26.5 ± 0.7 

kg•m2). Cognitive function was also estimated by mini-mental state examination. 

RESULTSWhen grip strength values were used to classify subjects into upper and 

lower halves of a fitness continuum, fitter subjects had a higher body mass (female, 

P=.023), body height (male, P=.010; female, P=.006), body balance (male, P=.017) 

and chair rise (male, P=.017; female, P=.041), but a lower velocity (male: TUGT, 

P=.041 and WALK, P=.011; female: TUGT, P=.001 and WALK, P=.005). Our multiple 

regression analyses demonstrated that TUGT (female, adjusted R2=.23, P=.001, no 

mediating effect), body balance (male, adjusted R2=.14, P=.038, mediated by age), 

WALK (female, adjusted R2=.17, P=.007, mediated by age and body mass) and 

chair rise (male, adjusted R2=.22, P=.006, mediated by cognitive function) were 

significantly predicted by grip strength. 

CONCLUSIONS Present data provide support for using grip strength as an overall 

indicator of physical function (about 20 percent of the explained variance) in nursing 

home residents. Nevertheless, this phenomenon appears to be explained by distinct 

variables in both genders. 


1020 Board #6 May 30, 8:00 AM - 10:00 AM 

The Effects Of Velocity Of Movement On strength, Peak 

Power, and average Power In The Elderly 

Paul D. House, Melissa Powers, Kristin Bogda. University of 

Central Oklahoma, Edmond, OK. 


INTrOduCTION: As our aging population grows, it is important to gain a greater 

understanding of how this population responds to various exercise interventions. Aging 

is accompanied by a loss of strength and power resulting in a decline in functionality. 

PurPOsE: The purpose of this study was to determine if there is a difference in 

velocity of resistance training and maximal strength and power gains. 

METhOd: Fourteen adults (63-79 yrs) participated in one of two resistance training 

groups designated low velocity (LV) and high velocity (HV). Both groups resistance 

trained two non-consecutive days/week for 12 weeks consisting of eight different 

exercises. Both groups performed 3 sets of 8 repetitions at 60% of their 1RM for each 

exercise. The subjects in the LV group (n=5) were instructed to perform the concentric 

and eccentric phases of each repetition over a 2-3 second time intervals. Conversely, 

participants in the HV group (n=9) were instructed to lift the weights concentrically as 

fast as possible while lowering the weight over a 2-3 second period. Pre-training (Pre) 

and post-training (Post) 1 RM’s were measured for both groups. Average and peak 

powers were measured for both groups Pre and Post using a chair stand test. 

rEsuLTs: The Multivariate ANOVA test revealed significant strength increases over 

time for the, knee curl, lateral raises, and the bent over rows with p=0.014, p=0.009, 

and p=0.011 respectively. There was a significant group x time interaction for the LR 

as well (p=0.028) with the LV and HV means increasing 22% (SD=10.35) and 2.7% 

(SD=2.7%) respectively. Average power significantly improved overtime for both 

groups (p=0.043) however, there was not a significant interaction. Furthermore, there 

were no significant increases in peak power for either group (p=0.182). 

CONCLusION: These results indicate that either slow or high velocity resistance 

training result in increases in average power and 1RM strength in most lifts but not in 

peak power with the aged population. It would appear that slower lifting might result 

in moderately greater increases in strength compared to the faster lifting at the same 

intensity. The possible reason for this is the greater time under tension in the slow 

lifting group. 

C-20 Free Communication/Slide - Anterior Cruciate 

Ligament 

May 30, 2013, 8:00 AM - 10:00 AM 

Room: Wabash 3 

1021 Chair: Robin M. Queen. Duke University, Durham, NC. 


1022 May 30, 8:00 AM - 8:15 AM 

aCL Loading and Jump Performance are decreased With 

Increased Knee Flexion Landing and soft Landing 

Boyi Dai 1 , William E. Garrett, FACSM 2 , Michael T. Gross 3 , 

Darin A. Padua 3 , Robin M. Queen 2 , Bing Yu 3 . 1 University 

of Wyoming, Laramie, WY. 2 Duke University, Durham, NC. 

3 University of North Carolina at Chapel Hill, Chapel Hill, NC. 


Anterior cruciate ligament (ACL) injuries usually occur during landing. One strategy 

to prevent ACL injuries is to adopt landing patterns that decrease ACL loading. Both 

landing with increased knee flexion and soft landing have been associated with decreased 

ACL loading. However, the effects of these two landings on performance remain unclear. 

PURPOSE: To determine the effects of landing with increased knee flexion and soft 

landing on ACL loading and jump performance during a stop-jump task. 

METhOds: Eighteen male and 18 female recreational athletes performed a stopjump 

task with three instructed techniques. The three techniques involved 1) jump 

as high as possible, 2) land with increased initial knee flexion and then jump as high 

as possible, 3) land softly and then jump as high as possible. Three-dimensional 

kinematic and ground reaction force data were collected for the dominant limb. Peak 

ACL force during landing was estimated from a musculoskeletal model. Performance 

variables included jump height, approach speed, stance time, and lower extremity 

mechanical work. 

rEsuLTs: Landing with increased knee flexion landing (0.64 body weight (BW)) 

and soft landing (0.71 BW) both decreased peak ACL forces compared to regular 

landing (0.88 BW, p< 0.001). Landing with increased knee flexion (0.45 m) and soft 

landing (0.45 m) both decreased jump height compared to regular landing (0.48 m, 

p< 0.001). Soft landing (2.1 m/s) decreased approaching speed compared to regular 

landing (2.3 m/s, p< 0.001). Landing with increased knee flexion (0.45 s) and soft 

landing (0.39 s) both increased stance time compared to regular landing (0.32 s, p< 

0.001). Landing with increased knee flexion (0.37 J/BW/body height (BH)) and soft 



landing (0.31 J/BW/ BH) both increased mechanical work compared to regular landing 

(0.28 J/BW/ BH, p< 0.001). CONCLUSION: Landing with increased knee flexion 

landing and soft landing both decreased ACL loading, but also decreased movement 

speed and jump height while increasing mechanical work indicating a decrease in 

performance. Simply instructing individuals to land with increased knee flexion or land 

softly might have limited application in athletic competition because of the decrease 

in performance. Long-term training may be necessary to modify movements without 

compromising performance. 

1023 May 30, 8:15 AM - 8:30 AM 

aCL Injury alters Pre-injury Coordination Of The hip and 

Knee: The JuMP aCL study 

Benjamin M. Goerger 1 , Stephen W. Marshall 2 , Anthony I. 

Beutler 3 , J. Troy Blackburn 2 , John H. Wilckens 4 , Darin A. 

Padua 2 . 1 George Mason University, Manassas, VA. 2 The 

University of North Carolina at Chapel Hill, Chapel Hill, 

NC. 3 Uniformed Services University of the Health Sciences, 

Bethesda, MD. 4 Johns Hopkins University, Baltimore, MD. 


Those with anterior cruciate ligament (ACL) injury and reconstruction (ACLR) display 

movement coordination that may predispose them to subsequent ACL injury and 

osteoarthritis. There is limited evidence regarding whether these factors are induced by 

ACLR or existed prior to injury. 

PurPOsE: The purpose of this study was to compare joint coordination prior to and 

following ACL injury and reconstruction in both the injured and noninjured limb. 

METhOds: Sixty-nine participants of the JUMP ACL study, a multi-year prospective 

study conducted at the United States service academies to identify risk factors for 

noncontact ACL injury, completed testing for this analysis, 31 that suffered an ACL 

injury (Cases), and 38 that did not. Because unilateral biomechanics were collected 

during initial testing the Cases were further divided into those that injured the tested 

limb (ACLR-INJ: n = 12 (8 m, 4 f), Age = 21.42 ± 0.79 years, Height = 174.29 ± 7.56 

cm, Mass = 76.25 ± 9.95 kg) and those that injured the non-tested limb (ACLR-NINJ: 

n = 19 (9 m, 10 f), Age = 21.47 ± 0.77 years, Height = 170.05 ± 9.13 cm, Mass = 72.87 

± 12.78 kg). Participants that never suffered an ACL injury (CON: n = 38 (19 m, 19 f), 

Age = 20.95 ± 0.73 years, Height = 172.16 ± 8.71 cm, Mass = 72.35 ± 12.37 kg) were 

matched based on cohort year, academy and gender. Average coupling angles during 

a double leg jump landing between the hip and knee were calculated using a vector 

coding technique prior to (Baseline) and following ACL injury and ACLR (Follow- 

Up). A 2x3 (Time: Baseline, Follow-Up; Group: ACLR-INJ, ACLR-NINJ, CON) 

mixed model ANCOVA (Gender) was performed for each dependent variable. 

rEsuLTs: We observed a significant change in the average coupling angle of the hip 

and knee in the transverse plane for the ALCR-INJ group (F(2,65)=4.40, p = 0.016). 

The change indicated the ACLR-INJ group had more equal relative motion between 

the hip and knee in the transverse plane following ACL injury and ACLR (Baseline: 

54.85 ± 6.96; Follow-Up: 47.97 ± 6.64). 

CONCLusION: Based on our observations, it appears ACL injury and/or ACLR 

caused altered coordination of hip and knee rotation, possibly due to decreased 

independence of knee rotation. Our findings may provide important insights into the 

specific dysfunction underlying the increased risk of recurrent ACL injury in those 

with prior ACL injury. 

1024 May 30, 8:30 AM - 8:45 AM 

adaptation Of Quadriceps and hamstring Co-contraction 

Following Landing Instruction In Patients With acl 

reconstruction 

Audrey RC Elias, Curt D. Hammill, Ryan L. Mizner. University 

of Montana, Missoula, MT. 


A growing body of evidence suggests the ACL reconstructed knee exhibits 

compromised ability to accept weight and attenuate force during high demand 

activities, which can be mitigated with instruction and training. Controversy exists 

surrounding the desired agonist-antagonist relationship of the hamstrings and 

quadriceps in landing tasks, particularly in ACL injury prevention and end-stage ACLR 

rehabilitation programs. 

PurPOsE: To explore adaptations in neuromuscular control of the quadriceps and 

hamstrings to instruction for improved knee performance during weight acceptance. 

METhOds: Thirty physically active subjects with unilateral ACLR and good clinical 

results participated in a one-time session analyzing single leg landing of the involved 

limb off a 20 cm platform using 3-D motion analysis system with force plates. 

Vertical ground reaction force (VGRF) and peak knee flexion served as measures of 

performance. Vastus lateralis and biceps femoris recruitment were analyzed using 

surface EMG and normalized to maximal voluntary isometric contraction(MVIC). 

Testing was repeated after 5 minutes of instruction in desired landing patterns. 

Hamstring/quadriceps co-contraction indices were integrated over the weight 

acceptance phase of landing, and results were analyzed with paired t-tests. 

rEsuLTs: Landing performance improved with training, with increased peak knee 


flexion (mean±SD; pre: 55±11°; post: 78±11°; p



rEsuLTs:There was a statistically significant interaction for the peak knee extension 

moment (p.12). There 

was no main effect of graft types for all measures (p>.12); Knee Flexion Excursion 

(KFE) (Allo: 16.49°+1.09°; Auto: 17.00° + 1.34°, p=0.78), external knee flexion 

moment at Peak Knee Extension (PKE) (Allo: 0.12+0.19 Nm/kg*m, Auto: 0.11 + 0.03 

Nm/kg*m, p=0.962). There was a main effect of limb for KFE (OP: 14.7° + 0.95°, 

NONOP: 18.79° + 0.91°, p


Anterior Drawer limited due to guarding. Posterior Drawer negative. McMurray 

positive. Patellar Apprehension and Varus/Valgus Stress Test negative. 

dIFFErENTIaL dIaGNOsIs: 

1. Meniscal Tear 

2. ACL Rupture 

3. Juvenile Idiopathic Arthritis 

4. Infectious Arthritis 

5. Reactive Arthritis 

6. Lyme Disease 

7. Malignancy 

TEsT aNd rEsuLTs: 

Left knee Xray: Large joint effusion without bony abnormality 

Left knee joint aspiration: 60ml yellow slightly cloudy synovial fluid, no crystals, 1545 

RBC, 3700 nucleated cells, 3 Segs, 1 Eos, 47 Lymphs, 19 Monos, 30 Macrophages. 

Gram Stain: no organisms. Aerobic, anerobic, chocolate agar cultures: no growth 

CBC: WBC 7.8, Hgb 15.6, Plt 156 

ANA Neg 

CRP 0.5, ESR 4 

Rheumatoid Factor 8.6 

Lyme Disease Serology Positive, Lyme Disease Western Blot Negative. 

Left Knee MRI without contrast: Large joint effusion with small to moderate intraarticular 

debris. Meniscus and ACL intact. 

Rheumatology Consult: Unlikely to be JIA, most likely traumatic injury to knee. 

Cannot exclude systemic cause. 

Urine Amplified DNA: Chlamydia positive, Gonorrhea negative 

FINaL WOrKING dIaGNOsIs: 

Reactive arthritis secondary to Chlamydia trachomatis infection 

TrEaTMENT aNd OuTCOMEs: 

1. Azithromycin 1 g PO X 1 

2. Ceftriaxone 250 mg IM X 1 

3. Repeat urine GC/CT testing in 3 weeks 

4. Tested for HIV, Hepatitis B & C, Syphilis: Negative 

5. Safer sex counseling; Notify, test all sexual contacts 

6. Naproxen for knee pain & swelling 

7. Upon further questioning, patient reports sexual intercourse several months 

preceding injury and condom use with every encounter. 

1034 May 30, 8:20 AM - 8:40 AM 

Exercise Induced hemoptysis: a hemodynamic Intervention 

Case report 

Miranda E. Contursi, Aaron L. Baggish, Gregory D. Lewis. 

Massachusetts General Hospital, Boston, MA. 


hIsTOry: A 47-yo male presented with recurrent episodes of exercise-induced 

hemoptysis (EIH) that consisted of 1-3 tbsp of bright red blood following intense bouts 

of aerobic exercise. He had no known history of heart or lung disease. 

PhysICaL EXaMINaTION:1.8m, 97kg, HR=77, BP=132/86, jugular venous 

pressure 5cm, regular S1 and S2 without murmurs, rubs or gallops, lungs clear to 

auscultation and percussion, no clubbing, cyanosis, or edema. 

PhysICaL EXaMINaTION: Bronchitis, bronchiectasis, malignancy, foreign 

body, infectious processes, inflammatory disorders, pre- or post-capillary pulmonary 

hypertension, pulmonary embolism. 

TEsT aNd rEsuLTs: Chest CT scan: mild mosaic attenuation with non-specific 

peripheral ground glass opacities; no nodules, pulmonary embolism, or pleural 

thickening/effusion. Bronchoscopy: petechiae on bronchial surfaces with slight 

hemorrhage when he coughed against the bronchoscope. Bronchoalveoloar lavage 

and coagulation studies: unremarkable. Incremental, upright cycle ergometery 

cardiopulmonary exercise testing (CPX) was performed with continuous invasive 

hemodynamic monitoring by radial and pulmonary arterial catheters: Normal peak 

VO2 (30.6 mL·min-1·kg-1, 112% predicted), peak cardiac output (17L/min), and 

resting hemodynamics but marked elevation in systemic BP (peak BP=261/134) and 

pulmonary capillary wedge pressure (peak PCWP=28mmHg) with normal pulmonary 

vascular resistance (exercise PVR = 1 Wood unit). 

FINaL WOrKING dIaGNOsIs: Exaggerated systemic BP response and diastolic 

dysfunction during exercise, leading to increased hydrostatic pressure transmitted to 

the lung, which increased the patient’s propensity to develop hemoptysis. 

TrEaTMENT aNd OuTCOMEs: Following the invasive CPX, we tested the 

hypothesis that pre-exercise nitrate therapy would attenuate systemic hypertension 

and elevation in PCWP in response to exercise. Repeat serial non-invasive CPXs 

before and after isosorbide dinitrate 10mg showed that nitrates reduced exercise BP 

(peak BP 188/80 vs. 230/110). We inferred dual contributions to EIH: pulmonary 

vascular fragility coupled with dynamic pulmonary venous hypertension, which was 

successfully attenuated by pre-exercise nitrate therapy. The patient was able to resume 

regular training without further hemoptysis. 


1035 May 30, 8:40 AM - 9:00 AM 

General Medicine-unusual Cause of Thoracic Pain 

Wade M. Rankin, Ryan Sprouse. University of Kentucky, 

Lexington, KY. 


hIsTOry:A 33y African American male, with past medical history significant for 

familial adenomatous polyposis, presented with mid-back paraspinal muscle pain/ 

tightness intermittently for 8 months. Initially patient was diagnosed with paraspinal 

muscle spasms and managed conservatively with ibuprofen, heat therapy, physical 

therapy, and posture correction. Patient reported the pain/tightness is worse with 

activity and radiated to his lower back. He denied any injury/trauma to the area. He 

denied any radicular symptoms, extremity weakness, shortness of breath, or fever/ 

chills. The pain/tightness became acutely worse and he has recently noticed a mass in 

the paraspinal musculature between the right scapula and spine. 

PhysICaL EXaM: Well appearing, thin male with no lymphadenopathy or masses 

noted to his neck, lungs clear to auscultation, non-labored breathing, heart RRR, equal 

pulses bilaterally. Two firm palpable 5x5cm non fluctuant masses with ill-defined 

borders over the mid-thoracic area with obvious visual malformations. Minimally 

tender to palpation over the spinous process between the two masses. Strength 5/5 in 

bilateral upper extremities. No sensory deficits. 

PhysICaL EXaMINaTION: 

Muscle spasm 

Muscle strain 

Myositis 

Tumor/mass 

Lipoma 

Scapulothoracic bursitis 

Vertebral fracture 

Hyperkyphosis 

Hematoma 

Abscess 

TEsTs aNd rEsuLTs 

Wbc 5.9, Hgb12.8, Hct 37.5 

US Chest: avascular solid mass measuring 7.3x2.1cm between right scapula and mid 

thoracic spine. MRI T-spine: 10x8x3 cm mass lesion within the bilateral erector spinae 

musculature, T6-T9 levels. Lesion effectively replaces the mulfidus and longissimus 

thoracis muscles at that level. Likely represents myositis of the longissimus thoracis 

and multifidus muscles with focal myonecrosis and/or a chronic hematoma. 

Biopsy: Non-atypical fibroproliferative process infiltrating skeletal muscle with mild 

chronic inflammation and rare possible regenerating myofibers. No evidence of 

metastatic carcinoma is seen on the touch prep slides or within the core biopsies. 

Possible diagnostic considerations include fibromatosis (desmoids tumor). 

FINaL/WOrKING dIaGNOsIs: 

Desmoid Tumor 

TrEaTMENT aNd OuTCOMEs 

1. Radiotherapy noted to lesion 

2. Adjuvant chemotherapy 

3. Patient currently undergoing above treatment 

1036 Withdrawn 

1037 May 30, 9:00 AM - 9:20 AM 

skin Infection in an Offensive Lineman 

Kyle E. Geissler, James Borchers, FACSM. Ohio State 

University, Columbus, OH. 


hIsTOry: 18 year old male presented with the complaint of left buttock pain 

and drainage. He is a lineman and started practice the week prior. He popped what 

appeared to be a pimple on his left buttock three days ago. The patient had increased 

pain, buttock erythema, intermittent fevers, nausea, and malaise for the two days 

prior to evaluation. He denied vomiting, dysuria, hematuria, or diarrhea. The patient 

reported having a history of a skin infection on his face while wrestling in high school, 

but did not know if he had MRSA. He was not on any prescribed medications. 

PhysICaL EXaM: In general, the patient appeared ill but was in no acute distress. 

Vital signs: temperature 100.6, pulse 97, blood pressure 148/55. His left buttock 

contained significant induration with a central area that was draining serosanguinous 

fluid. There was an area of fluctuance around the draining area. The erythema was 

approximately 10cm in size and extended to the rectum and perineum, but not to the 

scrotum. The rest of the external genitalia was normal in appearance. 

PhysICaL EXaMINaTION: Cellulitis, Perirectal abscess, Colorectal fistula, 

Fournier’s gangrene, Vascular occlusion syndromes, Necrolytic migratory erythema 

TEsTs/rEsuLTs: Labs: WBC 20K, BUN/Cr 11/1.25. The rest of the CBC and 

Chem 7 were within normal limits. CT scan of the pelvis revealed soft tissue stranding 

in the left ischiorectal fossa and medial aspect of the left buttock that courses towards 

the canal. 

FINaL dIaGNOsIs: Perirectal abscess progressing to Fournier’s gangrene 

Abstracts were prepared by the authors and printed as submitted. 

Thursday, May 30, 2013



TrEaTMENT/OuTCOME: The patient was admitted to the hospital and started 

on IV Vancomycin. Pain and nausea were treated symptomatically. An infectious 

disease consult was obtained and Daptomycin, ciprofloxacin, and Flagyl were started 

to additionally cover for enteric bacteria. Colorectal surgery was consulted, and they 

peformed a bedside incision and drainage. On day 3 of admission, the erythema had 

spread to the scrotum. The next day, the patient was taken for surgical debridement 

and drainage of a perirectal abscess. Following debridement, a diagnosis of Fournier’s 

gangrene was made. IV antibiotics were continued and the patient was discharged 

home on day 6 on oral ciprofloxacin and Flagyl, in addition to daily wet to dry dressing 

changes. He was able to return to play six weeks after discharge. 

C-22 Clinical Case Slide - Lower Extremity I 

May 30, 2013, 8:00 AM - 10:00 AM 

Room: 117 

1038 Chair: David Olson. University of Minnesota, St. Paul, MN. 


1039 discussant: Brian M. Babka. Lutheran General Hospital, 

Elmhurst, IL. 


1040 discussant: Elizabeth E. Rothe. Maine Medical Center Sports 

Medicine, Portland, ME. 


1041 May 30, 8:00 AM - 8:20 AM 

Leg Pain- rowing 

Kathryn Miller, Aurelia Nattiv, FACSM. UCLA, Los Angeles, CA. 


hIsTOry: 21 year old NCAA Division 1 female rower with prior rib stress fracture 

with right leg pain x 3 weeks starting in August 2012. Pain started during sprint 

intervals on track. Pain was aching pain along posterior, lateral thigh. Injury initially 

managed as quad strain by ATC, but pain continued to worsen despite relative rest. 

Over the summer, she had been running 60-70 miles weekly. 

Past medical/surgical History: None Except, Rib Stress Fracture (Spring 2012), 

Eumenorrheic, Menarche Age 12, No History Of Disordered Eating, Weight Stable 

Meds: None 

Family History: No History Of Osteoporosis Or Fractures 

Social History: Full Time Student, Junior, No Tobacco, Occasional Binge Drinking, No 

Milk, 6 Oz Yogurt/Week, No other sources dietary calcium 

ROS: Negative 14-point system review 

PhysICaL EXaMINaTION: 5’9”; 163 lbs. Healthy appearing. Normal gait, pes 

planus. No palpable masses, erythema, edema, ecchymosis over right thigh. Mild 

tenderness to palpation over lateral right thigh. Hip ROM full bilaterally. No pain 

with active/passive ROM of hip. No pain over spinous processes, paraspinal muscles, 

hamstrings, IT band insertion. On right +hop test, + fulcrum test, -FABER, -FADIR, 

+OBERS, -SLR bilaterally. 


1.Femoral stress reaction/fracture 

2.Quad strain 

3.IT Band Syndrome 

4.AVN of femoral head 

5.Referred pain 

TEsTs aNd rEsuLTs: 

Plain Radiographs of Right Femur and AP Pelvis: Normal 

MRI Right Femur: Periosteal edema along medial aspect of proximal femur with bone 

marrow edema for 4.4 cm along insertion of site of adductor longus. Also, small linear 

area of cortical signal visualized consistent with a small cortical stress fracture. 

Labs: TSH 1.2, PTH 20, Calcium 9.8, vitamin D 25-OH 56 

DXA: Spine Z-score +0.5; Total Hip Z-score +0.3; Femoral Neck Z-score -0.2. Normal 

BMD for age. 

Final Working Diagnosis: Femoral stress fracture 


1.Non-weight bearing x 3 weeks 

2.Transitioned to full weight bearing over 1 additional week 

3.Started swimming 4 weeks after diagnosis with increased pain with breaststroke kick 

4.Able to resume full pool workouts 5 weeks after diagnosis 

5.Light stationary bike without pain 8 weeks after diagnosis 

6.No impact activity for at least 10 weeks 

7.Plan to gradually add erging prior to running 

8.Referred to sports dietitian for consult 


1042 May 30, 8:20 AM - 8:40 AM 

rugby Player sustains Lower Extremity Injury during a 

Tackle 

Hamish A. Kerr. Albany Medical Center, Albany, NY. 


hIsTOry: 15 minutes into the 1st home game of the season, a 21 year old rugby 

player goes down in the center of the field. He does not get up. The athletic trainer and 

physician covering run on to evaluate. The player is in a great deal of discomfort, but 

cannot localize what hurts. He says he tried to get up but couldn’t weight bear on his 

right leg. Past Medical History: Acromio-clavicular sprain of his left shoulder. Denied 

any current medications and has no known drug allergies. He is a college student and 

this is his 2nd year playing rugby. He is a forward. He denied any contributory family 

history. On review of systems, he denied any back pain, or any paresthesiae in the 

lower extremity. He denied any trauma to his head, neck, or spine. He denied losing 

consciousness. 

PhysICaL EXaMINaTION (Er): BP 143/109, HR 64, RR 20; SpO2 100%; 

Height 175cm, Weight 94.35kg, BMI 30 

Generally he appeared in some distress. He was alert and oriented to time, place and 

person. His right leg was being held in a flexed position at the knee and hip. He had 

very large, muscular thighs. He had a palpable dorsalis pedis pulse. He was able to 

wiggle his toes on command. His sensory function of the distal right extremity was 

intact for light touch. Manipulation of his right thigh and hip provoked pain. He could 

flex his knee. There appeared to be deformity of his right buttock and the right leg 

appeared shorter than the left. 

dIFFErENTIaL dIaGNOsIs 

Fractured right femur 

Dislocated patella 

Dislocated right hip 

TEsTs aNd rEsuLTs: Patient was transported via EMS to the Emergency 

Department where initial X-ray imaging confirmed a posterior hip dislocation. 

FINAL WORKING DIAGNOSIS: Right Hip Dislocation 

TrEaTMENT aNd OuTCOMEs: The patient required conscious sedation with 

propofol and fentanyl to relocate the hip. He underwent computed tomography (CT) of 

the hip, confirming relocation and noting a small anterior, superior acetabular fracture. 

He was immobilized and maintained non-weight bearing. He was provided oral opiate 

analgesia. He was seen in follow-up at 48 hours and 3 weeks post-injury, when he was 

able to partially weight bear, had regained 90 degrees of hip flexion and 30 degrees of 

internal/external rotation. He understood he was not going to be able to return to rugby 

that season. 

1043 May 30, 8:40 AM - 9:00 AM 

hip Pain-Water skiing 

Christopher S. Karam1 , Andrew H. Gordon2 , Arthur J. De Luigi1 . 

1MedStar National Rehabilitation Network, Washington, DC. 

2The Johns Hopkins Hospital, Baltimore, MD. (Sponsor: Stuart 

Willick, FACSM) 


hIsTOry: A 42-year-old woman injured her right hip while waterskiing. She waterskied 

with one ski on her left lower extremity. She rested her right lower extremity, not 

placed into the ski, posteriorly on the ski attached to the left foot. When performing 

a twisting motion while skiing, she felt a deep pressure in her right hip while 

keeping balance on the ski. She initially rated her pain as 4/10, having some success 

using conservative measures of oral anti-inflammatory medications (diclofenac) 

and anesthetic patches (lidocaine) in combination with physical therapy and home 

exercise program. No imaging was obtained during the course of her initial injury. 

Approximately six months later, she aggravated her right hip injury while snow-skiing. 

She reported a constant 6/10 deep aching hip pain. Her right hip pain especially 

worsened with exercise, so she then stopped exercising. 



PhysICaL EXaMINaTION: Initial examination of the hip demonstrated 

tenderness to palpation over the right adductor muscle at its insertion point on the 

pubic rami. No tenderness to palpation of the lumbar paraspinals, anterior-superior 

iliac spine, iliac crest, sacroiliac joint or trochanteric bursas were noted. Provocative 

maneuvers with FADIR (Flexion Adduction Internal Rotation) test in her right hip. 


1. Osteoarthritis. 

2. Hip labral tear. 

3. Femoroacetabular impingement. 

TESTS AND rEsuLTs: 

Ultrasound of the right hip revealed an anterior-superior acetabular labral tear 

Magnetic Resonance Arthrogram (MRA) of the right hip confirmed anterior-superior 

labral tear 


Anterior-Superior Labral Tear of the Right Hip 


1. Failed repeat conservative management with oral diclofenac, transdermal lidocaine 

and physical therapy 

2. Advanced imaging obtained revealing pathology 

3. Surgery evaluation, patient opted for non-surgical management 

4. Ultrasound-guided platelet-rich plasma (PRP) of the hip was then performed for the 

anterior-superior labral tear of the right hip 

5. Four weeks post-injection she reported no pain, resumed waterskiing daily for the 

next three months with no recurrence of the hip pain at 6 months post procedure. 

1044 May 30, 9:00 AM - 9:20 AM 

Knee Injury-basketball 

Danielle G. Hirsch, Dilip Patel, FACSM, Vani Sabesan. Western 

Michigan University School of Medicine Clinics, Kalamazoo, 

MI. (Sponsor: Robert J Baker, FACSM) 


hIsTOry: A 15-year-old male presented to the clinic for evaluation of right knee 

pain that has been ongoing for the past year. The patient can recall two injuries to the 

knee directly both occurring while playing basketball. The first injury one month prior 

to presentation occurred during a basketball game when he “bumped knees” with 

another player requiring him to sit out of the game for about 5 minutes then returning 

to play where he had to stop because he reported his leg gave out upon return to play. 

He was evaluated by his team trainer and was given crutches which he used for a short 

time. The second injury occurred one week prior to presentation to the clinic where 

he reports that upon attempting a lay-up he felt his knee give out and had to stop 

playing. He reports a limp now and for the pain and swelling he has been using ice and 

ibuprofen inconsistently without much relief. 

PhysICaL EXaM: Right knee: 2+ effusion. Lachman test was positive with a soft 

end point. McMurray Negative, Varus-Valgus stress negative. Patellar apprehension 

negative. ROM: Pain and limited flexion of the right knee. Straight leg raise 

reproduced pain in the right knee and hip. Upon squatting on the right knee there was a 

noted loss of balance. There was no pain or tenderness to touch along the joint lines or 

patella. His gait is remarkable for a limp. 


1.ACL tear 

2.Tibial spine avulsion 

3.Osteochonral fracture 

4.Osteochondritis dissecans 

5.Medial meniscus tear 


MRI of Right knee: 

1.ACL tear 

2.Vertical peripheral posterior horn tears of the medial/lateral meniscus 

3.Osseous contusions of the lateral condyles 

4.Large effusion 


ACL, medial, and lateral meniscal tears 


1.ACL reconstruction with medial and lateral meniscal repair 

2.Physical therapy for range of motion and quad strengthening 

3.Post-op placed in a gravity flow cryotherapy on the right knee for ROM 

4.Weight bearing by 6 weeks post-op 

1045 May 30, 9:20 AM - 9:40 AM 

Exercise Induced arterial Compression 

Rick Morgan. Steadman Hawkins Clinic of the Carolinas, 

Greenville, SC. (Sponsor: Kyle Cassas, FACSM) 


hIsTOry: 22 year old elite level professional cyclist presents with left leg cramping 

and loss of power for several months. He denies injury, numbness or pain. The onset 

has been gradual but progressively worsening. He has never had this problem before. 

The feeling is similar to a cramp, but not as intensely painful, and it involves the entire 


leg. He denies back pain. He did change bike position over the winter and had some fit/ 

equipement issues with that including some mild low back pain that resolved. He had 

been the age group national champion the year prior, and despite more rigorous training 

and team support, had been unable to replicate that type of performance in the current 

season. At times he struggled with seasonal allergies and exercise induced asthma, both 

more significant in Europe than his native Utah. He was concerned about the fact that he 

had a series of mild viral illnesses throughout the early racing season and at one point 

was tested for EBV/mono and left Europe for several weeks to recover.He seemed to 

recover well at that point, but upon returning to Europe to race he noted more consistent 

and problematic left leg cramping sensation and loss of power. 

PhysICaL EXaMINaTION: Gen--well, NAD. Slender but athletic build. MSK-normal 

gait. ROM in the ankles, knees, hips and lumbar spine is normal. No swelling 

or bruising noted in B LE. Toe walk, heel walk and single leg stand are normal 

bilaterally. EHL intact. DTR 2+ bilateral patella and achilles. Sensation grossly intact 

to LT in all LE dermatomes. Negative SLR and x SLR. He has mild discomfort with 

FABER on the L, but not c/w his presenting complaint 

PhysICaL EXaMINaTION: EIAC, lumbar disk with radiculopathy, SI 

dysfunction, Mono syndrome 

TEsT aNd rEsuLTs: Baseline CBC, ferritin (1/2012) wnl, EBV titers revealing 

exposure to Mono (4/2012) but normal CBC, CMP, presumed subacute. Then in June, 

ABI (abnormal), CT angiogram (negative), MRA (abnormal), power study cycling 

FINaL WOrKING dIaGNOsIs: L internal iliac compression due to exercise 

TrEaTMENT aNd OuTCOMEs: L iliac artery graft, 8 cm bovine patch. 

Hospitalization for 5 days, 2 weeks of limited activity (walks) followed by a gradual 

increase in activity. Return to cycling at 8 weeks. Currently has returned to training, 

offseason, and will be racing professionally again in 2013. 

1046 May 30, 9:40 AM - 10:00 AM 

Proximal Thigh swelling Precipitates Numbness, Tingling 

and swelling In a 38yo stunt rider 

Ryan S. Wagner. Avita health System, Bucyrus, OH. 


hIsTOry: 38yo male presents to the clinic in mid-August 2012 with a complaint 

of a large hematoma over his proximal right thigh and focal swelling over his right 

patella after wrecking his motorcycle during a stunt-riding event on four weeks prior. 

He was diagnosed with hematoma and pre-patellar bursitis. The pre-patellar bursa 

was aspirated under ultrasound guidance and fully drained with prescription for 

prophylactic antibiotics. The bursitis resolved. 

Two months later he returned with persistent swelling to the proximal, anterolateral 

right thigh. He had developed constant numbness and tingling over the anterolateral 

aspect of his thigh progressing to just superior to the knee accompanied by severe 

burning pain. 

PhysICaL EXaMINaTION: Inspection: Discrete, fluctuant mass overlying the 

proximal anterolateral thigh, 10cm distal to inguinal crease, 10x7cm in dimension. No 

associated erythema, ecchymosis or wound. Otherwise unremarkable. 

Palpation: Burning pain is provoked with palpation of the medial third of the mass. 

Otherwise no specific tenderness. 

Neurologic: Normal strength and reflexes, diminished sensation in the distribution of 

the anterior branch of the Lateral Femoral Cutaneous Nerve (LCFN). 

Special maneuvers: +Tinel’s over the medial third of the fluctuant mass. 

PhysICaL EXaMINaTION: 1) Seroma, organized hematoma, soft tissue mass; 2) 

HNP/Radiculitis, meralgia paresthetica. 

TEsT aNd rEsuLTs: Diagnostic US of the lesion demonstrated a fluid filled 

mass with delineation between the muscular fascia and the sub-cutaneous tissue. A 

structure is visualized traversing the lumen located in the medial third of the lesion 

in the anatomic location of the LCFN, tented. The lesion was aspirated and 90mL of 

serosanguinous fluid was removed. 





FINaL WOrKING dIaGNOsIs: Morel-Lavallee lesion causing Meralgia 

Paresthetica 

TrEaTMENT aNd OuTCOMEs: The patient continued a compression wrap for 

3 days after which the lesion recurred. Pain returned 4-5 days later. He requested a 

second aspiration. This was performed with 60mL of serosanguinous fluid removed 

and 100mg of Doxycycline reconstituted in 10mL of sterile water was injected back 

into the lesion for sclerodesis. He was instructed on continuing the compression wrap 

for 3-4 weeks. At 2 weeks the lesion has not yet recurred. 

C-23 Clinical Case Slide - Running Issues I 

May 30, 2013, 8:00 AM - 10:00 AM 

Room: 123 

1047 Chair: Karl Bert Fields. Moses Cone Health System, Greensboro, NC. 


1048 discussant: Irene Davis, FACSM. Harvard Medical School, 

Boston, MA. 


1049 discussant: George Chiampas. Northwestern University, 

Chicago, IL. 


1050 May 30, 8:00 AM - 8:20 AM 

Leg swelling - runner 

Melody Hrubes. Schwab Rehabilitation Hospital, Chicago, IL. 

(Sponsor: Terry Nicola, FACSM) 


hIsTOry: A 23-year-old collegiate runner first noticed a bump on the anterior aspect 

of his left tibia 13 months prior. There was no known trauma or previous injury to the 

area. He competed his entire senior season and even set personal bests, although the 

bump grew in size over the year. It was painful only if he pressed on it after running, 

so he did not seek medical attention. He came into the Sports Medicine Clinic at the 

conclusion of his running season for further evaluation 

PhysICaL EXaMINaTION: Swelling was noted on the anterior-lateral aspect 

of the left tibia, approximately 2cm in diameter. It was non-tender, non-edematous, 

and non-blanching. Distal strength, pulses and reflexes were within normal limits and 

symmetric when compared to the right side. 


1. Enchondroma 

2. Tibial fracture with ossification center 

3. benign tumor 



Left Tibia/Fibula anterior-posterior and lateral radiographs: 

-Dense periosteal reaction is seen along the anterior medial aspect of the tibia that is 

focally greatest in the proximal third of the diaphysis. A horizontal lucency suggestive 

of a fracture is present through approximately 50% of the outer cortex. 


Dreaded black line (anterior tibial stress fracture) 


1. Immobilization with air cast 

2. Bone stimulation 

3. Non weight-bearing with crutches for six weeks 

4. Follow-up imaging at six weeks demonstrated interval healing and callous formation 

but continued visualization of fracture line, so continued crutches for five more weeks 

(11 weeks total). 

5. Progressed to walking without air cast or crutches after 11 weeks. Fracture 

successfully healed without need for surgical intervention. He is currently advancing 

his exercise demands while wearing the air cast and continues to be asymptomatic. 

6. Successful recovery from unstable fracture despite prior unrestricted competition for 

one year. 

1051 May 30, 8:20 AM - 8:40 AM 

Exertional Leg Pain - runner 

Neil Sparks, Mark Rogers, Delmas Bolin, FACSM. Edward Via 

College of Osteopathic Medicine, Blacksburg, VA. 


hIsTOry: A 19-year-old female ROTC cadet presented with one year of progressive 

right lower extremity pain, tightness, and parasthesias with running. Pain localized 

to the medial and anterior third of the tibia and the proximal third of her calf. Calf 

tightness noted diffusely. Parasthesias described circumferentially around the distal 2/3 

of the tibia and fibula to the toes. Symptoms possibly related to an increase in running 

intensity. Symptom onset within 8 to10 minutes of running, progresses to a 10/10 

severity, and improves within 30 minutes to two hours of rest. Past history positive for 

ACL reconstruction with revision 2010 on symptomatic leg. 

PhysICaL EXaMINaTION: Right lower extremity examination revealed no 

edema or ecchymosis. Sensation to light touch and vibration decreased over the 

middle third of the tibia. Fibular head motion restricted and the right tibia internally 

rotated relative to the femur. Tenderness at the medial head of the gastrocnemius, 

anterior middle and medial third of the tibia, medial aspect of the tibialis anterior, 

and cuneiforms. Fascial compartments soft without palpable masses. Subtalar motion 

restricted. 20 toe raises reproduced symptoms. Tinel’s was positive at the common 

peroneal and sural nerves. Tibialis anterior strength 4/5. 


1.Tibial Stress Fracture 

2.Medial Tibial Stress Syndrome 

3.Popliteal Artery Entrapment Syndrome 

4.Exertional Compartment Syndrome 


Tibia and fibula anterior-posterior and lateral radiographs: 

- Negative for stress fracture 

Lower extremity MRI: 

- Negative for stress fracture or mass 

Popliteal artery sonography: 

- No evidence of artery entrapment 

Compartment Pressure Testing of Two Compartments: 

- Elevated anterior compartment pressures at rest and increased with exertion. 

- Normal posterior compartment pressures 

Gait analysis: 

- Weak core with bilateral trendelenberg, limited external rotation of right tibia, lateral 

weight distribution throughout gait cycle 


Exertional (Anterior) Compartment Syndrome 

TREATMENT PLAN: 

1.Surgical consultation to discuss fasciotomy; considered early given patient’s need to 

maintain military status. 

2.Osteopathic manual treatment. 

3.Physical therapy to include gait training 

1052 May 30, 8:40 AM - 9:00 AM 

Finger Injury - running 

Fariba Shah, Monica Rho, Joel Press, FACSM. Rehabilitation 

Institute of Chicago, Chicago, IL. 


hIsTOry: A 37-year-old female runner sustained a finger injury when grasping her 

smart phone while running. At the end of her 3.5-mile run, she looked down at her 

phone to track her mileage, when she tripped and fell face forward to the ground. Her 

right hand was firmly grasping the phone, with her thumb on one side and her third 

and fourth digit wrapped around the back of the phone. The screen of the smart phone 

shattered on impact. She felt immediate pain with movement of her right fourth digit 



and reported numbness of the palmer surface of her hand. Her smart phone was still in 

her grip. 


Examination of her right hand revealed localized tenderness and bruising of 

the fingertip of her fourth digit. She had decreased active flexion at the distal 

interphalangeal joint. She had normal sensation, reflexes and strength of her upper 

extremities bilaterally. 


1.Jersey finger, partial tear of flexor digitorum profundus tendon 

2.Distal phalanx fracture 

3.Mallet Finger 


Anterior-posterior and lateral X-ray views of the right hand: 

--Normal, no fracture or dislocation noted 

Dynamic ultrasound examination while flexing and extending the right fourth digit to 

evaluate the tendon ends: 

--Partial avulsion of the flexor digitorum profundus 


Jersey finger, partial tear of flexor digitorum profundus tendon 


1.Immobilization with finger splint for 6 weeks. 

2.Passive range of motion exercises started twice a day from day one. 

3.Ice to reduce pain and inflammation, 20 to 30 minutes every 3 to 4 hours. 

4.Strengthening exercises using items such as putty and hand therapy balls started 6 

weeks post injury when pain free. 

5.Return to unrestricted activities when she has full, painless range of motion and 

normal strength. 

1053 May 30, 9:00 AM - 9:20 AM 

Knee Injury _ distance running 

Dwan R. Perry, Robert Hosey. University of Kentucky, 

Lexington, KY. (Sponsor: Mary Lloyd Ireland, FACSM) 


hIsTOry: A 37 year old male, former college cross country athlete noticed insidious 

onset of medial-sided right knee pain with his runs over the past month. He has 

participated in several 5Ks per year, including marathons. He recently increased his 

mileage to 12 miles per day in preparation for a half marathon. He describes his pain 

as sharp, intermittent, without radiation or swelling of the calf. He runs in his usual 

shoes and has not changed running style or surfaces. Cryotherapy and over-the-counter 

analgesics has provided mild relief. 


Right Knee: No visible effusion. Palpation revealed tenderness to palpation over the 

medial tibial plateau just above the pes anserine tendon insertion. There was no medial 

joint line tenderness. There was full range of motion at the knee with a negative bounce 

home test. No instability on varus or valgus stress testing at 0° and 30°. Ligamentously 

stable with negative Lachman’s test. McMurray’s test was also negative. There was no 

fullness in the popliteal space. The extremity was neurovascularly intact. 


1. Medial Meniscus Tear 

2. Medial Tibial Stress Fracture 

3. Articular Cartilage Defect of the Medial or Patellofemoral Compartment 

4. Pes Anserine Bursitis 

5. Tibial Bone Bruise 


Radiographs of the Bilateral Knee, standing 30° flexed PA views, patellar views, and 

lateral views obtained: 

1. No evidence of fracture. 

2. No joint space narrowing. 

3. No osseous loose bodies. 

MRI of the Right Knee without Contrast: 

1. Reactive bone marrow edema in the medial tibial plateau. 

2. Irregular edema within the fibular head indicative of early arthrosis affecting the 

proximal tibiofibular articulation. 

3. Normal appearing medial meniscus and articular cartilage. 


Medial Proximal Tibial Plateau Stress Fracture 


1. Cessation of the painful activities. 

2. As symptoms resolved, it was recommended to have a gradual return to running 

once asymptomatic. 

3. The patient began running again after pain subsided. This was followed by a 

recurrence of pain which prompted another period of rest from running. 

4. After resolution of pain, the patient was able to return to running pain free at one 

year after initial presentation and without need for further imaging. 


1054 May 30, 9:20 AM - 9:40 AM 

Knee Pain - runner 

Maria E. Reese, Monica Rho. Rehabilitation Institute of 

Chicago, Chicago, IL. (Sponsor: Joel Press, FACSM) 


hIsTOry: A 39-year-old male recreational runner presented with 3 week history of 

left anterior knee pain that started on mile 15 of an 18 mile run. He denied trauma, 

swelling, bruising, or prior knee pain. Pain was a dull ache progressing to sharp severe 

pain, 6/10, precluding running. For the next 3 days, pain progressively worsened 

and became present with walking. Pain was worse with weight bearing, especially 

descending stairs, and prolonged sitting. Pain was better with rest and stretching 

(quadriceps, hip flexors, and hamstrings). He denied clicking, popping, catching yet 

confirmed a feeling that his knee would “give out”. Pain improved with rest and he was 

able to walk pain free. He ran 3 miles during which he had mild left knee pain, yet the 

severe pain returned the following day. For the next 2 weeks, he decreased his running 

to 1 mile per week. The elliptical machine and stationary bicycle were non painful yet 

stairs continued to cause pain. He had not taken medications nor used ice. 

PhysICaL EXaMINaTION: Examination revealed mildly increased fullness of 

left tibial tuberosity when compared to right with full range of motion of the bilateral 

knees with mild discomfort at end range of left knee flexion. No bony tenderness 

to palpation bilaterally. Tenderness of the left distal patellar tendon, especially the 

medial aspect just superior to the tibial tuberosity yet no tenderness to palpation of 

the proximal and mid portions of the left patellar tendon. Hip exam and neurological 

testing were normal. He was unable to complete left single leg squat due to significant 

anterior knee pain. 


1. Left patellar tendonopathy 

2. Stress reaction of left tibial tuberosity 

3. Calcific tendonopathy of the left patellar tendon 

4. Patellofemoral syndrome 


Left knee ultrasound: 

- Tender 8.1mm x 3.4mm x 1.7mm hyperechoic structure located at distal medial 

aspect of left patellar tendon with acoustic shadowing 

- Minimal effusion underlying patellar tendon in area described above 

- No increased blood flow appreciated on Doppler imaging 


Calcific tendonopathy of the distal medial left patellar tendon 


1. Ibuprofen 600mg p.o. TID with food 

2. Ice as needed, especially following activity 

3. Eccentric strength training of quadriceps 

4. Return to running gradually 

1055 May 30, 9:40 AM - 10:00 AM 

Conservative Treatment of Plantar Fascia Pain in a 

recreational running athlete 

Noelle Selkow, Jeffrey G. Williams. Illinois State University, 

Normal, IL. (Sponsor: Kevin Laudner, FACSM) 


hIsTOry: A 24-year-old, female, recreational running athlete (height: 167.6 

cm, weight: 61.4 kg) reported with right plantar foot pain while training for a half 

marathon. Her pain was insidious and persistent for 7-weeks prior to presenting 

for evaluation and treatment. The patient’s symptoms began as minor pain at rest, 

discomfort and tightness in the plantar aspect of the foot, particularly upon waking in 

the morning. Patient stated that her pain progressed to feeling as if her plantar fascia 

was going to “tear in two pieces” while running. 

PhysICaL EXaMINaTION: The patient presented with right plantar foot pain. 

A pea–sized nodular deformity along the middle 1/3 of her medial longitudinal arch 

was identified and tender to palpate. Examination of range of motion (ROM) revealed 

limited active dorsiflexion in her affected ankle when compared bilaterally. Manual 

muscle testing revealed no deficiencies in surrounding foot, ankle, and lower leg 

musculature when compared bilaterally. Neurologic examination was negative. Initial 

sonographic images of the nodule revealed a 0.44 cm2 fibroma. 


1. Plantar fasciitis 

2. Chronic fascial rupture 

3. Inclusion cyst 

4. Foreign body granuloma 

5. Nerve sheath tumor 


Sonographic examination: 

-- Initial transverse sonographic images indicated a 0.44 cm 2 fibroma within the plantar 

fascia. 

Standard Goniometry: 

-- Lacking 3° of active dorsiflexion in the affected ankle. 





FINAL WORKING DIAGNOSIS: 

Plantar fibromatosis (fibroproliferative condition on the plantar fascia tissue) 


1. Immediate reduction of running workouts to within a pain free range. 

2. Two treatment sessions per week for four weeks within an athletic training facility 

incorporating an instrument-assisted-soft-tissue mobilization technique. 

3. Low intensity strengthening exercises and passive stretching were performed during 

treatment sessions. 

4. A home exercise program was prescribed on days when the patient was not treated 

by the clinician. 

5. Returned to full participation in running at week four of treatments with full, pain 

free ROM, pain free running gait and decreased size of the plantar fibroma by 17% 

(0.37cm 2 ). 

6. Patient successfully completed the half-marathon race, pain free and at goal pace 

1-month following the conclusion of treatment. 

C-24 Free Communication/Poster - Advances in 

Exercise Immunology 

May 30, 2013, 7:30 AM - 12:30 PM 

Room: Hall C 

1056 Board #1 May 30, 8:00 AM - 9:30 AM 

Endurance-training Effects On Intracellular Calcium and 

Iron In Cd4 + Lymphocytes In young and Old Men 

Suzanne Broadbent. Southern Cross University, Lismore NSW, 

Australia. 


Intracellular calcium (Ca 2+ i )and iron (Fe 3+ i) are critically involved in intracellular 

signalling within CD4 + cells yet little is known of long-term exercise effects on these 

variables in relation to CD4 + activation and proliferation. 

PurPOsE: To investigate the effects of 12 months of aerobic/endurance exercise 

on Ca2+i and Fe3+i concentrations within CD4+ lymphocytes in old and young men 

compared to sedentary controls. 

METhOds: We compared young (30±5 yr) trained (TRY, n=14) and sedentary (UTY, 

n=12) men to older (69±5 yr) trained (TRO, n=14) and sedentary (UTO, n=10) men for 

12 months. The TRY group completed daily endurance training (60-120 min day, 60- 

80% VO 2peak ) while the TRO group cycled for three 60 min sessions per week (60-75% 

VO 2peak ). Venous blood was analysed every month for resting lymphocyte counts. CD4 + 

cells were separated and stimulated with thapsigargin to quantify Ca 2+ i, using Fluo-3 

AM and flow cytometry. Further CD4 + lymphocytes were incubated with Calcein AM 

to assess Fe 3+ i. 

rEsuLTs: The TRY group had a significantly higher CD4+ concentration than 

UTY for 4 months (37±7%, p


1059 Board #4 May 30, 8:00 AM - 9:30 AM 

Length Of systemic Cytokine response after an ultramarathon 

race In Men 

Stephen M. Cornish1 , Jennifer L. Copeland2 . 1Athabasca University, Athabasca, AB, Canada. 2University of Lethbridge, 

Lethbridge, AB, Canada. 


Prolonged intensive exercise is known to cause a systemic inflammatory response, 

most likely due to micro-structural damage to muscle fibers, but how long this 

response persists is unclear. 

PurPOsE: To evaluate the inflammatory response for one week after an ultramarathon 

and to determine if the inflammatory response is associated with delayed 

onset muscle soreness (DOMS) and peak knee extensor torque. 

METhOds: Six male participants in a 50 km race volunteered for the study (Age: 

45.3±9.4 yrs; VO2max: 55.7±6.3 mL/kg/min; BMI: 25.7±2.4 kg/m2; % Body Fat: 

16.5±4.6 %). The race was primarily on trails with approximately 1300 metres of 

elevation gain and loss. Baseline measurements were taken one day before the race 

and measurements were repeated immediately post-race as well as 24 hours and 7 days 

after the race. Blood was sampled from the antecubital vein and was used to analyze 

interleukin-6 (IL-6), IL-10, and IL-1β via ELISA. DOMS was measured using a visual 

analogue scale. Peak isometric knee extensor torque was measured with an isokinetic 

dynamometer at baseline, 24 hours post race and 7 days post race. The dependent 

variables were analyzed using a one factor repeated measures ANOVA. 

rEsuLTs: IL-6 was elevated immediately post race (1.20±1.18 to 13.84±3.16 pg/ 

mL, p 30 kg/m2) or non-obese (N=15; BMI < 30 kg/m2). PBMCs (106 

cells/ml) were stimulated with leptin at 18.75 and 250 ng/ml in the presence of synthetic 

GC dexamethasone (DEX; 0, 10-8, 10-7, and 10-6 M) for 24 h at 37°C in 5% CO2. 

rEsuLTs: Leptin at the higher level induced greater IL-6 production in the obese 

than non-obese subjects (p



(treatment: p


ANOVA, controlling for age, weight, calcium and compliance. 

rEsuLTs: Six young adults (4F, 2M, age 23 ± 2.4 years) volunteered to participate. 

All bone, muscle and fat parameters improved over the training period, except tibial 

density at the 4% site, with greater improvements in the barefoot limb; however, no 

effect reached statistical significance. A 4.5% increase in lower extremity lean mass 

(p=0.01) and 10.1% decrease in fat mass (p=0.002) was observed in the barefoot limb 

only. 

CONCLusIONs: Power was low in this pilot trial, thus positive footwear-specific 

skeletal responses to the osteogenic training program did not reach statistical 

significance. By contrast, greater increases in lean mass and decreases in fat mass were 

detected in the lower extremity wearing the barefoot shoe during training. The novel 

within-subject design was an effective control of individual variation with no adverse 

effects. 

1069 Board #14 May 30, 9:00 AM - 10:30 AM 

Estrogen receptor-alpha Genotype affects Exercise-related 

Bone density In Japanese young Women 

Hiroyo Kondo 1 , Hidemi Fujino 2 , Shinichiro Murakami 3 , 

Naoto Fujita 2 , Fumiko Nagatomo 4 , Akihiko Ishihara 4 . 1 Nagoya 

Women’s University, Nagoya, Aichi, Japan. 2 Kobe University, 

Kobe, Japan. 3 Himeji Dokkyo University, Himeji, Japan. 4 Kyoto 

University, Kyoto, Japan. 


Osteoporosis is a systemic skeletal disease characterized by low density and fragile in 

bone. Estrogen is essential for mechanotransduction, and estrogen receptor alpfa (ER1) 

is one of genetic candidates for a prime regulator of bone metabolism. 

PurPOsE: The purpose of this study was to assess the interactive effects of habitual 

exercise, calcium intake and ER1 gene polymorphisms on bone density in young 

women. 

METhOds: 160 Japanese healthy young women (20-23 years old) were 

recruited in this study. Habitual exercise and nutrient intake were assessed using a 

questionnaire. Bone mass was measured by quantitative ultrasound measurement. The 

polymorphisms of ER1 at intron I (rs2234693 and rs9340799) was genotyped using the 

TaqMan probe-based SNP method. 

rEsuLTs: The subjects with habitual exercise and high milk intake were significantly 

higher bone density than those with non-habitual exercise and low milk intake. The 

subjects with ER1 genotype CC of rs2234693 had lower bone density than those 

with ER1 genotype TT in non-habitual exercise group. Interestingly, the subjects 

with ER1 allele C, or both CT and AG of rs9340799 in the habitual exercise group 

had significantly higher bone density than those in the non-habitual exercise group 

although the subjects without ER1 allele C or both CT and AG were no significant 

bone density between the habitual exercise group and the non-habitual exercise group. 

CONCLusIONs: These results suggest that habitual exercise is more important for 

bone mass metabolism in young women carrying C allele and/or AG genotype in ER1 

polymorphisms. 

Supported by Grants-in-Aid for Science Research from the Japanese Ministry of 

Education, Culture, Sports, Science and Technology. 

1070 Board #15 May 30, 9:00 AM - 10:30 AM 

relationship Between The sarcopenic Index, Body 

Composition and Muscular strength in Breast Cancer 

survivors 

Takudzwa A. Madzima1 , Emily Simonavice2 , Pei-Yang Liu3 , 

Jasminka Z Ilich1 , Jeong-Su Kim1 , Michael J. Ormsbee1 , Carla 

M. Prado1 , Lynn B. Panton, FACSM1 . 1Florida State University, 

Tallahassee, FL. 2Georgia College & State University, 

Milledgeville, GA. 3The University of Akron, Akron, OH. 


Breast cancer survivors (BCS) encounter side effects from cancer treatments that 

negatively affect body composition, particularly muscle loss which may lead to 

sarcopenia. Additionally, this may result in osteosarcopenia, the concurrent loss of 

bone and muscle mass. Appendicular skeletal muscle adjusted by squared height (ASM 

index; kg/m2) has been used to define sarcopenia. 

PurPOsE: To evaluate the relationships between the ASM index, strength, and total 

and regional bone mineral density (BMD) in BCS. 

METhOds: Forty-four (60±9 yrs) BCS participated. Body composition and BMD of 

the total body, lumbar spine (L1-L4), hip (femur), radius, ulna and total forearm were 

measured by DXA. Upper and lower body strength was measured via one-repetition 

maximum (1RM) on chest press and leg extension machines. Handgrip (HG) strength 

was assessed using a HG dynamometer. The BCS were separated into two groups 

comprised of those that fell above (>) and below ( 6.39 


kg/m2 (total body: >1.182±0.135 g/cm²; : 0.518±0.059 

g/cm²; : 0.474±0.064 g/cm²; : 0.499±0.059 g/cm²;



1073 Board #18 May 30, 9:00 AM - 10:30 AM 

Excess Body Fat has Negative Impacts on hip strength in 

Competitive athletes with Menstrual dysfunction 

Sheng-An Lo 1 , Kuei-Hui Chan 2 , Yi-Ting Lin 3 , Chien-Wen Ho 3 . 

1 Graduate Institute of Coaching Science, Taoyuan, Taiwan. 

2 Graduate Institute of Coaching Science, Taoyaun, Taiwan. 

3 Laboratory of exercise Biochemistry, Taipei, Taiwan. 


Hip strength (HS) analysis is measures of proximal femur strength in axial 

compression or bending. Fat mass (FM) and lean body mass (LBM) are positively 

related to bone mass in young athletes with eumenorrhea. However, the relation in 

ones with menstrual dysfunction is less known. 

PurPOsE: To determine effects of body composition (BC) on bone health in athletes 

with menstrual dysfunction. 

METhOds: Thirty-one athletes with MD (20.1±1.9 yrs) were selected by a 

questionnaire from 134 collegiate female athletes. They did not take any menstrual 

regulators during the past a year. Blood samples were collected during day-3 to 

day-5 of menses to assess sex hormones of luteinizing hormone, follicle-stimulating 

hormone, and estradiol. BC and bone mineral density (BMD) of hip, femoral neck, 

and Ward’s triangle were assessed by dual-energy X-ray absorptiometry. BC variables 

included LBM, FM in whole body (FMWB), wasit (FMW), and hip (FMh) and body 

fat percentage in the same parts (BF%WB, BF%w, and BF%h). HS variables of crosssectional 

area (CSA), cross-sectional moment of inertia (CSMI), hip axis length, and 

femur strength index (FSI) were assessed by the HS analysis program. All subjects 

were divided into normal (Nor) and high body fat (H) groups by BF% ≤25%. Pearson’s 

correlations and independent t-tests were used to analyze all continuous variables. 

rEsuLTs: Between the Nor and the H groups, there were significant differences in 

BMI, BF%WB, BF%W, BF%h, and FMWB (12.5±1.7 vs. 20.1±5.8 kg, p


1077 Board #22 May 30, 9:00 AM - 10:30 AM 

The Vertebral Curvature Of dancesport and Track and 

Field athletes 

Helena Liiv, Katre Maasalu, Jarek Mäestu, Toivo Jürimäe, Jaak 

Jürimäe. University of Tartu, Tartu, Estonia. 


Dancers have beautiful posture and keeping a straight spine line is typical not only 

during competitions, but in everyday life also. In dancesport athletes are training for 

many years to develop the right posture and dance hold. This raises the question: 

does keeping a nice posture becomes a habit and does the spine changes too? To 

investigate the influence of the specific training of dancesport to the spinal curvatures 

we compared dancers´ spinal curvatures with track and field athletes. We decided to 

compare dancesport with other sports to exclude the influence of sedentary lifestyle. 

The reason for choosing precisely track and field athletes was that both sports are 

having continues and various movements. 

PurPOsE: The aim of the current study was to evaluate lumbar lordosis and thoracal 

kyphosis of the international level dancesport dancers and to compare it with track and 

field athletes. 

METhOds: Participants: Thirty competitive dancesport couples (males 22.8±6.6 yrs 

and females 22.0±6.4 yrs) and 16 male (age 26.8±4.4 yrs) and 13 female (age 21.5±4.1 

yrs) track and field athletes served as subjects for this study. The track and field and 

dancesport groups were selected to match the age and gender profile. Spinal curvatures: 

Thoracal kyphosis, lumbar lordosis angle were measured in lateral view VFA scan using 

a Lunar DPX-IQ densitometer (Lunar Corporation, Madison, WI, USA). 

rEsuLTs: Male (5.7±4.7°) and female dancers (8.7±5.9°) had significantly smaller 

(p



associations between L foot and any DXA parameters. 

CONCLusIONs: It appears that there are significant relationships between bone 

health values from QUS and DXA. The association existed only for the R foot, which 

may be related to R-side dominance. These data suggest that QUS of the R Os Calcis 

may be sensitive to measuring the same bone health parameters as those elicited by the 

DXA giving cautious support for using QUS for intervention research. Further study 

using larger sample sizes and a more diverse population is needed to determine the 

validity and sensitivity of QUS to changes in bone health parameters over time and to 

test its application beyond fracture screening. 

1082 Board #27 May 30, 9:00 AM - 10:30 AM 

using Peripheral Quantitative Computed Tomography 

(pQCT) to Estimate soft Tissue Characteristics in Patients 

with Knee Osteoarthritis 

Dana L. Judd, Vanessa D. Sherk, Emily R. Rogers, Wendy M. 

Kohrt, FACSM, Jennifer E. Stevens-Lapsley. University of 

Colorado Anschutz Medical Campus, Aurora, CO. 


Patients with knee osteoarthritis (OA) have reduced quadriceps strength in the painful 

limb. Estimating muscle size and its contribution to strength loss is challenging but 

important for optimizing rehabilitation. Peripheral Quantitative Computed Tomography 

(pQCT) measures thigh muscle size but analysis is challenging due to noise in images 

of large limbs. Filtering decreases signal noise, but strategies vary. The effect on soft 

tissue quantification in those with poor muscle quality or larger limb size is unclear. 

PurPOsE: To determine if noise filtering affects the quantification of soft tissue in 

an OA cohort. 

METhOds: 28 patients with knee OA were enrolled (age 64.5 ± 8.0 y; BMI 28.6 ± 

4.3 kg/m2). pQCT scans were acquired at 33% of the femur length proximal to the 

lateral epicondyle. Scans were analyzed with 4 median filter methods (No filter, weak 

filter (F03F05), medium filter (F03F05F05), strong filter (F01F06U01)). Total area 

(TA), muscle area and density (MA, MD), and fat area and density (FA, FD) were 

measured. Repeated measures ANOVA with post hoc paired t-tests were performed. 

rEsuLTs: TA, MA, FA, FD and MD values were filter dependent. Each filtering 

method was significantly different from each other (Table 1; p


32.8 [Nm] and Achilles tendon elongation ICC: 0.89; TRV: 14.4 ± 8.6 %; Bias ± LoA: 

0.0 ± 0.5 cm. 

CONCLusION: Data suggests that the defining variables are reliable for the 

calculation of Achilles tendon stiffness and Young’s modulus. However, the relatively 

high test-retest variability of Achilles tendon elongation and muscle torque may lead 

to an increase in measurement error in the calculation of both tendon stiffness and 

Young’s modulus. 

1086 Board #31 May 30, 9:00 AM - 10:30 AM 

Intra- and Inter-observer Variability Of a retrospective 

analysis Of achilles Tendon ultrasound scans 

Monique Wochatz, Michael Cassel, Niklas Koenig, Katja 

Froehlich, Frank Mayer. University Outpatient Clinic Potsdam, 

Potsdam, Germany. 


Ultrasonography is commonly used in clinical practice to examine Achilles tendon 

(AT) structural alterations. Due to time and practical reasons, ultrasound investigations 

and the subsequent analyses of the respective scans are often done by two different 

examiners. Nevertheless, it is unclear whether those retrospective analyses are reliable. 

PurPOsE: To evaluate the intra- and inter-observer variability of AT thickness and 

cross-sectional area (CSA) analysis on pre-captured ultrasound scans done by an 

experienced (EI) and inexperienced investigator (II). 

METhOds: Both Achilles tendons of 12 asymptomatic subjects (29±6yrs, 

1.77±0.10m, 74±13kg) were investigated by ultrasound. Longitudinal and transversal 

ultrasound scans were captured at 20 mm proximal the calcaneal insertion by an EI. 

The scans were further retrospective analyzed, once by the EI and twice with one day 

in between by an II. Achilles tendon thickness was assessed on longitudinal scans and 

CSA on transversal scans by a freehand selection tool. To evaluate intra- and interobserver 

reliability, test-retest variability (TRV), intra-class correlation coefficient 2.1 

(ICC), Bias and 95% limits of agreement (LoA) were calculated. 

rEsuLTs: The Intra-observer AT-thickness values were 4.7±0.6mm (Mean±SD) 

(TRV: 3%; ICC: 0.95; Bias: -0.1mm; LoA: -0.4, 0.3mm) for the first (A1) and second 

analysis (A2) assessed by the II. CSA were 58.6±15.5mm² (A1) and 56.6±15.4mm² 

(A2) (TRV: 8%; ICC: 0.96; Bias: 1.9mm²; LoA: -5.9; 9.7mm²). The inter-observer 

AT-thickness values were 4.7±0.6mm for the II and 5.0±0.6mm for the EI (TRV: 8%; 

ICC: 0.81; Bias: -0.4mm; LoA: -0.6, -0.2mm). CSA were 58.6±15.5mm² for II and 

60.6±15.6mm² for the EI (TRV: 8%; ICC: 0.92; Bias: -2mm²; LoA: -13.7, 9.7mm²). 

CONCLusIONs: Intra-observer reliability was shown to be excellent on ATthickness 

and CSA analysis, even when performed by an II. Inter-observer reliability 

was good to excellent. The retrospective analysis of ultrasound scans done by 

differently experienced investigators was shown to be a practical and reliable method. 

1087 Board #32 May 30, 9:00 AM - 10:30 AM 

Mechanical Characteristics of younger and Older subjects’ 

Patellar Tendon via acoustoelasticity analysis of ultrasound 

Images 

Michele LeBlanc, Kyle Evans, Steven A. Hawkins, FACSM. 

California Lutheran University, Thousand Oaks, CA. 


Acoustoelasticity has been used to obtain non-invasive mechanical measures of in-vivo 

tendon from ultrasound images. 

PurPOsE: To use the acoustoelasticity-based software program, EchoSoft 

(Echometrix, Madison, WI), to compare strain developed in the patellar tendon during 

an isometric contraction between younger and older participants and to determine the 

behavior of the tendon’s strain-signal change (stiffness) curve. 

METhOds: Moderately active Younger subjects (n=14, age = 22.6 ± 3.8 years) and 

Older subjects (n=13, age = 82.2 ± 5.6 years) were recruited from the local community. 

The two groups’ activity level, height and mass were not significantly different. 

Graded isometric knee extensions were performed on an isokinetic dynamometer 

while ultrasound data was collected at 25 Hz. Ultrasound DICOM files were uploaded 

to the EchoSoft software to obtain strain and stiffness information for a region of 

interest 175 mm2 proximal to the tibial attachment site. One trial with increasing strain 

and stiffness for at least 800 ms was chosen for each subject’s leg for analysis. Four 

different types of curves were fit to each trial’s strain-stiffness data. 

rEsuLTs: There was no difference in the maximum strain experienced in the 800 

ms timeframe between the Younger and Older groups (8.4 ± 6.0% versus 8.7 ± 5.3%, 

respectively). There was a difference between the maximum strain values between legs 

for the Older group (p = 0.007), but not the Younger group. There was a significant 

relationship between the maximum strain and maximum torque values for the Younger 

group (r = 0.525; p = 0.004), but not the Older group (r = -0.030). The exponential 

curve and general linear model fits were best and nearly identical for both groups 

(R2 = 0.937 ± 0.045 for both curve types for the Younger group and R2 = 0.956 ± 

0.032 and 0.955 ± 0.032 for the Older group). The quadratic curve also fit well (R2 

= 0.925 ± 0.114 for the Younger group and R2 =0.949 ± 0.055 for the Older group) 

but individual curves differed in their concavity direction. The linear model through 

the origin did not fit as well as the other curves (R2 = 0.856 ± 0.119 and R2 = 0.898 ± 

0.071, respectively). 


CONCLusIONs: These observations support that the strain-stiffness curve is best 

described with an exponential or general linear model. 

1088 Board #33 May 30, 9:00 AM - 10:30 AM 

acl Failure Locus: a subject specific simulation-based 

Investigation 

Ruben Goebel. Qatar University, Doha, Qatar. 


PurPOsE: A full/partial tear of the anterior cruciate ligament (ACL), occurs 

approx. 250000 times annually in the U.S. An epidemiology study of athletic injuries 

determined that out of 19,530 injuries, 20% were ACL injuries. It is shown that ACL 

injury occurs when the athlete lands with knee close to full extension, in valgus, and 

the femur in external rotation. These studies assume that an ACL injury occurs only in 

certain combinations of loading. Aim of this study was to perform a parametric study 

based on knee joint movement, under different varus and valgus (V/V) ramping rates, 

to highlight which movement combinations are most detrimental to ligaments and soft 

tissues of knee joint. 

METhOds: Using a 3D FE knee joint model (bones modeled as rigid-, ligaments 

modeled as multi-bundled 3D solid structures) by using a transversely isotropic viscohyperelastic 

material model, our study provides a spectrum of injury propensity based 

on internal/external femoral rotation and (V/V) angle. Our models are based on subject 

specific geometrical models of the knee joint and accounts for bundle specific prestrain 

in 3D ligaments. 

rEsuLTs: ACL tears were monitored over a spectrum of motion combinations, at 

three relevant V/V ramping rates of 0.1 sec., 0.05 sec. and 0.01 sec. The results show 

negligible differences between failure angles for all movements. The largest difference 

for one axial rotation value was 0.42°. The results highlight external rotation combined 

with valgus angle as detrimental movement combination. Moreover, varus angle 

simulation requires less relative angle for ACL tear initiation when compared to valgus 

angle simulation. The posterolateral bundle (plACL) was shown to be more susceptible 

to rupture in 17 of 22 orientations. External femoral rotations are more susceptible to 

ligament failure than internal femoral rotation. plACL shows more injury susceptibility 

compared to the anteromedial bundle. 

CONCLusIONs: External rotation combined with valgus angle is determined as 

detrimental movement combination for knee joint injury. The current results will 

improve the knowledge base for injury mechanisms of the ligaments and soft tissue of 

the knee. In sports where ACL injuries are prevalent, our results can assist to develop 

training programs to address the avoidance of potentially harmful knee orientations. 

1089 Board #34 May 30, 9:00 AM - 10:30 AM 

Patients with Chronic rotator Cuff Tears have reduced 

supraspinatus Muscle Fiber Force Production, disordered 

Myofibrils and an accumulation of Fatty Macrophages 

Christopher L. Mendias, Stuart M. Roche, Evan B. Lynch, Max 

R. Davis, Caleb R. Bromley, Julie A. Harning, Elizabeth R. 

Sibilsky Enselman, Dennis R. Claflin, Asheesh Bedi. University of 

Michigan, Ann Arbor, MI. (Sponsor: John A Faulkner, FACSM) 


A common pathophysiological change that occurs in chronically torn rotator cuff 

muscles is atrophy of muscle fibers and an accumulation of intramuscular fat, 

collectively referred to as “fatty degeneration.” For many patients that undergo surgical 

repair of a torn cuff, fatty degeneration is not resolved. 

PurPOsE: To gain a greater understanding of the changes in muscle fiber contractility, 

myofibril architecture and fat accumulation in patients with rotator cuff tears. 

METhOds: Biopsies of the supraspinatus (SSP) and anterior deltoid were obtained 

from patients with chronic, full thickness SSP tears at the time of surgical repair. 

The contractility of permeabilized muscle fibers was measured, and force values of 

torn SSP and intact deltoid muscles were compared to age-matched force values of 

healthy fibers sampled from the vastus lateralis (VL) muscle in a previous study. N=27 

subjects for VL, N=8 subjects for SSP and deltoid. Differences between groups were 

tested using a one-way ANOVA (P



1090 Board #35 May 30, 9:00 AM - 10:30 AM 

systematic review of Contracture reduction in the Lower 

Extremity using dynamic splinting 

F, Buck Willis1 , John Furia2 , Ram Shanmugam3 , Sarah Curran4 . 

1 2 McMurry University, Abilene, TX. SUN Orthopaedic, 

Lewisburg, PA. 3Texas State University, San Marcos, TX. 

4University of Wales Institute, Cardiff, Cardiff, United Kingdom. 

Supported by F. Willis: Salary; Landmark Medical, Dynasplint Systems 

Research Board Membership. 

Background: Joint contractures are relatively common disorders that can result in 

significant long term morbidity. Initial treatment is non-operative and often entails 

the use of mechanical modalities such as dynamic and static splints. Although widely 

utilized, there is a paucity of data that supports the use of such measures. The purpose 

of this systematic review was to evaluate the safety and efficacy of dynamic splinting 

as it is used to treat joint contracture, and to determine if duration on total hours of 

stretching had an effect on outcomes. 

METhOds: Reviews of Pubmed, Science Direct, Medline, AMED, and EMBASE 

websites were conducted to identify the term ‘Contracture reduction’ in manuscripts 

published from January 2002 to January 2012. Publications selected for inclusion 

were controlled trials, cohort studies, or case series studies employing prolonged, 

passive stretching for lower extremity contracture reduction. A total of 354 abstracts 

were screened and eight studies (487 subjects) met the inclusion criteria. The primary 

outcome measure was change in active range of motion (AROM). 

rEsuLTs: The mean aggregate change in AROM was 23.5º. The weighted hours 

in meta-analysis showed significant difference within the analysis, with normal 

distribution. Both systemic and animal studies revealed a greater difference and 

improvement from prolonged passive stretching versus short durations of stretching. 

There was also consistency between studies of prolonged passive stretching in human 

patients with outcome in change of AROM. (N=487, ΔAROM = 23.5°, SD=7.6). In 

these studies there were zero adverse events. 

CONCLusIONs: There was a direct, linear correlation between the total number 

of hours in stretching and restored AROM (P=0.002). Dynamic splinting is a safe 

and efficacious treatment for lower extremity joint contractures. The joint specific 

stretching protocols accomplished 

greater durations of end-range stretching which is considered responsible for 

connective tissue elongation. 

Key Words: Connective Tissue, Home Therapy, Rehabilitation 

1091 Board #36 May 30, 9:00 AM - 10:30 AM 

ultrasonographic Measurements of supraspinatus 

Thickness, Pain scores and Treatment 

Marni Hillinger, Christopher Visco. New York Presbyterian - 

Columbia and Cornell, New York, NY. 


Abstract: 

Shoulder injury and pain complaints are common in the primary care, orthopedic and 

physiatric outpatient setting. The supraspinatus tendon is a commonly involved tendon 

in rotator cuff injuries. Musculoskeletal ultrasound is becoming a popular tool to aid in 

the diagnosis of pathologic conditions of the supraspinatus tendon. 

PurPOsE: To determine whether a relationship may exist between supraspinatus 

thickness and pain scores among patients who present with a primary complaint of 

shoulder pain. We hypothesize that a positive correlation exists and that this could aid 

clinical development of targeted treatment strategies and earlier identification of those 

who require a more aggressive therapeutic approach. 

METhOds: A retrospective analysis of supraspinatus thickness was performed by 

analyzing ultrasonographic shoulder examinations of patients who presented to the 

Columbia University musculoskeletal clinic with a primary complaint of shoulder pain. 

This included 58 separate shoulder studies among 52 different patients. An average 

thickness was obtained by utilizing the DICOM ultrasonographic software ruler tool. 

Outpatient records were reviewed including pertinent follow-up visits. Pain scores and 

treatment at the time of presentation and follow-up were recorded. 

rEsuLTs: There was no correlation (Pearson correlation =-0.008) found between 

supraspinatus tendinous thickness and pain scores at the time of presentation. Average 

supraspinatus thickness was found to be 0.506cm ± 0.113 among women and 0.556cm 

±0.157 among men. Average pain score was found to be 5.4±2.2 among women and 

5.7±2.28 among men on initial evaluation. Of those who followed-up, an average 

pain score at the time of re-assessment was 3.5±2.63. 73% of patients were referred 

for physical therapy, 8% were referred for surgical evaluation and 27% underwent a 

steroid injection upon initial evaluation. 

CONCLusIONs: This study did not identify a correlation between 

ultrasonographically identified supraspinatus thickness and pain scores for patients 

who present with a primary complaint of shoulder pain. The majority of patients 

underwent conservative management. Future research should continue to distinguish 

ultrasonographically identifiable risk factors for the development of shoulder 

pathologies. 


1092 Board #37 May 30, 9:00 AM - 10:30 AM 

Extreme Glenoid retroversion is associated with Increased 

rotator Cuff strength in the shoulder 

Kenneth L. Cameron, Scot E. Campbell, Karen Y. Peck, Richard 

B. Westrick, Brett D. Owens. Keller Army Hospital, United 

States Military Academy, West Point, NY. 


The rotator cuff muscles are critical secondary stabilizers in the shoulder. Increased 

glenoid retroversion has been associated with the risk of posterior shoulder instability; 

however, the impact of increased glenoid retroversion on rotator cuff strength remains 

unclear. 

PurPOsE: To examine the association between glenoid retroversion and rotator cuff 

strength in the shoulder. 

METhOds: We conducted a prospective cohort study over a four-year period 

within a high risk group of young athletes to identify the risk factors for shoulder 

instability. Subjects were 1050 freshman entering a U.S. Service Academy in June of 

2006. Baseline data collected upon entry into the study included MRI assessments of 

glenoid version. All measures of glenoid version were performed by a musculoskeletal 

radiologist blinded to all other baseline data. Rotator cuff strength was also assessed 

at baseline using a hand held dynamometer. Internal and external rotation strength was 

assessed with the glenohumeral joint positioned in neutral and in 45º of abduction. 

The current study represents a cross-sectional analysis of the baseline data from this 

study. The primary dependent variables of interest were the four measures of rotator 

cuff strength. The independent variable consisted of four levels based on quartile cut 

points for the degree of glenoid retroversion. Four separate one-way ANOVAs, along 

with Scheffe post-hoc tests, were used to examine mean between group differences in 

rotator cuff strength. 

rEsuLTs: We observed significant main effects for internal (F3,1144=11.79, 

p


1094 Board #39 May 30, 9:00 AM - 10:30 AM 

hyaline Cartilage regeneration in Focal Cartilage defect is 

stimulated by an Innovative acellular Bi-Phasic scaffold 

Elizaveta Kon 1 , Ken Zaslav 2 , Andrew S. Levy 3 , Jonathan Shani 4 , 

Vincenzo Condello 5 , Dror Robinson 6 , Nir Altschuler 6 . 1 Rizzoli 

Orthopaedic Institute, Bologna, Italy. 2 Advanced Orthopedic 

Centers, Richmond, VA. 3 The Center for Advanced Sports 

Medicine, Millburn, NJ. 4 Chavat Daat Veterinary Center, Kfar 

Saba, Israel. 5 Sacre Cuore Don Calabria Hospital, Verona, Italy. 

6 Cartiheal Ltd., Kfar Saba, Israel. 

Supported by E. Kon: Consulting Fee; CartiHeal. 

PurPOsE: The current study was designed to assess the ability in a caprine model 

of a bi-phasic cell-free scaffold to support regeneration of bone and cartilage. Results 

of twelve month pre-clinical study are presented as well as anecdotal results of human 

implantations. 

METhOds: The study was conducted on twenty-four Saanen goats. A critical sized 

focal cartilage defect measuring 6mm diameter by 10mm depth was created in the 

medial femoral condyle. In sixteen of the goats a bi-phasic implant was inserted 

into the defect the reset served as empty defect control. The goats were followed for 

periods of six and twelve months. In vivo the goats were assessed by ultrasonography 

to evaluate the quality of repair tissue using a categorical score. Following sacrifice, 

macroscopic evaluation by independent blinded experts (according to Fortier and 

ICRS), radiographs, micro CT, MRI and blinded histology evaluation (by BioMatech 

NAMSA) of the condyle were performed. Samples of blood, synovial tissue and 

synovial fluid were analyzed. 

rEsuLTs: In the Agili-C (CartiHeal (2009) Ltd.) implanted goats, but not in controls 

there was evidence of both cartilage and bone regeneration. ICRS macroscopic 

evaluation at six months after implantation of an Agili-C implant (n=9) were 9.57 ±1.4 

vs. 6.33±4.5 in the control group (n=5, 

and at twelve months after implantation of an Agili-C implant (n=7) 11.29±0.9 vs. 

7.33±0.5 in the control group (n=3, p



possible attenuating effect of non weight-bearing activity on bone strength parameters 

between genders. 

1098 Board #43 May 30, 9:00 AM - 10:30 AM 

disc degeneration and Limbus Vertebra in Japanese 

Collegiate Gymnasts 

Koji Koyama1 , Koichi Nakazato2 , Seok Ki Min2 , Koji Gushiken2 , 

Yoshiaki Hatakeda2 , Kyoko Seo2 , Kenji Hiranuma2 . 1Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan. 

2Nippon Sport Science University, Tokyo, Japan. 


Magnetic resonance imaging (MRI) studies have shown a higher frequency of 

radiological abnormalities such as disc degeneration (DD), and limbus vertebra (LV) 

among gymnasts. These 2 abnormalities seem to coexist at the same spinal level. 

However, their relationship remains unclear. 

PurPOsE: To investigate the association between DD and adjacent LV in Japanese 

collegiate gymnasts. 

METhOds: The subjects were 104 Japanese collegiate gymnasts (70 men and 33 

women aged 19.7 ± 1.0 years, with 11.8 ± 3.6 years of sporting experience), and 

included Olympic and World Championship medalists. DD and LV were evaluated 

using T1- and T2-weighted MRI. DD was defined as reduced signal intensity of the 

intervertebral discs from L1/L2 to L5/S1. The grading system for the assessment 

of DD was based on the Pfirrmann classification, with grades 3, 4, and 5 indicating 

degeneration. LV was defined as separate, sclerotic, triangular ossicles adjacent to, but 

separate from the vertebral endplate. MRI was performed on all the gymnasts, and the 

images were evaluated by 2 experienced orthopedic surgeons, blinded to the clinical 

status of the gymnasts. 

rEsuLTs: The prevalence of DD and LV in the gymnasts was 40.4% (42/104) and 

20.2% (21/104), respectively. The incidence of DD was significantly higher in gymnasts 

with LV than in those without LV, as determined by the chi-square test. By using logistic 

regression analysis, a significant association of DD with LV (adjusted odds ratio (OR) = 

8.54; 95% confidence interval (CI), 2.64-27.57) and with sporting experience (adjusted 

OR = 0.86; 95% CI, 0.76-0.99) was observed. In addition, we grouped DDs into those 

occurring in the upper (L1/2, L2/3, and L3/4 discs) and lower (L4/5 and L5/S1 discs) 

lumbar regions. The presence of upper DD was associated with adjacent LV (adjusted 

OR = 56.81; 95% CI, 8.87-363.68), and sporting experience (adjusted OR = 0.87; 

95% CI, 0.70-1.07). Similarly, the presence of lower DD was associated with adjacent 

LV(adjusted OR = 8.45; 95% CI, 1.88-38.05), but not sporting experience. 

CONCLusIONs: Adjacent LV is associated with both, upper and lower DD, and may 

be an etiological factor for DD in Japanese collegiate gymnasts. 

1099 Board #44 May 30, 9:00 AM - 10:30 AM 

Whole-Body Vibration attenuates Bone resorption Marker 

responses to acute resistance Exercise in young Men 

Pragya Sharma-Ghimire, Zhaojing Chen, Xin Ye, Tory Keeter, 

Kaelin Young, Eonho Kim, Christopher Poole, Daeyeol Kim, 

Michael Bemben, FACSM, Debra Bemben, FACSM. University 

of Oklahoma, Norman, OK. 


Bone turnover marker (BTM) responses to acute exercise is an area of growing 

interest, however, few studies have examined BTM responses to combined resistance 

exercise and whole-body vibration (WBV). 

PurPOsE: To investigate acute BTM responses to high-intensity resistance exercise 

with and without whole-body vibration in young men. 

METhOds: 10 men (23.1± 1.9 years) participated in this randomized crossover 

study. 1-RM testing was performed for 4 lower body and 2 upper body isotonic 

resistance exercises. Subjects performed 2 protocols in random order separated 

by 2-week wash out periods: 1) resistance exercise only (RE) and 2) WBV + RE. 

For WBV + RE, subjects stood barefoot with knees slightly flexed on the vibration 

platform for 5, 1-minute bouts at 20 Hz and 1.25 mm (amplitude) separated by 

1-minute rest intervals, followed by resistance exercise. For RE, subjects completed 3 

sets of 10 reps at 80% 1-RM. Fasting morning blood draws were taken before (Pre), 

immediately post (IP) exercise, and 30 minutes (30P) after exercise. WBV + RE also 

included a blood draw between the WBV exposure and resistance exercise (VibP). 

Blood samples were analyzed for hematocrit, bone-specific alkaline phosphatase (Bone 

ALP, U/L) and tartrate-resistant acid phosphatase 5b (TRAP5b, U/L). 

rEsuLTs: There was a significant time effect for Bone ALP (p


point system. One point deductions were assigned on SLF for 5 knots± on airspeed, 

100ft± on altitude, or 5 degrees± in heading. Total time (s) for CT was recorded across 

3 segments. 

rEsuLTs: There were a higher number of total penalty points on SLF with the ED 

vs. the placebo (P) in the MED (ED 58.4±9.2 vs. P 34.0 ±6.6, p .05, respectively). Time to complete CT was higher for 

P in MED vs. HI (349.4±26.5s vs. 279.1±17.5s, p 0.05) in time to complete CT between ED and P or MED vs. HI. 

CONCLusIONs: With highly technical flight skills requiring precision, coordination 

and sequencing of movements, EDs may reduce overall performance. Athletes and 

pilots should cautiously interpret claims for the performance enhancing effects of 

energy drinks when shifting focus and technical motor skills are involved. 

1102 Board #47 May 30, 8:00 AM - 9:30 AM 

The Effects of a supplement designed to attenuate the 

adverse Effects of Fatigue 

Adam J. Wells, Adam M. Gonzalez, Gerald T. Mangine, Nadia 

S. Emerson, William P. McCormack, Adam R. Jajtner, Jeremy R. 

Townsend, Tyler C. Scanlon, Edward H. Robinson, IV, Jeffrey 

R. Stout, FACSM, Jay R. Hoffman, FACSM, Maren S. Fragala. 

University of Central Florida, Orlando, FL. 


Phosphatidylserine (PS) supplementation may play a role in attenuating the adverse 

effects of physical fatigue on cognition, mood, and motor function. However, the 

results from recent investigations remain equivocal. 

PurPOsE: To examine the effect of ingesting a supplement (S) containing PS (400 

mg·day-1) and caffeine (100 mg·day-1) for 14 days, on measures of cognitive function 

(CF), reaction time (RT), and mood (MD), following an acute exercise stress. 

METhOds: Twenty-one recreationally trained men and women (age: 22.5 ± 3.4 

yrs; height: 1.76 ± 1.0 m; weight: 77.6 ± 12.6 kg; body fat: 14.6 ± 6.6 %) volunteered 

for this double-blind, controlled study. Participants completed two acute bouts of 

resistance exercise (T1 and T2), separated by two weeks of supplementation with S or 

control (C). Measures of RT (Dynavision D2), CF (Serial Subtraction Test), and MD 

(Profile of Mood States) were assessed pre and post exercise at T1 and T2. A 2 x 2 

(time x treatment) repeated measures analysis of variance was used to analyze the data. 

rEsuLTs: When collapsed across groups, a significant decrease (p = 0.05) in RT 

performance (# of strikes) was seen in the 60-second reaction drill from pre to post 

exercise at T1. All other RT tests were similar from pre to post exercise at T1. RT was 

not significantly changed in response to PS (p > 0.05), and no significant between 

group differences were noted at T2. When collapsed across groups, a significant 

increase in the number of correct answers, and a significant decrease in time to answer 

was seen from pre to post workout at T1 (p = 0.004 and p = 0.007, respectively) and T2 

(p = 0.004 and 0.018, respectively) in the CF test. A significant increase in total mood 

score was observed for C but not for S (p = 0.034). Additionally, C experienced a 13% 

greater increase (p = 0.031) in pre to post exercise perception of fatigue compared to S. 

A significant decrease in confusion was observed in S at T2 (p = 0.041). 

CONCLusION: Ingestion of 400 mg·day-1 of PS and 100 mg·day-1 of caffeine for 

14-days appears to attenuate post-exercise MD scores and perception of fatigue, but 

does not improve reaction time in recreationally trained individuals following acute 

resistance exercise. An acute bout of resistance exercise may improve CF; however, PS 

provides no further benefit. 

1103 Board #48 May 30, 8:00 AM - 9:30 AM 

Physiological responses To a Thermogenic Nutritional 

supplement during rest, Exercise, and recovery In Women 

Haley C. Bergstrom 1 , Terry J. Housh, FACSM 1 , Daniel A. 

Traylor 1 , Robert W. Lewis Jr. 1 , Glen O. Johnson, FACSM 1 , 

Richard J. Schmidt 1 , Dona J. Housh, FACSM 2 , Nathaniel D.M. 

Jenkins 1 , Kristen C. Cochrane 1 . 1 University of Nebraska-Lincoln, 

Lincoln, NE. 2 University of Nebraska Medical Center, Lincoln, 

NE. 


PurPOsE: The purpose of this study was to examine the acute physiological 

responses to a thermogenic nutritional supplement at rest, during low-intensity 

exercise, and recovery from exercise in women. 

METhOds: Twelve recreationally active women (mean ± SD; age, 22.9 ± 3.1 

years) were recruited for this randomized, double-blinded, placebo-controlled, 

crossover study. The nutritional supplement capsules included 200 mg caffeine, 100 

mg capsicum extract, 2 mg piperine, 250 mg boswellia serrate extract, 500 mg dried 

ginger root, 100 mg cinnamon bark, 20 mg niacin, and 500 mg macuna pruriens. The 

placebo capsules were matched in size and appearance and contained microcrystalline 

cellulose. Each testing session consisted of 4 phases: 1) 30 min of initial resting 

measures, followed by ingestion of the placebo or thermogenic nutritional supplement; 

2) 50 min of post-supplementation resting; 3) 60 min of treadmill walking (3.2 – 4.8 


km·hr-1); and 4) 50 min of post-exercise resting. Indirect calorimeter was used to 

measure energy expenditure (EE) and oxygen consumption rate (VO2). The EE and 

VO2 variables were recorded and reported as 10 min averages. During exercise, the 

rating of perceived exertion (RPE) was recorded every 15 min. Statistical analyses 

included separate 2-way repeated-measures ANOVAs (condition x time), 1-way 

repeated-measures ANOVAs, and paired t-tests (p < 0.05). 

rEsuLTs: There were no significant differences for any of the measures between 

the supplement and placebo groups during the initial 30 min resting or the 50 min 

post-supplementation time periods. During exercise, EE was 3 to 4% greater for the 

supplement than the placebo at each 10 min average, with no significant differences in 

RPE. Post-exercise, EE was 5 to 7% greater for the supplement group than the placebo 

group at 10, 20, and 40 min, VO2 was 5% greater at 20 min and 4% greater at 40 min. 

CONCLusION: The current findings 

indicated that the thermogenic nutritional supplement increased EE and VO 2 with 

no effect on RPE. These findings suggested that supplementation with the blend of 

ingredients in the thermogenic nutritional supplement may aid in a weight management 

program that includes long duration (60 min) low intensity (walking) exercise. 

This study was supported by a clinical trial grant from General Nutrition Corporation. 

1104 Board #49 May 30, 8:00 AM - 9:30 AM 

Effects of acute Caffeine Intake on Wingate Test 

Performance in a Creatine supplemented state 

Andrew M. Seaton1 , Charles R.C Marks1 , Mark J. Seaton1 , 

Hermann J. Engels, FACSM2 , Tamara Hew-Butler, FACSM1 . 

1 2 Oakland University, Rochester, MI. Wayne State University, 

Detroit, MI. 


PurPOsE: This study investigated the effects of acute caffeine consumption on 

supramaximal exercise performance in a creatine monohydrate supplemented state. 

METhOds: Fourteen college age adults (age: 23.9±4.3 years; weight: 69.6±11.6 

kg; height: 171.9±8.1 cm) on a supplement-free diet performed a standard leg cycle 

ergometry Wingate test (WanT) to establish baseline (C0) performance characteristics 

for peak anaerobic power (watts/kg; PAP), mean anaerobic power (watts/kg; MAP), 

and rate of fatigue (%; RF). Participants then underwent a creatine monohydrate 

supplementation intervention in the form of a 6 day loading phase (20 g/day) 

followed by a 3 day maintenance phase (5 g/day). Using a double-blind protocol and a 

randomized test order, at the beginning and conclusion of the maintenance phase, each 

subject completed a WanT 60 min after the acute intake of a placebo (C1) or 6 mg/kg 

caffeine (C2). Data were analyzed with a one-way repeated measure ANOVA (alpha < 

.05) and using protected paired t tests (Bonferroni - Holm’s sequential adjustment) for 

post hoc analysis (SPSS v14.0). 

rEsuLTs: There was a significant main effect (p 0.05) for RF (C0 = 46.1 ± 8.0 %; C1 = 50 ± 4.9 

%; C2 = 51.3 ± 7.1 %) and MAP (C0 = 3.1 ± 0.6 W/kg; C1 = 3.1 ± 0.7 W/kg; C2 = 3.2 

± 0.6 W/kg). 

CONCLusION: The present data indicate 6 mg/kg acute caffeine consumption does 

not significantly affect creatine monohydrate loading’s impact on PAP, MAP, or RF 

during a WanT. 

1105 Board #50 May 30, 8:00 AM - 9:30 AM 

The Effects of Caffeine on Time to Exhaustion during 

Treadmill running 

Amanda Locke, Kevin Sartin, Danny Accola, Steve Burns. 

University of Central Missouri, Warrensburg, MO. (Sponsor: 

Michael Godard, FACSM) 


Caffeine is often used to enhance athletic performance. Today, committees are 

questioning if it should be a substance banned during competition. 

PurPOsE: The primary purpose of this study was to determine the effect caffeine 

had on the time until exhaustion while running. 

METhOds: Participants included 8, moderately active males (22.0 ± 1.7 years, 184.9 

±5.3 cm, 83.8 ±11.4 kg). Subjects reported to the lab on 3 separate occasions, with 

no less than 48 hours of rest in between each visit. On the first visit, subjects ran on 

a treadmill to determine their max heart rate. This was done by increasing the speed 

until volitional exhaustion; the final speed and heart rate are considered maximums. 

They returned to the lab two additional times and ran at 70% of their max heart rate, 

determined during the first visit, for 15 minutes. Immediately after the 15 minutes 

concluded, the treadmill speed was increased to the final speed at which exhaustion 

was reached during trial one. This pace was maintained until volitional exhaustion. On 

one occasion subjects were given water with caffeine (5mg/kg) and on the other water 

without caffeine 45 min prior to each run. Rate Perceived Exertion (RPE) was recorded 

every 5 minutes and after the exhaustive bout. Blood lactate was sampled immediately 





following each test, and every minute for three minutes thereafter. Heart rate was 

monitored throughout all tests. 

rEsuLTs: A repeated measures ANOVA was conducted to determine if time until 

exhaustion increased due to the consumption of caffeine before exercise. No significant 

difference in the time to exhaustion was observed when compared to the placebo 

(caffeine time = 208.0±77.1 seconds, placebo time = 154.9±44.1 seconds). 

CONCLusION: These results suggest that caffeine does not have an effect on time to 

exhaustion following submaximal running. 

Key Words: caffeine, time to exhaustion. 

1106 Board #51 May 30, 8:00 AM - 9:30 AM 

The Influence of Caffeine on Power Output and response 

Time 

Erika Rauk, David Connor, Allison Brumet, Eric Strubeck, 

Karen M. Brown, John G. Seifert. Montana State University, 

Bozeman, MT. 


Athletes consume caffeine supplements (CAF) in hopes of improving endurance 

performance, strength performance, and a reducing RPE. Caffeine is typically dosed 

on a per kg BW basis before or during exercise in a research setting and usually in a 

fasted state. It is likely that in a real world scenario caffeinated products are typically 

ingested by competitive and recreational athletes per given serving size or volume, 

regardless of BW. Caffeine is known to be a central nervous system stimulant. It is not 

known, however, if CAF would affect a marker of central fatigue following endurance 

exercise. 

PurPOsE: To compare auditory response time (RT), HR, RPE, metabolic, and power 

output (PO) responses between the ingestion of a commercially available CAF product 

and a flavored, non-caloric placebo (PL) during endurance cycling. 

METhOds: Fourteen subjects completed a 120 min work bout which was divided 

into 8x15 min intervals (13 min at 70% VO2max, 2 min at 90% VO2max), and ended 

with a 6 min PO performance task. Caffeine was ingested at a dose of 256 mg caffeine/ 

hr; 200 mL/hr of plain water was co-ingested with CAF and PL. Blood glucose, HR, 

RPE, RER, and RT were measured throughout the 120 min exercise. The PO task 

required subjects to cycle at their highest sustainable power output for 6 min. Cycling 

resistance was set at 5% BW. The CAF and PL treatments were administered in a 

double blind, randomly assigned protocol. All subjects exercised at 3 hrs post prandial. 

Data are listed as mean (+ SD). 

rEsuLTs: No statistical differences between treatments were observed for mean PO 

(p=.08, CAF: 290 +57, PL: 282 +63 W), RT (p=.06, CAF: 0.232 +.06, PL: 0.226 +.04 

sec), HR (CAF: 143.1 + 15.6, PL: 141.0 + 14.5 bpm), RPE (CAF: 13.5 + 1.2, PL: 13.8 

+ 1.9), and RER (CAF: .87 +.04, PL: .86 +.04), and BG (CAF: 4.9 +.6, PL: 4.7 +.8 

mM/L). 

CONCLusION: Ingestion of a moderate dose of CAF (~6.8 mg/kg BW) did not result 

in significant improvements in RT and PO when evaluated against a non-caloric PL. 

Additionally, CAF ingestion did not change substrate utilization, as measured by BG and 

RER, during exercise. These results indicate that the CAF formula used in this study has 

minimal influence on physiological function and performance under the given conditions. 

This study was supported by a grant from PacificHealth Laboratories, Inc. 

1107 Board #52 May 30, 8:00 AM - 9:30 AM 

The Influence Of Carbohydrate, Protein, and Caffeine On 

Power Output and response Time 

David A. Connor, Eric Strubeck, Karen M. Brown, John G. 

Seifert. Montana State University, Bozeman, MT. 


Caffeine has been reported to confer numerous benefits such as improved endurance 

and high intensity performances, reaction time and fat metabolism, and reduced RPE. 

The ingestion of CHO generally leads to improved endurance and high intensity 

performances while markers of central fatigue are mitigated with the feeding. There 

has been interest if combining CHO and caffeine would have a synergistic effect 

on response time and performance as the CHO would aid in physical performance 

while the caffeine would potentially improve markers of central fatigue. Purpose. To 

compare auditory response time (RT), power output (PO), and metabolic responses 

between a commercially available CHO + PRO + caffeine sports gel (GEL) and a 

caffeine supplement (CAF) during endurance cycling. Methods. 14 cyclists completed 

two cycling trials by ingesting GEL (22.5g CHO/hr, 3.75g PRO/hr, 188 mg caffeine/ 

hr) or CAF (256 mg caffeine/hr) along with 200 mL/hr of water during the 2 hr 

exercise. Auditory RT was assessed by averaging stop switch times from10 beeps. 

Exercise was divided into 8x15 min intervals of 13 min at 70% VO2max and 2 min 

at 90% VO2max. Blood glucose (BG), RT, HR, RPE, and RER were also collected 

during the test. After the 2 hr ride, riders completed a 6 min cycling test where they 

attempted maintain as great of PO as possible at a resistance of 5% BW. Significance 

was set at p < 0.05. All data are listed as mean (+SD). Results. The GEL resulted in 

statistically greater mean PO (309.1 +/- 60 W vs. 290.2 +/- 57 W); RT (0.219 +/- .049 

sec vs. 0.232 +/- .060 sec); BG (5.5 +/- 0.8 mM/L vs. 4.9 +/- 0.7 mM/L), and lower 

HR (138.5 +/- 16.0 bpm vs. 143.1 +/- 15.6 bpm) and RPE (13.0 +/- 1.7 vs. 13.5 +/- 

1.2) than the CAF treatment. Conclusions. Co-ingestion of CHO, PRO and caffeine 


significantly improved RT and PO (by 5.7% and by 6.5%, respectively) compared to 

CAF even though the caffeine dose was 27% lower with GEL than CAF. The present 

study mimicked real life conditions by having subjects fed prior to exercise, providing 

doses that represented what may occur in a ‘real world’ setting, and by measuring 

performance by a muscular PO test and a measure that may be indicative of central 

fatigue. These results demonstrate the synergistic effects of CHO, PRO, and caffeine 

and the performance benefits to athletes. Supported by a grant from PacificHealth 

Laboratories, Inc. 

1108 Board #53 May 30, 8:00 AM - 9:30 AM 

role of Caffeine Intake on short Bouts Frequency in Light 

and Moderate-to-Vigorous Physical activity Patterns 

Pedro B. Júdice, Catarina N. Matias, Diana A. Santos, João 

P. Magalhães, Luís B. Sardinha, Analiza M. Silva. Technical 

University of Lisbon, Lisbon, Portugal. 


Shifting sedentary behavior (SedB) to light intensity physical activity (LPA) by 

introducing short bouts (SB) into daily routine is expected to contribute to higher 

PA energy expenditure (PAEE). If caffeine (Caf) intake plays a role in increasing the 

frequency of SB during free-living conditions is unknown. Purposes: The aim of this 

study was twofold: i) to determine the impact of a moderate dose of Caf on daily 

number of SB of at least 1 up to 5 min of either LPA or moderate-to-vigorous PA 

(MVPA) and PAEE; ii) to analyze the association between SB and PAEE under both 

conditions. 

METhOds: Using a double-blind crossover trial (ClinicalTrials. 

govID;NCT01477294) with two conditions (4-day each with 3-day washout) randomly 

ordered as Caf (5mg/kg/day) and placebo (Plc) (malt-dextrin) administered twice a 

day (2.5mg/kg), a total of 21 active males, low caffeine users (


CONCLusION: Caffeine enhanced triathlon performance, but the effect was not 

as pronounced as seen in previous laboratory trials. Caffeine supplementation taken 

45-60 minutes before an Olympic-distance triathlon exerted the greatest effect on 

performance in the swimming section of the triathlon, as well as on the overall time to 

complete the triathlon, in the whole subject group. 

1110 Board #55 May 30, 8:00 AM - 9:30 AM 

high but not Low Caffeine Ingestion augments Fluid and 

Electrolyte Excretion at rest 

Stavros A. Kavouras, FACSM1 , Costas N. Bardis2 , Petros 

Grigorakis2 , Georgia Georgiou2 , Anna Gavrieli2 , Mary 

Yannakoulia2 . 1University of Arkansas, Human Performance 

Lab, Fayetteville, AR. 2Harokopio University, Athens, Greece. 

Supported by s.a. Kavouras: Consulting Fee; Gatorade Sports Science 

Insitute. 

It is documented that at rest, large doses of caffeine have diuretic effect and in turn 

may lead to hypohydration. However, the acute effect of smaller caffeine doses on 

urine excretion is less clear. 

PurPOsE: The aim of the present investigation was to examine the acute effect of 

coffee with low (3 mg/kg; L-CAF) or high (6 mg/kg ; H-CAF) caffeine content on fluid 

and electrolyte urinary excretion in habitual coffee drinkers at rest. 

METhOds: Twenty-five healthy adult males (age: 28±5 y, body mass index: 28±5, 

mass: 84.6±7.7 kg, height: 1.79±0.01 m) consumed 200 ml of water (W) or coffee 

with 3 mg/kg caffeine (L-CAF) on two separate occasions. Nine of the 25 subjects 

participated in a third trial when consumed coffee high in caffeine (H-CAF). Subjects 

remained in the laboratory while urine samples were collected every 60 min for three 

hours. Mean caffeine consumption for L-CAF and H-CAF trials was 254 mg and 552 

mg, respectively. The subjects were habitual coffee drinkers (2-3 cups per day) who 

abstained from foods and drinks containing caffeine or other methylxanthines 24 h 

before each study. All sessions were performed at 0900 in a counterbalance, crossover 

manner, at least 5 days apart. 

rEsuLTs: Cumulative urine volume during the 3h period was significantly elevated 

only in the higher caffeine trial (W: 292±165 ml, L-CAF: 316±194 ml, and H-CAF: 

630±391 ml; P



methods reached significant levels. 4 correlation tests reached level at 0.01 (M-mode 

Teichholz and 3D-STE (r=.754, p=0.000), M-mode Teichholz and 3D-AT (r=.-834, 

p=0.000), 2D Simpson and 3D-STE (r=.610, p=0.007), 3D-STE and 3D-AT (r=.-893, 

p=0.000). 2 other correlation tests reached level at 0.05 (M-mode Teichholz and 2D 

Simpson (r=.555, p=0.017), 2D Simpson and 3D-AT (r= -.473, p=0.480). 

CONCLusION: The differences of correlation levels might be due to several reasons 

such as dimensional differences, regional vs. global evaluation, resolution quality 

of images and individual differences of cardiac conditions. 3D Wall Motion Area 

Tracking can be an alternative for the evaluation of LV-EF. However, further studies 

with comparison to MRI are needed to evaluate a superiority over one- and twodimensional 

parameters. 

1114 Board #59 May 30, 8:00 AM - 9:30 AM 

Is The Vasis Classification suitable For Bradycardic 

Endurance athletes? 

Frédéric Schnell 1 , David Matelot 1 , Nima Endjah 2 , Gaelle 

Kervio 3 , Nathalie Thillaye du Boullay 3 , François Carré 1 . 1 LTSI 

INSERM U1099, Rennes, France. 2 University Hospital of Rennes 

- Hospital Pontchaillou, Rennes, France. 3 CIC-IT INSERM 

U804, Rennes, France. 


Currently, VASIS II (cardioinhibitory) syncope during tilt test is objectivated by a 

Heart Rate (HR)10 sec. However, such classification may be unadapted 

to bradycardic athletes. Indeed, HR during tilt test can differ a lot between subjects, 

depending on their resting HR and their individual HR responses to the test. Moreover, 

tilt test is usually stopped when subjects experience syncope, or intolerable presyncope 

associated with significant arterial hypotension. In this latter case, HR does 

not reach its lower value when the test is stopped. 

PurPOsE. The aim of this study was to assess if the VASIS classification is adapted 

for bradycardic endurance athletes. 

METhOd. 39 healthy endurance trained non-smoker men (18-35 years old), with 

various resting HR, experienced an 80° tilt test for 45 min, without provocative drugs, 

and with beat-to-beat hemodynamic parameters recording (Task Force Monitor). 

Tilt test results were blindly and independently classified by 3 investigators used 

to this test, according to the current VASIS classification, and were then discussed. 

rEsuLTs. Mean resting HR was 58.4±9.5 bpm, ranging from 40.3 to 76.8. Mean 

HR in the first 5 min of the tilt test was 75.3±12.1 bpm, ranging from 54.5 to 103.4. 

Few results raise some questions, as illustrated by the 2 following cases. A bradycardic 

athlete exhibited a drop of 0.5 bpm/sec (from 64 to 39 bpm in 50 sec), leading to 

a VASIS II classification. Inversely, a non bradycardic athlete exhibited a drop of 

6.6 bpm/sec (from 88 to 55 bpm in 5 sec). However, HR remained >40 bpm as the 

test was early stopped to avoid complications, so this case was classified VASIS I. 

CONCLusION. Current criteria proposed to differenciate VASIS I from VASIS II 

could lead to VASIS II false positive diagnostic in bradycardic athletes, and VASIS 

II false negative diagnostic in subjects with a high HR during the tilt test. Regarding 

our results, the question of a new criteria based on the severity and the velocity of the 

HR drop, and not only on the 40 bpm absolute value may be suggested. This criteria 

seems particularly relevant for endurance athletes who are both bradycardic and prone 

to syncope. 

1115 Board #60 May 30, 8:00 AM - 9:30 AM 

Borderline Long QT and QT Interval Prolonging 

Medications in adolescent athletes 

Christopher Hoyte 1 , Elizabeth Terhune 2 , Anthony McCanta 2 , 

Rachel A. Coel 2 . 1 University of Colorado School of Medicine, 

Aurora, CO. 2 Children’s Hospital Colorado, Aurora, CO. 

(Sponsor: John Hill, DO, FACSM) 


PurPOsE: To determine whether adolescent athletes taking QT prolonging 

medications are more likely to display a borderline long or long QT interval. 

METhOds: Preparticipation exams consisting of physical exam, 12 Lead ECG, and 

health history including current prescription and over-the-counter medications were 

performed on 484 adolescents. ECGs with heart rate < 60 or > 100 were interpreted 

by a pediatric cardiologist using Bazett’s correction formula. Borderline long QT was 

defined as QTc of 450-500 ms in males and 460-500 ms in females. Long QT was 

defined as QTc > 500 ms. QT prolonging medications were identified from the Arizona 

Center for Education and Research on Therapeutics list. Males and females were 

analyzed separately using Fisher’s exact tests and multiple linear regression analysis. 

rEsuLTs: Zero athletes exhibited a QTc > 500 ms. Borderline long QT was seen in 

2.99% [95% CI: 0.98-6.85%] of females and 8.60% [95% CI: 5.74-12.26%] of males. 

Median QTc length was 425 ms [range: 373-478] for females and 421msec [range: 

358-487] for males. In both the female and male cohorts, there was no difference 

[p>0.999] in the proportion of subjects with borderline long QTc among subjects 

taking the QT prolonging medications compared to those subjects not taking the 

medications (Table 1). After controlling for gender, age and their interaction, there 

was no difference in QTc interval among subjects taking the medications compared to 


those not taking the medications [mean difference -0.72 ms, 95% CI: -5.92 to 4.35 ms, 

p=0.8318]. 

CONCLusION: QT prolonging medications were not significantly associated with 

the presence of borderline/long QT interval. Further research is needed to evaluate the 

effects and risks of these drugs during exercise. 

1116 Board #61 May 30, 8:00 AM - 9:30 AM 

Echocardiographic Characteristics of Freshmen NCaa 

division I Football athletes 

Dustin P. Joubert 1 , Steven E. Martin 1 , Thomas H. Meade 2 , 

Freddy Cruz 2 , John P. Erwin 3 , Stephanie White 3 , David Weir 1 , 

JP Bramhall 1 , Kory Gill 4 , Karl Kapchinski 1 , Stephen F. Crouse, 

FACSM 1 . 1 Texas A&M University, College Station, TX. 2 Scott & 

White Clinic, College Station, TX. 3 Scott & White Clinic, Temple, 

TX. 4 Texas A&M Health Science Center, College Station, TX. 


In the general population, increased left ventricular mass and left atrial size are 

cardiovascular risk factors. Some data exist describing abnormal cardiac structure in 

professional American football players after retirement. Less is known about earlier in 

their careers. 

PurPOsE: To determine echocardiographic characteristics of freshmen collegiate 

football athletes relative to reference standards. 

METhOds: Prior to their competitive season, standard echocardiogram procedures 

were performed on freshmen, Division I collegiate football athletes (n = 35, age = 18 

± 1 yr, height = 185.9 ± 7.0 cm, weight = 100.0 ± 20.4 kg, body composition = 15.1 ± 

8.9 % fat, VO2max = 49.7 ± 7.1 ml·kg-1·min-1). The following cardiac measures were 

compared to reference ranges for both absolute values and relative to body surface area 

(BSA, m2) to determine the percentage of athletes exceeding normal: Left ventricle 

(LV) internal diameter diastolic (LVIDd), left atrial diameter (LAD), LV end diastolic 

volume (LVEDV), LV end systolic volume (LVESV), interventricular septum (IVS) 

thickness, LV posterior wall (LVPW) thickness, LV mass (LVM), and ejection fraction 

(EF). 

rEsuLTs: 

Variable Athlete (n = 35) Reference Range % Above Range 

LVIDd cm 5.4 ± 0.4 4.2-5.9 8.6 

cm·m-2 2.4 ± 0.2 2.2-3.1 0 

LAD cm 4.2 ± 0.4 3-4 70.6 

cm·m-2 1.9 ± 0.2 1.5-2.3 0 

LVEDV ml 144.6 ± 25.8 67-155 34.3 

ml·m-2 64.3 ± 10.0 35-75 8.6 

LVESV ml 56.7 ± 13.1 22-58 48.6 

ml·m-2 25.3 ± 5.6 12-30 20.0 

IVS cm 1.0 ± 0.1 0.6-1.0 37.1 

cm·m-2 0.4 ± 0.1 

LVPW cm 1.0 ± 0.1 0.6-1.0 37.1 

cm·m-2 0.5 ± 0 

LVM g 213.8 ± 42.4 88-224 40.0 

g·m-2 96.6 ± 20.2 49-115 11.4 

EF % 60.8 ± 5.9 >55 11.4* 

Values represent mean ± SD. 

* represents % below reference range 

CONCLusION: Greater than 30% of the athletes exceeded reference ranges for 

LAD, LVEDV, LVESV, IVS, LVPW, and LVM. However when expressed relative to BSA, 

only LVM and LVESV were over range in more than 10% of the athletes. These 

observations are similar to those found previously in collegiate football players 

entering the NFL. It appears that cardiac structure in collegiate football athletes is 

not abnormal when indexed by body size. 

Supported in part by Huffines Institute of Sports Medicine and Human Performance 



1117 Board #62 May 30, 8:00 AM - 9:30 AM 

a Comparison of Topical analgesic Gels on Blood Flow and 

Vascular responses to Exercise 

Paula Papanek, FACSM, Alyson N. Cybulski, Katalin W. 

Skelton, Alexander V. Ng, FACSM, Robert Topp. Marquette 

University, Milwaukee, WI. 

Supported by P. Papanek: Contracted Research - Including Principle 

Investigator; Performance Health. 

It has been previously demonstrated that a common over the counter topical analgesic 

gel containing 3.5% menthol significantly reduced arterial blood flow similar to ice 

therapy even following acute muscular contraction. The formulary of this gel (OF) has 

been recently changed (NF) and evidence to support its useis lacking. 

PurPOsE: To compare vascular responses following an application of OF, or NF and 

acute muscle contraction. 

METhOds: Healthy adults (9 males and 9 females) mean age of 22.44 (SD + 1.95) 

with a mean BMI of 23.97 (SD+ 3.88) were recruited. Two data collection sessions, 

were separated by at least 5 d. OF and NF application (5 ml applied to Right upper 

arm) were randomized. Heart Rate (HR), right brachial artery blood flow (ml/min) and 

right brachial artery diameter were measured by Ultrasound Doppler (General Electric 

3). Measurements were collected at baseline (T1) and 5 minutes after application of 

treatment (T2). After T2, 5 maximal right-hand grip contractions were performed using 

a handgrip dynamometer (Lafayette Instrument) with measurements made immediately 

following exercise (T3), 2 min post-exercise (T4) and 4 min post exercise (T5). 

rEsuLTs: Comparisons over time and between the treatment conditions were 

conducted. When comparing T1 with T2 there were no changes in heart rate or vessel 

diameter under either treatment condition. Between T1 and T2 only NF exhibited a 

significant decline in blood flow (-22.6%) which was not different than declines in 

flow under OF (-21.8%). Flow and vessel diameter significantly increased with the 

OF (492% and 3.4% respectively) between T2 and T3 as a result of the exercise but 

not to a level greater than the nonsignificant increases in flow and diameter measured 

with NF (356% and 2.0% respectively). When comparing data collected at the three 

post exercise points (T3, T4, T5) no significant differences were detected in flow or 

diameter between either condition. 

CONCLusIONs: The OF and NF conditions resulted in similar changes in blood 

flow and vascular responses to exercise. These results suggest that the formulations 

act similarly, and are equally effective in modulating vascular responses in muscle and 

have equal therapeutic value. Supported by Performance Health, Akron Ohio 

1118 Board #63 May 30, 8:00 AM - 9:30 AM 

Metabolic syndrome in NCaa division I College Football 

Players: a Pilot study 

Joi J. Thomas, Enette Larson-Meyer, FACSM. University of 

Wyoming, Laramie, WY. 


Football has recently come under fire as health risks associated with the sport are 

increasingly highlighted by the media and addressed in medical journals. These 

risks include the risk of cardiovascular disease. Offensive and defensive linemen 

are significantly larger than athletes playing the same position over 20 years ago. 

With this increased mass comes the concern of increased cardiovascular disease risk. 

PurPOsE: The purpose of this study was to evaluate a small cohort (n=17) of NCAA 

division I football players for the presence of metabolic syndrome using the National 

Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATP III) criteria. 

METhOds: 17 football players on the current roster of a NCAA division I university 

including 13 linemen were evaluated for height, weight, 

waist circumference, neck circumference, and blood pressure. Fasting, venous 

samples of blood were drawn and analyzed for triglycerides, total cholesterol, highdensity 

lipoprotein, low-density lipoprotein, glucose, insulin, C-reactive protein, 

and leptin. Metabolic syndrome was defined as having at least three of the following 

manifestations: waist circumference > 102 cm in men, serum triglycerides > 150 mg/ 

dl, high-density lipoprotein < 40 mg/dl in men, blood pressure > 130/85 mm/Hg, and 

serum glucose > 110mg/dl. Body composition was also assessed via Dual Energy Xray 

absorptiometry within several weeks of testing. Permission was obtained to access the 

participants’ medical history which included familial history of heart disease. 

rEsuLTs: Six of the thirteen linemen (46.15%) met the criteria for metabolic 

syndrome (at least 3 of 5 criteria). Of the four 

non-linemen one met the criteria for metabolic syndrome. Eleven of the thirteen 

linemen evaluated had a waist circumference greater than 102 cm (84.62%). Nine of 

the thirteen linemen and one of the four non-linemen had high-density lipoprotein less 

than 40 mg/dl. 

CONCLusIONs: We found a high incidence of metabolic syndrome 

in this cohort. Although athletes are often assumed to be protected from the risks 

of cardiovascular disease, this may be sport and position dependent. Awareness 

education should be encouraged for athletes, coaches, and athletic trainers. Screening 

and intervention programs may also help decrease the cardiovascular risk in this 

population. 


1119 Board #64 May 30, 8:00 AM - 9:30 AM 

sudden death In young Competitive athletes: analysis Of 

deaths In The united states, 2008-2011 

Russell T. Baker1 , Jeff Seegmiller2 , Mike Chisar3 , Stephanie 

Perez1 . 1California Baptist University, Riverside, CA. 2University of Idaho, Moscow, ID. 3Diablo Valley College, Pleasant Hill, 

CA. (Sponsor: Lee E. Brown, FACSM) 


Sudden death in young competitive athletes has recently garnered increased media 

attention and intensified efforts for athlete safety legislation. The frequency with which 

these catastrophes occur is largely unknown. 

PurPOsE: To develop incidence data of sudden death in young competitive athletes. 

METhOds: Cases of sudden athlete death (SAD) were documented through news 

media reports identified using internet search engines (Google, Yahoo, Ask, and Bing) 

and Foundation websites (Parent Heart Watch, Sudden Cardiac Arrest Association, 

and Hypertrophic Cardiomyopathy Association). Cases included athletes (Elementary 

School through College) participating in athletic practices, competitions, events, or 

physical education classes in the United States. Cases of SAD were verified using two 

different media reports. To be included, the case had to involve a school aged athlete 

participating in traditional athletic events without evidence of recreational drug use. 

Causes of death were only included when autopsy results were cited. 

rEsuLTs: From 2008 through 2011, 372 SAD’s were identified (mean age of 16.15). 

Of these, 159 (42.7%) were explained by sudden cardiac arrest, 32 (8.6%) by traumatic 

brain injury, and 16 (4.3%) by heat illness. Autopsy results indicating an inconclusive 

cause of death were reported in 18 (4.8%) cases. A cause of death could not be 

confirmed in two media sources in 117 (31.4%) of the cases. The most common sports 

involved were football (103 cases, 27.7%), basketball (102 cases, 27.4%), and track/ 

cross-country (42 cases, 11.3%). Collapse commonly occurred during or immediately 

after an academic institution sponsored practice, formal athletic contest, or physical 

education course (227 cases, 61%). Collapse also occurred while athletes participated 

in recreational (youth league, intramural sport, health club, or sport camp) activities 

(108 cases, 29%) or during the evening following participation in an athletic event (37 

cases, 10%). 

CONCLusIONs: The incidence of SAD was higher than previous reports examining 

a similar population. These data support the need for mandatory reporting of SAD’s to 

a national registry and highlight the importance of increased awareness to reduce the 

risk. 

1120 Board #65 May 30, 8:00 AM - 9:30 AM 

Effect Of Whole-Body Vibration On Peripheral Blood Flow 

and Muscle Oxygenation: a Meta-analysis 

Kenneth E. Games, JoEllen M. Sefton. Auburn University, 

Auburn, AL. 


Whole-body vibration (WBV) is being used as a therapeutic and fitness modality. 

Two reported effects of WBV are increased peripheral blood flow and altered muscle 

oxygenation. The literature in this area is conflicting possibly due to the varied WBV 

parameters utilized by studies. 

PurPOsE: To quantitatively examine the literature investigating the effect of WBV 

on peripheral blood flow and muscle oxygenation. 

METhOds: PubMed and Web of Science electronic databases were searched 

utilizing multiple keywords. The reference lists of retrieved articles were also searched 

for relevant articles. Thirty-five data points from five studies met the inclusion criteria 

for muscle oxygenation; ninety data points from eight studies met the inclusion criteria 

for peripheral blood. Two weighted, random effects meta-analyses were completed. 

Hedges’ g and 95% confidence intervals (CI) for each analysis were calculated. A 

follow-up analysis on vibration type’s (vertical vs. side-alternating) influence on 

peripheral blood flow was also completed. 

rEsuLTs: Results suggest WBV increases peripheral blood flow above control 

measures [g = 1.179; 95% CI (0.945 - 1.416)], while WBV does not alter muscle 

oxygenation levels from control measures [g = -0.005; 95% CI (-0.272 - 0.261)]. Sidealternating 

vibration appears to increase peripheral blood flow above control measures 

[g = 1.906; 95% CI (1.628 - 2.184)] while vertical vibration does not appear to have an 

effect on peripheral blood flow [g = 0.182; 95% CI (-0.067 - 0.431)]. 

CONCLusIONs: WBV may be a viable modality to increase peripheral blood flow 

in healthy adults. Vibration type appears to be a key parameter in determining WBV’s 

effect on peripheral blood flow. Future research should examine the effect of vibration 

type on the reported benefits of WBV. 





1121 Board #66 May 30, 8:00 AM - 9:30 AM 

Prevalence Of respiratory symptoms among Judo athletes 

Compared With swimmers 

Tomoko Imai, Shumpei Miyakawa, Koichi Watanabe. University 

of Tsukuba, Tsukuba, Japan. 


Prevalence of exercised-induced bronchospasm (EIB) among Olympic athletes has 

been reported to be as much as five times greater than that of the general population. 

Judo is one of the Olympic events and played all over the ages, involving throw and 

ground techniques on the mat. Therefore, Judo athletes may inhale or contact with 

more allergens rising from the mat, whereas the prevalence of respiratory symptoms 

among judo athletes has not been examined. 

PurPOsE: The purpose of this study is to examine the prevalence of respiratory 

symptoms among judo athletes and to compare with those of swimmers. 

METhOds: 46 collegiate judo athletes participated in this study.The history of 

respiratory symptoms, pulmonary functions including forced expiratory volume in 

1 second as percent of FVC (FEV %(G)) by spirometer and fraction of exhaled 

1.0 

nitric oxide (FeNO) by a portable NINOX MINO were obtained. Additionally, the 

respiratory resistance at 5Hz (R5), frequency of resonance (Fres), and low-frequency 

reactance area (ALX) were measured by using forced oscillation technique. These 

data were compared with the data obtained from the 22 collegiate swimmers. 

rEsuLTs: Average age of judo athletes was 19.9±1.4yr and that of the swimmers 

was 20.5±1.2yr. Weight and BMI of judo athletes were significantly higher than those 

of swimmers. As to the history, 32.6% of judo athletes experienced asthma and 58.7% 

had allergies, while 22.7% swimmers had asthma and 54.5% with allergy. 32.6% of 

judo athletes and 31.8% of swimmers revealed FeNO values over 25ppb which was the 

normal limit. 19.6% of the judo athletes and 27.3% of the swimmers were below 80% 

of FEV %(G). Respiratory resistance such as Fres and ALX were significantly higher 

1.0 

in judo athletes than swimmers, which was significantly correlated with their weight 

and BMI. 

CONCLusIONs: The judo athletes also had relatively high prevalence of respiratory 

symptoms like swimmers. 

1122 Board #67 May 30, 8:00 AM - 9:30 AM 

relationship Between the Control of Blood Flow and the 

Female athlete Triad 

Julee A. Campbell, Anne L. Friedlander, Robert R. Roe, John E. 

Davis. Alma College, Alma, MI. 


The female athlete triad has been well documented to produce clinical conditions 

including disordered eating, functional hypothalamic amenorrhea, and osteoporosis. 

Furthermore, it has been previously reported that estrogen augments cardiac output and 

arterial flow velocity and decreases vascular resistance in animal testing. However, to 

our knowledge no studies have shown a relationship between triad components and the 

control of blood flow. 

PurPOsE: To determine the prevalence of the female athlete triad components in 

collegiate athletes and relate it to the control of blood flow. 

METhOds: Twenty-seven athletes (four swimmers, two divers, three bowlers, five 

basketball players, eleven runners, and two track and field athletes) and thirty-four 

non-athletes participated in this study after giving informed consent. The Eating 

Disorder Examination Questionnaire (EDE-Q) was administered to all participants 

to determine prevalence of the triad components. A Global Eating Disturbance Score 

(GEDS) was then calculated. Venous occlusion plethysmography was used to measure 

forearm blood flow. Reactive hyperemia was assessed by occluding the forearm to 

250 mmHg for 5 minutes and measuring forearm blood flow post-occlusion. The 

hyperemic response was then determined by calculating the area under the curve for 

the subsequent measurements of forearm blood flow. 

rEsuLTs: Athletes had a greater reactive hyperemic response than non-athletes (77.5 

± 6.1 mL/min.sec vs. 60.4 ± 3.0 mL/min.sec). In those with eating disturbances, the 

reactive hyperemic response was lower than those with normal eating behavior (48.7 

± 5.7 mL/min.sec vs. 77.0 ± 2.0 mL/min.sec (p < 0.05)). There was a significantly 

greater GEDS in those subjects reporting stress fractures (p< 0.05). 

CONCLusION: These data suggest that athletes with eating disturbances have a 

reduced reactive hyperemic response. This could be due to a reduction in estrogen 

that has been previously reported in female athletes with triad symptoms. There was a 

relationship between stress fractures and eating disturbances. This supports previous 

claims that eating disturbances can lead to low bone mineral density. 


1123 Board #68 May 30, 8:00 AM - 9:30 AM 

arterial Baroreflex Control Of Muscle sympathetic Nerve 

activity Following Mixed Meal Ingestion: Influence Of 

Endurance Training 

Seth W. Holwerda, Daniel P. Credeur, Paul J. Fadel. University 

of Missouri, Columbia, MO. 


Recent studies have reported that physiological elevations in plasma insulin, such as 

following meal ingestion, increase sympathetic baroreflex sensitivity. Insulin resistance 

has been linked to decreases in baroreflex sensitivity, which has been attributed 

to a blunted transport of insulin into the brain. What remains unclear is whether 

improvements in insulin sensitivity, such as that which occurs with endurance training, 

enhance the acute effects of insulin to increase arterial baroreflex sensitivity. 

PurPOsE: To determine whether improvements in insulin sensitivity following 

chronic endurance training enhances the acute effect of insulin to increase sympathetic 

baroreflex sensitivity. 

METhOds: Muscle sympathetic nerve activity (MSNA; microneurography), arterial 

blood pressure (finger photoplethysmography), plasma insulin and glucose levels were 

obtained in 5 high fit (HF; VO2 66±2 ml/kg/min) and 6 average fit (AF; VO2 45±1 ml/ 

kg/min) subjects before, and every 30 min after mixed meal ingestion (57% CHO, 28% 

Fat, 15% Protein). Sympathetic baroreflex sensitivity was assessed by determining the 

relationship between spontaneously occurring fluctuations in diastolic blood pressure 

and MSNA burst incidence. 

rEsuLTs: Plasma insulin was significantly elevated following mixed meal intake, 

and as expected, responses were greater in AF than HF (e.g., 60 min: 38±6 AF vs 

25±2 HF uIU/ml; P0.05). Following mixed meal 

intake sympathetic baroreflex sensitivity was similarly increased in both groups at 60 

(-4.2±0.5 AF vs -4.7±0.8 HF burst/100heart beats/mmHg; P>0.05) and 120 minutes 

(-5.7±0.9 AF vs -4.4±0.7 HF burst/100heart beats/mmHg; P>0.05). 

CONCLusION: These preliminary results suggest that increases in sympathetic 

baroreflex sensitivity following meal intake are similar between AF and HF subjects. 

However, the significantly lower increase in plasma insulin in the HF subjects suggests 

enhanced sympathetic baroreflex reactivity to insulin with chronic endurance exercise 

training. 

1124 Board #69 May 30, 8:00 AM - 9:30 AM 

Exercise related syncope In active duty soldiers 

Chad Asplund, FACSM. Eisenhower Army Medical Center, Fort 

Gordon, GA. 


PurPOsE: To better characterize the prevalence of exercise related syncope (ERS) in 

an active duty military population as well as examine possible factors associated with 

ERS. 

METhOds aNd sTudy dEsIGN: Cohort study design. The Armed Forces Health 

Longitudinal Technical Application (AHLTA) electronic health record was queried 

for all cases of syncope (780.2) seen at Eisenhower Army Medical Center in primary 

care clinics from 2005-2010 and charts were reviewed. Those with syncope related 

to exercise had charts followed prospectively until completion of specialty evaluation 

and diagnosis. Main outcome measure was a medical diagnosis requiring restriction 

from duty or from participation in sports. Demographic data analyzed with descriptive 

statistics and main outcome measure with multiple logistic regression. 

rEsuLTs: 123 total cases of syncope and 58 cases of ERS were reviewed. 40 

cases had witnessed collapse, 16 cases were found to have a medical etiology (6 

neurological, 3 pulmonary, 3 cardiac, 2 migraine, 2 heat related), 24 had unexplained 

etiology. Average age was 25.67 +/- 5.92 (range 18-39) years. After controlling for age, 

past medical history, history of collapse, and smoking, those Soldiers with a history of 

migraine headaches were 11.3 times more likely to have a medical etiology associated 

with their exercise related syncope compared to those without migraine (p


C-28 Free Communication/Poster - Energy 

Expenditure 

May 30, 2013, 7:30 AM - 12:30 PM 

Room: Hall C 

1125 Board #70 May 30, 9:00 AM - 10:30 AM 

associations of Macronutrient Profiles, Energy Expenditure 

and Body Composition with resting Metabolic rate 

John C. Sieverdes1 , Robin P. Shook2 , Amanda E. Paluch2 , 

Gregory A. Hand2 , Thomas G. Hurley2 , Vivek Prasad2 , Jason 

R. Jaggers2 , E. Patrick Crowley2 , Steven N. Blair, FACSM2 . 

1Medical University of South Carolina, Charleston, SC. 

2University of South Carolina, Columbia, SC. 


Various models have been used to explain the relationship of resting metabolic rate 

(RMR) with age, body weight, gender, and height. Recent scientific advancements 

have allowed more accurate measures to assess body composition, energy expenditure 

(EE), and dietary intake. 

PurPOsE: This study examines the relationship between RMR, dietary intake, EE, 

and body composition. 

METhOds: Participants completed a maximal treadmill exercise test to measure 

oxygen consumption (VO ) and a fasted 50-minute ventilated hood resting RMR using 

2 

a Parvo Medics TruOne® system on separate days. RMR was measured in a dark quiet 

room in the supine position while awake. Average oxygen consumption was measured 

over a 10-minute period after values stabilized. Body composition was measured using 

DXA scans during the RMR visit. Dietary intake was assessed by three random 24-hr 

dietary recalls during the 10 days following the RMR. Total EE was measured using 

the Bodymedia® armband during the same 10-day period. 

rEsuLTs: We analyzed data from 430 participants (212 men, 218 women). Mean 

(+/- standard deviation) age was 27.7 +/- 3.8 years (range 20 - 35) and BMI was 25.4 

+/- 3.8 kg/m2. Body fat measured 28.0% +/- 10.8% and RMR was 0.221 +/- 0.038 

L/min or 2.96 +/- 0.35 ml/kg/min. Peak VO2 resulted in a mean of 38.7 +/- 10.4 ml/ 

kg/min and macronutrient breakdown consisted of 32.8% +/- 7.5% calories from fat, 

47.1% +/- 10.0% from carbohydrates, and 17.2% +/- 5.0% from protein. Pearson 

correlations for each macronutrient in relation to RMR (L/min) resulted in correlations 

-0.31 < r < 0.21 when depicted as percentages of daily caloric intake. VO2 was found 

to be r = 0.39. Correlations r > 0.5 included mean waist circumference (r = 0.61). 

Overall EE (r = 0.79), lean body mass (r = 0.85), and overall weight (r = 0.77) had 

higher correlations with RMR than other variables. EE was correlated and showed 

moderate collinearity with lean body mass (r = 0.83, VIF = 5.4). Stepwise regression 

found lean body mass, overall weight, and VO2 to be significant predictors for RMR 

(adjusted r2 = 0.78, SE = 0.018). 

CONCLusION: Macronutrient proportions exhibited weaker correlations and 

predictive value for RMR than body composition or fitness variables. Results may aid 

in developing energy balance strategies or assessments. 

Supported by an unrestricted grant from the Coca-Cola Company 

1126 Board #71 May 30, 9:00 AM - 10:30 AM 

Validation of air displacement Plethysmography’s utility in 

Predicting resting Metabolic rate 

Brian Miller1 , Chris Faciana1 , Kelsey F. O’Driscoll1 , Laura 

McElrath2 , Stephanie Pence2 , Ronald W. Mendel2 , Ronald 

Otterstetter1 . 1University of Akron, Akron, OH. 2University of 

Mount Union, Alliance, OH. 


PurPOsE: Air displacement plethysmography (ADP) is a well validated method for 

estimating body composition. Similarly, predictive equations derived from regression 

techniques on large populations are extensively utilized in estimating resting metabolic 

rate (RMR). The ADP system utilizes a predictive equation to estimate RMR based 

on the Nelson 1992 model. However, the accuracy of the predictive model being 

used has come into question. The aim of this study is to validate the RMR estimation 

model used by the ADP system against an indirect calorimetry system in addition 

to other predictive RMR models and to derive a model based on the specific use of 

measurements from the ADP system. 

METhOds: Sixty six apparently healthy subjects (25 men, 41 women) participated 

in the trial. All subjects adhered to the following instructions: Fast 12 hrs prior to 

the test, no strenuous exercise, nicotine, or alcohol 24 hrs prior to the test, and tight 

fitting clothing during ADP trial. Each subject layed in a quiet room for 30 min during 

measurement of RMR via metabolic cart (CART). The first 15 min of RMR data was 

discarded and the average VO2 of the last 15 min was used as the subject’s RMR. 

Immediately after the CART RMR, subjects moved directly to the ADP and underwent 

testing following the manufacturers standardized protocol, and an estimated RMR was 


obtained. Measures from both ADP and CART were tested against nine other validated 

models using ANOVA techniques with post hoc testing. 

rEsuLTs: The Nelson 1992 model under-predicted RMR compared to CART 

(p



Oxygen consumption was greater in ARM and FWD compared to UR (25.59±3.91, 

24.98±3.81 vs. 23.51±3.90 ml/kg/min, P < 0.05), but ARM and FWD were not 

different from each other (P = 0.19). This similarity was in spite of the active use of 

additional arm musculature during ARM not present in FWD. Additional subjects will 

be collected to confirm these preliminary findings. 

CONCLusION: For this exercise modality, utilizing one’s arms or leaning forward 

while anchoring the upper body resulted in similar increases in heart rate and oxygen 

consumption relative to an unstabilized upright posture at the same machine settings. 

Supported by Cybex International Inc. 

1129 Board #74 May 30, 9:00 AM - 10:30 AM 

Cross-Validation of a recently Published Equation 

Predicting Energy Expenditure to run or Walk a Mile 

Cody E. Morris, Mark Loftin, FACSM, Scott Owens, Dwight 

Waddell, Martha Bass, John Bentley. The University of 

Mississippi, University, MS. 


PurPOsE: Establishing a caloric prediction equation based on distance walked or run 

rather than time is an important goal in attempting to more accurately estimate energy 

expenditure (EE). The primary purpose of this study was to cross-validate the recently 

published Loftin et al. (2010) prediction equation for walking or running a mile. 

METhOds: Participants consisted of 10 normal weight walkers (NWW), 10 

overweight walkers (OW), and 10 distance runners (DR). Gender was balanced across 

sub-groups. Participants walked or ran for 5 minutes at their preferred pace. Preferred 

walking pace was determined by six timed 50-ft trials and preferred running pace 

was determined by the runner’s preferred training pace. Energy expenditure (EE) was 

determined via indirect calorimetry and reported in absolute units (kcal), and corrected 

to a mile distance. Body composition was assessed via DXA. EE per mile was 

predicted using the Loftin, et al. (2010) equation. 

rEsuLTs: Absolute EE per mile for the cross-validation (CV) group was similar 

across sub-groups (NWW = 100.2 kcal/mile, OW = 115.6 kcal/mile, DR = 107.8 

kcal/mile) and did not show significant difference between groups (p > 0.05). The 

overall mean for the absolute EE was 107.8 + 15.5 kcal/mile. The Loftin, et al. (2010) 

equation yielded an overall mean for the predicted EE per mile of 99.7 + 10.9 kcal/ 

mile. This was significantly different (p < 0.05) than the mean actual value from the 

cross-validation group, although the difference was within the published standard error 

of the estimate (SEE) of the original equation (SEE = 10.9 kcal/mile). A regression 

equation for the CV group produced an R2 of 0.605 and the SEE (9.8 kcal/mile) was 

similar to the original equation. Further, a Chow test found no significant differences 

(p > 0.05) between regression coefficients of the original equation and the CV group 

equation and the estimated shrinkage on cross-validation was 0.027; which is minimal 

and suggestive of no significant difference in R2 values. 

CONCLusIONs: The cross-validation results support the original equation (Loftin 

et al., 2010) as valid. We suggest the Loftin, et al. (2010) regression equation is useful 

for exercise prescription in that it allows for the prediction of EE for either walking or 

running a mile in normal weight and overweight adults. 

1130 Board #75 May 30, 9:00 AM - 10:30 AM 

Total Energy Expenditure and Energy Expenditure Per 

Kilogram of Body Weight Comparison among young adults 

Vivek K. Prasad, Gregory A. Hand, FACSM, Jason R. Jaggers, 

Robin P. Shook, Amanda Paluch, Stephanie Burgess, Xuemei 

Sui, Steven N. Blair, FACSM. University of South Carolina, 

Columbia, SC. 


PurPOsE: Total energy expenditure (EE) consists of resting EE which account 

for approximately 60% of total EE (mainly due to metabolic cost of processes); 

10% accounts for the thermal effect of feeding; and 30% accounts for nonresting EE 

(remaining expenditure of energy, mainly in the form of physical activity). All the 

above processes for EE depend upon body composition to a great extent. The present 

study was designed to compare overweight and normal weight participants for their 

total EE and EE per kilogram (KG) body weight. 

METhOds: A group of healthy women and men were assessed for body fat (BF) 

percent and BMI. BF percentage was calculated as the percentage of total weight 

identified as fat tissue by dual x-ray absorptiometry (DXA). BMI was calculated as 

measured weight in KG/ht in meters². Participants were categorized into overweight 

and normal weight groups according to BF percent and BMI. Overweight cut points 

by BF percent were ≥19.5% and ≥25.4% for men and women, respectively, where as 

normal weight cut points were ≤19.4% and ≥25.3% for men and women, respectively. 

BMI overweight and normal weight cut points were ≥25.0 and ≤24.9 KG/ht in meters² 

for both men and women. T-tests were used to compare means of EE (total and per KG 

body weight) between overweight and normal weight by gender. 

rEsuLTs: The study population consisted of 429 healthy young adults (212 men 

and 217 women; aged 21 to 35 years). In the BF percent classifications we found 

overweight and normal weight participants had no difference in total EE, but normal 

weight participants were expending significantly higher energy per KG body weight 


(p < 0.001). When classified by BMI, overweight participants expended significantly 

higher overall energy than the normal weight group (p = 0.023 for men; and


LR trial during both exercise (141.1 ± 20.1 vs. 124.0 ± 15.9 b•min-1, p < 0.05) and 

recovery (81.6 ± 10.7 vs. 68.3 ± 6.0 b•min-1, p < 0.05). 

CONCLusION: A decrease in RI during moderate intensity RE resulted in a twofold 

decrease in exercise time and a significant increase in post-exercise VO2 and energy 

expenditure. When body mass management is the primary goal of RE, short RI may 

optimize calorie expenditure and while conserving time. 

1133 Board #78 May 30, 9:00 AM - 10:30 AM 

Effects Of high Intensity Intermittent Exercise On Postexercise 

resting Oxygen Consumption 

Katsunori Tsuji, Xin Liu, Yu Zhong Xu, Izumi Tabata, FACSM. 

Ritsumeikan University, Kusatsu, Japan. (Sponsor: Izumi Tabata, 

FACSM) 


PurPOsE:The purpose of the present investigation is to elucidate the effects of 

short-lasting high intensity intermittent exercise on post-exercise resting oxygen 

consumption. 

METhOds:Seven young healthy males volunteered for the experiment. Means ± 

standard deviations (SDs) of the subjects’ age (yrs), height (m), body mass (kg), and 

V(●)O2 max (ml/kg/min) were 24±1, 1.72±0.05, 65.9±6.5, and 46.4±1.6, respectively. 

For the exercise (E) day, the subjects entered the metabolic chamber at 10:00. After 

10 min of warming up, the subjects conducted exhaustive high-intensity intermittent 

exercise (6 to 7 sets of 20-s exercise at an intensity of 170% V(•)O 2max with a 10-s rest 

between each bout). After the exercise, the subjects stayed in the metabolic chamber 

to the next morning. They consumed lunch and supper at fixed time of the day. For 

control (C) day, the subjects followed the same protocol, except for the HIIE. The 

order of the exercise and the control experiment were randomly assigned for each 

subject. 

rEsuLTs:Basal oxygen consumption measured in the morning before the subjects 

entered the chamber was not different between E and C day. After HIIE, oxygen 

consumption was continuously higher than that observed for C day. The difference 

in oxygen uptake between E day and C day (246±72 ml/kg/12hour) was positively 

correlated with accumulated oxygen uptake during the exercise (121±15 ml/kg, r=0.82, 

p0.10). These results may suggest that elevated oxygen uptake after high intensity 

intermittent exercise does not necessarily represent energy needs for resynthesis of 

anaerobic energy substrates (i.e. creatine phosphate and glycogen). Even after adding 

energy consumption during the HIIE, the total difference in energy expenditure 

between E and C day was 121±28 kcal. 

CONCLusIONs:Short-lasting high intensity intermittent exercise may elevate 

resting energy consumption. However, its quantitative contribution to weight-reduction 

is limited. 

1134 Board #79 May 30, 9:00 AM - 10:30 AM 

Nighttime Consumption of Protein or Carbohydrate 

Improves Morning resting Energy Expenditure in active 

College-aged Men 

Amber W. Kinsey, Takudzwa A. Madzima, Lynn B. Panton, 

FACSM, Sarah K. Fretti, Michael J. Ormsbee. Florida State 

University, Tallahassee, FL. 


Nighttime eating is an unexplored component of nutrient timing and no data exist 

regarding the satiating and metabolic effects of macronutrients consumed at night 

before sleep. 

PurPOsE: To investigate whether whey protein (WP), casein protein (CP), 

carbohydrate (CHO), or a non-caloric placebo (PLA) consumed prior to sleep alters 

morning appetite and resting energy expenditure (REE) in active men. 

METhOds: Eleven physically active men (age, 23.6 ± 3.1 years; body fat, 16.3 ± 

8.2%) participated in this randomized, double blind, crossover study. A single dose of 

WP (30g), CP (30g), CHO (33g) or PLA was consumed 30 minutes prior to sleep and 

each trial was separated by 48-72 hours. The next morning (0500-0800), measurements 

of satiety, hunger, and desire to eat (visual analog scale) and REE (indirect calorimetry) 

were performed. After a 30 minute equilibration period, 60 minutes of REE in the 

supine position was measured. Ten-minute means (total of 5) over the final 50 minutes 

of measurement were analyzed. Outcome variables were oxygen consumption (VO2), 

REE, and respiratory quotient (RQ). Statistical analyses were conducted using a 4 x 

5 (group x time) repeated measures ANOVA for metabolic variables and a one way 

ANOVA was used for changes in appetite markers. Group differences were examined 

by Tukey post-hoc analyses. Data are reported as mean ± SE. 

rEsuLTs: There were no significant differences in appetite measures among or 

between groups. There were no group x time interactions for VO2, REE, and RQ; 

however there was a main effect for group. VO2 was significantly greater for WP 

(3.35 ± 0.03 ml/kg/min) and CP (3.30 ± 0.03 ml/kg/min, p < 0.0001) when compared 

to PLA (3.16 ± 0.03 ml/kg/min), but not CHO (3.25 ± 0.03 ml/kg/min). Predicted 

REE was significantly greater after WP (1947 ± 16 kcal/d), CP (1941 ± 16 kcal/d) 

and CHO (1908 ± 16 kcal/d) compared to PLA (1843 ± 16 kcal/d, p < 0.0001). RQ 

was significantly lower after PLA (0.759 ± 0.003) compared to WP (0.773 ± 0.003) 


and CHO (0.773 ± 0.003, p < 0.0001) but not CP (0.764 ± 0.003). There were no 

significant differences between WP and CP in any metabolic measurements. 

CONCLusION: Nighttime consumption of WP, CP, or CHO, in close proximity to 

sleep, elicits favorable effects on next morning metabolism when compared to a noncaloric 

PLA in active young men. 

1135 Board #80 May 30, 9:00 AM - 10:30 AM 

Total Energy Expenditure approaches 4 xBMr in 

septuagenarians during the race across america (raaM) 

Brent C. Ruby, FACSM 1 , Nate Keck 1 , Tim Shriver 2 , Dale 

Schoeller 2 . 1 University of Montana, Missoula, MT. 2 The 

University of Wisconsin - Madison, Madison, WI. 


Previous data has demonstrated that riders in the Tour de France maintain a physical 

activity level (PAL) between 3.5-5.5 times basal metabolic rate (xBMR) (Westerterp et 

al., 1986). In contrast, the PAL for male septuagenarians has been reported to average 

1.7 xBMR (Manini et al., 2009). 

PurPOsE: To measure the total energy expenditure (TEE) and water turnover in a 

4-man team of septuagenarians during the Race Across America (RAAM). 

METhOds: Study participants included four males (70±1.6 yrs, 72.0±5.1kg) 

competing as a team during the 2012 RAAM bicycle event (4817 km). Participants 

were provided with an oral dose of doubly labeled water after a background urine 

sample late in the evening the night before the start. Early the following morning, 

a second void urine sample was collected in parallel with a measure of nude body 

weight. Subsequent urine samples and body weights were collected on the third 

and fifth morning and upon completion of the event to analyze values across three 

segments of the race. 

rEsuLTs: The four man septuagenarian team finished in 6.55 days with an average 

speed of 30.6 km/hr (age group course record). Body weight showed subtle changes 

(71.6±6.1 and 70.2±6.5 kg for pre to post race, respectively). Total energy expenditure 

averaged 24.8±4.2 MJ/day (5,936±995 kcal/day) (range = 19.16-30.24 MJ/day, 4,578- 

7,230 kcal/day) throughout the continuous event. The range of TEE expressed relative 

to basal metabolic rate was 2.9-4.0 xBMR. Water efflux averaged 10.5±1.4 L/day 

resulting in an overall turnover amounting to 1.6±0.4 times initial total body water 

(45.3±3.9 L). 

CONCLusION: Highly active septuagenarians maintain near energy balance when 

TEE approaches 4 xBMR. These values exceed twice those of less active, similarly 

aged males and are comparable to riders during portions of the Tour de France. 

1136 Board #81 May 30, 9:00 AM - 10:30 AM 

Interactions between the Thermic Effect of Food and 

Exercise on Total Energy Expenditure among Females 

Ashley Binns, Michelle Gray. University of Arkansas, 

Fayetteville, AR. 


It is well known that both diet and exercise are key components in overall maintenance 

of optimal health. Exercise, in both aerobic and anaerobic forms contributes to overall 

energy expenditure (TEE). Additionally, the thermic effect of food (TEF) has also been 

recognized to impact energy expenditure. 

PurPOsE: The aim of the present investigation was to determine the interaction 

between TEF and exercise on total energy expenditure (TEE) based on protein content 

of a meal in moderately active females. 

METhOds: Twelve active females of normal body composition participated in the 

study. Preliminary maximal aerobic capacity (VO2max) was determined. Participants 

returned for three additional randomized testing sessions in which a 30-minute bout 

of exercise was performed at 60% VO2max after consumption of a high protein (45% 

total kcal), low protein (15% total kcal), or in the fasted state. 

rEsuLTs: Repeated measures ANOVA indicated a significant main effect for the 

feeding protocols (α = .05). The TEF of food was 30.39% greater in the high protein 

meal when compared to the low protein meal (p = .006) and 98.15% greater when 

compared to the fasted state (p = .000). Low protein meal consumption resulted in a 

94.34% higher TEF when compared to the fasted state (p = .000). In combination with 

exercise, the TEF of food with a high protein meal was significantly greater compared 

to the fasted state (p = .010) but was not different compared to the low protein meal (p 

= .122). No significant differences were found between low protein meal consumption 

combined with exercise compared to the fasted state (p = .094). 

CONCLusION: Findings of this study suggest an effect between protein content 

of a meal, moderate-intensity exercise, TEF, and TEE. Acute bouts of high and low 

protein feedings potentiated significant increases in energy expenditure through TEF. 

In combination with exercise, a significant increase in TEE was only found with high 

protein meal consumption when compared to the fasted state. Trends for increased TEF 

with exercise were present for exercise performed after consumption of a low protein 

meal compared to the high protein meal and the fasted state, though not statistically 

significant. 





C-29 Free Communication/Poster - Epidemiology 

of Physical Activity and Cardiovascular 

Disease and Cardio Fitness 

May 30, 2013, 7:30 AM - 12:30 PM 

Room: Hall C 

1137 Board #82 May 30, 8:00 AM - 9:30 AM 

Cardiorespiratory Fitness, Muscular strength, and 

Mortality 

Duck-chul Lee1 , Gregory J. Welk, FACSM 1 , Warren D. Franke, 

FACSM 1 , Xuemei Sui2 , Steven N. Blair, FACSM 2 . 1Iowa State 

University, Ames, IA. 2University of South Carolina, Columbia, SC. 


PurPOsE: To determine the independent and combined associations of 

cardiorespiratory fitness (CRF) and muscular strength (MS) with all-cause mortality. 

METhOds: Participants comprised 7,492 men aged ≥20 years (mean age 42) who 

had a medical examination during 1980-1989 in the Aerobics Center Longitudinal 

Study. They were free of cardiovascular disease (CVD), cancer, and had ≥85% of their 

age-predicted maximal heart rate on a treadmill test and ≥1 year of follow-up. CRF, 

in metabolic equivalents (METs), was estimated from a maximal treadmill test. MS 

was measured by 1 repetition maximums of bench and leg presses and a composite 

MS score was computed by combining the standardized values of both tests. We 

used tertiles of the age-specific METs and strength scores. Further, CRF and MS 

were dichotomized into either fit or strong (upper two-thirds), or unfit or weak (lower 

one-third) in a joint analysis of CRF and MS with mortality. Mortality follow-up was 

through 2003 using the National Death Index. Cox regression models included baseline 

age, body mass index, smoking status, alcohol drinking, medical conditions, parental 

CVD, and MS score for CRF or METs for MS. 

rEsuLTs: During an average follow-up of 18.5 years, 400 deaths occurred. The 

hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were 0.82 (0.65- 

1.04), and 0.69 (0.52-0.93) in middle and upper CRF categories, and 0.73 (0.58-0.93) 

and 0.74 (0.57-0.95) in middle and upper MS categories, respectively, compared with 

each lower category after adjusting for confounders and MS or CRF for each other. 

In the joint analysis, compared with unfit and weak group, HRs (95% CIs) were 0.54 

(0.40-0.74) in unfit and strong group, 0.60 (0.43-0.83) in fit and weak group, and 

0.53 (0.41-0.69) in fit and strong group. In age-stratified analyses, the strength of the 

association between CRF and mortality was similar in age-groups of 40-49, 50-59, 

and ≥60 years. However, MS was getting more strongly associated with mortality with 

increasing age, especially in age groups of 50-59 and ≥60 years. 

CONCLusION: Both CRF and MS are independent predictors of mortality. The 

increased importance of MS with age should be considered when promoting exercise 

for seniors. 

Supported by NIH Grant AG06945, HL62508, DK088195, and an unrestricted 

research grant from The Coca-Cola Company. 

1138 Board #83 May 30, 8:00 AM - 9:30 AM 

Cardiorespiratory Fitness and Incidence Of urolithiasis: 

retrospective Cohort study Of Japanese Men 

Susumu S. Sawada, FACSM1 , Ryoko Kawakami1 , Takashi 

Okamoto2 , Koji Tsukamoto2 , I-Min Lee, FACSM3 , Steven Blair, 

FACSM4 , Motohiko Miyachi1 . 1National Institute of Health and 

Nutrition, Tokyo, Japan. 2Tokyo Gas Co. LTD.,, Tokyo, Japan. 

3 4 Harvard Medical School, Boston, MA. University of South 

Carolina, Columbia, SC. 


Physical movement with physical activity and water intake after exercise or sport 

may enhance the early release of urinary tract stone(s). Cardiorespiratory fitness is 

an objective marker of habitual physical activity or exercise/sports. However, to our 

knowledge, there is no paper focusing on the relationship between cardiorespiratory 

fitness and incidence of urolithiasis. 

PurPOsE: To investigate the association between cardiorespiratory fitness and 

incidence of urolithiasis among Japanese males. 

METhOds: We evaluated the cardiorespiratory fitness and incidence of urolithiasis 

of 4,074 Japanese men [median (IQR) age31 (28-35) years]. Participants were given 

a submaximal exercise test, a medical examination, and questionnaires on their health 

habits in 1985. Cardiorespiratory fitness was measured using a cycle ergometer test, 

and maximal oxygen uptake was estimated. The development of urolithiasis was based 

on self-reports from questionnaires at a subsequent medical examination in 2004. 

Relative risks and 95% confidence intervals (95%CI) for incidence of urolithiasis were 

obtained using Cox proportional hazard models. 

rEsuLTs: During follow-up period 258 participants developed urolithiasis. 

Following age adjustments, and using the lowest cardiorespiratory fitness (1st tertile) 


group as a reference, the relative risks (95%CIs) for 2nd and 3rd tertiles were: 0.93 

(0.67-1.26) and 0.75 (0.54-1.03), respectively; p for trend = 0.08. After adjusting for 

body mass index, cigarette smoking, and alcohol intake, the relative risks (95%CIs) 

were: 1.01 (0.74-1.39), 0.84 and (0.59-1.19), respectively; p for trend = 0.32. 

CONCLusIONs: These findings suggest that cardiorespiratory fitness is not a 

predictor of incidence of urolithiasis in Japanese men. However, it is possible that only 

high-impact exercises, such as jogging, running, or jumping rope, affect the incidence 

of urolithiasis. Thus, research into the relationship between these specific exercises and 

the incidence of urolithiasis should be examined in the future. 

1139 Board #84 May 30, 8:00 AM - 9:30 AM 

relationship Between risk Factors for Cardiovascular 

disease in undergraduate students and Body Composition 

Henry H. Leon Ariza1 , Aura C. Zea Robles1 , Walter E. Rodriguez 

Alvarez2 . 1Universidad Santo Tomás, Bogotá, Colombia. 

2Louisville University, Louisville, KY. 


Cardiovascular disease (CVD) is the leading cause of death worldwide with 

approximately 17 million deaths per year. This situation is getting worse in part due 

to the increasing prevalence of metabolic syndrome, obesity and physical inactivity in 

youth. 

PurPOsE: to assess the prevalence of major risk factors for CVD including tobacco 

use, high blood pressure (BP), high blood glucose (HBG), lipid abnormalities (LA), 

obesity, and physical inactivity, in a population of first-year undergraduate students at 

the University of Santo Tomas (Colombia). 

METhOds: We conducted a study of prevalence of risk factors for CVD with a 

random sample of 192 healthy students (94 women and 99 men), who were 16 to 

22 years old. Participants answered a survey to assess nutritional habits, lifestyle 

and stress. Glucose, total cholesterol, high density lipoproteins (HDL), low density 

lipoproteins (LDL), and triglycerides (TG) were measured in blood to assess HBG and 

LA risk factors. Resting BP was measured to evaluate the risk factor of high BP. Waist 

circumference, height and weight were measured; and the percentages of body fat 

and muscle mass were calculated by bioelectrical impedance analysis (BIA). Pearson 

correlations were used (level of significance of p18% (50.0%) and HDL-C23% 

(56.3%), LDL-C ≥ 100 mg/dl (50.3%), and HDL-C 0.21. Interestingly, there was a 

relationship between the AIx and anthropometric factors, such as body mass index 

(BMI) (0.48 p


predictor of FN-BMD. In women (R2=22.5%), weight, CRF, and physical activity 

were significantly and positively associated with FN-BMD; age and post-menopausal 

status were significantly negatively associated with FN-BMD; smoking was not 

significantly associated with FN-BMD. In men (R2=9.9%), weight and CRF were 

significantly positively associated with FN-BMD; age, physical activity and smoking 

were not significantly associated with FN-BMD. 

CONCLusION: Femoral neck bone mineral density levels are positively associated 

with cardiorespiratory fitness in both women and men aged 40 years and older. Further 

prospective studies are warranted. 

1141 Board #86 May 30, 8:00 AM - 9:30 AM 

associations of Physical activity With Cardiovascular risk 

Factors in Middle-aged Chinese Women 

Wenfei Zhu1 , Steven P. Hooker, FACSM1 , Jianmin Cao2 , Minhao 

Xie2 . 1Arizona State University, Phoenix, AZ. 2Beijing Sport 

University, Beijing, China. 


PurPOsE: High levels of physical activity (PA) are associated with a favorable 

cardiovascular (CV) risk profile. However, there has been no thorough exploration of 

the independent contribution of PA to CV risk factors in middle-aged Chinese women. 

Thus, the purpose of this study was to investigate the potential relationship between PA 

and CV risk factors in 40-49 years old women in Beijing. 

METhOds: A cross-sectional study was conducted in 204 urban communitydwelling 

asymptomatic women (40-49 yr). The International Physical Activity 

Questionnaire (IPAQ) was used to measure PA and categorize women into three groups 

(low, moderate and high PA). CV risk factors, including body mass index (BMI), body 

fat percentage (BF%), blood glucose, blood lipids, blood pressure, and pulse wave 

velocity (PWV) were measured at rest. Cycle ergometer exercise tests were conducted 

to assess cardiorespiratory fitness. Electrocardiogram and other dynamic risk factors 

were recorded during exercise. 

rEsuLTs: There were significant differences in total PA (388.2±163.1, 1798.9±607.8, 

6390.8±4317.6 MET*min/wk, P



HOMA-IR and triglycerides (TG). However, this effect remained significant after adjusting 

for BMI, but not after adjusting for WC. No associations were observed in EAs. 

CONCLusIONs: PA affected the concentrations of several plasma proteins involved 

in different disease risk pathways representing possible novel links between PA and 

health. Our findings also support the importance of adjusting for WC instead of BMI to 

assess the relationship between PA and disease risk. 

1145 Board #90 May 30, 8:00 AM - 9:30 AM 

Gender differences in high sensitivity C-reactive Protein 

and self-reported Muscle strengthening activity among 

u.s. adults 

Michael R. Richardson, William R. Boyer, James R. Churilla, 

FACSM. University of North Florida, Jacksonville, FL. 


PurPOsE: To examine the gender differences between high sensitivity C-reactive 

protein (CRP) and muscle strengthening activity (MSA) in a nationally representative 

sample of U.S. adults. 

METhOds: Sample (n=4,998) included adults (>20 years of age) that participated 

in the 1999-2004 National Health and Nutrition Examination Survey. Three categories 

of MSA participation were created: no MSA (referent group), some MSA (>1 to 

2 days/week). The dependent variable was elevated CRP 

(3


1149 Board #94 May 30, 8:00 AM - 9:30 AM 

Physical activity Intensity and Weight Control status among 

adults with diabetes 

Paul D. Loprinzi, Gina Pariser. Bellarmine University, 

Louisville, KY. 


Adults who are overweight or obese are at an increased risk for developing diabetes. 

Given that physical activity may serve as a method to help reduce adiposity and 

treat diabetes, increasing activity levels among adults with diabetes is important. To 

effectively do so, it is important to understand the activity patterns of adults with 

diabetes who are trying to lose or manage their weight. 

PurPOsE: To describe accelerometer-assessed physical activity levels by weight 

control status (i.e., trying to lose weight, trying to maintain weight, and neither trying 

to lose or maintain weight) among a nationally representative sample of adults with 

evidence of diabetes. 

METhOds: Data from NHANES 2003-2006 were used. After excluding 

participations with insufficient accelerometry data, missing data on the covariates, 

missing weight control status data, and those who did not demonstrate evidence of 

diabetes, 695 adults (≥ 18 years) constituted the analytic sample (367 males; 328 

females). Multivariate association between physical activity and weight control status 

was examined using a polytomous regression. 

rEsuLTs: Results were not significant for men, but were for women. Women trying 

to lose weight (329.1 min/day [305.5-352.7]) engaged in more light-intensity physical 

activity than those trying to maintain weight (286.3 min/day [233.8-338.7]) or those 

not trying to lose or maintain weight (277.8 min/day [256.1-299.5]) (p = 0.003). After 

adjustments, for every 60-minute increase in light-intensity physical activity, women 

were 45% (OR = 1.45; 95% CI: 1.09-1.92) more likely to try to lose weight than not 

try to lose or maintain their weight. Regardless of gender, few participants who were 

trying to lose weight were sufficiently active. Only 3.9% and 6.0%, respectively, 

of men and women who were trying to lose weight met current physical activity 

guidelines. 

CONCLusION: American adults with diabetes are not sufficiently active even when 

trying to lose or maintain their weight. Clinicians are encouraged to increase their 

patient’s awareness of the minimum level of physical activity as well as help them 

achieve this dose of physical activity. This is important for both genders, but may be 

particularly important among men as their activity patterns did not differ across the 

weight control practices. 

1150 Board #95 May 30, 8:00 AM - 9:30 AM 

relationship Between Physical activity and serum Testosterone 

Levels In us Men: results From Nhanes 1999-2004 

Jeremy A. Steeves 1 , Eugene C. Fitzhugh 2 , Sarah Peskoe 3 , Victoria 

Fairchild 3 , Gary Bradwin 4 , Katherine A. McGlynn 1 , Elizabeth A. 

Platz, 3 , Corinne E. Joshu, 3 . 1 National Cancer Institute, Rockville, 

MD. 2 University of Tennessee, Knoxville, TN. 3 Johns Hopkins 

Bloomberg School of Public Health, Baltimore, MD. 4 Harvard 

Medical School and Children’s Hospital, Boston, MA. 


PurPOsE: Testosterone levels and physical activity (PA) each play important roles 

in men’s health, but the relationship between PA and male testosterone levels remains 

unclear. We evaluated the association between total PA and testosterone in a nationally 

representative sample of healthy men. 

METhOds: Serum testosterone concentration was measured by 

electrochemiluminescence immunoassay previously for 990 men 20 years of age 

or older who participated in the National Health and Nutrition Examination Survey 

(NHANES) in 1999-2004. These analyses included 738 men who had complete 

information on PA and covariates, no history of prostate cancer, and no limitations to 

engaging in PA. PA was self-reported during interview, and tertiles of total PA were 

created based on MET-minutes per week. Multivariable-adjusted geometric mean 

testosterone concentrations across tertiles of PA were estimated using linear regression. 

The odds ratio (OR) and 95% confidence interval (CI) of low testosterone (≤3.46 ng/ 

mL) were estimated comparing the middle and top tertiles of PA to the lowest tertile. 

Stratified analysis by age (20-49, ≥ 50 years), and obesity status (BMI 300 min/wk. Prevalence 

estimates and multivariable logistic regression analyses were performed. Analyses 

were stratified by age (18-34, 35-64, 65+ years) due to a significant age by PA 

interaction. 

rEsuLTs: Overall, 48% of adults with limitations report poor HRQOL. Across age 

groups we found decreasing trends in the prevalence of poor HRQOL as PA level 

increased. Among adults aged 35-64 and 65+, engaging in any level of PA vs. none 

was significantly associated with lower odds of poor HRQOL. In adults aged 18-34, 

lower odds were noted in those doing PA at least 150 min/wk compared to inactive 

adults. (Table). 

Table. Adjusted* Odds Ratios of Poor HRQOL among Adults with Limitations by Age Group 

18-34 years 35-64 years 65+ years 

AOR 95% CI AOR 95% CI AOR 95% CI 

PA Level (minutes/week) 

Inactive 1.00 ref. 1.00 ref. 1.00 ref. 

10-60 0.93 0.60,1.43 0.56 0.50,0.63 0.57 0.50,0.64 

61-149 0.75 0.50,1.12 0.45 0.40,0.50 0.51 0.45,0.57 

150-300 0.61 0.43,0.89 0.37 0.33,0.41 0.47 0.42,0.53 

301+ 0.59 † 0.43,0.80 0.34 †,± 0.30,0.37 0.41 †,± 0.37,0.46 

*Adjusted for gender, race/ethnicity, education, marital status, BMI category, smoking heavy 

drinking status, and age as a continuous variable. 

† Significant linear trend 

± Significant quadratic trend 

CONCLusION: PA is associated with HRQOL among adults with limitations. 

There is evidence of a dose response relationship, but the shape of the association 

varied by age group. Results suggest efforts to increase PA may help improve 

HRQOL among persons with limitations. 

1152 Board #97 May 30, 8:00 AM - 9:30 AM 

relationship Between sleep and Next day Physical activity 

Lendrum Morrow. Brigham Young University, Provo, UT. 


OBJECTIVE: The purpose of this study was to examine the effect that sleep duration 

and quality has on next day physical activity among a population of young adult 

women. Subjects: Three-hundred and seventy-five women (18-24 yrs) were recruited 

to participate in the study. Measurements: Each participant wore an accelerometer 

for 7 consecutive days and nights to measure sleep and physical activity. Sleep logs 

were used to verify the bedtime and wake time for each night. Actigraph data was then 

evaluated to determine sleep latency, efficiency, and number of awakenings. Physical 

activity data was also evaluated for intensity (sedentary, light, Moderate and Vigorous) 

and duration. 

rEsuLTs: Two thousand six hundred and fort one observations were collected 

and 2144 observations were used. There was an inverse relationship between total 

sleep time and next day activity (F = 102.76, p < 0.0001). However, controlling for 

wake time reduced the magnitude of the relationship by 92%. Wake time was the 

best predictor of next day physical activity (F = 202.02, p < 0.0001). There was a 

significant drop in physical activity for every hour after 7:30 in the morning that the 

participants got out of bed (F = 32.24, p < 0.0001). While sleep efficiency did not 

correlate with overall activity, it did show an inverse relationship with light activity (F 

= 48.94, p < 0.0001) and a positive relationship with sedentary activity (F = 39.73, p 

< 0.0001). 

CONCLusIONs: Sleep duration and more specifically, time getting out of bed are 





related to next day physical activity. Arising earlier in the morning may significantly 

increase physical activity, which may be due to simply having more time to be active 

during the day. 

1153 Board #98 May 30, 8:00 AM - 9:30 AM 

association between Isokinetic Muscular strength and all- 

Cause Mortality in Males 

James M. Pattarini1 , Rebecca S. Blue1 , Steven N. Blair, 

FACSM2 , Duck-Chul Lee3 , Steven Russell4 , Xuemei Sui2 , Smith 

L. Johnston5 . 1University of Texas Medical Branch, Galveston, 

TX. 2University of South Carolina, Columbia, SC. 3Iowa State 

University, Ames, IA. 4Injury Reduction Technology, Inc, Pawleys 

Island, SC. 5National Aeronautics and Space Administration, 

Houston, TX. 


PurPOsE: Studies have demonstrated an association between declining muscle 

mass and increased all-cause mortality in men. Past studies are limited by predictive 

power as a result of subject variability, as direct strength measures of specific muscle 

groups do not necessarily represent a subject’s overall body strength. Isokinetic testing 

evaluates the resistance strength of a muscle moving at a constant rate of speed and 

may provide a more accurate measurement of strength. The current study identifies the 

prognostic value of isokinetic strength parameters on longevity in male subjects. 

METhOds: A prospective observational study was undertaken on male subjects that 

underwent isokinetic strength testing for pre-employment screening for physicallydemanding 

manual labor positions between 1999 and 2002. Subjects performed 

exercise tests on isokinetic dynanometers with flexion/extension torque measurements 

of knees, shoulders, and the back. A standardized algorithm adjusted for body weight 

and combined scores into a strength index score (SIS). SIS scores of≤2.93 were 

considered “low,” SIS of >2.93 to ≤3.14 “medium,” SIS of >3.14 to ≤3.37 “high,” and 

SIS of >3.37 “very high.” 

rEsuLTs: 5593 men, 41-78 years old, received isokinetic testing during preemployment 

screening. During 63,751 person-years of observation and an average 

follow-up of 11.4 years, 270 deaths occurred.After adjusting for age, Cox proportional 

hazards regression analysis showed a significant reduction in the hazard of death for 

each integer unit increase of SIS score (hazard ratio = 0.50; 95% CI (0.37,0.70); P < 

0.001). 

CONCLusIONs:A significant inverse relationship between strength and mortality 

was demonstrated for males, suggesting that isokinetic strength could be used as a 

marker of mortality risk. Further study is warranted to better evaluate the relationship 

between muscle strength and mortality, and whether such a relationship would hold 

true for a female population. 

1154 Board #99 May 30, 8:00 AM - 9:30 AM 

Behavioral Intent to Change Body Weight and actual Body 

Weight Change 

Amanda Lewis1 , Sarah Sloan1 , Jessica Peacock1 , Arupendra 

Mozumdar2 , Charles Fountaine3 , John Schuna, Jr. 4 , Gary 

Liguori, FACSM1 . 1University of Tennessee at Chattanooga, 

Chattanooga, TN. 2Population Health Council, New Delhi, 

India. 3University of Minnesota Duluth, Duluth, MN. 

4Pennington Biomedical Research Center, Baton Rouge, LA. 


PurPOsE: Behavioral choice and behavioral intent are two primary factors that 

influence health behaviors. This study sought to determine if behavioral intention (BI) 

to change body weight led to an actual change in body weight. 

METhOds: Students enrolled in two separate university-required general education 

courses were recruited to complete a health behavior survey monthly from September 

(T1) through December (T4), 2009. The 25-item survey included questions on body 

weight and body image. To identify BI, students were asked if they were trying to 1) 

lose weight, 2) gain weight, 3) maintain weight, or 4) do nothing about their weight. 

Students also had their height and weight directly measured at T1 and T4. Change 

in body weight by BI, and differences in mean BMI by BI at baseline were analyzed 

using the chi square procedure and confirmed via analysis of variance (ANOVA). 

Alpha was p 2 kg) and 

again tested for association with BI. No significant relationship was found (p = 0.66). 

CONCLusION: In this sample of college students, the intent to change body weight 

was largely unrelated to weight change, as overall there was an increase in mean 


body weight. In fact, students reporting intentions to lose weight or maintain weight 

actually gained more than students intending to gain weight. Although college students 

typically do gain weight, assessing weight change based on BI has not previously 

been reported. These results, however, indicate that BI alone may not be sufficient 

for students to change their weight, at least not given the limited timeframe of this 

data collection period. Further research is warranted to better determine factors that 

influence weight change among college students. 

1155 Board #100 May 30, 8:00 AM - 9:30 AM 

Combined Impact of Lifestyle Factors on Lifetime risk of 

Chronic disease Mortality in Men and Women 

Chong-Do Lee, FACSM. Arizona State University, Phoenix, AZ. 


The impact of lifestyle factors on lifetime risk of chronic disease mortality in U.S. 

population remains less explored. 

PurPOsE: We investigated the combined effects of lifestyle factors on lifetime risk 

of chronic disease mortality at 40 years of age in US men and women. 

METhOds: Lifetime risks of chronic disease mortality to 80 years of age were 

estimated for men and women, with death free of chronic diseases as a competing 

event. We followed up 7848 men and women, aged 40 to 80 years, who participated 

in the Third National Health and Nutrition Examination Survey. All participants 

completed baseline lifestyle behavior questionnaires. A healthy lifestyle profile 

was defined as never smoking, physically active, and a healthy diet defined by the 

American Heart Association Strategic Committee. They were further categorized as 

having 0, 1, 2, or 3 combined healthy lifestyle factors. 

rEsuLTs: During an average of 13.2 years of follow-up (103,851 person years), 

there were a total of 1645 chronic disease deaths (915 CVD, 546 cancer, 281 

respiratory disease, 98 diabetes mellitus). At 40 years of age, lifetime risks of chronic 

disease mortality were 38.1% (95% CI: 35.7 to 40.5) for men and 30.7% (95% CI: 28.5 

to 33.0) for women. Men and women who were physically active, never smoked, and 

had a healthy diet had a substantially lower lifetime risk of chronic disease mortality. 

The lifetime risks of chronic disease mortality across 0, 1, 2, and 3 combined healthy 

lifestyle factors were 47.2%, 33.0%, 21.2%, and 16.2%, respectively. After adjustment 

for multiple risk factors, men and women with all 3 healthy lifestyle factors had a 36% 

(95% CI: 28% to 42%) lower risk of chronic disease mortality compared with men and 

women with zero healthy lifestyle factors. Persons with 0 compared with 3 healthy 

lifestyle factors had a shorter life expectancy by 10 years (95% CI: 7.8 to 12.1 years). 

Approximately 30% (95% CI: 14% to 43%) of chronic disease deaths might have been 

avoided if men and women had maintained all 3 healthy lifestyle factors. 

CONCLusION: Maintaining a healthy lifestyle is associated with lower risk of 

chronic disease mortality in men and women. Nationwide primordial prevention efforts 

are needed to support the attainment of healthy lifestyles for the lifetime. 

1156 Board #101 May 30, 8:00 AM - 9:30 AM 

hand-Grip strength and Prevalence Of diabetes, 

hypertension, and dyslipidemia: a Cross-sectional study 

among Japanese Males 

Ryoko Kawakami 1 , Susumu S. Sawada, FACSM 2 , Takashi 

Okamoto 3 , Koji Tsukamoto 3 , Noriko Tanaka 2 , Mitsuru Higuchi, 

FACSM 1 , I-Min Lee, FACSM 4 , Steven N. Blair, FACSM 5 , 

Motohiko Miyachi 2 . 1 Waseda University, Saitama, Japan. 

2 National Institute of Health and Nutrition, Tokyo, Japan. 3 Tokyo 

Gas Health Promotion Center, Tokyo, Japan. 4 Harvard Medical 

School, Boston, MA. 5 University of South Carolina, Columbia, SC. 


Limited data are available on the relationship between muscle strength and the 

prevalence of type 2 diabetes, hypertension, and dyslipidemia. 

PurPOsE: To examine the cross-sectional relationship between hand-grip strength 

and the prevalence of type 2 diabetes, hypertension, and dyslipidemia among Japanese 

males. 

METhOds: We evaluated 2,517 male workers (median age 53 years) who were 

measured for hand-grip strength. Participants were divided into quartiles based on 

their relative value of hand-grip strength (hand-grip strength (kg) / body weight (kg)). 

Prevalence of each disease was diagnosed by means of an annual health checkup and 

questionnaire. Odds ratios and 95% confidence intervals (95%CI) for the prevalence 

of type 2 diabetes, hypertension, and dyslipidemia were obtained by using logistic 

regression model. 

rEsuLTs: 258 participants had type 2 diabetes, 1,039 had hypertension, and 1,286 

had dyslipidemia. Adjusting for age, cigarette smoking, alcohol intake, and family 

history of each disease, using the highest hand-grip strength group as reference, 

the odds ratios (95%CI) for the second to fourth quartiles groups were 1.32 (0.86- 

2.00), 0.98 (0.63-1.52), and 2.48 (1.69-3.64), P for trend < 0.001 for type 2 diabetes, 

1.22 (0.96-1.56), 1.33 (1.04-1.69), and 2.33 (1.83-2.97), P for trend < 0.001 for 

hypertension, and 1.41 (1.12-1.76), 1.92 (1.53-2.40), and 2.41 (1.91-3.03), P for trend 

< 0.001 for dyslipidemia, respectively. After additional adjusting for body mass index, 

the odds ratios (95%CI) were 1.08 (0.70-1.66), 0.68 (0.43-1.08), and 1.23 (0.78-1.94), 



P for trend = 0.671 for type 2 diabetes, 0.96 (0.75-1.24), 0.87 (0.67-1.13), and 1.07 

(0.80-1.43), P for trend = 0.874 for hypertension, and 1.16 (0.92-1.46), 1.35 (1.06- 

1.72), and 1.25 (0.96-1.64), P for trend = 0.045 for dyslipidemia, respectively. 

CONCLusIONs: These results suggest that hand-grip strength is associated with the 

prevalence of dyslipidemia among Japanese males, although its relation was attenuated 

after adjusting for body mass index. 

1157 Board #102 May 30, 8:00 AM - 9:30 AM 

dyspnea and all-cause Mortality: 28 year Follow-up study 

among Twins 

Katja Waller1 , Jaakko Kaprio2 , Urho M. Kujala1 . 1University of 

Jyväskylä, Jyväskylä, Finland. 2University of Helsinki, Helsinki, 

Finland. 


Dyspnea is defined as a respiratory discomfort and breathlessness during exercise 

and daily activities. In research, dyspnea is often used as pulmonary symptom among 

medically ill. However, among healthy people, the use of dyspnea during specified 

activities as a measurement of fitness has not been widely used even though it 

correlates well with fitness measurements. 

PurPOsE: The aim is to look how baseline dyspnea, assessed at baseline of a 

longitudinal study, and changes in it, predicts all-cause mortality during 28 year 

follow-up. 

METhOds: The study is based on a prospective Finnish Twin Cohort, which includes 

all same-sex twin pairs born before 1958. The number of twin pairs with both members 

alive was 12 069 at the beginning of the follow-up in 1975. These twins answered 

questionnaires in 1975 and 1981, including questions on physical activity, dyspnea, 

alcohol use, smoking, and physician diagnosed diseases. Dyspnea is measured by 

using a five item modified MRC scale. The change in dyspnea between 1975 and 1981 

is used as the baseline predictor for mortality. Cox proportional hazard model was used 

for mortality analysis, and it was started from 1.1.1982 and continued until 31.12.2010. 

rEsuLTs: Tendency for higher hazard ratios (HR) for mortality was observed 

among participants who had experienced dyspnea at both (persistent dyspnea) or 

either of the baseline years. Age, sex and physical activity adjusted analysis showed 

that participants with persistent dyspnea had higher risk for mortality (HR 1.71, 95 

% CI 1.57 - 1.85) compared to participants with no dyspnea. Also, participants with 

change in dyspnea status showed increased risk, as HR for dyspnea increasers was 

1.34 (1.21 - 1.48) and decreasers was 1.23 (1.11 - 1.36) compared to totally symptom 

free participants. Similar results are shown for a subgroup of healthy subjects as HR 

with same adjustments was 1.60 (1.40 - 1.83), 1.39 (1.18 - 1.64) and 1.22 (1.05 - 1.41) 

respectively. 

dIsCussION: Results show that persistent dyspnea or dyspnea even at one baseline 

point predicts increased mortality during 28 year follow-up also among healthy 

subjects. This indicates that easily measured dyspnea score, which correlate well with 

fitness outcomes, could have a potential as a screening tool for finding people with low 

levels of fitness and increased mortality risk. 

1158 Board #103 May 30, 8:00 AM - 9:30 AM 

relationship of Contraceptive use, Estrogen replacement 

Therapy and age on Blood Lipid Profiles in Women 

Kenneth R. Ecker, FACSM. University of Wisconsin, River 

Falls, WI. 


PurPOsE: The purpose of this investigation was to assess the relationship of aging, 

contraceptive use and estrogen replacement therapy on blood lipid profiles in women. 

METhOds: Six-hundred and thirty-three females ranging in age from 21 to 69 yearsof-age 

were obtained from a hospital wellness center database. All of the subjects had 

signed medical release and informed consent prior to when the tests were conducted. 

The females were comprised of five age groups of ten year increments. A one-way 

ANOVA was used to analyze the data (p < 0.05), in addition to employing post-hoc 

comparisons of the least significant difference (p



1161 Board #106 May 30, 8:00 AM - 9:30 AM 

Physical activity and Benign Prostatic hyperplasia / Lower 

urinary Tract symptoms 

Kathleen Y. Wolin, FACSM1 , Robert Grubb, III1 , Ratna 

Pakpahan1 , Lawrence Ragard2 , Jerome Mabie3 , Gerald Andriole1 , 

Siobhan Sutcliffe1 . 1Washington University School of Medicine 

St Louis, St Louis, MO. 2Westat, Rockville, MD. 3IMS, Inc, 

Calverton, MD. 


Benign prostatic hyperplasia (BPH) and its associated lower urinary tract symptoms 

(LUTS) are extremely common among middle- and older-aged American men. Few 

studies have investigated physical activity (PA) in relation to BPH/LUTS, with 

inconclusive results in cross-sectional studies suggesting a protective association. 

However, as this association may potentially reflect the influence of BPH/LUTS on PA 

rather than PA on BPH/LUTS, prospective investigations are necessary. 

PurPOsE: To examine the association of physical activity with incident BPH/LUTS. 

METhOds: Using observational data from the PLCO, a large well-characterized 

clinical trial sample, we examined the association of self-reported vigorous PA (current 

and at age 40) with incident BPH/LUTS. BPH/LUTS was measured at baseline 

(1993-2001) and follow-up (2006-8) using self-report of physician diagnosis, BPH 

surgery, finasteride use, nocturia, prostate-specific antigen (PSA) elevation, and large 

prostate volume. We included 4,771 men in the incident analysis. Poisson regression 

with robust variance estimation was used to calculate multivariable relative risks 

(RR) adjusted for age, follow-up time, and number of PSA tests and digital rectal 

examinations, as appropriate. 

rEsuLTs: As hypothesized, associations for incident BPH/LUTS differed from 

previous cross-sectional findings for prevalent BPH/LUTS. PA was not associated with 

elevated PSA, greater prostate volume, physician diagnosis of BPH, or finasteride use, 

although it was still inversely associated with nocturia. Men engaging in PA 4+ h/wk 

were 14% (RR=0.86, 95% CI: 0.76-0.99) less likely to report nocturia ≥2 times/wk and 

32% (RR=0.68, 95%CI: 0.51-0.92) less likely to report nocturia ≥3 times/wk than men 

who were not active. PA at age 40 was not associated with incident BPH. 

CONCLusIONs: The association of PA with incident BPH/LUTS differs from 

previous findings for prevalent BPH/LUTS. PA was not associated with incident BPH/ 

LUTS except when defined as nocturia. Previous studies have suggested that PA may 

increase sleep quality, which may explain why PA was only associated with nocturia 

and not other dimensions of BPH/LUTS. 

1162 Board #107 May 30, 8:00 AM - 9:30 AM 

Moderate-to-vigorous Physical activity Thresholds 

associated with Metabolic syndrome risk Factors 

Tiago V. Barreira, John M. Schuna, Catrine Tudor-Locke, 

FACSM, Peter T. Katzmarzyk, FACSM. Pennington Biomedical 

Research Center, Baton Rouge, LA. 


Current physical activity (PA) guidelines were primarily developed from 

epidemiological evidence linking self-reported PA levels with chronic disease 

outcomes. Recently, accelerometer PA data from the National Health and Nutrition 

Examination Survey (NHANES) has been used to estimate the proportion of US adults 

meeting PA guidelines. However, PA information collected via self-report and from 

accelerometers may not be equivalent. 

PurPOsE: To determine if levels of objectively monitored moderate-to-vigorous 

PA (MVPA) can adequately discriminate between adults with and without metabolic 

syndrome (MetS) risk factors. 

METhOds: 2103 fasted, non-pregnant participants ≥ 20 years of age who had ≥ 4 

days of valid accelerometer data (≥ 10 h/dy) and non-missing data for the harmonized 

MetS risk factors (blood pressure [BP], triglycerides [TG], fasting blood glucose 

[GLU], high-density lipoprotein [HDL-C], waist circumference [WC]) were included 

in this analysis of the 03-06 NHANES. MVPA was defined using a threshold of 2020 

counts/min. Participants were classified as healthy or unhealthy using the harmonized 

MetS risk cut-points for each risk factor. MetS was defined as the presence of ≥ 3 risk 

factors. Receiver operating characteristic curve analysis was used to identify optimal 

MVPA thresholds to discriminate between healthy and unhealthy adults. 

rEsuLTs: Discriminatory MVPA thresholds for all MetS risk factors in men were 

identified with area under the curve (AUC) values ranging from 0.55-0.65 (all p < 0.01). 

MVPA thresholds were 14-16 min/day for BP, TG, and GLU, 24 min/day for WC, 25 

min/day for HDL-C, and 14 min/day for MetS (sensitivity 51%, specificity 72%, AUC 

0.63). The optimal MVPA threshold for HDL-C in women was 16 min/day however the 

AUC (0.55) was non-significant (p = 0.09). MVPA thresholds for all other MetS risk 

factors were identified, with AUC values ranging from 0.65-0.72 (all p < 0.01). Optimal 

MVPA thresholds were 10-11 min/day for BP, TG, GLU, and WC. For MetS the MVPA 

threshold was 10 min/day (sensitivity 71%, specificity 61%, AUC 0.70). 

CONCLusIONs: Although discriminatory thresholds of MVPA in relation to MetS 

risk factors were identified, all AUC, sensitivity, and specificity values were fairly low. 

Daily MVPA thresholds were lower than the current guidelines and different between 

men and women. 


1163 Board #108 May 30, 8:00 AM - 9:30 AM 

Vitality age: Calibration Of a Modifiable risk-related age 

algorithm, Part of an Incentivised Wellness Program 

Estelle V. Lambert1 , Kolbe-Alexander Tracy1 , Maroba Josiase2 , 

Mweete Naglazi1 , Deepak Patel2 , Lori Serradas3 , Rhonda 

Roscoe3 , Jonathon Dugas3 , Adam Noach2 . 1University of 

Cape Town, Newlands, South Africa. 2Discovery Health, 

Johannesburg, South Africa. 3The Vitality Group, Chicago, IL. 


PurPOsE: The primary aim of this study was to compare the Vitality Risk Age (VA), 

based entirely on modifiable risk factors for cardio-metabolic disease (CMD), against 

the Framingham Heart Score (FHS) in a cross-sectional sample of persons registered 

for an employee-sponsored, Vitality wellness program. 

METhOds: The VA algorithm is comprised of modifiable risk factors including: 

BMI, smoking, physical activity, alcohol, blood pressure, fasting glucose, cholesterol, 

depression/anxiety and dietary behavior scores. A combined relative risk was 

calculated (CRR), to adjust actual age to risk age, based on standardized life 

expectancy (VA diff %). The sample included de-identified data from all members who 

completed the health risk assessment (HRA) from Jan-Sept 2011 (Total N=41067, of 

whom, 4049 reported cardio-metabolic disease, CMD). We calculated the odds ratios 

for CMD, for each risk factor that contributed to the algorithm, adjusting for gender, 

and generated receiver operator characteristic curves (ROC) for risk scores predicting 

CMD, separately for men and women. 

rEsuLTs: The VA difference for the entire sample was 3.8+4.6 yrs (9% older 

by risk). The VA diff (yrs and %) were significantly correlated to the FHS scores 

(r=0.50,r=0.49, respectively, P<0.001). Persons meeting physical activity (PA) 

guidelines had significantly lower odds ratios for CMD (OR=0.65, 95%CI: 0.60-0.70, 

P < 0.001). For every 1mmHg increase in systolic blood pressure, there was an 

2% increase in the odds of CMD, and for each kg/m2 BMI and cm change in waist 

circumference, there was a 10% and 4% increase in the odds of CMD, respectively. 

The c-statistic for the ROC curves for CRR were 0.60 and 0.71, , compared to 0.49 and 

0.68 for the FHS, for men and women, respectively. The odds of CMD increased by 

1% for each 1% diff in VA diff (%), (P < 0.001). 

CONCLusIONs: Risk algorithms based on modifiable behaviors, such as physical 

activity, compare favorably to established risk scores for predicting CMD and provide 

useful tools to convey behavior change recommendations. 

1164 Board #109 May 30, 8:00 AM - 9:30 AM 

differential sex Effects on Lean Body Mass in response to 

Concurrent high Intensity Exercise Training 

Joshua A. Cotter 1 , Tomasz Owerkowicz 2 , Alvin M. Yu 1 , 

Marinelle L. Camilon 1 , Theresa Hoang 1 , Per A. Tesch 3 , Vincent 

J. Caiozzo, FACSM 1 , Gregory R. Adams, FACSM 1 . 1 University 

of California, Irvine, CA. 2 California State University, San 

Bernardino, CA. 3 Karolinska Institute, Stockholm, Sweden. 

(Sponsor: Vincent J. Caiozzo, FACSM) 


General health, sporting requirements, and environments, e.g. space flight, that warrant 

the need for cardiovascular and musculoskeletal maintenance often incorporate both 

aerobic (AE) and resistance exercise (RE) training. Concurrent training has shown 

potential interference effects and therefore it is important to examine whether there 

are sex differences on lean body mass (LBM) responses to concurrent high intensity 

training. 

PurPOsE: To determine if concurrent training utilizing high-intensity interval 

rowing and maximal concentric/eccentric exercise on the Multi-Mode Exercise 

Device (M-MED), a gravity-independent flywheel exercise device, will exhibit similar 

changes in LBM regardless of sex. 

METhOds: Twelve healthy, sedentary males (n=6 , 23.0 ±4.6 yrs, 69.0 ±6.1 kg) and 

females (n=6, 23.8 ±2.4 yrs, 68.8 ±15.5 kg) completed 5 weeks of concurrent exercise 

training on the M-MED with alternating days of AE and RE training sessions. AE 

consisted of high-intensity interval rowing alternating 4 minutes of high intensity (HR 

at ≥90% VO2max) and 4 minutes of low intensity (HR at 50% VO2max) exercise. RE 

included maximal intensity horizontal squats, hamstring curls, and heel raises. LBM 

was assessed using dual energy X-ray absorptiometry (DXA) and whole muscle cross 

sectional area (CSA) by magnetic resonance imaging (MRI). Training and gender 

comparisons were made using a two-way ANOVA with repeated measures. 

rEsuLTs: LBM (3.3%, p


CSA of leg musculature in both males and females with males having a greater 

response in the quadriceps and hamstrings. 

1165 Board #110 May 30, 8:00 AM - 9:30 AM 

Effects Of accelerometer-based Intervention To Go Beyond 

Physical activity reference For Japanese On The Prevalence 

Of Low-back Pain: a randomized Control Trial 

Motohiko Miyachi 1 , Haruka Murakami 1 , Ryoko Kawakami 2 , 

Nobuyuki Miyatake 3 , Takeyuki Numata 4 , Izumi Tabata, 

FACSM 5 . 1 National Institute of Health and Nutrition, Tokyo, 

Japan. 2 Waseda University, Saitama, Japan. 3 Kagawa University, 

Takamatsu, Japan. 4 Okayama Southern Institute of Health, 

Oakayama, Japan. 5 Ritsumeikan University, Kusatsu, Japan. 

(Sponsor: Izumi Tabata, FACSM) 


Low-back pain is a leading symptom in the Japanese population. The evidence for an 

association between amount of physical activity and prevalence of low-back pain is 

insufficient. 

PurPOsE: Using a randomized-control trial design, we determined the effects of 

accelerometer-based intervention to go beyond the Physical Activity Reference value 

for Japanese (PARJ) on the prevalence of low-back pain. 

METhOds: A total of 821 healthy men and women, 30 to 64 years old, were 

divided into the active group (n=345) who met PARJ (23 METs-h/week of MVPA) 

or the inactive group (n=476) who did not meet PARJ. Moreover, the participants of 

the inactive group were randomly assigned to either the intervention group (n=239) 

or the control group (n=237). The control group was instructed not to alter their 

normal activity levels throughout the study period. The intervention group received 

accelerometer-based counseling to go beyond PARJ for one year. The prevalence of 

low-back pain was evaluated by the question: “did you have low-back pain lasting 

longer than 3 months during the last 12 months?” The point prevalence of low-back 

pain was based on that with a current episode of pain. Adjusting hazard ratio and 95% 

confidence intervals (95%CI) for the prevalence of low-back pain were obtained using 

the Cox hazard regression model. 

rEsuLTs: Among the 821 participants, 526 had no low-back pain at baseline and 

have been followed-up for more than one year. In the intervention group, the amount of 

physical activity significantly increased and the mean value reached 23 METs-h/week 

after one year of intervention. There was no such change in the control group. Seventythree 

participants reported low-back pain during the average 2.3-year observation 

period (range: 1-4 years). Using the control group as a reference, the adjusted hazard 

ratios (95%CI) for the intervention and active groups were 0.50 (0.27-0.94) and 0.65 

(0.38-1.09), respectively. 

CONCLusIONs: These results suggest that the accelerometer-based intervention to 

go beyond 23 METs-h/week defined as PARJ attenuates the prevalence of low-back 

pain by ~50%. (NCT00926744) 

C-31 Free Communication/Poster - Epidemiology 

of Physical Activity in Pregnancy 

May 30, 2013, 7:30 AM - 12:30 PM 

Room: Hall C 

1166 Board #111 May 30, 8:00 AM - 9:30 AM 

description of Motives for and Barriers to Exercising across 

Pregnancy 

Erin E. White1 , Karin A. Pfeiffer, FACSM2 , Claudia B. 

Holzman2 , Daniel R. Gould2 , James M. Pivarnik, FACSM2 . 

1 2 Winona State University, Winona, MN. Michigan State 

University, East Lansing, MI. 


Maternal exercise usually decreases as gestation progresses even though there 

are numerous benefits derived from continuing this behavior during pregnancy. 

Understanding motives for and barriers to maternal exercise by trimester may allow 

physical activity professionals to better individualize maternal exercise programs and 

increase adherence. 

PurPOsE: The purpose of this study was to describe the most frequent motives for 

and barriers to maternal exercise by trimester. 

METhOds: Women (n = 295) who belonged to a commercial fitness club and had 

given birth within the last five years completed a retrospective survey regarding 

trimester-specific motives for and barriers to exercise during pregnancy. Women chose 

up to three motives and barriers per trimester from a predetermined list (including 9 

motives and 27 barriers) based on previous literature. Descriptive statistics were used 

to assess the frequency of motives and barriers. 

rEsuLTs: Mean ± SD maternal age at delivery was 27 ± 5.1 yr. Maternal height 


and weight at the time of survey completion were 165.2 ± 6.5 cm and 79.5 ± 20.8 

kg, respectively. The top two primary motives in trimesters 1, 2, and 3 were to stay 

healthy (37.4%, 35.5%, and 32.9%, respectively) and weight control (19.8%, 27.1%, 

and 25.5%, respectively). The third primary motive in trimesters 1 and 2 was fitness 

(13.7% and 11.6%, respectively); while in trimester 3 it was to relieve stress (10.7%). 

The top primary barrier to exercise across all three trimesters was lack of energy 

(27.0%, 18.9%, and 19.4%, respectively). Other primary barriers in trimester 1 were 

pregnancy-related illness (18.5%) and lack of time (9.3%). Trimester 2 primary 

barriers included lack of time (9.6%) and lack of motivation (8.2%), while third 

trimester primary barriers included exercise being too uncomfortable (17.2%) and on 

bed rest (6.8%). 

CONCLusION: While the motives of exercise do not change considerably across 

trimesters of pregnancy, barriers do. More women may continue to exercise throughout 

pregnancy if they are made aware of various modalities to make exercise more 

comfortable for them, especially as pregnancy progresses. In addition, discussing time 

management skills and how to overcome a “lack of energy” may increase exercise 

participation. 

Funding: Blue Cross Blue Shield of Michigan Student Award 

1167 Board #112 May 30, 8:00 AM - 9:30 AM 

reliability and Validity of Three Physical activity 

Measurements during Pregnancy and Postpartum 

Deanna M. L. Phelan1 , Mallory R. Marshall1 , Rebecca A. 

Schlaff2 , Alaina K. Vince1 , Karin A. Pfeiffer, FACSM1 , James M. 

Pivarnik, FACSM1 . 1Michigan State University, East Lansing, 

MI. 2Saginaw Valley State University, University Center, MI. 


Quality physical activity (PA) studies during pregnancy depend on the accuracy of 

data collected. However, little is known about the reliability and validity of current 

modalities designed to measure PA during pregnancy in a free-living environment. 

PurPOsE: Our purpose was to assess reliability and validity of three PA measures 

used during pregnancy and postpartum: the Omron pedometer (PED; steps/day/ 

hr) the SenseWear Armband (SA; kcal/kg/hr), and the Pregnancy Physical Activity 

Questionnaire (PPAQ; met.min/week). 

METhOds: Subjects (n=20) wore the PED and SA devices in free-living 

environments for two consecutive weeks at 20 weeks gestation, 32 weeks gestation, 

and 12 weeks postpartum. At the end of each week of wear, subjects completed 

the PPAQ recall instrument to evaluate the prior week’s PA. Intraclass correlation 

coefficients (ICC) and standard errors of measurement (SEM) were calculated to 

estimate reliability for the two weeks of wear/recall at each of the three time points. 

Convergent validity was assessed by averaging consecutive week values for every 

measure at each time point and performing Pearson correlations among the three 

modalities. 

rEsuLTs: Across the study period, PA estimates were 497±192 steps/day/hour, 

13.3±3.7 kcal/kg/hour, and 15853±5702 met.min/week. ICC (SEM) values for PED 

at 20 weeks, 32 weeks, and 12 weeks postpartum were 0.42 (126), 0.89 (53), and 0.86 

(93), respectively. Reliability of SA was lower than PED and PPAQ at all three time 

points (20 weeks=0.55 (1.3), 32 weeks=0.42 (1.2), postpartum=0.19 (2.8)). The PPAQ 

was more reliable across both pregnancy time points, compared to postpartum (0.88 

(3867) and 0.83 (3820) versus 0.57 (5592) for postpartum). Validity estimates were 

low and variable (-0.37-0.30). 

CONCLusIONs: Overall, reliability was acceptable for use of these measurement 

techniques to assess PA in free-living environments during pregnancy. However, 

convergent validity was poor among the three instruments. Poor validity could be 

a function of the three modalities measuring different constructs in a free-living 

environment. In addition, increasing the sample size of our ongoing investigation 

will allow further and more detailed evaluation of the relationship among these PA 

measurement modalities during pregnancy and postpartum. 

1168 Board #113 May 30, 8:00 AM - 9:30 AM 

Plasma Lipid Changes associated with Lifestyle Factors 

across Pregnancy 

Christina G. Campbell 1 , Courtney K. Blomme 1 , Diana R. 

DiFabio 1 , Kai Ling Kong 1 , Lorraine M. Lanningham-Foster 1 , 

Danielle J. Richardson 1 , Katie M. Smith 1 , William G. Thorland 2 . 

1 Iowa State University, Ames, IA. 2 Nurse Family Partnership, 

Denver, CO. (Sponsor: Gregory J. Welk, FACSM) 


Plasma lipid values are known to increase as pregnancy progresses, however the role 

that lifestyle factors may have on this physiological response during pregnancy is not 

well defined. 

PurPOsE: The purpose of this study was to evaluate potential factors that may 

influence the change in lipid values across pregnancy. 

METhOds: At weeks 18 and 35 of pregnancy, 57 women provided a fasted blood 

sample, 3-day weighed diet record, and wore an activity armband for a 7-day, 24hour 

period. Multiple regression analyses were conducted to evaluate the role of the 





following independent variables on lipids: body weight, pre-pregnancy body mass 

index (BMI), daily energy expenditure (EE), daily energy intake (EI), and weekly 

minutes of moderate-vigorous physical activity (MVPA) performed in ≥10-minute 

bouts. Measured plasma lipids included total cholesterol (TC), high-density lipoprotein 

(HDL), and triglycerides (TG); low-density lipoprotein (LDL) was calculated. In each 

regression model, the respective lipid values (TC, LDL, HDL, or TG) at week 18 were 

also entered as independent values to adjust for variation in the week 35 values. 

rEsuLTs: EI was 2145 ± 446 and 2320 ± 497 kcals/d; EE was 1714 ± 280 and 1811 

± 273 kcals/d; and MVPA was 171.5 ± 112.8 and 157.9 ± 143.9 min/wk at week 18 

and 35, respectively. While both TC (215.0 ± 36.3 and 267.1 ± 57.3 mg/dL at week 18 

and 35, respectively) and LDL (115.0 ± 30.5 and 154.4 ± 48.7 mg/dL at week 18 and 

35, respectively) levels at week 35 were related to corresponding lipid levels at week 

18 (P


and shoulder and pelvis tilt angle did not change significantly in both groups. The 

perceived health (from 4.24±1.08 to 3.06±0.81 in YG, from 4.31±0.99 to 3.29±0.72 in 

CG), self-esteem (from 5.01±0.41 to 3.98±0.64 in YG, from 5.50±0.80 to 4.27±0.77 

in CG), and general physical concept (from 3.43±0.64 to 3.04±0.94 in YG, from 

3.53±0.90 to 3.54±0.96 in CG) decreased significantly (p60 min/d), 

moderately active (15-59 min/d) or least active (0-15 min/d). 

rEsuLTs: Overall, one-third of the sample was overweight (17.2%) or obese 

(16.1%) and 62.5% did not meet the recommendation for MVPA of 60 min/d 

(43.7+1.8% in boys and 30.9+1.6 in girls). Furthermore, 18.5% of the total sample 

spent



(RT3, triaxial accelerometer) were collected for 3 days every 4 mo from age 3 to age 7 y 

from 2001-2006. Weather information (temperature maximum/minimum, precipitation, 

wind speed) from the local municipal airport was obtained from the US National 

Climatic Data Center and merged with 9,264 participant-days of PA data. Heating and 

cooling degrees, a measure used to estimate energy requirements for geographic areas 

in the form of degree days, were calculated using 65 degrees Fahrenheit (F) as a basis. 

Pearson correlation coefficients were calculated between PA variables (counts per minute 

(cpm), minutes Moderate/Vigorous PA) and weather variables. Multivariate regression 

was used to test the relationship between weather and PA. 

rEsuLTs: Temperatures ranged between -8 to 100 degrees F over the duration of 

the study. Mean daily precipitation was 0.1 inches and wind speed mean was 6 mph. 

Across the 5 years of the study, mean total PA was 609 ± 258 (standard deviation) and 

mean MVPA was 88 ± 57 minutes. Both TPA (r = -0.15) and MVPA (r = -0.16) were 

both significantly negatively correlated with cooling/heating degrees (P < 0.0001). 

They were significantly negatively associated with precipitation (r = 0.07 for both) 

and wind speed (r = -0.06 for both) (P < 0.0001). Heating/cooling degrees were 

significantly associated with TPA and MVPA independent of precipitation and wind 

speed. Each 10 additional heating/cooling degrees in the model was associated with 8 

minutes less MVPA. 

CONCLusIONs: More extreme weather (higher or lower temperatures, higher wind, 

more rain/snow) is associated with decreased physical activity in young children. 

As weather patterns become more extreme, PA interventions should be designed and 

tested with consideration of weather effects. 

Supported in part by grants: NIH NHLBI R01HL064022, NCATS KL2TR000078, & 

the CCHMC Heart Institute Research Core. 

1177 Board #122 May 30, 8:00 AM - 9:30 AM 

relationship Between Technology usage and health 

Behaviors among Late adolescents 

Bridget Melton 1 , Lauren Bigham 2 , Matthew Bird 1 , Helen 

Welle Bland 1 , Ciaran Fairman 1 . 1 Georgia Southern University, 

Statesboro, GA. 2 University of Georgia, Athens, GA. 


While previous literature has been limited in focus to screen time, little research has 

analyzed the various technology modalities in relation to specific health outcomes. 

PurPOsE: This study aimed to assess BMI, physical activity, sleep patterns, and 

nutrition with regards to technology use among adolescents in a rural southeastern 

region of the United States. 

METhOds: The study employed a quantitative, descriptive methodology that utilized 

non-probability, purposive sampling. On a technology-based survey, participants 

delineated technology usage by type and frequency, and reported on physical activity 

levels, sleep patterns, and specific dietary patterns (n=591). Current physical activity 

levels were ascertained by the IPAQ and health behaviors by questions from the 

American College Health Association Risk Assessment. 

rEsuLTs: Chi-Square analyses determined significant differences by technology use 

and physical activity levels and Body Mass Index. Participants reporting higher general 

Internet surfing were significantly more likely to be in low physical activity (p=0.014) 

and obese (p=0.050). ANOVA analyses found participants with lower general Internet 

use were significantly more likely to have higher levels of moderate (p=0.022) and 

vigorous (p=0.001) exercise. Walking was significantly correlated with higher social 

networking (p=0.005), Internet surfing (p=0.001) and television watching (p=0.013). 

Participants, who watched less TV, ate significantly higher daily amounts of fruits 

(p=0.006) and vegetables (p=0.054). Participants who used pedometers, heart rate 

monitors, nutrition trackers, Wii, and social networking for health and fitness reported 

significantly more fruit and vegetable consumption (p2.32, 

p


weekend screen time was obtained by combining questions for watching TV, watching 

DVDs or videos, video/computer games, and internet/computer usage. Two questions 

asked about phone use on weekdays and weekends. Response options ranged from 

“none” to “6+ hours” per day and weighted averages provided average weekly screen 

time and phone use. Participants reported demographics and perceived neighborhood 

environment. Measured height and weight were used to calculate Body Mass Index 

(BMI) z-score. The participant’s parent/guardian completed the Physical Activity 

and Media Inventory to assess the home screen media environment. Geographic 

Information Systems software was used to create a “walkability” score for a 1-mile 

buffer around the participant’s home. Hierarchical regression analyses were conducted 

to predict follow-up screen time and phone use. 

rEsuLTs: The full model for screen time, which controlled for baseline screen time 

and demographics, indicated that the size of the primary TV significantly predicted 

follow-up screen time (Coeff [SE]= 84.5 (43.01), p= 0.05). Marginally positive 

associations were detected for the percent of children’s bedrooms with TVs (Coeff 

[SE]= 76.6 [42.2], p= 0.07) and having cable service (versus no cable or no TV) (45.2 

[25.17], p= 0.07). For females’ phone use, baseline perceived lack of neighborhood 

safety (7.4 [3.49]) and BMI z-score (21.7 [10.24]) were both positively associated with 

follow-up phone use (both p=0.04). There were no significant predictors of phone use 

for males. 

CONCLusIONs: Home environment variables significantly predicted screen time for 

both genders while, for phone use, the neighborhood environment was influential for 

females. Interventions to reduce screen time may want to focus on changing the home 

environment while, for reducing phone use, the safety of the larger neighborhood may 

be an intervention target for female youth. 

1181 Board #126 May 30, 8:00 AM - 9:30 AM 

a survey of Physical activity and Medical Expense among 

Chinese College Freshmen 

Hongjun Yu 1 , Zhu Weimo, FACSM 2 , Zhang Chenggang 1 , Jun 

Qiu 1 . 1 Tsinghua University, Beijing, China. 2 University of Illinois 

at Urbana-Champaign, Illinois, IL. (Sponsor: Weimo Zhu, 

FACSM) 


PurPOsE: To investigate the relationship between physical activity (PA) and medical 

expense among the Chinese college freshmen. 

METhOds: 7 days’ self-report PA data of the freshmen from a major China research 

university (N = 3085, aged 18.2±0.9 yr., male = 2063& female = 1022; height = 

171.4±7.8 cm; weight = 62.6±13.6 kg& BMI = 21.2±3.8) were collected and analyzed 

using the International Physical Activity Questionnaires (IPAQ-short version). In 

addition, their medical expense during the previous year was also collected through 

self-reporting. The data were analyzed using both correlation and t-test. 

rEsuLTs: The Chinese college freshmen spent 89.46±104.27 min for vigorous PA 

192.49±179.21 min, for moderate PA and 64.35±110.92 min for walking. The mean 

of medical expense was 797.10 RMB with a SD of 755.21 RMB. The correlation 

between medical expense and vigorous, moderate, walking and siting were r = 0.211, 

0.133,0.051 r=-0.039, respectively. . When classifying medical expense into Q1-Q4 

groups (Q1=0 RMB, Q2=1-1000RMB, Q3=1001-3000RMB, Q4=3000+ RMB), it was 

found that those who spent less in medicine exercised more (Table 1) 

CONCLusION: There is a trend that college students who exercise more, especially 

vigorous PA, tend to spend less in medicine. 

Table 1 Descriptive statistics of PA by all four medical expense groups 

Groups Group 1 Group 2 Group 3 Group 4 

Category N Mean±SD N Mean±SD N Mean±SD N Mean±SD 

Vigorous(minutes/week) 135 111.3±125.8 2345 89.2±105.3 475 87.2±98.1 73 79.1±90.0 

Moderate(minutes/week) 135 186.5±157.2 2345 194.2±182.6 475 193.8±175.1 73 162.1±183.0 

Walk(minutes/week) 135 54.0±102.6 2345 62.2±108.6 475 74.7±123.4 73 79.0±117.4 

sitting(hours/day) 128 9.0±3.0 2292 9.2±8.3 463 9.1±2.7 71 8.9±2.9 

1182 Board #127 May 30, 8:00 AM - 9:30 AM 

The College alcohol Environment’s affect on student 

alcohol Consumption and Physical activity 

Mallory M. Koenings 1 , Kendra K. Kattelmann 2 , Melissa Olfert 1 . 

1 West Virginia University, Morgantown, WV. 2 South Dakota State 

University, Brookings, SD. 


This is an ancillary study of YEAH Project, a randomized controlled trial to investigate 

the effectiveness of a web-delivered, theory-based educational intervention to prevent 

excessive weight gain in college students. 

PurPOsE:To examine 1) associations between distance to the nearest alcohol outlet 

(AO) and alcohol outlet density (AOD) around students’ residences and their alcohol 

consumption; and 2) associations between students’ alcohol consumption and physical 

activity (PA). 


METhOds: Students on 13 campuses in January and February 2011 provided 

addresses (n=1491, 465 males, 982 females). Lists of active liquor licenses were 

obtained from city and state government agencies. Geographic Information Systems 

software was used to calculate distance from students’ residences to the nearest AO 

and AOD at six different radii (0.1, 0.25, 0.5, 1, 2, and 5 miles) surrounding student’s 

residences. Alcohol consumption was measured in terms of exceeding the 2010 

Dietary Guidelines for Americans (DGAs) recommendation for alcohol and binge 

drinking. PA was measured in terms of meeting the 2008 Physical Activity Guidelines 

for Americans (PAGs) for moderate (MPA) and vigorous (VPA). Multiple logistic 

regressions were used to test the associations listed above while adjusting for gender, 

region of the US, age, race/ethnicity, and smoking status. 

rEsuLTs: Students living more than 1 mile from the nearest AO were 2.6 times more 

likely not to binge drink compared to students who lived less than 0.25 miles from the 

nearest AO (OR=2.62, 95% CI= 1.43-4.82, p



by race/ethnicity, median household income and education. 

rEsuLTs: In urban block groups, 42.6% of U.S school-age youth had park access 

compared to those living in large rural (9.7%), small rural (6.5%) and isolated block 

groups (3.0%) Park access was higher in youth living in urban block groups, compared 

to those living in rural block groups, for all race-ethnic, education, and income 

categories (Table). Asian/Pacific Islanders had the greatest proportion of youth with 

park access while American Indian/Alaskan Native had the lowest proportion of youth 

with park access. In states with >80% of block groups classified as urban, median 

park access was 44.0% whereas states with


percentage of girls meet the HFZ for BC. With AC and BC for both boys and girls, 

among those students in the needs improvement categories, the majority of 

individuals were considered high risk. The prevalences of needing improvement 

in AC and BC are important considering the impact of childhood health-related 

fitness on risk of chronic disease and mortality in adulthood. 

1188 Board #133 May 30, 8:00 AM - 9:30 AM 

relationship between Waist Circumference and Body Mass 

Index in Chinese Children and adolescents 

Xiao Jian Yin 1 , Chen Ye Ji 2 , Liu Ji 3 , Qiang Guo 3 , Shi chang 

Li 3 , Sadayoshi Taguchi, FACSM 4 , Toyoho Tanaka 5 . 1 Key 

Laboratory of Adolescent Health Assessment and Exercise 

Intervention, Ministry of Education,East China Normal 

University, Shang Hai, China. 2 Institute of Child and Adolescent 

Health, Peking University Health Science Center, Beijing, 

China. 3 Key Laboratory of Adolescent Health Assessment 

and Exercise Intervention, Ministry of Education, Shang 

Hai, China. 4 Graduate School of Sport and Health Science, 

Ritsumeikan University, Kusatsu, Japan. 5 School of Health and 

Sports Sciences, Chukyo University, Toyota, Japan. (Sponsor: 

Sadayoshi Taguchi, FACSM) 


PurPOsE: To study the distribution of normal WC and provide a reference for 

the screening criteria of overweight and obesity in Chinese children and adolescent 

utilizing the BMI criteria for children and adolescents developed by WGOC (The 

Working Group on Obesity in China) as a standard. 

METhOds: 146,306 Han primary and middle school students aged 7-18 years old 

from 15 provinces or cities monitored by National Student Physical Health Survey 

in 2008 were recruited as subjects. Using BMI criteria for children and adolescents 

developed by The WGOC as the reference, the WC cutoff points of overweight and 

obesity in children and adolescents were analyzed with ROC curve (Receiver Operator 

Characteristic Curve). 

rEsuLTs: The correlation coefficients between BMI and WC were generally beyond 

0.8 for boys, and were beyond 0.7 for girls (except 7-year-old girls); For overweight 

category, WC cutoff point of 7-12 years boys were mainly at the 70th percentile 

(WC :57.0-69.0cm), for13-18 years were at the 75th percentile(71.5-77.0cm) , 

the sensitivities and the specificities were between 0.808-0.922 and 0.824-0.912, 

respectively. WC cutoff point of 7-8 years girls were mainly at the 75th percentile 

(56.3-58.1cm), and 9-18 years at the 80th percentile (61.5-72.4cm), the sensitivities 

and the specificities were between 0.770-0.905 and 0.811-0.983, respectively. 

For obesity category, WC cutoff point of 7-12 years boys were mainly at the 85th 

percentile (60.0-73.8cm), for 13-18 years at the 90th percentile (78.8-82.1cm), 

the sensitivities and the specificities were between 0.872-0.937 and 0.868-0.943, 

respectively. WC cutoff point of 7-10 years girls were mainly at the 85th percentile 

(59.1-65.3cm), and 11-18 years at the 90th percentile (70.1-76.5cm), the sensitivities 

and the specificities were between 0.789-0.936 and 0.881-0.932, respectively. 

CONCLusIONs: For overweight category, The WC cutoff points were proposed at 

the 70th percentile for 7-12 yrs boys, 75th for 13-18 yrs. The girls were proposed at 

the 75th percentile for 7-8 yrs, 80th for 9-18 yrs. For obesity category, The WC cutoff 

points before the puberty were proposed at the 85th percentile, and after the puberty 

(boys of 13 years old, girls of 11 years old in China) at the 90th percentile. 

1189 Board #134 May 30, 8:00 AM - 9:30 AM 

Continuous Metabolic syndrome risk score and Time 

Expended In Moderate To Vigorous Physical activity In 

adolescents 

Wagner De Campos1 , Antonio Stabelini Neto2 , Géssika 

Castilho dos Santos3 , Sergio G. da Silva1 , Oldemar Mazzardo 

Jr. 1 . 1Universidade Federal do Paraná, Curitiba, Pr, Brazil. 

2Universidade Estadual do Norte do Paraná, Jacarézinho, Pr, 

Brazil. 3Universidade Estadual do Norte do Paraná, Curitiba, 

Pr, Brazil. (Sponsor: Carlo Baldari, FACSM) 


PurPOsE: To associate the continuous risk score for metabolic syndrome with time 

spent engaging in moderate to vigorous physical activity (MVPA) among adolescents. 

METhOds: The study involved 391 participants, aged 10 to 18 years. Physical 

activity was measured by accelerometry. The counts obtained in the different activities 

were transformed into metabolic equivalents (METs) and classified as light (≥ 1.5 but < 

3.0 METs), moderate (≥ 3.0 but < 6.0 METs) and vigorous (≥ 6.0 METs) activities. The 

continuous risk score for metabolic syndrome was calculated using the following risk 

factors: waist circumference, blood pressure, blood glucose, HDL-C and triglycerides. 

The statistical analyses used were the t-test, Pearson correlation, ANOVA and ROC 

curve. 

rEsuLTs: Time spent in MVPA was inversely associated with the continuous risk 


score for metabolic syndrome (p 20.2 kg/m 2 in 6 th graders and BMI>23.4 kg/m 2 in 10 th graders). After four years 

of implementation of the CSHEC, BMI was assessed in the then 10 th grade males, 

and respectively, in the study and control groups 41.5% and 70.6% were categorized 

as either overweight or obese. To analyze the data, BMI values were converted to 

percentile rankings (consistent with CDC BMI-for-age-guidelines) and a statistical 

t-test (p



compared to those with later AR, adjusting for age and gender. After adjustment for 

potential confounders associations weakened but still remained for BMI (very early 

AR β = 0.70, 95%CI 0.35 to 1.05, p=


METhOds: Staff (N=51) from three child care centers in rural North Carolina 

completed a survey addressing current PA habits as well as barriers to PA and PA selfefficacy. 

PA questions included weekly moderate and vigorous PA participation (min/ 

wk of each intensity calculated) and resistance training (yes/no). Participants reported 

their top five barriers to PA and rated their PA self-efficacy with a standard scale 

(summary score calculated: 0-1400). Basic demographics included education level 

and knowledge of PA guidelines for children and for adults. Height (cm), weight (kg), 

blood pressure and waist and hip circumferences (cm) were measured and disease risk 

classification determined. Descriptive statistics were calculated. 

rEsuLTs: With regards to PA, 76.9% reported any participation in moderate PA 

and 30.8% any vigorous PA. However, only 26.7% moderate activity participants 

achieved 150 minutes or more of moderate intensity activity while 73.3% vigorous 

activity participants achieved 75 minutes or more of vigorous PA. Additionally, only 

17.3% perform resistance training. The top barriers to PA participation included: not 

enough time, too tired, and lack of motivation. PA self-efficacy was moderate with 

a summary score of 910.0±274.6. While 83.7% reported having some knowledge of 

physical activity recommendations for children and youth, 71.2% had some knowledge 

of recommendations for adults. Almost half (48.1%) were classified as increased risk 

based on BMI and waist circumference and 51.8% were pre-hypertensive. 

CONCLusIONs: Child care staff are minimally active and moderately confident 

in their ability be physically active. In addition, while they are knowledgeable about 

PA recommendations they tend to struggle to participate in PA due to time constraints 

related to their occupation. With the increased emphasis on understanding potential 

influences of childhood obesity, including child care staff PA behaviors, is warranted. 

1197 Board #142 May 30, 8:00 AM - 9:30 AM 

associations between Physical activity and Other healthrelated 

Behaviors in a National sample of College students 

Mary K. Dinger, FACSM, Danielle R. Brittain, Susan R. 

Hutchinson. University of Northern Colorado, Greeley, CO. 


Understanding the relationships between sufficient amounts of physical activity 

(PA) and other health-related behaviors is important for professionals who design 

interventions to promote PA in college students. 

PurPOsE: The purpose of this study was to examine the associations between PA 

and other health-related behaviors in a national sample of college students. 

METhOds: College students from 157 campuses in the United States completed the 

National College Health Assessment during the 2008-2009 academic year. Participants 

were categorized as meeting the current PA recommendation if they engaged in ≥ 75 

minutes of vigorous PA, ≥ 150 minutes of moderate PA, or ≥ 150 minutes of moderate 

to vigorous PA weekly. Hierarchical binary logistic regression was used to examine 

the contribution of variables in predicting whether or not participants met the PA 

recommendation. Variables were entered into the model in three steps. Step 1 included 

gender, age and race; step 2 included club and intramural sports participation; and 

step 3 included 14 health-related behavior/characteristic variables (general health, 

seatbelt use, physical fighting, smoking, marijuana use, binge drinking, prescription 

drug misuse, number of sexual partners, fruit and vegetable consumption, depression, 

suicide ideation, stress, sleep and BMI). A Bonferroni-adjusted alpha of .0026 was 

used to assess significance. 

rEsuLTs: There were 67,861 students (67.6% female, 72.9% white) included in the 

analysis. All of the variables entered into the model at steps 1 and 2 were significant. 

The addition of the 14 health-related variables at step 3 resulted in a statistically 

significant improvement in the model, χ2 (14, N = 67,861) = 1779.23, p < .001, Cox 

& Snell R2 = .06. The highest adjusted odds ratios (AOR) were for fruit and vegetable 

consumption (AOR = 2.81) and perceived general health status (AOR = 1.75). Use 

of marijuana, prescription drug misuse, contemplating suicide and stress level did not 

contribute significantly to the model (p > .0026). 

CONCLusION: Demographic, sports participation and 10 of the 14 health-related 

variables significantly predicted meeting the PA recommendation in this national 

sample of college students. 


C-33 Exercise is Medicine/Poster - Exercise 

is Medicine - Implications for Body 

Composition 

May 30, 2013, 7:30 AM - 12:30 PM 

Room: Hall C 

1198 Board #143 May 30, 8:00 AM - 9:30 AM 

Behavioral Changes Laterly resulted after Lifestyle 

Changing: Impacts On Fitness, diet and Metabolic 

syndrome 

Roberto Carlos Burini, Edilaine Michelin, Muriel Siqueira, 

Fernando Moreto, Katia Cristina Portero-McLellan. UNESP, Sao 

Paulo, Brazil. 


PurPOsE:The aim of the study was to evaluate the remaining impact of 6 month 

of lifestyle changing program (LISC) on physical activity, fitness, dietary quality and 

metabolic syndrome (MetS) frequency after step down of the re-education program 

METhOds:From an ongoing longitudinal program of LISC 153 subjects adults 

(54.2 + 9.0 yrs, 71.2% < 60 yrs), 80% females, 69,2% married fullfiled the ethical 

and inclusion criteria for the intervention with supervised daily exercises (aerobic 

walking - 3x/wk and strength-2x/wk, associated with dietary counseling). Assessment 

included body anthropometry, clinical, blood biochemistry, physical activity (PA) by 

(IPAQ), fitness (VO2max, trunk flexibility and hand grip strength) healthy eating index 

(HEI) and MetS diagnosis (NCEP ATPIII, 2004). Moments and groups were compared 

statistically with p



26.6% and boys in the HFZ group increased by 12.9% across the three years, whereas 

the number of S2 boys in the at-risk or HFZ group did not change. As for girls, 

although numbers of at-risk girls in both schools increased, S1 had a much smaller 

increase rate (10%) than S2 (50%). Finally, the ANCOVA did not identify betweenschool 

differences in %BF at the follow-up (p > .40) controlling for baseline data. 

CONCLusION: Relatively large amount of MVPA in PE classes impacts more 

positively on students’ %BF against FITNESSGRAM HFZ, and examining changes in 

%BF against HFZ is a meaningful way to track %BF for youth. 

1200 Board #145 May 30, 8:00 AM - 9:30 AM 

Effect Of Exercise Training Modality On abdominal Fat 

reduction In Obese Persons 

Haifeng Zhang1 , Tom K. Tong2 , Jingjing Wang1 , Shaosheng 

Liu1 , Yuxiu He1 . 1College of Physical education, Hebei Normal 

University, Shijiazhuang, China. 2Department of Physical 

Education, Hong Kong Baptist University, Hong Kong, China. 


High-volume continuous training (CT) program at moderate intensity is one of the 

fundamental strategies for obesity control. Recently, interval training (IT) program, 

which is a time-efficient modality, was reported to be effective to induce similar 

favourable metabolic adaptations associated with traditional CT. However, it was 

not known if the IT program could benefit obese people in fat control (visceral and 

subcutaneous fat) in the same way as that resulting from the CT. 

PurPOsE: To compare the changes in abdominal visceral (AVFA) and subcutaneous 

(ASFA) fat areas in obese adults resulting from an IT program and that from a CT 

program with equivalent training load. 

METhOds: 24 obese women were evenly assigned into two groups to complete a 

12-week (4 day/wk) exercise program. In IT group, subjects (21±1 yrs, 31.3 ±3.6%fat) 

performed four 4-min interval treadmill running at 85-95% of peak heart rate (HR ) peak 

interspersed by 3-min walking at 50-60% of HR and 7-min rest. In CT group, 

peak 

subjects (20.6±1.2 yrs, 32.0±2.4% fat) participated in training consisted of continuous 

run at 60-70% of HR for 33 mins representing equivalent training load as IT group. 

peak 

10-min warm-up and 5-min cool down exercise at 50-60% of HR were identical 

peak 

in the two groups. All subjects maintained their normal diet habit during the entire 

experiment. Computed tomography scans obtained at the L4-L5 disc-space were 

used to determine AVFA and ASFA. Whole-body %fat was assessed by bioelectrical 

impedance. 

rEsuLTs: Subjects’ characteristics of the two groups were similar pre-training. 

After training, similar reductions in body weight (IT: 66.4 ±9.3 vs 61.2 ±8.4 kg; CT: 

64.8 ±6.1 vs 60.3 ±5.8 kg, p 110 mg/dl and 

resting blood pressure > 130/85 mm Hg. Aerobic exercise participation was determined 

by self reported activity from a standard health history questionnaire. Subjects were 

classified for aerobic exercise participation as: aerobic exercise participation of less 

than or equal to 1 day per week (LOW), 2 to 3 days per week (MOD), and aerobic 

exercise participation greater than or equal to 4 days per week (HIGH). 

rEsuLTs: The subjects were divided into groups based on the level of weekly 


aerobic activity. All data were analyzed using a Chi Square test (p < 0.05). Of the 177 

firefighters tested 46.3% (82) reported LOW, 48% (85) reported MOD, and 5.6% (10) 

reported HIGH weekly aerobic activity. The prevalence of Metabolic Syndrome for 

LOW was 25.6% (21) while the prevalence of Metabolic Syndrome for MOD was 

15.3% (13). No one in the HIGH group met the criteria for Metabolic Syndrome. 

CONCLusIONs: Participation in aerobic exercise appears to affect the incidence of 

metabolic syndrome in adult male fire fighters. 

1202 Board #147 May 30, 8:00 AM - 9:30 AM 

relationship Between site-specific Muscle Loss Of The Thigh 

and One-leg standing Balance In Women: The hiregasaki 

study 

Takashi Abe1 , Madoka Ogawa2 , Jeremy P. Loenneke3 , Robert 

S. Thiebaud3 , Mark Loftin, FACSM1 , Naotoshi Mitsukawa2 . 

1 2 University of Mississippi, Oxford, MS. Toyo Gakuen University, 

Nagareyama, Japan. 3University of Oklahoma, Norman, OK. 


Balance ability is a significant predictor of injurious falls. Recently, we reported 

that sarcopenia is observed as a site-specific loss of muscle mass, especially for the 

quadriceps muscles. However, it is unknown whether there is significant correlation 

between site-specific muscle loss of the thigh and static balance ability. 

PurPOsE: To investigate the relationship between age-related site-specific loss of 

thigh muscle and one-leg standing balance. 

METhOds: Fifty-two women aged 52-83 years (mean age, 66 [SD 7] years) 

volunteered. Muscle thickness (MTH) was measured by ultrasound at 3 sites on the 

anterior (30% and 50% of thigh length) and posterior (70% of thigh length) aspects of 

the thigh. MTH ratios were calculated to assess the site-specific sarcopenia (anterior 

30%:posterior 70% MTH [A30:P70 MTH] and anterior 50%:posterior 70% MTH 

[A50:P70 MTH]). For the one-leg standing balance test, subjects were instructed to 

start in a position with a comfortable base of support, with eyes open, and with arms by 

the side of the trunk and then to stand unassisted on any one leg. The test was timed in 

seconds from the time one foot was lifted from the floor to when it touched the ground 

or the standing leg, with a longer time (up to 120 seconds) indicating better balance 

ability. Maximum voluntary isometric knee extension strength was also measured. 

The differences between three balance ability groups (less 60 seconds [n=16, G1], 

60 to 120 seconds [n=10, G2], and over 120 seconds [n=26, G3]) were tested for 

significance using a one-way analysis of variance. Pearson product correlations were 

performed to determine the relationships between age, MTH ratios, isometric strength, 

and one-leg standing balance. 

rEsuLTs: Age was inversely correlated with ratios of A30:P70 MTH (r=−0.389, 

P


59.8 ± 1.3% lean, p ≤ 0.03). Fat oxidation was higher for YOGA at rest vs CON (T0: 

58 ± 3.8 vs 46 ± 3.0%; T6M: 52.3 ± 3.1 vs 44.7 ± 3.3%, p ≤ 0.05). Dominant hand-grip 

strength tended to be greater for YOGA vs CON (T0: 36.3 ± 3.8 vs 30.4 ± 2.0 kg, p = 

0.08; T6M: 37.4 ± 3.9 vs 30.7 ± 2.4 kg, p = 0.07). Timed one leg balance was longer 

for YOGA on both legs compared with CON (T0: 56.0 ± 2.4 vs 45.5 ± 4.7 right leg, 

52.0 ± 3.8 vs 39.4 ± 5.2 sec left leg, p ≤ 0.04; T6M: 57.3 ± 2.7 vs 46.1 ± 4.0 right leg, 

54.7 ± 2.8 vs 43.6 ± 3.7 sec left leg, p < 0.02). 

CONCLusIONs: Routine vinyasa yoga appears beneficial for maintaining healthy 

weight and body composition. The unique finding of higher resting fat oxidation for 

YOGA combined with better balance and the tendency for improved upper body 

strength suggest that yoga may maintain function and LBM over time. Research 

regarding yoga’s potential as an alternative mode of exercise in models of healthy 

aging is warranted. 

1204 Board #149 May 30, 8:00 AM - 9:30 AM 

adopting a Modest-Intensity Exercise Program Can Improve 

Metabolic health in Obese adults Even Without Weight- 

Loss 

Rachael K. Nelson, Jeffrey Horowitz, FACSM. University of 

Michigan, Ann Arbor, MI. 


Many metabolic health benefits of a vigorous exercise program are evident even 

after the first exercise session. However, vigorous exercise is not well tolerated by 

many obese patients, and early adaptations in markers of metabolic health soon after 

adopting a more modest exercise program are not well defined. 

PurPOsE: To characterize key adaptations in glucose and fatty acid metabolism in 

the first 2 weeks of a modest-intensity exercise program in obese adults. 

METhOds: 9 sedentary obese adults (men/women: 3/6; 38±2 kg/m2; 30±3 yrs) 

participated in 3 experimental trials: 1) before beginning the exercise program 

(“PRE”), 2) after a single session of modest-intensity exercise (40min at 60% HRmax), 

and 3) after 2 weeks (6 days/wk) of this same exercise (“2WKS”). We performed 

a meal tolerance test (MTT) 1h after exercise (or without prior exercise in “PRE”) 

to calculate established indices of insulin sensitivity in liver (0-30min area-undercurve 

for glucose × insulin) and muscle ((Δglucose/Δtime) ÷ [Insulin]). The day after 

exercise, we performed a hyperinsulinemic-euglycemic clamp to assess peripheral 

insulin sensitivity. We also measured fatty acid (palmitate) rate of disappearance from 

plasma (Palm Rd) and total fatty acid oxidation (FAO). 

rEsuLTs: A single session of exercise did not significantly alter any of our primary 

outcome measures. However, by 2WKS our MTT revealed an improvement in our 

index of hepatic insulin sensitivity (42±16 vs. 33±11; P≤0.05) but improvement in 

the MTT index of muscle insulin sensitivity did not quite reach statistical significance 

(2.2±0.5 vs. 2.5±0.3; P=0.07). Peripheral insulin sensitivity measured the day after 

exercise was not different between PRE and 2WKS (8.1±1.1 vs. 9.2±1.5; P=0.75). In 

contrast, FAO was greater the day after exercise at 2WKS vs. PRE (4.2±0.3 vs. 3.6±0.2 

µmol/kgFFM/min; P=0.04), without a change in plasma fatty acid uptake (Palm Rd: 

3.1±0.2 vs. 2.9±0.2 µmol/kgFFM/min, P=0.66). Importantly, all adaptations were 

independent of any change in body mass (109±5 vs. 109±5 kg). 

CONCLusION: Although a single 40 min session of exercise performed at 

60%HRmax was not sufficient to induce any measurable changes in our metabolic 

markers, we did find improvements in meal tolerance in obese adults after 2 weeks of 

this modest exercise program without any weight loss. 

1205 Board #150 May 30, 8:00 AM - 9:30 AM 

Changes in Body Composition, Bone Mineral density, 

Muscle strength and Functional ability following Exercise 

Training in Old adults 

Matthew Scott 1 , Neil M. Johannsen 1 , Michael A. Welsch, 

FACSM 1 , Daniel P. Credeur 2 , Tim S. Church, FACSM 3 , Eric 

Ravussin 3 , Jason D. Allen, FACSM 4 . 1 Louisiana State University, 

Baton Rouge, LA. 2 University of Missouri, Columbia, MO. 

3 Pennington Biomedical Research Center, Baton Rouge, LA. 

4 Duke University Medical Center, Durham, NC. 


PurPOsE: To determine effects of 8 wks of progressive whole-body training (WBT), 

preceded by 4 wks of regional specific (RSTS) or aerobic exercise training (AE), on 

body composition (lean mass (LM) and bone mineral density (BMD)), muscle strength 

and functional ability. 

METhOds: Subjects (Age: 75±5yrs, n=57), who scored between 218-490 yrds on a 

6-min walk test, were randomized to AE or RSTS for 4 wks (Phase 1). AE consisted of 

45min of walking/biking at 40-60% of HRR, 3 d/wk. RSTS consisted of specific calf, 

thigh, buttocks, arms, shoulders, and torso exercises. Exercises were performed for 3-5 

min, at 40-70% of maximal strength of the muscle group of interest, for 45min, 3 d/wk. 

Subjects were progressed as tolerated. After Phase 1, subjects advanced to WBT using 

established guidelines (Phase 2). Body composition (DXA), muscle strength (Sum of 

chest/leg press, seated row and handgrip (TOT)) and functional ability (Senior Fitness 

Test (SFT)) was examined before, after 4 and 12 wks. 


rEsuLTs: Table I indicates a time effect for bodyweight (p=0.002), fat mass 

(p=0.09), leg LM (p=0.003), pelvic BMD (p=0.005), and SFT % rank (p=0.0001). 

There was a grp*time effect (p=0.006) for TOT, thoracic (p=0.02) and lumbar BMD 

(p=0.09). Change in TOT and pelvic BMD (r=0.32, p=0.03) were related. 

CONCLusION: Progressive WBT resulted in decreased body weight and fat mass, 

and increased leg LM and SFT scores. Both groups showed gains in strength and 

BMD, with the magnitude of change greater in those using RSTS during phase 1. This 

suggests RSTS serves as a significant local stimulus for rapid musculoskeletal gains, 

and the importance of WBT to improve functional ability in frail elderly. 

This Research was supported by NIH (1RC1AG035822-01-Dr. Jason D. Allen (PI)) 

1206 Board #151 May 30, 8:00 AM - 9:30 AM 

Exercise and Bone Mineral density in Premenopausal 

Women: a Meta-analysis of randomized Controlled Trials 

George A. Kelley, FACSM 1 , Kristi S. Kelley 1 , Wendy M. 

Kohrt, FACSM 2 . 1 West Virginia University, Morgantown, WV. 

2 University of Colorado Denver, Aurora, CO. 


Maintaining optimal bone mineral density (BMD) during the premenopausal years is 

important for reducing the risk of osteoporosis and subsequent fractures during the 

postmenopausal years. Previous randomized controlled trials addressing the effects 

of joint and/or ground reaction force exercise on femoral neck (FN) and lumbar 

spine (LS) BMD in premenopausal women have led to conflicting and less than 

overwhelming results. 

PurPOsE: Examine the effects of exercise on FN and LS BMD in premenopausal 

women. 

METhOds: Meta-analysis of randomized controlled exercise trials >24 weeks in 

premenopausal women. Standardized effect sizes (g) were calculated for each result 

and pooled using random-effects models, Z-score alpha values, 95% confidence 

intervals (CI) and number-needed-to-treat (NNT). Heterogeneity was examined using 

Q and I-squared. Moderator and predictor analyses using mixed-effects ANOVA and 

simple meta-regression were conducted. Statistical significance was set at p



mineral content [BMC], bone mineral density [BMD], and BMD z-score [BMDz]) of 

the lumbar spine, hip, and full body minus the head (body). 

rEsuLTs: Bivariate correlations showed that SED was negatively associated with 

hip BMDz (r=-0.557; p=0.016). LPA was positively associated with hip BMDz 

(r=0.484; p=0.042). MPA had positive associations with hip BMD (r=.569, p=.014), 

hip BMDz (r=.656, p=.003), and body BMDz (r=.636, p= .005). MVPA had positive 

influences on hip BMDz (r= .589, p=.010), hip BMD (r=.566, p=.014), body BMC 

(r=.509, p=.031), and body BMDz (r=.539, p=.021). VPA was positively associated 

with spine BMC (r=.516; p=.034). 

CONCLusIONs: These results show multiple positive associations between MVPA 

and bone density in PWS youth. Interestingly, VPA was associated with only one bone 

parameter, possibly due to the low amount of VPA in these PWS youth (~10 min). 

The negative association between activities that are sedentary and hip BMDz supports 

the notion that in addition to insufficient PA, excessive sitting can also negatively 

influence BMD. Similar to other youth, PA of moderate plus vigorous intensity must be 

encouraged and sedentary activities discouraged in this population despite the inherent 

low stamina in PWS. 

Supported by USAMRAA Award W81XWH-09-1-0682 

C-34 Free Communication/Poster - Gene 

Expression and Cell Signaling 

May 30, 2013, 7:30 AM - 12:30 PM 

Room: Hall C 

1208 Board #153 May 30, 9:00 AM - 10:30 AM 

Monocarboxylate Transporter-1 Expression at the Onset of 

skeletal Muscle regeration 

Dameon A. Smith, Tyrone A. Washington. University of Arkansas, 

Fayetteville, AR. (Sponsor: Stavros Kavouras, FACSM) 


Skeletal muscle is extremely plastic and has the remarkable ability to recover from 

injury. In diseases, such as muscular dystrophy, regeneration of skeletal muscle is 

impaired. Monocarboxylate transporters, or MCTs, are involved with lactate transport 

across the cell membrane. This transport has important implications for the energetic 

efficiency of skeletal muscle. MCT expression is known to be affected by skeletal 

muscle hypertrophy, chronic electrical stimuli, and voluntary wheel running. However, 

the cellular regulation of MCT1 protein expression at the onset of skeletal muscle 

regeneration has not been determined. 

PurPOsE: To determine the protein and gene expression of MCT1 at the onset of 

skeletal muscle regeneration. 

METhOds: Twelve male C57/BL6 mice (12 weeks old) were randomly assigned to 

either a control (uninjured) or bupivacaine (injured) group. Bupivacaine was injected 

into the tibialis anterior (TA) of the injured group, and phosphate buffered saline (PBS) 

was injected into the TA of the uninjured group. 3 days post-bupivacaine injection the 

TA was extracted. MCT1 protein and gene expression were determined. 

rEsuLTs: A 12% decrease in TA muscle mass to tibia length (2.43 ± 0.12 mg/mm vs. 

2.14 ± 0.19 mg/mm, p < 0.02) was observed 3 days post-bupivacaine injection. IGF-1 

gene expression increased 5.0-fold (p < 0.05) 3 days post-bupivacaine injection. MyoD 

gene expression increased 3.5-fold (p < 0.05) 3 days post-bupivacaine injection. MCT- 

1 gene expression was not altered 3 days post-bupivacaine injection. However, MCT-1 

protein was decreased 32% (p < 0.03) 3 days post-bupivacaine injection. 

CONCLusION: In conclusion, at the onset of skeletal muscle regeneration MCT1 

protein is decreased and this appears to be regulated at the post-transcriptional level. 

1209 Board #154 May 30, 9:00 AM - 10:30 AM 

Oxidative stress results In Telomere shortening In Isolated 

skeletal Muscle Fibers 

Andrew T. Ludlow, Espen E. Spangenburg, Eva R. Chin, 

Wen Hsing Cheng, Stephen M. Roth, FACSM. University of 

Maryland, College Park, MD. 


We have recently provided evidence that long-term voluntary exercise in rodents 

results in shorter skeletal muscle telomeres compared to young and age-matched 

sedentary animals. The mechanism of telomere shortening induced by long-term 

exercise is currently unknown. We hypothesized that reactive oxygen species induced 

by muscle contractions could induce oxidative stress and damage telomeres resulting 

in non-replicative based telomere shortening. 

PurPOsE: The purpose of our investigation was to 1) Determine the response of 

skeletal muscle telomeres to oxidative stress, and 2) Determine if basal telomere length 

influences telomere dynamics in response to oxidative stress. 

METhOds: Flexor digitorum brevis muscles were dissected from 15 male C57BL/6 

(long telomere) and 20 male CAST/Ei (wild-derived, short telomere) mice and 

dissociated into single fibers. Fibers were cultured in physiological oxygen (2-5%) for 


5 days in the presence or absence of hydrogen peroxide (oxidant), or a combination 

of N–acetylcysteine (antioxidant) and hydrogen peroxide. Telomere length, telomerase 

activity, and protein content of telomere-repeat binding factors 1 and 2 (TRF1 and 

TRF2; important for telomere protection) were determined. 

rEsuLTs: In isolated skeletal muscle fibers of both mouse strains, oxidative stress 

resulted in significant telomere shortening. Telomerase enzyme activity was not altered 

by oxidative stress but was different between strains, with greater telomerase activity 

in long-telomere C57BL/6 mice (p < 0.01). TRF1 protein content was increased in 

CAST/Ei fibers that were exposed to the combination of hydrogen peroxide and N– 

acetylcysteine. In hydrogen peroxide -treated C57BL/6 fibers TRF2 protein content 

was increased compared to control fibers but this was attenuated in the presence of 

N–acetylcysteine. 

CONCLusIONs: Strain-specific telomere length dictates the response of telomere 

protective proteins to oxidative stress, with long-telomere mice responding by 

increasing expression of TRF2 and short telomere mice up-regulating expression of 

TRF1. These data suggest a mechanism by which increased oxidative stress during 

exercise induces shorter skeletal muscle telomere lengths. 

FuNdING AG000268 and CA124334 A.T. Ludlow. 

1210 Board #155 May 30, 9:00 AM - 10:30 AM 

Mechanical Modulation Of The Mtor Pathway Is dependent 

upon The Magnitude Of Cyclic Compressive Load 

Emily H. Brownell, Sarah Abshire, Esther Dupont-Versteegden, 

Timothy A. Butterfield. University of Kentucky, Lexington, KY. 

(Sponsor: Thomas M. Best, FACSM) 


Massage is a therapeutic tool that has been used clinically to facilitate muscle recovery, 

decrease soreness, and reduce muscle edema. The underlying mechanisms for its 

beneficial effects are not well known, but one effect of massage that has been noted 

sporadically and anecdotally in the literature is a potential to decrease atrophy. If 

massage can attenuate the loss of muscle mass and associated muscle function, then 

manual therapies may prove to be an effective a means to facilitate an earlier return to 

normal function. 

PurPOsE: To test the hypothesis that p70s6k phosphorylation will increase 

following cyclic compressive loading (CCL, a massage-mimetic), and is dependent 

upon the magnitude of applied load. 

METhOds: Fifteen male Wistar Rats were divided into three groups, and the right 

tibialis anterior muscle was subjected to one bout of 30 minutes massage-mimetic 

loading. Group 1 (N=6) received CCL of 1.4 N, Group 2 received CCL of 4.5 N, and 

Group 3 served as a pure control. Tissues were harvested six hours post CCL. 

rEsuLTs: Following massage-mimetic loading, the mTOR pathway was 

significantly upregulated compared to controls (p=0.042). Post-hoc analysis revealed 

the upregulation of pp70s6k was significantly increased in the 4.5N load compared to 

the control group (5.132au +/- 1.528 au compared to 2.898 au +/- 1.145 au., p=0.017). 

There was also a trend for greater upregulation of the mTOR pathway following 

massage with the 4.5N load compared to massage with the 1.4N load (5.132au +/- 

1.528 au compared to 3.909 au +/- 0.511 au., p=0.088). Applied massage of 1.4N load 

did not result in a difference in upregulation of pp70s6k when compared to the control 

limbs (3.909 a.u +/- 0.511 a.u., compared to 2.898 +/- 1.145 a.u., p=0.2334), indicating 

a load dependent response of the mTOR pathway. 

CONCLusION: Applying a massage-mimetic to muscle tissue resulted in an increase 

in phosphorylation of p70s6k (pp70s6k), a protein marker that directly induces protein 

synthesis. Phosphorylation of p70s6k is notably increased in a load dependent manner, 

and is significantly upregulated following CCL of 4.5 N in healthy rat muscle. This 

indicates that massage may be an effective intervention to attenuate muscle atrophy 

through upregulation of mTOR pathway and its downstream targets. Funded by an 

NATA Osternig Research Award. 

1211 Board #156 May 30, 9:00 AM - 10:30 AM 

mTOr Pathway activation Following resistance Exercise 

with Vibration in human subjects 

Michael G. Leavitt, J. Brent Feland, David M. Thomson, Gary 

W. Mack, FACSM, Daniel S. Nelson, Brenda Benson, Allen C. 

Parcell, FACSM. Brigham Young University, Provo, UT. 


Functional adaptations in human skeletal muscle following a period of resistance 

exercise are the result of regular activation of cellular signaling pathways that elevate 

muscle protein synthesis. It has been reported that the addition of whole body vibration 

(WBV) to a resistance exercise program enhances performance. Such improvements 

in muscle function may be the result of increased activation of cellular signaling 

pathways associated with muscle growth. 

PurPOsE: We have investigated whether an acute bout of resistance exercise in 

combination with WBV results in a greater activation of the mTOR signaling pathway 

compared to resistance exercise alone. 

METhOds: Eight untrained college-age males (23±2 yrs, 179±1 cm, 75±2.5 kg, and 

12.6±1.8% body fat) performed unilateral leg press exercises with (Vbx) and without 

(RT) vibration. Muscle samples were obtained from the vastus lateralis muscle pre- 



exercise (baseline) and one-hour following the bout of resistance exercise. Muscle 

tissue samples were analyzed for phosphorylated levels of mTOR, p70S6K, and 4E- 

BP1 proteins. 

rEsuLTs: One-hour following the resistance exercise bout there were no differences 

between phosphorylated levels of mTOR or 4E-BP1 in Vbx or RT (p>0.05). Levels 

of phosphorylated p70S6K were increased at the one-hour post-exercise time-point in 

both Vbx (22±9 fold increase, p



(RR vs. RX/XX) had different methylation pattern following five weeks of training in 

both exercise protocols. AE+RE, 8,981 CpG sites (5952 genes), and RE, 3,432 CpG 

sites (2550 genes) had different methylation pattern between the 2 genotype groups. 

CONCLusION: As hypothesized, ACTN3 R577X genotype has a significant effect 

on the methylation profile in skeletal muscle at baseline and following five weeks of 

exercise training. Our findings suggest that ACTN3 R577X genotype can influence 

epigenetic signature and skeletal muscle response to exercise. 

This work was supported in part by the National Space Biology Research Institute 

NSBRI, NCC 9-58-70, MA01601 (Adams), UL1TR000153, and by NICHD/NINDS 

5R24HD050846-08: NCMRR-DC Core Molecular and Functional Outcome Measures 

in Rehabilitation Medicine. 

1216 Board #161 May 30, 9:00 AM - 10:30 AM 

Exercise Increases Insulin sensitivity related To Obesity By 

reducing The Pro-Inflammatory Biomarkers In rat skeletal 

Muscle 

Leandro P. Moura1 , Luciana S. Pauli2 , Eduardo R. Ropelle2 , 

Dennys E. Cintra2 , Rodolfo Marinho1 , Eliete Luciano1 , Maria 

Alice R. Mello1 , José Rodrigo Pauli2 . 1UNESP, São Paulo State 

University, Rio Claro, Brazil. 2Campinas University State, 

Limeira, Brazil. 


INTrOduCTION: Among non-pharmacological therapies for the treatment of 

Diabetes Mellitus stands out the regular practice of physical exercises. 

PurPOsE: The present study investigated the effects of physical exercise on proinflammatory 

proteins and insulin signaling in skeletal muscle of obese rats. 

METhOds: In order to analyze the effects of administration of high fat diet, young 

Wistar rats (1 month old) were divided into 3 groups: control (C) rats treated with 

standard chow and Sedentary (SO) and Trained Obese (TO) were fed with high 

fat diet during 8 weeks. The TO group was submitted to two sessions of 1 hour of 

swimming exercise with 30 min interval between them. The body weight, epididymal 

fat, insulin sensitivity (Kitt), glucose and insulin were measured. In skeletal muscle 

(gastrocnemius) the activity of the insulin signaling pathway such as analysis of 

insulin receptor (IR), insulin receptor substrate 1 (IRS-1) and protein kinase B (Akt) 

were analyzed. It was also analyzed in the gastrocnemius muscle expression of 

proinflammatory proteins such as Jun N-terminal kinase (JNK), IKappa kinase beta 

(IKKβ) and Toll Like Receptor (TLR-4). 

rEsuLTs: The results show that acute exercise did not alter the body weight of 

this animals, but was effective in decreasing the inflammatory process in obesity and 

improve insulin sensitivity by improving the activity of key proteins of the signaling 

cascade via this hormone. 

CONCLusION: It is concluded that acute exercise can reduce the inflammation 

induced by obesity regardless of body mass reduction. 

1217 Board #162 May 30, 9:00 AM - 10:30 AM 

acute Normobaric hypoxia Blunts The Blood Glucose Peak 

after a high-glycemic Meal In humans 

Gommaar D’Hulst, Ruud Van Thienen, Peter Hespel, Louise 

Deldicque. KU Leuven, Leuven, Belgium. 


In muscle cells glucose transport is regulated by insulin and by stimuli that increase the 

demand for glucose such as contraction and hypoxia. Those latter stimuli are known to 

induce the translocation of GLUT4 vesicles from the cytoplasm to the cell membrane 

via, amongst others, the activation of PKB and/or AMPK. Unlike for insulin and 

contraction, much less is known about how hypoxia regulates glucose metabolism and 

induces GLUT4 translocation in human skeletal muscle. 

PurPOsE: To investigate the molecular mechanisms by which hypoxia regulates 

glucose transport in human skeletal muscle. 

METhOds: According to a randomized cross-over study, 15 healthy men 

participated in 2 experimental sessions separated by a 4-week wash-out period. After 

a standardized, high glycemic breakfast (65% carbohydrate, 29% fat and 6% protein, 

glycemic load: 56g), subjects were subjected in random order to either 4 hours of 

normoxia (NOR) or severe hypoxia (11% O2, HYP). Biopsies were taken at the start 

(T0), after 1h (T60) and at the end of the trial (T240). Arterial blood saturation (SpO2) 

was measured by pulsoximetry. Phosphorylation status and mRNA level of various 

molecular regulators involved in glucose metabolism were measured by Western Blot 

and qPCR, respectively. 

rEsuLTs: Mean SpO2 dropped from 99.0 ± 0.2% in NOR to 75.0 ± 2.0% in HYP. 

Blood glucose peaked ~60min after termination of breakfast in both NOR and HYP, 

but the peak was more pronounced in NOR (after 30min: NOR, 113.8 ± 5.4 mg.dl-1 

vs. HYP, 102.2 ± 4.7 mg.dl-1, p < 0.10; after 60 min: NOR, 113.8 ± 5.4 vs. HYP, 89.5 

± 4.7 mg.dl-1, p < 0.05; after 90 min; NOR, 97.2 ± 3.7 vs. HYP, 85.6 ± 4.8 mg.dl-1, 

p < 0.05). There were no differences between conditions in plasma insulin at T0 and 

T60. In contrast, at T240, when blood glucose had returned to baseline levels, plasma 

insulin was ~2-fold higher in HYP compared to NOR (p < 0.05). Phospho-PKB 

(Ser473) followed the insulin pattern almost completely, with no differences between 


conditions at T0 and T60, and a ~2-fold higher phosphorylation in HYP at T240 (p < 

0.05). Phospho-AMPK (Thr172) and HIF-1α at protein or mRNA level did not differ 

between conditions or with time. 

CONCLusIONs: Acute systemic hypoxia rapidly blunts the peak in blood glucose 

after a high glycemic meal independently of plasma insulin concentrations and PKB 

and AMPK phosphorylation. 

1218 Board #163 May 30, 9:00 AM - 10:30 AM 

autophagy In Muscle Of Mice during Exercise In a Fasted 

Or In a Fed state 

Marc Francaux, Damien Naslain, Hélène Gilson, Cécile Jamart. 

Université catholique de Louvain, Louvain-la-Neuve, Belgium. 


PurPOsE: Recent findings suggest that activation of autophagy in skeletal muscle is 

essential for inducing beneficial effects of exercise in mice fed with a high fat diet (He 

et al. Nature 481 :511-5, 2012). As autophagy is also activated by food deprivation and 

as exercising in a fasted state is a common practice in endurance athletes, we designed 

a study the purpose of which was investigating various markers of autophagy in 

skeletal muscle of mice running in a fasted or fed state. 

METhOds: Thirty-six C57BL6/R3 female mice, 12 weeks old, were divided into 

4 groups. Eight animals were fed ad-libitum (NE-Fed) and 8 others were kept fasted 

(NE-Fasted) for 9h30 before being anesthetized and then sacrificed. The 16 other 

mice were submitted to an exercise of 1H30 on a treadmill at a speed of 10m/min, 

which corresponds to moderate intensity exercise for those mice. Half of the mice 

performed the exercise in a fasted state (Ex-Fasted) and the other half was fed ad 

libitum (Ex-Fed). Mice were anesthetized immediately after exercise completion and 

the gastrocnemius muscles were removed. Soluble proteins were extracted for Western 

blotting analyses. Plasma insulin concentration was assayed by ELISA. An ANOVA 

design was used to assess the statistical significance of the differences between the 

means. When appropriate, a Bonferroni test was applied as a post-hoc. 

rEsuLTs: As expected, fasting and exercise lowered plasma insulin concentration, 

which was the lowest in Ex-Fasted. The highest values of LC3b-II, ATG12 and 

GABARAP-I and the lowest value of p62 were observed in Ex-Fasted indicating 

that autophagy is more activated in this condition than in Ex-Fed and in NE-Fasted. 

The phosphorylation state of Ulk-1 (ser757) that controls the initiation of autophagy 

was also more decreased in EX-Fasted in comparison with the other conditions. 

Ulk-1 is controlled by mTORC1 whose activity was decreased as assessed by the 

phosphorylation state of two downstream targets (S6K1 and 4EBP1). mTORC1 is 

under the control of both AMPK and PKB. AMPK was unaffected in all conditions 

whereas PKB followed the changes observed in plasma insulin concentrations. 

CONCLusION: Exercising in a fasted state is an efficient strategy to activate 

autophagy in mice. This activation seems related to the decrease in plasma insulin 

concentration. 

1219 Board #164 May 30, 9:00 AM - 10:30 AM 

Cachectic skeletal Muscle response To a Novel Bout Of Low 

Frequency stimulation 

Melissa Puppa, James Carson, FACSM. University of South 

Carolina, Columbia, SC. 


Cachexia is a condition of skeletal muscle wasting associated with an underlying 

disease. It is commonly associated with a loss in muscle function. While we have 

demonstrated exercise training benefits related to cachexia-induced muscle and body 

weight loss, the cachectic muscle’s response to an acute bout of exercise is unknown. 

PurPOsE: The purpose of this study was to determine if cachectic mice are able to 

respond to an acute bout of low frequency muscle stimulation (LoFS). 

METhOds: Cachectic ApcMin/+ (Min) and wild type (WT) mice had the left leg 

undergo a simulated endurance exercise bout, while the right leg served as the intraanimal 

control. The siatic nerve was stimulated for one second at 10Hz every other 

second for thirty minutes. Mice were sacrificed 3h after completion of the protocol. 

rEsuLTs: Min mice exhibited a 13.8±2.9% decrease in body weight from peak 

weight and gastrocnemius muscle mass was significantly reduced compared to WT 

mice (p


C-35 Free Communication/Poster - Pain, RPE and 

Fatigue 

May 30, 2013, 7:30 AM - 12:30 PM 

Room: Hall C 

1220 Board #165 May 30, 9:00 AM - 10:30 AM 

The Effect of submaximal Isometric Exercise to Fatigue on 

Pressure Pain Threshold in the Finger 

Alexander R. Gonglach, Brandon K. Tynes, Dwight E. Waddell, 

Mark Loftin, FACSM, Christopher D. Black. University of 

Mississippi, University, MS. 


Exercise reduces pressure pain thresholds (PPT) in muscles, especially those 

activated during the exercise bout. The effect(s) in non-contracting tissue are less well 

characterized and limited due to methodological considerations. 

PurPOsE: The purpose of this study was to examine the effects of isometric exercise 

to fatigue with the knee extensors on PPT in the finger. 

METhOds: Data were collected on 25 males (age: 19-29 yrs). Testing consisted 

of participants holding 25% of maximal voluntary contraction (MVC) with the knee 

extensor muscles until fatigue. Fatigue was defined as a force declining >10% below 

the target force. PPT was assessed before, 2-minutes and 15-minutes following 

exercise in the middle finger on the right hand using a pressure algometer. Applied 

force was progressively increased until participants indicated the stimulus moved from 

being “uncomfortable” to “faintly painful.” 

rEsuLTs: Prior to exercise PPT was 5.5±2.6 kg/cm^2. Following exercise, PPT 

showed a trend toward an increase (p=0.087) with values increasing to 6.2±2.4 and 

5.8±2.5 kg/cm^2 at 2-minutes 15-minutes post-exercise, respectively. 

CONCLusIONs: The results of the present study indicated fatiguing isometric 

exercise with the knee extensors did not alter pressure pain threshold in the finger 2 

minutes and 15 minutes post-exercise. Indicating exercise restricted to a single muscle 

group may not significantly alter central pain processing in a manner sufficient to alter 

pain sensitivity in a more distant tissue. 

1221 Board #166 May 30, 9:00 AM - 10:30 AM 

a randomized, Controlled, Crossover study Investigating 

the repeated Bout Effect of Eccentric Exercise 

Mahdi Hosseinzadeh, Ole K. Andersen, Lars Arendt-Nielsen, 

Pascal Madeleine. Aalborg University, Aalborg, Denmark. 

(Sponsor: Jonathan Myers, FACSM) 


Pain experienced after unaccustomed eccentric exercise induces delayed onset muscle 

soreness (DOMS). However, eccentric exercise training (ECC) is suggested to have a 

protective effect on subsequent bouts of ECC, known as repeated bout effect (RBE). 

PurPOsE: This randomized controlled crossover study tested the protective effect of 

repeated bouts of ECC using both subjective and objective pain assessment methods. 

METhOds: 16 healthy students (age 25.7 ± 0.6 years, BMI 24.8 ± 1kg.m-2) 

participated in the study. Two identical bouts of high intensity eccentric exercises 

(ECC1 and ECC2) on tibialis anterior (TA) muscle were performed 7 days apart. 

Control sessions were performed 4 weeks apart from the exercise sessions in a 

randomized and balanced design. Pressure pain thresholds (PPTs) as a subjective 

outcome, and the nociceptive withdrawal reflex threshold (NWRT) as an 

electrophysiological outcome, were recorded before, immediately after, and the day 

after both exercises. 

rEsuLTs: Deep tissue sensitivity measured by PPT decreased significantly at two TA 

muscle belly sites by 59% and 66% the day after ECC1 compared to baseline (P



RPE despite contraction mode (ECC or CON). Validation of the relation between 

RPE and muscle activation was further supported. Results suggest ECC loads ranging 

from 30-70% of 1-RM are altered by time under tension. This preliminary evidence 

reveals how time under tension impacts effort during ECC loads for the knee extension 

exercise. 

1224 Board #169 May 30, 9:00 AM - 10:30 AM 

relationship Between student and Observer rPE during 

Fitness activities in a Physical Education setting 

Kristen M. Lagally, FACSM, Kim Walker-Smith, Deborah A. 

Garrahy, Skip M. Williams, Mary L. Henninger. Illinois State 

University, Normal, IL. 


PurPOsE: The purpose of this investigation was to examine the relationship between 

ratings of perceived exertion (RPE) reported by students and RPE estimated by a 

trained observer during physical education class. 

METhOds: As part of the fitness unit of physical education class, students in grades 

six through eight (N=78; Mean age = 12.3+.88 years) performed cardiovascular and 

muscular endurance exercises in a circuit format. Each exercise lasted between two 

and three minutes. Heart rate from a Polar monitor, and both overall body (RPE-O) and 

active muscle RPE (RPE-AM) from mode-specific OMNI-Child scales were recorded 

by the students. An observer trained in physical education separately estimated overall 

body and active muscle RPE of students using an exertional observation technique. All 

measures were recorded at the end of the exercise bout. 

rEsuLTs: Relationships were examined using bivariate correlation coefficients. 

For the cardiovascular exercise, correlations between observer and student ratings 

were r=0.47 (p


However, exercise has been shown to increase pain sensitivity in clinical pain 

populations. 

PurPOsE: Delayed-onset muscle soreness (DOMS) approximates clinical pain; thus 

the purpose of this study was to examine the effects of fatiguing isometric exercise on 

PPT in the presence and absence of DOMS. 

METhOds: Data were collected on 23 males (age: 19-29yrs). Following 

familiarization, baseline testing (no DOMS) was performed. Eccentric exercise was 

then performed to induce DOMS, and all tests were repeated 48-hours later when 

DOMS was present. Participants held 25% of maximum voluntary contraction (MVC) 

until fatigue, defined as force declining >10% below the target force. PPT was assessed 

in the left and right rectus femoris at the mid-point between the patella and ASIS prior 

to, every 30 seconds during, and 2 and 15-minutes post exercise. 

rEsuLTs: No condition x time interactions were found for either the ipsilateral 

(p=0.81) or contralateral (p=0.61) thigh nor was a main effect for condition found 

(p=0.65). A main effect for time was found with PPT being elevated during (p≤0.001) 

and after exercise in the ipsilateal thigh (p≤0.039), but only during exercise in the 

contralateral thigh (p≤0.002). 

CONCLusIONs: Unlike clinical pain, DOMS had no effect on the PPT response 

exercise in either the ipsilateral or contralateral thigh. Increases in PPT during exercise 

in both thighs suggests a centralized alteration in pain sensitivity. The restriction of 

post-exercise effects to the contracting thigh suggests a localized mechanism due to 

contraction may be at play. 

1229 Board #174 May 30, 9:00 AM - 10:30 AM 

Work distribution Influences session rPE during resistance 

Exercise 

Justin A. Kraft1 , James M. Green, FACSM2 , Tyler M. Gast1 . 

1 2 Missouri Western State University, St. Joseph, MO. University 

of North Alabama, Florence, AL. 


Previous research has indicated that session ratings of perceived exertion (RPE) are 

sensitive to changes in both total work volume and work rate (total work/unit time) 

during resistance training. 

PurPOsE: This study examined the influence of work distribution (varied load, set, 

and repetitions (reps)) on session RPE in two resistance exercise trials matched for 

total work volume and work rate. 

METhOds: Participants were tested for their one repetition maximum (1RM) on the 

bench press, lat pull down, overhead press, upright row, triceps extension, and biceps 

curl. Participants then completed a low load/high rep (LLHR) trial (2 sets x 12 reps x 

3 min recovery at ~60% 1RM) and a high load/low rep (HLLR) trial (3 sets x 6 reps x 

1.5 min recovery at ~80% 1RM) of each exercise that differentiated work distribution 

but equated work volume and rate. One warm-up set of 12 reps at ~40% 1RM was 

completed prior to the bench press. A standard 2 min recovery separated each exercise 

in both trials. Session RPE and recovery heart rate (HR) were recorded 20 min after 

exercise. Differences were considered significant at the p ≤ 0.05 level. 

rEsuLTs: Pre-set RPE and post-set RPE were significantly lower for LLHR vs. 

HLLR (2.1 ± 1.4 vs. 3.0 ± 1.9) and (4.6 ± 0.8 vs. 5.8 ± 1.0) respectively despite 

matched total volume and work rate. Pre-set HR (96 ± 11 bpm vs. 105 ± 16 bpm) and 

post-set HR (128 ± 12 bpm vs. 137 ± 16 bpm) were significantly higher for HLLR 

when compared to LLHR. Session RPE results indicated the LLHR trial was perceived 

as significantly easier (4.5 ± 1.3) vs. the HLLR (5.8 ± 1.6) trial. No difference in 

recovery HR (20 min post) was observed between trials (86 ± 8 bpm (LLHR) vs. 85 ± 

11 bpm (HLLR)). 

CONCLusIONs: Session RPE was sensitive to changes in work distribution and 

increased with increased load even when total volume and work rate were matched. 

Significantly higher pre-set RPE and pre-set HR in HLLR may indicate differences in 

recovery between sets. Significantly higher post-set RPE and post-set HR in HLLR 

indicated increased difficulty of individual sets in the HLLR trial. Differences in 

recovery and individual set difficulty likely contributed to session RPE differences. 

Differences in session RPE despite no difference in recovery HR indicate that session 

RPE is sensitive to variation in work distribution but is estimated independently of 

recovery HR. 

1230 Board #175 May 30, 9:00 AM - 10:30 AM 

do division III Cross Country runners Experience the 

Intended Coach Prescribed Training Impulse (TrIMP)? 

Mitchell A. Hagen1 , Colleen E. Bouchard2 , Jacquie M. 

Donohue2 , Mary C. Stenson3 , Don V. Fischer3 . 1Saint John’s 

University, Collegeville, MN. 2College of Saint Benedict, Saint 

Joseph, MN. 3College of Saint Benedict /Saint John’s University, 

Saint Joseph and Collegeville, MN. 


Cross country coaches create training plans to induce desired adaptations. However, 

research suggests athletes do not consistently train as the coach prescribed. 

PurPOsE: To examine the relationship between coach intended, athlete-perceived, 

and physiological training impulses (TRIMPs) during recovery, slow long distance, 


tempo, and interval training performed by 14 Division III female cross country 

runners. 

METhOds: A TRIMP weighting scale and an associated rate perceived exertion 

(RPE) scale were created for each athlete based on the individual’s blood lactate 

curve. Heart rate data were collected using Polar Team System heart rate (HR) 

monitors during a two week in-season period; athletes were blinded to the HR data. 

Physiological TRIMPs were calculated by multiplying time spent in each HR zone by 

the assigned weighting factor. Coach intended TRIMPs for each practice session were 

calculated by multiplying the time spent training by the weighting factor associated 

with the prescribed session RPE. . The athlete perceived TRIMPs for each practice 

session were calculated by multiplying the time spent training by the weighting factor 

associated with the athlete-perceived session RPE. 

rEsuLTs: One-way ANOVA revealed significant differences between the coach 

intended, athlete-perceived, and physiological mean TRIMPs for recovery [(F (2,204) 

= 3.359, p < .05], tempo [(F (2, 75) = 19.034; p < .001)], and interval [(F (2, 55) = 

4.161, p .05)]. Least Significant Difference post-hoc testing revealed a significant difference 

(p < .05) in the mean coach intended (52.52 ± 29.73) and physiological (65.80 ± 32.50) 

TRIMPs during recovery training. Post-hoc testing also revealed significant differences 

(p < .001) in the mean coach intended and athlete perceived TRIMPS during tempo (C: 

109.87 ± 26.54; A: 62.77 ± 30.37) and interval training (C: 72.17 ± 38.16; A: 41.93 ± 

26.21). 

CONCLusION: During recovery sessions, participants ran at intensities greater than 

that prescribed by the coach. During tempo and interval training, athletes ran at the 

coach indicated intensity, but perceived themselves to be training at a lower intensity. 

Closer monitoring of training intensity may be needed to ensure the appropriate 

training stimulus is achieved. 

1231 Board #176 May 30, 9:00 AM - 10:30 AM 

Effect of the Exercise setting on Body Consciousness, Body 

satisfaction and social Physique anxiety in Females 

Isaura Castillo-Hernández 1 , Vanessa Smith-Castro 2 , Walter 

Salazar-Rojas 1 , José Moncada-Jiménez 3 . 1 University of Costa 

Rica, San José, Costa Rica. 2 Psychological Research Institute 

(IIP), UCR, San José, Costa Rica. 3 Human Movement Sciences 

Laboratory (LACIMOV), UCR, San José, Costa Rica. 


The beneficial effects of exercise programs are widely recognized; however, the use of 

mirrors in the exercise setting might counteract the positive acute and chronic effects 

of resistance training programs. 

PurPOsE: To examine the acute and chronic effects of a resistance training program 

performed with and without mirrors on the social physique anxiety (SPA), objectified 

body consciousness (OBC; body surveillance [BS], body shame [BSH] and appearance 

control beliefs [ACB]), body segment satisfaction (BSS), and body image satisfaction 

(BIS; actual figure [AF] and desired figure [DF]) of sedentary females. 

METhOds: Volunteers were 52 females (Mean age = 22.6 ± 5.15 yrs.) randomly 

allocated in four experimental groups: a) 25-min resistance training exercise in front of 

a mirror at 70% 1RM; b) 25-min resistance training exercise at 70% 1RM, no mirror; 

c) 25-min passive table games in front of a mirror; and d) 25-min passive table games, 

no mirror. Participants performed one session per week in their respective experimental 

condition for six weeks and filled the Social Physique Anxiety Scale, the Objectified 

Body Consciousness Scale, the Multidimensional Body Self Relations Questionnaire 

(Body Segment Satisfaction subscale) and the Contour Drawing Rating Scale, at the 

beginning (pre-test) and at the end of the program (post-test). BIS was computed as the 

difference between the AF minus the DF scores. 

rEsuLTs: Three-way analysis of variance revealed a significant main effect (p = 

0.027) in the acute AF between females performing exercise (M = 6.15 ± 0.38) and 

those performing table games (M = 4.92 ± 0.39). Significant main effects were found 

for chronic exercise on BS (Pre-test = 4.54 ± 0.21 vs. Post-test = 4.26 ± 0.19; p = 

0.360), experimental paradigm on AF (Exercise = 6.12 ± 0.36 vs. Table games = 4.98 

± 0.37; p = 0.032), measurement time on the DF (Pre-test = 4.34 ± 0.16 vs. Post-test = 

4.68 ± 0.17; p = 0.36) and measurement time on BIS (Pre-test = 1.15 ± 0.22 vs. Posttest 

= 0.93 ± 0.19; p = 0.046). No significant interactions or main effects were obtained 

for the acute or chronic effects on SPA, BSH, ACB, BSS, and SPC. 

CONCLusIONs: No acute or chronic effect of a resistance training program 

performed with or without mirrors was observed on body consciousness, body 

satisfaction and social physique anxiety in sedentary females. 

1232 Board #177 May 30, 9:00 AM - 10:30 AM 

The rating of Fatigue scale (rOF) 

Abdulaziz Al Salman 1 , Alan St Clair Gibson 2 , Dominic 

Micklewright 1 . 1 University of Essex, Colchester, United 

Kingdom. 2 Northumbria University, Newcastle, United Kingdom. 


PurPOsE: Perceived exertion scales represent how ‘hard’ an exercise feels but not 

how ‘fatigued’ an athlete feels. Measuring perceived fatigue may be advantageous in 





monitoring overtraining, tiredness in the build up to a race, between bouts of exercise 

or during recovery. These studies developed a rating of fatigue scale (ROF) 

METhOds: A 0-11 scale, 12 adjectives and 12 pictures were presented independently 

to 18 participants at 100 s intervals during a graded cycling test to exhaustion and 30 

minutes during recovery. Blood lactate (BLc), oxygen uptake (VO2), heart rate reserve 

(HRR) and RPE were also measured. The five adjectives and pictures used to construct 

the ROF were the modal ones given by participants at the numeric points of 0, 2/3, 

5, 7/8 and 10. ROF scores were correlated with various physiological measurements, 

RPE and time to exhaustion to ascertain validity. Various ratings of ROF face validity 

were taken from 95 participants, using a scale of 0 (low) to 4 (high). 

rEsuLTs: The ROF scale, established through modal responses, is presented in 

Figure 1. A strong association was found between ROF and RPE (r-mean= 0.992, 

P


1236 Board #181 May 30, 9:00 AM - 10:30 AM 

Intensity Thresholds For aerobic Exercise-induced 

hypoalgesia To Pressure, Prolonged Thermal, and Temporal 

summation Pain responses 

Kelly M. Naugle, Keith E. Naugle, Brian Samuels, Joseph L. 

Riley, 3rd. University of Florida, Gainesville, FL. 


Despite many studies investigating exercise-induced hypoalgesia, there is limited 

understanding of the optimal intensity of aerobic exercise in producing these effects 

across different types of pain stimuli. Given that not all individuals are willing or 

capable of engaging in high intensity aerobic exercise, whether moderate intensity 

aerobic exercise is associated with a hypoalgesic response and whether this response 

generalizes to multiple pain induction techniques needs to be substantiated. 

PurPOsE: To test for differences in the magnitude of pressure and thermal pain 

modulation induced by moderate (MAE) and vigorous (VAE) intensity aerobic exercise. 

METhOds: Eleven healthy males (age=24±5 yrs) and 11 females (age=20 ±1 yrs) 

completed one training session and three testing sessions consisting of 25 minutes 

of either 1) stationary cycling at 70% heart rate reserve (HRR), 2) stationary cycling 

at 50% HRR (MAE), or 3) quiet rest (control). Pain testing was conducted on both 

forearms prior to and immediately following each condition and included the following 

tests: pressure pain threshold (PPT) and suprathresholds (PPS), 30 s prolonged heat 

stimulus, and temporal summation (TS) of late pain responses to thermal stimuli (i.e., 

increased pain evoked by repetitive stimuli at a constant intensity). Subjects rated 

pain using a 0-100 visual analogue scale. A Sex × Forearm × Time ANOVA with 

repeated measures on Forearm and Time was conducted on each pain measure for each 

condition. 

rEsuLTs: No significant results were found for the control condition. PPT’s were 

increased following MAE (pre=2.96kg±.98, post=3.17kg ±1.14; p



(Compared to Weekday)< 0.05


of 2% when averaged out across the two experimental conditions. The use of music, 

regardless of its motivational qualities, resulted in higher self-reported motivation as 

well as more dissociative thoughts. 

1244 Board #189 May 30, 9:00 AM - 10:30 AM 

Treatment of shoulder Impingement syndrome Pain 

Richard Radnovich1 , Arnold Gammaitoni2 , Jeremiah Trudeau3 , 

Thomas Marriott4 . 1Injury Care Medical Center, Boise, ID. 2Nuvo Research, West Chester, PA. 3Analgesic Solutions, Natick, MA. 

4Nuvo Research, Salt Lake City, UT. 

Supported by r. radnovich: Consulting Fee; Nuvo Research. Contracted 

Research - Including Principle Investigator; Nuvo Research. 

Patients treated twice daily for 14 days with the heated lidocaine/tetracaine patch 

(“HLT patch”) for acute musculoskeletal pain associated with shoulder impingement 

syndrome (SIS) demonstrated clinically important decreases in pain and functional 

improvement in an open-label pilot study. 

PurPOsE: To compare the efficacy of the HLT patch with a single corticosteroid 

injection in the treatment of SIS pain in a 6-week, open-label study. 

METhOds: Patients with SIS of ≥14 days duration with an average pain score of ≥4 

(0 to 10 scale) were enrolled in the study and randomized to treatment with a single 

HLT patch twice daily for 14 days or to a single subacromial corticosteroid injection. 

After 2 weeks, patients in the HLT patch group could continue with treatment on 

an as-needed basis for an additional 2 weeks. After 4 weeks no additional treatment 

was allowed. At baseline and at 2, 4, and 6 weeks patients rated their pain and pain 

interference with specific activities (0 to 10 scale). 

rEsuLTs: Sixty patients enrolled in the study (average age=51, range 18 to 75, n=21 

female). Patients in the HLT patch group averaged 1 patch/day during the 2 weeks of 

as-needed treatment. Average pain scores at baseline were similar in the HLT patch 

(6.0, n=29) and injection (5.6, n=31) groups. Twenty-three patients in each group 

completed the study. Both per-protocol groups demonstrated a significant (P



in TUG (6%; P=0.01), stride length (3%; P=0.008), single limb support time (1.3%; 

P=0.006), balance confidence (5.2%; P


rEsuLTs: Both groups significantly improved between each pre/post trial. The 

children improved 0.7007 seconds (p=.00188) and the adults improved .9632 seconds 

(p=.00365). 

CONCLusIONs: Results show that subjects in this investigation saw positive effects 

from physical stimulation on the receptors of the feet. This study suggests that those 

experiencing balance deficiencies, such as the elderly population, may benefit from 

daily brushings of the feet. 

1251 Board #197 May 30, 9:00 AM - 10:30 AM 

Concurrent Validity Of Two Postural stability Tests In a 

healthy Population 

A. Page Glave1 , Jennifer J. Didier1 , Jacqueline Weatherwax1 , 

Casidhe Leonard1 , Sarah Barragan1 , Robert Fiasco1 , Vanessa 

Fiaud2 . 1Sam Houston State University, Huntsville, TX. 2West Texas A & M University, Canyon, TX. 


The Biodex Balance System Limits of Stability Test (LOS) and Star Excursion Balance 

Test (SEBT) are described as measuring dynamic aspects of balance. Practitioners 

tend to base test choice on their assessment of face validity in relation to the desired 

outcome. This is commonplace with psychomotor testing, but it is important to 

establish concurrent validity to ensure the same construct is being assessed. 

PurPOsE: To examine concurrent validity of LOS and SEBT. 

METhOds: Healthy adult participants (n = 31) were randomly assigned to different 

testing orders to randomize the order of tests within the LOS and SEBT tests. LOS 

was tested under more stable (12) and less stable (6) conditions using the moderate 

setting. SEBT was tested on the right and left legs. Following practice, three trials 

were obtained on both tests. LOS scores were averaged using the system protocol, 

which does not control for height in dynamic tests. Outliers were eliminated for SEBT 

scores and scores were averaged. SEBT directions were offset by 180o to approximate 

similar movement patterns to LOS direction. The ipsilateral leg score was used for 

the diagonal and frontal directions; bilateral scores were combined for the anterior 

and posterior directions on the SEBT. Subjects’ height affects balance, thus partial 

correlations were used to examine the relationship between SEBT and LOS while 

controlling for height. SAS 9.2 was used to analyze the data. 

rEsuLTs: Height was directly related to all directions for SEBT (r = 0.53 – 0.59, p 

< .01) and inversely related to some directions for LOS (6: right – r = -0.41, back – r 

= -0.41, back left – r = -0.36; 12: front – r = -0.39, back left – r = -0.53; all p ≤ .05). 

There were no significant partial correlations between SEBT and LOS scores. Partial 

correlations were negative for all directions between SEBT and LOS except for 270o 

and right at a platform setting of 12 on the LOS (rSEBT, LOS. H = 0.09, p = .71). 

CONCLusIONs: It appears the SEBT and LOS assess different balance constructs, 

though both involve dynamic balance. Using these tests could identify different 

balance deficiencies and/or potential injury risks. Additional research is needed to 

determine and define what specific constructs of balance are being assessed. 

1252 Board #198 May 30, 9:00 AM - 10:30 AM 

Effect of Water Immersion and Jet resistance on Postural 

sway 

Matt Baldwin, Talin Louder, Breanna Studenka, Eadric Bressel. 

Utah State University, Logan, UT. 


Assessment of postural sway or balance is a common practice in athletic rehabilitation 

and special populations. Researchers have postulated that water immersion has an 

effect on balance due to buoyancy, in part, but the extent of this effect has not been 

determined. 

PurPOsE: To quantify the effect of water depth and water jet intensity on measures 

of postural sway. 

METhOds: Ten healthy participants (female = 5, male = 5: Age = 24.1 ± 3.6 years; 

weight = 721.5 ± 222.6 N) volunteered for the study. Postural sway measurements 

were collected using a waterproof force plate (20 Hz) as participants stood quietly for 

90 s, with eyes open, in a double support stance under the following conditions: Land 

and water immersion at the level of the greater trochanter (GT) and xiphoid (XI). At 

the xiphoid water depth, participants were also perturbed by underwater jets at three 

intensities (20%, 40%, and 60%). The area covered by the trajectory of the center of 

pressure was computed as a 95% confidence ellipse which served as the dependent 

measure in the study. The effect of water depth and jet intensity on the 95% ellipse was 

determined using repeated-measures ANOVA with follow-up comparisons. 

rEsuLTs: There was a significant main effect (F = 36.68, p = 0.0001) and followup 

comparisons revealed that the 95% ellipse area was greater for GT and XI depths 

(6.76 ± 4.31 cm2 and 13.4 ± 5.14 cm2, respectfully) when compared to land (3.13 ± 

2.48 cm2). Differences were also observed across jet intensities (20% = 14.81 ± 4.98 

cm2, 40% = 32.67 ± 10.55 cm2, 60% = 76.65 ± 24.42 cm2, p = 0.003 - 0.026) except 

between the 0%/xiphoid condition and the 20%/xiphoid condition (p = 0.530). 

CONCLusION: Water immersion and jet intensity have a significant effect on 

balance. Based on the results of this study, balance becomes progressively more 

challenging with increasing water depth and jet intensity. However, no significant 

change was observed when comparing no jet resistance to 20% jet intensity. Therefore, 


in clinical applications where desired functional outcomes include improvement in 

postural stability, water immersion to the XI and jet intensities at or above 40% may be 

more effective than land therapies in stimulating postural sway. 

1253 Board #199 May 30, 9:00 AM - 10:30 AM 

Familiarization Trial Needed When Measuring Postural 

sway with a Mobile device 

Carina A. Staab, Elizabeth J. Epps, Jeremy A. Patterson, 

FACSM. Wichita State University, Wichita, KS. 


The latest Smartphone’s have built-in motion sensors called a tri-axis accelerometer. 

One of the clinical measures that can take advantage of this technology is balance 

assessment. Previous studies assessing balance show the need for familiarization. 

PurPOsE: The purpose of this study was to determine if a familiarization test was 

needed when using Smartphone devices to measure balance. 

METhOds: 49 healthy individuals (18 male, 31 female; 23.1±2.6 years) performed a 

bilateral, tandem, and single leg balance tests. A barefoot familiarization was recorded 

for the 3 stances, and then follow-up testing was done in barefoot, five-toed shoes, and 

athletic shoes. All trials consisted of 10-second measures with eyes closed and were 

random in order. A commercially available Smartphone was used to determine postural 

sway. One trial was completed for each test with an average of 4-minute rest between 

trials. 

rEsuLTs: Significant differences were demonstrated between familiarization and 

each of the assessments that followed (barefoot p=0.007; five-toed shoes p=0.023; 

athletic shoe p=0.028). No differences were observed between barefoot and five-toed 

shoes (p=0.576), barefoot and athletic shoes (p=0.521), or five-toed shoes and athletic 

shoes (p=0.901). 

CONCLusION: Outcomes of this study show that balance data measured with a 

mobile device requires a familiarization trial. This is in agreement with previous 

publications using laboratory based balance assessment equipment and shows that 

familiarization is necessary when assessing balance regardless of equipment used. 

This may also suggest good consistency with Smartphone technology but should to be 

studied further. 

1254 Board #200 May 30, 9:00 AM - 10:30 AM 

Influence Of age On Balance Initiation 

Karen Roemer 1 , Stephanie Hamilton 2 , Louisa Raisbeck 2 . 

1 Central Washington University, Ellensburg, WA. 2 Michigan 

Technological University, Houghton, MI. 


Single Leg Stance (SLS) is often used as a test in clinical settings to assess balance 

disorders and risk of falling in various age groups (Berg, 1989; Jonsson et al., 2004). 

Establishing the SLS requires controlled transfer of weight from one base of support 

to another, which has been shown to deteriorate with age for various activities such as 

gait, unrestricted stance, or sit-to-stand movements (Jonsson et al., 2007; Prado et al., 

2011). Little is known about the age related effects on the early phase of establishing 

a SLS. 

PurPOsE: This study aims to investigate the effect of age on the early phase of 

balance initiation during a SLS. 

METhOds: Twenty-three subjects (Y: n=15, Mean + SD; Age= 22.5 + 3.4; Wt= 63.2 

+ 10.5 kg; Ht = 168.9 + 9.3 cm; O: Y: n=8, Mean + SD; Age= 67.6 + 4.1; Wt= 63.2 + 

13.9 kg; Ht = 162.6 + 10.4 cm) who were considered healthy with no previous injuries 

or history of falls performed a SLS on a force plate. Subjects were instructed to stand 

behind the force plate and to perform a step onto the force plate to establish SLS 

and maintain it for 15 seconds. The first second of SLS (initiation) and the next two 

seconds (maintenance) were analyzed. Dependent variables: maximum and average 

sway velocity, sway area, semi-major and semi-minor axes of the sway area. Variables 

were analyzed for the dominant leg. Leg dominance was determined using the balance 

recovery test. One-way ANOVA was used to identify differences between Y and O. 

rEsuLTs: O compared to Y showed significantly increased values for average sway 

velocity (O: 18.9±7.2cm/s, Y: 13.1 ±3.2cm/s, p=0.015) in the initial phase and in the 

maintenance phase for average sway velocity (O: 12.5±4.8cm/s , Y: 6.1 ±2.1cm/s, 

p



1255 Board #201 May 30, 9:00 AM - 10:30 AM 

Postural Control Variation in the single Leg anterior reach 

Maria Talarico, Dustin Grooms, Meghan Miller, Paul Gubanich, 

Jennifer Novak, James Borchers, FACSM, James Onate. The 

Ohio State University, Columbus, OH. 


The single leg anterior reach (SLAR) of the star excursion balance test is often used 

to assess dynamic postural control. However, the SLAR has yet to undergo a balance 

plate assessment of postural control that may yield information on the movement 

coordination strategy utilized during the SLAR. 

PurPOsE:To examine the effect of different postural control strategies utilized to 

complete SLAR and how variability affects injury risk from future injury data.. 

METhOds:Prior to the start of the season 31 male professional lacrosse athletes 

(26.7±2.87 years, 1.82±0.07 m, and 89.7±11.1 kg) and 15 NCAA Division 1 female 

volleyball athletes (19.4±1.15 years, 1.82±0.08 m, and 75.6±7.6 kg) performed balance 

plate instrumented SLAR measurements. While maintaining a single-leg stance, 

participants maximally reached with the contralateral limb in the anterior direction, 

touched the tape measure with the distal part of the foot, and returned to starting 

position. The reach distance, normalized to leg length, was measured (cm) from the 

starting point to the farthest point on the measurement line the participant was able 

to touch. SLAR center of pressure (CoP) excursion was collected during each trial 

by a balance plate and was dichotomized into high CoP excursion (greater movement 

variability) and low excursion (lower movement variability). Between group t-tests 

were performed between high vs. low CoP groups to assess normalized reach distance 

between movement strategy with an alpha level set at .05. 

rEsuLTs:Reach distance was significantly higher in those with higher CoP 

excursion in the lateral plane (Left: 63.2±4.01 cm high excursion (HE), 60±3.35 cm 

low excursion (LE), Right: 62.4±5.56 cm HE, 59.40±3.82 cm LE) and no difference 

in reach distance for CoP excursion in the sagittal plane (Left: 62.82±4.77 cm HE, 

60.96±4.07 cm LE, Right: 61.07±5.55 cm HE, 60.72±4.39 cm LE). 

CONCLusIONs:Increased frontal plane movement variability during a sagittal reach 

SLAR task resulted in greater reach performance. These findings may have clinical 

implications for individuals demonstrating a lack of movement variability in the frontal 

plane resulting in lower sagittal plane reach distances. Improvements to frontal plane 

movement variability strategies may result in increased dynamic postural control. 

1256 Board #202 May 30, 9:00 AM - 10:30 AM 

Comparison Of Balance Outcomes Between aquatic 

and Land-based Exercises In Older adults With Knee 

Osteoarthritis 

Gioella Chaparro, Cameron Lievense, Leora Gabay, 

Konstantinos Vrongistinos, Shane Stecyk, Taeyou Jung. Cal- 

State University Northridge, Northridge, CA. 


Balance improvement has been well documented in healthy older adults after 

participating in aquatic or land-based exercise programs. Aquatic exercise is frequently 

recommended for people with arthritis. While various effects of aquatic exercise have 

been studied, limited research has investigated its effects on balance among people 

with osteoarthritis (OA). 

PurPOsE: To compare balance outcomes between aquatic and land-based exercise 

programs in older adults with knee OA. 

METhOds: A total of 20 participants (Mean age 74.1 ± 14.2, 17 females, and 

3 males) with knee OA were randomly assigned to an aquatic exercise group or a 

land exercise group. The aquatic group participants completed a 45-minute Arthritis 

Foundation Aquatic Program (AFAP) 3 times a week for 12 weeks while the land 

exercise group performed the Arthritis Foundation Land Program (AFLP). Balance 

outcomes were measured by using a computerized posturographic balance assessment 

equipment (Neurocom Balance Master, NeuroCom International, Clackamas, OR, 

2010) and a psychometric balance test, the activities-specific balance confidence 

(ABC) scale. The posturographic balance tests were performed pre and postintervention 

including the sensory organization test (SOT), motor control test (MCT), 

adaptation test (AT), and the limits of stability test (LOS). 

rEsuLTs: MANOVA showed no group-interaction in all balance measures except 

in the ABC scale in which the land exercise group revealed greater improvement (p 

< .05). Within group analyses demonstrated that both groups increased MCT and AT 

scores after 12-week intervention (all ps < .05) while no significant changes were 

noted in SOT score. 

CONCLusION: The findings indicate that both aquatic and land exercise programs 

can help older adults with knee OA improve their balance. Our results also suggest that 

land-based intervention may be more effective in increasing balance confidence than 

aquatic environment in this particular population. 


1257 Board #203 May 30, 9:00 AM - 10:30 AM 

reliability study of a Wireless accelerometer for the 

assessment of Postural Control in Older adults 

Nathan W. Saunders 1 , Panagiotis Koutakis 2 , Deborah A. 

Kegelmeyer 1 , Anne D. Kloos 1 , Jessica D. Dicke 1 , Richard 

A. LaFountain 1 , Steven T. Devor, FACSM 1 . 1 The Ohio State 

University, Columbus, OH. 2 University of Nebraska Medical 

Center, Omaha, NE. 


Studies have shown that a single accelerometer placed on the lower back at L3 

(the estimated center of mass) is capable of discriminating between both distinct 

populations and clinical conditions. We evaluated the reliability of a new wireless 

tri-axial accelerometer that is smaller, less expensive, and more sensitive than those 

previously utilized in postural control studies. 

PurPOsE: Our specific aim was to assess the test-retest reliability of this 

accelerometer for quantifying postural control in healthy older adults. To achieve our 

aim, we tested the hypothesis that the trial-to-trial variability would be relatively small 

indicated by high intraclass correlation coefficients (ICC), low coefficients of variation 

(CV), and absolutely small indicated by small within-subject standard deviations (Sw). 

METhOds: Four common testing conditions (eyes 1. open or 2. closed, while on 

a 3. firm or 4. compliant surface) were utilized to progressively challenge the static 

balance of 20 healthy male (n=8) and female (n=12) older adults (age: 81±4.3 yr). 

Subjects completed three 30-second trials per condition with a brief rest between 

trials and conditions. The accelerometer was applied to L3 with surgical tape and 

positioned to acquire mediolateral (ML) and anterior-posterior (AP) accelerations. The 

raw acceleration signal was transformed to correct for pelvic tilt and adjust for low 

frequency body sway using custom made Matlab programs, and the root mean square 

(RMS) subsequently calculated. Finally, ICC, CV, and Sw were calculated for each 

condition and horizontal axis. 

rEsuLTs: ICCs were good to high with values ranging from 0.74 for AP RMS for 

the mat eyes closed condition to 0.97 for ML RMS for the floor eyes closed condition. 

Unlike the ICCs, we observed a broad range of CVs values (15.3 for ML RMS for the 

floor eyes closed condition to 54.4 for AP RMS for the mat eyes closed). Finally, Sw 

values were consistently very low with values ranging from 0.0017 for ML RMS for 

the floor eyes open condition to 0.0134 for AP RMS for the mat eyes closed condition. 

CONCLusIONs: Our hypothesis of high relative test-retest reliability was not 

consistently supported. However, similar to a previous study of accelerometer 

reliability, our accelerometer demonstrated very low absolute variability. 

1258 Board #204 May 30, 9:00 AM - 10:30 AM 

Limb segment Vibration Modulates Neural Control 

strategies during a Postural Task 

Colleen L. McHenry, Elizabeth Easker, Kelsey Hake, Katrina J. 

Risma, Richard K. Shields. The University of Iowa, Iowa City, 

IA. 


Mechanical oscillation training reduces postural control disruptions resulting from 

age or extended bed rest. However, these whole body vibration interventions activate 

vestibular, muscular, and neural systems simultaneously. Accordingly, the local effect 

of limb segment vibration on balance control strategies has not been examined. Recent 

fMRI studies support that localized metatarsal vibration modulates brain activity that is 

associated with postural control. 

PurPOsE: We determined the effect of isolated limb segment vibration on center of 

pressure (CoP), joint kinematics (KIN), and muscle activity (EMG) during single leg 

stance. 

METhOds: Thirty-five motion capture markers were placed on 21 subjects to 

collect kinematic data of the ankle, knee, and hip during single leg stance with eyes 

closed. Postural sway (AP/ML) and soleus/tibialis anterior EMG were measured while 

standing on a force plate. Each subject had the non-dominant lower leg assessed before 

and after limb segment vibration (0.6g, 30 Hz) for 15 minutes. We used paired t-tests 

to determine significant changes in kinematics, EMG, and postural sway (ML/AP). 

rEsuLTs: Soleus and tibialis anterior muscle activity increased by 7.9%MVC and 

30.1%MVC, respectively (p


1259 Board #205 May 30, 9:00 AM - 10:30 AM 

underlying Motor Control of the romberg and Wii Balance 

assessments in Concussed athletes 

Nicholas G. Murray 1 , Anthony P. Salvatore 1 , Joe Tomaka 1 , 

Arthur Islas 2 , Rebecca J. Reed-Jones 1 . 1 The University of Texas 

at El Paso, El Paso, TX. 2 Texas Tech University Health Sciences 

Center, El Paso, TX. 


Approximately 300,000 sports-related concussion injuries occur yearly in the United 

States. Balance disturbances, which occur in approximately 30% of these injuries, are 

typically assessed via the Romberg Test. Recently, the NCAA has recommended the 

WiiFit as an alternative measure of balance post-concussion However, the reliability 

and validity of the Wii, and its relationship to the Romberg test, are unknown. 

PurPOsE: This study examined relationships among the WiiFit Balance Test, 

the Romberg Test, and composite scores on the ImPACT test in a sample of postconcussed 

athletes. Composite scores were included as indicators of the motor 

processes underlying the balance tests. 

METhOd: 55 post-concussed athletes (40 male) completed the Romberg Test 

(-/+), the WiiFit balance test, and ImPACT test. WiiFit balance performance was 

operationalized as the number of successfully completed trials (of 5 trials of increasing 

difficulty) within 30 seconds. Pearson’s correlations examined univariate associations 

among the variables. ROC curves evaluated the sensitivity and specificity of each 

balance test against performance on the ImPACT. Lastly, a multiple regression analysis 

examined whether the Romberg and Wii tests shared redundant or unique variance 

with ImPACT composite score. 

rEsuLTs: The Romberg test and Wii balance test were not significantly related (r 

= -.029, p = .832). The Romberg correlated positively with ImPACT scores (r = .26, 

p = .041), whereas Wii trials did not (r = -.20, p = .155). Romberg scores positively 

correlated with ImPACT Visual Processing Speed Score (r = .27, p = .036) and 

Reaction Time score (r = .34, p =0.006). In contrast, Wii trials correlated negatively 

with the ImPACT Visual Memory Score (r = -.41, p = .003). The Romberg test resulted 

in sensitivity = 0.55 and specificity = 0.77, while the Wii had specificity and sensitivity 

values of 0.76 and 0.57 respectively. Lastly, a multiple regression analysis suggested 

that Wii balance scores accounted for variance in overall ImPACT scores (b= -.37, p < 

.05) independently of variance accounted for by Romberg scores. 

CONCLusION: The Wii Fit balance game and Romberg assess unique aspects of 

balance and motor control. The Romberg test relates directly to single sensory motor 

processing, while the Wii balance game related to multi-sensory motor processing. 

1260 Board #206 May 30, 9:00 AM - 10:30 AM 

Balance and sensibility Impairments In adults diagnosed 

With hiv: Effectiveness Of an Exercise Program 

Maryvi Gonzalez-sola 1 , Martin Rosario 1 , Angel Rosado 2 , Alexis 

Ortiz 3 . 1 University of Puerto Rico, Medical Sciences Campus, 

San Juan, Puerto Rico. 2 Polytechnic University of Puerto Rico, 

San Juan, Puerto Rico. 3 Texas Woman’s University, School of 

Physical Therapy, Texas, TX. 


Balance and sensibility impairments are common in adults diagnosed with HIV as a 

consequence of infection and from secondary effects of medications. 

PurPOsE aNd hyPOThEsIs: To assess the effectiveness of a three-month 

exercise program on to balance and sensibility in adults diagnosed with HIV. We 

hypothesized participation in a three-month exercise program will improve balance and 

foot sensation in individulas diagnosed with HIV. 

METhOds: Participants (n = 16) were assessed previous to participating in a 

community-based physical fitness exercise program and three months after program 

initiation. Balance was measured with a MatScan as the displacement of the 

center of pressure in cube centimeters in two conditions; eyes open and eyes closed. 

Sensibility was evaluated by Semmes-Weinstein monofilaments. Paired t-tests were 

used to compare pre and post balance and sensibility values for both conditions. 

rEsuLTs: Balance values with the eyes open improved significantly (p = 0.04) from 

baseline (3.78 ± 1.4 cm 2 ) to three months (0.84 ± 0.14 cm 2 ) post exercise participation. 

Although, balance with eyes closed improved over time (2.26 ± 0.56 cm 2 to 1.42 ± 

0.37 cm 2 ), such improvement was not statistically significant (p = 0.15). Sensibility 

values did not change after the intervention. 

CONCLusIONs: Participation in a fitness program appears to improve balance 

with opened eyes suggesting improvement throughout the visual, vestibular, and 

proprioceptive systems without improvements in sensibility scoress. 


1261 Board #207 May 30, 9:00 AM - 10:30 AM 

Influence of Cognitive Function on Clinical Balance 

assessments in Community-dwelling Elderly 

Stephanie A. Bomberger, Bonita L. Marks, FACSM, Abbie E. 

Smith-Ryan, Tiffany E. Shubert. University of North Carolina at 

Chapel Hill, Chapel Hill, NC. 


Deficits to balance, mobility, muscle strength, and cognition are risk factors for 

falling. In the clinical setting, performance assessments are commonly used to identify 

physical deficits; however cognition is rarely screened or assessed. Identifying balance, 

mobility or strength tests associated with cognitive performance may enable clinicians 

to better assess the risk factors associated with falling and develop appropriate 

interventions. 

PurPOsE: To investigate relationships between cognitive function, balance, mobility, 

and muscular strength in higher functioning community-dwelling elderly volunteers. 

METhOds: This was a cross-sectional study. Age-adjusted multiple regression 

models were used to assess relationships between cognitive function (Symbol Digit 

Modalities Test, SDMT) and performance assessments of balance (Single-Leg Stance 

Test, SLS; Tandem Stance Test, TS; Four Square Step Test, FSST); mobility (gait 

velocity per 10-Meter Walk,10MW); and muscular strength (Timed Chair Rise, TCR). 

rEsuLTs: Data from 107 older adults (75% female), aged 65-93 years (mean 78.1 

± 7.2) were analyzed. All completed 12+ years of school; 82% completed postsecondary 

education. Age was a significant in all models, uniquely responsible for 

29-30% of the variability in SDMT score (p < 0.01). The FSST (β = -0.289, p < 0.01) 

and gait velocity (β = 0.256, p < 0.01) were the only significant predictors for SDMT 

performance. 

CONCLusIONs: Faster gait velocity (10MW) and faster FSST (dynamic balance) 

performance may be predictive of better cognitive function. In a clinical setting, the 

FSST and 10MW are reliable and valid assessments of fall risk. These two assessments 

may also provide additional insight about cognitive and physical risk factors, without 

having to do a formal cognitive assessment. This may aid clinicians in prescribing 

balance intervention protocols tailored to cognitive ability that will be efficacious for 

reducing fall risk. 

1262 Board #208 May 30, 9:00 AM - 10:30 AM 

Best Predictors of Impending Loss of Balance in single Leg 

stance 

KyungMo Han 1 , Mark D. Ricard 2 , KiHong Kim 3 . 1 San Jose State 

University, San Jose, CA. 2 The University of Texas at Arlington, 

Arlington, TX. 3 Dankook University, Cheonan, Republic of 

Korea. 


The typical measures of balance from center of pressure variables include radial area, x 

& y: amplitude, area, velocity and mean frequency. Single leg stance trials in which the 

subjects loose balance are typically discarded. We theorized that the data just prior to 

the loss of balance contain valuable information on impending loss of balance. 

PurPOsE: To determine which center of pressure variables are significantly different 

between stable and unstable (impending loss of balance) in single leg stance. 

METhOds: Sixteen (8 females, 8 males) healthy college age subjects (age = 

20.8±2.4 yrs, height = 157.5±6.3 cm, mass = 63.3±7.9 kg) were participated in the 

study. Each subject completed 8 trials of single leg balance on a force platform. 

The force data were sampled for 15 seconds at 60 Hz and low pass filtered with a 

10 Hz cutoff. The first trial where the subject lost balance was retained for analysis. 

Impending loss of balance was identified by visual inspection of vertical, anteriorposterior, 

and medial-lateral force signals. The center of pressure data were separated 

into stable and unstable epochs within each loss of balance trial. Total travel distance, 

radial area, x & y: amplitude, area, velocity and mean frequency for stable and 

unstable phases in single leg stance were compared using dependent t-tests. 

rEsuLTs: There were no differences between stable and unstable phases for: 

Vx (0.15±0.73 cm/s, −0.14±1.29 cm/s), Vy(−0.03±0.38 cm/s, −1.34±3.00 cm/s), x 

Amplitude (0.08±0.02 cm, 0.08±0.07 cm), x Range (4.02±0.09 cm, 3.65±3.00 cm), 

and XY area (22.21±11.87 cm2, 42.78±42.87 cm2), respectively p>0.05. There were 

significant differences between stable and unstable phases for: Total travel distance 

(0.13±0.04 cm, 0.26±0.11 cm), y Amplitude (0.08±0.03 cm, 0.23±0.10 cm), y Range 

(5.31±2.37 cm, 10.48±4.52 cm), radial area(1.50±0.47 cm2, 2.39±1.29 cm2), x mean 

frequency (3.67±1.23 Hz, 5.56±1.25 Hz), and y mean frequency (2.17±0.98 Hz, 

5.49±1.54 Hz), respectively, p



C-37 Free Communication/Poster - Respiratory 

System and Exercise 

May 30, 2013, 7:30 AM - 12:30 PM 

Room: Hall C 

1263 Board #209 May 30, 8:00 AM - 9:30 AM 

day To day repeatability and Circadian Variation Of Lung 

Volume Measurements 

Arne Instebø, Vegard Helgheim, Gottfried Greve, Thomas 

Halvorsen. Haukeland University Hospital, Bergen, Norway. 


Knowledge on circadian rhythms in human pulmonary function is controversial, and 

predominantly related to patients with asthma exhibiting early morning obstruction 

with corresponding decreases in forced expiratory volume in first second (FEV1). 

PurPOsE: To study day to day repeatability and circadian variation during daytime 

hours for forced vital capacity (FVC), FEV1 and residual volume (RV) in healthy 

individuals. 

METhOds: Ten healthy non-smoking men (age: 26.1± 3.6 years) performed 

spirometry and body plethysmography according to guidelines once on day one and 

day two (08.00 am) and three times on day three (08.00 am, 12.00 am and 16.00 

pm) after having abstained from coffee and alcohol at least twelve hours. All tests 

were done in the same laboratory at similar room temperatures and barometric 

pressures using Vmax 22 spirometer and Autobox 6200 whole body plethysmograph 

(SensorMedics, Anaheim, USA). Calibration was performed in accordance with 

automated procedures and instructions given by the manufacturer. Coefficients 

of repeatability (COR) were calculated as two standard deviations (SD) for the 

differences between replicate measurements and given as percentages of their mean 

values. 

rEsuLTs: Lung volumes (litre) (first vs. second day): FVC (SD) 5.9 (0.7) vs. 5.8 

(0.7), COR 4.3; FEV1 (SD) 4.9 (0.6) vs. 4.8 (0.5), COR 3.6; RV (SD) 1.6 (0.5) vs. 

1.4 (0.5), COR 23.3. Lung volumes (litre) measured the third day (08.00 am/12.00 

am/16.00 pm): FVC (SD) 5.8 (0.7) vs. 5.8 (0.7) vs. 5.8 (0.7); FEV1 (SD) 4.8 (0.5) 

vs. 4.8 (0.5) vs. 4.9 (0.5); RV (SD) 1.6 (0.5) vs. 1.4 (0.5) vs. 1.5 (0.4). Measurements 

obtained 08.00 am day one vs. day two and day two vs. day three did not differ 

significantly (paired samples t-tests). 

CONCLusION: Excellent day to day repeatability was observed for FEV1 and FVC, 

and these were better than for RV. No circadian variations were observed for any of the 

lung volumes measured. 

1264 Board #210 May 30, 8:00 AM - 9:30 AM 

The Ergogenic Effect of Chronic high dose salbutamol 

John Molphy1 , John Dickinson2 , Neil Chester1 , Mike 

Loosemoore3 , Gregory Whyte, FACSM1 . 1Liverpool John 

Moores University, Liverpool, United Kingdom. 2University of 

Kent, Chatham Maritime, United Kingdom. 3English Institute of 

Sport, Sheffield, United Kingdom. 


There is limited evidence to suggest the acute inhalation of short acting β2-agonist have 

an ergogenic effect. To date, no study has examined the ergogenic impact following the 

chronic use of inhaled Salbutamol at the WADA upper daily limit (1600 µg). 

PurPOsE: To determine the effect of the WADA upper limit of 1600 μg per 

day Salbutamol every day for six weeks, on endurance, strength, power and body 

composition. 

METhOds: Sixteen trained male athletes provided written consent and agreed to take 

part in the study (mean + SD: age 20.1 ± 1.6 years; height 179.9 ± 8.2 cm; weight 74.6 

± 9.1 kg). Participants entered into a 6-week, 4 times per week training study having 

been assigned to one of two groups in a double blind design. Group 1 (n=8) inhaled 

4 x100 μg of placebo, via pocket chamber, 4 times per day for 6 weeks (PLA). Group 

2 (n=8) inhaled 4 x100 μg of Salbutamol, via pocket chamber, 4 times per day for 6 

weeks (SAL). Pre- and post-training endurance, body composition, power and strength 

was assessed. 

rEsuLTs: In both groups there was an overall improvement in (Pre- Post-) VO2peak 

(51.7 ± 4.7 - 56.8 ± 7.1 ml.min.kg-1; 53.1 ± 6.1 -55.0 ± 6.7 ml.min.kg-1); 3 km 

running time-trial performance (988.6 ± 194.6 - 947.5 ± 155.5 s; 1040.4 ± 187.4 

-1004.2 ± 199.4 s); 1RM bench press (65.7 ± 15.4 - 70.3 ± 13.8 kg; 64.3 ± 14.0 - 72.5 

± 15.3 kg) and leg press (250.0 ± 76.4 - 282.5 ± 63.6 kg; 217.9 ± 54.0 - 282.8 ± 51.9 

kg) between SAL and PLA, respectively. Peak extension and flexion torque, and body 

composition remained unchanged across the study period. Of note, no difference in any 

endurance; strength and power; or body composition measures were noted between 

SAL and PLA groups pre-, during, or post-intervention. 

CONCLusION: There was no significant improvement in endurance, or strength 

and power performance following the inhalation of 1600 µg Salbutamol per day 

for six weeks in non-asthmatic males, compared to placebo. The current WADA 


recommendations, of up to 1600 µg inhaled Salbutamol per day, appear sufficient to 

avoid an ergogenic impact on endurance, strength and power performance. Data from 

this study will assist WADA in the implementation of regulations on the use of inhaled 

short acting β2-agonist and in the resolution of contested doping violations. 

1265 Board #211 May 30, 8:00 AM - 9:30 AM 

Oxygen Cost of Breathing does Not differ Between Obese 

Women With vs. Without dyspnea on Exertion 

Vipa Bernhardt, Santiago Lorenzo, Raksa B. Moran, J. Todd 

Bassett, Sarah F. Haller, Jessica N. Pineda, Tony G. Babb, 

FACSM. Institute for Exercise and Environmental Medicine, 

Texas Health Presbyterian Hospital Dallas and University of 

Texas Southwestern Medical Center, Dallas, TX. 


PurPOsE: During constant load cycling exercise, some otherwise healthy obese 

women experience dyspnea on exertion (+DOE), while others do not (-DOE). In 

previous studies, we observed the oxygen cost of breathing to be increased in +DOE. 

We wondered if this would remain true in a larger sample of obese women. To 

investigate, we recruited 80 obese women who were divided into groups based on their 

Ratings of Perceived Breathlessness (RPB, Borg 0-10 scale) at the end of 6 minutes of 

constant load cycling at 60 W as in the previous studies. 

METhOds: 34 women were classified as +DOE (RPB ≥ 4, 34 ± 7 yr, 36 ± 5 kg/m 2 

BMI, 46 ± 4% body fat; mean ± SD) and 24 women as -DOE (RPB ≤ 2, 33 ± 8 yr, 37 ± 

4 kg/m 2 BMI, 45 ± 5% body fat; p > 0.05 from +DOE). 22 women with RPB = 3 were 

excluded to better delineate the +DOE and -DOE groups. The oxygen cost of breathing 

was obtained from the slope of the oxygen uptake (ml/min) vs. ventilation (L/min) 

relationship during eucapnic voluntary hyperpnea (EVH) at 40 and 60 L/min. Data 

were analyzed between groups by independent t-test. 

rEsuLTs: Breathlessness ratings during each level of EVH was significantly greater 

in the +DOE than the -DOE women (p < 0.0001). However, there was no significant 

difference in the oxygen cost of breathing between +DOE (2.24 ± 0.88 ml/L; n = 33) 

and -DOE (2.22 ± 0.85 ml/L; n = 22). The only other difference between groups during 

EVH was a relatively larger minute ventilation (as a percentage of maximal voluntary 

ventilation) (p < 0.05), which, however, was not associated with the oxygen cost of 

breathing. 

CONCLusIONs: Many obese women experience significant increases in the 

intensity of breathlessness during submaximal exercise and EVH; but in contrast 

to previous studies, the oxygen cost of breathing was not uniformly larger in obese 

women +DOE compared with -DOE. 

Supported by NIH Grant R01 HL096782 and King Charitable Foundation Trust. 

1266 Board #212 May 30, 8:00 AM - 9:30 AM 

The Effect of Combining Fish Oil and Vitamin C on 

hyperpnea-Induced Bronchoconstriction in asthmatic 

adults 

Sally K. Head 1 , Joseph W. Duke 2 , Timothy D. Mickleborough, 

FACSM 2 . 1 Indiana University School of Medicine, Indianapolis, 

IN. 2 Indiana University, Bloomington, IN. 


Asthma is a multi-faceted disease that often includes exercise-induced 

bronchoconstriction (EIB). Previous research has demonstrated that individual 

nutritional supplements, such as fish oil and vitamin C, alleviate EIB. Hyperpneainduced 

bronchoconstriction (HIB) has been shown to reliably detect EIB. 

PurPOsE: To determine whether the combination of fish oil and vitamin C 

supplementation offers increased protection against HIB over either one alone. 

METhOds: Fourteen subjects (18-29 yrs; 8 M, 6 F) with asthma and HIB 

participated in a randomized, double-blind, parallel group trial consisting of two 

treatment periods in which subjects first received either active fish oil (Fish Oil Group, 

n = 7) or vitamin C supplements (Vitamin C Group, n = 7) every day for 3 weeks. 

After a 2-week washout period, all subjects received both active fish oil and vitamin 

C for 3 weeks. Subjects visited the laboratory following an initial 2-week run-in phase 

and after each supplementation phase for a total of three visits. Bronchoprovocation 

was elicited with eucapnic voluntary hyperventilation (EVH), a surrogate exercise 

challenge involving rapid breathing. Pulmonary function and fraction of exhaled nitric 

oxide (FENO) were measured pre- and post-EVH. 

rEsuLTs: Fourteen subjects completed the trial. One subject, whose post-EVH 

forced expiratory volume in one second (FEV1) progressively worsened during the 

study, was deemed a “non-responder” and was excluded from further data analysis. 

The two groups of subjects were analyzed separately. For the primary outcome of 

maximum percent change in post-EVH FEV1, the Fish Oil Group (n = 6) significantly 

improved (p < 0.016) with fish oil (9.94 ± 1.90%), but not with the combination 

treatment (10.19 ± 3.35%), as compared to pre-supplementation (17.29 ± 1.98%). The 

Vitamin C Group (n = 7) did not show a significant change (p > 0.016) with either 

vitamin C (18.03 ± 7.05%) or combination treatment (8.64 ± 2.14%) as compared to 

pre-supplementation (23.48 ± 4.50%). 

CONCLusIONs: Previous research has shown that either fish oil or vitamin C 



can reduce bronchoconstriction and airway inflammation on their own. The variable 

responses obtained in this study suggest that for subjects not reaping the full benefits 

from either supplement alone, a combination of fish oil and vitamin C may be more 

effective. 

1267 Board #213 May 30, 8:00 AM - 9:30 AM 

decrements In Pulmonary diffusing Capacity With duration 

Of disease In Type-1 diabetes 

Michelle J. Lee1 , J Christopher Baldi, FACSM2 , J Richard, 

Coast, FACSM1 . 1Northern Arizona University, Flagstaff, AZ. 

2University of Otago, Dunedin, New Zealand. 


Diabetes is known to affect peripheral tissues by damaging capillaries and basement 

membranes, however, its effects on the lung are less known. Lung diffusing capacity 

(DLCO) is influenced by alveolar-capillary membrane conductance (DM) and 

pulmonary capillary blood volume (VC), both of which have shown impairments in 

adults with type-1 diabetes (T1D). 

PurPOsE: We sought to determine the effect of T1D, age, and diabetes duration on 

DLCO, DM, VC, and cardiac output (Q). 

METhOd: We recruited 48 subjects, 24 people with T1D (ages 10.7 – 52.8 years old) 

and 24 non-diabetic controls matched for age, gender, and fitness level and measured 

DLCO, DM, VC, and Q at rest and three exercise workloads (40% VO2max, 70% 

VO2max, and 90% VO2max). 

rEsuLTs: When stratified into two groups based on age (young < 20.6 years old), 

there were no significant differences in DLCO, DM, VC, or Q (all of which were 

normalized to body surface area [BSA]) in the young group, or in the old group. When 

stratified into two groups based on diabetes duration (short duration range 0.33 – 8.9 

years, long duration range 9.6 – 28 years), the T1D in the long duration group had 

significantly lower DLCO/BSA and DM/BSA compared to the matched controls (16.5 

± 0.6 and 19.0 ± 0.6 mL/min/mmHg/BSA, p= 0.014 and 22.5 ± 0.9 and 25.6 ± 0.9 mL/ 

min/mmHg/BSA, p= 0.033, respectively) with no differences in VC/BSA and Q/BSA. 

There were no differences in any of the variables in the short duration group. 

CONCLusION: While we initially hypothesized that age would be a factor in the 

decrements in lung function, this study has shown that independent of age, duration 

of diabetes is a factor more associated with decrements in diffusing capacity and its 

components. Supported by NIH Grant R15 HL097335-01A1. 

1268 Board #214 May 30, 8:00 AM - 9:30 AM 

Carbon Monoxide reduces O 2 Extraction but not Peripheral 

Tissue diffusing Capacity at VO 2 max 

George H. Crocker, James H. Jones. University of California, 

Davis, CA. 


PurPOsE: We hypothesized that breathing hypoxic gas and/or carbon monoxide 

(CO) would similarly affect peripheral tissue (skeletal muscle) O2 extraction (EO2, 

fraction of O2 delivered that is consumed) and diffusing capacity for O2 (DTO2), 

despite altering aerobic capacity by different mechanisms – decreased blood O2 

saturation (hypoxia) vs. decreased circulatory capacitance (CO). 

METhOds: We ran six goats on a treadmill at speeds eliciting maximal aerobic 

capacity while breathing inspired O2 fraction (FIO2) of 0.21 or 0.12 and maintaining 

carboxyhemoglobin fraction (FHbCO) of 0.02 or 0.30. We measured O2 consumption 

(VO2) and sampled arterial and mixed-venous blood to calculate cardiac output (Q) via 

Fick Principle and total cardiopulmonary O2 delivery (TO2, product of Q and arterial 

[O2]). We calculated for each gas EO2 as VO2/TO2 and DTO2 as VO2/mixed-venous 

O2 tension (PvO2). 

rEsuLTs: Compared to room air (EO2 0.90 ± 0.03), EO2 decreased with FHbCO 

0.30 when breathing either FIO2 0.21 or 0.12 (EO2 0.79 ± 0.04 and 0.81 ± 0.03) and 

increased with hypoxia alone (EO2 0.92 ± 0.02). The VO2 and PvO2 were highly 

correlated and the slopes of the regressions were significant for five of six goats 

(0.951 < R2 < 0.994, P < 0.001 for each). The DTO2 did not differ between the four 

FIO2/FHbCO combinations (P = 0.867). We analyzed data from previous studies that 

calculated DTO2 as the slope of VO2 vs. PvO2 for various inspired gases. Compared 

to the means of individual points, DTO2 estimates based on slope are biased high when 

the VO2 vs. PvO2 intercept is negative and low when the VO2 vs. PvO2 intercept is 

positive. 

CONCLusIONs: The EO2 differed for hypoxia and elevated FHbCO, indicating 

goats had to deliver more O2 with elevated FHbCO than with hypoxia to reach 

similar VO2, suggesting CO impairs (and hypoxia improves) the ability to extract 

and consume O2 compared to normoxia. However, DTO2 was unchanged by FIO2 

or FHbCO. Oxyhemoglobin affinity effects on diffusion pressure head explain the 

EO2 differences observed. Because non-zero intercepts of VO2 vs. PvO2 bias DTO2 

estimates, future studies should calculate DTO2 both as the average of individual gas 

mixtures as well as the slope of VO2 vs. PvO2 for all gases. Supported by the U.S. 

Army Medical Research and Materiel Command (Contract No. W81XWH-11-D-0011) 

through L-3/Jaycor. 


1269 Board #215 May 30, 8:00 AM - 9:30 AM 

Breathing Pattern and strategy during Exercise In young 

swimmers and Non-swim Trained Children 

Joel M. Stager, FACSM, Kosuke Kojima, Masataka Ishimatsu, 

Daniel P. Wilhite, Brian V. Wright. Indiana University, 

Bloomington, IN. 


Swim training has been suggested to promote proportionate lung growth though the 

training effects on pulmonary function remain controversial (Courteix et al., 1997; 

Silvestri et al., 2012). Specifically, breathing patterns and strategies during incremental 

exercise in young swimmers as compared with non-swim trained children have not 

been documented. 

PurPOsE: To characterize the breathing patterns and strategies of young swimmers 

during incremental exercise to volitional exhaustion and compare those measures to 

age- and size-matched non-swim trained children. 

METhOds: Twenty four healthy non-asthmatic, young, competitive swimmers (12 

girls and 12 boys; 10.5 yrs, 144.5 cm, 38.0 kg) and 11 non-swim trained children (4 

girls and 7 boys; 10.2 yrs, 141.1 cm, 33.3 kg) performed resting pulmonary function 

and incremental exercise tests to volitional exhaustion (VO 2peak ) on a cycle ergometer. 

Pulmonary function was collected during a set of maximal inspiratory and expiratory 

maneuvers for the determination of the maximal flow-volume loop. Metabolic 

and ventilatory data were recorded at each minute during the VO 2peak test. Exercise 

inspiratory and expiratory tidal volume (V Tinsp and V Texp ) and peak flow (PF Tinsp and 

PF Texp ) were measured during the last 30 sec of each minute, and inspiratory and 

expiratory reserve volumes (IRV and ERV) were determined using inspiratory capacity 

maneuvers. 

rEsuLTs: At rest, swimmers showed significantly greater forced vital capacity (2.37 

± 0.40 vs. 1.84 ± 0.56 L) and maximal mid expiratory flow (2.90 ± 0.71 vs. 2.34 ± 0.65 

Lsec-1). The groups were similar in relative VO2 (47.3 ± 7.95 vs. 43.7 ± 9.09 mlmin- 

1kg-1 at peak), breathing frequency, and IRV at 60, 70, 80, 90 and 100% of VO2peak. 

Greater minute ventilation (70.6 ± 19.3 vs. 53.6 ± 11.2 L at VO2peak), tidal volume 

(1.29 ± 0.32 vs. 0.99 ± 0.19 L at VO2peak), ERV, VTinsp, VTexp, PFTinsp, and 

PFTexp were observed in swimmers throughout the exercise bout (p < 0.05). 

CONCLusION: With no difference in breathing frequency, the higher tidal flow in 

young swimmers permitted a higher tidal volume, thus allowing for greater minute 

ventilation during incremental exercise. Young swimmers seem to exploit a higher 

available expiratory airflow by breathing at higher lung volumes possibly as a means 

of avoiding mechanical constraints to ventilation. 

1270 Board #216 May 30, 8:00 AM - 9:30 AM 

Effects Of heliox On respiratory Mechanics and Cycling 

Performance In Endurance-trained Men and Women 

Sabrina S. Wilkie, Paolo B. Dominelli, Benjamin C. Sporer, 

Michael S. Koehle, A. William Sheel. University of British 

Columbia, Vancouver, BC, Canada. 


Mechanical ventilatory constraints develop in some endurance-trained (ET) men 

during strenuous exercise. Both ET and untrained women have been shown to develop 

expiratory flow limitation (EFL) during maximal and sub-maximal exercise. Women’s 

increased susceptibility to EFL can be attributed to structural and functional sex-based 

differences with respect to the pulmonary system. Consequently women’s endurance 

performance may be limited to a larger extent than men’s through increases in the work 

of breathing (WOB) and higher sensations of leg and breathing discomfort. 

PurPOsE: To determine the effects of partially unloading the respiratory system 

using a heliox (He-O2; 79% He, 21% O2) inspirate on EFL, the WOB, operational 

lung volumes, sensory responses (leg and breathing discomfort) and cycling 

performance between men and women. 

METhOds: Competitive cyclists (n = 11 men; n = 11 women) completed two 5-km 

time trials (TT), breathing either room air (RA) or He-O2. The maximum expiratory 

flow-volume (MEFV) curve method was used to determine EFL. The WOB was 

measured with an esophageal balloon catheter. 

rEsuLTs: During both the RA and He-O2 TTs EFL developed in men (RA: n = 

36%; He-O2: n = 45%) and women (RA: n = 60%; He-O2: n = 40%). The magnitude 

of EFL was variable throughout both TTs for all subjects due to alterations in endexpired 

lung volume and expiratory flow rates. At 5-km women’s minute ventilation 

was significantly lower than men’s (RA-women: 94.417.8; men: 134.412.7; p



1271 Board #217 May 30, 8:00 AM - 9:30 AM 

Marine Lipid Fraction PCsO-524 (Lyprinol®/Omega 

XL®) attenuates airway Inflammation and hyperpnea- 

Induced Bronchoconstriction in asthmatic Individuals 

Timothy D. Mickleborough, FACSM, Cherissa L. Vaughn, Ren- 

Jay Shei, Eliza M. Davis, Jacob A. Sinex, David Platt, Daniel P. 

Wilhite. Indiana University, Bloomington, IN. 


It has previously been shown that fish oil supplementation, rich in the omega-3 

fatty acids (Ω3FAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid 

(DHA) can attenuate airway inflammation and exercise and hyperpnea-induced 

bronchoconstriction (EIB and HIB respectively) in elite athletes and asthmatics. 

PCSO-524 (Lyprinol®/Omega XL®) is a supplement extracted from the New 

Zealand green-lipped mussel (Perna Canaliculus) comprising 14 + 7% EPA and 11 

+ 7% DHA, and containing up to 22 times more fatty acids than regular fish oil. It 

has been shown that PCSO-524 can moderate airway inflammation in humans with 

asthma, and in a murine-model of allergic airway disease. 

PurPOsE: Evaluate the effect of PCSO-524 on airway inflammation and the 

bronchoconstrictor response to eucapnic voluntary hyperpnea (EVH) in asthmatics. 

METhOds: In this model of EIB twenty asthmatic subjects, with HIB, participated in 

a placebo controlled double-blind randomized crossover trial. Subjects entered the study 

on their usual diet and were then placed on 3 weeks of PCSO-524 (~56 mg EPA/day; 

~44 mg DHA/day) or placebo supplementation (olive oil), followed by a 2 week washout 

period, before crossing over to the alternative diet. Pre- and post-EVH pulmonary 

function, fraction of exhaled nitric oxide (F E NO), asthma symptom scores, medication 

use, exhaled breath condensate (EBC) pH, cysteinyl leukotrienes (cyst-LT), 8-isoprostane 

and urinary 9α, 11β-prostaglandin (PG)F 2 and Clara (CC16) protein concentrations were 

assessed at the beginning of the trial and at the end of each treatment period. 

rEsuLTs: The PCSO-524 diet significantly reduced (p


1275 Board #221 May 30, 8:00 AM - 9:30 AM 

a Multivariable Index for Grading Exercise Gas Exchange 

severity in Patients with Pulmonary arterial hypertension 

and heart Failure 

Chul-Ho Kim, Steve Anderson, Dean McMacarter, Bruce D. 

Johnson. Mayo Clinic, Rochester, MN. 


Patients with pulmonary arterial hypertension (PAH) and heart failure (HF) display 

a number of abnormalities in respiratory gas exchange with exercise. These 

abnormalities track disease severity and are associated with prognosis. However, there 

are limitations due to the large number of variables and difficulty in interpretation. 

PurPOsE. To develop a multivariable gas exchange index (MVI) that integrates key 

variables obtained during submaximal exercise and to demonstrate its utility clinical 

populations. 

METhOds. 1) Normal values and ranges of 6 gas exchange variables (Rest PetCO2, 

Delta PetCO2, SaO2, OUES, VE/VCO2 and PCAP) that are associated with a higher 

risk in PAH and HF were obtained from previous literature and used to develop a 

score. 2) To test the MVI score, the gas exchange data from 3 populations (42-PAH, 

47-HF, 25-controls) were gathered. Each variable was scored based on severity 

(=4=very severe) in HF or PAH and was calculated into a weighted cumulative 

individual variable index score which was then divided by total number of variables 

to get the MVI. Relationships between individual gas exchange measures, calculated 

MVI, cardiac Index (CI), New York Heart Association (NYHA), Right Ventricular 

Systolic Pressure (RVSP) and WHO classification were examined. 

rEsuLTs. We developed a model to integrate gas exchange variables using a 

weighted classification system that categorized disease severity based on the final MVI 

outcome. A MVI value of



1279 Board #225 May 30, 8:00 AM - 9:30 AM 

Comparison Of Oxygen utilization during Magnetic Muscle 

stimulation With That during handgrip Exercise 

Tadashi Saitoh, Kyuichi Niizeki. Yamagata University, 

Yonezawa, Japan. 


PurPOsE: This study aimed to investigate the dynamics of oxygen utilization during 

intermittent muscle contraction induced by magnetic stimulation compared with that 

during handgrip exercise. 

METhOds: This study included 7 healthy volunteers (means ± SD: age, 24.4 ± 

5.6 yr; height, 167.9 ± 3.8 cm; body mass, 63.3 ± 6.4 kg). After a 2-minute rest, 

the volunteers received magnetic stimuli with a magnitude of 0.4 kV in the flexor 

digitorum superficialis muscle or performed handgrip exercise for 2 min at 1 Hz, 

followed by a 2-minute rest. The intensity of the handgrip exercise was controlled so 

that its amplitude, as measured by mechanomyography, matched that of the magnetic 

stimulation. Pulmonary gas exchange rates, ventilation level, and heart rate were 

measured breath by breath. Hemoglobin concentrations were measured at 1 Hz using 

near-infrared spectroscopy. 

rEsuLTs: During the handgrip exercise, oxygen uptake and heart rate immediately 

increased to 407.6 ± 117.7 ml/min (baseline, 196.6 ± 47.3 ml/min) and 76.6 ± 8.6 

beats/min (baseline, 66.2 ± 7.0 beats/min), respectively. Moreover, deoxyhemoglobin 

levels exponentially increased at an amplitude of 15.4 μM. On the other hand, during 

the magnetic stimulation, oxygen uptake, heart rate, and the levels of oxyhemoglobin, 

deoxyhemoglobin, and total hemoglobin remained constant. 

CONCLusIONs: This experiment showed that oxygen utilization did not 

increase during the intermittent muscle contraction induced by magnetic 

stimulation. The data also suggest that the aTP-PCr system served as the primary 

energy supply system for contraction during magnetic stimulation, or that muscle 

contraction during magnetic stimulation did not require aTP. 

1280 Board #226 May 30, 8:00 AM - 9:30 AM 

Effects of stretch shortening Cycle Warm-up on Cycling 

Performance in Females 

Jessica W. Chow1 , David Heikkinen2 , Elaina Mertens3 , Tracey 

D. Matthews3 , Vincent J. Paolone, FACSM3 . 1Brooklyn College, 

Brooklyn, NY. 2Fitchburg State University, Fitchburg, MA. 

3Springfield College, Springfield, MA. 


Respiratory muscle fatigue has been recognized to be a contributing factor to the 

termination of high intensity exercise performance due to a sympathetically mediated 

vasoconstriction response in the peripheral muscles. Inspiratory muscle specific warmup 

(2 x 30 repetitions) has been reported to improve performance in several high 

intensity activities. 

PurPOsE: To determine the effects of performing 2 x 30 stretch shortening cycling 

(SSC) respiratory muscle warm-up on cycling performance. 

METhOds:Fifteen highly fit female subjects (VO2peak: 51.70 ± 6.67 ml·kg-1·min-1) 

participated in the study. The control trial involved a 5 min whole body warm-up 

cycling at 40% of peak power output. The experimental trial consisted of 2 x 30 

breathing exercises following the 5 min whole body warm-up. Maximum expiratory 

volume (MEV) and maximum inspiratory volume (MIV) were assessed after the 

warm-up routines and post exercise. Subjects exercised at 85% of peak power output 

until volitional fatigue. During the exercise test minute ventilation (VE), relative 

volume of oxygen consumption (VO2/kg), tidal volume (VT), breathing frequency 

(F), rating of perceived breathlessness (RPE-B), respiratory exchange ratio (RER), 

and breathing economy (VE/VO2) were measured every minute. Time to exhaustion 

(TEX) was also measured to assess performance. Multiple statistical analyses were 

used including one paired sample t-test, three analysis of variance (ANOVA), and one 

multivariate analysis of variance (MANOVA) to assess for statistical differences. 

rEsuLTs: No significant differences were observed between the treatment and 


control for MIV, MEV, VE, VO2/kg, VT, F, RPE-B, RER, and VE/VO2 (p > .05). 

Expected exercise physiological responses were observed over time for VE, VO2/ 

kg, VT, F, RPE-B, RER and VE/VO2. No significant differences were observed for 

MIV (2.425 L ±.104 vs. 2.358 L ±.084, p > .05). MEV was significantly reduced post 

exercise (3.168 L ± 0.151 vs. 2.994 L ± 0.127, p < .05). 

CONCLusIONs:Performing the 2 x 30 repetition of SSC warm-up breathing 

exercises with whole body warm-up appeared to have an ergolytic effect on cycling 

performance by exasperating respiratory muscle fatigue,inducing the sympathetically 

mediated vasoconstriction response in the peripheral muscles. 

1281 Board #227 May 30, 8:00 AM - 9:30 AM 

Effects of acute Oleic acid-induced Lung Injury on aerobic 

Capacity 

James H. Jones, George H. Crocker. University of California, 

Davis, CA. 


Soldiers in combat, rescue workers and miners may receive blast injuries that reduce 

pulmonary diffusing capacity for O2 (DLO2) and aerobic capacity (VO2max), 

jeopardizing their ability to escape to safety. 

PurPOsE: We tested the hypothesis that we could simulate acute lung injury that 

reduces DLO2 with oleic acid (OA) infusion and that it would decrease VO2max. 

METhOds: We infused OA (0.05 ml/kg) coupled with high-velocity saline through a 

dual-lumen catheter into the right atria of five goats to evenly distribute OA throughout 

their lungs. At 2-h and 24-h post-OA infusion or without OA infusion (control), goats 

ran on a treadmill at speeds eliciting VO2max while we measured O2 consumption, 

heart rate (fH) and sampled arterial and mixed-venous blood. We measured pulmonary 

diffusing capacity for CO (DLCO) using a rebreathing method both pre-infusion and 

pre-exercise. 

rEsuLTs: The DLCO returned to control values within ~3 days post-OA. Compared 

to control, VO2max decreased by 33% at 2-h and 24% at 24-h post-OA (P = 0.007), 

although VO2max did not differ between times (P = 0.319). The fH decreased by 29%, 

stroke volume (VS) did not change and cardiac output (Q) tended to decrease post-OA 

(fH, P = 0.009; VS, P = 0.155; Q, P = 0.073). However, OA also reduced arterio-mixed 

venous [O2] difference by 17% (P < 0.001) because arterial [O2] (CaO2) decreased 

by 17% (P < 0.001) with only a tendency for mixed-venous [O2] to do so (P = 0.080). 

Decreased CaO2 resulted from O2 saturation decreasing by 21% (P < 0.001) due to 

hypoxemia from impaired gas exchange (alveolar-arterial O2 partial pressure (PO2) 

difference increased by 32 Torr (P < 0.001)), not hypoventilation (P = 0.899). We 

tested whether fH decreased due to direct OA effect or due to hypoxemia by running 

the goats on the treadmill post-OA while breathing hyperoxic gas (30% O2) to defend 

arterial PO2. The fH remained lower in hyperoxia, not different from breathing 

normoxic gas (P = 0.803), suggesting OA directly affects fH. 

CONCLusIONs: The OA decreased pulmonary diffusing capacity, fH, CaO2 and 

VO2max, supporting our hypothesis. Infusion of OA may provide a reproducible and 

repeatable model of acute lung injury for animals in exercise studies. Supported by 

the U.S. Army Medical Research and Materiel Command (Contract No. W81XWH- 

11-D-0011) through L-3/Jaycor. 

C-38 Free Communication/Poster - Upper 

Extremity Mechanics 

May 30, 2013, 7:30 AM - 12:30 PM 

Room: Hall C 

1282 Board #228 May 30, 9:00 AM - 10:30 AM 

Vibration Exercise With Or Without Xco-trainer In 

Epicondylitis (VIBEs) - a randomized study 

Karsten Knobloch, Berit Schiffke. Sports Private Practice Prof. 

Karsten Knobloch, FACS, Hannover, Germany. 


PurPOsE: To study the effect of vibration training with or without a dynamic mass 

training (XCO-Trainer) on lateral epicondylitis. 

Hypothesis: A proprioceptive training with a dynamic mass device (XCO-Trainer) 

intervention is beneficial in terms of pain reduction and improvement of function in 

lateral epicondylitis. 

METhOds: We performed a randomized study and included a total number of 72 

patients with unilateral lateral elbow tendinopathy and randomized in a 1:1 allocation 

to two groups: 

•Group A (n=40, final analysis n=29): Flexi-Bar only: vibration training only over 12 

weeks with three distinct exercises and 10min training twice daily 

•Group B (n=32, final analysis n=28): Flexi-Bar+XCO Trainer: Combination 

intervention using vibration device Flexi-Bar and XCO-Trainer (oscillating mass 

within a tube moved during running 40-60min/week with reactive impact technology) 

The primary outcome parameter wa pain on visual analogue scale (VAS 0=no pain, 



10=worst pain), secondary outcome parameters were 

oDASH score [0=no impairment, 100=severe impairment] 

oGrip strength (JAMAR) [kg] in 0° and 90° elbow flexion 

oVibration using 128 Hz tuning fork 

ClinicalTrials.gov NCT01269879. 

rEsuLTs: •Pain was reduced in the vibration training only group (A) from 3.6±2.0 

to 2.4±2.0 (p=0.019) and in the combination group (Flexi-Bar + XCO-Trainer) from 

3.6±2.3 to 2.1±1.8 (p=0.002) 

oThere was no intergroup difference in terms of pain reduction superiority (figure 1) 

•DASH: Improvement in both groups (A: 30±13 to 14±12, p=0.001; B: 26±13 to 

12±11, p=0.001, no intergroup differences) 

•Grip strength: significant improvement in 0° elbow flexion in both groups 

•128 Hz tuning fork: Improvement in both groups (A: 6.1 to 6.3, B: 6.1±0.8 to 6.4±0.6, 

both p



1286 Board #232 May 30, 9:00 AM - 10:30 AM 

heterogeneous Mechanomyographic activity of Wrist 

Extensors in response to Eccentric Exercise 

Afshin Samani1 , Ernst A. Hansen1 , Adam Kawczynski2 , Pascal 

Madeleine1 . 1Aalborg University, Aalborg, Denmark. 2University School of Physical Education, Wroclaw, Poland. 


The mechanomyography (MMG) signal furnishes information on the intrinsic muscle 

mechanical activity. Heterogeneous MMG activity has been reported for erector spinae 

and trapezius muscle during sustained contraction but no studies have investigated the 

effects of high intensity eccentric exercise on the spatio-temporal MMG activity. 

PurPOsE: To investigate spatio-temporal MMG activity of wrist extensor muscles 

before and after eccentric exercise in healthy subjects. 

METhOds: Twelve volunteers performed one bout of repeated eccentric exercise at 

high intensity involving wrist extensors of the dominant arm. MMG signals from wrist 

extensors were detected by means of accelerometers placed over 12 points forming a 

3×4 grid. MMG recordings were made during standardized wrist isometric, concentric 

and eccentric contractions performed before, immediately after and 24 hours after 

eccentric exercise. Root mean square (RMS) and percentage of determinism (%DET) 

of the MMG signals were computed to estimate the level muscular activation and the 

amount of regularity of the MMG signals. RMS and %DET were used as markers of 

neuromuscular changes due to fatigue and delayed onset muscle soreness. 

rEsuLTs: Muscle strength decreased by 14% and soreness intensity was 4.1 ± 0.8 

cm (mean ± SEM) 24 hours after eccentric exercise. There was a significant increase 

in RMS immediately after and 24 hours after compared with before eccentric exercise, 

respectively 23.8 and 15.5 vs. 13.3 ± 0.3 mm/s-2 (P < 0.05). The %DET was higher 

at 24 hours after compared with before and immediately after eccentric exercise, 

respectively 96.7 vs. 95.8 and 96.0 ± 0.1 % (P < 0.05). The RMS and %DET depended 

on the accelerometer locations (P < 0.001) with higher RMS values (25 %) and lower 

%DET (1.4 %) on extensor digitorum communis compared with extensor carpi radialis 

ulnaris. 

CONCLusIONs: These present study depicted neuromuscular changes exemplified 

by increase MMG activity and regularity in MMG signals in presence of delayed onset 

muscle soreness. Inhomogeneous MMG activity in wrist extensors muscles was also 

found confirming the importance of using multiple recording sites when assessing 

muscle MMG activity. 

Supported by GigtForeningen R77-A1202 and Danish Ministry of Culture Committee 

on Sports Research grants. 

1287 Board #233 May 30, 9:00 AM - 10:30 AM 

Comparison of Electromyographic activity of Muscles 

associated with Elbow Flexion using different resistance 

devices 

Melissa Humphres, Cole Sillaman, Craig Parker, Christine 

Rettig, Peter Jordan, Patrick Sells. Belmont University, 

Nashville, TN. 


BaCKGrOuNd: Research has demonstrated that forces exerted on muscles when 

using different resistance devices significantly affect how the muscles respond and 

develop. Moreover, exercise performed in stable environments will isolate and 

recruit individual muscles to achieve a desired motion, while exercise in unstable 

environments will globally recruit groups of muscles to achieve the same motion. 

Researchers of this study were looking to combine these two notions to determine if a 

potentially stable device would elicit more muscle activity within an individual muscle, 

and if a potentially unstable device would require recruitment of additional muscles. 

The newly designed HaloBell is designed to distribute its weight evenly in all planes 

providing a potentially stable device, and the dumbbell distributes its weight to the 

poles of the device in a single plane providing a potentially more unstable device. 

PurPOsE: The purpose of this study is to determine if different resistance devices, 

the traditional dumbbell and the HaloBell, yield different levels of muscle activity in 

the elbow flexors during a standard biceps curl. 

METhOds: EMG activity was collected from 33 healthy participants that completed 

a MVIC in three positions. After randomizing the trials, subjects underwent four sets 

of three repetitions of elbow flexion in order to use each device in midposition and 

supination. Data was analyzed using a 3x2x2 ANOVA. 

rEsuLTs: A significant difference (p < 0.05) was found between devices with the 

forearm in midposition (p = 0.033) for the biceps brachii; the HaloBell was found to 

elicit less EMG activity (48% of MVIC) than the traditional dumbbell (50% of MVIC). 

The data did not produce any significant differences between devices with any other 

combinations examined. 

CONCLusION: The overall findings were not pronounced, and inferences that can 

be made from the data are limited. It cannot be concluded that the HaloBell is able to 

definitively elicit a greater EMG activity in target muscles compared to the traditional 

dumbbell. However, EMG activity was similar between the two devices suggesting 

similar efficacy. 


1288 Board #234 May 30, 9:00 AM - 10:30 AM 

shoulder Joint reaction Forces during Wheelchair 

Propulsion With arms and arm-legs By The Elderly 

Xiang Ke 1 , Yaping Zhong 2 , Peng Liu 2 , Yong Tai Wang, FACSM 3 . 

1 Georgia State University, Atlanta, GA. 2 Shandong Sport 

University, Jinan, China. 3 Shandong Sport University and 

Georgia State University, Atlanta, GA. 


PurPOsE: This study was to investigate the difference of SJRFs between wheelchair 

propulsion with arms (AP) and with combination of arms and legs (ALP) in the elderly. 

METhOds: Fourteen subjects aged 65 to 90 years old were recruited from local 

assisted living facilities, with five in AP group and nine in ALP group. Each subject 

performed two wheelchair locomotive activities (moving straight or along a curved 

line) at self-comfortable speed, using three different types of wheelchairs (drive-axis 

positioned in the front, middle, or rear). A Qualisys motion analysis system was 

employed to record and analyzed 3-D kinematical data from the land-markers of the 

right shoulder, elbow, wrist, hip, knee and ankle, and 5 th metacarpal joints. A JR3 

force measurement system built in the drive-axis was used to record 3-D right hand 

contact reaction forces from the pushrim. Peak SJRFs were predicted by an inverse 

dynamic model. The differences of SJFRs between two groups across two locomotive 

activities and three wheelchair types were determined by a three-way ANOVA, and the 

differences between two groups, in straight or curved locomotive activities with the 

same wheelchair type were compared by an Independent T test. 

rEsuLTs: SJFRs between AP group and ALP group across wheelchair activities 

and types were 78.5±7.9 N and 74.9±5.9 N (p=.716) and no differences were 

identified between the two groups across wheelchair activities and types, except for 

the interaction of three factors (group, wheelchair activity and type) together. In the 

straight wheelchair activity, there were no significant differences between AP and ALP 

groups with neither middle nor rear drive-axis wheelchairs (82.9±49.6 vs 48.3±11.6N, 

p=.195; 66.4±20.2 vs 50.0±14.1N, p=.098, respectively), but a significant difference 

was founded when propelling with front drive-axis wheelchair (55.2±14.7 vs 

126.9±63.1 N, p=.009). No significant differences were found between the two groups 

in the curved activity with respect to the front, or middle, or rear drive-axis wheelchair 

(67.2±27.3 vs 55.2±14.1N, p=.291; 75.9±37.5 vs 81.1±45.3N, p=.833; 123.6±97.6 vs 

88.2±53.3N, p=.484, correspondingly). 

CONCLusIONs: The involvement of legs with arms may not effectively facilitate 

reduction of SJFR for the elderly during wheelchair propulsion. 

1289 Board #235 May 30, 9:00 AM - 10:30 AM 

does Mode of Wheelchair Propulsion Influence Interlimb 

Wrist Coordination? 

Mark D. Tillman, FACSM, Patty Hovis, Lisa A. Zukowski, 

Jaimie A. Roper, Dana M. Otzel, Orit Shechtman, Ryan 

Roemmich. Univ. of Florida, Gainesville, FL. 


Individuals who use manual wheelchairs for mobility have increased risk of upper 

extremity pain that can lead to loss of mobility and decreased quality of life. In fact, 

49 to 63% of conventional manual wheelchair (CMW) users suffer from carpal tunnel 

syndrome (CTS). Our recent work has revealed that use of an ergonomic hand drive 

(EHD) mechanism for propulsion improves utilizes more neutral wrist orientation. In 

addition, other researchers have indicated that interlimb coordination is constrained 

(and potentially harmful) in CMW users with shoulder pain. Similar effects may occur 

at the wrist when using different propulsion techniques and have not been investigated. 

PurPOsE: To evaluate interlimb coordination of the wrist via cross-correlation 

coefficients (CCC) in relation to angular movements while using an EHD mechanism 

and a CMW. 

METhOds: Fourteen full-time CMW users (41.4±15.9 yrs, 73.4±16.7 kg, and 

172.3±12.9 cm) participated in the study. Motion data were captured by 11 cameras 

as participants propelled across a length of 8m completing 5 trials in a CMW and 5 

trials in the same CMW fitted with the EHD. Angular kinematics and CCC of the wrist 

(flexion/extension, radial/ulnar deviation) were calculated with the understanding that 

lower values would indicate reduced symmetry and constraint. At least one push phase 

was analyzed per trial and all trials were combined to calculate an average push per 

participant. CCC from the two propulsion styles were compared using paired samples 

t-tests (α=0.05). 

rEsuLTs: Use of the EHDM resulted in reduced flexion/extension CCC compared 

to CMW (0.509 and 0.908, respectively; p=0.012). Radial/ulnar deviation CCC did not 

vary between propulsion techniques (p>0.05). 

CONCLusION: EHD use resulted in reduced interlimb coordination regarding 

wrist flexion/extension. These results indicate that EHD employment may ease 

constraints on wrist flexion and extension during wheeling. The observed differences 

in coordination/symmetry may have clinical implications regarding overuse injuries 

of the wrist including CTS. This work supported by the Clinical and Translational 

Science Institute Pilot & Collaborative Research Projects (NIH: UL1 RR02980). The 

EHD is the intellectual property of Shands Healthcare. 



1290 Board #236 May 30, 9:00 AM - 10:30 AM 

Efficacy of shoulder rehabilitation with the Infinity Method 

Treatment 

Michaela Tomanova1 , Lee Cabell2 . 1Rehabilitation Clinic, 

Brandys nad Orlici, Czech Republic. 2Seton Hall University, 

South Orange, NJ. 


INTrOduCTION: The Infinity method represents a kinesitherapy approach based 

on anatomy, neurophysiology, and biomechanics of musculoskeletal dysfunction. In 

the early post-operative phases, static sub-maximal isometric contraction with exercise 

is utilized. In subsequent phases, 3-dimensional (3-D) movements in figure eight, 

circular, and spiral dynamic stabilization exercises are used in shoulder rehabilitation 

patients with functional and structural joint instabilities. 

PurPOsE: To test the efficacy of rehabilitation on shoulder joint stabilization utilizing 

the Infinity method from four to six weeks for 30 min daily in patients treated with 

conservative conventional method treatment (CMT) and post-surgical treatment (PST). 

METhOds: Quasi-experimental, non-randomized study in a rehabilitation hospital 

with 81 participants divided into CMT (n=34, 61.6±10.9 years) and PST (n=47, 

61.3±16.2 years) groups. The dependent variables, the visual analog scale (VAS) of 

shoulder subjective pain scores (from 1 for “no pain” to 10 for “very severe pain”), 

and the 3-D shoulder range of motion (ROM), were analyzed with the Wilcoxon and 

paired t tests. 

rEsuLTs: After the Infinity treatment was applied, the CMT group showed a 

decrease in VAS pain score of 5.72 vs. 3.33 (p



D-12 Thematic Poster - Cardiovascular 

Responses to Resistance Exercise 

May 30, 2013, 1:00 PM - 3:00 PM 

Room: 206 

1336 Chair: Randal P. Claytor. Miami University and CCHMC, 

Oxford, OH. 


1337 Board #1 May 30, 1:00 PM - 3:00 PM 

Cardiovascular responses to Eight Weeks of high-Intensity 

resistance Training 

Lindy M. Rossow, Christopher A. Fahs, Robert S. Thiebaud, 

Jeremy P. Loenneke, Daeyeol Kim, Grant Mouser, Erin A. 

Shore, Emily A. Siegrist, Michael G. Bemben, FACSM. 

University of Oklahoma, Norman, OK. 


Resistance exercise training is beneficial for the musculoskeletal health of a wide range 

of people. Previous studies have suggested resistance training may benefit, harm, or 

have no effect on cardiovascular function. Further examinations of cardiovascular 

responses to this type of training in women, particularly older women, are needed. 

PurPOsE: The purpose of this study was to determine cardiovascular responses to 

high-intensity resistance training in young (aged 18-25; n = 10) and older (aged 50-64; 

n = 8) women. 

METhOds: Brachial systolic (SBP) and diastolic (DBP) blood pressures, heart rate 

(HR), central (carotid to femoral) and peripheral (femoral to posterior tibial) arterial 

pulse wave velocity (PWV), resting forearm blood flow (fBF), and forearm reactive 

hyperemia (fRH) were assessed approximately two weeks prior to exercise training 

(Pre1), immediately prior to exercise training (Pre2), and immediately following 

exercise training (Post). Exercise training consisted of 8 weeks of 3 sets (10 reps, 10 

reps, reps to failure) of 6 (3 upper, 3 lower) different exercises performed on standard 

weight-machines 3 days per week. Paired-samples t-tests compared Pre1 to Pre2. As no 

t-tests were statistically significant, Pre1 and Pre2 values were then averaged and 2 x 2 

(group x time) repeated measures ANOVA was performed. Data are reported as mean ± 

standard error. Statistical significance was set at p


untrained participants over time. 

rEsuLTs: Participants were similar for age (22 ± 2 yrs), height (1.72 ± 0.10m) and 

weight (73.0 ± 16.7 kg) but there were significant differences (p



and MuRF-1 (51%). A significant relationship was found between IL-6 and MuRF-1 

expression after incubation with PGE2 (r=0.77, P


1350 Board #7 May 30, 1:00 PM - 3:00 PM 

aMPK Play a role In The substrate Energy selection 

during Post Exercise recovery 

Andreas Mæchel Fritzen, 1987, Mette Landau Brabæk 

Christiansen, Jacob Jeppesen, Bente Kiens. Copenhagen 

University, Copenhagen, Denmark. 


Several studies have shown a substantial fractional fatty acid (FA) oxidation during 

the post exercise period. It appears that after exercise muscle glycogen resynthesis has 

such a high metabolic priority that a higher utilization of lipids to cover the energy 

expenditure in the muscle cell is observed. Interestingly, the mechanisms responsible 

for the selection of energy substrate in muscle post-exercise are virtually unknown, 

and the mechanism(s) regulating post exercise increased FA oxidation has not been 

fully explained. AMP-activated kinase (AMPK) has been found to be involved in FA 

oxidation at rest and could potentially play a role in fuel selection post exercise. 

PurPOsE: To investigate the possible role of AMPK for the energy substrate 

selection in post exercise recovery. 

METhOds: Homozygote AMPKα2 knock-out (KO) and wildtype (WT) littermates 

were allocated into 3 groups: a resting control group, an exercise group and a postexercise 

group. Treadmill exercise was performed for 2 hours at 50% of maximal 

running capacity for each group. Post-exercise recovery group was studied 6 hours post 

exercise. Oxygen uptake and respiratory exchange ratio were measured in metabolic 

chambers during both resting, exercise and in post-exercise recovery conditions. 

rEsuLTs: In both genotypes RER was lower (p



performed with a validated and reliable software tool (Optidiet, Linden, Germany). 

The reference value for vitamin C used in our study (100mg/d; which is 40 mg/d above 

the recommendations of the US Food and Drug Administration (FDA)) was based 

on the recommendations of the European and German societies of nutrition. Blood 

samples were collected 1-week pre-race (V2), and immediately (V3), 24-h (V4), and 

72-h (V5) post-race, and were analyzed for inflammatory parameters (IL-6, highsensitivity 

CRP, and blood leukocyte counts). 

URTI rates were assessed by the Wisconsin Upper Respiratory Symptom Survey 

(WURSS-21), with symptoms recorded by the participants for two weeks following the 

race. The association between URTI incidence, inflammatory parameters, and vitamin 

C intake was investigated. 

rEsuLTs Incidence of URTI during the 2-week post-marathon period was inversely 

related to pre-race vitamin C intake (mean vitamin C-intake and URTI incidence: < 

50mg/d, 20%; 50-75mg/d, 18%; 75-100mg/d, 10%; 100-125mg/d, 8%; >125mg/d, 4%; 

p for trend = 0.04). This was observed independent from other potential confounders 

such as intake of polyphenols or total energy intake. Low vitamin C intake (


1358 Board #6 May 30, 1:00 PM - 3:00 PM 

Effects Of a Freeze-dried Fruit-vegetable Juice Powder On 

Exercise-induced Metabolic Outcomes: a Metabolomics 

approach 

Amy M. Knab 1 , David C. Nieman, FACSM 1 , Nicholas D. 

Gillitt 2 , R. Andrew Shanely 1 , Lynn Cialdella-Kam 1 , Dru A. 

Henson 3 , Wei Sha 4 , Mary Pat Meaney 1 . 1 Appalachian State 

University, Human Performance Laboratory, North Carolina 

Research Campus, Kannapolis, NC. 2 Dole Nutrition Research 

Laboratory, North Carolina Research Campus, Kannapolis, 

NC. 3 Appalachian State University, Boone, NC. 4 Bioinformatics 

Services Division, University of North Carolina at Charlotte, 

North Carolina Research Campus, Kannapolis, NC. 

Supported by a.M. Knab: Contracted Research - Including Principle 

Investigator; Dole Foods Inc.. 

PurPOsE: To investigate a freeze-dried fruit-vegetable juice powder (JUICE) in 

decreasing exercise-induced inflammation, oxidative stress, and immune perturbations. 

METhOds: Thirty-four endurance cyclists (25 male, 9 female) were randomized to 

control (non-JUICE) or JUICE for 17 days. JUICE provided 230 mg of flavonoids/ 

day, doubling the typical adult daily intake. On days 15-17, subjects cycled at 70-75% 

VO2max for 2.25-h, followed by a 15 min time trial. Blood samples were collected 

pre-suppl, post-suppl (pre-exercise), and immediately post-exercise and 14-h postexercise 

on the third day. Samples were analyzed for inflammation [interleukin (IL)- 

6, IL-8, tumor necrosis factor alpha (TNFα), monocyte chemoattractant protein 1 

(MCP-1)], oxidative stress (ORAC, FRAP, reduced and oxidized glutathione, protein 

carbonyls), and immune function [granulocyte (G-PHAG) and monocyte (M-PHAG) 

phagocytosis and oxidative burst activity] biomarkers, with metabolomics conducted 

using gas and liquid chromatographic mass spectrometry (GC-MS; LC-MS). 

rEsuLTs: A 2 (group) x 4 (time points) repeated measures ANOVA revealed 

significant time effects due to 3 days of exercise for IL-6 (396% increase), IL-8 (78% 

increase), TNFα (12% increase), MCP-1 (30% increase), G-PHAG (38% increase), 

M-PHAG (36% increase), FRAP (12.6% increase), ORAC (11% decrease at 14-h 

post-exercise), and protein carbonyls (82% increase at 14-h post-exercise) (p < 0.01). 

No significant interaction effects were found for all of the inflammation, oxidative 

stress, and immune function measures. Repeated measures ANOVA revealed a >2-fold 

shift in 103 metabolites due to exercise in the non-JUICE condition (FDR p-values 

all 20% DV) of five 

nutrients (22% vitamin A, 245% vitamin C, 20.5% vitamin B6, 23.6% potassium, and 

33.7% folate). Funded by Dole Foods Inc. 

D-15 Thematic Poster - Immunology 

May 30, 2013, 1:00 PM - 3:00 PM 

Room: 209 

1359 Chair: Jeffrey A. Woods, FACSM. University of Illinois, 

Urbana, IL. 


1360 Board #1 May 30, 1:00 PM - 3:00 PM 

Microarray analysis revealed Gene Expression Profiling 

In Lps- stimulated Whole Blood Following Prolonged 

Exhaustive Exercise 

Asghar Abbasi1 , Melanie Hauth1 , Michael Walter2 , Jens 

Hudemann3 , Veit Wank4 , Andreas M. Niess3 , Hinnak Northoff1 . 

1Clinical and Experimental Transfusion Medicine, Tübingen, 

Germany. 2Medical Genetics, Tübingen, Germany. 3Institute of Sports Medicine, Tübingen, Germany. 4Institute of Sports 

Science, Tübingen, Germany. 


An acute bout of prolonged exhaustive exercise can cause adverse effects on the 

immunity reflected by transient immunosuppression following the event. 

PurPOsE: To gain more insight into these mechanisms, the capacity of whole blood 

cultures in profiling gene expression in response to endotoxin (LPS) was studied in 

athletes before, 30min after, 3h after and 24h after a half-marathon run. 

METhOds: Eight well trained men and 8 well trained women were participated 


and gene expression patterns were assessed in LPS-stimulated (1h) and un-stimulated 

whole blood using Affymetrix GeneChip microarrays. 

rEsuLTs: Results showed that prolonged exhaustive exercise altered several genes 

in LPS-stimulated cultures relative to un-stimulated cultures. These included genes 

related to inflammatory response (30min and 3h post-exercise/both sexes), activation 

of AMPK activity, response to hypoxia (3h post exercise/men), angiogenesis (3h post 

exercise/women), prostaglandin biosynthetic process (30min and 3h post-exercise/ 

both sexes), myeloid cell differentiation (24h post exercise/women) Functional 

categorization (KEGG pathway analysis) showed that genes associated with TLRs 

signalling were the most significantly over presented in both sexes. 

CONCLusION: The results of the present study indicate that prolonged exhaustive 

exercise resulted in a rich variety of changes in expression of inflammatory and antiinflammatory 

genes in short-time LPS stimulated whole blood cultures. This may 

provides novel insights into the molecular processes involved in the immune response 

following exhaustive exercise. 

This work was supported by a grant from the Bundesinstitut für Sportwissenschaften 

(Bonn, Germany, KZIIA1-070108/08-09). 

1361 Board #2 May 30, 1:00 PM - 3:00 PM 

The Impact of Ironman Triathlon on Innate Immune Cell 

Numbers and Function 

Shlomit Radom-Aizik 1 , Carl M. Maresh, FACSM 2 , Fadia 

Haddad 1 , Dan M. Cooper 1 , Cherryl Nugas 1 , Douglas J. 

Casa, FACSM 2 , Jenna M. Apicella 2 , Elaine C. Lee 2 , Julie K. 

DeMartini 2 , Colleen X. Munoz 2 , Frank Zaldivar 1 . 1 Pediatric 

Exercise Research Center, UC Irvine, Irvine, CA. 2 Korey Stringer 

Institute, University of Connecticut, Storrs, CT. (Sponsor: Carl 

M. Maresh, FACSM) 


Prolonged, high-intensity endurance exercise activities such as the Ironman Triathlon 

(typically lasting 10-12 hours) profoundly perturb homeostasis in a variety of 

physiological systems, and would likely impact key cellular components of innate 

immunity (e.g., natural killer cells and monocytes), a “first responder” to stress and 

infection. The effect of such exercise on numbers and functional indexes of circulating 

innate immune cells is poorly understood. 

PurPOsE: To study the impact of the Ironman Triathlon on innate immune cell 

number and function. We hypothesized that there would be immediate effects on 

measures of number of cells and cellular activation in NK cells (KIR, killer cell 

immunoglobulin-like receptors) and in monocytes (toll-like receptors, TLR) which 

would continue throughout the recovery period. 

METhOds: 10 elite male triathletes, 32-64 y/o volunteered. Blood was drawn 

between 2-3 days before the triathlon (baseline), and during recovery at 1-, 24-, 

and 48-h after completion. CBC and standard flow cytometry methods were used 

to determine monocyte and NK cell (CD3 - CD56+) count, NK dim and bright 

subpopulation (CD56 dim and CD56 bright ), and cell function (NK, KIR2DL2; and 

monocyte, TLR4). Repeated Measure ANOVA was applied (p



rEsuLTs: Elite marathon runners tend to have lower concentrations of salivary 

antimicrobial peptides (HBD-2 and LL-37) than sedentary subjects(P


pain, and pain/effusion) with a week between each condition. A single injection of 5% 

sodium chloride (1 mL) to the right infrapatellar fat pad and 0.9% sodium chloride (50 

mL) to the suprapatellar pouch were administered to induce knee pain and effusion, 

respectively. To induce pain/effusion, both injections were employed. No injection 

was performed for the control. High-speed videography was used to measure lowerextremity 

joint kinematics during walking. For each condition, subjects walked at three 

time intervals: precondition (prior to injections), condition (3 minutes post injections), 

and postcondition (30 min post injections). Functional linear models were utilized 

to detect differences between groups. This analysis used all of the data during stance 

phase, rather than discrete values. 

rEsuLTs: The biggest changes were observed under the pain/effusion condition. 

Compared to the precondition, subjects walked with more dorsiflexion (initial contact, 

35-60% of stance phase, and toe off), more knee flexion (at initial contact and 30-90% 

of stance phase), and less hip extension (37-82% of stance phase) in the involved side. 

In the uninvolved side, subjects walked with more dorsiflexion (10-35% of stance 

phase), knee flexion (3-20% and 50-70% of stance phase), and less hip abduction at toe 

off. Subjects walked with more knee flexion (50-70% of stance phase) under isolated 

knee pain condition while they walked with more knee flexion (45-80% of stance 

phase) and more dorsiflexion at initial contact under isolated knee effusion condition. 

CONCLusIONs: When a knee stimulus is combined with knee joint effusion it 

appears to produce a summative effect on joint kinematics. Since knee joint effusion 

is typically accompanied by pain, both variables should be aggressively managed in 

acute and chronic stages of knee joint injury and rehabilitation in order to avoid plastic 

changes to movement strategies. 

1368 Board #2 May 30, 1:00 PM - 3:00 PM 

Gait and speech are Interdependent in young healthy 

adults 

Tiphanie Raffegeau, Shirley Rietdyk, Jeffery M. Haddad, Jessica 

Huber. Purdue University, West Lafayette, IN. 


Recent studies have demonstrated that gait involves executive function (EF). In healthy 

adults, performing a concurrent task typically resulted in decreased performance of 

the secondary task and reduced gait speed. Arbitrary tasks, typical to dual-task gait 

research, such as counting backwards, may result in stronger associations between gait 

and EF due to the novelty of the task and may not reflect typical behavior. Therefore, 

it is important to extend the observations to common well-practiced tasks to fully 

examine the relationship between gait and EF. Conversational speech relies on EF, and 

people often talk while walking with a friend, providing an ideal concurrent task. 

PurPOsE: To investigate the interdependence of gait and speech in young healthy 

adults. 

METhOds: 16 adults (9 males, 22±1.4 yrs) walked under two speech conditions, 

talking and not talking. A topic was selected from a list and subjects spoke 

extemporaneously for one minute. Gait and speech measures were recorded. Paired 

t-tests were used to compare across conditions. Speech measures are currently being 

analyzed, only gait measures are reported here 

rEsuLTs: When speaking, gait speed decreased (1.44 ± .56 m/s to 1.36 ± .56 m/s, 

(p



PurPOsE: Examine the dose-response relationship between load carried and sagittal 

plane knee mechanics during walking. 

METhOds: 25 active duty male volunteers (20.9 ± 3.3 yrs; 178.1 ± 8.3 cm; 86.3 

± 14.6 kg) carried 5 vest borne loads while walking on a force sensing treadmill at 

1.34m/s for 10 minutes. Soldiers first walked with body weight only, which served as 

a baseline condition. The 5 loads (15, 25, 35, 45 and 55 kg) were presented randomly 

with at least 3 min rest between loads. Kinematic and kinetic data were collected. Knee 

extensor moments (Mkne) and range of motion (ROM) from footstrike to mid-stance 

were compared across all 5 loads using repeated measures ANOVAs (p < .05). 

rEsuLTs: Post hocs revealed (Table 1) significant differences between each 

increasing load for Mkne (p < .025) but no differences for ROM (p ≥ .175). The Mkne 

increase from 45 to 55 kg was 1.9 times greater than any other increase in Mkne. 

CONCLusIONs: At a constant velocity and with no change in ROM across trials, 

the elevated Mkne was likely a mechanism by which the body responded to increasing 

loads. If these elevated Mkne are not sustainable, then Soldiers may be exposed to a 

greater risk of injury. Therefore, the disproportionate changes to Mkne at heavier loads 

suggest a threshold exists above which injury risk may be magnified. 

1372 Board #6 May 30, 1:00 PM - 3:00 PM 

Greater step Widths reduce Knee abduction Moments in 

Knee Osteoarthritis Patients during stair ascent 

Max R. Paquette 1 , Songning Zhang, FACSM 2 , Gary Klipple 3 . 

1 University of Memphis, Memphis, TN. 2 University of Tennessee, 

Knoxville, TN. 3 University of Tennessee Medical Center, 

Knoxville, TN. 


Research shows that increased step width (SW) during stair descent reduces first 

and second peak internal knee abduction moments in healthy adults but not in knee 

osteoarthritis (OA) patients. 

PurPOsE: To study the effects of increased SW on knee abduction moment and knee 

pain in 

healthy and knee OA adults during stair ascent. 

METhOds: 13 healthy 

adults (58.9±8.3 yrs) and 13 medial compartment knee OA patients (62.5±9.0 yrs) 

were recruited. A 9-camera motion analysis system, two force platforms and an 

instrumented staircase were used to obtain the 3D stance phase kinematic and GRF 

data. Participants performed 5 stair ascent trials at a self-selected speed using preferred 

SW, wide SW, and wider SW. The wide and wider SW conditions were normalized 

to 26 and 39% of leg length, respectively. A two-way (Group x SW) mixed design 

ANOVA was used to detect any differences between groups and SWs. 

rEsuLTs: The average self-selected stair ascent walking speed was slower (p=0.044) 

in knee OA patients (0.52±0.09 m/s) compared to healthy adults (0.60±0.06 m/s). 

In both groups 1st (KAM1) and 2nd (KAM2) peak internal abduction moments and 

abduction moment impulse (MI) were all 

reduced in wide and wider SW compared to preferred SW and in wider compared to 

wide SW (Table 1). Healthy adults rated no pain. Pain scores of knee OA patients were 

13.5±15.0mm for preferred,12.9±16.9mm for wide and 10.7±11.6mm for wider SW 

but were not significantly different (p>0.05). 

CONCLusION: Our results indicate that increased SW reduces peak knee abduction 

moments in both healthy and knee OA patients during stair ascent and could have 

implications on lowering medial knee joint loads during stair ascent. However, 

increased SW did not reduce knee pain in knee OA patients. 


1373 Board #7 May 30, 1:00 PM - 3:00 PM 

Frontal Plane Walking Mechanics and hip strength 

In College-aged Individuals Who are Post-medial 

Meniscectomy 

Richard W. Willy, Brian C. Clark, FACSM, Megan A. Ossim, 

James S. Thomas. Ohio University, Athens, OH. 


More than 50% of those who undergo partial medial meniscectomy (PMM) have knee 

osteoarthritis (OA) 12 years post-procedure. PMM individuals have previously been 

reported to walk with an excessive knee external adduction moment (KEAM) 1-3 

months after surgery, likely increasing medial knee joint loads. However, it is unknown 

if these gait patterns persist long term. In addition, excessive frontal plane hip and 

trunk mechanics, perhaps due to hip abductor weakness, may contribute to high levels 

of KEAM in PMM individuals. 

PurPOsE:To compare gait mechanics and hip strength in college-aged individuals, 

post-PMM due to a traumatic meniscal tear, with healthy controls. Besides deficits 

in hip abductor strength (HABDS), PMM subjects were hypothesized to walk with 

greater peak knee adduction (KAD), KEAM, internal hip abduction moment (HAM), 

and greater trunk sidebending at peak KEAM (TLKEAM). 

METhOds:To date, 11 PMM subjects (9 males, post-PMM 40 months ±18.4) and 7 

healthy controls (6 males) have been collected. Isometric HABDS and the Knee Injury 

and Osteoarthritis Outcome Score (KOOS) were collected. Using standard motion 

capture procedures, walking mechanics were sampled as subjects traversed a 10-m 

runway at 1.3 m/s (+/-5%). Effect sizes were calculated in this incomplete cohort. 

rEsuLTs: To date, PMM subjects walked with greater peak KEAM, even when 

normalized to body mass. Interestingly, HAM and TLKEAM were greater while 

HABDS was less in PMM subjects. 

CONCLusIONs:These preliminary data suggest that young individuals who are 

post-PMM walk with excessive KEAM, possibly contributing to their high risk of knee 

OA. Potential therapies to reduce KEAM may include movement retraining of the hip 

and trunk or strengthening of the hip abductors. 

Variables of interest (±sd) and effect size calculations 

PMM Control Effect size (d) 

Age (Years) 23.1 (6.4) 23.3 (2.8) 0.05 

BMI (kg/m2) 26.5(3.2) 24.03(2.3) 0.88 

Tegner (x/10) 7.1(1.4) 7.1(0.7) 0.01 

KOOS (x/100) 86.3 (9.8) 99.2 (1.2) 2.33 

Peak KAD (deg) -3.4(3.9) -2.8 (2.8) 0.44 

Peak KEAM (N*m/kg*m) 0.415 (0.147) 0.291(0.111) 0.95 

Peak HAM(N*m/kg*m) -0.745(0.243) -0.581(0.121) 0.90 

TLKEAM (deg) 2.9 (2.1) 1.3 (0.6) 1.12 

HABDS (%BW*m) 12.6 (3.6) 16.6 (4.4) 0.93 

1374 Board #8 May 30, 1:00 PM - 3:00 PM 

Overground Gait aftereffects Produced By split-belt 

Treadmill Walking and unilateral stepping 

Kristin V. Huynh, Carolina H. Sarmento, Ryan T. Roemmich, 

Chris J. Hass, FACSM. University of Florida, Gainesville, FL. 


PurPOsE: To compare the transfer of unilateral stepping and split-belt treadmill 

walking aftereffects to overground gait. Rehabilitation to target gait asymmetry in 

various movement disorders is needed. Although both split-belt and unilateral step 

training have been reported to reduce these asymmetries, these methods have not been 

directly compared. 

METhOds: Thirteen healthy young adults (21 ± 2 y) participated in this study. 

Kinematic data were collected using a 10-camera motion capture system (120Hz). The 

participants first performed ten baseline gait trials across a 12-m walkway. Participants 

then selected a “fast” walking speed on the treadmill (1.48 ± 0.11 m/s); the “slow” 

speed was 50% of the fast speed. All participants completed three treadmill conditions 

in a randomized order for 10 minutes each: (1) during slow unilateral, the left leg 

walked at the slow speed while the right leg was stationary, (2) during fast unilateral, 

the left leg walked at the fast speed while the right leg was stationary, and (3) during 

split-belt, the left leg walked at the fast speed and the right leg walked at the slow 

speed. Following each condition, the participants performed ten overground gait trials. 

Step length asymmetry (SLA) was calculated for each stride by subtracting right step 

length from left step length. Linear regressions were fit to model the initial aftereffect 

(intercept, β0) and decay (slope, β1) of SLA along the number of steps during the gait 

trials following each treadmill condition and during baseline. 

rEsuLTs: We observed significantly larger aftereffect in SLA (β0) after split-belt 

compared to slow unilateral (β0=.056 vs. .022, p=.003). β0 was also significantly 

higher after fast versus slow unilateral (β0= .044 vs. .022, p= .005). 

The aftereffect decay (β1) was significantly higher after split-belt and fast unilateral 

compared to baseline (β1=-.0024 and -.0018 vs. -.0001, p=.005 and .048, respectively). 

β1 was also significantly higher after split-belt compared to slow unilateral (β1=-.0024 

vs. -.0009, p= .005). 



CONCLusION: Our results indicate that transfer of adapted gait parameters to 

overground gait following split-belt walking are greater than unilateral stepping, 

however some populations with gait asymmetry may benefit from unilateral stepping if 

they lack access to a split-belt treadmill. 

D-17 Free Communication/Slide - Advancing 

Physical Activity Assessment Methods 

May 30, 2013, 1:00 PM - 3:00 PM 

Room: 125 

1375 Chair: Scott Crouter, FACSM. University of Massachusetts 

Boston, Boston, MA. 


1376 May 30, 1:00 PM - 1:15 PM 

Expressing Energy Expenditure in youth: allometric scaling 

and Corrected METs 

Brian C. Rider, David R. Bassett, Jr., FACSM, Dawn P. Coe. 

University Of Tennessee, Knoxville, TN. 


Many physiological variables show associations with body size. It has been shown 

that scaling submaximal VO2 values helps to normalize the data across individuals 

of different size/age/gender. This reduces the likelihood that differences in VO2 will 

appear to exist, when in fact, they are due primarily to differences in body size. This 

could possibly be achieved by using allometric scaling or corrected METS (i.e. activity 

EE/estimated RMR). 

PurPOsE: To explore the use of allometric scaling and corrected METs to achieve 

better estimates of children’s energy expenditure (EE) based on speed of locomotion, 

during treadmill walking and running. 

METhOds: Mean data were taken from 13 studies that contained childhood (8- 

14y) VO2 data, obtained during submaximal treadmill tests. Due to the fact that each 

study had different numbers of participants, studies with a greater number numbers 

of subjects were assigned more weight. Linear regression was used to determine the 

relationship between VO2 and treadmill speed. For the allometric scaling method, 

body mass was expressed in ml.kg-0.75 min-1. Corrected METs were computed using 

the Schofield equation to estimate RMR, using both weight (w) and height and weight 

(h&w). 

rEsuLTs: Both allometric scaling and corrected METs improved the ability to 

estimate EE based on speed of locomotion. There was a tighter relationship between 

speed and VO2 scaled to body weight raised to the 0.75 power, than there was between 

speed and standard METs (i.e. activity EE/3.5) [Walking: r2= 0.6482, vs. 0.2859. 

Running: r2= 0.8247 vs. 0.6281]. Corrected METs also showed tighter relationships 

with speed than did standard METs [Walking: r2= 0.8722 (h&w) and 0.7942(w) vs 

0.2859; Running: r2= 0.4773 (h&w) and 0.6421 (w) vs 0.6281]. 

CONCLusION: Both allometric scaling and corrected METs yielded stronger 

associations with speed of locomotion, than standard METs. Corrected METs also 

showed a stronger correlation with submaximal running speeds, but only when using 

the Schofield equation based on weight. Further research is needed to determine the 

best method available for normalizing energy costs of treadmill walking and running 

for youth of different sizes/genders/ages. 

1377 May 30, 1:15 PM - 1:30 PM 

using receiver Operating Characteristic Curves and 

accelerometry To Establish step-count Guidelines For 

Twelve-year-old Children 

Timothy Fulton, Fabio Fontana, Kent Ingvalson, Kimberly 

Decker, Ripley Marston, Kevin Finn. University of Northern 

Iowa, Cedar Falls, IA. 


Current physical activity guidelines are based on frequency, duration, and intensity 

of physical activity. Recollection of physical activity duration and understanding of 

physical activity intensity are difficult tasks. Restructuring current guidelines to stepcounts 

may facilitate the identification of children not reaching adequate physical 

activity levels. 

PurPOsE: To measure the ability of step-counts to discriminate between adequate 

and inadequate physical activity levels, and establish gender-specific step-count 

guidelines for twelve-year-old children. 

METhOds: This study employed a fully cross-sectional design. A total of 106 

children participated in the study (N girls = 62; N boys = 44). Participants wore a pedometer 

and an accelerometer for one full day, and recorded the number of steps on an 

activity log. The Freedson equation was used to compute duration and intensity of 

exercise. Receiver Operating Characteristic curves were used to determine the ability 

of step-counts to discriminate between adequate and inadequate physical activity 


levels. Optimal cutoff points were based on sensitive scores larger than .80 due to the 

importance of identifying children and adolescents with inadequate levels of physical 

activity, and the maximum sum of sensitive and specificity scores. 

rEsuLTs: The area under the curve for each of the sub-groups (AUCgirls = .85, 

95% CI = .76 - .95, p > .01; AUCboys = .85, 95% CI = .72 - .97, p > .01) was high, 

indicating good ability of step-counts to discriminate among children with adequate 

and inadequate levels of physical activity. To achieve minimum daily physical activity, 

we suggest 12,007 and 12,605 steps/day for 12-year-old girls and boys respectively. 

CONCLusION: Pedometer step-counts discriminate well among children with 

adequate and inadequate levels of physical activity. To our knowledge, this is the 

first attempt to develop gender- and age-specific guidelines. With the current levels 

of obesity on the rise, the use of the suggested step-count guidelines may be a useful 

initial epidemiological step in the identification of children with low levels of physical 

activity. 

1378 May 30, 1:30 PM - 1:45 PM 

Comparisons Of Prediction Equations For Estimating 

Energy Expenditure In youth 

Youngwon Kim 1 , Scott E. Crouter, FACSM 2 , Jung-Min Lee 1 , 

Yang Bai 1 , Glenn A. Gaesser, FACSM 3 , Gregory J. Welk, 

FACSM 1 . 1 Iowa State University, Ames, IA. 2 University of 

Massachusetts Boston, Boston, MA. 3 Arizona State University, 

Tempe, AZ. 


Various sets of prediction equations for the Actigraph have been developed to estimate 

energy expenditure (EE) in youth, but there is no consensus about the best approach. A 

set of two 2-regression models (2RM) have been proposed as alternative to traditional 

single regression models (1RM), but they have not been directly compared. 

PurPOsE: The purpose of this study was to compare the VM (VM2RM) and VA 

(VA2RM) and 1RM models from Freedson/Trost (FT), Trost (TR), Puyau (PU) and 

Treuth (TH) to indirect calorimetry for estimating EE in youth. 

METhOds: Fifty nine participants (7- 13 yrs; male: 41) performed 12 different 

activities (randomly assigned from a set of 24) that would mimic “free-living” 

activities in youth. While performing these activities, the participants were 

concurrently measured with a metabolic gas analyzer (Oxycon Mobile; OM) and an 

Actigraph accelerometer. Each activity was performed for 5-min, with a 1-min rest 

between activities. Estimates of METs were obtained from the ActiGraph prediction 

methods and were compared to OM measured METs (measured VO2/predicted 

RMR). Comparisons were first made using the aggregated data from the whole trial 

(i.e. between-subject comparisons; n = 59) and then for each individual activity (i.e. 

activity-by-activity comparisons; n=24). Agreement with OM values was evaluated 

using repeated measures of ANOVA (with Tukey-Kramer pairwise comparisons), and 

absolute percent errors (APE). 

rEsuLTs: For the whole trial comparisons, estimated EE from each of the ActiGraph 

prediction methods significantly underestimated measured OM EE (P



METhOds: Activity data were collected during a longitudinal bone growth study, 

contrasting gymnasts (GYM: non-seasonal OPA) vs. non-gymnasts (NON: seasonal 

OPA). Activity-specific OPA for each calendar month was recorded using semi-annual 

questionnaires. Total OPA monthly means (MOPA) and annual means (AOPA) were 

calculated. For individual subjects, MOPA and AOPA means, standard deviations (sd) 

and coefficients of variation (CV, sd/mean) were calculated; similar group statistics 

were calculated for GYM, NON and ALL (GYM + NON). 

rEsuLTs: OPA data were analyzed for 59 girls (27 GYM, 32 NON), aged 8-17 yrs. 

AOPA group means were as follows: ALL 8.5 h/wk (sd 5.3); GYM 12.6 h/wk (sd 4.3); 

NON 5.1 h/wk (sd 3.4). For MOPA, mean intra-subject CVs (INTRACV) were: ALL 

52%, GYM 35% and NON 66%. For AOPA, mean inter-subject CVs (INTERCV) 

were: ALL 63%, GYM 34%, NON 66%. Thus, monthly intra-individual variability 

(MOPA INTRACV) was high and similar to annual inter-individual variability (AOPA 

INTERCV). 

suMMary: For females in late childhood and adolescence, MOPA differs widely 

from month-to-month and may not reflect annual VPA exposure. Thus, use of 

“snapshot” activity sampling may weaken associations with biological properties of 

interest, as intra-individual variation across time rivals inter-individual differences. For 

growing females, use of general AOPA records may be more appropriate for studies of 

skeletal adaptation and maintenance than extrapolation from more specific “snapshot” 

sampling. 

1380 May 30, 2:00 PM - 2:15 PM 

assessment of Light-Intensity activities and sedentary 

Behaviors using Multiple Measurement devices 

Nathanael Meckes, Laura R. Brittain, Barbara E. Ainsworth, 

FACSM. Arizona State University, Phoenix, AZ. 


PurPOsE: To examine the accuracy of three measurement devices (ActiGraph 

GT3x+, ActivPAL, and Sensewear Armband) in assessing sedentary behavior and 

light-intensity physical activity (PA) against a referent measure of oxygen uptake 

(Oxycon Mobile). 

METhOds: 16 adults (8 males, 8 females) wore the four measurement devices 

while performing 7 activities (walking at 1.0 mph, 1.5 mph, 2.0 mph, cleaning a 

kitchen, standing and reading, typing at a computer, and playing board games) 

classified in the 2011 Compendium of Physical Activities between 1.2 and 1.8 METs 

or were unmeasured activities that were light-intensity in nature. Activities were 

classified as either sedentary or light-intensity according to the oxygen uptake, and 

the other measurement devices were compared against oxygen uptake for accuracy 

in measurement. Mean absolute percent error (MAPE) was used to calculate 

measurement accuracy. 

rEsuLTs: The Sensewear Armband measured treadmill walking accurately (0% 

MAPE), but activities requiring arm movement were less accurate (typing - 50.00% 

MAPE). The ActivPAL also measured treadmill walking accurately (1.88% MAPE) 

but misclassified standing activities (reading - 86.88% MAPE). The ActiGraph GT3X+ 

misclassified activities with slow (


activity protocol (median=11.5%, range=6.3%-27.4%) compared to the lifestyle 

activity protocol (median=77.2%, range=60.6%-98.3%). Patterns of prevalence 

for both activity protocols were similar for sex, race/ethnicity, education, and BMI 

subgroups. Prevalence decreased with age for the walking/running activity protocol 

whereas prevalence increased for 25-44 year olds before decreasing with age for the 

lifestyle activity protocol. 

CONCLusION: Prevalence estimates for meeting Guidelines in U.S. adults varied 

widely, indicating the choice of cut point impacts the prevalence estimates. Whether 

accuracy of the prevalence for meeting Guidelines for U.S. adults may be further 

improved if cut points (1) captured lifestyle activities in which many U.S. adults 

participate and (2) were generated from samples with characteristics similar to that of 

the U.S. adult population should be evaluated. 

D-18 Clinical Case Slide - Low Back Issues 

May 30, 2013, 1:00 PM - 2:40 PM 

Room: 103 

1384 Chair: Stanley A. Herring, FACSM. University of Washington 

Medical Center, Seattle, WA. 


1385 discussant: Gary P. Chimes. Northwestern University, Chicago, IL. 


1386 discussant: Lisa Colvin, FACSM. ULM, Monroe, LA. 


1387 May 30, 1:00 PM - 1:20 PM 

spine Injury _ Gymnast 

Bryan Murtaugh, Ellen Casey. Northwestern McGaw Medical 

Center, Chicago, IL. (Sponsor: Joel Press, FACSM) 


hIsTOry: 16-year-old gymnast and cheerleader presenting for second opinion 

for 6 month history of low back pain. During the onset of pain, she was returning 

to gymnastics after several months of limited participation while recovering from 

a right knee injury. She was initially seen by another physician, and had x-rays and 

MRI, which were interpreted as a stress fracture of the superior endplate of S1. Initial 

treatment included a lumbar corset, NSAIDs, PT, and modified gymnastics. Pain 

persisted, so she received a different soft orthosis, and stopped all gymnastics and 

cheerleading 2 months prior to presentation. 

PhysICaL EXaMINaTION: Increased thoracic kyphosis, decreased lumbar 

lordosis, and pelvic obliquity. Tenderness at L5 and S1 spinous processes and bilateral 

sacral sulcus. Significantly restricted lumbar extension. Strength 5-/5 for right great toe 

extension and eversion. Seated slump and straight leg raise causes bilateral posterior 

thigh pain that improves with cervical extension. 

PhysICaL EXaMINaTION: 1.Spondylolysis 2.Persistent S1 ring apophysis 

fracture 3.Sacral stress fracture 4.Lumbosacral radiculopathy 


1.Lumbosacral xrays: No DDD, spondylosis, or spondylolisthesis. 2.Lumbosacral MRI 

11/2011: L5-S1 with a linear low signal endplate irregularity in the superior margin of 

the superior S1 endplate, right disc bulge with encroachment upon S1. 3.Lumbosacral 

MRI 4/2012: L5-S1 focal depression of the posterior portion of the superior S1 

endplate to the right of the midline, disc bulge L5-S1. 

FINaL WOrKING dIaGNOsIs: Right L5-S1 radiculopathy 

TrEaTMENT aNd OuTCOMEs: 1. Further imaging with a focused CT of 

L5-S1 obtained to determine if she truly has a persistent ring apophysis fracture. 

CT demonstrated that the presumed S1 endplate fracture was actually a congenital 

anomaly rather than an acute injury. 2. Treatment plan for R L5-S1 radiculopathy, 

including extension-biased mechanical diagnosis and treatment. Trial of Gabapentin 

200 mg PO HS. 3. Activity modification - No gymnastics until strength normalized, 

and pain decreased with daily activities, then progressed to stretching and conditioning 

with team. 4. She had 80% improvement with the treatment, and gradually returned to 

cheerleading and gymnastics without limitation from pain. 

1388 May 30, 1:20 PM - 1:40 PM 

Back Pain - Football 

Jesse Sally, Gary Chimes, Tanya Hagen. UPMC, Pittsburgh, PA. 


hIsTOry: A 22 year-old college football player presents with low back pain after 

being hit from behind, striking his back on the top of the opposing player’s helmet. 

He had acute pain in the left low back at the time of the injury, which persisted during 

practice the following week. He describes dull, aching pain in the left low back and 

paraspinal region that is worsened by prolonged standing and walking. He also reports 

pain with sitting upright for extended periods and bending forward to put on shoes. 

PhysICaL EXaMINaTION: Pain with lumbar range of motion was most 


significant between 30-70 degrees of lumbar flexion. There was tenderness to palpation 

of left lower lumbar paraspinals. With the knee flexed, the patient could flex, internally 

rotate, and externally rotate the hip without limitation. Sensation is intact to light 

touch throughout his L2-S2 dermatomes bilaterally. Manual muscle testing revealed 

5/5 strength throughout his L2-S2 myotomes. Muscle stretch reflexes were 2+/4 at 

the knee, medial hamstring, and ankle bilaterally. Stork maneuver with reproduction 

of low back pain bilaterally. Slump-sit test with reproduction of concordant back pain 

bilaterally, more intensely on the left and better with cervical extension on the left. 


Pars interarticularis fracture 

Lumbar facet syndrome 

Sacroiliac joint inflammation 

Lumbar disc herniation 

Lumbar annular tear 

Lumbar radiculitis 


Lumbar spine x-ray imaging without acute fracture or spondylolisthesis. 

MRI of the lumbar spine with left paracentral disc protrusion at L4-5. Bilateral facet 

hypertrophy also at the same level with minimal foraminal encroachment. 

Standing extension-based exercises performed in the clinic helped to centralize pain 

from the left low back into the axial spine. This confirmed the diagnosis and helped 

guide treatment. 


L4-5 left paracentral disc protrusion with L5 radiculitis 


Left L5 transforaminal epidural steroid injection. 

Immediate improvement in symptoms post-injection. 

Prescribed physical therapy with focus on centralization (if symptoms were to recur), 

core stabilization, and lumbar strengthening for high level functionality. 

Full return to competition and practice without symptoms when evaluated for clinical 

follow-up. 

1389 May 30, 1:40 PM - 2:00 PM 

Lumbar spine-professional Ladies Professional Golf 

association Golfer 

Michael W. Perry, Elizabeth M. Hudak, Michael Weiss. Laser 

Spine Institute, Tampa, FL. 


hIsTOry: In 2010, a 27-year old LPGA golfer presented with a 7-year history 

of intermittent shooting sharp pain in her left lower back and left hip flexors. She 

also noticed a sensation of weakness in her left hip. Pain severity increased with 

posture and rotation, spine loading, sitting, and playing golf. There were no radicular 

symptoms, numbing, tingling, or changes in gait. Failed attempts to alleviate pain 

included acupuncture, spinal decompression using the DRX-9000, chiropractic care, 

hydro-therapy, and yoga. In 2008, short-term pain relief was achieved through a caudal 

epidural and facet injections. 

PhysICaL EXaMINaTION: The patient had a negative straight leg raise. 

Dorsiflexion and plantar flexion strength was 5/5 bilaterally. There was no alteration 

to sensation distally. Bilateral paraventrebal tenderness was noted at the left lumbar 

region. Pain was noted in the lumbar-thoracic spine with flexion, hyperextension, left 

lateral flexion and left rotation. Motor strength was satisfactory with a score of 5/5 in 

all muscle groups. No pathologic deep tendon reflexes were elicited. 


1.lumbar disc disruption 

2.lumbar facet disease 

3.lumbar paraspinal muscle strain 


MRI of the lumbar spine: 

•degenerative disc disease and bulge at L3-S1 

•annular tear at L3/4 

•degenerative facet disease at L4/5 

•mild forminal narrowing at L4/5 and L5/S1 

•mild spinal stenosis at L3-5 

X-Ray of the lumbar spine: 

•no instability or acute osseus abnormalities 

•disc spaces relatively maintained 

•mild facet changes of the lower lumbar facets at L4/5 and L5/S1 

X-Ray of the pelvis: 

•concentric hips without degenerative changes 

•pseudoarthrosis is not well visualized 


1.facet degeneration 

2.lumbar arthritis/osteoarthritis without myelopathy 

3.bulging disc 


1.minimally invasive endoscopic spinal surgery 

•destruction by thermal ablation of the paravertebral facet joint nerves at bilateral L3/4, 

bilateral L4/5, and bilateral L5/S1 facet joints 

2.post-operative care 





•lumbar bracing 

•follow-up evaluations 

•physical therapy 

3.surgical outcomes 

•back pain 6-months post-surgery: a short course of NSAIDs resolved all symptoms 

•patient is free from back pain, uses no pain medications, and playing in the LPGA tour 

1390 May 30, 2:00 PM - 2:20 PM 

Tingling and Weakness - Gymnastics 

Nailah Coleman, FACSM. Children’s National Medical Center, 

Washington, DC. 


hIsTOry: 16 y/o gymnast presented with sharp right patellar tendon pain and midlower 

back pain after two separate vault injuries within the prior two weeks. Her pain 

was exacerbated by movement and use of her knee and back. She denied sedentary 

pain, sleep disturbance, or bowel-bladder insufficiency. She noted atraumatic “pins and 

needles” on her right dorsal hand over the past five days but denied neck, elbow, or jaw 

pain or injury. 

Her past medical and surgical histories were unremarkable. 

Her only medicine was Aleve. She had no known allergies. 

Exam: she was WDWN in NAD. She had symmetric appearance of her extremities 

and a minimal curvature of her spine. She had a normal gait and was able to heel, toe, 

and duck walk. She was nontender to palpation. She had full motion of her trunk and 

extremities but pain with lumbar extension. Strength, sensation, and neurovascular 

status were intact and symmetric, except for 4+/5 strength in the right upper extremity. 

She had right hand cramping with elevated arm stress test and right shoulder pain with 

empty can, O’Brien’s test, and Speed’s test. 


•Spinal cord lesion 

•Nerve root compression 

•Peripheral nerve disease 

•Patellar tendinitis 

•Spondylolysis 

•Back strain 


X-rays 

•Cervical spine with oblique views: increased transverse processes 

•Scoliosis views: minimal curvature 

•Lumbar spine with oblique views: normal 

•Shoulder: normal 

•Knee: normal 

MRI 

•Spine: a lesion at C4-C5 measuring 5 mm (width) x 15 mm (cranial-caudal) with mild 

enhancement, which could signal a demyelinating process, tumor, or trauma. 

•Brain: findings suggestive of volume loss without evidence of gliosis or 

demyelination process. 

Final Working Diagnosis: transverse myelitis 


•Urgently seen by Neurology and admitted from clinic with a progressively 

symptomatic exam, including hyperreflexia and clonus. 

•CSF and serum studies for infectious and rheumatologic diseases were normal, except 

for an elevated ANA. A definitive etiology has not been found. 

•She was given a three-day course of methylprednisolone and responded well. 

•She was discharged home with plans for Neuro-Ophthalmology, PM&R, and repeat 

imaging. 

•New studies are pending. 

1391 May 30, 2:20 PM - 2:40 PM 

acute Back Pain-Football 

Tom W. Bartsokas, FACSM. Summa Orthopaedics & Sports 

Medicine, Streetsboro, OH. 


hIsTOry: 13-yo male sustained direct blow to right lumbar area from helmet. 

Pain progressed over next 2 days, was constant, rated 9/10 at worst and 6/10 at least, 

radiated from right LB to right knee, and was associated with severe loss of spinal 

motion. Denied changes in bowel/bladder control, hematuria, weakness, previous 

episodes of LBP. 

PhysICaL EXaMINaTION: Standing exam revealed neutral spinal alignment. 

AROM: moderate restriction to flexion; severe restriction to extension (caused 

severe right LBP); severe restriction to right sidebending; moderate restriction to left 

sidebending; moderate restrictions to rotation bilateral. Gait was slightly antalgic 

secondary to back pain. 4+ TTP over right lumbar paraspinals, which had moderately 

increased tonus. No TTP at midline, SI joints, sciatic notches bilateral. DTR’s 2/4. 

PhysICaL EXaMINaTION: Lumbar contusion, Spondylolysis, Facet syndrome, 

Fracture (spinous process, transverse process, pedicle, vertebral body), Lumbar disc 

displacement 

TEsT aNd rEsuLTs: X-rays of lumbar spine: 5 lumbar vertebrae in normal 


alignment. Slerotic line at right L5 pars interarticularis. No other suggestive evidence 

for fractures. Lumbar MRI scan: nondisplaced right L2 transverse process fracture, 

bone marrow edema at right L3 & L4 transverse processes. 

FINaL WOrKING dIaGNOsIs: Right L2 transverse process fracture 

TrEaTMENT aNd OuTCOMEs: First visit: TLSO brace 23 hours/day and 

withheld from sports/PE. Second visit: Feeling better, walking normally, throwing 

football without pain; continue brace use when up and rest for another 3 weeks. Third 

visit: Released to full activity 4.5 weeks after injury. 

D-19 Clinical Case Slide - Football I 

May 30, 2013, 1:00 PM - 2:40 PM 

Room: 117 

1392 Chair: Jeffrey M. Anderson, FACSM. Univ. of Connecticut, 

Storrs, CT. 


1393 discussant: Bryan Wiley. Rancho Cucamonga, CA. 


1394 discussant: Aaron Rubin, FACSM. Kaiser Permanente Sports 

Medicine Program, Fontana, CA. 


1395 May 30, 1:00 PM - 1:20 PM 

recurrent deep Vein Thrombosis - Football 

Dale C. Gold. University of Colorado, Littleton, CO. (Sponsor: 

Tod Sweeney, FACSM) 


hIsTOry: 18 year old high school football player presented with right upper 

extremity pain and swelling. He reported no injury to the area other than normal hits 

playing football. He reported recent heavy weight lifting. Ultrasound showed a right 

axillary DVT. Hypercoagulable workup was negative. He was treated with 6 months 

of warfarin therapy then cleared for athletic participation. In May 2010 the patient 

resumed weight lifting after a four month break and presented with pain and swelling 

of the right arm. Ultrasound showed a right subclavian DVT. He was restarted on 

warfarin and evaluated by vascular surgery in February 2011. A venogram performed 

April 2011 showed no acute clots. He was determined a non-surgical candidate due to 

the chronic nature of the occlusion. In June 2011, Warfarin was discontinued and low 

dose aspirin was started. In October 2011, patient presented with right arm swelling 

and pain after 2 weeks of lifting. Ultrasound showed an axillary vein DVT. Patient 

restarted on warfarin. Between acute episodes the patient had stable mild edema of the 

right arm after lifting, occasional bluish discoloration of the right upper extremity, and 

occasional pain in his right shoulder and neck. 

PysICaL EXaMINaTION: Examination when presenting with acute complaints 

reveal: 

5/10: Right arm notably swollen compared to left, 2+ radial pulses bilaterally 

10/11: subtle swelling of the right dorsal hand 


1. Paget-Schroetter Syndrome: 

- Increased muscle mass/impingement of vein by musculature of dominant arm 

- Cervical rib 

2. Hypercoagulable state 

3. Cervical Radiculopathy 


Hypercoagulable workup: 

- Negative Factor V, Factor II DNA mutation, anticardiolipin antibodies, homocysteine 

level, protein C & S 

IMaGING: 

4/08: US: thrombus right axillary vein 

8/08: CTPE negative 

11/08: US: no thrombus 

5/10: US: thrombus right subclavian vein 

2/11: US: no thrombus 

4/11: Venogram: chronic occlusion of right subclavian vein at level of thoracic inlet 

with mature appearing collaterals. 

10/11: US: thrombus right axillary vein 


Paget-Schroetter Syndrome due to venous impingement by musculature of dominant 

arm. 

TrEaTMENT aNd rECCOMEdaTIONs: 

1. Chronic Warfarin therapy 

2. Modified activity while on warfarin 

3. Repeat Surgical Evaluation 



1396 May 30, 1:20 PM - 1:40 PM 

Wrist Injury _ Football 

Patrick Moreno1 , Steven Collina1 , David Webner1 , Andrew 

Reisman2 . 1Crozer Keystone, Springfield, PA. 2University of 

Delaware, Newark, DE. (Sponsor: Daniel Miles, FACSM) 


hIsTOry: 21 y/o male college football cornerback presented with right wrist pain 

after forced wrist flexion during a ball stripping drill at practice. He reported pain 

localized to the dorsoradial aspect of the wrist that was worse with flexion. Although 

he did not recall a previous injury to the wrist, he mentioned having intermittent wrist 

pain for 1 year in the same location. He did not experience paresthesias or weakness. 

PhysICaL EXaMINaTION: Passive range of motion with wrist flexion to 65 

degrees, extension to 50 degrees, radial deviation to 18 degrees, ulnar deviation to 30 

degrees. There was no tenderness over the anatomic snuffbox. There was tenderness 

over the scapholunate junction. Watson’s test was positive. 


1. Scaphoid fracture 

2. Scapholunate ligament dissociation 

3. DISI (Dorsal Intercalated Segmental Instability) 

4. SLAC (Scapho-Lunate Advance Collapse) 

5. CMC joint arthritis 


Wrist A/P, lateral, and scaphoid radiographs: 

-widening of the scapholunate joint to 4.8mm with avulsion of the scaphoid 

Wrist Magnetic Resonance Imaging: 

-4mm scapholunate diastasis. Scapholunate angle increased to 80 degrees 


DISI with scapholunate ligament tear 


1. Initially treated with wrist splint and evaluation by hand specialist. 

2. As an academic senior with 2 years of eligibility and redshirted as a freshman he 

elected to have custom wrist splint and continue playing the rest of the season. 

3. Reconstruction of the scapholunate ligament is planned for after the season. 

1397 May 30, 1:40 PM - 2:00 PM 

Knee Injury - Football 

Karen Gustafson, Aaron Provance. University of Colorado, 

Denver, CO. (Sponsor: John Hill, FACSM) 


hIsTOry: 10 year-old football player with left knee pain after sustaining two patellar 

contusions two weeks prior to presentation. He describes pain along the medial border 

of the patella that then causes his quad to spasm, along with general stiffness. He 

denied having any pain in his left knee prior to contusions, nor any locking or catching 

episodes. No right knee pain. His father states he has been grasping the banister while 

walking up and down the stairs for months. 


Left Knee 

No swelling, deformity or ecchymosis. Tenderness to palpation over the medial border 

of the patella. ROM with full extension/flexion. Neurovascular exam intact with brisk 

pulses, 2 second capillary refill and a normal motor and sensory nerve examination in 

the affected limb. No laxity with valgus, varus stress testing at 0 and 30 deg. Negative 

anterior/posterior drawer, lachman’s, McMurray’s tests. 


1.Patella Contusion 

2.Patella Fracture 

3.Patella Osteochondral Injury 


Left Knee 4 view-xray 

-bony defect is noted in the posterior patella, likely residing at the level of the middle 

patella facet, which measures 1 cm in the craniocaudal dimension 

-findings compatible with osteochondral injury of the patella. 

MRI Left Knee 

-Regional marrow edema involving three quarters of the patella. 

-Defect arising from the subchondral bone of the middle patella facet with dimensions 

of 3.5 CC x 10 AP x 1.6 cm ML mm. 

-Overlying hyaline cartilage remains intact. 


Osteochondritis Dissecans of the patella. 


1.Immobilization in hinge-knee brace with limited flexion, 0 to 30 degrees, for 6 

weeks. 

2.No running, jumping activities. 

3.Return to clinic in 6 weeks for repeat physical examination and xrays. 


1398 May 30, 2:00 PM - 2:20 PM 

Leg Injury- Football 

David C. Waterson. Western Michigan University, Kalamazoo, 

MI. (Sponsor: Dilip Patel, FACSM) 


hIsTOry: A 17 year-old high school football offensive lineman sustained a right leg 

injury while blocking down field. Late in the game, he describes a hypertextension 

injury to the right knee. A defender missed the ball carrier and ran into his knee forcing 

it into hyperextension. He was unable to continue play or bear weight. There was knee 

swelling immediately following the injury. 

PhysICaL EXaMINaTION: Examination at an injury clinic the following morning 

revealed a large right knee effusion, slight flexion contracture, minimal active flexion 

secondary to pain, gapping of the medial joint line when testing near zero degrees, 

limited Lachman’s test due to effusion and limited range of motion, and medial joint 

line tenderness. The right lower extremity was neurovascularly intact. 

PhysICaL EXaMINaTION: 1. MCL sprain 

2. Torn PCL 

3. Torn ACL 

4. Tibia fracture 

5. Femur fracture 

TEST AND 

rEsuLTs: Right knee- anterior-posterior, lateral, and sunrise radiographs ( initial 

films). 

-effusion 

-fracture of the medial femoral condyle with a 2 mm step off at the trochlea 

-a couple of lucent areas running horizontally at the distal medial femur 

Right knee-anterior-posterior, lateral, and sunrise radiographs (repeated two days after 

initial films): 

-as above with increased step off at the trochlea 

CT scan of the right knee- sagittal and coronal images: 

-large hemarthrosis 

-horizontally oriented fracture through the medial aspect of the distal femoral physis 

extending in a sagittaly oriented fashion into both the intercondylar notch and the 

patellofemoral joint 

Right knee-anterior-posterior, lateral, and sunrise radiographs ( taken postoperatively): 

-evidence of two screws in the distal femur 

-anatomic reduction of the fracture in the AP and lateral views with step off of 1mm or 

less in the sunrise view 

FINaL WOrKING dIaGNOsIs: Medial femoral condyle fracture 


1. Open reduction and internal fixation of the fracture. 

2. Placed in a knee immobilizer and made non-weightbearing for at least two months. 

3. Start with formal physical therapy one month out from the surgical intervention. 

This will include gentle range of motion. 

4. Doing well eleven days postoperatively. The pain is decreasing and he is compliant 

with non-weightbearing. 

1399 May 30, 2:20 PM - 2:40 PM 

Knee Injury - Football 

Lauren M. Salas, Jeffrey A. Bonacci. University of Arkansas, 

Fayetteville, AR. (Sponsor: Barry S Brown, FACSM) 


hIsTOry: A 21-year-old junior male NCAA division I football wide receiver entered 

the athletic training room with complaints of posterior joint line left knee pain. The 

athlete complained of pain with both flexion and extension. Athlete also complained 

of pain with running, cutting, and abrupt stopping. There was no known mechanism of 

injury. Athlete had history of a left knee injury which included one meniscal repair and 

two menisectomies of the medial meniscus. The surgeries occurred two years prior to 

the diagnosis, five months prior to the diagnosis, and a month prior to diagnosis. 

PhysICaL EXaMINaTION:Tenderness over the medial and posterior joint line 

of the left knee and pain on the posterior side of the knee. Passive and active range of 

motion was only slightly decreased and created minor pain for the athlete. Positive 

McMurray’s test was found for a meniscus tear. Athlete performed functional tests 

including running, cutting, and jumping which also created some pain, Athlete was still 

able to perform wide receiver duties during practice and games. 


1.Meniscus tear 

2.Distal strain of the hamstrings (biceps femoris, semitendinosus, or 

semimembranosus) 

3.Baker’s cyst 


McMurray’s Test 

•positive for posterior medial joint line pain 

Manual Muscle Test 

•increased pain in distal hamstring tendons without weakness 

Magnetic resonance imaging (MRI) 

•normal findings for ligaments and muscles 





•cyst found in posterior compartment of the knee 

•cyst was not found on previous knee arthroscopy to repair meniscus 


Symptomatic Baker’s cyst in the left knee 


1.Removal of cyst through constant draining 

2.Anti-inflammatory medication was used on continuous basis to control swelling 

3.Increase range of motion by stretching to regain any lost flexibility 

4.Strengthening of surrounding musculature including hamstrings and quadriceps 

5.Kept playing during season and drained cyst four times after initial draining 

throughout season and since the completion of that season 

6.Wore knee compression sleeve or brace to take tension off knee joint and provided 

support. 

7.Athlete continued participation with cyst and treated systematically 

D-20 Clinical Case Slide - Upper Extremity II 

May 30, 2013, 1:00 PM - 3:00 PM 

Room: 123 

1400 Chair: Mary Lloyd Ireland, FACSM. Kentucky Sports Medicine 

Clinic, Lexington, KY. 


1401 discussant: Jimmy D. Bowen. Advanced Orthopedic Specialists, 

Cape Girardeau, MO. 


1402 discussant: David L. Weldy, FACSM. University of Toledo, 

Toledo, OH. 


1403 May 30, 1:00 PM - 1:20 PM 

Forearm Pain in a high school softball athlete 

Charles F. Ware, III1 , Thomas L. Pommering2 . 1Mount Carmel 

West Hospital, Columbus, OH. 2Nationwide Children’s Hospital, 

Columbus, OH. 


hIsTOry: A 14 y/o F softball pitcher with insidious onset L forearm pain. She is 

a L hand dominant, two sport athlete, who participates in both basketball and year 

round softball. She presented with L medial forearm pain for the past 2 weeks. There 

is no specific injury noted, but was first apparent during softball practice. She was 

first seen at urgent care, where XR of the forearm yielded normal results, and was 

placed in a sling. The aching pain starts below the elbow, radiates to the wrist, and has 

been increasing over the past 2 weeks. There is a throbbing pain over the ulna while 

throwing which worsens to a 10/10 as she continues to throw. She has a new complaint 

of intermittent numbness and tingling with activity and is located over the radial side 

of the forearm, and radiates to her ring finger. 

PhysICaL EXaMINaTION: Upon palpation of her LUE reveals tenderness at the 

olecranon, and wrist extensor. She has full ROM and 5/5 strength throughout, though 

notes pain with extension and supination of her LUE. There is no atrophy, motor 

weakness, and the elbow remains stable. Neurovascular exam reveals normal pulses, 

decreased sensation over the ulna distribution of the forearm and digits. 


1. Ulnar stress fracture 

2. Extensor train / Tear 

3. Tendinitis / Tenosynovitis 

4. Entrapment neuropathy 

Tests & Results 

X-Rays: Initial & 2 weeks Later both normal 

MRI: Abnormal signal within L intramedullary space and periosteum of 

ulnar diaphysis indicating a stress injury 

EMG: Mild L ulnar neuropathy at the elbow 

Final Working Diagnosis 

Ulnar midshaft stress fracture in a softball pitcher, associated with left ulnar 

neuropathy 

TrEaTMENT aNd OuTCOME: Following the urgent care visit she was provided 

a tennis elbow strap brace to wear as needed for pain relief. She was recommended 

to abstain from participation until MRI. Once her MRI indicated a stress injury she 

was instructed to stop her current summer softball season. Her LUE paresthesias were 

now more localized to an ulnar nerve distribution, so an EMG was ordered. After a 

period of rest and symptom resolution, she completed a course of PT emphasizing 

functional progression back to sports. Her symptoms continued to improve and she 

was essentially pain-free at follow-up. She will enter her winter basketball season and 

subsequent softball season without restrictions. 


1404 May 30, 1:20 PM - 1:40 PM 

Elbow Injury In Female softball Player 

Ryan P. Cole. Rush University Medical Center, Chicago, IL. 


hIsTOry: Patient is a 21 year old right hand dominant softball pitcher who presents 

for evaluation of her right elbow. Several months prior she suffered a fall on the field 

and has progressive soreness over the medial aspect of her elbow. Pain is worse with 

overhead throwing motions and with pitching. She has attempted physical therapy, ice 

and heat modalities with little improvement. 

PhysICaL EXaMINaTION: Patient has full range of motion about the right elbow 

although complains of discomfort of medial aspect, she is tender to palpation medially, 

mild to moderate laxity with valgus stress, neurologic testing normal 


1. Ulnar Collateral ligament (UCL) injury 

2. Flexor/Pronator tendinopathy 

3. Ulnar Neuritis 


MRI shows partial thickness tear of the UCL 


Partial thickness tear of the right UCL 


Received 3 PRP injections. Repeat MRI shows improvement in UCL tear. She was 

pain free upon follow up exam and was able to return to play pain free. 

1405 May 30, 1:40 PM - 2:00 PM 

acute arm swelling-Tennis 

Fred Reifsteck, III. University of Georgia, Athens, GA. (Sponsor: 

Andrew Gregory, FACSM) 


hIsTOry: 18 yo D I RHD female tennis player who presented with acute swelling 

of the right upper extremity and hand. The swelling occured during a tennis practice. 

Four days earlier had an IV placed for rehydration after a match for cramping in the 

contralateral arm. The swelling subsided and almost totally resolved a few minutes 

after resting. Patient relates no previous episodes or injuries. 

PhysICaL EXaMINaTION: Muscular hypertrophy of the right upper extremity, 

approriate for sport. Swelling from elbow distally. Pulses equal and strong bilaterally. 

Patient had full range of motion and strength was normal. Pulse did not diminish with 

Adson test 

PhysICaL EXaMINaTION: 1) Non-occlusive venous disease-Thoracic Outlet 

Syndrome 

2) Occlusive venous disease-Padgett Schroetter 

3) Lymphedema 

4) Acute muscle injury, tear vs. strain 

TEsT aNd rEsuLTs: AP cervial radiograh- no cervical rib 

Venous Doppler exam right upper extremity- negative 

Contrast venography- presence of occlusion in the subclavian vein near the jugular/ 

subclavian junction 

FINaL WOrKING dIaGNOsIs: Transient venous occlusion of the suclavian vein 

TrEaTMENT aNd OuTCOMEs:1) rest-resolution of symptoms 

2) Clopidogrel 75 mg daily, after a 300 mg loading dose 

3) Return to play after 4 to 6 weeks of rest, finished season 

4) Repeat, 2 months after initial study, contrast venography RESOLUTION of the 

venous clot 

5) Hydration during play 

6) Discontinuation of estrogen containing OCP 



1406 May 30, 2:00 PM - 2:20 PM 

Medial Elbow Pain - softball athlete 

Mary Lloyd Ireland, FACSM, D. Jeff Covell. University of 

Kentucky Healthcare, Lexington, KY. 


hIsTOry: 17YO female, right hand dominant softball athlete fell on outstretched 

right arm when she dived back to base to avoid being thrown out. She had immediate 

pain in the medial aspect of her right elbow. No previous injuries. She went to an urgent 

treatment center and radiographs showed a medial epicondyle avulsion fracture, joint 

was reduced. Neurocirculatory status was intact and she was seen the following day. 

PhysICaL EXaMINaTION: Right elbow: Active range of motion was 45-110. 

Ecchymosis medially. Tenderness over the medial epicondyle. 2+ opening on valgus 

stress testing at maximal extension of 45°. No tenderness over the radial head. 

Negative Tinel’s over the ulnar nerve. Pulses present. No firmness of the forearm 

compartments. Normal wrist and shoulder exam. 


1. Elbow dislocation, reduced. 

2. Medial epicondyle fracture. 

3. Ulnar collateral ligament partial vs complete tear. 

4. Radial head fracture, distal humeral fracture, coronoid fracture. 


RADIOGRAPHS: AP lateral, oblique views showed medial epicondyle fracture in 

two pieces which measure 8 mm and 3 mm. Stress views showed opening medially. 

Epiphyseal plates closed. 

MRI scan showed disruption of ulnar collateral ligament proximally, comminuted 

medial epicondyle fracture, bone edema of the posterior aspect of the radial head 

consistent with valgus axial loading mechanism. 


1. Medial humeral epicondyle comminuted fracture. 

2. Proximal ulnar collateral ligament proximal tear. 


The patient was placed in a hinged elbow brace. She began active and passive ROM. 

Two weeks after her injury, her ROM was 30-120°. Patient underwent right elbow 

internal fixation of the medial humeral epicondyle fracture with repair proximally of 

the ulnar collateral ligament. Ulnar nerve was inspected but was left in its anatomic 

position. Postoperatively she was immobilized for a couple of weeks to allow for 

healing of the incision and then range of motion emphasizing extension more than 

flexion was done. At 6 months followup, range of motion was 2-140°. Her elbow was 

stable. She returned to full activity. 

The interesting message about this case is that surgery is indicated to manage medial 

epicondyle fracture/UCL sprain from an elbow dislocation on the dominant arm of a 

throwing athlete. 

1407 May 30, 2:20 PM - 2:40 PM 

Wrist Injury In Collegiate Basketball Player 

Abigail K. DeBusk, Robert G. Hosey, FACSM, Wade M. 

Rankin, Scott D. Mair. University of Kentucky, Lexington, KY. 


hIsTOry: 23-year-old collegiate women’s basketball player complaining of left wrist 

pain presented to clinic with a three week history of intermittent pain after falling on 

an outstretched hand during off season workouts. She described pain with dorsiflexion 

of the wrist and especially with weight-bearing activity. She denied radiation of pain 

into her hand or elbow. She had been taping the wrist and continuing to play with some 

pain. She also had taken an anti-inflammatory in the past which helped as well. Initial 

xrays were interpreted as negative. 

PhysICaL EXaM: She had full range of motion in dorsiflexsion, pronation, and 

supination of the wrist. She had pain with active and resisted dorsiflexion over dorsum 

of her wrist. Radial pulses 2+ bilaterally. She was neurologically intact. Negative 

Watson’s test. No TFCC tenderness. No pain over carpal bones. 

8-10 weeks later patient presented and still had recurrent and worsening symptoms 

with weight lifting and playing basketball. Physical exam at this time showed 

decreased dorsiflexion of approximately ten degrees with continued pain. Xrays now 

showed widening of scapholunate ligament and flattening of lunate with mild sclerosis. 


1. Carpal fracture 

2. Extensor Carpi Ulnaris tendinitis 

3. Osteochondrosis of the lunate (Kienbock’s Disease) 

4. Carpal Tunnel Syndrome 

5. Ganglion Cyst 

6. Scapholunate ligament disruption 


L wrist xrays: 

-July:No acute bony injury or significant degenerative changes 

-December: Widening of scapholunate ligament and flattening of lunate with mild 

sclerosis 

MR Arthrogram Left Wrist with corticosteroid injection: 

-Disruption of scapholunate ligament 


-AVN with fragmentation of the lunate 

-Joint effusion and synovitis 

-Volar ganglion on the radioscaphoid articulation 


Kienbock’s Disease (avascular necrosis of the lunate) 

TrEaTMENT/OuTCOME: 

1. Initial treatmenta. 

She had good relief of symptoms with the injection at the time of MR arthrogram. 

b. She continued to play basketball. 

c. Repeat corticosteroid injection in February, again with good results of symptom relief 

2. Surgery May 2012 

a. Radial shortening with plate fixation 

b. Graduated and was lost to follow up 

c. Currently playing basketball in European leagues 

1408 May 30, 2:40 PM - 3:00 PM 

shoulder Injury in soccer player 

Zarinah Hud. LECOM Medical Fitness & Wellness Center, Erie, 

PA. (Sponsor: Patrick Leary and Gregory Coppola, FACSM) 


hIsTOry: A right hand dominant, 19 year old male college soccer player is seen 21 

days post right shoulder injury in the clinic. He reported that he fell directly onto right 

side of his neck and abducted shoulder. He denied numbness, weakness or pain at the 

time of impact, but did report immediate dysesthesia in right shoulder that worsened 

throughout the game. He was evaluated after the game by an ATC. The athlete 

denied headache, cervical, elbow and wrist pain. No prior history of upper extremity 

injuries. Review of systems, social history, and past medical history was otherwise 

unremarkable. 

PhysIaL EXaMINaTION: Athlete in no acute distress. Right upper limb 

inspection revealed atrophy in the deltoid, rhomboid, upper/middle trapezius, 

supraspinatus and infraspinatus; elevated shoulder and upward, internally rotated 

scapula at rest. There was generalized tenderness over the superior and anterolateral 

right shoulder. The cervical spine exam revealed full AROM/PROM without restriction 

in all planes and no tenderness over midline or paraspinal musculature. Spurling’s test 

was negative bilateral. The manual muscle test revealed maximum resistance against 

AROM (5/5) throughout the upper extremity on the left and right except for: shoulder 

abduction, flexion, and external rotation on the right, which exhibited incomplete range 

of motion against gravity (3-/5). DTR’s: +1/4 over bicep, brachioradialis and triceps 

tendons bilateral. Sensation was intact to light touch and pinprick C5-T1 bilateral. 


1.Mononeuropathy vs plexopathy 

2. Adhesive Capsulitis 

3. Rotator cuff Tear 

4. Parsonage-Turner Syndrome 

5. Occult fracture 


I. Shoulder X-ray Findings (AP/Lateral) 

- Non displaced greater tuberosity fracture 

II.MRI Shoulder w/o Contrast 

-Fracture of greater tuberosity of humerus and bony contusion; tendinosis of 

supraspinatus and infraspinatus tendons without tear 

III. EMG Evaluation 

-No evidence for a right upper extremity radiculopathy, plexopathy or mononeuropathy 


Neer’s II Classification Humeral head fracture 


1. Greater Tuberosity ORIF 

2. Shoulder Immobilization 

3. Repeat X-rays 

4. Rehabilitation: Throwers Ten, Scapulo-thoracic strengthening exercises 

5. Will RTP once he has full painless ROM and normal strength 





D-21 Free Communication/Poster - Assessment of 

Physical Activity and Energy Expenditure 

May 30, 2013, 1:00 PM - 6:00 PM 

Room: Hall C 

1409 Board #1 May 30, 2:00 PM - 3:30 PM 

Estimating Food Energy requirements and average daily 

Metabolic rate For The us Population: 2005-2006 

Edward Archer, Greg A. Hand, FACSM, James R. Hebert, Erica 

Lau, Xuewen Wang, Robin Shook, Raja Fayad, Steven N. Blair, 

FACSM. Univeristy of South Carolina, Columbia, SC. 


PurPOsE:To estimate population-level food energy requirements (FER), total daily 

energy expenditure (TDEE), and average daily metabolic rate (ADMR) in a nationally 

representative sample of US adults. 

METhOds:FER, TDEE, and ADMR were estimated via a factorial equation in 

a nationally representative, cross-sectional, stratified sample of 2597 adults, aged 

20 to 74 years (US National Health and Nutrition Examination Survey; NHANES 

2005-2006). TDEE was calculated using estimated resting energy expenditure (REE), 

ADMR, and thermic effect of food (TEF). REE was derived from validated equations 

using demographic (i.e., age and sex) and anthropometric (i.e., height and weight) data. 

ADMR was calculated from objectively measured PA via accelerometry-based activity 

monitors and self-reported sleep duration. TEF was assigned a value of 7.5% of TDEE 

based on previous calorimetric research. 

rEsuLTs:The 2005-2006 estimated FER for the US population were 2940 kcal/day 

for men and 2275 kcal/day for women. FER ranged from 3230 kcal/day in obese (i.e., 

BMI ≥30kg/m2) men to 2026 kcal/day in normal weight (BMI < 25kg/m2) women. 

There were significant inverse relationships between ADMR and obesity and age. For 

men and women, the ADMR values were 1.53 and 1.52, respectively. Obese men and 

women had lower ADMR values than normal weight (p


1413 Board #5 May 30, 2:00 PM - 3:30 PM 

Effect Of seasonality and Temperature On Free-living 

Physical activity: PaMs Project 

Jung-Min Lee, Youngwon Kim, Sarah M. Nusser, Alicia L. 

Carriquiry, Gregory J. Welk, FACSM. Iowa Sate University, 

Ames, IA. 


Considerable work has been done to understand aspects of the built environment 

but few studies have systematically studied the effect of weather temperature on PA 

behavior. Cold weather and lack of daylight are commonly cited as barriers to PA but 

the impact has not been systematically studied. 

PurPOsE: The present study fills this gap by examining the weather temperature 

variability in PA in a free-living population. The study capitalizes on a unique dataset 

collected through the Physical Activity Measurement Study (PAMS), a large fieldbased 

study of PA behavior conducted in Iowa. 

METhOd: A representative sample of 1405 adults (ages 21-70) wore a SenseWear 

Mini Armband (SWA) for a randomly assigned day and then completed a 24PAR 

survey administered by a trained interviewer using a computerized telephone system. 

Estimates of minutes of moderate and vigorous physical activity (MVPA) were 

obtained from both instruments. The data were collected over a two year time span 

with an average of 19.7 ± 5.5 days per month so means reflect seasonal variation in this 

representative sample. Koppen’s weather climate classification was used to specifically 

classify the temperature: cold (-13 to 32ºF), cool (32 to 50 ºF), mild (50 to 64ºF), 

warm (64 to 73 ºF), and hot (73 to 95 ºF). A three-way ANOVA (gender x age group x 

temperature) was used to examine the impact of weather temperature variability on the 

objectively and subjectively monitored physical activity. 

rEsuLT: The overall F-test for the evaluation of temperature differences was 

significant (SWA: F = 8.05, p < .001, 24PAR: F=2.54, p < .001). There was significant 

main effect for gender in SWA and 24PAR, and a significant main effect for age for 

the SWA. Interestingly, the main effect of temperature was not significant for either 

measure. The minutes of MVPA (mean ± SD) were consistent across the 5 temperature 

codes for both the SWA (117.4 ± 4.9) as well as the 24PAR (139.1 ± 10.2). Similar 

patterns of consistent PA levels were observed when examined across the 12 months. 

CONCLusION: The present study revealed the expected patterns for age group 

and gender but rather subtle differences in MVPA minutes with both objective and 

subjective methods across temperature conditions. The results discount the widely 

assumed notion that physical activity levels are lower in winter when weather is colder. 

1414 Board #6 May 30, 2:00 PM - 3:30 PM 

Validation of the senseWear armband in Estimating Energy 

Expenditure in Professional Female soccer Players 

Bei Wang, Chen Wang, Fenglei Qian, Defeng Zhao, Haiyan 

Zhao. Shanghai Research Institute of Sports Science, Shanghai, 

China. 


Maintaining energy balance is important for optimal body composition and exercise 

performance in athletes. However, the total daily energy expenditure in athletes is not 

easily measured. A portable device, the SenseWear armband (SWA), was shown to be 

valid in estimating energy expenditure in free-living individuals at rest and during lowto-moderate 

intensity activities. However, whether the SWA is reliable in estimating 

energy expenditure during exercise in professional athletes is not known. 

PurPOsE: To assess the validity and reliability of the SWA in professional female 

soccer players at various exercise intensities. 

METhOds: After 2-hour fasting, nine professional female soccer players (19.2±1.4 

yrs) rested at sitting position for 10 minutes and then performed four 10-min treadmill 

runs at 50, 65, 75, and 85% of their VO 2max each. Energy expenditure was assessed 

with SWA and a portable indirect calorimetry (IC).They were asked to rest between 

each trial to allow their heart rate recovery below 100 bpm before start of the next trial. 

Heart rate was monitored during the whole process. 

rEsuLTs: The intra-individual minute-by-minute correlations between 

energy expenditure assessed by the SWA and IC were significant for all nine subjects 

(r=0.879-0.987, mean=0.95±0.01). However, energy expenditure calculated by 

the SWA and IC was significantly different at all trials except when running at 

65%VO2max (p



1417 Board #9 May 30, 2:00 PM - 3:30 PM 

Estimation Of steps recorded By The sensewear armband 

during Treadmill Walking and Free-living 

Jeff C. Mathis, Laura A. Wheatley, Joey A. Lee, Dale D. Brown, 

Dr, FACSM, Kelly R. Laurson, Dr. Illinois State University, 

Normal, IL. 


The Sensewear Armband (SWA) is relatively accurate when used to assess daily 

energy expenditure and is increasingly being used by clinicians and researchers during 

physical activity interventions. However, the layperson may have difficulty interpreting 

SWA physical activity metrics such as minutes of moderate activity or kilocalories 

expended in regard to goal-setting. Steps per day is a more interpretable metric that 

could be used instead, if measured accurately by the SWA. 

PurPOsE: To compare estimations of steps taken by the SWA during treadmill 

walking and free-living. 

METhOds: Healthy adult participants (n = 41, mean age = 21.9 ± 2.0 years) wore 

the SWA during five 3-minute stages of treadmill walking at 54, 67, 80, 94, and 107 

meters per minute while steps were also counted using a manual counter (serving as 

the treadmill criterion). Additionally, during three days of free-living, the subjects 

also wore the SWA and a pedometer that has been previously validated for research 

purposes (Yamax Digiwalker SW-701 pedometer [DIGI], serving as the free-living 

criterion). SWA performance was evaluated using Pearson’s correlation coefficients 

and paired-samples t-tests against the respective criterion method. 

rEsuLTs: During treadmill walking, steps recorded by the SWA were significantly 

correlated with manually counted steps. The strength of the association tended to 

increase as walking speed increased (r = 0.37, 0.47, 0.69, 0.77, and 0.78 at 54, 67, 

80, 94, and 107 meters per minute, respectively). However, the results of the t-tests 

indicated that the SWA significantly underestimated steps taken at each speed (mean 

percent difference from criterion ranged from 16.0% to 5.6%, all p < 0.05). In contrast, 

during free-living, the SWA significantly overestimated steps taken in comparison to 

the DIGI by an average of 1,023 steps per day (11.3% difference, p < 0.001). Although 

the correlation between mean steps taken per day between the SWA and DIGI was 

strong (r = 0.96, p < 0.001). 

CONCLusIONs: Under controlled conditions the SWA significantly underestimated 

steps. During free-living conditions the SWA appears to significantly overestimate 

steps, perhaps over-counting during non-ambulatory activity. Clinicians and 

researchers should use caution in setting stepping goals with the SWA during activity 

interventions. 

1418 Board #10 May 30, 2:00 PM - 3:30 PM 

Inter-instrument reliability Of Gt3x accelerometers In a 

Free-living Condition 

Emily E. Davis, Wonwoo Byun, Cemal Ozemek, Leonard A. 

Kaminsky, FACSM. Ball State University, Muncie, IN. 


Accelerometers have the advantage of providing objective measures of both 

physical activity performed at various intensities and of sedentary time. Actigraph 

accelerometers are widely used, however with technological advancements new 

models are periodically released. The GT3X is the most recent model. Although 

research has shown previous Actigraph models to be reliable, little information is 

available on the inter-instrument reliability of GT3X accelerometers. 

PurPOsE: To determine inter-instrument reliability of GT3X accelerometers 

measures of physical activity and inactivity in a free-living condition. 

METhOds: Sixteen women and 11 men (age 24.6 ± 9.9 yr, BMI 24.1 ± 3.6 kg/m2) 

wore two accelerometers simultaneously, one on the left and one on the right hip, 

for >4 consecutive days. Accelerometers were initialized to collect step counts and 

activity counts/minute (cpm), simultaneously. Activity counts (60 sec epochs) were 

categorized into time spent in sedentary (


1421 Board #13 May 30, 2:00 PM - 3:30 PM 

development and Validation of sedentary Behavior record 

(sBr) Instrument 

Rose M. D. Carter, Saori Ishikawa, James L. Farnsworth, 

Vaughn W. Barry. Middle Tennessee State University, 

Murfreesboro, TN. (Sponsor: Dr. Minsoo Kang, FACSM) 


Prior measures of sedentary behavior have not systematically measured sedentary 

activities in multiple domains and over various routinely performed daily sedentary 

activities with a user-friendly device. The Sedentary Behavior Record (SBR) was 

designed to fill the gap in the literature in measuring sedentary behavior. The SBR is 

an adaptation of the 3-day Physical Activity Record for the purpose of quantifying 

sedentary behavior time (SBT) over a 24-hour day. The SBR includes 3 domains 

(work, non-work sitting and lying down or reclining) and a choice of 3 activities under 

each domain (transportation, screen time, and other) to quantify SBT by 15-minute 

blocks of time for 24-hours. 

PurPOsE: Develop and validate the SBR instrument. 

METhOds: A total of 46 adults, aged 37 ± 12 years old, wore an Actigraph 

accelerometer and recorded subjective SBT by SBR for 7 consecutive days. Outcome 

measurements included SBT for 24-hour day with with sleep (SBT-S) and SBT without 

sleep time (SBT-NS), beginning when accelerometer is reported as off the body for 

sleep, measured by Actigraph (activity counts per minute < 100) and by SBR. Pearson 

correlations and paired sample t tests were examined to establish concurrent validity 

evidence. The alpha level was set at .025, adjusted by the Bonferroni technique. 

Intraclass correlation coefficients (ICC) were also computed for reliability. 

rEsuLTs: SBT-NS as measured by Actigraph (M = 574.48; SD = 83.33) and SBR 

(M = 524.54; SD = 180.49) had a moderate-to-strong relationship (r = .59, p < .001), 

and SBT-S as measured by Actigraph (M = 1041.04; SD = 148.31) and SBR (M = 

987.87; SD = 196.74) had a low-to-moderate relationship (r = .31, p 

CONCLusIONs:Overall, the results support the potential use of SBT-NS and SBT-S 

from the SBR instrument. Further studies are warranted to validate the SBR instrument 

in other populations. 

1422 Board #14 May 30, 2:00 PM - 3:30 PM 

Validity and reliability of Two self-report Measures to 

assess sedentary Behavior in Older adults 

Keith P. Gennuso 1 , Charles E. Matthews, FACSM 2 , Dale A. 

Schoeller 1 , Lisa H. Colbert, FACSM 1 . 1 University of Wisconsin 

- Madison, Madison, WI. 2 National Cancer Institute, National 

Institutes of Health, Bethesda, MD. 


PurPOsE: To examine the test-retest reliability and criterion-related validity of 

the Yale Physical Activity Survey for Older Adults (YPAS) and Community Health 

Activities Model Program for Seniors (CHAMPS) survey to assess sedentary behavior 

(SB) in older adults. 

METhOds: Adults aged 65 years and older were recruited to participate in a 

larger study comparing the validity of various objective and self-report measures of 

physical activity. Participants completed the YPAS and CHAMPS before and after 

a 10 day period during which they wore an Actigraph accelerometer (ACC). ACCderived 

average daily SB time (defined as



1425 Board #17 May 30, 2:00 PM - 3:30 PM 

Pedometer-determined Physical activity Patterns in adults 

with Mild Intellectual disabilities 

Sharon Hsu1 , Bo Fernhall, FACSM2 , Stanley Hui, FACSM3 , 

James Halle4 . 1California State University, Northridge, 

Northridge, CA. 2University of Illinois, Chicago, Chicago, 

IL. 3Chinese University of Hong Kong, Shatin, Hong Kong. 

4University of Illinois, Urbana-Champaign, Urbana, IL. 


The increasing prevalence of overweight and obesity is a worldwide problem. Regular 

physical activity participation is a determinant to reverse the obesity epidemic and a 

key element in health promotion. 

PurPOsE: The purpose of this study was to investigate pedometer-determined 

physical activity patterns in adults with mild intellectual disabilities (MID). 

METhOds: A sample of 120 adults with MID (Age: M = 26.6 ±8.8) in Taiwan 

participated in this study. Among those participants, 52.5% were males, 31.7% lived in 

cities, 77.5% lived with their families, 64.2% were employed; 65% had a high school 

diploma, and 56.7% were overweight or obese (OW/OB; BMI, M = 23.95±4.28). Step 

count data were gathered using Yamax DigiWalker SW-200 pedometers from each 

participant for 7 consecutive days. 

rEsuLTs: Participants walked an average of 8868 steps per day (±4830). They had 

significantly higher step counts (t119 = 5.195, p


METhOds: Fifty-three women wore the SenseWear® Mini armband for 7-days at 

week 18 and 35 of pregnancy. All MVPA completed in at least 10-, 20-, or 30-minute 

bouts were summed. Total MET-minutes for the week were summed to reflect total PA 

including sedentary and light activity. GWG was calculated as the difference of prepregnancy 

weight from measured weight at week 35. A one-way ANOVA evaluated the 

differences in GWG for women meeting prenatal PA recommendations (sufficient PA; 

>150 min MVPA per week), those with insufficient PA (1-149 min), and none (0 min) 

for all 3 bout lengths. Total MET-minutes per week were compared with independent 

t-tests for women gaining within or in excess of the IOM guidelines. 

rEsuLTs: Twenty-six (49%) women gained in excess of IOM guidelines. A trend 

for MVPA completed in ≥ 10 min bouts was identified: sufficient PA (11.3 ± 4.3 

kg), insufficient PA (13.3 ± 5.1 kg), and none (18.9 ± 4.2 kg) (P = 0.056). GWG 

was not significantly different when PA was analyzed in at least 20 or 30 min bouts. 

Participants who gained within IOM guidelines had significantly higher MET-minutes 

at week 18 than women who gained in excess (11,068 vs. 10,414, respectively; 

P=0.032). PA at week 35 was not significantly related to weight gain. 

CONCLusION: Longer sustained activity (> 20 or 30 min bouts) did not significantly 

affect GWG, whereas moderate PA completed in ≥10-minute bouts may be a beneficial 

strategy to promote healthy GWG. Total activity (e.g. total MET-minutes per week) 

had a significant favorable relationship with GWG. Future work should address 

reducing sedentary time and increasing PA in at least 10-minute bouts. 

1429 Board #21 May 30, 2:00 PM - 3:30 PM 

Objectively Measured Total accelerometer Counts and 

MVPa: Contrasting relationships with Biomarkers using 

2003 - 2006 NhaNEs 

Dana L. Wolff1 , Eugene C. Fitzhugh1 , David R. Bassett, 

FACSM1 , James R. Churilla, FACSM2 . 1University of Tennessee, 

Knoxville, TN. 2University of North Florida, Jacksonville, FL. 


PurPOsE: To contrast the associations of objectively measured moderate-tovigorous 

physical activity (MVPA) and total accelerometer counts with biomarkers in 

a representative sample of U.S. adults. 

METhOds: Data from the 2003 – 2006 NHANES were used for this analysis. The 

sample included adults ≥ 20 y, not pregnant or lactating, who had self-reported PA and 

≥ 4 d of accelerometer data with ≥ 10 h wear time (N = 5668). MVPA was defined 

as the mean minutes with counts ≥ 2020 using a 10-min bout criterion on valid days. 

Total accelerometer counts represented the mean total counts acquired on valid days. 

Biomarkers included: blood pressure, body mass index (BMI), waist circumference, 

triceps and subscapular skinfolds, cholesterol, triglyceride, glycohemoglobin, plasma 

glucose, C-peptide, insulin, C-reactive protein, and homocysteine. Simultaneous 

regressions were conducted in which each biomarker was regressed on MVPA and total 

accelerometer counts per day independently while adjusting for relevant covariates. 

rEsuLTs: When compared to MVPA, total accelerometer counts per day displayed 

stronger associations with the following biomarkers: BMI, waist circumference, triceps 

skinfolds, subscapular skinfolds, HDL, triglycerides, plasma glucose, C-peptide, 

insulin, C-reactive protein, and homocysteine (adj. Wald F = 9.04 – 97.41, P < 

0.05 – 0.0001). Only one biomarker, glycohemoglobin, had stronger associations 

with MVPA (F = 6.67, P ≤ 0.05) than total accelerometer counts (F= 0.87, P > 0.05). 

After adjusting for BMI and other relevant covariates, total accelerometer counts 

remained more strongly associated with cardiometabolic biomarkers than MVPA, with 

glycohemoglobin found to have no relationship with either PA variable. 

CONCLusIONs: Total accelerometer counts per day were more robustly associated 

with various cardiobiomarkers than MVPA. Thus, using total accelerometer counts per 

day may provide a better estimate of the strength of the relationship between PA and 

biomarkers. 

1430 Board #22 May 30, 2:00 PM - 3:30 PM 

reliability of Peak stepping Cadences using Generalizability 

Theory 

Minsoo Kang, FACSM1 , Youngdeok Kim1 , David A. Rowe, 

FACSM2 . 1Middle Tennessee State University, Murfreesboro, TN. 

2University of Strathclyde, Glasgow, United Kingdom. 


Recent studies have introduced the concept of using peak stepping cadences to 

quantify the intensity of ambulatory physical activity using step-count data. Although 

this is a novel approach and has demonstrated evidence of validity (Tudor-Locke 

et al., 2011), the reliability of peak stepping cadences associated with measurement 

conditions (e.g., a number of monitoring days) has not been addressed. 

PurPOsE: The purpose of this study was to establish the minimum number of days 

required for reliably estimating peak stepping cadence among adults. 

METhOds: Data from the 2005-2006 National Health and Nutrition Examination 

Survey were analyzed. A total of 1,300 adults (> 17 yr) with valid accelerometer 

step-count data (defined as 7 days with ≥ 10 hr wear time) were included. One-min, 

30-min, and 60-min peak cadences were obtained across 7 days. Generalizability (G) 

theory with unbalanced two-facet nested design [i.e., person x (days: type of days)] 

was applied for each peak stepping cadence, with days nested within weekend or week 


days. G-studies were performed to quantify the percentage of variance associated 

with each facet and interaction in the model. Follow-up D-studies were performed to 

determine the optimal combinations of number of days for weekend and week days to 

achieve a desirable reliability coefficient (G ≥ .80). 

rEsuLTs: The G-study showed that the relative magnitudes of variances attributed 

to differences between weekend and week days were relatively low (i.e., < 10%) for 

all peak stepping cadence measures; however, the D-study indicated that at least 1 

weekend day should be included in the monitoring period in addition to 4 week days 

for 1-min peak cadence. For 30-min and 60-min peak cadences, at least 5 week days, 

or the combinations of 1 weekend day and 3 week days, or 2 weekend days and 2 week 

days would be necessary for reliable measures of peak stepping cadences. 

CONCLusIONs: This study provides empirical evidence of the number of required 

monitoring days to obtain reliable measures of peak stepping cadences based on a 

large, nationally-representative sample of US adults. The guidelines suggested in 

this study could be applied in future research as a reference for monitoring periods to 

obtain a reliable measure of peak stepping cadences. 

1431 Board #23 May 30, 2:00 PM - 3:30 PM 

Physical activity and Energy Expenditure Measurements 

using sensewear armband, actiheart and actigraph in 

adults 

Dharini M. Bhammar, Brandon J. Sawyer, Wesley J. Tucker, 

Julian C. Baez, Glenn A. Gaesser, FACSM. Arizona State 

University, Phoenix, AZ. 


PurPOsE: Our aim was to estimate validity and reliability of the Sensewear 

Armband (SWA), Actiheart (AH) and Actigraph GT3X+ (AG) monitors for assessing 

physical activity (PA) levels and energy expenditure (EE) in adults. 

METhOds: Twenty-four adults (ages 29 ± 9 years; BMI: 23.9 ± 3.7 kg/m 2 ) 

underwent two identical 96-min exercise sessions, at least 24 h apart, including 

walking, cycling, arm cranking, and simulated activities of daily living. Each activity 

lasted 8 min with a 4-min seated rest period between activities. EE and PA levels were 

measured by indirect calorimetry using the Oxycon Mobile TM (OM) and estimated by 

four activity monitors: SWA (version 7.0), AH software versions 2.0 (AH 2.0) and 4.0 

(AH 4.0) and AG. Linear mixed models and intraclass correlation coefficients (ICC) 

were used for statistical analysis. 

rEsuLTs: Total EE for 96-min was not significantly different between SWA and OM 

(P = 0.084). Total EE for AH 4.0, AH 2.0 and AG was significantly lower than OM 

by 62 ± 63 kcal (P = 0.015), 110 ± 47 kcal (P < 0.001) and 129 ± 60 kcal (P < 0.001) 

respectively. During steady-state periods (min 4 to 7 of each activity), only AH 4.0 

accurately predicted walking EE (P = 1.000) and only AH 2.0 accurately predicted 

jogging EE (P = 0.704). AH 2.0 and AH 4.0 accurately estimated time spent in light 

and moderate PA, while only AH 2.0 accurately tracked time spent in vigorous PA. 

ICC analysis for OM and the four activity monitors showed high test-retest reliability 

for total EE (0.847 to 0.911) and for time spent in moderate to vigorous PA (MVPA; 

0.888 to 0.999). ICC analysis for individual activities showed high test-retest reliability 

for walking at 3 mph (0.824 to 0.943), moderate-to-high reliability for walking at 4 

mph, jogging at 5 mph, sweeping, and loading and unloading boxes (0.506 to 0.989), 

and low to moderate reliability for cycling, arm cranking and seated rest (0.005 to 

0.738). 

CONCLusIONs: The SWA provides valid estimates for total EE, while the AH 

provides valid estimates for walking and jogging EE. All devices were unreliable 

for estimating EE for activities with minimal or variable accelerometer input such 

as cycling, arm cranking and activities of daily living. Additionally, only AH 2.0 

accurately tracked time spent in MVPA suggesting that it may be the best device for 

tracking PA levels. 

supported by NIh grant r01 hL091006 

1432 Board #24 May 30, 2:00 PM - 3:30 PM 

The Context of Physical activity in a representative sample 

of adults: Physical activity Measurement survey 

Bradley P. Peters, Youngwon Kim, Gregory J. Welk, FACSM, 

Sarah M. Nusser, Alicia L. Carriquiry, Miguel A. Calabro, 

Jungmin Lee. Iowa State University, Ames, IA. 


Numerous studies have sought to assess and evaluate levels of participation in physical 

activity (PA) in the population but few studies have provided contextual information 

about PA behaviors. This information is needed to better understand and promote PA 

in the population. PURPOSE: The purpose of this study was to provide insights on the 

purpose and location of accumulating PA in a representative sample of adults ages 21 

to 70. 

METhOds: Data were obtained from the Physical Activity Measurement Survey 

(PAMS), a large field-based study of PA behavior conducted in Iowa. As part of the 

study, a representative sample of 1459 Iowa adults from four counties completed a 

telephone-administered 24hour PA recall (PAR). Participants were asked to report 

participation in different types of PA and to categorize each activity by both purpose 

(work, home/family, leisure, sports, education/volunteering) and location (work, home/ 





indoor, home/outdoor, transportation, and community). The proportion of time spent 

in moderate PA (MPA) and vigorous PA (VPA) was segmented by both purpose and 

location to understand the context of PA behavior. 

rEsuLTs: Approximately 83% of participants reported participating in some MPA 

(3-6 METS) on the previous day (mean = 156.4 +/- 32.6 min) while 21% reported 

participating in some VPA (> 6 METS) on the previous day (mean = 67.1 +/- 9.1 

min). Participants reported that they performed 42% of their MPA while working, 

37% for home needs, 14% for leisure, 5% for sports, and about 2% for volunteer 

/ education tasks. Corresponding allocations for VPA were 33%, 27%, 14%, 25%, 

and 1%, respectively. The majority of MPA was performed at work (41%) followed 

by home indoor (26%), community settings (18%), home outdoor (13%), and in 

transportation (2%). The majority of VPA was also performed at work (33%), 

followed by community settings (32%), home indoor (21%), home outdoor (13%) and 

transportation (1%). Differences in allocations for purpose and location were noted 

when the sample was stratified by gender, age, and education 

CONCLusION: The results demonstrate the diverse nature of PA behavior and reveal 

that the majority of MPA and VPA is accumulated as part of daily living rather than for 

leisure or recreation. These results provide new insights about the settings and context 

of PA behavior in adults. 

1433 Board #25 May 30, 2:00 PM - 3:30 PM 

Pedometer accuracy in Lower-Limb amputees 

John D. Smith 1 , Gary Guerra 2 . 1 Texas A&M University-San 

Antonio, San Antonio, TX. 2 Loma Linda University, Loma Linda, 

CA. 


The accuracy of the pedometer on lower limb amputees has yet to be explored. 

PurPOsE: To assess the accuracy of pedometers in lower limb amputees. 

METhOds: Thirty-nine participants (age = 48.0±14.1 yrs, ht = 172.7±9.3 cm, wt 

= 76.2±14.8 kg) had their height and weight measured and were then fitted with a 

pedometer belt around the waistline at the hip. They were fitted with three pedometers: 

a SW-701 spring-levered pedometer on the anterior mid-line of the right hip, an NL-800 

pedometer just laterally to the SW-701, and an Omron HJ-112 on the outside of the NL- 

800. They then engaged in one over-ground level walk for 200m at a self-selected pace at 

an indoor facility. At the end of each trial pedometer counts and actual step counts from 

a hand tally (AC) were recorded. A repeated measures ANOVA was used to determine 

significant differences between the counts. Single measure intraclass correlation (ICC) 

from a two-way random effects ANOVA was used to assess the agreement between 

AC and pedometer counts. Bland-Altman plots of AC vs. pedometer counts were also 

used to provide an indication of agreement between the measures. Pedometer error was 

calculated as [(pedometer steps-actual steps)/actual steps] * 100. 

rEsuLTs: Counts from the SW were significantly lower than AC (255.6±12.6 and 

314.7±6.0 steps, p = .001) and counts from the NL and Omron were not significantly 

different from AC (p > .05). Agreement according to ICC was very low (0.26) for the 

SW, low for the NL (0.71) and high for the Omron (.98). Bland-Altman plots indicated 

agreement was strongest with the Omron and weakest with the SW. Percent error was 

greatest with SW at 18.0%, 2.1% for the NL, and least in the Omron (0.7%). 

CONCLusION: The results indicate that of the three pedometers tested, the Omron 

HJ-112 is the best pedometer for a person with a lower limb amputation wearing a 

prosthesis. 

1434 Board #26 May 30, 2:00 PM - 3:30 PM 

association Between Cardiorespiratory Fitness and 

Metabolic risk Factors: an application of Quantile 

regression 

Wonwoo Byun1 , Jonathan A. Mitchell2 , Mitchell H. 

Whaley, FACSM1 , Leonard A. Kaminsky, FACSM1 . 1Ball State University, Muncie, IN. 2University of Pennsylvania, 

Philadelphia, PA. 


Higher cardiorespiratory fitness (CRF) has been associated with improved metabolic 

risk factors (MRFs). However, the evidence that exists largely assessed the mean 

values of MRFs and it is not known if the association between CRF and MRFs is 

uniform across the distributions of individual MRFs. 

PurPOsE: To determine the association between CRF and MRFs, using quantile 

regression, in a cross-sectional sample of men and women. 

METhOds: Participants were 429 adults (Female: 51%, Age: 49 ± 13 yrs), who 

enrolled in Adult Physical Fitness Program at Ball State University. CRF was assessed 

via maximal exercise testing with measured VO max (ml/kg/min). Participants were 

2 

also screened for fasting glucose (GLU), triglycerides (TG), high-density lipoprotein 

cholesterol (HDL-C), mean arterial blood pressure (MAP), and waist circumference 

(WC). Quantile regression was used to examine the associations between CRF 

and MRFs at the 10th , 25th , 50th , 75th , and 90th percentiles of each MRF. The models 

were adjusted for age, gender, education level, smoking status, and medications for 

hypertension, diabetes, and dyslipidemia. 

rEsuLTs: CRF was inversely associated with GLU at the 50th (β= -0.34, 95% CI: 


-0.52, -0.17), 75th (β= -0.53, 95% CI: -0.74, -0.32), and 90th (β= -0.70, 95% CI: -0.99, 

-0.40) percentiles; and inversely associated with MAP at the 50th (β= -0.21, 95% CI: 

-0.35, -0.07), 75th (β= -0.25, 95% CI: -0.44, -0.06), and 90th (β= -0.29, 95% CI: -0.49, 

-0.09) percentiles. Significant inverse associations between CRF and TG and WC were 

found at the 10th, 25th, 50th, 75th, and 90th percentiles; the magnitude of associations 

were gradually stronger at upper tails of TG distribution (from 10th percentile β= 

-1.14, 95% CI: -1.62, -0.66 to 90th percentile β= -3.74, 95% CI: -6.75, -0.72) and WC 

distribution (from 10th percentile β= -0.72, 95% CI: -1.10, -0.33 to 90th percentile β= 

-1.25, 95% CI: -1.48, -1.02). CRF was positively associated with HDL-C at 25th (β= 

0.33, 95% CI: 0.21, 0.45), 50th (β= 0.28, 95% CI: 0.11, 0.45), 75th (β= 0.39, 95% CI: 

0.07, 0.71), and 90th (β= 0.43, 95% CI: 0.09, 0.85) percentiles. 

CONCLusION: CRF was significantly associated with better MRFs profiles. 

The associations were stronger at upper tails of MRFs distributions indicating that 

improving CRF is especially important for those with poor MRF profiles. 

1435 Board #27 May 30, 2:00 PM - 3:30 PM 

Type I and Type II Errors in Correlation analyses of Various 

sample sizes 

Duane Knudson, FACSM1 , Crawford Lindsey2 . 1Texas State 

University, San Marcos, TX. 2Tennis Warehouse, San Louis 

Obispo, CA. 


Studies are designed to balance pragmatic and theoretical issues. A common problem 

in sport and exercise science research is small sample sizes, which was recently noted 

in ACSM abstracts (Pyne & Hopkins, 2012). 

PurPOsE: This study documented the likely rates of type I and type II errors in 

correlation analyses in sample sizes common in sport and exercise science. 

METhOds: Data from mechanical testing of most all polyester tennis strings 

commercially available in 2012 using the protocol by Cross et al. (2000) were analyzed 

in this study. Variables measured were gauge, impact duration, string deflection, peak 

force, string stiffness, and energy return for 198 different strings tested at 276 N of 

tension. Three additional sample sizes were created by randomly down sampling to 99, 

50, and 25. Correlations and partial correlations were calculated and compared to those 

observed for the complete sample (N=198). 

rEsuLTs: For the whole sample, 14 of 15 zero-order correlations were significant 

(p


There were no significant differences between actual steps taken and Yamax 

and Omron recorded steps (p>0.05). In addition, there were no significant 

differences between actual distance traveled and Yamax and Omron recorded 

distance (p>0.05). However, the BCF pedometer significantly underestimated 

step count (p



group. However, given the line equation between HR and PR in subjects with SPAH 

is significantly different compared to NPAH and MPAH, using PR in predicting 

HR may be inaccurate and misleading. This puts into question the utility of PR in 

predicting actual HR. To monitor intensity of exercise, HR should be measured by 

electrocardiography during the 6 minute walk test. 

1441 Board #33 May 30, 3:30 PM - 5:00 PM 

Characterization of the Ventilatory drive in Patients with 

Pulmonary hypertension and Interstitial Lung disease 

Lisa M. K. Chin1 , Randall E. Keyser, FACSM2 , Joshua G. 

Woolstenhulme1 , Bart Drinkard1 , Gerilynn Connors3 , Steven 

D. Nathan3 , Leighton Chan1 . 1National Institutes of Health, 

Bethesda, MD. 2George Mason University, Fairfax, VA. 3Inova Fairfax Hospital, Falls Church, VA. 


Pulmonary hypertension (PH) and interstitial lung disease (ILD) are conditions that 

may develop without a known cause (idiopathic) or in association with other etiologies 

such as connective tissue disease. Both conditions result in exercise intolerance, yet the 

pathomechanisms by which these conditions limit cardiorespiratory function are likely 

different. 

PurPOsE: To characterize differences in pulmonary respiration and/or ventilatory 

function that may limit cardiorespiratory capacity among patients with PH and ILD. 

METhOds: Six patients with idiopathic PH (iPH), 20 patients with associative PH 

(aPH), 16 patients with ILD, and 14 healthy controls (HC) completed a symptomlimited 

treadmill cardiopulmonary exercise test (CPET) as part of the NIH Exercise 

Therapy for Advanced Lung Disease Trial. Patients with right or left heart failure or 

PH that was co-morbid with ILD were not included. Pulmonary gas exchange was 

measured breath-by-breath. Variables of interest included peak oxygen consumption 

(VO ), expired carbon dioxide volume (VCO ), expired ventilatory volume (Ve), tidal 

2 2 

volume (Vt), breathing frequency (f), ventilatory equivalent ratio for carbon dioxide 

(Ve/VCO ) and end tidal partial pressure of CO (PETCO ). 

2 2 2 

rEsuLTs:Age and BMI (52 ± 11 yrs; 30.7 ± 6.8 kg/m2 ) were similar across all 

groups. Diminished (P < 0.05) peak VO , VCO , Ve and Vt were observed in patients 

2 2 

with iPH, aPH and ILD compared to HC. Peak f was higher (P


METhOds: Fourteen older (67.9 ± 1.2 yr) obese adults (BMI: 34.2 ± 1.1kg/m2) with 

metabolic syndrome underwent 12-weeks of supervised exercise training (60 minutes/d 

for 5 d/week at ~85% HRmax). Peripheral insulin sensitivity was determined by 

the euglycemic-hyperinsulinic clamp (40 mU·m2·min-1), hepatic insulin action was 

estimated by HOMA-IR, and 2-hr glucose levels were determined after a 75 gram oral 

glucose tolerance test. Visceral fat was determined by computerized tomography. Basal 

fat oxidation and aerobic fitness was measured by indirect calorimetry. Plasma DPP-4 

was analyzed using an enzyme-linked immunosorbent assay. 

rEsuLTs: Exercise decreased body weight and visceral fat and increased aerobic 

fitness (p



was obtained and serum cortisol was measured. Additionally, a 60 min intravenous 

glucose tolerance test was completed. The product of glucose and insulin area under 

curve (AUC) was used to estimate IS. Linear mixed models were used to assess sex 

differences, and correlations determined associations of cortisol and AUC. 

rEsuLTs: Cortisol was significantly lower in males compared to females in both 

conditions (p


of HMG-CoA reductase, LDL-R, SR-BI and StAR protein in Leydig’s cells were 

examined by the real-time PCR with the Taq-man probe technique. 

rEsuLTs: The results showed that the serum T of TA group decreased significantly 

(1.44±0.42 vs. 8.83±4.57ng/ml, p



PurPOsE: To assess the impact of sex/gender on the associations of MQ, estimated 

using laboratory (MQ-L) or field (MQ-F) methods, to functional performance tasks 

varying in muscle mass recruitment. 

METhOds: Age- and BMI-matched, community-dwelling older men (n = 40, 76.2 

± 6.2 years, BMI = 27.3 ± 3.8 kg/m2) and women (n = 40, 75.8 ± 5.5 years, BMI = 

27.0 ± 3.8 kg/m2) were assessed for grip strength via Jamar dynamometer, leg power 

via Nottingham Power Rig, and body composition via DXA. Physical function was 

assessed with the 30-sec chair rise (CHR) and the Physical Performance Test (PPT; 

score range = 0 to 36). MQ-L was calculated as total leg power divided by lower body 

lean mass. MQ-F was calculated as total grip strength divided by BMI. 

rEsuLTs: MQ methods were correlated (r=0.52, p


or compared to the normal-weight women during both conditions. There were no 

significant group*condition interactions or main effects for total activity or sedentary, 

moderate, or vigorous activity time (P>0.05). 

CONCLusION: Acute sleep deprivation and obesity may influence dietary intake at 

certain times of the day but does not appear to acutely influence physical activity or 

physical activity intensity. Additional work examining the relationship between sleep 

deprivation and energy balance pathways is needed. 

1461 Board #53 May 30, 3:30 PM - 5:00 PM 

The relationship between Objectively Measured sleep and 

diet Quality in College Women 

Timothy W. Hope, Wyatt W. Sessions, James LeCheminant, 

FACSM, Bruce W. Bailey. Brigham Young University, Provo, UT. 


OBJECTIVE: The purpose of this study was to examine the relationship between 

sleep (duration and quality) and diet quality among young adult women. Subjects: 

Three-hundred seventy-five women (18-24 years) were recruited to participate in the 

study. Measurements: Each participant wore an actigraph for 7 consecutive nights to 

measure sleep. Sleep logs were used to verify bedtime and wake time for each night. 

Actigraph data was then evaluated to determine sleep latency, efficiency, and number 

of awakenings. Diet was evaluated using automated self-administered 24-hour recall 

over three nonconsecutive days. Diet quality was evaluated using the 2005 Healthy 

Eating Index (HEI 2005), consumption of fruits and vegetables and consumption of 

non-nutrient dense foods (NNDF). 

rEsuLTs: On average women in the study consumed 1980 ± 540 calories per day, 

1.2 ± 0.7 servings of fruits and vegetables per 1000 calories and 27.4 ± 11.9% of their 

calories from junk foods. The average Healthy Eating Index score was 59.3 ± 12.5, 

which is classified as “needs improvement.” The HEI 2005 was negatively related to 

bedtime (F = 7.89, p = 0.0053) and the coefficient of variation in wake time (F = 5.13, 

p = 0.0242). Fruit and vegetable consumption was negatively related to wake time (F 

= 9.85, p = 0.0019)and the coefficient of variation in wake time (F = 6.34, p = 0.0123). 

NNDF was positively related to bedtime (F = 4.82, p = 0.0289). 

CONCLusIONs: Result for this study suggest that young adult women who go to 

sleep earlier, wake up earlier and have more consistent sleep patterns eat less NNDF, 

more fruits and vegetables and better meet dietary recommendations than women who 

go to sleep later, wake up later and have less consistent sleep patterns. 

1462 Board #54 May 30, 3:30 PM - 5:00 PM 

Modification Of students adiposity according To Nutritional 

status: an analysis Of 30 years 

Gerson Luis de Moraes Ferrari1 , Sandra Matsudo2 , Timoteo 

L. Araujo2 , Luis Carlos Oliveira2 , Victor Rodrigues Matsudo2 . 

1 2 CELAFISCS - UNIFESP, Itu, Brazil. CELAFISCS, São 

Caetano do Sul, Brazil. 


OBJECTIVE: To analyze the adiposity changes over 30 year-period, according to the 

nutritional status in students. 

METhOds: Sample is part of the Ilhabela Mixed-Longitudinal Project on Growth 

and Physical Fitness*, which is held since 1978. From a data base of 16.000 students of 

both sexes, 1144 students, 635 males and 509 females, from 10 to 11 years-old met the 

following inclusion criteria: to be in the prepubertal stage of sexual maturation; to be 

apparently healthy; and do not have physical impairments.The selected data were part 

of a database from 1978/1980 (Initial), 1988/1990 (10 years), 1998/2000 (20 years) and 

2008/2010 (30 years). The variables analyzed were: body mass, body height and fatness: 

average of seven skinfolds. Children were categorized according to the nutritional status 

through the WHO body mass index curves for age and sex in normal, overweight and 

obese. Used was ANOVA one-way, followed by post-hoc Scheffé was p



ID genotypes whereas insulin (from 3.84 to 2.69) and HOMA-IR (from 1.57 to 1.08) 

in DD genotype were significantly decreased after exercise program (p 0.05). 

Aspartate transaminase remained unchanged from pre- to post-testing (Control 3.50 +/- 

7.23, PL -2.01 +/- 5.83, EX -1.70 +/- 12.95IU/L, p > 0.05). No significant interactions 

were observed between groups for the aforementioned blood values (interaction p > 

0.095). 

CONCLusIONs: The nutritional supplements used in the current investigation 

enhanced total body fat loss when added to a reduced calorie diet. Both the diet alone 

and the diet with supplements did not alter hepatic or renal functions negatively. 



1469 Board #61 May 30, 3:30 PM - 5:00 PM 

Paleolithic diet and Exercise suppress hunger during Inter- 

Meal Interval By different Mechanisms 

Po-Ju Lin, Katarina Borer. University of Michigan, Ann Arbor, MI. 


Both exercise and higher fat and protein diet have been shown to reduce hunger ratings 

compared to high carbohydrate diet or sedentary condition. To find out whether this 

effect has a common mechanism, we examined how Paleolithic (P) versus Western diet 

(W), and exercise (X) versus sedentary (S) condition affected hunger ratings. Gastric 

inhibitory polypeptide (GIP) secretion and acetaminophen (APAP) absorption as a 

marker of gastric emptying (GE) served as a measure of gastrointestinal food transit 

(GFT). Although GIP has not been implicated in the control of hunger, GIP could 

affect hunger ratings indirectly by changing GE. 

PurPOsE: Examine the effect of P and W meal on hunger ratings and plasma GIP 

and APAP concentrations during X or S condition. 

METhOds: Twenty-four healthy postmenopausal women participated in 1 of 4 

conditions: S or 2 h of X (14 to 16 h) with P or W meal (PS, PX, WS, WX; n=8 each). 

The P meal contained 30% carbohydrate (CHO), 25% protein (PRO), and 45% FAT 

while W meal contained 60% CHO, 15% PRO, and 25% FAT. The meal was provided 

at 10 h. Participants were provided 20ml of liquid acetaminophen (160mg/5ml), 

30 minutes after the start of the meal. Plasma GIP and APAP concentrations were 

measured, and hunger ratings assessed with a visual analog scale, at hourly intervals 

during 3 h after the start of exercise. Changes in hunger ratings, GIP and APAP 

concentrations were analyzed with repeated measures mixed model ANOVA. 

rEsuLTs: Hunger ratings were overall significantly higher after W than after P meal 

(F=10.3, p



Moreover, it affects the synthesis of inflammatory proteins, promoting a picture of lowintensity 

inflammation. Despite this evidence, little attention is given for investigation 

of strategies that may attenuate this situation. Therefore, the aim of this study was to 

analyze the effect of caloric restriction on the fat depots and inflammatory proteins in 

detrained rats. 

METhOds: Twelve (12) male adult Sprague-Dawley rats were divided into 3 groups 

(n = 4) after 8 weeks of training on a treadmill. One group (TRAIN) consisted of 

animals that continued training for 6 more weeks with access to food ad libitum. The 

other two groups discontinued training and had either access to food ad libitum (DT) 

or 30% caloric restriction (DTRC) for the next 6 weeks. The animals were euthanized 

and blood was collected for adipocytokine measurements (leptin, adiponectin, PAI-1 

and MCP-1). Retroperitoneal (RET), epididymal (EPI) and subcutaneous (SUB) fat 

pads were excised and weighed on an analytical scale. Adipocytokines were measured 

using Lincoplex 200. For statistical analysis, one-way ANOVA was used followed by 

Scheffe post-hoc test, considering P


practice and may provide an opportunity for trainees to achieve the required physical 

activity to maintain cardiovascular health through routine activity. 

PurPOsE: The purpose of this study is to determine the level of activity of PM&R 

residents as measured by the number of steps taken during both a typical workday from 

7:30am to 4:30pm and during a 24 hour call period. We quantified physical activity in 

order to make recommendations specific to PM&R residents as to whether additional 

exercise is needed to maintain cardiovascular health. 

METhOds: The resident-on-call (ROC) at the Rehabilitation Institute of Chicago 

wore a FitBit accelerometer in order to record how many steps were tracked every 

minute of every day. The accelerometer was attached to the ROC’s keys, which are 

with him/her at all times. Subjects were blinded to the number of steps they took. 

rEsuLTs: On average, residents walked 6673 ± 2040 steps per 24h period; only 1 of 

the 30 days (3.3%) consisted of greater than 10,000 steps. During the typical workday, 

residents walked 3129 ± 1244 steps with no workdays reaching the required 10,000 

steps. 

CONCLusIONs: During the typical workday and when on 24-hour in-house call, 

residents training in PM&R do not achieve the level of daily activity required to 

maintain cardiovascular health. Consequently, PM&R residents would be required 

to achieve activity comparable to approximately 7,000 daily steps outside of work to 

achieve recommended guidelines. 

1477 Board #69 May 30, 2:00 PM - 3:30 PM 

Feasibility and acceptance of Breaks in Office-Based 

Occupational sedentary Time 

Eszter Füzéki, Lutz Vogt, Katharina Schmidt, Markus Stross, 

Winfried Banzer. Goethe University Frankfurt, Frankfurt am 

Main, Germany. 


Recent evidence suggests that prolonged sitting might be detrimental to health, 

independent of leisure time physical activity or exercise, and that breaks in sedentary 

time can counteract these effects. However there is only limited evidence how 

acceptable and feasible breaks are in office jobs. 

PurPOsE: To investigate the feasibility and acceptance of breaks at different time 

intervals in office-based occupational sitting. 

METhOds: Using a standardized diary subjects (n=18; age 37.2 years; BMI 25.4 kg/ 

m2) documented the number of regular breaks in occupational sitting at baseline (T0). 

After having received written information on health risks of prolonged sitting subjects 

were randomized into 3 groups (breaks at every 30, 60, 120 min.). All subjects were 

encouraged to follow their respective break interval during their workday (≥8 hrs). 

Number, time, duration and cause of breaks were reported by subjects on 5 consecutive 

working days. The general practicability (10=very difficult) and subjective experience 

(10=very disturbing) were reported on a visual analogue scale at the end of every day. 

Compliance with break intervals was based on the calculation of the average difference 

per week between the target and the actual number of breaks per subject. 

rEsuLTs: No between-groups difference was observed in the number (range 2-17) of 

breaks taken at baseline. Subjects worked on average 8:51 h/d. The duration per break 

ranged from 1:40 - 15:00 min. More than 40% of all breaks were work-related. The 

average number (mean±SE) of actual breaks for group 1 to 3 per week was 9.5±1.0 

vs. 6.4±1.2 vs. 6.9±1.2, corresponding to average differences from the target number 

of breaks of 2.8±2.2 vs. -1.4±1.4 vs. 3.3±1.2. No significant differences in the number 

of actual breaks between groups or consecutive days of self-report were detected. 

Subjective ratings for practicability and experience were 4.1±0.6 and 1.8±0.3. 

CONCLusIONs: The present findings demonstrate that subjects feel comfortable 

with breaks at different intervals. Although statistics failed significance data suggest 

that breaks at every 60 min. in office-based occupational sedentary time seem 

most feasible. Since breaks were to a large extent work-related behavioural and 

environmental support in the office setting might enhance readiness to take breaks 

more often. 

1478 Board #70 May 30, 2:00 PM - 3:30 PM 

hamsters Without Wheels: The Built Classroom 

Environment Makes undergraduates Inactive and 

unhealthy 

Matthew Kuennen1 , Jorge Granados1 , Trevor Gillum2 . 1West Texas A&M University, Canyon, TX. 2California Baptist 

University, Riverside, CA. 


Sedentarism is a learned behavior that increases the incidence of hypertension (30%), 

Alzheimer’s disease (40%), coronary artery disease (45%), type II diabetes (50%), 

stroke (60%), and costs U.S. taxpayers >2.4 billion dollars annually. College students 

spend >75% of each school day engaged in sedentary pursuits. 

PurPOsE: Our purposes were threefold: 1) Determine the contribution of the seated 

classroom environment to sedentarism in college students; 2) Define the relationship 

between sedentarism and physiological and psychological health; and 3) Discern 

whether sedentarism influences student outcomes on academic coursework. 

METhOds: 12 male and 12 female undergraduates tracked the number of steps they 

took before, during, and after school each day for 1 week; these data were used to 


stratify students into groups (high, moderate, or low physical activity). Risk factors 

for atherosclerotic cardiovascular disease (age, family history, cigarette smoking, 

sedentary lifestyle, hypertension, dyslipidemia, prediabetes); psychological health 

(Beck Depression Inventory); and academic outcomes (student’s final course grades) 

were assessed. A Pearson correlation was used to determine the relationship between 

student’s physical activity levels and their risk for atherosclerotic cardiovascular 

disease. A one-way ANOVA was used to determine if psychological health and 

academic outcomes differed between physical activity groups. 

rEsuLTs: Time spent in the seated classroom environment was the single largest 

contributor to physical inactivity during the school day in this undergraduate student 

cohort. 14 of 24 (58%) students did not achieve recommended physical activity levels 

(10,000 steps/d). An inverse relationship (r = 0.71; p



were included. 

rEsuLTs: The literature reviewed draws attention to the global health crisis 

that is being caused by physical inactivity. Inactive children have a higher risk of 

developing chronic diseases such as obesity, type 2 diabetes, high blood cholesterol 

and hypertension. Other undesirable consequences include orthopaedic problems, 

cardiovascular disease and various psychological complications. Both aerobic and 

resistance training should be incorporated into paediatric exercise programs. The 

recommended guidelines for childhood activity are 60 minutes of moderate intensity 

exercise every day of the week. 

CONCLusION: This abstract highlights the importance of formalised paediatric 

exercise programs in disease prevention and health promotion. A healthy and happy 

adolescent population ultimately contributes to a low risk adult population. The 

combined effect of healthy children and adults will in the long-term decrease the 

burden on the national health sector. Therefore both children and parents should be 

encouraged to participate in regular activity. 

1481 Board #73 May 30, 2:00 PM - 3:30 PM 

awareness Of aCsM Physical activity recommendations 

for health Promotion among Portuguese and Polish College 

students 

Jolanta Zuzda1 , Dulce Esteves2 , Paulo Pinheiro3 , Kelly O’Hara2 , 

Rui Brás4 , Robert Latosiewicz5 . 1University Bialystok of 

Technology, Bialystock, Poland. 2University of Beira Interior, 

CIDESD, Covilhã, Portugal. 3University of Beira Interior, 

NECE, Covilhã, Portugal. 4University of Beira Interior, 

CIDESD, Covilhã, Portugal. 5Medical University of Lublin, 

Lublin, Poland. 


Embracing an active lifestyle has an important role in preventing chronic disease and 

improving mental health, perceived health status, and quality of life. Many health 

behaviors, such physical activity (PA) level are established during early adulthood, 

when many attend college, so the decline in PA during college is a disturbing trend. 

Little investigation has focus on students’ awareness on adequate PA characteristics for 

health improvement, and if that awareness presents differences for students of different 

contexts. 

PurPOsE: This study aims to examine the extent to which knowledge of the ACSM 

PA recommendations has diffused through portuguese and polish college students. 

METhOds: The study included a stratified randomly recruited sample of 300 

Portuguese students (23.7% M; 76.3% F), 19.58±1.61 y and 358 Polish students 

(39.1% M; 60.9% F), 21.06±1.39 y. The awareness of ACSM Physical Activity 

Recommendations for Health Promotion was assessed as indicated by Bennett et al. 

(2009). 

rEsuLTs: 43.0% of Portuguese and 31.9% of Polish students were accurately 

knowledgeable of the ACSM physical activity recommendations. Recommendations 

knowledge was slightly higher among male students (45.1% for Portuguese and 32.9% 

for Polish) than females (42.1% for Portuguese and 31.2% for Polish). 

CONCLusIONs: Despite efforts to promote PA and widespread knowledge on 

ACSM recommendations, more than an half of college students can not accurately 

identify adequate PA characteristics for health improvement. This lack of awareness 

is common in students from different universities and from different countries. These 

findings highlight the need for more effective campaigns to widespread ACSM 

recommendations for health promotion among universities. 

References: Bennett, G., Wolin, K. et al. (2009) Awareness of National Physical 

Activity Recommendations for Health Promotion among US Adults. Med Sci Sports 

Exerc. 41(10), pp. 1849-1855 

1482 Board #74 May 30, 2:00 PM - 3:30 PM 

Physical activity habits and related Counseling Practices 

among health Care Providers: a Literature review 

Isabel Garcia de Quevedo 1 , John Duperly 2 , Felipe Lobelo 1 . 

1 Centers for Disease Control and Prevention, Atlanta, GA. 

2 Universidad de los Andes, Bogota, Colombia. 


Health care providers (HCPs) play a key role counseling their patients to adopt healthy 

physical activity (PA) levels, (Healthy People 2020 objective). It has been reported 

that active HCPs that are more likely to counsel and give better, more credible and 

motivating PA counseling to their patients. 

PurPOsE. Summarize the evidence on HCPs personal PA habits and related 

counseling practices. 

METhOds. A snow-ball literature search methodology based on relevant articles 

and key search terms (“attitudes”, “habits”, “health personnel”, “physical activity”, 

“exercise” and “role model”) was used to select applicable articles in PubMed between 

1979 and 2012. 

rEsuLTs. Out of 196 articles screened, 26 were finally included in this review, 23 

observational studies and three interventions to modify HCP, PA habits, counseling 

or both. Most studies were from the US (n=16) and included MD’s samples (n=18). 


Synthesis from the findings suggests that, compared to general population, MD’s 

report higher compliance with current PA recommendations, ranging from 45 to 90%. 

Among other HCP (nurses and dietitians) compliance with PA recommendations 

ranged from 39 to 70%. MD PA advice found to be influenced by: older age, being 

female, being physically active, and patients’ higher level of education. Specialty 

was also an important factor being GPs and internists the ones that counsel more. PA 

counseling among other HCP (nurses, social workers and dietitians) ranged from 88 to 

95%. In general knowledge of current PA recommendations was low and ranged from 

12-27% among MD’s and from 9 to7% among other HCP. The most common barriers 

reported for not counseling on PA were similar among physicians and non-physicians 

and included lack of time, low self-efficacy, lack of PA counseling materials and lack 

of knowledge. Some interventions successfully improved MD’s PA/fitness, access to 

training and materials, and increased PA prescription knowledge, but no significant 

increase in PA counseling was observed. 

CONCLusION. Personal PA habits are associated with HCP’s PA-related counseling. 

More research is needed on effective interventions to improve HCPs PA habits and 

address other PA counseling barriers in particular among non-physician population and 

in low-to-middle income countries where the burden of inactivity is greatest. 

1483 Board #75 May 30, 2:00 PM - 3:30 PM 

Long Term Effects Of a Community Group Versus 

Physiotherapist-led home-based Physical activity Program 

Nicole Freene, Gordon Waddington, Wendy Chesworth, Rachel 

Davey, Tom Cochrane. University of Canberra, Bruce, Australia. 


Few studies have compared the long term effects of physical activity programs with 

varying program methods, program deliverers and participant preferences. 

PurPOsE: To compare a physiotherapist-led home-based physical activity program 

to a standard community group exercise program to determine the long term physical 

activity adherence and health benefits. 

METhOds: A pragmatic quasi-experimental design was used to compare a nonrandomized 

group and home-based intervention over 18 months. Sedentary community 

dwelling 50-65 year olds were recruited using the Australian Federal Electoral Roll 

(n=2105). Initially participants were invited to a community group exercise program 

(G, n=93). Those not interested in the group exercise program were invited to take 

part in a physiotherapist-led home-based physical activity program (HB, n=65). Both 

interventions were for 6 months over the same time period. The primary outcome 

was physical activity adherence derived from exercise diaries. Secondary outcomes 

included the Active Australia Survey, accelerometry, aerobic capacity (step test), 

quality of life (SF-12v2), blood pressure, waist circumference, waist-to-hip ratio 

(WHR) and body mass index. Comparisons between interventions were made using a 

repeated measures ANCOVA. 

rEsuLTs: Home-based participants were more likely to be younger, working full 

time and not be in a relationship (p


rEsuLTs: Based on Repeated Measures ANOVAs, there were significant program 

main effects for sedentary [F(2, 74)=31.38, p



participants were asked to maintain normal diet, and record daily fluid intake while the 

E group participants were asked to maintain normal diet, consume an additional 710 

ml of water daily, and record daily fluid intake. 

rEsuLTs: During Pre, hydration status was not significantly different between the 

groups and both groups appeared to be hypohydrated (p>0.05, C: 1.025 ± 0.005; E: 

1.025 ± 0.004). During the week leading to the Post, the average fluid intake was 

significantly greater in the E group compared to C group (p = 0.03, C = 2160 ± 1080 

ml; E: 3033 ± 934 ml), yet, hydration status was not significantly different during Post 

(p>0.05, C: 1.025 ± 0.007; E: 1.020 ± 0.006). 

CONCLusION: The results of the study demonstrated that, similar to other reports, 

Division III collegiate athletes were hypohydrated prior to practice. In addition, 

although the hydration regimen resulted in a greater fluid consumption, hydration 

status between the groups was not different. 

1489 Board #81 May 30, 3:30 PM - 5:00 PM 

Influence of hydration status on Ironman Triathletes using 

heart rate Based Pace Feedback 

Rebecca L. Stearns, Douglas J. Casa, FACSM, Julie K. 

DeMartini, Tracy L. Hicks, Robert A. Huggins, Lesley W. 

Vandermark, Evan C. Johnson, Colleen X. Muñoz. University of 

Connecticut, Storrs, CT. 


Endurance athletes commonly use heart rate (HR) to pace themselves. However, 

dehydration elevates HR, potentially impacting pacing during an endurance event. 

PurPOsE: Evaluate the influence of hydration status on triathletes utilizing heart rate 

(HR) to pace themselves during the bike and run sections of an Ironman triathlon. 

METhOds: Sixteen athletes (3 women, 13 men) in the 2012 Lake Placid 

Ironman traiathlon participated (Mean±SD: age=40±5yrs, height=173±12cm, body 

fat=16.1±6.5%). Average HR (HRavg), global positioning system (GPS) data, 

percent body mass loss (%BML), urine color (UC) and urine specific gravity (USG) 

were collected. HRavg and pace (min*km-1) for the two identical bike (B1, B2) and 

run (R1, R2) course loops were collected. Based on post race USG, subjects were 

divided into two groups: hydrated (HY, USG


Mean Local Sweat Rate (mg/min/cm2) ± SD 

Drink 15 min 30 min 50 min 60 min 75 min 

1.5ºC 0.20 ± 0.09 0.40 ± 0.11 0.53 ± 0.12 0.58 ± 0.14 0.69 ± 0.15 

37ºC 0.23 ± 0.11 0.50 ± 0.17 0.61 ± 0.22 0.66 ± 0.24 0.72 ± 0.27 

50ºC 0.29 ± 0.15 0.61 ± 0.18 0.74 ± 0.21 0.79 ± 0.22 0.78 ± 0.23 

NG 50ºC 0.39 ± 0.23 0.65 ± 0.23 0.70 ± 0.23 0.71 ± 0.23 0.69 ± 0.24 

NG 1.5ºC 0.27 ± 0.11 0.43 ± 0.15 0.49 ± 0.16 0.51 ± 0.15 0.57 ± 0.16 

SW 50ºC 0.29 ± 0.17 0.50 ± 0.20 0.57 ± 0.24 0.60 ± 0.21 0.61 ± 0.21 

SW 1.5ºC 0.36 ± 0.29 0.51 ± 0.24 0.62 ± 0.22 0.60 ± 0.24 0.60 ± 0.24 

1493 Board #85 May 30, 3:30 PM - 5:00 PM 

sweat sodium Content: Concurrent Validity Of The horiba 

C-122 Tm and Wescor sweat Chek Tm analysers 

Eric DB Goulet, Tommy Dion, Audrey Asselin, Félix A. Savoie. 

University of Sherbrooke, Sherbrooke, QC, Canada. 


Currently, there exists two instruments that coaches and scientists can use to measure 

sweat sodium content under field conditions: the Horiba C-122TM and Wescor Sweat 

ChekTM. The former device (ion selective electrode technology) is low weight (~ 

40g), low cost (~250 US$), pocket-sized and battery operated, whereas the latter (ion 

conductance technology) is semi portable (~1 kg), medium-priced (~2000 US$) and 

electrically operated. No studies have yet concurrently compared the validity of both 

instruments. This is an important issue, given the discrepant cost and physical and 

technical characteristics of the two devices. 

PurPOsE: To simultaneously determine the validity of the Horiba C-122TM and 

Wescor Sweat ChekTM against sweat sodium concentration values obtained with 

the flame photometry technique, which is the accepted reference method for the 

measurement of bodily sodium contents. 

METhOds: Sweat sodium samples (N=74) (patch collection technique, 5 x 7 cm 

non-adherent pads covered with highly-adhesive transparent dressings) were obtained 

from 26 exercising, heat-acclimatized soccer players, runners and triathletes, who 

each provided between 1 to 4 sweat samples from 1 to 4 different anatomical sites 

(forefront, thigh, upper back or forearm). 

rEsuLTs: Data were normally distributed (kolmogorov-smirnov test) and showed 

no sign of heteroscedasticity (standardized residuals vs. dependent variables). Sweat 

sodium concentration values obtained with the Horiba C-122TM and Wescor Sweat 

ChekTM correlated highly with those determined by flame photometry (Pearson 

product-moment correlation coefficient: r=0.98 vs. r=0.99; single measures (two-way 

random/absolute agreement) intra-class correlation coefficient: r=0.97 vs. r=0.98). In 

comparison to flame photometry, the Horiba C-122TM and Wescor Sweat ChekTM 

demonstrated similar biases (-3 mmol/L vs. 1 mmol/L), pure error of measurements (6 

mmol/L vs. 5 mmol/L), standard error of the estimates (5.51 mmol/L vs. 3.53 mmol/L) 

and 95% Bland and Altman level of agreement confidence intervals (-3 ± 12 mmol/L 

vs. 1 ± 10 mmol/L). 

CONCLusION: These results indicate that both the Horiba C-122TM and Wescor 

Sweat ChekTM portable sodium analysers demonstrate a moderate level of agreement 

with the flame photometry technique. 

1494 Board #86 May 30, 3:30 PM - 5:00 PM 

sweat Electrolyte Content and Fluid Loss in Elite Triathletes 

Riana R. Pryor, Amy B. Mausser, Douglas J. Casa, FACSM, 

J Luke Pryor, Lawrence E. Armstrong, FACSM, Evan C. 

Johnson, Brittanie M. Volk, Amy L. McKenzie, Luke N. Belval. 

University of Connecticut, Storrs, CT. 


Knowledge of 24-hour sodium and water turnover in trained triathletes during 

training in a warm environment is important for personalized nutrition, hydration and 

performance. 

PurPOsE: This study investigated triathlete urine and sodium 24-hour turnover 

during a period that included endurance exercise in a warm environment to determine 

if increases or decreases in consumption are necessary. 

METhOds: Thirty-three sponsored triathletes (19 men, 14 women; age: 37 ± 11 y, 

32 ± 6 y; height: 181 ± 6 cm, 170 ± 4 cm; weight: 75.7 ± 7.6 kg, 60.1 ± 5.9 kg; best 

half Ironman time 4:16 ± 0:24 hr:min, 4:42 ± 0:20 hr:min, respectively) completed a 

43.4 ± 3.8 minute treadmill run or friction resisted cycle ergometer ride (28.0 ± 0.5 ºC; 

27.2 ± 4.9 % RH) at a self-selected intensity which was estimated to be similar to half 

Ironman triathlon race pace for the chosen modality. Whole body wash-down (WBW) 

determined sweat electrolyte content. Twenty-four hour urine and dietary records were 

collected to calculate sodium and water intake and losses. 

rEsuLTs: Both 24-hour water and sodium balance were similar between men and 

women. 


Water (L·d-1 ) Sodium (mg) 

Male Female Male Female 

Total Intake 4.1 ± 1.9 3.0 ± 1.2 5081 ± 2277 3589 ± 1005* 

Exercise Intake 0.4 ± 0.4 0.3 ± 0.2 --- --- 

Sweat Output 1.4 ± 0.3 1.0 ± 0.3* 1423 ± 438 941 ± 476* 

Urine Output 2.8 ± 0.8 2.4 ± 0.7 4687 ± 1419 2791 ± 1162* 

Net Balance -0.2 ± 1.9 -0.5 ± 1.4 -1048 ± 2229 -161 ± 1435 

Note. *Difference between sexes, p ≤ 0.05. Total water intake includes exercise 

intake. 

CONCLusION: Twenty-four hour sodium and water turnover were similar 

between trained male and female triathletes. When exercising in warm conditions, 

trained triathletes may need to slightly increase water replacement (5-17%) and 

moderately increase sodium supplementation (4-21%) to remain homeostatic. 

Supported by Timex, Inc., Middlebury, CT. 

1495 Board #87 May 30, 3:30 PM - 5:00 PM 

Physiological Effects of Compression Garments during 

uncompensable heat stress 

Joshua T. Bautz, David Hostler, FACSM, Priya Khorana, Joe 

Suyama. Emergency Responder Human Performance Lab, 

University of Pittsburgh, Pittsburgh, PA. 


Thermal protective clothing (TPC) worn by firefighters protect users from flames but 

prevent evaporative cooling. Volume lost from sweating combined with heat stress 

and physical exertion places considerable strain on the cardiovascular system. Lower 

extremity compression garments (LECGs) have gained popularity with endurance 

athletes and are purported to improve performance by augmenting venous return. We 

hypothesized that the use of LECGs would therefore preserve intravascular volume 

leading to a lower heart rate (HR) while working in a hot environment. 

PurPOsE. Examine the effect of wearing LECGs under TPC on HR, core 

temperature (Tc), and markers of hydration during treadmill exercise. 

METhOds. Ten male subjects (mean age 27± 6 years, height 1.78± 0.092 m, mass 

74.75± 6.974 kg, body fat 10.6± 4.22%, VO2 max 57.8± 9.29 mL/kg/min) completed 

the control (no LECG) and LECG experimental conditions in randomly assigned 

order. Protocols were separated by a minimum of three days. Subjects exercised for 

90 minutes on a treadmill while wearing wilderness firefighter TPC and helmet in a 

heated room. Venous blood was drawn pre and post exercise to measure hemoglobin 

(Hgb), hematocrit (Hct), serum OSM (OSM), and serum CPK (CPK). Vital signs and 

perceptual measures of comfort and exertion were recorded every five minutes during 

the protocol. Paired samples t-tests were performed to compare the change in metrics 

between the two conditions. 

rEsuLTs. In comparing the LECG condition with the control condition, there were 

no differences in the change in HR (84±27 vs. 85±14 bpm, p=0.9), Hgb (0.49±0.66 

vs. 0.33±1.11 g/dL, p=0.7), Hct (1.22±1.92 vs. 1.11±3.62%, p=0.9), or body mass 

(1.72±0.78 vs. 1.77±0.58 kg, p=0.7). There were no differences in distance walked 

(3.9±0.5 vs. 4.0±0.5 miles, p=0.2), exercise interval (88.6±3.5 vs. 88.4±3.6 minutes, 

p= 0.8), or perceptual measures of comfort or exertion. Additionally, there were 

no differences in Tc rise (1.8±0.6 vs. 1.9±0.5°C, p=0.394), OSM (1.67±6.34 vs. 

6.22±11.39 mOsm/kg, p = 0.3), or CPK (22.2±30.2 vs. 29.8±19.4 IU/L, p = 0.5). 

Conclusions. LECG worn beneath TPC did not acutely alter the physiologic response 

to exertion in TPC. These data neither encourage nor discourage LECG use during 

uncompensable heat stress. 

1496 Board #88 May 30, 3:30 PM - 5:00 PM 

Effects of different Types of Clothing on Thermoregulation 

and Microenvironments during simulated american 

Football 

Eric J. Jones, Nathan Frischmann, Mark D. Faries, Wesley 

Kephart. Stephen F. Austin State University, Nacogdoches, TX. 

(Sponsor: Thomas J. Pujol, FACSM) 


PurPOsE: This study assessed the effects of two different types of clothing on core 

temperature (Tc), skin temperature (Ts), and the microenvironments (ME) of collegeaged 

males during a simulated football game within hot environments. 

METhOds: Trained college-aged males (n = 10) participated in a series of 5-second 

ergometer sprints in a climate-controlled chamber (35°C, 55%RH). The sprint protocol 

was based on the average number and length of plays within NCCA Division I 

football games. Subjects performed two separate trials, each consisting of 85 minutes, 

separated by a 48-hour washout period. During trials, either cotton or channeled fabric 

clothing (CFC) was donned under protective football gear. Tc, Ts, and ME temperature 

and humidity was monitored throughout trials. 

rEsuLTs: Paired samples t-test revealed significant differences (p



CFC was 2.6±0.8 and 2.2±1.1 respectively (p=0.04). ME chest temperature changes 

for cotton and CFC were 3.7±1.05 and 3.0±0.91, respectively (p


when compared to the smaller (1A-2A) schools. 

CONCLusIONs: These results suggest the larger schools (3A-4A) have greater 

access to an increased level of Sports Medicine coverage and as such appear to have 

an increased level of care for their high school student-athletes. Based on these results, 

there is a clear trend towards the smaller schools being at a disadvantage when it come 

is having an acceptable standard of “Sports Medicine coverage” at their schools. 

1501 Board #93 May 30, 2:00 PM - 3:30 PM 

assessing the Impact of youth Climate differences in Elite 

Major League Baseball Pitchers 

Gregory Paul Kolovich, Lorena Floccari, Mark Schickedantz, 

David C. Flanigan, Grant L. Jones, Michael Griesser. Wexner 

Medical Center at The Ohio State University, Columbus, OH. 


PurPOsE: Recent studies demonstrate the detrimental effects on the glenohumeral 

joint by repetitive throwing at an early age in organized youth baseball. Pitchers born 

in warmer climates are more likely to throw year round, as opposed to pitchers born 

in colder climates, where young pitchers are likely to take a break from throwing 

during the winter. The purpose of this study was to investigate whether youth climate 

differences affect longevity of elite MLB pitchers. 

METhOds: Data were collected from all 710 Major League Baseball (MLB) pitchers 

who compiled a minimum of 1500 career innings. Forty pitchers were excluded from 

the study as they were currently active on a MLB roster in 2011 bringing the total to 

670 MLB pitchers. Six outcome variables were investigated: career innings, career 

wins, career losses, career complete games, career games started, and career years 

pitched. 

rEsuLTs: We found that MLB pitchers born in regions with colder average 

temperatures (Canada, Europe, Midwest US, and Northeast US) compiled an average 

of 187 more career innings (2497 v. 2310 p < 0.0049), had 13 more career wins (153 

v. 140 p < 0.005), and had 49 more career complete games (153 v 104 p < 0.000) than 

pitchers born in regions with warmer average temperatures (Southeast US, Southwest 

US, West US, Latin America, and Asia). 

CONCLusIONs: MLB pitchers born in regions with colder average temperatures 

are more likely to break from throwing during the winter season. These colder weather 

youth pitchers compiled greater career innings, career wins and career complete games 

suggesting that pitching year round at an early age may be detrimental to the longevity 

of Major League pitchers. These findings support the need for continued pitch count 

regulation in youth baseball as well suggest a need for monitored rest from throwing 

during the offseason. 

1502 Board #94 May 30, 2:00 PM - 3:30 PM 

Preparticipation Physical Evaluation Forms and 

Implementation Policies differ across united states high 

school athletic associations 

Mary C. Chabolla, Amanda M. Caswell, Jatin P. Ambegaonkar, 

Nelson Cortes, Shane V. Caswell. George Mason University, 

Manassas, VA. 


The American Academy of Pediatrics’ (AAP) Preparticipation Physical Evaluation 4 th 

edition (PPE) monograph contains guidelines for screening and determining eligibility 

for United States (US) high school athletes. However, evidence of how PPEs are being 

implemented and AAP whether guidelines are being followed is lacking. 

PurPOsE: To investigate current PPE policies and practices in US high school 

athletic associations (HSAA). 

METhOds: We accessed publicly available PPE forms, policies, and procedures 

documents from all 50 states’ and the District of Columbia’s HSAA. We analyzed 

the content of PPE documents from each state using an electronic coding form 

for: A) policy existence, B) update frequency and C) format of PPE and examined 

requirements of the frequency of administration, and D) providers approved to perform 

PPEs. The PPE content was analyzed to determine whether a heart health history 

(HHR) component was included. Analyses were calculated for all PPE content items. 

rEsuLTs: Forty-nine states (96%) require that PPEs be completed for HS sport 

participation eligibility, while in 2 states (4%) it is recommended. Seventeen (33%) states 

either recommended (13.7%) or required (19.6%) use of the AAP 4th edition PPE form. 

Fifteen (30%) states revised PPE forms in 2012, while 5 (



CONCLusION: A positive significant correlation between the Single hop and Triple 

hop tests suggests that assessment of patients’ physical function by either test might 

provide relatively comparable data. There was also a significant correlation between 

knee passive laxity (anterior tibial translation) measured by application of 150N 

force and maximal manual force using an arthrometer, suggesting that these measures 

can be used interchangeably. Questionnaire results were not correlated with any of 

the objective measures. Further investigation on a larger population is underway. 

Investigation of correlations between the results of functional tests and KT arthrometer 

measurements may help inform clinical decision-making. 

1505 Board #97 May 30, 2:00 PM - 3:30 PM 

Quadriceps strength, Not activation, Improves in the 

unexercised Limb Following a single-Legged Eccentric 

Exercise Program 

Lindsey Lepley, Riann Palmieri-Smith. University of Michigan, 

Ann Arbor, MI. 


Following injury, eccentric exercise of the injured limb is often contraindicated. Crosseducation 

training, whereby the uninvolved limb is exercised, is an alternative that may 

improve quadriceps strength and activation in the unexercised limb. Understanding 

the benefits of eccentric cross-education training can help determine if this exercise 

regimen can be used in individuals post-injury. 

PurPOsE: Determine if eccentric exercise is capable of producing quadriceps 

strength and activation gains in the unexercised limbs of healthy participants. 

METhOds: Eccentric exercise group (EX; 4f/5m; age 23.3±2.4 yrs; height 1.7±0.1 

m; mass 70.6±14.3 kg) and control group (CNTRL; 6f/3m; age 22.6±3.6 yrs; height 

1.7±0.1 m; mass 66.7±10.1 kg) had quadriceps strength and activation measures 

collected at pre-, mid- and post-intervention time points. EX participants exercised 

their dominant limb with an isokinetic dynamometer in eccentric mode at 60°/sec, 

three times per week for eight weeks. Quadriceps strength was quantified at 30 and 

60°/sec in concentric and eccentric modes. Quadriceps activation was assessed using 

the burst superimposition technique and quantified via the central activation ratio. 2x3 

Repeated Measures ANOVA was used to detect the effects of group and testing session 

on quadriceps strength and activation. Where appropriate, post hoc Bonferroni multiple 

comparison procedures were used. 

rEsuLTs: Greater eccentric quadriceps strength was found in the unexercised limbs 

of EX participants between the pre-to-mid and pre-to-post intervention time points 

(30°/sec (Nm/kg): Pre=2.2±0.2, Mid=3.4±0.4, Post=3.5±0.4, Pre-to-Mid P=0.05, 

Pre-to-Post P=0.02; 60°/sec: Pre=2.1±0.2, Post=3.9±0.5, P=0.02). No differences 

were noted between the mid-to-post time point (30°/sec P=0.06; 60°/sec P=0.18) 

or in concentric strength (P>0.05). No gains in quadriceps activation were detected 

(P=0.06). CNTRL participants strength did not change (P>0.05). 

CONCLusION: Exercising with eccentric contractions resulted in mode specific 

gains in quadriceps strength in the unexercised limbs of healthy participants at four 

weeks. No gains in quadriceps muscle activation were detected. Rehabilitation 

programs can utilize this type of eccentric exercise to safely improve quadriceps 

strength in the injured knee. 

1506 Board #98 May 30, 2:00 PM - 3:30 PM 

Platelet rich Plasma: Improvement in Pain by anatomical 

site and Number of Injections 

Bronson Elizabeth Delasobera1 , Neal Shelley1 , Scott Robinson2 , 

Garry Ho, FACSM3 , Thomas Howard, FACSM3 . 1Georgetown University, Washington, DC. 2United States Army, Lacey, WA. 

3Virginia Commonwealth University, Fairfax, VA. 


INTrOduCTION: Platelet rich plasma (PRP) treatment has been used for years in 

the sports medicine community, but there are very few studies evaluating its efficacy. 

We measured pain scores following PRP injections in a variety of anatomic sites, 

receiving either single or multiple injections. Our null hypotheses were that, among 

patients treated with PRP: 1) there are no significant differences in mean pain by 

anatomic region and 2) there is no significant difference in mean pain scores between 

patients receiving either single or multiple injections. 

METhOds: Study type: a retrospective, survey-based, cohort study. Setting: an 

academic sports medicine clinic where PRP injections are frequently performed. 

Subjects who received PRP injections completed surveys to quantify their pain and 

percent improvement. Each subject filled out the survey approximately one month 

post-injection and reported three pain scores: within 72 hours post-injection (PS1), 

one week following injection (PS2), and approximately one month following injection 

(PS3). Descriptive statistics and hypothesis testing (using a one way analysis of 

variance or Student’s t test where appropriate) were performed. Alpha was set at 0.05 

for all comparisons. 

rEsuLTs: One hundred thirty five patients, who received two hundred PRP 

injections, were included for study. Overall, patients reported a 49.2% (95% CI: 45.2- 

54%) mean improvement in pain scores (for combined single and multiple injection 

subjects). The mean percent improvements in pain scores by anatomic sites were 

not significantly different (p=0.58; see Table and Figure below). The mean percent 


improvement (regardless of anatomical site) for patients who received multiple 

injections (mean 58.9%; 95% CI: 50.9-66.9%), compared to those who received a 

single injection (mean 54.3% (95% CI: 47.8-60.8%) was not significantly different 

(p=0.4). 

CONCLusIONs: PRP injections (combined single and multiple) are associated with 

a significant improvement in reported pain one-month post injection. PRP injections 

are most effective for thigh injuries, and least effective for hip injuries. We identified 

no significant difference in pain scores for patients receiving single vs. multiple 

injections. 

1507 Board #99 May 30, 2:00 PM - 3:30 PM 

Gold Medal sports Medicine: Integrative Model of Medical 

Care during International Competition 

John P. Vardiman1 , Jake Siedlik1 , Michael Cooper1 , Russell 

Emmons1 , William Moreau2 , Dustin Nabhan3 , Jenna Street3 , 

Philip M. Gallagher1 . 1University of Kansas, Lawrence, KS. 

2United States Olympic Committee, Colorado Spring, CO. 

3United States Olympic Committee, Colorado Springs, CO. 

(Sponsor: Joseph Weir, FACSM) 


Many manual therapy techniques and therapeutic modalities are utilized to return 

patients to functional activities or activities of daily living. Assessing the change in a 

patients perception of their functional ability after receiving Instrument Assisted Soft 

Tissue Mobilization (IASTM) treatment has yet to be determined. 

PurPOsE: The purpose of this project was to assess the efficacy of the Instrument 

Assisted Soft Tissue Mobilization (IASTM) technique at changing a patient’s 

functional ability as well as their perception of functional ability of the functional squat 

test. 

METhOds: Twenty-four college-aged students (20.96±1.27 years, 62.11±13.11 kg, 

168.52±9.08cm) participated in this study. Eleven subjects (8 female, 2 male) were 

randomly selected to receive the IASTM treatment (TG) and 13 subjects (11 female, 3 

male) were randomly selected for the control group (CG). All subjects completed the 

Perception of Functional Ability Questionnaire (PFAQ) and then performed a baseline 

functional squat test using a 3-D Marker-less Motion Capture System (Dynamic 

Athletics, Overland Park, KS). The TG received a bilateral IASTM treatment to the 

posterior lower leg and the CG rested in a prone position for 10 minutes and did not 

receive the treatment. After the IASTM or 10 minute rest period all subjects performed 

a follow-up functional squat test in the motion capture system and completed a followup 

PFAQ. All pre-test post-test data was analyzed using a 2x2 repeated measures 

ANOVA (p


CONCLusIONs: Diagnosis of Achilles tendinopathy in adolescent athletes is 

rare and less frequent than in adult athletes. Clinical findings were observed more 

frequent in males than in females, which is comparable to data in older athletes. 

Neovascularizations are present in both painful and asymptomatic tendons. 

Nevertheless, in spite of a low prevalence of 2.3% Achilles tendinopathy has to be 

considered in differential diagnosis of heel pain. 

1509 Board #101 May 30, 2:00 PM - 3:30 PM 

The Iontophoresis delivery of dexamethasone Measured via 

Microdialysis 

Justin H. Rigby, Chase D. Frampton, David O. Draper, Gary W. 

Mack, FACSM. Brigham Young University, Provo, UT. 


Dexamethasone sodium phosphate (DEX-P), the prodrug of the biologically active 

dexamethasone (DEX), is a corticosteroid used during transdermal drug delivery via 

iontophoresis. The ability of iontophoresis to increase tissue DEX concentrations has 

been difficult to assess in vivo in human subjects. 

PurPOsE: To determine the subcutaneous tissue concentration of DEX during 

iontophoretic delivery of DEX-P. 

METhOds: Hollow fiber (18 KD MWCO) microdialysis probes perfused at 1 µl/min 

with saline were used to assess [DEX] in dialysate from probes placed at 1.5±0.3 and 

4.0±0.5 mm below the calf skin surface during iontophoresis (4 mA x 10 min) of 4 mg/ 

ml DEX-P in 10 healthy subjects. Following a 60 min recovery period following probe 

insertion, DEX-P was delivered to the treatment area via a 12.6 cm2 delivery pad. Three 

dialysates were collected per probe at 50 minute intervals starting at the initiation of the 

iontophoresis treatment. [DEX] in dialysates was analyzed by RP-HPLC. 

rEsuLTs: Microdialysis probe integrity was evaluated by two bench-top trials. First, 

retrograde dialysis in air showed a 104 ± 16% recovery of DEX. Second, recovery 

of DEX from a well-mixed bath containing 2 µg/ml DEX in a 2% BSA solution was 

determined to be 63 ± 6%. During iontophoresis of DEX-P on human skin, only three 

out of 10 subjects showed any measurable levels of DEX in probes placed 1 mm 

below the skin surface. The average concentration of DEX in these three subjects was 

54.04±17.62 ng/mL. None of the dialysate samples from probes at 4 mm depth showed 

any sign of DEX. 

CONCLusION: The microdialysis probes used in this study did not retain any DEX 

on its components based upon the 104% recovery of DEX during retrograde dialysate. 

In addition, an in vitro experiment demonstrated significant DEX recovery (63%) 

from a bath containing DEX in an artificial skin interstitial fluid solution. Finally, 

transdermal delivery of 4 µg/ml DEX-P using a 40mA*min iontophoretic dose was 

only able to deliver DEX 1 mm deep into the skin and this was only 30% effective. 

The concentration of DEX detected in the three samples was high enough to produce 

biological effects, however, the 40mA*min iontophoretic dose is ineffective in 

delivering DEX to deeper subcutaneous tissues. 

1510 Board #102 May 30, 2:00 PM - 3:30 PM 

Injury Incidence and Injury Patterns in high school 

Volleyball student-athletes - a retrospective study 

Lobo H. Louie. Hong Kong Baptist University, Hong Kong, 

Hong Kong. (Sponsor: Stephen Wong, FACSM) 


Volleyball was originated in the United States in 1895 as a blend of basketball, 

baseball, tennis, and handball. Today, volleyball has spread to more than 200 countries 

around the world, and is recognized as an international, widely played, popular sport 

in schools. Previous studies indicated that ankle sprains are the most common injuries 

in volleyball, accounting for about half of all injuries and with an incidence of about 

one per 1000 player hours. Apart from the ankle, knee, shoulder, fingers and the back 

are the common injury sites. However, most injuries were classified as being of minor 

severity and about half of the injuries occurred during spiking and blocking. 

PurPOsE: To describe the incidence and patterns of volleyball injuries among the 

high school student-athletes in Hong Kong. 

METhOds: Questionnaires were administered to 206 high school volleyball 

student-athletes who participated in the inter-school volleyball competitions during 

the academic season of 2011 to 2012 in Hong Kong. Data recorded including the 

anatomical site, nature, cause, severity of injury, playing time, level, and treatment. 

rEsuLTs: A total of 148 injury cases were reported during 37,770 hours of exposure, 

giving an injury incidence of 3.9 injuries/1000 player-hours. 64.1% of the respondents 

have suffered from at least one injury during the past season. The most frequently 

injured sites were ankle (35.2%), fingers (24.3%), knee (16.2%), and shoulder 

(10.8%). Regarding the playing positions, ace spikers had the highest injury rate (4.8 

injuries/1000h), followed by quick spikers (3.9 injuries/1000h), and assistant setters 

(3.7 injuries/1000h). No significant (p>0.05) differences in the injury rates between 

male and female players as well as various age groups were found. 65.1% of the 

injured athletes reported to have recurrent injury and only 4.5% of all injuries required 

hospitalization. 

CONCLusIONs: The injury incidence rate of high school volleyball student-athletes 

in Hong Kong was found to be 3.9 injuries/1000 player-hours. The majority of the 

injuries occurred in the ankle, fingers, knee and shoulder. 


1511 Board #103 May 30, 2:00 PM - 3:30 PM 

arthroscopic double Bundle anterior Cruciate Ligament 

reconstruction : Prospective Clinical and MrI Evaluation 

study in athletes 

Ashish Devgan. Pt BD Sharma Post Graduate Institute of 

Medical Sciences, Rohtak, Haryana, India. 


PurPOsE: Single-bundle (SB) anterior cruciate ligament (ACL) reconstruction has 

been the current standard for treating of ACL deficiency. However, a significant subset 

of patients continues to report residual symptoms of instability with a poor pivot 

control especially during sports, after such reconstructions. Cadaveric biomechanical 

studies have shown that double-bundle (DB) ACL reconstructions better restore knee 

kinematics but clinical trials are few and in between. 

METhOds: We report current clinical outcomes of 30 consecutive patients who 

underwent anatomic DB ACL reconstruction with an average follow-up of 12-24 

months. All patients were prospectively evaluated by arthrometer, functional knee 

scores (IKDC & Lysholm) and post operative MRI imaging of both knees for 

comparing the orientation and size of graft with that of normal ACL in contraleteral 

knee. 

rEsuLTs: Mean postoperative Lysholm score was 93.13 ± 3.31(p < 0.0001). 

22 (73.3%) had excellent results, 8 (26.6%) cases had good result. Post operative 

objective IKDC score showed 26 patients (86.6%) in group A while four (13.3%) in 

group B with none in group C or D. The mean differential anterior tibial translation 

by GNRB arthrometer was 1.07 ± 0.8 mm (range 0.1 - 2.3mm). At one year follow 

up, all showed a negative pivot shift test. None reported instability during activities 

of daily living or during sports. MRI of operated and contralateral knee showed mean 

sagital ACL-tibial angle of 56.1 + 5.06 in operated knee, which was comparable to 

the values of ACL in the contralateral normal knee - 58.8 + 4.9 (p >0.05). The mean 

coronal ACL-tibial angle of 74.86 + 5.69 too was comparable to the values of ACL in 

contralateral normal knee - 69.6+5.6 (p value >0.05). The size of the tibial footprint 

of the graft in sagital section was 12.65 + 1.93 mm which was in accordance with the 

values of contralateral normal knee - 12.38+0.64. (p >0.05) 

CONCLusIONs: The study objectively demonstrates that DB ACL reconstruction 

truly restores ACL anatomically in terms of footprint size and angle of orientation of 

graft; as well as excellent restoration of antero-posterior & rotatory stability. Subjective 

scores too depict excellent patient-reported outcomes when evaluated two years after 

surgery. 

1512 Board #104 May 30, 2:00 PM - 3:30 PM 

diclofenac sodium Topical Gel (dsG) 1% For acute soft 

Tissue Injuries/contusions Of The Limbs 

Helmut Pabst 1 , Bruno Giannetti 2 , Ian Burnett 3 , Joelle Monnet 3 . 

1 Independent Physician, Gilching, Germany. 2 CRM Clinical 

Trials GmbH, Rheinbach, Germany. 3 Novartis Consumer Health, 

Nyon, Switzerland. 

Supported by h. Pabst: Contracted Research - Including Principle 

Investigator; Novartis Consumer Health. 

Contusions are among the most common sports-related injuries and are often are 

self-treated. Many over-the-counter oral medications, known to reduce pain and 

inflammation, may be associated with an increased risk for gastrointestinal adverse 

events, while topically applied rubefacients, while popular, are seldom effective. DSG 

1% is clinically proven to effectively relieve pain due to osteoarthritis, and it could 

represent a new option for the treatment of acute blunt trauma. 

PurPOsE: This study evaluated the efficacy and safety of DSG 1% in subjects with 

acute blunt, soft tissue injuries/contusions of the limbs compared with placebo. 

METhOds: In this double-blind, multicenter study, 204 patients with acute blunt, 

soft tissue injuries/contusions of the limbs were randomized in a 1:1 ratio to DSG 1% 

(n=104) or placebo (n=100) applied q.i.d. for ≥48 hours and up to 7 days. Follow-up 

visits were made at 4, 12, 24, 36, and 48 hours, and 7 days after treatment initiation. 

The primary efficacy outcome was pain-on-movement (POM) at 24 hours. Secondary 

outcomes included POM at all other time points, spontaneous pain intensity (SPI) 

and spontaneous pain relief (SPR), assessed at regular intervals on Day 1 and over 

the 7 day treatment period. All adverse events were recorded and blood samples were 

collected for laboratory safety analysis. 

rEsuLTs: Patients treated with DSG 1% experienced significantly greater reduction 

in POM at 24 hours with a mean decrease in VAS score of 47 mm compared with 

13 mm in the placebo group (p



treatment for the symptoms of blunt soft tissue injuries/contusions of the limbs, with a 

perceptible onset of effect after the first application. 

1513 Board #105 May 30, 2:00 PM - 3:30 PM 

Perception of Cold Intensity of Topical Vapocoolant sprays 

in human subjects 

Kimberly M. Martin, Mark A. Merrick. The Ohio State 

University, Columbus, OH. 


Ethyl chloride (EC) is a topical vapocoolant whose flammability limits potential 

clinical usage. Another topical vapocoolant (AV) spray has been offered as an 

alternative with similar cooling properties. 

PurPOsE: The purpose of this study was to compare subjects’ ratings of the cold 

intensities they experience of the forearm during a typical application of vapocoolant. 

METhOds: A 2x2x2 factorial design produced eight testing conditions for each 

vapocoolant product from three independent variables; nozzle (mist & stream), 

distance (near & far), and duration (short & long). Treatment order was determined 

using a balanced Latin square. 20 healthy college-age subjects without a history of 

cold sensitivity, prior forearm injury or any other exclusionary criteria consented to 

participate in this study. In the first arm of the study AV was applied to the forearm 

of each subject according to the parameters of each of the eight testing conditions. In 

the second arm of the study, EC was applied in the same manner. Subjects rated their 

perception of the cold sensation using a 100mm VAS labeled “Not Cold” on one end to 

“Coldest Thing Ever” on the other. Dependent measure was cold perception score out 

of ten. Data were analyzed using a repeated measures MANOVA with α=0.05. 

rEsuLTs: Subjects did not perceive a difference between the two products across 

conditions (p=0.214). Subjects perceived the mist nozzle (5.067±0.31) to feel colder 

than the stream nozzle (4.120±0.36; p=0.015), close distance spray (4.961±0.30) to 

feel colder than far distance spray (4.226±0.35; p=0.036) and longer duration spray 

(5.603±0.31) to feel colder than shorter duration (3.584±0.30; p


1517 Board #109 May 30, 2:00 PM - 3:30 PM 

a Phase 3 study of diclofenac sodium Topical Gel (dsG) 1% 

for acute ankle sprains 

Hans-Georg Predel 1 , Bruno Giannetti 2 , Ian Burnett 3 , Morris 

Gold 4 . 1 German Sports University, Cologne, Germany. 2 CRM 

Clinical Trials GmbH, Rheinbach, Germany. 3 Novartis 

Consumer Health, Nyon, Switzerland. 4 Novartis Consumer 

Health, Parsippany, NJ. 

Supported by h. Predel: Contracted Research - Including Principle 

Investigator; Novartis Consumer Health. 

Ankle sprains are one of the most common sports injuries and are frequently selftreated. 

Over-the-counter treatment options mainly include oral non-steroidal antiinflammatory 

drugs (NSAIDs), which, however, may cause an increased rate of 

systemic side effects (e.g. gastrointestinal), and topical rubefacients, which, while 

popular, are frequently ineffective. DSG 1%, which has been proven to be effective 

and well tolerated for the treatment of osteoarthritis, could be a good alternative for the 

treatment of acute conditions such as ankle sprains. 

PurPOsE: This study evaluated the efficacy and safety of DSG 1% in subjects with 

acute ankle sprain. 

METhOds: In a double-blind, multicenter study, 205 patients with acute sprain of 

the lateral ankle (Grade l-ll) were randomized in a 1:1 ratio to DSG 1% (n=102) or 

placebo (n=103) applied q.i.d for 7 days. Follow-up visits were made at 12, 24, and 72 

hours and 7 days after treatment initiation. The primary efficacy outcome was pain-onmovement 

(POM) at 72 hours. Secondary outcomes included POM at all other time 

points, spontaneous pain intensity (SPI) and spontaneous pain relief (SPR), assessed at 

regular intervals on Day 1 and over the 7 day treatment period. All adverse events were 

recorded and blood samples were collected for laboratory safety analysis. 

rEsuLTs: DSG 1% treatment resulted in significantly greater reduction of POM at 

72 hours with a mean decrease in VAS score of 57 mm compared with 21 mm in the 

placebo group (p



CONCLusION: Four hours of accumulated acupuncture treatment significantly 

improved limb flexibility, which may, in part, be attributed to change in tension within 

the muscle, allowing for relaxation and elongation. 

1521 Board #113 May 30, 2:00 PM - 3:30 PM 

Influence of Time since aCL Injury and rehabilitation 

Frequency on Patient-Based Outcome Measures 

Jessica C. Martinez, Thomas Trojian, Michael Joseph, Timothy 

Rubino, Max Soontararak, Lindsay J. DiStefano. University of 

Connecticut, Storrs, CT. (Sponsor: Dr. Douglas Casa, FACSM) 


Previous research has shown that patients who have sustained an ACL injury are at an 

increased risk for early onset of osteoarthritis and knee re-injury, which can result in 

increased pain, decreased function and decreased quality of life. 

PurPOsE: To determine if time since sustaining an ACL injury or the number of 

rehabilitation visits have an effect on function and willingness to be active in daily 

living as measured by the International Knee Documentation Committee (IKDC) 

Subjective Knee Form and the Lysholm Knee Score. 

METhOds: 20 healthy, active subjects (10 males, 10 females, Age=22+4 yrs, 

Height=173.0+7.3 cm, Mass=75.6+9.9 kg) with a history of an ACL reconstruction 

(57.0 +39.9 months since surgery) completed a questionnaire about their rehabilitation, 

a Lysholm Knee Score, and an IKDC questionnaire. Both scales have been found to be 

valid and reliable in measuring health-related quality of life and function. A high score 

on both scales indicates high levels of function and activity. A linear regression model 

was used to examine the relationship between each outcome scale and time since ACL 

injury, as well as the number of rehabilitation visits (α≤.05). A correlation was utilized 

to determine the relationship between Lysholm score and IKDC score. 

rEsuLTs: There were no significant relationships between time since ACL injury 

(R2=0.001, P=0.90) or number of rehabilitation visits (R2=0.02, P=0.59) and the 

Lysholm Knee Score. Similarly, time since ACL injury (R2=0.007, P=0.72) and the 

number of rehabilitation visits (R2=0.03, P=0.54) were not significantly related to the 

IKDC score. A high score on the Lysholm Knee Score was significantly correlated with 

a high IKDC score (r=0.68, p=0.001). 

CONCLusION: Clinicians should not use number of rehabilitation visits or time 

since injury as the principle methods to predict positive outcomes in a patient with an 

ACL reconstruction. Other factors such as injury history or concomitant injury may be 

more predictive when determining a patients’ level of function. 

1522 Board #114 May 30, 2:00 PM - 3:30 PM 

rehabilitation attendance Following Knee surgery is not 

Influenced by driving distance 

Jenny L. Toonstra, Carl G. Mattacola, Christian Lattermann, 

Jennifer S. Howard. University of Kentucky, Lexington, KY. 


Travel distances beyond 10 miles have been shown to adversely affect the utilization 

of health care services. To achieve optimum outcome following knee surgery, frequent 

access to rehabilitation services is required. Therefore, limited access to rehabilitation 

services in close proximity to one’s home may ultimately influence post-operative 

rehabilitation participation. 

PurPOsE: To examine rehabilitation attendance in postoperative patients to 

determine if travel distance influences the frequency of rehabilitation visits. We 

hypothesized that patients traveling greater than 10 miles for rehabilitation would 

average fewer visits/week than patients traveling less than 10 miles. 

METhOds: Data on patients undergoing autologous chondrocyte implantation 

(ACI) for articular cartilage defects of the knee were collected retrospectively. Home 

addresses of patients and locations of their respective rehabilitation centers were 

entered into MapQuest to estimate driving distance. The total number of rehabilitation 

sessions and duration of therapy were assessed from rehabilitation records. The 

number of attended rehabilitation sessions/week was compared between patients living 

less than or greater than 10 miles from their rehabilitation. An independent t-test was 

used to compare number of visits/week between groups. 

rEsuLTs: Seven patients (4 male, 3 female, age 33.9±7.6) traveled > 10 miles for 

rehabilitation (mean=27.3 miles) while nine patients (3 male, 6 female, age 36.3±7.6) 

traveled 10 miles 

for rehabilitation attended a significantly greater number of rehabilitation sessions/ 

week than patients traveling


both motor and non-motor symptoms of PD was detected: UPDRS-III 21.1 ± 3.5 vs. 

14.1 ± 3.5, p



1529 Board #121 May 30, 2:00 PM - 3:30 PM 

Examination of sustained Gait speed in Individuals with 

Chronic stroke 

Tracy A. Dierks1 , Peter A. Altenburger1 , Kristine K. Miller2 , 

Rebecca L. Phipps3 , Arlene A. Schmid2 . 1Indiana University, 

Indianapolis, IN. 2Roudebush VA Medical Center, Indianapolis, 

IN. 3Indiana University Health, Indianapolis, IN. (Sponsor: 

Stuart J. Warden, FACSM) 


While improvements in gait speed are commonly achieved following therapy for 

individuals with stroke, many in the chronic stages still experience gait deficits, 

causing declines in community ambulation. This may be associated with an inability to 

sustain gait speed for an extended period of walking, yet little is known regarding gait 

speed sustainability. 

PurPOsE: To determine if individuals with chronic stroke have the ability to sustain 

gait speed for 6 minutes of walking. 

METhOds: Forty-five individuals with chronic stroke completed a 10 meter walk 

test (10MWT) and 6 minute walk test (6MWT) over a gait mat. For the 10MWT, 

subjects walked at the fastest pace possible that felt safe. For the 6MWT, subjects 

walked at a comfortable pace for 6 minutes while traversing a 30-meter walkway, 

allowing for multiple passes over the gait mat. Gait speed sustainability was measured 

as the difference between the peak speed during the 6MWT and the speed at the end. 

rEsuLTs: The 6MWT peak speed (0.89 m/s ±0.38) was significantly slower than the 

10MWT speed (1.06 m/s ±0.51), suggesting subjects were capable of selecting a fast 

pace versus one for extended walking. Yet, there was a significant gait speed reduction 

of 0.07 m/s (±0.09) from peak to end (0.82 m/s ±0.36) during the 6MWT, indicating an 

inability to sustain speed. These findings were most evident in Unlimited Community 

Ambulators (CA) (10MWT 1.38 m/s; 6MWT peak 1.15, end 1.07), followed by 

Limited CA (10MWT 0.71 m/s; 6MWT peak 0.61, end 0.55), while Household 

Ambulators showed no differences (10MWT 0.34 m/s; 6MWT peak 0.30, end 0.28). 

The total distance walked during the 6MWT (277.7 m ±135.5) was significantly less 

than the estimated distance (320.9 m ±138.2) based on peak speed. Subjects also 

displayed a significant increase in Rating of Perceived Exertion at the end (8 ±3 to 12 

±4) of the 6MWT. These indicate that the declining gait speed occurred with increased 

exertion and a reduction in total distance walked. 

CONCLusION: Individuals with chronic stroke could not sustain their gait speed 

for extended walking, which was associated with increased exertion and a reduction 

in estimated total distance walked. As these differences were primarily observed in 

Unlimited and Limited CA subgroups, community ambulation potential might be 

incomplete without assessing gait speed sustainability. 

1530 Board #122 May 30, 2:00 PM - 3:30 PM 

Investigating The Walking ability Of Patients With 

Parkinson’s disease Via Non-motorized Treadmills 

Han-Wen Chang1 , Wen-Hsu Sung1 , Tien-Yow Chuang2 . 

1 2 National Yang-Ming University, Taipei, Taiwan. Taipei Veterans 

General Hospital, Taipei, Taiwan. 


Decreased walking ability of patients with Parkinson’s disease (PD) may result in the 

limitations of activity of daily living. Non-motorized treadmills (NMTs) can provide 

active walking training. Subjects need to exert force from lower limbs to drive the belt 

forward to walk on it. Currently there are still few studies on the application of NMTs, 

especially on patients with PD. 

PurPOsE: The purpose of this study is to investigate the walking ability of patients 

with PD and to compare the walking ability between healthy adults and the patients 

with PD via NMTs. 

METhOd: Six healthy adults (group A) and six patients with PD (group B) were 

recruited. Group B was assessed during on-period (in 2 hours after taking medicine). 

Subjects were asked to walk on the NMT at self-paced speed and at as fast as possible 

speed for 1 minute respectively. We acquired the data of walking velocity, cadence, 

step length, and ground reaction force (GRF, which was normalized to body weight 

and conveyed to %BW). Independent sample t-test was used to analyze the data. 

Statistical significance was set at level of 0.05. 

rEsuLT: The mean age (y/o) (70.83±3.60 vs. 72.08±5.55; p=.654), height (cm) 

(161.33±11.27 vs. 161.83±8.86; p=.934), and weight (kgw) (61.67 ±11.48 vs. 

68.67±11.22; p=.311) between two groups were shown no significant difference. 

At self-paced speed, parameters of group A & group B: walking velocity (m/sec) is 

0.58±0.13 vs. 0.47±0.25 (p=.395); cadence (step/min) is 98.00±18.85 vs.100.50±18.76 

(p=.823); step length (m) is 0.36±0.10 vs. 0.28±0.10 (p=.185); GRF (%BW) is 

1.16±0.36 vs. 1.02±0.03 (p=.381). At fast speed, parameters of the two groups: 

walking velocity (m/sec) is 0.86±0.12 vs. 0.60±0.31 (p=.101); cadence (step/min) is 

122.00±17.66 vs. 124.50±20.50 (p=.826); step length (m) is 0.43±0.11 vs. 0.29±0.12 

(p=.054); GRF (%BW) is 1.16±0.34 vs. 1.03±0.02 (p=.401). There was no significant 

difference in these parameters between two groups. 

CONCLusION: The parameters revealed no significant difference between groups. 

However, the walking velocity of group B was slower than group A (self-paced 


speed & as fast as possible speed: 82.32% & 69.50% respectively); step length was 

decreased (76.85% & 65.77% resp.); GRF is decreased (87.94% & 88.91% resp.). 

Our preliminary results may be a reference for the further NMT training on patients 

with PD. 

1531 Board #123 May 30, 2:00 PM - 3:30 PM 

Validity of handgrip Exercise to study Vascular Function in 

Parkinson’s disease 

Kylene Peroutky, Brandon Pollock, Keith Burns, John 

McDaniel, Angela Ridgel. Kent State University, Kent, OH. 

(Sponsor: Ellen L Glickman, FACSM) 


BaCKGrOuNd: Parkinson’s disease (PD) is a degenerative disorder of the central 

nervous system characterized by symptoms of motor dysfunction including tremors, 

impaired gait, and rigidity. Although autonomic dysfunction impairs the regulation 

of the cardiovascular system and oxidative stress may be associated with peripheral 

vascular dysfunction in this population, blood flow limitations during exercise and the 

extent of vascular dysfunction has yet to be established. Although handgrip exercise is 

a common modality used to evaluate blood flow and vascular function during exercise, 

the impaired motor control of this population may prevent from being a valid testing 

modality. PUPROSE: This study was used to validate whether the PD group was 

capable of performing consistent handgrip contractions over a prolonged duration and 

across various intensities. 

METhOds: Ten volunteers, 5 with PD and 5 controls matched for age performed a 

four stage handgrip protocol. Each participant was instructed to squeeze a handgrip 

dynamometer once per second for 3 minutes at 4 different intensities (30, 60, 90, and 

120 N). The subjects had real-time visual feedback of the force tracings during the 

entire protocol as well as a horizontal guideline which represented the target force. 

rEsuLTs: Statistical analysis indicated that across the entire protocol there was 

no difference in the percentage of contractions between the control (63.3±7.8%) and 

PD (69.7±9.9%) groups that were within 10% of the target force. There was also no 

statistical significance in the absolute error between the control (3.6±1.4 N, 5.6±0.84 

N, 7.7±0.90 N, 10.8±3.4 N) and PD (2.9±0.79 N, 5.3±1.03 N, 7.2±1.5 N, 8.2±1.3 

N) groups for the 4 levels of increasing intensity, respectively. In addition, although 

the duration of the contraction increased from Stage 1 to Stage 4 for both groups 

(approximately 298 ms to 534 ms) there was no statistical difference between the 

healthy controls and PD. 

CONCLusION: The results of this study indicate that the PD patients are capable 

of performing the handgrip exercise to the same aptitude as the control group. This 

suggests that the handgrip protocol is a valid method that can be used to evaluate 

vascular health and blood flow in PD patients compared to controls. 

1532 Board #124 May 30, 2:00 PM - 3:30 PM 

Loading asymmetry during the sit to stand in People with 

Multiples sclerosis 

Bradley J. Bowser 1 , Cathleen N. Brown 2 , Lesley J. White, 

FACSM 2 , Simpson J. Simpson, FACSM 2 . 1 South Dakota State 

University, Brookings, SD. 2 University of Georgia, Athens, GA. 


Mediolateral (ML) postural instability for people with multiple sclerosis (MS) is 

largely influenced by interlimb loading asymmetries. During quiet standing, people 

with MS favor their stronger limb by shifting their center of pressure towards the 

stronger leg side and simultaneously increasing the vertical ground reaction forces 

(GRF) to that leg. While ML postural stability and loading asymmetries have been 

examined during quiet standing, no research has examined these two variables during a 

sit to stand (STS) movement. 

PurPOsE: To compare ML stability and loading asymmetry between MS and non- 

MS persons during a STS movement. 

METhOds: Participants were divided into three groups: an MS group with leg 

weakness, less than 1.4 BW on 1RM leg press (MS-LW; n = 10; 49 ± 10 yr), an MS 

group with comparable strength to controls, greater than 1.4 BW on 1RM leg press 

(MS-CS; n = 11; 40 ± 12 yr), and a non-MS control group (CON; n = 12; 43 ± 12 yr). 

GRFs were captured bilaterally during five STS trials. ANOVAs followed by post-hoc 

testing (α = 0.05) were used to determine group differences for the variables of interest 

displayed in Table 1. 

rEsuLTs: Significant group differences for 1RM leg press, RLA, and ML stability 

were revealed (Table 1). Post-hoc comparisons indicate lower 1RM leg press and 

increased ML instability for MS-LW compared to both CON and MS-CS (Table 1). 

RLA was also higher in MS-LW compared to CON (Table 1). 

CONCLusION: During the STS, persons with MS who have leg weakness display 

greater ML instability that is likely due to greater vertical loading occurring on the 

dominant/stronger limb. MS training protocols that emphasize both strength and 

symmetry training may be needed in order to improve ML stability during dynamic 

movements such as the STS. 



1533 Board #125 May 30, 2:00 PM - 3:30 PM 

Effectiveness of Cognitive Movement Training Machine for 

hemiplegic Patients 

Kimiyasu Hayakawa1 , Makoto Maruya1 , Takaaki Sekiya1 , 

Mayumi Takahashi1 , Kazuyuki Koike1 , Hisao Fujii1 , Minoru 

Hashimoto1 , Kando Kobayashi2 . 1Sendai University, Shibata, 

Miyagi, Japan. 2The University of Tokyo, Chiba, Japan. 


Functional recovery through rehabilitation is essential for patients with post-stroke 

hemiplegia. Various training methods based on approaches such as physical therapy 

and occupational therapy have been conducted for patients at medical and other 

facilities, and have been effective to some extent. 

PurPOsE: The objective of the present study was to elucidate the effectiveness of a 

“cognitive movement training machine” in hemiplegic patients. 

METhOds: Training using the cognitive movement training machine was conducted 

for Mr. A, a hemiplegic patient (age, 62 years; height, 172.0 cm; body weight, 70.2 kg; 

body fat percentage, 21.1%). The cognitive movement training machine is designed 

as a walking training device, and training using this device consists of both automatic 

(passive) exercise with electric control and active exercise involving conscious 

movement. The training aims to increase the stride during walking and to enable 

the legs to rotate more greatly and smoothly around the trunk. The present training 

machine was developed at the University of Tokyo (inventor: Kando Kobayashi). The 

subject engaged in training using this machine for approximately 45 min per week, 

and 50-m walking ability was measured for 1 year using a three-dimensional analysis 

device. 

rEsuLTs: Marked improvements were seen when compared to general medical 

findings. Specifically, the patient, who initially had difficulty maintaining balance 

while walking, even with the use of a walking stick, became able to walk without 

requiring a walking stick. The 50-m walking time improved from 85.6 s during the 

initial stages of training to 59.1 s (using a stick) after 5 months and 52.4 s after 10 

months, while stride increased from 41.5 cm during the initial stage of training to 64.4 

cm (using a stick) after 5 months and 58.5 cm after 10 months, indicating marked 

improvements in quality of motion (QOM). 

CONCLusION: The present training machine was developed with the objective 

of improving QOM in walking, an essential activity in daily life. Performance of 

the innovative balance exercise described above, which involves active and passive 

exercises, enhanced the effectiveness of rehabilitation for hemiplegic patients. 

D-30 Free Communication/Poster - Neuromuscular 

Mechanics 

May 30, 2013, 1:00 PM - 6:00 PM 

Room: Hall C 

1534 Board #126 May 30, 2:00 PM - 3:30 PM 

Length and activation dependent Variations In Muscle 

shear Wave speed 

Laura Chernak, Ryan DeWall, Ken Lee, Darryl Thelen. 

University of Wisconsin-Madison, Madison, WI. 


Muscle mechanical properties, such as stiffness, are closely linked with neuromuscular 

health. Current clinical methods for quantifying these properties, however, have 

significant limitations including cost. We were interested in evaluating the capability of 

a novel quantitative ultrasound technique to characterize muscle stiffness. 

PurPOsE: To investigate the capability of ultrasound shear wave elastography 

(SWE) to measure load-dependent changes in muscle shear wave speed during both 

active and passive loading. 

METhOds: Ten healthy young adults (25 5.5 yrs) were recruited, and shear 


wave speeds were evaluated by positioning an ultrasound transducer (Aixplorer 

Clinical Scanner, Supersonic Imagine, Aix-en-Provence, France) over the medial 

gastrocnemius. Data were collected from the relaxed muscle at ankle angles throughout 

the range of motion, and also during voluntary contractions of the plantarflexor 

muscles at a neutral ankle angle. 

rEsuLTs: Shear wave speed increased significantly with passive dorsiflexion from 

2.62 m/s to 5.61 m/s when the knee was in an extended position, with little effect on 

shear wave speed noted during dorsiflexion when the gastrocnemius was shortened in 

a flexed knee posture. Active contractions in the extended knee posture also caused 

an increase in shear wave speed to 8.28 m/s when maximally contracted. A linear 

correlation between shear wave speed and normalized load was noted for both the 

active and passive conditions, with a steeper slope of shear wave speed to normalized 

load for the data collected during the passive trials. 

CONCLusION: SWE shows promise as a method for quantitatively measuring in 

vivo muscle loading, however, our results suggest that loading conditions are relevant 

to consider when using SWE to characterize in vivo muscle mechanical properties. 

Supported by NIH AR056201. 

1535 Board #127 May 30, 2:00 PM - 3:30 PM 

Bilateral Tremor responses are Induced With Maximal 

Effort Contractions Of a single Limb 

Justin Kavanagh 1 , Andrew Cresswell 2 , Robert Stolz 1 , Surendran 

Sabapathy 1 , Timothy Carroll 2 . 1 Griffith University, Gold Coast, 

Australia. 2 University of Queensland, Brisbane, Australia. 

(Sponsor: A/Prof Belinda Beck, FACSM) 


Although within-limb physiological tremor has been extensively studied, betweenlimb 

tremor relationships are not well understood. Early investigations proposed that 

tremor in each limb was driven by parallel CNS oscillators. However, recent evidence 

suggests that bilateral tremor relationships emerge under perturbed conditions such as 

maximal effort muscle contractions and neuromuscular fatigue. 

PurPOsE: To examine bilateral tremor responses to maximal effort intermittent 

contractions of a single limb. 

METhOds: Nine healthy subjects (age: 26 ± 5 yr) adopted a seated posture 

where each humerus was held vertical and the elbows were flexed to 90 degrees. 

Lightweight accelerometers were attached over the head of radius so that tremor about 

the elbow joint could be measured. Surface EMG was measured for biceps brachii 

and brachioradialis. An intermittent protocol was performed which consisted of 

maximal effort isometric elbow flexions of the preferred limb, with 1 s of rest between 

contractions. The protocol continued until the maximum torque that the subject could 

generate about the elbow joint declined by 50%. Subjects were continually encouraged 

to relax their non-exercising limb during testing. 

rEsuLTs: In the initial stages of the protocol, maximal effort contractions of a single 

limb resulted in increased tremor and muscle activity in both the active and non-active 

limbs. When the unilateral contractions were repeated until elbow joint torque declined 

by 50%, tremor and brachioradialis EMG were decreased in the fatigued limb but 

increased in the contralateral non-fatigued limb. 

CONCLusION: Maximal effort unilateral contractions induced tremor and muscle 

responses in the non-active contralateral limb. Bilateral responses were most likely 

mediated by increased cortical drive to the target and non-target motor neuron pool, 

and changes to the gain of the stretch reflex which plays a major role in tremor 

generation. 

1536 Board #128 May 30, 2:00 PM - 3:30 PM 

Neuromechanical analysis of Overload Eccentric 

Contractions of Elbow Flexors 

Frederico Leal. University of Saskatchewan, Saskatoon, SK, 

Canada. 


Eccentric (ECC) overload in training settings utilizes loads higher than concentric 

(CON) one repetition maximum (1RM). There is no clear definition of ECC “failure” 

or 1RM using conventional weights; ECC 1RM is defined between 145-190% CON 

1RM. The highest intensity used for ECC overload is typically 120% despite little 

research using conventional weights with higher ECC intensities. 

PurPOsE: To conduct an exploratory neuromechanical analysis of different 

intensities of elbow flexors ECC overload using free weights by examining angular 

kinematics during contraction. 

METhOds: Twenty male participants with weight training experience had unilateral 

concentration curl isometric (ISO) peak torque (dynamometer) and CON 1RM 

(dumbbells) assessed with biceps brachii electromyography (EMG) and elbow joint 

angle (electrogoniometer) recordings. Elbow joint torques were estimated using 

inverse dynamics. Participants were randomly assigned in counter balanced order 

to perform ECC actions at 120%, 140%, 150%, 160% and 170% CON 1RM with 4 

minutes rest between. Variables included peak torque (PT), angular velocity at PT 

(AVp), impulse (IM), power (PW), mean EMG, and EMG normalized to peak ISO 

(EMG%). Data were analyzed using repeated measures ANOVA or a Friedman test. 

rEsuLTs: AVp was significantly lower for 120% (65.3 ± 40.8°/s) compared to all 





other conditions (range: 65.3 ± 40.8 to 162.1 ± 75.2°/s; p


and-restart in the re-go trials with a PI of 150 ms while they execute two processes 

for stop and restart separately in the re-go trials with a PI of 250 ms. Moreover, this 

second EEG phase-locking weakened in slow re-go response trials compared with fast 

re-go response trials, indicating that stop-and-restart difficulty with a PI of 250 ms 

might be associated with an insufficient re-go-signal perception. 

CONCLusIONs: These results suggest that difficulty to restart 250 ms after stopping 

a movement is related to the presence of the second processes for re-go-signal 

perception. 

1541 Board #133 May 30, 2:00 PM - 3:30 PM 

The acute Effects of static stretching on the Passive Muscle 

Properties of the Leg Extensors 

Jake A. Deckert, Trent J. Herda, Phil Vardiman, Phil M. 

Gallagher, Michael A. Cooper. The University of Kansas, 

Lawrence, KS. (Sponsor: Joseph P. Weir, FACSM) 


PurPOsE: The purpose of this study was to examine the effects of static stretching 

on the passive range of motion (PROM) and musculotendinous stiffness (MTS) of the 

leg extensors. 

METhOds: Six individuals (mean ± SD; age = 24.5 ± 6.6 yr, height = 143.7 ± 

29.8 cm, weight = 66.3 ± 7.3 kg) performed a PROM assessment with the isokinetic 

dynamometer (Biodex Medical Systems, Inc., Shirley, New York) programed in 

passive mode, which extended the right leg at an angular velocity of 5°s-1. The hip 

was hyperextended at an angle of 148° to 152° during all range of motion assessments. 

The maximal ROM was determined as the point of discomfort but not pain, as 

acknowledged by the subject. MTS of the leg extensors was quantified using a fourthorder 

polynomial regression model that was fitted to the passive angle-torque curves 

for each subject. MTS (Nm°-1) was calculated for each degree increment in the passive 

angle-torque relationship. For analysis, MTS was determined at the second to last joint 

angle for the pre-stretching assessment and the same common joint angle selected 

during the post-stretching assessment. MTS was calculated offline using a customwritten 

software (LabVIEW 8.5, National Instruments, Austin, TX), which included 

a gravity correction of the limb. Surface electromyography (EMG) (Ag-AgCL, 

Quinton Quik Prep, Quinton Instruments Co., Bothell, WA) was monitored to ensure 

the movement was passive. If EMG activity was above baseline during the PROM 

assessment, the trial was removed from further analysis. For the stretching of the right 

leg extensors, subjects completed four repetitions of four stretches lasting 30 seconds 

with 10 seconds rest between stretches, which included three assisted stretches and one 

unassisted stretch. Paired samples t-tests were used to examine possible differences 

pre- to post-stretching for PROM and MTS. 

rEsuLTs: There were no significant differences for PROM (P = 0.099) or MTS (P = 

0.470) between pre- and post-stretching. 

CONCLusION: In contrast to previous studies testing other muscle groups, there 

were no differences between pre- and post-stretching for PROM and MTS. The 

subject position in the isokinetic dynamometer may have not allowed for an accurate 

assessment of PROM or MTS. Future studies may want to further hyperextend the hip 

past the range used in the present study (148° – 152°). 

1542 Board #134 May 30, 2:00 PM - 3:30 PM 

Contributions of Neural Excitability and Voluntary 

activation to Quadriceps Muscle strength 

Adam S. Lepley, Nael O. Bahhur, Amanda M. Murray, Brian G. 

Pietrosimone. University of Toledo, Toledo, OH. 


Previous investigations have suggested that both morphological and neural adaptations 

are responsible for modifying muscle strength. New rehabilitative strategies targeting 

neural excitability and voluntary activation have been proposed to improve muscle 

strength. Understanding how neural excitability and voluntary activation contribute to 

muscle strength is critical in developing new therapeutic techniques. 

PurPOsE: Determine if spinal-reflexive excitability, corticospinal excitability, and 

voluntary activation predict quadriceps strength. 

METhOds: Twenty healthy participants (12 Male, 8 Female; 22.1±2.4yrs; 

173.4±7.5cm, 71.6±8.2kg) were included. Quadriceps strength was assessed via 

maximal voluntary isometric contractions (MVIC) performed at 90° of knee flexion. 

Spinal-reflexive excitability was assessed using Hoffmann reflexes normalized to 

maximal muscle responses (H:M ratio). Corticospinal excitability was evaluated with 

active motor thresholds (AMT), which were elicited by stimulating specific areas 

on the motor cortex using Transcranial Magnetic Stimulation during a standardized 

contraction at 5% of MVIC. Voluntary activation was measured via a superimposed 

burst technique and the central activation ratio (CAR). A hierarchal multiple Linear 

Regression model was used to determine the ability of H:M, AMT and CAR to predict 

MVIC. The change in R2 to the model from the addition of each predictor variable was 

also analyzed. 

rEsuLTs: The overall multiple regression model significantly predicted 45% of the 

variance in MVIC (R2 = 0.45, P=0.01; MVIC = 2.3H:M -.03AMT + 3.3CAR + 1.2). 

Initial imputation of H:M into the model accounted for 24% (R2=0.24, P=0.02) of 

the variance in MVIC. The subsequent addition of AMT accounted for a significant 


increase of 16% (Δ R2 = 0.16, P=0.04) in the prediction capability of the model. 

Lastly, CAR contributed an insignificant increase of 5%(Δ R2 = 0.05, P=0.23) to the 

prediction capability of the model, and was therefore removed. 

CONCLusION: Neural excitability predicted nearly half of the variance in 

quadriceps strength. This may be interpreted as evidence that neural pathways are 

essential in maintaining and increasing quadriceps strength. Interventions targeting 

neural pathways may be beneficial to gain and restore optimal quadriceps strength. 

1543 Board #135 May 30, 2:00 PM - 3:30 PM 

The Effect of Massed versus distributed Practice on the 

Variability of Muscle activity and Force 

Jessica McGuire 1 , Lara Green 1 , Kristina M. Calder 2 , Jae 

Patterson 1 , David A. Gabriel, FACSM 1 . 1 Brock University, St. 

Catharines, ON, Canada. 2 McMaster University, Hamilton, ON, 

Canada. 


PurPOsE: The purpose of this study was to determine if the initial phase of learning 

a resistive exercise task is affected by the structure of the practice (i.e., contraction) 

schedule. 

METhOds: Twenty-six female university students were recruited. Participants were 

randomly assigned to one of two experimental groups: massed, which performed 15 

isometric elbow flexion contractions on one day, or distributed, which performed the 

15 contractions across three days (5 per day). All participants performed two retention 

tests, each consisting of 5 contractions, which occurred two weeks and three months 

after the final test session. Each contraction was 5-sec in length with a 3-minute intertrial 

period. Surface electromyographic (sEMG) activity and force were recorded 

concurrently. Mean amplitude values (MAV) and variance ratios (VR) were calculated 

for the biceps and triceps sEMG data and force. 

rEsuLTs: There was a significant increase in force (∆27.7 N, or 26%) and biceps 

brachii sEMG (∆77 µV, or 29.6%) in both groups (p’s0.05). In contrast, the pattern of 

change in force variability was different between the two practice schedules (p=0.05). 

Force variability for the massed group decreased but plateaued after the first block 

of trials, whereas the distributed group exhibited a more gradual reduction of similar 

magnitude. Both groups maintained a nearly 60% decrease in force variability across 

the two retention tests. The variability in biceps and triceps sEMG mirrored the 

variability in force but the F-ratios were non-significant (p’s>0.05). 

CONCLusION: The magnitude of force and sEMG revealed no difference between 

practice schedules, but the force variability data followed the classic findings for 

massed versus distributed practice. The initial phase of learning a resistive exercise 

task was, therefore, affected by the type of practice schedule. This work was supported 

by the Natural Sciences and Engineering Research Council of Canada. 

1544 Board #136 May 30, 2:00 PM - 3:30 PM 

h-index Measurement Is Important In Persons With 

Peripheral Neuropathy 

Matthew Homles 1 , Shuqi Zhang 2 , Duckchan Jang 3 , Li Li, 

FACSM 1 . 1 Georgia Southern University, Statesboro, GA. 

2 Louisiana State University, Baton Rouge, LA. 3 Keimyung 

University, Daegu, Republic of Korea. 


Peripheral neuropathy (PN) is a neurodegenerative disease that damages the peripheral 

nervous system. The presentation of PN is usually symmetrical sensory nerve damage 

to distal extremities but progresses proximally. Strength, sensitivity, and endurance 

measures are useful tools in understanding effectiveness of interventions. However, 

nerve function measures should be considered for this population. H-index is 

measure used in many neurological studies and can provide new insight to peripheral 

neuropathy. 

PurPOsE: To better understand nerve function, as measured by H-index, and its 

relation to functional motor output in people with PN. 

METhOds: H-index, standing balance, Timed up-and-go (TUG), 6-min walk test, 

peak knee flexion/extension torque were measured from 12 participants with PN. 

H-index was determined by eliciting electrical stimulation at the posterior tibial nerve 

and recording latency of M- and H-waves by EMG on the lateral gastrocnemius. 

H-index was calculated as (Height (cm) / (latency (ms))^2* 2. Participants were 

seated and asked to walk as quickly and safely as possible around a cone placed 3 m 

away then return to their seat, TUG was the average time of three trials. For the 6 min 

walk test, participants were encouraged to walk as far as possible in 6 min. Peak knee 

flexion/extension was performed on a Biodex. Pearson correlation was performed 

between H-index and other measures of interest. 

rEsuLTs: 12 participants (8 women, 4 men) age (72.5 ± 9.2), height (163.0 ± 11.9), 

body mass (171.8 ± 46.2) diagnosed with PN were tested. Causes of PN included 

diabetes (n=2), trauma (n=1), and idiopathic (n=9). Duration of PN was 10.0 ± 1.7 

(Mean ± SD) years. Mean and standard error of mean for our measures of interest 

were as follows: H-index (61.21 ± 4.52); TUG (9.22±0.41); 6 min walk (429.58 ± 





26.37); 95% area (0.82 ± 0.13); peak flexion (37.15 ± 6.43); and peak extension (64.73 

± 6.52). H-index was correlated with 95% area (R²=.26), TUG (R²=.51), 6 min walk 

(R²=.27), but not peak flexion (R²=.04) or peak extension (R²=.002). 

CONCLusIONs: H-index as a measure of nerve function in people with PN is 

related to functional outcomes but not strength measures. H-index could be useful 

in understanding functional impairments in gait and standing balance among people 

with PN. 

1545 Board #137 May 30, 2:00 PM - 3:30 PM 

h-index Is Independent From Other sensory Measures 

among People With Peripheral Neuropathy 

Shuqi Zhang1 , Matthew Homles2 , Duckchan Jang3 , Li Li, 

FACSM4 . 1Louisiana State University, Baton Rouge, LA. 

2 3 Georgia Southern University, Statesboro, GA. Keimyung 

University, Daegu, Republic of Korea. 4Goergia Southern 

University, Statesboro, GA. 


The balance problem in people with peripheral neuropathy (PN) is believed to be 

from deteriorated function of afferent information collection and transition. Nerve 

transmission speed in peripheral and central nervous system is critical for movement 

control. H-index, as a representative measure of transmit speed in nervous system, is a 

potential measure to explain neurological impairments among people with PN. 

PurPOsE: This study was to examine if H-index is an independent measure from 

other common sensory measures of people with PN. 

METhOds: 12 participants (8 women, 4 men) age (72.5 ± 9.2), height (163.0 

± 11.9), body mass (171.8 ± 46.2) diagnosed with PN were tested. Causes of PN 

included diabetes (n=2), trauma (n=1), and idiopathic (n=9). Duration of PN was 

10.0 ± 1.7 (Mean ± SD) years. The foot sole sensitivity was tested at big toe (BT), 

1st and 5th metatarsal (M1 and M5), midfoot (MF) and medial heel (MH) with a 5.07 

monofilament. The overall score of one foot is the number of its sensitive sites, ranged 

from 0 to 5. H-index is based on the linear relationship between participant height and 

the latency between H- and M-wave. H- and M-waves were elicited by stimulating 

tibial nerve at back of right knee joint and signals were picked up at calf muscle in all 

participations. H-index is calculated by [(Height (cm))/(latency(ms)) ]^2*2. Active 

ankle proprioception, measured from maximal inversion to the target positions at 

inversion of -15°, 0° and eversion of 10°. Proprioception was represented by the errors 

between the stop positions and target positions. Pearson correlation analysis examined 

the relationship between H-index and plantar sensitivity as well as proprioception of 

ankle at three target positions separately. 

rEsuLTs: H-index is not correlated with ankle proprioception at 0°, inversion of 

-15°, and eversion of 10°, nor with foot sole sensation (R-square = 0.0253, =7E-05, 

=0.1914, =0.1233, and =0.0189, respectively). 

CONCLusIONs: These results indicate H-index is a neurological parameter can be 

measured in nervous system, independently from plantar tactile sensation and ankle 

joint proprioception, among this population. In further study, H-index should be 

employed to explain how PN affects the nerve system in addition to the deterioration 

of proprioception and tactile sensation. 

1546 Board #138 May 30, 2:00 PM - 3:30 PM 

Corticospinal and spinal Variability during Lengthening 

and shortening Contractions Performed by Trained and 

untrained Males 

Glyn Howatson, FACSM1 , Jamie Tallent1 , Stuart Goodall1 , Alan 

St Clair Gibson1 , Tibor Hortobagyi, FACSM2 . 1Northumbria University, Newcastle-upon-Tyne, United Kingdom. 2University of Groningen, Groningen, Netherlands. 


There is a controversy concerning the mechanism and pathways involved in the neural 

adaptations to resistance training. Here we examined the hypothesis that corticospinal 

and spinal excitability differs between previously strength trained (ST) and untrained 

(UT) males. 

PurPOsE: To compare corticospinal and spinal excitability measured during 

dynamic muscle contractions in ST and UT males and to determine the impact of 

training status on the variability in motor evoked potentials (MEPs). 

METhOds: Nine UT and 10 ST male volunteers reported to the laboratory on 

two occasions separated by 24 h. On each visit, MEPs and the cortical silent period 

were evoked by transcranial magnetic brain stimulation applied to the left primary 

motor cortex and recorded from the tibialis anterior at the instant when the dominant, 

right ankle was at 90° during shortening and lengthening contractions. The H-reflex 

and V-waves were also evoked during contractions by peripheral nerve stimulation. 

Differences in MEP variability were investigated between groups on day 1 and changes 

within groups from days 1 to 2. 

rEsuLTs: Although the ST vs. UT group was 24% stronger (P = 0.02), there were no 

differences in corticospinal or spinal excitability between the groups. MEP variability 

was similar in the two groups on day 1 (39.1 and 40.9%, respectively) but variability 

of the resting MEPs was significantly lower on day 2 in ST (25%, P < 0.005). 


CONCLusION: Against expectations, corticospinal and spinal excitability were 

similar in ST and UT, the decrease in resting MEP variability from day 1 to day 2 

in the ST compared with UT suggests that chronic resistance training may produce 

a greater degree of acute plasticity of the CNS under the present experimental 

conditions. 

1547 Board #139 May 30, 2:00 PM - 3:30 PM 

stiffness Quantification of human Calf Muscle during 

standing Wall stretching using ultrasound shear-wave 

Elastography 

Keigo Taniguchi1 , Minoru Shinohara, FACSM2 , Shuhei Nozaki1 , 

Masaki Katayose1 . 1Sapporo Medical University, Sapporo, 

Japan. 2Georgia Institute of Technology, Atlanta, GA. 


Stretching for calf muscle is commonly prescribed to increase the range of motion for 

ankle dorsiflexion. The magnitude of changes in the stiffness of muscle belly during 

stretching in a weight-bearing position is unknown. Recent development of shear-wave 

elastography has opened the possibility for objectively quantifying muscle stiffness 

(Shinohara et al. 2010). 

PurPOsE: To quantify the changes in muscle stiffness of the triceps surae belly 

during standing wall stretching with the novel ultrasound shear-wave elastography. 

METhOds: Eleven healthy young adults performed standing wall stretching that 

consisted of 10 and 20 deg of ankle dorsiflexion while maintaining the right hip and 

knee in an extended position. Longitudinal ultrasonic images of the medial (MG) and 

lateral (LG) gastrocnemius and soleus (SOL) muscles of the right leg were obtained 

while the subjects maintained 50% of their body weight on the foot. Shear-wave 

elastography was applied with the ankle joint angle in neutral position (0 deg) during 

standing and at 10 and 20 deg dorsiflexion during stretching. Based on shear-wave 

propagation velocity, muscle stiffness was quantified as shear modulus in the muscle 

fascicular area. 

rEsuLTs: The reproducibility of shear modulus was confirmed by the intra-rater 

intraclass correlation coefficient (0.95 for MG, 0.94 for LG, 0.72 for SOL) between 

measurements. Shear modulus increased as the ankle joint angle changed from 0 to 20 

deg: 25.7 ± 9.2 vs. 90.9 ± 27.9 kPa (3.5-fold) in MG, 17.3 ± 3.9 vs. 51.0 ± 11.6 kPa 

(2.9-fold) in LG, and 24.7 ± 5.6 vs. 38.2 ± 8.2 kPa (1.5-fold) in SOL. Furthermore, 

shear modulus of MG was significantly higher than that of LG and SOL at 20 deg 

dorsiflexion (p < 0.05). 

CONCLusION: The findings indicated that the stiffness of triceps surae belly 

progressively increased by 1.5 to 3.5-fold in response to progressive dorsiflexion. 

Variability in the index of stiffness between muscles may be related to variability in 

passive tension between muscles during standing wall stretching. Quantification of 

muscle stiffness during stretching with ultrasound elastography would provide useful 

information to develop effective therapeutic exercise for improving joint flexibility. 

1548 Board #140 May 30, 2:00 PM - 3:30 PM 

Is Neuromuscular activation Of Vastus Intermedius Muscle 

Induced By hip Flexion Movement? 

Akira Saito, Hiroshi Akima. Nagoya University, Nagoya, Japan. 

(Sponsor: Katsumi Asano, FACSM) 


The quadriceps femoris (QF) composed of four knee extensor muscles, i.e. vastus 

intermedius (VI), vastus lateralis, vastus medialis (VM) and rectus femoris (RF). The 

RF acts as not only the knee extensor but also hip flexor. Montgomery et al. (1994) 

found out that activation of VI was similar to that of RF during hip and knee flexion 

phase of running, which reached to 17% of maximal knee extension. However, 

it is unclear whether the activation of VI was actually induced by the hip flexion 

movements. A neural pathway from the sensory nerves in the cruciate ligament to 

the thigh muscles was reported in humans. If the VI activity is elicited by hip flexion 

movement, it would be one of the factors. 

PurPOsE: The purpose of this study is to examine the neuromuscular activation of 

VI during isometric hip flexion at different hip joint angles. 

METhOds: Ten healthy men (age 25.3 ± 6.9 years, height 174.6 ± 6.3 cm and weight 

67.2 ± 10.3 kg) performed 25%, 50%, 75%, 100% of maximal voluntary contraction 

(MVC) of isometric hip flexion at 90°, 110° and 130° of hip joint angles (180° is 

fully extended). We recorded the surface electromyography (EMG) of four individual 

muscles of the QF as previous study (Watanabe & Akima 2009). The root mean square 

(RMS) of individual muscles of the QF was normalized by the RMS of MVC during 

isometric knee extension. Onsets of muscle activation for VI and RF were defined 

as 5%RMS deviation from baselines during isometric knee extension MVC, and we 

calculated the time lag between both muscles. 

rEsuLTs: Normalized EMG of the RF was significantly higher than other three 

synergists of the QF (all P < 0.05) and normalized EMG of the VI was significantly 

higher than that of the VM during MVC at 110° and 130° of hip joint angles (all P < 

0.05). During hip flexion tasks, activation delay comparing to the RF was observed in 

the VI at three hip joint angles (230 to 240 msec), and these were significantly later 

than during knee extensions (-19 to 6 msec) at each hip joint angle (all P < 0.05). 

CONCLusIONs: Neuromuscular activation of the VI appears during isometric hip 



flexion followed by the RF muscle activity. The delay of VI activity was too long in 

terms of the spinal reflex. The VI activation may be elicited by afferent input from the 

sensory receptors in the knee joint via supraspinal pathway. 

1549 Board #141 May 30, 2:00 PM - 3:30 PM 

Power and strength Training on Functionality and Maximal 

Isometric Contractions in Elderly 

Paula B. Lopes1 , Paulo C. Bento1 , Gleber Pereira2 , Jean F. 

Cavazza1 , Renata Wolf1 , André F. Rodacki1 . 1Federal University of 

Paraná, Curitiba, Brazil. 2Positivo University, Curitiba, Brazil. 


It has been proposed that the ability to generate force quickly (power) is more effective 

than the ability to produce large amounts of force (peak force) (MARSH et al., 2009), 

which are relevant aspects to reduce the risk of falls (MELZER et al., 2009). Studies 

involving strength and power training have presented conflicting results on functional 

ability, torque and rate o force development. 

PurPOsE:To compare the effects of power and strength training on the functional 

capacity, torque and rate of torque development of the elderly. 

METhOds:Thirty-seven elderly women (above 60 years) were divided into 3 

groups: control group (CG; n=11), power (PT; n=12) and strength (ST; n=14) training. 

Participants were invited to perform four functional tests: 6 minutes walking, seat 

and reach test, seat to stand and the foot up and go test (RIKLI & JONES, 1999). The 

ability to produce maximal voluntary isometric contractions (peak and rate of torque 

development) was determined using a maximal voluntary isometric contraction test 

applied to the extensor and flexor muscles of the hip, knee and ankle joints. The PT 

and ST groups underwent a 12-wk training period and all groups were requested 

not to engage in any other physical activity program during the study or to change 

their physical activity routines. A one-way ANOVA was used to compare the results 

between the groups (p



1553 Board #145 May 30, 2:00 PM - 3:30 PM 

Practice Effects of Consecutive administrations of the 

sensory Organization Test in healthy College students 

Hyung Rock Lee1 , Jessica R. Dysart2 , Michael S. Ferrara2 . 

1 2 Murray State University, Murray, KY. The University of 

Georgia, Athens, GA. 


Postural control is a complex feedback process utilizing multiple sensory-motor 

systems, gathering input from the visual, vestibular and somatosensory receptors. The 

sensory organization test (SOT) assesses these sensory-motor systems and has been 

utilized in concussion management. However, limited research of the SOT has been 

conducted to evaluate the practice effect. 

PurPOsE: To evaluate the practice effects of four administrations of the SOT within 

one day compared to one test on four consecutive days. 

METhOds: Twenty-eight healthy college students were divided into two groups; 

Group A (10 males, 7 females, age 22.82 ± 5.1 years) and Group B (7 males, 4 

females, age 20.27 ± 1.1). Subjects in Group A performed the SOT once a day over 

four consecutive days. Subjects in Group B performed the SOT four times in one day 

with 20 minute breaks between each SOT. The SOT composite equilibrium score 

provided an overall determination of balance performance for each subject. Subcomposite 

scores were also calculated for somatosensory, visual, vestibular, and visual 

conflict. These scores were analyzed to determine practice effects. Repeated measures 

ANOVA was used with statistical significance set at p 0.05). However, the reduction in MVIC was 

greater for men (228 ± 18 Nm to 156 ± 18 Nm, 36% decline) than women (147 ± 14 

Nm to 114 ± 12 Nm, 22% decline, P < 0.05). Men and women had similar voluntary 

activation during control contractions when measured with electrical stimulation over 

the muscle (91 ± 3% vs 93 ± 2%, respectively) and with TMS (96 ± 2% vs 94 ± 3%, 

respectively). Voluntary activation decreased similarly for men and women after the 

dynamic contractions when assessed with electrical stimulation (to 85 ± 3% vs 85 ± 2%, 

respectively). Likewise, the increase in superimposed twitch elicited with TMS increased 

similarly for men and women (from 1.3 ± 1% to 3.4 ± 1% vs 1.1 ± 1% to 2.6 ±1%). 

CONCLusION: Despite similar reductions in power during 6 minutes of dynamic 

maximal-velocity knee extension, men exhibited greater fatigue of maximal isometric 

force than women. Central and supraspinal fatigue both contributed to the reduction in 

MVIC at end-exercise but did not explain the greater fatigue of MVICs exhibited by 

men compared with women. 


D-31 Free Communication/Poster - Neuroscience 

May 30, 2013, 1:00 PM - 6:00 PM 

Room: Hall C 

1555 Board #147 May 30, 3:30 PM - 5:00 PM 

Influence Of Physical Exercise On hippocampal Cb-1 

receptor Expression 

Ricardo M. Arida, Lívia Blazechi Ferreira, Sérgio Gomes da 

Silva, Fabiano Guimarães Novaes Gomes, Alexandre Aparecido 

de Almeida, Fulvio Alexandre Scorza, Esper Abrão Cavalheiro. 

Universidade Federal de São Paulo, São Paulo, Brazil. 


It has been shown that activation of the cannabinoid receptor subtype 1 (CB-1) 

modulates neuronal activity and inhibits the release of some neurotransmitters in 

the central nervous system. A wide range of neurobiological rewards following 

moderate and intense aerobic activity were reported by humans, popularly referred 

to the ‘runner’s high’, which may function to encourage habitual aerobic exercise. 

Endocannabinoids are endogenous neurotransmitters that appear to play a major role in 

generating these rewards by activating cannabinoid receptors as CB-1 in brain reward 

regions like hippocampus during and after exercise. 

PurPOsE: To investigate the effects of different types and intensities of physical 

exercise on the hippocampal expression of CB-1 receptor 

METhOds: Animals were submitted to forced or voluntary exercise. To the forced 

exercise, Wistar rats were submitted to a program of 5 sessions (acute group) or 30 

sessions (chronic group) on a treadmill. For intensive exercise, the speed was gradually 

increased to 30 min at 22 m/min; to moderate exercise the speed was gradually 

increased to 30 min at 16m/min. For voluntary exercise, each animal was placed in 

a box containing a wheel connected to a shaft which has an odometer to measure the 

number of turns performed. The animals from chronic and acute groups were divided 

into good runners and bad runners, according to the number of turns marked on the 

odometer. Their brains were processed for analysis of CB-1 receptor by Western-Blot 

technique. 

rEsuLTs: A significant increase in the expression of CB-1 receptor was observed in 

acute voluntary good runner (1.30) and intensive forced runner (1.26) when compared 

to the control group (0.57; p=0.017 and p=0.02 respectively). It was also detected 

significant reduction of CB-1 receptor expression in chronic voluntary good runner 

(0.35) and intensive forced runner (0.55) compared to control group (1.80; p=0.027 

and p=0.035 respectively) and between moderate and intensive forced group (1.51 vs 

0.55; p=0.032). 

CONCLusION: Our results suggest that an intensive training is necessary to change 

the expression of the receptor CB-1 on hippocampus. Thus short term exercise 

increased (upregulation) and a long term exercise decreased (downregulation) CB-1 

receptor expression. 

Suppoted by CAPES, FAPESP and CNPq 

1556 Board #148 May 30, 3:30 PM - 5:00 PM 

Brain-derived Neurotropic Factor (BdNF) Increases More 

in Trained than untrained Females Following acute Exercise 

Rick Carter, FACSM 1 , Rachelle Barry 1 , Yunsuk Koh 1 , Allen 

Sexton 1 , Jason Fondrick 1 , Dan Chilek 1 , James Williams, 

FACSM 2 . 1 Lamar University, Beaumont, TX. 2 Texas State 

University, San Marcus, TX. 


PurPOsE: To investigate the amplitude and pattern of plasma BDNF concentration 

shifts between trained and untrained females, following an acute bout of exercise. 

METhOds: Thirteen (7 soccer players; 6 controls) (mean ± SD: age 20.7±1.8 yrs; 

height 65.3±2.3 in; weight 147.2±30.5 lbs; BMI 24.2±4.7 kg/m 2 ; waist/hip ratio .7 ± 

.1 ) college age women who were free from chronic disease consented to participate 

in the study. All subjects completed a cycle ergometry protocol to peak effort with 

controls averaging 80% of age, gender specific predicted VO 2peak while soccer players 

averaged 138% of predicted. Blood specimens were collected before, immediately 

following, and 30 minutes after completing a half hour of cycle exercise at 60% of the 

measured VO 2peak . 

rEsuLTs: Baseline BDNF (T0) and cortisol values were equivalent (P > .05). A 

significant increase in plasma BDNF was noted from baseline to immediately post 

exercise (p < .05) with no other statistical differences noted. Trends did appear with 

respect to BDNF changes with soccer players maintaining higher values at 30 minutes 

of recovery as compared to controls (Plasma BDNF declined 14% in soccer players 

and 28% for controls). However, the rate of disappearance did not reach statistical 

significance. 

CONCLusION: These data confirm that acute moderate to high intensity exercise 

elevated plasma BDNF values. Chronically trained females (soccer) had a greater 

increase in BDNF as compared to controls with plasma concentrations remaining 



higher following exercise. Thus, exercise by stimulating the release of BDNF may 

impart protective effects on neurons, facilitate repair, while improving memory and 

cognitive attributes, as noted in prior studies. Further, chronic training appears to 

enhance plasma BDNF values. 

Keywords: Acute Exercise, Chronic Training, Neurotropins 

1557 Board #149 May 30, 3:30 PM - 5:00 PM 

Cognitive Load Induced response Variability in young 

adults with a history of Concussion 

Andrew C. Parks1 , Robert D. Moore2 , Steven P. Broglio3 , 

Tracey Covassin1 , Charles H. Hillman2 , Matthew B. Pontifex1 . 

1 2 Michigan State University, East Lansing, MI. University of 

Illinois at Urbana-Champaign, Urbana, IL. 3University of 

Michigan, Ann Arbor, MI. 


As sport-related concussions have become a growing health concern, a greater 

understanding of the long-term cognitive deficits associated with a concussion is of 

increasing importance. 

PurPOsE: The current study examined the persistent effect of concussion on 

neurocognitive variability to determine if cognitive load mediates intra-individual 

variability in performance in those with and without concussion history. 

METhOds: Ninety-eight college-aged young adults were separated into groups 

according to their concussion history (50 healthy control; 48 with a history of one 

or more concussions). Intra-individual variability of performance was assessed in 

response to a low-cognitive load oddball task and a high-cognitive load flanker task, 

which requires greater levels of cognitive control. 

rEsuLTs: Analyses revealed no significant differences between groups for mean 

level performance or any measure of variability in response to the oddball task. 

However, in response to the flanker task, individuals with a history of concussion 

exhibited decreased overall response accuracy, and an increase in the standard 

deviation and coefficient of variation for reaction time. 

CONCLusIONs: This study suggests that the level of cognitive load imposed by 

a given task is an important consideration for understanding the persistent influence 

of concussive history on cognitive performance. Young adults with a concussion 

history likely hold enough cognitive reserve to compensate on simple tasks, but falter 

as task complexity increases. Further, intra-individual variability appears to be more 

sensitive than mean-level reaction time in detecting deficits associated with a history 

of concussion. 

1558 Board #150 May 30, 3:30 PM - 5:00 PM 

hippocampal Glycogen dynamics with acute Moderate 

Exercise in Type 2 diabetic rats 

Takeru Shima, Takashi Matsui, Hideaki Soya. University of 

Tsukuba Institute of Health & Sports Sciences, Ibaraki, Japan. 


Cognitive decline can be a complication induced by type 2 diabetes mellitus (T2DM) 

probably due to lowered hippocampal glucose metabolism; T2DM rats shows 

lowered glycogen (Gly) levels and metabolic activity and inhibition of hippocampal 

glycogenolysis induces cognitive decline. Thus hippocampal Gly would be a crucial 

energy source for maintaining hippocampal functions. We recently reported exerciseinduced 

Gly decreases in the hippocampus and muscle, and there is subsequent 

supercompensation. In T2DM, muscle Gly decreases but its supercompensation does 

not occur via lower muscular glucose metabolism, so we postulated that this is also the 

case in the T2DM hippocampus. 

PurPOsE: We aim to clarify the dynamics of hippocampal Gly metabolism during 

acute exercise in T2DM. 

METhOds: Male Otsuka Long Evans Tokushima Fatty rats (OLETF; T2DM model) 

with cognitive decline and Long Evans Tokushima rats (LETO; control) exercised for 

30 min on a treadmill at moderate intensity (based on lactate threshold: OLETF: 12.5, 

LETO: 20.0 m/min), an intensity used in human T2DM therapy. Rats were sacrificed 

pre-exercise at rest, and at 0,1, 3, 6 and 24 h post-exercise using high-power (10 kW) 

microwave irradiation (MI), as the golden standard for brain Gly detection, to measure 

the Gly levels in the hippocampus and soleus muscle. 

rEsuLTs: OLETF showed hyperglycemia (9.51±0.32 mM) with hyperphagia and 

obesity, and higher basal levels of hippocampal Gly as compared with LETO (p < 

0.01). Soleus Gly levels decreased with acute exercise, and supercompensated after 

exercise in LETO but not in OLETF as with previous studies. Hippocampal Gly 

levels decreased in LETO and OLETF. Further, the percentage of decrease in OLETF 

was higher than that in LETO (p < 0.01). Hippocampal Gly supercompensation after 

exercise occurred in LETO but not in OLETF. 

CONCLusIONs: Surprisingly, we found for the first time that T2DM rats have a 

high hippocampal Gly levels, unlike previous result. This result is likely due to the 

use of MI. Further, hippocampal Gly in T2DM decreased significantly during exercise 

but there was no supercompensation after exercise. The T2DM rat hippocampus could 

compensate for decreased blood glucose utilization via its high level of Gly, implying a 

new clinical target for treating cognitive decline as a complication of T2DM. 


1559 Board #151 May 30, 3:30 PM - 5:00 PM 

Modulation of Brain Function in Children during and after 

Exercise 

Eric S. Drollette, Christopher E. Komisarz, Mark R. Scudder, 

Lauren B. Raine, Charles H. Hillman. University of Illinois 

Urbana-Champaign, Urbana, IL. 


Previous research on acute exercise has demonstrated that children can effectively 

maintain and improve aspects of cognition during and following the cessation of a 

single bout of exercise. However, the underlying neural processes that contribute to 

such outcomes are not well understood. 

PurPOsE: The present study examined the effects of moderate cycling (60% of 

heart rate max) on behavioral and neuroelectric outcomes of cognitive control in 9- to 

10-year-old children. 

METhOds: Event-related brain potential (ERP) analysis of 40 children employed 

a modified no-go/flanker task on two separate days (i.e., exercise, rest). Task 

performance and ERPs were measured before, during, after, and 40 minutes following 

cycling or resting on the bike without pedaling. The task involved three types of 

equiprobable trials (i.e., congruent, incongruent, no-go) that necessitate a behavioral 

response for congruent and incongruent trials and inhibition of a response for no-go 

trials. Cycling and rest days were counterbalanced across participants. Analysis was 

completed using a repeated measures within-subjects design. 

rEsuLTs: Cycling resulted in no change in task performance relative to seated rest 

across all trials and time periods. Increased P3 amplitude was observed during, after, 

and 40 minutes following exercise over the parietal scalp region compared to rest. 

Additionally, P3 amplitude was largest immediately following exercise compared to 

during and 40 minutes after exercise. 

CONCLusIONs: Results indicated that children effectively maintain cognitive 

control performance both during and following exercise relative to rest, suggesting 

the maintenance of cognitive function during a dual task environment. Although 

differences in behavioral results were not realized following exercise, the larger P3 

amplitude indicates greater recruitment of neuroelectric resources, suggesting that 

exercise may be beneficial for improving the cognitive control of attention following 

the cessation of an exercise bout. Such findings have implications for how exercise 

might be inserted into the classroom to compliment the educational environment. 

1560 Board #152 Withdrawn 

1561 Board #153 May 30, 3:30 PM - 5:00 PM 

Blood Flow in the Frontal Cerebral Cortex during Cascade 

Juggling 

Shuji Shimonagata, Keisuke Koizumi, Katsuo Sugita. Chiba 

University, Chiba, Japan. 


With the global increase in the aged population, cognitive disorders, such as dementia, 

are becoming a big social problem. These days, there is some research that suggests 

that juggling exercises have beneficial effects on the function of a brain and nerve 

systems (Jan Scholz et al., 2009, Janina Boyk et al., 2008, Nakahara et al., 2007). 

These studies showed the effect of juggling exercise from the comparison between pre- 

and post-training, using fMRI, diffusion imaging and scores of psychological tests. 

However they did not evaluate the change, state and effect during juggling. 

PurPOsE: The purpose of this study was to evaluate the blood flow in the frontal 

cerebral cortex during the cascade juggling of three balls, using Near-infrared 

spectroscopy (NIRS). 

METhOds: The subjects were 12 healthy men(age: 22.17±1.59 years), and they 

were able to continue the three balls cascade juggling for 30 seconds or more. The 

oxygenated hemoglobin (oxy-Hb), de-oxygenated hemoglobin (deoxy-Hb) and total 

hemoglobin (total-Hb) were measured by using the Pocket NIRS by Dynascense 

Inc. Heart rates (HR) were measured by a Heart Rate Monitor, RS800CX by Polar. 

The NIRS probe was attached to each subject on the prefrontal cortex (Fp1, Fp2, 

International ten-twenty EEG system), and their blood flow was measured during the 

juggling in two minutes. Before the juggling, we indicated that they did not move their 

heads during their play, because the hemoglobin values were changed by nodding 

actions. After the juggling, the subjects pedaled bicycle ergometer with incremental 

load test. 

rEsuLTs: The %HR reserve during juggling was 26.60±9.22(%). The oxy-Hb(Fp1, 

Fp2) increased 34.37±16.35% and 37.34±16.18% respectively and the total-Hb(Fp1, 

Fp2) increased 24.16±15.39% and 27.07±12.91% respectively during juggling. The 

oxy-Hb(Fp1,Fp2) were 6.22±14.43% and 7.59±14.88%, and the total-Hb(Fp1,Fp2) 

were 5.02±11.51% and 4.38±11.23% during pedaling bicycle ergometer at the same 

%HR reserve during juggling. The oxy-Hb and total-Hb during juggling were higher 

than the oxy-Hb and total-Hb during pedaling exercise significantly (p



D-32 Free Communication/Poster - Physical 

Activity Interventions in Older Adults 

May 30, 2013, 1:00 PM - 6:00 PM 

Room: Hall C 

1562 Board #154 May 30, 2:00 PM - 3:30 PM 

Effect of Continuous Versus discontinuous aerobic Exercise 

on hemodynamics in young and Older adults 

Marco Meucci 1 , Michael J. Landram 1 , Alan C. Utter, FACSM 2 , 

Steven R. McAnulty 2 , Carlo Baldari, FACSM 3 , Laura Guidetti, 

FACSM 3 , Scott R. Collier, FACSM 2 . 1 University of Rome “Foro 

Italico”, Rome, Italy. 2 Appalachian State University, Boone, NC. 

3 University of Rome, Rome, Italy. 


It has been shown that four weeks of exercise are effective in decreasing blood 

pressure in older pre-to-stage-one hypertensive adults. However, little is known how 

exercise intensity effects age-related change in blood pressure following an exercise 

intervention. 

PurPOsE: The aim of this study was to examine the changes in systolic (SBP), 

diastolic blood pressure (DBP) and maximal oxygen consumption (VO2max), in 

continuous vs. discontinuous exercise in college-aged versus middle-aged adult 

subjects. 

METhOds: Forty-five male and female subjects (18 young adults, 21.6±0.4 years; 

27 older adults, 48.3±0.8 years) were recruited for this study. Each subject was 

randomly assigned to one of two protocols prior to baseline testing for VO2max 

and hemodynamic measurements. Participants were then given a four week, nonintervention 

control period before repeating the testing for a second time and starting 

one month of either 30 minutes continuous aerobic treadmill work at 70-75% of 

maximal heart rate (HRmax) or three bouts of 10 minutes of exercise at 70-75% 

HRmax with two 10 minute break periods in between (a total of 30 minutes of aerobic 

work). 

rEsuLTs: Both continuous and discontinuous exercise groups demonstrated a 

significant improvement in VO2max (p


1566 Board #158 May 30, 2:00 PM - 3:30 PM 

Pulmonary Function Changes In The aged Following Pilates 

Exercise Training 

Brandon S. Shaw1 , Gertruide M. Gildenhuys2 , Marinda Fourie2 , 

Ina Shaw3 , Gregory A. Brown, FACSM4 . 1Tshwane University of 

Technology, Johannesburg, South Africa. 2Tshwane University of 

Technology, Pretoria, South Africa. 3Monash South Africa and 

Tshwane University of Technology, Johannesburg, South Africa. 

4University of Nebraska at Kearney, Kearney, NE. 


With the passage of time, declining pulmonary function leads to a progressive fall in 

maximal strength, maximal oxygen uptake, and therefore reduced exercise capacity, 

physical function and health resulting in a detrimental cycle of decreasing pulmonary 

function, exercise capacity, physical function and health. Pilates, with its emphasis on 

controlled breathing during exercise, may prevent or reverse the functional reductions 

associated with age related pulmonary decline. 

PurPOsE: The purpose was to determine the effects of Pilates on pulmonary 

function in the aged. 

METhOds: Fifty sedentary, apparently healthy females aged 60 years and older were 

randomly assigned to a non-exercising control (n = 25) or a Pilates intervention (n = 

25) group. While the non-exercising control group maintained their usual activities and 

did not partake in any structured exercises, the Pilates intervention group took part in 

an eight-week supervised progressive exercise program. The Pilates program consisted 

of three weekly, non-consecutive, 60-minute sessions being conducted by a qualified 

Pilates instructor. All sessions commenced with breathing, followed by a flowing 

system from standing, to sitting, to lying exercises. 

rEsuLTs: Following Pilates training, significant (p ≤ 0.05) improvements were 

found in maximum expiratory flow at 25% forced vital capacity (FVC) (MEF 25%) 

(3.59±1.26% vs. 4.16±1.25%; p=0.008) and peak expiratory flow (PEF) (4.06±1.32 

L.sec-1 vs. 4.55±1.46 L.sec-1; p=0.049), but not in FVC (2.45±0.47 L vs. 2.41±0.49 L; 

p=0.484), forced expiratory volume in 1 second (FEV1) (1.93±0.39 L vs. 1.92±0.37 L; 

p=0.937), MEF 50% (2.49±0.81% vs. 2.59±0.75%; p=0.312), MEF 75% (0.96±0.38 vs. 

0.90±0.29; p=0.347), FEV1/FVC% (80.07±5.72 % vs. 81.72±4.80 %; p=0.157), peak 

inspiratory flow (3.22±1.33 L.sec-1 vs. 3.08±1.40 L.sec-1; p=0.543) and forced midexpiratory 

flow (FEF 25-75%) (1.93±0.59 L.sec-1 vs. 1.98 ± 0.55 L.sec-1; p=0.495). 

CONCLusIONs: Exercise training programs utilizing Pilates can improve 

pulmonary function in the aged and may improve the associated impaired exercise 

capacity, physical function and health consequences. 

1567 Board #159 May 30, 2:00 PM - 3:30 PM 

short-term step aerobic Exercise Training and detraining 

Effects On Functional Fitness In Postmenopausal Women 

Huei-Jhen Wen1 , Tzai-Li Li2 , Pao-Sheng Yen3 . 1Tzu Chi 

University, Hualien City, Taiwan. 2National Taiwan Sport 

University, Taoyuan County, Taiwan. 3Tzu Chi General Hospital, 

Taichung, Taiwan. (Sponsor: Chodzko-Zajko, Wojciech, FACSM) 


PurPOsE: To explore the effects of 10 weeks group-based step aerobic (GBSA) 

intervention and 6 weeks detraining on functional fitness and body composition in 

healthy postmenopausal women (PMW). 

METhOds: Twenty-two healthy PMW (age 60.05 ± 2.68 years) were recruited and 

randomly assigned to either an exercise group (EG, n=11) or a control group (CG, 

n=11). The participants in EG performed a GBSA exercise program including 10- 

15 minutes warm-up, 40-45 minutes high-intermediate intensity (75-85% heart rate 

reserve) GBSA exercise, and 30 minutes balance/stretching for 10 weeks and then 

followed a 6-week detraining. The participants in CG remained their regular lifestyle 

and did not participate in regular exercise. Body composition (body fat, lean body 

mass, and bone mineral content) determined by dual-energy X-ray absorptiometry and 

functional fitness (chair-stand test [CS], back scratch [BS], arm curl test [AC], 8-ft upand-go, 

chair sit-and-reach, and 2-minute knee-up [2MK]) were measured before the 

intervention and upon completion of the 10-week exercise intervention and the 6-week 

detraining. All data were analyzed by a mixed two-way ANOVA. Significant level was 

set at α= .05. 

rEsuLT: The results showed that body weight (EG: ↓1.2%; CG:↑0.5%; p=0.02), 

CS (EG:↑61.9%; CG:↓2.2%, p=0.00), AC (EG:↑43.0%; CG:↑6.8%, p=0.01), and 

2MK (EG:↑33.2%; CG:↑3.5%, p=0.00) were significantly influenced by the 10-week 

of GBSA; whereas no significant difference between groups was found in body 

composition. After the 6-week of detraining, the levels in CS (EG: 17.18 ± 2.75 vs. 

26.73 ± 4.76 times/30 sec., CG: 22.91 ± 7.50 vs. 24.77 ± 7.13 times/30 sec., p=0.00), 

AC (EG: 14.49 ± 4.42 vs. 24.55 ± 5.07 times/ 30 sec., CG: 20.64 ± 4.30 vs. 24.45 

± 4.11 times/ 30 sec., p=0.02) and 2MK (EG: 82.18 ± 14.89 vs. 107.36 ± 12.73 

times/ 2min., CG: 96.91 ± 16.61 vs. 103.91 ± 19.13 times/ 2 min., p=0.02) remained 

significantly elevated whereas the levels of body weight (53.62 ± 4.78 vs. 52.40 ± 

5.07 kg, p=0.002) and BMI (22.25 ± 1.94 vs. 21.68 ± 1.99 kg/m2, p=0.004) remained 

significantly lower compared to baseline in EG. 


CONCLusION: The findings of this study suggest that a 10-week GBSA appears to 

improve functional fitness in PMW and these advantages remain steady after a 6-week 

period of detraining. 

Supported by National Council of Science NSC 100-2410-H-320-014. 

1568 Board #160 May 30, 2:00 PM - 3:30 PM 

Effect of Transcutaneous Electrical Nerve stimulation on 

Cardiopulmonary responses during Endurance Exercise in 

healthy subjects 

Fernanda P. Tomasi1 , Gaspar R. Chiappa2 , Vinicius M. da Silva1 , 

Marianne L. da Silva1 , Alexandra Lima1 , Ross Arena3 , Gerson 

Cipriano Jr. 1 . 1University of Brasilia, Brasilia, Brazil. 2Clinical Hospital of Porto Alegre, Porto Alegre, Brazil. 3University of 

New Mexico, Albuquerque, NM. 


PurPOsE: This study evaluated the hypothesis that application of transcutaneous 

electrical nerve stimulation (TENS) at the ganglionic region improves aerobic exercise 

performance in healthy subjects. 

METhOds: 11 healthy males (age: 21.3 ± 2.4 years) performed two high-intensity 

constant work exercise test (CWT) sessions on a cycle ergometer. The intensity for the 

CWT sessions was determined by maximal exercise testing in the following way: the 

level of oxygen consumption (VO2) that exceeded the first ventilatory threshold (VT) 

by a value of 60% of the difference between peak VO2 and VT (~80% peak work rate). 

TENS or placebo was randomly administered on each side of the vertebral process 

at C7 (channel 1) and T4 (channel 2) for 30 min at rest prior to and during the entire 

CWT sessions. Sessions were separated by 72 hours of rest. Peak oxygen pulse (VO2/ 

heart rate), gross mechanical efficiency (ME), and time to exercise fatigue (Tlim) were 

obtained during both CWT sessions. Paired t-testing was used to compare variables of 

interest between the two CWT sessions. The level of statistical significance was set at 

p < 0.05 for all tests. 

rEsuLTs: Tlim was significantly longer (390 s ± 41 vs. 321 ± 41 s; p < 0.05) 

during the application of TENS in comparison with placebo. TENS also significantly 

decreased oxygen pulse at peak exercise (17.96 ± 1.9 vs. 20.38 ± 1 ml/beat, p < 0.05) 

in comparison to placebo. Lastly, ME improved during Tlim with TENS (3.95 ± 0.67 

vs. 3.77 ± 0.45 %, p < 0.05). 

CONCLusIONs: These results suggest TENS application results in improved 

exercise performance in healthy subjects. Future research should determine if similar 

effects are observed in patient populations with exercise limitations, such as heart 

failure, diabetes and peripheral arterial disease. 

1569 Board #161 May 30, 2:00 PM - 3:30 PM 

The Effect Of Variety On Time spent In Moderate- To 

Vigorous-intensity Physical activity 

Hollie A. Raynor 1 , Dale S. Bond 2 . 1 University of Tennessee, 

Knoxville, TN. 2 Brown Medical School, Providence, RI. 


Incorporating a variety of activities into a physical activity program may be a 

strategy to increase moderate- to vigorous-intensity physical activity (MVPA). While 

observational research has shown that performing a variety of activities is associated 

with higher MVPA levels, the effect of variety on amount of MVPA performed has not 

been previously tested within an experimental paradigm. 

PurPOsE: To conduct a laboratory-based investigation examining the effect 

of having access to a greater variety of active videogames on minutes of MVPA 

performed in non-obese, regularly active young adults. 

METhOds: Twelve participants (age = 21.9 + 4.0 yrs; body mass index = 22.6 

+ 3.0 kg/m2; 58.3% female; 66.7% white) who self-reported a history of playing 

active videogames and habitual MVPA (293.8 + 103.6 min/wk), participated in 

two experimental sessions, VARIETY (access to 4 different active videogames 

during 4, 15-minute bouts) and NON-VARIETY (access to only the most highly 

liked active videogame during 4, 15-minute bouts), with order of experimental 

sessions counterbalanced across participants. According to 100 mm visual analogue 

scales, participants liked the four Xbox 360 Kinect active videogames used in the 

investigation (adventure game = 77.6 + 12.8 mm; dance = 76.8 + 16.0 mm; soccer 

= 75.6 + 17.9 mm; tennis = 68.8 + 15.8 mm). During each bout, participants could 

choose to engage in the active videogame or sit quietly and read magazines. The 

Sensewear Mini Armband assessed MVPA duration. 

rEsuLTs: Mixed-factor ANOVAs (between-subject factor of counter-balanced order 

and within-subject factors of experimental session and bouts) indicated a significant 

main effect of session, with VARIETY performing more MVPA than NON-VARIETY 

(9.0 + 2.8 min vs. 5.8 + 4.2 min, p < 0.05). A significant main effect of bout was found 

for MVPA-related energy expenditure, with bout 1 significantly greater than bout 4 

(202.5 + 82.7 kcal vs. 111.0 + 62.3 kcal, p < 0.05), and a non-significant trend (p < 

0.08) for a main effect of session, with VARIETY producing greater MVPA-related 

energy expenditure than NON-VARIETY (179.5 + 90.3 kcal vs. 107.5 + 83.7 kcal). 

CONCLusION: Providing access to a greater variety of activities within an exercise 

session can increase amount of time engaged in MVPA. 





\1570 Board #162 May 30, 2:00 PM - 3:30 PM 

Comparing The health Outcomes among Fitness Center 

Members From high and Low Education and Income 

Groups 

Rebecca Abaddi1 , Olivia Smith2 , Kisha Virgil3 , NiCole Keith, 

FACSM3 . 1Hamilton Southeastern High School, Indianapolis, 

IN. 2Pike High School, Indianapolis, IN. 3Indiana University- 

Purdue University, Indianapolis, Indianapolis, IN. 


Socioeconomic status has been shown to influence health. 

PurPOsE: We evaluated whether health differences between income and education 

groups persisted when common fitness center barriers (location and cost) were 

eliminated. 

METhOds: Members completed a Demographics and Health History Questionnaire. 

One-way ANOVA and T-tests were used to analyze cross-sectional data. 

rEsuLTs: Of the 323 evaluated, 13% were not high school graduates (LE), 54.52% 

had a high school diploma or some college (ME), 33% had a college degree (HE), 

27.86% were below (LI) and 72% were above the poverty threshold (HI). LI people 

had a higher RHR (81.06+13.10 vs. 75.21+12.39, p


1574 Board #166 May 30, 2:00 PM - 3:30 PM 

Effect Of a Very Low-calorie diet On Weight Loss and 

selected Measures Of Physical health 

Andy Matthews 1 , Jordan Glenn 1 , Casey Sams 2 , Robert Feezell 2 , 

Matt Ganio 1 . 1 University of Arkansas, Fayetteville, AR. 2 New 

Directions Weight Loss, Bentonville, AR. (Sponsor: Stavros 

Anastassios Kavouras, FACSM) 


American obesity rates have dramatically increased with multiple theories and factors 

considered to contribute to this epidemic. Research indicates that controlled caloric 

restriction can lead to weight loss and improved physical health, but limited data 

is available on the effect of a very low-calorie diet (VLCD) on body mass loss and 

standard health measures. 

PurPOsE: The purpose of this study was to determine the effect of a physician 

supervised VLCD on weight loss and selected measures of physical health. 

METhOds: Twenty-one males (47±13 years, 158±7 cm) and forty-five females 

(44±13 years, 144±5 cm) participated in a meal replacement VLCD program (1,000 

and 600 kcal/day, respectively). Prior to starting the VLCD, subjects were evaluated 

on body mass, percent body fat (BF; bioelectrical impedance analysis), triglycerides 

(TRY), cholesterol (CHOL), and blood glucose (BG) levels. Follow-up measures were 

taken after 12 and 24 weeks of being on the VLCD. Due to scheduling, not all subjects 

participated at all time-points. Repeated measures analysis of variance (ANOVA) tests 

were performed to compare changes from base line to 12 weeks and from 12 to 24 

weeks. 

rEsuLTs: Significant reductions in body mass (112.3±4.3 vs 94.1±3.5 kg, n =24), 

BF (36.2±1.0 vs 29.6±1.2 %, n =23), TRY (161.7±27.5 vs 77.4±8.0 mg/dL, n =12), 

and CHOL (191.2±18.1 vs 152.7±12.2 mg/dL, n=12) occurred from baseline to 12 

weeks, respectively (all p



1578 Board #170 May 30, 2:00 PM - 3:30 PM 

development of Family-Based Obesity Prevention and 

Control approaches Through Community Engagement and 

Intervention Mapping 

Joel Edward Williams1 , Stephanie Mihaly1 , Maciel U. Gonzáles1 , 

Adam Yates1 , Sarah F. Griffin1 , Sarah T. Agate2 . 1Clemson University, Clemson, SC. 2Southern Illinois University, 

Carbondale, IL. 


A critical step in developing successful interventions to increase physical activity (PA) 

and healthy eating involves understanding how the family environment influences 

these weight-regulating behaviors, detection of barriers and facilitators of these 

behaviors, and identification of the best ways to engage families for comprehensive 

health promotion efforts. 

PurPOsE: To develop a family-centered obesity prevention and control intervention 

for low-income families based on formative participatory research and guided by the 

Intervention Mapping protocol. 

METhOds: In-depth interviews and focus groups were used to elicit information 

from community informants (administrators and staff) and potential intervention 

participants (low-income, African American families) associated with the Expanded 

Food and Nutrition Education Program (EFNEP). Interviews with administrators 

(n=4) and focus groups (n=7) with EFNEP staff and low-income families were 

recorded and transcribed verbatim. An initial coding dictionary was developed and 

additional codes were added during transcript coding, which occurred in three steps. 

First, pairs of coders independently applied codes to segments of text then met to 

resolve discrepancies. Next, a separate team member, not involved in the first step of 

coding, reviewed the initial pair’s codes. Finally, all three coders met to come to final 

consensus. Consensus codes were electronically applied to the transcripts and major 

themes were extracted using NVivo qualitative software. 

rEsuLTs: Answers to four important questions emerged from the data related to: 

who to target (e.g., entire communities including “established” sub-groups); what 

to include as essential elements (e.g., parenting behaviors, family PA opportunities, 

nutrition education and healthy cooking); how to focus intervention messages (e.g., 

emphasizing healthy lifestyle vs. losing weight); and where intervention meetings 

should occur (e.g., community centers, churches). 

CONCLusIONs: This study highlights several important theoretical and practical 

issues for informing the development of a culturally-appropriate family-centered 

obesity intervention. Related program objectives, performance objectives and 

intervention strategies are presented. 

1579 Board #171 May 30, 2:00 PM - 3:30 PM 

Factors related To Partner Involvement In The development 

Of The u.s. National Physical activity Plan 

Daniel B. Bornstein 1 , Cheryl Carnoske 2 , Rachel Tabak 3 , Jay 

Maddock 4 , Steven Hooker 5 , Kelly Evenson 6 , Russell Pate, 

FACSM 1 . 1 University of South Carolina, Columbia, SC. 

2 Washington Univeresity at St. Louis, St. Louis, MO. 3 Washington 

University at St. Louis, Sr. Louis, MO. 4 University of Hawai’i, 

Honolulu, HI. 5 Arizona State University, Phoenix, AZ. 

6 University of North Carolina at Chapel Hill, Chapel Hill, NC. 


PurPOsE: Physical activity coalitions (PACs) are increasingly forming to meet 

the demands associated with increasing population levels of physical activity. Little 

is known about what makes PACs successful, however some evidence suggests that 

factors related to each organization that joins a coalition may explain coalition success/ 

failure. The purpose of this study was to employ qualitative methods to understand the 

factors related to organizations’ decisions to commit to the coalition that developed the 

U.S. National Physical Activity Plan (NPAP). 

METhOds: Qualitative semi-structured interviews were conducted with key 

informants from NPAP’s partner organizations. The interview guide was designed to 

elucidate the key factors explaining why and how partner organizations decided to 

commit to the NPAP coalition. Interviews were transcribed verbatim and were coded 

separately by two members of the research team. 

rEsuLTs: : Five primary factors emerged: (1) Strategic Alignment; (2) 

Organizational Alignment; (3) Provide Input; (4) Seminal Event; (5) Cost/Benefit 

Ratio. 

CONCLusIONs: Building and maintaining a PAC with highly committed partners 

may hinge upon the ability to fully understand how each current or prospective partner 

believes it could benefit from the five factors identified in this study. 


1580 Board #172 May 30, 2:00 PM - 3:30 PM 

Effect Of Face-to-face Vs. E-mail Communication In an 

Employee-based Walking Program 

Doug K. Miller1 , Amy Faus2 . 1Messiah College, Grantham, PA. 

2Drexel University School of Public Health, Philadelphia, PA. 

(Sponsor: Stephen Simons, FACSM) 


PurPOsE: Effective modes of communication are an integral part of the success of 

work-site wellness programs. Email communication offers advantages of affordability 

and convenience, but can lack the motivational power of social support provided via 

face-to-face contact between the program participant and leader. The purpose of this 

study was to compare the effectiveness of face-to-face and email communication styles 

on fitness and quality of life outcomes in a work-site walking program. 

METhOds: Twenty sedentary employees (age = 49 + 6.8 yr), participated in a 10week 

walking program. Subjects were asked to walk 4 days per week, at a moderate 

intensity, with duration progressing from 20 to 45 minutes. All workouts were recorded 

on an exercise log. Eleven subjects were randomly assigned to an email (E) group 

and received weekly email motivational information and walking prescriptions. The 

other nine subjects were assigned to a face-to-face (F) group and met with an exercise 

instructor and other subjects once a week for a group walk. During the walk, the 

instructor verbally delivered the same messages that the email group received. Prior 

to and following the 10-week program, resting blood pressures were recorded, and 

subjects completed the WHOQOL-BREF quality of life questionnaire, the Rockport 

Walk Test, and a 5-minute sub-maximal treadmill walk at 1% grade and 3.5 mph. 

rEsuLTs: All participants showed significant improvement on Rockport time (15.89 

+ .94 vs 14.56 + .89 min, p


1582 Board #174 May 30, 2:00 PM - 3:30 PM 

The Effects of Progressive resistance Exercise versus a 

Power-Periodization Exercise approach to Training Very 

Old adults at risk for sarcopenia 

Dennis Hunt, Kathy Swanick, Andrew Hovanec. Florida Gulf 

Coast University, Fort Myers, FL. 


PurPOsE: The purpose of this study was to determine the most effective resistance 

training program to enhance overall function in very old adults who are at risk for 

experiencing sarcopenia-related health declines. Sarcopenia, a term that describes the 

involuntary loss of lean muscle mass that occurs during the aging process beginning 

in middle adulthood. Two exercise programs were examined in this study, progressive 

resistance exercise (PRE) and periodized-power resistance (PPRT). 

METhOds: The study randomized participants into two intervention groups: one 

group receiving progressive resistance exercise training without a power component 

and one group receiving periodized-power resistance training. The duration of each 

intervention was 12 weeks, including a shared one-week familiarization phase. Pretesting 

was performed prior to the beginning of the intervention and post-testing was 

conducted at the conclusion of the intervention. Outcome measures included strength 

assessment, functional power assessment, balance assessment, and body composition 

analysis. 

rEsuLTs: Nine participants completed the PRE program (mean age = 83 years) 

and six participants completed the PPRT program (mean age= 81 years). The PRE 

group experienced significant (p < .05) gains in strength as measured by the Leg press 

1RM (+27.6%) and Chest Press 1RM (+28.7%). The PPRT group also experienced 

significant (p < .05) gains in strength in Leg Press 1RM (+29.9%) and Chest Press 

1RM (+20.8%). However, the PPRT group also demonstrated significant (p < .05) 

improvements in functional power as measured by the Five-Times-Sit-To-Stand Test 

(FTSTS). 

CONCLusIONs: Both PRE and PPRT groups experienced similar significant gains 

in upper and lower extremity strength. The FTSTS assessment was the only outcome 

measure where there was significant difference between groups, suggesting that the 

PPRT program was more effective than the PRE program in yielding adaptations in 

functional power production in the study population. The study results also suggest 

that a Periodized power resistance training program is safe and effective for yielding 

both strength and power gains in the older adult population. 

1583 Board #175 May 30, 2:00 PM - 3:30 PM 

stability Of Pedometer-determined Physical activity In 

2-, 4-, and 9-year Follow-up studies Of healthy Elderly 

Japanese 

Naofumi Yamamoto1 , Mieko Shimada2 , Naoki Nakagawa3 , 

Yasuo Kimura4 , Mamoru Nishimuta2 , Susumu S Sawada, 

FACSM5 , Hidenori Asai1 , Yutaka Yoshitake6 . 1Ehime University, 

Matsuyama, Japan. 2Chiba Prefectural University of Health 

Sciences, Chiba, Japan. 3SANNO University, Isehara, Japan. 

4 5 Saga University, Saga, Japan. National Institute of Health and 

Nutrition, Tokyo, Japan. 6National Institute of Fitness and Sports 

in Kanoya, Kanoya, Japan. 


BaCKGrOuNd: Understanding the stability of physical activity later in life is 

important for predicting the future physical activity levels of the elderly and planning 

appropriate intervention with physical activities. However, as far as we know, there 

are no reports examining the stability of physical activity in the elderly using objective 

measures. 


PurPOsE: The purpose of this study was to examine the stability of physical activity, 

as assessed with pedometry, in healthy elderly Japanese over a follow-up period of 

nine years. 

METhOds: The participants included 191 elderly (115 males and 76 females) aged 

71 at baseline who were followed from 2000 to 2008. The participants wore a waistmounted 

pedometer (Yamasa, MP-300, Japan) for seven consecutive day or more at 

ages 71, 73, 75, and 80. The stability of physical activity, defined as the maintenance 

of the relative rank of daily steps, was examined using Spearman’s rho. In this 

study, “inactive” was defined as a level of less than 4,000 steps per day (Aoyagi and 

Shephard, 2010). 

rEsuLTs: Compared with the baseline levels of daily steps (males; 6,946 ± 2,604 

steps/day, females; 6,438 ± 2,443 steps/day), the percentages of daily steps taken at 

ages 73, 75 and 80 were 89.8% (6,235 ± 2,979 steps/day), 84.4% (6,056 ± 2,808 steps/ 

day) and 71.1% (4,836 ± 2,559 steps/day), respectively, in the males, and 90.0% (5,795 

± 2,199 steps/day), 82.9% (5,235 ± 1,846 steps/day) and 72.4% (4,810 ± 2,104 steps/ 

day), respectively, in the females. The stabilities of daily steps (Spearman’s rho) at 

ages 73, 75 and 80 were 0.76, 0.72 and 0.67, respectively, in the males, and 0.72, 0.65, 

and 0.62, respectively, in the females. The values of Spearman’s rho were larger than 

0.60, suggesting a high stability of daily steps. The results of a logistic regression 

analysis using gender, BMI and grip strength as the items of covariance showed 

that the participants who were low in daily steps at baseline were more likely to be 

“inactive” at ages 73, 75, and 80. 

CONCLusION: In this study, although the number of daily steps declined with age, 

the stability of the daily steps remained high over the nine years follow-up period. 

Moreover, the results suggested that, even in the elderly, the current level of physical 

activity is a strong predictive factor of the future level of physical activity later in life. 

D-33 Free Communication/Poster - Physical 

Activity Interventions/Promotion in Adults 

May 30, 2013, 1:00 PM - 6:00 PM 

Room: Hall C 

1584 Board #176 May 30, 3:30 PM - 5:00 PM 

The Effects of Concurrent Circuit Exercise Training on 

Metabolic syndrome in Middle-aged Woman 

Mien Mien Lee 1 , Ting Yao Wang 2 , Shao Zeng Hu 1 , Kuei Hui 

Chan 1 . 1 National Taiwan Sport University, Taoyuan, Taiwan. 

2 National Yang-Ming University, Taipei, Taiwan. 


Metabolic syndrome is a cluster of metabolic risk factors that comprises 

hyperglycemia, dyslipidemia, abdominal obesity, and hypertension. Recent data 

suggest that the prevalence of metabolic syndrome in woman is higher than in men. 

Concurrent circuit exercise (CCE) is a program that combines aerobic exercise and 

hydraulic resistance exercise in circuit mode. 

PurPOsE: To determine the CCE program on weight, body fat percentage, waist-tohip 

ration (WHR), blood pressure, fasting glucose (GLU), and lipid profile in middleaged 

woman. 

METhOd: Twenty-four middle-aged women were randomly assigned to CCE (45.58 

± 9.09 yrs) and control (CON, 43.50 ± 10.38 yrs) groups. Subjects in CCE group 

performed CCE 30 min (including 3 min warm up, 24 min main activity keeping 

heart rate at 60%~80% HRmax and 3 min stretching exercise) 3 times per week for 

12 weeks. Subjects in CON group did not training during the experimental period and 

were asked to keep their daily life and diet as usual. Pre- and post experimental period, 

the body weight, body fat percentage, WHR, blood pressure of subjects were assessed. 

Fasting blood sample were also taken to determine the GLU, triglyceride (TG), total 

cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), as well as calculated 

the low-density lipoprotein cholesterol (LDL-C) and atherosclerosis index (AI). The 

effects of the intervention (time and groups) were evaluated by two-way ANOVA with 

mixed design. 

rEsuLT: There were no differences between groups at pre and post of the study. 

However, after the CCE training, blood GLU and TG in CCE group significantly 

decreased (80.75 ± 7.84 to 74.33 ± 4.89 mg/dl, and 81.00 ± 42.92 to 67.75 ± 30.88 mg/ 

dl, respectively, p < 0.05). 

CONCLusION: Twelve weeks of CCE training may be an effective exercise program 

to prevent metabolic syndrome by reducing GLU and TG in middle-aged woman. 

Key words: aerobic exercise, hydraulic resistance exercise, glucose, triglyceride 





1585 Board #177 May 30, 3:30 PM - 5:00 PM 

Concurrent Exercise Training restores heart rate 

Variability in Methamphetamine-dependent Individuals 

Brett A. Dolezal1 , Marlon Abrazado1 , Michael Lau1 , Joy 

Chudzynski2 , Rick Rawson2 , Alan Garfinkel3 , Christopher 

B. Cooper1 . 1David Geffen School of Medicine at UCLA, Los 

Angeles, CA. 2Integrated Substance Abuse Program, Semel 

Institute, Los Angeles, CA. 3Department of Integrative Biology 

and Physiology, Los Angeles, CA. 


INTrOduCTION: Healthy, trained individuals exhibit high heart rate variability 

(HRV) reflecting the ability of the autonomic nervous system (ANS) to adapt quickly 

to physical challenges. Methamphetamine (MA) dependency causes ANS dysfunction 

and diminished (HRV) but it is unknown whether HRV can be restored with exercise 

training. 

PurPOsE: In recently abstinent MA-dependent individuals in a residential facility: 

(i) to assess HRV compared with drug-free, age-matched sedentary controls (DF), 

and (ii) to assess HRV before and after 8-weeks supervised endurance and resistance 

training (ET) compared with those who did not receive training (EA). 

METhOds: In 50 subjects (DF=22; ET=14, EA=14) resting heart rate was recorded 

over 5 min while seated using a monitor affixed to a chest strap. Previously reported 

time- and frequency-domain parameters of HRV (LFn, HFn, L/F ratio, SDNN, 

RMSSD and pNN50) were calculated with customized software. MA-dependent 

individuals were randomized to 3 days/week of exercise training (ET) or equal 

attention without training (EA) over 8 weeks. An analysis of variance (ANOVA) with 

Duncan’s post-hoc testing was performed to compare HRV indices between and within 

groups. Significance was set at P ≤ 0.05. 

rEsuLTs: Subject characteristics were matched between groups: age 34 (5) years; 

height 1.76 (0.06) m, and BMI 26.0 (3.5) kg/m2, mean (SD). The EA and ET groups, 

compared with DF, had significantly higher resting heart rate, LF, and LF/HF ratio 

(P


change between controls and active intervention at 6 or 18 months. Average attendance 

was 33% through month 6 and 22% for the 144 classes offered between months 7 and 

18. On treatment analyses (n=117) indicated significant association of class attendance 

with test time (p=0.02) and stage 1 HR response (p=0.05) at 18 months. 

CONCLusION: Participation in group exercises classes resulted in long-term 

cardiorespiratory fitness benefits for adults with SMI. Supported by NIMH Grant 

5R01MH080964. 

1589 Board #181 May 30, 3:30 PM - 5:00 PM 

The Effect Of high-intensity Intermittent Exercise On 

Postprandial Lipaemia 

Martin Thong Soon Tan, Rachel Moy Fat Chan, Yati N. 

Boutcher, Stephen H. Boutcher, FACSM. University of New 

South Wales, Sydney, Australia. 


Moderate aerobic exercise attenuates postprandial lipemia, however, the effect of highintensity 

intermittent exercise (HIIE) on postprandial lipemia is undetermined. 

PurPOsE: The effects of a 20-min bout of HIIE on blood triacylglycerol levels after 

the consumption of a high-fat meal were examined. 

METhOds: 

Twelve young, untrained, overweight female volunteers (BMI 25.1 ± 0.2 kg m-2; 

aged 21.3 ± 0.6 years) underwent a maximal oxygen uptake test and then on different 

days underwent either an exercise or a no-exercise lipemic condition. Both conditions 

involved digesting a high-fat meal after a 12-hour fast. The high-fat meal was in 

milkshake form and consisted of 275 mL of thickened cream, 50 g of specialty ice 

cream, and 2 g of artificial sweetener. The meal provided 4169.5 kJ (992.7 kcal)of 

energy, 97.7 g fat (63.6 g saturated, 0.35 g monounsaturated, 0.75 g polyunsaturated), 

24.0 g carbohydrate, and 8.4 g protein. Order was counter-balanced. In the exercise 

condition participants completed a 20-min HIIE cycling protocol consisting of repeated 

bouts of 8 s sprint cycling (60-65% maximal oxygen uptake at 100-115 revolutions per 

minute) and 12 s recovery (40 revolutions per minute) 14 hours before consuming the 

high-fat meal. Blood samples were collected after the high-fat meal every hour for 4 

hours and triacylglycerol levels were assessed using an AccutrendPlus analyser. 

rEsuLTs: Fasting triacylglycerol was significantly lower by 14.8% in the exercise 

compared to the no-exercise condition, P = 0.02. Postprandial triacylglycerol, 

measured by total area under the curve, was 13.0% lower, P = 0.004, in the exercise 

(5.84 ± 0.31mmol·hr L-1) compared to the no-exercise condition (6.71 ± 0.47 

mmol·hr L-1). There was a significant correlation (r = 0.74; P = 0.006) between 

energy expenditure during HIIE and the difference in exercise and no-exercise fasting 

triacylglycerol values. 

CONCLusIONs: HIIE attenuated postprandial triacylglycerol levels after the 

consumption of a high-fat meal in young untrained females. 

1590 Board #182 May 30, 3:30 PM - 5:00 PM 

Effects Of a self-directed, Multicomponent Exercise 

Program For adults With arthritis 

Sara Wilcox, FACSM 1 , Bruce McClenaghan 1 , Patricia A. 

Sharpe 1 , Katherine Leith 1 , Jennifer M. Hootman, FACSM 2 , 

Meghan Baruth 1 , Ellen Wingard 1 , Andrew Ortaglia 1 . 1 University 

of South Carolina, Columbia, SC. 2 Centers for Disease Control 

and Prevention, Atlanta, GA. 


Physical activity (PA) plays an important role in arthritis disease self-management, 

but adults with arthritis are less active than the general population. Self-directed, 

pre-packaged PA programs, if effective, could meet the needs of this population in a 

relatively low cost manner. 

PurPOsE: To investigate the impact of a 12-wk, self-directed, multicomponent PA 

program, First Step to Active Health®, on functional outcomes, arthritis symptoms and 

management, and PA. 

METhOds: Adults with arthritis (n=401, 56±10 yrs, 86% women) were randomized 

to a 12-wk PA program or an attention control group (self-directed nutrition education). 

The PA program included aerobic, strength, flexibility, and balance exercises and 

emphasized a self-paced, stepped approach. Primary outcomes were measured at 

baseline and 12-wks. Functional performance measures were the 30-sec chair stand, 

6-min walk, and seated reach. A visual numeric scale measured pain, fatigue, and 

stiffness. Lorig’s Arthritis Self-Efficacy Scale measured arthritis management selfefficacy. 

The CHAMPS questionnaire measured hrs/wk of self-reported moderate- to 

vigorous-intensity PA (MVPA) and leisure-time MVPA. Repeated measures linear 

regression models tested group, time, and Group x Time effects in outcomes. Due to 

normality violations for MVPA and leisure-time MVPA models, these outcomes were 

dichotomized as < or ≥ a1.5 hr/wk increase, and logistic regression was used instead. 

Models adjusted for marital status due to baseline group differences. 

rEsuLTs: 12-wk retention was 80% and did not differ by group. Time effects 

indicated statistically significant improvements in chair stands, 6-min walk, seated 

reach, pain, fatigue, and arthritis self-management (p values < .01). A Group x Time 

interaction indicated greater improvement in stiffness in the attention control group 


(p = .02). Participants randomized to the PA group were significantly more likely than 

those in the control group to show a ≥ 1.5 hr/wk increase in MVPA and leisure-time 

MVPA (p values < .01). 

CONCLusION: A 12-wk, self-directed, multicomponent PA program improved 

function, reduced pain and fatigue, enhanced disease management self-efficacy, and 

increased MVPA in adults with arthritis. With the exception of MVPA, however, 

results did not differ by randomization group. 

1591 Board #183 May 30, 3:30 PM - 5:00 PM 

The relationship between Electronic Lifestyle selfmonitoring 

and Weight Loss 

Vaughn W. Barry1 , Amanda McClain2 , Jihong Liu3 , J. Larry 

Durstine, FACSM3 , Gregory Hand3 , Sara Wilcox3 , Steven 

N. Blair, FACSM3 . 1Middle Tennessee State University, 

Murfreesboro, TN. 2Cornell University, Ithaca, NY. 3University of 

South Carolina, Columbia, SC. 


PurPOsE: It is unclear what lifestyle self-monitoring (SM) dose is needed for 

successful weight loss. We aimed to quantify the frequency and duration of electronic 

lifestyle SM, via the SenseWear Armband, needed for clinically significant weight loss 

(i.e. >5%). 

METhOds: This analysis was limited to two of four randomization groups of a larger 

weight loss trial where participants (n = 77) wore the SenseWear Armbands to SM 

physical activity (PA) and dietary intake (DI). One randomization group (n = 38) also 

attended 14 group weight loss sessions. After completing a 9 month intervention, low 

(SM PA and DI 50% of days and DI 50% of days) categories were created according 

to the participant armband adherence data. The SM categories were compared to 

percentage weight change using the general linear model. Fractional polynomial 

models were used to evaluate the association of the frequency and duration of armband 

wear and the DI SM needed for more than 5% of weight loss. 

rEsuLTs: Participants with moderate (n = 20) or high (n = 33) SM lost -4.5%, (95% 

CI, -8.0 - -1.1 %) and -9.0% (-12.8 - -5.2%) of their weight, respectively, while those 

with low (n = 24) SM lost 0% (-3.7 - 3.7%) of their weight. Participants were more 

likely to experience clinically significant weight loss if they wore the armband 14 

hours per day, 80% of the days (i.e. 178 of 222 days), and monitored DI 47% of the 

days (i.e. 104 of 222 days). 

CONCLusIONs: Individuals can experience modest weight loss through moderate 

electronic SM (i.e. SM PA > 50% of the time); however, for greater weight loss, 

participants need to monitor both PA and DI the majority of the time. To aid in 

clinically significant weight loss, users of the SenseWear armband should consistently 

wear the device while regularly monitoring DI. 

1592 Board #184 May 30, 3:30 PM - 5:00 PM 

The Impact Of Cell Phone use On The Intensity and Liking 

Of a Bout Of Treadmill Exercise 

Michael J. Rebold 1 , Gabriel Sanders 2 , Jacob E. Barkley 1 . 1 Kent 

State University, Kent, OH. 2 Northern Kentucky University, 

Highland Heights, KY. (Sponsor: Dr. Ellen Glickman, FACSM) 


Cellular telephones (cell phones) possess a variety of functions that have historically 

been classified as sedentary behaviors (e.g. talking on the phone) which are known to 

be inversely related to exercise behavior. However, other cell phone functions (e.g., 

playing music) may have a positive effect on exercise behavior. 

PurPOsE: This project compared the average speed and liking of 30-minute bouts 

of treadmill exercise during which participants utilized common cell phone functions 

(texting, talking, listening to music). 

METhOds: Twenty five adults (N = 19 females and 6 males, 21.9 ± 1.3 years) 

each participated in four, separate, 30-minute exercise conditions on a treadmill, in 

a random order. During each condition, the time and speed displays on the treadmill 

were shielded from the participants. However, participants were able to alter the speed 

whenever they wished. Treadmill grade was set at zero and not altered. For two of the 

conditions, research personnel used a pre-determined script to interview participants 

over their cell phone by text message (texting condition) and voice conversation 

(talking condition) for the duration of the conditions. During another condition, 

participants used their cell phone to listen to music (music condition) of their own 

choosing. Finally, participants completed a control condition where they did not have 

access to their cell phone. Upon completion of each condition, average speed and 

liking (via visual analog scale) of the condition was assessed. 

rEsuLTs: One-way repeated measures ANOVAs revealed a significant (p < 0.001) 

main effect of condition for average speed and liking. Speed in the music (3.4 ± 

1.4 miles·hour-1) and control conditions (3.2 ± 1.3 miles·hour-1) was significantly 

(p ≤ 0.02) greater than both texting (2.8 ± 1.2 miles·hour-1) and talking (2.9 ± 1.1 

miles·hour-1). Liking of exercise during the listening to music condition (7.7 ± 1.4 cm) 

was significantly greater (p < 0.001) than all other conditions (4.6 ± 2.2 cm texting, 5.8 

± 1.6 cm talking, 4.1 ± 2.4 cm control). 

CONCLusION: Cell phones have some features (playing music) that have the ability 





to increase the intensity and liking of a bout of exercise. However, other cell phone 

functions (texting, talking) may interfere with exercise by reducing intensity. 

1593 Board #185 May 30, 3:30 PM - 5:00 PM 

The Effects Of Green Tea Extract Consumption and highintensity 

Intermittent Exercise On Body Composition Of 

Overweight Men 

Ehsan Gahreman, Mehrdad Heydari, Yati Boutcher, Stephen H. 

Boutcher, FACSM. University of New South Wales, Kensington, 

Australia. (Sponsor: Stephen H. Boutcher, FACSM) 


The ability of high-intensity intermittent exercise (HIIE) and green tea consumption to 

influence body composition of young adult males is undetermined. 

PurPOsE: Thus, the effect of a 12-week HIIE intervention with and without daily 

green tea extract consumption on body composition of sedentary overweight men was 

assessed. 

METhOds: Inactive young men (26.1 ± 0.8 years; N = 48) were randomly assigned 

to control, HIIE, green tea, or HIIE plus green tea groups. In the green tea group 

males consumed a capsule of green tea three times per day, whereas subjects in the 

HIIE group performed 20 minutes of intermittent sprinting (8 s sprint, 12 s recovery), 

three times per week. Controls performed no structured exercise for 12 weeks. Body 

composition was assessed by dual energy x-ray absorptiometry. 

rEsuLTs: Maximal oxygen uptake was significantly improved, P < 0.05, by an 

increase of 15% in the HIIE (34.1 ± 1.4 to 39.3 ± 0.7 ml·kg-1·min-1) and 18% in the 

HIIE plus green tea (34.2 ± 2.1 to 40.4 ± 0.7 ml·kg-1·min-1) groups but was unchanged 

in the green tea only and control groups. Total fat mass was significantly reduced, P 

< 0.05, by 7% after the intervention for the exercise (29.6 ± 2.3 to 27.7 ± 2.3 kg) and 

green tea and exercise groups by 6% (28.5 ± 3.6 to 26.2 ± 3.5 kg) with no significant 

change in the control and green tea only groups. Abdominal fat was significantly 

reduced, P < 0.05, by 6% after the intervention for the exercise (2.33 ± 0.2 to 2.20± 0.2 

kg), and green tea and exercise groups by 11% (2.31 ± 0.3 to 2.07 ± 0.2 kg) with no 

significant change in the control and green tea only groups. A non-significant increase 

in fat free mass was found after the intervention for the exercise (+.56 ± 0.4 kg) and 

green tea and exercise groups (+.55 ± 0.5kg) but a small decrease in fat free mass 

occurred in the control and green tea only groups. 

CONCLusION: Twenty minutes of HIIE, with or without green tea consumption, 

three times a week for 12 weeks, led to significant increases in maximal oxygen uptake 

and a significant reduction in total and abdominal fat mass in overweight, young males. 

The consumption of green tea extract without exercise did not result in any body 

composition change. 

1594 Board #186 May 30, 3:30 PM - 5:00 PM 

The Effects of a six-month Pedometer-based Physical 

activity Intervention on Body Composition Characteristics 

in a u.s. university Worksite setting: The asuKI step 

study 

Jenelle Walker 1 , Ali Soroush 2 , Michael Belyea 1 , Barbara 

Ainsworth, FACSM 1 , Pamela Swan, FACSM 1 , Agneta Yngve 3 , 

Agneta Yngve 3 . 1 Arizona State University, Phoenix, AZ. 

2 Karolinska Institutet,; Kermanshah University of Medical 

Sciences (KUMS), Stockholm, Sweden. 3 Karolinska Institutet; 

Oslo and Akershus University College of Applied Sciences, 

Stockholm, Sweden. 


Background: Physical activity is important for weight maintenance and improvements 

in health. 

PurPOsE: This study determined the effects of a six month pedometer-based 

walking intervention on body composition characteristics in 712 employees at Arizona 

State University. Participants were encouraged to reach a goal of 10,000 steps per day. 

METhOds: Randomly selected employees (n = 142; age = 41±11.5) from the 

walking cohort participated in supplemental body composition testing sessions. 

Anthropometric measurements [height, weight, waist circumference (WC), percent 

body fat (BF), and sagittal abdominal diameter (SAD)] were taken at months one, 

three, and six. A multi-level growth modeling approach was used to explore change 

over time and predict change by steps, age, gender, and body fat categories for body 

composition measures (BMI, BF, WC and SAD). Each body composition measure was 

analyzed as an unconditional model (1), in conditional models [age (2), gender (3)] and 

in a final conditional model (4) (with steps taken, age groups, gender, and initial body 

fat as predictors of body composition changes). 

rEsuLTs: In the unconditional model (1), individual differences were observed in 

all body composition variables at the start of the study(reflected by the intercepts) (p 

.05). 

CONCLusION: The six-month walking program resulted in changes in abdominal 


adiposity measures in the unconditional model. Despite differences in initial 

descriptive and body composition measures, no differences in body composition 

measures were observed during the six-month study after accounting for the predictor 

variables. 

1595 Board #187 May 30, 3:30 PM - 5:00 PM 

heated Pool Exercise Training reduces Office Blood 

Pressure In Patients With resistant hypertension: a Casecontrol 

study 

Guilherme V. Guimaraes1 , Lais Galvani de Barros Cruz2 , 

Emmanuel Gomes Ciolac1 , Egidio Lima Dorea1 , Miguel Morita 

Fernades-Silva1 , Edimar Alcides Bocchi1 . 1Heart Institute - 

HCFMUSP, São Paulo, Brazil. 2Laboratory of Physical Activity 

and Health, São Paulo, Brazil. 


BaCKGrOuNd: Regular exercise lowers office BP in patients with mild-tomoderate 

hypertension, but there is very little available information on its effects 

in patients with resistant hypertension. There is no data concerning the effects of 

exercise training in heated pool in hypertensive patients. Our purpose was to evaluate 

the effects of short-term exercise training in heated pool on office BP in resistant 

hypertension patients. 

METhOds: We studied 16 patients (8 female), age 55 ± 6 years, BMI 29 ± 4 kg/ 

m2, peak VO2 25 ± 4 ml/kg/min, systolic and diastolic office blood pressure 163 ± 21 

and 90 ± 8 mmHg, respectively, with the diagnosis of resistant hypertension in use of 

three or more antihypertensive agents of different classes. All patients were monitored 

for 24-hour ambulatory blood pressure monitoring (ABPM) before and after having 

participated of a two-week exercise program in a controlled (32oC) temperature pool. 

rEsuLTs: The systolic and diastolic office BPs at the second week of training was 

145 ± 8, and 87 ± 8 mmHg, respectively, with a significant decrease from its baseline 

value (p


CONCLusION: The 12-week SCT intervention is effective in improving moderate 

PA, as well as perceptions of self-efficacy, outcome expectation, and perceived barriers 

toward PA in AID. 

1597 Board #189 May 30, 3:30 PM - 5:00 PM 

Injury Prevention In Veteran soccer Players: a Clusterrandomized 

Trial 

Daniel Hammes, Karen aus der Fünten, Stephanie Kaiser, Eugen 

Frisen, Tim Meyer, FACSM. Saarland University, Saarbrücken, 

Germany. 


About 27% of all German soccer players are registered in veteran soccer clubs. They 

compete within a league system and friendly matches. A pilot study indicated a high 

injury risk in that population, but effectiveness of preventive programs has not been 

evaluated yet. 

PurPOsE: To determine the preventive effects of the FIFA injury prevention program 

“11+” in veteran soccer players. 

METhOds: 20 veteran soccer teams (n = 265) of Saarland county were recruited for 

a 9 months (one season) cluster-randomized trial. The intervention group (INT, n = 

146; 45 ± 8 years; BMI kg/m 2 : 27 ± 3) performed the 11+ program once a week at the 

beginning of each training session supervised by trained sport scientists. The control 

group (CON, N = 119; 43 ± 6 years; BMI kg/m 2 : 26 ± 3) followed its regular training 

routine usually without a structured warm-up. During the study, player exposure 

hours (training and match) and injuries were recorded according to the FIFA/UEFA 

consensus statement. 

rEsuLTs: The 11+ were completed in 96.9% of all team training sessions and 14.4 

± 8.2 times by each player. 89 soccer injuries occurred. No significant difference was 

found between the INT and the CON group in overall injury incidence (injuries per 

1000 h) (12.2; 95% confidence interval CI: [8.9 15.6] vs. 12.9 [8.8 17.1]; incidence 

rate ratio IRR: 0.94 [0.62 – 1.44]; p = 0.79). Similarly, there was no significant effect 

on training (5.5 [2.8 – 8.1] vs. 8.1 [4.0 – 12.1.]; IRR: 0.68 [0.33 – 1.37]; p = 0.28) or 

match injury incidence (28.3 [18.9 – 37.7] vs. 21.4 [12.7 – 30.2]; IRR: 1.32 [0.78 – 

2.23]; p = 0.30). The same applied to contact (3.9 [2.0 – 5.7] vs. 5.1 [2.5 – 7.7]; IRR: 

0.75 [0.37 – 1.52]; p = 0.43) and non-contact injuries (8.4 [5.6 – 11.2] vs. 7.8 [4.6 – 

11.0]; IRR: 1.07 [0.63 – 1.81]; p = 0.80). 

CONCLusION: The 11+ program, performed at the beginning of each training 

session, did not exert a significant preventive effect on injury incidence in veteran 

soccer players. Given that neuromuscular improvements from prevention programs 

are considered helpful for preventing injuries, limited amount of training sessions per 

week may have limited such effects and therefore injury prevention. 

Supported by grants from F-MARC (FIFA) and the German Soccer Federation (DFB). 

1598 Board #190 May 30, 3:30 PM - 5:00 PM 

Pedometer Feedback Interventions Increase Total 

Physical activity on days Patients do not attend Cardiac 

rehabilitation 

Cemal Ozemek1 , Wonwoo Byun1 , Katrina Riggin2 , Scott J. 

Strath3 , Leonard A. Kaminsky, FACSM1 . 1Ball State University, 

Muncie, IN. 2IU Health Ball Memorial Hospital, Muncie, IN. 

3University of Wisconsin-Milwaukee, Milwaukee, WI. 


Maintenance cardiac rehabilitation (CR) programs have been shown to be effective in 

increasing physical activity (PA) on days patients attend CR, while having little effect 

on days patients do not attend CR. Pedometer feedback has previously been shown to 

increase total PA and may be a viable tool in increasing steps on days patients do not 

attend CR. 

PurPOsE: To examine the effect of PF and/or motivational messaging interventions 

on total PA (steps/day) on days cardiac patients do not attend CR. 

METhOds: A total of 79 (61 men and 18 women, 61±10 years) patients entering 

a maintenance CR program participated in a 12-week PA intervention. Patients were 

randomized to one of four groups; usual care (UC), PF, motivational messaging (MM), 

or PF with individualized MM. PF and PF+MM groups were given step goals each 

week which increased by 10% of the patient’s baseline value when the step goals 

were achieved. MM and PF+MM groups received weekly motivational newsletters 

containing strategies to increase PA. Lifecorder PLUS monitors (Kenz, Nagoya, Japan) 

were used to assess patients’ baseline PA before beginning CR as well as throughout 

the intervention. Only average steps taken during the last week of intervention on days 

patients did not attend CR were compared with baseline. Time × group interaction was 

tested using two-way mixed ANOVA. Dependent t tests and one-way ANOVA were 

used to test within- and between-group differences in average steps/day on days not 

attending CR. 

rEsuLTs: There were no group differences in daily step counts at baseline (p=0.88). 

A significant time × group interaction was found (p=0.02). PF and PF+MM groups 

significantly increased steps/day from baseline to the last week of intervention (PF: 

5407 ± 2773 to 7110 ± 3525, p=0.02 and PF+MM: 5409 ± 1955 to 7547± 3584, 

p=0.01). PF and PF+MM groups had greater increases in step counts on days not 


attending CR compared with UC and MM groups (PF: 1702±3487 and PF+MM: 

2137±3321 steps/day, p24 weeks were included. 

Standardized effect sizes (g) were calculated and pooled using random-effects models, 

Z-score alpha values and 95% confidence intervals (CI). Heterogeneity was examined 

using Q and I-squared. Statistical significance was set at a two-tailed alpha value (p) of 

0.05 to < 0.10. 

rEsuLTs: A moderate and statistically significant improvement was found at the 

FN (3 g’s, 187 participants, g=0.583, 95% CI=0.031, 1.135, p=0.04, Q=5.6, p=0.06, 

I-squared=64%) while a small trend was observed at the LS (5 g’s, 275 participants, 

g=0.190, 95% CI = -0.036, 0.416, p=0.10, Q=3.0, p=0.55, I-squared=0%). Results 

were sensitive to influence analysis as well as collapsing multiple groups from the 

same studies so that only one g represented each study. 

CONCLusIONs: There is currently insufficient evidence to recommend ground and/ 

or joint reaction force exercise for improving and/or maintaining FN and LS BMD in 

men. Additional well-designed randomized controlled trials are needed before any final 

recommendations can be formulated. 

1600 Board #192 May 30, 3:30 PM - 5:00 PM 

Multifaceted Pedometer Program results In Favorable 

Changes In sitting Time, Physical activity, and Weight 

Saurabh S. Thosar, Sylvanna Bielko, Jeanne D. Johnston. 

Indiana University Bloomington, Bloomington, IN. (Sponsor: Dr. 

Janet P. Wallace, FACSM) 


Physical inactivity is a prime risk factor for metabolic and cardiovascular disease and a 

public health crisis. Decreasing sitting time (ST) and increasing physical activity (PA) 

are unique behaviors which historically have been addressed separately. Pedometer 

interventions which are able to target both behaviors simultaneously may be effective 

to improve health related outcomes. 

PurPOsE: To study the impact of a campus wide self-guided pedometer program on 

ST, PA, weight (WT) and body mass index (BMI). 

METhOds: 4 men and 22 women (53.0 ± 12.4 years) completed a pedometer 

program at a Midwestern University. Participants received a pedometer (Omron HJ- 

720 ITC) and were instructed to wear the pedometer throughout the 12 week program. 

Subjects were provided with software and education on using the pedometer output 

(hourly step count) as a cue to reduce their ST, and to increase PA. Subjects were asked 

to be active during the hours for which they had zero steps. They were encouraged 

to download their data every week to observe and make behavior changes for the 

subsequent week. They received 2 emails·week-1 with tips on PA, nutrition, goal 

setting, and stress reduction. The program also included weekly health related trivia 

questions and competitions among groups. Pre- and post-intervention PA (steps·day-1) 

and ST (no. of hours with step count equal to zero) were recorded via Omron HJ-720 

ITC pedometer and the Omron Health Management Software. WT and height were 

recorded using standard procedures and BMI was calculated. Descriptive statistics and 

repeated measures ANOVA were performed to analyze the changes in ST, PA, WT and 

BMI. Significance was set at p < 0.05. 

rEsuLTs: A significant decrease in ST (4.0±2.2 to 3.3±2.2 hr. day-1; p=0.041) was 

observed as a result of the intervention. PA significantly increased (6454±2602 to 

7485±2870 steps.day-1; p=0.008) whereas a significant reduction was observed in WT 

(76.9±14.9 to 75.8±15.3 kg; p=0.005) and BMI (28.77±6.04 to 28.36±6.19 kg/m2; 

p=0.004). 

CONCLusION: A 12 week pedometer program targeted at reducing ST and 

increasing PA resulted in positive changes in weight and BMI. Pedometers can be used 

in an innovative fashion to decrease sedentary time and promote favorable metabolic 

profiles. 





1601 Board #193 May 30, 3:30 PM - 5:00 PM 

Parkinson’s disease Patients Tolerate Multifaceted Exercise 

Intervention While Improving health-related Physical 

Fitness 

Corey A. Peacock1 , Kayla A. Wilson2 , Gabriel J. Sanders3 , Duane 

B. Corbett2 , Emily J. Fickes-Ryan4 , Ellen L. Glickman, FACSM2 , 

Angela L. Ridgel2 . 1Nova Southeastern University, Fort 

Lauderdale, FL. 2Kent State University, Kent, OH. 3Northern Kentucky University, Highland Heights, KY. 4West Virginia 

Univesity, Morgantown, WV. 


Parkinson’s disease (PD) is a progressive neurological disorder ensuing impaired 

physical fitness and neuromuscular function. Multiple studies have demonstrated 

physical improvements associated with either aerobic exercise or anaerobic exercise. 

However, little research exists demonstrating the effects of an exercise program 

combining both. 

PurPOsE: To determine if PD patients can tolerate sessions of combined anaerobic 

and aerobic training over the course of an eight week intervention. 

METhOds: 13 PD patients completed the preliminary 24-session, cohesive 

anaerobic and aerobic exercise protocol fixed over an eight week period. Our protocol 

consisted of 30 min bouts of aerobic cycle ergometry at an active-assisted pace of 

85 RPM. In addition, participants completed 40 min of anaerobic resistance training 

(55-67% of their 1-RM for sets ranging between 12-15 repetitions), balance training, 

and flexibility training. As accepted by the ACSM, we collected pre- and post- healthrelated 

physical fitness data including cardiovascular health (modified YMCA 3-min 

step test), muscular strength (1-RM chest press), muscular endurance (curl-up test), 

and flexibility (sit-n-reach). 

rEsuLTs: Repeated-measures analysis of variance demonstrated a significant (p ≤ 

0.002) improvement in cardiovascular health (102 beats·min-1 pre, 94 beats·min-1 

post), muscular strength (61.5±30.9 lbs. pre, 83.2±38.5 lbs. post), muscular endurance 

(22 reps. pre, 34 reps. post), and flexibility (9.0±2.3 in. pre, 10.5±3.1 in. post). 

CONCLusION: Our preliminary multi-facet intervention program demonstrated 

both tolerance and health-related physical fitness improvements in PD patients. Further 

research needs to be explored observing neurological changes from this tolerated 

intervention. 

1602 Board #194 May 30, 3:30 PM - 5:00 PM 

resistive Breathing Effects On Pulmonary Function, aerobic 

Capacity and Medication usage In adult asthmatics 

Ina Shaw 1 , Brandon S. Shaw 2 , Gregory A. Brown, FACSM 3 . 

1 Monash South Africa and Tshwane University of Technology, 

Johannesburg, South Africa. 2 Tshwane University of Technology, 

Pretoria, South Africa. 3 University of Nebraska at Kearney, 

Kearney, NE. 


The number of individuals with asthma continues to grow. In the United States of 

America, 1 in 12 individuals (about 25 million, or 8% of the U.S. population) had 

asthma in 2009, compared with 1 in 14 (about 20 million, or 7%) in 2001. Resistive 

breathing is a non-pharmacological treatment for asthma that is attractive both 

financially and as a more holistic approach to managing a chronic condition. 

PurPOsE: The purpose was to determine the effects of resistive breathing on 

pulmonary function, aerobic capacity and medication usage in adults with asthma. 

METhOds: Sedentary asthmatics were assigned to either a non-exercising control 

group (n = 22) or eight-week resistive breathing group (n = 22). Following five 

minutes of easy walking and eight minutes of stretching, resistive breathing group 

participants inspired and expired maximally in the semi-recumbent position through 

a tube 10cm in length and 1cm in diameter. Participants performed these breathing 

exercises for three sets of five to 10 repetitions at a 1:2 second inspiration to expiration 

ratio, three sets of 10 to 15 repetitions at a 2:4 ratio and three sets of 15 to 20 

repetitions at a 3:6 ratio. 

rEsuLTs: Eight weeks of resistive breathing significantly (p≤0.05) increased forced 

vital capacity (FVC) (3.01±0.58 L vs. 3.52±0.74; p=0.000), forced expiratory volume 

in one second (FEV1) (2.85±0.57 L vs. 3.22±0.63 L; p=0.000), peak expiratory 

flow (PEF) (7.1±1.57 L.sec-1 vs. 7.68±1.26 L.sec-1; p=0.008) and FEV1/FVC% 

(94.86±4.94% vs. 90.64±6.67%; p=0.003), while significantly decreasing medication 

usage, but not FEF-25 (2.51±0.87 L.sec-1 vs. 2.19±0.63 L.sec-1; p=0.067), FEF-50 

(4.51±1.23 L.sec-1 vs. 4.32±1.16 L.sec-1; p=0.431), FEF-75 (6.39±1.56 L.sec-1 vs. 

6.72±1.50 L.sec-1; p=0.175), FEF 25-75 (4.07±1.13 L.sec-1 vs. 3.87±1.04 L.sec-1; 

p=0.308), MVV (107.43±34.65 L.min-1 vs. 109.62±38.91 L.min-1; p=0.701) and 

aerobic capacity (38.45±8.45 mL.kg-1.min-1 vs. 38.76±7.57 mL.kg-1.min-1; p=0.702). 

CONCLusION: These findings suggest that resistive breathing training has some 

success at improving pulmonary function and reducing medication usage in adults with 

asthma, but does not increase aerobic capacity. 


1603 Board #195 May 30, 3:30 PM - 5:00 PM 

Influence Of aerobic Exercise On Non-exercise Physical 

activity: Midwest Exercise Trial-2 (MET-2) 

Erik A. Willis1 , Stephen D. Herrmann1 , Jeffrey J. Honas1 , 

Jaehoon Lee2 , Richard A. Washburn, FACSM1 , Joseph E. 

Donnelly, FACSM1 . 1University of Kansas Medical Center, 

Kansas City, KS. 2University of Kansas, Lawrence, KS. 


INTrOduCTION: Compensatory changes in non-exercise physical activity (NEPA) 

in response to an aerobic exercise training program may impact weight loss. 

PurPOsE: To examine changes in NEPA in response to 2 levels of aerobic exercise 

training. 

METhOds: Ninety-two overweight/obese (BMI 25-39.9) sedentary young adults 

(18-30 yrs.) completed (i.e. ≥ 90% scheduled exercise sessions) a 10-mo. trial of 

aerobic exercise (5 days/wk.,70-80% max heart rate, supervised ≥4 days/wk.) at 

either 2,000 (n = 37; 19 females) or 3,000 (n = 37; 18 females) kcal/wk. or served as 

non-exercise controls (n = 18, 9 females. NEPA was assessed over 7 consecutive days 

by accelerometer (ActiGraph Model GT1M) at baseline, 3.5, 7 and 10 mos. Mixed 

modeling was used to examine differences between groups (group effect), within 

groups (time effect) and group-by-time interaction for NEPA assessed as average 

counts/min, and time spent sedentary ( 5999 counts/min) intensity PA. 

rEsuLTs: Within the exercise groups (2,000 and 3,000) N=74, there were no 

significant effects (all p > 0.05) of group, time, or group- by-time interactions for 

NEPA assessed as counts/minute, sedentary time, or time spent in light, moderate or 

vigorous intensity PA. However, activity counts/min were significantly higher (p < 

0.001) in the 3,000 kcal/wk. group (346±141min.) vs. controls (290±106min.) at 7 

mos. and significantly higher (p < 0.001) in both the 3,000 kcal/wk. (345±163min.) and 

2,000 kcal/wk. groups (317±146min.) vs. controls (277±116min.) at 10 mos. Although 

non-significant, sedentary time increased slightly (+2.3%) in controls and decreased in 

both the 2,000 kcal/wk. (-6.2%) and 3,000 kcal/wk. groups (-4.3%). 

CONCLusION: A 10-mo. aerobic exercise training program at either 2,000 or 3,000 

kcal/wk. was not associated with compensatory changes in NEPA. However, the 

observation of significantly higher levels of NEPA (counts/min) and lower sedentary 

time in exercisers vs. controls suggest that, contrary to conventional wisdom, 

overweight and obese individuals do not become less physically active or spend more 

time in sedentary pursuits in response to exercise. 

supported by NIh r01 dK49181 

1604 Board #196 May 30, 3:30 PM - 5:00 PM 

Effect Of Training In Chi-running On running 

Biomechanics 

Deepak Kumar, Kelly McDermott, Haojun Feng, Veronica 

Goldman, Anthony Luke, FACSM, Richard Souza, Frederick M. 

Hecht. University of CA San Francisco, San Francisco, CA. 


Running injuries are reported by up to 80% of runners. ChiRunning is an approach 

to running form that is thought to reduce the rate of injuries through encouraging a 

mid-foot strike, forward lean, shorter strides and other variations. No studies report 

the effect of ChiRunning training on running biomechanics in individuals without a 

current running practice . 

PurPOsE: To evaluate kinematic and kinetic patterns before and after training in 

ChiRunning . 

METhOds: Data were drawn from a randomized pilot study evaluating a running 

program for participants with pre-hypertension. The 12-week study had 3 arms: 1) 

intervention, group-based training in ChiWalk/Run lead by a certified ChiRunning 

coach (n=9); 2) active control, a group-based training in walk/run approach covering 

general topics about running (excluding running form) (n=5); 3) usual care, a group 

provided with educational materials about adopting a walk/run program (n=6). 3-D 

kinematic [over-ground (OG), treadmill] and kinetic (OG) data were collected from all 

subjects pre- and post-intervention. At the moment, OG stance phase data have been 

analyzed from 7 individuals (Age: 53±8 yr; Weight: 79.3±16.8 kg, M:F= 4:3) in the 

chi-running group, compared using paired t-tests. 

rEsuLTs: Post-intervention, the subjects had slightly slower running velocity (Pre: 

3.1±0.6 m/s, Post: 2.9±0.4 m/s, p = 0.04), greater forward lean (p = 0.04) and less 

over-striding (p = 0.02). Other differences included a lower external knee adduction 

moment (p = 0.03), greater ankle eversion (p = 0.02) and greater external ankle 

eversion moment (p = 0.01). There were trends for a more anterior strike index (9% to 

14 % foot length, p = 0.08), lower power generation at the ankle during preswing (p = 

0.08), lower power absorption at the knee (p = 0.07), greater knee flexion (p = 0.09), 

greater power absorption at the hip (p = 0.08) and shorter sagittal hip excursion (p = 

0.06). There were reductions in vertical instantaneous loading rate, vertical average 

loading rate and vertical impact loading but the differences did not reach significance. 

CONCLusIONs: ChiRunning intervention leads to changes in running 

biomechanics, which may lead to lower stress on distal lower extremity joints and 

tissues (ankle, tibia, knee) but the impact on proximal joints (hip, lower back) needs 

further investigation. 



1605 Board #197 May 30, 3:30 PM - 5:00 PM 

descriptive Evaluation Of a Low-Frequency running 

Program 

Angela Lanier1 , Erica Jackson, FACSM2 . 1Berry College, Mount 

Berry, GA. 2Delaware State University, Dover, DE. 


The Furman Institute of Running and Scientific Marathon Training program may be 

ideal for preparing individuals with limited time for a half marathon because it is based 

on a three-day-per-week training schedule. 

PurPOsE: The purpose of the study was to examine the effects of a low-frequency 

running program on health-related fitness and psychological factors related to exercise 

participation of college staff and students. 

METhOds: Participants were nine men and 37 women aged 18-55 years. The fortysix 

novice participants completed the half marathon training program. Body mass, 

peak oxygen uptake, flexibility, body fat composition, decisional balance, outcome 

expectations, physical activity enjoyment, and exercise confidence were assessed 

before and after the 20 weeks of training. Ten of the participants were assessed seven 

months following the race. 

rEsuLTs: Participants experienced increases in peak oxygen uptake from 42.1±7.1 

to 44.3±6.8 ml/kg/min (p=0.001). Although there was a slight decrease in body mass 

(p=0.032), body fat composition decreased from 29.6±8.6 to 27.1±11.2% (p=0.027). 

Flexibility did not change over the five months of training (p = 0.25). Psychological 

factors associated with future exercise participation increased over the 20 weeks of 

training (p ≤ 0.01). Moreover, there were no changes in measures of fitness (p ≥ 0.29) 

and psychological factors (p ≥ 0.08) in thirteen of the participants who were assessed 

seven months after the race. 

CONCLusIONs: Participation in a low-frequency training program such as the 

Furman Institute of Running and Scientific Marathon Training appears to be effective 

for individuals who have limited time for running but want to complete a half 

marathon. Additionally, completion of the low-frequency program over five months 

resulted in health-related fitness benefits and improvement in factors related to future 

exercise adherence. 

1606 Board #198 May 30, 3:30 PM - 5:00 PM 

Effect of diet and Exercise-Induced Weight Loss on Physical 

Function 

Brian B. Parr1 , Roop C. Jayaraman2 , Katie C. Elder3 , Richard 

B. Parr, FACSM2 . 1University of South Carolina Aiken, Aiken, 

SC. 2Central Michigan University, Mt. Pleasant, MI. 3Albion College, Albion, MI. 


Previous research suggests that obesity is associated with physical function limitations 

which may interfere with activities of daily living. 

PurPOsE: To determine the effect of weight loss on physical function in overweight 

and obese adults. 

METhOds: Forty-eight subjects (14 male, 34 female), ages (mean±SD) 52±11 y 

and BMI 35.7±8.0 kg•m-2, participated in one of two 8 week weight loss programs. 

Subjects followed a low-calorie diet (~1200 kcals•day-1) and participated in daily 

exercise, progressing to 60 min•day-1 of walking. Physical function was assessed 

using the timed get-up and go test (TGUG), in which the time required to rise from 

a chair, walk 3 m, and return to the chair was measured. A subset of 18 subjects also 

completed the physical functioning domain of the Short-Form 36 Health Status Survey 

(SF-36). 

rEsuLTs: The diet and exercise programs resulted in significant weight loss 

(98.3±24.7 kg to 92.2±22.3 kg, p



bioelectrical impedance analysis (BIVA method; BIA Analyzer STA, AKERN, Florence, 

Italy), lipid profile, muscle strength by handgrip strength test (JAMAR hand dynamometer, 

Fred Sammons, Brookfield, IL) and the Mental (MSC) and Physical (PSC) Summary 

Component using SF-36. Assessments were conducted at enrollment and after a supervised 

progressive exercise training performed three-weekly for 12 weeks. 

rEsuLTs: A significant reduction in fat mass weight (14.1 ± 10.8 vs. 19.9 ± 9.6, p


1614 Board #206 May 30, 3:30 PM - 5:00 PM 

The Effectiveness Of Wii Fit Plus strength Training In 

Community dwelling Older adults 

Chandrasekhar Bulusu. University of Texas at El Paso, El 

Paso, TX. 


PurPOsE: To identify whether Wii Fit Plus strength training would improve physical 

fitness in community dwelling older adults comparing a Wii strength-training group 

(Wii SG) to a control group (CG) over a twelve-week period. 

METhOds: 18 older adults (mean ± SD age: 71.06±10.04; BMI: 29.91±5.19) 

interested in exercising with Wii Fit Plus strength training were recruited from the 

community and randomly assigned to the Wii strength-training group (Wii SG) and 

control (CG). The subjects in the Wii SG performed three sets of ten repetitions for 

each exercise weekly twice for twelve weeks. The subjects in Wii SG started with five 

exercises in first week and progressed to nine exercises by the end of twelve weeks. 

The duration of each exercise session was 90 minutes. The subjects in CG did not 

participate in any kind of exercise activities. Pre, Mid and Post testing sessions were 

conducted to assess subjects physical fitness. The tests included dynamic handgrip 

strength, 30-second chair stand; 30-second arm curl, timed up and go (TUG) and 

gallon jug transfer tests. Data was analyzed between the Wii SG and CG using general 

linear mixed model and alpha level was set at p



METhOds: A total of 43 females participated (control vs. pain groups: 23 vs. 20 

individuals, age 36.83±8.04 vs. 46.65±12.66 yrs, BMI 22.77±2.99 vs. 24.07±3.32, 

& WHR .76±.05 vs. .80±.069). As subjective measures of the pain rating, Visual 

Analogue Scale(VAS score 0~10; Huskisson, 1979) and Oswestry back pain disability 

index (ODI score 0~45; Fairbank et al., 1980) were employed. As an objective 

measure, a mean of Time Up and Go test(TUG; Podsiadlo et al., 1991) was employed, 

which is a 3m round-trip walk from the sit position (second) performing three times. A 

pedometer(HJ720IT, Omron; Zhu & Lee, 2010) was worn for 7 consecutive days. After 

running descriptive analysis, ANCOVA was applied to examine the group difference 

adjusted for age. To scrutinize the construct and convergent validity of the pain scales, 

the spearman correlations were calculated. ROC curves were calculated to determine 

the cut-off of pain scores for setting the walking steps with SPSS 20 and α=.05. 

rEsuLTs: The means of major variables by groups(control vs. pain) were as follows: 

Total steps: 8164±3473 vs. 7632±3586; VAS 1.00±1.04 vs. 3.25±1.89; ODI 2.96±2.27 

vs. 10.05±6.07; TUG7.43±0.49 vs. 8.22±0.78, respectively. After adjusted for age, 

VAS, ODI, and TUG showed the statistical difference by groups with p


1622 Board #214 May 30, 3:30 PM - 5:00 PM 

Translating health Promotion research Into Community 

Practice: The Manup Project 

Cristina M. Caperchione 1 , Mitch J. Duncan 2 , Gregory S. 

Kolt 3 , Corneel Vandelanotte 2 , Anthony Maeder 3 , Richard R. 

Rosenkranz 4 , Manny Noakes 5 , Karunanithi Mohanraj 6 , W. 

Kerry Mummery 7 . 1 Univerisity of British Columbia, Kelowna, 

BC, Canada. 2 Central Queensland University, Rockhampton, 

Australia. 3 Univerisity of Western Sydney, Sydney, Australia. 

4 Kansas State University, Manhattan, KS. 5 CSIRO Food 

and Nutritional Sciences, Adelaide, Australia. 6 CSIRO The 

Australian eHealth Research, Brisbane, Australia. 7 Univerisity 

of Alberta, Edmonton, AB, Canada. (Sponsor: Karen Croteau, 

FACSM) 


Understanding the process of translating evidence-based interventions into longterm 

community practice and the impact that this process has on the population is 

paramount to the future development of health promoting initiatives. 

PurPOsE: The aim of this study was to examine this impact by using the RE- 

AIM evaluation on the ManUp Project, a physical activity (PA) and healthy eating 

intervention for middle-aged males. 

METhOds: Data were collected for each RE-AIM measure using a computer 

assisted telephone interview survey (N=312), interviews with key individuals from 

local organisations (N=12), and examination of project related statistics and findings. 

Reach was assessed by level of individual awareness of ManUp and the number of 

organisations that requested ManUp information/resources (N=108). Efficacy was 

assessed by changes in PA and nutrition behaviours. Adoption was assessed by number 

of individuals who registered for the program (and their recall of the program). 

Implementation was assessed by number of organisations that implemented the 

program in their workplace. Maintenance was assessed by website usage patterns 

and number of organisations that made ManUp part of their general workplace health 

initiative 

rEsuLTs: In terms of Reach, the overall level of awareness was 46.5%, and all 

organisations requested subsequent ManUp information/resources; Efficacy, the 

intervention was successful in increasing the weekly mins (p



1626 Board #218 May 30, 3:30 PM - 5:00 PM 

rural Veterans Telerehabilitation Initiative for rural 

Veterans with Multiple sclerosis 

Sean C. McCoy1 , Toni Chiara1 , Huanguang Jia1 , David Omura2 , 

Charles Levy1 , Paul Hoffman1 . 1Gainesville VAMC, Gainesville, 

FL. 2William Jennings Bryan Dorn VAMC, Columbia, SC. 


BaCKGrOuNd: Multiple sclerosis (MS) is the most common cause of nontraumatic 

disability in young adults. Participation in structured and monitored physical 

activity programs found improvements in the functional capacity of persons with 

MS. However, access to such programs is limited for some MS patients due to their 

geographic locations and/or mobility restraint. 

PurPOsE: To evaluate the efficacy of a televideo health care delivery model to 

maintain functional capacity in persons with MS while providing a high degree of 

patient satisfaction. 

METhOds: This is a retrospective evaluation of the Rural Veterans Telerehabilitation 

Initiative (RVTRI). All participants of the RVTRI were referred by 

local VA primary care providers. The Veterans’ participated in the tele-rehabilitation 

program were assessed using the following outcome measures: Montreal Cognitive 

Assessment (MOCA), Functional Independence Measure (FIM), Quick DASH, 

and health-related quality of life (VR 12), Patient and Provider Satisfaction. These 

outcomes were collected both at baseline/admission and discharge. The WilCoxon 

signed rank test was applied to compare each outcome measure between baseline and 

follow-up scores. 

rEsuLTs: The RVTRI included 9 participants with MS (8 male/1 female) aged 

between 50-65 years. These participants lived an average 71 miles away from the VA 

Medical Center. On the average, they spent 116 days in the program with an average 

of 10 visits by the allied professionals (PT, OT, RT). With the RVTRI program, the 

travel time saved was an average of 22 hours driving time, 1,300 road miles, and 

$537 of reimburseable travel per patient (p


strength was placement of the individual at the core of both development and 

implementation. We would endorse further attempts at face-to-face communication 

during public health promotion and would encourage others to think of it as a brief 

intervention, meriting formal evaluation. 

1630 Board #222 May 30, 3:30 PM - 5:00 PM 

differences in health Choices and Fitness scores Between 

Fully Online and Blended Instruction of health and Fitness 

Course 

Karen K. Dennis, Dale D. Brown, FACSM, Shannon E. O’Hara, 

Ali M. Lierman. Illinois State University, Normal, IL. 


Many colleges and universities offer or require courses on healthy activity, nutrition, 

and chronic-disease prevention techniques. These classes often consist of both lecture 

and activity components. Generally, these classes are taught in traditional face-to-face 

environment. However, given the trend of increased enrollment in online classes, and 

projected increases in non-traditional student population in post-secondary institutions 

that may further increase online class demand, it is worthwhile to consider alternative 

methods of delivery for this type of class. 

PurPOsE: The purpose of this study was to identify which was more effective: 

teaching a health and fitness course 100% online (OL) or blended (lecture online, 

activity face-to-face, each 50% of class) (BL), for encouraging positive health choices 

and improving fitness scores. 

METhOds: Study participants were 12 students, 75% female, 58% upperclassmen 

with six enrolled in a 100% OL and six enrolled in a BL personal health and fitness 

course during spring 2012 semester. Data sources used were a survey of activity, 

nutrition, and chronic disease prevention choices, and pre- and post-class fitness testing 

results. 

rEsuLTs: Survey results show that 100% of students in the BL and 67% of students 

in the OL class increased physical activity levels from prior to beginning the course. 

100% of students in both classes indicated intent to maintain regular physical activity 

after the course was completed. Additionally, 100% of students in both classes 

indicated that as a result of the class, they believed the choices they make regarding 

physical activity, nutrition, and other lifestyle factors is important for health and 

chronic disease prevention, with 33% in both the OL and BL classes “Almost Always” 

and 50% “Often” intentionally making choices that may reduce their risk of chronic 

diseases. An independent samples t-test on changes in fitness scores from pre- to postclass 

indicated that waist circumference was the only score statistically significant 

(p



foundation for further study on the impact clergy may have on the health beliefs and 

habits of their congregations. 

1634 Board #226 May 30, 3:30 PM - 5:00 PM 

Effects of Combined Exercise Program 0n Functional Fitness 

For Community-dwelling Japanese Women with Knee Pain 

Hiroshi Kohno1 , Hidenori Asai2 . 1Toyo Univ. Human Life Design, 

Asaka-Shi, Saitama, Japan. 2Ehime Univ., Matsuyama-Shi, 

Ehime, Japan. 


PurPOsE:To examine the effects of a combined exercise program for a functional 

fitness promotion program composed of exercise program and facilitating program for 

elderly Japanese women with knee pain. 

METhOds:Participants: The subjects were asked to participate in an anti-knee 

pain class for community-dwelling people. The subjects were 24 females (64.5±1.2 

yrs, BMI25.7±2.5) in the intervention group (IG) and 20 females (65.1±2.8 yrs, BMI 

25.4±3.0) in the control group (CG). Intervention:The home-based exercise program 

was composed of stretching, resistance exercise, and a self-care relaxation program 

for muscle stiffness. The facilitating program was designed to enhance subjects’ selfefficacy 

for the exercise program using stages of change model. The classes were held 

once a week for 6 months. assessments: Information on knee muscle strength, thigh 

muscle flexibility measured by hip-to-heel distance, functional fitness for ADLs and 

pain score (modified-WOMAC) were measured using standardized tests before and 

after the intervention period. The CG received a stretching exercise advice booklet. 

Comparison of two groups were made by ANCOVA. 

rEsuLTs:Physical fitness level and pain score in the IG was not significantly 

different from those in the CG at pre data. The program adherence at the home, 

calculated from exercise records and class participation were 80.9±22.0% and 

75.3±13.3% at the end of the intervention period, respectively. IG showed significant 

improvement in knee muscle strength(IG: 230.0±90.8 to 276.4± 65.4N ,P


12,000-19,999 steps per day and 0.05), small variations in week-to-week PA did exist. Post-survey 

data indicated that 85.0% of participants believed that they benefited from the social 

media group and 80.0% would “absolutely” participate again in this, or a similar, 

program. 

CONCLusION: Although respondents were in strong support of the social media 

platform to deliver the program, participation rates were low and PA behavior was not 

impacted. Future studies should examine how to increase participation in social mediadelivered 

programs, and investigate the linkages between social media facilitation and 

PA behavior change. 

1639 Board #231 May 30, 3:30 PM - 5:00 PM 

What Intensity of Physical activity should We Be 

Prescribing to Manage Weight-related health risk? 

Emily Knight, Melanie I. Stuckey, Robert J. Petrella, FACSM. 

Western University, London, ON, Canada. 


PurPOsE: Traditionally, physical activity (PA) interventions have focused on 

increasing the amount and intensity of activity and little attention has been given to 

reducing physical inactivity or modifying behavioural factors to engage in healthy 

lifestyles. The purpose of this study was to test the effectiveness of a home health 

monitoring study with tailored exercise prescription targeting changes in various 

intensities of PA (e.g. exercise, sedentary behaviour, or both). The program and 

baseline characteristics will be presented. 

METhOd: 61 older adults (55-75 years of age) participated in a 12-week health 

behaviour intervention involving personalized activity prescriptions tailored to baseline 

aerobic fitness using the Step Test and Exercise Prescription (STEP) tool. During 

enrolment, participants were randomized to either control or one of three intervention 

groups each targeting a specific intensity of PA: increasing high-intensity PA (i.e. 

exercise prescription); decreasing low-intensity PA (reducing sedentary behaviour 

prescription); or both (comprehensive PA prescription). At baseline, clinical measures 

for risk of cardiovascular disease were recorded, including blood pressure, fasting 

glucose, cholesterol, body mass index, waist circumference, and aerobic capacity. 

rEsuLTs: Data is presented as mean (+SD). The average age of the sample was 62.6 

(+4) years, and the sample was 59% female. Body mass index was 31.4 (+5) kg/m2. 

Waist circumference was 101.6 cm (+13) for females, and 113.6 cm (+16) for males. 

Aerobic fitness was 25.96 ml/kg/min (+5.4) for females, and 32.76 ml/kg/min (+ 7.4) 

for males. No significant differences were found between groups for baseline clinic 

measures. 

CONCLusIONs: On average, our sample had undesirable anthropometric and 

aerobic fitness. This novel intervention aimed to explore the effect of prescribing 

various intensities of PA on changes in clinical risk for cardiovascular disease. Results 

from this study will help to inform future programs for activity prescription by health 

care professionals. 


1640 Board #232 May 30, 3:30 PM - 5:00 PM 

Changes In Physical activity, Fitness and Perceptions due 

To Participation In a Corporate Wellness Program 

Elizabeth G. Groendal 1 , Jeremy L. Knous 1 , Samantha J. 

Danbert 2 , Rebecca A. Schlaff 1 , Joshua J. Ode 1 . 1 Saginaw 

Valley State University, University Center, MI. 2 Michigan State 

University, East Lansing, MI. 


Exercise is Medicine (EIM), a national initiative aimed at improving physical activity 

(PA) and health, is often promoted through the development of employee wellness 

programs. Evaluating changes in individuals who have consistently participated in 

wellness programs can demonstrate success and identify areas for improvement. 

PurPOsE: Therefore, the purpose was to evaluate changes in components of fitness, 

PA levels, perception of program components, and barriers to PA in employees who 

participated in a wellness program. 

METhOds: Participants included 44 employees enrolled in a wellness program, who 

had baseline and follow-up components of fitness and survey data within a single year. 

Physical assessments included anthropometrics with a calculation of body mass index, 

body composition, flexibility, muscular endurance, muscular strength, and an estimated 

aerobic capacity test. PA, perceptions, and barriers were all assessed via online survey. 

Descriptive data were reported as mean±SD. Repeated measures ANOVA was used to 

compare individual fitness assessment measures. Chi-square analyses and T-tests were 

used to assess gender differences. 

rEsuLTs: Mean age was 43±11 years at follow-up with 63% of participants being 

female. All component of fitness measures showed a trend for improvement at followup, 

with only push-ups (#1: 27±14; #2: 29±14) and estimated aerobic capacity (#1: 

35±10 ml/kg/min, #2: 39±9 ml/kg/min) reaching statistical significance (p≤0.05). 

Additionally, a statistical difference in systolic blood pressure (#1: 129±15mmHg; 

#2: 123±11mmHg) was found in males. Aside from the electronic exercise log being 

beneficial to the participants’ overall wellness, no change was found in PA levels, 

barriers to PA, or perceptions of program components. 

CONCLusION: While neither PA levels nor the barriers to PA changed as a result of 

the wellness program, there were trends of improved component of fitness measures at 

follow-up. While not statistically significant, this improvement highlights the impact of 

the employee wellness program. Further, participants did not show a decline in health 

and fitness measures which implies stability throughout a year. Finally, data show that 

wellness program improvements should aim to increase PA levels and decrease barriers. 

1641 Board #233 May 30, 3:30 PM - 5:00 PM 

The Virtual Trainer: Facilitating Physical activity and 

Fitness Improvement Through Internet and Mobile Phones 

Stanley Sai-chuen Hui, FACSM 1 , Ron Chi-wai Kwok 2 , Jacky 

Ka-wai Chan 1 , Emmanuel A. Hui 1 . 1 The Chinese University of 

Hong Kong, Shatin, Hong Kong. 2 The City University of Hong 

Kong, Kowloon Tong, Hong Kong. 


Health promotion websites have become popular means to motivate people to do more 

exercise. By applying various cyber-psychological theories and integrating smartphone 

technology, a free interactive website called “Virtual Trainer” (VT) was developed 

to help foster a physically active lifestyle. Given a participant’s self reported data, 

personal exercise prescriptions, online health and fitness evaluations, and text message 

reminders for adherence to the self-determined training schedule are some ways 

through which VT promoted exercise. 

PurPOsE: To evaluate the effectiveness of the VT program in increasing physical 

activity (PA) knowledge, practice, and health-related fitness. 

METhOds: Registered VT users (n=126; age=20.98 +/- 5.35 yrs.), who completed 

at least 8 weeks of online exercise training as well as online pre-post questionnaires on 

PA knowledge and practice, were extracted for analysis. Another 140 users completed 

the online pre-post health-related fitness assessments. The online questionnaire 

included 29 items on PA knowledge and PA participation measured by the International 

Physical Activity Questionnaire (IPAQ). For online health fitness assessment users 

were asked to follow online instructions and animations for self-administered fitness 

tests. Fitness items included a 3-min stepping test for aerobic fitness, sit-and-reach 

flexibility, cadence curl-up, push up, blood pressure and a stress inventory. 

rEsuLTs: Users demonstrated 37% increase in PA knowledge scores (from 

16.5 to 22.6, p



1642 Board #234 May 30, 3:30 PM - 5:00 PM 

Motivation to Integrate Physical activity into daily Life: 

2012 JaM World record 

Miriam Skrade, Spyridoula Vazou. Iowa State University, Ames, 

IA. (Sponsor: Panteleimon Ekkekakis, FACSM) 


The problem of physical inactivity and the epidemic of obesity among children around 

the world are well-documented. As several organizations have highlighted, efforts 

should be strengthened for the norm of physical inactivity to be reversed. Schools are 

often portrayed as having the potential to influence children’s physical activity (PA) 

levels. However, research on the motivation of stakeholders to integrate PA into daily 

school life is limited. 

PurPOsE: To examine the motivational profile and intentions of adult participants at 

a world-record activity break. 

METhOds: After the 2012 Just-A-Minute (JAM) World Record, 686 adults (90 M, 591 

F; 293 PE teachers, 230 classroom teachers, 87 school admin and staff, 69 non-school 

related, 7 missing) anonymously completed an online survey about their motivation to 

participate (Situational Motivation Scale; Standage et al., 2003), their intention to use 

the JAM routines in the future and their intention to participate in a new record-breaking 

attempt next year. Ninety-four percent of the responders participated for others, the 

majority (76.1%) of whom was children under the age of 10. 

rEsuLTs: All participants reported high intrinsic motivation and low extrinsic 

motivation and amotivation for participation in the next JAM World Record. Groups 

were compared with one-way ANOVA on motivational factors and intention. 

Participants that had a role in schools were more intrinsically motivated (Identified 

regulation; F=9.15, p


Table. Variety of physical activity * and its association with meeting the aerobic 

guideline overall and by sex, 2010 

Overall Boys Girls 

Variety of physical activity * 

Mean (95% CI) 

6.5 (6.3, 6.7) 6.8 (6.6, 7.1) 6.2 (6.0, 6.4) 

AOR † (95% CI) AOR † (95% CI) AOR † (95% CI) 

1-2 1.0 1.0 1.0 

3-4 1.7 (1.1, 2.4) 1.7 (1.1, 2.6) 1.6 (0.9, 2.9) 

5-6 2.5 (1.7, 3.6) 2.5 (1.6, 4.0) 2.3 (1.4, 3.7) 

7-8 3.2 (2.2, 4.5) 2.5 (1.5, 4.2) 4.0 (2.2, 7.0) 

9+ 4.4 (2.8, 6.8) 4.1 (2.5, 6.9) 4.3 (2.6, 7.1) 

CI = confidence interval 

* Variety of physical activity is the sum of reported activities among students 

reporting ≥ 1 activity † AOR: odds ratio adjusting for covariates 

CONCLusION: Boys and girls who participated in a larger variety of activities 

were more likely to meet the aerobic activity guideline. Our findings support 

encouraging youth to participate in a variety of physical activities. 

1646 Board #238 May 30, 2:00 PM - 3:30 PM 

Meeting Physical activity Guidelines and health Outcomes 

James R. Morrow, Jr., FACSM, Allen W. Jackson, FACSM, 

Earlynn Lauer, Scott B. Martin. University of North Texas, 

Denton, TX. 


The 2008 US Physical Activity Guidelines (PAG) for Americans suggest improved 

health benefits with increasing physical activity (PA). Some amount of PA is reported 

to be better than no PA. The PAG suggest min/week (150) and METmin/week (500) 

as thresholds for substantial health outcomes. Additional health benefits are reportedly 

gained with additional PA (i.e., 300 min/week and 1000 METmin/week). 

PurPOsE: To relate health markers (blood pressure, percent fat, BMI, blood 

glucose, cholesterol, and cardiorespiratory fitness [CRF]) to levels of self-reported PA 

associated with PAG recommendations. 

METhOds: Participants were Cooper Clinic (Dallas TX) physical examination 

patients. 506 non-smoking participants (367 M; 139 F) completed self-reported PA 

behaviors and completed medical screening for health markers. CRF was estimated 

from maximal treadmill time. Self-reported PA behaviors were recoded consistent with 

PAG (Group 1:



Physical activity was assessed by using ActiGraph GT3X+ accelerometers for seven 

consecutive days. Mode of travel to school was investigated by questionnaire. Parents 

were encouraged to help the children to fill out the questionnaire. 

rEsuLTs:The mean (SD) physical activity level was 731 (200) counts/min among 

girls and 817 (216) counts/min among boys (p


rEsuLTs:In K-6 data, moderate to strong correlations were found between OW/OB 

and Behavior (0.40), Clinical Care (0.28) and SES (0.37). Significant individual items 

included Smoking (0.30), Diet and Exercise (0.26), Alcohol (0.45), Education (0.52), 

Employment (0.39), Air Quality (-0.34) and Clinical Quality (0.31). When SES was 

controlled the correlations became non-significant. For 7-12 grade, the only factor 

that was significantly correlated with OW/OB was SES (0.27). Significant individual 

factors included Employment (0.34), Quality of Care (0.24) and Air Quality (-0.31). 

When SES was controlled for correlations between OW/OB and Clinical Care (0.24) 

and Environment (-0.28) became significant. 

CONCLusIONs: County health rankings may provide useful indicators to evaluate 

social and environmental factors influencing health outcomes such as obesity. 

Monitoring of these factors may help evaluate large-scale policy and environmental 

interventions but SES needs to be controlled. 

1654 Board #246 May 30, 2:00 PM - 3:30 PM 

Obesity-related health risk In asian-subgroups In Canada: 

a Cross-sectional analysis 

Chris I. Ardern, Jason X. Nie. York University, Toronto, ON, 

Canada. 


PurPOsE: Obesity-related health risk has been shown to vary across ethnicity and 

time-in-country; however, reliance on broad categories of ethnicity in populationbased 

surveys have limited epidemiological insight. The purpose of this study was to 

therefore examine the association between the World Health Organization’s Asianspecific 

cut-offs of overweight (Body Mass Index (BMI) ≥23 kg.m-2) and obesity 

(BMI ≥27.5 kg.m-2) with self-reported cardiovascular-related conditions (high blood 

pressure, diabetes, heart disease, and ‘at least one’ condition) in Asian-Canadian subgroups 

(Chinese, South Asian, Filipino, Southeast Asian, Arab, West Asian, Japanese, 

and Korean) who are at elevated risk for cardiometabolic disease. 

METhOds: Six cycles of the Canadian Community Health Survey (2001-2009; 

N=18,794) were pooled, and weighted to represent the Asian-Canadian population 

across 9 years. Multivariable logistic regression, adjusting for demographic and 

lifestyle characteristics, was used to estimate the odds of cardiovascular outcomes 

across each of eight Asian sub-groups. 

rEsuLTs: Overall, compared to South Asians (OR=1.00), Filipinos had higher 

odds of having ‘at least 1’ chronic condition (OR=1.29, 95% CI: 1.04-1.62), whereas 

Chinese (0.63, 0.474-0.9) and Arab-Canadians had lower odds (0.38, 0.28-0.51). 

Compared to the normal weight BMI category in each respective ethnic group, the 

association between overweight and obesity on ‘at least 1’ chronic condition was 

highest amongst Chinese (overweight: 3.6, 2.34-5.63; obese: 8.9, 3.6-22.01), whereas 

no significant gradient was observed in Japanese, Arab, and West Asian sub-groups. 

Using normal weight South Asians as the referent, obese Chinese, South Asian, 

Filipino, West Asian, and Korean groups were approximately 3-times as likely to 

report ‘at least 1’ chronic condition. 

CONCLusIONs: The relationship between overweight, obesity, and health risk 

varied within Asian-Canadian subgroups, and was strongest for Chinese-Canadians. 

Reliance on traditional BMI thresholds and broad categories of ethnicity may mask 

cardiometabolic health risk in need of targeted intervention. 

1655 Board #247 May 30, 2:00 PM - 3:30 PM 

Changes in Walking for Transportation among u.s. adults 

2005-2010, National health Interview survey 

Prabasaj Paul, Susan A. Carlson, Dianna D. Carroll, Janet E. 

Fulton, FACSM. Centers for Disease Control and Prevention, 

Atlanta, GA. 


Walking is the most commonly reported physical activity among U.S. adults and is one 

of the ways to obtain adequate aerobic physical activity for substantial health benefits. 

PurPOsE:To estimate changes in prevalence of participation in, and mean volume 

of, transportation walking among U.S. adults from 2005 to 2010, by demographic 

characteristics and BMI category. 

METhOds: Data from the core and Cancer Control Supplement of the National 

Health Interview Survey - an interviewer-administered survey of U.S. adults - from 

2005 (n=26,372) and 2010 (n=23,147) were examined for transportation walking 

prevalence (≥1 ≥10-minute bout in the previous 7 days) and for mean walking volume. 

Data were examined by sex, age group, race/ethnicity, education, BMI category and 

adherence to the aerobic component of the 2008 Physical Activity Guidelines for 

adults. 

rEsuLTs: In almost every group examined, transportation walking prevalence did 

not change significantly whereas transportation walking volume decreased significantly 

from 2005 to 2010. Overall, the change in prevalence of transportation walking [2005: 

29.2%; 95% CI (28.2%, 30.1%); 2010: 30.2% (29.3%, 31.1%)] was not significant, 

but the population mean volume (minutes/week) of transportation walking decreased 

significantly [2005: 44.1 (41.3, 46.9); 2010: 32.1 (29.6, 34.6)]. Some groups, however, 

increased prevalence and decreased volume of transportation walking, including men 

[prevalence 2005: 30.8% (29.7%, 31.9%); 2010: 32.6% (31.4%, 33.8%) and volume 

2005: 52.7 (48.3, 57.2); 2010: 36.4 (33.0, 39.9)], and Hispanic Americans [prevalence 


2005: 30.4% (28.5%, 32.3%); 2010: 33.3% (31.4%, 35.1%) and volume 2005: 

57.0 (49.9, 64.0); 2010: 45.1 (38.2, 52.0)]. Findings are similar for mean volume of 

transportation walking among those who walk for transportation. 

CONCLusIONs: From 2005 to 2010, prevalence of participation in transportation 

walking remained the same; however, mean time spent walking for transportation 

decreased. These findings demonstrate that prevalence and mean volume are 

distinct measures that should both be included for a more comprehensive view of 

transportation walking behavior. The distinction between the measures should be 

considered when designing surveillance systems, setting health behavior targets and 

targeting interventions. 

1656 Board #248 May 30, 2:00 PM - 3:30 PM 

association Between 25-hydroxyvitamin d and 

Cardiorespiratory Fitness In The National health and 

Nutrition Examination survey 

Patrick B. Wilson, John Fitzgerald, Stacy J. Ingraham. University 

of Minnesota, Minneapolis, MN. 


BaCKGrOuNd: Low cardiorespiratory fitness (CRF) and serum 25-hydroxyvitamin 

D (25[OH]D) are associated with cardiovascular morbidity/mortality. Studies suggest 

that 25(OH)D is associated with CRF but have come from selective samples. 

PurPOsE: To examine the association between CRF and serum 25(OH)D from 

a nationally representative sample, the National Health and Nutrition Examination 

Survey (NHANES). 

METhOds: Participants aged 12-49 were eligible for a CRF test, which involved a 

submaximal walking protocol to estimate VO . Participants were assigned to one of 

2max 

eight protocols based on sex, age, body mass index (BMI), and self-reported physical 

activity. Estimated VO values > 75 ml/kg/min were recoded as 75 ml/kg/min 2max . 

Serum 25(OH)D was assessed with the Diasorin assay. The Pearson correlation was 

used to examine the bivariate association between CRF and serum 25(OH)D. SPSS 

Complex Samples general linear model was used to adjust for potential covariates and 

account for the complex sampling design of NHANES. Means and standard errors for 

descriptive statistics were calculated using Complex Samples. 

rEsuLTs: CRF, serum 25(OH)D, and covariate data were available from 5,392 

participants from the 2001-2002 and 2003-2004 NHANES (out of 21,161). 

Approximately 48% of the sample was female, and the average age and BMI were 28.9 

± 0.2 years and 26.0 ± 0.1 kg/m2. Mean serum 25(OH)D was 24.8 ± 0.3 ng/ml, with 

33.4% classified as deficient (< 20 ng/ml). Mean VO2max was 40.4 ± 0.3 ml/kg/min. 

Serum 25(OH)D was significantly positively correlated with estimated VO2max (r = 

.099, p < .001). In a multivariate model including age, gender, race/ethnicity, season 

(winter vs. summer), self-reported physical activity, and BMI, serum 25(OH)D was not 

significantly associated with estimated VO2max (Beta = .03, p = .277). However, when 

classifying serum 25(OH)D in terms of deficiency (< 20 ng/ml), there was a significant 

effect, with deficient participants having a 1.14 ml/kg/min lower estimated VO2max 

(p = .005). 

CONCLusIONs: Among healthy individuals, 25(OH)D analyzed as a continuous 

measure is not significantly associated with CRF after adjusting for relevant covariates. 

In contrast, when analyzed in terms of deficiency, 25(OH)D does show a significant 

association with CRF, although the clinical significance is unknown. 

1657 Board #249 May 30, 2:00 PM - 3:30 PM 

If you Build It, Who Will Come? analysis of 1710 activity 

areas in 50 Community Parks 

Thomas L. McKenzie, FACSM 1 , Deborah A. Cohen 2 , 

Williamson Stephanie 2 , Terry Marsh 2 , Kathryn P. Derose 2 . 1 San 

Diego State University, San Diego, CA. 2 RAND Corporation, 

Santa Monica, CA. 


Community parks are important resources for population level leisure time physical 

activity (PA), especially for those in low-income areas. Few studies have examined 

how specific activity area types within parks serve community residents. 

PurPOsE: To assess relationships among park area/facility types and observed area 

and user characteristics (e.g., PA, gender, and age, race/ethnicity). 

METhOds: Trained observers used the System for Observing Physical Activity and 

Recreation in Communities (SOPARC) to assess the use and PA of 1710 activity areas 

in 50 parks that served a wide diversity of racial/ethnic groups and income levels in 

Los Angeles. Each area was observed 4 times/day for each day of the week (7d). 

rEsuLTs: We made 47,732 activity area visits and observed 104,101 park users, 

including children (32%), adolescents (14%), adults (51%), and seniors (4%). Over 60 

activity area types were seen; all parks had playgrounds, and most had gymnasiums 

(92%), outdoor basketball courts (88%), and baseball/softball fields (80%). Areas 

were accessible (91%) and usable (98%) most of the time, but rarely equipped (3%), 

supervised (2%), or organized (2%) and were often empty (67%). Area types were used 

differentially by gender, age, and race/ethnicity groupings. Most park visitors were 

male (62%), and they dominated sport facilities, including basketball (91%), soccer 

(82%), and baseball/softball (71%) areas and accrued greater person-MET values than 

females in all areas except playgrounds (overall observed number x MET intensity = 





159,191 vs. 88,900). Males were less sedentary (overall, 58% vs. 66%), and engaged 

in more vigorous PA in all area types (overall, 15% vs. 11%). Few seniors (4%) used 

parks, but were more prevalent on walking paths (8%), picnic areas (11%), and tennis 

courts (13%). 

CONCLusIONs: Findings shed light on how specific spaces in community 

parks serve area users. Sport facilities and programs dominated all 50 parks, and 

differentially served males. Facilities were unused most of the time; strategic 

programming might attract more users, especially females and seniors who were 

underserved. 

Supported by Grant R01HL083869 

D-53 Thematic Poster - Functional Rehabilitation 

May 30, 2013, 3:15 PM - 5:15 PM 

Room: 207 

1717 Chair: Tamerah Hunt. The Ohio State University, Columbus, OH. 


1718 Board #1 May 30, 3:15 PM - 5:15 PM 

Physical Training- related Injuries and Illnesses In a 

sergeants Major academy Class 

Ludmila M. Cosio-Lima 1 , Kathleen Brown 2 , Katy Reynolds 1 , 

Ricky A. Perry 1 . 1 University of West Florida, Pensacola, FL. 

2 U.S. ARMY (retired), U.S. ARMY (retired), MA. 


PurPOsE: This study examined the incidence of and risk factors for training injuries 

and illnesses for 149 male and female U.S. Army Sergeants Major Academy (SGMA) 

students. 

METhOds: This was a retrospective report based in data collected during the 

9.5-month training program. Only data from injuries and illnesses incurred during 

physical fitness training were included in the present study. 

rEsuLTs: During this time period, 49.7% (74/149) of the students were injured at 

least once. The crude incidence rate (initial injuries) was 5.2 injuries (68.9%), and 

accounted for a total of 1749 limited duty days. The three most common overuse 

injuries were pain, muscle strain, and tendinitis/bursitis. For illnesses, 63.1% (94/149) 

of the SGMA students had one or more illness visits to a medical treatment facility. 

The crude incidence rate (initial illnesses) was 6.6 illnesses per 100 soldiers per 

month. Infectious illnesses was the most frequent illness category reported (48.3%), 

and 94 students had a total of 311 days of illness-associated limited duty days. The 

most frequent types of infectious illnesses were bacterial and viral and these illnesses 

primarily affected the respiratory system. 

CONCLusIONs: Major conclusions drawn from this study include the following 

1) musculoskeletal injuries were the major cause of limited duty days during physical 

fitness training, 2) overuse lower extremity and lower back injuries were the most 

commonly reported injuries, 3) respiratory bacterial and viral infectious illnesses were 

the most commonly reported illnesses, 4) alcohol consumption was a risk factor for the 

development of infectious illnesses, 5) smoking was associated with slower 2-mile run 

times when compared with nonsmokers, and 6) smokers had higher cholesterol levels 

than nonsmokers. 

1719 Board #2 May 30, 3:15 PM - 5:15 PM 

reach asymmetry during y-Balance Test associated with 

Injury in division I athletes 

Craig Smith 1 , Nicole J. Chimera 2 , Ryan Pinson 1 , Meghan 

Warren 1 . 1 Northern Arizona University, Flagstaff, AZ. 2 Daeman 

College, Amherst, NY. 


The Y Balance Test (YBT) is a screen of single leg balance assessed with stance leg 

stability while the contralateral leg reaches in anterior (ANT), posteromedial (PM), 

posterolateral (PL) directions. YBT composite score (CS) and ANT asymmetry have 

been associated with future injury in high school athletes, but research is needed to 

support YBT use in college athletics. 

PurPOsE:To determine the association between YBT CS and asymmetrical reach 

distances with non-contact and overuse injury in Division I (DI) collegiate athletes 

during an athletic season. 

METhOds: 184 DI athletes (20.2 ± 1.5 yrs, 1.78 ± 0.11 m, 80.2 ± 21.1 kg), injury 

free at the time of testing, performed the YBT to determine asymmetry (absolute 

difference between legs in ANT, PL and PM), and CS (summed average of right and 

left ANT, PM and PL normalized to leg length). Athletic trainers recorded injury 

throughout the season that caused the athlete to report to the athletic training room. 

Contact injuries were excluded from analysis. Sensitivity (SN) and specificity (SP) at 

different cut-points (94, 98, 101, 104, 106% for CS and 1, 2, 3, 4, 5 cm for asymmetry) 

were calculated, and ROC curves were created to determine best cut-points for 


predicting injury. Logistic regression models were used to determine the odds of injury 

with CS and asymmetry. Previous injury and sport were included as confounders. 

rEsuLTs: 81 athletes were injured with no difference in mean CS between injured 

(101.3 ± 7.9%) and not injured (101.2 ± 7.1%; t-test p=0.95). The best cut-points for 

predicting injury were CS < 106% of leg length (SN= 73%; SP=24%) and asymmetry 

> 4 cm (SN=59%; SP=72%). After adjusting for confounders, ANT asymmetry was the 

only variable found to be significantly associated with injury (odds ratio = 0.43, 95% 

confidence interval [0.21-0.87]). 

CONCLusIONs: As found in previous research, only ANT asymmetry was 

associated with increased risk of non-contact and overuse injury in this group of 

athletes. CS was a poor predictor of injury in DI athletes due to low specificity and 

similar scores between injured and non-injured; however, published data of high school 

athletes found females with CS < 94% were at greater risk to be injured. Therefore, 

CS may not be consistent across different ages and not useful for injury screening with 

college athletes. 

1720 Board #3 May 30, 3:15 PM - 5:15 PM 

Individual FMs Tests differ between Collegiate Women 

rowers and soccer Players despite similar Total scores 

Monique Mokha. Nova Southeastern University, Davie, FL. 


Total scores of .05, for all tests except rotary instability (ROW 

2.33+0.48; SOC 2.10+0.31; p=0.38). 

CONCLusION: ROW and SOC performed similarly on the FMSTM. However, more 

individual SOC were at risk for injury, and SOC scored lower on the rotary instability 

test. Examining individual test scores within the FMSTM provides more specific injury 

risk information that can be used for exercise programming. 

1721 Board #4 May 30, 3:15 PM - 5:15 PM 

sex differences In Functional Movement screen and y 

Balance Test In division I Collegiate athletes 

Nicole Chimera 1 , Craig Smith 2 , Meghan Warren 2 . 1 Daemen 

College, Amherst, NY. 2 Northern Arizona University, Flagstaff, AZ. 


The Functional Movement Screen (FMS) and Y Balance Test (YBT) have been 

suggested to predict injury risk. Most literature included only male or adolescent 

participants and only evaluated composite score, (FMS: sum [max 21] of 7 components 

[0-3]; YBT: sum of 3 reach directions normalized as % leg length). Sex differences 

exist in movement patterns; thus, before assuming injury risk is similar it is important 

to evaluate if females and males perform equally on these screens. 

PurPOsE: To determine the effect of sex on FMS composite (CS) and component 

scores and YBT composite score (CS) and asymmetries. 

METhOds: 200 Division I athletes [F: 92; M: 108; 20.0 (1.4) vs. 20.0 (1.5) yrs, 

22.8 (3.1) vs. 27.0 (4.6) kg/m2] were screened for participation (excluded if not in 

correct attire or injured). FMS assessed performance of fundamental (components) 

movements (squat, lunge, hurdle step, straight leg raise [SLR], shoulder mobility, 

trunk stability, rotary stability). YBT assessed stance leg balance while reaching with 

the contralateral limb (anterior [ANT], posteromedial [PM], posterolateral [PL]) and 

asymmetry (absolute difference between limb reach in each direction). Independent 

t-tests established differences in mean FMS CS, YBT CS, and YBT asymmetry; Mann 

Whitney U determined differences in mean ranks of FMS components. 

rEsuLTs: 170 (F: 81; M: 89) participants completed FMS; no difference in mean CS 

(14.3 ± 2.4 vs.14.0 ± 2.5; p = 0.37), deep squat (p = 0.10), or hurdle step (p = 0.871). 

Females performed significantly worse in trunk stability (p < 0.001) and rotary stability 

(p = 0.01), but significantly better in lunge (p = 0.008), shoulder mobility (p < 0.001), 

and SLR (p < 0.001). 190 (F: 87; M: 103) participants completed YBT; no difference 

in mean CS (100 ± 6% vs. 102 ± 8%; p < 0.52). Females demonstrated significantly 

less asymmetry than males in ANT (2.7 ± 2.3 cm vs. 4.3 ± 6.7 cm; p = 0.02); no 

asymmetry differences occurred in PM (3.1 ± 2.7 cm vs. 3.8 ± 3.5 cm; p = 0.14) and 



PL (3.7 ± 2.8 cm vs. 3.6 ± 2.8 cm; p = 0.75). 

CONCLusION: While females and males may perform similarly in FMS and YBT 

CS, differences appear in some FMS components and YBT ANT asymmetry. Females 

performed better on FMS components involving flexibility and balance, but worse on 

components associated with core strength. Researchers should consider sex stratified 

analysis. 

1722 Board #5 May 30, 3:15 PM - 5:15 PM 

Physical Contributors to Glenohumeral Internal rotation 

deficit in high school Baseball Players 

Elizabeth E. Hibberd1 , Casey E. Shutt2 , Sakiko Oyama3 , J. Troy 

Blackburn1 , Joseph B. Myers1 . 1UNC-Chapel Hill, Chapel Hill, 

NC. 2U.S. Army-Baylor University, San Antonio, TX. 3University of Texas- San Antonio, San Antonio, TX. (Sponsor: Kevin 

Guskiewicz, FACSM) 


Glenohumeral Internal Rotation Deficit (GIRD) of the throwing shoulder relative to 

the non-throwing shoulder in baseball players is a risk factor for shoulder and elbow 

injury. Although this evidence forms a basis for recommending stretching exercises 

to prevent injuries, clinical measures of internal rotation range of motion (ROM) do 

not differentiate if GIRD is due to muscular, capsuloligamentous, or bony factors. 

Understanding the contributions of these components is important for the development 

of targeted interventions. 

PurPOsE: The purpose of this study was to determine the extent to which the 

muscular, capsuloligamentous, and bony components contribute to GIRD in high 

school baseball players. 

METhOds: 166 baseball players (age=15.9 ± 1.4yrs, height=178.4 ± 6.5cm, 

mass=74.1±12.2kg) were evaluated on internal rotation ROM (digital inclinometer), 

teres minor, infraspinatus, and posterior deltoid muscle stiffness (muscle compliance 

probe), posterior capsule thickness (diagnostic ultrasound), and humeral retrotorsion 

(diagnostic ultrasound). A side-to-side difference in each variable was calculated 

as dependent variables. Variables were entered into a stepwise linear regression to 

determine the predictors of GIRD, where only variables that significantly contributed 

to the model (p



rEsuLTs: 74 athletes were injured during their sport season. FMS total score was 

not different between those who sustained an injury (14.3±2.5) and those who did 

not (14.1±2.4; p = 0.57). No ROC curve maximized sensitivity and specificity, so 

previous published cut-point of 14 or less (n=92) vs. greater than 14 (n=78) was 

used for analysis with injury (sensitivity = 54%, specificity 46%). After adjustment 

for confounders, no statistically significant association between FMS total score 

(dichotomoized at 14) and injury (odds ratio [OR] = 1.02, 95% confidence interval 

[CI] 0.54 - 2.0) existed. Lunge was the only component that was statistically associated 

with injury; those scoring 3 were less likely to have an injury compared with those 

who scored 2 (OR = 0.21, 95% CI 0.08 - 0.58). 

CONCLusIONs: Using a clinically relevant definition of injury, FMS total score was 

a poor predictor of non-contact and overuse injury in this group of DI athletes. The 

lunge was able to predict injury. 

D-54 Thematic Poster - Injury Epidemiology 

May 30, 2013, 3:15 PM - 5:15 PM 

Room: 208 

1726 Chair: Carlo Baldari, FACSM. University of Rome, Rome, Italy. 


1727 Board #1 May 30, 3:15 PM - 5:15 PM 

The Eagle Tactical athlete Program reduces 

Musculoskeletal Injuries in the 101st airborne division (air 

assault) 

Timothy C. Sell1 , John P. Abt1 , Takashi Nagai1 , Jennifer B. 

Deluzio1 , Mita Lovalekar1 , Michael D. Wirt2 , Scott M. Lephart, 

FACSM1 . 1University of Pittsburgh, Pittsburgh, PA. 2U.S Army’s 

101st Airborne Division (Air Assault), Fort Campbell, KY. 


The Eagle Tactical Athlete Program (ETAP) was scientifically developed specifically 

for the U.S Army’s 101st Airborne Division (Air Assault) to counter the significant 

number of sustained unintentional musculoskeletal injuries. ETAP was previously 

demonstrated to improve human performance characteristics, but the capability of 

ETAP to reduce injuries had not been studied. 

PurPOsE: To determine if ETAP would reduce unintentional musculoskeletal 

injuries in garrison in a group of 101st Airborne Division (Air Assault) Soldiers. 

METhOds: Non-commissioned officers led their respective units during physical 

training following certification in the training components of ETAP as taught during 

an ETAP Instructor Certification School. A total of 1641 Soldiers were enrolled (N = 

1106 experimental group, N = 540 control group) to evaluate changes in injury data. 

Injuries were tracked for 5 months prior to and after ETAP participation during a 

pre-deployment workup phase. ICD-9CM codes were used to categorize preventable 

musculoskeletal injuries (total, regional distribution, acute or overuse). A McNemar 

analysis was conducted to evaluate the effect of ETAP on the overall injury rate within 

each group. 

rEsuLTs: There was a significant reduction in overall injury rates (pre-ETAP: 

209/1106 (18.9%), post-ETAP: 177/1106 (16.0%), p = 0.045) in the experimental 

group while no differences in the control group were found. A reduction in injury rates 

were also observed in overuse injuries and specific injuries to the lower extremity, 

knee, and lumbopelvic region in the experimental group. 

CONCLusIONs: The Eagle Tactical Athlete Program was scientifically designed 

to optimize performance and reduce injuries. The current analysis demonstrated that 

ETAP reduces preventable musculoskeletal injuries in garrison. The capability of 

ETAP to reduce injuries confirms the vital role of a scientifically designed training 

program on force readiness and health. 

Supported by USAMRMC #W81XWH-11-2-0097 

1728 Board #2 May 30, 3:15 PM - 5:15 PM 

association of Physical Fitness assessments and Injury risk 

among u.s. army soldiers 

Timothy T. Bushman, Tyson Grier, Michelle Chervak, Morgan 

Anderson, Bruce Jones, FACSM. United States Army Institute of 

Public Health, Aberdeen Proving Ground, MD. 


PurPOsE: Physical fitness assessments are commonly used to determine an athlete’s 

performance abilities. It has been suggested that such assessments can also be used 

to predict injury risk. To investigate the association of multiple physical fitness 

assessments with injury risk among U.S. Army Soldiers. 

METhOds: Male Soldiers aged 17-58 years completed the Functional Movement 

Screening Test (FMS) (n = 1078), Army Physical Fitness Test (APFT) (n = 1265), 

2-mile run (part of the APFT) (n = 1537), Y-Balance (n = 1135), weighted 300-yard 

shuttle run (n = 367), un-weighted 300-yard shuttle run (n = 1125), crossover hops (n 


= 1132), pull-ups (n = 1033), and vertical jump (n = 1140). Medical record data for 

injuries nine months before and after fitness testing were obtained from the Defense 

Medical Surveillance System; demographic and health behavior data were collected by 

survey. A majority of the fitness assessment variables were categorized into quartiles 

where Q1 = highest performance and Q4 = lowest performance. Multivariate odds 

ratios (OR) and 95% confidence intervals (95% CI) were calculated. 

rEsuLTs: After controlling for age, body mass index (BMI), smoking, and previous 

injury; higher injury risk was associated with: FMS total score (OR(≤14/19-21)=1.62, 

95%CI 1.04-2.54), Y-Balance posteromedial difference (OR(≥7.01 centimeters/≤2.00 

centimeters)=1.53, 95%CI 1.02-2.28), and un-weighted 300-yard shuttle run 

(OR(≥73.81 seconds/≤66.00 seconds)=1.86, 95%CI 1.19-2.91). Controlling for the 

same variables, higher overuse injury risk was associated with: FMS total score 

(OR(≤14/19-21)=1.86, 95%CI 1.13-3.05), (OR(15-16/19-21)=1.67, 95%CI 1.02-2.72), 

Y-Balance posteromedial difference (OR(≥7.01 centimeters/≤2.00 centimeters)=1.91, 

95%CI 1.21-3.00), and un-weighted 300-yard shuttle run (OR(≥73.81 seconds/≤66.00 

seconds)=2.00, 95%CI 1.22-3.28). 

CONCLusIONs: The FMS, Y-Balance, and un-weighted 300-yard shuttle run had 

the highest risk for those who performed poorly or had asymmetries. These tests may 

help identify Soldiers at risk of musculoskeletal injuries, such that interventions can be 

put into place to reduce injury risk. 

1729 Board #3 May 30, 3:15 PM - 5:15 PM 

The utility of accessing Emergency department data for 

sport and recreational Injury surveillance 

Alex F. Howard, Julia F. Costich, Carl G. Mattacola, Svetla S. 

Slavova, Heather M. Bush, F. Douglas Scutchfield. University of 

Kentucky, Lexington, KY. 


Participation in sport and recreational physical activity carries with it an inherent risk 

of injury, thereby necessitating the need for injury prevention efforts and identification 

of risk factors. Surveillance systems are an effective means to identify injury risk 

factors and develop appropriate injury prevention services. In 2009, Kentucky’s 

Governor, Steve Beshear, signed into law House Bill 383 which called for a safety 

assessment of all interscholastic athletics in Kentucky’s high schools and middle 

schools. This action reiterated the importance of a dedicated sport injury surveillance 

system (SISS); however, this legislative action was never implemented, prompting an 

examination of injury risk factors, using emergency department data. 

PurPOsE: To investigate the epidemiology of sport and recreational injury (SRI) 

among middle and high school-aged Kentucky youth, using a population-based 

surveillance technique. 

METhOds: We analyzed unintentional injuries from the 2008-2010 Kentucky 

emergency department (ED) administrative records for patients age 10-18 using 

descriptive statistics. SRIs were identified based on external codes of injuries 

(E-codes), according to International Classification of Diseases, Clinical Modification, 

ninth revision (ICD-9-CM). 

rEsuLTs: A total of 135,287 ED visits occurred between 2008-2010, of which 

28,225 (20.9%) were related to participation in physical activity. Males accounted 

for 73.1% of SRIs, with overall injury events peaking at age 14 for this age group. 

The primary mechanisms for SRIs were being struck by or against something (55%), 

falls (21.2%), cycling (12.2%), and overexertion ( 8.1%). Superficial contusions and 

abrasions (32.9%), sprains and strains (30.2%), and fractures (14.6%) were the primary 

ED diagnoses, and the total charges billed for SRIs were more than $31.7 million, or 

21.2% of the total charges billed for all unintentional injuries. 

CONCLusIONs: The present study illustrates the use of ED data, specifically 

E-codes, as surveillance tools to provide information on the distribution of injuries, 

risk factors for injury, and an estimate of their economic impact. In the absence of a 

dedicated SISS, ED data could be used to inform decision making about youth sports 

and physical activity related injuries and their prevention. 

1730 Board #4 May 30, 3:15 PM - 5:15 PM 

What are The risk Factors For running-related 

Musculoskeletal Injuries? a systematic review 

Bruno T. Saragiotto, Tiê P. Yamato, Luiz Carlos Hespanhol 

Junior, Alexandre Dias Lopes. Universidade Cidade de São 

Paulo, São Paulo, Brazil. 


The number of runners has grown significantly over the past decade and the health 

benefits of running are already well known. However, the number of running injuries is 

high. Despite several studies have been conducted on running injuries, the risk factors 

for running-related injuries is still not clear in the literature. 

PurPOsE:The aim of this study is to systematically review the risk factors for 

overall running-related musculoskeletal injuries. 

METhOds:: We conducted an electronic search on EMBASE (1981 to May 

2012), MEDLINE (1973 to May 2012), SPORTDiscus (1977 to May 2012), Latin 

American and Caribbean Centre on Health Sciences Information (LILACS) (1986 to 

May 2012) and Scientific Electronic Library Online (SCIELO) (1998 to May 2012) 

databases, without a limit on date of publication. Only prospective studies aimed to 



investigate the risk factors for running-related injuries were included in this review. 

We excluded articles that studied specific injuries on running (e.g. stress fractures), 

studies aimed to analyse risk factors and/or injuries of other sports (e.g. triathlon) and 

studies comparing the effectiveness of interventions on running injuries or prevention 

programs. Each article was screened by three independent reviewers and, if they did 

not reach a consensus, a fourth reviewer decided whether or not the article should be 

included. The risk factors were divided into intrinsic and extrinsic factors. 

rEsuLTs:A total of 1934 studies were found through the database search. After the 

analysis of the title, abstract and full text 12 articles were eligible to be included in 

this systematic review. The main intrinsic risk factor reported was previous injury in 

the past 12 months and the main extrinsic factor reported was weekly running distance 

more than 64 km. BMI, age and running experience showed conflicting results. 

Biomechanical factors, behaviour and running shoes showed limited evidence, i.e. few 

studies reported an association with running injuries. There was no evidence for an 

association between stretching and running injuries. 

CONCLusIONs:The main risk factors identified in this review were previous injury 

and weekly running distances. We observed that majority of risk factors are still 

inconclusive, which reflects the lack of prospective studies investigating risk factors on 

running injury 

1731 Board #5 May 30, 3:15 PM - 5:15 PM 

Physical activity Injuries: Not so Bad after all! 

Erica N. Howard 1 , Laura F. DeFina 1 , Michelle A. Custodio 1 , 

James R. Morrow, FACSM 2 . 1 The Cooper Institute, Dallas, TX. 

2 University of North Texas, Denton, TX. 


PurPOsE: Increased injury rates have been associated with increased physical 

activity (PA); however, it is not known if the types of musculoskeletal injuries (MSI) 

resulting from PA are substantially different from those occurring within the same 

timeframe, yet are unrelated to PA. The purpose of this study is to qualitatively and 

quantitatively describe the pattern of PA and non-PA MSI incurred by communitydwelling 

women. 

METhOds: Data were extracted from The Women’s Injury Study (WIN), a 

web-based observational study that tracked PA behaviors and self-reported MSI of 

community-dwelling adult women during 2007-2009. Data were collected via a 

secure website where participants reported weekly PA and injury occurrence. An MSI 

was defined as “an injury (new, old, or recurrent) this week that caused you to see a 

health care provider or interrupt your daily activities for 2 or more days.” Follow-up 

telephone reporting of a PA-related MSI including body part, self-treatment, specific 

activity, and other relevant information provided the opportunity to fully describe the 

MSI. 

rEsuLTs: A total of 323 and 330 musculoskeletal injuries were reported during PA 

and non-PA events respectively across 83,241 person-weeks of reporting. Communitydwelling 

women injured during non-PA events were more likely to incur injuries of 

the head/jaw/neck; however, lower limb injuries were the most prevalent PA-related 

MSI. The risk of injury coming “...on suddenly with no apparent cause” was 54% for 

non-PA MSI vs. 8% for PA-related MSI. Reported PA-related MSIs were generally 

minor and less likely to require treatment from health care providers (60% vs. 80%) 

and resulted in less initial reporting of missed days of work/school (11%) compared to 

non-PA MSIs (17%). 

CONCLusION: Overall, the nature of MSIs occurring during PA is not dramatically 

different than MSIs reported during community-dwelling non-PA behaviors. This 

provides additional validation of the important role that PA behaviors can have on 

quality of life without substantially increasing the MSI risk beyond that in general 

living activities. 

This work was supported in part by a grant from the National Institute of Arthritis and 

Musculoskeletal and Skin Diseases R01 

AR052459. 

1732 Board #6 May 30, 3:15 PM - 5:15 PM 

Incidence, Mechanisms, and severity of Collegiate Women’s 

soccer Injuries on artificial Turf Versus Natural Grass 

Michael C. Meyers, FACSM. College of Western Idaho, Nampa, 

ID. 

Supported by M.C. Meyers: Contracted Research - Including Principle 

Investigator; Partial support by FieldTurf, USA. 

Numerous injuries have been attributed to playing on artificial turf. Newer generations 

of artificial turf, however, were developed to duplicate the playing characteristics 

of natural grass. Minimal long-term studies have been conducted comparing matchrelated 

collegiate women’s soccer injuries between the two surfaces. 

PurPOsE: To quantify incidence, mechanisms, and severity of match-related 

collegiate women’s soccer injuries on artificial turf versus natural grass. 

METhOds: A total of 13 universities were evaluated over 5 competitive seasons for 

injury incidence, injury category, time of injury, injury time loss, player position, injury 

mechanism and situation, primary type of injury, injury grade and anatomical location, 

field location at time of injury, injury severity, head and lower extremity trauma, cleat 

design, turf age, and environmental factors. 


rEsuLTs: A total of 797 collegiate matches were evaluated for soccer injuries 

sustained on artificial turf or natural grass during 5 seasons, with 355 team matches 

(44.5%) played on artificial turf versus 442 team matches (55.5%) played on natural 

grass. A total of 693 injuries were documented, with 272 (39.2%) occurring during 

play on artificial turf, and 421 (60.8%) on natural grass. Multivariate analysis per 

10 team matches indicated a significant playing surface effect, F 2,690 = 6.435, 

P = .002, n - β = 0.904. Significantly lower total injury incidence rates (IIR), 7.7 

(95% confidence interval [CI], 7.2-8.1) versus 9.5 (95% CI, 9.3-9.7, P = .0001), and 

substantial IIRs, 0.7 (95% CI, 0.5-1.0) versus 1.5 (95% CI, 1.2-1.9, P = .001), were 

documented on artificial turf versus natural grass, respectively. Analyses also indicated 

significantly less trauma (P = 0.040 to 0.0001) on artificial turf when comparing injury 

time loss, player position, injury situation, injury grade, injuries under various field 

conditions and temperature, cleat design and turf age. 

CONCLusION: Although similarities existed between artificial turf and natural grass 

during competitive match play, artificial turf is a practical alternative when comparing 

injuries in collegiate women’s soccer. It must be reiterated that the findings of this 

study may be generalizable to only collegiate women’s competition and this specific 

artificial surface. 

D-55 Thematic Poster - Mechanics of Strike 

Patterns in Running 

May 30, 2013, 3:15 PM - 5:15 PM 

Room: 104 

1733 Chair: Irene Davis, ACSM. Harvard Medical School, Boston, MA. 


1734 Board #1 May 30, 3:15 PM - 5:15 PM 

No differences in self-reported Injuries or Performance 

Between Characterized Foot-strike Patterns amongst us 

army soldiers 

Bradley J. Warr 1 , Rebecca E. Fellin 1 , Peter N. Frykman 1 , 

Shane G. Sauer 1 , Donald L. Goss 2 , Joseph J. Seay 1 . 1 U.S. Army 

Research Institute of Environmental Medicine, Natick, MA. 

2 U.S. Army/Baylor University Physical Therapy Program, San 

Antonio, TX. (Sponsor: Dr. Edward J. Zambraski, FACSM) 


There is currently little data characterizing Soldiers’ foot-strike (FS) patterns and 

the potential relationship to running related injuries and performance. Literature has 

characterized FS pattern distribution in marathon runners reporting a heel-strike (HS) 

prevalence of 75%-94% in marathoners, with the remainder (6-25%) exhibiting a midfoot 

or fore-foot pattern (non heel-strike, NHS). Recent studies have reported that NHS 

runners had fewer running related injuries and better performance. 

PurPOsE: To characterize the distribution of FS patterns in US Army Soldiers and 

determine if FS patterns are related to self-reported running injuries and performance. 

METhOds: 342 male Soldiers (24.7±5.1 y/o, 177.3+7.3 cm, 81.7+16.9 kg) from a 

US Army Combined Arms Battalion completed a FS analysis and survey. Multiple 

foot-strikes were recorded in the sagittal plane using a high-definition video camera 

as each Soldier ran through a designated lane at a typical training pace. Soldiers 

then completed a survey related to training habits and injury history. The association 

between FS and the occurrence of a running-related injury was analyzed using a Chisquared 

test. Kruskal-Wallis test evaluated relationship between reported days that 

training was modified due to injury as well as 2-mile run time between Soldiers with 

NHS and HS patterns. 

rEsuLTs: 13% of the participating Soldiers were characterized as NHS runners 

and 87% were characterized as HS. There was no significant difference (p≥.05) in the 

percentage of Soldiers reporting a running-related injury between those characterized 

with a NHS versus a HS (55.6 v 51.0%). There were no significant difference between 

NHS pattern versus HS pattern in the number of days training was modified due to 

injury (21.8±78.4 v 13.9±49.5 days/yr), or 2-mile run time (14.8±1.6 v 14.8±1.7 min). 

CONCLusIONs: This cohort of US Army Soldiers demonstrated a prevalence of 

HS similar to what has previously been reported in marathon runners. Based on this 

preliminary analysis, neither FS pattern is advantageous in terms of impact on selfreported, 

retrospective injury or performance. 





1735 Board #2 May 30, 3:15 PM - 5:15 PM 

Foot strike Pattern during a 161-km ultramarathon 

Mark E. Kasmer 1 , Jeremy J. Wren 2 , Martin D. Hoffman, 

FACSM 3 . 1 Medical College of Wisconsin, Milwaukee, WI. 

2 University of California - Davis, Sacramento, CA. 3 VA Northern 

California Health Care System and University of California - 

Davis, Sacramento, CA. 


PurPOsE: The purpose of this study was to characterize the foot strike pattern of 

ultramarathon runners during a 161-km mountain trail run; examine the effect of 

fatigue on foot strike pattern; examine the effect of a downhill gradient on foot strike 

pattern; determine if foot strike pattern is related to performance; and ascertain if postrace 

blood creatine phosphokinase (CK) concentrations differ by foot strike pattern. 

METhOds: Foot strike pattern was determined for race participants of the 2012 

Western States Endurance Run at three level sites and one downhill site (9% gradient). 

Post-race blood samples were collected immediately after finishing and analyzed for 

CK concentration. Chi-square analyses were used to compare foot strike patterns at 

each level site with prior published data from road marathons. Finish time and blood 

CK concentration were compared among foot strike group categories for each filming 

location and collectively across all three sites with Kruskal-Wallis tests followed by 

Dunn’s multiple comparison post-tests as data did not pass the normality test and could 

not be successfully normalized. 

rEsuLTs: Observed rear-foot strike (RFS) prevalence was 79.9% at 16.5 km, which 

was less than (p=0.02) previously observed in one study at a road marathon. RFS 

prevalence increased significantly to 89.0% at 90.3 km (n=246, p=0.04), then decreased 

significantly to 83.9% at 161.1 km (n=225, p=0.03). RFS prevalence was 84.8% at the 

downhill site (90.7 km), which was not significantly different (p=0.8) from the level site 

at 90.3 km. There was no significant effect (p=0.3) of foot strike pattern on performance. 

There was a trend toward greater blood CK values among non-RFS compared to RFS 

runners, reaching statistical significance (p


models to estimate internal knee loads during running, and have shown that increasing 

step rate (i.e. shortening step length) can reduce patellofemoral (PF) loading. However, 

many clinics do not have sophisticated modeling technology available, and would 

benefit from a simpler way to assess PF loads. 

PurPOsE: To determine what kinematic and kinetic variables predict PF loads when 

running. 

METhOds: 30 healthy runners (35±15 yrs, 69.6±10.8 kg, 1.76±0.10 m) had 

whole body kinematics and ground reaction forces measured while running on an 

instrumented treadmill. Each ran at his/her preferred speed (2.79±0.48 m/s) at three 

step rates: 90, 100, and 110% of preferred. Running mechanics were analyzed using 

a musculoskeletal model that included a 1-degree of freedom PF joint. Inverse 

kinematics and dynamics were used to compute joint angles and moments. Numerical 

optimization was then used to estimate muscle, patellar tendon and joint reaction 

forces. Peak PF force was calculated over five strides from each condition. A forward 

step-wise fitted repeated measures-ANOVA model was created with PF force per unit 

body weight as the response variable. 

rEsuLTs: PF force was significantly increased (+15%) at the 90% step rate, and 

decreased (-14%) at the 110% condition (p



compared to 85% VO2max (2.54 ± 0.73 vs. 2.01 ± 0.45 ml min-1 mmHg-1, resp). 

CVC increased (p 0.05) for both conditions. The amount of RMF was related (r=0.61; p 0.05) 

between the ΔFEV1% pre-post exercise and %EFL at VO2max. However, in children 


that demonstrated clinically relevant EIB (i.e.,>10% decrease in FEV1; n=22), there 

was a significant relationship (r = 0.66, p < 0.05) between EIB and EFL. In study 

two (n=16), with training, children improved pre-post exercise ΔFEV1% (pre:-7.60 ± 

2.10%, post:-1.10 ± 1.80%, p < 0.05). There was an association between ΔFEV1% and 

Δ%EFL from pre- to post-training (r = 0.77, p < 0.05) in the TRG only. 

CONCLusION: These data suggest that pre-adolescent children who exhibit 

clinically relevant EIB also demonstrate the most severe expiratory flow limitation 

during exercise. With exercise training, reductions in EIB are associated with reduced 

EFL. These findings may be important in prevention and treatment of exercise 

intolerance in pre-adolescent children. 

1746 Board #4 May 30, 3:15 PM - 5:15 PM 

Peak Oxygen uptake differs Between Obese Women With 

Vs. Without dyspnea On Exertion 

J. Todd Bassett, Vipa Bernhardt, Santiago Lorenzo, Raksa 

B. Moran, Sarah F. Haller, Jessica M. Pineda, Tony G. Babb, 

FACSM. Institute for Exercise and Environmental Medicine, 

Texas Health Presbyterian Hospital Dallas and University of 

Texas Southwestern Medical Center, Dallas, TX. 


PurPOsE: During constant load exercise, some otherwise healthy obese women 

experience dyspnea on exertion (+DOE), while others do not (-DOE). In previous 

studies, we observed exercise capacity to be similar in -DOE and +DOE. We 

questioned whether this would remain true if we sampled a larger number of obese 

women. 

METhOds: To investigate, we recruited 80 otherwise healthy obese women who 

were divided into groups based on their Ratings of Perceived Breathlessness (RPB, 

Borg 0-10 scale) at the end of 6 minutes of constant load cycling (60W), as in prior 

studies. 24 women were designated as -DOE (RPB≤2, 32±8 yr, 37±4 BMI, mean±SD) 

and 34 women were classified as +DOE (RPB≥4, 34±7 yr, 36±5 BMI). 22 women 

with RPB=3 were excluded to better delineate the groups. Peak oxygen uptake was 

determined during maximal incremental cycle ergometry. Data were analyzed between 

groups by independent t-test. The relationship between variables was determined by 

linear regression analysis. 

rEsuLTs: While peak oxygen uptake was within normal limits in both groups, 

exercise capacity (as % of predicted) was greater (p


ERS guidelines. Maximal inspiratory and expiratory pressures were also determined. 

Data were analyzed between groups by independent t-tests. The relationships between 

variables were determined by linear regression analysis. 

rEsuLTs: There were no meaningful relationships between pulmonary function 

parameters and RPB during constant load cycling within the groups or when 

combined. Differences in maximal voluntary ventilation between the -DOE (112±13) 

and +DOE (104±15) groups approached significance (p=0.0553). Only maximal 

expiratory pressure reached significance (p=0.0258) between the groups (108±26 

%predicted and 94±22, respectively). 

CONCLusION: As in previous studies, pulmonary function, with only a few 

exceptions, does not differ between otherwise healthy obese women without vs. with 

DOE. 

Supported by NIH Grant Funding #HL096782 and The King Charitable Foundation 

Trust. 

1748 Board #6 May 30, 3:15 PM - 5:15 PM 

Impact of Expiratory Flow Limitation on Performance at 

simulated altitude 

Joshua C. Weavil, Jonathon L. Stickford, Joseph W. Duke, 

Robert F. Chapman, FACSM, Joel M. Stager, FACSM, Timothy 

D. Mickleborough, FACSM. Indiana University, Bloomington, 

IN. 


Many athletes exhibit expiratory flow limitation (FL) during heavy exercise and 

consequently may be additionally challenged when exercising at moderate altitude. 

PurPOsE: To determine how FL affects aerobic performance at modest altitude. 

We hypothesized that NFL athletes will be at a competitive advantage where altitudeinduced 

declines in SaO2 present less of a consequence than the coincident increases 

in ventilation and work of breathing experienced by the non-flow limited athlete. 

METhOds: Flow limited (FL n=7) and non-flow limited (NFL n=7) male cyclists 

performed three 5-km time trials on a Velotron cycle ergometer on separate days. 

Expired gases were measured at rest and throughout each time trial. Participants 

performed a familiarization trial followed by a single-blinded normoxic (FiO 2 = 0.21) 

and hypoxic (FiO 2 = 0.17, approximately 2000m altitude) trial in random order. Time to 

completion (T TT ) and average power output (P TT ) were used to assess performance. 

rEsuLTs: Metabolic, ventilatory, and performance measures were similar between 

groups (FL vs. NFL) in normoxia. However, when comparing the normoxic and 

hypoxic trials, the FL group had a significantly smaller (p



collegiate runners during treadmill locomotion. 

METhOds: Subjects gave informed consent to procedures approved by the 

Eastern Michigan University CHHS Human Subject Review Committee. 9 female 

(22.4±2.2yr, 52.2±5.5kg, 55.9±6.8ml/kg/min) and 8 male NCAA D-I intercollegiate 

runners (23.6±2.2yr, 69.1±5.9kg, 67.4±6.7ml/kg/min) performed incremental 

VO2max trials while wearing lumbar mounted HRA (Microstrain, VT; 617 Hz). 

Aggregate acceleration for VT, AP, and ML axes were recorded and Euclidian 

resultants were computed (RES). Trials started at 8kph and increased 2 kph every 3 

min until exhaustion. Group comparisons were made from 12-16 kph, as all subjects 

completed these stages. Axial root mean square (RMS) and ratio of RMS/RES (RA) 

were compared between women and men to identify differences in running mechanics 

between groups. Expired gases were collected using an Oxycon Mobile (Viasys, CA). 

VO2 and RER were used to determine O2 cost (O2C) and energy expenditure (EE). 

MANOVAs were performed using PASW 17.0 (SPSS, IL) α = 0.05. 

rEsuLTs: VT (p=0.032) and VT ratio (VT/RES) (p=0.002) were significantly lower 

in women than men. ML and AP accelerations were not significantly different between 

groups. During tests, VO2, RER, O2 Cost, and EE were significantly higher for women 

(46 ml/kg/min, 1.00, 180.87 ml/kg/min, 0.913 kcal/kg/min) compared to men (43.728 

ml/kg/min, 0.924, 161.9 ml/kg/min, 0.799 kcal/kg/min) across all speeds. 

CONCLusION: These data show that women accelerate less in the VT axis than 

men. At the same time, they are less metabolically economical in all measures (VO2, 

RER, O2C, and EE) then men. Therefore, gender differences in running economy 

between similarly trained runners could come more from the VT accelerations rather 

than the AP or ML. 

1753 Board #3 May 30, 3:15 PM - 5:15 PM 

Precooling By Ice slurry Ingestion reduces Core 

Temperature and Thermal sensation during 5km running 

Emily J. Sauers, Nicole A. Lisicky, Donald Cummings, Molly 

Winke, Chad A. Witmer, Shala E. Davis, FACSM. East 

Stroudsburg University, East Stroudsburg, PA. 


Previous evidence suggests that precooling an athlete’s core temperature prior to 

physical activity may reduce the negative effects of heat on performance 

PurPOsE: The purpose of the present study is to examine the impact of pre-race 

ice slurry ingestion on core temperature and performance in competitive well-trained 

runners. 

METhOds: The subjects in this study included 14 competitive male (n=11; age: 

28.00±1.7yrs; height: 69.50±1.4in; weight: 70.42±2.7kg; body fat: 10.92±1.4%; 

VO2max: 67.70±1.9 ml/kg/min) and female (n=3; age: 33.00±5.0yrs; height: 

65.00±0.6in; weight: 58.4±2.9kg; body fat: 15.87±1.7%; VO2max: 58.57±2.3ml/ 

kg/min ) distance runners currently involved in an endurance-training program. All 

runners completed two 5km race, consuming either cold water (CW; 4°C) or an ice 

slurry (IS; -1°C) prior to the trial. Core temperature was recorded using an ingestible 

capsule containing a radiotelemetry temperature sensor (VitalSense System, Philips 

Respironics, Bend, Oregon) 4 hours before each race. Thermal sensation was assessed 

prior to warm-up, after warm-up, and immediately after trial completion. Urine 

specific gravity will be determined by refractometer (Antago, Bellvue, WA). A oneway 

repeated measures ANOVA was used to evaluate performance, core temperature, 

thermal sensation and RPE. Significance was defined as p


5 mph,tests started at 7 mph and increased speed by 1 mph every 2 min till voluntary 

exhaustion and were separated by a minimum of 7 days. LT tests started at 5 mph and 

increased speed to 6, 7, 7.5, 8.0, 8.5, 9.0 (additional stages increase speed by 0.5 mph) 

every 3 min until the subject reached ≈85% of. LT tests were separated by a minimum 

3 days. Plasma lactate concentrations were determined from venous blood samples (4 

ml) obtained at rest and during the last minute of each exercise stage. Lactate threshold 

was determined from a log-log plot of lactate concentration (mM) and relative (ml 

O2•min-1•kg-1 BW). Results. determined during running at 100% and 80% loading 

were similar ( 52.3 ± 0.9 and 52.7 ± 0.7 ml O2•min-1•kg-1 BW, respectively). The 

energy cost of running at 9 mph (all subjects completed stages between 5 and 9 

mph) was reduced by 12% at 80% body weight (37.2 ± 2.9 ml O2•min-1•kg-1 BW) 

compared to running at 100% body weight (42.3 ± 1.7 ml O2•min-1•kg-1 BW, 

p



providing an antagonistic force that resists joint translation. 

PurPOsE: To determine if differences in dorsiflexion (DF) and plantar flexion (PF) 

isokinetic strength exist between subjects with self-reported ankle instability (AI), a 

coper (COP) group, and healthy (HEA) subjects free from previous ankle injury. 

METhOds: A total of 135 (65 females & 70 males) intercollegiate athletes were 

screened prior to the beginning of their athletic careers. Using CAIT scores, subjects 

were divided into AI (32), COP (46), and HEA (57) categories. Isokinetic strength 

assessment included tests of peak torque (PT) at 30 and 120 deg/sec and involved both 

concentric (CON) and eccentric (ECC) muscle actions. A between groups ANOVA 

was conducted using normalized (lean body mass) PT to determine if differences in 

isokinetic strength existed between the 3 groups. 

rEsuLTs: For contrast, the raw PT values regardless of group status 

averaged (Mean±SD in Nm) DFCON30=49.7±16.9, DFECC30=71.9±23.0, 

DFCON120=32.2±13.2, DFECC120=74.9±24.5, PFCON30=157.3±53.8, 

PFECC30=235.0±83.2, PFCON120=96.7±34.8, PFECC120=126.2±41.3. There was a 

significant difference in the normalized PT ratios between the groups for DFCON120, 

with those in the HEA group (.24±.09) having higher ratios (stronger) than either the 

COP (.21±.06) and AI groups (.20±.05). There were no significant differences between 

any of the other 7 measures of isokinetic strength. 

CONCLusION: This is the first large scale strength study to involve a COP group 

of subjects who have suffered an ankle injury, but have not developed AI. DF strength 

deficits were evident in the AI and COP groups at the highest isokinetic velocity tested; 

indicating quite possibly a functional discrepancy between the groups. This finding 

has implications for the clinician in dealing with both AI and COP patients; high speed 

strength redevelopment may be of extreme importance. 

1761 May 30, 3:30 PM - 3:45 PM 

Time Trial Pacing Characteristics Of Junior Team sport 

Players 

David B. Pyne, FACSM1 , Philo U. Saunders1 , Michael J. 

Davies1 , James P. Veale2 , Markus U. Deutsch3 . 1Australian Institute of Sport, Belconnen, Australia. 2Australian Football 

League, Melbourne, Australia. 3Fusion Sport Pty Ltd, Brisbane, 

Australia. 


Time trials are occasionally used in field-based team sports to assess the endurance 

fitness of players. Anecdotally it appears some junior team sport players are naïve to 

pacing strategies underpinning optimal running performance. 

PurPOsE: To characterize relationships between 3 km time trial performance and 

variability in pacing, and between manual (stopwatch) and automated (RFID timing 

system) timed splits. 

METhOds: Junior Australian Football players (males n=64, age 19 ± 1 y; height 1.88 

± 0.08 m; mass 81 ± 8 kg; mean ± SD) were tested during the annual National Draft 

Combine. Splits times for the 3 km time trial over the six laps were recorded both 

manually and with an automated chip system outdoors (18 ºC, 50% humidity) on a 

non-standard distance (476 m) synthetic running track. 

rEsuLTs: The final 3 km time was 11:09 ± 0:47 min:s (mean ± SD) with a 

coefficient of variation (CV) in pacing of laps of 6.5% ± 2.3%. Players exhibited the 

classic fast start and end spurt pattern in split times - the first lap was 8.5%, ±0.7% 

(mean, ±90% confidence limits) faster than the second, and the final lap 9.1%, ±1.0%) 

faster than the penultimate lap. In contrast to the documented even-pace strategies of 

international middle-distance runners, there was a gradual slowing of up to 3% per 

lap split in the 3rd, 4th and 5th laps. The fastest runners had the lowest variability in 

pacing of lap splits with a large correlation (r=0.73, ±0.10) between variability in split 

times and 3 km running performance time. The fastest quartile of runners had two-fold 

less variability in lap split times (CV 4.9%, ±0.4%) than the slowest quartile (10.6%, 

±2.5%). There was a perfect correlation (r=1.00, ±0.00) in final time between manual 

(stopwatch) and automated RFID timing systems. 

CONCLusION: Junior football players could improve 3 km time trial performance 

by adopting a more consistent pacing strategy. 

1762 May 30, 3:45 PM - 4:00 PM 

Importance Of standardized dXa Protocol For assessing 

Body Composition Changes In athletes 

Alisa Nana1 , Gary J. Slater2 , Will G. Hopkins, FACSM3 , Louise 

M. Burke, FACSM1 . 1Australian Institute of Sport, Bruce, 

Australia. 2University of the Sunshine Coast, Maroochydore, 

Australia. 3Auckland University of Technology, Auckland, New 

Zealand. 


PurPOsE: We investigated the implications of undertaking DXA scans using the 

Best Practice Protocol (subjects fasted and rested) or a less precise but more practical 

protocol in assessing chronic changes in body composition following training and a 

specialized recovery technique (cold water immersion therapy). 

METhOds: Twenty-one nationally competitive male cyclists completed an overload 

training program, in which they were randomized to four sessions per week of either 


cold water immersion therapy or control groups. Whole-body DXA scans were 

undertaken with Best Practice (BEST) or Random Activity (RANDOM) Protocols 

at baseline, after 3 weeks of overload training and after a 2 week taper. Magnitudes 

of changes in total, lean and fat mass from baseline-overload, overload-taper and 

baseline-taper were assessed by standardization. 

rEsuLTs: The standard deviations of change scores for total and lean mass from 

RANDOM scans (2-3%) were approximately double those observed in the BEST 

protocol (1-2%), owing to extra random errors associated with RANDOM scans at 

baseline. There was little difference in change scores for fat mass. The effect of cold 

water immersion therapy on baseline-taper changes in lean mass was possibly harmful 

(-0.7%; 90% confidence limits ±1.2%) with BEST scans but unclear with RANDOM 

scans (0.9%; ±2.0%). Both BEST and RANDOM protocols gave similar possibly 

harmful effects of cold water immersion therapy on changes in fat mass (6.9%, ±13.5% 

and 5.5%, ±14.3%, respectively). 

CONCLusIONs: An interesting effect of cold water immersion therapy on traininginduced 

changes in body composition might have been missed with a less precise 

scanning protocol. Therefore, DXA scans should be undertaken with the Best Practice 

Protocol consisted of fasted and rested subjects, as well as standardized subject 

positioning on the scanning bed and regional demarcating analysis techniques. 

1763 May 30, 4:00 PM - 4:15 PM 

swimsuit Constraints Favor Women at the 2012 Olympic 

swim Competition 

Chris Brammer, Joel Stager, FACSM. Indiana University, 

Bloomington, IN. 


INTrOduCTION: Modeling of athletic performance suggests that men will continue 

to outperform women by the same margin well into the future (Peronnet, 1989). 

However, competitive rule changes may affect performance, favoring improvement in 

one sex over the other. Unlike at the 2008 Games, current suit policies in swimming 

dictate men to have considerably less skin coverage by their swimsuit than women. 

PurPOsE: To determine, relative to 2008, if the women performed differently 

than the men during the 2012 Olympic swim competition following new suit design 

constraints. 

METhOds: The top eight times from the men’s and women’s finals of Olympic 

swim events from 2008 and 2012 were obtained from the public domain. A two-way 

mixed design ANOVA was used to test the interaction between sex and Olympic year 

for swim performance, with Olympic year as the within-subjects factor. Separately, 

for both men and women, paired t-tests were used to compare 2008 and 2012 Olympic 

swim performances for each event. 

rEsuLTs: ANOVA revealed a significant sex by year interaction (F(1,14) = 14.47, p 

< .01). Simple effect analysis showed the women were significantly faster in 2012 than 

in 2008 (p < .001), whereas the men were not different. Paired t-tests for each event 

revealed 61% (8/13) of women’s events in 2012 were significantly faster than in 2008, 

and the remaining five events were not different. For the men, 15% (2/13) of all events 

were significantly faster in 2012 than in 2008, 54% (7/13) were not different, and 31% 

(4/13) were actually slower. 

CONCLusIONs: The results indicate that, relative to the 2008 Games, the 

women outperformed the men in London. Given a performance bias observed in 

2008 (Brammer, 2012), it was expected, as a result of the new suit constraints, that 

performances would not improve. However, the women continued to improve on 

historical performances while the men did not. Therefore, the rule change imposed a 

greater constraint on performances of the men relative to the women. 

1764 May 30, 4:15 PM - 4:30 PM 

Comparisons of Training session and In-Game heart rates 

in division I Collegiate Ice hockey Players 

Emily A. Niemyjski, Christopher P. Connolly, James M. 

Pivarnik, FACSM, Elizabeth Watson, Michael Vorkapich. 

Michigan State University, East Lansing, MI. 


Heart rate (HR) monitoring has been used recently by some collegiate ice hockey 

teams to assess the intensity of training sessions. However, the extent to which heart 

rate (HR) during preseason and in-season training sessions compares to ice hockey 

game HR response is unknown. 

PurPOsE: To compare the intensity of off-ice training, on-ice practices, and games 

through HR monitoring throughout a season. 

METhOds: HR monitors were worn by members of a Division I collegiate men’s 

ice hockey team (n = 24) for 22 on-ice practices, 55 off-ice training sessions, and four 

games. On-ice practices consisted of game-type situational simulations and highintensity 

drills. Off-ice training sessions consisted of either total-body circuit resistance 

training or interval cycling. HR zones included for analysis were 50-59%, 60-69%, 

70-79%, 80-89%, and 90-100% of maximal HR, which was determined for each player 

during previously completed graded exercise tests. Averages (±SD) for the percentage 

of training time spent in each HR zone were computed for September, December, 

January, and February. Averages (±SD) for the percentage of game time spent in each 

HR zone were found for pre-game activity and each period of play. 



rEsuLTs: On-ice practice time gradually increased as the season progressed 

from 102.0 ± 0 minutes preseason to 131.2 ± 23.4 minutes during the final month. 

Off-ice training time decreased from 141.4 ± 66.4 minutes preseason to 31.0 ± 27.8 

minutes during the final month. Intensity of both on and off-ice training decreased 

from preseason into the season and as the season progressed (percentage of on-ice 

practices at 90-100% of maximal HR: 15.6 ± 10.6 preseason vs. 1.2 ± 1.7 final 

month, percentage of off-ice training sessions from 90-100% of maximal HR:10.1 ± 

9.3 preseason vs. 1.3 ± 4.2 final month). Percentage of game time spent in each HR 

zone indicated similar intensity for each period, including 9% of game time spent at 

90-100% of maximal HR. Preseason off and on-ice training/practices most closely 

resembled game HR zone averages. 

CONCLusION: Intensity of preseason training closely simulates game intensity. Inseason 

training is less intense than games and decreases as the season progresses. 

1765 May 30, 4:30 PM - 4:45 PM 

Tracking Changes In Body Composition Within Elite 

Wheelchair Basketball Players 

Mhairi Keil1 , Alan M. Batterham, FACSM2 , Vicky Goosey- 

Tolfrey3 . 1English Institute of Sport/Loughborough University, 

Birmingham, United Kingdom. 2Teesside University, UK, 

Middlesborough, United Kingdom. 3Loughborough University, 

Loughborough, United Kingdom. 


Practical methods for monitoring body composition changes are important when 

preparing wheelchair basketball players for competition. 

PurPOsE: To evaluate the tracking of within-athlete changes in criterion measures 

of body composition (dual energy X-ray absorptiometry; DXA) with simple skinfold 

thickness measures over a 15-month competitive training period. 

METhOds: Participants were male Great Britain Wheelchair Basketball players 

(n=16) who underwent body composition assessments at 5 time points over 15 months. 

The primary outcome was DXA-derived body fat percentage, with sum of 4, 6, or 8 

skinfolds (mm) as the predictor variable. Data were analysed using a linear mixed 

model (random slope and intercept) to derive the within-athlete typical error of the 

estimate in predicting criterion body fat percentage from sum of skinfolds. This typical 

error allowed us evaluate how well a simple measure of the sum of skinfolds could 

track criterion changes in body fat percentage; that is, we derived the change in sum 

of skinfolds that would have to be observed in an individual athlete to conclude that 

a substantial change in body fat percentage had occurred (greater than the minimum 

important difference given by a standardised mean difference of 0.2 standard 

deviations). All data were log-transformed prior to analysis. 

rEsuLTs: The sum of 8 skinfolds was the most precise practical measure for 

tracking changes in body fat percentage. The within-subject correlation (r) between the 

sum of 8 skinfolds and DXA body fat percentage was 0.86 (95% confidence interval, 

0.81 to 0.90). For the monitoring of an individual male wheelchair basketball player, 

a change in sum of 8 skinfolds by a factor of greater than 1.13 (multiply or divide by 

1.13) is associated with a practically meaningful change in body fat percentage. For 

example, an athlete whose sum of 8 skinfolds decreased from 114 mm to 100 mm (a 

reduction greater than 114/1.13) could be said to have become leaner. Reductions in 

sum of skinfolds lower than this value would be considered trivial, given the typical 

prediction error observed. 

CONCLusIONs: A measure of the sum of 8 skinfolds can track changes in body fat 

percentage within individual wheelchair athletes with adequate precision, providing a 

useful field monitoring tool in the absence of often impractical criterion measures. 

1766 May 30, 4:45 PM - 5:00 PM 

differences In skeletal Muscle Contractile Properties among 

Power and Endurance Elite athletes 

Irineu Loturco1 , Hamilton Roschel2 , Carlos Ugrinowitsch2 , 

Cristiano Laurino3 , Saulo Gil1 , Ronaldo Kobal1 , Valmor Tricoli2 . 

1Pão de Açúcar Group - Nucleus of High Performance in Sports, 

São Paulo, Brazil. 2University of São Paulo, São Paulo, Brazil. 

3BM&F - Bovespa Track & Field Club, São Paulo, Brazil. 


Measurements of muscle belly responses to electrical stimuli using a displacement 

sensor provide valuable information about the skeletal muscle contractile properties. 

In this regard, it has been proposed that muscle contraction time (Tc) could be used as 

an accurate non-invasive predictor of fiber type composition. Additionally, the muscle 

radial displacement (Dm) is considered as a reliable measurement of muscle stiffness. 

Thus, it is conceivable that power and endurance elite athletes present significant 

differences between these skeletal muscle mechanical properties. 

PurPOsE: The purpose of this study was to evaluate if there are significant 

differences in muscle contractile properties among power and endurance elite athletes. 

METhOds: Thirty-four elite male track and field athletes were divided into two 

different groups: power athletes (PA) (sprinters and jumpers; n=18; age: 26 ± 3, 8 

years; height: 179 ± 6, 8 cm; weight: 77, 8 ± 8, 2kg) and endurance athletes (EA) 

(endurance runners and triathletes; n=16; 26, 4 ± 7, 2 years; height: 168 ± 9, 2 cm; 


weight: 61 ± 12, 2 kg). Dm and Tc were measured in both the rectus femoris (RF) and 

the biceps femoris (BF) muscles from the dominant leg, using a Tensiomyographer 

device (TMG Measurement System, TMG-BMC Ltd., Ljubljana, Slovenia). 

Unpaired t-tests were used to compare the differences between the groups. Statistical 

significance was set at P



D-59 Clinical Case Slide - Cardiovascular 

May 30, 2013, 3:15 PM - 5:15 PM 

Room: 103 

1768 Chair: Aaron L. Baggish. Massachusetts General Hospital, 

Boston, MA. 


1769 discussant: Sandra J. Hoffmann, FACSM. Idaho State University, 

Pocatello, ID. 


1770 discussant: Warren B. Howe, FACSM. Bellingham, WA. 


1771 May 30, 3:15 PM - 3:35 PM 

sudden Cardiac death--running 

Kenneth Leclerc, James Watts, Mark Peele, Kevin Steel, Michael 

Rose. San Antonio Military Medical Center, Fort Sam Houston, TX. 


hIsTOry: A 51-year-old male had sudden loss of consciousness while running on 

a treadmill at the gym. He had been evaluated 4 months prior for a neurocardiogenic 

syncopal event following a colonoscopy. Patient found to be without a pulse. 

Bystander CPR was performed and the use of an automated external defibrillator 

(AED) with successful restoration of a regular pulse. Interrogation of the AED 

revealed ventricular fibrillation appropriately defibrillated to normal sinus rhythm. 

PhysICaL EXaMINaTION: Heart rate 60, Blood pressure 130/81, Respiratory 

rate 12. His breath sounds were clear to auscultation. His heart was regular in rate and 

rhythm, normal S1 and S2 without murmur. He had no elevation in his jugular venous 

pulsation and was without lower extremity edema. 


1. Acute coronary syndrome 

2. Arrhythmogenic right ventricular cardiomyopathy 

3. Catecholaminergic polymorphic ventricular tachycardia 

4. Brugada syndrome 

5. Long QT syndrome 

6. Torsades de Pointe 


EKG 

--Normal sinus rhythm, right axis deviation, and right bundle branch block 

Echocardiogram 

--Normal left ventricular size, wall thickness and function with moderate dilation of 

the right ventricle and right atrium. 

Coronary Angiography 

--Luminal irregularities 

Cardiac MRI 

--Mildly dilated right ventricle with a mildly low right ventricular ejection fraction of 

46.4% without other evidence for arrhythmogenic right ventricular dysplasia 

Electrophysiology Study 

--No accessory pathway found, no evidence of dual AV node physiology, and 

normal corrected QT interval after epinephrine infusion. A monomorphic ventricular 

tachycardia occurred after high dose (20mcg/min) isoproterenol infusion 

Genetic Testing 

--4 novel gene mutations coding for sarcomeric proteins (actinin, myosin, and titin). 


Catecholamine sensitive ventricular tachycardia with aborted sudden death secondary 

to apparent RV cardiomyopathy 


1. AICD placed for secondary prevention of sudden cardiac death 

2. Suppressive long-acting beta-blocker therapy 

3. Cardiac rehabilitation without recurrence of symptoms 

4. Genetic counseling for the patient and first degree relatives 

5. Further evaluation as to the role that the genetic variants may play into malignant 

arrhythmias 

1772 May 30, 3:35 PM - 3:55 PM 

syncope and abnormal Electrocardiogram in an adolescent 

Basketball Player 

Jodi L. Zilinski, Miranda E. Contursi, Patricia A. Lowry, Caitlin 

H. O’Callaghan, Michael A. Fifer, Gregory D. Lewis, Aaron L. 

Baggish. Massachusetts General Hospital, Boston, MA. 


hIsTOry: A 17 year old Caucasian male basketball player presented following a 

syncopal episode, which occurred during basketball practice. He had just completed 


sprinting drills and was walking to the bench when he felt lightheaded and lost 

consciousness for approximately 30 seconds. He sustained no injuries. He had recently 

completed a course of azithromycin for an upper respiratory tract illness. He denied 

antecedent chest pain, palpitations, and prior syncope. 


Vital signs: Ht 1.78 meters, Wt 68.0 kg, Heart rate 50 bpm, Blood Pressure 112/62 

mmHg 

Healthy appearing. Lungs clear. Bradycardic regular rate, normal S1 and S2 without 

murmur or gallop. Nonfocal neurologic examination. 


Neurally mediated syncope 

Cardiac arrhythmia 

Anomalous origin of coronary artery 

Structural heart disease (HCM, ARVC) 

Athletic remodeling 

Myocarditis 


ECG: (Fig. a) 

- Sinus bradycardia 

- QTc 428 ms 

- Increased precordial voltage 

- Diffuse repolarization abnormalities 

Echocardiogram: 

- LV- asymmetric hypertrophy (LV mass 107 g/m 2 , wall measurements: interventricular 

septum 9 mm, posterior wall thickness 12 mm) 

- RV- normal structure and function 

- Coronary Arteries- well visualized, normal coronary origins and proximal courses 

Cardiac MRI: (Fig. B) 

-LV mass 115 g/m 2 

- Asymmetric LV hypertrophy (max wall thickness = 15 mm in inferior region) 

- No T2 weighted edema, early or late gadolinium enhancement 

- No RV hypertrophy 

Cardiopulmonary Exercise Test (CPET): 

- Exercise time: 12:54 min 

- Peak workload 196 Watts 

- Maximal oxygen uptake (VO2) 33.4 ml·kg -1 ·min -1 (75% predicted) 

- Decreased peak O2 pulse consistent with abnormal stroke volume augmentation 

- No arrhythmias 

WOrKING dIaGNOsEs: 

Hypertrophic cardiomyopathy vs. Athletic remodeling with neurally mediated syncope 


1. Prescribed detraining x 6 months 

2. Repeat EKG (Fig. C): Persistent although less marked repolarization abnormalities 

3. Repeat Cardiac MRI (Fig. d): Marked regression of LV wall thickness (max = 10 

mm in inferolateral region) and LV mass 79 g/m 2 (Δ = -36 g/m 2 , % Δ = -31%) 

Discussion with patient and family regarding prognostic uncertainties surrounding 

“bizarre” ECG patterns in the absence of structural heart disease. Ultimately cleared 

for participation with close follow-up. 

1773 May 30, 3:55 PM - 4:15 PM 

decreased Ejection Fraction - Baseball 

Peter H. Seidenberg, Wayne J. Sebastianelli. Penn State 

University, State College, PA. (Sponsor: Francis G. O’Connor, 

FACSM) 


hIsTOry: A 19 year old freshman baseball catcher underwent routine screening 

2D echocardiography as part of his initial preparticipation evaluation. He reports no 

history of chest pain, syncope, dizziness, palpitations, or shortness of breath. His past 

medical history is unremarkable. There is no history of recent illness. There is a history 

of a severe flu-like illness 2-3 years ago, for which he did not seek medical attention. 

There is no significant family medical history. He has no current or prior history of 

smoking, alcohol use, drug use, or anabolic steroid use. 




Height 6’ 1.5”, Weight 175 lbs, BP 114/64, HR 58 

General: WD, WN, NAD, A&O x 3 

HEENT: WNL 

Neck: no JVD, bruit, thyromegaly, or lymphadenopathy 

CV: RRR without murmur, rub or gallop - auscultated in supine and upright positions; 

equal peripheral pulses; normal chest wall 

Lungs: CTAB 

ABD: ND, BS(+), NT, no HSM 

EXT: no edema or cyanosis 

Skin, MSK, and Neuro: WNL 

2D screening echocardiogram: Moderately dilated LV, with EF 40%. No wall motion 

abnormalities. No LVH. Normal LVOT. Mild mitral regurgitation. Mild tricuspid 

regurgitation. Normal pulmonary pressure. Patent foramen ovale with left to right shunt. 


1. Myocarditis 

2. Idiopathic cardiomyopathy 

3. Prior stimulant or anabolic steroid abuse 


Stress echocardiogram: Physiologic hemodynamic response to exercise. HRR at 1 

minute 52. EF at rest 45%. Improved global LV function with exercise but does not 

get as hyperdynamic as expected for age, HR, and MET level achieved. No ischemic 

changes. Rare PAC’s. No arrhythmias. 

Cardiac MRI: LV dilated with diffuse hypokinesis. LVEF = 46%. RV dilated with mild 

diffuse hypokinesis. RVEF 51%. Trivial pericardial effusion. No myocardial edema. 

Diffuse myocardial fibrosis. Consistent with nonischemic cardiomyopathy. 


Resolved myocarditis with resultant myocardial scarring 


Athlete is withheld from sports participation and exercise. He was placed on a low 

dose ACE-I. A repeat echocardiogram is scheduled for 3 months and follow up cardiac 

MRI is scheduled in 6 months. 

1774 May 30, 4:15 PM - 4:35 PM 

heart Murmur- Basketball 

Michael R. Tiso, Luis Salazar. Ohio State, Columbus, OH. 

(Sponsor: Thomas M. Best, FACSM) 


hIsTOry: A 19-year-old African American college sophomore basketball player 

presented for a routine pre-participation physical. He reported no previous medical 

conditions or injuries, syncope with exercise, or previous loss of consciousness. He 

stated he had never had chest pain, shortness of breath, or palpitations while playing 

basketball. The athlete had no family history of sudden death but reports his mother 

had a “heart valve problem with prior surgeries.” 

PhysICaL EXaMINaTION: Vitals: Blood pressure 120/80, pulse 55, respiratory 

rate 14, and BMI 25. The patient was a physically fit athlete in no distress. A 

musculoskeletal exam showed normal strength, tone, and sensation. Respirations were 

clear to auscultation bilaterally. Cardiac exam revealed a regular rate and rhythm with 

normal S1/S2 and no gallop, rub, S3, or S4. JVD was not present, he had brisk carotid 

upstrokes bilaterally, and peripheral pulses were 2+ throughout. A 3/6 systolic murmur 

was heard loudest along the left sternal border which decreased in intensity with 

squatting and increased for 3-5 beats upon standing. 


1. Physiologic murmur 

2. Hypertrophic obstructive cardiomyopathy 

3. Mitral regurgitation 

4. Ventricular septal defect 

5. Aortic stenosis 


ECG: 

-Sinus bradycardia with LVH and T wave inversions in V3 - V5 

Echocardiogram: 

-Normal LV function with EF of 65%. 

-Intraventricular septal wall 1.1cm in diameter, left ventricular posterior wall 1.4cm. 

Cardiac MRI: 

-Concentrically hypertrophied LV with normal cavity size and EF of 65%. 

-RV minimally hypertrophied with prominent trabeculations. 

-Septal thickness 1.4cm, LV free wall thickness 1.3cm 

-Anatomically normal valves. 

FINaL / WOrKING dIaGNOsIs: 

Hypertrophic obstructive cardiomyopathy 


1. Case was discussed between cardiology and sports medicine as the posterior wall 

thickness was in a diagnostic indeterminate zone. 

2. Imaging did not meet criteria for hypertrophic cardiomyopathy; therefore athlete 

could not be disqualified from play. 

3. Recommended deconditioning for six months with follow up echocardiogram / 

cardiac MRI. 

4. Athlete decided to continue to play the season without incident. 


1775 May 30, 4:35 PM - 4:55 PM 

Thigh Pain--cyclist 

Brian C. Liem, Mark A. Harrast. University of Washington, 

Seattle, WA. (Sponsor: Stanley Herring, FACSM) 


hIsTOry: A 49 year old competitive cyclist presented with progressively worsening 

10 year history of right anterior thigh pain with exercise. She experienced a severe 

cramping sensation that would start in the anterior thigh and travel into the posterior 

thigh and calf with cycling and after several minutes. During more aggressive time 

trials or faster sprints her symptoms could present just after 30 seconds. She noted that 

when her heart rate reached 155 bpm symptoms would worsen and her leg would “shut 

down.” By slowing down and resting her pain improved. She had not been able to race 

at the level she wanted to for the prior 2 years specifically due to this right leg pain. 

She denied pain or weakness with regular ambulation. 


Normal gait. Normal lumbar and hip range of motion without reproduction of 

symptoms. No tenderness to palpation over the groin or anterior thigh. Strength is 

5/5 lower extremities bilaterally, sensation is normal and reflexes are symmetric. 

Negative dural tension signs. FABER and FADIR maneuvers negative. Normal pedal 

and popliteal pulses. Femoral pulses intact in supine but with hip flexion right femoral 

pulse diminishes. 


1. Hip Pathology 

2. Lumbar radiculopathy 

3. Vascular claudication 

4. Femoral neuropathy 


1. Pelvis and Right femur X-rays: Normal. No fracture or osteoarthritis 

2. Right Ankle Brachial Indexes: 1.29 pre-exercise, 0.38 post exercise 

3. Duplex Doppler: Post exercise external iliac artery velocity 231 cm/sec, 50-99% 

stenosis. 

4. CT angiogram: No stenosis. Minimal narrowing right external iliac artery 


Right External Iliac Artery Endofibrosis 


1. Given her desire to return to high level competition, referred patient for consultation 

with vascular surgery. 

2. Underwent saphenous vein patch angioplasty. 

3. Returned to cycling competition. 

1776 May 30, 4:55 PM - 5:15 PM 

Concerns Of The heart In a Professional Football hopeful 

Leonie Prao 1 , Andrew Tucker 2 . 1 Union Memorial Hospital and 

University of Maryland Medical Center, Baltimore, MD. 2 Union 

Memorial Hospital, Baltimore, MD. 


hIsTOry: 22 year old AA male presents for a professional football free agent 

PPE . He denies any current complaints, but admits to history of a heart murmur. 

Awareness of his heart murmur resulted from a syncopal episode at the age of 16. 

While standing during a wedding, he felt dizzy, and fainted. This syncopal episode 

was thought to be vasovagal or neurocardiogenic in origin. Pediatric cardiology 

evaluation and echocardiogram in May of 2008 revealed mild MV prolapse and trivial, 

hemodynamically insignificant MV regurgitation. He was cleared to participate in 

college football and has had no cardiac symptoms throughout college. He currently 

denies any chest pain, palpitations, easy fatigability, or peripheral edema. 


The player was noted to have normal blood pressure and heart rate. Cardiac 

examination revealed a 3/6 holosystolic murmur with a mid-systolic click, best heard 

at the base, but able to be heard at the apex and bilateral sternal borders. Murmur 

increased with squatting. Normal S1, S2. No diastolic murmurs. No JVD. No 

peripheral edema, 2+ distal pulses bilaterally. Pulmonary exam normal. 


1) Persistent/Worsening Mitral Valve Prolapse/Regurgitation 

2) Mitral/Aortic Stenosis 

3) Atrial Myxoma 

4) HOCM 


EKG: Sinus bradycardia, HR 56, LVH, normal QRS 

aP/Lateral CXr-- mild cardiomegaly, rounded cardiac appearance 

TTE-Normal LV function w/ estimated LV EF 60%. No obvious segmental wall 

motion abnormalities. Mild tricuspid regurgitation. Pulmonary artery pressure 

48mmHg consistent with pulmonary hypertension. 3+(Moderate) mitral regurgitation. 

Prominent prolapse of the posterior mitral valve. Normal intra-atrial and intraventricular 

septum. 


Persistent/Progressive Mitral Valve Prolapse/Regurgitation 






1) Referred to cardiology for further evaluation 

2) TEE completed- progressive MV prolapse/regurgitation with the development of 

pulmonary HTN, the player underwent MV annuloplasty. 

3) Repeat TTE 5 weeks status-post annuloplasty revealed normalization of PA 

pressures, resolved MV prolapse, but persistent mild-to-moderate MR. 

4) Player was not cleared for participation. He was asked to return for 

re-evaluation 12 weeks after surgery to allow for ring stabilization. 

D-60 Clinical Case Slide - Pediatric Issues 

May 30, 2013, 3:15 PM - 5:15 PM 

Room: 117 

1777 Chair: Nailah Coleman, FACSM. Phoebe Putney Memorial 

Hospital, Albany, GA. 


1778 discussant: Andrew Gregory, FACSM. Vanderbilt University, 

Nashville, TN. 


1779 discussant: Angela Smith, FACSM. Bryn Mawr, PA. 


1780 May 30, 3:15 PM - 3:35 PM 

head Injury In youth Football (FB) - a Case report 

Verle D. Valentine1 , Jason C. Dorman2 , Shanna L. Kindt2 , 

Thayne A. Munce2 , Morgan M. Avery2 , Caitlin J. Pearl2 , Hannah 

K. Nelson2 , Tryg O. Odney2 , Michael F. Bergeron, FACSM2 . 

1 2 Sanford Health, Sioux Falls, SD. National Institute for Athletic 

Health & Performance, Sioux Falls, SD. 


hIsTOry: A 12-year-old FB running back presented about one hour after he was 

hit at nearly the same instant by two defenders while attempting to run the ball. Both 

hits involved helmet-to-helmet contact to the frontal area of his helmet and were the 

first head impacts he sustained during the game. The athlete was wearing a helmet 

instrumented with Riddell® HITSystem accelerometers at the time of the injury. 

There was no LOC, but he appeared dazed with poor balance and was removed from 

the game immediately. Symptoms included headache, fogginess, feeling slowed down, 

and dizziness. No history of previous head injury. 

PhysICaL EXaMINaTION:Patient was alert & oriented, answered questions 

slowly and appeared dazed. Cranial nerves were intact, and neck was non-tender with 

normal ROM. No focal neurological deficits were noted. No amnesia. Immediate 

memory and 5-minute recall were normal, however concentration was poor. King- 

Devick (K-D) testing and reaction time were slower than baseline. Postural stability 

was poor compared to baseline. 


- Concussion 

- Intracranial bleed 

- Second-impact syndrome 


- Helmet accelerometers: two simultaneous impacts (peak linear accelerations) of 52.4 

& 52.2 g’s. 

- ImPACT testing: abnormal at day 0, 2, 6 & 12; normal at day 20 

- Reaction time: abnormal at day 0, 2, 6 & 12; normal at day 20 

- K-D testing: abnormal at day 0, 2, 6 & 12; normal at day 20 

- Postural stability testing: abnormal at day 0, 2, 6 & 12; normal at day 20 

- NeuroCom® SOT scores: abnormal at day 2, 6 & 12; normal at day 20 

- Post Concussion Symptom Score: abnormal at day 0, 2, 6, 12 & 20. 


Concussion from two simultaneous head impacts of moderate magnitude. 


Physical rest and cognitive rest were advised. He was gradually returned to school 

after one week with accommodations as symptoms improved. His testing scores and 

physical examination returned to normal after 20 days; however, symptoms persisted 

past four weeks. 

dIsCussION: These data are particularly unique in that the breadth of baseline, 

immediate post-concussion and recovery evaluations is extensive. Moreover, this is the 

first report of quantifiable head impact data leading to a concussion in youth football. 


1781 May 30, 3:35 PM - 3:55 PM 

subtle Wrist pain - dance 

Chae Ko, Kyle Cassas, FACSM. Steadman Hawkins Clinic of 

the Carolinas, Greenville, SC. (Sponsor: Delmas Bolin, FACSM) 


hIsTOry: 10 year old female dancer. She complains of pain and swelling to left 

wrist. This has been intermittent since 6 months ago with no known injury. She 

actively participates in dance and has been in competition. Five months ago, she 

experienced swelling. She does not have any history of rheumatologic disease but this 

does run in the family. Denies any fevers or redness. No other joint involvement. She 

reports pain primarily along the distal radius. 

PhysICaL EXaM: Hand/wrist exam: On examination there is soft tissue swelling 

involving the left wrist. Her range of motion is limited because of pain. Pain with full 

pronation and supination. There is warmth but no erythema. She does have diffuse 

tenderness along the left wrist but no focal area that seems to be the most painful. She 

is neurovascularly intact. No other joint involvement. 

General exam is negative 

DIFFERENTIAL DIAGNOSES: 

1. Distal radius physeal injury 

2. Rheumatologic disease 

3. Leukemia (Acute lymphocytic leukemia) 

4. Post-infectious arthritis 

5. Septic arthritis 

6. Lyme disease 

7. Behcet Syndrome 

8. SLE 


1. CBC with diff (Heme Profile with diff, HP with diff) neg 

2. Sed Rate (ESR) 12 

3. CRP Non Cardiac (C Reactive Protein) 2.8 

4. Antinuclear Antibodies (ANA), reflex to titer positive (1:160) 

5. Rheumatoid Factor (RA Factor, RF Factor) neg 

6. ASO Quantitative (ASO Screen, Anti-streptolysin O Ab), serum neg 

7. Comprehensive Metabolic Panel (CMP, CMET) neg 

8. Lyme Disease AB Total w/reflex Western Blot neg 

9. Hep B Core IgM ab neg 

10. Hep B surf Ag neg 

11. Hep A IgM ab neg 

12. Hep C IgG ab neg 

13. HLA B27 neg 

14. Native DNA ab neg 

IMAGING: 

Xrays of AP, oblique, and lateral of left wrist is negative 

MRI left wrist: 

Swelling to radiocarpal joint space. Inflammation along dorsum of wrist and proximaly 

along distal radius. Subarticular bone marrow edema of scaphoid, lunate, and radial 

epiphysis. Tenosynovitis of 2 nd -5 th extensor compartments. Mild tenosynovitis of flexor 

tendons. Preserved articular cartilage. Sever/active inflammatory arthropathy, likely 

juvenile idiopathic arthropathy. 


Juvenile Idiopathic Arthritis 

TrEaTMENT aNd OuTCOME: 

1. Immobilization and bracing for protection 

2. Physical Therapy 

3. Naprosyn BID 

4. Pediatric rheumatology referral 

5. Methotrexate 15mg PO q week 

6. Follow up with pediatric rheumatology 



1782 May 30, 3:55 PM - 4:15 PM 

hip Injury – Football 

Joseph Mitchell, Robert Hosey, FACSM, Wade Rankin, 

Raymond Wright. University of Kentucky, Lexington, KY. 


hIsTOry: 10 year-old football player presented with left hip pain following a contact 

football injury. He reported that another player fell on his leg at the bottom of a pile. 

He had sharp pain in the area and limped after the injury. Reported improvement over 

next 2-3 weeks, but worsened when he tried to return to football and felt a “pop” in his 

hip while running. He localized the pain to the groin region and lateral side of the hip. 

He had no history of bruising or swelling, and denied radiating pain or neuralgias. 

PhysICaL EXaMINaTION: Patient had full ROM of his back without discomfort. 

He had no tenderness to palpation to left hip, and had symmetric leg lengths. He 

ambulated with antalgic gait, especially on the left. Pain and decreased range of 

motion were elicited with internal and external rotation of left hip when compared 

to right hip, especially in a flexed position. Motor strength testing was 5/5 in both 

lower extremities. Sensation was grossly intact to light touch throughout bilateral 

lower extremities. Patient had negative straight-leg raise testing bilaterally, and intact 

palpable DP/PT pulses bilaterally. 


1.Labral Tear 

2.Legg-Calve-Perthes disease 

3.Slipped capital femoral epiphysis 

4.Femoral neck stress fracture 

5.Left hip dislocation 

6.Acetabular fracture 


AP/Lateral radiographs of left hip and AP pelvis: 

-No acute bony injuries with the normal physis 

MRI/CT of left hip: 

-comminuted, mildly displaced fracture of the left posterior acetabular wall 

-punctate loose bodies within the superior joint space 

-subchondral fracture of medial femoral head 

-posterior labrum attached to the fracture piece of the acetabulum 

Final Working Diagnosis: 

1.Left posterior hip dislocation with posterior wall acetabular fracture with attached 

labrum 

2.Subchondral fracture of femoral head 

TrEaTMENT/OuTCOME: 

1.Non-weight bearing with crutches 

2.An open fixation of posterior acetabular wall fracture piece by a 5-hole pelvic 

reconstruction plate was performed using a Kocher-Langenbeck approach one week 

after diagnosis 

3.Treatment plan: 

-Discharged on crutches with toe-touch only weight bearing precautions. 

-Plan to follow-up in 2 weeks with orthopedic surgery for repeat radiographs. Will base 

advancement of physical therapy program on condition at that visit. 

1783 May 30, 4:15 PM - 4:35 PM 

Bilateral Knee Injuries- soccer 

Ben Locke1 , David Soma2 , Aaron Provance1 . 1Children’s Hospital Colorado, Aurora, CO. 2University of Colorado, 

Aurora, CO. (Sponsor: John Hill, FACSM) 


hIsTOry: 14 year old female soccer player sustained a left knee injury playing 

soccer. It was later discovered that she injured her right knee playing soccer 4 weeks 

prior. During a soccer practice, she attempted to kick the ball but while planting her left 

leg she felt a twist and a pop. She was unable to fully flex or extend her left knee due 

to mechanical symptoms. Patient had pain and swelling. Patient was initially evaluated 

by athletic trainer as well as team physician. Due to concern of injury, patient was 

referred for prompt evaluation at sports medicine clinic. During evaluation the next 

day, she shared details of a right knee injury that occurred 4 weeks prior. Initially, she 

was evaluated in an urgent care and diagnosed with a right knee sprain. She attempted 

to return to sport with continued pain and mild instability of right knee. The patient 

reported a similar twisting and pop of her right knee following a kick during practice. 

She developed swelling within a few hours of injury. 

PhysICaL EXaMINaTION: Initial examination of left knee following injury: 

Left knee without deformity. Tenderness along medial joint line. ROM limited to 75 

degrees of flexion and extension lacking 15 degrees. Unable to perform Lachman’s. 

Medial joint line pain with McMurray’s. 

Examination in the sports medicine clinic the next day: Left knee: Same exam as 

previous now with large effusion. Right Knee: Trace effusion present. ROM limited to 

100 degrees flexion. Lachman’s revealed laxity with spongy endpoint. 


1. Patellar dislocation 

2. Complex meniscal injury 


3. ACL tear 

4. MCL sprain 

5. PCL tear 


Left knee radiographs 

- Moderate joint effusion 

- No bony abnormalities 

Right knee radiographs 

- No bony abnormalities 

MRI of left knee 

- Complete tear of ACL 

- Complex radial/vertical longitudinal tear of posterior horn of lateral meniscus 

- Grade II sprain of MCL 

MRI of right knee 

- Complete tear of ACL 


Right ACL tear. Left ACL tear with complex meniscus tear and grade II MCL sprain 


1. Patient will undergo right ACL reconstruction following physical therapy targeted at 

increased knee flexion 

2. Following right ACL reconstruction and adequate healing of left MCL, patient 

will undergo left ACL reconstruction with meniscus repair. Goal interval of 2 months 

between surgeries 

1784 May 30, 4:35 PM - 4:55 PM 

Painful Lumps Of The Lower Leg While Weight Bearing - 

Cheerleading 

Stacy A. Frye. Geisinger Medical Center, Danville, PA. 


hIsTOry: 12 year-old female presents due to 2 lumps on the right anterolateral 

shin. They are intermittent - only visible when standing. The first bulge was noticed 

6 months ago. The second, inferior and smaller, was noticed 2 weeks ago. They are 

painful when present; she describes the discomfort as “pressure”. Unable to continue 

cheerleading due to pain with acting as base for stunts and prolonged standing. No 

overlying skin changes. No recent illness, known animal/insect exposures or recent 

trauma. No similar condition in left leg. 

PhysICaL EXaMINaTION: Vital signs within normal limits. Right anterolateral 

mid-shin with 2 masses, visible only with weight bearing. Both easily compressible 

and with distinct margins. Overlying skin without bruising, abrasion, redness or sign 

of injury. No surrounding swelling. Superior mass about 1.5 cm diameter; inferior and 

more lateral mass about 2 cm. Tender to compression/palpation. Nonmobile. Pain with 

resisted dorsiflexion more so than plantarflexion; no pain with passive range of motion. 

Strength 4/5 with dorsiflexion and plantarflexion of right ankle. Normal heel-toe gait; 

not antalgic. Sensation, reflexes normal. Left lower leg unremarkable. 


1. Muscle herniation 

2. Sebaceous cyst 

3. Chronic compartment syndrome 

4. Ganglion cyst 

5. Soft tissue tumor 


Ultrasound of right lower leg: 

• Hernia of the tibialis anterior and extensor hallucis longus muscles through the 

anterior compartment fascia measuring 1.7 x 0.6 x 0.9 cm at maximal herniation. 

• Hernia of the peroneus brevis muscle through the lateral compartment fascia 

measuring 0.9 x 0.2 x 0.8 cm at maximal herniation. 


Transfascial muscle hernias of the tibialis anterior, extensor hallucis longus and 

peroneus brevis muscles through the anterior and lateral compartment fasciae. 


1. Referral to plastic surgery. Treatment options discussed - including (1) observation 

with compression wrap/orthosis during physical activity, (2) herniation repair, likely 

with biological patch, (3) fasciotomy. 

2. Family chose to observe for now. Elected to use compression wrap as needed for 

comfort during activity. 

3. Education provided regarding concerning signs that should prompt return. 

4. Returned to full activity, no restrictions. 

1785 May 30, 4:55 PM - 5:15 PM 

Chronic hip Pain - In an active 21 year Old 

Julie A. Kafka, Ken Bielak, FACSM. University of Tennessee 

Knoxville, Knoxville, TN. 


hIsTOry: A 21-year old female presented to the orthopedic clinic complaining of 

longstanding bilateral hip and knee pain. Her hip pain was worse than the knee pain 

and she said the right side bothered her the most. The pain has been evident since 

middle school. She denied trauma prior to the noted pain. Exercise did worsen the 





pain, especially running. She found running greater than two miles led to increased 

right hip pain. The location of pain was in the deep groin region. She denied lateral hip 

pain and lower leg numbness or tingling. Also she felt that her hips would snap with 

movement. 

PhysICaL EXaMINaTION: Examination revealed ambulation without limping. 

She denied pain with palpation of her hip and lumbar spine. Pain was elicited with 

internal and external rotation of both hips. Range of motion was limited with this 

movement. A snapping sensation was noted with right hip flexion and extension. 

Straight leg test bilaterally was negative. She complained of medial joint line 

tenderness of both knees and anterior knee pain. No obvious effusion. Range of motion 

was appropriate. Stability was noted with varus and valgus stressing and Lachman’s. 

PhysICaL EXaMINaTION: Iliopsoas tendinopathy, Labral Tear, Femoral Stress 

Fracture, Hip Joint Instability, Chondral Lesion of the Hip 

TEsT aNd rEsuLTs: X-Ray - AP, Lateral Bilateral Knees: No significant 

abnormality, maintenance of joint space, no fractures or dislocations. X-Ray - AP 

Pelvis, Lateral Right and Left Hip: Significant hip dysplasia, right hip worse, spur at 

femoral neck region of right hip, good maintenance of joint space, but a significant 

portion of her femoral heads are uncovered bilaterally, valgus orientation of hips. 

MRI Bilateral Hip without contrast: Development dysplasia of the bilateral hips, 

more pronounced on the right. No evidence of osteoarthritic changes, labral tear, or 

chondromalacia 

FINaL WOrKING dIaGNOsIs: Bilateral Congenital Hip Dysplasia 

TrEaTMENT aNd OuTCOMEs: Stop impact activities, such as running. Can proceed 

with non-impact exercises, like biking. Referral was made to a specialist that specialized in 

peri-acetabular osteotomy (PAO). Surgery is planned over the winter and spring. 

D-61 Clinical Case Slide - Shoulder Injury II 

May 30, 2013, 3:15 PM - 5:15 PM 

Room: 123 

1786 Chair: James Borchers, FACSM. The Ohio State University, 

Columbus, OH. 


1787 discussant: Christopher C. Kaeding. The Ohio State University 

Medical Center, Columbus, OH. 


1788 discussant: Eugene Hong. Drexel University, Newtown Square, PA. 


1789 May 30, 3:15 PM - 3:35 PM 

shoulder Injury-Ice hockey 

Richard Wilson, Cynthia Schroeder. Lindenwood University, St. 

Charles, MO. 


hIsTOry: A 19-year-old male collegiate ice hockey player presented with history of 

persistent anterior shoulder dislocations. These injuries occurred while participating in 

ice hockey practices and competition, upon sleeping and while performing activities of 

daily living. Two years prior he suffered a right shoulder dislocation while diving head 

first into home plate during a high school baseball game. Only physical therapy was 

prescribed at this point to increase general shoulder strength focusing on periscapular, 

rotator cuff, and trapezius areas of the shoulder. This therapy provided some relief, 

however, over the next 2 years the athlete experienced persistent right shoulder joint 

instability, increasing pain and frequent dislocations. 

PhysICaL EXaMINaTION: Examination of right shoulder revealed no erythema, 

bruising or swelling. Pain with palpation over anterior 

shoulder region. No AC or SC joint tenderness. Positive test for apprehension and 

relocation test, negative posterior jerk test. Full strength in deltoids, supraspinatus, and 

subscapularis muscles with maximal grip strength. No scapular 

dyskinesia or winging. Neurological signs normal and circulatory tests revealed 2+ 

wrist pulse and good capillary refill. 


1. Proximal humerus fracture 

2. Capsular tear 

3. Rotator cuff tear 

4. Scalloping of anterior glenoid 


X-ray: 

-Humeral head intact 

-Scalloping of anterior glenoid 

CT scan: 

-Comminuted long linear fracture arising from inferior aspect of glenoid 

-Joint bodies present anterior to glenoid, medial to coracoid process 

-Localized deformity of contour of humeral head posteriolaterally- Hill-Sach’s 

deformity 


-Bony fragment medial to humeral neck (2x5mm) 


Chronic right shoulder anterior-inferior instability with Hill-Sach’s deformity 


1. Surgical intervention - Latarjet procedure. 

2. Immobilization - 4 weeks post-surgery, gentle ROM exercises. 

2 weeks - AROM 10 degrees external rotation, 60 degrees abduction, no numbness and 

tingling 

4 weeks - AROM 20 degrees external rotation, 90 degrees abduction 

3. Active/assisted strength program initiated 6 weeks 

post-surgery. 

4. Along with specific shoulder rehabilitation, a general lower body strengthening and 

conditioning program initiated. 

1790 May 30, 3:35 PM - 3:55 PM 

shoulder Pain: remember The red Flags 

Stephan Esser 1 , Robert Shannon 1 , Robert Johnson, FACSM 2 . 

1 Mayo Clinic, Jacksonville, FL. 2 Hennepin County Medical 

Center, Minneapolis, MN. (Sponsor: Robert Johnson, FACSM) 


hIsTOry: 88-year-old, right-handed female, with 2 years of worsening left 

postero-lateral shoulder pain and 3 months of rapidly progressive shoulder weakness. 

Treatment to date included glenohumeral and subacromial steroid injections without 

improvement. 

Past medical History: Bilateral Breast Cancer, s/p mastectomy/ radiation, Colon cancer, 

s/p hemicolectomy. Squamous Cell Skin Cancer. Pertinent Meds: Flexeril, Tramadol 

PhysICaL EXaMINaTION: Gait: non-antalgic, mild ataxia. BP 108/60, RR 18, P 

76, SPO2 96%. A and O x 3. No increased work of breathing. Cervical spine: limited 

rotation bilaterally. Spurling’s on the left causes posterior neck and left shoulder pain 

without radiation to the arm. Shoulder exam: atrophy of the left deltoid, inferospinatus, 

teres minor and supraspinatus. Shoulder range of motion is normal on the right and 

limited on the left with abduction and flexion of 70 degrees, external rotation to 40 

and internal rotation limited by pain. Muscle testing shows 3/5 strength in the C5- 

C7 myotomes with preserved 5/5 strength in the distal C8-T1 muscles. Decreased 

sensation to light touch in the C6-C7 dermatomes of the left forearm and hand. 

Reflexes: on left are limited by guarding and appear reduced throughout. The right arm 

and bilateral legs demonstrate normal strength, reflexes and sensation without evidence 

of myelopathy. 


1. Brachial Plexopathy 

-Tumor, Post-Radiation Changes 

2. Multilevel Cervical Radiculopathy 

3. Mononeuritis Multiplex 

4. Cervical Spinal Stenosis 

5. Cervical Myelopathy 

6. Brachial Amyotrophy 

7. Rotator Cuff Dysfunction 


EMG Left brachial plexopathy with involvement of the posterior cord and 

suprascapular nerve 

Comprehensive lab panel: HCT: 10.7 

M. R. cervical spine: Multilevel spondylosis most significant at C3-C4 and C6-C7 levels. 

Bone Scan: Negative for osseous metastasis. 

M.R. Brachial Plexus:5x4x5cm lobulated cystic mass with rim of soft tissue within the 

left axilla encasing the traversing neurovascular bundle. 

IR CT Guided Biopsy: Positive for Squamous Cell Carcinoma 


Squamous Cell Carcinoma in the Axilla with brachial plexus involvement. 


Aggressive pain management 

Palliative Radiation 

Referral to Hospice 



1791 May 30, 3:55 PM - 4:15 PM 

shoulder Pain in a Golfer 

Jothi Murali1 , Michel Arcand2 . 1Brown University/Rhode Island 

Hospital, Providence, RI. 2Center for Orthopaedics, Johnston, RI. 


hIsTOry: A 67-year-old man played 18 holes of golf. That evening, he woke up 

from sleep with pain in his right shoulder. He did not feel any sensation that his 

shoulder had dislocated. He went to the emergency room for evaluation, had xrays 

taken, was given a sling, and came to the office for follow-up one week later. He 

reported the pain to be on the superior aspect of his shoulder and denied any numbness 

or tingling. 

PhysICaL EXaMINaTION: Obvious deformity with prominence and ecchymosis 

over the distal clavicle. Tenderness to palpation over the distal clavicle. Positive Neer 

and Hawkins impingement signs. Pain with cross-body adduction. No subluxation or 

dislocation. No rotator cuff weakness. 


1. Acromioclavicular arthritis 

2. Subacromial bursitis/impingement syndrome 


4. Glenohumeral arthritis 

5. Acromioclavicular separation 

TEsT aNd rEsuLTs: Xrays show a type III AC joint separation. 

FINaL WOrKING dIaGNOsIs: Type III AC joint separation. 

TrEaTMENT aNd OuTCOMEs: The patient was slowly weaned out of the sling 

and allowed to use his arm as tolerated. At one month follow-up, the patient was 

started on physical therapy for passive, active-assisted, and active range-of-motion 

with progression to strengthening as tolerated. He will be seen again at a ten-week 

follow-up to evaluate his progress. It was discussed with the patient that he could be 

successfully treated non-operatively with good results. With failure of non-operative 

management, a coracoclavicular ligament reconstruction would be done. 

1792 May 30, 4:15 PM - 4:35 PM 

shoulder Pain - Basketball 

Yogesh V. Kolwadkar, Paul Sherbondy, Peter H. Seidenberg. 

Penn State University, State College, PA. (Sponsor: Scott 

Magnes, FACSM) 


hIsTOry: 23 year - old left hand dominant male fell on his abducted right shoulder 

while playing basketball. He had the sensation that the shoulder dislocated and 

spontaneously relocated. He also experienced dead arm syndrome that resolved 2 days 

later. He continued to play, but later had to stop because of pain. He had a previous 

instability injury 2 years ago treated with physiotherapy, and remained asymptomatic 

until the current episode. 

PhysICaL EXaMINaTION: He had full AROM in forward flexion and abduction, 

but lacked 3 vertebral levels with adduction and IR. He had mild tenderness in the 

posterior aspect of shoulder and scapular winging. He had positive apprehension 

and relocation signs as well as a positive O’Brien’s test. Sensation and strength were 

normal. His Speed’s test and sulcus sign were negative. 

dIFFErENTIaL dIaGNOsIs 

1. Bankart lesion 

2. HAGL lesion 

3. SLAP lesion 




X- ray - AP, supraspinatus outlet and axillary lateral were normal. 

MRI ARTHROGRAM - Hill - Sachs and soft tissue Bankart lesions. 

FINAL WORKING DIAGNOSIS: Recurrent anterior - inferior instability of right 

shoulder, soft tissue Bankart lesion, HAGL lesion, SLAP lesion, Hill - Sachs lesion. 


1. Arthroscopic SLAP repair, open Bankart and HAGL lesion repairs, loose body 

removal, no treatment for non- engaging Hill - Sachs lesion. 

2. 6 months post - op: pain free, full AROM except 5 degrees loss of ER. 

3. Continue home exercise program to maintain ROM and progress with strengthening. 

4. He may chip and putt golf balls, swim, and perform low intensity basketball 

shooting. 

5. No contact or collision activities. 

6. Reevaluate in 2 months for return to play decision. 

1793 May 30, 4:35 PM - 4:55 PM 

shoulder Injury-Motocross rider 

Kelly L. Evans-Rankin, Robert Hosey, FACSM, Rebecca 

Mercer. University of Kentucky, Lexington, KY. (Sponsor: Robert 

Hosey, FACSM) 


hIsTOry: A 15-year-old male motocross rider sustained a right shoulder injury 

after falling off his motorbike. He took a jump and landed on the ground square onto 

his right shoulder with his arm in adduction. He had immediate pain to his shoulder 

and shortness of breath with deep inspiration. There was no numbness, weakness, 

tingling, or paresthesias of the upper extremity. He initially presented to the ER where 

radiographs showed only a widened acromioclavicular (AC) joint . He was placed in a 

sling and given analgesics. 

Two days later, he presented to the sports medicine clinic with continued pain at the 

sternoclavicular (SC) joint, increased shortness of breath, and dysphagia. 

PhysICaL EXaM: Exam noted mild tachypnea, and soft tissue swelling at the SC 

joint. He had TTP over the AC joint, mid-clavicle, and SC joint. The medial aspect of 

the clavicle was felt to be slightly depressed at the SC joint on palpation. He had full 

active range of motion (ROM) of neck but neck extension and flexion were painful. He 

had overall decreased ROM of his right shoulder secondary to pain. Lungs were CTA 

with good air movement. He had 2+ distal pulses and sensation intact to light touch. 


1. AC Sprain/Separation 

2. SC Sprain/Dislocation 

3. Rib Fracture 

4. Clavicle Fracture 

5. Sternal Fracture 

6. Pneumothorax 

TEsTs/rEsuLTs 

Chest A/P and lateral radiographs (CXR): 

-widening of the right AC joint, concerning for type II AC separation. 

CXR (2 days later): 

-symmetric appearing SC joints, although minimally rotated limiting evaluation. 

CT of chest without contrast: 

-posterior displacement of the medial end of the clavicle near the trachea. 


Posterior SC dislocation 

AC separation 


1. Operating room for closed reduction under anesthesia. 

2. Normal appearing SC joint with slight widening of AC joint on post reduction films. 

3. Placed in sling and given prescription analgesics. 

4. Overhead ROM activities and pendulum exercises started 10 days post-op. 

5. Clavicle and serendipity view radiographs showed no change at 1 month. 

6. Cleared to ride at 2 months post-op. 

7. Cleared to race and participate in full contact sports at 4 months. 

1794 May 30, 4:55 PM - 5:15 PM 

shoulder Injury - Men’s Ice hockey 

Matthew Hall 1 , Giselle Aerni 1 , Robert Arciero 2 . 1 University 

of Connecticut, Hartford, CT. 2 University of Connecticut, 

Farmington, CT. (Sponsor: Thomas Trojian, FACSM) 


hIsTOry: 21 year old male freshman ice hockey player presents with shoulder 

instability. He reports a history of frank anterior dislocations and is status-post an 

arthroscopic repair in 2009. He began having instability episodes again approximately 

two years after the procedure. These events have increased in frequency, and he is 

now reporting instability with trivial events such as sleeping and once with sneezing. 

He has continued to play through several hockey seasons without significant pain or 

limitations. 


Examination of the shoulder revealed no asymmetry or muscle atrophy. He had mild 

tenderness to palpation over the greater tuberosity and biceps tendon. There was full 





active range of motion with 5/5 strength testing of the rotator cuff, and 5/5 strength of 

the deltoid. There was some discomfort with supraspinatus strength testing. Negative 

for impingement. On stability testing, sulcus sign was equal bilaterally. There was a 

positive apprehension/relocation test on exam. No significant anterior or posterior shift 

was noted with load-shift testing, however the patient guarded extensively. No sensory 

deficits noted over the lateral shoulder/deltoid area. 


1. Recurrent shoulder instability 

2. Glenoid fracture 


Plain radiographs left shoulder - 3 views 

- Read by radiology as normal. 

CT scan left shoulder with 3D reconstruction: chosen to evaluate bony anatomy given 

the number of instability episodes, and for surgical planning. 

- Broad Hill-Sachs lesion of moderate depth. 

- Approximately 40% anterior glenoid bone loss. 


Recurrent anterior-inferior shoulder instability with bone loss. 


1. Patient made an informed decision to attempt to play the season. 

2. Allowed to return to play with Sully brace for support. 

3. Continue with rotator cuff strengthening rehabilitation. 

4. Monitor number of instability episodes, if continues to have multiple instability 

episodes during the season, will need to consider surgical treatment sooner. Otherwise, 

plan for open Laterjet procedure at the end of the current season. 

D-66 Basic Science Poster Reception 

May 30, 2013, 5:45 PM - 6:45 PM 

Room: Sagamore 1 Lobby 

1803 Board #1 May 30, 5:45 PM - 6:45 PM 

The Influence of respiratory Muscle Fatigue on Inactive 

arm Blood Flow during Cycling Exercise 

Joshua Smith, Carl J. Ade, Ryan M. Broxterman, Benjamin C. 

Skutnik, Craig A. Harms, FACSM. Kansas State University, 

Manhattan, KS. 

Leg blood flow decreases during heavy exercise with an increased work of breathing 

(Wb). Increased Wb contributes to respiratory muscle fatigue (RMF) during sustained 

exercise > 85%VO2max. During heavy exercise, blood flow increases to inactive arm 

muscle 2-3 fold. It is not known, however, if RMF influences blood flow to inactive 

muscle. 

PurPOsE: To determine if RMF during cycling exercise would reduce blood 

flow and vascular conductance to inactive arm muscle. Also, to examine if similar 

reductions occur in skin blood flow. 

METhOds: Twelve healthy men (23 ± 2 yrs) completed baseline pulmonary function 

tests followed by an incremental cycle test to VO2max. Subjects then cycled at both 

70% and 85% VO2max (randomized) for 20 minutes. Maximum inspiratory pressures 

(PImax) were measured prior to and immediately following each exercise trial to 

determine RMF. During exercise, brachial artery blood flow (BABF) was measured 

via Doppler ultrasound and arm skin blood flow was assessed by laser-Doppler 

flowometry. Cutaneous vascular conductance (CVC) was calculated as flux/mean 

arterial pressure and scaled as % maximal CVC (sites heated to 430C). Mean arterial 

pressure (MAP) was measured manually. 

rEsuLTs: Significant RMF occurred with the 85%VO2max trial (12.7± 9.8%), 

but not with 70% VO2max (p >0.05). BABF significantly increased from baseline 

to end exercise in both conditions (70% VO2max 194.7 ± 80.4%; 85% VO2max 

144.7 ± 57.9%), and was significantly lower (25%) at 85% VO2max. The amount of 

RMF at 85% VO2max was related to the change in BABF (r= 0.66, p


1806 Board #4 May 30, 5:45 PM - 6:45 PM 

Myofiber Composition and Fiber Type-specific Expression of 

Oxidative Capacity-related Genes Following acute aerobic 

Exercise 

Miranda Undem, Adam R. Konopka, Bozena Jemiolo, Scott 

W. Trappe, FACSM, Matthew P. Harber, FACSM. Ball State 

University, Muncie, IN. 

PurPOsE: To examine the relationship between myofiber composition and the 

expression of genes involved in skeletal muscle oxidative capacity in response to a 

single bout of aerobic exercise in slow and fast myofibers. 

METhOds: Recreationally active men (n=6, 25±1y, 54±3ml·kg-1·min-1) underwent 

60 minutes of cycling at 72±1% VO2max. Gene expression was assessed by qPCR 

in slow (MHC I) and fast (MHC IIa) myofiber pools isolated from vastus lateralis 

muscle biopsy samples obtained at rest and 2h after exercise. Pearson correlations 

were performed to analyze relationships between myofiber composition and exerciseinduced 

gene expression. 

rEsuLTs: The composition (%) of hybrid myofibers (range 1.6 to 18.0%) was 

correlated (P



1810 Board #8 May 30, 5:45 PM - 6:45 PM 

Mitochondrial related Gene Expression is suppressed after 

simulated high altitude Exposure 

Dustin Slivka 1 , Matthew Heesch 1 , John Cuddy 2 , Walter Hailes 2 , 

Charles Dumke, FACSM 2 , Brent Ruby, FACSM 2 . 1 University 

of Nebraska at Omaha, Omaha, NE. 2 University of Montana, 

Missoula, MT. 

Short term exposure to altitude / hypoxia (train high / live low) has demonstrated an 

increase in mitochondrial function whereas chronic exposure (train high / live high) 

has shown a decrease in mitochondrial function. 

PurPOsE: To determine the acute gene response after exercise when exposed to 

simulated high altitude during recovery. 

METhOds: Ten recreationally active males (25 ± 2 yrs, 78.9 ±8.6 kg, 178 ± 8 cm, 

13.1 ± 4.5 % fat, 4.3 ± 0.6 L·min-1 VO2 max) cycled for 90 minutes in laboratory 

conditions and then either recovered for 6 hours in laboratory conditions (975 m; 

normoxia) or at a high simulated high altitude (5000 m; hypoxia). Skeletal muscle 

biopsies from the vastus lateralis were obtained before exercise, after exercise, and 

6 hours after exercise for the measurement of metabolic gene expression and muscle 

glycogen. Blood oxygen saturation was measured via pulse oximetry before exercise, 

after exercise, and during recovery. Participants received a liquid carbohydrate 

beverage immediately after exercise (1.2 g ·kg-1) and solid feedings (1.28 g · kg-1 

carbohydrate, 0.15 g · kg-1 fat, and 0.29 g · kg-1 protein) at 2 and 4 hours into 

recovery. 

rEsuLTs:Blood oxygen saturation was lower during hypoxia trials than normoxia 

trials (p < 0.05). Muscle glycogen decreased with exercise (61 ± 13%, p < 0.05) and 

increased with recovery (78 ± 35%, p < 0.05) with no difference between trials (p > 

0.05). HIF1α, HIF2α, OPA1, MFN2, NRF2, SOD, COX, and PGC1α gene expression 

were suppressed after altitude exposure (p < 0.05) while FIS1, HO1, PFK, and HK 

were unaffected by altitude exposure (p > 0.05). 

CONCLusIONs: High altitude exposure during recovery from exercise inhibits 

gene expression associated with mitochondrial development without affecting muscle 

glycogen resynthesis. These data may explain the mechanism by which mitochondrial 

function is reduced after extended stays at altitude. 

Supported by the Defense Medical Research and Development Program, award 

number W81XWH-10-2-0120. 

1811 Board #9 May 30, 5:45 PM - 6:45 PM 

Effect Of systemic hypoxia On aMPK/PGC-1α signaling 

Pathway 

Ming-Chiang Lai 1 , Chien-Wen Hou 1 , Chung-Yu Chen 1 , Yi- 

Hung Liao 2 , Li-Ching Chou 3 , Sun-Chin Yang 4 , Chia-Hua Kuo, 

FACSM 1 . 1 Taipei Physical Education College, Taipei, Taiwan. 

2 National Taipei University of Nursing and Health Sciences, 

Taipei, Taiwan. 3 Ming Chuan University, Taipei, Taiwan. 4 Shih 

Hsin University, Taipei, Taiwan. (Sponsor: Kuo, Chia-Hua, 

FACSM) 


PurPOsE: Hypoxia could increase blood glucose clearance. Normobaric systemic 

hypoxia has been demonstrated to improve the ability of glycemic control. Moreover, 

stress-induced activation of AMPK and PGC-1α would enhance muscle glucose 

uptake. The purpose of this study was to investigate the effect of normobaric systemic 

hypoxia exposure on the expression of AMPK and PGC-1α in rat skeletal muscle. 

METhOds: Forty Sprag-Dawley rats were randomly divided into 5 groups, including 

control (C), 30 mins hypoxia (H-30), 60 mins hypoxia (H-60), 120 mins hypoxia 

(H-120) and 240 mins hypoxia (H-240). During hypoxia exposure, blood glucose 

was measured. After the treatment, skeletal muscles were excised to determine the 

phosphorylation status of AMPK and gene expression of PGC-1α and HIF-1α. 

rEsuLTs: Significant increase in blood glucose level was observed under acute 

normobaric hypoxia in H-30 (p < 0.05), and returned to the basal level after one hour. 

Increased phosphorylated AMPK was observed with hypoxia in H-30 (p < 0.05), 

H-60 (p < 0.05), H-120 (p < 0.05) but no change in H-240. Increased PGC-1α gene 

expression was determined under hypoxia from 60 - 240 mins hypoxia exposure (p < 

0.05). However, there is no difference in HIF-1α gene expression among all groups. 

CONCLusIONs: Acute 14% normobaric systemic hypoxia exposure can increase the 

PGC-1α gene expression via AMPK signaling pathway in rat skeletal muscle. 


1812 Board #10 May 30, 5:45 PM - 6:45 PM 

differential Baroreceptor Modulation of sweat rate and 

Cutaneous Vascular Conductance in hyperthermic humans 

Zachary J. Schlader 1 , Rebekah A.i. Lucas 2 , James Pearson 2 , 

Craig G. Crandall, FACSM 2 . 1 Institute for Exercise and 

Environmental Medicine, Dallas, TX. 2 Institute for Exercise and 

Environmental Medicine and University of Texas Southwestern 

Medical Center, Dallas, TX. 

PurPOsE: To test the hypothesis that the baroreceptor unloading that occurs during 

passive heat stress limits increases in cutaneous vascular conductance (CVC) and 

sweat rate. 

METhOds: Two protocols were performed (mean age and weight: 27 ± 5 y, 73.3 ± 

13.5 kg). In both protocols subjects underwent passive heat stress, eliciting an increase 

in intestinal temperature of ~1.8°C. Protocol 1 (N=10) - Upon attaining hyperthermia, 

a bolus (19 ml/kg) of warm (~38°C) isotonic saline was rapidly (5-10 min) 

intravenously infused to elevate central venous pressure (CVP). Primary dependent 

variables were: CVP, mean arterial pressure (MAP), forearm sweat rate, and forearm 

CVC. Protocol 2 - Upon attaining hyperthermia, phenylephrine was intravenously 

infused (60-120 μg/min) to elevate MAP. Dependent variables were the same as 

Protocol 1 except that CVP and CVC were not measured. Data are reported during 

normothermia, hyperthermia just prior to infusion, and during the last min of infusion. 

rEsuLTs:Protocol 1 - Hyperthermia reduced CVP from 3.9 ± 1.9 mmHg 

(normothermia) to -0.6 ± 1.4 mmHg (P


CONCLusION: These data suggest a striking discrepancy between ATs’ perceived 

knowledge and competence in managing athletes with MHDs. Our findings will 

contribute to the currently limited sports medicine literature examining ATs’ 

competence and experiences with MHDs. Clinical implications, including the 

development of standards of care and clinical decision rules will be discussed. 

1815 Board #2 May 30, 5:45 PM - 6:45 PM 

Examining Neurocognitive Function in Previously Concussed 

high school Female soccer Players 

Cameron R. Forbes, Joseph J. Glutting, Thomas W. Kaminski, 

FACSM. University of Delaware, Newark, DE. 

Care of sport-related concussions in soccer has gained recent attention in the medical 

community. Interestingly, purposeful heading_a unique, yet strategic and inherent 

part of soccer involves repeated sub-concussive blows to the head. Of importance, the 

developing female adolescent brain seems vulnerable to deficits in neurocognition and 

physical symptoms associated with sustaining a concussion. 

PurPOsE: To determine whether previous concussion history produces a decline in 

neurocognitive performance and concussion-related symptoms over the course of a 

competitive season when compared to healthy controls. 

METhOds: 210 female interscholastic soccer players were equally divided into 

control [CON] (never concussed) and experimental [EXP] (previously concussed) 

groups. We assessed neurocognitive performance using the ANAM (Automated 

Neuropsychological Assessment Metrics) computer program before and after their 

competitive season. Throughput scores, which measure cognitive speed and accuracy, 

were computed for seven subtests on the ANAM. In addition, total concussion 

symptom checklist (CSC) scores were gathered on each subject. Headers were 

recorded at all sanctioned matches throughout the season. Data were analyzed using a 

series of one-way ANCOVAs. Covariates comprised pretest scores on the dependent 

variables under consideration (ANAM and CSC scores), age, height, weight, and the 

total number of headers. Missing values were handled using multiple imputation. 

rEsuLTs: Despite having played in more games (16.1 vs. 12.9), the EXP had fewer 

total headers than the CON (24.9 vs. 28.1). Additionally, headers per game were 

surprisingly low in both groups (1.4 in EXP vs. 1.2 in CON). Unexpectedly, there were 

no significant differences between the EXP and CON across all dependent variables 

measured (p > .05). 

CONCLusION: History of previous concussion has been reported to increase 

subsequent concussion risk as much as fourfold. This study suggests that although 

previously concussed subjects involve themselves in purposeful heading (i.e. subconcussive 

insults) throughout a competitive season, there appears to be no additional 

risk for a decline of neuropsychological test performance or concussion symptoms. 

Additional research is needed as to what may result over the course of a playing career. 

1816 Board #3 May 30, 5:45 PM - 6:45 PM 

Vestibular and Cognitive Impairment in athletes with 

Protracted Concussion 

Anthony P. Kontos 1 , R J. Elbin 2 , Jonathan French 3 , Michael 

Collins 3 . 1 University of Pittsburgh- School of Medicine, 

Pittsburgh, PA. 2 University of Pittsburgh-School of Medicine, 

Pittsburgh, PA. 3 UPMC Sports Medicine Concussion Program, 

Pittsburgh, PA. 

A “miserable minority” (~20%) of athletes require more than 21 days to recover from 

concussion. Researchers and clinicians have speculated that vestibular impairments 

may play a role in this protracted or “chronic” concussion population. 

PurPOsE: To compare cognitive performance and symptoms of athletes with and 

without vestibular impairments following protracted concussion. 

METhOds: A comparative cross-sectional design involving 48 athletes (28 males, 

20 females) aged 9 to 23 yrs (M= 15.28, SD= 3.00) with a diagnosed protracted (>21 

days since injury) concussion. Participants completed a computerized neurocognitive 

test and symptom report at their initial clinic visit. At this time, a health care provider 

trained in sport-related concussion and vestibular assessment completed a vestibular 

screening form for each athlete, which includes clinical interview and exams covering 

three domains: vestibular dizziness, vestibulo-spinal, vestibulo-ocular. Visual 

convergence and accommodation distances were also measured. Analyses included 

ANOVAs with Bonferroni adjustment (p6 cm) convergence distance scored lower on RT (F=3.96, p=.05) 

than those without. A dose-response for vestibular impairments was supported for 

total (F=4.59, p=.007), cognitive (F=3.25, p=.03), somatic (F=8.43, p=.001) and 

sleep (F=3.56, p=.02) symptoms. Non-significant dose-response trends for vestibular 

impairment on cognitive performance were also supported. 

CONCLusIONs: Athletes with vestibular impairment from protracted concussion 

experience slower RT and more symptoms than those without. Brief vestibular 


assessments may help identify these athletes for targeted therapies. This research was 

supported by the Albert B. Ferguson, Jr. M.D. Orthopaedic Fund of the Pittsburgh 

Foundation Research Grant. 

1817 Board #4 May 30, 5:45 PM - 6:45 PM 

Test-retest and Inter-rater reliability Of The Functional 

Lower Extremity Evaluation 

Melissa Hodgins1 , Karyn Haitz1 , Rebecca Shultz2 , Gordon 

Matheson2 . 1Stanford University, STANFORD, CA. 2Stanford University, Stanford, CA. 

PurPOsE: The Functional Lower Extremity Evaluation (FLEE) is a standardized 

testing protocol that may be a valuable tool in return to play decision making for 

measuring lower extremity function and assessing re-injury risk factors. This study 

aimed to establish the test-retest and inter-rater reliability of the FLEE. 

METhOds: FLEE is a battery of tests (Table 1) that were administered and rated for 

40 uninjured student athletes from various disciplines. Each athlete was tested twice, 

one week apart, to assess test-retest reliability. The same research intern administered 

and scored all tests during both sessions, whereas a physical therapist and an athletic 

trainer scored only one session per athlete to determine inter-rater reliability. The 

intern was blinded to first session scores during the second session, and all raters were 

blinded to each other. For six of the tests (excluding “Lateral Leap and Catch” and 

“LEFT” tests), limb symmetry means were calculated and 95% confidence intervals 

of the three scores using a one-sample t-test. The LEFT (Lower Extremity Functional 

Test) was not included in this study as it requires a learning session. 

rEsuLTs: Inter-rater reliability was shown to be in the excellent range (0.80 to 1.00) 

for all tests (Table 1). Test-retest reliability was also excellent for all tests except for 

the “Timed Lateral Step Down,” for which it was moderate (0.60 to 0.80). 

CONCLusION: FLEE is a reliable assessment tool. Future studies should investigate 

the validity of FLEE to reduce re-injury rates. 

Table 1 

Results for test-retest (Pearson’s correlation), inter-rater ( Intra-class correlation 

coefficient (ICC)), limb symmetry means and 95% confidence interval using the FLEE 

test for healthy athletes. 

Pearson ICC 

Limb Symmetry Limb Symmetry 

(test(inter- Mean [%] 95% CI 

retest)rater) Timed Lateral Step 

0.772 0.829 114.4 [102.3, 126.4] 

Down 

Lateral Leap and 

0.731 0.846 -- -- 

Catch 

Single Leg Hop for 

0.912 0.996 97.3 [97.8, 102.0] 

Distance 

Timed Hop 0.917 0.891 98.6 [97.0, 100.3] 

Triple Hop 0.948 0.996 98.6 [96.8, 100.4] 

Crossover Hop 0.942 0.997 100.2 [98.0, 102.3] 

Square Hop 0.833 0.982 102.2 [93.7, 110.7] 

1818 Board #5 May 30, 5:45 PM - 6:45 PM 

Tingling and Weakness - Gymnastics 

Nailah Coleman, FACSM. Children’s National Medical Center, 

Alexandria, VA. 


hIsTOry: 16 y/o gymnast presented with sharp right patellar tendon pain and midlower 

back pain after two separate vault injuries within the prior two weeks. Her pain 

was exacerbated by movement and use of her knee and back. She denied sedentary 

pain, sleep disturbance, or bowel-bladder insufficiency. She noted atraumatic “pins and 

needles” on her right dorsal hand over the past five days but denied neck, elbow, or jaw 

pain or injury. 

Her past medical and surgical histories were unremarkable. 

Her only medicine was Aleve. She had no known allergies. 

Exam: she was WDWN in NAD. She had symmetric appearance of her extremities 

and a minimal curvature of her spine. She had a normal gait and was able to heel, toe, 

and duck walk. She was nontender to palpation. She had full motion of her trunk and 

extremities but pain with lumbar extension. Strength, sensation, and neurovascular 

status were intact and symmetric, except for 4+/5 strength in the right upper extremity. 

She had right hand cramping with elevated arm stress test and right shoulder pain with 

empty can, O’Brien’s test, and Speed’s test. 


•Spinal cord lesion 

•Nerve root compression 

•Peripheral nerve disease 

•Patellar tendinitis 

•Spondylolysis 

•Back strain 


X-rays 

•Cervical spine with oblique views: increased transverse processes 





•Scoliosis views: minimal curvature 

•Lumbar spine with oblique views: normal 

•Shoulder: normal 

•Knee: normal 

MRI 

•Spine: a lesion at C4-C5 measuring 5 mm (width) x 15 mm (cranial-caudal) with mild 

enhancement, which could signal a demyelinating process, tumor, or trauma. 

•Brain: findings suggestive of volume loss without evidence of gliosis or 

demyelination process. 

Final Working Diagnosis: transverse myelitis 


•Urgently seen by Neurology and admitted from clinic with a progressively 

symptomatic exam, including hyperreflexia and clonus. 

•CSF and serum studies for infectious and rheumatologic diseases were normal, except 

for an elevated ANA. A definitive etiology has not been found. 

•She was given a three-day course of methylprednisolone and responded well. 

•She was discharged home with plans for Neuro-Ophthalmology, PM&R, and repeat 

imaging. 

•New studies are pending. 

1819 Board #6 May 30, 5:45 PM - 6:45 PM 

Functional Movement screen is a Poor Predictor of Injury in 

division I athletes 

Meghan Warren 1 , Craig A. Smith 1 , Ryan Pinson 1 , Nicole J. 

Chimera 2 . 1 Northern Arizona University, Flagstaff, AZ. 2 Daeman 

College, Amherst, NY. 

The Functional Movement Screen (FMS) evaluates performance in deep squat, hurdle 

step, inline lunge, shoulder mobility, active straight leg raise, trunk stability pushup, 

and rotational stability using a 4 point ordinal scale (3-0). A summed FMS score of 14 

or less has been associated with increased risk of serious injury (i.e., 3 wks inactivity) 

in professional football players and lower extremity injury in female Division II 

volleyball, basketball, and soccer athletes. These studies are limited to specific sports 

and injury definition. 

PurPOsE: To determine the association between FMS total score and component 

scores and non-contact and overuse injuries in Division I (DI) athletes. 

METhOds: 170 athletes (20.2 ± 1.5 yrs, 1.77±0.10 m, 79.2± 20.7 kg, n = 89 male), 

injury-free at the time of testing, completed the FMS prior to their respective seasons. 

Athletes competed in their season and any injury that caused the athlete to report 

to the athletic training room was collected. Contact injuries were excluded. ROC 

curves were created to determine the best FMS cut-points (7, 10, 12, 14, 16, 18) for 

predicting injury. An independent t-test assessed differences in mean FMS between 

those injured or not. Logistic regression determined the odds of injury with FMS total 

score and components. History of previous injury and sex were included in the models 

as confounders. 

rEsuLTs: 74 athletes were injured during their sport season. FMS total score was 

not different between those who sustained an injury (14.3±2.5) and those who did 

not (14.1±2.4; p = 0.57). No ROC curve maximized sensitivity and specificity, so 

previous published cut-point of 14 or less (n=92) vs. greater than 14 (n=78) was 

used for analysis with injury (sensitivity = 54%, specificity 46%). After adjustment 

for confounders, no statistically significant association between FMS total score 

(dichotomoized at 14) and injury (odds ratio [OR] = 1.02, 95% confidence interval 

[CI] 0.54 - 2.0) existed. Lunge was the only component that was statistically associated 

with injury; those scoring 3 were less likely to have an injury compared with those 

who scored 2 (OR = 0.21, 95% CI 0.08 - 0.58). 

CONCLusIONs: Using a clinically relevant definition of injury, FMS total score was 

a poor predictor of non-contact and overuse injury in this group of DI athletes. The 

lunge was able to predict injury. 

1820 Board #7 May 30, 5:45 PM - 6:45 PM 

Exercise related syncope In active duty soldiers 

Chad Asplund. Eisenhower Army Medical Center, Fort Gordon, 

GA. 

PurPOsE: To better characterize the prevalence of exercise related syncope (ERS) 

in an active duty military population as well as examine possible factors associated 

with ERS. 

Methods and Study Design: Cohort study design. The Armed Forces Health 

Longitudinal Technical Application (AHLTA) electronic health record was queried 

for all cases of syncope (780.2) seen at Eisenhower Army Medical Center in primary 

care clinics from 2005-2010 and charts were reviewed. Those with syncope related 

to exercise had charts followed prospectively until completion of specialty evaluation 

and diagnosis. Main outcome measure was a medical diagnosis requiring restriction 

from duty or from participation in sports. Demographic data analyzed with descriptive 

statistics and main outcome measure with multiple logistic regression. 

rEsuLTs: 123 total cases of syncope and 58 cases of ERS were reviewed. 40 

cases had witnessed collapse, 16 cases were found to have a medical etiology (6 

neurological, 3 pulmonary, 3 cardiac, 2 migraine, 2 heat related), 24 had unexplained 

etiology. Average age was 25.67 +/- 5.92 (range 18-39) years. After controlling for age, 

past medical history, history of collapse, and smoking, those Soldiers with a history of 


migraine headaches were 11.3 times more likely to have a medical etiology associated 

with their exercise related syncope compared to those without migraine (p


TTE-Normal LV function w/ estimated LV EF 60%. No obvious segmental wall 

motion abnormalities. Mild tricuspid regurgitation. Pulmonary artery pressure 

48mmHg consistent with pulmonary hypertension. 3+(Moderate) mitral regurgitation. 

Prominent prolapse of the posterior mitral valve. Normal intra-atrial and intraventricular 

septum. 


Persistent/Progressive Mitral Valve Prolapse/Regurgitation 


1) Referred to cardiology for further evaluation 

2) TEE completed- progressive MV prolapse/regurgitation with the development of 

pulmonary HTN, the player underwent MV annuloplasty. 

3) Repeat TTE 5 weeks status-post annuloplasty revealed normalization of PA 

pressures, resolved MV prolapse, but persistent mild-to-moderate MR. 

4) Player was not cleared for participation. He was asked to return for 

re-evaluation 12 weeks after surgery to allow for ring stabilization. 

1823 Board #10 May 30, 5:45 PM - 6:45 PM 

Proximal Thigh swelling Precipitates Numbness, Tingling 

and swelling In a 38yo stunt rider 

Ryan S. Wagner. Avita health System, Bucyrus, OH. 

hIsTOry: 38yo male presents to the clinic in mid-August 2012 with a complaint 

of a large hematoma over his proximal right thigh and focal swelling over his right 

patella after wrecking his motorcycle during a stunt-riding event on four weeks prior. 

He was diagnosed with hematoma and pre-patellar bursitis. The pre-patellar bursa 

was aspirated under ultrasound guidance and fully drained with prescription for 

prophylactic antibiotics. The bursitis resolved. 

Two months later he returned with persistent swelling to the proximal, anterolateral 

right thigh. He had developed constant numbness and tingling over the anterolateral 

aspect of his thigh progressing to just superior to the knee accompanied by severe 

burning pain. 


Inspection: Discrete, fluctuant mass overlying the proximal anterolateral thigh, 10cm 

distal to inguinal crease, 10x7cm in dimension. No associated erythema, ecchymosis or 

wound. Otherwise unremarkable. 

Palpation: Burning pain is provoked with palpation of the medial third of the mass. 

Otherwise no specific tenderness. 

Neurologic: Normal strength and reflexes, diminished sensation in the distribution of 

the anterior branch of the Lateral Femoral Cutaneous Nerve (LCFN). 

Special maneuvers: +Tinel’s over the medial third of the fluctuant mass. 

PhysICaL EXaMINaTION: 1) Seroma, organized hematoma, soft tissue mass; 2) 

HNP/Radiculitis, meralgia paresthetica. 

TEsT aNd rEsuLTs: Diagnostic US of the lesion demonstrated a fluid filled 

mass with delineation between the muscular fascia and the sub-cutaneous tissue. A 

structure is visualized traversing the lumen located in the medial third of the lesion 

in the anatomic location of the LCFN, tented. The lesion was aspirated and 90mL of 

serosanguinous fluid was removed. 

FINaL WOrKING dIaGNOsIs: Morel-Lavallee lesion causing Meralgia 

Paresthetica 

TrEaTMENT aNd OuTCOMEs: The patient continued a compression wrap for 


3 days after which the lesion recurred. Pain returned 4-5 days later. He requested a 

second aspiration. This was performed with 60mL of serosanguinous fluid removed 

and 100mg of Doxycycline reconstituted in 10mL of sterile water was injected back 

into the lesion for sclerodesis. He was instructed on continuing the compression wrap 

for 3-4 weeks. At 2 weeks the lesion has not yet recurred.

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