Publications by authors named "Donald L Hoover"

25 Publications

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Retrospective Chart Review Examining Differences and Timelines in Delivered Wheelchair Equipment in a Midwestern Dedicated Seating Department.

Arch Phys Med Rehabil 2021 Nov 30. Epub 2021 Nov 30.

Doctor of Physical Therapy Department, Western Michigan University, United States. Electronic address:

Objective: This study compares recommended wheeled mobility equipment to delivered equipment, excluding custom seats and backs, considering demographic factors such as sex, age, and funding source, as well as the timeline of the procurement process.

Design: Retrospective chart review.

Setting: Dedicated wheelchair seating department within a Midwestern rehabilitation hospital and associated complex rehabilitation technology durable medical equipment suppliers.

Sample: Wheelchair recommendations (n = 546) made between January 1, 2017 and December 31, 2017.

Interventions: N/A.

Main Outcome Measure(s): Recommended and delivered wheelchair equipment type and length of time between recommendation and delivery.

Results: Differences were found between the recommended and delivered equipment in manual wheelchairs, power mobility devices, seat backs, cushions, and power option equipment groups (p = ≤.001). Delivered manual wheelchairs were 7% more likely to be different than recommended for each year decrease in age (p = ≤.001), although the model lacked sufficient predictive accuracy for clinical application. Average length of time from equipment recommendation to delivery was about 6 months (M = 176 days). Standard and complex power mobility devices were associated with longer timelines (Mdn = 137, 173 days respectively; p = .001); although, only complex power mobility device timelines were significantly associated with public funding sources (p = .02).

Conclusions: Wheelchair bases, positioning accessories, and power options may be delivered differently than originally recommended, and the process for procuring complex power mobility devices with public funding sources should be further studied. Health care professionals should consistently follow-up on delivered equipment to ensure expectations and needs of the wheelchair user are met. Reducing systemic barriers to interdisciplinary communication post-recommendation may improve patient outcomes.
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http://dx.doi.org/10.1016/j.apmr.2021.11.002DOI Listing
November 2021

Hydration to Maximize Performance and Recovery: Knowledge, Attitudes, and Behaviors Among Collegiate Track and Field Throwers.

J Hum Kinet 2021 Jul 28;79:111-122. Epub 2021 Jul 28.

College of Physical Education and sport sciences, The Hashemite University, Zarqa, Jordan.

Hydration plays an important role in performance, injury prevention, and recovery for athletes engaged in competitive sports. Therefore, it is important that strength and conditioning coaches understand an athlete's hydration needs to prevent illness and enhance performance. The purpose of this study was to identify hydration knowledge, attitudes, and behaviors of collegiate track and field throwers, as well as identify barriers to hydration and sources of nutritional information. The Rehydration and Refueling in Collegiate Track and Field Throwers Survey was sent to 271 track and field thrower coaches with a request to forward the email to current track and field throwers. Pearson correlation coefficients were calculated regarding knowledge, attitude, and behavior scores among the participants in this sample. Differences among response patterns were assessed via Chi-square analysis. Alpha level was set at p = .05. Results demonstrated that 97.3% (n = 287) of respondents knew that dehydration would decrease performance, but 50.5% (n = 149) erroneously believed thirst was the best indicator of dehydration. Chi-square analysis demonstrated a significant difference in reported values between participants who intended to eat a performance-enhancing diet and those who consumed less fluid than recomended values (207 - 295 m)l in the 2-3 hours prior to competition (χ2 = 10.87, p < .05). Pearson correlation coefficients demonstrated a large association between knowledge and behavior (r = .70, p < .05), a medium association between knowledge and attitude (r = .41, p < .05), and a small association between attitude and behavior (r = .21, p < .05). This suggests that strength and conditioning coaches and health staff need to educate and monitor hydration behaviors among collegiate track and field throwers to optimize performance.
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http://dx.doi.org/10.2478/hukin-2021-0065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336541PMC
July 2021

Systematic review of the effectiveness of caregiver training with functional mobility tasks for informal caregivers assisting patients with neurological diagnoses.

Disabil Rehabil 2021 Jun 24:1-8. Epub 2021 Jun 24.

Department of Physical Therapy, Western Michigan University, Kalamazoo, MI, USA.

Purpose: To complete a systematic review to identify evidence of the effectiveness of informal caregiver training with functional mobility tasks for patients with neurological diagnoses routinely completed by physical therapists (PTs).

Methods: Databases searched: PubMed, PEDro, CINAHL, Web of Science, Proquest Health and Medical, and Scopus. Authors included studies with adult patients requiring assistance with functional mobility due to a neurological diagnosis, with the care provided by informal caregivers. Authors excluded studies with paid caregivers, or patient diagnoses of human immunodeficiency virus, dementia, or cancer. Data extracted included type of study, methodological quality review (using Downs and Black scale), number of subjects, outcome measures, interventions, and main results.

Results: Of 2372 total articles screened, 36 full-text articles were analyzed, with seven articles identified for inclusion in the review. All studies showed variability in number of subjects, methods, interventions, outcome measures, and results. Four of the studies showed positive results from the training of informal caregivers.

Conclusions: While there is initial evidence that training informal caregivers in physical mobility tasks may help to lessen caregiver burden, further investigation is warranted. The topics typically addressed by PTs with informal caregiver training, such as transfers and ambulation, have not been extensively studied in the literature.Implications for rehabilitationPhysical therapists routinely complete training for caregivers on functional mobility tasks, with some initial evidence of the effectiveness of this training.Training for informal caregivers assisting individuals with neurological conditions has the potential to reduce injuries and decrease caregiver burden.Rehabilitation professionals should implement effective training methods for caregivers, resulting in a safer home environment for individuals with neurological diagnoses.
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http://dx.doi.org/10.1080/09638288.2021.1923073DOI Listing
June 2021

Efficacy Sources that Predict Leadership Behaviors in Coaches of Athletes with Disabilities.

J Hum Kinet 2021 Mar 31;78:271-281. Epub 2021 Mar 31.

University of North Carolina at Charlotte, Charlotte, USA.

Researchers suggest that sport participation among athletes with disabilities promotes healthier lifestyles, increases self-esteem, and enhances peer acceptance. Ideally, coaches should be confident in teaching skills, tactics, and sportsmanship, while exhibiting appropriate leadership behaviors in order to positively impact the psychosocial development of any athlete. Thus, the present research examined sources of coaching efficacy that predict leadership behaviors in coaches who work with athletes who have physical disabilities. Seventy international Paralympic coaches of female and male sport teams completed a modified version of the Coaching Success Questionnaire-2, the Coaching Efficacy Scale and the Leadership Scale for Sports. Regression models indicated that total coaching efficacy was a significant predictor of instructional and positive feedback leadership behaviors, with prior success also being a significant predictor of instructional behavior.
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http://dx.doi.org/10.2478/hukin-2021-0056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120963PMC
March 2021

Predictive Validity of a Functional Movement Screen in Professional Basketball Players.

Medicina (Kaunas) 2020 Dec 21;56(12). Epub 2020 Dec 21.

School of Kinesiology, Ball State University, Muncie, IN 47306, USA.

: Striking a balance between maximizing performance and preventing injury remains elusive in many professional sports. The purpose of this study was to assess the relative risk of non-contact injuries in professional basketball players based on predictive cut scores on the Functional Movement Screen™ (FMS). : Thirty-two professional basketball players from the National Basketball Association (NBA) and Women's National Basketball Association (WNBA) participated in this study. This observational pilot cohort study assessed and scored each participant using the FMS during training camp. Each athlete was then tracked throughout the season while recording the number, type, and time lost due to injuries. Possible exposures, actual exposures, and exposures missed due to non-contact injury (NCI) for each athlete were calculated and then used to determine the crude and specific incident rates for exposures missed due to NCI per 1000 exposures. : Linear regression models were used to evaluate the predictive ability of the FMS score for total missed exposures, NCI, and CI missed exposures. In all models, the FMS total score failed to attain significance as a predictor ( > 0.05). FMS scores ranged from 5 to 18. The recommended cut score of 14 showed a sensitivity of 0.474 and a specificity of 0.750. The cut score of 15 showed the best combination, exhibiting a sensitivity of 0.579 and specificity of 0.625. A total of 5784 exposures to NCI were possible for the men and women combined, and 681 possible exposures were missed. Of these, 23.5% were due to NCI, 16.5% were due to contact injuries (CI), and 60% were due to illnesses and personal reasons. : The FMS proved to be a measure that was not associated with any injury measure in this sample of professional basketball players, suggesting the instrument lacks predictive validity in this population.
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http://dx.doi.org/10.3390/medicina56120724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767371PMC
December 2020

A Fraction of Recommended Practices: Implementation of the FIFA 11+ in NCAA Soccer Programs.

Medicina (Kaunas) 2020 Aug 19;56(9). Epub 2020 Aug 19.

School of Kinesiology, University of North Carolina at Charlotte, Charlotte, NC 28223, USA.

National Collegiate Athletic Association (NCAA) soccer coaches implement numerous warm-up and flexibility strategies to prepare athletes for training and competition. The Fédération Internationale de Football Association (FIFA) developed the 11+ injury prevention program to reduce non-contact injuries. This study aimed to analyze the level of familiarity with and implementation of the evidence-based FIFA 11+ amongst NCAA Division I (DI) and Division III (DIII) men's and women's soccer coaches. NCAA soccer coaches in the United States received an Institutional Review Board-approved survey hyperlink. A total of 240 coaches completed the survey. The respondents represented 47.5% men's and 52.5% women's teams distributed within DI and DIII programs. Descriptive statistics are reported as frequency counts and mean ± standard deviation where applicable. Pearson's chi-square tests were performed to assess potential differences with a significance level set at α < 0.05. The results indicated that approximately 62% of the respondents reported being familiar with the FIFA 11+ program. Of those coaches familiar with the program, 15.0% reported full implementation, 57.5% reported partial implementation, and 27.5% reported no implementation. Chi-square analyses revealed significant differences in FIFA 11+ implementation based upon division level (χ = 4.56, = 0.033) and coaching certification levels (χ = 13.11, = 0.011). This study indicates that there is a gap between FIFA 11+ knowledge and actual implementation. To reduce the risk of non-contact injury, there is a need to educate coaches and athletic trainers on the purpose of the FIFA 11+ program and how to perform the exercises correctly.
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http://dx.doi.org/10.3390/medicina56090417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558407PMC
August 2020

Pre- and Post-Activity Stretching Practices of Collegiate Soccer Coaches in the United State.

Int J Exerc Sci 2020 1;13(6):260-272. Epub 2020 Feb 1.

Biomechanics Laboratory, Ball State University, Muncie, IN, USA.

Current pre- and post-activity stretching guidelines are designed to optimize performance and reduce injury risk. However, it is unclear whether soccer coaches adhere to these recommendations. The purpose of this study was to determine if collegiate soccer coaches' perceptions and practices align with current scientific recommendations. A total of 781 questionnaires were electronically distributed to soccer coaches from NCAA Division I and III universities. The questionnaire obtained demographic, professional, and educational information, as well as stretching practices. Statistical analysis consisted of computing frequency counts and means where applicable. Pearson's Chi-square tests were performed to assess the potential differences in stretching perceptions and practices among the cohort of soccer coaches. Results suggest that soccer coaches are choosing some forms of stretching more frequently than other coaches (χ = 342.7, < 0.001). Further analysis failed to determine significant associations between stretching type and coaching certification, level, sex, years of experience, and age. Of the 209 respondents, 84.9% believed pre-activity stretching to be of greater than average importance on a seven-point Likert scale. Dynamic stretching (68.7%) or a combination of static and ballistic stretching (18.0%) prior to athletic events was the most typical stretching prescribed. Current post-activity practices demonstrate that most coaches (95.4%) are using some form of a general cool-down following practice or competition. This study is an important assessment of the extent to which collegiate coaches administer appropriate stretching techniques. Most coaches adhere to current recommendations; however, they should continue to evaluate their practices against ongoing research and the practices of their peers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039475PMC
February 2020

Metabolic flexibility is impaired in women who are pregnant and overweight/obese and related to insulin resistance and inflammation.

Metabolism 2020 03 10;104:154142. Epub 2020 Jan 10.

Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA. Electronic address:

Context: Maternal obesity is a significant public health concern that contributes to unfavorable outcomes such as inflammation and insulin resistance. Women with obesity may have impaired metabolic flexibility (i.e. an inability to adjust substrate metabolism according to fuel availability). Impaired metabolic flexibility during pregnancy may mediate poor pregnancy outcomes in women with obesity.

Purpose: The purposes of this study were to: 1) compare metabolic flexibility between overweight/obese and lean women; and 2) determine the relationships between metabolic flexibility, inflammation following a high-fat meal, and maternal metabolic health outcomes (i.e. gestational weight gain and insulin resistance).

Procedures: This interventional physiology study assessed lipid oxidation rates via indirect calorimetry before and after consumption of a high-fat meal. The percent change in lipid metabolism was calculated to determine 'metabolic flexibility.' Maternal inflammatory profiles (CRP, IL-6, IL-8, IL-10, IL-12, TNF-α) and insulin resistance (HOMA-IR) were determined via plasma analyses.

Main Findings: 64 women who were pregnant (lean = 35, overweight/obese = 29) participated between 32 and 38 weeks gestation. Lean women had significantly higher metabolic flexibility compared to overweight/obese women (lean 48.0 ± 34.1% vs overweight/obese 29.3 ± 34.3%, p = .035). Even when controlling for pre-pregnancy BMI, there was a negative relationship between metabolic flexibility and percent change in CRP among the overweight/obese group (r = -0.526, p = .017). Metabolic flexibility (per kg fat free mass) was negatively correlated with postprandial HOMA-IR (2 h: r = -0.325, p = .016; 4 h: r = -0.319, p = .019).

Conclusions: Overweight and obese women who are pregnant are less 'metabolically flexible' than lean women, and this is related to postprandial inflammation and insulin resistance.
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http://dx.doi.org/10.1016/j.metabol.2020.154142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046129PMC
March 2020

Practices, Perceived Benefits, and Barriers to Resistance Training Among Women Enrolled in College.

Int J Exerc Sci 2018 1;11(5):226-238. Epub 2018 May 1.

School of Kinesiology and Department of Educational PsychologyBall State University, USA.

The American College of Sports Medicine (ACSM) has recommended that resistance training be performed at least twice per week, with 8-12 repetitions of 8-10 exercises targeting all major muscle groups (1). However, Kruger, Carlson, and Kohl (18) reported that women were participating less than the U.S. population on the whole, as only 20% of women were engaging in resistance training two or more times per week. In order to better understand why only 1 in 5 women participate regularly in this form of physical activity, this study investigated current resistance training practices, perceived benefits, and barriers to resistance training among college women. One-hundred and sixteen women college students from a large, public, Midwestern university participated in this study. Correlation and hierarchical multiple regression analyses were used to identify the strongest predictors of resistance training behaviors. The predictors in the regression model included demographic characteristics in block one, perceived barriers to resistance training in block two, and perceived benefits of resistance training in block three. Results indicated that the level of perceived "time/effort" barriers significantly predicted resistance training behavior. Findings in this area may help researchers, university recreation programmers, personal trainers, and other health and fitness professionals better understand the attitudes and actions of college women regarding resistance training, toward the goal of promoting fitness center environments that college women find more inviting.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5955292PMC
May 2018

Effects of Environmental Context on Physiological Response During Team Handball Small Sided Games.

Int J Exerc Sci 2017;10(8):1263-1274. Epub 2017 Dec 1.

Ball State University, School of Kinesiology, Health and Physical Activity Building (HP), Room 360M Ball State University Muncie, IN USA.

This study examined the distance covered and physiological effects of altering the number of players during small-sided games (SSG) in team handball. Twelve professional female handball players [24.6±3.7 years, 172±6.2 cm, 68.2 ± 9.9kg, 22.7 ± 2 kg/m] participated in this study. The SSG were played, first with five on each side (SSG 5), then four (SSG 4), then three (SSG 3). Each game was four minutes long, followed by three minutes of rest. The distance covered and time spent in four speed zones (based on player movement speed) were selected for analysis: Zone 1 (0-1.4 m/s), Zone 2 (1.5-3.4 m/s), Zone 3 (3.5-5.2 m/s), and Zone 4 (>5.2 m/s). Statistically significant differences were found in Zone 2, between conditions SSG 3 and SSG 4 (p=.049,ω= .32). The highest average heart rate (HR) occurred during SSG 3. Average HR between SSG 3 (89.7 % HRmax) and SSG 5 (87.8 % HRmax) (p= .04, ω2= .26) were also significantly different. Participant HR response between the speed zones was not statistically significant. HR response was negatively correlated with the number of players within the SSG condition. Statistically significant results were found for RPE between SSG 3 and the other two SSG conditions (SSG 4, = .01, and SSG 5, = .00). These results indicate that changing the number of SSG players can be used to manipulate the physiological response during handball training.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786196PMC
December 2017

Management of a patient's gait abnormality using smartphone technology in-clinic for improved qualitative analysis: A case report.

Physiother Theory Pract 2018 May 8;34(5):403-410. Epub 2018 Jan 8.

b Department of Physical Therapy , Western Michigan University , Kalamazoo , MI.

Background And Purpose: Qualitative analysis has its limitations as the speed of human movement often occurs more quickly than can be comprehended. Digital video allows for frame-by-frame analysis, and therefore likely more effective interventions for gait dysfunction. Although the use of digital video outside laboratory settings, just a decade ago, was challenging due to cost and time constraints, rapid use of smartphones and software applications has made this technology much more practical for clinical usage.

Case Description: A 35-year-old man presented for evaluation with the chief complaint of knee pain 24 months status-post triple arthrodesis following a work-related crush injury. In-clinic qualitative gait analysis revealed gait dysfunction, which was augmented by using a standard IPhone® 3GS camera. After video capture, an IPhone® application (Speed Up TV®, https://itunes.apple.com/us/app/speeduptv/id386986953?mt=8 ) allowed for frame-by-frame analysis. Corrective techniques were employed using in-clinic equipment to develop and apply a temporary heel-to-toe rocker sole (HTRS) to the patient's shoe.

Outcomes: Post-intervention video revealed significantly improved gait efficiency with a decrease in pain. The patient was promptly fitted with a permanent HTRS orthosis. This intervention enabled the patient to successfully complete a work conditioning program and progress to job retraining.

Discussion: Video allows for multiple views, which can be further enhanced by using applications for frame-by-frame analysis and zoom capabilities. This is especially useful for less experienced observers of human motion, as well as for establishing comparative signs prior to implementation of training and/or permanent devices.
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http://dx.doi.org/10.1080/09593985.2017.1419326DOI Listing
May 2018

LOWER EXTREMITY KINEMATICS OF ACL-REPAIRED AND NON-INJURED FEMALES WHEN USING KNEE SAVERS®.

Int J Sports Phys Ther 2017 Oct;12(5):737-746

Department of Physical Therapy, Western Michigan University, Kalamazoo, IN, USA.

Background: Knee Savers® (KS) are an ergonomic aid purported to lessen the risk of injuries linked to deep squats. While widely used in sports such as baseball and softball, KS have not been tested to determine their effect upon lower extremity kinematics in any population.

Purpose: The purpose of the study was to determine if KS influenced the lower extremity kinematics when females with previous anterior cruciate ligament (ACL)-reconstruction and healthy participants completed an end-range squat.

Study Design: A repeated measures, counter-balanced laboratory study design was used.

Methods: Twenty female participants (mean (SD) - age: 21.65 (2.06) yrs, height: 175.26 (9.29) cm, weight: 64.66 (7.72) kg) with a history of ACL-repair (n=10) or non-injury (n=10) completed this study. Participants completed a standardized trial of three deep squats with and without KS. Movement was analyzed using 2D video analysis methods increasingly available in clinical environments.

Results: During the ascending phases of a squatting motion, there was significantly greater medial ( = .009) and lateral ( = .005) motion of the patella in the frontal plane for non-injured participants, when compared to the ACL-repaired group. No significant differences were found in sagittal plane lower extremity kinematics when squatting with and without KS. Ascending angular velocity was slower in ACL-repaired than non-injured females ( = .008) and slower with the KS than without KS for non-injured females ( = .007).

Conclusions: When squatting with and without KS, the non-injured group experienced more frontal plane motion at the knee, compared to the ACL-repaired group. However, while KS are purported to influence lower extremity joint positions during the bottom phase of a deep squat, the data from the current study did not support this claim. Additionally, KS appear to slow ascending velocity for those without a history of ACL-repair. These findings may have clinically meaningful implications for athletes who use KS during sport activities.

Level Of Evidence: Level 2.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685415PMC
October 2017

Assessment of endpoint criteria and perceived barriers during maximal cardiorespiratory fitness testing among pregnant women.

J Sports Med Phys Fitness 2018 Dec 17;58(12):1844-1851. Epub 2017 Nov 17.

School of Kinesiology, Recreation and Sport, Western Kentucky University, Bowling Green, KY, USA.

Background: A plateau in volume of oxygen consumption (VO2) is the primary indicator for determining if an individual has reached their maximal aerobic capacity. However, secondary criteria can also be used to identify maximal effort (i.e. lactate level, rating of perceived exertion [RPE], percent of age-predicted maximal heart rate [HR] and respiratory exchange ratio [RER]). Age and gender-specific secondary criteria have been developed for the general population, but no secondary criteria have been established for pregnant women. The primary purpose of this study was to analyze secondary endpoint criteria during VO2max testing among pregnant women. A secondary purpose was to identify emotional and physical barriers pregnant women have that may prevent them from reaching maximal effort.

Methods: Twenty-five pregnant women (age= 30.0±3.6 years; gestation age= 22.1±1.4 weeks, pre-pregnancy BMI= 23.68±4.04 kg/m2) participated. Each participant completed a Bruce protocol treadmill test and maximal HR, RER, lactate, and RPE were assessed and compared to standards. Barriers were assessed immediately postexercise via open-ended questions.

Results: The mean VO2max was 32.9±8.8 mL/kg/min. Mean RPEmax was 17.6±1.8 versus the standard of RPE≥17 (P=0.12). Percent of age-predicted HRmax was 88.0±6.8% versus the standard of ≥95% (P<0.001). Immediate postexercise lactate was 6.8±2.4mM versus the standard of ≥8 mM (P=0.03). Maximal RER was 1.2±0.2 versus the standard of RERmax ≥1.1 (P=0.08).

Conclusions: Our data provide preliminary evidence that secondary criteria may need to be adjusted for pregnant women. Additionally, physical and emotional barriers may be enhanced by pregnancy (e.g. pain, discomfort, anxiety, health concerns), and may limit the performance of pregnant women during maximal exercise.
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http://dx.doi.org/10.23736/S0022-4707.17.07750-7DOI Listing
December 2018

Mood and Performance Anxiety in High School Basketball Players: A Pilot Study.

Int J Exerc Sci 2017;10(4):604-618. Epub 2017 Jul 1.

Western Kentucky University, Bowling Green, KY, USA.

Participation in competitive sport may impact psychological measures, such as mood and performance anxiety, which in turn may impact enjoyment, adherence, continued participation, and so on. This study assessed the feasibility - in terms of process, resources, management, and potential scientific value- of measuring the effect of varying competitive challenges upon the mood and performance anxiety measures of high school athletes. The participants (n=12) consisted of the boys' varsity basketball team at a high school in a rural Midwestern community. Participants completed the Profile of Mood States (POMS) to assess mood and the Sport Anxiety Scale-2 (SAS-2) to assess performance anxiety, respectively. Survey administration occurred at and prior to games designated as , , and . feasibility measures were achieved in this prospective design. Significant correlations on the subscale measures were found on the POMS and SAS-2 administered before the four conditions in this study; Chronbach's alpha ranged from 0.54-0.94 across conditions for POMS subscales, and Chronbach's alpha ranged from 0.73-0.97 across all conditions for SAS-2 subscales, respectively. Significant differences were found across conditions in the POMS subscale [(3,33) = 5.71, = 0.01] and in the SAS-2 subscale [(3,33) = 6.13, =0.01]. These preliminary findings suggest that the competitive conditions in this study significantly affected some measures of mood and performance anxiety in high school basketball players. These findings warrant further investigation, as well as suggest coaches could gather such information from their players, ultimately aiding in player development and team performance.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466400PMC
July 2017

Physical therapist screening and differential diagnosis for traumatic-onset elbow pain: A case report.

Physiother Theory Pract 2016 Oct 12;32(7):556-65. Epub 2016 Sep 12.

b Graves Gilbert Clinic , Bowling Green , KY , USA.

Background And Purpose: Elbow pain can originate from many sources yet have similar signs and symptoms, thereby presenting differential diagnostic challenges. The elbow is commonly injured, thus requiring all clinicians to possess excellent diagnostic skills.

Case Description: A 24-year-old woman slipped and fell on her outstretched left hand, experiencing immediate elbow pain. The same day radiographs were deemed negative by her orthopedist, who referred her to physical therapy with the diagnoses of elbow sprain and contusion. Immediately after examining the patient, the physical therapist consulted with the referring orthopedist. The decision to consult was based on: the mechanism of injury, pain severity out of proportion to the referred diagnoses, significantly limited ROM, abnormal joint end feels, exquisite pain with tactile and tuning fork bony palpation, and positive elbow extension test.

Outcomes: The treating physical therapist shared the above-noted findings with the orthopedist, who overruled and recommended continuing the original prescription of non-steroidal anti-inflammatory medication and physical therapist treatment for four weeks. The physical therapist's updated plan of care at four weeks noted the patient's continued reports of pain, functional limitations, and disability. A magnetic resonance image (MRI) was then ordered, revealing a radial head fracture.

Discussion: A thorough history and examination by the physical therapist led to clustering of signs and symptoms, allowing for the development of a differential diagnosis list which included occult radial head fracture. All clinicians should be prepared to screen for complex conditions. Timely diagnosis and improved outcomes for clinically complex patients are increasingly necessary in contemporary healthcare reimbursement models.
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http://dx.doi.org/10.1080/09593985.2016.1219798DOI Listing
October 2016

Effects of acute androstenedione supplementation on testosterone levels in older men.

Aging Male 2016 Sep 25;19(3):161-167. Epub 2016 Aug 25.

d Human Performance Laboratory, Ball State University , Muncie , IN , USA.

The purpose of the study was to examine the effects of acute androstenedione supplementation on hormone levels in older men at rest and during exercise. Men (n = 11) between the ages of 58 and 69 were divided into an experimental (n = 6; 62.33 ± 2.57 y) and control (n = 5; 60.2 ± 1.02 y) groups. Each participant received an oral 300 mg dose of either androstenedione (experimental) or a cellulose placebo (control) for 7 d. Pre- and post-supplementation participants completed two separate, 20-min strength tasks consisting of leg extension and leg curls at different percentages of their 10-RM. Researchers collected blood samples pre-, during, and post-exercise. Blood samples were analyzed for testosterone, androstenedione, and estradiol levels. The researchers found a significant difference between pre- (4.36 ± 56 ng/mL) and post- (5.51 ± 0.35 ng/mL) testosterone levels, as well as pre- (0.88 ± 0.20) and post- (7.46 ± 1.25) androstenedione levels, but no significant differences between pre- and post-estradiol levels for either group. It appears that short-term androstenedione supplementation augmented acute testosterone responses to resistance exercise in older men. However, further study of this supplement is needed to determine any potential it may have in mitigating andropause.
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http://dx.doi.org/10.3109/13685538.2016.1167180DOI Listing
September 2016

The Impact of Competitive Trait Anxiety on Collegiate Powerlifting Performance.

J Strength Cond Res 2016 Sep;30(9):2399-405

1School of Kinesiology, Ball State University, Muncie, Indiana; 2School of Kinesiology, University of Louisiana Lafayette, Lafayette, Louisiana; 3Doctor of Physical Therapy Program, Western Kentucky, Bowling Green, Kentucky; and 4Indiana University School of Medicine, Indianapolis, Indiana.

Judge, LW, Urbina, LJ, Hoover, DL, Craig, BW, Judge, LM, Leitzelar, BM, Pearson, DR, Holtzclaw, KA, and Bellar, DM. The impact of competitive trait anxiety on collegiate powerlifting performance. J Strength Cond Res 30(9): 2399-2405, 2016-The purpose of this study was to determine the relationship between competitive trait anxiety measures and powerlifting (PL) performance. Thirty-six collegiate powerlifters on club teams from 3 universities were recruited during a competition (men = 26, women = 10; age = 19.9 ± 1.5 years; height = 172.5 ± 8.6 cm; weight = 81.4 ± 21.0 kg). The athletes were distributed across weight classes for collegiate PL (47.6 kg: 1; 51.7 kg: 1; 54.9 kg: 1; 59.8 kg: 3; 67.1 kg: 2; 74.8 kg: 7; 82.1 kg: 4; 89.8 kg: 9; 99.8 kg: 5; super heavyweight: 3). A survey containing questions about PL performance history and the 15-item Sport Competition Anxiety Test (SCAT) were administered to the participants before competing. The SCAT total was negatively correlated (r = -0.397; p = 0.02) to the athletes' percentage of best total achieved in the competition (actual performance total/best comp total × 100). Of the individual lifts, the SCAT score was negatively correlated to the personal best for bench press (r = -0.368; p = 0.03) and deadlift (r = -0.317, p = 0.05), but did not significantly correlate for squat (r = -0.182, p = 0.27). These results indicate a negative correlation between the SCAT score and athletes' personal best totals in PL. Increased SCAT scores were associated with decreased personal best PL totals. The results suggest that competitive trait anxiety may have negatively impacted performance and that some PL athletes may benefit from interventions aimed at decreasing anxiety before and during performance.
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September 2016

Periodization and physical therapy: Bridging the gap between training and rehabilitation.

Phys Ther Sport 2016 Mar 9;18:1-20. Epub 2015 Sep 9.

Ball State University, Muncie, IN, USA. Electronic address:

Background: Exercise prescription and training progression for competitive athletes has evolved considerably in recent decades, as strength and conditioning coaches increasingly use periodization models to inform the development and implementation of training programs for their athletes. Similarly, exercise prescription and progression is a fundamental skill for sport physical therapists, and is necessary for balancing the physiological stresses of injury with an athlete's capacity for recovery.

Objective: This article will provide the sport physical therapist with an overview of periodization models and their application to rehabilitation.

Summary: In recent decades models for exercise prescription and progression also have evolved in theory and scope, contributing to improved rehabilitation for countless athletes, when compared to care offered to athletes of previous generations. Nonetheless, despite such advances, such models typically fail to fully bridge the gap between such rehabilitation schemes and the corresponding training models that coaches use to help athletes peak for competition. Greater knowledge of periodization models can help sport physical therapists in their evaluation, clinical reasoning skills, exercise progression, and goal setting for the sustained return of athletes to high level competition.
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http://dx.doi.org/10.1016/j.ptsp.2015.08.003DOI Listing
March 2016

Pre- and Post-Activity Stretching Practices of Collegiate Athletic Trainers in the United States.

J Strength Cond Res 2017 Sep;31(9):2347-2354

1School of Kinesiology, Ball State University, Muncie, Indiana; 2School of Kinesiology, University of Louisiana Lafayette, Lafayette, Louisiana; and 3Department of Physical Therapy, Western Kentucky University, Bowling Green, Kentucky.

Popp, JK, Bellar, DM, Hoover, DL, Craig, BW, Leitzelar, BN, Wanless, EA, and Judge, LW. Pre- and post-activity stretching practices of collegiate athletic trainers in the United States. J Strength Cond Res 31(9): 2347-2354, 2017-The aim of the study was to investigate the knowledge and practices of collegiate-certified athletic trainers (ATs) in the United States. Participants (n = 521) were provided an overview of the study and a hyperlink to a web-based survey. The "pre- and post-activity practices in athletic training questionnaire" consisted of demographic items and elements to measure knowledge and practices related to pre- and post-activity stretching routines. In previous studies, the survey demonstrated construct validity, α = 0.722. Pearson chi-square test was used to evaluate goodness of fit, and kappa was calculated to measure agreement between items. Only 32.2% of ATs recommended dynamic stretching (DS) to be performed pre-activity, whereas a larger percentage (42.2%) recommended a combination of static stretching (SS) and DS. Athletic trainers reported that only 28.0% of athletes are performing DS before activity. Conversely, 60.6% of collegiate ATs recommended SS postexercise, and 61.0% of athletes agree and perform after workout SS (κ = 0.761, p < 0.001). Collegiate ATs seem to underuse the current research evidence, which indicates that DS is more beneficial than SS when used pre-activity, and ATs continue to regularly incorporate SS in their pre-activity routines. However, there is evidence that collegiate ATs in the United States emphasize SS postactivity in a manner consistent with current research.
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September 2017

Creatine Usage and Education of Track and Field Throwers at National Collegiate Athletic Association Division I Universities.

J Strength Cond Res 2015 Jul;29(7):2034-40

1School of Physical Education, Sport, and Exercise Science, Ball State University, Muncie, Indiana; 2Department of Health, Human Performance, and Recreation, School of Education, Waco, Texas; 3Department of Physical Therapy, Western Kentucky University, Bowling Green, Kentucky; 4Advancing Knowledge in Health Care, Chicago, Illinois; 5New Castle School Corporation, New Castle, Indiana; 6Department of Sport Rehabilitation, Hashemite University, Zarqa, Jordan; and 7School of Kinesiology, University of Louisiana Lafayette, Lafayette, Louisiana.

The purpose of this study was to analyze the level of creatine use along with the perceived benefits and barriers of creatine use among collegiate athletes who participate in throwing events within the sport of track and field. A total of 258 throwers from National Collegiate Athletic Association Division I institutions completed an online survey regarding creatine. The results provided baseline levels of creatine use and allowed for the analysis of factors related to athletic conference affiliation. Results indicate that creatine use remains to be a common (32.7%) practice among throwers with significantly higher levels of use among Football Bowl Subdivision (FBS) conference athletes (44.6%) than Football Championship Subdivision (FCS) conference athletes (28.8%), χ² = 5.505, p = 0.019. The most common reasons for using creatine included a desire to improve/increase: strength (83.3%), recovery time (69.0%), and performance (60.7%). The most common perceived obstacles included contamination/quality control (39.5%), cost (33.3%), inconvenience (16.7%), and cramping (14.3%). A desire for additional education and training was noted through an expression of interest (55.6%) with significantly higher levels of interest from FBS athletes (65.6%) than FCS athletes (52.2%), χ² = 6.425, p = 0.039. However, the athletic departments provide nutritional supplement counseling at only 26.6% of the schools. Although the access to full-time nutritionist counsel was available at 57.3% of the schools, there was a significant difference (χ² = 9.096, p = 0.003) between FBS schools (73.7%) and FCS schools (51.7%).
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July 2015

The acute effects of various types of stretching static, dynamic, ballistic, and no stretch of the iliopsoas on 40-yard sprint times in recreational runners.

Int J Sports Phys Ther 2012 Oct;7(5):540-7

Western Kentucky University, Bowling Green, Kentucky, USA.

Background And Purpose: The potential adverse effects of static stretching on athletic performance are well documented, but still appears to be controversial, especially as they relates to sprinting. The prevalence of this practice is demonstrated by the number of competitive and recreational athletes who regularly engage in stretching immediately prior to sprinting with the mindset of optimizing their performance. The purpose of this study was to examine the effects of acute static, dynamic, and ballistic stretching, and no stretching of the iliopsoas muscle on 40-yard sprint times in 18-37 year-old non-competitive, recreational runners.

Methods: Twenty-five healthy recreational runners (16 male and 9 female) between the ages of 24 and 35 (Mean = 26.76 yrs., SD = 2.42 yrs.) completed this study. A repeated measures design was used, which consisted of running a 40-yard sprint trial immediately following each of 4 different stretching conditions aimed at the iliopsoas muscle and lasting 1 minute each. The 4 conditions were completed in a randomized order within a 2-week time period, allowing 48-72 hours between each condition. Prior to each 40-yard sprint trial, a 5-minute walking warm-up was performed at 3.5 mph on a treadmill. The subject then ran a baseline 40-yard sprint. After a 10-minute self-paced walk, each subject performed one of the 4 stretching conditions (ballistic, dynamic, static, and no stretch) and then immediately ran a timed 40-yard sprint.

Results: There was a significant interaction between stretching conditions and their effects on sprint times, F(3,72) = 9.422, p<.0005. To break down this interaction, simple main effects were performed with 2 repeated measures ANOVAs and 4 paired t-tests using a Bonferroni corrected alpha (α = .0083). There were no significant differences between the 4 pre-condition times, p = 0.103 (Greenhouse-Geisser) or the post-condition times, p = 0.029. In the no stretch condition, subjects improved significantly from pre- to post- sprint times (p<0.0005). There were no statistically significant differences in pre- and post-stretch condition sprint times among the static (p = 0.804), ballistic (p = 0.217), and dynamic (p = 0.022) stretching conditions.

Conclusions: Sprint performance may show greatest improvement without stretching and through the use of a walking generalized warmup on a treadmill. These findings have clinically meaningful implications for runners who include iliopsoas muscle stretching as a component of the warm-up.

Level Of Evidence: Level 2.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474300PMC
October 2012

The influence of core musculature engagement on hip and knee kinematics in women during a single leg squat.

Int J Sports Phys Ther 2012 Feb;7(1):1-12

Purpose/background: Excessive frontal plane motion and valgus torques have been linked to knee injuries, particularly in women. Studies have investigated the role of lower extremity musculature, yet few have studied the activation of trunk or "core" musculature on hip and knee kinematics. Therefore, this study evaluated the influence of intentional core engagement on hip and knee kinematics during a single leg squat.

Methods: Participants (n = 14) performed a single leg squat from a 6 inch step under 2 conditions: core intentionally engaged (CORE) and no intentional core engagement (NOCORE). Participants were also evaluated for core activation ability using Sahrmann's model, and the resulting scores were used to divide participants into low (LOWCORE) and high scoring (HIGHCORE) groups. All trials were captured using 3-D motion analysis, and data were normalized for height and time. Paired t-tests and repeated measures, mixed model MANOVAs were used to assess condition and group differences.

Results: The CORE condition, compared to NOCORE, was characterized by smaller right [t(13) = 3.03, p = .01] and left [t(13) = 3.04, p = .01] hip frontal plane displacement and larger knee flexion range of motion [t(13) = 3.08, p = .009]. Subsequent MANOVAs and follow-up analyses revealed that: (1) the CORE condition demonstrated smaller right and left hip medial-lateral displacement in the LOWCORE group (p = .001), but not in the HIGHCORE group; (2) the CORE condition showed larger overall knee flexion range of motion across LOWCORE and HIGHCORE groups (p = .021); and (3) the HIGHCORE group exhibited less knee varus range of motion across CORE and NOCORE conditions (p = .028).

Conclusions: Intentional core activation influenced hip and knee kinematics during single leg squats, with greater positive effect noted in the LOWCORE group. These findings may have implications for preventing and rehabilitating knee injuries among women.

Level Of Evidence: 2B, Cohort laboratory study, mixed model design.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273878PMC
February 2012

Research and Critical Thinking : An Important Link for Exercise Science Students Transitioning to Physical Therapy.

Int J Exerc Sci 2012;5(2):93-96. Epub 2012 Apr 15.

Department of Physical Therapy Education, Rockhurst University, Kansas City, MO, USA.

Critical thinking skills are increasingly necessary for success in professional health care careers. Changes in the contemporary healthcare system in the United States arguably make these critical thinking skills more important than they have ever been, as clinicians are required on a daily basis to evaluate multiple bits of information about patients with multiple-systemic health concerns and make appropriate treatment decisions based on this information. We believe the IJES, with its emphasis on engaging undergraduate and graduate students in research and scholarly activity, is a valuable resource for promoting the higher-order critical thinking skills necessary for preparing exercise science students with an interest in professional healthcare careers such as physical therapy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738974PMC
April 2012

Does the Friel Anaerobic Threshold Test Accurately Detect Heart Rate Deflection in Trained Cyclists?

Int J Exerc Sci 2011;4(3):164-175. Epub 2011 Jul 15.

Georgia Holland Research Laboratory, Department of Physical Therapy Education and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.

The Friel Anaerobic Threshold Test (FATT) has been used to determine anaerobic threshold (AT). The FATT suggests AT occurs near the heart rate deflection point (HRDP) at a rating of perceived exertion (RPE) of 17.

Purpose: The primary purpose of this study was to determine 1) whether the HRDP could be determined using the FATT, 2) examine differences between HRVT and HR that coincided Borg's rating of perceived exertion (RPE) of 17, and 3) if riding position (hoods or aero) would influence performance.

Methods: Fourteen male cyclists (30.4 ± 7.41years of age; 151.8 ± 60.4 cycled miles/week) participated in the study. Each subject performed the FATT on two occasions within one week.

Results: The findings of this study suggest that the FATT can determine HRDP in trained cyclists while riding in the hoods position but not the aero position. No significant difference was found between the hoods and aero position for HRVT as measured by the metabolic cart. Our data suggest that HR at an RPE of 15 more accurately reflects the HRVT than the RPE of 17. A low, non-significant correlation was found for both the hoods and aero (0.41 and 0.44, respectively; p > 0.20) for the HR at RPE of 17.

Conclusion: The findings of this study suggest that the FATT can determine HRDP in trained cyclists. However, HRDP was identified in the cyclists preferred riding position. When performing the FATT, HRVT at an RPE of 15 should be used to estimate VT over the suggested RPE of 17.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738906PMC
July 2011

Biomechanical analysis of women weightlifters during the snatch.

J Strength Cond Res 2006 Aug;20(3):627-33

Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN 46217, USA.

The majority of the research to date on weightlifting has focused on men competitors. This study attempted to bridge the sex-based gap evident in the scientific literature. The performances of 10 women weightlifters competing in the 1999 United States national championships were analyzed. The performance of the athletes competing in the 69-kg class was recorded and analyzed using a Peak5 2D Motion Analysis system. The purpose of this study was 3-fold: (a) analyze the horizontal bar displacement of women weightlifters, (b) analyze key kinematic variables related to performance, and (c) compare the power outputs of the first, second, and total pulls in the snatch. Less than half (<50%) of the snatch attempts demonstrated by the women weightlifters in this study displayed the optimal toward-away-toward horizontal bar trajectory reported elsewhere. The women in this study demonstrated greater drop displacement and drop under times than those previously reported for men weightlifters. They also demonstrated lesser maximal vertically velocities of the barbell than those reported for world class women weightlifters. These women weightlifters demonstrated statistically significant differences (p < 0.05) during each phase of the snatch, and total power output values were comparable to values previously reported. The results of this study suggest that women demonstrate performance characteristics that differ subtly from those reported in men weightlifters. Knowledge of performance measures during the snatch may help coaches and athletes more fully refine the training leading to competition.
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http://dx.doi.org/10.1519/R-17625.1DOI Listing
August 2006
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