Daniel V. Gaz

Psychosocial benefits and implications of exercise.

This review is based on a case report that concerns a young female athlete who experienced some of the negative aspects of exercise. Overtraining, a negative byproduct of excessive exercise, can turn the positive psychosocial and physiologic benefits of regular physical activity into an activity detrimental to ones health. With the proper psychological skills and appropriate exercise regimen, these negatives can be turned into positives. Once learned, the psychosocial benefits of exercise, as well as the positive implications, will become more prevalent, similar to the way in which proper physical training helps one become more fit over time.

Does fair play reduce concussions? A prospective, comparative analysis of competitive youth hockey tournaments

Background/aim To determine if Boys Bantam and Peewee and Girls U14 sustain fewer concussions, head hits, ‘other injuries’ and penalties in hockey tournaments governed by intensified fair play (IFP) than non-intensified fair play (NIFP). Methods A prospective comparison of IFP, a behaviour modification programme that promotes sportsmanship, versus control (non-intensified, NIFP) effects on numbers of diagnosed concussions, head hits without diagnosed concussion (HHWDC), ‘other injuries’, number of penalties and fair play points (FPPs). 1514 players, ages 11–14 years, in 6 IFP (N=950) and 5 NIFP (N=564) tournaments were studied. Results Two diagnosed concussions, four HHWDC, and six ‘other injuries’ occurred in IFP tournaments compared to one concussion, eight HHWDC and five ‘other injuries’ in NIFP. There were significantly fewer HHWDC in IFP than NIFP (p=0.018). However, diagnosed concussions, ‘other injuries’, penalties and FPPs did not differ significantly between conditions. In IFP, a minority of teams forfeited the majority of FPPs. Most diagnosed concussions, HHWDC, and other injuries occurred to Bantam B players and usually in penalised teams that forfeited their FPPs. Conclusions In response to significant differences in HHWDC between IFP and NIFP tournaments, the following considerations are encouraged: mandatory implementation of fair play in regular season and tournaments, empowering tournament directors to not accept heavily penalised teams, and introducing ‘no body checking’ in Bantam.

Behavioral Modification to Reduce Concussion in Collision Sports: Ice Hockey

IntroductionConcussion awareness in contact or collision sports likeice hockey has escalated recently (16) in both genders at alllevels (2). The increase in sport-related concussion (SRC) isattributed to better symptom recognition, increased playerspeed and size and perceived player invincibility. For ex-ample, sales of the Cascade M11 hockey helmet soared in2009, when it was marketed as the ‘‘Enemy of Concussion.’’Parents rushed to ensure their youth hockey player’s brainwas protected by this ‘‘special’’ helmet. The aggressive ad-vertising campaign was withdrawn due to a lack of evidencesupporting the contention that the helmet reduced con-cussion risk. In fact, none of the commercially availablehelmets reduce the large linear and rotational forces trans-mitted to a hockey player’s head (8,9), Contrary to theplayers’ perception, equipment may not have protectivevalue and modern equipment design may actually increasethe incidence and severity of concussion. For example,hard shell elbow and shoulder pads may protect the wearerbut may injure opponents or teammates in collisions (1).Concussion reduction efforts must address the multifac-eted aspects of brain injury (16). Significant effort and ex-pense have been directed toward producing safer equipmentand better understanding of the injury process with respectto single or repetitive exposure to linear and rotational ac-celeration and deceleration forces. Finite element modeling(4,11) has been used to detect the strain and strain rates thatcause tissue damage. New evidence is emerging on the ben-efits and limitations of neuroimaging and neuropsychologi-cal testing in assessing concussion severity and return to play(5,6). Fundamental research into the role of biomarkers,proteins, and enzymes was released after trauma; diffuseaxonal injury, the metabolic cascade (3), and the behavior ofglial cells that engulf traumatized neurons also have helpedus better understand the neuropathology of concussion. De-spite this body of scientific data, we have not advanced thetreatment of SRC beyond removal of the concussed athletefrom sport for cognitive and physical rest until the symptomshave resolved completely with vigorous activity.Considering the dictum ‘‘an ounce of prevention is wortha pound of cure,’’ it is surprising that little effort has beendirected toward behavioral modification in injury and con-cussion prevention. This simple, inexpensive, evidence-basedmethod of changing behavior is a major construct in thepractice of medicine, coaching, and officiating that shouldbe applied to injury reduction in hockey and other sports.The principles of behavioral modification, known as op-erant conditioning, are based on the work of Skinner (10,13).The central premise of operant conditioning (10) is that be-havior is governed by reinforcing desirable behavior andpunishing undesirable behavior. For example, law enforce-ment and insurance companies reduce the risks of speedingby suspending a driver’s license after too many citations.Conversely years of violation-free driving results in lowercar insurance premiums Vpunish the bad behavior and re-ward the good. In sports medicine, patients who adhere toa daily regimen of strengthening muscle groups followinginjury are ‘‘rewarded’’ by a faster return to pain-free move-ment. The most effective way to decrease concussion preva-lence is to implement a behavior modification program toalter the culture of collision sports where equipment im-provements have made players feel ‘‘invincible.’’ Reducingaggressive and violent on-ice behavior will prevent the ma-jority of SRC that are associated with illegal and unneces-sarily rough behavior. Accidental collisions will still occur,but most SRCs result from on-ice infractions, many ofwhich are not noticed by the officials. Sadly infractionsmay be encouraged by some coaches and general man-agers, who try to win by intimidation, and by fans whoenjoy the violence (15). An example of a perverse use ofbehavioral modification in football is the provision of afinancial reward when an opposing player is injured andremoved from the game.Aggressive behavior is defined by most sport scientistsas physical or psychosocial behavior intended to intimidateor injure (18). Most major hockey penalties are levied for

Ice hockey summit II: Zero tolerance for head hits and fighting

This study aimed to present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building upon the Ice Hockey Summit I action plan (2011) to reduce SRC. The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure for the science and discussion held during Summit II (Mayo Clinic, Rochester, MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward, (2) Acute and Chronic Concussion Care: Making a Difference, (3) Preventing Concussions via Behavior, Rules, Education, and Measuring Effectiveness, (4) Updates in Equipment: Their Relationship to Industry Standards, and (5) Policies and Plans at State, National, and Federal Levels To Reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were voted on subsequently for purposes of prioritization. The following proceedings include the knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. The highest-priority action items identified from the Summit include the following: (1) eliminate head hits from all levels of ice hockey, (2) change body checking policies, and (3) eliminate fighting in all amateur and professional hockey.

Ice Hockey Summit II: zero tolerance for head hits and fighting.

Objective:To present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building on the Ice Hockey Summit I action plan (2011) to reduce SRC. Methods:The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure, for the science and discussion held during Summit II (Mayo Clinic, Rochester MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward; (2) Acute and Chronic Concussion Care: Making a Difference; (3) Preventing Concussions via Behavior, Rules, Education and Measuring Effectiveness; (4) Updates in Equipment: their Relationship to Industry Standards; and (5) Policies and Plans at State, National and Federal Levels to reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were subsequently voted on for purposes of prioritization. The following proceedings include knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. Results:The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. Conclusions:The highest priority action items identified from the Summit includes the following: (1) eliminate head hits from all levels of ice hockey, (2) change body-checking policies, and (3) eliminate fighting in all amateur and professional hockey.

Ice Hockey Summit II: Zero Tolerance for Head Hits and Fighting

To present currently known basic science and on‐ice influences of sport related concussion (SRC) in hockey, building upon the Ice Hockey Summit I action plan (2011) to reduce SRC.

The most cut-resistant neck guard for preventing lacerations to the neck

Objective:To evaluate the effectiveness of a variety of neck guard brands when contacted by a sharpened hockey skate blade. Design:Analytic experimental. Setting:Laboratory. Participants:Neck surrogate. Interventions:Forty-six samples of 14 different types of neck guards were tested on a custom-made laceration machine using a neck surrogate. Closed-cell polyethylene foam was placed between the neck surrogate and the protective device. Main Outcome Measures:The effectiveness of the neck guard was evaluated by observation of the foam after the simulated slicing action of the skate blade. Two sets of tests were performed on each device sample including low and high force. For low-force tests, initial compression loads of 100, 200, and 300 N were applied between the neck surrogate for each of 2 orientations of the blade at 45 and 90 degrees. For high-force tests, representing a more severe simulation, the applied load was increased to 600 N and a blade angle fixed at 45 degrees. All tests were performed at a blade speed of 5 m/s. Results:Only 1 product, the Bauer N7 Nectech, failed during the 300-N compression tests. All of the neck guards failed during 600-N test condition except for the Skate Armor device and 1 of the 3 Reebok 11K devices. Conclusions:A skate blade angle of 45 degrees increased the likelihood of a neck laceration compared with a skate blade angle of 90 degrees due to decreased contact area. Damage to the neck guard is not an indicator of the cut resistance of a neck guard. Neck protectors with Spectra fibers were the most cut resistant. Clinical Relevance:The study provides data for the selection of neck guards and neck guard materials that can reduce lacerations to the neck.

Determining the Validity and Accuracy of Multiple Activity-Tracking Devices in Controlled and Free-Walking Conditions

Purpose: Clinicians and fitness professionals are increasingly recommending the use of activity trackers. This study compares commercially available activity tracking devices for step and distance accuracy in common exercise settings. Design: Cross sectional. Setting: Rochester, Minnesota. Participants: Thirty-two men (n = 10) and women (n = 22) participated in the study. Measures: Researchers manually counted steps and measured distance for all trials, while participants wore 6 activity tracking devices that measured steps and distance. Analysis: We computed the difference between the number of steps measured by the device and the actual number of steps recorded by the observers, as well as the distance displayed by the device and the actual distance measured. Results: The analyses showed that both the device and walking trials affected the accuracy of the results (steps or distance, P < .001). Hip-based devices were more accurate and consistent for measuring step count. No significant differences were found among devices or locations for the distance measured. Conclusions: Hip-based activity tracking devices varied in accuracy but performed better than their wrist-based counterparts for step accuracy. Distance measurements for both types of devices were more consistent but lacked accuracy.

Interpreting oblique impact data from an accelerometer-instrumented ice hockey helmet

The purpose of this study was to assess the correlations of acceleration measurements between an instrumented hockey helmet and the Hybrid III headform and to determine whether collision with a broad surface affects the correlations between these data. A CCM Vector hockey helmet, instrumented with the Head Impact Telemetry System, was fitted onto an instrumented Hybrid III headform and dropped onto an inclined plate to simulate impacts in hockey. The helmet and headform were dropped from 0.15, 0.30, and 0.60 m at different orientations to create impacts to the vertex, occipital, right, left, and forehead surfaces. Peak linear and rotational acceleration magnitudes and head injury criteria were assessed for each system. Correlations were assessed with the Pearson correlation coefficient, and linear regression models were generated. Relative error was assessed, and results were compared with the Wilcoxon signed rank test. Peak acceleration magnitudes generally had strong mathematical correlations, although a 1:1 linear relationship for rotational acceleration data was not observed. Differences between helmet and head peak acceleration magnitudes were significant. The linear relationship varied according to the impact direction. Instrumented helmet and head data demonstrated a strong mathematical correlation, but measures of linear acceleration generally had better 1:1 agreement than rotational acceleration measures. There is some dependence in the relationship between the helmet and head data on the impact direction, with vertex strikes showing the weakest correlation. Although data generated from the helmet may be useful for interpreting head accelerations experienced by on-ice players, additional analysis of the time-series data should be performed to understand its full utility.

Activity Tracking and Improved Health Outcomes

Activity tracking devices are a popular way for health-minded individuals to measure daily movement and estimate energy expenditure. Tracking, in its many forms, has been proven to improve health outcomes. From paper diaries to devices and smartphone applications, these data are becoming more important and have the potential to be used in the physicians office as part of a realistic physical activity plan for improved health outcomes. As a health-care professional, amid a rapidly expanding accelerometer market, it is important to know the application and practicality of these devices, as well as the evidence behind an individuals usage. What we choose to recommend, as health-care professionals, can influence the health and well-being of patients in the wellness arena. This chapter will look at research focused on activity tracking, including metrics such as sleep, nutrition, and physical activity, and health outcomes to further educate health-care professionals in an ever-evolving field.