- Email: [email protected]
Keynote
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Thursday 1 November Papers / Journal of Science and Medicine in Sport 15 (2013) S34–S126
particularly in novices. To date no true effective preventive strategies against running related injuries in novice runners are available. Studies have shown abnormal running kinematics to be a predisposing factor for injury. In addition, core stability has been widely accepted as an influential factor for running kinematics, running performance and injury prevention. While core stability is arguably low in novice runners who pick up running for health reasons, this might pose a novel hook for preventive programs against running injuries in novices. Evidence concerning running kinematics in novices and relations with core stability is lacking, however. Methods: Seventeen novice runners who participated in a start-to-run program, participated in a controlled running-induced fatigue protocol and core endurance assessment. Kinematic data were analyzed for the lower extremities and trunk throughout the running protocol and, on separate days, core endurance measures were recorded. Changes in pre- and post-fatigue running kinematics and relations with core endurance measures were analyzed. Results: Significant changes in trunk flexion, trunk extension, bilateral hip extension, bilateral ankle pronation, and non-dominant ankle supination were found as a result of runninginduced fatigue. Kinematic changes displayed positive relations with core endurance measures, in contrast to expected negative relations. Discussion: Core endurance measures display unexpected relations with running kinematics and require further investigation. Novice runners, however, do display changes in trunk flexion and extension, indicating an overall increase in trunk-flexed posture during fatigued running. Changes in hip extension, ankle pronation, and ankle supination additionally occur. Such fatigue induced kinematic changes have not been found for experienced competitive runners. From these findings it can be concluded that kinematic changes due to fatigue may be predisposing factors for injury that should be considered in future preventive strategies. http://dx.doi.org/10.1016/j.jsams.2012.11.097 95 SMA’s role in bridging the gaps between different fields N. Marino ∗
research through the Journal of Science and Medicine in Sport and the SMA Research Foundation and the translation of key research into more accessible information through various mediums are also examples of SMA’s support of collaboration across the industry and the delivery of its vision. The Smartplay program has also for a number of years stood as means of promoting sports injury information to the broader sporting community through the support of research and the dissemination of sport safety information and advice. The Be Active Conference is a further example of SMA facilitating cross sectoral collaboration, combining the National Physical Activity Conference, The Australian Conference of Science and Medicine in Sport and the National Sports Injury Prevention Conference. It is one of the few events of its kind which actively seeks to encourage cross collaboration of important disciplines and sectors associated with various aspects of sport, health and physical activity. This presentation will focus on the importance of an organisation like SMA in ensuring the various key sectors continue to collaborate in the delivery of better sport and physical activity outcomes for all of our communities. http://dx.doi.org/10.1016/j.jsams.2012.11.098 Closing the gap between injury prevention research and community safety promotion practice
96 Keynote NSW Sporting Injuries Sponsored Speaker D. Hanson ∗ Mackay Health Service District Sports Medicine Australia aims to promote and promulgate high-quality, innovative research. As laudable as this is, it is not enough. Unless this research culminates in practical and costeffective interventions capable of attracting the political and social support required to allow effective implementation; it will not prevent harm or save lives. The Public Health Model has been proposed as a framework to promote the progression of sports medicine research towards realworld application. In this four-stage model, research progresses in a stepwise manner through:
Sports Medicine Australia Sports Medicine Australia (SMA) is comprised of a multidisciplinary membership committed to ensuring safe participation in sport, physical activity. As an organisation which is approaching its 50th year, it has continued to evolve from an organisation borne out of providing sports medicine services for athletes at sporting events, to one which actively promotes safe participation more broadly through the facilitation of research, community education, professional development, advocacy. Like its membership, SMA’s diversity enables it to play a significant role in numerous associated industries, through varied initiatives. Its slogan ‘Safety, Prevention, Advice’ also encompasses what it considers as key factors often overlooked in the delivery of key sport, physical activity promotion strategies. Examples of its key programs include the Safer Sport community education program which has trained over 100,000 Australians in injury prevention and management techniques and maintained a standard in the Australian sports industry for this type of personnel. Professional development of the SMA membership in injury prevention and management techniques which ultimately filter into elite and community sport through policy, the encouragement of
Stage 1: Stage 2: Stage 3: Stage 4:
establishing the magnitude of the problem identifying risk factors developing effective interventions ensuring widespread adoption and use
Unfortunately most sports injury research does not result in adequate dissemination or widespread use of effective interventions. Several gaps between injury prevention research and safety promotion practice are identified: • the efficacy and effectiveness gap (a scientific problem), • the research to practice gap (an implementation problem), • the injury prevention to safety promotion gap (a political problem). These gaps stem from the contrasting approaches researchers, policy makers, practitioners and the community take to the scientific, practical, and social challenges posed by the contextual complexity of injury. Some researchers believe that stages 1 to 3 constitute the real scientific work of injury prevention arguing that Stage 4, dissemination and adoption, can essentially be delegated
Thursday 1 November Papers / Journal of Science and Medicine in Sport 15 (2013) S34–S126
to practitioners who merely have to apply their research findings. This approach underestimates the importance of the contextual determinants of success. Three types of experts are required to design effective interventions capable of dissemination into the wider community: researchers (content experts), practitioners (process experts) the target community itself (context experts). From the outset, an open transdisciplinary dialogue that synthesizes the expertise of all stakeholders is required to design effective interventions that can be applied in the real world. http://dx.doi.org/10.1016/j.jsams.2012.11.099 97 Birth weight, sedentary time and abdominal adiposity in youth: The international children’s accelerometry database (ICAD) U. Ekelund 1,∗ , K. Wijndaele 2 , L. Sherar 3 , A. Cooper 4 1
Department of Sport Medicine, Norwegian School of Sport Sciences MRC Epidemiology Unit, Cambridge, UK 3 School of Sport, Exercise and Health Sciences, Loughborough University, UK 4 Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, UK 2
Introduction: Low birth weight (BW) is linked to higher risk of metabolic diseases in adulthood whereas high BW appears to be associated with high general and central adiposity. Higher amounts of time spent sedentary is also associated with abdominal adiposity in children but this association may be bi-directional. The aim of the present study was to examine the associations between BW and central adiposity and whether this association is mediated by time spent sedentary in children. Methods: We used data from 11,643 children (5,511 boys) aged 11.6 ± 1.7 yrs. from the International Children’s Accelerometry Database (ICAD) comprising 7 countries. BW was obtained by maternal report. Waist circumference (WC) was measured according to standardized procedures. Sedentary time (<100 counts/min) was assessed by Actigraph accelerometry after reanalyzing all raw data. The association between BW and WC was analyzed by general linear modeling adjusted for sex, study, and age. In the second model we examined the association between BW and sedentary time adjusting for the same covariates as above and monitor wear time. Finally, we analyzed the association between BW and WC with additional adjustment for sedentary time. Results: Girls accumulated significantly higher amounts of sedentary time than boys (368 ± 86 min/d vs 350 ± 89, P < 0.0001). BW (3457 ± 588 g vs 3341 ± 536 g, P < 0.0001) and WC (66.8 ± 9.4 cm vs 65.7 ± 9.3, P < 0.0001) was significantly higher in boys than in girls. After adjusting for sex, age, and study, a bi-directional cross-sectional association between sedentary time and WC was observed (P < 0.0001). BW was positively associated with higher WC (=0.002, 95% CI, 0.001;0.003, P < 0.0001), suggesting that a 1 kg higher BW was associated with a 2 cm larger WC. Similarly, BW was significantly and positively associated with sedentary time (=0.005, 95% CI, 0.003;0.008). We thereafter analyzed whether sedentary time mediated the association between BW and WC by including sedentary time as a covariate in the model and the association between BW and WC was only slightly attenuated (=0.002, 95% CI, 0.001;0.002). Discussion: High BW is associated with a larger WC independent of sedentary time in children which may influence their current and future health. The bi-directional association between sedentary time and WC complicates the interpretation on whether
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sedentary time acts as a mediator on the association between BW and WC. Given the association between maternal obesity during pregnancy and high birth weights, preventive efforts should aim to promote healthy body weight in young women of childbearing age. http://dx.doi.org/10.1016/j.jsams.2012.11.100 98 Associations of physical activity and sedentary time with weight status among school-aged girls and boys across five European countries I. De Bourdeaudhuij 1,∗ , M. Verloigne 1 , L. Maes 1 , W. Van Lippevelde 1 , M. Chinapaw 2 , S. te Velde 2 , Y. Manios 3 , E. Kovacs 4 , A. Dossegger 5 , J. Brug 2 1
Ghent University VU University Medical Center, Amsterdam 3 Harokopio University, Athens 4 University of Pécs 5 Federal Institute of Sport Magglingen 2
Introduction: No study included objective measures of both sedentary time and physical activity to study their combined or independent associations with or effect on overweight among (school) children. The aim of this study is to identify subgroups of children based on their moderate-to-vigorous physical activity and sedentary time, and explore the differences in body mass index (BMI), waist circumference and overweight prevalence between these subgroups. Methods: Randomly selected primary schools from cities with a different degree of urbanization in five European countries were included within the EU funded ENERGY project. A sample of 722 children, 53.2% girls, mean age 11.6 years (sd = 0.8) was recruited from Hungary (n = 147), Belgium (n = 107), The Netherlands (n = 102), Greece (n = 160) and Switzerland (n = 206). Measures included objectively measured BMI, waist circumference and overweight/obesity and accelerometer based sedentary time and physical activity. Results: Cluster analysis revealed four clusters in both gender groups showing an unhealthy pattern (low physical activity/high sedentary time), a healthy pattern (high physical activity/low sedentary time), a low mixed pattern (low physical activity/low sedentary time), and a moderate to high mixed pattern (moderate to high physical activity/moderate sedentary time). In girls, the high physical activity/low sedentary time cluster had a significantly lower mean BMI (p≤0.05), a lower waist circumference (p≤0.01), and the lowest percentage of overweight (p≤0.10) compared to the other three clusters. In boys, both clusters with higher activity levels had significantly lower BMIs (p≤0.001) and waist circumference (p≤0.001) than the two low activity clusters, independent of sedentary time. Discussion: Engagement in more physical activity and less sedentary time is associated with more favorable weight and weight status among girls. Among boys physical activity seems most important for weight and weight status, while sedentary time appears to be less relevant. http://dx.doi.org/10.1016/j.jsams.2012.11.101
Thursday 1 November Papers / Journal of Science and Medicine in Sport 15 (2013) S34–S126
particularly in novices. To date no true effective preventive strategies against running related injuries in novice runners are available. Studies have shown abnormal running kinematics to be a predisposing factor for injury. In addition, core stability has been widely accepted as an influential factor for running kinematics, running performance and injury prevention. While core stability is arguably low in novice runners who pick up running for health reasons, this might pose a novel hook for preventive programs against running injuries in novices. Evidence concerning running kinematics in novices and relations with core stability is lacking, however. Methods: Seventeen novice runners who participated in a start-to-run program, participated in a controlled running-induced fatigue protocol and core endurance assessment. Kinematic data were analyzed for the lower extremities and trunk throughout the running protocol and, on separate days, core endurance measures were recorded. Changes in pre- and post-fatigue running kinematics and relations with core endurance measures were analyzed. Results: Significant changes in trunk flexion, trunk extension, bilateral hip extension, bilateral ankle pronation, and non-dominant ankle supination were found as a result of runninginduced fatigue. Kinematic changes displayed positive relations with core endurance measures, in contrast to expected negative relations. Discussion: Core endurance measures display unexpected relations with running kinematics and require further investigation. Novice runners, however, do display changes in trunk flexion and extension, indicating an overall increase in trunk-flexed posture during fatigued running. Changes in hip extension, ankle pronation, and ankle supination additionally occur. Such fatigue induced kinematic changes have not been found for experienced competitive runners. From these findings it can be concluded that kinematic changes due to fatigue may be predisposing factors for injury that should be considered in future preventive strategies. http://dx.doi.org/10.1016/j.jsams.2012.11.097 95 SMA’s role in bridging the gaps between different fields N. Marino ∗
research through the Journal of Science and Medicine in Sport and the SMA Research Foundation and the translation of key research into more accessible information through various mediums are also examples of SMA’s support of collaboration across the industry and the delivery of its vision. The Smartplay program has also for a number of years stood as means of promoting sports injury information to the broader sporting community through the support of research and the dissemination of sport safety information and advice. The Be Active Conference is a further example of SMA facilitating cross sectoral collaboration, combining the National Physical Activity Conference, The Australian Conference of Science and Medicine in Sport and the National Sports Injury Prevention Conference. It is one of the few events of its kind which actively seeks to encourage cross collaboration of important disciplines and sectors associated with various aspects of sport, health and physical activity. This presentation will focus on the importance of an organisation like SMA in ensuring the various key sectors continue to collaborate in the delivery of better sport and physical activity outcomes for all of our communities. http://dx.doi.org/10.1016/j.jsams.2012.11.098 Closing the gap between injury prevention research and community safety promotion practice
96 Keynote NSW Sporting Injuries Sponsored Speaker D. Hanson ∗ Mackay Health Service District Sports Medicine Australia aims to promote and promulgate high-quality, innovative research. As laudable as this is, it is not enough. Unless this research culminates in practical and costeffective interventions capable of attracting the political and social support required to allow effective implementation; it will not prevent harm or save lives. The Public Health Model has been proposed as a framework to promote the progression of sports medicine research towards realworld application. In this four-stage model, research progresses in a stepwise manner through:
Sports Medicine Australia Sports Medicine Australia (SMA) is comprised of a multidisciplinary membership committed to ensuring safe participation in sport, physical activity. As an organisation which is approaching its 50th year, it has continued to evolve from an organisation borne out of providing sports medicine services for athletes at sporting events, to one which actively promotes safe participation more broadly through the facilitation of research, community education, professional development, advocacy. Like its membership, SMA’s diversity enables it to play a significant role in numerous associated industries, through varied initiatives. Its slogan ‘Safety, Prevention, Advice’ also encompasses what it considers as key factors often overlooked in the delivery of key sport, physical activity promotion strategies. Examples of its key programs include the Safer Sport community education program which has trained over 100,000 Australians in injury prevention and management techniques and maintained a standard in the Australian sports industry for this type of personnel. Professional development of the SMA membership in injury prevention and management techniques which ultimately filter into elite and community sport through policy, the encouragement of
Stage 1: Stage 2: Stage 3: Stage 4:
establishing the magnitude of the problem identifying risk factors developing effective interventions ensuring widespread adoption and use
Unfortunately most sports injury research does not result in adequate dissemination or widespread use of effective interventions. Several gaps between injury prevention research and safety promotion practice are identified: • the efficacy and effectiveness gap (a scientific problem), • the research to practice gap (an implementation problem), • the injury prevention to safety promotion gap (a political problem). These gaps stem from the contrasting approaches researchers, policy makers, practitioners and the community take to the scientific, practical, and social challenges posed by the contextual complexity of injury. Some researchers believe that stages 1 to 3 constitute the real scientific work of injury prevention arguing that Stage 4, dissemination and adoption, can essentially be delegated
Thursday 1 November Papers / Journal of Science and Medicine in Sport 15 (2013) S34–S126
to practitioners who merely have to apply their research findings. This approach underestimates the importance of the contextual determinants of success. Three types of experts are required to design effective interventions capable of dissemination into the wider community: researchers (content experts), practitioners (process experts) the target community itself (context experts). From the outset, an open transdisciplinary dialogue that synthesizes the expertise of all stakeholders is required to design effective interventions that can be applied in the real world. http://dx.doi.org/10.1016/j.jsams.2012.11.099 97 Birth weight, sedentary time and abdominal adiposity in youth: The international children’s accelerometry database (ICAD) U. Ekelund 1,∗ , K. Wijndaele 2 , L. Sherar 3 , A. Cooper 4 1
Department of Sport Medicine, Norwegian School of Sport Sciences MRC Epidemiology Unit, Cambridge, UK 3 School of Sport, Exercise and Health Sciences, Loughborough University, UK 4 Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, UK 2
Introduction: Low birth weight (BW) is linked to higher risk of metabolic diseases in adulthood whereas high BW appears to be associated with high general and central adiposity. Higher amounts of time spent sedentary is also associated with abdominal adiposity in children but this association may be bi-directional. The aim of the present study was to examine the associations between BW and central adiposity and whether this association is mediated by time spent sedentary in children. Methods: We used data from 11,643 children (5,511 boys) aged 11.6 ± 1.7 yrs. from the International Children’s Accelerometry Database (ICAD) comprising 7 countries. BW was obtained by maternal report. Waist circumference (WC) was measured according to standardized procedures. Sedentary time (<100 counts/min) was assessed by Actigraph accelerometry after reanalyzing all raw data. The association between BW and WC was analyzed by general linear modeling adjusted for sex, study, and age. In the second model we examined the association between BW and sedentary time adjusting for the same covariates as above and monitor wear time. Finally, we analyzed the association between BW and WC with additional adjustment for sedentary time. Results: Girls accumulated significantly higher amounts of sedentary time than boys (368 ± 86 min/d vs 350 ± 89, P < 0.0001). BW (3457 ± 588 g vs 3341 ± 536 g, P < 0.0001) and WC (66.8 ± 9.4 cm vs 65.7 ± 9.3, P < 0.0001) was significantly higher in boys than in girls. After adjusting for sex, age, and study, a bi-directional cross-sectional association between sedentary time and WC was observed (P < 0.0001). BW was positively associated with higher WC (=0.002, 95% CI, 0.001;0.003, P < 0.0001), suggesting that a 1 kg higher BW was associated with a 2 cm larger WC. Similarly, BW was significantly and positively associated with sedentary time (=0.005, 95% CI, 0.003;0.008). We thereafter analyzed whether sedentary time mediated the association between BW and WC by including sedentary time as a covariate in the model and the association between BW and WC was only slightly attenuated (=0.002, 95% CI, 0.001;0.002). Discussion: High BW is associated with a larger WC independent of sedentary time in children which may influence their current and future health. The bi-directional association between sedentary time and WC complicates the interpretation on whether
S41
sedentary time acts as a mediator on the association between BW and WC. Given the association between maternal obesity during pregnancy and high birth weights, preventive efforts should aim to promote healthy body weight in young women of childbearing age. http://dx.doi.org/10.1016/j.jsams.2012.11.100 98 Associations of physical activity and sedentary time with weight status among school-aged girls and boys across five European countries I. De Bourdeaudhuij 1,∗ , M. Verloigne 1 , L. Maes 1 , W. Van Lippevelde 1 , M. Chinapaw 2 , S. te Velde 2 , Y. Manios 3 , E. Kovacs 4 , A. Dossegger 5 , J. Brug 2 1
Ghent University VU University Medical Center, Amsterdam 3 Harokopio University, Athens 4 University of Pécs 5 Federal Institute of Sport Magglingen 2
Introduction: No study included objective measures of both sedentary time and physical activity to study their combined or independent associations with or effect on overweight among (school) children. The aim of this study is to identify subgroups of children based on their moderate-to-vigorous physical activity and sedentary time, and explore the differences in body mass index (BMI), waist circumference and overweight prevalence between these subgroups. Methods: Randomly selected primary schools from cities with a different degree of urbanization in five European countries were included within the EU funded ENERGY project. A sample of 722 children, 53.2% girls, mean age 11.6 years (sd = 0.8) was recruited from Hungary (n = 147), Belgium (n = 107), The Netherlands (n = 102), Greece (n = 160) and Switzerland (n = 206). Measures included objectively measured BMI, waist circumference and overweight/obesity and accelerometer based sedentary time and physical activity. Results: Cluster analysis revealed four clusters in both gender groups showing an unhealthy pattern (low physical activity/high sedentary time), a healthy pattern (high physical activity/low sedentary time), a low mixed pattern (low physical activity/low sedentary time), and a moderate to high mixed pattern (moderate to high physical activity/moderate sedentary time). In girls, the high physical activity/low sedentary time cluster had a significantly lower mean BMI (p≤0.05), a lower waist circumference (p≤0.01), and the lowest percentage of overweight (p≤0.10) compared to the other three clusters. In boys, both clusters with higher activity levels had significantly lower BMIs (p≤0.001) and waist circumference (p≤0.001) than the two low activity clusters, independent of sedentary time. Discussion: Engagement in more physical activity and less sedentary time is associated with more favorable weight and weight status among girls. Among boys physical activity seems most important for weight and weight status, while sedentary time appears to be less relevant. http://dx.doi.org/10.1016/j.jsams.2012.11.101