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A-44 Free Communication/Poster - Special Populations

Medicine & Science in Sports & Exercise: May 2013 - Volume 45 - Issue 5S - p 71–75
doi: 10.1249/01.mss.0000433619.89544.63

May 29, 2013, 7:30 AM - 12:30 PM

Room: Hall C

318 Board #170 May 29, 11:00 AM - 12:30 PM

Muscle Oxidative Capacity is Reduced in Prostate Cancer Survivors Undergoing Curative Radiotherapy

Carlynn A. Alt1, Elizabeth M. Gore2, Robert Prost2, Ellen Heyer3, Alexander V. Ng, FACSM3. 1University of Wisconsin Milwaukee, Milwaukee, WI. 2Medical College of Wisconsin, Milwaukee, WI. 3Marquette University, Milwaukee, WI.

(No relationships reported)

It has been previously shown that decreased muscle endurance in prostate cancer survivors undergoing radiotherapy may be related to cancer-related fatigue (CRF) and due to decreased oxidative muscle capacity.

PURPOSE: To determine if local muscle oxidative capacity and cancer-related fatigue were different in prostate cancer survivors (CS) undergoing curative radiotherapy compared with age-matched controls (C).

METHODS: This cross sectional pilot study examined prostate cancer survivors after 5-6 weeks of curative radiotherapy (n=8, 58.5 yrs ± 24.9), and age-matched controls (n= 7, 62.8 yrs ± 8.7). In each subject CRF was indicated by the revised Piper Fatigue Scale (PFS) and Fatigue Inventory Scale (FIS). Sleepiness (Epworth Sleepiness Scale), depression (Centers for Disease-Depression subscale), and cognition (Mini Mental State Exam) were also assessed. Muscle oxidative capacity was assessed with 31P- MR spectroscopy to measure the rate of phosphocreatine (PCr) recovery (kPCr), which reflects muscle oxidative capacity, following a maximal 15 s isometric contraction of the ankle dorsiflexors. Physical activity (PA) levels were measured using accelerometers and hemoglobin was evaluated with blood samples. Testing occurred following 84% (32/38) of prescribed radiotherapy. Analyses were with independent t-tests. Data are Mean ± SD and Mean ± SE (questionnaires), significance level p<0.05.

RESULTS: PCr recovery was faster in age-matched controls (kPCr = 0.035 ± 0.016) compared with prostate cancer survivors (kPCr = 0.020 ± 0.008, p= 0.043). There were no differences in PA or hemoglobin concentrations. Prostate cancer survivors also had greater CRF [PFS, cognitive subscale (xcs=3.13 ± 0.63, xc=0.82 ± 0.38, p=0.014), sensory subscale (xcs=4.18 ± 0.84, xc=1.27 ± 0.62, p=0.023), and FIS (xcs=46.23 ± 9.89, xc=8.50 ± 3.96, p =0.009)] with no difference in sleepiness, depression or mental state.

CONCLUSION: Prostate cancer survivors undergoing curative radiotherapy demonstrate slower phosphocreatine recovery, suggesting reduced local muscle oxidative capacity, compared with controls. This lower muscle oxidative capacity may be associated with CRF.

Funded by The Lance Armstrong Foundation

319 Board #171 May 29, 11:00 AM - 12:30 PM

Supervised Exercise Reduces Cancer Related Fatigue in Breast Cancer Patients

Eduardo Oliveira1, Maria João Cardoso1, André Seabra2, Sofia Magalhães1, Sara M. Oliveira1, Diana Carvalho1, José Soares2. 1Mama Help-Support Centre for Breast Cancer Patients, Porto, Portugal. 2Sports Faculty of University of Porto, Porto, Portugal.

(No relationships reported)

Fatigue is one of the most prevalent and distressing symptoms of cancer, and is a common side-effect of the disease and its treatments. Despite the recognition ofthe fact, there are few evidence-based exercise supervised interventions available to help in the management of cancer derived fatigue.

PURPOSE: To assess the feasibility of an exercise supervised program and its effects upon cancer related fatigue in breast cancer patients during treatment.

METHODS: Breast cancer patients were allocated into an exercise intervention program (EI, n=40) and to a control group (CG, n= 8) that received standard care. The intervention comprised cardiovascular training at 70-85% of VO2max in cycle ergometer, resistence training, and specific rehabilitation arm exercises. Patients were trained during 60 minutes, two times per week, during 12 weeks, with progression in time and intensity during the intervention period with the main goal to achieve at week 12, thirty minutes at 85%VO2max. The exercise program also comprised resistance training, and specific rehabilitation arm exercises. Primary outcome was change in cancer related fatigue, as determined by VO2max incremental direct bycicle ergometer between baseline and follow up. Health related quality of life was assessed by the European Organization for Reasearch and Treatment of Cancer (EORTC QLQ-C30), with analysis of fatigue and pain symptoms. General linear model for repeated measures was used to compare (baseline and 12-week follow-up) with group assignment and time x group interaction included as fixed effects (p≤.05 for significance).

RESULTS: The fatigue deacreased by 16.4 points in the intervention group compared with only 2.7 points in the control group (p<.001). A significant deacrese in pain was obtained for the intervention group with a reduction by 20.4 points vs 2.6 points for the control group (p<.001). VO2max increased by 4.6 ml/kg/min-1 (17.5%) in patients in the intervention group and by 1,5 ml/kg/min-1 (7.1%) in the control group (p<.05). There were no diferences in global health status.

CONCLUSIONS: A supervised,12-week aerobic and strength training, exercise program had significant changes in cancer related fatigue in breast patients during treatment.

320 Board #172 May 29, 11:00 AM - 12:30 PM

Exercise Enhances Lower Body Muscular Strength/endurance In Cancer Survivors

Philip M. Anton, Laura Collebrusco. Southern Illinois University Carbondale, Carbondale, IL. (Sponsor: Juliane Wallace, FACSM)

(No relationships reported)

The inability to perform activities of daily living (ADL) and a lowered quality of life (QOL) are common dilemmas facing many cancer survivors face following chemotherapy treatment. These declines are often the result of a decrease in muscle strength and endurance, particularly in the lower extremities. These deleterious effects are often magnified by the fact the chemotherapy treatment typically contributes to an overall decline in physical activity level.

PURPOSE: The purpose of this investigation was to examine the influence of individualized prescriptive exercise on sit and stand performance in a population of cancer survivors who had undergone chemotherapy, relative to a group of apparently healthy controls.

METHODS: Participants treated previously with chemotherapy (C: n = 29), and age-matched non-cancer controls (NC: n = 29) were assigned to an exercise specialist who constructed and supervised two exercise sessions per week spanning the 12-week exercise intervention. The exercise program was based on each participant’s medical profile, initial fitness status, and quality of life goals. Exercise sessions were approximately an hour in length and were comprised of a combination of aerobic, resistance, balance, and flexibility exercise. Prior to and following the intervention, all participants were assessed on sit and stand performance (seconds to complete 10 sit/stand cycles). The results of the sit and stand tests were analyzed using a 2 (condition) X 2 (test) ANOVA.

RESULTS: The analysis indicated that the main effect for Condition was not significant (F 1,56 = 0.059, p = 0.809); however, the main effect for Test was significant (F 1,56 = 249.16, p = 0.001), with both conditions improving from the pre-test to the post-test (C: 28.9s → 18.7s, -35.3%; NC: 26.4s → 24.2s, - 8.3%). The interaction of Condition and Test was not significant.

CONCLUSIONS: The results of this study indicate that prescribed exercise has a positive influence on the performance of the sit to stand task in both patient and non-patient populations. This finding may very well translate to other ADL, and the practical significance of this improvement may be a powerful motivator for both cancer survivors and rehabilitation exercise specialists to target ADL in their respective efforts to improve QOL.

321 Board #173 May 29, 11:00 AM - 12:30 PM


G. Stephen Morris, FACSM, Webb A. Smith, Melissa M. Hudson, James G. Gurney, Leslie L. Robison, Kirsten K. Ness. St. Jude Children’s Research Hospital, Memphis, TN.

(No relationships reported)

PURPOSE: We recently demonstrated that a subset of adult survivors of childhood cancers were unable to achieve age predicted maximum heart rates despite having an respiratory exchange ratio (RER) > 1.10 (MSSE. 2012;44(5S):375). This finding suggests an inability to appropriately match heart rate with increasing exertional demand i.e. chronotrophic incompetence (CI). Thus, we hypothesized that these patients had CI and the purpose of this study was to make that determination.

METHODS: Adult survivors of childhood cancer enrolled in the St. Jude Children’s Research Hospital Lifetime Cohort Study (SJLIFE) completed a cardiopulmonary stress test (CPT). Heart rate (HR), oxygen consumption and RER were measured continuously during a modified Bruce treadmill protocol. Participants who achieved a RER > 1.10 during the CPT were considered to have achieved maximal exercise exertion. CI was defined as failing to 1) achieve at leaset 85% of age predicted maximum HR (220-age) during a maximal exercise test and 2) achieve at least 80% of HR reserve (HRmax measured - HRrest)/(HRmax predicted - HRrest) (Brubaker & Kitzman. Circ. 2011:123:1010).

RESULTS: 93 survivors completed the CPT test with an RER > 1.10 (1.16 + 0.0609; range 1.1 - 1.35). Of these patients, 77 (83%) demonstrated both criteria used to define CI. Mean measured and derived HRs are presented in Table 1.

CONCLUSIONS: The presence of CI may contribute to the exercise intolerance demonstrated by some cancer survivors. Participation in exercise training may improve chronotrophic regulation in these survivors.

Table 1.

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322 Board #174 May 29, 11:00 AM - 12:30 PM

Case Study: Acute Detraining Following Whipple Procedure Surgery

Cory Whitmer, Raymond Peralta, Michele Aquino, Mariel Wenzel, Laura D’Amore, John Wygand, Robert M. Otto, FACSM. Adelphi University, Garden City, NY.

(No relationships reported)

Based on diagnosis of adenocarcinoma, a male collegiate weightlifter(24 yrs., 178 cm, 93.6 kg) underwent a partial Whipple procedure, which included surgical removal of the head of the pancreas, the proximal duodenum, the proximal bile duct, the gallbladder and associated lymph nodes. The average age of a patient receiving the Whipple procedure is 72 yrs. The patient was vigorously training and physically active until surgery and confined to complete bed rest for 17 of 19 days immediately post-surgery.

PURPOSE: The purpose of this study was to monitor detraining and the time course of recovery.

METHODS: The subject performed a battery of tests within four days pre-surgery and repeated all tests at 62 days post-surgery, except cycleVO2max test and Wingate Anaerobic Test (WAnT) performed at 88 days post-surgery.

RESULTS: BMR: 34.7 vs.30.55 kCalm2hr-1; Hand Grip Dynamometer: dominant hand 61.4 vs.44.1 kg, nondominant hand 54.5 vs.40 kg; BIA Body composition: 13 vs.9.6% body fat,11.08 vs. 6.8 kg fat mass, 77.2 vs. 65.5 kg fat free mass; Isokinetic testing for unilateral knee extension: Peak Torque (PT) 147 vs.116ft/lbs, μPT(reps 1-3)144 vs. 107 ft/lbs, μPT(reps 48-50) 83 vs. 41ft/lbs, fatigue index 42.7 vs. 62%; Cycle VO2max: 3.79 vs. 3.18 L/min, 42.7 vs. 40.4 mL/kg/min, peak workload 300 vs. 250 W, max HR 188 vs. 196 b/min, peak blood lactate 12.3 vs. 13.2 mmolL-1; WAnT: peak power (PP) 1543 vs. 1093 W, PP/Body Mass 17.3 vs. 14.01 W/kg, total work 26453 vs. 19350 J, were obtained pre-surgery and post-surgery, respectively. Caloric expenditure (Kcal/hr) decreased 18.7%, BMR decreased 12%. WAnT: PP decreased 29.2%; relative PP decreased 19.2%. Absolute VO2 max decreased 16.4%; relative VO2 max decreased 5.4%.

CONCLUSION: Despite IV nutrition intended to maintain an isocaloric intake, after 23 days of predominantly bed rest, body mass decreased 1.14 kg/day from 93.6 to 67.3 kg with a concomitant reduction in muscle function. The 11.7 kg loss of fat free mass drastically reduced absolute function, but relative muscle function was attenuated markedly less.

323 Board #175 May 29, 11:00 AM - 12:30 PM

Impact of Obesity On Functional Independence In Older Adults

L. Jerome Brandon, FACSM. Georgia State University, Atlanta, GA.

(No relationships reported)

Obesity, not only has an effect on health, but may also impacts independent living in older adults.

PURPOSE: This study was designed to investigate the effects that obesity has on relative strength and physical function in older adults.

METHODS: Participants for this study were 109 older (age 68.9 yrs) men and women (52 and 59 respectively). The participants were divided into obese (body fat ≥ 30%-OB-) and non-obese (< 30% - NOB) groups by gender and were evaluated for strength on 11 muscle groups, five functional tasks, body fat, waist circumference and body mass index. Relative strength (one repetition maximum-kg-/body weight - kg) was divided into five-upper, three-trunk and three-lower body groups. Mobility tasks were times up & go - rising from a chair, walking 10 feet and back; upstairs - walking up and downstairs - walking down a flight of 8 stairs with a 2.3 kg weight. Function was time required to rising from the floor and flexibility was modified sit and reach.

RESULTS: Body fat of the NOB men and women were 25.6 ± 3.0% and 26.8 ± 2.3% respectively, and the OB men and women were 35.2 ± 3.1% and 38.6 ± 4.4% respectively. The NOB had relative strength values 14.8 and 18.1% greater than the OB men and women, respectively. Since the response trends were similar, data from men and women were combined. Physical function showed the NOB to have better values of 0.1%, 5.3% and 9.9% for flexibility, function and mobility, respectively, but there was no difference (p < 0.05) between the overall physical function of the two groups. A stepwise regression showed that upper body muscle groups were significant predictors of mobility and function (R218.6 and 20.0%, respectively) in the NOB and trunk for mobility and function (R210.9 and 11.3%) in the OB.

CONCLUSION: These results indicate that obesity does not (p> 0.05) alter physical function in independent living older adults. Apparently, the relative strength for both OB and NOB was above the minimal strength threshold need for independent function and strength above the minimal needed provided no additional benefits.

324 Board #176 May 29, 11:00 AM - 12:30 PM

Assessment of Eating Behavior Patterns using Factor Analysis in NCAA Athletes

Jonathan Kurka1, Matthew P. Buman1, Beth Gevirtz2, Amy Overlin2, Barbara E. Ainsworth, FACSM1. 1Arizona State University, Phoenix, AZ. 2Arizona State University, Tempe, AZ.

(No relationships reported)

PURPOSE: Athletes may be at risk for developing adverse health outcomes due to poor eating behaviors during collegiate sport. This study examined Rapid Eating Assessment for Patients (REAP) as a valid tool for analyzing eating characteristics of NCAA Division-I athletes at a large southwestern university and investigated the relationships between uncovered eating behavior patterns with BMI and aesthetic (AS) versus non-aesthetic sport (NAS) athletes.

METHODS: REAP was adapted and completed by consenting student athletes (86 males; 64 females) as part of the mandated annual physical examination. Principal component analysis for ordinal responses (PCA) was conducted on the 25 eating-frequency questions. Sampling adequacy was verified and the scree plot suggested four factors be retained. Eight questions were removed due to cross-loading and low communality estimates (<.30). A confirmatory factor analysis (CFA) was conducted on a larger sample of the same population to confirm good model fit.

RESULTS: The resulting principal components were unhealthy eating habits (UEH), healthy eating habits (HEH), high-fat meat consumption (HFM), and unhealthy fat and oil consumption (UFO). BMI was associated with HEH (r= -0.17, p=.04) and HFM (r= -0.20, p=.01). Reporting effect size and p-value (significance <.05), AS males had higher HEH scores (6.2%, p=.02) and lower BMI (23.6±3.3, 27.7±5.7) than NAS males. AS females had higher UEH (9.0%, p=.02), HFM (12.9%, p=.003) and total eating behavior scores (7.7%, p=.03) than NAS females. For males and females combined, AS athletes had higher HFM (6.0%, p=.003), total eating behavior score (4.4%, p=.01) and BMI (23.2±3.4, 26.3±5.4) than NAS athletes. The CFA on the larger sample confirmed the aforementioned model to be of good fit (RMSE=0.058, GFI=0.920, χ2<.0001).

CONCLUSIONS: Four distinct eating behavior patterns were observed and confirmed among a sample of Division-I collegiate athletes. REAP indicated more favorable eating behavior patterns and lower BMIs among AE than NAS athletes. These analyses suggest that the aesthetic nature of the athlete’s sport may be an important factor impacting personal eating habits. Further research involving college athletes and their eating behavior patterns on more specific health parameters warrants investigation.

325 Board #177 May 29, 11:00 AM - 12:30 PM

Prevalence of Menstrual Dysfunction And Low BMD Among High School Cross-Country Runners Without Disordered Eating

Mitchell J. Rauh, FACSM1, Michelle T. Barrack2, Marta D. Van Loan, FACSM3, Jeanne F. Nichols, FACSM4. 1San Diego State University, San Diego, CA. 2California State University, Northridge, Northridge, CA. 3University of California, Davis, CA. 4University of California San Diego, San Diego, CA.

(No relationships reported)

While much attention has been devoted to female athletes with disordered eating and its relationship to menstrual status and bone mineral density (BMD), less is known about the occurrence of these conditions in female athletes with normal eating behaviors.

PURPOSE: To determine the prevalence of menstrual dysfunction (MD), low BMD and low levels of selected hormones among adolescent female runners with normal eating behaviors.

METHODS: Thirty-eight cross-country runners (age 16.1.7 ± 0.2y) participated in the study which included completing the Eating Disorder Examination Questionnaire (EDE-Q) and providing information about their menstrual history. Runners with an EDE-Q restrained eating subscale score <3.0 were classified as having normal eating behaviors. The runners also completed a 7-day dietary assessment using a food record and daily 24 hour recalls; a blood test to measure serum leptin, estradiol, IGF-1, T3, and BAP and CTX; and an evaluation of height, weight, bone mass, and body composition using DXA. Abnormal bone turnover (ABT) was defined as a BAP and/or CTX level ≥ the 97th or ≤ the 3rd percentile using age-specific reference curves.

RESULTS: Thirty-five runners (92.1%) reported normal eating behaviors. Of these 35, 48.6% reported menstrual dysfunction (MD) during the past year, 25.7% had low BMD (Z-Score≤-1), 7day energy intake <2000 kcals (22.9%), energy availability (EA) <40 (37.1%), and ABT (37.1%). The runners had low (bottom tertile) levels of leptin (40.0%), estradiol (34.3%), IGF-1 (31.4%), T3 (28.8%). Four runners reported MD and had low BMD. Of these, the following percentages were observed: 7day <2000 kcals (25.0%), leptin (100.0%), estradiol (75.0%), IGF-1 (50.0%), T3 (25.0%) and ABT (75.0%).

CONCLUSIONS: Our findings indicate that female high school runners who report normal eating behaviors may still be at risk for MD and low BMD as they may inadvertently consume insufficient energy to balance their high exercise expenditure. Interventions targeted to decrease health risks associated with low energy status require different approaches for athletes with and without disordered eating.

326 Board #178 May 29, 11:00 AM - 12:30 PM

Bone Stress Injury and Relationships between Single and Combined Female Athlete Triad Risk Factors

Michelle T. Barrack1, Jenna C. Gibbs2, Mary Jane De Souza, FACSM2, Nancy I. Williams, FACSM2, Jeanne F. Nichols, FACSM3, Mitchell J. Rauh, FACSM4, Aurelia Nattiv, FACSM5. 1California State University, Northridge, CA. 2Pennsylvania State University, University Park, PA. 3University of California, San Diego, CA. 4San Diego State University, San Diego, CA. 5University of California, Los Angeles, CA.

(No relationships reported)

Identifying factors associated with bone stress injury (BSI), including stress reaction and stress fracture, may aid in targeting those at risk and formulating prevention guidelines for exercising girls and women.

PURPOSE: To evaluate the effect of single or combined risk factors associated with the Female Athlete Triad on the incidence of BSI among a multi-center prospective sample of 4 cohorts of physically active girls and women.

METHODS: At baseline, participants’ (N= 262, mean age 18.2 ± 0.2y) eating attitudes and behaviors, menstrual function, sports participation or exercise activity, injury history, and pathologic weight control behaviors were assessed. Dual-energy x-ray absorptiometry (DXA) measured bone mass of the whole body, total hip, femoral neck, lumbar spine and body composition. Participants were followed prospectively for occurrence of injury; those confirmed by a physician were recorded.

RESULTS: Twenty-eight (10.7%) participants incurred a BSI. Leanness competitive sport athletes exhibited the highest percent of injuries, compared to non-leanness competitive sport athletes and exercising women (18.7% vs. 8.1% vs. 4.2%, respectively, X2= 10.0, p< 0.01). The single risk factor most predictive of BSI was low BMD, defined as a Z-score ≤ -1.0, (odds ratio [OR] = 3.2, 95% confidence interval [CI]: 1.4, 7.1). Among those with BMD Z-score ≤ -1.0, 20.6% incurred BSI. The strongest 2- and 3-variable combined risk factors were low BMD (≤ -1.0) + BMI <21.0 (OR= 4.6, 95% CI: 2.0, 10.7; 27.5% incurred BSI), and low BMD (≤ -1.0) + BMI <21.0 + Oligo/Amenorrhea (O/A) (OR= 9.6, 95% CI: 2.3, 40.8; 50% incurred BSI). For individuals with BMD ≤ -1.0, BMI <21.0, dietary restraint, leanness sport, and O/A (compared to those with BMD > -1.0), 44% incurred BSI (OR= 9.8, 95% CI: 2.4).

CONCLUSIONS: While low bone mass emerged as the strongest single predictor of bone stress injury, the percent of exercising women and adolescents with injury more than doubled among those with additional risk factors including BMI <21.0, O/A, high dietary restraint, and participation in leanness sport. These data support the notion that the cumulative risk for BSI increases as the number of Triad-related risk factors accumulate.

Supported by US DOD PR054531, A. Thornton Cardiopulmonary Fund NBGH, UCLA GCRC#M01RR00865, USOC SS&T Grant, NATA

327 Board #179 May 29, 11:00 AM - 12:30 PM

Anthropometric, Bone, And Hormonal Characteristics Of Amenorrheic, Oligomenorrheic, And Eumenorrheic Adolescent Runners

Jeanne Nichols, FACSM1, Mitchell Rauh, FACSM2, Michelle Barrack3, Marta Van Loan4. 1University of California, San Diego, San Diego, CA. 2San Diego State University, San Diego, CA. 3California State University, Northridge, Northridge, CA. 4USDA-ARS-WHNRC, Davis, CA.

(No relationships reported)

The prevalence of menstrual disturbances among adolescent athletes has been reported to range from 24 to 53%. These estimates are concerning, as lower levels of circulating estrogen in amenorrheic athletes compromise bone health and may be particularly harmful during adolescence. The underlying cause of menstrual disturbances and low bone mass appears to be chronic energy deficiency.

PURPOSE: To assess anthropometrics, bone mass/strength, and hormones indicative of energy deficiency in high school distance grouped by menstrual status: primary/secondary amenorrhea (A), oligomenorrhea (O), eumenorrhea (E).

METHODS: Thirty-five cross-country runners (age, 16.2±0.9 y) training at least 25 mi/wk were evaluated for bone health and body composition by DXA, and hormones (triiodothyronine, leptin, estradiol, by Immulite Immunoassay, and 25(OH)D3 by RIA.


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1ANOVA with Bonferroni post-hoc tests. 2 LTMI= lean tissue mass index (lean mass/ht (m2), 3Cross-sectional area, 4Cross-sectional moment of inertia, 5Bone Strength Index, estimated from proximal femur DXA scan. *p<0.05, **p<0.01, †p<0.10.

CONCLUSION: These data provide additional evidence that menstrual abnormalities, including oligomenorrhea, are common among adolescent runners and are associated with indicators of energy deficiency and low bone mass/strength. Our findings underscore the need for screening for menstrual status to help prevent negative effects on bone health in high school runners.

328 Board #180 May 29, 11:00 AM - 12:30 PM

Relation Between Vo2 Peak And Energy Expenditure In Adults With And Without Intellectual Disabilities

Guillermo R. Oviedo1, Casimiro Javierre2, Elisabeth Guillamó2, Juan Mariano Alamo2, Bo Fernhall, FACSM3, Silvia Barnet1, María Giné-Garriga1, Miriam Guerra1. 1FPCEE-Blanquerna (URL), Barcelona, Spain. 2University of Barcelona, Barcelona, Spain. 3University of Illinois at Chicago, Chicago, IL.

(No relationships reported)

Introduction: Individuals with intellectual disabilities (ID) have a lower energy expenditure (EE) compared to persons without ID.

PURPOSE: To determine and compare relations between VO2 peak and total energy expenditure (TEE), in adults with and without ID that participated in a physical activity program.

METHODS: 29 adults (12 women, 17 men), 42.1±9.8 year-old with moderate to severe ID and 14 adults (10 women, 4 men), 69.4±3.3 year-old without disabilities participated in this study. The adults with ID followed a physical activity (PA) program for 14 weeks, 1 hour 3 times per week. The adults without ID followed a PA program for 10 weeks, 1.5 hour 2 times a week. TEE was obtained through triaxial accelerometry during 7 consecutive days. The accelerometers were placed on the right side of the hip. VO2 peak was obtained during a metabolic treadmill test. A linear regression analysis was used to evaluate relationships between VO2 peak and TEE. A multivariate linear regression analysis was used to evaluate factors contributing to VO2 peak.

RESULTS: Relative VO2 peak was not different between adults with ID (29.3±8.2 ml/kg/min.) and adults without ID (27.8±6.4 ml/kg/min.). Adults without ID exhibited higher TEE (3044.1±1253.8 kcal) than adults with ID (2037.3±1160.2 kcal) (t=-2.6; p=0.013). There were significant correlations between VO2 peak and TEE in adults without ID (r=0.84; p<0.001) and adults with ID (r=0.54; p=0.003). Multivariate linear regression showed that age, ID % (70.6±7.0 %) and TEE (2037.3±1160.2 kcal) contribute to VO2 peak (2.0±0.6 L/min) in adults with ID (R2=0.32). In adults without ID the most important variables contributing to VO2 peak (2.1±0.4 L/min) were age and hourly energy needs (29.6±12.3 kcal) (R2=0.72).

CONCLUSIONS: Adults with and without ID have similar relative VO2 peak. In both populations there are significant relations between VO2 peak and TEE.

329 Board #181 May 29, 11:00 AM - 12:30 PM

Reliability Of The 6-minute Walk Test In Adults With Intellectual Disabilities

Míriam Guerra1, Guillermo Oviedo1, Casimiro Javierre2, M Carmen Delicado2, Carlos Soto2, Maria Carbó1, Bo Fernhall, FACSM3. 1FPCEE Blanquerna (URL), Barcelona, Spain. 2University of Barcelona, Barcelona, Spain. 3University of Illinois at Chicago, Chicago, IL.

(No relationships reported)

Introduction: Adults with intellectual disabilities (ID) have significantly lower rates of physical activity and fitness than adults without disabilities. The 6-Minute Walk Test (6MWT) is an inexpensive and simple way to test mobility and submaximal work capacity.

PURPOSE: To evaluate the reliability of the 6MWT in adults with ID and explore factors contributing to the 6MWT distance (6MWD).

METHODS: (20 women and 26 men with moderate to severe ID volunteered (age= 41.2±12.2 y), and performed 3 6MWT with the first one (t1) used for familiarization. To analyze factors contributing to the 6MWD, sex, height, thigh skinfold, hip circumference, ID%, long jump and relative peak oxygen uptake (VO2 peak) were also measured. Cronbach’s Alpha coefficient was used for 6MWTs reliability. A multivariate linear regression analysis was used to evaluate factors contributing to the 6MWD.

RESULTS: The walking distances for t1, t2 and t3 were 460.3±81.7 m, 491.3±81.7 m, and 489.4±99.2 m, respectively. The 6MWDs between t1 / t2 and t1 / t3 were significantly different (t=4.9, p<0.001; t=4.1, p<0.001), but t2 and t3 were not different. Cronbach’s Alpha reliability coefficient between t2 and t3 was α=0.907 with an intraclass correlation coefficient of 0.83. Sex, height (160.0±13.4 cm), thigh skinfold (41.7±18.2 mm), hip circumference (97.9±8.6 cm), ID% (71.4±6.7 %), longitudinal jump (0.6±0.4 m) and relative VO2 peak (26.4±6.7 ml/kg/min) significantly contributed to the 6MWD (R2=0.68).

CONCLUSIONS: The 6MWT is an easy, inexpensive and reliable test for adults with ID. Familiarization is necessary to obtain reliable values. Sex, height, thigh skinfold, hip circumference, ID%, longitudinal jump and relative VO2 peak have significant impact on the distance walked.

330 Board #182 May 29, 11:00 AM - 12:30 PM

Collegiate Athletic Trainers’ Understanding of and Experience in Managing Mental Health Disorders

Zach Fournier1, Bentley A. Krause2, Will Soto1, James E. Sturmi3. 1Ohio University, Athens, OH. 2Ohio University Heritage College of Osteopathic Medicine, Athens, OH. 3MAX Sports Medicine, Columbus, OH.

(No relationships reported)

Mental health disorders (MHDs) and related issues are of significant public concern. Recognition of and management strategies for MHDs are central to patient care. Improved public awareness of MHDs and their associated morbidity and mortality is encouraging. As primary care providers to college student athletes, athletic trainers (ATs) must take a lead role in the comprehensive management of MHDs. This requires an understanding of the spectrum of mental illness, diagnostic criteria, referral options, pharmacological and psychological interventions, as well as coordinating patient-centered care with team physicians and other healthcare providers.

PURPOSE: To investigate ATs’ understanding of and experience in the management of collegiate student athletes with MHDs.

METHODS: ATs (n=211; males=114, females=97; M age=38.5y; M years of clinical practice=15.2y) from NCAA member institutions were emailed a link to a web-based survey (response rate = 27.9%).

RESULTS: The majority (75.9%) of collegiate ATs have managed a MHDs. Athletic trainers report having managed the following MHDs most often ADHD (86.7%), disordered eating (84.8%), depression (83.9%), anxiety (78.2%) and substance use/abuse (75.8%). Approximately 70% of ATs feel competent in recognizing sign and symptoms of MHDs and making the appropriate referral options. However, ATs’ overall competence in using MHDs diagnostic criteria was 44.0% and only 23.5% indicated knowledge of DSMV-TR norms. Athletic trainers report moderate confidence in their ability to manage MHDs acutely (63.2%) and long-term (43.9%). Greater than 70% report they are not knowledgeable about the medications prescribed and adverse reactions of drugs used to treat MHDs.

CONCLUSION: These data suggest a striking discrepancy between ATs’ perceived knowledge and competence in managing athletes with MHDs. Our findings will contribute to the currently limited sports medicine literature examining ATs’ competence and experiences with MHDs. Clinical implications, including the development of standards of care and clinical decision rules will be discussed.

330a Board #183 May 29, 11:00 AM - 12:30 PM

Traumatic Deaths: The Leading Cause of Sudden Death in Collegiate Athletes

Irfan M. Asif1, David Klossner2, Kimberly G. Harmon, FACSM3. 1University of Tennessee, Knoxville, TN. 2National Collegiate Athletic Association, Indianapolis, IN. 3University of Washington, Seattle, WA.

(No relationships reported)

Background: Team physicians and medical personnel have unique responsibilities that include maintaining the mental and physical well-being of athletes and their teams. This includes providing optimal health care through injury prevention strategies and managing the aftermath of a catastrophic incident to a student-athlete, coach or staff member. While studies have examined common medical causes of sudden death during exertional activity in National Collegiate Athletic Association (NCAA) Athletes, no large-scale study has been performed detailing the leading overall causes of death in this population. A thorough understanding of all causes of sudden death may form the basis for targeted prevention programs and catastrophic incident preparedness.

PURPOSE: To determine the most common causes of death in NCAA athletes.

METHODS: From January 2004 through December 2008, all cases of sudden death in NCAA student-athletes were identified by use of an NCAA database, weekly systematic search of public media reports, and catastrophic insurance claims. During the 5-year period, there were 273 deaths and a total of 1,969,663 athlete participant-years. Of these 273 deaths, 145 (53%) were due to accidents or unintentional injury, 45 (16%) were due to cardiac arrest, 25 (9%) were due to suicide, and 18 (7%) were due to homicide. The incidence of death due to accidents was 1:13,583 participants per year. Motor vehicle accidents accounted for 100 (69%) accidents. There was no significant difference in accident rates between NCAA divisions. Accidents were twice as likely in men compared to women (p<0.0001). There was no significant difference in the accident rates in white vs. black athletes. While accidents generally occur more frequently in the general population compared to NCAA athletes, certain athlete subgroups (Division I wrestling, Divisions I and II basketball, and Divisions I and II football) appear to be high-risk populations that have death rates that are no different than the general population.

CONCLUSIONS: Travel-related accidental death is the most common cause of sudden death in young athletes across divisions, genders, black and white athletes, and sports. This information can be used to establish a catastrophic incident plan and design effective safety programs, which should broadly be implemented by institutions or the medical team providing care for these athletes.

© 2013 American College of Sports Medicine