Journal articles on the topic 'Sports science and exercise not elsewhere classified'

Functional dietary supplements are now regarded as an important factor to keep physical health, maintain exercise status and improve athletic performance. More and more sports industries are focusing on such supplements, which makes the industry develop rapidly and pay more and more attention to the research and development of different products, functions and the efficacy of health care. In this paper, the functional dietary supplements were classified and summarized, and energy supply supplements were discussed in detail: glucose and Adenosine Triphosphate; Exercise protection supplements: chondroitin sulphate, glucosamine, collagen, vitamin D and calcium; Endurance supplements: strength supplements such as protein, creatine, β-alanine, epicatechin, and taurine. The existing problems of functional dietary supplements were analysed and summarized, and the future development prospects were prospected, hoping to provide references for the development and research of new products of functional dietary supplements.

In the training process of professional athletes, to optimize the training plan and make the athletes play the best competitive state at a special time point, it is usually achieved by controlling the training load and active and effective recovery process. For the general public, daily exercise is mainly for physical fitness and physical rehabilitation. Whether it is a professional athlete or the general public, there are times when injuries occur during sports. The appropriate degree of exercise load varies from person to person. According to different sports, people’s exercise suitability is also different. Therefore, it is meaningful to analyze and monitor the exercise load of the athlete during exercise. This paper proposes to use radial basis neural network (RBFNN) in the analysis of sports f-load of athletes. RBFNN is a kind of neural network that relies on error backpropagation for parameter adjustment, and its convergence speed is slow. When the data dimension is large and the amount of data is large, it will affect the classification accuracy of the data. For this reason, this paper integrates the gray wolf optimization algorithm (GWO) and RBFNN, and applies GWO to the initial value determination of weights and thresholds, which can effectively reduce the adjustment range of parameters and improve the accuracy of data classification. The model can more accurately analyze the exercise load state of athletes during exercise. The experimental results show that the high-quality heart rate data can be classified based on the model used in this paper, so that the exercise load state can be correctly judged. This has a good reference value for the analysis of exercise load during sports training and the next monitoring.

With the vigorous development of the Chinese economy and people’s pursuit of quality, sports activities of people pursuit are no longer limited to simple physical exercise, but a way that pursues higher-quality sports tourism. As a new industry, it cannot guarantee that sports tourism will be accepted by all people, and it will be limited by geographical, economic, time, and other conditions. The participation number of Chinese sports tourism is more concerned by organizers or operators. Predicting the participation number of sports tourism based on the knowledge discovery method is meaningful and economical work. In this paper, a variety of sports tourism data are classified by clustering method, and the categories with similar characteristics are classified. Then, the convolution and long short-term memory hybrid neural network are used to extract the spatial and temporal information of sports tourism characteristics, which completes the prediction of Chinese sports tourism categories. The research results show that the clustering method has high accuracy for the classification of sports tourism categories, and the weights occupied by the categories are relatively uniform. The ConvLSTM neural network also has obvious advantages in predicting Chinese sports tourism methods. The largest error is only 2.89%, and the correlation coefficient also reaches 0.98, which is enough to be trusted for the prediction of Chinese sports tourism categories.

Strenuous exercise (any activity that expends six metabolic equivalents per minute or more causing sensations of fatigue and exhaustion to occur, inducing deleterious effects, affecting negatively different cells), induces muscle damage and hematological changes associated with high production of pro-inflammatory mediators related to muscle damage and sports anemia. The objective of this study was to determine whether short-term oral ubiquinol supplementation can prevent accumulation of inflammatory mediators and hematological impairment associated to strenuous exercise. For this purpose, 100 healthy and well-trained firemen were classified in two groups: Ubiquinol (experimental group), and placebo group (control). The protocol was two identical strenuous exercise tests with rest period between tests of 24 h. Blood samples were collected before supplementation (basal value) (T1), after supplementation (T2), after first physical exercise test (T3), after 24 h of rest (T4), and after second physical exercise test (T5). Hematological parameters, pro- and anti-inflammatory cytokines and growth factors were measured. Red blood cells (RBC), hematocrit, hemoglobin, VEGF, NO, EGF, IL-1ra, and IL-10 increased in the ubiquinol group while IL-1, IL-8, and MCP-1 decreased. Ubiquinol supplementation during high intensity exercise could modulate inflammatory signaling, expression of pro-inflammatory, and increasing some anti-inflammatory cytokines. During exercise, RBC, hemoglobin, hematocrit, VEGF, and EGF increased in ubiquinol group, revealing a possible pro-angiogenic effect, improving oxygen supply and exerting a possible protective effect on other physiological alterations.

This cross-sectional study analyses differences in dietary habits, taste preferences, variety of protein sources and body composition (BC) profiles among individuals following omnivorous, flexitarian, lacto-ovo-vegetarian and pescatarian diets. Furthermore, it assesses the correlations between these dietary patterns and various sports, classified by exercise intensity, in relation to BC parameters. The study analysed the eating habits and BC data of 1342 participants aged 18–65 years, classified into four diet groups based on their 7-day food diaries and questionnaire responses. Our analysis revealed gender- and age-related differences in weekly food consumption and protein source variety, with men generally consuming more meat, processed meat and fish than women, especially in younger age groups. Differences in dairy and soy consumption were also noted between age groups, while legume and soy preferences showed no gender disparity across all ages. Among non-sporting individuals, vegetarians exhibited lower fat mass (FM%) compared to other diets, while among athletes, vegetarians and pescatarians in in endurance and strength sports, respectively, displayed lower FM%, with flexitarians and omnivores in endurance sports showing higher FM%. Non-athletic omnivores and vegetarians demonstrated a greater proportion of body protein, while among athletes, those engaged in strength training exhibited a higher body protein content across all dietary groups compared to those in endurance training. Among non-athletic groups, vegetarians exhibited the lowest FM/FFM (fat mass/fat-free mass) ratio, while among athletes, vegetarians in endurance sports and participants in strength training across other diets showed lower FM/FFM ratios. The results emphasise the complex interaction between diet, BC and lifestyle choices, revealing how different combinations of diet and sport are associated with optimised BC.

According to the traditional data mining method, it is no longer applicable to obtain knowledge from the database, and the knowledge mined in the past must be constantly updated. In the last few years, Internet technology and cloud computing technology have emerged. The emergence of these two technologies has brought about Earth-shaking changes in certain industries. In order to efficiently retrieve and count a large amount of data at a lower cost, big data technology is proposed. Big data technology has played an important role for data with various types, huge quantities, and extremely fast changing speeds. However, big data technology still has some limitations, and researchers still cannot obtain the value of data in a short period of time with low cost and high efficiency. The sports database constructed in this paper can effectively carry out statistics and analysis on the data of sports learning. In the prototype system, log files can be mined, classified, and preprocessed. For the incremental data obtained by preprocessing, incremental data mining can be performed, a classification model can be established, and the database can be updated to provide users with personalized services. Through the method of data survey, the author studied the students’ exercise status, and the feedback data show that college students lack the awareness of physical exercise and have no fitness habit. It is necessary to accelerate the reform of college sports and cultivate students’ good sports awareness.

The methods of measuring aerobic power in dance is reviewed. The underlying metabolic pathways used during dance class and performance are examined and, in conclusion, dance has been classified as an intermittent form of exercise. The relevancy of measuring maximal oxygen uptake (VO2max) in relation to intermit-tent exercise is discussed with regard to other sports. Previous dance VO2max data is examined in relationship to other exercise forms and it is shown to be comparable to results in other non-endurance sports. The limitations of graded exercise tests with regards to extrapolating oxygen data from heart rates during dance has been highlighted as a flaw in a number of previous research studies and a limitation to be aware of in future re-search. Due to the infancy of dance science, the availability of valid and reliable laboratory and field tests are limited and, therefore, until further research is done, there needs to be a reliance on tests de-veloped in the health and sport environ-ments. Such tests should be graded, either in speed or gradient, with stages of at least 3 minutes and be weight-bearing. Even though no research to date has shown that dancers with improved VO2max perform better, the review suggests that both the aerobic and anaerobic systems need to be stressed to a greater extent than seen presently within dance class.

The purpose of the study was to determine the peculiarities of motor skills development in boys aged 14-15. Materials and methods. The study participants were boys aged 14 (n=20) and 15 (n=20). The children and their parents were fully informed about all the features of the study and gave their consent to participate in the experiment. To solve the tasks set, the following research methods were used: study and analysis of scientific and methodological literature; pedagogical observation, timing of training tasks; pedagogical experiment, methods of mathematical statistics, discriminant analysis, nearest neighbor analysis. Results. The study made an assumption about a significant influence of the modes of alternating exercise repetitions and the rest interval on the effectiveness of motor skills development in boys aged 14 and 15. The standardized canonical discriminant function coefficients helped to determine age peculiarities and the peculiarities of influence of exercise modes on the effectiveness of motor skills development. They showed that the components of motor fitness are a priority in developing motor skills. The structure canonical discriminant function coefficients indicate the importance of movement control skills for mastering the entire exercise. Conclusions. Discriminant analysis revealed the peculiarities of motor skills development in boys aged 14 and 15, depending on age and exercise modes. With the first exercise mode, boys aged 15 master the first, second, and fourth series of training tasks more quickly. Boys aged 14 – the sixth series (exercise mode: 6 repetitions, rest interval of 60 s). With the second exercise mode, boys aged 14 master the first and fourth series of training tasks more quickly. Boys aged 15 – the second series (exercise mode: 12 repetitions, rest interval of 60 s). The coordinates of centroids for four groups indicate a significant difference in the influence of exercise repetition modes on the number of repetitions required for motor skills development in boys aged 14-15 during physical education classes. The results of group classification show that 87.5% of the original grouped cases were classified correctly.

Exercise programs of moderate-to-vigorous intensity have been shown to improve the cognitive performance of older people. However, the specific effects of sports-based exercise programs on cognitive performance, particularly executive functions, remain unclear. Therefore, the purpose of this study is to clarify the effects of sports-based exercise programs on executive functions in older adults using a systematic review and meta-analysis of the scientific literature. A systematic review was conducted between 1 March and 1 July 2022, to look for published scientific evidence that analyzed different sports programs that may have affected executive function in healthy older adults. Longitudinal studies, which assessed the effects of sports interventions on healthy older adults, were identified through a systematic search of the four principal electronic databases: Web of Science, PubMed, Scopus, and EBSCO. A total of nine studies with a total of 398 subjects met the inclusion criteria and were classified based on one or more of the following categories: working memory, inhibition, and cognitive flexibility. The DerSimonian and Laird random-effects model was performed using the Comprehensive Meta-Analysis software to facilitate the analysis of the studies. Statistical significance was set at p ≤ 0.05. In terms of working memory, a small but positive significant effect was noted for the intervention group compared to the control group (effect size (ES) = 0.35, 95% confidence interval (CI) = 0.04–0.67; p = 0.029; I2 = 36.7%); in terms of inhibition, the intervention had a small favoring but no significant effect compared to the control group (ES = 0.20, 95% CI = −0.42–0.84; p = 0.517; I2 = 78.8%); and in terms of cognitive flexibility, the intervention had a small favoring but no significant effect compared to the control group (ES = 0.39, 95% CI = −0.11–0.89; p = 0.131; I2 = 75.5%). Our findings suggest that healthy older adults should be encouraged to participate in sports to improve their working memory; however, more studies are required in this area to reach more robust conclusions. This systematic review was registered with the International Prospective Register of Systematic Reviews (registration number: CRD42022284788).

The use of artificial intelligence technology to analyze human behavior is one of the key research topics in the world. In order to detect and analyze the characteristics of human body behavior after training, a detection model combined with a convolutional neural network (CNN) is proposed. Firstly, the human skeleton suggestion model is established to analyze the driving mode of the human body in motion. Secondly, the number of layers and neurons in CNN are set according to the skeleton feature map. Then, the output information is classified according to the fatigue degree according to the body state after exercise. Finally, the training and performance test of the model are carried out, and the effect of the body behavior feature detection model in use is analyzed. The results show that the CNN designed in the study shows high accuracy and low loss rate in training and testing and also has high accuracy in the practical application of fatigue degree recognition after human training. According to the subjective evaluation of volunteers, the overall average evaluation is more than 9 points. The above results show that the designed convolution neural network-based detection model of body behavior characteristics after training has good performance and is feasible and practical, which has guiding significance for the design of sports training and training schemes.

BACKGROUND There has been an evolution of athlete specific Electrocardiogram (EKG) criteria over the years, resulting in improved specificity and lower false positive rates, starting with the European Society of Cardiology 2005 guidelines and most recently with the current 2017 International Recommendations. The consistency of EKG interpretation with the 2017 International Criteria have been compared between various groups, including local and specialized center physicians. Whether novice EKG interpreters (undergraduate/graduate students) can be taught to accurately interpret athletes’ EKGs with the 2017 International Criteria has not been extensively studied. This study seeks to assess the accuracy and variability of novice EKG interpreters, compared to cardiologist interpretations and expert readers. METHODS Three novice EKG interpreters (undergraduate exercise science students) were trained in interpreting EKGs of athletes with the 2017 International Criteria during one semester under the instruction of an expert reader. During an annual high school, sports screening day 1350 EKGs were collected and assigned a corresponding number. The on-site cardiologists evaluated the EKGs in real-time and classified as “normal” or “abnormal” according to the International Criteria. Following the sports physical day, three novice EKG interpreters (students), a cardiologist and a Clinical Exercise Physiology Professor (expert reader) were asked separately to classify the same EKGs as “normal or “abnormal” according to the International Criteria. All readers were blinded to the initial classifications made by the cardiologist during the sports physical event. Information regarding the athlete's age, gender, race/ethnicity, and sport was provided on the EKGs. We assessed the agreement between the cardiologist, expert reader and students in interpreting EKGs using Fleiss' kappa analysis. RESULTS 1350 athlete EKGs (males = 879; females = 471, age (mean + SD) 15.09 + 1.3y) including 37 (2.7%) abnormal cases were reviewed. The inter-rater agreement between novice readers, expert reader, and physicians in classifying an EKG as abnormal was good (k = 0.7, p < .001). CONCLUSION This study demonstrated that novice EKG readers could correctly classify EKGs based on the International Criteria as “normal and abnormal” to identify athletes at high risk of acute cardiovascular events

Sports supplements are commonly used by elite athletes with the main goal of enhancing sport performance. Supplements use might be substantially different depending on the sport discipline, sex, and competitive level. To date, data about prevalence and the most-commonly used supplements in handball are scarce. Thus, the aim of this investigation was to determine the patterns of supplements use by handball players of both sexes and with different competitive levels: One hundred and eighty-seven handball players (112 men and 75 women) of different competitive levels (106 professional and 81 amateur) completed a validated self-administered questionnaire about supplements use. Supplements were classified according to the categorization of the Australian Institute of Sport (AIS). Overall, 59.9% of the handball players (n = 112) declared the use of at least one supplement and there were no significant differences between men and women (58.9% vs. 61.3%, p = 0.762) nor between professional vs. amateur handball players (67.1% vs. 53.8%, p = 0.074). The most prevalent supplements were sports drinks (42.2%), followed by energy bars (35.3%) and caffeine-containing products (31.6%). However, a greater consumption of group A supplements (those with strong scientific evidence; p = 0.029) and group B supplements (those with emerging scientific support, p = 0.012) was observed in male compared to female handball players. Supplements categorized as medical supplements were more commonly consumed in professional vs. amateur players (0.48 ± 0.80 vs. 0.21 ± 0.44, supplements p < 0.006). Additionally, a higher consumption of group B supplements was observed in professional compared to amateur players (0.58 ± 0.88 vs. 0.33 ± 0.72 supplements, p = 0.015). Handball players revealed a moderate use of supplements while sex and competitive level slighted changed the pattern of supplements use. A high portion of handball players use supplements as fuel during exercise and reported the use of caffeine-containing supplements to enhance performance.

Trimetazidine (TMZ), used for treating stable angina pectoris, has garnered attention in the realm of sports due to its potential performance-enhancing properties, and the World Anti-Doping Agency (WADA) has classified TMZ on the S4 list of prohibited substances since 2014. The purpose of this narrative mini-review is to emphasize the biochemical aspects underlying the abusive use of TMZ among athletes as a metabolic modulator of cardiac energy metabolism. The myocardium’s ability to adapt its energy substrate utilization between glucose and fatty acids is crucial for maintaining cardiac function under various conditions, such as rest, moderate exercise, and intense effort. TMZ acts as a partial inhibitor of fatty acid oxidation by inhibiting 3-ketoacyl-CoA thiolase (KAT), shifting energy production from long-chain fatty acids to glucose, reducing oxygen consumption, improving cardiac function, and enhancing exercise capacity. Furthermore, TMZ modulates pyruvate dehydrogenase (PDH) activity, promoting glucose oxidation while lowering lactate production, and ultimately stabilizing myocardial function. TMZs role in reducing oxidative stress is notable, as it activates antioxidant enzymes like glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD). In conclusion, TMZs biochemical mechanisms make it an attractive but controversial option for athletes seeking a competitive edge.

Throughout the sport-science and sports-medicine literature, the term “elite” subjects might be one of the most overused and ill-defined terms. Currently, there is no common perspective or terminology to characterize the caliber and training status of an individual or cohort. This paper presents a 6-tiered Participant Classification Framework whereby all individuals across a spectrum of exercise backgrounds and athletic abilities can be classified. The Participant Classification Framework uses training volume and performance metrics to classify a participant to one of the following: Tier 0: Sedentary; Tier 1: Recreationally Active; Tier 2: Trained/Developmental; Tier 3: Highly Trained/National Level; Tier 4: Elite/International Level; or Tier 5: World Class. We suggest the Participant Classification Framework can be used to classify participants both prospectively (as part of study participant recruitment) and retrospectively (during systematic reviews and/or meta-analyses). Discussion around how the Participant Classification Framework can be tailored toward different sports, athletes, and/or events has occurred, and sport-specific examples provided. Additional nuances such as depth of sport participation, nationality differences, and gender parity within a sport are all discussed. Finally, chronological age with reference to the junior and masters athlete, as well as the Paralympic athlete, and their inclusion within the Participant Classification Framework has also been considered. It is our intention that this framework be widely implemented to systematically classify participants in research featuring exercise, sport, performance, health, and/or fitness outcomes going forward, providing the much-needed uniformity to classification practices.

The spread of COVID-19 worldwide challenged the foundations of many people's lives. This research aimed to investigate the impact of the pandemic and its associated lockdown restrictions on the physical activity behaviours and attitudes of a small group of sports science students in a provincial state university in Indonesia. The study results showed that most of the respondents (93%) believed in the importance of maintaining their physical activity during lockdown. However, the actual activity levels practised failed to match the international guidelines considered necessary for this age group. Only 23% practised daily physical activity, and 40% were active for three days or less. The intensity of the physical activity was only classified as light in over 80% of the cases, and 26% reported that their activity was less than 30 minutes. A further concern about mental health was identified in the finding that over 73% of the participants reported suffering significant boredom during the lockdown conditions imposed. Students reported carrying out exercise and a range of other activities aimed to reduce boredom and avoid more potentially dangerous feelings of stress and depression. Recommendations include maintaining and improving fitness through physical activity and participating in moderate activity between 70 - 80% with a maximum pulse rate of 150 - 300 minutes per week to high intensity between 80 - 90% maximum pulse with a frequency of at least 3 days or more per week, 75-150 minutes per week. All physical activities can be done gradually over time with the principle of progressive exercise. Meanwhile, to reduce boredom, apart from doing physical activity in the form of sports and exercise, other active daily physical activities such as washing vehicles, gardening, cleaning the house and environment, and pursuing hobbies may be considered.

Branched-chain amino acids (BCAAs) are oxidized in the muscle and result in stimulating anabolic signals—which in return may optimize performance, body composition and recovery. Meanwhile, among athletes, the evidence about BCAA supplementation is not clear. The aim of this study was to review the effects of BCAAs in athletic populations. The research was conducted in three databases: Web of Science (all databases), PubMed and Scopus. The inclusion criteria involved participants classified both as athletes and people who train regularly, and who were orally supplemented with BCAAs. The risk of bias was individually assessed for each study using the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). From the 2298 records found, 24 studies met the inclusion criteria. Although BCAAs tended to activate anabolic signals, the benefits on performance and body composition were negligible. On the other hand, studies that included resistance participants showed that BCAAs attenuated muscle soreness after exercise, while in endurance sports the findings were inconsistent. The protocols of BCAA supplements differed considerably between studies. Moreover, most of the studies did not report the total protein intake across the day and, consequently, the benefits of BCAAs should be interpreted with caution.

The study's purpose was to determine the specific features of the effect of the number of repetitions and rest intervals on the effectiveness of the standing long jump training program for 14-year-old girls. Materials and methods. The study participants were 40 girls aged 14. The study participants were informed about all the features of the experiment and gave their consent to participate therein. The study used methods of analysis of scientific and methodological literature, observation, pedagogical experiment, and methods of mathematical statistics. The pedagogical experiment was designed as a full factorial experiment with a 2к factorial design. The effect of the number of repetitions (6 to 12 times) and the rest interval (60 to 120 s) on the effectiveness of the standing long jump training program for 14-year-old girls was investigated. Discriminant analysis was used for data analysis. Results. The analysis of the experimental data showed that the modes of alternating physical exercise performance and rest intervals have a statistically significant effect on the formation of the motor skill of standing long jump in 14-year-old girls (p < 0.001). It is after the third exercise performance mode that the girls spent the smallest total number of repetitions required for the formation of the standing long jump skill. Thus, the 1st, 4th and 6th series of training tasks are learned faster after the third exercise performance mode, the 3rd series of training tasks is learned faster after the second exercise performance mode, and the 2nd and 5th series of training tasks are learned faster after the fourth exercise performance mode (p<0.001). Conclusions. It was established that the mode of alternating exercises in 3 sets of 2 repetitions with a rest interval of 120 s is classified as the most rational. A specific feature of the formation of the motor skill is that each of the modes can be considered as a priority for one or another motor task. In the investigation of the learning process, discriminant analysis makes it possible to classify work modes and determine the relationship between the motor tasks within the training program.

Creatine is classified as a “sports supplement”, but it also has health benefits. The purpose of this study was to assess use of creatine as a dietary supplement in adult non-athletes. Three hundred ninety-nine adults (19–89 years) completed an online survey. Among the respondents, 77% (n = 307) were regularly active, including participation in weightlifting (34%), running (34%), and cycling (21%). Twenty-eight percent (n = 111) reported use of creatine with an average dose of 6.4 ± 4.5 g. Daily creatine use was reported by 45%, and 38% reported using creatine 2–6 times weekly. Primary sources of information about creatine were trainers/coaches (29%), friends/family (32%), and internet (28%). Forty percent (n = 44) of creatine users were female. When compared by age, 46% of young, 32% of midlife, and 6% of old respondents reported creatine use with no differences in dose or frequency. Young and midlife respondents reported primarily trainers/coaches, friends/family, and internet as sources of information about creatine, but old respondents limited their sources to friends/family and fitness magazines. Although creatine is widely used by adult non-athletes who regularly exercise, dietitians and other healthcare providers are not the primary source of information. Fitness trainers can appropriately provide guidance and education regarding safe and effective use of creatine.

Introduction: Soccer is the sport with the highest risk of muscle injury for players. Eccentric exercise is fundamental for reducing injury rates and isoinertial technology devices cause an increase in eccentric demands after a concentric contraction.Objective: To identify the use of isoinertial technology in the fields of physical activity and sports for rehabilitation and prevention of muscle injuries reported in scientific literature.Materials and methods: A search of scientific papers in PubMed, Google Scholar, EMBASE and Science Direct data base was performed by using the following MeSH medical terms and search equations: [isoinertial AND technology AND flywheels] and [free weight AND sport AND humans AND soccer].Results: 23 references, classified into three approaches, were selected: isoinertial technology for rehabilitation, fitness and injury prevention. The use of this technology is fundamental due to the increase of the eccentric demand in muscle groups.Conclusions: Isoinertial technology is a useful tool for treating and preventing injuries, as well as for the development of physical qualities. However, it is necessary to work on protocols that allow unifying its usage parameters so that it can be included in prevention programs.

The purpose of the study was to determine the impact of exercises modes on developing a small ball throwing skill in boys aged 8. Materials and methods. The study participants were 21 boys aged 8, who were randomly divided into three groups of 7 people. The children and their parents were fully informed about all the features of the study and gave their consent to participate in the experiment. The study examined the influence of the number of repetitions on the effectiveness of teaching boys aged 8 throwing a small ball at a target. A pedagogical experiment examined the influence of 6, 12, and 18 repetitions with a 60-second rest interval on the increase in the level of proficiency in exercises of boys aged 8. In the first group, the boys repeated the task 6 times with a rest interval of 60 s, in the second group – 12 times with a rest interval of 60 s, in the third group 18 times with a rest interval of 60 s. When teaching throwing exercises during the class, the study evaluated the level of proficiency by the alternative method (“performed”, “failed”) and calculated the probability of exercise performance (p = n/m, where n is the number of successful attempts, m is the total number of attempts). In teaching boys aged 8, the method of algorithmic instructions was used. The next exercise started after three successful attempts. Throwing a ball at a vertical target was taught. The study materials were processed by the IBM SPSS 20 statistical analysis software. During discriminant analysis, a prognostic model for group membership was created. Results. Discriminant analysis made it possible to determine the impact of the number of repetitions on the effectiveness of developing the skills of throwing a small ball at a target; answer the question as to how significantly the modes of repetitions differ by the effectiveness of motor skills development, what class the object belongs to based on the values of discriminant variables. Conclusions. Based on the analysis of group centroids, it was found that in boys aged 8, six repetitions of the exercise (6 sets one time with a rest interval of 60 s) significantly influence the increase in the level of proficiency in exercises during physical education lessons. The results of group classification show that 85.7% of the original grouped observations were classified correctly.

The benefits of regular exercise include improved physical and mental health. The school gym is a particular micro-environment where students perform intensive physical training. The question is if there is an increased risk of microbiological contamination. This preliminary work studied the exposure of students to bacterial aerosol (BA) in a highschool gym located in an urban area of Southern Poland. A sampling of BA was undertaken with an Andersen six-stage impactor (ANDI). BA was identified using API (analytical profile index) tests. The BA concentrations were expressed as Colony Forming Units (CFU) per cubic metre of air. The results showed that before gym classes (BGC), the concentration of BA was 4.20 × 102 ± 49.19 CFU/m3, while during gym classes (DGC), the level of BA more than doubled (8.75 × 102 ± 121.39 CFU/m3). There was also an increase in the respirable fraction of BA (particles less than 3.3 µm). Before the start of the sports activities, respirable fraction accounted for 30% of the BA, while during physical education classes, this share increased to over 80%. Identification of BA species showed that the dominant group of bacteria in the indoor air of the gym BGC was Gram-positive rods (61%) and for DGC it was Gram-positive cocci (81%). We detected that one bacteria strain (Corynebacterium striatum) was classified into risk group 2 (RG2) according to Directive 2000/54/EC. Additionally, multi-antibiotic resistance (MAR) showed that among the isolated airborne bacteria, the highest antibiotic resistance was demonstrated by Staphylococcus epidermis (isolated DGC) and Pseudomonas sp. (isolated BGC). The quantitative and qualitative information on microbiological air quality (MIAQ) in the school gym indicates that the actions to improve indoor physical activity spaces are recommended.

Background: Musculoskeletal pain (MSP) conditions are common in the educational leaning environment and are often associated with poor ergonomic conditions. Objective: This study investigated the prevalence, pattern and possible risk factors of MSP among undergraduate students of occupational therapy and physiotherapy in a South African university. Methods: A cross-sectional survey using an internet-based self-designed electronic questionnaire was used to obtain information about participants’ socio-demography, ergonomic hazards, MSP, and relevant personal information. Descriptive statistics, chi-square, and logistic regression were used in analyzing the data. Results: There were 145 participants (females 115 (79.3%); physiotherapy (74) 51.03%), making 36.7% of the present undergraduate student population in the two departments. The most prevalent ergonomic work hazards were prolonged sitting (71.7%) and repetitive movements (53.8%). The 12 months prevalence of MSP among the students was 89.7%. The pattern of MSP revealed that pain on the neck region was most prevalent (66.2%) followed by pain in the low back region (64.4%). Duration of daily travels and participation in regular exercise activities were significantly associated with the prevalence of MSP. Logistic model explained 23.6% of the variance in prevalence of MSP and correctly classified 94.1% of cases ([Formula: see text], [Formula: see text]). The right-handed students were 0.13 times more likely to present with MSP than left-handed students. Also, students who exercised regularly were 9.47 times less likely to present with MSP. Conclusion: MSP is highly prevalent among health science undergraduates and is significantly associated with sedentary postures and inadequacy in structured physical activity participation.

A questionnaire-based screening tool for male athletes at risk of low energy availability (LEA) could facilitate both research and clinical practice. The present options rely on proxies for LEA such screening tools for disordered eating, exercise dependence, or those validated in female athlete populations. in which the female-specific sections are excluded. To overcome these limitations and support progress in understanding LEA in males, centres in Australia, Norway, Denmark, and Sweden collaborated to develop a screening tool (LEAM-Q) based on clinical investigations of elite and sub-elite male athletes from multiple countries and ethnicities, and a variety of endurance and weight-sensitive sports. A bank of questions was developed from previously validated questionnaires and expert opinion on various clinical markers of LEA in athletic or eating disorder populations, dizziness, thermoregulation, gastrointestinal symptoms, injury, illness, wellbeing, recovery, sleep and sex drive. The validation process covered reliability, content validity, a multivariate analysis of associations between variable responses and clinical markers, and Receiver Operating Characteristics (ROC) curve analysis of variables, with the inclusion threshold being set at 60% sensitivity. Comparison of the scores of the retained questionnaire variables between subjects classified as cases or controls based on clinical markers of LEA revealed an internal consistency and reliability of 0.71. Scores for sleep and thermoregulation were not associated with any clinical marker and were excluded from any further analysis. Of the remaining variables, dizziness, illness, fatigue, and sex drive had sufficient sensitivity to be retained in the questionnaire, but only low sex drive was able to distinguish between LEA cases and controls and was associated with perturbations in key clinical markers and questionnaire responses. In summary, in this large and international cohort, low sex drive was the most effective self-reported symptom in identifying male athletes requiring further clinical assessment for LEA.

Reference: Schneider KJ, Iverson GL, Emery CA, McCrory P, Herring SA, Meeuwisse WH. The effects of rest and treatment following sport-related concussion: a systematic review of the literature. Br J Sports Med. 2013;47(5):304–307. Clinical Question: After concussion and a period of symptom-limited physical and cognitive rest, do athletes who experience intermittent symptoms return to asymptomatic condition more quickly with physical activity than with prolonged physical rest? Data Sources: One investigator performed an individual search for each research question using the following databases: CINAHL, Cochrane Controlled Trials Registers, EMBASE, HealthSTAR, ProQuest, PsychInfo, PubMed, SPORTDiscus, and Web of Science. Search terms for rest were brain concussion, cognitive rest, mild traumatic brain injury, physical exertion, postconcussive syndrome, rehabilitation, sport-related concussion, therapy, treatment, and treatment outcome. Search terms for treatment were the same terms as for rest, as well as brain training, cervical spine, cognitive therapy, dizziness, exercise, headache, neck, pharmacotherapy, postural balance, and vertigo. The authors included peer-reviewed, published articles and abstracts and performed a citation search. Study Selection: Studies were included based on the following criteria as determined before searching: classified as original research, symptoms resulted after sport-related concussion, and investigation of the effects of either rest or treatment on symptoms. Abstracts that were excluded failed to evaluate rest, omitted sport-related concussion as the cause of symptoms, failed to evaluate a treatment's effect on sport-related concussion, or did not present original research. Data Extraction: The following data were extracted from each study that fit the selection criteria: study design; sample size; participants' demographic information (age and sex); type, duration, and intensity of treatment; key findings including effect sizes and means with 95% confidence intervals (calculated when possible using the data provided in the original study, even if not presented in the original study); and relevant comments. Main Results: The search revealed 749 articles evaluating the effects of rest and 1175 articles evaluating the effects of treatment. Of the 749 articles evaluating the effects of rest, only 2 met all the inclusion criteria. Of the 1175 articles evaluating the effects of treatment, only 10 met all the inclusion criteria. Ultimately, the authors were able to identify additional treatment articles that met the inclusion criteria, for a total of 12. The nature of the treatments and the participants differed enough that meta-analysis was not possible. One of the 2 articles that evaluated rest was a retrospective analysis of athletes that showed those who were prescribed a period of cognitive rest had a longer duration of symptoms. The other study followed athletes postconcussion who were retrospectively assigned to groups based on self-reported activity level after injury. Those who reported moderate levels of cognitive and physical exertion over the first month postinjury appeared to demonstrate improved outcomes compared with those who pursued small or large amounts of activity. Twelve studies evaluated the effects of treatment on symptoms after sport-related concussion. Various interventions were reviewed, including pharmacotherapy, light aerobic activity, graded exercise treadmill test, hyperbaric oxygen therapy, vestibular physiotherapy, and cervical spine manual therapy. Unfortunately, the authors did not report effect sizes for specific interventions, and due to the varied nature of each study and its respective treatment approach, no pooled data could be analyzed. However, a group of adolescents treated with submaximal aerobic and coordination exercises, visualization, and imagery returned to full normal physical activity at a mean duration of 4.4 weeks (95% confidence interval = 3.1, 5.7 weeks). Furthermore, a randomized controlled trial of patients experiencing persistent neck pain, dizziness, and headaches who underwent manual and physical therapy showed they were more likely to return to sport after 8 weeks of treatment. Despite the inability to pool data, the authors concluded that each treatment appeared to positively influence specific aspects of certain patients' symptoms. Conclusions: Little high-quality evidence has addressed the effects of rest and treatment after sport-related concussion. Current evidence suggests that an initial period of rest appears to be beneficial. Further research is needed to evaluate the long-term outcomes of rest (including the quality and quantity of the rest). Low levels of exercise may benefit the athlete postinjury, but additional study is required to determine the optimal timing for initiation of treatment postinjury. Patients with cervical spine or vestibular dysfunction may benefit from rehabilitation techniques targeted at their individual symptom profile to facilitate recovery. Overall, we need high-quality studies evaluating resting period, pharmacologic interventions, rehabilitative techniques, and exercise and their effects on patients slow to recover from concussion symptoms.

Olahraga yang berkembang di masyarakat telah banyak menerima IPTEK sebagai pelengkap dalam setiap melakukan aktivitas olahraga. tetapi banyak masyarakat yang melakukan aktivitas olahraga, tidak terlepas dari cedera akibat melakukan olahraga tersebut. Cedera akibat olahraga berdampak pada aktivitas sehari-hari dan gangguan tubuh yang lain. Karateristik cedera yang dialami oleh para olahragawan seperti cedera ringan, sedang dan berat Cedera pada olahragawan dapat dikelompokkan yaitu cedera derajat-1, cedera derajat-2 dan cedera derajat-3. Cedera derajat-2 dan cedera derajat-3 pada umumnya dilakukan pengobatannya oleh dokter oleh karena cedera derajat-2 dan cedera derajat-3 biasanya jaringan otot robek atau patah tulang, dll. Macam cedera yang tejadi pada tubuh seperti: tulang, otot, ligamen dan persendian anggota gerak tubuh, baik olahraga body contact ataupun non body contact. Cedera yang terjadi tidak dihiraukan oleh para olahragawan dan mereka masih tetap berlatih, bertanding ataupun melakukan aktivitas olahraga untuk prestasi, hobi ataupun kebugaran. Saat cedera terjadi para olahragawan tidak mau untuk beristirahat supaya pulih dari cederanya. Dampak dari tidak adanya istirahat yang terprogram mengakibatkan proses peradangan timbul kembali, kelemahan pada otot semakin tinggi, kreatin kinase meningkat sehingga menimbulkan atrophy otot, dan cedera lama timbul kembali sehingga nyeri terus terasa setiap saat. Kekurangan Kreatin Kinase didalam sarkoplasma otot menyebabkan kemampuan otot menurun tetapi ketika kreatin kinase meningkat akan minimbulkan atrophy pada otot. Istirahat yang terprogram dan cukup sangat penting bagi olahragawan yang mengalami pasca cedera supaya dapat meraih prestasi, kesehatan, kebugaran dan hobi dalam berolahraga kembali. THE BENEFITS OF REST FOLLOWING INJURED DUE TO SPORTS Abstract In modern era, sports will engange with science and technology then improving human performance to get achievement, health and recreation through sports. Science and technology used in various sports, on the other hand it causes injured then impact on daily activities. Injury characteristics experienced by athletes such as minor, moderate and severe injuries. Injured can be classified as first-degree injuries, second-degree injuries and third-degree injuries. Second-degree injuries and third-degree injuries are generally treated by doctors because its usually torn or broken muscle tissue, etc. Types of injuries that occur in the body such as: bones, muscles, ligaments and joints of the limbs, both body contact or non-body contact sports. Sometimes athletes deny that suffers injury and still go the the field for training, compete or do exercise. When the feeling of injury arise, athletes tend to deny the tears and continue their training. Impact of deny to take a rest program will cause inflammation process reappears, weakness in the muscles gets higher, creatine kinase increases, causing muscle atrophy, and overpast injuries reappear so that the pain continues to be felt any time. Creatine kinase decrease in muscle sarcoplasm causing downward muscle ability, while creatine kinase increases, it will generate muscle atrophy. Recovery program is important for athletes who suffering injured so that he/she should come back to the field to get achievement, health, fitness and passion in sports.

Background. Over the years, the concern over bone health deterioration in children with Neurological Disabilities (ND) has caught the interest of the research community. As the current traditional exercise methods are considered too challenging for children with ND, it is essential to seek effective rehabilitation programs with minimum difficulties and movement restrictions for children with disabilities, ultimately improving their muscle and bone health. Therefore, this study was performed to evaluate the potential application of Whole-body Vibration Training (WBVT) as a beneficial and effective approach to improving Bone Mineral Density (BMD), total body Bone Mineral Content (BMC), and lean mass in children with ND. Methodology. The impact of WBVT on children with ND was investigated using a systematic review and meta-analysis approach following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A database search was conducted to screen and select past literature sources that were published from January 2002 to July 2022 from EBSCO, PubMed, Scopus, and Web of Science databases and met the inclusion and exclusion criteria. Following the quality assessment (PEDro scale and NIH scale) and sensitivity analysis, the Standardised Mean Difference (SMD) was conducted using the STATA 15.1 software with a 95% Confidence interval (95% CI). (PROSPERO registration number: CRD42022343789). Results. Eight studies (four Randomised Controlled Trial (RCT) and four non-RCT studies) were selected, which involved 184 male and 130 female participants. Based on the PEDro scale, all RCT studies were classified as high methodological quality, while the NIH scale rated all non-RCT papers as "Good". In addition, the meta-analysis results indicated that WBVT substantially enhanced femur BMD [(P ＜ 0.01, z = 3.37), SMD (95% CI) = 0.47 (0.20, 0.74)], lumbar spine BMD [(P = 0.02, z = 2.32), SMD (95% CI) = 0.32 (0.05, 0.58)], total body BMC [(P ＜ 0.01, z = 3.42), SMD (95% CI) = 0.29 (0.12, 0.46)] and lean mass [(P ＜ 0.01, z = 2.80), SMD (95% CI) = 0.25 (0.07, 0.42)] of children with ND. However, the effect of WBVT was insignificant on the total body BMD of children with ND [(P = 0.22, z = 1.24), SMD (95% CI) = 0.14 (-0.08, 0.37)]. Conclusion. The meta-analysis demonstrated the significant effect of WBVT on the femur BMD, lumbar spine BMD, total body BMC, and lean mass in children with ND. Hence, WBVT can be suggested as a complementary treatment prescription for children with ND.

Background Accelerometry has gained increasing popularity and yields numerous physical activity (PA) outcomes (Rowlands et al., 2019). These include traditional cut-point-based (i.e. light, moderate, and vigorous PA) and cut-point-free metrics (i.e. intensity gradient [IG] and average acceleration [AvAcc]). IG reflects the intensity distribution of PA across the day (Rowlands et al., 2018; Fairclough et al., 2019). AvAcc is a proxy for the daily volume of PA ( Rowlands et al., 2018; Fairclough et al., 2019). Cut-point-based metrics are commonly expressed in minutes per day, making their interpretation simple (Troiano et al., 2014). Yet, the measured acceleration needs to be categorised by setting population- and device-dependent cut-points to obtain these metrics (Troiano et al., 2014). Cut-point-free metrics, on the other hand, are comparable across studies, accelerometer brands (Migueles et al., 2022), and diverse populations (Rowlands et al., 2018). However, their interpretation is not easy. Besides, it is unknown how cut-point-free metrics are associated with cardiorespiratory fitness (CRF), an important health indicator in healthy individuals and patient populations with impaired CRF (Kodama et al., 2009). We thus aimed to 1) compare the association of CRF with cut-point-free metrics to that with cut-point-based metrics in a prospective cohort of healthy adults aged 20 to 89 years and patients with heart failure, and 2) provide age-, sex-, and CRF-related reference values for healthy adults. Methods The COmPLETE study was cross-sectional. Healthy individuals were recruited via unaddressed letters sent to randomly selected postal districts in the Basel area (Wagner et al., 2019). Patients with heart failure were approached as described elsewhere (Wagner et al., 2019). Subjects were asked to wear GENEActiv accelerometers on their non-dominant wrist for up to 14 days and undergo cardiopulmonary exercise testing on a cycle ergometer to determine CRF. Raw accelerometer data were processed using the R-package GGIR (Migueles et al., 2019; van Hees et al., 2013). Associations between CRF and accelerometer metrics were examined using multiple linear regression models adjusted for sex, age, and body mass index. Percentile curves were generated with Generalised Additive Models for Location, Scale, and Shape (Stasinopoulos & Rigby, 2008). Results Four hundred and sixty-three healthy adults and 67 patients with heart failure were included in the analyses. IG and AvAcc provide complementary information on PA. Both metrics were independently associated with CRF in healthy individuals. The best cut-point-free regression model (AvAcc+IG) performed similar to the best cut-point-based model (vigorous activity) and explained 73.9% and 74.2% of the variance in CRF, respectively. In patients with heart failure, IG was associated with CRF, independent of AvAcc. Cut-point-free models (IG+AvAcc, IG alone) had comparable predictive value for CRF as the best cut-point-based metric (moderate-to-vigorous activity). We produced age-, sex-, and CRF-related reference values for IG, AvAcc, moderate-to-vigorous, and vigorous activity for healthy adults. Moreover, we developed a web-based application (rawacceleration) facilitating the interpretation of cut-point-free metrics. Conclusions Cut-point-free metrics are not only more robust than cut-point-based metrics, but also have similar predictive value for CRF and, in turn, indirectly for the risk of mortality and longevity (Kodama et al., 2009; Mok et al., 2019). This may be the case in both healthy individuals and patients with heart failure. Our findings together with those of previous studies (Rowlands et al., 2018; Fairclough et al., 2019), therefore, provide a rationale that cut-point-free metrics facilitate the capture of the volume and intensity distribution of the PA profile across populations, and thus may be a viable alternative to cut-point-based metrics in describing PA. Our reference values will enhance the utility of IG and AvAcc and facilitate their interpretation. Finally, our web-based application will simplify this process and also support the translation of cut-point-free metrics into meaningful outcomes. References Fairclough, S. J., Taylor, S., Rowlands, A. V., Boddy, L. M., & Noonan, R. J. (2019) Average acceleration and intensity gradient of primary school children and associations with indicators of health and well-being. Journal of Sports Sciences, 37(18), 2159-2167. https://doi.org/10.1080/02640414.2019.1624313 Kodama, S., Saito, K., Tanaka, S., Maki, M., Yachi, Y., Asumi, M., Sugawara, A., Totsuka, K., Shimano, H., Ohashi, Y., Yamada, N., & Sone, H. (2009). Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: A meta-analysis. JAMA, 301(19), 2024-35.https://doi.org/10.1001/jama.2009.681 Migueles, J. H., Molina-Garcia, P., Torres-Lopez, L. V., Cadenas-Sanchez, C., Rowlands, A. V., Ebner-Priemer, U. W., Koch, E. D., Reif, A., & Ortega, F. B. (2022). Equivalency of four research-grade movement sensors to assess movement behaviors and its implications for population surveillance. Science Reports, 12, Article 5525. https://doi.org/10.1038/s41598-022-09469-2 Migueles, J. H., Rowlands, A. V., Huber, F., Sabia, S., & van Hees, V. T. (2019). GGIR: A research community–driven open source R package for generating physical activity and sleep outcomes from multi-day raw accelerometer data. Journal for the Measurement of Physical Behaviour, 2(3),188-96. https://doi.org/10.1123/jmpb.2018-0063 Mok, A., Khaw, K.-T., Luben, R., Wareham, N., & Brage, S. (2019). Physical activity trajectories and mortality: Population based cohort study. BMJ, 365, l2323. https://doi.org/10.1136/bmj.l2323 Rowlands, A. V., Edwardson, C. L., Davies, M. J., Khunti, K., Harrington, D. M., & Yates, T. (2018). Beyond cut points: Accelerometer metrics that capture the physical activity profile. Medicine & Science in Sports & Exercise, 50(6), 1323-32. https://doi.org/10.1249/MSS.0000000000001561 Rowlands, A. V., Fairclough, S. J., Yates, T., Edwardson, C. L., Davies, M., Munir, F., Khunti, K., & Stiles, V. H. (2019). Activity intensity, volume, and norms: Utility and interpretation of accelerometer metrics. Medicine & Science in Sports & Exercise, 51(11), 2410-2422. https://doi.org/10.1249/MSS.0000000000002047 Stasinopoulos, D. M., & Rigby, R. A. (2008). Generalized additive models for location scale and shape (GAMLSS) in R. Journal of Statistical Software, 23(7), 1 - 46. https://doi.org/10.18637/jss.v023.i07 Troiano, R. P., McClain, J. J., Brychta, R. J., & Chen, K. Y. (2014). Evolution of accelerometer methods for physical activity research. British Journal of Sports Medicine, 48(13), 1019-1023. https://doi.org/10.1136/bjsports-2014-093546 van Hees, V. T., Gorzelniak, L., Dean León, E. C., Eder, M., Pias, M., Taherian, S., Ekelung, U., Renström, F., Franks, P. W., Horsch, A., & Brage, S. (2013). Separating movement and gravity components in an acceleration signal and implications for the assessment of human daily physical activity. PloS one, 8(4), Article e61691. https://doi.org/10.1371/journal.pone.0061691 Wagner, J., Knaier, R., Infanger, D., Arbeev, K., Briel, M., Dieterle, T., Hanssen, H., Faude, O., Roth, R., Hinrichs, T., & Schmidt-Trucksäss, A. (2019). Functional aging in health and heart failure: The COmPLETE Study. BMC Cardiovascular Disorders, 19, Article 180. https://doi.org/10.1186/s12872-019-1164-6

Category: Other; Ankle; Ankle Arthritis; Bunion; Hindfoot; Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Fulfilment of patients' expectations following foot and ankle surgery has been previously studied, and shown to be an effective modality in assessing patient-reported outcomes (PROs). While this assessment has been shown to correlate well with patient satisfaction and other validated PROs, the impact of postoperative complications on fulfilment of expectations is unknown. The aim of this study is to therefore investigate the impact of postoperative complications on fulfilment of patients' expectations. Methods: Preoperatively, patients completed a validated Foot and Ankle Expectations Survey consisting of 23 questions encompassing domains including pain, ambulation, daily function, exercise, and shoe wear. At 2 years postoperatively, patients answered how much improvement they received for each item cited preoperatively. A fulfilment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. Chart review was performed to identify patient demographics, comorbidities, pain management, and postoperative complications, which were classified as minor (infection requiring antibiotics) or major (return to OR for revision, deep infection). FP in patients with a complication was compared to patients who did not experience a complication. In addition, the Foot and Ankle Outcomes Score (FAOS), satisfaction, and Delighted-Terrible scale (how they would feel if asked to spend the rest of their life with their current foot/ankle symptom) were collected at final follow-up. Results: Of the 271 patients (mean age 55.4 years, 65% female), 31 (11.4%, mean age 53.6, 58% female) had a postoperative complication: 25 major (19 revisions, 6 deep infections requiring I&D), 4 minor (4 superficial infections requiring antibiotics), and 2 major and minor (revision and superficial infection). Average time from complication to completion of fulfilment survey was 15 (+- 3.6) months. The groups were similar in diagnoses. Complications were associated with significantly worse FP (0.69 +- 0.45 vs 0.86 +- 0.40, p=0.02). Having a complication significantly correlated with worse satisfaction, Delighted-Terrible scale, and FP (p<0.001). FAOS domains were similar between groups preoperatively; postoperatively, patients without complications had significantly higher ADL and QoL scores (p<0.05). Demographically, there was no difference in age, sex, BMI, Charlson Comorbidity Index, depression/anxiety, or pain management between the two groups. Conclusion: Our data suggests that postoperative complications following foot and ankle surgery are associated with worse patient-reported fulfilment of their surgical expectations even after recovery from the initial surgery and complication. This finding is independent of preoperative expectations, and correlates with patient satisfaction with their procedure. Therefore, while patient-perceived fulfilment following foot and ankle surgery is multifactorial, the incidence of a postoperative complication negatively impacts fulfilment as well as satisfaction following surgery.

Introduction Muscular strength can be viewed as a product of force and velocity. Increases in both maximal force and velocity will ultimately result in an increase in power (Suchomel et al., 2016), thus contributing to performance in tasks such as athletic competition or police and military special operations. Testing isometric peak force is a reliable method to assess maximal strength (De Witt et al., 2018). Isometric mid-thigh pull tests and squat tests in various knee- and hip angles are well known. These tests, however, require force plates with computer and software, as well as a barbell that disallows displacement of the bar (usually a heavy equipment). Decentralized testing requires a reliable, lightweight and mobile measurement device comparable to standard isometric tests as described elsewhere (Maier et al., 2016). Therefore, a tension gauge (load cells) was attached to a board and a handle to perform isometric sumo stance deadlifts. The question is whether the mobile device produces comparable results to maximal isometric strength tests on force plates. Method Correlation analysis (Bayesian Pearson’s rho, Prior~Beta 1,1) and Equivalence Bayesian Paired Samples T-Tests (Lakens, 2017; Prior~Cauchy 0,0.707, a priori Limits of Agreement = +/-5%) of the measurements from the mobile test device and from force plates (CYCCESS) were performed using JASP Version 0.14.1. Healthy, trained subjects (n = 12) volunteered to perform maximal isometric deadlifts on each test device. Results were validated by additional 6 pairs of lifts on each device. Results Pearson’s rho was 0.969 (95% credible interval of the posterior distribution 0.824, 0.993). After adjusting the measures of the mobile device for the offset (mean of the differences of 416 N), Bayes factor favoring the hypothesis that the effect size lies inside the interval of +/-5% was 3.006. The additional measurements confirmed the substantial evidence for equivalence of the two measurements. Discussion Isometric tests are relatively simple, safe and time efficient to administer and possess high degrees of reliability (Grgic et al., 2022). The strong relationship between isometric peak force and deadlift 1RM (De Witt et al., 2018) makes them a valuable tool for exercise prescription. Our lightweight, mobile test device offers high precision (technical measurement error of the load cells = 0.5%) and safe testing procedure. Concurrent validity, as well as face validity, seems to be reasonably high: measurements with the mobile device do not differ from a isometric deadlift test on force plates, and lifting casualties and heavy loads could be well represented by force produced from the floor position (Bartolomei et al., 2022). References Bartolomei, S., Rovai, C., Lanzoni, I. M., & di Michele, R. (2022). Relationships between muscle architecture, deadlift performance, and maximal isometric force produced at the midthigh and midshin pull in resistance-trained individuals. Journal of Strength and Conditioniung Research, 36(2), 299-303. https://doi.org/10.1519/jsc.0000000000003455 De Witt, J. K., English, K. L., Crowell, J. B., Kalogera, K. L., Guilliams, M. E., Nieschwitz, B. E., Hanson, A. M., & Ploutz-Snyder, L. L. (2018). Isometric midthigh pull reliability and relationship to deadlift one repetition maximum. The Journal of Strength and Conditioning Research, 32(2), 528-533. https://doi.org/10.1519/jsc.0000000000001605 Grgic, J., Scapec, B., Mikulic, P., & Pedisic, Z. (2022). Test-retest reliability of isometric mid-thigh pull maximum strength assessment: A systematic review. Biology of Sport, 39(2), 407-414. https://doi.org/10.5114/biolsport.2022.106149 Lakens, D. (2017). Equivalence tests: A practical primer for t tests, correlations, and meta-analyses. Social Psychological and Personality Science, 8(4), 355-362. https://doi.org/10.1177/1948550617697177 Maier, T., Gross, M., Trösch, S., Steiner, T., Müller, B., Bourban, P., Schärer, C., Hübner, K., Wehrlin, J., Tschopp, M., Wilhelm, M., Clenin, G. E., Züst, P., & Seidel, R. (2016). Manual Leistungsdiagnostik [Performance diagnostics manual]. http://www.swissolympic.ch/Portaldata/41/Resources/03_sport/00_dokumente/Manual_Leistungsdiagnostik_(letzte_Aenderung_01.02.2016).pdf Suchomel, T. J., Nimphius, S., & Stone, M. H. (2016). The importance of muscular strength in athletic performance. Sports Medicine, 46(10), 1419-1449. https://doi.org/10.1007/s40279-016-0486-0

Abstract Physical education needs to focus on improving students’ physical fitness and quality and psychological training for students. Therefore, this paper proposes a strategy to combine sports psychology with realistic teaching to optimize innovative teaching paths in line with students’ development to develop students’ comprehensive quality level in college sports psychology teaching. The indicators in the teaching evaluation are classified and summarized to complete a multi-indicator evaluation to improve the quality of teaching. The theory of sports psychology is adjusted and improved, and the teaching guideline is changed to apply PCA (principal component analysis algorithm) of multivariate statistical analysis to teaching evaluation. The raw data of students’ evaluation were processed by calculation and analysis to determine the main factors affecting teaching quality and analyzed with experiments. The results show that 78.1% of college students think that physical exercise can enhance self-confidence and 77.4% think physical exercise can promote healthy growth. It can be seen that combining the content of sports psychology with practical training effectively improves students’ sports psychological quality.

Purpose Sports garments play an important role in the well-being of an athlete by protecting the wearer from changing environmental conditions and providing a comfortable feel. Clothing requirements have changed in recent years and demand for apparel with a higher comfort performance has been rising. Hence, the purpose of this study is to explore consumers’ expectations and perception of comfort and to examine how different textiles are perceived by consumers to provide useful knowledge that allows to engineer comfort into fabrics and sports garments. Design/methodology/approach This online survey comprised 292 respondents, classified by sex, age, nationality and physical activity. The respondents were asked a total of 18 questions through the Bristol Online Survey tool to explore expectation, perception and preference of clothing comfort, specifically of sportswear. Findings Fit and comfort are closely linked together, both forming part of the clothing comfort concept. When purchasing garments online, the haptics of fabrics were identified as a crucial missing parameter. However, priorities of attributes within the concept varied according to the person’s sex and nationality. Women put more emphasis on garment fit and showed a higher need for tactile input, whereas men prioritised physiological comfort descriptors, i.e. properties which facilitate thermoregulation. Furthermore, there is an increased importance of physiological comfort parameters for people exercising for 10 or more hours per week. Finally, it was possible to identify common associations and preferences for textile materials (cotton, polyester, cotton/polyester blend and wool). However, consideration should be taken concerning sex and nationality. Originality/value Sex and nationality are parameters modulating the clothing comfort concept and the conceptualised feel of materials. Therefore, the sex and nationality of the end-consumer should be considered during the development phase of sports garments and particular attention should be given to the targeted market in which these will be sold.

Abstract Background Sleep loss may influence subsequent physical performance. Quantifying the impact of sleep loss on physical performance is critical for individuals involved in athletic pursuits. Design Systematic review and meta-analysis. Search and Inclusion Studies were identified via the Web of Science, Scopus, and PsycINFO online databases. Investigations measuring exercise performance under ‘control’ (i.e., normal sleep, > 6 h in any 24 h period) and ‘intervention’ (i.e., sleep loss, ≤ 6 h sleep in any 24 h period) conditions were included. Performance tasks were classified into different exercise categories (anaerobic power, speed/power endurance, high-intensity interval exercise (HIIE), strength, endurance, strength-endurance, and skill). Multi-level random-effects meta-analyses and meta-regression analyses were conducted, including subgroup analyses to explore the influence of sleep-loss protocol (e.g., deprivation, restriction, early [delayed sleep onset] and late restriction [earlier than normal waking]), time of day the exercise task was performed (AM vs. PM) and body limb strength (upper vs. lower body). Results Overall, 227 outcome measures (anaerobic power: n = 58; speed/power endurance: n = 32; HIIE: n = 27; strength: n = 66; endurance: n = 22; strength-endurance: n = 9; skill: n = 13) derived from 69 publications were included. Results indicated a negative impact of sleep loss on the percentage change (%Δ) in exercise performance (n = 959 [89%] male; mean %Δ = − 7.56%, 95% CI − 11.9 to − 3.13, p = 0.001, I2 = 98.1%). Effects were significant for all exercise categories. Subgroup analyses indicated that the pattern of sleep loss (i.e., deprivation, early and late restriction) preceding exercise is an important factor, with consistent negative effects only observed with deprivation and late-restriction protocols. A significant positive relationship was observed between time awake prior to the exercise task and %Δ in performance for both deprivation and late-restriction protocols (~ 0.4% decrease for every hour awake prior to exercise). The negative effects of sleep loss on different exercise tasks performed in the PM were consistent, while tasks performed in the AM were largely unaffected. Conclusions Sleep loss appears to have a negative impact on exercise performance. If sleep loss is anticipated and unavoidable, individuals should avoid situations that lead to experiencing deprivation or late restriction, and prioritise morning exercise in an effort to maintain performance.

The authors aimed to provide an overview of the evidence on the effects of exercise in people with Alzheimer’s disease through a comprehensive review of the existing systematic reviews and meta-analyses. A literature search was performed in CINAHL, Cochrane Library, EMBASE, PubMed, SPORTDiscus, Scopus, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The AMSTAR-2-Tool was used for the quality assessment. Twenty-three reviews fulfilled the criteria. Most of the reviews investigated the effects of aerobic exercise on Alzheimer’s disease symptoms. The largest effects of exercise were seen in terms of improved cognition by multiple exercises. The majority of the reviews were rated as being of moderate quality and none were classified as having high quality. Exercise is an effective way to treat Alzheimer’s disease symptoms and has a low incidence of related adverse events. As most reviews were evaluated as low-moderate quality, caution is needed in the interpretation of the results.

Exercise interventions are evident in the treatment of mid-portion Achilles tendinopathy (AT). However, there is still a lack of knowledge concerning the effect of different exercise treatments on improving a specific function (e.g., strength) in this population. Thus, this study aimed to systematically review the effect of exercise treatments on different functional outcomes in mid-portion AT. An electronic database of Pubmed, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception to 21 February 2023. Studies that investigated changes in plantar flexor function with exercise treatments were considered in mid-portion AT. Only randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were included. Functional outcomes were classified by kinetic (e.g., strength), kinematic [e.g., ankle range of motion (ROM)], and sensorimotor (e.g., balance index) parameters. The types of exercise treatments were classified into eccentric, concentric, and combined (eccentric plus concentric) training modes. Quality assessment was appraised using the Physiotherapy Evidence Database scale for RCTs, and the Joanna Briggs Institute scale for CCTs. The search yielded 2,260 records, and a total of ten studies were included. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Eccentric training led to improvements in power outcomes (e.g., height of countermovement jump), and in strength outcomes (e.g., peak torque). Concentric training regimens showed moderate enhanced power outcomes. Moreover, one high-quality study showed an improvement in the balance index by eccentric training, whereas the application of concentric training did not. Combined training modalities did not lead to improvements in strength and power outcomes. Plantarflexion and dorsiflexion ROM measures did not show relevant changes by the exercise treatments. In conclusion, eccentric training is evident in improving strength outcomes in AT patients. Moreover, it shows moderate evidence improvements in power and the sensorimotor parameter “balance index”. Concentric training presents moderate evidence in the power outcomes and can therefore be considered as an alternative to improve this function. Kinematic analysis of plantarflexion and dorsiflexion ROM might not be useful in AT people. This study expands the knowledge what types of exercise regimes should be considered to improve the functional outcomes in AT.

Endurance athletes commonly experience lower gastrointestinal (GI) symptoms similar to those of irritable bowel syndrome (IBS). Previous research on the restriction of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP), a diet-based mitigation strategy initially developed for IBS, has shown promise for application in athlete populations. Athlete's dietary strategies surrounding exercise have not been formally assessed in relation to FODMAP content of foods or sports nutrition products. Additionally, the FODMAP content of athlete's habitual diets has not been examined in larger sample sizes. This research aims to investigate the FODMAP content of endurance athlete diets by examining these three areas, in conjunction with GI symptoms. Dietary habits surrounding exercise and GI symptoms were examined in 430 endurance athletes using a previously validated Endurance Athlete Questionnaire. A subset of athletes (n = 73) completed a FODMAP-specific food frequency questionnaire for habitual intake. The most commonly reported sports nutrition products were analyzed for FODMAP content using standardized analytical methods. Mean habitual intakes were compared to previous FODMAP studies and medians were compared between those with and without lower GI symptoms. Athletes commonly consumed high FODMAP foods during pre-race dinners and breakfasts, with over 60% reporting specific high FODMAP foods. More frequent nutrition product use, particularly solid, gel/gummy, and homemade products, was often related to increased frequency of GI symptoms. Of the sixteen commonly used sports nutrition products tested, seven were high FODMAP in one serving. All but one of the remaining products became high FODMAP when consumed in multiple servings, as is likely the case during endurance exercise. Average habitual FODMAP intake was 26.1 g (±15.9 g), similar to intakes classified as high FODMAP in previous research on FODMAPs and IBS or GI symptoms. Only 15.1% of athletes consumed a diet that would be considered low in FODMAP. Exploratory analyses showed higher intake of some FODMAP types among athletes exhibiting various lower GI symptoms. Overall, this study demonstrated that FODMAP intake by endurance athletes is high both surrounding exercise and habitually, and may be contributing to GI symptoms experienced during exercise. This information can be utilized when analyzing athlete diets and selecting foods to decrease GI symptoms.

Abstract Background Tendinopathy is a common clinical condition that can significantly affect a person’s physical function and quality of life. Despite exercise therapy being the mainstay of tendinopathy management, there are many potential adjunct therapies that remain under investigated, one of which is photobiomodulation (PBM). PBM uses varied wavelengths of light to create a biological effect. While PBM is used frequently in the management of tendinopathy, high quality evidence supporting its utility is lacking. Methods A systematic search of the Pubmed, CINAHL, SCOPUS, Cochrane Database, Web of Science and SPORTSDICUS databases was performed for eligible articles in August 2020. Randomized Control Trials that used red or near-infrared PBM to treat tendinopathy disorders that made comparisons with a sham or ‘other’ intervention were included. Pain and function data were extracted from the included studies. The data were synthesized using a random effects model. The meta-analysis was performed using the mean difference (MD) and standardized mean difference (SMD) statistics. Results A total of 17 trials were included (n = 835). When compared solely to other interventions PBM resulted in similar decreases in pain (MD -0.09; 95% CI − 0.79 to 0.61) and a smaller improvement in function (SMD -0.52; 95% CI − 0.81 to − 0.23). When PBM plus exercise was compared to sham treatment plus exercise, PBM demonstrated greater decreases in pain (MD 1.06; 95% CI 0.57 to 1.55) and improved function (MD 5.65; 95% CI 0.25 to 11.04). When PBM plus exercise was compared to other interventions plus exercise, no differences were noted in pain levels (MD 0.31; 95% CI − 0.07 to 0.70). Most studies were judged as low-risk of bias. The outcome measures were classified as very low to moderate evidence quality according to the Grading of Recommendation, Development and Evaluation tool. Conclusion There is very-low-to-moderate quality evidence demonstrating that PBM has utility as a standalone and/or adjunctive therapy for tendinopathy disorders. Trial registration PROPERO registration number: CRD42020202508.

Background: Interpreting the electrocardiography (ECG) recording in young athletes is challenging for the sports doctor. Changes in intraventricular conduction and early ventricular repolarization observed during sports training are not always confirmed in the literature. We test healthy people and look for irregularities in their ECG records. The study aims to draw attention to ST-Elevation (STE) as a variant of the White Athlete's heart norm, with a frequency lower than an inverted T wave (TWI), but also as an effect of early repolarization of the ventricles in young athletes. Is it physiology? Case report: 14-year-old football player, examined for five years at a sports clinic, cardiology checked every year. Changes like symptomatic adult ECGs with STE and myocardial necrosis were suspected during our observation. Echocardiography, stress test good. A simple response to exercise is to adapt the athlete's heart by ischemia, preconditioning for the heart muscle, and a reversible remodelling that disappears after the sports period. We focus on changes in ECG, which are observed in athletes under 14 years of age, while most of the ECG classifications in an athlete were described above 16 years of age. Conclusion: the variant observed in our White Athlete is an example of several similar repolarization changes in ECG not yet classified as physiological or resulting from intensive training.

Introduction: Sports-related concussions (SRCs) have received attention due to their prevalence in youth. An SRC results from a strong force causing neurological impairment. Recent research has recommended rehabilitation within the first week post-SRC after 24 to 48 hours of rest. The postacute phase is defined as 48 hours to 7 days post-SRC. It is imperative to evaluate the most effective mode and intensity of physical activity to reduce symptoms and improve outcomes. Methods: CINAHL, PubMed, SPORTDiscus, and Web of Science databases were used to search the terms “brain concussion” AND “exercise” and variations of these terms. The evidence level for each study was evaluated using the 2011 Oxford Center for Evidence-Based Medicine Guide. The methodological rigor of each study was evaluated using a scale adapted from Medlicott and Harris. Results: Two thousand sixty-eight records were identified. Six studies were included in this systematic review. Three studies were classified as moderately strong. The remaining 3 studies were considered weak. Five of the studies used either a cycle ergometer or a treadmill. The sixth study used walking, cycling, and swimming, as well as sports drills. All of these modes of exercise were determined to be safe. All studies utilized low- and moderate-intensity interventions, which were found to be nondetrimental and showed improved recovery time and symptom resolution. Five of the studies also incorporated components of high-intensity exercise that was also found to be nondetrimental, and they showed a positive influence on recovery time and symptom resolution. However, all activity in each of the reviewed studies started at a low level and progressed up to a higher level only as each individual client’s symptoms permitted. Discussion: Overall, this review found that various modes of activity at light-, moderate-, and high-intensity levels are efficacious and can be safely used during the postacute phase of SRC. Conclusion: Though the volume of literature at this time is limited, therapists should consider prescribing closely monitored individualized exercise programs utilizing progressive intensities when treating patients during the postacute phase of SRC.

Objective This systematic review and meta-analysis aimed to assess the effectiveness of exercise-based injury prevention programmes in preventing sports injuries in team handball players. Data Sources Two independent researchers performed a systematic search in the electronic databases Scopus, PubMed, Web of Science (WOS), SPORTDiscus, and CINAHL from inception until Aprile 2023. Study Selection Studies were included if they were randomized-controlled or prospective cohort trials, contained a population of competitive team handball players, included an intervention designed specifically to prevent or reduce the risk of team handball injury, and reported injury incidence rates specific to team handball players. Two researchers independently assessed trials for inclusion criteria and methodological quality. Data Extraction Study design, intervention details, participant characteristics, and the number of injuries in each group were extracted from each study by two independent researchers. The outcome of interest was the incidence rate of injury. Injury data were classified into 5 groups: lower extremity injuries, shoulder injuries, knee injuries, ankle sprains, or ACL injuries. Extracted data were analyzed by Comprehensive Meta-Analysis software, version 3.0 (CMA.V2) using a random-effects model to compute the overall effect estimates of injury prevention programmes in reducing the risk of injuries. Odds ratios (ORs) with 95% CIs were calculated based on the number of injuries in each group. Data Synthesis Meta-analyses were conducted independently for each injury classification. Results indicate that prevention programmes significantly reduced the risk of shoulder injuries (OR, 0.56; 95% CI, 0.36-0.87; P = 0.01), lower extremity (OR, 0.59; 95% CI, 0.37-0.98; P = 0.03), knee (OR, 0.53; 95% CI, 0.35-0.78; P = 0.002) and ankle sprains (OR, 0.57; 95% CI, 0.40-0.81; P = 0.002), and ACL ruptures (OR, 0.67; 95% CI, 0.45-0.97; P = 0.03) in team handball players. Conclusion In team handball players, prevention programmes appear effective in reducing the risk of shoulder, lower extremity, knee, ankle, and ACL injuries.

ObjectiveHealth disparities are widely prevalent; however, little has been done to examine and address their causes and effects in sports and exercise medicine (SEM). We aimed to summarise the focus areas and methodology used for existing North American health disparity research in SEM and to identify gaps in the evidence base.DesignScoping review.Data sourcesSystematic literature search of PubMed, Scopus, SPORTDiscus, CINAHL Plus with Full Text, Web of Science Core Collection and Cochrane Central Register of Controlled Trials.Eligibility criteriaFull-text, peer-reviewed manuscripts of primary research, conducted in North America; published in the year 2000 or after, in English; and focusing on organised sports were included.Results103 articles met inclusion criteria. Articles were classified into five focus areas: access to and participation in sports (n=45), access to SEM care (n=28), health-related outcomes in SEM (n=24), provider representation in SEM (n=5) and methodology (n=1). Race/ethnicity (n=39), socioeconomic status (n=28) and sex (n=27) were the most studied potential causes of health disparities, whereas sexual orientation (n=5), location (rural/urban/suburban, n=5), education level (n=5), body composition (n=5), gender identity (n=4) and language (n=2) were the least studied. Most articles (n=74) were cross-sectional, conducted on youth (n=55) and originated in the USA (n=90).ConclusionHealth disparity research relevant to SEM in North America is limited. The overall volume and breadth of research required to identify patterns in a heterogeneous sports landscape, which can then be used to inform positive change, need expansion. Intentional research focused on assessing the intersectionality, causes and consequences of health disparities in SEM is necessary.

Background: Both exercise addiction (EA) and muscle dysmorphia (MD) primarily involve the compulsive practice of physical exercise and are classified as behavioral addictions in different lines of research. These types of addictions are frequently comorbid with other addictive pathologies, such as emotional dependence (ED), which is closely related to childhood attachment. This study is presented to address the scarcity of research relating EA and MD with other behavioral addictions. The aims are to analyze the sex differences found in emotional dependence, attachment dimensions, EA and MD; to analyze the association between EA and MD and other behavioral addictions, such as emotional dependence and attachment dimensions; and to analyze the possible role that childhood attachment plays in mediating the interaction between emotional dependence and EA and MD.Method: The sample comprised 366 participants (54.6% women) aged 17–31 (M = 23.53; SD = 6.48).Results: There are sex differences, with men scoring higher in EA, MD, and ED. The positive relationship between EA and ED (values between 0.16 and 0.28), MD (presenting values between 0.42 and 0.70), and attachment styles based on preoccupation, interference, permissiveness, and value of parental authority (values between 0.11 and 0.14) is highlighted. On the other hand, MD was positively related to ED (values ranging from 0.24 to 0.36) and attachment styles based on the value of parental authority, self-sufficiency, and resentment toward parents (between 0.17 and 0.18), and negatively related to secure attachment (values between −0.13 and −0.18). Likewise, the predictive role of ED and attachment styles in EA and MD was tested. And it was observed how attachment styles mediated the relationship between EA and ED, as well as the relationship between MD and ED. Thus, it has been shown that people with EA and MD present attachment styles that may influence negatively the decision-making process when choosing inappropriate strategies to achieve adequate emotional regulation, even selecting inappropriate goals for physical exercise with negative consequences.Conclusions: The dissemination of the findings among mental health and sports science professionals is necessary to develop prevention and intervention strategies for people affected by EA and MD.

Abstract Background The study aims to update the specific classification of mechanisms of death in swimming and to demonstrate these categories are reasonable, by analyzing more characteristics of death cases, evaluating the available evidence and determining their quality. Methods Original articles were queried from PubMed, Web of Science, Embase databases, Cochrane Library, and Scopus. Included studies, which were evaluated as level 4 evidence or higher according to the Oxford Centre for Evidence-Based Medicine, discussed hypothesized mechanisms of death in swimming. Parameters analyzed in this study included decedents’ characteristics, outcome measures, findings, methodological index for non-randomized studies (MINORS), and critical evaluation of each study classified by death mechanism. Results A total of twenty-five studies were included for further analysis: fourteen were associated with cardiovascular diseases, two were about cerebrovascular diseases, two contained respiratory diseases, seven were about hazardous conditions and three contained other drownings, which provided evidence for mechanisms of death. Conclusions It is found that cardiovascular disease is the main cause or contributing factor of death in swimming. Respiratory diseases and cerebrovascular diseases are difficult to be definitive mechanism categories due to insufficient evidence. Hazardous conditions appear to be one of the possible risk factors because there are more cases of deaths from unsafe environments in swimming, but further statistics and research are still needed to support this view. Our study may have important implications for developing potential prevention strategies for sports and exercise medicine. Trial registration PROSPERO ID (CRD42021267330). Registered Aug 13th 2021.

Abstract Background Despite numerous low back pain (LBP) clinical practice guidelines, published studies suggest guideline nonconcordant care is still offered. However, there is limited literature evaluating the degree to which chiropractors, particularly students, follow clinical practice guidelines when managing LBP. The aim of this study was to evaluate the frequency of use of specific interventions for LBP by students at a chiropractic teaching clinic, mapping recommended, not recommend, and without recommendation interventions based on two clinical practice guidelines. Methods This was a retrospective chart review of patients presenting to the Canadian Memorial Chiropractic College teaching clinic with a new complaint of LBP from January to July 2019. Interventions provided under treatment plans for each patient were extracted. Interventions were classified as recommended, not recommended, or without recommendation according to two guidelines, the NICE and OPTIMa LBP guideline. Results 1000 patient files were identified with 377 files meeting the inclusion criteria. The most frequent interventions provided to patients were manipulation/mobilization (99%) and soft tissue therapy (91%). Exercise, localized percussion, and advice and/or education were included in just under half of the treatment plans. Patient files contained similar amounts of recommended (70%) and not recommended (80%) interventions according to the NICE guideline classification, with half the treatment plans including an intervention without recommendation. Under the OPTIMa acute guideline, patient files contained similar amounts of recommended and not recommended care, while more recommended care was provided than not recommended under the OPTIMa chronic guideline. Conclusions Despite chiropractic interns providing guideline concordant care for the majority of LBP patients, interventions classified as not recommended and without recommendation are still frequently offered. This study provides a starting point to understand the treatment interventions provided by chiropractic interns. Further research should be conducted to improve our understanding of the use of LBP guideline recommended care in the chiropractic profession. Trial registration Open Science Framework # g74e8.

Numerous experimental pieces of evidence have been examining the effects of plyometric training (PT) in improving sports performance and physical fitness. However, the nature of the surface and type of jump may cause the training outcomes to vary. Therefore this study aimed at analyzing the effects of five weeks of sand-based plyometric jump training on improving muscle power and strength. The pretest-posttest randomized experimental design was conducted on student-athletes which then classified into three groups: the plyometric knee tuck jump (TJ, n=11), hurdle jump (HJ, n=11), and control (C, n=11). Subjects in TJ and HJ groups were assigned to five weeks of plyometric exercise, comprising 15 sessions in total, with intensities ranging from 80% to 100%. Data were obtained using NordBord and Force Decks prior to and after they completed the whole set of exercises. Data were analyzed using SPSS 23 and presented descriptively in mean and standard deviation. Paired sample t-test and one-way ANOVA were done to compare the differences between groups. Five weeks of TJ and HJ resulted in similar improvements in strength and power (p ≤ 0.05). However, statistically significant between groups differences at the post-test were noted for HJ (p=0.000) in favor of both measured variables. Based on these findings, it was concluded that plyometric training in general increased strength and power of muscle leg better than conventional training.

AbstractBackgroundTotal hip arthroplasty (THA) is a surgical procedure that can alter physical function and quality of life.ObjectivesThe aim was to verify the effects of aquatic exercises compared with exercises on land, control or other modalities, in patients undergoing THA on the primary outcomes: self‐reported physical function, quality of life and pain; and secondary outcomes: muscle strength, functional capacity and gait.DesignSystematic review that followed the PRISMA Statement and PROSPERO registered. The search was performed in the following databases: Web of Science, Embase, Medline, Cinahl, Lilacs, SPORTDiscus, Cochrane Library, Scopus, SciELO, and PEDro, from 1945 to 2022. The risk of bias assessment was performed using the Risk of Bias 2 (RoB2) from the Cochrane Collaboration.ResultsThree randomized controlled trials (RCTs) were included, with a total of 364 participants. In the selection process, two publications from the same study were found. The RoB2 assessment classified one RCT as “high risk of bias” and the others as “low risk of bias”. Therefore, the analysis of the results considered only studies with a low risk of bias. For the self‐reported physical function outcome, evaluated by WOMAC, improvement was observed in favor of aquatic exercises, when started on the 14th postoperative day. Pain improved after 24th week postoperative, in favor of exercise (effect size between 0.2 and 0.4). Quality of life, verified only by one RCT, improved at each time point evaluated (effect size between 0.01 and 0.10). The functional capacity showed no difference between the groups. This was the first systematic review to assess the benefits of aquatic exercises specifically in THA and it was possible to infer that the exercises initiated after 14 days of postoperative are safer. The protocol should include proprioceptive, coordination, and resistance exercises. The session can last around 30 min and is held three times a week.ConclusionDecision making for treatment in the postoperative of THA may include aquatic exercises as a safe and efficacious alternative to improve self‐reported physical function, pain, quality of life, and muscle resistance.

Exercise training influences phospholipid fatty acid composition in skeletal muscle and these changes are associated with physiological phenotypes. Recently we have found that peroxisome proliferator‐activated receptor γ coactivator 1α (PGC‐1α), a nuclear receptor coactivator, affected lipid profiles in skeletal muscle and increased several phospholipid species in glycolytic muscle, namely phosphatidylcholine (PC) (18:0/22:6) and phosphatidylethanolamine (PE) (18:0/22:6). We also found that exercise training increased PC (18:0/22:6) and PE (18:0/22:6) in glycolytic muscle and that PGC‐1α was required for these alterations. On the other hand, a decrease in docosahexaenoic acid [22:6 (n‐3)] from the skeletal muscle phospholipid fraction was observed in dystrophic mdx mice, suggesting changes of phospholipid fatty acid composition related with physiological phenotypes of skeletal muscle. However, the molecular mechanism of this influence on compositional changes is poorly understood. Forkhead box protein O1 (FOXO1) is a transcriptional factor that plays an important role in regulation of skeletal muscle mass. Because we have demonstrated that muscle‐specific overexpression of FOXO1 is sufficient to cause skeletal muscle atrophy in vivo, we speculated that FOXO1 contribute to the atrophy‐mediated change in phospholipid fatty acid composition. To determine the role of FOXO1, we performed lipidomics analyses of skeletal muscle from genetically modified mice that overexpress FOXO1 in skeletal muscle. After lipid extraction from EDL or soleus by Bligh and Dyer method, the lipid samples were injected into LC‐MS and determined peaks were re‐analyzed by MS/MS for identification of lipid species. Using these data, principal component analysis was done to classified the changes of lipid species depending on muscle fiber type and FOXO1 expression. As a result, we observed that PC and PE containing specific fatty acid species changed in both of EDL and soleus derived from mice that overexpress FOXO1 in skeletal muscle. From these results, it was suggested that FOXO1 expression changed fatty acid composition of PC and PE and these changes might be involved in the physiological phenotype of muscle atrophy.Support or Funding InformationThis study was supported by the Council for Science, Technology and Innovation (CSTI), Cross‐ministerial Strategic Innovation Promotion Program (SIP, No.14533567), and “Technologies for creating next‐generation agriculture, forestry and fisheries” (funding agency: Bio‐oriented Technology Research Advancement Institution, NARO), The Tojuro Iijima Foundation for Food Science and Technology (Chiba, Japan), Grants‐in‐Aid for Scientific Research (KAKENHI, No. 26282184, 26560400, 21300240) from the Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT, Tokyo), The Uehara Memorial Foundation (Tokyo, Japan), The Kao Research Council for the Study of Healthcare Science (Tokyo, Japan, No. A‐31006), and University of Shizuoka Grant for Scientific and Educational Research.

IntroductionCan a person’s tastes in art, music, literature, cinema, sport, humour or other fields be changed through online activity? This article explores that question by comparing recent research findings in the areas of neuroplasticity and flow. Neuroplasticity, also known as brain plasticity, is the idea that the human brain can change its structure and function through thought and activity, even into old age (Doidge). The second concept—flow—comes from the field of psychology, and refers to a deeply satisfying state of focused attention that people sometimes experience while engaging in an enjoyable activity such as browsing the Web (Csikszentmihalyi, Flow). Research into the experiences of web users, conducted from these two different perspectives, reveal interesting connections to the acquisition of taste and opportunities for further investigation. Neuroplasticity The term neuroplasticity comes from the words neuron and plastic. Neurons are the nerve cells in our brains and nervous systems. Plastic, in this context, means flexibility or malleability. Neuroplasticity has replaced the formerly-held belief that the brain is a physiologically static organ, hard-wired like a machine (Kolb, Gibb and Robinson). For much of the last century, scientists believed that adult brains, unlike those of children, could not produce new neurons or build new pathways or connections between neurons. According to this view, any brain function that was lost through damage was irretrievable. Today, research into neuroplasticity has proven that this is not the case. In the late 1960s and 1970s pioneering scientists such as Paul Bach-y-Rita demonstrated that brains change their structure with different activities they perform (Kercel). When certain parts fail, other parts can sometimes take over. Subsequent research by many scientists has validated this once-controversial idea, leading to practical benefits such as the restoration of limb function in stroke victims, and improved cognition and perception in people with learning disabilities (Nowak et al.). Merzenich, for example, has demonstrated how a brain’s processing areas, called brain maps, change in response to what people do over the course of their lives. Different brain maps exist for different activities and functions, including sensory perception, motor skills and higher mental activities. Brain maps are governed by competition for mental resources and the principle of “use it or lose it.” If a person stops exercising particular mental skills, such as speaking Spanish or playing piano, then the brain map space for those skills is handed over to skills that they practise instead. Brain maps are also governed by a principle that is summarised by the expression, “neurons that fire together wire together” (Doidge 63). Neurons in brain maps develop stronger connections to each other when they are activated at the same moment in time. Consequently people are able to form new maps by developing new neural connections. Acquiring Tastes Doidge has illustrated the role that neuroplasticity plays in acquiring new tastes by explaining how habitual viewing of online pornography can shape sexual tastes (102). In the mid- to late-1990s, Doidge (a psychiatrist and psychoanalyst) treated several men who had lost interest in their sexual partners as a consequence of their addiction to online pornography. Doidge explains their change of sexual taste in terms of neuroplasticity, noting that “pornography, delivered by high-speed Internet connections, satisfies every one of the prerequisites for neuroplastic change” (102). The sexual excitement of viewing pornography releases a chemical neurotransmitter named dopamine that activates the brain’s pleasure centres. Since “neurons that fire together wire together”, the repeated viewing of pornography effectively wires the pornographic images into the pleasure centres of the brain with the focused attention required for neuroplastic change. In other words, habitual viewers of pornography develop new brain maps based on the photos and videos they see. And since the brain operates on a “use it or lose it” principle, they long to keep those new maps activated. Consequently, pornography has an addictive power. Like all addicts, the men who Doidge treated developed a tolerance to the photos and videos they observed and sought out progressively higher levels of stimulation for satisfaction. Doidge explains the result: The content of what they found exciting changed as the Web sites introduced themes and scripts that altered their brains without their awareness. Because plasticity is competitive, the brain maps for new, exciting images increased at the expense of what had previously attracted them—the reason, I believe, they began to find their girlfriends less of a turn-on. (109) If the habitual viewing of online pornography can change sexual tastes, what other tastes can be changed through online activity? Art? Music? Literature? Cinema? Sport? Humour? One avenue for investigating this question is to consider existing research into the flow experiences of web users. The term flow refers to a deeply satisfying state of focused attention that was first identified by psychologist Mihaly Csikszentmihalyi (Beyond Boredom) in his studies of optimal experiences. According to Csikszentmihalyi, people in flow “are so involved in an activity that nothing else seems to matter; the experience itself is so enjoyable that people will do it even at great cost, for the sheer sake of doing it” (Flow 4). Flow experiences are characterised by some common elements, which include a balance between the challenges of an activity and the skills required to meet those challenges; clear goals and feedback; concentration on the task at hand; a sense of control; a merging of action and awareness; a loss of self-consciousness; a distorted sense of time; and the autotelic experience. The term autotelic refers to an activity that is done, not with the expectation of some future benefit, but simply because the doing itself is the reward. Whenever people reflect on their flow experiences, they mention some, and often all, of these characteristics. Support for Csikszentmihalyi’s characterisation of flow can be found in studies of many diverse activities, such as playing computer games (Chen) and participating in sport (Jackson), to mention just two examples. The activities that people engage in to experience flow vary enormously, but they describe how it feels in almost identical terms. Pace has developed a grounded theory of the flow experiences of web users engaged in content-seeking activities including directed searching and exploratory browsing. The term grounded in this instance refers to the fact that the theory was developed using the Grounded Theory research method, and its explanations are grounded in the study’s data rather than deduced from research literature (Charmaz). A review of that theory reveals many similarities between the flow experiences of web users engaged in content-seeking activities and the experiences of habitual viewers of online pornography described by Doidge. The following sections will consider several of those similarities. Focused Attention Focused attention is essential for long-term neuroplastic change. Goleman notes that “when practice occurs while we are focusing elsewhere, the brain does not rewire the relevant circuitry for that particular routine” (164). In a series of brain mapping experiments with monkeys, Merzenich discovered that “lasting changes occurred only when his monkeys paid close attention” (Doidge 68). When the animals performed tasks without paying close attention, their brain maps changed, but the changes did not last. Focused attention also plays a central role in the flow experiences of web users. The higher-than-average challenges associated with flow activities require a complete focusing of attention on the task at hand, or as Csikszentmihalyi puts it, “a centering of attention on a limited stimulus field” (Beyond Boredom 40). An important by-product of this fact is that flow leaves no room in one’s consciousness for irrelevant thoughts, worries or distractions (Csikszentmihalyi, Flow 58). People who experience flow frequently report that, while it lasts, they are able to forget about the unpleasant aspects of life. Consider the following comment from a 42-year-old male’s recollection of experiencing flow while using the Web: “It’s a total concentration experience. You’re so interested in doing what it is you’re doing that nothing’s interrupting you.” In everyday life, one’s concentration is rarely so intense that all preoccupations disappear from consciousness, but that is precisely what happens in a flow experience. All of the troubling thoughts that normally occupy the mind are temporarily suspended while the pressing demands of the flow activity consume one’s attention. Let’s now consider a second similarity between the flow experiences of web users and the taste-changing experiences of habitual viewers of online pornography. Enjoyment The pleasure experienced by the pornography addicts treated by Doidge played an important role in the alteration of their brain maps and sexual tastes. Since “neurons that fire together wire together”, the repeated viewing of pornographic photos and videos wired those images into the pleasure centres of their brains with the focused attention required for neuroplastic change. Web users in flow also experience enjoyment, but possibly a different kind of enjoyment to the pleasure described by Doidge. Seligman and Csikszentmihalyi make the following distinction between pleasure and enjoyment: Pleasure is the good feeling that comes from satisfying homeostatic needs such as hunger, sex, and bodily comfort. Enjoyment, on the other hand, refers to the good feelings people experience when they break through the limits of homeostasis—when they do something that stretches them beyond what they were—in an athletic event, an artistic performance, a good deed, a stimulating conversation. (12) The enjoyment experienced by people in flow is sometimes described as “the autotelic experience.” According to Csikszentmihalyi, an autotelic experience is “a self-contained activity, one that is done not with the expectation of some future benefit, but simply because the doing itself is the reward” (Flow 67). Because autotelic experiences are so satisfying, they create a strong desire to repeat the activity that produced the experience. Consider the following comment from a web user about the reasons he enjoys online content-seeking activities that have led to flow: It’s like going to somewhere new. You’re always learning something. You’re always finding something. And you don’t know what it is you’re going to find. There’s so much out there that you’ll go there one day and then you’ll come back, and you’ll actually end up on a different path and finding something different. So it’s investigation of the unknown really. This comment, like many web users’ recollections of their flow experiences, points to a relationship between enjoyment and discovery. This connection is also evident in flow experiences that occur during other kinds of activities. For example, Csikszentmihalyi suggests that “the reason we enjoy a particular activity is not because such pleasure has been previously programmed in our nervous system, but because of something discovered as a result of interaction” (The Evolving Self 189). He illustrates this point with the example of a person who is at first indifferent to or bored by a particular activity, such as listening to classical music. When opportunities for action in the context of the activity become clearer, or when the individual’s skills improve, the activity may start to be interesting and finally gratifying. For example, if a person begins to understand the design underlying a symphony he or she might begin to enjoy the act of listening. This example hints at how discovery, enjoyment and other rewards of flow may engender change in a person’s taste. Let’s now consider a third similarity between the two areas of research. Compulsive Behaviour One consequence of flow experiences being so enjoyable is that they create a strong desire to repeat whatever helped to make them happen. If a person experiences flow while browsing online for new music, for example, he or she will probably want to repeat that activity to enjoy the experience again. Consider the following comment from a 28-year-old female web user who recalled experiencing flow intermittently over a period of three days: “I did go to bed—really late. And then as soon as I got up in the morning I was zoom—straight back on there […] I guess it’s a bit like a gambling addiction.” This study informant’s use of the term addiction highlights another similarity between the flow experiences of web users and habitual viewing of online pornography. Flow experiences can, in a very small percentage of cases, encourage compulsive behaviour and possibly addiction. A study by Khang, Kim and Kim found that “experiences of the flow state significantly influenced media addiction” across three media forms: the Internet, mobile phones and video games (2423). Examples of problems associated with excessive Internet use include sleep deprivation, poor eating and exercise habits, conflict with family members, and neglect of academic, interpersonal, financial and, occupational responsibilities (Douglas et al). Some heavy Internet users report feelings of moodiness and anxiety while they are offline, along with an intense desire to log in. Doidge states that “the addictiveness of Internet pornography is not a metaphor” (106), but many researchers are reluctant to apply the term addiction to heavy Internet use. Internet addiction first came to the attention of the research community in the mid-1990s when Young conceptualised it as an impulse-control disorder and proposed a set of diagnostic criteria based on the diagnostic criteria for pathological gambling in the Diagnostic and Statistical Manual of Mental Disorders. However, after more than fifteen years of research on this subject, there is still no agreement on a definition or diagnostic criteria for Internet addiction. Some researchers argue that Internet addiction is not a true addiction and may be no more than a symptom of other existing disorders such as anxiety or depression (Weinstein and Lejoyeux). Regardless of this controversy, the potential for compulsive behaviour is another clear similarity between the flow experiences of web users and the neuroplastic change caused by habitual viewing of online pornography. One more similarity will be considered. Sidetracks In Pace’s study of the flow experiences of web users, informants reported engaging in two general types of content-seeking behaviour: (1) a directed searching mode in which one is motivated to find a particular piece of content such as the answer to a question or a specific music video; and (2) an exploratory browsing mode that is characterised by diffuse motives such as passing time or seeking stimulation. Directed searching and exploratory browsing are not dichotomous forms of navigation behaviour. On the contrary, they are closely interrelated. Web users move back and forth between the two modes, often many times within the same session. Just as web users can change from one navigation mode to another, they can also get sidetracked from one topic to another. For instance, it is reportedly quite common for a web user engaged in a content-seeking activity to decide to pursue a different goal because his or her curiosity is aroused by interesting content or links that are not directly relevant to the task at hand. Consider the following comment from a 21-year-old female web user whose desire to find contact details for a local Tai Chi group disappeared when a link to the Sportsgirl web site attracted her attention: I think I typed in “sports” […] I was actually looking for a place to do Tai Chi and that sort of thing. So I was looking for a sport. And it ended up coming up with the Sportsgirl web site. And I ended up looking at clothes all afternoon. So that was kind of cool. Sidetracks are a common feature of the flow experiences of web users. They are also a prominent feature of the description that Doidge provided of the pornography addicts’ neuroplastic change (109). The content of what the men found exciting changed as the web sites they viewed introduced “themes and scripts” or sidetracks that altered their brain maps. “Without being fully aware of what they were looking for, they scanned hundreds of images and scenarios until they hit upon an image or sexual script that touched some buried theme that really excited them”, Doidge notes (110). Conclusion Can a person’s tastes in art, music, literature, cinema, sport, humour or some other field be changed through online activity, just as sexual tastes can? This article alone cannot conclusively answer that question, but significant similarities between the flow experiences of web users and the neuroplastic change experienced by habitual viewers of online pornography suggest that flow theory could be a fruitful line of investigation. Can the flow experiences of web users lead to changes in taste, just as the neuroplastic change caused by habitual viewing of online pornography can lead to changes in sexual taste? What is the relationship between flow and neuroplastic change? Is the Internet the most appropriate environment for exploring these questions about taste, or do offline flow activities provide insights that have been neglected? These are some of the unanswered questions arising from this discussion that require further investigation. Advances in the field of neuroplasticity have been described as some of “the most extraordinary discoveries of the twentieth century” (Doidge xv). These advances provide an opportunity to revisit related theories and to enhance our understanding of phenomena such as flow and taste. References Charmaz, Kathy. Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Thousand Oaks, California: Sage Publications, 2006. Chen, Jenova. “Flow in Games (and Everything Else).” Communications of the ACM 50.4 (2007): 31–34. Csikszentmihalyi, Mihaly. Beyond Boredom and Anxiety: The Experience of Play in Work and Games. San Francisco: Jossey-Bass Publishers, 1975. Csikszentmihalyi, Mihaly. The Evolving Self: A Psychology for the Third Millennium. New York: HarperPerennial, 1993. Csikszentmihalyi, Mihaly. Flow: The Psychology of Optimal Experience. New York: HarperPerennial, 1990. Doidge, Norman. The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. Melbourne: Scribe Publications, 2010. Douglas, Alecia C., Juline E. Mills, Mamadou Niang, Svetlana Stepchenkova, Sookeun Byun, Celestino Ruffini, Seul Ki Lee, Jihad Loutfi, Jung-Kook Lee, Mikhail Atallah, and Marina Blanton. “Internet Addiction: Meta-Synthesis of Qualitative Research for the Decade 1996-2006.” Computers in Human Behavior 24 (2008): 3027–3044. Goleman, Daniel. Focus: The Hidden Driver of Excellence. New York: HarperCollins, 2013. Jackson, Susan. “Toward a Conceptual Understanding of the Flow Experience in Elite Athletes.” Research Quarterly for Exercise and Sport 67.1 (1996): 76–90. Khang, Hyoungkoo, Jung Kyu Kim, and Yeojin Kim. “Self-Traits and Motivations as Antecedents of Digital Media Flow and Addiction: The Internet, Mobile Phones, and Video Games.” Computers in Human Behavior 29 (2013): 2416–2424. Kercel, Stephen W. “Editorial: The Wide-Ranging Impact of the Work of Paul Bach-y-Rita.” Journal of Integrative Neuroscience 4.4 (2005): 403–406. Kolb, Bryan, Robbin Gibb, and Terry E. Robinson. “Brain Plasticity and Behavior.” Current Directions in Psychological Science 12.1 (2003): 1–5. Merzenich, Michael. Soft-Wired: How the New Science of Brain Plasticity Can Change Your Life. San Francisco: Parnassus Publishing, 2013. Nowak, Dennis A., Kathrin Bösl, Jitka Podubeckà, and James R. Carey. “Noninvasive Brain Stimulation and Motor Recovery After Stroke.” Restorative Neurology and Neuroscience 28 (2010): 531–544. Pace, Steven. “A Grounded Theory of the Flow Experiences of Web Users.” International Journal of Human-Computer Studies 60.3 (2004): 327–363. Seligman, Martin E. P., and Mihaly Csikszentmihalyi. “Positive Psychology: An Introduction.” American Psychologist 55.1 (2000): 5–14. Weinstein, Aviv, and Michel Lejoyeux. “Internet Addiction or Excessive Internet Use.” The American Journal of Drug and Alcohol Abuse 36 (2010): 277–283. Young, Kimberly S. Caught in the Net: How to Recognize the Signs of Internet Addiction—And a Winning Strategy for Recovery. New York: John Wiley & Sons, 1998.

Discussions of the economic theory of planned obsolescence—the purposeful embedding of redundancy into the functionality or other aspect of a product—in the 1980s and 1990s often focused on the impact of such a design strategy on manufacturers, consumers, the market, and, ultimately, profits (see, for example, Bulow; Lee and Lee; Waldman). More recently, assessments of such shortened product life cycles have included calculations of the environmental and other costs of such waste (Claudio; Kondoh; Unruh). Commonly utilised examples are consumer products such as cars, whitegoods and small appliances, fashion clothing and accessories, and, more recently, new technologies and their constituent components. This discourse has been adopted by those who configure workers as human resources, and who speak both of skills (Janßen and Backes-Gellner) and human capital itself (Chauhan and Chauhan) being made obsolete by market forces in both predictable and unplanned ways. This includes debate over whether formal education can assist in developing the skills that make their possessors less liable to become obsolete in the workforce (Dubin; Holtmann; Borghans and de Grip; Gould, Moav and Weinberg). However, aside from periodic expressions of disciplinary angst (as in questions such as whether the Liberal Arts and other disciplines are becoming obsolete) are rarely found in discussions regarding higher education. Yet, higher education has been subsumed into a culture of commercial service provision as driven by markets and profit as the industries that design and deliver consumer goods. McKelvey and Holmén characterise this as a shift “from social institution to knowledge business” in the subtitle of their 2009 volume on European universities, and the recent decade has seen many higher educational institutions openly striving to be entrepreneurial. Despite some debate over the functioning of market or market-like mechanisms in higher education (see, for instance, Texeira et al), the corporatisation of higher education has led inevitably to market segmentation in the products the sector delivers. Such market segmentation results in what are called over-differentiated products, seemingly endless variations in the same product to attempt to increase consumption and attendant sales. Milk is a commonly cited example, with supermarkets today stocking full cream, semi-skimmed, skimmed, lactose-free, soy, rice, goat, GM-free and ‘smart’ (enriched with various vitamins, minerals and proteins) varieties; and many of these available in fresh, UHT, dehydrated and/or organic versions. In the education market, this practice has resulted in a large number of often minutely differentiated, but differently named, degrees and other programs. Where there were once a small number of undergraduate degrees with discipline variety within them (including the Bachelor of Arts and Bachelor of Science awards), students can now graduate with a named qualification in a myriad of discipline and professional areas. The attempt to secure a larger percentage of the potential client pool (who are themselves often seeking to update their own skills and knowledges to avoid workforce obsolescence) has also resulted in a significant increase in the number of postgraduate coursework certificates, diplomas and other qualifications across the sector. The Masters degree has fractured from a research program into a range of coursework, coursework plus research, and research only programs. Such proliferation has also affected one of the foundations of the quality and integrity of the higher education system, and one of the last bastions of conventional practice, the doctoral degree. The PhD as ‘Gold-Standard’ Market Leader? The Doctor of Philosophy (PhD) is usually understood as a largely independent discipline-based research project that results in a substantial piece of reporting, the thesis, that makes a “substantial original contribution to knowledge in the form of new knowledge or significant and original adaptation, application and interpretation of existing knowledge” (AQF). As the highest level of degree conferred by most universities, the PhD is commonly understood as indicating the height of formal educational attainment, and has, until relatively recently, been above reproach and alteration. Yet, whereas universities internationally once offered a single doctorate named the PhD, many now offer a number of doctoral level degrees. In Australia, for example, candidates can also complete PhDs by Publication and by Project, as well as practice-led doctorates in, and named Doctorates of/in, Creative Arts, Creative Industries, Laws, Performance and other ‘new’ discipline areas. The Professional Doctorate, introduced into Australia in the early 1990s, has achieved such longevity that it now has it’s own “first generation” incarnations in (and about) disciplines such as Education, Business, Psychology and Journalism, as well as a contemporary “second generation” version which features professionally-practice-led Mode 2 knowledge production (Maxwell; also discussed in Lee, Brennan and Green 281). The uniquely Australian PhD by Project in the disciplines of architecture, design, business, engineering and education also includes coursework, and is practice and particularly workplace (or community) focused, but unlike the above, does not have to include a research element—although this is not precluded (Usher). A significant number of Australian universities also currently offer a PhD by Publication, known also as the PhD by Published Papers and PhD by Published Works. Introduced in the 1960s in the UK, the PhD by Publication there is today almost exclusively undertaken by academic staff at their own institutions, and usually consists of published work(s), a critical appraisal of that work within the research context, and an oral examination. The named degree is rare in the USA, although the practice of granting PhDs on the basis of prior publications is not unknown. In Australia, an examination of a number of universities that offer the degree reveals no consistency in terms of the framing policies except for the generic Australian Qualifications Framework accreditation statement (AQF), entry requirements and conditions of candidature, or resulting form and examination guidelines. Some Australian universities, for instance, require all externally peer-refereed publications, while others will count works that are self-published. Some require actual publications or works in press, but others count works that are still at submission stage. The UK PhD by Publication shows similar variation, with no consensus on purpose, length or format of this degree (Draper). Across Australia and the UK, some institutions accept previously published work and require little or no campus participation, while others have a significant minimum enrolment period and count only work generated during candidature (see Brien for more detail). Despite the plethora of named degrees at doctoral level, many academics continue to support the PhD’s claim to rigor and intellectual attainment. Most often, however, these arguments cite tradition rather than any real assessment of quality. The archaic trappings of conferral—the caps, gowns and various other instruments of distinction—emphasise a narrative in which it is often noted that doctorates were first conferred by the University of Paris in the 12th century and then elsewhere in medieval Europe. However, challenges to this account note that today’s largely independently researched thesis is a relatively recent arrival to educational history, being only introduced into Germany in the early nineteenth century (Bourner, Bowden and Laing; Park 4), the USA in a modified form in the mid-nineteenth century and the UK in 1917 (Jolley 227). The Australian PhD is even more recent, with the first only awarded in 1948 and still relatively rare until the 1970s (Nelson 3; Valadkhani and Ville). Additionally, PhDs in the USA, Canada and Denmark today almost always incorporate a significant taught coursework element (Noble). This is unlike the ‘traditional’ PhD in the UK and Australia, although the UK also currently offers a number of what are known there as ‘taught doctorates’. Somewhat confusingly, while these do incorporate coursework, they still include a significant research component (UKCGE). However, the UK is also adopting what has been identified as an American-inflected model which consists mostly, or largely, of coursework, and which is becoming known as the ‘New Route British PhD’ (Jolley 228). It could be posited that, within such a competitive market environment, which appears to be driven by both a drive for novelty and a desire to meet consumer demand, obsolescence therefore, and necessarily, threatens the very existence of the ‘traditional’ PhD. This obsolescence could be seen as especially likely as, alongside the existence of the above mentioned ‘new’ degrees, the ‘traditional’ research-based PhD at some universities in Australia and the UK in particular is, itself, also in the process of becoming ‘professionalised’, with some (still traditionally-framed) programs nevertheless incorporating workplace-oriented frameworks and/or experiences (Jolley 229; Kroll and Brien) to meet professionally-focused objectives that it is acknowledged cannot be met by producing a research thesis alone. While this emphasis can be seen as operating at the expense of specific disciplinary knowledge (Pole 107; Ball; Laing and Brabazon 265), and criticised for that, this workplace focus has arisen, internationally, as an institutional response to requests from both governments and industry for training in generic skills in university programs at all levels (Manathunga and Wissler). At the same time, the acknowledged unpredictability of the future workplace is driving a cognate move from discipline specific knowledge to what have been described as “problem solving and knowledge management approaches” across all disciplines (Gilbert; Valadkhani and Ville 2). While few query a link between university-level learning and the needs of the workplace, or the motivating belief that the overarching role of higher education is the provision of professional training for its client-students (see Laing and Brabazon for an exception), it also should be noted that a lack of relevance is one of the contributors to dysfunction, and thence to obsolescence. The PhD as Dysfunctional Degree? Perhaps, however, it is not competition that threatens the traditional PhD but, rather, its own design flaws. A report in The New York Times in 2007 alerted readers to what many supervisors, candidates, and researchers internationally have recognised for some time: that the PhD may be dysfunctional (Berger). In Australia and elsewhere, attention has focused on the uneven quality of doctoral-level degrees across institutions, especially in relation to their content, rigor, entry and assessment standards, and this has not precluded questions regarding the PhD (AVCC; Carey, Webb, Brien; Neumann; Jolley; McWilliam et al., "Silly"). It should be noted that this important examination of standards has, however, been accompanied by an increase in the awarding of Honorary Doctorates. This practice ranges from the most reputable universities’ recognising individuals’ significant contributions to knowledge, culture and/or society, to wholly disreputable institutions offering such qualifications in return for payment (Starrs). While generally contested in terms of their status, Honorary Doctorates granted to sports, show business and political figures are the most controversial and include an award conferred on puppet Kermit the Frog in 1996 (Jeffries), and some leading institutions including MIT, Cornell University and the London School of Economics and Political Science are distinctive in not awarding Honorary Doctorates. However, while distracting, the Honorary Doctorate itself does not answer all the questions regarding the quality of doctoral programs in general, or the Doctor of Philosophy in particular. The PhD also has high attrition rates: 50 per cent or more across Australia, the USA and Canada (Halse 322; Lovitts and Nelson). For those who remain in the programs, lengthy completion times (known internationally as ‘time-to-degree’) are common in many countries, with averages of 10.5 years to completion in Canada, and from 8.2 to more than 13 years (depending on discipline) in the USA (Berger). The current government performance-based funding model for Australian research higher degrees focuses attention on timely completion, and there is no doubt that, under this system—where universities only receive funding for a minimum period of candidature when those candidates have completed their degrees—more candidates are completing within the required time periods (Cuthbert). Yet, such a focus has distracted from assessment of the quality and outcomes of such programs of study. A detailed survey, based on the theses lodged in Australian libraries, has estimated that at least 51,000 PhD theses were completed in Australia to 2003 (Evans et al. 7). However, little attention has been paid to the consequences of this work, that is, the effects that the generation of these theses has had on either candidates or the nation. There has been no assessment, for instance, of the impact on candidates of undertaking and completing a doctorate on such facets of their lives as their employment opportunities, professional choices and salary levels, nor any effect on their personal happiness or levels of creativity. Nor has there been any real evaluation of the effect of these degrees on GDP, rates of the commercialisation of research, the generation of intellectual property, meeting national agendas in areas such as innovation, productivity or creativity, and/or the quality of the Australian creative and performing arts. Government-funded and other Australian studies have, however, noted for at least a decade both that the high numbers of graduates are mismatched to a lack of market demand for doctoral qualifications outside of academia (Kemp), and that an oversupply of doctorally qualified job seekers is driving wages down in some sectors (Jones 26). Even academia is demanding more than a PhD. Within the USA, doctoral graduates of some disciplines (English is an often-cited example) are undertaking second PhDs in their quest to secure an academic position. In Australia, entry-level academic positions increasingly require a scholarly publishing history alongside a doctoral-level qualification and, in common with other quantitative exercises in the UK and in New Zealand, the current Excellence in Research for Australia research evaluation exercise values scholarly publications more than higher degree qualifications. Concluding Remarks: The PhD as Obsolete or Retro-Chic? Disciplines and fields are reacting to this situation in various ways, but the trend appears to be towards increased market segmentation. Despite these charges of PhD dysfunction, there are also dangers in the over-differentiation of higher degrees as a practice. If universities do not adequately resource the professional development and other support for supervisors and all those involved in the delivery of all these degrees, those institutions may find that they have spread the existing skills, knowledge and other institutional assets too thinly to sustain some or even any of these degrees. This could lead to the diminishing quality (and an attendant diminishing perception of the value) of all the higher degrees available in those institutions as well as the reputation of the hosting country’s entire higher education system. As works in progress, the various ‘new’ doctoral degrees can also promote a sense of working on unstable ground for both candidates and supervisors (McWilliam et al., Research Training), and higher degree examiners will necessarily be unfamiliar with expected standards. Candidates are attempting to discern the advantages and disadvantages of each form in order to choose the degree that they believe is right for them (see, for example, Robins and Kanowski), but such assessment is difficult without the benefit of hindsight. Furthermore, not every form may fit the unpredictable future aspirations of candidates or the volatile future needs of the workplace. The rate with which everything once new descends from stylish popularity through stages of unfashionableness to become outdated and, eventually, discarded is increasing. This escalation may result in the discipline-based research PhD becoming seen as archaic and, eventually, obsolete. Perhaps, alternatively, it will lead to newer and more fashionable forms of doctoral study being discarded instead. Laing and Brabazon go further to find that all doctoral level study’s inability to “contribute in a measurable and quantifiable way to social, economic or political change” problematises the very existence of all these degrees (265). Yet, we all know that some objects, styles, practices and technologies that become obsolete are later recovered and reassessed as once again interesting. They rise once again to be judged as fashionable and valuable. Perhaps even if made obsolete, this will be the fate of the PhD or other doctoral degrees?References Australian Qualifications Framework (AQF). “Doctoral Degree”. AQF Qualifications. 4 May 2009 ‹http://www.aqf.edu.au/doctor.htm›. Australian Vice-Chancellors’ Committee (AVCC). Universities and Their Students: Principles for the Provision of Education by Australian Universities. Canberra: AVCC, 2002. 4 May 2009 ‹http://www.universitiesaustralia.edu.au/documents/publications/Principles_final_Dec02.pdf›. 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Boxing is a purely masculine activity and it inhabits a purely masculine world. […] Boxing is for men, and it is about men, and is men. (Joyce Carol Oates) IntroductionWriting about boxing is an intimate, private, and unusual activity. Although a decade has passed since I first “stepped into the ring” (sparring or fighting), I have not engaged with boxing in academic terms. I undertook a doctoral degree from 2012 to 2016, during which I competed and won amateur titles in three different countries. Boxing, in a sense, shadowed my research. My fieldwork, researching heritage foods networks, brought me to various locales, situating my body in reference to participants and academics as well as my textual analysis. My daily interactions and reflections in the boxing gym, though, were marginalised to give priority to my doctorate. In a mirrored journey to Wacquant’s “carnal ethnography of the skilled body” (Habitus 87), I boxed as a hobby. It was a means to escape my life as a doctoral student, my thesis, and the library. Research belonged to the realm of academia; boxing, to the realm of the physical. In this paper, I seek to implode this self-imposed distinction.Practising the “noble art,” as boxing is commonly called, profoundly altered not only my body but also my way of seeing the world, myself, and others. I explore these themes through an autoethnographic account of my experience in the ring. Focusing on sparring, rather than competing, I explore conceptualisations of my face as a material, as well as part of my body, and also as a surface for violence and apprenticeship. Reflecting upon a decade of sparring, the analysis presented in this paper is grounded in the phenomenological tradition whereby knowledge is not an abstract notion that exists over and above felt experience: it is sensed and embodied through practice.I delve into the narratives of my personal “social logic of a bodily craft” of boxing (Wacquant, Habitus 85). More specifically, I reflect upon my experiences of getting hit in the face by men in the ring, and the acclimatisation required, evolving from feelings of intrusion, betrayal, and physical pain to habit, and at times, excitement. As a surface for punching, my face became both material and immaterial. It was a tool that had to be tuned to varying degrees of pain to inform me of my performance as well as my opponent’s. Simultaneously, it was a surface that was abstracted and side-lined in order to put myself purposefully in harm’s way as one does when stepping into the ring. Through reflecting on my face, I consider how the sport offered new embodied experiences through which I became keenly aware of my body as a delineated target for—as well as the source of—violence. In particular, my body boundaries were profoundly reconfigured in the ring: sparring partners demonstrated their respect by hitting me, validating both my body and my skill as a boxer. In this manner, I discuss the spatiality of the ring as eliciting transitions of felt and abstracted pain as well as shaping my self-image as a re-gendered boxer in the ring and out. Throughout my account, I briefly engage with Wacquant’s discussion of “pugilistic habitus” (Body 99) and his claims that boxing is the epitome of masculine valour. In the final section, I conclude with deliberations upon the new bodily awareness(es) I gained through the sport, and the re-materiality I experienced as a strong woman.Methodological and Conceptual FrameworksThe analysis in this paper is based on the hybrid narrative of ethnography and autobiography: autoethnography. In the words of Tami Spry, autoethnography is “a self-narrative that critiques the situatedness of self and others in social context” (710). As such, I take stock in hindsight (Bruner; Denzin) of the evolution of my thoughts on boxing, my stance as a boxer, and the ways the ring has affected my sense of self and my body.Unlike Wacquant's “carnal ethnography” (Habitus 83) whose involvement with boxing was foregrounded in an academic context where he wrote detailed field-notes and conducted participant observation, my involvement was deliberately non-academic until I began to write this paper. Based on hindsight, the data collected through this autoethnography are value-inflected in ways that differ from other modes of data collection. But I have sought to recreate a dialectic between perceptual experience and cultural practices and patterns, in a manner aligned with Csordas’s paradigm of embodiment. My method is to “retrospectively and selectively write about epiphanies that stem from, or are made possible by, being part of a culture” (Ellis et al. 276) of boxing. These epiphanies, as sensed and embodied knowledge, were not solely conceptual moments but also physical realisations that my body performed, such as understanding—and executing—a well-timed slip to the side to avoid a punch.Focusing on my embodied experiences in the ring and out, I have sought to uncover “somatic modes of attention:” the “culturally elaborated ways of attending to and with one’s body in surroundings that include the embodied presence of others” (Csordas 138). The aim of this engagement is to convey my self-representation as a boxer in the ring, which emerged in part through the inter-subjectivity of interacting with other boxers whilst prioritising representations of my face. As such, my personal narrative is enmeshed with insights gleaned during embodied epiphanies I had in the ring, interweaving storytelling with theory.I have chosen to use the conventions of storytelling (Ellis and Ellingson) to explore the defining moments that shaped the image I hold of myself as a boxer. My personal narrative—where I view myself as the phenomenon—seeks “to produce aesthetic and evocative thick descriptions of personal and interpersonal experience” (Ellis et al. 287) whilst striving to remain accessible to a broader audience than within academia (Bochner). Personal narratives offer an understanding of the “self or aspect of a life as it intersects with a cultural context, connect to other participants as co-researchers, and invite readers to enter the author's world and to use what they learn there to reflect on, understand, and cope with their own lives” (Ellis 14; see also Ellis et al. 289).As the focus of my narrative is my face, I used my body, in Longhurst et al.’s words, as the “primary tool through which all interactions and emotions filter in accessing subjects and their geographies” (208). As “the foundation of the entire pugilistic regimen”, the body is the site of an intimate self-awareness, of the “body-sense” (Heiskanen 26). Taking my body as the starting point of my analysis, my conceptual framework is heavily informed by Thrift’s non-representational theory, enabling me to inquire into the “skills and knowledges [people] get from being embodied beings” (127), and specifically, embodied boxers. The analysis presented here is thus based on an “epistemic reflexivity” (Wacquant, Habitus 89) and responds to what Wacquant coins the “pugilistic habitus” (Body 99): a set of acquired dispositions of the boxer. Bourdieu believes that people are social agents who actively construct social reality through “categories of perception, appreciation and action” (30). The boxing habitus needs to be grasped with one’s body: it intermingles “cognitive categories, bodily skills and desires which together define the competence and appetence specific to the boxer” (Wacquant, Habitus 87). Through this habitus, I construct an image of myself not only as a boxer, but also as a re-gendered being, directly critiquing Wacquant’s arguments of the “pugilist” as fundamentally male.Resistance to Female BoxingMischa Merz’s manuscript on her boxing experience is the most accurate narrative I have yet read on female boxing, as a visceral as well as incorporeal experience, which led Merz to question and reconsider her own identity. When Merz published her manuscript in 2000, six years before I put the gloves on, the boxing world was still resisting the presence of women in the ring. In the UK, licenses for boxing were refused to women until 1998, and in New South Wales, Australia, it was illegal for women to compete until December 2008. It was not until 2012 that female boxing became internationally recognised as a sport in its own right. During the London Olympics, after a sulphurous debate on whether women should be made to box in skirts to “differentiate” them from men, women were finally allowed to compete in three weight categories, compared to ten for men.When I first started training in 2006 at the age of 21, I was unaware of the long list of determined and courageous women who had carved their way—and facilitated mine—into the ring, fighting for their right to practise a sport considered men’s exclusive domain. By the time I started learning the “sweet science” (another popular term used for boxing), my presence was accepted, albeit still unusual. My university had decreed boxing a violent sport that could not be allowed on campus. As a result, I only started boxing when I obtained a driving licence, and could attend training sessions off-campus. My desire to box had been sparked five years before, when I viewed Girlfight, a film depicting a young woman’s journey into the ring. Until then, I had never imagined a woman could box, let alone be inspirational in the use of her strength, aggression, and violence; to be strong was, for me, to be manly—which, as a woman, translated as monstrous or a perversion. I suddenly recognised in boxing a possibility to rid myself of the burden of what I saw as my bulk, and transform my body into a graceful pugilist—a fighter.First Sparring SessionTwo months after I had first thrown a punch in my coach’s pad—the gear coaches wear to protect their hands when a boxer is punching them to train—I was allowed into the ring to spar. Building up to this moment, I had anticipated and dreaded my first steps in the ring as the test of my skill and worthiness as a boxer. This moment would show my physical conditioning: whether I had trained and dieted correctly, if I was strong or resilient enough to fight. More crucially, it would lay bare my personality, the strength of my character, the extent of my willpower and belief in myself: it would reveal, in boxing terminology, if I had “heart.” Needless to say I had fantasised often about this moment. It was my initiation into the art of being punched and I hoped I would prove myself a hardened individual, capable of withstanding pain without flinching or retreating.The memory of the first punch to my face—my nose, to be exact—remains clear and vivid. My sparring partner was my coach, a retired boxer who hit me repeatedly in the head during the entirety of my first round. Getting hit in the face for the first time is a profound moment of rupture. Until then, my face had been a bodily surface reserved for affective gestures by individuals of trust: kisses of greeting on the cheeks or caresses from lovers. Only once had I been slapped, in an act of aggression that had left me paralysed with shock and feeling violated. Now in the ring, being punched in the face by a man I trusted, vastly more experienced and stronger than I, provoked a violent reaction of indignation and betrayal. Feelings of deceit, physical intrusion, and confusion overwhelmed me; pain was an entirely secondary concern. I had, without realising, assumed my coach would “go easy” on me, softening his punches and giving me time to react adequately to his attacks as we had practised on the pads. A couple of endless minutes later, I stepped out of the ring, breathless and staring at the floor to hide my tears of humiliation and overwhelming frustration.It is a common experience amongst novices, when first stepping into the ring, to forget everything they have been taught: footwork, defence, combinations, chin down, guard up … etc. They often freeze, as I did, with the first physical contact. Suddenly and concretely, with the immediacy of pain, they become aware of the extent of the danger they have purposely placed themselves in. The disturbance I felt was matched in part by my belief that I was essentially a coward. In an act condemned by the boxing community, I had turned my face away from punches: I tried to escape the ring instead of dominating it. Merz succinctly describes this experience in the boxing realm: “aspects of my character were frequently tossed in my face for assessment. I saw gaping holes in my tenacity, my resilience, my courage, my athleticism” (49). That night, I felt an unfamiliar sting as I took my jumper off, noticing a slight yet painful bruise on the bridge of my nose. It reminded me of my inadequacy and, I believed at the time, a fundamental failure of character: I lacked heart.My Face: A Tool for Sensing and Ignoring PainTo get as accustomed as a punching bag to repeated hits without flinching I had to mould my face into a mask of impassivity, revealing little to my opponent. My face also became a calibrated tool to measure my opponent’s skill, strength, and intent through the levels of pain it would experience. If an opponent repeatedly targeted my nose, I knew the sparring session was not a “friendly encounter.” Most often though, we would nod at each other in acknowledgement of the other’s successful “contact,” such as when their punches hurt my body. The ring is the only space I know and inhabit where the display of physical violence can be interpreted as a “friendly gesture” (Merz 12).Boxers, like most athletes, are carefully attuned to measuring the degrees of pain they undergo during a fight and training, whilst accomplishing the paradoxical feat—when they are hit—of setting aside that pain lest it be a distraction. In other words, boxers’ bodies are both material and immaterial: they are sites for accessing sensory information, notably pain levels, as well as tools that—at times detrimentally—have learned to abstract pain in the effort to ignore physical limitations, impediments or fatigue. Boxers with “heart,” I believe, are those who inhabit this duality of material and immaterial bodies.I have systematically been questioned whether I fear bruising or scarring my face. It would seem illogical to many that a woman would voluntarily engage in an activity that could blemish her appearance. Beyond this concern lies the issue, as Merz puts it, that “physical prowess and femininity seem to be so fundamentally incompatible” (476). My face used to be solely a source of concern as a medium of beautification and the platform from which I believed the world judged my degree of attractiveness. It also served as a marker of distinction: those I trusted intimately could touch my face, others could not. Throughout my training, my face evolved and also became an instrument that I conditioned and used strategically in the ring. The bruises I received attested to my readiness to exchange punches, a mark of valour I came to relish more than looking “nice.”Boxing has taught me how to feel my body in new ways. I no longer inhabit an “absent body” (Leder). I intimately know the border between my skin and the world, aware of exactly how far my body extends into that world and how much “punishment” (getting hit) it can withstand: boxing—which Oates (26) observed as a spectator rather than boxer—“is an act of consummate self-determination—the constant re-establishment of the parameters of one’s being.” A strong initial allure of boxing was the strict discipline it gave to my eating habits, an anchor—and at times, a torture—for someone who suffered from decade-long eating disorders. Although boxing plagued me with the need to “make weight”—to fight in a designated weight category—I no longer sought to be as petite as I could manage. As a female boxer, I was reminded of my gender, and my “unusual” body, as I am uncommonly big, strong, and heavy compared to most female fighters. I still find it difficult to find women to spar with, let alone fight. Unlike in the world outside the gym, though, my size is something I continuously learn to value as an advantage in the ring, a tool for affirmation, and significantly, a means of acceptance by, and equality with, men.The Ring: A Place of Re-GenderingAs sparring became routine, I had an epiphany: what I had taken as an act of betrayal from my coach was actually one of respect. Opponents who threw “honest” (painful) punches esteemed me as a boxer. I have, to this day, very rarely sparred with women. I often get told that I punch “like a guy,” an ability with which I have sought to impress coaches and boxers alike. As such, I am usually partnered with men who believe, as they have told me, that hitting a “girl”—and even worse, hitting a girl in the face—is simply unacceptable. Many have admitted that they fear hurting me, though some have quickly wanted to after a couple of exchanges. I have found that their views of “acceptable” violence seem unchanged after a session, as I believe they have come to view me as a boxer first and as a woman second.It would be disingenuous to omit that boxing attracted me as much for the novelty status I have gained within and outside of it. I have often walked a thin line between revelling in the sense of belonging that boxing provides me—anchored in a feeling that gender no longer matters—and the acute sense of feeling special because I am a woman performing as a man in what is still considered a man’s world. I have wavered between feeling as though I am shrugging off the very notion of gender in the ring, to deeply reconsidering what my gender means to me and the world, embracing a more fluid and performative understanding of gender than I had before (Messner; Young).In a way, my sense of self is shaped conflictingly by the ways in which boxers behave towards me in the ring, and how others see me outside of the boxing gym. As de Bruin and de Haan suggest, my body, in its active dimension, is open to the other and grounds inter-subjectivity. This inter-subjectivity of embodiment—how other bodies constitute my own sensory and perceptual experience of being-in-the-world—remains ambivalent. It has led me to feel at times genderless—or rather, beyond gender—in the ring and, because of this feeling, I simultaneously question and continuously re-explore more vividly what can be understood as “female masculinity” (Halberstam). As training progressed, I increasingly felt that:If women are going to fight, we have to be reminded, at every chance available, time and again, that they are still feminine or capable, at least, of wearing the costume of femininity, being hobbled by high heels and constrained by tight dresses. All female athletes in a way are burdened with having to re-iterate this same public narrative. (Merz)As I learned to box, I also learned to delineate myself alongside the ring: as I questioned notions of gender inside, I consequently sought to reaffirm a specific and static idea of gender through overt femininity outside the ring, as other female athletes have also been seen to do (Duncan). During my first years of training, I was the only woman at the gyms I trained in. I believed I had to erase any physical reminders of femininity: my sport clothes were loose fitting, my hair short, and I never wore jewellery or make-up. I wanted to be seen as a boxer, not a woman: my physical attractiveness was, for once, irrelevant. Ironically, I could not conceive of myself as a woman in the ring, and did not believe I could be seen as a woman in the ring. Outside the gym, I increasingly sought to reassert a stereotypical feminine appearance, taking pleasure in subverting another set of beliefs. People are usually hesitant to visualise a woman in a skirt, without a broken nose, as a competitive fighter with a mouth guard and headgear. As Wacquant succinctly put it, “I led a sort of Dr. Jekyll-and-Mr. Hyde existence” (Habitus 86), which crystallised when one of my coaches failed to recognise me on three occasions outside the gym, in my “normal” clothes.I have now come to resent profoundly the marginal, sensationalised status that being a boxer denotes for a woman. This is premised on particular social norms surrounding gender, which dictate that if a woman boxes, she is not “your usual” woman. I have striven to re-gender my experience, especially in light of the recent explosion of interest in female boxing, where new norms are being established. As I have trained around the world, including in Cuba, France, and the USA, and competed in the UK, Mexico, and Belgium, I have valued the tacit connection between those who practice the “noble art.” Boxing fashions a particular habitus (Bourdieu), the “pugilistic habitus” (Wacquant, Body 12). Stepping into the ring, and being able to handle getting hit in the face, constitutes a common language that boxers around the world, male and female, understand, value, and share; a language that transcends the tacit everyday embodiments of gender and class. Boxing is habitually said to give access to an upward mobility (Wacquant, Habitus; Heiskanen). In my case, as a white, educated, middle-class woman, boxing has given me access to cross-class associations: I have trained alongside men who had been shot in Coventry, were jobless in Cuba, or dealt with drug gangs in Mexico. The ring is an equalising space, where social, gender—and in my experience, ethnic—divides can be smoothed down to leave the pugilistic valour, the property of boxing excellence, as the main metric of appreciation.The freedom I have found in the ring is one that has allowed my gendered identity to be thought of in new and creative ways that invite continuous revision. I have discovered myself not solely through the prism of a gendered lens, but as an emotive athlete, and as a person desperate to be accepted despite—or because of—her physical strength. I find myself returning to Merz’s eloquence: “boxing cannot help but make you question who you really are. You cannot hide from yourself in a boxing ring. It might seem a crazy path to self-knowledge, but to me it has been the most rich, rewarding, and perhaps, the only true one” (111). Using Wacquant’s own words to disprove his theory that boxing is fundamentally a virile activity that reaffirms specific notions of masculinity, to become a boxer is to “efface the distinction between the physical and the spiritual [...] to defy the border between reason and passion” (Body 20). In my view, it is to implode the oppositional definitions that have kept males inside the ring and females, out. The ring, in ways unrivalled elsewhere, has shown me that I am not reducible, as the world has at times convinced me, to my strength or my gender. I can, and indeed do, coalesce and transcend both.ConclusionAfter having pondered the significance of the ring to my life, I now begin to understand Merz’s journey as “so much more than a mere dalliance on the dark side of masculine culture” (21). When I box, I am always boxing against myself. The ring is the ultimate space of revelation, where one is starkly confronted with one’s own weaknesses and fears. As a naked mirror, the ring is also a place for redemption, where one can overcome flaws, and uncover facets of who one is. Having spent almost as much time at university as I have boxing, it was in the ring that I learned that “thinking otherwise entails being otherwise, relating to oneself, one’s body, and ambient beings in a new way” (Sharp 749). Through the “boxing habitus,” I have simultaneously developed a boxer’s body and habits as well as integrated new notions of gender. As an exercise in re-gendering, sparring has led me to reflect more purposefully on the multiplicity of meanings that gender can espouse, and on the possibilities of negotiating the world as both strong and female. Practising the “noble art” has given me new tools with which to carve out, within the structures of the society I inhabit, liberating possibilities of being a pugilistic woman. 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