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Pulse Spring 2011


Pulse Spring 2011

SMCA Board of Directors Ray Kardas - President Dwayne Laing - Past President Vacant - Vice-President Breda Lau - Secretary Michael Becher - Treasurer Vacant - CASM Rep Chris Holt - SPC Rep Dexter Nelson - AATA Rep Stephane Simard - SSAA Rep Steve Johnson - SNS Rep Garnet Brown - Member at Large Kristine Godziuk - Member at Large Maria Smith - Member at Large Michael Wagner - Member at Large

SMCA Employees Barb Adamson - Executive Director Janice Peters - Office Manager Nicole Lemke - Technical Director

Inside Pulse‌ Highlights from the Pan Pacific Conference of Medicine and Science in Sport

Inside this issue: Pan Pacific Conference - President’s Message

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Functional Return to Sport: Bridging the Gap between the Clinician and the Strength Coach

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Caffeine and Ergogenics in Sport Performance: Why Caffeine But Not Coffee?

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Creatine Application Strategies during Resistance Training in Healthy Older Adults

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Leading the Way to Active and Healthy Lifestyles

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SCI Action Canada: Advancing Physical Activity Knowledge and Participation among Canadians with Spinal Cord Injury

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What is Sports Psychology?

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SMCA Resources: What is a Concussion?

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Hydration - Water

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Pulse Magazine Published by: Sport Medicine Council of Alberta 11759 Groat Road Edmonton, Alberta, Canada T5M 3K6 Phone: (780) 415-0812 Fax: (780) 422-3093 Website: www.sportmedab.ca Contents copyright 2011 by SMCA. Articles/abstracts may not be reprinted without permission. The opinions are those of the respective authors and are not necessarily those of the SMCA. ISSN: 1181-9812 Publication agreement no. 40038086

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Spring 2011


Sport Nutrition Level 1

The Sport Medicine Council of Alberta would like to Thank our Partners for their ongoing Support:

UPCOMING

SMCA

COURSES

May 7, 2011 Location: Edmonton Host: SMCA 10:00 a.m. - 4:00 p.m.

Athletic Injury Management

May 14, 2011 Location: Grande Prairie Host: Alberta Sport Development 9:00 a.m. - 5:00 p.m.

June 11, 2011 Location: Sherwood Park Host: Strathcona Minor Football Association 9:00 a.m. - 5:00 p.m.

Sport Taping & Strapping

May 15, 2011 Location: Grande Prairie Host: Alberta Sport Development 9:00 a.m. - 5:00 p.m.

June 12, 2011 Location: Sherwood Park Host: Strathcona Minor Football Association 9:00 a.m. - 5:00 p.m.

Sport Trainer

*Combination of Athletic Injury Management and Taping & Strapping May 14 - 15, 2011 June 11 - 12, 2011 Location: Grande Prairie Location: Sherwood Park Host: Alberta Sport Development Host: Strathcona Minor 9:00 a.m. - 5:00 p.m. Football Association 9:00 a.m. - 5:00 p.m.

For more information on any of the above courses or to register, visit sportmedab.ca/courses

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The Pan Pacific Conference of Medicine and Science in Sport JANUARY 27-29, 2011: HONOLULU, HAWAII

Pan Pacific Conference of Medicine and Science in Sport

PRESIDENT’S MESSAGE “The Quality of the keynote speakers” “Developing networks with Canadian counterparts” “Meeting so many enthusiastic people” The above quotations randomly selected from the postconference survey fairly represent the overall comments submitted by the attending delegates of this historically significant Conference. There may never have been a Conference of any discipline CO-HOSTED by two countries so widely separated by time and space. The collaboration of the SPORT MEDICINE COUNCIL OF ALBERTA (SMCA) and the SPORTS MEDICINE AUSTRALIA: QUEENSLAND BRANCH (SMAQ) was the catalyst that brought together delegates from Australia, Canada, the United States, England, Denmark, and Norway. It was truly an International gathering that will no doubt lead to many other International collaborations of the professional kind. Sport physicians, physiotherapists, athletic therapists, dieticians and nutritionists, researchers and academics assembled in Hawaii to SHARE, UNITE, and ENGAGE as was the stated theme for the Conference. Keynote presentations and session speakers -all recognized experts in their respective specialties- brought instant respectability to the proceedings and were provided to the delegates in a post-Conference package that should further stimulate international co-operation. Additionally, there were 20 “FREE PAPERS” delivered to the enthusiastic registrants by noted researchers from Australia, Canada, United Kingdom and the United States. The sun and warmth of Hawaii was the perfect setting for the gathering that surely enhanced the social activities which were considered to be a major highlight of the Conference agenda. These social moments UNITED the delegates in the SHARED pursuit of excellence in this diverse profession of Sport Medicine and in doing so led effortlessly to the ENGAGEMENTS that was the dream for the organizers. The SMAQ hosted a Queensland Night on the Thursday night (January 27th) which was a perfect informal “uniting” of the delegates and the SMCA sponsored a more formal “Taste of Alberta” evening dinner (January 28), with Alberta performing artists (John Wort Hannam, Kat Danser, and Trevor Panczak) after which it could be said with confidence that the “sharing” and “engaging” would follow. It is very important to recognize the financial support provided for the Conference by the Alberta Sport, Recreation, Parks and Wildlife Foundation and SMCA Board as well as by Alberta Founsportmedab.ca

Hawaii 2013

dation for the Arts. Additionally, major sponsors for the “Taste of Alberta”, DG MORRIS of Manulife Financial, APEX Oilfields Services, Masuda Munro Chartered Accountants, and Hawkings Epp Dumont LLP. The countless hours spent by the SMCA Executive Director- Barb Adamson- as well as her counterpart in AustraliaMark Brown- must be recognized herein. I would also be remiss if I failed to acknowledge Dr. Kerry Mummery, Dean of the Faculty of Physical Education and Recreation of the University of Alberta who was Chair of the Scientific Committee and who planted the idea for the collaboration between SMAQ and SMCA while he was still in Australia and preparing for his return to Canada. His efforts to pull the free papers together from his Faculty and the Faculty at the University of Calgary will undoubtedly lead to creating a climate of cooperation in Alberta that will make us the envy of the rest of Canada. Finally, and this is perhaps the best testament to the success of the Conference: There has been a clarion call for a SECOND PAN PACIFIC CONFERENCE OF MEDICINE AND SCIENCE IN SPORT that should take place once again in Hawaii in mid-February of 2013 (If the Mayan Calendar is found to be somewhat hasty in its predictions). To that end, the Conference that is, the Board of the SMCA has formed a Committee to plan for the 2nd PAN PACIFIC CONFERENCE. Please watch for the developments for the Conference on the website of the SMCA: www.sportmedab.ca and you would do well to enter a note in your agendas and future plans. I look forward to meeting returning delegates and new registrants in Hawaii. 5


Functional Return to Sport: Bridging the Gap between the Clinician and the Strength Coach By Jeff Cubos, BPHE MSc DC FRCCSS(C) CSCS Most sports medicine professionals are well educated in the diagnosis and management of common disorders sustained in sport. However, the functional return to training is often limited by a disconnect, both in practice and in the communication between professionals working with the athlete. Lacking standardization in baseline minimums, both amateur and professional athletes alike often return to play too soon or without the requisite physical fundamentals necessary for prevention of further injury. Previous injury, and what we may be failing to do as clinicians and strength coaches with these injuries, seems to be a major risk factor for future injury in sport. Noncontact injuries such as muscle strains, tendinopathies, and low back and pelvic pain for example, commonly recur and are often the result of incomplete care and subsequently, premature return-to-play. Certainly, return-to-play decision making involves more in-depth considerations than simple rehabilitation1. However, post-injury rehabilitation and training must be an individualized approach taking into account neuromusculoskeletal movement impairment assessments, functional capacity evaluations, and their corresponding resolutions, as well as pertinent principles of Recent research has demonstrated the periodization. Functional Movement Screen (FMS) as a reliable tool in pre-participation injury risk In concert with respecting and addressing prediction. A ranking and grading system traditional P.R.I.C.E. (Protection, Relative that documents movement patterns to Rest, Ice, Compression and Elevation) prin- identify functional limitations and asymmeciples, it is important that non-painful dys- tries, the FMS has been validated as a pracfunctions be simultaneously addressed in tical application for modeling of functional order to improve any mobility and / or sta- and corrective exercise in professional bility limitations that may have contributed football players3 and firefighters4. This relito the cause of injury in the first place. By able5 screening system utilizes a series of way of a thorough, whole body movement seven screens such as the “Deep Squat”, assessment, seemingly unrelated dysfunc- “In-Line Lunge” and “Active Straight Leg tions may be revealed, represented by Raise” to assess and clear the fundamental asymmetries, muscle imbalances, and motor programs of human movement that faulty motor control. This approach, are pertinent to everyday living and athtermed “Regional Interdependence2” by letic performance. By way of modifying James Cyriax, enables rehabilitation profes- such limitations, the aim of this low-tech sionals to accurately treat areas outside of tool is to guide corrective exercise protopain in lieu of the fact that the presence of cols for the purposes of minimizing one’s pain often coincides with a high-threshold risk of future injury. Much like a blood presor pain-adaptation strategy of compensa- sure test may identify those at risk for cartion. diovascular disease, the FMS may identify 6

those at risk for movement-based dysfunction. Currently, the majority of use of the Func tional Movement Screen is in preparticipation testing scenarios as part of pre-season physical fitness testing. However, I would argue that this screening system would provide equal benefit in the clinic and training room. Quite often athletes are deemed “clinically recovered” in the absence of any of the following; pain, range of motion limitation, and / or upon passing of performance testing criteria. Unfortunately, rarely is quality of movement assessed prior to return-to-play. Also owing to the aforementioned presence of previous injury as a major risk factor for future injury, it would be prudent to incorporate such a systematic movement-based screening protocol following “clinical recovery” to filter out any missed movement dysfunctions, provide the necessary and Spring 2011


related corrective strategies, and therefore, potentially minimize any risk of re-injury in sport. The current state of the literature has also demonstrated various tests and requisite minimums of strength ratios and core endurance for injury prevention, while leading researchers have also suggested the importance of addressing aerobic capacity and breathing integrity in sports performance. Once injured tissues have healed and movement dysfunctions have been corrected, the next step to consider prior to returning an athlete to play are the requisite strength ratios specific to injury mechanisms in the athlete’s given sport (when relevant)6. Similarly, research based out of the University of Waterloo suggests that achieving specific minimum endurance ratios among the various trunk musculature (flexors, extensors, and lateral musculature) may minimize the risk of low back pain in certain populations7. Ensuring that each athlete possesses minimum required aerobic capacities specific to their sport (especially following a prolonged period of inactivity) would also facilitate a smoother transition between the protocols implemented in each of the clinic, the training room, and the performance centre. Not only may this enhance the athlete’s ability to optimally perform without the presence of undue fatigue, but doing so will also promote increased core integrity since the dual-functioning diaphragm will always give preference to respiration over stability in the presence of fatigue. Finally, it is important that both the clinician and strength coach respect the foundations and principles of periodization. Periodization, or the planned manipulation of training variables (loads, sets, and repetitions) to maximize training adaptations and prevent the onset of overtraining syndrome8, while common in the athlete development and strength and conditioning realms, is often overlooked in traditional rehabilitation settings. However, whether choosing a linear (based on changing exercise volume and load across predictable cycles) or undulating (frequent altering of volume and load to allow more frequent neuromusculoskeletal recovery) model, it is important that such principles be incorporated to both the rehabilitation and training programs, especially in athletic populations. Doing so will not only facilitate more desired adaptations secondary to the principle of overload, but may in fact promote a more rapid return to sport participation.

References: 1. Creighton, D.W., Shrier, I., Shultz, R., Meeuwisse, W.H. & Matheson, G.O. (2010). Return to play in sport: A decision-based model. Clinical Journal of Sport Medicine, 20(5); 379-385. 2. Wainner, R.S., Whitman, J.M., Cleland, J.A. & Flynn, T.W.(2007). Regional Interdependence: A musculoskeletal examination model whose time has come. Journal of Orthopaedic and Sports Physical Therapy, 37 (11); 658-660. 3. Kiesel, K., Plisky, P. & Voight, M. (2007). Can serious injury in professional football be predicted by a preseason functional movement screen? North American Journal of Sport Physical Therapy, 2(3); 147-158. 4. Peate, W.F., Bates, G., Lunda, K., Francis, S. & Bellamy, K. (2007). Core strength: A new model for injury prediction and prevention. Journal of Occupational Medicine and Toxicology, 2(3) 5. Minick, K.I., Kiesel, K.B., Burton, L., Taylor, A., Plisky, P. & Butler, R.J. (2010). Interrater reliability of the functional movement screen. Journal of Strength & Conditioning Research, 24(2); 479-486. 6. Maffey, L. & Emery, C. (2007). What are the risk factors for groin strain injury in sport? A systematic review of the literature. Sports Medicine, 37 (10); 881-894. 7. McGill, S., Childs, A. & Liebenson, C. (1999). Endurance times for low back stabilization exercises: Clinical targets for testing and training from a normal database. Archives of Physical Medicine & Rehabilitation, 80 (8); 941-944. 8. Buford, T.W., Rossi, S.J., Smith, D.B. & Warren, A.J. (2007). A compare son of periodization models during nine weeks with equated volume and intensity for strength. Journal of Strength & Conditioning Research, 21; 1245-1250.

The functional return to training is often limited by a disconnect, both in practice and in the communication, between professionals working with the athlete.

Utilizing the strategies mentioned it is important to systematically identify and address common movement and functional capacity limitations to effective post-rehabilitation training practices of athletes. Providing evidence-based solutions for the implementation and modification of training programs following “clinical recovery” from sport injuries may enhance the return-to-play decision making process and therefore…bridge the gap between the clinician and the strength coach!

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Caffeine and Ergogenics in Sport Performance Why caffeine, but not coffee? By Craig J. Brososky, B.Sc., B.Sc.PT, IMC caffeine as an ergogenic aid for training and this author is no exception. As an example I include caffeine in the form of de -fizzed cola (referred to generically as ‘rocket fuel’) when I am going for long and intense rides, heavier intensity or maximal intensity workouts in the gym and as a staple to alleviate boredom on long runs if I have to run alone (by gaining the benefit of caffeine’s effect as a mental stimulant).

If you’ve ever wondered about the effects of caffeine on performance, you’re not alone. Caffeine and its use as a mental stimulant is familiar to virtually every postsecondary student and anyone who works long hours. Many people are familiar with the physical effects of ephedrine/caffeine stacking used by athletes in high intensity short duration repetition sports such as football. If you watch the Tour de France and keep a close eye on the athletes in the ‘feed zone’ you will see cans of Coke Classic being passed out the windows of the support vehicles to the riders who then drink the Coca-Cola in one shot. Research in Canada on the effects of caffeine was stimulated (pardon the pun) at a time when Sport Canada was trying to reduce drug use in Canadian sport after the Ben Johnson doping scandal in 1988. Sport Canada funded Terry Graham of the University of Guelph in an effort to show that caffeine had no beneficial effect on sport performance. Ironically, this research showed the exact opposite.

ingestion well within the legal limits imposed by the International Olympic Committee (IOC) could increase cycling and running performance at 85% VO2max by a staggering 20% to 50%! This has been independently replicated in a Dutch study in 1995 (Pasman et al. 1995) where the performance boost even in highly trained cyclists was 23%! Caffeine also increases performance duration for all out efforts (i.e. VO2max) at around 20% (Jackman et al. 1996). Caffeine also has a positive effect on maximum voluntary contraction (MVC) of about 3% (Kalmar and Cafarelli 1999) while lowering the perception of effort, and also has an ergogenic effect on repeated bouts of high intensity exercise like swimming intervals (Collomp et al. 1992).

Given this particular collection of effects, caffeine is overwhelmingly supported by research as a powerful training partner, letting you exercise longer and harder with greater effort and higher load, allowing maximal stimulus to the systems speIn particular, one early study (T.E. Graham cifically needed for high intensity exercise and L.L Spriet, 1991) showed that caffeine and sport performance. Many athletes use 8

The plot thickens considerably, however; research shows that on a 100 km cycling time trial with highly trained cyclists there was no effect on performance even with high dosages! (Hunter et al. 2002). This stunning research given the overwhelming support for caffeine as an ergogenic aid perhaps points to its mechanism of action. I say perhaps because the mechanisms of action by which caffeine does enhance exercise are actually not well defined, but we do know some things about what caffeine does and does not do with respect to exercise ergogenics. For example, on one hand we know that the small percentage increase in maximal voluntary contraction (MVC) is due to increased skeletal muscle recruitment caused by caffeine’s action on the cerebral cortex of the brain. On the other hand we know that the modest fat store mobilization which occurs in individuals at rest consuming caffeine, does not occur in individuals during exercise, nor is there any improvement in oxidative metabolism efficiency (Graham et al. 2000). This suggests that the effect of caffeine is independent of any effect on metabolism and more likely to be involved with the central nervous system. The fact that these effects are not seen in a 100 km cycling time trial Spring 2011


suggests that different central nervous system strategies are used in choosing a pacing strategy, rather than working at a given power output for a prolonged period. The plot thickens yet further as we also know that the source of caffeine is important, and we turn back now to the author’s ‘rocket fuel’ source, de-fizzed cola. Coffee, although a significant source of caffeine, does not demonstrate a significant ergogenic effect as pure caffeine does (Graham et al. 1998). This suggests that other chemicals in coffee may prevent the caffeine present in coffee from providing an ergogenic effect. To maximize the ergogenic effect of caffeine it may be advisable to consume it in a tablet form (typically 100 to 200 mg).

Graham et al. Metabolic and Exercise Endurance Effects of Coffee and Caffeine Ingestion. J. Appl. Physiol. 85(3):883-889, 1998. Wemple et al. Caffeine vs. caffeine-free sports drinks: effects on urine production at rest and during prolonged exercise. Int. J. Sports Med. 18:40–46, 1997.

WEST END PHYSIOTHERAPY provides Physical Therapy Services West End Medical & Professional Building Bookings available from 7:00 a.m. - 7:00 p.m. Mondays through Fridays, no referral required.

The practical take home message for the athlete is that caffeine is valuable, essentially harmless and ubiquitously available, as well as a legal agent that can improve performance and training. It should probably not be taken in the form of coffee if an ergogenic effect is desired, and need not be consumed at doses higher than 3 to 6 mg per kg of body weight (Colas have between 30 and 50 mg of caffeine in a 375 ml can and also provide carbohydrates for use during exercise). One last interesting bit of information: for those athletes concerned with race performance possibly being affected by caffeine use causing increased frequency of urination, you can put those fears to rest! Caffeine does not increase urine production during exercise (Wemple et al. 1997). About the author: Craig Brososky is a physiotherapist with a special interest in running and sport performance who graduated with two degrees from the University of Alberta (B.Sc. 1993, B.Sc.PT 1998) and has been a cyclist since his parents bought his first banana seat cruiser at age 6 and a long distance runner since age 13. He currently owns West End Physiotherapy in Edmonton Alberta and is a consultant to several sport and fitness groups in the city. Citations: Graham TE, Spriet LL. Performance and metabolic responses to a high caffeine dose during prolonged exercise. J. Appl. Physiol. 71(6):22922298, 1991. Pasman et al. Caffeine Effect on Endurance Times. Int. J. Sports Med. 16:225-230, 1995. Jackman et al. Metabolic, catecholamine, and endurance responses to caffeine during intense exercise. J. Appl. Physiol. 81(4):1658–1663, 1996. Kalmar, JM, Cafarelli, E. Effects of caffeine on neuromuscular function. J. Appl. Physiol. 87(2):801-808, 1999. Collomp et al. Benefits of caffeine ingestion on sprint performance in trained and untrained swimmers. Eur. J. Appl. Physiol. 64:377–380, 1992.

Improve running efficiency and enjoyment, run faster! High level fitness assessments for runners and cyclists. Craig is registered as a running super specialist. Close supervision and answers to your questions! A quick phone call or e-mail away, you can expect good results with practical tools to help you maintain and progress your abilities further and faster. Craig J. Brososky B.Sc., B.Sc.PT, IMC Owner, Physiotherapist West End Medical & Professional Bldg. Room 311, 9509 - 156 Street Edmonton, Alberta T5P 4J5 phone: (780) 484-0514 fax: (780) 484-1347

email: c.brososky@wephysio.com http://www.wephysio.com

Hunter et al. Caffeine ingestion does not alter performance during a 100km cycling time-trial performance. Int. J. Sport Nutr. Exerc. Metab. 12:438-452, 2002. Graham et al. Caffeine ingestion does not alter carbohydrate or fat metabolism in human skeletal muscle during exercise. The Journal of Physiology, 529:837-847, 2000.

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Creatine Application Strategies during Resistance-Training in Healthy Older Adults Abstract Darren Candow1, Katherine MacLeod1, Gordon Zello2, Binbing Ling2, Jonathan P. Farthing3, Jonathan Harris4, Shanthi Johnson1

Introduction Sarcopenia is defined as the age-related loss of muscle mass which has a negative effect on strength (von Haehling, 2010) and metabolic rate (Piers et al. 1998) leading to an increase in fat mass (Marzetti et al. 2009). One contributing factor for sarcopenia is adequate nutrition. Creatine is a nitrogen-containing compound naturally produced in the body from reactions involving the amino acids glycine, arginine, and methionine and is also found in the diet primarily in red meat and seafood (Wyss & KaddurahDaouk, 2000). Research showing a positive effect from creatine supplementation on aging muscle mass and strength is increasing (Candow & Chilibeck, 2008). Mechanistically, in addition to its role in maintaining the ATP/ADP ratio during intense muscle contraction (Harris et al., 1992), creatine supplementation may enhance aging muscle hypertrophy through an increase in cellular hydration status (Balsom et al., 1995), satellite cell activity (Olsen et al., 2006), anabolic hormone secretion (i.e. IGF-I; Burke et al., 2008), myogenic transcription factors (Willoughby & Rosene, 2003), or by reducing protein catabolism (Candow et al., 2008). Emerging research suggests that the timing of creatine supplementation (i.e. immediately before and immediately after resistancetraining) may be important for creating an anabolic environment for muscle growth (for review see Candow & Chilibeck, 2008). For example, the strategic ingestion of creatine immediately before (0.05g•kg-1) and immediately after (0.05g•kg-1) resistance training sessions (3 days/week, 10 weeks) resulted in greater wholebody muscle hypertrophy (2.0 ± 0.3cm) compared to placebo (0.8 ± 0.3cm) in healthy older males (59-77 years; Candow et al. 2008). Creatine supplementation also reduced muscle protein catabolism (urinary 3-methylhistidine) by 40% compared to a 30% increase for the placebo group (Candow et al., 2008). However, a key deficit in the literature is that no study has directly examined whether creatine supplementation before or following resistance -training is more beneficial for stimulating muscle accretion and strength in older adults. Therefore, the primary purpose of this study was to directly compare the effects of the timing of creatine supplementation (immediately before vs. immediately following resistance-training) in healthy older adults. Using a double-blind, repeated measures design, subjects were randomly assigned to one of three groups: CR-Before (0.1g•kg-1 creatine before + 0.1g•kg-1 placebo [rice flour] after resistancetraining, N=11, 4 male, 7 female; 56 yrs), CR-After (placebo before + creatine after resistance-training, N=11, 5 male, 6 female; 55 yrs), and PLA (placebo before and after resistance-training, N=11, 7 male, 4 female; 61 yrs) during 12 weeks of resistance-training (9 whole-body exercises, 3 sets of 10 repetitions, 3 days/week). Creatine and placebo capsules (i.e. 1 gram each) were identical in taste, texture, color and appearance. Subjects consumed the creatine or placebo capsules, with water, immediately before (i.e. 5 minutes) and immediately after (i.e. 5 minutes) each resistancetraining session. The dependent variables measured before and after 12 weeks of supplementation and resistance-training were: (1) lean tissue mass (air-displacement plethysmography, (2) mus10

cle thickness of the elbow and knee flexors and extensors (ultrasound), (3) strength (leg press and chest press one repetition maximum; 1-RM), (4) urinary 3-methylhistidine excretion (an index of muscle protein catabolism), and (5) urinary microalbumin (an indicator of kidney function). Results showed that subjects who supplemented with creatine (i.e. before and after exercise) experienced a significant increase in lean tissue mass and muscle strength and decrease in muscle protein catabolism over time. Interestingly, only the subjects who supplemented with creatine after exercise experienced a greater increase in muscle size of the elbow flexors and chest press strength compared to placebo. Creatine had no negative effect on kidney function.

% Change in Lean Tissue Mass

Authors:

8 6

*

*

4 2 0 CR-Before

CR-After

PLA

Figure 1. Change in lean tissue mass after 12-weeks of supplementation and resistance-training for CR-Before (N=11), Cr-After (N=11), and PLA (N=11) groups. Values are means ± standard deviation.* CR-Before and CR-After groups experienced a significant increase and in lean tissue mass over time (p<0.05).

Figure 2. Change in leg press strength after 12-weeks of supplementation and resistance-training for CR-Before (N=11), Cr-After (N=11), and PLA (N=11) groups. Values are means ± standard deviation. *Significant increase over time (p<0.05). ** CR-Before and CR-After groups experienced a greater increase in leg press strength compared to the PLA group (p<0.05). Spring 2011


These results suggest that creatine supplementation, provided only on resistance-training days, has a positive effect on muscle mass and strength in healthy older adults. Creatine supplementation immediately after resistance-training sessions may provide slightly greater beneficial effects. Creatine had a positive effect on muscle protein catabolism and no effect on kidney function over time.

References 1. Balsom PD, Soderlund K, Sjodin B, Ekblom B. Skeletal muscle metabo lism during short duration high-intensity exercise: influence of creatine supplementation. Acta Physiol Scand. 1995; 154: 303-10. 2. Burke DG, Candow DG, Chilibeck PD, MacNeil LG, Roy BD, Tarnopolsky MA, Ziegenfuss T. Effect of creatine supplementation and resistanceexercise training on muscle insulin-like growth factor in young adults. Int J Sport Nutr Exerc Metab. 2008; 18: 389-98. 3. Candow DG, Chilibeck PD. Timing of creatine or protein supplementa tion and resistance training in the elderly. Appl Physiol Nutr Metab. 2008; 33: 184-90. 4. Candow DG, Little JP, Chilibeck PD, Abeysekara S, Zello GA, Kazach kov M, Cornish SM, Yu PH. Low-dose creatine combined with protein during resistance training in older men. Med Sci Sports Exerc. 2008; 40: 1645-52. 5. Harris RC, Soderland K, Hultman E. Elevation of creatine in resting and exercise muscle of normal subjects by creatine supplementation. Clin Sci. 1992; 83:367-74. 6. Marzetti E, Lees HA, Wohlgemuth SE, Leeuwenburgh C. Sarcopenia of aging: underlying cellular mechanisms and protection by calorie restrict tion. Biofactors. 2009; 35: 28-35. 7. Olsen S, Aagaard P, Kadi F et al. Creatine supplementation augments the increase in satellite cell and myonuclei number in human skeletal muscle induced by strength training. J Physiol. 2006; 1: 525-34. 8. Piers LS, Soares MJ, McCormack LM, O'Dea K. Is there evidence for an age-related reduction in metabolic rate? J Appl Physiol. 1998; 85: 21962204. 9. von Haehling S, Morley JE, Stefan D. An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle. 2010; 1:129â&#x20AC;&#x201C;33 10. Willoughby DS, Rosene JM. Effects of oral creatine and resistance training on myogenic regulatory factor expression. Med Sci Sports Exerc. 2003; 35: 923-29. 11. Wyss M, Kaddurah-Daouk R. Creatine and creatinine metabolism. Physiol Rev. 2000; 80: 1107-13

Affiliations: Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada Running Head: Creatine application strategies Address for Correspondence: Darren G. Candow, Ph.D., Associate Professor Faculty of Kinesiology & Health Studies Centre on Aging and Health University of Regina Regina, SK, Canada S4S 0A2 Tel: (306) 585-4906 Fax: (306): 585-4854 E-mail: Darren.Candow@uregina.ca

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Leading the way to Active and Healthy Lifestyles By Cristina Caperchione

We are all well aware of the numerous physical and mental health benefits associated with being physically active, yet our physical activity levels remain generally low. Women in particular are one population showing the lowest levels of physical activity. There are a number of factors beyond personal motivation which may help to explain women’s low levels of participation in physical activity, including a number of psychological, socio-cultural, and environmental barriers (1,2). In response to these barriers, researchers have revealed mechanisms which have the potential to assist women with engaging in regular physical activity. From a socio-cultural perspective, group based physical activity has been associated with positive outcomes including increased participation and attendance to group exercise classes (3), reduced drop out from group classes (4), and a more positive attitude towards physical activity in general (5). It seems that women (and adults in general) prefer to become active and maintain an active lifestyle if they have the opportunity to interact and communicate with others, gain friends, and enjoy the camaraderie of others around them (6). To further increase this camaraderie and social interaction, researchers have stressed the need for a leader to help guide the group through its journey to reaching their health and activity goals, whilst providing an environment which is socially appealing. Some research concerning leaders of group exercise classes have indicated that the group leader is capable of developing group unity by promoting and encouraging feelings of solidarity, mutual respect and acceptance (7). Moreover, those in leadership positions are able to engage participants more, resulting in greater group cohesion, higher levels of overall satisfaction, greater feelings of revitalisation and increased activity participation and performance (8, 9).

each group member and are available outside of the group for further advice, were likely to have greater cohesiveness within their groups. So what does this all mean? Well what we have here is a promising avenue for physical activity sustainability. Leaders may be the missing link to assist with the transition from short term to long term behaviour change as they have the potential to prolong activities and keep programs thriving.

With this in mind, is it possible that leaders could also have this same impact on more informal, unstructured physical activity However, from a research perspective, caution should be taken groups for women? If so, what types of leaders would be most as this was preliminary work, and thus requires a more detailed effective? look at how leaders affect actual physical activity behaviour. In addition, the work outlined here does not examine the potential We attempted to address these questions by examining the reciprocal relationship between the leader and group members. relationship between leadership, group cohesion, and physical It is very probable that leaders have varying perspectives to activity in women’s informal walking groups. In doing this, we their group members concerning the leader behaviours which asked a number of women’s walking groups to report on the influence a group as a whole. It would be valuable to undercohesiveness of their own groups, as well as indicate the types stand the perceptions of those in leadership roles and compare of leaders they felt would assist with this cohesiveness and po- the similarities and differences between the leader and group tentially help them reach their activity goals. members. This will provide leaders with information regarding member expectations, as well as provide leaders with the opWhat we found was an indication that leaders do impact the portunity to adapt certain leader behaviours to align with the cohesiveness of a group and thus could potentially influence needs of the group members. women’s physical activity behaviours. In particular, group leaders who are enthusiastic, have the ability to motivate their Withstanding some of these research limitations, leaders can group members, are able to provide personal instruction to effectively impact their group and influence its development 12

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and sustainability, and thus should be a factor for consideration when developing physical activity and health promotion initiatives.

References 1) Caperchione C, Mummery K, Joyner K. Addressing the challenges, barriers and enablers to physical activity participation in priority women's groups: Findings from the WALK Program. J Phys Act Health. 2009;6:58996. 2) Eyler AA, Matson-Koffman D, Rohm Young D, et al. Quantitative study of correlates of physical activity in women from diverse racial/ethnic groups: Women's Cardiovascular Health Network Project--introduction and methodology. Am J Prev Med. 2003 Oct;25(3Suppl 1):5-14. 3) Fraser SN, Spink KS. Examining the role of social support and group cohesion in exercise compliance. J Behav Med. 2002 Jun;25(3):233-49. 4) Spink KS, Carron AV. Group cohesion effects in exercise classes. Small Group Research.1994;25:26-42.

6) Estabrooks PA. The role of group cohesion in exercise behaviour of older adults. London, Ontario: University of Western Ontario; 1999. 7) Christensen U, Schmidt L, Budtz-Jorgensen E, et al. Group cohesion and social support in exercise classes: results from a danish intervention study. Health Educ Behav. 2006 Oct;33(5):677-89. 8) Carron AV, Spink KS. Team building in an exercise setting. The Sport Psych. 1993;7:8-18. 9) Turner EE, Rejeski WJ, Brawley LR. Psychological benefits of physical activity are influenced by the social environment. J Sport Exerc Psych. 1997;19:119-30.

5) Estabrooks PA, Carron AV. Group cohesion in older adult exercisers: prediction and intervention effects. J Behav Med. 1999 Dec;22(6):575-88.

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SCI Action Canada: Advancing Physical Activity Knowledge and Participation Among Canadians with Spinal Cord Injury By Spero Ginis (SCI Action Canada), Kathleen Martin Ginis (McMaster University), Amy Latimer (Queen’s University), Adrienne Sinden (SCI Action Canada) A Real Need Approximately 85,000 Canadians currently live with a spinal cord injury (SCI). Nearly half of this population engage in no leisure time physical activity whatsoever (e.g., sports, exercise). Not surprisingly, programs and information to support physical activity are two of the services most desired but least available to the SCI community. Seeing a real need, SCI Action Canada was established with a vision of advancing physical activity knowledge and participation among Canadians living with spinal cord injury.

physical activity promotion initiatives. This information provided the basis for Phase Two activities. Phase Two Phase Two focused on developing activityenhancing interventions, strengthening partnerships, and generating SCI-specific physical activity guidelines.

SCI Action Canada SCI Action Canada is an alliance of 16 community organizations and 15 universitybased researchers. The alliance was established in 2007 with funding from the Social Sciences and Humanities Research Council of Canada (SSHRC). Alliance members have come together with the common goal of advancing physical activity knowledge and participation among people with SCI. In order to achieve this goal, alliance activities have proceeded in three phases. A Three-Phased Approach Phase One Phase one activities consisted of projects designed to inform the subsequent development of physical activity interventions. These projects focused on developing a comprehensive understanding of: the ideal messengers and methods for conveying physical activity information to the SCI community; factors that motivate people with SCI to participate in physical activity; and existing physical activity promotion resources available to SCI service organizations. Based on the results, we concluded that intervention strategies should: a) deliver key messages by peers and health service providers, b) utilize passive sources to disseminate interventions, c) teach physical activity self-regulation strategies, and d) provide SCI service organizations with the necessary resources to implement 14

physical activity, increase the number of minutes/week spent on physical activity, and report improvements in health and life satisfaction. Active Homes The purpose of this pilot study was to examine the efficacy of a peer-mediated, home-based introductory strengthtraining session for people with SCI who did not already have a routine strengthtraining program. A certified personal trainer and a physically active peer visited participants in their homes. The trainer designed a personalized resistancetraining program and the peer demonstrated the exercises. Participants were given tips on how to be active right in their own homes and how to maintain their exercise program. After the visit, participants reported feeling more confident in their ability to perform resistance exercises, greater intentions to exercise, and more effective exercise planning. In addition, they significantly increased the number of minutes/week spent on strength-training. Strengthening Partnerships

Developing Interventions We developed several interventions to change theory-based, empirically established determinants of physical activity while taking into account Phase One findings. Below are two examples. Get In Motion Get in Motion is a free, telephone-based physical activity counseling service for Canadians with SCI. This service is designed to provide ongoing physical activity information, counseling, and support to meet personal physical activity goals. Our preliminary data indicate that clients strengthen their intentions to engage in

Several of our activities have focused on facilitating and strengthening collaboration among community partners. One event involved bringing together clients from the Canadian Paraplegic Association (CPA) – Hamilton to participate in a wheelchair tennis “Have a Go” event, facilitated by the Ontario Wheelchair Sports Association’s Bridging the Gap program. We also collaborated with the Active Living Alliance for Canadians with a Disability to host All Abilities in Action, a one-day event showcasing sport and exercise opportunities for people with disabilities. The work done for, and with, the Canadian Paralympic Committee (CPC) highlights a different aspect of how we work with our partners. Since 2008, SCI Action Canada has provided support staff to help develop CPC’s Feel the Rush database - an online resource that Canadians can use to find accessible sport opportunities. Spring 2011


Physical Activity Guidelines Physical activity promotion is facilitated by the availability of evidence-informed guidelines that provide specific information regarding the types, amounts, and intensities of activity needed to yield health and fitness benefits. SCI Action Canada has been involved in the development of evidence-based physical activity guidelines for adults with SCI. These are the first national physical activity guidelines to be developed for Canadians with any type of disability (www.sciactioncanada.ca). activity-enhancing initiatives. Phase Three We are now working to package, implement, and evaluate the Phase 2 interventions through our network of communitybased partner organizations. SCI Action Canada has developed knowledge translation plans to target three key audiences: a) People with SCI, b) Peer Support Networks and c) Health Care Professionals. In the following sections we describe strategies for reaching each of these groups. People with SCI The objective here is to create interest among recipients of physical activity messages, and direct them to more specific resources to meet their individual physical activity information needs. Primary vehicles for conveying these messages are the SCI physical activity guidelines, the SCI Action Canada website, and our partner organizations. Peer Support Networks A key finding from Phase One was that peers with SCI are a highly valued source of physical activity motivation and information. We are working to put this valuable information into practice. Specifically, SCI Action Canada is working with CPA-Ontario to identify opportunities for delivering physical activity information through its well-established peer support program. Health Care Providers Phase One research reinforced the central role that health care providers can play in physical activity behavior change. SCI Action Canada will target a broad range of health care providers such as kinesiologists, physiotherapists, occupational therapists, recreation therapists, general practitioners, and physiatrists. In doing so, we aim to convey the following messages: “It is important to talk to your patients about physical activity” and “There are physical activity resources available to help you and your patients.” Looking Forward Over the past three years, SCI Action Canada has developed a comprehensive strategy for enhancing physical activity knowledge and participation among people with spinal cord injury. The coming years will be spent implementing and evaluating the strategy within the SCI Community. We are also hopeful that the SCI Action Canada framework will provide a blueprint for other disability communities to develop their own physical activity-enhancing initiatives.

www.sciactioncanada.ca

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Check out the SMCA Resource Library! Skeletal Muscle Damage and Repair by Peter M. Thiidus (Editor) 2008 Catalogue Number: AIT35 Professionals and students interested in understanding the physiological mechanisms of skeletal muscle damage and repair will welcome this uniquely comprehensive text.

Athletic Training Education Series - Therapeutic Exercise for Athletic Injuries By Peggy A. Houglum 2001 Catalogue Number: AIT08 This text presents athletic trainers, physical therapists, and other sports medicine specialists with a solid base in the science of practice of designing effective therapeutic exercise programs. Therapeutic Exercise for Athletic Injuries is suitable for both undergraduate students and professionals using it as a reference.

Performance-Enhancing Substances in Sport and Exercise by Michael S. Bahrke, Charles E. Yesalis 2002 Catalog Number: DST01 The reference book contains 29 chapters covering dozens of substances, thousands of references, and chapters devoted to the history and future of performance-enhancing substances in sport and exercise, the determination of the efficacy of substances, drug testing, and legal issues.

Visit sportmedab.ca/library for information or to borrow a resource.

SMCA Members receive a 20% Discount on Medical Supplies when ordered on-line. Visit the Store... www.sportmedab.ca

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Spring 2011


What is Sport Psychology? The American Psychological Association defines sport and exercise psychology as the scientific study of the psychological factors associated with participation and performance in sport. Sport Psychology can be applied to anger management when dealing with referees and coaches. Many times athletes have difficulties accepting a poor call (or a call they disagree with) from a referee. A sport psychologist can provide skills to athletes to deal with these so-called “losses of control”. Even business professionals can benefit from sport psychology skills in the application of dealing with employees and employers. Sport psychology is as unique as the individual athletes who seek help from a sport psychologist. Working with a sport psychologist typically begins with an assessment to determine what performance goals are to be accomplished. Following sessions are used to develop skills and abilities that will help the athlete accomplish their goals. For athletes, sport psychology explores the mental game and how psychological aspects of sport can make an athlete a better performer. Traditionally there are several basic mental skills that have been taught to athletes. These skills include: Self-awareness, relaxation, goal setting, Imagery/Visualization, Self-Talk maintenance, concentration/focus, and motivation. However, sport psychology is not limited to just these skills, in fact sport psychology has a large host of applications that many athletes ignore. For example, sport psychologist’s can provide athletes skills and knowledge that will help confuse or disrupt an opponent’s con-

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centration. Sport psychology can help coaches develop better tactics to use against an opponent or team through attacking not only technical and physical weaknesses, but mental weaknesses as well. Sport psychologists can provide coaches with new strategies to communicate with teams and athletes, sometimes diffusing difficult or tense situations. More importantly, sport psychologists are also trained to deal with significant mental health problems such as eating disorders and depression. Athletes often experience additional life stressors and the added pressure can very often be overwhelming, resulting in the development of depression, anxiety disorders, or even eating disorders. Sport psychologists are not only trained to deal with sports related issues but mental health issues that may even be life threatening. Athletes reaching retirement are often faced with a significant change in lifestyle that can be difficult to accept. In fact, retiring from a sport can sometimes be as traumatic for an athlete as losing a loved one. Sport psychologists can help guide athletes through the emotions that come up during retirement from sport. If you are an athlete in need of a sport psychologist or just need someone to speak to regarding a problem you may be facing, River Valley Counselling Services can help. There are problems . . . and there are solutions, we invite you to come find yours. 780-430-9224 or visit our website at ww.rivervalleycounselling.ca.

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What is a Concussion?

A concussion should be suspected in the presence of any one of the signs or symptoms. Return to Activity Return to activity should be gradual and monitored by a medical professional. Return to play steps should include: Step 1: No activity.; only complete rest Step 2: Light aerobic exercise Step 3: Sport specific activities Step 4: Drills without body contact; light resistance training Step 5: Drills with body contact Step 6: Game play Athletes should proceed through these steps only when they are symptom free and there should be 24 hours between each step.

Immediate Response • Protective equipment must be certi- • Remove the player from the current What is a Concussion? • Occurs when an athlete is moving at fied, good quality, well maintained game or practice a high rate of speed and collides with and properly fitted. another object. • Do not leave the player alone; moni• Coaches, parents and athletes need tor for signs and symptoms • The brain shifts inside the skull and to recognize the signs/symptoms of a strikes the bony surfaces. concussion. • Do not administer medication • An athlete can suffer a concussion without actually striking their head. • The result is a mild traumatic brain injury that changes normal brain function • Can happen with or without a loss of consciousness T5M 3K6 Prevention • Pre-season concussion screening asking about previous symptoms and incidents is important. • Complete a baseline cognitive assessment and symptom score for each athlete. • All athletes should be properly educated on the correct sport technique and safety rules need to be enforced. 18

Signs and Symptoms • Inform the coach, parent or guardian • Nausea, vomiting about the injury • Dizziness • Confusion • The player should be evaluated by a • Fatigue medical doctor after any blow to the • Light headedness head • Headaches • Irritability • Disorientation • Seeing bright lights or stars Check out these and other • Feeling of being stunned resources on • Depression SMCA’s web site! • Inappropriate behavior • Decreased work/playing ability www.sportmedab.ca • Inability to perform daily activities • Cognitive and memory dysfunction (reduced attention, difficulty concentrating) • Sleep disturbances • Vacant stare • Poor balance Spring 2011


Hydration: Water The most important and most often neglected nutrient! About 60% of our body weight is water and our need for water increases greatly with exercise. Adequate fluid intake before, during and after exercise is critical in preventing dehydration. DO NOT use thirst as the gauge for your bodyâ&#x20AC;&#x2122;s water needs. Athletes lose more contests through not drinking enough water than any other nutritional cause.

Dehydration Dehydration occurs when fluid losses exceed 1% of body weight. Symptoms include headache, irritability and fatigue. Urine should be clear and copious.

For maximum hydration, follow these recommendations: Consume cool fluids in small volumes at regular intervals.

Prevention is the Best Cure. The hydration status of the body is determined by the balance between water intake and water loss.

For exercise lasting less than 60 minutes, cool water is the best replacement. For intense exercise lasting greater than 60 minutes, diluted glucose and electrolyte solutions (sport drinks) are recommended to provide fuel for working muscles.

Interested in writing for Pulse? Is there an article you would like to see? Let us knowâ&#x20AC;Ś. We value your feedback?

Email: smcapulse@gmail.com sportmedab.ca

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Pulse Spring 2011  

The 2011 Spring issue showcases The Pan Pacific Conference of Medicine and Science in Sport that was co hosted by Sports Medicine Australia...

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