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Rebelo-Marques A, Coelho-Ribeiro B, De Sousa Lages A, Andrade R, Afonso J, Pereira R, Batista AS, Teixeira VH, Jácome C. Trends and Missing Links in (De)Hydration Research: A Narrative Review. Nutrients 2024; 16:1709. [PMID: 38892642 PMCID: PMC11174495 DOI: 10.3390/nu16111709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Despite decades of literature on (de)hydration in healthy individuals, many unanswered questions remain. To outline research and policy priorities, it is fundamental to recognize the literature trends on (de)hydration and identify current research gaps, which herein we aimed to pinpoint. From a representative sample of 180 (de)hydration studies with 4350 individuals, we found that research is mainly limited to small-scale laboratory-based sample sizes, with high variability in demographics (sex, age, and level of competition); to non-ecological (highly simulated and controlled) conditions; and with a focus on recreationally active male adults (e.g., Tier 1, non-athletes). The laboratory-simulated environments are limiting factors underpinning the need to better translate scientific research into field studies. Although, consistently, dehydration is defined as the loss of 2% of body weight, the hydration status is estimated using a very heterogeneous range of parameters. Water is the most researched hydration fluid, followed by alcoholic beverages with added carbohydrates (CHO). The current research still overlooks beverages supplemented with proteins, amino acids (AA), and glycerol. Future research should invest more effort in "real-world" studies with larger and more heterogeneous cohorts, exploring the entire available spectrum of fluids while addressing hydration outcomes more harmoniously.
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Affiliation(s)
- Alexandre Rebelo-Marques
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal
- Magismed Innovation Institute, 4710-353 Braga, Portugal
| | - Bruna Coelho-Ribeiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, 4806-909 Guimarães, Portugal
| | | | - Renato Andrade
- Clínica Espregueira—FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Dom Henrique Research Centre, 4350-415 Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, 4200-450 Porto, Portugal
| | - José Afonso
- Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - Rogério Pereira
- Clínica Espregueira—FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Dom Henrique Research Centre, 4350-415 Porto, Portugal
- Higher School of Health Fernando Pessoa, 4200-253 Porto, Portugal
| | | | - Vitor Hugo Teixeira
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal
- Research Center in Physical Activity, Health and Leisure, CIAFEL, Faculty of Sports, University of Porto, FADEUP, 4200-540 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health, ITR, 4050-600 Porto, Portugal
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
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Bates K, Zeppieri G, Young C, Bruner M, Moser M, Farmer KW, Pozzi F. Preseason lower extremity range of motion, flexibility, and strength in relation to in-season injuries in NCAA division I gymnasts. PHYSICIAN SPORTSMED 2024; 52:200-206. [PMID: 37216208 PMCID: PMC10803174 DOI: 10.1080/00913847.2023.2215775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To determine if preseason lower extremity ROM, flexibility, and strength differ in collegiate gymnasts (NCAA Division 1) who do or do not sustain an injury during the competitive season. METHODS Over four seasons, a total of 15 female gymnasts (age = 20.5 ± 1.0 years) underwent preseason screening (30 gymnast-season). We tested joint ROM (hip: flexion, internal and external rotation; ankle: weightbearing dorsiflexion), muscle flexibility (passive straight leg raise, Thomas,' Ober's, Ely's tests) and strength (hip extensors, abductors, and flexors isometric strength via a handheld dynamometer; knee: quadriceps and hamstring isokinetic strength at 60°/sec). The team athletic trainer tracked overuse lower extremity injuries (restricted gymnasts from full participation, occurred as from participation in organized practice or competition, and required medical attention) during each season. For athletes that tested multiple seasons, each encounter was considered independent, and each preseason assessment was linked to overuse injuries sustained during the same competitive season. Gymnasts were dichotomized into injured and non-injured groups. An independent t-test was used to measure differences in preseason outcomes between injured and non-injured groups. RESULTS During four years, we recorded 23 overuse lower extremity injuries. Gymnasts that sustained an in-season overuse injury demonstrated significantly lower hip flexion ROM (mean difference: -10.6°; 95% confidence interval: -16.5, -4.6; p < 0.01) and lower hip abduction strength (mean difference: -4.7% of body weight; 95% confidence interval: -9.2, -0.3; p = 0.04). CONCLUSION Gymnasts who sustain an in-season overuse lower extremity injury have significant preseason deficit of hip flexion ROM and weakness in the hip abductors. These findings indicate potential impairments in the kinematic & kinetic chains responsible for skill performance and energy absorption during landing.
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Affiliation(s)
- Kaysha Bates
- Victory lab PT and performance, Jackson, Wyoming, USA
- Sport Physical Therapy Residency Program, University of Florida Health, Gainesville, FL, USA
| | - Giorgio Zeppieri
- Department of Rehabilitation, University of Florida Health, Gainesville, FL, USA
| | - Candace Young
- Sport Physical Therapy Residency Program, University of Florida Health, Gainesville, FL, USA
- Department of Rehabilitation, Hospital for Special Surgery, New York, NY, USA
| | - Michelle Bruner
- Department of Orthopaedics and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Moser
- Department of Orthopaedics and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin W. Farmer
- Department of Orthopaedics and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Federico Pozzi
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
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Afonso J, Andrade R, Rocha-Rodrigues S, Nakamura FY, Sarmento H, Freitas SR, Silva AF, Laporta L, Abarghoueinejad M, Akyildiz Z, Chen R, Pizarro A, Ramirez-Campillo R, Clemente FM. What We Do Not Know About Stretching in Healthy Athletes: A Scoping Review with Evidence Gap Map from 300 Trials. Sports Med 2024:10.1007/s40279-024-02002-7. [PMID: 38457105 DOI: 10.1007/s40279-024-02002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Stretching has garnered significant attention in sports sciences, resulting in numerous studies. However, there is no comprehensive overview on investigation of stretching in healthy athletes. OBJECTIVES To perform a systematic scoping review with an evidence gap map of stretching studies in healthy athletes, identify current gaps in the literature, and provide stakeholders with priorities for future research. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and PRISMA-ScR guidelines were followed. We included studies comprising healthy athletes exposed to acute and/or chronic stretching interventions. Six databases were searched (CINAHL, EMBASE, PubMed, Scopus, SPORTDiscus, and Web of Science) until 1 January 2023. The relevant data were narratively synthesized; quantitative data summaries were provided for key data items. An evidence gap map was developed to offer an overview of the existing research and relevant gaps. RESULTS Of ~ 220,000 screened records, we included 300 trials involving 7080 athletes [mostly males (~ 65% versus ~ 20% female, and ~ 15% unreported) under 36 years of age; tiers 2 and 3 of the Participant Classification Framework] across 43 sports. Sports requiring extreme range of motion (e.g., gymnastics) were underrepresented. Most trials assessed the acute effects of stretching, with chronic effects being scrutinized in less than 20% of trials. Chronic interventions averaged 7.4 ± 5.1 weeks and never exceeded 6 months. Most trials (~ 85%) implemented stretching within the warm-up, with other application timings (e.g., post-exercise) being under-researched. Most trials examined static active stretching (62.3%), followed by dynamic stretching (38.3%) and proprioceptive neuromuscular facilitation (PNF) stretching (12.0%), with scarce research on alternative methods (e.g., ballistic stretching). Comparators were mostly limited to passive controls, with ~ 25% of trials including active controls (e.g., strength training). The lower limbs were primarily targeted by interventions (~ 75%). Reporting of dose was heterogeneous in style (e.g., 10 repetitions versus 10 s for dynamic stretching) and completeness of information (i.e., with disparities in the comprehensiveness of the provided information). Most trials (~ 90%) reported performance-related outcomes (mainly strength/power and range of motion); sport-specific outcomes were collected in less than 15% of trials. Biomechanical, physiological, and neural/psychological outcomes were assessed sparsely and heterogeneously; only five trials investigated injury-related outcomes. CONCLUSIONS There is room for improvement, with many areas of research on stretching being underexplored and others currently too heterogeneous for reliable comparisons between studies. There is limited representation of elite-level athletes (~ 5% tier 4 and no tier 5) and underpowered sample sizes (≤ 20 participants). Research was biased toward adult male athletes of sports not requiring extreme ranges of motion, and mostly assessed the acute effects of static active stretching and dynamic stretching during the warm-up. Dose-response relationships remain largely underexplored. Outcomes were mostly limited to general performance testing. Injury prevention and other effects of stretching remain poorly investigated. These relevant research gaps should be prioritized by funding policies. REGISTRATION OSF project ( https://osf.io/6auyj/ ) and registration ( https://osf.io/gu8ya ).
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Affiliation(s)
- José Afonso
- Faculty of Sport, Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), University of Porto, Porto, Portugal.
| | - Renato Andrade
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal
| | - Sílvia Rocha-Rodrigues
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun'Alvares, 4900-347, Viana do Castelo, Portugal
- Tumour and Microenvironment Interactions Group, INEB-Institute of Biomedical Engineering, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 4200-153, Porto, Portugal
- Sport Physical Activity and Health Research & Innovation Center, 4900-347, Viana do Castelo, Portugal
| | - Fábio Yuzo Nakamura
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Maia, Maia, Portugal
| | - Hugo Sarmento
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| | - Sandro R Freitas
- Laboratório de Função Neuromuscular, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal
| | - Ana Filipa Silva
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun'Alvares, 4900-347, Viana do Castelo, Portugal
- Sport Physical Activity and Health Research & Innovation Center, 4900-347, Viana do Castelo, Portugal
| | - Lorenzo Laporta
- Núcleo de Estudos em Performance Analysis Esportiva (NEPAE/UFSM), Universidade Federal de Santa Maria, Avenida Roraima, nº 1000, Cidade Universitária, Bairro Camobi, Santa Maria, RS, CEP: 97105-900, Brazil
| | | | - Zeki Akyildiz
- Sports Science Faculty, Department of Coaching Education, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Rongzhi Chen
- Faculty of Sport, Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), University of Porto, Porto, Portugal
| | - Andreia Pizarro
- Faculty of Sport, Research Center in Physical Activity, Health and Leisure (CIAFEL), University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas, 135, 4050-600, Porto, Portugal
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy. Faculty of Rehabilitation Sciences, Universidad Andres Bello, 7591538, Santiago, Chile
| | - Filipe Manuel Clemente
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun'Alvares, 4900-347, Viana do Castelo, Portugal
- Sport Physical Activity and Health Research & Innovation Center, 4900-347, Viana do Castelo, Portugal
- Gdańsk University of Physical Education and Sport, 80-336, Gdańsk, Poland
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Miller M, Zeppieri G, Farmer KW, Pozzi F. Blood Flow Restriction Training for Subacromial Pain: Two Case Reports. JOSPT CASES 2022; 2:55-61. [PMID: 36582265 PMCID: PMC9793793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Blood flow restriction training (BFRT) appears to promote the strengthening of shoulder muscles, but primary clinical applications are limited to the lower extremity. CASE PRESENTATION Two female recreational athletes (Case A: 27 years old; Case B: 28 years old) with subacromial pain were treated with BFRT (50% occlusion) during 3 isotonic strengthening exercises of the upper extremity against 20% of the maximal isometric strength. At the beginning of each treatment week, we measured strength with a handheld dynamometer to ensure appropriate load progression. OUTCOME AND FOLLOW-UP Case A completed 16 visits and Case B completed 22 visits of BFRT with no adverse events. At discharge, we found meaningful improvement for patient-reported function, clinical measures of shoulder flexion and external-rotation range of motion and isometric strength, supraspinatus and infraspinatus cross-sectional area, and upper extremity performance. DISCUSSION BFRT may be a valuable adjunct to standard rehabilitation for the conservative management of subacromial pain. Despite the inherent limitations of our design, we believe these preliminary findings are compelling to warrant future investigations.
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Affiliation(s)
- Matthew Miller
- UF Health Sport Physical Therapy Residency, Department of Rehabilitation, University of Florida Health, Gainesville, FL
| | - Giorgio Zeppieri
- Department of Rehabilitation, University of Florida Health, Gainesville, FL
| | - Kevin W. Farmer
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL
| | - Federico Pozzi
- Department of Physical Therapy, University of Florida Gainesville, FL
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Guy CR, Zeppieri G, Bruner ML, Davis K, Farmer KW. Shoulder and Hip Range of Motion and Strength Changes Throughout a Season in College Softball Players. Int J Sports Phys Ther 2021; 16:1492-1503. [PMID: 34909255 PMCID: PMC8637248 DOI: 10.26603/001c.29515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many studies have been done on the strength and mobility of the shoulder and hip in baseball players, but fewer studies have examined these metrics in softball players. PURPOSE The purpose of this study was to observe and analyze changes in range of motion (ROM) and strength at the hip and shoulder that occur over the course of a competitive season, to describe preseason ROM and strength at the hip and shoulder in healthy college softball players through side-to-side comparison, and to compare measurements between pitchers and position players. STUDY DESIGN Descriptive Cohort Study. METHODS Data was collected over the course of six seasons, and a total of fifty-four healthy softball athletes (including pitchers and postiion players) who completed at least one set of preseason and postseason measurements were included. Subjects underwent passive ROM (External rotation [ER], internal rotation [IR], total arc of motion [TAM]) and strength (ER/IR at the shoulder, abduction/extension at the hip) measurements at preseason and postseason timepoints. RESULTS Over a season, position players demonstrated an increase in all ROM metrics in both shoulders, except dominant IR, and a decrease in ER strength at the shoulder bilaterally (p<0.05). They also showed decreased ROM in all metrics across both hips (p<0.05). Pitchers had increased IR and TAM ROM in the dominant shoulder, decreased strength in both shoulders (ER throwing; ER and IR non-throwing), decreased ROM in both hips, and decreased abduction strength in the non-dominant hip (p<0.05). Position players showed less preseason IR in the dominant shoulder compared to non-dominant IR (Dominant: 31.7 ± 1.6°, Non-dominant: 37.0 ± 2.3°; p<0.05). CONCLUSION Softball pitchers and position players both show increased ROM at the shoulder and decreased ROM at the hip over the course of a season. Position players demonstrated side-to-side discrepancies and seasonal changes at the throwing shoulder similar to those seen in baseball players. The preseason mobility of the dominant shoulder of pitchers increased over the season while strength of hip abduction in the non-dominant side was reduced. LEVEL OF EVIDENCE 3.
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