2011 ArkAHPERD Journal

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April 2012 – Arkansas Journal – Volume 47 – Number 1
CCOONNTTEENNTTSS
News and Information
Award Qualifications . . . . . . . 2
Message from the President. . . . . . . 3
ArkAHPERD Board of Directors. . . . . . 4
Articles
The Effects of Activity Level and Weight Status on Walking
Velocity in College-Aged Females: A Pilot Study - Page Glave,
Danika Applegate, Jacilyn Olson, and Ro DiBrezzo . . . 5
Arkansas Department of Education Physical Education Curriculum Materials - Andy Mooneyhan, Jim Stillwell, and Thomas Castilaw. . 11
Osteoporosis Prevention among College Students: Strategies for
Health Professionals - Ellen Edmonds, Lori Turner, Sharon Hunt,
and Deidre Leaver-Dunn . . . . . . . 13
Environmental Hazards: Prevention and Care of Athletic
Injury and Illness - Brian Lyons, Ben Davidson, and J.J. Mayo. . . 21
Relationship Between Hiking Difficulty Ratings and Heart
Rate - Shelia Jackson and Annette Holeyfield . . . . 28
Biomechanical Analysis of Badminton Serves Using
Standard and Body Scaled Equipment: A Perception-
Action Perspective - Shelia Jackson . . . . . 31
Training for Peak Performance and Reduced Injury in Female
Athletes: Appropriate Use of Weight Training and
Plyometrics - Timothy Baghurst, Ro DiBrezzo, and Inza Fort . . 37

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AWARD QUALIFICATIONS
HONOR
Candidate must meet the following qualifications:
A. Be at least 30 years of age and have earned a Master’s degree or its equivalent.
B. Have served the profession for at least five years prior to the nomination.
C. Be a current member of ArkAHPERD. Former members who have retired from professional work may be exempt.
D. Be of high moral character and personal integrity who by their leadership and industry have made outstanding and noteworthy contributions to the advancement of our profession in the state of Arkansas.
To indicate leadership or meritorious contributions, the nominator shall present evidence of the nominee’s successful experiences in any two of the following categories of service:
1. Service to the association.
2. Advancement of the profession through leadership of outstanding programs.
3. Advancement of the profession through presentation, writings, or research.
Any ArkAHPERD member may submit nominations by sending six (6) copies of the candidate’s qualifications to Janet Forbess, jforbess@uark.edu.
HIGHER EDUCATOR OF THE YEAR
A. Have served the profession for at least three years prior to the nomination.
B. Be a member of ArkAHPERD
C. Be of high moral character and personal integrity who by their leadership and industry have made outstanding and noteworthy contributions to the advancement of teaching , research, or service in the state of Arkansas.
D. Be employed by an institution of higher education in the state of Arkansas.
Any ArkAHPERD member may submit nominations by sending a copy of the candidate’s qualifications to Susan Mayes, smayes@uark.edu
TEACHER OF THE YEAR
Teacher awards are presented in the areas of elementary physical education, middle school physical education, secondary physical education, dance, and health.
A. Have served the profession for at least three years prior to the nomination.
B. Be a member of AAHPERD & ArkAHPERD.
C. Be of high moral character and personal integrity who by their leadership and industry have made outstanding and noteworthy contributions to the advancement of teaching in the state of Arkansas.
D. Be employed by a public school system in the state of Arkansas.
E. Have a full time teaching contract, and have a minimum of 60% of their total teaching responsibility in the nominated area.
F. Have a minimum of five years teaching experience in the nominated area.
G. Conduct a quality program.
They must submit three letters of recommendation and agree to make complete NASPE application if selected.
Any ArkAHPERD member may submit nominations by contacting Jamie Oitker, Jamie.oitker@cps.k12.ar.us.
STUDENT
Scholarships
ArkAHPERD awards four scholarships annually for students majoring in HPERD. They include the Newman McGee, Past President’s, Jeff Farris Jr., and John Hosinski scholarships. Students must possess a minimum 2.5 GPA. [See your academic advisor for details.]
Research Award
Research awards of $100, $50, and $25 are awarded to undergraduate and graduate students who are members of ArkAHPERD. Students must submit an abstract and a complete paper to Mitch Parker, MParker@uca.edu by October 1. Papers selected for the research awards must be presented by the student in an oral or poster format at the November convention.
ArkAHPERD Web Site: http://www.arkahperd.org/

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My how time flies. It seems like last week we were all gathered in Little Rock for the convention but as you read this, preparations are beginning for the 2012 ArkAHPERD Convention to be held on November 1st and 2nd at the Embassy Suites, Little Rock. We hope this will be the largest convention ever! Please SAVE THE DATE!
In the “State of the Association” address, I challenged each of you to do something, daily, to make a difference in physical education or health education where you work. Hopefully you took the challenge to heart and tried on a daily bases to be a better educator and example to our students.
As we look to November, we need your help again. We had a record number of 503 attendees last fall and would like to build on that number. Bring a friend, a new educator, or an administrator. The more we can get our message out, the stronger the association grows. As the numbers grow, we also need for more and more presenters from the different disciplines that we service to volunteer to share their knowledge.
Please continue your efforts on the membership drive. If you have any questions or comments, do not hesitate to contact me (mmathis@astate.edu). I hope you have a productive end of the school year, a re-energizing summer break, and I look forward to seeing each and everyone in the fall.
With regards,
Mitch Mathis,
PRESIDENT ArkAHPERD
Message from the President

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ArkAHPERD Board of Directors
Mathis, Mitch President mmathis@astate.edu
Prince, Bennie President-elect bfprince@ualr.edu
Forbess, Janet Program Coordinator jforbess@uark.edu
Mooneyhan, Andy Executive Director amooneyh@astate.edu
Gaines, Cathryn JRFH Coordinator cathryn.gaines@rsdmail.k12.ar.us
Robinson Beaton, Lindsay HRH Coordinator lrobinson@dewitt.k12.ar.us
Mooneyhan, Andy Journal/Newsletter Editor amooneyh@astate.edu
Parker, Mitch WEB Master mparker@uca.edu
Division Vice Presidents / VP-elects
Friend, Ashley Athletics & Sports afriend@sdale.org
--- Athletics & Sports-elect Elected 2012
Hilson, Valarie Health vhilson@astate.edu
Queen, Leah Health-elect lqueenb@gentrypioneers.com
Moore, Jessica Recreation jmoore@harding.edu
Mooneyhan, Allen Recreation-elect amooneyhan@asun.edu
Bryant, Lance General lgbryant@astate.edu
--- General-elect Elected 2012
Robinson Beaton, Lindsay Dance lrobinson@dewitt.k12.ar.us
Gaines, Cathryn Dance-elect cathryn.gaines@rsdmail.k12.ar.us
Keese, Pam Physical Education pkeese@harding.edu --- Physical Education-elect Elected 2012
Section Chairs / Chair-elects
Quimby, Donna Exercise Science dgquimby@ualr.edu
Hanna, Shellie Exercise Science-elect shanna@atu.edu
Wheeler, Amanda Athletic Training awheeler@astate.edu
Mathis, Kembra Athletic Training-elect kmathisatc@yahoo.com
Lothian, Jamie Elementary Phys Ed Lothian@cox.net
Reaper, Jeannie Elementary Phys Ed-elect jenreaper@pangburnschools.org
Baggett-McMinn, sherry Higher Education SBaggett.McMinn@saumag.edu Burks, Stephen Higher Education-elect sburks@harding.edu
Parker, Mitch Research mparker@uca.edu
Torrence, William Research-elect torrencew@uapb.edu
Key,s Jason Secondary Phys Ed jaybugs20@hotmail.com
Stone, Brett Secondary Phys Ed-elect bastone@ozarks.edu
Standing Committee Chairs
Mooneyhan, Andy Constitution amooneyh@astate.edu
Mathis, Mitch District Organization mmathis@astate.edu
Pederson, Rockie Scholarships rpederson@atu.edu
Mayes, Susan Higher Educator of the Year smayes@uark.edu
Forbess, Janet Honor Award jforbess@uark.edu
Smith-Nix, Angela Necrology ansmith@uark.edu
Oitker, Jamie Teacher Awards jamie.oitker@cps.k12.ar.us
ArkAHPERD 2012 State Convention will be November 1-2
Embassy Suites Hotel
11301 Financial Centre Parkway : Little Rock, AR 72211
Phone: 1-501-312-9000

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A Peer Reviewed Article
Disease Risk Comparisons for High School Male Athletes and Nor-athletes
Monte Douglas, Marla Graves, Tom M. Adams II, and Matthew J. Comeau
Abstract
Objective: The purpose of this study was to compare the degree of association of potential disease risk defined by body mass index (BMI), skinfold measures, and waist circumference measures in high school male athletes and non-athletes.
Design: A total of 128 high school males, athletes and non-athletes, were recruited to participate. The study included 78 athletes and 50 non-athletes. Following IRB approval, male athletes and non-athletes from Jonesboro High School and Nettleton High School in Jonesboro, Arkansas, were asked to participate in this study. The subjects consisted of 9th to 12th graders between the ages of 15 to 18 years. Non-athletes were recruited based on nonparticipation in school related sports. Male athletes were recruited based on participation in at least one school sport. Males participating in more than one sport were also included in the study. Subjects in the study that identified themselves as athletes participated in one more of the following sports: baseball, football, track, basketball, golf, swimming, and tennis. The principle investigator recorded demographic data including age, height and weight. By utilizing a crosstab Somers’d, disease risk categorical values of the participants were determined by comparing BMI to body composition and BMI to waist circumference.
Results: No significant differences were found for athletes and non-athletes (p=.000) when comparing BMI to percent body fat and BMI to waist circumference disease risk classifications. The data indicated a strong symmetric relationship of .649 (athletes) and .723 (non-athletes) between BMI and percent body fat. There was also a strong symmetric relationship of .737 (athletes) and .746 (non-athletes) between BMI and waist circumference.
Conclusion: This study supports the use of BMI to predict disease risk evidenced by its strong association with percent body fat and waist circumference. However, assessing adolescents with a combination of BMI and percent body fat or BMI and waist circumference may yield a more proper disease risk classification for athletes and non-athletes.

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Introduction
Obesity is a serious health problem in the United States affecting adults as well as children and adolescents (Field, Laird, Steinberg, Fallon, Janneh, & Yanovski, 2003). Among adolescents, the prevalence of overweight individuals has increased by more than 100% in the past two decades and is associated with increases in morbidity. It is essential to the well being of the obese adolescent, that the signs and symptoms of obesity are identified early and that an intervention is begun to combat the potentially debilitating effects. It is essential to intervene early because children and adolescent who are overweight or obese are more likely to become obese adults (Field et al., 2003). Obesity in childhood affects virtually every organ system in an negative manner (Daniels, 2009).
Arkansas was one of the first states that attempted to increase awareness of obesity in children by passing legislation that mandated BMI assessments in public schools. In 2003, Arkansas passed Act 1220. This legislation mandates that every child, enrolled in public school, undergo a BMI assessment. The results of the assessment are then reported to the parents either via mail or it may be included as a separate document that is sent home along with the child’s report card.
In 2007 the Arkansas General Assembly modified the original annual assessment requirements (Raczynski et al., 2009). Beginning in the 2008-2009 school year, the assessment for each child was to be done every two years for students enrolled in even-numbered grades from kindergarten through grade 10 (Raczynski et al., 2009). Results of the first reporting of BMI assessment revealed that 38% of Arkansas’ youth were overweight or at risk for disease.
Since the implementation of the Arkansas Act 1220 of 2003, the percentage of children in all BMI categories reported by Arkansas schools has remained unchanged for the previous six years.
Some parents with overweight children are unable to correctly identify their children as obese or normal weight, which has become a major health concern in the state (Raczynski, Phillips, Bursac, Pulley, West, Birdsong, Evans, Gauss, Louvring, & Walker, 2005). Therefore, it is imperative for parents to receive the most accurate and valid measure of their child’s disease risk classification.
There are various measures to assess obesity such as body weight, body mass index (BMI), and waist circumference. However, these surrogate measures do not measure percent body fat (Prentice & Jebb, 2001). Although BMI does not measure percent body fat, the Center for Disease Control and Prevention (CDC) traditionally relies on this measurement to determine obesity as well as risk for disease in adolescents.
There has been little research comparing BMI, skinfold measurements and waist circumference in male athletes and non-athletes. Since BMI standard does not take into account percent lean body mass versus fat mass, it may be beneficial to consider using additional methods for determining disease risk. Potential findings of the present research will be advantageous in comparing BMI, skinfold, and waist circumference measurements. Findings of this study will allow the examination of association among these different methods of predicting potential disease risk in student athletes and non-athletes.
Purpose

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The purpose of this study was to compare the degree of association of potential disease risk defined by body mass index (BMI), skinfold measures, and waist circumference measures in high school male athletes and non-athletes.
Sample
Following IRB approval, male athletes and non-athletes from Jonesboro High School and Nettleton High School in Jonesboro, Arkansas were asked to participate in this study. The subjects consisted of male students in the 9th through 12th grade, and were 15 to 18 years old. Non-athletes were recruited based on nonparticipation in school related sports. Male athletes were recruited based on participation in at least one school sport. Males participating in more than one sport were also included in the study. Those identified as athletes participated in one or more of the following sports: baseball, football, track, basketball, golf, swimming, and tennis. The principle investigator documented the descriptive statistics including age, height and weight.
Body mass index (BMI), skinfold caliper measurements and waist circumference assessments were used to determine potential disease risk. BMI requires the measurement of weight and height. Each subject wore athletic shorts and a t-shirt only. A Befour Inc., Saukville WI, digital scale was used to measure weight in pounds. A standard measuring tape was mounted to a wall to determine height in inches to the nearest quarter inch. Each subject stood with his back to the wall with the feet together and heels flat on the floor. A ruler was placed on top of the head to mark the height of each participant. BMI was calculated by dividing body weight in pounds by height in inches squared and multiplied by 703. BMI scores were assigned the following categorical values: 1= underweight (<5th percentile); 2 = normal weight/ no risk (5th - <85th percentile); 3 = at risk (85th - <95th percentile); 4 = overweight/high risk for disease risk (≥95th percentile) (CDC, 2000).
Skinfold thickness was assessed using the Lange skinfold caliper. Using the FITNESSGRAM’S guidelines, each subject was marked with a pen on the right tricep and calf. To assure measurements were taken at the same site on the triceps, the site was marked on the posterior midline of the upper arm halfway between the acromion and olecranon processes with the arm hanging freely to the side of the body. The calf was marked at the maximum circumference on the midline of its medial border (Meredith & Welk, 1999). Each site was assessed a minimum of two times and had to be within 2mm of the prior measurements to ensure accuracy. If the site measured wasn’t within 2mm, additional assessments were made until accuracy was established. The tricep was measured first, followed by the calf to allow the skin to regain normal thickness for each site. The average of the two scores from each site was calculated to produce an accurate measurement. According to the FITNESSGRAM, the categorical values selected for disease risk as determined by skinfold for percent body fat were: 1 = low; 2 = optimal range; 3 = moderate high; 4 = high; 5 = very high (Meredith & Welk, 1999).
Waist circumference measurements were taken midway between the lowest rib and the supra iliac crest or the hip bone. A Gulick tension regulated tape measure was used to measure waist circumference in centimeters. Waist circumference was taken a minimum of two times, and the measurements had to be within 2 cm to ensure accuracy. A final value was calculated by taking the average of the two scores. For waist circumference, the categorical values were: 1= low (<10th percentile); 2 = normal (<75th percentile); 3 = at risk (75th – 90th percentile); 4 = high

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risk (>90th percentile) according to the waist circumference chart (Fernandez, Redden, & Pietrobelli, 2005).
Data Analysis
Data were analyzed using Statistical Package for Social Science (SPSS) computer software. A crosstab Somers’d was run to determine the relationship in categorical values between BMI, percent body fat, and waist circumference. A significance level of .05 was used for all significant relationship tests.
Results
The data indicated a strong symmetric relationship of .649 (athletes) and .723 (non-athletes) between BMI and percent body fat. There were also a strong symmetric relationship of .737 (athletes) and .746 (non-athletes) between BMI and waist circumference.
However, when analyzing the Somers’d Crosstab disease risk classification, 55.6% athletes were classified at an optimal range as determined by percent body fat, but they were classified at a risk for disease based on BMI values. This indicates percent body fat may be a better predictor in classifying disease risk for athletes.
When analyzing disease risk classification for non-athletes, 3.2% were classified at a very high risk for disease based on percent body fat classification, but they were categorized as ‘normal’ based on BMI measures.
When analyzing disease risk classification for athletes, 83.3% were classified as ‘normal’ based on waist circumference classification, but were classified as ‘at risk for disease’ according to their BMI values (Table 1). When analyzing disease risk classification for non-athletes, 60% were classified as ‘normal’ according to waist circumference but were classified as ‘at a risk for disease’ as determined by BMI values (Table 2). This data indicates a relatively large number of both athletes and non-athletes may have been misclassified as being ‘at risk’ based on BMI values, but were considered ‘normal’ according to waist circumference values. This data may indicate a strong need to include waist circumference assessments along with BMI measures.
Discussion
BMI is one of the most commonly used methods in classifying students as ‘at risk’ for hypokinetic diseases, however, it is a less accurate and less valid measure than skinfold assessment because BMI does not discriminate between fat mass and fat free mass. (Houtkooper, 1996; Mei et al., 2002). Figure 1 represents the relationship between BMI classification and body fat classification in male athletes and shows there is a significant positive relationship between BMI and percent body fat with a symmetric value of .649. This indicates there is a strong correlation between BMI and percent body fat which indicates there is a strong association between percent body fat and BMI. This finding was expected since higher body fat and higher total body weight are strongly associated.
BMI is inexpensive and easy to perform, but the validity of BMI in accurately classifying adolescents’ disease risk has been questioned (Mei et al., 2002). Figure 2 shows the relationship between BMI classification and percent body fat classification in male non-athletes. According to Figure 2, there is a significant positive relationship between BMI and percent body fat classification with a symmetric value of .723 for non-athletes. This indicates there is a strong correlation between BMI and percent body fat, which supports the argument that BMI may yield similar results as percent body fat in predicting disease risk classification for non-athletes.

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When comparing Figures 1 and 2, there are relationship differences between BMI and percent body fat. The non-athletes (Figure 2) had a greater symmetric value (.723) compared to the symmetric value (.649) in athletes (Figure 1). This indicates BMI and percent body fat classification had a stronger positive relationship for non- athletes. Houtkeeper (1996) found percent body fat to be a better predictor for disease risk. However, since BMI only takes into consideration height and weight, it doesn’t correlate well with fat mass in adolescents (Hergenroeder & Klish, 1990). Therefore, based on the current data, it is recommended to use percent body fat assessments to predict disease risk for athletes.
Figure 3 represents the relationship between BMI classification and waist circumference classification in male athletes. According to Figure 3, there is a significant positive relationship between BMI and waist circumference with a symmetric value of .737. This indicates there is a strong correlation between BMI and waist circumference and it may be beneficial to use waist circumference in addition to BMI to determine disease risk classification for athletes.
Figure 4 represents the relationship between BMI classification and waist circumference classification in male non-athletes. According to Figure 4, there is a significant positive relationship between BMI and waist circumference with a symmetric value of .746. This indicates there is a strong correlation between BMI and waist circumference and using both values to determine disease risk may be beneficial.
When comparing Figures 3 and 4, there are relationship differences between BMI and waist circumference. The non-athletes (Figure 4) had a greater symmetric value of .746 compared to the athletes symmetric value of .737 in Figure 3. This indicates there was a stronger positive relationship between BMI and waist circumference classification in non-athletes compared to athletes. Therefore, based on this current data, it may be more appropriate to use waist circumference assessments to predict disease risk for athletes than to use BMI values alone. Figures 3 and 4 support findings of Taylor, Jones, Williams, and Goulding (2000), in which they determined waist circumference to be a better predictor for disease risk in youth.
In conclusion, parents need to be aware that BMI data provides valuable information concerning disease risk for children and has a positive association to more direct measures of body fatness such as percent body fat and waist circumference. However, assessing adolescents with a combination of BMI, percent body fat, or BMI and waist circumference may give the adolescent and his/her parents more information regarding actual percent body fat, body fat distribution, and disease risk.
Table 1 Descriptive Statistics (Mean±SD)
Males
Subjects
age (y)
Ht. (y)
Wt. (lbs)
Athlete
78
15.8±1.2
69.6±2.7
180.8±43.8
Non- athlete
50
16.7±1.2
68.7±2.5
165.9±33.3
Total
128
16.1±1.2
69.3±2.7
174.9±40.5

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Table 1 Comparison of BMI classification for athletes Table 2 Comparison of BMI classification for non-athletes
Figure 1 Figure 2
Significant (p=.000) positive relationship Significant (p=.000) positive relationship
between BMI and percent body fat between BMI and percent body fat
classification for athletes. Classification for non-athletes.
Figure 3 Figure 4
Significant (p=.000) positive relationship Significant (p=.000) positive between BMI
and waist relationship between BMI and waist
BMI Classification vs % Body Fat Classification in Athletes
y = 1.0661x - 0.3113
0
1
2
3
4
5
6
0 1 2 3 4 5
BMI Classification
% Body Fat Classification
BMI Classification vs % Body Fat Classification in Non-athletes
y = 1.2216x - 0.3074
0
1
2
3
4
5
6
0 1 2 3 4 5
BMI Classification
BMI Classification vs Waist Circumference Classification in Athletes
y = 0.6873x + 0.5069
0
1
2
3
4
5
0 1 2 3 4 5
BMI Classification
Waist Circumference Classification
BMI Classification vs Waist Circumference Classification in Non-athletes
y = 0.7018x + 0.4433
0
1
2
3
4
5
0 1 2 3 4 5
BMI Classification
Waist Circumference Classification
Low
Risk
1
Optimal
Range
2
Moderate
Risk
3
High
Risk
4
Very
High
Risk
5
Total
BMI
Classification
2 Normal
Weight
5
16.1%
21
67.7%
4
12.9%
0
0%
1
3.2%
31
100%
3 At Risk
0
0%
0
0%
3
30%
6
60%
1
10%
10
100%
4 High Risk
0
0%
0
0%
1
11.1%
4
44.4%
4
44.4%
9
100%
Total
5
10%
21
42%
8
16.00%
10
20.00%
6
12%
50
100%
Low
Risk
Optimal
Range
Moderate
Risk
High
Risk
Very
High
Risk Total
BMI
Classification 1 2 3 4 5
2 Normal
Weight
9
23.1%
25
64.1%
5
12.8%
0
0%
0
0%
39
100%
3 At Risk
1
5.6%
9
50%
5
27.8%
3
16.7%
0
0%
18
100%
4 High Risk
0
0%
1
4.8%
6
28.6%
4
19%
10
47.6%
21
100%
Total
10
12.8%
35
44.9%
16
20.5%
7
9%
10
12.8%
78
100%

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circumference classification in athletes. circumference classification in non-athletes.
REFERENCES
1. Daniels, S. R. (2009). Complications of obesity in children and adolescents. Int J Obes (Lond), 33 Suppl 1, S60-65.
2. Fernandez, J., Redden, D., & Pietrobelli, A. (2005). Waist circumference percentiles in children and adolescents. Growth, Genetics and Hormones, 21(1).
2. Field, A., Laird, N., Steinberg, E., Fallon, E., Janneh, M. S., & Yanovski, J. (2003). Which metric of relative weight best captures body fatness in children? Obesity Research, 11(11), 1345-1352.
3. Hergenroeder, A., & Klish, W. (1990). Body composition in adolescent athletes. Pediatric Clinics of North America, 37(5), 1057-1083.
4. Houtkooper, L. (1996). Assessment of body composition in youths and relationship to sport. International Journal of Sport Nutrition, 6, 146-164.
5. Mei, Z., Grummer-Strawn, L., Pietrobelli, A., Goulding, A., Goran, M., & Dietz, W. (2002). Validity of body mass index compared with other body-composition screening indexes for the assessment of body fatness in children and adolescents. American Journal of Clinical Nutrition, 75, 978-985.
6. Meredith, M. D., & Welk, G. J. (1999). Fitnessgram test administration manual (Second Edition ed.). Dallas, Tx: Human Kinetics.
7. Prentice, A. M., & Jebb, S. A. (2001). Beyond body mass index. International Association for the Study of Obesity, 2, 141-147.
8. Raczynski, J., Phillips, M., Bursac, Z., Pulley, L., West, D., Birdsong, M., et al. (2005). Establishing a baseline to evaluate act 1220 of 2003. Little Rock: University of Arkansas for Medical Sciences.
Raczynski, J. M., Thompson, J. W., Phillips, M. M., Ryan, K. W., & Cleveland, H. W. (2009). Arkansas Act 1220 of 2003 to reduce childhood obesity: its implementation and impact on child and adolescent body mass index. J Public Health Policy, 30 Suppl 1, S124-140.
9. Taylor, R., Jones, I., Williams, S., & Goulding, A. (2000). Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high truck fat mass, as measured by dual-energy x-ray absorptiometry, in children aged 3-19 y. American Journal of Clinical Nutrition, 72, 490-495.

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Arkansas Department of Education
Physical Education Curriculum Materials
Andy Mooneyhan, Jim Stillwell, and Thomas Castilaw
State Departments of Education have traditionally provided curriculum materials to K-12 educators to assist them in the development, implementation and assessment of their educational programs. With the evolution of the computer age, more specifically the Internet, this material has been made ready available online. To get a clear understanding of the types of educational materials provided to today’s physical educators, the investigators examined the state department websites (see Table 1) of the 13 states within the Southern District Association of the American Alliance for Health, Physical Education, Recreation, and Dance (SDAAHPERD). Specifically, the investigators
Table 1
State Website
Alabama www.alsde.edu/home/Default.aspx/
Arkansas http://arkansased.org/
Florida http://www.fldoe.org/
Georgia http://www.doe.k12.ga.us/
Kentucky http://www.education.ky.gov/KDE/
Louisiana www.louisianaschools.net/default.html/
Mississippi http://www.mde.k12.ms.us/
North Carolina http://www.dpi.state.nc.us/
Oklahoma http://www.sde.state.ok.us/
South Carolina http://ed.sc.gov/
Tennessee http://www.state.tn.us/education/
Texas http://www.tea.state.tx.us/
Virginia http://www.doe.virginia.gov/
Sought to find if available curriculum content cut across the following areas (see Table 2).
Table 2 - Curriculum Content Areas
Assessment tools
Integrated activities
Lesson plans
Philosophy
Standards or frameworks
Student objectives or outcomes

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The purpose of this paper was to (a) present current information relative to the physical education curriculum content provided by the Arkansas Department of Education (ADE) and (b) compare it to the content provided by the remaining 12 SDAAHPERD states.
It was found that Arkansas, as did all Southern District state agencies, provided curriculum materials on its Department of Education website. Relative to Table 2 the only curriculum material provided were NASPE based frameworks and student objectives. Those items missing from the state’s website were (a) assessment information; (b) any integrated activities; (c) sample lesson plans; and (d) a physical education philosophy. Even though these four, sought-after content areas were missing, the ADE website provided additional items, including a state accepted physical education equipment list, a list of state adopted teaching materials, and a question and answer section.
The NASPE based frameworks were presented in two separate documents, those being:
Document 1 - Physical Education Curriculum Framework – Revised Summer 2005
Document 2 - K-8 Physical Education and Health Curriculum Framework – Revised 2005
Four physical education standards were included in both framework documents. These standards are (a) motor skills and movement pattern; (b) health-related fitness; (c) lifetime sports and recreation; and (d) personal and social behavior. The 13 page Document 1 was written for grades 9-12.
In addition to these four standards, the 72 page Document 2 included seven additional standards related to health, those being (a) human growth and development; (b) disease prevention; (c) community health and promotion; (d) healthy life skills and relationships; (e) alcohol, tobacco, and other drugs; (f) personal health and safety; and (g) nutrition.
In conclusion, the ADE does provide curriculum materials to its public school physical educators. However, this content is minimal. It is noteworthy that the ADE provides NASPE based frameworks and that the website allows for information retrieval in either a PDF or Word format. But, it is the investigators’ recommendation that the ADE work to expand and update its web-based content, specifically in the five areas shown in Table 2.

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Osteoporosis Prevention among College Students: Strategies for Health Professionals
Ellen Edmonds, Lori Turner, Sharon Hunt, and Deidre Leaver-Dunn
Osteoporosis is a skeletal disorder characterized by compromised bone strength, predisposing to an increase risk of fracture. Osteoporosis is a serious public health concern that affects both men and women. It is estimated that ten million individuals have osteoporosis and another thirty-four million suffer from low bone density (NOF, “America’s Bone Health,” 2002). By 2020, approximately sixty-one million individuals will have osteoporosis or low bone density (NOF, “America’s Bone Health,” 2002). The increase risk of fractures leads to increased morbidity and mortality (Sharp & Thombs, 2003). The estimated cost of osteoporosis will rise to $200 billion by 2040 if prevention efforts do not improve (McBean, Forgac, & Calvert, 1994).
The most deleterious effects of osteoporosis are fractures. One in three women and one in eight men over fifty years of age will experience fractures due to osteoporosis; these fractures are costly to both the government and the person. Twenty-four percent of hip fracture patients aged fifty years and older die in the year following the fracture, with higher death rates among men than among women and among non-white women than among white women (CDC, “Healthy Aging,” 2008).
The most common sites of fractures are at the spine, wrist, and hip which are where trabecular bone predominates. Spine fractures usually occur in the middle or lower section of the back. Wrist fractures include fractures of the radius, ulna, or the small bones of the wrist. Approximately 1.5 million fractures are associated with osteoporosis each year. This includes 300,000 hip fractures, 700,000 vertebral fractures, 250,000 distal forearm fractures and 250,000 fractures at other sites (Sharp & Thombs, 2003). Hip fractures were listed as the cause of death on 12,661 death certificates in 1999 (USDHHS, 2004). Approximately 20% of hip fracture patients die within a year of the fracture (Leibson, Tostenson, Gabriel, Ranson, & Melton, 2002).
Bone diseases are more likely to lead to poor health than to death (USDHHS, 2004). In 1995, osteoporosis fractures led to more than half a million hospitalizations, over 800,000 emergency room encounters, more than 2.6 million physician office visits, and the placement of nearly 180,000 individuals into nursing homes (USDHHS, 2004). Fractures resulting from osteoporosis can lead to pain, height loss, inability to stand, disfigurement, depressions, isolation and the inability to walk (Salkeld et al., 2000). Only 40%-79% of patients regain their previous function a year after the fracture (USDHHS, 2004). Hip fractures are the most disabling type of fracture and usually result in permanent disability (Kanis & Johnell, 1999). Hip fractures are the most disabling type of fracture in people with osteoporosis. More than one in four individuals suffering a hip fracture becomes disabled in the following year because of the fracture. Nearly one in five requires long-term nursing home care. In 1995, 140,000 persons were admitted to nursing homes due to hip fractures (USDHHS, 2004).

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In 2002, the annual direct care expenditures for osteoporotic fractures were $12.2 billion - $17.9 billion per year. Hip fractures are the most ravaging and most costly of all fractures, representing $11.3 billion of the total direct expenditure of osteoporosis.
Purpose
The purpose of this review was to describe the disease of osteoporosis and its costly outcomes; to discuss risk factors among college students; and to develop strategies for health professionals based on the studies reviewed.
Methods
Articles were obtained from multiple databases; study inclusion criteria were publication in years 1998-2010. Key words of osteoporosis, bone health, calcium, college women were used.
Results
Osteoporosis Risk Factors
Older white women have a higher prevalence of the disease than other ethnicities and ages. Women over age fifty accounted for over 75% of the total cases in 2002. Women are more at risk than men; this is attributed to the fact that fewer men have low levels of bone density as compared to women. However, men account for two million of the people living with osteoporosis (NOF, 2008). Osteoporosis in men is under-diagnosed, undertreated, under-reported, and inadequately researched.
According to the Surgeon General’s Report on Osteoporosis (USDHHS, 2004), genetics accounts for 50%-90% of bone mass in individuals. Genetics sets perimeters on bone structure, rate of bone loss, and skeletal response to environmental stimuli such as nutrition and physical activity (USDHHS, 2004). If either of one’s parents had osteoporosis or a history of broken bone, he/she is at higher risk.
Fear of being overweight and an obsession with thinness among females may translate into diets that fail to meet their caloric, calcium, or protein needs (Van Loan & Keim, 2000). Low body weight and the desire to be overly thin especially during pubertal development can predict low bone mass in adolescents (USDHHS, 2004). Many girls and young women begin to diet. Dieting can reduce bone mass by limiting the caloric, calcium, and protein needs. It can also result in lower body weights.
Low BMI is associated with low stores of body fat and lower circulating estrogen levels, which help prevent loss of bone tissue (Asomaning, Bertone-Johnson, Nasca, Hooven, & Pekow, 2006). Estrogen is enormously important in regulating and maintaining bone strength. Estrogen produced as a child and early in puberty has the prospect to increase bone growth. Estrogen acts to inhibit bone breakdown and may even stimulate bone formation (NOF, 2008). At the end of puberty, there is a high concentration of estrogen which stops further growth in height by closing the cartilage plates at the ends of long bone. Excessive dieting and weight loss among young college women can cause estrogen deficiency which affects calcium metabolism, fracture risk, and bone mineral content (USDHHS, 2004).
Nutrition is a modifiable factor in the prevention and treatment of osteoporosis, primarily by providing bone building nutrients and by influencing absorption and retention of these nutrients (Morgan, 2008). Calcium is crucial for achieving peak bone mass in an individual’s twenties and thirties of life and for maintaining bone mass for later in life (USDHHS, 2004). Other dietary components required for normal bone metabolism are vitamins D, K, A, C, protein, zinc, copper, iron, fluoride, and magnesium (Morgan, 2008). Diet plays a vital role in manufacturing and preserving bone mass throughout life
Bone mass is responsive to the load placed on the skeleton. Although there are many documented benefits of physical activity, more than 60% of American women do not engage in the recommended amount of physical activity (CDC, “Physical Activity for Everyone,” 2008). In addition to adults, results from Valois, Umstattd, Zullig, & Paxton (2008) suggest public high school adolescents are not engaging in moderate, vigorous, or strengthening physical activity behaviors. Perceived barriers play an important role in exercise adherence (Ransdell, 2004). Young women cite the following barriers to physical activity: multiple role expectations; fear of safety; fear of pain; lack of time; lack of access to facilities; poor instruction; threat of embarrassment; lack of family encouragement; overweight status; older age; poverty status; single parenthood; and cost (Ransdell, 2004).

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Smoking is correlated with reduced risk of bone mass and increased fracture risk. Smoking can lower the amount of calcium absorbed from the intestine, and it also has an effect in lowering body weight (Brot, Jorgensen, & Sorensen, 1999; Krall & Dawson-Hughes, 1999). Additionally, the nicotine has a direct effect on bone cells (USDHHS, 2004). Smoking also influences estrogen metabolism which means that a higher dose of estrogen hormone therapy is needed to achieve the clinical effects on bone density (Tansavatdi, McClain, & Herrington, 2004).
Alcohol inhibits bone remodeling. It may even reduce bone formation or affect vitamin D, which will affect calcium absorption (Laitinen et al, 1991). A moderate amount of alcohol seems to increase the risk of fractures (USDHHS, 2004). Alcohol use, especially during adolescence and young adulthood, affects bone structure and peak bone mass (Sampson, 2002).
The desire for the female athlete to succeed and to achieve a prescribed body weight can advance the development of the female athlete triad (Beals, Brey, & Gonyou, 1999). The female athlete triad may manifest itself as eating disorders, functional hypothalamic amenorrhea, or osteoporosis (ACSM, 2007). Bone health and development is impaired by low energy availability by inducing amenorrhea and removing estrogen’s control on bone resorption and suppressing the hormones that promote bone formation (ACSM, 2007).
Amenorrhea is the absence of three or more consecutive menstrual cycles. Primary amenorrhea is delayed menstruation by age sixteen in a female who contains secondary sex characteristics. Secondary amenorrhea is the absence of three or more consecutive menstrual cycles after menarche. Premature bone loss and inadequate bone formation resulting in low bone mineral density, microarchitectural deterioration, increased skeletal fragility, and increased risk of stress fractures to the extremities, hips, and spine are common in young female athletes with osteoporosis (USDHHS, 2004). Stress fractures are two to four times greater in amenorrheic than eumenorrheic athletes and occur more often in physically active women with menstrual irregularities and/or low BMD (Bennell, Matheson, Meeuwisse, & Brukner, 1999). The bone mineral lost due to the female athlete triad is at least partly irreversible.
Prevention and Treatment
Maintenance of bone health is the overall goal for both prevention and treatment of osteoporosis. Risk factors such as a diet low in calcium and limited weight-bearing physical activity must be minimized to reduce osteoporosis. These risk factors need to be reversed for optimal bone health. In some cases, individuals should be instructed on how to reduce risk of falls. Interventions focusing on maximizing benefits of physical activity and reduction of other risk factors are needed. Prevention is the key to attempt to reduce costs and symptoms associated with osteoporosis (USDHHS, 2004).
Health professionals must be able to recognize the warning signs of potential problems with a patient’s bone health. These signals apply to both men and women and all ethnicities. Fragility related fractures are one of the strongest indicators of bone disease (Ettinger, Ray, Pressman, & Gluck, 2003; Haentjens et al., 2003). If an individual has a history of fractures related to only mild or moderate trauma, he/she should be assessed further for potential bone disease (USDHHS, 2004).
Another warning sign is a family history of osteoporosis. Health professionals should look for all family members who have bone disease which could lead to early diagnosis and treatment (USDHHS, 2004).
Low body weight is a third warning sign for potential osteoporosis. Low body weight is associated with lower BMD and greater bone loss (Bainbridge, Sowers, Lin, & Harlow, 2004). For the elderly, a weight loss of more than 1% per year is associated with more rapid bone loss and an increase risk of fracture (Ensrud et al., 2003; Hannan et al., 2000; Knoke & Barrett-Conner, 2003).
Warning signs for adolescents include abnormalities of sex hormone function. Late onset of sexual development, cessation of menstrual periods, anorexia nervosa, or athletic amenorrhea syndrome is also risk factors for adolescents (USDHHS, 2004). Other warning signs include calcium and vitamin D deficiency, prolonged immobilization, paralysis, arthritis, kidney disorders, gastrointestinal disorders, and treatment with drugs that affect bone (USDHHS, 2004).
Once a high-risk patient is identified, further evaluation of his/her BMD is demonstrated. Measuring BMD is chosen because bone strength is related to BMD. It is a predictor of fracture risk (USDHHS, 2004). The dual x-ray

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absortiometry (DXA) is the most common method for measuring BMD. DXA consists of levels of radiation measuring BMD of the spine and hip sites. There are other methods for measuring BMD; however, the WHO’s recommendations for interpreting BMD results for diagnosis are based on DXA measurements of the hip or spine (USDHHS, 2004).
To interpret the results, the patient’s BMD is compared to the mean value in a reference population (young healthy adults). The difference between an individual’s BMD and the mean BMD for the reference population is expressed in standard deviation units. A score of zero indicates a BMD equal to the mean. A score of positive one indicates one standard deviation above the mean, and a score of negative one is one standard deviation below the mean. This standard deviation measurement is known as the T-score (USDHHS, 2004).
Four diagnostic categories were proposed for assessments done with DXA (Kanis, 2002; Kanis, Melton, Christianse, Johnston, & Khaltaev, 1994). The normal category is a hip BMD of no more than 1 standard deviation below the young adult female reference mean. The low bone mass category is a hip BMD between 1 and 2.5 standard deviations below the young adult female mean. The osteoporosis category is a hip BMD that is 2.5 standard deviations or more below the young adult female mean. The severe osteoporosis category is a hip BMD that is 2.5 standard deviations or more below the young adult mean in the presence of one or more fragility fractures (Kanis, 2002; Kanis, Melton, Christianse, Johnston, & Khaltaev 1994).
Another option for expressing BMD is the Z-score, which compares an individual with age, gender, and ethnicity matched norms. Z-scores are not the gold standard for diagnosis; however, they are useful in determining how an individual’s BMD compares with another individual similar to him/her. Patients with a low Z-score are in need of an evaluation for secondary causes of osteoporosis. The Z-score is particularly useful in children. T-scores should not be used for children since they have not reached peak bone mass (USDHHS, 2004).
Osteoporosis Education
For primary prevention, individuals should be advised to take steps to prevent osteoporosis (Germalmaz & Oge, 2008). Knowledge is considered the first step of behavior change (Ailinger, Braun, Lasus, & Whitt, 2005).
Sedlak, Doheny, and Jones (2000) demonstrated that participants’ osteoporosis knowledge can increase through osteoporosis education. This is consistent with findings from Ailinger, Braun, Lasus, & Whitt (2005), where they found that individuals who had received previous information about osteoporosis had more knowledge. While education improves knowledge, behavior change does not always follow (Kasper, Peterson, & Allegrante, 2001; Sedlak, Doheny, & Jones, 2000).
Ribeiro, Blakeley, & Laryea (2000) found that additional knowledge resulted in women assessing their risk of developing osteoporosis, requesting diagnostic tests, and taking preventative actions toward warding off this disease.
Women need to know that osteoporosis can start well before menopause in some women (Ribeiro, Blakeley, & Laryea, 2000); that hormone replacement therapy can be used effectively and safely; the benefits and risks of hormone replacement therapy and associated precautions; and that knowledge in the area of prevention and treatment can allow them to make informed choices regarding the use of medication or prompt treatment of potential side effects (Ribeiro, Blakeley, & Laryea, 2000).
Martin et al. (2004) discovered that 107 adolescent girls lacked knowledge of risk factors, calcium-rich foods, dietary calcium requirements, and the type of exercise needed to reduce the risk of osteoporosis. This population did correctly identify cheese and yogurt as good sources of dietary calcium but were not able to identify dietary sources of calcium when the choices did not include an obvious dietary source.
Kasper, Peterson, and Allegrante (2001) conducted research on 325 college women. This study produced information concerning methods of learning which women prefer concerning osteoporosis knowledge. They found that women prefer handouts, brochures, magazine articles, and short five-minute counseling sessions during medical office visits. Facilitating this preference is practical and efficient.
Education involves presenting information in an understandable manner. People need to perceive that they are susceptible to a disease and that the outcomes of the disease are serious (Rosenstock, 1974). Helping women overcome

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barriers is important, especially related to calcium intake (Ali, 1996). In a study conducted by Schmiege, Aiken, Sander, & Gerend (2007), barriers and self-efficacy directly predicted intentions to consume calcium among young women. Overcoming barriers and enhancing self-efficacy are recommended (Ali, 1996; Wallace, 2002).
Understanding reasons for non-compliance with treatment recommendations is helpful. For example, a reason typically cited for non-compliance to osteoporosis treatment is the belief that osteoporosis is not severe. Drozdzowska, Pluskiewicz, & Skiba (2004) found 50% of women believed osteoporosis is a minor health problem, and 53% think it is a curable disease. Health care providers can increase the likelihood of osteo-protective behaviors if people perceive it as severe. In a study conducted by Turner et al. (2004), presenting the negative outcomes associated with osteoporosis such as death, fractures, physical pain and emotional suffering was successful in modifying perceived severity.
Another reason for non-compliance is low perceived susceptibility. Some women assume osteoporosis only happens to elderly women. People who perceive themselves as not susceptible are less likely to take preventative actions (Turner, Hunt, DiBrezzo, & Jones, 2004). Patients who were told they had osteoporosis by a doctor or nurse were more likely to start medication; however, even among this group only 102 of 164 patients actually started treatment (Yood et al., 2008).
Many young adults do not perceive themselves at risk for osteoporosis; therefore, they do not practice preventative lifestyle habits. In addition, several perceive osteoporosis as a “women’s health” issue affecting only older women. Little attention has been paid to men or to women of ethnicities other than Caucasian (Johnson, McLeod, Kennedy, & McLeod, 2008). In a study conducted by Johnson, McLeod, Kennedy, & McLeod (2008), it was determined that young adults perceived themselves as less susceptible than older adults. Women believed they were more susceptible than men in each corresponding age group (Johnson, McLeod, Kennedy, & McLeod, 2008). Sixty five percent of young women thought osteoporosis was a disease of women more than seventy years of age (Hazavehei, Taghdisi, & Saidi , 2007).
Johnson, McLeod, Kennedy, & McLeod (2008) reported that men had low perceived severity concerning osteoporosis and were unlikely to make behavior modifications to combat the disease. Men also did not perceive themselves as susceptible to osteoporosis (Johnson, McLeod, Kennedy, & McLeod, 2008).
The national action plan for bone health is aimed at improving overall health and quality of life by enhancing the underlying bone health of all individuals, including women, men, racial and ethnic minorities, children, adolescents, and adults. Great improvements in bone health can be made by applying what is already known about early prevention, assessment, diagnosis, and treatment. Health care providers can assist patients in enhancing their bone health by promoting regular physical activity, a bone-healthy diet, and avoid behaviors that can damage bone such as use of tobacco and excessive use of alcohol. Health care professionals can play a significant role in supporting individuals in making these positive choices. Additionally health care providers can identify high-risk individuals and follow up with screening and treatment when appropriate.
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Environmental Hazards: Prevention and Care of Athletic
Injury and Illness
Brian Lyons, Ben Davidson, and J.J. Mayo
Introduction
Athletic participation places the contestants under extraordinary stress as enhanced levels of performance are sought. Athletes must adapt to the imposed physical, psychological, and emotional demands of high level human performance. Physical demands may be metabolic or environmental, and often these demands are synergistically coupled. Athletes do not compete in a vacuum; they always perform in a social and environmental milieu. Environmental conditions that may challenge athletic performance, and under certain conditions, may compromise the well-being of an athlete include extreme temperatures, wind, humidity, high altitude, lightning, poor air quality, exposure to sun, and synthetic playing turf. Even seemingly innocuous factors such as air travel can produce detrimental changes in circadian rhythms that can result in poor performance.
Coaches, athletic trainers, and players should be familiar with the etiologies of common environmental injuries and illnesses, the prevention of said conditions, and appropriate means of responding to these situations. The purpose of this paper is to provide a review of the causes, prevention, and care of environmental injuries and illness.
Heat Illnesses
The body is a biochemical machine and like any machine, it requires control mechanisms, a motor, and fuel systems. Control is effectuated primarily by the nervous and endocrine systems (Brooks, Fahey, & Baldwin, 2004). Muscles pulling on bones to create movements about joints represent the motor within the machine, and cellular systems including the phosphagen system, glycolytic system, and oxidative phosphorylation provide the energy necessary to perform work. These cellular systems are supported by the digestive, endocrine, cardiovascular, and pulmonary systems (Brooks, Fahey, & Baldwin, 2004). When energy is converted from its chemical forms, adenosine triphosphate, glycogen, glucose, and fatty acids, to produce mechanical work, some of the energy is lost in the form of heat. Thus, when the body increases its work intensity, cellular energy systems respond to meet the new higher energy demands and much heat is produced. Initially, increased heat production is advantageous as it serves to warm up the machine making it more efficient. However, increased heat production eventually becomes deleterious to the biochemical machine because its primary structural components are made of proteins. Also, the enzymes that catalyze the chemical reactions that modulate cellular function, including energy production, are made of proteins. Most of the hormones that effectuate systemic and cellular change during exercise are also comprised of proteins. When body temperature rises too much, these proteins will be destroyed and the machine breaks down (Brooks, Fahey, & Baldwin, 2004). Thus, coaches must recognize that it is “good to warm-up, but overheating must be avoided!”
Typically, when body temperature rises, thermoregulation is accomplished through circulation, perspiration, and evaporation. Any situation that compromises circulation, perspiration, or evaporation can quickly lead to an inability to dissipate excess heat (Brooks, Fahey, & Baldwin, 2004). To compound the challenge, environmental factors such as high ambient temperature, strong and direct sunlight, and high humidity can make it very difficult to dissipate heat (ACSM,

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2009; Brooks, Fahey, & Baldwin, 2004; Casa, Clarkson, & Roberts, 2005; Moran, 2001). Other factors including subcutaneous fat, clothing, and hydration level will also play an important role in thermoregulation (ACSM, 2009).
Excessive heat buildup can result in a number of hyperthermic effects, ranging from fatigue to death. Sport professionals should be familiar with the signs and symptoms of heat cramps, heat exhaustion, and heat stroke. Heat cramps and heat exhaustion are fairly common problems, but are usually not deadly. Heat stroke is less common, but can be fatal (ACSM, 2009).
Environmental factors that influence heat dissipation include temperature, direct sunlight, and humidity. High ambient temperatures make it difficult to transfer body heat to the environment; direct sunlight imparts more heat to the body than sun rays that are partially blocked by clouds; and high humidity interferes with evaporative cooling (ACSM, 2009; Brooks, Fahey, & Baldwin, 2004). A wet bulb global thermometer (WBGT) takes these factors into consideration and can provide a fairly good indication of the situational playing context. Sport leaders should become concerned when the WBGT index hits 80 and extreme caution should be exercised when the WBGT index is 85 and above (ACSM, 2009).
Heat cramps involve severe enduring painful spasms of the muscles. Traditionally, it has been purported that the etiology of heat cramps is linked to dehydration and electrolyte depletion (ACSM, 2009; Schwellnus, Derman, & Noakes, 1997). Another plausible explanation is that there exists neurological malfunction associated with muscle fatigue and enhanced muscle spindle excitability and concomitant Golgi tendon organ suppression (Brooks, Fahey, & Baldwin, 2004). In any event, it is imperative to keep the athlete well hydrated in order to reduce the incidence of heat cramps. Athletes should be directed to drink before, during, and after exertion. Athletes, of course, should be encouraged to consume adequate amounts of fruits and vegetables, which contain vitamins and minerals. If conditions are severe, sport drinks that contain glucose polymers and electrolytes should be consumed in order to prevent exertional hyponatremia (ACSM, 2009).
Heat exhaustion is more serious than heat cramps. It is typical with heat exhaustion that dehydration leads to decreased circulation, and consequently, “exhaustion” and an inability to continue to exercise. Sport leaders should be attentive to athletes who manifest unexpected or unusual fatigue, copious sweating, strong thirst, low dark colored urine output, cramping, and nausea. Heat exhaustion must be differentiated from heat stroke. The best way to make this distinction is to assess core temperature by taking a rectal reading. Temperatures below 104 degrees F are indicative of heat exhaustion; temperatures of 104 degrees F or higher would be indicative of heat stroke (ACSM, 2009). If it isn’t possible to discern whether the athlete is suffering from heat exhaustion or heat stroke, then the athlete should be treated for heat stroke. Again, the primary means of preventing any heat illness is to maintain adequate hydration and electrolyte levels. Athletes suffering from heat exhaustion should be offered fluids and cooled down by removing unnecessary clothing and moving the athlete to a cooler environment such as shade or an air conditioned training room.
Heat stroke is the most serious heat illness. It should be considered a medical emergency. Heat stroke can result in death. The person’s ability to circulate, “perspirate,” and evaporate is severely compromised and core temperatures are rising to very dangerous levels (> 104 degrees F). The athlete may or may not be sweating; the face is flushed and hot; the athlete is likely to be disoriented; nausea and vomiting may be present; coordination is often decreased; tachycardia and increased ventilatory rate are likely; and blood pressure abnormalities, usually hypotension, may manifest. Circulatory collapse is a major concern. Rapid recognition and action are required. The athlete must be immediately cooled and transported to a medical facility. Intravenous fluids should be given as soon as possible (ACSM, 2009).
Cold Injuries
Exposure to the cold can result in several injuries. Low ambient temperature, wind chill, and moisture, either from perspiration, precipitation, or immersion can predispose the athlete to cold injuries. Environmental conditions can result in general hypothermia, or more specific insult may result in frost nip or frostbite (Biem, Koehncke, Classen, et al., 2003; Cappaert, Stone, Castellini, et al. 2005; Moran, 2001) Appropriate clothing is probably the single greatest preventive measure regarding cold injuries. In extreme conditions, a hat and gloves should be worn, and sometimes it is necessary to cover the face as well. Clothing should be layered and it should be made of waterproof breathable material in order to keep moisture out and allow perspiration to evaporate. Layers can be added or removed as deemed necessary according to the conditions. Endurance athletes who compete in cold environments must be admonished to replace fluids. Dehydration is an insidious problem for cold weather athletes (Cappaert, Stone, Castellini, et al. 2005).

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Frost nip, as the name suggests, is an early mild form of frostbite. Exposed body parts such as the ears, nose, and fingers are particularly vulnerable. The toes are also especially susceptible to cold injury. Frost nip occurs when body parts are exposed to the cold and ice crystals may actually form within the tissues. These ice crystals generally melt quickly when the person is warmed. When “nipped,” the skin turns pale and there is typically numbness rather than pain. The skin is firm, but not hard. Warming and, if necessary, drying the afflicted body parts should provide adequate relief for frost nip. Breathing into the hands or placing the hands under the armpits can alleviate finger nip. Covering the ears and nose with the hands can be effective in treating nip in these areas. The toes must often be dried and warmed by removing the person’s shoes and getting him to a warmer environment. Rubbing the affected area must be avoided. Rubbing compresses the crystals and can cause further damage to the tissues (Cappaert, Stone, Castellini, et al. 2005).
Frostbite is more serious in that deeper tissues are usually affected. Frostbite is often accompanied by general hypothermia. The afflicted areas are typically grey or pale and hard and waxy. Blisters may be present. Generally, pain is not present, but numbness and clumsiness are experienced. Frostbitten persons need medical attention. Partial thawing and refreezing is contraindicated and may make the injury much worse. Affected areas must not be rubbed, and they must be immobilized using a splinting technique if possible. Blisters should not be broken. Once the athlete has reached a medical facility, rapid rewarming will commence. The affected parts will be immersed in 104 degree F water for twenty to thirty minutes. During and after rewarming, intense pain may be felt. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be administered to help with pain and to combat inflammation. Frostbitten areas that suffer too much damage may have to be amputated (Biem, Koehncke, Classen, et al., 2003; Cappaert, Stone, Castellini, et al. 2005).
A common sign of general hypothermia is shivering. Shivering, or chilblains, is a reflexive attempt by the body to generate more metabolic heat. Unfortunately, severe hypothermia resulting in core temperatures below 85-90 degrees F cannot be diagnosed by shivering because at these low temperatures shivering often ceases. Hypothermia may result in poor coordination and mental confusion. If temperatures are low enough, sleepiness may be experienced. If the core temperature drops below 85 degrees F, the individual may die. Treatment includes removing wet clothing, and getting the individual to a warmer environment. When the individual shows signs of lucidity, then warm fluids can be administered (Biem, Koehncke, Classen, et al., 2003; Cappaert, Stone, Castellini, et al. 2005).
Thin Air/High Altitude
High altitude can create special challenges for competitors. If altitude is going to prove problematic, it typically does so for the athlete who has traveled to high altitude and not the one who resides at high altitude. At higher altitudes, the partial pressure of oxygen is lower due to lower barometric pressures. Lower partial pressure of oxygen translates to compromised transfer of oxygen from the inspired air to the pulmonary capillaries and from the muscle capillaries to the muscle cells. Thus, hypoxia can result. Hypoxia is often compensated for by increasing ventilation and cardiac output at submaximal work intensities. At higher altitudes, air is typically cooler and drier as well. Hyperventilation coupled with dry air can quickly lead to dehydration. Hypoxia and dehydration can lead to reduced performance, but they can also lead to high altitude sickness, or acute mountain sickness. Mild altitude sickness usually involves headache, shortness of breath, increased heart and ventilatory rates, and fatigue (Basnyat & Murdoch, 2003; Berry & Pollard, 2009; Orchard, 2002).
Severe altitude sickness can involve pulmonary or cerebral edema. If pulmonary or cerebral edema is suspected, then this must be considered a medical emergency. At altitudes above 9,000 feet, some athletes will accumulate fluid in their lungs, and this accumulation typically worsens when the athlete is lying down. There exists a real risk that the athlete, untreated, could drown in this accumulated fluid. Athletes suffering from pulmonary edema will, of course, have a moderate to severe shortness of breath, fatigue, increased heart rate, and headache. It is common for them to develop a cough as they try to clear the lungs. Their compromised ability to deliver, extract, and utilize oxygen may result in cyanosis. Athletes suspected of presenting with pulmonary edema must be moved to a lower altitude as soon as possible. It is often helpful to administer oxygen to these athletes as well (Berry & Pollard, 2009; Orchard, 2002).
Cerebral edema involves the swelling of the brain. It is very dangerous and can prove fatal. A severe headache is a common symptom of cerebral edema. This headache will be accompanied by other signs and symptoms such as

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drowsiness and lost mental function, fatigue, and psychomotor sluggishness (Serrano-Duenas, 2005). Athletes who manifest these signs and symptoms must be moved to lower elevations immediately and they must be transported to a hospital as soon as possible (Basnyat & Murdoch, 2003; Berry & Pollard, 2009; Orchard, 2002).
Playing Outside in the Sun
Many sporting events take place out of doors. Sunshine provides light and warmth, but can prove very harmful when overexposure occurs. The sun’s rays are very damaging to the skin, and too much sunshine can lead to sunburn, premature aging of the skin, and premature death from cancer of the sunbather (Elwood & Jopson, 1997; Han & Maibach, 2004). Skin pigmentation influences the impact of the sun’s rays on the skin. Darker skinned people are somewhat less susceptible than light skinned people, but the sun does damage to all skin, regardless of the pigmentation. Thus, all people must be wary of the damaging impact of the sun (Elwood & Jopson, 1997; Han & Maibach, 2004).
The skin must be protected from the sun, and this protection should start in infancy. Athletes must be informed that sunscreen is essential and that clothing only partially blocks the sun’s rays. Athletes who practice or compete outside for several hours for many consecutive days should wear a broad spectrum sunscreen with a sun protection factor of at least 30. Sunscreens must be applied generously and must be reapplied. Sunscreens are not really waterproof regardless of manufacturer’s claims. Perspiration and exposure to water does degrade the protective function of sunscreen. The sunscreen should be applied all over the body because clothing is only partially effective in blocking the sun’s harmful rays. Certainly, this advice applies to all who are associated with competition. Thus, coaches, trainers, and fans should be wary of the potentially harmful effects of the sun as well. (Elwood & Jopson, 1997; Han & Maibach, 2004).
Common sunburn can result in three degrees of severity. First degree sunburn involves redness and pain. Second degree sunburn involves redness, pain, and blistering. Third degree sunburn is the most severe and involves charring. Third degree sunburn requires medical attention. First and second degree sunburns can usually be treated by the athletic trainer who may choose to consult with a physician. Treatment involves rapid removal from the sun, hydration, covering any open wounds, and NSAIDs for the pain. Aloe may be applied to promote healing and reduce pain. Other over the counter ointments are available as well. Oil based substances must not be applied to the burn. Old fashioned treatments involving butter and lard are absolutely contraindicated because they promote further burning. Sunburn predisposes one to skin cancer and should be avoided whenever possible (Elwood & Jopson, 1997; Han & Maibach, 2004).
Melanoma is becoming more common in society. Melanoma is a type of skin cancer that is deadly. Sport leaders should know how to recognize melanoma. Changes in a mole or other birthmark can indicate cancer. Changes in size, shape, or color should not be ignored. Pain or bleeding must not be ignored. If changes in moles are detected, then the individual should see a physician, preferably a dermatologist immediately. Early detection and treatment increases the probably of successful treatment. (Elwood & Jopson, 1997).
Playing Outside and Lightning
Lightning is a concern for those who spend time in the outdoors. Golfers are particularly susceptible, as are persons on ball fields, hikers, bikers, and boaters (Cherington, 2001). Lightning represents an electric discharge from the clouds, and lightning is always associated with thunder, whether or not the thunder can be heard. Lightning provides enough current pushed by sufficient pressure to be fatal. Lightning seeks ground and, thus, tall trees and hills must be avoided during lightning storms. If athletes are on a relatively flat surface such as a playing field, they must seek shelter immediately because they will be the highest structure around. All persons must avoid standing water during lightning storms because the water is a fairly good conductor of electricity. An indirect strike into a pool of water can be deadly. Fans in stadiums are also at risk because of their elevation. This situation is exacerbated if the structure is made of metal; metal is an excellent conductor of electricity (Cherington, 2001; Gratz & Noble, 2006). School buses used to transport fans and athletic teams, as well as spectator automobiles, can provide safe shelter for those in a lightning storm (Cherington, 2001).
Sport leaders should be aware of the flash-bang interval. The number of seconds between the illumination from lightning and the ensuing crackle or bang of thunder can provide a reasonable estimate of the distance between the lightning and the listener. The number of seconds should be divided by five in order to calculate the distance in miles. Thus, if the flash- bang interval is 10 seconds, then the lightning strike is two miles away. It is recommended that play be discontinued if lightning comes within three miles of the participants. Thus, if the flash-bang interval is 15 or less, then

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play should be suspended and shelter should be sought. Play should not be resumed for at least 30 minutes following the last episode of lightning and/or thunder (Cherington, 2001; Gratz & Noble, 2006).
Playing Outside and Air Pollution
It is an unfortunate fact that air quality is not what it used to be. Industrialized societies, including the U.S., have experienced the adverse effects of man-made pollution. Poor air quality is generally not life threatening for athletes; however, it can make it quite difficult to perform at the highest levels, and for certain athletes who have pulmonary problems such as asthma, smog can be quite problematic. Smog is formed when carbon monoxide and sulfur dioxide combine. Both carbon monoxide and sulfur dioxide are produced when fossil fuels such as gasoline and diesel fuel are burned. Smog tends to irritate the nasal and pulmonary passageways, and it can interfere with delivery, extraction, and utilization of oxygen to the working tissues (Abelsohn, Stieb, & Sanborn, 2002).
Smog is not the only consideration when considering air quality. Ozone, which ironically is disappearing at the earth’s poles making the sun’s rays more dangerous, can collect in urban areas near the earth’s surface. Ozone, or O3, forms when hydrocarbons from fossil fuel combustion combine with oxygen and nitrogen oxides in the presence of sunlight. Ozone can compromise performance, and it too is irritating to those who breathe it. Athletes performing in high smog and high ozone environments are particularly susceptible to ocular, nasal, and pulmonary irritation. Sport leaders and participants must recognize that air pollution can exacerbate asthmatic symptoms (Abelsohn, Stieb, & Sanborn, 2002).
Playing on Synthetic Turf
Synthetic turf has become quite popular. It offers many advantages such as requiring no water, no seeds, no fertilizers, and no mowing (E Magazine, 2008; Williams, 2008). It does not come without drawbacks, however. The commercial surfaces have, historically, been hard; and this makes it quite hard on those who fall on it (Orchard, 2002). These artificial surfaces have typically had high friction coefficients decreasing slippage tremendously. The elimination of slippage coupled with better footing may initially sound auspicious, but upon further consideration, it has also meant that injuries, especially, to the lower extremities, may have been increased because there is no play when athletes decelerate and pivot and when they are hit by other players (Abelsohn, Stieb, & Sanborn, 2002). The research that has investigated whether or not playing on artificial surfaces leads to increased incidence of serious injury is, to date, inconclusive (Lambson, Barnhill, & Higgins, 1996; Rodeo, O’Brien, Warren, et al. 1990).
Clearly, it is evident that skin abrasions will increase on the higher friction surfaces unless protective clothing is worn. Another injury that seems to be more prevalent on synthetic turf is turf toe, or the excessive hyperextension of the metatarsophalangeal joint of the great toe (Childs, 2006). The etiology of this injury typically involves an aggressive explosive push off while accelerating or changing direction. Turf toe can, in part, be prevented by wearing athletic footwear with a firm sole.
Resilient infill turf is becoming popular. Part of this turf involves a base comprised of little rubber pellets (ACSM, 2009; Brooks, Fahey, & Baldwin, 2004; E Magazine, 2008; Lioy & Weisel, 2008). Very little research has been do establish the safety of this turf. It is conceivable that these pellets could come loose and enter someone’s eyes or even get into their mouths. Consequences of contact with or ingestion of these pellets have not, as yet, been determined. It has been determined that some forms of synthetic turf contain lead, which is very damaging to the nervous system (Lioy & Weisel, 2008).
Jet Lag
Jet lag is typically not considered an “environmental injury or illness.” It is a condition associated with travel across time zones; it can reduce performance (Reilly, 2009; Durst, Waterhouse, Atkinson, et al. 2005). Circadian rhythms refer to the physiological and mental cycling that organisms use to efficiently exist in their environments. Typically, this cycling revolves around a 24 hour period, and is effectuated by changes in hormone release. Travelling across time zones, this is east to west or vice versa, can disrupt the synchronicity of the circadian rhythms and the local chronological clocks. In other words, the athlete’s body will be on one time and this time will differ from the actual local time. Travelling across multiple time zones will exacerbate the situation. Leg lag can result in a syndrome of conditions including headache, insomnia, dehydration; irritability; fatigue, and decreased mental function. Traveler’s constipation is a real phenomenon that is likely related to disrupted circadian rhythms (Reilly, Atkinson, & Waterhouse, 1997; Drust, Waterhouse, Atkinson,

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et al. 2005). It is very difficult to prevent jet lag, but if travel is anticipated, there are some steps that can be taken. It is reasonable and prudent to recommend that the athletes drink plenty of fluids before, during, and after travel. Recommending a moderate amount of fiber supplement may be wise as well. If the team is to travel west, then local times at arrival will be earlier than departure times. Athletes should be urged to get to bed earlier and to wake up earlier for several days before departure. If the team is to travel east, then local times at arrival will be later than departure times. Athletes should be urged to try to stay up later before going to bed and to try to sleep in for several days before departure. Unfortunately, this strategy is of little use if the athletes are expected to practice and play in the days prior to the departure; asking them to alter their sleep patterns would be tantamount to imposing disrupted circadian rhythms on them (Brooks, Fahey, & Baldwin, 2004; Drust, Waterhouse, Atkinson, et al. 2005).
Conclusion
Coaches and athletic trainers are interested in increasing human performance and protecting the well being of their athletes. Environmental conditions present certain challenges to the sport leaders and players. A football player from Tulane University who is expected to compete at the University of Utah in September will cross time zones and experience an increase in altitude, a cooler environment, and lower humidity. He may very well experience headache and fatigue, and he may become dehydrated as well. To make matters worse, he may not be able to poop. Sport leaders can ameliorate many of these difficulties by taking preventive measures and recognizing deleterious circumstances.
References
Abelsohn, A., Stieb, D., Sanborn, M.D., & Weir, E. (2002). Identifying and managing adverse environmental health effects: Outdoor Air Pollution. Canadian Medical Association Journal. 166, 1161-1167.
American College of Sports Medicine and National Athletic Training Association Joint Statement. Inter-association task force on exertional heat illnesses consensus statement. Available at: http://www.the-aps.org/news/consensus.pdf. Accessed March 7, 2010.
Barry, P.W., & Pollard, A.J. (2009). Altitude illness. British Medical Journal. 32, 915-919.
Basnyat, B., & Murdoch, D. (2003). High-altitude illness. The Lancet. 361, 1967-1974.
Biem, J., Koehncke, N., Classen, D., & Dosman, J. (2003). Out of the cold: Management of hypothermia and frostbite. Canadian Medical Association Journal. 168, 305-311.
Brooks, G., Fahey, T., & Baldwin, K. (2004). Exercise Physiology: Human Bioenergetics and Its Applications 4th ed. New York: McGraw-Hill.
Casa, D., Clarkson, P.M., & Roberts, W.O. (2005). American college of sports medicine roundtable on hydration and physical activity: Consensus statements. Current Sports Medicine Reports. 4, 115-127.
Cappaert, T.A., Stone, J.A., Castellini, J.W., Krause, B.A., Smith, D., & Stephens, B.A. (2008). National athletic trainers’ association position statement: Environmental cold injuries. Journal of Athletic Training. 43, 640-658.
Cherington, M. (2001). Lightning injuries in sports: Situations to avoid. Sports Medicine. 31, 301-308.
Childs, S.G. (2006). The pathogenesis and biomechanics of turf toe. Orthopaedic Nursing. 25, 276-280.
Drust, B., Waterhouse, J., Atkinson, G., Edwards, B., & Reilly, T. (2005). Circadian rhythms in sports performance - An update. Chronobiology International. 22, 21-44.
Elwood, J.M., & Jopson, J. (1997). Melanoma and sun exposure: An overview of published studies. International Journal of Cancer. 73, 198-203.
E Magazine. (2008). Artificial turf wars. Mar/Apr, 12-13.

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Gratz, J., & Noble, E. (2006). Lightning safety and large stadiums. American Meteorological Society. Sept, 1187-1194.
Han, A., Maibach, H. (2004). Management of acute sunburn. American Journal of Clinical Dermatology. 5, 39-47.
Lambson, R.B., Barnhill, B.S., & Higgins, R.W. (1996). Football cleat design and its effect on anterior cruciate ligament injuries. A three-year prospective study. American Journal of Sports Medicine. 24, 155-159.
Lioy, P.J., & Weisel, C.P. (2008). Artificial turf: Safe or out on ball fields around the world. Journal of Exposure Science & Environmental Epidemiology. 18, 533-534.
Moran, D.S. (2001). Potential applications of heat and cold stress indices to sporting events. Sports Medicine. 31, 909-917.
Orchard, J. (2002). Is there a relationship between ground and climactic conditions and injuries in football? Sports Medicine. 32, 419-432.
Richards, P. (2004). High altitude sickness. Practice Nurse. 27, 49-55.
Rodeo, S.A., O’Brien, S., Warren, R.F., Barnes, R., Wickiewicz. T.L., & Dillingham, M.F. (1990). Turf-toe: An analysis of metatarsophalangeal joint sprains in professional football players. American Journal of Sports Medicine. 18, 280-285.
Schwellnus, M.P., Derman, E.W., & Noakes, T.D. (1997). Aetiology of skeletal muscle ‘cramps’ during exercise: A novel hypothesis. Journal of Sports Sciences. 15, 277-285.
Serrano-Duenas, M. (2005). High altitude headache. A prospective study of its clinical characterisitics. Cephalalgia. 25, 1110-1111.
Reilly, T. (2009). The body clock and athletic performance. Biological Rhythm Research. 40, 37-44.
Reilly, T., Atkinson, G., & Waterhouse, J. (1997). Travel fatigue and jet-lag. Journal of Sport Sciences. 15, 365-369.
William, C. (2008). Synthetic turf. Encounter. 21, 2-4.

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Relationship Between Hiking Difficulty Ratings and Heart Rate
Shelia Jackson and Annette Holeyfield
Introduction
Persons opting to spend their vacations in national and state parks often buy guidebooks to aid them in deciding what hikes they would like to undertake. Usually such guidebooks describe the trails with regard to where the trailheads are located, length, scenic aspects, route, approximate time to complete, elevation changes, and difficulty. Information about difficulty is quite valuable for those hikers who (1)want a challenging hike, (2)are trying to decide if a trail is appropriate to take a child, or (3)have restrictive physical conditions. Therefore, it becomes important to know the accuracy of these ratings.
Burtscher (2004) reported more than 10 million hikers and skiers annually visit the moderate altitudes of the Austrian Alps and estimated more than100 million mountain tourists worldwide.
Many researchers are concerned that tourists are not physically prepared to undertake the demands of mountain sport activities and found many hikers have pre-existing medical problems thus risking injury and death (Burtscher, 2004; Burtscher, Pachinger, Schocke, & Ulmer, 2007, Faulhaber, Flatz, Gatterer, Schobersberger, & Burtscher, 2007; Stephens, Diekema, & Klein, 2005; Saito, Tobe, Harada, Aso, Nishihara, & Shimada; 2002). In Japan, Saito et al. (2002) interviewed and conducted physical exams on 176 hikers of a middle altitude mountain and found 70% of the hikers were over 50, and 75% of the hikers over 70 had some pre-existing medical problems. Faulhaber et al. (2007) surveyed 1431 hikers in the Alps and reported 12.7% had at least one type of cardiovascular disease. Burtscher et al. (2007) reported hikers who died suddenly during mountain hiking when compared to a matched control group, had significantly (p < .001) more incidences of prior myocardial infarction (MI), known coronary artery disease without MI, diabetes, or hypercholesterolemia. They also found the control group participated in regular mountain sports activities significantly more (p < .001) than the hikers who died. In a study conducted in Mount Rainier and Olympic National Parks in Washington State, Stephens et al. (2005) reported 19 deaths in the parks between 1997 and 2001. Hiking (58%) was the most common activity at the time of death, and medical was the cause 21% of the time. Burtscher et al. (2007, p. 621) stated, “About 50% of all fatalities during mountain hiking are sudden cardiac deaths.”
In many recent studies, researchers investigated the use of hiking poles on the heart rates of hikers (Duckham, Bassett, Swibas, & Mcmahan, 2009; Duncan & Lyons, 2008). More related to the present study, however, is heart rate and hiking research found in three older studies by Huonker, Schmitdt-Trucksass, Sorichter, Irmer, Durr, Lehmann, and Keul (1997), Lehmann, Kaplan, Bingissen, Bloch, and Spinas (1997), and Watts, Martin, Schmeling, Silta, and Watts (1990).
In a study by Huonker, et al. (1997), in which hiking exercise was “prescribed” to patients with histories of coronary artery disease, heart rate changes occurred just as they would in cycle ergometry. Lehmann, et al. (1997) found that endurance exercise programs such as hiking, biking, or long-distance running 135 minutes per week for 3 months significantly decreased (p < .01) resting heart rate beats per minute by 9 percent. Watts, et al. (1990) recorded and averaged heart rates over 5-second to 1-minute intervals during selected mountaineering activities during a 7 day ice climbing seminar in the North Cascades. The researchers monitored two of the six subjects during a 6 hour summit ascent on snow and ice and found the experienced climber did not show an increase in heart rate as much as the inexperienced climber, but changes in heart rate did occur.
In summary, the literature reports (1)hiking is very popular, (2)hikers are often older, (3)the older the hikers, the more likely they have pre-existing medical conditions,(4)most hikers who died while hiking had pre-existing medical conditions, (5)experienced hikers were less likely to die while hiking, and (6)hiking can improve heart rate efficiency. Hikers know their age, pre-existing medical conditions, and experience and can use that knowledge to select hiking trails to match their abilities. However, they often rely on the ratings (e.g., easy, moderate, difficult) of guidebooks in this selection; therefore, the accuracy of these ratings becomes apparent. The purpose of this study was to compare the difficulty ratings of a

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popular hiking guidebook to the average and maximum heart rates of two subjects hiking six trails in Glacier National Park.
Methods
Two females, ages 38 and 39, volunteered to participate in this study. Both trained by walking and/or running an average of 4 to 8 miles a day 3 weeks prior to the hikes. Their resting heart rates prior to the hikes were 51 and 57 bpm, respectively.
The subjects selected eight hikes (four moderate, four difficult) from Molvar’s (1999) guidebook to hike in a 9 day period.1 One hike was completed each day except the fourth day for a total of 84 miles. Hikes received difficulty ratings of easy, moderate, and difficult (ordinal data) based on a table found in the appendix of the guidebook.
Polar Vantage XL Heart Rate Monitors were worn by the hikers which collected and stored heart rate data at 15-second intervals. Because a monitor had a memory capacity of 8 hr 20 minutes, subjects used10 monitors to store approximately 74 hours of data. Using the POLAR Computer interface/software, researchers downloaded the heart rate data collected from the hikes and determined the average heart rates, maximum heart rates, and hiking speeds per hike. They then calculated correlation coefficients between (a) the average heart rates of Subject 1 and Subject 2, (b) the average heart rates and difficulty ratings, and (c) the maximum heart rates and difficulty ratings using a Spearman rank order correlation (SPSS software program).
Results
Because of a malfunction with one of the heart rate monitors, the data of two hikes on Subject 1 were lost and, therefore, researchers ran correlations on the remaining six hikes (three moderate, three difficult). To calculate the Spearman rank order correlation with the difficulty ratings, hikes with a moderate rating had a rank of one and hikes with a difficult rating had a rank of two.
Presented in Table 1 are the difficulty ratings and elevations for each hike, as well as the hiking speeds, average heart rates, maximum heart rates, and percent of maximum heart rates of subjects. There was a high direct relationship (rs = .829) between Subject 1 and Subject 2’s average heart rates on the six hikes. There was a moderate direct relationship (rs = .432) between the average heart rates and difficulty ratings and a high indirect relationship (rs = -.671) between maximum heart rates and difficulty ratings (Miller, 2006). Ninety-five percent confidence intervals calculated on each of the correlations found intervals of -2.81 to 2.81, -2.39 to 6.39, and -11.31 to 15.31 for the average heart rates between Subject 1 and 2, for average heart rates and difficulty ratings, and for maximum heart rates and difficulty ratings, respectively (Spatz, 1993).
Discussion
Without an objective method of rating, trails may receive improper ratings, and persons may attempt hikes for which they are truly not prepared. In this study, the high direct relationship between the average heart rates of the two subjects indicated that the hikes that were the most intense for one subject were intense for the other. The moderate direct relationship between average heart rates and difficulty ratings indicated that the hikers experienced higher average heart rates with the difficult-rated hikes. However, the high indirect relationship between maximum heart rates and difficulty ratings indicated that the hikers had their highest heart rates with the moderate-rated hikes. Although the moderate-rated hikes had fewer elevation changes than those rated as difficult, the maximum heart rates and the speed of the hikers on the moderate-rated hikes indicate that the terrain was difficult and/or there were some very steep areas (see Table 1). Such information might be very valuable to someone with a heart condition when selecting appropriate hikes.
With only two subjects in this study, both trained and fit, generalization is limited. Recommendations for future studies include (1) having additional subjects representing a diversified segment of the population, (2) including hikes with difficulty ratings ranging from easy to difficult from a variety of parks, and (3) correlating altitudes with heart rate data.
Footnotes
1Falcon Guides publishes over 100 hiking guides for parks in over half the states of the USA. The publisher, Jay Nichols, of Falcon Guides was contacted via e-mail and asked how the difficulty rating scales in their guidebooks were formulated. Mr. Nichols e-mailed the following response: “The difficulty rating we use in our guidebooks is a relatively subjective rating with quite a bit of variation between authors” (personal communication, September 20, 2000).
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performance and physiological variables during mountain climbing. Journal of Exercise
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Duncan, M. & Lyons, M. (2008). The effect of hiking poles on oxygen uptake, perceived
exertion and mood state during a one hour uphill walk. Journal of Exercise Physiology, 11(3), 20-25.
Faulhaber, M., Flatz, M. Gatterer, H., Schobersberger, W., & Burtscher, M. (2007). Prevalence
of cardiovascular diseases among Alpine skiers and hikers in the Austrian Alps. High
Altitude Medicine & Biology, 8, 245-252. doi: 10.1089/ham.2007.1005
Huonker, M., Schmidt-Trucksass, A., Sorichter, S., Irmer, M., Durr, H., Lehmann, M., & Keul, J.
(1997). Highland mountain hiking and coronary artery disease: exercise tolerance and effects on left ventricular function. Medicine and Science in Sports and Exercise, 12, 1554-60.
Lehmann, R., Kaplan, V., Bingissen, R., Bloch, K. E., & Spinas, G. A. (1997). Impact of physical activity on cardiovascular risk factors in IDDM. Diabetes Care, 10, 1603-11.
Miller, D. (2006). Measurement by the physical educator: How and why. (5th ed.) Boston, MA:
McGraw-Hill.
Molvar, E. (1999). Hiking Glacier and Waterton Lakes National Parks. Helena, MT: Falcon.
Saito, S., Tobe, K., Harada, N., Aso, C., Nishihara, F., & Shimada, H. (2002). Physical condition
among middle altitude trekkers in an aging society. The American Journal of Emergency
Medicine, 20, 291-294.
Spatz, C. (1993). Basic statistics: Tales of distributions (5th ed.). Pacific Grove, CA: Brooks/Cole
Publishing Company.
Stephens, B., Diekema, D., & Klein, E. (2005). Recreational injuries in Washington state
national parks. Wilderness & Environmental Medicine, 16(4), 192-197.
Watts, P. B., Martin, D. T., Schmeling, M. H., Silta, B. C. & Watts, A. G. (1990). Exertional
intensities and energy requirements of technical mountaineering at moderate altitude.
Journal of Sports Medicine and Physical Fitness, 4, 365-76.
Table 1
Hiking Variables
__________________________________________________________________________
Rating Time Elevation Speed Ave HR Max HRH % of Max
(hours) (feet) (mph) (bpm) (bpm)
__________________________________________________________________________
M 5.13 60 1.3 121 212 117%
M 6.56 200 2.3 123 201 111%
M 2.48 460 1.2 119 175 97%
D 4.53 1600 2.4 127 172 95%
D 4.08 1700 2.1 119 177 98%
D 3.43 2240 2.7 125 173 96%
Note: M = moderate, D = difficult

32
Biomechanical Analysis of Badminton Serves Using Standard and Body Scaled Equipment: A Perception-Action Perspective
Shelia Jackson
Introduction
It is not unusual to go to the tennis courts and see a small child trying to swing a large racquet by choking up on the handle that he/she must hold with two hands because of its weight and the diameter of the grip. Who has not been amused at five-year olds’ attempts at shooting a regulation basketball at a regulation goal, or of a toddler crawling up stairs? However, what would be the pattern of an adult swinging a two meter racquet, shooting a medicine ball at a 10- meter goal from 15 meters, or trying to climb stairs that were 1.5 meters high? Would children exhibit patterns similar to those of adults given equipment fitted in size and weight and targets at lengths and heights based on their body size? Would they learn the mature patterns of movement sooner? J.J. Gibson (1979) based his theory of the perception-action perspective concerning such questions. Two basic concepts in J.J. Gibson’s perception-action perspective are (a) movement is often dictated by what the environment affords the individual to do (affordance), and (b) if tools and spaces are fitted based on the individual’s body size (body scaling) more mature patterns would be seen. Using the perception- action perspective of motor development, scaling environmental objects such as racquets, nets, balls, bats, goals, stairs, etc. to body size would allow for movements that were previously impossible (Haywood, 1993).
Numerous studies conducted examine the effects of modifying basket heights and ball size on performance in basketball with many showing that such modifications can lead to better form (Chase, Ewing, Lirgg, George, 1994; Gabbard & Shea, 1980; Isaacs & Karpman, 1981; Lindeburg & Hewitt, 1964). Saturn, Messier, & Keller (1989) conducted a biomechanical study on foul shooting and found that while changing the height of the basket affected performance, changing the size of the ball did not.
Using a scientific approach, the racket sport industry (i.e., badminton, squash, tennis, etc.) investigated the effect of equipment on fast interceptive actions, hand-eye coordination, and perception-action coupling in the field of motor control (Lees, 2003). Farrow and Reid (2010) found beginning tennis players in a modified ball/scaled court intervention group rated their experience participating in a 5-week tennis program as significantly “happier” than the group using standardized equipment. This supports Withagen and van der Kamp (2010) who stated, “What a pattern in the ambient flow informs about depends on the perceiver who uses it.” In a biomechanical study, Gagan (2003) reported children had greater racquet head speeds and more accuracy when they used one of four different size tennis racquets striking a stationary tennis ball. However, there was not a significant correlation between the size of the racquet they performed best with and the size, strength, or height of the participants.
Leading authors in the field of motor development recognize the need of and potential insight gained using advanced technology, in particular biomechanics that can provide quantifiable data (Lockman & Thelen, 1993; Wickstrom, 1983). This study compared serving patterns of children using standard badminton equipment and equipment scaled for their size thus testing the perception-action perspective of motor development that equipment scaled to body size affords children the ability to exhibit more mature patterns.
Method
Terminology
Transfer of momentum. Also known as the summation of speed principle, this was indicated when the movement of each segment started at the moment of greatest velocity of the preceding segment (Bunn, 1972).
Sequential pattern. This pattern was indicated when the timing of peak linear velocities of the shoulder, elbow, wrist, and shuttlecock were sequential beginning with the shoulder and ending with the shuttlecock (see Figure 1). According to Bunn (1972) and Hudson and Hills (1991), this would be the mature pattern in such open-link chain patterns as striking.

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Early release. This pattern was indicated when the shuttlecock was contacted prior to the wrist reaching its greatest velocity. This would be an example of an incomplete transfer of momentum (see Figure 2).
Other pattern. This pattern was indicated when the linear velocities did not follow the sequential pattern or early release pattern (see Figure 3).
Subjects
Subjects consisted of 12 children (6 males, 6 females), matched based on age, height, and weight) without previous badminton experience who volunteered with their parents’ permission from a local elementary school. Height, weight, and hand span measurements determined the proper racquet selection and the court dimensions for the body scaled trials. The means and ranges for age, height, weight, and hand span were as follows: age = 9.2 years ranging from 6.8 to 11.8; height = 1.34 meters ranging from 1.11 to 1.57; weight = 32.65 kg ranging from 18.61 to 66.28; and hand span = 16.46 cm ranging from 13.97 to 20.32. The elite male subject’s age, height, weight, and hand span were 67 years, 1.75 meters, 64.55 kg, and 23.08 cm, respectively. He had a previous state ranking of number two and had 19 years of experience.
Procedure
Filming was at 60 frames per second (fps) in the sagittal plane. Subjects had reflective markers placed on the shoulder, elbow, wrist, and base of the second metacarpal of the serving arm to aid in digitizing. With the exception of the elite subject, all subjects performed 10 trials serving in two conditions for a total of 20 trials. Prior to performing, the researcher demonstrated a legal serve to each subject. According to Pool and Poole (1996), a serve requires some part of both feet remain in contact with the floor within the boundaries of the service court until the server makes contact, and at contact, the shuttle must not be higher than the waist with the head of the racquet completely below any part of the server’s hand.
Condition A consisted of serving with a standard racquet over a standard net and into a standard court. Each subject served from a distance halfway between the short and long service line.
Condition B consisted of serving with a modified racquet based on the height, weight, and hand span of the subject according to the results and recommendations of Gowitzke and Waddell (1994). Subjects with hand spans less than 16.6 cm ranging in age from 6 – 8 years served with a 50 cm long, 95 gram racquet with a grip circumference of 7.0 cm. Subjects 9 – 11 years of age with hand spans less than 17.6 cm served with a 57 cm long, 100 grams racquet with a grip circumference of 8.0 cm. The court dimensions were body scaled according to the height of the subject. The net height was 92% of the height of the subject, and the long and short service lines determined by multiplying the subject’s height by 4.06 and 1.2, respectively. The researcher developed these adjustments by using the average height of a male adult, 165 cm (Department of Health and Human Services, Centers for Disease Control and Prevention, 2002), to body scale the standard court. For instance, the standard badminton net is 92% of an adult 165 cm tall, and the long service line is 4.06 times 165 cm. Each subject served from a distance halfway between the short and long service lines of the body scaled court.
In order to control for a learning effect, half the subjects performed Condition A first and the other half performed Condition B first. Each shuttlecock had a 2kg test fishing line 50 cm long attached to increase the probability of striking it. These “string birdies” allowed the novice subjects to strike a stationary shuttle versus having to drop or toss it to serve. The elite subject performed 10 serves under Condition A with a regular shuttlecock. The researcher recorded where the serve landed and the subject’s comments for each serve. Trial selection for digitizing was determined using the performance data taken on all trials. The trials digitized for kinematic analysis were those receiving the highest score in each condition for each subject.
Performance Analysis
Performance data on each trial were given point values based on the following criteria: (a) 5: over the net and in the court; (b) 4: over the net but short of the service line; (c) 3: contact on the face of the racquet but not over the net; (d) 2: contact with the face of the racquet but the shuttlecock hit the ceiling (7.32 m); (e) 1: contact with any part of the racquet other than the face; and (f) 0: no contact. Data from total points for each subject in each condition were applied to the Wilcoxon Matched Pairs Signed Ranks test.

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Kinematic Analysis
Film analysis was 2-dimensional analysis (60 fps) using a PEAK Performance movement analysis system. A Butterworth digital filter smoothed the data. In all trials, digitizing began with the first forward movement of the racquet towards the shuttlecock and ended five frames following contact. The linear velocities of the shoulder, elbow, wrist, hand, and shuttlecock were then calculated. Based on the order and magnitude of these linear velocities, the digitized trials were Early, Other, or Sequential as defined previously. Comparisons between the two conditions (body scaled and standard) were made using the Chi-Square Test of Independence and Wilcoxon Signed-Ranks t-Test.
Results
Because there were multiple tests, the Bonferroni adjusted for inflation of alpha allowing for an alpha of .01 to be set.
Performance
The results of the Wilcoxon Signed-Ranks t-Test on performance data indicated a significant (p < .01) increase in performance using the body scaled equipment. The mean score for Condition A was 20 with a standard deviation of 14.81; the mean score for Condition B was 29 with a standard deviation of 11.88.
Kinematic
The Wilcoxon Signed-Ranks t-Test revealed no significant differences (p > .01) in maximum linear velocities of the shuttlecock in the body scaled trials versus the standard trials. The mean velocities and standard deviations for the body scaled and standard trials were M = 14.1761 m/s, SD = 4.0 and M = 13.547 m/s, SD = 5.539, respectively. Only two subjects (two of the largest subjects) had greater linear velocities with the standard racquets. The elite badminton player generated a maximum linear velocity of 29.035 m/s serving the shuttlecock.
Maximum linear velocity of the shuttlecock determined the point of contact (see Figures 1, 2, &3). The elite badminton player exhibited a sequential pattern. Novice subjects exhibited the more mature sequential pattern 11% of the time in Condition A and 66% of the time in Condition B (see Figure 4). Contact with the shuttlecock prior to the subject’s proximal joint reaching maximum linear velocity (an “Early” release) was present 55% of the time in Condition A and 22% of the time in Condition B. Patterns of simultaneous maximum velocities or combinations of sequential, early, and simultaneous were categorized under “Other” with 35% of the subjects exhibiting these patterns during Condition A and 12% exhibiting them during Condition B. A Chi-Square Test of Independence revealed the sequential pattern was displayed significantly more often (p < .01) in the body scaled trials than in the standard trials.
Discussion
Numerous researchers found the sequential pattern of coordination to be the most prevalent timing sequence for expert performers in tasks where the object (e.g., ball, disc, and racquet) is light, velocity is important, and there is an open link system (Bunn, 1972; Hudson & Hills, 1991; Jackson & Healey, 1997; Jackson & Tanner, 1993; Miller & Jackson, 1995). Biomechanical research (Gowitzke & Waddell, 1991; Luhtanen & Blomqvist, 1996) indicated that the sequential pattern was prevalent among the most advanced badminton players in underarm power strokes and clears. In agreement with the related literature, the pattern of the elite badminton player’s serve in this study was sequential. Although there was no significant difference between the two conditions with regard to the velocity of the shuttlecock, the frequency of the mature sequential pattern of serving occurred significantly more often in the body scaled trials. Performance using the body scaled equipment, as indicated by serving locations, was significantly better than with the standard equipment. This is in agreement with Gagan (2003) who also found children performed best using tennis racquets of 23-inches and 25- inches versus the standard 27-inches.
Finally, the unsolicited comments from the two smallest male subjects indicated they perceived body scaled trials were easier. Subject 8 (height = 1.11 m, weight = 18.61 kg, hand span = 14 cm), having completed the trials using the standard equipment stated after his first trial with the modified equipment, “This is easy!” Subject 9 (height = 1.27 m, weight = 27.69 kg, hand span = 15 cm) having completed the trials using the modified equipment, observed the standard court and racquet and remarked, “Oh no!” Noted during video analysis was that the length of the standard racquet prevented the smaller subjects from extending their elbows during the serve making it impossible for them to have a sequential pattern; however, they were able to do this with the modified rackets. According to the perception- action perspective, the modified rackets afforded the smaller subjects the ability to perform the more mature pattern whereas the standard racquet did not.

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Understanding and utilizing such theories as the perception-action perspective in the planning of activities helps ensure that the task, equipment, and environment interact to encourage appropriate movements (Gagen & Getchell, 2006). Questions remain as to whether having small children use standard equipment discourages them to the point they no longer attempt many physical skills, or because of the size and weight of the equipment, they learn inappropriate patterns that are hard to break when they get older. Regardless, with the variety of equipment available today, there is little excuse for physical education programs not to provide equipment based on the average size and strength of its students.
References
Bunn, J. W. (1972). Scientific principles of coaching (2nd ed.). Englewood Cliffs, NJ: Prentice
Hall, Inc.
Chase, M., Ewing, M., Lirgg, C., & George, T. (1994). The effects of equipment modification on
children's self-efficacy and basketball shooting performance. Research Quarterly for Exercise and Sport, 65(2), 159-168.
Department of Health and Human Services, Centers for Disease Control and Prevention, and
National Center for Health Statistics (2002). 2000 Growth charts for the United States: Methods and development (Series 11, No. 246).
Retrieved from http://www.cdc.gov/nchs/data/series/sr_11/sr11_246.pdf
Farrow, D. & Reid, M. (2010). The effect of equipment scaling on the skill acquisition of
beginning tennis players. Journal of Sports Sciences, 28, 723-732. doi: 10.1080/02640411003770238
Gabbard, C. P. & Shea, C. H. (1980). Effects of varied goal height practice on basketball foul
shooting performance. Coach and Athlete, 42, 10-11.
Gagan, L.M. (2003). Choosing a racket for striking tasks in elementary school. Journal of Physical Education, Recreation, & Dance, 74(7), 39-40.
Gagen, L. M. & Getchell, N. (2006). Using ‘constraints’ to design developmentally appropriate
movement activities for early childhood education. Early Childhood Education Journal, 34, 227-232. doi: 10.1007/s10643- 006-0135-6
Gibson, J. J. (1979). An ecological approach to visual perception. Boston: Houghton Mifflin.
Gowitzke, B.A. & Waddell, D.B. (1991). Biomechanical studies of badminton underarm power
strokes, court movement, and flexibility: A review. In C. Tant, P. Patterson, S. York
(Eds.), Biomechanics in Sports IX (pp. 215-219). Ames, Iowa: Iowa State University.
Haywood, K. M. (1993). Life span motor development (2nd ed.). Champaign, IL: Human
Kinetics Publishers.
Hudson, J.L. & Hills, L. (1991). Concepts of coordination. In C. Tant, P. Patterson, S. York
(Eds.) Biomechanics in Sports IX (pp. 215-219). Ames, Iowa: Iowa State University.
Isaacs, L. D. & Karpman, M. B. (1981). Factors effecting children's basketball shooting
performance: A log-linear analysis. Carnegie School of Physical Education and Human Movement, 1, 29-32.
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Adapted Physical Activity, Quebec, Canada.
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Amherst, MA: University of Massachusetts Amherst.

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Lee, A. (2003). Science and the major racket sports: a review. Journal of Sports Sciences, 21(9),
707-732.
Lindeburg, F. A. & Hewitt, J. E. (1964). Effect of an oversized basketball on shooting ability and
ball handling. Research Quarterly, 36, 164-167.
Lockman, J. & Thelen, E. (1993). Developmental biodynamics: Brain, body, behavior
connections. Child Development, 64(4), 953-59.
Luhtanen, P.H. & Blomqvist, M.T. (1996). Kinematics of clears in junior badminton players. In
J. M. C. S. Abrantes (Ed.), Proceedings of the XIV ISBS Symposium (pp. 236-239).
Lisboa Codex, Portugal: Edicoes FMH. Miller, S. & Jackson, S. (1995). Kinematic comparative analysis of the coordination pattern of the basketball free throw. In T. Bauer (Ed.), Proceedings of the XIII International Symposium on Biomechanics in Sports (pp. 71-74). Thunder Bay, Canada: Lakehead University.
Poole, J. & Poole, J. (1996). Badminton (4th ed.) Prospect Heights, Illinois: Waveland Press Inc.
Satern, M. N., Messier, S. P., & Keller-McNulty, S. (1989). The effects of ball size and basket
height on the mechanics of the basketball free throw. Journal of Human Movement Studies, 16, 123-137.
Wickstrom, R. L. (1983). Fundamental motor patterns. Philadelphia: Lea and Febiger.
Withagen, R. & van der Kamp, J. (2010). Towards a new ecological conception of perceptual
information: Lessons from a developmental systems perspective. Human Movement
Science, 29, 149-163. doi: 10.1016/j.humov.2009.09.003
0
2
4
6
8
10
1
2
3
4
5
6
7
8
9
10
Meters/Second
Shuttlecock Contact at Frame 9
Figure 1. Resultant Linear Velocities of Sequential Pattern
Shoulder

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0
2
4
6
8
10
1
2
3
4
5
6
7
8
9
10
Meters/Second
Figure 2. Resultant Linear Velocities of Early Pattern
Shoul…
0
2
4
6
8
10
1
2
3
4
5
6
7
8
9
10
Meters/Second
Figure 3. Resultant Linear Velocities of Other Pattern
Should…
0
10
20
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70
Sequential
Early
Other
Percent
Patterns
Figure 4: Percent of Patterns in Each Condition
A: Standard
B: Modified

38
Training for Peak Performance and Reduced Injury in Female Athletes: Appropriate Use of Weight Training and Plyometrics
Timothy Baghurst, Ro DiBrezzo, and Inza Fort
Abstract
With the inception of Title IX in 1972, female participation in sports has risen dramatically (NCAA, 2008; NFHS, 2008). In fact, women are participating in sport, fitness, and recreational activities like never before. Although the number of injuries has also risen with this greater participation, this increase cannot account for the higher rate and severity of injuries reported by female athletes. In comparison sports, females report greater rates of injury than their male counterparts. The purpose of this article, therefore, is to highlight how weight training and plyometrics can be adapted to reduce the incidence of injury and enhance peak performance in female athletes. Practical application for the coach and educator is provided.
Introduction
The introduction of Title IX has transformed the gender balance of participation in sports both in schools and colleges. In 1982, for example, there were 74,239 female athletes competing in championship sports at the collegiate level. This has more than doubled to 174,534 in 2007 (NCAA, 2008) which in turn has directly affected the number of females participating in high school sports. In 1971, only 294,015 girls participated in high school sports contrasting with 3,021,807 in 2007 (NFHS, 2008).
Although this increase in sports participation by females is encouraging due to the many health benefits associated with physical activity and exercise, unfortunately this participation comes at a cost. Not surprisingly, the number of sports related injuries reported by females has also increased. In 2007, the Journal of Athletic Training dedicated an entire volume to the incidence of injuries in collegiate sports. Although a variety of male and female sports were assessed, only the sports in which both genders compete are compared and presented in Table 1. Interestingly, the injury rates per 1000 athletes suggest that males are more injury prone than females. This is not particularly surprising, given the greater forces that can be generated by males. However, of particular concern is that females appear to have a higher injury rate than males during practice in all the sports presented. Also, with the exception of softball, the injuries sustained are more severe than their male counterparts. These findings may suggest that males are more willing to take risks during competition. However, an additional possibility exists that females may be training inappropriately leading to a higher rate of practice related injuries and those classified as severe.
Severe Female Injuries
Although severe injuries can occur due to unexpected circumstances (i.e. a soccer player has the misfortune of becoming overly familiar with a goal post), many of the severe injuries that occur are a result of lower extremity strains, tears, or ruptures of muscles, tendons, or ligaments (Le Gall, Carling, & Reilly, 2008). Such injuries are devastating, can cause significant loss of playing time, and potentially affect the athlete for the rest of her life.
Unfortunately, such injuries are all too common in sports. In high risk sports such as soccer and basketball, the likelihood of an anterior cruciate ligament (ACL) is four to six times more likely for females than males when the rules are similar (Myer, Ford, Paterno, Nick, & Hewett, 2008). The lower limbs are subjected to particularly high forces during these activities, and without proper flexibility and strength of the supporting muscles, these ligaments are prone to fail.
The high incidence of serious injuries among female sports participants has been receiving greater attention in the national media. For example, a recent New York Times article by Sokolove (2008) highlights the seriousness and frequency of these injuries.

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"This casualty rate… is part of a national trend in the wake of Title IX and the explosion of sports participation among girls and young women… women are suffering injuries that take them off the field for weeks or seasons at a time, sometimes forever." (p.54)
These editorial comments are not without merit. An eight year longitudinal study of 119 female youth soccer players reported 619 injuries, 35.7% of which were categorized as moderate, 12.4% as major, with 83.4% of total injuries occurring in the lower extremities (Le Gall et al. 2008). Similarly, Schiff (2007) found that of the 49 female youth soccer players that had reported being injured, 77.5% occurred in the lower extremities.
Reduction Strategies
It is understandable that injuries will occur. After all, injuries can occur doing almost any activity, whether sporting or not. The key is to identify how teachers, coaches, and practitioners can reduce the likelihood of these severe, sometimes preventable injuries. For example, Hutchinson and Ireland (1995) suggest that female knee injuries are a result of a combination of lower extremity alignment, pelvis width, tibial rotation, foot alignment, lower extremity alignment, and a gender difference in baseline level of conditioning. Although some of these areas cannot be anatomically modified, we propose that modifications to female conditioning through the inclusion of gender-adjusted weight training and plyometric exercises will help to reduce the prevalence of these injuries in female sports.
Weight & Resistance Training
An athlete, whether recreational or competitive, needs to be physically prepared to accomplish her goal. Traditionally, exercise and fitness experts created generic training programs and exercise that appealed to the heterogeneous group (Wilmore, Costill, & Kenney, 2008). Unfortunately, one size does not fit all, with weight training and resistance training certainly not the exception.
Weight training serves multiple purposes in sport and exercise. Primarily, it enhances muscular strength and/or muscular endurance, but can also reduce injury rates, encourage good posture, strengthen tendons and ligaments, and improve body composition (Fahey, Insel, & Roth, 2009). In order to promote muscular strength or muscular endurance, a muscle or muscle group must undergo some form of overload. This overload must be gradual and progressive whereby the muscle is stressed and thereby forced into adapting. In addition, resistive training needs to be target specific with consideration given to the training intensity, muscle group, type of contraction, range of movement, and the speed at which the training is completed (Heyward, 2006).
When weight training, it is important to give muscular parity due consideration. That is, the ratio between muscle groups needs to be carefully monitored. A strengthening of an agonist muscle without strengthening its contrasting antagonist can lead to a muscular imbalance; thus, both agonist and antagonist muscle groups must be overloaded for adaptation to occur in a balanced design. For example, with respect to knee stability, Baratta, Solomonow, Zhou, Letson, Chuinard, and D'Ambrosia (1988) suggest that a coactivation of the antagonist muscle is needed to assist the ligaments in maintaining joint stability. It was concluded that knee injuries could be reduced by the use of resistive exercises designed to strengthen the antagonist which would in turn reduce muscular imbalance.
Only recently has specific consideration been given to weight training programs designed specifically for females (Wilmore et al., 2008). If the data derived from men have collected through the years relative to fitness programs and superimpose it on women we may fall short. There are of course significant skeletal differences as well as lean mass and muscle mass differences which render some fitness regimes inappropriate.
Plyometrics
The term plyometrics is derived from the Greek plio (more) and metric (measure), and became popular as a result of the jumping performances observed in the 1960s in Eastern Europeans (Houglum, 2005). It was first introduced as a training technique to bridge the gap between strength and speed (Wilt, 1975), and is very applicable to many sports, as most require a combination or synthesis of both. Plyometrics can continue to develop athletes’ strength and speed, yet permit them to rest from the typical mechanical motions of that sport, for its purpose is to replicate or parallel movement patterns used by athletes (Potteiger, Lockwood, Haub, Dolezal, Almuzani, Schroeder et al., 1999).

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The use of plyometrics to reduce injury rate in female sports has for the most part been positively supported in research. Pfeiffer, Shea, Roberts, Grandstrand, and Bond (2006) implemented a twenty minute, twice weekly, plyometric-based training program with female high school athletes over a two year period. The training focused on deceleration from a sprint and the mechanics of landing from a jump during their respective seasons. The rate of noncontact ACL injuries was not found to differ between those that completed the plyometric training and those who did not.
However, Mandelbaum and colleagues (2005) placed 844 female soccer players between the ages of 14 and 18 in a sports-specific training intervention that occurred prior to their soccer practice. The intervention included a variety of plyometric exercises to improve core strength and balance. The authors compared this group to 1913 females who did not complete the intervention. They found that those in the intervention group had an 88% decrease in ACL injuries during the first year of the study and 74% in the second year compared with those in the control group.
Similarly, other studies that have assessed the inclusion of plyometric training on serious injuries have found that such training reduces the incidence among female athletes in multiple sports (Hewett, Lindenfeld, Riccoene, & Noyes, 1999), and can decrease impact forces and increase hamstring torques in jumping activities (Hewett, Stroupe, Nance, & Noyes, 1996).
Application
Plyometrics comprise of a variety of exercises that enable a muscle to reach its maximum possible strength through lengthening and then shortening the muscle so that it produces an increase in power output. Such exercises frequently utilize the force of gravity to store energy in the muscle. This allows the eccentric and concentric phases of a muscle contraction to be trained.
A plyometric exercise typically goes through a three phase process which can be referred to as the stretch-shortening cycle: the eccentric, amortization, and concentric phases (Houglum, 2005). The first phase consists of a fast eccentric movement (e.g. hopping off a platform and landing) where elastic energy is stored. It is considered to be the most important phase and should be done quickly with a partial range of motion.
The second phase, or the amortization phase, is a very quick transition phase which consists of the time needed to halt eccentric movement and transfer it to concentric movement (e.g. stopping the force of gravity). The shorter this phase is, the more powerful the third phase will be.
The concentric phase is the third and final phase and consists of an explosive muscle contraction (e.g. leaping back up). Thus, if both the eccentric and amortization phases were done quickly, the outcome evidenced in the concentric movement should be fast and powerful. The regular use of these phases should increase motor unit recruitment and efficiency thereby enhancing strength-speed production (Houglum, 2005).
There are literally dozens of plyometric exercises. However, consider these examples which should be well-known or self-explanatory by their name: vertical jumps, lunges, front obstacle jumps, lateral obstacle jumps, repeated tuck jumps, repeated long jumps, diagonal forward/backward obstacle jumps, alternate leg bounding, squat jump, single leg hops, and hand clap push-ups.
When designing and incorporating a plyometric program into sports training, it is vital that several safety precautions are taken. First, plyometrics should be progressive; that is, a command of general exercises should precede sports specific exercises, and simple exercises should be achieved before complex exercises are introduced (Houglum, 2005). Second, hold only two or three sessions per week, separated by at least 48 hours, to allow the body to adapt and recover. Third, be sure to properly warm up and stretch all joints and muscles. Fourth, wear adequate and well-cushioned footwear (Ratamess, Kraemer, Volek, French, Rubin, Gomez et al., 2007), and consider using softer landing surfaces such as grass, sand, or mats (Crowther, Spinks, Leicht, & Spinks, 2007; Impellizzeri, Rampinini, Castagna, Martino, Fiorini, & Wisloff, 2008). Fifth, maintain correct technique and posture. This is an imperative, for poor technique can lead to injury. It is strongly advised that practitioners conduct plyometric training before rather than after a sports-specific training session so that energy and concentration levels are high. In addition, athletes should be halted when technique falters and given adequate time to recover.

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A quality plyometrics session can be completed in 30-45 minutes. However, duration depends on the time given to rest between exercises. Typically, plyometric exercises are implemented for anaerobic sports that involve very quick, explosive movements. Longer rest periods between sets emphasize power, whereas shorted rest periods focus primarily on endurance (Willardson, 2006). Although some athletes will recover faster than others, 45 to 60 seconds is a sensible initial rest period between exercises that can be shortened as the athletes adapt. For example, tennis players are permitted 25 seconds between points. Therefore, by reducing the rest period between exercises to this time, adaption to the actual sport occurs. Finally, several other considerations should be noted by the practitioner including participant age, body weight (Allerheiligen & Rogers, 1995), and competitive level (Houglum, 2005), as each of these variables will moderate the duration and type of plyometric exercises performed.
Conclusion
Although the incidence rate of injuries in sport does not greatly differ by gender, females are at greater risk of severe injuries and injuries that occur during practice. These injuries frequently occur in the lower extremities due to the explosive nature of many sports. We propose that modifications in training need to be implemented in order to help reduce the likelihood and frequency of these injuries and enhance peak performance. First, weight training programs need to be designed for specificity and adaptation over tradition. Because agonists and antagonists work in tandem, the over-strengthening of one can lead to the detriment of the other. Thus, muscular parity is a necessity, and too often the emphasis for women is strength training with no consideration of muscular balance. Second, coaches and exercise practitioners should consider incorporating plyometrics into their training program. By doing so, core strength, speed, and power will be improved with the strong possibility of a reduction in injury rate.
References
Allerheiligen, B., & Rogers, R. (1995). Plyometrics program design. Strength and Conditioning, 17, 26-31.
Baratta, R., Solomonow, M., Zhou, B.H., Letson, D., Chuinard, R., & D'Ambrosia, R. (1988). Muscular coactivation: The role of the antagonist musculature in maintaining knee stability. The American Journal of Sports Medicine, 16, 113- 122.
Crowther, R.G., Spinks, W.L., Leicht, A.S., & Spinks, C.D. (2007). Kinematic responses to plyometric exercises conducted on compliant and noncompliant surfaces. Journal of Strength and Conditioning Research, 21(2), 460-465.
Fahey, T.D., Insel, P. M., & Roth, W.T. (2009). Fit & well: core concepts and labs in physical fitness and wellness. Boston, MA: McGraw-Hill.
Hewett, T.E., Lindenfeld, T.N., Riccobene, J.V., & Noyes, F.R. (1999). The effect of neuromuscular training on the incidence of knee injury in female athletes. The American Journal of Sports Medicine, 27, 699-706.
Hewett, T.E., Stroupe, A.L., Nance, T.A., & Noyes, F.R. (1996). Plyometric training in female athletes. The American Journal of Sports Medicine, 24, 765-773.
Houglum, P.A. (2005). Therapeutic exercise for musculoskeletal injuries. Champaign, IL: Human Kinetics.
Hutchinson, M.R. (1995). Knee injuries in female athletes. Sports Medicine, 19(4), 288-302.
Impellizzeri, F.M., Rampinini, E., Castagna, C., Martino, F., Fiorini, S., & Wisloff, U. (2008). Effect of plyometric training on sand versus grass on muscle soreness and jumping and sprinting ability in soccer players. British Journal of Sports Medicine, 42(1), 42-46.
Le Gall, F., Carling, C., & Reilly, T. (2008). Injuries in young elite female soccer players; an 8-season prospective study. The American Journal of Sports Medicine 36(2), 276-285.
Mandelbaum, B.R., Silvers, H.J., Watanabe, D.S., Knarr, J. F., Thomas, S.D., Griffin, L.Y. et al.
(2005). Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. The American Journal of Sports Medicine, 33(7), 1003.

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Myer, G.D., Ford, K.R., Paterno, M.V., Nick, T.G., & Hewett, T.E. (2008). The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes. The American Journal of Sports Medicine, 36(6), 1073-11.
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sports sponsorship and participation rates report. Retrieved 05/22, 2008 from http://www.ncaapublications.com/ProductsDetailView.aspx?sku=PR2008.
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Pfeiffer, R.P., Shea, K.G., Roberts, D. Grandstrand, S., & Bond, L. (2006). Lack of effect of a knee ligament injury prevention program on the incidence of noncontact anterior cruciate ligament injury, The Journal of Bone and Joint Surgery (American), 88, 1769-1774.
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Ratamess, N.A., Kraemer, W.J., Volek, J.S., French, D.N., Rubin, M.R., Gomez, A.L., et al. (2007). The effects of ten weeks of resistance and combined plyometric/strength training with the Meridian Elyte Athletic Shoe on muscular performance in women. Journal of Strength and Conditioning Research, 21(3), 882-887.
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Table 1
Rates and severity of injuries by gender in collegiate sports (adapted from the Journal of Athletic Training, 2007, 42).
Male
Female
I/R (per 1000) a
G/P Rate Ratio b
% Severe (G/P) c
I/R
(per 1000) a
G/P
Ratio b
% Severe
(G/P) c
Baseball/Softball
7.4
3.1
25/25
6.2
2.2
22/22
Basketball
12.9
2.3
18/18
12.9
1.9
25/25
Ice Hockey
17.4
8.3
27/25
11.3
5.0
no data
Lacrosse
15.7
3.9
21/21
9.1
2.2
22/24
Soccer
22.9
4.3
19/15
18.7
3.3
22/17
Note: a Injury rates (I/R) per 1000 athletes exposed by games or practice, data from 2002-2003 season.
b Rate ratio for injuries occurring during games (G) or practice (P).
c Percentage of injuries that are severe (lasting 10 or more days) caused by games or practice.

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