Feasibility of a 10-week, School-based Childhood Wellness Intervention

American Medical Society for Sports Medicine 18th Annual Meeting, Tampa, FL April 25–29, 2009 RESEARCH PRESENTATIONS Feasibility of a 10-week, School-based Childhood Wellness Intervention Paul J. Gubanich, MD, MPH, Emily Harold, MD, Laura Mowad, PhD, Jason Brayley, MD, and Anthony Miniaci, MD. Affiliation: Cleveland Clinic, Cleveland, OH. Purpose: Poor health practices such as suboptimum levels of physical activity, unhealthy dietary habits, risk taking behavior, low-self-esteem, and early exposure and use of tobacco, alcohol, and drugs threaten the health of our youth. Health habits learned early in life (both healthy and unhealthy) have been strongly associated with adult behavior. The purpose of this study is to examine the feasibility of a wellness initiative to promote positive health behavior in elementary school students. This pilot study will examine baseline health characteristics as well as the effectiveness of an educational intervention in modifying health-related knowledge, attitude, and behavior. Methods and Study Design: Eight 5th grade classrooms were paired within schools and cluster-randomized to participate as either an intervention or control classroom. All participating classrooms were drawn from one ‘‘firstring’’ school district in a large metropolitan city. Intervention classrooms received formalized instruction in the ‘‘Healthy Futures’’ curriculum, a program developed to meet age-appropriate health education standards to promote physical activity, nutrition, safety, confidence and self-esteem, and the dangers of tobacco, alcohol and drugs. Weekly sessions occurred during one classroom period over 10 weeks and were taught by physicians. Incentives were utilized to encourage participation and the completion of additional assignments. Baseline and post-program assessments were conducted in both intervention and control groups and consisted of measurement of height, weight, GB-23 survey (54 questions modified from the Middle School and High School Youth Risk Behavior Survey), and a one-mile run. Results: One hundred and six of a possible 193 participants enrolled in the study. Seventy-eight completed both baseline and post-program surveys (47 intervention, 31 control). At baseline, 40 of 100 participants (20/63 (32%) intervention, 20/37 (54%) control) displayed a body mass index (BMI) .85th percentile for age-sex matched norms (NSS). Follow-up assessments revealed that 14/50 (28%) of the intervention group and 17/32 (53%) of controls demonstrated a BMI. 85th percentile for age-sex matched norms (NSS). Exploratory analysis of the GB-23 survey exhibited an underreporting of weight (1.5 kg for intervention and 4.1 kg for control groups) vs measured weight at baseline (NSS). At baseline, most participants reported never smoking (96%) or drinking alcohol (71%). Improvements in self-reported physical activity, alcohol consumption (less), and breakfast consumption (more) were reported at follow-up in the intervention group. Conclusions: A 10-week, school-based wellness initiative was successfully implemented in this pilot study. Participation was lower than expected (55%) but in line with other school-based interventions. An improvement in BMI was noted in the intervention group but was not statistically significant. Further modification of outcomes instruments should be considered to reflect the needs of this age group. Significance of Findings: This study examines the heath knowledge and behavior of a large group of elementary school students. This study is the first step in a series of investigations designed to examine the efficacy of interventions in this population. Additional outcomes tools (surveys, devices, fitness tests) may be beneficial to validate current techniques and address some of the limitations encountered in this study. Acknowledgements: Cleveland Clinic Sports Health, Gary Baxter Second Line of Defense Foundation, Cleveland Clinic Childhood Wellness Committee, and my wife, Krista, for their time, support, and encouragement in this initiative. Pre-race Sodium Concentrations Associated with Post-race Sodium Concentration but not Pre-race Fluid Intake Before a Marathon Shane Shapiro, Rebecca McNeil, PhD, Michael Mohseni, MD, Walt Taylor, MD, Jennifer Roth, MD, Scott Silvers, MD, Tyler Vadeboncoeur, MD, Sherry Mahoney, MBA, RD, CDE, and Edith Perez, MD. Affiliation: Mayo Clinic Florida, Jacksonville, FL. Purpose: Confusion exists among endurance athletes as to the best way to replace fluids lost during exercise. We have previously reported hyponatremia caused by excessive pre-race hydration. This prompted concern that athletes who over-hydrate prior to races may begin competition at low sodium levels. We sought to test this hypothesis in a marathon setting. Methods and Study Design: Two hundred fifty subjects participating in The National Marathon to Fight Breast Cancer consented to complete a preand post-race survey and blood test. As part of this study, total fluid consumed by participants on the evening and morning before the race was estimated from continuous intake data and compared to preand post-race sodium using the Spearman correlation coefficient. Results: There was a faint, but not statistically significant, correlation between total fluid intake and sodium levels before the race. Higher fluid intake correlated with lower sodium levels (r = 20.13, P = 0.09). There was no correlation between the amount of fluid intake before the race and sodium levels after the race (r = 0.11, P = 0.14). Pre-race sodium and post-race sodium correlated positively and was statistically significant (r = 0.24, P = 0.0026). Conclusions: While pre-race sodium levels correlated with post-race sodium levels, the amount of fluid intake prior to the race did not correlate significantly with either. Increased fluid intake prior to endurance races would not seem to result in hyponatremia. Significance of Findings: Presumably healthy athletes with normal homeostasis will physiologically correct for the increased volume, preventing hyponatremia. Indeed, in our previously reported case, the athlete was using prescription medication which may have affected antidiuretic hormone. It appears that dilutional hyponatremia occurring during endurance sports is likely due to other factors. We report separately in this forum sodium levels which correlate with race finish time during this same marathon. Acknowledgements: Much appreciation is given to the Runners Science Group 2008 for their study organization and data collection. Risk Factors for Medical Withdrawals in USTA Junior National Tennis Tournaments Neeru Jayanthi, MD, Jeff O’Boyle, ATC, Ramon Durazo, PhD, and Amy Luke, PhD. Clin J Sport Med Volume 19, Number 2, March 2009 155 Affiliation: Loyola University Chicago Stritch School of Medicine, Maywood, IL, Department of Family Medicine, Orthopaedic Surgery & Rehabilitation, Score Tennis and Fitness, Countryside, IL, and Department of Preventative Medicine & Epidemiology. Purpose: There has been no large-scale epidemiologic study done to determine if match volume, age, sex, or singles are risk factors related to medical withdrawal in United States Tennis Association (USTA) junior national tennis tournaments. Such data can be used to provide evidence-based recommendations for the USTA to offer guidelines particularly for match volume in such tournaments. Methods and Study Design: A retrospective cohort analysis of data collected of every match of all four supernational (largest) tournaments (spring, summer, fall, winter) for both boys and girls divisions and all age divisions (12s, 14s, 16s, 18s) during a single year was performed. Data was obtained from USTA.com publicly available Internet site for all tournaments. Incidence and prevalence of medical withdrawals (retirements and walkovers due to injury or illness) was determined with matches played as the exposure. Logistic regression analysis was performed to determine relative risk of all interested factors. Additional analysis was performed to determine which match number in a tournament would substantially increase a player’s risk of medical withdrawal. Results: There were a total of 28 376 (14 108 male, 14 105 female) match exposures analyzed with an even distribution with respect to age as well (7056 in 12s, 7184 in 14s, 7002 in 16s, 7094 in 18s). The total medical withdrawal rate was 15.6/1000 match exposures. Every factor of interest was highly significant in predicting a higher rate of medical withdrawal/1000 match exposures: SEX: males (16.9/1000) vs females (14.0/1000), (P, 0.01); AGE: 12s (7.4/1000), 14s (11.7/1000), 16s (20.6/1000), 18s (22.7/1000), (P, 0.0001); main draw (8.1/1000) vs consolation (28.9/1000), (P, 0.0001), singles (17.9/1000) vs doubles (9.8/1000), (P, 0.0001). Medical withdrawal rate in the first through fourth matches in a tournament were (12.7/1000) vs fifth match and beyond (26.3/1000), (P, 0.0001). All of these results were highly significant even when only analyzing main draw matches or only main draw, singles matches. Conclusions: In USTA national junior tennis tournaments, there is a highly significant increase in risk of medical withdrawal directly related to higher age division matches, male matches, singles matches and main draw matches. More specifically, there is a significant increase in medical withdrawal rates beyond the fourth match in the tournament regardless of whether it is a main draw, consolation, singles, or doubles match. Significance of Findings: Recommendations can be made to exercise caution in tournaments that involve males, older age divisions, and singles. Additionally, there is sufficient evidence to suggest intervention within a tournament when players play beyond their fourth match. Susceptibility of Hydrostatic Weighing to Intentional Error in Weight Certification Use for Wrestlers Douglas C. Burns, MS, and Kevin N. Waninger, MD, MS. Affiliation: Sport and Exercise Science Program, Department of Natural Science, DeSales University, Center Valley, PA, and Department of Family Medicine and Emergency Medicine, St. Luke’s Hospital, Primary Care Sports Medicine Fellowship, Bethlehem, PA. Purpose: Recent efforts at education and optimal weight certification for high-school and collegiate wrestlers have improved health and safety for these athletes. Nevertheless, the culture of the sport continues to value an unrestricted freedom to lose unsafe amounts of body weight, largely through fluid loss, in order to wrestle at weight classes lower than those which are safe and/or optimal for the wrestler. Ordinarily body composition is assessed by the use of skinfolds, but many governing bodies permit a wrestler who believes that his body fat has been underestimated to appeal the skinfold estimation by hydrodensitometry in an accredited laboratory. The presumptions of hydrodensitometry presume cooperation by the subject in obtaining accurate assessments of body composition. When wrestlers are motivated to generate an erroneously high body fat ratio which will gain permission to lose an unsafe amount of body weight, they are able to manipulate the results of hydrodensitometry to achieve this end. This study was conducted to validate the susceptibility of hydrodensitometry to this intentional error. Methods and Study Design: In the first portion of the study, 12 collegiate athletes had their body composition estimated by hydrodensitometry using a system which measured their residual volume by helium dilution at the same moment that the submerged weight was recorded. They also had their body composition estimated by hydrodensitometry using the methodology in most common use for the appeals process for wrestlers. This included measurement of vital capacity in air and estimation of residual volume from this value. During hydrodensitometry, athletes were coached first to exhale as fully as possible for the residual volume maneuver and were then coached to selectively exhale less than fully so that the actual residual volume during the weighing maneuver was greater than the estimated value. Results: By selective retention of air during the residual volume maneuver, these athletes were able to raise their apparent body fat by 4% to 8% above the estimate made by actual measurement of residual volume. Conclusions: This study demonstrates the susceptibility of hydrodensitometry to intentional error when carried out in the manner prescribed by the appeals process of most governing bodies, ie, estimation of residual volume from a measured in-air vital capacity. Significance of Findings: Results of hydrodensitometry in this population need to be interpreted with great care. The Role of Vision on Knee Kinetic and Kinematic Variables During Drop Jumps from Unknown Heights Adam T. Chrusch, MD, C. Buz. Swanik, PhD, ATC, Matthew L. Hinsey, BS, ATC, Stephen J. Thomas, MEd, ATC, Gregory M. Gutierrez, PhD, Andrew S. Reisman, MD, ATC, David Webner, MD, Steven Collina, MD, and Jason Beaulieu, CSCS. Affiliation: University of Delaware, Newark, DE, and Crozer Keystone Sports Medicine Fellowship, Springfield, PA. Purpose: To establish the role of vision on knee biomechanics during drop jumps from unknown heights. Methods and Study Design: A one-group repeated measures design was used assessing 20 healthy collegiate football players. The independent variables were knowledge of the drop jump height (vision, no vision) and 2 drop heights (50 cm control height, 35 cm early landing height). Subjects self initiated a drop from a hydraulic lift platform (Central Hydraulics, Inc) onto an AMTI force plate (Watertown, Massachusetts), landing on both legs and jumping vertically as high as possible. Height and vision conditions were randomized during 12 jumps. Reflective markers defined the trunk, thigh, lower leg, and foot segments and were recorded (240 Hz) with 8 cameras (Motion Analysis Corp, Santa Rosa, California). Kinematic and kinetic data was imported into Visual3d software (C-motion, Inc, Rockville, Maryland) for processing. Two-way ANOVA’s were performed on peak vertical ground reaction force (N), time to peak force (ms), knee angle at ground contact (deg), maximum knee flexion angle (deg) and knee excursion (deg). Results: Time to peak force was significantly less in the no vision (time = 45 6 12 ms) versus vision conditions (time = .54 6 13 ms) (P = 0.003), and peak force was significantly greater (P = .018) in the no vision (force = 2409 6 874 N) versus vision conditions (force = 2016 6 656 N). A significant (P = .01) interaction was identified whereby peak force was even greater in the no vision-50 cm condition. Knee angle was significantly less flexed when landing without vision and the least flexed during the no vision-35 cm condition. Conclusions: Unanticipated early landings that occur without reliance upon visual cues leads to higher forces in a shorter period of time and with the knee in a more extended position. Significance of Findings: The methodology used in this study creates biomechanical aberrations that may simulate, in a controlled laboratory setting, the unanticipated events leading to non-contact knee injuries where visual-spatial disorientation disrupts the dynamic restraint mechanism. 156 q 2009 Lippincott Williams & Wilkins Abstracts Clin J Sport Med Volume 19, Number 2, March 2009