Pulse Spring 2011

Pulse Spring 2011

SMCA Board of Directors Ray Kardas - President

Dwayne Laing - Past President

Vacant - Vice-President

Breda Lau - Secretary

Michael Becher - Treasurer

Vacant - CASM Rep

Chris Holt - SPC Rep

Dexter Nelson - AATA Rep

Stephane Simard - SSAA Rep

Steve Johnson - SNS Rep

Garnet Brown - Member at Large

Kristine Godziuk - Member at Large

Maria Smith - Member at Large

Michael Wagner - Member at Large

SMCA Employees Barb Adamson - Executive Director

Janice Peters - Office Manager

Nicole Lemke - Technical Director

Pulse Magazine Published by: Sport Medicine Council of Alberta

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Website: www.sportmedab.ca

Contents copyright 2011 by SMCA.

Articles/abstracts may not be reprinted

without permission. The opinions are

those of the respective authors and are

not necessarily those of the SMCA.

ISSN: 1181-9812

Publication agreement no. 40038086

2 Spring 2011

Inside this issue:

Pan Pacific Conference - President’s Message 5

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

6

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

8

Creatine Application Strategies during Resistance Training in Healthy Older Adults

10

Leading the Way to Active and Healthy Lifestyles 12

SCI Action Canada: Advancing Physical Activity Knowledge and

Participation among Canadians with Spinal Cord Injury

14

What is Sports Psychology? 17

SMCA Resources: What is a Concussion? 18

Hydration - Water 19

Highlights from the Pan Pacific Conference of

Medicine and Science in Sport

Inside Pulse…

3 sportmedab.ca

The Sport Medicine Council of Alberta would like to Thank our Partners for

their ongoing Support:

Sport Nutrition Level 1

May 7, 2011

Location: Edmonton Host: SMCA

10:00 a.m. - 4:00 p.m.

Athletic Injury Management

May 14, 2011 June 11, 2011

Location: Grande Prairie Location: Sherwood Park Host: Alberta Sport Development Host: Strathcona Minor

9:00 a.m. - 5:00 p.m. Football Association

9:00 a.m. - 5:00 p.m.

Sport Taping & Strapping

May 15, 2011 June 12, 2011

Location: Grande Prairie Location: Sherwood Park Host: Alberta Sport Development Host: Strathcona Minor

9:00 a.m. - 5:00 p.m. Football Association 9:00 a.m. - 5:00 p.m.

Sport Trainer *Combination of Athletic Injury Management and

Taping & Strapping

May 14 - 15, 2011 June 11 - 12, 2011 Location: Grande Prairie Location: Sherwood Park

Host: Alberta Sport Development Host: Strathcona Minor 9:00 a.m. - 5:00 p.m. Football Association

9:00 a.m. - 5:00 p.m.

For more information on any of the above courses or to

register, visit sportmedab.ca/courses

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The Pan Pacific Conference of Medicine and Science in

Sport JANUARY 27-29, 2011: HONOLULU, HAWAII

PRESIDENT’S MESSAGE

“The Quality of the keynote speakers”

“Developing networks with Canadian counterparts”

“Meeting so many enthusiastic people”

The above quotations randomly selected from the post-conference survey fairly represent the overall comments submit-ted by the attending delegates of this historically significant Con-ference. There may never have been a Conference of any disci-pline CO-HOSTED by two countries so widely separated by time and space. The collaboration of the SPORT MEDICINE COUNCIL OF ALBERTA (SMCA) and the SPORTS MEDICINE AUSTRALIA: QUEENSLAND BRANCH (SMAQ) was the catalyst that brought together delegates from Australia, Canada, the United States, England, Denmark, and Norway. It was truly an International gathering that will no doubt lead to many other International collaborations of the professional kind.

Sport physicians, physiotherapists, athletic therapists, dieticians and nutritionists, researchers and academics assembled in Hawaii to SHARE, UNITE, and ENGAGE as was the stated theme for the Conference. Keynote presentations and session speakers -all rec-ognized experts in their respective specialties- brought instant respectability to the proceedings and were provided to the dele-gates in a post-Conference package that should further stimulate international co-operation. Additionally, there were 20 “FREE PAPERS” delivered to the enthusiastic registrants by noted re-searchers from Australia, Canada, United Kingdom and the United States.

The sun and warmth of Hawaii was the perfect setting for the gathering that surely enhanced the social activities which were considered to be a major highlight of the Conference agenda. These social moments UNITED the delegates in the SHARED pur-suit of excellence in this diverse profession of Sport Medicine and in doing so led effortlessly to the ENGAGEMENTS that was the dream for the organizers. The SMAQ hosted a Queensland Night on the Thursday night (January 27th) which was a perfect informal “uniting” of the delegates and the SMCA sponsored a more for-mal “Taste of Alberta” evening dinner (January 28), with Alberta performing artists (John Wort Hannam, Kat Danser, and Trevor Panczak) after which it could be said with confidence that the “sharing” and “engaging” would follow.

It is very important to recognize the financial support provided for the Conference by the Alberta Sport, Recreation, Parks and Wildlife Foundation and SMCA Board as well as by Alberta Foun-

dation for the Arts. Additionally, major sponsors for the “Taste of Alberta”, DG MORRIS of Manulife Financial, APEX Oilfields Ser-vices, Masuda Munro Chartered Accountants, and Hawkings Epp Dumont LLP. The countless hours spent by the SMCA Executive Director- Barb Adamson- as well as her counterpart in Australia- Mark Brown- must be recognized herein. I would also be remiss if I failed to acknowledge Dr. Kerry Mummery, Dean of the Faculty of Physical Education and Recreation of the University of Alberta who was Chair of the Scientific Committee and who planted the idea for the collaboration between SMAQ and SMCA while he was still in Australia and preparing for his return to Canada. His efforts to pull the free papers together from his Faculty and the Faculty at the University of Calgary will undoubtedly lead to cre-ating a climate of cooperation in Alberta that will make us the envy of the rest of Canada.

Finally, and this is perhaps the best testament to the success of the Conference: There has been a clarion call for a SECOND PAN PACIFIC CONFERENCE OF MEDICINE AND SCIENCE IN SPORT that should take place once again in Hawaii in mid-February of 2013 (If the Mayan Calendar is found to be somewhat hasty in its predic-tions). To that end, the Conference that is, the Board of the SMCA has formed a Committee to plan for the 2nd PAN PACIFIC CONFERENCE. Please watch for the developments for the Con-ference on the website of the SMCA: www.sportmedab.ca and you would do well to enter a note in your agendas and future plans. I look forward to meeting returning delegates and new registrants in Hawaii.

5 sportmedab.ca

Pan Pacific Conference

of Medicine and Science

in Sport

Hawaii 2013

Most sports medicine professionals are well educated in the diagnosis and man-agement of common disorders sustained in sport. However, the functional return to training is often limited by a disconnect, both in practice and in the communication between professionals working with the athlete. Lacking standardization in baseline minimums, both amateur and professional athletes alike often return to play too soon or without the requisite physical funda-mentals necessary for prevention of fur-ther injury.

Previous injury, and what we may be failing to do as clinicians and strength coaches with these injuries, seems to be a major risk factor for future injury in sport. Non-contact injuries such as muscle strains, tendinopathies, and low back and pelvic pain for example, commonly recur and are often the result of incomplete care and subsequently, premature return-to-play. Certainly, return-to-play decision making involves more in-depth considerations than simple rehabilitation1. However, post-injury rehabilitation and training must be an indi-vidualized approach taking into account neuromusculoskeletal movement impair-ment assessments, functional capacity evaluations, and their corresponding reso-lutions, as well as pertinent principles of periodization. In concert with respecting and addressing traditional P.R.I.C.E. (Protection, Relative Rest, Ice, Compression and Elevation) prin-ciples, it is important that non-painful dys-functions be simultaneously addressed in order to improve any mobility and / or sta-bility limitations that may have contributed to the cause of injury in the first place. By way of a thorough, whole body movement assessment, seemingly unrelated dysfunc-tions may be revealed, represented by asymmetries, muscle imbalances, and faulty motor control. This approach, termed “Regional Interdependence2” by James Cyriax, enables rehabilitation profes-sionals to accurately treat areas outside of pain in lieu of the fact that the presence of pain often coincides with a high-threshold or pain-adaptation strategy of compensa-tion.

Recent research has demonstrated the Functional Movement Screen (FMS) as a reliable tool in pre-participation injury risk prediction. A ranking and grading system that documents movement patterns to identify functional limitations and asymme-tries, the FMS has been validated as a prac-tical application for modeling of functional and corrective exercise in professional football players3 and firefighters4. This reli-able5 screening system utilizes a series of seven screens such as the “Deep Squat”, “In-Line Lunge” and “Active Straight Leg Raise” to assess and clear the fundamental motor programs of human movement that are pertinent to everyday living and ath-letic performance. By way of modifying such limitations, the aim of this low-tech tool is to guide corrective exercise proto-cols for the purposes of minimizing one’s risk of future injury. Much like a blood pres-sure test may identify those at risk for car-diovascular disease, the FMS may identify

those at risk for movement-based dysfunc-tion.

Currently, the majority of use of the Func tional Movement Screen is in pre- participation testing scenarios as part of pre-season physical fitness testing. How-ever, I would argue that this screening sys-tem would provide equal benefit in the clinic and training room. Quite often ath-letes are deemed “clinically recovered” in the absence of any of the following; pain, range of motion limitation, and / or upon passing of performance testing criteria. Unfortunately, rarely is quality of move-ment assessed prior to return-to-play. Also owing to the aforementioned presence of previous injury as a major risk factor for future injury, it would be prudent to incor-porate such a systematic movement-based screening protocol following “clinical re-covery” to filter out any missed movement dysfunctions, provide the necessary and

6 Spring 2011

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

By Jeff Cubos, BPHE MSc DC FRCCSS(C) CSCS

7 sportmedab.ca

related corrective strategies, and therefore, potentially minimize any risk of re-injury in sport. The current state of the literature has also demonstrated various tests and requisite minimums of strength ratios and core endur-ance for injury prevention, while leading researchers have also suggested the importance of addressing aerobic capacity and breathing integrity in sports performance. Once injured tissues have healed and movement dysfunctions have been corrected, the next step to consider prior to returning an athlete to play are the requisite strength ratios specific to injury mechanisms in the athlete’s given sport (when relevant)6. Similarly, research based out of the University of Waterloo suggests that achieving specific minimum endurance ratios among the various trunk musculature (flexors, extensors, and lateral musculature) may minimize the risk of low back pain in certain populations7. Ensuring that each athlete possesses minimum required aerobic capacities specific to their sport (especially following a prolonged period of inactiv-ity) would also facilitate a smoother transition between the pro-tocols implemented in each of the clinic, the training room, and the performance centre. Not only may this enhance the athlete’s ability to optimally perform without the presence of undue fa-tigue, but doing so will also promote increased core integrity since the dual-functioning diaphragm will always give preference to respiration over stability in the presence of fatigue.

Finally, it is important that both the clinician and strength coach respect the foundations and principles of periodization. Periodi-zation, or the planned manipulation of training variables (loads, sets, and repetitions) to maximize training adaptations and pre-vent the onset of overtraining syndrome8, while common in the athlete development and strength and conditioning realms, is often overlooked in traditional rehabilitation settings. However, whether choosing a linear (based on changing exercise volume and load across predictable cycles) or undulating (frequent alter-ing of volume and load to allow more frequent neuromuscu-loskeletal recovery) model, it is important that such principles be incorporated to both the rehabilitation and training programs, especially in athletic populations. Doing so will not only facilitate more desired adaptations secondary to the principle of overload, but may in fact promote a more rapid return to sport participation. Utilizing the strategies mentioned it is impor-tant to systematically identify and address com-mon movement and functional capacity limita-tions to effective post-rehabilitation training practices of athletes. Providing evidence-based solutions for the implementation and modifica-tion of training programs following “clinical recovery” from sport injuries may enhance the return-to-play decision making process and therefore…bridge the gap between the clini-cian and the strength coach!

References: 1. Creighton, D.W., Shrier, I., Shultz, R., Meeuwisse, W.H. & Matheson,

G.O. (2010). Return to play in sport: A decision-based model. Clinical Journal of Sport Medicine, 20(5); 379-385.

2. Wainner, R.S., Whitman, J.M., Cleland, J.A. & Flynn, T.W.(2007). Re-

gional Interdependence: A musculoskeletal examination model whose time has come. Journal of Orthopaedic and Sports Physical Therapy, 37(11); 658-660.

3. Kiesel, K., Plisky, P. & Voight, M. (2007). Can serious injury in profes-

sional football be predicted by a preseason functional movement screen? North American Journal of Sport Physical Therapy, 2(3); 147-158.

4. Peate, W.F., Bates, G., Lunda, K., Francis, S. & Bellamy, K. (2007). Core

strength: A new model for injury prediction and prevention. Journal of Occupational Medicine and Toxicology, 2(3)

5. Minick, K.I., Kiesel, K.B., Burton, L., Taylor, A., Plisky, P. & Butler, R.J.

(2010). Interrater reliability of the functional movement screen. Journal of Strength & Conditioning Research, 24(2); 479-486.

6. Maffey, L. & Emery, C. (2007). What are the risk factors for groin strain

injury in sport? A systematic review of the literature. Sports Medicine, 37 (10); 881-894.

7. McGill, S., Childs, A. & Liebenson, C. (1999). Endurance times for low

back stabilization exercises: Clinical targets for testing and training from a normal database. Archives of Physical Medicine & Rehabilitation, 80 (8); 941-944.

8. Buford, T.W., Rossi, S.J., Smith, D.B. & Warren, A.J. (2007). A compare

son of periodization models during nine weeks with equated volume and intensity for strength. Journal of Strength & Conditioning Re-search, 21; 1245-1250.

The functional return to training is

often limited by a disconnect, both in practice

and in the communication, between

professionals working with the athlete.

If you’ve ever wondered about the effects of caffeine on performance, you’re not alone. Caffeine and its use as a mental stimulant is familiar to virtually every post-secondary student and anyone who works long hours. Many people are familiar with the physical effects of ephedrine/caffeine stacking used by athletes in high intensity short duration repetition sports such as football. If you watch the Tour de France and keep a close eye on the athletes in the ‘feed zone’ you will see cans of Coke Clas-sic being passed out the windows of the support vehicles to the riders who then drink the Coca-Cola in one shot. Research in Canada on the effects of caf-feine was stimulated (pardon the pun) at a time when Sport Canada was trying to reduce drug use in Canadian sport after the Ben Johnson doping scandal in 1988. Sport Canada funded Terry Graham of the University of Guelph in an effort to show that caffeine had no beneficial effect on sport performance. Ironically, this re-search showed the exact opposite. In particular, one early study (T.E. Graham and L.L Spriet, 1991) showed that caffeine

ingestion well within the legal limits im-posed by the International Olympic Com-mittee (IOC) could increase cycling and running performance at 85% VO2max by a staggering 20% to 50%! This has been inde-pendently replicated in a Dutch study in 1995 (Pasman et al. 1995) where the per-formance boost even in highly trained cy-clists was 23%! Caffeine also increases performance dura-tion for all out efforts (i.e. VO2max) at around 20% (Jackman et al. 1996). Caffeine also has a positive effect on maximum voluntary contraction (MVC) of about 3% (Kalmar and Cafarelli 1999) while lowering the perception of effort, and also has an ergogenic effect on repeated bouts of high intensity exercise like swimming inter-v a l s ( C o l l o m p e t a l . 1 9 9 2 ) . Given this particular collection of effects, caffeine is overwhelmingly supported by research as a powerful training partner, letting you exercise longer and harder with greater effort and higher load, allow-ing maximal stimulus to the systems spe-cifically needed for high intensity exercise and sport performance. Many athletes use

caffeine as an ergogenic aid for training and this author is no exception. As an example I include caffeine in the form of de-fizzed cola (referred to generically as ‘rocket fuel’) when I am going for long and intense rides, heavier intensity or maximal intensity work-outs in the gym and as a staple to alleviate bore-dom on long runs if I have to run alone (by gaining the benefit of caffeine’s effect as a mental stimulant). The plot thickens consid-erably, however; re-search shows that on a 100 km cycling time trial with highly trained cy-

clists there was no effect on performance even with high dosages! (Hunter et al. 2002). This stunning research given the overwhelming support for caffeine as an ergogenic aid perhaps points to its mecha-nism of action. I say perhaps because the mechanisms of action by which caffeine does enhance exercise are actually not well defined, but we do know some things about what caffeine does and does not do with respect to exercise ergogenics. For example, on one hand we know that the small percentage increase in maximal voluntary contraction (MVC) is due to in-creased skeletal muscle recruitment caused by caffeine’s action on the cerebral cortex of the brain. On the other hand we know that the modest fat store mobiliza-tion which occurs in individuals at rest con-suming caffeine, does not occur in indi-viduals during exercise, nor is there any improvement in oxidative metabolism effi-ciency (Graham et al. 2000). This suggests that the effect of caffeine is independent of any effect on metabolism and more likely to be involved with the central nerv-ous system. The fact that these effects are not seen in a 100 km cycling time trial

Caffeine and Ergogenics in Sport Performance Why caffeine, but not coffee?

By Craig J. Brososky, B.Sc., B.Sc.PT, IMC

8 Spring 2011

suggests that different central nervous system strategies are used in choosing a pacing strategy, rather than working at a given power output for a prolonged period. The plot thickens yet further as we also know that the source of caffeine is important, and we turn back now to the author’s ‘rocket fuel’ source, de-fizzed cola. Coffee, although a significant source of caffeine, does not demonstrate a significant ergogenic effect as pure caffeine does (Graham et al. 1998). This suggests that other chemicals in coffee may prevent the caffeine present in coffee from providing an ergogenic effect. To maximize the ergogenic effect of caffeine it may be advisable to consume it in a tablet form (typically 100 to 200 mg). The practical take home message for the athlete is that caffeine is valuable, essentially harmless and ubiquitously available, as well as a legal agent that can improve performance and training. It should probably not be taken in the form of coffee if an er-gogenic effect is desired, and need not be consumed at doses higher than 3 to 6 mg per kg of body weight (Colas have be-tween 30 and 50 mg of caffeine in a 375 ml can and also provide carbohydrates for use during exercise). One last interesting bit of information: for those athletes con-cerned with race performance possibly being affected by caf-feine use causing increased frequency of urination, you can put those fears to rest! Caffeine does not increase urine production during exercise (Wemple et al. 1997). About the author: Craig Brososky is a physiotherapist with a special in-terest in running and sport performance who graduated with two de-grees from the University of Alberta (B.Sc. 1993, B.Sc.PT 1998) and has been a cyclist since his parents bought his first banana seat cruiser at age 6 and a long distance runner since age 13. He currently owns West End Physiotherapy in Edmonton Alberta and is a consultant to several sport and fitness groups in the city.

Citations: Graham TE, Spriet LL. Performance and metabolic responses to a high caffeine dose during prolonged exercise. J. Appl. Physiol. 71(6):2292-2298, 1991.

Pasman et al. Caffeine Effect on Endurance Times. Int. J. Sports Med. 16:225-230, 1995.

Jackman et al. Metabolic, catecholamine, and endurance responses to caffeine during intense exercise. J. Appl. Physiol. 81(4):1658–1663, 1996.

Kalmar, JM, Cafarelli, E. Effects of caffeine on neuromuscular function. J. Appl. Physiol. 87(2):801-808, 1999.

Collomp et al. Benefits of caffeine ingestion on sprint performance in trained and untrained swimmers. Eur. J. Appl. Physiol. 64:377–380, 1992. Hunter et al. Caffeine ingestion does not alter performance during a 100-km cycling time-trial performance. Int. J. Sport Nutr. Exerc. Metab. 12:438-452, 2002. Graham et al. Caffeine ingestion does not alter carbohydrate or fat me-tabolism in human skeletal muscle during exercise. The Journal of Physi-ology, 529:837-847, 2000.

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

9 sportmedab.ca

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Bookings available from 7:00 a.m. - 7:00 p.m. Mondays through Fridays, no referral required.

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results with practical tools to help you maintain and progress your abilities further and faster.

Craig J. Brososky B.Sc., B.Sc.PT, IMC Owner, Physiotherapist

West End Medical & Professional Bldg.

Room 311, 9509 - 156 Street Edmonton, Alberta T5P 4J5

phone: (780) 484-0514 fax: (780) 484-1347

email: c.brososky@wephysio.com

http://www.wephysio.com

10 Spring 2011

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

cle thickness of the elbow and knee flexors and extensors (ultrasound), (3) strength (leg press and chest press one repeti-tion maximum; 1-RM), (4) urinary 3-methylhistidine excretion (an index of muscle protein catabolism), and (5) urinary microalbumin (an indicator of kidney function).

Results showed that subjects who supplemented with creatine (i.e. before and after exercise) experienced a significant increase in lean tissue mass and muscle strength and decrease in muscle protein catabolism over time. Interestingly, only the subjects who supplemented with creatine after exercise experienced a greater increase in muscle size of the elbow flexors and chest press strength compared to placebo. Creatine had no negative effect on kidney function.

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

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

Creatine Application Strategies during Resistance-Training in Healthy Older Adults Abstract

Authors: Darren Candow1, Katherine MacLeod1, Gordon Zello2, Binbing Ling2, Jonathan P. Farthing3, Jonathan Harris4, Shanthi Johnson1

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11 sportmedab.ca

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

References 1. Balsom PD, Soderlund K, Sjodin B, Ekblom B. Skeletal muscle metabo lism during short duration high-intensity exercise: influence of creatine supplementation. Acta Physiol Scand. 1995; 154: 303-10. 2. Burke DG, Candow DG, Chilibeck PD, MacNeil LG, Roy BD, Tarnopolsky MA, Ziegenfuss T. Effect of creatine supplementation and resistance- exercise training on muscle insulin-like growth factor in young adults. Int J Sport Nutr Exerc Metab. 2008; 18: 389-98. 3. Candow DG, Chilibeck PD. Timing of creatine or protein supplementa tion and resistance training in the elderly. Appl Physiol Nutr Metab. 2008; 33: 184-90. 4. Candow DG, Little JP, Chilibeck PD, Abeysekara S, Zello GA, Kazach kov M, Cornish SM, Yu PH. Low-dose creatine combined with protein during resistance training in older men. Med Sci Sports Exerc. 2008; 40: 1645-52. 5. Harris RC, Soderland K, Hultman E. Elevation of creatine in resting and exercise muscle of normal subjects by creatine supplementation. Clin Sci. 1992; 83:367-74. 6. Marzetti E, Lees HA, Wohlgemuth SE, Leeuwenburgh C. Sarcopenia of aging: underlying cellular mechanisms and protection by calorie restrict tion. Biofactors. 2009; 35: 28-35. 7. Olsen S, Aagaard P, Kadi F et al. Creatine supplementation augments the increase in satellite cell and myonuclei number in human skeletal muscle induced by strength training. J Physiol. 2006; 1: 525-34. 8. Piers LS, Soares MJ, McCormack LM, O'Dea K. Is there evidence for an age-related reduction in metabolic rate? J Appl Physiol. 1998; 85: 2196- 2204. 9. von Haehling S, Morley JE, Stefan D. An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle. 2010; 1:129–33 10. Willoughby DS, Rosene JM. Effects of oral creatine and resistance training on myogenic regulatory factor expression. Med Sci Sports Exerc. 2003; 35: 923-29. 11. Wyss M, Kaddurah-Daouk R. Creatine and creatinine metabolism. Physiol Rev. 2000; 80: 1107-13

Affiliations: Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada

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

12 Spring 2011

We are all well aware of the numerous physical and mental health benefits associated with being physically active, yet our physical activity levels remain generally low. Women in particu-lar are one population showing the lowest levels of physical ac-tivity. There are a number of factors beyond personal motiva-tion which may help to explain women’s low levels of participa-tion in physical activity, including a number of psychological, socio-cultural, and environmental barriers (1,2). In response to these barriers, researchers have revealed mechanisms which have the potential to assist women with engaging in regular physical activity. From a socio-cultural perspective, group based physical activity has been associated with positive outcomes including increased participation and attendance to group exer-cise classes (3), reduced drop out from group classes (4), and a more positive attitude towards physical activity in general (5). It seems that women (and adults in general) prefer to become active and maintain an active lifestyle if they have the opportu-nity to interact and communicate with others, gain friends, and enjoy the camaraderie of others around them (6). To further increase this camaraderie and social interaction, researchers have stressed the need for a leader to help guide the group through its journey to reaching their health and activity goals, whilst providing an environment which is socially appealing. Some research concerning leaders of group exercise classes have indicated that the group leader is capable of developing group unity by promoting and encouraging feelings of solidarity, mutual respect and acceptance (7). Moreover, those in leader-ship positions are able to engage participants more, resulting in greater group cohesion, higher levels of overall satisfaction, greater feelings of revitalisation and increased activity participa-tion and performance (8, 9). With this in mind, is it possible that leaders could also have this same impact on more informal, unstructured physical activity groups for women? If so, what types of leaders would be most effective? We attempted to address these questions by examining the relationship between leadership, group cohesion, and physical activity in women’s informal walking groups. In doing this, we asked a number of women’s walking groups to report on the cohesiveness of their own groups, as well as indicate the types of leaders they felt would assist with this cohesiveness and po-tentially help them reach their activity goals. What we found was an indication that leaders do impact the cohesiveness of a group and thus could potentially influence women’s physical activity behaviours. In particular, group lead-ers who are enthusiastic, have the ability to motivate their group members, are able to provide personal instruction to

each group member and are available outside of the group for further advice, were likely to have greater cohesiveness within their groups. So what does this all mean? Well what we have here is a promis-ing avenue for physical activity sustainability. Leaders may be the missing link to assist with the transition from short term to long term behaviour change as they have the potential to pro-long activities and keep programs thriving. However, from a research perspective, caution should be taken as this was preliminary work, and thus requires a more detailed look at how leaders affect actual physical activity behaviour. In addition, the work outlined here does not examine the potential reciprocal relationship between the leader and group members. It is very probable that leaders have varying perspectives to their group members concerning the leader behaviours which influence a group as a whole. It would be valuable to under-stand the perceptions of those in leadership roles and compare the similarities and differences between the leader and group members. This will provide leaders with information regarding member expectations, as well as provide leaders with the op-portunity to adapt certain leader behaviours to align with the needs of the group members. Withstanding some of these research limitations, leaders can effectively impact their group and influence its development

Leading the way to Active and Healthy Lifestyles

By Cristina Caperchione

13 sportmedab.ca

and sustainability, and thus should be a factor for consideration when developing physical activity and health promotion initiatives. References 1) Caperchione C, Mummery K, Joyner K. Addressing the challenges, bar-riers and enablers to physical activity participation in priority women's groups: Findings from the WALK Program. J Phys Act Health. 2009;6:589-96. 2) Eyler AA, Matson-Koffman D, Rohm Young D, et al. Quantitative study of correlates of physical activity in women from diverse racial/ethnic groups: Women's Cardiovascular Health Network Project--introduction and methodology. Am J Prev Med. 2003 Oct;25(3Suppl 1):5-14. 3) Fraser SN, Spink KS. Examining the role of social support and group cohesion in exercise compliance. J Behav Med. 2002 Jun;25(3):233-49. 4) Spink KS, Carron AV. Group cohesion effects in exercise classes. Small Group Research.1994;25:26-42. 5) Estabrooks PA, Carron AV. Group cohesion in older adult exercisers: prediction and intervention effects. J Behav Med. 1999 Dec;22(6):575-88.

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

14 Spring 2011

A Real Need Approximately 85,000 Canadians currently live with a spinal cord injury (SCI). Nearly half of this population engage in no leisure time physical activity whatsoever (e.g., sports, exercise). Not surprisingly, pro-grams and information to support physical activity are two of the services most de-sired but least available to the SCI commu-nity. Seeing a real need, SCI Action Canada was established with a vision of advancing physical activity knowledge and participa-tion among Canadians living with spinal cord injury.

SCI Action Canada SCI Action Canada is an alliance of 16 com-munity organizations and 15 university-based researchers. The alliance was es-tablished in 2007 with funding from the Social Sciences and Humanities Research Council of Canada (SSHRC). Alliance mem-bers have come together with the com-mon goal of advancing physical activity knowledge and participation among peo-ple with SCI. In order to achieve this goal, alliance activities have proceeded in three phases.

A Three-Phased Approach

Phase One Phase one activities consisted of projects designed to inform the subsequent devel-opment of physical activity interventions. These projects focused on developing a comprehensive understanding of: the ideal messengers and methods for con-veying physical activity information to the SCI community; factors that motivate peo-ple with SCI to participate in physical activ-ity; and existing physical activity promo-tion resources available to SCI service or-ganizations.

Based on the results, we concluded that intervention strategies should: a) deliver key messages by peers and health service providers, b) utilize passive sources to disseminate interventions, c) teach physi-cal activity self-regulation strategies, and d) provide SCI service organizations with the necessary resources to implement

physical activity promotion initiatives. This information provided the basis for Phase Two activities.

Phase Two

Phase Two focused on developing activity-enhancing interventions, strengthening partnerships, and generating SCI-specific physical activity guidelines.

Developing Interventions

We developed several interventions to change theory-based, empirically estab-lished determinants of physical activity while taking into account Phase One find-ings. Below are two examples.

Get In Motion Get in Motion is a free, telephone-based physical activity counseling service for Canadians with SCI. This service is de-signed to provide ongoing physical activity information, counseling, and support to meet personal physical activity goals. Our preliminary data indicate that clients strengthen their intentions to engage in

physical activity, increase the number of minutes/week spent on physical activity, and report improvements in health and life satisfaction.

Active Homes The purpose of this pilot study was to ex-amine the efficacy of a peer-mediated, home-based introductory strength-training session for people with SCI who did not already have a routine strength-training program. A certified personal trainer and a physically active peer visited participants in their homes. The trainer designed a personalized resistance-training program and the peer demon-strated the exercises. Participants were given tips on how to be active right in their own homes and how to maintain their exercise program. After the visit, participants reported feeling more confi-dent in their ability to perform resistance exercises, greater intentions to exercise, and more effective exercise planning. In addition, they significantly increased the number of minutes/week spent on strength-training.

Strengthening Partnerships

Several of our activities have focused on facilitating and strengthening collabora-tion among community partners. One event involved bringing together clients from the Canadian Paraplegic Association (CPA) – Hamilton to participate in a wheel-chair tennis “Have a Go” event, facilitated by the Ontario Wheelchair Sports Associa-tion’s Bridging the Gap program. We also collaborated with the Active Living Alli-ance for Canadians with a Disability to host All Abilities in Action, a one-day event showcasing sport and exercise opportuni-ties for people with disabilities. The work done for, and with, the Canadian Paralym-pic Committee (CPC) highlights a different aspect of how we work with our partners. Since 2008, SCI Action Canada has pro-vided support staff to help develop CPC’s Feel the Rush database - an online re-source that Canadians can use to find ac-cessible sport opportunities.

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

By Spero Ginis (SCI Action Canada), Kathleen Martin Ginis (McMaster University), Amy Latimer (Queen’s University), Adrienne Sinden (SCI Action Canada)

15 sportmedab.ca

Physical Activity Guidelines Physical activity promotion is facilitated by the availability of evidence-informed guidelines that provide specific informa-tion regarding the types, amounts, and intensities of activity needed to yield health and fitness benefits. SCI Action Canada has been involved in the develop-ment of evidence-based physical activity guidelines for adults with SCI. These are the first national physical activity guide-lines to be developed for Canadians with any type of disability (www.sciactioncanada.ca). activity-enhancing initiatives.

Phase Three We are now working to package, imple-ment, and evaluate the Phase 2 interven-tions through our network of community-based partner organizations. SCI Action Canada has developed knowledge transla-tion plans to target three key audiences: a) People with SCI, b) Peer Support Net-works and c) Health Care Professionals. In the following sections we describe strategies for reaching each of these groups.

People with SCI The objective here is to create interest among recipients of physical activity messages, and direct them to more specific resources to meet their individual physical activity information needs. Primary vehicles for conveying these messages are the SCI physical activity guidelines, the SCI Action Canada website, and our partner organizations.

Peer Support Networks A key finding from Phase One was that peers with SCI are a highly valued source of physical activity motivation and information. We are working to put this valuable information into practice. Specifically, SCI Action Canada is working with CPA-Ontario to identify op-portunities for delivering physical activity information through its well-established peer support program.

Health Care Providers Phase One research reinforced the central role that health care providers can play in physical activity behavior change. SCI Action Can-ada will target a broad range of health care providers such as kinesiologists, physiotherapists, occupational therapists, recreation therapists, general practitioners, and physiatrists. In doing so, we aim to convey the following messages: “It is important to talk to

your patients about physical activity” and “There are physi-cal activity resources available to help you and your pa-tients.”

Looking Forward Over the past three years, SCI Action Canada has developed a comprehensive strategy for enhancing physical activity knowledge and participation among people with spinal cord injury. The coming years will be spent implementing and evaluating the strategy within the SCI Community. We are also hopeful that the SCI Action Canada framework will pro-vide a blueprint for other disability communities to develop their own physical activity-enhancing initiatives.

www.sciactioncanada.ca

16 Spring 2011

Check out the SMCA Resource Library!

Skeletal Muscle Damage and Repair by Peter M. Thiidus (Editor) 2008 Catalogue Number: AIT35

Professionals and students interested in understanding the physiological mechanisms of

skeletal muscle damage and repair will welcome this uniquely comprehensive text.

Athletic Training Education Series - Therapeutic Exercise for Athletic Injuries

By Peggy A. Houglum 2001

Catalogue Number: AIT08 This text presents athletic trainers, physical therapists, and other sports medicine specialists

with a solid base in the science of practice of designing effective therapeutic exercise pro-grams. Therapeutic Exercise for Athletic Injuries is suitable for both undergraduate

students and professionals using it as a reference.

Performance-Enhancing Substances in Sport and Exercise

by Michael S. Bahrke, Charles E. Yesalis 2002

Catalog Number: DST01 The reference book contains 29 chapters covering dozens of substances, thousands of

references, and chapters devoted to the history and future of performance-enhancing substances in sport and exercise, the determination of the efficacy of substances, drug test-

ing, and legal issues.

Visit sportmedab.ca/library for information or

to borrow a resource.

SMCA Members receive a 20% Discount

on Medical Supplies

when ordered on-line.

Visit the Store...

www.sportmedab.ca

What is Sport Psychology?

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

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

780-430-9224 or visit our website at ww.rivervalleycounselling.ca.

17 sportmedab.ca

What is a Concussion? • Occurs when an athlete is moving at

a high rate of speed and collides with another object.

• The brain shifts inside the skull and

strikes the bony surfaces. • An athlete can suffer a concussion

without actually striking their head. • The result is a mild traumatic brain

injury that changes normal brain func-tion

• Can happen with or without a loss of

consciousness T5M 3K6

Prevention • Pre-season concussion screening ask-

ing about previous symptoms and incidents is important.

• Complete a baseline cognitive assess-

ment and symptom score for each athlete.

• All athletes should be properly edu-

cated on the correct sport technique and safety rules need to be enforced.

• Protective equipment must be certi-fied, good quality, well maintained and properly fitted.

• Coaches, parents and athletes need

to recognize the signs/symptoms of a concussion.

Signs and Symptoms • Nausea, vomiting • Dizziness • Confusion • Fatigue • Light headedness • Headaches • Irritability • Disorientation • Seeing bright lights or stars • Feeling of being stunned • Depression • Inappropriate behavior • Decreased work/playing ability • Inability to perform daily activities • Cognitive and memory dysfunction

(reduced attention, difficulty concen-trating)

• Sleep disturbances • Vacant stare • Poor balance

A concussion should be suspected in the presence of any one of the signs or symptoms.

Return to Activity Return to activity should be gradual and monitored by a medical profes-sional. Return to play steps should include: Step 1: No activity.; only complete rest Step 2: Light aerobic exercise Step 3: Sport specific activities Step 4: Drills without body contact;

light resistance training Step 5: Drills with body contact Step 6: Game play Athletes should proceed through these steps only when they are symptom free and there should be 24 hours between each step.

Immediate Response • Remove the player from the current

game or practice • Do not leave the player alone; moni-

tor for signs and symptoms • Do not administer medication • Inform the coach, parent or guardian

about the injury • The player should be evaluated by a

medical doctor after any blow to the head

What is a Concussion?

Check out these and other resources on

SMCA’s web site!

www.sportmedab.ca

18 Spring 2011

Interested in writing for Pulse?

Is there an article you would like to see?

Let us know…. We value your feedback?

Email: smcapulse@gmail.com

Hydration: Water

The most important and most

often neglected

nutrient!

About 60% of our body weight is water and our need for water increases greatly with exercise. Adequate fluid intake before, during and after exercise is critical in preventing dehydration. DO NOT use thirst as the gauge for your body’s water needs. Athletes lose more contests through not drinking enough water than any other nutritional cause.

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

For maximum hydration, follow these recommendations: Consume cool fluids in small volumes at regular intervals. For exercise lasting less than 60 minutes, cool water is the best replacement. For intense exercise lasting greater than 60 minutes, di-luted glucose and electrolyte solutions (sport drinks) are recommended to provide fuel for working muscles.

Prevention is the Best Cure.

The hydration status of the body is determined by the balance between

water intake and water loss.

19 sportmedab.ca