FitBits
Exercise ETC's Monthly Research Review
April 15, 2007
Compiled by Chris Marino, MS, CSCS
Director of Education
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No More Rescue Breathing?
Immediate CPR (cardio-pulmonary resuscitation) has long been a determinant of both survival and neurological damage in victims of cardiac arrest. Although traditional CPR continues to be supported by the American Heart Association (AHA), new research suggests that rescue breathing is an unnecessary component and may even be detrimental in cases of cardiac arrest. In a study published last month in the Lancet, researchers reported that compression-only CPR more than doubled the survival rate for heart attack victims compared to traditional CPR.
In a prospective, observational study, researchers in Japan evaluated 4,668 heart attack cases in which 439 (11%) received only chest compressions, and 712 (18%) received conventional CPR performed by bystanders. Twenty-two percent of victims who received chest-compression only CPR survived cardiac arrest compared to just 10% of those receiving traditional CPR.
It was suggested that the blood is adequately oxygenated just prior to cardiac arrest and that chest compressions are essential to maintain blood pressure, which controls the delivery of oxygen to the brain. Furthermore, stopping to perform ventilations may cause a reduction in venous return to the heart which would further reduce both coronary and cerebral blood flow.
Just last year the AHA revised CPR guidelines to reflect 30 chest compressions per two rescue breaths (the previous ratio was 15:2). Although the AHA is not planning to further alter their guidelines, the organization does support compression-only CPR in cases where individuals are unwilling or unable to provide ventilations.
This study was initially undertaken because of the suspected unwillingness of bystanders to provide mouth-to-mouth CPR to victims. In fact, less than one-third of all victims included in this research received CPR. Experts expect that if armed with this new information, more people may be willing to provide CPR and consequently more lives will be saved.
It’s important to note that compression only CPR is not effective in cases of respiratory arrest.
Lancet. 2007;369:882-884, 920-926. The Associated Press. March 17, 2007. Medscape Medical News. March 20, 2007
Older Golfers Benefit from Functional Training
"Functional training" refers to the use of therapeutic exercise progressions to improve joint stability, coordination, strength and endurance in both rehabilitating injury and more recently to enhance performance. This method of exercise programming is seen by many to be the latest fad in fitness and performance training. Unfortunately, this perception has resulted from a lack of research to collaborate the claims made by practitioners. A study published last month in the Journal of Strength and Conditioning Research was one of the first to put “functional training” to the test.
The study performed at the University of San Francisco evaluated the effects of a specific functional training protocol on both golf performance and function in older men. Eighteen male recreational golfers between ages 60 and 80 years were divided into two groups, intervention and controls.
The intervention group participated in three 90-minute training sessions per week for 8-weeks. The exercise program was based on the Optimum Performance Training model developed by the National Academy of Sports Medicine. This system is designed to guide the trainer in progressing exercise from an initial emphasis on spinal stabilization and neuromuscular control to strength building and then finally to improving speed and power.
Participants were assessed using the Senior Fitness Test (SFT), a battery of six tests that represent functional ability, and Club Head Speed (CHS) was evaluated using a SwingMate radar device.
At the end of 8-weeks, four of the six tests of function had improved significantly indicating that the “functional” exercise progression used in the study was indeed effective. Performance measures also showed significant improvement as CHS increased on average 3.9 mph. Such increases in CHS are associated with an increased drive distance of 10-15 yards or more, a definite advantage on the golf course. Interestingly, the controls showed a slight decrease in CHS at the conclusion of the study.
Although the application of this training method is broad, improvement in the SFT measures indicates a reduced risk of falls and potentially fewer injuries for an older adult population.
Thompson,
C.J. et al. (2007) Functional Training Improves Club Head Speed and Functional
Fitness in Older Golfers. Journal of Strength and Conditioning Research.21(1):131-137.
An occasional feature in which Exercise ETC’s Director of Education Chris Marino, MS, CSCS answers your questions. You may write to Chris at info@exerciseetc.com Make sure to put "Attn: Chris Marino" on the subject line. Unfortunately, due to the volume of e-mails, individual replies are not possible.
"To Flick or Not to Flick"
Question: I’ve heard that if you "flick" the wrist at the end range of motion when performing a triceps kickback it will increase triceps muscle activity. Is this accurate? If so, what is the mechanism? I thought the triceps were responsible for elbow extension , not the wrist muscles. Carolyn S., NY, NY
Answer: Some early bodybuilders did recommend the wrist "flick," however there have been no research studies to date that have put this technique to the test. Our Exercise ETC faculty did some of their own research into the possible mechanics of this exercise to provide the following answer.
The wrist "flick" is typically a ballistic movement into wrist adduction performed at end range of elbow extension in a triceps kickback exercise. Although the triceps and anconeus muscles are the prime movers in elbow extension, the flexor carpi ulnaris, because of its attachment on the medial epicondyle of the humerus, also functions in elbow extension. Hence, the forearm muscles that act to produce lateral flexion may create additional elbow extension, and theoretically permit further shortening of the triceps.
The ballistic nature of the wrist "flick" commonly increases shoulder internal rotation and extension in the frontal plane. When training the elbow extensors, the long head of the triceps is the last to recruit under resistance, however it can be challenged directionally with resistance into external rotation and flexion. Thus, this movement would again theoretically create greater overall recruitment of the triceps by activating the long head of the triceps.
Unfortunately, although this technique may increase triceps muscle activity it is not advisable for most clients. The terminal range of extension created by "flicking" the wrist is non-functional because it exceeds the capacity of the biceps to stabilize the elbow via co-contraction. Ultimately this increases the risk for hyper-extending the elbow and could be potentially damaging to ligaments and other soft tissues surrounding the joint. In addition, excessive and ballistic internal rotation and extension of the shoulder can aggravate impingement syndromes.
Given the variety of exercise choices available for training the triceps, it would be advisable to use the triceps kickback as an accessory exercise and avoid the wrist "flick." The exception to this rule may be an advanced weight lifter or bodybuilder with considerable training experience who possesses the awareness and neuromuscular control to incorporate the movement without injury.
Increased
Risk of
Overuse Injuries in Children
Increasing pressure on young athletes for prowess in a single sport has led to the virtual extinction of the three-sport athlete and is leading to higher sports drop-out rates; it is also taking its toll on their physical well-being. A recent paper, published by Reuters Health summarized the discussion on youth sport-related injuries at the annual meeting of the American Academy of Orthopedic Surgeons.
Physicians expressed concern over the growing number of overuse injuries in adolescents, and even preadolescents, as young as 4 years old. In fact, approximately one half of children currently seen in sports medicine clinics for sport-related injuries are diagnosed with some form of overuse injury. Such injuries include ACL tears, chronic tendonitis, stress fractures, knee pain, heel injuries, cartilage damage, and Little Leaguer's elbow or shoulder, which occurs as result of overthrowing.
It was noted that certain sports are associated with higher risk of overuse injury due to increased impact stress from running and jumping. These include football, basketball, gymnastics and soccer.
Physicians blame the increased year-round participation in a single sport, which does not permit adequate time for the muscles, bones and soft tissues of the body to rest and recuperate from repetitive strain. Although adequate recovery is essential for athletes at all ages, it is of utmost importance to adolescents who are still developing their structural foundation.
This news should be of specific interest to trainers involved in youth sports strength and conditioning programs. Such individuals are directly situated to reduce the risk of injury by providing direction for recovery, improving body mechanics, and selectively increasing strength and endurance to protect the joints from injury. Unfortunately, many youth programs are contributing to the problem by stressing the muscles and repetitive movements of the sport in effort to improve performance. The principle of specificity may need to be modified under these circumstances.
According to some fitness and performance experts, children should not train for sport-specificity until they are 14, or high school age. Pre-adolescent children should instead be encouraged to develop proficiency at many sports, which enhances overall coordination and improves movement skill. Training at young ages should therefore focus on improving joint stability and body mechanics rather than sport-specificity.
Doctors are recommending that more regulations be placed on children who participate in single-sports throughout the year to avoid long term damage from overuse injury.
Reuters Health. Feb 15, 2007
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