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  • A Crash Course in Olympic Rugby

    by Caitlin Kinser | Jul 24, 2024
    Cover image featuring the title of the blog post, and a female rugby player holding the ball

    History of Olympic Rugby — Rugby 15s

    One of the greatest developments in modern Olympics was the creation of the International Olympic Committees’ (IOC’s) Olympic Agenda 2020, which sought to safeguard Olympic values and strengthen the role of sport in modern society. In essence, this agenda permitted host countries’ organizing committees to propose new sports for the Games they would be hosting. The primary purpose of this agenda was to prioritize innovation, youth engagement, and gender balance. In recent years, this has been successfully implemented, with sports like surfing, skateboarding, karate, baseball, softball and sport climbing debuting or reemerging at the 2020 Summer Olympics held in Tokyo, Japan, in 2021.

    Alternatively, some sports may be removed from the Olympics due to disinterest or lack of appropriate global governing body; for example, sports like baseball and softball were previously removed from the Summer Games in 2005 due to the belief that those sports were only popular (e.g., competitive) in the Americas and parts of Australia and eastern Asia. Unfortunately, Olympic rugby shares a similar history.

    Rugby debuted in the Olympics in the 15-a-side variation of the game in 1900 in Paris. This variation features 15 players on each team competing for possession of the ball through grappling, tracking, rucking, scrummaging, etc., in order to advance it across the pitch (which is 100 m long and up to 70 m wide) across the try line, similar to an end zone in American-style football. These matches last 80 minutes, broken down into two 40-minute halves.

    Unlike American-style football, after each tackle, play keeps going, whereby tacklers have a moment to release the ball carrier and roll away, followed by the ball carrier releasing the ball, placing it towards their team and likewise rolling away. Amidst this chaos, arriving players on defense and offense will contest for the ball in a ruck, whereby they will bind to one another and attempt to drive the opposing player off of the ball. In rugby, the ball may only be passed backwards or laterally; however, you may advance the ball forward by running or kicking it.

    If any of this sounds confusing to you as a new fan of the sport, you are not alone. For this, and many other reasons such as the lengthy matches, necessary time to recover between matches, and lack of global presence, rugby 15s fell out of the Olympics in 1924.

    Graphic depicting a rugby scrum with two teams of 8 players eachModern Olympic Rugby — Rugby 7s

    Rugby 7s, a variation of rugby 15s which is played on the same-sized pitch but with seven players per side and only seven-minute halves, was presented for inclusion in the 2012 Games, but was not formally accepted as an Olympic sport until the 2016 Olympics.

    Rugby 7s has since been a staple of the modern Olympics, joining Paralympic Rugby (which has been included since the 2000 Games), as it is a sport played worldwide, with minimal equipment, and is the only collision sport where men and women play by the same rules. This version of rugby is more easily understood by laypeople, all the while presenting high-speed action and scoring. This upcoming Olympics will be the third consecutive Summer Games with Rugby 7s, giving the impression that rugby 7s is here to stay in modern-day Olympic competition.

    American Rugby

    Rugby is one of the most rapidly growing collision sports in the United States, and about one-third of registered players are women, which permits increasing opportunities for female athletes to participate at the collegiate level and receive financial support to do so. Currently, there are over four dozen men’s and women’s varsity rugby programs nationwide and countless club-level teams, with women’s rugby programs in particular seeking to grow to 40 varsity programs nationwide in order to achieve NCAA status.

    Bath Rugby Club pushing against an F1 Race Car

    Demands of the Game — Biomechanics of the Scrum

    As mentioned above, rugby is a high-velocity and physically demanding sport. One of the hallmarks of physicality in rugby is the scrum. In the 15s variation of the game, the scrum consists of eight players from each team bound to one another (Figure 1) using only their legs and feet to drive over the mark of the scrum to move the ball to the back of the scrum to make it playable by their team.

    The strength behind this movement has been featured in promotional content such as Oracle Red Bull Racing, whereby the Bath Rugby Club bound to one another in a scrummaging stance to compete against an F1 car — and the players didn’t give up any ground (Figure 2). In a scrum, the team producing the greatest force, in a controlled manner, will successfully win the scrum, providing tactical advantages in a game. Thus, force production is of great interest for rugby stakeholders.

    Within the scrum, one can expect to see a sustained force output of 4-8,000 N for full packs (i.e., eight people) of male players. This force is typically maximized when players are binding at ~40% of their stature with feet parallel to one another and with the knees and hips at an angle of around 120°. Indeed, the maximum force measured during a sustained push of a full pack in laboratory conditions has been shown to be upwards of 16,000 N, which can be normalized to roughly twice their force-to-body-mass ratio. Importantly, these forces are less pronounced in the 7s variation of the game as there is only one row of three players from each team competing for the ball, with the focus in 7s being more on speed, longer runs and more frequent scoring.

     

    Katie Hunzinger headshot

    Katie Hunzinger, Ph.D., ACSM-CEP, is a biomechanist, clinical exercise physiologist, and assistant professor of exercise science at Thomas Jefferson University. She is a former Division I rugby player and remains involved in rugby as either a consultant, World Rugby Educator, or regional-level rugby referee. Moreover, her research actively recruits rugby players as a means to better understand the mid- to late-life effects of repetitive neurotrauma through collision sports. Dr. Hunzinger’s goal is to make sport inclusive, safe, and sustainable.

  • Hot Topic | Summertime and the 24-Hour Day: Get Teens Moving!

    by Greg Margason | Jul 23, 2024

    Everyone looks forward to the summer, especially teens. In the United States, this two- to three-month period is typically characterized by sleeping in, catching up on shows and taking part in assorted adventures. 

    But today’s adventures may be different than those of the past. Just in case parents of today’s teens needed a reminder, we no longer live in the summers of our youth where we played outdoors — likely unsupervised, and certainly without cellphones. 

    Traditionally, researchers and practitioners focused on physical activity, sedentary behavior (namely, sedentary screen time) and sleep as individual behaviors. More recently, these three behaviors were combined into a single concept christened “24-hour movement behaviors” by a Canadian group in a momentous, multi-behavior step forward. The concept was initially created for children ages 5-17, but similar guidelines have followed for younger children (0-4), and recently adults (18-64) and older adults (65+). 

    The past decade has produced evidence, mainly cross-sectional, that achieving ideal goals in multiple categories is beneficial for physical and mental health across the lifespan. One of the next steps forward, then, should be to create an intervention or program aimed at improving 24-hour movement behaviors for another distinct age group: teens. 

    Very few teens meet guidelines for physical activity, sedentary behavior and sleep. In fact, recent systematic reviews demonstrate only ~5% of teens (ages 12-17) meet all three guidelines, and around 30% of teens meet none of them. 

    Ideally, teens should perform ≥60 minutes/day of moderate-to-vigorous physical activity, including three or more days of muscle-strengthening activities; limit sedentary behavior, particularly recreational screen time, to no more than two hours per day; and sleep 9-11 hours per night (ages 5-13) or 8-10 hours per night (ages 14-17), with consistent bed and wakeup times. 

    There is clear evidence that all three behaviors change during the summer: in general, adolescents are less active and have higher screen time during this period, and their sleep timing is shifts. These changes are likely due to a lack of pre-planned events or routines, as proposed in the Structured Day Hypothesis and observed during the COVID-19 pandemic

    The home is the one place where all three behaviors occur. Thus, it is also the ideal place to make changes across the 24-hour day. Families, including siblings, may help facilitate more daily physical activity, less screen time and consistent sleep through routines and prioritizing healthy behaviors. 

    What could a 24-hour program for teens look like? 

    First, reducing sedentary screen time, given very few teens (~15%) meet this individual guideline. Replacing this time with a physical activity that can be performed close to home, preferably outdoors, is a great place to start. These activities may include family walks, walking the dog, going to a park and helping neighbors with tasks (e.g., mowing the lawn). Outside of the home, it may include a summer camp, volunteering or a part-time job to keep teens off the couch. 

    Second, creating routines for the whole family. This change may seem counterintuitive with travel and camps cropping up every other week, but everyone (even parents) can benefit from consistent bed and wake times. Proper sleep hygiene, including limiting screens before bed (again, even for parents), may help promote earlier sleep onset. 

    Third, consider introducing a reward system to promote adherence throughout the summer. Remember, the “prize” should also be a positive, physically active behavior, so think of a trip to a water park or local lake rather than a weekend binging a show. 

    How do we get started? 

    Parents: Don’t wait for the new year to make a change. Something as close as the next Monday or beginning of the month is a good time to begin creating routines and promoting healthier behavior. Establishing a program in mid- or late summer can also give teens a head start on these behavior changes before school begins. 

    Practitioners: Consider assessing sedentary time and sleep as part of evaluations performed during the summer. Promoting adequate amounts of these important behaviors will provide additive benefits beyond those gained from solely focusing on physical activity promotion. 

    Researchers: Be sure to assess all three behaviors in your current research, and asses through both survey- and device-based measures. Finally, evaluating guidelines amongst longitudinal cohorts will likely improve the predominantly cross-sectional evidence.   

     

    Chelsea Kracht, Ph.D., is an assistant professor in the Division of Physical Activity and Weight Management and Department of Internal Medicine at the University of Kansas Medical Center. Her mission is to conduct research that informs public health initiatives related to child and caregiver health, with specific focus on research that promotes an adequate balance of 24-hour movement behaviors (physical activity, sedentary behavior and sleep) across the lifespan. Dr. Kracht has been an ACSM member since 2015. 

  • Clinical Highlights from Current Sports Medicine Reports | Q2 2024

    by Caitlin Kinser | Jul 15, 2024
    Quarterly Editor's picks with a headshot of Dr. Shawn Kane and the cover of Current Sports Medicine Reports

    Welcome to the highlights and the review of the AWESOME articles and case reports published over the last quarter in Current Sports Medicine Reports (CSMR). This past quarter for CSMR was amazing. I was going through the articles and cases that were published and on my first review I selected almost all of them. While this is a great problem to have, it would make this quarterly highlight too long, so I went back and selected what I thought were the best of the best.

    Four highlighted section articles from the past quarter:

    Oxygen Straight to the Brain: An Overview of Hyperbaric Oxygen Therapy for a Variety of Brain Morbidities written by Leighton, VanHorne and Parsons. This is a very interesting topic to me as we are frequently asked about hyperbaric oxygen therapy (HBOT) by veterans and first responders who are participating in the The THRIVE Program here at the University of North Carolina, Chapel Hill. The authors do a great job explaining what HBOT is, how it works and what the current FDA indications are for HBOT. They then examine the use of HBOT for mTBI, PTSD and headaches. They present and critique the evidence that is out there and rightly state “hyperbaric therapeutic impacts for these in the acute and chronic or prolonged symptoms are elusive.” Cost and lack of sustained relief are two areas emphasized by the authors and they conclude that better studies are needed to provide high fidelity treatment metrics.

    Adaptive Athlete Considerations for Races and Other Mass Participation Sporting Events written by Sedgley, et al. There is always a lot of discussion on emergency action plans (EAPs) and one thing I liked about this topic when the authors approached me was the singular focus on adaptive athletes. Both the number of adaptive athletes participating in sports and the number of sports available to adaptive athletes continues to rise. This is a population that has unique medical complications and risks from athletic participation that must be considered. The authors did a great job of using current EAPs and highlighting the specific needs of adaptive athletes.

    Vigorous Exercise in Patients with Hypertrophic Cardiomyopathy written by Fox, et al. It always felt to me that we talked about hypertrophic cardiomyopathy (HCM) from the standpoint of you can’t miss this on the PPE -- sudden cardiac death = no sports. However, we never talked about what can we do for these patients, other than not let them play sports.  The authors do a great job reviewing the evolving data on the topic and emphasizing shared decision making with HCM patients to allow participation in health promoting activities. 

    A Scoping Review of the Epidemiology, Management, and Outcomes of Golf-Related Fractures written by Chen, et al. We just had the US Open down the road a bit in Pinehurst and I wanted to highlight golfers and note that Donald Ross can make some challenging greens. I love the game of golf but can’t really play due to some injuries. When I did golf, I just hoped my shots landed on earth. Watching the pros try to land their ball in a 3 x 5-inch area from 300 yards away is impressive. I wanted to highlight this article that thoroughly reviews golf-related fractures, not just the pisiform bone.

     

    Case Reports

    Case reports are a great way to learn, whether it is some rare, uncommon condition or just a different presentation of a common problem. I would like to highlight three not-to-be-missed cases from the past quarter:

    Ice Sheet Cooling in the Field Reduces Morbidity in Exertional Heat Stroke written by Willcox, Rhodehouse and DeGroot. I had the privilege to work with Dr. Dave DeGroot while in the military and the work that continues to come out of The Army Heat Center under his direction is saving lives. They are working to find and show evidence-based ways to decrease the morbidity and mortality related to heat stroke during military training. Ice sheets work!

    Gluteus Maximus Distal Myotendinous Junction Tear in a Pickleball Player: A Case Report written by King, Johnson and Jelsing. I have a couple older patients who are very active and competitive playing pickleball -- I never thought you could get hurt playing it. This is an interesting case report about a 72-year-old male who injured his gluteus maximus playing pickleball. This is an interesting case with an excellent review of anatomy.

    Ankle Pain Due to Pigmented Villonodular Synovitis written by Chambers, Carey and Silvis. This is a super interesting case that reminds us to create broad differential diagnosis. I will admit I have only seen pigmented villonodular synovitis a couple times in the knee and it wouldn’t have been on my initial differential, but it will be now.

    CSMR is ACSM’s official monthly clinical review e-journal. Written specifically for physician and clinician members, CSMR articles provide thorough overviews of the most current sports medicine literature. ACSM physician members receive an online subscription to this journal as a member benefit.

     

    Shawn F. Kane, MD, FACSM, is a family physician, professor in the Department of Family Medicine, and adjunct assistant professor in the Department of Exercise and Sports Science at the University of North Carolina (UNC) Chapel Hill. He received his medical degree from the Uniformed Services University of the Health Sciences and served in the U.S. Army for 27 years. While in the Army he spent more than 18 years serving as a physician-leader in numerous units within the US Army Special Operations Command. He is interested in sports medicine, concussion care, veterans’ health, and primary care of patients with post-traumatic stress disorder. Dr. Kane joined ACSM in 2003 and became a fellow in 2011. He currently serves as the editor-in-chief for Current Sports Medicine Reports, on ACSM’s Clinical Sports Medicine Leadership Committee, ACSM’s Health & Fitness Summit Program Committee, and ACSM’s Program Committee. Outside of the office, Dr. Kane enjoys hanging out with his Leonbergers (big furry, cute German Mountain dogs), as well as working out and traveling.

  • NFL Smart Hearts Sports Coalition Summer Updates

    by Caitlin Kinser | Jul 11, 2024
    U.S. capitol building on a blog cover image with a black and blue background and lime green stripes

    ACSM is a member of the Coalition that is helping drive legislation to support its goal of all 50 states adopting evidence-based policies preventing fatal outcomes from Sudden Cardiac Arrest (SCA) among high school students.

    The coalition is advocating for the implementation of three best practice policies:

    1. Emergency Action Plans (EAPs) for each high school athletic venue that are widely distributed, posted, rehearsed, and updated annually;
    2. Clearly marked automated external defibrillator (AEDs) at each athletic venue or within 1-3 minutes of each venue where high school practices or competitions are held; and,
    3. CPR and AED education for coaches.

    Here’s a summary of the coalition’s progress over the last month:

    State Laws

    • Ohio – On Wednesday, June 28th, the Ohio Senate unanimously (31-0) passed HB 47, following the long-awaited approval of the Senate Health Committee, where it had been pending since 2023. The House voted overwhelmingly (81-10) to concur with the Senate’s version, which included a few technical amendments. The bill now is headed to OH Governor Mike DeWine’s desk, and its anticipated that he will sign it, which would implement the two missing policies (AEDs, EAPs) in the state.
    • Oklahoma – On Friday, June 14th, OK Governor Kevin Stitt signed SB 1921 into law, implementing all three policies in the state. The Governor is considering hosting a bill-signing ceremony in July. The bill passed the House on April 8th (following approval in the Senate), but lawmakers in a last-minute maneuver struck the title and enacting clause in the bill, putting the bill in limbo until further negotiations between legislators and the Governor regarding unrelated issues (i.e., the budget) were resolved.
    • Kansas – On Thursday, May 16th, KS Governor Laura Kelly held a bill-signing ceremony in Topeka, Kansas. With SB 19 (AEDs) enacted into law, Kansas now has all three policies in place. The Governor approved the bill on April 23rd.
    • During the next several months, groundwork will continue to build on the progress that’s been made in a number of states (including NY, MN, SC, VA and NH), so the coalition will be in a strong position to help enact legislation in 2025.

    Federal– Access to AEDs Act/HEARTS Act

    • House – The HEARTS Act – which now includes key provisions of the Access to AEDs Act – is poised to be taken up on the House floor. It passed the House E&C Committee on February 14th and has been placed on the Union Calendar.
    • Senate – The Access to AEDs Act picked up additional sponsors as a result of AHA’s “Hearts on the Hill” Advocacy Day on May 23rd. Sens. Durbin (D-IL), Boozman (R-AR), Klobuchar (D-MN), Shaheen (D-NH), and Peters (D-MI) are now among the 19 Senate cosponsors.
  • FY 2025 Congressional Appropriations and NIH Reform

    by Caitlin Kinser | Jul 11, 2024
    the US capitol building on a blog cover image featuring the title of the blog post

    FY 2025 Congressional Appropriations 

    As House spending bills undergo subcommittee markups, Senate appropriators have outlined 302(b) allocations, despite a lack of Republican agreement to expedite bill consideration. Currently, only the Agriculture, Military Construction-VA, and legislative branch measures have received allocations and will be considered at the full committee level on July 11, bypassing the subcommittee markups. 

    In the House, the Commerce, Justice, Science and Related Agencies bill has been released for subcommittee markup. On July 9, the House Appropriations Committee approved it with a recorded vote of 31–26. The bill allocates $9.3 billion for the National Science Foundation (NSF), exceeding the fiscal year (FY) 2024 enacted level by $199 million (2%) and falling $924 million below the president’s budget request. During the subcommittee meeting, the bill was moved to the full committee without amendments via a voice vote. The funding aims to maintain America’s global scientific prominence in the face of competition from China. However, both Matt Cartwright and Rosa DeLauro, ranking members of the subcommittee and full committee respectively, urged a no vote against the bill, citing concerns about defunding and politicizing law enforcement. A summary of the bill is available here

    The Labor, Health and Human Services, Education and Related Agencies (LHHS) bill allocates $48.6 billion to the National Institutes of Health (NIH), matching the FY 2024 enacted level. This proposal represents the largest restructuring of the NIH in a generation, consolidating 27 centers into 15. Subcommittee Chair Robert Aderholt considers the NIH overhaul a key goal. The LHHS bill strongly supports basic biomedical research focused on curing cancers, Alzheimer’s disease, and other chronic and rare conditions. During the subcommittee markup, Chair Robert Aderholt emphasized that amendments would occur at the full committee level, emphasizing the need to rein in excessive spending and restore fiscal responsibility. The bill proposes reductions in 40 programs and eliminates over 50 programs lacking proper authorizations. A summary of the bill may be found here.   

    Full Committee Chair Tom Cole praised the bill’s investment in impactful resources for the National Institutes of Health. He commended Chair Aderholt for initiating discussions on necessary reforms within agencies. While acknowledging that not all reforms can be addressed in this bill, Cole highlighted the valuable dialogue and cooperation with the authorizing committee. 

    Representative Rosa DeLauro expressed reservations about restructuring the agency through the appropriations bill. She emphasized the importance of public hearings and thoughtful processes to enhance the NIH’s status as a premier biomedical research institution. 

    Aderholt specifically highlighted provisions in the bill, including no funding for diversity activities, defunding Planned Parenthood, prohibiting funds for abortion-related fetal tissue research, restricting research dollars to labs in Russia or China to prevent future pandemics, and banning gain-of-function research. 

    The bill also maintains the Hyde amendment. Cole acknowledged that the bill’s final form may evolve, anticipating Democratic opposition to the initial version and Republican steadfastness on the Hyde amendment. The bill passed the subcommittee vote on June 27. 

     

    Reforming NIH 

    On June 14, House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) asked stakeholders to provide their input on reforming the National Institutes of Health (NIH) to be more accountable, integrated, and agile; ensuring NIH funding mechanisms are clear and reflective of Congressional intent; and safeguarding NIH grants against national security risks and threats. 

    Rodgers also, along with Robert Aderholt (R-AL), Chair of the Labor, Health and Human Services, and Education Appropriations Subcommittee, which has funding jurisdiction over NIH, wrote an opinion piece in STAT news, “NIH Needs Reform and Restructuring, Key Republican Chairs Say.” Their reasons for reform included NIH approval of grants that conducted dangerous experiments and the lack of transparency at every state of various congressional inquiries. Rodgers and Aderholt ’s proposals include lowering the number of institutes and centers by combining them to reduce research duplication and potential misconduct. It has been nearly two decades since Congress evaluated NIH and advanced structural reform. Some stakeholders would like to see reform but with zero impact to the NIH budget.  

    The American College of Sports Medicine (ACSM) is closely monitoring these proposed changes to the National Institutes of Health (NIH). As part of our commitment to advancing scientific research and public health, we plan to submit comments on these proposed modifications. We value our members expertise and insights. If you have thoughts, concerns, or recommendations related to the NIH changes, we encourage you to share them with us. Your input will help shape our official response. 

    Please send your feedback to Monte Ward by August 1, 2024. We appreciate your active engagement in this critical matter. 

     

    NIH Request for Information in Public Policy Access 

    On June 17, 2024, the National Institutes of Health (NIH) released a Request for Information (RFI) entitled, Request for Information on the National Institutes of Health Draft Public Access Policy. NIH is soliciting comments from the public on the NIH Draft Public Access Policy and two supplemental draft guidance documents regarding government use license and rights and costs for publications. The NIH Draft Public Access Policy builds upon NIH’s long history of providing public access to scholarly publications resulting from the research it supports and proposes additional steps to accelerate access. 

     

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