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  • 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. 

     

  • Nanograms, Nanograms, Nanograms: THC and the NCAA

    by Caitlin Kinser | Jul 09, 2024
    various medicinal cannabis products, including hemp leaves, seeds and oil, on a green backdrop

    This past month, the National Collegiate Athletic Association (NCAA) voted to remove cannabinoids from the banned substance list

    I applaud this decision. Not because I support uncontrolled self-dosing of marijuana but because I have long been a firm believer that our messaging was not effective and that the testing approach did not accomplish the desired effect of overall deterrence. In explaining the decision, the NCAA noted a lack of scientific evidence that marijuana provides a competitive advantage and further acknowledged the ineffectiveness of the existing policy of penalizing athletes after positive tests. Rather, a harm-reduction strategy implemented at the institutional level is the preferred approach. 

    Did you ever wonder what a nanogram is? Or why 150 nanograms/milliliter (ng/mL) were set as a threshold for a positive test that sent each athlete toward a required counseling session, suspensions, community service and other forms of punishment? In a world where we practice evidence-based medicine, we have neglected to make a correlation between nanograms and how they specifically can impair one’s cognitive and physical performance. 

    Consider the following hypothetical situation: Two teammates meet up on a given night, and they each smoke the exact same amount of marijuana. Let’s assume there are no previous amounts in their system. Two weeks later, they are both called in for a random drug test. The results reveal that one of the individuals tests positive at 155 ng/mL while the other tests negative at 145ng/mL. One enters “the program”; the other is not required to. Merely by genetics, hydration status, ability to excrete, dietary habits and a host of other factors, despite testing so close to one another they are managed very differently. 

    Imagine for a second if you will that as compared to zero, 145 ng/mL and 155 ng/mL are essentially the same amount of tetrahydrocannabinol (THC) in one’s system. Would it make more sense to better understand what that amount of THC in the system does to performance rather than impart a penalty to one athlete and not the other? Do we even know that an arbitrary number of 150 ng/mL impairs everyone in the same manner? Think about alcohol. While we know that the blood alcohol content (BAC) of 0.08% represents legal impairment for driving, we do not have similar impairment thresholds for THC. Doesn’t every person react differently to different amounts of alcohol despite an impairment threshold? Wouldn’t it make sense, therefore, that individuals are also affected differently using different amounts of marijuana? Perhaps some individuals demonstrate cognitive deficiencies and reaction-time deficits with just 40 ng/mL of THC in the system. Yet others who yield highly positive tests may develop a tolerance to THC and not necessarily show the same performance deficits. The key here is to understand that in a harm-reduction model, we should focus on individual use and individualized interventions. What works for some does not work for others. Abstinence is not an effective form of messaging. Neither is just telling athletes that marijuana is bad. We have tried and failed for decades using these approaches. The solution is tying the outcomes of individual THC use to the identify of an athlete — being an athlete. 

    This is not to say that counseling interventions and mental health are not important. Quite the contrary. Among many other reasons, understanding why individuals partake in marijuana use, and helping with coping mechanisms, justifies such interventions. Counseling, however, should not be viewed as a punishment. These must be meaningful and trustworthy sessions, or the athlete will view them as checking a box in order to keep playing. A team approach to messaging is essential, and mental health professionals are a welcome addition to the support staff. 

    So, what is a nanogram? A nanogram is a measure of weight equal to one billionth of a gram. Can something this small in the body be so impactful and deleterious to performance? Is there really a difference between 145 and 155? Is it a one-size-fits-all approach? I suggest that moving forward, we begin to ask more relevant and meaningful questions in an effort to obtain more factual and practical information. We can measure so much now with the technology made available to us. It is time that we apply this technology toward assessing the correlation of THC in the body with metrics that matter and the factors that athletes view to be important to them. 

    As our thinking advances, we will also better learn about the many other non-euphoric cannabinoids (e.g., CBD, CBG) and the therapeutic effects that they may provide related to sleep, inflammation, pain, anxiety, recovery and who knows what else. There is a wealth of information yet to be learned once we break down the single word “cannabis” into the various entities that it is comprised of.  

    Change is difficult. Change can also be exciting. The change of the cannabis classification by the NCAA will have ripple effects for athletes and those physically active of all ages. 

     

    Read Dr. Konin's recent article "The Cannabis Shift: How We Educate and Message is Key" in the latest issue of Current Sports Medicine Reports.

     

    Jeff G. Konin, PhD, ATC, PT, FACSM, FNATA, FNAPis a clinical professor and director of the Doctor of Athletic Training program at Florida International University. He is a frequent speaker at conferences on the topic of cannabis and athletic performance and consults with numerous athletic programs at various levels, delivering contemporary cannabis education to coaches, athletes and support staff. 

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