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U.S. Army Research Institute of Environmental Medicine

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Research output, citation impact, and the most-cited recent papers from U.S. Army Research Institute of Environmental Medicine (United States). Aggregated across the NobleBlocks index of 300M+ scholarly works.

Total works
4.7K
Citations
342.5K
h-index
217
i10-index
5.7K
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U.S. Army Research Institute of Environmental Medicine

Top-cited papers from U.S. Army Research Institute of Environmental Medicine

A review of caffeine’s effects on cognitive, physical and occupational performance
Tom M. McLellan, John A. Caldwell, Harris R. Lieberman
2016· Neuroscience & Biobehavioral Reviews799doi:10.1016/j.neubiorev.2016.09.001

). Many occupations, including military, first responders, transport workers and factory shift workers, require optimal physical and cognitive function to ensure success, workplace safety and productivity. In these circumstances, that may include restricted sleep, repeated administration of caffeine is an effective strategy to maintain physical and cognitive capabilities.

Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes
Joseph J. Knapik, Connie L. Bauman, Bruce H. Jones, John Harris +1 more
1991· The American Journal of Sports Medicine693doi:10.1177/036354659101900113

One hundred thirty-eight female collegiate athletes, participating in eight weightbearing varsity sports, were administered preseason strength and flexibility tests and followed for injuries during their sports seasons. Strength was measured as the maximal isokinetic torque of the right and left knee flexors and knee extensors at 30 and 180 deg/sec. Flexibility was measured as the active range of motion of several lower body joints. An athletic trainer evaluated and recorded injuries occurring to the athletes in practice or competition. Forty percent of the women suffered one or more injuries. Athletes experienced more lower extremity injuries if they had: 1) a right knee flexor 15% stronger than the left knee flexor at 180 deg/sec; 2) a right hip extensor 15% more flexible than the left hip extensor; 3) a knee flexor/knee extensor ratio of less than 0.75 at 180 deg/sec. There was a trend for higher injury rates to be associated with knee flexor or hip extensor imbalances of 15% or more on either side of the body. These data demonstrate that specific strength and flexibility imbalances are associated with lower extremity injuries in female collegiate athletes.

Hormonal and growth factor responses to heavy resistance exercise protocols
William J. Kraemer, L. J. Marchitelli, Scott E. Gordon, E. A. Harman +4 more
1990· Journal of Applied Physiology690doi:10.1152/jappl.1990.69.4.1442

To examine endogenous anabolic hormone and growth factor responses to various heavy resistance exercise protocols (HREPs), nine male subjects performed each of six randomly assigned HREPs, which consisted of identically ordered exercises carefully designed to control for load [5 vs. 10 repetitions maximum (RM)], rest period length (1 vs. 3 min), and total work effects. Serum human growth hormone (hGH), testosterone (T), somatomedin-C (SM-C), glucose, and whole blood lactate (HLa) concentrations were determined preexercise, midexercise (i.e., after 4 of 8 exercises), and at 0, 5, 15, 30, 60, 90, and 120 min postexercise. All HREPs produced significant (P less than 0.05) temporal increases in serum T concentrations, although the magnitude and time point of occurrence above resting values varied across HREPs. No differences were observed for T when integrated areas under the curve (AUCs) were compared. Although not all HREPs produced increases in serum hGH, the highest responses were observed consequent to the H10/1 exercise protocol (high total work, 1 min rest, 10-RM load) for both temporal and time integrated (AUC) responses. The pattern of SM-C increases varied among HREPs and did not consistently follow hGH changes. Whereas temporal changes were observed, no integrated time (AUC) differences between exercise protocols occurred. These data indicate that the release patterns (temporal or time integrated) observed are complex functions of the type of HREPs utilized and the physiological mechanisms involved with determining peripheral circulatory concentrations (e.g., clearance rates, transport, receptor binding). All HREPs may not affect muscle and connective tissue growth in the same manner because of possible differences in hormonal and growth factor release.

Invited Review: Effects of heat and cold stress on mammalian gene expression
Larry A. Sonna, Jun Fujita, Stephen L. Gaffin, Craig M. Lilly
2002· Journal of Applied Physiology646doi:10.1152/japplphysiol.01143.2001

This review examines the effects of thermal stress on gene expression, with special emphasis on changes in the expression of genes other than heat shock proteins (HSPs). There are approximately 50 genes not traditionally considered to be HSPs that have been shown, by conventional techniques, to change expression as a result of heat stress, and there are <20 genes (including HSPs) that have been shown to be affected by cold. These numbers will likely become much larger as gene chip array and proteomic technologies are applied to the study of the cell stress response. Several mechanisms have been identified by which gene expression may be altered by heat and cold stress. The similarities and differences between the cellular responses to heat and cold may yield key insights into how cells, and by extension tissues and organisms, survive and adapt to stress.

A physiological strain index to evaluate heat stress
Daniel S. Moran, Avraham Shitzer, K. B. Pandolf
1998· American Journal of Physiology-Regulatory, Integrative and Comparative Physiology605doi:10.1152/ajpregu.1998.275.1.r129

A physiological strain index (PSI), based on rectal temperature (Tre) and heart rate (HR), capable of indicating heat strain online and analyzing existing databases, has been developed. The index rates the physiological strain on a universal scale of 0-10. It was assumed that the maximal Tre and HR rise during exposure to exercise heat stress from normothermia to hyperthermia was 3 degrees C (36.5-39.5 degrees C) and 120 beats/min (60-180 beats/min), respectively. Tre and HR were assigned the same weight functions as follows: PSI = 5(Tret - Tre0) . (39.5 - Tre0)-1 + 5(HRt - HR0) . (180 - HR0)-1, where Tret and HRt are simultaneous measurements taken at any time during the exposure and Tre0 and HR0 are the initial measurements. PSI was applied to data obtained from 100 men performing exercise in the heat (40 degrees C, 40% relative humidity; 1.34 m/s at a 2% grade) for 120 min. A separate database representing seven men wearing protective clothing and exercising in hot-dry and hot-wet environmental conditions was applied to test the validity of the present index. PSI differentiated significantly (P < 0.05) between the two climates. This index has the potential to be widely accepted and to serve universally after extending its validity to women and other age groups.

Soldier Load Carriage: Historical, Physiological, Biomechanical, and Medical Aspects
Joseph J. Knapik, Katy Reynolds, Everett A. Harman
2004· Military Medicine592doi:10.7205/milmed.169.1.45

This study reviews historical and biomedical aspects of soldier load carriage. Before the 18th century, foot soldiers seldom carried more than 15 kg while on the march, but loads have progressively risen since then. This load increase is presumably due to the weight of weapons and equipment that incorporate new technologies to increase protection, firepower, communications, and mobility. Research shows that locating the load center of mass as close as possible to the body center of mass results in the lowest energy cost and tends to keep the body in an upright position similar to unloaded walking. Loads carried on other parts of the body result in higher energy expenditures: each kilogram added to the foot increases energy expenditure 7% to 10%; each kilogram added to the thigh increases energy expenditure 4%. Hip belts on rucksacks should be used whenever possible as they reduce pressure on the shoulders and increase comfort. Low or mid-back load placement might be preferable on uneven terrain but high load placement may be best for even terrain. In some tactical situations, combat load carts can be used, and these can considerably reduce energy expenditure and improve performance. Physical training that includes aerobic exercise, resistance training targeted at specific muscle groups, and regular road marching can considerably improve road marching speed and efficiency. The energy cost of walking with backpack loads increases progressively with increases in weight carried, body mass, walking speed, or grade; type of terrain also influences energy cost. Predictive equations have been developed, but these may not be accurate for prolonged load carriage. Common injuries associated with prolonged load carriage include foot blisters, stress fractures, back strains, metatarsalgia, rucksack palsy, and knee pain. Load carriage can be facilitated by lightening loads, improving load distribution, optimizing load-carriage equipment, and taking preventive action to reduce the incidence of injury.

Effects of Psychological, Environmental and Physical Stressors on the Gut Microbiota
J. Philip Karl, Adrienne Hatch‐McChesney, Steven Arcidiacono, Sarah Pearce +3 more
2018· Frontiers in Microbiology524doi:10.3389/fmicb.2018.02013

Stress, a ubiquitous part of daily human life, has varied biological effects which are increasingly recognized as including modulation of commensal microorganisms residing in the gastrointestinal tract, the gut microbiota. In turn, the gut microbiota influences the host stress response and associated sequelae, thereby implicating the gut microbiota as an important mediator of host health. This narrative review aims to summarize evidence concerning the impact of psychological, environmental, and physical stressors on gut microbiota composition and function. The stressors reviewed include psychological stress, circadian disruption, sleep deprivation, environmental extremes (high altitude, heat, and cold), environmental pathogens, toxicants, pollutants, and noise, physical activity, and diet (nutrient composition and food restriction). Stressors were selected for their direct relevance to military personnel, a population that is commonly exposed to these stressors, often at extremes, and in combination. However, the selected stressors are also common, alone or in combination, in some civilian populations. Evidence from preclinical studies collectively indicates that the reviewed stressors alter the composition, function and metabolic activity of the gut microbiota, but that effects vary across stressors, and can include effects that may be beneficial or detrimental to host health. Translation of these findings to humans is largely lacking at present. This gap precludes concluding with certainty that transient or cumulative exposures to psychological, environmental, and physical stressors have any consistent, meaningful impact on the human gut microbiota. However, provocative preclinical evidence highlights a need for translational research aiming to elucidate the impact of stressors on the human gut microbiota, and how the gut microbiota can be manipulated, for example by using nutrition, to mitigate adverse stress responses.

Simulation-Based Power Analysis for Factorial Analysis of Variance Designs
Daniël Lakens, Aaron R. Caldwell
2021· Advances in Methods and Practices in Psychological Science519doi:10.1177/2515245920951503

Researchers often rely on analysis of variance (ANOVA) when they report results of experiments. To ensure that a study is adequately powered to yield informative results with an ANOVA, researchers can perform an a priori power analysis. However, power analysis for factorial ANOVA designs is often a challenge. Current software solutions do not allow power analyses for complex designs with several within-participants factors. Moreover, power analyses often need [Formula: see text] or Cohen’s f as input, but these effect sizes are not intuitive and do not generalize to different experimental designs. We have created the R package Superpower and online Shiny apps to enable researchers without extensive programming experience to perform simulation-based power analysis for ANOVA designs of up to three within- or between-participants factors. Predicted effects are entered by specifying means, standard deviations, and, for within-participants factors, the correlations. The simulation provides the statistical power for all ANOVA main effects, interactions, and individual comparisons. The software can plot power across a range of sample sizes, can control for multiple comparisons, and can compute power when the homogeneity or sphericity assumption is violated. This Tutorial demonstrates how to perform a priori power analysis to design informative studies for main effects, interactions, and individual comparisons and highlights important factors that determine the statistical power for factorial ANOVA designs.

Intrinsic risk factors for exercise-related injuries among male and female army trainees
Bruce H. Jones, Matthew Bovee, John Harris, David N. Cowan
1993· The American Journal of Sports Medicine515doi:10.1177/036354659302100512

Physical training-related injuries are common among army recruits and other vigorously active populations, but little is known about their causation. To identify intrinsic risk factors, we prospectively measured 391 army trainees. For 8 weeks of basic training, 124 men and 186 women (79.3%) were studied. They answered questionnaires on past activities and sports participation, and were measured for height, weight, and body fat percentage; 71% of the subjects took an initial army physical training test. Women had a significantly higher incidence of time-loss injuries than men, 44.6% compared with 29.0%. During training, more time-loss injuries occurred among the 50% of the men who were slower on the mile run, 29.0% versus 0.0%. Slower women were likewise at greater risk than faster ones, 38.2% versus 18.5%. Men with histories of inactivity and with higher body mass index were at greater injury risk than other men, as were the shortest women. We conclude that female gender and low aerobic fitness measured by run times are risk factors for training injuries in army trainees, and that other factors such as prior activity levels and stature may affect men and women differently.

Heat stroke: Role of the systemic inflammatory response
Lisa R. Leon, Bryan G. Helwig
2010· Journal of Applied Physiology493doi:10.1152/japplphysiol.00301.2010

Heat stroke is a life-threatening illness that is characterized clinically by central nervous system dysfunction, including delirium, seizures, or coma and severe hyperthermia. Rapid cooling and support of multi-organ function are the most effective clinical treatments, but many patients experience permanent neurological impairments or death despite these efforts. The highest incidence of heat stroke deaths occurs in very young or elderly individuals during summer heat waves, with ∼ 200 deaths per year in the United States. Young, fit individuals may experience exertional heat stroke while performing strenuous physical activity in temperate or hot climates. Factors that predispose to heat stroke collapse include pre-existing illness, cardiovascular disease, drug use, and poor fitness level. For decades the magnitude of the hyperthermic response in heat stroke patients was considered the primary determinant of morbidity and mortality. However, recent clinical and experimental evidence suggests a complex interplay between heat cytotoxicity, coagulation, and the systemic inflammatory response syndrome (SIRS) that ensues following damage to the gut and other organs. Cytokines are immune modulators that have been implicated as adverse mediators of the SIRS, but recent data suggest a protective role for these proteins in the resolution of inflammation. Multi-organ system failure is the ultimate cause of mortality, and recent experimental data indicate that current clinical markers of heat stroke recovery may not adequately reflect heat stroke recovery in all cases. Currently heat stroke is a more preventable than treatable condition, and novel therapeutics are required to improve patient outcome.

Endogenous Anabolic Hormonal and Growth Factor Responses to Heavy Resistance Exercise in Males and Females
William J. Kraemer, Scott D. Gordon, Steven J. Fleck, L. J. Marchitelli +4 more
1991· International Journal of Sports Medicine476doi:10.1055/s-2007-1024673

To examine endogenous anabolic hormonal responses to two different types of heavy resistance exercise protocols (HREPs), eight male and eight female subjects performed two randomly assigned protocols (i.e. P-1 and P-2) on separate days. Each protocol consisted of eight identically ordered exercises carefully designed to control for load, rest period length, and total work (J) effects. P-1 utilized a 5 RM load, 3-min rest periods and had lower total work than P-2. P-2 utilized a 10 RM load, 1-min rest periods and had a higher total work than P-1. Whole blood lactate and serum glucose, human growth hormone (hGH), testosterone (T), and somatomedin-C [SM-C] (i.e. insulin-like growth factor 1, IGF-1) were determined pre-exercise, mid-exercise (i.e. after 4 of the 8 exercises), and at 0, 5, 15, 30, and 60 min post-exercise. Males demonstrated significant (p less than 0.05) increases above rest in serum T values, and all serum concentrations were greater than corresponding female values. Growth hormone increases in both males and females following the P-2 HREP were significantly greater at all time points than corresponding P-1 values. Females exhibited significantly higher pre-exercise hGH levels compared to males. The P-1 exercise protocol did not result in any hGH increases in females. SM-C demonstrated random significant increases above rest in both males and females in response to both HREPs.(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanisms of aerobic performance impairment with heat stress and dehydration
Samuel N. Cheuvront, Robert W. Kenefick, Scott J. Montain, Michael N. Sawka
2010· Journal of Applied Physiology474doi:10.1152/japplphysiol.00367.2010

Environmental heat stress can challenge the limits of human cardiovascular and temperature regulation, body fluid balance, and thus aerobic performance. This minireview proposes that the cardiovascular adjustments accompanying high skin temperatures (T(sk)), alone or in combination with high core body temperatures (T(c)), provide a primary explanation for impaired aerobic exercise performance in warm-hot environments. The independent (T(sk)) and combined (T(sk) + T(c)) effects of hyperthermia reduce maximal oxygen uptake (Vo(2max)), which leads to higher relative exercise intensity and an exponential decline in aerobic performance at any given exercise workload. Greater relative exercise intensity increases cardiovascular strain, which is a prominent mediator of rated perceived exertion. As a consequence, incremental or constant-rate exercise is more difficult to sustain (earlier fatigue) or requires a slowing of self-paced exercise to achieve a similar sensation of effort. It is proposed that high T(sk) and T(c) impair aerobic performance in tandem primarily through elevated cardiovascular strain, rather than a deterioration in central nervous system (CNS) function or skeletal muscle metabolism. Evaporative sweating is the principal means of heat loss in warm-hot environments where sweat losses frequently exceed fluid intakes. When dehydration exceeds 3% of total body water (2% of body mass) then aerobic performance is consistently impaired independent and additive to heat stress. Dehydration augments hyperthermia and plasma volume reductions, which combine to accentuate cardiovascular strain and reduce Vo(2max). Importantly, the negative performance consequences of dehydration worsen as T(sk) increases.

Integrated Physiological Mechanisms of Exercise Performance, Adaptation, and Maladaptation to Heat Stress
Michael N. Sawka, Lisa R. Leon, Scott J. Montain, Larry A. Sonna
2011· Comprehensive physiology462doi:10.1002/cphy.c100082

This article emphasizes significant recent advances regarding heat stress and its impact on exercise performance, adaptations, fluid electrolyte imbalances, and pathophysiology. During exercise-heat stress, the physiological burden of supporting high skin blood flow and high sweating rates can impose considerable cardiovascular strain and initiate a cascade of pathophysiological events leading to heat stroke. We examine the association between heat stress, particularly high skin temperature, on diminishing cardiovascular/aerobic reserves as well as increasing relative intensity and perceptual cues that degrade aerobic exercise performance. We discuss novel systemic (heat acclimation) and cellular (acquired thermal tolerance) adaptations that improve performance in hot and temperate environments and protect organs from heat stroke as well as other dissimilar stresses. We delineate how heat stroke evolves from gut underperfusion/ischemia causing endotoxin release or the release of mitochondrial DNA fragments in response to cell necrosis, to mediate a systemic inflammatory syndrome inducing coagulopathies, immune dysfunction, cytokine modulation, and multiorgan damage and failure. We discuss how an inflammatory response that induces simultaneous fever and/or prior exposure to a pathogen (e.g., viral infection) that deactivates molecular protective mechanisms interacts synergistically with the hyperthermia of exercise to perhaps explain heat stroke cases reported in low-risk populations performing routine activities. Importantly, we question the "traditional" notion that high core temperature is the critical mediator of exercise performance degradation and heat stroke. Published 2011. This article is a U.S. Government work and is in the public domain in the USA.

Dehydration: Physiology, Assessment, and Performance Effects
Samuel N. Cheuvront, Robert W. Kenefick
2014· Comprehensive physiology452doi:10.1002/cphy.c130017

This article provides a comprehensive review of dehydration assessment and presents a unique evaluation of the dehydration and performance literature. The importance of osmolality and volume are emphasized when discussing the physiology, assessment, and performance effects of dehydration. The underappreciated physiologic distinction between a loss of hypo-osmotic body water (intracellular dehydration) and an iso-osmotic loss of body water (extracellular dehydration) is presented and argued as the single most essential aspect of dehydration assessment. The importance of diagnostic and biological variation analyses to dehydration assessment methods is reviewed and their use in gauging the true potential of any dehydration assessment method highlighted. The necessity for establishing proper baselines is discussed, as is the magnitude of dehydration required to elicit reliable and detectable osmotic or volume-mediated compensatory physiologic responses. The discussion of physiologic responses further helps inform and explain our analysis of the literature suggesting a ≥ 2% dehydration threshold for impaired endurance exercise performance mediated by volume loss. In contrast, no clear threshold or plausible mechanism(s) support the marginal, but potentially important, impairment in strength, and power observed with dehydration. Similarly, the potential for dehydration to impair cognition appears small and related primarily to distraction or discomfort. The impact of dehydration on any particular sport skill or task is therefore likely dependent upon the makeup of the task itself (e.g., endurance, strength, cognitive, and motor skill).

Blood volume: importance and adaptations to exercise training, environmental stresses, and trauma/sickness
Michael N. Sawka, Víctor A. Convertino, E. Randy Eichner, SUZANNE M. SCHNIEDER +1 more
2000· Medicine & Science in Sports & Exercise445doi:10.1097/00005768-200002000-00012

This paper reviews the influence of several perturbations (physical exercise, heat stress, terrestrial altitude, microgravity, and trauma/sickness) on adaptations of blood volume (BV), erythrocyte volume (EV), and plasma volume (PV). Exercise training can induce BV expansion: PV expansion usually occurs immediately, but EV expansion takes weeks. EV and PV expansion contribute to aerobic power improvements associated with exercise training. Repeated heat exposure induces PV expansion but does not alter EV. PV expansion does not improve thermoregulation, but EV expansion improves thermoregulation during exercise in the heat. Dehydration decreases PV (and increases plasma tonicity) which elevates heat strain and reduces exercise performance. High altitude exposure causes rapid (hours) plasma loss. During initial weeks at altitude, EV is unaffected, but a gradual expansion occurs with extended acclimatization. BV adjustments contribute, but are not key, to altitude acclimatization. Microgravity decreases PV and EV which contribute to orthostatic intolerance and decreased exercise capacity in astronauts. PV decreases may result from lower set points for total body water and central venous pressure, while EV decreases may result from increased erythrocyte destruction. Trauma, renal disease, and chronic diseases cause anemia from hemorrhage and immune activation which suppresses erythropoiesis. The re-establishment of EV is associated with healing, improved life quality, and exercise capabilities for these injured/sick persons.

Prospective, Double-Blind, Concurrent, Placebo-Controlled Clinical Trial of Intravenous Ribavirin Therapy of Hemorrhagic Fever with Renal Syndrome
John W. Huggins, C. M. Hsiang, Thomas M. Cosgriff, M. Y. Guang +4 more
1991· The Journal of Infectious Diseases445doi:10.1093/infdis/164.6.1119

A prospective, randomized, double-blind, concurrent, placebo-controlled clinical trial of intravenous ribavirin (loading dose of 33 mg/kg, 16 mg/kg every 6 h for 4 days, and 8 mg/kg every 8 h for 3 days) was conducted in 242 patients with serologically confirmed hemorrhagic fever with renal syndrome (HFRS) in the People's Republic of China. Mortality was significantly reduced (sevenfold decrease in risk) among ribavirin-treated patients, when comparisons were adjusted for baseline risk estimators of mortality (P = .01; two-tailed). HFRS typically consists of five consecutive but frequently overlapping clinical phases. Only occurrence of oliguric phase and hemorrhage was associated with severity of clinical disease in the placebo group. Ribavirin therapy also resulted in a significant reduction in the risk of entering the oliguric phase and experiencing hemorrhage. The only ribavirin-related side effect was a well-recognized, fully reversible anemia after completion of therapy.

Prevalence of Dietary Supplement Use by Athletes: Systematic Review and Meta-Analysis
Joseph J. Knapik, Ryan Steelman, Sally S Hoedebecke, Krista G. Austin +2 more
2015· Sports Medicine425doi:10.1007/s40279-015-0387-7

BACKGROUND: Dietary supplements (DSs) are commercially available products consumed as an addition to the usual diet and are frequently ingested by athletes. OBJECTIVE: Our objective was to examine the prevalence of DS use by athletes. DATA SOURCES: PubMed, Ovid MEDLINE, OVID Healthstar, and Cumulative Index to Nursing and Allied Health were searched for original research articles published up to August 2014. Search terms included specific sports, specific DSs, and other terms. STUDY SELECTION: Studies were selected if they were written in English, involved athletes, and provided a quantitative assessment of the proportion of athletes using specific DSs. Percent of athletes using specific DSs. SYNTHESIS OF DATA: Methodological quality of studies was assessed by three reviewers using an 8-point scale that included evaluations for sampling methods, sampling frame, sample size, measurement tools, bias, response rate, statistical presentation, and description of the participant sample. Where there were at least two investigations, meta-analysis was performed to obtain summary (pooled) prevalence estimates (SPEs) on (1) DS use prevalence by sport and sex, (2) DS use prevalence by elite versus non-elite athletic status, and (3) specific DS prevalence for all athletic groups combined. Meta-analyses included evaluations of homogeneity and publication bias. RESULTS: A total of 159 unique studies met the review criteria. Methodological quality was generally low with an average ± standard deviation of 43 ± 16% of available rating points. There was low homogeneity for SPEs when compiled by sport, athletic status, and/or specific DSs. Contributing to the lack of homogeneity were differences in studies' objectives and types of assessments used (e.g., dietary surveys, interviews, questionnaires). Despite these limitations, the data generally indicated that elite athletes used DSs much more than their non-elite counterparts. For most DSs, use prevalence was similar for men and women except that a larger proportion of women used iron while a larger proportion of men used vitamin E, protein, and creatine. No consistent change in use over time was observed because even the earliest investigations showed relatively high use prevalence. CONCLUSION: It was difficult to generalize regarding DS use by athletes because of the lack of homogeneity among studies. Nonetheless, the data suggested that elite athletes used dietary supplements far more than their non-elite counterparts; use was similar for men and women with a few exceptions; use appeared to change little over time; and a larger proportion of athletes used DSs compared with the general US population. Improvements in study methodology should be considered in future studies especially (1) defining DSs for participants; (2) querying for very specific DSs; (3) using a variety of reporting timeframes (e.g., daily, 2-6 times/week, 1 time/week and <1 time/week); (4) reporting the sampling frame, number of individuals solicited, and number responding; (5) reporting characteristics of volunteers (and non-volunteers, if available); and (6) using similar methods on several occasions to examine possible temporal trends among athletes.

Systematic review of the potential adverse effects of caffeine consumption in healthy adults, pregnant women, adolescents, and children
Daniele Wikoff, Brian T. Welsh, Rayetta G. Henderson, Gregory P. Brorby +4 more
2017· Food and Chemical Toxicology422doi:10.1016/j.fct.2017.04.002

To date, one of the most heavily cited assessments of caffeine safety in the peer-reviewed literature is that issued by Health Canada (Nawrot et al., 2003). Since then, >10,000 papers have been published related to caffeine, including hundreds of reviews on specific human health effects; however, to date, none have compared the wide range of topics evaluated by Nawrot et al. (2003). Thus, as an update to this foundational publication, we conducted a systematic review of data on potential adverse effects of caffeine published from 2001 to June 2015. Subject matter experts and research team participants developed five PECO (population, exposure, comparator, and outcome) questions to address five types of outcomes (acute toxicity, cardiovascular toxicity, bone and calcium effects, behavior, and development and reproduction) in four healthy populations (adults, pregnant women, adolescents, and children) relative to caffeine intake doses determined not to be associated with adverse effects by Health Canada (comparators: 400 mg/day for adults [10 g for lethality], 300 mg/day for pregnant women, and 2.5 mg/kg/day for children and adolescents). The a priori search strategy identified >5000 articles that were screened, with 381 meeting inclusion/exclusion criteria for the five outcomes (pharmacokinetics was addressed contextually, adding 46 more studies). Data were extracted by the research team and rated for risk of bias and indirectness (internal and external validity). Selected no- and low-effect intakes were assessed relative to the population-specific comparator. Conclusions were drawn for the body of evidence for each outcome, as well as endpoints within an outcome, using a weight of evidence approach. When the total body of evidence was evaluated and when study quality, consistency, level of adversity, and magnitude of response were considered, the evidence generally supports that consumption of up to 400 mg caffeine/day in healthy adults is not associated with overt, adverse cardiovascular effects, behavioral effects, reproductive and developmental effects, acute effects, or bone status. Evidence also supports consumption of up to 300 mg caffeine/day in healthy pregnant women as an intake that is generally not associated with adverse reproductive and developmental effects. Limited data were identified for child and adolescent populations; the available evidence suggests that 2.5 mg caffeine/kg body weight/day remains an appropriate recommendation. The results of this systematic review support a shift in caffeine research to focus on characterizing effects in sensitive populations and establishing better quantitative characterization of interindividual variability (e.g., epigenetic trends), subpopulations (e.g., unhealthy populations, individuals with preexisting conditions), conditions (e.g., coexposures), and outcomes (e.g., exacerbation of risk-taking behavior) that could render individuals to be at greater risk relative to healthy adults and healthy pregnant women. This review, being one of the first to apply systematic review methodologies to toxicological assessments, also highlights the need for refined guidance and frameworks unique to the conduct of systematic review in this field.

Epidemiology of injuries associated with physical training among young men in the army
Bruce H. Jones, David N. Cowan, J. PITT TOMLISON, John R. Robinson +2 more
1993· Medicine & Science in Sports & Exercise419doi:10.1249/00005768-199302000-00006

It is widely acknowledged that musculoskeletal injuries occur as a result of vigorous physical activity and exercise, but little quantitative documentation exists on the incidence of or risk factors for these injuries. This study was conducted to assess the incidence, types, and risk factors for training-related injuries among young men undergoing Army infantry basic training. Prior to training we evaluated 303 men (median age 19 yr), utilizing questionnaires and measurements of physical fitness. Subjects were followed over 12 wk of training. Physical training was documented on a daily basis, and injuries were ascertained by review of medical records for every trainee. We performed univariate and multivariate analyses of the data. Cumulative incidence of subjects with one or more lower extremity training-related injury was 37% (80% of all injuries). The most common injuries were muscle strains, sprains, and overuse knee conditions. A number of risk factors were identified, including: older age, smoking, previous injury (sprained ankles), low levels of previous occupational and physical activity, low frequency of running before entry into the Army, flexibility (both high and low), low physical fitness on entry, and unit training (high running mileage).

The effects of arms and countermovement on vertical jumping
Everett A. Harman, Michael T. Rosenstein, Peter Frykman, Richard Rosenstein
1990· Medicine & Science in Sports & Exercise412doi:10.1249/00005768-199012000-00015

Countermovement and arm-swing characterize most jumping. For determination of their effects and interaction, 18 males jumped for maximal height from a force platform in all four combinations of arm-swing/no-arm-swing and countermovement/no-countermovement. For all jumps, vertical velocity peaked 0.03 s before and dropped 6-7% by takeoff. Peak positive power averaged over 3,000 W, and occurred about 0.07 s before takeoff, shortly after peak vertical ground reaction force (VGRF) and just before peak vertical velocity. Both countermovement and arm-swing significantly (P less than 0.05) improved jump height, but arm-swing's effect was greater, enhancing peak total body center of mass (TBCM) rise both pre and posttakeoff. Countermovement only affected the post-takeoff rise. The arm-swing resulted in higher peak VGRF and peak positive power. During countermovement, the use of arms resulted in less unweighting, slower and less extensive TBCM drop, and less negative power. Countermovement increased pretakeoff jump duration by 71-76%, increased average positive power, and yielded large positive and negative impulses. High test-retest reliability was shown for jump descriptive variables. Body weight together with peak posttakeoff TBCM rise effectively predicted peak power (multiple R2 = 0.89, standard error of estimate = 243 W). The results lend insight into which jumping techniques are most appropriate for given sports situations and indicate that a jump test can effectively be used to estimate peak power output.