Health, Nutrition & Exercise Science

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Research from the Department of Health, Nutrition & Exercise Science. The department website may be found at https://www.ndsu.edu/hnes/

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The Acute Effects of L-Arginine Supplementation on Flow-Mediated Dilation after Resistance Training to Fatigue
(North Dakota State University, 2017) Streeter, Daniel
The purpose of this study was to determine the effects of acute L-arginine supplementation on the endothelial health in healthy adults by assessing flow-mediated dilation (FMD) and cardiovascular indicators both before and after resistance exercise to fatigue. Thirty (15 male, 15 female) physically active healthy participants (mean ± SD: age 20.4 ± 1.8 years, height 176.9 ± 10.2 cm, body mass 76.0 ± 12.2 kg) volunteered for a randomized, cross-over, double-blind, placebo controlled clinical trial. Participants completed five sets of isokinetic elbow extension/flexion exercise after consumption of either placebo or 3 g L-arginine one hour prior. Baseline brachial artery diameter significantly increased post FMD (p<0.001), post-exercise (p<0.001), post-exercise FMD (p<0.001). There was no significant supplement effect on FMD (p=0.179). The increase in brachial diameter due to fatiguing exercise was not enhanced by acute supplementation with L-arginine nor did supplementation alter FMD responses after exercise.
Ad Libitum Fluid Intake and Plasma Responses Following Pickle Juice, Hypertonic Saline, and Deionized Water Ingestion
(North Dakota State University, 2012) Allen, Scott Thomas
Some clinicians warn against pickle juice (PJ) ingestion due to its sodium. PJ drinking guidelines have been developed but never tested. The purpose of this study was to determine if drinking PJ, hypertonic saline (HS), or deionized water (DIW) affected ad libitum DIW ingestion, plasma variables, or perceptions of thirst, fullness, or nausea (perceptual indicators). On three days, subjects were dehydrated (~2%), given one of three treatment drinks, rated its palatability, and rehydrated with DIW ad libitum. Over 60 minutes of rehydration blood samples and perceptual indicators were collected. Subjects consumed more DIW ad libitum following HS and PJ than DIW. Plasma variables and perceptions of thirst, fullness and nausea didn’t differ between treatment drinks. The rationale behind PJ drinking guidelines is questionable. Subjects drink more, not less, after PJ ingestion. Plasma variables and perceptual indicators didn’t differ between PJ and DIW. Athletes should schedule their drinking to fully rehydrate.
Analysis of Availability, Quality, and Price of Food Options in Denver, CO Grocery Stores
(North Dakota State University, 2016) Lunsford, Jesse Adam
In certain areas in the United States low-income, non-white populations have less access to healthy foods. This lack of access can manifest itself with higher costs, lower quality, or less availability of healthy food options. Research has shown a correlation between health status and ethnic and/or income status, which is related to negative correlations in health disparities and dietary intake. This study examined the Denver area grocery stores to identify if any populations had significant differences in food cost, food availability, or food quality. Thirty stores were randomly selected from Denver and analyzed using Nutritional Environmental Measure Survey for Supermarkets (NEMS-S). Results showed no significant relationships between cost, availability, or quality and socioeconomic status or minority status. Large supermarkets had better prices of healthier food options, and of higher quality than small, ethnic markets. Further research should assess behavioral decisions by consumers in Denver.
An Analysis of Certified Athletic Trainers’ Ability to Provide High-Quality Cardiopulmonary Resuscitation (CPR) over Hockey Shoulder Pads
(North Dakota State University, 2018) Estabrooks, Adam Gregory
Certified Athletic Trainers (ATCs) are expected to perform CPR for athletes regardless of whether the athlete is wearing protective equipment. The goal of this research was to determine /if ATCs were able to/ deliver high-quality CPR over hockey shoulder pads. Fifty ATCs completed CPR according to 2015 AHA guidelines on a medium-fidelity manikin, which had been fitted with hockey shoulder pads. CPR quality was measured with the Resusci Anne Wireless SkillReporter. CPR data included the following dimensions of compressions: overall score, mean rate, chest compression fraction, mean depth, % chest recoil, and % compressions with appropriate depth. Data were analyzed to compare differences of CPR performance between covariates. Overall score separated by gender was significant with men outperforming women. 56% of ATCs did not compress at the recommended depth. Therefore, the removal of hockey shoulder pads is recommended to ensure high-quality CPR performance as administered by ATCs.
Anterior Cruciate Ligament Neuromuscular Training Protocol of the Core and Hip Musculature: Effects On Female Athletes' Landing Mechanics
(North Dakota State University, 2013) Young, Charley John
Landing is a dynamic activity and considered one of the leading causes of noncontact ACL injuries. Poor biomechanics during dynamic activity resulting from neuromuscular imbalances may contribute to ACL injury. The purpose of this study was to determine if a trunk and hip neuromuscular training program for female high school athletes facilitates neuromuscular changes during landing mechanics. Participants were assessed using the Landing Error Scoring System (LESS) after a drop box jump, pre-test, mid-test, and post-test. A high LESS score indicates poor landing mechanics. Additionally, participants filled out a survey regarding their perceptions of neuromuscular changes and their landing mechanics. LESS scores decreased significantly between pre to post testing. Participants believed their landing mechanics improved, they became stronger, and they become more aware of their body. Results showed that an eight week hip and trunk neuromuscular program improved landing mechanics and may help decrease noncontact ACL injuries in this population.
Assessing Critical Thinking Skills of Athletic Training Professional and Post-Professional Students
(North Dakota State University, 2014) Adamietz, Daniel James
Critical thinking (CT) can be described as using resources, identifying assumptions, asking questions, comparing alternatives, and finally coming to a conclusion. Critical thinking can be used in daily life, general work, or in specialty situations and is a valuable skill in health professions. Athletic training integrates CT into evaluations, treatments, rehabilitation programs, and other activities. Critical thinking is needed in the profession of athletic training to increase accuracy of diagnosis and evaluation and to improve patient outcomes. The purpose of this study was to establish CT baseline scores for athletic training professional and post-professional students. Results revealed that the post-professional students in this sample scored higher on the Health Science Reasoning Test than professional students.
Assessing the Reliability of Two Orthopedic Special Tests to Determine Hip Flexor Contracture with the Assessment of Pelvic Tilt Angle during a Back Squat
(North Dakota State University, 2018) Grieshaber, Derrick
Orthopedic specialists use Special Tests to determine a pathology’s presence. Hip flexor contracture is linked to injury predisposition and postural anomalies. This research examined reliability for the Modified Thomas and Ely’s Special Tests when evaluating hip flexor contracture, and its effect on dynamic exercise. Twenty adults were randomized in a study and analyzed for hip flexor contracture. Dartfish Motion Analysis measured hip and knee flexion angles. Participants performed isometric squats to determine their maximal voluntary isometric contraction, which was later used to calculate exercise prescription for the eight-repetition dynamic back squat. Inter-rater reliability was slight to fair for iliopsoas contracture during the Modified Thomas Test. Overall analysis of pre-/post-test pelvic tilt and dynamic pelvic tilt between repetitions was not statistically significant (p<.05). Hip flexion between repetitions was statistically significant (p=.016). Clinicians should exert caution when defining pathology utilizing Special Tests and the effect of hip flexor contracture on dynamic movement.
Assessment of Protein Intake and Social Support among Bariatric Surgery Patients
(North Dakota State University, 2017) Gehl, Ashley Marie
People who have bariatric surgery often fall short of their desired weight loss. The purpose of this study was to assess adherence to protein recommendations of the post-bariatric surgery patients. Results of 59 participants indicated that over half did not meet protein recommendations. Over half used protein supplements to help meet the recommendations. Another purpose of this study was to determine individuals whom post bariatric surgery patients identified as important in their social support network. The use of social support bariatric groups was also assessed. Results showed bariatric support groups were an important form of social support to aid in weight loss. Both studies will aid healthcare professionals deepen their understanding of the long journey of weight loss in post-bariatric surgery patients. Bariatric surgery is an effective solution for individuals with obesity because it results in long-term weight loss; therefore, learning the characteristics of successful bariatric surgery patients is priority.
The Association Between Workplace Lactation Accommodations and Corporate Lactation Programs and Breastfeeding Duration in Working Women
(North Dakota State University, 2017) Hilliard, Elizabeth
Breastfeeding support has increased over the past 2 decades, especially in the workplace. The Patient Protection and Affordable Care Act of 2010 provided several protections for working, breastfeeding women. Prior to the passage of this legislation, the North Dakota State Legislature amended SB 2344 to create an Infant Friendly business designation available to any business or organization in the state providing specified lactation accommodations for their employees. While this amendment has been in effect since 2009, and the first cohort of businesses was designated in 2011, there has been no evaluation of this designation to determine effectiveness. The purpose of this research is to examine the difference in breastfeeding continuation rates between women working for Infant Friendly and non-designated businesses, and to identify how intention, self-efficacy, and other worksite factors influence breastfeeding duration. An 85 item online questionnaire was developed and distributed using various sampling methods to working women across the state of North Dakota. T-tests, Analysis of Variance, and forward step-wise regression were used to analyze results. While there was no statistically significant difference in breastfeeding duration between designated and non - designated businesses, there was a 3-month difference in duration between continually designated businesses and those letting their designation lapse. Participants disagreed that breastfeeding education was available from their employers. With regard to intention, women who intended to exclusively breastfeed did so with a four month longer duration than those with other feeding intentions, although the results were not statistically significant. Women who perceived only minor challenges with combining breastfeeding and working, and those with greater self-efficacy for breastfeeding had longer breastfeeding durations as well. While the designation is a starting point for worksite breastfeeding support, it could be more comprehensive. Adding a policy promotion and breastfeeding education component to the designation may improve awareness and use of accommodations, making the designation more impactful. These additions may also aid in increasing breastfeeding intention and self-efficacy among working women, and decrease the perception of barriers.
Associations between Physical Activity and Quality of Life: Implications for Primary Care
(North Dakota State University, 2018) Meyer, Stefanie Marie
It is increasingly well-known that chronic diseases are placing a burden on the United States, including the healthcare system. Considering chronic disease risk and quality of life (QOL) measures, improving lifestyle behaviors such as physical activity (PA) should be further explored. In particular, using a place-based approach such as the healthcare system to improve lifestyle behaviors is a strategy to explore. Lifestyle Medicine (LM) is an approach that uses behavior as therapy to treat conditions and is suggested as an approach for primary care. The purpose of study 1 was to explore potential differences in QOL of patients who were referred to LM and are categorized into one of three groups 1) did not engaged in LM 2) engaged in up to two sessions of LM 3) engaged in three or more sessions of LM. The purpose of study 2 was to explore the relationship among provider QOL, PA level, and referral practices to LM. Participants completed demographic and lifestyle referral practices questionnaire, RAND-36 item health questionnaire, and Physical Activity Vital Sign questions. Results from study 1 include no significant differences between LM groups, QOL, and PA. Additionally, a significant difference was found for patient general health QOL score for those who met PA guidelines (M = 68.16, SD = 23.346) versus those who did not meet PA guidelines (M = 54.67, SD = 16.23); t (48) = 2.41, p = .02. Results for study 2 include no significant differences between provider PA minutes and LM referral as well as provider general health QOL and LM referral. A significant difference was found for provider general health QOL score for those who met PA guidelines (M = 85.833, SD = 10.68) versus those who did not meet PA guidelines (M = 67, SD = 9.08); t (9) = 3.109, p = .013. This dissertation will further inform the healthcare community (health system and health professionals) about the importance of PA to overall QOL for patients and providers. Moving from sick care to preventive care using LM approaches must be further explored and studied for both improved health outcomes and financial sustainability.
Attracting a New Generation of Participants to the Elderly Nutrition Program
(North Dakota State University, 2017) Stangl, Christa Ann
The purpose of this study was to explore the types of services, programs, and activities needed and/or desired by older adults. The secondary purpose of this study is to explore what prompts and/or influences older adults, to participate in programs related to their health and wellbeing. This study is needed, because the population of older adults has increased, due to the baby boomer generation. Even though there is a large population increase there is a decrease in the use of senior centers. The study used qualitative methods by the means of eight focus group locations in the state of North Dakota. The results showed that current senior centers are not meeting the baby boomers’ expectations and/or needs to successfully age in place. Therefore, if changes are not made to the current senior center to attract baby boomers, it will no longer be a major service provider to older adults.
Best Practices for Strengthening Physical Activity Policies at Childcare
(North Dakota State University, 2017) Strang, Michelle
The sharp increase in childhood obesity in recent years has been dramatic and continues to negatively impact children and their families. Low levels of physical activity (PA) during the preschool years is likely a contributing factor. Considering that most children in the U.S. attend some type of childcare, this is an ideal venue for implementing policies that shape children’s activity and sedentary (SED) patterns. The purpose of this dissertation was twofold. The first study compared levels of moderate-to-vigorous PA (MVPA) and SED in children attending licensed childcare centers with a PA-policy with those attending centers without a PA policy. The second study identified correlates (child-level, teacher-level, and classroom-level) of children’s MVPA and SED at childcare. Preschoolers (191), lead teachers (23), and center directors (12) from 12 licensed childcare centers (6 intervention/6 comparison) participated in the study. Children wore accelerometers during childcare for 3 days in the spring (April/May) of 2016. For the first study, separate mixed-model ANCOVAs were utilized to examine group differences in MVPA and SED, with gender entered as a covariate and classroom as a random factor. Levels of MVPA (6.74 min/h vs. 5.62 min/h, p = 0.06) and SED (29.97 min/h vs. 31.30 min/h, p = 0.32) were not significantly different between intervention and comparison groups, Findings from study one suggest the implementing a PA policy may not improving children’s PA behaviors, although compliance to policy guidelines was low. For study two, accelerometry data were utilized to examine potential correlates (measured by surveys completed by parents, teachers, and directors) of children’s PA and SED. Correlation and mixed-model regression analyses were conducted to examine associations between 18 potential correlates across multiple domains (demographic, anthropometric, social, and environmental), accounting for gender and clustering of activity within classrooms. Results from study two indicate that gender (boys) (p < .01), time spent outdoors (p < .05) and the amount of play equipment available (p < .05) were positively associated with MVPA, and gender (boys) (p < .01), and time spent outdoors (p < .05) were negatively associated with SED.
Caffeine Intake in College Students
(North Dakota State University, 2015) Caldarone, Michelle Gail
Caffeine is a widely consumed substance that is readily available through many sources that may influence consumption in the college setting. The purpose of this study was to examine the relationship between caffeine intake and sleep behavior and the effect of campus dining frequency on caffeine intake in college students. Three hundred and fifty students (212 males and 138 females) participated in a 72-hour dietary analysis that provided the students’ age, gender, body mass index (BMI), and physical activity level. The students were asked to record dining frequency as well. Ninety-six of the 350 students completed a 7-day sleep diary to complete the sleep analysis. Chi-square tests, regression analysis, and t-tests were performed to analyze relationships and differences between variables. Results showed that there were no significant relationships between caffeine intake and age, gender, BMI, physical activity, sleep time, or frequency of dining and caffeine intake in college students.
Changes in Physical Activity and Quality of Life of Cancer Survivors Participating in a Group Exercise Program
(North Dakota State University, 2017) Greterman, Sarah
Although cancer survival rates are improving, cancer treatment is often associated with adverse biopsychosocial symptoms, including increased risk of anxiety, depression, and social isolation, and reduced physical fitness and quality of life (QOL) (Courneya, 2003; Howlader, et al., 2012; Rajotte, et al., 2012). Since the early 1990’s, interest in the potential benefits of participation in exercise on the well-being of cancer survivors has been growing (Pinto & Floyd, 2007). Although physical activity (PA) has shown to improve physical functioning and QOL many adverse biopsychosocial effects often impact one’s ability to engage in regular PA, and challenges overall well-being. (Knobf, Musanti, & Dorward, 2007). To overcome some of these barriers, the LIVESTRONG® Foundation partnered with numerous YMCA’s establishing a structured 12-week post-treatment group exercise program for cancer survivors. The purpose of this study was to evaluate changes in PA and QOL among cancer survivors participating in a LIVESTRONG® at the YMCA group-exercise program. Subjects (N=47) participating in a program in Fargo, North Dakota, between July 2011 and August 2014, were grouped into cohorts based on their monthly start date. PA was monitored using the SenseWear armband activity monitor and QOL was assessed using the FACT-G. Both PA and QOL were evaluated at three different time points: end of week 1, week 6, and week 12. Overall, results indicated participants engaged in more than 4 hours of PA each day, with more than 40 minutes of moderate-vigorous PA per day. Furthermore, significant declines in sedentary activity were observed from week 1 to week 6 and week 6 to week 12, based on wear time. In addition, participants started the program with relatively high QOL. All areas of QOL improved, with the most significant improvements correlated with physical well-being. Although it was difficult to determine exact cause and effect relationships relative to participation in the LIVESTRONG® at the YMCA group exercise program, the fact that participants met the minimum ACSM PA recommendations at each time point, expressed a significant decline in sedentary activity, and displayed improvements in QOL is promising.
Clinical Outcomes of Different Tempos of Music during Exercise in Cardiac Rehabilitation Patients
(North Dakota State University, 2014) Miller, Jarad Steven
This study examined the effects of stimulating and sedative music on ratings of perceived exertion (RPE), heart rate (HR), blood pressure (BP), and feeling status during exercise in cardiac rehabilitation (CR) patients. Twenty-two male and female older adults age 64 ± 8.0 y currently enrolled in phase III CR completed the study. Repeated measures crossover designs guided data collection. The manipulated independent variable was music condition (sedative, stimulating, and non-music control). The dependent variables were RPE, BP, HR, and feeling status with each represented by four repeated measures ANOVAs over time via SAS 9.3. Data analysis indicated significant differences for all exercise related variables besides BP. While standardizing the exercise, we observed that sedative music is the best choice to manipulate for decreases in RPE (p=.0019), increases in feeling status (p=.0192), and decreases in HR (p<.0001). Stimulating music would only be the correct choice to observe increases in HR (p<.001).
Communication in the Workplace: Does Communicating Breastfeeding Needs Affect Breastfeeding Duration for Working Mothers?
(North Dakota State University, 2018) Millner, Madison Sara
The purpose of this study was to identify if employer interpersonal communication and support are factors that reduce breastfeeding duration. An online, 85-item questionnaire was completed by employed breastfeeding mothers in the state of North Dakota. Of the 502 respondents, responses of a subset of 214 mothers who had concluded breastfeeding were analyzed. Shorter breastfeeding duration was seen in mothers who reported not being confident in combining breastfeeding and working. This was further seen in shorter breastfeeding duration among mothers who did not feel comfortable asking for accommodations or taking breastfeeding breaks. Mothers who were unsure about manager’s support of breastfeeding had shorter breastfeeding duration. Many respondents stated that their employer did not provide instrumental support. Over half of the respondents (60%) were unsure or disagreed/strongly disagreed that written policies concerning breastfeeding or pumping were present. Further research is needed to determine additional workplace barriers that reduce breastfeeding duration.
Comparing Different Brands of Kinesiology Tape for Subjects with Patellofemoral Pain Syndrome
(North Dakota State University, 2019) Marcus, Benjamin Leonard
Kinesiology tape is a common therapeutic intervention although inconsistent results are reported in the literature. The purposes of this research were to determine if the Kinesio® Taping Space Correction web cut increases patellofemoral joint space when applied to subjects with PFPS; to determine if this taping method affects patient outcomes; and to compare this taping method using two different brands: Kinesio® Tape and KT Tape®. In this randomized, controlled, double-blinded study, 32 participants with PFPS were placed into one of four groups; (1) Kinesio® Tape with tension, (2) Kinesio® Tape without tension, (3) KT Tape® with tension, and (4) KT Tape® without tension. After analyzing diagnostic ultrasound measurements, Visual Analogue Scale (VAS), and Kujala Patellofemoral Scoring System (KPSS), researchers concluded the tape significantly increased patellofemoral joint space after 10 minutes and effects were maintained for 24 hours. Pain and other symptoms decreased significantly although no differences were noted between groups.
Comparison of Ulnohumeral Joint Space, Ulnar Collateral Ligament Width, and Abnormality in Collegiate Baseball Players Using Musculoskeletal Ultrasound
(North Dakota State University, 2015) Bummer, Matthew Stephen
The purpose of this thesis is to examine the difference in ulnar collateral ligaments (UCL) between pitchers and position players in collegiate baseball players. Differences were found using musculoskeletal ultrasound and each had both the dominant and non-dominant arms examined. The following research questions guided this study: Is there a difference in ulnohumeral joint space between pitchers and position players, is there a difference in UCL width between pitchers and position players, and is there a difference in the amount of damage to the UCL between pitchers and position players? Both pitchers and position players were found to have changes when compared to their non-dominant side. Position players were found to have significantly wider ligaments than pitchers, which may suggest a difference in forces placed on the elbow. This study introduces ideas that will lead to future research to confirm this data.
Concurrent Validity of the Fitbit Flex Personal Activity Monitor and ActiGraph GT3X+ in Free-Living Setting
(North Dakota State University, 2016) Redenius, Nicklaus Alan
This study investigated the concurrent validity of two accelerometer-based physical activity (PA) monitors, the wrist-worn Fitbit Flex, and ActiGraph’s hip-worn GT3X+. Specifically, we examined the relationship, differences, and level of agreement between Fitbit and GT3X+ sedentary behavior (SED) and moderate-to-vigorous PA (MVPA) estimates. Sixty-seven adults (mean age: 47.1 ± 14.1, female: 73.1%) from North Dakota State University wore the Fitbit and GT3X+, and logged any sleep and non-wear time, for seven consecutive days in free-living conditions. GT3X+ estimates were calculated using ActiGraph Freedson, Troiano, and Freedson’s VM3 cut-points. Fitbit estimates were calculated via Fitabase. Only data during waking hours where both PA monitors were worn were analyzed. Fitbit and GTX+ estimates strongly correlated. Fitbit produced similar SED (mean difference = -35.83 minutes (min)/day), but significantly higher MVPA (mean differences = -59.7 – 77.41 min/day) to GT3X+. As the mean volume of MVPA increased, so did differences between Fitbit and GT3X+ estimates.
Cramp Threshold Frequency in a Fatgiued Flexor Hallicus Longus Compared to a Rested Flexor Hallicus Longus
(North Dakota State University, 2014) Drayton, Alexandra Marjorie
Muscle fatigue is thought to cause a person’s exercise associated muscle cramps (EAMCs). However, there is little support that fatigue is the reason EAMCs occur. We examined if a fatigued muscle would make it more susceptible to an EAMC. Subjects were exposed to a cramping protocol, which included two seconds of stimulation with a minute rest until a muscle cramp was induced. The participant rested for 30 minutes and then completed a fatigue protocol. The subject performed reps of toe curls against a resistance band (sets of 10 curls with a one minute break in between sets) until muscle failure. Following fatigue, participants immediately completed the cramping protocol. Paired t-test analysis revealed that the change in cramp threshold frequency was not statistically significantly different in a fatigued flexor hallicus longus than in a rested flexor hallicus longus (t(9)= 1.69, p > .05). Although not statistically significant, results indicated a difference between the mean cramp threshold frequency in a fatigued flexor hallicus longus (25.80Hz ± 7.33) when compared to a rested flexor hallicus longus (28.20Hz ± 7.91) condition. Fatigue does not play a factor on EAMCs. Future studies should focus on a larger sample size and evaluation of other possible factors that influence EAMCs.

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