Health, Nutrition & Exercise Science Doctoral Work

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Altering Cardiopulmonary Resuscitation (CPR) Education for Allied Health Care Providers Based on Self-Reported Experiences with Recertification
(North Dakota State University, 2021) Landin, Kassiann Deen
Health care providers (nurses, athletic trainers, and emergency medical services [EMS] personnel) are expected to perform high-quality cardiopulmonary resuscitation (CPR) regardless of their confidence. Also, regardless the design of CPR recertification courses, it is expected that health care providers perform high-quality CPR. The first goal of the study pertained to self-efficacy. This research investigated health care professionals reports of self-efficacy of CPR performance with the current CPR guidelines for a specific amount of time as well as over athletic equipment. Secondly, this research explored differences in recertification expectations and educational approaches between professions. Ninety-nine health care professionals (36 nurses, 36 athletic trainers, and 27 EMS personnel) completed a self-efficacy questionnaire and a CPR recertification questionnaire. For investigation one, raw data and, a 3X2 ANOVA model was estimated to test for differences between the professional groups and for the condition of athletic equipment in place. For investigation two, descriptive statistics, means, standard deviations, and frequencies were utilized to analyze the differences between professions in CPR recertification components. Health care providers claimed to have high levels of self-efficacy for CPR performance over an extended period of time, but a low level of self-efficacy when asked about performing CPR for an extended period of time over athletic equipment (40.09% of health care providers agreed/strongly agreed they could perform CPR for an extended period of time over athletic equipment). Nurses reported a lower total score for self-efficacy for CPR performance over protective athletic equipment when compared to athletic trainers and EMS personnel. Six percent of surveyed health care providers reported they trained on high-fidelity equipment in their most recent certification. Ninety-seven percent indicated that feedback directly from a manikin enhanced their ability to perform high-quality CPR. Only 41% of reported participation in booster sessions with 38% of nurses reporting participation every 3 months and 45% of athletic trainers never participated in booster session. The relationship between confidence and CPR quality must be explored further to ensure CPR education is revised. Also, because results provide baseline data clarifying differences between specific health care professions, deliberate practice specific to professionals for CPR education can occur.
An Analysis of Muscle Activity During Load Carriage, ACFT Scores, and Back Pain in Army ROTC Cadets
(North Dakota State University, 2021) Longo, Jennifer Ann
Context: Low back pain (LBP) is a leading musculoskeletal complaint among the military population. Load carriage tasks are a frequently reported mechanism of injury for low back pain (LBP) in the Army. Furthermore, researchers have demonstrated a clear association between physical fitness and injury incidence. Objectives: 1) to analyze changes in muscle activity during load carriage and how LBP relates to changes in muscle activation; and 2) to analyze a possible relationship between performance on the Army Combat Fitness Test (ACFT) and LBP, muscle activity, and kinesiophobia in Army Reserve Officer Training Corps (ROTC) cadets. Methods: 30 Army ROTC cadets (age 21±1.82) completed a 5-kilometer walk with and without a 35-pound load. Electromyography (EMG) data were obtained of the rectus femoris (RF), rectus abdominis (RA), gluteus medius (GM), gluteus maximus (GMx), erector spinae (ES), and biceps femoris (BF), and a questionnaire was used to assess LBP. Twenty-one cadets from the initial sample completed the six-event ACFT, the Tampa Scale of Kinesiophobia (TSK), and visual analog scales (VAS). ANOVA models were estimated for each muscle with time and load as independent factors. Correlations were used to assess relationships between pain and muscle activity. Regression was used to model the ability of muscle activity, MMBQ, TSK, and VAS scores to predict performance on each component of the ACFT. Results: Muscle activation for all muscles declined significantly over time (p<.001). Amplitude of RF (p=.014), GM (p<.001), and GMx (p=.007) significantly increased in the LC condition. Cadets who reported pain had greater average muscle activation; however, only the RF showed a significant association (p=.01). Significant regression equations were found for the Sprint-Drag-Carry (p=.009) and two-mile run (p=.004). Conclusion: Due to the associations between LBP and increased muscle activation with added loads, cadets displaying muscle activity at greater percentages of their MVC should consider adopting a core strengthening program prior to embarking on foot marches with load carriage. Additionally, cadets with poor performance on the SDC and 2MR should require a fitness program focused on improving these measures, as they are significantly associated with LBP.
Appraising Anterior Cruciate Ligament Injury Risk: Single-Legged Jump-Landing Dynamic Postural Stability
(North Dakota State University, 2022) Bond, Colin
Appraising anterior cruciate ligament (ACL) injury risk is of great interest to the orthopedic and sports medicine professional. Due to the high prevalence of non-contact ACL injuries, professionals have sought to identify intrinsic and modifiable neuromuscular and biomechanical risk factors to aid in the design of injury risk screens that have the discriminatory capacity to stratify ACL injury risk and the efficiency to be implemented at-scale. Prospective studies have revealed that poor dynamic postural stability (DPS), quantified as time to stabilization (TTS), following a backwards single-legged jump-landing (BSLJL) and poor hip external rotation and abduction strength relative to body weight, quantified using a handheld dynamometer, are two risk factors for ACL injury. The purposes of this study were to assess the effects of repeated BSLJL on within-session motor learning as quantified by DPS, evaluate the reliability of DPS, and determine the relation between DPS, hip strength, and fatigue. Twenty-seven recreationally active college-aged adults (24.0 ± 2.8 y, 1.73 ± 0.08 m, 75. ± 14.0 kg) were enrolled in this semi-randomized, cross-over study. During visit one, subjects completed 10 BSLJL trials per leg without familiarization and had their hip external rotation and abduction strength measured. During visits two through four, subjects complete two fatigue sessions and one control session in a randomized order. During these sessions, subjects completed two sets of three BSLJL trials per leg separate by either a seated rest in a chair (control) or a short-term functional fatigue protocol (fatigue). DPS was quantified as TTS and the dynamic postural stability index (DPSI). To appropriately familiarize a subject to the BSLJL, results suggest that a minimum of six familiarization trials per leg are required to sufficiently reduce the motor learning effect. Results also indicate that TTS reliability is poor after 10 trials per leg whereas DPSI reliability is good after just two trials per leg and excellent after just six trials per leg. Finally, results indicate that following completion of a fatigue protocol, there are decrements in TTS, but not in DPSI. Further, greater hip abduction strength is associated with better DPSI when rested and fatigued, but not TTS.
Barriers and Strategies to Optimize Diabetes Management in Emerging Adults with Type 1 Diabetes
(North Dakota State University, 2021) Sawyer, Bailee Catherine
Emerging adults aged 18 – 30 years with type 1 diabetes (T1DM) make unique lifestyle choices that can create complications for disease management. The objective of this study was to identify barriers and strategies for management of T1DM in young adults (YA). A non-experimental, causal-comparative, observational cross-sectional study using both quantitative and qualitative methods was utilized for the study. In May 2020, YA with T1DM (n = 115; mean age diagnosed 14 ± 7.23) aged 18 – 30 years (64% in age group 25 – 30 years) were recruited to complete the Managing Diabetes in Young Adults Survey. Participant self-reported biomarkers and demographics. The survey included: T1DM management questions from the Diabetes Empowerment Scale (DES), the Diabetes Self-Management Questionnaire (DSMQ), the Diabetes Eating Problems Survey – Revised (DEPS-R), and select questions from the Centers for Disease Control Youth Risk Behavior Surveillance System (YRBSS). Qualitative methods included a telephone interview. From the survey, ‘good’ glycemic control (GC) was associated with higher DSMQ overall scores (p = 0.0003) and the DSMQ glucose management subscale (p = 0.0027) compared to ‘medium’ and ‘poor’ GC. Participants with ‘good’ GC were observed to have higher eating disorder/disordered eating risk (DEPS-R score  20) than the ‘medium’ GC group (mean 28.60 ± 6.86 vs. mean 22.17 ± 2.56, p = 0.0320). Participants who drank more alcohol per session and per week were more likely to adjust dietary intake and insulin dosage: (F (1,114) = 9.52, R^2=0.0770,p=0.0026), (F (1,114) = 5.14, R^2=0.0431,p= 0.0253). There was a weak negative association observed from the Spearman correlation coefficient (-0.0755; 95% CI -0.2665, 0.1154) for ‘good’ GC and those who are at risk for low blood glucose during physical activity. Qualitative examination exposed various barriers and strategies for T1DM management. From the survey participants, 21 volunteered for the telephone interview (female = 19, male = 2) (diagnosed age: mean 15.00 ± 8.00). Barrier themes included physiology, environment, and insurance and subthemes, mental health, lack of social support and weather. Strategy themes included medical technology, social support, and physical activity; and strategy subthemes, supplies, compliance, social media and accountability.
A Biomechanical and Electromyographic Analysis of Elite Shot Putters at a Division I University
(North Dakota State University, 2022) Waldera, Roman
In effort to understand the most optimal technique for shot put throwing, researchers have investigated the individual factors of the throw that may contribute to elite level performances. Two techniques are commonly utilized by shot put throwers, known as the glide and rotational techniques. Within research studies, electromyography (EMG) and kinematic motion capture (MOCAP) analysis technologies are common data collection tools utilized by the authors. Within the dynamic shot put throwing movement, muscle activations and kinematic positions demonstrated by a thrower in motion will vary throughout the four phases of the throw, which are commonly referred to as: initiation, flight, landing, and completion phase In the current analysis of shot putters (n = 12, Males = 6, Females = 6), EMG analysis was conducted on seven muscles throughout the four phases of the throw: Rectus Femoris (RF), Biceps Femoris (BF), Gastrocnemius (GAS), Triceps (TRI), Latissimus Dorsi (LAT), External Oblique (EO), and Gluteus Medius (GM). The majority of MOCAP data variables within the current study were analyzed in the landing phase: Shoulder-Hip (S-H) Separation and Trunk Angle in the X, Y, and Z planes. Additionally, the maximum height which the thrower achieves during the flight phase, referred to as Peak Height of Center of Mass (PCOM), was analyzed using MOCAP. Significant relationships were found between thrown distance and activation of RF, EO, LAT, and GAS, with some differences existing between technique groups. For MOCAP data, significant relationships were found between thrown distance and angles of trunk inclination and trunk lateral flexion, with some differences existing between groups of technique and sex. The findings of this study are practical to track and field coaches in their understanding of the muscle activations in various phases of the throw as well as kinematic positions exhibited by athletes in the landing phase.
The Effects of Greater Dietary Protein Spread and Quality on Muscle Health in Healthy Adults
(North Dakota State University, 2022) Johnson, Nathaniel
Skeletal muscle is critically important, but is often overlooked, not getting the respect or attention the tissue demands. Muscle is responsible for locomotion and physical performance, uses large amount of energy preventing gains in fat mass, and acts as an amino acid reservoir during trauma. Nonetheless, as individuals age, they lose muscle and to a greater extent strength. Maintaining muscle mass and strength is paramount for preventing disability and mortality. There are many aspects of diet that affect muscle tissue, but dietary protein directly activates muscle protein synthesis, so is important to consider as part of a balanced diet. Research regarding dietary protein intake has focused on the amount of protein consumed, but the quality and distribution of dietary protein also determines the body’s anabolic response. Two different cross-sectional studies were completed to determine the associations between dietary protein intake and muscular performance. Dietary intake was measured using three-day food diaries. Isokinetic dynamometry determined lower-body strength and endurance. Handgrip strength measured upper-body strength. Dual x-ray absorptiometry evaluated lean body mass. Thirty-second chair stand and six-meter gait speed tests determined functional ability. Self-reported age and moderate-to-vigorous physical activty, assessed via accelerometry, were included in all models as covariates. Increased intake of higher quality proteins from animal sources was positively associated with lower-body strength (β ± S.E.; 65.874±19.855, p =0.001), lower-body endurance (549.944±232.478, p =0.020), and handgrip strength (0.349±0.171, p = 0.045) in the cross-sectional sample of 91 middle-aged men (n=41) and women (n=50) when controlling for relative energy intake and percent energy from the macronutrients. Using another sample of 192 women 18 to 79 years, achieving intakes of at 25 grams per meal was positively associated with lean mass (1.067±0.273 kg, p<0.001) and upper-body (3.274±0.737 kg, p<0.001) and lower-body strength (22.858±7.918 Nm, p=0.004) controlling for relative energy intake and percent of energy from protein. In a subgroup of this sample aged 61-79, animal-based protein intake was related to increased lower-body strength (14.834±7.287 Nm, p=0.049) and faster gait speed (-0.177±0.087 s, p=0.049). To benefit muscle and performance, people should strive to consume enough high-quality protein at each meal.
Exercise and Nutrition to Counter Age-Related Decrements in Muscle Health and Function
(North Dakota State University, 2020) Trautman, Kara Ann
Muscle atrophy and strength decrements can occur following disease (e.g., cachexia), with increasing age (e.g., sarcopenia), or from disuse related to injury or occupational environment (e.g., microgravity). High-load resistance training and adequate protein and amino acid intake are effective countermeasures. However, high-load training may not be feasible in all populations. Lower intensity resistance training with blood flow restriction (BFR) is an effective alternative and its benefits may be increased when combined with supplementation of protein and leucine. Two studies explored the relationships between nutrient intake and physical activity and the effects of short-term combination on muscle health in middle age. Methods: To compare muscle strength and size, 98 participants were divided by age and physical activity (young active adults = 23.0 ± 3.1 years, sedentary young adults = 26.3 ± 4.7 years, middle-aged active adults = 57.3 ± 4.0 years, middle-aged sedentary adults = 57.9 ± 4.4 years). Relationships between muscular health, nutrient intake, and physical activity were also examined. Next, 16 participants (age = 36.0 ± 10.1 yrs., BMI = 27.2 ± 5.0 kg/m2) completed BFR training with supplementation of 28g of leucine-rich protein or an isocaloric placebo to evaluate the effects on health and performance. Results: There were significant group effects for muscle strength (p = .003-.010) and size (p=.002). Physical activity, protein intake, and leucine were significantly and positively associated with knee flexor size and strength (R2 = 0.28-0.71, p<.05). Physical activity and protein intake were negatively associated with dorsiflexor strength (r2 = 0.48-0.58, p<0.05). Total leucine intake (g/day) increased by ~38% with supplementation. Training volume in all exercises, sit-to-stand repetitions, gait speed increased significantly with BFR exercise while resting heart rate significantly decreased (p<0.05). Conclusion: These results indicate that muscle size and strength are lower in middle age and increased physical activity, protein intake, and leucine intake may be able to preserve muscle size and strength in larger muscle groups of the lower body. Additionally, they show that BFR exercise can improve muscular and cardiovascular health in middle-aged adults, however, there was no short-term benefit to increasing protein and leucine intake above the recommended dietary allowance.
Identification and Comparison of Hydration Practices in Marathon Runners During Intended Training, an Intended Marathon, and Self-Reported Hydration Practices During a Marathon Event
(North Dakota State University, 2020) Young, Suzanne Louise
Title: Comparing hydration practices of long-distance runners during intended training, an intended event, and an actual event during COVID-19. Context: Prior studies on long-distance runners have yet to compare hydration practices intended in training to an actual event. Optimal hydration strategies and knowledge of EAH was assessed. Objective: The purpose of this research was to assess and compare the self-reported hydration practices of long-distance runners during an intended training run, an intended event, and during an event. Design: Cross-sectional online survey design Setting: 2020 Hyannis, Massachusetts Marathon; Connecticut trail races; online. Participants: There were 46 participants in the Hyannis, 26 participants in the Connecticut trail races, and 203 participants in the long-distance running studies. Main outcome Measure(s): Survey questions addressed hydration practices, including hydration strategies, and volumes consumed before and during a run. Additional data included demographics, training experience, sources of hydration information, and knowledge of EAH. Results: When comparing volumes consumed, higher correlations were found when comparing intended events in all three studies. In other words, runners intended to drink the same in an intended training run and an intended event. More variation was found when comparing intended volumes to actual volumes. All studies showed strong agreement in the selected hydration strategies between the scenarios and most were statistically significant. The “drinking to thirst hydration strategy”, was selected on average 17% of the time for Hyannis marathoners, 30% of the time for Connecticut trail runners, and 23% of the time for long-distance runners. This hydration strategy is recommended to decrease the risk of EAH in lieu of a personalized hydration plan. EAH awareness among runners was reported between 50-59% of the time in all studies. However, there was inconsistency in recognizing contributing and preventive EAH factors. Conclusion: There were differences in hydration practices when comparing an intended training run, an intended event, and an event. This indicates a need for ongoing education on hydration practices and EAH. If runners mimic appropriate hydration practices during training when running in an event, the risk of EAH may be decreased. The limitation of this research is the self-reported nature of historical data.
A Path Analysis Model Examining Parent Perception, Dieting, and Food Behaviors on BMI Among Predominately Hispanic Families with Preschool Children
(North Dakota State University, 2022) Quiroz, Alicia
Children and adults continue to suffer from obesity, which poses a great public health threat. This research focused on protective factors for its prevention. Parent’s perception of a healthy child’s body size, parent dieting, child dieting, and food behaviors influence on Hispanic preschool children’s weight (assessed by BMI z-scores and raw BMI) was examined in 534 mother-child dyads. A hypothesized model was constructed and tested through a secondary analysis of baseline data collected in fall 2018 from the South Texas Early Prevention Study Project. All data except BMI, were collected via self-administered questionnaires completed by the parents (or guardians). Path analysis was conducted to identify relationships. The conceptual model consisted of various simple and mediated models (i.e., the age model, the perception model, the parent model, and the child model). Inside each of these models, several paths were found to be statistically significant. Within the parent-mediated model, perception of a healthy child’s body size and parent’s dieting had a statistically significant effect on raw BMI. Within the full model, age, parent’s dieting, and child’s dieting had the greatest effects on child’s BMI z-score. As a result, children whose mothers were currently dieting are significantly more likely to diet and gain weight. This effect increased with age. Mothers are crucial to the development of children, and a great deal of research has confirmed this. Perceptions of weight, shape, and appearance are sociocultural values passed on by mothers. Therefore, it is critical to ensure that parents have healthy behaviors not only for themselves but for the sake of their children. As the population of Hispanics increases in the United States, it is important to continue to examine this area in this population.
Strategies for the Reduction of Adipose Tissue and Retention of Muscle Mass in Overweight Individuals
(North Dakota State University, 2020) Kotarsky, Christopher Joseph
Purpose: The purpose of this study was to determine whether time-restricted feeding (TRF) was an effective dietary strategy for reducing fat mass and preserving fat-free mass while evaluating potential changes in cardiometabolic biomarkers, hormones, muscle performance, and energy and macronutrient intake after eight weeks of aerobic exercise and resistance training in overweight and obese adults. Methods: This study was a randomized, controlled trial. Sedentary, overweight and obese adults (mean ± SD; age: 44.48 ± 7.28 years; BMI: 29.61 ± 2.62 kg/m2; females: 85.71%; males: 14.29%) were randomly assigned to a TRF or normal feeding (NF) dietary strategy group. The TRF group consumed all calories between 1200 and 2000 hours, whereas the NF group ate their typical diet. All groups completed eight weeks of aerobic exercise and supervised resistance training. Body composition, muscle performance, energy and macronutrient intake, physical activity, and physiological variables were assessed week zero and week nine. Results: A total of 21 participants completed the study (NF: n = 10; TRF: n = 11). A mild energy restriction was seen for the TRF (~300 kcal/day, 14.0%) and NF (~250 kcal/d, 11.0%) groups between baseline and week seven. Losses of total body mass were significantly greater for TRF (3.3%) relative to NF (0.2%), of which TRF had significantly greater losses of fat mass (9.0%) compared to NF (3.3%) despite similar reductions in energy intake. Lean mass increased across the intervention for both TRF (0.6%) and NF (1.9%), with no group differences. Conclusion: These data support the use of TRF and concurrent exercise training as a short-term dietary strategy for reducing fat mass and preserving lean mass in overweight and obese adults.
Systematic Intervention Component Analysis: Dose-Response for Therapeutic Ultrasound
(North Dakota State University, 2022) Hamersky, Stephanie
Therapeutic ultrasound has been well documented in the literature to affect human tissue. The four main parameters practitioners are able to influence are frequency, duty cycle, intensity, and treatment time. Alteration to one or more of these parameters will affect the total dose of acoustical energy delivered to the tissue resulting in a target tissue temperature increase or biophysical effect. The goal of this two-part study was to determine the appropriate energy dose of therapeutic ultrasounds needed to create a beneficial intervention when treating unhealthy human tissue. Prior to the investigation a non-systematic review was conducted to determine the dose-response and thermal outcome in laboratory studies. The first investigation used a systematic intervention component analysis (ICA) to determine the effectiveness and empirical relationship between the different parameters of an ultrasound intervention when treating unhealthy tissue. The second investigation included a four-part survey which addressed trends within parameter selection in the clinical setting and influences on clinical decision making. The first investigation findings indicated no one parameter had significant influence on the ultrasound treatment effectiveness. The second investigation findings indicated practitioners set a treatment goal of 2℃ and a mean predictive outcome between 1.85 and 2.56℃ regardless of the condition.
Using Electronic Handgrip Dynamometry to Determine Human Performance in Master's Aged Cyclists and Triathletes
(North Dakota State University, 2022) Klawitter, Lukus
Purpose: This dissertation study sought to examine the correlations of maximal handgrip strength (HGS), rate of HGS force development, and HGS fatigability on lean body mass, peak power, functional threshold power, and aerobic capacity in master’s aged cyclists and triathletes. Methods: A cross-sectional design was utilized and the analytic sample included n=31 master’s aged cyclists and triathletes (age: 49.1±10.4 years). Achievement motivation was self-reported with a Situational Motivation Scale Questionnaire. A stationary bicycle trainer and metabolic cart was used to evaluate peak power and aerobic capacity with standardized protocols. Whole body bioelectrical impedance measured lean body mass. An electronic handgrip dynamometer examined maximal HGS, rate of HGS force development, and HGS fatigability. Results: Maximal HGS was moderately correlated with peak power (r=0.46; p<0.01), lean body mass was moderately correlated with peak power (r=0.48; p<0.01) and negligibly correlated with aerobic capacity (r=0.37; p=0.04). Rate of HGS force development was also moderately correlated with peak power (r=0.36; p=0.04). Maximal HGS was moderately correlated with rate of HGS force development (r=0.63; p<0.01). Moreover, after ranking the measures, maximal HGS was moderately correlated with peak power (r=0.40; p=0.02) and lean body mass was moderately correlated with peak power (r=0.50; p<0.01). Conclusions: The findings from this dissertation study suggests that maximal HGS and rate of HGS force development share a signal with peak power in master’s aged cyclists and triathletes. Further, increased lean body mass is related to greater peak power. Maximal HGS and rate of HGS force development show promise for being utilized in a single protocol as a correlate for peak power when exhaustive testing is not possible, and maintaining lean mass is also advised for human performance in older endurance athletes.

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