Health, Nutrition & Exercise Science Doctoral Work

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Therapeutic ultrasound: providing an educational intervention on best practice techniques and their implications
(North Dakota State University, 2024) Kjellerson, Michael
BACKGROUND: Therapeutic ultrasound is a modality that is commonly used in the treatment of musculoskeletal injuries by healthcare professionals throughout the world for both its thermal and non-thermal effects. PURPOSE: This study used an in-person or virtual asynchronous educational intervention to educate and demonstrate best practice techniques to practicing athletic trainers while surveying their usage, perception, confidence, and knowledge regarding the modality. METHODS: Thirty-one athletic trainers completed the educational intervention, including 13 who participated in the in-person session and 18 in the virtual asynchronous session. Qualtrics based surveys occurred immediately before and after each educational intervention and four weeks following the completion of the intervention. RESULTS: Descriptive statistics were performed including means, standard deviation, and frequencies. Repeated measures ANOVA testing was used to compare the pre-educational intervention survey, post-intervention survey and the third follow-up educational intervention survey. A statically significant increase in overall mean US knowledge scores was observed from the pre-educational intervention survey to the post-educational intervention survey. Results from the ANOVA were F(2, 74) = 11.49, p < 0.0001. The Tukey-Kramer post hoc test revealed significant differences between the pre-educational session and the post-educational session. There was no significance when examining thermal and non-thermal ultrasound usage and perception amongst clinicians using a p-value of ≤ 0.05. CONCLUSION: The educational intervention was effective in increasing thermal and non-thermal ultrasound knowledge, perception, and usage. A feasibility component to this study exists to determine if these educational formats are a viable option for increasing ultrasound knowledge, perception, and usage among athletic trainers in the future.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
An Investigation of Physical Activity and Cardiorespiratory Fitness in Career Firefighters
(North Dakota State University, 2018) Barry, Allison Michelle
Firefighters are responsible for protecting citizens as well as the infrastructure of cities across the United States. In order to safely protect and perform on-duty tasks, firefighters must be capable of performing physiologically demanding skills. Emerging evidence has led to heightened concern for firefighters’ increased obesity levels and decreased physical activity (PA). Formal exercise and PA research specific to firefighters is lacking. More specifically, there is a lack of literature using accelerometers to objectively measure PA. There is more evidence, however, to demonstrate firefighters have a high prevalence of obesity surpassing the general population. Not only are firefighters overweight and inactive, but also they are not aerobically fit to adequately perform their job-specific tasks. Purpose: To examine the relationship of PA and obesity to cardiorespiratory fitness (CRF). Methods: Firefighters (n=29) wore an accelerometer for eight consecutive on- and off-duty days. The accelerometer was worn on the right hip and tracked sedentary activity, light physical activity (LPA), moderate physical activity (MPA), vigorous physical activity (VPA), and moderate-to-vigorous physical activity (MPVA). Additionally, each participant completed a stage-graded exercise test with submaximal square-wave verification bout to determine maximal oxygen uptake (VO2max). A stepwise linear regression model was conducted using physical activity intensity, body mass index (BMI), and waist circumference (WC) as predictor variables for CRF. Results: According to the World Health Organization BMI categorization, none were normal weight, 20 were overweight, and 9 were obese. Firefighters spent roughly 61% of their waking hours in sedentary activity, 35.4% in LPA, and only 3.6% in MVPA. The two linear regression models were used to investigate whether PA intensity, step count, physical activity rating scale, BMI, or WC were more predictive of VO2max. VPA was predictive of VO2max (F(1,27) = 7.89, R2 = 0.23, p <0.01). Additionally, when BMI and WC were added, only WC was predictive of VO2max (F(1,27) = 11.76, R2 = 0.30, p<0.01). Conclusion: It is imperative fire departments emphasize the importance of cultivating an environment where improved health and wellness is essential for firefighters to adequately perform their physiologically demanding tasks.
Interval Training Methods to Increase Performance Markers and Load Carriage in Tactical Professionals
(North Dakota State University, 2019) Dicks, Nathan D.
Load carriage is an inherent part of the military and other tactical occupations (e.g., law enforcement, firefighters). Variation in load carriage ranges from 7-60 kg and can increase energy expenditure as well as lead to higher injury risk. Various novel training methods such as low-intensity interval training (LIT) in combination with blood flow restriction (BFR) as well as high-intensity interval training (HIT) aim at enhancing critical velocity (CV), aerobic fitness, and load carriage performance. Two investigations identified the feasibility of LIT with BFR and the use of HIT to increase performance and load carriage. Methods: Twelve male participants (21.8 +/- 1.5 yrs) underwent LIT with (BFR-LOAD) and without BFR (LOAD) loaded with 15% of their body mass to compare the acute metabolic and perceptual responses. Next, twenty adult participants (male = 15, female = 5) (age = 21.8 +/- 1.5 yrs) completed 4-weeks of HIT (2 d⋅wk-1) to compare aerobic fitness and load carriage task performance. Results: Metabolic responses (VO2) were elevated 7% during BFR-LOAD (p = .001) compared with BFR familiarization and LOAD Condition. There were significant increases with CV (p = .005) and velocity at VO2max (vVO2max) (p = .037), but there was no statistical difference between the groups. There were load carriage performance improvements for the 3200 m task (p < .001) with a decrease of 9.8% in completion times. Conclusion: There was an increased metabolic response during the BFR-LOAD condition. Thus, there is a potential for BFR to limit the use of load carriage for individuals engaging in rehabilitation and reconditioning programs due to injury. Furthermore, four weeks of 2 d⋅wk-1 HIT was appropriate to see improvements in with aerobic measures of CV and vVO2max as well as improvements in the load carriage task performances. LIT and HIT methods warrant continued research to increase aerobic fitness and load carriage performance.
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.
External Ankle Supports Alter Kinematics and Kinetics during Drop-Jump Landing and Forward-Jump Landing Tasks
(North Dakota State University, 2014) Okamatsu, Hidefusa
This research project was designed to understand the influence of excessively restricting ankle range of motion (ROM) on knee injuries, especially non-contact anterior cruciate ligament (ACL) tear. Participating in physical activity without injuries is important to maintain physically active life style and well-being. To prevent ankle injuries, external ankle supports (EAS) are widely used in sport settings by limiting frontal plane ankle ROM; however, the EAS also restricts sagittal plane ankle ROM that could increase the risk of non-contact ACL injury by intensifying the medial knee displacement (MKD) and ground reaction force (GRF). In this research, the effects of external ankle supports (EAS) on landing mechanics were investigated among 19 physically active college-aged females. Two research manuscripts report the results of this research project. The first manuscript investigated the effect of EAS on landing kinematics and kinetics during a drop-jump landing task. The results demonstrated the use of EAS altered the ankle displacement, total MKD, and vertical GRF; however, no relationship was observed between isokinetic plantar flexor strength and landing mechanics. The second manuscript compared the effect of EAS on landing kinematics and kinetics between drop-jump landing and forward-jump landing tasks. The result exhibited the use of EAS similarly affect ankle displacement, knee displacement, peak MKD in drop-jump landing and forward-jump landing tasks. However, the landing tasks affected the posterior GRF differently, and the EAS altered vertical GRF differently in the two landing tasks. Overall, excessively restricted ankle ROM changed the landing kinematics and kinetics, especially MKD and GRF during landing tasks. Our findings indicate that healthcare professionals should use EAS with care because the overly limited ankle ROM could increase the risk of non-contact knee injuries by increased MKD and GRF. Future research should include an examination of the effect of EAS on the magnitude of ACL strain, an assessment of the strength of the other muscles, an evaluation of the muscular activation during a landing task. These studies help understand the landing techniques and strength training to reduce the risk of non-contact ACL tear among physically active population.
The Relationship Between Exercise and Mental Health in College Students
(North Dakota State University, 2013) Demers, Nikki Richelle
The purpose of this study was to evaluate the influence of an exercise program on aspects of wellness in college students. The study explored changes in physical fitness and on self-reports of anxiety and depression symptoms before and after participating in a six-week exercise program at a Midwestern university. The study participants consisted of 53 undergraduate students from activity courses, and 25 undergraduate students from a lecture course. The Burns' Anxiety Inventory, Burns' Depression Inventory, and the Attitudes Towards Exercise Inventory were used for assessment. Quantifiable measures of physical fitness were assessed using anthropometric measures for weight and body composition, and the Rockport walking test was used as a measure of cardiovascular fitness. Results indicated significant differences existed between pre- and post-scores for the treatment group that participated in the six-week exercise program in categories of anxiety, depression, attitudes/beliefs that exercise can improve mental health, and maximal oxygen uptake (VO2 max) scores which indicate cardiorespiratory fitness. Non-significant differences were found between pre and post data in the measures of attitudes in the stages of change, body composition and Body Mass Index for the treatment group. In the control group, a significant difference was noted in VO2 max, but no differences were found in all other categories of anxiety, depression, attitudes towards exercise, body fat, and Body Mass Index. Results from this study indicate that an exercise prescription may be used as a tool to alleviate symptoms of depression and anxiety in college students. Additional studies may confirm significance in reducing anxiety and depression symptoms or seeing changes in body composition while adhering to a regular exercise program.
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.
Effects of Nutrition Education and Fruit and Vegetable Consumption on Knowledge of Antioxidants and Biomarkers of Inflammation and Chronic Disease
(North Dakota State University, 2012) Wagner, Meredith Grace
Obesity rates have reached epidemic proportions contributing to the majority of Americans experiencing a state of chronic inflammation. Associations between inflammation, oxidative stress, and increased disease risk contribute to detrimental consequences of obesity. Regulation of inflammation and oxidative stress is possible via antioxidants consumed through a diet adequate in fruits and vegetables but consumption among adults is poor. Previous studies have assessed the impact of fruit, vegetable, and antioxidant consumption on oxidative stress and inflammation among healthy individuals. However, no studies have examined effects of education and fruit and vegetable consumption on markers of oxidative stress, inflammation, and other chronic disease biomarkers in a single study of overweight and obese adults. The purposes of this study were to examine effects of nutrition education and fruit and vegetable consumption on: interest and knowledge related to antioxidants; consumption patterns; weight, body mass index (BMI), body composition, blood lipids, and blood glucose; and biomarkers of oxidative stress and inflammation. Fifty-four adults (19 men/35 women; age 44.7±12.1 y; BMI 33.2±7.7 kg/m2 were randomly assigned to one of three intervention groups. The control group received no intervention, the education group attended weekly nutrition lessons, and the fruit and vegetable group attended weekly nutrition lessons and received one serving of fruits and two servings of vegetables per day for 10 weeks. Fruit and vegetable-related knowledge, attitudes, and behaviors were assessed using questionnaires. Fruit, vegetable, and antioxidant consumption was assessed using semi-quantitative food frequency questionnaires and three-day food records and anthropometric measurements and fasting blood draws were conducted. Results indicated improvements in fruit and vegetable-related knowledge, attitudes, and behaviors and increased consumption of antioxidant-rich fruits and vegetables following nutrition education. Associations existed between increased fruit and vegetable consumption and improvements in LDL cholesterol. However, minimal associations between changes in consumption of fruits, vegetables, and antioxidants and biomarkers of inflammation and oxidative stress were indicated. In order to be effective, nutrition intervention programs need to thoroughly address participants' fruit and vegetable-related knowledge and attitudes, provide exposure to fruits and vegetables, and promote adequate consumption of antioxidant-rich fruits and vegetables while concurrently emphasizing management of overall energy intake.

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