Masters Degrees (Sports and Exercise Medicine)

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Browsing Masters Degrees (Sports and Exercise Medicine) by Author "Holtzhausen, L."

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    Concussion knowledge and practice among role players in primary school rugby in the North West Province
    (University of the Free State, 2013) Jansen van Rensburg, Magrietha; Schoeman, M.; Holtzhausen, L.; Patricios, J.
    Background: Concussion is a common medical problem which can have devastating complications, particularly in young adults and children. Due to the nature of rugby, concussions are frequently sustained by the players engaging in this contact sport. Since children are more susceptible to sustain a concussion, medical personnel such as doctors or paramedics should theoretically be the role players responsible for medical decision making next to the school rugby field. Coaches, who are often teachers, are often the primary source of medical support next to school sports field. Since failure to recognise or mismanagement of a concussion may lead to serious medical complications and delayed recovery, all role players involved with a potentially concussed child should be knowledgeable on the factors influencing medical decision making. These factors include knowledge on the prevention, recognition and management of a concussion, knowledge on the consequences of a sustained concussion and when to clear a child to Return to Play (RTP). Aims: This study aimed to report on the general and essential knowledge to be able to recognise a concussion of role players potentially involved with a concussed primary school rugby player and knowledge of role players regarding the prevention and consequences of concussion. In addition, knowledge and practices of role players regarding the management of a suspected or confirmed concussion, as well as knowledge and practices of role players regarding Return to Play (RTP) decision making following a concussion were assessed. Methods: A self-administered questionnaire was developed according to guidelines from literature to assess the child-specific concussion knowledge and practices of role players. These questionnaires were completed by primary school rugby coaches (n=51), paramedics (n = 39) and doctors (n = 20) in the Klerksdorp, Orkney, Stilfontein and Hartbeesfontein (KOSH) area in the North West Province. The outcome measures consisted of scores (out of a potential 100% if all the correct answers were given) on the prevention, management, recognition, RTP and consequences of a concussion. In addition, the knowledge regarded by literature as being essential to the safe practice of doctors were also assessed among all role players. Results: It was found that coaches and paramedics were generally the most senior persons responsible for medical decision making next to the rugby field. A substantial proportion of coaches (60.8%) were not BokSmart certified at the time of data collection and therefore not adhering to this requirement set out by SA Rugby. There was no relationship between the time since the coaches received their last concussion-related information and their concussion knowledge. There was also no relationship between the coaches’ concussion knowledge and whether they attended a recognised concussion training programme such as BokSmart. The only variable to show a relationship (p = 0.001) with the coaches’ overall essential knowledge needed for safe practice was the amount of years they have been coaching rugby. The coaches, who were also teachers, displayed a general lack in knowledge on the effect of a concussion on a child’s school work and the need for cognitive rest following a concussion. The paramedics displayed a widespread weakness in their knowledge pertaining to the cognitive aspects associated with a concussion. There was general consensus that the decision to clear a child to Return to Play (RTP) should rest with a doctor. However, the results from this study indicates that a considerable proportion of doctors (30.0%) were unaware of the fact that a child should be free from concussion symptoms not only during physical activity, but also at rest, which may result in premature RTP. The role players displayed a less than adequate knowledge on sport-related concussion with the coaches scoring 71.44 ± 12.03%, the paramedics scoring 67.01 ± 12.29% and the doctors scoring 76.67 ± 6.56% on the overall essential knowledge needed for safe practice Conclusions: Despite the fact that the doctors scored significantly better compared to the coaches and paramedics on their overall essential knowledge score (all of the essential knowledge items combined), very few doctors did not present with considerable gaps in their essential knowledge needed for safe practice when dealing with a concussed child. By implication the findings from this study indicates that children suffering from a concussion may be at risk for receiving inappropriate or insufficient medical care when sustaining a concussion. These findings should be communicated to sport governing bodies such as SA Rugby and further research undertaken to address the lack in knowledge among role players potentially dealing with concussed athletes as a matter of urgency.
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    Detection of respiratory illness in athletes of the University of the Free State through a periodic health evaluation with and without spirometry
    (University of the Free State, 2014) Joubert, Isstelle J.; Holtzhausen, L.; Prins, M.
    Background: Exercise-induced bronchospasm (EIB) is a common medical condition which can have devastating complications, particularly in otherwise healthy active athletes. Since EIB is unpredictable but preventable, medical personnel and coaches are often the primary support givers in such events and need to be informed about the risk factors and proper management of the athlete with this, sometimes undiagnosed, respiratory problem. The periodic health evaluation (PHE) is mandatory in some, but not all, sports and covers a few basic questions regarding the athlete’s respiratory health. Aims: The objective of this study was to determine the prevalence of underlying respiratory disease in a population of varsity level athletes. In addition, the study aimed to test whether the addition of a specific tool would increase the sensitivity of the PHE as it is implemented by the International Olympic Committee (IOC), therefore investigating if spirometry before and after an exercise challenge would diagnose any new athletes with exercise-induced bronchospasm (EIB). Methods: Thirty-two participants met the inclusion criteria. Periodic health evaluations were done to enquire about a detailed history from the athletes and physical examination with special attention to the respiratory system. Baseline spirometry followed by an exercise challenge test and serial post-exercise spirometries were done on all the participants according to the guidelines provided by the American Thoracic Society. Results: The results of this study confirmed that a thorough history and clinical examination alone do not lead to the diagnosis of EIB. Furthermore, we conclude that a resting baseline spirometry does not indicate that an athlete is at risk for or has EIB. In the absence of eucapnic voluntary hyperpnea (EVH) as the preferred challenge test according to the International Olympic Committee-Medical Commission (IOC-MC), an exercise challenge test will be as valuable. Almost 10% of the athletes in our study, which were healthy according to the PHE and baseline spirometry, had a positive spirometry for EIB after an exercise challenge test as indicated by a fall of ≥ 10% from the baseline forced expiratory volume in one second (FEV1).
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    The effects of weight training on pain relief and fatique in patients with fibromyalgia
    (University of the Free State, 2014-01) Coetzer, Gerhardus; Coetzee, F. F.; Holtzhausen, L.
    Objectives: The aim of this study was to determine the effect of weight training on pain relief and fatigue in patients with fibromyalgia (FM). Methods: This study was a randomized control study on patients diagnosed with FM. The group of FM patients was subjected to inclusion and exclusion criteria. Randomization was done on the patients who have met the inclusion criteria by the Department of Biostatistics at the University of The Free State. The experimental group was subjected to a training programme under supervision while the control group received verbal instructions to follow a training programme and the benefits thereof (Glombiewski et al., 2010), but did not undergo supervised training. The training period was 12 weeks. The subjects maintained their ordinary daily chores and physical activity. The experimental group started a supervised strength training period. Training was carried out 3 times a week and. During the first 3 weeks patients started with 8 - 12 repetitions for each set, with loads of 40 – 60% of the one repetition maximum (1 RM) and continued during the next 4 weeks with 10 – 12 repetitions with loads of 60 – 70% of 1 RM. Subsequently, during week 8 – 12 the number of repetitions was 10 for each set with loads of 60 – 80% of 1 RM. In addition to the muscle strengthening exercises each session ended with 5 – 10 minutes of core strengthening. All training sessions included warm up and cool down exercises using either a treadmill or bicycle ergometer and muscle stretching. Moreover, the subjects continued their ordinary chores and physical activities. The patients did a 15 minute warm up consisting of 10 minutes light aerobic work followed by 30 – 40 minutes weight training followed by 10 – 15 minutes of cool down. The programme differed from a Monday, to a Wednesday, to a Friday, where different muscle groups were targeted by the weight training. Results: The anthropometric characteristics in the current study for the exercise and control group are very similar. The Student T-Test was used to test for significant differences between the control and experimental group Fibromyalgia Impact Questionnaire (FIQ) scores over the 12 weeks. A 95% confidence interval was used to determine the difference between the two groups. The confidence interval shows that there is no statistical difference between the FM experimental (FMT) and FM control group (FMC). The following variable, V = FIQ: W4-W1 is where the FIQ score of week 4 were subtracted from week 1. No statistical difference (p<0.05) was observed between the control and the exersice group between week 1 and 4. The exercise group’s progress was statistically better (p<0.05) than control group in week 4 - 8. At week 8 the FMT group’s fibromyalgia impact questionnaire score median was 39 compared to the FMC group’s median of 63. Unfortunately, the exercise group deteriorated statistically significant (p<0.05) in the FIQ scores compared to control group improvement from week 8 – 12. Lastly, there was no statistical difference (p<0.05) between week 1 and week 12 between the FM control group and the exersise group regarding improvement of symptoms as reported in the FM impact questionnaire. Conclusions: It is still unclear what combination of type, intensity and duration of exercise treatment works best in the treatment of FM. It is important to recognize that in the case of a chronic pain disorder like FM, treatment must be focused not just on immediate symptom relief but also on maintaining long term lifestyle behaviour. As long as FM aetiology remains unclear, there is a need to explore mediating variables that can be used to intervene in order to ameliorate symptoms. Research efforts must continue to explore methods to relieve symptoms short term and support ongoing long term behaviour change to improve functioning and enhance the quality of life for patients with FM.
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    An evaluation of the mental skills, nutritional preferences and anthropometric characteristics of the pro junior under 20 surfers in the 2008 Billabong Junior Series in South Africa
    (University of the Free State, 2012-01) Oosthuizen, F. P.; Holtzhausen, L.
    Shortboard surfing continues to increase in popularity. In South Africa, surfing is not yet truly a profession. Successful u/20 surfers are rewarded with lucrative sponsorships, prize money and selection for national surf teams. For many competitive u/20 surfers, their ultimate goal is to qualify for the lucrative World Qualifying Series (WQS) and World Championship Tour (WCT). The competitive junior surfer and his support team (family, coach, and sponsors) invest a lot of time, commitment and money in striving for success. Whilst the u/20 surfer strives for quality water time in all conditions, he will benefit should his support staff be well informed about mental skills and nutrition. The aim of this research was to identify variables which can influence the surfer’s ability to perform consistently at a higher level of competition. Past research in surfing has shown that, although smaller in stature than other elite sportsmen, physical traits in surfing are less important than mental skills and correct nutrition. 107 Surfers entered in the 2008 Billabong Junior Series of 5 contests around South Africa. 41 Of these surfers participated in this research. Their anthropometric variables namely height, mass, body density, body mass index and % fat were recorded. Waist to hip, chest to waist and chest to hip ratios were measured. The Ottawa Mental Skills Assessment Tool was used to assess mental skills and a 24 hour dietary recall questionnaire was completed. The main findings were that with a shorter stature, the surfers chose a sport which suited their physique best. The mental skills of commitment self-confidence and goal setting scored high, but stress reactions and refocusing skills were poor. At the contest venues, the food and fluid available determined their diet. They had no definite pre heat, inter heat or post heat eating plans. We concluded that mental skills and correct nutrition are two factors which a competitive surfer can utilize to improve their surfing performance. We recommend that a 12 variable progressive forward discriminant analysis be applied to talent identification in surfing, as also to identify and to improve necessary skills which are lacking in the competitive u/20 surfer.
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    Prevalence and blood profile analysis of South African gold-miners working underground who present with exercise-associated muscle cramps at work
    (University of the Free State, 2015-01) De Wet, R.; Holtzhausen, L.; Schoeman, M.
    Background: Almost a hundred years after the first reports on the possible aetiology of muscle cramping in mine workers, the debate on the mechanism and contributing factors to the development of cramping rages on and we are no closer to preventing cramping. The current theories of the “Electrolyte depletion and Dehydration model” or “Salty Sweat” with the addition of fatigue (Bergeron, 2003; Eichner, 2007; Armstrong, et al., 2007) and the current, and more accepted “Altered Neuromuscular Control” hypotheses (Schwellnus, 2008) are still polarising the debate surrounding EAMC. Aims: The aim of this study was not to prove or disprove any of the current theories surrounding EAMC. This study’s aims were to describe the prevalence and certain environmental, biochemical and haematological variables in gold miners working underground who presented with exercise-associated muscle cramps (EAMC) at work. It further aimed to formulate or describe the ‘normal’ profile of haematological and biochemical changes during a shift, in the mining population. This “normal” control data were also generated to assist in the interpretation of the haematological and biochemical variables from the group who presented with EAMC. Methods: This study consisted of two parts: Part 1 was a retrospective descriptive study of the blood profiles of underground mine workers who presented with EAMC, together with biological factors relating to these workers. The procedure for data collection for the cramp group was to extract routine data from the clinical notes of miners who presented to the medical stations with EAMC. Part 2 was a prospective study consisting of a collection of blood-samples, before and after an 8 hour shift (2 hours commuting and 6 hours of physical labour), on a volunteer group of healthy underground mine workers not presenting with cramps. The data were sent for statistical analyses. Due to the exploratory nature of this study, descriptive statistics were primarily used to report the findings. Trends were observed and expanded on based on available literature and specialist consultation. Results: Due to the large amount of data generated by the study, the discussion of the results was presented under four main category headings. These categories were chosen following a literature review and specialist consultation on the significant findings from the study. These categories were hydration and electrolyte disturbances, muscle damage, muscle fatigue and inflammation. The “normal” or control participants were well to slightly over hydrated individuals, with progressive muscle injury (increased CK levels, but no increase in myoglobin) during a working week. The participants experience muscle fatigue with a slight WCC reaction as a result of his daily labours. The individual mostly worked in cramped spaces with heavy and sometimes vibrating tools or walked long distances or stood for long periods of time. They were also able to regulate their body temperature and homeostasis with minimal stress on their liver and kidneys. The participants who presented with EAMC mainly performed heavy physical labour but there were also the group that remained in cramped positions for prolonged periods. They showed possible signs of dehydration, muscle fatigue, muscle damage (raised myoglobin and CK levels), and inflammation. Conclusion: There seems to be an unnecessary polarisation between those for and those against the inclusion of electrolyte and dehydration into the aetiology of EAMC. One of the main arguments against the inclusion of these hypotheses (electrolyte & dehydration) is that the proponents basically fail to link how a systemic abnormality may cause a local disruption in homeostasis. This is a sound argument if we consider electrolyte disturbances and dehydration to be the sole cause of cramping. One should rather see this as part of a collective subset of contributing factors that each add to priming the body’s muscles for developing cramps. Single or groups of muscles that do then cramp are being triggered to cramp in the “primed” environment by factors such as fatigue.