Abstract Introduction Sickle cell trait carriers may experience sickling events, which can cause severe health problems. Some sickle cell haplotypes contain genetic modifiers that are associated with increased levels of fetal hemoglobin, which is resistant to sickling. The aim of this study is to determine if sickle cell trait individuals who do not carry these modifiers are more likely to experience sickling episodes than those who do carry the modifiers. Methods: Participants were eligible for inclusion in this study if they were male, 18 years of age or older, a sickle cell trait carrier, and had previously played any level of organized football. Participants were recruited via Facebook, www.clinicaltrials.gov, e-mail, phone calls, and word of mouth. They were asked to complete a survey and return a buccal swab for genetic analysis to look for alleles associated with fetal hemoglobin persistence. To date, no genetic analyses have been run. Data from the surveys was analyzed using Fisher's Exact Test with the SAS 9.2 software. Results: Twenty participants were included in this phase of the study and all returned both the survey and buccal swab. Five of the 20 participants had been diagnosed with exertional sickling, 2 with heat illness, and 12 had experienced dehydration. Conclusion: Data in this study is purely observational, as no genetic analyses have been performed at this point. Early results indicate that the probability a player feels their muscle pain lasts longer than their peers' is greater among those who feel it takes their muscles longer to recover than their peers'.

Throughout the performance horse industry, the occurance of various muscle disorders is common and can be detrimental to the performance and longevity of equine athletes. Research has revealed effects of diet manipulation, exercise, and electrolyte supplementation on the symptoms and occurrence of disorders like exertional rhabdomyolysis (ER). However, there has been no investigation on effects of Mg on muscle function in horses during exercise. Six Quarter Horse mares were used to study the effects of varying levels of Mg on indices of muscular dysfunction during a standardized exercise test (SET) on a highspeed treadmill. Three rations were used over three 28 d periods: control (Trt 1), low Mg (Trt 2), and high Mg (Trt 3). A baseline SET was conducted prior to day 0 (Trt 0). Blood samples were taken during the SET at rest, immediately post, 1 h, 6 h, and 24 h post exercise for analyses of serum muscle enzymes and Mg concentrations. Heart rates (HR), respiration rates (RR), and rectal temperatures (RT) also were documented. No effect of Trt was observed on HR or RR at any point throughout the SET. Resting RT?s were lowest in Trt 0 (P<0.05). There was no Trt effect on blood lactate (LA) during the SET; however, blood glucose (GLU) at rest in Trt 2 was lower than Trt 0 (P<0.05). Treatment had an effect on both resting serum creatine phosphokinase (CK), as Trt 3 was higher than Trt 0, and the change in CK from rest to 24 h post SET, where Trt 1 exhibited the greatest increase in CK concentration (P<0.05). Serum aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) were not affected by Trt (P>0.05). Serum alkaline phosphatase (AP) at rest and 6 h post exercise was lower in Trt 2 than in Trt 3 (P<0.05). Additionally, serum P was lowest at rest in Trt 0 and highest 6 h post exercise in Trt 3, also varying within each Trt. Average daily intake (ADI) of Mg was higher in Trt 1 and 3 than in Trt 2 (P<0.05). Finally, at rest, immediately post and 24 h post exercise, serum Mg was highest in Trt 3 (P<0.05). Results suggest there is an effect of dietary Mg on serum muscle enzyme and Mg concentrations and potentially, overall performance in the equine athlete.

Victims of exertional heat stroke (EHS) in whom treatment is delayed have higher rates of multi-organ failure and a greater number of fatalities. Death related to EHS is preventable, through immediate treatment via cold-water immersion (CWI). To date little is known about the influence of treatment delays on core cooling following EHS. Thus we sought to examine the effects of treatment delays on cardiovascular and thermal responses prior to, during, and following CWI treatment in individuals with exercise-induced hyperthermia. Our findings demonstrate that treatment delays resulted in a sustained level of hyperthermia and cardiovascular strain that significantly increased the time an individual is at risk to the potential lethal effects of EHS. Moreover, we report that cold water immersion treatment is powerful enough to overcome the adverse effects of treatment delays and rapidly reduce core temperatures while facilitating the re-establishment of blood pressure towards normal resting levels.

This thesis examined the effect of differences in body surface area-to-lean body mass ratio (AD/LBM) on core temperature cooling rates during cold water immersion (2°C, CWI) and temperate water immersion (26°C, TWI) following exercise-induced hyperthermia (end-exercise rectal temperature of 40°C). Individuals with a High AD/LBM (315 cm2/kg) had a ~1.7-fold greater overall rectal cooling rate relative to those with Low AD/LBM (275 cm2/kg) during both CWI and TWI. Further, overall rectal cooling rates during CWI were ~2.7-fold greater than during TWI for both the High and Low AD/LBM groups. Study findings show that AD/LBM must be considered when determining the duration of the immersion period. However, CWI provides the most effective cooling treatment for EHS patients irrespective of physical differences between individuals.

Chronic exertional compartment syndrome (CECS) is a common problem within both military and athletic populations that can be difficult to diagnose. Furthermore, it is unclear what causes the development of CECS, particularly in the military population, as personnel undertake a variety of activities that can cause pain with CECS such as fast walking, marching and running. Chronic exertional compartment syndrome has been hypothesised to develop due to excessive muscle activity, foot pronation and abnormal biomechanics predominantly at the ankle. Treatment of CECS through running re-education to correct these abnormalities has been reported to improve symptoms. However no primary research has been carried out to investigate the biomechanical, muscle activation and clinical characteristics of military patients with CECS. The purpose of this thesis was to provide an original contribution to the knowledge through the exploration of these characteristics; and the development of insights into the development of CECS, with implications for prevention and treatment. Study one investigated the clinical characteristics of 93 service personnel with CECS. Plantar pressure variables, related to foot type and anterior compartment muscle activity, and ankle joint mobility were compared during walking between 70 cases and 70 controls in study two. Study three compared three-dimensional whole body kinematics, kinetics and lower limb muscle activity during walking and marching between 20 cases and 20 controls. Study four compared kinematics and lower limb muscle activity during running in a separate case-control cohort (n=40). Differences in electromyography (EMG) intensity during the gait cycle were compared in the frequency and time domain using wavelet analysis. All studies investigated subject anthropometry. Cases typically presented with bilateral, ‘tight’ or ‘burning’ pain in the anterior and lateral compartments of the lower leg that occurred within 10 minutes of exercise. This pain stopped all cases from exercising during marching and/or running. As such subsequent studies investigated the biomechanics of both ambulatory and running gaits. Cases in all case-control studies were 2-10 cm shorter; and were typically overweight resulting in a higher body mass index (BMI) than controls. There was strong evidence from study 3 that cases had greater relative stride lengths than controls during marching gait. This was achieved through an increase in ankle plantarflexion during late stance and a concomitant increase in the gastrocnemius medialis contraction intensity within the medium-high frequency wavelets. Given the differences in height observed, this may reflect ingrained alterations in gait resulting from military training; whereby all personnel are required to move at an even cadence and speed. These differences in stride length were also observed in walking and running gaits although to a lesser extent. There was no evidence from the EMG data that cases had greater tibialis anterior activation than controls during any activity tested, at any point in the gait cycle or in any frequency band. In agreement, there was also no evidence of differences between groups in plantar pressure derived measures of foot type, which modulate TA activity. Toe extensor - related plantar pressure variables also did not differ between groups. In summary, contrary to earlier theories, increased muscle activity of the anterior compartment musculature does not appear to be associated with CECS. The kinematic differences observed during running only partially matched the clinical observations previously described in the literature. Cases displayed less anterior trunk lean and less anterior pelvic tilt throughout the whole gait cycle and a more upright shank inclination angle during late swing (peak mean difference 3.5°, 4.1° and 7.3° respectively). However, no consistent differences were found at the ankle joint suggesting that running is unlikely to be the cause of CECS in the military; and that the reported success of biomechanical interventions may be due to reasons other than modifying pathological aspects of gait. In summary, the data presented in the thesis suggest that CECS is more likely to develop in subjects of shorter stature and that this is associated with marching at a constant speed and cadence. Biomechanical interventions for CECS, such as a change in foot strike or the use of foot orthotics, are unlikely to be efficacious for the military as personnel will continue to be required to march at prescribed speeds to satisfy occupational requirements. Preventative strategies that allow marching with a natural gait and/or at slower speeds may help reduce the incidence of CECS. The lack of association with foot type or muscle activity suggests that foot orthoses would not be a useful prevention strategy or treatment option for this condition.

Victims of exertional heat stroke (EHS) in whom treatment is delayed have higher rates of multi-organ failure and a greater number of fatalities. Death related to EHS is preventable, through immediate treatment via cold-water immersion (CWI). To date little is known about the influence of treatment delays on core cooling following EHS. Thus we sought to examine the effects of treatment delays on cardiovascular and thermal responses prior to, during, and following CWI treatment in individuals with exercise-induced hyperthermia. Our findings demonstrate that treatment delays resulted in a sustained level of hyperthermia and cardiovascular strain that significantly increased the time an individual is at risk to the potential lethal effects of EHS. Moreover, we report that cold water immersion treatment is powerful enough to overcome the adverse effects of treatment delays and rapidly reduce core temperatures while facilitating the re-establishment of blood pressure towards normal resting levels.

This thesis examined the effect of differences in body surface area-to-lean body mass ratio (AD/LBM) on core temperature cooling rates during cold water immersion (2°C, CWI) and temperate water immersion (26°C, TWI) following exercise-induced hyperthermia (end-exercise rectal temperature of 40°C). Individuals with a High AD/LBM (315 cm2/kg) had a ~1.7-fold greater overall rectal cooling rate relative to those with Low AD/LBM (275 cm2/kg) during both CWI and TWI. Further, overall rectal cooling rates during CWI were ~2.7-fold greater than during TWI for both the High and Low AD/LBM groups. Study findings show that AD/LBM must be considered when determining the duration of the immersion period. However, CWI provides the most effective cooling treatment for EHS patients irrespective of physical differences between individuals.

abstract: Exertional heat stroke continues to be one of the leading causes of illness and death in sport in the United States, with an athlete’s experienced microclimate varying by venue design and location. A limited number of studies have attempted to determine the relationship between observed wet bulb globe temperature (WBGT) and WBGT derived from regional weather station data. Moreover, only one study has quantified the relationship between regionally modeled and on-site measured WBGT over different athletic surfaces (natural grass, rubber track, and concrete tennis court). The current research expands on previous studies to examine how different athletic surfaces influence the thermal environment in the Phoenix Metropolitan Area using a combination of fieldwork, modeling, and statistical analysis. Meteorological data were collected from 0700–1900hr across 6 days in June and 5 days in August 2019 in Tempe, Arizona at various Sun Devil Athletics facilities. This research also explored the influence of surface temperatures on WBGT and the changes projected under a future warmer climate. Results indicate that based on American College of Sports Medicine guidelines practice would not be cancelled in June (WBGT≥32.3°C); however, in August, ~33% of practice time was lost across multiple surfaces. The second-tier recommendations (WBGT≥30.1°C) to limit intense exercise were reached an average of 7 hours each day for all surfaces in August. Further, WBGT was calculated using data from four Arizona Meteorological Network (AZMET) weather stations to provide regional WBGT values for comparison. The on-site (field/court) WBGT values were consistently higher than regional values and significantly different (p<0.05). Thus, using regionally-modeled WBGT data to guide activity or clothing modification for heat safety may lead to misclassification and unsafe conditions. Surface temperature measurements indicate a maximum temperature (170°F) occurring around solar noon, yet WBGT reached its highest level mid-afternoon and on the artificial turf surface (2–5PM). Climate projections show that WBGT values are expected to rise, further restricting the amount of practice and games than can take place outdoors during the afternoon. The findings from this study can be used to inform athletic trainers and coaches about the thermal environment through WBGT values on-field. / Dissertation/Thesis / Masters Thesis Geography 2020

The purpose of this study was to assess and determine the current level of knowledge that National Collegiate Athletic Association (NCAA) Strength and Conditioning Coaches (SCCs) possess regarding exertional heat stroke (EHS) prevention and recognition and to determine if SCC certification type had any effect. Major findings of this study support the view that SCCs need more preparation, education and training to increase their competency in preventing and recognizing EHS. Research found that there was no significant difference in scores on the EHS scale based on SCC certification (CSCS vs. SCCC) after accounting for experience, education or division but the CSCS certified professionals scored higher on all the factors as compared to SCCs without the CSCS.. The major key finding was that SCCs lacked essential knowledge to prevent or recognize EHS. Furthermore, the study defines relevant EHS prevention and recognition competencies that an undergraduate curriculum, graduate curriculum and professional certification providers, should include and emphasize in their preparation programs.

Children are considered a vulnerable population in society. While thermoregulation in children is similar to that of an adult, children are vulnerable to heat-related illness. Student athletes have been found to be particularly vulnerable to heat-related illness for numerous reasons, including intense outdoor play. Football players are perhaps the most at-risk population of student athletes due to the intense physical requirements, outdoor practice during the hottest months of the year, and the extensive protective equipment required. By conducting a literature review on the subject of pediatric heat illness, the purpose of this thesis is to explore evidenced based research and guidelines regarding heat-related illness prevention. This review of literature was conducted through the utilization of the University of Central Florida's online databases using the EBSCOhost platform of: CINAHL Plus with Full Text, Cochrane Database of Systematic Reviews, ERIC, Health Source: Nursing/Academic Edition, MEDLINE, PsycINFO and SPORTDiscus. This thesis is unique because it does not focus on an individual sport; rather, it focuses on pediatric athletes from various disciplines. The prevalence, pathophysiology, prevention, and treatment of heat-related injuries are complex phenomena requiring the attention of law makers, athletic associations, school officials, coaches, athletic trainers, parents, and students.