Monthly Archives: June 2017

Athletic Training

Athletic training has been recognized by the American Medical Association (AMA) as an allied health care profession since June 1991.

There are five domains of athletic training listed in the 7th edition (2015) of the Athletic Training Practice Analysis:

  • Injury and Illness Prevention and Wellness Promotion
  • Examination, Assessment and Diagnosis
  • Immediate and Emergency Care
  • Therapeutic Intervention
  • Healthcare Administration and Professional Responsibility

An athletic trainer functions as an integral member of the health care team in clinics, secondary schools, colleges and universities, professional sports programs, and other athletic health care settings.

Athletic training in the United States began in October 1881 when Harvard University hired James Robinson to work conditioning their football team. At the time, the term “athletic trainer” meant one who worked with track and field athletes. Robinson had worked with track and field athletes and the name “athletic trainer” transferred to those working on conditioning these football players and later other athletes. Athletic trainers began to treat and rehabilitate injuries in order to keep the athletes participating. The first major text on athletic training and the care of athletic injuries was called Athletic Training (later changed to The Trainer’s Bible) written in 1917 by Samuel E. Bilik. Early athletic trainers had “no technical knowledge, their athletic training techniques usually consisted of a rub, the application of some type of counterirritant, and occasionally the prescription of various home remedies and poultices”. In 1918, Chuck Cramer started the Cramer Chemical Company (now Cramer Products) that produced a line of products used by athletic trainers and began publishing a newsletter in 1932 entitled The First Aider.

An organization named the National Athletic Trainers’ Association (NATA) was founded in 1938 and folded in 1944. Another NATA was founded in 1950 and still exists. The first athletic training curriculum approved by NATA was in 1959 and the amount of athletic training programs began to grow throughout colleges and universities in the United States. In the early development of the major, athletic training was geared more towards prepping the student for teaching at the secondary level, emphasizing on health and physical education. This program was first introduced at an undergraduate level in 1969 to the schools of Mankato State University, Indiana State University, Lamar University, and the University of New Mexico.

Through the years athletic training has evolved to be defined as “health care professionals who specialize in preventing, recognizing, managing, and rehabilitating injures”. During the 1970s the NATA Professional Education Committee formed a list of objectives to define athletic training as a major course of study and to eliminate it as a secondary-level teaching credential. By June 1982, there were nine NATA-approved graduate athletic training education programs. On July 1, 1986, this work was used to implement athletic training as a major course of study in at least 10 colleges and universities, and to only start the development of the major in a handful of others.

Once athletic training was recognized as an allied health profession the process of accrediting programs began. NATA’s Professional Education Committee (PEC) was the first to take on this role of approving athletic training educational programs. The AMA’s Committee on Allied Health Education and Accreditation (CAHEA) was given the responsibility in 1993 to develop requirements for the programs of entry-level athletic trainers. At this time all programs had to go through the CAHEA accreditation process. A year later CAHEA was broken up and replaced with the Commission on Accreditation of Allied Health Education Programs (CAAHEP), which then lead the accreditation process. In 2003 JRC-AT, Joint Review Committee on Athletic Training completely took over the process and became an independent accrediting agency like all other allied health professions had. Three years later JRC-AT officially became the Committee for Accreditation of Athletic Training Education (CAATE), which is fully in charge of accrediting athletic training programs in the United States. NATA produced the NATABOC in 1969 in order to implement a certification process for the profession for an entry-level athletic trainer. In 1989, became an independent non-profit corporation and soon later changed its name to the Board of Certification (BOC).

Diet

In nutrition, diet is the sum of food consumed by a person or other organism. The word diet often implies the use of specific intake of nutrition for health or weight-management reasons (with the two often being related). Although humans are omnivores, each culture and each person holds some food preferences or some food taboos. This may be due to personal tastes or ethical reasons. Individual dietary choices may be more or less healthy.

Diet is the practice of eating food in a regulated and supervised fashion to decrease, maintain, or increase body weight. In other words, it is conscious control or restriction of the diet. A restricted diet is often used by those who are overweight or obese, sometimes in combination with physical exercise, to reduce body weight. Some people follow a diet to gain weight (usually in the form of muscle). Diets can also be used to maintain a stable body weight and improve health. In particular, diets can be designed to prevent or treat diabetes.

Diets to promote weight loss can be categorized as: low-fat, low-carbohydrate, low-calorie, very low calorie and more recently flexible dieting. A meta-analysis of six randomized controlled trials found no difference between low-calorie, low-carbohydrate, and low-fat diets, with a 2–4 kilogram weight loss over 12–18 months in all studies. At two years, all calorie-reduced diet types cause equal weight loss irrespective of the macronutrients emphasized. In general, the most effective diet is any which reduces calorie consumption.

A study published in American Psychologist found that short-term dieting involving “severe restriction of calorie intake” does not lead to “sustained improvements in weight and health for the majority of individuals”. Other studies have found that the average individual maintains some weight loss after dieting. Weight loss by dieting, while of benefit to those classified as unhealthy, may slightly increase the mortality rate for individuals who are otherwise healthy. Complete nutrition requires ingestion and absorption of vitamins, minerals, and food energy in the form of carbohydrates, proteins, and fats. Dietary habits and choices play a significant role in the quality of life, health and longevity.

A particular diet may be chosen to seek weight loss or weight gain. Changing a subject’s dietary intake, or “going on a diet”, can change the energy balance and increase or decrease the amount of fat stored by the body. Some foods are specifically recommended, or even altered, for conformity to the requirements of a particular diet. These diets are often recommended in conjunction with exercise. Specific weight loss programs can be harmful to health, while others may be beneficial and can thus be coined as healthy diets. The terms “healthy diet” and “diet for weight management” are often related, as the two promote healthy weight management. Having a healthy diet is a way to prevent health problems, and will provide the body with the right balance of vitamins, minerals, and other nutrients.

A healthy diet may improve or maintain optimal health. In developed countries, affluence enables unconstrained caloric intake and possibly inappropriate food choices. Health agencies recommend that people maintain a normal weight by limiting consumption of energy-dense foods and sugary drinks, eating plant-based food, limiting consumption of red and processed meat, and limiting alcohol intake.

Many people choose to forgo food from animal sources to varying degrees  for health reasons, issues surrounding morality, or to reduce their personal impact on the environment, although some of the public assumptions about which diets have lower impacts are known to be incorrect. Raw foodism is another contemporary trend. These diets may require tuning or supplementation such as vitamins to meet ordinary nutritional needs.

  • Low-fat

Low-fat diets involve the reduction of the percentage of fat in one’s diet. Calorie consumption is reduced because less fat is consumed. Diets of this type include NCEP Step I and II. A meta-analysis of 16 trials of 2–12 months’ duration found that low-fat diets (without intentional restriction of caloric intake) resulted in average weight loss of 3.2 kg (7.1 lb) over habitual eating.

  • Low-carbohydrate

Low-carbohydrate diets such as Atkins and Protein Power are relatively high in protein and fats. Low-carbohydrate diets are sometimes ketogenic (i.e., they restrict carbohydrate intake sufficiently to cause ketosis).

  • Low-calorie

Low-calorie diets usually produce an energy deficit of 500–1,000 calories per day, which can result in a 0.5 to 1 kilogram (1.1 to 2.2 pounds) weight loss per week. Some of the most commonly used low-calorie diets include DASH diet and Weight Watchers. The National Institutes of Health reviewed 34 randomized controlled trials to determine the effectiveness of low-calorie diets. They found that these diets lowered total body mass by 8% in the short term, over 3–12 months. Women doing low-calorie diets should have at least 1,200 calories per day. Men should have at least 1,800 calories per day.

  • Very low-calorie

Very low calorie diets provide 200–800 calories per day, maintaining protein intake but limiting calories from both fat and carbohydrates. They subject the body to starvation and produce an average loss of 1.5–2.5 kg (3.3–5.5 lb) per week. “2-4-6-8”, a popular diet of this variety, follows a four-day cycle in which only 200 calories are consumed the first day, 400 the second day, 600 the third day, 800 the fourth day, and then totally fasting, after which the cycle repeats. These diets are not recommended for general use as they are associated with adverse side effects such as loss of lean muscle mass, increased risks of gout, and electrolyte imbalances. People attempting these diets must be monitored closely by a physician to prevent complications.

  • Detox

Detox diets claim to eliminate “toxins” from the human body rather than claiming to cause weight loss. Many of these use herbs or celery and other juicy low-calorie vegetables.

  • Religious

Religious prescription may be a factor in motivating people to adopt a specific restrictive diet. For example, the Biblical Book of Daniel (1:2-20, and 10:2-3) refers to a 10- or 21-day avoidance of foods (Daniel Fast) declared unclean by God in the laws of Moses. In modern versions of the Daniel Fast, food choices may be limited to whole grains, fruits, vegetables, pulses, nuts, seeds and oil. The Daniel Fast resembles the vegan diet in that it excludes foods of animal origin. The passages strongly suggest that the Daniel Fast will promote good health and mental performance.

  • Nutrition

Weight loss diets that manipulate the proportion of macronutrients (low-fat, low-carbohydrate, etc.) have been shown to be more effective than diets that maintain a typical mix of foods with smaller portions and perhaps some substitutions (e.g. low-fat milk, or less salad dressing). Extreme diets may, in some cases, lead to malnutrition. Nutritionists also agree on the importance of avoiding fats, especially saturated fats, to reduce weight and to be healthier. They also agree on the importance of reducing salt intake because foods including snacks, biscuits, and bread already contain ocean-salt, contributing to an excess of salt daily intake.

  • How the body eliminates fat

When the body is expending more energy than it is consuming (e.g. when exercising), the body’s cells rely on internally stored energy sources, such as complex carbohydrates and fats, for energy. The first source to which the body turns is glycogen (by glycogenolysis). Glycogen is a complex carbohydrate, 65% of which is stored in skeletal muscles and the remainder in the liver (totaling about 2,000 kcal in the whole body).

  • Weight loss groups

Some weight loss groups aim to make money, others work as charities. The former include Weight Watchers and Peertrainer. The latter include Overeaters Anonymous and groups run by local organizations. These organizations’ customs and practices differ widely. Some groups are modelled on twelve-step programs, while others are quite informal. Some groups advocate certain prepared foods or special menus, while others train dieters to make healthy choices from restaurant menus and while grocery-shopping and cooking.

  • Food diary

A 2008 study published in the American Journal of Preventive Medicine showed that dieters who kept a daily food diary (or diet journal), lost twice as much weight as those who did not keep a food log, suggesting that if you record your eating, you wouldn’t eat as many calories.

Nutrition and Pregnancy

Nutrition and pregnancy refers to the nutrient intake, and dietary planning that is undertaken before, during and after pregnancy. Nutrition of the fetus begins at conception. For this reason, the nutrition of the mother is important from before conception (probably several months before) as well as throughout pregnancy and breast feeding. An ever-increasing number of studies have shown that the nutrition of the mother will have an effect on the child, up to and including the risk for cancer, cardiovascular disease, hypertension and diabetes throughout life.

An inadequate or excessive amount of some nutrients may cause malformations or medical problems in the fetus, and neurological disorders and handicaps are a risk that is run by mothers who are malnourished. 23.8% of babies worldwide are estimated to be born with lower than optimal weights at birth due to lack of proper nutrition. Personal habits such as smoking, alcohol, caffeine, using certain medications and street drugs can negatively and irreversibly affect the development of the baby, which happens in the early stages of pregnancy.

Caffeine is sometimes assumed to cause harm to the unborn baby but there is not enough evidence so say if this is true. A recent review showed that more research is needed to show whether caffeine intake effects birth weight, preterm births, gestational diabetes and other outcomes.

Beneficial pre-pregnancy nutrients

As with most diets, there are chances of over-supplementing, however, as general advice, both state and medical recommendations are that mothers follow instructions listed on particular vitamin packaging as to the correct or recommended daily allowance (RDA). Daily prenatal use of iron substantially improves birth weight, potentially reducing the risk of Low birth weight.

  • Folic acid supplementation is recommended prior to conception, to prevent development of spina bifida and other neural tube defects. It should be taken as at least 0.4 mg/day throughout the first trimester of pregnancy, 0.6 mg/day through the pregnancy, and 0.5 mg/day while breastfeeding in addition to eating foods rich in folic acid such as green leafy vegetables.
  • Iodine levels are frequently too low in pregnant women, and iodine is necessary for normal thyroid function and mental development of the fetus, even cretinism. Pregnant women should take prenatal vitamins containing iodine.
  • Vitamin D levels vary with exposure to sunlight. While it was assumed that supplementation was necessary only in areas of high latitudes, recent studies of Vitamin D levels throughout the United States and many other countries have shown a large number of women with low levels. For this reason, there is a growing movement to recommend supplementation with 1000 mg of Vitamin D daily throughout pregnancy, vitamin D is necessary to prevent rickets, a disease causing weak bones.
  • A large number of pregnant women have been found to have low levels of vitamin B12, but supplementation has not yet been shown to improve pregnancy outcome or the health of the newborn, although there are suspicions.
  • Polyunsaturated fatty acids, specifically docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are very beneficial for fetal development. Several studies have shown a small drop in preterm delivery and in low birth weight in mothers with higher intakes. The best dietary source of omega-3 fatty acids is oily fish. Some other omega-3 fatty acids not found in fish can be found in foods such as flaxseeds, walnuts, pumpkin seeds, and enriched eggs.
  • Iron is needed for the healthy growth of the fetus and placenta, especially during the second and third trimesters. It is also essential before pregnancy for the production of hemoglobin.There is no evidence that a hemoglobin level of 7 grams/100 ml or higher is detrimental to pregnancy, but it must be acknowledged that maternal hemorrhage is a major source of maternal mortality worldwide, and a reserve capacity to carry oxygen is desirable. According to the Cochrane review conclusions iron supplementation reduces the risk of maternal anaemia and iron deficiency in pregnancy but the positive effect on other maternal and infant outcomes is less clear.