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INAUGURAL
EXPERT EDITION
Volume 1 Number 1
NFP
Review Journal
A Non-Profit Organization
Editors-In-Chief
Gerard Malanga, Atlantic Sports Health, NJ
Ken Mautner, Emory University
James Ross, BocaCare Orthopedics, FL
Published Reviews
James Alex, MD & William Dexter, MD David Siebert, MD & Ashwin Rao, MD
James Presley, MD & Jonathon Finnoff, DO Elizabeth Joy, MD, MPH
Walter Sussman, DO & Ken Mautner, MD Ruben Tresgallo & Ricardo Colberg, MD
Founder & Publisher Sports Review Journal , NFP is produced and edited by Fellowship Trained Sports Medicine Physicians.
Joshua Rothenberg The reviews and summaries included in the publication are intended solely for the education of medical
Sports Review Journal, NFP professionals as assistance in reviewing the large volume of literature that exists in the sports medicine
field. The summaries are not to be used as the basis of clinical diagnosis, management, side effects, or
2805 E Oakland Park Blvd # 155 complications, and are not a substitute for analyzing the original research. Reviews may include subjective
Ft. Lauderale, FL components, and are not entirely objective, thus, it remains noteworthy to refer to the original research
33306 in the journal cited. All journal reviews and summaries include citation to the journal with the original
research. Publication and funding is provided by the publisher himself. No profits or money are collected.
Editorial Contact & Manuscript Submission
Peter Navarro, Submissions Manager Due to the overwhelming presence of cancer in the community, I would like to raise awareness
Email: Submission@sportsreviewjournal.com each issue for a different cancer. As the yellow ribbon represents ‘Sarcoma’ Awareness’, this will be
our inaugural edition ribbon in support of our Editor-in-Chief, Gerard Malanga.
In This Issue
William Dexter Biography 4
Does foot strike pattern significantly alter anterior knee forces in runners? 10
James Alex, MD and William Dexter, MD reviewing Vannatta CN et al. Patellofemoral Joint Stress during Running with
Alterations in Foot Strike Pattern. Medicine & Science in Sports & Exercise. 2015 May; 47(5): 1001-1008.
The Contribution of Medial Elbow Structures to Joint Stability Determined by Stress Ultrasound and Surgical Sectioning
in Cadavers 14
James Presley, MD and Jonathan Finnoff, DO reviewing Ciccotti et al. Stress Ultrasound Evaluation of Medial Elbow
Instability in a Cadaveric Model. Am J Sports Med. 2014 Oct; 42 (10): 2463-9.
Major League Baseball Pitchers That Underwent Revision Ulnar Collateral Ligament Reconstruction: A Look at Post-Revi-
sion Pitching Performance and Longevity. 16
Ruben Tresgallo, BS and Ricardo E. Colberg, MD reviewing Marshall et al. Pitching Performance and Longevity After
Revision Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers. Am J Sports Med; 43 (1051).
Expert Author
William Dexter, MD
Dr. Dexter, a recipient of the Maine Governors Council on Physical Activity Lifetime Achievement Award, is a past
President of the American College of Sports Medicine (2013-14). He is the Director of the Sports Medicine Program for
Maine Medical Center, Professor of Family Medicine at Tufts University School of Medicine and adjunct faculty at the
University of Southern Maine, where he also serves as Head Team Physician and Medical Director for the Athletic Training
program. He is the school and team physician for Cheverus HS and a team physician for the Portland Pirates (AHL), Medical
Director of the Maine Marathon and sports medicine consultant for a number of community sports organizations. Graduating
from Dartmouth College and the Medical College of Virginia, he completed his Family Medicine residency at Maine Med-
ical Center and his Sports Medicine fellowship at Hennepin County Medical Center in Minneapolis. Dr. Dexter is active in
sports medicine research and education. He has given over 160 invited presentations nationally and internationally; he serves
on numerous scientific, non-profit and review and editorial boards and in addition to co-editing a textbook on musculoskeletal
ultrasound, has published over 70 book chapters, articles and abstracts. A charter member of the American Medical Society
for Sports Medicine, he chairs the Faculty Development committee and is very involved in “teaching the teachers”. Married to
Cindy, aka “Born to be Wild Rose” (Maine Roller Derby) and a father of three active 20-somethings, he is an avid skier (goal
not yet achieved: 50 days per year!), recreational rower, a hack golfer (24 handicap) and a life-long rugby enthusiast – a former
national team trialist, U-19 coach and referee he continues his involvement in the sport on the USARFU Medical Board.
Expert Author
Ashwin Rao, MD
Dr. Ashwin Rao is board certified in family medicine and sports medicine. He completed his undergraduate studies at
Swarthmore College and his medical degree at Case Western Reserve University. Dr. Rao completed his residency training in
family medicine and his sports medicine fellowship at the University of Washington. He currently assumes the role of associate
professor in UW’s Department of Family Medicine. He is the program director of the University of Washington’s Sports
Medicine Fellowship. Dr. Rao sees patients at the UW Sports Medicine Clinic at Husky Stadium and the UWNC Northgate
Clinic.
Dr. Rao serves as a team physician for University of Washington Husky Athletics and the Seattle Seahawks. He works in both
primary care and sports medicine settings. He is a member of the American Medical Society of Sports Medicine (AMSSM),
the American College of Sports Medicine (ACSM), and the American Academy of Family Physicians (AAFP). He serves
as the chair of the University of Washington ’s Sports Medicine Grand Rounds. He also serves on the Research Committee,
Fellowship Committee, and Program Planning Committee of AMSSM.
Dr. Rao has been honored as a “Top Doctor” by Seattle Met magazine and has served as a team physician for the Super Bowl
XLVIII champion Seattle Seahawks and the five-time defending national champion University of Washington’s crew team, as
well as for UW baseball and UW women’s crew teams.He has won numerous patient satisfaction awards, including the UW
Cares and PRAISE awards. His academic interests include primary and secondary prevention of sudden cardiac death in ath-
letes, mental well-being in athletes, and medical student and resident education and mentorship. His clinical interests include
ultrasound guided procedures, platelet rich plasma (PRP), selective peripheral nerve hydrodissection, management of chronic
tendinopathy and arthritis, concussion evaluation and management, and comprehensive wellness care for the professional and
recreational athlete.
Expert Author
Jonathon Finnoff, DO
Jonathan Finnoff, DO, FACSM obtained his medical degree from the University of New England. He then completed a resi-
dency in PM&R at the University of Utah, and a Sports Medicine fellowship at the Mayo Clinic. Dr. Finnoff is board certified
in PM&R and Sports Medicine. He is currently the medical director of the Mayo Clinic Sports Medicine Center in
Minneapolis, MN.
Dr. Finnoff has published over 70 articles in peer reviewed journals, and has authored multiple book chapters. He co-edited a
book with Mark Harrast, MD, titled “Sports Medicine: Study Guide and Review for Boards”. Dr. Finnoff has been the key-
note speaker at numerous national and international conferences, and is frequently invited to speak as a guest faculty member at
Universities and hospitals around the country.
Dr. Finnoff is a member of the AAPM&R Board of Governors and was previously the chair of the AAPM&R Musculoskel-
etal Council. He has served as the course director for multiple AAPM&R Musculoskeletal Ultrasound courses and was the
chair of the AAPM&R’s Musculoskeletal Ultrasound Task Force for several years. He is also on the Board of Directors for
the AMSSM, is the Sports Ultrasound Committee Chair, and the program chair for the AMSSM Sports Ultrasound Courses.
Dr. Finnoff is the co-chair of the Comprehensive Sports Medicine Update and Board Review Course co-sponsored by Mayo
Clinic, AAPM&R, ACSM, and AMSSM.
Dr. Finnoff has been a team physician for the United States Ski Team for more than a decade, and has provided medical cover-
age for the team at the Winter Olympics as well as multiple world cup and world championship competitions. He is currently
the head team physician for the United States Nordic Combined team. He was in charge of the Athlete’s Clinic at the Soldier
Hollow venue during the 2002 Olympic Games in Salt Lake City, UT, and was the director of all athlete and spectator medical
care at the Soldier Hollow venue during the 2002 Paralympic Games. He is currently a team physician for the Timberwolves
NBA basketball team, and Lynx WNBA basketball team. Dr. Finnoff has also served as the head team physician for a division
1 university, and has also taken care of multiple high school and club sports teams. Dr. Finnoff has been the medical director
for multiple mass participation sports events including marathons and iron man length triathlons.
Expert Author
Ricardo Colberg, MD
Ricardo E. Colberg, M.D., is a non-surgical sports medicine and orthopedic physician at the Andrews Sports Medicine and
Orthopaedics Center in Birmingham, AL. He is a Diplomate of the ABPM&R and has a CAQ in Sports Medicine. Dr. Col-
berg has a strong commitment to providing evidenced-based medical care through a patient-centered and holistic approach.
Dr. Colberg grew up in Puerto Rico playing tennis and enjoying water sports such as surfing and sailing. He completed his
undergraduate degree at the University of Pennsylvania. He then moved back to Puerto Rico where he graduated from the
University of Puerto Rico Medical School with an M.D. degree and a Certification in Clinical Research. Dr. Colberg com-
pleted a residency in PM&R at Emory University and a fellowship in Primary Care Sports Medicine at the American Sports
Medicine Institute.
Dr. Colberg has a special interest in treating acute and chronic musculoskeletal injuries, including bone, joint, ligament, muscle
and tendon injuries. He performs various treatment modalities in the clinic that assist the patient in their recovery from the
injury, among them diagnostic musculoskeletal sonography, ultrasound-guided injections, and platelet-rich plasma therapy. His
areas of expertise also include non-surgical management of fractures and dislocations, peripheral nerve injuries (e.g. carpal tun-
nel syndrome), sport-related spine injuries, pediatric sports injuries, biomechanical evaluation of the injured athlete, implement-
ing sports injury prevention protocols, management of osteoarthritis and screening for potential cases that may have a better
outcome by undergoing a surgical procedure.
Dr. Colberg is head team physician for Minor High School, Lawson State Community College, and Alabama Soccer Associ-
ation’s Olympic Development Program (ODP). He has also worked as team physician for the U.S.A. Paralympic Team at the
Lakeshore Foundation, the Chicago White Sox’s AA affiliate team - the Birmingham Barons, the Alabama Ballet, the Univer-
sity of Alabama at Tuscaloosa, University of West Alabama and other local high schools and colleges. He has earned the certi-
fication of Elite Professional from the United States Professional Tennis Association and is currently working with developing
injury prevention protocols for tennis athletes through the American Sports Medicine Institute. In addition, he has extensive
clinical research experience, including a national multi-center study on a regenerative medicine procedure called platelet-rich
plasma injection.
Expert Author
Ken Mautner, MD
Dr. Mautner is assistant professor in the department of PM&R and the department of Orthopedics at Emory University in
Atlanta, GA. He is the director of Primary Care Sports Medicine at Emory Sports Medicine Center. He is also the Program
Director of Emory’s Primary Care Sports Medicine Fellowship.
Dr. Mautner came to Emory in 2004, after completing a Fellowship in Primary Care Sports Medicine at the American Sports
Medicine Institute in Birmingham, Alabama. He is board certified in PM&R with a subspecialty certification in Sports Medi-
cine. Dr. Mautner currently serves as head team physician for Agnes Scott College and Pace Academy and a team physician for
Emory University and a consulting physician for Georgia Tech Athletics.
Dr. Mautner is an expert in diagnostic and interventional musculoskeletal ultrasound and teaches and directs courses across the
country on how to perform office-based ultrasound. He regularly performs Platelet Rich Plasma (PRP) and Stem Cell injec-
tions for patients with chronic tendon and joint related problems and is recognized as an expert and thought leader in this area.
In addition, he is the co-editor of the Atlas of Interventional Musculoskeletal Ultrasound.
Dr. Mautner’s other areas of clinical interest include sports concussions, where he is regarded as a local and regional expert in
the field. He was recently co-chairman of the Georgia Concussion Coalition, a group of diverse stakeholders whose aim is to
increase concussion awareness, education, and legislation in Georgia and was instrumental in passing the Georgia Return to
Play Act for concussion.
Expert Author
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10 © The Authors © 2014 Joshua Rothenberg. All Rights Reserved.
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Review Journal
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groups of runners. The study was also appropriately from rearfoot to forefoot strike running significantly
powered with an analyzed sample size (16) greater reduces PFJS. The statistical analyses appear well
than the minimum of 14 calculated with beta=0.2 and applied and the methods used for data collection are
alpha=0.05. well-established. Despite a high internal validity,
Weaknesses: While this study intended to care should be taken in extrapolating the results
characterize changes in biomechanical forces to demographics outside of the inclusion/exclusion
among healthy subjects, it specifically excludes a criteria.
key demographic target of its findings: those with Practice Pearl: This study suggests forefoot running
patellofemoral pain limiting their activity within may be a low-risk therapeutic option for habitual
the last 12 months. Further research is required to rearfoot runners who experience patellofemoral pain
validate the results within clinically significant patient in the absence of pathology within the kinetic chain
populations. In addition, the study does not account of foot plantarflexion. A gradual transition to forefoot
for potential biomechanical adaptations which may running would ideally be used to reduce the rate of
occur with transition to habitual forefoot running. injury seen among fast-transitioning runners.
Lastly, the use of a standardized joint model in References:
this study introduces error between the actual joint
(1) Vannatta CN, Kernozek TW. Patellofemoral Joint
geometry of subjects and that of the standardized
Stress during Running with Alterations in Foot Strike
model.
Pattern. Medicine & Science in Sports & Exercise.
Conclusion: Despite the aforementioned weaknesses, 2015 May; 47(5): 1001-1008.
this study provides convincing evidence that changing
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12 © The Authors © 2014 Joshua Rothenberg. All Rights Reserved.
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loss or persistence of delta waves during exercise. notable portion of the conclusions the review cites.
EP studies carry procedural risks, up to and including The review does not distinguish low- from moderate-
death. The decision to pursue testing should involve and high-intensity sports, which could offer further
a pre-procedural, patient-centered discussion with an guidance to physicians less familiar with athletics.
experienced specialist. Intra-procedural identification Conclusions: Despite unavoidable limitations
of a “shortest pre-excited R-R interval” (SPERRI) stemming from the level of evidence of some of the
of <250 milliseconds during induced AF implies a manuscripts from which it draws its conclusions, this
high-risk pathway, and ablation should be considered. review offers up-to-date recommendations for the safe
Inducible supraventricular tachycardia should management of any athlete diagnosed with WPW.
also prompt consideration of ablation, as should Practice Pearl: Athletes with WPW and persistent
symptomatic athletes. Athletes not meeting any of preexcitation on baseline ECG should be assessed
these three criteria can be followed conservatively. for the resolution of preexcitation during exercise.
Strengths: This review identifies and interprets the EP studies are indicated in athletes who demonstrate
best-available evidence on WPW. It cites manuscripts continued preexcitation during exercise or participate
that represent the cornerstones of the syndrome’s in moderate- to high-intensity sports. Ablation should
diagnosis and treatment, and it synthesizes them be considered for symptomatic athletes or those who
into an evaluation and management strategy that demonstrate EP evidence of a high-risk accessory
is tailored specifically to athletes. It also offers an pathway.
easy-to-follow algorithm to guide clinician decision- References:
making while appropriately accounting for the risks of
(1) Rao AL, Salerno JC, Asif IM, Drezner JA.
EP studies themselves.
Evaluation and Management of Wolff-Parkinson-
Weaknesses: Expert consensus statements, which White in Athletes. Sports Health. 2014 Jul;6(4)326-
represent a lower level of evidence, account for a 32.
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14 © The Authors © 2014 Joshua Rothenberg. All Rights Reserved.
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Review Journal
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performed vital components to the study for accuracy structure to joint stability.
and consistency and a standardized device was used Conclusion: This was a well-designed study that
for supplying valgus joint load. The study represents demonstrated the ability of ultrasound to reliably
the only cadaveric study using high resolution detect ulnohumeral joint gapping with valgus elbow
ultrasound to evaluate ulnohumeral joint laxity after stress, and that the primary restraint to valgus elbow
sectioning of individual medial elbow stabilizing stability at 30 degrees of elbow flexion is the anterior
structures. bundle of the UCL.
Weaknesses: Weaknesses of this study include use of Practice Pearl: This study suggests that ultrasound
a cadaveric model, a lack of blinding of the radiologist can be used to evaluate medial elbow instability, and
to which structures had been sacrificed prior to that significant laxity of the medial elbow with valgus
measuring joint gapping, only testing the stabilizing stress at 30 degrees of flexion is due to an injury of the
effects of each structure in 30 degrees of elbow anterior bundle of the UCL.
flexion, and small number of cadaveric specimens
References:
necessitating sequential sectioning of structures rather
than sectioning in isolation which may be a more (1) Ciccotti, MC et al. Stress Ultrasound Evaluation
accurate predictor of contribution of an individual of Medial Elbow Instability in a Cadaveric Model.
Am J Sports Med 2014 Oct; 42(10): 2463-9.
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16 © The Authors © 2014 Joshua Rothenberg. All Rights Reserved.
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Weaknesses: This study had a relatively small Conclusion: Although there are some evident
sample size (N: 33). In addition, they only looked weaknesses to this study, the authors accurately
at statistics. In order to adequately measure pitching demonstrated that the rUCL-R pitchers have
performance, the statistics should be accompanied significantly shorter careers when compared to the
by a biomechanical analysis of the pitchers’ throwing Control group. In contrast, rUCL-R pitchers do not
motion. There may be nothing physiologically or have a significant decrease in performance when
mechanically wrong with the post UCL revision compared to the Control group.
pitcher’s throwing motion, but still have performance Practice Pearl: The information in this study can
deficits related to other confounding factors such as be used as a proof of concept. This study shows
loss of their confidence. Comparing velocities from that pitchers who have underwent Revision Ulnar
individual pitchers pre and post surgery would have Collateral Ligament Reconstruction Surgery have
given more validity to the performance results. The shorter careers but do not have any performance
authors did not separate pitchers into roles. When deficits after rehabilitation.
numerical comparisons of ERA, Wins, Losses,
References:
etc. are being used to determine performance, it
is important to separate pitchers into relievers and (1) Nathan E. Marshall et al. Pitching Performance
starters because there are fluctuations in these types of and Longevity After Revision Ulnar Collateral
numbers even when comparing two elite and healthy Ligament Reconstruction in Major League Baseball
pitchers. Pitchers. Am J Sports Med 2015; 43(1051) published
online on April 10, 2015
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18 © The Authors © 2014 Joshua Rothenberg. All Rights Reserved.
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to use the 3-month data as the primary end-point glucocorticoid or saline injections at 3-months. The
instead of the 12-month data post hoc. This is a major abbreviated follow up used by Krogh et al. limits the
limitation, as the maximum benefit from a PRP conclusions that can be drawn from this study as the
injection may not be realized until 6 months after maximum benefit from PRP may not be realized at
the injection (3). Another limitation is that the saline 3-month follow-up.
injection technique was not an inactive placebo, and References:
involved performing 7 tendon perforations at the
(1) Carofino B, Chowaniec DM, McCarthy MB,
origin of the common tendon. In fact, percutaneous
et al. Corticosteroids and local anesthetics decrease
needle tenotomy alone has been shown to be an
positive effects of platelet-rich plasma: an in
effective treatment in itself for LE in numerous
vitro study on human tendon cells. Arthroscopy.
studies (2). Finally, while research is limited there
2012;28(5):711-719.
are studies suggesting that the method used by Krogh
et al. could have inhibited the efficacy of the PRP. In (2) Housner JA, Jacobson JA, Misko R.
Krogh et al. lidocaine was injected in the paratendon, Sonographically guided percutaneous needle tenotomy
and lidocaine has been shown to significantly decrease for the treatment of chronic tendinosis. J Ultrasound
tenocyte proliferation when used with PRP in an in Med. 2009 Sep;28(9):1187-1192.
vitro study of human tendon cells (1). (3) Peerbooms JC, Sluimer J, Bruijn DJ, et al. Positive
Conclusion: In the abbreviated 3-month follow up, effect of an autologous platelet concentrate in lateral
there was no significant difference between PRP, epicondylitis in a doubleblind randomized controlled
glucocorticoid or saline (plus needle tenotomy) on trial: platelet-rich plasma versus corticosteroid
subjective pain scores. injection with a 1-year follow-up. Am J Sports Med.
2010;38(2):255-262.
Practice Pearl: There remains no consensus on
managing chronic LE, and while PRP has shown (4) Krogh TP et al. Treatment of lateral epicondylitis
promise for the treatment of chronic LE in earlier with platelet-rich plasma, glucocorticoid, or saline: A
articles, this study did not find PRP superior to randomized, double-blind, placebo-controlled trial.
Am J Sports Med. 2013;41:625-635.
School-age children and adolescents spend Methods: The article, “The Fun Integration Theory:
Toward Sustaining Children and Adolescents Sport
Participation,” published in the Journal of Physical
Activity in Health (2), recruited 142 soccer players, 37
a coaches and 57 parents to participate in a qualitative
Elizabeth Joy, MD, MPH reviewing Visek AJ, et al. The fun
integration theory: toward sustaining children and adolescents sport study aimed at identifying all of the things that
participation. J Phys Act Health. 2015 Mar;12(3):424-33.
b
Community Health & Sports Medicine, Intermountain Healthcare,
make playing sports fun for players. From their data
Salt Lake City, UT they created FUN MAPS that provide an evidence-
c
Corresponding Author: Elizabeth Joy based blueprint for the Fun Integration Theory –
Email: liz.joy@imail.org
described as a multitheoretical, multidimensional, and
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20 © The Authors © 2014 Joshua Rothenberg. All Rights Reserved.
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stakeholder derived framework that can be used to to identify those with greatest influence on sustained
maximize fun for children and adolescents, as well as participation, the Fun Integration Theory can provide
promote and sustain physical activity. coaches, teachers, parents, even physicians, with
Results: This mapping process first identified 81 information that can be used to encourage regular
fun determinants through a brainstorming process, physical activity and sustained sport participation
sorted them into 11 themes, and then quantified how for youth. It can also be used to determine why a
important each was to a player’s perception of fun. child or adolescent seems to have lost interest in
When it was all said and done, the 3 most important physical activity and sport, and could be used as a
dimensions of fun were “positive team dynamics”, tool to identify those determinants that resonate the
“trying hard”, and “positive coaching”. Determinants loudest with an individual and help them find their
within “positive team dynamics” include playing well way back into sport. For coaches and physical activity
together as a team, being supported by teammates, educators the key dimensions and their determinants
and showing good sportsmanship. “Trying Hard” should ALWAYS be a part of sport and activity
includes trying your best, exercising and being active, programming.
along with being strong and confident. Twelve Practice Pearl: Physical activity begun during childhood
determinants make up “positive coaching”, which and sustained in adolescence sets the stage for an active
includes when a coach treats a player with respect, lifestyle throughout life. It’s intuitively obvious that
encourages the team, and serves as a positive role “fun” is an important determinant for activity and sports
model. participation. Understanding the determinants that
Strengths: A strength of this study is its mixed create and support that “fun” sporting environment is
method design, along with a significant sample size important for all of us who promote activity in children
including 236 athletes, coaches and parents providing and adolescents.
investigators with a breadth of data on the various References:
determinants that contribute to sustained sport (1) Laurson KR1, Lee JA, Eisenmann JC. The
participation. cumulative impact of physical activity, sleep duration,
Weaknesses: The athletes in this study were only and television time on adolescent obesity: 2011
soccer players, and results may not generalize to youth risk behavior survey. J Phys Act Health. 2015
athletes in other sports, or to athletes in individual (vs. Mar;12(3):355-60.
team) sports. The vast majority of study participants (2) Visek AJ, Achrati SM, Mannix H, McDonnell
were Caucasian. Future studies should intentionally K, Harris BS, DiPietro L. The fun integration
include athletes, parents and coaches with greater theory: toward sustaining children and adolescents
racial/ethnic and sport diversity. sport participation. J Phys Act Health. 2015
Conclusion: Having identified key determinants to Mar;12(3):424-33.
sports participation, followed by a process that seeks