Ph.D. - Kinesiology and Rehabilitation Science
Permanent URI for this collectionhttps://hdl.handle.net/10125/75858
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Item type: Item , EXAMINING ETHNIC IDENTITY AND PHYSICAL ACTIVITY AMONG ADULTS(University of Hawai'i at Manoa, 2024) Cohen, Shoshana K.; Morgan, Charles; Kinesiology and Rehabilitation ScienceIntroduction: This study examined ethnic identity and physical activity behavior across a diverse sample of 430 adults residing in Hawaiʻi and the continental U.S. to determine how strength of ethnic identity may act to moderate associations between race and ethnicity and physical activity. Methods: Participants completed an anonymous online questionnaire designed to collect data on cultural connectedness via measures of ethnic identity, self-reported physical activity, and other health- and fitness-related variables. SPSS (Version 29) was used for all data processing and analyses. Preliminary analyses consisted of descriptive statistics, ANOVAs, and correlations. Outcomes observed from the preliminary analyses were used to model the subsequent and primary analyses, which included multivariate regression and moderation. Results: The overall effects of race and ethnicity were significant with self-reported physical activity (p < .05) and strength of ethnic identity (p < .001). When controlling for age, sex, education, lifetime discrimination, and perceived health, race and ethnicity were significant predictors of total physical activity (p < .05). The interaction between race and ethnicity and strength of ethnic identity was observed to be significant for those who identified as Native Hawaiian or Other Pacific Islander (p < .05). Conclusion: The results of the primary analysis indicated that the strength of ethnic identity does act to moderate the relationship between race and ethnicity and physical activity, with stronger ethnic identify being associated with increased levels of physical activity throughout the week and having varying degrees of impact across the racial and ethnic groups represented in the sample.Item type: Item , The Effect of Anterior Cruciate Ligament Reconstruction on Long-Term Post-Traumatic Knee Osteoarthritis Risk Due to Persistent Biomechanical Loading Alterations(University of Hawai'i at Manoa, 2024) Takata, Andrew A.; Stickley, Christopher; Kinesiology and Rehabilitation ScienceContext: Persistent compensatory underloading of the knee during running may play a critical role in driving cellular and metabolic changes associated with the progression of knee OA. However, evidence of long-term running mechanics following anterior cruciate ligament reconstruction (ACLR) remains equivocal. Therefore, the purpose of this study was to investigate biomechanical loading differences during running between participants with a history of unilateral ACLR more than two years prior and healthy matched controls (CON) to determine influences that may contribute to the increased risks of PTOA development. Methods: Running biomechanics of 37 ACLR (27.0 ± 6.6yr, 1.7 ± 0.1m, 75.6 ± 21.1kg; 23 females; 8.3 ± 5.3 years post-ACLR) and 37 healthy control participants (24.6 ± 4.7yr, 1.7 ± 0.1m, 73.0 ± 20.1kg; 23 females) were evaluated. Current activity levels were evaluated with the Tegner Activity Scale (5.84 ± 1.4 ACLR, 5.73 ± 1.6 CON). Participants performed trials running at a velocity of 4.0 m/s-1 ± 10%. The ACLR limb was individually matched to CON via limb dominance. Kinematics were collected at 240Hz via 3D motion capture system (Vicon, Colorado, USA); kinetics were collected at 960Hz using a force plate (AMTI, Massachusetts, USA). Kinematic and kinetic data were smoothed using a Butterworth filter with a 10Hz cut-off frequency, except for ground reaction force which was filtered at 50 Hz, and processed using Visual 3D (C-Motion, Inc., Germantown, MD). Two-way full factorial ANOVA and t-tests were used to determine differences in gait-related variables during stance between ACLR versus their contralateral limb (CONTRA) and versus CON matched limbs. Results: ACL limbs demonstrated decreased KFM and KFM impulse compared to healthy controls and their CONTRA limbs. ACL limbs had an increased hip adduction and hip internal rotation moment compared to healthy controls, while an increase in hip adduction and hip internal rotation power were observed compared to their CONTRA limb. Conclusions: Persistent knee underloading was evident with lower peak KFM and KFM impulse following ACLR when compared to healthy matched controls and the CONTRA limb. The ACL limb demonstrated compensatory hip loading strategies, primarily with increased frontal and transverse plane hip moments compared to healthy controls, and with increased hip frontal and transverse plane hip powers compared to the CONTRA limb. In conjunction with knee underloading demonstrated during walking, these findings during running may contribute to and exacerbate gradual articular cartilage degeneration and the development of PTOA within 10-20 years after ACLR.Item type: Item , Methodological Considerations Of Body Composition Assessments And Predicting Athletic Performance: The Da Kine Study(University of Hawaii at Manoa, 2023) Cataldi, Devon; Shepherd, John A.; Kinesiology and Rehabilitation ScienceAssessment of body composition provides clinically relevant data on fat and fat-free mass (FM, FFM) that deepens the knowledge of body mass alone, to enhance human performance and identify links between disease/cancer risk. Total body water (TBW), typically 0.73% of FFM is the body's largest compartment; therefore, errors in its measure can impact body composition estimates the greatest, especially in special populations like athletes who tend to be outside of normal hydration, leading to deleterious effects on performance. However, the accuracy and association of various body composition methods, including emerging and standard techniques remain unclear. The central hypothesis of this dissertation was that body composition measures that adjusted for hydration status were more accurate to muscle performance than those insensitive to hydration. The objective of this dissertation was to determine how to derive accurate and precise body composition in athletes with varying states of hydration by exploring specific TBW methodologies, and finally how these measures are associated with muscular strength. The Da Kine Study of 80(40male) athletes aged 21.8 (SD-4.2) years was conducted to achieve this goal by introducing three central study aims. Aim I compared the accuracy using Lin’s (CCC) and precision by root-mean-square coefficient of variation (RMS-CV%) of differing body composition models/methods to the criterion five-compartment model (5CM). Laboratory methods included: air-displacement plethysmography (ADP), deuterium (D2O) dilution [using Fourier-transform infrared spectrophotometry (FTIR), and isotope-ratio mass-spectrometry (IRMS)], dual-energy x-ray absorptiometry (DXA), underwater-weighing (UWW), and field-methods: three bioelectrical impedance (BIA) devices (S10/SFB7/SOZO), and 3-Dimensional Optical (3DO) scans. Leg and trunk strength was measured via dynamometry. Athletes' hydration status was significantly (p=0.001) outside of the normal range in both males (63-73%) and females (58-78%). While no significant mean differences were present between methods, significant individual accuracy and precision estimates were observed. ADP and DXA produced the highest agreement of FM and FFM to the 5CM (CCC=0.90-0.95) in both sexes. All measures of FFM produced excellent precision (<1%), whereas only ADP, DXA, D2O, and S10 had <2%. More accurate body composition (ADP/DXA) determination produced better associations with muscle strength. Aim II assessed the impact of accuracy and precision on TBW estimates using various specimen types (saliva/urine), analytical methods (FTIR/IRMS/BIA), and across three laboratories. These measurements were then substituted into both the 5CM and the 2-compartment model (2CM) for FM. TBW precision varied between techniques (0.3-1.2%) with D2O-IRMS-saliva as the criterion. All TBW measures produced substantial-perfect agreement with the criterion (CCC>0.90), except for SFB7/SOZO (CCC<0.90). FM from nearly all 2CM-D2O/BIA produced poor agreement, however, the 5CM-D2O produced substantial agreement and the BIA devices S10/SOZO had a moderate agreement. Aim III compared a novel approach to measure skeletal muscle mass by deuterated creatine (D3Cr) dilution and its relationship to muscle strength and similar measures using DXA. All measures of leg/trunk strength were more highly associated with DXA, with female trunk strength as the highest (R2=0.61, RMSE=19.4) when compared to D3Cr (R2=0.54, RMSE=17.4). Additionally, whole body values of body composition produced higher associations to muscle strength over normalized values to body weight or height. Concluding that accurate and precise estimates of body composition can be determined in athletes of varying states of hydration and suggest that a more accurate body composition produces better strength estimates. The study emphasizes the importance of using criterion modeling, specific TBW methodologies, and various devices such as DXA, 3DO, and BIA, to serve as reliable approaches for assessing body composition and enhancing human performance.Item type: Item , Innovative Approach To Concussion Assessment(University of Hawaii at Manoa, 2023) Hashida, Kumiko; Tamura, Kaori; Kinesiology and Rehabilitation ScienceThe current return to learn or play protocol following concussions dictates a gradual return to learn or play by increasing the difficulty of physical and cognitive activities in a controlled environment under the supervision of health care providers. While the return to learn or play protocol is well established and universally accepted, about half of the concussed individuals reported recurrent symptoms or worsening of symptoms after returning to school and sports activities following a gradual RTP protocol. A possible explanation for this return to learn or play failure is that the current concussion assessment tools are not able to identify the residual post-concussion deficits effectively. This indicates that there is a need for concussion assessment tools that are able to identify residual post-concussion deficits precisely in clinical settings. To better inform the ultimate understanding of post-concussion deficits and improve concussion assessment, this dissertation proposes three innovative approaches to concussion assessment using dual task, mobile application-based neurocognitive test, and subtype.Item type: Item , Exploring the Efficacy of Exercise Interventions To Improve Phase Angle(University of Hawaii at Manoa, 2023) Short, Trevor; Yamada, Paulette M. M.; Kinesiology and Rehabilitation ScienceBioelectrical impedance analysis derived phase angle (PhA) has emerged as a non-invasive and easy-to-measure variable with significant implications. In clinical settings, PhA has shown associations with mortality, malnutrition, disease severity, and fitness. Individuals such as cancer survivors who undergo damaging treatments (i.e. chemotherapy and radiation therapy) present low PhA values. Since PhA is associated with levels of fitness in clinical populations, it was plausible that an exercise-based cancer rehabilitation program may improve PhA. However, no study prior to this work had shown a significant improvement in the PhA of cancer survivors. The foundational chapter in this dissertation was conducted to explore the relationships between health-related fitness components and PhA in breast cancer survivors. These findings indicate that PhA is more related to neuromuscular performance measures, such as muscular strength, rather than cardiovascular endurance-based performance. With this information, a concurrent exercise-based cancer rehabilitation program was designed that produced significant increases in the PhA breast cancer survivors. However, the efficacy of different training types on PhA remained unclear. Due to the multifactorial and detrimental effects of cancer treatments, it is unethical to ask cancer survivors to refrain from participating in exercise-based interventions that have been shown to mediate the aforementioned effects of treatment and improve quality of life. Therefore, the following chapters were conducted in a healthy population to explore the relationships between PhA and other measures of athletic performance and determine the effects of different training types (sprint interval training, resistance training, endurance training) on PhA. The novel findings of this dissertation inform practitioners of the relationships between PhA and athletic performance and provide valuable insights into longitudinal changes of PhA in response to different types of exercise interventions.Item type: Item , Obesity And Osteoarthritis: A Biomechanical And Global Health Evaluation Of Total Knee Arthroplasty Patients And Healthy Controls(University of Hawaii at Manoa, 2021) Linsley, Laura Mary; Stickley, Christopher; Kinesiology and Rehabilitation ScienceThree-dimensional biomechanical gait analysis is a clinical tool to measure patient function prior to and following total knee arthroplasty (TKA). Patient-reported outcome (PRO) measures are psychometric questionnaires that also measure patient function prior to and following TKA. Different insight is gained from each of these measurement tools, the biomechanical data measures local factors, the PRO measures global factors, the current study utilized the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR.) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical Health (GPH) and Global Mental Health (GMH). Body mass index (BMI) is another important measurement tool that provides insight into patient health, BMI is a local factor as well. How do TKA patients recover over time in terms of their BMI, biomechanical gait, and PRO measures? Results of this dissertation suggest that biomechanically, there were significant group differences between healthy controls and TKA patients. Comparing healthy controls to TKA patients also revealed that there were baseline differences related to BMI, and group differences over time related to BMI that significantly affected the biomechanical gait outcomes. Furthermore, PRO measures for all TKA patients improved over time. The KOOS JR. and PROMIS GPH significantly improved at each timepoint, there was a lag effect for the PROMIS GMH. Patients with a higher BMI had worse baseline KOOS JR., GPH, and GMH scores. For the GPH and GMH the effect of BMI was non-significant over time. The KOOS JR. scores significantly interacted with BMI, over time at six months and one year, suggesting that heavier patients improve their scores more over time.Item type: Item , Biomechanical Considerations For Neuromuscular Control Of Knee Arthroplasty Patients And Proprioception Of Healthy Participants(University of Hawaii at Manoa, 2021) Beeler, Derek Michael; Stickley, Christopher; Kinesiology and Rehabilitation ScienceKnee osteoarthritis (OA) patients often experience significant limitations in walking and stair negotiation abilities. Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) patients are frequently unable to ascend and/or descend stairs due to pain, limited pre- and post-operative range of motion, or poor limb coordination associated with diminished quadriceps performance. Three-dimensional (3D) biomechanical gait analysis has served as a measurement technique to assess these pre- and post-operative functional deficits. Through the use of 3D biomechanical analysis, various indicators of knee OA progression and development, as well as risk of revision, have been established with external knee adduction moment (KAM) and knee flexion moment (KFM), among others. Though these risk factors are adequate in predicting medial loading and willingness to load the limb, respectively, they are not sufficient in determining pre- and post-operative neuromuscular control deficiencies. Longitudinal analyses of time-derivatives for frontal and sagittal plane measures of knee joint loading, as well as aggregate measures of leg stiffness are examined in this dissertation. These areas have been less well studied in this population and may further explain neuromuscular deficits from a biomechanical perspective. To further examine how biomechanical variables may explain neuromuscular control, this dissertation also includes a cross sectional analysis of knee joint proprioception, specifically joint position sense (JPS), in several testing positions for a healthy cohort. Several analyses were conducted to examine any differences in JPS between limbs, and associations between biomechanical measures of loading and knee joint proprioception in healthy individuals. Given the lack of evidence examining these associations, these analyses were largely exploratory; however, hypothesis driven analyses were conducted. The novel findings of this dissertation inform on these associations (or lack thereof) and provide insight into longitudinal gait changes between TKA and UKA patients. The results also inform on neuromuscular considerations for knee biomechanics in these patients during stair negotiation and level walking.Item type: Item , The Relationship Between Depression, Anxiety, And Resilience In College Student Athletes(University of Hawaii at Manoa, 2021) Ma, Rong; Murata, Nathan M.; Kinesiology and Rehabilitation ScienceAnxiety disorder is becoming increasingly prevalent across college campuses, particularly amongst student athletes who face additional stressors and challenges than their peers. Given the well-documented correlation between anxiety and depression, the number of collegiate athletes suffering from depression is unsurprisingly growing as well. Psychologists have recently begun to take a more prophylactic approach to treating these disorders through resilience training. Resilience training focuses on developing greater mental fortitude and confidence to better cope with mental and emotional challenges. The purpose of this study was to analyze the association between resilience, depression, and anxiety for college student athletes. It sought to contribute to the development of an effective resilience educational modules that collegiate sports programs across the country can readily employ. Research Design: The proposed project employed a survey research design to explore the complex relationship between depression, anxiety, and resilience for college student athletes. Data Analysis Strategy: A Structure Equation Modeling (“SEM”) was employed to account for any measurement error between the observed items (responses on the instruments) and the latent variables (anxiety, resilience, and depression). More importantly, SEM examined whether the collected data supported the theoretical model proposed in this research. Key Measures: levels of anxiety, depression, and resilience in current collegiate athletes at the University of Hawaiʻi at Mānoa.