Research Publications

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Stakeholder perceptions of a tackle law variation to reduce concussion incidence in community rugby union: a qualitative study
(SAGE Publications Inc., 2024) van Tonder, Riaan; Kraak, Wilbur
This study aimed to investigate the perceptions of key stakeholder groups, i.e. coaches, players, and referees, of a reduced maximum legal tackle height law variation trial in a collegiate amateur rugby competition. A pragmatic qualitative approach was used. Eighteen semi-structured interviews were performed. Thematic analysis was used to analyse the data. Three main law trial-related themes and four additional contextual themes were identified. The most important contextual factors include perceptions of resource scarcity of the implementation context, deficient concussion knowledge and lack of education among all stakeholder groups, tackle technique deficiencies, and an entrenched culture of a dismissive attitude towards serious injuries and non-disclosure of concussion by players. Real-world challenges such as inconsistent sanctioning during gameplay, multi-tackler tackles, and player fatigue underscore the gap between the theoretical knowledge of the law and the complex, dynamic nature of its execution. Furthermore, deeply ingrained issues like entrenched tackle techniques, the quality of coaching, and prevailing attitudes towards concussion compounded these challenges, indicating a need for a more comprehensive approach to bridge the divide between understanding and implementation. Despite these challenges, several participants felt the law variation was still more effective than the existing law; and that it created more awareness around concussion, while sending a clear message that player welfare is being taken seriously. Collectively these factors indicate the difficulty of addressing a complex problem such as concussion, with a law variation intervention in a challenging (resource-constrained) setting.
Injury incidence according to athlete impairment type during the 2012 and 2016 summer paralympic games: a combined analysis of 101 108 athlete days
(BMJ Publishing Group, 2024) Adam, Faatima; Jordaan, Esme
Objectives The relationship between sport-related injuries and Para athlete impairment type has not yet been comprehensively studied. This study aimed to describe injury incidence according to athlete impairment type during the London 2012 and Rio 2016 Summer Paralympic Games, by sex, age, Games period, chronicity and anatomical area. Methods A combined analysis of 7222 athletes was conducted comprising 101 108 athlete days, using pooled data. Internet sources were used to identify impairments of registered athletes. Impairment types: brain disorders (BD), limb deficiency, neuromuscular disorders (NMD), spinal cord-related disorders, visual impairment (VI) and’all others’ (OTH: impaired passive range of movement, intellectual impairment, leg length difference, short stature and unknown impairments). Results by impairment type are reported as univariate unadjusted incidences (injuries/1000 athlete days; 95% CIs). Statistical significance between impairment types was determined when 95% CIs did not overlap. Results The overall crude unadjusted incidence of injury was 11.1 (95% CI 10.4 to 11.9), significantly higher in VI (13.7 (95% CI 11.0 to 15.7)) and NMD (13.3 (95% CI 11.1 to 16.1)) compared with BD (9.1 (95% CI 7.7 to 10.8)). Acute (sudden onset) (8.6 (95% CI 7.3 to 10.1)) and lower limb (6.6 (95% CI 5.4 to 8.1)) injuries were higher among athletes with VI, while athletes with NMD had a higher incidence of repetitive (gradual onset) (5.9 (95% CI 4.3 to 8.0)) and upper limb (6.9 (95% CI 5.2 to 9.0)) injuries compared with other impairments. Conclusions Incidence and type of injuries differed between athlete impairment types. Athletes with VI or NMD sustained the highest incidence of injury, and athletes with BD had the lowest. Findings of this study can inform the management of competition-related injuries in Para athletes. © Author(s) (or their employer(s))
Supplementation strategies for strength and power athletes: Carbohydrate, Protein, and Amino Acid Ingestion
(MDPI, 2024) Meeusen, Romain; Bird, Stephen P.; Nienhuis, Mitch
It is a common belief amongst strength and power athletes that nutritional supplementation strategies aid recovery by shifting the anabolic/catabolic profile toward anabolism. Factors such as nutrient quantity, nutrient quality, and nutrient timing significantly impact upon the effectiveness of nutritional strategies in optimizing the acute responses to resistance exercise and the adaptive response to resistance training (i.e., muscle growth and strength expression). Specifically, the aim of this review is to address carbohydrates (CHOs), protein (PRO), and/or amino acids (AAs) supplementation strategies, as there is growing evidence suggesting a link between nutrient signaling and the initiation of protein synthesis, muscle glycogen resynthesis, and the attenuation of myofibrillar protein degradation following resistance exercise. Collectively, the current scientific literature indicates that nutritional supplementation strategies utilizing CHO, PRO, and/or AA represents an important approach aimed at enhancing muscular responses for strength and power athletes, primarily increased muscular hypertrophy and enhanced strength expression. There appears to be a critical interaction between resistance exercise and nutrient–cell signaling associated with the principle of nutrient timing (i.e., pre-exercise, during, and post-exercise). Recommendations for nutritional supplementation strategies to promote muscular responses for strength and athletes are provided.
Association between physical fitness and cardiovascular health in firefighters
(MDPI, 2023) Ras, Jaron; Smith, Denise L.; Soteriades, Elpidoforos S.
Firefighters perform strenuous work in dangerous and unpredictable environments requiring optimal physical conditioning. The aim of this study was to investigate the association between physical fitness and cardiovascular health (CVH) in firefighters. This cross-sectional study systematically recruited 309 full-time male and female firefighters between the ages of 20 to 65 years in Cape Town, South Africa. Physical fitness was assessed using absolute (ab˙VO2max) and relative oxygen consumption (relVO2max), grip and leg strength, push-ups and sit-ups, sit-and-reach for flexibility and lean body mass (LBM). CVH encompassed age, smoking, blood pressure (BP), blood glucose, lipid profile, body mass index, body fat percentage (BF%), and waist circumference. Linear regressions and logistic regressions were applied. Multivariable analysis indicated that relVO2max was associated with systolic BP (p < 0.001), diastolic BP (p < 0.001), non-fasting blood glucose (p < 0.001), and total cholesterol (p = 0.037). Poor CVH index was negatively associated with rel˙VO2max (p < 0.001), leg strength (p = 0.019), and push-ups (p = 0.012).
Association between cardiovascular disease risk factors and cardiorespiratory fitness in firefighters: A systematic review and meta-analysis
(MDPI, 2023) Ras, Jaron; Kengne, Andre P.; Smith, Denise L.
Approximately 45% of on-duty related mortalities were due to sudden cardiac death, with many of these fatalities related to cardiovascular disease and overexertion, while performing emergency duties. Therefore, the aim of this systematic review was to determine the association between cardiovascular disease risk factors and cardiorespiratory fitness in firefighters. A literature search of PubMed, SCOPUS, Web of Science, Embase, EBSCOHost, and ScienceDirect was conducted; the Rayyan® intelligent systematic review tool was used to screen and select studies for inclusion. The appraisal tool for cross-sectional studies and the Critical Appraisal Skills Programme toolkit were used for methodological assessment of included studies. Data were analyzed using the Review Manager 5.3 and MedCalc® statistical softwares to determine the effects of obesity (Z = 10.29, p < 0.001) and aging (Z = 4.72, p < 0.001) on cardiorespiratory fitness.
Physical activity, including active commuting, and health status of rural school children in South Africa
(University of Stellenbosch, 2019) Travill, Andre L.; Wildschutt, Phillip J.
Physical activity is considered a key preventative measure for various diseases, such as diabetes and cardio-vascular disorders. The majority of South Africans studied in various regional cross sectional surveys, suggest that most young people fail to meet recommended minimum physical activity standards. The main objective of this study was to ascertain the physical activity patterns and health status of rural schoolchildren. A comparative and correlational cross-sectional study design was used to assess the physical activity levels and health status of 162 rural schoolchildren. The participation levels in light and moderate to vigorous physical activity were 44.6% and 55.4% respectively. Walking to and from school was the most prevalent physical activity reported. Thirty-eight percent (38%) of the children were hypertensive. More than 50% of the children participated in health-enhancing physical activity. The low physical inactivity prevalence was most likely a result of their habitual activity patterns, which included active commuting to and from school.
Female sport administrators’ experiences of organisational fit in the workplace
(AFAHPER-SD, 2011) Titus, Simone
Gender inequality in South African sport has been legislated against by a number of constitutionally binding Acts. Although these policies have done much to address the general absence of women in leadership positions in sport, this absence is undoubtedly linked to gender inequality in sport. This is a reflection of the realities which shape women’s understanding of their organizational experiences in the workplace. The purpose of this study was to report on female sport administrators’ experiences of organisational fit in their places of work with regard to their experiences of resistance and exclusion, decision making, the absence of women in leadership positions and tokenism in sport. A qualitative method was used to explore organisational fit as experienced by participants in their places of work. Candidates were purposively selected to reflect the cultural and historical diversity of the women in leadership positions in sport in the Western Cape. Data was collected by using semi-structured interviews and analysed using thematic analysis. Reflexivity and trustworthiness were ensured by doing member checks, clarifying researcher bias and peer review and debriefing.
Analysis of social networking sites used by student spectators in university sport
(AFAHPER-SD, 2021) Phillips, Kirby; Titus, Simone
Social media usage has caused a notable shift in the use of strategies and relevant tools with which to communicate with sport spectators, catapulting sports into one of the most read topics on social media. This rapid growth of social media in sport has stimulated research in this field of study, delineating the different parts of social media, including social networking sites, and creating opportunities for university sport departments to foster relationships between university sport and student spectators. The purpose of this study was to identify the social networking sites used by student spectators in university sport. Based on a cross-sectional research design, amodified survey was distributed electronically to a randomly selected sample of 540 full-time registered studentsat the University of the Western Cape.The findings indicated that WhatsApp, Facebook, and Instagram were the most popular social networking sites used by student spectators in university sport. This study concluded that thethree social networking sites were the most preferredamong student spectators. Therefore, this research provides higher education institutions the opportunity to leverage off the students’ usageof social networking sitesfor marketing purposes. The study recommendsthe need for social media-based marketing strategies by university sports departments to be targeted at social networking sites visited by student spectators.
Experiences of young South African gymnasts, parents and coaches about the health benefits of sport participation
(AFAHPER-SD, 2019) Lucas, Warren; Titus, Simone; Young, Marie Elizabeth
Gymnastics, as a physical activity, presents young people with opportunities to learn physical skills, improve eye-hand coordination, develop gross and fine motor skills, and socially develop through engagement with other young people. An understanding of aerobic and anaerobic physical activities is important to enhance young people’s physical, emotional, cognitive and social development. This study investigated the perceptions of a purposively sampled group of young people in the Western Cape of South Africa about the health benefits of gymnastics participation , and reported findings from the perspectives of registered competitive gymnasts, gymnastics coaches, and parents of gymnasts (total n=34), with specific reference to the domains of physical, cognitive and socio-emotional development. A qualitative approach based on the Process-Person-Context-Time (PPCT) concept, adapted from the bioecological model, was used as the theoretical framework to underpin, analyze and interpret findings of the study. Four key informant interviews were conducted with four coaches, and five focus group discussions were held with gymnasts, parents of gymnasts and gymnastics coaches.
If you build it will they come? Park upgrades, park use and park-based physical activity in urban Cape Town, South Africa—The sun study
(MDPI, 2023) Bartels, Clare A.; Lambert, Estelle V.; Young, Marié E. M.
The development and upgrade of recreational public spaces are key government strategies to increase opportunities for physical activity (PA) and enhance social interaction and community cohesion. This study aimed to evaluate differences in park use and park-based PA in recently upgraded/developed parks (intervention, n = 4) against established parks (control, n = 4) and in regional parks in high- and low-income settings (n = 2). Additionally, associations between target area features, park use and PA were identified. Direct observation of park use and attributes was conducted using the System for Observing Play and Recreation in Communities (SOPARC) over four months. Despite more park users in intervention parks (2519 vs. 1432), control park visitors were 48% more likely to be engaged in PA (p < 0.001). Similarly, while high-income park users attracted more visitors (2135 vs. 1111), they were 79% less likely to be engaged in any PA compared with low-income park visitors. The likelihood of both use of and PA by gender and age differed by features. Active recreation features in intervention parks attracted more users than the same features in control parks. In this study, upgraded or newly developed parks attracted more visitors but not necessarily overall greater levels of physical activity.
Alcohol consumption, physical activity, and cad risk factors in firefighters
(Bentham Open, 2023) Ras, Jaron; Leach, Lloyd
Firefighting is a physically and psychologically stressful occupation, where firefighters often resort to alcohol use as a coping strategy. Firefighters are particularly vulnerable to alcohol misuse and alcohol disorders, negatively affecting their health, well-being and, possibly, work performance. Therefore, this study investigated the prevalence of alcohol consumption and its relationship with the participants’ sociodemographic characteristics, weekly physical activity, and coronary artery disease (CAD) risk factors. This study used a quantitative, cross-sectional and descriptive design. A total of 124 full-time firefighters, males and females, were conveniently recruited from the City of Cape Town Fire and Rescue Service, South Africa, between September to November, 2020. Firefighters were then separated according to sex, age, ethnicity, and CAD risk factors. Mann-Whitney U and Kruskal-Wallis H were used to determine the statistical differences between groups, Kendall’s Tau was used to assess the correlation between ordinal and continuous variables, and Chi-square to assess the association between categorical variables. A p-value of less than 0.05 was used to indicate statistical significance.
Cardiovascular disease risk factors, musculoskeletal health, physical fitness, and occupational performance in firefighters: A narrative review
(Hindawi Journal of Environmental and Public Health, 2022) Ras, Jaron
Introduction. Firefighting is a strenuous occupation that requires firefighters to be in peak physical condition. However, many firefighters have risk factors for cardiovascular disease, impaired musculoskeletal health, and are not physically fit for duty, which all negatively impact their occupational performance. Therefore, the aim of this review is to determine the relationship between cardiovascular disease risk factors, musculoskeletal health, physical fitness, and occupational performance in firefighters. Methods. The electronic databases PubMed, SCOPUS, and Web of Science were searched online via the library portal of the University of the Western Cape. Publications and grey literature between the years 2000 to present were used. In total, 2607 articles were identified; after the removal of duplicates 1188 articles were then screened, and were excluded for not meeting initial screening criteria. The remaining 209 full-text articles were screened based on the inclusion and exclusion criteria, where 163 articles were excluded. Only studies that were quantitative were included. This left 46 articles that were then finally included in the current narrative review. Results. The current literature indicated that significant relationships existed between cardiovascular risk factors, musculoskeletal health, physical fitness, and occupational performance. The results indicated firefighters who were aged, obese, physically inactive, cigarette smokers, and unfit were at the highest risk for cardiovascular and musculoskeletal health complications, and unsatisfactory occupational performance. Musculoskeletal health complications significantly affected occupational performance and work ability and were related to physical fitness of firefighters. Most cardiovascular risk factors were related to physical fitness, and all physical fitness parameters were related to occupational performance in firefighters. Conclusion. The overwhelming evidence in the current review established that physical fitness is related to occupational performance. However, the relationship between cardiovascular risk factors and musculoskeletal health in relation to occupational performance is less clear and still understudied. Significant gaps remain in the literature.
Can social innovation advance the PMTCT programme? A South African reflection
(Sinnergiak Social Innovation, 2022) Mdleleni, Lwando; Velapi, Linda
The prevention of mother to child transmission (PMTCT) programme is an initiative developed to enable health care practitioners to provide essential care to mothers in order to prevent the transmission of HIV to their infants.However,the PMTCT programme has not been reaching its intended prevention objectives. This paper identifies the social issues that elucidate the gap between PMTCT program goals and the role that Social Innovation could play in improving the status quo.Supporting Social Innovationin health helps reduce infectious diseases by empowering communities to become active participants in their health challenges through local adaptation of global strategies that facilitate the reduction of health system limitations.The article combines a review of the literature with empirical evidence extracted from research that has analyzed the postpartum experiences of mothers living with HIV in the context of the PMTCT program in Khayelitsha, Cape Town, South Africa in 2021.
Effects of an isometric exercise training program on muscular strength, ankle mobility, and balance in patients with diabetic peripheral neuropathy in the lower legs in South Africa
(Springer, 2022) du Plessis, Ronél; Dembskey, Nadia; Bassett, Susan H
Background: Patients who suffer from diabetic peripheral neuropathy in the lower leg experience a greater risk of falls due to a decrease in strength of the lower extremities. Methods: Fourteen participants, diagnosed with diabetic peripheral neuropathy or nocturnal allodynia in either one or both extremities, volunteered to participate in this study. Participants were purposively selected from two private Podiatry practices based on their signs and symptoms, age, gender, and doctor's clearance to participate in any form of physical activity. Dependent variables included isometric muscle strength of the hip, knee and ankle, range of motion of the ankle in plantarflexion and dorsiflexion and an assessment of balance, which were measured pre- and post-intervention. The researcher developed a scientifically based exercise intervention program to target the entire kinetic chain, and to develop a standard isometric protocol for patients with DPN. The intervention program consisted of a combination of ankle, hip, and knee specific rehabilitation. The intervention took place 3 times a week for 45 min per session. Results: The Mann-Whitney test was used to evaluate the differences in dependent variables from pre- to post-intervention. The level of significance was set at p<0.05. Notable increases were observed in range of motion in ankle plantarflexion and in balance time in the intervention group, post-intervention. Conclusions: Although many of the changes noted were insignificant, the trends indicated an improvement in the intervention group over the 10-week intervention period. These improvements can be considered clinically important.
Effects of cardiovascular health, musculoskeletal health and physical fitness on occupational performance of firefighters: Protocol for a systematic review and meta-analysis
(BMC, 2022) Ras, Jaron; Kengne, Andre Pascal; Smith, Denise
Firefighting is a hazardous occupation, where firefighters are involved in life-threatening situations, being placed under tremendous physical strain, while wearing heavy and insulated equipment to protect them from chemicals, fumes and high temperatures. This necessitates that firefighter stay in good physical condition and maintain adequate cardiovascular fitness to cope with these stressors and perform their duties with minimal health risks. The aim of this systematic review and metaanalysis is to determine the effect of cardiovascular health, musculoskeletal health and physical fitness on the occupational performance of firefighters.
Association between major coronary artery disease risk factors in the city of Cape Town firefighter and rescue service
(Bentham Science Publishers, 2021) Leach, Lloyd; Ras, Jaron
Background: Many CAD risk factors occur concurrently, increasing the odds of the development of other risk factors, which is particularly seen in male and older firefighters. Objective: The purpose of this study was to determine the association and odds ratios between the various CAD risk factors in firefighters. Methods: This study used a quantitative, cross-sectional and correlational design. A total of 124 full-time firefighters, males and females, were conveniently recruited from the City of Cape Town Fire and Rescue Service. A researcher generated questionnaire was used to collect participant sociodemographic information, and all research procedures were conducted according to the ACSM guidelines. The study took place between September and November 2019. Results: There were significant associations between hypertension and age [χ2 (1) = 18.0, p < 0.001, OR = 6.3 (95% CI: 2.6, 15.5)], hypertension and obesity [χ2 (1) = 7.9, p = 0.005, OR = 3.0 (95% CI: 1.4, 6.6)], hypertension and diabetes [χ2 (1) = 5.1, p = 0.040, OR = 4.0 (95% CI: 1.1, 14.8)], and hypertension and dyslipidaemia [χ2 (1) = 8.5, p = 0.004, OR = 3.1 (95% CI: 1.4, 6.7)], family history and central obesity [χ2 (1) = 3.9, p = 0.04, OR = 2.4 (95% CI: 0.9, 5.8)], and family history and central obesity [χ2 (1) = 3.9, p = 0.04, OR = 2.4 (95% CI: 0.9, 5.8)]. Conclusion: Increased age, central obesity, hypertension and dyslipidaemia increased the odds of developing other major CAD risk factors, which was predominantly apparent in male firefighters of mixed ethnicity. The City of Cape Town Fire and Rescue Service should emphasize the mitigation of these major CAD risk factors through education and behavioural modification, especially as male firefighters aged.
Recommendations to enhance parental involvement and adolescent participation in physical activity
(MPDI, 2022) Cozett, Colleen; Roman, Nicolette V.
Adolescents are influenced by external factors which may impact their level of physical activity. Parents require specific strategies to become involved and to increase physical activity participation in adolescence. Objective: Thus, the current study aimed to design recommendations to increase physical activity participation and parental involvement. Methods: The current study forms part of a broader mixed-method study in which the results of the phases and stages of the pre-studies informed the current study. Thus, the current study uses an agreement workshop to develop recommendations with stakeholder and expert input in two rounds. Participants were invited to participate in the current study n = 100, and n = 65 participated in round one. Round two consisted of n = 20 experts invited to an agreement workshop, with n = 11 attending and making an input on the final recommendations. Therefore, experts and parents in the field of parenting, physical activity, and physical education, were invited to participate in the study rounds. After each round, the responses from the panellists were collated, interpreted, and developed into a framework for recommendations using thematic analysis. Themes were generated and refined using an agreement format.
Relationship between physical activity, coronary artery disease risk factors and musculoskeletal injuries in the City of Cape Town fire and rescue service
(SAGE, 2022) Ras, Jaron; Leach, Lloyd
Musculoskeletal injuries in firefighters are a common occurrence, that increase as firefighters age, and may be related to the firefighters’ physical activity habits outside of the job. Certain CAD risk factors, such as obesity, cigarette smoking and ageing may be linked to increased injury risk in firefighters. Although firefighters may meet the recommended minimum physical activity minutes, they may remain at risk for sustaining musculoskeletal injuries. Therefore, this study aims to determine the relationship between physical activity and CAD risk factors, between CAD risk factors and musculoskeletal injuries and between physical activity and musculoskeletal injuries. A total of 124 full-time firefighters, males and females, were conveniently recruited from the City of Cape Town Fire and Rescue Service. A researchergenerated questionnaire was used to collect injury, CAD risk factor and physical activity data. The proportion of firefighters who participated in leisure-time physical activity (LTPA) was 63.7%, and those who were physically inactive was 69.4%. The prevalence musculoskeletal injuries among all firefighters was 27.4%. The most prevalent musculoskeletal injury was shoulder injuries in 35.3% of firefighters, followed by multiple injuries in 26.5% and back injuries in 14.7%. Age was a significant predictor of physical inactivity in firefighters [P = .002, OR = 1.08], BMI was a significant predictor of physical inactivity [P = .050, OR = 1.08], cigarette smoking was a significant predictor of firefighters not exercising [P = .007, OR = 2.31] and the total amount of vigorous-intensity exercise was a significant predictor of musculoskeletal injuries [P = .050, OR = 1.00]. In conclusion, older firefighters were more physically inactive and had a higher prevalence of musculoskeletal injuries, and the latter decreased significantly after the age of 50 years. Emphasis should be placed on firefighters exercising in their leisure-time, especially as they aged.
Access to healthcare for people with disabilities in South Africa: Bad at any time, worse during COVID-19?
(AOSIS, 2021) McKinney, Emma L.; McKinney, Victor; Swartz, Leslie
People with disabilities, especially those living in low- and middle-income countries, experience significant challenges in accessing healthcare services and support. At times of disasters and emergencies, people with disabilities are further marginalised and excluded. During the coronavirus disease 2019 (COVID-19) pandemic, many people with disabilities are unable to access healthcare facilities, receive therapeutic interventions or rehabilitation, or gain access to medication. Of those who are able to access facilities, many experience challenges, and at times direct discrimination, accessing life-saving treatment such as intensive care unit admission and ventilator support. In addition, research has shown that people with disabilities are at higher risk of contracting the virus because of factors that include the need for interpersonal caregivers and living in residential facilities. We explore some of the challenges that people with disabilities residing in South Africa currently experience in relation to accessing healthcare facilities.
Relationship between shoulder complex strength and throwing velocity in club cricketers
(Universidad de Alicante, 2019) LEACH, L.L.; November, R.V.C.
Cricket is a game of immense physical prowess requiring high levels of fitness and skill. Purpose: The aim of this study focused on examining the relationship between shoulder concentric strength and throwing velocity amongst club cricketers. Method: The study used a quantitative, cross-sectional design. A convenient sample of 40 male university cricketers was tested. Shoulder concentric strength was measured at 60º•sec-1 and 90º•sec-1 using an isokinetic dynamometer. Throwing velocity was measured using a Speed Gun. Results: Significant correlations were found between peak torque during concentric internal rotation at 60º•sec-1 and maximal throwing velocity for the first team (r = 0.72; p = 0.01), second team (r = 0.67; p = 0.03), third team (r = 0.73; p = 0.01) and fourth team (r = 0.69; p = 0.02). The correlation between strength ratio at 60º•sec-1 and maximal throwing velocity was also significant for the first team (r = 0.76; p = 0.01), second team (r = 0.83; p = 0.002), third team (r = 0.70; p = 0.02) and fourth team (r = 0.94; p = 0.0001).

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