Background and Objectives: Restless legs syndrome (RLS) is a common, underdiagnosed neurological movement disorder of undetermined etiology. The primary treatments for restless legs syndrome are pharmacological. To date, no randomized controlled trials have examined the effectiveness of an exercise program on the symptoms of RLS.Methods: Study participants (N ‫؍‬ 41) were randomized to either exercise or control groups. 28 participants (average age 53.7; 39% males) were available and willing to begin the 12-week trial. The exercise group was prescribed a conditioning program of aerobic and lower-body resistance training 3 days per week. Restless legs symptoms were assessed by the International RLS Study Group (IRLSSG) severity scale and an ordinal scale of RLS severity at the beginning of the trial, and at 3, 6, 9, and 12 weeks.Results: Twenty-three participants completed the trial. At the end of the 12 weeks, the exercise group (N ‫؍‬ 11) had a significant improvement in symptoms compared with the control group (N ‫؍‬ 12) (P ‫؍‬ .001 for the IRLSSG severity scale and P < .001 for the ordinal scale). Conclusions Background and ObjectivesRestless Legs Syndrome (RLS) is a common neurological movement disorder affecting a large segment of the population. Studies of the prevalence of RLS suggest the condition affects approximately 10% of the adult population, although one study found a prevalence of 24% in patients presenting to a primary care office.1-3 Although RLS is common, it is seldom diagnosed. The 2001 Sleep in America Poll found a prevalence of 13% in the adult population, but only 3% of those had actually been diagnosed with RLS. 4 Factors associated with higher incidence of RLS include older age, multiparity, sedentary lifestyle, positive family history, and obesity.1,2 Secondary causes of RLS include iron deficiency, renal failure, neuropathy, pregnancy, and certain medications. 5 RLS is associated with depression, anxiety, and negative quality of life. 6,7 The diagnosis of RLS is clinical. Minimal criteria for the diagnosis are: 1) a compelling urge to move the limbs, usually associated with paresthesias/dysesthesias; 2) motor restlessness as seen in activities such as floor pacing, tossing and turning in bed, and rubbing the legs; 3) symptoms worse or exclusively present at rest (ie, lying, sitting) with variable and temporary relief by activity; and 4) symptoms worse in the evening and at night. 8 RLS tends to cluster in older, overweight adults, 6,9,10 who are at increased risk for comorbid conditions. Physical activity and exercise may be important in the reduction of the risk for comorbid conditions; however, the effects of exercise on RLS severity are unknown. Furthermore, the current treatment for RLS is primarily pharmacological in nature. The vast majority of clinical trials have concentrated on the use of dopaminergic agents, anticonvulsants, and benzodiazepines.11-13 These agents often have significant side effects. Little research has been undertaken to determine whether lifestyle changes, ...

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These preliminary findings suggest that medical coverage of high school athletics in North Carolina, as in other states, is lacking and inconsistent.

ObjectiveTo assess diagnostic accuracy and reliability of sideline concussion tests in college athletes.MethodsAthletes completed baseline concussion tests including Post-Concussion Symptom Scale, Standardised Assessment of Concussion (SAC), modified Balance Error Scoring System (m-BESS), King-Devick test and EYE-SYNC Smooth Pursuits. Testing was repeated in athletes diagnosed acutely with concussion and compared to a matched teammate without concussion.ResultsData were collected on 41 concussed athletes and 41 matched controls. Test–retest reliability for symptom score and symptom severity assessed using control athletes was 0.09 (−0.70 to 0.88) and 0.08 (−1.00 to 1.00) (unweighted kappa). Intraclass correlations were SAC 0.33 (−0.02 to 0.61), m-BESS 0.33 (−0.2 to 0.60), EYE-SYNC Smooth Pursuit tangential variability 0.70 (0.50 to 0.83), radial variability 0.47 (0.19 to 0.69) and King-Devick test 0.71 (0.49 to 0.84). The maximum identified sensitivity/specificity of each test for predicting clinical concussion diagnosis was: symptom score 81%/94% (3-point increase), symptom severity score 91%/81% (3-point increase), SAC 44%/72% (2-point decline), m-BESS 40%/92% (5-point increase), King-Devick 85%/76% (any increase in time) and EYE-SYNC Smooth Pursuit tangential variability 48%/58% and radial variability 52%/61% (any increase). Adjusted area under the curve was: symptom score 0.95 (0.89, 0.99), symptom severity 0.95 (95% CI 0.88 to 0.99), SAC 0.66 (95% CI 0.54 to 0.79), m-BESS 0.71 (0.60, 0.83), King-Devick 0.78 (0.69, 0.87), radial variability 0.47 (0.34, 0.59), tangential variability 0.41 (0.30, 0.54)ConclusionTest–retest reliability of most sideline concussion tests was poor in uninjured athletes, raising concern about the accuracy of these tests to detect new concussion. Symptom score/severity had the greatest sensitivity and specificity, and of the objective tests, the King-Devick test performed best.

Concussions have always been common in sports, but the awareness and associated diagnosis of the condition have been trending upward, gaining significant attention through medical literature, news media, and entertainment. Concussion management in the collegiate athlete is of specific concern, as over 460,000 young adults compete in collegiate athletics annually. The NCAA and other groups have strived to provide consensus guidelines, but many student-athletes still are not being managed as recommended. The return to play process should begin only after a student-athlete is symptom free and has returned to his or her baseline functioning. Return to play should follow a progressive, stepwise approach, using uniform steps that have been established through association recommendations. Returning to academics, or return to learn, often proves to be more challenging, as this process requires a multidisciplinary approach involving academic and administrative representatives in addition to the medical team. As further scientific evidence comes out, is it imperative that professionals providing concussion care remain up-to-date on this ever-evolving topic.