ATHLETIC TRAINERS‟ PERCEPTION OF INTERVAL/INTERMITTENT
TRAINING IN REHABILITATION

A THESIS
Submitted to the Faculty of the School of Graduate Studies and
Research
of
California University of Pennsylvania in partial fulfillment
of the requirements for the degree of
Master of Science

by
Erin Schneider

Research Advisor, Dr. Robert Kane
California, Pennsylvania
2010

ii

iii

ACKNOWLEDGEMENTS

First and foremost I‟d like to thank my thesis chair,
Dr. Robert Kane, and my graduate program director, Dr. Tom
West. Thank you for your patience, time, and guidance
during this entire process. Thank you also to my committee
for your time and patience as well.
To my roommates Sarah (Matera), Jenna(-er), and
Meg(o): Thank you for being there and willing (or not so
willing) to listen when it got rough and for putting up
with the craziness this year.
To my classmates: WE MADE IT! Finally! Ya‟ll rock and
I‟ll miss you as we leave for our separate paths at the end
of the year. The pool dates, the 30 minute “therapy
session” rides to chipotle, being snowed in- twice-,
Lagerhead Adventures and all the other fun times kept me
motivated and laughing.
To my parents and family: thank you for always being
there and supporting me.

iv

TABLE OF CONTENTS

Page
SIGNATURE PAGE

. . . . . . . . . . . . . . . ii

AKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii
TABLE OF CONTENTS
LIST OF TABLES
INTRODUCTION
METHODS

. . . . . . . . . . . . . . iv

. . . . . . . . . . . . . . . vii

. . . . . . . . . . . . . . . . 1

. . . . . . . . . . . . . . . . . . 3

Research Design. . . . . . . . . . . . . . . 3
Subjects

. . . . . . . . . . . . . . . . . 4

Instruments . . . . . . . . . . . . . . . . 4
Procedures. . . . . . . . . . . . . . . . . 5
Hypotheses. . . . . . . . . . . . . . . . . 7
Data Analysis
RESULTS

. . . . . . . . . . . . . . . 7

. . . . . . . . . . . . . . . . . . 10

Demographic Data . . . . . . . . . . . . . . 10
Hypothesis Testing

. . . . . . . . . . . . . 11

Additional Findings . . . . . . . . . . . . . 13
DISCUSSION . . . . . . . . . . . . . . . . . 17
Discussion of Results . . . . . . . . . . . . 17
Conclusions . . . . . . . . . . . . . . . . 21
Recommendations

. . . . . . . . . . . . . . 22

v
REFERENCES . . . . . . . . . . . . . . . . . 23
APPENDICES . . . . . . . . . . . . . . . . . 24
APPENDIX A: Review of Literature
Introduction

. . . . . . . . 25

. . . . . . . . . . . . . . . 26

Interval Training . . . . . . . . . . . . . . 27
Definition . . . . . . . . . . . . . . . 27
Effects on VO2

. . . . . . . . . . . . . 28

Effects on Strength . . . . . . . . . . . 29
Intermittent Training . . . . . . . . . . . . 31
Definition . . . . . . . . . . . . . . . 31
Effects on VO2

. . . . . . . . . . . . . 32

Effects on Strength . . . . . . . . . . . 33
Overall Effectiveness of Interval/Intermittent
Training

. . . . . . . . . . . . . . . . . 34

High Intensity versus Low Intensity Exercise . 35
Interval/Intermittent Training and
Rehabilitation

. . . . . . . . . . . . . . 37

Summary . . . . . . . . . . . . . . . . . . 39
APPENDIX B: The Problem . . . . . . . . . . . . 40
Definition of Terms . . . . . . . . . . . . . 42
Basic Assumptions . . . . . . . . . . . . . . 42
Limitations of the Study . . . . . . . . . . . 43
Significance of the Study. . . . . . . . . . . 43
APPENDIX C: Additional Methods . . . . . . . . . 45

vi
Cover Letter (C1) . . . . . . . . . . . . . . 46
Interval/Intermittent Training Method
Survey (C2). . . . . . . . . . . . . 48
Institutional Review Board (C3 . . . . . . . 54
NATA Student Survey Distribution Form (C4 ). . 68
Follow-Up Email (C5). . . . . . . . . . . . 71
Open-Ended Question Results (C6) . . . . . . 73
REFERENCES. . . . . . . . . . . . . . . . . 84
ABSTRACT . . . . . . . . . . . . . . . . . . 87

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LIST OF TABLES
Table

Title

1

Distribution of Athletic Trainers‟
Credentials . . . . . . . . . . . . . 11

2

A 1 X 4 Chi Square Goodness of Fit
Test to determine the distribution
of athletic trainers‟ familiarity with
interval/intermittent training methods

3

Page

. . 12

Distribution of Benefits . . . . . . . . 16

1

INTRODUCTION

Various forms of high-and low-intensity intermittent
and interval training techniques have been studied and
documented to have some sort of effectiveness in general
fitness training.

The terms “interval” and “intermittent”

have become synonymous1 in that both have defined rest and
work periods.

What makes them different is that while

interval training has “fixed” work and rest periods2,
intermittent training work and rest rates are more varied
(i.e. a 10 second run at 100% intensity, then rest,
followed by a 20 second run at 130% intensity)3.

Both,

however, have been shown to have beneficial effects on
muscular strength gains4,5 and aerobic capacity3,6.
But what about in rehabilitation?

There is very

little to no research that explores the effectiveness of
interval/intermittent training methods in rehabilitation
protocols or even if athletic trainers use
interval/intermittent training methods in those protocols.
Often the goals of rehabilitation include maintaining the
athlete‟s current conditioning and returning the athlete is
as good of condition as they were prior to injury.

This

2
often means maintaining their current aerobic capacity
(VO2).

Some goals also include muscular strength gains.

These two goals are benefits of interval/intermittent
training methods.

If the benefits of interval/intermittent

training match the goals of rehabilitation then it makes
sense that these training methods could be beneficial in
rehabilitation.

The purpose of this study is to discover

if athletic trainers utilize interval/intermittent training
methods in their rehabilitation protocols and if they do
to, how do they use them.

3

METHODS

The primary purpose of this study was to discover if
athletic trainers utilize interval or intermittent training
in their rehabilitation protocols.
the following subsections:

This section includes

research design, subjects,

instruments, procedures, hypotheses, and data analysis.

Research Design

A descriptive design was used for this study.

The

independent variable was interval/intermittent training
methods.

The dependent variables were:

athletic trainers‟

use of interval/intermittent training methods, how they
used these methods (i.e. what kind of equipment did they
use, what conditions they were treating using these
methods, their goals for using interval/intermittent
training methods, and what kind of timing/interval did they
use), athletic trainers‟ perception of the benefits of
interval/intermittent training in rehabilitation protocols,
athletic trainers‟ familiarity of these training methods,
and who used interval/intermittent training methods more-

4
athletic trainers‟ without additional certifications or
athletic trainers with additional certifications (i.e.
CSCS/CPT, PES, ACSM, EMT, etc.)

Subjects

Subjects included certified athletic trainers in
District 2 of the National Athletic Trainers‟ Association
(NATA), where N=952. District 2 encompasses athletic
trainers located in Delaware, Pennsylvania, New Jersey, and
New York.

Informed consent was implied by the completion

of the survey as well as stated prior to the start of the
survey.

The District 2 secretary distributed the survey

via email with a cover letter (Appendix C1) and direct link
to the survey (Appendix C2).

The survey was completed

online; this allowed for respondents‟ email addresses
within District 2 to remain confidential.

Instrumentation

An original survey was created by the researcher to
determine if athletic trainers are familiar with interval
or intermittent training methods and if they utilize those
methods in rehabilitation protocols.

The survey consisted

5
of five questions (Appendix C2).

One question asked

demographic information to determine if athletic trainers
are in a setting that allows them to perform rehabilitation
protocols while another asks what other credentials the
athletic trainer holds.

The rest of the questions asked

athletic trainer‟s opinions on interval/intermittent
training in terms of rehabilitation: how familiar are they
(athletic trainers) with interval/intermittent training
methods, if athletic trainers believe these training
methods could be beneficial in rehabilitation, if they have
used it before in rehab, and if they think they would use
interval/intermittent training methods in their rehab
protocols in the future.

Utilizing the online survey

program, Surveymonkey.com, the data obtained from the
survey was automatically collected by Survey Monkey and
placed into a spreadsheet format for further analysis.

Procedures

Prior to distribution of the survey, a review of the
survey was conducted using a panel of five experts from
California University of Pennsylvania.

This panel reviewed

the survey and provided suggestions for improvements.

The

panel included five certified athletic trainers from the

6
graduate athletic training program.

The researcher then

applied for and obtained Institutional Review Board
(Appendix C3) approval at California University of
Pennsylvania.

Permission from the NATA District 2

secretary to distribute the survey was applied for and
received (Appendix C4). The survey was distributed by
District 2 officials to certified athletic trainers in
District 2 of the National Athletic Trainers‟ Association
(NATA) with a cover letter stating the risks, benefits, and
what the purpose of the survey is, as well as informed
consent.

The researcher was not allowed access to the

email list of athletic trainers within District 2,
therefore, the surveys remained anonymous.

Athletic

trainers invited to complete the survey were given two
weeks to complete the survey.

A follow-up email (Appendix

C5) was sent as a reminder for the athletic trainers at the
beginning of the second week of the survey distribution
period.

It stated to athletic trainers that if they have

already taken the survey, they do not need to take it
again.

After the two week period, the survey closed and

Survey Monkey automatically calculated the results and
placed them in a spread sheet that could be accessed in
SPSS 16.0.

Data analysis was performed after the two week

distribution period.

7

Hypotheses

The following hypotheses are based off a review of the
literature and the intuition of the researcher:
1. Certified Athletic Trainers will be shown to be
vaguely familiar with interval/intermittent training
methods.
2. The majority of certified athletic trainers will be
shown to not use these training methods in their
rehabilitation protocols.
3. Certified Athletic Trainers holding more than just the
certification of an athletic trainer will be found to
use these training methods in their rehabilitation
protocols.
4. Certified Athletic Trainers holding a type of strength
and conditioning credential will be found to use these
interval/intermittent training methods.

Data Analysis

The level of significance was set as α ≤ 0.05.
Hypothesis 1: A 1 (athletic trainer response) X 4
(familiarity with interval/intermittent training methods-

8
Very Familiar, Vaguely-somewhat Familiar, Not Very
Familiar, Interval-what?) Chi Square Goodness of Fit Test
was used to determine the distribution of athletic trainers
familiarity with interval/intermittent training methods.

Hypothesis 2: A descriptive analysis was performed to
determine the percentage of athletic trainers who utilize
interval/intermittent training methods in their
rehabilitation protocols.

Hypothesis 3: A 2 (athletic trainer‟s use of
interval/intermittent training methods in rehabilitationyes/no) X 2 (athletic trainers‟ credentials- No Additional
Credentials/ATC, Additional Credentials/ATC and other) Chi
Square Test Of Independence was used to determine if
athletic trainers with additional credentials were more
likely to use interval/intermittent training methods.

Hypothesis 4: A 2 (athletic trainer‟s use of
interval/intermittent training methods in rehabilitationyes/no) X 2 (athletic trainers who have a fitness/strength
and conditioning credential yes/no) Chi Square Test of
Independence was used to determine if athletic trainers
holding a type of strength and conditioning credential are

9
more likely to use interval/intermittent training methods
in rehabilitation.

If the athletic trainer held a

credential from the ACSM, NSCA, or NASM or indicated that
they held a personal training credential in the “other”
category, then they were determined to have a
“fitness/strength and conditioning credential”.

10

RESULTS

The goal of this study was to determine if athletic
trainers utilize interval/intermittent training techniques
in rehabilitation and if they do, discover how they use
these training techniques via survey.

This section

provides the results of the survey.

Demographic Information

Out of 952 surveys that were sent out, 131 certified
athletic trainers responded, a 13.8% return.

Of those

certified athletic trainers that responded, 87% responded
that they were in settings which allowed them to work with
patients in terms of rehabilitation.

The majority of those

who responded work in a secondary (high school or middle
school) setting at 37.12% or in a college setting at 32.6%
of all responses.

Other settings that the certified

athletic trainers responded that they worked in included:
academic appointments (program director/clinical
instructor) at 4.54%, clinic (outpatient/Physical
therapy/hospital) at 8.33%, professional sports at 3.79%,

11
clinical-high school at 5.30%, other clinical settings at
5.30%.

Four athletic trainers responded that they worked

in multiple settings (at 3.03%).

The certified athletic

trainers who responded had a mean of 11.6 ± 7.0 years of
experience.

Table 1 shows the distribution of athletic

trainers‟ additional credentials.
Table 1. Distribution of Athletic Trainers‟ credentials
Credential
Frequency
Percentage
ACSM (CPT, HFS, CES,
0
0%
RCEP, CET, CIFT,
PAPHS)
NASM (PES, CES)
11
8.4%
NSCA (CSCS, CPT)
8
6.1%
PT/DPT
3
2.3%
PTA
2
1.5%
PA
1
0.8%
None
77
58.8%
Other
20
15.3%
More than 1 Additional
9
6.9%
Credential

Hypothesis Testing

The following hypotheses were tested in this study.
All hypotheses were tested with a level of significance set
at α ≤ 0.05
Hypothesis 1:

A 1 (athletic trainer response) X 4

(familiarity with interval/intermittent training methodsvery familiar, vaguely-somewhat familiar, not very

12
familiar, interval-what?) Chi-Square goodness of fit test
was used to determine the distribution of athletic
trainers‟ familiarity with interval/intermittent training
methods.

A significant interaction was found (X2= 0.00, p<

0.05) (see Table 2). 53.4% of athletic trainers that
responded to the survey indicated that they were “vaguelysomewhat familiar” with interval/intermittent training
methods.
Table 2. A 1 X 4 Chi Square Goodness of Fit Test to
determine the distribution of athletic trainers‟
familiarity with interval/intermittent training methods.
Familiarity
Observed
Percentage
P Value
Very Familiar
43
32.8
0.00
Vaguely-Somewhat
70
53.4
Familiar
Not Very Familiar
15
11.6
Interval-what?
3
2.2

Hypothesis 2:

A descriptive analysis was performed to

determine the percentage of athletic trainers who utilize
interval/intermittent training methods in their
rehabilitations protocols.

It was found that 44.3% of

athletic trainers who responded to the survey have used
interval/intermittent training methods in rehabilitation
while 55.7% of athletic trainers did not.

This supports

the hypothesis two which stated that the majority of
athletic trainers would not use interval/intermittent
training methods in their rehabilitation protocols.

13
Hypothesis 3:

A 2(athletic trainer‟s use of

interval/intermittent training methods in rehabilitationyes/no) X 2 (Athletic Trainers‟ credentials- No Additional
Credentials/ATC, Additional Credentials/ATC and other) Chi
Square Test of Independence was used to determine if
athletic trainers with additional credentials were more
likely to use interval/intermittent training methods.

No

significant relationship was found (X2= .069, p> 0.05).
Hypothesis 4:

A 2 (athletic trainer‟s use of

interval/intermittent training methods in rehabilitationyes/no) X 2 (athletic trainer‟s fitness/strength and
conditioning credential- yes/no) Chi Square Test of
Independence was used to determine if athletic trainers
holding a type of strength and conditioning credential were
more likely to use interval/intermittent training methods
in rehabilitation.

No significant relationship was found

(X2=.078, p> 0.05).

Additional Findings

In addition to the hypothesis testing, athletic
trainers were asked that if they used interval/intermittent
training in their rehabilitation protocols to describe how

14
they used it.

Appendix C6 lists the responses to these

open-ended questions.

Thirty-two point eight percent or 19

out of 58 athletic trainers mentioned that they used
interval/intermittent training methods to rehabilitate ACL
(anterior cruciate ligament) injuries.

Other injuries that

the athletic trainers responded that they treated using
interval/intermittent training methods included: sprains,
strains, stress fractures/stress reactions,
anterior/lateral compartment syndrome, Achilles Tendon
problems, hip labral tears, and shin splints (Appendix C6).
Most athletic trainers responded that the goal of the
interval/intermittent training that they used were to
“improve overall fitness”, improve aerobic capacity,
strength, endurance, and to prepare athletes to return to
play.

For goals that were not met, athletic trainers

stated that it was due to poor patient compliance, pain,
and no improvement in the patient/athlete‟s speed (Appendix
C6).
Athletic trainers who utilized interval/intermittent
training methods reported to use stationary bikes,
treadmills, elliptical, slideboards, jump ropes, BOSUTM ,
swiss/physio balls, tracks (400 m), medicine balls, weight
machines, Pilates, swimming pools, TherabandsTM, plyo-boxes,
DynadisksTM, kettlebells, versa climbers, BAPS board

15
(Biomechanical ankle platform system), etc (Appendix C6).
The interval/intermittent training work: rest ratios that
athletic trainers reported using were: 1:2 up to 1:5, 2:1
at 70% of HR max, fast/slow and high/low intensity, Tabata
training (4 minutes of 20 seconds on/work followed by 10
seconds off/rest), and 3:l.

Most did not specify the

specific intensity/time interval/ rest: work/ work: rest
ratio.
Athletic trainers were asked if they believed
interval/intermittent training was beneficial and if so,
why or why not.

Of the athletic trainers who responded,

93.9% felt that these training methods are beneficial in
rehabilitation protocols.

The athletic trainers indicated

which benefits they believed interval/intermittent training
had on rehabilitation.

Table 3 indicates the distribution

of benefits of the athletic trainers‟ responses.

16
Table 3. Distribution of Benefits
Benefit
Muscular Strength
Aerobic Capacity/VO2
Improvement
Balance/Coordination
Improvement
Improved Proprioception
Muscular Endurance
Improvement
Improved Speed
Improved Agility
Greater ROM
Improved Running/Walking Gait
Other

Frequency
70
93
46
50
94
63
54
26
26
7

Athletic trainers also asked if they would ever use
interval/intermittent training methods in their
rehabilitation protocols in the future; 89.3% indicated
that they would. They were asked to expand as to why they
would or would not use the training methods; answers
included, “they work”, required limited amounts of time, it
was more sport specific, and helped preventing deconditioning of the athlete.
can be found in Appendix C6.

A complete list of responses

17

DISCUSSION

The following section included: 1) Discussion of
Results, 2) Conclusions and 3) Recommendations.

Discussion of Results

This study focused on discovering if certified
athletic trainers used interval/intermittent training
methods in their rehabilitation protocols, and if they did,
how.

The primary findings of this study were that the

majority of certified athletic trainers, at 55.7%, did not
use interval training in their rehabilitation protocol.
This supports hypothesis two.
In terms of hypothesis three, of the athletic trainers
that did have an additional credential other than certified
athletic trainer, 53.7% responded they did use
interval/intermittent training while 46.3% did not.

Of the

athletic trainers that did not hold an additional
credential, 37.7% did use interval/intermittent training
while 62.3% did not.

Of all athletic trainers that did

respond to the survey, 22.1% of athletic trainers held an

18
additional credential and used interval training.
Hypothesis three stated that certified athletic trainers
holding more than just the certification of an athletic
trainer will be found to use these training methods in
their rehabilitation protocols.

While this study did in

fact find that 22.1% of athletic trainers that responded to
the survey held an additional credential and used
interval/intermittent training methods in rehabilitation,
it is not considered to be significant given that P=0.069.
It was also found that 22.1% of athletic trainers that
responded to the survey did not have additional credentials
but did use interval/intermittent training methods in
rehabilitation.

This is interesting because these results

show that having an additional credential in general does
not necessarily predict if the athletic trainer will use
these training methods in rehabilitation.
In addition, this study found that of those athletic
trainers that held a type of strength and conditioning
credential, 58.6% responded that they do use these training
methods in rehabilitation while 41.4 do not.

Of the

athletic trainers that do not hold a type of strength and
conditioning credential, 40.2% responded that they do use
these training methods while 59.8% do.

Overall, 13% of all

athletic trainers that responded both held a type of

19
strength and conditioning credential and used
interval/intermittent training methods in rehabilitation.
While this supports hypothesis three, it was not found to
be significant because P=.078.

It is important to note

however that while the findings were found to not be
significant, trends were still found.

For example, 46.6%

of all athletic trainers that responded to the survey did
not hold a type of strength and conditioning credential and
did not use interval/intermittent training methods.

This

makes sense because athletic trainers holding an additional
strength and conditioning credential theoretically have
more education in areas that include sport performance,
improving fitness, strength training, etc., and
interval/intermittent training methods fall into those
areas, so those athletic trainers that do not have that
additional credential are likely to not have that
additional education and therefore would be less likely to
use these training methods.

It is also unexpected that

this survey found that of all the athletic trainers that
responded, the majority (at 31.3%) did not have an
additional strength and conditioning credential but did use
interval/intermittent training methods in their
rehabilitation protocols.

This means that having a type of

strength and conditioning credential does not necessarily

20
predict whether an athletic trainer will or will not use
these training methods.
The additional findings were especially interesting in
this study. 32.8% of athletic trainers that responded to
the question of what conditions they treated using
interval/intermittent training responded that they treated
ACL reconstruction surgery.

When the researcher went back

to the literature, there was no research indicating that
ACL reconstruction surgery could benefit from this form of
training method.

Literature that indicated that

interval/intermittent training showed benefits in gait
training, or increase/improve ranges of motion was also
very limited.

There is some indication that interval

training can be beneficial to sport specific
proprioception.

In a study using the Canadian Curling

Team, Behm found that interval training was beneficial to
decrease the propriceptive fatigue the curlers experience
during a game/match.7

Quite a few responses indicated that

athletic trainers‟ have use interval/intermittent training
in rehabilitation to help with the return to play process.
This is supported by a study by Axe, Windley, and SnyderMackler.

In their study, they found that interval throwing

programs helped the return to play youth to college
baseball players who suffered injuries.8

21
The data that was collected, though mostly
insignificant, shows a need for further research.
Interval/intermittent training methods can be a useful tool
to athletic trainers who play an integral role in an
athlete‟s rehabilitation process.

It is important for

athletic trainers to share ideas and methods so that
rehabilitation never becomes stagnant.

Conclusions

After reviewing the results of the study, it is
concluded that the majority of the surveyed athletic
trainers are vaguely-somewhat familiar with
interval/intermittent training methods.

The majority of

surveyed athletic trainers also did not utilize these
training methods in their rehabilitation protocols.
While shown as insignificant, athletic trainers
holding more than just the credential of an athletic
trainer were found to utilize these training methods the
same as those who do not have an additional credential.
Athletic trainers who hold a type of strength and
conditioning credential were not more likely to utilize
these training methods than those athletic trainers who did
not have the additional credential.

However, those

22
athletic trainers that did not hold the additional strength
and conditioning credential were less likely to utilize
interval/intermittent training methods.

Recommendations

Further research recommendations for this study
include determining if interval/intermittent training
methods create beneficial effects in terms of gait training
and improving joint ranges of motion.

This would give

valid support to those athletic trainers who responded to
the survey indicating that these training methods benefited
these areas of rehabilitation.

Another possible area for

additional research is to explore the validity that ACL
reconstruction surgeries truly benefit from
interval/intermittent training.

It would also be

beneficial to research the exact effects that
interval/intermittent training has on propriception and
balance.
It is recommended that further education on the
concepts of interval/intermittent training be introduced in
entry level athletic training education programs and
strength and conditioning classes.

23
REFERENCES
1.

Daniels J, Scardina N. Interval training and
performance. Sports Med. 1984; 1(4): 327-334.

2.

Berger NJA, Tolfrey K, Williams AG, Jones AM.
Influence of continuous and interval training on
oxygen uptake on-kinetics. Med Sci Sport Exer. 2006;
38(3): 504-512.

3.

Nourry C, Deruelle F, Guinhouya C, Baquet G, Fabre C,
Bart F, Berthoin S, Mucci P. High-intensity
intermittent running training improves pulmonary
function and alters exercise breathing pattern in
children. Eur J Appl Physiol. 2005; 94(4): 415-423.

4.

Buresh R, Berg K, French J. The effect of resistive
exercise rest interval on hormonal response, strength,
and hypertrophy with training. J Strength Cond Res.
2009; 23(1): 62-71.

5.

Wernborn M, Augustsson J, Thomee R. The influence of
frequency, intensity, volume and mode of strength
training on whole muscle cross-sectional area in
humans. Sports Med. 2007; 37(3): 225-264.

6.

Dolgener FA, Brookes WB. The effects of interval and
continuous training on VO2 max and performance in the
mile run. J Sport Med Phys Fit. 1978; 18(4): 345- 352.

7.

Behm DG. Periodized training program of the Canadian
Olympic Curling Team. Strength Cond J. 2007; 29(3):
24-31.

8.

Axe M, Windley TC, Snyder-Mackler L. Data-based
interval throwing programs for baseball position
players from age 13 to college level. J Sport Rehabil.
2001; 10(4): 267-286.

24

APPENDICES

25

APPENDIX A
Review of Literature

26

REVIEW OF LITERATURE
Introduction

Various strength and conditioning training techniques
are used by active populations for a variety of reasons.
These reasons, or goals, can vary from athletes wanting to
improve performance to an untrained individual merely
wanting to get in shape.

Often, interval training or

intermittent training techniques are used by active
populations to achieve their goals. Research studies have
documented the effectiveness of basic forms of interval1-8 or
intermittent9-15 training in areas of endurance and strength,
however, research is limited in the use of
interval/intermittent training methods in rehabilitation.
The purpose of this review is to discuss the current
research on interval and intermittent training methods and
how they relate to rehabilitation. This will be
accomplished by examining the research on interval
training, intermittent training, and the effects each has
on strength and aerobic capacity (VO2).

27
Interval Training

Definition
Interval training can be defined as exercise that is
performed during pre-determined amounts of time (fixed work
rates), with set, or fixed, rest periods in between
exercise bouts.1,2 For example, Berger et al. performed
research using interval training methods. Subjects were
divided into three groups: two training groups and one
control group. One training group went through a continuous
training program of 30 minute exercise bouts at 60% of
their VO2 peak. The other training group went through an
interval training program of 20 one-minute exercise bouts
at 90% of their VO2 peak, each exercise bout separated by
one-minute of rest. In this study, the defined fixed work
rate for exercise was one minute and the fixed resting
period was also one minute.
In an interval training study performed by Helgerud et
al., four training groups were used, with two performing
interval training. One interval training group had a fixed
work and rest interval of 15 minutes each, while the second
interval training group had a fixed work rate of 4 minutes
and a fixed resting period of 3 minutes.3 It is the
researcher‟s discretion to determine what the interval

28
resting and work rates will be. It is important to note
that the difference between interval training and
intermittent training is that interval training work and
rest periods are consistent where as the training and rest
periods during intermittent training can be varied. A more
thorough definition of intermittent training will be
discussed later.

Effects on VO2
In past studies, interval training has been shown to
improve aerobic capacity (VO2). Using untrained, healthy
subjects, Dolgener et al. found the average improvement in
the 1 mile run was higher for the interval training group
in their study. Both their control group and interval
training group exercised 3 days/week for 50 minutes/day.
The control group participated in a continuous exercise
regimen while the interval training group participated in
220 yard runs at maximum speeds with 220 yard walks in
between.4 In a separate study, it was stated that in well
trained cyclists, increases or improvements in ventilation
thresholds, time trials, VO2 peaks, and resting levels of
pulmonary ventilation were found with the use of varied
types of interval training5.

29
Using moderately trained male athletes, Helgerud et
al. found that the two interval training groups were shown
to have greater improvements in VO2 compared to the
continuous training groups. One interval training group
exercised at a 15/15 interval: 15 seconds of running at 9095% of their heart rate max, followed by 15 seconds of
walking (recovery). The other interval training group
exercised at a 4-minute interval: 4 minutes of running at
90-95% of their heart rate max followed by 3 minutes of
walking (recovery), done 4 times. In conclusion, it seems
as though no matter how long the specific interval,
interval training in general affects positively on VO2.

Effects on Strength
While studies are limited, some research does support
the idea that interval training can be used in resistive
training resulting in improved strength gains. In a study
by Burest et al., 12 untrained men were divided into two
different interval groups. Group 1 exercised at a 1 minute
rest interval while group 2 exercised at a 2.5 minute rest
interval. Each group exercised for 10 weeks with both
groups participating in a resistive training program that
consisted of 3 sets. The intensity was set to where the
third set resulted in failure. Initially, group 1 showed

30
greater improvements, but by the end of the 10 weeks of
training the difference disappeared. Both groups showed
similar decreases in fat-mass and increases in lean body
mass. In another study, 20 firemen participated in a 10
week interval running and circuit weight training program7.
Significant changes in body composition and strength were
found which had the potential to decrease fire department
recruitment dropout rates.
Increases in strength using interval training had not
been limited to males. In a study by Hill-Haas et al, women
were also found to improve in strength gains. 18 women were
randomly assigned a group. Group one participated in a
resistive training program with 20 second rest intervals,
and group 2 participated in resistive training with 80
second rest intervals. The results showed greater
improvements in strength in group one.8
While studies are limited in their scope of research
in regards to strength gains and the use of interval
training, there are a few studies that have shown basic
improvements in untrained men and women. Further research
is necessary to determine if interval training is effective
for trained individuals or elite athletes.

31
Intermittent Training

Definition
Intermittent training is often interchanged with
interval training9. Both are alike in that the actual
configuration (intensity, mode, duration, etc) is to the
researcher‟s discretion. There are no predefined boundaries
or values to which intermittent or interval training are
performed. Also, both consist of a rest period and a work
period (time in which exercise is performed).
Though very similar in nature, intermittent training
is more varied in its structure. While interval training
consists of fixed work rates and resting intervals
(specific “start” and “stop” times) intermittent training
often has varied worked rates at varying intensities. For
example, in a study by Nourry et al., the work rate
consisted of run periods that lasted 10 or 20 seconds with
intensities varying from 100% to 130% of the participant‟s
maximum aerobic speed. The maximum aerobic speed was
determined by a 20 meter shuttle run test that the
participant ran prior to training10.
Intermittent training is also considered to be more
sport-specific in nature compared to interval training.
Sports like soccer and hockey, where athletes usually never

32
start and stop at specific times, are considered more
intermittent in nature11,12. For example, during a soccer
game, it is not likely that a soccer player will run at 90%
of their maximum aerobic capacity (or sprint) for one
minute and jog (or rest) for two minutes and repeat that
process (i.e. interval training). It is more likely that a
soccer player may sprint for 30 seconds, stop for 10, jog
for 20 seconds, and go back to a sprint for 15 seconds
(i.e. intermittent training).

Effects on VO2
Research has indicated that intermittent training can
be effective in improving aerobic capacity (VO2). Nourry et
al. found that prepubescent childrens‟ pulmonary function
was greatly improved in their intermittent test group as
compared to their control, non-training group10. In a
separate study, it was found that when subjects were put
through a supra-maximal exercise regimen, VO2 was improved
as well and participants were able to exercise longer
compared to the amount of time the participants were able
to exercise prior to the exercise regiment13.

33
Effects on Strength
While there is not a lot of research indicating that
strength is affected by intermittent training, it can be
assumed that due to the similar characteristics between
interval training and intermittent training, intermittent
training may have similar effects on strength compared to
interval training. In a systematic review on intensity,
duration, and types of training that influenced strength
gains, it was concluded that most studies of significance
held that a frequency of 3 days/week with a wide range of
intensities were all shown to produce increases in crosssectional areas of muscle.14 Multiple sets of an exercise
(more than 2) were also concluded to increase crosssectional areas of muscle and therefore increase a
subject‟s strength14. It can then be theorized that as long
as the intermittent strength training consists of at least
three days of training per week for at least two weeks and
each exercise is performed with more than two sets at
intensities closer to the subject‟s maximum repetition (1
RM), some sort of strength improvement will be made.

34
Overall Effectiveness of Interval/Intermittent Training

In general, interval/intermittent training has been
found to be effective in improving sport performance16-18 as
well as performance on the job7,19. A study performed by
Krustrup et al., indicated that sport specificity- training
that closely resembles the actual sport- is important to
improve performance. This was found especially important
for sports like soccer; Krustrup et al. found that due to
the high-intensity and intermittent nature of the sport,
the training ought to reflect that same nature16.
Studies have also indicated that interval/intermittent
training can be beneficial to other high-intensity or
intermittent sports. For swimmers, interval training has
shown to improve a swimmer‟s maximum aerobic speed17,
overall work load, and VO217. Improvements in VO2,
ventilation thresholds, and time trials were found in welltrained cyclists who were put through an interval training
program5.
Interval/intermittent training have also proved
beneficial to the work force. As mentioned before, firemen
who were put through an interval training regimen were
found to have improved strength and body composition7. In a
separate study by Marcinik et al., shipmen were divided

35
into two groups: group one consisted of a
circuit/continuous running program while group two
consisted of a circuit/interval running program. It was
found that both improved the mens‟ fitness but in areas of
certain muscular endurance, greater improvements were seen
with the interval training program19.
Both interval training and intermittent training have
been determined to be valid forms of training. Research has
shown that both can produce desirable effects in regards to
fitness and performance.

High Intensity versus Low Intensity Exercise

It is important to understand that different kinds of
training can influence different kinds of changes, and
therefore it is important to understand the kinds of
changes that are trying to be influenced in this study. In
terms of training, intensity can play a vital role in
determining what kind of fitness is achieved (i.e. strength
versus endurance). Studies vary their definitions as to
what exactly determines an exercise as high or low
intensity. One study determined a high intensity at 80-85%
of the subject‟s VO2 maximum and a low intensity at 45% of
the subject‟s VO2 maximum.20 Other studies have determined

36
high-intensity exercise to be at 125-170% of a subject‟s
VO2 maximum13,

15

or 80-95% of a subject‟s heart rate

maximum.3
No matter the specific definitions of high- and lowintensity exercise, it is generally agreed that high
intensity exercise influences more of the body‟s anaerobic
systems, and low-intensity exercise influences more of the
body‟s aerobic energy systems.13,

15, 30

Research has also

found that there is some cross over in regards to high- and
low- intensity training. In a study performed by Tanaka and
Swensen (1998), swimmers who performed a sport-specific
resistive training (high intensity) program along with
their swimming regimen (low intensity) were found to have
improved their velocity in the water.21 The study also
indicated that general resistive training in conjunction
with aerobic training benefited performance with cyclists
and runners.21
This crossover between anaerobic and aerobic energy
systems is due to the fact that the body never shuts off
one system completely when the other is being worked.22,23
Without going into an in-depth explanation into the
physiology of the body and to put it simply, once the
energy has been tapped out of the anaerobic energy system,
the body then takes from the aerobic energy system or vice

37
versa.22,23,24 In this study, even though the training
regiment is high-intensity in nature and therefore
anaerobic, it is expected that there will be some cross
over effect due to the mechanisms mentioned.

Interval/Intermittent Training and Rehabilitation

Interval or intermittent training methods are not well
documented in rehabilitation protocols. This could be due
to the fact that often, rehabilitation protocols are up to
the health care practitioner‟s- physical therapists,
athletic trainers, etc- imagination or creativity. This
makes it hard to document all of the rehabilitation
exercises or protocols that athletic trainers use,
especially when often exercises that are documented are
called different things in different regions.
While there remains little documentation or evidence
of interval/intermittent training methods in rehabilitation
protocols, there is some evidence that
interval/intermittent training can prevent injuries.25 In
one study on Australian football players, it was found that
those who had participated in an aerobic interval training
program sustained fewer hamstring tears than those who did
not.26 In another study performed with soccer players,

38
researchers found that the intermittent nature of soccer
causes an increase in fatigue in the hamstrings due to the
constant changes in speed and that eccentric strength is
not reacquired during the resting state of the half time
interval.27 It was therefore suggested that eccentric
hamstring strength at high speeds along with resistance
exercises in a fashion that would resemble soccer specific
and game specific patterns (i.e. a type of intermittent
training) should be a part of the conditioning program for
soccer players.27
It is logical to think that if there is evidence that
states that interval/intermittent training can prevent
injury, then interval/intermittent training can be
beneficial in rehabilitation. So the question of this study
is this: if interval/intermittent training methods have
been shown to have beneficial effects in strength and
endurance training as well as beneficial effects in the
prevention of some types of injuries, could
interval/intermittent training methods also be beneficial
in the treatment (i.e. in the rehabilitation) of injuries?

39
Summary

Research has shown that interval/intermittent training
methods can be effective in terms of muscular strength
gains6,7,14

and improvements in aerobic capacity4,5,10.

However, there is little to no evidence that explores if
interval/intermittent training methods have been used in
rehabilitation protocols.
From an athletic trainer‟s point of view, it is often
the goal of later stages of rehabilitation to make sure
that the athlete is as strong as they (the athlete) were
prior to the injury, if not stronger or in better shape.
This means that muscular strength gains and improved
aerobic capacity are often sought. If the goals of
rehabilitation are the same as the beneficial effects of
interval/intermittent training, why not use these training
methods in rehabilitation? It is therefore the purpose of
this study to discover if athletic trainers utilize
interval or intermittent training in their rehabilitation
protocols.

40

APPENDIX B
The Problem

41
THE PROBLEM

Statement of the Problem
Various forms of high-and low-intensity intermittent
training techniques have been studied and documented to
have some sort of effectiveness in general fitness
training. But what about in rehabilitation? There is very
little to no research that explores the effectiveness of
interval/intermittent training methods in rehabilitation
protocols or even if athletic trainers use
interval/intermittent training methods in those protocols.
Often the goal of a rehabilitation protocol is to increase
range of motion, increase muscular strength/endurance, etc.
Interval/intermittent training methods have been shown to
have beneficial effects in terms of muscular strength
gains6,7,14 and improvements in aerobic capacity4,5,10. So if
interval/intermittent training methods have already been
shown to have improvements in the same goals as
rehabilitation, why not use interval/intermittent training
methods in those protocols? That is the purpose of this
study: to discover if athletic trainers use
interval/intermittent training methods in their
rehabilitation protocols and if so, how.

42

Definition of Terms
To have a better understanding of this study, it is
necessary to operationally define some terms. These terms
are used throughout the study and will be defined as they
pertain to this study:
1.

Untrained: individuals who have are not currently or
just started training for less than two months.

2.

Rehabilitation Protocol: prescribed exercises given to
a patient/client/athlete to improve neuromuscular
function after an injury

3.

Strength: the maximal force a muscle/muscle group can
generate at a specified velocity.22

4.

Aerobic Capacity: also known as VO2

max

(maximal oxygen

uptake); the greatest amount of oxygen that can be
used at the cellular level of the body. It is the most
accepted and widely used measure of cardio-respiratory
fitness.

22

Basic Assumptions
The following are basic assumptions that the
researcher is making:
1.

Readers of this study have a basic knowledge of
exercise physiology and energy systems.

43
2.

The subjects will answer honestly and to the best of
their knowledge.

3.

The survey will have face validity after review by a
panel of experts.

4.

Subjects will not receive outside help from any other
individual or from an outside source on any question.

Limitations of the Study
The following are possible limitations of the study:
1.

The response rate of the survey could be low due to
busy schedules of the athletic trainers.

2.

As with all anonymous surveys, answers may not be
answered honestly by the subjects.

3.

Incorrect names or email addresses of certified
athletic trainers could be included in the list serve.

Significance of the Problem
Athletic trainers should have basic knowledge of
interval/intermittent training methods, however, whether
they use-or thought to use- these methods is the question.
Athletic trainers are always in search of new or different
ways to make their rehabilitation protocols creative and
less monotonous. Based off the intuition of the researcher,
it is believed that most athletic trainers have not thought

44
to use interval/intermittent training methods in later
stages of rehabilitation.
It is important to explore why athletic trainers have
chosen to not use these methods because using
interval/intermittent training methods can be useful and
beneficial to the athlete. It is also important to explore
how athletic trainers do use these training methods because
for some, especially those newly certified, it may never
cross their minds that interval/intermittent training
methods can be used in rehabilitation. To put it simply, it
is important to share ideas, especially good ideas. An
athletic trainer can never have too many options in terms
of ideas for rehabilitation.

45

APPENDIX C
Additional Methods

46

APPENDIX C1
Cover Letter

47

2/25/2010
Dear Fellow Certified Athletic Trainer:
My name is Erin Schneider and I am currently a graduate student at California University
of Pennsylvania pursing a Master of Science in Athletic Training. Part of the graduate
study curriculum is to complete a research thesis through conducting research. I am
conducting survey research to determine if athletic trainers use interval or intermittent
training techniques in their rehabilitation protocols. The goal of the information provided
in the survey is to share ideas as to how other athletic trainers have used
interval/intermittent training methods in their rehabilitation protocols.
Certified athletic trainers’ in the National Athletic Trainers’ Association District 2 are
being asked to participate; however, your participation is voluntary and you do have the
right to choose not to participate. You also have the right to discontinue participation at
any time during the survey completion process at which time your data will be discarded.
The California University of Pennsylvania Institutional Review Board has reviewed and
approved this project. The approval is effective 03/04/10 and expires 03/04/11.
All survey responses are anonymous and will be kept confidential, and informed consent
to use the data collected will be assumed upon return of the survey. Aggregate survey
responses will be housed in a password protected file on the CalU campus. Minimal risk
is posed by participating as a subject in this study. I ask that you please take this survey
at your earliest convenience as it will take approximately 15 minutes to complete. If you
have any questions regarding this project, please feel free to contact the primary
researcher, Erin Schneider at sch5405@calu.edu. You can also contact the faculty
advisor for this research, Dr. Robert Kane ATC, PT at 724-938-4562 or kane@calu.edu.
Thanks in advance for your participation. Please click the following link to access the
survey http://www.surveymonkey.com/s/athletictrainersperspective.
Thank you for taking the time to take part in my thesis research. I greatly appreciate your
time and effort put into this task.
Sincerely,
Erin Schneider ATC, CSCS
Primary Researcher
California University of Pennsylvania
250 University Ave
California, PA 15419
(571)228-0886
Sch5405@calu.edu

48

Appendix C2
Interval/Intermittent Training Method Survey

49

1. Informed Consent
33%

Purpose of this study: to discover athletic trainers’ perception
of interval/intermittent training methods in rehabilitation
protocols.
Procedure: You will be asked to answer a series of questions
regarding your opinion on interval/intermittent training
methods. No identifying characteristics will be asked of you.
Duration: 10-15 minutes
Confidentiality: Your participation as well as the information
you provide in the survey will be kept confidential. All answers
to the survey will be anonymous in that identifiers will not be
used in the data collected. Your confidentiality will be kept to
the degree permitted by the technology used. No guarantees
can be made regarding the interception of data sent via the
Internet by any third parties.
Right to ask questions: Please contact Erin Schneider at
(571)228-0886 or at sch5405@calu.edu or Dr. Robert Kane at
kane@calu.edu or at (724)938-4562 with any questions or
concerns regarding the study.
Participation: Participation is completely voluntary. If you wish
to not finish, or not answer any of the questions, simply close
the browser. There will be no penalty for discontinuing
participation in the study and the information you did provide
will be discarded.
Risks and Benefits: There is no anticipated risk nor benefit to
you by participation in this study.
It is implied that if you click NEXT, you have read the above
information and are agreeing to the informed consent. If you
DO NOT wish to participate in the study, simply close out of
the browser.
Next

50

2. Survey
67%

*
1. Are you in a setting that allows you to work with (in terms of
rehabilitation) patients/clients/athletes?
Yes
No

*
2. Indicate which kind of setting you PRIMARILY work in:
Secondary School (high school/middle school)
College/University
Dual Appointment (clinical/teaching)
Academic appointment (i.e. Program director/ clinical coordinator,
professor, etc)
Occupational /Industrial/ Business
Clinic (Outpatient/Physical Therapy/ Hospital)
Professional Sports
Youth Sports
Military
Clinical-High School
Other (please specify)

*
3. How long have you been a Certified Athletic Trainer (ATC)?

In years

*

51
4. What other certifications do you have?
ACSM
NASM
CSCS/CPTPT/DPT
(CPT,
(PES,
HFS, CES, CES)
RCEP,
CET,
CIFT,
PAPHS)

PTA

PA

None

Other (please specify)

*
5. How would you rank your familiarity with
interval/intermittent training?
Very familiar
Vaguely-somewhat familiar
Not very Familiar
Interval-what?

*
6. Do you feel that interval/intermittent training can be
beneficial in a rehabilitation protocol?
Yes
No
7. If you said “yes” please indicate which you feel is a potential
benefit (Mark all that apply):
Muscular strength gains
Aerobic Capacity/VO2 improvement
Balance/Coordination improvement
Improved proprioception
Muscular endurance improvements
Improved speed
Improved agility
Greater Ranges of Motion
Improved Running/Walking Gait

52
Other (please specify)

*
8. Have you used interval or intermittent training in a
rehabilitation protocol?
Yes
No
If you said “yes” please answer questions 9-15. If you said “no” please
skip to question 16.
9. What injury/condition(s) were you treating?

10. For each injury/condition that you listed, what was the goal
of the rehabilitation protocol that utilized interval/intermittent
training? (i.e. improving aerobic capacity/fitness, increase
strength, increase ROM etc.)

11. For each condition, did you achieve the stated goal?
Yes
No
12. For each condition/injury that you did NOT achieve the
stated goal, please describe why the goal was not achieved:

13. What kind(s) of equipment did you utilize in each case?
(i.e. bike, BOSU, treadmill, swiss ball, etc.)

14. What kind of interval/intermittent training technique did
you use in each case? (i.e. rest: work interval, intensity: time
interval, etc)

53
15. What were the specifics of your interval/intermittent
training technique that are not already mentioned above?

*
16. Do you feel you would ever use interval/intermittent
training methods in your rehab protocols in the future?
Yes

No

Why or Why not?
Prev

Next

54

Appendix C3
Institutional Review Board

55
Proposal Number
Date Received

PROTOCOL for Research
Involving Human Subjects

Institutional Review Board (IRB) approval is required before
beginning any research and/or data collection involving human subjects

(Reference IRB Policies and Procedures for clarification)

Project Title Athletic Trainers’ Perspective of Interval/Intermittent Training in Rehabilitation
Researcher/Project Director

Erin Schneider

Phone # 571-228-0886

E-mail Address sch5405@calu.edu

Faculty Sponsor (if required) Dr. Robert Kane
Department Health Science
Project Dates January 1, 2010 to December 1, 2010
Sponsoring Agent (if applicable)
Project to be Conducted at California University of Pennsylvania, Herron Hall
Project Purpose:

Thesis

Research

Class Project

Keep a copy of this form for your records.

Other

56
Please attach a typed, detailed summary of your project AND complete items 2
through 6.
1. Provide an overview of your project-proposal describing what you plan to do and how you
will go about doing it. Include any hypothesis(ses)or research questions that might be
involved and explain how the information you gather will be analyzed. For a complete list of
what should be included in your summary, please refer to Appendix B of the IRB Policies and
Procedures Manual.
The purpose of this study is to discover if athletic trainers utilize interval/intermittent training
methods in their rehabilitation protocols. Subjects will include certified athletic trainers in the
National Athletic Trainers' Association District 2- PA, NJ, NY, and DE- where N=1000. The
study will utilize a survey (attached) and it will be distributed electronically through Survey
Monkey. The District 2 secretary will distribute the survey to the athletic trainers so that
athletic trainers who participate will remain anonymous and confidential. In the distributing
email, a cover letter (attached) is attached stating the purpose, risk, benefits, researcher
contact information, a direct link to the survey, and other information pertaining to the study.
Upon clicking on the link in that cover letter, the first page the subject will see is an informed
consent (attached) that again states the risks, benefits, researcher information, the rights of the
subject, etc. By clicking "next" and completing the survey, informed consent will be implied.
The subject can also close out of the browswer to exit out of the survey.
The following hypotheses will be addressed in the survey:
1. Certified Athletic Trainers will be shown to be vaguely familiar with
interval/intermittent training methods
2. The majority of certified athletic trainers will be shown to not use these training
methods in their rehabilitation protocols
3. Certified Athletic trainers holding more than just the certification of an athletic trainer
will be found to use these training methods in their rehabilitation protocols
4. Certified Athletic Trainers holding more than just the certification of an athletic trainer
will find more benefits in the usage of interval/intermittent training methods
The survey will address these hypotheses by asking if the Certified Athletic Trainer: what
other certifications the subjects holds, if they use interval/intermittent training methods in
their rehabilitation protocols, if they do, how have they used it, and if they find these training
methods beneficial, and if so, what benefits. (The survey is attached).

2. Section 46.11 of the Federal Regulations state that research proposals involving human
subjects must satisfy certain requirements before the IRB can grant approval. You should
describe in detail how the following requirements will be satisfied. Be sure to address each
area separately.
a. How will you insure that any risks to subjects are minimized? If there are potential
risks, describe what will be done to minimize these risks. If there are risks, describe
why the risks to participants are reasonable in relation to the anticipated benefits.
All subject responses will remain anonymous. All responses are the opinion of the
subjects.

57
b. How will you insure that the selection of subjects is equitable? Take into account
your purpose(s). Be sure you address research problems involving vulnerable
populations such as children, prisoners, pregnant women, mentally disabled persons,
and economically or educationally disadvantaged persons. If this is an in-class
project describe how you will minimize the possibility that students will feel coerced.
All subjects will be volunteers and over the age of 18. No vulnerable populations will
be sought out.
c. How will you obtain informed consent from each participant or the subject’s legally
authorized representative and ensure that all consent forms are appropriately
documented? Be sure to attach a copy of your consent form to the project summary.
Each subject will be emailed with an informational cover letter stating the purpose,
risks, and benefits of the study. By completing the survey, informed consent is
implied, however the first page of the survey is an informed consent form where the
purpose, who's asked to participate, the benefits, risks, researcher contact
information, etc, is again stated and the subject is required to click "next" to continue
on to the survey or close out of the browser to leave the survey.
d. Show that the research plan makes provisions to monitor the data collected to insure
the safety of all subjects. This includes the privacy of subjects’ responses and
provisions for maintaining the security and confidentiality of the data.
Data will be collected during the spring semester. Responses to the survey will be
kept in a secure location that is only accessible to the researcher and research advisor.
3. Check the appropriate box(es) that describe the subjects you plan to use.

Adult volunteers

Mentally Disabled People

CAL University Students

Economically Disadvantaged People

Other Students

Educationally Disadvantaged People

Prisoners

Fetuses or fetal material

Pregnant Women

Children Under 18

Physically Handicapped People

Neonates

4. Is remuneration involved in your project?
5. Is this project part of a grant?

Yes or

Yes or
No

No. If yes, Explain here.

If yes, provide the following information:

Title of the Grant Proposal
Name of the Funding Agency
Dates of the Project Period
6.

Does your project involve the debriefing of those who participated?

Yes or

No

58
If Yes, explain the debriefing process here.
7. If your project involves a questionnaire interview, ensure that it meets the requirements of
Appendix
in the Policies and Procedures Manual.

59
California University of Pennsylvania Institutional Review Board
Survey/Interview/Questionnaire Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview or questionnaire?
YES—Complete this form
NO—You MUST complete the “Informed Consent Checklist”—skip the remainder
of this form
Does your survey/interview/questionnaire cover letter or explanatory statement include:
(1) Statement about the general nature of the survey and how the data will be
used?
(2) Statement as to who the primary researcher is, including name, phone, and
email address?
(3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact information
provided?
(4) Statement that participation is voluntary?
(5) Statement that participation may be discontinued at any time without penalty
and all data discarded?
(6) Statement that the results are confidential?
(7) Statement that results are anonymous?
(8) Statement as to level of risk anticipated or that minimal risk is anticipated?
(NOTE: If more than minimal risk is anticipated, a full consent form is required—and
the Informed Consent Checklist must be completed)
(9) Statement that returning the survey is an indication of consent to use the data?
(10) Who to contact regarding the project and how to contact this person?
(11) Statement as to where the results will be housed and how maintained? (unless
otherwise approved by the IRB, must be a secure location on University premises)
(12) Is there text equivalent to: “Approved by the California University of
Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and
expires mm/mm/mm”? (the actual dates will be specified in the approval notice from
the IRB)?

60
(13) FOR ELECTRONIC/WEBSITE SURVEYS: Does the text of the cover letter
or
explanatory statement appear before any data is requested from the participant?
(14) FOR ELECTONIC/WEBSITE SURVEYS: Can the participant discontinue
participation at any point in the process and all data is immediately discarded?

61
California University of Pennsylvania Institutional Review Board
Informed Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview, or questionnaire?
YES—DO NOT complete this form. You MUST complete the
“Survey/Interview/Questionnaire Consent Checklist” instead.
NO—Complete the remainder of this form.
1. Introduction (check each)
(1.1) Is there a statement that the study involves research?
(1.2) Is there an explanation of the purpose of the research?
2. Is the participant. (check each)
(2.1) Given an invitation to participate?
(2.2) Told why he/she was selected.
(2.3) Told the expected duration of the participation.
(2.4) Informed that participation is voluntary?
(2.5) Informed that all records are confidential?
(2.6) Told that he/she may withdraw from the research at any time without
penalty or loss of benefits?
(2.7) 18 years of age or older? (if not, see Section #9, Special Considerations
below)
3. Procedures (check each).
(3.1) Are the procedures identified and explained?
(3.2) Are the procedures that are being investigated clearly identified?
(3.3) Are treatment conditions identified?
4. Risks and discomforts. (check each)
(4.1) Are foreseeable risks or discomforts identified?
(4.2) Is the likelihood of any risks or discomforts identified?
(4.3) Is there a description of the steps that will be taken to minimize any risks or
discomforts?
(4.4) Is there an acknowledgement of potentially unforeseeable risks?
(4.5) Is the participant informed about what treatment or follow up courses of
action are available should there be some physical, emotional, or psychological harm?
(4.6) Is there a description of the benefits, if any, to the participant or to others
that may be reasonably expected from the research and an estimate of the likelihood
of these benefits?
(4.7) Is there a disclosure of any appropriate alternative procedures or courses of
treatment that might be advantageous to the participant?
5. Records and documentation. (check each)

62
(5.1) Is there a statement describing how records will be kept confidential?
(5.2) Is there a statement as to where the records will be kept and that this is a
secure location?
(5.3) Is there a statement as to who will have access to the records?

63
6. For research involving more than minimal risk (check each),
(6.1) Is there an explanation and description of any compensation and other
medical or counseling treatments that are available if the participants are injured
through participation?
(6.2) Is there a statement where further information can be obtained regarding the
treatments?
(6.3) Is there information regarding who to contact in the event of researchrelated injury?
7. Contacts.(check each)
(7.1) Is the participant given a list of contacts for answers to questions about the
research and the participant’s rights?
(7.2) Is the principal researcher identified with name and phone number and
email address?
(7.3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact
information provided?
8. General Considerations (check each)
(8.1) Is there a statement indicating that the participant is making a decision
whether or not to participate, and that his/her signature indicates that he/she has
decided to participate having read and discussed the information in the informed
consent?
(8.2) Are all technical terms fully explained to the participant?
(8.3) Is the informed consent written at a level that the participant can understand?
(8.4) Is there text equivalent to: “Approved by the California University of
Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and
expires mm/mm/mm”? (the actual dates will be specified in the approval notice from
the IRB)
9. Specific Considerations (check as appropriate)
(9.1) If the participant is or may become pregnant is there a statement that the
particular treatment or procedure may involve risks, foreseeable or currently
unforeseeable, to the participant or to the embryo or fetus?
(9.2) Is there a statement specifying the circumstances in which the participation
may be terminated by the investigator without the participant’s consent?
(9.3) Are any costs to the participant clearly spelled out?
(9.4) If the participant desires to withdraw from the research, are procedures for
orderly termination spelled out?
(9.5) Is there a statement that the Principal Investigator will inform the participant
or any significant new findings developed during the research that may affect them
and influence their willingness to continue participation?
(9.6) Is the participant is less than 18 years of age? If so, a parent or guardian must
sign the consent form and assent must be obtained from the child
Is the consent form written in such a manner that it is clear that the
parent/guardian is giving permission for their child to participate?

64
Is a child assent form being used?
Does the assent form (if used) clearly indicate that the child can freely refuse
to participate or discontinue participation at any time without penalty or coercion?
(9.7) Are all consent and assent forms written at a level that the intended
participant can understand? (generally, 8th grade level for adults, age-appropriate for
children)

65
California University of Pennsylvania Institutional Review Board
Review Request Checklist (v021209)
This form MUST accompany all IRB review requests.
Unless otherwise specified, ALL items must be present in your review request.
Have you:
(1.0) FOR ALL STUDIES: Completed ALL items on the Review Request Form?
Pay particular attention to:
(1.1) Names and email addresses of all investigators
(1.1.1) FOR ALL STUDENTS: use only your CalU email
address)
(1.1.2) FOR ALL STUDENTS: Name and email address of your
faculty research advisor
(1.2) Project dates (must be in the future—no studies will be approved
which have already begun or scheduled to begin before final IRB approval—
NO EXCEPTIONS)
(1.3) Answered completely and in detail, the questions in items 2a through
2d?
2a: NOTE: No studies can have zero risk, the lowest risk is
“minimal risk”. If more than minimal risk is involved you MUST:
i. Delineate all anticipated risks in detail;
ii. Explain in detail how these risks will be minimized;
iii. Detail the procedures for dealing with adverse outcomes
due to these risks.
iv. Cite peer reviewed references in support of your
explanation.
2b. Complete all items.
2c. Describe informed consent procedures in detail.
2d. NOTE: to maintain security and confidentiality of data, all
study records must be housed in a secure (locked) location ON
UNIVERSITY PREMISES. The actual location (department, office,
etc.) must be specified in your explanation and be listed on any
consent forms or cover letters.
(1.4) Checked all appropriate boxes in Section 3? If participants under the
age of 18 years are to be included (regardless of what the study involves) you
MUST:
(1.4.1) Obtain informed consent from the parent or guardian—
consent forms must be written so that it is clear that the
parent/guardian is giving permission for their child to participate.
(1.4.2) Document how you will obtain assent from the child—
This must be done in an age-appropriate manner. Regardless of
whether the parent/guardian has given permission, a child is
completely free to refuse to participate, so the investigator must
document how the child indicated agreement to participate
(“assent”).

66
(1.5) Included all grant information in section 5?
(1.6) Included ALL signatures?
(2.0) FOR STUDIES INVOLVING MORE THAN JUST SURVEYS,
INTERVIEWS, OR QUESTIONNAIRES:
(2.1) Attached a copy of all consent form(s)?
(2.2) FOR STUDIES INVOLVING INDIVIDUALS LESS THAN 18
YEARS OF AGE: attached a copy of all assent forms (if such a form is used)?
(2.3) Completed and attached a copy of the Consent Form Checklist? (as
appropriate—see that checklist for instructions)
(3.0) FOR STUDIES INVOLVING ONLY SURVEYS, INTERVIEWS, OR
QUESTIONNAIRES:
(3.1) Attached a copy of the cover letter/information sheet?
(3.2) Completed and attached a copy of the
Survey/Interview/Questionnaire Consent Checklist? (see that checklist for
instructions)
(3.3) Attached a copy of the actual survey, interview, or questionnaire
questions in their final form?
(4.0) FOR ALL STUDENTS: Has your faculty research advisor:
(4.1) Thoroughly reviewed and approved your study?
(4.2) Thoroughly reviewed and approved your IRB paperwork? including:
(4.2.1) Review request form,
(4.2.2) All consent forms, (if used)
(4.2.3) All assent forms (if used)
(4.2.4) All Survey/Interview/Questionnaire cover letters (if used)
(4.2.5) All checklists
(4.3) IMPORTANT NOTE: Your advisor’s signature on the review request
form indicates that they have thoroughly reviewed your proposal and verified
that it meets all IRB and University requirements.
(5.0) Have you retained a copy of all submitted documentation for your records?

67

Institutional Review Board
California University of Pennsylvania
Psychology Department LRC, Room 310
250 University Avenue
California, PA 15419
instreviewboard@cup.edu
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair

Erin Schneider,
Please consider this email as official notification that your proposal titled “Athletic
Trainers’ Perspective of Interval/Intermittent Training in Rehabilitation”
(Proposal #09-064) has been approved by the California University of
Pennsylvania Institutional Review Board as submitted.
The effective date of the approval is 3-4-2010 and the expiration date is 3-42011. These dates must appear on the consent form .
Please note that Federal Policy requires that you notify the IRB promptly regarding
any of the following:
(1) Any additions or changes in procedures you might wish for your study
(additions or changes must be approved by the IRB before they are
implemented)
(2) Any events that affect the safety or well-being of subjects
(3) Any modifications of your study or other responses that are necessitated
by any events reported in (2).
(4) To continue your research beyond the approval expiration date of 3-42011 you must file additional information to be considered for
continuing review. Please contact instreviewboard@calu.edu

Please notify the Board when data collection is complete.
Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board

68

Appendix C4
NATA District 2 Survey Distribution Form

69

70

71

Appendix C5
Survey Follow-Up Email

72

Follow- Up Email
Dear Fellow Athletic Trainer:
My name is Erin Schneider and I am a graduate student at
California University of Pennsylvania and this is a followup email for my survey titled “Athletic Trainers‟
Perspective of Interval/Intermittent Training Methods in
Rehabilitation”. If you have already taken the survey,
thank you so much and please disregard this email. If you
have not taken the survey, this is a kind reminder that the
survey is still available for you to take until March 29,
2010. If you chose to take the survey, please follow the
link:
http://www.surveymonkey.com/s/athletictrainersperspective.
If you have any questions about the study please feel free
to contact me at (571)228-0886 or at sch5405@calu.edu.
Thank you for your time, and I hope you have a great day!
Sincerely,
Erin Schneider ATC, CSCS
California University of Pennsylvania
Graduate Student

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Appendix C6
Open-Ended Question Results

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Open Ended Question Results/Responses
The following are athletic trainers‟
answers/responses to the open-ended questions in the
survey.
Question 9: Injury/Condition being Treated
Quadriceps strain
all injuries
All types, mostly LE
ACl post op
acl repair
Lower extremity injuries(spains ,stress reactions,over
use injuries)
Grade 3 ankle sprain
ACL Rehabilitation, Bliateral Anterior/Lateral
Compartment Syndrome Repair
Shin splints
ACLs, Ankles, Achilles, Hip labral repairs
lower extremity
low back injuries
Lower extremity; grade II muscle strain; ACL repair
all
Knee, ankle, Low back
ACLR; Hamstring/Groin Injuries
Knee Sprains, Muscle Strains, Most lower leg strains
and sprains
acl repair, post surgical
post-op lower extremities
lower leg stress fracture
Muscle strains, ligament sprains
lower extremity
musculoskeletal injury--preparing for return-to-play
after deconditioning
Lower Extremity
Strains/sprians, muscle imbalances
sprains/strains
muscles strains or sprains
ACL Reconstruction, UCL Reconstruction, Instability of
shoulder
post surgical ACL
Lower Leg Muscle Strain
Fractures, post-ops (ACL, shoulder reconstructions),
hamstrings strains
knee injuries
ACL reconstruction
Ankle sprains, knee sprain, hamstring/quadriceps
strains
stress fractures
ACL reconstruction, multidirectional shoulder

75
instability
Ankle Sprain/Strains; Thigh Strains.
Muscle strains/ACL rehab
any legs injury, upper body injuries
soft tissue injuries of upper and lower extremity
hamstring, quad
hamstring strain
Track/Running Injuries
ACL-R, ankle reconstruction, Arthroscopic knee
ankle sprains, muscle strains, knee ligament sprains,
shoulder sprains/strains
strains, general weakness
low back strain
upper and lower extremities
hamstring strains, post acl/r
ACL reconstruction
ankle and knee injuries
Lower Body...HS/quad/calf strains
Various Upper and Lower Extremity Conditions
ACL and MCL surgery
Acl reconstruction
acl, pcl, shoulder
musculoskeletal
Question 10: Goal of the Treatment
improve anaerobic and/or aerobic capacity/fitness, muscular strength and
endurance
Improve overall fitness prior to sport specific activity
aerobic fitness
Return to play/work
Increased strength and agility
all of the above trying to get back to competition
Cross training for fitness/aerobic/endurance/strength
improving aerobic capacity, increase lower extremity strength
Improving aerobic capacity and increased muscular strength and speed
Improve fitness, speed
Improving fitness, promoting seamless return to sport
fitness to return from sugery, ACL sports spec. activities
increase strength, increase ROM
Gaining functional endurance, strength for RTP
maintain fitness
improve aerobic capacity, increase endurance
Improve overall fitness; break monotony of rehab; increase strength;
increase functionality
improving aerobic capacity
Build strength, maintain aerobic ability while rehabing injury, increase ROM
and flexibility
return to play training. endurance
increase fitness
improving CV endurance through gradual loading

76
increasing strength, proprioception
general reconditioning, propioception, coordination, balance
improving aerobic capacity/fitness
increase strength, proprioception, agility, CV
Strengthening, proprioception and increased fitness
increased strength, increased muscular endurance
improving aerobic capacity
Improving balance, coordination, proprioception, musclular strength and
agility and speed
increase conditioning, improve gait, increase muscular strength
Improved Aerobic and increase muscle endurance
all of the above
aerobic, sport-specific activities
Increase muscular strength/endurance
Improve aerobic fitness, progress to sports specific training and return to
full activity
improving aerobic capacity/fitness
increasing aerobic capacity
prep for RTP.
Increase strength, muscle endurance, propioception
improved fitness, strength
Improve or maintain CV fitness, improve muscular endurance and coordination
for quick changes in position or direction on the field or court.
trp
Increase strength and endurance
Increase strength, endurance, better overall running gait, muscular and
anaerobic improvements
improving aerobic capacity and muscular endurance
maintain/improve sport-specific muscular endurance demands in anticipation
of return to play
increased strength, endurance
increase strentgth
to progress fitness capacity as well as maintain body characteristics and
transition
increase strength and endurance
Increase strength, speed, agility, confidence in knee
improve aerobic capacity and return to play
Return to sport prep
Condition Dependent - Based on Individual Needs of the Patient
strength and ROM
increased strength,increase power, increases aerobic capacity
improving aerobic capacity
increased ROM, strength, endurance

Question 13: Equipment used
bike, treadmill, elliptical, slideboard, jump-rope, bosu, swiss ball, etc
HR monitor, Bike, 400-meter track, swiss ball, medicine ball
bike, treadmill
Cardio, BOSU, Med Ball,
bike, treadmill bosu cones

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bike ,elliptical,bosu,fitter,rope weight eq and track
Stationary bike/eliptical/treadmill/weight machines/bosu gym ball/ mat
exercise/pilates ex.
Bike
Bike, Treadmill, synthetic turf, pool
bike, elliptical
Bike, Stairmaster, track, treadmill
elliptical, bike, bosu, box
UPE, swiss ball, weights, theraband
Dynadisk, aquatic therapy, ellipticals, physioball
Bike
bike, treadmill, elliptical,
Kettlebells, Bosu, Versaclimber, AirRunner, Slam Ball, SLide Board,
Skiier, MEdicine Balls
treadmill
Mostly and exercise bike, sometimes a treadmill
bike, running, elipitical, arm bike
bosu, slide board, track
treadmill
bike, elliptical, BOSU
Bosu, running
bike, elliptical trainer, treadmill
bike, treadmill, track
BAPS, swiss ball, teadmill, bikes, ellipical
BOSU, bike, swiss ball, airex balance pad
treadmill, elliptical
Treadmill, elliptical, BOSU, cones, tennis ball, physioball - athletes'
own body
track, elastic bands
Cybex Arch Trainer, Eliptical, Treadmill
Bike, EFX, Treadmill, plyo boxes, dynadiscs, Bosu ball, agility ladder,
physioballs
BOSU, swiss ball, therabands, etc
Bike, Treadmill, Trampoline, Medicine Ball
Bike, treadmill, track, gymnasium
bike, treadmill, eilliptical, UBE
upper body ergometer
Treadmills, Stationary Bikes; Steppers
bike, treadmill, balance equipment, hurdles
bike, weights
Bike, elliptical, treadmill, traditional playing surface, sport specific
implements (i.e., tennis racket, etc)
bike treadmill
eliptical trainer, swiss ball, fitter, balance disk
Bike, Treadmill
bike, Elyptical, stairmaster
Bike, Elliptical, treadmill, UBE, BOSU, Airex, Physio Ball, floor dots
for plyometric training
bike, eliptical, treadmill BOSU, swiss
swiss ball
step box, various other basic exercises
bike, treadmill, track

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bike, stairs, jump boxes, medicine ball, kettle bell,
bike and running in the gym
Bike, TM, running
Variety - Cycle Ergometers, Treadmills, Balls, Bands, Walls, etc.
bosu, Swiss ball, baps board, thera band
mini trampoline,BOSU
bike, elliptical, versaclimber
treadmill, ball, weight equipment

Question 14: Interval/Intermittent Parameters
work:rest interval and/or intensity:time interval
work:rest, intensity:time
work/rest
intensity : time
time interval
intensity and time
intensity- time type of training
2min hard 3min soft working at an intensity range of 4.5 being soft to 6.0
being hard
rest:work interval; intensity:time interval
time interval and work interval
mostly rest:work interval
intensity, work load,
Combination depending on athlete sport, function
intensity/time interval
intensity, speed, duration
Time Interval, Intensity, Weights
time and work interval
1 1/2 minute easy, increase resistence and sprint for 1 minutes as hard and
fast as they can go, then back to easy no resistence for 1 1/2 minutes and do
that for a specified amount of time.
work intervals
rest/work, intensity levels
fast walk/jog intervals
intensity:time
Ratios of 1:2 up to 1:5
intensity:time intervals
time interval
Intensity/ time
work interval, intensity, time interval
intensity time interval
time interval, changes in work and rest time as they progress
2:1 work:rest, 70% max HR
Fast/slow, high/Low intensity
rest:work; intensity:time; max:moderate
intensity, time
Intensity & Rest
rest:work, and intensity:time

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varied but most intensity
time interval
Variation of Tabata protocol.
time interval
tabata- 4 min of 20s on/10s rest, and basic bike intervals, various work to
rest intervals
rest:work with varying intensities
intensity
timed intervals, speed variation, intensity variable
Depends on the day and what was trying to achieve. 1:3, 1:1, or 1:2 depending
on tolerance of athlete and injury
intensity: time interval
rest:work interval
intensity over time interval, rest work
time interval
work/rest ratios
all of the above
depending on stage of rehab I used a combination
rest:work, & Time with intensity increase
Time Intervals and Work Intervals depending on status of patient and
individual needs
intensity time intervals
10 seconds rest 30 seconds rest 3:1 rest:work ratio
intensity time interval
increase intensity, decrease rest
Question 16: Benefits of Interval/Intermittent Training in Rehab
Interval training has been effective pushing the athlete's ability to make
gains in the specific parameter of training, either aerobic or anaerobic,
strength or endurance. Plus most athletes are competitive by nature so this
gives them the predefined "rules of the game" to pace and/or perform in the
limited rehab domain. They also have the advantage of seeing objective
gains with successive trials or sessions.
In order to better prepare that athlete for return to play activities.
It's a very easy and useful technique to improve fitness.
I need to learn more about interval/intermittent training but if and when
the time comes it could be a usefull tool to get athletes back to pre-injury
levels of fitness sooner.
Different protocals may be more appropiate for a given population
They worked
I believe it is a valuable too in rehabilitation of any athletic injury.
I think in order to get athletes back to full capacity they also need rehab
that correlates to their sport in intensity,work etc.
If I learned more about the specific protocol and reviewed some peer
reviewed literature saying that this technique is benefitial...Good luck

80
with your research

:)

I feel interval training would be beneficial in my rehab protocols, but I
have not been in a situation where I believe it would have benefitted my
athlete for the minimal rehabilitation that I have done up to this point.
if I perceived a need
My current job is more evaluation and case management, very little
rehabilitation.
challenges keep them from boredom of rehab and promotes a more sucessful
total recovery
Interval/intermittent training is a useful tool that can be utilized in a
variety of ways throughout the rehabilitation process.
They work.
Rehab is just more than return to play. It is a means of making the athlete
better than when they came in with an injury and that means all aspects not
just strength and function but functional strength and functional capacity
to perform at a better level than before. Interval training is an asset to
be used with certain sports and a must for other sports.
my main goal is to get the athlete back to a stage that they can work out on
their own. if I am understanding this survey correctly, I would allow the
athlete to work out on a bike to make gains in ROM and mild aerobic
conditioning in order to get the blood pumping. But any long term training
should be on the athlete to do.
If indicated, I would have no qualms about using it!
I find that it is more interesting for the patient.
engaged. Good results
Not sure what it is. So I don't know.
limited for one on one rehab

Keeps the patient more

Also working in a HS, time is

Seems to be a great way to get the athlete back faster
I believe it gets the athlete ready to return to full activity faster
because it keeps them aerobically fit pluse works on all muscle fibers to
keep them all up to speed during their down time.
If indicated and time allows
I am not familar with it.
part of athletics
If I had a high performance athlete then yes I would, however clinical you
are limited by time. Interval training is probably best suited for the
strength and conditioning professionals post-rehab
I would use these methods for the above stated reasons.

However, I would

81
use them toward the end of rehab in preparation for return to play.
a useful tool when creating programs
Benefits to the athletes and to create rehab programs where the athlete
feels challenged.
I feel that they are effective in gradual loading of the musculoskeletal
system; they allow the athlete to begin to trust their 'systems' again
It is part of real life, which makes it part of the final recovery.
Interval/intermittent training methods are helpful to regain conditioning
after a period of inactivity.
I feel it is a good way to keep the athlete interested in their rehab and it
creates muscle confusion which then helps them see results however working
in thesecondary schoool setting I can say the one on one time needed to
create interval training programs with specific athletes is not always
practical.
I'm consistently adding new things to my rehab protocols. Once I learn more
about interval/intermittent training methods I will be sure to implement it.
Presently, not a treating clinician, my role is almost purely administrative
so I don't anticipate an opportunity
They are beneficial to meeting the goals.
Not familiar enough with it.
I'll continue using using the techniques
It is beneficial in that it will help to get the athlete back to play sooner
by improving their aerobic capacity faster
It is an excellent way to restore agility and speed, balance and
proprioception and muscular strength.
We utilize it to return to sport demands, structuring it specifically to
each athlete's needs.
effective way of reconditioning athletes
When given the opportunity interval training can be very beneficial
especially when looking to make quick improvements.
I would like to become more accustomed to using them
Past

experiences, but it remains dependent on the injury

Interval training is a key component to building/returning to a specific
aerobic activity level. It is especially important to sports that are more
stop and go. Interval training is a great way to maintain fitness when
injured.

82
I would need to learn more about it, and if it proved to be useful then I
would definitely incorporate it.
it works
Not working in a setting where I would have the ability to use.
If I thought my patient needed it would have some benefit from it
important to prepare for return to play.
In rehabilitation, we must get the athlete back to full, game ready capacity
as quickly as possible. It's also very time efficient way of training.
Because they help prevent an athlete from deconditioning and help an athlete
to return gradually to sport specific skills at competition levels.
due to the gains you get from interval training
Feel that it can be beneficial
Time
Found it to be very beneficial progression to full return to athletics.
Athletes were very healthy in their return and had no additional issues
They help make the rehabilitation process more functional and/or sportspecific; can easily manipulate the intensity for the athlete to re-gain
necessary weaknesses due to the injury and/or time-off due to injury
I don't really know much about it, so I would need to do alot more research
on it before I used the methods in my rehab protocols
No longer in the sports medicine environment, but it is something I would
like to have tried.
1. Rehab. was not a major component of the duties at last position.
returned to school to persue new career

2. have

Yes it can be implemented easily for many types of injuries.
If the situation would occur that it would be practical and effective, I may
use interval/intermittent training as part of the rehabilitation protocol.
If I was working with an athlete in a sport requiring significant power and
strength in addition to overall endurance - attempting to recondition for
RTP
would be good adjunct to functional progression back to dance, as demands of
dance are largely intermittent in nature.
This style of training leads to a more sports specific result.
can better guage his or her progress.

The athlete

It helps the athletes build back up to game play
For Return to sport...& would be specific to each sport
I find it to be very useful if used properly. I also think it is a great way
to rehab without potentially re-injury.

83
Because I think that it would benefit the athletes that I work with
It is something that can be time-consuming, but something I would consider
using especially in the later stages of rehabilitation. This is not
something that many athletic trainers have time for, especially in the high
school setting where many other demands are placed upon the athletic trainer
that are usually outside the scope of practice.
It is a tested method of increasing strength, endurance, ROM in the patients
I work with.
I believe they will make differences in performance
Limited space as of now.

84

REFERENCES
1.

Berger NJA, Tolfrey K, Williams AG, Jones AM.
Influence of continuous and interval training on
oxygen uptake on-kinetics. Med Sci Sport Exer. 2006;
38(3): 504-512.

2.

Billat LV. Interval training for performance: A
scientific and empirical practice: special
recommendations for middle- and long- distance
running. Part II: Anaerobic interval training. Sports
Med. 2001; 31(2): 75-90.

3.

Helgerud J, Hoydal K, Wang E, Karlsen T, Berg P,
Bjerkaas M, Simonsen T, Helgesen C, Hjorth N, Bach R,
Hoff J. Aerobic high-intensity intervals improve
VO2max more than moderate training. Med Sci Sport
Exer. 2007; 39(4): 665-671.

4.

Dolgener FA, Brookes WB. The effects of interval and
continuous training on VO2 max and performance in the
mile run. J Sport Med Phys Fit. 1978; 18(4): 345- 352.

5.

Laursen PB, Shing CM, Peake JM, Coombes JS, Jenkins
DG. Influence of high-intensity interval training on
adaptations in well-trained cyclists. J Strength Cond
Res. 2005; 19(3): 527-533.

6.

Buresh R, Berg K, French J. The effect of resistive
exercise rest interval on hormonal response, strength,
and hypertrophy with training. J Strength Cond Res.
2009; 23(1): 62-71.

7.

Pipes TV. Physiological responses of fire fighting
recruits to high-intensity training. JOM-J Occup Med.
1977; 19(2): 129-132.

8.

Hill-Haas S, Bishop D, Dawson B, Goodman C, Edge J.
Effects of rest interval during high-repetition
resistance training on strength, aerobic fitness, and
repeated-sprint ability. J Sport Sci. 2007; 25(6):
619-628.

9.

Daniels J, Scardina N. Interval training and
performance. Sports Med. 1984; 1(4): 327-334.

85
10.

Nourry C, Deruelle F, Guinhouya C, Baquet G, Fabre C,
Bart F, Berthoin S, Mucci P. High-intensity
intermittent running training improves pulmonary
function and alters exercise breathing pattern in
children. Eur J Appl Physiol. 2005; 94(4): 415-423.

11.

Siegler J, Gaskill S, Ruby B. Changes evaluated in
soccer-specific power endurance either with or without
a 10 week, in-season, intermittent, high-intensity
training protocol. J Strength Cond Res. 2003; 17(2):
379-387.

12.

Carey DG, Drake MM, Pliego GJ, Raymond RL. Do hockey
players need aerobic fitness? Relation between VO2max
and fatigue during high-intensity intermittent ice
skating. J Strength Cond Res. 2007; 21(3): 963-966.

13.

Leddy JJ, Fisher NM, Pendergast DR. Metabolic
responses to multiple bouts of supra-maximal exercise
in trained and untrained subjects. Int Sportmed J.
2004; 5(2): 155-168.

14.

Wernborn M, Augustsson J, Thomee R. The influence of
frequency, intensity, volume and mode of strength
training on whole muscle cross-sectional area in
humans. Sports Med. 2007; 37(3): 225-264.

15.

Tabata I, Nishimura K, Kouzaki M, Hirai Y, Ogita F,
Miyachi M, Yamamoto K. Effects of moderate-intensity
endurance and high-intensity intermittent training on
anaerobic capacity and VO2max. Med Sci Sport Exer.
1996; 28 (10): 1327-1330.

16.

Krustrup P, Mohr M, Ellingsgaard H, Bangsbo J.
Physical demands during an elite female soccer game:
importance of training status. Med Sci Sport Exer.
2005; 37(7): 1242-1248.

17.

Renoux JC. Evaluating the time limit at maximum
aerobic speed in elite swimmers: Training
implications. Arch Physiol Biochem. 2001; 109(5): 424429.

18.

Jenkins DG, Quigley BM. The influence of highintensity exercise training on the Wlim-Tlim

86
relationship. Med Sci Sport Exer. 1993; 25(2): 275282.
19.

Marcinik EG, Hodgdon JA, Englund CE, O‟Brien JJ.
Changes in fitness and shipboard task performance
following circuit weight training programs featuring
continuous or interval training. Eur J Appl Physiol O.
1987; 56(2): 132-137.

20.

Gaesser GA. Effects of high- and low-intensity
exercise training on aerobic capacity and blood
lipids. Med Sci Sport Exer. 1984; 16(3):269.

21.

Tanaka H, Swensen T. Impact of resistance training on
endurance performance: A new form of cross training?.
Sports Med. 1998; 25(3): 181-200.

22.

Baechle TR, Earle RW. Essentials of Strength Training
and Conditioning. Champaign, IL: Human Kinetics; 2008.

23.

McArdle WD, Katch FI, Katch VL. Exercise Physiology:
Energy, Nutrition & Human Performance (6 Ed.).
Philadelphia: Lippencott Williams & Wilkins; 2007.

24.

Tabata I, Irisawa K, Kouzaki M, Nishimura K, Ogita F,
Miyachi M. Metabolic profile of high intensity
intermittent exercises. Med Sci Sport Exer. 1997;
29(3): 390-395.

25.

Copland ST, Tipton JS, Fields KB. Evidence-based
treatment of hamstring tears. Curr Sports Med Rep.
2009; 8(6): 308-314.

26.

Verrall GM, Slavotinek JP, Barnes PG. The effects of
sports-specific training on reducing the incidence of
hamstring injuries in professional Australian rules
football players. Brit J Sport Med. 2005; 39(6): 363368.

27.

Greig M, Siegler JC. Soccer-specific fatigue and
eccentric hamstring muscle strength. J Athl Training.
2009; 44(2): 180-184.

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ABSTRACT
Title:

Athletic Trainers‟ Perception of
Interval/Intermittent Training in
Rehabilitation

Researcher:

Erin Schneider, ATC, CSCS, PES

Adviser:

Robert Kane, EdD, ATC, PT

Date:

May 2010

Research Type: Master‟s Thesis
Objective:

Setting:

Participants:

Study to determine if athletic trainers
utilize interval/intermittent training
methods in their rehabilitation protocols,
and if they do, how.
An email was sent out to certified athletic
trainers in the NATA District 2 with a link
to the survey to be completed on an internet
based program at the athletic trainers own
discretion.
953 certified athletic trainers from the
NATA District 2 were asked to volunteer
their time and participate in the study. 131
athletic trainers responded to the survey.

Interventions: An original survey was created for this
study. The survey was examined by a panel of
experts to determine the validity of the
survey. Then an IRB approved survey was sent
to 5 certified athletic trainers to test its
reliability. The survey was created on the
web server „Survey Monkey‟ and sent via
email to the athletic trainers. A cover
letter explaining the study was also
uploaded with the survey.
Main Outcome
Measures:
The research hypotheses will be analyzed
using chi-square goodness of fit test and
chi-square test of independence at an alpha
level of 0.05.
Results:

A significant interaction was found in
athletic trainers‟ familiarity with

88
interval/intermittent training methods. The
majority- at 53.4%- were found to be
vaguely-somewhat familiar. The majority of
athletic trainers were also found to not use
these training methods in their
rehabilitation protocols at 55.7%. An
insignificant relationship was found between
athletic trainers‟ use of
interval/intermittent training and whether
athletic trainers held an additional
credential where X2= .069, p> 0.05. An
insignificant relationship was also found
between athletic trainer‟s use of
interval/intermittent training methods and
whether the athletic trainers held a type of
strength and conditioning credential where
X2= .078, p> 0.05.
Conclusions:

Word Count: 393

While the results of this study were
statistically insignificant, trends were
found. Holding an additional credential, or
specifically a type of strength and
conditioning credential, did not predict use
of interval/intermittent training methods in
rehabilitation protocols. Athletic trainers‟
familiarity with interval/intermittent
training was found to be statistically
significant indicating that while the
majority of athletic trainers were found to
be vaguely-somewhat familiar with these
training methods, most of them did not
utilize them in their rehabilitation
protocols. Further research is necessary to
determine if there is a relationship between
interval/intermittent training and improving
balance/coordination/proprioception, or if
there is any validity that ACL
reconstruction surgery truly benefits from
these training methods due to the large
responses in these two areas specifically.