Sports Medicine - Open最新文献

Background: Despite the great contribution of the cycling segment to the Sprint-Distance Triathlon (SDT) races, very few studies have reported the power output of elite triathletes during races. The aim of this study was to analyse the competitive demands of elite triathletes during the cycling segment of SDT races and their influence on the subsequent running segment performance, considering the different types of race courses.

Methods: Power variables during the cycling segment as well as the running performance metrics during 82 SDT races organised by World Triathlon (68 Continental Cups and Championships, 12 World Cups, and 2 World Triathlon Series) were analysed in 10 male and 7 female U23 participants.

Results: The number of power peaks above 800 W and 1000 W for males was significantly greater (p < 0.05) in the technical courses (23 ± 13 and 5 ± 6 peaks, respectively) compared to the rolling courses (10 ± 6 and 2 ± 2 peaks, respectively). Similarly, females presented more (p < 0.05) power peaks above 500 W in the technical courses (24 ± 9 peaks) than in the rolling courses (14 ± 7 peaks). Additionally, the percentage of race time in severe power bands increased from rolling to technical courses in both sexes (males 21 ± 1% to 24 ± 2% and females 12 ± 1% to 15 ± 1%, both p < 0.05). Males spent a greater percentage of race time in the moderate (< 2 W·kg⁻¹) and severe (> 6 W·kg⁻¹) power bands, but a lower percentage in the heavy (2-6 W·kg⁻¹) band compared to females (p < 0.05). Time spent in the heavy (200-400 W) and severe (> 400 W) power bands showed a strong correlation with running rankings for males on both rolling (r = 0.62) and technical (r = 0.55) courses, as well as for females on rolling courses (r = 0.52).

Conclusions: An increased number of corners in SDT cycling courses requires more focused training on repeated power peaks and spending more time in the > 6 W·kg⁻¹ power bands to minimize performance losses in the subsequent running segment.

Background: Pre-participation evaluation (PPE) aims to support safe participation in sports. The goal of this systematic review was to aggregate evidence- and consensus-based recommendations for the PPE of recreational or competitive athletes as preparation for developing a German guideline on this subject.

Methods: Five databases, including MEDLINE, were searched in August 2022, complemented by searches on the websites of relevant guideline organisations and specialty medical associations and citation screening. We included guidelines/consensus statements with recommendations for PPE of adult recreational athletes or competitive athletes of any age, excluding those with certain chronic illnesses. We extracted and synthesised data in a structured manner and appraised quality using selected domains of the AGREE-II tool.

Results: From the 6611 records found, we included 35 documents. Overall, the quality of the included documents was low. Seven documents (20%) made recommendations on the entire PPE process, while the remainder focussed on cardiovascular screening (16/35, 45.7%) or other topics. We extracted 305 recommendations. Of these, 11.8% (36/305) applied to recreational athletes and 88.2% (269/305) applied to athletes in organised or competitive sports. A total of 12.8% (39/305) of recommendations were directly linked to evidence from primary studies.

Conclusion: Many recommendations exist for PPE, but only a few are evidence based. The lack of primary studies evaluating the effects of screening on health outcomes may have led to this lack of evidence-based guidelines and contributed to poor rigour in guideline development. Future guidelines/consensus statements require a more robust evidence base, and reporting should improve.

Registration: PROSPERO CRD42022355112.

Metabolic syndrome (MetS) is a combination of risk factors that contribute to the development of many of today's chronic diseases. Rates of MetS continue to increase and it is now considered a worldwide epidemic. As with many chronic diseases it may take years for symptoms and the effects of MetS to manifest into severe health problems. Therefore, early detection is paramount A recently proposed method for the early detection of MetS is the assessment of an individual's metabolic flexibility during exercise. Metabolic flexibility is defined as the ability of the body to switch between energy substrates, primarily fats and carbohydrates, to produce energy and meet metabolic demand. This provides an indication of mitochondrial health, the possible beginning point of early insulin resistance and the development of MetS.Although there is widespread use of exercise and expired gas analysis to determine metabolic flexibility, there is no consensus on the appropriate guidelines, protocol, or interpretation of the subsequent data. Studies have used a variety of different protocols involving maximal and submaximal tests with step protocols ranging from 2 to 10 min, differences in data averaging, analysis, and stoichiometric equations, as well as variations in nutritional status of participants, and mode of exercise. This has led to considerable variation in reported results. Although the use of exercise to determine metabolic flexibility and act as a possible marker of early mitochondrial dysfunction holds significant promise, more work is required to determine the optimal protocol for clinical and research purposes.

Background: Even well-planned no-decompression dives can still produce inert gas bubbles that increase decompression sickness risk. A previously proposed formula for predicting post-dive bubble grades integrates individual factors (age, breathing gas consumption) with dive parameters (maximum depth, surface interval). This study aimed to confirm the formula's validity in an independent dataset and to find out whether detailed dive profile data are of further relevance in predicting echocardiography-derived post-dive bubble grades. Additionally, we explored whether machine learning models leveraging detailed dive profile data could enhance predictive accuracy.

Results: A total of 59 divers performed 359 no-decompression open-circuit air dives in freshwater and saltwater. Post-dive transthoracic echocardiography detected bubbles (Eftedal-Brubakk grade ≥ 1) in 29.8% of dives. Maximum depth, total dive time, air consumption, and age correlated significantly with observed bubble grades (r_s=0.37, r_s=0.16, r_s=0.27, r_s=0.13, respectively). The original prediction formula remained valid (r_s=0.39) and adequately captured higher-grade dives. Spending additional time in shallow water after deep segments reduced bubble formation. Machine learning approaches based on typical dive computer data (e.g. dive profile) provided stronger predictions (r_s=0.49).

Conclusions: This study shows that maximum depth, age, surface interval and total breathing gas consumption are sufficient predictors of post-dive bubble load in no-decompression air dives. This allows divers to individually adopt bubble-reducing measures-such as resting, hydrating, and extending surface intervals-once alerted to a higher-risk class. Integrating the formula into dive computers may offer real-time, individualised risk guidance and help prevent decompression sickness despite following computer-derived profiles in recreational diving.

Background: Several studies have evaluated the most predictive discipline (swimming, cycling, and running) of performance in elite IRONMAN^® triathletes. However, no study has ever determined the most decisive discipline for IRONMAN^® age group triathletes. The present study analyzed the importance of the three disciplines on the overall race times in IRONMAN^® age group triathletes, in order to try and determine the most predictive discipline in IRONMAN^® for age group triathletes, and whether the importance of the split disciplines changes with increasing age.

Methods: This cross-sectional study used 687,696 IRONMAN^® age group triathletes race records (553,608 from males and 134,088 from females). Age group athletes were divided in 5-year age groups (i.e., 18-24, 25-29, 30-34,…,70-74, and last 75 + years). The relationships between split disciplines (i.e., swimming, cycling, and running) and overall race times were evaluated using Spearman and Pearson correlations. A multi-linear regression model was used to calculate their prediction strength.

Results: The overall finish time correlated more with cycling and running times than with swimming times for both male and female IRONMAN^® age group triathletes (r = 0.88 and r = 0.89 for females; r = 0.89 and r = 0.90 for males, respectively). All correlation coefficients decreased with increasing age, which was more noticeable for the swimming discipline.

Conclusions: Both cycling and running are more predictive than swimming in IRONMAN^® age group triathletes, where the correlation between the overall race times and the split times decreased with increasing age more in swimming than in cycling and running. These insights are useful for IRONMAN^® age group triathletes and their coaches in planning their IRONMAN^® race preparation and concentrating training on the more predictive disciplines.

Background: Formal statements articulating the meaning of primary, secondary and tertiary prevention concepts are commonly used in the musculoskeletal sports injuries literature, but appear to be employed inconsistently and incorrectly. Standard definitions, appropriate to athletic health and performance practice, are required to systematically develop the state-of-the-art. To accomplish this, we summarized prevention definitions with the aim of improving conceptual clarity across the musculoskeletal sports injuries literature.

Main body: We used a rapid literature review method, searching Scopus, PubMed/Medline, Cochrane Library reviews/trials, Web of Science, Sports Medicine and Education Index, SPORTDiscus and CINAHL databases for titles/abstracts for available literature, published in English from database-inception to November 2023. Our search terms were: sport/athlete, injury, primary prevention, secondary prevention, and/or tertiary prevention. Definitions were extracted to create categories illustrating overlap and variation. We extracted definitions from 144 included studies (n). Primary prevention appears focused on mitigating injury risk (n = 52) and preventing initial injuries (n = 42). Secondary prevention appears to address five distinct concepts: preventing recurrences (n = 42), preventing sequelae (n = 41), preventing index injury worsening (n = 27), mitigating injury risk (n = 15), and restoring function (n = 12). Tertiary prevention appears focused on preventing sequelae (n = 17) and restoring function (n = 9).

Conclusions: From a definition viewpoint, the aim of primary prevention is narrowly conceptualized and consistent in the musculoskeletal sports injury research literature. However, secondary prevention definitions vary substantially, with at least three distinct conceptual aims observable. Tertiary prevention definitions appear infrequently in the literature and when observed tend to overlap with secondary prevention. Currently, researchers are likely to struggle with the formulation of clearly-defined and transferrable research questions relating to the aims of secondary prevention.

Background: Interest in 'exercise snacks' has increased, yet a comprehensive and holistic review of this novel concept is lacking. We aimed to map global research on 'exercise snacks', across youth, adult and clinical populations through a scoping review.

Methods: A systematic search was conducted in six databases. Grey literature searches were also conducted. Studies whereby participants were prescribed a structured bout of intense exercise dispersed across the day, or the exercise was explicitly defined as a form of 'snacks', in any setting were included. We used the Consensus on Exercise Reporting Template (CERT) to assess the completeness of exercise descriptions. Data were recorded into spreadsheets, then descriptively analyzed and summarized in graphic form.

Results: The 45 publications meeting our inclusion criteria represented 33 original studies. These 33 studies enrolled a total of 1118 participants, with a median sample size of 24. Studies were categorized as either acute (n = 12) or chronic (n = 21) trials with both trial types performed across a wide range of participant ages (range 8.7 to 78 years) but mostly conducted on healthy adults and older adults. The majority of studies (20/33) defined the concept as 'exercise snacks', with study context being predominantly the laboratory or home. A wide variety of exercise modes (e.g., cycling, stair climbing, body weight exercises) and comparator conditions (e.g., moderate intensity continuous exercise, prolonged sitting, non-exercise controls) were used. 'Exercise snack' intensity was prescribed more frequently than it was reported, and, of the available data, mean intensity was estimated at 76.9% of maximal heart rate and 5.2 Arbitrary Units (AU) on the Ratings of Perceived Exertion (RPE) CR10 scale. Study outcome measures were predominantly cardiovascular, metabolic, muscular, and psychological, with studies mostly adhering to the CERT, though there was underreporting of detail for the exercise provider, motivation strategies, adverse events and intervention fidelity.

Conclusion: The 'exercise snack' concept is being increasingly used to cover an array of exercise models. The most common protocols to date utilize body weight exercises or stair climbing. We recommend 'exercise snacks' terminology is consistently used to describe protocols whereby short, purposeful structured exercise is dispersed throughout the day. Future studies should provide detailed descriptions of their 'exercise snacks' model, through exercise and adverse event reporting checklists.

Background: Endurance athletes' competitions have increased over the decades and marathon races are becoming increasingly popular. Proper nutrition is critical for optimal performance and long-term health in marathon athletes. This study aimed to investigate runners' nutritional intake, especially fluids, food, and supplements, competing in the Seville Marathon. A descriptive and cross-sectional study was carried out to obtain information on the consumption of liquids, food, and supplements. A total of 160 runners (aged 42.2 ± 7.3 years) who were primarily men (87.5%) who participated in the 2022 Seville marathon took part in the study.

Results: There was no significant difference (p > 0.050) between marathon finish time (from 2 h 12 min to 5 h) or sports experience and fluid, carbohydrates (CHO), sodium, and caffeine intake pre- and post-competition. However, according to the results obtained, the athletes who met CHO intake recommendations during the competition (60-90 g/h) were more likely to finish the marathon in less than 180 min (p = 0.035).

Conclusions: The intake of CHO (35 ± 17 g/h), sodium (192 ± 150 mg/h) and caffeine (57 ± 49 mg/h) was low compared to the current recommendations during the competition. The intake of fluids (466 ± 279 mL/h) was at the lower limit of recommendations. Most athletes did not receive nutritional counselling by a sport dietitian, which may explain why athletes failed to meet specific nutrient recommendations. Future investigations with a larger sample size are warranted to assess the relationship between dietary intake and finish time.

Background: There are no reviews describing current measurement protocols and accelerometer processing decisions that are being used in 24-h MovBeh studies, across the lifespan. We aim to synthesise information on methods for assessing 24-h movement behaviors using accelerometry across all age groups.

Main body: PubMed, PsycINFO, SPORTDiscus, and EMBASE were searched until December 2022. Observational or intervention reports describing accelerometry methods in studies on combinations of movement behaviors, with a 24-h protocol across all ages, were included. This review included 102 studies: three studies in toddlers, 15 in preschoolers, 17 in children, 23 in adolescents and 44 in adults and older adults. The Actigraph GT3X was the most commonly used device; the majority of the included reports collected data for seven days, including three weekdays and one weekend day, with a ≥ 16 h/day per 24-h period for valid data. The criteria for non-wear time varied between ≥ 20 and  ≥ 90 min of consecutive zero counts, depending on the age group. The most common epoch used was 15 or 60 s for youth and adults, respectively. The choice of sleep algorithms and SB/PA cut-points, of the included reports, depended on age and the original validation/calibration study. To deal with non-compliant participants, exclusion of non-compliant participants from the analysis was most frequently used. Most studies used diaries/logs to complement the accelerometer data.

Conclusions: Accelerometer protocols and methodological decisions varied considerably between reports. Therefore, consensus on methodological decisions is needed to improve precision and comparability between studies, which is challenging given the complexity of the procedures, the number of available brands and types of accelerometers, and the plethora of programming options.

Background: Concussion is a common consequence of engaging in collision sports, with the often mild, transient nature of symptoms posing a considerable diagnostic and management challenge. This challenge is vastly magnified for athletes competing at grassroots/non-professional levels, who lack field side access to medical expertise in the assessment of a player's capacity to continue playing or need for further medical attention. The aim of this pilot study was to evaluate the utility of the BrainEye application and hardware (BrainEye platform) as a concussion screening tool, specifically determining (1) its sensitivity and specificity with respect to identifying an individual with a clinically diagnosed concussion, (2) the stability of the platform through test completion/failure rates, and (3) its usability through operator feedback and uptake/integration into concussion management protocols.

Results: Using the BrainEye platform, 348 male professional Australian Rules footballers from 10 Australian Football League (AFL) clubs completed 4 simple ocular protocols (pupillary light reflex, PLR; smooth pursuit eye movements, SMP; near-point convergence, NPC; horizontal gaze nystagmus, HGN) at baseline, prior to the onset of the 2022 AFL season, and following the clinical diagnosis of concussion throughout the season during a game/training/practice (n = 11 players immediately following a concussive event, and on 14 occasions 2-7 days following a concussive event). Although club participation and protocol adherence rates were suboptimal, with clubs citing COVID-19 restrictions and cumbersome hardware set-up as primary reasons for non-participation/missing data, a BrainEye score that derived from an algorithm combining smooth pursuit and pupillary light reflex measures, achieved 100% sensitivity relative to clinical judgement, in identifying all instances of clinically diagnosed concussion, and 85% specificity.

Conclusions: Collectively, the results of this study suggest that by removing the requirement for add-on hardware and providing a smartphone-only option with direct feedback on performance to the user, the BrainEye application may provide a useful screening tool for sport-related concussion.