Sports Medicine - Open最新文献

Background: Spinal cord injury (SCI) affects motor and autonomic functions that reduce exercise capacity. Specifically, the loss of sympathetic drive following SCI at or above the sixth thoracic segment (≥ T6) can impair cardiovascular responses to exercise. This systematic scoping review aimed to identify ergogenic strategies that may augment the cardiovascular system and acutely enhance exercise performance in individuals with SCI.

Methods: A systematic literature search was conducted using electronic databases (Medline, Embase, Web of Science) from inception to 1st April 2025. Studies were included if they met the following eligibility criteria: (1) human participants (aged ≥ 16 years); (2) any acquired SCI (traumatic, infection, cancer); (3) any sample size but must be > 80% SCI; (4) acute, single, volitional exercise sessions with cross-over design (i.e., ergogenic strategy and control sessions); (5) report a measurable exercise performance outcome, and (6) the strategy used to enhance performance must have a theoretical effect on the cardiovascular system. Data were extracted from eligible studies and charted. Hedges' g summary effect sizes were calculated to quantify the magnitude of effects across strategies.

Results: A total of 7266 possible articles were identified. Following a full-text review, 32 articles were included. Findings were reported by strategy, defined as either mechanical (e.g., abdominal binders, lower-body compression, passive leg exercise and supine posture) or neuromodulatory [e.g., autonomic dysreflexia (AD), functional electrical stimulation (FES), pharmaceuticals/supplements/stimulants, and spinal cord stimulation (SCS)]. The neuromodulatory strategies appeared more robust at augmenting cardiovascular and performance outcomes, particularly AD, FES, and SCS.

Conclusions: We examined methods to improve acute exercise performance by augmenting the cardiovascular system in individuals with SCI. The large heterogeneity across methodologies and outcome measures made it challenging to draw conclusions regarding the underlying physiological mechanisms. Consequently, providing definitive recommendations on the best strategies to enhance performance was not possible based on current literature. Future research should be conducted across all ergogenic strategies, with a careful focus on females, trained and untrained participants, and individuals who are more likely to benefit from improvements in cardiovascular output (i.e., SCI ≥ T6). Registration This review was pre-registered on the Open Science Framework ( https://osf.io/w7apu/ ).

Background: Disability negatively impacts body composition due to muscle disuse in paralyzed or amputated limbs. This study aimed to describe and compare the anthropometric profile and body composition of professional wheelchair basketball players according to their functional classification. In this cross-sectional descriptive study, a non-probabilistic convenience sampling of professional wheelchair basketball teams competing in the Honor Division was performed. Anthropometric measurements were taken according to ISO 7250-1:2017 and the International Society for the Advancement of Kinanthropometry (ISAK) standard. Body mass, sitting height, arm span, six skinfolds, girth, breadth, and lengths were collected. SPSS version 27 was used for general descriptive analysis and by functional groups, and for inferential analysis and calculation of percentiles tables in men.

Results: Females presented higher fat mass values than males. Between functional categories, differences were observed in weight, sitting height, and fat-free mass, with lower values in subjects with greater impairment. The percentiles of the variables weight, sitting height, arm span, total skinfolds, and fat mass showed an upward trend according to the functional category, being higher in the higher categories.

Conclusion: The determination of body composition is a useful tool for addressing multidisciplinary strategies in the performance and prevention of injury of wheelchair basketball players.

Background: After an anterior cruciate ligament (ACL) rupture, characteristics of patients that may benefit from having ACL reconstruction (ACLR) versus undergoing non-surgical treatment are still largely not known. Identifying patient subgroups may help clinicians and researchers better understand the unique needs of individuals within common clinical profiles. The primary aim of this study was to identify subgroups of patients with an ACL injury, based on patient characteristics, psychological and social factors, and the extent of the initial injury, and to evaluate subgroup characteristics based on undergoing ACLR versus non-surgical management. The secondary aim was to compare subgroups on their knee function and return to sports outcomes.

Results: A total of 275 participants (age 15-40, 48% male) with an acute ACL injury treated with usual care, either ACLR or not, from the Natural Corollaries and Recovery after ACL injury (NACOX) multicenter longitudinal cohort study were included. At two years after injury, 169 (62%) had undergone ACLR. The analysis uncovered 3 latent classes (entropy = 0.91, Akaike's information criterion (AIC) = 12125.2, Bayesian information criteria (BIC) = 12302.4, sample size adjusted BIC = 12147.0, Vuong-Lo-Mendell-Rubin (VLMR) likelihood ratio test=-6085.8, VLMR p-value = 0.5). Participants in Class 2 (n = 155) had 1.8 times (hazards ratio (HR):1.814, 95% confidence interval (CI) 1.293-2.545, p < 0.001) higher probability for having an ACLR compared to Class 3 (n = 98). There were no statistically significant differences in patient reported knee function (International Knee Documentation Committee (IKDC) score) at one- or two-years follow-up between the classes. A higher proportion of participants in Class 3 returned to same or higher activity level compared to Class 1 (n = 22) and 2.

Conclusions: The three distinct subgroups of patients after ACL rupture differed in probability to undergo ACLR and return to activity after injury at one and two years after injury. There was no difference between subgroups in patient-reported knee function at one or two years after injury. Clinicians should consider the differentiating characteristics between subgroups along with the goals of their patients when engaging in shared decision-making about surgical or nonsurgical management.

Background: Disordered eating is common in elite athletes and may be motivated by perceived performance advantages associated with becoming leaner. However, few studies have examined the performance outcomes associated with disordered eating over time in this population. This study investigated self-reported performance and days missed from training/competition due to injury as longitudinal outcomes of disordered eating.

Methods: Current elite athletes predominantly from Australia and the US (N = 178; 72.4% female, M_age=23.9, SD_age=7.0) completed online surveys between March-September 2023 at baseline (T1), and after 6-months (T2; N = 110) and 12-months (T3; N = 91), including measures of demographic data, disordered eating, self-reported performance in training and competition, and days missed due to injury over the last 6-months. T1-disordered eating was examined as a predictor of T2-performance and T2-days missed due to injury via multiple regression controlling for autocorrelations, with multiple imputation to account for data attrition. The relationships over 12-months were examined via multilevel mixed-effects analyses.

Results: Greater T1-disordered eating significantly predicted a greater increase in days missed due to injury at 6-month (B = 0.04, 95% CI = 0.01-0.07), but not 12-month, follow-up, controlling for gender. Greater disordered eating was significantly associated with poorer self-reported performance across timepoints (r = - .23, p = .027 to r = - .39, p < .001); however, T1-disordered eating did not predict a significant change in performance over time, controlling for gender.

Conclusions: Disordered eating should not be considered as either normal or necessary to improve athletic performance, but rather a potential pathway towards injuries and absences from training and/or competition. These findings highlight a need for future research investigating outcomes associated with disordered eating across more specific aspects of performance and injury.

Background: The effects of Blood Flow Restriction (BFR) training are well-established, but its impact on the inflammatory response remains unclear. This systematic review evaluates whether BFR training induces acute inflammation by analyzing changes in inflammatory parameters.

Methods: This review was conducted according to PRISMA guidelines. The literature search was performed across PubMed, Web of Science, BISp-Surf and Google Scholar up to July 2025. Studies were included if they reported acute changes in inflammatory markers within 72 h after BFR training, as well as macrophage presence up to 14 days. Only trials involving healthy adults with inflammatory parameters assessed via peripheral blood or muscle biopsy were considered. Risk of bias was assessed using RoB 2 and ROBINS-I. Standardized mean differences (SMDs) were calculated to quantify within-study changes. In addition, relative percentage changes were calculated to enable a comparison of the magnitude of inflammatory responses across studies. An effect direction plot was created to summarize the direction of inflammatory marker changes (SWiM 2020).

Results: Nine studies involving 189 healthy adults were included in the systematic review. Transient increases in total leukocytes (18-33%) and lymphocytes (37-43%) were consistently observed in peripheral blood following exercise. Significant increases in total tissue macrophages (200%) were also reported. Findings on neutrophils (up to + 40%), cytokines (up to + 340%), and lymphocyte subpopulations (TCD4⁺: +25%, TCD8⁺: +39%) varied across studies.

Conclusion: The findings suggest that BFR training induces acute inflammation, characterized by transient leukocytosis, lymphocytosis, and increased macrophage activity. However, the variability in neutrophil and cytokine responses, as well as in lymphocyte subsets, may be attributed to variations in training parameters and methodological approaches. Overall, these responses appear comparable to those observed following high-load resistance training (HL-RT). Further research is needed to clarify the underlying mechanisms and their potential contribution to muscle adaptation.

Background: Running is an effective exercise for personal fitness, yet many recreational runners suffer from running-related injuries. Prolonged running induces neuromuscular fatigue, interfering with an individual's preferred running gait and increasing the injury risk. This study aimed to examine gait patterns associated with fatigue in runners during a full marathon by analyzing lower limb segment and pelvis kinematics captured via multiple inertial measurement units (IMU).

Methods: Three IMUs were attached to measure the rearfoot, shank, and pelvis kinematics of 23 male recreational runners during an outdoor marathon. Data were extracted for nine time points: the baseline, and at the 5th, 10th, 15th, up to the 40th kilometer. Each segment's free acceleration and angular velocity during the stance phase at these nine timelines were analyzed using statistical non-parametric mapping.

Results: Male recreational runners exhibited a lower running speed (1.13 km/h, p < 0.001), lengthened stance time (0.009 s, p ≤ 0.001), and prolonged stride time (0.014 s, p < 0.05) after 35 km of running, alongside a smaller anterior and superior acceleration of rearfoot and shank during the propulsion phase (p < 0.05). With increasing running mileage, the rearfoot demonstrated a gradual increase in lateral acceleration and external rotation velocity during the propulsion phase (p < 0.01). The shank exhibited a progressive decline in anterior tilt velocity during the loading response phase (p < 0.05). Additionally, the pelvis displayed significantly greater anterior acceleration during propulsion at the 40 km mark (p < 0.01).

Conclusions: Male recreational runners exhibit a marked decline in performance only after 35 km. The progressive increase in rearfoot lateral acceleration and external rotation velocity during the propulsion phase, may be associated with a compensatory distal strategy to maintain balance stability. The gradual reduction in anterior tilt velocity of the shank during the loading response likely reflects a stiffness-enhancing mechanism in the lower limb to preserve locomotor efficiency under fatigue. The increased anterior acceleration of the pelvis at the 40 km mark suggests a proximal shift in propulsion mechanics due to fatigue. These findings underscore the necessity of long-distance protocols, continuous kinematic monitoring, and full stance-phase analysis to study running fatigue.

Background: Maximal fat oxidation (MFO) and its intensity (FAT_max) are important for metabolic health, but current models explain only partially their variability. Research suggests that factors like oxygen uptake efficiency (i.e., OUES and OUEP) may better predict MFO and FAT_max than maximal oxygen uptake (VO_2max) and the first ventilatory threshold (VT1). This study investigates whether OUES and OUEP can explain more of the variation in fat oxidation during exercise.

Methods: Fifty-five healthy male participants underwent a series of tests, including body composition measurements, resting metabolic rate, and a treadmill exercise trial to assess cardiovascular fitness (CRF) and fat oxidation. The incremental exercise test measured gas exchange and heart rate, and blood samples were collected for glucose and lactate analysis. Statistical analyses, including multivariate regression, were used to explore relationships between CRF biomarkers, OUES, OUEP, and fat oxidation, with significance set at p < 0.05.

Results: Participants with excellent cardiovascular fitness (CRF) showed lower body fat, higher fat-free mass, and higher VO_2max, MFO, and FAT_max compared to those with poor or regular CRF. When oxygen uptake efficiency and VT1 were included in the models, VT1 and OUEP emerged as stronger predictors of MFO and FATmax than VO_2max. The OUES did not significantly relate to MFO or FAT_max but was a key moderator of VO_2max, explaining 71% of its variance.

Conclusions: VT1 and OUEP are stronger predictors of MFO and FAT_max than VO_2max, while OUES significantly moderates VO_2max, highlighting the importance of submaximal biomarkers in fat oxidation capacity.

Maximal exercise testing is a fundamental component of sports medicine and clinical practice, essential for evaluating physical fitness, tailoring training programs, and diagnosing health conditions. A crucial aspect of maximal exercise testing is ensuring that participants exert maximal effort, as insufficient effort can compromise the validity of results, potentially leading to misdiagnoses, misinterpretation of outcomes, and inappropriate exercise recommendations. Various strategies, including verbal, audio, and video-based methods, have been used in research and practice to encourage maximal effort. Despite the recognized importance of these strategies, understanding of them remains limited, with recommendations being either inconsistent or entirely lacking. Notably, innovative approaches that harness the potential of digital methods are still relatively scarce. In this article, we discuss the potential of incorporating game elements as an innovative encouragement strategy during maximal exercise testing. Drawing from research on exergaming, we provide examples of impactful game features and discuss their potential integration into exercise testing. This innovative approach has the potential to improve test reliability, enhance validity, streamline workflows, and positively influence attitudes toward exercise testing. We advocate for establishing a new area of research focused on gamifying maximal exercise tests to elevate exercise diagnostics to the next level.

Background: Sports and exercise medicine is important in the prevention, diagnosis, and management of a variety of musculoskeletal presentations and injuries as well as aiding athletes' recovery and enhancing public health by promoting physical activity for all. It has evolved from a subspecialty into a distinct interdisciplinary domain. Using scientometric analysis, this study examines sports and exercise medicine's scope, history, current landscape and future directions. Utilising data from the Web of Science, covering 150,380 publications up to November 2022, trends from the early 1970s to 2022 are analysed.

Main findings: There was gradual growth in the field between 1980 and 2000 and a significant surge post-2000. The study reveals global distribution, with the United States contributing over half of the field's output. However, questions arise about international collaboration and resource allocation. Citespace analysis visualises 26 research streams in sports and exercise medicine, with many emerging around 2000, showcasing adaptability to trends. Document co-citation and citation burst analyses highlight pivotal moments in sports medicine's intellectual history and foundational knowledge. Semantic analysis categorises sports medicine into four primary divisions: Exercise, Lower limb injuries, Physical activity, and Biomechanics in sport, emphasising its multidisciplinary nature.

Conclusions: This scientometric analysis highlights sports medicine's evolution into a diverse, interdisciplinary field, with significant growth since 2000. By identifying and mapping trends, global contributions, and key research themes (Exercise variables, Lower limb injuries, Sports dynamics, and Biomechanics) this study provides valuable insights for guiding collaboration, research, and resource allocation to advance athletes' well-being and health at a population level.

Key points: Sports and exercise medicine research has seen steady growth since the 1970s, with peaks in publication numbers, notably in 2020, followed by a decline attributed to changes in publication indexing practices. Analysis reveals a diverse array of 26 distinct research streams, evolving from a singular focus on anaerobic capacity to encompass modern topics like concussion management and sports psychology.

Background: An increasing number of studies reveal that concussion rates in male soccer are comparable to other contact sports. Due to their possible negative effects on the neurological health, detecting potential concussion events (PCEs) during a match is essential to account for their medical consequences. The objective of this study was to investigate the incidence and characteristics of the PCEs, as well as the refereeing and medical consequences, and the return-to-play time, of a leading male soccer team of the first division of the Spanish Professional Soccer League throughout a complete season.

Results: A total of 61 PCEs from direct head impacts were identified across the 38 matches played by Real Madrid CF-the 2019-2020 regular season champions and the only team with complete match records, reflecting an incidence of 48.6/1000 h. Most of the PCEs occurred due to "elbow-head" mechanisms or during "aerial heading duels", affecting parietal-occipital and frontonasal areas, with increased incidence in defenses, in the penalty areas, during minutes 45 to 60, and with a tie score. No sanction was given in 54.8% of the PCEs. Medical assistance was requested in only 32.2% of the cases, and only 29.0% of cases resulted in a substitution. The players returned to play after a mean of 9.5 (SD: 11.0) days from the event and 74.2% of the players returned to play in or less than 7 days.

Conclusions: These results are consistent with previous studies in nearby countries and reveal a high incidence and high likelihood of repeated PCEs, with limited impact on refereeing decisions, minimal medical intervention, and short return-to-play periods. Given the potential neurological risks of concussions, greater awareness is needed among professionals, medical teams, the public, and authorities.