BMJ Open Sport & Exercise Medicine最新文献

The incidence of breast cancer has increased from 900 000 to 2.3 million new annual cases over the last 25 years. The 5-year survival rate has markedly risen to over 90% worldwide due to significant therapeutic advancements. Longer survival in patients with breast cancer means more patients may experience long-term effects of their treatments, including cancer therapy-related cardiac dysfunction (CTRCD). To date, there is no established primary prevention to minimise CTRCD. The Cardiac Health in Breast Cancer study is a two-arm, single-centre, randomised controlled trial investigating the impact of an exercise programme on cardiac changes in patients with breast cancer undergoing cardiotoxic cancer therapy. 48 females with breast cancer will be randomised to either a 12-month intervention group (IG) or a control group (CG). The IG will receive a combination of supervised high-intensity interval training (HIIT) and high-intensity resistance training (HIRT) for 6 months, while the CG will follow WHO guidelines for physical activity independently. All participants will undergo transthoracic echocardiography, cardiac magnetic resonance (CMR) imaging and cardiopulmonary exercise testing at baseline, after 6 months and after 12 months. The primary endpoint is the occurrence of symptomatic or asymptomatic CTRCD at the time points of examination, detected by cardiac imaging, which may be mitigated by structured physical exercise. Secondary endpoints include assessments of cardiac inflammation as detected by CMR, mitochondrial dysfunction, health-related quality of life, the occurrence of fatigue, depression and anxiety, as well as exercise capacity, average heart rate, heart rate variability and daily physical activity.

In recent years, organised and competitive video gaming, esports, has gained enormous popularity in many parts of the world, contributing to the growing professionalisation of this sports branch. To become or remain a professional esports player, individuals practice video gaming for several hours a day while remaining in a sitting posture which may not only lead to a decrease in training quality in the short term (eg, due to cognitive fatigue) but also put them at a higher risk for negative health events in the long-term (eg, overuse injuries). Thus, interrupting periods of prolonged video gaming in a sitting posture with acute physical exercise is strongly recommended for esports players even though the optimal dosage of acute physical exercise breaks remains unclear. To address this gap, we propose in this viewpoint that traditional concepts of exercise prescription and dosage determination using the variables frequency, intensity, time (also referred to as duration) and type of physical exercise (ie, abbreviated with the acronym FITT) should be complemented by the variable density which characterises the timing of consecutive bouts of acute physical exercise during an esports session.

The 24-hour Movement Behaviour (24-h MovBeh) paradigm, encompassing physical activity (PA), sedentary behaviour (SB) and sleep patterns, is recognised as a holistic approach to adolescent health. It emphasises promoting PA, reducing SB and ensuring sufficient sleep, especially in school environments. Understanding the links between lifestyle factors and health outcomes is crucial for clinical and public health, informing interventions for lifestyle changes among adolescents. This study aims to assess adherence to 24-h MovBeh among Lithuanian adolescents, examining the patterns, inter-relationships and impacts on socio-demographic status, 24-h MovBeh, health-related fitness, blood pressure, body composition, dietary patterns, health-related quality of life, mental health, physical and exercise motivation, other lifestyles and health indicators, and academic performance. The 24-h MovBeh study is a prospective cohort study beginning in 2025 with baseline data collected in schools. It will recruit 500 primary and secondary school adolescents (11-14 years old) from Klaipeda and Kaunas, Lithuania. The study will evaluate 11 main categories: Socio-demographic status, 24-h MovBeh, health-related fitness, blood pressure, body composition, dietary patterns, health-related quality of life, mental health, physical and exercise motivation, other lifestyles and health indicators, and academic performance. Statistical analysis will estimate adherence to 24-h MovBeh and its inter-relationships with individual and environmental factors and health outcomes. The 24-h MovBeh study will be a crucial step towards establishing a monitoring system for health and lifestyle outcomes, benefiting researchers, policymakers, adolescents, and parents, while laying the groundwork for future intervention studies.

Objective: Shoulder pain, primarily due to rotator cuff tendinopathy, significantly impacts function and quality of life, with considerable socioeconomic implications. Physiotherapy myofascial trigger point therapy (MPT) is traditionally used, but therapeutic exercise (TE) has gained attention for its potential administrative and implementation benefits. The aim of this study was to evaluate the efficacy of TE compared with MPT in treating shoulder tendinopathies.

Methods: A single-blind randomised controlled trial was conducted comparing TE and MPT. Outcome measures included pain intensity with the Numerical Rating Scale, pressure pain threshold (PPT) and range of motion (ROM), assessed before and after 10 treatment sessions. A total number of 72 participants (TE group n=36 age 49.22±15.29/MTP group n=36 age 49.03±19.12) participated in the study.

Interventions: Participants in both groups were evaluated before treatment and after 10 sessions. A total of 10 sessions were conducted over 5 weeks of intervention.

Results: Both interventions showed improvements in pain intensity and ROM, with no significant differences between the groups in most measures except PPT, where TE demonstrated a greater decrease in pressure-induced pain.

Conclusion: TE could serve as an alternative to manual therapy, offering cost-benefit advantages, especially in administration via telecare and group sessions, highlighting its broader application in physiotherapy.

Trial registration number: NCT06241404.

[This corrects the article DOI: 10.1136/bmjsem-2024-002066.].

Non-communicable diseases (NCDs) represent a high burden for the society and affected individuals. Conservative non-pharmacological interventions play a first-line role in the treatment and management of most NCDs. Systematic reviews (SRs) provide the highest level of evidence and significantly influence clinical decision-making. The primary aim of this study is to provide an overview of the evidence on the effectiveness of recommended conservative non-pharmacological interventions for highly burdensome NCDs. The secondary aim is to provide an overview of the evidence for guideline implementation. A literature search was performed in Medline (PubMed), EMBASE and Cochrane CENTRAL. Six reviewers will, in duplicate, independently screen and select studies following eligibility criteria. The population will include individuals with NCDs from disease categories chosen based on WHO burden of disease data and the importance of conservative rehabilitation for their management. Eligible interventions will encompass conservative non-pharmacological approaches recommended by clinical practice guidelines (ie, physical, psychological and education/advice). Eligible comparator will include no or minimal intervention and other competitive interventions. Outcomes will comprise proposed core outcomes for the respective diseases, including patient-reported (eg, pain) and performance-based (eg, physical functioning) outcomes. SRs published in the last 5 years as peer-reviewed journal article in the English language will be eligible. The overview will be reported in accordance with the Preferred Reporting Items for Overviews of reviews.

This study aimed to explore the barriers and enablers to physiotherapist-prescribed rehabilitation exercises for people with rotator cuff-related shoulder pain (RCRSP) and to guide the development of a theoretically informed intervention for people with this condition. Eleven people receiving physiotherapy for RCRSP (M=69 ± 12 years) participated in semistructured interviews. Data were analysed using content analysis, the Theoretical Domains Framework (TDF). The following barriers and enablers were identified in line with the six themes and assigned relevant TDF domains. (1) The impact of previous knowledge and experience on beliefs, (2) therapeutic relationships, (3) expectations around diagnosis, (4) a long and slow pathway to treatment, (5) patients' experience of doing the home exercise rehabilitation programme and (6) seeing positive outcomes. Patients' beliefs that an investigation was necessary to make a diagnosis are incongruent with clinical guidelines. Several enablers identified that influence adherence to shoulder rehabilitation exercises will inform the development of interventions designed to improve adherence. Our findings highlight the importance of educating patients to alleviate identified barriers to self-management for RCRSP. Furthermore, it underscores the need to train healthcare professionals with the necessary skills to effectively educate patients, specifically about misconceptions and uncertainties about the condition and exercise.

Interprofessional healthcare teams have become the benchmark for optimising athlete health and performance in high-stakes sports. Despite a history of utility as provider partners, chiropractors are currently a relatively underutilised human resource in this rapidly developing and challenging field. Consequently, our study explored the global experiences and distinct perspectives of elite-level career sports chiropractors. Through a qualitative explorative single case study, we purposively sampled and interviewed 15 chiropractors active in elite-level athletic contexts. 'Professional characteristics and competencies', 'Running the gamut of professional career development' and 'Navigating team development in a small organisational structure' emerged as the three key themes from the data. Our data indicate that chiropractors gain provider as members of the elite athletic health and performance management team as multirole manual medicine practitioners. However, thriving in a team-oriented practice, this context appears to be reliant on their capacity for development as part of a small organisational group.

Objectives: This case study reports the real-world practicalities of implementing a mixed-methods heat acclimation (HA) programme before the 2022 FIFA World Cup.

Methods: One male English soccer referee (age: 44 years; height: 1.82 m; body mass: 76.0 kg) who had officiated professionally for over 17 years and had over 10 years' experience officiating in European and international matches undertook an 11-session HA programme over 22 days. On days 1 and 22, a 30 min fixed-intensity heat tolerance test (9 km.h^-1, 2% gradient, 40°C, 40% relative humidity) was performed, and physiological and perceptual responses were measured. A mixed-methods HA approach was used, including environmental chamber isothermic training, post-temperate training saunas and hot water immersion.

Results: Compared with the pre-test, peak core temperature reduced by 0.40°C (38.4 vs 38.0°C; minimal detectable change (MDC) = 0.34°C), peak skin temperature reduced by 0.5°C (36.7 vs 36.2°C; MDC=0.28°C) and peak heart rate reduced by 5 b·min^-1 (167 vs. 162 b·min^-1; MDC=4 b·min^-1) in the post-test. In the post-test, the sweat rate increased by 17% (1.94 vs 2.27 L.h^-1; MDC=0.42 L.h^-1). Peak thermal sensation (7 = 'hot') and the rating of perceived exertion (3 = 'moderate') were unchanged between the tests. However, peak thermal comfort (3 = 'slightly uncomfortable' vs 2 = 'uncomfortable') was rated lower in the post-test.

Conclusion: The HA programme elicited positive physiological but indifferent perceptual responses, highlighting that mixed-methods HA can be implemented when a referee still has officiating, travel and training responsibilities during the HA window.

Objectives: This study aims to understand the prevalence, incidence rate, anatomical sites, injury severity and main medical actions carried out during official training and racing by elite downhill mountain biking (DHMTB) riders during the 2023 Union Cycliste Internationale (UCI) Cycling World Championships.

Methods: The participants of this prospective, observational study were elite male and female cyclists competing at the UCI DHMTB World Championships located in the Nevis range in Fort William, Scotland, in 2023. This study followed the injury reporting guidelines established by the International Olympic Committee, which include the Strengthening the Reporting of Observational Studies in Epidemiology-Sports Injury and Illness Surveillance (SIIS) and the cycling-specific extension. Injuries were defined as 'tissue damage or other derangement of normal physical function due to participation in sports, resulting from rapid or repetitive transfer of kinetic energy requiring medical attention'. All epidemiological data were collected by the local organising committee medical professionals working at the event through an online survey. All data inputted were screened daily by the lead event physician and UCI medical delegate.

Results: Throughout 5 days of the championships, 10.4% of the 230 cyclists sustained at least one injury. The overall injury incidence rate was 3.3 (95% CI 3.1 to 3.5) per 100 rides. The incidence rates were higher in the training 4.3 (95% CI 4.0 to 4.6)/100 rides than in the racing 2.2 (95% CI 2.1 to 2.3)/100 rides. There was a greater incidence of injury in female cyclists in the training 5.8 (95% CI 5.0 to 6.6)/100 rides and racing 4.5 (95% CI 3.9 to 4.9)/100 rides compared with male cyclists. Female cyclists experienced more severe injuries, with an average of 12.6 (±14, 95% CI 5.66 to 19.54) days lost to injury compared with 5.5 (±1.6 95% CI 1.89 to 9.11) seen in male cyclists. The main event medical actions were lifting, immobilisation and helmet removal.

Conclusion: This study provides insights into the risk of injury to athletes within DHMTB. Our findings suggest more focus should be placed on the female DHMTB athlete. Additionally, this study provides unique information about common medical actions required of medical professionals working at DHMTB events and the importance of pre-event scenario training.