BMJ Open Sport & Exercise Medicine最新文献

The combination of chronic kidney disease (CKD) and peripheral artery disease (PAD) enhances the already present high cardiovascular risk, exposing the affected patients to unfavourable long-term clinical outcomes. Physical exercise is considered an effective treatment for reducing sedentary behaviour and improving quality of life, but several barriers limit patient participation. In this parallel-design, single-blinded, randomised controlled trial, we will enrol 130 patients with concomitant CKD at stages III and IV and PAD at the claudication stage to be randomised into a 6-month exercise (Ex) or control (Co) intervention. The Ex programme will consist of two daily 10 min interval walking sessions (1 min of walking followed by 1 min of resting), with gait speed controlled via a metronome and increased approximately weekly. The Co group will receive standard nephrological care. Outcomes will be assessed before and after treatment, as well as at the 12-month follow-up. The primary outcome will be the 6 min walking distance. The secondary outcomes will include quality of life, lower limb and handgrip strength, body composition and bone mineral density, as well as circulating indexes of kidney function and long-term clinical outcomes. Since no trials have been published that purposely enrol this high-risk population (CKD-PAD), the eventual positive results will validate a simple, pain-free exercise intervention that can be carried out at home to improve patients' mobility and quality of life. Trial registration number: NCT06621264.

Objective: This study aimed to examine the incidence of musculoskeletal time-loss injuries during physical education (PE) classes and their association with non-modifiable risk factors.

Methods: A 1 year prospective study was conducted in four Austrian schools, involving 683 individuals (290 boys, 393 girls; mean age 13.4±2.0 years). During follow-up, weekly exposure (participation in PE classes) and injury characteristics (eg, type and location) were registered. Injury incidence was calculated per 1000 hours of PE participation, and binary logistic regression was used to examine associations with non-modifiable risk factors (age, sex, weight, Body Mass Index, activity level, membership in a sports club, history of previous injury, maturity status).

Results: Over 48 162.5 hours of PE, 77 injuries were recorded (1.60 injuries per 1000 hours, 95% CI 1.35 to 1.89). Injuries primarily affected the lower limb (49.35%), with ligament and joint capsule lesions being most common (31.17%). Non-contact injuries made up 57.14% of the total, and acute injuries constituted 94.81% of cases. There was a strong association between maturity offset and injury incidence (p<0.001), demonstrating a higher risk at the pre-peak height velocity (PHV) stage when compared with the at-PHV (OR=0.48, 95% CI 0.24 to 0.94, p=0.03) and the post-PHV stage (OR=0.13, 95% CI 0.06 to 0.24, p<0.001).

Conclusion: This study highlights a notable incidence of sports-related musculoskeletal time-loss injuries during PE classes, emphasising the need for targeted preventive measures that account for the influence of biological maturation, particularly maturity offset, on injury risk in schoolchildren.

Many studies have supported the positive effects of an active lifestyle on the prevention and treatment of pregnancy-related complications, as well as maintaining fitness and functionality. The COVID-19 pandemic has underscored the need for virtual approaches to health interventions; however, few studies have examined the effectiveness of these interventions. The Standard Protocol Items: Recommendations for Interventional Trials 2025 guidelines were followed to describe the protocol of the ACTIVE PREGNANCY trial, an intervention study that delivers a physical exercise programme in-person (IN) and online (ON) to improve maternal physical activity (PA), fitness and healthy lifestyle parameters in pregnant women. Pregnant women will be invited to participate in a multisite, multicomponent exercise programme delivered either IN or ON by qualified exercise physiologists. Both groups will receive an exercise intervention delivered in different real-life environments. Participants will undergo basic fitness field tests and complete questionnaires assessing PA, fitness and lifestyle parameters before starting the exercise programme and after completing 12 weeks of the intervention. Researchers will test whether the intervention is beneficial in maintaining or improving maternal parameters after 12 weeks and will compare the effectiveness of different exercise modes. Subgroups of maternal age and weekly volume of PA will also be analysed. Primary outcomes: PA volume and health-related and functional fitness. Secondary outcomes: healthy lifestyle parameters. Additional outcomes: satisfaction with the exercise interventions and resources. This study was approved by the Ethics Committee of Santarém Polytechnic University and registered on ClinicalTrials.gov (NCT06954454). Findings will be disseminated via publications, conferences and training programmes.

Objective: To assess the knowledge, attitudes and behaviours regarding anterior cruciate ligament (ACL) injury prevention among individuals involved in women's football at all levels, including players and staff across Union of European Football Associations (UEFA) nations.

Methods: A cross-sectional, questionnaire-based survey was conducted to evaluate the knowledge, attitudes and behavioural adoption of ACL injury prevention strategies among players, coaches, medical staff and other stakeholders in European women's football.

Results: A total of 2384 responses from 47 of the 55 UEFA national associations were analysed. While 95% of participants demonstrated awareness of ACL injuries, knowledge of specific exercise programmes to prevent such injuries was limited in coaches (62%) and players (32%), particularly at grassroots and recreational levels. Participants expressed positive attitudes towards integrating prevention programmes into regular routines with 97% expressing they would perform it if it significantly reduced ACL injuries; however, the actual implementation of these programmes remained low across all levels of play with 22% of players, 51% of coaches and 61% of medical staff reported having performed or facilitated an ACL prevention exercise programme.

Conclusion: Despite positive attitudes towards ACL injury prevention, the practical application of prevention programmes in women's football is insufficient, especially below the national top-division level. This highlights the need for targeted educational initiatives to enhance knowledge and facilitate implementation among recreational players, coaches and medical staff.

Physical activity guidance and support for pregnant and postpartum populations across the island of Ireland (Republic of Ireland and Northern Ireland) could be strengthened to better reflect international progress in this area. While Northern Ireland can align with UK guidelines and benefit from initiatives established in mainland UK, the Republic of Ireland has yet to develop updated recommendations or equivalent programmes. Although many pregnant and postpartum individuals know the benefits of physical activity, a significant gap remains in the support they receive to engage in it. While research in this area is emerging in mainland UK, comparable evidence remains limited across the island of Ireland. This underscores the need for policy reforms to embed physical activity guidance into routine maternity care. Eight actionable steps are proposed to address these gaps, with a focus on supporting the timely publication of physical activity guidelines specific to the Republic of Ireland for pregnancy and following childbirth, introducing specialised roles, accredited training and governance structures. These measures aim to empower individuals and professionals, ensuring effective delivery of physical activity support during these critical life stages. By prioritising these changes, the island of Ireland can enhance health outcomes for pregnant and postpartum populations, fostering long-term benefits for maternal and child health.

Background: Out-of-hospital cardiac arrest (OHCA) in the young is a tragic event. Regular exercise reduces cardiovascular disease (CVD) risk but, at certain intensities and volumes, is associated with increased OHCA risk. Understanding symptoms, risk factors and aetiology is central for primary prevention.

Objective: Assess symptoms and risk factors related to OHCA aetiology in young Norwegians, and the role of exercise volume.

Method: We obtained data from the Norwegian Cardiac Arrest Registry (2015-2017), medical records, autopsy reports and questionnaires. Inclusion criteria were ages 12-49 years and OHCA of presumed cardiac aetiology.

Results: Data from 134 individuals (81 survivors, 53 deceased) showed that CVD symptoms were present during both rest/everyday activity and exercise in most victims, and were reported by more survivors than by next-of-kin of the deceased (78% vs 60%). Only 12% had symptoms just during exercise. Ischaemic heart disease was the leading cause (58% in males vs 38% in females), followed by structural, non-ischaemic heart disease. Sudden unexpected death syndrome (SUDS) was most common in individuals aged ≤35 years. Risk factors were present in 74%, with family history for CVD most prevalent (51%) and overweight in at least 33%. There were no significant differences in symptoms, risk factors or OHCA aetiology related to exercise volume prior to OHCA.

Conclusion: Symptoms and CVD risk factors were prevalent in young Norwegians suffering OHCA regardless of exercise volume. Ischaemic heart disease was the leading cause of OHCA. We suggest evaluating symptoms carefully and addressing risk factors to prevent OHCA in young Norwegians regardless of exercise habits.

Objectives: This study aimed to estimate the combined effects of long-term fine particulate matter (PM_2.5) exposure and physical activity (PA) on cardiovascular disease (CVD) risk and to assess whether the cardiovascular benefits of PA outweigh the potential adverse effects of PM_2.5 exposure.

Methods: Data were obtained from the China Health and Retirement Longitudinal Study and the ChinaHighAirPollutants datasets. Cox proportional hazards models were used to assess the independent and combined effects of PA and long-term PM_2.5 exposure on CVD. Interaction analyses were conducted to determine whether the cardiovascular effects of PM_2.5 or PA were modified by each other.

Results: PA was negatively associated with CVD risk. Each IQR increase in PA significantly reduced the risk of CVD by 10% (HR=0.90, 95% CI 0.83 to 0.98). While PM_2.5 exposure was positively associated with CVD, a 10 μg/m³ increase in PM_2.5 significantly increased 5% risk of CVD (HR=1.05, 95% CI 1.00 to 1.09). Compared with participants with high PA and low PM_2.5 exposure, those with low PA and high PM_2.5 exposure had the highest risk of CVD (HR=1.56, 95% CI 1.15 to 2.13). Long-term PM_2.5 exposure increased the risk of CVD in participants with low and moderate PAs, but not high PA.

Conclusion: The beneficial effects of high levels of PA may mitigate the detrimental effects of PM_2.5 exposure, indicating that PA is an effective strategy for reducing the risk of CVD, even among individuals living in areas with elevated PM_2.5 concentrations.

Background: Bone stress injury (BSI) is a common overuse injury in female athletes that can occur in a variety of bones, including both proximal (pelvis, sacrum, femoral neck) or distal (tibia, fibula, metatarsals) locations. Prior work has demonstrated differences in running biomechanics in those with BSI; however, this was not separated by anatomy. We hypothesised that both female athletes with distal BSI and female athletes with proximal BSI would have lower cadence, higher centre of mass (COM) and lower duty factor than those without prior BSI.

Methods: Cross-sectional study of 45 female athletes (15 with prior distal BSI, 15 with prior proximal BSI and 15 with no BSI history). Each ran on an instrumented treadmill at self-selected and 5-kilometre race speeds, with data collected in a fresh and exerted state. A series of analysis of variance tests (ANOVAs, group by condition) were used to analyse the results.

Results: Participants with previous proximal BSI ran with greater vertical COM excursion compared with those with no previous BSI at race speed (10.2±1.7 cm vs 8.5±0.8 cm (p<0.001)). The proximal BSI population had a lower cadence than the no prior BSI population at race speed (170±13 steps per minute vs 180±10 steps per minute (p=0.012)). Duty factor was lower in the proximal BSI group compared with the distal BSI group at the race speed (32±3% vs 34±3% (p=0.013)).

Conclusion: COM and cadence should be further investigated for association with proximal BSI.

Objectives: To evaluate the financial impact of player injuries on team performance in German football's first and second divisions, focusing on the indirect costs related to reduced performance and lost revenue.

Method: This retrospective, longitudinal study analysed data from seven seasons (2014/2015 to 2020/2021) of the Bundesliga. Injury metrics (incidence, burden and matchday unavailability) were examined using linear mixed models to assess their relationship with team performance (league rank and points). Financial impacts were estimated by translating performance declines into revenue losses from TV broadcasting rights and prize money.

Results: Findings show a significant negative relationship between most injury measures and team performance across both divisions. In the second division, an additional 333 injury days were associated with a one-rank drop, while the relationship was not statistically significant in the first division. For injury incidence, an increase of 4.33 injured players in the first division and 2.64 injured players in the second division corresponded to a one-rank drop. Matchday unavailability had similarly strong effects: in the first division, an additional 1.62 unavailable players per matchday were linked to a one-rank drop, while in the second division, only 0.71 unavailable players resulted in the same outcome. Financial losses due to injury-related performance declines were substantial, particularly for higher-ranked teams in the first division.

Conclusions: Injuries significantly affect team performance, causing notable financial losses through reduced league rankings and points.

Osteoarthritis (OA) is a common degenerative condition primarily affecting the knee joint. OA is defined as the gradual degradation of the cartilage in the joints, accompanied by changes in the bone underlying the cartilage, the synovial fluid, the ligaments and the muscles around the affected area. Common manifestations of OA include sensations of pain, stiffness and decreased physical movement. The estimated worldwide incidence of OA is 16.0%. The treatment known as mobilisation with movement (MWM) reduces pain and restores a full range of motion in the affected joint. This study will be a randomised, single-blind controlled trial. 50 adult patients diagnosed with knee OA will be recruited. Participants will be randomly assigned to receive either MWM or conventional physiotherapy treatment. Outcome measures will include the Numerical Pain Rating Scale for assessing pain intensity, a goniometer for measuring joint range of motion, and the Western Ontario and McMaster Universities Osteoarthritis Index for evaluating functional status. Assessments will be conducted at baseline (pretest) and after the intervention (post-test). The Institutional Review Board of the Bangladesh Health Professions Institute has approved the study. Every participant will give their informed consent, and only authorised people will have access to the anonymised data. The study results will be presented at conferences and in peer-reviewed journals. Trial registration number: CTRI/2025/05/086343.