BMJ Open Sport & Exercise Medicine最新文献

Coronary artery disease (CAD) is the leading cause of death worldwide. Patients with CAD exhibit increased levels of kynurenine (KYN) pathway (KP) metabolites, which are key products of tryptophan (TRP) catabolism and have been identified as predictive markers for cardiovascular events and atherosclerosis progression. However, the effects of exercise on KP metabolites and their influence on atherosclerosis and inflammation in these patients remain poorly understood. We aim to investigate exercise's acute and chronic effects on carotid intima-media thickness, KP metabolites, inflammatory markers and plasma-soluble adhesion molecules in patients with CAD. Patients with CAD aged 40-70 will undergo exercise training (three times per week for 12 weeks). A healthy reference group will also be included. Evaluations will occur at baseline and post-intervention. On the first visit, carotid artery thickness will be assessed via ultrasound before and after cardiopulmonary exercise testing. The second visit will include an endothelial function evaluation using venous occlusion plethysmography and 30 min of moderate-intensity aerobic exercise. Blood samples will be collected pre-exercise and post-exercise. Levels of KP metabolites (TRP, KYN, kynurenic acid and quinolinic acid), inflammatory cytokines (interleukin-6, tumour necrosis factor-alpha and interferon-gamma), T-cell subpopulations and soluble adhesion molecules (soluble P-selectin, soluble vascular cell adhesion molecule-1 and soluble intercellular adhesion molecule-1) will be assessed via ELISA, flow cytometry and multiplex assays, respectively. This study was approved by the Ethics Committee of Pedro Ernesto University Hospital (CAAE 81718324.3.0000.5259) and registered on ClinicalTrials.gov (NCT06579807). Dissemination of the findings will include peer-reviewed publications, conference presentations and media releases.

Non-traumatic avascular necrosis of the femoral head (AVNFH) is a progressive condition that often affects young individuals, leading to bone death and eventual collapse. This degeneration is causing pain and limited function in daily activities over time. This study will plan to enrol 53 male and female participants, aged 18-50 years, who have been diagnosed with AVNFH. Participants will be randomly assigned to one of two groups: (1) the Exe+Functional group, which will receive 12 weeks of mixed therapeutic exercises combined with functional resistance exercises and self-management education and (2) the control group, which will receive the same interventions but without functional exercises. The Exe+Functional group will engage in two times per week sessions of low-intensity resistance, and mobility exercises, along with a one time per week functional exercise session. The control group will have 3 weekly sessions of low-intensity exercises (resistance and mobility) without functional exercises. The primary outcomes of the study will be pain, measured using a Visual Analogue Scale (VAS) and functional pain, assessed using a Numeric Rating Scale (NRS). Secondary outcomes will include the Harris Hip Score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for hip osteoarthritis, the Timed Up and Go (TUG) test, the 30 s Chair Stand Test, active range of motion, muscle strength and the 10-metre walk test. Data will be collected at baseline (preintervention), postintervention at 12 weeks and at a 4 month follow-up. Trial registration number: IRCT20220510054814N2.

Objective: The monitoring and diagnosis of sports-related mild traumatic brain injury (SR-mTBI) remains a challenge. This systematic review summarises the current monitoring tools used for on-the-day assessment and diagnosis of SR-mTBI and their performance.

Design: Systematic review, using Quality Assessment of Diagnostic Accuracy Studies assessment.

Data sources: Embase via Ovid, IEEEXplore, Medline via Ovid, Scopus and Web of Science were searched up to June 2024.

Eligibility criteria: Peer-reviewed English-language journal articles which measured athletes using the index test within a day of injury and provided a performance measure for the method used. Studies of all designs were accepted, and no reference methods were required.

Results: 2534 unique records were retrieved, with 52 reports included in the review. Participants were 76% male, when reported, and the mean injury-to-measurement time was reported in 10% of reports. 46 different methods were investigated. 38 different reference methods were used, highlighting the lack of gold standard within the field. Area under the curve (AUC), sensitivity and specificity were the most frequent outcome metrics provided. The most frequent index test was the King-Devick (KD) test. However, there were large variations in accuracy metrics between reports for the KD test, for instance, the range of AUC: 0.51-0.92.

Conclusion: Combinations of existing methods and the KD test were most accurate in assessing SR-mTBI, despite the inconsistent accuracy values related to the KD test. The absence of a gold-standard measurement hampers our ability to diagnose or monitor SR-mTBI. Further exploration of the mechanisms and time-dependent pathophysiology of SR-mTBI could result in more targeted diagnostic and monitoring techniques. The Podium Institute for Sports Medicine and Technology funded this work.

Prospero registration number: CRD42022376560.

Objectives: This study aims to examine the association of time to recovery between early versus late presentation to outpatient community-based concussion management clinics following sport-related concussion (SRC) among adolescent Canadian athletes.

Methods: Using electronic health records (between January 2017 and December 2019) from the Complete Concussion Management Inc (CCMI) database, this was a historical cohort study of Canadian athletes aged 12-18 presenting for care early (0-7 days) or late (8-28 days) after SRC. Time-to-recovery was defined as the date of clinician clearance to return to sport. Propensity scores were first derived from logistic regression with early versus late clinical presentation as the outcome. Cox proportional hazards regression analysis was then used to model the relationship between early versus late clinical presentation and time to recovery, while including the propensity score to adjust for confounding. The association was expressed using hazard rate ratios (HRR) with 95% CIs.

Results: A total of 4696 patient records (mean age of 14.71 (±1.69 SD); 57.7% male) were eligible. Early presentation to a concussion management clinic following SRC was associated with faster time to recovery (adjusted HRR 1.23; 95% CI 1.14 to 1.32, p<0.001). This association was consistent within each quintile of the propensity score. The median time to recovery was 18 versus 22 days in the early and late groups, respectively.

Conclusion: Adolescent athletes with SRC have favourable recovery trajectories when presenting for care up to 28 days. Time to recovery (clinician clearance to return to sport) may be quicker with an earlier presentation which can lead to a faster return to sport.

Abstract:

Objective: To analyse the association between the level of use of injury risk estimation feedback (I-REF) provided to athletes and the injury burden during an athletics season.

Method: We conducted a prospective cohort study over a 38-week follow-up period on athletes competing at the French Federation of Athletics. Athletes completed daily questionnaires on their athletics activity, psychological state, sleep, self-reported level of I-REF use, and injuries. I-REF provided a daily estimation of the injury risk for the next day, ranging from 0% (no risk of injury) to 100% (maximum risk of injury). The primary outcome was the injury burden during the follow-up, defined as the number of days with injury per 1000 hours of athletics activity. A negative binomial regression model was used to analyse the association between self-reported I-REF use and the injury burden.

Results: Of the 897 athletes who met the inclusion criteria, 112 (38% women) were included in the analysis. The mean daily response rate of the follow-up was 37%±30%. The primary analysis found no significant association between the self-reported I-REF use and the injury burden (n=112, e ^β: 0.992, 95% CI: 0.977 to 1.007; p=0.308). However, when considering athletes' daily response rate in secondary analysis, for a response rate of at least 9%, we observed a significant association between the self-reported level of I-REF use and the injury burden (n=76, e ^β: 0.981, 95% CI: 0.965 to 0.998; p=0.027).

Conclusions: Daily injury risk estimation feedback using machine learning was not associated with reducing injury burden.

Objective: Glenohumeral (GH) osteoarthritis (OA) is the third most common large joint disease, after hip and knee OA. This study aimed to identify risk factors for GH OA.

Methods: We used data from the Dallas Shoulder cohort, including individuals aged 40-85. Those with confirmed GH OA based on X-ray were cases, and those without were controls. Univariate, least absolute shrinkage and selection operator and multivariate analyses identified risk factors, including age, body mass index (BMI), sex, work-related shoulder problems, shoulder disability, dislocation, previous trauma, surgery, smoking, hypertension, diabetes, depression, heart disease, OA, night pain and overall sleep quality.

Results: A total of 1827 cases and 1556 controls were identified for GH OA. In univariate analysis, significant associations with GH OA were found for increasing age (>40 to ≤50: OR 3.29, 95% CI 2.44 to 4.45; >50 to ≤60: OR 5.90, 95% CI 4.49 to 7.77; >60 to ≤70: OR 12.18, 95% CI 9.22 to 16.08 and >70: OR 16.54, 95% CI 12.47 to 21.94), higher BMI (≤19: OR 1.44, 95% CI 1.01 to 2.04; >25 to ≤30: OR 1.57, 95% CI 1.32 to 1.86; >30 to ≤35: OR 1.85, 95% CI 1.54 to 2.22 and >35: OR 1.77, 95% CI 1.28 to 2.45), prior shoulder injury (OR 1.30; 95% CI 1.12 to 1.50), shoulder surgery history (OR 0.71; 95% CI 0.57 to 0.87), shoulder pain at night (OR 1.35; 95% CI 1.07 to 1.70) and hypertension (OR 0.70; 95% CI 0.60 to 0.81). In multivariate analysis, significant associations remained for age (>40 to ≤50: OR 2.99, 95% CI 2.21 to 4.06; >50 to ≤60: OR 5.48, 95% CI 4.14 to 7.23; >60 to ≤70: OR 11.22, 95% CI 8.44 to 14.88 and >70: OR 16.65, 95% CI 12.45 to 22.17), BMI (≤19: OR 1.49, 95% CI 1.01 to 2.20; >25 to ≤30: OR 1.45, 95% CI 1.20 to 1.77; >30 to ≤35: OR 1.70, 95% CI 1.39 to 2.09 and >35: OR 1.78, 95% CI 1.25 to 2.55) and previous shoulder trauma (OR 0.80; 95% CI 0.68 to 0.94).

Conclusion: We identified increasing age and higher BMI as factors associated with GH OA. Due to the large sample size, many risk factors were assessed. Since the shoulder is not a weight-bearing joint, the BMI-GH OA link is likely molecular and systemic, warranting further investigation.

Level of evidence: Prognostic level III.

Objectives: Masculine norms of toughness and self-reliance can discourage help-seeking among elite athletes who are men. Effective ways to leverage masculine norms for help-seeking is a relatively unexplored area in athlete mental health. The study aimed to investigate how masculine health-related values measured by the Intentions Masculine Values Scale (IMVS) affect help-seeking behaviours among male elite rugby players.

Methods: A cross-sectional survey was conducted among 220 Japanese male elite rugby players in the Japan Rugby League One (response rate: 40.6%). Participants completed an online survey assessing help-seeking knowledge, attitudes and behaviours, along with masculine health-related values using the IMVS. Psychological safety within sports settings was evaluated using the Sport Psychological Safety Inventory (SPSI). Multiple regression analyses examined relationships between help-seeking behaviours and IMVS/SPSI.

Results: The Open and Selfless IMVS value was significantly associated with help-seeking knowledge (β=0.059, p=0.009) and attitudes (β=0.064, p=0.006), increasing recognition of the need for help and willingness to seek it. However, no significant association with actual help-seeking behaviour was found (β=-0.006, p=0.774). The Healthy and Autonomous IMVS value was associated with lower help-seeking behaviour (β=0.060, p=0.010), indicating higher autonomy may inhibit seeking professional support. The SPSI was not significantly related to help-seeking measures.

Conclusion: Findings highlight critical gaps between intention and actual help-seeking behaviour among male elite athletes. Further research is needed to explore additional cultural and organisational factors that may better explain help-seeking behaviour and inform effective intervention strategies.

Objectives: Relative energy deficiency in sport (REDs) is a syndrome resulting from problematic low energy availability (LEA). Low areal bone mineral density (aBMD) is a primary indicator of LEA, measured by dual X-ray absorptiometry (DXA). High-resolution peripheral quantitative CT (HR-pQCT) is an advanced imaging device that provides measures of volumetric BMD (vBMD), bone microarchitecture, geometry and strength. This study aimed to assess the prevalence of REDs in elite winter sport athletes and to observe the associations in bone parameters using HR-pQCT in athletes identified as at-risk or not at-risk of REDs.

Methods: Participants included 101 elite athletes (24.1±4.4 SD years; 52% female). The REDs Clinical Assessment Tool (CAT2) was used to determine REDs risk. HR-pQCT scans of the non-dominant radius and left tibia were analysed on REDs risk grouping.

Results: 17 athletes (17%; 71% female) were at-risk based on the REDs CAT2. After covarying for lean mass, OR suggested a higher likelihood of REDs risk classification for athletes with low cortical thickness, cortical area, total vBMD and bone strength.

Conclusions: Impaired total vBMD, bone strength and cortical bone parameters were approximately twice as likely (OR: 1.9-3.0) in athletes at-risk of REDs. Results agree with the consensus statement that HR-pQCT may identify impaired bone health in athletes at-risk of REDs. Future directions should use HR-pQCT to explore REDs risk longitudinally, using bone change over time, as this may provide greater insight. Using advanced imaging to explore REDs risk in a population of winter high-performance athletes is novel.

Background/aim: This study focuses on the development of the Cambridge Knee Injury Tool (CamKIT), a clinical prediction tool developed as a 12-point scoring tool based on a modified e-Delphi study.

Methods: A retrospective cohort evaluation was conducted involving 229 patients presenting to a Major Trauma Centre with acute knee pain over 3 months. The evaluation extracted data on the 12 scoring tool variables as well as diagnostic and management pathway outcomes. CamKIT scores for the injured and non-injured cohorts were then calculated and evaluated.

Results: The CamKIT yielded a median score of 7.5 (IQR: 6-9) in the injured cohort, compared with a median score of 2 (IQR: 1-4) in the non-injured cohort, with a statistically significant difference (p<0.0001). When constructed as a three-tier risk stratification tool, the CamKIT produces a sensitivity of 100%, a specificity of 94.3%, a positive predictive value of 89% and a negative predictive value of 100% for diagnosing clinically significant soft tissue knee injuries.

Conclusion: The CamKIT provides a non-invasive tool that has the potential to streamline the diagnostic process and empower healthcare workers in resource-stretched settings by instilling confidence and promoting accuracy in clinical decision-making. The CamKIT also has the potential to support efficiency in the secondary healthcare setting by enabling more targeted and timely use of specialist resources. This research contributes to the ongoing efforts to enhance patient outcomes and the overall quality of care in managing acute knee injuries.

The Achilles tendon is the strongest and largest tendon in the human body, yet it is also the most frequently ruptured. The incidence of Achilles tendon rupture (ATR) is increasing due to an ageing population, rising obesity rates and greater sports participation. The Achilles Tendon Total Rupture Score (ATRS) is a validated patient-reported outcome measure widely used to assess clinical and functional outcomes after ATR. However, there is no culturally adapted and validated Spanish version of this tool, limiting its applicability in Spanish-speaking populations. The aim is to translate, culturally adapt and validate the Spanish version of the ATRS following international guidelines and to analyse its psychometric properties for assessing clinical and functional outcomes in patients with ATR. This study protocol outlines a cross-sectional design adhering to Strengthening the Reporting of Observational Studies in Epidemiology and Checklist for Reporting Results of Internet E-Surveys guidelines for observational studies and online surveys. The ATRS will be translated and culturally adapted, psychometric analysis will follow COnsensus-based Standards for the selection of health Measurement INstruments standards, including reliability, validity and sensitivity assessments. Participants will include patients treated surgically for ATR in hospitals across Madrid and healthy controls recruited through social media. Sociodemographic, clinical and functional data will also be collected to support the validation process. This study protocol was approved by the Universidad Europea de Madrid Institutional Board (Approval ID: CI 2024/897) prior to data collection based one the Declaration of Helsinki. The study's findings will be distributed to athletes, physicians and academics via peer-reviewed publications and national/international conferences.