BMJ Open Sport & Exercise Medicine最新文献

Objective: This systematic review aims to evaluate the effectiveness of exercise interventions in alleviating depression and anxiety symptoms in women with polycystic ovary syndrome (PCOS).

Data sources: PubMed, CINAHL, Cochrane Library, SportDiscus, EMBASE and Web of Science databases were searched from their inception to July 2025.

Eligibility criteria for selecting studies: Randomised controlled trials were eligible if they examined the effects of exercise lasting ≥4 weeks on validated measures of depression and/or anxiety in women aged 18-45 with PCOS diagnosed using the Rotterdam criteria. Publications not written in English were excluded.

Data extraction and synthesis: Two reviewers independently extracted data and assessed study quality using the Cochrane Risk of Bias tool. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science guidelines. A narrative/qualitative synthesis was used to provide an overview of the current literature on the topic. Given the limited number of eligible trials, outcomes and measurement tools, a meta-analysis was not undertaken.

Results: From 363 full-text records, three trials (n=221) met the inclusion criteria. Interventions lasted 12-16 weeks, and aerobic exercise (continuous, intermittent or high-intensity interval training) was prescribed at least three times per week. Across all studies, depression symptoms improved by 4.8%-32.4%, with one study indicating a minimal clinically important difference, while anxiety symptoms decreased by 3.6%-42.2%, measured using validated scales, including Hospital Anxiety and Depression Measurement Scale, Depression, Anxiety, and Stress Scale-21, Montgomery Åsberg Depression Rating Scale and Brief Scale for Anxiety.

Conclusion: Findings should be interpreted cautiously due to limited report numbers, methodological concerns and heterogeneity in interventions and outcome measures. While this review aimed to assess all exercise modalities, only aerobic exercise interventions were identified. These interventions appear effective in reducing depression and anxiety symptoms in women with PCOS. Future research should include psychological outcomes and explore resistance or combined diet-exercise interventions.

Prospero registration number: CRD42023408190.

Objective: To synthesise global qualitative evidence on healthcare professionals' (HCPs) experiences, barriers and enablers in delivering physical activity (PA) advice to pregnant and postpartum women.

Design: Systematic review of qualitative, mixed-methods and multimethod studies, using thematic synthesis. Study quality was assessed using the National Institute for Health and Care Excellence critical appraisal checklist.

Data sources: Three electronic databases were searched up to 31 July 2024.

Eligibility criteria for selecting studies: Studies published after 2010 with a qualitative component exploring HCPs' perspectives on providing PA advice in maternity care. Only qualitative data were extracted and synthesised.

Results: Twenty-six studies from 10 countries were included, involving midwives, obstetricians, physiotherapists and other HCPs (sample sizes: 7-192), with experience ranging from 0.5 to 41 years. All studies were qualitative, with four using a multimethod study design. 18 studies focused on pregnancy, 3 on postpartum and 5 on both. Seven themes and 24 subthemes were identified. These included HCPs' attitudes toward PA, variability in advice provision and systemic and individual level barriers (eg, time constraints, lack of training, limited confidence). Proposed solutions included formal PA education, institutional support and improved resources. Fifteen studies were rated high quality and 11 moderate.

Conclusion: Most studies were from high-income countries, limiting generalisability to low-resource settings. The evidence base was predominantly focused on pregnancy, with limited data on postpartum PA advice. Across settings, HCPs face persistent barriers to delivering effective PA advice. Addressing these challenges through structured training and systemic support is essential to empower HCPs and promote maternal PA engagement.

Prospero registration number: CRD42023483377.

Objectives: To examine associations between The Daily Mile, a school-based active mile intervention, and pupils' physical activity, mental health and educational performance.

Methods: Year 1 pupils (aged 5-6 years) from Greater London primary schools were invited. Schools were allocated to The Daily Mile or non-Daily Mile group based on their reported Daily Mile participation. We measured weekday school hours mean minutes of moderate-to-vigorous physical activity (MVPA) using GENEActiv accelerometers. Other outcomes included time spent sedentary and in light activity, mental health and educational performance. Multi-level linear regression models examined differences accounting for repeated measurements (day) clustered by pupils-, class- and school-level, with adjustments for sex, ethnic group, area-level deprivation and month of assessment.

Results: A total of 1004 pupils/40 schools were recruited and assessed between October 2021 and January 2023; 21 schools/499 pupils comprised The Daily Mile group; 19 schools/505 pupils the non-Daily Mile group. Daily Mile pupils spent 2.2 min more in MVPA compared with non-Daily Mile pupils, but the difference was not significant (0.78, 95% CI -2.14 to 3.69). Daily Mile pupils spent less time sedentary and more time in light activity compared with the non-Daily Mile pupils, but not significantly (-5.06, 95% CI -15.37 to 5.26 and 3.27, 95% CI -4.26 to 10.81, respectively). There were no differences in mental health or educational performance.

Conclusions: We found no associations between The Daily Mile and pupils' physical activity, mental health and educational performance. Pupils in our study were in year 1 with early exposure to the intervention; assessments over longer periods are needed to understand any benefits.

Objectives: To study the prevalence of pain and analgesic use in amateur football players and explore sex-based and age-based differences.

Methods: A prospective cohort study of 316 amateur football players (185 females, 131 males), mean age 20 years (range 15-54). Baseline data on demographics and pain history in the preceding season were collected. Players reported training/match participation, pain, analgesic use and injuries every 2 weeks over a 7-month season (April-October 2023).

Results: 2439 weekly reports were analysed. Weekly pain prevalence was 40.7% (95% CI 36.4% to 45.4%) in female players and 37.2% (32.4% to 42.7%) in male players. Moderate to severe pain was more frequently reported in youth females than youth males (weekly prevalence 20.5% (15.8% to 26.8%) vs 13.1% (9.6% to 17.9%), p=0.032). Female players reported more analgesic use than male players (27.6% (23.8% to 32.1%) vs 11.2% (8.4% to 14.8%), p<0.001). Gradual-onset injuries were the predominant cause of pain (47% in females, 50% in males). Over-the-counter paracetamol (female 70%, male 61%) and non-steroidal anti-inflammatory drugs (female 67%, male 44%) were most commonly used. Analgesic use was primarily driven by non-injury-related pain in females and gradual-onset injuries in males.

Conclusions: Pain was common among amateur football players, with more than one-third of players reporting pain in a given week. Female youth players reported higher prevalence of moderate to severe pain, and both female youths and female adults used more analgesics than male counterparts. These findings call for sex-specific pain strategies and educational programmes targeting pain and medication management in amateur sports.

Abstract:

Objective: To report pooled injury incidence rates stratified by rugby format, level of play, injury outcome and sex, and to identify the most common injury sites and types.

Design: Systematic review and meta-analysis.

Data sources: Electronic databases (PubMed/MEDLINE, Web of Science and Scopus) were searched for inception to October 2024 following registration on PROSPERO.

Eligibility criteria: Reports reporting injury incidence per 1000 player hours in rugby were included. Pooled incidence rates with 95% CIs were estimated using a random effects model. Injuries were analysed by exposure type, anatomical location, injury type, rugby format, injury outcome and sex. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, and the PRISMA checklist was utilised. The risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies.

Results: Across 148 reports and 8 384 430 player hours, 96 506 rugby injuries were reported. Injury incidence was 71.6 per 1000 player hours (95% CI 38.5 to 132.9) for time-loss injuries and 138.9 (95% CI 56.8 to 339.2) for medical-attention injuries in Rugby Sevens. In Rugby League, incidence was 24.3 (95% CI 9.1 to 64.4) time loss and 61.9 (95% CI 29.9 to 127.9) medical attention per 1000 player hours. In Rugby Union, incidence was 19.9 (95% CI 14.2 to 27.7) time loss and 33.6 (95% CI 22.2 to 50.8) medical attention per 1000 player hours. Match-related injuries were consistently higher than training-related injuries across all rugby formats. Professional players demonstrated higher injury incidence than amateur players in Rugby Union and Rugby League, whereas the opposite trend was observed in Rugby Sevens. Lower limb injuries were most common, followed by head and upper limb injuries. Sprains were the most frequent injury type.

Conclusion: Injury incidence is high across rugby formats, particularly in Sevens, and most injuries occur during matches. Lower limb injuries and sprains predominate. Findings are limited by heterogeneity in injury definitions and study quality.

Prospero registration number: ghttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024599999.

Injury prevention programmes can reduce injuries in youth team sports, including handball. However, real-world effectiveness and impact of such programmes are limited due to poor implementation. To address this in Swedish youth handball, the 'Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball' (I-PROTECT) programme was co-created with end-users, including coaches. Despite tailoring the programme and its strategies to the context and needs of end-users, weekly adherence and programme fidelity remain low. Understanding coaches' experiences of I-PROTECT may provide insights to revise existing and inform new strategies to support the implementation of injury prevention training in youth handball. The aim of this qualitative study was to explore coaches' perceptions of the implementation and usability of I-PROTECT. Six coaches (two women), purposively recruited, participated in a 1.5-hour online workshop, including two group activities. They provided feedback on using I-PROTECT and identified challenges and driving conditions for its implementation. Data were collected via an online whiteboard, and audio and video were recorded and transcribed verbatim. The data were analysed using reflexive thematic analysis, guided by self-determination theory (SDT). Three themes were developed: (1) Navigating choices and chores, (2) Learning by doing and (3) Sharing is caring. Coaches responded positively to I-PROTECT and suggested strategies to enhance motivation for using injury prevention training, primarily focusing on app improvements, education and organisational support. Strategies that support coaches' autonomy, competence and relatedness could be applied in future studies to support the implementation of injury prevention training in youth sports.

Objectives: Accurate assessment of injury severity is crucial for effective injury risk management in elite sports. To standardise the documentation of injury severity, the International Hockey Federation (FIH) introduced a new injury assessment protocol (IAP), completed by FIH medical officials. This study aimed to evaluate the application of the IAP, with a specific focus on capturing injury severity.

Methods: Injury data, including injury site, affected body part, cause and type of injury, were collected during the Olympic Games (2021, 2024), Commonwealth Games (2022) and Women's FIH World Cup (2022). Medical officials classified injury severity based on estimated absence from competition: mild (1-7 days), moderate (8-28 days) and severe (>28 days).

Results: The overall injury incidence was 39.71 per 1000 player match hours in men and 29.99 in women. Overall, 22 injuries were classified as moderate, representing 8.9% of male and 14.4% of female injuries. Four severe injuries were recorded (3.3% in men, 1.0% in women). The remaining cases were no time-loss injuries and mild injuries (87.8% in men, 84.6% in women). Among female athletes, 64.3% (9/14) of moderate injuries involved the head. Among men, 75.0% (6/8) of moderate injuries affected the upper and lower extremities. Severe injuries included two contusions, one ACL tear and one temporal bone fracture.

Conclusion: The IAP delivered comprehensive injury data, including severity. The introduction of the IAP will contribute to setting a new standard of injury surveillance in (elite) field hockey. Special attention will need to be paid to head injuries in future trials.

Objectives: To date, consistent evidence for consequences of heading in football (soccer) on the structure and function of the brain is lacking, but first studies indicate a potential effect of specific high-magnitude headers. The purpose of this longitudinal, prospective study was to investigate whether potential structural and/or functional alterations within the brain were associated with (high-magnitude) heading.

Methods: 3T MRI sequences were obtained from active high-level male players before and after an observation period of 17.2 months (median). Cortical thickness and grey matter (GM) volume were investigated on a whole-brain level. Functional connectivity (FC) was analysed in the default mode network (DMN) and salience network (SN). During the observation period, each training and each match was videotaped and evaluated regarding the heading exposure. Significant structural and functional findings were subsequently correlated with specific header characteristics.

Results: 14 included participants (mean age: 20.36±3.34 years) played 5822 headers. GM volume remained unchanged, whereas cortical thickness decreased minimally from pre-measurement to post-measurement in a left precentral region (mean change: 0.048±0.128 mm; clusterwise p=0.0416). Within the SN, FC increased in one cluster (false discovery rate corrected p=0.026). FC remained stable within the DMN and between DMN and SN. Change from pre-measurement to post-measurement for the significant results did not correlate with heading variables.

Conclusion: Our findings may indicate no cumulative effect of heading during the observation period. As these results contrast with cross-sectional findings, more longitudinal, prospective studies with a greater sample size are urgently needed to understand potential heading effects.