BMJ Open Sport & Exercise Medicine最新文献

Returning to a high level of performance after injury is a significant challenge for athletes. However, current best practices for return-to-performance in competitive snow sports are not well understood due to a lack of research evidence and international harmonisation. The International Ski and Snowboard Federation commissioned this consensus statement to provide recommendations for the safe and successful return of competitive alpine and freestyle skiers and snowboarders to competitive performance. An international consensus panel was formed to contribute their knowledge and perspectives on return-to-performance. The panel included experts with extensive experience in return-to-performance. The panel consisted of 23 experts (7 women and 16 men) from various skiing and snowboarding disciplines and levels of competition. It included 16 researchers, 6 snow sports or International Olympic Committee officials, 9 physicians, 6 physical therapists, 2 sports psychologists, 2 coaches and 2 former athletes, some of whom had two backgrounds/functions. However, it was disproportionately European (78%) and North American (13%), with minimal representation from South America (4%) and Africa (4%) and no representation from Asia or Australasia. The RAND-UCLA Appropriateness Method was adopted for the underlying consensus process. First, the panel discussed which topics and questions should be included in the consensus statement before developing an overall structure. The consensus process then involved providing key content based on the literature or statements from experts/panel members. These were voted on three times by all the panel members, resulting in a list of 196 statements. The jointly developed overall structure and the final statement list then formed the basis for preparing the manuscript. This consensus statement aims to assist athletes, coaches and medical staff of international and national federations in planning and implementing safe and successful return-to-performance strategies for competitive alpine and freestyle skiers and snowboarders.

Background: Patellofemoral pain (PFP) is a chronic knee pain disorder that has high recurrence rates after treatment. While longer pain duration (>4 months) is one of the primary mediators for poor PFP prognosis, there are no clinical studies testing patients' response to early physiotherapy. This study aims to determine the effectiveness of an early physiotherapy programme compared with a delayed-delivery programme for people with PFP at short-term, medium-term and long-term follow-up.

Methods: Young adults (18-35 years old) with PFP will be recruited in Brazil, the USA and Belgium. 152 eligible participants will be assessed at baseline and allocated to early (treatment initiated between 4 and 12 weeks after pain onset) or delayed (treatment initiated after ≥6 months after pain onset) intervention groups. The programme (education plus exercise therapy) will be similar for both groups and consists of a 12-week online programme with individual supervised and unsupervised sessions performed three times a week. Primary (self-reported pain, function, recovery and treatment response) and secondary (psychosocial features) outcomes will be reassessed immediately and at 3, 6 and 12 months after treatment completion. Regression models with generalised estimating equations or χ² tests will determine group*time interactions (intention-to-treat analyses).

Impact: The timing of physiotherapy may have a significant effect on patient outcomes with PFP. This study can provide relevant clinical messages about early management of PFP.

Climbing is an Olympic sport featuring three disciplines: lead climbing, speed climbing and bouldering. The injury burden associated with climbing has been well documented. However, the content of rehabilitation programmes, the outcome measures and the return-to-sport (RTS) criteria after injury are sparse. This review will map the content of rehabilitation programmes, examine outcome measures to inform rehabilitation and RTS using a COSMIN-aligned approach, and identify objective and subjective criteria used for return to climbing after musculoskeletal injury (MSKI). The methodological framework of Arksey and O'Malley will be applied for this scoping review. A systematic review of four online databases and a manual search of reference lists of identified articles will be used to identify relevant papers. Given the limited empirical literature on this topic, both peer-reviewed and non-peer-reviewed sources written in English will be used. Sources reporting rehabilitation, recovery, outcome measures in injured and uninjured climbers and RTS/return to climbing criteria after MSKI will be included. All climbers (elite, professional and/or recreational) of any age and sex will be included. Statistical analysis of agreement between reviewers at each stage of the review will be undertaken. This review will inform future research on the rehabilitation content after MSKI. It will also aid in designing sports-specific testing batteries and in return-to-climbing decision-making criteria. The result of this review will be relevant to clinicians, performance staff and researchers and will be disseminated through publications and presentations.

Objective: Assess the reporting of interventions in exercise trials for patients with spondyloarthritis, evaluate whether reporting has improved and explore whether reporting practices influence the effect on disease activity.

Design: Systematic review.

Data sources: MEDLINE, EMBASE, CINAHL, Cochrane Library and PEDro. Completeness of reporting was assessed with the Consensus on Exercise Reporting Template (CERT). Temporal trends in percentage completeness were assessed via linear regression on publication year. Meta-regression assessed whether completeness of CERT moderated the effect of exercise interventions on disease activity, measured as standardised mean difference (SMD).

Eligibility criteria for selecting studies: Randomised controlled trials (RCTs) of cardiorespiratory, resistance, flexibility and/or neuromotor exercise interventions in adults with spondyloarthritis, published between January 2003 and November 2025.

Results: Overall completeness of exercise reporting was moderate, with a mean CERT score of 9.9 (SD 3.4) (52%) across 42 RCTs. Exercise reporting showed modest improvement over the past two decades, 1.09 percentage points per year (95% CI 0.27 to 1.90). Pooled data indicated a moderate effect of exercise interventions on disease activity (SMD=-0.46, 95% CI -0.62 to -0.30), with no evidence that completeness of reporting moderated the effect size (β=-0.19, 95% CI -1.11 to 0.73).

Conclusion: About half the relevant information is provided for exercise interventions in spondyloarthritis, with only very slight improvements in recent decades. Key aspects such as exercise specifics, adherence and adverse events were often missing. Clarity of reporting did not appear to be related to how well exercise worked, but this relationship was highly variable.

Prospero registration number: CRD42023438199.

There is a gap between the evaluation of injury prevention programmes in controlled trials and their use in real-world practice, and implementation research seeks to bridge this gap by supporting programme uptake beyond research settings. This study explored implementation processes and influencing factors during and after effectiveness trials of injury prevention programmes, and examined strategies used for scale-up following trials. Using a mixed methodologies design, corresponding authors of published injury prevention trials were contacted and invited to complete a survey on implementation activities conducted during their trial and, where applicable, during scale-up. A subsample of respondents also participated in semi-structured interviews. In total, 107 injury prevention studies were identified, of which 39 authors completed the survey and nine took part in interviews. Implementation strategies applied during trials were often underreported in published studies but were identified through the survey, with common strategies including in-person training, staff education, and the provision of supportive materials. Only approximately one-third of the studies resulted in scale-up beyond the trial context. Survey responses and interview data highlighted several facilitators and barriers relevant to both trial implementation and scale-up, such as programme context, coach and athlete motivation, and organisational support. Other factors were phase-specific: trial implementation benefited from structured programme development and close researcher involvement, whereas scale-up was more strongly influenced by limited resources and external momentum, such as public events. These findings suggest that to enhance implementation and scale-up of injury prevention programmes, implementation factors should be considered throughout both the development and evaluation phases. Systematic reporting and assessment of facilitators and barriers during trials and broader scale-up initiatives, along with transparent descriptions of implementation strategies used in effectiveness studies, are essential to improve the translation of research findings into practice.

Objectives: To identify demographic, clinical, socioeconomic and referral-pathway determinants of engagement, early dropout and non-participation in a large metropolitan exercise referral scheme (ERS), and to assess whether machine learning (ML) methods provide additional explanatory value beyond conventional regression.

Methods: This retrospective cohort study analysed data from 11 909 adults (≥18 years) referred for ERS in Manchester, UK, between 27 January 2022 and 28 February 2025. Outcomes were programme adherence (completion of ≥12 exercise sessions), early dropout and non-participation. Multinomial logistic regression was used to examine predictors of outcomes. ML methods, including Random Forest models and k-means clustering, were applied to assess predictive performance, rank feature importance and identify participant subgroups.

Results: Of 11 909 referrals, 34.6% completed the programme, 34.2% declined to participate and 8.0% left early. Younger age, higher neighbourhood deprivation and psychosocial referral reasons (eg, loneliness, long covid) were associated with lower completion. Participants referred through outreach/social prescribing pathways were substantially more likely to remain in an 'intends to participate' state rather than complete, compared with those referred through clinical pathways. Random Forest models demonstrated good predictive accuracy, with early engagement indicators and deprivation emerging as the strongest predictors. Clustering identified a high-risk subgroup characterised by younger age, higher deprivation and low early attendance.

Conclusions: Engagement and adherence in ERS were strongly shaped by early engagement, deprivation, age and referral pathways. ML methods identified high-risk subgroups and reinforced the importance of early attendance. Targeted early support and ML-informed risk indicators may improve retention, particularly among younger and more deprived participants.

Background: Professional road cycling is associated with a high incidence of traumatic injuries. Despite these risks, current injury data-collection methods lack consistency and standardisation, thereby limiting meaningful surveillance and prevention efforts.

Aim: To describe the development of a secure, centralised injury surveillance system for elite cycling that enables standardised data collection, contextual integration and long-term injury tracking while ensuring compliance with ethical and data protection standards.

Methods: The system integrates an incident-activated Qualtrics-based injury reporting platform (hosted at Queen's University Belfast) used by team medical staff and accessed via (or) within a secure, access-controlled server infrastructure hosted at IDLab, Ghent University. The database is protected by role-based authentication, encrypted data transmission and application programming interface-based access controls. Race footage and contextual data (eg, weather including ambient temperature, terrain) will be linked to medical reports to improve understanding of injury mechanisms.

Ethics and governance: The system is designed to comply with the General Data Protection Regulation. Data pseudonymisation, consent protocols and ethics are built into the design. All access is logged, monitored and restricted to authorised users only.

Expected outcomes: The project is expected to improve the quality and completeness of injury data in professional road cycling, facilitate epidemiological research, inform the development and evaluation of injury prevention strategies and support international policy development.

Introduction: People with multiple sclerosis (MS) engage in less physical activity and experience higher rates of osteoporosis, falls and fractures than the general population, contributing to reduced health-related quality of life (HRQoL) and increased healthcare costs. High-intensity resistance and impact training (HiRIT) has beneficial effects on bone, muscle and physical function in other populations, but its effectiveness in people with MS is unclear.

Methods and analysis: STRONG-MS is a codesigned, clinician-led, single-blind, randomised controlled trial evaluating the effect of a HiRIT programme, ONERO, on HRQoL for people with MS. Secondary aims include assessing changes in bone mineral density, body composition, physical function, fatigue, mood as well as intervention safety, feasibility, acceptability, sustainability and cost-effectiveness. One hundred and eighty participants will be randomised (2:1) to ONERO or usual care for 12 months. The intervention comprises two times weekly, supervised, small-group sessions delivered by accredited allied health professionals. Outcomes will be assessed at 12 and 24 months using intention-to-treat analyses. Sustainability will be evaluated during a second 12-month period, during which participants fund ongoing participation privately or through support schemes.

Ethics and dissemination: The study has approval from a Health Human Research Ethics Committee. All participants will provide written informed consent. Findings will be disseminated through peer-reviewed publications, conference presentations and summaries for participants, consumer representatives and community organisations. This study will provide novel evidence on the ability of the ONERO to improve HRQoL and musculoskeletal health in people with MS as well as its feasibility, acceptability and sustainability, to inform poststudy implementation.

Objectives: To explore the epidemiology, incidence and distribution of sports-related concussion (SRC) among middle- and high-school students from Japan sustained during extracurricular sports.

Methods: We conducted a retrospective observational analysis of the Injury and Accident Mutual Aid Benefit System database from April 2012 to March 2020. Cases of SRC diagnosed by healthcare providers were extracted, with club membership numbers obtained from external sources to calculate sport-specific incidence per 1000 members. Data were stratified by sex, school type, grade, injury timing and sport. Statistical analyses included the χ² test and descriptive statistics.

Results: Among over 8 million injuries, 12 158 SRC cases were identified. Of these, 11 660 cases occurred across 24 sports based on available membership data. Boys accounted for 84% of SRCs in these 24 sports, with the highest rates in contact sports. Second-year students in both middle and high school were most affected. Rugby exhibited the highest SRC incidence (8.10 per 1000 members), followed by judo and karate, highlighting traditional Japanese martial arts as previously under-recognised high-risk activities. Concussions were more frequent in competition (49%) than in training (44%), particularly in contact sports. SRC incidence rose from 2012, peaking in the late-2010s (0.28/1000 in middle school; 0.82/1000 in high school).

Conclusion: SRC risk varied by sex, grade and sport, with contact sports and traditional martial arts showing an elevated incidence. These findings underscore the need for targeted concussion prevention, education and safety guideline revisions for high-risk groups. Further research should explore sport-specific risk factors to enhance prevention.

This scoping review examined the prevalence and characteristics of musculoskeletal injuries in rock climbing and identified existing knowledge and methodology gaps. The methodological guidance of the Joanna Briggs Institute (JBI) was followed. Forty-five studies examining musculoskeletal injuries in rock climbing and climbing-specific training were included, encompassing climbers of various skill levels and age groups. The most common injuries were ligament sprains and muscle or tendon strains, particularly in the fingers, hands, ankles and shoulders. Finger pulley injuries were frequent in both sport climbing and bouldering, while ankle sprains were common in bouldering. Across both acute and chronic categories, finger and ankle injuries were predominant. Future studies with a broader inclusion of under-represented populations (paediatric, women and older adults) and standardised diagnostic reporting are recommended to better understand specific injury mechanisms to reduce injury risk and promote safer climbing practices, as well as to inform clinical practice by supporting the development of targeted interventions.