BMJ Open Sport & Exercise Medicine最新文献

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.

Concussions in contact sports are challenging for athletes, health professionals and sporting bodies to prevent, detect and manage. Design of interventions for primary prevention, early recognition of concussion and continuing to improve postconcussion management are essential for protecting athletes and promoting brain health. Over the last decade, there have been advancements in video technology for analysing head impact events and improvements in the clinical management of concussions. This study protocol describes how researchers, clinicians and staff from the Australasian National Rugby League (NRL) have brought these advancements together and developed a database of videos with head impact events and clinical outcomes. The intended outputs from this work will enhance the understanding of head impact events in NRL, from biomechanical and gameplay factors to concussion and return to play outcomes. Publishing this protocol increases the transparency of this large-scale effort to better identify head impacts and their relationship to concussions and player movement behaviour to contextualise these variables to generate new knowledge and support the reproducibility of these emerging findings. Between 2017 and 2023, over 5250 head contact cases were recorded in the database, from which >1700 head injury assessments were performed, and >600 concussions were diagnosed. Future studies using these data are planned to inform both primary and secondary injury prevention initiatives, such as risk analysis and prediction of game scenarios that result in concussion, as well as investigation of features and factors that help to inform the duration of recovery and return to play.

Exercise improves pregnancy outcomes, but few pregnant individuals meet physical activity guidelines. The main objective of this study was to explore the perception of exercise during pregnancy using posts and comments on Reddit, a large social media platform. Relevant user-generated posts and comments were identified on Reddit by searching systematically for a combination of keywords related to pregnancy and exercise. A dataset of 120 posts and 2892 comments was randomly selected for reflexive thematic analysis. Three themes relating to perceptions of benefits and risks to exercise in pregnancy and how they influence decision-making were generated: (1) perceived benefits of exercise: 'We all know that exercise is good for us'; (2) perceived risks of exercise: Exercise as 'off limits'; and (3) information seeking and decision-making: 'I'm kinda stumped on exercise'. While the benefits of exercise during pregnancy are well recognised among Reddit users, perceived risks significantly influence their decisions to start, continue, adjust or stop exercising. Healthcare providers play a crucial role in guiding these exercise choices, emphasising the need for them to provide evidence-based advice and support pregnant individuals in achieving optimal physical activity levels. Addressing misinformation and providing supportive counselling can help pregnant individuals navigate the complexities of exercise during this critical period.

[This corrects the article DOI: 10.1136/bmjsem-2024-002013.].

Previous work has demonstrated the protective effect of shoe cushioning on injury risk in leisure-time runners, but most models currently available on the market have greater cushioning than those investigated so far. Also, the optimal level of cushioning and the role of cushioning on the forepart of the shoe for injury prevention are still unknown. The main aim of this study is to determine whether (1) current 'extra soft' cushioning material at the rear part of the shoe reduces injury risk compared with stiffer material and (2) cushioning under the forepart of the shoe also contributes to injury risk reduction. This randomised trial with a 6-month intervention will involve 1000+ healthy leisure-time runners who will randomly receive one of the three running shoe versions. Study shoe versions will differ in their cushioning properties (ie, stiffness) at the rear or the forepart. Participants will self-report any lower limb or lower back problems on a dedicated electronic system every week, while the system will collect training data from the participant's sports watch. Time-to-event analyses will be used to compare injury risk between the three study groups and to investigate the association between the runner's characteristics, cushioning level and position, training and injury risk. The study was approved by the National Ethics Committee for Research (Ref: 202405/02 v2.0), and the protocol has been registered on https://clinicaltrials.gov/ (NCT06384872, 02/08/2024). Outcomes will be disseminated through presentations at international conferences and publications in peer-reviewed journals, popular magazines and specialised websites.

[This corrects the article DOI: 10.1136/bmjsem-2024-001974.].