BMJ Open Sport & Exercise Medicine最新文献

Objective: The objective of this study was to compare the effects of novel, time-efficient, low-volume combined aerobic and resistance high-intensity interval training (C-HIIT), and current exercise guidelines (210 min/week of combined moderate-intensity continuous training (C-MICT)), with waitlist control (CON) on glycaemic control in people with type 2 diabetes mellitus (T2D).

Methods: Sixty-nine low-active people with T2D were randomised to 8 weeks of supervised C-HIIT (78 min/week), supervised C-MICT (210 min/week), or waitlist CON. Those in waitlist CON were re-randomised to supervised C-HIIT/C-MICT at week 8. Following 8 weeks of supervised training, participants completed 10 months of self-directed exercise. Outcomes were assessed at baseline, week 8 and month 12. Participants in waitlist CON were only included in the exercise groups for the month 12 analysis. Analyses were completed using intention-to-treat analysis of covariance (n=69; week 8) and linear mixed modelling (n=63; month 12).

Results: Compared with CON, at week 8, HbA_1c decreased in C-HIIT (adjusted mean difference: -0.7% (95% CI -1.3, -0.2%)) and C-MICT (-1.2% (-1.9, -0.6%)). There were also improvements in C-HIIT and C-MICT versus CON at week 8 for fat mass (-1.9 (-3.1, -0.6) and -1.5 (-2.6, -0.4) kg, respectively), lean mass (1.5 (0.8, 2.3) and 0.9 (0.1, 1.7) kg), and exercise capacity (124 (77, 171) and 49 (5, 93) s). At month 12, adherence was low, and most measures returned to baseline.

Conclusions: Low-volume C-HIIT (78 min/week) and C-MICT (210 min/week) improved glycaemic control, body composition and exercise capacity similarly over 8 weeks in people with T2D. However, at month 12, improvements were not maintained following self-directed exercise. Regardless, these data suggest that supervised low-volume C-HIIT is a time-efficient and effective strategy for improving outcomes in T2D.

Background: Current injury prevention programmes in football are limited by a one-size-fits-all approach, which predominantly focuses on preventive exercise programmes while ignoring differences in risk profiles between individuals and teams.

Objective: To address this gap, we developed a new data-driven, customisable approach based on the principles of risk management. We collaborated with key stakeholders to identify focus areas for injury and illness prevention and determine their priorities.

Setting: The team medical and coaching staff included members from 17 professional football clubs, the national team and a youth football academy in Qatar.

Methods: In 2015, we launched a series of annual workshops under the Aspetar Sports Injury and Illness Prevention Programme. The workshops included club medical personnel and fitness coaches in a process to develop team-specific programmes for injury and illness prevention based on the principle of risk management. Over 2 years, workshops refined focus areas through discussions, surveys and small-group presentations, culminating in the creation a novel programme for football injury prevention.

Results: Out of 44 focus areas first identified, 23 were selected as priorities for inclusion in multimodal injury and illness prevention programmes. The identified focus areas represent a variety of aspects, including social/behavioural/lifestyle, exercise programmes/training, load management, recovery and equipment. The top priorities included communication, the Nordic hamstring exercise, training load, recovery strategies, nutrition, sleep, warm-up, the Copenhagen adduction exercise and core and dynamic stability.

Conclusion: We have developed a comprehensive framework for preventing injuries and illnesses in football grounded in the general principles of risk management. This framework has proven feasible and led to the creation of a new multicomponent programme, The Aspetar IP² (Injury and Illness Prevention for Performance) NetWork, focusing on a range of areas beyond preventive exercise programmes only.

Objective: To examine the likelihood of head acceleration events (HAEs) as a function of previously identified risk factors: match time, player status (starter or substitute) and pitch location in elite-level men's and women's rugby union matches.

Methods: Instrumented mouthguard data were collected from 179 and 107 players in the men's and women's games and synchronised to video-coded match footage. Head peak resultant linear acceleration (PLA) and peak resultant angular acceleration were extracted from each HAE. Field location was determined for HAEs linked to a tackle, carry or ruck. HAE incidence was calculated per player hour across PLA recording thresholds with 95% CIs estimated. Propensity was calculated as the percentage of contact events that caused HAEs across PLA recording thresholds, with a 95% CI estimated. Significance was assessed by non-overlapping 95% CIs.

Results: 29 099 and 6277 HAEs were collected from 1214 and 577 player-matches in the men's and women's games. No significant differences in match quarter HAE incidence or propensity were found. Substitutes had higher HAE incidence than starters at lower PLA recording thresholds for men but similar HAE propensity. HAEs were more likely to occur in field locations with high contact event occurrence.

Conclusion: Strategies to reduce HAE incidence need not consider match time or status as a substitute or starter as HAE rates are similar throughout matches, without differences in propensity between starters and substitutes. HAE incidence is proportional to contact frequency, and strategies that reduce either frequency or propensity for contact to cause head contact may be explored.

Objectives: Physical function is often a main focus of knee injury rehabilitation, but recent recommendations include increasing attention to psychological factors. We have developed the MOTor Imagery to Facilitate Sensorimotor re-learning (MOTIFS) training model which integrates dynamic motor imagery into physical rehabilitation. The objective is to report interim analysis results of an adaptive randomised controlled trial regarding the pre-defined continuation criteria.

Methods: Following a 12-week intervention in which participants were randomised to either MOTIFS or Care-as-Usual training, n=42 people undergoing rehabilitation for a traumatic knee injury were assessed for change from baseline to follow-up in psychological readiness to return to activity, using the ACL Return to Sport after Injury Scale (ACL-RSI), and side hop limb symmetry index. Continuation criteria included differences of ≥5 points in ACL-RSI and ≥8 points in side hop limb symmetry index in favour of the MOTIFS group. If these were not met, ≥5 points change in enjoyment was acceptable.

Results: Pre-defined continuation criteria were not met for ACL-RSI (mean difference -8.1 (SE 4.1)), side hop limb symmetry index (mean difference 4.4 (SE 7.8)), nor enjoyment (mean difference 3.9 (SE 4.5)), indicating that major modifications are required for continuation of the MOTIFS trial.

Conclusion: While results of this interim analysis did not show differences in psychological readiness to return to activity or side hop performance, previous research shows that the MOTIFS model is positive and enjoyable. Further research is warranted to evaluate more appropriate outcomes related to the holistic nature of physical and psychological readiness to return to activity.

Trial registration number: NCT03473821.

Objectives: This study aimed to evaluate the effects of a novel, low-volume combined high-intensity interval training (HIIT) and progressive resistance training (PRT) in overweight/obese adults.

Methods: This randomised control trial compared the effect of regular supervised HIIT combined with PRT (Exercise) with an unsupervised stretching intervention (Control), in previously inactive adults with either normal glucose (NG), pre-diabetes or type 2 diabetes (T2DM) with body mass index of >25 kg/m². Participants were randomly allocated (1:1) to receive low-volume exercise or control by an online randomisation tool. The primary outcome was the difference in change of hepatic steatosis between Exercise and Control. A prespecified sensitivity analysis was undertaken for weight stable participants (<5% change in bodyweight from baseline). Secondary outcomes were change in hepatic steatosis within the glucose groups, glycaemic control, cardiorespiratory fitness, muscle strength and body composition.

Results: Between June 2018 and May 2021, 162 participants were randomly assigned (NG: 76, pre-diabetes: 60, T2DM: 26) and 144 were included in the final analysis. Mean absolute change in hepatic steatosis was -1.4% (4.9) in Exercise (n=73) and -0.1% (7.2) in Control (n=71)(p=0.25). By preplanned sensitivity analysis, the mean change in hepatic steatosis with Exercise (n=70) was -1.5% (5) compared with 0.7% (4.6) with Control (n=61) (p=0.017). Subgroup analysis within the glucose groups showed that exercise reduced hepatic steatosis in those with pre-diabetes but not NG or T2DM (pre-diabetes: -1.2% (4.4) in Exercise and 1.75% (5.7) in Control, p=0.019).

Conclusion: These findings show that low-volume HIIT with PRT yields improvements in muscle strength and cardiorespiratory fitness and may have a small effect on hepatic steatosis.

Trial registration number: The trial was prospectively registered with the ANZCTR (ACTRN12617000552381).

Background: There is a research gap in the survey of injuries and illnesses in the sport of luge.

Objective: To analyse the type, frequency and burden of injuries and illnesses that occurred over a preparation period and a competition period in elite luge athletes.

Methods: In total 40 elite luge athletes, who were all part of a national team and competed internationally, self-reported acute injuries, overuse injuries and illnesses weekly using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems.

Results: The most frequently stated health problems were illnesses with 41.9% (n=75), followed by acute injuries at 31.9% (n=57). Overuse injuries accounted for 24.0% (n=43). Illnesses represented the greatest burden with a median severity score of 60.0 (IQR: 23.63), followed by acute injuries with 42.0 (IQR: 26.83) and overuse injuries with 35.0 (IQR: 23.95). In the case of acute injuries, the anatomical regions most affected were the hand (n=8, 14.0 %), foot (n=8, 14.0 %), head (n=7, 12.3 %) and neck (n=6, 10.5 %). In the case of overuse injuries, the shoulder (n=9, 20.9 %) and lumbar spine (n=7, 16.3 %) were most frequently reported. Strains (n=15, 26.3 %) and contusions (n=14, 24.6 %) were the predominant types of acute injuries. Four concussions were recorded, with none of the athletes taking a break from normal training of more than 3 days. This stands in contrast to the current recommendations for the return to sport after concussion.

Conclusion: The results of this study represent the current incidence rates and health burden of acute and chronic injuries in this constantly evolving sport. 95% of all athletes reported at least one health problem during the observation period. These findings support the need for specific prevention programmes. The establishment of a concussion protocol should be considered.

The long-term health effects of football (soccer) have received significant attention in recent years. While brain health is currently the focus of this interest, potential long-term risks or benefits related to cardiovascular and metabolic diseases and cancer are also of interest to sports medicine professionals. However, studies assessing the overall health risks for professional football players remain scarce. We introduce 'SoccHealth', a satellite project to the German National Cohort (NAKO), Germany's largest population-based cohort study. SoccHealth examined 348 former professional football players aged 40-69 using the infrastructure and comprehensive examination programme of NAKO. The German Statutory Accidental Insurance for Professional Athletes identified and invited male players, while female players were recruited among former national team members. Details of the examination programme and the sociodemographic and career-related characteristics of the participants are described. The identical examination programme for the NAKO participants provides the opportunity to draw general population controls according to various definitions and focus on the respective research question to be analysed. This report delineates one approach to evaluate the long-term health effects of football across a broad range of diseases.

Abstract:

Background: Low energy availability (LEA) occurs when athletes' energy intake fails to match the energy expended during exercise, resulting in insufficient energy to support essential functions for optimal health, a condition known as relative energy deficiency in sports (REDs).

Objective: This study aims to explore the prevalence of LEA among Malaysian national athletes and its associations with health-related outcomes.

Methods: A total of 43 athletes (51.2% males, aged 18-40) identified previously as having moderate or high risk of REDs through a questionnaire underwent comprehensive clinical assessments. Resting metabolic rate (RMR) was measured using indirect calorimetry, with an RMR ratio of <0.90 indicating LEA. Weight and height were measured, and fasting blood samples were analysed for ferritin, free triiodothyronine (fT3), follicle-stimulating hormone (FSH), luteinising hormone (LH), estradiol (female athletes) and testosterone (male athletes). Bone mineral density (BMD) of the lumbar spine and total left hip, as well as body composition, were measured using dual-energy X-ray absorptiometry (DXA).

Results: Out of the 43 athletes, 12 showed evidence of LEA, exhibiting at least one of the following characteristics: low estradiol levels (87.5%), low testosterone (75.0%), low fT3 (66.7%), low LH (58.3%), low FSH (58.3%), low ferritin (25.0%) and low BMD (8.3%). Notably, fT3, estradiol and testosterone were significant predictors for LEA.

Conclusions: A low but noteworthy incidence of LEA among Malaysian national athletes was associated with hormone imbalances. Awareness about LEA among athletes and sports personnel is essential for early detection and appropriate intervention.