BMJ Open Sport & Exercise Medicine最新文献

Objective: This study aimed to develop a reliable, comprehensive and fit-for-purpose tool for classifying ovarian hormone profiles (OHPs) (step one of a two-step process) in postmenarcheal to perimenopausal female athletes.

Methods: The OHP classification tool was designed by a team of sport scientists, practitioners and medics and is intended for use by sport practitioners. It incorporates self-reported data and guides subsequent verification methods. Written feedback was received from practitioners currently working with elite female athletes (n=5), ensuring its applicability in an applied sport setting. In addition, inter-user (n=2) and intra-user (n=30) repeatability was assessed.

Results: All practitioners agreed that the online tool was user-friendly. Four (out of five) practitioners stated they would include the tool in their practice, with the fifth stating that they did not have the capacity to incorporate it in their practice at present. The OHP classification tool showed excellent test-retest reliability with Cronbach's alpha values exceeding 0.9.

Conclusion: This tool facilitates the classification of OHPs and promotes discussions between athletes and practitioners, enhancing understanding and management of ovarian hormone health in sportswomen.

Objectives: Following anterior cruciate ligament reconstruction (ACLR), maladaptive changes occur in the motor cortex representation of the quadriceps, evidenced by increases in intracortical inhibition and facilitation. The primary objective of this proof-of-concept study was to determine if anodal transcranial direct current stimulation (tDCS) can alter quadriceps intracortical inhibition and facilitation in an early-ACLR population after 6 weeks of application during exercise.

Methods: We performed a randomised, triple-blind controlled trial for proof of concept comparing anodal-tDCS to sham-tDCS following ACLR. Anodal-tDCS or sham-tDCS was delivered to the primary motor cortex for 20 min, three times per week, for 6 weeks from week 2 post ACLR. Transcranial magnetic stimulation quantified quadriceps short-interval intracortical inhibition (SICI), long-interval intracortical inhibition (LICI) and short-interval intracortical facilitation (SICF). Significance at p<0.05.

Results: Participants were randomised to anodal (n=11) or sham (n=10) tDCS. Participants were predominantly male (n=13) and had a mean (SD) age of 24.4 (4.7) years. For SICI, there was a group-by-time effect for anodal-tDCS (β=0.519, 95% CI 0.057 to 0.981, p=0.028) and an effect for time (β=-1.421, 95% CI -1.919 to -0.923, p<0.001). For LICI, there was no group-by-time (β=-0.217, 95% CI -0.916 to 0.482, p=0.543) or time effect (β=0.039, 95% CI -0.815 to -0.893, p=0.928). For SICF, there was a group-by-time effect for anodal-tDCS (β=-0.764, 95%CI -1.407 to -0.120, p=0.020) but not time (β=0.504, 95% CI -0.627 to 1.635, p=0.383).

Conclusion: This study provided proof of the efficacy of anodal-tDCS post ACLR in reducing maladaptive quadriceps inhibition and facilitation. We demonstrated anodal-tDCS improved facilitation and inhibition post ACLR, which are drivers of arthrogenic muscle inhibition.

Introduction: Mental health and well-being is a relatively under-researched area in rugby, especially outside the elite men's game. Evidence suggests that physical activity and sports benefit mental health and well-being, and rugby provides health-enhancing moderate-to-vigorous physical activity.

Objective: This cross-sectional study used an online approach and engaged national rugby governing bodies to understand adult rugby players' mental health and well-being and increase the diversity of the current evidence base.

Results: 500 rugby players completed an online survey. 44% of participants identified as female, and 55% as male. The UK (67%), Ireland (15%) and South Africa (12%) were the countries with the highest representation. 71% of participants were amateur players, with elite players making up 20% of the population. 87% of players participated in contact forms of the game, with 9% predominantly playing non-contact rugby. Over 50% of participants reported that rugby impacted 'extremely' positively on both their mental health and well-being. Based on the Kessler psychological distress scale (K10), 57.8% of all respondents belonged to the 'psychologically well' group. Males were more likely to belong to this group than females (p=0.01). Non-contact and amateur players had lower scores of psychological distress than contact and professional players (p=0.001 and p=0.006), respectively. Non-contact players had higher well-being (Short Warwick-Edinburgh Mental Well-being Scale) scores than contact players (p<0.001).

Conclusion: This study provides new insights into the mental health and well-being of a diverse group of rugby players.

The prevalence of chronic low back pain (CLBP) among the Pakistani population is reported to be as high as 78%, leading towards different physiological and psychosocial alterations, with the worst cases suffering from disabilities. This study protocol will be a randomised controlled trial designed to compare the effectiveness of biofeedback surface electromyography (sEMG) for CLBP in the Pakistani population. This will be a single-centre study to be conducted on patients with CLBP randomised into two groups, namely, Group A (intervention group) and Group B (control group) to receive biofeedback sEMG therapy as an intervention or no intervention, respectively. All participants will receive treatment for 8 weeks virtually. The primary and secondary outcomes will be assessed during the study, including the pain intensity and interference (Brief Pain Inventory), anxiety and depression (State-Trait Anxiety Inventory (STAI)), disability (The Oswestry Disability Index (ODI)) and quality of life. Further, physiological parameters, including altered cortisol levels, beta-endorphins and substance P, will also be measured. All outcomes will be assessed at baseline, immediately post-intervention and 3 months follow-up.

Objective: To evaluate the relationship between adherence to muscle-strengthening guidelines in young adulthood and inflammation markers over a 17-year follow-up period. Additionally, it aims to examine whether body mass index (BMI) and waist circumference (WC) act as mediators in this relationship.

Methods: The study analysed data from young adults aged 18-26 years who participated in waves III (2001-2002), IV (2008-2009) and V (2016-2018) of the Add Health Study. Adherence to muscle-strengthening guidelines was self-reported, and participants were classified as adherent if they engaged in strength training ≥2 days per week across all waves. Venous blood samples were collected at participants' homes to measure high-sensitivity C reactive protein (hs-CRP) levels and various cytokine concentrations, including interleukin (IL)-6, IL-1beta, IL-8, IL-10 and tumour necrosis factor-alpha (TNF-α). A global inflammation score was also calculated using z-scores of these markers.

Results: A total of 2320 individuals participated (60.8% females). Participants adhering to muscle-strengthening guidelines exhibited significant reductions in hs-CRP, IL-6 and the inflammation z-score, with mean difference (MD) of -1.556 mg/L (95% CI BCa -2.312 to -0.799), -0.324 pg/mL (95% BCa CI -0.586 to -0.062), and -0.400 (95% BCa CI -0.785 to -0.035), respectively. Mediation analysis revealed that BMI and WC levels at wave V significantly mediated the relationship between strength training and inflammation z-score, with significant indirect effects of -0.142 (95% CI -0.231 to -0.055) for BMI and -0.210 (95% CI -0.308 to -0.124) for WC.

Conclusion: Adherence to muscle-strengthening guidelines alone may not be sufficient to achieve a notable decrease in inflammation without concurrent reductions in these obesity parameters.

Background: This study aimed to investigate the role of physical exercises as a non-pharmacological intervention for ameliorating post-stroke dysregulated homeostatic parameters.

Methods: Embase, PubMed, PEDro, ISI Web of Science and CENTRAL were searched until April 2024. Parallel randomised controlled trials (RCTs) analysing the effect of post-stroke physical exercises (PSPE) on homeostatic parameters such as blood glucose, oxygen consumption (VO₂), high-density lipoprotein (HDL), low-density lipoprotein (LDL), systolic (SBP) and diastolic blood pressure (DBP) in individuals with stroke were selected.

Results: Sixteen RCTs (n=698) were included. PSPE reduced fasting glucose levels (MD=-0.22; 95% CI -0.22 to -0.02; p=0.00) and increased the VO₂ (MD=2.51; 95% CI 1.65 to 3.37; p=0.00) and blood HDL levels (MD=0.07; 95% CI 0.00 to 0.13; p=0.00). However, we did not observe beneficial effects on LDL, SBP and DBP parameters. Further analyses demonstrated that both low and moderate exercises are more suitable for improving blood glucose and VO₂ in this population.

Discussion: PSPE have the potential to improve dysregulated post-stroke parameters by reducing blood glucose levels and increasing VO₂ and HDL levels. However, the small size and limited number of included studies limited the precision of our results. Further research is needed to comprehensively analyse the effects of PSPE, particularly on LDL levels and blood pressure.

Prospero registration number: CRD42023395715.

Objective: This study aimed to explore the association between handgrip strength, cardiometabolic risk (CMR) and body composition in youth with type 1 diabetes.

Methods: For this prospective cohort study, muscular fitness was assessed via handgrip test and relativised by weight, and body composition, evaluated through dual-energy X-ray absorptiometry in type 1 diabetes patients aged 6-18 years. CMR score included z-scores for total body fat, blood pressure, glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride-glucose index.

Results: Eighty-three patients were analysed at baseline and 1-year follow-up (44.6% females, mean age 12.77 years). Individuals with high handgrip strength tended to have lower CMR and body fat compared with those with low handgrip strength. Over a year, individuals with high handgrip strength showed reduced HbA1c, CMR and subcutaneous fat. Consistently meeting high handgrip strength criteria resulted in reductions in HbA1c levels, CMR score and subcutaneous adipose tissue compared with those who never complied or lost compliance during follow-up. Additionally, subjects classified with high handgrip strength both at baseline and follow-up had a lower likelihood of being classified with high CMR (OR=0.241, 95% CI 0.121 to 0.947, p=0.044).

Conclusions: High handgrip strength was associated with significant cardiometabolic and body composition benefits in youth with type 1 diabetes. This tool could be considered of potential clinical value for incorporating assessments like handgrip tests to monitor and address cardiometabolic health.

Abstract:

Objective: To systematically review the literature on the incidence, prevalence, anatomical injury localisation and risk factors in Olympic weightlifting and powerlifting.

Design: Updated systematic review, PROSPERO registration (CRD42022382364).

Data sources: Four databases (PubMed, Embase, SPORTDiscus and Web of Science) were searched on 19 February 2024.

Eligibility: Reports assessing injury incidence and prevalence in Olympic weightlifting and powerlifting, published between January 2015 and February 2024, were included in addition to reports from a previous systematic review. The 'Quality Assessment Tool for Observational Cohort and Cross-sectional Studies' was used to assess methodological quality.

Results: Of 1765 screened records, eight new reports were found, resulting in 17 reports in the review. 12 reports covered weightlifting and seven covered powerlifting, with two of the reports included in both categories as they addressed both sports. In weightlifting, the period prevalence of injuries during competitions was 10.7%-68%, the incidence was 2.4-3.3 injuries/1000 hours of training, and the most common injury sites were the knee, lower back, shoulder and hands/fingers. In powerlifting, one report showed a point prevalence of 70%. Injury incidence was 1.0-4.4 injuries/1000 hours of training, and the most common injury sites were the lower back/pelvis, shoulder and elbow/upper arm. Both sports showed a high prevalence of pelvic floor dysfunction (eg, urinary incontinence) among females (50%) compared with males (9.3%).

Conclusions: This updated systematic review supports the conclusions of previous reviews and shows new findings that pelvic floor dysfunction is very common in both sports. Due to the distinctly different study designs and settings, further direct comparisons between sports were difficult. In weightlifting, reports mainly focused on injuries during competitions. In powerlifting, injury incidence was low, but injury prevalence was high when defining injury as a painful condition that impairs training/competition.

The HEALTHYBACK trial is based on a multimodal intervention to determine the effectiveness of a supervised physical exercise, mindfulness, behaviour change and pain neuroscience education programme on several health variables in individuals with chronic primary low back pain (CPLBP). The study will be a randomised controlled trial among 70 individuals diagnosed with CPLBP (aged 18-65 years). The intervention will be conducted in person within a hospital setting for 16 weeks and comprises a first phase (16 sessions supervised physical exercise (2 days/week, 45 min/session), mindfulness (1 day/week, 2.5 hours/session), behaviour change (daily/24 hours via a wrist-worn activity prompting device) and pain neuroscience education (1 day/biweekly, 2 hours/session)) and a second phase (16 sessions functional full-body muscle strengthening exercise, 3 days/week, 50 min/session). The primary outcomes will include perceived acute pain, pain pressure threshold, conditioned pain modulation, temporal summation of pain and disability due to pain. Secondary measures will include physical fitness, body composition, gait parameters, device-measured physical activity and sedentary behaviour, haematological profile, self-reported sedentary behaviour, quality of life, pain catastrophising, mental health, sleep duration and quality, and symptoms related to central sensitisation. The groups will undergo pretest (before the intervention), post-test (after each phase of the intervention) and retest (at a 6-week detraining period after the intervention) measurements. The results will determine the effectiveness of multidimensional interventions on several health parameters in individuals with CPLBP. They will provide knowledge for pain management and functioning in affected individuals, which might diminish the need for primary healthcare services. Trial registration number: NCT06114264.

Abstract:

Objective: To determine the epidemiology and clinical characteristics of match and training injuries among football players at an academy in Ghana.

Methods: In this prospective observational study, we followed 80 youth and adult football players at a Ghanaian academy over a season of 39 weeks. Medical attention and time-loss injuries, as well as exposure times of players, were recorded by resident physiotherapists using a standardised injury surveillance form. The average weekly injury prevalence was calculated. Injury incidence rates were calculated per 1000 exposure hours, with significance indicated as 95% CIs.

Results: 126 injuries were recorded during the season, with an average weekly injury prevalence of 4.1%. The overall injury incidence was 4.5 (95% CI 3.8 to 5.4) injuries per 1000 hours with under 14 (5.8 (3.3 to 10.2)/1000 hours) and under 18 players (5.7 (4.4 to 7.4)/1000 hours) recording a higher incidence than under 16 (5.1 (3.5 to 7.4)/1000 hours) and senior players (2.7 (1.9 to 3.9)/1000 hours). Match injury incidence was 13 times higher than training injury incidence (27.4 (21.5 to 34.9) vs 2.3 (1.8 to 3.0) injuries/1000 hours). Injuries to the lower extremities had the highest incidence (3.9 (2.1 to 7.2) injuries/1000 hours), with the knee being the most commonly injured site (n=30, 23.8%). The most common type of injury was a joint sprain (1.9 (1.5 to 2.5) injuries/1000 hours), and the most common injury mechanism was direct contact with another player (1.5 (1.1 to 2.0) injuries/1000 hours). Most injuries were moderately severe (2.0 (1.5 to 2.6) injuries/1000 hours).

Conclusion: Ghanaian academy football players have a substantial risk of sustaining injuries, especially among younger players. Further studies should focus on developing specific injury prevention programmes in under-researched football-playing populations.