BMJ Open Sport & Exercise Medicine最新文献

Sports-related concussions (SRCs) typically occur when the brain is hyperthermic. Acute head-and-neck cooling should, therefore, reduce the brain's metabolic demands, with the potential to improve recovery following an SRC. Elite ice hockey players who underwent head-and-neck cooling after sustaining a concussion (SRC) showed reduced return-to-play times, although further investigation is warranted. This paper aims to describe the methods proposed for investigating the clinical effects and feasibility of acute head-and-neck cooling in elite male rugby union players. A quasi-experimental study will be conducted in two professional male rugby competitions (clusters): the United Rugby Championship 'intervention group' and the PREM Rugby 'standard care group'. Both groups will follow World Rugby's standardised, graduated return-to-play concussion management protocols. In addition to this, within 30 min of the SRC, the intervention group will be offered head-and-neck cooling for 45 min. The quantitative phase of the study will collect return-to-play times and clinical outcomes in both groups (sample size calculated: 100 concussions per cohort). The qualitative phase will explore the experiences of players and medical teams with the intervention. Intention-to-treat and per-protocol analyses, using appropriate regression modelling techniques, will adjust for possible confounders between the two groups, and thematic content analysis will be employed in the analysis of the respective phases. The Clinical Observed Outcomes with Local HEad-neck cooling After Diagnosed concussions study will provide evidence regarding acute head-and-neck cooling as a potential adjunct treatment to current concussion management in elite male rugby union.

Objectives: Non-insertional Achilles tendinopathy (AT) is a common running injury. Exercise loading programme (EXER) is the primary treatment. Other options include radial pressure wave (RPW, commonly referred to as shockwave) and photobiomodulation therapy (PBMT). We hypothesised that EXER+RPW and EXER+RPW+PBMT would result in greater reduction in symptoms measured using the eight-item Victorian Institute of Sports Assessment-Achilles (VISA-A) and greater improvement in functional outcomes compared with EXER. A secondary aim was to explore outcomes using elective treatment for three additional months.

Methods: Runners with AT and symptoms exceeding 3 months were randomised to EXER, EXER+RPW or EXER+RPW+ PBMT. RPW was delivered once weekly for three treatments. Those assigned to receive PBMT additionally received treatment two times a week for 3 weeks. VISA-A, University of Wisconsin Running Injury and Recovery Index and Patient-Reported Outcomes Measurement Information System 29-item were obtained at baseline and intervals over 3 months. Afterwards, runners could elect to receive a different treatment for three additional months.

Results: Forty-six runners enrolled (24 males, 22 females; average age±SD:40±12 years). Runners assigned EXER+RPW had a greater improvement than EXER at 3 months in VISA-A (mean 33 vs 18 points, p=0.023; 95% CI 28.4 to 2.4), and no differences were detected between EXER+RPW+ PBMT and EXER (25 vs 18 points, p=0.12; 95% CI 25.9 to -10.8). There were greater improvements in running index measures, pain interference and social roles in EXER+RPW compared with EXER. VISA-A increased over 3 month crossover to EXER+RPW and EXER+RPW+PBMT (11 points, both p<0.05 compared with EXER).

Discussion: Combined EXER and RPW had the largest measured reduction in symptoms at 3 months. However, all groups met clinical improvement, highlighting the importance of EXER. Larger studies in other physically active populations may clarify clinical benefits of each treatment.

Trial registration number: NCT04725513.

Background: Obesity is a known risk factor for hypertension, but the extent to which physical activity mediates this relationship remains unclear.

Methods: Cross-sectional data from medical exams of Swiss Armed Forces conscripts between 2007 and 2022 (N=382 583). Physical fitness was assessed via the Conscription Physical Test (CPT), which included five components, one of which was an endurance test (ET). Both CPT and ET results were categorised as 'fit' or 'unfit'. Weight status was classified based on body mass index (BMI) into normal weight, overweight (BMI 25-29.99) and obesity (BMI≥30 kg/m²). Hypertension was defined as ≥140/90 mm Hg. The study explored CPT and ET as mediators between BMI and hypertension.

Results: 20.6% of the conscripts had hypertension, 20.4% overweight and 4.5% obese. Conscripts with overweight or obesity had a higher risk of hypertension compared with normal weight (OR and (bias-corrected 95% CI) of natural direct effect: 1.803 (1.766 to 1.845) and 2.727 (2.570 to 2.865)), with a protective effect of being fit (natural indirect effect for CPT: 0.976 (0.971 to 0.982) and 0.917 (0.881 to 0.953)). When ET was assessed, similar findings were obtained: 1.765 (1.731 to 1.804) and 2.680 (2.482 to 2.887) for overweight and obesity, with a protective effect of being fit (0.991 (0.983 to 0.999) and 0.925 (0.861 to 0.991)).

Conclusions: Male Swiss conscripts with overweight and obesity face an increasing risk of hypertension, with the protective benefit of physical fitness showing an increasing trend as BMI increases.

Background: There are limited studies regarding risk factors for sports-related injuries in adolescent athletes.

Objectives: The primary aim was to identify risk factors for sustaining a sports-related injury among adolescent athletes during a follow-up of up to 1 year. A further aim was to investigate sex differences.

Methods: Potential risk factors in adolescent elite athletes (n=171) were addressed through a baseline questionnaire. An injury was defined as any physical complaint resulting from competition or training, regardless of medical attention or time loss. The occurrence of new injuries was prospectively monitored during the following year using weekly questionnaires. χ² test and independent t-test were used to analyse sex differences in baseline data. Logistic regression analysis was used to examine baseline variables as potential risk factors for the appearance of new injuries.

Results: Female sex (OR 3.51, p=0.02) increased the injury risk. Training ≥9 sessions/week increased the risk in males (OR 3.98, p=0.03). Sleep amount ≥8 hours/night (OR 0.16, p=0.049) decreased the risk in females. Male athletes trained ≥9 sessions/week to a greater extent compared with female athletes (57% of males vs 30% of females (p<0.001)). The yearly injury prevalence for all athletes was 81%.

Conclusions: Female sex is a risk factor for sports-related injuries in adolescent athletes, as well as low sleep amount in females and high weekly training volume in males. Adolescents are injury-prone, and further development and optimisation of programmes for injury prevention is crucial, especially in female adolescent athletes.

The Sport Mental Health Assessment Tool-1 (SMHAT-1) screens for athlete mental health concerns, yet little is known about outcomes following positive screens.

Objective: This study examined the follow-up outcomes of Team USA athletes who exceeded thresholds on the SMHAT-1 questionnaire prior to the 2024 Paris Olympic and Paralympic Games.

Methods: A total of 847 SMHAT-1 assessments were completed (Paralympic, 26.7%; women, 52%). Questionnaires exceeding established thresholds were classified as a positive screen, which elicited follow-up by a Team USA mental health provider. During follow-up, mental health providers recorded follow-up outcomes using one of nine predefined outcomes. Outcomes were analysed for athletes with a single positive screen and for all unique positive screen combinations.

Results: 450 (53.1%) athletes had a positive screen. The most common outcomes were: 'discussion without further action' (31.8%), 'athlete already connected to outside services' (26.0%) and 'inability to contact the athlete' (20.4%). However, 43.1% of follow-ups required a service to be provided to the athlete.

Conclusion: While many positive screens did not require new clinical interventions, the proportion of athletes receiving follow-up care (43.1%) or were already in care (26.0%), underscores the need for diverse psychological resources to support elite athlete mental health. The inability to reach 20.4% of athletes following a positive screen suggests that alternative approaches for the deployment of the SMHAT-1 may be needed to allow for immediate clinician follow-up care. These findings support ongoing SMHAT-1 use and highlight the need for sufficient psychological services resources to meet athletes' follow-up needs.

Objective: Handball is a popular team sport with injury risks, especially to the shoulder. This systematic review aims to assess the effectiveness of prevention programmes in reducing the incidence of shoulder injuries in handball.

Design: Systematic review with meta-analysis.

Data sources: The systematic review was conducted using Embase, PubMed and Cochrane databases with specified keywords.

Eligibility criteria for selecting studies: Inclusion criteria encompassed randomised clinical trials focusing on adult and youth handball players, involving a preventive programme with specific exercises to reduce shoulder injuries, with a control group maintaining regular warm-up.

Results and summary: The initial database search identified 224 records (107 articles from Embase, 85 from PubMed and 32 from Cochrane). Five articles met inclusion criteria which recruited 1872 players (977 females/895 males). The programmes were varied but all included muscle strengthening exercises. Depending on the programme, they also incorporated exercises concerning range of motion, scapular, trunk and neuromuscular. Results from three studies included in the meta-analysis showed no significant difference in shoulder injury incidence rates between prevention programme and usual warm-up (OR: 0.73; 95% CI: 0.45 to 1.17; n=747).

Conclusion: This study did not demonstrate the effectiveness of prevention programmes for handball shoulder injuries and emphasises the need for more standardised research protocols to improve knowledge in this area.

Prospero registration number: CRD42022356497.

Abstract:

Objective: To (1) describe the incidence and characteristics of injuries and illnesses reported by Team USA athletes competing in the 2024 Paris Summer Olympic Games (PSOG) and Paralympic Games (PSPG); (2) compare injury and illness incidence between Olympic and Paralympic cohorts and (3) quantify the burden of respiratory and thermoregulatory illnesses under standard (post-COVID) public health conditions.

Methods: The United States Olympic & Paralympic Committee (USOPC) Injury and Illness Surveillance system was used to document the details of all injuries and illnesses reported by any of the 862 athletes, alternates and guides competing for Team USA in the PSOG and PSPG. Illness and injury incidence per 1000 athlete-days (AD) and incidence ratios (IR) were calculated, both with 95% CI.

Results: Team USA Paralympic athletes sustained 20.5 injuries per 1000 AD versus 14.6 among Olympic athletes (IR (95% CI): 1.4 (1.1 to 1.8)). Illness incidence was 15.7 per 1000 AD among Paralympic athletes versus 8.3 in Olympic athletes (IR (95% CI): 1.9 (1.4 to 2.6)). Among Team USA Paralympic athletes, injuries sustained outside of sport settings accounted for 38.5% (30/78) of all Paralympic injuries, the largest single setting category. The most common system affected by illness at both PSOG and PSPG was the respiratory system, with 7.4% of all athletes reporting a respiratory illness. Despite concerns ahead of the Games related to extreme heat, only two (0.3%) Olympic athletes and zero (0.0%) Paralympic athletes from Team USA reported a heat-related illness.

Conclusion: Injury and illness rates were higher among Team USA Paralympic athletes compared with Olympic athletes during the Paris 2024 Games. Respiratory illnesses were the most frequent medical problem, despite a pre-Games prevention campaign, highlighting the need for stronger infection-control strategies at future Games. The absence of heat illness suggests current heat-mitigation measures were effective. Comprehensive injury-prevention and illness-prevention strategies are needed for both Olympic and Paralympic athletes, with additional attention to the environmental and accessibility risks that disproportionately affect Paralympic competitors.

Menstrual cycle tracking is increasingly recognised as an important aspect of supporting female athletes. However, its application in football remains inconsistent and under-researched. This consensus statement, initiated by the Union of European Football Associations Medical and Anti-Doping Unit, provides evidence-informed guidance on best practices for menstrual cycle tracking in women's football. Developed using the RAND-UCLA appropriateness method, the consensus involved a multidisciplinary expert panel that reviewed the literature and reached agreement on 82 statements across five key domains: the rationale for tracking, meaningful metrics, appropriate methods, implementation strategies and methodological considerations for research. The consensus underscores that while current evidence linking menstrual cycle phases to performance or injury risk remains inconclusive, tracking can support athlete well-being by identifying menstrual irregularities, managing symptoms and enhancing player education and autonomy. Practical recommendations are provided for measuring cycle characteristics, ovulation, hormonal profiles and symptoms, whereas ethical and cultural considerations are emphasised. This statement aims to promote standardised, athlete-centred tracking protocols and establish priorities for practice and future research in female football.

Previous research has shown that stakeholders in the competitive alpine skiing communities consider risk management to be crucial in sports injury prevention. However, to date, there is a lack of a publicly available systematic and structured risk management approach for the competitive alpine skiing context. This work describes the codevelopment process of a risk management framework with stakeholders in the field of competitive alpine skiing. A panel of international experts invited through personal requests and with expertise in health protection and performance enhancement in competitive alpine skiing convened three times through online group meetings to co-develop a risk management framework through different activities. The underlying discussions focused on the fundamental questions of 'why', 'what', 'who', 'how' and 'for whom' and included the debate on specific examples from sports practice. The outcome after three meetings was a risk management framework. This framework includes a competitive alpine skiing-specific prevention wheel that integrates different stakeholder views relevant to different levels, their risk priorities, the main five domains and intervention areas identified from the literature, the graded and progressive timescale to intervene and the potential targets for risk management interventions. Moreover, the framework includes a decision-making tree, which operationalises the prevention wheel into a step-by-step sequence for risk management, including risk identification, risk assessment and risk mitigation. It should help stakeholders recognise their responsibilities and the potential actions they can take. Practical examples are provided to demonstrate how to apply the framework and to illustrate the complexity and dynamic interaction of the various factors in the competitive alpine skiing setting. The risk management framework developed lays a strong foundation for creating a safer environment for alpine skiers. It likewise contributes to providing overall awareness of the complexity and inter-relations of risks and prevention measures in the sport. By doing so, this framework has the potential to initiate further processes and on-field translation to sustainably and long-term improve athlete health and safety in competitive alpine skiing.

Objective: To describe the prevalence and nature of Olympic-career related injuries and illnesses, and behaviours during injury/illness, in Olympians in the 4 years prior to their participation at the Tokyo 2020 and Beijing 2022 Olympic Games.

Methods: 315 current Olympians from 70 countries completed a cross-sectional online survey, distributed by direct email through National Olympian Associations and World Olympians Association databases. Questions included Olympic sport exposure, significant training and competition injury and illness history (lasting >2 weeks) and athlete behaviours during injury/illness.

Results: 65% of Olympians were women (35% men), representing 51 sports (37 summer, 14 winter), aged 28.6 years (4.6). Overall, 58.5% (95% CI 52.2% to 64.9%) of summer and 55.6% (95% CI 44.7% to 66.4%) of winter Olympians were injured, with knee injuries most frequent (19.6% summer, 27.8% winter Olympians). Injury rates were similar between males and females. 17.1% (95% CI 12.3% to 21.9%) of summer and 23.5% (95% CI 13.1% to 31.3%) of winter Olympians were ill, with respiratory illness most frequent. Illness rates were (non-significantly) higher for female versus male winter Olympians (adjusted relative risk 2.04 (95% CI 0.73 to 5.76)) but similar between male and female summer Olympians. 78% of Olympians said they put the most pressure on themselves to return from injury/illness quickly. Almost half reported using painkillers during injury, while one-quarter continued full training/competition during injury/illness. Injury and illness prevalence followed similar bimodal and trimodal seasonal patterns for summer and winter Olympians, respectively.

Conclusions: Olympians report a significant history of injury and illness across the 4 years before the Olympic Games. A biopsychosocial approach that supports athletes during injury/illness absences is needed. Concurrent injury/illness prevention strategies should be considered to reduce the burden of both injuries and illnesses at key times in an athlete's season.