BMJ Open Sport & Exercise Medicine最新文献

Effective youth sport injury interventions exist, but their use in applied settings is limited by low coach adherence and lack of contextual adaptation. To address this, the #Utviklingsklar intervention was developed, a club-based intervention for youth handball and football, based on interdisciplinary programme theory and collaboration with sport organisation partners and user groups (club leaders, coaches, parents, players). The intervention supports coaches and club leaders in developing team-specific plans to improve injury-preventive practices for warm-up, strength training and pain and injury management. This qualitative feasibility study, based on observation and interview data, examines the acceptability, practicality, possibilities and challenges of #Utviklingsklar's e-learning and workshop activities. Three workshops led by physiotherapists were observed, involving 23 participants (17 coaches, three club leaders and three workshop leaders). Subsequently, 15 participants consented to be interviewed, comprising 10 coaches, two club leaders and three workshop leaders. Data were analysed using deductive thematic analysis principles. The e-learning was found to be user-friendly, accessible and relevant, while the workshop was valued for fostering discussions and collaboration around team-specific injury prevention plans and practices. However, some coaches sought more tailored content (ie, topics related to their own specific training sessions and players), and workshop leaders expressed a need for additional preparation and practice time to feel confident in their roles. Improved communication of #Utviklingsklar's flexible approach, along with enhanced preparation and practice for workshop leaders in supporting coaches' and club leaders' development of team-specific plans and practices, is needed to enhance understanding and engagement across clubs.

Objective: Recovery duration following adolescent sport-related concussion (SRC) is variable. Previous research revealed exercise intolerance is associated with delayed recovery (predominantly male Australian cohort). Additional sport contexts and considerations of sex are necessary. This study investigated sex-specific associations between exercise intolerance and time-to-medical clearance to return-to-sport (RTS) following SRC in adolescents (ages 10-19).

Methods: Adolescent athletes participating in the pan-Canadian SHRed Concussions cohort study were included within 14 days following a physician diagnosed SRC. Participants completed the Buffalo Concussion Treadmill Test (BCTT). Pre-BCTT Sport Concussion Assessment Tool 5 (SCAT5) Symptom Severity Score (SSS;/132) and concussion Overall Condition score (OC;/10) were recorded. Termination criteria for BCTT were participants who experienced ≥3/10 increase for OC (exercise intolerant) or reached volitional fatigue (≥180bpm, ≥18/20 rating of perceived exertion, exercise tolerant).

Results: 281 adolescents (126 male and 155 female), of whom 204 (72.6%) (100 male (79.4%), 104 female (67.1%)) were exercise tolerant and 77 (27.4%) (26 male (20.6%), 51 female (32.9%)) were intolerant following SRC. Based on the point estimate, females had a 1.45 times higher risk of exercise intolerance compared with males (risk ratio=1.45, 95% CI 0.96 to 2.20). Exercise intolerance was associated with a 36% longer medical clearance time to RTS following SRC for females (time ratio=1.36, 95% CI 1.12 to 1.64), while for males, no association was observed (time ratio=1.13, 95% CI 0.90 to 1.42) (adjusted for age, BCTT duration, SCAT5 SSS and days from SRC to BCTT).

Conclusion: Exertion testing may identify female adolescents at higher risk of delayed medical clearance recovery to RTS, informing the comprehensive clinical management of SRC.

Despite the developmental benefits of sport in adolescence, injury is common and can have a profound impact beyond just physical symptoms. This qualitative study aims to explore the lived experiences of adolescent athletes with sports- related injury in Ireland. This was a qualitative study using one-on-one semi-structured interviews and a phenomenology method. Twenty-one secondary school students from across the Island of Ireland aged 15-18 years who had experienced a sports-related injury within the last 2 years agreed to take part. Reflexive thematic analysis was used to analyse the collected data. Seventeen adolescents (eight female, mean age 16.2 (range 15-18) years) from five different sports were included for analysis. Predominantly negative experiences were described with four overarching themes identified through thematic analysis: playing through pain and injury, the social influence on playing through pain and injury behaviour, the psychological impact of sports injury and player confidence and its role in returning to sport. In conclusion, a culture of playing through pain and even injury is widely accepted in adolescent sports and is influenced by the social circles that surround these young athletes. The impact of sports injury goes beyond just the physical, with these athletes experiencing devastation and a loss of identity due to their absence from sport. Sports coaches can help reduce this negative impact by keeping injured players involved in the team/sport as much as possible. Conversely, sports injury also provided opportunity for personal growth in some cases, improving mental resilience and self-reliance.

Objective: Junior Australian football players with sport-related concussion (SRC) often do not access optimal healthcare. We aimed to evaluate the feasibility of an industry-supported healthcare programme that removed financial and logistical barriers to accessing care for SRC and adherence to the Australian Football League's (AFL) SRC management guidelines.

Methods: Junior Australian football players (from a Melbourne-based league of 9852; under 8-18 competitions) who sustained a suspected or diagnosed SRC during the 2023 season were recruited. Players underwent assessment and management for SRC by a sport and exercise medicine registrar, including return to school and play planning in accordance with the AFL guidelines. Outcomes included programme demand, implementation, acceptability and adherence to the AFL's guidelines (median, (range) days for return to school, training and play).

Results: From 154 eligible players, 58 (37.7%) participated, resulting in a weekly demand of 4.1 players (95% CI 3.1 to 5.2). 49 players were diagnosed with an SRC, and 9 players were cleared for SRC at their initial appointment. 44 players with SRC (89.8%) adhered to all medical advice and returned to play after receiving a medical clearance. All players returned to school (1 (0-10) days), unrestricted training (16 (2-53) days) and play (21 (7-63) days).

Conclusion: The low programme demand indicates financial constraints and/or access to medical practitioners are not the main barriers for players with suspected SRC to formally seek healthcare in a metropolitan context. Those who did participate demonstrated high levels of appointment attendance, acceptability and adherence to AFL guidelines.

Objectives: To examine the contribution of walking, running and cycling to moderate-to-vigorous physical activity (MVPA) and total physical activity (TPA) across and within seasons in adolescents and adults.

Methods: We included 4433 adolescents (mean age 15.4 years, range 13-17, 56.4% female) and 28 082 adults (mean age 53.1 years, range 18-103, 56.9% female) who participated in the population-based HUNT Study from 2017 to 2019. Participants wore two accelerometers (mean wear time 5.6 days (SD 1.1), range 1-7 days), one on the thigh and one on the lower back, to determine MVPA (defined as moderate/brisk walking (>4.0 km/hour), running and cycling) and TPA (MVPA plus slow walking (≤4.0 km/hour)).

Results: Median MVPA (min/week) across seasons was 224 (36% of TPA) in adolescents and 152 (24% of TPA), 150 (22% of TPA), 100 (17% of TPA) and 34 (8% of TPA) in adults aged 18-49, 50-64, 65-74 and ≥75 years, respectively. Slow walking constituted 64% of TPA across seasons among adolescents, increasing to 92% among those aged ≥75 years.Within seasons, moderate/brisk walking constituted 77-82% of MVPA in adolescents and 72-99% in adults. Adolescents accumulated 104 min/week (IQR 58-175) less MVPA during winter than summer. The corresponding differences in adults aged 18-49 and 50-64 years were 59 (40-90) and 51 (33-77), min/week, respectively. Seasonal differences in MVPA were less pronounced in the age groups 65-74 and ≥75 years.

Conclusion: Moderate/brisk walking is the main contributor to MVPA in adolescents and adults. The level of MVPA, its seasonal variation and its relative proportion of TPA decrease from adolescence throughout adulthood.

Objectives: To describe the characteristics of COVID-19 among elite Japanese athletes and their return-to-play (RTP) time.

Methods: We retrospectively reviewed clinical records at the Japan Institute of Sports Sciences between June 2022 and May 2023. Elite athletes who underwent periodic health examinations were examined by a physician to confirm COVID-19 history, symptoms and the RTP time.

Results: Of 994 athletes, 456 had a COVID-19 history (mean±SD, 23.3±4.6 years; 56% male). Most infections occurred during the sixth wave (Omicron variant), followed by the seventh and eighth waves, with 88% recorded after the fifth wave. Indoor athletes were more frequently affected than outdoor athletes (306 vs 150, p<0.05). Badminton athletes were the most commonly affected athletes (16%), followed by volleyball (10%) and handball (7%). Among those with a history of COVID-19, 89% reported symptoms, while 11% were asymptomatic. Fever was the most common symptom (80%), followed by sore throat (58%) and cough (44%). The median (IQR) RTP time was 10 (7-14) days. Overall, 472 athletes resumed play within 28 days, while 20 returned after 28 days. RTP delays were more frequent before Omicron (9/59 athletes) than after (11/433 athletes, p<0.05).

Conclusion: COVID-19 was more common among indoor sports athletes, primarily during the Omicron wave, with most cases being symptomatic but resolving quickly. These findings likely reflect factors such as close-contact training, immune changes during intensive training and international travel and may help characterise COVID-19 outcomes in elite athletes.

Objectives: Our aim was to describe the absence days caused by the 30 most frequent injury diagnoses in elite European women's club football.

Methods: Members of the medical staff in football clubs participating in the Union of European Football Associations (UEFA) Women's Elite Club Injury Study (WECIS) reported injury occurrences from a total of 72 team-seasons. Injury absence was defined as the number of days between injury occurrence and when the injured player was allowed to return to full participation by the medical team.

Results: In total, 2 390 injuries were registered and included in the study. Sixty-six per cent of these injuries were included among the 30 most common injury diagnoses. Most of the injuries included among the 30 most common were mild leading to a median absence of 7 days or less in 397 cases (23%) or moderate leading to a median absence of 7-28 days in 1177 cases (69%). Severe injuries accounted for a median absence of ≥28 days in 140 cases (8%) were less common and included only four diagnoses, all related to knee injuries. These four diagnoses, however, caused 35% of all absence during the study period.

Conclusion: Most of the time lost due to injuries in elite European women's football teams results from moderate and severe injuries. This article provides guidelines for expected time-loss for the most common injury types in women's professional football and will aid clinicians to make more accurate estimations of when players can be expected to return to participation following injuries.

Objectives: To describe injury epidemiology in British basketball, assess sex-based differences and injury risk factors.

Methods: 122 athletes from British basketball leagues and national teams completed an online questionnaire collecting demographic, sporting and injury data from the 2021/2022 season. A medical-attention and 24-hour time-loss injury definition was used. Injury incidence rate (IIR) (injuries/1000 athlete-exposure (AE) hours) was calculated as (number of injuries/season AE-hours)×1000. Mann-Whitney tests assessed sex differences in IIRs. Χ² tests assessed sex differences in injury proportions. Linear regression assessed relationships between IIR and reported risk factors.

Results: 46 men and 76 women (median age (IQR): 23.0 years (19.0-26.0)) reported 140 injuries. Median IIR was 2.1 injuries/1000 AE-hours (IQR: 0.0-3.5). Lower limb injuries were most common (70.7%), specifically ankle (32.9%) and knee (25.7%). No significant sex differences were noted in injury site, type, mechanism, timing or severity. Higher IIR was associated with advancing age (B=0.182, 95% CI: 0.038 to 0.325, p=0.014), increased weight (B=0.140, 95% CI: 0.071 to 0.210, p≤0.001), female sex (B=2.214, 95% CI: 0.424 to 4.003, p=0.016), comorbidities (B=2.782, 95% CI: 0.967 to 4.598, p=0.003) and 1-3 years of elite experience (B=2.950, 95% CI: 1.561 to 4.340, p≤0.001 vs 3-8 years). Guards (B=4.996, 95% CI: 3.603 to 6.389, p≤0.001) and forwards (B=3.180, 95% CI: 1.627 to 4.732, p≤0.001) were associated with higher IIR than centres.

Conclusion: Lower limb injuries were most common. IIR was positively associated with age, weight, female sex, comorbidities and 1-3 years of elite experience. Guards and forwards had the strongest associations compared with centres. Findings may inform targeted injury prevention strategies. Future research should prospectively assess injury risk.

Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a global health issue due to its high prevalence, yet the impact of accelerometer-measured physical activity on clinical outcomes remains unclear. This study aims to examine the associations of physical activity with the risk of liver cirrhosis, cancer, cardiovascular disease (CVD) incidence and mortality.

Methods: 32 681 MASLD participants with accelerometer-derived physical activity data from the UK Biobank were analysed. Physical activity intensity was categorised into light (LPA), moderate (MPA) and vigorous (VPA) intensity. Cox proportional hazard and acceleration failure models were employed to assess associations between physical activity duration and outcomes.

Results: During a median follow-up of 7.5-7.9 years, 1883 deaths, 151 liver cirrhosis, 3312 cancers and 6657 CVD events were recorded. Physical activity, regardless of intensity, was consistently associated with a reduced risk of liver cirrhosis, CVD and all-cause mortality. Compared with non-MASLD individuals, our analysis indicates that longer duration of physical activity, specifically >1945 min/week of LPA or >383 min/week of MPA may theoretically eliminate the excess risk of mortality associated with MASLD.

Conclusions: Among MASLD individuals, longer physical activity duration, regardless of intensity, was associated with reduced risks of liver cirrhosis and mortality. MPA and VPA were associated with lower CVD risk, while VPA was associated with reduced cancer risk, highlighting the potential benefits of increasing the intensity and duration of physical activity in MASLD management.

Objectives: To assess the mental health status of referees in Cameroonian professional football and identify associated risk factors.

Methods: A cross-sectional analytical study was conducted among referees from the Cameroon Elite One, Elite Two and Female Super League during the 2024-2025 season. The Depression Anxiety Stress Scale-21 was used to assess mental health status after officiating a match, classifying scores as normal, mild, moderate, severe or extremely severe for depression, anxiety and stress symptoms. Data were analysed using R Studio (V.4.2.2). Logistic regression identified associations with statistical significance set at p<0.05.

Results: Out of 179 professional referees in Cameroon, 150 (83.8%) participated. Ages ranged from 18 to 45 years (mean=30±5.86 years). Depression symptoms were observed in 28%, with higher rates in assistant referees (32.4%) than in central referees (23.7%). Anxiety symptoms were present in 42.7% of participants, while 12% exhibited stress symptoms. Lower level referees had higher levels of all symptoms. Notably, 90.5% of referees with symptoms of depression had at least one additional mental health symptom. Severe symptoms of depression co-occurred with severe anxiety and stress symptoms. Having another profession significantly increased risks of depression symptoms (p=0.007, OR 7.7) and anxiety (p=0.003, OR 4.2). Performance concerns were the main psychological stressor (74.0%).

Conclusion: Cameroonian referees experience high levels of depression, anxiety and stress symptoms, with assistant referees more affected. Holding another profession increases mental health risks. Targeted interventions are needed to address psychological stressors and improve referees' well-being.