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Background: Psychological determinants are increasingly recognized as central contributors to both performance decline and recovery in competitive sport; however, contemporary evidence integrating injury-related and non-injury performance contexts remains fragmented.

Objective: This systematic review synthesized empirical evidence (2016-2025) examining psychological determinants associated with return to sport (RTS), reinjury risk, burnout, injury incidence, and performance decline among competitive athletes.

Methods: Conducted in accordance with PRISMA 2020 guidelines, a systematic search of PubMed, Scopus, Web of Science, and SPORTDiscus identified peer-reviewed studies published between January 2016 and December 2025. Eligibility criteria were defined using a PICO framework. Prospective cohort studies, longitudinal multi-wave investigations, one randomized controlled trial, matched cohort studies, diary-based designs, and injury-related observational studies were included. Due to heterogeneity in constructs and outcomes, findings were synthesized narratively.

Results: Fourteen studies met the inclusion criteria, including prospective cohort studies, multi-wave longitudinal designs, one randomized controlled trial, one matched cohort study, and a diary-based investigation. Seven independent cohorts examined psychological readiness using the Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI) in athletes with anterior cruciate ligament (ACL) injuries (sample sizes ranging from n = 39 to n = 384), consistently demonstrating that higher readiness predicted successful RTS at 6-24 months, while two prospective studies reported contrasting associations with second ACL injury risk. Four longitudinal studies (n = 93-491) showed that increased burnout and controlled motivation predicted performance decline and dropout trajectories, whereas higher resilience and mental toughness reduced burnout progression. One seasonal longitudinal study (n = 21) linked elevated cognitive anxiety and mood disturbance to increased injury incidence.

Conclusion: Psychological determinants operate across deterioration and restoration pathways. Psychological readiness shows the strongest predictive consistency for RTS, while burnout, motivational climate, and resilience significantly shape long-term performance sustainability and injury-related outcomes.

Biological differences between sexes-particularly due to fluctuating levels of 17β-estradiol and menstrual cycle dynamics-may influence exercise-induced reactive oxygen species (ROS) formation, inflammation and exercise performance. Despite these considerations, there is a lack of research exploring how estradiol and menstrual cycle phases may impact exercise performance, exercise-induced ROS formation and inflammation. This study aimed to examine whether estradiol concentration or menstrual cycle phase may be significantly associated with resistance circuit high-intensity interval training (HIIT) performance, as well as exercise-induced formation of ROS and Interleukin-6 (IL-6). A total of 30 young healthy female participants completed a single bout of resistance-based HIIT in a fasted state. Blood samples were collected at four time points: at baseline after overnight fasting, two hours after consumption of 0.5 L of water (pre-HIIT), immediately post exercise (post-HIIT) and after 15 min of recovery (15-post-HIIT). Additionally, participants attended six fasting baseline assessments scheduled across various menstrual cycle days. These sessions enabled the assessment of estradiol, ROS and IL-6 concentrations throughout the menstrual cycle without being confounded by nutritional factors. Neither baseline levels of ROS nor IL-6 differed significantly between menstrual cycle phases (luteal vs. follicular ROS: 0.013 µmol/min, p = 0.716; IL-6: 0.052, p = 0.679) menstruation status (yes vs. no ROS: -0.056 µmol/min, p = 0.259; IL-6: -0.302 pg/mL, p = 0.088) or 17β-estradiol concentrations (low (11-≤72.5 pg/mL) vs. high (>72.5-394 pg/mL) ROS: -0.038 µmol/min, p = 0.266; IL-6: +0.015 pg/mL, p = 0.906). On the resistance-circuit-HIIT intervention day, no significant differences in ROS or IL-6 were observed between estradiol concentrations (ROS: p = 0.477; IL-6: p = 0.249), menstrual cycle phase (ROS; p = 0.752; IL-6: p = 0.557) or menstruation status (ROS: p = 0.383; IL-6: p = 0.808) from baseline to pre-HIIT, post-HIIT or 15-post-HIIT. These findings should be interpreted with caution, as the menstrual cycle phases were assigned using a calendar-based approach without biochemical ovulation confirmation and the subgroup sizes were relatively small. These findings suggest that natural 17-beta-Estradiol fluctuations within the menstrual cycle, as well as differences in the menstrual cycle itself, may not substantially modulate ROS or IL-6 responses to acute resistance-based HIIT in young healthy female adults.

The aim of this study was to understand the female swimmers' annual performance progression and stability between 10 and 18 years across swimming distances and techniques. Data from female Portuguese Top-50 rankings in the short-course pool was extracted from an open access database (swimrankings.net). Performances were grouped by distances (50-, 100- and 200 m) and techniques (freestyle, backstroke, breaststroke and butterfly), totalizing 12 events as performance metrics. A total of 343 swimmers and 3087 performances distributed by nine consecutive competitive seasons were retrospectively assessed. The mean and normative stability were computed for tracking performance trends, while reporting the year-to-year percentage improvement. The differences across distances and techniques were tested with a linear mixed-effects model using intraclass correlation coefficient (ICC). The performance progression was characterized by marked improvements during the early ages (up to 13% yearly) and an emerging plateau around the 15-16 years. The stability patterns varied between events, with the backstroke technique (ICC = 0.13) demonstrating greater consistency of individual differences on developmental trajectories, whereas shorter races (i.e., 50 m; ICC = 0.15) tended to be more stable than 100 m or 200 m (ICC = 0.12). It can be concluded that female swimmers' performance stabilizes at the 15-16 years of age. Despite reduced differences, the backstroke technique and short distances seem to show a slightly more stable trend in progressing from childhood to adulthood.

This study aimed to collect survey data on physical activity and organized sport participation among children across different weight categories. Using online data collection, 906 parents provided information about 1002 children (age = 10.9 ± 2.5 years, body height = 150.2 ± 16.4 cm, and body mass = 42.4 ± 15.8 kg). Most children (79%) achieved the recommended 60 min. of moderate-to-vigorous physical activity (MVPA) per day; 50% participated in club sports; and 41% took part in organized sports. Most of them (69%) were in the healthy weight category, 7% were underweight, and 22% of the children were overweight or obese. Participation in sports activities among overweight and obese children was nearly as high as among their peers. Achieving 60 min. of MVPA/day was associated with significantly lower odds (OR = 0.51 CI: 0.30-0.85; p < 0.01) of childhood obesity in the total sample. Football was the most popular club and organized sport among boys, while dancing was most preferred among girls. The preferred sports were generally well-suited to the respective weight categories. The relatively high levels of physical activity observed may be explained by daily physical education (PE) classes in schools and governmental support for sports. Our findings suggest that further research is needed to support effective obesity prevention, particularly those examining dietary habits and other lifestyle factors.

Background: The COVID-19 pandemic posed unprecedented challenges for elite athletes, disrupting training routines and affecting mental health. This study examined the impact of social isolation on training, sleep, motivation, and psychological well-being among Portuguese Paralympic athletes.

Methods: Forty-five athletes (31.36 ± 10.81 years) from the Paralympic Preparation Program participated, divided into the Paralympic Preparation Project (PPP; n = 21) and the Paralympic Hopes and Talents Project (PHTP; n = 24). Training routines before and during social isolation were compared. Sleep duration, training motivation, and mental health were assessed using the Mental Health Inventory-5 (MHI-5). The analysis employed paired and independent t-tests and a multiple linear regression (Enter method) to examine predictors of mental health.

Results: Daily training duration declined by 34.3% (p < 0.001), though weekly frequency remained stable (p = 0.061). PPP athletes reported higher mental health scores than PHTP athletes (66.24 vs. 60.37; p = 0.048). The regression model explained 42.8% of the variance in mental health (R² = 0.428). Sleep duration was positively associated with mental health and showed the highest standardized coefficient in the regression (β = 0.351; p = 0.008), followed by PPP status (β = 0.315; p = 0.024) and motivation (β = 0.278; p = 0.041).

Conclusions: Maintaining biological routines, particularly sleep and motivation, supports mental health under social isolation. Higher well-being among PPP athletes underscores the need for targeted interventions for less experienced athletes. Sports organizations should prioritize sleep hygiene and psychological support to mitigate vulnerability during crises.

Bone health in highly trained female athletes is critical for performance and long-term wellbeing, yet systematic evidence regarding seasonal changes remains limited. The main objective of this systematic review (PROSPERO ID: 420251230393) is to determine changes in bone mineral density (BMD) and bone mineral content (BMC) across the sport macrocycle in highly trained female athletes, encompassing both elite and collegiate (NCAA) populations. Six databases were searched for studies published between 2010 and 2025, with inclusion requiring female athletes, BMD/BMC measurements, and longitudinal assessment across a macrocycle. Fourteen studies involving 522 premenopausal athletes were included, with dual-energy X-ray absorptiometry measurements conducted approximately six months apart. Study quality was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and indicated a predominantly good quality. Five studies reported no significant change in BMD/BMC, five demonstrated improvements, three reported mixed findings across sports or athlete subgroups, and one reported a significant decline. Only two studies attempted to account for all three primary confounders-menstrual cycle status, dietary intake, and physical activity monitoring-while seven reported no confounding variables. While bone health appears largely maintained across the sport macrocycle in highly trained premenopausal female athletes, these findings should be interpreted cautiously given the inadequate confounder reporting, heterogeneous sport exposures, variability in skeletal sites measured, and inconsistent measurement timing. Future research must comprehensively assess these variables alongside sport-specific skeletal measurements to identify athletes at risk of bone health deterioration.

This study analysed the potential influence of crew size on performance (stroke rate, strokes/min; distance travelled, m/min; and average power, W), physiological responses (post-exercise heart rate and heart rate measured three minutes after exercise) and perceptual responses (Borg scale). A total of 136 adolescent athletes (100 males and 36 females; mean age = 15.79 ± 1.14 years) performed four three-minute maximal-effort trials on a rowing ergometer across four conditions: individual trials (C1), two-person crews (C2), four-person crews (C3), and eight-person crews (C4). Results showed a significant increase in stroke rate (strokes/min) in both sexes as crew size increased (C1 33.16 ± 2.54 vs. C4 34.19 ± 2.21 strokes/min; C1-C4 p = 0.01; C2-C4 p = 0.003). Men reported greater perceived exertion in C1 compared with C4 (Borg 7.80 ± 0.79 vs. 7.46 ± 0.74; p = 0.032), despite no associated changes in performance (863.88 ± 45.10 vs. 863.26 ± 47.63 m/min) or average power (311.71 ± 46.43 vs. 311.44 ± 50.43 W), whereas no differences in perceived exertion were observed in women (Borg 7.59 ± 0.84 vs. 7.56 ± 0.76). Cardiovascular responses were similar across sexes and experimental conditions. In summary, these preliminary findings could point toward the existence of sex-differentiated patterns. The data appear to suggest a more pronounced tendency toward the 'crew-size effect' among the men in the sample, whereas an inclination toward maintaining individual responsibility is observed in the women.

This study investigated interlimb asymmetries in lower limb performance using both vertical and horizontal jump tests in elite young basketball players. Specifically, it aimed to determine whether (1) unilateral jump performance and (2) the magnitude of interlimb asymmetry differed across maturity groups, whether (3) limb dominance influences performance, and whether (4) asymmetry direction is consistent across tests. One hundred elite male basketball players (U13 to U19) were categorised into three maturational stages: Pre-PHV (n = 19), Circa-PHV (n = 29), and Post-PHV (n = 52). Each athlete performed the following unilateral tests with both the dominant and non-dominant leg: single-leg hop, triple hop for distance, 6 m timed hop, single-leg countermovement jump (SL-CMJ), and single-leg drop jump (SL-DJ) from a 30 cm box. The Bilateral Strength Asymmetry (BSA) index was computed for each test. All tests showed significant differences between Pre-PHV and Circa-PHV groups (p < 0.001), whereas only the 6 m timed hop differed between Circa-PHV and Post-PHV (p < 0.01). BSA did not differ significantly across maturation stages in any test, except for the single-leg hop. Agreement in asymmetry direction between test pairs was slight to fair (kappa ≤ 0.29). BSA values remained largely stable across maturational stages, suggesting that interlimb asymmetries are established before PHV, likely during childhood. Limb dominance did not affect jump performance, and asymmetry direction varied between tests, confirming they are not interchangeable.

Post-exercise appetite loss may interfere with adequate recovery nutrition in athletes; however, the substantial inter-individual variability in appetite responses remains insufficiently understood. This exploratory cross-sectional study investigated lifestyle- and health-related factors associated with post-exercise appetite loss in 35 female university athletes. Appetite loss was assessed as a self-reported binary outcome (often, sometimes/never). Associations with subjective sleep quality and other lifestyle-related variables were examined using contingency analysis, followed by exploratory logistic regression. Post-exercise appetite loss was reported by 74.3% of participants and did not differ across sports disciplines, indicating that the sport type alone did not explain the observed variability. Poor/fair subjective sleep quality was associated with appetite loss (OR = 11.6, 95% CI: 1.9-73.6) and remained associated in the multivariate model. Other lifestyle-related variables were not independently associated. These findings imply a potential connection linking post-exercise appetite responses in female university athletes to broader lifestyle-related factors, particularly subjective sleep quality, rather than exercise characteristics alone. Monitoring sleep quality may therefore help identify athletes who may be at risk of insufficient post-exercise energy intake and compromised recovery. Further studies with larger samples and longitudinal designs are needed to clarify these relationships.

Background: Handball involves unilateral, high-demand actions that increase injury risk. The Windlass mechanism (WM) is a position-dependent plantar fascia tensioning system, activated by dorsiflexion of the first metatarsophalangeal joint, which increases medial longitudinal arch stiffness and contributes to foot stability. WM activation can be mechanically simulated using hallux wedges to induce controlled dorsiflexion, allowing graded engagement of the mechanism under standardized conditions. The primary aim of this study was to investigate how different wedge inclinations, with and without visual biofeedback, affect foot muscle activity during squats in elite female handball players.

Methods: Seventeen elite female handball players performed squats at 65% of one-repetition maximum under six conditions combining three wedge inclinations (0°, 10°, 30°) with the presence or absence of visual biofeedback. Electromyographic activity (RMS and %MVC) of intrinsic and extrinsic foot muscles was recorded.

Results: A significant increase in left abductor hallucis activation with the 10° wedge without biofeedback. Visual biofeedback significantly increased RMS and %MVC in intrinsic foot muscles and increased RMS in the left gastrocnemius (p < 0.05). No significant interaction was observed between wedge inclination and biofeedback.

Conclusions: Controlled activation of the WM via hallux wedges and the use of visual biofeedback modulate foot muscle activity during squats. These strategies may be considered in training programs aimed at improving foot stability and reducing injury risk in elite female handball players.