Sports Health-A Multidisciplinary Approach最新文献

Background: The combination of transcranial direct current stimulation (tDCS) with balance training could integrate central and peripheral neural mechanisms. This study aimed to investigate the effects of concurrent balance training and tDCS over the supplementary motor area (SMA) on anticipatory postural adjustments during gait initiation (GI) in persons with chronic ankle instability (CAI).

Hypothesis: Balance training will increase the center of pressure (COP) velocity and displacement during GI phases in all participants, and those receiving real tDCS will show greater increases.

Study design: Randomized controlled trial.

Level of evidence: Level 2.

Methods: A total of 32 subjects were allocated to 2 groups: (1) intervention (balance training plus real tDCS) and (2) control (balance training plus sham tDCS). Outcome measures were COP-related parameters (displacement and velocity) during phases of GI (anticipatory, weight transition, and locomotor).

Results: The results showed that, in the anticipatory phase, the anteroposterior displacement of the COP was increased significantly at posttest relative to pretest across both groups, F(1,30) = 5.733, P = 0.02. In addition, both groups revealed an increase in the mediolateral COP velocity at posttest, F(1,30) = 10.523, P < 0.01. In the weight transition phase, both groups had higher mediolateral COP velocity at posttest, F(1,30) = 30.636, P < 0.01. In the locomotor phase, in both groups, the anteroposterior COP velocity was increased significantly at posttest compared with pretest, F(1,30) = 5.883, P = 0.02.

Conclusion: Both groups demonstrated improvements in the anticipatory and execution phases of GI. Since no between-group difference was found, it can be interpreted that the anodal tDCS applied over the SMA has no added value over sham stimulation.

Clinical relevance: Balance training is beneficial for persons with CAI and can improve the anticipation and execution phases of GI without the aid of brain stimulation.

Background: Maximal oxygen uptake (VO_2max) is an important determinant of endurance performance. Heat acclimation/acclimatization (HA/HAz) elicits improvements in endurance performance. Upon heat exposure reduction, intermittent heat training (IHT) may alleviate HA/HAz adaptation decay; however, corresponding VO_2max responses are unknown.

Hypothesis: VO_2max is maintained after HAz/HA; IHT mitigates decrements in aerobic power after HAz/HA.

Study design: Interventional study.

Level of evidence: Level 3.

Methods: A total of 27 male endurance runners (mean ± SD; age, 36 ± 12 years; body mass, 73.03 ± 8.97 kg; height, 178.81 ± 6.39 cm) completed VO_2max testing at 5 timepoints; baseline, post-HAz, post-HA, and weeks 4 and 8 of IHT (IHT₄, IHT₈). After baseline testing, participants completed HAz, preceded by 5 days of HA involving exercise to induce hyperthermia for 60 minutes in the heat (ambient temperature, 39.13 ± 1.37°C; relative humidity, 51.08 ± 8.42%). Participants were assigned randomly to 1 of 3 IHT groups: once-weekly, twice-weekly, or no IHT. Differences in VO_2max, velocity at VO_2max (vVO₂), and maximal heart rate (HR_max) at all 5 timepoints were analyzed using repeated-measure analyses of variance with Bonferroni corrections post hoc.

Results: No significant VO_2max or vVO₂ differences were observed between baseline, post-HAz, or post-HA (P = 0.36 and P = 0.09, respectively). No significant group or time effects were identified for VO_2max or vVO₂ at post-HA, IHT₄, and IHT₈ (P = 0.67 and P = 0.21, respectively). Significant HR_max differences were observed between baseline and post-HA tests (P < 0.01). No significant group or time HR_max differences shown for post-HA, IHT₄, and IHT₈ (P = 0.59).

Conclusion: VO_2max was not reduced among endurance runners after HA/HAz and IHT potentially due to participants' similar aerobic training status and high aerobic fitness levels.

Clinical relevance: HAz/HA and IHT maintain aerobic power in endurance runners, with HAz/HA procuring reductions in HR_max.

Background: The influence of external workload variables on the development of calf muscle strainsin football players has not been previously explored.

Hypothesis: Overloaded players would have an increased risk of calf muscle strain injury.

Study design: Prospective observational study.

Level of evidence: Level 4.

Methods: A total of 41 professional football players from 1 team were monitored for 2 consecutive seasons. Total distance covered (TD), and distances covered at high-intensity running, high sprint running, low (LACC) and high (HACC) acceleration, low (LDEC) and high (HDEC) deceleration, and at high metabolic load distance (HMLD) were monitored with GPS units. Accumulated players' external workload in the week before injury was compared with the weekly mean value of the 6 weeks before injury occurred for each player.

Results: Ten players (24.3%) suffered 16 calf muscle strain injuries (3.1 injuries per 1000 hours of match play; 0.5 injuries per 1000 hours of training exposure). Players with a calf muscle injury were older (p = 0.03), with higher body weight (p = 0.01) and height (p = 0.03). Injured players displayed substantially higher total training volume (p < 0.01), TD (p < 0.01), LACC (p < 0.01), LDEC (p < 0.01), HACC (p < 0.01), HDEC (p < 0.01), and HMLD (p = 0.03) in the week before injury, in comparison with the mean values of these variables in the 6 weeks before injury.

Conclusion: A week with a higher-than-habitual external workload might increase the risk of calf muscle strain injury in professional football players. Calf muscle injuries were preceded by a week with unusually high workloads associated with accelerating and decelerating distances and higher training volumes.

Clinical relevance: Monitoring external workload indicators may be helpful in determine players with a higher risk of calf muscle strain injury due to excessive workload during training/competition.

Background: The purpose of this study was to characterize the prevalence of venous thromboembolism (VTE; including deep vein thrombosis [DVT] and pulmonary embolism [PE]) after sports medicine knee procedures by a single surgeon at an academic institution, identify factors associated with increased risk of VTE, and determine risk factor thresholds for beyond which VTE risk is elevated.

Hypothesis: We hypothesized that the prevalence of VTE after sports medicine knee procedures is low, but that increasing weight and body mass index (BMI) would be associated with elevated risk.

Study design: Retrospective case-control study.

Level of evidence: Level 3.

Methods: A retrospective case-control study analyzing sports medicine knee surgeries from 2017 to 2020 was conducted using current procedural terminology codes to identify cases. Optimal cutoff points for specific continuous patient characteristics were calculated to determine elevated risk of postoperative VTE. Overall VTE-free survival was assessed using Kaplan-Meier analysis and Cox proportional hazard regression models.

Results: Among the 724 eligible patients, there were 13 postoperative VTE events (1.79% prevalence; 12 DVTs, 1 DVT/PE). Increasing weight and BMI were significant risk factors for postoperative VTE (P = 0.03 and P = 0.04, respectively), with weight >94.7 kg and BMI >27.9 kg/m² associated with elevated risk in male patients and weight >79.1 kg and BMI >28.1 kg/m² associated with elevated risk for female patients. Cox regression demonstrated a significantly increased risk of postoperative VTE for male patients with BMI ≥27.9 kg/m².

Conclusion: Patients who undergo sports medicine knee surgery with increased weight and BMI are at an elevated risk of postoperative VTE. An individualized approach should be considered for chemoprophylaxis in patients with these risk factors.

Clinical relevance: Consider chemoprophylaxis in patients with increased weight and BMI who undergo sports medicine knee surgery since they are at an elevated risk of postoperative VTE.

Background: Increase in supraspinatus tendon thickness (STT) resulting from swimming practice has been observed in those with a history of shoulder pain. The magnitude of change in STT after a swimming session and its rate of recovery may be an indicator of future shoulder pain incidence.

Hypothesis: The supraspinatus tendons that demonstrate a greater increase in thickness as a result of swimming practice will have an increased likelihood of future shoulder pain in a cohort of competitive swimmers over a period of 6 months.

Design: Descriptive epidemiology study.

Level of evidence: Level 2b, individual cohort studies.

Methods: A cohort of 50 nationally qualified swimmers aged between 14 and 22 years, from 3 open National Swimming Programs in Victoria, Australia, were recruited for this study. Ultrasonographic measurements of swimmers' STT was obtained of both shoulders, before, immediately after, and 6 hours after a single swimming practice session. Data were recorded of any significant interfering shoulder pain at 3 and 6 months after the initial testing session.

Results: Stepwise logistic regression models indicated that significant predictors of the likelihood of experiencing significant interfering pain were sex [significant at 6 months; odds ratio (OR) 4.2] and the extent of change in STT immediately (OR 2.3 and 1.3 per mm at 3 and 6 months, respectively) and 6 hours postpractice (OR 1.9 and 1.5 per mm at 3 and 6 months, respectively).

Conclusion: The current data suggest larger increases in tendon thickness after training are associated with an increased likelihood of future shoulder pain.

Clinical relevance: These data may be valuable for monitoring training load and identifying athletes who may have an increased likelihood of shoulder pain.

Background: In subacromial pain syndrome (SPS), it is unknown whether posterior shoulder stretching exercises (PSSE) with rapid eccentric contraction, a muscle energy technique, improve clinical and ultrasonographic outcomes more than no stretching or static PSSE.

Hypothesis: PSSE with rapid eccentric contraction is superior to no stretching and static PSSE in improving clinical and ultrasonographic outcomes in SPS.

Study design: Randomized controlled trial.

Level of evidence: Level 1.

Methods: Seventy patients with SPS and glenohumeral internal rotation deficit were randomized into the modified cross-body stretching with rapid eccentric contraction group (EMCBS; n = 24), static MCBS group (SMCBS; n = 23), or control group (CG; n = 23). In addition to 4-week physical therapy, EMCBS received PSSE with rapid eccentric contraction, SMCBS static PSSE, and CG no PSSE. The primary outcome was internal rotation range of motion (ROM). Secondary outcomes were posterior shoulder tightness, external rotation ROM (ERROM), pain, modified Constant-Murley score, short form of the disabilities of the arm, shoulder, and hand questionnaire (QuickDASH), rotator cuff strength, acromiohumeral distance (AHD), supraspinatus tendon thickness, and supraspinatus tendon occupation ratio (STOR).

Results: Shoulder mobility, pain, function and disability, strength, AHD, and STOR improved in all groups (P < 0.05).

Conclusion: In patients with SPS, PSSE with rapid eccentric contraction and static PSSE were superior to no stretching in improving clinical and ultrasonographic outcomes. Stretching with rapid eccentric contraction was not superior to static stretching, but improved ERROM compared with no stretching.

Clinical relevance: In SPS, both PSSE with rapid eccentric contraction and static PSSE included in physical therapy program are beneficial to improve posterior shoulder mobility and other clinical and ultrasonographic outcomes. In the case of ERROM deficiency, rapid eccentric contraction might be preferred.

Background: Vitamin D has been proven experimentally to affect musculoskeletal health. The purpose of this study was to identify the relationship between vitamin D deficiency and patellar instability.

Hypothesis: Vitamin D deficiency is associated with an increased risk of experiencing primary patellar instability and recurrent patellar dislocation after primary surgical stabilization.

Study design: Retrospective comparative study.

Level of evidence: Level 3.

Methods: A 1:1 matched retrospective study of 328,011 patients diagnosed with vitamin D deficiency was performed using the PearlDiver database. Incidence of primary patellar instability was calculated according to sex and age. Rates of primary patellar instability and surgical stabilization for recurrent dislocation were calculated with sex- and age-specific stratifications. Multivariable logistic regression was used to compare the rates of primary injury and recurrent stabilization while controlling for demographics and medical comorbidities.

Results: A total of 656,022 patients were analyzed. The overall 1-year incidence rate of patellar instability in patients with vitamin D deficiency was 82.6 per 100,000 person-years (95% CI, 73.2-92.9), compared with 48.5 (95% CI, 41.4-56.5) in the matched control. Women were significantly more likely to experience primary patellar instability within 1 (adjusted odds ratio [aOR] = 1.45; 95% CI, 1.12-1.88) and 2 years (aOR, 1.31; 95% CI, 1.07-1.59) of hypovitaminosis D diagnosis. Patients aged 10 to 25 years with hypovitaminosis D were at greater risk of requiring recurrent patellar stabilization for both men (aOR, 2.48; 95% CI, 1.06-5.80) and women (aOR, 1.77; 95% CI, 1.04-3.02).

Conclusion: Patients diagnosed with vitamin D deficiency experienced higher rates of primary patellar instability and have greater risk of requiring recurrent surgical stabilization for subsequent dislocations.

Clinical relevance: These results suggest that monitoring and proactively treating vitamin D deficiency in the physically active patient may lower the risk of suffering primary patellar instability or recurrence after surgical stabilization.

Context: A sport-related concussion (SRC) is a traumatic brain injury that is caused by biomechanical stresses and results in a complex pathophysiological process in the brain. Some in the sporting community believe that headgear (HG) can prevent SRC, and several professional Australian sports organizations, including rugby, football, and soccer clubs, recommend its use.

Objective: The purpose of this study is to determine whether HG is effective in lowering the prevalence of SRC in sports.

Data sources: A systematic search for related studies published between 1985 and 2023 was conducted using the following databases: Cochrane Library, AMED, PubMed, Web of Science, and Physiotherapy Evidence Database (PEDro).

Study selection: Only randomized controlled trials (RCTs) that investigated the effectiveness of HG in reducing SRC rate were included.

Study design: Systematic review and meta-analysis of RCTs.

Level of evidence: Level 1a.

Data extraction: Two researchers independently completed the title and abstract search and performed full-text reviews. A third reviewer was consulted to reach a consensus if any discrepancies were noted. The PEDro scale was used to evaluate the quality of the included RCTs. Data recorded from each study included authors, year of publication, type and number of players, study design, duration of the study, injury rate, compliance (%), sports/level, and exposure hours.

Results: The pooled results of 6311 players and 173,383 exposure hours showed 0% SRC reduction per 1000 hours of exposure in the experimental group compared with the control group, with an injury risk ratio of 1.03 (95% CI, 0.82-1.30; P = 0.79).

Conclusion: This systematic review and meta-analysis demonstrates that HG does not prevent SRC among soccer and rugby players, and therefore the findings from this meta-analysis do not currently support the use of HG to prevent SRC in soccer or rugby.

Context: Home-based exercise programs are a good strategy to promote benefits to health for people who cannot visit gyms, clinics, or have limited time for physical activity outside.

Objective: To synthesize the effect of home-based indoor physical activity on psychosocial outcomes and mobility in community-dwelling older adults.

Data sources: A comprehensive search was conducted in the MEDLINE, PubMed, Embase, SPORTDiscus, Cochrane Library, Scopus, and Google Scholar databases.

Study selection: A total of 11 studies (13 publications) were included involving a total of 1004 older adults.

Study design: A systematic review of randomized controlled trials was conducted using the aforementioned 7 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Level of evidence: Level 2.

Data extraction: Two authors independently selected studies, extracted data, and determined the risk of bias and evidence level using the Grading quality of evidence and strength of recommendations (GRADE) guidelines. We conducted a synthesis without meta-analysis (SWiM) to assess the outcome.

Results: There is moderately certain evidence that home-based exercise programs reduced the fear of falling. Psychosocial (mental health and quality of life) and mobility outcomes may improve after participating in the intervention inside the home.

Conclusion: The review found very low to certain evidence that home-based exercises programs improved psychosocial outcomes (mental health and quality of life) and walking speed (mobility). Moderately certain evidence suggests that home-based exercises improved fear of falling.

Protocol register number: CRD42020182008.