Sports Health-A Multidisciplinary Approach最新文献

Background: Engaging in physical exercise is recommended to enhance cardiovascular health and manage blood sugar levels in people with type 1 diabetes (T1D).

Hypothesis: The impact of high-intensity interval exercise with elastic bands (EB-HIIE) versus continuous moderate-intensity aerobic exercise (CONT) on glycemic control is different in men with T1D.

Study design: Crossover study design.

Level of evidence: Level 3.

Methods: Participants (39 men with T1D) underwent either an EB-HIIE or a CONT session in randomized order, with a separation of ≥72 hours to avoid carry-over effects. Changes in glucose values during exercise were measured simultaneously from venous blood (YSI) and interstitial fluid (Dexcom G6 glucose sensor). Subsequent 24-hour glucose was monitored using the glucose sensor.

Results: Blood glucose was lower in CONT vs EB-HIIE (P < .01). Post hoc analysis revealed clinically relevant differences during exercise (-35.1 mg/dl; P = .02), at its end (-49.5 mg/dl; P < .01), and at 10 and 20 minutes after completion (-51.2 mg/dl; P < .01 and -45.9 mg/dl; P < .01, respectively). Time-in-range 24 hours after exercise completion was significantly higher with EB-HIIE than with CONT (66.5% vs 59.3%), although both were significantly better than the previous 24 hours before exercise (50%).

Conclusion: Results suggest that EB-HIIE is a safe training method for male adults with diabetes, resulting in euglycemia during and immediately after exercise and improving glucose outcomes in the subsequent 24 hours.

Clinical relevance: This study provides new evidence and practical information on how to implement safe physical activity in daily life of patients with diabetes. EB-HIIT exhibited lower hypoglycemia risk during exercise and better glycemic control in the subsequent 24 hours. In contrast, practicing CONT exercise is associated with higher risk of hypoglycemia. Healthcare providers should take this information into account when prescribing exercise.

Background: Elite gymnasts are exposed to high levels of physical stress, during both childhood and adolescence, with significantly late maturation and high injury prevalence. Here, we compare the physiological characteristics of female gymnasts in 2 age groups: young (9-12 years) and adolescent (≥13 years) in 3 disciplines of competitive gymnastics.

Hypothesis: Participants' physiological characteristics will differ by age group and by gymnastic discipline.

Study design: Cohort study.

Level of evidence: Level 2.

Methods: The study included 274 gymnasts, aged 11.8 ± 1.9 years. Data collection included anthropometric measures, Tanner stage, and menarche age; ultrasound assessments were used to assess bone properties, including bone strength, skeletal age, and final-height prediction.

Results: Univariate analysis of variance showed age × discipline interactions for body mass index (BMI) percentiles (F_{(2, 266)} = 4.379; P = 0.01), skeletal age (F_{(2, 241)} = 3.808; P = 0.02), and final-height prediction (F_{(2, 240)} = 3.377, P = 0.04). Moreover, in both age groups, artistic gymnasts exhibited significantly higher BMI percentiles than rhythmic gymnasts (P < 0.05). In the adolescent group, final-height prediction for rhythmic gymnasts was significantly greater than that of artistic gymnasts (P < 0.05). Finally, in adolescent gymnasts, regression lines showed that skeletal age was lower than chronological age (P < 0.05).

Conclusion: Artistic gymnasts were shorter than rhythmic and acrobatic gymnasts. Despite similar BMI and body fat, maturity patterns, and training-volume history, artistic gymnasts had lower bone-strength than rhythmic and acrobatic gymnasts. Combined with their high-impact and intensive training, this could increase their risk of musculoskeletal injuries.

Clinical relevance: The current study may help athletic trainers and medical teams define "norms" for different age groups and gymnastic disciplines, based on what may be expected during the athletes' early and late maturation. This knowledge can be used to modify, individualize, and optimize training programs.

Background: Research on catastrophic injuries and medical conditions among majority girls' and women's sports are underrepresented. In this study, we describe the incidence, characteristics, and mechanisms of severe softball injuries/medical conditions between 2014 and 2021.

Hypothesis: Catastrophic injury and illness patterns will be observed with a higher incidence rate at the collegiate level.

Study design: Descriptive epidemiologic study.

Level of evidence: Level 3.

Methods: Events from the National Center for Catastrophic Sport Injury Research (NCCSIR) and National Electronic Injury Surveillance System (NEISS) were included. NCCSIR included catastrophic injuries during participation in high school (HS) or college sponsored girls'/women's softball resulting in death, temporary or permanent disability, or life-threatening injury. NEISS included severe girls'/women's softball injuries (product code 5034) among 13- to 17- and 18- to 24-year-olds among severe dispositions. National estimates were derived using a weighted sample for NEISS. Counts (%) and incidence rates (IR) per 100,000 participants overall and by age level, injury/medical event, and outcome were reported.

Results: NCCSIR captured 0.3 events per 100,000 participants (95% confidence interval, 0.1-0.5), and incidence was higher in college (IR, 2.5; 0.9-6.6) compared with HS (IR, 0.1; 0.1-0.4). Sudden cardiac arrest was the most common event (5, 63%), and 2 (25%) fatalities were reported. NEISS captured 10.2 events per 100,000 participants (9.7-10.8). Incidence was higher in 18- to 24-year-olds (IR, 8.9; 8.3-9.6) compared with 13- to 17-year-olds (IR, 4.2; 3.8-4.6), and no fatalities were captured.

Conclusion: Collegiate and 18- to 24-year-old athletes demonstrated a higher incidence of severe injuries than HS and 13- to 17-year-old athletes across both surveillance systems. NEISS captured a higher incidence of catastrophic events than NCCSIR. NCCSIR observed more cardiac events, whereas NEISS observed more head/face injuries.

Clinical relevance: Continued monitoring of severe injuries and medical events in softball is necessary to support response and prevention measures.

Background: Lateral epicondylitis is caused by overuse and manifests as pain, weakness, and difficulty with object manipulation. Platelet-rich plasma (PRP) and dextrose injections have shown promise in reducing pain and improving function.

Hypothesis: PRP is more effective for force precision control of the extensor carpi radialis brevis (ECRB) muscle than dextrose injection for patients with chronic lateral epicondylitis (CLE).

Study design: Randomized, double-blinded clinical trial.

Level of evidence: Level 1.

Methods: A total of 62 participants (25 healthy subjects and 37 CLE patients) were assigned randomly to either PRP (19) or dextrose (18) groups. Assessments included maximal voluntary contraction (MVC), wrist extension force, questionnaires, sonography, and electromyography assessments.

Results: PRP and dextrose had similar effects on clinical questionnaire scores. Compared with pre-test values, only PRP demonstrated a significant increase in MVC (PRP, 75.3 ± 107.7%; P < 0.01; dextrose, 34.0 ± 66.1%; P = 0.08), and greater reduction in force fluctuations (PRP, -27.4 ± 13.3%; P < 0.01; dextrose, -5.4 ± 33.2%; P = 0.22) during post-test wrist extension. After treatment, the PRP group experienced a roughly 41.7% increase in motor units (MUs) with recruitment thresholds (Rec_TH) (pre-test, 3.67 ± 6.15% MVC; post-test, 5.20 ± 8.02% MVC; P < 0.01). The dextrose group showed no significant change (-3.74%) in MU Rec_THs (pre-test, 3.48 ± 6.80% MVC; post-test, 3.35 ± 6.62% MVC; P = 0.75). PRP increased the MU discharge rate with Rec_THs at <30% MVC, whereas dextrose administration elevated MU discharge rate with Rec_THs >20% MVC.

Conclusion: PRP may be more effective than dextrose in improving neuromuscular control of the ECRB muscle, particularly for enhancing the scaling of force during wrist extension, attributed to distinct MU activation strategies.

Clinical relevance: Detailed comparison and head-to-head analysis of PRP and dextrose injections offers more options for patients considering injections.

Risk factors associated with depression in athletes include biological sex, physical pain, and history of sport-related concussion (SRC). However, although there are well-documented benefits of sport and physical activity on mental health, many sportspeople still take the risk of competing in contact sports. Therefore, this infographic, supported by scientific evidence, aims to provide sportspeople with an informed decision on their participation. This infographic can be used by sports clubs or governing bodies to illustrate the risk that SRC has on the mental health of sportspeople. Likewise, it highlights the elevated risk of being in physical pain and being a female sportsperson. Therefore, this infographic provides a simple message to enhance the decision-making process of sportspeople, ensuring they are making a better-informed choice of their sporting participation and making their own cost/reward judgment.

Background: The elderly US population is growing quickly and staying active longer. However, there is limited information on sports-related injuries in older adults.

Hypotheses: (1) National estimate and incidence of sports-related orthopaedic injuries in the US elderly population have increased over the last 10 years, (2) types and causes of sports-related injuries in the elderly have changed, and (3) elderly sports-related injuries will increase more than the number of treating physicians by 2040.

Study design: Descriptive epidemiology study.

Level of evidence: Level 4.

Methods: The National Electronic Injury Surveillance System database was used to identify all patients aged ≥65 years with sports-related orthopaedic injuries in US emergency departments from 2012 to 2021. Surgeon and physician estimates were calculated using the Physician Compare database. Population data were obtained from US Census estimates and used to calculate annual incidence rates of injuries and to project total injuries through 2040. Injury characteristics were analyzed using Wilcoxon Rank-Sum tests and Chi-square or Fisher exact tests.

Results: An estimated 444,078 sports-related orthopaedic injuries occurred in the elderly from 2012 to 2021. There were significant increases in injuries (from 32,573 in 2012 to 50,909 in 2021; P < 0.01) and in the national incidence of injuries (from 78 per 100,000 in 2012 to 91 per 100,000 in 2021; P = 0.01). The number of sports-related injuries in the elderly is projected to reach 111,245 by 2040, an increase of 119% from 2021. The number of orthopaedic surgeons and sports medicine physicians is projected to increase by only 19.7% over the same timeperiod.

Conclusion: Sports-related orthopaedic injuries in the elderly are increasing in both number and incidence.

Clinical relevance: Orthopaedic surgeons and other practitioners should be prepared to treat an increasing number of active elderly patients.

Background: The cumulative effect of repetitive subconcussive head impacts on neurocognitive function during youth contact sports remains largely unknown. There is a paucity of literature evaluating cumulative helmet forces over a season and their correlation with preseason and postseason cognitive performance tasks such as the King-Devick test (KDT).

Hypothesis: Higher helmet forces recorded throughout a 10-week, 10-game youth football season would correlate with slower performance on postseason KDT.

Study design: Prospective cohort study.

Level of evidence: Level 3.

Methods: A cohort of 58 youth football players (ages 9-13 years) underwent pre- and postseason KDT. Players wore SpeedFlex helmets (Riddell) fitted with InSite Impact Response System helmet accelerometers (Riddell) which recorded impacts of ≥15g. Head impacts were tallied over a season and assigned a score of 1, 2, or 3 based on magnitude of g forces. Suspected concussions were correlated with KDT times and recorded instances of head impact. Pre- and postseason KDT scores were compared.

Results: During the season, 2013 head impacts were recorded. Median (range) total cumulative force score was 24 (5-476); 6 players sustained head impacts concerning for concussion, and 4 were clinically diagnosed with concussions. Overall, postseason KDT times improved compared with preseason, with a median (range) change of -4.8 seconds (-7.6, -1.1). Analysis showed no correlation between changes in KDT time and total cumulative force score over the season.

Conclusion: KDT times in youth football players did not change significantly based on head impact exposure over a single youth football season; most players' KDT times improved from preseason to postseason.

Clinical relevance: Although our study did not show significant cognitive impact as measured by KDT over a single youth football season, the long-term effects of concussion on the immature brain and how it can impact cognitive development remains largely unknown and should be an area of ongoing study.

Background: Previous studies have identified demographic, radiographic, and intraoperative predictors of outcomes after hip arthroscopy for femoroacetabular impingement syndrome, yet few studies have identified whether preoperative gait metrics can predict outcomes.

Hypothesis: Increased preoperative step count, walking speed, step length, and gait symmetry will be associated with better outcomes after surgery.

Study design: Retrospective cohort study.

Level of evidence: Level 4.

Methods: Patients who underwent hip arthroscopy between 2019 and 2022 and downloaded the smartphone app rHip, allowing for retroactive access of gait metric data, were identified. Preoperative gait metrics, age, sex, body mass index (BMI), and exercise participation were analyzed via multivariate stepwise linear regression for a relationship with 1-year postoperative patient-reported outcomes (PROs), including Hip Outcome Scale-Activities of Daily Living (HOS-ADL); HOS-Sports Subscale (HOS-SS), and 12-item international Hip Outcome Tool (iHOT-12). Thresholds for preoperative gait metrics were analyzed via receiver operator characteristic curve. A subgroup analysis was performed to compare those who did and did not reach this threshold.

Results: A total of 43 patients (86% female; age, 33.1 ± 13.7 years; BMI, 23.9 ± 4.4 kg/m²) met inclusion criteria. Multivariate regression found that preoperative walking speed was significantly associated with postoperative HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .01). A preoperative walking speed threshold of 1.065 m/s was predictive of outcome achievement. Those who failed to achieve this threshold were significantly older, of greater BMI, and less active (P ≤ .04). They also showed significantly worse 1-year postoperative scores (P ≤ .02) and lower PASS achievement for HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .04).

Conclusion: Preoperative walking speed is significantly associated with 1-year outcomes after hip arthroscopy. Patients who averaged <1.065 m/s show significantly worse outcomes after surgery.

Clinical relevance: Assessment of preoperative walking speed may allow physicians to better counsel patients regarding expected outcomes after hip arthroscopy.

Background: Exercise and its effect on cardiovascular diseases have been extensively studied in the elderly population. The difference in blood pressure (BP) between fit and unfit subjects can be >5 mmHg. It is not well established whether the positive effects of exercising on BP are associated with exercise type, be it aerobic or anaerobic (maximal muscle strength).

Hypothesis: Anaerobic training (maximal muscle strength) causes greater improvements than aerobic training on BP in active older adults.

Study design: Clinical trial.

Level of evidence: Level 4.

Methods: This clinical trial was carried out with 202 participants (n = 116 aerobic program [ABPG], n = 86 strength program [SBPG]; 58.05% female; age 67.61 ± 5.01 years). The training program was carried out between 2018 and 2021. Periodic evaluations of BP (systolic BP [SBP] and diastolic BP [DBP]) were conducted with a frequency of twice per year. BP comparisons were made by using 2 × 2 analysis of variance with repeated measurements over the course of the 4 years of the project.

Results: Throughout the training program, SBPG showed significant and consistent improvements in both SBP and DBP (P < 0.01). On the other hand, the ABPG reported a significant initial improvement (P < 0.01), which was not repeated in subsequent years. BP monitoring carried out over the 4 years showed a decrease in DBP and SBP, with this decrease being more pronounced in SBPG. However, the differences between the groups were not significant (2021; DBP, F = 1.227; P = 0.27; SBP, F = 0.826, P = 0.36).

Conclusion: Among persons aged ≥65 years, muscle strength training programs appear to be more effective in inducing exercise-related positive changes in BP and cardiovascular risk factors compared with aerobic exercise programs.

Clinical relevance: Muscle strength training programs result in favorable changes in BP and cardiovascular risk factors.

Background: Overuse injuries in youth athletes are associated with risks, including sports specialization, biological maturation, female sex, and workload measures. As no assessment tool exists to evaluate risk accumulation, we developed a novel risk factor scoring system (Sport Training Assessment of Risk [STAR]) to assess participants' risk of overuse injury and explore association with return-to-play (RTP) time periods.

Hypothesis: (1) STAR will reach an acceptable predictive threshold in the assessment of overuse injury in youth athletes. (2) Higher STAR scores will be associated with increased RTP time periods after injury.

Study design: Longitudinal cohort study.

Level of evidence: Level 3.

Methods: Youth athletes with an injury sustained during competitive sport completed questionnaires. Association of questionnaire variables with injury risk type was evaluated via logistic regression analyses, and unweighted and weighted versions of a total risk score were developed. RTP was defined by physician clearance per electronic medical record review. Mantel-Haenszel chi-square tests and Kendall's rank correlation coefficients were used to assess the relationship between weighted total risk score and RTP time periods. The weighted STAR model was analyzed with receiver operating characteristic (ROC) curves.

Results: The weighted STAR model trended toward an acceptable level of prediction for overuse (nonserious + serious) injury (area under the ROC curve [AUC], 0.66; 95% CI, 0.61-0.71), but was less predictive for serious overuse injury (AUC, 0.63; 95% CI, 0.55-0.71). Weighted total risk score was weakly associated with return to full play (ρ = 0.11; P < 0.01), and potentially with return to modified play (ρ = -0.08; P = 0.04).

Conclusion: STAR may be a feasible tool for assessing overuse injury risk and RTP time periods in youth athletes but requires further development, as it did not reach an acceptable predictive threshold in this preliminary study.

Clinical relevance: Clinicians can use STAR to assess overuse injury risk in youth athletes.