Sports Health-A Multidisciplinary Approach最新文献

Background: Monitoring training load and competition load is crucial for evaluating and improving athlete performance. This study proposes an applied approach to characterize and classify the training task specificity in relation to competition in a top-level rink hockey team, considering external and internal load from training tasks and competition.

Hypothesis: Training tasks and game demands have significant dose-response differences, and exercises can be classified successfully based on their physiological and biomechanical demands.

Study design: Cross-sectional study.

Level of evidence: Level 5.

Methods: Ten elite-level male rink hockey players participated in this study. Players were monitored on 6 different task categories during 8 training sessions and 2 official games. A linear mixed model with random intercepts was used to compare training tasks and competition load, accounting for individual repeated measures. A 2-step cluster analysis was performed to classify the training tasks and games based on physiological and biomechanical load, employing log-likelihood as the distance measure and Schwartz's Bayesian criterion.

Results: Average heartrate , maximum heartrate, and high-speed skating (18.1-30 km/h) were the best physiological load predictors, while the most effective biomechanical load predictors were impacts [8-10] g(n), decelerations [-10 to -3]m/s²(n), and accelerations [3-10]m/s²(n). Different physiological and biomechanical responses were verified between training tasks and match demands. A 4-quadrant efforts assessment for each task category revealed that training tasks used by the team in the analysis presented lower biomechanical and physiological load demands than competition.

Conclusion: Training tasks failed to adequately replicate the specific demands of competition, especially regarding high mechanical stress, such as the absence of high-intensity impacts and decelerations.

Clinical relevance: This method of classification of training tasks may allow coaches to understand further the specificity and contribution of each task to competition demands, consequently improving the capacity of load management and the preparedness and readiness of players for competition.

Background: This study explores the association between vitamin D deficiency and distal biceps tendon injuries, illustrating that, although vitamin D deficiency is associated with prolonged hospital stays and various musculoskeletal problems, its connection to distal biceps tendon injuries is unknown.

Hypothesis: Vitamin D deficiency is associated with an elevated risk of distal biceps injury but not with increased rates of subsequent surgery or revision surgery.

Study design: Case-control study.

Level of evidence: Level 3.

Methods: A 1:1 matched retrospective comparative study of 336,320 vitamin-D-deficient patients was performed using PearlDiver data (between January 1, 2011 and October 31, 2018). Cohorts, with a mean age of 55.7 ± 13.2 years, underwent multivariate logistic regression to calculate distal biceps tendon injury and surgical repair incidence according to age and sex, while controlling for demographics and comorbidities.

Results: The 1-year incidence of distal biceps tendinopathy in vitamin-D-deficient patients was 118 per 100,000 person-years (95% CI) compared with 44.3 per 100,000 person-years in matched controls. Male patients with vitamin D deficiency were at a greater risk for distal biceps tendinopathy after 1 and 2 years (adjusted odds ratio [aOR] = 2.81, 2.08-3.83; aOR = 2.80, 2.21-3.56). Female patients were also at a greater risk after both years (aOR = 1.69, 1.27-2.27; aOR = 1.57, 1.26-1.96). Vitamin D deficiency was not associated with an elevated risk of surgical repair or revision surgery.

Conclusion: In a nationwide cohort, a diagnosis of vitamin D deficiency elevated the risk of distal biceps tendinopathy but did not raise the rate of surgical repair or revision. As a result, prevention strategies in the form of vitamin supplementation should be increased for athletes.Clinical Relevance: These findings emphasize the clinical relevance of monitoring vitamin D levels in patients at risk for musculoskeletal injuries, and providing adequate care to those involved in high-demand physical activities.Strength of Recommendation: B.

Background: Load management is a sports science concept describing the execution of well-established training principles to measure athletic workloads and enhance performance. The term 'load management' has become common in sports media to refer to a much wider range of scenarios, including the idea that by limiting regular season workload for athletes, their health and playoff performance will improve. Varying links between load and performance have been demonstrated in baseball and soccer. The purpose of this study was to objectively assess the impact of regular season workload on postseason performance among National Hockey League (NHL) goalies.

Hypothesis: NHL goalies with lighter regular season workloads will perform better in postseason appearances.

Study design: Retrospective cohort.

Level of evidence: Level 3.

Methods: NHL goalies with a minimum of 20 regular season games played and 3 playoff game appearances in the same season since 2013-2014 were eligible for inclusion. All regular season and postseason workload and performance metrics were collected from publicly available statistical databases. Workload outcomes included games started, minutes played, and shots faced. Performance outcomes included goals against average, save percentage, goals saved above average, and quality start percentage. Multivariable linear regression was used to determine whether regular season workload predicted postseason performance, when controlling for age and injury status.

Results: A total of 51 goalies contributed 111 goalie-seasons to the analysis. The results of the primary model indicated that regular season workload explained only 6.8% of the variance in postseason performance, and that this relationship was not significant (R² = 0.068; F(5,92) = 1.335; P = 0.26).

Conclusion: Based on data from 6 full seasons, there is no evidence to support a specific regular season game limit among NHL goalies with the aim of improved performance.

Clinical relevance: Individualized workload plans may be more appropriate than a single league-wide standard.

Background: Australian Rules Football athletes complete long preseasons, yet injuries occur frequently at early stages of the competitive season. Little is known about the high-speed running (HSR) prescription during a preseason or whether players are adequately prepared for competition. This study described absolute and relative preseason and in-season HSR demands of 2 professional Australian football teams.

Hypothesis: HSR and sprinting volumes are significantly lower in elite Australian Rules football athletes during in-season compared with preseason.

Study design: Cohort study.

Level of evidence: Level 3.

Methods: During the 2019 season, HSR volume was collected for 2 professional Australian football teams (n = 55). Individual maximum speeds (V_max) were captured to calculate relative running speed thresholds, as reported in 5% increments from 70%V_max to 100%V_max.

Results: Weekly volume of running above 70%V_max (P = 0.01; r = 0.56) and 80%V_max (P = 0.01; r = 0.58) was significantly greater in the preseason than the in-season. The weekly volume completed above 90%V_max was not significantly greater in the preseason than the in-season (P = 0.10; r = 0.22). Individual variation in the distance completed at specific percentages of V_max expressed as a coefficient of variation was reported as 51% at 71% to 80%V_max, 39% at 81% to 90%V_max, and 41% at 91% to 100%V_max.

Conclusion: The volume of HSR completed by athletes is far greater in the initial 4 weeks of the preseason than in any other point in preseason or competitive phases. At the individual level, there is substantial variation in the distance covered. This supports the concept of a heavily individualized approach to high-speed prescription and monitoring.

Clinical relevance: Practitioners should carefully consider individual variation regarding sprinting volume during both preseason and in-season when prescribing and monitoring training to improve on-field performance and reduce the risk of injury.

Background: Pitchers frequently experience anterior shoulder pain, possibly associated with coracohumeral impingement; however, whether the coracohumeral distance (CHD) and/or subscapularis tendon adapt chronically (bilateral difference) due to pitching, and whether clinical measures are associated with CHD and subscapularis tendon organization have not been evaluated in professional pitchers.

Hypothesis: The authors hypothesized that dominant arm CHD would be smaller than the nondominant arm, dominant subscapularis tendon would have increased spatial frequency (ie, be more disorganized), and humeral retroversion (HR) would predict CHD and subscapularis tendon organization.

Level of evidence: Level 4.

Methods: Healthy professional baseball pitchers were recruited during their preseason physical examination. Bilateral diagnostic ultrasound measured CHD, HR, and posterior capsule thickness (PCT), and quantified subscapularis tendon organization. External rotation, neutral, and crossbody CHD was measured.

Results: Overall, 52 healthy professional baseball pitchers participated. The dominant arm of pitchers demonstrated a significantly narrower CHD in all 3 positions (P < 0.01), increased scapular protraction (163 vs 156 mm; P < 0.01), and increased spatial frequency of the subscapularis tendon (1.8 vs 1.6 peaks/mm; P < 0.01). HR was associated with CHD in 30° of external rotation (R² = 0.12; P < 0.01), neutral rotation (R² = 0.11; P < 0.01), and the crossbody position (R² = 0.28; P < 0.01). PCT was associated with CHD in 30° of external rotation (R² = 0.16; P = 0.05). HR and CHD in 30° of external rotation was associated most strongly with subscapularis tendon organization (R² = 0.11; P = 0.03).

Conclusion: The dominant shoulder of professional pitchers presents with a smaller CHD, more scapular protraction, and more subscapularis tendon disorganization than the nondominant shoulder.

Clinical relevance: Professional pitchers demonstrate chronic CHD and subscapularis tendon adaptations, which may increase their risk for anterior shoulder pain and subscapularis tendon injury.

Context: Mental health is a growing area of concern for elite athletes.

Objective: To determine the sex differences in mental health symptoms in elite athletes.

Data sources: PubMed, EMBASE, and Cochrane Library databases were used.

Study selection: Included studies included comparisons of mental health symptoms of athletes by sex.

Study design: Systematic review and meta-analysis were conducted following the PRISMA guidelines.

Level of evidence: Level 2a.

Data extraction: The rate ratio (RR) was calculated as the rates in female and male athletes. Data were pooled using a random-effects model.

Results: Of 1945 articles identified, 60 articles were included. Male athletes reported higher alcohol misuse (RR, 0.74; CI, 0.68-0.80), illicit drug abuse (RR, 0.82; CI, 0.75-0.89), and gambling problems (RR, 0.14; CI, 0.08-0.25). Female athletes reported higher overall anxiety (RR, 1.17; CI, 1.08-1.27), depression (RR, 1.42; CI, 1.31-1.54), distress (RR, 1.98; CI, 1.40-2.81), and disordered eating (RR, 2.19; CI, 1.58-3.02). Sleep disturbances were reported at similar rates in male and female athletes (RR, 1.13; CI, 0.98-1.30).

Conclusion: Female and male athletes have significant differences in reported mental health symptoms. Female athletes are more likely to report anxiety, depression, distress, and disordered eating, while male athletes report more alcohol misuse, illicit drug abuse, and gambling. Monitoring and evaluation of mental health is a necessary part of any sport, including access to resources. Longitudinal studies following athletes over time to determine the development and causation for mental health symptoms should be included in future research directions.

Context: Pain and symptoms of patellofemoral pain (PFP) are often exacerbated during daily activities, which may result in reduced overall physical activity levels.

Objective: To summarize the evidence for physical activity levels among persons with PFP compared with pain-free controls.

Data sources: PubMed, Embase, CINHAL, Cochrane Library, and SPORTDiscus were searched from January 1, 2000 to February 22, 2024.

Study selection: Peer-reviewed studies published in English that measured physical activity subjectively or objectively in persons with PFP and pain-free controls.

Study design: Systematic review with meta-analysis.

Level of evidence: Level 1.

Data extraction: Standardized mean difference (SMD) with 95% CI are reported based on Hedges' g effect sizes.

Results: From 23,745 records, 41 studies met the eligibility criteria. There was high-to-moderate-certainty evidence that persons with PFP reported higher physical activity levels compared with pain-free controls using the International Physical Activity Questionnaire (SMD, 0.27; 95% CI 0.03, 0.51), whereas lower physical activity levels compared with pain-free controls using the Tegner Activity Scale (SMD, -0.31; 95% CI -0.57, -0.04). There was low-to-moderate-certainty evidence that there was no group difference in physical activity levels using the Baecke Physical Activity Questionnaire (SMD, 0.17; 95% CI -0.09, 0.44) or self-reported sports participation duration (SMD, -0.46; 95% CI -0.98, 0.05). There was high-certainty evidence that runners with PFP reported shorter running distances compared with pain-free runners (SMD, -0.36, 95% CI -0.57, -0.14). No data pooling was possible for objectively measured physical activity levels due to device heterogeneity (ie, different algorithms used to quantify the intensity of physical activity).

Conclusion: Self-reported physical activity levels among persons with PFP were inconsistent depending on the physical activity measurement tool used or which specific physical activity was measured. Clinicians should integrate multiple physical activity assessment tools to determine the extent to which PFP influences physical activity levels.

Trial registration: PROSPERO #CRD42022314598.

Background: Both autoregulatory progressive resistance exercise (APRE) and velocity-based resistance training (VBRT) utilize real-time monitoring of athlete physical performance to adjust training loads to provide appropriate training stimuli. However, the monitoring and adjustment approaches differ between both methods. This study aimed to compare the effects of APRE and VBRT on the muscle strength, power, and agility of college taekwondo athletes.

Hypothesis: Eight weeks of APRE and VBRT will promote similar results to strength gains in regards maximal strength, but VBRT will be superior to APRE in explosive power and agility.

Study design: Clinical trial.

Level of evidence: Level 3.

Methods: Thirty taekwondo athletes were divided randomly into 2 groups (VBRT/APRE), and all participants completed an 8-week APRE/VBRT intervention. Maximum strength, explosive power, and agility performance were assessed during the squat 1-repetition maximum (1RM), countermovement jump (CMJ), drop jump (DJ), kicking strength test (KST), taekwondo-specific agility test (TSAT), and hexagon test (HT).

Results: Highly significant time effects (P < 0.01) were observed for squat 1RM, CMJ, and TSAT in both the APRE and VBRT groups. However, there were no significant group-by-time differences for any of the measured outcomes to intergroup (P > 0.05), but APRE had a small effect size (ES) over VBRT for CMJ (ES = 0.48, $\eta 2p$ = 0.06), TSAT (ES = 0.26, $\eta 2p$ = 0.02), and HT (ES = 0.42, $\eta 2p$ = 0.05).

Conclusion: An 8-week autoregulatory APRE and VBRT can both effectively improve both the maximal strength, explosive power, and agility performance of taekwondo athletes, with APRE exhibiting potential advantages in improving CMJ, TSAT, and HT.

Clinical relevance: These results provide important insights into the selection of suitable resistance training programs by professional coaches, taking into account athlete needs, training efficiency, and safety considerations.

Background: This study evaluated 2 different dual-task (DT) conditions during tandem gait (TG) to predict sport-related concussion (SRC) diagnosis.

Hypothesis: The best (fastest) single-task (ST) gait will differ between groups (controls vs SRC; baseline vs SRC), with auditory pure switching task (APST) response rate being the most important behavioral variable to aid prediction of SRC.

Study design: Cohort design.

Level of evidence: Level 3.

Methods: A total of 409 National Collegiate Athletic Association Division I student-athlete controls and 21 team-physician-diagnosed SRC participated. All data were collected at preseason physicals (baseline) and within 7 days of injury for SRC. Each participant completed 3 conditions of TG in a pseudorandomized order: (1) ST, (2) DT with serial-7s (SS) subtractions, and (3) DT with APST. Outcomes of time-to-complete for TG and behavioral (eg, responses per second) for SS and APST were recorded for each trial.

Results: ST Trials 2 (P = 0.03) and 3 (P = 0.01) were significantly different between controls and SRC. ST Trial 3 (P = 0.04) was significantly different between baseline and SRC. Average responses per second for APST were significantly different between- (P < 0.01) and within- (P = 0.01) group.

Conclusion: The results suggest that ST is significantly slower after SRC. However, DT (both SS and APST) time-to-complete are also important variables when predicting the SRC diagnosis. It is advised that both ST and DT be administered when making clinical decisions regarding postural instability after SRC.

Clinical relevance: The best ST TG time to complete gait is an important objective marker of concussion while DT paradigms, specifically SS and APST, are highly variable. DT may be more useful for clinical observable signs of SRC. Both SS and APST have unique usefulness, but APST response rate per second can be relied upon numerically for clinical decisions.

Background: Earlier statements suggested a negative impact of coronavirus disease 2019 (COVID-19) infection on sports performance and injury risk. With the COVID-19 pandemic under control and the dominance of a less-severe strain of the virus, there is a need to confirm whether these adverse effects still apply to the current situation.

Hypothesis: Infected players would have a higher noncontact muscle injury incidence compared with noninfected counterparts.

Study design: Cohort observational study.

Level of evidence: Level 3.

Methods: Seven teams (n = 147 players) competing in the Spanish professional women's football league (Liga F) were prospectively monitored during the 2021-2022 season. Data from noncontact injuries were recorded and classified following the latest consensus statement from the International Olympic Committee. COVID-19 was certified by the medical staff by regular polymerase chain reaction analysis.

Results: Ninety-two players suffered at least 1 noncontact muscle injury during the season. Injury incidence during the season was similar in players with COVID-19 (n = 83) and players without infection (5.1 ± 6.7 versus 4.9 ± 10.0 injuries/1000 h of play, respectively; P = 0.90). Players with COVID-19 were not more likely to suffer noncontact injuries compared with those players without infection (R² = 0.02; odds ratio [OR] 95% confidence interval [95% CI] = 0.36-1.38; P = 0.31). There was no effect of COVID-19 on the days of absence due to injury (R² = 0.01; OR 95% CI = 1.00-1.01; P = 0.44) or in the classification of the severity of the injury (P = 0.79).

Conclusion: COVID-19 has no significant effect on noncontact injury incidence and severity in professional female football players.

Clinical relevance: Currently, COVID-19 infection does not alter noncontact muscle injury risk in professional football and requires no further attention in terms of injury management. Usual return-to-play protocols apply to COVID-19 considering the particularities of each player since the severity of infection, period of inactivity, and effects on the player's health and performance.