Estimating Maturity Status in Elite Youth Soccer Players: Evaluation of Methods.

PURPOSE: The objective of this study is to evaluate the concordance of predicted maturity status classifications (pre-, circa-, or post-peak height velocity (PHV)) relative to observed age at PHV in youth soccer players. METHODS: Longitudinal height records for 124 male soccer players were extracted from academy records spanning the 2000 to 2022 seasons. Age at PHV for each player was estimated with the Superimposition by Translation and Rotation model. Players were classified as pre-, circa-, or post-PHV using both ±1- and ±0.5-yr criteria to define the circa-PHV interval. Maturity status was estimated with several prediction protocols: maturity offset (Mirwald, Moore-1, Moore-2), maturity ratio (Fransen), and percentage of predicted adult height (PAH%) using the Khamis-Roche and Tanner-Whitehouse 2 equations using several bands: 85% to 96%, 88% to 96%, 88% to 93%, and 90% to 93% for the circa-PHV interval, and visual evaluation of individual growth curves alone or with PAH% based on Khamis-Roche and Tanner-Whitehouse 2. Concordance of maturity status classifications based on complete growth curves and predicted estimates of maturity status was addressed with percentage agreement and Cohen's kappa. RESULTS: Visual evaluation of the growth curves had the highest concordance (≈80%) with maturity status classifications (pre-, circa-, post-PHV) based on longitudinal data for individual players. Predicted maturity offset with the Mirwald, Moore-1, and Fransen equations misclassified about one-third to one-half of the players, whereas concordance based on PAH% varied with the band used, but not with the method of height prediction. CONCLUSIONS: Visual assessment of the individual growth curves by an experienced assessor provides an accurate estimate of maturity status relative to PHV. Maturity offset prediction equations misclassify the majority of players, whereas PAH% provides a reasonably valid alternative.

The combined effects of growth and maturity status on injury risk in an elite football academy.

This study aimed to explore the interaction between growth rate on specific injury incidence and burden on pre-, circa- and post-peak height velocity (PHV) periods. Injury and stature data collected during the 2000-2020 seasons in an elite football academy were retrospectively analysed. Only players with height measurements from childhood until the attainment of adult height were included in the study (N = 84). Growth data were smoothed using a cubic spline to calculate daily growth rate and height. Growth rate was categorised into three groups: fast (> 7.2 cm/year), moderate (3.5-7.2 cm/year) and slow (< 3.5 cm/year). Percentage of observed adult height was used to classify players as pre-PHV (< 88%), circa-PHV (88-95%) or post-PHV (> 95%). Overall and specific injury incidence and burden and rate ratios for comparisons between growth rate groups were calculated on pre-, circa- and post-PHV periods, separately. Overall injury incidence and burden were greater in pre-PHV players with quicker growth rates compared to players growing moderately and slowly. All in all, players with more rapid growth-rates were at higher risk for growth-related injuries in all pre-, circa- and post-PHV periods. Post-PHV, the incidence and burden of joint/ligament injuries were 2.4 and 2.6-times greater in players growing slowly compared to players growing moderately. Practitioners should monitor growth rate and maturity status and consider their interaction to facilitate the design of targeted injury risk reduction strategies.

Lost in transition: Exploring injury risk in academy footballers shifting between the second and first teams.

OBJECTIVES: To compare the injury profiles of football players shifting between second and first teams with those of second- and first-team players, and to examine the opinions of shifting players. DESIGN: Prospective cohort study. METHODS: 170 male players from Athletic Club (second team = 90, shifting = 20, first team = 60) were followed over eight seasons. Injuries and exposure time were recorded following the FIFA consensus, and 18 shifting players answered a seven-item questionnaire on their experience. RESULTS: 35 % shifting players became full-time first-team players, in contrast to only 8 % of second-team players (odds ratio = 6.4, p < 0.01). There were no differences in the overall injury incidence, but the overall burden of injuries was higher in second-team (172 days lost/1000 h) and shifting players (194 days lost/1000 h) compared with first-team players (114 days lost/1000 h, p < 0.01). Shifting players had a higher burden of knee joint/ligament injuries compared with first-team players (137 vs. 18 days lost/1000 h, p < 0.01) and anterior cruciate ligament (ACL) ruptures (122 vs. 10 days lost/1000 h, p < 0.01). There was a trend towards a higher burden of ACL ruptures in shifting players than in second-team players (122 vs. 41 days lost/1000 h, p = 0.07). Shifting players reported constant pressure and better communication with the second-team coaching staff than with the first-team staff. CONCLUSIONS: The high burden of injuries in shifting players, particularly from ACL ruptures, highlights the need for action. Ensuring high-quality communication between second- and first-team staff remains a key challenge.

An injury burden heat map of all men's and women's teams of a professional football club over a decade.

The aim was to present a descriptive 10-season summary of injury data from all teams of a professional football club using a heat map approach. Injuries and exposure time were registered according to the FIFA consensus in all men's and women's teams from Athletic Club over 10 seasons. A team-by-injury table was created, showing the incidence, median severity, and burden in each cell. Cells were coloured based on the injury burden value using a green - yellow-red gradient (lowest to highest). The highest overall injury burden was found in the women's 2nd and 1st teams and the men's U(under)17 team (>200 days lost/1000 h). Muscle injury burden demonstrated an increasing pattern with age. Knee joint/ligament injuries, particularly anterior cruciate ligament ruptures, had the highest impact on women's teams, followed by the men's 2nd team. In comparison, ankle joint/ligament injuries had a relatively low injury burden in most teams. Growth-related injuries were the most impactful injuries in the men's U15 and younger teams, and the women's U14 team. In conclusion, epidemiological data on injuries can inform and guide injury management processes. New and improved visualization methods might be important assets when presenting injury data to key decision-makers.

What Are the Load and Wellness of Young Second-Team Football Players When Transitioning to the First Team? A Comparison of 2 Consecutive Preseasons.

PURPOSE: To compare the load and wellness of second-team academy football players during a first-team preseason with those of first-team players and those of their previous second-team preseason. METHODS: Athletic Club's first- (n = 10) and second-team (n = 9) players were prospectively followed during the 2019-20 first- and second-team and 2020-21 first-team preseasons. Weekly external and internal loads and average wellness z-scores (fatigue, sleep quality, muscle soreness, stress, and mood) were compared between preseasons and teams. RESULTS: While training together during the 2020-21 preseason, second-team players performed more decelerations <-3 m/s2 per week than first-team players (moderate effect size). For first-team players, there were only small differences between preseasons in external load, but session rating of perceived exertion was higher (moderate) and stress (moderate) and mood (large) z-scores were worse in 2020-21. For second-team players, more total distance (large), accelerations >3 m/s2 (large), and decelerations <-3 m/s2 (very large) were performed; total loading (moderate) and session rating of perceived exertion (moderate) were higher; and fatigue (very large) and stress (moderate) z-scores were worse during the 2020-21 first-team preseason compared to their previous second-team preseason. CONCLUSIONS: Players transitioning from the second team faced higher external and internal loads, fatigue, and stress during the first-team preseason compared to the previous second-team preseason. Player development and monitoring plans appear necessary to manage the transition from the academy to the first team.

Peak Height Velocity Affects Injury Burden in Circa-PHV Soccer Players.

Growth and maturation are potential risk factors for soccer injuries. This research sought to describe how peak height velocity (PHV) affects overall and specific injury burden in circa- and post-PHV elite academy soccer players. Injuries and growth data collected from 2000 to 2020 were studied retrospectively. Longitudinal height records for 124 players were fitted with the Super-Imposition by Translation and Rotation model to calculate PHV (cm/year) and age at PHV. Players were classified according to PHV percentile (fast:≥75th; average: 25-75th; slow:≤25th) and maturity status (circa- or post-PHV). Overall and specific injury burden (days lost/player-season) and rate ratios for comparisons between groups were calculated based on zero-inflated negative binomial models. Confidence intervals were calculated at the 95% confidence level (CI) and the significance level was set at<0.05. In circa-PHV, players with fast PHV had 2.6 (CI: 1.4-4.8)- and 3.3 (CI:1.3-6.7)-times higher overall burden and 2.9 (CI:1.1-7.1)- and 4.1 (CI: 1.4-15.2)-times higher for growth-related injury burden compared to players with average and slow PHV, respectively. Regular monitoring of growth seems important to detect players at higher risk for being disrupted by growth-related injuries.

The burden of injuries according to maturity status and timing: A two-decade study with 110 growth curves in an elite football academy.

Injuries have a negative impact on the development of football players. Maturation is a potential risk factor for football injuries but available data on this topic provide limited evidence due to methodological shortcomings. The aim of this study was to describe the injury burden of male academy football players according to growth curve-derived maturity status and timing. Injury and growth data were collected from 2000 to 2020. Longitudinal height records for 110 individual players were fitted with the Super-Imposition by Translation and Rotation model to estimate age at peak height velocity (PHV). Players were clustered according to maturity status (pre-, circa-, post-PHV, or adults) and timing (early, on-time, late maturers). Overall and specific injury burdens (days lost/player-season) and rate ratios for comparisons between groups were calculated. Overall injury burden increased with advanced maturity status; pre-PHV players had 3.2-, 3.7-, and 5.5-times lower burden compared with circa-PHV, post-PHV, and adult players, respectively. Growth-related injuries were more burdensome circa-PHV, while muscle and joint/ligament injuries had a higher impact post-PHV and in adults. Further, in the pre-PHV period, late maturers showed lower burden of overall, growth-related, anterior inferior iliac spine osteochondrosis, and knee joint/ligament injuries compared with on-time maturers. In adult players, however, injuries were less burdensome for early maturers than on-time and late maturers. In addition, joint/ligament injuries of adult late maturers were 4.5-times more burdensome than those of early maturers. Therefore, monitoring maturity seems crucial to define each player's maturation profile and facilitate design of targeted injury prevention programmes.Highlights Injury burden is significantly lower in football players at pre-peak height velocity (PHV). Growth-related injuries are most burdensome circa-PHV, while muscle and joint/ligament injuries are more burdensome post-PHV and especially in adults.Before PHV, growth-related and knee joint/ligament injuries have lower burden in players who mature late than those who mature on-time. Adult late maturers have greater burden of overall and joint/ligament injuries than early maturers.Football academies should regularly assess the maturity status and timing of young football players, as the impact of injuries varies with maturation status and timing.Management of the maturity-related injury risk profile, in combination with other relevant factors (training load, neuromuscular and biomechanical factors, physiotherapy, coaching, communication, psychosocial factors …), might help improve the success of player development programmes and protect the health of young football players.

Relationship between strength training and shoulder pain in male and female water polo players.

The objective of this study was to assess the effect of two different strength-training methods on both male and female water polo players' performance and shoulder pain. The players were randomly allocated to a maximum strength (MS: 14 males, 8 females) or power strength (PS: 13 males, 8 females) training group. Before and after the intervention, we assessed player's anthropometric characteristics, shoulder internal and external rotation strength, hand grip strength, upper body strength, countermovement jump height, throwing velocity, swimming speed, shoulder pain on a visual analogue scale (VAS), wellness, and rate of perceived exertion per session. We observed no significant improvement (P<0.05) in specific skills but enhancement in hand grip strength in male players. In female players in the MS group, throwing speed and bench press weight decreased significantly (P<0.05). Shoulder external rotation strength at 240°/sec in male MS group players and shoulder external rotation strength at 60°/sec in female PS group players decreased significantly (P<0.05). In addition, from the first to the last week, shoulder pain increased significantly (P<0.05) in all players. Inverse correlations (P<0.05) were found between VAS and shoulder rotation strength in males in the PS group, and between wellness and shoulder internal rotation strength in men in the MS group and women in the PS group. We found that both MS and PS training did not enhance performance and increased shoulder pain in male and female water polo players.

Injuries are negatively associated with player progression in an elite football academy.

BACKGROUND: The aim was to investigate the association of injuries with male football player continuity, progression and chances of reaching the First team in an elite academy. METHODS: Injuries and exposure time were prospectively recorded, following the FIFA guidelines, over 6 seasons (2011-2017) in Under (U)12, U14, U16, U19, 2nd/3rd team and First team players from the same professional football club. RESULTS: U19 and 2nd/3rd team players progressing to the next level had a lower injury burden and higher match availability compared to players that did not progress. Injury burden was lower in players progressing from U12 to U14. All players progressing from the 2nd/3rd teams to the First team had a match availability higher than 84% and did not suffer an anterior cruciate ligament (ACL) rupture or an injury requiring over 200 (+200) days to return to play. In U19 and 2nd/3rd team players, injuries requiring +100 and +200 days to return to play, ACL ruptures and groin pain, but not hamstring and ankle ligament injuries, were associated with lower odds of continuing in the academy each season. CONCLUSION: Injuries were negatively associated with player progression, and injury prevention and return-to-play strategies should be a priority for football academies.

Relative skeletal maturity status affects injury burden in U14 elite academy football players.

Maturation progresses at different times and at different rates between individuals. Thus, differences in maturity status exist among players in the same chronological age-based category, especially in U14 players. The purpose of this prospective study was to describe injury burden according to the relative skeletal maturity status in U14 elite academy football players. From 2011 to 2020, injuries and individual exposure (training and match) were prospectively recorded in 183 male U14 players. Skeletal age (SA) was assessed using the Tanner-Whitehouse 2 method. Relative skeletal maturity status [SA minus chronological age (CA)] was classified as follows: early (SA-CA > 0.5), on-time (SA-CA ± 0.5), and late (SA-CA < -0.5). Overall and specific injury burden (days lost/1000 h) and rate ratios for comparisons between groups were calculated. Overall injury burden was 2.8 times higher (3.6 times in training) in early maturers compared with late maturers. Growth-related injuries were the most burdensome injuries in all three groups, but significant differences were not found between groups. Muscle injuries were 4 times more burdensome in early maturers compared with on-time and late maturers. Besides, joint/ligament injuries were 7 and 12 times less burdensome in late maturers than in on-time and late maturers, respectively. Significant differences between groups in overall and specific injury burden were not found in matches. Our results showed different injury patterns in U14 early, on-time, and late maturers. Hence, monitoring maturity seems crucial to detect potential injuries that cause the greatest disruption, and facilitate design of targeted injury prevention programs.

Effects of multicomponent and dual-task exercise on falls in nursing homes: The AgeingOn Dual-Task study.

OBJECTIVE: To compare the effects of a multicomponent exercise program and a dual-task exercise program on the number of falls (fall rate) and number of fallers (fall incidence) and on parameters associated with fall risk in older adults living in long-term nursing homes (LTNH). STUDY DESIGN: This is a secondary analysis of a single-blind randomized controlled trial involving 85 older adults in nine LTNHs (Gipuzkoa, Spain). Participants allocated to the multicomponent group underwent a twice-a-week 3-month individualized and progressive resistance and balance program. The dual-task group performed simultaneous cognitive training with the same multicomponent exercises. MAIN OUTCOMES: Fall rate and incidence were analyzed using Poisson regression (adjusting for cognitive function and previous fall rate) and Kaplan-Meier analysis, respectively. Handgrip asymmetry, single- and dual-task TUG velocity and cost were assessed using two-way ANOVA for repeated measures and paired Student's t-tests. RESULTS: The dual-task group showed a 3.8 times greater risk of falling than the multicomponent group during the intervention, and a 2.59 times greater risk during the 12-month follow-up. There were no between-group differences in fall incidence. There were between-group differences in handgrip strength asymmetry in favor of the multicomponent group. While only the multicomponent group improved on the TUG test, the dual-task group improved on dual-task cost. CONCLUSIONS: Compared with the dual-task program, the multicomponent exercise program showed more benefits in reducing falls and in parameters associated with fall risk in LTNH residents. Future studies are warranted to confirm our results and continue to explore physical and cognitive interventions to prevent falls in LTNHs. Australian New Zealand Clinical Trials Registry ACTRN12618000536268.

Injury risk is greater in physically mature versus biologically younger male soccer players from academies in different countries.

OBJECTIVES: To investigate if maturity status was associated with injury risk in male academy soccer players. DESIGN: Prospective cohort surveillance study. SETTING: Professional soccer academies. PARTICIPANTS: 501 players (aged 9-23 years) from eight academies in England, Spain, Uruguay and Brazil. MAIN OUTCOME MEASURES: Players were grouped by maturity offset as pre-peak height velocity (PHV), circa-PHV, post-PHV or adult. Injury prevalence proportion (IPP) and days missed were recorded for one season per player, with training/match exposure recorded in a sub-sample (n = 166). RESULTS: IPP for all injuries combined increased with advancing maturity, with circa-PHV (p = 0.032), post-PHV (p < 0.001) and adult (p < 0.001) higher than pre-PHV. IPP was higher in post-PHV and adult than pre-PHV for non-contact (p = 0.001 and p = 0.012), soft-tissue (both p < 0.001), non-contact soft-tissue (p < 0.001 and p = 0.005), muscle (both p < 0.001), thigh (both p < 0.001), ankle (p = 0.035 and p = 0.007) and hamstring injuries (p = 0.041 and p = 0.017). Ligament/tendon IPP was greater in adult versus pre-PHV (p = 0.002). IPP for growth-related injuries was lower in post-PHV than pre-PHV (p = 0.039). Injury incidence rates (n = 166) exhibited similar patterns to IPP in the full cohort. CONCLUSIONS: Injury patterns were similar between post-PHV and adult academy players but, crucially, relatively more of these groups suffered injuries compared to pre- and circa-PHV (except growth-related injuries).

Playing Position and the Injury Incidence Rate in Male Academy Soccer Players.

CONTEXT: Whether playing position influences injury in male academy soccer players (ASPs) is unclear. OBJECTIVE: To determine if playing position was associated with injury in ASPs. DESIGN: Descriptive epidemiology study. SETTING: English, Spanish, Uruguayan, and Brazilian soccer academies. PATIENTS OR OTHER PARTICIPANTS: A total of 369 ASPs from the under-14 to under-23 age groups, classified as post-peak height velocity using maturity offset, and grouped as goalkeepers, lateral defenders, central defenders, lateral midfielders, central midfielders, or forwards. MAIN OUTCOME MEASURE(S): Injuries were recorded prospectively over 1 season. Injury prevalence proportion (IPP), days missed, and injury incidence rate (IIR, injuries/1000 training or match hours, n = 116) were analyzed according to playing position. RESULTS: No association with playing position was observed for any injury type or location regarding IPP (P ≥ .089) or days missed (P ≥ .235). The IIR was higher in central defenders than in lateral defenders for general (9.30 versus 4.18 injuries/1000 h, P = .009), soft tissue (5.14 versus 1.95 injuries/1000 h, P = .026), and ligament or tendon injuries (2.69 versus 0.56 injuries/1000 h, P = .040). The central versus lateral or forward positions were not associated with IPP (P ≥ .051) or days missed (P ≥ .083), but general IIR was greater in the central position than the lateral or forward positions (8.67 versus 6.12 injuries/1000 h, P = .047). CONCLUSIONS: Academy soccer players' playing positions were not associated with IPP or days missed, but the higher general, soft tissue, and ligament or tendon IIRs in central defenders suggest that this position warrants specific attention regarding injury-prevention strategies. These novel findings highlight the importance of considering training or match exposure when investigating the influence of playing position on injury in ASPs.

The genetic association with injury risk in male academy soccer players depends on maturity status.

It is currently unknown if injury risk is associated with genetic variation in academy soccer players (ASP). We investigated whether nine candidate single nucleotide polymorphisms were associated (individually and in combination) with injury in ASP at different stages of maturation. Saliva samples and one season's injury records were collected from 402 Caucasian male ASP from England, Spain, Uruguay, and Brazil, whose maturity status was defined as pre- or post-peak height velocity (PHV). Pre-PHV COL5A1 rs12722 CC homozygotes had relatively higher prevalence of any musculoskeletal soft tissue (22.4% vs. 3.0%, p = 0.018) and ligament (18.8% vs. 11.8%, p = 0.029) injury than T-allele carriers, while VEGFA rs2010963 CC homozygotes had greater risk of ligament/tendon injury than G-allele carriers. Post-PHV IL6 rs1800795 CC homozygotes had a relatively higher prevalence of any (67.6% vs. 40.6%, p = 0.003) and muscle (38.2% vs. 19.2%, p = 0.013) injuries than G-allele carriers. Relatively more post-PHV EMILIN1 rs2289360 CC homozygotes suffered any injury than CT and TT genotypes (56.4% vs. 40.3% and 32.8%, p = 0.007), while the "protective" EMILIN1 TT genotype was more frequent in post- than pre-PHV ASP (22.3 vs. 10.0%, p = 0.008). Regardless of maturity status, T-alleles of ACTN3 rs1815739 and EMILIN1 rs2289360 were associated with greater absence following ankle injury, while the MMP3 rs679620 T-allele and MYLK rs28497577 GT genotype were associated with greater absence following knee injury. The combination of injury-associated genotypes was greater in injured vs. non-injured ASP. This study is the first to demonstrate that a genetic association exists with injury prevalence in ASP, which differs according to maturity status.

Effects of Massage and Cold Water Immersion After an Exhaustive Run on Running Economy and Biomechanics: A Randomized Controlled Trial.

ABSTRACT: Duñabeitia, I, Arrieta, H, Rodriguez-Larrad, A, Gil, J, Esain, I, Gil, SM, Irazusta, J, and Bidaurrazaga-Letona, I. Effects of massage and cold water immersion after an exhaustive run on running economy and biomechanics: A randomized controlled trial. J Strength Cond Res 36(1): 149-155, 2022-This study compares the effects of 2 common recovery interventions performed shortly after an exhausting interval running session on running economy (RE) and biomechanics. Forty-eight well-trained male runners performed an exhaustive interval running protocol and an incremental treadmill test 24 hours later at 3 speeds: 12, 14, and 16 km·h-1. Subjects randomly received either massage, cold water immersion (CWI), or passive rest (control). Runners repeated the treadmill test 48 hours after the first test. A two-way mixed analysis of variance was performed comparing groups and testing times. The massage group had significantly better recovery than the control group at 14 km·h-1 in RE (p < 0.05; η2 = 0.176) and greater stride height and angle changes at 16 km·h-1 (p < 0.05; η2 = 0.166 and p < 0.05; η2 = 0.208, respectively). No differences were observed between the CWI and control groups. The massage group had greater stride height and angle changes at 16 km·h-1 than the CWI group (p < 0.05; η2 = 0.139 and p < 0.05; η2 = 0.168, respectively). Moreover, differences in magnitude suggested moderate effects on RE (η2 = 0.076) and swing time (η2 = 0.110). These results suggest that massage intervention promotes faster recovery of RE and running biomechanics than CWI or passive rest.

Pituitary Society Delphi Survey: An international perspective on endocrine management of patients undergoing transsphenoidal surgery for pituitary adenomas.

PURPOSE: In adults and children, transsphenoidal surgery (TSS) represents the cornerstone of management for most large or functioning sellar lesions with the exception of prolactinomas. Endocrine evaluation and management are an essential part of perioperative care. However, the details of endocrine assessment and care are not universally agreed upon. METHODS: To build consensus on the endocrine evaluation and management of adults undergoing TSS, a Delphi process was used. Thirty-five statements were developed by the Pituitary Society's Education Committee. Fifty-five pituitary endocrinologists, all members of the Pituitary Society, were invited to participate in two Delphi rounds and rate their extent of agreement with statements pertaining to perioperative endocrine evaluation and management, using a Likert-type scale. Anonymized data on the proportion of panelists' agreeing with each item were summarized. A list of items that achieved consensus, based on predefined criteria, was tabulated. RESULTS: Strong consensus (≥ 80% of panelists rating their agreement as 6-7 on a scale from 1 to 7) was achieved for 68.6% (24/35) items. If less strict agreement criteria were applied (ratings 5-7 on the Likert-type scale), consensus was achieved for 88% (31/35) items. CONCLUSIONS: We achieved consensus on a large majority of items pertaining to perioperative endocrine evaluation and management using a Delphi process. This provides an international real-world clinical perspective from an expert group and facilitates a framework for future guideline development. Some of the items for which consensus was not reached, including the assessment of immediate postoperative remission in acromegaly or Cushing's disease, represent areas where further research is needed.

[Women over 65 years of age performing supervised physical exercise: Differences in physical capacity, physical activity and quality of life according to walking speed]. / Mujeres mayores de 65 años que realizan ejercicio físico supervisado: diferencias en la capacidad física, la actividad física y la calidad de vida en función de su velocidad de la marcha.

INTRODUCTION: Walking speed (WS) is an easy, quick and inexpensive measure that could be used to discern between older people with greater and lesser function and thus individualize physical exercise programs. OBJECTIVES: To analyze the differences in physical capacity, physical activity, and quality of life in people over 65years of age who attended a physical exercise program according to their WS and age. METHODS: 55 women (mean age: 76.67±6.66years) were divided into groups based on their WS (low WS: ≤1.59m/s and high WS: >1.59m/s) and age (older-younger: ≤76years and older-older: >76years). The following parameters were compared: 10Meters Walk Test (10MWT), Arm Curl Test, Handgrip, Chair Stand Test, 8Foot Up and Go Test (8FUG), 6Minute Walk Test (6MWT), and the Minnesota and The Short Form-36 Health Survey (SF-36) questionnaires. RESULTS: The level of physical activity was higher than 3000METs/week in all groups. The high WS group had better results in the Arm Curl Test, 10MWT, 8FUG and 6MWT and in the Physical Role and Vitality dimensions of the SF-36 (P<.05). The older-older group had lower weight, BMI and Handgrip (P<.01). CONCLUSIONS: The best results in physical capacity and quality of life are in those women with higher WS, suggesting that WS could be useful to individualize physical exercise programs.

Effectiveness of equine-assisted therapies for improving health outcomes in people with multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND: Scientific evidence has shown that equine-assisted therapies (EAT) lead to improvements in the physical function and the quality of life (QoL) of people with disabilities through the practice of hippotherapy or therapeutic riding (TR). There is a need to confirm whether people with multiple sclerosis (PwMS) can also benefit from its practice. This review aimed to systematically evaluate and meta-analyze the available data on the potential health benefits of EAT in PwMS. METHODS: Four electronic databases (MEDLINE/PubMed, Web of Science, SPORTDiscus, and Scopus) were searched systematically from their inception until June 2021 for randomized controlled trials (RCTs) and comparative studies that provided information regarding the effects of EAT on PwMS. The studies' methodological quality assessment was performed using the PEDro and the MINORS scales. For the meta-analysis, heterogeneity across studies was quantified using the I2 statistic. Fixed-effect or random-effects models were applied to obtain the pooled results in the case of low (I2 < 30%) or high (I2 > 30%) heterogeneity values, respectively. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated to assess the change in each outcome. RESULTS: After removing duplicated studies, 234 results were retrieved by the literature search and 11 were eligible for full text search. Finally, 9 studies with a methodological quality ranging from good to low quality met the inclusion criteria. Six of them focused on hippotherapy and 4 of them were included in the quantitative analysis. Totally, 225 PwMS patients were evaluated. Findings from the meta-analysis indicated that this therapy improved static (SMD = 0.42; 95% CI: 0.05, 0.78) but not dynamic balance (SMD = 0.51; 95% CI: -0.04, 1.06), while significant benefits were observed on the patients' QoL (SMD = 0.37; 95% CI: 0.00, 0.73). Hippotherapy showed effectiveness for reducing self-perceived fatigue (SMD = 0.70; 95% CI: 0.33, 1.07), while TR showed mixed effects on balance and QoL. CONCLUSION: The actual evidence on the effectiveness of EAT in PwMS is mainly limited to hippotherapy. This rehabilitation approach seems to have beneficial effects on static balance, QoL and fatigue, but not directly on gait and dynamic balance. Altogether, the findings suggest that hippotherapy could be incorporated as a complementary therapy when developing comprehensive care plans for PwMS.

The relative age effect in young athletes: A countywide analysis of 9-14-year-old participants in all competitive sports.

The relative age effect (RAE) has primarily been investigated in male athletes involved in popular sports and high-level competitions. However, occurrence of RAE in other types of sports at the grassroots level, particularly in female athletes, is less well-studied. Thus, we examined the RAE in a large cohort of young athletes who participated in all competitive sports in Bizkaia, Spain, according to gender and specificity of the sport. The birth dates of 38,381 participants (65.1% males and 34.9% females) aged 9-14 years old in 37 competitive sports were analyzed. Birth dates were divided into four birth-quarters and compared to those of all children born in the same period using a χ2 goodness-of-fit test and standardized residuals. The effect size Cramer's V was measured, and odds ratio and 95% confidence intervals were calculated to determine the odds of athletes born in January playing in the highest leagues. In the total sample, in boys RAE was evident in football, but only in higher-competition leagues (p<0.001, large effect size). In girls, RAE was evident in the most popular team sports: basketball (p<0.001, large effect size in basketball 1st league), handball and football (p<0.05, both small effect sizes). Players born in January were 3.23- and 2.89-times more likely to play in the 1st leagues than those born in December, for boys (football) and girls (basketball) respectively. In the overall analysis and in the remaining sports, presence of RAE was negligible. Therefore, the date of birth does not seem to be a constraint to participating in most sports in Bizkaia. The potential mechanisms for RAE are multifactorial and complex, yet a combination of factors, such as the popularity of a sport and the depth of competition, physicality and social influences may be involved. We discuss these mechanisms and potential measures to mitigate RAE.

Increased risk of preneoplastic colonic lesions and colorectal carcinoma in acromegaly: multicenter case-control study.

PURPOSE: Current international guidelines recommend colonoscopy in patients with acromegaly at the time of diagnosis, even though the risk of developing colorectal neoplasm is still controversial. The main objective of this Argentine multicenter study was to analyze through screening colonoscopy the presence of advanced neoplastic lesions considered as precancerous, in patients with acromegaly compared to a control group. METHODS: This is a case-control retrospective study. Full length colonoscopy of 70 acromegalic patients and 128 control subjects were studied. Polyps were classified into non pre-cancerous lesions and advance neoplastic lesions which included advanced adenomas (preneoplastic) and colorectal carcinomas. RESULTS: Thirty three out of 70 acromegalic patients and 32 out of 128 subjects controls presented polyps in the colonoscopy [47.1% vs 25%, p = 0.002, OR 2.68]. Non precancerous polyps were found in 11 (15.7%) and 23 (17.9%) (p = 0.690), while advanced neoplastic lesions were found in 22 (31.4%) and 9 (7.0%) (p = 0,0001 - OR: 6.06) patients and controls respectively. Advanced adenomas and colorectal carcinomas were found in 18 (27.3%) and 9 (7.0%) (p = 0,0006-OR: 4,57), and 4 (5.7%) and 0 (0.0%) p = 0.0063) of patients and controls respectively. The presence of insulin resistance was the only statistically significant associated factor among acromegalic patients with and without colonic polyps. CONCLUSIONS: Our findings show an increased risk of preneoplastic colonic lesions and colorectal carcinoma in patients with chronic and sustained GH excess compared to a control group. This supports the recommendation to perform screening colonoscopy at diagnosis of acromegaly.