Cold operational readiness in the military: from science to practice.

Cold weather operations are logistically difficult to orchestrate and extremely challenging for soldiers. Decades of research and empirical evidence indicate that humans are extremely vulnerable to cold and that individual responses are highly variable. In this context, it may be necessary to develop personalised strategies to sustain soldiers' performance and ensure overall mission success in the cold. Systematic cold weather training is essential for soldiers to best prepare to operate during, and recover from, cold weather operations. The purpose of this review is to highlight key aspects of cold weather training, including (1) human responses to cold, (2) nutrition, (3) sleep and (4) protective equipment requirements. Bringing science to practice to improve training principles can facilitate soldiers performing safely and effectively in the cold. Cold weather training prepares soldiers for operations in cold, harsh environments. However, decreases in physical, psychological and thermoregulatory performance have been reported following such training, which influences operational ability and increases the overall risk of injuries. When optimising the planning of field training exercises or operational missions, it is important to understand the soldiers' physical and cognitive performance capacity, as well as their capacity to cope and recover during and after the exercise or mission. Even though the body is fully recovered in terms of body composition or hormonal concentrations, physical or cognitive performance can still be unrecovered. When overlooked, symptoms of overtraining and risk of injury may increase, decreasing operational readiness.

Failure and complication rates following meniscal all-inside and inside-out repairs: A systematic review and meta-analysis.

PURPOSE: This study examines failure rates, complication rates and patient-reported outcome measures (PROMs) for meniscal all-inside (AI) and inside-out (IO) repair techniques. METHODS: A systematic search was conducted on PubMed, Embase and Cochrane (inception to January 2024) assessing for Level I-III studies evaluating outcomes after meniscal repair. The primary outcome regarded differences in failure rates between AI and IO repair techniques. Secondary outcomes included a comparison of complication rates and PROMs. Quality assessment was performed using the Grading of Recommendations Assessment, Development and Evaluation and Methodological Index for Non-Randomized Studies criteria. A meta-analysis was conducted for outcomes reported by more than three comparative studies. RESULTS: A total of 24 studies (13 studies and 912 menisci for AI vs. 17 studies and 1,117 menisci for IO) were included. The mean follow-up ranges were 22-192 months (AI) and 18.5-155 months (IO). The overall reported AI failure rate ranged from 5% to 35% compared to 0% to 25% within the IO group. When comparing meniscal repair failure rates in the setting of concomitant anterior cruciate ligament reconstruction, the AI group had a failure rate (AI: 5%-34%; IO: 0%-12.9%). The complication rate ranged from 0% to 40% for AI and 0% to 20.5% for IO. Post-operative PROM scores ranged from 81.2 to 93.8 (AI) versus 89.6 to 94 (IO) for IKDC and 4.0-7.02 (AI) versus 4.0-8.0 (IO) for Tegner. Upon pooling of six comparative studies, a significantly lower failure rate favouring the IO technique was observed (15.9% AI vs. 11.1% IO; p = 0.02), although this result was influenced by a study with a predominantly elite athlete population. Moreover, no significant differences were found regarding complication rates between cohorts (7.3% AI vs. 4.8% IO; p = 0.86). CONCLUSION: The present study underscores comparable clinical success between AI and IO meniscal repair techniques, with both techniques demonstrating similar complication rates. However, the AI repair technique was associated with 1.77 times higher odds of failure compared to the IO cohort. LEVEL OF EVIDENCE: Level III.

Return to play and performance after patellar fracture in American Professional Sports: a case-control cohort analysis.

OBJECTIVES: This study describes the effects of patellar fracture on return to play (RTP) and functional outcomes among athletes in American professional sports. METHODS: Professional athletes from the National Football League (NFL), National Basketball Association (NBA), Major League Baseball (MLB), and National Hockey League (NHL) who suffered a patellar fracture between January 1965 and December 2021 were identified through injury reports and public archives. Performance scores, play time, and games played were collected for the season preceding patellar fracture and 2 seasons after RTP, and differences in recorded metrics compared to pre-injury levels and matched controls were analyzed. RESULTS: Twenty-nine of 41 (71%) injured athletes returned to play at an average of 217 days. Among all players, play volume decreased in year 1 compared to baseline but recovered to pre-injury levels in year 2. Athletes treated operatively experienced an initial decline in performance (p < 0.01) but recovered to pre-injury performance level in year 2. Nonoperative management resulted in a decline in performance in year 2 of RTP (p = 0.02). Athletes treated operatively performed significantly worse than matched controls in year 1 of RTP (64% vs. 99%; p = 0.04) but recovered to a similar level of performance as controls in year 2 (87% vs. 91%; p = 0.90). CONCLUSION: A 71% rate of RTP was demonstrated among this limited cohort of 29 athletes in American professional sports after isolated patellar fracture. Although details regarding fracture characteristics and operative reports were not available for analysis, operative management was not associated with longer absence from play compared to nonoperative treatment. Despite the limitations of this study, the findings suggesting operative management may improve prospects of maintaining elite performance following RTP warrant further investigation. LEVEL OF EVIDENCE: Case control cohort analysis; Level of evidence, 3.

Does wet-cupping therapy improve repeated sprint ability, perceived wellness, and rating of perceived exertion in young active males?

Wet-cupping therapy (WCT) is one of the oldest known medical techniques, used as a traditional and complementary therapy with a wide application all around the world for general health. Research on the effects of WCT on sports performance are sparse and inconsistent. Thus, we aimed to explore the effects of WCT on repeated sprint ability, wellness, and exertion in young active males. Forty-nine active adult males (age: [28 â€‹± â€‹5] years; body height [177 â€‹± â€‹8] cm; body mass: [79 â€‹± â€‹7] kg; body mass index: [25.4 â€‹± â€‹1.8] kg/m2) were selected for the study. The participants performed a running-based sprint test on two separate occasions (Control and Post-WCT). WCT was performed 24 â€‹h before the testing session. They completed the Hooper questionnaire to assess their well-being ( i.e. , sleep, stress, fatigue, and soreness) before each session. The rating of perceived exertion (RPE) was collected after each testing session. A higher maximum power (p â€‹< â€‹0.05, effect size [ES] â€‹= â€‹0.6), mean power (p â€‹< â€‹0.01, ES â€‹= â€‹0.5) and minimum power (p â€‹< â€‹0.01, ES â€‹= â€‹0.6) were recorded post-WCT as compared to Control session along with a better perceived sleep (p â€‹< â€‹0.01, ES â€‹= â€‹0.85). Perceived stress (p â€‹< â€‹0.01, ES â€‹= â€‹0.6) and RPE (p â€‹< â€‹0.001; ES â€‹= â€‹1.1) were lower during the post-WCT compared to the Control session. The present findings demonstrated that WCT moderately enhanced repeated sprint ability and had positive effects on perceived sleep, stress, and exertion. WCT may be an effective ergogenic aid to improve repeated sprint ability and general well-being in young adult males. Future large-scale multicentric clinical studies are paramount to confirm the results of our study.

Framing racial disparities within sports related concussion (SRC): an ecological framework for understanding biases and disparities in concussion care for black athletes.

Privilege and marginalization associated with racial background have been posited as contributors to why Black athletes face disparities within their care, treatment, and recovery from sport-related concussion (SRC). However, empirical findings have limited exploration on how disparate outcomes have emerged, and the interaction with systems of biases, power and disenfranchisement. To understand concussion care disparities, a qualitative content analysis was conducted in three phases: [I] identifying salient literature on racial differences for Black athletes with SRC (N = 29), [II] qualitative analysis of literature to determine salient topics, themes and patterns within the literature, and [III] constructing a novel ecological-systems framework that encapsulates the 'why' and 'how' related to psychosocial and sociocultural experiences of power, access, and biases for Black athletes. The content analysis yielded two patterns, where concussion care decisions are influenced by (1) biased, unconscious beliefs that posit Black athletes as uniquely invincible to injury and pain, and (2) inadequate access to concussion knowledge and resources, which both moderate SRC injury risk, diagnosis, recovery and outcomes. Ultimately, our novel framework provides a clear thread on how historical, macro-level policy and perceptions can impact micro-level clinical care and decision-making for Black athletes with SRC.

A cross-sectional study of the association between physical activity and depressive symptoms among adolescents in southwest China stratified by parental absence: the mediating role of insomnia and the moderating role of resilience.

OBJECTIVES: This study explored the mechanisms by which physical activity was associated with depressive symptoms in multi-ethnic (Han, Yi and Tibetan) adolescents in southwest China. The mediating role of insomnia in the association of physical activity with depressive symptoms, the moderating role of resilience in this mediation model and the moderating role of parental absence in the moderated mediation model were also examined. DESIGN: A cross-sectional survey. SETTING: In southwest China (Sichuan Province and Tibet Autonomous Region). PARTICIPANTS: 3195 adolescents from a school-based survey conducted between April and October 2020. METHODS: There were 3143 valid samples in this study (47.2% males with mean age=12.88±1.68 years). Structural equation models were developed to estimate the direct and mediating effect, and the moderating effect. Multigroup comparison was performed to examine the differences and similarities of the moderated mediation model across three parental absence subgroups: (1) both parents present, (2) one parent absent and (3) both parents absent. RESULTS: As hypothesised, physical activity was significantly and positively associated with the reduction of depressive symptoms in adolescents. Insomnia partially mediated the effect of physical activity on depressive symptoms. In addition, resilience moderated the direct and indirect effects of physical activity (through insomnia) on depressive symptoms. Finally, the multigroup comparison indicated the moderating effect of parental absence on the moderated mediation model. CONCLUSIONS: Physical activity was associated with alleviating insomnia symptoms among adolescents, thus correlating with the improvement of their depressive symptoms. Resilience was associated with enhancing the beneficial effects of physical activity, further improving depressive symptoms among adolescents, especially those with both absent parents. It is evident that physical activity interventions should be further incorporated into public health programmes to foster the physical and mental health of left-behind adolescents in southwest China.

Outcome measures used in adolescent sport-related concussion research: a scoping review.

OBJECTIVES: To provide an overview of the outcome measures currently used after sports-related concussion (SRC) in adolescents, categorising by the constructs they assess, follow-up duration and their feasibility of use. DESIGN: Scoping review. DATA SOURCES: We searched three electronic databases (MEDLINE, EMBASE and CINAHL). We also undertook citation tracking of the included articles and searched for ongoing or unpublished trials using ClinicalTrials.gov and Theses Global. ELIGIBILITY CRITERIA: Studies tracking concussion recovery in adolescent athletes. RESULTS: 15 782 records were identified. After initial title and abstract screening, we retrieved 87 studies for full-text screening, with 75 studies fulfilling the eligibility criteria and included in the review, comprising 13 107 participants (9480 male, 3615 female and 12 unreported), ranging in age from 5 to 19 years. 46 different outcome measures were used, with Post-Concussion Symptom Scale (n=42) and Immediate Post-Concussion Assessment and Cognitive Testing (n=21) the most common. Most outcome measures quantified aspects of sensorimotor function including balance, oculomotor function and cognition. Follow-up duration ranged from 7 days to 1 year. 60% of studies ceased follow-up assessments within 6 weeks post-SRC. CONCLUSIONS: Adolescent SRC literature uses a wide range of outcome measures. Most research quantifies cognitive/fatigue domains in the acute/subacute stages post-SRC, using male participants. Other key domains such as anxiety/mood, migraine and key modifiers (cervical and sleep disturbance) are less well represented in the literature. Many of the outcome measures used in current research are associated with high cost and require highly qualified examiners, creating barriers to their implementation in some adolescent sporting environments. STUDY REGISTRATION: https://doi.org/10.17605/OSF.IO/N937E.

Effects of dry needling on vertical jump performance in female volleyball players. A randomized controlled trial.

Introduction: Injury prevention and performance enhancement are paramount goals in sports. Myofascial Pain Syndrome, primarily caused by myofascial trigger points, can result in referred pain, stiffness, muscle shortening, and weakness. This study aimed to assess the impact of dry needling (DN) on latent myofascial trigger points on vertical jump performance in female volleyball players. Methods: A single-blind, randomized controlled clinical trial was conducted with twenty-six healthy female volleyball players who had no lower limb injuries in the last six months, exhibited latent trigger points in the triceps surae muscles, and were familiar with the countermovement jump test. Participants were randomly assigned to either a control group or an experimental group (which received a single DN session). Vertical jump performance variables, including jump height as the primary outcome, were assessed using a force platform at five time points: before the intervention, immediately post-treatment, 24 h post-treatment, 72 h post-treatment, and one-week post-intervention. Results: The experimental group showed significantly lower values for vertical jump height, flight time, velocity, strength, and power immediately after the needling intervention (p < 0.05). However, these values were significantly higher one-week post-intervention across all variables (p < 0.01). These findings indicate that DN initially decreases jumping performance, but improvements are observed one week after the intervention. In the comparison between groups, the experimental group exhibited higher values at the one-week follow-up for vertical jump height, flight time, speed, and power compared to the control group (p < 0.05). Conclusions: DN appears to be an effective technique for improving vertical jump performance in female volleyball players one week after its application. Clinical Trial Registration: ClinicalTrials.gov, identifier (NCT06184672).

Effects of Swimming Exercise on Early Adolescents' Physical Conditioning and Physical Health: A Systematic Review.

BACKGROUND/OBJECTIVES: Swimming is a popular and cost-effective way to prevent sedentary behavior and improve physical conditioning and health during early adolescence. However, information on its impact and benefits on daily life activities is lacking. This systematic review aims to summarize the chronic effects of swimming on physical conditioning and physical health outcomes in early adolescents. METHODS: The PRISMA 2020 guidelines were followed and PubMed, Scopus, Web of Science, and International Symposium of Biomechanics and Medicine in Swimming proceedings databases were searched. Eligibility criteria were defined on the PICOS framework (healthy adolescents in early puberty, swimming programmes or training, passive or active control groups, general effects on physical conditioning or health, longitudinal) and risk of bias was assessed using RoBANS 2. RESULTS: From 2365 records, 20 non-randomized studies met the defined criteria. High heterogeneity in sample size and intervention was observed. While studies related to physical conditioning (n = 5) focused on physiological variables and muscular function, the evidence regarding physical health outcomes (n = 15) explored bone accrual, haemodynamics, body composition, musculoskeletal system, and lung growth. High overall risk of bias (70%) was observed due to strict criteria. CONCLUSIONS: Swimming exercise seems to improve cardiorespiratory fitness, cardiac output, haemodynamics, heart growth, motor performance, and body composition of early adolescents. Despite clear evidence that exists on these chronic effects, research on bone health, postural deficit, motor skills, and sleep quality is still missing.

The Effect of Blood Flow Restriction during Low-Load Resistance Training Unit on Knee Flexor Muscle Fatigue in Recreational Athletes: A Randomized Double-Blinded Placebo-Controlled Pilot Study.

Background/Objectives: Despite the growing popularity of training with a controlled form of vascular occlusion, known as blood flow restriction (BFR) training, in the rehabilitation of orthopedic patients and sports medicine, there remains ample space for understanding the basis of its mechanism. The pilot study assessed the effect of BFR during a low-load resistance training unit on knee flexor muscle fatigue, intending to decide whether a larger trial is needed and feasible. Methods: The study used a prospective, randomized, parallel, double-blind, placebo-controlled design. Fifteen male healthy recreational athletes were randomly assigned to three equal groups: BFR Group, Placebo Group, and Control Group. The primary outcome was the change in the surface electromyography-based (sEMG-based) muscle fatigue index, which was determined by comparing the results obtained before and after the intervention. The intervention was the application of BFR during low-load resistance training for knee flexors. The occurrence of any adverse events was documented. Results: In all groups, the sEMG-based fatigue index for semitendinosus and biceps femoris muscles decreased after low-load resistance training, with the largest decrease in the BFR group. Although not statistically significant, BFR showed moderate and large effect sizes for the fatigue index of semitendinosus and biceps femoris, respectively. No adverse events were noted. Conclusions: The pilot study suggested that BFR during a low-load resistance training unit might affect knee flexor muscle fatigue, supporting the development of a larger randomized clinical trial.

The Relationship between Training Load and Injury Risk in Basketball: A Systematic Review.

The relationship between training load and injury risk in basketball is an important area in sports injury prevention and performance enhancement; however, there is limited conclusive evidence of their associations. The aim of this systematic review was to examine the evidence of the relationship between training load and injury risk in basketball, which is one of the most common sports worldwide. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted on the PubMed, SCOPUS, and Web of Science databases up until March 2024. The search aimed to identify studies that prospectively and/or retrospectively examined the relationship between training load and injury risk in basketball. Inclusion criteria were limited to studies published before February 2024. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale and Oxford Centre for Evidence-Based Medicine levels of evidence. A narrative synthesis of the findings was performed. A total of 14 articles met the inclusion criteria and were included in the review. Of these, 11 studies reported at least partially statistically significant results, providing evidence of a relationship between training load and injury risk. In conclusion, the findings of this review suggest a clear relationship between training load and injury risk in basketball.

Assessment of Sex-Specific Associations between Athletic Identity and Nutrition Habits in Competitive Youth Athletes.

Given the psychological aspects of sports nutrition, understanding one's athletic identity (AI) may improve targeted nutrition education. Therefore, the purpose of this study was to examine nutrition habits and AI among uninjured youth athletes. Athletic Identity Measurement Scale (AIMS) and custom Sports Nutrition Assessment for Consultation (SNAC) scores collected prospectively at local sporting events were retrospectively assessed via Mann-Whitney, Kruskal-Wallis, logistic regression, and ANCOVA tests (95% CI). Among 583 athletes (14.5 ± 2.1 years; 59.9% female), the total AIMS scores did not differ by sex (males 39.9 ± 7.2; females 39.3 ± 7.5; maximum 70). The Social Identity (p = 0.009) and Exclusivity (p = 0.001) subscores were higher in males, while the Negative Affectivity subscores were lower (p = 0.019). Females reported frequent associations between SNAC and AIMS, particularly Negative Affectivity, which was positively associated with stress fracture history (p = 0.001), meal-skipping (p = 0.026), and desiring nutrition knowledge (p = 0.017). Males receiving weight recommendations reported higher Negative Affectivity subscores (p = 0.003), and higher total AIMS scores were observed in males with fatigue history (p = 0.004) and a desire for nutrition knowledge (p = 0.012). Fatigue and stress fracture history predominated in high-AI males and females, respectively, suggesting that poor sports nutrition may present differently by sex. As suboptimal nutrition was frequently related to high Negative Affectivity subscores, these habits may increase following poor sports performance.

Increased rate of injuries to the anterior cruciate ligament in amateur soccer players after the COVID-19 pandemic lockdown.

The COVID-19 pandemic led to the discontinuation of soccer activities at all levels of play. Injuries to the anterior cruciate ligament (ACL) are still one of the most severe injuries in soccer. The aim of this investigation was to analyze the changes in the incidence and mechanism of ACL injuries in professional and amateur soccer before and after the lockdown period. Injury data were prospectively collected using the database 'ACL registry in German soccer'. Between 2019 and 2021, 10 matches in professional, semi-professional, and amateur leagues before and after the lockdown were analyzed for the incidence and mechanism of ACL injuries. Data were collected using standardized and recently published study methods. Mean incidence of the 84 ACL injuries recorded during the study period was 0.083 injuries per 1000 h of exposure before and 0.079 injuries per 1000 h of exposure after the lockdown period (p = 0.699). In amateur soccer, the incidence of ACL injuries increased significantly from 0.058 injuries per 1000 h of exposure before to 0.128 injuries per 1000 h of exposure after the lockdown period (p = 0.026), in contrast to professional (p = 0.436) and semi-professional (p = 0.802) soccer. The predominant mechanisms of ACL injuries were non-contact injuries (pre-COVID: 59.1%; post-COVID: 57.7%) and indirect contact injuries (pre-COVID: 31.8%; post-COVID: 30.8%). The absence from training and match practice in German soccer during the COVID-19 lockdown led to a significantly increased ACL injury rate in amateur leagues, while in professional and semi-professional soccer no differences were reported. The mechanism of ACL injuries did not change after the lockdown period.Level of evidence: II.

HealthyTrailsBR - The prevalence of running-related injuries and cramps, and the description of personal and running characteristics in Brazilian trail runners: a cross-sectional study.

BACKGROUND: Physical activity in natural environments, such as trail running, is a way to nurture physical and mental health. However, running has an inherent risk of musculoskeletal injuries. OBJECTIVES: To investigate the prevalence of running-related injuries (RRI) and cramps, and to describe the personal and training characteristics of Brazilian trail runners. METHODS: A total of 1068 trail runners were included in this observational cross-sectional study. The participants had at least six months of trail running experience. The data were collected between April 2019 and February 2020 through an online and self-reported survey. RESULTS: The point prevalence of RRIs was 39.2 % (95 % credible interval [CrI]: 36.3, 42.1). The body region with the highest point prevalence was the knee. The 12-month period prevalence of RRIs was 69.2 % (95 %CrI: 66.4, 72.0). The body region with the highest 12-month period prevalence was the lower leg. 1- and 12-month period prevalence of cramps was 19.5 % (95 %CrI: 17.1, 21.9) and 36.0 % (95 %CrI: 33.0, 38.8), respectively. Triceps surae was the muscle most affected by cramps. CONCLUSIONS: Two in 5 (40 %) trail runners reported being injured at the time of data collection, and about 2 of 3 reported previous RRIs in the last 12 months. The most prevalent injured body regions were the knee and the lower leg. One in 5 trail runners reported cramps in the last month, increasing to 36 % in the last 12 months. Knowing better the characteristics of the population and the burden of health conditions may inform better decisions regarding implementation actions toward trail running practice.

Athlete Health Implications of Match Injuries in Portuguese Rugby Union.

OBJECTIVE: Our aim was to report time-loss match injuries in Portugal's "Divisão de Honra" (Portuguese first tier) in the 2022/2023 season, focusing on injury incidence, burden, anatomical region, and type, to assess their impact on athletes' health and availability to play. METHODS: A prospective cohort study was conducted monitoring injuries via an online form filled in by each team's medical department, categorizing player position, as well as injury type, location, and severity. Incidence and burden were calculated per 1000 player-match-hours. RESULTS: The overall injury incidence was 54.4 injuries per 1000 player-match-hours (95% CI 30.3-96.2). Forwards had higher injury incidence than backs. Lower limbs were the most affected locations-29 injuries/1000 h of exposure (95% CI 13.7-52.0). Sprain/ligaments injuries were the most common type of injury (14.4 injuries/1000 h (95% CI 3.7-30.0), followed by muscle injuries (8.1 injuries/1000 h 95% CI 4.9-11.5). DISCUSSION: Injury incidence was higher than what is reported in amateur competitions and lower than for professionals. Injury severity was similar to that in other studies. Our study suggests a lower injury burden than in other semi-professional and elite leagues. These findings highlight the need for targeted injury prevention strategies in the Portuguese Rugby Union to increase athletes' availability by decreasing injury incidence and/or burden. Further research with broader participation and training injury data is needed.

New, Optimized Skin Calorimeter Version for Measuring Thermal Responses of Localized Skin Areas during Physical Activity.

We present an optimized version of the skin calorimeter for measuring localized skin thermal responses during physical activity. Enhancements include a new holding system, more sensitive thermopiles, and an upgraded spiked heat sink for improved efficiency. In addition, we used a new, improved calorimetric model that takes into account all the variables that influence the measurement process. Resolution in power measurement is 1 mW. Performance tests under air currents and movement disturbances showed that the device maintains high accuracy; the deviation produced by these significant disturbances is less than 5%. Human subject tests, both at rest and during exercise, confirmed its ability to accurately measure localized skin heat flux, heat capacity, and thermal resistance (less than 5% uncertainty). These findings highlight the calorimeter's potential for applications in sports medicine and physiological studies.

Creating a postgraduate syllabus for a team care diploma examination: a Delphi study.

Objectives: There is no agreed standard assessment of the minimum knowledge and skills that are required to provide healthcare to participants in individual or team sports. This study aims to develop a syllabus for the Faculty of Sport and Exercise Medicine (FSEM) Team Care Diploma examination. This will provide a recognised assessment of the minimum required skills and knowledge for healthcare professionals providing care in an individual and team sport environment. Methods: A modified Delphi approach was used. A syllabus was developed by a purposeful selection of members of the FSEM, all of whom have significant team care experience. This was then reviewed by the Delphi expert panel who were team care practitioners with at least 5 years of experience. A two-round Delphi approach was used to develop a consensus. Results: The expert panel consisted of 50 individuals, with 46 (92%) completing both rounds. Of the 447 learning objectives (LOs) proposed; 430 (96%) were accepted outright, 17 (4%) were rejected and four new LOs were introduced based on expert panel feedback. The final syllabus contained 434 LOs across 6 modules (clinical governance, safe and effective practice, interdisciplinary teamwork, specific athlete groups, specific health conditions and duties of the medical team). Conclusion: This standardised syllabus will be used as the basis for the new FSEM Team Care Diploma examination which will aim to provide world-leading standardised assessment of the minimum skills and knowledge required for healthcare professionals across the multidisciplinary team providing care in individual and team sport.

Observational study of the effects of maximal oxygen uptake on cognitive function and performance during prolonged military exercise.

INTRODUCTION: Military operations place high demands on many cognitive functions, and stressful events characterise the military work environment. The study aimed to examine the relationship between cardiorespiratory fitness, stress response, cognitive function and military performance during prolonged military exercise. METHODS: 66 army cadets were included in the study. The subjects participated in a 4.5-day military winter training in northern Sweden. Maximal oxygen uptake (VO2max) was estimated from a cycle test. Cognitive tests (design fluency, DF test) and measurements of heart rate variability (HRV) were conducted before and after the exercise. Assessment of military performance as an individual soldier (P-ind) and performance as a team leader (P-lead) was carried out during the final day of the exercise. Pearson's coefficient of correlation (r) and Spearman's rho were used to evaluate correlations, and linear regressions were used to examine the relationships between VO2max, HRV, DF test scores and military performance. Simple mediation analyses were performed with DF test scores and military performance (P-ind, P-lead) as dependent variables, VO2max as a predictor and HRV as a mediator. RESULTS: Post-exercise HRV was related to military performance (P-ind: r=0.40, p<0.01; P-lead: r=0.32, p<0.05). Absolute VO2max was positively correlated with P-ind (r=0.28, p<0.05), and the effect of VO2max on military performance was mediated by HRV. Post-test DF scores were negatively correlated with post-exercise HRV (total correct designs: r=-0.26, p<0.05; total incorrect designs: r=-0.27, p<0.05). CONCLUSIONS: Results suggest that high absolute VO2max predicts military performance by reducing the stress response to prolonged military exercise. Aerobic capacity may provide a meaningful effect on the ability to preserve military performance. Future studies need to identify thresholds for this capacity. PRE-REGISTRATION: The protocol was retrospectively registered at OSF (https://osf.io/), registration DOI 10.17605/OSF.IO/ND6XM.

Concussion Reduction in Division I and II Athletes: Effects of Simple Cervical Spine Exercise Regimen.

INTRODUCTION:  Primary preventative medicine lacks a consensus on effective concussion prevention strategies for collegiate athletes. Cervical strength has been identified as a potential factor in concussion risk reduction. This study evaluates the impact of a commercially available, portable cervical muscle stretching and strengthening device, NeckX®, on cervical strength, range of motion (ROM), and concussion incidence in collegiate athletes participating in high-concussion-risk sports. METHODS:  A single-arm prospective cohort study was conducted with 162 collegiate athletes from various sports. Participants underwent a 12-week neck exercise protocol using the NeckX® device. Clinical data, including neck strength and ROM, were collected at weeks 0, 6, and 12. Concussion incidence was self-reported by participants and cross-referenced with records from the athletic department. Data were analyzed for significant neck strength and ROM changes throughout the 12-week study. A two-way analysis of variance multiple comparisons with the Tukey-Kramer significant difference test was utilized, using the Holm-Sidak method, with an alpha of 0.05. RESULTS:  All athletic teams experienced a significant increase in cervical strength during the 12-week intervention (α = 0.05, p < 0.05). Increases in cervical flexion and extension force were most consistent between teams. Cervical ROM increased significantly in male and female soccer players (α = 0.05, p < 0.05). The overall incidence of head and neck injuries, including concussions, was reduced to 6.60% during the study period, the lowest recorded value in the university's athletic department history. CONCLUSION:  The use of the NeckX® device for 12 weeks was effective in enhancing pericervical muscle strength and ROM while reducing concussion incidence in collegiate athletes participating in high-concussion-risk sports. Interestingly, the positive outcomes were consistent for both males and females, indicating the universal advantages of neck training among collegiate athletes. These findings support existing research on the benefits of cervical strengthening exercises for reducing concussions in collegiate athletes and highlight the convenience and affordability of using this device.

"I'd rather do that (Knee Control) than be injured and not able to play": a qualitative study on youth floorball players' and coaches' perspectives of how to overcome barriers for injury prevention exercise programme use.

This study explored youth floorball players' and coaches' perspectives on using the injury prevention exercise programmes (IPEPs) Knee Control or Knee Control+ (Knee Control programmes) and how to overcome barriers to programme use. We used a qualitative design with eight semistructured focus group discussions, six with players, 11-17 years old (n =42) and two with coaches (n =12). Data analysis followed the principles of qualitative content analysis. Three main categories emerged: challenges related to preventive training, promoting factors and solutions to facilitate the use of preventive training. To overcome barriers, players and coaches gave examples of how to tailor preventive programmes, such as adding joyful sport specific components. Player-perceived improved performance, with increased strength and speed from the preventive training, could be a promoting factor to increase motivation and enable IPEP use. Players and coaches offered examples of how to adapt and progress the preventive training by progressing gradually and choosing exercises that fit the team. Coaches emphasised that preventive training is important but difficult to prioritise in time-limited training sessions. Coaches' suggestions to overcome barriers were through collaboration and support from other coaches, to start using the IPEP at an early age, to keep it simple and motivating the players with, for example, positive role models. Players found the Knee Control exercises boring but necessary for injury prevention. Sometimes, coaches felt uncertain of their competence to use the Knee Control programmes and wished for support from the federation, club and other coaches. Players and coaches shared ideas on how to overcome barriers to IPEP use, such as to increase players' motivation, having a good structure, setting up routines for preventive training and to tailor the preventive training to the team. These findings can be used to further develop practical workshops and recommendations for programme use for players and coaches in youth team ball sports.