The Enhanced Games: a timely injection for the International Olympic Committee.

The Enhanced Games, a privately funded sporting megaevent aspiring to rival the Olympic Games, have garnered significant media attention since its public inception in 2023. This attention has primarily been driven by the Enhanced Games' embrace of performance-enhancing drugs. Lost in the public fixation on the event's green-lit drug-use, however, is the fact that the Enhanced Games distance themselves from current Olympic standards in numerous ways beyond drug-policies alone. More precisely, the Enhanced Games promote themselves as a more economically and ecologically sustainable alternative to the Olympics, as well as a megaevent that aims to put athletes and their safety front-and-center. With an eye towards current Olympic standards, we suggest that closer examination of the Enhanced Games offers novel perspectives on the future of the Olympics and global sporting events more broadly.

Para-athletes are exposed to bullying as much as non-disabled athletes.

OBJECTIVES: Exposure to bullying and high levels of anxiety are important determinants of the quality and duration of athletes' experiences of success. The aim of this study was to determine which behaviors are most commonly perceived as bullying by para athletes and whether the exposure to bullying or levels of trait anxiety differ between para athletes and non-disabled athletes. METHODS: It is a cross-sectional study. Two groups consisting of professional para athletes (n = 104) and non-disabled athletes (n = 129) between the ages of 18-45 affiliated to the national athletics federation were included in the study. The questionnaire included information about demographics and the two scales, the Negative Acts Questionnaire-Revised (NAQ-R) and the Sport Anxiety Scale-2 (SAS-2). RESULTS: Withholding information that could affect performance and spreading rumors (item 1,5) were the most frequently reported bullying behaviors. No statistically significant difference was found between para athletes and non-disabled athletes or between male and female genders in terms of total or any subdimension NAQ-R scores (p > 0.05). SAS-2 total and SAS-2-worry subdimension scores were significantly lower in the para athletes (p = 0.018 and p = 0.020). Total and all SAS-2 subdimension scores were significantly higher in female athletes (p < 0.05). CONCLUSION: The knowledge about bullying exposure in para-athletes is quite limited. The para-athlete group has fewer opportunities than the non-disabled group in terms of financial opportunities, physical conditions, media coverage and many other aspects. However, in our study, they reported bullying exposure at a similar rate with the non-disabled group. Although there is a similar level of exposure, it is clear that the results will not be similar in the two groups due to the different psychological bases. According to the results of this study, it is thought that stakeholders who have responsibility for the para-athlete group should be further educated.

Corrigendum: Cardiac function and autonomic cardiac function during a multi-stage cycling event: a brief report.

[This corrects the article DOI: 10.3389/fspor.2024.1356577.].

Acute Calcific Tendinitis of the Flexor Hallucis Brevis Associated With Muay Thai.

Calcific tendinitis manifesting in the foot and toes is a rare condition that often goes unnoticed, even by podiatric specialists and healthcare practitioners. Characterized by an acute onset, this condition presents with pronounced local inflammatory indicators accompanied by pain, often complicating its differentiation from other conditions. We document our experience with a 27-year-old female patient presenting with calcific tendinitis in the flexor hallucis brevis (FHB), along with a review of the relevant literature.

Os Vesalianum Pedis in a Professional Badminton Player: A Case Report.

Os vesalianum pedis (OVP) is one of the exquisite accessory ossicles adjacent to the foot's fifth metatarsal base. Though most of the OVP cases are asymptomatic, only a handful of patients who presented with lateral foot pain have been reported. A 36-year-old professional badminton player presented with swelling and tenderness in the right foot at the metatarsal base. An initial radiographic examination revealed a pseudo-Jones fracture. As a result of persistent pain and concerns regarding OVP, a reassessment of the X-ray was conducted. The examination revealed a radiolucent line with well-defined and well-corticated edges, uniformly separating the ossicle from the metatarsal in the right foot, consequently leading to the diagnosis of OVP. Following diagnosis, the patient was managed conservatively. Os vesalianum is not a common source of pain on the midfoot's lateral side. An oblique radiograph is an appreciable strategy to demonstrate the accessory ossicle. Thus, a careful clinical examination, coupled with the correlation of radiological findings, is a prerequisite to prevent misdiagnosis and overtreatment thereafter.

Energy availability and its association with health-related outcomes among national athletes at risk of relative energy deficiency in sports (REDs).

Background: Low energy availability (LEA) occurs when athletes' energy intake fails to match the energy expended during exercise, resulting in insufficient energy to support essential functions for optimal health, a condition known as relative energy deficiency in sports (REDs). Objective: This study aims to explore the prevalence of LEA among Malaysian national athletes and its associations with health-related outcomes. Methods: A total of 43 athletes (51.2% males, aged 18-40) identified previously as having moderate or high risk of REDs through a questionnaire underwent comprehensive clinical assessments. Resting metabolic rate (RMR) was measured using indirect calorimetry, with an RMR ratio of <0.90 indicating LEA. Weight and height were measured, and fasting blood samples were analysed for ferritin, free triiodothyronine (fT3), follicle-stimulating hormone (FSH), luteinising hormone (LH), estradiol (female athletes) and testosterone (male athletes). Bone mineral density (BMD) of the lumbar spine and total left hip, as well as body composition, were measured using dual-energy X-ray absorptiometry (DXA). Results: Out of the 43 athletes, 12 showed evidence of LEA, exhibiting at least one of the following characteristics: low estradiol levels (87.5%), low testosterone (75.0%), low fT3 (66.7%), low LH (58.3%), low FSH (58.3%), low ferritin (25.0%) and low BMD (8.3%). Notably, fT3, estradiol and testosterone were significant predictors for LEA. Conclusions: A low but noteworthy incidence of LEA among Malaysian national athletes was associated with hormone imbalances. Awareness about LEA among athletes and sports personnel is essential for early detection and appropriate intervention.

Pickleball Injuries in the Aging Athlete: A Critical Analysis Review.

The popularity of pickleball has rapidly increased in the United States, with over 48 million adult participants in recent years, leading to a growing need to better understand injuries exclusive to pickleball. Pickleball-related injuries are predominantly musculoskeletal, most commonly sprains and strains to the upper and lower extremities. Sport-specific variables, including sporting equipment, playing conditions, and proper technique may be utilized to guide clinicians in injury management and preventative treatment. Future research is warranted to better direct care for pickleball athletes with a focus on the aging population.

Sport-Related Injury and Performance Enhancing Substance Use by Young Athletes.

BACKGROUND: Legal performance enhancing substance (PES) use is increasing in young athletes and may lead to banned PES use. This study examines legal PES use and consideration of banned PES use in young athletes with a season-ending injury (SEI) compared to young athletes with non-SEI/no previous injury. HYPOTHESIS: Young athletes sustaining SEI or concussions have increased odds of reporting legal PES use and consideration of banned PES use compared with non-SEI or no injury. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: Cross-sectional study from 2013 to 2020 of athletes aged 6 to 25 years. RESULTS: No association was found between reporting legal PES use or consideration of banned PES use and young athletes with SEI or concussion compared with no injury/non-SEI. 14% of athletes reported legal PES use and 3% reported consideration of banned PES use. In adjusted analysis, athletes who were male (odds ratio [OR], 1.38; 95% CI, 1.16-1.73; P = 0.03), have history of depression (OR, 3.01; 95% CI, 1.26-7.18; P = 0.01), weight train (OR, 1.66; 95% CI, 1.04-2.65; P = 0.03), and believe that athletic ability is influenced by weight (OR, 1.75; 95% CI, 1.08-2.83; P = 0.02) had increased odds of reporting legal PES use. Older (OR, 1.18; 95% CI, 1.03-1.36; P = 0.02) and male (OR, 1.57; 95% CI, 1.02-1.81; P < 0.04) athletes had increased odds of consideration of banned PES use. CONCLUSION: This study found no increased odds of reported PES use in young athletes with sports-related injury or concussion regardless of injury type or severity. Factors associated with PES use were male sex, age, history of depression, weight training, and belief that weight affects athletic performance. CLINICAL RELEVANCE: Risk factors associated with PES use in young athletes are essentially unknown. This study can inform pertinent clinical care, education, and policy implementation.

Preparticipation Sports Physical Evaluation in Adolescents.

The purpose of the preparticipation physical evaluation (PPE) is to promote safe participation in sport and to restrict participation only when necessary for the safety of the athlete. Based on expert opinion, this tool is considered standard of care. Six stakeholder professional societies collaboratively published the Preparticipation Physical Evaluation Monograph to guide a more useful experience for both examiners and athletes. The PPE uses systems-based history-taking and physical examinations to determine medical eligibility for participation in sport.

Preliminary Evaluation of Self-Reported Training Volume as an Adjunct Measure of Female Athlete Triad Risk in Division 1 Collegiate Female Runners.

Background/Objectives: This study tested whether self-reported training volume is predictive of female athlete triad risk collected using an established twelve-question triad screening tool in National Collegiate Athletic Association (NCAA) Division I (DI) collegiate female runners. Methods: A total of 319 institutions were initially contacted, seven of which agreed to distribute surveys to their female cross-country and track and field athletes. A total of 41 of 149 respondents completed the survey and met all inclusion criteria. Linear and binomial logistic regressions examined the relationships between self-reported training volumes and estimated triad risk. Independent samples t-tests were also used to compare training volumes across the high (> 50th percentile for risk factor counts) vs. low-risk groups. Results: Total weekly competition and conditioning resistance training hours were associated with the total number of triad risk factors (p = 0.044) and were also predictive of the triad risk group (p = 0.037). Likewise, both competition and conditioning resistance training hours (p = 0.034) were higher in the high-risk group versus the low-risk group. Conclusions: These findings suggest that self-reported resistance training volume is predictive of triad risk, but additional research is required to determine if monitoring training volume can provide valuable, real-time assessments of triad risk in DI collegiate female runners.

Differential Resting-State Brain Characteristics of Skeleton Athletes and Non-Athletes: A Preliminary Resting-State fMRI Study.

(1) Background: This study investigates the resting-state brain characteristics of skeleton athletes compared to healthy age-matched non-athletes, using resting-state fMRI to investigate long-term skeleton-training-related changes in the brain. (2) Methods: Eleven skeleton athletes and twenty-three matched novices with no prior experience with skeleton were recruited. Amplitude of low-frequency fluctuation (ALFF) and seed-based functional connectivity analyses were explored to investigate resting-state functional magnetic resonance imaging (rs-fMRI) data, aiming to elucidate differences in resting-state brain function between the two groups. (3) Results: Compared to the control group, skeleton athletes exhibited significantly higher ALFF in the left fusiform, left inferior temporal gyrus, right inferior frontal gyrus, left middle temporal gyrus, left and right insula, left Rolandic operculum, left inferior frontal gyrus, and left superior temporal gyrus. Skeleton athletes exhibit stronger functional connectivity in brain regions associated with cognitive and motor control (superior frontal gyrus, insula), as well as those related to reward learning (putamen), visual processing (precuneus), spatial cognition (inferior parietal), and emotional processing (amygdala), during resting-state brain function. (4) Conclusions: The study contributes to understanding how motor training history shapes skeleton athletes' brains, which have distinct neural characteristics compared to the control population, indicating potential adaptations in brain function related to their specialized training and expertise in the sport.

Athlete's ECG Made Easy: A Practical Guide to Surviving Everyday Clinical Practice.

Electrocardiogram modifications in athletes are common and usually reflect structural and electrical heart adaptations to regular physical training, known as the athlete's heart. However, these electrical modifications sometimes overlap with electrocardiogram findings that are characteristic of various heart diseases. A missed or incorrect diagnosis can significantly impact a young athlete's life and potentially have fatal consequences during exercise, such as sudden cardiac death, which is the leading cause of death in athletes. Therefore, it is crucial to correctly distinguish between expected exercise-related electrocardiogram changes in an athlete and several electrocardiogram abnormalities that may indicate underlying heart disease. This review aims to serve as a practical guide for cardiologists and sports clinicians, helping to define normal and physiology-induced electrocardiogram findings from those borderlines or pathological, and indicating when further investigations are necessary. Therefore, the possible athlete's electrocardiogram findings, including rhythm or myocardial adaptation, will be analyzed here, focusing mainly on the differentiation from pathological findings.

Electrocardiographic Clues for Early Diagnosis of Ventricular Pre-Excitation and Non-Invasive Risk Stratification in Athletes: A Practical Guide for Sports Cardiologists.

Ventricular pre-excitation (VP) is a cardiac disorder characterized by the presence of an accessory pathway (AP) that bypasses the atrioventricular node (AVN), which, although often asymptomatic, exposes individuals to an increased risk of re-entrant supraventricular tachycardias and sudden cardiac death (SCD) due to rapid atrial fibrillation (AF) conduction. This condition is particularly significant in sports cardiology, where preparticipation ECG screening is routinely performed on athletes. Professional athletes, given their elevated risk of developing malignant arrhythmias, require careful assessment. Early identification of VP and proper risk stratification are crucial for determining the most appropriate management strategy and ensuring the safety of these individuals during competitive sports. Non-invasive tools, such as resting electrocardiograms (ECGs), ambulatory ECG monitoring, and exercise stress tests, are commonly employed, although their interpretation can sometimes be challenging. This review aims to provide practical tips and electrocardiographic clues for detecting VP beyond the classical triad (short PR interval, delta wave, and prolonged QRS interval) and offers guidance on non-invasive risk stratification. Although the diagnostic gold standard remains invasive electrophysiological study, appropriate interpretation of the ECG can help limit unnecessary referrals for young, often asymptomatic, athletes.

Low Energy Availability Risk Is Associated with Anxiety in Female Collegiate Athletes.

This study investigated the association between the risk of low energy availability, disordered eating, and anxiety in collegiate female athletes. Female athletes (n = 115) completed questionnaires that assessed disordered eating (Disordered Eating Screen for Athletes, DESA-6; and the Eating Disorder Examination Questionnaire Short, EDE-QS), anxiety (Generalized Anxiety Disorder-7) and the risk of low energy availability (Low Energy Availability in Females Questionnaire; LEAF-Q). The athletes were 19.9 ± 0.1 years old and presented with no anxiety (14.8%), mild (33.0%), moderate (24.3%), and severe (27.8%) anxiety. The EDE-QS scores revealed that 22.6% of the participants had a high risk of an eating disorder, while the DESA-6 scores revealed that 31.3% of the participants scored positive for a risk of disordered eating. The LEAF-Q total scores revealed that 68.7% of the participants were at risk of low energy availability. Increased GAD-7 scores were associated (p < 0.001) with measures of disordered eating (EDE-QS and DESA-6) and the risk of low energy availability (LEAF-Q total score). Non-parametric partial correlations demonstrated that anxiety (increased GAD-7 scores) correlated with the risk of low energy availability (increased LEAF-Q total scores) while controlling for eating disorder scores (EDE-QS) (r (112) = 0.353, p < 0.001), or while controlling for the risk of disordered eating (DESA-6 scores) (r (112) = 0.349, p < 0.001). In female collegiate athletes, both disordered eating and the risk of low energy availability were positively associated with increased anxiety.

Specializing When It Counts: Comparing the Dose-Time Effect of Distance Variety between Swimming and Track Running.

OBJECTIVE: To conduct a longitudinal retrospective analysis, explore the relationship between success at peak performance age and the number of different race distances athletes competed in each year (within-sport distance variety), and compare the dose-time effect of this distance variety throughout the development process between male swimmers and track runners. METHODOLOGY: Male swimmers (n = 6033) and track runners (n = 19,278) still competing at peak performance age were ranked, and the number of different race distances was extracted retrospectively for each year until early junior age (13-14-year-old category) from the databases of the European Aquatics and World Athletics federations. Firstly, correlation analysis determined the relationship between ranking at peak performance age and distance variety. Secondly, Poisson distribution provided the probability and dose-time effect of distance variety for becoming an international-class athlete at peak performance age. RESULTS: Generally, correlation analysis revealed low coefficients (r ≤ 0.22) but significant effects (p < 0.001) for larger distance variety and success at peak performance age. Poisson distribution revealed the highest probability of becoming an international-class swimmer when competing in 2-4 race distances at junior age, depending on the primary race distance. The dose-time effect indicated a gradual reduction in the number of race distances as athletes approached peak performance age, narrowing down to 1-2, 2-3, and 3-4 distances for sprint, middle-, and long-distance races, respectively. Track runners exhibited a lower distance variety than swimmers, with a consistent optimum of 1-2 race distances across the age groups. CONCLUSIONS: The present findings including data of the most combined race distances for each primary race distance and a comparison between swimming and track running provide new background information to challenge traditional training regimes and help establish new strategies for long-term athlete development.

Physical Therapy in Neurorehabilitation with an Emphasis on Sports: A Bibliometric Analysis and Narrative Review.

The increasing interest in physical therapy in sports neurorehabilitation stems from the high incidence of neurological injuries among athletes and the crucial role of rehabilitation in facilitating their safe return to sports. This study aims to provide a comprehensive analysis of research trends in physical therapy and neurorehabilitation in athletes. This study presents a bibliometric analysis of 103 documents from the Scopus database, followed by a narrative review of the identified thematic areas. Together, these approaches offer a comprehensive overview of the international literature on the application of physical therapy in sports neurorehabilitation, highlighting key trends and contributors. The software VOSviewer and Power BI (2.136.1202.0) were used for the bibliometric analysis and the visualization of the results. Techniques such as performance analysis (documents per year, top sources and countries in documents, and top authors in citations) and science mapping (co-authorship, bibliographic coupling, co-citation, and co-occurrence) were conducted. The results revealed the journals and the authors with the greatest impact in the field and collaborations between various countries. From the co-occurrence analysis of the keywords, three key thematic clusters were identified, Clinical Approaches and Outcomes in Neurorehabilitation, Athlete-Centered Neurorehabilitation Techniques, and Specialized Interventions in Sports Medicine and Neurorehabilitation, which were used to conduct the narrative review. These findings provide a solid foundation for future research and clinical practice aimed at enhancing recovery times and overall performance in athletes with neurological injuries.

Psychiatric risk factors in Formula One and the importance of integrating mental health into driver science.

Formula One (F1) racing has recently grown in popularity, extending well beyond its traditional European roots. However, there has been a paucity of scholarly research dedicated to the health of drivers and even less discussion of the prevalence of psychiatric symptoms, risk factors, and types of psychopathology in F1. This is notable given advancements in sports psychiatry and evidence of psychiatric disorders emerging across other sports. Accordingly, this perspective paper details the physiological conditions in F1 and the socioenvironmental pressures that a driver may encounter during their career, including heat stress, weight restrictions, harassment, and other factors. These extreme physiological and psychological stressors, both in racing and non-racing environments, alongside sport-specific psychosocial pressures, may cause HPA axis dysregulation and other issues in drivers, heightening vulnerabilities for mental health concerns. Additionally, F1 is still affected by stigmatizing attitudes and regressive sociocultural norms, which could inhibit progress toward promoting sustainable wellbeing. Consequently, drivers may be at risk for mental disorder and a decrease in overall health and wellbeing. Against this background, we thereby recommend mental health programs and regulatory actions that could better address these challenges and promote mental wellbeing across F1.

Discrepancies in internal and external training load measurements during low-intensity biathlon training.

Purpose: This study aimed to differentiate external and internal training loads during on-snow biathlon training by adding an accelerometer-derived metric. Methods: Eleven adolescent athletes were fitted with a combined heart rate (HR) and accelerometer to be worn during all training sessions. Duration, HR, training impulse (TRIMP), and average net force ( A v F N e t ) were used as training variables. All training was divided into either low-intensity training (LIT), or high-intensity training (HIT) based on reported intensity. The training was further categorized as training without any shooting practice (NS) or as a combination of skiing and shooting (COMB). Duration, HR, TRIMP, and A v F N e t were analyzed in a linear mixed model for the different training modalities. Results: All training was similar in duration for LIT and HIT sessions (p = .0521) and NS and COMB sessions (p = .988). TRIMP did not differentiate between LIT or HIT training (p = .350) or for NS compared to COMB (p = .298). While A v F N e t decreased during COMB compared to NS during LIT sessions (p < .001) it remained similar during HIT training (p = 1.00). Conclusion: The study's findings indicated that there were no notable differences in internal training load (TRIMP) when comparing various training intensities and modes. However, the type of training had a significant impact on A v F N e t , especially leading to a decrease during COMB sessions under LIT conditions. Incorporating an external load metric could offer a fresh approach when prescribing and evaluating training, providing deeper insights into the training load.

Are we asking the right questions? Female athletes' perspectives on the menstrual cycle in sport.

BACKGROUND: Menstrual cycle (MC) research employing qualitative and quantitative methods has recently increased in athlete populations. A move towards a participant-centered approach to help formulate questions that align with practitioners' and stakeholders' priorities in the sport environment is needed. Therefore, our study aims were to 1) understand what athletes feel is important to consider regarding their MC in sport, and 2) provide practical recommendations for coaches and practitioners to support a positive sport culture around the MC. METHODS: Participants were Canadian female athletes competing at national and international levels. Team (n = 10) and individual (n = 10) sport athletes (median age 23 years) shared their experiences and values in one-on-one semi-structured interviews. RESULTS: Three main theories were identified by constructive grounded theory analyses: 1) training and performance, 2) culture, and 3) health. Athletes expressed a desire for symptom management strategies and more evidence on MC training periodization to optimize performance. Key determinants in creating a positive culture included communication and feeling supported. Athletes also expressed challenges in balancing health with performance and felt ill-informed on how hormonal contraceptives could potentially impact performance. Practical recommendations included 1) addressing individualized, context-specific symptom impacts on the athlete's sport demands, 2) using a group-based approach to initiate MC communication topics and, 3) designate female health point-of-contact staff to facilitate MC information. CONCLUSION: Future research should continue to evaluate MC impacts on training and performance and study designs should include participants who are using hormonal contraceptives. Coaches and sport practitioners should prioritize female athlete health alongside performance goals.

An investigation on main effects and interactions of relative age effects and playing position in female elite football in Germany.

Athlete age-grouping and age-banding has been shown to impact sport participation and athlete development. The current study examined the impact of within-year (WYEs) and between-year effects (BYEs), and their interactions with playing position, on female participation in elite German football. The sample of 1,378 German first-league players revealed expected participation inequities within-year with relatively older players being over-represented and younger players being under-represented. From a between-year perspective there were no participation differences. The interaction of WYEs and BYEs revealed an over-representation of odd-year players in Q1, and Q2 in even years. With respect to the interaction between year effects and playing position, for WYEs the expected effect was present for goalkeepers and defenders, while there was no significant interaction for BYEs. Overall, the results offer insight regarding the impact of system structure on participation, and highlight unique characteristics associated with playing positions.