The Role of Musculoskeletal Training During Return to Performance Following Relative Energy Deficiency in Sport.

BACKGROUND: Relative energy deficiency in sport (REDs) is a condition that is associated with negative health and performance outcomes in athletes. Insufficient energy intake relative to exercise energy expenditure, resulting in low energy availability, is the underlying cause, which triggers numerous adverse physiological consequences including several associated with musculoskeletal (MSK) health and neuromuscular performance. PURPOSE: This commentary aims to (1) discuss the health and performance implications of REDs on the skeletal and neuromuscular systems and (2) examine the role that MSK training (ie, strength and plyometric training) during treatment and return to performance following REDs might have on health and performance in athletes, with practical guidelines provided. CONCLUSIONS: REDs is associated with decreases in markers of bone health, lean body mass, maximal and explosive strength, and muscle work capacity. Restoration of optimal energy availability, mainly through an increase in energy intake, is the primary goal during the initial treatment of REDs with a return to performance managed by a multidisciplinary team of specialists. MSK training is an effective nonpharmacological component of treatment for REDs, which offers multiple long-term health and performance benefits, assuming the energy needs of athletes are met as part of their recovery. Supervised, prescribed, and gradually progressive MSK training should include a combination of resistance training and high-impact plyometric-based exercise to promote MSK adaptations, with an initial focus on achieving movement competency. Progressing MSK training exercises to higher intensities will have the greatest effects on bone health and strength performance in the long term.

Durability of Running Economy: Differences between Quantification Methods and Performance Status in Male Runners.

INTRODUCTION: Running economy (RE) deteriorates during prolonged running, although the effect of measuring energy cost (EC) or oxygen cost (OC) on the magnitude of these changes has not been investigated. Similarly, it is unknown if runners' performance level may influence the deterioration of RE during prolonged running. The aims of this study were to compare changes in EC and OC measurements of RE during a prolonged run in a large cohort of well-trained male runners, and to compare changes between runners of high and low performance standard. METHODS: Forty-four male runners (maximal oxygen uptake (V̇O2max) 62.4 ml·kg-1·min-1; 10 km time 35:50 ± 4:40 mm:ss) completed an incremental test determining lactate threshold 1 (LT1) and V̇O2max, and on a separate occasion, a 90 min run at LT1. Respiratory gases were collected at 15 min intervals. Subsequently, sub-groups of high- (HP, 10 km 31:20 ± 01:00 mm:ss) and low-performing (LP, 10 km 41:50 ± 01:20 mm:ss) runners were compared. RESULTS: RE deterioration was only fractionally larger when expressed as OC than EC (0.1% greater from 30-90 min; p < 0.001), perhaps due to the small change in RER (-0.01) in this study. For the HP group increases were lower than LP after 90 min in both EC (+2.3 vs +4.3%; p < 0.01) and OC (+2.4 vs +4.5%; p < 0.01). Similarly, at standardized distances, changes were lower for HP vs LP e.g. at 16.7 km +1.0 vs +3.2% for EC (p < 0.01), and + 1.2 vs +3.4% for OC (p < 0.001). CONCLUSIONS: The deterioration of RE was dependent on athlete's performance level, with HP runners displaying superior RE durability. The use of EC or OC had only a fractional influence on RE durability, although this may gain importance with larger shifts in substrate metabolism.

Energy availability modulates regional blood flow via estrogen-independent pathways in regularly menstruating young women.

PURPOSE: This study aimed to investigate the impact of short-term low energy availability (LEA) on vascular function in young, regularly menstruating women. METHODS: Participants were 19 women, aged 22.9 ± 4.2 years, with body mass index 18-30 kg·m2. They were divided into two groups and completed two conditions in a crossover design: a 3-day control condition (CON) with an energy availability of 45 kcals·kgFFM-1·day-1 and a 3-day LEA condition of 15 kcals·kgFFM-1 day-1. Assessments were conducted during the early follicular phase of the menstrual cycle. Outcome measures included forearm blood flow (FBF), heart rate, blood pressure, arterial stiffness, resting energy expenditure (REE), metabolic blood markers and body composition. RESULTS: Significant time-by-condition interactions were found for resting FBF (p = .004), REE (p = .042), triiodothyronine (p = .006), ß-hydroxybutyrate (p = .002) and body mass (p < .001). Resting FBF was 1.43 ± 1.01 and 1.31 ± 0.61 (arbitrary units) at pre and post, respectively, in LEA and 1.52 ± 0.7 and 1.76 ± 0.57 at pre and post in CON. The LEA condition led to a decrease in triiodothyronine (pre: 1.54 ± 0.28, post: 1.29 ± 0.27 ng ml-1), REE (pre: 1588 ± 165, post: 1487 ± 160 kcals day-1) and body mass (pre: 61.4 ± 7.5, post: 59.6 ± 7.3 kg). Changes in resting FBF were significantly correlated with changes in REE in the LEA condition (r = 0.53; p = 0.02). CONCLUSION: Short-term LEA modifies regional blood flow and this might contribute to the observed decreased in REE. Findings emphasize the need for careful management of energy availability in populations at risk of LEA.

Do Exercise-Based Prevention Programs Reduce Injury in Endurance Runners? A Systematic Review and Meta-Analysis.

BACKGROUND: Endurance running is a popular sport and recreational activity yet is associated with a high prevalence of injury. Running related injuries (RRIs) are a leading cause of drop-out and represent a substantial financial burden to runners and healthcare services. There is clear evidence for the use of exercise-based injury prevention programs in games-based and youth sport settings, yet the research investigating the use of exercise to reduce injury risk in endurance runners has not been adequately reviewed recently. OBJECTIVES: The aim of this review and meta-analysis was to systematically summarize the current research that has investigated the effect of exercise-based prevention programs and their state of supervision on the risk of RRIs in endurance runners. METHODS: Three databases were searched for relevant studies. Selection and review were completed by two independent reviewers using the following inclusion criteria: (1) study population used endurance running training for health, occupational, or performance outcome(s); (2) participants performed running as their main form of exercise (> 50% of their total training time); (3) study was a randomized controlled trial; (4) a non-running-based exercise intervention was used; (5) a running-only or placebo exercise control group was included; (6) injury rate or incidence was reported; (7) injuries were recorded prospectively alongside the exercise training. Two meta-analyses were conducted using random-effects models, one based on log risk ratio and one based on log incidence rate ratio. The Cochrane Risk of Bias Assessment Tool 2 was used to evaluate the quality of studies and the Grading of Recommendations Assessment, Development and Evaluations approach was employed to grade the certainty of evidence. RESULTS: A total of nine articles containing 1904 participants were included in analysis. Overall pooled results showed no significant differences between intervention and control groups in injury risk (z = - 1.60; p = 0.110) and injury rate (z = - 0.98; p = 0.329), while a post hoc analysis evaluating supervised interventions only showed that injury risk was significantly lower in the intervention group compared to the control group (z = - 3.75, p < 0.001). Risk of bias assessment revealed that seven studies included in the analysis were of low quality. CONCLUSIONS: Exercise-based interventions do not appear to reduce the risk and rate of running-related injuries. Supervision may be essential for exercise-based intervention programs to reduce risk of RRIs, possibly due to increased compliance. Studies with more robust designs that include supervised exercise interventions should be prioritized in the future. TRIAL REGISTRY: Clinical Trial Registration: PROSPERO CRD42021211274.

Talent identification and development in an English Premiership rugby union club: the perspectives of players and coaches.

The pathway towards senior professional status in sport is affected by a multitude of factors. An abductive examination of the talent identification and development processes at an English Premiership rugby union (RU) club was undertaken for the present study. Part one examined the perspectives on the selection and development processes of senior academy male players (n = 8), whereas part two explored the perceptions of male coaches (n = 7). A total of three focus groups were used. Three main themes were confirmed by players and coaches: (a) task constraints, (b) performer constraints, and (c) environmental constraints. Specifically, although athletes and coaches believed that performer constraints were highly impactful on players' career in RU, there were inconsistencies surrounding the task and environmental constraints. Despite an indication that three common themes impacted an players path, this preliminary study shows an imbalance in the understanding of some of the key factors perceived to be important for talent progression in the present rugby academy. More research using similar qualitative methods is recommended to better understand the differences in opinions between players and coaches. Meanwhile, practitioners should consider implementing objective and holistic strategies to improve the talent pathway in English RU academies.

High-impact jumping mitigates the short-term effects of low energy availability on bone resorption but not formation in regularly menstruating females: A randomized control trial.

Low energy availability (LEA) is prevalent in active individuals and negatively impacts bone turnover in young females. High-impact exercise can promote bone health in an energy efficient manner and may benefit bone during periods of LEA. Nineteen regularly menstruating females (aged 18-31 years) participated in two three-day conditions providing 15 (LEA) and 45 kcals kg fat-free mass-1 day-1 (BAL) of energy availability, each beginning 3 ± 1 days following the self-reported onset of menses. Participants either did (LEA+J, n = 10) or did not (LEA, n = 9) perform 20 high-impact jumps twice per day during LEA, with P1NP, ß-CTx (circulating biomarkers of bone formation and resorption, respectively) and other markers of LEA measured pre and post in a resting and fasted state. Data are presented as estimated marginal mean ± 95% CI. P1NP was significantly reduced in LEA (71.8 ± 6.1-60.4 ± 6.2 ng mL-1 , p < 0.001, d = 2.36) and LEA+J (93.9 ± 13.4-85.2 ± 12.3 ng mL-1 , p < 0.001, d = 1.66), and these effects were not significantly different (time by condition interaction: p = 0.269). ß-CTx was significantly increased in LEA (0.39 ± 0.09-0.46 ± 0.10 ng mL-1 , p = 0.002, d = 1.11) but not in LEA+J (0.65 ± 0.08-0.65 ± 0.08 ng mL-1 , p > 0.999, d = 0.19), and these effects were significantly different (time by condition interaction: p = 0.007). Morning basal bone formation rate is reduced following 3 days LEA, induced via dietary restriction, with or without high-impact jumping in regularly menstruating young females. However, high-impact jumping can prevent an increase in morning basal bone resorption rate and may benefit long-term bone health in individuals repeatedly exposed to such bouts.

How Lifestyle Changes during the COVID-19 Global Pandemic Affected the Pattern and Symptoms of the Menstrual Cycle.

This research investigated the implications that the COVID-19 pandemic had on the menstrual cycle and any contributing factors to these changes. A questionnaire was completed by 559 eumenorrheic participants, capturing detail on menstrual cycle symptoms and characteristics prior to and during the COVID-19 pandemic lockdown period. Over half of all participants reported to have experienced lack of motivation (61.5%), focus (54.7%) and concentration (57.8%). 52.8% of participants reported an increase in cycle length. Specifically, there was an increase in the median cycle length reported of 5 days (minimum 2 days, maximum 32 days), with a median decrease of 3 days (minimum 2 days and maximum 17 days). A lack of focus was significantly associated with a change in menstrual cycle length (p = 0.038) reported to have increased by 61% of participants. Changes to eating patterns of white meat (increase p = 0.035, decrease p = 0.003) and processed meat (increase p = 0.002 and decrease p = 0.001) were significantly associated with a change in menstrual cycle length. It is important that females and practitioners become aware of implications of environmental stressors and the possible long-term effects on fertility. Future research should continue to investigate any long-lasting changes in symptoms, as well as providing education and support for females undergoing any life stressors that may implicate their menstrual cycle and/or symptoms.

A Multidisciplinary Investigation into the Talent Development Processes in an English Premiership Rugby Union Academy: A Preliminary Study through an Ecological Lens.

(1) Background: The progression of youth rugby union (RU) players towards senior professional levels can be the result of various different constraints. The aim of this study was to examine characteristics that differentiated playing positions and player rankings in an English Premiership RU academy. (2) Methods: Thirty players (mean age = 18.5 ± 2.8 years) were divided by playing positions (forwards = 18, backs = 12) and ranked (one to thirty) by coaches based on their potential to achieve senior professional status. Players were analysed across 32 characteristics from eight overreaching factors based on task, environmental, and performer constraints. MANOVA and ANOVA were used to calculate differences among variables in players' positions (i.e., forwards vs. backs) and ranks (i.e., top 10 vs. bottom 10), with a Welch's t-test applied to identify individual differences amongst groups and effect sizes calculated. (3) Results: Large effect sizes were found between groups for socioeconomic, sport activity, anthropometric, physical, and psychological factors. Moreover, environmental and performer constraints differentiated playing positions, whereas task and environmental constraints discriminated player ranks. (4) Conclusion: Present findings showed that playing positions and player ranks can be distinguished according to specific constraints.

Incidence of bone stress injury is greater in competitive female distance runners with menstrual disturbances independent of participation in plyometric training.

Bone stress injury (BSI) is prevalent in female distance runners. Menstrual disturbances are associated with impaired bone health in endurance athletes. This study aimed to investigate the association between menstrual function and BSI and explore whether plyometric training may protect against BSI in individuals with menstrual disturbances. Competitive female distance runners (n = 183) aged 18-40 years were surveyed for training habits, menstrual function, and BSI, during the previous 12 months. Oligo/amenorrhoea during the previous 12 months (<9 menses) was deemed to indicate menstrual disturbance; hormonal contraceptive users and those previously diagnosed with a pathology that impacted menstrual function were excluded. BSI incidence rate was 2.25 (p = 0.02, 95% CI: 1.14-4.41) times greater in oligo/amenorrhoeic than eumenorrhoeic runners. BSI incidence rate was similar in oligo/amenorrhoeic and eumenorrhoeic runners that did plyometric training, but 3.78 (p = 0.001, 95% CI: 1.68-8.5) times greater in oligo/amenorrhoeic versus eumenorrhoeic runners that did not. However, the effect of plyometrics was non-significant (menstrual function × plyometric training interaction, p = 0.06; main effect, p = 0.89). Conventional plyometric training may not reduce BSI incidence in female distance runners, but menstrual disturbances and prolonged periods of low energy availability should be avoided.

Talent Identification in an English Premiership Rugby Union Academy: Multidisciplinary Characteristics of Selected and Non-selected Male Under-15 Players.

Entry into an academy can be a defining moment for a promising young player. The aim of this study was to explore the multidimensional characteristics that differentiated selected and non-selected male under-15 rugby union players at an English Premiership academy. Seventy-four players (mean age 14.6 ± 0.3 years: selected n = 29; non-selected n = 45) were measured across nine characteristics from four overarching factors: (a) anthropometric (n = 2), (b) physiological (n = 5), (c) cognitive (n = 1), and (d) birth quartile. An ANOVA compared differences between groups (selected vs. non-selected), whilst a Welch's t-test and Cohen's d were used for further comparisons. A multivariate logistic regression was also used to predict selection. Results showed significant differences between selected and non-selected players for anthropometric (P = 0.021) and physiological factors (P < 0.001). Moreover, relatively older players were overrepresented with 65% born in the first half of the year, whereas no significant differences were apparent for the cognitive test. More specifically, selected players possessed greater body mass (P = 0.022, d = 0.5) and handgrip strength (P = 0.020, d = 0.5) compared to non-selected players, whilst multivariate analysis showed the 20 m sprint explained 25.4% of the variance (P = 0.001). Overall, it appears selection into an English Premiership rugby union academy may be due to enhanced physical attributes rather than cognitive abilities.

COVID-19-Considerations for the Female Athlete.

The SARS CoV-2 virus (COVID-19) caused the whole sporting calendar to be paused. As we embark on the challenge of navigating through the return to play (RTP) process, there is a necessity to consider the needs of all athletes. This commentary specifically considers recommendations and requirements for the female athlete with a physiological emphasis during and following the COVID-19 pandemic, however, it will be relevant for any similar future scenarios that may present. It is important to acknowledge that there remain many unknowns surrounding COVID-19 and the female athlete both in the short- and long-term.

Speed Demands of Women's Rugby Sevens Match Play.

ABSTRACT: Misseldine, ND, Blagrove, RC, and Goodwin, JE. Speed demands of women's rugby sevens match play. J Strength Cond Res 35(1): 183-189, 2021-The purpose of this study was to quantify the running speed demands of elite female rugby sevens match play, both absolute and relative to maximal ability, and determine the importance of maximal velocity running to performance. Individual maximal running velocity (Vmax) was established for 12 professional female rugby sevens athletes before the collection of global positioning system data during all 6 games of an international tournament. The subjective importance of each maximal velocity running effort was established using visual analogue scale ratings of video clips by coaches. Differences in velocity demands between backs and forwards were analyzed using a one-way multivariate analysis of variance, and differences in "sprint" distance using the typical-standard and female-adjusted sprint thresholds were compared using a paired-samples t-test. The mean peak velocity reached per game by all players was 90.6 ± 7.9% Vmax. Players covered 1,556 ± 233 m per game, with "sprinting" representing 6 ± 4% of this total distance using the typical-standard "sprint" threshold (5.6 m·s-1), but a significantly (p < 0.001) greater 12 ± 4% using the female-adjusted threshold (4.7 m·s-1). Despite similar total distances, backs reached significantly (p < 0.05) greater peak running velocity and covered more distance at sprint, >75% Vmax and >90% Vmax speeds when compared to forwards. More than half of the running efforts peaking at ≥90% Vmax were considered very influential to game outcomes. These findings suggest that maximal velocity running is important to female rugby sevens performance, and that high-speed demands are different for backs and forwards. Furthermore, the typical-standard sprint thresholds significantly underestimate the true running demands of female rugby sevens.

Inter-limb strength asymmetry in adolescent distance runners: Test-retest reliability and relationships with performance and running economy.

The purpose of this investigation was, firstly, to quantify the test-retest reliability of strength measures in adolescent distance runners; and secondly, to explore the relationships between inter-limb strength asymmetry and performance and running economy (RE) in a similar cohort of young runners. For the reliability study, twelve (n = 6 female) post-pubertal adolescent distance runners performed an isometric quarter-squat on a dual force plate and unilateral isometric hip extension and hip abduction tests on two occasions. For the correlation study, participants (n = 31) performed the strength tests plus a submaximal incremental running assessment and a maximal running test. Running economy was expressed as the average energy cost of running for all speeds below lactate turnpoint and was scaled for body mass using a previously calculated power exponent. Allometrically scaled peak force during the quarter-squat and peak torque in the hip strength tasks showed acceptable levels of reproducibility (typical error ≤6.3%). Relationships between strength asymmetry and performance and RE were low or negligible (r < 0.47, p > 0.05), except for hip abduction strength asymmetry and RE in the female participants (r = 0.85, p < 0.001, n = 16). Practitioners should consider inter-limb hip abduction strength asymmetry on an individual level, and attempting to reduce this asymmetry in females may positively impact RE.

Effects of Low Energy Availability on Bone Health in Endurance Athletes and High-Impact Exercise as A Potential Countermeasure: A Narrative Review.

Endurance athletes expend large amounts of energy in prolonged high-intensity exercise and, due to the weight-sensitive nature of most endurance sports, often practice periods of dietary restriction. The Female Athlete Triad and Relative Energy Deficiency in Sport models consider endurance athletes at high-risk for suffering from low energy availability and associated health complications, including an increased chance of bone stress injury. Several studies have examined the effects of low energy availability on various parameters of bone structure and markers of bone (re)modelling; however, there are differences in findings and research methods and critical summaries are lacking. It is difficult for athletes to reduce energy expenditure or increase energy intake (to restore energy availability) in an environment where performance is a priority. Development of an alternative tool to help protect bone health would be beneficial. High-impact exercise can be highly osteogenic and energy efficient; however, at present, it is rarely utilized to promote bone health in endurance athletes. Therefore, with a view to reducing the prevalence of bone stress injury, the objectives of this review are to evaluate the effects of low energy availability on bone health in endurance athletes and explore whether a high-impact exercise intervention may help to prevent those effects from occurring.

Variations in strength-related measures during the menstrual cycle in eumenorrheic women: A systematic review and meta-analysis.

OBJECTIVES: To systematically review the current body of research that has investigated changes in strength-related variables during different phases of the menstrual cycle in eumenorrheic women. DESIGN: Systematic review and meta-analysis. METHODS: A literature search was conducted in Pubmed, SPORTDiscus and Web of Science using search terms related to the menstrual cycle and strength-related measures. Two reviewers reached consensus that 21 studies met the criteria for inclusion. Methodological rigour was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Random effects meta-analyses were used to compare the early-follicular, ovulatory and mid-luteal phases for maximal voluntary contraction, isokinetic peak torque, and explosive strength. RESULTS: The assessment of study quality showed that a high level of bias exists in specific areas of study design. Non-significant and small or trivial effect sizes (p≥0.26, Hedges g≤0.35) were identified for all strength-related variables in each comparison between phases. 95% confidence intervals for each comparison suggested the uncertainty associated with each estimate extends to a small effect on strength performance with unclear direction (-0.42≤g≤0.48). The heterogeneity for each comparison was also small (p≥0.83, I2=0%). CONCLUSIONS: Strength-related measures appear to be minimally altered (g≤0.35) by the fluctuations in ovarian sex hormones that occur during the menstrual cycle. This finding should be interpreted with caution due to the methodological shortcomings identified by the quality assessment.

Strength and Conditioning Habits of Competitive Distance Runners.

Blagrove, RC, Brown, N, Howatson, G, and Hayes, PR. Strength and conditioning habits of competitive distance runners. J Strength Cond Res 34(5): 1392-1399, 2020-Targeted strength and conditioning (S&C) programs can potentially improve performance and reduce injury risk factors in competitive runners. However, S&C practices of distance runners are unknown. This study aimed to explore S&C practices of competitive middle- and long-distance runners and examined whether reported frequency of injuries was influenced by training behaviors. One thousand eight hundred eighty-three distance runners (≥15 years old) completed an online survey. All runners who raced competitively were included in data analysis (n = 667). Distance runners mainly engaged with S&C activities to lower risk of injury (63.1%) and improve performance (53.8%). The most common activities used were stretching (86.2%) and core stability exercises (70.2%). Resistance training (RT) and plyometric training (PT) were used by 62.5 and 35.1% of runners, respectively. Junior (under-20) runners include PT, running drills, and circuit training more so than masters runners. Significantly more international standard runners engaged in RT, PT, and fundamental movement skills training compared with competitive club runners. Middle-distance (800-3,000 m) specialists were more likely to include RT, PT, running drills, circuit training, and barefoot exercises in their program than longer-distance runners. Injury frequency was associated with typical weekly running volume and run frequency. Strength and conditioning did not seem to confer a protection against the number of injuries the runners experienced. Practitioners working with distance runners should critically evaluate the current S&C practices of their athletes, to ensure that activities prescribed have a sound evidence-based rationale.

Quantification of aerobic determinants of performance in post-pubertal adolescent middle-distance runners.

PURPOSE: The use of oxygen cost ([Formula: see text]aero) parameters to predict endurance performance has recently been criticized. Instead, it is suggested that aerobic energy cost ([Formula: see text]) provides greater validity; however, a comparison of these quantification methods has not previously been made. METHODS: Fifty-six male (n = 34) and female (n = 22) competitive adolescent (17 ± 1 years) middle-distance runners participated in a sub-maximal and maximal incremental treadmill test. Running economy (RE) was measured at the speed corresponding to lactate turnpoint, and the three speeds prior. Maximal oxygen uptake ([Formula: see text]O2max), speed at [Formula: see text]O2max and fraction of [Formula: see text]O2max utilized across a range of intensities, and speeds from 0.8, 1.5 and 3 km races were also quantified. RE and fractional utilization were calculated in units of [Formula: see text]aero and [Formula: see text]aero. RESULTS: Multiple linear regression models demonstrated no discernible difference in the predictive capability of RE, fractional utilization and [Formula: see text]O2max when expressed as [Formula: see text]aero or [Formula: see text]aero in both sexes. When plotted as a function of running speed, [Formula: see text]aero displayed a stepwise decrease (F = 11.59, p < 0.001) whereas [Formula: see text]aero exhibited a curvilinear response (F = 4.74, p = 0.015). Differences were also evident in the slopes plotted for %[Formula: see text]O2max and %[Formula: see text]aeromax against running speed (F = 5.38, p = 0.021). CONCLUSIONS: Quantifying aerobic determinants of performance in units of [Formula: see text]aero provides no greater validity compared to [Formula: see text]aero-based measurement. Although both [Formula: see text]aero and [Formula: see text]aero are sensitive to changes in speed, [Formula: see text]aero provides the more valid reflection of the underlying metabolic cost of running. Physiologists should also be aware of the potential differences between expression of aerobic running intensity based upon %[Formula: see text]O2max compared to %[Formula: see text]aeromax.

Effects of Small-Sided Games vs. Conventional Endurance Training on Endurance Performance in Male Youth Soccer Players: A Meta-Analytical Comparison.

BACKGROUND: Small-sided games have been suggested as a viable alternative to conventional endurance training to enhance endurance performance in youth soccer players. This has important implications for long-term athlete development because it suggests that players can increase aerobic endurance through activities that closely resemble their sport of choice. OBJECTIVES: The objectives of this meta-analysis were to compare male youth soccer players' adaptability to small-sided games vs. conventional endurance training and to establish exercise prescription guidelines for this population. DATA SOURCES: The data sources utilised were Google Scholar, PubMed and Microsoft Academic. STUDY ELIGIBILITY CRITERIA: Studies were eligible for inclusion if interventions were carried out in male soccer players (aged < 18 years) and compared the effects of small-sided games and conventional endurance training on aerobic endurance performance. We defined small-sided games as "modified [soccer] games played on reduced pitch areas, often using adapted rules and involving a smaller number of players than traditional games". We defined conventional endurance training as continuous running or extensive interval training consisting of work durations > 3 min. STUDY APPRAISAL AND SYNTHESIS METHODS: The inverse-variance random-effects model for meta-analyses was used because it allocates a proportionate weight to trials based on the size of their individual standard errors and facilitates analysis whilst accounting for heterogeneity across studies. Effect sizes were represented by the standardised mean difference and presented alongside 95% confidence intervals. RESULTS: Seven studies were included in this meta-analysis. Both modes of training were effective in increasing endurance performance. Within-mode effect sizes were both of moderate magnitude [small-sided games: 0.82 (95% confidence interval 0.05, 1.60), Z = 2.07 (p = 0.04); conventional endurance training: 0.89 (95% confidence interval 0.06, 1.72), Z = 2.10 (p = 0.04)]. There were only trivial differences [0.04 (95% confidence interval - 0.36, 0.43), Z = 0.18 (p = 0.86)] between the effects on aerobic endurance performance of small-sided games and conventional endurance training. Subgroup analyses showed mostly trivial differences between the training methods across key programming variables such as set duration (≥ or < 4 min) and recovery period between sets (≥ or < 3 min). Programmes that were longer than 8 weeks favoured small-sided games [effect size = 0.45 (95% confidence interval - 0.12, 1.02), Z = 1.54 (p = 0.12)], with the opposite being true for conventional endurance training [effect size = - 0.33 (95% confidence interval - 0.79, 0.14), Z = 1.39 (p = 0.16)]. Programmes with more than 4 sets per session favoured small-sided games [effect size = 0.53 (95% confidence interval - 0.52, 1.58), Z = 0.98 (p = 0.33)] with only a trivial difference between those with 4, or fewer, sets [effect size = - 0.13 (95% confidence interval - 0.52, 0.26), Z = 0.65 (p = 0.52)]. CONCLUSIONS: Small-sided games are as effective as conventional endurance training for increasing aerobic endurance performance in male youth soccer players. This is important for practitioners as it means that small-sided games can allow both endurance and skills training to be carried out simultaneously, thus providing a more efficient training stimulus. Small-sided games offer the same benefits as conventional endurance training with two sessions per week, with ≥ 4 sets of 4 min of activity, interspersed with recovery periods of 3 min, recommended in this population.