More than a Metric: How Training Load is Used in Elite Sport for Athlete Management.

Training load monitoring is a core aspect of modern-day sport science practice. Collecting, cleaning, analysing, interpreting, and disseminating load data is usually undertaken with a view to improve player performance and/or manage injury risk. To target these outcomes, practitioners attempt to optimise load at different stages throughout the training process, like adjusting individual sessions, planning day-to-day, periodising the season, and managing athletes with a long-term view. With greater investment in training load monitoring comes greater expectations, as stakeholders count on practitioners to transform data into informed, meaningful decisions. In this editorial we highlight how training load monitoring has many potential applications and cannot be simply reduced to one metric and/or calculation. With experience across a variety of sporting backgrounds, this editorial details the challenges and contextual factors that must be considered when interpreting such data. It further demonstrates the need for those working with athletes to develop strong communication channels with all stakeholders in the decision-making process. Importantly, this editorial highlights the complexity associated with using training load for managing injury risk and explores the potential for framing training load with a performance and training progression mindset.

Close encounters of the US kind: illness and injury among US athletes at the PyeongChang 2018 Winter Olympic Games.

AIM: To describe injury and illness incidence during the 2018 Winter Olympic Games (WOG) by Team USA. METHODS: A descriptive observational study. We used registered Team USA Olympic athletes' electronic medical records to review preparticipation health histories and medical encounters immediately prior to and throughout the 2018 WOG. Medical encounters were defined as all medical services provided by a healthcare provider, including evaluation, treatment and prophylactic services. All medical conditions were described according to International Olympic Committee injury and illness reporting criteria. RESULTS: Team USA included 134 men and 108 women, aged 18-39 years, who represented 17 sport federations. The 47 Team USA medical staff documented 1744 medical encounters on 242 registered athletes (7.2 medical encounters per athlete). Forty-seven illnesses (194.2/1000 athletes) and 32 time loss injuries (132.2/1000 athletes) were recorded during the Games. CONCLUSIONS: An injury surveillance programme consisting of an electronic preparticipation health history and surveillance of medical encounters during the WOG was used to describe the health status of Team USA. We noted limitations to the surveillance process that can be addressed at future events.

How do training and competition workloads relate to injury? The workload-injury aetiology model.

Injury aetiology models that have evolved over the previous two decades highlight a number of factors which contribute to the causal mechanisms for athletic injuries. These models highlight the pathway to injury, including (1) internal risk factors (eg, age, neuromuscular control) which predispose athletes to injury, (2) exposure to external risk factors (eg, playing surface, equipment), and finally (3) an inciting event, wherein biomechanical breakdown and injury occurs. The most recent aetiological model proposed in 2007 was the first to detail the dynamic nature of injury risk, whereby participation may or may not result in injury, and participation itself alters injury risk through adaptation. However, although training and competition workloads are strongly associated with injury, existing aetiology models neither include them nor provide an explanation for how workloads alter injury risk. Therefore, we propose an updated injury aetiology model which includes the effects of workloads. Within this model, internal risk factors are differentiated into modifiable and non-modifiable factors, and workloads contribute to injury in three ways: (1) exposure to external risk factors and potential inciting events, (2) fatigue, or negative physiological effects, and (3) fitness, or positive physiological adaptations. Exposure is determined solely by total load, while positive and negative adaptations are controlled both by total workloads, as well as changes in load (eg, the acute:chronic workload ratio). Finally, we describe how this model explains the load-injury relationships for total workloads, acute:chronic workload ratios and the training load-injury paradox.

Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review.

Low-carbohydrate high-fat (LCHF) diets are a highly contentious current topic in nutrition. This narrative review aims to provide clinicians with a broad overview of the effects of LCHF diets on body weight, glycaemic control and cardiovascular risk factors while addressing some common concerns and misconceptions. Blood total cholesterol and LDL-cholesterol concentrations show a variable, highly individual response to LCHF diets, and should be monitored in patients adhering to this diet. In contrast, available evidence from clinical and preclinical studies indicates that LCHF diets consistently improve all other markers of cardiovascular risk-lowering elevated blood glucose, insulin, triglyceride, ApoB and saturated fat (especially palmitoleic acid) concentrations, reducing small dense LDL particle numbers, glycated haemoglobin (HbA1c) levels, blood pressure and body weight while increasing low HDL-cholesterol concentrations and reversing non-alcoholic fatty liver disease (NAFLD). This particular combination of favourable modifications to all these risk factors is a benefit unique to LCHF diets. These effects are likely due in part to reduced hunger and decreased ad libitum calorie intake common to low-carbohydrate diets, allied to a reduction in hyperinsulinaemia, and reversal of NAFLD. Although LCHF diets may not be suitable for everyone, available evidence shows this eating plan to be a safe and efficacious dietary option to be considered. LCHF diets may also be particularly beneficial in patients with atherogenic dyslipidaemia, insulin resistance, and the frequently associated NAFLD.

Training load--injury paradox: is greater preseason participation associated with lower in-season injury risk in elite rugby league players?

AIM: To determine whether players who completed a greater number of planned preseason training sessions were more or less likely to be injured during the competitive season. METHODS: A cohort of 30 elite rugby league players was prospectively studied during their 17-week preseason and 26-round competitive season. Injuries were recorded using a match time loss definition. Preseason participation was quantified as the number of 'full' training sessions that players completed, excluding modified, rehabilitation or missed sessions. In-season training load variables, collected using global positioning system (GPS) data, included distance covered (m), high-speed distance covered (m) and the percentage of distance covered at high speeds (%). Multilevel logistic regression models were used to determine injury likelihood in the current and subsequent week, with random intercepts for each player. Odds ratios (OR) were used as effect size measures to determine the changes in injury likelihood with (1) a 10-session increase in preseason training participation or (2) standardised changes in training load variables. RESULTS: Controlling for training load in a given week, completing 10 additional preseason sessions was associated with a 17% reduction in the odds of injury in the subsequent week (OR=0.83, 95% CI=0.70 to 0.99). Increased preseason participation was associated with a lower percentage of games missed due to injury (r=-0.40, p<0.05), with 10 preseason sessions predicting a 5% reduction in the percentage of games missed. CONCLUSIONS: Maximising participation in preseason training may protect elite rugby league players against in-season injury.

Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review.

BACKGROUND: Chronic lateral epicondylar tendinopathy is frequent in athletes, and platelet-rich plasma (PRP) is being used increasingly in its treatment. OBJECTIVE: To systematically review the literature on the efficacy of PRP injections for chronic lateral epicondylar tendinopathy. METHODS: The databases of PubMed, EMBASE, CINAHL, Medline OvidSP, Scopus, Google Scholar, Web of Science and Cochrane Library were searched in October 2013. Inclusion criteria were a clinical diagnosis of chronic lateral epicondylar tendinopathy, a randomised controlled trial, an intervention with a PRP injection and the outcome measures described in terms of pain and/or function. One author screened the search results and two authors independently assessed the study quality using the Physiotherapy Evidence Database (PEDro) score. A study was considered to be of high quality if its PEDro score was ≥6. A best evidence synthesis was used to identify the level of evidence. RESULTS: 6 studies were included, of which four were considered to be of high quality. Three high-quality studies (75%) and two low-quality studies showed no significant benefit at the final follow-up measurement or predefined primary outcome score when compared with a control group. One high-quality study (25%) showed a beneficial effect of a PRP injection when compared with a corticosteroid injection (corticosteroid injections are harmful in tendinopathy). Based on the best evidence synthesis, there is strong evidence that PRP injections are not efficacious in chronic lateral epicondylar tendinopathy. CONCLUSIONS: There is strong evidence that PRP injections are not efficacious in the management of chronic lateral elbow tendinopathy.

2014 consensus statement from the first Economics of Physical Inactivity Consensus (EPIC) conference (Vancouver).

This article describes major topics discussed from the 'Economics of Physical Inactivity Consensus Workshop' (EPIC), held in Vancouver, Canada, in April 2011. Specifically, we (1) detail existing evidence on effective physical inactivity prevention strategies; (2) introduce economic evaluation and its role in health policy decisions; (3) discuss key challenges in establishing and building health economic evaluation evidence (including accurate and reliable costs and clinical outcome measurement) and (4) provide insight into interpretation of economic evaluations in this critically important field. We found that most methodological challenges are related to (1) accurately and objectively valuing outcomes; (2) determining meaningful clinically important differences in objective measures of physical inactivity; (3) estimating investment and disinvestment costs and (4) addressing barriers to implementation. We propose that guidelines specific for economic evaluations of physical inactivity intervention studies are developed to ensure that related costs and effects are robustly, consistently and accurately measured. This will also facilitate comparisons among future economic evidence.