Meta-analysis of genomic variants in power and endurance sports to decode the impact of genomics on athletic performance and success.

Association between genomic variants and athletic performance has seen a high degree of controversy, as there is often conflicting data as far as the association of genomic variants with endurance, speed and strength is concerned. Here, findings from a thorough meta-analysis from 4228 articles exploring the association of genomic variants with athletic performance in power and endurance sports are summarized, aiming to confirm or overrule the association of genetic variants with athletic performance of all types. From the 4228 articles, only 107 were eligible for further analysis, including 37 different genes. From these, there were 21 articles for the ACE gene, 29 articles for the ACTN3 gene and 8 articles for both the ACE and ACTN3 genes, including 54,382 subjects in total, from which 11,501 were endurance and power athletes and 42,881 control subjects. These data show that there is no statistically significant association between genomic variants and athletic performance either for endurance or power sports, underlying the fact that it is highly risky and even unethical to make such genetic testing services for athletic performance available to the general public. Overall, a strict regulatory monitoring should be exercised by health and other legislative authorities to protect the public from such services from an emerging discipline that still lacks the necessary scientific evidence and subsequent regulatory approval.

Injury profiles in sub-elite Women's Cricket: Exploring incidence, prevalence, nature, onset and body region.

INTRODUCTION: The rise in participation in sports, like women's cricket, is linked with increased injury risk. Providing high-level longitudinal data is the first step in implementing evidence-based injury prevention strategies. DESIGN: Prospective cohort study. OBJECTIVE: This cohort study aims to describe the injury profiles in sub-elite women's cricket in South Africa during the 2022/23 season. METHODS: Injuries were prospectively recorded using injury surveillance questionnaires, injury surveillance database, and logbooks completed by each team's medical staff. Injury rates were investigated for match and training days, body region, player role, nature, and activity at the time of injury. RESULTS: Three teams with a total of 44 players (20.86 ± 1.6 years) were included in the study. Injury incidence was 85.23 per 1000 player match days, 15.91 for match time-loss and 69.32 for non-time-loss, with 2.95% of players unavailable for match selection on any day. Fast bowlers had the highest injury incidence. Fielding caused 46.67% of all injuries. Injury incidence was higher in training than in matches. The wrist/hand had the highest injury incidence and caused the most match time-loss. CONCLUSION: This study provides valuable insights regarding the current injury rates in sub-elite female cricket players.

Assessing criterion and longitudinal validity of submaximal heart rate indices as measures of cardiorespiratory fitness: A preliminary study in football.

OBJECTIVES: To evaluate the criterion and longitudinal validity of field- and laboratory-derived heart rate (HR) indices of resting and submaximal fitness tests (SMFTs) as measures of cardiorespiratory fitness. DESIGN: Observational, repeated measures. METHODS: Twenty-nine semi-professional footballers participated. Laboratory assessments took place at the start and end of a preseason training period, whereby resting, SMFT HR-derived indices, and criterion measures of cardiorespiratory fitness (running economy [RE], maximal oxygen uptake [V̇O2 max] and aerobic speed [MAS]) were collected. Throughout this training period, two field-based SMFT protocols, prescribed at different intensities, were administered weekly. Individual slopes were calculated from the analysis of within-athlete change scores. Associations between laboratory and field measures were assessed via Pearson's correlation coefficient (r) and linear regression models. RESULTS: Relationships between SMFT HR-derived indices from laboratory and field were very-large for exercise HR (r = 0.74 to 0.87) and moderate to very-large for HR recovery (0.43 to 0.76). Moderate to very-large inverse relationships were observed between exercise HR and HR recovery with V̇O2 max and MAS (-0.41 to -0.78), whereas resting HR showed no substantial relationships. Changes in exercise HR showed large and very-large inverse correlations with preseason changes in V̇O2 max (-0.54 to -0.60) and MAS (-0.64 to -0.83). Relationships between changes in HR recovery and maximal cardiorespiratory criterion measures were moderate to large (-0.32 to -0.63). CONCLUSION: SMFT exercise HR is a valid proxy measure of cardiorespiratory fitness irrespective of test setting, whereas the validity of HRR remains elusive and appears to vary between exercise intensities.

Rehabilitation Protocols in Elbow Medial Ulnar Collateral Ligament Injuries: A Systematic Review of Articles Published in the Last 20 Years.

CONTEXT: Elbow medial ulnar collateral ligament (UCL) injuries have become increasingly common in athletes. Despite this, rehabilitation protocols appear to vary drastically, which may explain the clinical equipoise regarding optimal management. OBJECTIVE: This systematic review reports rehabilitation characteristics reported after UCL injuries and compares reported outcomes based on early versus delayed rehabilitation. DATA SOURCES: Our search utilized PubMed/MEDLINE, Embase, Web of Science, and Cochrane to identify all articles on UCL rehabilitation published between January 1, 2002 and October 1, 2022. STUDY SELECTION: Studies in English with ≥5 patients that reported rehabilitation protocols for UCL injuries were evaluated. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data included sample characteristics, time to achieve physical therapy milestones, outcome scores, and return-to-play (RTP) rate and timing. RESULTS: Our review included 105 articles with a total of 15,928 elbows (98% male; weighted mean age, 23 years; follow-up, 47 months), with 15,077 treated operatively and 851 treated nonoperatively. The weighted mean time patients spent adhering to nonweightbearing status was 42 days. The mean time until patients were given clearance for active range of motion (ROM) 15 days, full ROM 40 days, and elbow strengthening exercises 32 days. The mean time until all restrictions were lifted was 309 days. The mean time to begin a throwing program was 120 days. Across all rehabilitation characteristics, protocols for patients undergoing nonoperative management started patients on rehabilitation earlier. After UCL reconstruction, earlier active ROM (≤14 days), elbow strengthening (≤30 days), no restrictions (≤180 days), and throwing (≤120 days) postoperatively led to earlier RTP without a negative effect on functional outcome scores. CONCLUSION: Current literature provides a spectrum of protocols for elbow UCL rehabilitation, regardless of management. Nonoperative patients began ROM activities, strengthening, and throwing programs sooner than operative patients, and earlier milestones led to earlier RTP.

Explore athletes' sports attitude and its influence on mental health.

This study is devoted to exploring how athletes' sports attitude affects their mental health, and explores this complex relationship through descriptive statistics, longitudinal analysis, correlation analysis and regression analysis. The research sample includes athlete data at multiple time points, covering mental health indicators such as positive attitude, negative attitude, anxiety, depression and self-esteem. Descriptive statistical results reveal the overall trend of athletes in positive attitude, anxiety, depression and self-esteem. On average, athletes show a positive attitude towards sports, but there are some variability in mental health indicators. The results of longitudinal analysis show that with the progress of the season, the positive attitude shows an upward trend, while the level of anxiety and depression shows a downward trend in some cases, which provides a detailed observation for the long-term evolution of athletes' psychological state. Correlation analysis reveals the positive correlation between positive attitude and self-esteem, positive correlation between negative attitude and anxiety, and negative correlation between teamwork attitude and depression. Regression analysis further verified the influence of positive attitude and negative attitude on anxiety. The results emphasize that the improvement of positive attitude may help to slow down the increase of anxiety level, while the increase of negative attitude may be related to the increase of anxiety. Generally speaking, the findings of this study highlight the complex relationship between athletes' mental health and their attitude towards sports. This study provides profound insights for formulating targeted psychological support strategies and emphasizes the importance of comprehensively considering multi-dimensional factors in athletes' mental health management.

Comparison of Australian Football League Women's athletes match day energy and nutrient intake to recommendations.

AIMS: This cross-sectional observational study quantified Australian Football League Women's athletes' match volume, and compared match-day dietary intakes against recommendations. METHODS: Self-report, direct observation, and fluid measurements determined dietary intake (n = 17, 25 ± 4.5 years, 22.8 ± 1.8 kg/m2) on five home match days (early or late starting). Global positioning system software captured match volume. Linear mixed effects models evaluated differences in early versus late match volume and nutrient intakes. Data are presented as mean ± standard deviation. RESULTS: Athletes covered 6712 ± 622 m during matches, with similar numbers of very high-intensity running efforts over equal distances in early and late matches (early vs. late efforts [no.]: 8.5 ± 4.9 vs. 9.5 ± 5.5; distance [m]: 203 ± 127 vs. 212 ± 113). Across all match days, 71% (n = 12) of athletes met their predicted daily energy requirements. However, 82% (n = 14) failed to meet minimum daily carbohydrate recommendations; intake was lower on early compared with late match days (4.7 g/day vs. 5.4 g/kg/day, p = 0.027). On average, no athletes met carbohydrate recommendations in the 2 h prior to a match and only 24% (n = 4) met recommendations during matches. All athletes met post-match carbohydrate and protein requirements. CONCLUSION: Athletes cover large distances during games with frequent bursts of high-intensity running. However, they do not adjust their intake to meet the energy demands of competition, with inadequate fuelling prior to and during matches. These findings emphasise the need for greater athlete education and dietary support to maximise strategic fuelling to optimise athletic performance.

Habitual Nocturnal Sleep, Napping Behavior, and Recovery Following Training and Competition in Elite Water Polo: Sex-Related Effects.

PURPOSE: To examine nocturnal sleep patterns, napping behaviors, and subjective wellness responses of elite water polo players within an in-season week and to identify whether sleeping patterns differ between men and women. METHODS: Sleep characteristics of 10 male and 17 female professional water polo players were objectively assessed during 1 week of the in-season period, including 5 training days, 1 match day, and 1 day of rest. Internal load (rating of perceived exertion × duration of training or match) was assessed 30 minutes posttraining or postmatch, and the total quality of recovery was recorded every morning. A series of multilevel models were used to analyze the data. RESULTS: Time in bed and wake-up time were earlier on both training (P < .001) and rest days (P < .001) than on the day of the match. Internal workload did not predict any of the players' sleeping patterns. Midday naps predicted less time in bed (P = .03) and likely less sleep time (P = .08). The total quality of recovery was predicted only by the total sleep time (P < .01). Women exhibited higher sleep efficiency (P < .001), less waking after sleep onset (P = .01), and a lower number of awakenings (P = .02) than men. CONCLUSIONS: The current results indicate that the nocturnal sleep patterns of elite water polo players are not associated with internal load and that women display better nocturnal sleep quality compared with men. As long naps interfere with nocturnal sleep, and total nocturnal sleep time predicts total quality of recovery, we suggest that athletes follow hygiene sleep strategies to facilitate adequate nocturnal sleep and next-day recovery.

Six-minute walk test in healthy British service personnel.

INTRODUCTION: The 6 min walk test (6MWT) is a widely used, safe and effective submaximal exercise test. The primary outcome is the distance walked, but additional physiological and patient-reported metrics can be recorded. It is used to assess function and is commonly used within UK Defence Rehabilitation. However, there are no published British military 6MWT data in a non-injured population. This study reports the 6MWT procedure and results from healthy British service personnel. METHODS: A convenience sample of 46 individuals (male n=40) undertook 95 6MWTs over three study visits throughout a year. They were performed on a 20 m straight-line route, administered by an exercise rehabilitation instructor and preceded by anthropometric measurements (height, weight). Physiological measures (HR, oxygen saturations (SpO2)) and patient-reported measures (Borg shortness of breath (SoB), rate of perceived exertion (RPE) and fatigue) were taken before and after the assessment. Statistical tests were performed between pre-test and post-test measures, and sex and body mass, and concurrent cardiopulmonary exercise tests (CPET) with 6MWT distance. RESULTS: The mean 6MWT distance was 705.5±86 m; males 709.4±86.9 m and females 685.9±81.9 m (p=0.32), with a median Borg SoB of 1 (IQR: 0-2) and RPE 9 (IQR: 7-11), and a negative correlation between body mass index and 6MWT distance, p=0.007. There were no significant differences between pre-test and post-test measures. Peak workload and VO2 Max correlated weakly with 6MWT distance (0.336, p=0.01 and 0.375, p=0.09, respectively), but submaximal CPET measures did not. CONCLUSION: These results provide a benchmark for British military 6MWT data to guide clinical and research use. However, a larger dataset is required for validation and normative values.

A wearable flexible triboelectric nanogenerator for bio-mechanical energy harvesting and badminton monitoring.

Recently, textile materials used for wearable flexible sensors have received much attention. Wearable textile based triboelectric nanogenerator (TENG) not only has unique advantages in mechanical energy harvesting, but also has application value in the direction of motion sensing. Here, we proposed a non-woven fabric triboelectric nanogenerator (NW-TENG) for mechanical energy harvesting and badminton monitoring. The non-woven fabric play the role of positive triboelectric, and the fluffy fiber structure endows NW-TENG with a sensitive response to pressure. The pressure sensing sensitivity of NW-TENG sensor can reach 1.22 V N-1 (Pressure range: 0-7 N) and 0.18 V N-1 (Pressure range: 8 N-55 N). Furthermore, the NW-TENG can be installed on the body joints of badminton players for analyzing joint movements, thereby achieving data-driven badminton training and facilitating the evaluation of training effectiveness. This research provide a new path to promote TENG to the badminton monitoring field.

The Segond Fracture as a Vital Diagnostic Tool for Anterior Cruciate Ligament Injury in Acute Settings: A Case Report.

A Segond fracture is a specific type of avulsion fracture involving the lateral aspect of the proximal tibia adjacent to the tibial plateau. Segond fractures are indicative of ligamentous injury in the knee. In this case report, a 29-year-old male delivery driver presented to the ED with acute onset right knee pain after losing control of his motorbike at low speed. Examination revealed significant effusion and medial and lateral joint line tenderness. An anterior-posterior radiograph of the knee showed a Segond fracture. Subsequent MRI confirmed a full-thickness anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) tear. Despite surgical reconstruction options, the patient chose conservative management. At eight-week follow-up, he demonstrated satisfactory progress. This case highlights the diagnostic significance of Segond fractures in identifying ligamentous damage in the knee without the availability of MRI. It also highlights the feasibility of non-operative management in some instances.

Atrial remodelling associated with sporting discipline, sex and duration in elite sports: a cross-sectional echocardiographic study among Danish elite athletes.

Background: Elite endurance training is characterised by a high-volume load of the heart and has been associated with atrial fibrillation (AF) in middle-aged men. We compared left atrial (LA) remodelling among elite athletes engaged in sports, categorised as having low, intermediate, and high cardiac demands. Methods: This cross-sectional echocardiographic study of healthy elite athletes evaluated LA size and function measured as LA maximum volume (maxLAVi) and contraction strain. Athletes were grouped according to the cardiac demands of their sport (low, intermediate, high). Morphological measures were indexed to body surface area and reported as least square means; differences between groups were reported with 95% CIs. Results: We included 482 elite athletes (age 21±5 years (mean±SD), 39% women). MaxLAVi was larger in the high group (28.4 mL/m2) compared with the low group (20.2 mL/m2; difference: 8.2, CI 5.3 to 11.1 mL/m2; p<0.001), where measurements in men exceed those in women (26.4 mL/m2 vs 24.7 mL/m2; difference 1.6 mL/m2; CI 0.3 to 2.9 mL/m2; p=0.0175). In the high group, LA contraction strain was lower compared with the low group (-10.1% vs -12.9%; difference: 2.8%; CI 1.3 to 4.3%; p<0.001), and men had less LA contraction strain compared with women (-10.3% vs -11.0%; difference 0.7%; CI 0.0 to 1.4%; p=0.049). Years in training did not affect maxLAVi or LA contraction strain. Conclusion: MaxLAVi was higher while LA contraction strain was lower with increased cardiac demands. MaxLAVi was larger, and LA contraction was lower in men compared with women. Whether these sex-based differences in LA remodelling are a precursor to pathological remodelling in male athletes is unknown.

Reliability and responsiveness of the Swedish short Hip-RSI.

Purpose: The aim of this study was to examine test-retest reliability and responsiveness of the short version (6-item) Hip Return to Sport after Injury (Hip-RSI) scale in patients following hip arthroscopy. Methods: The study included 100 hip arthroscopy patients responding to a digital survey including the short version (6-item) Hip-RSI, International Hip Outcome Tool (short version) (iHOT-12) and RTS status 3, 6 and 9 months following surgery. The Hip-RSI was administered twice at 3-month follow-up. Test-retest reliability was evaluated using intraclass correlation coefficients. Responsiveness was tested by correlations between changes in Hip-RSI and iHOT-12 scores and by comparing change in Hip-RSI scores of patients who progressed on the return to sport (RTS) continuum (from return to any sport to return to performance) to patients who did not, using independent samples t-tests. Results: Hip-RSI was found to have excellent test-retest reliability on the individual (intraclass correlation coefficient, ICC [95% confidence interval, CI]: 0.90 [0.83-0.94]) and group level (ICC [95% CI]: 0.95 [0.91-0.97]) with a standard error of measurement of 5.53 and smallest detectable change of 15.3 on the individual and 2.2 on the group level. Hip-RSI was found responsive to change through positive correlations of changes in scores with changes in iHOT-12 scores from 3 to 6 months (r [95% CI]: 0.51 [0.35-0.65]; p < 0.001) and from 3 to 9 months following arthroscopy (r [95% CI]: 0.61 [0.57-0.79); p < 0.001). Further responsiveness was shown by significant mean changes in scores among patients that progressed on the RTS-continuum (3-6 months: 8.6 [95% CI: 3.8- 13.5); 3-9 months: 12.6 [5.6-19.7]). Conclusion: The short version (6-item) Hip-RSI demonstrated excellent test-retest reliability and responsiveness to change in the evaluation of psychological readiness to RTS following hip arthroscopy. Level of Evidence: Level II.

Investigation of the effect of circadian rhythm on the performances of NBA teams.

Professional athletes competing in the NBA are frequently exposed to time-zone-shifting travels. These time zone changes may cause circadian rhythm (CR) phase shifts and these shifts affect sportive performance. The aim of this study was to investigate the effects of CR phase shifts on the performance of NBA teams. 25016 regular season games across 21 consecutive seasons were included in the CR phase shift calculations. To examine the CR phase shift effect on team performance, teams were divided into three groups regarding Coordinated Universal Time (UTC): the same internal UTC as the local UTC (LS); the internal UTC ahead of the local UTC (LA); and the internal UTC behind the local UTC (LB). With a different approach, teams were divided into another three categories: the same internal UTC as its opponent's internal UTC (OS); the internal UTC ahead of its opponent's internal UTC (OA); and the internal UTC behind its opponent's internal UTC (OB). 24985 game data were used to compare these groups in terms of 25 variables. Statistical analyses were conducted separately for home and away teams. For home games, it was found that LA and OA are the most and LB is the least successful group in winning and scoring performances. For away games, it was determined that LS is the most advantageous group with the best winning percentage. These results revealed that teams from more west may have a CR advantage in regular season home games. However, it is thought that the performance of away teams depends more on travel fatigue than CR phase shifts.

Popping pills in youth elite sports - fact or fiction? A 36-week prospective cohort study of analgesic use in 1195 youth elite athletes and student controls.

OBJECTIVE: To investigate analgesic use in a cohort of Danish youth elite athletes, and compare weekly analgesic use over 36 weeks to student controls. We also investigated and compared reasons for analgesic use and types of analgesics used. DESIGN: Prospective cohort study. METHODS: 690 youth elite athletes (44% females) and 505 student controls (59% females) (age 15-20 years) provided weekly reports on analgesic use over 36 weeks. We asked about number of days with analgesic use, reasons for use, and types of analgesics used. Prevalence and frequency of analgesic use was compared between youth elite athletes and student controls using mixed effects logistic regression and mixed effects Poisson regression models. Reasons for and types of analgesics used was compared between groups using Chi-square tests. Subgroup analyses were performed, stratified by sex. RESULTS: Overall, athletes had lower odds of analgesic use (OR 0.78, 95% CI 0.64 to 0.95) compared with student controls. The overall usage rate was similar between the groups (IRR 1.04, 95% CI 0.99 to 1.11). Subgroup analyses suggested no statistically significant differences in the odds of analgesic use. Significantly more athletes reported using analgesics to prevent or treat pain or injury in relation to sports participation and to use topical gels compared with student controls. CONCLUSION: Participating in youth elite sports was associated with lower odds of analgesic use compared to student controls, but usage rate was similar between the groups. Reasons for use and types of analgesics use differed between athletes and student controls.

[Physical activity to reduce cardiovascular risk -Why deprive yourself ?] / L'activité sportive pour réduire le risque cardiovasculaire ­ Pourquoi s'en priverait-on ?

Sports-related sudden death is an uncommon event, affecting mainly middle-aged men who practice leisure sports, and is related to unknown coronary artery disease. In athletes, cardiac causes are also predominant, with a greater proportion of structural and electrical heart disease. If first-aid resuscitation measures are initiated, survival easily exceeds 50%, and this is an excellent educational illustration of how to improve the prognosis of non-sport-related cardiac arrest. Prevention of a sport-related cardiovascular event remains difficult, and relies on clinical examination, questioning (including family history) and resting ECG in participants >35 years old. The non-contraindication visit is also an opportunity to pass on to the patient the rules of good sports "hygiene" and life-saving gestures in the event of sudden death during sport in one of the partners (and the importance of regularly educating oneself in life-saving gestures...).

Addressing Barriers to Timely Orthopaedic Follow-up for Foot and Ankle Fractures After Emergency Department Visits.

INTRODUCTION: Foot and ankle fractures present common challenges in emergency departments, warranting careful follow-up protocols for optimal patient outcomes. This study investigates the predictors of orthopaedic follow-up for these injuries after an emergency department (ED) visit. METHODS: A retrospective observational study of 1450 patients seen in the ED with foot or ankle fractures from July 2015 to February 2023 was conducted. All included patients were discharged with instructions to follow-up with an orthopaedic provider. Demographic data, fracture details, and follow-up patterns were extracted from medical records. Social vulnerability was assessed using the Centers for Disease Control (CDC) Social Vulnerability Index. Univariate and multivariate analyses were performed to identify predictors of follow-up. A subgroup analysis comparing patients who followed up >7 days from ED presentation (ie, delayed follow-up) to those who followed up within 7 days of presentation was then performed. Statistical significance was assessed at P < .05. RESULTS: Overall, 974/1450 (67.2%) patients followed up with orthopaedics at an average time of 4.16 days. After risk adjustment, Medicaid coverage (odds ratio [OR] = 0.56, P = .018), increased overall social vulnerability (OR = 0.83, P = .032), and increased vulnerability across the dimensions of socioeconomic status (P = .002), household characteristics (P = .034), racial and ethnic minority status (P = .007), and household type and transportation (P = .032) were all associated with lower odds of follow-up. Phalangeal fractures were also associated with decreased odds of follow-up (OR = 0.039, P < .001), whereas ankle fractures were more likely to follow-up (OR = 1.52, P = .002). In the subgroup analysis, patients of older age (P = .008), non-white race (P = .024), motor vehicle accident (MVA) (P = .027) or non-private insurance (P = .027), those experiencing phalangeal fractures (P = .015), and those seen by an orthopaedic provider in the ED (P = .006) were more likely to present with delayed follow-up. CONCLUSION: Patients with increased social vulnerability and Medicaid insurance are less likely to seek follow-up care after presentation to the ED with foot and ankle fractures.

Musculoskeletal Knowledge on the in-Training Examination Improves in Family Medicine Residents Participating in a Longitudinal Sports Medicine Clinical Track.

Objectives: The study aims to assess the impacts of a sports medicine (SM) track on musculoskeletal (MSK) knowledge of family medicine (FM) residents. In-training examination (ITE) results were used to compare the MSK knowledge of FM residents with and without SM track participation. Methods: A single-center, retrospective study was completed on 85 FM residents from the 2018 to 2024 graduating classes who completed the ITE from 2017 to 2021. Residents were categorized by participation in the SM track, where half a day of FM continuity clinic per week is replaced with an SM clinic, supervised by a fellowship-trained SM physician. ITE scores throughout training were compared between the 2 groups using mixed-effects regression. Results: The ITE MSK scores increased among both SM track participants (+77 points/year, p = .001) and nonparticipants (+39 points/year, p = .001) throughout their training. By postgraduate year 3, SM track participants performed significantly better on the MSK portion of the ITE (+87 points compared to non-participants, p = .045). No significant difference in total ITE scores was seen between groups. Conclusions: Our data demonstrates that participation in an SM track is associated with an increase in MSK knowledge of ITE, suggesting that an SM track may provide FM residents with a better understanding of MSK conditions.