Training zones in competitive swimming: a biophysical approach.

Since swimming performance depends on both physical conditioning and technical proficiency, training zones should be built based on physiology and biomechanics inputs to dispose of structured and effective training programs. This paper presents a zone-based swimming training, supported by the oxygen uptake (V˙O2) kinetics at low, moderate, heavy, severe and extreme intensities concurrently with lactate and heart rate values. Since technique is vital for efficiently moving through the water, upper limbs frequency and length should also be targeted during the workouts. The index of coordination was also added to our proposal since upper limbs synchronization is a key technical factor. To better establish and characterize a wide range of swimming intensities, the training methods and corresponding contents that better fit each training zone will be suggested. It will be shown that when under/at the anaerobic threshold (at low-to-moderate intensities), swimmers are at homeostasis and can maintain stable internal and external load indicators. However, above that boundary (at heavy and severe intensities), the physiological stable state is no longer observed and the anaerobic metabolism starts contributing significantly, with a technical degradation being more evident when performing near/at the V˙O2max intensity. Then, when performing above aerobic power, on typical anaerobic intensities, V˙O2 kinetics presents a very evident fast rise, ending abruptly due to exhaustion caused by muscle acidosis. This overall knowledge allows advancing toward more objective training programs and highlights the importance of systematic training control and swimmers' evaluation and advice.

Effect of experimentally induced muscle pain on neuromuscular control of force production.

PURPOSE: Neural and peripheral effects of induced muscle pain on explosive force production were investigated. METHODS: Nine participants performed two maximal, six explosive, and six electrical stimulations induced (twitches and octets) isometric knee extensions before and after (15 min of rest) receiving an intramuscular injection of hypertonic saline (pain inducer) or isotonic (placebo) infusions in two laboratory visits separated by 7 days. RESULTS: It was observed a reduction of peak torque production in maximal voluntary contraction in both conditions (9.3 and 3.3% for pain and placebo, respectively) and in the rate of torque development in placebo (7%). There was an increase in the rate of torque development for twitch and octets (10.5 and 15.8%, respectively) in the pain condition and peak torque for twitch (12%) in both conditions (as did the total rate of torque development for octets). CONCLUSION: Force production decreases and increases during voluntary and involuntary contractions, respectively, suggesting that acute pain impairs force production via central mechanisms.

Effect of the Fran CrossFit Workout on Oxygen Uptake Kinetics, Energetics, and Postexercise Muscle Function in Trained CrossFitters.

PURPOSE: Fran is one of the most popular CrossFit benchmark workouts used to control CrossFitters' improvements. Detailed physiological characterization of Fran is needed for a more specific evaluation of CrossFitters' training performance improvements. The aim of the study was to analyze the oxygen uptake (V˙O2) kinetics and characterize the energy system contributions and the degree of postexercise fatigue of the unbroken Fran. METHODS: Twenty trained CrossFitters performed Fran at maximal exertion. V˙O2 and heart-rate kinetics were assessed at baseline and during and post-Fran. Blood lactate and glucose concentrations and muscular fatigue were measured at baseline and in the recovery period. RESULTS: A marked increase in V˙O2 kinetics was observed at the beginning of Fran, remaining elevated until the end (V˙O2peak: 49.2 [3.7] mL·kg-1·min-1, V˙O2 amplitude: 35.8 [5.2] mL·kg-1·min-1, time delay: 4.7 [2.5] s and time constant: 23.7 [11.1] s; mean [SD]). Aerobic, anaerobic lactic, and alactic pathways accounted for 62% (4%), 26% (4%), and 12% (2%) of energy contribution. Reduction in muscle function in jumping ability (jump height: 8% [6%], peak force: 6% [4%], and maximum velocity: 4% [2%]) and plank prone test (46% [20%]) was observed in the recovery period. CONCLUSIONS: The Fran unbroken workout is a high-intensity effort associated with an elevated metabolic response. This pattern of energy response highlights the primary contribution of aerobic energy metabolism, even during short and very intense CrossFit workouts, and that recovery can take >24 hours due to cumulative fatigue.

Effect of Randall foils on the rowing propulsive cycle.

Rowing performance depends on the design and building materials used for competition. Recently, attempting to improve rowing performance, the Randall foil has been attached to the top edge of a rowing Big blade, making it spoon shaped. The current study aimed to analyse the differences between Big blades with and without Randall foils in force-related variables. Nineteen rowers performed two bouts of 90 s at maximal effort tethered rowing and differences were found in cycle average peak force (4.33 ± 1.46 vs. 5.26 ± 1.57 N/kg), propulsive cycle average time (1.79 ± 0.38 vs. 1.52 ± 0.24 N/kg.s) and rate of force development (8.79 ± 4.75 vs. 12.07 ± 4.60 N/kg/s) for Big blades with and without foils (respectively). Differences were also observed between the middle (4.79 ± 1.21 vs. 4.08 ± 1.48 N/kg) and final phases (4.86 ± 1.45 vs. 4.04 ± 1.47 N/kg) of the rowing effort for the cycle average peak force of Big blades with and without Randall foils. Data suggest a positive effect of these foils on the force-time curve profile. Future studies should focus on testing its influence on free on-water rowing.

Assessment of Cardiorespiratory and Metabolic Contributions in an Extreme Intensity CrossFit® Benchmark Workout.

Our purpose was to characterize the oxygen uptake kinetics (VO2), energy systems contributions and total energy expenditure during a CrossFit® benchmark workout performed in the extreme intensity domain. Fourteen highly trained male CrossFitters, aged 28.3 ± 5.4 years, with height 177.8 ± 9.4 cm, body mass 87.9 ± 10.5 kg and 5.6 ± 1.8 years of training experience, performed the Isabel workout at maximal exertion. Cardiorespiratory variables were measured at baseline, during exercise and the recovery period, with blood lactate and glucose concentrations, including the ratings of perceived exertion, measured pre- and post-workout. The Isabel workout was 117 ± 10 s in duration and the VO2 peak was 47.2 ± 4.7 mL·kg-1·min-1, the primary component amplitude was 42.0 ± 6.0 mL·kg-1·min-1, the time delay was 4.3 ± 2.2 s and the time constant was 14.2 ± 6.0 s. The accumulated VO2 (0.6 ± 0.1 vs. 4.8 ± 1.0 L·min-1) value post-workout increased substantially when compared to baseline. Oxidative phosphorylation (40%), glycolytic (45%) and phosphagen (15%) pathways contributed to the 245 ± 25 kJ total energy expenditure. Despite the short ~2 min duration of the Isabel workout, the oxygen-dependent and oxygen-independent metabolism energy contributions to the total metabolic energy release were similar. The CrossFit® Isabel requires maximal effort and the pattern of physiological demands identifies this as a highly intensive and effective workout for developing fitness and conditioning for sports.

Biophysical characterization of the tennis serve: A systematic scoping review with evidence gap map.

OBJECTIVES: We aimed to assess the available evidence on the biophysics of the tennis serve, mapping the populations, interventions, contexts and other relevant information to highlight what is already known and to identify gaps in the literature. DESIGN: Systematic scoping review with evidence gap map. METHODS: The protocol was designed according to PRISMA 2020, Prisma-ScR guidelines and the Cochrane Handbook. The searches were conducted on July 20, 2022 and updated on April 1, 2023, in PubMed, Scopus and Web of Science (core collection). The risk of bias assessment was performed using the Cochranes method for nonrandomized studies (RoBANS) and a narrative synthesis of the main findings was performed and supplemented with an evidence gap map. RESULTS: Most trials were found on serve kinematics and kinetics (95 %), analyzing only flat serves (84 and 72 %, respectively). Few trials focused on physiology (20 %; e.g. biomarkers), under-19, left or both-handed, female and intermediate beginner or starter players (29, 17, 8 and 7 %, respectively). We found a preponderance of low and unclear risk of bias (63 and 31 %, respectively) and only 7 % high, particularly, on the assessment of confounding variables. CONCLUSIONS: The current scoping review reveals a few trials on physiological rather than biomechanical variables, as well as the absence of the kick and slice serve, foot-back and foot-up serve, and left-handed, female, and young player analyses. We did not find systematic mistakes or limitations in the design, conduct, or analysis that would distort the results, since only 7 % presented a high risk of bias.

Swimmers' Effective Actions during the Backstroke Start Technique.

The analysis of the external forces of swimming starts has revealed how swimmers propel themselves out of the block, but data should be properly interpreted to fully understand force-generation mechanisms. This study aimed to assess horizontal and vertical forces in the backstroke start based on swimmers' structural and propulsive actions. Firstly, a simulated structural force was estimated by two transient backstroke-start inter-segmental realistic body positions: a maximally tucked position and an extended one (just before the hands-off and the take-off, respectively). Secondly, 10 competitive backstroke swimmers performed four 15 m maximal backstroke starts with the external forces estimated. Thirdly, the simulated structural force was subtracted from raw horizontal and vertical force data, measured between hands-off and take-off instants, resulting in the propulsive forces. The application of the algorithm has evidenced that backstrokers' horizontal and vertical simulated-structural-force components contributed to ~40% of total force during start propulsion (~0.2-0.12 s before the take-off), followed by the propulsive horizontal force increment and a progressive vertical component reduction (~0.05 s) with ~20° take-off angle. Based on these findings, researchers and coaches can better guide swimmers as to the proper mechanical strategies to achieve effectiveness in the backstroke start, and to improve direct transfer of resistance training programs.

From Entry to Finals: Progression and Variability of Swimming Performance at the 2022 FINA World Championships.

The aim of the present study was two-fold: (i) to analyze the progression and variability of swimming performance (from entry times to best performances) in the 50, 100, and 200 m at the most recent FINA World Championships and (ii) to compare the performance of the Top16, semifinalists, and finalists between all rounds. Swimmers who qualified with the FINA A and B standards for the Budapest 2022 World Championships were considered. A total of 1102 individual performances swimmers were analyzed in freestyle, backstroke, breaststroke, and butterfly events. The data was retrieved from the official open-access websites of OMEGA and FINA. Wilcoxon test was used to compare swimmers' entry times and best performances. Repeated measures ANOVA followed by the Bonferroni post-hoc test were performed to analyze the round-to-round progression. The percentage of improvement and variation in the swimmers' performance was computed between rounds. A negative progression (entry times better than best performance) and a high variability (> 0.69%) were found for most events. The finalists showed a positive progression with a greater improvement (~1%) from the heats to the semifinals. However, the performance progression remained unchanged between the semifinals and finals. The variability tended to decrease between rounds making each round more homogeneous. Coaches and swimmers can use these indicators to prepare a race strategy between rounds.

Breaking Barriers: Artificial Intelligence Interpreting the Interplay between Mental Illness and Pain as Defined by the International Association for the Study of Pain.

Low back pain is one of the main causes of motor disabilities and psychological stress, with the painful process encompassing sensory and affective components. Noxious stimuli originate on the periphery; however, the stimuli are recombined in the brain and therefore processed differently due to the emotional environment. To better understand this process, our objective was to develop a mathematical representation of the International Association for the Study of Pain (IASP) model of pain, covering the multidimensional representation of this phenomenon. Data from the Oswestry disability index; the short form of the depression, anxiety, and stress scale; and pain catastrophizing daily questionnaires were collected through online completion, available from 8 June 2022, to 8 April 2023 (1021 cases). Using the information collected, an artificial neural network structure was trained (based on anomaly detection methods) to identify the patterns that emerge from the relationship between the variables. The developed model proved to be robust and able to show the patterns and the relationship between the variables, and it allowed for differentiating the groups with altered patterns in the context of low back pain. The distinct groups all behave according to the main finding that psychological and pain events are directly associated. We conclude that our proposal is effective as it is able to test and confirm the definition of the IASP for the study of pain. Here we show that the fiscal and mental dimensions of pain are directly associated, meaning that mental illness can be an enhancer of pain episodes and functionality.

Swimming sprint performance depends on upper/lower limbs strength and swimmers level.

Swimming performance is likely influenced by strength, but differences between butterfly, backstroke, breaststroke and front crawl, as well as between novice and expert swimmers, are unclear. We have examined the associations between sprint performances, upper and lower limb strength, and anthropometric characteristics in 14 (six males and eight females) non-elite and 16 (nine males and seven females) elite-level swimmers. After an anthropometric characterisation, participants performed four 25 m maximal swims (one per technique) with 10 min intervals, right and left shoulder flexion/extension isokinetic testing at 90 and 300º/s angular velocities and three countermovement jumps. Pearson correlation analysis showed that sprint times were moderate-largely negatively correlated with upper and lower limb strength and power (r ± 95%CI = 0.39 ± 0.26-0.77 ± 0.13, p < 0.05). Elite swimmers higher strength levels were associated with longer stroke length in butterfly and front crawl, and with higher stroke rate in backstroke and breaststroke (r ± 95%CI = 0.37 ± 0.32-0.68 ± 0.21; p < 0.05). Butterfly, backstroke and front crawl sprint times were moderate-largely negatively related with arm span (r ± 95%CI = 0.37 ± 0.26, 0.39 ± 0.25 and 0.69 ± 0.17, p < 0.05). The predictive model indicated that higher dry-land strength values distinguished elite from non-elite swimmers (r2 = 0.67-0.81; p < 0.001). This association was not observed per performance level and per sex, confirming that sprint swimming performance levels can be differentiated by dry-land strength testing.

Is the use of the coefficient of variation a valid way to assess the swimming intra-cycle velocity fluctuation?

OBJECTIVES: Swimming intra-cycle velocity fluctuation has often been assessed using the coefficient of variation, which requires a mathematical assumption of a positive linear relationship between the velocity mean and standard deviation. As this assumption has never been tested, the current study aimed to investigate the within-participant relationship between the mean and standard deviation of the intra-cycle velocity. DESIGN: Cross-sectional study. METHODS: The intra-trial mean and standard deviation of one stroke cycle centre of mass velocity (vCMmean and vCMSD, respectively) were obtained from 80 front crawl trials (10 participants × eight swimming speeds) using whole-body three-dimensional motion analysis. The linear mixed-effect model and intra-class correlation analysis were used to test the linear relationship between vCMmean and vCMSD (n = 80) and the absolute agreement between vCMmean and vCMSD relative to those during the fastest trial (n = 70). RESULTS: Neither the linear regression model (95 % confidence interval range of the fixed effect of vCMmean: -0.003-0.031) nor the intra-class correlation coefficient (ICC = 0.07; p = 0.26) verified linear relationships between vCMmean and vCMSD, which violated the background assumption of coefficient of variation calculation. CONCLUSIONS: When investigating the intra-cycle velocity fluctuation, the coefficient of variation should not be used alone. Researchers and practitioners should always interpret/report the obtained results together with the mean and standard deviation to avoid misleading conclusions and feedback because the coefficient of variation obtained from one cycle velocity data is likely biased by mean velocity.

Association between elite swimmers' force production and 100†m front crawl inter-lap pacing and kinematics.

The present study aimed to analyse the associations between force production and 100 m front crawl inter-lap pacing and kinematics. Eleven elite male swimmers performed a 100 m front crawl maximal effort to collect 50 m lap time (T50, s) and velocity (v, m·s-1) for pacing, stroke rate (SR), stroke length (SL) and stroke index (SI) as kinematic variables. A 30 s tethered effort allowed to determine the peak (Fpeak) and mean force (Fmean) as force production variables. The relative change (Δ) between 50 m laps was also calculated for all measures. A paired sample t-test was used to check differences between laps and Pearson correlation coefficients allowed to quantify the associations between force and remaining variables. The T50 increased from the first to the second lap (ΔT50 = 10.61%, p < 0.01, d = 2.68), while v (Δv = -5.92%, p < 0.01, d = 1.53), SR (ΔSR = -6.61%, p < 0.01, d = 0.45) and SI (ΔSI = -4.92%, p = 0.02, d = 0.45) decreased. SL remained unchanged between laps (ΔSL = 1.07%, p = 0.66, d = 0.08). No associations were found between force production and most of Δ, with the only exception being the reasonable good association between Fpeak and Δv (r = 0.62, p = 0.04). Although both pacing and kinematics fall from the first to the second sections of a 100 m front-crawl effort, the swimmers who exhibit higher Fpeak show a more stable front crawl v between both 50 m laps.

Exploring the Applicability of Physiological Monitoring to Manage Physical Fatigue in Firefighters.

Physical fatigue reduces productivity and quality of work while increasing the risk of injuries and accidents among safety-sensitive professionals. To prevent its adverse effects, researchers are developing automated assessment methods that, despite being highly accurate, require a comprehensive understanding of underlying mechanisms and variables' contributions to determine their real-life applicability. This work aims to evaluate the performance variations of a previously developed four-level physical fatigue model when alternating its inputs to have a comprehensive view of the impact of each physiological variable on the model's functioning. Data from heart rate, breathing rate, core temperature and personal characteristics from 24 firefighters during an incremental running protocol were used to develop the physical fatigue model based on an XGBoosted tree classifier. The model was trained 11 times with different input combinations resulting from alternating four groups of features. Performance measures from each case showed that heart rate is the most relevant signal for estimating physical fatigue. Breathing rate and core temperature enhanced the model when combined with heart rate but showed poor performance individually. Overall, this study highlights the advantage of using more than one physiological measure for improving physical fatigue modelling. The findings can contribute to variables and sensor selection in occupational applications and as the foundation for further field research.

Physical Fitness Profile of High-Level Female Portuguese Handball Players.

We characterized the physical and physiological profiles of high-level female Portuguese handball players and examined the relationships between their anthropometric characteristics, general motor performance and cardiopulmonary fitness. Twenty-four high-level female handball players with an average age of 23.6 ± 5.5 years, height of 173.6 ± 5.1 cm and body mass of 72.6 ± 9.1 kg volunteered to participate. A Pearson correlation test was used to assess the relationship between variables. Direct relationships were observed between the players' height and arm span (r = 0.741), as well as between their squat jump and countermovement jump performances with regard to body mass (r = 0.448 and 0.496, respectively). The 9 m jump shot has a large relationship with the 7 m standing throw (r = 0.786) and between left hand dynamometry and body mass index (r = 0.595). The 30 m sprint has a relationship with the 7 m standing throw (r = -0.526) and the 9 m jump throw (r = -0.551). Oxygen uptake has a relationship with the players' height (r = -0.482) and time limit (r = 0.513), while the fitness index has a relation to the players' height (r = -0.488) and arm span (r = -0.422). Our results should be considered when using physical testing to plan optimal physical training regimens in elite team handball.

Bioenergetic Analysis and Fatigue Assessment During the Fran Workout in Experienced Crossfitters.

AIM: To quantify the physiological demands and impact of muscle function t of the Fran workout, one of the most popular CrossFit benchmarks. METHODS: Twenty experienced CrossFitters-16 male: 29 (6) years old and 4 female: 26 (5) years old- performed 3 rounds (with 30-s rests in between) of 21-21, 15-15, and 9-9 front squats to overhead press plus pull-up repetitions. Oxygen uptake and heart rate were measured at baseline, during the workout, and in the recovery period. Rating of perceived exertion, blood lactate, and glucose concentrations were assessed at rest, during the intervals, and in the recovery period. Muscular fatigue was also monitored at rest and at 5 minutes, 30 minutes, and 24 hours postexercise. Repeated-measures analysis of variance was performed to compare time points. RESULTS: Aerobic (52%-29%) and anaerobic alactic (30%-23%) energy contributions decreased and the anaerobic lactic contribution increased (18%-48%) across the 3 rounds of the Fran workout. Countermovement jump height decreased by 8% (-12 to -3) mean change (95% CI), flight duration by 14% (-19 to -7), maximum velocity by 3% (-5 to -0.1), peak force 4% (-7 to -0.1), and physical performance (plank prone 47% [-54 to -38]) were observed. CONCLUSIONS: It appears that the Fran workout is a physically demanding activity that recruits energy from both aerobic and anaerobic systems. This severe-intensity workout evokes substantial postexercise fatigue and corresponding reduction in muscle function.

Intracycle Velocity Variation in Swimming: A Systematic Scoping Review.

Intracycle velocity variation is a swimming relevant research topic, focusing on understanding the interaction between hydrodynamic propulsive and drag forces. We have performed a systematic scoping review to map the main concepts, sources and types of evidence accomplished. Searches were conducted in the PubMed, Scopus and Web of Science databases, as well as the Biomechanics and Medicine in Swimming Symposia Proceedings Book, with manual searches, snowballing citation tracking, and external experts consultation. The eligibility criteria included competitive swimmers' intracycle velocity variation assessment of any sex, distance, pace, swimming technique and protocol. Studies' characteristics were summarized and expressed in an evidence gap map, and the risk of bias was judged using RoBANS. A total of 76 studies, corresponding to 68 trials involving 1440 swimmers (55.2 and 34.1% males and females), were included, with only 20 (29.4%) presenting an overall low risk of bias. The front crawl was the most studied swimming technique and intracycle velocity variation was assessed and quantified in several ways, leading to extremely divergent results. Researchers related intracycle velocity variation to coordination, energy cost, fatigue, technical proficiency, velocity, swimming techniques variants and force. Future studies should focus on studying backstroke, breaststroke and butterfly at high intensities, in young, youth and world-class swimmers, as well as in IVV quantification.

Acute ventilatory responses to swimming at increasing intensities.

Background: Physical exercise is a source of stress to the human body, triggering different ventilatory responses through different regulatory mechanisms and the aquatic environment imposes several restrictions to the swimmer, particularly regarding the restricted ventilation. Thus, we aimed to assess the acute ventilatory responses and to characterize the adopted breathing patterns when swimming front crawl at increasing intensity domains. Methods: Eighteen well-trained swimmers performed 7 × 200 m front crawl (0.05 m∙s-1 velocity increments) and a maximal 100 m (30 s rest intervals). Pulmonary gas exchange and ventilation were continuously measured (breath-by-breath) and capillary blood samples for lactate concentration ([La-]) analysis were collected at rest, during intervals and at the end of the protocol, allowing the identification of the low, moderate, heavy, severe and extreme intensity domains. Results: With the swimming velocity rise, respiratory frequency (f R), [La-] and stroke rate (SR) increased ([29.1-49.7] breaths∙min-1, [2.7-11.4] mmol∙L-1, [26.23-40.85] cycles; respectively) and stroke length (SL) decreased ([2.43-2.04] m∙min-1; respectively). Oxygen uptake (VO2), minute ventilation (VE), carbon dioxide production (VCO2) and heart rate (HR) increased until severe ([37.5-53.5] mL∙kg-1∙min-1, [55.8-96.3] L∙min-1, [32.2-51.5] mL∙kg-1∙min-1 and [152-182] bpm; respectively) and stabilized from severe to extreme (53.1 ± 8.4, mL∙kg-1∙min-1, 99.5 ± 19.1 L∙min-1, 49.7 ± 8.3 mL∙kg-1∙min-1 and 186 ± 11 bpm; respectively) while tidal volume (VT) was similar from low to severe ([2.02-2.18] L) and decreased at extreme intensities (2.08 ± 0.56 L). Lastly, the f R/SR ratio increased from low to heavy and decreased from severe to the extreme intensity domains (1.12 ± 0.24, 1.19 ± 0.25, 1.26 ± 0.26, 1.32 ± 0.26 and 1.23 ± 0.26). Conclusions: Our findings confirm a different ventilatory response pattern at extreme intensities when compared to the usually evaluated exertions. This novel insight helps to understand and characterize the maximal efforts in swimming and reinforces the importance to include extreme efforts in future swimming evaluations.

Swimmers with Down Syndrome Are Healthier and Physically Fit than Their Untrained Peers.

While there are positive benefits from physical activity participation for individuals with Down syndrome, little is known about the effects of swimming training. The aim of this study was to compare the body composition and physical fitness profile of competitive swimmers and moderately active (untrained) individuals with Down syndrome. The Eurofit Special test was applied to a group of competitive swimmers (n = 18) and a group of untrained individuals (n = 19), all with Down syndrome. In addition, measurements were taken to determine body composition characteristics. The results showed differences between swimmers and untrained subjects in height, sum of the four skinfolds, body fat %, fat mass index and all items of the Eurofit Special test. Swimmers with Down syndrome exhibited physical fitness levels near to the Eurofit standards, although lower fitness levels were attained by these persons when compared to athletes with intellectual disability. It can be concluded that the practice of competitive swimming seems to counteract the tendency for obesity in persons with Down syndrome and also helps to increase strength, speed and balance.

Effectiveness of Conservative Interventions After Acute Hamstrings Injuries in Athletes: A Living Systematic Review.

BACKGROUND: Hamstrings injuries are common in sports and the reinjury risk is high. Despite the extensive literature on hamstrings injuries, the effectiveness of the different conservative (i.e., non-surgical) interventions (i.e., modalities and doses) for the rehabilitation of athletes with acute hamstrings injuries is unclear. OBJECTIVE: We aimed to compare the effects of different conservative interventions in time to return to sport (TRTS) and/or time to return to full training (TRFT) and reinjury-related outcomes after acute hamstrings injuries in athletes. DATA SOURCES: We searched CINAHL, Cochrane Library, EMBASE, PubMed, Scopus, SPORTDiscus, and Web of Science databases up to 1 January, 2022, complemented with manual searches, prospective citation tracking, and consultation of external experts. ELIGIBILITY CRITERIA: The eligibility criteria were multi-arm studies (randomized and non-randomized) that compared conservative treatments of acute hamstrings injuries in athletes. DATA ANALYSIS: We summarized the characteristics of included studies and conservative interventions and analyzed data for main outcomes (TRTS, TRFT, and rate of reinjuries). The risk of bias was judged using the Cochrane tools. Quality and completeness of reporting of therapeutic exercise programs were appraised with the i-CONTENT tool and the certainty of evidence was judged using the GRADE framework. TRTS and TRFT were analyzed using mean differences and the risk of reinjury with relative risks. RESULTS: Fourteen studies (12 randomized and two non-randomized) comprising 730 athletes (mostly men with ages between 14 and 49 years) from different sports were included. Nine randomized studies were judged at high risk and three at low risk of bias, and the two non-randomized studies were judged at critical risk of bias. Seven randomized studies compared exercise-based interventions (e.g., L-protocol vs C-protocol), one randomized study compared the use of low-level laser therapy, and three randomized and two non-randomized studies compared injections of platelet-rich plasma to placebo or no injection. These low-level laser therapy and platelet-rich plasma studies complemented their interventions with an exercise program. Only three studies were judged at low overall risk of ineffectiveness (i-CONTENT). No single intervention or combination of interventions proved superior in achieving a faster TRTS/TRFT or reducing the risk of reinjury. Only eccentric lengthening exercises showed limited evidence in allowing a shorter TRFT. The platelet-rich plasma treatment did not consistently reduce the TRFT or have any effect on the risk of new hamstrings injuries. The certainty of evidence was very low for all outcomes and comparisons. CONCLUSIONS: Available evidence precludes the prioritization of a particular exercise-based intervention for athletes with acute hamstrings injuries, as different exercise-based interventions showed comparable effects on TRTS/TRFT and the risk of reinjuries. Available evidence also does not support the use of platelet-rich plasma or low-level laser therapy in clinical practice. The currently available literature is limited because of the risk of bias, risk of ineffectiveness of exercise protocols (as assessed with the i-CONTENT), and the lack of comparability across existing studies. CLINICAL TRIAL REGISTRATION: PROSPERO CRD42021268499 and OSF ( https://osf.io/3k4u2/ ).