Relative energy deficiency in dance (RED-D): a consensus method approach to REDs in dance.

Relative energy deficiency in sport (REDs) is a potentially severe, challenging, broad-spectrum syndrome with potential negative health and performance outcomes. The numerous research publications and International Olympic Committee consensus statements relating to REDs testify to the challenges faced in early identification or screening, diagnosis and management. Like sport, dance, in its simplest form, can be identified as an activity resulting in physiological energy demands and, as such, requires appropriate energy availability concerning energy expenditures. However, the specificity of physiological and psychological demands in dance must be considered when considering REDs. An environment where physical activity can exceed 30 hours per week and where culture may instil a value that thinness is required puts dancers at increased risk for REDs. The purpose of this study was to provide dance-specific guidance dance on this complex condition. An RAND/UCLA Delphi Panel method with nominal group technique was used to review the literature from REDs to evaluate how it may relate to dance. In addition to the EP, which was assembled from a multidisciplinary background with expertise in REDs and multiple genres of dance, six focus groups were commissioned. Four of the focus groups were drawn from the EP members and two additional focus groups formed by dancers and artistic leaders. These panels were used to guide the development of a RED-D diagnosis pathway, management plan and risk stratification and return to dance pathway. The dance-specific pathways are designed to be a practical tool for guiding and supporting clinicians managing RED-D. Furthermore, this paper represents an important focus of this area in dance and serves to stimulate discussion and further research within the sector.

Cross-sectional study of characteristics and prevalence of musculoskeletal complaints in 1170 male golfers.

Objectives: The primary aim was to describe the characteristics and prevalence of musculoskeletal complaints of a large group of non-professional golfers. Secondary aims were to compare golfers different in (A) skill-level, (B) presence of low back pain (LBP) and (C) performance of prevention exercises. Methods: A sample of 1170 male golfers (mean age 54.98, SD=13.3) were surveyed online on personal and golf-specific characteristics, medical history and complaints in the preceding 7 days. Subgroups (A) with different golfing handicap (0 to 5, >5 to 10, >10), (B) with and without LBP and (C) who performed versus did not perform injury prevention exercises were compared using analysis of variance and χ2 test. Results: The prevalence and severity of musculoskeletal complaints was similar in everyday life and when playing golf. More than one-third of the golfers (n=436; 37.3%) reported LBP in the preceding 7 days, while other frequently affected body parts were the shoulder and knee. Golfers with different skill level differed in age and most golf-related characteristics but not in prevalence and severity of musculoskeletal complaints. Golfers with and without LBP were similar in almost all variables. Golfers who performed prevention exercises (n=371; 27.1%) were older and had a higher prevalence of complaints. Conclusion: The prevalence and severity of musculoskeletal complaints in golfers were similar to the wider population. It seems that injury prevention exercises were implemented after injury, rather than as primary prevention. Prospective studies looking at the epidemiology of injury, risk factors and interventions are required.

Beyond the medals: a cross-sectional study exploring retired elite female athletes' health.

Objectives: Little is known about the impact of elite sport participation on long-term athlete health. We aimed to: (1) describe musculoskeletal, mental health, reproductive/endocrine and cardiovascular characteristics in retired elite female athletes and compare to the general population and (2) explore athletes' perceptions of their elite sport participation and its impact on health. Methods: A 136-item online questionnaire was disseminated to Canadian elite female rowing and rugby athletes >18 years old, >2 years retired from elite competition. Matched general population data were obtained from Statistics Canada when available. Results: Seventy-four (24% response rate) athletes (average age 45 (±9) years; retired 15 (±9) years) completed the questionnaire (30 rowing, 44 rugby athletes). During their career, 63 athletes (85%) experienced a hip/groin, knee, foot/ankle injury, or low back pain, with 42 (67%) reporting ongoing symptoms. Athletes 35-54 years reported worse knee symptoms and quality of life compared with the general population (symptom: p=0.197; d=1.15 [0.66, 1.63]; quality of life: p=0.312 d=1.03 [0.54, 1.51]) while other hip, knee and foot/ankle outcome scores were similar. Retired athletes had lower odds of anxiety (OR=0.155 [95% CI0.062 to 0.384]), greater lifetime/ever odds of amenorrhea (OR=6.10 [95%CI 2.67 to 13.96]) and gave birth when older (p<0.05). Fifty-nine (79%) recalled witnessing or experiencing at least one form of harassment/abuse during their career. Sixty athletes (81%) rated their current health as above average or excellent and 61 (82%) would compete at the same level again if given the choice. Conclusion: These novel insights can inform future preventative efforts to promote positive elite sport-related outcomes for current, former and future female athletes.

'Knowing we have these rights does not always mean we feel free to use them': athletes' perceptions of their human rights in sport.

Objectives: Modern sport safeguarding strategies include published global rights declarations that enshrine athletes' entitlements at the policy level. It is unclear how these documents translate to athletes' lived experiences. The study aimed to determine athletes' knowledge, attitudes and beliefs about their human rights in sports settings. Setting: Web-based survey. Participants: 1159 athletes from 70 countries completed a validated web-based survey. Over half of participants (60.1%) were between 18 and 29 years, currently competing (67.1%), not members of players' unions (54.6%), elite (60.0%) and participating in individual (55.8%) non-contact (75.6%) Olympic (77.9%) sports. Gender distribution was equal. Primary and secondary outcome measures: Participant demographics (eg, gender, age) and athletes' knowledge, attitudes and beliefs about their human rights in sports settings. Results: Most (78.5%) were unaware of any athletes' rights declarations. Gender influenced participants' confidence in acting on their rights in sport significantly. Males were more likely to accept pressure from coaches and teammates than females, but age affected how likely males were to accept this pressure. Paralympic athletes were less likely to agree that violence is acceptable in sports, compared with Olympic. Player union membership increased confidence in freely expressing one's opinion in sports settings. Athletes' rights-related awareness, knowledge and beliefs were disconnected. Conclusions: Awareness raising is not enough to prevent human rights violations in sports. The cultural climate of the entire ecosystem must be targeted, using systems-level strategies to shift stakeholders' biases, beliefs and behaviours. This approach takes the onus of addressing abuse off athletes' shoulders and places accountability on sports organisations.

Implementation of Injury and Illness Surveillance Protocols in Varsity Athletes.

OBJECTIVE: To develop and implement a prospective varsity athlete surveillance system to identify injury and illness trends in a multisport varsity-level university setting. DESIGN: Longitudinal prospective surveillance study. SETTING: Varsity-level sport program at the University of Guelph, Guelph, ON, Canada. PARTICIPANTS: Athletic therapists (ATs) (n = 35) from 17 varsity sports provided injury and illness information on 624 varsity-level athletes (381 men and 243 women) during the 2016/2017 competitive season. INTERVENTIONS: Team ATs reported athlete health complaints weekly. Athletes reported additional details on the injury or illness that was reported. MAIN OUTCOME MEASURES: The outcome measurements included when the injury or illness occurred, anatomical location, diagnosis, cause, perceived severity, treatment, estimated athlete exposure (AE) to training and competition, and time loss from sport. Measures were recorded from the teams' first competition through to the end the season and/or playoffs. RESULTS: Twenty-nine of 30 varsity sports teams participated in this injury and illness surveillance protocol. The compliance of team ATs and varsity athletes was 89% (men: 94%, women: 82%). The overall injury and illness rates were 5.5 injuries and 1.7 illnesses per 1000 AEs, respectively. Men's injury rates were greater than women's, and injury rates of contact sports were greater than noncontact sports. CONCLUSIONS: The utilization of a prospective injury and illness surveillance protocol in the Canadian University sport system is feasible with good athlete, AT, and coach acceptance. The surveillance data should inform future injury and illness prevention strategies.