Brain local stability and network flexibility of table tennis players: a 7T MRI study.

Table tennis players have adaptive visual and sensorimotor networks, which are the key brain regions to acquire environmental information and generate motor output. This study examined 20 table tennis players and 21 control subjects through ultrahigh field 7 Tesla magnetic resonance imaging. First, we measured percentage amplitude of fluctuation across five different frequency bands and found that table tennis players had significantly lower percentage amplitude of fluctuation values than control subjects in 18 brain regions, suggesting enhanced stability of spontaneous brain fluctuation amplitudes in visual and sensorimotor networks. Functional connectional analyses revealed increased static functional connectivity between two sensorimotor nodes and other frontal-parietal regions among table tennis players. Additionally, these players displayed enhanced dynamic functional connectivity coupled with reduced static connectivity between five nodes processing visual and sensory information input, and other large-scale cross-regional areas. These findings highlight that table tennis players undergo neural adaptability through a dual mechanism, characterized by global stability in spontaneous brain fluctuation amplitudes and heightened flexibility in visual sensory networks. Our study offers novel insights into the mechanisms of neural adaptability in athletes, providing a foundation for future efforts to enhance cognitive functions in diverse populations, such as athletes, older adults, and individuals with cognitive impairments.

Metabolomic profiling of elite female soccer players: urinary biomarkers over a championship season.

INTRODUCTION: In soccer, most studies evaluate metabolic profile changes in male athletes, often using data from a single match. Given the current landscape of women's soccer and the effects of biological sex on the physiological response and adaptation to exercise, more studies targeting female athletes and analyzing pre- and post-game moments throughout the season are necessary. OBJECTIVES: To describe the metabolomics profile of female soccer athletes from an elite team in Brazil. The study observed the separation of groups in three pre- and post-game moments and identified the discriminating metabolites. METHODS: The study included 14 female soccer athletes. Urine samples were collected and analyzed using Nuclear Magnetic Resonance in pre-game and immediate post-game moments over three national championship games. The metabolomics data were then used to generate OPLS-DA and VIP plots. RESULTS: Forty-three metabolites were identified in the samples. OPLS-DA analyses demonstrated a progressive separation between pre-post conditions, as supported by an increasing Q2 value (0.534, 0.625, and 0.899 for games 1, 2 and 3, respectively) and the first component value (20.2% and 19.1% in games 1 and 2 vs. 29.9% in game 3). Eight out of the fifteen most discriminating metabolites appeared consistently across the three games: glycine, formate, citrate, 3-hydroxyvalerate, glycolic acid, trimethylamine, urea, and dimethylglycine. CONCLUSION: The main difference between the three games was the increasing separation between groups throughout the championship. Since the higher VIP-scores metabolites are linked to energy and protein metabolism, this separation may be attributed several factors, one being the accumulation of fatigue.

Nightmares in Swiss elite athletes: Associated factors.

Nightmares, defined as extremely dysphoric dreams, can cause significant distress in everyday life if they occur frequently. Their aetiology is based on a disposition-stress model. As elite athletes often experience high stress levels, the present study investigated factors that might be associated with nightmare frequency in a large cohort of 2297 Swiss elite athletes (1066 women, 1231 men) with a mean age of 22.05 ± 7.53 years. In total, about 6% of the athletes reported frequent nightmares (once a week or more often). We found that well-established factors like female gender and general stress levels were related to nightmare frequency. To a smaller extent, the number of training hours, lost training days due to illness, and having early training sessions were also associated with nightmare frequency. Sport discipline was not related to nightmare frequency. An unexpected finding was the association between late alcohol intake 4 hr prior to bedtime and nightmare frequency. Our findings support the idea that stress related to practicing sports might affect nightmare frequency. Future research should study whether inventions designed for athletes suffering from frequent nightmares are beneficial for them and might even improve their athletic performance.

Disruptions to sleep and circadian rhythms are associated with poorer athlete mental health in female, but not male, elite Australian Rules footballers.

Elite athletes are vulnerable to sleep and circadian disruption and associated mental health symptoms. This study aimed to investigate sex differences in sleep, circadian rhythms, and mental health, as well as the moderating role of sex in the prediction of mental health, among male professional and female semi-professional elite athletes. Participants were 87 elite Australian Rules football (ARF) athletes (43% female; mean [standard deviation] age 24.0 [4.1] years). Participants completed baseline questionnaires, 2 weeks of sleep/wake monitoring via actigraphy, and a circadian phase assessment (dim-light melatonin onset [DLMO]). Cross-sectional data were collected in training-only Australian Football League (AFL) Men's and Women's pre-season periods, with 53 providing data in two pre-seasons. Female athletes, relative to males, reported poorer mental health (a higher athlete psychological strain score), had a later mid-sleep time (by 28 min), reported a greater preference towards eveningness, and displayed a later circadian phase (by 33 min). For female athletes, lower sleep efficiency and lower sleep regularity were associated with poorer mental health. For female athletes, there were U-shaped relationships between both morningness-eveningness and phase angle (interval between sleep onset and DLMO time) and mental health. No significant relationships were found for male athletes. In summary, elite female ARF athletes reported poorer mental health, relative to males, especially when experiencing sleep or circadian disruption. Lifestyle factors associated with sex differences in ARF professionalism (scheduling, finances, supports) may contribute to these findings. Programmes to improve sleep, circadian alignment, and mental health among female semi-professional elite athletes should be strongly considered.

Coping profiles of adolescent football players and association with interpersonal coping: Do emotional competence and psychological need satisfaction matter?

Using a person-centered approach, the present study aimed to investigate the coping profiles of adolescent football players involved in elite football training centers. The purposes were to (1) identify coping profiles based on the reported use of multiple coping strategies in response to competitive stress, (2) explore whether emotional competencies and psychological need satisfaction would predict coping profile membership, and (3) examine the extent to which coping profiles were differently associated with individual and team perceived stress, interpersonal coping, and subjective team performance, as well as demographic characteristics. A sample of 416 young French football players (males = 282; females = 134; Mage = 16.2; SDage = 1.2) from 12 elite football training centers participated in this study. Latent profile analysis results yielded three coping profiles allowing players to be grouped according to their preferences for a combined use of certain strategies (i.e., low copers, high disengaged copers, and high task copers). Results provided further insight into each coping profile membership by indicating the role played by intrapersonal emotional competence and psychological need satisfaction. Finally, differences between coping profiles have been shown in terms of individual perceived stress intensity, interpersonal coping approach, and gender. These findings provide a deeper understanding of adaptive coping profiles within a population of adolescent football players involved in elite training centers. Implications for developing and tailoring psychoeducational interventions for adolescent football players exhibiting a maladaptive coping profile (i.e., disengagement-oriented coping profile) are considered.

Characterization of muscle oxygenation response in well-trained handcyclists.

PURPOSE:  Peripheral responses might be important in handcycling, given the involvement of small muscles compared to other exercise modalities. Therefore, the goal of this study was to compare changes in muscle oxygen saturation (∆SmO2) and deoxyhemoglobin level (∆[HHb]) between different efforts and muscles. METHODS:  Handcyclists participated in a Wingate, a maximal incremental test and a 20-min time-trial (TT). Oxygen uptake (VO2) as well as ∆SmO2, ∆[HHb], deoxygenation and reoxygenation rates in the triceps brachii (TB), biceps brachii (BB), anterior deltoid (AD) and extensor carpi radialis brevis (ER) were measured. RESULTS:  ER ∆[HHb]max was 37% greater in the incremental test than in the Wingate (ES = 0.392, P = 0.031). TT mean power (W/kg) was associated with BB ∆SmO2min measured in the incremental test (r = -0.998 [-1.190, -0.806], P = 0.002) and in the Wingate (r = -0.994 [-1.327, -0.661], P = 0.006). MAP (W/kg) was associated with Wingate BB ∆SmO2min (r = -0.983 [-0.999, -0.839], P = 0.003), and Wingate peak (r = 0.649 [0.379, 0.895], P = 0.008) and mean power (W/kg) (r = 0.925 [0.752, 0.972], P = 0.003) was associated with right handgrip force. The strongest physiological predictor for TT performance was BB ∆SmO2min in the incremental test (P = 0.002, r2 = 0.993, SEE 0.016 W/kg), Wingate BB ∆SmO2min for MAP (P = 0.003, r2 = 0.956, SEE 0.058 W/kg) and right handgrip force for Wingate peak power (P = 0.005, r2 = 0.856, SEE 0.551 W/kg). CONCLUSION:  Peripheral aerobic responses (muscle oxygenation) were predictive of handcycling performance.

Association of central blood pressure with an exaggerated blood pressure response to exercise among elite athletes.

PURPOSE: The systolic blood pressure/workload (SBP/MET) slope was recently reported to be a reliable parameter to identify an exaggerated blood pressure response (eBPR) in the normal population and in athletes. However, it is unclear whether an eBPR correlates with central blood pressure (CBP) and vascular function in elite athletes. METHODS: We examined 618 healthy male elite athletes (age 25.8 ± 5.1 years) of mixed sports with a standardized maximum exercise test. CBP and vascular function were measured non-invasively with a validated oscillometric device. The SBP/MET slope was calculated and the threshold for an eBPR was set at > 6.2 mmHg/MET. Two groups were defined according to ≤ 6.2 and > 6.2 mmHg/MET, and associations of CBP and vascular function with the SBP/MET slope were compared for each group. RESULTS: Athletes with an eBPR (n = 180, 29%) displayed a significantly higher systolic CBP (102.9 ± 7.5 vs. 100 ± 7.7 mmHg, p = 0.001) but a lower absolute (295 ± 58 vs. 384 ± 68 W, p < 0.001) and relative workload (3.14 ± 0.54 vs. 4.27 ± 1.1 W/kg, p < 0.001) compared with athletes with a normal SBP/MET slope (n = 438, 71%). Systolic CBP was positively associated with the SBP/MET slope (r = 0.243, p < 0.001). In multiple logistic regression analyses, systolic CBP (odds ratio [OR] 1.099, 95% confidence interval [CI] 1.045-1.155, p < 0.001) and left atrial volume index (LAVI) (OR 1.282, CI 1.095-1.501, p = 0.002) were independent predictors of an eBPR. CONCLUSION: Systolic CBP and LAVI were independent predictors of an eBPR. An eBPR was further associated with a lower performance level, highlighting the influence of vascular function on the BPR and performance of male elite athletes.

Sprint training in hypoxia and with blood flow restriction: Controversies and perspectives.

This narrative review assesses the effects of repeated sprint training (RST) in hypoxia (RSH) and blood flow restriction (BFR) methods on skeletal muscle adaptations and performance. Current literature suggests that RSH promotes metabolic modifications in muscle cells, especially driven by reactive oxygen species production, HIF-1α stabilization, and changes in metabolism. Training with BFR promotes metabolite accumulation in working muscles due to limited blood flow, however, cellular mechanisms affected by BFR during RST are less explored. Data highlight that RSH improves repeated sprint ability (RSA) in several sport disciplines (e.g. rugby, tennis, soccer, cross-country skiing). However, recent studies showed that addition of hypoxia or BFR during RST did not promote supplementary benefits on aerobic performance, force-velocity power profile, and V˙O2max. Nonetheless, gains in V˙O2max were observed during sprint interval training protocols when BFR was applied during recovery between sets. Finally, recent studies highlighted that RSH can improve RSA in a short period. Thus, RSH and sprint training with BFR may be useful for sports disciplines requiring high glycolytic demand and can promote gains in RSA in a short window. Further studies must be encouraged to better understand the biological consequences of adding such stimuli to exercise, especially BFR, on long-term adaptation.

The Kinematic and Electromyographic Analysis of Roller Skating at Different Speeds on a Treadmill: A Case Study.

Elite athletes in speed roller skates perceive skating to be a more demanding exercise for the groin when compared to other cyclic disciplines, increasing their risk of injury. The objective of this study was to monitor the kinematic and electromyographic parameters of roller speed skaters, linearly, on a treadmill, and to compare different skating speeds, one at 20 km/h and one at 32 km/h, at a 1° inclination. The acquisition was carried out by placing an inertial sensor at the level of the first sacral vertebra, and eight surface electromyographic probes on both lower limbs. The kinematic and electromyographic analysis on the treadmill showed that a higher speed requires more muscle activation, in terms of maximum and average values and co-activation, as it not only increases the intrinsic muscle demand in the district, but also the athlete's ability to coordinate the skating technique. The present study allows us to indicate not only how individual muscle districts are activated during skating on a surface different from the road, but also how different speeds affect the overall district load distributions concerning effective force, which is essential for the physiotherapist and kinesiologist for preventive and conditional purposes, while also considering possible variations in the skating technique in linear advancement.

A New Versatile Jig for the Calibration and Validation of Force Metrics with Instrumented Paddles in Sprint Kayaking.

The interest in using new technologies to obtain recordings of on-water kinetic variables for assessing the performance of elite sprint kayakers has increased over the last decades but systematic approaches are warranted to ensure the validity and reliability of these measures. This study has an innovative approach, and the aim was to develop a new versatile jig including reference force sensors for both the calibration and validation of mutual static and dynamic stroke forces as measured with instrumented paddles at the high force levels used in elite sprint kayaking. METHODS: A jig was constructed using a modified gym weight stack and a frame consisting of aluminum profiles permitting a fastening of custom-made kayak paddle shaft and blade support devices with certified force transducers combined with a data acquisition system to record blade and hand forces during static (constant load) and dynamic conditions (by paddle stroke simulation). A linear motion path incorporating a ball-bearing equipped carriage with sensors for the measurement of vertical distance and horizontal displacement was attached to the frame for recordings of various position measures on the paddle. The jig design with all components is extensively described to permit replication. The procedures for assessing the accuracy of the jig force instrumentation are reported, and with one brand of instrumented paddle used as an example, methods are described for force calibration and validation during static and dynamic conditions. RESULTS: The results illustrate that the measured force with the jig instrumentation was similar to the applied force, calculated from the applied accurate mass (within a -1.4 to 1.8% difference) and similar to the force as calculated from the applied mass with the weight stack (within a -0.57 to 1.16% difference). The jig was suitable for the calibration and validation of forces in a range relevant for elite sprint kayaking under both static and dynamic conditions. During static conditions with a force direction equal to the calibration conditions and a force range from 98 to 590 N, all values for the instrumented paddle were within a -3.4 to 3.0% difference from the jig sensor values and 28 of 36 values were within ±2%. During dynamic conditions with paddle stroke simulations at 60 and 100 strokes/min and a target peak force of 400 N, the common force variables as measured by the instrumented paddle were not significantly different from the same measures by the jig (values at 100 strokes/min: peak force; 406.9 ± 18.4 vs. 401.9 ± 17.2 N, mean force; 212.8 ± 15.4 vs. 212.0 ± 14.4 N, time to peak force; 0.17 ± 0.02 vs. 0.18 ± 0.02 s, force impulse; 90.8 ± 11.2 vs. 90.5 ± 10.8 Ns, impulse duration; 0.43 ± 0.03 vs. 0.43 ± 0.03 s). CONCLUSION: A novel jig with several new functions is presented that enables the calibration and validation of force measurements with instrumented paddles by providing standardized conditions for calibration and force validation during both static and dynamic conditions in a force range relevant to elite sprint kayaking.

Differences in Troponin I and Troponin T Release in High-Performance Athletes Outside of Competition.

Troponin I and troponin T are critical biomarkers for myocardial infarction and damage and are pivotal in cardiological and laboratory diagnostics, including emergency settings. Rapid testing protocols have been developed for urgent care, particularly in emergency outpatient clinics. Studies indicate that strenuous physical activity can cause transient increases in these troponin levels, which are typically considered benign. This research focused on 219 elite athletes from national teams, evaluating their troponin I and T levels as part of routine sports medical exams, independent of competition-related physical stress. The results showed that 9.2% (18 athletes) had elevated troponin I levels above the reporting threshold, while their troponin T levels remained within the normal range. Conversely, only 0.9% (two athletes) had normal troponin I but raised troponin T levels, and 2.3% (five athletes) exhibited increases in both markers. No significant cardiovascular differences were noted between those with elevated troponin levels and those without. This study concludes that elevated troponin I is a common response to the intense physical training endured by high-performance endurance athletes, whereas troponin T elevation does not seem to be directly linked to physical exertion in this group. For cardiac assessments, particularly when ruling out cardiac damage in these athletes, troponin T might be a more reliable indicator than troponin I.

Changes in physical and technical match performance variables in football players promoted from the Spanish Second Division to the First Division.

The aim of this study was to compare physical and technical match performance variables in football players who competed in the Spanish second division for one season and were promoted to the top (first) division in the following season. A total of 97 male outfield football players who were promoted from the second to the first division of the Spanish professional football league within the same team were analysed. Data were recorded using the TRACAB (ChyronHego, New York, USA) multicamera computerised optical tracking system during five seasons (2015-2016 to 2019-2020). A one-way ANOVA repeated measures analysis showed that players executed a greater number of high-intensity running (HIR) efforts (P < 0.001; ES: 0.258), as well as covering greater HIR distance (P < 0.010; ES: 0.106) and total running distance (TD) (P < 0.010; ES: 0.080), when they played in the first division compared with the second division. Moreover, players performed a lower number of passes (P < 0.01; ES = 0.116), short passes (P < 0.01; ES = 0.106), long passes (P < 0.05; ES = 0.067), dribbles (P < 0.001; ES = 0.146) and shots (P < 0.01; ES = 0.074) in the first division compared to the second division. No significant differences were found for any of the defensive variables evaluated. In conclusion, being promoted from the second to the first division of professional football requires players to adapt to greater physical demands and a reduced number of technical actions.

Exercise testing for young athletes.

With increasing competitiveness across the sporting landscape, there is a need for more research into monitoring and managing the young athlete, as the needs of a young athlete are vastly different to those of an older athlete who is already established in their respective sport. As the age of sports specialisation seems to decrease, exercise testing in the younger cohort of athletes is crucial for safety and long-term success. This article provides a comprehensive summary of available testing and monitoring methods that can be used to assist young athletes as they mature and attempt to excel in their chosen sport.

Urinary Incontinence in Elite Female Athletes.

PURPOSE OF REVIEW: To summarize the current understanding on the epidemiology, pathophysiology, and management strategies of urinary incontinence (UI) in female athletes, highlighting findings specific to nulliparous elite athletes. RECENT FINDINGS: UI occurs in about 20-50% of female athletes of all ages and parity status, around 40% for younger nulliparous athletes, and is more prevalent in high-impact sports. Possible contributing factors to UI in female elite athletes include pelvic floor laxity and bladder neck descent, pelvic floor muscle fatigue, low energy availability, and hypermobility syndrome. In female elite athletes, urinary symptoms negatively affect quality of life, although the effects of symptoms on exercise participation are not well understood. Current management strategies are primarily conservative and centered on behavioral modifications and pelvic floor muscle physiotherapy. UI in female elite athletes appears to be multifactorial. Clarifying how individual factors influence UI in this population will inform athlete counseling, prevention, and treatment strategies.

Prevalence of symptoms of depression and generalized anxiety disorder in field hockey players of German first and lower leagues.

BACKGROUND: While several studies on mental health of elite athletes were published in recent years, few compared the prevalence with the general population and none included field hockey players. AIMS: To analyze the prevalence of symptoms of depression and generalized anxiety disorder in field hockey players of different skill levels and to compare it to the general population. METHODS: Male and female hockey players from different leagues were asked to answer questions on player characteristics, the Centre of Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder-7 (GAD-7). RESULTS: One hundred and eighty-seven players (incl. 54 first and 28 second league players) participated in the study (response rate 97.4%). More than a third (n = 64; 35.0%) reported to be affected by an injury/health complaint, but 157 (86.3%) were able to train and play without limitations. The CES-D score indicated depression symptoms in more female (n = 15; 18.3%) than male (n = 5; 4.8%) players (χ2=8.8; p < 0.01). No male and one female player had symptoms of generalized anxiety disorder. Players who played 60 or more matches in the previous 12 months had on average significantly higher depression (t = 2.3; p < 0.05) and generalized anxiety scores (t = 4.2; p < 0.001) than players who played fewer matches. The prevalence of depression and of generalized anxiety symptoms was similar to or lower than in the general population. Although 20 (10.7%) players had depression symptoms, only 4 (2.2%) received psychological counseling or psychotherapy. CONCLUSION: It is recommended to provide routine screening of mental health problems and low-threshold access to adequate treatment for elite athletes.

Training characteristics and performance of two male elite short-distance triathletes: From junior to "world-class".

OBJECTIVE: The sports-science literature lacks data on training and performance characteristics of international elite athletes over multiple seasons. The present case study provided general training characteristics and performance data of two male short-distance triathletes in the Junior, U23, and international Elite categories. METHODS: General training and performance data of two male elite triathletes were described in swimming, cycling, and running segments from the 2015 to 2022 season. The training load was presented using the ECO model while the training intensity distribution (TID) was a triphasic model. RESULTS: Both triathletes increased their performance throughout the seasons. Triathlete A increased his VO2max in cycling by 20.6%, in running by 16.7%. His power at VO2max and his speed at VO2max by 18.9% and 11.0%, respectively. Triathlete B improved his VO2max by 17.8% in cycling, by 16.1% in running and his power at VO2max by 24%, and his speed at VO2max by 14.3%. The triathletes trained on average 14-17 h a week. The TID model was polarized. CONCLUSIONS: To achieve the top international level, it is necessary to consider the following measures: training load progression; improvements in physiological variables; and participation in international events starting from youth categories.

Classification of middle- and long-distance runners based upon their performance.

The scientific literature lacks consensus on classification of middle- and long-distance runners. This creates situations where the sample studied may not represent the target population and could produce misleading conclusions. Thus, we present an approach for a data-driven classification of middle- and long-distance runners according to their competition results. The best annual results of middle- and long-distance track runners participating at major (Olympics, World and European Championships) and national championships (Denmark, Sweden, Finland, Norway) were gathered for the 2012-2018 period. Overall, 1920 men's and 1808 women's performance results were gathered. The results were grouped accordingly. Quadratic discriminant analysis was applied to define the limits between the groups. Three basic categories could be proposed for classification: world class, international and national. Classification provides a realistic overview of performance standards and the number of athletes for different categories in middle- and long-distance track running in real-world settings. The performance-based classification provides data-driven and unified criteria for reporting standards on athletes' proficiency levels. It allows for more consistent reporting practices on the target population in research. In addition to scientific research, the classification could also be employed for a variety of practical purposes.

Ability to return to sports after early lateral ligament repair of the ankle in 147 elite athletes.

PURPOSE: The literature on elite athletes' ability to return to sports (RTS) after early lateral ligament repair of the ankle remains inadequate. The time needed to RTS after modified Broström repair for acute grade III lateral ligament injuries in a large cohort of elite athletes was evaluated while assessing the impact of other associated injuries. METHODS: Prospective data from 147 elite athletes who underwent a primary lateral ligament repair for acute grade III injuries with clinical ankle instability from 2015 to 2019 with a minimum of 2-year follow-up were reviewed. Pertinent details such as characteristics of injury, time taken to RTS, impact of associated injuries on RTS and complications were recorded and analysed. RESULTS: The average age was 24.4 years (S.D = 4.9) with 89.1% males. Approximately two-thirds of the elite athletes were football players (66.0%) and 21.1% were rugby players. Isolated lateral ligament complex injuries were sustained by 122 (83%) patients, while 25 (17%) had associated injuries (osteochondral lesions of the talus/deltoid injury/syndesmosis injury). All 147 athletes returned to their preinjury level of sports with a median time of 69 days (range 58-132 days). There was no significant difference found in time to RTS between gender, age, and types of sports. However, there was a statistically significant difference noted in the time taken to RTS earlier in patients with isolated lateral ligament injuries when compared to those with associated injuries (68.6 vs. 82.8 days; p = 0.004). Multiple conditional linear regression yielded three independent predictors of longer time taken to RTS which were associated deltoid injury (7.5 days longer; 95% CI 2.9-12.3; p = 0.002), associated syndesmosis injury (6.7 days longer; 95% CI 0.5-12.8; p = 0.034) and associated OLT (30.3 days longer; 95% CI 25.1-35.5; p = 0.000). CONCLUSION: Early surgical repair for acute grade III lateral ligament injuries in elite athletes yielded excellent rate of RTS at 9-10 weeks and a re-injury rate of 2%. Concomitant injuries will delay RTS after surgical intervention. These findings serve as important guide to managing elite athletes following acute rupture of the lateral ligament complex. LEVEL OF EVIDENCE: Level III.

In elite athletes with meniscal injuries, always repair the lateral, think about the medial! A systematic review.

PURPOSE: This study aimed to evaluate and compare the time required to return to sports (RTS) after surgery, the rate of revision surgery and the time required for RTS after revision surgery in elite athletes undergoing meniscal repair or partial meniscectomy, particularly analysing the difference between medial and lateral menisci. It was hypothesised that both procedures would entail similar, high rates of RTS, with the lateral meniscus exhibiting higher potential healing postprocedure compared to the medial meniscus. METHODS: A systematic review was conducted based on the PRISMA guidelines. Quality assessment of the systematic review was performed using the AMSTAR-2 checklist. The following search terms were browsed in the title, abstract and keyword fields: 'meniscus' or 'meniscal' AND 'tear,' 'injury' or 'lesion' AND 'professional,' 'elite' or 'high-level' AND 'athletes,' 'sports,' 'sportsman,' 'soccer,' 'basketball,' 'football' or 'handball'. The resulting measures extracted from the studies were the rate of RTS, level of RTS, complications, revision surgery and subsequent RTS, Tegner, International Knee Documentation Committee (IKDC) and Visual Analogue Scale (VAS). RESULTS: In this study, the cohort consisted of 421 patients [415 (98.6%) men and 6 (1.4%) women] with a mean age of 23.0 ± 3.0 years. All patients were elite athletes in wrestling, baseball, soccer, rugby or handball. While 327 (77.7%) patients received partial meniscectomy at a mean age of 23.3 ± 2.6 years, 94 (22.3%) patients received meniscal repair at a mean age of 22.1 ± 4.0 years. After partial meniscectomy, 277 patients (84.7%) returned to their competitive sports activity and 256 (78.3%) returned to their pre-injury activity levels. A total of 12 (3.7%) patients required revision surgery because of persistent pain [5 (1.5%) patients], chondrolysis [2 (0.7%) patients] or both chondrolysis and lateral instability [5 (1.5%) patients]. Ten (83.3%) of the twelve patients had involvement of the lateral meniscus, whereas the location of injury was not specified in the remaining two patients. After revision surgery, all patients (100%) resumed sports activity. However, after meniscal repair, 80 (85.1%) athletes returned to their competitive sports activity and 71 (75.5%) returned to their pre-injury activity levels. A total of 16 (17.0%) patients required partial meniscectomy in cases of persistent pain or suture failure. Of these, 4 (25%) patients involved lateral and medial menisci each and 8 (50%) patients were not specified. After revision surgery, more than 80.0% of the patients (13) resumed sports activity. CONCLUSIONS: In elite athletes with isolated meniscal injury, partial meniscectomy and meniscal suture exhibited similar rates of RTS and return to pre-injury levels. Nonetheless, athletes required more time for RTS after meniscal repair and exhibited an increased rate of revision surgery associated with a reduced rate of RTS after the subsequent surgery. For lateral meniscus tears, meniscectomy was associated with a high rate of revision surgery and risk of chondrolysis, whereas partial medial meniscectomy allowed for rapid RTS but with the potential risk of developing knee osteoarthritis over the years. The findings of this systematic review suggested a suture on the lateral meniscus in elite athletes because of the high healing potential after the procedure, the reduced risk of developing chondrolysis and the high risk of revision surgery after partial meniscectomy. Furthermore, it is important to evaluate several factors while dealing with the medial meniscus. If rapid RTS activity is needed, a hyperselective meniscectomy is recommended; otherwise, a meniscal suture is recommended to avoid accelerated osteoarthritis. LEVEL OF EVIDENCE: Level IV. STUDY REGISTRATION: PROSPERO-CRD42022351979 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=351979 ).

Mental health, eating habits and physical activity levels of elite Iranian athletes during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has changed life styles of millions of people worldwide. This study investigated changes in the health, physical activity levels and eating habits of elite athletes during the COVID-19 pandemic lockdown in Iran. METHODS: 383 (248 female and 135 male) elite athletes (168.82 ± 0.07 cm; 63.92 ± 7.42 kg; the body mass index (BMI): 22.3 ± 0.78 kg/m2) participated in this study. The International Physical Activity Questionnaire (IPAQ), Depression Anxiety Stress Scales (DASS-21) and the Impact of Event Scale-Revised (IES-R) study tools were used to measure levels of physical activity and mental health status, respectively. The Emotional Eater Questionnaire (EEQ) was used to assess food consumption related to emotion. Pearson and Spearman correlation analysis test were used in data analysis. RESULTS: Levels of depression and stress were mild and moderate, while levels of anxiety were severe and very severe in most elite athletes. There were levels of low emotional eating by elite athletes during the COVID-19 pandemic. Physical activity levels were negatively correlated with psychological mood measures (p≤0.05), while there were positive correlations between emotional eating behaviours and psychological mood measures (moderate correlation; p≤0.01) and light physical activity levels (weak correlation; p≤0.05). CONCLUSION: This study provides the first preliminary evidence showing that the COVID-19 lockdown conditions negatively influenced the eating habits and levels of physical activity and mental health in elite athletes. Regular high intensity physical activity as health strategy in elite athletes and the general population remains a strategy to improve overall health during the COVID-19 pandemic. Additionally, these findings suggest the need to devise strategies to improve the life styles of elite athletes during pandemics such as the Covid-19 pandemic.

CONTEXTE: La pandémie de COVID-19 a changé les modes de vie de millions de personnes dans le monde. Cette étude a examiné certains indicateurs de bonne santé, les niveaux d'activité physique et les habitudes alimentaires d'athlètes Elite iraniens pendant le confinement lié à la pandémie de COVID-19.Méthodes : 383 (248 femmes et 135 hommes) athlètes élites (168,82 ± 0,07 cm ; 63,92 ± 7,42 kg ; indice de masse corporelle (IMC) : 22,3 ± 0,78 kg/m2) ont participé à cette étude. Le questionnaire international sur l'activité physique (IPAQ), l'échelle DASS-21 (Depression Anxiety Stress Scales) et les scores de l'auto-questionnaire Impact of Event Scale-Revised (IES-R) ont été utilisés pour mesurer les niveaux respectifs d'activité physique et de l'état de santé mentale. L'Emotional Eater Questionnaire (EEQ) a été utilisé pour évaluer les altérations de la prise alimentaire liées à l'émotion. Le test d'analyse de corrélation de Pearson et Spearman a été utilisé pour l'analyse des données.Résultats : Les niveaux de dépression et de stress étaient légers et modérés, tandis que les niveaux d'anxiété étaient sévères à très sévères chez la plupart des athlètes élites. Il y avait des niveaux de faible alimentation d'origine émotionnelle chez ces athlètes pendant la pandémie de COVID-19. Les niveaux d'activité physique étaient corrélés négativement avec les mesures de l'humeur psychologique (p≤0,05), tandis qu'il y avait des corrélations positives entre les comportements alimentaires émotionnels et les mesures de l'humeur psychologique (corrélation modérée ; p≤0,01) et les niveaux d'activité physique légère (faible corrélation ; p≤0,05). CONCLUSION: Cette étude apporte une preuve préliminaire que les conditions de confinement liées au COVID-19 ont influencé négativement les habitudes alimentaires et les niveaux d'activité physique et de santé mentale chez des athlètes élites. L'activité physique régulière à haute intensité aussi bien chez les athlètes élites que pour la population générale reste une stratégie pour améliorer la santé globale pendant la pandémie de COVID-19. De plus, ces résultats suggèrent la nécessité de concevoir des stratégies pour améliorer les styles de vie des athlètes élites lors de pandémies, telles que celle de Covid-19.