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Recently, we published self-reported data concerning the perceived effects of the menstrual cycle and hormonal contraceptives on the training and performance of 1086 female athletes participating in 57 sports. However, studies comparing differences between sports with large sample sizes are lacking. The aim of this ancillary study was to compare the impact of the menstrual cycle and hormonal contraceptives on training and performance between the three largest sports in the cohort, that is, football, handball, and orienteering, as well as the knowledge and support provided to the female athletes engaged in these sports. The results are from a web-based questionnaire completed by 312 football players, 243 handball players, and 93 orienteers. A total of 54% of the orienteers planned their training based on the menstrual cycle, which was a higher proportion compared to football (45%) and handball (29%) players (p < 0.05). Fewer football players believed that the menstrual cycle had an impact on their performance during training and competition compared to the two other sports. A high proportion of the athletes used hormonal contraceptives in all three sports, but a lower proportion of the orienteers (40%) used hormonal contraceptives compared to football (76%) and handball players (66%) (p < 0.05). Football and handball players received overall more support than orienteers, and the support was mostly provided by a physiotherapist and/or a strength and conditioner coach besides the main coach. These findings demonstrate that the perceived influence of the menstrual cycle and hormonal contraceptives on training and performance differs between endurance athletes in orienteering compared to team-sport athletes in football and handball. [ABSTRACT FROM AUTHOR]

Background: The menstrual cycle and its impact on training and performance are of growing interest. However, evidence is lacking whether periodized exercise based on the menstrual cycle is beneficial. The primary purpose of this proposed randomized, controlled trial, the IMPACT study, is to evaluate the effect of exercise periodization during different phases of the menstrual cycle, i.e., comparing follicular phase-based and luteal phase-based training with regular training during the menstrual cycle on physical performance in well-trained women. Methods: Healthy, well-trained, eumenorrheic women between 18 and 35 years (n = 120) will be recruited and first assessed for physical performance during a run-in menstrual cycle at different cycle phases and then randomized to three different interventions: follicular phase-based training, luteal phase-based training, or regular training during three menstrual cycles. The training intervention will consist of high-intensity spinning classes followed by strength training. The menstrual cycle phases will be determined by serum hormone analysis throughout the intervention period. Assessment of aerobic performance (primary outcome) and muscle strength, body composition, and blood markers will be performed at baseline and at the end of the intervention. Discussion: With a robust methodology, this study has the potential to provide evidence of the differential effects of exercise periodization during different phases of the menstrual cycle in female athletes. Trial registration: ClinicalTrials.gov NCT05697263. Registered on 25 January 2023 Key message: • The menstrual cycle has the potential to affect sporting performance in female athletes. Female athletes do perceive the impact of the menstrual cycle on physical performance. • This randomized, controlled trial will provide evidence of any differential effects of exercise periodization during different phases of the menstrual cycle in female athletes. • The results of this study might lead to new training recommendations given to exercising women. [ABSTRACT FROM AUTHOR]

Exposure to critical body weight comments in youth athletes could lead to decreased self-esteem, affect body image, and increase the risk of eating disorders and cause depressive symptoms. The aim was to explore differences between sex, body mass index, sports type, with regards to body weight satisfaction, exposure to critical body weight comments from their coach and nutrition status in adolescent elite athletes. A questionnaire about body weight, critical body weight comments and nutrition was distributed to 489 adolescent elite athletes and injury prevalence was monitored across 20 weeks. The results showed that almost one in four athletes (n=116, 24%) was not satisfied with their weight and 12% (n=59) had received critical body weight comments from their coach. Of the athletes who were unsatisfied with their body weight (n=116), 47% wanted to lose weight (n=55). A significant (p<0.05) higher proportion of ice hockey players and swimmers used nutritional supplements, were unsatisfied with their body weight, and were more exposed to critical body weight comments compared to athletes from other sports. Adolescent elite athletes as young as 15–16 years old are exposed to critical body weight comments from their coach and experience challenges with body weight satisfaction that is partly dependent on the sport-specific context. [ABSTRACT FROM AUTHOR]

Several risk factors for injury have been suggested in female elite athletes. However, there is a lack of prospective studies in young female athletes where multiple risk factors have been studied. The aim of this study was to identify risk factors for injury in female adolescent elite athletes. Substantial injuries were monitored in 222 athletes using the validated Oslo Sports Trauma Research Centre Questionnaire over 20 weeks. Over 20 potential risk factors were explored. Based on a binomial generalized linear mixed model, two significant (p<0.05) risk factors for injury were identified; previous injury within the last 12 months (OR 2.55) and well-being (OR 0.97). An athlete with a previous injury had twice as high a risk of injury (13% vs. 6%) compared to an athlete with no previous injury. Higher perceived well-being was associated with a decreased risk of injury. Based on a prospective design with a large sample of female adolescent elite athletes, investigating over 20 potential risk factors for injury, our results suggest that a previous injury and well-being are risk factors for injury. [ABSTRACT FROM AUTHOR]

The article offers information on the equality of female athletes in the recent Olympic Games in Tokyo, with nearly 49% female athletes, reflecting the general population's participation. Topics include underrepresentation of female participants in sports medicine and exercise physiology research, ignorance of the menstrual cycle in scientific studies leading to exclusion of women, and the neglected and taboo nature of women's diseases, including the menstrual cycle.

Abstract Background People with rheumatoid arthritis (RA) suffer increased risk of disability andpremature mortality. Health-enhancing physical activity (HEPA) could be one importantfactor to reduce this risk. Rising health care costs call for the development and evaluation ofnew modes of rehabilitation, including physical activity in settings outside the health caresystem. Methods/Design This cohort study targets 450 patients with RA that do not currently meet HEPA recommendations, recruited from six hospitals reporting to the Swedish Rheumatology Quality Registers (SRQ). We have developed a two-year real-life intervention program including a minimum of twice-weekly circuit training, moderately intense physical activity the remaining days of the week and group meetings to support behavior change every other week. Our hypothesis is that increased physical activity and exercise will improve perceived health, reduce pain and fatigue, increase muscle function and aerobic capacity, impact psychosocial factors and prevent future cardiovascular events. Research questions regard outcomes, retention rates, dose–response matters and the exploration of responder characteristics. This protocol outlines recruitment procedure, design, assessment methods and the intervention program of the study. Discussion The PARA 2010 project is designed to expand the knowledge on HEPA in RA by a progressive approach regarding population, setting, intervention, time frames and outcome measures. To our knowledge this is the first long-term HEPA program based on Social Cognitive Theory, and performed in a real life environment to demonstrate if this new setting can promote increased and maintained physical activity in people with RA. Trial registration number ISRCTN25539102

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Even though injury is common in elite sports, there is still a lack of knowledge of young athletes’ injury perception both during and after injury. The aim of this mixed-method study was, therefore, to explore, in-depth, data on injury consequences and adolescent elite athletes’ perceptions and experience of injury. Three hundred and forty adolescent elite athletes (age range 15-19), from 16 different sports, were bi-weekly monitored over 52 weeks using a valid questionnaire. Twenty athletes from the same cohort were interviewed in focus groups about injury experience and perceptions. The results show that the average bi-weekly prevalence of injury was 38.7% (95% CI 37.3-40.1), with 30.0% (n = 102) of the athletes injured for more than half of all reporting times. An overarching theme from the focus groups highlighted the risk among young athletes of a loss of identity while injured. The findings support several suggestions that may improve the rehabilitation process and enhance rehabilitation outcomes: (a) provide clear pathways to the medical team, (b) recognize the identity loss, (c) involve the injured athletes with the rest of the teammates and (d) educate athletes about how to interpret pain signals. Future research should explore and evaluate the effectiveness and generalization of such interventions. [ABSTRACT FROM AUTHOR]

Context: Our understanding of the injury burden in elite adolescent athletes in most sports is limited or unknown because of the lack of prospective, long-term injury studies. Objective: To describe injury patterns in terms of type, location, prevalence and incidence, recurrence and severity grade; time to first injury and prevalence of illness in elite adolescent athletes and to compare differences in injury data by sex and sport type. Design: Cohort study. Setting: Fifteen national sports high schools in Sweden. Patients or Other Participants: Participants were 284 elite adolescent athletes (boys = 147, girls = 137; median age = 17 years; 25th-75th percentile range = 16-18 years) competing at a high national level for their age in athletics (track and field), cross-country skiing, downhill skiing, freestyle skiing, handball, orienteering, or ski orienteering. Main Outcome Measure(s): All athletes were monitored weekly over 52 weeks, using a validated online questionnaire to identify injury type, location, prevalence or incidence and severity grade; time to first injury and prevalence of illness. Results: Among all athletes, 57.4% reported at least 1 new injury, whereas the 1-year injury prevalence was 91.6%. The overall injury incidence was 4.1/1000 hours of exposure to sport, and every week, on average, 3 of 10 (30.8%) elite adolescent athletes reported being injured. Of all injuries from which athletes recovered, 22.2% (n = 35) resulted in absence from normal training for at least 2 months. Female athletes reported higher (P < .05) average weekly injury prevalence and substantial injury prevalence (injuries leading to a moderate or severe reduction in sport performance or participation or time loss) than male athletes. Conclusions: A considerable number of elite adolescent athletes were injured weekly, resulting in serious consequences for sport participation, training, or performance (or a combination of these). Appropriately designed interventions to prevent knee and foot injuries will target both the greatest number of injuries and the injuries with the most serious consequences in elite adolescent athletes. [ABSTRACT FROM AUTHOR]

Background: Aerobic capacity tests are important to evaluate exercise programs and to encourage individuals to have a physically active lifestyle. Submaximal tests, if proven valid and reliable could be used for estimation of maximal oxygen uptake (VO2max). The purpose of the study was to examine the criterion-validity of the submaximal self-monitoring Fox-walk test and the submaximal Åstrand cycle test against a maximal cycle test in people with rheumatoid arthritis (RA). A secondary aim was to study the influence of different formulas for age predicted maximal heart rate when estimating VO2max by the Åstrand test. Methods: Twenty seven subjects (81% female), mean (SD) age 62 (8.1) years, diagnosed with RA since 17.9 (11.7) years, participated in the study. They performed the Fox-walk test (775 meters), the Åstrand test and the maximal cycle test (measured VO2max test). Pearson's correlation coefficients were calculated to determine the direction and strength of the association between the tests, and paired t-tests were used to test potential differences between the tests. Bland and Altman methods were used to assess whether there was any systematic disagreement between the submaximal tests and the maximal test. Results: The correlation between the estimated and measured VO2max valueswere strong and ranged between r = 0.52 and r = 0.82 including the use of different formulas for age predicted maximal heart rate, when estimating VO2max by the Åstrand test. VO2max was overestimated by 30% by the Fox-walk test and underestimated by 10% by the Åstrand test corrected for age. When the different formulas for age predicted maximal heart rate were used, the results showed that two formulas better predicted maximal heart rate and consequently a more precise estimation of VO2max. Conclusions: Despite the fact that the Fox-walk test overestimated VO2max substantially, the test is a promising method for self-monitoring VO2max and further development of the test is encouraged. The Åstrand test should be considered as highly valid and feasible and the two newly developed formulas for predicting maximal heart rate according to age are preferable to use when estimating VO2max by the Åstrand test. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to examine muscle strength and pain sensitivity in postmenopausal women with and without RA. Methods: Ten women with and ten without early RA were recruited. All were postmenopausal, and did not use hormone replacement therapy. Measurements of isokinetic muscle strength in knee flexors/extensors, hand grip strength, timed standing, pressure pain thresholds (PPT), suprathreshold pressure pain, and segmental and plurisegmental endogenous pain inhibitory mechanisms during muscle contraction were assessed. Results: Participants with early RA were weaker in knee flexors, in hand grip strength and they needed more time for the timed standing. Women with early RA had higher sensitivity to threshold pain and suprathreshold pressure pain compared to women without RA. PPTs increased in the contracting muscle as well as in a distant resting muscle during static contractions in both groups. Conclusions: Our results indicate differences in muscular strength between postmenopausal women with and without RA. Furthermore, women with RA had decreased PPT and hyperalgesia, but no dysfunction of segmental or plurisegmental pain inhibitory mechanisms during static exercise compared to healthy controls. The normal function of endogenous pain inhibitory mechanisms despite chronic pain in women with RA might contribute to the good effects of physical activity previously reported. [ABSTRACT FROM AUTHOR]

The article reports on research conducted to investigate the responsiveness of the one leg hop test and the square hop test to fatiguing intermittent aerobic work and subsequent recovery and to investigate sex difference trends with the jumps. Researchers evaluated 10 male and 10 female elite soccer players. They found that no significant difference in performance in either of the hop tests was found immediately after aerobic work and that there were no differences in trends between the sexes.

Purpose: The Fox-walk test is a new method used to estimate aerobic capacity outside a clinical environment, which may be useful in the implementation of daily health-enhancing physical activity. The aim of our study was to investigate the reliability of the test in people with rheumatoid arthritis (RA). Method: Fifteen participants performed the Fox-walk test three times with weekly intervals. The intraclass correlation coefficient (ICC), the standard error of measurement (SEM) and the smallest detectable change (SDC) were used to estimate the reliability. General health perception, lower limb pain and fatigue were measured to determine their potential influence on the reliability. Results: There were no systematic differences between the three test occasions (p = 0.190) and the reliability was almost perfect (ICC = 0.982). None of the covariates influenced the reliability. The SEM was 0.999 ml/kg/min or 3.4% and the SDC was 2.769 ml/kg/min or 9.4%. Conclusions: These findings demonstrate that the Fox-walk test is reliable in people with RA and enables differentiation between people with RA and monitoring progress. The validity of the test among people with RA is still to be determined. [ABSTRACT FROM AUTHOR]

The aim of the paper is to describe the introduction of a portfolio method of teaching and learning, and to describe students' perceptions of the method as well as a peer-review system in a course, in the physiotherapy programme, at the Karolinska Institutet. A further aim was to describe the level of grades over time. A modified form of a showcase portfolio method together with a three-graded assessment criteria was introduced into the course. Students, over five semesters, were included in the project ( n == 287) of which 91% answered questions and statements regarding their perception of the assessment method and the peer-review system. All portfolios were graded in a scale of three: fail, pass and pass with distinction. The majority of students were satisfied and reported positive learning effects with the assessment method and review system. However, the students asked for more guidance in how to give feedback. During these five semesters, the percentage of students that passed with distinction increased and the percentage of students that failed decreased. Three years after implementing the portfolio, our impression is that the method encourages students to take a more active part in learning and leads to a deeper approach to knowledge. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate postural control in women with and without premenstrual symptoms (PMS) in three hormonally verified phases of the menstrual cycle. Thirty-two women were recruited to participate in the study and 25 of these women were included in the results. Menstrual cycle phases were determined by sex hormone analyses in serum and LH detection in urine. A prospective rating of PMS was used to divide the subjects into two groups: one with PMS (cyclic) and one without (non-cyclic). For measurement of postural control, subjects stood on a force platform (AMTI®) in two-legged stance (eyes open and closed) and one-legged stance (eyes open and closed). There were no significant differences in the two-legged stance between the phases of the menstrual cycle or between groups. In one-legged stance with eyes open, there was a significant increase in postural displacement in the mid-luteal phase in the cyclic group, but no differences were detected between phases in the non-cyclic group. These findings may be related to the previously reported increased injury rate and psychomotor slowing in the luteal phase in women with PMS. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives. The aims of this study were to document adherence to and changes in health-enhancing physical activity (HEPA) levels and self-reported and assessed functioning and to explore aspects of adherence and response during the first year of an outsourced 2-year HEPA programme in people with RA. Methods. Two-hundred and twenty patients participated in this observational cohort study, which included daily physical activity, twice-weekly circuit training and biweekly support group meetings. Self-reported data included current (past week) and maintained (past 6 months) HEPA levels, sociodemographics and disease-related and psychosocial factors. Tests of aerobic capacity and muscle function were performed and anthropometric data were collected. Results. Eighty-eight per cent of the participants completed 1 year assessments. Self-reported current and maintained HEPA increased. General health perception and a number of other self-reported disease-related and psychosocial factors improved, while exercise self-efficacy declined. Aerobic capacity, timed standing and grip strength improved and waist circumference decreased. The mean number of circuit training sessions performed was 48, the mean number of days with HEPA was 189 and the mean number of support group meetings attended was 9. Better adherence to circuit training improved general health, and better adherence to group meetings improved timed standing. Exercise self-efficacy improved among those adhering more to circuit training or support group meetings. Conclusion. The outsourced HEPA programme had high retention and reasonable adherence. A number of health outcomes improved. Relationships between adherence to the programme components and response were not clear-cut and need further attention. Trial registration: ISRCTN register; http://www.controlled-trials.com. Trial registration number ISRCTN25539102.

Many female athletes perceive that symptoms related to the menstrual cycle such as dysmenorrhea, premenstrual symptoms, amenorrhea or side-effects of hormonal contraceptives negatively impact their training, performance, and general well-being. Knowledge and communication about female athletes' health is therefore important in the sport community. The aims of this study were to explore the level of knowledge and communication about menstrual cycle issues and use of hormonal contraceptives in the athletic community and to describe the kinds of medical support offered to female athletes. A total of 1086 Swedish and Norwegian athletes from 57 different sports responded to a web-based questionnaire. Of these, 58% ( n = 627) practiced team sports and 42% ( n = 459) individual sports. Twenty-six percent ( n = 278) of the athletes perceived their knowledge about female athlete health to be poor/very poor and the knowledge was most often acquired from medical staff. Fifty-three percent ( n = 572) of the athletes perceived the knowledge acquired of their coaches as poor/very poor, even though a significantly ( p < 0.001) higher proportion of athletes with a female coach (30%, n = 31) rated their coach's knowledge as very good/good, compared to athletes with a male coach (5%, n = 31). Only 11% ( n = 116) of the athletes discussed female health issues with their coach. The majority (81%, n = 842) of the athletes partly to strongly agreed that female athlete health is considered a taboo topic in the athletic community. Forty-seven percent ( n = 510) of the athletes had access to a physiotherapist, while only three percent ( n = 29) had access to a gynecologist. Low perceived knowledge, lack of communication and support demonstrate the need for a multi-professional medical team and enhanced educational efforts focused on female athlete health in the athletic community., Competing Interests: The authors declare no conflict of interest.

Background: Chronic inflammation leads to autonomic dysfunction, which may contribute to the increased risk of cardiovascular diseases (CVD) in patients with rheumatoid arthritis (RA). Exercise is known to restore autonomic nervous system (ANS) activity and particularly its parasympathetic component. A practical clinical tool to assess autonomic function, and in particular parasympathetic tone, is heart rate recovery (HRR). The aim of this substudy from the prospective PARA 2010 study was to determine changes in HRR post-maximal exercise electrocardiogram (ECG) after a 2-year physical activity program and to determine the main predictive factors associated with effects on HRR in RA. Methods: Twenty-five participants performed physiotherapist-guided aerobic and muscle-strengthening exercises for 1 year and were instructed to continue the unsupervised physical activity program autonomously in the next year. All participants were examined at baseline and at years 1 and 2 with a maximal exercise ECG on a cycle ergometer. HRR was measured at 1, 2, 3, 4, and 5 min following peak heart rate during exercise. Machine-learning algorithms with the elastic net linear regression models were performed to predict changes in HRR1 and HRR2 at 1 year and 2 years of the PARA program. Results: Mean age was 60 years, range of 41-73 years (88% women). Both HRR1 and HRR2 increased significantly from baseline to year 1 with guided physical activity and decreased significantly from year 1 to year 2 with unsupervised physical activity. Blood pressure response to exercise, low BMI, and muscular strength were the best predictors of HRR1/HRR2 increase during the first year and HRR1/HRR2 decrease during the second year of the PARA program. Conclusion: ANS activity in RA assessed by HRR was improved by guided physical activity, and machine learning allowed to identify predictors of the HRR response at the different time points. HRR could be a relevant marker of the effectiveness of physical activity recommended in patients with RA at high risk of CVD. Very inactive and/or high CVD risk RA patients may get substantial benefits from a physical activity program., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hupin, Sarajlic, Venkateshvaran, Fridén, Nordgren, Opava, Lundberg and Bäck.)

Aim: To evaluate person-centred home visits as an interprofessional learning (IPL) activity for undergraduate students during clinical placements in primary healthcare., Background: Interprofessional collaboration is known to improve patient safety, increase job satisfaction, and reduce stress among healthcare professionals. Students should already during their basic training experience interprofessional collaboration., Methods: Students from six different educational programmes and supervisors and adjunct clinical lecturers from different professions participated in the learning activity. The students read a description of the patient history before the visit together with a supervisor. During the home visit, the students were responsible for history-taking and for performing relevant examinations. Afterwards, the students made a joint care plan for the patient. Students, supervisors, and adjunct clinical lecturers discussed the outcomes in a seminar and reflected on each other's professional roles. The students and the patients answered a questionnaire about the activity, and the supervisors and the adjunct clinical lecturers were interviewed in focus groups., Findings: Thirty interprofessional home visits were conducted, involving 109 students from six different healthcare professions. The students reported that they had gained insights into how different professions could collaborate and an increased understanding of teamwork. All patients were satisfied with the visits and felt that they had been listened to. The interview analysis showed one overarching theme: 'Interprofessional home visits in primary healthcare were an appreciated and effective pedagogical learning activity with a sustainability dependent on organisational factors'., Conclusions: The students felt that participation in the activity increased their understanding of collaboration and of other professions' skills. The supervisors found the home visits to be an appreciated and effective learning activity. The results indicate that this learning activity can be used in primary healthcare settings to promote students' IPL, but organisational factors need to be considered in order to support sustainability.

Background: While physical activity has been shown to affect psychological as well as physiological stress responses, less research has explored the effects of acute stress on athletic performance. The current study hence aimed to investigate the effect of an acute psychological stress (APS) provocation on performance and plasma lactate concentration during a following 200-m swim race among elite male swimmers. Furthermore, associations between physiological stress responses (salivary cortisol and testosterone), and outcome measures (speed and lactate) were explored., Methods: Twenty-three elite male swimmers participated in an experimental counterbalanced within-group repeated measures design consisting of an APS provocation followed by a 200-m race and, on a separate day, a control race without prior stress exposure. Salivary cortisol and testosterone were collected prior to each race. Race time was recorded, and serum lactate was collected immediately following, and five min after completed race., Results: Race speed was significantly slower (1.53 [95% CI: 0.08-2.79] seconds) following the APS provocation than under control conditions. Prerace cortisol levels were positively associated with lactate response when preceding stress exposure was present (rho =0.483 immediately, and rho=0.429 five minutes post race, P<0.05). Under control conditions however, both increased testosterone (rho =-657, P=0.001) and cortisol (rho =-0.491, P=0.020) levels were associated with faster race times., Conclusions: The results indicated a negative impact of APS exposure on athletic performance. Further, potential beneficial effects on performance from physiological stress responses (as reflected by salivary cortisol and testosterone) may be diminished during performance following an APS provocation, compared with a regular non-provoked performance situation.

Context:   Our understanding of the injury burden in elite adolescent athletes in most sports is limited or unknown because of the lack of prospective, long-term injury studies., Objective:   To describe injury patterns in terms of type, location, prevalence and incidence, recurrence, and severity grade; time to first injury; and prevalence of illness in elite adolescent athletes and to compare differences in injury data by sex and sport type., Design:   Cohort study., Setting:   Fifteen national sports high schools in Sweden., Patients or Other Participants:   Participants were 284 elite adolescent athletes (boys = 147, girls = 137; median age = 17 years; 25th-75th percentile range = 16-18 years) competing at a high national level for their age in athletics (track and field), cross-country skiing, downhill skiing, freestyle skiing, handball, orienteering, or ski orienteering., Main Outcome Measure(s):   All athletes were monitored weekly over 52 weeks, using a validated online questionnaire to identify injury type, location, prevalence or incidence, and severity grade; time to first injury; and prevalence of illness., Results:   Among all athletes, 57.4% reported at least 1 new injury, whereas the 1-year injury prevalence was 91.6%. The overall injury incidence was 4.1/1000 hours of exposure to sport, and every week, on average, 3 of 10 (30.8%) elite adolescent athletes reported being injured. Of all injuries from which athletes recovered, 22.2% (n = 35) resulted in absence from normal training for at least 2 months. Female athletes reported higher ( P < .05) average weekly injury prevalence and substantial injury prevalence (injuries leading to a moderate or severe reduction in sport performance or participation or time loss) than male athletes., Conclusions:   A considerable number of elite adolescent athletes were injured weekly, resulting in serious consequences for sport participation, training, or performance (or a combination of these). Appropriately designed interventions to prevent knee and foot injuries will target both the greatest number of injuries and the injuries with the most serious consequences in elite adolescent athletes.

Objective Female adolescent athletes seem to use oral contraceptives (OCs) in the same proportion as the general population. In athletes not using OCs, menstrual irregularity (MI) is reported to be common but there are few studies of MI in adolescent athletes. The aim of the study was to survey menarche, menstrual irregularity and use of OCs in adolescent athletes in the National Sports High Schools in Sweden. A further aim was to study the associations between current sport injury and menstrual irregularity as well as use of OCs. Subjects Two hundred and ninety-eight female adolescent athletes at Swedish National Sports High Schools. Methods A web-based questionnaire containing questions related to menstrual status, contraception and current injury. Results One third (32.6%) of the athletes used OCs and of the remaining athletes 31.8% had MI. The group of athletes with MI had a significantly (p = 0.038; Cohen's d, 0.32) lower BMI and consisted of a significantly (p = 0.043) higher proportion of endurance athletes. OC users were less likely to participate in endurance sports compared to non-OC users (p = 0.024). Current injury was equally distributed in the OC and the non-OC group but athletes with MI had fewer sports injuries compared to eumenorrheic women. Conclusion OCs are frequently used among athletes at Swedish National Sports High Schools. OC users were less likely to participate in endurance sports compared to non-OC users. MI was common and athletes with MI had lower BMI compared to eumenorrheic athletes. Sports injuries were not associated with use of OC and eumenorrheic athletes had a higher proportion of current injury.

Objective: To investigate muscle strength and muscle endurance in women during 3 well-determined phases of the menstrual cycle: early follicular phase, ovulation phase, and midluteal phase., Design: Prospective, within-woman analysis was performed of muscle strength and muscle endurance by repeated measures analysis of variance in 3 hormonally verified phases of 2 consecutive menstrual cycles., Participants: Fifteen female subjects with moderate physical activity level and regular menstrual cycles volunteered to participate in the study. Analyses are based on 10 subjects who completed 2 consecutive menstrual cycles with hormonally verified phases., Main Outcome Measurements: Handgrip strength, 1-leg hop test, isokinetic muscle strength, and muscle endurance were measured in 2 consecutive menstrual cycles in the early follicular phase, in the ovulation phase, and in the midluteal phase. Isokinetic muscle strength and endurance were tested with knee extension exercise on a standard instrument. Menstrual cycle phases were determined by analysis of sex hormone levels in serum, and ovulation was detected by luteinizing hormone surge in urine., Results: No significant variation in muscle strength or muscle endurance could be detected during different well-determined phases of the menstrual cycle., Conclusions: This study detected no significant variation in muscle strength and muscle endurance during the menstrual cycle. In contrast to other studies showing variations in strength and endurance during the menstrual cycle, the present study was hormonally validated and was repeated in 2 consecutive menstrual cycles. However, it is unknown whether these data in moderately active university students would be relevant to the highly trained woman athlete.