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Introduction: Brain health has been a growing concern across a wide range of contact sports in the last three decades. While most of the early brain health research was focused on identifying and preventing concussions, newer research has found that an accumulation of repetitive head impacts (RHI) are more predictive of long-term brain health than the number of concussions sustained. Consequently, being able to assess RHI in sports despite the lack of outward symptoms has become paramount in promoting the long-term health of athletes. The sport of rodeo has long been regarded as one of the most dangerous contact sports. While some epidemiological research has been done on injury rates in rodeo that has largely backed up its dangerous reputation, no research has been done into RHI in rodeo athletes., Methods: Head acceleration events (HAE) were measured in collegiate athletes competing in the "Roughstock" events of Bareback Riding, Saddle Bronc Riding and Bull Riding. HAE were recorded using impact monitoring mouthgaurds (iMG) and subsequently confirmed using video verification and submitted to statistical analysis., Results: Rodeo has a high rate of HAE across all the Roughstock events. The Bull Riding experiences the highest magnitude HAE based on both linear and rotational acceleration. These events are primarily the result of the head impacting either the ground or the animal during the dismount phase of the ride. Bareback riding experiences the highest quantity of lower magnitude HAE which mainly result from whiplash-like movement of the head during the ride., Conclusions: Rodeo athletes experience a high volume of HAE that often reach concerning magnitude. A surprising amount of the HAE are the result not of impacts, but of the whiplash-like movement that is experienced during the rides., (Copyright© South Dakota State Medical Association.)

Objectives: While previous investigations have demonstrated a positive correlation between previous concussion and risk of subsequent lower extremity musculoskeletal injury (LEMSKI), the effect of sport- and patient-specific factors on time to injury has not been thoroughly described. This study's main objective was to evaluate the relationship between prior concussion and time to LEMSKI among a population of collegiate student-athletes. Secondary objectives were to evaluate the relationship between playing surface, sport contact status, and biologic sex on time to LEMSKI. We hypothesized that those with previous concussions, those competing on synthetic surfaces, and those competing in collision sports would experience decreased latency to LEMSKI overall., Methods: A retrospective observational analysis of National Collegiate Athletic Association (NCAA) Division I student-athletes was conducted utilizing a mixed linear model analysis with contrasts. Inclusion criteria included participation in the Pac-12 Health Analytics Program with a documented LEMSKI between 2017 and 2020. Exclusion criteria included concurrent concussion and LEMSKI, injury resulting in serious morbidity or mortality, and incomplete medical record. Participants were classified by whether they sustained a concussion prior to LEMSKI in each athletic season., Results: Of 1179 athletes included, 1140 had no previous concussion and 37 had a previous concussion. There was no observed effect of previous concussion (F ​= ​0.038; p ​= ​0.846) on time to LEMSKI overall. Student-athletes competing on constructed surfaces sustained a subsequent LEMSKI 14.5 days sooner (SE ​= ​5.255; p ​= ​0.045), and those competing on organic surfaces sustained a subsequent LEMSKI 23.5 days sooner (SE ​= ​4.018; p ​< ​0.001) in the season than those competing on synthetic surfaces. Contact sport student-athletes sustained a subsequent LEMSKI 52.1 days sooner than collision sport student-athletes (SE ​= ​5.248; p ​< ​0.001), and limited contact sport student-athletes sustained a subsequent LEMSKI 42.29 days sooner than collision sport student-athletes (SE ​= ​4.463; p ​< ​0.001). There was no observed effect of biologic sex (F ​= ​0.602; p ​= ​0.438) on time to LEMSKI overall., Conclusion: There was no observed impact of concussion on time on LEMSKI overall in this collegiate athletic population. Contact sports were associated with decreased time to LEMSK, while synthetic surfaces were associated with increased time to LEMSKI in this population. There was no observed impact of biologic sex on time to LEMSKI., Level of Evidence: Case-control, level of evidence III., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: Esports players' training takes long periods and they sit for a long time during competitions, which increases their risk of obesity and urges them to develop inappropriate eating behaviors. In this study, we aimed to investigate the night-eating syndrome and food addiction in esports players., Methods: This cross-sectional study was conducted with 248 esports players who were members of a university's esports community. The study data were collected using an online questionnaire consisting of the descriptive information form, Night Eating Questionnaire, and Yale Food Addiction Scale., Results: The mean age of the sports players participating in the study was 22.19 ± 5.97 years. Of them, 55.6% had a normal body weight, 13.4% were obese, 54.4% played esports for 3 years or more, 13.3% experienced night eating syndrome, and 21.4% experienced food addiction. While the weekly duration of playing esports and skipping meals were associated with night eating syndrome, the weekly duration of playing esports and smoking were associated with food addiction (p < 0.05). Additionally, although there was no statistically significant difference, the risk of food addiction was 2.12 times higher in those with poor perceived sleep quality., Conclusion: We observed that night eating syndrome was very common in esports players and that these individuals were at risk in terms of food addiction. Since esports has a more sedentary structure than traditional sports, we suggest that esports players should be evaluated in terms of their unhealthy eating behaviors and risk of eating disorders., (© 2024. The Author(s).)

Objectives: Polycystic ovary syndrome (PCOS), characterized by polycystic ovaries, anovulation, and hyperandrogenism, is believed to be an evolutionary mismatch disease. Past research has examined PCOS as a uniform disease, despite variation in phenotypes across diagnostic categories, but establishing an evolutionary mismatch requires a focus on individual traits. We suggest PCOS hyperandrogenism may have been beneficial in ancestral environments because it reduced fracture risk and associated morbidity and mortality due to increased bone mineral density (BMD). We test this hypothesis by assessing fracture frequency, a proxy for BMD, in highly active females with and without PCOS hyperandrogenism., Methods: Sixty-seven reproductive-aged women were surveyed and grouped as: high intensity interval training (HIIT; a proxy for metabolic and physical stress) athletes with hyperandrogenic PCOS (31.24%), HIIT athletes without PCOS (29.85%), and nonathletes with hyperandrogenic PCOS (38.81%). Fracture occurrence was compared between the groups using independent samples Kruskal-Wallis tests for non-normally distributed data, and multiple regression analysis was used to examine anthropometrics, lifestyle and reproductive factors, PCOS status, and exercise frequency on fracture occurrence., Results: Fracture occurrence was higher in non-PCOS athletes (3.8 ± 4.3) than PCOS-athletes (1.2 ± 1.4, p = .11) and PCOS-non-athletes (1.0 ± 1.4, p < .01). PCOS-athletes and nonathletes did not differ significantly in fracture occurrence (p = .33). These results were independent of factors associated with bone health., Conclusions: These preliminary findings suggest females with PCOS-related hyperandrogenism may be less likely to experience bone fractures and provide an initial step to explaining why PCOS has persisted despite marked negative reproductive consequences in modern populations., (© 2024 Wiley Periodicals LLC.)

Background: Epidemiological research highlights the need to understand sports injuries for effective prevention. Yet, detailed knowledge about lateral ankle sprain (LAS) in soccer, especially related to indirect contact mechanisms and specific sports movements, remains scarce. This study aimed to determine the prevalence of LAS by examining injury mechanisms, focusing on indirect contact, and analyzing sports-related movements., Study Design: Prospective study., Methods: In this prospective study, 304 high-school and college soccer players (age: 19.0 ± 2.2 years, height: 168.3 ± 10.6 cm, weight: 64.2 ± 11.1 kg) were monitored for 18.5 months. Attendance and LAS incidents were recorded daily. Injury details, including movement at the time of injury, contact presence, and direction, were collected through interviews conducted on the injury day. LAS were categorized into direct contact, indirect contact, and non-contact mechanisms. Direct contact injuries were due to external forces on the lower leg or foot. Indirect contact injuries resulted from impacts on areas other than the lower leg or foot, and non-contact injuries involved no interaction with the ball or opponent. Incidence rates per 1,000 athlete exposures and 95 % confidence intervals (CIs) were calculated, along with rate ratios (RR) to assess sex differences., Results: The study recorded 59 LAS injuries. Indirect injuries were predominant, accounting for 47.5 % (n = 28) of the cases. Men experienced a higher incidence of indirect injuries, with an RR of 2.29 (95 % CI: 1.06-4.96). Outward contact was the most common (77.8 %; n = 21), while inward contact occurred in 22.2 % of the cases (n = 6)., Conclusion: High school and college soccer players primarily sustained injuries through indirect contact mechanisms, with a significant number of injuries occurring during lateral contact. Men were more prone to indirect contact injuries. Furthermore, 47.5 % of LAS incidents involved reactive movements, and injuries frequently occurred during specific sports actions, such as ball interception., Competing Interests: Declaration of competing interest The authors report no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Accurate concussion monitoring requires access to preinjury baseline data. This is particularly important in adolescent athletes who have a high risk of concussion and are prone to prolonged recovery. As Rugby Union is governed by similar laws for men and women, it is also an ideal population to rigorously examine the impact of biological sex on concussion symptoms., Aims: To evaluate self-reported concussion symptoms at baseline in adolescent rugby union players, and examine if subtype-specific symptoms are affected by concussion history and biological sex., Methods: Adolescent rugby union players aged 16-18 years were recruited during the 2022-2023 playing season. Participants completed a series of questionnaires covering post-concussion symptoms, concussion clinical profiles, anxiety, depression and fear avoidance behaviours. Independent variables of interest in analysis were biological sex and concussion history., Results: 149 participants (75% male) were included. 42% (63/149) reported at least one previous concussion (average time since concussion: 18.7 months, range 1-72). Adolescents with a concussion history reported significantly higher scores than those with no history, across two clinical profiles (ocular and sleep), concussion symptom severity, and depression, all based on medium effect sizes (SMD 0.3-0.5). Females had significantly higher scores across cognitive/fatigue, ocular and sleep clinical profiles, concussion symptoms, anxiety and depression, each with large effect sizes (SMD > 0.5)., Conclusions: Concussion history and sex are associated with higher baseline scores on specific concussion clinical profile, concussion symptom severity, and anxiety symptoms. These findings highlight the importance of considering baseline differences when interpreting post-injury clinical profile symptoms in adolescent rugby players. (Trial registration: ACTRN12622000931774)., (© 2024. The Author(s).)

Introduction: Age differences between athletes born in the same year, as well as an over-representation of older players, are known as the Relative Age Effect (RAE). Players born at the beginning of the selection year have a physical and anthropometric advantage over their younger peers. Experts keep looking for new prediction variables for talent identification., Objectives: The aim of the study is to correlate anthropometric, strength and power variables with the relative age (RA) and the level of the teams in which players played in each age category., Methods: All players ( N  = 366) from an elite soccer academy of a Spanish club volunteered to participate in the study (U23-U10)., Results: There was a significant correlation between the RA of the players and the level of the team in which they played in each age category but no correlation between trimester of birth and level of the team. We found significant correlations between the players' physical capacities, anthropometry, RA and the level of the team in which they played for the same age category, mainly from U16 to U10. U23 did not show any correlation between RA and physical or anthropometric variables., Conclusion: Coaches should be cautious of choosing players based only on anthropometric or physical attributes.

Background and Objectives: While spinal cord neurapraxia (SCN) is a documented pathology in athletes, guidance for neurosurgeons evaluating these patients is sparse. Therefore, in a cohort of adolescent athletes with SCN, we sought to (1) review their presentation and management and (2) describe outcomes and return-to-play (RTP)., Methods: A single-center, retrospective case series was conducted to examine adolescent athletes diagnosed with SCN from 2017 to 2022. SCN was defined as an episode of bilateral upper and/or lower extremity weakness/numbness after an impact during sport. Collected variables included demographics, presentation, management, outcomes, and RTP., Results: Six patients were included (mean age = 14.5 ± 2.1 years, 100.0% male). Three American football players sustained tackle injuries, 1 ice hockey and 1 basketball player fell and landed on their head/neck, and 1 weight lifter sustained an axial load of weights to his neck. Motor symptoms ranged from quadriplegia to partial weakness. Full symptom resolution was seen in 6/6 patients: in <1 day for 3 patients, 2-3 days for 2 patients, and 1-2 months for 1 patient. All 6/6 patients received computed tomography of head/cervical spine and MRI of cervical spine, half of whom received computed tomography and MRI of thoracic/lumbar spine. No patient had congenital stenosis or abnormal T2 signal on MRI. Specific RTP recommendations varied. All 6 patients/parents were contacted at a mean of 16.6 ± 2.6 months from the injury. All patients returned to play at a mean of 5.7 ± 3.3 months. All 6 patients returned to their previous sports. Across all patients, no recurrence or neurological sequelae was endorsed in the follow-up period., Conclusion: Six athletes with SCN with no imaging abnormalities and full symptom resolution were able to RTP to their previous sport without future consequence. Symptom duration may not be clinically useful in determining the feasibility of RTP. Follow-up studies are warranted in this patient cohort to standardize RTP recommendations., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Objectives: Student-athletes are unique in their undertaking of full-time academic and athletic roles. Their dual roles impose a multitude of responsibilities in their daily lives, yet little is known about the factors that may negatively impact their ability to effectively manage these responsibilities. Participants: Data from a large sample of Canadian varsity athletes (N = 1,353) were used for the present study. Methods: The association between stress and difficulties managing daily responsibilities, while simultaneously investigating the roles of sleep difficulties and sense of belonging as contributing factors was examined. Results: Findings indicated that the moderated mediation model was significant, revealing that sleep difficulties were a significant mediator in the relationship between stress and difficulties managing daily responsibilities and that sense of belonging moderated the relationship between stress and sleep difficulties. Conclusions: The results expose complex ways that student-athletes' performances (academic and athletic) can be impaired, signaling the need to develop strategic actions toward prevention and management of stress among student-athletes.

Background: There have been several published studies on the prevalence of low energy availability (LEA) risk amongst North American and European endurance athletes. Yet the prevalence and risk factors amongst rugby league players are less well understood. This study assessed the prevalence of low energy availability risk, eating disorder risk, and food security amongst players from a female National Rugby League squad in Australia., Methods: Players from one Australian professional rugby league club volunteered to participate in the study. An online questionnaire was conducted to determine the prevalence of low energy availability (Low Energy Availability in Females Questionnaire [LEAF-Q]), eating disorder risk (Eating Disorders Inventory [EDI-3]), and food security., Results: Differences between those "at risk" and "not at risk" based on their total LEAF-Q score were determined. Of the 28 players, 64% (N.=18) were at risk of LEA. Raw scores for the EDI-3 subscales, body dissatisfaction (P=0.043), bulimia (P=0.002), composite score (P=0.038), were significantly higher for those at risk and not at risk of LEA. Forty percent of players had some level of food insecurity., Conclusions: The results suggest LEA risk is similar to other populations and those at risk of LEA are more likely to have an elevated clinical risk of eating disorders. Food security is also an issue in this population and could contribute to LEA risk for some. Future research is needed amongst team sports athletes to understand interplay between eating disorder risk and food insecurity with LEA risk.

In recent decades, scholars and practitioners alike have devoted increased attention to the psychological well-being of student-athletes. However, to date, far less research has examined the role of virtues, religion, and spirituality in contributing to well-being in student-athlete populations. In this study, we attempt to address these gaps by (a) assessing the association between trait courage, an understudied virtue in the sporting realm, and mental well-being, and then (b) considering how student-athletes' attachment to God might moderate the association between trait courage and depressive symptoms. Drawing on a sample of 415 student-athletes from the USA, regression results illustrate that courage was not significantly associated with lower depressive symptoms among student-athletes. However, a secure attachment to God appeared to function as a compensatory resource for student-athletes lacking in courage. On the contrary, athletes with low trait courage but who reported greater avoidant attachment to God reported greater depressive symptoms. Taken together, a more positive relationship with God could help provide athletes with lower trait courage a way to find meaning and strength that helps them with emotion-regulation strategies to deal with the pressures within and beyond their sport. This study clearly shows that greater attention should be paid to the religious and spiritual development of student-athletes., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Dancers are susceptible to relative energy deficiency in sport (RED-S), specifically low bone mineral density (BMD). Little is known about how dancers' BMD compares to other athletic populations. The objective of this study was to examine the association between participant characteristics and total body areal BMD (aBMD) among female pre-professional dancers compared to other female athletes. Two hundred sixty-nine females (132 pre-professional dancers (17.6 (3.2) years) and 137 sport participants (22.8 (2.6) years) were included in this study. aBMD (g/cm 2 ) was estimated using dual X-ray absorptiometry. Multivariable linear regression was used to examine the association between height-adjusted z -scores of total body aBMD (aBMD-Z) and age (years), body mass index (BMI) ( z -score), supplement intake, history of stress fracture, irregular menses, MRI/bone scan, 1-year injury history, oral contraceptives, and activity (dance/sport). Total body aBMD and aBMD-Z were lower in dancers than athletes (dancers: aBMD = 1.03 g/cm 2 (95% CI: 1.01, 1.05); aBMD-Z = -0.28 (-0.43, -0.12) ( p  < 0.001); athletes: aBMD = 1.14 g/cm 2 (95% CI: 1.12, 1.16); aBMD-Z = 0.41 (0.25, 0.57) ( p  < 0.001)). aBMD-Z increased with age (β = 0.054, 95% CI: 0.017, 0.092; p  = 0.004) and BMI (β = 0.221, 95% CI: 0.006, 0.415; p  = 0.043). Activity type modified the relationship between BMI and aBMD-Z (β = 0.323, 95% CI: 0.025, 0.621; p  < 0.033) with a stronger positive association in dancers, compared to other female athletes. Dancers had lower total body aBMD and aBMD-Z than other female athletes. aBMD-Z increases with age in female pre-professional dancers and other female athletes. A stronger association exists between aBMD-Z and BMI in dancers than athletes. Future studies should consider changes in aBMD-Z during adolescence and associations with increased risk of bone injury., Competing Interests: The authors declare there are no competing interests.

Abstract: Floersch, S, Vidden, C, Askow, AT, Jones, MT, Fields, JB, and Jagim, AR. Seasonal changes in match demands and workload distribution in collegiate soccer across two seasons. J Strength Cond Res 38(8): 1440-1446, 2024-The purpose of this study was to examine seasonal changes in match demands in a collegiate women's soccer team. Forty-eight NCAA Division III women soccer athletes (age: 19.5 ± 1.2 years; height: 1.67 ± 0.05 m; body mass: 64.8 ± 7.4 kg; fat-free mass: 50.0 ± 4.5 kg; body fat %: 22.6 ± 6.0) were equipped with wearable global positioning systems with inertial sensors and heart rate (HR) monitors during matches throughout the 2019 (n = 22) and 2021 seasons (n = 26). Players were classified by position: flank player (FP; n = 28), center midfielder (CM; n = 11), and center back fielder (CB; n = 9) and as starters (S, n = 17) or reserves (R, n = 31). Variables included HR, training load, total distance, high-speed distance, distance per minute, and weighted distance. Differences in match and practice session demands were analyzed using linear mixed-effects models with season (2 levels; 2019 and 2021) as a fixed factor, with alpha set to p = 0.05. Data across all matches and training sessions were collapsed and presented as mean ± SD for descriptive purposes and then grouped by session type (i.e., match or training) and position. Athletes traveled more distance at high speeds during match play in the 2021 season compared with 2019 (mean difference, 95% confidence intervals [CI]) (200, 95% CI: 104, 304 km; p < 0.05) but had a lower training load in 2021 compared with 2019 (-50, 95% CI: -63, -36; p < 0.05) during match play. For training sessions, mean HR (4, 95% CI: 2, 5 bpm), total distance (0.5, 95% CI: 0.4, 0.7), distance per minute (5.6, 95% CI: 4.5, 6.7 m·min-1), high-speed distance (43, 95% CI: 43, 18, 67 m), high accelerations (8.6, 95% CI: 5.4, 11.8 n), and high accelerations per minute (0.1, 95% CI: 0.1, 0.1 n·min-1) were all higher in 2021 compared with 2019 (p < 0.05). As a team, several differences in measures of external workload were found between seasons in both session types (training and matches). Variations in positional demands of match play appear to fluctuate by year., (Copyright © 2024 National Strength and Conditioning Association.)

Our primary objectives in this study were to translate and provide psychometric support for the Coach Athlete Relationship Questionnaire (CART-Q) Portuguese version, assess its invariance across sex, and explore its nomological validity in relation to enjoyment. Our sample participants were 470 athletes (226 females, 244 males) aged between 16 to 39 years from various individual and team sports. We found that the translated Portuguese version of the CART-Q exhibited satisfactory test-retest reliability and can serve as a reliable tool for evaluating the core constructs of the coach-athlete relationship - closeness, commitment, and complementarity. Moreover, this instrument showed evidence of nomological validity through significant positive correlations between its underlying factors and athletes' enjoyment with their sport. The proposed model for explaining item variance was also found to be invariant between male and female respondents. We recommend further use of this instrument in research and practical applications., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The present study evaluates the effects of pre-race sleep and training characteristics among ultra-athletes and support crew, and the influence of these factors on the athlete's performance in a 217-km ultramarathon. A total of 38 ultramarathon runners and 59 support crew members were assessed. The participants answered questionnaires about chronotype, sleep quality, sleepiness, basic demographics, and pre-race training. The clinical trial registration number is RBR-7j6d23v. The results showed that athletes and support crew had a morning-type chronotype and good sleep efficiency; most had poor-quality sleep. The athletes who finished the race had a higher sleep latency than non-finishers (p < 0.001). The quality of sleep may have impacted performance because the athletes with good sleep quality trained one day more per week than those without (p < 0.001), and training frequency was highly correlated with the race time (r = -0.59). These findings are novel, expand the data about sleep, training, and performance in an ultramarathon, and innovate by addressing the support crew., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Objectives: Anemia is a common condition in long-distance runners (LDRs). Recently, not only iron deficiency (ID) but also energy deficiency has been considered as a risk factor for anemia in athletes but no evidence has yet been established. The aim of this study was to investigate the prevalence of anemia and ID and the influence of body mass index (BMI) on anemia in high-school LDRs., Methods: The participants were 406 male and 235 female elite Japanese LDRs who competed in the All-Japan High-School Ekiden Championship 2019. They submitted their anthropometric data and results of a blood test within five days after the competition. The prevalence of anemia and ID and the influence of BMI on anemia were assessed retrospectively., Results: Mean hemoglobin concentrations (Hb) were 14.8 ± 0.9 g/dl in males and 13.2 ± 0.9 g/dl in females. The prevalence of anemia (Hb < 14 g/dl in males and < 12 g/dl in females) was significantly higher in males (16.3%) than females (6.4%), but males also showed higher prevalence of non-iron deficiency anemia (NIDA) than females (11.6% and 3.0%, respectively). No significant gender difference was found in the prevalence of iron deficiency anemia (IDA) (4.7% in males and 3.4% in females). ID (serum ferritin level < 25 ng/ml) was significantly more prevalent in females (37.4%) than males (18.5%). A binary logistic regression analysis revealed that low BMI was a contributor to anemia in females (odds ratios: 0.577 (95% CI: 0.369-0.901), p  = 0.012)., Conclusion: In Japanese high-school LDRs, one in six males was anemic, but most males did not have ID. Conversely, one-third of females were diagnosed with ID. Lower BMI was identified as a risk for anemia in females, suggesting that leanness may also lead to anemia in females.

Objective: To determine the prevalence and characteristics of food insecurity among female collegiate athletes., Participants: NCAA Division I female athletes attending a public university located in East Texas in 2018., Methods: A prospective cross-sectional online survey was employed to gather quantitative and qualitative data regarding food security status. Participants were instructed to complete the 26-item questionnaire, including the six-item USFSSM., Results: Participants (N = 78) were 18-22 years of age, largely white (75%). Despite most (89.74%) receiving some form of scholarship and 80% reporting provision of some meals, 32.10% were classified as food insecure. Barriers to food intake were two-fold higher among the food insecure (88% vs 43%, p < .001); limited time (43.6%) and finances (23.1%) were the most frequently reported barriers., Conclusions: Despite university support, food insecurity exists in female collegiate athletes. Outcomes warrant screening for food insecurity, referral to support resources throughout matriculation, and tailored intervention programs.

Objectives: Sleep is a key component of athletic recovery, yet training times could influence the sleep of athletes. The aim of the current study was to compare sleep difficulties in athletes across different training time groups (early morning, daytime, late evening, early morning plus late evening) and to investigate whether training time can predict sleep difficulties., Methods: Athletes from various sports who performed at a national-level (n = 273) answered the Athlete Sleep Screening Questionnaire (ASSQ) along with several other questionnaires related to demographics, exercise training, and mental health. From the ASSQ, a Sleep Difficulty Score (SDS) was calculated. Transformed SDS (tSDS) was compared across different training time categories using multiple one-way ANOVAs. A stepwise regression was then used to predict tSDS from various sleep-related factors., Results: SDSs ranged from none (31%), mild (38%), moderate (22%), and severe (9%). However, the one-way ANOVAs revealed training earlier or later vs. training daytime shifted the tSDS in a negative direction, a trend toward increased sleep difficulty. In particular, athletes training in the late evening (>20:00 or >21:00) had a significantly higher tSDS when compared to daytime training (p = .03 and p < .01, respectively). The regression model (p < .001) explained 27% of variance in the tSDS using depression score, age, training time, and chronotype score., Conclusion: Among a heterogeneous sample of national-level athletes, 31% displayed moderate to severe SDSs regardless of their training time. However, when athletes trained outside daytime hours there was a tendency for the prevalence of sleep difficulties to increase., Competing Interests: Declaration of conflicts of interest All authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Determine the association of cumulative concussion and repetitive head impacts with self-reported sleep quality in healthy collegiate-aged athletes., Methods: Collegiate-aged athletes (N = 212; mean age 21.00, 62.7% male) completed semistructured interviews for sport and concussion history and the Pittsburgh Sleep Quality Index (PSQI). Number of concussions was retrospectively determined based on the 1993 American Congress of Rehabilitation Medicine (ACRM) criteria; repetitive head impact was measured based on the cumulative years of contact sport exposure. Associations of number of concussions and repetitive head impact exposure with global PSQI score, overall poor (PSQI >5) vs. good sleep, and binarized subscale scores were tested. Secondary analyses were conducted using alternative concussion criteria and metrics of repetitive head impact., Results: The number of prior concussions was associated with higher PSQI global scores (B(SE)= 0.50(0.13), p < .001). Participants with more concussions were more likely to be poor sleepers (OR=1.52, p < .001), report poorer sleep quality (OR=1.29, p = .037), longer sleep latency (OR=1.34, p = .005), more sleep disturbances (OR=1.56, p = .001), increased use of sleep medications or sleep aids (OR=1.35, p = .008), and more sleep-related daily dysfunction (OR=1.38, p = .002). Similar results were observed for alternative definitions of concussion. No metric of repetitive head impact was associated with any sleep quality metric., Conclusions: More prior concussions, but not repetitive head impact exposure, are associated with worse self-reported sleep, with subscale analyses showing concussion history associated with multiple aspects of subjective sleep quality rather than sleep quantity. Sleep represents an important factor to consider for future research aimed at characterizing and ultimately preventing adverse long-term health outcomes associated with concussion history., Competing Interests: Declaration of conflicts of interest Dr Meier receives compensation as a member of the Clinical and Scientific Advisory Board for Quadrant Biosciences Inc. All other authors report no disclosures., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Sports supplements (SSs) are widely used among team sport athletes; however, evidence supporting the use of SSs among football referees at the elite level is scarce. The aim of the present study was to analyze the consumption of SSs among referees with respect to their level of competition and referee type (main referees (MRs) vs. assistant referees (ARs))., Methods: A total of 106 football referees participated in this study, with 46.2% from the First Spanish Division and 53.8% from the Second Spanish Division, representing 84.13% of the total number of referees. Each participant completed a validated questionnaire about SS consumption, with the SSs classified according to the Australian Institute of Sport (AIS) ABCD system: Group A has strong evidence for enhancing athlete health and performance, Group B shows potential benefits but needs more evidence, Group C has inconclusive evidence against use, and Group D includes prohibited substances., Results: A total of 84.0% of the MRs and ARs reported the consumption of at least one SS. Differences were found only in the consumption of medical supplements between division ( p = 0.016) and type of referee ( p = 0.041), though no significant differences were found among the remaining AIS SS categories ( p > 0.05). Sport performance (49.6%), Internet (41.0%), and dietitian-nutritionists (31.7%) were the primary reason for SS consumption, purchase location, and source of information, respectively. The most frequently consumed SS were whey protein (45.3%), followed by creatine (33.0%), sport bars and sports drinks (28.3%), and caffeine (19.8%)., Conclusions: MRs and ARs reported a high prevalence of dietary supplement (SS) consumption, with significant differences between division and referee type observed only in medical supplement consumption.

Background and Objectives : Although previous reports have shown that early anterior cruciate ligament (ACL) reconstruction is associated with an increased risk of stiffness, recommendations for delayed surgery are based on outdated literature. The advent of arthroscopic surgery and accelerated rehabilitation protocols warrants a reexamination of the optimal surgical timing. The purpose of this study was to investigate complications during early ACL reconstruction after injury in young athletes. Materials and Methods : A total of 87 patients (27 males and 60 females) were included in this study. Patients who underwent anatomic ACL reconstruction using hamstring autografts were evaluated. Patients under 25 years of age with a Tegner activity score greater than 6 were included and classified into three groups according to the time from injury to surgical treatment: one week from injury to surgery (early group), three to six weeks from injury to surgery (normal group), and three to six months from injury to surgery (delayed group). We evaluated the rates of various complications such as graft rupture, contralateral injury, the need for manipulation for loss of ROM, infection, and fracture around the knee up to 2 years postoperatively. In addition, we investigated postoperative muscle strength, Lysholm score, Tegner activity score, and period of the return to sport from injury. Results: Patients in the delayed group were younger than those in the other groups ( p = 0.009). Patients in the early group had a lower range of motion than those in the other groups preoperationly. However, the 1-month postoperative range of motion was comparable between groups. Patients in the early group had greater postoperative Tegner activity scores than those in the other groups. The period of return to sport from injury in the delayed group was longer than in the other groups. There were no statistically significant differences in the postoperative complication rate, muscle strength, or Lysholm score. Conclusions : ACL reconstruction performed 1 week from injury to surgery in young athletic patients indicated the rate of complications were not significantly different among the groups. Early ACL reconstruction with no postoperative complications may be related to early return to sports and a high level of sports.

Backstroke has been thoroughly investigated in the context of sports science. However, we have no knowledge about the nationalities of the fastest age group backstroke swimmers. Therefore, the present study intended to investigate the nationalities of the fastest backstroke swimmers. For all World Masters Championships held between 1986 and 2024, the year of competition, the first and last name, the age, and the age group, and both the stroke and the distance were recorded for each swimmer. Descriptive data were presented using mean, standard deviation, maximum and minimum values, and confidence intervals. The top ten race times for each swimming distance and sex were identified for descriptive purposes. Nationalities were then grouped into six categories: the top five nationalities with the most appearances in the backstroke swimming top ten times by distance each year and one group consisting of all other nationalities. The Kruskal-Wallis test compared nationality differences, followed by Bonferroni-adjusted pairwise comparisons to identify specific distinctions. Between 1986 and 2024, most age group backstroke swimmers (39.6%) competed in the 50 m event (11,964, 6206 women, and 5,758 men), followed by the 100 m event (32.3%, n = 9764, 5157 women, and 4607 men), and the 200 m event (28.1%, n = 8483, 4511 women, and 3,972 men). Germany had the highest number of top ten female swimmers in the 50 m backstroke distance. Brazil had the highest number of top ten male swimmers in the same distance. The USA had the highest number of female and male swimmers among the top ten in the 100 m and 200 m backstroke distances. Germany and Great Britain were the only countries with swimmers in the top ten for all female backstroke distances. Brazil, the USA, Italy, and Germany were the countries that had swimmers in the top ten for all male backstroke distances. In summary, the fastest backstroke age group swimmers originated from Germany, Brazil, USA, Great Britain, and Italy, where differences between the sexes and race distances exist., (© 2024. The Author(s).)

Objective: A periodic health evaluation (PHE) is a comprehensive and multidisciplinary investigation of athlete health widely used in elite sport, but its contents and benefits can be questioned. This study aimed to determine the prevalence of conditions identified by a PHE among Paralympic and Olympic athletes over four consecutive Games cycles from Rio de Janeiro 2016 to Beijing 2022 and to assess the benefits and potential pitfalls of a comprehensive PHE programme in detecting existing injuries, illnesses and other health issues., Methods: We collected extensive health history and clinical examination data on elite athletes: medical history, ECG, blood pressure, blood samples, spirometry, musculoskeletal health, cognitive function, mental health and compliance with public health programmes., Results: The final cohort included 87 Paralympic and 367 Olympic athletes, representing 565 PHE cycles. Musculoskeletal problems and unspecified pain, infections and allergies were the most frequent health issues. High blood pressure was the most prevalent cardiovascular finding, and vitamin D deficiency the most common laboratory abnormality. Most athletes complied with the public childhood vaccination programmes, but fewer with recommended cancer screening. Follow-up of health issues was variable., Conclusion: Our PHE programme identified musculoskeletal problems, infections, allergies, elevated blood pressure and vitamin D deficiency as common health conditions. Longitudinal follow-up of health conditions identified during screening and improved compliance with public health and cancer screening programmes is needed to determine the true benefits of athlete care prompted by the PHE., Competing Interests: Competing interests: KS is the coeditor of the British Journal of Sports Medicine-Injury Prevention and Health Protection. In the period, these data were collected, the Oslo Sports Trauma Research Center has had a non-financial research partnership with FitStats Technologies (2017 to present)., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: This study aimed to conduct a detailed and comparative analysis of body composition and dietary habits in elite swimming and water polo athletes. Through the examination of these key parameters, this study seeks to compare the dietary intake of these two distinct aquatic sports disciplines., Methods: A total of 10 top-level swimmers and 13 water polo athletes participated in anthropometric and body composition assessments, as well as a detailed analysis of nutritional intake. To compare the two groups, an independent samples t -test was used, and variance homogeneity was checked using Levene's test. The effect size of the group differences was evaluated using Hedges' g., Results: Water polo athletes showed significantly greater height (189.4 ± 2.9 vs. 186.5 ± 2.0 cm, p = 0.013), body mass index (24.3 ± 1.4 vs. 22.1 ± 0.5 kg/m 2 , p < 0.001), fat-free mass (62.9 ± 1.4 vs. 61.1 ± 1.38 kg, p < 0.001), skeletal muscle mass (47.1 ± 1.3 vs. 43.9 ± 1.6 kg, p < 0.001), and overall weight (86.9 ± 6.9 vs. 76.7 ± 2.2 kg, p < 0.001) in comparison to swimmers. Swimmers consumed greater amounts of mean daily energy (60.0 ± 1.0 vs. 39.0 ± 1.0 kcal/kg, p < 0.001), carbohydrate (7.8 ± 0.3 vs. 4.4 ± 0.5 g/kg, p < 0.001), protein (1.7 ± 0.5 vs. 1.4 ± 0.5 g/kg, p < 0.001), and fat (2.4 ± 0.5 vs. 1.7 ± 0.5 g/kg, p < 0.001) compared to water polo athletes., Conclusion: Our findings highlight the need for differentiated targeted nutritional interventions to enhance athletic performance in different types of water sports. Compared to water polo athletes, swimmers consumed significantly higher amounts of calories, matching their increased calorie demand from their specific training regime. However, this is an observational study and the differential needs of energy and macronutrients in water sports should be confirmed by studies with energy expenditure measurements.

Background: In the cognitive-affective model of athlete burnout, anxiety is a key physiological response to stress that influences the development of burnout in athletes. Despite its importance, there has been little research on the relationship between competitive anxiety and athlete burnout, particularly regarding the mediating mechanisms. This study aimed to explore the relationship between competitive anxiety and athlete burnout, with a focus on the mediating role of general need satisfaction from self-determination theory., Methods: The current study employed a cross-sectional design involving 618 college athletes (354 females, mean age 20.57 years), comprising 303 participants in individual sports and 315 in team sports. These participants completed the Sport Anxiety Scale-2 (SAS-2), the Athlete Burnout Questionnaire (ABQ), and the Basic Psychological Need Satisfaction Scale in General (BPNSS-G) online. Subsequently, correlation, regression, and mediation analyses were conducted using SPSS and JASP to examine the relationships between the variables., Results: Regression results indicated that somatic anxiety (beta = 0.116, t = 2.21, p = 0.028) and concentration disruption (beta = 0.259, t = 5.35, p < 0.001) in competitive anxiety were positively correlated with athlete burnout. Worry in competitive anxiety was negatively correlated with competence (beta =-0.149, t=-2.70, p = 0.007) and autonomy (beta =-0.179, t=-3.25, p = 0.001) in needs satisfaction. Additionally, the regression results found that competence (beta =-0.178, t=-3.39, p = 0.001) and Autonomy (beta =-0.208, t=-4.17, p < 0.001) were negatively associated with athlete burnout. Mediation analyses revealed significant direct effects in the relationship between somatic anxiety (Effect = 0.116, p = 0.026) along with concentration disruption (Effect = 0.259, p < 0.001) and athlete burnout. In the indirect effect, worry (Effect = 0.071, p = 0.002) as well as concentration disruption (Effect = 0.082, p < 0.001) had significant effects in relation to athlete burnout, respectively., Conclusions: Overall, the current study found that somatic anxiety and concentration disruption in competitive anxiety are related to athlete burnout. Moreover, competence and autonomy in need satisfaction mediated the relationship between competitive anxiety (worry and concentration disruption) and athlete burnout. The findings of this study not only shed further light on the relationship between competitive anxiety and athlete burnout but also provide theoretical insights into the mediating mechanisms of this relationship., (© 2024. The Author(s).)

Background: Adult-acquired flatfoot deformity (AAFD) is characterized by partial or complete flattening of the longitudinal medial arch, which develops after maturity. AAFD secondary to posterior tibialis tendon dysfunction (PTTD) is one of professional athletes' most common foot and ankle pathologies. Different modalities and procedures can be used to establish the diagnosis of AAFD and PTTD. However, imaging measurements such as the calcaneal inclination index and ultrasonography (US) of the posterior tibialis tendon (PTT) in professional athletes with medial ankle and focal pain along the PTT have yet to be widely studied. This study investigates the correlation of PTT ultrasound for evaluating PTTD with calcaneal inclination angle (CIA) for evaluating AAFD in professional athletes with medial ankle and focal pain along the PTT. Through this study, clinicians and radiologists may benefit from considering AAFD in athletes with PTTD. Methods: 112 Indonesian professional athletes with medial ankle or foot pain and focal pain along the direction of the PTT underwent foot radiography using the CIA and ankle ultrasound to observe PTT abnormalities. Results: A negative correlation between fluid thickness surrounding the PTT and the CIA (p<0.001; 95% CI - 0.945, - 0.885), as well as a negative correlation between PTT thickness and CIA (p<0.001, 95% CI - 0.926, - 0.845), with a correlation coefficient (r) of - 0.921 and - 0.892, respectively. No significant correlation was found between PTT tear and CIA (p = 0.728; 95% CI -0.223, - 0.159; r - 0.033). Conclusion: This study showed a negative correlation between PTTD and AAFD via ultrasound and CIA in professional athletes with medial ankle and focal pain along the PTT. A better understanding of PTTD and AAFD imaging will lead to more effective management and prompt treatment., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Background and Objectives: A sustained mismatch between energy intake (EI) and exercise energy expenditure (EEE) can lead to Low Energy Availability (LEA), as well as health and performance impairments characteristic of Relative Energy Deficiency in Sport (RED-S). Research in females has identified specific LEA cut-points for the risks of developing physiological and performance disturbances. Cut-points in males have yet to be evaluated; therefore, this study examined the prevalence of LEA in highly trained male cross-country skiers. The key purpose of this study was to analyze EI, resting energy expenditure (REE), EEE, and energy availability (EA) in highly trained cross-country skiers during the preparation and competition periods. The secondary objective of our study was to evaluate the relative contribution of fats and carbohydrates to EI, REE, and EEE., Materials and Methods: EI was determined by an estimated 24 h diet recall method, REE was assessed by indirect calorimetry, and EEE was estimated from heart rate in 27 cross-country skiers., Results: EI amounted to 4050 ± 797 kcal/day on a typical training day (TD) and 5986 ± 924 kcal/day ( p < 0.001) on a typical competition day (CD). REE on TDs (2111 ± 294 kcal/day or 30 ± 6 kcal/day/kg) was higher ( p < 0.05) than on CDs (1891 ± 504 kcal/day or 27 ± 7 kcal/day/kg). The EA in the athletes was <15 kcal∙kg FFM -1 ·d -1 on TDs and <65 kcal∙kg FFM -1 ·d -1 on CDs. EI was not optimal, as indicated by low EA throughout TDs (June). This could be associated with insufficient EI along with a high amount of EEE (3690.7 ± 485.2 kcal/day). During the transition from TD to CD, an increase in the contribution of fats to EI and EEE was observed in cross-country skiers., Conclusion: The conception of LEA and REDs and their potential implication for performance is underestimated among coaches and athletes. The importance of appropriate dietary strategies is essential to ensure that enough calories are consumed to support efficient training.

Sleep inadequacy has previously been associated with increased risk of injury and reduced performance. It is unclear if sleep disorders are associated with musculoskeletal symptoms, which may be a predictor of serious injury and affect performance. The aim was therefore to assess sleep behavior in elite junior badminton players and its association to musculoskeletal symptoms. In 2018, players at the World Junior Badminton Championship completed the Athlete Sleep Behavior Questionnaire and a modified version of the World Olympic Association Musculoskeletal Health Questionnaire. Participants were categorized with poor or moderate/good sleep behavior as the independent variable. Musculoskeletal symptoms were the primary outcome and was categorized using yes/no questions. Relevant musculoskeletal symptoms were defined as pain higher than 30 mm Numeric Rating Scale pain score or more than 30 minutes of joint stiffness a day. Group comparison was performed using chi-square analysis and logistic regression for primary outcome adjusted for age, sex, ethnicity, previous injury, training load, and resting days. Of the 153 participants, 28% reported poor sleep scores. There was no difference between poor and moderate/good sleep score concerning demographic variables such as sex, age, ethnicity, previous injury, training load, and resting days. There were 27% with current musculoskeletal symptoms but with no difference in groups between poor and moderate/good sleep score (P = .376). This yielded an adjusted odds ratio of 1.23 (95% confidence intervals 0.52; 2.90). Twenty-eight percent of the participants reported poor sleep behavior. Twenty-seven percent experienced current musculoskeletal symptoms. We found no statistical differences in reported musculoskeletal symptoms when comparing athletes with poor sleep behavior to athletes with moderate/good sleep behavior., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: Acrobatics and Tumbling (A&T), an emerging National Collegiate Athletics Association (NCAA) sport, involves athletes with rigorous training backgrounds, usually extending from youth through early adulthood. This study examines the sleep health, diet quality, and lipid profile of A&T athletes clustered by their performance position., Methods: Forty-two A&T athletes, clustered as tops ( n  = 19; age = 19.6 ± 1.0 years; body mass index [BMI] = 22.3 ± 1.7 kg/m 2 ) and bases ( n  = 23; age = 19.6 ± 1.3 years; BMI = 25.7 ± 2.5 kg/m 2 ), completed preseason sleep and diet quality (Rapid Eating Assessment for Participants-Shortened [REAP-S]) surveys. Fasting blood samples were collected for lipid analysis. Body composition was assessed via dual-energy X-ray absorptiometry., Results: Most athletes (71.4%; base n  = 14, top n  = 16) reported insufficient sleep (≤7 hours) and "good" sleep quality (90.4%, n  = 38; base n  = 18, top n  = 20). Average REAP-S score was 29.24 ± 3.74. Approximately 31% ( n  = 13) displayed at least one undesirable lipid concentration according to medical guidelines for normal levels (total cholesterol [TC] < 200 mg/dL, triglycerides [TG] < 150 mg/dL, high-density lipoprotein cholesterol [HDL-C] > 40 mg/dL, low-density lipoprotein cholesterol [LDL-C] < 130 mg/dL). Approximately 20% exhibited elevated TC (top n  = 4, base n  = 4), 12.5% had elevated TG (base n  = 5), 2.5% showed low HDL-C (base n  = 1), and 10% presented elevated LDL-C (top n  = 2, base n  = 2)., Conclusions: Most athletes experienced suboptimal sleep (≤7 hours/night) and 31% displayed at least one undesirable lipid concentration (elevated TC, TG, or LDL-C or reduced HDL-C). Tailoring interventions with sports dietitians is recommended, focused on increasing monounsaturated and polyunsaturated fat intake while reducing saturated fat consumption. These interventions could mitigate cardiovascular risks, improve recovery, and possibly enhance athletic performance.

Objective: The aim of the study was to explore the prevalence of food insecurity among child and adolescent athletics practitioners and to investigate factors associated with exercise performance, dietary habits, body composition, sleep, and socioeconomic status based on food security status., Methods: This was a cross-sectional, descriptive, and exploratory study conducted in Campinas, São Paulo, Brazil, between June and July 2023. The convenience sample included children and adolescents (7-17 y old) of both sexes. We evaluated exercise performance, household food insecurity (HFI), dietary-related parameters, and other body composition, lifestyle, and social-related variables. Exercise performance was assessed using the counter movement jump (CMJ), squat jump (SJ), horizontal long jump (HLJ), 50-m sprint test (50-m ST) and throwing strength test (TST). The assessment of HFI was conducted using the food insecurity experience scale (FIES). Comparisons and associations were investigated based on food security status., Results: The total sample size was comprised of 138 children (n = 42; 30.4%) and adolescents (n = 96; 69.6%). We found an association between food security status and sex (X 2 (138,1) = 4.42; P = 0.036). SJ was higher in the food security group than in the HFI group (t (117) = 2.112; P = 0.037; ES = 0.39). Sleep- and dietary-related factors did not differ between the groups., Conclusions: In summary, the prevalence of HFI among child and adolescent athletics participants was approximately 40%. Regarding exercise performance, SJ was better in the food security group than in the HFI group. Concerning dietary-related data, the HFI group had a lower number of meals per day than the food security group, and other dietary data did not differ between the groups. Body composition and sleep-related parameters were similar between the groups., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To investigate demographics, sport type, athletic identity, and COVID-19 sport season cancelation in relation to alcohol consumption among college student athletes shortly after the pandemic emerged. Participants: College student athletes recruited from U.S. athletic departments. Methods: Survey data were collected from 5,915 college student athletes in April/May 2020. Results: Being female, Latinx, and in a relationship were associated with lower alcohol consumption. Among males, team sport participation was related to greater alcohol consumption. Among females, athletic identity was inversely related to drinking, which was moderated by sport type, such that alcohol consumption was lower as athletic identity strengthened in individual (vs. team) sport athletes. However, we did not find a relationship of COVID-19 sport season cancelation with drinking. Conclusions: Our gender-specific findings are novel and generalizable based on a large, national sample of college student athletes, and may inform strategies for alcohol consumption education among college team sport athletes.

Objective: Cross-sectional evidence has demonstrated that parallel reactance obtained by bioelectrical impedance analysis (BIA) may be an alternative to the regularly used series of measurements to predict intracellular water (ICW) in athletes. However, we are not aware of any studies that have determined the predictive role or compared the effectiveness of both series and parallel reactance for tracking ICW changes during an athletic season. The main aim of this study was to determine the predictive role and compare both series and parallel reactance (Xc) in tracking ICW during an athletic season., Research Methods and Procedures: This longitudinal study analyzed 108 athletes in the preparatory and competitive periods. Using dilution techniques, total body water (TBW) and extracellular water (ECW) were determined and ICW was calculated. Resistance (R), Xc, and impedance (Z) standardized for height were obtained through BIA spectroscopy using a frequency of 50kHz in a series array and then mathematically transformed in a parallel array., Results: Multiple regression analyses showed that only changes in parallel Xc and capacitance (CAP) (P < 0.05) were predictors of delta ICW during the sports season. In contracts, this was not the case for Xcs. Both changes in R and Z, series and parallel, predicted similarly the changes in ECW and TBW (P < 0.05) in athletes., Conclusion: Our findings highlight the potential of parallel BIA values to detect changes in body water compartments over a competitive season. These data provide preliminary evidence that changes in parallel Xc/H, and ultimately CAP, represent valid markers of alterations in cell volume during a sports season., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: This is a cross-sectional study, aimed to develop and cross-validate a fat-free mass (FFM) predictive equation using single-frequency bioelectrical impedance (BIA), considering the predicted age at peak height velocity (PHV) as a variable. Additionally, the study aims to test the FFM-BIA obtained using a previous predictive equation that used skeletal maturity as a variable., Method: The participants (n = 169 male adolescent athletes) were randomly divided into two groups: development of a new predictive equation (n = 113), and cross-validation (n = 56). The concordance test between the FFM values obtained by Koury et al. predictive equation and DXA data was determined (n = 169). Bioelectrical data was obtained using a single-frequency analyzer., Results: Among the models tested, the new predictive equation has resistance index (height2/resistance) and predictive age at PHV as variables and presented R2 = 0.918. The frequency of maturity status using skeletal maturity and PHV diagnosis was inadequate (Kappa = 0.4257; 95%CI = 0.298-0.553). Bland-Altman plots and concordance correlation coefficient showed substantial concordance between the FFM-DXA values (48.8 ± 11.2 kg) and the new predictive equation (CCC = 0.960). The results showed that the new equation performed better than the equation developed by Koury et al. (CCC = 0.901)., Conclusions: Our results show that it is feasible to predict FFM in male adolescent athletes using predictive age at PHV, with moderate concordance. The calculation of FFM using more economical and less complex variables is viable and should be further explored., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: To assess the prevalence of anabolic steroid use and the level of knowledge on anabolic steroids among the male athletes in Al Madina Al Munawara, Saudi Arabia., Methods: A cross-sectional study was conducted on male athletes randomly selected from the private athletic centers in Al Madina Al Munawara over 5 months. Data were collected from all participants using a self-administered anonymous questionnaire with 33 questions. The questionnaire covered the socio-demographic characteristics of the participants, and their knowledge, attitudes, and use of anabolic steroids., Results: Of the 150 male athletes surveyed, 121 completed the questionnaire (response rate: 80.6%). Over half were aged between 18 and 23 years (56.2%) and were single (79.3%). Thirty-two percent reported using anabolic steroids, mainly to increase muscle mass, following coaches' advice (46.1%). Key sources included the internet (30.7%), coaches (30%), and friends (27.9%), and non-healthcare professionals. The top motivations were price, coach's/physician's advice, and availability. The perceived benefits included increased muscle mass, strength, and endurance, while the perceived adverse effects included kidney/liver damage and sexual problems., Conclusion: One-third of the male athletes surveyed used anabolic steroids, influenced by accessibility and social contact, rather than healthcare guidance. This highlights the need for greater awareness of the long-term health risks, ideally through education provided by sports medicine specialists., (Copyright: © Saudi Medical Journal.)

There is a knowledge gap on how ground-level particulate pollution affects labor productivity in emerging nations due to a lack of study, especially when it comes to outdoor work settings like couriers in the express delivery industry. Combining findings from two research projects, this paper examines the socioeconomic consequences of particulate matter and ground-level particulate pollution. Special panel dataset from China's express delivery companies are used, we study how particulate pollution affects courier productivity. The instrumental variable of our analysis was built by particulate pollution data from upwind towns. Moreover, a comparable rise in particulate levels during the 30 days caused a significant 23.7% decline in worker productivity. This draws attention to a neglected area of the economic effects of particulate pollution, especially in underdeveloped countries. Our results also highlight the wider health hazards connected to outdoor activities in high-pollution locations, drawing comparisons on outdoor exercisers and particulate matter concentrations. The critical need for coordinated policy attention addressing both ground-level Particulate and particle matters in developing nations is highlighted by the increased risk of lung function impairment among outdoor exercisers owing to excessive particulate matter concentrations. The interrelated risks that air pollution poses to public health and economic productivity are clarified by this Comprehensive viewpoint., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: In 1992 the American College of Sports Medicine first described the Female Athlete Triad. The Triad is a metabolic injury involving three distinct clinical traits: low energy availability, with possible eating disorder, low bone mineral density and menstrual dysfunction (MD). Although the estimated prevalence of the Triad is low (1.2 %), single factors are common in female athletes, at all competitive levels and ages. Even though the Triad was described over two decades ago, the interrelation of the three diagnostics components is still debated: additional evidence is required to improve the multidisciplinary treatment approach for this complex condition. MD is one of the first signs of energy impairment. The present study aims at investigating MD determinants and predictors in female athletes, to allow an early diagnosis of the Triad and to implement adequate preventive strategies., Materials and Methods: An original structured questionnaire was composed to detect the presence of MD risk factors. Included participants were active female athletes within reproductive age range (15-40 years old). Anthropometric parameters and training-related factors, possibly affecting the regularity of the menstrual cycle, were investigated., Results: Respondents were 288 female athletes. Among them, 73.3 % were under 25 years of age; 6.6 % resulted underweight; 30.6 % reported to follow a meal plan/diet and 13.9 % declared to be a smoker. Lean sports were practiced by 30.6 % of responders. Body-weight congruence was detected in in 79.9 % of participants, whereas overestimation of body image was found in 16.3 % of athletes. Irregular menstrual cycle, a possible MD predictor, was present in 33.0 % of athletes, with 41.1 % practicing some lean sport (p = 0.007). Also, overestimation of body image suggested an increased risk of menstrual irregularity (p = 0.001). BMI <18.5 or BMI >30 could also act as risk factor, although significance was not fully obtained (p = 0.053). Overall, practice of lean sports and overestimation of body image appeared good determinants of increased menstrual irregularity (AOR 2.02 and 3.83, respectively)., Conclusions: Menstrual irregularity in female athletes can be considered an early predictor of MD: risk is further increased in athletes of lean sports and reporting an overestimation of self-perceived body image. Screenings and awareness programs should specifically address female athletes, because of their vulnerable-group profile. In order to define a standardized at-risk profile for Triad onset and sequelae likelihood, evaluation of menstrual regularity should especially be considered, in conjunction with the assessment of other indicators of energy availability (e.g. TEE, lean and fat mass, BMC). Testing for sport-derived stress and disordered eating attitudes is also recommended. Preventive strategy should involve the proactive engagement of sport clubs and periodic competitive sport medical assessment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Calcaneal apophysitis (Sever's disease) is an overuse condition caused by repetitive traction stress to the calcaneal apophysis. Whether Achilles tendon morphology is altered in this young patient population remains unknown. Therefore, we aimed to identify differences in Achilles tendon morphology between youth athletes diagnosed with calcaneal apophysitis and healthy controls., Methods: This retrospective chart review included 46 patients (n = 23 Sever's disease, 15F/8M, 12.4 ± 2.3 years old) and (n = 23 healthy controls, 13F/10M, 15.9 ± 1.5 years old) who sought care in a Children's Hospital Sports Medicine/Orthopedics Department between 2012 and 2022. We measured ultrasound-derived degree of tendon thickening, Achilles tendon thickness (cm), and cross-sectional area (CSA [cm 2 ]). Separate multivariate analyses of covariance (MANCOVAs) were used to compare degree of thickening, mass-normalized Achilles tendon thickness, and CSA between participant groups, covarying for age. Cohen's d effect sizes were used to assess the magnitude of mean differences and standard error (MDSE) between groups., Results: Young athletes with Sever's disease had a significantly greater degree of tendon thickening with a large effect compared with healthy controls (MDSE: 0.07 [0.01] mm P < .001, d = 1.39). Achilles tendon thickness and CSA did not statistically differ between groups; however, the magnitude of between-group differences for these measures (MDSE: 0.18 [0.05] cm, MDSE: 0.27 [0.07] cm 2 , respectively) were moderate., Conclusions: Our findings demonstrate previously unrecognized differences in Achilles tendon morphology between young athletes with clinically diagnosed Sever's disease and healthy controls. Our study supports incorporating diagnostic ultrasound as part of a comprehensive examination to ensure appropriate diagnosis and clinical management for adolescents with heel pain., (© 2024 American Institute of Ultrasound in Medicine.)

Objective: To examine the impact of the RMR ratio cutoff point selected on the categorization of prevalence/absence of low energy availability among predictive equations in high-level athletes ( n  = 241 [99 women]; 52% competed at the World Championship and Olympic Games), and whether this categorization is influenced by sex and the predictive equation used., Methods: We assessed RMR using indirect calorimetry, predicted the RMR using the equations proposed by Harris-Benedict, FAO/WHO/UNU, de Lorenzo, ten Haaf and Wejis, Wong, Jagim, Cunningham, and Freire, and computed the RMR ratio for each equation., Results: We observed that the cumulative percentage of RMR ratio values increased at a faster rate using Jagim, ten Haaf and Wejis, and Cunningham equations compared to the other equations. At the 0.90 value (the most used cutoff point in literature), the Jagim equation categorized ≥ 50% of the athletes into "low energy availability". No Sex × Equation × Sport interaction effect was observed ( F = 0.10, p = 1.0). There was a significant main effect to Sex ( F = 11.7, p < 0.001, ES = 0.05), Sport ( F = 16.4, p < 0.001, ES = 0.01), and Equation ( F = 64.1, p < 0.001, ES = 0.19). Wong and FAO/WHO/UNU equations yielded the largest errors (assessed vs. predicted RMR) in men and women, respectively., Conclusion: The selected RMR ratio cutoff point influences the prevalence/absence of low energy availability characterization in high-level athletes and suggests that certain equations could bias its assessment.

Objective: Valid performance on preseason baseline neurocognitive testing is essential for accurate comparison between preseason and post-concussion test results. Immediate Post-Concussion and Cognitive Testing (ImPACT) is commonly used to measure baseline neurocognitive function in athletes. We examined the prevalence of invalid performance on ImPACT baseline testing and identified correlates of invalid performance. Method: The sample included 66,998 adolescents (ages 14-18, M  = 15.51 years, SD = 1.22) who completed ImPACT baseline tests between 2009 and 2019. Invalid performance was determined by the embedded validity indicators (EVI). Associations between invalid performance, demographic characteristics, and health conditions were assessed using chi-square tests and odds ratios (ORs). Results: Overall, 7.2% of adolescents had baseline tests identified as invalid by one or more of the EVIs. Individual validity indicators classified between 0.5% and 3.7% tests as invalid. Higher frequencies of invalid scores were observed among youth with neurodevelopmental, academic, and medical conditions. Youth who reported having learning disabilities ( n  = 3126), receiving special education ( n  = 3563), or problems with attention-deficit/hyperactivity disorder (ADHD; n  = 5104) obtained invalid baselines at frequencies of 16.4%, 16.0%, and 11.1%, respectively. Moreover, youth who reported receiving treatment for a substance use disorder ( n  = 311) or epilepsy ( n  = 718) obtained invalid baselines at frequencies of 17.0% and 11.1%, respectively. Conclusions: The base rate of invalid performance on ImPACT's EVIs was approximately 7%, consistent with prior research. Adolescents self-reporting neurodevelopmental conditions, academic difficulties, or a history of treatment for medical conditions obtained invalid baseline tests at higher frequencies. More research is needed to better understand invalid scores in youth with pre-existing conditions.

Participation in outdoor sports increases exposure to ultraviolet radiation, necessitating mitigation through sunscreen use. This prospective study examined the effects of sport, setting (practice vs. competition), gender, age and geographic location on sunscreen use and education among youth athletes in various sports. Six hundred and twelve athletes ≤18 years old completed an online survey on sunscreen education and use during competitions and practices. Regardless of sport, reported sunscreen use was higher during practices than competition ( p  < 0.0001). Sunscreen was used most by swimmers/divers (odds ratio: OR ≥ 1.9, p  < 0.001) and least by American football players (OR ≤ 0.57, p  ≤ 0.001). Coaches mentioned sunscreen use the most in track and field (OR 1.84, p  = 0.001) and the least in American football (OR 0.67, p  = 0.03). Athletes used sunscreen more if they were female (OR ≥ 1.9 1.38, p  ≤ 0.06) and younger (age OR ≤ 0.88, p  < 0.001). In conclusion, youth athletes differ in sunscreen use by sport and setting, highlighting the need for continued photoprotective education.

A high prevalence of low energy availability (LEA) has been reported in female football players. This is of concern as problematic LEA may evolve into a syndromic pattern known as relative energy deficiency in sport (REDs). Given the difficulties in accurately assessing LEA, our study shifts emphasis to measurable indicators of REDs, serving as proxies for health detriments caused by LEA. The present cross-sectional study aimed to quantify the risk of REDs and to assess the prevalence of indicators indicative of the syndrome. 60 players (tiers 3 and 4) from three Norwegian football teams were analyzed as a single cohort but also stratified based on player position and menstrual status. The proportion of players at risk for REDs was 22%, that is, 17% with mild, 3% with moderate to high, and 2% with very high/extreme risk, respectively. The majority of the cohort (71%) presented with no primary indicators, while 20%, 7%, and 2% presented with one, two, and three primary indicators, respectively. Regarding secondary indicators, 57% had none, 33% had one, and 10% had two indicators. For associated indicators, 30% had none, 42% had one, 18% had two, 8% had three, and 2% had four indicators. Player position did not affect the prevalence of REDs indicators. Among noncontraceptive users (n = 27), secondary amenorrhea (AME) was reported by 30%. These findings indicate that health and performance teams should prioritize universal health promoting strategies rather than selective or indicative strategies. Particularly, focus on nutritional periodization to secure sufficient energy availability, mitigating the risk of problematic LEA and REDs should be addressed., (© 2024 The Author(s). European Journal of Sport Science published by Wiley‐VCH GmbH on behalf of European College of Sport Science.)

Introduction and Objectives: The association between exercise and coronary atherosclerosis still remains unclarified. We aimed to analyze the prevalence of high coronary atherosclerotic burden in veteran athletes, considering cardiovascular (CV) risk and volume of exercise., Methods: A total of 105 asymptomatic male veteran athletes (48±5.6 years old) were studied. A high coronary atherosclerotic burden was defined as one of the following characteristics in coronary computed tomography angiography: calcium score >100, >75th percentile, obstructive plaques, involving left main, three-vessels or two-vessels including proximal anterior descending artery, segment involvement score >5 or CT-adapted Leaman score ≥5. CV risk was stratified by SCORE2 and volume of exercise by metabolic equivalent task score., Results: Most athletes (n=88) were engaged in endurance sports for 17.1±9.8 years, with a median exercise volume of 66 [IQR 44-103] metabolic equivalent of tasks/hour/week. The mean Systematic Coronary Risk Evaluation 2 was 2.8±1.5%; 76.9% of athletes had a low-moderate risk and none a very high risk. High coronary atherosclerotic burden was present in 25.7% athletes. Athletes with high cardiovascular risk and high exercise volume (above the median) showed significantly high coronary atherosclerotic burden compared to those with low-moderate risk and high volume (50.0% vs. 15.6%; p=0.017). Among athletes with low to moderate risk, a high volume of exercise tended to be protective, while in those with low volume, there was similar rate of high coronary atherosclerotic burden, regardless of CV risk., Conclusions: A combination of higher volume of exercise and high cardiovascular risk revealed the worst association with coronary atherosclerosis in veteran athletes. The relationship between these variables is controversial, but integrating exercise characteristics and risk assessment into preparticipation evaluation is essential., (Copyright © 2024 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

The aim of this study was to investigate the effect of pes planus level on counter movement jump (CMJ) performance parameters in amateur female and male volleyball players. In this context, amateur volleyball players aged between 18 and 23 years actively playing in the university school volleyball team were included in the study. Pes planus levels of the participants were analyzed using the navicular drop test (NDT). My Jump Lab application was used for CMJ measurement. Within the scope of CMJ, the participants' jump height, force, relative force, power, relative power, average speed, take-off speed, impulse, and flying time were analyzed. According to the linear regression results between NDT and CMJ parameters, force in males (t = 12.93, P = .049) and average speed in females (t = -3.52, P = .017) were significantly associated with NDT. NDT was similar in men and women (P > .05). However, all CMJ parameters were highly different between genders (P < .001). In the correlation analysis between sport age and physical characteristics and CMJ parameters; height (r = .386, P = .046), weight (r = .569, P = .002), leg length (r = .389, P = .045), foot length (r =. 558, P = .005), foot width (r = .478, P = .018), force (r = .407, P = .039), impulse (r = .460, P = .018) parameters, and sport age. The results suggest that the average speed in females and force in males both significantly influenced NDT, highlighting the significance of both factors in predicting NDT scores. Moreover, all CMJ measures showed significant variations between genders, although the NDT scores did not. Furthermore, the correlation analysis demonstrated a strong correlation between a number of physical attributes and CMJ parameters, highlighting the multifaceted nature of athletic performance and indicating the possible impact of these attributes on CMJ results., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Low energy availability (LEA) causes pathophysiology of the female athlete's body affecting the bone and reproductive health and was observed to have a high prevalence in recreational female athletes previously. The aim of this study was to analyse the relationship between low energy availability in females questionnaire (LEAF-Q), bone mineral density (BMD), and postural stability in recreational athletes., Methods: Recreational female athletes ( n = 24, age: 23.71 ± 2.94, Tier I) completed LEAF-Q, postural stability measurement during quiet stance (Zebris platform FDM; GmbH) and their BMD was measured using DXA (Hologic QDR Horizon A). Non-parametric statistical tests were used to analyse the relationships between LEAF-Q, BMD, and postural stability and to compare differences between participants divided by the LEAF-Q score and its subscales., Results: Risk of LEA was observed in 50% of recreational athletes participating in this study. Up to 46% of participants perceived menstrual bleeding changes related to training and 37.50% experienced menstrual dysfunction. Body composition and body weight fluctuations were observed to affect postural stability and BMD. With the risk score for LEA, the BMD and postural stability were not negatively affected in recreational athletes. However, the high number of recreational athletes in the risk score for LEA and menstrual dysfunctions highlights the need for public health programs aimed to increase awareness of LEA and its health consequences and for open communication about the menstrual cycle. Future longitudinal studies observing LEA, BMD, menstrual function, postural stability, and their interrelationship in female athletes are needed to increase the knowledge of this topic., Competing Interests: The authors declare that they have no competing interests., (© 2024 Gimunová et al.)

Injuries represent a serious concern for football players, with a significant loss in terms of sport participation and long periods of rehabilitation. According to the 2019/20 UEFA Élite Club Injury Report, the average incidence of injuries during training is 2.8 per 1000 h of training, with an average absence from training of 20 days. In addition, injured athletes are 4 to 7 times more likely to relapse than uninjured athletes. High workloads and reduced recovery periods represent two of the most important modifiable risk factors. In this context, prevention and an adequate rehabilitation protocol are vital in managing injuries, reducing their incidence, and improving the return to competition. In recent years, technological development has provided new tools in rehabilitation, and Virtual reality (VR) has shown interesting results in treating neurologic and orthopedic pathologies. Virtual Reality (VR) technology finds application in the sports industry as a tool to examine athletes' technical movements. The primary objective is to detect the biomechanical risk factors associated with anterior cruciate ligament injury. Additionally, VR can be used to train athletes in field-specific techniques and create safe and controlled therapeutic environments for post-injury recovery. Moreover, VR offers a customizable approach to treatment based on individual player data. It can be employed for both prevention and rehabilitation, tailoring the rehabilitation and training protocols according to the athletes' specific needs.

Fatty acids (FAs) are an essential component of the erythrocyte membrane, and nutrition and physical exercise are two variables that affect their structure and function. The aim of this study was to evaluate the erythrocyte profile in a group of high-level endurance runners, as well as the changes in different FAs, throughout a sports season in relation to the training performed. A total of 21 high-level male endurance runners (23 ± 4 years; height: 1.76 ± 0.05) were evaluated at four different times throughout a sports season. The athletes had at least 5 years of previous experience and participated in national and international competitions. The determination of the different FAs was carried out by gas chromatography. The runners exhibited low concentrations of docosahexaenoic acid (DHA) and omega-3 index (IND ω-3), as well as high values of stearic acid (SA), palmitic acid (PA), and arachidonic acid (AA), compared to the values of reference throughout the study. In conclusion, training modifies the erythrocyte FA profile in high-level endurance runners, reducing the concentrations of polyunsaturated fatty acids (PUFAs) such as DHA and AA and increasing the concentrations of saturated fatty acids (SFAs) such as SA and the PA. High-level endurance runners should pay special attention to the intake of PUFAs ω-3 in their diet or consider supplementation during training periods to avoid deficiency.

This study aimed to translate, culturally adapt, and validate "The Nutrition for Sport Knowledge Questionnaire (NSKQ)" for Brazilian athletes. The NSKQ is an Australian instrument composed of 87 questions divided into six subsections (weight control, macronutrients, micronutrients, sports nutrition, supplementation, and alcohol) designed to assess the nutritional knowledge (NK) of athletes. The translation process followed the recommendations of the World Health Organization for translating and adapting instruments. Semantic validation involved a panel of specialists ( n = 21), followed by an assessment performed by a group of adult Brazilian athletes from various sports ( n = 17). The reproducibility and internal consistency of the questionnaire were evaluated via a test-retest approach in a sample of adult Brazilian athletes ( n = 29) from diverse sports, who completed the Brazilian version of the NSKQ (NSKQ-BR). Overall, the NSKQ-BR presented good internal consistency (α = 0.95) and reproducibility (intraclass correlation coefficient (ICC) = 0.85). The factors "sports nutrition" and "alcohol" showed moderate reproducibility (ICC = 0.74 (0.46-0.88) and ICC = 0.68 (0.33-0.85), respectively). Most athletes ( n = 17; 58.6%) presented a medium NK score (50-65%). The NSKQ-BR is available to evaluate the NK levels of Brazilian athletes. The NSKQ-BR presented high internal consistency and reproducibility, validating its applicability among adult athletes across diverse sports.