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Purpose: To investigate differences in athletes’ knowledge, beliefs, and training practices during COVID-19 lockdowns with reference to sport classification and sex. This work extends an initial descriptive evaluation focusing on athlete classification. Methods: Athletes (12,526; 66% male; 142 countries) completed an online survey (May–July 2020) assessing knowledge, beliefs, and practices toward training. Sports were classified as team sports (45%), endurance (20%), power/technical (10%), combat (9%), aquatic (6%), recreational (4%), racquet (3%), precision (2%), parasports (1%), and others (1%). Further analysis by sex was performed. Results: During lockdown, athletes practiced body-weight-based exercises routinely (67% females and 64% males), ranging from 50% (precision) to 78% (parasports). More sport-specific technical skills were performed in combat, parasports, and precision (∼50%) than other sports (∼35%). Most athletes (range: 50% [parasports] to 75% [endurance]) performed cardiorespiratory training (trivial sex differences). Compared to prelockdown, perceived training intensity was reduced by 29% to 41%, depending on sport (largest decline: ∼38% in team sports, unaffected by sex). Some athletes (range: 7%–49%) maintained their training intensity for strength, endurance, speed, plyometric, change-of-direction, and technical training. Athletes who previously trained ≥5 sessions per week reduced their volume (range: 18%–28%) during lockdown. The proportion of athletes (81%) training ≥60 min/session reduced by 31% to 43% during lockdown. Males and females had comparable moderate levels of training knowledge (56% vs 58%) and beliefs/attitudes (54% vs 56%). Conclusions: Changes in athletes’ training practices were sport-specific, with few or no sex differences. Team-based sports were generally more susceptible to changes than individual sports. Policy makers should provide athletes with specific training arrangements and educational resources to facilitate remote and/or home-based training during lockdown-type events.

Insufficient physical activity (IPA) caused approximately 5% of mortalities in 2017 in Iran, almost double its global average. Despite the relatively considerable burden, a knowledge gap exists regarding the trend of IPA in recent years. We described the trend of IPA prevalence utilizing the data from six rounds of STEPwise approach to risk factor Surveillance (STEPS) in Iran. We estimated the physical activity status of Iranian adults from 2006 to 2016 after adjusting for years of schooling, urbanization percentage, and wealth index. We used the spatiotemporal model to interpolate and extrapolate the IPA prevalence for the years in-between the series and from 2001 to 2006, respectively. We used the data of 177,910 participants from six STEPS surveys and found that the national prevalence of IPA had steadily increased over the course of 16 years and had almost doubled in this time period (23.1% in 2001 to 55.4% in 2016). The increase was persistent across all age and gender strata and in every province. Moreover, IPA was more prevalent among women than their male peers regardless of their age category or province of residence. The prevalence of IPA in Khuzestan (highest prevalence) was almost double compared to that in Lorestan (lowest prevalence) in 2016. The IPA prevalence increased considerably and almost doubled in 16 years among Iranian adults, particularly women. Policies need to target IPA as a high priority contributing to the burden of Non-communicable diseases.

Due to concerns of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) transmission, professional football (soccer) was terminated almost everywhere in the world in early 2020. These are the results from a prospective cohort study conducted in Iran to analyze the resumption of professional football during the coronavirus disease 2019 (COVID-19) pandemic under assigned protocols and regulations. Sixteen teams consisting of 805 individuals formally agreed to follow the rules assigned by the ministry of health and CORONA headquarters in sport, and were subject to study monitoring. The resumption process was implemented over a 5-month period, beginning with a training phase followed by 14 match weeks of professional football. A self-declaration form was provided for the subjects to report any suspicious symptoms immediately and serial PCR testing was performed every 10 days using nasal swab samples. Those with positive tests were to be isolated until the symptoms were resolved or a negative test was returned. Of the 805 individuals included, 17.89% subjects were infected by the SARS-CoV‑2 virus (85 players and 59 staff members and officials). Only two matches were canceled in accordance with the regulations, and no severe cases were found. Case-tracing suggested that most transmissions occurred off the pitch. In conclusion, applying strict hygiene protocols and early case identification by performing repetitive PCR testing could benefit the resumption of professional football competitions.

Background: All sporting events were halted due to the COVID-19 pandemic, and many athletes suffered from the infection. Objectives: This study aimed to evaluate the clinical characteristics and training days lost to COVID-19 in professional football. Methods: This questionnaire-based report on COVID-19 symptoms was conducted during the 2019-20 Iranian men's premier league and second division football. Team members with positive PCR tests were enrolled in the study and were told to fill in the questionnaire after the resolution of the symptoms. The questionnaire was designed to measure the frequency, severity, and duration of COVID-19-related symptoms. Results: Out of 133 males, including 86 players and 47 team officials with a mean age of 30.81 ± 10.7 years, 63.2% reported experiencing no symptoms. The most frequent symptom was the loss of smell, while the least frequently reported symptom was gastrointestinal unrest. It was also revealed that our population missed an average of 12.89 days to return to the team training. Conclusions: Since most of the infected individuals in our population were asymptomatic proper case identification using regular PCR testing could stop the transmission of the disease more effectively. Also, more attention is required to be paid to less severe symptoms such as the loss of smell and taste. Moreover, the days lost due to COVID-19 are almost comparable to the days lost by other injuries for the players, which highlights the importance of taking proper preventive measures.

Lower extremity injuries are an ongoing concern for professional football players. This study aims to evaluate the relationship between foot posture and lower extremity injuries in professional football players.In this prospective cohort study, 420 male players of the Iran Premium football league were evaluated during the 2015-2016 season. The players were assessed for their foot types based on optical and static foot scans and foot posture index (FPI). The trained club physicians recorded all injuries during the season.The analyzed data of 244 players showed the highest rate of lower extremity injury in hamstrings, ankle, and groin, respectively. These injuries led to 46% of time loss. The probability of hamstrings injuries was higher among pronated players based on static, optic, FPI, and visual examination, 2.1, 1.8, 1.8, and 2.3, respectively. Medial Collateral Ligament (MCL) injuries were associated with subtalar joint abnormality defined by visual observation. An increased relative risk of leading-to-absence injuries among the flat foot group was significant based on optic scanning, FPI, and visual observation.Abnormal foot postures in professional football players may increase the risk of hamstring and MCL injuries and time loss due to lower extremity injuries.

Severe traumatic abdominal injuries and duodenal ruptures are relatively rare in soccer and can be easily missed and turn into a life-threatening condition. All team physicians need to be familiar with the warning sign in these situations. This report aims to report a case, discuss the diagnostic and treatment process and the return to play protocol.During a professional female soccer team training session, the injury occurred while the player's epigastrium was hit hardly by the opponent's knee. In the first evaluation, there was only mild epigastrium pain without any other sign. Eventually, pain exacerbated, nausea and vomiting were added. All the initial evaluation (Physical examination, abdominal X-ray, ultrasonography, blood tests) were normal. Eventually, she developed abdominal guarding and underwent abdominopelvic computed tomography with intravenous contrast where Duodenal rupture becomes evident. She underwent laparotomy and full duodenal repair and discharged from the hospital in good health.For the return to play determination in such injuries, the abdomen should not be imposed on any trauma for about 6 months, so while the player can start a self-training session firstly without a ball and then with a ball, she is not allowed to play or train with others for 6 months.

[Purpose] Considering the role of physical activity on public health and the high prevalence of physical inactivity worldwide, determining physical activity barriers is critical and will be a road map for future planning. This study aimed to develop a comprehensive questionnaire to determine physical activity barriers.[Methods] By reviewing previous studies, the main domains of the questionnaire were established. A physical activity expert interviewed 20 individuals aged 18 to 65 years. The results were evaluated by an expert panel for a content validity index. Face validity, test-retest reliability, and internal consistency were established on 204 individuals.[Results] The content validity index in all items was within the acceptable range (>0.85). Face validity was appropriate, and the misunderstanding index was < 20% in all items. Test-retest reliability in the final questionnaire in all items based on Cohen’s kappa was > 0.20, indicating fair agreement. Internal consistency with Cronbach’s alpha of 0.63 was within the acceptable range.[Conclusion] The study revealed that the newly designed survey is valid, accurate, and reliable. The use of this comprehensive tool by policymakers would help them properly identify the perceived barriers, and thus perform better physical activity interventions as promotional health programs.

The imposition of COVID-19 lockdown restricted the daily activities of many people, including athletes. This study investigated the training practices of athletes in the Philippines during the first COVID-19 lockdown. A total of 442 athletes answered an online survey (May-July 2020), with questions pertaining to training practices, such as training frequency and duration. Data were analyzed according to: athlete classification (world-class, international, national, state, or recreational), sport category (individual or team), and sex (male or female). During lockdown, significant reductions in training frequency (except recreational, i.e., lower pre-lockdown training) and duration were observed for all athlete classifications. Similarly, training frequency and duration decreased significantly irrespective of sport category and sex. World class athletes appeared to be less affected by lockdown (types of exercise and specific training) as compared to lower-classification athletes. Athletes grouped in accordance with sex and sport category demonstrated little to no difference in training practices during the COVID-19 lockdown. The findings of the current study highlight the challenges experienced by athletes during lockdown, which may aid policy makers in the development of guidelines related to lockdown or lockdown-like situations and establish appropriate support for affected athletes.

COVID-19 has stricken the world since the beginning of 2020. The pandemic is not controlled yet, and also the new variants of the virus are rapidly spreading. To reduce the virus's person-to-person transmission rate, health authorities and the government applied limitations to all activities (including sports activities). As a result, all football matches and team training worldwide were suspended for a limited period until a reduced infection risk was recognized. Even though training and competitions were gradually resuming worldwide, no spectators were allowed to attend any matches. After the successful experience of resuming football matches and tournaments following tight restrictions in keeping the players, staff, and organizers safe, it is time to let the spectators back in the stadiums and establish the needed guidelines. This commentary will highlight the most important aspects and issues that need to be addressed if the football federation and associations decide to let the spectators back into the stadiums, as football will lose its enthusiasm and financial turnover.

Background: Visual skills play a pivotal role in athletic performance. However, in a professional setting, visual assessment is limited to a brief examination of visual acuity by the Snellen chart. This is while visual skills in sport comprise several other components. Objectives: This study aimed to evaluate the potential relationship between visual skills and sports injuries in professional soccer players. Methods: Through a prospective cohort study between September 2017 and October 2018, professional soccer league players were recruited for a complete eye examination including visual acuity, field of vision, and color discrimination as pre-competition examination. Any possible relationship between an abnormal eye finding and sports injury during the upcoming season was investigated. Results: A total of 386 male soccer players in 4 different playing positions were recruited from 16 league teams. Myopia, visual field defects, and green/blue/red color blindness were the most common visual impairments. Overall, there was no significant relationship between abnormal visual skills and the incidence of low back and upper extremity injuries among soccer players. However, a logistic regression model showed that the odds of quadriceps injury is 1.92 times higher (P-value: 0.005) for one diopter increase in both eyes' sum of refractive error. There is also an increased risk of concussion in players who have visual field defects (P-value < 0.005). Conclusions: Visual field defects can put soccer players at a higher risk for concussion. Moreover, uncorrected refractive eye errors will increase the incidence of lower limb injuries, mostly quadriceps injuries.

Purpose of the study PCR is the current standard test for the diagnosis of SARS-CoV-2 infection. However, due to its limitations, serological testing is considered an alternative method for detecting SARS-CoV-2 exposure. In this study, we measured the level of SARS-CoV-2 IgM and IgG antibodies of male professional football players and compared the results with the standard PCR test to investigate the association between the two tests. Study design Participants were male professional football players and team officials. Nasopharyngeal swabs and peripheral blood samples were collected for the PCR and serological tests, respectively. Also, previous records of COVID-19 testing and symptoms were gathered. Those with previous positive PCR tests who tested negative for the second time were considered to be recovered patients. Results Of the 1243 subjects, 222 (17.9%) were seropositive, while 29 (2.3%) tested positive for the SARS-CoV-2 PCR test. Sixty percent of symptomatic cases with a negative PCR were found to be seropositive. The mean level of IgM was significantly higher in PCR-positive and symptomatic subjects, whereas the recovered cases showed significantly higher levels of IgG. Conclusion Our study revealed an inconsistency of results between the two tests; therefore, although application of serological assays alone seems insufficient in diagnosing COVID-19 disease, the findings are beneficial in the comprehension and the management of the disease.

According to the importance of physical activity in the child's physical and mental development and cognitive health, developing a valid, reliable, and comprehensive assessment tool for children's physical activity is mandated. The purpose of this study is the translation, cross-cultural adaptation, and validation of the Persian version of the Thailand Physical Activity Children Survey questionnaire to measure the level of physical activity in children aged between 6-9 years in Iran.This study consisted of three stages, first, the questionnaire translation into Persian language and modification of the sections according to the Iranian culture, then the evaluation of the questionnaire via a pilot study, and finally, assessing the reliability and validity of the tool. Participants of the pilot study were 250 healthy children, aged 6 to 9 years, meeting eligibility criteria, recruited through a stratified cluster sampling method from schools across Tehran.The Persian version of the questionnaire demonstrated an acceptable content validity (Content Validity Index between 0.88-1). The test-retest reliability reported the Intra-Class Correlation coefficient in the acceptable range in all sections (between 0.71-1). Cronbach's alpha was reported 0.993, which indicated excellent internal consistency.According to the acceptable validity and reliability of the Persian version of the Thailand Physical Activity Children Survey for children aged 6-9 years, it is recommended in research and surveillance studies to determine the level of physical activity of children of that age group in Iran.

Background: Considering the well-established benefits of physical activity in the health domain, the economy, and environment, physical activity programs should be considered as an important agenda in public health policymaking. Objectives: The objective of this qualitative study was to identify “Why the prevalence of physical inactivity has increased during the past decade in Iran, despite having various national physical activity documents? "using a Delphi technique. Methods: The “Delphi technique” process in this study consisted of literature review, selecting the research question, selection and recruitment of panel members, pilot study and conduction of round one (using an open question), round 2 (using a 5-point Likert scale), and round three (final ranking). Results: Statements with the highest scores in round three were recognized as the most important causes of the decreased level of physical activity based on the experts’ responses in Iran. Conclusions: The absence of executive support, coordination mechanisms, and appropriate infrastructure for conducting physical activity were the top challenges in improving the physical activity level in Iran.

Introduction : Soccer is a popular sport with a high injury rate. Lower limb injuries are accounted for 85% of injuries in professional Soccer player. It is important to identify the predisposing factors in professional Soccer players for screening players at an increased risk of injury. It is unclear whether to assume limited hip range of motion (ROM) as one of these factors this study aimed to evaluate the association between hip passive ROM and lower limb injury in Iranian professional Soccer players.Design : This prospective cohort study was conducted on 266 male professional Soccer players (with a mean age of 24.91 ± 4.38 years) playing in the Iran Soccer Premium League during the 2017-2018 and 2018-2019 season. Baseline hip joint passive ROM was evaluated in all subjects. All athletes were followed for two consecutive seasons and their lower limb injuries causing at least an absent from a competitive match was reported. The association between hip ROM and the incidence of lower limb injuries was analyzed.Results : The most common lower limb injuries were ankle and foot injuries (12.4%), groin pain (11.5%) and muscle strain (10.9%), respectively. Restricted hip internal rotation (IR) was associated with a higher incidence of groin pain, ACL injury and knee injury. A significant correlation was observed between decreased hip external rotation (ER) with muscle strain and knee injuries. The higher knee injury was also associated with reduced hip abduction. There was no association between ankle and foot injuries and hip passive ROM.Conclusions : This study showed that hip passive ROM could be used to identify Soccer players at a higher risk of lower limb injuries. Hip rotational ROM and abduction limitation were significantly associated with the incidence of several common Soccer injuries, including groin pain, muscle strain and ACL/knee injuries and precedes their development and could be used as a screening tool for professional male soccer players.

Nowadays, the Waist-Hip Ratio is considered one of the most important indices in predicting the risk of cardiovascular diseases. The usual method for calculating this index is by measuring the waist and hip circumferences with a measuring tape. However, bioelectrical impedance analysis (BIA) devices are also capable of calculating this ratio. Hence, the goal of this study was to calculate this ratio with the BIA device and to compare it with the manual method done with measuring tape. A cross-sectional study was conducted on 270 individuals attending the Sports Medicine Department of Taleghani Hospital. Height, weight, waist and hip circumference were measured, and the body mass index (BMI) and waist-hip ratio (WHR) were calculated. Using the BIA technique, the body fat percentage (BFP) and WHR were calculated. The absolute and difference percentage between the values calculated by the device and measuring tape were calculated and the determinant factors of this difference were examined. The mean absolute difference between the two methods was 0.054 and the difference percentage was 0.064. Kappa’s correlation coefficient between the two variables was 0.024, which indicates poor correlation between the findings of the two methods. Based on linear regression analysis, BFP, height, BMI, and total body water (TBW) significantly affected the difference percentage. On the contrary, age, waist circumference, hip circumference, and absolute body fat did not have such an effect. The absolute difference was 0.069 in women and 0.05 in men, which was statistically significant (p = 0.025). Taking the manual waist-hip ratio method as the gold standard, the BIA method lacks adequate accuracy. Many variables such as, gender, BFP, TBW, BMI and height affect the accuracy of this method. Hence, until this technique is modified based on the aforementioned variables, we recommend avoiding the application of this method for WHR calculation.

Background: Earthquakes are devastating natural disasters. When an earthquake occurs during a significant event, such as Asian football confederation (AFC) under-14 girls� regional championship in Nepal (2015), all catastrophic casualties should be taken into account, including mental side effects on young sensitive groups. The present paper aimed to report risk-reduction activities for posttraumatic stress disorder (PTSD) in 18 young members of the Iranian football team. Methods: Distant location of the team members persuaded the team physician to use Internet-based social applications for supportive psychotherapy during 1 year after the shock. The child report of posttraumatic symptoms (CROPS), along with the parent report of posttraumatic symptoms (PROPS), was used to collect data from players and their parents. No randomization (except for replications) was applied and no control group was recruited in this study. Results: The results showed that some of the girls had acute stress symptoms and were prone to acute stress disorder if left unattended. The average CROPS score was 20.06 (SD, 2.48) in the second week, which decreased to 1.33 (SD, 1.29) after 1 year. Similar results in the sixth and twelfth months showed that the girls could reach a stable mental status using online supportive psychotherapy. Conclusions: Despite lack of access to patients, use of supportive psychotherapy is still possible. Online meetings can help psychologists follow the stages of treatment accurately. The results of CROPS showed that it is possible to provide psychotherapy support through online discussions with patients. © 2017, Asian Journal of Sports Medicine.

The team physician has a major role in managing medical problems of a travelling adolescent team (1-3). In addition to the normal responsibilities, unexpected disasters could always be a challenge. A natural disaster can be defined as any multiple casualty incident that overwhelms the response capabilities of the available resources (4). On 25 April 2015 at 11:56 local time, a 7.8 magnitude earthquake struck Nepal (5) during AFC U-14 (The Asian football confederation, under 14 years old) girls regional football championship. Dozens of aftershocks followed, including a 6.7 magnitude earthquake on 26th April 2015 at 12:54 local time. The earthquake resulted in 8,604 casualties (6, 7). The Iranian national football team participated in AFC U-14 girls regional championship 20th-26th April 2015, and the author was the team physician of the Iranian team at the time. To my knowledge, there is just one article on role of medical directors in natural disasters occurring for travelling teams which has been published after the recent earthquake in Nepal (8). There are few articles available to discuss what a team physician will face in a national disaster during a sport event. The main focus of this topic is to make a better view of what a team will confront during an earthquake and which decisions could be more appropriate as a team physician.

Purpose Many factors such as lumbar instability and spinopelvic alignment are associated with low back pain. Our purpose was to analyze the pelvic incidence - one of spinopelvic alignment parameters- and spine instability correlations in patients with chronic low back pain. Methods Fifty-two patients suffering from chronic low back pain entered this case control study. Lateral spine radiography was taken from patients. pelvic incidence and L3, L4 and L5‘s vertebral body width were measured for all patients, and lumbar instability was evaluated in 3 different levels: L5-S1, L4-L5 and L3-L4. Results Thirty-two patients having lumbar instability formed group A and 20 patients without lumbar spine instability allocated to group B. Average age, mean weight, height, body mass index and mean vertebral width of both groups did not differ meaningfully. Pelvic incidence‘s mean amounts set to 53.9 in group B and 57.7 in group A without any significant difference; but pelvic incidence was significantly lower in patients with lumbar instability of L5-S1 origin (P=0.01). Conclusions Overall, pelvic incidence did not differ between two groups. However, separate evaluation of each level revealed lumbar instability of L5-S1 segment to be associated with lower pelvic incidence.