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Recently, we published self-reported data concerning the perceived effects of the menstrual cycle and hormonal contraceptives on the training and performance of 1086 female athletes participating in 57 sports. However, studies comparing differences between sports with large sample sizes are lacking. The aim of this ancillary study was to compare the impact of the menstrual cycle and hormonal contraceptives on training and performance between the three largest sports in the cohort, that is, football, handball, and orienteering, as well as the knowledge and support provided to the female athletes engaged in these sports. The results are from a web-based questionnaire completed by 312 football players, 243 handball players, and 93 orienteers. A total of 54% of the orienteers planned their training based on the menstrual cycle, which was a higher proportion compared to football (45%) and handball (29%) players (p < 0.05). Fewer football players believed that the menstrual cycle had an impact on their performance during training and competition compared to the two other sports. A high proportion of the athletes used hormonal contraceptives in all three sports, but a lower proportion of the orienteers (40%) used hormonal contraceptives compared to football (76%) and handball players (66%) (p < 0.05). Football and handball players received overall more support than orienteers, and the support was mostly provided by a physiotherapist and/or a strength and conditioner coach besides the main coach. These findings demonstrate that the perceived influence of the menstrual cycle and hormonal contraceptives on training and performance differs between endurance athletes in orienteering compared to team-sport athletes in football and handball., Validerad;2024;Nivå 2;2024-08-15 (hanlid);Funder: Swedish Olympic Committé;Full text license: CC BY

Background: The menstrual cycle and its impact on training and performance are of growing interest. However, evidence is lacking whether periodized exercise based on the menstrual cycle is beneficial. The primary purpose of this proposed randomized, controlled trial, the IMPACT study, is to evaluate the effect of exercise periodization during different phases of the menstrual cycle, i.e., comparing follicular phase-based and luteal phase-based training with regular training during the menstrual cycle on physical performance in well-trained women. Methods: Healthy, well-trained, eumenorrheic women between 18 and 35 years (n = 120) will be recruited and first assessed for physical performance during a run-in menstrual cycle at different cycle phases and then randomized to three different interventions: follicular phase-based training, luteal phase-based training, or regular training during three menstrual cycles. The training intervention will consist of high-intensity spinning classes followed by strength training. The menstrual cycle phases will be determined by serum hormone analysis throughout the intervention period. Assessment of aerobic performance (primary outcome) and muscle strength, body composition, and blood markers will be performed at baseline and at the end of the intervention. Discussion: With a robust methodology, this study has the potential to provide evidence of the differential effects of exercise periodization during different phases of the menstrual cycle in female athletes. Trial registration: ClinicalTrials.gov NCT05697263 . Registered on 25 January 2023, Validerad;2024;Nivå 2;2024-04-02 (signyg);Funder: The Swedish Olympic Committee; Oura Health Oy; Folksam Research Foundation;Full text license: CC-BY

Even though injuries are common in elite youth sports, rehabilitation experiences are limited explored in young athletes. This study explored rehabilitation experiences in athletes with a previous injury studying at sports high schools. Twenty-six (14/12 females/males) young elite athletes (age 15–19 years) from 11 individual/team sports were interviewed in focus groups about the rehabilitation experiences following a sports injury. Data were analysed using content analysis. The results led to four main categories identified: ‘High-quality rehabilitation’, ‘Lack of communication between healthcare and coach’, ‘Various consequences of injury’ and ‘No clear path to accessing rehabilitation’. The athletes valued that the healthcare providers had high expertise, were clear and signalled secureness and confidence. It was also important to receive help with rehabilitation as rapidly as possible. The athletes perceived that they felt responsible for providing information regarding rehabilitation progression between healthcare providers and their coach. It was also challenging not to be able to participate in training and competition while injured — causing a sense of frustration and fear of falling behind their peer athletes in terms of development and performance. The athletes described that no well-defined medical teams at the sports high schools were available— instead medical help was offered in several other ways. Based on our findings, the collaboration and communication between the healthcare providers and coaches need to be improved, addressing the rehabilitation content, progress and access to rehabilitation. Through these actions, the rehabilitation process will be more adjusted to the needs of young elite athletes.

Background/aim The injury risk is high in adolescent elite athletes. However, little is known about how the injury risk changes when young talented athletes start studying at a sports high school. The primary aim was therefore to explore the risk of injury when the athlete starts to study at a sports high school. A secondary aim was to identify risk factors for injury. Methods A total of 489 athletes (age 15–16 years) were followed for 20 weeks, including 10 weeks before and 10 weeks after the athlete had started to study at a sports high school. Substantial injury was monitored in adolescent elite athletes using the Oslo Sports Trauma Research Centre Questionnaire. Results The results showed that the mean difference (md) in injury prevalence was significantly (p=0.001) higher across the 10 weeks after school had started (md 3.6; 95% CI 1.5 to 5.8), compared with the 10 weeks before. Female athletes had significantly (p<0.001) higher injury prevalence (md 6.4%; 95% CI 3.0 to 9.8) across the 10 weeks after school had started, whereas male athletes (md 0.9%; 95% CI -1.8 to 3.6) had not (p=0.530). Three significant (p<0.05) risk factors were identified; previous injury within the past 12 months (OR 3.23), higher training volume (OR 0.97) and lower well-being (OR 0.71). Conclusions Our results provide supporting evidence for increased injury risk in female adolescent elite athletes after the athletes had started to study at a sports high school.

It is not clear whether oral contraceptive (OC) treatment affects premenstrual symptoms in women. The aim of the present study was to evaluate changes in premenstrual symptoms (PMS) in women starting to use or discontinuing the use of OCs. Twenty-four healthy women with no previous diagnosis of premenstrual dysphoric disorder were included in this study with a prospective crossover design. Nineteen women completed daily ratings of somatic and mood symptoms during two hormonally different cycles, during a normal menstrual cycle and while using OCs. The menstrual cycle phases were hormonally verified and the low-dose, monophasic OCs were used in a 21/7 regimen. The onset of OC use significantly decreased premenstrual somatic symptoms, but it did not affect mood symptoms. In the women who discontinued OC use, no significant changes in neither somatic nor mood symptoms appeared in the premenstrual phase.

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

Objectives: To compare, in a large well defined sample of individuals with RA at target for a physical activity (PA) trial, those who were finally included with those who were not. Methods: 3152 individuals answered questionnaires on socio-demographic, disease-related, and psycho-social factors and PA levels. Differences between individuals making it to the baseline assessments and those who did not were analyzed in three steps. Results: In a first step, 1932 individuals were eligible for the trial as they were interested, not physically active enough, and fluent in Swedish and not participating in any other study. They were mainly female, younger, better educated, had higher income, were more likely to live with children, and had better support for exercise and higher outcome expectations on PA than the 1208 non-eligible individuals. In a second step, the 286 individuals accepting participation were better educated, had higher income, more support for exercise, less fear-avoidance beliefs and higher outcome expectations on PA than the 1646 declining participation. In a third step, the 244 individuals assessed at baseline reported less fatigue than the 42 withdrawing before assessments. Conclusions: To our knowledge, this is the first study describing the entire selection procedure from a target sample for a PA trial to the sample assessed at baseline, in individuals with RA. Factors other than those related to the disease seem to mainly determine participation and largely resemble determinants in the general population. Socio-demographic and psycho-social factors should be recognized as important for PA in people with RA.

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

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