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Purpose Heat-and-moisture-exchanging devices (HME) are commonly used by endurance athletes during training in sub-zero environments, but their effects on performance are unknown. We investigated the influence of HME usage on running performance at − 15 °C. Methods Twenty-three healthy adults (15 male, 8 female; age 18–53 years; $$\dot{V}{\text O}_{2peak}$$ V ˙ O 2 p e a k men 56 ± 7, women 50 ± 4 mL·kg−1·min−1) performed two treadmill exercise tests with and without a mask-style HME in a randomised, crossover design. Participants performed a 30-min submaximal warm-up (SUB), followed by a 4-min maximal, self-paced running time-trial (TT). Heart rate (HR), respiratory frequency (fR), and thoracic area skin temperature (Tsk) were monitored using a chest-strap device; muscle oxygenation (SmO2) and deoxyhaemoglobin concentration ([HHb]) were derived from near-infra-red-spectroscopy sensors on m. vastus lateralis; blood lactate was measured 2 min before and after the TT. Results HME usage reduced distance covered in the TT by 1.4%, despite similar perceived exertion, HR, fR, and lactate accumulation. The magnitude of the negative effect of the HME on performance was positively associated with body mass (r2 = 0.22). SmO2 and [HHb] were 3.1% lower and 0.35 arb. unit higher, respectively, during the TT with HME, and Tsk was 0.66 °C higher during the HME TT in men. HR (+ 2.7 beats·min−1) and Tsk (+ 0.34 °C) were higher during SUB with HME. In the male participants, SmO2 was 3.8% lower and [HHb] 0.42 arb. unit higher during SUB with HME. Conclusion Our findings suggest that HME usage impairs maximal running performance and increases the physiological demands of submaximal exercise.

The Coronavirus Disease-19 (COVID-19) pandemic forced the Norwegian male premier league football season to reschedule, reducing the fixture calendar substantially. Previous research has shown that a congested match schedule can affect injury rates in professional football. Therefore, we aimed to investigate whether the Norwegian premier league teams suffered more injuries in the more match congested 2020 season than in the regular 2019-season. We invited all teams having participated in both seasons to export their injury data. Only teams that used the same medical staff to register injuries in both seasons were included, and to maximize data comparability between seasons, we applied a time-loss injury definition only. Seven of 13 teams agreed to participate and exported their injury data. Both seasons had 30 game weeks, but the 2020 season was 57 days shorter than the 2019 season. The match injury incidence did not differ significantly [incidence rate ratio 0.76 (0.48–1.20; p = 0.24) in the 2020 season compared to the 2019 season. Furthermore, we found no differences in the number of injuries, days lost to injury, matches missed to injury, or injury severity. We could not detect any differences between the two seasons, suggesting the congested match calendar combined with the safety measures in the 2020 season can be a safe alternative in future seasons. Injury characteristics in Norwegian male professional football: A comparison between a regular season and a season in the pandemic

Medical surveillance and risk mitigation protocols to reduce viral transmission have underpinned the return of elite football during the COVID-19 pandemic. This article describes the evidence-informed approach and surveillance findings from the English Football League across a 9-week period at the end of the 2019-20 season. Protocols were devised by the lead EFL Medical Advisor with specialist occupational medicine input. Isolation requirements for cases and contacts were in-line with UK Government regulations, with external contact tracing conducted by local public health authorities. Quantitative PCR testing was conducted twice weekly and within 72 hours of fixtures. 43 individuals, including 18 players returned positive tests. No positive results were returned after week 5 (round 10). Our findings support those from other leagues that with appropriate compliance, elite football can continue safely during this pandemic. We recommend that protocols and compliance should be revised as necessary according to community prevalence and changes in viral transmission dynamics.

Tendinopathy is a chronic degenerative musculoskeletal disorder that is common in both athletes and the general population. Exercise and extracorporeal shockwave therapy (ESWT) are among the most common treatments used to mediate tendon healing and regeneration. The review presents current understanding of mechanisms of action of ESWT and exercise in isolation and briefly synthesises evidence of their effectiveness for various tendinopathies. The central purpose of the review is to synthesise research findings investigating the combination of ESWT and exercise for five common tendinopathies (plantar heel pain, rotator cuff, lateral elbow, Achilles, and patellar tendinopathy) and provide recommendations on clinical applicability. Collectively, the available evidence indicates that ESWT combined with exercise in the form of eccentric training, tissue specific stretching or heavy slow resistance training are effective for specific tendinopathies and can therefore be recommended in treatment. Whilst there are at present a limited number of studies investigating combined EWST and exercise approaches, there is evidence to suggest that the combination improves outcomes in treatment of plantar heel pain, Achilles, lateral elbow, and rotator cuff tendinopathy. However, despite overall positive outcomes in patellar tendinopathy, the combined treatment has not been shown at present to offer additional benefit over eccentric exercise alone.

Movement behaviours have been found to be important correlates of health for children and may be particularly important for children with Developmental Coordination Disorder (DCD) who often experience greater mental health problems. To date, however, little research has investigated the daily movement composition of preschool children with Developmental Coordination Disorder (DCD) and/or its association with mental health. The purpose of the current study was to: 1) examine whether differences in movement compositions (i.e., sedentary time, light physical activity, moderate-to-vigorous activity) exist between typically developing (TD) preschool-age children and those at risk for DCD (rDCD); and 2) investigate associations between movement compositions and mental health indicators. This cross-sectional study used the baseline cohort data from the Coordination and Activity Tracking in CHildren (CATCH) study. A total of 589 preschool-age children (Mage = 4.94 ± 0.59 years; 57.4% boys) were included in this analysis, of which 288 were classified as rDCD. Wake time movement behaviours were measured using accelerometers and parents completed the Child Behavior Checklist to assess their child’s mental health (i.e., internalizing and externalizing problems). Compositional data analysis techniques were used. After adjusting for potential confounders, the results demonstrated similar movement compositions between TD and rDCD children. Among the full sample, findings revealed a significant association between sedentary time and externalizing problems, however, each of the other associations did not reach statistical significance. These results are consistent with emerging evidence demonstrating similar patterns of physical activity and sedentary time among TD children and those classified as rDCD during the preschool years. Although movement behaviours explained little variance in mental health during this period, future research should investigate when movement compositions diverge, and how these changes may impact the mental health of TD children and those classified as rDCD later in childhood.

Shoulder injuries are a common problem in handball. One likely cause of such injuries is excessive throwing. However, it is difficult to measure the number of player throws in large cohort studies using existing methods accurately. Therefore, the purpose of this study is to develop and validate a method for identifying overhead throws using a low-cost inertial measurement unit (IMU) worn on the wrist. In a two-stage approach, we developed a threshold-based automatic identification method for overhead throws in a laboratory study using the IMU. Subsequently, we validated the suggested thresholds in a field setting by comparing throws identified by the threshold-method to throws identified by video recordings of handball practices. The best set of threshold values resulted in a per-player median sensitivity of 100% (range: 84-100%) and a median positive predictive value (PPV) of 96% (range: 86-100%) in the development study. In the validation study, the per-player median sensitivity dropped to 78% sensitivity (range: 52-91%), while the per-player median PPV dropped to 79% (range: 47-90%). The proposed method is a promising method for automatically identifying handball throws in a cheap and feasible way.

Eating disorders (ED) are serious mental disorders, which can have serious health consequences and high mortality rates. Due to facing unique risk factors female athletes have increased susceptibility for ED. Female athletes are also at risk for subclinical conditions such as the Female Athlete Triad. There is a dearth of studies on preventing and identifying ED in female athletes and the role and responsibility of the sports coach is unclear. This study aimed to address the questions of whether female athletes are at increased risk for ED, what interventions currently show promise and what is the role of the sports coach in the intervention process. The study was based on a systematic review of relevant literature retrieved through PubMed and Sports Discus databases. Despite heterogeneity in prevalence studies, findings suggest that female athletes are at higher risk than male athletes and non-athletes and those in elite level sports or sports categorised as lean, aesthetic, endurance and weight-class are at increased risk for clinical and subclinical ED. Risk-factors unique to the sports environment such as weight pressures, competitive thinness and revealing uniforms, may lead to increased risk in female athletes. Despite a dearth of studies on interventions for ED in sport, findings suggest that primary prevention programs based on educating athletes such as ATHENA show most promise in prevention. Secondary prevention should focus on early identification using athlete-specific screening tools. Symptom checklists and pre-participation examinations can also assist coaches in early identification. Psychotherapy interventions such as CBT have had the best results for treatment. Sports coaches’ play a critical role in, early identification, referral, management and prevention of ED in female athletes. However, current findings suggest that many coaches lack knowledge about ED and require education to be able to intervene successfully in female athletes with ED. Inappropriate coaching behaviours have also been found to act as an additional risk-factor for ED. Recommendations for sports coaches in N.I. are provided to assist them in successful intervention, management and return to play of female athletes with ED.

This review highlights the importance of leadership within modern healthcare settings and provided an overview of common healthcare leadership approaches, including transactional and transformational leadership. Research has identified leader characters and specific competencies which are required by leaders in healthcare in order to achieve optimal outcomes. Although both transactional and transformational leadership approaches have their strengths and weaknesses, the evidence presented suggests a transformational leadership approach better suits the specific competencies required within a healthcare leadership context. Interventional, survey and qualitative studies have found a plethora of benefits associated with a transformational leadership approach in healthcare, including better patient outcomes and higher staff satisfaction and motivation compared to other approaches to leadership. Studies conducted with nursing and physiotherapy staff have consistently shown better outcomes with a transformational leadership approach, which is significant as they represent the second and third largest healthcare professions by numbers employed, respectively. Transformational leadership therefore appears to be the most evidence-based approach available within healthcare, at a time when evidence-based practice is considered mandatory within the NHS. Effective leadership within the NHS has never been more critical than at present, due to reduced government spending in healthcare and the increased pressures on the system during the Covid-19 pandemic. Although a transactional leadership approach in isolation has several weaknesses in modern healthcare and may be considered outdated, some of its components still possess merit and may have an additive effect if implemented alongside an overall transformational leadership approach in order to achieve optimal outcomes for patients and staff in healthcare settings.

Objectives: To conduct a systematic review and multilevel meta-analysis of the current literature as to the effects of interval training (IT) vs moderate intensity continuous training (MICT) on measures of body composition, both on a whole-body and regional level. Design: Systematic review and meta-analysis. Data sources: English-language searches of PubMed/MEDLINE, Scopus, and CINAHL conducted in accordance with PRISMA guidelines. Eligibility criteria for selecting studies: a) randomized controlled trials that directly compared IT vs MICT body composition using a validated measure in healthy children and adults; b) training was carried out a minimum of once per week for at least four weeks; c) published in a peer-reviewed English language journal or on a pre-print server. Results: The main model for fat mass effects revealed a trivial standardized point estimate with high precision for the interval estimate, with negligible heterogeneity. The main model for lean mass effects revealed a trivial standardized point estimate with high precision for the interval estimate, with negligible heterogeneity. The GRADE summary of findings suggested high certainty for both main model effects. In comparison to non-intervention control groups, the IT conditions resulted in small reductions in fat mass and trivial increases in lean mass. The MICT conditions also produced small reductions in fat mass, and trivial increases in lean mass. Analysis of regional fat loss revealed trivial between group comparative treatment effects for upper body, lower body and trunk regions with minimal differences between regions. Conclusion: Our findings provide compelling evidence that the intensity of effort during endurance exercise has minimal influence on longitudinal changes in fat mass and lean mass.

Background: The level of effort seems to play a key role in determining neuromuscular adaptations; however, less is known regarding the optimal dose-response for intra-set levels of effort on chronic resistance training (RT) adaptations. Objective: We aimed to synthesize the current literature on chronic RT adaptations in response to different intra-set velocity loss (VL) thresholds in the back squat exercise. We investigated changes in muscle strength, muscular endurance, sports-related physical performance, and muscle hypertrophy outcomes during resistance exercise to establish optimal dose-response relationships in physically active individuals.Methods: We conducted a literature search using PubMed (Medline), Web of Science™, Scopus, and Cochrane up to April 2021, with no restriction on year of publication. The inclusion criteria were based on the PICO strategy. A random-effect meta-analysis was performed to determine the standardized mean differences (SMD ± 95% confidence intervals) for different intra-set VL thresholds (low VL [< 15%], moderate VL [≥ 15% and < 30%], and high VL [≥ 30%]) in RT on maximum muscular strength, bar velocity against submaximal loads, endurance against a given load, countermovement jump height, running sprint time, and muscle hypertrophy. Results: A total of 4,031 articles were found and 11 studies met our eligibility criteria. Pooled results revealed improvements between pre- and post-training intervention in 1RM strength (SMD = 0.78; p < 0.001); bar velocity outputs (light-loads [SMD = 0.79; p < 0.001] and heavy-loads [SMD = 2.08; p < 0.001]); endurance against a given load (SMD = 1.21; p < 0.001); countermovement jump height (SMD = 0.50; p < 0.001); running sprint time (SMD = - 0.28; p = 0.001); and muscle hypertrophy (SMD = 0.31; p = 0.05), with no significant difference between VL thresholds (p > 0.05). However, low VL elicited greater within-group SMD for 1RM strength than moderate and high VL thresholds (SMD = 0.93; 0.72; and 0.75; for low, moderate, and high VL thresholds, respectively). Low and moderate VL thresholds resulted in greater within-group SMD than high VL thresholds for velocity against light loads (SMD for low VL = 0.89; moderate VL = 0.90; high VL = 0.59); countermovement jump height (SMD for low VL = 0.51; moderate VL = 0.58; high VL = 0.36); and running sprint time (SMD for low VL = -0.49; moderate VL = -0.32; high VL = -0.09). Moderate and high VL thresholds induced higher within-group SMD for muscle hypertrophy than low VL (SMD for low VL = 0.14; moderate VL = 0.40; high VL = 0.44). Conclusions: Low to moderate VL thresholds may provide more effective and efficient training stimuli for improving performance in strength-power tasks, due to the similar or even greater chronic adaptations achieved compared with high VL, despite the lower number of repetitions performed during the RT program. Conversely, moderate to high VL may provide more favorable training stimuli for inducing muscle hypertrophy. Strength coaches may apply these dose-response trends to design optimal RT stimuli based on their specific training goals. Protocol registration: The study protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020189321).

Purpose: Elite swimmers (SW) have reduced diastolic function compared to elite runners, possibly as an adaptation to the aquatic training environment. Water polo players (WP) and artistic swimmers (AS) are exposed to the same hydrostatic pressures as SW, but are subject to different training intensities, postures, and hemodynamic stressors. Our purpose was to compare resting and exercising cardiac function in elite SW, WP, and AS, to characterize the influence of training for aquatic-sport on left ventricular (LV) adaptation.Methods: Ninety athletes (SW:20M/17F; WP:21M/9F; AS:23F) at the 2019 FINA World Championships volunteered for resting and stress (3min 30% maximal isometric handgrip) echocardiographic assessment of LV global function and mechanics. Results: Male SW displayed improved resting systolic and diastolic function compared to WP; however, both groups maintained stroke volume under high-pressure handgrip stress (SW:∆-4±12%; WP:∆-1±13%, P=0.11). There were no differences between female SW and WP resting LV function, but SW demonstrated improved function over AS. During isometric handgrip, all female sport athletes maintained stroke volume (SW:∆3±16%; WP:∆-10±11%; AS:∆-2±14%, P=0.46), but WP had improved apical rotation (∆1.7±4.5°), which was reduced in AS (∆-3.1±4.5°) and maintained in SW (∆-0.5±3.8°, P=0.04). Unlike SW and WP, AS displayed a unique maintenance of early filling velocity during handgrip exercise (SW:∆-3.5±14.7cm/s; WP:∆-15.1±10.8cm/s; AS:∆1.5±15.3cm/s, P=0.02).Conclusion: Among male athletes, SW display primarily volume-based functional adaptations distinct from the mixed volume-pressure adaptations of WP; however, both groups can maintain stroke volume with increased afterload. Female SW and WP do not demonstrate sport-specific differences like males, perhaps owing to sex-differences in adaptation, but have greater volume-based adaptations than AS. Lastly, AS display unique functional adaptations, that may be driven by elevated pressures under low-volume conditions.

Objectives: The COVID-19 crisis also affected elite sport severely, as elite athletes either stopped or drastically reduced their training regimen due to the lack of competitions and the mandatory lockdown. The aim of this study was to test whether heart rate variability was a reliable index of training load, which was dramatically altered due to the mandatory lockdown that occurred as a consequence of the COVID-19. Equipment and methods: Training (volume and intensity) and heart rate variability of sixteen professional male (n=8; body mass index = 22.2±2.0) and female cyclists (n=8; body mass index = 20.3±1.1) before (4 weeks), during (7 weeks), and after (4 weeks) the mandatory lockdown in Spain were monitored. Results: Individual analyses showed that the mandatory lockdown caused reliable reductions in training volume in 13 subjects (-96 to -7 % reductions in minutes), that were followed by an increase after the lockdown in all subjects (5 to 270%). In contrast, changes in training load were not homogenous across individuals. Moreover, such changes were not matched by comparable variations in heart rate variability. A mixed model of the heart rate variability as a function of training volume and intensity revealed no significant modulation by these two variables, and subject specific effects on the slope. In this study, we did not find evidence of association between heart rate variability and training load and/or intensity as many previous reports have suggested, even if training conditions changed dramatically overnight.

During COVID-19 home confinement, athletes are likely exposed to some level of detraining (i.e. the partial or complete loss of training-induced morphological and physiological adaptations), as a consequence of insufficient and/or inappropriate training stimuli. Such changes may result in impaired performance and increased injury risk if, upon restart, an appropriate sport-specific reconditioning cannot be granted. With this editorial, we aim to recommend extreme caution in sports programming after the COVID-19 emergency

Introduction: Musculoskeletal disorders have a significant global burden, with tendinopathies of the lower limb having a high prevalence. Although the use of resistance training interventions as treatment for tendinopathies has become widespread, the reporting and description of these interventions is often poor, preventing translation to clinical practice. Specific exercise description and intervention variables must be reported in order to translate research findings into clinical practice. This scoping review aims to summarise reporting of current resistance training interventions as assessed by the Consensus on Exercise Reporting Template and Toigo and Boutellier Framework.Methods and analysis: The recommended methodological framework described by the Joanna Briggs Institute will be used to structure this review, with reporting in accordance with the PRISMA-ScR. Databases to be searched include MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), JBI Evidence Synthesis, and five trial registries. Two independent reviewers will screen studies at title/abstract and full text. Following screening, data will be extracted and charted, then presented as figures and table alongside a narrative synthesis. Dissemination: This scoping review will evaluate current resistance training exercise descriptors and program variables in lower limb tendinopathy using recommended frameworks for the first time in the literature. The results will allow dissemination of the parameters of research exercise interventions to clinical practitioners through peer-reviewed publication and social media outlets, allowing implementation in clinical practice. The review will also outline future research and exercise reporting needs within tendinopathy resistance training interventions.

Background: The “athlete’s heart” has been well characterized, and it is known that remodeling is dependent on the nature of the hemodynamic-stimuli. Aquatic-athletes are exposed to hydrostatic pressures, postural anomalies, and breath-holds that likely drive distinct cardiac adaptation; however, the aquatic-athlete’s heart has not been specifically interrogated. The aim of this investigation was to characterize and compare the sport-specific cardiac structure of elite aquatic-athletes. Methods: Ninety athletes at the 2019 FINA World Championships from swimming (SW:20M/17F), water-polo (WP:21M/9F), and artistic swimming (AS:23F) volunteered for echocardiographic assessment of cardiac structure. Results: Male SW displayed primarily eccentric volume-driven remodeling, while male WP had a greater incidence of pressure-driven concentric geometry (SW:5%, WP:25%) with elevated relative wall-thickness (RWT) (SW:0.35±0.04, WP:0.44±0.08, P

The purpose of the present systematic review and network meta-analysis is to compare the effectiveness of different treatment classes across a range of tendinopathies and outcomes to better establish a treatment hierarchy. Where sufficient data are obtained, the potential for covariates including patient demographics and condition specifics (e.g. symptom severity) to explain statistical heterogeneity will be explored.

Physical activity reduces cancer risk but the underlying mechanisms remain unclear. We meta-analysed the effects of acute exercise and exercise training on serum-stimulated cancer cell behaviours in vitro. Systematic searches of PubMed, Scopus and SPORTDiscus up to February 2021 revealed 8 studies reporting 61 effect sizes eligible for meta-analysis. Standardised mean differences (SMDs) between exercise-conditioned serum and resting serum were pooled using random-effects models. Acute exercise-conditioned serum significantly reduced cancer cell growth (SMD -1.31, 95% CI -1.77 to -0.86, p

Background: Research has established beneficial associations between 24-hour movement guideline adherence and several health outcomes in typically developing (TD) children, but these relationships are poorly understood in children with neurodevelopmental disorders (NDD). Purpose: To examine: (1) 24-hour movement guideline adherence; (2) the influence of disability severity; and (3) associations between guideline adherence and health outcomes in children with NDD and TD children. Methods: This cross-sectional study used data from the 2018-2019 cycles of the US National Survey of Children's Health. Parental/caregiver reports of movement behaviors (physical activity, screen time, and sleep), disability severity (limitations to daily activities) and health outcomes (general health status, anxiety, and depression) were provided for 8,554 children with NDD and 19,669 TD children aged 6-17 years. Results: Children with NDD had significantly lower odds of meeting each movement behavior guideline compared to TD children and these effects were most pronounced for those who experienced consistent limitations to daily activities. Meeting at least two guidelines significantly lowered the odds for anxiety and depression, and increased the odds for better general health for children with NDD. Conclusions: These findings suggest degree of disability severity has a strong influence on adherence to 24-hour movement guidelines among children with NDD. Funding: N/A., The Health & Fitness Journal of Canada, Vol. 14 No. 3 (2021): Proceedings from the 8th International Society for Physical Activity and Health Congress

A major objective of sport medicine research is to assess causes of injuries. Studying causes of subsequent injuries, including the effects of rehabilitation programs, presents unique challenges to provide appropriate guidance for treatment. In this commentary, we highlight the issue of “collider stratification bias”. Collider stratification bias is a major concern whenever we restrict populations based on variables that have multiple causes, which is common in surveillance programs studying subsequent injuries.

Background: Studies have shown reallocating screen time for healthy movement behaviours such as physical activity and sleep can provide important benefits for mental health. However, the focus on positive aspects of mental health such as wellbeing has received limited attention, particularly among adolescents. The purpose of this study was to examine the effects of reallocating physical activity, screen time, and sleep on mental wellbeing in adolescents. Methods: This study involved cross-sectional analysis of data from Wave 1 of the ADAPT study. A total of 1,118 Canadian adolescents enrolled in grade 11 classes (Mage = 15.92; 54.5% female) self-reported their movement behaviours using the International Physical Activity Questionnaire – Short Form to assess moderate-to-vigorous physical activity and daily recall questionnaires to assess recreational screen time and sleep. Participants also completed three measures of mental wellbeing: the Flourishing Scale, Rosenberg Self-Esteem Scale, and a brief Resiliency scale from the Canadian Campus Wellbeing Survey. Results: Isotemporal substitution analysis revealed replacing 60 minutes of screen time with either moderate-to-vigorous physical activity or sleep has significant benefits for mental wellbeing. Comparatively, reallocating 60 minutes between moderate-to-vigorous physical activity and sleep does not impact mental wellbeing. Discussion: Findings suggest healthy movement behaviours confer similar beneficial effects for adolescent’s mental wellbeing. Health promotion campaigns targeted towards adolescents should consider highlighting that reallocation of screen time to either sleep or moderate-to-vigorous physical activity may provide important benefits for mental wellbeing.

Introduction Low back pain is a major health issue in elite rowers. High training volume, frequent flexion movements of the lower spine and rotational movement in sweep rowing contribute to increased spinal strain and neuropathological patterns. Perturbation-based trunk stabilization training (PTT) may be effective to treat neuromuscular deficits and low back pain. Methods All boat classes (8+, 4+/-, 2-) of the male German national sweep rowing team participated in this non-randomized parallel group study. We included 26 athletes (PTT: n = 12, control group: n = 14) in our analysis. Physical and Sports therapists conducted 16 individualized PTT sessions á 30–40 minutes in 10 weeks, while the control group kept the usual routines. We collected data before and after intervention on back pain intensity and disability, maximum isometric trunk extension and flexion, jump height and postural sway of single-leg stance. Results We found less disability (5.3 points, 95% CI [0.4, 10.1], g = 0.42) for PTT compared to control. Pain intensity decreased similar in both groups (-14.4 and -15.4 points), yielding an inconclusive between-group effect (95% CI [-16.3, 14.3]). Postural sway, strength and jump height tend to have no between- and within-group effects. Conclusion Perturbation-based trunk stabilization training is possibly effective to improve the physical function of the lower back in elite rowers.

Background. Autism Spectrum Disorder (ASD) is a common neurodevelopmental condition characterised by social-communication deficits and is often accompanied by an array of symptoms, including cognitive and motor differences. Research has begun to investigate the utility of exergames (virtual exercise games) for combating some of the functionally impairing facets of ASD. However, no review to date has investigated the positive effects of exergaming for young individuals diagnosed with ASD, exclusive of their effects on fitness-related/health-related outcomes. Methods. We systematically reviewed the literature for articles published between 1990 – 2020, which aimed to examine the effectiveness of exergames for targeting some of the symptoms observed in children diagnosed with ASD, exclusive of physical fitness-related outcomes. Results. Out of 193 relevant articles, 10 met the inclusion criteria. All studies showed beneficial effects of exergaming for executive function and motor skills, however more work is needed to examine the beneficial effects of exergaming for social development in young autistic individuals. Conclusion. The present review supports the use of exergaming to improve some functions in ASD and suggests future research is needed to expand on this for the enhancement of social-communication skills.

Objective The aim of this systematic review and meta-analysis was to provide an updated analysis, including the use of more robust methods, on the effects of exercise on bone mineral density in men.Methods: Randomised Control Trials of >24 weeks and published in English up to 01/05/20 were retrieved from 3 electronic databases, cross-referencing, and expert review. The primary outcome measures were changes in FN, LS, and lower limb BMD Standardised effect sizes were calculated from each study and pooled using the inverse heterogeneity model. Results: A statistically significant benefit of exercise was observed on FN BMD (g = 0.21 [0.03, 0.40], Z = 2.23 p = 0.03), with no observed statistically significant benefit of exercise on LS BMD (g = 0.10 [-0.07, 0.26], Z = 1.15 p = 0.25). Conclusion: This analysis provided additional evidence to recommend ground- and/or joint-reaction force exercises for improving or maintaining FN, but not LS BMD. Additional well-designed RCTs are unlikely to alter this evidence, although interventions that include activities that directly load the lumbar spine are needed to ensure this is not a potential method of improving LS BMD. PROSPERO Registration number: CRD420201804

Background. Stress fractures are injuries caused by repetitive loading during activities such as running. The application of advanced analytical methods such as machine learning to data from multiple wearable sensors has allowed for predictions of biomechanical variables associated with running-related injuries like stress fractures. However, it is unclear if data from a single wearable sensor can accurately estimate variables that characterize external loading during running such as peak vertical ground reaction force (vGRF), vertical impulse, and ground contact time. Predicting these biomechanical variables with a single wearable sensor could allow researchers, clinicians, and coaches to longitudinally monitor biomechanical running-related injury risk factors without expensive force-measuring equipment.Purpose. We quantified the accuracy of applying quantile regression forest (QRF) and linear regression (LR) models to sacral-mounted accelerometer data to predict peak vGRF, vertical impulse, and ground contact time across a range of running speeds.Methods. Thirty-seven collegiate cross country runners (24 females, 13 males) ran on a force-measuring treadmill at 3.8 – 5.4 m/s while wearing an accelerometer clipped posteriorly to the waistband of their running shorts. We cross-validated QRF and LR models by training them on acceleration data, running speed, step frequency, and body mass as predictor variables. Trained models were then used to predict peak vGRF, vertical impulse, and contact time. We compared predicted values to those calculated from a force-measuring treadmill on a subset of data (n = 9) withheld during model training. We quantified prediction accuracy by calculating the root mean square error (RMSE) and mean absolute percentage error (MAPE).Results. The QRF model predicted peak vGRF with a RMSE of 0.150 body weights (BW) and MAPE ± SD of 4.27 ± 2.85%, predicted vertical impulse with a RMSE of 0.004 BW*s and MAPE of 0.80 ± 0.91%, and predicted contact time with a RMSE of 0.011 s and MAPE of 4.68 ± 3.00%. The LR model predicted peak vGRF with a RMSE of 0.139 BW and MAPE of 4.04 ± 2.57%, predicted vertical impulse with a RMSE of 0.002 BW*s and MAPE of 0.50 ± 0.42%, and predicted contact time with a RMSE of 0.008 s and MAPE of 3.50 ± 2.27%. There were no statistically significant differences between QRF and LR model prediction MAPE for peak vGRF (p = 0.549) or vertical impulse (p = 0.073), but the LR model’s MAPE for contact time was significantly lower than the QRF model’s MAPE (p = 0.0497).Conclusions. Our findings indicate that the QRF and LR models can accurately predict peak vGRF, vertical impulse, and contact time (MAPE < 5%) from a single sacral-mounted accelerometer across a range of running speeds. These findings may be beneficial for researchers, clinicians, or coaches seeking to monitor running-related injury risk factors without force-measuring equipment.

Recent work has demonstrated the collective impact of daily movement behaviours on mental health outcomes, however, positive aspects of mental health have received much less attention. The purpose of this study was to identify unique adolescent movement behaviour profiles and determine whether profile membership is associated with differences in mental wellbeing. This study used data from the baseline assessment of the ADAPT study. A total of 1166 Canadian adolescents enrolled in grade 11 classes (Mage = 15.91 ± 0.48; 54% female) self-reported their movement behaviours – moderate-to-vigorous physical activity (MVPA), recreational screen time (ST) and sleep – and completed three measures of mental wellbeing: flourishing, self-esteem and resiliency. Latent profile analysis with distal outcomes comparisons were conducted. Four distinct profiles were identified: one healthy profile (high MVPA/low ST), two mixed behavioural profiles (low MVPA/low ST and high MVPA/high ST), and one profile considered to be the least healthy (low MVPA and high ST). Sleep patterns were similar across the profiles. The healthiest profile was consistently associated with better mental wellbeing, followed by the mixed behaviour profiles, and the least healthy profile had the poorest scores for mental wellbeing. These findings highlight the additive benefits of engaging in a full complement of healthy movement behaviours. Moving forward, behavioural interventionists should consider adopting an integrated approach to promoting mental wellbeing through targeting each of the movement behaviours concurrently.

The objective of the present study was to estimate whether physical activity (i.e., step counts) on one day was associated with both sleep quality (i.e., sleep efficiency) and quantity (i.e., total sleep time) the following night and to examine to what extent sleep on one night was associated with physical activity the next day. We collected data continuously with a Fitbit Charge 3 among 33 young adults with overweight and obesity participating to a weight management program. A total of 7094 days and nights were analyzed (215 days on average per participants). Person-specific models (i.e., participants were not pooled together) were conducted to test the bi-directional associations for each participant separately. Results from linear regressions and Generalized Additive Models (GAMs) were compared to account for potential non-linearities in associations. Results suggest an absence of association between steps and sleep efficiency in the two directions for most participants [i.e., these associations were not significant for 31 (94%) and 32 (97%) of the participants]. More heterogeneous results were observed for the association between steps and total sleep time, with 19 participants (58%) showing a negative association between total sleep time and next day steps, and 9 (27%) showing a negative association between steps and next day total sleep time (results of the linear regressions). Taken together, these results suggest a potential conflicting association between total sleep time and physical activity in the daily lives of young adults with overweight and obesity.

Introduction: The issue of integrating transgender athletes into sport is becoming more prominent with the rising numbers of those identifying as transgender in society. Whether it is fair for transgender athletes to be included in their affirmed gender category across all levels of sport from grassroots to elite is the crux of the debate. Previous studies have shown muscle mass loss in transwomen and muscle mass and strength gain in transmen after 1 year of gender-affirming treatment (GAT). Wiik et al., 2020 found that transmen retain a strength disadvantage over cisgender men and transwomen retain muscle mass and strength advantages over cisgender women after 1 year of GAT. Roberts et al., 2020 also found that running performance in transwomen was maintained but not baseline muscular strength. However, very little data on sports performance measures outside muscular strength and running times exist, nor has any of the previous data been compared with a comparative control group. Aim: To investigate the effect of “muscle memory” in transgender athletes and investigate changes in physiology after 2 years of GAT such as bone mineral density, lean muscle mass, and fat mass, coupled with sports performance measures in transwomen and transmen athletes and compare them with a cisgender female athletic cohort. This will elucidate what advantages/disadvantages transgender athletes gain/retain after 2 years of GAT over their cisgender counterparts and this will better inform policymakers who control their integration into their affirmed gender category in sport.

Public health guidelines for resistance training emphasize a minimal effective dose intending for individuals to engage in these behaviors long-term. However, few studies have adequately examined the longitudinal time-course of strength adaptations to resistance training. The aim of this study was to examine the time-course of strength development from minimal dose resistance training in a large sample through retrospective training records from a private international exercise company. Data was available for analysis from 14,690 participants (60% female; aged 48±11 years) having undergone minimal dose resistance training (1x/week, single sets to momentary failure of six exercises) up to 352 weeks (~6.8 years) in length. Linear-log growth models examined strength development over time allowing random intercepts and slopes by participant. All models demonstrated a robust linear-log relationship with the first derivatives (i.e., changes in strength with time) trending asymptotically such that by ~1-2 years strength had practically reached a ‘plateau’. Sex, bodyweight, and age had minimal interaction effects. However, substantial strength gains were apparent; approximately ~30-50% gains over the first year reaching ~50-60% of baseline 6 years later. It is unclear if the ‘plateau’ can be overcome through alternative approaches, or whether over the long-term strength gains differ. Considering this, our results support public health recommendations for minimal dose resistance training for strength adaptations in adults.

Context: Motor pathways include upper motor-neurons from the cerebrum and brainstem and lower motor-neurons from the spinal cord. Together, these physiological components are effectors of knee neuromuscular control. Because multiple components are involved, each with an output that is asynchronous to the others, ‘whole-system’ output is characterized by irregular temporal behavior and signal fluctuations. The irregular temporal behavior of physiological signals is analyzed using ‘complexity’. Complexity-based measures reflect the ability to adapt motor output rapidly and accurately in response to external perturbations and provide physiological information missed by magnitude-based (variability) measures.Objective: To characterize side-to-side symmetry of knee neuromuscular control (sub-maximal isometric knee extension constant-force task) using variability (coefficient of variation [CV%]) and complexity (approximate entropy [ApEn], detrended fluctuation analysis [DFA α]) measures.Design: Cross-sectional.Setting: Laboratory.Patients or Other Participants: Sixteen (male/female n=11/5; age 24.0±5.3yr; height 1.74±0.08m; body-mass 68.3±11.1kg).Main Outcome Measure(s): Right/left and dominant/nondominant group-level (t-test) and individual-level (absolute-asymmetry [%]) comparisons. A limb-symmetry-index was calculated for each variable and clinically-significant absolute-asymmetry defined (>15%). Clinically-significant absolute-asymmetry prevalence (%) was computed for each variable.Results: The only significant side-to-side difference was for right/left DFA α (P=.000). Maximum absolute-asymmetries were (right/left, dominant/nondominant): CV 18.2%, 18.0%; ApEn 34.5%, 32.3%; DFA α 4.9%, 5.0%. Clinically-significant absolute-asymmetry prevalence was (right/left, dominant/nondominant): CV 43.8%, 43.8%; ApEn 62.5%, 50.0%; DFA α 0.0%, 0.0%.Conclusions: Different side-to-side comparison methods yield different findings. Large proportions of participants demonstrated wide ranges of side-to-side absolute-asymmetries. The finding of a significant difference for the right/left DFA α comparison but not for the right/left ApEn comparison suggests that different complexity variables assess different aspects of complexity. Consideration for how side-to-side comparisons are performed (right/left, dominant/nondominant) is required. Approximate entropy and DFA α assess different aspects of complexity and both should be used alongside other traditional magnitude-based measures when studying knee neuromuscular control.

A recent editorial in the British Journal of Sports Medicine (BJSM) suggested instrumental var-iable (IV) analysis has advantages in estimating causal effects when there is low compliance. We originally submitted a version of this commentary to BJSM as an editorial (they do not have a letter to editor section) but it was rejected without review. The original BJSM editorial included several important errors, presented results that are inconsistent with the results of an IV analysis, and omitted definitions and important limitations. All of these factors contrib-uted to inappropriate interpretations. This commentary highlights the most important er-rors. We also believe the BJSM editorial serves as another reminder that appropriate statisti-cians should be included from the beginning of the study wherever possible. At the very least, they should be the co-authors responsible for calculating results and ensuring the write-up is consistent with the results.

Objectives: The primary purpose of this systematic review is to examine the literature on resistance training interventions for lower limb tendinopathy to evaluate the proportion of interventions that implemented key resistance training principles (specificity, progression, overload, individualisation) and reported relevant prescription components (frequency, intensity, sets, repetitions) and reported intervention adherence. Design: Two reviewers performed a qualitative systematic review after screening titles and abstracts based on eligibility criteria. Identified papers were obtained in full text, with data extracted regarding the implementation of resistance training principles. Included articles were evaluated by the Cochrane risk of bias tool, with a scoring tool out of 10 used for implementation and reporting of the 5 key principles. Scientific databases were searched in November 2020 and included Medline, CINAHL, AMED, and Sportsdiscus.Results: 52 randomised controlled trials investigating resistance training in five different lower limb tendinopathies were included. Although most studies considered the principles of progression (92%) and individualisation (88%), only 19 studies (37%) appropriately described how this progression in resistance was achieved, and only 18 studies (35%) reported specific instruction on how individualisation was applied. Adherence was considered in 27 studies (52%), with only 17 studies (33%) reporting the levels of adherence. In the scoring criteria, only 5 studies (10%) achieved a total maximum score of 10, with 17 studies (33%) achieving a maximum score of 8 for implementing and reporting the principles of specificity, overload, progression and individualisation.Conclusion: There is meaningful variability and methodological concerns regarding the application and reporting of resistance training principles, particularly progression and individualisation, along with intervention adherence throughout studies. Collectively, these findings have important implications for the prescription of current resistance training interventions, including the design and implementation of future interventions for populations with lower limb tendinopathies.

Background: The use of gamification to change behaviors and promote physical activity is a promising avenue to tackle the global physical inactivity pandemic and the current prevalence of chronic diseases. However, we do not have yet evidence of the effectiveness of gamified interventions with the existence of mixed results in the literature.Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of gamified interventions and their healthcare potential by testing the scalability and sustainability of their influence on physical activity (PA) and sedentary behaviors (SB).Methods:Five electronic databases (Pubmed, EMBASE, Scopus, Web of Science and CENTRAL) were searched for randomized controlled trials (RCTs) published since 2010. Eligibility criteria were based on components of PICO (participants, interventions, comparators, and outcomes). Studies were included when they used gamified interventions in daily life with an active or inactive control group, and when they assessed a PA or SB outcome. Studies were excluded when the intervention was based on an active video game using a gaming console. We conducted meta-analyses using a random effects model approach. Sensitivity analyses, influence analyses and publication bias analyses were performed to examine the robustness of our results.Results: The main meta-analysis performed on 16 studies and 2407 participants, revealed a small to medium summary effect of gamified interventions on PA behavior (g = 0.42 (95%CI [0.14, 0.69]). No statistical difference was found between different subgroups (adults vs adolescents, healthy participants vs adults with chronic diseases) and no interaction effects with moderators like age, gender or BMI, suggesting good scalability of gamified interventions. Moreover, the effect appears better on the step count (MD = +1609.56 steps per day (95%CI [372.39, 2846.73]) than on moderate-to-vigorous PA (g = 0.31 (95%CI [-0.19, 0.80]). The long-term effect (measured with follow-up averaging 14 weeks after the end of the intervention) is more volatile with a very small to small effect (g = 0.15, [0.07, 0.23]).Conclusions: This meta-analysis confirms that gamified interventions are promising to promote PA in various publics. However, if the effect persists after the end of the program, suggesting that it is not just a novelty effect due to the playful nature of gamification, it seems volatile with a small long-term effect. The integration of gamification in more global healthcare interventions could be a way to address this low sustainability. Future rigorous trials are needed to explore these perspectives.

In the last decades, numerous interventions strategies (IS) have been set up in school/community or clinical sectors using physical activity (PA) in order to prevent youth obesity. Those two sectors have shown interesting elements in terms of efficient results and best practices mechanisms but they have been rarely compared to learn one from the other. The aims of the systematic review was to analyze and synthesize PA IS from school/community or clinical domains, for the period 2013-2017, in French or English, targeting youth 5-19 years old through primary, secondary and tertiary prevention. In total, 68 full articles were kept for data extraction and synthesis and 617 were excluded because didn’t meet eligibility criteria. Results identified a number of differences between the studies of the various IS sectors and identified a third type of IS: mixed sectors. They should be privileged because it can add at a time school/community-based and clinical-based strength. Mixed IS showed the most promising results. This review also showed differences between sectors and their IS on intervention team, prevention objective, duration, material and efficiency. Future studies should focus on establishing a prevention program in a given geographical area involving all stakeholders with their respective skills/knowledge, in decision making and in the development of the IS, that it be the most efficient and best adapted to its environment.

Background: Plantar heel pain (PHP) is a common musculoskeletal disorder, with both extracorporeal shockwave therapy (ESWT) and specific exercise such as plantar fascia specific stretching shown to be effective treatments. This review aimed to evaluate the effectiveness of combined ESWT and exercise interventions versus other interventions in treating PHP. Methods: A systematic review of effectiveness was conducted, adhering to the PRISMA guidelines. Five databases were searched for studies published between January 2000 and March 2020, with 12 studies meeting the inclusion criteria. The Grading of Recommendations Assessment Development and Evaluation (GRADE) framework was used to determine quality of recommendations. Results: The 12 included studies (n = 861) compared ESWT and stretching with various other treatments. Due to clinical and methodological heterogeneity, pooling of data was not possible, and a narrative synthesis of findings was provided. There was high quality evidence that combined ESWT and stretching interventions are more effective than those using either alone or botulinum toxin injections, and low-quality evidence of superiority versus ultrasound and stretching. There was moderate quality evidence that combined ESWT and stretching is no more effective than corticosteroid injection (CSI), and high quality evidence that the combination is no more effective than blood-derived injection therapies, custom orthotics or low-level laser therapy (LLLT) combined with stretching. There is high quality evidence that the use of topical corticosteroid or laser therapy in combination with ESWT and stretching increases effectiveness compared to ESWT and stretching alone, and moderate quality evidence for the additive effective of dry needling. Conclusions: Combined ESWT and stretching treatments are effective and may be recommended where they are available and practical to implement. Further high-quality studies with larger sample sizes and longer follow-up durations comparing combined interventions for PHP, including different exercise types such as resistance training are required.

Background: Plantar heel pain (PHP) is considered a tendinopathy and it affects up to 10% of the population. Both heavy slow resistance training (HSRT) and extracorporeal shockwave therapy (ESWT) have shown effectiveness for treating PHP in isolation. However more comprehensive exercise protocols and progression methods are needed due to poor long-term outcomes, and better standardization of ESWT protocols are required. Autoregulation of resistance training involves self-selecting exercise dosage based on individual factors. Although autoregulation has proven effective for strength gains in athletes, it has not been investigated in tendinopathy. It is recommended that PHP not be treated by one treatment in isolation, with there being a need to investigate feasibility and effectiveness of combined treatments in PHP. Currently, no studies have investigated autoregulated HSRT combined with ESWT, despite their individual efficacy. The optimal treatment protocol for PHP is unknown, and there is a need to ascertain whether the addition of ESWT to autoregulated HSRT leads to better outcomes compared to either alone. Methods: A three-arm randomised controlled trial (RCT) comparing these groups would be the ideal way to investigate this question, with a pilot RCT testing trial procedures and process evaluation required prior to a definitive RCT. Patients expectations, feasibility and acceptability of combined ESWT and exercise for PHP also remain unknown. Therefore, the addition of qualitative interviews in a mixed methods pilot RCT would help ascertain acceptability and help explain the intervention outcomes.

Background: Musculoskeletal disorders such as tendinopathy are having an increasing burden on society and health systems. Plantar heel pain (PHP) is considered a tendinopathy and it affects up to 10% of the population, having a high incidence in running athletes. Although resistance training has shown short-term effectiveness for treating PHP, more comprehensive exercise protocols and progression methods are needed due to poor long-term outcomes. Combining heavy slow resistance training with other types of exercise, such as plyometric exercise could lead to superior outcomes. It is recommended that PHP not be treated by one exercise type in isolation. However, studies often use only one type of exercise, with there being a need to investigate feasibility and effectiveness of comprehensive exercise programs in PHP. Resistance training programs in PHP are currently not achieving required intensity and dosage, leading to high recurrence rates. Therefore, better methods for progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress at their own rate, taking individual factors into account. Despite being found effective in increasing strength in healthy athletes, autoregulation methods have not been investigated in tendinopathy. Methods: A feasibility cohort study investigating a comprehensive exercise program for PHP could test feasibility and acceptability, prior to conducting a larger-scale study. A feasibility study would also help to determine if specific autoregulation progression methods for resistance training is feasible and acceptable for use with PHP patients. Patients expectations, and views on feasibility and acceptability of different types of exercise as well as autoregulation progression methods for PHP are unknown. Therefore, the addition of qualitative interviews in a mixed methods format would help ascertain acceptability of these methods and exercise interventions for the first time and help explain the intervention outcomes, allowing for design of a larger-scale study to determine effectiveness.

Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.

Review Objective: To synthesize the best available evidence on the effectiveness of interventions that have used autoregulated and individualised resistance training versus pre-determined and standardised resistance training in treating any tendinopathy. Introduction: Recent evidence suggests that individualised exercise may be more effective than standardised exercise for musculoskeletal disorders such as tendinopathy. However, no systematic reviews have been conducted on the topic and optimal treatment protocols and clinical recommendations are lacking.Inclusion criteria: Randomised controlled trials assessing the effectiveness of autoregulated and individualised resistance training versus pre-determined and standardised resistance training for tendinopathy in adults will be included. Methods: The authors will search for a wide range of sources to find both published and unpublished studies via EBSCOhost, including, but not limited to, MEDLINE, SPORTDiscus, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and Allied and Complementary Medicine Database (AMED). Studies published in a language other than English will only be considered if a translation is available. The JBI systematic review methodology will be followed when conducting the review. Data synthesis will be conducted using meta-analysis or narrative synthesis, where appropriate.

A conceptual framework has a central role in the scientific process. Its purpose is to synthesize evidence, assist in understanding phenomena, inform future research and act as a reference operational guide in practical settings. We propose an updated conceptual framework intended to facilitate the validation and interpretation of physical training measures. This revised conceptual framework was constructed through a process of qualitative analysis involving a synthesis of the literature, analysis and integration with existing frameworks (Banister and PerPot models). We identified, expanded and integrated four concepts that are important in the conceptualization of the process and outcomes of physical training. These were: 1) formal introduction of a new measurable component ‘training effects’, a higher order construct resulting from the combined effect of four possible responses (acute and chronic, positive and negative); 2) explanation, clarification and examples of training effect measures such as functional (performance-based), physiological, subjective and other measures (cognitive, biomechanical, etc.); 3) integration of the sport performance outcome continuum (from performance improvements to overtraining); 4) extension and definition of the network of linkages (uni and bidirectional) between individual and contextual factors and other constructs. Additionally, we provided examples of theoretical and practical applications of the conceptual framework such as validation and conceptualization of constructs (e.g. performance readiness), and understanding of higher order constructs, such as training tolerance when monitoring training to adapt to individual responses and effects. This conceptual framework provides an overarching model that may help understand and guide the development, validation, implementation, and interpretation of measures used for athlete monitoring.

Tendinopathy is a chronic degenerative tendon disorder which is characterised by pain, swelling and impaired physical function and performance, presenting in both athletes and the general population. Extracorporeal shockwave therapy (ESWT) is an increasingly common treatment for tendinopathy, which can initiate tendon healing and regeneration. The review presents current understanding of mechanisms of action of ESWT and provides a brief overview of its history and development. The central purpose of the review is to synthesise research findings investigating the effectiveness of ESWT for seven common tendinopathies (plantar heel pain, rotator cuff, lateral elbow, Achilles, gluteal, hamstring and patellar tendinopathy) and provide recommendations on clinical applicability. Collectively, the available evidence indicates that ESWT is effective and can be recommended in treatment for the seven tendinopathies. However, the evidence is stronger for certain tendinopathies compared to others and uncertainties remain regarding the optimal ESWT treatment parameters. The consensus from recent literature is that although ESWT can be effective in isolation it should be combined with other treatments in tendinopathy, which needs to be addressed in future research.

This systematic review is a student assignment during my MSc in Human Movement Science. In this systematic review, I collected secondary data, I appraised research studies and synthesized findings quantitatively in order to find out which GPS variables can predict non-contact injuries in soccer players.

The body of literature on tendinopathy management has come a long way in the last few decades and a variety of changes in the clinical approach have emerged from this research. One particular approach that shows promise has been called “heavy slow load” (HSL) and this has been the subject of investigation in a number of RCTs. While the premise for this approach is defensible, a critical examination of the implementation of these HSL protocols results in some concerns when compared to basic exercise science principles. This article lays out some considerations that will help future investigators to improve their exercise prescription approaches in this area.

Aims This meta-analysis aims to evaluate the effects of variable pacing strategies for outdoor cycling time trials in relation to reducing event time by optimising power distribution in parallel with course characteristics. Secondly, this meta-analysis seeks to compare the proposed time savings of variable pacing strategies to constant pacing during cycling time trails. Methods Pubmed, SportsDiscus and Scopus were used with the academic search engines Google Scholar and ResearchGate. The databases were searched for randomised control trials and repeated measures design studies and any other study type which met the inclusion criteria. Two repeated measures design studies, one randomised control trial and eight mathematical modelling and simulation studies were included after screening a total of 281 studies. Sample sizes range from 1-20 consisting of either mathematically modelled cyclists or well trained racing cyclists. Results Three different variable pacing strategies were explored (5%, 10% and 15% power variation) concerning three different course lengths; 10, 16.1 and 40-km. For all course profiles and conditions where it was possible, a 15% variation in power output resulted in the most significant time savings compared to constant pacing. The standardised mean difference for 15% variability for a 10-km time trial was -77.682 (s). For 40-km the time saving was -63.684(s). For courses where a 15% variation in power was not achievable (e.g courses with long steep uphill segments where a 15% variation would result in a power output significantly above critical power output) a 10% variation power resulted in the biggest time-saving. Conclusion The primary finding of this meta-analysis was that variable pacing strategies applied in parallel to course characteristics will always result in a significant time saving compared to constant pacing. Cyclists should aim to vary power output by 15% to experience maximal time savings. However, for a variation in power to be successful, it needs to be applied in parallel to course characteristics (course profile or wind conditions). A variable pacing strategy based on distance and irrespective of course characteristics was always detrimental to performance.

There is an opportunity for sports medicine to progress research ideation using synthetic datasets, maintaining research momentum when data collection is not feasible. These processes maximise the potential for application of open science practice, while retaining the commitment to privacy and ethics. Synthetic data could lead to more sustainable use of data, particularly in the form of hypothesis generation through exploratory research applied to synthetic datasets.

Background: Osgood-Schlatter disease (OSD) is a sport- and growth-associated knee pathology with painful osteochondrosis around the tibial tuberosity. Up to 10% of adolescents are affected by OSD. Treatment is primarily conservative or non-operative and includes injections, ice, braces, casts, tape and/or physiotherapy. However, treatment outcomes are often insufficiently described and there is lack of evidence for current best practice.Objective: The aims of this systematic review are to comprehensively identify conservative or non-operative treatment options for OSD, to compare their effectiveness in selected outcomes, and to describe potential research gaps. and to describe potential research gaps.Methods: This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. CENTRAL, CINAHL, EMBASE and MEDLINE via Ovid, and PEDro were searched through to January 6, 2020. In addition, ongoing and unpublished clinical studies, dissertations, and other grey literature on OSD were retrieved. We included prospective, retrospective, case control, randomised, and non-randomised studies reporting on the effectiveness of any conservative or non-operative treatment of 6- to 28-year-old OSD patients. Studies written in English, German, or French were included. The quality of the included studies was assessed using the PEDro scale and extracted outcome data were narratively synthesized. In addition, we also systematically retrieved review articles for extraction of treatment recommendations.Results: Of 767 identified studies, thirteen were included: two randomised controlled trials (RCTs), two prospective and eight retrospective observational studies, and one case series. Eight studies had no control group. The included studies were published from 1948 to 2019 and included 747 patients (563 male, 119 female, 65 sex not reported) with 937 affected knees. The study quality was poor to moderate. The two included RCTs examined the effectiveness of surplus dextrose-injection in OSD patients treated with local anaesthetics injection and came to opposite conclusions. Other than that, inter-study heterogeneity prohibited any descriptive cumulative analyses. Among the 15 review articles, the most prevalent treatment recommendations were activity modification (15/15), quadriceps and hamstring stretching (13/15), medication (11/15), ice (11/15), strengthening of the quadriceps (9/15), and knee straps or brace (8/15).Conclusion: Conflicting evidence exists to support the use of dextrose injections. Certain therapeutic approaches, such as stretching, seem to work, but no RCT comparing specific exercises with sham or usual care treatment exists. Carefully controlled studies on well- described treatment approaches are needed to establish which conservative or non-operative treatment options are most effective for patients with OSD.

Introduction: Advanced lung cancer patients face significant physical and psychological burden leading to reduced quality of life. Physical activity, nutrition, and palliative care interventions may enhance quality of life, however no study has combined these modalities in a multimodal intervention. Therefore, we assessed the feasibility and preliminary efficacy of an exercise, nutrition, and palliative symptom management intervention to improve quality of life in advanced lung cancer. Methods: Participants received an individually-tailored 12-week intervention featuring in-person group-based exercise classes, at-home physical activity prescription, and nutritional and palliative care consults. Patients reported symptom burden and quality of life pre-/post-class, as well as pre-/post-intervention, along with self-reported physical activity and a physical function assessment. Post-intervention interviews examined participant perspectives. Results: The multimodal program was feasible, with 44% recruitment, 75% class attendance, 89% nutrition and palliative consult attendance, and 85% assessment completion. Participants perceived the intervention as feasible and valuable. Physical activity, symptom burden, and quality of life were maintained, while tiredness decreased significantly. Exercise classes prompted acute clinically meaningful reductions in fatigue, tiredness, depression, pain, and increases in energy and well-being. Conclusion: A multimodal exercise, nutrition, and palliative symptom management intervention is feasible and shows potential benefits on quality of life that warrant further investigation.

Athletes, sponsors and sport organisations all have a vested interest in upholding the values of clean sport. Despite the considerable and concerted efforts of the global anti-doping system over two decades, the present system is imperfect. Capitalising upon consequent frustrations of athletes, event organisers and sponsors, alternative anti-doping systems have emerged outside the global regulatory framework. The operating principles of these systems raise several concerns, notably including accountability, legitimacy and fairness to athletes. In this paper, we scrutinise the Clean Protocol™, which is the most comprehensive alternative system, for its shortcomings through detailed analysis of its alleged logical and scientific merits. Specifically, we draw the attention of the anti-doping community - including researchers and practitioners - to the potential pitfalls of using assessment tools beyond the scope for which they have been validated, and implementing new approaches without validation. Further, we argue that whilst protecting clean sport is critically important to all stakeholders, protocols that put athletes in disadvantageous positions and/or pose risks to their professional and personal lives lack legitimacy. We criticise the use of anti-doping data and scientific research out of context, and highlight unintended harms that are likely to arise from the widespread implementation of such protocols in parallel with - or in place of - the existing global anti-doping framework. ispartof: INTERNATIONAL JOURNAL OF DRUG POLICY vol:93 ispartof: location:Netherlands status: published

Physical activity (PA) and exercise (E) (PA&E) decrease the risk of various chronic non-communicable diseases and early mortality. However, the dose-response relationship has not yet been elucidated. The main recommendations of PA&E have established 'dose' between approximately 500 to 1750 MET-min-wk, or 150-300 min and 75-150 min of moderate or vigorous efforts, respectively. We propose here that protective effect induced by PA&E is achieved at doses lower or higher than those proposed by the main recommendations of PA&E whenever the ideal 'volume-intensity counterbalance' (VIC) is reached. We will achieve a protective effect in different PA&E scenarios, including ‘very high intensity with very low volume’ or the opposite, 'very high volume with very low intensity'. Our hypothesis tries to overcome limitations of current references of dose-response, since our recommendations are paradoxically restrictive and unlimited: (a) they are restrictive because just reflect PA at leisure time, the volume is restricted to time (or duration), the intensity is given only by categories of effort (e.g., moderate and vigorous) and doses below to 500 MET-min-wk are not treated as effective for protection; (b) they are also unlimited because they treat the recommended dose as 'minimum', in such a way that it would be possible to assume that “the more exercise the better!”. However, this statement does not seem valid when considering VIC. We built our proposal from the accumulated scientific knowledge and brought additional elements to induce reflections that can contribute to new works.

In professional team sport, managing injury risk depends on the effective collaboration of technical/tactical coaches, strength and conditioning coaches, sports medicine practitioners and sport scientists within a multidisciplinary team (MDT). Yet, to date no research has examined how these professionals might co-ordinate their efforts. The aim of this study is to examine the processes and interactions utilized by a demonstrably effective MDT. The efficacy of the MDT was established by quantifying the injury burden of the team across two seasons. The MDT achieved a 60% reduction in team injury burden during the second season (first season 516, 95%CI 491 to 542 vs. second season 205, 95%CI 191 to 219 days/1000 hours). Semi-structured interviews were conducted with all MDT members to determine each individual’s role within the injury prevention process and how these were co-ordinated between disciplines. Thematic analysis identified three key constructs that contributed to the MDT’s success; 1) shared values, 2) expertise and 3) the effective operationalization of underpinning values and expertise. Shared values expressed by the MDT members included ‘future performance is driven by healthy performers’, and shared responsibility for injury prevention. All MDT members were experts in their own fields but identified that they had to learn how to be effective within the environment and required skill in building interpersonal relationships. The operationalisation of these principles took place through iterative plan-do-review cycles underpinned by sophisticated data collection and monitoring and the provision of time and resource to complete these operations. This research offers insights into “how” effective MDTs work to achieve injury reduction, and the models and processes presented will inform practice for other MDTs working in sport.

Since this is an editorial, no abstract is available.