The EYHS was designed in the early 1990s as a multicenter study. We aimed to overcome some of the limitations by (1) getting sufficient statistical power to show biologically important associations between PA and health outcomes by pooling data, (2) analysing determinants of PA, (3) comparing PA and cardiovascular disease (CVD) risk factor levels across cultures and (4) to improve the assessment of PA with objective methods and outcomes by constructing a composite risk factor score....]]> 2013-05-18T00:02:11-07:00 info:doi/10.1136/bjsports-2013-092407 hwp:master-id:bjsports;bjsports-2013-092407 British Association of Sport and Excercise Medicine 2013-05-18 Editorial http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091880v1?rss=1 A literature review was performed on the topic of urinary incontinence during physical activity and sports. This paper reviews the prevalence, risk factors, pathophysiology and treatment modalities of urinary incontinence in physically active women and female athletes. Urinary incontinence affects women of all ages, including top female athletes, but is often under-reported. The highest prevalence of urinary incontinence is reported in those participating in high impact sports. Pelvic floor muscle training is considered the first-line treatment, although more research is needed to determine optimal treatment protocols for exercising women and athletes. Trainers, coaches and other athletes’ caregivers should be educated and made aware of the need for proper urogynaecological assessment.

Young adults with clinical FAI completed six PRO questionnaires on two occasions, 1–2 weeks apart. The PROs were modified Harris Hip Score, Hip dysfunction and Osteoarthritis Score, Hip Outcome Score, Non-Arthritic Hip Score, International Hip Outcome Tool, Copenhagen Hip and Groin Outcome Score.

30 young adults (mean age 24 years, SD 4 years, range 18–30 years; 15 men) with stable symptoms participated. Intraclass correlation coefficient_(3,1) values ranged from 0.73 to 0.93 (95% CI 0.38 to 0.98) indicating that most questionnaires reached minimal reliability benchmarks. Measurement error at the individual level was quite large for most questionnaires (minimal detectable change (MDC₉₅) 12.4–35.6, 95% CI 8.7 to 54.0). In contrast, measurement error at the group level was quite small for most questionnaires (MDC₉₅ 2.2–7.3, 95% CI 1.6 to 11).

The majority of the questionnaires were reliable and precise enough for use at the group level. Samples of only 23–30 individuals were required to achieve acceptable measurement variation at the group level. Further direct comparisons of these questionnaires are required to assess other measurement properties such as validity, responsiveness and meaningful change in young people with FAI.

Testing was performed at three major international Paralympic events. Education regarding the dangers of AD was provided to athletes and team staff. Testing was conducted on athletes from the relevant sport classes: Athletics (wheelchair racing classes T51/T52/T53) and Handcycling (H1). Key parameters included the athlete's demographics (gender, country of origin), classification and blood pressure measurements. An extremely elevated blood pressure was considered to be a proxy maker for AD, and a systolic blood pressure of ≥180 mm Hg was considered a positive test.

A total of 78 tests for the presence of AD were performed during the three games combined. No athlete tested positive. The number of athletes tested, by classification, was: 6 in Athletics T51, 47 in Athletics T52, 9 in Athletics T53 and 16 in Handcycling H1. Of those tested, the average systolic and diastolic blood pressures were 135 mm Hg (range 98–178) and 82 mm Hg (range 44–112), respectively. All athletes were compliant with testing. No athletes were withdrawn from competition due to the presence of AD.

Testing for the presence of AD in paralympic athletes with SCI prior to competition has been carried out for the first time at three major international paralympic competitions. There have been no positive tests thus far. Knowledge gained during these early testing experiences will be used to guide ongoing refinement of the testing protocol and the development of further educational initiatives.

Participants were randomly allocated with a block on gender to a control (standard therapy) or intervention group (initial n=10 (6 boys) in each group; age 10±1 and 11±1 years). The latter group performed a combined programme (IMT (2 sessions/day) and aerobic+strength exercises (3 days/week, in-hospital)) that was followed by a 4-week detraining period. All participants were evaluated at baseline, post-training and detraining.

Adherence to the training programme averaged 97.5%±1.7%. There was a significant interaction (groupxtime) effect for PI_max, VO_2peak and five-repetition maximum strength (leg-press, bench-press, seated-row) (all (p<0.001), and also for %fat (p<0.023) and %fat-free mass (p=0.001), with training exerting a significant beneficial effect only in the intervention group, which was maintained after detraining for PI_max and leg-press.

The relatively short-term (8-week) training programme used here induced significant benefits in important health phenotypes of paediatric patients with CF. IMT is an easily applicable intervention that could be included, together with supervised exercise training in the standard care of these patients.

To compare the risk of injury in female versus male World Cup (WC) alpine skiers.

Injuries were recorded through the International Ski Federation Injury Surveillance System for six consecutive winter seasons (2006–2012), based on retrospective interviews with athletes from 10 teams at the end of each season. All acute training and competition injuries which required medical attention were recorded. Race exposure was calculated based on the exact number of runs started in the WC for each of the interviewed athletes each season.

Men had a higher overall rate of injury (relative risk (RR) 1.24, 95% CI 1.05 to 1.47), as well as a higher rate of time-loss injury (RR 1.23, 95% CI 1.03 to 1.48) than women in training and competitions, expressed as injuries/100 athletes/season. These sex differences were even more pronounced during WC races (RR 1.58, 95% CI 1.22 to 2.04 and RR 1.72, 95% CI 1.29 to 2.31, for overall and time-loss injuries, respectively). There was no sex difference in the risk of knee/anterior cruciate ligament (ACL) injuries.

No previous studies from competitive skiing have reported a significantly higher risk of injuries in men than women. In contrast to recreational skiing and team sports, there was no sex difference in the risk of knee/ACL injuries and prevention efforts should be directed as much towards male as female competitive skiers.

A prospective longitudinal study design was employed to evaluate young females active in soccer or basketball (N=862). Participants who completed at least 1-year follow-up to provide consecutive annual measures of BMIZ and %fat were included in the study analysis to determine the effect of knee injuries on the trajectory of these obesity markers in youth.

Of the 71 reported knee injuries, 12 (17%) occurred in athletes at the prepubertal stage, 24 (34%) in athletes at the pubertal stage, and 35 (49%) in postpubertal athletes. Controlling for the effects of maturation, female athletes who reported knee injury demonstrated a greater yearly increase in BMIZ (LS means and 95% CI for the injured group=0.039 (–0.012 to 0.089), for the non-injured group=–0.019 (–0.066 to 0.029), and group difference=0.057 (0.005 to 0.11), p=0.03) and in %body fat (LS means and 95% CI for the injured group=1.05 (0.45 to 1.65), for the non-injured group=0.22 (–0.21 to 0.064), and group difference=0.83 (0.21 to 1.45), p=0.009), compared to those without knee injuries. This indicates that the athletes with knee injuries will increase their body mass index percentile by up to 5 units more than someone of the same age without an injury, and in body fat by up to 1.5%, compared to their non-injured peers.

The present findings indicate that knee injury during the growing years may be associated with unfavourable changes in body composition.

In this prospective cohort study, 45 sailors (17 women and 28 men), age 17–31 years, were included. 24 sailors belonged to the SWE Sailing Team and 21 were club sailors. All the participants kept a training diary, and once a month for 12 months they reported their training and injuries through a web-based questionnaire. Each time a sailor reported an injury, they were contacted by the researchers and an injury form was completed.

The SWE Sailing Team performed significantly (p=0.006) more physical training than the club sailor. There was no significant difference (p=0.7) in hours of sail training. A total of 144 injuries were reported. The most common injury location was the knee (19%), followed by the lower leg (13%) and shoulder (12%). 30% of the injuries occurred during physical training, 17% during sail training and 12% during sail racing.

The most common injury location was the knee. The largest proportion of injuries occurred during physical training and unspecified activities. The least number of injuries occurred during sail racing. The injury location was different between the older more experienced sailor (more upper extremity injuries) compared with the younger sailors (more trunk injuries).

Summarise and critique studies evaluating LBP risk factors in cricketers, and evaluate the effectiveness of interventions designed to prevent or treat such LBP.

Systematic literature review.

MEDLINE, ISI Web of Knowledge, CINAHL, SportDiscus and the Cochrane Library were searched from inception using key terms relating to risk factors and interventions in LBP in cricketers. Quality of included studies was assessed using the Downs and Black Quality Index, data were extracted to complete the effect size and OR calculations and evidence levels were established using van Tulder's criteria.

12 studies (6 of high quality) investigating the factors associated with LBP in cricketers and 5 low-quality studies evaluating the interventions for the treatment/prevention of LBP in cricketers were identified. Moderate evidence indicates the presence of acute MRI bone stress as a risk factor for developing lumbar stress fractures. Additionally, moderate evidence indicates increased shoulder counter rotation (associated with mixed bowling actions) and decreased anterior abdominal fascial slide may be associated with LBP in cricketers.

Screening for bone stress on MRI should be considered by clinicians managing developing cricketers to identify the risk of lumbar stress fracture development. Numerous associative factors were outlined, although causality needs establishing to further guide interventions in cricketers with LBP. Intervention studies were of insufficient quality to generate concrete conclusions and these research failings require rapid attention.

To review the content of iPhone and iPad apps containing a claim to prevent sports and physical activity-related injuries and to appraise this claim against best available scientific evidence.

The US iTunes App Store was searched using the keywords ‘injury’, ‘prevention’ and ‘rehabilitation’. Apps within the categories ‘health & fitness’, ‘sports’ and ‘medical’ containing a preventive claim in the app name, description or screenshots were included. Claims were extracted and a search for best available evidence was performed.

Eighteen apps met our inclusion criteria. Four of these apps contained claims for which evidence was available: three apps covered ankle sprains and provided information on taping or neuromuscular training. Of these three apps, one app also provided information on prevention of dental injury with mouth guards. One app provided a routine to prevent anterior cruciate ligament injury. The main focus of the five apps was running injury prevention; for their content evidence of absence of efficacy was found. For nine apps no evidence supporting their content was found.

f 18 apps included, only four contained claims that could be supported by available literature and five apps contained false claims. This lack of scientifically sound apps provides an opportunity for caretakers to develop apps with evidence-based claims to prevent SPRIs.

To examine the prospective associations of total sitting time, TV-viewing time and occupational sitting with mortality from all causes and cardiometabolic diseases.

Data from 50 817 adults aged ≥20 years from the Nord-Trøndelag Health Study 3 (HUNT3) in 2006–2008 were linked to the Norwegian Cause of Death Registry up to 31 December 2010. Cox proportional hazards models examined all-cause and cardiometabolic disease-related mortality associated with total sitting time, TV-viewing and occupational sitting, adjusting for multiple potential confounders including physical activity.

After mean follow-up of 3.3 years (137 315.8 person-years), 1068 deaths were recorded of which 388 were related to cardiometabolic diseases. HRs for all-cause mortality associated with total sitting time were 1.12 (95% CI 0.89 to 1.42), 1.18 (95% CI 0.90 to 1.57) and 1.65 (95% CI 1.24 to 2.21) for total sitting time 4–<7, 7–<10 and ≥10 h/day, respectively, relative to <4 h/day after adjusting for confounders (p-trend=0.001). A similar pattern of associations was observed between total sitting time and mortality from cardiometabolic diseases, but TV-viewing time and occupational sitting showed no or borderline significant associations with all-cause or cardiometabolic disease-related mortality over the same follow-up period.

Total sitting time is associated with all-cause and cardiometabolic disease-related mortality in the short term. However, prolonged sitting in specific contexts (ie, watching TV, at work) do not adversely impact health in the same timeframe. These findings suggest that adults should be encouraged to sit less throughout the day to reduce their daily total sitting time.

Overweight and obese women (body mass index=29.6±4.0 kg/m²) performed a bout of cycling individually tailored to expend 400 kcal (EX) or a time-matched no exercise control condition in a randomised, counter-balanced order. 60 min after the cessation of exercise, an ad libitum test meal was provided. Substrate oxidation and subjective appetite ratings were measured during exercise/time-matched rest, and during the period between the cessation of exercise and food consumption.

While ad libitum energy intake (EI) did not differ between EX and the control condition (666.0±203.9 vs 664.6±174.4 kcal, respectively; ns), there was a marked individual variability in compensatory EI. The difference in EI between EX and the control condition ranged from –234.3 to 278.5 kcal. Carbohydrate oxidation during exercise was positively associated with postexercise EI, accounting for 37% of the variance in EI (r=0.57; p=0.02).

These data indicate that the capacity of acute exercise to create a short-term energy deficit in overweight and obese women is highly variable. Furthermore, exercise-induced CHO oxidation can explain a part of the variability in acute exercise-induced compensatory eating. Postexercise compensatory eating could serve as an adaptive response to facilitate the restoration of carbohydrate balance.

To prospectively implement and validate a novel muscle injury classification and to evaluate its predictive value for return to professional football.

The recently described Munich muscle injury classification was prospectively evaluated in 31 European professional male football teams during the 2011/2012 season. Thigh muscle injury types were recorded by team medical staff and correlated to individual player exposure and resultant time-loss.

In total, 393 thigh muscle injuries occurred. The muscle classification system was well received with a 100% response rate. Two-thirds of thigh muscle injuries were classified as structural and were associated with longer lay-off times compared to functional muscle disorders (p<0.001). Significant differences were observed between structural injury subgroups (minor partial, moderate partial and complete injuries) with increasing lay-off time associated with more severe structural injury. Median lay-off time of functional disorders was 5–8 days without significant differences between subgroups. There was no significant difference in the absence time between anterior and posterior thigh injuries.

The Munich muscle classification demonstrates a positive prognostic validity for return to play after thigh muscle injury in professional male football players. Structural injuries are associated with longer average lay-off times than functional muscle disorders. Subclassification of structural injuries correlates with return to play, while subgrouping of functional disorders shows less prognostic relevance. Functional disorders are often underestimated clinically and require further systematic study.

Prospective injury surveillance at three international championships in 2002, 2006 and 2010. Official match statistics were obtained for all the games played in the three championships.

2002, 2006 and 2010 FIFA World Cups.

National team players as well as the team doctors reporting all the injuries at the 2002, 2006 and 2010 FIFA World Cups.

Injury incidence and incidence rate ratios.

There were statistically significant differences in injury incidence related to changes in the score (p=0.026) and to the teams’ current drawing/losing/winning status (p=0.008). Injury incidence was lowest (54.8/1000 match-hours (mh), 95% CI 46.4 to 64.3) during the initial 0–0 score and highest (81.2/1000 mh, 60.5 to 106.8) when the score was even but goals had been scored. Winning teams had a tendency towards a higher injury incidence (81.0/1000 mh, 67.5 to 96.4) than losing or drawing teams (55.5/1000 mh, 44.4 to 68.4 and 59.7/1000 mh, 51.8 to 68.6, respectively). There were also statistically significant differences in injury incidence between the playing positions (p<0.001), with forwards having the highest injury incidence (85.7/1000 mh, 69.8 to 104.2). There was a linear relationship (p=0.043) between an increasing number of recovery days between matches and a higher injury incidence.

There is a considerable variation in injury incidence during a match in international men's football related to changes in the score. Players in a winning team run a higher risk of suffering an injury than players in a drawing or losing team. Identifying time periods with a high injury incidence may be of major importance to players and team personnel, as it may enable them to take precautions.

To study the association between injury rates and team performance in the domestic league play, and in European cups, in male professional football.

24 football teams from nine European countries were followed prospectively for 11 seasons (2001–2012), including 155 team-seasons. Individual training and match exposure and time-loss injuries were registered. To analyse the effect of injury rates on performance, a Generalised Estimating Equation was used to fit a linear regression on team-level data. Each team's season injury rate and performance were evaluated using its own preceding season data for comparison in the analyses.

7792 injuries were reported during 1 026 104 exposure hours. The total injury incidence was 7.7 injuries/1000 h, injury burden 130 injury days lost/1000 h and player match availability 86%. Lower injury burden (p=0.011) and higher match availability (p=0.031) were associated with higher final league ranking. Similarly, lower injury incidence (p=0.035), lower injury burden (p<0.001) and higher match availability (p<0.001) were associated with increased points per league match. Finally, lower injury burden (p=0.043) and higher match availability (p=0.048) were associated with an increase in the Union of European Football Association (UEFA) Season Club Coefficient, reflecting success in the UEFA Champions League or Europa League.

Injuries had a significant influence on performance in the league play and in European cups in male professional football. The findings stress the importance of injury prevention to increase a team's chances of success.

Five online databases (January 1970 and May 2012) were systematically searched followed by a manual search of retrieved papers.

Seventeen studies met the inclusion criteria. The heterogeneous diagnostic procedures and criteria for concussion prevented a pooling of data. When comparing the injury data of European and North American or Canadian leagues, the latter show a higher percentage of concussions in relation to the overall number of injuries (2–7% compared with 5.3–18.6%). The incidence ranged from 0.2/1000 to 6.5/1000 game-hours, 0.72/1000 to 1.81/1000 athlete-exposures and was estimated at 0.1/1000 practice-hours.

The included studies indicate a high incidence of concussion in professional and collegiate ice hockey. Despite all efforts there is no conclusive evidence that rule changes or other measures lead to a decrease in the actual incidence of concussions over the last few decades. This review supports the need for standardisation of the diagnostic criteria and reporting protocols for concussion to allow interstudy comparisons in the future.

To assess the reliability, content validity and concurrent validity of the survey and to evaluate if it provided more complete data on sports participation than a routine activity questionnaire.

145 consecutively included ACL-injured patients were eligible for the reliability study. The retest of the online activity survey was performed 2 days after the test response had been recorded. A subsample of 88 ACL-reconstructed patients was included in the validity study. The ACL-reconstructed patients completed the online activity survey from the first to the 12th postoperative month, and a routine activity questionnaire 6 and 12 months postoperatively.

The online activity survey was highly reliable ( ranging from 0.81 to 1). It contained all the common sports reported on the routine activity questionnaire. There was a substantial agreement between the two methods on return to preinjury main sport (=0.71 and 0.74 at 6 and 12 months postoperatively). The online activity survey revealed that a significantly higher number of patients reported to participate in running, cycling and strength training, and patients reported to participate in a greater number of sports.

The online activity survey is a highly reliable way of recording detailed changes in sports participation after ACL injury. The findings of this study support the content and concurrent validity of the survey, and suggest that the online activity survey can provide more complete data on sports participation than a routine activity questionnaire.

Case series of medically diagnosed concussions for regular season games over a 3.5-year period during the 2006–2010 seasons. Digital video records were coded and analysed using a standardised protocol.

88% (n=174/197) of concussions involved player-to-opponent contact. 16 diagnosed concussions were a result of fighting. Of the 158 concussions that involved player-to-opponent body contact, the most common mechanisms were direct contact to the head initiated by the shoulder 42% of the time (n=66/158), by the elbow 15% (n=24/158) and by gloves in 5% of cases (n=8/158). When the results of anatomical location are combined with initial contact, almost half of these events (n=74/158) were classified as direct contact to the lateral aspect of the head.

The predominant mechanism of concussion was consistently characterised by player-to-opponent contact, typically directed to the head by the shoulder, elbow or gloves. Also, several important characteristics were apparent: (1) contact was often to the lateral aspect of the head; (2) the player who suffered a concussion was often not in possession of the puck and (3) no penalty was called on the play.

Analysis of the incidence, characteristics and changes of football injury during international top-level tournaments 1998–2012.

All newly incurred football injuries during the FIFA tournaments and the Olympic Games were reported by the team physicians on a standardised injury report form after each match. The average response rate was 92%.

A total of 3944 injuries were reported from 1546 matches, equivalent to 2.6 injuries per match. The majority of injuries (80%) was caused by contact with another player, compared with 47% of contact injuries by foul play. The most frequently injured body parts were the ankle (19%), lower leg (16%) and head/neck (15%). Contusions (55%) were the most common type of injury, followed by sprains (17%) and strains (10%). On average, 1.1 injuries per match were expected to result in absence from a match or training. The incidence of time-loss injuries was highest in the FIFA World Cups and lowest in the FIFA U17 Women's World Cups. The injury rates in the various types of FIFA World Cups had different trends over the past 14 years.

Changes in the incidence of injuries in top-level tournaments might be influenced by the playing style, refereeing, extent and intensity of match play. Strict application of the Laws of the Games is an important means of injury prevention.

Logit and negative binomial regression were used to estimate the degree of association between walking, MVPA and neighbourhood green space in a sample of 203 883 adults from the Australian 45 and Up Study. Walking and MVPA were measured using the Active Australia Survey. Green space was measured as a percentage of the total land-use within 1 km radius of residence. We controlled for a range of individual and neighbourhood characteristics.

86.6% of the sample walked and 85.8% participated in MVPA at least once a week. These rates fell steeply with age. Compared with residents of neighbourhoods containing 0–20% green space, those in greener areas were significantly more likely to walk and participate in MVPAs at least once a week (trend for both p<0.001). Among those participating at least once a week, residents of neighbourhoods containing 80%+ green space participated with a greater frequency of walking (incidence rate ratio (IRR) 1.09, 95% CI 1.05 to 1.13) and MVPA (IRR 1.10, 95% CI 1.05 to 1.15).

Our findings suggest that the amount of green space available to adults in middle-to-older age within their neighbourhood environments could help to promote walking and MVPA.

A 20-month intervention was evaluated in a cluster randomised, controlled study of 1324 11-year-olds. Outcome variables were body mass index (BMI), BMI-for-age z-score (BMIz), waist circumference (WC), waist-to-height ratio (WTHR) and weight status (International Obesity Task Force's cut-offs). Weight, height and WC were measured objectively; pubertal status was self-reported and parental education was self-reported by the parents. Intervention effects were determined by one-way analysis of covariance and logistic regression, after checking for clustering effects of school, and moderating effects of gender, pubertal status and parental education.

Beneficial effects were found for BMI (p=0.02) and BMIz (p=0.003) in girls, but not in boys. While a beneficial effect was found for BMI (p=0.03) in participants of parents reporting a high level of education, a negative effect was found for WTHR in participants with parents reporting a low level of education (p=0.003). There were no intervention effects for WC and weight status.

A multicomponent 20-month school-based intervention had a beneficial effect on BMI and BMIz in adolescent girls, but not in boys. Furthermore, children of higher educated parents seemed to benefit more from the intervention, and this needs attention in future interventions to avoid further increase in social inequalities in overweight and obesity.

In a recent article, Ranthe et al6 presented...]]> 2013-04-26T00:01:08-07:00 info:doi/10.1136/bjsports-2013-092494 hwp:master-id:bjsports;bjsports-2013-092494 British Association of Sport and Excercise Medicine 2013-04-26 Editorial http://bjsm.bmj.com/cgi/content/short/bjsports-2013-092305v1?rss=1 Background

Medial collateral ligament (MCL) injury is the most common knee ligament injury in professional football.

To investigate the rate and circumstances of MCL injuries and development over the past decade.

Prospective cohort study, in which 27 professional European teams were followed over 11 seasons (2001/2002 to 2011/2012). Team medical staffs recorded player exposure and time loss injuries. MCL injuries were classified into four severity categories. Injury rate was defined as the number of injuries per 1000 player-hours.

346 MCL injuries occurred during 1 057 201 h (rate 0.33/1000 h). The match injury rate was nine times higher than the training injury rate (1.31 vs 0.14/1000 h, rate ratio 9.3, 95% CI 7.5 to 11.6, p<0.001). There was a significant average annual decrease of approximately 7% (p=0.023). The average lay-off was 23 days, and there was no difference in median lay-off between index injuries and reinjuries (18 vs 13, p=0.20). Almost 70% of all MCL injuries were contact-related, and there was no difference in median lay-off between contact and non-contact injuries (16 vs 16, p=0.74).

This largest series of MCL injuries in professional football suggests that the time loss from football for MCL injury is 23 days. Also, the MCL injury rate decreased significantly during the 11-year study period.

Intense exercise involving eccentric muscle contractions often leads to delayed onset muscle soreness. Eccentric muscle contractions cause damage to muscle fibres which lead to pain, stiffness and loss in joint range of motion.1 The anti-inflammatory effects of cold water immersion, a form of cryotherapy where the limb(s) or body is submerged in a cold water bath, are thought to reduce pain and swelling following acute soft tissue injury.2 Cold water immersion immediately after exercise may have anti-inflammatory effects and prevent delayed onset muscle soreness, however these effects remain unclear.

This study aimed to determine the effects of cold water immersion on the prevention of muscle soreness after exercise.

The following databases were searched up to 2010 or 2011: the Cochrane Bone,...]]> 2013-04-25T00:01:07-07:00 info:doi/10.1136/bjsports-2013-092433 hwp:master-id:bjsports;bjsports-2013-092433 British Association of Sport and Excercise Medicine 2013-04-25 PEDro systematic review update http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091875v1?rss=1 Background/Aim

During competitive diving, divers jump up from 1 to 3 m springboards or 5 to 10 m platforms and dive into the water. The impact forces are very large in the water entry phase, and, as such, microtraumatic injuries are common due to the tremendous physical stress placed on the diver. Low-back pain (LBP) is the most frequently reported symptom in divers. This study aimed to extract possible risk factors related to LBP from physical and technical characteristics in Japanese elite junior divers.

Eighty-three elite junior divers (42 men and 41 women) in Japan were included in this study. LBP was assessed by a questionnaire, interview and physical examination during a national training camp. Morphological data, physical fitness and diving skills were also evaluated. The factors related to LBP were extracted by using logistic-regression analysis and the forward-selection method (likelihood ratio).

A total of 37.3% (31 reports) of back pain occurred in the lumbar region. Shoulder flexibility (OR 0.919; 95% CI 0.851 to 0.992) and age (OR 0.441; 95% CI 0.239 to 0.814) were recognised as factors related to LBP in male-elite junior divers, whereas only age (OR 0.536; 95% CI 0.335 to 0.856) was a factor in female-elite junior divers.

Our results suggest that shoulder flexibility is important for preventing LBP in elite-male junior divers, since they require full shoulder flexion during the water entry phase. Limited shoulder flexibility could cause lumbar hyperextension when adjusting for the angle of water entry.

A questionnaire was sent to the member associations of FIFA. The first section addressed the previous events of SCA, SCD or unexplained sports-related sudden death within the last 10 years. Further questions focused on football player medical screening strategies and SCA resuscitation response protocols on the field.

126 of 170 questionnaires were returned (response rate 74.1%), and 103 questionnaires (60.6%) were completed sufficiently to include in further analysis. Overall, 107 cases of SCA/SCD and 5 unexplained football-associated sudden deaths were reported. These events occurred in 52 of 103 responding associations (50.5%). 23 of 112 (20.5%) footballers survived. 12 of 22 (54.5%) players treated with an available automated external defibrillators (AED) on the pitch survived. A national registry to monitor cardiac events was established in only 18.4% of the associations. Most associations (85.4%) provide regular cardiac screening for their national teams while 75% screen teams of the national leagues. An AED is available at all official matches in 68% of associations.

National registries to accurately measure SCA/SCD in football are rare and greatly needed. Deficiencies in emergency preparations, undersupply of AEDs on the field during matches, and variability in resuscitation response protocols and training of team-staff members should be addressed to effectively prevent SCD in football.

This study aims to investigate whether previous AAS-use affects mental health, present sociodemographic data, sport activity and substance abuse in a retrospective 30-year follow-up study of former elite athletes.

Swedish male-elite power sport athletes (n=683) on the top 10 national ranking lists during any of the years 1960–1979 in wrestling, Olympic lifting, powerlifting and the throwing events in track and field answered a questionnaire.

At least 20% of the former athletes admitted previous AAS-use. They had more often sought professional expertise for mental problems and had used illicit drugs compared to those not having used AAS. The AAS-users also differed in former sport activity pattern compared to non AAS-users.

It is clear that a relationship exists between use of AAS and mental-health problems. Further studies need to be done in order to clarify this relationship.

A literature review using the MEDLINE database was undertaken. Articles were selected that included evaluation and/or management in children aged 5–15 years.

There are no sideline assessment tools validated for use in this age group. There are a number of different symptom scales that have been validated during different stages of the follow-up assessment in children. No single paediatric concussion assessment tool has been validated for use from sideline through to all stages of recovery. Reliability studies have been published on Balance Error Scoring System in children, but validity studies in this age group have not been published. The management of concussion includes withdrawal from play on the day and cognitive and physical rest. The priority of concussion management in children is to return to learn; while this is usually rapid, there are some children in whom a graduated return to school is required, which should include a number of accommodations.

A young child is physically, cognitively and emotionally very different from adults, and requires the use of a different set of tools for the diagnosis, recovery-assessment and management of concussion. Age-specific, validated diagnostic tools are required, and management of concussion in children should focus attention on return to learn before considering return to play.

We now know that excessive intake of fluid during endurance events can lead to exercise-associated hyponatraemic encephalopathy (EAHE) or ‘water intoxication’.1 There have been a number of deaths reported from this syndrome. One of the researchers who has been prominent in researching this...]]> 2013-04-20T00:00:33-07:00 info:doi/10.1136/bjsports-2013-092440 hwp:master-id:bjsports;bjsports-2013-092440 British Association of Sport and Excercise Medicine 2013-04-20 Editorial http://bjsm.bmj.com/cgi/content/short/bjsports-2013-092175v1?rss=1 Background

For female marathon runners, breast pain (mastalgia) may be an important issue which has yet to be considered. This study aimed to determine the prevalence and severity of mastalgia in female marathon runners, identify factors that increase mastalgia and methods used to overcome mastalgia, and explore the impact that mastalgia may have on marathon training.

1397 female marathon runners were surveyed at the 2012 London Marathon Registration. All participants who completed the four-part, 30-question survey in its entirety have been included in the analysis (n=1285).

32% of participants experienced mastalgia. This was significantly related to cup size and was greater during vigorous compared with moderate physical activity. Exercise-related factors were the primary factors reported to increase mastalgia participation. Seventeen per cent of symptomatic participants reported that mastalgia affected their exercise behaviour. Methods reportedly used to overcome mastalgia included pain medication and firm breast support; however, 44% of participants took no measures to relieve symptoms despite over half describing their mastalgia as discomforting.

Mastalgia was experienced by a third of marathon runners and was found to be related to breast size which has previously been unreported. The link between exercise and mastalgia has yet to be established; however, this study identified that exercise was the most prevalent factor in mastalgia occurrence which may have implications for its management. The number of participants who took no measures to relieve their mastalgia, or resorted to pain medication, highlights the importance and significance of research into exercise-related mastalgia.

This was a prospective cohort study among Danish boys and girls (N=277) followed for up to 12 years (age 15.7 (0.4) at baseline) enrolled in the European Youth Heart Study. PA intensity was objectively measured at baseline and follow-up, and ultrasonography was performed on the Carotid arteries at follow-up. Data on carotid intima-media thickness (cIMT), Carotid Compliance and Young's Elastic Modules were used as outcome measures.

In the multivariable analyses (adjusted for personal—lifestyle and demographic factors) the mean exposure to moderate-and-vigorous PA from adolescence to adulthood was negatively associated with Young's Elastic Modules (β=–0.001x10³ kPa (95% CI –0.0015 to –0.0002), p=0.02) and positively associated with Carotid Compliance (β=0.004 mm² kPa^–1 (95% CI 0.002 to 0.008), p=0.003) and cIMT (β=0.0003 mm (95% CI 0.00001 to 0.0007), p=0.013). Increases in moderate-and-vigorous PA from adolescence to adulthood were negatively associated with Young's Elastic Modules in adulthood (β=–0.00007x10³ kPa (95% CI –0.0012 to –0.0001), p=0.01). Furthermore, participants with the largest decline in moderate-and-vigorous PA from adolescence to adulthood displayed significantly less compliant arteries compared with the remaining sample (p<0.05).

High mean exposure to moderate-and-vigorous PA levels and increases herein were independently associated with lower levels of carotid arterial stiffness in adulthood.

This was a prospective study of a sample of 254 children (baseline age 8–10 years) with a 6-year follow-up. The mean exposure and the change in minutes of moderate-and-vigorous and vigorous PA intensity were measured using the Actigraph activity monitor. Subclinical cardiovascular disease was expressed as cIMT, carotid arterial stiffness and secondarily as a metabolic risk z-score including the homoeostasis model assessment score of insulin resistance, triglycerides, total cholesterol to high-density lipoprotein ratio, inverse of cardiorespiratory fitness, systolic blood pressure and the sum of four skinfolds.

No associations were observed between PA intensity variables and cIMT or carotid arterial stiffness (p>0.05). Neither change in PA intensity (moderate-and-vigorous nor vigorous) nor mean minutes of moderate-and-vigorous PA intensity was associated to the metabolic risk z-score in adolescence (p>0.05). However, a significant inverse association was observed between mean minutes of vigorous PA and the metabolic risk z-score in adolescence independent of gender and biological maturity (standard β=–0.19 p=0.007).

A high mean exposure to, or changes in, minutes spent at higher PA intensities across childhood was not associated to cIMT or stiffness in the carotid arteries in adolescence. Our observations suggest that a high volume of vigorous PA across childhood independently associated with lower metabolic cardio vascular disease risk in adolescence.

People with peripheral arterial disease may experience symptoms of limb ischaemia. When this occurs with walking and ceases upon rest, it is termed intermittent claudication. Symptoms of limb ischaemia can range from aches, cramps, numbness or, more commonly, pain. These symptoms can manifest anywhere in the lower limb, although the most common site is the calf muscle due to insufficient patency of the superficial femoral artery.1 2 In addition, these symptoms limit walking capacity (speed and distance) and in turn lower the quality of life.3 4 Whether symptomatic or not, peripheral arterial disease is also associated with an increased risk of cardiovascular and cerebrovascular events, death, as well as accelerated rates of bone loss and increased fracture risk.1 5

Several types of intervention (often...]]> 2013-04-09T00:01:03-07:00 info:doi/10.1136/bjsports-2013-092322 hwp:master-id:bjsports;bjsports-2013-092322 British Association of Sport and Excercise Medicine 2013-04-09 PEDro systematic review update http://bjsm.bmj.com/cgi/content/short/bjsports-2012-092096v2?rss=1 Background

There is little information about Metatarsal Five (MT-5) fractures for specific sports.

To study the occurrence, the imaging characteristics, the lay-off times and healing problems of MT-5 fractures among male footballers.

Sixty-four European elite teams were monitored from 2001 to 2012. x-Rays were collected and classified by the Torg criteria.

Of 13 754 injuries, 0.5% (67) proved to be MT-5 fractures. Their incidence was 0.04 injuries/1000 h of exposure. A team of 25 players might thus expect an MT-5 fracture every fifth season. Of these fractures, 67% (38) were primary and 33% were refractures. One of the 38 primary fractures was an avulsion of the tuberosity; all the others (97%) located towards the base. In total, 32% of the players with MT-5 fracture were younger than 21 years, 40% of the fractures occurred during the preseason and 45% of the players had prodromal symptoms. In total, 54% of the initial x-rays were classified as Torg type II (stress fractures), and 46% were classified as Torg type I (acute type). After surgical treatment the fractures healed faster, compared with conservative treatment (75% vs 33%, p<0.05). There was no significant difference in lay-off days between players that had been operated, and those that had not (80 vs 74 days, p=0.67).

The majority of MT-5 fractures are stress fractures, and mainly occur among young players. There are frequent healing problems, which might be explained by the stress nature of the injury. After surgery there are less healing problems, compared with those in conservative treatment.

Cross-sectional study. Whole-body kinematics and knee joint kinetics were calculated in 123 female handball players (mean±SD, 22.5±7.0 years, 171±7 cm, 67±7 kg) performing sidestep cutting. Three cuts from each side were analysed. Linear regression was applied between selected technique factors and maximum knee abduction moment during the first 100 ms of the contact phase. Furthermore, we investigated to what degree the abduction moment originated from the magnitude of the ground reaction force (GRF) or the knee abduction moment arm of the GRF.

Technique factors explained 62% of the variance in knee abduction moments. Cut width, knee valgus, toe landing, approach speed and cutting angle were the most significant predictors. An increase in one of these factors of 1 SD increased the knee abduction moment from 12% to 19%. The effect of the moment arm of the GRF was more important than the force magnitude for maximum knee abduction moments.

Lower knee abduction loads during sidestep cutting may be achieved if cuts are performed as narrow cuts with low knee valgus and toe landings. These factors may be targeted in ACL injury prevention programmes.

600 high-level Arabic, 415 Black African, 160 Caucasian male athletes (exercising ≥6 h/week) and 201 Arabic controls presented for ECG and echocardiographic screening.

9 athletes (0.7%) were identified with a cardiac pathology associated with sudden cardiac death. Two Arabics (0.3%) and five Black Africans (1.2%) were diagnosed with hypertrophic cardiomyopathy; a prevalence four times greater in Black African compared to Arabic athletes. Arabic athletes had significantly greater (p<0.05) left ventricular (LV) end-diastolic diameters, maximal LV wall thicknesses and LV mass compared with controls; yet were significantly smaller than Black African and Caucasian athletes. The percentage of athletes demonstrating LV hypertrophy (≥12 mm) was comparable between Arabic, Black African and Caucasian populations (0.5%, 0.5% and 0.6%, respectively). There was no difference in the frequency of an uncommon and training-unrelated ECG between Arabic and Caucasian. However, Black Africans demonstrated a significantly greater prevalence than Arabic and Caucasian athletes (20% vs 8.4% and 6.9%, p<0.001); specifically more right/left atrial enlargement and T wave inversion.

Arabic athletes present significantly smaller cardiac dimensions than Black African and Caucasian athletes. There was no significant difference between the frequency of an uncommon and training-unrelated ECG between Arabic and Caucasian athletes. Therefore, the use of ESC guidelines for the interpretation of an athlete's ECG is clinically relevant and acceptable for use within Arabic athletes.

The aim of this cluster-randomised controlled trial was to assess whether different delivery methods of an injury prevention programme (FIFA 11+) to coaches could improve player performance, and to examine the effect of player adherence on performance and injury risk.

During the 2011 football season (May–August), coaches of 31 tiers 1–3 level teams were introduced to the 11+ through either an unsupervised website or a coach-focused workshop with and without additional on-field supervisions. Playing exposure, adherence to the 11+, and injuries were recorded for female 13-year-old to 18-year-old players. Performance testing included the Star Excursion Balance Test (SEBT), single-leg balance, triple hop and jumping-over-a-bar tests.

Complete preseason and postseason performance tests were available for 226 players (66.5%). Compared to the unsupervised group, single-leg balance (OR=2.8; 95% CI 1.1 to 4.6) and the anterior direction of the SEBT improved significantly in the onfield supervised group of players (OR=4.7; 95% CI 2.2 to 7.1), while 2-leg jumping performance decreased (OR=–5.1; 95% CI –9.9 to –0.2). However, significant improvements in 5 of 6 reach distances in the SEBT were found, favouring players who highly adhered to the 11+. Also, injury risk was lower for those players (injury rate ratio, IRR=0.28, 95% CI 0.10 to 0.79).

Different delivery methods of the FIFA 11+ to coaches influenced players’ physical performance minimally. However, high player adherence to the 11+ resulted in significant improvements in functional balance and reduced injury risk.

Prospective cohort study conducted during a 52-week period.

Male and female youth and adult athletics athletes ranked in the top 10 in Sweden (n=292).

199 (68%) athletes reported an injury during the study season. Ninety-six per cent of the reported injuries were non-traumatic (associated with overuse). Most injuries (51%) were severe, causing a period of absence from normal training exceeding 3 weeks. Log-rank tests revealed risk differences with regard to athlete category (p=0.046), recent previous injury (>3 weeks time-loss; p=0.039) and training load rank index (TLRI; p=0.019). Cox proportional hazards regression analyses showed that athletes in the third (HR 1.79; 95% CI 1.54 to 2.78) and fourth TLRI quartiles (HR 1.79; 95% CI 1.16 to 2.74) had almost a twofold increased risk of injury compared with their peers in the first quartile and interaction effects between athlete category and previous injury; youth male athletes with a previous serious injury had more than a fourfold increased risk of injury (HR=4.39; 95% CI 2.20 to 8.77) compared with youth females with no previous injury.

The injury incidence among both youth and adult elite athletics athletes is high. A training load index combing hours and intensity and a history of severe injury the previous year were predictors for injury. Further studies on measures to quantify training content and protocols for safe return to athletics are warranted.

To compare the effectiveness of two rehabilitation protocols after acute hamstring injury in Swedish elite football players by evaluating time needed to return to full participation in football team-training and availability for match selection.

Prospective randomised comparison of two rehabilitation protocols.

Seventy-five football players with an acute hamstring injury, verified by MRI, were randomly assigned to one of two rehabilitation protocols. Thirty-seven players were assigned to a protocol emphasising lengthening exercises, L-protocol and 38 players to a protocol consisting of conventional exercises, C-protocol. The outcome measure was the number of days to return to full-team training and availability for match selection. Reinjuries were registered during a period of 12 months after return.

Time to return was significantly shorter for the players in the L-protocol, mean 28 days (1SD±15, range 8–58 days), compared with the C-protocol, mean 51 days (1SD±21, range 12–94 days). Irrespective of protocol, stretching-type of hamstring injury took significantly longer time to return than sprinting-type, L-protocol: mean 43 vs 23 days and C-protocol: mean 74 vs 41 days, respectively. The L-protocol was significantly more effective than the C-protocol in both injury types. One reinjury was registered, in the C-protocol.

A rehabilitation protocol emphasising lengthening type of exercises is more effective than a protocol containing conventional exercises in promoting time to return in Swedish elite football.

Seventeen healthy adults underwent sonographic examination of the right patellar (n=9) and Achilles (n=8) tendons immediately prior to and following 90 repetitions of weight-bearing quadriceps and gastrocnemius-resistance exercise performed against an effective resistance of 175% and 250% body weight, respectively. Sagittal tendon thickness was determined 20 mm from the enthesis and transverse strain, as defined by the stretch ratio, was repeatedly monitored over a 24 h recovery period.

Resistance exercise resulted in an immediate decrease in Achilles (t₇=10.6, p<0.01) and patellar (t₈=8.9, p<0.01) tendon thickness, resulting in an average transverse stretch ratio of 0.86±0.04 and 0.82±0.05, which was not significantly different between tendons. The magnitude of the immediate transverse strain response, however, was reduced with advancing age (r=0.63, p<0.01). Recovery in transverse strain was prolonged compared with the duration of loading and exponential in nature. The average primary recovery time was not significantly different between the Achilles (6.5±3.2 h) and patellar (7.1±3.2 h) tendons. Body weight accounted for 62% and 64% of the variation in recovery time, respectively.

Despite structural and biochemical differences between the Achilles and patellar tendon, the mechanisms underlying transverse creep recovery in vivo appear similar and are highly time dependent. These novel findings have important implications concerning the time required for the mechanical recovery of high-stress tendons following an acute bout of exercise.

We examined the independent association of isometric muscle strength in youth with cardiovascular risk factors in young adulthood using data from the Danish European Youth Heart Study; a population-based prospective cohort study among boys and girls (n=332) followed for up to 12 years. In youth maximal voluntary contractions during isometric back extension and abdominal flexion were determined using a strain-gauge dynamometer and cardiorespiratory fitness was obtained from a maximal cycle ergometer test. Cardiovascular risk factors were obtained in youth and in young adulthood. Associations were examined using multivariable-adjusted regression models including major confounding factors.

Each 1 SD difference in isometric muscle strength in youth (0.17 N/kg) was inversely associated with body mass index (BMI; –0.60 kg/m², 95% CI –0.97 to –0.22), triglyceride (–0.09 mmol/l, 95% CI –0.16 to –0.02), diastolic blood pressure (BP) (–1.22 mm Hg, 95% CI –2.15 to –0.29) and a composite cardiovascular risk factor score (–0.61 SD, 95% CI –1.03 to –0.20) in young adulthood in multivariable-adjusted analyses including fitness. Associations to triglyceride, diastolic BP and the cardiovascular risk factor score remained with additional adjustment for waist circumference or BMI. Each 1 SD difference in isometric muscle strength in youth was significantly associated with 0.59 (95% CI 0.40 to 0.87) lower odds of general overweight/obesity in young adulthood (p=0.007) and was marginally associated with incident raised BP, raised triglyceride and low high-density lipoprotein cholesterol.

This study suggests that greater isometric muscle strength in youth is associated with lower levels of cardiovascular risk factors in young adulthood independent of fitness, adiposity and other confounding factors.

This is a secondary analysis of results of a randomised controlled trial of the effectiveness of DHC. Sixty-nine patients with subacromial impingement syndrome were prospectively included. Patients and the assessor were blinded to the study hypothesis and treatment, respectively. Patients underwent DHC or non-specific mobilisation as a control for 6 weeks in 15 supervised individual outpatient sessions with home exercises. Outcomes were pain-free range of motion and presence of painful arc of the shoulder, both in active flexion and abduction of the arm at 3 months.

At 3 months, pain-free range of motion, both flexion and abduction, was greater in the DHC group than in the mobilisation group. The number of patients with painful arc during flexion was decreased in the DHC group.

DHC improves painful active elevation of the arm. We suggest that DHC may act via a specific effect on subacromial impingement mechanism.

Primarily to investigate muscle activity of adductor longus during six traditional and two new hip adduction exercises. Additionally, to analyse muscle activation of gluteals and abdominals.

40 healthy male elite soccer players, training >5 h a week, participated in the study. Muscle activity using surface electromyography (sEMG) was measured bilaterally for the adductor longus during eight hip adduction strengthening exercises and peak EMG was normalised (nEMG) using an isometric maximal voluntary contraction (MVC) as reference. Furthermore, muscle activation of the gluteus medius, rectus abdominis and the external abdominal obliques was analysed during the exercises.

There were large differences in peak nEMG of the adductor longus between the exercises, with values ranging from 14% to 108% nEMG (p<0.0001). There was a significant difference between legs in three of the eight exercises (35–48%, p<0.0001). The peak nEMG results for the gluteals and the abdominals showed relatively low values (5–48% nEMG, p<0.001).

Specific hip adduction exercises can be graded by exercise intensity providing athletes and therapists with the knowledge to select appropriate exercises during different phases of prevention and treatment of groin injuries. The Copenhagen Adduction and the hip adduction with an elastic band are dynamic high-intensity exercises, which can easily be performed at any training facility and could therefore be relevant to include in future prevention and treatment programmes.

The suitability of the SIC model was demonstrated with date ordered sports injury data from a large injury database from community Australian football players over one playing season. A subsequent injury was defined to have occurred in the subset of players with two or more reported injuries.

282 players sustained 469 subsequent injuries of which 15.6% were coded to categories representing injuries that were directly related to previous index injuries. This demonstrates that players can sustain a number of injuries over one playing season. Many of these will be unrelated to previous injuries but subsequent injuries that are related to previous injury occurrences are not uncommon.

The handling of subsequent sports injuries is a substantial challenge for the sports medicine field—both in terms of injury treatment and in epidemiological research to quantify them. Application of the SIC model allows for multiple different injury types and relationships within players, as well as different index injuries.

Secondary analysis of data from a group-clustered randomised controlled trial.

A periodised exercise training warm-up programme was delivered to players during training sessions over an 8-week preseason (weeks 1–8) and 18-week playing season.

1564 community Australian football players.

Reach, measured weekly, was the number of players who attended training sessions. Adoption was the number of attending players who completed the programme in full, partially or not at all. Reasons for partial or non-participation were recorded.

In week 1, 599 players entered the programme; 55% attended 1 training session and 45% attended > 1 session. By week 12, 1540 players were recruited but training attendance (reach) decreased to <50%. When players attended training, the majority adopted the full programme—ranging from 96% (week 1) to above 80% until week 20. The most common reasons for low adoption were players being injured, too sore, being late for training or choosing their own warm-up.

The training programme's reach was highest preseason and halved at the playing season's end. However, when players attended training sessions, their adoption was high and remained close to 70% by season end. For sports injury prevention programmes to be fully effective across a season, attention also needs to be given to (1) encouraging players to attend formal training sessions and (2) considering the possibility of some form of programme delivery outside of formal training.

To develop a PRO questionnaire based on VISA questionnaire forms for patients with PHT.

Item generation, item reduction, item scaling and evaluation of the psychometric properties were used to develop a questionnaire to assess the severity of symptoms, function and ability to play sports in patients with PHT and healthy subjects. The final version, named Victorian Institute of Sport Assessment-Proximal Hamstring Tendons (VISA-H), consisted of eight questions that measured the domains of pain, function and sporting activity. The psychometric properties of a questionnaire were estimated in a population of non-surgical (n=20) and surgical (n=10) patients, as well as in healthy subjects (n=30).

The VISA-H questionnaire displayed a high degree of internal consistency, with a Cronbach α of 0.84. (The test–retest reliability was high for all groups of participants with an intraclass correlation coefficient ranging from 0.90 to 0.95.) The VISA-H exhibited a high correlation with the Nirschl phase rating scale (r ranging from –0.75 to –0.89) and a generic tendon grading system proposed by Curwin and Stanish (r ranging from –0.70 to –0.88). Also, the responsiveness was higher for the VISA-H questionnaire with an area under the curve of 0.90 and a minimum clinically important difference of 22 points.

The VISA-H is a PRO questionnaire with high psychometric properties for measuring pain, function and sporting activity in patients with PHT.

The electronic databases PubMed, EMBASE and SPORTDiscus were searched for relevant studies reporting on the effects of physical exercise on executive functions. Nineteen studies were selected.

There was a significant overall effect of acute physical exercise on executive functions (d=0.52, 95% CI 0.29 to 0.76, p<0.001). There were no significant differences between the three age groups (Q (2)=0.13, p=0.94). Furthermore, no significant overall effect of chronic physical exercise (d=0.14, 95%CI –0.04 to 0.32, p=0.19) on executive functions (Q (1)=5.08, p<0.05) was found. Meta-analytic effect sizes were calculated for the effects of acute physical exercise on the domain's inhibition/interference control (d=0.46, 95% CI 0.33 to 0.60, p<0.001) and working memory (d=0.05, 95% CI –0.51 to 0.61, p=0.86) as well as for the effects of chronic physical exercise on planning (d=0.16, 95% CI 0.18 to 0.89, p=0.18).

Results suggest that acute physical exercise enhances executive functioning. The number of studies on chronic physical exercise is limited and it should be investigated whether chronic physical exercise shows effects on executive functions comparable to acute physical exercise. This is highly relevant in preadolescent children and adolescents, given the importance of well-developed executive functions for daily life functioning and the current increase in sedentary behaviour in these age groups.

Using Emotiv EPOC, a low-cost mobile EEG recorder, participants took part in a 25 min walk through three different areas of Edinburgh. The areas (of approximately equal length) were labelled zone 1 (urban shopping street), zone 2 (path through green space) and zone 3 (street in a busy commercial district). The equipment provided continuous recordings from five channels, labelled excitement (short-term), frustration, engagement, long-term excitement (or arousal) and meditation.

A new form of high-dimensional correlated component logistic regression analysis showed evidence of lower frustration, engagement and arousal, and higher meditation when moving into the green space zone; and higher engagement when moving out of it.

Systematic differences in EEG recordings were found between three urban areas in line with restoration theory. This has implications for promoting urban green space as a mood-enhancing environment for walking or for other forms of physical or reflective activity.

10 participants performed four different shoulder-abduction exercises in two rounds (80 exercise scenarios in total). The scenarios were (1) low contraction speed, full range of motion (0–90°), (2) high contraction speed, full range of motion (0–90°), (3) low contraction speed, diminished range of motion (0–45°) and (4) unsystematic pull of the elastic exercise band. Stretch-sensor readings from each participant were recorded and presented randomly to the raters. Two raters were asked to differentiate between unsystematic pull (scenario 4), from shoulder abduction strength exercises (scenarios 1–3). The next two raters were asked to identify the four different exercise scenarios (scenarios 1–4).

The first two raters were able to differentiate between unsystematic pull (scenario 4) from shoulder abduction strength exercises (scenarios 1–3). They made no errors (100% success rate). The second two raters were both able to identify each of the 80 scenarios (scenarios 1–4). They too made no errors (100% success rate).

The stretch-sensor readings from the elastic exercise band allow health professionals to quantify whether strength-exercises have been performed as prescribed. These findings have great implications for future clinical practice and research where home exercises are the drugs-of-choice, as they enable clinicians and researchers to measure the exact adherence and quality of the prescribed exercises.

To identify and classify the content of concussion-related videos available on YouTube.

An observational study using content analysis.

YouTube's video database was systematically searched using 10 search terms selected from MeSH and Google Adwords. The 100 videos with the largest view counts were chosen from the identified videos. These videos and their accompanying text were analysed for purpose, source and description of content by a panel of assessors who classified them into data-driven thematic categories.

434 videos met the inclusion criteria and the 100 videos with the largest view counts were chosen. The most common categories of the videos were the depiction of a sporting injury (37%) and news reports (25%). News and media organisations were the predominant source (51%) of concussion-related videos on YouTube, with very few being uploaded by professional or academic organisations. The median number of views per video was 26 191.

Although a wide range of concussion-related videos were identified, there is a need for healthcare and educational organisations to explore YouTube as a medium for the dissemination of quality-controlled information on sports concussion.

The main outcome was ice hockey injury, defined as any injury occurring during the 2008/2009 season that required medical attention, and/or removal from a session and/or missing a subsequent session. Potential risk factors included age group, level of play, previous injury, ice hockey experience, physical activity level, weight, height, position of play and menarche. Incidence rate ratios (IRR) were estimated with Poisson Regression adjusted for cluster (team). Exposure data were collected for every session for each participating player.

Twenty-eight teams (n=324) from Atom (ages 9–10), PeeWee (11–12), Bantam (13–14) and Midget (15–17) participated with 53 reported injuries. The overall injury rate was 1.9 injuries/1000 player-hours (95% CI 1.4 to 2.7). Previous injury (IRR=2.7, 95% CI 1.7 to 4.3), games (IRR=2.1, 95% CI 1.1 to 4.2), menarche (PeeWee) (IRR=4.1, 95% CI 1.0 to 16.8) were significant risk factors. In Midget, the more elite divisions were associated with a lower injury risk (A-IRR=0.2, 95% CI 0.1 to 0.5) (AAA-IRR=0.5, 95% CI 0.2 to 0.9).

Injury rates were lower in this study than previously found in male youth and women's ice hockey populations. Previous injury and game play as risk factors are consistent with the literature. Menarche as a risk factor is a new finding in this study. This research will inform future studies of the development of injury prevention strategies in this population.

Ten trained cyclists participated in this study (33±9 years; 171.5±5.8 cm; 72.8±9.5 kg; 10–11 training years). After 20-min of receiving either anodal tDCS applied over the left TC (T3) or sham stimulation, subjects completed a maximal incremental cycling exercise test. RPE, heart rate (HR) and R–R intervals (as a measure of ANS function) were recorded continuously throughout the tests. Peak power output (PPO) was recorded at the end of the tests.

With anodal tDCS, PPO improved by ~4% (anodal tDCS: 313.2±29.9 vs 301.0±19.8 watts: sham tDCS; p=0.043), parasympathetic vagal withdrawal was delayed (anodal tDCS: 147.5±53.3 vs 125.0±35.4 watts: sham tDCS; p=0.041) and HR was reduced at submaximal workloads. RPE also increased more slowly during exercise following anodal tDCS application, but maximal RPE and HR values were not affected by cortical stimulation.

The findings suggest that non-invasive brain stimulation over the TC modulates the ANS activity and the sensory perception of effort and exercise performance, indicating that the brain plays a crucial role in the exercise performance regulation.

Patients, aged 35–75, attending four practices in socioeconomically deprived areas, were invited to complete a General Practice PA Questionnaire during routine consultations. Health professionals invited ‘inactive’ individuals to a pedometer-based intervention and were randomly allocated to group 1 (prescribed a self-determined goal) or group 2 (prescribed a specific goal of 2500 steps/day above baseline). Both groups kept step-count diaries and received telephone follow-up at 1, 2, 6 and 11 weeks. Step counts were reassessed after 12 weeks.

Of the 2154 patients attending, 192 questionnaires were completed (8.9%). Of these, 83 were classified as ‘inactive’; 41(10 men; 31 women) completed baseline assessments, with the mean age of participants being 51 years. Mean baseline step counts were similar in group 1 (5685, SD 2945) and group 2 (6513, SD 3350). The mean increase in steps/day was greater in groups 1 than 2 ((2602, SD 1957) vs (748, SD 1997) p=0.005).

A trial of a pedometer-based intervention using self-determined step counts appears feasible in primary care. Pedometers appear acceptable to women, particularly at a perimenopausal age, when it is important to engage in impact loading activities such as walking to maintain bone mineral density. An increase of 2500 steps/day is achievable for inactive patients, but the effectiveness of different approaches to realistic goal-setting warrants further study.

Osteochondral lesion of the talus.

The initial MRI (figure 3) identified subchondral oedema-like signal of the medial talus on the fluid-sensitive short tau inversion recovery (STIR) sequence. The T1-weighted sequence was normal. A small effusion was present and the talar cartilage, ligaments and tendons were normal (not shown).

Anteroposterior and lateral plain radiographs obtained at 18 months (figure 4) identified a 7 mm subchondral cyst within the medial talar dome. The talar dome was intact and there was no collapse of the cortex.

The second MRI (figure 5) showed a predominately high-T2 signal, low-T1 signal lesion within the subcortical bone corresponding to the original area of oedema-like signal in the presentation MRI (figure 3) and the cystic lucency on the 18 months radiograph (figure 4). A curvilinear focus of high signal immediately beneath the hyaline cartilage ( 2013-02-25T00:00:47-08:00 info:doi/10.1136/bjsports-2012-091947a hwp:master-id:bjsports;bjsports-2012-091947a British Association of Sport and Excercise Medicine 2013-02-25 I-test http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091290v2?rss=1 Background

In modern professional soccer, the ability to recover from official match-play and intense training is often considered a determining factor in subsequent performance.

To investigate the influence of playing multiple games with a short recovery time between matches on physical activity, technical performance and injury rates.

The variation of physical (overall distance, light-intensity, low-intensity, moderate-intensity and high-intensity running) and technical performance (successful passes, balls lost, number of touches per possession and duels won) of 16 international players was examined during three different congested periods of matches (six games in 18 days) from the French League and Cup (n=12), and the UEFA Champions’ League (n=6) during the 2011–2012 season and compared with that reported in matches outside these periods. Data were collected using a computerised match analysis system (Amisco). Injury rate, time loss injuries, as well as the mechanism, circumstances and severity of the injury were also analysed.

No differences were found across the six successive games in the congested period, and between no congested and the three congested periods for all the physical and technical activities. The total incidence of injury (matches and training) across the prolonged congested periods did not differ significantly to that reported in the non-congested periods. However, the injury rate during match-play was significantly higher during the congested period compared with the non-congested period (p<0.001). The injury rate during training time was significantly lower during the congested period compared with the non-congested periods (p<0.001). The mean lay-off duration for injuries was shorter during the congested periods compared with the non-congested periods (9.5±8.8 days vs 17.5±29.6 days, respectively p=0.012, effect sizes=0.5).

Although physical activity, technical performance and injury incidence were unaffected during a prolonged period of fixture congestion, injury rates during training and match-play and the lay-off duration were different to that reported in matches outside this period.

To describe a new surveillance method that is capable of recording all types of health problems and to use it to study the illness and injury patterns of Norwegian athletes preparing for the 2012 Olympic and Paralympic Games.

A total of 142 athletes were monitored over a 40-week period using a weekly online questionnaire on health problems. Team medical personnel were used to classify and diagnose all reported complaints.

A total of 617 health problems were registered during the project, including 329 illnesses and 288 injuries. At any given time, 36% of athletes had health problems (95% CI 34% to 38%) and 15% of athletes (95% CI 14% to 16%) had substantial problems, defined as those leading to moderate or severe reductions in sports performance or participation, or time loss. Overuse injuries represented 49% of the total burden of health problems, measured as the cumulative severity score, compared to illness (36%) and acute injuries (13%).

The new method was sensitive and valid in documenting the pattern of acute injuries, overuse injuries and illnesses in a large, heterogeneous group of athletes preparing for the Olympic and Paralympic Games.

We report a multistage campaign to facilitate and encourage the use of appropriate headgear among the estimated 100 000 hurling players in Ireland. This campaign lasted for 27 years between 1985 and 2012, and involved a number of different stages including: (1) facilitating the establishment of a business dedicated to developing head protection equipment suitable for hurling, (2) placing a particular emphasis on continual product enhancement to the highest industrial standards, (3) engaging continually with the game's controlling body, the Gaelic Athletic Association (GAA), with the ultimate objective of securing a mandatory usage policy for protective helmets and faceguards, (4) longitudinal research to monitor hurling injury, equipment usage and players’ attitudes and (5) widely communicating key research findings to GAA leaders and members, as well as to 1000 clubs and schools.

One of our three relevant studies included 798 patients and identified a dramatic association between the type of head protection used by a player, if any, and the site of the injury requiring treatment. While 51% of the injured players without head protection suffered head trauma, this rate was only 35% among the players wearing helmets and 5% among players who were wearing full head protection (both a helmet and faceguard).

The GAA responded in three stages to the accumulating evidence: (1) they introduced a mandatory regulation for those aged less than 18 years in 2005; (2) this ruling was extended to all players under 21 years in 2007 and (3) finally extended to all players irrespective of age, gender or grade from January 2010. The latter ruling applied to both games and organised training sessions.

To gain an understanding of the types and mechanisms of head injuries sustained by batters wearing a helmet.

Injury type, location and mechanism were categorised via analysis of 35 videos of National or International cricketers sustaining a head injury while batting.

53% of the injuries occurred following ball impact to either the helmet faceguard and peak, or the faceguard alone. Ten injuries (29%) resulted from the ball penetrating the gap between the helmet peak and faceguard. 29% of the injuries involved the ball contacting the face following penetration of the gap between the helmet peak and faceguard. Fractures, lacerations and contusions were the most common injuries associated with face or faceguard impacts while concussion was more commonly associated with impacts to the side or rear of the helmet shell. Many of the injuries described resulted in prolonged or permanent absence from cricket.

Significant head and facial injuries occur in cricket batters despite wearing of helmets. Cricket helmet design and associated National and International Safety Standards should be improved to provide increased protection against head injury related to ball impact to the faceguard and shell of the helmet.

To conduct injury surveillance across multiple teams during the ICC Cricket World Cup 2011.

An electronic system, based on the guidelines for injury surveillance in international cricket, was used to record all new injury episodes was used for data collection.

Twenty-three time-loss and 97 non-time-loss injuries were recorded. The injury incidence was 3.7/100 player-days (0.7 time-loss and 3.0 non-time-loss) with time-loss incidence being; for match injury 20.1/1000 player-days, bowling injury 3.3/100 bowling days and batting injuries 2.2/10 000 balls faced. Thigh muscle strain and medical illness were the diagnoses with the highest incidence. Fast bowlers, slow bowlers and batters all had a similar injury prevalence of approximately 5%. The bowling delivery stride was the activity that resulted in the greatest lost time.

This is the first study to use recommended injury surveillance guidelines to reporting injury rates across multiple teams at a major cricket tournament. Non-time-loss injury incidence appears relatively high and further study of the effect on performance and progression to subsequent time-loss is required. Fast bowler injury prevalence rates are lower than reported elsewhere, however this may be due to the nature of the tournament and match format, which is likely to impose a lower relative workload. In future, data from all competing teams over all formats of the game (Twenty20, ODI and Tests) needs to be analysed to effectively inform injury prevention research and practice.

30 club-level athletes were block randomised (using baseline 25[OH]D concentrations) into one of three groups receiving either a placebo (PLB), 20 000 or 40 000 IU/week oral vitamin D₃ for 12 weeks. Serum 25[OH]D and muscle function (1-RM bench press and leg press and vertical jump height) were measured presupplementation, 6 and 12 weeks postsupplementation. Vitamin D deficiency was defined in accordance with the US Institute of Medicine guideline (<50 nmol/l).

57% of the subject population were vitamin D deficient at baseline (mean±SD value 51±24 nmol/l). Following 6 and 12 weeks supplementation with 20 000 IU (79±14 and 85±10 nmol/l, respectively) or 40 000 IU vitamin D₃ (98±14 and 91±24 nmol/l, respectively), serum vitamin D concentrations increased in all participants, with every individual achieving concentrations greater than 50 nmol/l. In contrast, vitamin D concentration in the PLB group decreased at 6 and 12 weeks (37±18 and 41±22 nmol/l, respectively). Increasing serum 25[OH]D had no significant effect on any physical performance parameter (p>0.05).

Both 20 000 and 40 000 IU vitamin D₃ supplementation over a 6-week period elevates serum 25[OH]D concentrations above 50 nmol/l, but neither dose given for 12 weeks improved our chosen measures of physical performance.

The sample comprised 2506 Portuguese healthy children and adolescents aged 10–18 years, from a cross-sectional school-based study (2008). PA and sedentary behaviour were assessed with accelerometry. Participants were classified as meeting current PA guidelines for youth versus not meeting, and as low versus high sedentary (according to the median value of sedentary time/day by age and gender), and then grouped as follows: Low active—high sedentary; low active—low sedentary; high active—high sedentary; high active—low sedentary. CRF was assessed with the FITNESSGRAM 20 m shuttle-run test. Binary logistic regression models were constructed to verify the relationship between high CRF and the combined influence of MVPA/sedentary behaviour, adjusting for age, gender, body mass index and accelerometer wear time.

Participants classified as high active/low sedentary (OR=1.81; 95% CI 1.21 to 2.69), as well as those classified as low active/low sedentary (OR=1.27; 95% CI 1.01 to 1.61) were more likely to be fit, compared with those from the low-active/high-sedentary group.

MVPA and sedentary behaviour may act independently in their relation with CRF, and that MVPA levels may not overcome the deleterious influence of high-sedentary time in maximising CRF.

The lack of reliable, valid and responsive outcome measures for patients with hip and groin injuries...]]> 2013-02-13T00:00:36-08:00 info:doi/10.1136/bjsports-2012-092090 hwp:master-id:bjsports;bjsports-2012-092090 British Association of Sport and Excercise Medicine 2013-02-13 Editorial http://bjsm.bmj.com/cgi/content/short/bjsports-2012-092098v1?rss=1 Background

Sport and exercise medicine (SEM) in the UK is gaining the recognition of medical students as a potentially attractive career. The London 2012 Olympic health based legacy, together with the media spotlight on sports injuries, has served to further increase this interest in SEM at an undergraduate level. In this editorial, I address three barriers that students who are interested in SEM need to overcome to enter specialty training.

MRI (sagittal STIR and T1-weighted images and transversal T2-weighted, proton density and T2 fat-saturated images) revealed intact fibres of the quadriceps tendon....]]> 2013-02-08T00:00:36-08:00 info:doi/10.1136/bjsports-2012-091773 hwp:master-id:bjsports;bjsports-2012-091773 British Association of Sport and Excercise Medicine 2013-02-08 I-test http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091710v1?rss=1 Objective

To prospectively identify proximal risk factors contributing to the development of exertional medial tibial pain (EMTP).

Data were prospectively collected on healthy female students in physical education, who were freshmen in 2010–2011 and 2011–2012. 95 female students, aged 18.15±0.84, were tested at the beginning of their first academic year. Testing included isokinetic hip strength measurements of the abductors, adductors, internal rotators and external rotators. The follow-up of the individulas was assessed using a weekly online questionnaire and a 3-monthly retrospective control questionnaire. EMTP was diagnosed by an experienced MD (Doctor of Medicine). Cox regression analysis was used to identify the potential risk factors for the development of EMTP.

21 individuals were diagnosed with EMTP during follow-up. The results of this study identified that decreased hip abductor concentric strength is a predictive parameter for the development of EMTP in females. More specifically, total work (p=0.010) and average power (p=0.045) for concentric abduction strength were found to be significant predictors for this lower leg overuse injury.

Hip abductor weakness is a significant predictor for EMTP in women. Preventive screening methods for EMTP should therefore include this proximal contributing factor.

Men aged 18–22 years (n=189) from the Rochester Young Men's Study (2009–2010) participated in this analysis. Physical activity (h/week of moderate and vigorous exercise) and TV watching (h/week of TV, video or DVD watching) over the past 3 months were assessed via questionnaire. Semen quality was assessed by sperm concentration, motility, morphology and total sperm count.

Sperm concentration and total sperm count were directly related to physical activity after multivariable adjustment (p-trend=0.01 and 0.04); men in the highest quartile of moderate-to-vigorous activity (≥15 h/week) had 73% (95% CI 15% to 160%) higher sperm concentration than men in the lowest quartile (<5 h/week). TV watching was inversely associated with sperm concentration and total sperm count in multivariable analyses (p-trend=0.05 and 0.06); men in the highest quartile of TV watching (>20 h/week) had 44% (95% CI 15 to 63%) lower sperm concentration than men in the lowest quartile (0 h/week). These measures of physical and leisure time activities were not significantly associated with sperm motility or morphology.

In this population of healthy men, higher moderate-to-vigorous activity and less TV watching were significantly associated with higher total sperm count and sperm concentration.

Quadriceps femoris tendinopathy.

Jumper's knee is a degenerative condition of the knee extensor mechanism caused by overuse. While sometimes used synonymously for patellar tendinopathy alone, it is actually a tendinopathy affecting the distal insertion of the quadriceps tendon (25% of cases) or the patellar tendon.1 2 Jumper's knee is commonly seen in sports involving repetitive jumping, such as basketball and volleyball. In professional athletes, the prevalence is 14%.3 In professional basketball and volleyball players, the prevalence is 32% and 45%,3 respectively.

The multilayered quadriceps tendon connects the four quadriceps muscles to the superior pole of the patella. The patellar tendon connects the non-articulating base of the patella with the tibial tubercle. It is continuous with the quadriceps femoris tendon through the superficial rectus femoris tendon fibres that run over the anterior surface of the patella. The...]]> 2013-01-31T00:01:30-08:00 info:doi/10.1136/bjsports-2012-091773a hwp:master-id:bjsports;bjsports-2012-091773a British Association of Sport and Excercise Medicine 2013-01-31 I-test http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091567v1?rss=1 Objectives

To explore the factors that facilitate or hinder the development of healthy tennis clubs in the Netherlands and to identify suitable interventions that would help clubs to reach ‘healthy club’ status.

A maximum variation, purposive sampling strategy was used to identify and recruit board members (n=16) from 10 Dutch tennis clubs. Data were collected using in-depth interviews based on an interview guide. The interviews explored what steps the clubs had taken to create a healthy tennis club, and what the respondents perceived to be the barriers to reaching healthy club status. The data were analysed using thematic content analysis. An ecological model was used to frame the interpretation of the themes and guide the development of the interventions.

Four emerging themes were identified: provision of healthy foods, injury prevention and health services, social health and safety around the club. The main facilitators were found to be support from club management, having appropriate policies in place and having appointed officers. The main barriers were identified as a lack of policy templates, inadequate knowledge of coaches on injury prevention and injury management and fragmented access to relevant information.

Guided by an ecological model, this study demonstrates the many factors that influence tennis clubs and the individual members of a healthy tennis club. Using this model, a multilevel intervention framework has been created that could be used by the Royal Netherlands Lawn Tennis Association to increase the number of healthy tennis clubs in the Netherlands.

We randomly assigned 510 healthy gravida to either an exercise intervention or a usual care (control) group (n=255 each). The exercise programme focused on moderate-intensity resistance and aerobic exercises (three times/week, 50–55 min/session). GDM diabetes was diagnosed according to the WHO criteria and the International Association for Diabetes in Pregnancy Study Group (IADPSG).

The intervention did not reduce the risk of developing GDM (OR 0.84, 95% CI 0.50 to 1.40) when using the WHO criteria. We observed that the intervention reduced by 58% the GDM-related risk (WHO criteria) of having a newborn with macrosomia (OR 1.76, 95% CI 0.04 to 78.90 vs 4.22, 95% CI 1.35 to 13.19) in exercise and control groups, respectively), and by 34% the GDM-related risk of having acute and elective caesarean delivery (OR 1.30, 95% CI 0.44 to 3.84 vs 1.99, 95% CI 0.98 to 4.06 in exercise and control groups, respectively). Gestational age was similar across the treatment groups (control, exercise) and GDM category (GDM or non-GDM), and maternal weight gain was ~12% lower in the exercise group independent of whether women developed GDM. The results were similar when the IADPSG criteria were used instead.

Regular moderate-intensity exercise performed over the second-third trimesters of pregnancy can be used to attenuate important GDM-related adverse outcomes.

Systematic review to address the effect of PFMT during pregnancy and after delivery in the prevention and treatment of UI.

PubMed, CENTRAL, Cochrane Library, EMBASE and PEDro databases and hand search of available reference lists and conference abstracts (June 2012).

Study eligibility criteria: Randomised controlled trials (RCTs) and quasiexperimental trials published in the English language. Participants: Primiparous or multiparous pregnant or postpartum women. Interventions: PFMT with or without biofeedback, vaginal cones or electrical stimulation. Study appraisal and synthesis methods: Both authors independently reviewed, grouped and qualitatively synthesised the trials.

22 randomised or quasiexperimental trials were found. There is a very large heterogeneity in the populations studied, inclusion and exclusion criteria, outcome measures and content of PFMT interventions. Based on the studies with relevant sample size, high adherence to a strength-training protocol and close follow-up, we found that PFMT during pregnancy and after delivery can prevent and treat UI. A supervised training protocol following strength-training principles, emphasising close to maximum contractions and lasting at least 8 weeks is recommended.

PFMT is effective when supervised training is conducted. Further high-quality RCTs are needed especially after delivery. Given the prevalence of female UI and its impact on exercise participation, PFMT should be incorporated as a routine part of women's exercise programmes in general.

Participants at an elite-level track and field meet in North America were segregated into an interview or online response. After basic demographics, participants were presented with three variant ‘Goldman’ dilemmas counter-balanced for presentation order.

Only 2 out of 212 samples  (119 men, 93 women, mean age 20.89) reported that they would take the Faustian bargain offered by the original Goldman dilemma. However, if there were no consequences to the (illegal) drug use, then 25/212 indicated that they would take the substance (no death condition). Legality also changes the acceptance rate to 13/212 even with death as a consequence. Regression modelling showed that no other variable was significant (gender, competitive level, type of sport) and there was no statistical difference between the interview and online collection method.

Goldman's results do not match our sample. A subset of athletes is willing to dope and another subset is willing to sacrifice their life to achieve success, although to a much lesser degree than that observed by Goldman. A larger scale online survey is now viable to answer important questions such as variation across sports.

To present an evidence-based overview of the effectiveness of electrophysical modality treatments for both medial and lateral epicondylitis (LE).

Searches in PubMed, EMBASE, CINAHL and Pedro were performed to identify relevant randomised clinical trials (RCTs) and systematic reviews. Two reviewers independently extracted data and assessed the methodological quality. A best-evidence synthesis was used to summarise the results.

A total of 2 reviews and 20 RCTs were included, all of which concerned LE. Different electrophysical regimes were evaluated: ultrasound, laser, electrotherapy, ESWT, TENS and pulsed electromagnetic field therapy. Moderate evidence was found for the effectiveness of ultrasound versus placebo on mid-term follow-up. Ultrasound plus friction massage showed moderate evidence of effectiveness versus laser therapy on short-term follow-up. On the contrary, moderate evidence was found in favour of laser therapy over plyometric exercises on short-term follow-up. For all other modalities only limited/conflicting evidence for effectiveness or evidence of no difference in effect was found.

Potential effectiveness of ultrasound and laser for the management of LE was found. To draw more definite conclusions high-quality RCTs examining different intensities are needed as well as studies focusing on long-term follow-up results.

Twelve male rugby players participated in a 3-week cross-over trial where an intense 60 min conditioning session was followed immediately by 15 min of either 14°C CWI, 30°C warm-water immersion (WWI) or passive control (CON) recovery intervention. Postexercise body temperatures and subjective ratings of the recovery intervention were recorded and subsequently related to performance in a 5x40 m repeated sprint protocol undertaken 24 h later.

CWI induced large reductions in core body temperature postimmersion (effect size (ES) range 1.05–3.21) and improved subsequent sprint performance compared to WWI (ES 1.04±0.84) and CON (ES 1.44±0.84). Both the degree of temperature decrease at 60 min postimmersion (r=0.6948; p=0.0121) and the subjective rating of the recovery intervention (r=0.5886; p=0.0441) were related to subsequent sprint performance. A very strong linear correlation was observed when these two factors were integrated (r=0.7743; p=0.0031).

A combination of physiological and psychological indices provides an improved indication of subsequent performance and suggests an important role of individual perception in enhancing training recovery.

A cluster randomised controlled trial was conducted in 33 primary schools. The intervention group received the educational programme to improve falling skills during their physical education (PE) classes whereas the control group received their regular PE curriculum. At baseline (October 2009) and follow-up (May 2010), a questionnaire was completed by the children about their physical activity behaviours. Furthermore, fall-related injuries were registered continuously during an entire school-year.

A total of 36 incident injuries was reported in the intervention group, equalling an injury incidence density (IID) of 0.14 fall-related injuries per 1000 h of physical activity (95% CI 0.09 to 0.18). In contrast, 96 injuries were reported by the control group corresponding to an IID of 0.26 (95% CI 0.21 to 0.32). However, because intracluster correlation was high (ICC=0.46), differences in injury incidence were not statistically significant. When activity level was taken into account, a trend was shown suggesting that the ‘falling is a sport’ programme was effective in decreasing falling-related injury risk, but only in the least active children.

Although results did not reach significance because of strong clustering effects, a trend was found suggesting that a school-based educational programme to improve falling skills may be more beneficial for the prevention of falling-related injuries in children with low levels of habitual physical activity.

A description of clinical shoulder tests is provided with explanations on exact testing procedures and complimentary photographs.

Commercially available speed skating, bicycle and ice hockey helmets were evaluated using a three-impact condition test protocol at an impact velocity of 4 m/s.

Two speed skating helmet models yielded mean peak linear accelerations at a low-estimated probability range for sustaining a concussion for all three impact conditions. Conversely, the resulting mean peak rotational acceleration values were all found close to the high end of a probability range for sustaining a concussion. A similar tendency was observed for the bicycle and ice hockey helmets under the same impact conditions.

Speed skating helmets may not be as effective at managing rotational acceleration and therefore may not successfully protect the user against risks associated with concussion injuries.

To determine the effect of concussion on RT_clin and its sensitivity and specificity for concussion.

Concussed athletes (n=28) and non-concussed control team-mates (n=28) completed RT_clin assessments at baseline and within 48 h of injury. Repeated measures analysis of variance compared mean baseline and follow-up RT_clin values between groups. Sensitivity and specificity were calculated over a range of reliable change confidence levels.

RT_clin differed significantly between groups (p<0.001): there was significant prolongation from baseline to postinjury in the concussed group (p=0.003), with a trend towards improvement in the control group (p=0.058). Sensitivity and specificity were maximised when a critical change value of 0 ms was applied (ie, any increase in RT_clin from baseline was interpreted as abnormal), which corresponded to a sensitivity of 75%, specificity of 68% and a 65% reliable change confidence level.

RT_clin appears sensitive to the effects of concussion and distinguished concussed and non-concussed athletes with similar sensitivity and specificity to other commonly used concussion assessment tools. Given its simplicity, low cost and minimal time requirement, RT_clin should be considered a viable component of the sports medicine provider's multifaceted concussion assessment battery.

This updated systematic review by Gillespie et al4 aimed to assess the effects of interventions designed to prevent falls in older people living in the community. Different types of interventions were included, such as exercises, educational programmes, medication and surgery. The focus...]]> 2013-01-11T00:02:48-08:00 info:doi/10.1136/bjsports-2012-092065 hwp:master-id:bjsports;bjsports-2012-092065 British Association of Sport and Excercise Medicine 2013-01-11 PEDro systematic review update http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091891v1?rss=1 Background

Education of health professionals is a key element of the wider strategy to increase society's physical activity levels. To date, no study has directly assessed UK medical students’ knowledge of physical activity guidelines or their ability/willingness to prescribe exercise.

A questionnaire survey of final year medical students in Scottish Universities was conducted prior to a presentation on the current UK guidelines.

Completed questionnaires (n=177) represented 37% of the final year cohorts. Physical inactivity was incorrectly perceived to be the least important risk factor to global mortality. 40% stated they were aware of current guidelines, but in a forced choice, 68% were able to correctly identify them for adults. In comparison, 97% correctly identified the UK's alcohol guidelines. 52% stated they felt adequately trained to give physical activity advice to the general public.

The medical students in this study underestimated the risk of physical inactivity, and did not know the physical activity guidelines as well as other health promotion guidelines. A large proportion remained unconfident about giving physical activity advice. Improved education of this group is required.

To compare the incidence of incidents with a propensity for injury, from the 2000 season to the 2010 season in Norwegian male professional football using video analysis.

We conducted a video analysis of incidents in Norwegian professional football. An incident was recorded if the match was interrupted by the referee, and the player lay down for more than 15 s, and appeared to be in pain or received medical treatment. We also conducted a video analysis of all player-to-player contact situations occurring during 30 randomly selected matches.

A total of 1287 incidents were identified during the two seasons. The corresponding rate of incidents was 74.4 (95% CI 67.3 to 81.5) in the 2000 season and 109.6 (95% CI 102.3 to 116.9) in the 2010 season, a significant increase from 2000 to 2010 (rate ratio 1.47, 95% CI 1.31 to 1.66). We observed a significantly higher rate of opponent-to-player contact and non-contact incidents in the 2010 season, but no change in the proportion of fouls or sanctions awarded by the referee. The rate of player-to-player contact situations in both heading and tackling duels was lower during the 2010 season.

We found an increased rate of non-contact and opponent-to-player contact incidents in both heading and tackling duels in the 2010 season compared with 10 years earlier, even if there was no increase in the frequency of player-to-player contact situations.

To investigate the treatment effects of exercise compared with other treatments for anxiety disorders.

Randomised controlled trials (RCTs) of exercise interventions for anxiety disorders were identified by searching six online databases (July 2011). A number of journals were also hand searched.

Eight RCTs were included. For panic disorder: exercise appears to reduce anxiety symptoms but it is less effective than antidepressant medication (1 RCT); exercise combined with antidepressant medication improves the Clinical Global Impression outcomes (1 RCT, p<0.05); exercise combined with occupational therapy and lifestyle changes reduces Beck Anxiety Inventory outcomes (1 RCT, p=0.0002). For social phobias, added benefits of exercise when combined with group cognitive behavioural therapy (CBT) were shown (p<0.05). There was no significant difference between aerobic and anaerobic exercise groups (1 RCT, p>0.1) with both seeming to reduce anxiety symptoms (1 RCT, p<0.001). It remains unclear as to which type of exercise; moderate to hard or very light to light, is more effective in anxiety reduction (2 RCTs).

Exercise seems to be effective as an adjunctive treatment for anxiety disorders but it is less effective compared with antidepressant treatment. Both aerobic and non-aerobic exercise seems to reduce anxiety symptoms. Social phobics may benefit from exercise when combined with group CBT. Further well-conducted RCTs are needed.

The literature was searched for RCTs in persons diagnosed with a cancer other than breast. Data were extracted to evaluate the attention to the principles of exercise training in the study design and the reporting of and adherence to the exercise prescription used for the intervention.

Of the 33 studies reviewed, none attended to all of the exercise training principles. Specificity was applied by 89%, progression by 26%, overload by 37%, initial values by 26%, diminishing returns by 9% and reversibility by 3%. Only 2 of 33 studies (6%) reported both the exercise prescription in full and adherence to each individual component of the prescription.

Application of the principles of training in exercise RCTs of non-breast cancer survivors was incomplete and inconsistent. Given these observations, interpretation of findings from the reviewed studies should consider potential shortcomings in intervention design. Though the prescribed exercise programme was often described, adherence to the entire prescription was rarely reported providing a less accurate picture of dose–response and challenges in translating programmes to community settings.

We sought to evaluate whether the work of the heart limits VO_2max during upright incremental cycle exercise to exhaustion.

Eight trained men completed two incremental exercise trials, each terminating with exercise at two different rates of work eliciting VO_2max (MAX and SUPRAMAX). During each exercise trial we continuously recorded cardiac output using pulse-contour analysis calibrated with a lithium dilution method. Intra-arterial pressure was recorded from the radial artery while pulmonary gas exchange was measured continuously for an assessment of oxygen uptake.

The workload during SUPRAMAX (mean±SD: 346.5±43.2 W) was 10% greater than that achieved during MAX (315±39.3 W). There was no significant difference between MAX and SUPRAMAX for Q (28.7 vs 29.4 L/min) or VO₂ (4.3 vs 4.3 L/min). Mean arterial pressure was significantly higher during SUPRAMAX, corresponding to a higher cardiac power output (8.1 vs 8.5 W; p<0.06).

Despite similar VO₂ and Q, the greater cardiac work during SUPRAMAX supports the view that the heart is working submaximally at exhaustion during an incremental exercise test (MAX).

PLAYgrounds was evaluated by a controlled trial, with a follow-up during one school year (10 months). Accelerometer data were collected on 1500 children in total, divided over 19 sampling moments (every 2 weeks). SOPLAY data were collected at nine sampling moments (once a month). Four intervention and four control schools were matched for playground size, number of pupils and PA levels at baseline. The intervention consisted of restructuring the playground by playground markings and by encouragement of the active use of the playground, through the provision of play equipment and educational measures such as adult encouragement and supporting physical education classes. Multilevel regression analyses were performed to analyse the effects of the intervention.

PA levels in the intervention group (moderate PA) were significantly different (p<0.001) from the control group (light PA). During the intervention on an average 77.3% of the children engaged in moderate-to-vigorous physical activity in the intervention group and 38.7% in the control group. The effect of the intervention was significantly stronger for girls than for boys (p<0.001).

The PLAYgrounds programme was effective in increasing PA levels in children during recess over the course of one school year. Thus, the programme could be used to provide structured PA promotion.

45 patients (30 men and 15 women) participated at least 6 months following primary ACL reconstruction surgery. Participants were individually matched by age, gender and sports activity to healthy controls.

Postural control was measured using a Nintendo Wii Balance Board and customised software during static single-leg stance and with the addition of a secondary task. The secondary task required participants to match the movement of an oscillating marker by adducting and abducting their arm.

Centre of pressure (CoP) path length in both medial-lateral and anterior–posterior directions, and CoP total path length.

When compared with the control group, the anterior–posterior path length significantly increased in the ACL reconstruction patients' operated (12.3%, p=0.02) and non-operated limbs (12.8%, p=0.02) for the single-task condition, and the non-operated limb (11.5%, p=0.006) for the secondary task condition. The addition of a secondary task significantly increased CoP path lengths in all measures (p<0.001), although the magnitude of the increase was similar in both the ACL reconstruction and control groups.

ACL reconstruction patients showed a reduced ability in both limbs to control the movement of the body in the anterior–posterior direction. The secondary task affected postural control by comparable amounts in patients after ACL reconstruction and healthy controls. Devices for the objective measurement of postural control, such as the one used in this study, may help clinicians to more accurately identify patients with deficits who may benefit from targeted neuromuscular training programs.

Rugby Union is experiencing unprecedented global growth. In total, 3.5 million men, women and children play worldwide, with 117 Unions in membership of the IRB.3 Modern rugby is ever more physically demanding due to increases in ball in play time, and speed of play. A fourfold increase in tackles and rucks per game has been noted.4–6 Teams with the tallest and heaviest players outperformed others in the...]]> 2012-12-22T00:00:55-08:00 info:doi/10.1136/bjsports-2012-091844 hwp:master-id:bjsports;bjsports-2012-091844 British Association of Sport and Excercise Medicine 2012-12-22 Editorial http://bjsm.bmj.com/cgi/content/short/bjsports-2012-092005v1?rss=1 SPORT SPECIALISATION: FRIEND OR FOE?

Sports participation is increasing in the USA (US population 313 million inhabitants) and in Icelandic (population 320 thousand inhabitants) adolescents, it is estimated that 35–45 million youth 6–18 years of age participate in some form of organised or recreational athletics.1 2 However, sports specialisation including year-round sport-specific training, participation on multiple teams of the same sport and focused participation in a single sport is purported to be increasing in frequency in preadolescent children across the world. There are several factors that contribute to the desire of young athletes to specialise in a single sport including the pursuit of scholarships or professional contracts, being labelled as talented by parents or coaches, retailing industry and media reports.3 A 2006 New York Times article notes "A growing number of coaches, parents, and children believe that the best way to produce superior young athletes...]]> 2012-12-20T00:01:32-08:00 info:doi/10.1136/bjsports-2012-092005 hwp:master-id:bjsports;bjsports-2012-092005 British Association of Sport and Excercise Medicine 2012-12-20 Editorial http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091704v1?rss=1 This paper will help clinicians and researchers to understand studies on the validity, responsiveness and reliability of patient-reported outcome measures (PROMs) and to interpret the scores and change scores derived from these and other types of outcome measures. Validity studies provide a method for assessing whether the underlying construct of interest is adequately assessed. Responsiveness studies explore the longitudinal validity of a test and provide evidence that an instrument can detect change in the construct of interest. Reliability is commonly assessed with correlation indices, which indicate the stability of repeated measurements and the ‘noise’ or error in the measurement. Proposed indicators for clinical interpretation of test scores are the minimum clinically important difference, the standard error of measurement and the minimum detectable change. Studies of the Victorian Institute of Sports Assessment questionnaire for patellar tendinopathy and other PROMs are used to illustrate concepts.

The exercise-induced leg pain questionnaire for German-speaking patients (EILP-G) was developed in five steps: (1) initial item generation, (2) item reduction, (3) pretesting, (4) expert meeting and (5) validation. The resulting EILP-G was tested for reliability, validity and internal consistency in 20 patients with exercise-induced leg pain, 20 asymptomatic track and field athletes serving as a population at risk and 33 asymptomatic sport students.

The patient group scored the EILP-G questionnaire significantly lower than both control groups (each p<0.001). Test–retest demonstrates an excellent reliability in all tested groups (Intraclass Correlation Coefficient, ICC=0.861–0.987). Concurrent validity of the EILP-G questionnaire showed a substantial agreement when correlated with the chronic exertional compartment syndrome classification system of Schepsis (r=–0.743; p<0.001). Internal consistency for the EILP-G questionnaire was 0.924.

EILP-G questionnaire is a valid and reliable self-administered and disease-related outcome tool to measure the severity of symptoms that impact on function and sports ability in patients with exercise-induced leg pain. It can be recommended as a robust tool for measuring the subjectively perceived severity in German-speaking patients with exercise-induced leg pain.

To determine if people who do regular yoga practice perform better at a left/right judgement task than people who do not.

Previously collected, cross-sectional data were used. Using a case–control design, participants who reported taking part in regular yoga were selected against age, gender, neck pain and arm pain-matched controls. Participants viewed 40 photographs of a model with their head turned to the left or right, and were asked to judge the direction of neck rotation. They then completed a left/right-hand judgement task.

Of the 1737 participants, 86 of them reported regularly taking part in yoga. From the remaining participants, 86 matched controls were randomly selected from all matched controls. There was no difference between Groups (yoga and no yoga) for either response time (p=0.109) or accuracy (p=0.964). There was a difference between Tasks; people were faster (p<0.001) and more accurate (p=0.001) at making left/right neck rotation judgements than they were at making left/right-hand judgements, regardless of group.

People who do regular yoga perform no differently in a left/right judgement task than people who do not.

The prospective cohort design involved 6656 participants in the Australian Longitudinal Study on Women's Health who were followed for up to 9 years (2002, age 76–81, to 2011, age 85–90). Self-reported total sitting-time was linked to all-cause mortality data from the National Death Index from 2002 to 2011. Cox proportional hazard models were used to examine the relationship between sitting-time and all-cause mortality, with adjustment for potential sociodemographic, behavioural and health confounders.

There were 2003 (30.1%) deaths during a median follow-up of 6 years. Compared with participants who sat <4 h/day, those who sat 8–11 h/day had a 1.45 times higher risk of death and those who sat ≥11 h/day had a 1.65 times higher risk of death. These risks remained after adding sociodemographic and behavioural covariates, but were attenuated after adjustment for health covariates. A significant interaction (p=0.02) was found between sitting-time and physical activity (PA), with increased mortality risk for prolonged sitting only among participants not meeting PA guidelines (HR for sitting ≥8 h/day: 1.31, 95% CI 1.07 to 1.61); HR for sitting ≥11 h/day: 1.47, CI 1.15 to 1.93).

Prolonged sitting-time was positively associated with all-cause mortality. Women who reported sitting for more than 8 h/day and did not meet PA guidelines had an increased risk of dying within the next 9 years.

To examine knee function, knee muscle strength and performance in middle-aged patients with degenerative meniscal tears, eligible for arthroscopic partial meniscectomy.

Cross-sectional study.

Eighty-two participants with MRI verified degenerative meniscal tear (35% women, mean age 49 years) answered the Knee injury and Osteoarthritis Outcome Score (KOOS) and were tested for isokinetic knee muscle strength and lower extremity performance (one-leg hop for distance, 6 m timed hop and maximum number of knee-bends in 30 s). Limb Symmetry Index (LSI) was used to express side-to-side differences in per cent using the non-injured leg as the control. An LSI ≥90% was considered normal.

Mean scores of the five subscales of the KOOS were from 13 to 36 points lower compared with a population-based reference group and similar to patients prior to anterior cruciate ligament reconstruction. Quadriceps strength and lower-extremity performance were impaired for the injured leg compared with the non-injured leg (p<0.001), with a mean difference of 13% in quadriceps strength and between 8% and 13% in lower-extremity performance. Between 41% and 52% of the participants had abnormal LSI values in quadriceps muscle strength and lower-extremity performance.

Middle-aged patients with a symptomatic degenerative meniscal tear experience functional knee problems when eligible for meniscectomy. Included participants reported difficulty with knee pain, symptoms, function and quality of life and quadriceps strength and lower-extremity performance were impaired. Approximately 50% of the study group had clinically relevant impairments in quadriceps strength and lower-extremity performance, defined as >10% differences between the injured and the non-injured leg.

Pre–post, cross-sectional surveys were carried out in locations across England, Wales and Scotland; participants were aged 65+ living in intervention or comparison streets. A questionnaire covered health and quality of life, frequency of outdoor trips, time outdoors in different activities and a 38-item scale on neighbourhood open space. A cohort study explored changes in self-report activity and well-being postintervention. Activity levels were also measured by accelerometer and accompanying diary records.

The cross-sectional surveys showed outdoor activity predicted by having a clean, nuisance-free local park, attractive, barrier-free routes to it and other natural environments nearby. Being able to park one's car outside the house also predicted time outdoors. The environmental changes had an impact on perceptions of street walkability and safety at night, but not on overall activity levels, health or quality of life. Participants’ moderate-to-vigorous activity levels rarely met UK health recommendations.

Our study contributes to methodology in a longitudinal, pre–post design and points to factors in the built environment that support active ageing. We include an example of knowledge exchange guidance on age-friendly built environments for policy-makers and planners.

Albert Einstein defined insanity as ‘doing the same thing over and over again and expecting a different result.’

The excess mortality in Scotland requires something new to be done. It may partly stem from the social breakdown and loss of jobs when heavy industry (dominated by shipbuilding, coal mining and steel) declined, particularly in West...]]> 2012-12-13T00:01:48-08:00 info:doi/10.1136/bjsports-2012-091769 hwp:master-id:bjsports;bjsports-2012-091769 British Association of Sport and Excercise Medicine 2012-12-13 Editorial http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091619v1?rss=1

Sickle cell trait (SCT) has historically been thought of as a benign condition. However, there has been increasing recognition that, in athletes, SCT is associated with an elevated risk for exertion-related death (ERD).1 With the hope to minimise future tragedies, Harmon et al2 sought to quantify the association of SCT and ERD. They looked at data compiled on nearly two million collegiate ‘athlete-years’ between 2004 and 2008. Since the risk associated with SCT was highest among Division 1 (D1) football players, the authors elected to focus on that group. Their highlighted conclusions, ‘Sickle cell trait associated with a RR of death of 37 times...’, are now being referenced in discussions regarding SCT testing.3 4 Others may have concerns about generalising results from D1 athletes to all athletes or lack of discussion about the small number of deaths (from a statistical standpoint)...]]> 2012-12-13T00:01:47-08:00 info:doi/10.1136/bjsports-2012-091619 hwp:master-id:bjsports;bjsports-2012-091619 British Association of Sport and Excercise Medicine 2012-12-13 Editorial http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091339v1?rss=1 Objectives

To cross-culturally adapt the VISA-P questionnaire for Greek-speaking patients and evaluate its psychometric properties.

The VISA-P was developed in the English language to evaluate patients with patellar tendinopathy. The validity and use of self-administered questionnaires in different language and cultural populations require a specific procedure in order to maintain their content validity.

The VISA-P questionnaire was translated and cross-culturally adapted according to specific guidelines. The validity and reliability were tested in 61 healthy recreational athletes, 64 athletes at risk from different sports, 32 patellar tendinopathy patients and 30 patients with other knee injuries. Participants completed the questionnaire at baseline and after 15–17 days.

The questionnaire's face and content validity were judged as good by the expert committee, and the participants. Concurrent validity was almost perfect (=–0.839, p<0.001). Also, factorial validity testing revealed a two-factor solution, which explained 85.6% of the total variance. A one-factor solution explained 80.8% of the variance when the other knee injury group was excluded. Known group validity was demonstrated by significant differences between patients compared with the asymptomatic groups (p<0.001). The VISA-P-GR exhibited very good test–retest reliability (ICC=0.818, p<0.001; 95% CI 0.758 to 0.864) and internal consistency since Cronbach's α analysis ranged from α=0.785 to 0.784 following a 15–17 days interval.

The translated VISA-P-GR is a valid and reliable questionnaire and its psychometric properties are comparable with the original and adapted versions.

Step 5 of Intervention Mapping was used to plan strategies to enhance MSP adoption and implementation.

Coaches were identified as the primary MSP adopters and implementers within a system including administrators, players and referees. A local advisory group was established to ensure context relevance. Performance objectives (eg, attend MSP training for coaches) and determinants of adoption and implementation behaviour (eg, knowledge, beliefs, skills and environment) were identified, informed by Social Cognitive Theory. Adoption and implementation matrices were developed and change-objectives for coaches were identified (eg, skills to deliver MSP training to players). Finally, intervention methods and specific strategies (eg, coach education, social marketing and policy and by-law development) were identified based on advisory group member experience, evidence of effective coach safety behaviour-change interventions and Diffusion of Innovations theory.

This is the first published example of a systematic approach to plan injury prevention programme diffusion in community sports. The key strengths of this approach were an effective researcher–practitioner partnership; actively engaging local sports administrators; targeting specific behaviour determinants, informed by theory and evidence; and taking context-related practical strengths and constraints into consideration. The major challenges were the time involved in using a systematic diffusion planning approach for the first time; and finding a planning language that was acceptable and meaningful to researchers and practitioners.

Systematic review.

An electronic database search was conducted (to 6 August 2012) of databases such as: MEDLINE, CINAHL, EMBASE, PubMed and Cochrane Databases. References from identified articles were examined and seven authors of eligible studies were contacted for additional information.

Studies of any design, without language restriction, were included; however, systematic reviews were excluded. Eligible studies included participants with a suspected ankle syndesmosis injury but without fracture. Reliability studies compared one or more clinical tests and studies of test accuracy compared the clinical test with a reference standard.

The database search resulted in 114 full text articles which were assessed for eligibility. Three studies were included in the review and raw data of these studies were retrieved after contacting the authors. Eight clinical diagnostic tests were investigated; palpation of the tibiofibular ligaments, external rotation stress test, squeeze, Cotton, fibula translation, dorsiflexion range of motion (ROM) and anterior drawer tests. Two studies investigated diagnostic accuracy and both investigated the squeeze test by with conflicting results. Likelihood ratios (LR) ranging from LR+1.50 to LR–1.50 were found for other tests. High intra-rater reliability was found for the squeeze, Cotton, dorsiflexion ROM and external rotation tests (83–100% close agreement). Inter-rater reliability was good for the external rotation test (ICC_2,1>0.70). Fair-to-poor reliability was found for other tests.

This is the first systematic review to investigate the reliability and accuracy of clinical tests for the diagnosis of ankle syndesmosis injury. Few studies were identified and our findings show that clinicians cannot rely on a single test to identify ankle syndesmosis injury with certainty. Additional diagnostic tests, such as MRI, should be considered before making a final diagnosis of syndesmosis injury.

A prepost experimental design was used. Dominant limb flexor hallucis brevis cramp TF, cramp electromyography (EMG) amplitude and cramp intensity were measured in 10 euhydrated, unacclimated men (age=24±4 years, height=184.2±4.8 cm, mass=84.8±11.4 kg). Subjects alternated exercising with their non-dominant limb or upper body on a cycle ergometer every 15 min at a moderate intensity until 5% body mass loss or volitional exhaustion (3.8±0.8 h; 39.1±1.5°C; humidity 18.4±3%). Cramp variables were reassessed posthypohydration.

Subjects were well hydrated at the study's onset (urine specific gravity=1.005±0.002). They lost 4.7±0.5% of their body mass (3.9±0.5 litres of fluid), 4.0±1.5 g of Na⁺ and 0.6±0.1 g K⁺ via exercise-induced sweating. Significant (n=5) or serious hypohydration (n=5) did not alter cramp TF (euhydrated=15±5 Hz, hypohydrated=13±6 Hz; F_1,9=3.0, p=0.12), cramp intensity (euhydrated= 94.2±41%, hypohydrated=115.9±73%; F_1,9=1.9, p=0.2) or cramp EMG amplitude (euhydrated=0.18±0.06 µV, hypohydrated= 0.18±0.09 µV; F_1,9=0.1, p=0.79).

Significant and serious hypohydration with moderate electrolyte losses does not alter cramp susceptibility when fatigue and exercise intensity are controlled. Neuromuscular control may be more important in the onset of muscle cramps than dehydration or electrolyte losses.

To evaluate the outcome of surgery for Achilles tendinopathy.

This observational study included 13 patients (7 men and 6 women, mean age 53 years) with a long duration (6–120 months) of chronic painful bilateral midportion Achilles tendinopathy. The most painful side at the time for investigation was selected to be operated on first. Treatment was ultrasound-guided and Doppler-guided scraping procedure outside the ventral part of the tendon under local anaesthetic. The patients started walking on the first day after surgery. Follow-ups were conducted and the primary outcome was pain by visual analogue scale. In an additional part of the study, specimens from Achilles and plantaris tendons in three patients with bilateral Achilles tendinosis were examined.

Short-term follow-ups showed postoperative improvement on the non-operated side as well as the operated side in 11 of 13 patients. Final follow-up after 37 (mean) months showed significant pain relief and patient satisfaction on both sides for these 11 patients. In 2 of 13 patients operation on the other, initially non-operated side, was instituted due to persisting pain. Morphologically, it was found that there were similar morphological effects, and immunohistochemical patterns of enzyme involved in signal substance production, bilaterally.

Unilateral treatment with a scraping operation can have benefits contralaterally; the clinical implication is that unilateral surgery may be a logical first treatment in cases of bilateral Achilles tendinopathy.

A computer-assisted literature search of MEDLINE, CINHAL and EMBASE databases (January 1966 to January 2012) using keywords related to diagnostic accuracy of the hip joint. This systematic review with meta-analysis utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the search and reporting phases of the study. Der-Simonian and Laird random effects models were used to summarise sensitivities (SN), specificities (SP), likelihood ratios and diagnostic OR.

The employed search strategy revealed 25 potential articles, with 10 demonstrating high quality. Fourteen articles qualified for meta-analysis. The meta-analysis demonstrated that most tests possess weak diagnostic properties with the exception of the patellar-pubic percussion test, which had excellent pooled SN 95 (95% CI 92 to 97%) and good specificity 86 (95% CI 78 to 92%).

Several studies have investigated pathology in the hip. Few of the current studies are of substantial quality to dictate clinical decision-making. Currently, only the patellar-pubic percussion test is supported by the data as a stand-alone HPE test. Further studies involving high quality designs are needed to fully assess the value of HPE tests for patients with intra- and extra-articular hip dysfunction.

Despite impressive health and economic consequences, it is only recently that addressing physical inactivity has become a mainstream part of public...]]> 2012-11-07T00:02:52-08:00 info:doi/10.1136/bjsports-2012-091810 hwp:master-id:bjsports;bjsports-2012-091810 British Association of Sport and Excercise Medicine 2012-11-07 Commentary http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091585v1?rss=1 Gastrointestinal distress, such as diarrhoea, cramping, vomiting, nausea and gastric pain are common among athletes during training and competition. The mechanisms that cause these symptoms are not fully understood. The stress of heat and oxidative damage during exercise causes disruption to intestinal epithelial cell tight junction proteins resulting in increased permeability to luminal endotoxins. The endotoxin moves into the blood stream leading to a systemic immune response. Tight junction integrity is altered by the phosphoylation state of the proteins occludin and claudins, and may be regulated by the type of exercise performed. Prolonged exercise and high-intensity exercise lead to an increase in key phosphorylation enzymes that ultimately cause tight junction dysfunction, but the mechanisms are different. The purpose of this review is to (1) explain the function and physiology of tight junction regulation, (2) discuss the effects of prolonged and high-intensity exercise on tight junction permeability leading to gastrointestinal distress and (3) review agents that may increase or decrease tight junction integrity during exercise.

To systematically review the relationship between the observable structural change and clinical outcomes following therapeutic exercise.

An electronic search of AMED, CiNAHL, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PEDro and SPORTDiscus was undertaken from their inception to June 2012.

Any study design that incorporated observable structural outcomes and clinical outcomes when assessing the effect of therapeutic exercise on participants with tendinopathy.

Included studies were appraised for risk of bias using the tool developed by the Cochrane Back Review Group. Due to heterogeneity of studies, a qualitative synthesis was undertaken.

Twenty articles describing 625 patients were included. Overall, there is a strong evidence to refute any observable structural change as an explanation for the response to therapeutic exercise when treated by eccentric exercise training. Moderate evidence does exist to support the response of heavy-slow resistance training (HSR).

The available literature does not support observable structural change as an explanation for the response of therapeutic exercise except for some support from HSR. Future research should focus on indentifying other explanations including neural, biochemical and myogenic changes.

Registered with PROSPERO, registration number CRD42011001638.

A systematic, computerised literature search of PubMED, EMBASE, CINAHL and the Cochrane Library databases (from database inception through January 2012) using keywords related to diagnostic accuracy of physical examination tests of the scapula. The Quality Assessment of Diagnostic Accuracy Studies tool was used to critique the quality of each paper.

Eight articles met the inclusion criteria; three were considered to be of high quality. Of the three high-quality studies, two were in reference to a ‘diagnosis’ of shoulder pain. Only one high-quality article referenced specific shoulder pathology of acromioclavicular dislocation with reported sensitivity of 71% and 41% for the scapular dyskinesis and SICK scapula test, respectively.

Overall, no physical examination test of the scapula was found to be useful in differentially diagnosing pathologies of the shoulder.

Systematic review.

Electronic databases were searched from the earliest possible entry to March 2012. Quantitative studies were reviewed that included athletes who had sustained an athletic injury, reported the return to sport rate and measured at least one psychological variable. The risk of bias in each study was appraised with a quality checklist.

Eleven studies that evaluated 983 athletes and 15 psychological factors were included for review. The three central elements of self-determination theory—autonomy, competence and relatedness were found to be related to returning to sport following injury. Positive psychological responses including motivation, confidence and low fear were associated with a greater likelihood of returning to the preinjury level of participation and returning to sport more quickly. Fear was a prominent emotional response at the time of returning to sport despite the fact that overall emotions became more positive as recovery and rehabilitation progressed.

There is preliminary evidence that positive psychological responses are associated with a higher rate of returning to sport following athletic injury, and should be taken into account by clinicians during rehabilitation.

Exercise-induced bronchoconstriction (EIB) is a transient narrowing of the lower airways after vigorous exercise.1 Exercise requires increased ventilation, which results in respiratory water loss leading to airway drying and cooling. Evaporative water loss leading to an increase in the osmolarity of the airway surface liquid and consequent release of mediators is thought to be the major stimulus and mechanism for EIB.2 Mast cell mediators include histamine, leukotrienes and prostaglandins, which act on specific receptors on the bronchial smooth muscle causing bronchoconstriction.3 Leukotrienes from eosinophils and neuropeptides from sensory nerves may also be involved in EIB. EIB can occur in people with or without chronic asthma, although it is highly prevalent in people with asthma.1

The intensity and duration of exercise are key determinants of the airway response. 2012-10-04T00:02:20-07:00 info:doi/10.1136/bjsports-2012-091725 hwp:master-id:bjsports;bjsports-2012-091725 British Association of Sport and Excercise Medicine 2012-10-04 PEDro systematic review update http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091550v1?rss=1 Objective

To clarify the role of sports and exercise physicians as medical assessors.

Group discussion between senior doctors at a previous annual conference of the Australasian College of Sports Physicians, followed by further discussion between the authors. Clarification of the key requirements of insurers, and formulation of practical advice for those performing this work.

Our expertise in performing medical assessments for the purpose of fitness to play sport is a transferable skill. It can also be used to provide medical assessments for injured workers. Our expertise in rehabilitation is also of value to insurers and other interested parties.

The work is both challenging and rewarding, and can provide additional variety in the working week.

This paper compares five different survival models (Cox proportional hazards (CoxPH) model and the following generalisations to recurrent event data: Andersen-Gill (A-G), frailty, Wei-Lin-Weissfeld total time (WLW-TT) marginal, Prentice-Williams-Peterson gap time (PWP-GT) conditional models) for the analysis of recurrent injury data.

Empirical evaluation and comparison of different models were performed using model selection criteria and goodness-of-fit statistics. Simulation studies assessed the size and power of each model fit.

The modelling approach is demonstrated through direct application to Australian National Rugby League recurrent injury data collected over the 2008 playing season. Of the 35 players analysed, 14 (40%) players had more than 1 injury and 47 contact injuries were sustained over 29 matches. The CoxPH model provided the poorest fit to the recurrent sports injury data. The fit was improved with the A-G and frailty models, compared to WLW-TT and PWP-GT models.

Despite little difference in model fit between the A-G and frailty models, in the interest of fewer statistical assumptions it is recommended that, where relevant, future studies involving modelling of recurrent sports injury data use the frailty model in preference to the CoxPH model or its other generalisations. The paper provides a rationale for future statistical modelling approaches for recurrent sports injury.

To define the minimum clinically important difference (MCID) for the Victorian Institute of Sport Assessment scale (VISA-P) in athletes with patellar tendinopathy (PT) who underwent conservative treatment.

Ninety-eight athletes with PT were enrolled in the study. Each participant completed the VISA-P at admission, after 1 week, and at the final visit. Athletes also assessed their clinical change at discharge on a 15-point Likert scale. We equated important change with a score of ≥3 (somewhat better). Receiver-operating characteristic (ROC) curve analysis and mean change score were used to determine MCID. Minimal detectable change was calculated. The effect of baseline scores on MCID and different criteria used to define important change were investigated. A Bayesian analysis was used to establish the posterior probability of reporting clinical changes related to MCID value.

Athletes with PT who showed an absolute change greater than 13 points in the VISA-P score or 15.4–27% of relative change achieved a minimal important change in their clinical status. This value depended on baseline scores. The probability of a clinical change in a patient was 98% when this threshold was achieved and 45% when MCID was not achieved.

Definition of the MCID will enhance the interpretability of changes in the VISA-P score in the athletes with PT, but caution is required when these values are used.

We investigated the relationship between injury incidence and team success in Qatar first-division football clubs.

Using a prospective cohort study design, we captured exposure and injuries in Qatar male elite football for a season. Club performance was measured by total league points, ranking, goal scored, goals conceded and number of matches won, drawn or lost.

Lower injury incidence was strongly correlated with team ranking position (r=0.929, p=0.003), more games won (r=0.883, p=0.008), more goals scored (r=0.893, p=0.007), greater goal difference (r=0.821, p=0.003) and total points (r=0.929, p=0.003).

Lower incidence rate was strongly correlated with team success. Prevention of injuries may contribute to team success.

To define the clinical presentation of GTPS.

Forty-one people with GTPS, 20 with hip osteoarthritis (OA), and 23 age-matched and sex-matched asymptomatic participants (ASC) were recruited. Inclusion and exclusion criteria ensured mutually exclusive groups. Assessment: the Harris hip score (HHS), a battery of clinical tests, and single leg stance (SLS). Participants identified the site of reproduced pain. Analysis: Fisher's exact test, analysis of variance (ANOVA) informed recursive partitioning to develop two classification trees.

Maximum walking distance and the ability to manipulate shoes and socks were the only HHS domains to differentiate GTPS from OA (ANOVA: p=0.010 and <0.001); OR (95% CI) of 3.47 (1.09 to 10.93) and 0.06 (0.00 to 0.26), respectively. The lateral hip pain (LHP) classification tree: (dichotomous LHP associated with a flexion abduction external rotation (FABER) test) had a mean (SE) sensitivity and specificity of 0.81 (0.019) and 0.82 (0.044), respectively. A non-specific hip pain classification tree had a mean (SE) sensitivity and specificity of 0.78 (0.058) and 0.28 (0.080).

Patients with LHP in the absence of difficulty with manipulating shoes and socks, together with pain on palpation of the greater trochanter and LHP with a FABER test are likely to have GTPS.

A pilot study examining sedentary behaviour and physical activity counselling in a primary care clinic. A total of 157 patients completed a detailed survey related to lifestyle counselling received from their primary care physician. We analysed these responses to describe counselling practices within the 5A framework, and to examine correlates (ie, patients’ demographics, sedentary behaviour and physical activity and clinical variables) related to receiving counselling.

A total of 10% received general advice to decrease sitting time, in comparison with 53% receiving general physical activity counselling. None, however, received a written plan pertaining to sedentary behaviour whereas 14% received a written physical activity prescription. Only 2% were provided with specific strategies for sedentary behaviour change in comparison with 10% for physical activity change. Multivariable analysis revealed that patients who were obese were more likely to receive counselling to decrease sitting (OR=7.0; 95% CI 1.4 to 35.2). In comparison, higher odds for receiving physical activity counselling were associated with being younger, aged 40–59 years (OR=2.4; 95% CI 1.1 to 5.4); and being a non-smoker (OR=6.1; 95% CI 1.3 to 28.4).

This study is the first to assess sedentary behaviour counselling practices in primary care and such practices appear to be infrequent. Future research should attempt to establish a ‘knowledge base’ to inform development of sedentary behaviour interventions, which should be followed by testing feasibility, efficacy, and subsequent effectiveness of these programmes in a clinical setting.

Prospective cohort.

Elite cricket in New Zealand.

248 elite male cricketers.

Incidence and prevalence rates.

The overall match injury incidence rate for the international competition (51.6 injuries per 10 000 player-hours; 95% CI 40.1 to 65.3) was almost twice that of the domestic competition (27.2; 23.5 to 31.4). The prevalence rate for the international competition (12%; 11.3% to 12.8%) was significantly higher than that for the domestic competition (9.7%; 9.4% to 10.1%). Overall, 79.5% of injuries occurred in matches and 48.7% of all injuries were sustained while bowling. The lower limb was the body region most commonly injured (43.5%), the most common specific diagnosis was hamstring strains/tears (11.1%) and the injuries contributing the highest proportion of match days lost were stress fractures to the low back (22%).

The findings of this study support ongoing injury surveillance in New Zealand and other test cricket playing nations for the purpose of describing injury and monitoring the effect of interventions over time.

Seven NCAA Division I male tennis players performed three successful flat, kick and slice serves. Serves were recorded using an eight camera markerless motion capture system. Laser scanning was utilised to accurately collect body dimensions and data were computed using inverse kinematic methods.

There was no significant difference in maximum back extension angle for the flat, kick or slice serves. The kick serve had a higher force magnitude at the back than the flat and slice as well as larger posteriorly directed shoulder forces. The flat serve had significantly greater maximum shoulder internal rotation velocity versus the slice serve. Force and torque magnitudes at the elbow and wrist were not significantly different between the serves.

The kick serve places higher physical demands on the back and shoulder while the slice serve demonstrated lower overall kinetic forces. This information may have injury prevention and rehabilitation implications.

Younger (25–30 years), mid-aged (50–55 years) and older (76–81 years) participants in the Australian Longitudinal Study on Women's Health completed a mailed survey with questions about leisure, transport and house and garden activities. Well-being was assessed using the physical and mental components scores of the SF-36. Cross-sectional associations between the physical activity variables and well-being were modelled using General Additive Modelling.

Correlations between HGW and leisure/transport activity (LTA) were low (r<0.3, p<0.001). Positive curvilinear associations were found between LTA and physical and mental well-being in all three cohorts, and between HGW and physical and mental well-being in mid-aged and older women. In the younger women, an inverse relationship was found between HGW and well-being. When HGW and LTA were summed (TPA), the associations between TPA and well-being were attenuated compared with those for LTA alone and well-being.

In mid-aged and older women, relationships between HGW and well-being were similar to, but weaker than seen for LTA and well-being. In young women, well-being declined with increasing HGW. Summing HGW to LTA led to attenuated relationships, suggesting that domains of physical activity should not be summed when studying relationships with well-being.

To evaluate the effects of varying amounts of daily accelerometer wear time on PA data.

A total of 1000 days of accelerometer data from 1000 participants (age=38.7±14.3 years; body mass index=28.2±6.7 kg/m²) were selected from the 2005–2006 National Health and Nutrition Examination Study data set. A reference data set was created using 200 random days with 14 h/day of wear time. Four additional samples of 200 days were randomly selected with a wear time of 10, 11, 12 and 13 h/day¹. These data sets were used in day-to-day comparison to create four semisimulation data sets (10, 11, 12, 13 h/day) from the reference data set. Differences in step count and time spent in inactivity (<100 cts/min), light (100–1951 cts/min), moderate (1952–5724 cts/min) and vigorous (≥5725 cts/min) intensity PA were assessed using repeated-measures analysis of variance and absolute percent error (APE).

There were significant differences for moderate intensity PA between the reference data set and semisimulation data sets of 10 and 11 h/day. Differences were observed in 10–13 h/day¹ for inactivity and light intensity PA, and 10–12 h/day for steps (all p values <0.05). APE increased with shorter wear time (13 h/day=3.9–14.1%; 12 h/day=9.9–15.2%, 11 h/day=17.1–35.5%; 10 h/day=24.6–40.3%).

These data suggest that using accelerometer wear time criteria of 12 h/day or less may underestimate step count and time spent in various PA levels.

Each subject (n=12) randomly performed five repetitions of the turning kick (TK), clench axe kick (CA), front leg axe kick, jump back kick (JB) and jump spinning hook kick (JH) at the average standing head height for competitors in their weight division. A Hybrid II Crash Test Dummy head was fitted with a protective taekwondo helmet and instrumented with a triaxial accelerometer and fixed to a height-adjustable frame. Resultant head linear acceleration, HVEL, FVEL data were captured and processed using Qualysis Track Manager.

The TK (130.11±51.67 g) produced a higher RLA than the CA (54.95±20.08 g, p<0.001, d=1.84) and a higher HIC15 than the JH (672.74±540.89 vs 300.19±144.35, p<0.001, ES=0.97). There was no difference in HVEL of the TK (4.73±1.67 m/s) and that of the JB (4.43±0.78 m/s; p=0.977, ES<0.01).

The TK is of concern because it is the most common technique and cause of concussion in taekwondo. Future studies should aim to understand rotational accelerations of the head.

From 1994 to 2009, injury data from the US Open Tennis Championships were recorded. Injuries were classified by location and type using terminology derived from a consensus statement developed specifically for tennis. Injury rates were determined based on the exposure of an athlete to a match event, and were calculated as the ratio of injuries per 1000 match exposures (MEs).

There was a statistically significant fluctuation in injuries across the timeframe analysed (p<0.05). There were 76.2±19.6 total injuries and 43.8±11.8 acute injuries per year seeking medical assistance. Muscle or tendon injuries were the most common type of acute injury. The rate of lower limb injuries was significantly higher than upper limb and trunk injuries (p<0.01). The ankle, followed by the wrist, knee, foot/toe and shoulder/clavicle were the most common injury sites.

Acute injuries occurred more frequently than gradual-onset injuries, and most common injury types were similar to previously examined populations. However, there were differences in injury location trends compared to previous research, suggesting that further research in this elite-level population is warranted.

Assessment of intercoder agreement.

Community Australian football.

1082 standardised injury surveillance records.

Direct comparison of the four-character hierarchical OSICS-10 codes assigned by two independent coders (a sports physician and an epidemiologist). Adjudication by a third coder (biomechanist).

The coders agreed on the first character 95% of the time and on the first two characters 86% of the time. They assigned the same four-digit OSICS-10 code for only 46% of the 1082 injuries. The majority of disagreements occurred for the third character; 85% were because one coder assigned a non-specific ‘X’ code. The sports physician code was deemed correct in 53% of cases and the epidemiologist in 44%. Reasons for disagreement included the physician not using all of the collected information and the epidemiologist lacking specific anatomical knowledge.

Sports injury research requires accurate identification and classification of specific injuries and this study found an overall high level of agreement in coding according to OSICS-10. The fact that the majority of the disagreements occurred for the third OSICS character highlights the fact that increasing complexity and diagnostic specificity in injury coding can result in a loss of reliability and demands a high level of anatomical knowledge. Injury report form details need to reflect this level of complexity and data management teams need to include a broad range of expertise.

Twenty-two female, high school volleyball players performed three maximum DVJs in a laboratory setting. The average peak KAM was computed for each knee using marker and force data filtered with the same low cut-off frequencies and different cut-off frequencies.

Peak KAMs were significantly larger using different cut-off frequencies. The order of athletes ranked based on the magnitude of their peak KAMs did not significantly change across all filtering cut-off frequencies.

The magnitude of peak KAM may differ when the same low or different higher cut-off frequencies are used to filter marker and ground reaction forces (GRF) data collected using standard motion capture equipment. It is not clear to what extent the decrease in peak KAM reported when the same low cut-off frequencies were used was solely due to attenuation of the GRF signal.

Database searches for articles from 1966 to December 2011 were performed. Studies were eligible if they investigated ‘hands on’ soft tissue massage performed locally to the shoulder or exercises aimed at improving strength, range of motion or coordination; non-surgical painful shoulder disorders; included participants aged 18–80 years and outcomes measured included pain, disability, range of motion, quality of life, work status, global perceived effect, adverse events or recurrence.

Twenty-three papers met the selection criteria representing 20 individual trials. We found low-quality evidence that soft tissue massage was effective for producing moderate improvements in active flexion and abduction range of motion, pain and functional scores compared with no treatment, immediately after the cessation of treatment. Exercise was shown by meta-analysis to produce greater improvements than placebo, minimal or no treatment in reported pain (weighted mean=9.8 of 100, 95% CI 0.6 to 19.0) but these changes were of a magnitude that was less than that considered clinically worthwhile. Exercise did not produce greater improvements in shoulder function than placebo, minimal or no treatment (weighted mean=5.7 of 100, 95% CI –3.3 to 14.7).

There is low-quality evidence that soft tissue massage is effective for improving pain, function and range of motion in patients with shoulder pain in the short term. Exercise therapy is effective for producing small improvements in pain but not in function or range of motion.

The scientific literature concerning mechanisms underlying strength increases through resistance training has focused...]]> 2012-07-19T02:01:16-07:00 info:doi/10.1136/bjsports-2012-091295 hwp:master-id:bjsports;bjsports-2012-091295 British Association of Sport and Excercise Medicine 2012-07-19 Editorial http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091202v1?rss=1 Objective

To determine the cost-effectiveness of a physical activity programme (Be Active) aimed at city-dwelling adults living in Birmingham, UK.

Very little is known about the cost-effectiveness of public health programmes to improve city-wide physical activity rates. This paper presents a cost-effectiveness analysis that compares a physical activity intervention (Be Active) with no intervention (usual care) using an economic model to quantify the reduction in disease risk over a lifetime. Metabolic equivalent minutes achieved per week, quality-adjusted life years (QALYs) gained and healthcare costs were all included as the main outcome measures in the model. A cost-benefit analysis was also conducted using ‘willingness-to-pay’ as a measure of value.

Under base-case assumptions—that is, assuming that the benefits of increased physical activity are sustained over 5 years, participation in the Be Active programme increased quality-adjusted life expectancy by 0.06 years, at an expected discounted cost of £3552, and thus the cost-effectiveness of Be Active is £400 per QALY. When the start-up costs of the programme are removed from the economic model, the cost-effectiveness is further improved to £16 per QALY. The societal value placed on the Be Active programme was greater than the operation cost therefore the Be Active physical activity intervention results in a net benefit to society.

Participation in Be Active appeared to be cost-effective and cost-beneficial. These results support the use of Be Active as part of a public health programme to improve physical activity levels within the Birmingham-wide population.

Twelve young male subjects performed a 30 min treadmill exercise at 80% of the maximal oxygen capacity. Venous blood samples and urine collections were collected before and after exercise and after recovery period. GFR rates were calculated from serum Crn and Cyst C equations, and Cl-Crn measured from serum and urine Crn output. Albumin was also determined for all samples.

Under resting conditions, eGFR from Crn and Cyst C did not differ from Cl-Crn (p=0.39). Immediately after exercise, GFR decreased significantly, regardless of the method, but more so for Cl-Crn (–30.0%; p<0.05) compared with Crn (–18.2%) and Cyst C (–19.8%). After the recovery period, GFR determined by Cl-Crn was returned to initial values whereas Crn and Cyst C remained reduced. Although eGFR methods accurately estimate GFR at rest, those methods underestimated the change in GFR after acute exercise.

These results indicate that exercise-induced changes in GFR should be determined by Cl-Crn method.

The aim was to investigate the medial and lateral hamstring muscle activation balance during 14 selected therapeutic exercises.

The study design involved single-occasion repeated measures in a randomised manner. Sixteen female elite handball and soccer players with a mean (SD) age of 23 (3) years and no previous history of knee injury participated in the present study. Electromyographic (EMG) activity of the lateral (biceps femoris – BF) and medial (semitendinosus – ST) hamstring muscle was measured during selected strengthening and balance/coordination exercises, and normalised to EMG during isometric maximal voluntary contraction (MVC). A two-way analysis of variance was performed using the mixed procedure to determine whether differences existed in normalised EMG between exercises and muscles.

Kettlebell swing and Romanian deadlift targeted specifically ST over BF (17–22%, p<0.05) at very high levels of normalised EMG (73–115% of MVC). In contrast, the supine leg curl and hip extension specifically targeted the BF over the ST ( 20–23%, p<0.05) at very high levels of normalised EMG (75–87% of MVC).

Specific therapeutic exercises targeting the hamstrings can be divided into ST dominant or BF dominant hamstring exercises. Due to distinct functions of the medial and lateral hamstring muscles, this is an important knowledge in respect to prophylactic training and physical therapist practice.

We aimed to investigate the effect of an 8-week hip-adductor strengthening programme, including one hip-adduction exercise, on eccentric and isometric hip-adduction strength, using elastic bands as external load.

Thirty-four healthy, sub-elite soccer players, mean (±SD) age of 22.1 (±3.3) years, were randomised to either training or control. During the mid-season break, the training group performed 8 weeks of supervised, progressive hip-adduction strength training using elastic bands. The participants performed two training sessions per week (weeks 1–2) with 3x15 repetition maximum loading (RM), three training sessions per week (weeks 3–6) with 3x10 RM and three training sessions per week (weeks 7–8) with 3x8 RM. Eccentric hip-adduction (EHAD), isometric hip-adduction (IHAD) and isometric hip-abduction (IHAB) strength, and the IHAD/IHAB ratio were measured assessor-blinded preintervention and postintervention, using reliable hand-held dynamometry procedures.

In the training group, EHAD strength increased by 30% (p<0.001). In the control group, EHAD strength increased by 17% (p<0.001), but the increase was significantly larger in the training group compared with the control group (p=0.044). No other significant between-group strength-differences in IHAD, IHAB or the IHAD/IHAB ratio existed (p>0.05).

8 weeks of hip-adduction strength training, using elastic bands, induce a relevant increase in eccentric hip-adduction strength in soccer players, and thus may have implications as a promising approach towards prevention of groin injuries in soccer.

EP outcomes were put on the same scale and represent % changes in power output between euhydrated and dehydrated exercise tests. Random-effects model meta-regressions and weighted mean effect summaries, mixed-effects model analogue to the ANOVAs and magnitude-based effect statistics were used to delineate treatment effects.

Main results Fifteen research articles were included, producing 28 effect estimates, representing 122 subjects. Compared with euhydration, EID increased (0.09±2.60%, (p=0.9)) EP under time-trial exercise conditions, whereas it reduced it (1.91±1.53%, (p<0.05)) with NEV exercise protocols. Only with NEV exercise protocols did EID ≥ 2% bodyweight impair EP (p=0.03).

Evidence indicates that (1) EID ≤ 4% bodyweight is very unlikely to impair EP under real-world exercise conditions (time-trial type exercise) and; (2) under situations of fixed-exercise intensity, which may have some relevance for military and occupational settings, EID ≥ 2% bodyweight is associated with a reduction in endurance capacity. The 2% bodyweight loss rule has been established from findings of studies using NEV exercise protocols and does not apply to out-of-doors exercise conditions. Athletes are therefore encouraged to drink according to thirst during exercise.

A prospective, whole population survey.

615 international rugby players representing 20 teams competing at the IRB 2011 Rugby World Cup in New Zealand.

The study was implemented according to the international consensus statement for epidemiological studies in rugby union; the main measures included the players' age (years), stature (cm) and body mass (Kg) and the incidence (number of injuries/1000 player-hours), mean and median severity (days absence), location (%), type (%) and cause (%) of match and training injuries.

The incidences of injuries were 89.1/1000 player-match-hours (forwards: 85.0; backs: 93.8) and 2.2/1000 player-training-hours (forwards: 2.7; backs: 1.7). The mean severity of injuries was 23.6 days (forwards: 21.2; backs: 26.2) during matches and 26.9 (forwards: 33.4; backs: 14.3) during training. During matches, lower-limb muscle/tendon (31.6%) and ligament (15.8%) and, during training, lower-limb muscle/tendon (51.4%) and trunk muscle/tendon (11.4%) injuries were the most common injuries. The most common cause of injury during matches was the tackle (forwards: 43.6%, backs: 45.2%), and during training was full and semicontact skills activities.

The results confirm that rugby, like other full-contact sports, has a high incidence of injury: the results from IRB Rugby World Cup (RWC) 2011 were similar to those reported for RWC 2007.

Data from a preparticipation musculoskeletal screening test performed on 384 Australian Defence Force Academy Officer Cadets were compared against 693 injuries reported by 326 of the Officer Cadets in the following 16 months. Data were held in an Injury Surveillance database and analysed using 2 and Fisher's Exact tests, and Receiver Operating Characteristic Curve analysis.

Diagnosis of MTSS, confirmed by an independent blinded health practitioner.

Both the palpation and oedema clinical tests were each found to be significant predictors for later onset of MTSS. Specifically: Shin palpation test OR 4.63, 95% CI 2.5 to 8.5, Positive Likelihood Ratio 3.38, Negative Likelihood Ratio 0.732, Pearson 2 p<0.001; Shin oedema test OR 76.1 95% CI 9.6 to 602.7, Positive Likelihood Ratio 7.26, Negative Likelihood Ratio 0.095, Fisher's Exact p<0.001; Combined Shin Palpation Test and Shin Oedema Test Positive Likelihood Ratio 7.94, Negative Likelihood Ratio <0.001, Fisher's Exact p<0.001. Female gender was found to be an independent risk factor (OR 2.97, 95% CI 1.66 to 5.31, Positive Likelihood Ratio 2.09, Negative Likelihood Ratio 0.703, Pearson 2 p<0.001) for developing MTSS.

The tests for MTSS employed here are components of a normal clinical examination used to diagnose MTSS. This paper confirms that these tests and female gender can also be confidently applied in predicting those in an asymptomatic population who are at greater risk of developing MTSS symptoms with activity at some point in the future.

One approach that could be used to transfer the learnings...]]> 2012-05-03T02:01:02-07:00 info:doi/10.1136/bjsports-2011-090567 hwp:master-id:bjsports;bjsports-2011-090567 British Association of Sport and Excercise Medicine 2012-05-25 Editorial http://bjsm.bmj.com/cgi/content/short/bjsports-2012-091209v1?rss=1 In April of 2010, the National Collegiate Athletic Association (NCAA), supported by other professional organisations (College of American Pathologists 2007; National Athletic Trainers' Association 2007) approved mandatory testing for the presence of sickle cell carrier status in student athletes participating in Division I sports. This action was in part a response to the legal case against the NCAA and Rice University brought forward by the family of Dale Lloyd II. Dale Lloyd's death was attributed to exertional rhabdomyolysis associated with sickle cell trait; this association has been described in the medical literature in athletes, as well as in military populations.1