There is a need for research to identify effective implementation strategies for injury prevention training within real-world community sports. The aim of this ecological participatory study was to identify facilitators, among stakeholders at multiple levels, that could help injury prevention training become part of regular training routines in youth team handball. Concept mapping, a mixed-method approach for qualitative data collection and quantitative data analysis, was used. Stakeholders (n = 196) of two community team handball clubs (29% players, 13% coaches, 38% caregivers, 11% club, district and national handball administrators, 9% unknown) participated in a brainstorming process. After the research team synthesized the 235 generated statements, 50 stakeholders (34% players, 22% coaches, 24% caregivers, 20% administrators) sorted 89 unique facilitator statements into clusters and rated them for importance and feasibility. Multidimensional scaling and hierarchical cluster analysis yielded five clusters (stress value 0.231): "Understanding and applying knowledge," "Education, knowledge, and consistency," "Set-up and exercises," "Inspiration, motivation, and routines," and "Club policy and expert collaboration." The cluster "Understanding and applying knowledge" had the highest mean importance (3.17 out of 4) and feasibility (2.93) ratings. The 32 statements rated as both highly important and feasible (Go-zone) indicate action is required at the individual (end-users) and organizational (policymakers) levels to implement injury prevention training. Results suggest that developing evidence-based context-specific injury prevention training, incorporating physiological, biomechanical and psychological components, and an associated context-specific implementation plan in partnership with all stakeholders should be a high priority to facilitate the implementation of injury prevention training in youth team handball.

Recessive limb-girdle muscular dystrophies (LGMD2) involve progressive muscle weakness. Parental support is important for young adults living with LGMD2, but no study has been identified focusing on the parents experiences. The salutogenic perspective concentrates on how daily life is comprehended, managed and found meaningful, i.e. the persons sense of coherence. The aim of this study was to describe, from a salutogenic perspective, experiences of being parents of young adults living with LGMD2. Nineteen participants were included. Data were collected by semi-structured interviews and the self-administrated 13-item sense of coherence questionnaire. Interview data were analysed with content analysis and related to self-rated sense of coherence. The result shows experiences of being influenced, not only by thoughts and emotions connected to the disease but also by caregiving duties and the young adults well-being. Simultaneously, difficulty in fully grasping the disease was expressed and uncertainty about progression created worries about future management. Trying their best to support their young adults to experience well-being and to live fulfilled lives, the importance of having a social network, support from concerned professionals and eventually access to personal assistance was emphasized. The need to have meaningful pursuits of ones own was also described. The median sense of coherence score was 68 (range 53-86). Those who scored high (amp;gt;= 68) described satisfaction with social network, external support provided, work and leisure activities to a greater extent than those who scored low (amp;lt;68). The result shows that the young adults disease has a major impact on the parents lives. Assessment of how the parents comprehend, manage and find meaning in everyday life may highlight support needed to promote their health. (C) 2017 Elsevier B.V. All rights reserved.

There is a clear difference between the way football players and leaders regard the role of the referee, compared to the way the refereeing body looks at it. The refereeing body regard themselves as fundamental for the existence of the sport, while the other mentioned parties merely see them as functional justice makers. This view places the referees outside the field of football. This establishes a football culture, which is conflicted when it comes to the role of the referees on the field. The conflict comes to its edge in youth football, where the referees are under severe pressure. The only way for the referees to handle this pressure is through experience and respect, which is essential for creation of a well working referring role. Thus, a change in the football culture is necessary in order to include the referees in the football family and change the general conception of the referees’ role and function.

Objectives. Jumper's knee, or proximal patellar tendinopathy, is commonly seen among athletes in leg explosive sports, and for a subgroup surgical treatment is needed. The aim of this study was to identify what type of sports were most frequent among athletes treated surgically for Jumper's knee at an international tendon clinic during a consecutive 13-year period. Methods. The study included 344 consecutive patients (306 males, mean age 27 years, range 17-58; 38 females, mean age 24 years, range 18-44) from 21 different countries seeking help for therapy-resistant jumper's knee. There were 274 elite athletes, 168 being full-time professionals. All were diagnosed to have tendinopathy in the proximal patellar tendon and were operated on with ultrasound- and Doppler-guided arthroscopic shaving surgery. Results. The single most common sport was football (n = 95, 28%), followed by rugby (n = 37, 11%) and handball (n = 32, 9%), with 117 (34%) playing at a professional level. The rest of the athletes participated in 17 other different elite sports and nine recreational sports (running/jogging, padel, squash, biking, gym training, bowling, cheerleading, dancing, and ultimate frisbee). Conclusions. Football was the most common sport among patients requiring surgical treatment for jumper's knee, constituting 28% of all patients, and together with rugby and handball they constituted almost half of all patients. There was a wide sport distribution with 29 different team and individual sports represented.

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Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athletes return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.

Purpose To examine differences between men and women football players in clinically feasible jumping measures. Methods Female football players (N=46, ages 16-25) were matched based on age, training frequency, and playing position with 46 male players. All players performed the tuck jump and drop vertical jump (DVJ). DVJ was assessed quantitatively for valgus knee motion and probability of a high peak knee abduction moment (pKAM), as well as sagittal plane hip, knee, and ankle angles, and qualitatively with visual assessment of the players knees upon landing; graded as good, reduced, or poor control. Result Women had higher total tuck jump scores (52) (more technique flaws), than men (3 +/- 2, Pamp;lt;0.01). The quantitative analysis of the DVJ found that men had greater asymmetries between limbs, but women landed bilaterally in more knee valgus (interaction P=0.04, main effect of sex P=0.02). There was no difference in pKAM (interaction n.s.). Women also landed in less hip flexion (P=0.01) and ankle dorsiflexion (P=0.01) than men. The qualitative DVJ analysis found that more women (48%) had poor knee control compared to men (11%, Pamp;lt;0.01). Conclusions The results indicate that women perform worse on the tuck jump assessment than men. The results support previous findings that women land in more knee valgus than men, but also found that men may have larger asymmetries in knee valgus. These results from clinically feasible measures provide some suggestions for clinicians to consider during ACL reconstruction rehabilitation to enhance performance.

Purpose

To determine if female football players who had longer durations of rehabilitation, measured in months, after anterior cruciate ligament reconstruction would have lower tuck jump scores (fewer technique flaws) and smaller asymmetries during drop vertical jump landing.

Methods

One-hundred-and-seventeen female football players, aged 16ￜ25 years, after primary unilateral ACL reconstruction (median 16 months, range 6ￜ39) were included. Athletes reported the duration of rehabilitation they performed after anterior cruciate ligament reconstruction. Athletes also performed the tuck jump and drop vertical jump tests. Outcome variables were: tuck jump score, frontal plane knee motion and probability of peak knee abduction moment during drop vertical jump landing.

Results

There was no difference in tuck jump score based on duration of rehabilitation (n.s.). No interaction (n.s.), difference between limbs (n.s.), or duration of rehabilitation (n.s.) was found for peak knee abduction moment during drop vertical jump landing. No interaction (n.s.) or difference between limbs (n.s.) was found for frontal plane knee motion, but there was a difference based on duration of rehabilitation (P?=?0.01). Athletes with >?9 months of rehabilitation had more frontal plane knee motion (medial knee displacement) than athletes with <?6 months (P?=?0.01) or 6ￜ9 months (P?=?0.03).

Conclusion

As there was no difference in tuck jump score or peak knee abduction moment based on duration of rehabilitation, the results of this study press upon clinicians the importance of using objective measures to progress rehabilitation and clear athletes for return to sport, rather than time alone.

Shoulder problems are frequent among senior elite handball players. The objective of this study was to assess the prevalence of shoulder problems among adolescent elite handball players and to investigate potential differences in gender, school grade, playing position and playing level. During the 2014 and 2015 pre-season periods, 471 players (age 15-18 years, 54% female) completed a comprehensive baseline questionnaire regarding history of any shoulder pain and shoulder problems experienced during the past season. The players were monitored weekly for one competition season (September-April) regarding shoulder problems and the amount of match and training. Generalised linear models with a binomial link function were used to calculate a prevalence ratio (PR) with 95% confidence interval (CI) to compare the subgroups of players. In total, 110 players (23%) reported having substantial shoulder problems (defined as moderate/severe reduction in training volume, or moderate/severe reduction in performance, or complete inability to participate) at some point during the follow-up season, of which almost half reported complete inability to participate. Of those players reporting substantial problems, 43% (95% CI 39-48) did so for at least 3 consecutive weeks during the season. The prevalence was significantly higher in female players (PR 1.46, 95% 1.04-2.06) and in backcourt players (PR 1.58, 95% CI 1.08-2.32), but no differences were found for school grade (PR 1.21 95% CI 0.88-1.67) or playing level (PR 1.09 95% CI 0.76-1.56). The prevalence of substantial shoulder problems in adolescent elite handball players is high, especially among females, and this warrants further studies on risk factors for shoulder injury and the development of prevention strategies in handball players already before the age of 15. These findings also highlight the importance of introducing a clinical monitoring programme on a routine basis and improving the medical support, taking gender-related aspects into consideration, at handball-profiled secondary schools. II.

Background The risk of injury in adolescent handball is high, and shoulder and knee injuries are among the most frequent and burdensome. The Swedish Knee Control programme reduced the risk of anterior cruciate ligament injuries in female youth football players and traumatic knee injuries in male and female youth floorball players. However, to date, Knee Control has not been evaluated in an elite youth sport setting. The literature on the prevention of shoulder injuries in sport is scarce, and there are to our knowledge no previous studies evaluating the preventative efficacy of injury prevention exercise programmes (IPEPs) on shoulder injuries in adolescent handball players. Objectives To study the preventive efficacy of IPEPs on shoulder and knee injuries in adolescent elite handball players. Methods Eighteen Swedish handball-profiled secondary schools (clusters) with players aged 15-19 years, 54% males were randomised into either the Shoulder Group or Knee Group (interventions) or a Control Group. Players in the Shoulder Group were instructed to perform the Shoulder Control programme, and players in the Knee Group to perform the Knee Control programme, three times per week during May 2018 to May 2019. Control Group players continued their usual training. Outcomes were shoulder and knee injuries defined by the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Intention-to-treat analyses were performed using Cox regression models with hazard rate ratios (HRRs) with corresponding 95% confidence intervals (CI). Results Six clusters (199 players) in the Shoulder Group, six clusters (216 players) in the Knee Group and six clusters (212 players) in the Control Group were included. There were 100 shoulder injuries and 156 knee injuries. The Shoulder Group had a 56% lower shoulder injury rate, HRR 0.44 (95% CI 0.29 to 0.68), and the Knee Group had a 31% lower knee injury rate, HRR 0.69 (95% CI 0.49 to 0.97) than the Control Group. The absolute risk reduction was 11% and 8%, and the number needed to treat was 9 and 13, respectively. Conclusions Adolescent elite handball players who performed the Shoulder Control and the Knee Control programmes had a lower risk of shoulder and knee injuries, respectively, than players who continued their usual training. Further research on how these two programmes can be combined to reduce knee and shoulder injuries in a time effective way is warranted. Trial registration ISRCTN15946352.

Background: Handball is a physical contact sport that includes frequent overhead throwing, and this combination leads to a high rate of shoulder injuries. Several factors have been associated with shoulder injuries in overhead athletes, but strong scientific evidence is lacking for most suggested risk factors. We therefore designed the Karolinska Handball Study (KHAST) with the aim to identify risk factors for shoulder injuries in adolescent male and female elite handball players studying at handball-profiled secondary schools in Sweden. Secondary objectives are to investigate whether shoulder function changes during the competition season and whether the physical profile of the players changes during their time in secondary school. Methods: Players aged 15 to 19 years were included during the pre-season period of the 2014-2015 and the 2015-2016 seasons. At inclusion, players signed informed consent and filled in a questionnaire regarding playing position, playing level, previous handball experience, history of shoulder problems and athletic identity. Players also completed a detailed test battery at baseline evaluating the shoulder, neck and trunk. Players were then prospectively monitored weekly during the 2014-2015 and/or 2015-2016 competitive seasons regarding injuries and training/match workload. Results from the annual routine physical tests in the secondary school curriculum including bench press, deep squat, hand grip strength, clean lifts, squat jumps, counter movement jumps, amp;lt;30 m sprints, chins, dips and Coopers test will be collected until the end of the competitive season 2017-2018. The primary outcome is the incidence of shoulder injuries and shoulder problems. The secondary outcome is the prevalence of shoulder injuries and shoulder problems. Discussion: Shoulder problems are frequent among handball players and a reduction of these injuries is therefore warranted. However, in order to introduce appropriate preventive measures, a detailed understanding of the underlying risk factors is needed. Our study has a high potential to identify important risk factors for shoulder injuries in adolescent elite handball players owing to a large study sample, a high response rate, data collection during consecutive seasons, and recording of potential confounding factors.

Background: To better understand the childhood physical inactivity crisis, Report Cards on physical activity of children and youth were prepared concurrently in 30 very high Human Development Index countries. The aim of this article was to present, describe, and compare the findings from these Report Cards. Methods: The Report Cards were developed using a harmonized process for data gathering, assessing, and assigning grades to 10 common physical activity indicators. Descriptive statistics were calculated after converting letter grades to interval variables, and correlational analyses between the 10 common indicators were performed using Spearmans rank correlation coefficients. Results: A matrix of 300 grades was obtained with substantial variations within and between countries. Low grades were observed for behavioral indicators, and higher grades were observed for sources of influence indicators, indicating a disconnect between supports and desired behaviors. Conclusion: This analysis summarizes the level and context of the physical activity of children and youth among very high Human Development Index countries, and provides additional evidence that the situation regarding physical activity in children and youth is very concerning. Unless a major shift to a more active lifestyle happens soon, a high rate of noncommunicable diseases can be anticipated when this generation of children reaches adulthood.

This study explores the impact of missed workout sessions on cognitive functioning, focusing on stress, emotional well-being, attention and memory. Using a mixed-methods approach, survey data from 164 participants were analyzed through descriptive statistics, Pearson correlation and One-way ANOVA tests and a qualitative thematic analysis of open-ended responses. Results show a significant positive correlation between stress levels and negative mood impacts when workouts are missed (r = .681). One-way ANOVA indicated significant differences in stress levels and compensatory behaviors based on workout frequency, main goals and for how long the participants had been working out on a regular basis. Frequent exercisers reported higher stress and more compensatory behaviors. Thematic analysis identified themes like emotional responses, cognitive impacts and coping strategies. Findings highlight the importance of consistent exercise for cognitive and emotional stability. Further research should focus on interventions to support maintaining exercise routines and coping mechanisms for missed sessions.

BackgroundFlywheel resistance training has become more integrated within resistance training programs in a variety of sports due to the neuromuscular, strength, and task-specific enhancements reported with this training.ObjectiveThis paper aimed to present the consensus reached by internationally recognized experts during a meeting on current definitions and guidelines for the implementation of flywheel resistance training technology in sports.MethodsNineteen experts from different countries took part in the consensus process; 16 of them were present at the consensus meeting (18 May 2023) while three submitted their recommendations by e-mail. Prior to the meeting, evidence summaries were developed relating to areas of priority. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of flywheel resistance training technology in sports. The process to gain consensus had five steps: (1) performing a systematic review of systematic reviews, (2) updating the most recent umbrella review published on this topic, (3) first round discussion among a sample of the research group included in this consensus statement, (4) selection of research group members-process of the consensus meeting and formulation of the recommendations, and (5) the consensus process. The systematic analysis of the literature was performed to select the most up-to-date review papers available on the topic, which resulted in nine articles; their methodological quality was assessed according to AMSTAR 2 (Assessing the Methodological Quality of Systematic Review 2) and GRADE (Grading Recommendations Assessment Development and Evaluation). Statements and recommendations scoring 7-9 were considered appropriate.ResultsThe recommendations were based on the evidence summary and researchers' expertise; the consensus statement included three statements and seven recommendations for the use of flywheel resistance training technology. These statements and recommendations were anonymously voted on and qualitatively analyzed. The three statements reported a score ranging from 8.1 to 8.8, and therefore, all statements included in this consensus were considered appropriate. The recommendations (1-7) had a score ranging from 7.7 to 8.6, and therefore, all recommendations were considered appropriate.ConclusionsBecause of the consensus achieved among the experts in this project, it is suggested that practitioners and researchers should adopt the guidelines reported in this consensus statement regarding the use of flywheel resistance technology in sports.

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Background: Injuries are common in professional football, especially during matches, and they cause suffering for players, in both the short and the long term. It is therefore important to try to prevent these injuries. One of the most important steps in injury prevention is to fully understand the different risk factors that contribute to these injuries.

Aim: The aim of this thesis was therefore to investigate several match-related factors that have been suggested to be important for the risk of sustaining injuries during professional football matches.

Methods: The thesis consists of four papers, and all analyses are based on data gathered during a large-scale prospective cohort study that has been running since 2001: the UEFA Elite Club Injury Study. Medical teams from 61 clubs have been involved in this study, and they have prospectively gathered data about football exposure and injuries for their first team players.

Associations between the following factors and injuries have been analysed: • Match characteristics in terms of match venue, match result, and competition • Match congestion, both short and long term, and at team and individual player level • Number of completed training sessions between return to sport after an injury and the first match exposure

Results: All match characteristics studied were shown to be associated with injury rates, with higher injury rates during home matches compared with away matches, in matches that were lost or drawn compared with matches won, and in domestic league and Champions League matches compared with Europa League and other cup matches. It was also shown that injury rates, muscle injury rates in particular, were higher if the recovery time between matches was short. This association between match congestion and injury rates was shown when match congestion was considered at both team and individual player level. Finally, the odds of injury during the first match exposure after a period of absence due to injury was found to be higher if players had completed few training sessions between return to sport and their first match.

Conclusion: There are several match-related risk factors that contribute to the injury rate during professional football matches. A better understanding of these risk factors will help teams to make better estimations of the injury risks to which players are exposed in different situations (e.g. during periods of match congestion and when players return to sport after an injury). Knowledge about risk factors will also offer the possibility of reducing the number of injuries for football teams by addressing them with appropriate measures.

Background It has been hypothesised that injury risk after return to play following an injury absence is influenced by the amount of training completed before return to competition. Aim To analyse if the number of completed training sessions between return to play and the first subsequent match appearance was associated with the odds of injury in men's professional football. Methods From a cohort study, including 303 637 individual matches, 4805 first match appearances after return to play following moderate to severe injuries (≥8 days absence) were analysed. Rate ratios (RRs) were used to compare injury rates in the first match appearances with the average seasonal match injury rate. Odds ratios (ORs) were used to analyse associations between the number of completed training sessions and general (all injuries), muscle, and non-muscle injury odds. Results Injury rate in the first match after return to play was increased by 87% compared with the average seasonal match injury rate (46.9 vs 25.0/1000 hours, RR=1.87; 95% CI 1.64 to 2.14). The odds of injury dropped 7% with each training session before the first match (OR 0.93; 95% CI 0.87 to 0.98). The same association was found for muscle injuries (OR 0.87; 95% CI 0.79 to 0.95) but not for non-muscle injuries (OR 0.99; 95% CI 0.91 to 1.07). Conclusions Injury rates in the first match after injury are higher than the average seasonal match injury rate, but the propensity for player injury is decreased when players complete more training sessions before their first match. 

Background The association between match congestion and injury rates in professional football has yielded conflicting results. Aim To analyse associations between match congestion on an individual player level and injury rates during professional football matches. Methods Data from a prospective cohort study of professional football with 133 170 match observations were analysed with Poisson regressions. Associations between short-term match congestion, defined as number of days between two match exposures (3, 4, 5, 6 and 7-10 days) and injury rates were analysed. To analyse the influence of long-term match congestion, defined as individual match exposure hours in the 30 days preceding a match, observations were categorised into three groups (low, 4.5; medium, amp;gt;4.5to 7.5; and high, amp;gt;7.5hours). Results No differences in total match injury rates were found between the reference category (3 days) and the other categories of short-term congestion. Muscle injury rates were significantly lower in matches preceded by 6 (rate ratio (RR) 0.79; 95%CI 0.65 to 0.95) or 7-10 days (RR 0.81; 95%CI 0.71 to 0.93) compared with 3 days since the last match exposure. No differences in total and muscle injury rates between the three long-term match congestion groups were found. Conclusions In this study of male professional football players, there were no match congestion-related differences in total match injury rates, but muscle injury rates during matches were lower when players were given at least 6days between their match exposures.

Objective To describe the injury epidemiology in professional football in South America and compare it with European professional football. Methods Data about football exposures and injury occurrences were registered in Six teams participating in Copa Libertadores in 2016. These teams exposure and injury data were compared with teams participating in the UEFA Elite Club Injury Study during the 2015/2016 and 2016/2017 seasons. Results A total of 271 injuries were reported in the South American cohort representing a training injury incidence of 3.2 (95% CI=2.7 to 3.7) injuries/1000 hours of training exposure and 20.9 (95% CI=17.3 to 25.1) injuries/1000 hours of match exposure. While no differences in muscle injury incidence were observed between South American and European teams, the ligament injury incidence in training among South American teams was significantly higher than European teams (0.6 vs 0.3, RR 1.87, 95% CI 1.21 to 2.87). In addition, a significantly higher proportion of all reported injuries among South American teams than European teams occurred in training. Conclusions A larger proportion of injuries occur in training in South American compared with European professional football. Specifically, ligament injuries in training were more frequent among South American teams.

Background: Prolonged sedentary behavior, such as sitting or reclining, has consistently been identified as a stand-alone riskfactor for heightened cardiometabolic risk and overall mortality. Conversely, interrupting sedentary periods by incorporatingshort, active microbreaks has been shown to mitigate the negative effects of sedentary behavior. Casual exergames, which mixelements of casual gaming with physical activity, are one prospective intervention to reduce sedentary behavior because theyrequire physical exertion. Casual exergames have shown promise in fostering emotional and physical advantages when playedin specific circumstances. However, little research exists on how different types of movement interactions impact the psychologicaleffects as well as the physical exertion of playing casual exergames. Objective: The primary aim of this work was to explore the psychological effects and physical exertion of playing casualexergames lasting 2 minutes. More precisely, the investigation focused on comparing upper body and full body movementinteractions. In addition, the work examined variations in body positions, considering both standing and seated positions duringupper body movement interactions. Methods: Two casual exergames were developed and investigated through 2 quasi-experimental studies. In study 1, weinvestigated how players'perceptions of control, exertion, and immersion were affected by using upper body as opposed to fullbody exergame controllers when playing casual exergames. In study 2, we investigated differences in positive affect, performance,enjoyment, and exertion when playing casual exergames with upper body movement interactions in seated and standing positions. Results: Study 1 showed that perceived control was significantly higher for upper body movement interactions than for fullbody movement interactions (P=.04), but there were no significant differences regarding perceived exertion (P=.15) or immersion(P=.66). Study 2 showed that positive affect increased significantly for both standing (P=.003) and seated (P=.001) gameplay.The participants in the standing gameplay group showed slightly higher actual exertion; however, there were no differencesbetween the groups in terms of positive affect, perceived exertion, enjoyment, or performance. Conclusions: Casual exergames controlled by upper body movement interactions in seated gameplay can produce similarpsychological effects and physical exertion as upper body movement interactions in standing gameplay and full body movementinteractions. Therefore, upper body and seated casual exergames should not be overlooked as a suitable microbreak activity.

Decreasing sedentary behavior and taking active short duration breaks offers several positive benefits for office workers. One way to encourage active short duration breaks in an office environment is through the use of casual exergames. Previous research has shown that casual exergames offer benefits in terms of enjoyment, exertion, and increased positive affect. However, little is known about whether this holds true for short duration (e.g., 2 minutes) casual exergames and if seated compared to standing gameplay offers similar benefits. Through a quasi-experimental within-subjects design we investigated whether positive affect differs before and after short duration casual exergaming for seated and standing positions, and if seated compared to standing short duration casual exergaming differs in terms of positive affect, perceived exertion, enjoyment, and performance. The main results showed that short duration casual exergaming increased positive affect significantly for both standing and seated gameplay and that there were no differences between seated and standing gameplay in terms of positive affect, perceived exertion, enjoyment, and performance.

Background: Self-efficacy predicts school achievement. Participation is important for life outcomes. Functioning affects to what degree you can participate in everyday life situations. Participation-related constructs such as self-efficacy and functioning work both as a means of participation and as an end outcome. Learning takes place in this interrelationship. How relationships between participation and these constructs vary, depending on whether impacted by disability or not, how they develop over time and outcomes of these processes need to be explored.

Method: In this three-year longitudinal study developmental processes of student self-efficacy (PE specific and general), aptitude to participate and functioning were explored. The context is school-based Physical Education (PE) in mainstream inclusive secondary school in Sweden. Data was collected from student and teacher questionnaires and observations of PE lessons. Students self-rated their perceived self-efficacy, aptitude to participate and functioning in school years seven and nine. Teachers self-rated their teaching skills. Student engagement, teaching behaviors, interactions and activities in Swedish school-based PE were observed in year eight. Relationships between the constructs and how they develop over time were studied in a total sample of 450 students (aged 12,5-15,5). Specifically focusing on three student groups, students with diagnosed disabilities (n=30), students with low grades in PE (n=36), and students with high grades (n=53) in PE.

Results: Adapted instruments to measure self-efficacy (PE specific and general), aptitude to participate in PE, and functional skills (physical and socio-cognitive were developed and validated. PE specific self-efficacy is closely related to the aptitude to participate and has effects on student engagement and general self-efficacy. Over time PE specific self-efficacy increase in adolescents, but students with disabilities initially responded negatively if their PE teachers rated their teaching skills high. They were also more sensitive to the social environment, which was associated with PE grades over time. During this time the relationship between perceived physical functional skills and PE specific self-efficacy accelerated for students with disabilities. They were observed to be equally highly engaged in PE lessons as their peers. However, students with disabilities were observed to be closer to their teacher and tended to be less social and alone than their peers. Observed teaching skills as measured by level of alignment with syllabus, and affective tone when giving instructions showed differences in complexity and efficiency. Students in the study sample were more engaged in high-level teaching and were more frequently in communicative proximity to their teacher. In conditions of high-level teaching, teachers gave more instructions and used more materials for teaching purposes. Lessons were more often structured into whole group activities and lessons were more focused.

Conclusion: PE specific self-efficacy measures students’ perceived knowledge and skills in PE and is related to students’ aptitude to participate, general self-efficacy and functioning. The overall findings imply that the developmental processes of perceived self-efficacy (PE specific and general), aptitude to participate and functioning differ between the student groups. PE specific self-efficacy and socio-cognitive functioning improve over time in all groups. Stronger associations of PE specific self-efficacy with aptitude to participate and functional skills, and weaker with general self-efficacy were found in students with disabilities compared to their typically functioning peers. Individual factors are vital to learning, but students with disabilities seem to be more sensitive to environmental factors than their peers. The aptitude to participate declines in students with disabilities, probably due to their experience of having physical restrictions. However, while participating in PE, they were similarly relatively highly engaged as their typically functioning peers. Instructions in PE indicate differences in complexity and efficiency of PE teaching. More complex lesson content requires more  instructions and more purposeful materials. Time was used more efficiently in high-level teaching conditions. Lessons were more focused and had more flow, leaving students with less time to socialize. Space was also used more efficiently, and teachers were closer to their students. Indicating that more individual support, feed-back and feedforward was provided. Students with disabilities were more frequently close to their teacher than their typically functioning peers. The use of more whole group formats indicate that teaching is more differentiated in high-level teaching. When activating students physically, teachers may choose simpler self-sustaining activities, i.e. sports games. Small group formats may be used for individual development of motor skills or drills.

Background: Students with disability show an increasing incidence of school failure. Quality teaching and appropriate support may foster high self-efficacy, a predictive factor for successful school outcomes. Physical Education (PE) can provide students with a context in which self-efficacy and participation are promoted leading to improved academic achievement. The transition into secondary school can be challenging for many students with increased educational demands, developmental changes and individual social identification coinciding. A disability may add to the challenge of success.Methods: Three groups of students, aged 13 years and enrolled in Swedish mainstream schools were targeted (n=439). Groups included students with 1.A diagnosed disability, 2.Low grades in PE (D-F) and 3.High grades (A-C) in PE. Questionnaires were collected and analyzed from 30/439 students with a diagnosed disability (physical, neuro-developmental and intellectual) from 26 classes, their classmates and their PE-teachers (n=25). Relationships between student self-reports and PE-teachers self-ratings were investigated. Also examined was the potential to which students functional skills could predict elevated general school self-efficacy, PE specific self-efficacy and aptitude to participate in PE. Results were compared with the total sample and between the three target groups (n=121).Results: For students with disabilities, better self-rated teaching skills were related to lower student perceived general school self-efficacy, PE specific self-efficacy and aptitude to participate in PE. The impact of classroom climate in PE was more obvious among students with disabilities. Perceived functional skills were associated with elevated general school self-efficacy, PE specific self-efficacy and aptitude to participate in PE. Better socio-cognitive functional skills had an overall positive effect on all outcomes. Students with disabilities reported results similar to the total sample, the D-F group scored lower and the A-C group higher than the total sample and the disability group. Elevated self-efficacy in PE is six times less probable in students with disabilities, compared to the A-C group.Conclusions: Our findings that better teacher planning and grading skills, are detrimental to students disadvantaged by disability is contradictive. Improving the establishment and communication of adapted learning standards at the transition to secondary school is a crucial and a predictive factor for promoting positive school experiences for students with disability. Students with disabilities need to be assured that the intended learning outcomes can be reached by doing activities differently than their typically functioning peers. Consideration of class composition is suggested as a means of promoting a positive learning climate, which would particularly benefit students with disabilities. Allocation of resources to support student socio-cognitive skills would improve experiences for the D-F group and likely promote a positive learning environment.

The early vascular adaptation to indoor cycling, a popular activity at many fitness centres, is incompletely evaluated. Forty two healthy women (21-45 years) underwent measurements of arterial wall properties and geometry as well as a maximal bicycle exercise test before and after a 3 months period during which 21 of the women joined indoor cycling classes at a gym 2-3 times per week, while 21 women served as time controls. Peak work load increased by in average 16% (pamp;lt;0.001) and ascending aortic diameter by 4% (pamp;lt;0.01) in the exercise group, while unchanged in control group. The exercise intervention had no significant influence on the local intima-media thickness, blood pressure or the pulse pressure wave configuration while the carotid artery distensibility (pamp;lt;0.05) was higher after the intervention. There was a positive correlation between change in () peak work load and -diameter of tubular ascending aorta (r=0.42, pamp;lt;0.01) in the exercise group. In conclusion, after only 3 months of bicycle exercise training, signs of central arterial remodelling were seen in premenopausal women, which was associated to improvement in exercise capacity.

AimTo explore whether high-level endurance training in early age has an influence on the arterial wall properties in young women. MethodsForty-seven athletes (ATH) and 52 controls (CTR), all 17-25 years of age, were further divided into runners (RUN), whole-body endurance athletes (WBA), sedentary controls (SC) and normally active controls (AC). Two-dimensional ultrasound scanning of the carotid arteries was conducted to determine local common carotid artery (CCA) geometry and wall distensibility. Pulse waves were recorded with a tonometer to determine regional pulse wave velocity (PWV) and pulse pressure waveform. ResultsCarotid-radial PWV was lower in WBA than in RUN (P amp;lt; .05), indicating higher arterial distensibility along the arm. Mean arterial pressure was lower in ATH than in CTR and in RUN than in WBA (P amp;lt; .05). Synthesized aortic augmentation index (AI@75) was lower among ATH than among CTR (-12.8 1.6 vs -2.6 +/- 1.2%, P amp;lt; .001) and in WBA than in RUN (-16.4 +/- 2.5 vs -10.7 +/- 2.0%, P amp;lt; .05), suggesting a diminished return of reflection waves to the aorta during systole. Carotid-femoral PWV and intima-media thickness (IMT), lumen diameter and radial distensibility of the CCA were similar in ATH and CTR. ConclusionElastic artery distensibility and carotid artery IMT are not different in young women with extensive endurance training over several years and in those with sedentary lifestyle. On the other hand, our data suggest that long-term endurance training is associated with potentially favourable peripheral artery adaptation, especially in sports where upper body work is added. This adaptation, if persisting later in life, could contribute to lower cardiovascular risk.

Background There are limited data on the nature, type and incidence of illness in football. Previous studies indicate that gastrointestinal and respiratory tract illnesses are most common. Aim To describe the incidence and burden of illness in male professional football. Methods Over the 4-year study period, 2011-2014, 73 professional football teams in Europe participated, with a total of 1 261 367 player-days recorded. All time-loss illnesses were recorded by the medical staff of each club. A recordable illness episode was any physical or psychological symptom (not related to injury) that resulted in the player being unable to participate fully in training or match play. Results A total of 1914 illness episodes were recorded. The illness incidence was 1.5 per 1000 player-days, meaning that, on average, a player experienced an illness episode every second season, with a median of 3 days absence per illness episode. Severe illness (absence amp;gt;4 weeks) constituted 2% of all illnesses. Respiratory tract illness was the most common (58%), followed by gastrointestinal illness (38%). Respiratory tract illness, gastrointestinal illness and cardiovascular illness caused the highest illness burden. Conclusions The illness incidence among male professional football players is low compared with the injury incidence. We found that the highest illness burden was caused by illness to the respiratory tract, gastrointestinal tract and cardiovascular system.

BackgroundPhysical exercise improves mental health and cognitive function. The purpose of this systematic review was to evaluate the current literature examining the acute effects of a single exercise workout on learning and memory functions in young adults. MethodsThe review was conducted in alignment with the PRISMA guidelines. Studies were included if they were indexed in PubMed, published between 2009 and 2019, used an experimental study design and conducted on young human adults. The MeSH terms "exercise," "learning," and "young adults" were used together with the filters Publication dates-10 years; Human Species; and Article types-Clinical Trial. ResultsThirteen studies met the inclusion criteria and were evaluated. The types of exercise stimulus that were used was walking, running, or bicycling. Several different test instruments were used such as Rey Auditory Verbal Learning Test, Trail Making Test A and B, and Stroop Color Word Test. Exercise for two minutes to one hour at moderate to high intensity had a favorable effect on learning and memory functions in the selected studies. ConclusionsThis systematic review shows that aerobic, physical exercise before encoding improves learning and memory functions in young adults.

The purpose of the study was to investigate the influence of flotation REST upon skilled and less skilled golfers anxiety in terms of physiological indicators of stress, self-rated anxiety scores, muscle tension, and the effect on golf putting. Prior to performing the putting task participants underwent a treatment of flotation REST or a period of resting in an armchair. Participants completed both treatments in a randomized order with a two-week interval. The results showed that both flotation REST and the armchair treatment reduced systolic blood pressure and heart rate, with no differences between treatments or athlete skill levels. No significant differences between treatments were revealed regarding self-ratings, level of muscle tension or putting precision. The results indicate that flotation REST may be useful for reducing negative symptoms related to stress and anxiety in general; however, no support for direct positive effects on golf performance were found.

To determine the 1-year self-reported incidence of overuse and traumatic sport injuries and risk factors for injuries in children participating in a summer sports camp representing seven different sports. 4363 children, 11 to 15 years old participating in a summer camp in seven different sports answered a questionnaire. Injury in this cross-sectional study was defined as a sport-related trauma or overload leading to pain and dysfunction preventing the person from participation in training or competition for at least 1 week. A number of risk factors for injury were investigated such as sex, age, number of hours spent on training in general, and on resistance training with weights. Nearly half [49%, 95% confidence interval (CI) 48–51%] of the participants had been injured as a result of participation in a sport during the preceding year, significantly more boys than girls (53%, 95% CI 50–55% vs 46%, 95% CI 43–48%; P < 0.001). Three factors contributed to increased incidence of sport injuries: age, sex, and resistance training with weights. Time spent on resistance training with weights was significantly associated with sport injuries in a logistic regression analysis. In children age 11 to 15 years, the risk of having a sport-related injury increased with age and occurred more often in boys than in girls. Weight training was the only modifiable risk factor that contributed to a significant increase in the incidence of sport injuries.

The aim of this study was to examine the associations of fitness and physical activity with academic achievement in children with overweight/obesity. A total of 106 (10.0 +/- 1.1y, 61 boys) children participated. The fitness components were assessed by field and laboratory-based tests. Physical activity was measured via accelerometry. The academic achievement was assessed by a standardised test and school-grades. Field-based cardiorespiratory fitness was associated with language skills (ss-standardised- ranging from 0.281 to 0.365, p amp;lt; 0.01). The field-based muscular strength was associated with grade point average, natural and social sciences, and foreign language (ss = 0.280-0.326, all p amp;lt;= 0.01). Speed-agility was associated with some language-related skills (ss = 0.325-0.393, all p amp;lt;= 0.01). The laboratory-based muscular strength also showed an association with mathematics skills (ss = 0.251-0.306, all p amp;lt;= 0.01). Physical activity did not show significant association with academic achievement (p amp;gt; 0.01). Overall, the significant associations observed for muscular strength and speed/agility were attenuated and disappeared in many cases after additional adjustments for body mass index and cardiorespiratory fitness, indicating that these associations are inter-dependent. Our study contributes by indicating that other fitness components apart from cardiorespiratory fitness, such as muscular strength and speed-agility, are positively associated with academic achievement. However, these associations appear to be dependent on body mass index and cardiorespiratory fitness.

Objective: To study sleep quality and sleep hygiene in professional athletes and an age-matched cohort. Design: Cross-sectional study. Setting: Professional athletes and a sport medicine center. Participants: Professional rugby, netball and football athletes (n = 184) and attendees to a sport medicine center (n = 101). Interventions: Participants completed an online survey. Main Outcome Measures: Sleep Hygiene Index (SHI) and Pittsburgh Sleep Quality Index (PSQI). Results: Forty-five percent (n = 128) of respondents were aged between 18 and 24 years, 54% (n = 154) were men and 65% (n = 184) were professional athletes. The sleep duration of the professional athletes (mean rank 134.3, n = 181) was greater than the age-matched cohort (mean rank = 154.4, n = 101), U = 7835.0, z = -2.3, P = 0.02; however, they reported more sleep disturbance (mean ranking = 148.0, n = 181) than the age-matched cohort (mean rank = 129.8, n = 101), U = 7960.5 z = -2.5, P = 0.01, 2-tailed. Professional athletes had worse sleep regularity (mean rank = 152.3, n = 183) compared with the age-matched cohort (mean rank = 124.6, n = 101), U = 7448.5, z = -2.7, P = 0.006, 2-tailed, had an inferior sleep environment (mean rank = 149.5, n = 183) compared with the age-matched cohort (mean rank = 129.8, n = 101), U = 7959.5, z = -2.0, P = 0.047, and had more naps (mean rank = 156.2, n = 183) compared with the age-matched cohort (mean rank = 117.6, n = 101), U = 6729.0, z = -4.2, P = 0.00 0, 2-tailed. Conclusions: Professional athletes reported poorer sleep quality and sleep hygiene compared with an age-matched cohort, and difficulty falling asleep following competition. It is likely this is due to the stress of competition, training, and traveling. Because sleep plays an important role in postexercise recovery and has an impact on injury and athletic performance, it is important to have strategies to support better sleep quality and sleep hygiene in athletes.

Utvecklingen av idrotten – ursprungligen den obefläckade kampen mellan vackra nakna grekiska ynglingar, överflyttad till engelska public school-gräsmattor med på- och välklädda, och inte alltid så vackra överklassynglingar, i något skede som folklig kultur med brödrafolksambitioner, till dagens underhållningsidrott med ekonomiska snarare än ädla motiv – har beskrivits i många texter av skilda slag, inklusive avhandlingar. Det har stundtals klagats på en alltför deterministisk hållning inför utvecklingen, som vore den obehindrad, okontrollerbar, oförklarlig – och värst av allt, inte i behov av förklaring. Inte sällan tar studier avstamp i fait accompli som utvecklingens krona, snapshots från en ny tid. Men även i snävt avgränsade tidsrymder kan skeenden fångas, vilket Hans Lundberg, gammal forumrecensent och nybliven ekonomie doktor visar i sin avhandling Kommunikativt entreprenörskap: Underhållningsidrott som totalupplevelse före, under och efter formeringen av den svenska upplevelseindustrin 1999–2008 (Växjö University Press). Vi bad en annan forumrecensent, tillika nybliven idrottsvetenskaplig licentiat, David Cardell om en recension av Lundbergs idé- och empiritäta bok. Sin recension, som på ett närmast impressionistiskt sätt fångar avhandlingen essenser i smått och stort, avslutar Cardell med reflektionen att textens ställvisa svårgenomtränglighet till trots är Lundbergs dióktorsopus läsvärt för alla som uppmärksammat och häpnat inför idrottens senmoderna utveckling, och kanske än mer angelägen för den som inte ens noterat denna utveckling.

Work rate has a direct impact on the systolic blood pressure (SBP) during aerobic exercise, which may be challenging in the evaluation of the SBP response in athletes reaching high work rates. We aimed to investigate the exercise SBP response in endurance athletes in relation to oxygen uptake (VO2), work rate and to recent reference equations for exercise SBP in the general population. Endurance athletes with a left-ventricular end-diastolic diameter above the reference one performed a maximal bicycle cardiopulmonary exercise test. The increase in SBP during exercise was divided by the increase in VO2 (SBP/VO2 slope) and in Watts, respectively (SBP/W slope). The maximum SBP (SBPmax) and the SBP/W slope were compared to the predicted values. In total, 27 athletes (59% men) were included; mean age, 40 +/- 10 years; mean VO2max, 50 +/- 5 mL/kg/min. The mean SBP/VO2 slope was 29.8 +/- 10.2 mm Hg/L/min, and the mean SBP/W slope was 0.27 +/- 0.08 mm Hg/W. Compared to the predicted normative values, athletes had, on average, a 12.2 +/- 17.6 mm Hg higher SBPmax and a 0.12 +/- 0.08 mm Hg/W less steep SBP/W slope (p &lt; 0.01 and p &lt; 0.001, respectively). In conclusion, the higher SBPmax values and the less steep SBP/W slope highlight the importance of considering work rate when interpreting the SBP response in endurance athletes and suggest a need for specific normative values in athletes to help clinicians distinguish physiologically high maximal blood pressure from a pathological blood pressure response.

The fitness of firefighters is regularly evaluated using exercise tests. We aimed to compare, with respect to age and body composition, two test modalities for the assessment work capacity. A total of 424 Swedish firefighters with cycle ergometer (CE) and treadmill (TM) tests available from Jan 2004 to Dec 2010 were included. We compared results from CE (6 min at 200 W, 250 W or incremental ramp exercise) with TM (6 min at 8° inclination, 4·5 km h(-1) or faster, wearing 24-kg protective equipment). Oxygen requirements were estimated by prediction equations. It was more common to pass the TM test and fail the supposedly equivalent CE test (20%), than vice versa (0·5%), P<0·001. Low age and tall stature were significant predictors of passing both CE and TM tests (P<0·05), while low body mass predicted accomplishment of TM test only (P = 0·006). Firefighters who passed the TM but failed the supposedly equivalent CE test within 12 months had significantly lower body mass, lower BMI, lower BSA and shorter stature than did those who passed both tests. Calculated oxygen uptake was higher in TM tests compared with corresponding CE tests (P<0·001). Body constitution affected approval differently depending on the test modality. A higher approval rate in TM testing suggests lower cardiorespiratory requirements compared with CE testing, even though estimated oxygen uptake was higher during TM testing. The relevance of our findings in relation to the occupational demands needs reconsidering.

The purpose of this study was to explore the leadership experiences of elite football team physicians during the COVID-19 pandemic.

Objectives

To determine the incidence and prevalence of significantly interrupting shoulder pain (SIP) in young surf lifesavers and to determine association with training dosage and the ‘combined elevation test’.

Participants

54 surf lifesavers aged 10 – 18 from the Gold Coast, Australia.

Methods and Outcome Measures

Retrospective survey of SIP and training dosage. Cross-sectional measures of the combined elevation test.

Design

Retrospective.

Results

56.5% of female surf lifesavers reported a history of SIP compared to males with 48.5%. Females had a higher combined elevation score compared to males, 28.32±SD8.52cm and 26.09±SD6.64cm, respectively. Young surf lifesavers had an incidence rate of 2.1 SIP episodes per thousand hours of training, an incidence proportion of 51.9% and prevalence of 18.5%. Combined elevation had low level positive trends with training dosages and statistically significant negative correlation with board paddling sessions per week (r= -0.287, p=<0.05). Those with a history of SIP had a statistically significant higher number of sessions (p=0.008), duration (p=0.015) and distance (p=0.005) swimming per week.

Conclusion

Young surf lifesavers with a history of SIP have greater swimming dosage not associated with decrease in combined elevation score. More board paddling sessions per week decreased the combined elevation score of young surf lifesavers.

Background Although athletic endeavours are associated with a high amount of physical stress and injury, the prevalence of pain is underreported in the sports medicine literature with only a few studies reporting pain on collegiate athletes or exploring sex difference of pain. Impact of pain on athlete availability, training and performance can be mitigated when key epidemiological information is used to inform adequate pain management strategies. This study aims to 1) provide an epidemiological profile of self-reported pain experienced by the National Collegiate Athletic Association (NCAA) athletes by sex during the first half of the 2019 season, 2) describe their self-reported non-steroidal anti-inflammatory drug (NSAID) use. Methods Online survey was completed by athletes at three NCAA institutions from 1 August to 30 September 2019. Descriptive statistics were used to describe player demographic data, self-reported pain and self-reported NSAID use. Pain incidence proportion were calculated. Results Two hundred thirty female athletes and 83 male athletes completed the survey. Self-reported pain incidence proportion for female athletes was 45.0 (95% CI 41.5-48.5) vs 34.9 (95% CI 29.4-40.4) for male athletes. Majority of the athletes did not report pain (55% female vs 62% male) during the first half of the 2019 season. Female athletes reported pain in their back (35%), knee (26%), and ankle/foot (23%) whilst male athletes reported pain in their knee (35%), back (28%), and shoulder (24%). Of all athletes, 28% female vs 20% male athletes reported currently taking NSAIDs. Of athletes that reported pain, 46% female vs 38% male athletes currently took NSAIDs. 70% female vs 61% male athletes self-purchased NSAIDs, and 40% female vs 55% male athletes consumed alcohol. Conclusions Half of female athletes and one in three male athletes reported pain. Most commonly back, knee and foot/ankle pain and knee, back and shoulder pain was reported in female and male athletes respectively. One in four female athletes and one in five male athletes use NSAIDs for pain or prophylactic purpose. Majority self-purchase these medications indicating need for health literacy interventions to mitigate potential adverse effects.

A method of estimating subject specific muscle parameters of musculoskeletal models of elite athletes (skiers) was sought. Subject specific models are necessary due to large differences in general anatomy and physical performance of elite athletes relative the general population. Sought muscle parameters concern the force generating capabilities of muscles. The estimation was limited to only include the quadriceps-femoris and hamstring muscle groups due to these muscle having the highest influence on the performance of a skier. A modified interpretation of the method proposed by Heinen et al. [19] was implemented. The method includes experimental strength tests of knee extension and flexion muscles of a test subject, a musculoskeletal model of the experiments coupled with a mathematical optimisation minimisation formulation. The aim of the optimisation was to match the strength of a model to the experimentally obtained strength curve by minimising  error between the model and experimental results. The optimisation minimises the error between the model and the experimental data by varying the operating range and strength of the involved muscles. The musculo-tendon parameters are estimated through transformation equations, explicitly related to the design variables. Three healty and active males were involved in this study. An overall increase of the accuracy of the optimised model relative an unscaled reference model was observed, with the reduction of the objective function in a range of 80.2-92\% and a mean absolute error varying between 6.8 to 16.5 Nm. In the case of quadriceps-femoris muscles, the optimised model struggles with incorrect prediction of the peak torque and peak torque angle due to limitations of the muscle model and the distribution of the moment arm. The model predicts both peak torque and peak torque angle with high accuracy in the case of hamstring muscles. In addition, the model struggles with low precision for both knee extension and flexion for all of the involved test subjects. Although great improvement in the accuracy was observed, the model prediction was deemed to have low clinical significance, due too low accuracy and precision. The clinical significance could be improved, for example by a more detailed musculoskeletal model or by modifying the behaviour of the muscle model. Future work should focus on addressing the current issues presented in this study and a further development, as the method still is relatively new and untested. Parallelly, the researches should try to test the method in clinical studies, in order to evaluate the influence on the results by the implementation of this method of parameter estimation.

Background Athletes competing in athletics (track and field) at international level may be participating with underlying undiagnosed life-threatening cardiovascular conditions. Our objective was to analyse variations in pre-participation cardiac evaluation prevalence among athletes participating in two International Association of Athletics Federations (IAAF) World Athletics Championships, with regard to the human developmental level and global region of their home countries, as well as athletes’ age category, gender, event group and medical insurance type.

Design Cross-sectional web-based survey.MethodsA total of 1785 athletes competing in the IAAF World Under 18 Championships Nairobi 2017 and World Championships London 2017 were invited to complete a pre-participation health questionnaire investigating the experience of a pre-participation cardiac examination.

Results A total of 704 (39%) of the athletes participated. Among these, 59% (60% of women; 58% of men) reported that they had been provided at least one type of pre-participation cardiac evaluation. Athletes from very high income countries, Europe and Asia, showed a higher prevalence of at least one pre-participation cardiac evaluation.

Conclusions The prevalence of pre-participation cardiac evaluation in low to middle income countries, and the African continent in particular, needs urgent attention. Furthermore, increases in evaluation prevalence should be accompanied by the development of cost-effective methods that can be adopted in all global regions.

Aims A cardiopulmonary exercise (CPX) test is considered the gold standard in evaluating maximal oxygen uptake. This study aimed to evaluate the predictive validity of equations provided by Burr et al., Ross et al., Adedoyin et al., and Cahalin et al. in predicting peak VO2 from 6 min walk test (6MWT) distance in patients with heart failure (HF). Methods and Results New York Heart Association Class I-III HF patients performed a maximal effort CPX test and two 6MWTs. Correlations between CPX VO2 peak and the predicted VO2 peak, coefficient of determination (R-2), and mean absolute percentage error (MAPE) scores were calculated. P-values were set at 0.05. A total of 106 participants aged 62.5 +/- 11.5 years completed the tests. The mean VO2 peak from CPX testing was 16.4 +/- 3.9 mL/kg/min, and the mean 6MWT distance was 419.2 +/- 93.0 m. The predicted mean VO2 peak (mL/kg/min) by Burr et al., Ross et al., Adedoyin et al., and Cahalin et al. was 22.8 +/- 8.8, 14.6 +/- 2.1, 8.30 +/- 1.4, and 16.6 +/- 2.8. A significant correlation was observed between the CPX test VO2 peak and predicted values. The mean difference (0.1 mL/kg/min), R-2 (0.97), and MAPE (0.14) values suggest that the Cahalin et al. equation provided the best predictive validity. Conclusions The equation provided by Cahalin et al. is simple and has a strong predictive validity, and researchers may use the equation to predict mean VO2 peak in patients with HF. Based on our observation, equations to predict individual maximal oxygen uptake should be used cautiously.

Background Studies on subsequent anterior cruciate ligament (ACL) ruptures and career length in male professional football players after ACL reconstruction (ACLR) are scarce. Aim To investigate the second ACL injury rate, potential predictors of second ACL injury and the career length after ACLR. Study design Prospective cohort study. Setting Mens professional football. Methods 118 players with index ACL injury were tracked longitudinally for subsequent ACL injury and career length over 16.9 years. Multivariable Cox regression analysis with HR was carried out to study potential predictors for subsequent ACL injury. Results Median follow-up was 4.3 (IQR 4.6) years after ACLR. The second ACL injury rate after return to training (RTT) was 17.8% (n=21), with 9.3% (n=11) to the ipsilateral and 8.5% (n=10) to the contralateral knee. Significant predictors for second ACL injury were a non-contact index ACL injury (HR 7.16, 95% CI 1.63 to 31.22) and an isolated index ACL injury (HR 2.73, 95% CI 1.06 to 7.07). In total, 11 of 26 players (42%) with a non-contact isolated index ACL injury suffered a second ACL injury. RTT time was not an independent predictor of second ACL injury, even though there was a tendency for a risk reduction with longer time to RTT. Median career length after ACLR was 4.1 (IQR 4.0) years and 60% of players were still playing at preinjury level 5 years after ACLR. Conclusions Almost one out of five top-level professional male football players sustained a second ACL injury following ACLR and return to football, with a considerably increased risk for players with a non-contact or isolated index injury.

Purpose To study the epidemiology and return to play characteristics of anterior and posterior ankle impingement syndromes (AAIS and PAIS) over 18 consecutive seasons in male professional soccer players. Methods Between the 2001-2002 and 2018-2019 seasons, 120 European soccer teams were followed prospectively for various seasons. Time loss injuries and player exposures were recorded individually in 6754 unique players. Injury incidence and burden were reported as the number of injuries and days absence per 1000 h with 95% confidence intervals (CIs). Injury severity was reported as median absence in days with the interquartile range (IQR). Results Out of 25,462 reported injuries, 93 (0.4%) were diagnosed as AAIS (38%) or PAIS (62%) in 77 players. AAIS and PAIS were similar regarding injury characteristics except for a greater proportion of AAIS having a gradual onset (69% vs.47%; P = 0.03) and being re-injuries (31% vs. 9%; P = 0.01). Impingement syndromes resulted in an overall incidence of 0.03 injuries (95% CI 0.02-0.03) per 1000 h and an injury burden of 0.4 absence days per 1000 h. PAIS incidence was significantly higher than that for AAIS [0.02 (95% CI 0.002-0.03) vs. 0.01 (95% CI 0.005-0.01) injuries per 1000 h (RR = 1.7). The absence was significantly longer in AAIS than in PAIS [10 (22) vs. 6 (11) days; P = 0.023]. Impingement syndromes that presented with a gradual onset had longer absences in comparison to impingement with an acute onset [8 (22) vs. 5 (11) days; P = 0.014]. Match play was associated with a higher incidence and greater injury burden than training: 0.08 vs. 0.02 injuries per 1000 h (RR 4.7), respectively, and 0.9 vs. 0.3 days absence per 1000 h (RR 2.5). Conclusion Ankle injuries are frequent in mens professional soccer and ankle impingement is increasingly recognized as a common source of pain, limited range of motion, and potential time loss. In our study, ankle impingement was the cause of time loss in less than 0.5% of all injuries. PAIS was more frequently reported than AAIS, but AAIS was associated with more absence days and a higher re-injury rate than PAIS. The findings in this study can assist the physician in best practice management on ankle impingment syndromes in professional football.

Introduction: Exercise-induced cardiac remodeling is frequent in athletes. This adaptation is structurally manifested by an increase in cardiac dimensions and mass. Soldiers are also subject to intense physical exercise, although with different characteristics. Objective: To compare exercise-induced cardiac remodeling in competitive athletes and in soldiers on a special forces training course. Methods: We studied 17 soldiers (all male and Caucasian, mean age 21 3 years) who completed a special forces course and 17 basketball players (47.3% male, 64.7% Caucasian, mean age 21 +/- 3 years). Assessment included a transthoracic echocardiogram and analysis of myocardial mechanics. This assessment was performed at the beginning and end of the military course and the sports season, respectively. Results: Cardiac remodeling was observed in both groups. The soldiers presented a predominantly eccentric pattern, with increased left ventricular (LV) size (49.7 +/- 3.2 vs. 52.8 +/- 3.4 mm; p amp;lt; 0.01), increased LV mass (93.1 +/- 7.7 vs. 100.2 +/- 11.4 g/m2; p amp;lt; 0.01) and decreased relative wall thickness (0.40 +/- 0.1 vs. 0.36 +/- 0.1; p = 0.05). The basketball players showed a concentric pattern, with decreased LV size (52.0 +/- 4.7 vs. 50.4 +/- 4.7 mm; p = 0.05), and increased relative wall thickness (0.33 +/- 0.1 vs. 0.36 +/- 0.1; p = 0.05). Although there was no significant difference in LV myocardial strain in the groups separately, when compared there was a significant decrease (-20.2 +/- 1.6% vs. -19.4 +/- 2.1%; p = 0.03). Conclusion: Cardiac remodeling was frequent, with an eccentric pattern in soldiers and a concentric pattern in basketball players. Myocardial deformation may represent a physiological adaptation to physical exercise. (C) 2017 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.