Research Articles (Sports Medicine)

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Gender differences in response to strength and conditioning programs in collegiate athletes
Chen, Nora (Universidad Autonoma de Madrid y CV Ciencias del Deporte, 2025)
Research investigates how male and female college athletes react to strength and conditioning programs. This paper evaluates the impact of biological elements including muscle mass density and hormonal composition along with mental components including inspirational drive perception and performance awareness on shifting training success for athletic individuals of either sex. Men commonly achieve better results in muscle mass development because their higher testosterone creates improved strength gain potential yet women show different physical growth speeds and demonstrate superior physical flexibility at the same time. The research study based on primary data analysis for determine the overall research used Smart PLS Algorithm Model between the gender differences in response to strength and conditioning programs. Research demonstrates that individualized strength and conditioning programs need specific adjustments based on natural sex-based physiological differences which improve athletic performance while reducing safety risks. The knowledge of gender-specific responses enables strength and conditioning programming to produce better outcomes for male and female athletes who strive to achieve their best athletic level. Overall result found that directly link of gender differences in response to strength and conditioning programs.
Prevention strategies and modifiable risk factors for upper extremity injury : a systematic review and meta-analysis for the female, woman and girl Athlete Injury pRevention (FAIR) consensus
Heming, Emily E.; Gibson, Eric S.; Friesen, Kenzie B.; Martin, Chelsea L.; Maitland, Martin; Asker, Martin; Blauwet, Cheri; Bullock, Garrett S.; Fredriksen, Hilde; Galarneau, Jean-Michel; Hayden, K. Alix; Lee, Jae Hyung; Mosler, Andrea Britt; Myklebust, Grethe; Pluim, Babette M.; Thornton, Jane S.; Whittaker, Jackie L.; Whiteley, Rod; Crossley, Kay M.; Moller, Merete; Emery, Carolyn A. (BMJ Publishing Group, 2025-12)
OBJECTIVES : To examine injury prevention strategies and potentially modifiable risk factors (MRFs) for upper extremity (UE) injuries in female, woman and/or girl athletes (female/woman/girl). DESIGN : Systematic review with meta-analysis, semiquantitative analyses and Grading of Recommendations Assessment, Development and Evaluation in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. DATA SOURCES : MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), APA PsycINFO (American Psychological Association Psychological Information Database), SPORTDiscus (Sports Discus Database), EMBASE (Excerpta Medica Database), and ERIC (Education Resources Information Center) (30 October 2023) and Cochrane Systematic Review Database and the Cochrane Central Register of Controlled Trials (CENTRAL) (25 November 2023). ELIGIBILITY : Primary data studies with comparison group(s) assessing the association of prevention strategies and/or MRFs for sport-related UE injury, with ≥1 female/woman/girl in each study group. RESULTS : 55 studies (n=20 intervention, n=35 MRF) were included with 33 228 athletes (8642 female/woman/girl; 26%). Of these, 17 (31%) reported female/woman/girl-specific estimates and included five injury locations (n=3 general UE, n=12 shoulder, n=3 elbow, n=3 wrist/hand). One prevention strategy (n=5 shoulder-specific exercise programmes) and seven MRFs were identified, including less range of motion (n=6), less shoulder muscle strength (n=8), high training load (n=1), presence of scapular dyskinesis (n=3), high sport specialisation (n=2), equipment differences (n=1) and less sport-specific conditioning (n=1). Pooled data from three studies suggest that shoulder exercise programmes consisting of strength, stability/control and sport-specific exercises reduce shoulder injury rates by 51% (95% CI 0.30 to 079; I2 0.0%; very-low certainty evidence) across paediatric (≤18 years) and adult handball and volleyball players. CONCLUSIONS : Conclusions Our understanding of female/woman/girl UE injury prevention is limited by heterogeneity across injury outcomes, interventions, MRFs and limited female/woman/girl athlete-specific data. Shoulder-specific strengthening and stability exercise programmes may be beneficial to reduce shoulder injury rates in female/woman/girl handball and volleyball players. Future research should prioritise female/woman/girl athletes to reduce the burden of UE injuries. PROSPERO registration number : PROSPERO CRD42024494967.
Gender- and/or sex-specific considerations for sport-related injury : a concept mapping approach for the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus
Crossley, Kay M.; Haberfield, Melissa J.; Ross, Andrew G.; Gracias, Libby J.; Bruder, Andrea M.; Whittaker, Jackie L.; Chintoh, Araba; Thornton, Jane S.; Davenport, Margie H.; Mountjoy, Margo; Hayman, Melanie; Patterson, Brooke E.; Blauwet, Cheri A.; Verhagen, Evert; Van den Berg, Carla; Okoth, Carole Akinyi; Bolling, Caroline; Janse van Rensburg, Dina Christina; Casey, Ellen; Constantini, Naama W.; Adom-Aboagye, Nana Akua Achiaa; Tomas, Rita; Tsukahara, Yuka; Emery, Carolyn A.; Dijkstra, H. Paul; Donaldson, Alex (BMJ Publishing Group, 2025-12)
OBJECTIVE : This study aimed to gather and represent experts' perspectives on the gender- and/or sex-specific factors relevant to injury risk for female/woman/girl athletes. METHODS : Mixed-methods concept mapping study. Sixty-six experts including cisgendered (1) athlete/coach/carers, (2) clinicians, (3) sports science/high-performance professional, (4) administrators and (5) researchers brainstormed statements to a prompt ('What gender-specific and/or sex-specific factors do you think contribute to injury risk among female, woman and girl athletes?') before thematically sorting and rating the statements/factors for importance and modifiability (5-point Likert scales). RESULTS : Ten clusters were constructed from 101 unique statements/factors. The clusters (number of statements) include: (1) Inequitable organisational funding and support (n=17); (2) Athletes' lack of, and access to, resources (n=7); (3) Lack of knowledge and expertise among support staff (n=6); (4) Lack of evidence for, and implementation of gender and sex-appropriate injury prevention (n=20); (5) Sex-related factors (n=14); (6) Gendered health (n=8); (7) Gendered expectations to conform to athletic ideals and norms (n=10); (8) Gendered harassment (interpersonal violence) and social biases (n=9); (9) Gendered sport environment (7); (10) Gendered communication (n=3). Lack of knowledge and expertise among support staff was deemed the most important and modifiable cluster to address gender- and/or sex-specific factors relevant to injury prevention for female/woman/girl athletes. CONCLUSION : Ten gender- and/or sex-specific clusters, ranging from organisational to biological considerations and societal influences, were defined that could impact female/woman/girl athlete injury risk factors. Advancing stronger evidence for gender and sex appropriate injury prevention is urgently needed.
The LoaD study : the association between different types of physical activity and the progression of knee osteoarthritis - a cohort study protocol
Van der Voort, Joris W.; Voogt, Lennard; Huisken, Sanne; Oei, Edwin; Van Oeveren, Ben; Van Meurs, Joyce; Pluim, Babette M.; Bierma-Zeinstra, Sita M.A.; Van Middelkoop, Marienke (BMJ Publishing Group, 2025-11)
BACKGROUND : The global prevalence of osteoarthritis (OA) is expected to rise as the population ages, leading to increased physical impairments that often reduce physical activity. Knee OA, in particular, is a leading cause of chronic pain and disability in people over 40. OA progression varies among individuals, with factors such as higher age and body mass index contributing to a more rapid progression. However, research suggests that engaging in physical activity such as hiking and running may help alleviate pain and slow OA progression. However, current literature on the relationship between physical activity and knee OA is largely retrospective, lacks comparative analyses across different physical activity types and rarely considers the intensity of physical activity. To address these gaps, the LoaD study was designed as a prospective cohort study aimed at examining how different physical activity types (ie, hiking, running, cycling and tennis) and their intensities relate to knee OA progression over 24 months in physically active individuals with early signs of the condition. METHODS AND ANALYSIS : This prospective cohort study will include 300 participants (75 per physical activity group), who will be followed for 24 months. Eligible participants are aged 45–65, meet the National Institute for Health and Care Excellence (NICE) criteria for clinical knee OA and engage in a minimum weekly activity level for either running (60 min), cycling (120 min), playing tennis (60 min) or hiking (1 hike of 10 km). Baseline and follow-up assessments will include MRI, physical examination (eg, biometrics, lower extremity strength) and blood sampling for molecular biomarker assessment (eg, genetics, inflammatory biomarkers). Participants will receive monthly online questionnaires (eg, demographics, lifestyle, general health, history of knee injuries) and their physical activities will be tracked continuously by global positioning system data from wearable devices. The study’s primary outcomes focus on knee OA progression and symptom changes. These will be assessed through (1) structural progression of knee OA, measured using the MRI Osteoarthritis Knee Score (MOAKS) and (2) clinical symptom progression evaluated by (a) the Knee Injury and Osteoarthritis Outcome Score sport and recreation function subscale and (b) Visual Analogue Scale for pain during an activity nominated by the participant to be the most aggravating for knee pain in the past month (VASNA, 0–10). Differences between groups on the primary outcomes will be analysed using mixed-effects models to determine the impact of activity type and intensity on knee OA progression. ETHICS AND DISSEMINATION : The study is approved by the Erasmus MC Medical Research and Ethics Committee (MREC) (MEC-2022-0420). The results of this study will be made publicly available through peer-reviewed international open-access scientific journals and national and international conferences. Participants will be informed about the results as soon as they are published. STRENGTHS AND LIMITATIONS OF THIS STUDY • This is the first prospective cohort study to compare the effects of different types of physical activity on the structural and clinical progression of knee osteoarthritis. • Structural progression is assessed using MRI-based scoring (MRI Osteoarthritis Knee Score), providing detailed evaluation of joint changes over time. • Continuous, objective measurement of physical activity via wearables and monthly questionnaires enhances the accuracy of sports exposure data. • Participants may switch activities during follow-up due to symptoms, which could introduce crossover effects in sports exposure assessment.
Advancing global equity, diversity and inclusion in sport and exercise medicine consensus and research : deliberate, thoughtful steps from the FAIR consensus
Patterson, Brooke E.; Adom-Aboagye, Nana Akua Achiaa; Constantini, Naama; Okoth, Carole Akinyi; Tsukahara, Yuka; Janse van Rensburg, Dina Christina; Owoeye, Oluwatoyosi B.A.; Gracias, Libby J.; Haberfield, Melissa J.; Whittaker, Jackie L.; Dijkstra, H. Paul; Mchugh, Tara-Leigh; Emery, Carolyn A.; Crossley, Kay M. (BMJ Publishing Group, 2025)
As sport and exercise medicine (SEM), researchers and practitioners strive to enhance athlete health and safety; they must include globally diverse perspectives in research too—this is essential for integrity, international relevance and impact. Yet, the voices of globally under-represented athletes and communities that support them (eg, diverse racial, sociocultural, religious, socioeconomic, language and ethnic groups) are scarce. Without intentional global inclusion, especially from Global South Territories (including Africa, Asia and South America) and under-represented countries across all continents, we risk reinforcing systemic inequities and missing critical insights that could transform and advance SEM research and practice. This is particularly important for metaresearch (eg, reviews, consensus and guidelines), which aims for global impact. This editorial arises from reflections on the Female, Woman and/or Girl Athlete Injury pRevention (FAIR) Consensus 2025. While we focus here on global inclusion, we acknowledge the broad ranges of equity-deserving groups who are absent from SEM research.4–6 Female/women/girl athletes with multiple identities that cut across other under-represented groups (eg, female First Nations athletes and non-English speaking Para sport athletes) may face compounded barriers that affect their capability, opportunity and motivation to participate in research and access evidence-based injury prevention recommendations.
Risk management framework for competitive alpine skiing-co-developed with stakeholders
Bonell Monsonis, Oriol; Verhagen, Evert; Gouttebarge, Vincent; Alhammoud, Marine; Collins, Dave; Ellenberger, Lynn; Gilgien, Matthias; Jordan, Matt; Lasshofer, Michael; Mitterbauer, Gerald; Okell, Abi; Pasanen, Kati; Supej, Matej; Bolling, Caroline; Sporri, Jorg (BMJ Publishing Group, 2025-09)
Previous research has shown that stakeholders in the competitive alpine skiing communities consider risk management to be crucial in sports injury prevention. However, to date, there is a lack of a publicly available systematic and structured risk management approach for the competitive alpine skiing context. This work describes the codevelopment process of a risk management framework with stakeholders in the field of competitive alpine skiing. A panel of international experts invited through personal requests and with expertise in health protection and performance enhancement in competitive alpine skiing convened three times through online group meetings to co-develop a risk management framework through different activities. The underlying discussions focused on the fundamental questions of ‘why’, ‘what’, ‘who’, ‘how’ and ‘for whom’ and included the debate on specific examples from sports practice. The outcome after three meetings was a risk management framework. This framework includes a competitive alpine skiing-specific prevention wheel that integrates different stakeholder views relevant to different levels, their risk priorities, the main five domains and intervention areas identified from the literature, the graded and progressive timescale to intervene and the potential targets for risk management interventions. Moreover, the framework includes a decision-making tree, which operationalises the prevention wheel into a step-by-step sequence for risk management, including risk identification, risk assessment and risk mitigation. It should help stakeholders recognise their responsibilities and the potential actions they can take. Practical examples are provided to demonstrate how to apply the framework and to illustrate the complexity and dynamic interaction of the various factors in the competitive alpine skiing setting. The risk management framework developed lays a strong foundation for creating a safer environment for alpine skiers. It likewise contributes to providing overall awareness of the complexity and inter-relations of risks and prevention measures in the sport. By doing so, this framework has the potential to initiate further processes and on-field translation to sustainably and long-term improve athlete health and safety in competitive alpine skiing.
International Ski and Snowboard Federation (FIS) consensus statement on training and testing in competitive alpine and freestyle skiers and snowboarders
Sporri, Jorg; Bonell Monsonis, Oriol; Balsiger, Peter; Bahr, Roald; Dios, Caitlin; Engebretsen, Lars; Finnoff, Jonathan T.; Gillespie, Sarah; Horterer, Hubert; Mitterbauer, Gerald; Pasanen, Kati; Raschner, Christian; Reardon, Claudia L.; Scherr, Johannes; Schobersberger, Wolfgang; Valtonen, Maarit; Weirather, Tina; Gouttebarge, Vincent; Bolling, Caroline; Verhagen, Evert (BMJ Publishing Group, 2025-08)
To enhance performance, increase resilience and prevent injuries, training and testing (T&T) are the most important strategies for preparing athletes for the demands of their sport. However, for competitive snow sports such as alpine skiing, freestyle skiing and snowboarding, there is little evidence and a lack of international harmonisation of current best practices. This consensus statement, commissioned by the International Ski and Snowboard Federation (FIS), aims to provide recommendations for the physical and psychological T&T of competitive alpine and freestyle skiers and snowboarders within National Ski and Snowboard Associations. A diverse international consensus panel was selected to represent the subject matter regarding gender, nationality, expertise/background, level of competition and skiing and snowboarding discipline. Researchers, officials, physicians, physiotherapists, coaches and former athletes with extensive experience in the field were among the experts. However, the panel had a limited gender balance (seven women and 13 men) and was over-represented by European members (65%) and North American members (20%), whereas there was limited representation of perspectives from South American (5%), Australasian (5%) and African (5%) experts and a lack of experts from Asia. In the first step, the panel established an overarching structure of topics and questions to be addressed by the consensus statement. Following the RAND-UCLA appropriateness method, the consensus process subsequently included panellist ratings, discussions and revisions informed by statements derived from the literature or expert/panellist opinions. These two outcomes served as the basis for manuscript writing, which was finalised through two iterative rounds of manuscript feedback and revision. This consensus statement aims to help athletes, coaches and medical staff of international and national federations plan and implement effective T&T activities for competitive alpine and freestyle skiers and snowboarders.
Shoulder and knee surgery double odds of osteoarthritis in retired professional rugby players
Le Roux, Johan; Janse van Rensburg, Dina Christina; Kemp, Simon; Lambert, Mike; Readhead, Clint; Stokes, Keith; Viljoen, Wayne; Kerkhoffs, Gino; Gouttebarge, Vincent (Elsevier, 2025-09)
OBJECTIVES : This study i) described the prevalence of clinically diagnosed shoulder and knee osteoarthritis among retired male professional rugby players, ii) determined the association of severe injury and related surgery with shoulder and knee osteoarthritis, and iii) described players' level of shoulder and knee function and compared it to matched controls. DESIGN : Observational study with a cross-sectional design using questionnaires. METHODS : Retired professional rugby players and matched controls from a non-elite sporting background were recruited. Single questions and validated questionnaires determined clinical shoulder and knee osteoarthritis as well as shoulder and knee function. Logistic regression analysis was conducted to examine potential associations, whilst comparisons with matched controls for shoulder and knee function were explored using the Mann–Whitney test for independent samples. RESULTS : Fourteen percent of the retired male professional rugby players (n = 146; mean age = 39.6 years) had clinical shoulder osteoarthritis and 23 % had clinical knee osteoarthritis. Every shoulder surgery doubled retired rugby players' odds of having clinical shoulder osteoarthritis (odds ratio = 2.1; 95 % confidence interval = 1.1–3.9) and every knee surgery doubled retired rugby players' odds of having clinical knee osteoarthritis (odds ratio = 2.0; 95 % confidence interval = 1.2–3.3). CONCLUSIONS : Clinical shoulder and knee osteoarthritis is a common medical condition among retired professional rugby players. Long-term consequences should be considered when managing shoulder and knee injuries during professional rugby players' careers. PRACTICAL IMPLICATIONS • Long term consequences of treatment should be considered when managing shoulder and knee injuries during professional rugby players' careers. • The increased odds of developing clinical OA should be discussed with rugby players before treatment for shoulder and knee injuries is decided. • Tailored support should be provided for professional rugby players after retiring from the game to promote their long-term health.
Tackle safety in rugby : what guidance exists? A qualitative document analysis of publicly available guidelines amongst national and international rugby organisations
Dane, Kathryn; West, Stephen W.; Quarrie, Kenneth Lincoln; Yeomans, Caithriona; McLeod, Shreya; Wilson, Fiona; Hendricks, Sharief; Connors, Will; Van Dyk, Nicol; Ventresque, Anthony (Elsevier, 2025)
OBJECTIVES : To conduct a qualitative document and content analysis of publicly available tackle safety guidance amongst national and international rugby organisations, across both Rugby Union and Rugby League, in order to determine the number, type, and focus of current tackle safety guidance. DESIGN : Qualitative document and content analysis. METHODS : Tackle safety guidance was identified through (1) a structured online search via Google using targeted search terms and synonyms, and (2) a comprehensive manual search of national and international rugby organisation websites, at all levels of competition, conducted between September 2024 and January 2025. Resources, including documents, videos, e-learning modules, and other relevant materials, were included if they addressed tackle safety in rugby. Qualitative content analysis of each resource was performed, organising the information into themes and subthemes. RESULTS : A total of 123 documents were identified from 18 rugby organisations' websites. Portable Document Formats (PDFs) (n = 55) and webpages (n = 51) were the most common type of resources followed by infographics (n = 9) and eLearning (n = 8). Four themes emerged based on the content of the documents; these were tackle safety laws (35 %), tackle preparation (33 %), concussion specific guidance (20 %), and protective equipment (13 %). CONCLUSIONS : Whilst substantial efforts have been made in tackle safety resource development, few have been rigorously evaluated, and there is variation in the number, type, focus and implementation. Future tackle safety efforts should address key areas such as law variations, contact training loads, return-to-contact protocols, and education, with a particular focus on evaluations for underserved groups. Ongoing research and collaboration between knowledge creators and users are essential to optimise tackle safety for all. PRACTICAL IMPLICATIONS • There is significant variation in the number, type, and focus of tackle safety resources available across different rugby organisations. • Many existing tackle safety strategies lack rigorous evaluation of both their adoption and effectiveness in reducing tackle-related injury risks across various levels of rugby participation, particularly in youth and women's rugby. • Future tackle safety guidance could adopt a simplified, “less is more” approach, prioritising the development, implementation, and evaluation of targeted areas such as law variations, contact training loads, and return-to-contact protocols, with a focus on enhancing educational delivery to cater for diverse audiences.
Building the future of exercise oncology : current status of international workforce development and integration into standard cancer care
Wonders, Karen Y.; Kennedy, Mary A.; Capozzi, Lauren C.; Lei, Yao; Pillay, Lervasen; Azevedo Voltarelli, Fabrício; Wiskemann, Joachim; Campbell, Anna M. (Oxford University Press, 2025-09)
The complex requirements of people with cancer can impact the provision of safe, effective, evidence-based exercise prescription. Consequently, a range of essential competencies are required from the exercise oncology workforce. There is a global need for a standardized approach to the development of this workforce. By defining, standardizing, and training the workforce in essential competencies, this will enable various professionals to safely and effectively screen, access, design, and deliver appropriate exercise programs. Therefore, this is also a call for a global collaboration on the development of the exercise oncology workforce with special attention to assisting low- or middle-income countries with their increasing cancer burden and unique challenges, which may require unique context-specific strategies. The building of an appropriate internationally standardized workforce is essential in the provision of physical activity and exercise options as part of standard cancer care.
Consensus on the descriptors, definitions, and reporting methods for heading in football studies : a Delphi study
Peek, Kerry; Ross, Andrew G.; Williamson, Paula R.; Georgieva, Julia; Andersen, Thor Einar; Meyer, Tim; Gouttebarge, Vincent; Dahlen, Sara; Clarke, Mike; Serner, Andreas (Public Library of Science, 2025-07)
Heading in football (soccer) is a complex skill involving deliberate head-to-ball contact, which may pose short-, medium-, and long-term risk to player brain health. However, understanding header exposure during matches and training sessions, as well as comparing header incidence between studies is currently challenging given the lack of standardisation in descriptors, definitions, and reporting methods. This Delphi study aimed to establish a consensus on the descriptors, definitions, and reporting methods for heading in football research to improve consistency and quality. The study involved 167 participants from diverse football-related backgrounds including coaches, players, medical personnel, and researchers, with consensus achieved to include 27 descriptors in minimum reporting criteria for heading in football research. An additional 27 descriptors were also defined for inclusion in an expanded framework. The operational definition of a header was standardised as “a head-to-ball contact where the player makes a deliberate movement to redirect the trajectory of the ball using their head.” The consensus framework provides a standardised approach to heading in football research to enhance data quality and comparability across studies. Improved header incidence data quality has the potential to contribute significantly to our understanding of the risks associated with heading in football to inform future research and practice guidelines.
Health and performance challenges in the era of human enhancement : insights from sport medicine professionals
Hu, Ke; Schneider, Christian; Hutchinson, Mark R.; Ergen, Emin; Geistlinger, Michael; Killoughery, Iain; Braumann, Klaus-Michael; Lazzoli, Jose Kawazoe; Seto, Jane; Bigard, Xavier; Debruyne, Andre; Jegier, Anna; Papadopoulou, Theodora; Manonelles, Pedro; Arroyo, Francisco; Ghrairi, Mourad; Cintron, Ana V.; Zupet, Petra; Leitao, Marcelo Bichels; Kayikci, Umutcan; Kopile, Daniel Arkader; Pigozzi, Fabio; Fossati, Chiara; Di Gianfrancesco, Alessia; Di Luigi, Luigi; Stafrace, Kirill Micallef; Ionescu, Anca; Wolfarth, Bernd; Ergun, Metin; Roberts, William O.; Natsis, Konstantinos; Tooth, Camille; Rozenstoka, Sandra; Casajus, Jose Antonio; Muniz-Pardos, Borja; Nahon, Roberto Lohn; Shroff, Malav; Xie, Minhao; Constantinou, Demitri; Janse van Rensburg, Dina Christina; Ulkar, Buelent; Jowett, Andrew; Badtieva, Victoriya; Kaux, Jean-Francois; Baumgartl, Peter; Papaellina, Clea Hadjistephanou; Steinacker, Juergen; Motta-Pensabene, Julio; Reer, Ruediger; Bachl, Norbert; Migliorini, Sergio; Zahar, Maher; Stuart, Mark; Bilzon, James; Massazza, Giuseppe; Di Pietro, Bruno; Hassan, Khaled Massoud; Drummond, Felix Albuquerque; Fincoeur, Bertrand; Petroczi, Andrea; Pitsiladis, Yannis (Springer, 2025-10)
BACKGROUND : In the pursuit of sporting success, some elite athletes prioritise peak performance over long-term health, frequently resulting in significant and enduring health consequences. The Enhanced Games (TEG) position themselves as a bold experiment in transhumanism, advocating for the use of performance-enhancing drugs (PEDs), including methods banned by World Anti-Doping Agency (WADA), to push the boundaries of human athletic potential. OBJECTIVES : The aim of this study is to explore the perspectives of sport physicians, sport scientists, physiotherapists and other allied healthcare professionals on treating and supporting “enhanced athletes”, with the view of informing future guidelines. METHODS : Participants were invited via email and personal contacts within sport medicine communities to complete a brief anonymous survey via QuestionPro™. Descriptive statistics were performed using Excel™ and RStudio™. RESULTS : A total of 323 healthcare professionals responded (82% were sport physicians), among whom 74% expressed a willingness to treat acute lesions and/or chronic diseases in “enhanced athletes”. In comparison, a considerable minority (30%) expressed support for assisting athletes in their use of PEDs and methods under medically supervised conditions, with high consistency across professional roles. A relatively high readiness was observed in sport physicians treating acute (77% versus 58%; p < 0.01) and chronic (75% versus 63%; p = 0.11) diseases for “enhanced athletes”. As far as WADA rules and/or national anti-doping laws apply, this support presupposes compliance with the code and the respective national laws to protect physicians from serious professional, legal and personal consequences. CONCLUSION : The preliminary findings align with the broader goal of fostering a sport culture that values both peak performance and the short- and long-term health of all participants. These results emphasise the necessity of implementing professional guidelines and comprehensive support systems designed to safeguard the long-term well-being of all athletes and underscore the urgent need for further research into the impact of TEG on sport and its community.
Can we trust them? An expert evaluation of large language models to provide sleep and jet lag recommendations for athletes
Vitale, Jacopo; McCall, Alan; Cina, Andrea; Janse van Rensburg, Dina Christina; Halson, Shona (Springer Nature, 2025)
BACKGROUND : With the increasing use of artificial intelligence in healthcare and sports science, large language models (LLMs) are being explored as tools for delivering personalized, evidence-based guidance to athletes. OBJECTIVE : This study evaluated the capabilities of LLMs (ChatGPT-3.5, ChatGPT-4, and Google Bard) to deliver evidence-based advice on sleep and jet lag for athletes. METHODS : Conducted in two phases between January and June 2024, the study first identified ten frequently asked questions on these topics with input from experts and LLMs. In the second phase, 20 experts (mean age 43.9 ± 9.0 years; ten females, ten males) assessed LLM responses using Google Forms surveys administered at two intervals (T1 and T2). Inter-rater reliability was evaluated using Fleiss' Kappa, and intra-rater agreement using the Jaccard Similarity Index (JSI), and content validity through the content validity ratio (CVR). Differences among LLMs were analyzed using Friedman and Chi-square tests. RESULTS : Experts’ response rates were high (100% at T1 and 95% at T2). Inter-rater reliability was minimal (Fleiss' Kappa: 0.21–0.39), while intra-rater agreement was high, with 53% of experts achieving a JSI ≥ 0.75. ChatGPT-4 had the highest CVR for sleep (0.67) and was the only model with a valid CVR for jet lag (0.68). Google Bard showed the lowest CVR for jet lag (0%), with significant differences compared to ChatGPT-3.5 (p = 0.0073) and ChatGPT-4 (p < 0.0001). Reasons for inappropriate responses varied significantly for jet lag (p < 0.0001), with Google Bard criticized for insufficient information and frequent errors. ChatGPT-4 outperformed other models overall. CONCLUSIONS : This study highlights the potential of LLMs, particularly ChatGPT-4, to provide evidence-based advice on sleep but underscores the need for improved accuracy and validation for jet lag recommendations.
Exploring eccentric hamstring strength : peak force, torque, and impulse metrics in elite academy soccer players
Tondelli, Eduardo; Tomaghelli, Luciano; Tedesco, Franco; Feroldi, Alejo; Herbella, Juan; Baldjian, Agustin; Van Dyk, Nicol (Routledge, 2025)
This study aimed to characterize eccentric strength metrics and the bilateral asymmetry index of the knee flexor muscles across different categories in elite academy soccer players. Also, explore correlations between the metrics with demographic characteristics. With a cross-sectional design, data were collected over two weeks during the mid-year break of the 2023 season. Eccentric muscle strength was assessed with the Nordic Hamstring Exercise (NHE) with the NordBord®. One hundred thirty-two male elite academy soccer players between 13 and 20 years old (16.3 ± 2.2 years; body mass (BM): 68.8 ± 6.5 kg; height: 174 ± 7 cm) competing in the Argentinian Football League participated. Metrics included were relative and absolute peak force (PF), peak torque (PT), and eccentric impulse (EI). Bilateral asymmetry index (BAI) was calculated for each metric. Eccentric PF, PT, and EI significantly increased with age. BAI decreased from the U17 category onward. Moderate correlations were observed between PF and PT with BM (r = 0.45, p < .001, 95% CI: 0.31–0.58; and r = 0.54, p < .001, 95% CI: 0.41–0.65, respectively), and PF with body mass index (BMI) (r = 0.37, p < .001, 95% CI: 0.22–0.51). EI had weaker correlations with BM (r = 0.12, p < .1665, 95% CI: –0.061–0.3). PF and PT peaked at the U17 and declined in older categories. To conclude, this study found higher eccentric hamstring strength values in elite youth soccer players than previously reported. PF showed moderate correlation with BMI, while EI had weak correlations with BM. Significant age-related variations in BAI were observed, particularly in younger players.
International Tennis Federation (ITF), Women's Tennis Association (WTA), and Association of Tennis Professionals (ATP) expert group statement on nutrition in high-performance tennis. Current evidence to inform practical recommendations and guide future research
Vicente-Salar, Néstor; Crespo, Celda Miguel; Pluim, Babette M.; Fernández-Fernández, Jaime; Stroia, Kathleen; Ellenbecker, Todd; Sanz, David; Del Coso, Juan; Moreno-Pérez, Victor; Hainline, Brian; López-Samanes, Álvaro; LaRoche, Jessica; Parker-Simmons, Susie; Van Reijen, Miriam; Reid, Machar; Duffield, Rob; Girard, Olivier; Love, Page; Broad, Elizabeth; Halson, Shona; Ruiz-Cotorro, Angel; Sanz-Quinto, Santiago; Ruiz-Cotorro, Ángel Jr; Sánchez Pay, Alejandro; Burke Louise M. (Human Kinetics, 2025-11)
The sport of tennis involves unique nutritional demands for the physical and technical aspects of match play and training, as well as the nutritional challenges associated with extensive travel and a lengthy competition calendar. An expert group assembled by The International Tennis Federation, the Women's Tennis Association, and the Association of Tennis Professionals has produced a scientific review of current evidence to inform practical recommendations for high-performance tennis. The narrative summary considers the diversity within the tennis community, including male and female players, youth players, and wheelchair players. The Expert Group Statement addresses nine specific topics: (a) introduction to tennis; (b) physiological characteristics of tennis training and match play; (c) training nutrition; (d) body composition, low energy availability, and relative energy deficiency in sport; (e) match-day nutrition; (f) dietary supplements for tennis performance; (g) environmental and travel issues; (h) nutrition guidelines during periods of illness and injury rehabilitation; and (i) special population groups. The statement advocates for an evidence-based approach to nutrition in high-performance tennis and emphasizes a "food first" philosophy, prioritizing food over supplements to meet nutrient requirements effectively. In recognition of the benefits of sound nutrition, strategies in supporting health and performance over a player's career, academies, national federations, and international organizations are encouraged to engage professionals with appropriate nutrition-related qualifications and professional registrations to support players effectively.
Sex, training variables, history of chronic disease, and chronic injury are risk factors associated with a history of exercise-associated muscle cramping in 10,973 ultramarathon race entrants : a safer XXXVIII study
MacMillan, Candice; Sewry, Nicola Ann; Schwellnus, Martin Peter; Boulter, Jeremy; Dyer, Marlise; Jordaan, Esme (Edizioni Minerva Medica S.p.A., 2024-09)
BACKGROUND : The prevalence of a history of exercise-associated muscle cramping (hEAMC) among ultramarathon runners is high. While the Comrades is one of the most popular mass community-based participation ultramarathons (90 km) globally, research on the epidemiology, clinical characteristics, and risk factors of entrants' lifetime hEAMC are scarce. This research aimed to describe the epidemiology, clinical characteristics, and risk factors of hEAMC among Comrades Marathon entrants. METHODS : This was a retrospective, cross-sectional study in which 10973 race entrants of the 2022 Comrades Marathon participated. Entrants completed a prerace medical screening questionnaire that included questions related to the lifetime prevalence (%; 95% CI), severity, treatment and risk factors (demographics, training/racing variables, chronic disease/allergies, injury) for EAMC. RESULTS : One thousand five hundred eighty-two entrants reported hEAMC in their lifetime (14.4%; 95% CI: 13.77-15.09). There was a significantly (P<0.01) higher prevalence of male (16.10%; 95% CI:15.34-16.90) than female (8.31%; 95% CI: 7.27-9.50) entrants with hEAMC (PR=1.94; 95% CI:1.68-2.23). The prevalence of hEAMC was highest in entrants with a: 1) 1 disease increase in composite disease score (PR=1.31; 95% CI:1.25-1.39); 2) history of collapse (PR=1.87; 95% CI 1.47-2.38); 3) past chronic musculoskeletal (MSK) injury (PR=1.71; 95% CI 1.50-1.94); and 4) MSK injury in the previous 12 months (PR=2.38;95% CI: 2.05-2.77). Training-related risk factors included an increase of 10 km weekly running distance (PR=0.97; 95% CI:0.95-0.99) and a training pace increase of 1min/ km (slower) (PR=1.07; 95% CI:1.03-1.12). CONCLUSIONS : Future research should investigate the causal relationship between risk factors identified and hEAMC in ultramarathon runners. Findings from this study could assist in effective anticipation and adequate planning for treating EAMC encounters during community-based mass participation events.
International Olympic Committee consensus-driven guidelines for athlete mental health support at sporting events
Mountjoy, Margo; Sloan, Scott; Ali-Zada, Msomah; Bindra, Abhinav; Blauwet, Cheri; Budgett, Richard; Burrows, Kirsty; Currie, Alan; Engebretsen, Lars; Erdener, Ugur; Massey, Andrew; McDuff, David; Moran, Jane; Purcell, Rosemary; Putukian, Margot; Thornton, Jane S.; Viseras, Gloria; Fear, Joanna; Gouttebarge, Vincent (BMJ Publishing Group, 2025-11)
Event-related mental health problems among elite athletes are prevalent. However, empirical details on the development and implementation of a comprehensive mental health support programme at international sporting events are lacking. Therefore, this paper aims to provide consensus-driven, evidence-based recommendations to guide such a development and implementation. An 8-stage process based on the RAND-UCLA Appropriateness Method was adopted to collate and synthesise the available literature on this topic, to identify gaps in the scientific evidence and to enlist expert experience from a multidisciplinary expert panel to fill these gaps. Within such a process, the existing scientific literature was explored while experts (including athletes) were consulted to reach consensus on the recommendations. Accordingly, a robust pre-event plan is required to ensure the successful implementation of a comprehensive mental health programme during sport events, focussing on promotion, prevention, treatment and recovery. During sporting events, according to the defined pre-event plan, various activities targeting athletes, coaches, the entourage, officials or fans should be implemented: for example, educational programmes to decrease stigma, raise awareness and support help-seeking, a mental fitness area for decompression and relaxation, inperson mental health services provided by qualified mental health professionals with sport-specific as well as trauma-informed and violence-informed skills and mental health surveillance in parallel with the existing injury and illness surveillance programmes. Post event, a thorough evaluation of the implemented activities should be conducted while surveillance data should be analysed to identify areas requiring future targeted intervention(s). Also, particular attention should be given to postevent mental health support including the use of decompression interventions to support adjustment, emotional processing and reintegration.
The prevalence, size, and anatomic location of cartilage and osteochondral lesions in athletes with an acute ligamentous ankle injury
Baltes, Thomas P.A.; Dalansi, Feriel; Al-Naimi, Maryam R.; Bordalo, Marcelo; Holtzhausen, Louis; Whiteley, Rod; Cardinale, Marco; D'Hooghe, Pieter; Kerkhoffs, Gino M.M.J.; Tol, Johannes L. (Sage, 2025-07)
BACKGROUND : In athletes with an acute ligamentous ankle injury, cartilage and osteochondral lesions ([O]CLs) have been reported in 8% using 1.5-T magnetic resonance imaging (MRI). Visualization of cartilage injuries improves with the use of higher field strengths. PURPOSE : To evaluate the prevalence, size, and anatomic location of (O)CLs in athletes with an acute ligamentous ankle injury using 3-T MRI, as well as to determine the association of (O)CLs with injury of (1) the lateral ankle ligaments and (2) anterior syndesmosis. STUDY DESIGN : Cohort study; Level of evidence, 3. METHODS : For this prospective cohort study, all acute ligamentous ankle injuries in athletes (≥18 years of age) evaluated in the outpatient department of a specialized orthopaedic and sports medicine hospital within 7 days after injury were assed for eligibility. Acute ankle injuries were excluded if 3-T MRI could not be obtained within 10 days after injury or if imaging demonstrated a frank fracture. A musculoskeletal radiologist assessed MRI scans for the presence, location, and size of (O)CLs. Morphology was graded using the modified Berndt and Harty score, Griffith MRI score, and International Cartilage Regeneration & Joint Preservation Society score. In addition, injuries of the lateral ankle ligaments and anterior syndesmosis were graded. A multivariate logistic regression analysis was performed to evaluate the association between (O)CLs and injury of the (1) lateral ankle ligaments and (2) anterior syndesmosis. RESULTS : Between September 2016 and February 2020, 171 acute ankle injuries in 166 athletes were included in this study. The overall prevalence of (O)CLs was 14%. (O)CLs of the talus and tibia were observed in 24 (14%) and 9 (5%) acute ankle injuries, respectively. Of 33 (O)CLs, 28 (85%) were classified as cartilage lesions. Lateral ligament injury was observed in 73% of acute ankle injuries, and anterior syndesmosis injury in 38%. Multivariate logistic regression analysis did not show significantly higher odds of (O)CLs in the presence of anterior syndesmosis injury (OR, 2.16; 95% CI, 0.90-5.16). CONCLUSION : In athletes with an acute ligamentous ankle injury, a prevalence for (O)CLs of 14% was established using 3-T MRI. The majority were cartilage lesions. No statistically significant association was established between (O)CLs and lateral ligament or syndesmosis injury was established.
Protecting respiratory health of athletes : an Olympic challenge
Hull, James H.; Clemm, Hege; Backer, Vibeke; Koehle, Michael; Mountjoy, Margo; Schwellnus, Martin Peter; Olin, J. Tod (Elsevier, 2024-07)
The summer of 2024 will be remembered in part for the XXXIII Olympic and Paralympic Games in Paris, France. The Games provide a platform to highlight the value of sporting participation and remind us of the widespread health benefits of regular exercise, including for cardiovascular, metabolic, mental, and respiratory health
International perspectives on exercise oncology : current state, challenges, and opportunities for future development
Luo, Hao; Bergerot, Paulo Gustavo; Galvão, Daniel A.; Jeon, Justin Y.; Mustian, Karen Michelle; Newton, Robert U.; Pillay, Lervasen; Wiskemann, Joachim; Schmitz, Kathryn H. (Oxford University Press, 2025-09)
Exercise oncology has emerged as a distinctive area of research and clinical practice. To obtain a global overview of this field, we summarize viewpoints from experts across 6 continents on (1) the scope of exercise oncology research and programs, (2) the availability of reimbursement for cancer exercise services, and (3) pathways and initiatives for developing the exercise oncology workforce. From an international perspective, the field of exercise oncology has progressed substantially; however, gains made to date are uneven, with general underdevelopment in Africa, Asia, and South and Central America. In addition, the availability of cancer exercise services continues to fall short of the increasing demand worldwide. With the upcoming formation of the International Society of Exercise Oncology, we suggest leveraging coordinated efforts from the global exercise oncology community to optimize research capacity, enhance workforce development, and expand the delivery of exercise services to advance the field across the world.

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