Telehealth in Orthopedic Sports Medicine: A Survey Study on Patient Satisfaction and Experience.

Background: Telehealth has seen breakthroughs in many fields of medicine, but utilization remains limited in orthopedic sports medicine. The purpose of this investigation was to compare patient satisfaction, duration of care, and overall patient experiences with telehealth and in-person clinical visits for sports-related injuries. Methods: A cross-sectional survey study was conducted at an orthopedic sports medicine clinic during the peak of the COVID-19 pandemic between March and November 2020. Anonymous electronic surveys were used to record patient responses and statistical comparisons were drawn through two-sample t-tests. Results: A total of 175 patients (82 telehealth vs. 93 in-person) consented to participate in this investigation, and all were included in the final analysis. The overall composite satisfaction score, when compared between the two groups, did not differ (p = 0.63). Duration of care was significantly longer in the 93 patients who had in-person clinical visits as compared with the 82 patients who had telehealth visits (61/93: >31 min vs. 75/82: <30 min; p < 0.001). Finally, of the 82 patients who had telehealth, 3 respondents said they were "very unlikely" and "unlikely" to request another virtual clinical visit and/or recommend this mode of health care delivery to friends or family. Of the 93 patients had in-person clinical visits, only 15 respondents stated they were uninterested in telehealth under any circumstance. Conclusion: Most patients presenting to an orthopedic sports medicine clinic are open to telehealth, recognize its utility, and believe it to be just as comparable with in-person clinical visits. Level of Evidence: IV.

A Cross-Sectional Study of the Impact of the COVID-19 Pandemic and Lockdown Orders on Injury Prevalence in National Collegiate Athletic Association (NCAA) Division I Athletes.

Objective The purpose of this study was to analyze the effect of the coronavirus disease 2019 (COVID-19) on injury prevalence in National Collegiate Athletic Association (NCAA) varsity athletes following mandatory state-issued stay-at-home orders in March 2020. A secondary objective was to evaluate the relationship between COVID-19 infection and injury prevalence. Methods The respondents were recruited during pre-participation evaluations held at a Division I university in California in the summer of 2021, as well as via emails shared by athletic trainers at the institution. Data was collected using the Qualtrics Survey Platform (Qualtrics, Provo, UT). For all questions regarding the effects of the COVID-19 pandemic, the participants were asked to compare March 2020-March 2021 ("post-pandemic") to March 2019-March 2020 ("pre-pandemic"). Injury was defined as a physical complaint or condition sustained by an athlete during participation in training or competition that resulted in at least one missed day of practice or competition. The study participants were also asked to disclose their history of laboratory-confirmed COVID-19 infection. Results One hundred forty-six respondents completed the survey, with a 72.3% response rate. Of the respondents, 33.6% (n=49) reported sustaining at least one injury in the year preceding the pandemic, whereas 45.2% (n=66) of respondents reported sustaining at least one injury within the first year of the pandemic, a 34.5% relative increase in injuries (RR=1.35; 95% CI=1.01, 1.80). There was no significant difference in the number of upper body (RR=1.64; 95% CI=0.8, 3.34; p=0.177) versus lower body (RR=1.31; 95% CI=0.94, 1.82; p=0.11) injuries before and after the pandemic onset. Thirty-two respondents reported a history of COVID-19 infection. The athletes who reported a prior COVID-19 diagnosis were no more likely than the athletes with no prior COVID-19 diagnosis to obtain an injury from March 2020 to February 2021 (p=0.85). Conclusion This study indicates that the COVID-19 pandemic and stay-at-home orders were associated with a greater risk of injury in this cohort of collegiate athletes. Interestingly, a history of laboratory-confirmed COVID-19 infection was not associated with increased risk of injury.

Evaluating workforce well-being: an investigation of healthcare professionals' mental health and burnout symptoms at the Tokyo 2020 and Beijing 2022 Paralympic Games.

OBJECTIVE: To explore the prevalence of symptoms of mental health conditions and burnout of healthcare professionals (HCPs) working during the Tokyo 2020 Paralympic Games and the Beijing 2022 Paralympic Winter Games. METHODS: In this cross-sectional, observational study, HCPs working during the Tokyo 2020 and Beijing 2022 Paralympic Games were asked to complete an online, anonymous survey, which included demographic questions and questions regarding mental health symptoms including depression (Patient Health Questionnaire 9-item depression scale) and anxiety (Generalized Anxiety Disorder 7-item scale) as well as burnout (Maslach Burnout Inventory-Human Services Survey: depersonalisation, emotional exhaustion, personal accomplishment). Correlation coefficients (r) were calculated between demographic characteristics and mental health symptoms. RESULTS: In total, 256 HCPs (of 857 HCPs; 30%) completed the surveys. Twelve and eight per cent of HCP scores fell within the moderate to severe depression and moderate to severe anxiety categories, respectively. More than 30% reported moderate to high burnout (depersonalisation: 36%; emotional exhaustion: 36%; personal accomplishment: 58%). In addition, thoughts of self-harm and/or suicidality were reported by some HCPs (8%). Weak correlations were observed between age and depression (r=-0.13, p=0.046), anxiety (r=-0.16, p=0.010) and burnout (emotional exhaustion: r=-0.14, p=0.032; personal accomplishment: r=0.27, p<0.001). CONCLUSION: Although most HCPs reported good mental health, this study suggests that a subset of HCPs experienced symptoms of depression, anxiety, burnout or thoughts of self-harm during the Tokyo 2020 and Beijing 2022 Paralympic Games. While the generalisability of these findings outside of COVID-19 restrictions should be tested, appropriate guidance and mental health support of HCPs leading up to the Paralympic Games should be prioritised.

Pharmacy services at the Tokyo 2020 Olympic and Paralympic Games: perspectives of the pharmacy workforce.

OBJECTIVES: To evaluate the awareness of the volunteer pharmacy workforce of medication use and their satisfaction with the pharmacy services of the Tokyo 2020 Olympic and Paralympic Games from a pharmacist's perspective. METHODS: A questionnaire was developed from related articles in published peer-reviewed journals and modified prior to distribution to the whole population of pharmacists serving at the Tokyo 2020 Olympic and Paralympic Games. Validity tests were conducted based on expert opinions and Cronbach's alpha (0.79). The questionnaire consisted of demographics (11 questions), knowledge of medication use in sports (8 questions) and satisfaction on the provision of the service (5 questions). Responses using a 5-point-Likert scale, from strongly agree (5) to strongly disagree (1), and two free text questions were analysed with descriptive statistics. RESULTS: The response rate was 86% (n=32/37). Overall, the pharmacists reported a high awareness of medication use. Specifically, questions on the prohibited list of medications (mean 4.0±SD 0.7), COVID-19 policy (3.8±0.9), use of alternative non-prohibited medications (3.6±1.0) and therapeutic use exemptions (3.5±0.9). Moreover, they rated high satisfaction with the pharmacy service they provided. However, rates were ≤3 for knowledge of the International Olympic Committee Needle Policy (2.6±1.0), Medication Importation Declaration (2.9±1.0) and communication skills (3.0±1.0). CONCLUSION: Pharmacists were confident and satisfied with the pharmacy service at the games. The study confirms the importance of prior training and education. Game-specific policies and strategies to improve communication skills should be included in the pharmacy education for future Games.

Under-researched populations and topics in sport and exercise medicine (SEM)

Correspondence to Dr Sharief Hendricks, Division of Physiological Sciences and Health through Physical Activity, Lifetsyle and Sport Research Centre, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape 7725, South Africa;sharief.hendricks01@gmail.com In this South African Sports Medicine Association (SASMA) edition of BJSM, we spotlight work on under-researched populations and topics in sport and exercise medicine (SEM). Youth sport, TGNC athletes and mental health Access to athlete mental health care, like physical care, can be considered a resource that allows athletes to function, cope with stress, perform and achieve their goals. In 2019, the IOC established the Mental Health Working Group to develop an assessment battery for the early identification of mental health symptoms and disorders in elite athletes.3 The internal consistency of the mental health assessment battery has been tested in elite athletes, but can the same internal consistency be shown for student athletes?

Cardiovascular Risk Assessment after COVID-19 Infection before Resuming Sports Activities - Practical Flowchart and Meta-Analysis

Abstract Background: The risk of sports-related sudden cardiac arrest after COVID-19 infection can be a serious problem. There is an urgent need for evidence-based criteria to ensure patient safety before resuming exercise. Objective: To estimate the pooled prevalence of acute myocardial injury caused by COVID-19 and to provide an easy-to-use cardiovascular risk assessment toolkit prior to resuming sports activities after COVID-19 infection. Methods: We searched the Medline and Cochrane databases for articles on the prevalence of acute myocardial injury associated with COVID-19 infection. The pooled prevalence of acute myocardial injury was calculated for hospitalized patients treated in different settings (non-intensive care unit [ICU], ICU, overall hospitalization, and non-survivors). Statistical significance was accepted for p values <0.05. We propose a practical flowchart to assess the cardiovascular risk of individuals who recovered from COVID-19 before resuming sports activities. Results: A total of 20 studies (6,573 patients) were included. The overall pooled prevalence of acute myocardial injury in hospitalized patients was 21.7% (95% CI 17.3-26.5%). The non-ICU setting had the lowest prevalence (9.5%, 95% CI 1.5-23.4%), followed by the ICU setting (44.9%, 95% CI 27.7-62.8%), and the cohort of non-survivors (57.7% with 95% CI 38.5-75.7%). We provide an approach to assess cardiovascular risk based on the prevalence of acute myocardial injury in each setting. Conclusions: Acute myocardial injury is frequent and associated with more severe disease and hospital admissions. Cardiac involvement could be a potential trigger for exercise-induced clinical complications after COVID-19 infection. We created a toolkit to assist with clinical decision-making prior to resuming sports activities after COVID-19 infection.

Use of symptom-guided physical activity and exercise rehabilitation for COVID-19 and other postviral conditions.

There are many similarities in symptoms between postviral conditions, including clinical features such as fatigue, reduced daily activity and postexertional symptom exacerbation. Unfavourable responses to exercise have influenced the wider debate on how to reintegrate physical activity (PA) and exercise while simultaneously managing symptoms during recovery from post-COVID-19 syndrome (or Long COVID). This has resulted in inconsistent advice from the scientific and clinical rehabilitation community on how and when to resume PA and exercise following COVID-19 illness. This article provides commentary on the following topics: (1) controversies surrounding graded exercise therapy as a treatment modality for post-COVID-19 rehabilitation; (2) evidence supporting PA promotion, resistance exercise and cardiorespiratory fitness for population health, and the consequences of physical inactivity in patients with complex rehabilitation needs; (3) population-based challenges for UK Defence Rehabilitation practitioners for the management of postviral conditions; and (4) 'symptom guided PA and exercise rehabilitation' as an appropriate treatment option for managing individuals with multifaceted medical needs.

Students' and lecturers' perspectives on the implementation of online learning in medical education due to COVID-19 in Germany: a cross-sectional pilot study.

Background: During the coronavirus disease 2019 (COVID-19) crisis, many things changed in universities around the world. In-person learning was not possible. Instead, courses were offered in digital form. The sudden change posed enormous challenges to universities, students, and teachers. The aim of this study was to investigate the disadvantages as well as the advantages and opportunities of digital learning. Objective: This study investigated the evaluation of an elective module by medical students and teachers in the traditional in-person and virtual teaching forms during the COVID-19 pandemic. Methods: Using the elective module "Sports Medicine," which includes both lectures and practical units, the opinions of the medical students about conventional teaching compared to digital instruction were evaluated. In the winter semester of 2019/2020, all classes were taught face-to-face but had to be switched to virtual teaching in the summer semester of 2020 on an ad hoc basis due to the pandemic. The students were asked to answer questions on general conditions, participant behavior, instructor evaluation, skill acquisition, topic selection, and overall evaluation after both forms of teaching. Likewise, the lecturers of both courses were queried in semiqualitative interviews about the same topics. Descriptive data analysis was performed to process the data. Results: The students perceived digital teaching to be superior in most subareas compared to in-person teaching in terms of framework, instructor evaluation, skill acquisition, topic selection, and overall rating. Medical students seemed to feel better with digital teaching in most areas of evaluation. The lecturers found the new form of teaching rather unsettling and criticized the lack of verbal and especially nonverbal communication as well as the short preparation time for the new challenge. The instructors were uncomfortable with some aspects of the virtual teaching format. Conclusion: In the wake of the COVID-19 pandemic, medical schools should rapidly digitize their teaching offerings and support faculty members in their computer-based competence with continuing education opportunities and time resources.

MMSports'22: 5th International ACM Workshop on Multimedia Content Analysis in Sports

The fifth ACM International Workshop on Multimedia Content Analysis in Sports (ACM MMSports'22) is part of the ACM International Conference on Multimedia 2022 (ACM Multimedia 2022). After two years of pure virtual MMSports workshops due to COVID-19, MMSports'22 is held on-site again. The goal of this workshop is to bring together researchers and practitioners from academia and industry to address challenges and report progress in mining, analyzing, understanding, and visualizing multimedia/multimodal data in sports, sports broadcasts, sports games and sports medicine. The combination of sports and modern technology offers a novel and intriguing field of research with promising approaches for visual broadcast augmentation and understanding, for statistical analysis and evaluation, and for sensor fusion during workouts as well as competitions. There is a lack of research communities focusing on the fusion of multiple modalities. We are helping to close this research gap with this workshop series on multimedia content analysis in sports. Related Workshop Proceedings are available in the ACM DL at: https://dl.acm.org/doi/proceedings/10.1145/3552437. © 2022 Owner/Author.

The Effect of Probable COVID-19 Infection on the National Football League Players' Performance and Endurance During the 2020 Season.

Objective The objective of this study was to assess whether the National Football League (NFL) players with probable coronavirus disease 2019 (COVID-19) during the 2020 season experienced a decline in athletic performance and endurance. Methods All players who were listed on the NFL's COVID-19 Injury Reserve (COVID-IR) list were screened for inclusion. Players were included in the study if they had spent ≥10 days on the COVID-19 IR list (which indicated a positive PCR test based on the NFL COVID-19 policies), had played in at least two games before and after going on the IR list, and primarily played an offensive or defensive position. The mean number of snaps played per game and Pro Football Focus (PFF) score per game were collected for each athlete, which served as surrogate measures of endurance and performance, respectively. The results were analyzed with players grouped by position, and then all players grouped as a whole. Within-group comparisons were performed via t-tests. Results A total of 78 players met the criteria for inclusion in the study. The overall mean PFF score pre-COVID-19 infection was 62.15 (SD: 6.93), while it was 61.73 (SD: 7.42) post-COVID-19 infection, showing a decrease of 0.42 after infection (n=78, p=0.33). The mean number of snaps played per game pre-COVID-19 infection was 38.99 (SD: 16.46) while it was 38.10 (SD: 17.05) post-COVID-19 infection, showing a decrease of 0.89 after infection (n=78, p=0.30). When grouped by position, statistically significant differences were seen with Defensive Backs' mean snaps played per game decreasing by 18.30 (n=6, p=0.03) and Defensive Linemen's mean PFF score decreasing by 3.77 points (n=21, p=0.03). Conclusion Based on our findings, COVID-19 infection negatively impacted endurance in Defensive Backs, and performance in Defensive Linemen. However, there was inconclusive evidence to show whether COVID-19 infection negatively impacted other positions when analyzed separately or all positions when analyzed together. Further studies with more participants are needed to fully assess the effects of COVID-19 on performance and endurance in elite athletes.

UK physiotherapists delivering physical activity advice: what are the challenges and possible solutions? A qualitative study.

OBJECTIVES: Despite the known health benefits of physical activity (PA), PA levels are in decline. Healthcare professionals, including physiotherapists, have been identified as ideal conduits to promote PA, yet their knowledge and awareness of PA guidelines are poor. The aims of this study were to explore current knowledge of PA guidelines among UK physiotherapists and identify barriers and possible solutions to delivering PA advice. DESIGN: A qualitative approach using semistructured interviews that took place between March and May 2021. Data were analysed with a thematic approach using Braun and Clarke's six steps. SETTING: Various inpatient and outpatient clinical settings across six UK regions. PARTICIPANTS: Eighteen UK-based physiotherapists managing National Health Service patients were recruited through volunteer sampling in March 2021. RESULTS: Five themes and 16 subthemes (shown in parenthesis) were identified as barriers and solutions to delivering PA advice: physiotherapist intrinsic barriers (knowledge, fear/confidence); a lack of emphasis and priority given to PA (time constraints, minimal educational and staff training); patient barriers (compliance, expectations and fear of doing PA); increasing awareness of the PA guidelines (staff training, signposting awareness, use of social media and television campaigns); and optimising delivery (use of visual resources, good communication and approaches involving being individualised and gradual for patients with chronic conditions). CONCLUSIONS: In this study, physiotherapist participants seemed to have limited awareness of the PA guidelines despite recent updates and were faced with similar barriers to those previously reported in the literature. The solutions suggested could guide strategies to support physiotherapists being able to deliver PA advice. Further research is needed to evaluate the efficiency of any implemented solutions supporting the delivery of PA advice.

Feasibility, Safety and Efficacy of a Combined Supervised Physical Exercise and Nutritional Program in a Selected Population of Luminal Metastatic Breast Cancer Patients: Oncare01 Pilot Study

Background: Supervised exercise programs (SEP) have demonstrated an improvement in quality of life (QoL), cardiovascular health, treatment tolerance and disease outcomes in early breast cancer patients. In metastatic breast cancer (MBC), previous data suggest SEP are safe but no impact on QoL and a low adherence to programs were shown. These studies included a heterogenous population in terms of type of treatments received, numbers of previous lines or comorbidities. From our perspective, MBC profile that could benefit most from SEP needs to be explored. Thus, we conducted a pilot study to assess adherence, safety and impact on QoL of a combined SEP and nutritional program (NP) in a selected population of MBC of patients treated with cyclin-dependent kinase 4/6 inhibitors (iCDK 4/6). Method(s): This is a prospective, single center, single arm pilot study. SEP consisted in a 12-week intervention with twice a week in-person resistance exercise session. Patients also completed weekly aerobic exercise goals in self-managed sessions monitored with activity trackers. SEP was conducted by registered Physical Activity and Sports Science instructors that followed American College of Sports Medicine guidelines. In addition, participants had an initial nutritional assessment and personalized counselling by a qualified nutritionist. Adherence to treatment, biological variables and QoL assessments (FACIT-Fatigue and QLQ-C30 questionnaires) were collected at baseline (B) and week-12 (w12). Primary endpoint was global adherence (>=70% of attended sessions relative to scheduled sessions). Secondary endpoints included safety, changes in biological variables and QoL. Paired samples t-tests (Wilcoxon) were used to assess biological changes and QoL. Result(s): Patients (n=26) were recruited from October 2020 to November 2021. Median age was 47,5 years (45-55);84,6% of patients were ECOG 0. 42,3% of patients were receiving Abemaciclib;34,6% Ribociclib and 23,1% Palbociclib in first (73,1%) or second (26,9%) line treatment. Patients had bone (69,2%);visceral metastasis (57,7%) or both (30,8%). 2 patients did not start the intervention and additional 7 patients discontinued the program prematurely, the majority of them due to COVID-related concerns. Considering all patients who at least attended one session, global adherence was 66% (39-77,5%) and 45,8% of patients achieved an adherence of >= 70%. Patients reported an improvement in QoL [B global QLQ-C30 66,6 (50-75), w12 75 (66,6-83,3);p 0,0121] and fatigue [B FACIT-Fatigue 37 (30-44), w12 42 (38-48);p 0,0017]. Sit-to-stand repetitions in 30-second period also improved [(B 15 (12-17), 19 (15-23);p 0,0002]. Same benefits were seen in patients with adherence >= 70%. No statistically significant changes were seen in body fat or muscular composition and handgrip scores. Importantly, no safety issues related to study intervention were reported. Conclusion(s): Even though the study was conducted during COVID-19 pandemic, global adherence was 66%. For the first time in MBC, SEP and NP combined program demonstrated to be safe and improved QoL in patients with first or second line MBC treated with iCDK4/6. Further research is needed to identify strategies that improve QoL in MBC.

Telehealth as a therapeutic approach in the management of childhood obesity.

Overweight and obesity in childhood and adolescence are not only associated with severe medical and psychological complications and sequelae, but also represent one of the greatest challenges for the healthcare system from an economic point of view. The restrictions imposed by the global COVID-19 (coronavirus disease 2019) pandemic have further aggravated the already high prevalence of juvenile obesity. Since pharmacological treatment options are generally not approved in childhood/adolescence and therefore they are not an option, lifestyle modification has a separate role from a therapeutic perspective. Multimodal training concepts from various disciplines (e.g., psychology, nutrition, sports, medicine) currently show the best prospects of success. The targeted transfer of these training programs into telemedical concepts could sustainably improve their effectiveness and reduce resource requirements on both the therapeutic and patient side.Copyright © 2022, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Narrowing the gap

[...]less than 4% of media coverage is on female athletes.5 Since 2020, less girls are participating and staying involved in sport.1 When we think of women in sports, we tend to think of the lack of representation of women and non-binary individuals in healthcare roles working with a professional sports team, a disappointing trend for professions that are traditionally female dominated. Narrowing the gap: keeping kids active and healthy Children and youth are spending less time outdoors, are more sedentary, sleep more, and spend more time on screen-based activities compared with pre-COVID-19.8 As physiotherapists, we can play a pivotal role in promoting community-based physical activity and increasing children's functional abilities to help them thrive on and off the field. ‘The TransformUs! cluster RCT 18 and 30-month effects on children's physical activity sedentary time and cardiometabolic risk markers' ( see page 311 ) study reports on the efficacy of the Transform-Us! school-based and home-based intervention on children's physical activity, sedentary behaviour and cardiometabolic risk factors.

Delivering clinical studies of exercise in the COVID-19 pandemic: challenges and adaptations using a feasibility trial of isometric exercise to treat hypertension as an exemplar.

The COVID-19 pandemic has significantly impacted on the delivery of clinical trials in the UK, posing complicated organisational challenges and requiring adaptations, especially to exercise intervention studies based in the community. We aim to identify the challenges of public involvement, recruitment, consent, follow-up, intervention and the healthcare professional delivery aspects of a feasibility study of exercise in hypertensive primary care patients during the COVID-19 pandemic. While these challenges elicited many reactive changes which were specific to, and only relevant in the context of 'lockdown' requirements, some of the protocol developments that came about during this unprecedented period have great potential to inform more permanent practices for carrying out this type of research. To this end, we detail the necessary adaptations to many elements of the feasibility study and critically reflect on our approach to redesigning and amending this ongoing project in order to maintain its viability to date. Some of the more major protocol adaptations, such as moving the study to remote means wherever possible, had further unforeseen and undesirable outcomes (eg, additional appointments) with regards to extra resources required to deliver the study. However, other changes improved the efficiency of the study, such as the remote informed consent and the direct advertising with prescreening survey. The adaptations to the study have clear links to the UK Plan for the future of research delivery. It is intended that this specific documentation and critical evaluation will help those planning or delivering similar studies to do so in a more resource efficient and effective way. In conclusion, it is essential to reflect and respond with protocol changes in the current climate in order to deliver clinical research successfully, as in the case of this particular study.

SHAREABLE RESOURCE: New Year, Wiser You

The article presents the discussion on preparing a renewed health plan and absolve to change poor habits. Topics include pandemic accelerated many trends in the health and fitness industry and taught many lessons;and walking, running, hiking, biking, swimming, racquet sports, and seasonal sports being readily accessible.

Encuesta Nacional de Tendencias de Fitness en España para 2023 (National Survey of Fitness Trends in Spain for 2023)

Since the pioneering edition for the year 2017, the National Surveys of Fitness Trends have been developed in Spain, reproducing the methodology of the worldwide surveys promoted by the American College of Sports Medicine (ACSM). As every year, the objective of this study is to identify the main trends in the Spanish fitness sector by showing the results of the survey carried out for 2023, as well as to compare the results with those reported in the national and worldwide surveys of 2022. In addition, the possible impact of COVID-19 on the trends that, according to the respondents, will be more relevant in 2023 was also analyzed. The survey was sent through electronic platforms to 7,143 professionals related to the fitness sector, obtaining a response rate of 7.3%. Of the 506 total responses, 31.2% were from women. The top five trends for 2023 were, in decreasing order: "functional fitness training”, "small group personal training”, "personal training”, "hiring certified professionals” and "strength training with free weights”. The trends in the top-20 in Spain for 2023 were very similar to those of 2022, both in the number of matches (18 common trends) and in the positions held (within the top-10 there were 9 trends common to both surveys). Analogous to what happened in past editions, there was a greater discrepancy between the Spanish survey for 2023 and the worldwide survey for 2022, with 13 common trends in the top-20 and only four coincidences within the top-10. These results continue to confirm, consistent with previous editions, the stability of trends in the Spanish fitness sector and the greater divergence from worldwide trends. Key words: Spanish fitness survey, fitness trends, fitness industry, ACSM survey Alternate :Desde la pionera edición para el año 2017 se vienen desarrollando en España las Encuestas Nacionales de Tendencias de Fitness, reproduciendo la metodología de las encuestas internacionales desarrolladas por el Colegio Americano de Medicina del Deporte (ACSM). Como cada año, el objetivo del presente estudio es identificar las principales tendencias en el sector del fitness español mostrando los resultados de la encuesta realizada para 2023, así como comparar los resultados con los reportados en las encuestas nacional e internacional de 2022. Además, también se analizó el posible impacto del COVID-19 en las tendencias que, según los encuestados, serán más relevantes en 2023. La encuesta fue enviada mediante plataformas electrónicas a 7143 profesionales relacionados con el sector del fitness, obteniendo una tasa de respuesta del 7.3%. De las 506 respuestas totales un 31.2% fueron de mujeres. Las cinco tendencias más relevantes para 2023 fueron, en orden decreciente: "entrenamiento funcional de fitness”, "entrenamiento personal en pequeños grupos”, "entrenamiento personal”, "contratación de profesionales certificados” y "entrenamiento de fuerza con pesos libres”. Las tendencias en el top-20 en España para 2023 fueron muy similares a las de 2022, tanto en el número de coincidencias (18 tendencias comunes) como en las posiciones ocupadas (dentro del top-10 hubo 9 tendencias comunes a ambas encuestas). De forma análoga a lo acontecido en ediciones pasadas, se produjo una mayor discrepancia entre la encuesta española para 2023 y la encuesta internacional de 2022, con 13 tendencias comunes en el top-20 y únicamente cuatro coincidencias dentro del top-10. Estos resultados siguen confirmando, en congruencia con ediciones anteriores, la estabilidad de las tendencias en el sector del fitness español y la mayor divergencia con las tendencias internacionalesAlternate :Desde a edição pioneira do ano de 2017, as Pesquisas Nacionais de Tendências do Fitness são desenvolvidas na Espanha, reproduzindo a metodologia das pesquisas internacionais desenvolvidas pelo American College of Sports Medicine (ACSM). Como todos os anos, o objetivo deste estudo é identificar as principais tendências do setor de fitness espanhol, mostrando o resultados da pesquisa realizada para 2023, bem como comparar os resultados com os relatados nas pesquisas nacionais e internacionais de 2022 Além disso, também foi analisado o possível impacto do COVID-19 nas tendências que, segundo os entrevistados, serão mais relevantes em 2023. A pesquisa foi enviada por meio de plataformas eletrônicas a 7.143 profissionais relacionados ao setor de fitness, obtendo uma taxa de resposta de 7,3%. Do total de 506 respostas, 31,2% foram de mulheres. As cinco tendências mais relevantes para 2023 foram, em ordem decrescente: "treinamento funcional”, "treinamento pessoal em pequenos grupos”, "treinamento pessoal”, "contratação de profissionais certificados” e "treinamento de força com pesos livres”. As tendências do top 20 da Espanha para 2023 foram muito semelhantes às de 2022, tanto no número de coincidências (18 tendências comuns) quanto nas posições ocupadas (dentro do top 10 havia 9 tendências comuns a ambas as pesquisas) . À semelhança do que aconteceu nas edições anteriores, registou-se uma maior discrepância entre o inquérito espanhol de 2023 e o internacional de 2022, com 13 tendências comuns no top-20 e apenas quatro coincidências no top-10. Estes resultados continuam a confirmar, de forma consistente com as edições anteriores, a estabilidade das tendências do setor fitness espanhol e a maior divergência com as tendências internacionais.Palavras-chave: Pesquisa de fitness espanhola, tendências de fitness, indústria de fitness, pesquisa ACSM

Calling for improved equity, diversity and inclusion in sport and exercise medicine – it starts with us

Correspondence to Dr Jane S Thornton, Western Centre for Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada;jane.s.thornton@gmail.com Welcome to the Canadian Academy of Sport and Exercise Medicine (CASEM) issue. Antonio Garcia-Hermoso and team studied 3.3 million participants across 31 countries to explore adherence to aerobic and muscle strengthening activities guidelines in their systematic review and meta-analysis ( see page 225 ). The latest CASEM Position statement is a timely contribution from Michael Koehle and his team to outline personal strategies to mitigate the effects of air pollution exposure during sport and exercise ( see page 193 ).