ABSTRACT
SYNOPSIS: Randomized controlled trials (RCTs) are ubiquitous in medicine and have facilitated great strides in clinical care. However, when applied in sport, RCTs have limitations that hinder implementing effective interventions in the real-world clinical setting. Pragmatic clinical trials offer some solutions. Yet due to the competitive, high-pressure nature of sport at the individual, team, and governing body level, RCTs are likely infeasible in certain sport settings. The small number of athletes at the elite team level, along with the potential financial consequences of randomizing at the individual athlete and team level, also restricts study power and feasibility, limiting conclusions. Consequently, researchers may need to "think outside the box" and consider other research methodology, to help improve athlete care. In this Viewpoint, we detail alternative study designs that can help solve real-world problems in sports medicine and performance, while maintaining robust research standards and accounting for the challenges that RCTs pose. We also provide practical examples of alternative designs. J Orthop Sports Phys Ther 2023;53(6):1-4. Epub: 18 April 2023. doi:10.2519/jospt.2023.11824.
Subject(s)
Sports Medicine , Sports , Humans , Randomized Controlled Trials as Topic , AthletesABSTRACT
Introduction: The ParticipACTION Report Card on Physical Activity for Children and Youth is the most comprehensive national assessment of physical activity and related behaviors, characteristics, and opportunities for children and youth. The 2022 Report Card assigned grades based on data gathered during the COVID-19 pandemic to reflect this extraordinary time-period in Canada. Further, while not graded, efforts were made to summarize key findings for early years children and those identifying as: having a disability, Indigenous, 2SLGBTQ+, newcomers to Canada, racialized, or girls. The purpose of this paper is to summarize the 2022 ParticipACTION Report Card on Physical Activity for Children and Youth. Methods: The best available physical activity data captured during the whole COVID-19 pandemic was synthesized across 14 different indicators in four categories. The 2022 Report Card Research Committee assigned letter grades (i.e., A-F) based on expert consensus of the evidence. Synthesis: Grades were assigned for: Daily Behaviors (Overall Physical Activity: D; Active Play: D-; Active Transportation: C-; Organized Sport: C+; Physical Education: Incomplete [INC]; Sedentary Behaviors: F; Sleep: B; 24-Hour Movement Behaviors: F), Individual Characteristics (Physical Literacy: INC; Physical Fitness: INC), Spaces and Places (Household: C, School: B-, Community and Environment: B), and Strategies and Investments (Government: B-). Compared to the 2020 Report Card, the COVID-19 specific grades increased for Active Play and Active Transportation; and decreased for Overall Physical Activity, Sedentary Behaviors, Organized Sport, and Community and Environment. There were many data gaps for equity-deserving groups. Conclusion: During the COVID-19 pandemic, the grade for Overall Physical Activity decreased from a D+ (2020) to a D, coinciding with decreases in grades reflecting fewer opportunities for sport and community/facility-based activities as well as higher levels of sedentary behaviors. Fortunately, improvements in Active Transportation and Active Play during COVID-19 prevented a worse shift in children's health behaviors. Efforts are needed to improve physical activity for children and youth during and post-pandemic, with a greater emphasis on equity-deserving groups.
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COVID-19 , Sports , Female , Humans , Adolescent , Child , Pandemics , COVID-19/epidemiology , Exercise , Physical FitnessABSTRACT
ABSTRACT: The American Medical Society for Sports Medicine (AMSSM) convened an expert panel to address the current evidence, knowledge gaps, and recommendations surrounding the COVID vaccination in athletes during the SARS-CoV-2 pandemic. The group held a series of meetings beginning in July 2021 and reviewed the available literature while using an iterative process and expert consensus to finalize this guidance statement. This document is intended to provide clinicians with suggestions on how to incorporate the COVID vaccination during the preparticipation physical examination for athletes in all levels of training and competition. The statement is not intended to address treatment, infection control principles, safety, ethical discussion, or public health issues related to SARS-CoV-2. The AMSSM task force acknowledges the clinical uncertainty, evolving public health objectives, and the limited data currently available to create this guidance statement.
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COVID-19 , Sports , Athletes , Clinical Decision-Making , Humans , Pandemics , Physical Examination , SARS-CoV-2 , Uncertainty , VaccinationABSTRACT
OBJECTIVE: The COVID-19 pandemic has affected all elements of global society, and sport is not exempt. Many sporting events have been either postponed or canceled, and national sporting organizations have had to make highly complex decisions in the face of scientific uncertainty and risk. This article applies these lessons to the world of sport with the goal of assisting sporting organizations to make sound and reasoned decisions during a pandemic. DATA SOURCES: A narrative approach using both academic literature sources and live examples from the authors' experience. We use Daniels and Sabin's accountability for reasonableness framework to facilitate decision-making in the face of such uncertainty. MAIN RESULTS: Decision-making in the context of uncertainty has the potential to create conflict and disengagement from key stakeholders. Evidence from recent pandemics has illustrated that an ethical approach to decision-making results in reasoned decision-making and confers a legitimacy to decisions that ultimately supports engagement and satisfaction from stakeholders. CONCLUSIONS: The incorporation of ethical considerations into risk assessment and management when making complex decisions, which incorporate high levels of uncertainty, will assist sporting organizations have positive outcomes.
Subject(s)
COVID-19/psychology , Decision Making , Pandemics/prevention & control , Sports , COVID-19/epidemiology , Humans , SARS-CoV-2ABSTRACT
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.
Subject(s)
Sports , Heart Disease Risk Factors , COVID-19/complications , Myocarditis/complications , Death, Sudden, Cardiac , Risk Assessment/methods , Evidence-Based Practice/methods , AthletesABSTRACT
INTRODUCTION: COVID-19 is a multi-systemic disease which can target the lungs and the cardiovascular system and can also affect parts of the brain for prolonged periods of time. Even healthy athletes without comorbidities can be psychologically affected long-term by COVID-19. OBJECTIVE: This study aimed to investigate athletes' perceived mental stress and recovery levels in daily life, and their maximal aerobic power, at three different time points, post COVID-19. METHODS: In total, 99 athletes (62.6% male), who had been infected by COVID-19, filled out the Recovery Stress Questionnaire for Athletes (REST-Q-Sport) and completed cardiopulmonary exercise testing (endpoint maximal aerobic power output (Pmax)) at the initial screening (t1: 4 months after infection). Follow-up assessments occurred three (t2, n = 37) and seven months after t1 (t3, n = 19). RESULTS: Subgroup means from the Recovery category were significantly below the reference value of four at all three time points, except "General Recovery" (3.76 (± 0.96), p = 0.275, d = 0.968) at t3."Overtiredness" (2.34 (± 1.27), p = 0.020, r = 0.224) was significantly above the reference value of two at t1, while all other Stress subgroups were not significantly different from the reference value or were significantly below the maximum threshold of two at t1, t2 and t3. Spearman's ρ revealed a negative association between Pmax and the subcategories of stress (ρ = -0.54 to ρ = -0.11, p < 0.050), and positive correlations between Pmax and "Somatic Recovery" (ρ = 0.43, p < 0.001) and "General Recovery" (ρ = 0.23, p = 0.040) at t1. Pmax (t1: 3.83 (± 0.99), t2: 3.78 (± 1.14), ß = 0.06, p < 0.003) increased significantly from t1 to t2. In addition, REST-Q-Sport indicated a decrease in "Sleep" (t2 = 2.35 (± 0.62), t3 = 2.28(± 0.61), ß = -0.18, p < 0.023) at t3, when compared to t2. CONCLUSION: The perceived recovery seems to be negatively affected in post COVID-19 athletes. Physical performance post COVID-19 correlates with both "Emotional and Somatic Stress" and "Somatic and General Recovery", indicating potential mental and physical benefits of exercise. While it is evident that COVID-19, like other viral infections, may have an influence on physical performance, monitoring stress and recovery perceptions of athletes is critical to facilitate their return-to-sports, while minimizing long-term COVID-19 induced negative effects like the athletic objective and subjective perceived recovery and stress levels.
Subject(s)
COVID-19 , Sports , Humans , Male , Female , Exercise , Physical Functional Performance , PerceptionSubject(s)
Cardiology , Cardiovascular System , Social Media , Sports , Humans , Communication , Death, Sudden, CardiacABSTRACT
BACKGROUND: From 2020, most countries all over the world have implemented strategies aimed at limiting contagion of COVID-19. The pandemic caused a reduction in physical activity (PA) and sports at all levels. The aim of the present study was to analyze and quantify the related impact of imposed PA restrictions on functional capacity in young athletes. METHODS: This observational cohort study evaluated annually the exercise capacity of a sample of young athletes (N.=344) referred for the pre-participation screening at our Sports and Exercise Medicine Division (2017-2021). Standardized maximal exercise testing was performed on treadmill and linear mixed models analyzed metabolic equivalent of tasks (METs) and exercise time as dependent variables. RESULTS: METs and exercise time showed a reduction in the year 2020 and a subsequent increase in 2021, with males revealing a faster recovery in exercise capacity. Athletes who maintained >250 annual training hours were less affected by the pandemic. CONCLUSIONS: These data suggest a significant impact of forced physical inactivity on a cohort of apparently healthy young athletes. The COVID-19-related experience should lead to strategies to avoid negative effects and long-term consequences of containment measures.
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COVID-19 , Sports , Male , Humans , Pandemics , COVID-19/epidemiology , Athletes , ExerciseABSTRACT
OBJECTIVE: To explore experiences related to health-oriented behaviours during lockdown in the Spanish resident population from a gender perspective. METHOD: Qualitative research with a critical and feminist approach. Twenty-nine semi-structured interviews (17 women and 12 men) were conducted between June and July 2020 via telephone with people who had previously answered an online survey. The interviews were transcribed and a thematic content analysis was carried out, differentiating between the experiences of women and men. The data were triangulated by the research team. RESULTS: Among women, greater diversity emerged in terms of health behaviours. Among them, the difficult experiences related to COVID-19, the complexity of living together and doing unpaid care work, as well as the importance of support networks, stood out. Among men, there were different attitudes towards sport, self-care and having time for healthy eating were positively valued, and there was a good assessment of coexistence and organisation in household chores. In both men and women, work overload and economic problems were related to emotional distress and difficulties in carrying out healthy activities. CONCLUSIONS: Health-oriented behaviours during lockdown differed according to gender. They were mostly limited to COVID-19 experiences, socio-economic conditions and burden of care. It is essential to tailor public health and primary care programmes according to people's life moments, taking into account their social context and questioning traditional gender roles.
Subject(s)
COVID-19 , Health Behavior , Quarantine , Stress, Physiological , Humans , Male , Female , Spain/epidemiology , Quarantine/psychology , Quarantine/statistics & numerical data , Sex Factors , Qualitative Research , Telephone , Interviews as Topic , COVID-19/epidemiology , Diet, Healthy/psychology , Self Care/psychology , Sports/psychology , Workload/psychology , Financial Stress/psychology , Public Health , Psychosocial Support SystemsABSTRACT
AIMS: Our objective is to compare the functional results in patients that underwent surgery for recurrent anterior shoulder instability (RAGHI) during the COVID-19 pandemic with remotely-based rehabilitation, to those who had surgery before the pandemic and had in-person rehabilitation therapy. METHODS: A retrospective case series of 68 patients were included and divided into two groups: In person-group and Home-based group. Western Ontario Shoulder Instability Index (WOSI) and Subjective Shoulder Value (SSV) scores were used to evaluate objective and subjective clinical parameters. Time and level of return to sports was studied by the Subjective Patient Outcome for Return to Sports (SPORTS) score. RESULTS: The mean SSV score was 82% (40-100) on the In-Person group compared with 87% (65-100) for the Home-Based group. Results for WOSI score were similar, with an average of 210.42 (90%) for In-Person and 261.45 (88%) for the Home-Based group (p 0.12). Return to sports was carried out in an average of 6.6 (4-16) months for In-Person group, compared to 6.5 (5-8) months for Home-Based. CONCLUSION: Follow-up and rehabilitation methods for patients who underwent surgery for RAGHI, during COVID-19 lockdown, were not significantly (p 0.12) affected on functional and athletic return in comparison to traditional methods according to WOSI scale. LEVEL OF EVIDENCE: IV Retrospective series of cases.
Subject(s)
COVID-19 , Joint Instability , Shoulder Joint , Sports , Humans , Communicable Disease Control , Joint Instability/surgery , Pandemics , Retrospective Studies , Return to Sport , Shoulder Joint/surgeryABSTRACT
Background: The COVID-19 pandemic has had major impact on the daily lives of adolescents. This study examined whether mental health outcomes had changed over the pandemic, and if such changes were related to changes in physical activity (PA), sedentary time, sleep, screen time, and participation in organized sports. Materials and methods: In this longitudinal study, data were collected in autumn 2019 with follow-up measurements in spring 2021. In total, 558 schools were invited and 34 schools around Stockholm with a variation in socioeconomic background were included. Physical activity and sedentary time were measured for seven consecutive days by accelerometry (Actigraph). Anxiety, health-related quality of life (HRQoL), psychosomatic health, stress, sleep duration, screen time, and organized sports participation were self-reported in questionnaires. Linear models were applied to estimate associations between changes in mental health outcomes and exposures. Results: From the baseline sample of 1,139 participants, 585 (55% girls), mean (SD) age 14.9 (0.3) years, participated in the follow-up. Between 2019 and 2021, there was a decrease in HRQoL [mean difference -1.7 (-2.3, -1.2), p < 0.001], increase in psychosomatic health problems [mean difference 1.8 (1.3, 2.3), p < 0.001], and an increase in the number of participants with high stress [from 94 (28%) to 139 (42%), p < 0.001]. Weekly light PA and sleep duration decreased and weekly sedentary time and screen time increased unrelated to changes in mental health outcomes. An increase in sleep duration during weekdays was significantly related to both a decrease in anxiety (B = -0.71, CI: -1.36, -0.06) and an increase in HRQoL (B = 1.00, CI: 0.51, 1.49). Conclusion: During the COVID-19 pandemic, mental health appears to have been impaired in Swedish adolescents, but unrelated to changes in PA, sedentary time, screen time, or participation in organized sports. However, increased sleep duration on weekdays was related to less anxiety and better HRQoL. The results may help policy makers and other stakeholders comprehend the differential effects of the COVID-19 pandemic on mental health outcomes and help guiding the planning of policy actions. Trial registration: ISRCTN15689873.
Subject(s)
COVID-19 , Exercise , Health Behavior , Mental Health , Sedentary Behavior , COVID-19/epidemiology , Mental Health/statistics & numerical data , Humans , Male , Female , Adolescent , Sweden/epidemiology , Longitudinal Studies , Sleep Duration , Screen Time , Sports , Education, DistanceABSTRACT
PURPOSE: The purpose of this study is to evaluate a COVID-19 rapid antigen testing program among high school athletes through testing data and qualitative analysis from key stakeholders. METHODS: Testing data was obtained by the partnering school district. Testing staff, coaches, and parents participated in a focus group using a semi-structured focus group guide. Transcripts were analyzed using a grounded theory approach to produce the themes of the study. RESULTS: Rapid antigen tests quickly identified a COVID-19-positive student athlete, which allowed for quick isolation and zero transmission to teammates. Focus groups with parents, testing staff, and coaches indicated the testing program improved perceived safety and demonstrated the ability for school staff to implement a widespread COVID-19 screening program with minimal training. CONCLUSIONS: As schools continue to respond to various waves of COVID-19 infections, targeted testing for high-risk activities in school settings such as sports programs may help prevent school outbreaks during times of high community transmission rates. This evaluation adds to a body of literature that will aid schools and policy makers in their decision on how to best keep student athletes and school communities safe for future waves of COVID-19 infection and other pandemics.
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COVID-19 , Sports , Humans , COVID-19/diagnosis , COVID-19/prevention & control , Program Evaluation , Athletes , StudentsSubject(s)
COVID-19 , Sports , Vaccines , Humans , COVID-19/prevention & control , Athletes , Sports/physiologyABSTRACT
Introduction: New conflict types have arisen in leisure sports activities due to social regulations designed to address COVID-19. We analyze the differences in conflict-inducing factors and coping strategies across various types of leisure sports and levels of spatial proximity. Methods: Korean adults aged between 20 and 60 years, who had participated in leisure sports activities since the COVID-19 outbreak in January 2020, were surveyed, and 508 responses were collected for analysis. The differences in leisure sports conflicts and coping strategies across the types of leisure sports participation and spatial proximity were tested. Results: The results show that conflict due to prejudice was higher in typical indoor sports activities, such as Pilates, yoga, and gym workouts, whereas conflict due to competition or not observing etiquette was higher in indoor golf. Second, conflict due to prior expectations and prejudice was high in outdoor sports activities, such as jogging and hiking. Finally, all participants showed avoidance behavior, but it was observed more frequently in outdoor sports than indoor sports. Discussion: The study reveals how much leisure conflict is induced by various types of leisure sports participation, particularly during outdoor activities, which usually feature a relatively low density of participants. It underscores the necessity of developing structural approaches to resolving leisure conflicts in dangerous spaces or requiring intensive management and creating new leisure sports activities.