Parous women perform less moderate to vigorous physical activity than their nulliparous peers: a population-based study in Denmark.

OBJECTIVES: The World Health Organization (WHO) highlights parous women as a key population for monitoring trends of physical activity (PA). We aimed to estimate the proportion of Danish women non-adhering to WHO PA guidelines in parous women compared with nulliparous women and to describe leisure-time PA intensity in each of these groups. STUDY DESIGN: Cross-sectional study. METHODS: This population-based study builds on a sample of 27,668 women aged 16-40 years from the Danish National Health Survey 2021. These data were linked with childbirth data from the Danish National Birth Registry. The primary outcome was self-reported weekly hours of moderate to vigorous leisure-time PA (MVPA) dichotomized into: (i) adhering to WHO guidelines for MVPA or (ii) not adhering to WHO guidelines for MVPA. Binomial regression analysis was used to calculate prevalence proportions (PP) and prevalence proportion ratios (PPR). RESULTS: Of the 27,668 women, a total of 20,022 were included; 9338 (46.6%) parous women and 10,684 (53.4%) nulliparous women. The PP of women non-adhering to WHO PA guidelines was 63.8% (95% CI 62.9-64.8) for parous and 51.3% (95% CI 50.4-52.3) for nulliparous women, corresponding to a PPR of 1.24 (95% CI 1.21; 1.27). CONCLUSIONS: The proportion of parous women who did not adhere to WHO PA guidelines for MVPA was 24% higher than that of nulliparous women. This highlights parous women as a subgroup of the adult population at increased risk of non-adherence to WHO PA guidelines. These findings call for future research to inform new strategies aiming to promote PA in parous women.

The inter- and intrarater reliability and agreement for field-based assessment of scapular control, shoulder range of motion, and shoulder isometric strength in elite adolescent athletes.

OBJECTIVES: To investigate the intra- and interrater reliability and agreement for field-based assessment of scapular control, shoulder range of motion (ROM), and shoulder isometric strength in elite youth athletes. DESIGN: Test-retest reliability and agreement study. SETTING: Eight blinded raters (two for each assessment) assessed players on field during two testing sessions separated by one week. PARTICIPANTS: 162 elite youth handball players with or without a history of previous shoulder pain within the preceding six months. MAIN OUTCOME MEASURES: Kappa (κ) and prevalence-adjusted bias-adjusted kappa (PABAK) coefficients for scapular control reliability, and 95% limits of agreement (LOA) for ROM and strength agreement. RESULTS: Scapular control demonstrated substantial to almost perfect reliability (κ 0.67 to 0.84, PABAK from 0.68 to 0.88). Mean strength values ranged from 0.9 N/kg to 1.6 N/kg, and LOAs ranged from -0.7 N/kg to 0.8 N/kg. Rotational strength revealed additionally systematic bias between and within rater. No or acceptable systematic bias were evident for ROM and abduction strength measures. Mean values and LOAs for ROM ranged between 39.9° to 52.3°, and from -12.6° to 9.9°, respectively. CONCLUSIONS: Scapular control and ROM can be assessed on the field with acceptable reliability. The threshold for reliable measurements of isometric strength using handheld-dynamometers is high.

Injury prevalence across sports: a descriptive analysis on a representative sample of the Danish population.

BACKGROUND: Physical activity plays an important role in public health, owing to a range of health-related benefits that it provides. Sports-related injuries are known to be an important barrier to continued physical activity. Still, the prevalence of injuries on a general population level has not yet been explored in a descriptive epidemiological investigation. The purpose of the questionnaire-based study, therefore, was to describe the prevalence of injury in a representative sample of the Danish population. METHODS: Two samples of 10,000 adults (> 15 years) and 6500 children and adolescents (7-15 years) were invited to respond to a web-based questionnaire. Of these, 3498 adults (35.0%) and 3221 children (49.6%) responded successfully. The definition of sports injury was time-loss and medical attention-based, inhibiting participants from sports activity for at least 7 days, and/or involved contact with a healthcare professional, respectively. RESULTS: Amongst adults, 642 (18.4% [95%CI: 17.1%; 19.6%]) reported to have had an injury within the past 12 months. Males reported significantly more injuries than females (difference in prevalence proportion: 9.2%-points [95%CI: 6.7%-points; 11.8%-points]). The prevalence of injuries was greatest in running (ninj = 198), football (ninj = 94) and strength training (ninj = 89). Amongst children, 621 (19.3% [95%CI: 17.9%; 20.6%]) had been injured. No difference in injury prevalence proportion existed between boys and girls. The prevalence of injuries was greatest in football (ninj = 235), handball (ninj = 86) and gymnastics (ninj = 66). CONCLUSIONS: Sports injuries seem to be very frequent in Denmark, since a total of 18.4% of the adults and 19.3% of the children reported having had one or more injuries within the past 12 months, equal to either time lost with physical activity and/or contact to the health care system.

The association between eccentric hip abduction strength and hip and knee angular movements in recreational male runners: An explorative study.

Weak hip abductors may be related with increased hip adduction and knee abduction angular movement, which may be risk factors of lower extremity injuries. As the role of eccentric hip abduction strength (EHAS) on hip adduction angular movement and knee abduction angular movement (KABD) remains unclear, the purpose of this study was to explore the association between EHAS and hip and knee angular movement. In 100 healthy male recreational runners, EHAS was quantified using an isokinetic dynamometer, while hip and knee angular movements were collected using pressure-sensitive treadmill and Codamotion active marker system. Using multiple linear regression models (n=186 legs), no relationships between EHAS and hip and knee kinematics were found. A possible reason for the lack of relationship between EHAS and hip and knee kinematics may be owing to differences in the running kinematics. Some runners with weak EHAS may compensate the weakness by leaning toward the stance limb and thereby reduces the demand on the hip abductors with the consequence of increased knee abduction moment, which may lead to an increased knee abduction angular excursion. Possible, others mechanism as the quadriceps strength and activity in the hip and thigh muscles may also be able to explain the lack of relationship that may or may not exist. Despite the inconclusive results of this study, the findings may suggest that weak hip abductor muscles may be a relevant factor to focus on in future studies.

From control to causation: Validating a 'complex systems model' of running-related injury development and prevention.

INTRODUCTION: There is a need for an ecological and complex systems approach for better understanding the development and prevention of running-related injury (RRI). In a previous article, we proposed a prototype model of the Australian recreational distance running system which was based on the Systems Theoretic Accident Mapping and Processes (STAMP) method. That model included the influence of political, organisational, managerial, and sociocultural determinants alongside individual-level factors in relation to RRI development. The purpose of this study was to validate that prototype model by drawing on the expertise of both systems thinking and distance running experts. MATERIALS AND METHODS: This study used a modified Delphi technique involving a series of online surveys (December 2016- March 2017). The initial survey was divided into four sections containing a total of seven questions pertaining to different features associated with the prototype model. Consensus in opinion about the validity of the prototype model was reached when the number of experts who agreed or disagreed with survey statement was ≥75% of the total number of respondents. RESULTS: A total of two Delphi rounds was needed to validate the prototype model. Out of a total of 51 experts who were initially contacted, 50.9% (n = 26) completed the first round of the Delphi, and 92.3% (n = 24) of those in the first round participated in the second. Most of the 24 full participants considered themselves to be a running expert (66.7%), and approximately a third indicated their expertise as a systems thinker (33.3%). After the second round, 91.7% of the experts agreed that the prototype model was a valid description of the Australian distance running system. CONCLUSION: This is the first study to formally examine the development and prevention of RRI from an ecological and complex systems perspective. The validated model of the Australian distance running system facilitates theoretical advancement in terms of identifying practical system-wide opportunities for the implementation of sustainable RRI prevention interventions. This 'big picture' perspective represents the first step required when thinking about the range of contributory causal factors that affect other system elements, as well as runners' behaviours in relation to RRI risk.

DO GENERAL MEDICAL PRACTITIONERS EXAMINE INJURED RUNNERS?

BACKGROUND: General Medical Practitioners (GMP) in Denmark perform clinical examinations of patients with musculoskeletal pain. However, the prevalence proportion of examinations caused by running-related injuries remains unknown. PURPOSE: The primary purpose of the present study was to estimate the prevalence proportion of consultations in general medical practice caused by running-related injuries. The secondary purpose was to estimate the prevalence proportion of injured runners, who consult their GMP, that are referred to additional examinations or treatments. STUDY DESIGN: A survey-based study. METHODS: An online survey was distributed in October and November 2015 to more than 370 GMPs in Denmark and completed by 27. RESULTS: The median prevalence proportion of consultations caused by running-related injuries in the prior two weeks was 0.80% [25th percentile = 0.00%; 75th percentile = 1.43%]. Ten (37%) GMPs reported to refer between 0-24% of the injured runners to additional examination or treatment, whereas thirteen (48%) of GMPs referred between 25-49% and four (15%) referred 50-74% of injured runners. CONCLUSION: Although a very small part (<1%) of the GMPs consultations were related to running injuries, this result suggests that injured runners seek advice in the primary health-care system in Denmark. As a consequence, physiotherapists willing to treat runners with running-related injuries may inform the GMPs in their local community about the treatment possibilities they offer. The low response-proportion highlights the challenges recruiting GMPs willing to respond to questionnaires on running-related injuries. It is plausible to assume that the estimates reported in the present study are overestimated owing to selection bias. LEVEL OF EVIDENCE: 3.

A framework for the etiology of running-related injuries.

The etiology of running-related injury is important to consider as the effectiveness of a given running-related injury prevention intervention is dependent on whether etiologic factors are readily modifiable and consistent with a biologically plausible causal mechanism. Therefore, the purpose of the present article was to present an evidence-informed conceptual framework outlining the multifactorial nature of running-related injury etiology. In the framework, four mutually exclusive parts are presented: (a) Structure-specific capacity when entering a running session; (b) structure-specific cumulative load per running session; (c) reduction in the structure-specific capacity during a running session; and (d) exceeding the structure-specific capacity. The framework can then be used to inform the design of future running-related injury prevention studies, including the formation of research questions and hypotheses, as well as the monitoring of participation-related and non-participation-related exposures. In addition, future research applications should focus on addressing how changes in one or more exposures influence the risk of running-related injury. This necessitates the investigation of how different factors affect the structure-specific load and/or the load capacity, and the dose-response relationship between running participation and injury risk. Ultimately, this direction allows researchers to move beyond traditional risk factor identification to produce research findings that are not only reliably reported in terms of the observed cause-effect association, but also translatable in practice.

Handball load and shoulder injury rate: a 31-week cohort study of 679 elite youth handball players.

BACKGROUND: Knowledge of injury patterns, an essential step towards injury prevention, is lacking in youth handball. AIM: To investigate if an increase in handball load is associated with increased shoulder injury rates compared with a minor increase or decrease, and if an association is influenced by scapular control, isometric shoulder strength or glenohumeral range of motion (ROM). METHODS: 679 players (14-18 years) provided weekly reports on shoulder injury and handball load (training and competition hours) over 31 weeks using the SMS, phone and medical examination system. Handball load in a given week was categorised into (1) <20% increase or decrease (reference), (2) increase between 20% and 60% and (3) increase >60% relative to the weekly average amount of handball load the preceding 4 weeks. Assessment of shoulder isometric rotational and abduction strength, ROM and scapular control was performed at baseline and midseason. RESULTS: An increase in handball load by >60% was associated with greater shoulder injury rate (HR 1.91; 95% CI 1.00 to 3.70, p=0.05) compared with the reference group. The effect of an increase in handball load between 20% and 60% was exacerbated among players with reduced external rotational strength (HR 4.0; 95% CI 1.1 to 15.2, p=0.04) or scapular dyskinesis (HR 4.8; 95% CI 1.3 to 18.3, p=0.02). Reduced external rotational strength exacerbated the effect of an increase above 60% (HR 4.2; 95% CI 1.4 to 12.8, p=0.01). CONCLUSIONS: A large increase in weekly handball load increases the shoulder injury rate in elite youth handball players; particularly, in the presence of reduced external rotational strength or scapular dyskinesis.

Detection of genetic variation affecting milk coagulation properties in Danish Holstein dairy cattle by analyses of pooled whole-genome sequences from phenotypically extreme samples (pool-seq).

Rennet-induced milk coagulation is an important trait for cheese production. Recent studies have reported an alarming frequency of cows producing poorly coagulating milk unsuitable for cheese production. Several genetic factors are known to affect milk coagulation, including variation in the major milk proteins; however, recent association studies indicate genetic effects from other genomic regions as well. The aim of this study was to detect genetic variation affecting milk coagulation properties, measured as curd-firming rate (CFR) and milk pH. This was achieved by examining allele frequency differences between pooled whole-genome sequences of phenotypically extreme samples (pool-seq).. Curd-firming rate and raw milk pH were measured for 415 Danish Holstein cows, and each animal was sequenced at low coverage. Pools were created containing whole genome sequence reads from samples with "extreme" values (high or low) for both phenotypic traits. A total of 6,992,186 and 5,295,501 SNP were assessed in relation to CFR and milk pH, respectively. Allele frequency differences were calculated between pools and 32 significantly different SNP were detected, 1 for milk pH and 31 for CFR, of which 19 are located on chromosome 6. A total of 9 significant SNP, which were selected based on the possible function of proximal candidate genes, were genotyped in the entire sample set ( = 415) to test for an association. The most significant SNP was located proximal to , explaining 33% of the phenotypic variance. , coding for κ-casein, is the most studied in relation to milk coagulation due to its position on the surface of the casein micelles and the direct involvement in milk coagulation. Three additional SNP located on chromosome 6 showed significant associations explaining 7, 3.6, and 1.3% of the phenotypic variance of CFR. The significant SNP on chromosome 6 were shown to be in linkage disequilibrium with the SNP peaking proximal to ; however, after accounting for the genotype of the peak SNP within this QTL, significant effects (-value < 0.1) could still be detected for 2 of the SNP accounting for 2 and 1% of the phenotypic variance. These 2 interesting SNP were located within introns or proximal to the candidate genes-solute carrier family 4 (sodium bicarbonate cotransporter), member 4 () and LIM and calponin homology domains 1 (), respectively-making them interesting targets for further analysis.

Reliability of video-based identification of footstrike pattern and video time frame at initial contact in recreational runners.

INTRODUCTION: Two-dimensional video recordings are used in clinical practice to identify footstrike pattern. However, knowledge about the reliability of this method of identification is limited. OBJECTIVE: To evaluate intra- and inter-rater reliability of visual identification of footstrike pattern and video time frame at initial contact during treadmill running using two-dimensional (2D) video recordings. METHODS: Thirty-one recreational runners were recorded twice, 1 week apart, with a high-speed video camera. Two blinded raters evaluated each video twice with an interval of at least 14 days. RESULTS: Kappa values for within-day identification of footstrike pattern revealed intra-rater agreement of 0.83-0.88 and inter-rater agreement of 0.50-0.63. Corresponding figures for between-day identification of footstrike pattern were 0.63-0.69 and 0.41-0.53, respectively. Identification of video time frame at initial contact ranged from five frames to 12 frames (95% limits of agreement). CONCLUSION: For clinical use, the intra-rater within-day identification of footstrike pattern is highly reliable (kappa>0.80). For the inter-rater between-day identification inconsistencies may, in worst case, occur in 36% of the identifications (kappa=0.41). The 95% limits of agreement for identification of video time frame at initial contact may, at times, allow for different identification of footstrike pattern. Clinicians should, therefore, be encouraged to continue using clinical 2D video setups for intra-rater identification of footstrike pattern, but bear in mind the restrictions related to the between day identifications.

Normative values of eccentric hip abduction strength in novice runners: an equation adjusting for age and gender.

PURPOSE: Low eccentric strength of the hip abductors, might increase the risk of patellofemoral pain syndrome and iliotibial band syndrome in runners. No normative values for maximal eccentric hip abduction strength have been established. Therefore the purpose of this study was to establish normative values of maximal eccentric hip abduction strength in novice runners. METHODS: Novice healthy runners (n = 831) were recruited through advertisements at a hospital and a university. Maximal eccentric hip abduction strength was measured with a hand-held dynamometer. The demographic variables associated with maximal eccentric hip abduction strength from a univariate analysis were included in a multivariate linear regression model. Based on the results from the regression model, a regression equation for normative hip abduction strength is presented. RESULTS: A SIGNIFICANT DIFFERENCE IN MAXIMAL ECCENTRIC HIP ABDUCTION STRENGTH WAS FOUND BETWEEN MALES AND FEMALES: 1.62 ± 0.38 Nm/kg (SD) for males versus 1.41 ± 0.33 Nm/kg (SD) for females (p < 0.001). Age was associated with maximal eccentric hip abduction strength: per one year increase in age a -0.0045 ± 0.0013 Nm/kg (SD) decrease in strength was found, p < 0.001. Normative values were identified using a regression equation adjusting for age and gender. Based on this, the equation to calculate normative values for relative eccentric hip abduction strength became: (1.600 + (age * -0.005) + (gender (1 = male / 0 = female) * 0.215) ± 1 or 2 * 0.354) Nm/kg. CONCLUSION: Normative values for maximal eccentric hip abduction strength in novice runners can be calculated by taking into account the differences in strength across genders and the decline in strength that occurs with increasing age. Age and gender were associated with maximal eccentric hip abduction strength in novice runners, and these variables should be taken into account when evaluating eccentric hip abduction strength in this group of athletes. LEVEL OF EVIDENCE: 2A.

No association between q-angle and foot posture with running-related injuries: a 10 week prospective follow-up study.

BACKGROUND/PURPOSE: There is a paucity of knowledge on the association between different foot posture quantified by Foot Posture Index (FPI) and Quadriceps angle (Q-angle) with development of running-related injuries. Earlier studies investigating these associations did not include an objective measure of the amount of running performed. Therefore, the purpose of this study was to investigate if kilometers to running-related injury (RRI) differ among novice runners with different foot postures and Q-angles when running in a neutral running shoe. METHODS: A 10 week study was conducted including healthy, novice runners. At baseline foot posture was evaluated using the foot posture index (FPI) and the Q-angle was measured. Based on the FPI and Q-angle, right and left feet / knees of the runners were categorized into exposure groups. All participants received a Global Positioning System watch to allow them to quantify running volume and were instructed to run a minimum of two times per week in a conventional, neutral running shoe. The outcome was RRI. RESULTS: Fifty nine novice runners of mixed gender were included. Of these, 13 sustained a running-related injury. No significant difference in cumulative relative risk between persons with pronated feet and neutral feet was found after 125 km of running (Cumulative relative risk = 1.65 [0.65; 4.17], p = 0.29). Similarly, no difference was found between low and neutral Q-angle (Cumulative relative risk = 1.25 [0.49; 3.23], p = 0.63). CONCLUSION: Static foot posture as quantified by FPI and knee alignment as quantified by Q-angle do not seem to affect the risk of injury among novice runners taking up a running regimen wearing a conventional neutral running shoe. These results should be interpreted with caution due to a small sample size. LEVEL OF EVIDENCE: 2a.

MicroRNA identity and abundance in porcine skeletal muscles determined by deep sequencing.

MicroRNAs (miRNA) are short single-stranded RNA molecules that regulate gene expression post-transcriptionally by binding to complementary sequences in the 3' untranslated region (3' UTR) of target mRNAs. MiRNAs participate in the regulation of myogenesis, and identification of the complete set of miRNAs expressed in muscles is likely to significantly increase our understanding of muscle growth and development. To determine the identity and abundance of miRNA in porcine skeletal muscle, we applied a deep sequencing approach. This allowed us to identify the sequences and relative expression levels of 212 annotated miRNA genes, thereby providing a thorough account of the miRNA transcriptome in porcine muscle tissue. The expression levels displayed a very large range, as reflected by the number of sequence reads, which varied from single counts for rare miRNAs to several million reads for the most abundant miRNAs. Moreover, we identified numerous examples of mature miRNAs that were derived from opposite sides of the same predicted precursor stem-loop structures, and also observed length and sequence heterogeneity at the 5' and 3' ends. Furthermore, KEGG pathway analysis suggested that highly expressed miRNAs are involved in skeletal muscle development and regeneration, signal transduction, cell-cell and cell-extracellular matrix communication and neural development and function.