Return to play and performance after patellar fracture in American professional sports: a case-control cohort analysis.

OBJECTIVES: This study describes the effects of patellar fracture on return to play (RTP) and functional outcomes among athletes in American professional sports. METHODS: Professional athletes from the National Football League (NFL), National Basketball Association (NBA), Major League Baseball (MLB), and National Hockey League (NHL) who suffered a patellar fracture between January 1965 and December 2021 were identified through injury reports and public archives. Performance scores, play time, and games played were collected for the season preceding patellar fracture and 2 seasons after RTP, and differences in recorded metrics compared to pre-injury levels and matched controls were analyzed. RESULTS: Twenty-nine of 41 (71%) injured athletes returned to play at an average of 217 days. Among all players, play volume decreased in year 1 compared to baseline but recovered to pre-injury levels in year 2. Athletes treated operatively experienced an initial decline in performance (p < 0.01) but recovered to pre-injury performance level in year 2. Nonoperative management resulted in a decline in performance in year 2 of RTP (p = 0.02). Athletes treated operatively performed significantly worse than matched controls in year 1 of RTP (64% vs. 99%; p = 0.04) but recovered to a similar level of performance as controls in year 2 (87% vs. 91%; p = 0.90). CONCLUSION: A 71% rate of RTP was demonstrated among this limited cohort of 29 athletes in American professional sports after isolated patellar fracture. Although details regarding fracture characteristics and operative reports were not available for analysis, operative management was not associated with longer absence from play compared to nonoperative treatment. Despite the limitations of this study, the findings suggesting operative management may improve prospects of maintaining elite performance following RTP warrant further investigation. LEVEL OF EVIDENCE: Case-control cohort analysis; Level of evidence, 3.

Preliminary results of student survey at the University of Rome "Tor Vergata" practicing sports: a focus on the effects of Dual Career regulation.

The importance of sports and the approval of the Dual Career regulation at the University of Rome "Tor Vergata" are highly significant topics for the well-being and personal development of students. In line with European and international policies, this initiative recognizes the specific needs of student-athletes by offering them tools and flexibility to excel in both sports and academics. However, monitoring student-athletes by Universities requires thorough investigations and the development of initiatives to promote students' adherence to sports practice. Therefore, our study aims to analyze the results of a survey administered to students enrolled at the University of Rome "Tor Vergata" during the academic years 2020/2021, 2021/2022, 2022/2023, and 2023/2024, investigating the effects of the introduction of the Dual Career regulation on the student population. Our preliminary results showed that the introduction of the Dual Career program was associated with a significant increase in the number of students practising sports over the academic years, with greater participation in the academic years 2022/2023 and 2023/2024. Noteworthy, the number of student-athletes who applied to the Dual Career program markedly increased in the last year, with the highest number of enrollments in the macroareas of Medicine and Surgery, Economy, and Engineering. Overall, the Dual Career regulation offers the possibility to plan the study path in a personalized way, dedicated academic support, and flexibility in deadlines, making the University of Rome "Tor Vergata" a model of integration between education and sportiness.

Clinical Utility of Qualitative Change of Direction Movement Assessment in ACL Injury Risk Evaluation.

Anterior cruciate ligament (ACL) injuries are complex and influenced by numerous internal and external risk factors that should be considered to effectively mitigate injury and facilitate informed return to sport decision-making. Among these risk factors, movement quality exhibited during sport-specific tasks has been identified as a significant predictor of injury occurrence. Particularly, change of direction (COD) movements, when performed with sub-optimal movement quality, such as knee valgus and lateral trunk flexion, are prominent mechanisms of ACL injury in multidirectional sports. Unfortunately, the formal and objective assessment of COD movement quality is underutilized in clinical and sports practice, with existing methods often confined to expensive, sophisticated laboratory settings impractical for everyday clinicians. The purpose of this clinical commentary is to demonstrate the necessity of integrating COD movement assessments to screen for potential ACL injury risk, particularly among higher-risk populations. The authors will review cost-effective and clinic-friendly objective tests used to qualitatively screen COD movements, such as the Cutting Movement Assessment Score and The Expanded Cutting Alignment Tool. Additionally, this commentary will discuss key considerations when assessing COD movement. Level of Evidence: 5.

Using an integrated motor imagery and physical training intervention after knee injury: an interim analysis of the MOTIFS randomised controlled trial.

Objectives: Physical function is often a main focus of knee injury rehabilitation, but recent recommendations include increasing attention to psychological factors. We have developed the MOTor Imagery to Facilitate Sensorimotor re-learning (MOTIFS) training model which integrates dynamic motor imagery into physical rehabilitation. The objective is to report interim analysis results of an adaptive randomised controlled trial regarding the pre-defined continuation criteria. Methods: Following a 12-week intervention in which participants were randomised to either MOTIFS or Care-as-Usual training, n=42 people undergoing rehabilitation for a traumatic knee injury were assessed for change from baseline to follow-up in psychological readiness to return to activity, using the ACL Return to Sport after Injury Scale (ACL-RSI), and side hop limb symmetry index. Continuation criteria included differences of ≥5 points in ACL-RSI and ≥8 points in side hop limb symmetry index in favour of the MOTIFS group. If these were not met, ≥5 points change in enjoyment was acceptable. Results: Pre-defined continuation criteria were not met for ACL-RSI (mean difference -8.1 (SE 4.1)), side hop limb symmetry index (mean difference 4.4 (SE 7.8)), nor enjoyment (mean difference 3.9 (SE 4.5)), indicating that major modifications are required for continuation of the MOTIFS trial. Conclusion: While results of this interim analysis did not show differences in psychological readiness to return to activity or side hop performance, previous research shows that the MOTIFS model is positive and enjoyable. Further research is warranted to evaluate more appropriate outcomes related to the holistic nature of physical and psychological readiness to return to activity. Trial registration number: NCT03473821.

Anterior Cruciate Ligament (ACL) Repair Using Dynamic Intraligamentary Stabilization Combined with Lateral Extra-articular Augmentation: A Case Report and Technical Note.

The treatment options for an anterior cruciate ligament (ACL) rupture range from conservative therapy to ACL repair and reconstruction. ACL repair is particularly suitable for younger patients with an acute proximal tear, and moderate athletic demand. Preserving the ACL can restore its proprioceptive and stabilizing functions, avoid donor site morbidity, and shorten rehabilitation time. Repair techniques include the use of suture anchors, internal brace augmentation, and dynamic intraligamentary stabilization. Dynamic intraligamentary stabilization employs a coil spring mechanism for dynamic tibial fixation, allowing posterior translation during knee flexion, which stabilizes the ACL for optimal healing. However, patients with a positive preoperative pivot shift test have shown worse postoperative outcomes and higher failure rates after ACL repair. To address this, lateral extraarticular augmentation is recommended during ACL reconstruction to restore stability and prevent graft failure. We present the case of a 27-year-old female recreational handball player who sustained an acute proximal ACL rupture. Arthroscopic ACL repair was performed using the technique of dynamic intraligamentary stabilization combined with lateral extra-articular augmentation in the modified Lemaire technique. At six weeks postoperatively, the patient presented with a hard endpoint at Lachman's test and negative pivot shift. At five months, the isokinetic strength testing showed above-average strength values. At eight months, the patient underwent hardware removal and arthroscopically showed a fully healed ACL. For the final examination 12 months postoperatively, the patient presented with in-reference strength values in isokinetic strength testing and excellent scoring in patient-reported outcome measurements. The combination of dynamic intraligamentary stabilization and lateral extra-articular augmentation demonstrates an adequate treatment option for patients with proximal ACL ruptures and immediate functional demands in moderate activity level sports due to the rapid achievement of clinical and subjective stability as well as excellent results in isokinetic strength testing.

Effect of Hit-Sport-Game Exercise Training on Self-Control and Regulation in Children With Attention Deficit Hyperactivity Disorder (ADHD).

Objective. To determine the effect of a physical exercise training program, "HitSportGame" (HSG), on self-regulation of children with ADHD. Subjects and methods. The participants (N = 44) were children with ADHD aged 8 to 12 years (Mean 10.5 SD 1.4) without comorbidity with other neurodevelopmental disorders. Children were randomized to an experimental group and a wait-list control group. The experimental group participated in the Hit-Sport-Game (HSG) training program thrice a week for 12 weeks. The self-control skills of the participants in both groups were evaluated with the CACIA (Child and Adolescent Self-Control Questionnaire) 1 week before and 1 week after completing the entire intervention. Results. The results showed significant improvements with effect sizes from moderate to large in the scales of personal feedback (P = .003; η2 p = 0.183), criteria self-control (P = .029; η2 p = 0.112), and procedural self-control (P = .015; η2 p = 0.131) after the intervention in the experimental group compared to the control group, which showed no difference on any of these scales. The reward delay scale did not show significant changes associated with the intervention (P = .104; η2 p = 0.059). Conclusions. HitSportGame physical exercise training demonstrated favorable effects on some self-control skills such as personal feedback, criterial self-control and procedural self-control of children with ADHD. However, it did not show any effect on the ability to delay rewards in this population.

Effects of Training With Different Hang-Power-Clean Intensities on the Maximum Dynamic Strength, Vertical Jump, and Sprint Performance of Female Handball Players.

PURPOSE: To compare the effects of 7 weeks of training with different hang-power-clean (HPC) intensities on the maximum dynamic strength, vertical jump, and sprint performance of female handball players. METHODS: Professional handball athletes with at least 1 year of HPC experience volunteered to participate. The athletes were balanced by position and randomly assigned to a group with HPC at 90% (HPC90%) or 50% (HPC50%) of HPC 1-repetition maximum (1RM). The training volume was equalized between groups. Pretraining and posttraining assessments included 1RM HPC, jump height in the squat jump (SJ) and countermovement jump (CMJ), and sprint speeds at 5, 20, and 30 m. RESULTS: From pretraining to posttraining, both groups significantly increased (P ≤ .05) 1RM HPC, although a small effect size was observed in favor of HPC90%. HPC90% and HPC50% did not induce significant changes (P > .05) in the SJ and CMJ height, although for the SJ, a small effect size was observed in favor of HPC90%. Both groups induced a significant improvement (P ≤ .05) in 5-, 20-, and 30-m sprint speeds, although for all speeds, small to moderate effect sizes were observed in favor of HPC90%. CONCLUSIONS: Both training groups induced significant improvements in 1RM HPC and sprint speeds, whereas no significant changes were observed in vertical jumps. In addition, based mainly on the effect sizes, the HPC90% group was more effective for increasing 1RM HPC, SJ, and sprint speeds than the HPC50% group.

EEG differences in competitive female gymnastics, soccer, and esports athletes between resting states with eyes closed and open.

Athletes heavily rely on visual perception for performance. This study delves into electroencephalographic (EEG) brain activity among gymnastics, soccer, and esports athletes during resting states with eyes closed (REC) and open (REO) and compares differences in EEG alpha power from REC to REO (∆ EC-EO Alpha) across athlete groups. Forty-two female participants, including 14 from each athletic discipline, underwent two 5-minute EEG recordings, first during REC and then during REO conditions. Absolute EEG power was analyzed for delta (δ), theta (θ), alpha (α), and beta (ß) frequency bands across various brain regions, and ∆ EC-EO Alpha values were computed. During REC, soccer players exhibited heightened α power at the midline frontopolar (Fpz) and ß power at the midline occipital (Oz). Conversely, during REO, soccer players displayed increased δ power at Fpz and midline frontal (Fz) and reduced α power at the midline central (Cz) compared to gymnasts, along with elevated θ power at Fpz. Esports athletes demonstrated higher δ power and decreased α power at Fpz and Cz compared to gymnasts. Gymnasts exhibited distinct cortical activation patterns characterized by lower ∆ EC-EO Alpha at multiple electrode sites. These findings highlight sport-specific cortical activation patterns linked to visual attention among athletes. Understanding these neural adaptations could refine training methods and enhance performance outcomes in sports.

Polyphenols and metabolism: from present knowledge to future challenges.

A diet rich in polyphenols and other types of phytonutrients can reduce the occurrence of chronic diseases. However, a well-established cause-and-effect association has not been clearly demonstrated and several other issues will need to be fully understood before general recommendations will be carried out In the present review, some of the future challenges that the research on phenolic compounds will have to face in the next years are discussed: toxicological aspects of polyphenols and safety risk assessment; synergistic effects between different polyphenols; metabotype-based nutritional advice based on a differential gut microbial metabolism of polyphenols (precision nutrition); combination of polyphenols with other bioactive compounds; innovative formulations to improve the bioavailability of phenolic compounds; and polyphenols in sports nutrition and recovery.Other aspects related to polyphenol research that will have a boost in the next years are: polyphenol and gut microbiota crosstalk, including prebiotic effects and biotransformation of phenolic compounds into bioactive metabolites by gut microorganisms; molecular docking, molecular dynamics simulation, and quantum and molecular mechanics studies on the protein-polyphenol complexes; and polyphenol-based coating films, nanoparticles, and hydrogels to facilitate the delivery of drugs, nucleic acids and proteins.In summary, this article provides some constructive inspirations for advancing in the research of the applications, risk assessment and metabolic effects of dietary polyphenols in humans.

Sport participation, weight status, and physical fitness in French adolescents.

The primary objective of this study was to investigate the associations between sport participation and weight status with physical fitness among French adolescents. The secondary aim was to establish sex- and age-specific physical fitness percentiles for French adolescents. The sample comprised 8084 adolescents (4126 boys, 3958 girls), aged 10-14 years. Participants were tested on cardiorespiratory fitness and muscular strength using the following tests: 20-m shuttle run test and handgrip strength test. A questionnaire on organized sport participation was completed. Physical fitness levels were better in boys (P < 0.005). Handgrip strength increased with age whereas 20-m shuttle run performance decreased with age. Overweight and obese adolescents had significantly lower cardiorespiratory fitness levels than their normal-weight peers (P < 0.005), whereas normal-weight adolescents had lower cardiorespiratory fitness than thin adolescents (P < 0.005). Sport participation was higher for boys (57.2% boys vs. 52.8% girls) (P < 0.001). Adolescents who participated in at least one organized sport (either through a club or at school) were fitter than those who did not participate in organized sports (P < 0.005). Adolescents who engaged in organized sports were more active and physically fit than those who did not participate. The fitness benefits of club sports are greater than those provided by school-based sports, highlighting the potential of sports clubs as a key setting for promoting health. What is Known: • Physical fitness is a strong marker of health in children and adolescents. • The last French Report Card highlighted the lack of fitness data and the need for nationwide programs, while showing a significant decline in cardiorespiratory fitness among youth in recent decades.. What is New: • This study reveals that adolescents participating in organized sports have better physical fitness compared to their peers who do not, emphasizing the potential advantages of club sports over school-based activities. • We highlight the need for targeted strategies, particularly for overweight or obese adolescents and girls, to increase participation in organized sports and enhance health outcomes. • The study emphasizes the need to develop policies that improve access to organized sports clubs and expand physical education in schools, aiming to improve CRF in adolescents.

Nutritional knowledge, attitudes and behaviours in rugby league; influences of age, body composition and ancestry.

INTRODUCTION: Rugby league is a physically demanding sport that necessitates considerable nutritional intake, focusing on quality and type, in order to optimize training and competition demands. However, rugby league athletes are reported to have inadequate nutrition intake to match these demands. Some factors that may determine an athlete's nutrition intake have been reported in other sports, including (but not limited to, knowledge, time, cooking skills, food costs, income, belief in the importance of nutrition, body composition goals, and family/cultural support). However, these potential factors are relatively unexplored in rugby league, where a range of personal (age, body composition) or social (ancestry) influences could affect nutritional intake. Further exploration of these factors is warranted to understand the knowledge, attitudes and behavior underlying rugby league athletes' nutritional intake that can provide practitioners with a more detailed understanding of how to approach nutrition behaviors and attitudes in rugby league athletes. OBJECTIVES: The primary aim was to describe the nutrition behaviors and knowledge of rugby league athletes. A secondary aim was to compare nutrition knowledge and behavior based on age, body composition and self-identified ancestry. METHODS: Fifty professional rugby league athletes anonymously completed a seventy-six-question online survey. The survey consisted of three sections : 1) sports nutrition knowledge, 2) attitudes toward nutrition on performance , and 3) nutrition behaviors. All participants completed the online survey without assistance using their own personal device, with data entered via REDCap during pre-season. Nutrition knowledge was compared based on age (years), body composition (body fat percentage (%)) and ancestral groups (Pasifika, Aboriginal and/or Torres Strait Islander (ATSI) and Anglo- European).Pearson correlation was used for the relationship between nutrition knowledge, age and body composition. An Analysis of Covariance (ANCOVA) was used to determine nutrition knowledge differences between ancestral groups with age and body composition as covariates. Attitudes and behaviors were compared based on age groups (<20, 20-24 and >25 y), ancestry and body composition. Attitudes and behaviors were analyzed by Pearson correlation for body composition, one-way ANOVA for age groups and ANCOVA for ancestry with covariates age and body composition. RESULTS: Overall athletes' nutrition knowledge score was reported as 40 ± 12% (overall rating "poor"). Nutritional behaviors were significant for body composition, as those with lower body fat percentage had higher intakes of vegetables and dairy products (p = 0.046, p = 0.009), and ate more in the afternoon (lunch p = 0.048, afternoon snack p = 0.036). For ancestry, after adjustment for both age and body composition, Pasifika athletes were more inclined to miss breakfast and lunch compared to their Anglo-European (p = 0.037, p = 0.012) and ATSI (p = 0.022, p = 0.006) counterparts and ate more fruit than Anglo-Europeans (p = 0.006, p = 0.016). After adjustment for body composition, ATSI athletes also viewed the impact of nutrition on mental health and well-being significantly lower than Pasifika (p = 0.044). CONCLUSION: These findings suggest differences exist within rugby league athletes based on ancestral backgrounds and body composition for nutrition attitudes, behaviors and knowledge. Such outcomes could be used when designing nutrition education interventions, with consideration given to these factors to optimize long-term positive behavior change.

Dual career policy at federal universities in Brazil: analysis of academic and sporting support.

Internationally, the implementation of holistic programs aimed at academic, financial and retirement preparation support for student-athletes who find themselves in dual careers, such as university students, has been widespread and intensified. However, little is known about the subject in the Brazilian national context, because although there are related studies, they are punctual and related to specific universities. In view of the above, this study aimed to investigate public policy aimed at student-athletes at Brazilian federal universities. This is an exploratory, qualitative, cross-sectional and documentary study, using the websites, internal regulations and public notices of 69 Brazilian federal universities for the year 2023, using the content analysis technique. The results indicate that 72.05% offer some kind of support to DC based on the holistic model, 66.17% of which is academic and 60.29% sports. Among the academic support, the flexibility of assessments (57.35%) and the differentiated treatment of absences (51.47%) were close. The sporting support is centered on partial payment of competition costs (60.29%) and athlete grants are restricted to 20.58% of universities. It can be concluded that Brazil's federal universities have policies that include support actions that integrate the holistic model (academic), with incipient coverage of scholarships (sports), but do not effectively follow the holistic model.

Standardization of gut microbiome analysis in sports.

The gut microbiome plays a significant role in physiological functions such as nutrient processing, vitamin production, inflammatory response, and immune modulation, which, in turn, are important contributors to athlete health and performance. To date, the interpretation, discussion, and visualization of microbiome results of athletes are challenging, due to a lack of standard parameters and reference data for collection and comparison. The purpose of this perspective piece is to provide researchers with an easy-to-understand framework for the collection, analysis, and data management related to the gut microbiome with a specific focus on athletic populations. In the absence of a consensus on microbiome research in the sports field, we hope that these considerations serve as foundational "best practice." Adherence to these standard operating procedures will accelerate the path toward improving the quality of data and ultimately our understanding of the influence of the gut microbiome in sport settings.

Examining football players' perceived social support across organizational levels and its links to holistic talent development outcomes in German youth academies.

Sport research highlights the significance of supportive relationships and a psychologically safe environment for promoting desirable talent development outcomes associated with young athletes' performance, wellbeing, and personal development. Against this background, this study aimed to investigate youth football players' perceived availability of different kinds of social support from various stakeholders along the talent pathway in German elite youth academies (1). It further sought to examine the link of such social support perceptions to wellbeing, sport commitment and individual performance satisfaction as relevant development outcomes (2). Finally, the study examined potential mechanism underlying these associations by considering psychological safety as a potential mediator (3). For this purpose, N = 271 youth academy players participating in teams of under-13s, under-15s, and under-17/19s age groups completed a multi-section online survey including the PASS-Q, PsySafety-Check, and WHO-5 as well as subscales of the ASQ (i.e., individual performance satisfaction) and YSCS (i.e., sport commitment). Multivariate analyses indicated significant differences in players' perceptions of social support depending on its kind and provider as well as on players' age group. Further, path models highlighted the importance of emotional and esteem support provided by coaches and management for players' talent development outcomes. However, psychological safety seemed to only play a minor role within those associations, partially mediating the effects of emotional support. Overall, these findings encourage a critical reflection of youth players' social support needs and opportunities to optimally address those within elite youth academies as prominent talent development environments in football.

[Physical activity and diabetes: Where, when, how and with whom?] / Activité physique et diabète : où, quand, comment et avec qui ?

Today, physical activity is one of the most effective preventive and health-promoting factors for people with diabetes. Understanding the issues involved and how to implement it will help you to support patients in maintaining this practice.

You have to work twice as hard as a woman to show that you are competent. Experiences, opportunities and workplace gender harassment for Sport and Exercise Medicine practitioners working in elite sport in Australia.

OBJECTIVE: Our aim was to investigate (1) gender representation, (2) opportunities and training and (3) harassment experiences in Sport and Exercise Medicine (SEM) practitioners working in elite sport in Australia. METHODS: All titled Australian Physiotherapy Association Sport and Exercise Physiotherapists, SEM Physicians and Registrars and doctors and physiotherapists (SEM practitioners) currently/previously/aspiring to work in Australian elite sport were invited to participate in a bespoke online survey and the Gender Experiences Questionnaire. RESULTS: For SEM practitioners currently working in elite sport, men worked more paid hours each week (mean difference (MD) 12.2 (95% CI 5.5 to 19.0)) and more paid weeks each year (MD 6.8 (95% CI 1.2 to 12.5)). Women SEM practitioners (both currently and previously) were more likely than men to work with women, rather than men athletes. All women SEM practitioners experienced significantly more gender harassment, infantilisation, work/family policing and gender policing than men. For SEM practitioners (both current and previous), there were no gender differences in how practitioners found out about or were recruited to their elite sports roles. Women were four times more likely than men to report that their gender or sexual orientation influenced their opportunities in elite sport. Most roles were not advertised with direct approach being the most common method of job recruitment. CONCLUSION: Women SEM practitioners currently working in elite sport worked less paid hours per week and less paid weeks per year. All SEM practitioners were appointed to positions without established procedures, and there were significant challenges for women SEM practitioners in the elite sport workplace with women facing considerably more gender harassment than men.

Pulsed Electromagnetic Field (PEMF) stimulation as an adjunct to exercise: a brief review.

Pulsed Electromagnetic Field (PEMF) therapy is a non-invasive treatment that utilizes electromagnetic fields to stimulate and promote natural healing processes within the body. PEMF therapy works by emitting low-frequency electromagnetic pulses, which penetrate deep into tissues and cells, enhancing cellular function and health. PEMF applications are vast, ranging from enhancing recovery in athletes to supporting overall well-being in everyday individuals. PEMF therapy is increasingly recognized in the realm of sports and physical activity for its profound benefits in enhancing performance, accelerating recovery, and preventing injuries. By improving circulation, enhancing tissue oxygenation, and promoting the body's natural healing processes, PEMF therapy has become an invaluable tool in sports medicine, contributing to optimized physical health and prolonged athletic careers. In this review, we explore the effects of PEMF on exercise and the underlying physiological mechanisms.