Longitudinal Internal Training Load and Exposure in a High-Performance Basketball Academy.

ABSTRACT: Lever, JR, Duffield, R, Murray, A, Bartlett, JD, and Fullagar, HHK. Longitudinal internal training load and exposure in a high-performance basketball academy. J Strength Cond Res XX(X): 000-000, 2024-This study describes the longitudinal training exposure (session counts) and internal training load (Rating of Perceived Exertion [RPE] and Session Rating of Perceived Exertion [sRPE]) of youth basketball players at a high-performance academy, based on the training year, training term, and playing position. Historical internal training load and training exposure data were collated from 45 male high-performance youth basketball athletes between 2015 and 2019. Data included session duration, RPE, sRPE, training type, and date. Linear mixed models and pairwise comparisons were performed on the weekly means and categorized by training year (year 1, year 2, year 3), term (term 1, term 2, term 3, term 4), and playing position (Backcourt, Frontcourt). Linear mixed models indicate that the individual athlete had the greatest influence on variance in training load and exposure. Significant differences were observed for increased session count, duration, and sRPE (p < 0.001) in year 2 compared with year 1. These measures also increased within each year whereby term 3 and term 4 (p < 0.001) were significantly greater than term 1 and term 2. No significant differences were observed between playing position (p > 0.05). Training exposure and internal training load increase in year 2 from year 1 for high-performance youth basketball academy athletes. Differences between training load and exposure for terms (i.e., training blocks) suggest the phase of season influences training prescription, while playing position has limited effect.

The effect of sleep restriction, with or without high-intensity interval exercise, on behavioural alertness and mood state in young healthy males.

Mood state and alertness are negatively affected by sleep loss, and can be positively influenced by exercise. However, the potential mitigating effects of exercise on sleep-loss-induced changes in mood state and alertness have not been studied comprehensively. Twenty-four healthy young males were matched into one of three, 5-night sleep interventions: normal sleep (NS; total sleep time (TST) per night = 449 ± 22 min), sleep restriction (SR; TST = 230 ± 5 min), or sleep restriction and exercise (SR + EX; TST = 235 ± 5 min, plus three sessions of high-intensity interval exercise (HIIE)). Mood state was assessed using the profile of mood states (POMS) and a daily well-being questionnaire. Alertness was assessed using psychomotor vigilance testing (PVT). Following the intervention, POMS total mood disturbance scores significantly increased for both the SR and SR + EX groups, and were greater than the NS group (SR vs NS; 31.0 ± 10.7 A.U., [4.4-57.7 A.U.], p = 0.020; SR + EX vs NS; 38.6 ± 14.9 A.U., [11.1-66.1 A.U.], p = 0.004). The PVT reaction times increased in the SR (p = 0.049) and SR + EX groups (p = 0.033) and the daily well-being questionnaire revealed increased levels of fatigue in both groups (SR; p = 0.041, SR + EX; p = 0.026) during the intervention. Despite previously demonstrated physiological benefits of performing three sessions of HIIE during five nights of sleep restriction, the detriments to mood, wellness, and alertness were not mitigated by exercise in this study. Whether alternatively timed exercise sessions or other exercise protocols could promote more positive outcomes on these factors during sleep restriction requires further research.

Resistance-only and concurrent exercise induce similar myofibrillar protein synthesis rates and associated molecular responses in moderately active men before and after training.

Aerobic and resistance exercise (RE) induce distinct molecular responses. One hypothesis is that these responses are antagonistic and unfavorable for the anabolic response to RE when concurrent exercise is performed. This thesis may also depend on the participants' training status and concurrent exercise order. We measured free-living myofibrillar protein synthesis (MyoPS) rates and associated molecular responses to resistance-only and concurrent exercise (with different exercise orders), before and after training. Moderately active men completed one of three exercise interventions (matched for age, baseline strength, body composition, and aerobic capacity): resistance-only exercise (RE, n = 8), RE plus high-intensity interval exercise (RE+HIIE, n = 8), or HIIE+RE (n = 9). Participants trained 3 days/week for 10 weeks; concurrent sessions were separated by 3 h. On the first day of Weeks 1 and 10, muscle was sampled immediately before and after, and 3 h after each exercise mode and analyzed for molecular markers of MyoPS and muscle glycogen. Additional muscle, sampled pre- and post-training, was used to determine MyoPS using orally administered deuterium oxide (D2 O). In both weeks, MyoPS rates were comparable between groups. Post-exercise changes in proteins reflective of protein synthesis were also similar between groups, though MuRF1 and MAFbx mRNA exhibited some exercise order-dependent responses. In Week 10, exercise-induced changes in MyoPS and some genes (PGC-1ɑ and MuRF1) were dampened from Week 1. Concurrent exercise (in either order) did not compromise the anabolic response to resistance-only exercise, before or after training. MyoPS rates and some molecular responses to exercise are diminished after training.

The Effect of Sleep Restriction, With or Without Exercise, on Skeletal Muscle Transcriptomic Profiles in Healthy Young Males.

Background: Inadequate sleep is associated with many detrimental health effects, including increased risk of developing insulin resistance and type 2 diabetes. These effects have been associated with changes to the skeletal muscle transcriptome, although this has not been characterised in response to a period of sleep restriction. Exercise induces a beneficial transcriptional response within skeletal muscle that may counteract some of the negative effects associated with sleep restriction. We hypothesised that sleep restriction would down-regulate transcriptional pathways associated with glucose metabolism, but that performing exercise would mitigate these effects. Methods: 20 healthy young males were allocated to one of three experimental groups: a Normal Sleep (NS) group (8 h time in bed per night (TIB), for five nights (11 pm - 7 am)), a Sleep Restriction (SR) group (4 h TIB, for five nights (3 am - 7 am)), and a Sleep Restriction and Exercise group (SR+EX) (4 h TIB, for five nights (3 am - 7 am) and three high-intensity interval exercise (HIIE) sessions (performed at 10 am)). RNA sequencing was performed on muscle samples collected pre- and post-intervention. Our data was then compared to skeletal muscle transcriptomic data previously reported following sleep deprivation (24 h without sleep). Results: Gene set enrichment analysis (GSEA) indicated there was an increased enrichment of inflammatory and immune response related pathways in the SR group post-intervention. However, in the SR+EX group the direction of enrichment in these same pathways occurred in the opposite directions. Despite this, there were no significant changes at the individual gene level from pre- to post-intervention. A set of genes previously shown to be decreased with sleep deprivation was also decreased in the SR group, but increased in the SR+EX group. Conclusion: The alterations to inflammatory and immune related pathways in skeletal muscle, following five nights of sleep restriction, provide insight regarding the transcriptional changes that underpin the detrimental effects associated with sleep loss. Performing three sessions of HIIE during sleep restriction attenuated some of these transcriptional changes. Overall, the transcriptional alterations observed with a moderate period of sleep restriction were less evident than previously reported changes following a period of sleep deprivation.

When can anterior dislocations of the shoulder with an isolated fracture of the greater tuberosity be safely reduced in the emergency department?

Following dislocation of the glenohumeral joint with an isolated greater tuberosity fracture, closed reduction in the emergency department can lead to fracture propagation or iatrogenic fractures. This article assesses the evidence regarding when anterior dislocations of the shoulder with an isolated fracture of the greater tuberosity can be safely reduced in the emergency department, as there is currently no clear guidance on this. A total of eight articles described 172 cases which underwent closed reduction, which resulted in 22 cases of iatrogenic fractures. Female sex, increased patient age and fragments of the greater tuberosity were associated with an increased risk of iatrogenic fractures. Closed reduction in the emergency department appears to be a safe option in younger patients and those with greater tuberosity fractures less than 40% of the width of the humeral head.

Effect of Divergent Solar Radiation Exposure With Outdoor Versus Indoor Training in the Heat: Implications for Performance.

ABSTRACT: O'Connor, FK, Doering, TM, Minett, GM, Reaburn, PR, Bartlett, JD and Coffey, VG. Effect of divergent solar radiation exposure with outdoor versus indoor training in the heat: implications for performance. J Strength Cond Res 36(6): 1622-1628, 2022-The aim of this study was to determine physiological and perceptual responses and performance outcomes when completing high-intensity exercise in outdoor and indoor hot environments with contrasting solar radiation exposure. Seven cyclists and 9 Australian Football League (AFL) players undertook cycling trials in hot conditions (≥30 °C) outdoors and indoors. Cyclists completed 5 × 4 minutes intervals (∼80% peak power output [PPO]) with 2 minutes recovery (∼40% PPO) before a 20-km self-paced ride. Australian Football League players completed a standardized 20 minutes warm-up (∼65% mean 4-minute power output) then 5 × 2 minutes maximal effort intervals. Heart rate (HR), PO, ratings of perceived exertion (RPE), thermal comfort (TC), and thermal sensation (TS) were recorded. Core (Tc) and skin temperature (Tsk) were monitored in cyclists alone. In both studies, ambient temperature, relative humidity, and solar radiation were monitored outdoors and matched for ambient temperature and relative humidity indoors, generating different wet bulb globe temperature (WBGT) for cyclists, but the similar WBGT for AFL players through higher relative humidity indoors. The statistical significance was set at p ≤ 0.05. Cyclists' HR (p = 0.05), Tc (p = 0.03), and Tsk (p = 0.03) were higher outdoors with variable effects for increased RPE, TS, and TC (d = 0.2-1.3). Power output during intervals was not different between trials, but there were small-moderate improvements in cyclists' PO and 20-km time indoors (d = 0.3-0.6). There was a small effect (d = 0.2) for AFL players' mean PO to increase outdoors for interval 4 alone (p = 0.04); however, overall there were small-moderate effects for lower RPE and TS indoors (d = 0.2-0.5). Indoor training in hot conditions without solar radiation may promote modest reductions in physiological strain and improve performance capacity in well-trained athletes.

Exercise mitigates sleep-loss-induced changes in glucose tolerance, mitochondrial function, sarcoplasmic protein synthesis, and diurnal rhythms.

OBJECTIVE: Sleep loss has emerged as a risk factor for the development of impaired glucose tolerance. The mechanisms underpinning this observation are unknown; however, both mitochondrial dysfunction and circadian misalignment have been proposed. Because exercise improves glucose tolerance and mitochondrial function, and alters circadian rhythms, we investigated whether exercise may counteract the effects induced by inadequate sleep. METHODS: To minimize between-group differences of baseline characteristics, 24 healthy young males were allocated into one of the three experimental groups: a Normal Sleep (NS) group (8 h time in bed (TIB) per night, for five nights), a Sleep Restriction (SR) group (4 h TIB per night, for five nights), and a Sleep Restriction and Exercise group (SR+EX) (4 h TIB per night, for five nights and three high-intensity interval exercise (HIIE) sessions). Glucose tolerance, mitochondrial respiratory function, sarcoplasmic protein synthesis (SarcPS), and diurnal measures of peripheral skin temperature were assessed pre- and post-intervention. RESULTS: We report that the SR group had reduced glucose tolerance post-intervention (mean change ± SD, P value, SR glucose AUC: 149 ± 115 A.U., P = 0.002), which was also associated with reductions in mitochondrial respiratory function (SR: -15.9 ± 12.4 pmol O2.s-1.mg-1, P = 0.001), a lower rate of SarcPS (FSR%/day SR: 1.11 ± 0.25%, P < 0.001), and reduced amplitude of diurnal rhythms. These effects were not observed when incorporating three sessions of HIIE during this period (SR+EX: glucose AUC 67 ± 57, P = 0.239, mitochondrial respiratory function: 0.6 ± 11.8 pmol O2.s-1.mg-1, P = 0.997, and SarcPS (FSR%/day): 1.77 ± 0.22%, P = 0.971). CONCLUSIONS: A five-night period of sleep restriction leads to reductions in mitochondrial respiratory function, SarcPS, and amplitude of skin temperature diurnal rhythms, with a concurrent reduction in glucose tolerance. We provide novel data demonstrating that these same detrimental effects are not observed when HIIE is performed during the period of sleep restriction. These data therefore provide evidence in support of the use of HIIE as an intervention to mitigate the detrimental physiological effects of sleep loss.

A framework for effective knowledge translation and performance delivery of Sport Scientists in professional sport.

Sport Science is considered the study and application of scientific principles and techniques to improve sporting performance. Thus, a key role of the Sport Scientist is to translate complex information into usable and contextual performance solutions for a range of different stakeholders. These stakeholders consist of athletes, coaches, recruiting, performance support, medical, administration and operations staff and have varying interests and priorities meaning the information required can be vastly different. In addition to these different needs, sport is fast-moving, diverse and complex meaning there are a number of potential translational barriers. Sport Science training programmes entail the development of technical knowledge and practical skills; however, little is considered in view of interpersonal craft skill development and knowledge translation (KT). Given the reported barriers and challenges to effective KT in sport, this lack of specific training may render KT as ineffective and suboptimal. Accordingly, in this article, we propose a framework and work-based training model with the aim of developing the KT process and performance delivery of Sport Scientists operating in professional sport. Firstly, we define the current perspectives and challenges for Sport Scientists in the context of KT, before proposing a framework that focusses on Evidence-Based-Practice, Philosophy, Recipients and Facilitation, in which Sport Scientists can use to develop their interpersonal craft and subsequent KT approach. We finish by presenting a model of sport science practitioner training; the professional sport-doctoral training programme, that combined with the framework, can be effective in developing Sport Scientists.

Utilising one minute and four minute recovery when employing the resistance training contrast method does not negatively affect subsequent jump performance in the presence of concurrent training.

BACKGROUND: Little is known about contrast training and post-activation performance enhancement (PAPE) in a same day concurrent training model. The aim of the current study was to examine the use of two short duration (1-min and 4-min) recovery periods on drop jump performance in same day concurrently trained athletes. METHODS: Ten professional Australian Rules footballers (age, 20.6 ± 1.9 yr; height, 184.8 ± 6.9 cm; body mass, 85.8 ± 8.4 kg) completed two resistance training sessions with different PAPE recovery durations; 1-min and 4-min, 1 h following a field-based endurance session. Baseline (pre) drop jumps were compared to post-test maximal drop jumps, performed after each set of three squats (where each participant was encouraged to lift as heavy as they could), to determine changes between 1-min and 4-min recovery periods. Data were analysed by fitting a mixed model (significance was set at P ≤ 0.05). Corrected Hedges' g standardised effect sizes ±95% confidence limits were calculated using group means ± SDs. RESULTS: There were no significant differences between baseline and experimental sets 1, 2 and 3 for reactive strength index (RSI), flight time, and total and relative impulse for either recovery duration. However, for contact time, 1-min baseline was significantly different from set 2 (mean difference; 95% CI [0.029; 0.000-0.057 s], P = 0.047, ES; 95% CI [-0.27; -1.20 to 0.66]). For RSI and flight time, 1-min was significantly higher than 4-min (RSI: 0.367; 0.091 to 0.642, P = 0.010, ES; 95% CI [0.52; -0.37 to 1.42]; flight time: 0.033; 0.003 to 0.063 s, P = 0.027, ES; 95% CI [0.86; -0.06 to 1.78]). DISCUSSION: Short recovery periods of 1-min may be a time-efficient form of prescribing strength-power exercise in contrast loading schemes. Longer recovery periods do not appear to benefit immediate, subsequent performance.

Effect of Individual Environmental Heat-Stress Variables on Training and Recovery in Professional Team Sport.

CONTEXT: Exercise in hot environments increases body temperature and thermoregulatory strain. However, little is known regarding the magnitude of effect that ambient temperature (Ta), relative humidity (RH), and solar radiation individually have on team-sport athletes. PURPOSE: To determine the effect of these individual heat-stress variables on team-sport training performance and recovery. METHODS: Professional Australian Rules Football players (N = 45) undertook 8-wk preseason training producing a total of 579 outdoor field-based observations with Ta, RH, and solar radiation recorded at every training session. External load (distance covered, in m/min; percentage high-speed running [%HSR] >14.4 km/h) was collected via a global positioning system. Internal load (ratings of perceived exertion and heart rate) and recovery (subjective ratings of well-being and heart-rate variability [root mean square of the successive differences]) were monitored throughout the training period. Mixed-effects linear models analyzed relationships between variables using standardized regression coefficients. RESULTS: Increased solar-radiation exposure was associated with reduced distance covered (-19.7 m/min, P < .001), %HSR (-10%, P < .001) during training and rMSSD 48 h posttraining (-16.9 ms, P = .019). Greater RH was associated with decreased %HSR (-3.4%, P = .010) but increased percentage duration >85% HRmax (3.9%, P < .001), ratings of perceived exertion (1.8 AU, P < .001), and self-reported stress 24 h posttraining (-0.11 AU, P = .002). In contrast, higher Ta was associated with increased distance covered (19.7 m/min, P < .001) and %HSR (3.5%, P = .005). CONCLUSIONS: The authors show the importance of considering the individual factors contributing to thermal load in isolation for team-sport athletes and that solar radiation and RH reduce work capacity during team-sport training and have the potential to slow recovery between sessions.

Order of same-day concurrent training influences some indices of power development, but not strength, lean mass, or aerobic fitness in healthy, moderately-active men after 9 weeks of training.

BACKGROUND: The importance of concurrent exercise order for improving endurance and resistance adaptations remains unclear, particularly when sessions are performed a few hours apart. We investigated the effects of concurrent training (in alternate orders, separated by ~3 hours) on endurance and resistance training adaptations, compared to resistance-only training. MATERIALS AND METHODS: Twenty-nine healthy, moderately-active men (mean ± SD; age 24.5 ± 4.7 y; body mass 74.9 ± 10.8 kg; height 179.7 ± 6.5 cm) performed either resistance-only training (RT, n = 9), or same-day concurrent training whereby high-intensity interval training was performed either 3 hours before (HIIT+RT, n = 10) or after resistance training (RT+HIIT, n = 10), for 3 d.wk-1 over 9 weeks. Training-induced changes in leg press 1-repetition maximal (1-RM) strength, countermovement jump (CMJ) performance, body composition, peak oxygen uptake ([Formula: see text]), aerobic power ([Formula: see text]), and lactate threshold ([Formula: see text]) were assessed before, and after both 5 and 9 weeks of training. RESULTS: After 9 weeks, all training groups increased leg press 1-RM (~24-28%) and total lean mass (~3-4%), with no clear differences between groups. Both concurrent groups elicited similar small-to-moderate improvements in all markers of aerobic fitness ([Formula: see text] ~8-9%; [Formula: see text] ~16-20%; [Formula: see text] ~14-15%). RT improved CMJ displacement (mean ± SD, 5.3 ± 6.3%), velocity (2.2 ± 2.7%), force (absolute: 10.1 ± 10.1%), and power (absolute: 9.8 ± 7.6%; relative: 6.0 ± 6.6%). HIIT+RT elicited comparable improvements in CMJ velocity only (2.2 ± 2.7%). Compared to RT, RT+HIIT attenuated CMJ displacement (mean difference ± 90%CI, -5.1 ± 4.3%), force (absolute: -8.2 ± 7.1%) and power (absolute: -6.0 ± 4.7%). Only RT+HIIT reduced absolute fat mass (mean ± SD, -11.0 ± 11.7%). CONCLUSIONS: In moderately-active males, concurrent training, regardless of the exercise order, presents a viable strategy to improve lower-body maximal strength and total lean mass comparably to resistance-only training, whilst also improving indices of aerobic fitness. However, improvements in CMJ displacement, force, and power were attenuated when RT was performed before HIIT, and as such, exercise order may be an important consideration when designing training programs in which the goal is to improve lower-body power.

The Effects of Endurance-Based Skills-Specific Running Loads on Same-Day Resistance-Training Performance in Professional Australian Rules Football Players.

Little is known about the effect of preceding endurance-exercise bouts on subsequent resistance-training (RT) performance in team-sport players. PURPOSE: To examine the effect of prior skills/endurance training and different recovery time periods on subsequent same-day RT performance in professional Australian football players. METHODS: Sport-specific endurance-running loads (duration [in minutes], total distance [in meters], mean speed [in meters per minute], high-speed running >15 km·h-1, and relative high-speed running [>75% and >85% of maximal velocity]) were obtained for 46 professional Australian football players for each training session across an entire competitive season. RT was prescribed in 3 weekly mesocycles with tonnage (in kilograms) lifted recorded as RT performance. Endurance and RT sessions were interspersed by different recovery durations: ∼20 min and 1, 2, and 3 h. Fixed- and mixed-effect linear models assessed the influence of skills/endurance-running loads on RT performance. Models also accounted for season period (preseason vs in-season) and recovery duration between concurrent training bouts. RESULTS: An increase in high-speed running and distance covered >75% and >85% of maximal velocity had the greatest reductions on RT performance. In-season total distance covered displayed greater negative effects on subsequent RT performance compared with preseason, while ∼20-min recovery between skills/endurance and RT was associated with greater reductions in RT performance, compared with 1-, 2-, and 3-h recovery. CONCLUSIONS: Sport-specific endurance-running loads negatively affect subsequent same-day RT performance, and this effect is greater in-season and with shorter recovery durations between bouts.

The effect of sleep restriction, with or without high-intensity interval exercise, on myofibrillar protein synthesis in healthy young men.

KEY POINTS: Sleep restriction has previously been associated with the loss of muscle mass in both human and animal models. The rate of myofibrillar protein synthesis (MyoPS) is a key variable in regulating skeletal muscle mass and can be increased by performing high-intensity interval exercise (HIIE), although the effect of sleep restriction on MyoPS is unknown. In the present study, we demonstrate that participants undergoing a sleep restriction protocol (five nights, with 4 h in bed each night) had lower rates of skeletal muscle MyoPS; however, rates of MyoPS were maintained at control levels by performing HIIE during this period. Our data suggest that the lower rates of MyoPS in the sleep restriction group may contribute to the detrimental effects of sleep loss on muscle mass and that HIIE may be used as an intervention to counteract these effects. ABSTRACT: The present study aimed to investigate the effect of sleep restriction, with or without high-intensity interval exercise (HIIE), on the potential mechanisms underpinning previously-reported sleep-loss-induced reductions to muscle mass. Twenty-four healthy, young men underwent a protocol consisting of two nights of controlled baseline sleep and a five-night intervention period. Participants were allocated into one of three parallel groups, matched for age, V̇O2peak , body mass index and habitual sleep duration; a normal sleep (NS) group [8 h time in bed (TIB) each night], a sleep restriction (SR) group (4 h TIB each night), and a sleep restriction and exercise group (SR+EX, 4 h TIB each night, with three sessions of HIIE). Deuterium oxide was ingested prior to commencing the study and muscle biopsies obtained pre- and post-intervention were used to assess myofibrillar protein synthesis (MyoPS) and molecular markers of protein synthesis and degradation signalling pathways. MyoPS was lower in the SR group [fractional synthetic rate (% day-1 ), mean ± SD, 1.24 ± 0.21] compared to both the NS (1.53 ± 0.09) and SR+EX groups (1.61 ± 0.14) (P < 0.05). However, there were no changes in the purported regulators of protein synthesis (i.e. p-AKTser473 and p-mTORser2448 ) and degradation (i.e. Foxo1/3 mRNA and LC3 protein) in any group. These data suggest that MyoPS is acutely reduced by sleep restriction, although MyoPS can be maintained by performing HIIE. These findings may explain the sleep-loss-induced reductions in muscle mass previously reported and also highlight the potential therapeutic benefit of HIIE to maintain myofibrillar remodelling in this context.

The learning curves of a validated virtual reality hip arthroscopy simulator.

INTRODUCTION: Decreases in trainees' working hours, coupled with evidence of worse outcomes when hip arthroscopies are performed by inexperienced surgeons, mandate an additional means of training. Though virtual reality simulation has been adopted by other surgical specialities, its slow uptake in arthroscopic training is due to a lack of evidence as to its benefits. These benefits can be demonstrated through learning curves associated with simulator training-with practice reflecting increases in validated performance metrics. METHODS: Twenty-five medical students with no previous experience of hip arthroscopy completed seven weekly simulated arthroscopies of a healthy virtual hip joint using a 70° arthroscope in the supine position. Twelve targets were visualised within the central compartment, six via the anterior portal, three via the anterolateral portal and three via the posterolateral portal. Task duration, number of collisions (bone and soft-tissue), and distance travelled by arthroscope were measured by the simulator for every session of each student. RESULTS: Learning curves were demonstrated by the students, with improvements in time taken, number of collisions (bone and soft-tissue), collision length and efficiency of movement (all p < 0.01). Improvements in time taken, efficiency of movement and number of collisions with soft-tissue were first seen in session 3 and improvements in all other parameters were seen in session 4. No differences were found after session 5 for time taken and length of soft-tissue collision. No differences in number of collisions (bone and soft-tissue), length of collisions with bone, and efficiency of movement were found after session 6. CONCLUSIONS: The results of this study demonstrate learning curves for a hip arthroscopy simulator, with significant improvements seen after three sessions. All performance metrics were found to improved, demonstrating sufficient visuo-haptic consistency within the virtual environment, enabling individuals to develop basic arthroscopic skills.

DXA-derived estimates of energy balance and its relationship with changes in body composition across a season in team sport athletes.

This study examined the relationship between dual-energy x-ray absorptiometry (DXA)-derived estimates of energy balance (EB) and changes in body composition across various seasonal phases in team sport athletes. Forty-five Australian rules footballers underwent six DXA scans across a 12-month period (off-season [OS, Week 0-13], early [PS1, Week 13-22] and late pre-season [PS2, Week 22-31] and early [IS1, Week 3-42] and late in-season [IS2, Week 42-51]). EB (kcal·day-1) was estimated from changes in fat free soft tissue mass (FFSTM) and fat mass (FM) between scans according to a validated formula. An EB threshold of ± 123 kcal·day-1 for >60 days demonstrated a very likely (>95% probability) change in FFSTM (>1.0 kg) and FM (>0.7 kg). There were small to almost perfect relationships between EB and changes in FM (r = 0.97, 95% CI, 0.96-0.98), FFSTM (r = -0.41, -0.92 to -0.52) and body mass (r = 0.27, 0.14-0.40). EB was lowest during PS1 compared to all other phases (range, -265 to -142 kcal·day-1), with no other changes at any time. Increases in FFSTM were higher during OS compared to PS2 (1.6 ± 0.4 kg), and higher during PS1 compared to PS2, IS1, and IS2 (range, 1.6-2.1 kg). There were no changes during in-season (-0.1-0.05 kg). FM decreased only in PS1 compared to all other seasonal phases (-1.8 to -1.0 kg). Assessments of body composition can be used as a tool to estimate EB, which practically can be used to indicate athlete's training and nutrition behaviours/practices.

Greater Association of Relative Thresholds Than Absolute Thresholds With Noncontact Lower-Body Injury in Professional Australian Rules Footballers: Implications for Sprint Monitoring.

Sprint capacity is an important attribute for team-sport athletes, yet the most appropriate method to analyze it is unclear. PURPOSE: To examine the relationship between sprint workloads using relative versus absolute thresholds and lower-body soft-tissue and bone-stress injury incidence in professional Australian rules football. METHODS: Fifty-three professional Australian rules football athletes' noncontact soft-tissue and bone-stress lower-body injuries (N = 62) were recorded, and sprint workloads were quantified over ∼18 months using the global positioning system. Sprint volume (m) and exposures (n) were determined using 2 methods: absolute (>24.9 km·h-1) and relative (≥75%, ≥80%, ≥85%, ≥90%, ≥95% of maximal velocity). Relationships between threshold methods and injury incidence were assessed using logistic generalized additive models. Incidence rate ratios and model performances' area under the curve were reported. RESULTS: Mean (SD) maximal velocity for the group was 31.5 (1.4), range 28.6 to 34.9 km·h-1. In comparing relative and absolute thresholds, 75% maximal velocity equated to ~1.5 km·h-1 below the absolute speed threshold, while 80% and 85% maximal velocity were 0.1 and 1.7 km·h-1 above the absolute speed threshold, respectively. Model area under the curve ranged from 0.48 to 0.61. Very low and very high cumulative sprint loads ≥80% across a 4-week period, when measured relatively, resulted in higher incidence rate ratios (2.54-3.29), than absolute thresholds (1.18-1.58). DISCUSSION: Monitoring sprinting volume relative to an athlete's maximal velocity should be incorporated into athlete monitoring systems. Specifically, quantifying the distance covered at >80% maximal velocity will ensure greater accuracy in determining sprint workloads and associated injury risk.

Virtual reality hip arthroscopy simulator demonstrates sufficient face validity.

PURPOSE: To test the face validity of the hip diagnostics module of a virtual reality hip arthroscopy simulator. METHODS: A total of 25 orthopaedic surgeons, 7 faculty members and 18 orthopaedic residents, performed diagnostic supine hip arthroscopies of a healthy virtual reality hip joint using a 70° arthroscope. Twelve specific targets were visualised within the central compartment; six via the anterior portal, three via the anterolateral portal and three via the posterolateral portal. This task was immediately followed by a questionnaire regarding the realism and training capability of the system. This consisted of seven questions addressing the verisimilitude of the simulator and five questions addressing the training environment of the simulator. Each question consisted of a statement stem and 10-point Likert scale. Following similar work in surgical simulators, a rating of 7 or above was considered an acceptable level of realism. RESULTS: The diagnostic hip arthroscopy module was found to have an acceptable level of realism in all domains apart from the tactile feedback received from the soft tissue. 23 out of 25 participants (92%) felt the simulator provided a non-threatening learning environment and 22 participants (88%) stated they enjoyed using the simulator. It was most frequently agreed that the level of trainees who would benefit most from the simulator were registrars and fellows (22 participants; 88%). Additionally, 21 of the participants (84%) agreed that this would be a beneficial training modality for foundation and core trainees, and 20 participants (80%) agreed that his would be beneficial for consultants. CONCLUSIONS: This VR hip arthroscopy simulator was demonstrated to have a sufficient level of realism, thus establishing its face validity. These results suggest this simulator has sufficient realism for use in the acquisition of basic arthroscopic skills and supports its use in orthopaedics surgical training. LEVEL OF EVIDENCE: I.

Differential training loads and individual fitness responses to pre-season in professional rugby union players.

We aimed to compare differentiated training loads (TL) between fitness responders and non-responders to an eight-week pre-season training period in a squad of thirty-five professional rugby union players. Differential TL were calculated by multiplying player's perceptions of breathlessness (sRPE-B) and leg muscle exertion (sRPE-L) with training duration for each completed session. Performance-based fitness measures included the Yo-Yo Intermittent Recovery Test Level 1 (YYIRTL1), 10-, 20-, and 30-m linear sprint times, countermovement jump height (CMJ) and predicted one-repetition maximum back squat (P1RM Squat). The proportion of responders (≥ 75% chance that the observed change in fitness was > typical error and smallest worthwhile change) were 37%, 50%, 52%, 82% and 70% for YYIRTL1, 20/30-m, 10-m, CMJ and P1RM Squat, respectively. Weekly sRPE-B-TL was very likely higher in YYIRTL1 responders (mean difference = 18%; ±90% confidence limits 11%), likely lower in 20/30-m (19%; ±20%) and 10-m (18%; ±17%) responders, and likely higher in CMJ responders (15%; ±16%). All other comparisons were unclear. Weekly sRPE-B discriminate between rugby union players who respond to pre-season training when compared with players who do not. Our findings support the collection of differential ratings of perceived exertion and the use of individual response analysis in team-sport athletes.

Fuel for the Work Required: A Theoretical Framework for Carbohydrate Periodization and the Glycogen Threshold Hypothesis.

Deliberately training with reduced carbohydrate (CHO) availability to enhance endurance-training-induced metabolic adaptations of skeletal muscle (i.e. the 'train low, compete high' paradigm) is a hot topic within sport nutrition. Train-low studies involve periodically training (e.g., 30-50% of training sessions) with reduced CHO availability, where train-low models include twice per day training, fasted training, post-exercise CHO restriction and 'sleep low, train low'. When compared with high CHO availability, data suggest that augmented cell signalling (73% of 11 studies), gene expression (75% of 12 studies) and training-induced increases in oxidative enzyme activity/protein content (78% of 9 studies) associated with 'train low' are especially apparent when training sessions are commenced within a specific range of muscle glycogen concentrations. Nonetheless, such muscle adaptations do not always translate to improved exercise performance (e.g. 37 and 63% of 11 studies show improvements or no change, respectively). Herein, we present our rationale for the glycogen threshold hypothesis, a window of muscle glycogen concentrations that simultaneously permits completion of required training workloads and activation of the molecular machinery regulating training adaptations. We also present the 'fuel for the work required' paradigm (representative of an amalgamation of train-low models) whereby CHO availability is adjusted in accordance with the demands of the upcoming training session(s). In order to strategically implement train-low sessions, our challenge now is to quantify the glycogen cost of habitual training sessions (so as to inform the attainment of any potential threshold) and ensure absolute training intensity is not compromised, while also creating a metabolic milieu conducive to facilitating the endurance phenotype.

What Is the Risk Posed to the Lateral Femoral Cutaneous Nerve During the Use of the Anterior Portal of Supine Hip Arthroscopy and the Minimally Invasive Anterior Approach for Total Hip Arthroplasty?

PURPOSE: To determine: (1) What is the proximity of the lateral femoral cutaneous nerve (LFCN) to the anterior portal (AP) used in supine hip arthroscopy? (2) What is the proximity of the LCFN to the incision in the minimally invasive anterior approach (MIAA) for total hip arthroplasty? (3) What effect does lateralizing the AP have on the likelihood of nerve injury? (4) What branching patterns are observable in the LFCN? METHODS: Forty-five hemipelves were dissected. The LFCN was identified and its path dissected. The positions of the nerve in relation to the AP and the MIAA incision were measured. RESULTS: The AP intersected with 38% of nerves. In the remainder, the LFCN was located 5.7 ± 4.5 mm from the portal's edge. In addition, 44% of nerves crossed the incision of the MIAA. Of those that did not, the average minimum distance from the incision was 14.4 ± 7.0 mm. We found a significant reduction in risk if the AP is moved medially by 5 mm or laterally by 15 mm (P = .0054 and P = .0002). The LFCN showed considerable variation with 4 branching variants. CONCLUSIONS: These results show that the LFCN is at high risk during supine hip arthroscopy and the MIAA, emphasizing the need for meticulous dissection. We suggest that relocation of the AP 5 mm medially or 15 mm laterally will reduce the risk to the LFCN. CLINICAL RELEVANCE: These findings should aid surgeons in minimizing the risk to the LCFN during hip arthroscopy and the minimally invasive anterior approach to the hip.