BMJ Open Sports and Exercise Medicine

This pilot protocol study aims to evaluate the effects of an adapted Taekwondo-based intervention on upper limb strength and overall functional capacity in elderly care home residents. Considering the global trend of population ageing, physical activity interventions in care facilities are essential to mitigate functional decline and enhance well-being among this population. 20 participants will be stratified into walking and non-walking groups to reflect the diverse functional levels within the facility. The primary outcome will focus on upper limb strength, which will be assessed using the handgrip test. In contrast, secondary outcomes will evaluate functional capacity through the Short Physical Performance Battery, the Senior Fitness Test and mobility assessments. With its emphasis on arm movements, the Taekwondo-based intervention is expected to improve upper limb strength and overall functional abilities, supporting active ageing and enhancing participants’ quality of life.

Objective This systematic review and meta-analysis examined the effects of school-based interventions on all 24-hour movement behaviours. Design Systematic review and meta-analysis. Data sources Studies published in English, French, and Spanish from four databases from inception to February 2024 were identified. Eligibility criteria for selecting studies Eligible articles were randomised controlled trials (RCTs) that targeted and assessed physical activity (PA), sedentary behaviour (SB) and sleep duration among school-aged youth (3–17 years). Risk of bias and quality assessment were assessed using the Risk of Bias Tool 2 and Quality Assessment of Controlled Intervention Studies tool, respectively. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool evaluated the certainty of evidence. The study was registered in International Prospective Register of Systematic Reviews (PROSPERO) (ID: removed for peer review). Results Of the 5141 records initially identified, 41 studies remained for full-text review. After full reading, 7 RCTs, comprising 8234 participants (49% girls), were included. Results indicated no effect in PA-related outcomes (Hedge’s g =0.12, –0.05 to 0.28), a small reduction in SB-related outcomes (g=−0.33, –0.51 to −0.16) and a small increase in sleep duration (g=0.30, 0.16 to 0.43) according to Hedges’ g (small effects (0≤g ≤0.50)). The GRADE, risk of bias and quality assessment tools indicated that most of the studies have a low risk of bias and are of good quality. Conclusions More school-based interventions promoting all movement behaviours are needed to determine if schools are optimal for encouraging 24-hour movement behaviours among young people.

Stroke is one of the most common causes of disability and death worldwide. With the rapidly growing stroke survivor population, it is crucial to identify an effective method for their healthcare. Recovery from stroke is followed by physiotherapy to promote rehabilitation. Task-oriented circuit training is designed to improve stroke patients’ overall functioning during rehabilitation. This research aims to assess the effectiveness of task-oriented circuit training compared with conventional physiotherapy. The investigators have planned an 8-week parallel, two-arm, prospective, randomised clinical study. Participants will be enrolled from eight branches of the centre for the rehabilitation of the paralysed (CRP). We have planned to recruit 506 stroke survivors via a 1:1 random assignment procedure for 24 months. As a main objective, the Action Arm Research Test and the Timed Up and Go will be used to test upper and lower limb motor function. The secondary objectives will include daily living and balance activities, which will be evaluated using the Barthel Index and the Berg Balance Scale. The post-test and follow-up data will be collected after 8 and 12 weeks. The final analysis will include dropouts and treatment side effects. This study has been granted ethical approval by the Ethics Review Committee of the CRP (CRP-R&E-0401-357)). All activities and interventions will be carried out following the Helsinki Declaration of 2020. The findings will be published in peer-reviewed journals and disseminated at international conferences. Trial registration number: CTRI/2023/09/057907 (21 September 2023) (Prospectively registered).

Background This study aimed to investigate the relationship between participation in football and health-related quality of life (HRQOL) in middle-aged and older men in Japan. Methods This was a survey with cross-sectional design. Middle-aged and older men who were registered members of the Japan Football Association as players were recruited (Football group). We also performed an online survey of middle-aged and older men and categorised them into two groups based on questions for this survey about their current engagement in sports/exercise activities (none group and individual sports group). HRQOL was assessed using the 36-Item Short Form Health Survey (SF-36). The physical component summary (PCS) score and mental component summary (MCS) score were calculated based on eight SF-36 subscales. Results The total number of participants in this survey was 5761 (none: 1988; individual sports: 1,776; football: 1997). After adjustment for covariates, PCS scores revealed no differences among groups (none: 51.2±11.1; individual sports: 51.9±8.9; football: 52.1±5.6), although the corresponding subscale scores differed significantly among groups. The football group exhibited significantly higher MCS scores compared with the other groups (none: 48.9±10.1; individual sports: 52.2±9.5; football: 56.2±7.2). The corresponding subscale scores of the MCS were significantly higher in the Football group compared with the other groups. Conclusions Findings suggest that middle-aged and older men who are registered football players had better HRQOL in the mental aspect compared with those without any exercise habits and to those who engage in individual sports, although the cross-sectional design could not establish causality.

Objectives To describe national team biathletes’ experiences of their menstrual cycle (MC) while training and competing, and to identify factors to be considered in the development of policy and practice to support these athletes. Methods Participants included 18 national team biathletes (ages 17–32 years) who experience the MC. Following a qualitative description design, athletes participated in one-on-one semistructured interviews that were audio-recorded, transcribed verbatim and analysed using a content analysis process. Results Four descriptive themes represent the findings: (a) ‘A very under-rated part of performance and training’: Critical impacts of the MC on sport; (b) ‘It varies month to month’: Fluctuation in occurrence and impact of MC symptoms; (c) ‘Block out and get through it’: Managing the MC for performance; and (d) ‘For the next generation’: Improving policy and practice around the MC. Findings from this research outline actionable steps to support athletes who experience a MC, including developing mandatory MC education, increasing knowledge about the management of MC symptoms (eg, MC tracking, leakproof suits), and creating a fair point system of the overall biathlon season ranking allowing elimination of two race results that may have been affected by a health issue, such as adverse MC symptoms. Conclusions This research outlines the critical need for ‘macro’ level policies and practices that reduce the perceived impact of MC symptoms on athletes’ training and performance. Furthermore, individual variations described in this study highlight the importance of individualised approaches to supporting athletes as they navigate the MC alongside the demands of sport.

Objectives We have previously reported high levels of oral disease in professional senior team footballers in England and Wales. In this study, we aimed to determine the prevalence of oral disease in professional academy footballers, to identify if problems start earlier and to inform health promotion strategies. Method Professional academy football clubs in England (footballers aged 16–18 years) were invited to participate. Questionnaires were used to collect oral health behaviours and self-reported impacts and validated clinical outcomes to assess oral health. Results 160 academy footballers were recruited from 10 English academy football clubs, of whom 86.8% (n=139) were men and 13.2% (n=21) were women, with a median age of 16.9 years. We identified high levels of oral disease: 31.2% (n=50) had dental caries requiring treatment; 76.8% (n=123) had gingivitis; and 22.5% (n=36) had periodontitis. Tooth wear affecting up to at least 50% of tooth structure was present in 15.5% (n=25) of participants. While 76.2% (n=122) self-reported brushing their teeth twice a day, 15.5% (n=25) brushed once or less a day and 21% (n=34) had not attended the dentist for >2 years. There was a general perception that oral health issues impacted the sporting performance of participants. Conclusion In this study, the prevalence of oral diseases among professional academy footballers in England was high and greater than found in national surveys of a similar age demographic. Urgent action is needed to embed oral health promotion in development and youth football, to reverse and prevent the disadvantages that will have lifelong consequences for treatment burden, quality of life and sporting performance.

Background/objectives The tackle has the highest risk and causes the most concussions in rugby union. As such, law variation prevention strategies aiming to reduce head contact have been introduced. This study investigated whether a law variation lowering the maximum legal height of the tackle, from the shoulder to the base of the sternum, was an effective approach to change players’ tackling behaviour and reduce head contact events in Scottish men’s community rugby. Methods This retrospective video analysis study compared game metrics and tackle characteristics from the pre (2022/2023) to lowered tackle height (LTH) season (2023/2024). Sixty games were analysed (30 each season), variables coded for the tackle event included tackle type, body position, contact point and head contact. Results The rate of bent at waist tackling increased during the LTH season (rate ratio (RR)=1.22 (95% CI 1.17 to 1.27)), which resulted in tacklers making initial contact with the ball carriers’ lower torso or arms more often (RR=1.08 (95% CI 1.03 to 1.14)). While overall tackler head contact to the ball carrier (any region) increased (RR=1.12 (95% CI 1.06 to 1.18)), head-to-head contacts with the ball carrier decreased (RR=0.55 (95% CI 0.33 to 0.92)) and head to upper leg contacts increased (RR=1.39 (95% CI 1.24 to 1.56)). Conclusions Lowering the maximum legal height of the tackle in men’s community rugby led to increased rates of bent at waist tackling, resulting in more tackles making initial contact with the ball carrier’s lower torso and legs. This change in behaviour likely reduced the rate of contact between tackler and ball carrier heads.

In recent years, there has been growing concern about the high rate of injuries in adolescent players, particularly those who engage in early sports specialisation, and there is a need for more effective and integrated sports-specific strategies that can reduce the rate of injuries and improve physical performance in this population. The primary purpose of this study is to compare the efficacy of an integrated injury prevention strategy combined with education versus conventional approaches in reducing injury rates, improving parental and coach awareness and enhancing physical performance in adolescent badminton players with early sports specialisation. Participants will be randomly assigned to either the integrated injury prevention strategy combined with the education or conventional approach group. The study will be conducted over 6 months, with measurements taken at baseline, and 6 months. The primary outcome measures will include injury rates, parental and coach awareness and physical performance. The results of this study will help determine whether the integrated approach can reduce injury rates, improve parent and coach awareness and enhance physical performance. Additionally, the study will assess the cost-effectiveness of the integrated approach and the level of player satisfaction. In conclusion, the outcomes of this randomised controlled trial will be useful for creating better injury prevention strategies for this group of athletes. This intervention trial is prospectively registered with Clinical Trials Registry India (CTRI Number-CTRI/2024/12/078261).

Objective To investigate the effects of a 12- week aerobic dance programme on systolic blood pressure (SBP) in stage one hypertensive adults. Methods This study employed an experimental research design. 36 out of 58 stage one hypertensive adults randomly assigned into experimental and control groups completed the programme. SBP was measured using a mercury sphygmomanometer at baseline and post programme. The experimental group participants trained thrice a week, 45 min per session, and at a moderate intensity, but the control group continued doing their daily routines. Data were analysed using SPSS V.20. A two- tailed t- test was used to compare the mean differences of the two groups. A p value of <0.05 was considered statistically significant. Results The experimental group had a mean SBP of 143.83±6.382 mm Hg at baseline, while the control had 137.61±6.400 mm Hg. After a 12- week aerobic dance programme, the mean SBP of the experimental group reduced to 136.33±9.191 mm Hg, while that of the control group increased to 139.56±9.954 mm Hg. This implies that the 12- week aerobic dance programme reduced the SBP of the experimental group by −7.50 mm Hg while that of the control group remained more or less the same by having a marginal increment of 1.50 mm Hg. The changes were statistically significant (p<0.002) after a 12- week aerobic dance programme. Conclusion The aerobic dance programme effectively manages the SBP of stage one hypertensive adults. In Uganda, stakeholders and policymakers should consider incorporating aerobic dance as a non- pharmacological method for hypertension management protocols.

Objectives To describe the prevalence, incidence and burden of injuries and illnesses, including their patterns (mechanisms, affected body parts/organ systems) across playing positions (wing, back, line and goalkeeper) in elite adult male handball players. Methods The Slovenian version of the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2-SLO) was used to record health problems (HP) weekly during the 45-week handball season 2022/23. Results The study included 189 athletes (age: 23.3±4.4 years). With a weekly response rate of 93%, the mean weekly prevalence of HP was 13.3% (95% CI: 12% to 15%). The overall incidence was 2.2 HP per player per year (95% CI: 1.9 to 2.4), with a cumulative 3318 days lost and a mean time loss of 10.7 days per problem. Acute injuries represented the highest prevalence, incidence and more than 4× greater burden than overuse injuries and illnesses. The knee was the most frequently injured site for both acute and overuse injuries. For acute injuries, the ankle was the second most affected site, while the pelvis/lower back and shoulder were common in overuse injuries. Respiratory illnesses comprised 48% of all illnesses. Wings had the highest prevalence (17%), while backs exhibited the highest incidence (0.99 HP per player per year 95% CI 0.84-1.17), and goalkeepers faced the longest time-loss per HP. Conclusion Our findings emphasise the need for position-specific medical care and prevention programmes, targeting knee, ankle, pelvis/lower back, shoulder and respiratory tract. Wings and backs require particular attention due to their high prevalence and burden, while goalkeepers need specialised rehabilitation protocols. Trial registration number NCT05471297.

Sedentary behaviour is associated with an increased risk of cardiovascular disease and all-cause mortality in individuals with type 1 diabetes (T1D). Recent laboratory-based research suggests that breaking up prolonged sedentary periods improves glycaemic markers in people with T1D. However, the effects of breaking up sedentary behaviour for prolonged periods in real-world settings remain unknown. This study aims to assess the effect of 4 weeks of active breaks on time spent within the target glycaemic range (time in range (TIR), 3.9–10.0 mmol/L) in adults with T1D Adults with T1D (n=118) who are sedentary for ≥8 hours per day will first complete a 7-day baseline assessment. Participants will then be randomised into either a control group (maintenance of habitual lifestyle) or an intervention group, where active breaks (3 min of self-paced walking every 30 min between 09:00 and 17:00, Monday through Friday) will be prescribed for 4 weeks. Activity levels (activPAL), TIR (via continuous glucose monitor), insulin dose and carbohydrate intake will be monitored throughout. The effect of active breaks on TIR will be compared between baseline and week 4, with data analysed using analysis of covariance (ANCOVA). The trial has been approved in the UK by the West Midlands-Solihull Ethics Committee (22/WM/0221). The findings from the study will be disseminated through peer-reviewed journals and presentations at national and international scientific conferences. Trial registration number NCT05706298 .

Background Data on upper limb injuries in elite female rugby athletes are limited. This study aims to describe the incidence, severity and burden of upper limb injuries over five seasons in elite women’s rugby at both the club and international levels in training and matches. Methods A longitudinal cohort study was conducted from the 2017/2018 to 2021/2022 seasons, involving female players from the English club top tier and international team. Data on upper limb injuries were reported by team medical staff, capturing injury type, location, severity and mechanism. Injury incidence was calculated per 1000 hours of match/training exposure, and burden was measured by multiplying incidence by severity. Results A total of 190 upper limb injuries were recorded, with shoulder injuries the most common, representing 43% of all injuries. Median severity (mid-range of injury severity within the data) in international settings was lower than in club settings (Club matches 38 days, IQR 65, international matches 15 days, IQR 55). Injury burden (which is derived from injury mean severity and injury incidence) was significantly higher at international level (club matches, 265 days/1000 hours, 95% CI 213 to 328; club training 6 days/1000 hours, 95% CI 6 to 8; international matches 2638 days/1000 hours, 95% CI 2000 to 3481; international training 51 days/1000 hours, 95% CI 30 to 88). Conclusions The current study data highlight a low injury severity at an international level. Although the international injury severity rate is higher than club injury incidence and burden. Hand injuries were more common within club training settings, and the shoulder was more prevalent in all other settings.

Introduction Knee osteoarthritis (OA) is a leading cause of pain and disability worldwide. While exercise is crucial for managing OA, the effectiveness of a well-structured and efficient home-based, self-management exercise programme remains unclear. Therefore, this two-phase randomised controlled trial will evaluate the effectiveness of a structured home-based exercise programme (HEP) and concentric-based stair training programme versus eccentric-based stair training programme (CSTP vs ESTP) to develop an evidence-based approach for knee OA. Methods and analysis This study will be a participant and assessor-blinded, randomised controlled trial that will enrol 247 knee OA participants. In Phase I, there will be a 1:1 split of participants into: an HEP and a control group P I for 8 weeks. In Phase II, eligible participants from Phase I will be a 1:1:1 split into: a CSTP, an ESTP and a control group P II for another 8 weeks. The number of exercise programmes will last for 16 weeks, including a 24-week follow-up. The primary outcomes of pain intensity, pressure pain threshold and functional ability will be measured using a numeric pain rating scale, pressure algometer and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). The secondary outcomes of muscle strength, range of motion, aerobic capacity and quality of life will be measured using a modified sphygmomanometer, universal goniometer, 6-minute walk test and 36-item short-form survey. All outcomes will be measured at pretest (T 1 ), post-test (T 2 and T 3 ) and follow-up (T 4 ). Ethics and dissemination All activities and exercise programmes will follow the Helsinki Declaration of 2020. The findings will be published in peer-reviewed journals and disseminated at international conferences. Trial registration number CTRI/2025/03/081574.

Objective Our objective was to evaluate the effects of long-term reduced training on the left atrium (LA) in elite endurance athletes and to elucidate sex-specific differences in LA detraining patterns. Methods In this long-term longitudinal echocardiographic study of 50 active elite endurance athletes a follow-up examination was performed 7 years after retirement from the elite programme. All echocardiographic measurements were indexed for body surface area. We analysed the changes between baseline and follow-up measures using analysis of covariance models adjusted for baseline level, sex and enrolment age as covariates. Results are reported as least squares means with two-sided 95% CIs. Results LA enlargement (left atrial maximum volume index) remained unchanged from baseline (change from baseline: 1.4mL/m ² , 95% CI: −0.7 to 3.5 mL/m ² ) despite significant reductions in VO 2 max (change from baseline: −864mL/min, 95% CI: −1091 to −637 mL/min). In contrast, left ventricular (LV) end-diastolic volume was reduced (change from baseline: −8mL/m ² , 95% CI: −11 to −5 mL/m ² ), consistent with reduced VO 2 max. LA contraction strain was increased (change from baseline: 1.4%, 95% CI: 0.4% to 2.5%), while LV filling pressure increased (E/e’ change from baseline: 0.4, 95% CI: 0.1 to 0.7). Conclusions 7 years of reduced training does not reverse exercise-induced LA enlargement in former elite endurance athletes. LA contractile function improved with higher LV filling pressure, suggesting that age-related LV pressure increases may contribute to chronic LA dilation, though irreversible adaptations like fibrosis cannot be ruled out. Trial registration number NCT05555849 .

Objectives Proximal hamstring tendon avulsion injuries are severe and potentially career-threatening for elite athletes. Until now, no data have been published on the non-operative treatment of this injury in elite athletes. Therefore, the objective of this case series was to describe return to performance in elite athletes after non-operative treatment of full-thickness proximal hamstring tendon avulsion injuries as well as provide detailed description of the rehabilitation process and provide a mechanobiological hypothesis on processes leading to successful outcomes. Methods In this retrospective case series, we included three elite athletes with four MRI-confirmed acute proximal hamstring tendon avulsions of the conjoint tendon and/or the semimembranosus tendon who opted for non-operative treatment following shared decision-making, consisting of an individualised rehabilitation programme. The primary outcome was time to return to performance (in weeks). Secondary outcomes were time to and rate of return to competition, rate of return to performance and re-injury rate. Results Four proximal hamstring tendon avulsions in three elite athletes were included. All elite athletes returned to performance within 8–33 weeks, which for three out of four cases was at Olympic (gold medal) level. Conclusion This (pilot) case series indicates that non-operative treatment for full-thickness proximal hamstring avulsion injury can result in return to performance in elite athletes. Non-operative treatment may therefore be a viable treatment option in selected (elite) athletes.

Objective To examine the mediation of obesity-related variables in the association between physical fitness and cardiometabolic risk in children and adolescents. Design Systematic review and meta-analysis. Data sources Studies from electronic databases from inception to 31 December 2023. Eligibility criteria for selecting studies Included were 123 observational studies (cross-sectional and longitudinal) that assessed risk by constructing a continuous score incorporating cardiometabolic parameters. Studies were considered if they evaluated at least one fitness component as an exposure in children and adolescents (5–19 years). Thirty-one were included in the main meta-analyses. Results Cross-sectional findings indicate that cardiorespiratory fitness is modestly but beneficially associated with cardiometabolic risk, either indirectly via obesity-related variables (indirect standardized beta coefficient [β Indirect ]=−0.17; 95% confidence interval [CI] −0.23; −0.11; inconsistency index [I ² ]=94.4%) or directly and independently from obesity-related variables (r=−0.11; 95% CI −0.15; −0.07; I ² =87.4%), whereas muscular fitness seems to be associated with risk only via obesity-related variables (β Indirect =−0.34; 95% CI −0.47; −0.20; I ² =85.1%). There was no cross-sectional difference between biological sexes (p≥0.199). Longitudinal findings indicate no total (r=−0.12; 95% CI −0.24; 0.01; I ² =23.1%) and direct (r=−0.03; 95% CI −0.08; 0.03; I ² =0%) associations. Conclusion The association between fitness and risk appears to take place either indirectly through the reduction of obesity-related levels or directly by influencing risk. The latter underscores that the inverse association extends beyond a mere reduction in obesity-related variables, encompassing specific enhancements linked to exercise training, including increased metabolic efficiency, and cardiovascular capacity. PROSPERO registration number CRD42022354628.

Objectives Physical activity is important for health, but the influence of structured, supervised aerobic exercise sessions on habitual physical activity in healthy older adults is unclear. Methods We evaluated habitual physical activity in the Hertfordshire Physical Activity Trial, where healthy older adults were randomised to 36 supervised 1-hour gymnasium sessions on a cycle ergometer at moderate intensity over 12 weeks or to a control group with no intervention. We estimated physical activity energy expenditure (PAEE) and time spent in sedentary behaviour and light and moderate or vigorous physical activity over 7 days at three time points (before, during and immediately after the intervention) with individually calibrated combined heart rate and movement sensing. Results Of 100 randomised participants (44% female, aged 67–76 years), 96% completed follow-up. Midway through the intervention, neither overall PAEE nor time spent at different intensities were different between groups. However, on the 3 days of the week that the structured exercise sessions occurred (Monday, Wednesday, Friday), the exercise group had a 9.1 kJ kg⁻¹ day⁻¹ ((2.5, 15.7), p=0.007) increase in PAEE, a reduction in sedentary time and increased time spent at light and moderate or vigorous physical activity, compared with the control group. Conclusions Three 1-hour bouts per week of structured aerobic exercise increased daily physical activity on the days they occurred, but not overall physical activity across the whole week. Population-wide strategies such as better cycling and walking infrastructure may increase physical activity in healthy older adults more effectively than treatment with structured exercise programmes. Trial registration number ISRCTN60986572.

Background Sportspeople suffering from mild traumatic brain injury (mTBI) who return prematurely to sport are at an increased risk of delayed recovery, repeat concussion events and, in the longer-term, the development of chronic traumatic encephalopathy. Therefore, determining the appropriate recovery time, without unnecessarily delaying return to sport, is paramount at a professional/semi-professional level, yet notoriously difficult to predict. Objectives To use machine learning to develop a multivariate model for the prediction of concussion recovery in sportspeople. Methods Demographics, injury history, Sport Concussion Assessment Tool fifth edition questionnaire and MRI head reports were collected for sportspeople who suffered mTBI and were referred to a tertiary university hospital in the West Midlands over 3 years. Random forest (RF) machine learning algorithms were trained and tuned on a 90% outcome-balanced corpus subset, with subsequent validation testing on the previously unseen 10% subset for binary prediction of greater than five missed sporting games. Confusion matrices and receiver operator curves were used to determine model discrimination. Results 375 sportspeople were included. A final composite model accuracy of 94.6% based on the unseen testing subset was obtained, yielding a sensitivity of 100% and specificity of 93.8% with a positive predictive value of 71.4% and a negative predictive value of 100%. The area under the curve was 96.3%. Discussion In this large single-centre cohort study, a composite RF machine learning algorithm demonstrated high performance in predicting sporting games missed post-mTBI injury. Validation of this novel model on larger external datasets is therefore warranted. Trial registration number ISRCTN16974791 .

Objectives To assess the association between (1) dietary habits and knee/shoulder injury incidence in male and female adolescent handball players and (2) menstrual dysfunction and injury incidence in females. Methods This study is based on seasons 2020–2022 of the Swedish Handball Cohort including 1144 participants (1703 player seasons) free from a substantial knee and shoulder injury. Participants self-reported meal frequency, meal timing, nutritional intake and menstrual function (season 2022/2023) at baseline. Weekly follow-ups throughout the season assessed training and matches, and substantial knee/shoulder injuries. Cox regression analyses estimated a hazard rate ratio (HRR) with the first event of a knee/shoulder injury (combined), with minutes of handball training and matches as the timescale. Results In females, adjusted analyses generated an HRR for knee/shoulder injuries of 1.46 (95% CI 1.08, 1.98) for moderate-high nutritional quality compared with low quality and an HRR of 1.38 (95% CI 1.02, 1.86) for ≥2 unfavourable dietary habits compared with 1 unfavourable dietary habit. For poor meal timing, adjusted analyses generated an HRR of 1.20 (95% CI 0.90, 1.61) compared with adequate timing in females. In males, adjusted analyses generated an HRR of 1.23 (95% CI 0.69, 2.17) for low meal frequency and an HRR of 0.83 (95% CI 0.60, 1.15) for poor meal timing. Conclusions In adolescent female handball players, moderate-high nutritional quality and ≥2 unfavourable dietary habits are associated with higher knee/shoulder injury incidence; whereas, no or unprecise associations were found for other dietary habits in females and males and for menstrual dysfunction in females.

Objectives Sport injuries in youth sports are common, and holistic predictive approaches have been called for to better understand how combinations of risk and protective factors contribute to injury occurrence. This study utilises a person-centred approach to identify how combinations of psychological and physical factors are associated with injuries in youth floorball players. Methods At season start, 222 youth athletes conducted physical field tests and measures of self-reported mental health and demographics. Postseason, participants reported any sustained acute or overuse injuries during the season. Latent profile analysis, using psychological (anxiety and depression) and physical (field test performance) factors, such as input variables, was employed to identify risk profiles. Covariate analysis was conducted with demographic predictors of profile membership. Finally, sport injury occurrence was compared between profiles. Results Three profiles were identified: ‘Moderate mental health/high physical performance’ (profile 1, n=101), ‘Very low mental health/average physical performance’ (profile 2, n=49) and ‘High mental health/low physical performance’ (profile 3, n=72). Athletes injured at baseline were less likely to belong to profile 1. Profile 1 had higher injury occurrence than profile 2 (OR=3.63, 95% CI (1.34 to 9.81)) and profile 3 (OR=2.63, 95% CI (1.06 to 6.47)) during the season. Conclusion Our results indicate that players in the profile characterised by moderate mental health and high physical performance (profile 1) at the start of the season, reported the highest injury occurrence during the season (based on retrospective injury reporting). Future studies should explore factors that can explain this relationship, such as engagement in risk situations, load and recovery.

Communication influences players’ performance and health and is influenced by the leadership style of coaches, internal team communication and the integration of the medical team in the professional men’s football setting. However, the communication process between medical teams and other stakeholders in professional football has not been described in depth. Therefore, we explored the perspectives of team doctors regarding the communication process within the medical team and with other stakeholders in men’s professional football. We conducted semistructured interviews with 10 team doctors from nine teams in six countries playing at the highest level of European professional football participating in the UEFA Elite Club Injury Study. Data were audio recorded, transcribed and analysed through reflexive thematic analysis. Three main themes described the communication process: (1) communication practices, (2) communication context and (3) communication foundation. The communication practices included involving specific stakeholders, using different communication channels and considering timing. The contextual factors in team structure, available resources and team standings require them to adapt their communication strategies. The foundation of effective communication relied on cultivating trust, acting respectfully, defining clear roles, following ethics and proactively developing relationships over time. In conclusion, the communication process is highly influenced by the context while team doctors constantly communicate with a diverse stakeholder group. This requires the team doctors to adapt to the different scenarios of professional football and dedicate time and effort to cultivating trustworthy relationships with stakeholders.

Introduction One of the most widespread non-communicable diseases in the world is type 2 diabetes mellitus (T2DM) which increases the risk of cardiovascular mortality and morbidity, in addition to elevated blood pressure, and lipid disorders, for which physical activity and exercise programmes have shown a great impact on reducing cholesterol and glucose level. So, this study aims to generate a proper or Structured Physical Exercise Programme (SPEP) for the glycaemic control of people with T2DM. Methods and analysis The study will be a double-blinded, multicentre, randomised controlled trial where participants with T2DM will be enrolled from three Diabetic Centres in Bangladesh. All the participants will be allocated to experimental and control groups in a 1:1 ratio. Both groups will receive 18 sessions/6 weeks of intervention with an additional 24-week follow-up. Warm-up exercises, stretching and aerobic exercise will be provided along with medication for experimental and conventional approaches will be provided in the control group. A glucometer will measure the primary outcome (capillary blood glucose level). The secondary outcomes (cardiorespiratory fitness, T2DM-related comorbidities and quality of life) will be measured by a 6-min walk-test, self-structured questionnaire and SF-36. All outcomes will be measured at baseline, post-test after 6 weeks and follow-up after 24 weeks. Trial registration number CTRI/2023/08/057032.

Objective To compare the severity of head impacts between professional and Division I (D-I) collegiate football games for the purpose of improving protective equipment. Methods A total of 243 football players from the National Football League (NFL) and from D-I of the National Collegiate Athletic Association (NCAA) were equipped with instrumented mouthpieces capable of measuring six degrees-of-freedom head kinematics. Head impacts were processed using a custom algorithm and combined with game period descriptors to produce a curated dataset for analysis. Head impact severity distributions for several kinematic-based metrics were compared within position groupings between leagues. Results A total of 11 038 head impacts greater than 10 g from 1208 player-games were collected during 286 player-seasons (2019–2022). No significant differences were found between leagues in the distributions of kinematic-based metrics for all investigated position groupings (p≥0.320). The median and IQRs for peak linear acceleration for NFL and NCAA were 17.2 (9.3) g and 17.0 (8.6) g for linemen, 20.7 (13.8) g and 20.0 (13.5) g for hybrid and 21.0 (17.0) g and 20.8 (15.5) g for speed position groupings, respectively. Conclusion The absence of statistically significant differences in the distributions of head impact severity between professional and D-I collegiate football players indicates that these data can be combined for the purpose of understanding the range of loading conditions for which new protective equipment, such as position-specific helmets, should be designed. This observation underscores the potential for knowledge transfer regarding biomechanical factors affecting head loading across professional and D-I college football, highlighting crucial implications for innovation in protective equipment.

There is very little data about the physical fitness of transgender and gender-diverse (TGD) youth. This protocol paper describes the methods for a pilot study that aims to measure changes in fitness levels in TGD adolescents undergoing gender-affirming hormone therapy (GAHT) using FitnessGram, a reliable, validated tool used to measure physical fitness. A secondary aim of the study is to compare the physical fitness of TGD adolescents with normative data for cisgender individuals. This will be a prospective cohort study. We will recruit 25 TGD participants who are 13–18 years old and patients in our organisation’s Gender Development Clinic, planning to initiate GAHT. Participants will complete FitnessGram before starting GAHT and undergo repeat assessments 6 months and 12 months after GAHT initiation. Participants will also complete the Physical Activity Questionnaire for Adolescents. We plan to report changes in the participant’s ability to achieve the FitnessGram standards over 12 months. Secondary outcomes will include a comparison of the achievement of the FitnessGram standards in the cohort with the reported achievement of standards for cisgender adolescents.

Liver transplant recipients experience comorbidities, including impaired physical fitness, which could be managed by exercise and physical activity interventions. This study aims to evaluate the feasibility, clinical effectiveness and cost-effectiveness of a 6-month exercise intervention, followed by a 15-month tailored physical activity maintenance intervention, in de novo liver transplant recipients. This single-centre, randomised, controlled, single-blinded trial will recruit 147 adult liver transplant recipients at 3–5 months post-transplant. Participants will be randomised into (1) 6 months of enhanced usual care, not followed by a physical activity intervention (control (CON) group, n=49), (2) 6 months of moderate-intensity exercise training, followed by a physical activity intervention (moderate-intensity training (MIT) group; n=49) or (3) consecutively 3 months of moderate-intensity exercise training, 3 months of high-intensity interval training and a physical activity intervention (moderate and high-intensity training (MHIT) group; n=49). Exercise training will consist of home-based stationary bicycling and muscle-strengthening exercises, partially supervised by participants’ local physiotherapists. The physical activity intervention includes an array of behaviour change techniques. Primary hypothesis: after the exercise intervention, peak oxygen uptake (V̇O 2 peak) will be higher in MHIT versus CON (α-level 0.05). Secondary hypotheses: after the exercise intervention, V̇O 2 peak will be higher in MIT versus CON and MHIT versus MIT (α-level 0.025). Secondary outcomes, assessed up to 2 years post-transplant, include physical fitness, cardiovascular and graft health, quality of life, physical activity and implementation outcomes. Trial registration number NCT06302205 .