Sport-specific training is an integral component of the return to sport (RTS) process, preparing the athlete for the demands of their sport and level of participation.1 2 The control-chaos continuum (CCC) was originally constructed as an adaptable framework for on-pitch rehabilitation in elite football but the key concepts of the CCC may also guide sport-specific rehabilitation in other sports.3 4

Objective Motherhood within sport has become more common with many female athletes seeking to return-to-sport (RTS) postpartum; yet few sport organisations possess policies that support female athletes to RTS postpartum. Our aim was to synthesise existing literature to identify the barriers and enablers that influence female athlete RTS postpartum to help guide the development of evidence-based policies

Objective Vertical jump tests are more sensitive in revealing asymmetries in performance metrics at the time of return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR) than horizontal hop tests. However, it remains unclear which vertical tests (bilateral or unilateral) and which metrics (kinetics or performance) are most effective in informing the rehabilitation status and readiness

I evaluated the importance of hip joint imaging findings in young adult football (Australian football and soccer) players with longstanding hip and/or groin pain (HGP). Participation in football is associated with increased odds of developing hip osteoarthritis (OA) in later life.1 The path towards OA may commence early in the lifespan of a football player, but studies of young adult football players

Objective To use individual patient data (IPD) to investigate if the effect of pain on sports-related disability is mediated through physical (lower extremity isometric strength) or psychological (depression/anxiety and knee confidence) factors in adolescents with non-traumatic anterior knee pain. Methods This study included four datasets from a previously harmonised IPD dataset. Prior to analysis

Objective Using a biopsychosocial framework and the three-factor fatigue model, we aimed to (1) plot recovery of fatigue over the 3 months following paediatric concussion and (2) explore factors associated with persisting fatigue during the first 3 months postconcussion. Methods 240 children and adolescents aged 5–18 years (M=11.64, SD=3.16) completed assessments from time of injury to 3 months postinjury

New and emerging technologies have re-engineered healthcare delivery for a post-COVID-19 world.1 Rapid advances in artificial intelligence (AI) and their integration into existing tech-based, healthcare delivery platforms are set to further transform our ability to digitally reach, meet and treat people for a wide range of chronic disease conditions and risk factors.2 In this editorial, we consider

Pelvic floor dysfunction (PFD) is an umbrella term including a myriad of conditions including urinary and anal incontinence, pelvic organ prolapse, pelvic pain and sexual dysfunction.1 High-impact sports have been linked with an increased risk of developing PFD. For instance, up to 76% of female volleyball players reported urinary symptoms.2 Despite the widespread occurrence and consequences of PFD

The aim of my PhD research was to better understand injury patterns in youth football (soccer) and athletics (track and field) and explore growth rates and skeletal maturity as injury risk factors. In the studies included, we examined differences between recorders within an injury surveillance programme, described the most common and burdensome injuries in youth athletes participating in football and

Objective To perform a large-scale pairwise and network meta-analysis on the effects of all relevant exercise training modes on resting blood pressure to establish optimal antihypertensive exercise prescription practices. Design Systematic review and network meta-analysis. Data sources PubMed (Medline), the Cochrane library and Web of Science were systematically searched. Eligibility criteria Randomised

In many sports, a player or coach receiving a ‘red card’ is immediately dismissed from the field of play and cannot return to the competition: an event to be avoided! Another red card to be avoided occurs across all sports and levels of participation: the Relative Energy Deficiency in Sport (REDs) card. Elite athletes often push the boundaries of activity considered to be healthy in the quest to maximise

Female participation in sport is growing, including at the elite level. The Tokyo 2020 Olympic Games saw the most gender-equal athlete pool in Summer Olympic Games history along with a female athlete-led campaign to prevent the separation of a lactating athlete from her infant.1 Despite growing numbers of females participating in exercise and sport during pregnancy, there is very little evidence to

Sports medicine and sport science research has been dominated by studies examining male athletes—with one notable exception: the field of Relative Energy Deficiency in Sports (REDs). This anomaly has occurred due to the accumulation of scientific publications studying the female athlete triad (expanded to REDs beginning in 2014), along with increased interest in the role of the menstrual cycle on training

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Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee’s expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been

The 2023 International Olympic Committee (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs) notes that exposure to low energy availability (LEA) exists on a continuum between adaptable and problematic LEA, with a range of potential effects on both health and performance. However, there is variability in the outcomes of LEA exposure between and among individuals as well as the specific

Relative Energy Deficiency in Sport (REDs) has various different risk factors, numerous signs and symptoms and is heavily influenced by one’s environment. Accordingly, there is no singular validated diagnostic test. This 2023 International Olympic Committee’s REDs Clinical Assessment Tool—V.2 (IOC REDs CAT2) implements a three-step process of: (1) initial screening; (2) severity/risk stratification

Relative Energy Deficiency in Sport (REDs) is common among female and male athletes representing various sports at different performance levels, and the underlying cause is problematic low energy availability (LEA). It is essential to prevent problematic LEA to decrease the risk of serious health and performance consequences. This narrative review addresses REDs primary, secondary and tertiary prevention

Overall athlete health is a stated priority by the International Olympic Committee (IOC), yet it can be difficult for athletes to safely balance nutritional needs, training load, recovery, social interactions, expectations and other demands. The effect of energy intake and, especially, low energy availability (LEA) on athlete mental health, is understudied. In this narrative review, we examine research

In the past decade, the study of relationships among nutrition, exercise and the effects on health and athletic performance, has substantially increased. The 2014 introduction of Relative Energy Deficiency in Sport (REDs) prompted sports scientists and clinicians to investigate these relationships in more populations and with more outcomes than had been previously pursued in mostly white, adolescent

Background The assessment of body composition (BC) in sport raises concern for athlete health, especially where an overfocus on being lighter or leaner increases the risk of Relative Energy Deficiency in Sport (REDs) and disordered eating. Methods We undertook a critical review of the effect of BC on performance (29 longitudinal, prospective or intervention studies) and explored current practice related

Objectives One in two women experiencing pelvic floor (PF) symptoms stop playing sport or exercising. The study examines the perspective of women with PF symptoms to inform acceptable screening practices within sport and exercise settings. Methods Explanatory, sequential, mixed-methods design. Phase 1: survey of 18–65 years, symptomatic, Australian women (n=4556). Phase 2: semistructured interviews

Objectives Perform a comprehensive video analysis of all anterior cruciate ligament (ACL) injuries in National Basketball Association (NBA) athletes from 2006 to 2022 to determine the associated biomechanics, injury mechanism and game situation. Methods NBA players diagnosed with an ACL tear from 2006 to 2022 were identified and videos of each injury evaluated by two reviewers. Visual evaluation included

Objective To determine whether individuals with a prior concussion exhibit biomechanical alterations in balance, gait and jump-landing tasks with and without cognitive demands that are associated with risk of lateral ankle sprain (LAS) and anterior cruciate ligament (ACL) injury. Design Systematic review and meta-analysis. Data sources Five electronic databases (Web of Science, Scopus, PubMed, SPORTDiscus

The necessity of sufficient sleep for health and sustained high performance in athletes is increasingly recognised. There are frequently scenarios where an athlete’s opportunity for sleep (eg, travelling East across several time zones, sports fixture congestion) and propensity for sleep (eg, overarousal, anxiety, insomnia, circadian rhythm shifts) may compromise sleep quality and/or quantity.1 For

Objective To investigate the effects of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis. Design Systematic review of randomised controlled trials (RCTs). Data sources AMED, MEDLINE, PEDro, Cochrane, SPORTDiscus, CINAHL, EMBASE and PsycINFO without language or date restrictions up to 3 February 2023. Eligibility criteria RCTs that evaluated the

In my doctoral thesis, we studied the effects of high-load (HL) and low-load (LL) resistance training (RT) both combined with aerobic training (AT) and compared the two training modalities with AT alone as a standard care in an exercise-based cardiac rehabilitation (CR) for patients with coronary artery disease (CAD).1 In absence of safety and efficacy evidence of HL-RT in an early phase of CR, we

Hypertension is a leading modifiable risk factor for morbidity and mortality.1 Commonly prescribed medications to treat high blood pressure carry a number of substantial limitations including adverse side effects, considerable economic costs and poor adherence rates.2 As such, research into the optimisation of non-pharmacological approaches, such as exercise training, remains imperative. The role of

Objectives To assess the associations between cardiorespiratory fitness (CRF) in young men and the incidence of site-specific cancer. Methods A Swedish population-based cohort study with register linkage of men who underwent military conscription in 1968–2005 was undertaken. CRF was assessed by maximal aerobic workload cycle test at conscription. Cox regression models assessed linear associations and

Objectives To determine whether quantifying both the absolute and relative intensity of accelerometer-assessed physical activity (PA) can inform PA interventions. We hypothesised that individuals whose free-living PA is at a low relative intensity are more likely to increase PA in response to an intervention, as they have spare physical capacity. Method We conducted a secondary data analysis of a 12-month

For many years, researchers and clinicians believed that individuals with flat feet were at high risk of sustaining a musculoskeletal injury during sports and activities of daily living. Even though this theory was postulated a long time ago, it was revived during the second half of the 20th century when Root et al 1 popularised the concept of ‘ideal feet’. According to those authors, feet that did

The recognition of myocarditis as a rare side effect of SARS-CoV-2 mRNA vaccination has sparked a global debate on vaccine safety, especially in the realm of sports. The main proposed mechanisms in the pathogenesis of COVID-19 mRNA vaccination-associated myocarditis (C-VAM) are based on the activation of the innate- and adaptive immune system against a susceptible immune-genetic background, including

Despite the established health benefits of sport participation, the associated injury risk to athletes participating in sport must also be considered. When a catastrophic injury occurs, such as the January 2023 collapse and on-field cardiac arrest of National Football League athlete Damar Hamlin, a heightened sense of awareness surrounding athlete health and safety is reinjected into discussions on

There are several benefits of physical activity (PA) in pregnancy, yet engagement levels are low. Less than 30% of pregnant women worldwide meet PA recommendations, compared with 45%–55% of non-pregnant women in developed countries.1 Benefits of PA in pregnancy include: reduced risk of hypertensive disorders and gestational diabetes and decreased gestational weight gain.1 2 Furthermore, PA can be used

Stepping—encompassing walking, running and stair-climbing—is the fundamental mode of human movement. Higher stepping volume and intensity is associated with favourable health outcomes.1 2 Over the last quarter of the century, stepping has declined by over 1000 steps per day (7%–13% of total count,3 roughly equivalent to ~10 min of brisk walking). As a simple ‘objective’ measure of ambulatory physical

Hundreds of millions of people own wearable devices capable of tracking their movement patterns.1 Accelerometers are also increasingly the preferred tool to measure physical activity in research studies.2 However, national and international physical activity guidelines, which recommend adults undertake at least 150–300 min of moderate intensity physical activity (MPA) or 75–150 min of vigorous intensity

Low physical activity increases the risk of cardiovascular disease (CVD).1 2 Conversely, once CVD develops, it can reduce the ability to be active. This suggests measurement of physical activity using wearables or smartphones may provide clinically useful ‘digital biomarkers’ for prediction, diagnosis and treatment selection in CVD. For any biomarker to be used in healthcare, its measurement must influence

I investigated the relationship between psychological health before total knee arthroplasty (TKA) and health service outcomes after TKA. I developed a psychologically informed physiotherapy intervention for patients before TKA, and pilot tested this intervention, evaluating patient outcomes, health service outcomes and implementation outcomes. I developed and tested a training intervention to upskill

The aims of the PhD were: to understand the training load demands experienced by professional ballet dancers; to explore the relationship between training load and musculoskeletal injury in professional ballet and to develop and validate measures of internal and external training load, providing ballet companies with practical tools and recommendations for training load management. Ballet dancers incur

Objective To identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults. Design Systematic review and Bayesian model-based network meta-analysis. Data sources Four databases were searched from inception to 20 June 2022. Eligibility criteria for selecting studies Randomised controlled trials that assessed the

We live in a new era of information, where the number of academic publications has reached exponential growth without precedent. This may be beneficial to all of us, but excess information without a clear synthesis can lead to uncertain conclusions that hinder clinical, research and policy progress. In BJSM alone, more than 400 systematic reviews (SRs) have been published in the past decade. In this

> …the injury incidence among runners varies between 11–85% or 2.5 to 38 injuries per 1000 hours of running.1 As the Danish proverb goes: ‘ It’s difficult to make predictions, especially about the future.’ To the average clinician, it certainly might seem that way when it comes to predicting which runners will get injured. The range of injury incidence cited above—or a slight variation—is a common

Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioural condition presumed to be more prevalent among athletes.1 The American Medical Society for Sports Medicine created a writing group in 2022 with the goal of publishing a position statement describing the unique challenges of diagnosing and managing athletes with ADHD.2 The position statement guides sports and exercise medicine

Psychological safety is a buzzword that has garnered a lot of traction in recent years, especially in high-performance sports. It is defined as ‘a climate in which people are comfortable expressing and being themselves’.1–3 Psychological safety as a conceptual term was popularised by Edgar Schneider and Warren Bennis in 1965 and resurrected in 1990 by William Khan. They believed organisations needed

Objectives Restrictive spirometry pattern (RSP) suggests an impairment of lung function associated with a significantly increased risk of premature mortality. We evaluated the independent and joint associations of cardiorespiratory fitness (CRF) and body mass index with incident RSP. Methods Data from the Aerobics Centre Longitudinal Study included 12 360 participants (18–82 years). CRF was assessed

Objective To (1) develop and evaluate a machine learning model incorporating gait and physical activity to predict medial tibiofemoral cartilage worsening over 2 years in individuals without advanced knee osteoarthritis and (2) identify influential predictors in the model and quantify their effect on cartilage worsening. Design An ensemble machine learning model was developed to predict worsened cartilage

Objective Although hip arthroscopy is a widely adopted treatment option for hip-related pain, it is unknown whether preoperative clinical information can be used to assist surgical decision-making to avoid offering surgery to patients with limited potential for a successful outcome. We aimed to develop and validate clinical prediction models to identify patients more likely to have an unsuccessful

Objective To determine and compare the dose–response effects of exercise and caloric restriction on visceral adipose tissue in overweight and obese adults, while controlling for the weekly energy deficit induced by the interventions. Methods PubMed, Embase, CINAHL and Web of Science were searched for randomised controlled trials comparing exercise or caloric restriction against eucaloric controls in

Despite the high prevalence of tendon pathology in athletes, the underlying pathogenesis is still poorly understood. Various aetiological theories have been presented and rejected in the past, but the tendon cell response model still holds true. This model describes how the tendon cell is the key regulator of the extracellular matrix and how pathology is induced by a failed adaptation to a disturbance

Objective To estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias. Design Systematic review and meta-analysis with meta-regression. Data sources The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and

I aimed to develop an objective and reliable measurement tool to quantify subanaesthetic levels of gas narcosis in scuba divers. I investigated pupillometry, critical flicker fusion frequency and novel quantitative electroencephalogram (EEG) algorithms. Divers venturing underwater, either for work or pleasure, may experience narcotic effects caused by their breathing gases. The onset of narcosis symptoms

The main aim of my PhD thesis was to describe the extent of the injury and illness problem in competitive adolescent (13–18 years old) distance runners (800 m up to 10 000 m, including the steeplechase). My thesis also: (1) examined the validity of session rating of perceived exertion (sRPE), to quantify internal training load, and (2) explored psychosocial responses to running-related injury (RRI)

Objective The Sport Mental Health Assessment Tool 1 (SMHAT-1) was introduced as a critical component to the athlete health evaluation. However, the effectiveness of the initial triage step questionnaire (Athlete Psychological Strain Questionnaire (APSQ)) has yet to be analysed within a National Olympic and Paralympic Committee delegation. This study evaluated the ability of the APSQ to identify athletes

In 2019, the International Olympic Committee (IOC) published a consensus statement outlining the principles for recording and reporting injury and illness in elite sport. The authors encouraged sport federations to adapt the framework to their sport-specific context. Since this publication, several sports have published extensions to the IOC consensus statement. In response to a paucity of epidemiological

Nau mai haere mai to the Australasian College of Sport and Exercise Physicians (ACSEP) edition of the British Journal of Sports Medicine (BJSM). A recent highlight for the ACSEP has been our annual scientific meeting which took place in Adelaide, Australia. The main theme was the ‘changing climate’ of sport and exercise medicine (SEM). During the meeting, there were multiple sessions that reflected

Ageing is a universal phenomenon that affects all humans. It is an inevitable process usually characterised by a gradual decline in physical and cognitive function over time.1 Recent research in the field of geroscience has focused on exploring the potential for antiageing interventions. Researchers have identified 12 distinct ageing traits, referred to as ‘hallmarks’, which are interconnected and

Alpine skiing ranks among the most popular winter sports worldwide, with an estimated 400 million skier days in a typical year. Alpine skiing is performed in greater than 2000 downhill ski areas spread across 67 countries1 and is associated with about 800 000 injuries per year (2 injuries per 1000 skier days).2 The knee joint is the most frequently affected anatomical location of all ski injuries (approximately

It is widely understood that race is a social and not biological construct,1 and racial disparities significantly impact cardiovascular health outcomes. Understanding the effects of social determinants of health, racial essentialism and discrimination on cardiovascular outcomes is crucial to improve health equity and requires a critical examination of race-based clinical practices. The nascent field

Objective We assessed whether late versus early initiation of physical therapy (PT) was related to greater risk of future opioid use in people with knee osteoarthritis (OA) who receive PT. Methods We used Commercial and Medicare Advantage claims data from 1999 to 2018 from American adults with incident knee OA referred for PT within 1 year of diagnosis. We categorised people as opioid naïve or opioid

Objective We determined if postoperative physical activity prevents or delays cancer recurrence in patients with stage III colon cancer. Methods This cohort study nested within a randomised trial enrolled 1696 patients with surgically resected stage III colon cancer. Physical activity was calculated based on self-reporting during and after chemotherapy. Patients were classified as physically active