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1.
  • Ageberg, Eva, et al. (författare)
  • Cocreating injury prevention training for youth team handball : bridging theory and practice
  • 2022
  • Ingår i: BMJ Open Sport and Exercise Medicine. - London : BMJ Publishing Group Ltd. - 2055-7647. ; 8:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The € Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)' uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants' contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice. © 2022 BMJ Publishing Group. All rights reserved. © 2022 BMJ Publishing Group. All rights reserved.
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2.
  • Alerskans, Sofie, et al. (författare)
  • Patient's subjective knee function 3-5 years following partial meniscectomy or meniscus repair compared to a normal population : A retrospective cohort study
  • 2022
  • Ingår i: BMJ Open Sport and Exercise Medicine. - : BMJ. - 2055-7647. ; 8:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose Evaluate patient-reported knee function after arthroscopic partial meniscectomy (APM) and meniscus suture repair in two different age cohorts compared with a normal population. Method Arthroscopic meniscus surgery was performed on 421 patients at Skåne University Hospital from 2010 to 2014, with a mean (SD) follow-up of 4.2 (1.4) years. Patients and controls were divided into two age cohorts; 18-34 years (younger) and 35-54 years (middle-aged) as well as according to surgery performed; either solely meniscus surgery or with concurrent anterior cruciate ligament reconstruction (ACLR). The outcome is measured with the five subscales of the Knee and Osteoarthritis Outcome Score (KOOS). Results No significant difference in outcome after all studied types of meniscus surgeries between younger-aged and middle-aged patients. Younger patients with APM or meniscus suture repair, with or without, ACLR score lower than the normal population in all subscales of KOOS (p<0.001), except in Activities of Daily Living (ADL) for meniscus suture patients. Middle-aged patients with APM score lower in all subscales than the normal population (p≤0.009). Those with meniscus suture repair score lower than the normal population only for the subscales Sport/Rec and quality of life (p<0.001). Both younger-aged and middle-aged patients achieve better KOOS values after meniscus suture repair and ACLR than after all other combinations of surgery. Conclusion Patients with meniscus injuries do not reach the same KOOS score as the normal population, irrespective of age or type of meniscus surgery performed. However, combined with ACLR in younger-aged and middle-aged patients, meniscus suture gives a better subjective outcome than isolated meniscus surgery.
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3.
  • Alfredson, Håkan, et al. (författare)
  • Surgical plantaris tendon removal for patients with plantaris tendon-related pain only and a normal Achilles tendon : a case series
  • 2018
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 4:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Surgical removal of the plantaris tendon can cure plantaris-associated Achilles tendinopathy, a condition in which Achilles and plantaris tendinopathy coexist. However, rare cases with plantaris tendinopathy alone are often misdiagnosed due to a normal Achilles tendon.Design and setting: Prospective case series study at one centre.Participants: Ten consecutive patients (9 men and one woman, mean age 35 years, range 19–67) with plantaris tendon-related pain alone in altogether 13 tendons were included. All had had a long duration (median 10 months, range 3 months to 10 years) of pain symptoms on the medial side of the Achilles tendon mid-portion. Preoperative ultrasound showed thickened plantaris tendon but a normal Achilles tendon.Interventions: Operative treatment consisting of ultrasound-guided excision of the plantaris tendon.Primary and secondary outcome measures: Scores from Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A)were taken preoperatively and postoperatively (median duration 10 months). Patient satisfaction and time until full return to sports activity level was asked by a questionnaire.Results: The VISA-A scores increased from 61 (range 45–81) preoperatively to 97 (range 94–100) postoperatively (p<0.01). Follow-up results at 10 months (range 7–72 months) on 9/10 patients showed full satisfaction and return to their preinjury sports or recreational activityConclusion: The plantaris tendon should be kept in mind when evaluating painful conditions in the Achilles tendon region, especially when no Achilles tendinopathy is present. Excision of the plantaris tendon via a minor surgical procedure in local anaesthesia results in a good outcome.
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4.
  • Alfredson, Håkan, et al. (författare)
  • Surgical treatment of insertional Achilles tendinopathy : results after removal of the subcutaneous bursa alone-a case series
  • 2020
  • Ingår i: BMJ OPEN SPORT & EXERCISE MEDICINE. - : BMJ PUBLISHING GROUP. - 2398-9459 .- 2055-7647. ; 6:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Insertional Achilles tendinopathy is well known to be difficult to treat, especially when there is intra-tendinous bone pathology. This study is a case series on patients with chronic insertional Achilles tendon pain and major intra-tendinous bony pathology together with bursa and tendon pathology, treated with excision of the subcutaneous bursa alone. Methods Eleven patients (eight men and three women) with a mean age of 44 years (range 24-62) and a chronic (>6 months) painful condition from altogether 15 Achilles tendon insertions were included. In all patients, ultrasound examination showed intra-tendinous bone pathology together with pathology in the tendon and subcutaneous bursa, and all were surgically treated with an open excision of the whole subcutaneous bursa alone. This was followed by full weight-bearing walking in a shoe with open heel for 6 weeks. Results At follow-up 21 (median, range 12-108) months after surgery, 9/11 patients (12/15 tendons) were satisfied with the result of the operation and 10/11 (13/15 tendons) were back in their previous sport and recreational activities. The median VISA-A score had improved from 41 (range 0-52) to 91 (range 33-100) (p<0.01). Conclusion In patients with chronic painful insertional Achilles tendinopathy with intra-tendinous bone pathology, tendon and bursa pathology, open removal of the subcutaneous bursa alone can relieve the pain and allow for Achilles tendon loading activities. The results in this case series highlight the need for more studies on the pain mechanisms in insertional Achilles tendinopathy and the need for randomised studies to strengthen the conclusions.
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5.
  • Alfredson, Håkan, et al. (författare)
  • Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: A case series
  • 2021
  • Ingår i: BMJ Open Sport and Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 7:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Chronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.Methods: Ninety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24-64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.Results: In 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.Conclusion: Plantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.Level of evidence: IV case series.
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6.
  • Alim, Md Abdul, et al. (författare)
  • Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture.
  • 2016
  • Ingår i: BMJ open sport & exercise medicine. - London, UK : BMJ. - 2055-7647. ; 2:1
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Patients who sustain acute Achilles tendon rupture (ATR) exhibit variable and mostly impaired long-term functional, and patient-reported outcomes. However, there exists a lack of early predictive markers of long-term outcomes to facilitate the development of improved treatment methods. The aim of this study was to assess markers of tendon callus production in patients with ATR in terms of outcome, pain, and fatigue.STUDY DESIGN AND SETTING: Prospective cohort study; level of evidence 2. Outpatient orthopaedic/sports medicine department.PATIENTS: A total of 65 patients (57 men, 8 women; mean age 41±7 years) with ATR were prospectively assessed.ASSESSMENTS: Markers of tendon callus production, procollagen type I N-terminal propeptide (PINP) and procollagen type III N-terminal propeptide (PIIINP), were assessed 2 weeks postoperatively using microdialysis followed by enzymatic quantification. Normalised procollagen levels (n-PINP and n-PIIINP) were calculated as the ratio of procollagen to total protein content. Pain and fatigue were assessed at 1 year using reliable questionnaires Achilles tendon Total Rupture Score (ATRS).RESULTS: Patients exhibited fatigue (77.6%) and pain (44.1%) to some extent. Higher levels of n-PINP (R=0.38, p=0.016) and n-PIIINP (R=0.33, p=0.046) were significantly associated with less pain in the limb. Increased concentrations of PINP (R=-0.47, p=0.002) and PIIINP (R=-0.37, p=0.024) were related to more self-reported fatigue in the leg. The results were corroborated by multiple linear regression analyses.CONCLUSIONS: Assessment of procollagen markers in early tendon healing can predict long-term patient-reported outcomes after ATR. These novel findings suggest that procollagen markers could be used to facilitate the development of improved treatment methods in patients who sustain ATR.TRIAL REGISTRATION NUMBERS: NCT01317160: Results. NCT02318472: Pre-results.
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8.
  • Arvidsson, Elin, et al. (författare)
  • Exercise training and physiological responses to acute stress: study protocol and methodological considerations of a randomised controlled trial
  • 2018
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ. - 2055-7647. ; 4:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: This paper describes the protocol and methodological prerequisites for a randomised controlled exercise intervention. Selected baseline data from the study are also presented, demonstrating some methodological challenges related to exercise intervention trials. The aim of the trial was to study the effects of exercise training on physiological responses to acute psychosocial stress in untrained individuals. Methods: Individuals with a low level of physical activity were invited to participate in an exercise intervention lasting for 6 months. A total of 119 participants were included and went through a peak oxygen uptake test and a psychosocial stress test at baseline. Adrenocorticotropic hormone (ACTH) and cortisol were measured in connection to the stress test to identify the physiological response. Results: Almost 90% of the participants reported themselves as untrained, but results from the objectively measured oxygen uptake did not seem to correspond to the reported sedentary lifestyle. The primary outcome measures at baseline varied between individuals. The mean change from pre-test to peak value was 214% for ACTH and 94% for cortisol. Of these, 13 individuals did not respond in ACTH and/or and cortisol. Discussion: Supposedly untrained individuals seeking participation in an exercise intervention might not be as untrained as they report, a methodological consideration of importance when evaluating the effects of training. Another important consideration is related to the primary outcome measure, which should be measurable and possible to affect. Absence of reaction at baseline means that changes can only be detected as an increased reaction.
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9.
  • Beischer, Susanne, et al. (författare)
  • Knee strength, hop performance and self-efficacy at 4 months are associated with symmetrical knee muscle function in young athletes 1 year after an anterior cruciate ligament reconstruction.
  • 2019
  • Ingår i: BMJ open sport & exercise medicine. - : BMJ. - 2055-7647. ; 5:1
  • Tidskriftsartikel (refereegranskat)abstract
    • We investigated whether patient demographics, 4-month patient-reported outcomes (PRO) and muscle function predicted young athletes regaining symmetrical muscle function in five tests of muscle function 1year after ACL reconstruction.We extracted data on patient demographics, PROs and the results of five tests of muscle function from a rehabilitation-specific register. Athletes were 15-30 years of age, involved in knee-strenuous sport and had undergone a primary ACL reconstruction. The primary outcome was achieving a Limb Symmetry Index of ≥90% for the battery of tests 1year after ACL reconstruction. Patient demographics, muscle-function data and results for PROs at the 4-month follow-up were analysed.In all, 237 athletes (59% female; mean age 22±4 years) were included in the study. One year after ACL reconstruction, 26% (62/237) of the included athletes had achieved symmetrical muscle function. Univariable analysis showed that symmetrical muscle function was associated with present self-efficacy, OR 1.28 (95%CI 1.04 to 1.58, p=0.011), knee-extension strength, OR 1.73 (95% CI 1.28 to 2.34), knee-flexion strength, OR 1.39 (95% CI 1.07 to 1.81), vertical hop, OR 1.77 (95% CI 1.27 to 2.45), single-leg hop for distance, OR 1.98 (95% CI 1.24 to 3.17) and side hop, OR 1.64 (95% CI 1.15 to 2.33).Symmetrical knee-extension and knee-flexion strength, a more symmetrical hop performance and higher present self-efficacy at an early stage all increased the odds of achieving symmetrical muscle function in young athletes 1year after ACL reconstruction.
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10.
  • Bengtsson, Håkan, et al. (författare)
  • Injury epidemiology in professional football in South America compared with Europe
  • 2021
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 7:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To describe the injury epidemiology in professional football in South America and compare it with European professional football. Methods Data about football exposures and injury occurrences were registered in Six teams participating in Copa Libertadores in 2016. These teams exposure and injury data were compared with teams participating in the UEFA Elite Club Injury Study during the 2015/2016 and 2016/2017 seasons. Results A total of 271 injuries were reported in the South American cohort representing a training injury incidence of 3.2 (95% CI=2.7 to 3.7) injuries/1000 hours of training exposure and 20.9 (95% CI=17.3 to 25.1) injuries/1000 hours of match exposure. While no differences in muscle injury incidence were observed between South American and European teams, the ligament injury incidence in training among South American teams was significantly higher than European teams (0.6 vs 0.3, RR 1.87, 95% CI 1.21 to 2.87). In addition, a significantly higher proportion of all reported injuries among South American teams than European teams occurred in training. Conclusions A larger proportion of injuries occur in training in South American compared with European professional football. Specifically, ligament injuries in training were more frequent among South American teams.
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11.
  • Bengtsson, Victor, et al. (författare)
  • Narrative review of injuries in powerlifting with special reference to their association to the squat, bench press and deadlift
  • 2018
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 4
  • Tidskriftsartikel (refereegranskat)abstract
    • Pain and injuries are considered a common problem among elite athletes and recreational lifters performing the squat, bench press and deadlift. Since all three lifts engage multiple joints and expose the lifters' bodies to high physical demands often several times a week, it has been suggested that their injuries might be related to the excessively heavy loads, the large range of motion during the exercises, insufficient resting times between training sessions and/or faulty lifting technique. However, no previous article has summarised what is known about specific injuries and the injury aetiology associated with the three lifts. Thus, the aim of this narrative review was to summarise what is known about the relationships between the powerlifting exercises and the specific injuries or movement impairments that are common among lifters and recreationally active individuals.
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12.
  • Bessa, Agustina, et al. (författare)
  • Is there a role for physical activity interventions in the treatment pathway of bladder cancer? A scoping review of the literature
  • 2021
  • Ingår i: BMJ Open Sport &amp; Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647 .- 2398-9459. ; 7:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Physical activity (PA) interventions have been introduced in patients with cancer as they may contribute to better treatment outcomes and quality of life (QoL). However, little is known about the impact of PA on patients with bladder cancer (BC). This scoping review aimed to explore efficacy and feasibility of existing PA interventions in the BC care pathway.Methods and analysis: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines and the Levac methodology framework were used; electronic databases were searched. Two independent reviewers screened all titles, abstracts and full-text publications for inclusion. The feasibility of integrating a PA intervention in the BC treatment pathway was discussed in a consultation phase with healthcare professionals and patient and public representatives.Results: A total of 675 records were identified through database searching of which 14 studies were included in our scoping review. An additional 17 clinical trials were identified of which 12 were included for which no results have been published yet. The included studies looked at the feasibility of a PA intervention programme, the associations between PA, obesity and BC, but also the determinants of PA engagement for BC patients and the assessment of QoL.Conclusion: This scoping review highlights that despite the general recognition on the role of PA in the BC treatment pathway, there is a gap regarding the understanding of the impact of PA interventions in BC care pathways as well as the limited understanding of factors underlying possible benefits of PA. No clear conclusions could be made regarding structure and processes of PA interventions that may lead to better outcomes. Further PA studies for patients with BC are needed to understand how to incorporate exercise guidelines recommendations. 
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13.
  • Bolin, Kristian (författare)
  • Physical inactivity: Productivity losses and healthcare costs 2002 and 2016 in Sweden
  • 2018
  • Ingår i: BMJ Open Sport and Exercise Medicine. - : BMJ. - 2055-7647. ; 4:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To estimate the costs associated with physical inactivity in Sweden for the year 2016. Methods: The costs associated with insufficient physical activity was calculated employing population attributable fractions (PAFs) and register information on healthcare utilisation, mortality and disability pensions. The PAFs were calculated using information on exercise habits and morbidity-specific relative risks. The healthcare cost components were calculated based on registry data on inpatient-care, outpatient-care and primary care utilisation. Registry data on cause-specific mortality and granted disability pensions were used to calculate the productivity loss components. Costs associated with pharmaceutical utilisation were not included due lack of data. Results: Physical exercise habits improved somewhat between 2002 and 2016. Thus, the associated morbidityspecific PAFs decreased over the same time period. Conclusions: The economic costs attributable to insufficient physical activity decrease between the year 2002 and 2016. Healthcare costs attributable to insufficient physical activity as share of total healthcare expenses increased from 0.86 % in 2002 to 0.91 % in 2016.
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14.
  • Burman, Erik, et al. (författare)
  • Concussed athletes are more prone to injury both before and after their index concussion : A data base analysis of 699 concussed contact sports athletes
  • 2016
  • Ingår i: BMJ Open Sport and Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 2:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Ice hockey and football players suffering concussions might have an increased risk for injuries afterwards. We aimed to investigate if concussions predisposed athletes for subsequent sport injuries.Methods: Patient data were obtained from a data base established at the University Hospital in Umea, Sweden. Athletes who had suffered a concussion were included if they had been aged between 15 and 35 years of age, and played ice hockey, football (soccer), floorball and handball. They were studied in terms of all new or previous injuries during 24 months before and after their concussion. Results were compared with a control group of athletes from the same four sports with an ankle injury.Results: Athletes with a concussion were more likely to sustain injuries compared with the control group, both before (OR 1.98. 95% CI 1.45 to 2.72) and after the concussion (OR 1.72. 95% CI 1.26 to 2.37). No increase in frequency of injury was found after a concussion compared with before. This was true for athletes in all four sports and for both sexes.Conclusions: This study indicates that athletes sustaining a concussion may have a more aggressive or risk-taking style of play than their counterparts. Our data do not suggest that a concussion injury, per se, leads to subsequent injuries.
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16.
  • Cederström, Niklas, et al. (författare)
  • Lived experiences of patients undergoing treatment for traumatic knee injury using integrated psychological training (MOTIFS) in the context of care-as-usual training : a phenomenological interview study
  • 2022
  • Ingår i: BMJ Open Sport and Exercise Medicine. - : BMJ. - 2055-7647. ; 8:4
  • Tidskriftsartikel (refereegranskat)abstract
    • The objective was to increase understanding of how knee-injured people make sense of using the Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) training intervention. This model integrates structured psychological skills training into existing care-as-usual (CaU) rehabilitation protocols. To better understand patients' lived experiences of MOTIFS, it was necessary to understand those of CaU training. Interviews were conducted with five people undergoing knee-injury rehabilitation according to the MOTIFS model, as well as seven receiving treatment according to CaU. Interpretive phenomenological analysis was used to explore patients' lived experiences. Results indicate that patients in the MOTIFS group perceive individualised meaning and sport relevance in their rehabilitation training. Imagery is perceived to be a concrete strategy that can be difficult, but encourages a biopsychosocial interaction to improve confidence, motivation, enjoyment and sport-relevant context, thereby aiding in physically and psychologically preparing patients for return to activity. CaU training is discussed in terms of physical factors, though patients identify psychological factors as important, perceiving a lack of focus on this, resulting in inadequate psychological readiness to return to activity. In conclusion, the MOTIFS model is perceived as focusing more on psychological factors in rehabilitation, helping to develop coping strategies and physically and psychologically prepare for return to activity. Patients in the CaU group perceive rehabilitation training as restoring strength and function, but lack structured psychological strategies to aid in return to activity preparation.
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18.
  • Cumming, Jennifer, et al. (författare)
  • High time to enhance dancer welfare : a call to action to improve safeguarding and abuse prevention in dance.
  • 2024
  • Ingår i: BMJ open sport & exercise medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 10:2
  • Tidskriftsartikel (refereegranskat)abstract
    • While there is a lack of research into abuse in elite dance, numerous allegations of emotional, sexual and physical abuse of dancers can be found anecdotally in the media, legal convictions and personal accounts. As more dancers speak out, the scale of the problem within preprofessional schools and professional companies is becoming apparent. Accordingly, effective safeguarding mechanisms for preventing, identifying and reporting abuse are urgently needed. This viewpoint is intended to raise health professionals' awareness of factors contributing to abusive practices found in dance environments and the potential clinical implications of abuse to dancers' health and well-being. We also call for research and policy engagement on safeguarding and abuse prevention designed and implemented in partnership with stakeholders, aiming to promote safe and positive dance environments for all.
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19.
  • Danielsson, Tom, 1969-, et al. (författare)
  • Two-peaked increase of serum myosin heavy chain-α after triathlon suggests heart muscle cell death
  • 2019
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647 .- 2055-7647. ; 5
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective It has been suggested that the mechanism behind cardiac troponin elevation after strenuous exercise is passage through a cell membrane with changed permeability rather than myocardial cell death. We hypothesised that an increase of cardiac specific myosin heavy chain-alpha (MHC-α; 224 kDa compared with cardiac troponin T’s (cTnT) 37 kDa) could hardly be explained by passage through a cell membrane.Methods Blood samples were collected from 56 athletes (15 female, age 42.5±9.7, range 24–70 years) before, directly after and on days 1–8 after an Ironman. Biomarkers (C reactive protein (CRP), cTnT, creatinekinase (CK), MHC-α, myoglobin (MG), creatinine (C) and N-terminal prohormone of brain natriuretic peptide (NTproBNP) were measured.Results The course of MHC-α concentration (μg/L) was 1.33±0.53 (before), 2.57±0.78 (directly after), 1.51±0.53 (day 1), 2.74±0.55 (day 4) and 1.83±0.76 (day 6). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ±80 ng/L (12–440; reference<15), NT-proBNP 776±684 ng/L (92–4700; ref.<300), CK 68±55 μkat/L (5–280; ref.<1.9), MG 2088±2350 μg/L (130–17 000; ref.<72) and creatinine 100±20 μmol/L (74–161; ref.<100), CRP 49±23 mg/L(15–119; ref.<5).Conclusion MHC-α exhibited a two-peaked increase which could represent a first release from the cytosolic pool and later from cell necrosis. This is the first investigation of MHC-α plasma concentration afterexercise.
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20.
  • Ekenros, L., et al. (författare)
  • Does injury risk increase when youth athletes start to study at a sports high school?
  • 2023
  • Ingår i: BMJ Open Sport and Exercise Medicine. - : BMJ Publishing Group. - 2055-7647. ; 9:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background/aim The injury risk is high in adolescent elite athletes. However, little is known about how the injury risk changes when young talented athletes start studying at a sports high school. The primary aim was therefore to explore the risk of injury when the athlete starts to study at a sports high school. A secondary aim was to identify risk factors for injury. Methods A total of 489 athletes (age 15–16 years) were followed for 20 weeks, including 10 weeks before and 10 weeks after the athlete had started to study at a sports high school. Substantial injury was monitored in adolescent elite athletes using the Oslo Sports Trauma Research Centre Questionnaire. Results The results showed that the mean difference (md) in injury prevalence was significantly (p=0.001) higher across the 10 weeks after school had started (md 3.6; 95% CI 1.5 to 5.8), compared with the 10 weeks before. Female athletes had significantly (p<0.001) higher injury prevalence (md 6.4%; 95% CI 3.0 to 9.8) across the 10 weeks after school had started, whereas male athletes (md 0.9%; 95% CI -1.8 to 3.6) had not (p=0.530). Three significant (p<0.05) risk factors were identified; previous injury within the past 12 months (OR 3.23), higher training volume (OR 0.97) and lower well-being (OR 0.71). Conclusions Our results provide supporting evidence for increased injury risk in female adolescent elite athletes after the athletes had started to study at a sports high school.
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21.
  • Ekenros, L., et al. (författare)
  • Experiences of rehabilitation in young elite athletes : an interview study
  • 2023
  • Ingår i: BMJ Open Sport and Exercise Medicine. - : BMJ Publishing Group. - 2055-7647. ; 9:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Even though injuries are common in elite youth sports, rehabilitation experiences are limited explored in young athletes. This study explored rehabilitation experiences in athletes with a previous injury studying at sports high schools. Twenty-six (14/12 females/males) young elite athletes (age 15–19 years) from 11 individual/team sports were interviewed in focus groups about the rehabilitation experiences following a sports injury. Data were analysed using content analysis. The results led to four main categories identified: ‘High-quality rehabilitation’, ‘Lack of communication between healthcare and coach’, ‘Various consequences of injury’ and ‘No clear path to accessing rehabilitation’. The athletes valued that the healthcare providers had high expertise, were clear and signalled secureness and confidence. It was also important to receive help with rehabilitation as rapidly as possible. The athletes perceived that they felt responsible for providing information regarding rehabilitation progression between healthcare providers and their coach. It was also challenging not to be able to participate in training and competition while injured — causing a sense of frustration and fear of falling behind their peer athletes in terms of development and performance. The athletes described that no well-defined medical teams at the sports high schools were available— instead medical help was offered in several other ways. Based on our findings, the collaboration and communication between the healthcare providers and coaches need to be improved, addressing the rehabilitation content, progress and access to rehabilitation. Through these actions, the rehabilitation process will be more adjusted to the needs of young elite athletes.
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22.
  • Ekstrand, Jan, et al. (författare)
  • Changes in head staff members in male elite-level football teams are associated with increased hamstring injury burden for that season: the UEFA Elite Club Injury Study
  • 2023
  • Ingår i: BMJ OPEN SPORT & EXERCISE MEDICINE. - : BMJ PUBLISHING GROUP. - 2055-7647. ; 9:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To evaluate whether a change of head coach or other head staff before or during a season is correlated to hamstring injury (HI) burden in male elite-level football (soccer) in Europe.Methods The survey was conducted using a questionnaire reporting any staff change within the team. Data about the head staff changes and hamstring injury burdens were collected from 14 teams participating in the Elite Club Injury Study (ECIS) during the 2019/2020, 2020/2021 and 2021/2022 seasons.Results On average, replacing the head coach before or during a season happens in every second season. All changes, except for the change of the head coach during a season, indicate an association with an increase in HI burden (ranging from 10% to 81%). However, only changes in the fitness coach and team doctor roles reached statistical significance. The HI burden seems to be influenced by adding new staff members, such as the head of fitness/performance coach in 36% of the teams and the team doctor in 17%. New head coaches starting the season with their own, for the team new, fitness/performance coach was highly associated with increased HI burden (p<0.001).Conclusions Bringing their own fitness/performance coaches is common for managers entering a new elite male football club. However, this paper has highlighted that this trend seems to lead to a three times increase in HI burden. Similarly, replacing the team doctor was also associated with increased HI burden. Instability among head staff members in male elite-level football teams seems associated with increased HI burden during the season.
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23.
  • Ekstrand, Jan, et al. (författare)
  • Low adoption in womens professional football: teams that used the Nordic Hamstring Exercise in the team training had fewer match hamstring injuries
  • 2023
  • Ingår i: BMJ OPEN SPORT & EXERCISE MEDICINE. - : BMJ PUBLISHING GROUP. - 2055-7647. ; 9:2
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesThe primary objective was to study the reach, effectiveness, adoption, implementation and maintenance of the Nordic Hamstring Exercise (NHE) programme in womens elite teams in Europe in the 2020-21 season. The secondary objective was to compare hamstring injury rates between teams that used the NHE programme regularly in team training and teams that did not.MethodsEleven teams participating in the Womens Elite Club Injury Study during the 2020-21 season provided data about injury rates and the implementation of the NHE programme.ResultsOne team (9%) used the full original NHE programme, and four teams used the programme in the team training during parts of the season (team training group, n=5). Five teams did not use the NHE, or used it only sporadically for individual players, and one team used NHE only for players with a previous or current hamstring injury (no team training group, n=6). The team training group had a lower incidence of hamstring injuries during match-play (1.4 vs 4.0, p=0.028) than the non-team training group while no difference between groups was shown for the hamstring injury incidence in training (0.6 vs 0.7, p=0.502).ConclusionA low adoption of the NHE programme was reported during the 2020-21 season. However, teams that used NHE for the whole team or most players had a lower hamstring injury incidence at match-play than teams that did not use the NHE or used it for individual players only.
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24.
  • Ekstrand, Jan, et al. (författare)
  • Risk factors for hamstring muscle injury in male elite football: medical expert experience and conclusions from 15 European Champions League clubs
  • 2023
  • Ingår i: BMJ OPEN SPORT & EXERCISE MEDICINE. - : BMJ PUBLISHING GROUP. - 2055-7647. ; 9:1
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesTo describe the perceived importance of suggested hamstring injury risk factors according to chief medical officers (CMOs) of European male professional football clubs. A secondary objective was to compare if these perceptions differed between teams with a lower-than-average hamstring injury burden and teams with a higher than average hamstring injury burden.MethodsFirst, CMOs of 15 European professional male football clubs were asked to suggest risk factors for hamstring injury in their club. The perceived importance of the suggested risk factors was then rated by all participants on a 5-graded Likert scale. Participating teams were divided in two groups depending on their hamstring injury burden during the 2019/2020 and 2020/2021 seasons. The LOW group consisted of seven teams that had a lower than average hamstring injury burden. The HIGH group consisted of eight teams that had a higher-than-average hamstring injury burden.ResultsTwenty-one risk factors were suggested. The majority were extrinsic in nature, associated with coaching staff, team or club rather than players themselves. Lack of communication between medical staff and coaching staff had the highest average importance (weighted average=3.7) followed by Lack of regular exposure to high-speed football during training sessions (weighted average=3.6). The HIGH group perceived the player factors fatigue and wellness as more important than the LOW group.ConclusionAccording to CMOs recruited in this study, most risk factors for hamstring injuries are extrinsic and associated with the club and coaching staff, and not the players themselves.
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25.
  • Ekstrand, Jan, et al. (författare)
  • Still poorly adopted in male professional football : but teams that used the Nordic Hamstring Exercise in team training had fewer hamstring injuries - a retrospective survey of 17 teams of the UEFA Elite Club Injury Study during the 2020-2021 season
  • 2022
  • Ingår i: BMJ Open Sports & Exercise Medicine. - : BMJ Publishing Group. - 2398-9459 .- 2055-7647. ; 8:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives The primary objective was to study the adoption of the NHE programme in European football teams in the 2020/21 season and to compare it to the previous study. A second objective was to compare hamstring injury rates between teams that used the NHE programme in the team training and teams that used the NHE only for players with previous or current hamstring injuries. Methods Data about the implementation of the NHE programme and injury rates were included for 17 teams participating in the Elite Club Injury Study during the 2020/2021 season. Results One team (6%) used the full original NHE programme, and another four teams used it for all or most players in the team (team training group, n=5). Eleven teams used NHE only for players with a previous or current hamstring injury (individual training group), and one team did not use NHE. The team training group had fewer hamstring injuries (5 vs 11 per team, p=0.008) and a lower injury burden (12 vs 35 lay-off days per 1000 hours, p=0.003) than the individual training group. Conclusion Similar to previous reports, low adoption of the NHE programme was seen in the 2020/2021 season. The low adoption rate (13%) relates to the number of teams fully or partly using NHE programmes. Teams that used NHE for the whole team or most players had a lower hamstring injury burden than teams that used NHE only for individual players.
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26.
  • Fagher, K., et al. (författare)
  • Preparing for snow-sport events at the Paralympic Games in Beijing in 2022 : recommendations and remaining questions
  • 2022
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ. - 2055-7647. ; 8:1
  • Forskningsöversikt (refereegranskat)abstract
    • During the 2022 Winter Paralympic Games in Beijing, the Para snow-sport events will be held at high altitudes and in possibly cold conditions while also requiring adjustment to several time zones. Furthermore, the ongoing COVID-19 pandemic may lead to suboptimal preparations. Another concern is the high rate of injuries that have been reported in the Para alpine and snowboard events. In addition to these challenges, Para athletes various impairments may affect both sports-specific demands and athlete health. However, the group of Para snow-sport athletes is an understudied population. Accordingly, this perspective paper summarises current knowledge to consider when preparing for the Paralympic Games in Beijing and point out important unanswered questions. We here focus specifically on how sport-specific demands and impairment-related considerations are influenced by altitude acclimatisation, cold conditions, travel fatigue and jetlag, complications due to the COVID-19 pandemic, and injury prevention and sports safety considerations. As Para athletes with spinal cord injury, limb deficiency, cerebral palsy and visual impairment account for the majority of the Para snow-sport athletes, the focus is mainly on these impairment groups. In brief, we highlight the extra caution required to ensure athlete health, performance and sports safety among Para athletes participating in the snow-sport events in the 2022 Beijing Paralympic Games. Although there is an urgent need for more high-quality research focusing on Para winter athletes, we hope these non-consensus recommendations will help prepare for the 2022 Beijing Paralympic Winter Games.
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27.
  • Fagher, Kristina, et al. (författare)
  • Safe and Healthy Para sport project (SHAPE) : a study protocol of a complex intervention within Para sport.
  • 2022
  • Ingår i: BMJ open sport & exercise medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 8:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Elite Para athletes report a high incidence of sports injuries, illnesses and other health issues. Despite this, there are few prevention programmes in Para sport, and many of the existing prevention programmes are not adapted to Para athletes. To improve the success of preventive measures, it has been suggested that sports safety work should facilitate health promotion, including athlete health education. Therefore, the overarching aim of this project is to evaluate an accessible health promotion web platform as part of a complex intervention that aims to improve knowledge of athlete health in Para sport. In this protocol, the development, future implementation and evaluation of the intervention are described. To inform the implementation and use of such interventions, it is recommended to involve end users in the development and implementation process. Therefore, a participatory design process, including athletes and the sports organisation, was used to develop an accessible health promotion web platform. To evaluate this complex intervention, a process evaluation combining quantitative evaluation assessing causal pathways with qualitative methods assessing multifaceted pathways will be used. The primary outcomes are injury/illness incidence, athlete health parameters, health literacy and user behaviour. A cohort of elite Para athletes (n=150) from Sweden and South Africa will be invited to participate. This project will be the first that aims to improve athlete health in Para sport through pragmatic and accessible health promotion. It is a boundary-crossing project that will be conducted in a real-world sport setting, including athletes with different socioeconomic backgrounds.
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28.
  • Fagher, Kristina, et al. (författare)
  • When women can be stars in sports, why is it so difficult in sports and exercise medicine research?
  • 2022
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ. - 2055-7647. ; 8
  • Tidskriftsartikel (refereegranskat)abstract
    • Watching the Olympic and Paralympics Games, we notice that both men and women achieve world-class performances. We see the world’s best sports stars perform extraordinary athletic feats, regardless of who they are or where they come from. This equity was not always present at this world stage. For instance, until 1984, women were prohibited from running marathons during the Olympic Games.1 It may also surprise you that it was not until the 2012 London Games that all delegations sent a team consisting of both sexes.Over the last decades, the Olympic and Paralympic movements have worked proactively for equity through leadership development and advocacy campaigns, leading to opportunities for women to also become sports stars. Nonetheless, it appears that we in Sports and Exercise Medicine (SEM) are falling behind. Although most of us aim for equity and equivalence, women are still heavily underrepresented in SEM research. In this editorial, we discuss existing concerns and possible solutions.
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29.
  • Flosadottir, Vala, et al. (författare)
  • Muscle function is associated with future patient-reported outcomes in young adults with ACL injury
  • 2016
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ. - 2055-7647. ; 2:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND/AIM: Consequences of an anterior cruciate ligament (ACL) injury include worse patient-reported outcomes (PROs) and a decrease in activity level. Muscle function can be improved by targeted exercise. Our aims were to investigate cross-sectional and longitudinal associations among lower extremity muscle function and PROs after ACL injury.METHODS: Fifty-four participants (15 women, mean 30 years) with ACL injury or reconstruction, from the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) trial (ISRCTN84752559), were assessed with hop performance, muscle power and postural orientation 3 years (SD 0.85) after ACL injury. PROs at 3 and 5 years after injury included Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Function in sport and recreation (KOOS Sport/rec) and Knee-related Quality of life (KOOS QoL), KOOS item Q3 (KOOS Q3), Tegner Activity Scale and Activity Rating Scale (ARS). Partial Spearman's rank-order correlation was used to analyse correlations between muscle function and PROs, controlling for gender and treatment.RESULTS: Numerous cross-sectional correlations were observed between muscle function and PROs (rsp≈0.3-0.5, p≤0.045). Worse hop performance and worse postural orientation were associated with worse KOOS scores 2 years later (rsp≥0.280, p≤0.045). Worse muscle power was associated with lower future ARS scores (rsp=0.281, p=0.044).CONCLUSIONS: The moderate associations suggest that improving muscle function during rehabilitation could improve present and future PROs.
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30.
  • Fomin, Sanne, et al. (författare)
  • Short-term recovery of physical activity and knee function after an acute knee injury
  • 2020
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 6:1
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesTo describe self-reported knee function, participation in physical activity and the number of knee surgeries at 3 and 6 months following acute knee injury.MethodsProspective cohort study. Participants, aged 15-40 years with an acute knee injury sustained no more than 6 weeks prior to inclusion, were recruited. There were 279 participants with ACL injury and 101 participants with other acute knee injuries included. Follow-up questionnaires were sent at 3 and 6 months after injury. Demographic information, activity participation, International Knee Documentation Committee subjective knee form (IKDC-SKF) and the Single Assessment Numeric Evaluation (SANE) score were collected. Additional knee injuries were obtained from self-report and medical charts.ResultsThe IKDC-SKF, SANE and physical activity participation were reduced at 3-month and 6-month follow-up. The number of participants who achieved health-promoting physical activity levels was reduced by 50% at 6-month follow-up compared with before injury. Seventeen per cent of participants with ACL injury and 41% of participants with other acute knee injuries had returned to their preinjury physical activity at 6 months. Participants with ACL injury reported worse knee function, lower physical activity participation and had more surgeries (128 surgeries, including 109 ACL-reconstructions) compared with participants with other acute knee injuries (six surgeries).ConclusionAcute knee injuries, including ACL injuries, affected self-reported knee function and physical activity participation for at least 6 months after index injury. More research is needed to understand how best to help people with acute knee injuries return to physical activity and achieve satisfactory knee function.
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31.
  • Fridén, C, et al. (författare)
  • Previous injury, sex and well-being are associated with injury profiles in 422 adolescent elite athletes of age 15-16 years: a 20-week longitudinal study
  • 2023
  • Ingår i: BMJ open sport & exercise medicine. - : BMJ. - 2055-7647. ; 9:1, s. e001485-
  • Tidskriftsartikel (refereegranskat)abstract
    • Adolescent elite athletes have a high injury risk and many risk factors for injury have been suggested. However, there is a lack of prospective studies in adolescent elite athletes of age 15–16 years.AimThe aim of the study was to prospectively explore risk factors associated with different injury prevalence profiles in adolescent elite athletes.MethodsSubstantial injury was monitored in adolescent elite athletes (n=422) using the validated Oslo Sports Trauma Research Center Questionnaire over 20 weeks. Athletes were categorised in tertiles based on injury prevalence.ResultsThe median substantial injury prevalence for all athletes was 10% (IQR 0%–20%). Compared with the ‘no injury’ group, previous injury (p<0.001, OR 3.91) and well-being (p<0.001, OR 0.93) were associated with the ‘high injury’ group, and previous injury (p=0.006, OR 1.96) and being a female athlete (p=0.002, OR 2.08) with the ‘low injury’ group. A female athlete with a previous injury and low perceived well-being (25th percentile) had a 48% risk (95% CI 36% to 59%) of belonging to the ‘high injury’ group, compared with 7% (95% CI 4% to 12%) for a male athlete with no previous injury and high well-being (75th percentile).ConclusionMedical personnel should be aware of the high injury risk and risk factors for injury in adolescent elite athletes, and closely monitor the rehabilitation post-injury as a previous injury is such a strong risk factor for a new injury.
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32.
  • Hausken-Sutter, Solveig E., et al. (författare)
  • Youth sport injury research : a narrative review and the potential of interdisciplinarity
  • 2021
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 7:1
  • Forskningsöversikt (refereegranskat)abstract
    • To prevent sports injuries, researchers have aimed to understand injury aetiology from both the natural and social sciences and through applying different methodologies. This research has produced strong disciplinary knowledge and a number of injury prevention programmes. Yet, the injury rate continues to be high, especially in youth sport and youth football. A key reason for the continued high injury rate is the development of injury prevention programmes based on monodisciplinary knowledge that does not account for the complex nature of sport injury aetiology. The purpose of this paper is to consider and outline an interdisciplinary research process to research the complex nature of sport injury aetiology. To support our proposition, we first present a narrative review of existing youth football and youth sport injury research demonstrating an absence of paradigmatic integration across the research areas’ main disciplines of biomedicine, psychology and sociology. We then demonstrate how interdisciplinary research can address the complexity of youth sport injury aetiology. Finally, we introduce the interdisciplinary process we have recently followed in a youth football injury research project. While further research is necessary, particularly regarding the integration of qualitative and quantitative sport injury data, we propose that the pragmatic interdisciplinary research process can be useful for researchers who aim to work across disciplines and paradigms and aim to employ methodological pluralism in their research.
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33.
  • Hedman, Kristofer, et al. (författare)
  • Cardiac systolic regional function and synchrony in endurance trained and untrained females
  • 2015
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ. - 2055-7647. ; 25:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Most studies on cardiac function in athletes describe overall heart function in predominately male participants. We aimed to compare segmental, regional and overall myocardial function and synchrony in female endurance athletes (ATH) and in age-matched sedentary females (CON).Methods In 46 ATH and 48 CON, echocardiography was used to measure peak longitudinal systolic strain and myocardial velocities in 12 left ventricular (LV) and 2 right ventricular (RV) segments. Regional and overall systolic function were calculated together with four indices of dyssynchrony.Results There were no differences in regional or overall LV systolic function between groups, or in any of the four dyssynchrony indices. Peak systolic velocity (s′) was higher in the RV of ATH than in CON (9.7±1.5 vs 8.7±1.5 cm/s, p=0.004), but not after indexing by cardiac length (p=0.331). Strain was similar in ATH and CON in 8 of 12 LV myocardial segments. In septum and anteroseptum, basal and mid-ventricular s′ was 6–7% and 17–19% higher in ATH than in CON (p<0.05), respectively, while s′ was 12% higher in CON in the basal LV lateral wall (p=0.013). After indexing by cardiac length, s′ was only higher in ATH in the mid-ventricular septum (p=0.041).Conclusions We found differences between trained and untrained females in segmental systolic myocardial function, but not in global measures of systolic function, including cardiac synchrony. These findings give new insights into cardiac adaptation to endurance training and could also be of use for sports cardiologists evaluating female athletes.
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34.
  • Hedman, Kristofer, et al. (författare)
  • Impact of the distance from the chest wall to the heart on surface ECG voltage in athletes
  • 2020
  • Ingår i: BMJ OPEN SPORT & EXERCISE MEDICINE. - : BMJ Publishing Group Ltd. - 2055-7647. ; 6:1
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveAvailable ECG criteria for detection of left ventricular (LV) hypertrophy have been reported to have limited diagnostic capability. Our goal was to describe how the distance between the chest wall and the left ventricle determined by echocardiography affected the relationship between ECG voltage and LV mass (LVM) in athletes.MethodsWe retrospectively evaluated digitised ECG data from college athletes undergoing routine echocardiography as part of their preparticipation evaluation. Along with LV mass and volume, we determined the chest wall-LV distance in the parasternal short-axis and long-axis views from two-dimensional transthoracic echocardiographic images and explored the relation with ECG QRS voltages in all leads, as well as summed voltages as included in six major ECG-LVH criteria.Results239 athletes (43 women) were included (age 191years). In men, greater LV-chest wall distance was associated with higher R-wave amplitudes in leads aVL and I (R=0.20and R=0.25, both p<0.01), while in women greater distance was associated with higher R-amplitudes in V5 and V6 (R=0.42and R=0.34, both p<0.01). In women, the chest wall-LV distance was the only variable independently (and positively) associated with R V5 voltage, while LVM, height and weight contributed to the relationship in men.ConclusionsThe chest wall-LV distance was weakly associated with ECG voltage in athletes. Inconsistent associations in men and women imply different intrathoracic factors affecting impedance and conductance between sexes. This may help explain the poor relationship between QRS voltage and LVM in athletes.
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35.
  • Hedman, Kristofer, Docent, 1984-, et al. (författare)
  • Low but not high exercise systolic blood pressure is associated with long-term all-cause mortality
  • 2021
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ Publishing Group Ltd. - 2398-9459 .- 2055-7647. ; 7:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The risks associated with achieving a high peak systolic blood pressure (SBP) during clinical exercise testing remain controversial, although this issue has not been evaluated in relation to predicted SBP standards. This cohort study aimed to evaluate the long-term risk of all-cause mortality in males in relation to reference values of peak SBP and the increase in SBP during exercise from the Fitness Registry and the Importance of Exercise: A National Database (FRIEND).Methods: We followed 7164 males (mean age: 58.2±10.6 years) over 95 998 person-years of follow-up (mean 13.4±5.4 years), who performed a maximal treadmill exercise test at baseline. SBP was measured at rest and at peak exercise. Risk of all-cause mortality over 20 years (Cox regression) was determined in relation to reference percentiles of peak SBP and increase in SBP with exercise: <10th (low), 10th-90th, >90th (high) percentiles.Results: A high peak or a large increase in SBP with exercise was not associated with all-cause mortality. Subjects with a low peak SBP had a 20% higher unadjusted risk for all-cause death compared with those with a normal value (1.20 (1.11-1.31)), and a statistically non-significant 7% higher risk after adjustment for all baseline risk factors (1.07 (0.97-1.18)). The corresponding unadjusted and adjusted risks associated with a low increase in SBP were 1.24 (1.15-1.35) and 1.11 (1.02-1.21), respectively.Conclusions: A low-but not high-peak SBP is associated with increased unadjusted risk of all-cause mortality. The FRIEND percentiles of exercise SBP can aid clinicians in individualising risk assessment.
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36.
  • Jacobsson, Jenny, 1962-, et al. (författare)
  • Youth athletes at Swedish sports high schools with an athletics specialism emphasise environmental support for injury risk management : a focus group study.
  • 2023
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 9:2
  • Tidskriftsartikel (refereegranskat)abstract
    • In this study, we examined knowledge and understanding of sport-related injuries among youth athletics (track and field) athletes and assessed their needs in managing any health problems. Qualitative data were collected via 12 focus groups with youth athletes (16-19 years) studying at Swedish sports high schools with an athletics specialism. All focus group discussions were audiorecorded and transcribed before being analysed using a thematic analysis approach. Four researchers independently reviewed the transcripts, generated codes and developed themes. Three overarching themes related to the athletes' knowledge and understanding of sport-related injury were developed: (1) awareness of injuries, (2) perception of injuries, and (3) factors contributing to injuries. The youth athletes were typically uncertain about how to acknowledge a sport-related injury. They expressed that knowledge about injuries was obtained in part by reflecting on the lived experiences of their peers. It was also demonstrated that there appears to be a 'culture of acceptance' regarding injury occurrence. In contrast, causes of injuries were viewed as dependent on multiple factors (eg, lack of context-specific knowledge about training practices). Regarding athletes' needs in managing injuries, an additional three themes were developed: (1) creating functioning elite sports environments, (2) application of knowledge and (3) fostering athletes. An apparent lack of structure and organisation related to the school environment was identified as an important issue to review to create opportunities for sustainable athletic development. The study identified areas that can be improved in Swedish sports high schools with an athletic specialism and could be applied in other youth sports contexts. The results of this study guide school stakeholders, alongside the sport governing bodies who have the mandate to influence activities in youth sports contexts, whereby special attention should be directed towards improving the social environment for youth athletes.
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37.
  • Jederström, Moa, et al. (författare)
  • A cross-sectional study of anxiety and depression caseness in female competitive figure skaters in Sweden
  • 2023
  • Ingår i: BMJ Open sport & exercise medicine. - : BMJ. - 2055-7647. ; 9:1
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesLittle is known about figure skaters' mental health. This study aimed to describe anxiety and depression caseness (defined as a screening condition qualifying for psychiatric examination) in competitive figure skaters and analyse factors associated with such caseness.MethodsA cross-sectional study was performed in April 2019 among all competitive figure skaters in the south-eastern region of Sweden (N=400). The primary outcomes were anxiety caseness, measured using the short-form Spielberger State-Trait Anxiety Inventory and depression caseness, measured using the WHO-5 index. Multivariable logistic regression models were employed to determine the association between anxiety caseness and explanatory factors.ResultsIn total, 36% (n=142) of the invited skaters participated. Only females (n=137), mean age 12.9 (SD 3.0) years) were selected for analysis. Of the participating skaters, 47% displayed anxiety caseness and 10% depression caseness. Overweight body image perception (OR 5.9; 95% CI 2.0 to 17.6; p=0.001) and older age (OR 1.2; 95% CI 1.1 to 1.4; p=0.005) were associated with anxiety caseness. Skaters reporting no caseness were younger than those reporting only anxiety caseness (mean age difference -1.9 years; 95% CI -3.1 to -0.7; p=0.001) or anxiety and depression caseness (OR -3.5 years; 95% CI -5.6 to -1.5 years; p<0.001).ConclusionAnxiety caseness was associated with overweight body image perception and older age in female competitive figure skaters. Older skaters reported generally worse mental health. More research on the mental health of figure skaters is warranted, considering comorbidity and focusing on those needing further assessment and support.
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38.
  • Johansson, Hanna, 1996-, et al. (författare)
  • Skating on thin ice? Mental health and well-being in women’s ice hockey
  • 2023
  • Ingår i: BMJ Open Sport & Exercise Medicine. - London : BMJ Publishing Group Ltd. - 2055-7647. ; 9:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: First, to map the prevalence of symptoms of positive mental health, anxiety, depression and sleep difficulties, along with the coexistence of these symptoms, among players in the Swedish Women’s Hockey League (SDHL). Second, to investigate relationships between these mental health symptoms and demographic variables (ie, age, injuries, dual careers), social support and psychological flexibility.Methods: Players from nine teams in SDHL (n=182; mean age 22.3±SD 4.8, range 16–35) participated in this cross-sectional study. An online survey, including validated self-assessment questionnaires, conducted data collection. The questionnaires were distributed just before the play-offs started in the 2022–2023 season. Mental health variables were presented as descriptive statistics, and associations were investigated through multivariate binary logistic regression analyses.Results: The response rate was 91%. Moderate or severe symptoms were reported among 29.7% for sleep difficulties, 20.9% for anxiety and 18.1% for depression. Nineteen per cent reported comorbidities. Sixty percent reported flourishing mental health. Lower psychological flexibility was associated with lower odds of flourishing mental health and higher odds of symptoms of anxiety, depression and sleep difficulties. Social support was associated with higher odds of flourishing mental health and lower odds of sleep difficulties.Conclusion: 6 of every 10 players reported not reaching the ideal state of mental health (ie, flourishing mental health without mental illness). Mental health symptoms were statistically significantly associated with psychological flexibility and social support, suggesting that these factors will be beneficial to consider when preventing mental illness and promoting mental health in this population.
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39.
  • Jungmalm, Jonatan, 1991, et al. (författare)
  • Study protocol of a 52-week Prospective Running Injury study in Gothenburg (SPRING)
  • 2018
  • Ingår i: BMJ Open Sport Exercise Medicine. - : BMJ. - 2044-6055 .- 2055-7647. ; 4:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction It is assumed that a running-related (overuse) injury occurs when a specific structure of the human body is exposed to a load that exceeds that structures’ load capacity. Therefore, monitoring training load is an important key to understanding the development of a running-related injury. Additionally, other distribution, magnitude and capacity-related factors should be considered when aiming to understand the causal chain of injury development. This paper presents a study protocol for a prospective cohort study that aims to add comprehensive information on the aetiology of running-related injuries and present a new approach for investigating changes in training load with regard to running-related injuries. Methods and analysis This study focused on recreational runners, that is, runners exposed to a minimum weekly average of 15 km for at least 1 year. Participants will undergo baseline tests consisting of a clinical/anthropometrical examination and biomechanical measurements. Furthermore, participants will log all training sessions in a diary on a weekly basis for 1 year. The primary exposure variable is changes in training load. A medical practitioner will examine runners suffering from running-related pain and, if possible, make a clear diagnosis. Finally, additional time-varying exposure variables will be included in the main analysis, whereas the analysis for the secondary purpose is based on timefixed baseline-related risk factors.
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40.
  • Karlsson, Elin, et al. (författare)
  • Symptoms of eating disorders and low energy availability in recreational active female runners
  • 2023
  • Ingår i: BMJ Open sport & exercise medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 9:3
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesThis retrospective, cross-sectional study aimed to investigate symptoms of eating disorders (EDs) and low energy availability (LEA) among recreational female runners.MethodsFemales (18-39 years) (n=89) participating in running group sessions organised by running clubs and companies were recruited via social media and completed an anonymous online survey compromising the Eating Disorder Examination Questionnaire (EDE-Q) and Low Energy Availability in Females Questionnaire (LEAF-Q). An EDE-Q global score & GE;2.3 and a LEAF-Q total score & GE;8 (in combination with an injury score & GE;2 and/or menstruation dysfunction score & GE;4) were used to categorise subjects as having symptoms of EDs and LEA, respectively.ResultsAmong the subjects fulfilling the age criteria (n=85), 18% (n=15) had symptoms of EDs and 19% (n=16) had symptoms of LEA. Of those with symptoms of EDs, 13% (n=2) had concomitant symptoms of LEA. The higher the EDE-Q dietary restraint score, the higher the gastrointestinal problem score (r=0.23, p=0.04), otherwise no other associations were found between EDE-Q global or subscale scores and LEAF-Q scores. ConclusionOur results indicate that symptoms of EDs and LEA are frequent among adult females at all athletic levels, including the recreational level. Hence, to prevent the negative health consequences of EDs and LEA, preventative initiatives are also needed in recreational running communities.
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41.
  • Karlsson, Øyvind, 1989-, et al. (författare)
  • Health problems in national team cross-country skiers over a competitive season : a 17-week prospective cohort study
  • 2022
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ. - 2055-7647. ; 8:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective Few long-term prospective studies have investigated health problems in elite competitive cross-country (XC) skiers. Hence, our objective was to compare the prevalence of health problems in national team XC skiers over a competitive season.Methods Forty national team XC skiers participated in this prospective, observational study. Two groups were characterized according to performance level: senior (n=18, ~26 years old, 9 women) and development (n=22, ~21 years old, 9 women). The skiers reported all and substantial injuries and illnesses weekly for 17 consecutive weeks throughout the 2019/2020 competitive season using the Oslo Sports Trauma Research Center Questionnaire on Health Problems.Results The average weekly prevalence of all and substantial health problems was 19% (95% CI: 16% to 22%) and 12% (95% CI: 9% to 15%), respectively, and was similar between senior and development level skiers (p>0.05). The injury prevalence was higher in senior versus development level skiers (12%, 95% CI: 9% to 15% vs 5%, 95% CI: 3% to 7%; p<0.001), while illnesses were less common (8%, 95% CI: 3% to 13% vs 13%, 95% CI: 9% to 17%, respectively; p=0.031). Illnesses accounted for 72% of all problems. The prevalence of all health problems was higher in female than in male skiers (23%, 95% CI: 19% to 27% vs 15%, 95% CI: 11% to 19%; p<0.003).Conclusions Health problems, especially illnesses, were relatively common, with approximately one in five skiers (19%) reporting at least one problem in any given week. Both performance level and sex influenced the prevalence of different types of health problems.
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42.
  • Kilic, Ö., et al. (författare)
  • Exposure to physical and psychosocial stressors in relation to symptoms of common mental disorders among European professional football referees : A prospective cohort study
  • 2018
  • Ingår i: BMJ Open Sport and Exercise Medicine. - London : BMJ Publishing Group Ltd. - 2055-7647. ; 4:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives The study aim was to explore the association of physical and psychosocial stressors (severe injuries, surgeries, recent life events, social support) with one-season onset of symptoms of common mental disorders (CMDs) among European professional football referees. Methods An observational prospective cohort study over a follow-up period of one season (2015-2016) was conducted among professional football referees from Belgium, Finland, France, Germany, Norway, Russia, Scotland and Sweden. Based on physical and psychosocial stressors as well as symptoms of CMD, an electronic questionnaire in English and French was set up and distributed by eight football federations involved. Results The prevalence of symptoms of CMD ranged from 5.9% for distress to 19.2% for eating disorders. A higher number of severe injuries and a lower degree of satisfaction about social support were significantly related to the occurrence of symptoms of CMD with an OR of 2.63 and an OR of 1.10, respectively. Conclusion A higher number of severe injuries and a lower degree on satisfaction about social support were found to be significantly associated with the onset of symptoms of CMD among European professional football referees. Referees suffering from severe injuries were nearly three times more likely to report symptoms of anxiety and depression. Referees who reported a low satisfaction of social support were significantly more likely to report symptoms of eating disorder. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.
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43.
  • Lahti, Amanda, et al. (författare)
  • Long-term effects of daily physical education throughout compulsory school on duration of physical activity in young adulthood : An 11-year prospective controlled study
  • 2018
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ. - 2055-7647. ; 4:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives We examined whether daily physical activity (PA) during compulsory school encourages children to be more physically active during the intervention and 4 years after termination of the programme. Methods This prospective controlled intervention study followed the same 124 children (81 children in an intervention group and 43 controls) aged 7.7±0.6 (mean±SD) during a 7-year PA intervention and 4 years after the intervention when the children were 18.7±0.3 years old. The intervention included daily school physical education (PE) (200 min/week), whereas the controls continued with the Swedish standard of 60 min/week. Using a questionnaire, we gathered data about total PA, leisure time PA and sedentary activities (SA). Group comparisons are adjusted for age and gender, and data are provided as means with 95% CIs. Results At baseline, we found similar duration of PA and SA between groups. After a mean of 7 years with intervention, the intervention group was more physically active than the controls (+4.5 (2.9 to 6.0) hours/week), whereas SA was similar (+0.6 (-2.5 to 3.9) hours/week). Four years beyond the intervention, the intervention group was still more physically active than the controls (2.7 (0.8 to 4.7) hours/week), and SA was still similar (-3.9 (-9.7 to 1.7) hours/week). Conclusions Intervention with daily school PE throughout compulsory school is associated with higher duration of PA not only during the intervention but also 4 years after termination of the programme.
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44.
  • Lahti, Amanda, et al. (författare)
  • Socioecological and biological associations of lower levels of physical activity in 8-year-old children : A 2-year prospective study
  • 2019
  • Ingår i: BMJ Open Sport & Exercise Medicine. - 2055-7647. ; 5:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Evaluate if socioecological and biological factors, at the age of 8 years, are associated with lower level of physical activity (PA) 2 years later. Method: In a study cohort of 199 children aged 7.8±0.6 years, we used questionnaires and physical measurements to evaluate biological (eg, sex), social (eg, parental PA) and environmental (eg, school settings) factors. Objective PA was measured 2 years later with accelerometers. General PA (GPA) was defined as mean counts per minute (cpm) and moderate to vigorous PA (MVPA) as min/day >3500 cpm. We used analysis of covariance to evaluate if socioecological factors at age 8 are associated with level of PA 2 years later. Results: Daily GPA was 690.5±216.6 cpm and the children spent 40.9±18.3 min on MVPA. Female sex is associated with-131.1 (-183.4,-78.7) cpm GPA, each 10 cm shorter body height with-48.7 (-94.8,-26.5), each unit higher body mass index (BMI) with-26.0 (-37.5,-14.5) and allocation to 60 min school PA/week with-73.8 (-131.5,-16.2) compared with allocation to 200 min school PA/week. Female sex is associated with-10.3 (-14.8,-5.7) min of MVPA and each unit higher BMI with-1.9 (-2.9,-0.9) min. Conclusion: Female sex, shorter body height and higher BMI are at age 8 years associated with lower level of PA 2 years later. It appears possible to increase PA by daily school PA.
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45.
  • Laxdal, Aron, et al. (författare)
  • FIDES Athlete Development Programme : project background and study protocol of an embedded multiple case study
  • 2024
  • Ingår i: BMJ Open sport & exercise medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 10:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Most sports science research revolves around male subjects. As a result, most of the knowledge and practices within sports are male-centric. Failing to take the biological, psychological and social (biopsychosocial) particularities of females into account is believed to hinder optimal sports participation, development and performance, with potential negative effects on the health and well-being of females. To close the knowledge gap and alleviate these issues, we aim to develop and evaluate a 12-video educational intervention that addresses female-specific subject matter: the FIDES Athlete Development Programme. The study is designed as an embedded multiple case study where at least 1320 Swedish female athletes aged 13-16 will participate, in addition to their parents and their coaches. The girls will be recruited through their sports clubs, with half being exposed to the FIDES Athlete Development Programme and the other half serving as control cases. The primary outcomes are well-being and sporting experience. To further increase our understanding of the intervention and its implications, interviews and focus group interviews with a reference group of girls and focus group interviews with a randomly selected subsample of coaches and parents will also be performed. The project is approved by the Swedish ethics committee (number: 2023-05264-01) and will be carried out in compliance with the Declaration of Helsinki. Results from the project will be published open access in peer-reviewed journals, at national and international conferences, in mass media, and a PhD thesis. The anonymised data will be made openly available in a data repository.
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46.
  • Lundqvist, Carolina, 1977-, et al. (författare)
  • Nuances in key constructs need attention in research on mental health and psychiatric disorders in sports medicine
  • 2022
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 8:3
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • The WHO1 defines mental health as ‘a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community’ (p. 12). According to this definition, mental health is more than a lack of symptoms of mental ill-being or disorders. Variations in mood and perception of symptoms, also with aversive valence, may occur during regular participation in competitive sports. This editorial discusses the importance of acknowledging nuances in studies of mental health and psychiatric disorders in sports medicine and calls for a deepened understanding of ‘mental health’ and how various mental health symptoms and disorders are reported.
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47.
  • Lundqvist, Carolina, 1977-, et al. (författare)
  • Untangling the relationships between age, gender, type of sport, perfectionistic self-presentation, and motivation on body satisfaction. : A cross-sectional study on aesthetic and non-aesthetic female and male athletes aged 10 to 22.
  • 2024
  • Ingår i: BMJ Open Sport & Exercise Medicine. - 2055-7647.
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To explore the relationships between age, gender, type of sport, perfectionistic self-presentation and motivation on body satisfaction among young athletes in one aesthetic sport (gymnastics) and one non-aesthetic sport (basketball). The study hypothesise that (1) age, gender, and type of sport (aesthetic or non-aesthetic) will predict body satisfaction scores, (2) autonomous motivation will positively relate to body satisfaction, and (3) perfectionistic self-presentation will negatively relate to body satisfaction.Design: Cross-sectional. Method: 209 athletes (132 gymnasts and 77 basketball players) aged 10-22 (median=13 years) were recruited. After data screening, 200 athletes were included in analyses (females: n=155; males: n=45). Participants completed an online survey which assessed demographic information, athlete motivation (Behavioral Regulation in Sport Questionnaire), perfectionistic self-presentation (Perfectionistic Self-Presentation Scale – Junior Form) and body satisfaction (Body Appreciation Scale-2). Results: Hierarchical multiple regression showed age, self-assigned gender, and two facets of perfectionism (perfectionistic self-presentation and non-disclosure of imperfection) to predict reported levels of body satisfaction significantly. Subsequently, adding motivational variables did not improve the model. A moderation analysis showed that the relationship between non-disclosure of imperfection and body satisfaction was significantly moderated by gender. Conclusions: Two facets of perfectionism were associated with reported body satisfaction. Additionally, the relationship between non-disclosure of imperfection and body satisfaction appears to differ between female and male athletes. Researchers should move beyond sport types and identify factors (e.g., perfectionistic self-presentation) at the individual and environmental level that can protect young athletes’ body satisfaction.
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48.
  • Malmborg, Julia S, 1988-, et al. (författare)
  • Musculoskeletal pain and its association with maturity and sports performance in 14-year-old sport school students
  • 2018
  • Ingår i: BMJ Open Sport and Exercise Medicine. - London : BMJ. - 2055-7647. ; 4:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: In youth sports, musculoskeletal pain is often studied from the standpoint of sports injuries, but little is known about pain conditions in which athletes still participate. The aim was to study the frequency of pain and associations with maturity offset, health status and sports performance in 14-year-old sport school students. Methods: Cross-sectional design. One hundred and seventy-eight students (108 boys and 70 girls) completed anthropometric measures for maturity offset (height, weight and sitting height), questionnaires (pain mannequin and EQ-5D for health status) and sports performance tests (sprint, agility, counter-movement jump and grip strength). Differences between groups were analysed with Student's t-test and analysis of covariance. Results: Thirty-one students (18.6%) reported infrequent pain, 85 (50.9%) frequent pain and 51 (30.5%) constant pain. Students in the constant pain group had worse health status than those in the infrequent pain group. Boys with constant pain (n=27) had a lower mean maturity offset (-0.38 vs 0.07 years; p=0.03) than boys with infrequent pain (n=22), and pain was associated with worse sports performance. There was no difference in maturity or sports performance between girls with constant pain (n=24) and girls with infrequent pain (n=9). Conclusion: Musculoskeletal pain is common in sport school students and coincides with worse health status and with a younger biological age in boys. The high prevalence of pain should be acknowledged by coaches and student healthcare workers in order to promote a healthy and sustainable development in young athletes.
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49.
  • Malmborg, Julia S, 1988-, et al. (författare)
  • Musculoskeletal pain and its association with maturity and sports performance in 14-year-old sport school students
  • 2018
  • Ingår i: BMJ Open Sport & Exercise Medicine. - London : BMJ. - 2055-7647. ; 4:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives In youth sports, musculoskeletal pain is often studied from the standpoint of sports injuries, but little is known about pain conditions in which athletes still participate. The aim was to study the frequency of pain and associations with maturity offset, health status and sports performance in 14-year-old sport school students. Methods Cross-sectional design. One hundred and seventy-eight students (108 boys and 70 girls) completed anthropometric measures for maturity offset (height, weight and sitting height), questionnaires (pain mannequin and EQ-5D for health status) and sports performance tests (sprint, agility, counter-movement jump and grip strength). Differences between groups were analysed with Student's t-test and analysis of covariance. Results Thirty-one students (18.6%) reported infrequent pain, 85 (50.9%) frequent pain and 51 (30.5%) constant pain. Students in the constant pain group had worse health status than those in the infrequent pain group. Boys with constant pain (n=27) had a lower mean maturity offset (-0.38 vs 0.07 years; p=0.03) than boys with infrequent pain (n=22), and pain was associated with worse sports performance. There was no difference in maturity or sports performance between girls with constant pain (n=24) and girls with infrequent pain (n=9). Conclusion Musculoskeletal pain is common in sport school students and coincides with worse health status and with a younger biological age in boys. The high prevalence of pain should be acknowledged by coaches and student healthcare workers in order to promote a healthy and sustainable development in young athletes.
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50.
  • Masci, Lorenzo, et al. (författare)
  • Achilles tendinopathy - do plantaris tendon removal and Achilles tendon scraping improve tendon structure? : A prospective study using ultrasound tissue characterisation
  • 2015
  • Ingår i: BMJ Open Sport & Exercise Medicine. - : BMJ. - 2055-7647. ; 1:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives The plantaris tendon has recently been described as a possible important factor in midportion Achilles tendinopathy. Ultrasound tissue characterisation (UTC) is a method to study tendon structure (matrix integrity). The effect of plantaris tendon removal on Achilles tendon structure was studied using UTC.Design and setting Prospective case series study at one centre.Participants Nine tendons in eight physically active and healthy patients (mean age 39 years) with chronic painful midportion Achilles tendinopathy were included. Preoperative two-dimensional ultrasound and UTC showed midportion Achilles tendinopathy (tendinosis) with medial tendon changes and suspected plantaris tendon involvement. Patients with previous operations to the Achilles tendon were excluded.Interventions Operative treatment consisted of excision of the plantaris tendon and scraping of the ventromedial surface of the Achilles tendon under a local anaesthetic.Primary and secondary outcome measures UTC examination and clinical scoring with the VISA-A questionnaire were performed preoperatively and 6 months postoperatively.Results At 6 months follow-up, UTC demonstrated a statistically significant (t=5.40, p<0.001) increase in the mean organised matrix (echo-type I+II) and a decrease in the mean disorganised matrix (echo-type III+IV). Seven out of eight patients were satisfied, and the VISA-A score had increased significantly (p<0.001) from 56.8 (range 34–73) preoperatively to 93.3 (range 87–100) postoperatively.Conclusions Excision of the plantaris tendon and scraping of the ventromedial Achilles tendon in chronic midportion tendinopathy seem to have the potential to improve tendon structure and reduce tendon pain. Studies on a larger group of patients and with a longer follow-up period are needed.
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