The Effect of Pedal Pump Lymphatic Technique Versus Passive Recovery Following Maximal Exercise: A Randomized Cross-Over Trial

Context Muscle damage and delayed onset muscle soreness (DOMS) can occur following intense exercise. Various modalities have been studied to improve blood lactate accumulation, which is a primary reason for DOMS. It has been well established that active recovery facilitates blood lactate removal more rapidly that passive recovery due to the pumping action of the muscle. The pedal pump is a manual lymphatic technique used in osteopathic manipulative medicine to increase lymphatic drainage throughout the body. Pedal pump has been shown to increase lymphatic flow and improve immunity. This may improve circulation and improve clearance of metabolites post-exercise. Objective This study compared the use of pedal pump lymphatic technique to passive supine recovery following maximal exercise. Methods 17 subjects (male n = 10, age 23 ± 3.01; female n = 7, age 24 ± 1.8), performed a maximal volume O2 test (VO2 max) using a Bruce protocol, followed by a recovery protocol using either pedal pump technique or supine passive rest for 10 min, followed by sitting for 10 min. Outcome measures included blood lactate concentration (BL), heart rate (HR), systolic blood pressure (SBP) and VO2. Subjects returned on another day to repeat the VO2 max test to perform the other recovery protocol. All outcomes were measured at rest, within 1- minute post-peak exercise, and at minutes 4, 7, 10 and 20 of the recovery protocols. A 2 × 6 repeated measures ANOVA was used to compare outcome measures (p ≤ 0.05). Results No significant differences were found in VO2, HR, or SBP between any of the recovery protocols. There was no significant difference in BL concentrations for recovery at minutes 4, 7, or 10 (p > 0.05). However, the pedal pump recovery displayed significantly lower BL concentrations at minute 20 of recovery (p = 0.04). Conclusion The pedal pump significantly decreased blood lactate concentrations following intense exercise at recovery minute 20. The use of manual lymphatic techniques in exercise recovery should be investigated further.

The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians

Background Despite calf muscle strain injuries (CMSI) being problematic in many sports, there is a dearth of research to guide clinicians dealing with these injuries. The aim of this study was to evaluate the current practices and perspectives of a select group of international experts regarding the assessment, management and prevention of CMSI using in-depth semi-structured interviews. Results Twenty expert clinicians working in elite sport and/or clinician-researchers specialising in the field completed interviews. A number of key points emerged from the interviews. Characteristics of CMSI were considered unique compared to other muscle strains. Rigor in the clinical approach clarifies the diagnosis, whereas ongoing monitoring of calf capacity and responses to loading exposure provides the most accurate estimate of prognosis. Athlete intrinsic characteristics, injury factors and sport demands shaped rehabilitation across six management phases, which were guided by key principles to optimise performance at return to play (RTP) while avoiding subsequent injury or recurrence. To prevent CMSI, periodic monitoring is common, but practices vary and data are collected to inform load-management and exercise selection rather than predict future CMSI. A universal injury prevention program for CMSI may not exist. Instead, individualised strategies should reflect athlete intrinsic characteristics and sport demands. Conclusions Information provided by experts enabled a recommended approach to clinically evaluate CMSI to be outlined, highlighting the injury characteristics considered most important for diagnosis and prognosis. Principles for optimal management after CMSI were also identified, which involved a systematic approach to rehabilitation and the RTP decision. Although CMSI were reportedly difficult to prevent, on- and off-field strategies were implemented by experts to mitigate risk, particularly in susceptible athletes.

Predictive Value of Technical Throwing Skills on Nomination Status in Youth and Long-Term Career Attainment in Handball

Background Research on talent in sports aims to identify predictors of future performance. This study retrospectively investigated 1) relationships between young handball field players’ technical throwing skills and (a) their potential nomination to youth national teams and (b) their long-term career attainment 10 years later, and 2) associations between nomination status and career attainment. Results Results from retrospectively predicting nomination status and career attainment using logistic regression analyses show that technical throwing skills were partly able to explain players’ nomination status (Nagelkerke R2: females 9.2%, males 13.1%) and career attainment (Nagelkerke R2: 9.8% for female players). Here, variables throwing velocity and time on exercise showed statistically significant effects. In addition, nomination status and career attainment were shown to be associated using chi-square tests (w of .37 and .23 for female and male players, respectively) and nomination status as a predictor increased the prediction of career attainment remarkably (Nagelkerke R2: females 20.3%, males 12.7%). Conclusions Given these results, basic technical throwing skills may serve rather as a prerequisite in this age group on national level, emphasizing its importance already on lower levels and in younger age groups. Furthermore, advantages from entering the national TID system early especially for females are discussed.

The Reliability of Transcranial Magnetic Stimulation-Derived Corticomotor Inhibition as a Brain Health Evaluation Tool in Soccer Players

Background The suitability of corticomotor inhibition and corticospinal excitability to measure brain health outcomes and recovery of sport-related head impact (concussion and subconcussion) depends on good inter-day reliability, which is evaluated in this study. Transcranial magnetic stimulation (TMS) reliability in soccer players is assessed by comparing soccer players, for whom reliability on this measure may be reduced due to exposure to head impacts, to generally active individuals not engaged in contact sport. Methods TMS-derived corticomotor inhibition and corticospinal excitability were recorded from the rectus femoris muscle during two testing sessions, spaced 1–2 weeks apart in 19 soccer players (SOC—age 22 ± 3 years) and 20 generally active (CON—age 24 ± 4 years) healthy volunteers. Inter-day reliability between the two time points was quantified by using intra-class correlation coefficients (ICC). Intra-group reliability and group differences on actual measurement values were also explored. Results Good inter-day reliability was evident for corticomotor inhibition (ICCSOC = 0.61; ICCCON = 0.70) and corticospinal excitability (ICCSOC = 0.59; ICCCON = 0.70) in both generally active individuals and soccer players routinely exposed to sport-related head impacts. Corticomotor inhibition showed lower coefficients of variation than excitability for both groups (InhibSOC = 15.2%; InhibCON = 9.7%; ExcitabSOC = 41.6%; ExcitabCON = 39.5%). No group differences between soccer players and generally active individuals were found on the corticomotor inhibition value (p > 0.05), but levels of corticospinal excitability were significantly lower in soccer players (45.1 ± 20.8 vs 85.4 ± 6.2%Mmax, p < 0.0001). Corticomotor inhibition also showed excellent inter-rater reliability (ICC = 0.87). Conclusions Corticomotor inhibition and corticospinal excitability are stable and maintain good degrees of reliability when assessed over different days in soccer players, despite their routine exposure to head impacts. However, based on intra-group reliability and group differences of the levels of excitability, we conclude that corticomotor inhibition is best suited for the evaluation of neuromuscular alterations associated with head impacts in contact sports.

ADHD Prescription Medications and Their Effect on Athletic Performance: A Systematic Review and Meta-analysis

Background Stimulant medications used for the treatment of Attention Deficit-Hyperactivity Disorder (ADHD) are believed to provide a physical advantage in athletics, but several of these medications are not regulated by the World Anti-Doping Association. Given the prevalence of ADHD among the athlete population and concern for abuse of ADHD medications, this review and meta-analysis aimed to evaluate effects of ADHD medications on athletic performance, thereby appraising the validity of claims of performance enhancement. Methods A search of MEDLINE, Embase, CINAHL, and Cochrane Review databases was performed for all randomized controlled trials evaluating athletic performance after ingestion of placebo or ADHD treatment medications from August 2020 through November 2020. All RCTs identified from these search criteria were included for screening, with exclusion of any animal studies. Two reviewers (JB, CK) assessed methodological quality and risk of bias using CONSORT 2010 and Cochrane Collaboration tools. Study results were compiled with corresponding p values for each finding. Effect sizes (Cohen’s D) for athletic performance and physiological changes were aggregated for each study. Studies were further screened for homogeneity that would allow for meta-analysis. Heterogeneity was calculated using I2. Results A total of 13,033 abstracts evaluating amphetamine, methamphetamine, methylphenidate, and bupropion were screened. The final analysis included nine studies, six of which found significant improvement in athletic performance with use of stimulant medications (p < 0.05). Methylphenidate and amphetamine were consistently identified to have a performance effect. Secondary effects identified included significant increase in heart rate, core temperature, and elevation of various serum hormone levels (p < 0.05). Effect size evaluation found seven studies demonstrating small to large effects on physical performance, as well as in categories of cardiometabolic, temperature, hormone, and ratings of perceived exertion, to varying degrees. A meta-analysis was performed on two studies, demonstrating conflicting results. Conclusions Dopaminergic/noradrenergic agonist medications appear to have a positive effect on athletic performance, as well as effects on physiological parameters. Further consideration of medications currently not regulated, i.e. bupropion, is warranted given evidence of athletic performance enhancement. PROSPERO trial registration number: CRD42020211062; 10/29/2020 retrospectively registered.

In-Competition Severe Injury Events in Elite Alpine Ski Racing from 1997 to 2020: The Case of the Austrian Ski Team

Background To increase safety in elite alpine ski racing Injury Surveillance Systems were implemented and preventive measures introduced. However, studies analysing the change in athletes’ injury risk by controlling for their exposure are still scarce. Objectives This study aimed to describe and analyse the risk of in-competition severe injury events (SIEcomp) in elite alpine ski racing. Methods Data recorded in the Austrian Ski Federation’s Injury Surveillance System were used to analyse the SIEcomp incidence. Information on athletes’ competition exposure was obtained from the official website of the International Ski Federation. In 23 seasons, 2333 skier seasons were recorded for the Austrian Ski Team. Within a total of 114,531 runs 169 SIEcomp occurred. Generalised Estimating Equation for Poisson Regressions were applied. Results The SIEcomp incidence per 1000 runs was 1.48 [95% confidence interval (CI) 1.26–1.73] for elite alpine ski racers and 2.21 (95% CI 1.79–2.75) for the subgroup of World Cup racers. A significant sex difference was detected for the subgroup of junior racers with a higher risk for female athletes [risk ratio (RR): 2.97, 95% CI 1.46–6.05]. Between the seasons of 1997 and 2020, the seasonal SIEcomp incidence increased by a factor of 2.67 for elite alpine ski racers and 3.53 for World Cup racers. Downhill (2.75, 95% CI 2.18–3.47) had the highest SIEcomp incidence, followed by super-G (1.94, 95% CI 1.30–2.88), giant slalom (1.40, 95% CI 1.06–1.85), and slalom (0.64, 95% CI 0.43–0.96). Conclusion Although many preventive measures have been implemented in elite alpine ski racing, the risk of SIEcomp has increased over the last two decades.

Energetics of Floor Gymnastics: Aerobic and Anaerobic Share in Male and Female Sub-elite Gymnasts

Background Artistic gymnastics is a popular Olympic discipline where female athletes compete in four and male athletes in six events with floor exercise having the longest competition duration in Women’s and Men’s artistic gymnastics (WAG, MAG). To date no valid information on the energetics of floor gymnastics is available although this may be important for specific conditioning programming. This study evaluated the metabolic profile of a simulated floor competition in sub-elite gymnasts. Methods 17 (9 male, 8 female) sub-elite gymnasts aged 22.5 ± 2.6y took part in a floor-training-competition where oxygen uptake was measured during and until 15 min post-exercise. Additionally, resting and peak blood lactate concentration after exercise were obtained. The PCr-LA-O2 method was used to calculate the metabolic energy and the relative aerobic (WAER), anaerobic alactic (WPCr) and anaerobic lactic (WBLC) energy contribution. Further, the athletes completed a 30 s Bosco-jumping test, a countermovement jump and a drop jump. Results The competition scores were 9.2 (CI:8.9–9.3) in WAG and 10.6 (CI:10.4–10.9) in MAG. The metabolic profile of the floor routine was mainly aerobic (58.9%, CI: 56.0–61.8%) followed by the anaerobic alactic (24.2%, CI: 21.3–27.1%) and anaerobic lactic shares (16.9%, CI:14.9–18.8%). While sex had a significant (p = .010, d = 1.207) large effect on energy contribution, this was not the case for competition duration (p = .728, d = 0.061). Relative energy contribution of WAG and MAG differed in WAER (64.0 ± 4.7% vs. 54.4 ± 6.8%, p = .004, d = 1.739) but not in WPCr (21.3 ± 6.1% vs. 26.7 ± 8.0%, p = .144, d = 0.801) and WBLC (14.7 ± 5.4% vs. 18.9 ± 4.2%, p = .085, d = 0.954). Further no correlation between any energy share and performance was found but between WPCr and training experience (r = .680, p = .044) and WBLC and competition level (r = .668, p = .049). Conclusion The results show a predominant aerobic energy contribution and a considerable anaerobic contribution with no significant difference between anaerobic shares. Consequently, gymnastic specific aerobic training should not be neglected, while a different aerobic share in WAG and MAG strengthens sex-specific conditioning. All in all, the specific metabolic share must secure adequate energy provision, while relative proportions of the two anaerobic pathways seem to depend on training and competition history.

Convergent Validity of Ratings of Perceived Exertion During Resistance Exercise in Healthy Participants: A Systematic Review and Meta-Analysis

Background The validity of ratings of perceived exertion (RPE) during aerobic training is well established; however, its validity during resistance exercise is less clear. This meta-analysis used the known relationships between RPE and exercise intensity (EI), heart rate (HR), blood lactate (BLa), blood pressure (BP) and electromyography (EMG) to determine the convergent validity of RPE as a measure of resistance exercise intensity and physiological exertion, during different forms of resistance exercise. Additionally, this study aims to assess the effect of several moderator variables on the strength of the validity coefficients, so that clearer guidance can be given on the use of RPE during resistance exercise. Methods An online search of 4 databases and websites (PubMed, Web of Science SPORTDiscus and ResearchGate) was conducted up to 28 February 2020. Additionally, the reference lists of the included articles were inspected manually for further unidentified studies. The inclusion criteria were healthy participants of any age, a rating scale used to measure RPE, resistance exercise of any type, one cohort receiving no other intervention, and must present data from one of the following outcome measures: EI, HR, BP, EMG or BLa. Weighted mean effect sizes (r) were calculated using a random-effects model. Heterogeneity was assessed using the τ2 and I2 statistics. Moderator analysis was conducted using random-effects meta-regression. Results One-hundred and eighteen studies were included in the qualitative synthesis, with 75 studies (99 unique cohorts) included in the meta-analysis. The overall weighted mean validity coefficient was large (0.88; 95% CI 0.84–0.91) and between studies heterogeneity was very large (τ2 = 0.526, I2 = 96.1%). Studies using greater workload ranges, isometric muscle actions, and those that manipulated workload or repetition time, showed the highest validity coefficients. Conversely, sex, age, training status, RPE scale used, and outcome measure no significant effect. Conclusions RPE provides a valid measure of exercise intensity and physiological exertion during resistance exercise, with effect sizes comparable to or greater than those shown during aerobic exercise. Therefore, RPE may provide an easily accessible means of prescribing and monitoring resistance exercise training. Trial Registration The systematic review protocol was registered on the PROSPERO database (CRD42018102640).

Retrospective Analysis of Training Intensity Distribution Based on Race Pace Versus Physiological Benchmarks in Highly Trained Sprint Kayakers

Background Research results on the training intensity distribution (TID) in endurance athletes are equivocal. This non-uniformity appears to be partially founded in the different quantification methods that are implemented. So far, TID research has solely focused on sports involving the lower-body muscles as prime movers (e.g. running). Sprint kayaking imposes high demands on the upper-body endurance capacity of the athlete. As there are structural and physiological differences between upper- and lower-body musculature, TID in kayaking should be different to lower-body dominant sports. Therefore, we aimed to compare the training intensity distribution during an 8-wk macrocycle in a group of highly trained sprint kayakers employing three different methods of training intensity quantification. Methods Heart rate (HR) and velocity during on-water training of nine highly trained German sprint kayakers were recorded during the final 8 weeks of a competition period leading to the national championships. The fractional analysis of TID was based on three zones (Z) derived from either HR (TIDBla-HR) or velocity (TIDBla-V) based on blood lactate (Bla) concentrations (Z1 ≤ 2.5 mmol L−1 Bla, Z2 = 2.5–4.0 mmol L−1 Bla, Z3 ≥ 4.0 mmol L−1 Bla) of an incremental test or the 1000-m race pace (TIDRace): Z1 ≤ 85% of race pace, Z2 = 86–95% and Z3 ≥ 95%. Results TIDBla-V (Z1: 68%, Z2: 14%, Z3: 18%) differed from TIDBla-HR (Z1: 91%, Z2: 6%, Z3: 3%) in each zone (all p < 0.01). TIDRace (Z1: 73%, Z2: 20%, Z3: 7%) differed to Z3 in TIDBla-V (p < 0.01) and all three TIDBla-HR zones (all p < 0.01). Individual analysis revealed ranges of Z1, Z2, Z3 fractions for TIDBla-HR of 85–98%, 2–11% and 0.1–6%. For TIDBla-V, the individual ranges were 41–82% (Z1), 6–30% (Z2) and 8–30% (Z3) and for TIDRace 64–81% (Z1), 14–29% (Z2) and 4–10% (Z3). Conclusion The results show that the method of training intensity quantification substantially affects the fraction of TID in well-trained sprint kayakers. TIDRace determination shows low interindividual variation compared to the physiologically based TIDBla-HR and TIDBla-V. Depending on the aim of the analysis TIDRace, TIDBla-HR and TIDBla-V have advantages as well as drawbacks and may be implemented in conjunction to maximize adaptation.

Urinary Incontinence in Competitive Women Powerlifters: A Cross-Sectional Survey

Background Urinary incontinence (UI) can negatively affect a woman’s quality of life, participation in sport and athletic performance. The objectives of this study were to determine the prevalence of UI in competitive women powerlifters; identify possible risk factors and activities likely to provoke UI; and establish self-care practices. Methods This international cross-sectional study was conducted using an online survey completed by 480 competitive women powerlifters aged between 20 and 71 years. The Incontinence Severity Index (ISI) was used to determine the severity of UI. Results We found that 43.9% of women had experienced UI within the three months prior to this study. The deadlift was the most likely, and the bench-press the least likely exercise to provoke UI. ISI scores were positively correlated with parity (τ = 0.227, p < 0.001), age (τ = 0.179, p < 0.001), competition total (τ = 0.105, p = 0.002) and body mass index score (τ = 0.089, p = 0.009). There was no significant correlation between ISI and years strength training (τ = − 0.052, p = 0.147) or years powerlifting (τ = 0.041, p = 0.275). There was a negative correlation between ISI score with having a pelvic floor assessment (η = 0.197), and the ability to correctly perform pelvic floor exercises (η = 0.172). Conclusion The prevalence of UI in this cohort was at the upper limit experienced by women in the general population. Women who had undergone a pelvic floor examination or were confident in correctly performing pelvic floor exercises experienced less severe UI.