Pain and physical activity levels among Rheumatoid Arthritis patients between the ages of 18 to 50 years in South Africa

Background: Little epidemiological research on rheumatoid arthritis (RA) has been done in Africa, suggesting that it is an uncommon illness. In rural South Africa, RA has an overall prevalence of 0.07% and a prevalence of 2.5% in urban areas; therefore, it is not as uncommon as perceived by the lack of research. Patient-centred programmes to improve physical function have been lacking and, as a result, the prior assumption was that physical activity should be avoided. Objectives: To determine pain and physical activity levels among RA patients between the ages of 18 to 50 years in South Africa. Methods: A combination of two questionnaires were used, namely, the Global Physical Activity Questionnaire (2002) and the Pain Outcomes Questionnaire (2003). The collated questionnaires were distributed by rheumatologists and on social media platforms to RA patients between the ages of 18 to 50 years old living in South Africa. This study had a sample size of 105 participants, with participation occurring through the online Google forms platform. Results: One hundred and five participants with RA were recruited with an average age of 38±9 years. Most of the participants were females (93.3%). Seventy-two percent of the sample was classified as physically active, where work, leisure and travel activities were considered. No significant correlation between pain and physical activity was evident (r=0.10; p=0.311). Results showed significant correlations between pain and personal grooming (r=0.30; p=0.002), pain and ambulation (r=0.60; p=0.000), and pain and stair climbing (r=0.60; p=0.000). Conclusion: Physical activity has proven to have multiple benefits for those suffering with RA. In this South African sample of RA patients, the majority were classified as physically active, and pain did not affect the activity levels of the involved participants. This study opens further research questions regarding RA prevalence in South Africa, and the type and intensity of physical activity that would be beneficial for RA.

Major steps in 2021

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Position-specific physical and technical demands during the 2019 COPA America Football tournament

Objective: The purpose of the study was to examine the physical and technical characteristics of football players according to specific playing positions at the 2019 COPA America tournament. Methods: A total of 180 match observations from 13 games were monitored using the InStat tracking system. Players were grouped into the following five playing positions: central defenders (n = 45), wide defenders (n = 46), central midfielders (n = 50), wide midfielders (n = 17), and forwards (n = 22). Results: Descriptive statistics (means ± standard deviations) and a one-way analysis of variance were used to analyse the data. Findings showed the total distance covered by central midfielders (10553 ± 763) was significantly (p < 0.01) higher than central defenders (9226 ± 720 m; ES: 1.79), wide defenders (9929 ± 633 m; ES: 0.89) and forwards (9383 ± 820 m; ES: 1.45). Wide midfielders (214 ± 170 m), wide defenders (152 ± 199 m) and forwards (138 ± 94 m) covered greater distances sprinting than central defenders (67 ± 42 m; ES: 1.19, 0.59, 0.98) and central midfielders (91 ± 66 m; ES: 0.95, 0.41, 0.58). Concerning technical variables, central midfielders played significantly more passes compared to players in other playing positions (p < 0.01). In relation to crossing, wide defenders completed significantly more crosses than players in other positions (p < 0.01). Conclusion: These findings have direct implications for tailoring tactics so players can meet the physical and technical demands of the game.

Absolute and relative reliability of SCRuM test battery components assembled for schoolboy rugby players playing competitive rugby in low-resource settings: A pragmatic in-season test-retest approach

Background: Schoolboy rugby is a popular sport which forms the bedrock of rugby development in many African countries, including Zimbabwe. With burgeoning talent identification programmes, the development of multi-dimensional, logically- validated, and reliable test batteries is essential to inform the objective selection of potentially talented young rugby athletes. Objectives: This study sought evidence on the absolute and relative test-retest reliability of the component test items in the newly-assembled SCRuM test battery. Methods: Utilising a pragmatic test-retest experimental design, a sample of 41 Under-19 schoolboy players playing competitive rugby in the elite Super Eight Schools Rugby League in Harare, Zimbabwe, participated in the study. Results: Physiological and game-specific skills tests which showed good to excellent relative reliability and acceptable absolute reliability, included: 20 m and 40 m speed, L-run, Vertical Jump (VJ), 60 s Push-Up, 2 kg Medicine Ball Chest Throw test (2 kg MBCT), Wall Sit Leg Strength test (WSLS), Repeated High Intensity Exercise test (RHIE), One Repetition Maximum Back Squat (1-RM BS) and Bench Press tests (1-RM BP), Yo-Yo Intermittent Recovery Level 1 test (Yo-Yo IRT L1), Tackling Proficiency test, Passing Ability Skill test and Running and Catching Ability skill test. Conclusion: All these tests are reliable and warrant inclusion in the SCRuM test battery for possible profiling of U19 schoolboy rugby players during the ‘in-season’ phase provided there is adequate participant familiarisation and test standardisation. The test-retest ICCs and measurement errors are generalisable to other young athletes in this population, making the tests useful for the evaluation of training and developmental effects of the measured constructs.

24 hour movement behaviours and the health and development of pre-school children from Zimbabwean settings: the SUNRISE pilot study

Background: In 2019, the World Health Organization (WHO) released global guidelines for physical activity, sedentary behaviour and sleep for the early years. The International Study of Movement Behaviours in the Early Years, SUNRISE, aimed to assess the extent to which children aged three and four years meet the WHO global guidelines and its association with health and development. Objectives: To assess movement behaviours in pre-school children from low-income settings in Zimbabwe and to establish associations between these movement behaviours and adiposity, motor skills and executive function.Methods: Pre-school children/caregivers were recruited from two urban and two rural public schools respectively in Zimbabwe. The caregivers answered questions on the children’s physical activity, screen time, sedentary behaviour and sleep patterns. Children’s movement behaviours were objectively measured using accelerometers. Gross and fine motor skills and executive function were assessed using the Ages and Stages Questionnaire-3 and Early Years Toolbox, respectively. Focus group discussions were carried out with caregivers and teachers on the acceptability and feasibility of the study. Results: Eighty-one children participated in the study. The proportions of children meeting the guidelines were physical activity 92%, sedentary behaviour 70%, and sleep 86%, and all guidelines combined 24%. Boys and girls were similar (p>0.05 for all variables) for all executive function variables, but rural children had significantly lower inhibition scores (p=0.026) than urban children. Conclusion: The study adds to the growing literature on movement behaviours and associated risk factors in low-resourced settings. Further investigations of movement behaviours in this age group in Zimbabwe are recommended.

Injury incidence and burden during senior inter-provincial field hockey tournaments

Background: Field hockey is an Olympic sport played internationally and in which South Africa is a participating nation. It also has its own world cup. Few injury studies have been published on South African field hockey. Research efforts should increase within the sport to ensure safe participation and mitigate the inherent injury risks. Objectives: The objective of the study was to attend the male and female inter-provincial field hockey tournaments in South Africa and determine the incidence of injury and burden of acquired sport injuries (time-loss and medical attention). Methods: A quantitative, descriptive, longitudinal study, including 133 females and 139 males, was conducted. Participants completed baseline questionnaires prior to the tournament and post-match questionnaires detailing injuries during the tournament. Results: The recorded injuries were 77.9 (females) and 99.5 (males) per 1 000 player match hours. Medical attention was 51.9 (females) and 70.3 (males) injuries per 1 000 player match hours. The result for time-loss injuries was 4.3 (females) and 7.5 (males) injuries per 1 000 player match hours. Discussion: The study found high incidence rates of all injuries and medical attention injuries; however, the incidence of time-loss injuries was low in comparison to existing literature. Comparing current results to existing literature is challenging due to the heterogeneity of methodologies and injury definitions in field hockey research. Conclusion: This was the largest observational study in field hockey conducted in South Africa. The international sporting body should establish a consensus for future research and the South African Hockey Association explore long-term surveillance in South Africa to mimic similar national codes.

Recommendations for the return of spectators to sport stadiums: A South African Sports Medicine Association (SASMA) position statement – Part 4

All sports were discontinued in 2020 with the arrival of COVID-19. Since then most have been reinstated, albeit without spectators. However, several countries have put together a number of different risk-mitigating strategies to allow spectators back into stadiums. This position statement gives an outline of the minimum requirements that should be considered upon the return of spectators at live sporting events.

Recommendations for athletes and COVID-19 vaccinations: A South African Sports Medicine Association (SASMA) position statement – Part 3

The COVID-19 pandemic initially led to the shutdown of all sport at a high cost to both the economy and athlete health. As risk-mitigating protocols evolved and were implemented, the playing of sport returned slowly to normal. The introduction of COVID-19 vaccinations enhances the means of protection and risk management for all. This South African Sports Medicine Association position statement provides recommendations for the vaccination of athletes.

Self-compassion mediates the relationship between dispositional mindfulness and athlete burnout among adolescent squash players in South Africa

Background: Dispositional mindfulness has been found to positively impact athlete burnout. Furthermore, self- compassion has been identified as a potential mechanism of action through which mindfulness is related to lower rates of athlete burnout. However, this interaction has yet to be investigated among adolescents. Objectives: To determine whether self-compassion mediates the relationship between dispositional mindfulness and athlete burnout among adolescent squash players in South Africa. Methods: Competitive adolescent squash players (n=158) from two provinces in South Africa completed measures of dispositional mindfulness, self-compassion and athlete burnout. Intercorrelations were calculated between the three variables. An ordinary least squares regression analysis was performed to test the indirect effect of self-compassion on the relationship between dispositional mindfulness and the three components of athlete burnout. Results: Both dispositional mindfulness and self-compassion were negatively related to athlete burnout, while displaying positive correlations with each other. Self-compassion was found to partially mediate the relationship between dispositional mindfulness and a sense of reduced accomplishment (b = -0.075; 95% CI [-0.037;-0.012]), as well as the association between dispositional mindfulness and sport devaluation (b = -0.056; 95% CI [-0.099;-0.022]). The relationship between dispositional mindfulness and exhaustion was, however, not mediated by self-compassion (b = -0.002; 95% CI [-0.052; 0.049]). Conclusion: The effect of dispositional mindfulness on certain components of athlete burnout is partially mediated by self- compassion among adolescent athletes. Based on the current findings, interventions aimed at increasing mindfulness among adolescent athletes appear to be a potential avenue by which to reduce certain aspects of burnout, partially through increasing self-compassion.

The prevention of injuries among youth basketballers according to the “Sequence of Prevention’’: a systematic review

Background: Basketball is played by the youth worldwide, and various injuries occur in youth basketball. There is currently no overview of the incidence, the risk factors and preventive measures of musculoskeletal injuries among youth basketball players. Objective: This systematic review describes the most common injuries among youth basketball players. The most common risk factors and various preventive measures and interventions have also been reported and discussed. Methods: Search strategies were built based on groups of keywords, namely ‘injury’, ‘youth basketball’, and ‘cohort’. Search strategies were entered into Medline and SPORTDiscus. Titles, abstracts and full text articles were screened by two researchers. Data from the included articles were extracted by one researcher and checked by another researcher. Results: Twenty-seven studies showed that the overall injury rate ranged from 2.64 to 3.83 per 1 000 hours of exposure. Ankle- (22%-37%) and knee injuries (5%-41%) were the most common injuries. Risk factors for knee injuries included ankle dorsiflexion with a range less than 36.5 degrees and female athletes with greater hip abduction strength. High variations of postural sway corresponded to occurrences of ankle injuries (p=0.01, OR =1.22; p<0.001, OR =1.22). A core intervention (rate = 4.99/1 000 athlete exposure (AEs)) focused on the trunk and lower extremity led to a reduction in injuries compared to a sham intervention (rate =7.72/1 000 AEs) (p=0.02). Wearing a McDavid Ultralight 195 brace reduced ankle injuries compared to the controls (HR 0.30; 95 % CI 0.17 0.90; p=0.03). Conclusion: Ankle and knee injuries are the most common injuries among youth basketball players. Poor postural control, reduced ankle dorsiflexion and high hip abduction strength are the main risk factors. A neuromuscular warm-up, in combination with strength and stability exercises, seems to be the best training method to prevent injuries. Ankle injuries can be reduced by wearing a lace-up ankle brace.