Profiles of illness and injury among South African elite athletes with disability at the 2012 Summer Paralympic Games

Epidemiological data is important to better understand injury and illness patterns in para athletes. Medical teams used a web-based injury and illness surveillance system (WEB-IISS system) to all the para-athlete injuries and illnesses during the 2012 London Paralympic games. All team physicians could access the system at any time to log data, providing a vast database for potential research. The relative ease of data collection permits large amounts of data to be analysed, providing important surveillance data on injury and illness. Data on the South African para-athletes, provided by the team's Chief Medical Officer, were assessed and compared to all countries. This study aimed to describe the illness and injury profiles in South African elite paraathletes who participated in the 2012 Summer Paralympic Games; and compare these profiles to data from the other countries that participated. A retrospective sub-analysis of the data-set collected from a large prospective study of injury and illness at the London Summer Paralympic Games in 2012 was compared to data collected on all para-athletes from input by team physicians into the WEB-ISS system. In total, 62 South African para-athletes presented with 19 injuries, with an injury rate of 21.9 per 1000 athlete days. Twenty-five para-athletes presented illness, with an illness rate of 28.8 per 1000 athlete days. The overall injury and illness rate in the South African para-athletes was higher than the injury and illness rate in all para-athlete participants at the London Paralympic Games. The anatomical distribution of injuries (lower limbs, axial and upper limbs) and the nature of illness (respiratory, skin & subcutaneous and digestive systems) were however similar. Causative factors are not evident and need to be further studied. Increased efforts in injury and illness surveillance and preventative programmes should be employed to reduce the incidence of injury and illness, and their severity . Such efforts in para-athlete care should be ongoing with surveillance to monitor and manage trends to ensure the culmination of Paralympic competition does not result in high rates of injury and illness. Education of healthcare providers, para-athletes, coaches and others in the management of para-athletes, is key

The great pretender: Multi-system tuberculosis and pathological fracture masquerading as a severe acute football groin injury ‒ Case study with a 5-year follow-up

In this clinical case, a man presented with a groin injury on his dominant side, which he apparently sustained in football (soccer) practice on the previous day. The man was unable to walk unassisted and had to be transported in a wheelchair. The consulting practitioner grew suspicious upon finding minimal clinical evidence and nothing notable on the X-ray to suggest a severe acute injury. A subsequent detailed workup revealed extrapulmonary tuberculosis (EPTB) of the musculoskeletal (MSK) and genitourinary tract (GUT) systems, complicated by a pathological fracture of the acetabulum, as the cause of the groin injury. Management of the EPTB resolved the condition with no relapse nor long-term sequelae beyond five years, despite being immunocompromised. We present the clinical case and a five year follow-up. The case serves as a reminder of the possibility that other conditions may mimic sports injuries and further illustrates a rare presentation of such a condition

Injuries at Johannesburg high school rugby festivals

Thesis (M.Sc.(Emergency Medicine))--University of the Witwatersrand, Faculty of Health Sciences, 2014.Aim. The aim of the study was to analyse the prevalence and type of injuries over two years of a Johannesburg High School rugby festival by assessing the injuries (number, anatomical sites, types and severity), to compare the injuries between the two years and to compare the injuries between the three days of the festival. Methods. The study design was a retrospective, descriptive and observational study. The study population was the participating rugby players at the two rugby festivals in 2010 and 2011. Medical records of rugby related injuries in schoolboy participants were used for capturing injury data. Results. A total of 626 players participated (322 and 304 in 2010 and 2011 respectively) of which there were a total of 100 injury data sets analysed. The injury rate per player in year one was 16.8%, and 15.2% in year two. There was no statistical difference (P = 0.6526) in the injury numbers between the two years. The injury profiles between the respective days between the two years were not statistically different. Most injuries were to the head/face, with the majority being concussion related. The next commonest injuries were to the neck area. Most injured players had not had previous similar injuries. Tackles were the commonest mechanism of injuries. Twenty four percent of injuries were deemed severe enough to stop the players from continuing play. Few required referral for investigations or specialist physician care and most were managed with simple first aid at the primary care level. Conclusion. The nature and mechanisms were in keeping with numerous local and international studies of schoolboy rugby players, but with a lower injury frequency. Providing medical services at rugby events such as these festivals is a requirement and adequate standardised record keeping is recommended to increase knowledge and monitor trends as the dynamic nature of the game of schoolboy rugby continues to develop and change

Effect of the 90-second ‘Gear’ exercise programme on cardiometabolic risk factors in persons with an elevated risk of cardiovascular disease

Background: High-intensity interval training has recently gained popularity at improving cardiometabolic health. However, a close investigation of high-intensity interval training reveals that the exercise duration is similar to moderate-intensity continuous exercise.Objective: To compare the effect of the time-efficient ‘Gear’ exercise programmes to traditional exercise on cardiometabolic risk factors in persons with an elevated risk of cardiovascular disease. Methods: The study implemented a six-week, randomised controlled trial. The variables were low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, total cholesterol, glycated haemoglobin (HbA1c), blood pressure and body composition. Forty-eight participants completed the study. Participants were randomly assigned to either the ‘Gear’ exercise programme repeated at different times during the day (GEP-DT): cycled for 90 seconds, repeated three times/day, for three days/week (n = 12); ‘Gear’ exercise programme at one point in time (GEP-OT): cycled for 90 seconds followed by 4 minutes and 30 seconds rest, repeated three times at one point in time, for three days/week (n = 14); 30 minutes of moderate-intensity continuous cycling repeated three days/week at 55-69% HRmax (n = 11); and the controls, who were encouraged not to exercise (n = 11). A demonstration of the ‘Gear’ exercise programme can be viewed on the following link https://www.youtube.com/watch?v=KAbkRg9ex94 Results: The 90-second GEP-DT intervention reduced HbA1c post six-weeks of training (MD = ­0.1±0.4, % Δ = -1.3%, d = ˗0.70). The GEP-OT group decreased blood triglycerides with a large effect size (MD = ­0.6±1.3, % Δ = ˗31.9%, d = ˗0.83). Conclusion: The novel 90-second ‘Gear’ exercise programme moderately reduced HbA1c and the 18-minute GEP-OT lowered blood triglycerides. ‘Gear’ exercise programmes will encourage future research in persons with non-communicable diseases, and it should be considered as a public health initiative to promote exercise in clinical, home and work environments

Changes in cardiorespiratory fitness and cardiovascular health in the workplace: a case study

Background: Cardiorespiratory fitness (CRF) is an independent predictor of cardiovascular (CV) and all-cause mortality, contributing a higher proportion of CV risk compared to other traditionally recognised risk factors. However, CRF is not included in usual workplace wellness protocols and, as such, employers are not aware of the importance of this factor. Aim: The aim of this case study was to explore the effect of a 12-week exercise intervention programme on CRF, CV health and medical health claims in a male participant who was employed by a corporate company with existing chronic diseases. Findings: Health outcome measures improved after the 12-week exercise intervention programme. CRF showed the greatest improvement and medical health claims were lowered during the three-month post-intervention period. Implications: CRF should be included as a health outcome measure in worksite wellness programmes and monitored

Exercise intervention for post-acute COVID-19 syndrome – do FITT-VP principles apply? A case study

The lack of standardisation of reporting exercise interventions hampers the development of best practice guidelines for long COVID patients. This case study on the effect of an exercise intervention in a long COVID patient applied the Consensus on Exercise Reporting Template (CERT) for reporting interventions. FITT-VP exercise prescription principles for long COVID rehabilitation are also suggested. A 58-year-old male, previously hospitalised for 14 days in the ward for the intensive care for the management of severe COVID-19 infection, joined an exercise rehabilitation programme. A medical history, anthropometric, biochemical, lung function, blood pressure, cardiorespiratory fitness and strength measures were all assessed before and after the eight week exercise intervention programme. Positive changes were found in all lung function test measures. Cardiorespiratory fitness, endurance capacity and muscle strength improved. However, the greatest improvements occurred in functional status, fatigue, dyspnoea and the state of depression levels. This case study suggested that in the absence of other instruments, the FITTVP principles may be used for long COVID patients, and CERT for reporting interventions, but these should be further researched

Management of Reduced Bone Mineral Density in HIV: Pharmacological Challenges and the Role of Exercise

Low bone mineral density is becoming more common among people living with HIV following the use of current antiretroviral therapy drugs such as tenofovir. Although pharmacological therapies used to treat low bone mineral density are associated with adverse effects and may increase the pill burden in people living with HIV who are already burdened by antiretroviral therapy drugs, non-pharmacological strategies to prevent and treat reduced bone mineral density resulting from antiretroviral therapy drugs in people living with HIV have not been fully explored. Despite evidence that exercise is effective in increasing bone mineral density, effects of exercise on low bone mineral density resulting from antiretroviral therapy drugs in HIV infected individuals are still unknown. This review highlights gaps in the strategies used to manage reduced bone mineral density resulting from antiretroviral therapy drugs and focuses on exercise as an alternative or adjunctive strategy

Postactivation performance enhancement (PAPE) of sprint acceleration performance

Postactivation performance enhancement (PAPE) is a principle that an acute bout of high-intensity voluntary exercise is followed by an enhancement in strength, speed or power production. This study intended to show a direct correlation between intensity, specificity and the outcome of a maximal task of sprint accelerations compared to a previously defined weighted plyometric intervention. In a randomised controlled, double-blind trial, professional footballers undertook 20 m maximal sprint accelerations at a baseline and at 2 and 6 min post-intervention after 1 of 3 interventions; 2 repetitions of 20 m sprint accelerations (S), 3 × 10 alternative leg weighted bounding (P) and control (C). Relative to the baseline there was a significant improvement for S over 10 and 20 m at 2 min of 0.12m.s−1 and 0.11m.s−1 and 6 min of 0.11m.s−1 and 0.12m.s−1. Relative to the baseline P also had a significant improvement over 10 and 20 m at 2 min 0.09m.s−1 and 0.09m.s−1 and 6 min of 0.11m.s−1 and 0.09m.s−1. There was a significant improvement in C between 2 and 6 min post-intervention at 10 and 20 m of 0.06m.s−1 and 0.08m.s−1. This finding suggests a maximal sprint acceleration may enhance the outcome of a subsequent maximal sprint acceleration at 2 min, but the latter results could not be directly attributed to the interventions as previous testing is likely to have influenced these outcomes

Radiological changes among artistic gymnasts in Gauteng Province

Background. The skeletal immaturity of competitive female gymnasts allows for a unique physiological predisposition to injuries as a result of the spine, limbs, ankles and wrists still growing. Studies have shown that lower back (spinal) injuries account for approximately 12% of injuries in female gymnasts.Objectives. The primary objective of the study was to determine the prevalence of radiological changes in female artistic gymnasts in South Africa. A further objective was to determine whether these radiological changes were associated with symptoms and with the amount of time spent training.Methods. A sample of 40 female artistic gymnasts with a mean of age 15.2 years (range 10 - 31) was included in the study. Thirty-one were active gymnasts and nine were retired at the time of the current study. Measuring instruments included questionnaires and X-rays.Results. X-ray analysis of symptomatic versus asymptomatic gymnasts showed no significant differences. Of the 18 gymnasts training <25 h/week, 13 (72%) had degenerative changes detectable by X-ray. Of the 22 gymnasts training >25 h/week, 15 (68%) had degenerative changes detected by X-ray. Radiological changes were higher than those in other studies.Conclusion. The prevalence of radiological changes was higher than international norms, however there was little difference between symptomatic and asymptomatic gymnasts. Patient self-reports of symptoms had little value in diagnosing change in the lumbar spine. Training duration affected the prevalence of changes in the lumbar spine and could be related to conditioning and experience

‘I’m doing it for myself’: Using a smartphone-based exercise service during the COVID-19 lockdown in the Faculty of Health Sciences, University of the Witwatersrand, South Africa

Background: Sufficient physical activity (PA) lowers poor health outcomes, with data showing these protective effects in populations under varying levels of lockdown during the COVID-19 pandemic. The advent of online PA programmes has created novel opportunities to offset the deleterious effects of inactivity. However, data are limited and the readiness and acceptance of such technology is unknown. These authors nevertheless noted an opportunity to investigate this approach based on promising emerging data at the time of the hard lockdown in South Africa. Objective: This exploratory study investigated the engagement and perceptions of a smartphone application to promote health and fitness in a sample of employees at a South African university. Methods: Employed members of staff (n=15) of the University of the Witwatersrand were recruited through email invitation during the hard Level 5 COVID-19 lockdown in 2020. Individualised home-based PA programmes were prescribed through a mobile application for a period of eight weeks. Researchers qualified in Biokinetics provided online supervision of the exercise sessions during the intervention. Participants were asked to complete a self-reported questionnaire about their use of the application. Thematic analysis was used to understand these responses. Results: Lack of motivation was perceived to have a negative effect on participation in the online PA programme. Only one participant reported using the mobile application consistently during the study period, while half of the participants reported having trouble with the usage of the application. The participants frequently mentioned the need for technical support and further engagement from the clinicians supervising the PA programme to ensure use and progression. Staff identified issues with connectivity and already having too many phone applications (apps) amongst the reasons for the technical difficulties. Conclusion: This study demonstrates the challenges and potential for the uptake of online PA interventions during COVID-19 and, despite its small sample size, the data provide important lessons learned that will be used as information in further investigations