Managing travel fatigue and jet lag in athletes : a review and consensus statement

Athletes are increasingly required to travel domestically and internationally, often resulting in travel fatigue and jet lag. Despite considerable agreement that travel fatigue and jet lag can be a real and impactful issue for athletes regarding performance and risk of illness and injury, evidence on optimal assessment and management is lacking. Therefore 26 researchers and/or clinicians with knowledge in travel fatigue, jet lag and sleep in the sports setting, formed an expert panel to formalise a review and consensus document. This manuscript includes definitions of terminology commonly used in the field of circadian physiology, outlines basic information on the human circadian system and how it is affected by time-givers, discusses the causes and consequences of travel fatigue and jet lag, and provides consensus on recommendations for managing travel fatigue and jet lag in athletes. The lack of evidence restricts the strength of recommendations that are possible but the consensus group identified the fundamental principles and interventions to consider for both the assessment and management of travel fatigue and jet lag. These are summarised in travel toolboxes including strategies for pre-flight, during flight and post-flight. The consensus group also outlined specific steps to advance theory and practice in these areas.https://www.springer.com/journal/402792022-07-14hj2021Sports MedicineStatistic

Comparison of low-fat chocolate flavoured milk to the standard practice of care as a recovery intervention in Ironman athletes: A randomised control trial

The study compared whether athletes who ingested low-fat chocolate milk (LFCM), or the current standard oral intervention (water and Coca-Colaa) spent the same or shorter times in the end medical tent when presenting with exertional conditions during the 2018 Ironman South Africa (IMSA) triathlon competition. This randomised control trial included 42 athletes (aged 23 to 63 years; 7 Females; 35 Males) who completed the race and entered the medical tent due to an exertional condition. The athletes underwent a baseline assessment and were assigned to either an experimental group (EG: which consumed 350ml LFCM; n=22) or control group (CG: which ingested 350ml water and Coca-Cola; n=20). We determined ratios (After/Before) for all variables, including vital signs, venous blood gas analysis and modified Profile of Mood States (POMS) subscales. Both groups spent similar time-in-tent, recorded similar ratios and recovered as per expectation after strenuous exercise. Athletes in the EG had significantly lower heart rate (HR)(p=0.003), systolic blood pressure (p=0.041), pH (p<0.001), and POMS Fatigue-Inertia (p<0.001) after the recovery period, while partial pressure carbon dioxide (p<0.001), potassium (p=0.001), glucose (p=0.039), and POMS Vigour-Activity (p=0.023) readings increased significantly. Athletes in the CG had significantly lower HR (p<0.001) and POMS Fatigue-inertia (p=0.008) readings after the recovery period. Compared to current standard oral intervention, athletes with exertional conditions who drank LFCM did not experience any side effects or spend longer times in the final medical tent. Low-fat chocolate milk may be an acceptable alternative to conventional carbonated beverages and an optional oral recovery drink for ultra-endurance athletes in the medical tent

The use of skeletal muscle relaxants in musculoskeletal injuries: what is the evidence?

Skeletal muscle relaxants (SMRs) consist of a heterogeneous group of medications with a side effect profile of concern. The aim of this paper was to review the evidence of use of SMRs in the treatment of sports injuries. A literature search between 2005 – 2018 (Ovid MEDLINE, SPORTDiscus and SCOPUS) were conducted. In addition, citations within articles were searched, and the most commonly prescribed SMRs in South Africa were also used to explore the literature for additional publications. Relevant studies that met the inclusion criteria were selected. Clinical recommendations for general practitioners are given based on the Strength of Recommendation Taxonomy (SORT) level of evidence. Combination drugs rather than single agents are mostly used, however the effectiveness of SMR agents, single and in combination, as well as its significance as opposed to analgesics and non-steroidal anti-inflammatory drugs, still has to be evaluated. Evidence suggest SMRs to be probably effective for use in non-specific lower back pain (acute and chronic lower back muscle strains, ligament sprains, soft tissue contusions), as well as for whiplash associated disorder, mechanical neck disorders, piriformis syndrome, lateral epicondylosis, and plantar fasciitis. It does not appear if there is a role for SMRs as part of combination management for acute cervical strains, post-exercise muscle soreness or myofacial pain syndrome. However, substantial evidence to confirm the use of SMRs in the treatment of sports injuries have not been adequately investigated and is currently largely based on case reports and general reviews

How to manage travel fatigue and jet lag in athletes? A systematic review of interventions

Lastella, AM ORCiD: 0000-0003-1793-3811; Sargent, C ORCiD: 0000-0001-5340-4701; Vincent, GE ORCiD: 0000-0002-7036-7823Objectives: We investigated the management of travel fatigue and jet lag in athlete populations by evaluating studies that have applied non-pharmacological interventions (exercise, sleep, light and nutrition), and pharmacological interventions (melatonin, sedatives, stimulants, melatonin analogues, glucocorticoids and antihistamines) following long-haul transmeridian travel-based, or laboratory-based circadian system phase-shifts. Design: Systematic review Eligibility criteria Randomised controlled trials (RCTs), and non-RCTs including experimental studies and observational studies, exploring interventions to manage travel fatigue and jet lag involving actual travel-based or laboratory-based phase-shifts. Studies included participants who were athletes, except for interventions rendering no athlete studies, then the search was expanded to include studies on healthy populations. Data sources: Electronic searches in PubMed, MEDLINE, CINAHL, Google Scholar and SPORTDiscus from inception to March 2019. We assessed included articles for risk of bias, methodological quality, level of evidence and quality of evidence. Results: Twenty-two articles were included: 8 non-RCTs and 14 RCTs. No relevant travel fatigue papers were found. For jet lag, only 12 athlete-specific studies were available (six non-RCTs, six RCTs). In total (athletes and healthy populations), 11 non-pharmacological studies (participants 600; intervention group 290; four non-RCTs, seven RCTs) and 11 pharmacological studies (participants 1202; intervention group 870; four non-RCTs, seven RCTs) were included. For non-pharmacological interventions, seven studies across interventions related to actual travel and four to simulated travel. For pharmacological interventions, eight studies were based on actual travel and three on simulated travel. Conclusions: We found no literature pertaining to the management of travel fatigue. Evidence for the successful management of jet lag in athletes was of low quality. More field-based studies specifically on athlete populations are required with a multifaceted approach, better design and implementation to draw valid conclusions. PROSPERO registration number The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42019126852). © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ

Trail running injury risk factors: a living systematic review

OBJECTIVE: To review and frequently update the available evidence on injury risk factors and epidemiology of injury in trail running. DESIGN: Living systematic review. Updated searches will be done every 6 months for a minimum period of 5 years. DATA SOURCES: Eight electronic databases were searched from inception to 18 March 2021. ELIGIBILITY CRITERIA: Studies that investigated injury risk factors and/or reported the epidemiology of injury in trail running. RESULTS: Nineteen eligible studies were included, of which 10 studies investigated injury risk factors among 2 785 participants. Significant intrinsic factors associated with injury are: more running experience, level A runner and higher total propensity to sports accident questionnaire (PAD-22) score. Previous history of cramping and postrace biomarkers of muscle damage is associated with cramping. Younger age and low skin phototypes are associated with sunburn. Significant extrinsic factors associated with injury are neglecting warm-up, no specialised running plan, training on asphalt, double training sessions per day and physical labour occupations. A slower race finishing time is associated with cramping, while more than 3 hours of training per day, shade as the primary mode of sun protection and being single are associated with sunburn. An injury incidence range 0.7-61.2 injuries/1000 hours of running and prevalence range 1.3% to 90% were reported. The lower limb was the most reported region of injury, specifically involving blisters of the foot/toe. CONCLUSION: Limited studies investigated injury risk factors in trail running. Our review found eight intrinsic and nine extrinsic injury risk factors. This review highlighted areas for future research that may aid in designing injury risk management strategies for safer trail running participation.PROSPERO registration numberCRD42021240832

Sex differences in the nine-point Beighton hypermobility test scores

Joint hypermobility syndromes are often misinterpreted and wrongly diagnosed. Widely accepted naming such as Heritable Disorder of Connective Tissue has been shown to manifest features that closely overlap with better known disorders such as Marfan and Ehlers-Danlos syndromes and Osteogenesis Imperfecta. Currently the widely accepted - all-inclusive - diagnosis for generalised hypermobility is known as Benign Joint Hypermobility Syndrome (BJHS). People that do not have pain in their joints but still have lax joints are just considered to be hypermobile. It is currently understood that these are genetic-based conditions where connective tissue proteins such as collagen are formed differently. This results in the joints, muscles, tendons and ligaments being laxer and more fragile than is the case in non-hypermobile individuals. The aim of this study was to investigate possible differences in the occurrence of BJHS between males and females from a representative sample of a general population (aged 18-25). Testing was done on 300 recruits and 180 university students. The sample consisted of 55% males and 45% females. All subjects were tested using the 9-point Beighton criteria for diagnosis of BJHS, with scores of 4/9 and greater being indicative of BJHS. All data were pooled and differences were observed when comparing male and female Beighton test scores. Results showed 36.41% incidence for females compared to 13.96% for males (p ≤ 0.05). These differences may be due to hormonal influence on the laxity of tendons and ligaments. Furthermore it can also question the efficiency with which the Beighton score distinguishes between BJHS and general joint flexibility.http://www.ajol.info/journal_index.php?jid=153&ab=ajpher

The physical demands of wheelchair tennis match play: a systematic review with meta-analysis

BackgroundWheelchair tennis, a globally popular sport, features a professional tour spanning 40 countries and over 160 tournaments. Despite its widespread appeal, information about the physical demands of wheelchair tennis is scattered across various studies, necessitating a comprehensive systematic review to synthesise available data.ObjectiveThe aim was to provide a detailed synthesis of the physical demands associated with wheelchair tennis, encompassing diverse factors such as court surfaces, performance levels, sport classes, and sexes.MethodsWe conducted comprehensive searches in the PubMed, Embase, CINAHL, and SPORTDiscus databases, covering articles from inception to March 1, 2023. Forward and backward citation tracking from the included articles was carried out using Scopus, and we established eligibility criteria following the Population, Exposure, Comparison, Outcome, and Study design (PECOS) framework. Our study focused on wheelchair tennis players participating at regional, national, or international levels, including both juniors and adults, and open and quad players. We analysed singles and doubles matches and considered sex (male, female), sport class (open, quad), and court surface type (hard, clay, grass) as key comparative points. The outcomes of interest encompassed play duration, on-court movement, stroke performance, and physiological match variables. The selected study designs included observational cross-sectional, longitudinal, and intervention studies (baseline data only). We calculated pooled means or mean differences with 95% confidence intervals (CIs) and employed a random-effects meta-analysis with robust variance estimation. We assessed heterogeneity using Cochrane Q and 95% prediction intervals.ResultsOur literature search retrieved 643 records, with 24 articles meeting our inclusion criteria. Most available information focused on international male wheelchair tennis players in the open division, primarily competing in singles on hard courts. Key findings (mean [95% CI]) for these players on hard courts were match duration 65.9 min [55.0–78.8], set duration 35.0 min [28.2–43.5], game duration 4.6 min [0.92–23.3], rally duration 6.1 s [3.7–10.2], effective playing time 19.8% [18.9–20.7], and work-to-rest ratio 1:4.1 [1:3.7–1:4.4]. Insufficient data were available to analyse play duration for female players. However, for the available data on hard court matches, the average set duration was 34.8 min [32.5–37.2]. International male players on hard court covered an average distance per match of 3859 m [1917–7768], with mean and peak average forward speeds of 1.06 m/s [0.85–1.32] and 3.55 m/s [2.92–4.31], respectively. These players executed an average of 365.9 [317.2–422.1] strokes per match, 200.6 [134.7–299.0] per set, 25.4 [16.7–38.7] per game, and 3.4 [2.6–4.6] per rally. Insufficient data were available for a meta-analysis of female players’ on-court movement and stroke performance. The average and peak heart rates of international male players on hard court were 134.3 [124.2–145.1] and 166.0 [132.7–207.6] beats per minute, and the average match heart rate expressed as a percentage of peak heart rate was 74.7% [46.4–100]. We found no studies concerning regional players or juniors, and only one study on doubles match play.ConclusionsWhile we present a comprehensive overview of the physical demands of wheelchair tennis, our understanding predominantly centres around international male players competing on hard courts in the open division. To attain a more comprehensive insight into the sport’s physical requirements, future research should prioritise the inclusion of data on female and quad players, juniors, doubles, and matches played on clay and grass court surfaces. Such endeavours will facilitate the development of more tailored and effective training programmes for wheelchair tennis players and coaches.The protocol for this systematic review was registered a priori at the International Platform of Registered Systematic Review and Meta-analysis Protocols (Registration https://doi.org/10.37766/inplasy2023.3.0060)

The Physical Demands of Wheelchair Tennis Match Play: A Systematic Review with Meta-analysis.

Wheelchair tennis, a globally popular sport, features a professional tour spanning 40 countries and over 160 tournaments. Despite its widespread appeal, information about the physical demands of wheelchair tennis is scattered across various studies, necessitating a comprehensive systematic review to synthesise available data. The aim was to provide a detailed synthesis of the physical demands associated with wheelchair tennis, encompassing diverse factors such as court surfaces, performance levels, sport classes, and sexes. We conducted comprehensive searches in the PubMed, Embase, CINAHL, and SPORTDiscus databases, covering articles from inception to March 1, 2023. Forward and backward citation tracking from the included articles was carried out using Scopus, and we established eligibility criteria following the Population, Exposure, Comparison, Outcome, and Study design (PECOS) framework. Our study focused on wheelchair tennis players participating at regional, national, or international levels, including both juniors and adults, and open and quad players. We analysed singles and doubles matches and considered sex (male, female), sport class (open, quad), and court surface type (hard, clay, grass) as key comparative points. The outcomes of interest encompassed play duration, on-court movement, stroke performance, and physiological match variables. The selected study designs included observational cross-sectional, longitudinal, and intervention studies (baseline data only). We calculated pooled means or mean differences with 95% confidence intervals (CIs) and employed a random-effects meta-analysis with robust variance estimation. We assessed heterogeneity using Cochrane Q and 95% prediction intervals. Our literature search retrieved 643 records, with 24 articles meeting our inclusion criteria. Most available information focused on international male wheelchair tennis players in the open division, primarily competing in singles on hard courts. Key findings (mean [95% CI]) for these players on hard courts were match duration 65.9 min [55.0-78.8], set duration 35.0 min [28.2-43.5], game duration 4.6 min [0.92-23.3], rally duration 6.1 s [3.7-10.2], effective playing time 19.8% [18.9-20.7], and work-to-rest ratio 1:4.1 [1:3.7-1:4.4]. Insufficient data were available to analyse play duration for female players. However, for the available data on hard court matches, the average set duration was 34.8 min [32.5-37.2]. International male players on hard court covered an average distance per match of 3859 m [1917-7768], with mean and peak average forward speeds of 1.06 m/s [0.85-1.32] and 3.55 m/s [2.92-4.31], respectively. These players executed an average of 365.9 [317.2-422.1] strokes per match, 200.6 [134.7-299.0] per set, 25.4 [16.7-38.7] per game, and 3.4 [2.6-4.6] per rally. Insufficient data were available for a meta-analysis of female players' on-court movement and stroke performance. The average and peak heart rates of international male players on hard court were 134.3 [124.2-145.1] and 166.0 [132.7-207.6] beats per minute, and the average match heart rate expressed as a percentage of peak heart rate was 74.7% [46.4-100]. We found no studies concerning regional players or juniors, and only one study on doubles match play. While we present a comprehensive overview of the physical demands of wheelchair tennis, our understanding predominantly centres around international male players competing on hard courts in the open division. To attain a more comprehensive insight into the sport's physical requirements, future research should prioritise the inclusion of data on female and quad players, juniors, doubles, and matches played on clay and grass court surfaces. Such endeavours will facilitate the development of more tailored and effective training programmes for wheelchair tennis players and coaches. The protocol for this systematic review was registered a priori at the International Platform of Registered Systematic Review and Meta-analysis Protocols (Registration https://doi.org/10.37766/inplasy2023.3.0060 ). [Abstract copyright: © 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.