The Challenge of Applying and Undertaking Research in Female Sport

In recent years there has been an exponential rise in the professionalism and success of female sports. Practitioners (e.g., sport science professionals) aim to apply evidence-informed approaches to optimise athlete performance and well-being. Evidence-informed practices should be derived from research literature. Given the lack of research on elite female athletes, this is challenging at present. This limits the ability to adopt an evidence-informed approach when working in female sports, and as such, we are likely failing to maximize the performance potential of female athletes. This article discusses the challenges of applying an evidence base derived from male athletes to female athletes. A conceptual framework is presented, which depicts the need to question the current (male) evidence base due to the differences of the "female athlete" and the "female sporting environment," which pose a number of challenges for practitioners working in the field. Until a comparable applied sport science research evidence base is established in female athletes, evidence-informed approaches will remain a challenge for those working in female sport

Association between sodium-glucose cotransporter 2 (SGLT2) inhibitors and lower extremity amputation: A systematic review and meta-analysis

BACKGROUND: The association between sodium-glucose cotransporter 2 inhibitors (SGLT2i\u27s) and lower extremity amputation is unclear. PURPOSE: To systematically review randomized control trials (RCTs) and observational studies quantifying risk of lower extremity amputations associated with SGLT2i use. DATA SOURCES AND STUDY SELECTION: We searched PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials from January 2011 to February 2020 for RCTs and observational studies including lower extremity amputation outcomes for individuals with type 2 diabetes mellitus treated with SGLT2i\u27s vs. alternative treatments or placebo. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data. MAIN OUTCOMES AND MEASURES: Our primary outcome was risk of lower limb amputation. Secondary outcomes included peripheral arterial disease, peripheral vascular disease, venous ulcerations, and diabetic foot infections. We also evaluated the risk of bias. We conducted random and fixed effects relative risk meta-analysis of RCTs. RESULTS: After screening 2,006 studies, 12 RCTs and 18 observational studies were included, of which 7 RCTs and 18 observational studies had at least one event. The random effects meta-analysis of 7 RCTs suggested the absence of a statistically significant association between SGLT2i exposure with evidence of substantial statistical heterogeneity (n = 424/23,716 vs n = 267/18,737 in controls; RR 1.28, CI\u27s 0.93-1.76; I2 = 62.0%; p = 0.12) whereas fixed effects analysis showed an increased risk with statistical heterogeneity (RR 1.27, 1.09-1.48; I2 = 62%; p = 0.003). Subgroup analysis of canagliflozin vs placebo showed a statistically significantly increased risk in a fixed effects meta-analysis (n = 2 RCTs, RR 1.59, 1.26-2.01; I2 = 88%; p = 0.0001) whereas the meta-analysis of dapagliflozin or empagliflozin (n = 2 RCTs each) and a single RCT for ertugliflozin did not show a significantly increased risk. The findings from observational studies were too heterogeneous to be pooled in a meta-analysis and draw meaningful conclusions. Both randomized and observational studies were of generally good methodological quality. CONCLUSIONS: Overall, there was no consistent evidence of SGLT2i exposure and increased risk of amputation. The increased risk of amputation seen in the large, long-term Canagliflozin Cardiovascular Assessment Study (CANVAS) trial for canagliflozin, and select observational studies, merits continued exploration

The propensity of non-concussive and concussive head contacts during elite-level women's rugby league matches : A prospective analysis of over 14,000 tackle events

Objectives Identify the frequency, propensity, and factors related to tackle events which result in contact with the head in elite-level women's rugby league. Design Prospective video analysis study. Methods Video footage from 59 Women's Super League matches were analysed (n = 14,378 tackle events). All tackle events were coded as no head contact or head contact. Other independent variables included: area contacting head, impacted player, concussion outcome, penalty outcome, round of competition, time in match and team standard. Results There were 83.0 ± 20.0 (propensity 304.0/1000 tackle events) head contacts per match. The propensity of head contact was significantly greater for the tackler than ball-carrier (178.5 vs. 125.7/1000 tackle events; incident rate ratio 1.42, 95 % confidence interval 1.34 to 1.50). Head contacts occurring from an arm, shoulder, and head occurred significantly more than any other contact type. The propensity of concussions was 2.7/1000 head contacts. There was no significant influence of team standard or time in match on the propensity of head contacts. Conclusions The observed head contacts can inform interventions, primarily focusing on the tackler not contacting the ball-carrier's head. The tackler's head should also be appropriately positioned to avoid contact with the ball-carrier's knee (highest propensity for concussion). The findings are consistent with other research in men's rugby. Law modifications and/or enforcement (reducing the number of un-penalised head contacts), concurrent with coaching interventions (optimising head placement or reducing the head being contacted) may help minimise head contact risk factors for women's rugby league

Oral contraceptive use in Premiership and Championship women's rugby union: perceived symptomology, management strategies, and performance and wellness effects

The aim of this study was to investigate the prevalence of oral contraceptive use in domestic rugby union, to compare symptomology by contraceptive use, and to determine symptom management strategies. Additionally, to characterise the perceived influence of oral contraceptive use and non-use on wellness and performance. A total of 238 Premiership and Championship women's rugby union players completed an online questionnaire. The survey was comprised of questions relating to player characteristics, hormonal or non-hormonal contraceptive characteristics, perceived symptomology, symptom management strategies, and performance and wellness characteristics. The prevalence of oral contraceptive users was 26%. Non-hormonal contraceptive users reported greater perceived negative symptomology (i.e., back pain, nausea, sore breasts) and performance and wellness effects (i.e., fatigue, stress, mood, concentration, power, match-play) than oral contraceptive users. The most common symptom management strategies were medication (33%), nutritional interventions (20%), and training modulation (20%). Twelve percent of players had previously spoken to staff about their menstrual cycle (i.e., regular and irregular) or contraceptive use. The most common barriers to speaking to staff were 'male staff' (29%) and 'club culture' (24%). The importance of assisting non-hormonal contraceptive users in managing symptoms is evident. Emphasis on overcoming barriers to staff-player dialogue regarding menstrual/contraceptive cycle is required

Shoulder complaints in wheelchair athletes: A systematic review

Background: In recent years the popularity of disabled sports and competition among disabled athletes has grown considerably. With this rise in exposure of, and participation in wheelchair sports comes an increase in related stressors, including musculoskeletal load. External mechanical loading may increase the risk of shoulder complaints. The objective of this literature review was to 1) identify and describe the prevalence and/or incidence of shoulder complaints in wheelchair athletes in the literature, to 2) examine the factors and underlying mechanisms that could be potentially involved, and 3) provide some insights into the development of preventative measures. Methods: A literature search was conducted using PubMed, Scopus and Embase databases, to identify relevant published articles. All articles in the English language that contained any type of shoulder complaint in relation with a wheelchair sports player, at any level of status (recreational to elite), of any sport, were included. Articles were excluded if they did not include any statistical analysis. Articles that included studies with wheelchair athletes in combination with athletes of other disability sports were excluded in order to be able to differentiate between the two. Narrative, exploratory and case studies were also excluded. Two reviewers independently assessed articles for inclusion. Thirteen articles matched the selection criteria. These were judged on their quality by use of an adapted version of the Webster checklist. Results: Of the included studies the overall quality was low. A relatively high prevalence of complaints was found, ranging from 16% to 76%. Pain was found to be a common complaint in wheelchair athletes. Based on the current literature the cause of shoulder problems is difficult to identify and is likely multifactorial, nevertheless characteristics of the user (i.e. increased years of disability, age and BMI) were shown to increase risk. Preventative measures were indistinct. There may be a role for balanced strength training regimens to decrease risk. Conclusion: Shoulder complaints in wheelchair athletes are a common problem that must be addressed further. Future studies on shoulder overuse injuries of wheelchair athletes should be directed towards biomechanical modeling to develop knowledge of load and its effects

Conceptual model described by Hoozemans et al. [7], based upon the model of Westgaard and Winkel [33] and the model of Van Dijk [34].

<p>Conceptual model described by Hoozemans et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0188410#pone.0188410.ref007" target="_blank">7</a>], based upon the model of Westgaard and Winkel [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0188410#pone.0188410.ref033" target="_blank">33</a>] and the model of Van Dijk [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0188410#pone.0188410.ref034" target="_blank">34</a>].</p

Summary of studies describing the subjects and athletic activities, where the samples were drawn from, the study designs, measurement tools, types of complaints, current prevalence, proposed mechanisms and potential preventative measures.

<p>Summary of studies describing the subjects and athletic activities, where the samples were drawn from, the study designs, measurement tools, types of complaints, current prevalence, proposed mechanisms and potential preventative measures.</p

Quality assessment adapted from Webster et al. [23].

<p>Quality assessment adapted from Webster et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0188410#pone.0188410.ref023" target="_blank">23</a>].</p

The effect of load on Achilles tendon structure in novice runners

Objectives: To observe the changes in Achilles tendon structure in novice runners, with loading prescriptions of 100% body weight compared to 20% body weight. Design: Randomised crossover. Methods: Twenty novice runners participated in two separate running bouts spaced 14 days apart, one of high load at 100% body weight, and one of low load at 20% body weight. Tendon structure was measured by ultrasonographic tissue characterisation on 6 occasions; immediately prior to each run, 2 and 7 days after each run. Results: The interaction effect of time and condition was not found to be significant for echotypes I-IV [Wald chi-square = 2.8, d.f. = 2, P=0.247; Wald chi-square=2.888, d.f. = 2, P=0.236; Wald chi-square=1.385, d.f. = 2, P=0.5; Wald chi-square=4.19, d.f. = 2, P=0.123], respectively. A significant effect of time was found for echotypes Ill [Wald chi-square=6.785, d.f. = 2, P=0.0.034] and IV [Wald chi-square=7.491, d.f. = 2, P=0.0.024]. Conclusions: The decrease in echotypes III and IV suggest that moderate loads can be applied to the Achilles tendon without compromising tendon structure. Low to moderate loads may be beneficial in the management of Achilles tendinopathy. Further studies should focus on protocols with higher loading and/or repetitive loading in athletic populations with and without Achilles tendinopathy to assess any differences in tendon structure. (C) 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved

Association between task and user factors and complaints.

<p>Association between task and user factors and complaints.</p