South African Sports Medicine Association position statement on exercise in pregnancy

There are many concerns about exercise during pregnancy, with medical advice historically dissuading women from continuing or initiating regular exercise programmes. However, research has shown that high levels of exercise are not associated with an increased incidence of negative events. Currently, many women of childbearing age wish to continue with their exercise programmes during pregnancy. Appropriate guidance and exercise counselling by the attending care provider can fulfil this need. This position statement aims to assist pregnant women and their care providers in assessing the merits and benefits of improving and maintaining fitness during this period.http://www.journals.co.za/sama/m_sajsm.htm

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.http://www.safpj.co.za/index.php/safpjam2019PhysiotherapySports Medicin

One in five trail running race entrants sustained an injury in the 12 months training period before the 2021 Mac Mac ultra race

DATA AVAILABILITY: Data are available upon reasonable request.BACKGROUND : Trail running is characterised by large elevation gains/losses and varying uneven running surfaces. Limited literature is available to help guide injury prevention strategies among trail runners. The purpose of this study was to determine the epidemiology, clinical characteristics, and related risk factors for running-related injuries (RRIs) amid trail runners who entered the 2021 Mac Mac Ultra races. METHODS : DESIGN : Descriptive cross-sectional study. SETTING : 2021 Mac Mac Ultra Race. PARTICIPANTS : Consent for data analysis was given by 251 of 330 (76%) race entrants. MAIN OUTCOME MEASURES : Point prevalence (%), frequency (n, %), retrospective annual incidence (RRIs/100 athlete-years), characteristics (pathology type, tissue type, body area, anatomical region), and associated injury risk factors (training and demographic variables) of RRIs. RESULTS : In the sample, the retrospective annual incidence was 19.92/100 athlete-years. The point prevalence was 4%. Injuries mostly appeared in the lower limb (95%), with the lower leg (26%), thigh (22%), ankle and foot (13%) described as the highest injured body areas. Of tissue type injuries, muscle/tendon comprised 60%. Muscle injury (36%), tendinopathy (24%), and joint sprain (9%) were the most reported pathology types. No related injury risk factors were discovered in this study. CONCLUSIONS : One in five trail runners reported one or more RRI during the 12 months before a competitive event. RRIs commonly involved the low.https://www.mdpi.com/journal/applsciPhysiotherapySports MedicineStatistic

Chronic disease, allergies, and increased years of running are risk factors predicting gradual onset running-related injuries in ultramarathon runners—SAFER XIX study in 29 585 race entrants

OBJECTIVES : To identify risk factors that predict gradual onset running-related injuries (GORRIs) in ultramarathon runners entering a mass community-based event. DESIGN : Descriptive cross-sectional study. SETTING : Two Oceans 56 km ultramarathon 2012 to 2015. PARTICIPANTS : Race entrants (n = 42 003) completed a compulsory pre-race medical history questionnaire; 29 585 (70.4%) of entrants consented. DEPENDENT/OUTCOME VARIABLE : A history of GORRIs in the past 12 months among race entrants. MAIN OUTCOME MEASURES : In a multi-variate model, runner demographics, training variables (years of recreational running, weekly running distance, training running speed), history of chronic disease (composite score), and history of allergies were included as factors predicting GORRIs. Prevalence (%) and prevalence ratios (PR, 95% CIs) are reported. RESULTS : The lifetime prevalence of GORRIs in ultramarathon runners was 24.4%. Independent factors predicting GORRIs were: higher chronic disease composite score (PR = 2.05 times increase risk for every 2 additional chronic diseases; P < 0.0001), history of allergies (PR = 1.66; P < 0.0001), increased years of recreational running (PR = 1.07 times increased risk for every 5 year increase in running; P < 0.0001), lower average weekly running distance (PR = 0.98 times decreased risk for every 15 km increase weekly running distance; P < 0.0001), and slower average training running speed (PR = 0.96 times decreased risk for every km/h increase in training running speed; P < 0.0001). CONCLUSIONS : Novel risk factors predicting GORRIs are increased number of chronic diseases and a history of allergies. These factors, together with training variables (years of recreational running, weekly running distance, and training running speed) can be targeted to develop and implement injury prevention, treatment, and rehabilitation interventions in ultramarathon runners.IOC Research Centre (South Africa) and South African Medical Research Council.http://www.cjsportmed.com2022-06-09hj2021Sports Medicin

Chronic Disease, Allergies, and Increased Years of Running Are Risk Factors Predicting Gradual Onset Running-Related Injuries in Ultramarathon Runners—SAFER XIX Study in 29 585 Race Entrants

OBJECTIVES : To identify risk factors that predict gradual onset running-related injuries (GORRIs) in ultramarathon runners entering a mass community-based event. DESIGN : Descriptive cross-sectional study. SETTING : Two Oceans 56 km ultramarathon 2012 to 2015. PARTICIPANTS : Race entrants (n = 42 003) completed a compulsory pre-race medical history questionnaire; 29 585 (70.4%) of entrants consented. DEPENDENT/OUTCOME VARIABLE : A history of GORRIs in the past 12 months among race entrants. MAIN OUTCOME MEASURES : In a multi-variate model, runner demographics, training variables (years of recreational running, weekly running distance, training running speed), history of chronic disease (composite score), and history of allergies were included as factors predicting GORRIs. Prevalence (%) and prevalence ratios (PR, 95% CIs) are reported. RESULTS : The lifetime prevalence of GORRIs in ultramarathon runners was 24.4%. Independent factors predicting GORRIs were: higher chronic disease composite score (PR = 2.05 times increase risk for every 2 additional chronic diseases; P < 0.0001), history of allergies (PR = 1.66; P < 0.0001), increased years of recreational running (PR = 1.07 times increased risk for every 5 year increase in running; P < 0.0001), lower average weekly running distance (PR = 0.98 times decreased risk for every 15 km increase weekly running distance; P < 0.0001), and slower average training running speed (PR = 0.96 times decreased risk for every km/h increase in training running speed; P < 0.0001). CONCLUSIONS : Novel risk factors predicting GORRIs are increased number of chronic diseases and a history of allergies. These factors, together with training variables (years of recreational running, weekly running distance, and training running speed) can be targeted to develop and implement injury prevention, treatment, and rehabilitation interventions in ultramarathon runners.IOC Research Centre (South Africa) and South African Medical Research Council.http://www.cjsportmed.com2022-06-09hj2021Sports Medicin

Chronic prescription medication use in endurance runners : a cross-sectional study in 76,654 race entrants – SAFER XV

OBJECTIVE : To determine the prevalence of chronic prescription medication (CPM) use in distant runners (by age and sex) and to compare CPM use in 21.1 km vs. 56 km race entrants. METHODS : A cross-sectional study of 76,654 race entrants who completed a pre-race medical screening questionnaire during race registration, which included questions on the use of CPM and CPM use in eight main categories of CPM. Prevalence (%, 95%CIs) and prevalence ratios (PR) are reported. RESULTS : The prevalence of any CPM use was 12.5% (12.2–12.8). CPM use was higher in older age categories vs. the youngest age category (31–40 yrs vs. ≤30 yrs: PR = 1.4; 41–50 yrs vs. ≤30 yrs: PR = 2.1; >50 yrs vs. ≤30 yrs: PR = 3.4) (p < 0.0001) and females vs. males (PR = 1.1; p < 0.0001). The use of any CPM was significantly higher in 21.1 km vs. 56 km race entrants (PR = 1.2; p < 0.0001). Prevalence of CPM use in main categories was: blood pressure lowering medication (3.7%), cholesterol lowering medication (3.6%), asthma medication (3.1%), and medication to treat anxiety/depression (2.6%). The pattern of CPM in the main categories differed between 21.1 km and 56 km race entrants. CONCLUSIONS : One in eight race entrants use CPM, with a higher prevalence of use among older race entrants, female vs. males, and 21.1 km vs. 56 km race entrants. Frequent CPMs used are blood pressure lowering medication, cholesterol lowering medication, asthma medication, and medication to treat anxiety/depression. The use of CPM medications may increase the risk of medical complications during exercise, and these data help identify subgroups of entrants that may be at higher risk for race medical encounters.The International Olympic Committee (IOC) Research Centre (South Africa) at the University of Pretoria and the South African Medical Research Council (SAMRC).https://tandfonline.com/toc/ipsm20hj2022Sports Medicin

Nowhere to hide : the significant impact of coronavirus disease 2019 (COVID-19) measures on elite and semi-elite South African athletes

OBJECTIVES : To describe the perceptions of South African elite and semi-elite athletes on return to sport (RTS); maintenance of physical conditioning and other activities; sleep; nutrition; mental health; healthcare access; and knowledge of coronavirus disease 2019 (COVID-19). DESIGN : Cross- sectional study. METHODS : A Google Forms survey was distributed to athletes from 15 sports in the final phase (last week of April 2020) of the level 5 lockdown period. Descriptive statistics were used to describe player demographic data. Chi-squared tests investigated significance ( p < 0.05) between observed and expected values and explored sex differences. Post hoc tests with a Bonferroni adjustment were included where applicable. RESULTS : 67% of the 692 respondents were males. The majority (56%) expected RTS after 1–6 months. Most athletes trained alone (61%; p < 0.0001), daily (61%; p < 0.0001) at moderate intensity (58%; p < 0.0001) and for 30–60 min (72%). During leisure time athletes preferred sedentary above active behaviour ( p < 0.0001). Sleep patterns changed significantly (79%; p < 0.0001). A significant number of athletes consumed excessive amounts of carbohydrates (76%; p < 0.0001; males 73%; females 80%). Many athletes felt depressed (52%), and required motivation to keep active (55%). Most had access to healthcare during lockdown (80%) and knew proceedings when suspecting COVID-19 (92%). CONCLUSIONS : COVID-19 had physical, nutritional and psychological consequences that may impact on the safe RTS and general health of athletes. Lost opportunities and uncertain financial and sporting futures may have significant effects on athletes and the sports industry. Government and sporting federations must support athletes and develop and implement guidelines to reduce the risk in a COVID-19 environment.http://www.elsevier.com/locate/jsam2021-07-01hj2020Sports MedicineStatistic

Efficacy of an exercise programme on the functional capacity and disease activity in females with rheumatoid arthritis

BACKGROUND: Rheumatoid arthritis (RA) is a chronic, immune-inflammatory disease of unknown aetiology affecting the synovial membrane of joints and surrounding tissues. Typically RA affects both large and small joints in a bilateral, symmetrical, poly-articular fashion. Degradation of bone, cartilage and muscle eventually lead to a reduction in physical function. The purpose of this study was to determine the efficacy of an endurance exercise programme on the fitness parameters (flexibility, strength and aerobic measurements), quality of life (visual analogue scale and health assessment questionnaire) and disease activity (DAS28[4] version with CRP) of female RA patients. METHODS: Female RA patients were randomly allocated to the experimental group (EG) (n=19) and the control group (CG) (n=8). All participants went through a battery of tests before the intervention, and again after completion of the study. The 12 week training programme consisted of three 45-minute training sessions per week and included walking or aquatics, as well as stretches and isotonic strengthening exercises. The Mann-Whitney U test was used to compare measurements between groups. The Wilcoxon signed-rank test was used to compare baseline and post-intervention measurements within each group. RESULTS: At the initiation of the study the CG and the EG were comparable for fitness, quality of life and disease activity. On completion of the training programme, statistically significant improvements at the 5% level of significance were seen between the EG and CG, in favour of the EG, for left lateral flexion (p=O.O15) and the 1 mile walk test (p=O.O11). Within the EG there were improvement of knee flexion left (p=O.026), knee extension (right p=O.O11; left p=O.009), scratch test (right p=O.007; left p=O.O1), chair sit and reach (right p=O.Ol1; left p<O.OOl), strength parameters (p<O.05), 1 mile walk test (p<O.OO1), V02 max (p=O.O1) and DAS scores (p<O.OO1). Within the CG, improvements were shown for knee extension(right p=O.05; left p=O.013). Although their strength parameters improved significantly it was not in the same order as for the EG. The CG had a decline in their aerobic measurements but their HAQ score improved (p=O.03). CONCLUSION: An endurance exercise programme, combined with isotonic strengthening exercise and stretching, improves the functional capacity, quality of life and disease activity of female patients with RA. Attention received during the study may have led to some placebo-induced improvements in control subjects, but not to the same extent as those involved in exercise programmes

Training for shorter ultra-trail races results in a higher injury rate, a more diverse injury profile, and more severe injuries : 2022 Mac ultra races

DATA STATEMENT : The research data related to this study will be made available upon reasonable request.OBJECTIVES : Determine and compare the epidemiology, clinical characteristics, and injury severity among race entrants training towards different ultra-trail race distances. DESIGN : Retrospective cross-sectional study. SETTING : The six months training period before the 2022 Mac Ultra races (46 km, 80 km, 161 km and 322 km). PARTICIPANTS : Of the 245 race entrants, 162 (66% of Mac ultra-trail runners) consented to analyse their data. OUTCOME MEASURES : Injury rate (injuries per 1000 h of running), point prevalence (% of currently injured participants), injury severity (time loss), and the frequency (n, %) of injuries reported during pre-race medical screening in the six months before the race. Using inferential statistics, we compared the injury rates between the different race distance categories (46 km, 80 km, 161 km, 322 km). All tests were performed at a 5% level of significance. RESULTS : We reported a statistically significantly higher injury rate among 46 km study participants (3.09 injuries per 1000 h) compared to the injury rates reported among 80 km (0.68 injuries per 1000 h; p = 0.001) and 161 km (1.09 injuries per 1000 h; p = 0.028) participants. The lower limb (89%) was the most injured anatomical region, with only 46 km study participants reporting upper limb, trunk, and head injuries (11%). Muscle/tendon was the most reported injured tissue type (56%), with muscle injuries (31%) the most reported pathology type. Shorter distance ultra-trail runners reported the highest injury severity. CONCLUSION : Ultra-trail runners training towards shorter ultra-trail distance races presented with a higher injury rate, more diverse injury profile, and a higher injury severity.https://www.elsevier.com/ptsp2024-11-16hj2023PhysiotherapySports MedicineStatisticsSDG-03:Good heatlh and well-bein

Establishing a global standard for wearable devices in sport and exercise medicine : perspectives from academic and industry stakeholders

Millions of consumer sport and fitness wearables (CSFWs) are used worldwide, and millions of datapoints are generated by each device. Moreover, these numbers are rapidly growing, and they contain a heterogeneity of devices, data types, and contexts for data collection. Companies and consumers would benefit from guiding standards on device quality and data formats. To address this growing need, we convened a virtual panel of industry and academic stakeholders, and this manuscript summarizes the outcomes of the discussion. Our objectives were to identify (1) key facilitators of and barriers to participation by CSFW manufacturers in guiding standards and (2) stakeholder priorities. The venues were the Yale Center for Biomedical Data Science Digital Health Monthly Seminar Series (62 participants) and the New England Chapter of the American College of Sports Medicine Annual Meeting (59 participants). In the discussion, stakeholders outlined both facilitators of (e.g., commercial return on investment in device quality, lucrative research partnerships, and transparent and multilevel evaluation of device quality) and barriers (e.g., competitive advantage conflict, lack of flexibility in previously developed devices) to participation in guiding standards. There was general agreement to adopt Keadle et al.’s standard pathway for testing devices (i.e., benchtop, laboratory, field-based, implementation) without consensus on the prioritization of these steps. Overall, there was enthusiasm not to add prescriptive or regulatory steps, but instead create a networking hub that connects companies to consumers and researchers for flexible guidance navigating the heterogeneity, multi-tiered development, dynamicity, and nebulousness of the CSFW field.https://www.springer.com/journal/402792022-09-01hj2021Sports Medicin