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, Anthony Turner, Paul Comfort, John R. Harry, John J. McMahon, Shyam Chavda, Chris Bishop
Published: 20 March 2023
Journal: Sports Medicine
Abstract:
Background: The heights obtained during the countermovement jump and drop jump tests have been measured by numerous studies using different calculation methods and pieces of equipment. However, the differences in calculation methods and equipment used have resulted in discrepancies in jump height being reported. Objectives: The aim of this systematic review was to examine the available literature pertaining to the different calculation methods to estimate the jump height during the countermovement jump and drop jump. Methods: A systematic review of the literature was undertaken using the SPORTDiscus, MEDLINE, CINAHL, and PubMed electronic databases, with all articles required to meet specified criteria based on a quality scoring system. Results: Twenty-one articles met the inclusion criteria, relating various calculation methods and equipment employed when measuring jump height in either of these two tests. The flight time and jump-and-reach methods provide practitioners with jump height data in the shortest time, but their accuracy is affected by factors such as participant conditions or equipment sensitivity. The motion capture systems and the double integration method measure the jump height from the centre of mass height at the initial flat foot standing to the apex of jumping, where the centre of mass displacement generated by the ankle plantarflexion is known. The impulse-momentum and flight time methods could only measure the jump height from the centre of mass height at the instant of take-off to the apex of jumping, thus, providing statistically significantly lower jump height values compared with the former two methods. However, further research is warranted to investigate the reliability of each calculation method when using different equipment settings. Conclusions: Our findings indicate that using the impulse-momentum method via a force platform is the most appropriate way for the jump height from the instant of take-off to the apex of jumping to be measured. Alternatively, the double integration method via a force platform is preferred to quantify the jump height from the initial flat foot standing to the apex of jumping.
Nithin Jacob, Isis So, Bhanu Sharma, Susan Marzolini, Maria Carmela Tartaglia, Paul Oh,
Published: 14 March 2023
Journal: Sports Medicine
The publisher has not yet granted permission to display this abstract.
, Rohit K. Thapa, José Afonso, Alejandro Perez-Castilla, Chris Bishop, Paul J. Byrne,
Published: 11 March 2023
Journal: Sports Medicine
Abstract:
Background: The reactive strength index (RSI) is meaningfully associated with independent markers of athletic (e.g., linear sprint speed) and neuromuscular performance [e.g., stretch–shortening cycle (SSC)]. Plyometric jump training (PJT) is particularly suitable to improve the RSI due to exercises performed in the SSC. However, no literature review has attempted to meta-analyse the large number of studies regarding the potential effects of PJT on the RSI in healthy individuals across the lifespan. Objective: The aim of this systematic review with meta-analysis was to examine the effects of PJT on the RSI of healthy individuals across the lifespan compared with active/specific-active controls. Methods: Three electronic databases (PubMed, Scopus, Web of Science) were searched up to May 2022. According to the PICOS approach, the eligibility criteria were: (1) healthy participants, (2) PJT interventions of ≥ 3 weeks, (3) active (e.g., athletes involved in standard training) and specific-active (e.g., individuals using heavy resistance training) control group(s), (4) a measure of jump-based RSI pre-post training, and (5) controlled studies with multi-groups in randomised and non-randomised designs. The Physiotherapy Evidence Database (PEDro) scale was used to assess the risk of bias. The random-effects model was used to compute the meta-analyses, reporting Hedges’ g effect sizes (ES) with 95% confidence intervals (95% CIs). Statistical significance was set at p ≤ 0.05. Subgroup analyses were performed (chronological age; PJT duration, frequency, number of sessions, total number of jumps; randomization). A meta-regression was conducted to verify if PJT frequency, duration, and total number of sessions predicted the effects of PJT on the RSI. Certainty or confidence in the body of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Potential adverse health effects derived from PJT were researched and reported. Results: Sixty-one articles were meta-analysed, with a median PEDro score of 6.0, a low risk of bias and good methodological quality, comprising 2576 participants with an age range of 8.1–73.1 years (males, ~ 78%; aged under 18 years, ~ 60%); 42 studies included participants with a sport background (e.g., soccer, runners). The PJT duration ranged from 4 to 96 weeks, with one to three weekly exercise sessions. The RSI testing protocols involved the use of contact mats (n = 42) and force platforms (n = 19). Most studies reported RSI as mm/ms (n = 25 studies) from drop jump analysis (n = 47 studies). In general, PJT groups improved RSI compared to controls: ES = 0.54, 95% CI 0.46–0.62, p < 0.001. Training-induced RSI changes were greater (p = 0.023) for adults [i.e., age ≥ 18 years (group mean)] compared with youth. PJT was more effective with a duration of > 7 weeks versus ≤ 7 weeks, > 14 total PJT sessions versus ≤ 14 sessions, and three weekly sessions versus < three sessions (p = 0.027–0.060). Similar RSI improvements were noted after ≤ 1080 versus > 1080 total jumps, and for non-randomised versus randomised studies. Heterogeneity (I2) was low (0.0–22.2%) in nine analyses and moderate in three analyses (29.1–58.1%). According to the meta-regression, none of the analysed training variables explained the effects of PJT on RSI (p = 0.714–0.984, R2 = 0.0). The certainty of the evidence was moderate for the main analysis, and low-to-moderate across the moderator analyses. Most studies did not report soreness, pain, injury or related adverse effects related to PJT. Conclusions: The effects of PJT on the RSI were greater compared with active/specific-active controls, including traditional sport-specific training as well as alternative training interventions (e.g., high-load slow-speed resistance training). This conclusion is derived from 61 articles with low risk of bias (good methodological quality), low heterogeneity, and moderate certainty of evidence, comprising 2576 participants. PJT-related improvements on RSI were greater for adults versus youths, after > 7 training weeks versus ≤ 7 weeks, with > 14 total PJT versus ≤ 14 sessions, and with three versus < three weekly sessions.
, Asier Santibañez-Gutierrez, Nikola Todorovic, Valdemar Stajer, Sergej M. Ostojic
Published: 6 March 2023
Journal: Sports Medicine
The publisher has not yet granted permission to display this abstract.
Published: 2 March 2023
Journal: Sports Medicine
Abstract:
Background: Advanced footwear technology improves average running economy compared with racing flats in sub-elite athletes. However, not all athletes benefit as performance changes vary from a 10% drawback to a 14% improvement. The main beneficiaries from such technologies, world-class athletes, have only been analyzed using race times. Objective: The aim of this study was to measure running economy on a laboratory treadmill in advanced footwear technology compared to a traditional racing flat in world-class Kenyan (mean half-marathon time: 59:30 min:s) versus European amateur runners. Methods: Seven world-class Kenyan and seven amateur European male runners completed a maximal oxygen uptake assessment and submaximal steady-state running economy trials in three different models of advanced footwear technology and a racing flat. To confirm our results and better understand the overall effect of new technology in running shoes, we conducted a systematic search and meta-analysis. Results: Laboratory results revealed large variability in both world-class Kenyan road runners, which ranged from a 11.3% drawback to a 11.4% benefit, and amateur Europeans, which ranged from a 9.7% benefit to a 1.1% drawback in running economy of advanced footwear technology compared to a flat. The post-hoc meta-analysis revealed an overall significant medium benefit of advanced footwear technology on running economy compared with traditional flats. Conclusions: Variability of advanced footwear technology performance appears in both world-class and amateur runners, suggesting further testing should examine such variability to ensure validity of results and explain the cause as a more personalized approach to shoe selection might be necessary for optimal benefit.
, Emily Taylor, Vanessa Ng, , Aditya Patil, , Mitch Wolden, ,
Published: 2 March 2023
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 871-886; https://doi.org/10.1007/s40279-023-01817-0

Abstract:
Background: Aerobic exercise training (AET) prescribed as lipid management treatment positively affects the standard lipid profile and reduces cardiovascular disease (CVD) risk. Apolipoproteins, lipid and apolipoprotein ratios, and lipoprotein sub-fractions may more effectively predict CVD risk than the standard lipid profile but an AET response in these biomarkers has not been established. Objectives: We conducted a quantitative systematic review of randomised controlled trials (RCTs) to (1) determine the effects of AET on lipoprotein sub-fractions, apolipoproteins and relevant ratios; and (2) identify study or intervention covariates associated with change in these biomarkers. Methods: We searched PubMed, EMBASE, all Web of Science and EBSCO health and medical online databases from inception to 31 December 2021. We included published RCTs of adult humans with ≥ 10 per group of participants; an AET intervention duration ≥ 12 weeks of at least moderate intensity (> 40% maximum oxygen consumption); and reporting pre/post measurements. Non-sedentary subjects, or those with chronic disease other than Metabolic Syndrome factors, or pregnant/lactating, as well as trials testing diet/medications, or resistance/isometric/unconventional training interventions, were excluded. Results: Fifty-seven RCTs totalling 3194 participants were analysed. Multivariate meta-analysis showed AET significantly raised antiatherogenic apolipoproteins and lipoprotein sub-fractions (mmol/L mean difference (MD) 0.047 (95% confidence interval (CI) 0.011, 0.082), P = .01); lowered atherogenic apoliproteins and lipoprotein sub-fractions (mmol/L MD − 0.08 (95% CI − 0.161, 0.0003), P = .05); and improved atherogenic lipid ratios (MD − 0.201 (95% CI − 0.291, − 0.111), P < .0001). Multivariate meta-regression showed intervention variables contributed to change in lipid, sub-fraction, and apoliprotein ratios. Conclusion: Aerobic exercise training positively impacts atherogenic lipid and apolipoprotein ratios, alipoproteins, and lipoprotein sub-fractions; and antiatherogenic apolipoproteins and lipoprotein sub-fractions. Cardiovascular disease risk predicted by these biomarkers may be lowered when AET is prescribed as treatment or prevention. PROSPERO ID: CRD42020151925.
Jorn Trommelen, Glenn A. A. van Lieshout, Pardeep Pabla, Jean Nyakayiru, Floris K. Hendriks, Joan M. Senden, Joy P. B. Goessens, Janneau M. X. van Kranenburg, Annemie P. Gijsen, Lex B. Verdijk, et al.
Published: 1 March 2023
Journal: Sports Medicine
Abstract:
Background: Casein protein ingestion prior to sleep has been shown to increase myofibrillar protein synthesis rates during overnight sleep. It remains to be assessed whether pre-sleep protein ingestion can also increase mitochondrial protein synthesis rates. Though it has been suggested that casein protein may be preferred as a pre-sleep protein source, no study has compared the impact of pre-sleep whey versus casein ingestion on overnight muscle protein synthesis rates. Objective: We aimed to assess the impact of casein and whey protein ingestion prior to sleep on mitochondrial and myofibrillar protein synthesis rates during overnight recovery from a bout of endurance-type exercise. Methods: Thirty-six healthy young men performed a single bout of endurance-type exercise in the evening (19:45 h). Thirty minutes prior to sleep (23:30 h), participants ingested 45 g of casein protein, 45 g of whey protein, or a non-caloric placebo. Continuous intravenous l-[ring-13C6]-phenylalanine infusions were applied, with blood and muscle tissue samples being collected to assess overnight mitochondrial and myofibrillar protein synthesis rates. Results: Pooled protein ingestion resulted in greater mitochondrial (0.087 ± 0.020 vs 0.067 ± 0.016%·h−1, p = 0.005) and myofibrillar (0.060 ± 0.014 vs 0.047 ± 0.011%·h−1, p = 0.012) protein synthesis rates when compared with placebo. Casein and whey protein ingestion did not differ in their capacity to stimulate mitochondrial (0.082 ± 0.019 vs 0.092 ± 0.020%·h−1, p = 0.690) and myofibrillar (0.056 ± 0.009 vs 0.064 ± 0.018%·h−1, p = 0.440) protein synthesis rates. Conclusions: Protein ingestion prior to sleep increases both mitochondrial and myofibrillar protein synthesis rates during overnight recovery from exercise. The overnight muscle protein synthetic response to whey and casein protein does not differ. Clinical Trial Registration: NTR7251.
Stefano Amatori, Carlo Ferri Marini, , Davide Sisti, Germana Giombini, Rosalba Rombaldoni, Marco B. L. Rocchi, Francesco Lucertini, Ario Federici, Fabrizio Perroni, et al.
Published: 25 February 2023
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 887-901; https://doi.org/10.1007/s40279-023-01821-4

Abstract:
Background: Workplace exercise interventions showed good results, but lack of time was often reported as a barrier to participation. To overcome this problem, several studies attempted to implement short high-intensity interval training (HIT) within the workplace. Objectives: The aim of this systematic review is to explore the feasibility and effectiveness of HIT interventions within the workplace setting. Data sources: A systematic literature search was conducted in PubMed and SPORTDiscus to identify articles related to HIT within the workplace. Study eligibility criteria: Only interventions that consisted of HIT programmes within the workplace and tested at least one physiological, psychological, or work-related outcome were included. Results: Seven studies (317 participants) met the inclusion criteria. HIT interventions lasted 6–12 weeks, with a frequency of 2–4 sessions/week and a duration of 8–30 min per session. Feasibility was qualitatively investigated in four studies, with key positive aspects reported for HIT time-appeal, the sense of competence driven by individual intensity, and improved intention to exercise; five studies reported adherence rates > 80%. Small-to-large effect sizes were reported for improvements in cardiorespiratory and muscular fitness. Small-to-medium effect sizes were reported for blood parameters and health-related quality of life. Conclusions: HIT interventions in the workplace showed limited effectiveness in improving health-related outcomes, while promising results regarding feasibility were reported, mainly due to the time-efficiency and the positive post-exercise psychosocial responses. However, further high-quality studies involving more participants are still needed to make firm conclusions on HIT effectiveness and feasibility compared to other types of exercise in this context.
Published: 24 February 2023
Journal: Sports Medicine
Abstract:
Background: Nicotine is a psychostimulant drug with purported use in sports environments, though the use of nicotine among athletes has not been studied extensively. Objective: The aim of this study was to assess the nicotine positivity rate in 60,802 anti-doping urine samples from 2012 to 2020. Methods: Urine samples obtained in-competition at different national and international sports events held in Italy during the period 2012–2020 were analysed. All samples were from anonymous athletes that were collected and analysed at the WADA-accredited antidoping laboratory in Rome, Italy. Samples were analysed by gas chromatography coupled with mass spectrometry, with a cut-off concentration for nicotine of > 50 ng/mL. Results were stratified by year, sport and sex. Results: An overall mean of 22.7% of the samples (n = 13,804; males: n = 11,099; females: n = 2705) showed nicotine intake, with male samples also displaying higher positivity rates than female (24.1% vs 18.5%). Sample positivity was higher during 2012–2014 (25–33%) than 2015–2020 (15–20%). Samples from team sports displayed a higher positivity rate than those from individual sports (31.4 vs 14.1%). Conclusions: The current data demonstrates that one in five samples from a range of 90 sports test positive for nicotine in-competition. There is a lower positivity rate in endurance versus power/strength athletes and higher positivity rate in team versus individual sports, probably accounted for by differences in physiological and psychological demands and the desire for socialisation. WADA, international and national sports federations should consider these findings with concern, proactively investigate this phenomenon and act in order to protect the health and welfare of its athletes.
Franck Le Mat, Mathias Géry, Thibault Besson, Cyril Ferdynus, Nicolas Bouscaren,
Published: 21 February 2023
Journal: Sports Medicine
The publisher has not yet granted permission to display this abstract.
Correction
, Camilla J. Knight, Ross Hall, Catherine Shearer, Ross Nicholas, David A. Shearer
Published: 18 February 2023
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 803-806; https://doi.org/10.1007/s40279-023-01824-1

Published: 13 February 2023
Journal: Sports Medicine
Abstract:
The introduction of carbon fiber plate footwear has led to performance benefits in runners. The mechanism for these changes in running economy includes altered biomechanics of the foot and ankle. The association of this footwear with injuries has been a topic of debate clinically, but not described in the literature. In this Current Opinion article, illustrated by a case series of five navicular bone stress injuries in highly competitive running athletes, we discuss the development of running-related injuries in association with the use of carbon fiber plate footwear. While the performance benefits of this footwear are considerable, sports medicine providers should consider injuries possibly related to altered biomechanical demands affecting athletes who use carbon fiber plate footwear. Given the introduction of carbon fiber plate footwear into athletics and other endurance sports, strategies may be required to reduce risk of injury due to altered foot and ankle mechanics. This article is intended (1) to raise awareness on possible health concerns around the use of carbon fiber plate footwear, (2) to suggest a slow gradual transition from habitual to carbon fiber plate footwear, and (3) to foster medical research related to carbon fiber plate technology and injuries.
, Adrian Wolfberg, , Gregory Dupont, Amelie Larocque, Johann Bilsborough
Published: 10 February 2023
Journal: Sports Medicine
Abstract:
Background: Athlete monitoring trends appear to be favouring objective over subjective measures. One reason of potentially several is that subjective monitoring affords athletes to give dishonest responses. Indeed, athletes have never been systematically researched to understand why they are honest or not. Objective: Because we do not know what motivates professional athletes to be honest or not when responding to subjective monitoring, our objective is to explore the motives for why the athlete may or may not respond honestly. Methods: A qualitative and phenomenological approach was used, interviewing 11 world-class team-sport athletes (five women, six men) about their experiences when asked to respond to subjective monitoring questionnaires. Interview transcripts were read in full and significant quotations/statements extracted. Meanings were formulated for each interviewees’ story and assigned codes. Codes were reflected upon and labelled as categories, with similar categories grouped into an overall theme. Themes were examined, articulated, re-interpreted, re-formulated, and written as a thematic story, drawing on elements reported from different athletes creating a blended story, allowing readers a feel for what it is like to live the experience. Results: Overall, four key themes emerged: (i) pursuit of the ideal-self, (ii) individual barriers to athlete engagement, (iii) social facilitators to athlete engagement; and (iv) feeling compassion from performance staff. Conclusions: Our main insight is that athletes’ emotions play a major role in whether they respond honestly or not, with these emotions being driven at least in part by the performance staff asking the questions.
, Ilir Hoxha, Rina Meha, Arber Lama, Altina Bimbashi, Dorentina Kuqi, Bujar Shabani, Tim Meyer, Karen Aus der Fünten
Published: 8 February 2023
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 837-848; https://doi.org/10.1007/s40279-022-01797-7

Abstract:
Background: Playing football is associated with a high risk of injury. Injury prevention is a priority as injuries not only negatively impact health but also potentially performance. Various multi-component exercise-based injury prevention programs for football players have been examined in studies. Objective: We aimed to investigate the efficacy of multi-component exercise-based injury prevention programs among footballers of all age groups in comparison to a control group. Methods: We conducted a systematic review and meta-analysis of randomized and cluster-randomized controlled trials. CINAHL, Cochrane, PubMed, Scopus, and Web of Science databases were searched from inception to June 2022. The following inclusion criteria were used for studies to determine their eligibility: they (1) include football (soccer) players; (2) investigate the preventive effect of multi-component exercise-based injury prevention programs in football; (3) contain original data from a randomized or cluster-randomized trial; and (4) investigate football injuries as the outcome. The risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), respectively. The outcome measures were the risk ratio (RR) between the intervention and the control group for the overall number of injuries and body region-specific, contact, and non-contact injuries sustained during the study period in training and match play. Results: Fifteen randomized and cluster-randomized controlled trials with 22,177 players, 5080 injuries, and 1,587,327 exposure hours fulfilled the inclusion criteria and reported the required outcome measures. The point estimate (RR) for the overall number of injuries was 0.71 (95% confidence interval [CI] 0.59–0.85; 95% prediction interval [PI] 0.38–1.32) with very low-quality evidence. The point estimate (RR) for lower limb injuries was 0.82 (95% CI 0.71–0.94; 95% PI 0.58–1.15) with moderate-quality evidence; for hip/groin injuries, the RR was 0.56 (95% CI 0.30–1.05; 95% PI 0.00–102.92) with low-quality evidence; for knee injuries, the RR was 0.69 (95% CI 0.52–0.90; 95% PI 0.31–1.50) with low-quality evidence; for ankle injuries, the RR was 0.73 (95% CI 0.55–0.96; 95% PI 0.36–1.46) with moderate-quality evidence; and for hamstring injuries, the RR was 0.83 (95% CI 0.50–1.37) with low-quality evidence. The point estimate (RR) for contact injuries was 0.70 (95% CI 0.56–0.88; 95% PI 0.40–1.24) with moderate-quality evidence, while for non-contact injuries, the RR was 0.78 (95% CI 0.55–1.10; 95% PI 0.25–2.47) with low-quality evidence. Conclusions: This systematic review and meta-analysis indicated that the treatment effect associated with the use of multi-component exercise-based injury prevention programs in football is uncertain and inconclusive. In addition, the majority of the results are based on low-quality evidence. Therefore, future high-quality trials are needed to provide more reliable evidence. Clinical Trial Registration: PROSPERO CRD42020221772.
Fabian Arntz, Adrian Markov, David G. Behm, Martin Behrens, Yassine Negra, Masatoshi Nakamura, Jason Moran,
Published: 31 January 2023
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 723-745; https://doi.org/10.1007/s40279-022-01806-9

Abstract:
Background: The current literature on the chronic effects of static stretching (SS) exercises on muscle strength and power is unclear and controversial. Objective: We aimed to examine the chronic effects of SS exercises on muscle strength and power as well as flexibility in healthy individuals across the lifespan. Design: Systematic review with meta-analysis of (randomized) controlled trials. Data Sources: A systematic literature search was conducted in the databases PubMed, Web of Science, Cochrane Library, and SPORTDiscus up to May 2022. Eligibility Criteria for Selecting Studies: We included studies that investigated the chronic effects of SS exercises on at least one muscle strength and power outcome compared to an active/passive control group or the contralateral leg (i.e., using between- or within-study designs, respectively) in healthy individuals, irrespective of age, sex, and training status. Results: The main findings of 41 studies indicated trivial-to-small positive effects of chronic SS exercises on muscle strength (standardized mean difference [SMD] = 0.21, [95% confidence interval 0.10–0.32], p = 0.001) and power (SMD = 0.19, 95% confidence interval 0.12–0.26], p < 0.001). For flexibility, moderate-to-large increases were observed (SMD = 0.96, [95% confidence interval 0.70–1.22], p < 0.001). Subgroup analyses, taking the participants’ training status into account, revealed a larger muscle strength improvement for sedentary (SMD = 0.58, p < 0.001) compared with recreationally active participants (SMD = 0.16, p = 0.029). Additionally, larger flexibility gains were observed following passive (SMD = 0.97, p < 0.001) compared with active SS exercises (SMD = 0.59, p = 0.001). The chronic effects of SS on muscle strength were moderated by the proportion of female individuals in the sample (β = 0.004, p = 0.042), with higher proportions experiencing larger gains. Other moderating variables included mean age (β = 0.011, p < 0.001), with older individuals showing larger muscle strength gains, and the number of repetitions per stretching exercise and session (β = 0.023, p = 0.004 and β = 0.013, p = 0.008, respectively), with more repetitions associated with larger muscle strength improvements. Muscle power was also moderated by mean age (β = 0.006, p = 0.007) with larger gains in older individuals. The meta-regression analysis indicated larger flexibility gains with more repetitions per session (β = 0.094, p = 0.016), more time under stretching per session (β = 0.090, p = 0.026), and more total time under stretching (β = 0.078, p = 0.034). Conclusions: The main findings indicated that chronic SS exercises have the potential to improve muscle strength and power. Such improvements appear to benefit sedentary more than recreationally active participants. Likewise, chronic SS exercises result in a marked enhancement in flexibility with larger effects of passive, as compared with active, SS. The results of the meta-regression analysis for muscle strength indicated larger benefits of chronic SS exercises in samples with higher proportions of female, older participants, and a higher number of repetitions per stretching exercise and session. For muscle power, results suggested larger gains for older participants. Regarding flexibility, findings indicated larger benefits following a higher number of repetitions per exercise and a longer time under stretching per session as well as a longer total time under stretching.
, Z. Taggart Wilber, Brooks Taylor Robinson
Published: 30 January 2023
Journal: Sports Medicine
The publisher has not yet granted permission to display this abstract.
, David A. Groneberg, Jan Wilke
Published: 30 January 2023
Journal: Sports Medicine
Abstract:
Background: The most effective way to cope with high blood sugar spikes is to engage in physical activity in temporal proximity to food intake. However, so far, it is unclear as to whether there is an optimal time for physical activity around food intake. Objectives: We aimed to identify the impact of pre- and post-meal exercise on postprandial glucose excursions in humans with and without type 2 diabetes mellitus. Methods: We conducted a systematic review with meta-analysis, PROSPERO registration number: CRD42022324070. We screened MEDLINE/PubMed, Cochrane/CINAHL/EMBASE, and Web of Knowledge until 1 May, 2022. We used the risk of bias rating with the crossover extension of the Cochrane risk of bias assessment tool II. Standardized mean differences (SMDs, Hedges’ g) with 95% confidence intervals (CIs) were calculated as pooled effect estimates of a random-effects meta-analysis. Eligibility criteria included three-armed randomized controlled trials comparing the acute effects of pre- and post-meal exercise to a no-exercise control in humans. Results: Eight randomized controlled trials (crossover trials, high risk of bias) with 30 interventions in 116 participants (47 diagnosed with type 2 diabetes, 69 without type 2 diabetes) were eligible. Exercise after meal ingestion (real food or meal replacement drinks) led to a reduction in postprandial glucose excursions compared with exercise before eating (15 effect sizes; SMD = 0.47 [95% CI 0.23, 0.70]) and an inactive control condition (15 effect sizes; SMD = 0.55 [95% CI 0.34, 0.75]. Pre-meal exercise did not lead to significantly lower postprandial glucose compared to an inactive control (15 effect sizes; SMD = − 0.13 [95% CI − 0.42, 0.17]). The time between meal and exercise (estimate = − 0.0151; standard error = 0.00473; Z = − 3.19; p = 0.001; 95% CI − 0.024, − 0.006) had a moderating influence on postprandial glucose excursions. Conclusions: Exercise, i.e., walking, has a greater acute beneficial impact on postprandial hyperglycemia when undertaken as soon as possible after a meal rather than after a longer interval or before eating. Clinical Trial Registration: The review was pre-registered in the PROSPERO database (CRD42022324070). The date of submission was 07.04.2022, with the registration on 08.05.2022.
, Camilla J. Knight, Ross Hall, Catherine Shearer, Ross Nicholas, David A. Shearer
Published: 25 January 2023
Journal: Sports Medicine
Abstract:
Taper is a common training strategy used to reduce fatigue and enhance athletic performance. However, currently, no review has summarised what psychological research has been conducted examining taper, what this research shows and what future research needs to be undertaken to extend the field. Consequently, a scoping review was conducted with three aims: (a) to determine the characteristics of psychological research examining taper, (b) to summarise psychological research collected during taper with adult athletes and coaches, and (c) to identify gaps in psychological research examining taper. Forty-eight articles were identified following an exhaustive search strategy and charted following scoping review guidelines. Results showed most research was quantitative, used a longitudinal design, was conducted in swimming, triathlon, cycling or across multiple sports, and used a university-, regional- or national-level male athlete sample. Eight themes were developed to summarise the research: Mood, Perception of Effort, Perceived Fatigue and Wellness, Recovery-Stress, Taper as a Stressor, Stress Tolerance, Psychological Preparation and Cognitive Functioning. Additionally, four research recommendations were identified: (a) conducting exploratory research that examines the impact taper has on athletes’ and coaches’ competition preparation and stress experience, (b) asking more advanced psychological questions and conducting multi-disciplinary research, (c) including a more diverse participant sample in studies and (d) examining the impact of psychological interventions during taper. Overall, this scoping review has highlighted the limited research examining the psychology of taper and the need for focused research that asks more complex questions across diverse populations.
, Simon Marwood
Published: 9 January 2023
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 595-613; https://doi.org/10.1007/s40279-022-01805-w

Abstract:
The physiological determinants of high-intensity exercise tolerance are important for both elite human performance and morbidity, mortality and disease in clinical settings. The asymptote of the hyperbolic relation between external power and time to task failure, critical power, represents the threshold intensity above which systemic and intramuscular metabolic homeostasis can no longer be maintained. After ~ 60 years of research into the phenomenon of critical power, a clear understanding of its physiological determinants has emerged. The purpose of the present review is to critically examine this contemporary evidence in order to explain the physiological underpinnings of critical power. Evidence demonstrating that alterations in convective and diffusive oxygen delivery can impact upon critical power is first addressed. Subsequently, evidence is considered that shows that rates of muscle oxygen utilisation, inferred via the kinetics of pulmonary oxygen consumption, can influence critical power. The data reveal a clear picture that alterations in the rates of flux along every step of the oxygen transport and utilisation pathways influence critical power. It is also clear that critical power is influenced by motor unit recruitment patterns. On this basis, it is proposed that convective and diffusive oxygen delivery act in concert with muscle oxygen utilisation rates to determine the intracellular metabolic milieu and state of fatigue within the myocytes. This interacts with exercising muscle mass and motor unit recruitment patterns to ultimately determine critical power.
Shahab Alizadeh, Abdolhamid Daneshjoo, Ali Zahiri, Saman Hadjizadeh Anvar, Reza Goudini, Jared P. Hicks, Andreas Konrad,
Published: 9 January 2023
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 707-722; https://doi.org/10.1007/s40279-022-01804-x

Abstract:
Background: Although it is known that resistance training can be as effective as stretch training to increase joint range of motion, to date no comprehensive meta-analysis has investigated the effects of resistance training on range of motion with all its potential affecting variables. Objective: The objective of this systematic review with meta-analysis was to evaluate the effect of chronic resistance training on range of motion compared either to a control condition or stretch training or to a combination of resistance training and stretch training to stretch training, while assessing moderating variables. Design: For the main analysis, a random-effect meta-analysis was used and for the subgroup analysis a mixed-effect model was implemented. Whilst subgroup analyses included sex and participants’ activity levels, meta-regression included age, frequency, and duration of resistance training. Data Sources: Following the systematic search in four databases (PubMed, Scopus, SPORTDiscus, and Web of Science) and reference lists, 55 studies were found to be eligible. Eligibility Criteria: Controlled or randomized controlled trials that separately compared the training effects of resistance training exercises with either a control group, stretching group, or combined stretch and resistance training group on range of motion in healthy participants. Results: Resistance training increased range of motion (effect size [ES] = 0.73; p < 0.001) with the exception of no significant range of motion improvement with resistance training using only body mass. There were no significant differences between resistance training versus stretch training (ES = 0.08; p = 0.79) or between resistance training and stretch training versus stretch training alone (ES = − 0.001; p = 0.99). Although “trained or active people” increased range of motion (ES = 0.43; p < 0.001) “untrained and sedentary” individuals had significantly (p = 0.005) higher magnitude range of motion changes (ES = 1.042; p < 0.001). There were no detected differences between sex and contraction type. Meta-regression showed no effect of age, training duration, or frequency. Conclusions: As resistance training with external loads can improve range of motion, stretching prior to or after resistance training may not be necessary to enhance flexibility.
Published: 17 December 2022
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 667-685; https://doi.org/10.1007/s40279-022-01799-5

Abstract:
Background: Professional soccer teams are often required to compete with ≤ 4 days recovery between matches. Since congested schedules reduce recovery time between matches, players are possibly at an increased injury risk. To date, there are no published systematic reviews on the impact of match congestion on injuries during professional male soccer. Objective: The aim of this systematic review was to assess the effects of fixture congestion on injuries during professional soccer. Methods: Following pre-registration on the Open Science Framework (https://osf.io/86m25/) and conforming with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, systematic searches of four electronic databases (PubMed, Scopus, SPORTDiscus, and Web of Science) were conducted by independent researchers from inception until February 2022. Articles were included if they were original articles written in English and contained relevant time-loss injury data (injury that results in unavailability for training and/or match-play) for male professional soccer players regarding periods of fixture congestion (a minimum of two matches with ≤ 4 days recovery). Results: A total of eight articles were included in the review. Five studies identified that congested fixture schedules expose players to increased match injury incidence, although layoff duration was typically lower during congested periods. Two studies identified that training and overall injury incidence were higher during congested periods, with another study identifying a lower training injury incidence during congested periods. Conclusion: Injury risk is, overall, increased during fixture-congested periods; however, the layoff duration is typically shorter. The current findings have implications for practitioners regarding the management, periodisation, monitoring, and design of training and competition schedules.
Landon B. Lempke, Samuel R. Walton, Benjamin L. Brett, Avinash Chandran, J. D. DeFreese, Rebekah Mannix, Ruben J. Echemendia, Michael A. McCrea, Kevin M. Guskiewicz, William P. Meehan, et al.
Published: 7 December 2022
Journal: Sports Medicine
The publisher has not yet granted permission to display this abstract.
Published: 30 November 2022
Journal: Sports Medicine
Sports Medicine, Volume 52, pp 69-90; https://doi.org/10.1007/s40279-022-01796-8

Abstract:
The plant defence compound caffeine is widely consumed as a performance enhancer in a sporting context, with potential benefits expected in both physiological and psychological terms. However, although caffeine modestly but consistently improves alertness and fatigue, its effects on mental performance are largely restricted to improved attention or concentration. It has no consistent effect within other cognitive domains that are important to sporting performance, including working memory, executive function and long-term memory. Although caffeine’s central nervous system effects are often attributed to blockade of the receptors for the inhibitory neuromodulator adenosine, it also inhibits a number of enzymes involved both in neurotransmission and in cellular homeostasis and signal propagation. Furthermore, it modulates the pharmacokinetics of other endogenous and exogenous bioactive molecules, in part via interactions with shared cytochrome P450 enzymes. Caffeine therefore enjoys interactive relationships with a wide range of bioactive medicinal and dietary compounds, potentially broadening, increasing, decreasing, or modulating the time course of their functional effects, or vice versa. This narrative review explores the mechanisms of action and efficacy of caffeine and the potential for combinations of caffeine and other dietary compounds to exert psychological effects in excess of those expected following caffeine alone. The review focusses on, and indeed restricted its untargeted search to, the most commonly consumed sources of caffeine: products derived from caffeine-synthesising plants that give us tea (Camellia sinensis), coffee (Coffea genus), cocoa (Theabroma cacao) and guaraná (Paullinia cupana), plus multi-component energy drinks and shots. This literature suggests relevant benefits to mental performance that exceed those associated with caffeine for multi-ingredient energy drinks/shots and several low-caffeine extracts, including high-flavanol cocoa and guarana. However, there is a general lack of research conducted in such a way as to disentangle the relative contributions of the component parts of these products.
Chris Chow Li Tee, Matthew B. Cooke, Mee Chee Chong, Wee Kian Yeo,
Published: 28 November 2022
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 327-348; https://doi.org/10.1007/s40279-022-01782-0

Abstract:
Obesity is a major global health issue and a primary risk factor for metabolic-related disorders. While physical inactivity is one of the main contributors to obesity, it is a modifiable risk factor with exercise training as an established non-pharmacological treatment to prevent the onset of metabolic-related disorders, including obesity. Exposure to hypoxia via normobaric hypoxia (simulated altitude via reduced inspired oxygen fraction), termed hypoxic conditioning, in combination with exercise has been increasingly shown in the last decade to enhance blood glucose regulation and decrease the body mass index, providing a feasible strategy to treat obesity. However, there is no current consensus in the literature regarding the optimal combination of exercise variables such as the mode, duration, and intensity of exercise, as well as the level of hypoxia to maximize fat loss and overall body compositional changes with hypoxic conditioning. In this narrative review, we discuss the effects of such diverse exercise and hypoxic variables on the systematic and myocellular mechanisms, along with physiological responses, implicated in the development of obesity. These include markers of appetite regulation and inflammation, body conformational changes, and blood glucose regulation. As such, we consolidate findings from human studies to provide greater clarity for implementing hypoxic conditioning with exercise as a safe, practical, and effective treatment strategy for obesity.
Robert W. Spitz, Ryo Kataoka, Scott J. Dankel, Zachary W. Bell, Jun Seob Song, Vickie Wong, Yujiro Yamada,
Published: 18 November 2022
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 637-648; https://doi.org/10.1007/s40279-022-01790-0

The publisher has not yet granted permission to display this abstract.
Published: 18 November 2022
Journal: Sports Medicine
Sports Medicine, Volume 52, pp 119-128; https://doi.org/10.1007/s40279-022-01785-x

Abstract:
The human gut microbiome is a complex ecosystem of microorganisms that play an important role in human health, influencing functions such as vitamin uptake, digestion and immunomodulation. While research of the gut microbiome has expanded considerably over the past decade, some areas such as the relationship between exercise and the microbiome remain relatively under investigated. Despite this, multiple studies have shown a potential bidirectional relationship between exercise and the gut microbiome, with some studies demonstrating the possibility of influencing this relationship. This, in turn, could provide a useful route to influence athletic performance via microbiome manipulation, a valuable prospect for many elite athletes and their teams. The evidence supporting the potential benefits of pursuing this route and associated future perspectives are discussed in this review.
, Michael J. Popovich, Kristen H. Schuyten, Stanley A. Herring, Katie L. Scott, James R. Clugston, Meeryo C. Choe, Christopher M. Bailey, M. Alison Brooks, Scott A. Anderson, et al.
Published: 18 November 2022
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 903-916; https://doi.org/10.1007/s40279-022-01788-8

The publisher has not yet granted permission to display this abstract.
, Jens Bangsbo
Published: 16 November 2022
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 577-594; https://doi.org/10.1007/s40279-022-01791-z

The publisher has not yet granted permission to display this abstract.
, David G. Behm
Published: 15 November 2022
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 349-370; https://doi.org/10.1007/s40279-022-01789-7

Abstract:
Background: Balance and resistance training applied as single-mode interventions have proven to enhance measures of balance and/or muscular fitness in youth and youth athletes. Less is known on the effectiveness of combined or sequenced balance and resistance training in youth and youth athletes. Objective: The objective of this scoping review was to describe the effects of concurrently performed balance and resistance training (i.e., metastable resistance training) and different sequencing schemes of balance and resistance training on measures of balance and/or muscular fitness in healthy youth and youth athletes. We additionally aimed to identify knowledge gaps in the literature. Methods: According to the principles of a scoping review, we followed a broad research question, identified gaps in the literature, and reported findings on the level of single studies but did not aggregate and meta-analyze outcomes across studies. For this purpose, systematic literature searches were conducted in the electronic databases PubMed (including MEDLINE), Web of Science, and SPORTDiscus from inception until August 2022. We included metastable resistance training and sequenced balance and resistance training studies in healthy youth and youth athletes aged 6–18 years that investigated the training-induced effects on measures of balance (e.g., stork balance test) and muscular fitness (e.g., countermovement jump test) in contrast to active/passive controls. The Physiotherapy Evidence Database (PEDro) scale was used to assess the risk of bias. The Strength of Recommendation Taxonomy (SORT) was applied for the whole scoping review on levels A (high strength of recommendation) to C (low strength of recommendation) and for individual studies on levels 1 (high-quality evidence) to 3 (low-quality evidence). Results: The strength of recommendation for the scoping review was level B based on inconsistent or limited-quality evidence. Eleven randomized controlled trials were eligible to be included in this scoping review and each study was rated as ‘limited-quality evidence’. A median PEDro score of 6 was computed across the included studies. Four studies examined the effects of metastable resistance training (e.g., plyometric training on unstable surfaces) on measures of balance and/or muscle fitness in youth athletes. The remaining seven studies investigated the impact of sequenced balance and resistance training (e.g., blocked balance training followed by blocked resistance training) on measures of balance and/or muscle fitness in youth and youth athletes. The duration of the intervention programs ranged from 6 to 10 weeks with 2-weekly to 3-weekly exercise sessions. Participants’ age range was 10–18 years (mean 15 years). Ten studies examined young male and female athletes from different sports (i.e., basketball, handball, soccer) and one study physical education students. Metastable resistance training compared with plyometric training performed on stable surfaces showed no extra effect on measures of balance and muscular fitness. Stable plyometric training appears to be even more effective to improve jump performance. Sequenced balance and resistance training in the form of a mesocycle of balance followed by plyometric training seems to be particularly effective to improve measures of balance and muscular fitness in young athletes. This scoping review identified knowledge gaps that may indicate future research avenues: (i) comparative studies should be designed to examine how sex, age, maturity status, and expertise level impact on the adaptive potential following metastable resistance training or sequenced balance and resistance training in youth and youth athletes, (ii) at least one established measure of balance and muscular fitness should always be included in study designs to allow future comparison between studies and to aggregate (meta-analyze) findings across studies and (iii) studies are needed that examine neuromuscular and tendomuscular adaptations following these exercise types as well as dosage effects. Conclusions: According to the results of this scoping review, balance training should be an essential training component for youth that is incorporated with the resistance training exercises or introduced at least a month before resistance and plyometric training within a periodized training program. More research is needed to examine the moderating roles of age, maturity status, and sex.
, Tyrel Stokes, ChinChin Wang, Jorge Trejovargas, Franco M. Impellizzeri, Russell J. Steele
Published: 15 November 2022
Journal: Sports Medicine
The publisher has not yet granted permission to display this abstract.
, Eric R. Helms, Eric. T. Trexler, D. Lee Hamilton, Jackson J. Fyfe
Published: 5 November 2022
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 649-665; https://doi.org/10.1007/s40279-022-01784-y

Abstract:
Background and Objective: This systematic review with meta-analysis investigated the influence of resistance training proximity-to-failure on muscle hypertrophy. Methods: Literature searches in the PubMed, SCOPUS and SPORTDiscus databases identified a total of 15 studies that measured muscle hypertrophy (in healthy adults of any age and resistance training experience) and compared resistance training performed to: (A) momentary muscular failure versus non-failure; (B) set failure (defined as anything other than momentary muscular failure) versus non-failure; or (C) different velocity loss thresholds. Results: There was a trivial advantage for resistance training performed to set failure versus non-failure for muscle hypertrophy in studies applying any definition of set failure [effect size=0.19 (95% confidence interval 0.00, 0.37), p=0.045], with no moderating effect of volume load (p=0.884) or relative load (p=0.525). Given the variability in set failure definitions applied across studies, sub-group analyses were conducted and found no advantage for either resistance training performed to momentary muscular failure versus non-failure for muscle hypertrophy [effect size=0.12 (95% confidence interval −0.13, 0.37), p=0.343], or for resistance training performed to high (>25%) versus moderate (20–25%) velocity loss thresholds [effect size=0.08 (95% confidence interval −0.16, 0.32), p=0.529]. Conclusion: Overall, our main findings suggest that (i) there is no evidence to support that resistance training performed to momentary muscular failure is superior to non-failure resistance training for muscle hypertrophy and (ii) higher velocity loss thresholds, and theoretically closer proximities-to-failure do not always elicit greater muscle hypertrophy. As such, these results provide evidence for a potential non-linear relationship between proximity-to-failure and muscle hypertrophy.
Dean Campelj,
Published: 4 November 2022
Journal: Sports Medicine
Sports Medicine, Volume 52, pp 91-99; https://doi.org/10.1007/s40279-022-01772-2

Abstract:
Nicotinamide adenine dinucleotide (NAD+) is a vital energy intermediate in skeletal muscle. The discovery of dietary-derived NAD+ precursors has led to the rapid development of NAD+ therapeutics designed to manipulate NAD+ content in target tissues. Of those developed, nicotinamide riboside and nicotinamide mononucleotide have been reported to display health benefit in humans under clinical scenarios of NAD+ deficiency. In contrast, relatively little is known regarding the potential benefit of nicotinamide riboside and nicotinamide mononucleotide supplementation in healthy individuals, with questions remaining as to whether NAD+ therapeutics can be used to support training adaptation or improve performance in athletic populations. Examining animal and human nicotinamide riboside supplementation studies, this review discusses current evidence suggesting that NAD+ therapeutics do not alter skeletal muscle metabolism or improve athletic performance in healthy humans. Further, we will highlight potential reasons why nicotinamide riboside supplementation studies do not translate to healthy populations and discuss the futility of testing NAD+ therapeutics outside of the clinical populations where NAD+ deficiency is present.
Published: 4 November 2022
Journal: Sports Medicine
Sports Medicine, Volume 53, pp 371-413; https://doi.org/10.1007/s40279-022-01773-1

Abstract:
Background: Sided games (i.e., small sided, medium sided, large sided) involve tactical, technical, physical, and psychological elements and are commonly implemented in soccer training. Although soccer sided-games research is plentiful, a meta-analytical synthesis of external load exposure during sided games is lacking. Objective: The objective of this systematic review and meta-analysis was to: (1) synthesize the evidence on high-speed and sprint running exposure induced by sided games in adult soccer players, (2) establish pooled estimates and intra-individual reliability for high-speed and sprint running exposure, and (3) explore the moderating effects of game format and playing constraints. Methods: A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Four databases (PubMed/MEDLINE, Scopus, SPORTDiscus, Web of Science Core Collection) were systematically searched up to 25 January, 2022. Eligibility criteria were adult soccer players (population); training programs incorporating sided games (intervention); game manipulations including number of players, pitch dimension, and game orientation (comparator); and high-speed, very high-speed, and sprint relative (m $$\cdot$$· min−1) running distances and associated intra-individual reliability (outcome). Eligible study risk of bias was evaluated using RoBANS. Pooled estimates for high-speed and sprint running exposure, and their intra-individual reliability, along with the moderating effect of tracking device running velocity thresholds, pitch dimension (i.e., area per player), and game orientation (i.e. score or possession), were determined via a multi-level mixed-effects meta-analysis. Estimate uncertainty is presented as 95% compatibility intervals (CIs) with the likely range of relative distances in similar future studies determined via 95% prediction intervals. Results: A total of 104 and 7 studies met our eligibility criteria for the main and reliability analyses, respectively. The range of relative distances covered across small-sided games, medium-sided games, and large-sided games was 14.8 m $$\cdot$$· min−1 (95% CI 12.3–17.4) to 17.2 m $$\cdot$$· min−1 (95% CI 13.5–20.8) for high-speed running, 2.7 m $$\cdot$$· min−1 (95% CI 1.8–3.5) to 3.6 m $$\cdot$$· min−1 (95% CI 2.3–4.8) for very high-speed running, and 0.2 m $$\cdot$$· min−1 (95% CI 0.1–0.4) to 0.7 m $$\cdot$$· min−1 (95% CI 0.5–0.9) for sprinting. Across different game formats, 95% prediction intervals showed future exposure for high-speed, very high-speed running, and sprinting to be 0–46.5 m $$\cdot$$· min−1, 0–14.2 m $$\cdot$$· min−1, and 0–2.6 m $$\cdot$$· min−1, respectively. High-speed, very high-speed running, and sprinting showed poor reliability with a pooled coefficient of variation of 22.8% with distances being moderated by device speed thresholds, pitch dimension, and game orientation. Conclusions: This review is the first to provide a detailed synthesis of exposure and intra-individual reliability of high-speed and sprint running during soccer sided games. Our estimates, along with the moderating influence of common programming variables such as velocity thresholds, area per player, and game orientation should be considered for informed planning of small-sided games, medium-sided games, and large-sided games soccer training. Clinical Trial Registration: Open Science Framework available through https://osf.io/a4xr2/.
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