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Background: While the burgeoning researcher and practitioner interest in physical literacy has stimulated new assessment approaches, the optimal tool for assessment among school-aged children remains unclear. Objective: The purpose of this review was to: (i) identify assessment instruments designed to measure physical literacy in school-aged children; (ii) map instruments to a holistic construct of physical literacy (as specified by the Australian Physical Literacy Framework); (iii) document the validity and reliability for these instruments; and (iv) assess the feasibility of these instruments for use in school environments. Design: This systematic review (registered with PROSPERO on 21 August, 2022) was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Data Sources: Reviews of physical literacy assessments in the past 5 years (2017 +) were initially used to identify relevant assessments. Following that, a search (20 July, 2022) in six databases (CINAHL, ERIC, GlobalHealth, MEDLINE, PsycINFO, SPORTDiscus) was conducted for assessments that were missed/or published since publication of the reviews. Each step of screening involved evaluation from two authors, with any issues resolved through discussion with a third author. Nine instruments were identified from eight reviews. The database search identified 375 potential papers of which 67 full text papers were screened, resulting in 39 papers relevant to a physical literacy assessment. Inclusion and Exclusion Criteria: Instruments were classified against the Australian Physical Literacy Framework and needed to have assessed at least three of the Australian Physical Literacy Framework domains (i.e., psychological, social, cognitive, and/or physical). Analyses: Instruments were assessed for five aspects of validity (test content, response processes, internal structure, relations with other variables, and the consequences of testing). Feasibility in schools was documented according to time, space, equipment, training, and qualifications. Results: Assessments with more validity/reliability evidence, according to age, were as follows: for children, the Physical Literacy in Children Questionnaire (PL-C Quest) and Passport for Life (PFL). For older children and adolescents, the Canadian Assessment for Physical Literacy (CAPL version 2). For adolescents, the Adolescent Physical Literacy Questionnaire (APLQ) and Portuguese Physical Literacy Assessment Questionnaire (PPLA-Q). Survey-based instruments were appraised to be the most feasible to administer in schools. Conclusions: This review identified optimal physical literacy assessments for children and adolescents based on current validity and reliability data. Instrument validity for specific populations was a clear gap, particularly for children with disability. While survey-based instruments were deemed the most feasible for use in schools, a comprehensive assessment may arguably require objective measures for elements in the physical domain. If a physical literacy assessment in schools is to be performed by teachers, this may require linking physical literacy to the curriculum and developing teachers' skills to develop and assess children's physical literacy. [ABSTRACT FROM AUTHOR]

Background: Among ultra-endurance runners (UER), the mental, behavioral, and physical demands of training/competition can result in maladaptive outcomes. Mental health issues are common in athletes and can impact psychology, physical health, and performance. Objective: To synthesize information regarding the incidence/prevalence and factors associated with mental health issues among UER. Methods: Systematic searches were performed in PubMed, SPORTDiscus, Scopus, Cochrane databases, CINAHL, Web of Science, and Medline Ovid using key terms related to UER (e.g., trail running, road running) and psychological issues (e.g., exercise addiction, depression). Inclusion criteria included original articles published in peer-reviewed journals in English, using qualitative or quantitative approaches. We considered papers reporting incidence/prevalence and associated factors with mental health outcomes in UER of both sexes, all ages, and levels of competition (e.g., elite, nonprofessional runners). The Joanna Briggs Institute Analytical Cross-Sectional Studies critical appraisal tool was used for quality assessment. Results: A total of 282 studies were identified, and 11 studies were included in the final selection. A total of 3670 UER were included in the studies. The prevalence of mental health issues among UER ranged between 32.0% and 62.5% for eating disorders, from 11.5% to 18.2% for exercise addiction, 18.6% for depressive symptoms, and 24.5% for sleep disturbance. Exercise addiction was not related to weekly volume, but a strong relationship with exercise in an unstructured space, age, and body mass index was shown. Conclusion: Mental health issues among UER are common, especially eating disorders, exercise addiction, sleep disturbances, and depressive symptoms. Further high-quality studies are needed to examine underlying factors and find preventative strategies to protect UER. Registration: The protocol of this systematic review was registered at the PROSPERO—CRD42022338743. [ABSTRACT FROM AUTHOR]

Background: Elevated glucose and insulin levels are major risk factors in the development of cardiometabolic disease. Aerobic exercise is widely recommended to improve glycaemic control, yet its acute effect on glycaemia and glucoregulatory hormones has not been systematically reviewed and analysed in healthy adults. Objective: To determine the effect of a single bout of continuous aerobic exercise on circulating glucose, insulin, and glucagon concentrations in healthy adults. Methods: CENTRAL, CINAHL, Embase, Global Health, HMIC, Medline, PubMed, PsycINFO, ScienceDirect, Scopus and Web of Science databases were searched from inception to May 2020. Papers were included if they reported a randomised, crossover study measuring glucose and/or insulin and/or glucagon concentrations before and immediately after a single bout of continuous aerobic exercise (≥ 30 min) compared to a time-matched, resting control arm in healthy adults. The risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Tool and GRADE approach, respectively. Random-effects meta-analyses were performed for glucose, insulin, and glucagon. Sub-group meta-analyses and meta-regression were performed for categorical (metabolic state [postprandial or fasted], exercise mode [cycle ergometer or treadmill]) and continuous (age, body mass index, % males, maximal aerobic capacity, exercise duration, exercise intensity) covariates, respectively. Results: 42 papers (51 studies) were considered eligible: glucose (45 studies, 391 participants), insulin (38 studies, 377 participants) and glucagon (5 studies, 47 participants). Acute aerobic exercise had no significant effect on glucose concentrations (mean difference: − 0.05 mmol/L; 95% CI, − 0.22 to 0.13 mmol/L; P = 0.589; I2: 91.08%, large heterogeneity; moderate-quality evidence). Acute aerobic exercise significantly decreased insulin concentrations (mean difference: − 18.07 pmol/L; 95% CI, − 30.47 to − 5.66 pmol/L; P = 0.004; I2: 95.39%, large heterogeneity; moderate-quality evidence) and significantly increased glucagon concentrations (mean difference: 24.60 ng/L; 95% CI, 16.25 to 32.95 ng/L; P < 0.001; I2: 79.36%, large heterogeneity; moderate-quality evidence). Sub-group meta-analyses identified that metabolic state modified glucose and insulin responses, in which aerobic exercise significantly decreased glucose (mean difference: − 0.27 mmol/L; 95% CI, − 0.55 to − 0.00 mmol/L; P = 0.049; I2: 89.72%, large heterogeneity) and insulin (mean difference: − 42.63 pmol/L; 95% CI, − 66.18 to − 19.09 pmol/L; P < 0.001; I2: 81.29%, large heterogeneity) concentrations in the postprandial but not fasted state. Meta-regression revealed that the glucose concentrations were also moderated by exercise duration and maximal aerobic capacity. Conclusions: Acute aerobic exercise performed in the postprandial state decreases glucose and insulin concentrations in healthy adults. Acute aerobic exercise also increases glucagon concentrations irrespective of metabolic state. Therefore, aerobic exercise undertaken in the postprandial state is an effective strategy to improve acute glycaemic control in healthy adults, supporting the role of aerobic exercise in reducing cardiometabolic disease incidence. PROSPERO registration number: CRD42020191345. [ABSTRACT FROM AUTHOR]

Amputation of a limb may have a negative impact on the psychological and physical well-being, mobility and social life of individuals with limb amputations. Participation in sports and/or regular physical activity has a positive effect on the above mentioned areas in able-bodied individuals. Data concerning participation in sports or regular physical activity together with its benefits and risks for individuals with limb amputations are scarce. No systematic review exists that addresses a wide range of outcomes such as biomechanics, cardiopulmonary function, psychology, sport participation and sport injuries. Therefore, the aim of this article is to systematically review the literature about individuals with limb amputations and sport participation. MEDLINE (PubMed), EMBASE, CINAHL® and SportDiscus® were searched without time or language restrictions using free text words and MeSH terms. The last search date was 31 March 2010. Books, internet sites and references of included papers were checked for papers relevant to the topic under review. Papers were included if the research topic concerned sports and a minimum of ten individuals with limb amputations were part of the study population. Papers were excluded if they included individuals with amputations of body parts other than upper or lower limbs or more distal than the wrist or ankle, or if they consisted of case reports, narrative reviews, books, notes or letters to the editor. Title, abstract and full-text assessments were performed by two independent observers following a list of preset criteria. Of the 3689 papers originally identified, 47 were included in the review. Most of the included studies were older than 10 years and had cross-sectional designs. Study participants were generally younger and often had more traumatic amputations than the general population of individuals with limb amputations. Heterogeneity in population characteristics, intervention types and main outcomes made data pooling impossible. In general, sports were associated with a beneficial effect on the cardiopulmonary system, psychological well-being, social reintegration and physical functioning. Younger individuals with unilateral transtibial amputations achieve better athletic performance and encounter fewer problems when participating in sports compared with older individuals with bilateral transfemoral amputations. Regardless of their amputation level, individuals with limb amputations participate in a wide range of recreational activities. The majority of them were not aware of the sport facilities in their area and were not informed about available recreational activities. Sport prosthetic devices were used mostly by competitive athletes. For football, the injury rate and pattern of the players with an amputation were similar to those of able-bodied players. Individuals with limb amputations appear to benefit both physically and psychologically from participation in sports and/or regular physical activity. Therefore, sports should be included in rehabilitation programmes, and individuals with limb amputations should be encouraged to pursue a physically active life following hospital discharge. [ABSTRACT FROM AUTHOR]

Background: Several studies have utilised isometric, eccentric and downhill walking pre-conditioning as a strategy for alleviating the signs and symptoms of exercise-induced muscle damage (EIMD) following a bout of damaging physical activity. Objectives: This systematic review and meta-analysis examined the effects of pre-conditioning strategies on indices of muscle damage and physical performance measures following a second bout of strenuous physical activity. Data Sources: PubMed, CINAHL and Scopus. Eligibility Criteria: Studies meeting the PICO (population, intervention/exposure, comparison, and outcome) criteria were included in this review: (1) general population or "untrained" participants with no contraindications affecting physical performance; (2) studies with a parallel design to examine the prevention and severity of muscle-damaging contractions; (3) outcome measures were compared using baseline and post-intervention measures; and (4) outcome measures included any markers of indirect muscle damage and muscular contractility measures. Participants: Individuals with no resistance training experiences in the previous 6 or more months. Interventions: A single bout of pre-conditioning exercises consisting of eccentric or isometric contractions performed a minimum of 24 h prior to a bout of damaging physical activity were compared to control interventions that did not perform pre-conditioning prior to damaging physical activity. Study Appraisal: Kmet appraisal system. Synthesis Methods: Quantitative analysis was conducted using forest plots to examine standardised mean differences (SMD, i.e. effect size), test statistics for statistical significance (i.e. Z-values) and between-study heterogeneity by inspecting I2. Results: Following abstract and full-text screening, 23 articles were included in this paper. Based on the meta-analysis, the pre-conditioning group exhibited lower levels of creatine kinase at 24 h (SMD = − 1.64; Z = 8.39; p = 0.00001), 48 h (SMD = − 2.65; Z = 7.78; p = 0.00001), 72 h (SMD = − 2.39; Z = 5.71; p = 0.00001) and 96 h post-exercise (SMD = − 3.52; Z = 7.39; p = 0.00001) than the control group. Delayed-onset muscle soreness was also lower for the pre-conditioning group at 24 h (SMD = − 1.89; Z = 6.17; p = 0.00001), 48 h (SMD = − 2.50; Z = 7.99; p = 0.00001), 72 h (SMD = − 2.73; Z = 7.86; p = 0.00001) and 96 h post-exercise (SMD = − 3.30; Z = 8.47; p = 0.00001). Maximal voluntary contraction force was maintained and returned to normal sooner in the pre-conditioning group than in the control group, 24 h (SMD = 1.46; Z = 5.49; p = 0.00001), 48 h (SMD = 1.59; Z = 6.04; p = 0.00001), 72 h (SMD = 2.02; Z = 6.09; p = 0.00001) and 96 h post-exercise (SMD = 2.16; Z = 5.69; p = 0.00001). Range of motion was better maintained by the pre-conditioning group compared with the control group at 24 h (SMD = 1.48; Z = 4.30; p = 0.00001), 48 h (SMD = 2.20; Z = 5.64; p = 0.00001), 72 h (SMD = 2.66; Z = 5.42; p = 0.00001) and 96 h post-exercise (SMD = 2.5; Z = 5.46; p = 0.00001). Based on qualitative analyses, pre-conditioning activities were more effective when performed at 2–4 days before the muscle-damaging protocol compared with immediately prior to the muscle-damaging protocol, or 1–3 weeks prior to the muscle-damaging protocol. Furthermore, pre-conditioning activities performed using eccentric contractions over isometric contractions, with higher volumes, greater intensity and more lengthened muscle contractions provided greater protection from EIMD. Limitations: Several outcome measures showed high inter-study heterogeneity. The inability to account for differences in durations between pre-conditioning and the second bout of damaging physical activity was also limiting. Conclusions: Pre-conditioning significantly reduced the severity of creatine kinase release, delayed-onset muscle soreness, loss of maximal voluntary contraction force and the range of motion decrease. Pre-conditioning may prevent severe EIMD and accelerate recovery of muscle force generation capacity. [ABSTRACT FROM AUTHOR]

Background: Understanding the determinants of children's health behaviours is important to develop successful behaviour-change interventions. Objective: We aimed to synthesise the evidence around determinants ('preceding predictors') of change in physical activity (PA) in young children (0-6 years of age). Methods: As part of a suite of reviews, prospective quantitative studies investigating change in physical activity in children aged 0-6 years were identified from eight databases (to October 2015): MEDLINE, Embase, CINAHL, PsycINFO, Web of Knowledge, British Nursing Index, Applied Social Sciences Index and Abstracts, and Sociological Abstracts. Determinants and direction of association were extracted, described and synthesised according to the socio-ecological model (individual, interpersonal, organisational, community, policy). Results: Forty-four determinants, predominantly in the interpersonal and organisational domains, were reported across 44 papers (six prospective cohort, 38 interventional); 14 determinants were assessed in four or more papers. Parental monitoring showed a consistent positive association with change in PA; provider training was positively associated with change in children's moderate-to-vigorous PA only. Five (sex, parental goal setting, social support, motor skill training and increased time for PA) showed no clear association. A further seven (child knowledge, parental knowledge, parental motivation, parenting skills, parental self-efficacy, curriculum materials and portable equipment) were consistently not associated with change in children's PA. Maternal role-modelling was positively associated with change in PA in all three studies in which it was examined. Conclusions: A range of studied determinants of change in young children's PA were identified, but only parental monitoring was found to be consistently positively associated. More evidence dealing with community and policy domains from low-/middle-income countries and about lesser-explored modifiable family- and childcare-related determinants is required. International Prospective Register for Systematic Reviews (PROSPERO) Registration Number: CRD42012002881. [ABSTRACT FROM AUTHOR]

Background: The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified. Objective: The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR. Methods: A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed. The GRADE tool was used to assess evidence quality. Results: Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury (OR 3.91, 95% CI 1.69–9.04), increased tibial slope (degrees) (OR 2.21, 95% CI 1.26–3.86), lower psychological readiness to return to sport (RTS) (OR 2.18, 95% CI 1.32–3.61), early surgery (< 12 vs ≥ 12 months) (OR 1.87, 95% CI 1.58–2.22), RTS (pre-injury level) (OR 1.87, 95% CI 1.21–2.91) and family history of ACL injury (OR 1.76, 95% CI 1.34–2.31) were all associated with increased odds of graft rupture. Higher age (OR 0.47, 95% CI 0.39–0.59), female sex (OR 0.88, 95% CI 0.79–0.98), fewer self-reported knee symptoms pre-reconstruction (OR 0.81, 95% CI 0.69–0.95) and concomitant cartilage injuries (OR 0.70, 95% CI 0.62–0.79) instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture. Conclusion: Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data. [ABSTRACT FROM AUTHOR]

Background: Male youth soccer players competing at a high level will typically engage in large volumes of soccer training from a young age. However, it is not known whether the high levels of habitual training that these high-performing players are exposed to limit their ability to respond to strength, plyometric or combined training interventions. Objective: The primary aim of our systematic review and meta-analysis was to compare the specific effects of strength, plyometric and combined training with active controls (standard soccer training) on the strength, power and speed characteristics of high-level, highly trained young male soccer players. Methods: We performed a literature search across PubMed, Scopus, CINAHL, Web of Science and SPORTDiscus to identify controlled studies that implemented strength, plyometric or combined training in high-level male youth soccer players. Participants were defined as high level or highly trained based on established guidelines related to either competition level or age-related weekly hours spent in soccer training. Studies needed to report at least one outcome of lower body strength, squat jump, countermovement jump, horizontal power, acceleration (0–10 m), speed (15–40 m) or change of direction speed. A meta-analysis was then performed using a random-effects model to determine the magnitude (Hedge's g) of training responses and whether effects differed across modes of training. Results: From an initial return of 5464 papers, n = 34 studies met the inclusion criteria and provided a total sample of n = 1396 high-level male youth soccer players. Strength, plyometric and combined training resulted in improvements in strength, squat and countermovement jump, horizontal power, acceleration, change of direction speed (all p < 0.05; g = 0.73–1.08, moderate) and speed (p < 0.05; g = 0.40–0.59, small). Lower body strength was the only outcome where training mode had a significant effect (p < 0.05), with plyometric training producing small effects (g = 0.27, p < 0.05) compared with moderate effects for strength (g = 1.07, p < 0.05) and combined (g = 0.75, p < 0.05) training. Prediction intervals for overall effects (all training modes combined) showed that the greatest confidence that future training will lead to positive effects was in the squat and countermovement jump, horizontal power and acceleration (prediction intervals = 0.03–1.81). Conclusions: High-level, highly trained male youth soccer players can experience positive gains in indices of strength, power and speed from strength, plyometric and combined training, and the magnitude of gains are mostly similar across modes of training. Based on prediction intervals, there is a good level of certainty that future strength, plyometric and combined training in this population would lead to positive improvements in vertical and horizontal power and sprint acceleration. [ABSTRACT FROM AUTHOR]

Background: Recreational football is an intense, versatile form of exercise with multiple high- and odd-impact actions. Recreational football is therefore hypothesized to be suitable for bone modeling and bone health. Objective: The aim of the present systematic review and meta-analysis was to evaluate the effects of recreational football on bone mineral density (BMD), bone mineral content (BMC) and bone turnover markers (BTM). Design: Systematic review and meta-analysis. Data Sources: MEDLINE, PubMed, SPORTDiscus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Google Scholar were searched prior to September 2021. A manual database search was also performed using the following key terms, either singly or in combination: recreational football/soccer, street football/soccer, recreational small-sided games, effect, influence, impact, bone turnover markers, bone mineral density, bone turnover marker, bone health, osteogenesis, CTX, osteocalcin, P1NP. Eligibility Criteria for Selecting Studies: Randomised and matched controlled trials with participants allocated to a recreational football group or any other type of training intervention or passive control group were included. The primary outcome measures were total BMD, lower limb BMD, total BMC, lower limb BMC, osteocalcin, procollagen type 1N-terminal propeptide (P1NP) and collagen type 1 cross-linked C-telopeptide (CTX). A total of 17 papers met the inclusion criteria and were included. Statistical Analysis: Comprehensive Meta-analysis V.2 software (Biostat, Englewood, New Jersey, USA) was used for the meta-analyses. Risk of Bias: Agreement between the two reviewers was assessed using RoB2 tool and k statistics for full-text screening and rating of relevance and risk of bias. The k agreement rate between reviewers was k = 0.92. Results: The football interventions included were based on studies having a duration of 12–64 weeks with one 5-year follow-up study and with a training frequency of 1–3 sessions/wk. Training sessions were 45–60 min sessions of 3v3 – 7v7 small-sided games. The subjects covered an age span from 9 to 73 years. Five studies examined recreational football effects in females, nine studies in males and three studies included both sexes. Recreational football training produced a statistically significant effect (mean difference = 0.02 g/cm2, 95% confidence interval: 0.00–0.03, P = 0.02) on lower limb BMD and negligible effects for total BMD compared to no-exercise controls. The recreational football effects on total and lower limb BMC, when compared to both no-exercise controls and exercise controls, were negligible. A moderate to large significant increase in osteocalcin, P1NP and CTX was observed for recreational football compared to both no-exercise controls and exercise controls. Conclusion: In conclusion, recreational football training regimes lasting 12–64 weeks have a large osteogenic impact on bone turnover markers in comparison with no-exercise controls as well as exercise controls, and beneficial effects on lower limb BMD compared to no-exercise controls. Short and medium duration recreational football interventions have negligible effects on whole-body BMD and BMC (total and lower limb), with magnitudes similar to those of other exercise modes. [ABSTRACT FROM AUTHOR]

Background: Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive–motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury.The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance.Scoping review.We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases.Only primary studies published in English were included without time limitations.Qualitative analysis of the included studies was performed.We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual–cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls.Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual–cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R.IV.The protocol was a priori registered on Open Science Framework (https://osf.io/p4j95/).Objectives: Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive–motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury.The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance.Scoping review.We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases.Only primary studies published in English were included without time limitations.Qualitative analysis of the included studies was performed.We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual–cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls.Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual–cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R.IV.The protocol was a priori registered on Open Science Framework (https://osf.io/p4j95/).Design: Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive–motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury.The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance.Scoping review.We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases.Only primary studies published in English were included without time limitations.Qualitative analysis of the included studies was performed.We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual–cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls.Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual–cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R.IV.The protocol was a priori registered on Open Science Framework (https://osf.io/p4j95/).Literature search: Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive–motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury.The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance.Scoping review.We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases.Only primary studies published in English were included without time limitations.Qualitative analysis of the included studies was performed.We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual–cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls.Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual–cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R.IV.The protocol was a priori registered on Open Science Framework (https://osf.io/p4j95/).Study selection criteria: Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive–motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury.The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance.Scoping review.We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases.Only primary studies published in English were included without time limitations.Qualitative analysis of the included studies was performed.We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual–cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls.Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual–cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R.IV.The protocol was a priori registered on Open Science Framework (https://osf.io/p4j95/).Data synthesis: Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive–motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury.The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance.Scoping review.We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases.Only primary studies published in English were included without time limitations.Qualitative analysis of the included studies was performed.We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual–cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls.Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual–cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R.IV.The protocol was a priori registered on Open Science Framework (https://osf.io/p4j95/).Results: Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive–motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury.The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance.Scoping review.We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases.Only primary studies published in English were included without time limitations.Qualitative analysis of the included studies was performed.We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual–cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls.Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual–cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R.IV.The protocol was a priori registered on Open Science Framework (https://osf.io/p4j95/).Conclusions: Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive–motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury.The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance.Scoping review.We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases.Only primary studies published in English were included without time limitations.Qualitative analysis of the included studies was performed.We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual–cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls.Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual–cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R.IV.The protocol was a priori registered on Open Science Framework (https://osf.io/p4j95/).Level of evidence: Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive–motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury.The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance.Scoping review.We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases.Only primary studies published in English were included without time limitations.Qualitative analysis of the included studies was performed.We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual–cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls.Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual–cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R.IV.The protocol was a priori registered on Open Science Framework (https://osf.io/p4j95/). [ABSTRACT FROM AUTHOR]

Background: The ability to monitor training load accurately in professional sports is proving vital for athlete preparedness and injury prevention. While numerous monitoring techniques have been developed to assess the running demands of many team sports, these methods are not well suited to throwing-dominant sports that are infrequently linked to high running volumes. Therefore, other techniques are required to monitor the differing demands of these sports to ensure athletes are adequately prepared for competition. Objective: To investigate the different methodologies used to quantitatively monitor training load in throwing-dominant sports. Methods: A systematic review of the methods used to monitor training load in throwing-dominant sports was conducted using variations of terms that described different load-monitoring techniques and different sports. Studies included in this review were published prior to June 2015 and were identified through a systematic search of four electronic databases including Academic Search Complete, CINAHL, Medline and SPORTDiscus. Only full-length peer-reviewed articles investigating workload monitoring in throwing-dominant sports were selected for review. Results: A total of 8098 studies were initially retrieved from the four databases and 7334 results were removed as they were either duplicates, review articles, non-peer-reviewed articles, conference abstracts or articles written in languages other than English. After screening the titles and abstracts of the remaining papers, 28 full-text papers were reviewed, resulting in the identification of 20 articles meeting the inclusion criteria for monitoring workloads in throwing-dominant sports. Reference lists of selected articles were then scanned to identify other potential articles, which yielded one additional article. Ten articles investigated workload monitoring in cricket, while baseball provided eight results, and handball, softball and water polo each contributed one article. Results demonstrated varying techniques used to monitor workload and purposes for monitoring workload, encompassing the relationship between workload and injury, individual responses to workloads, the effect of workload on subsequent performance and the future directions of workload-monitoring techniques. Conclusion: This systematic review highlighted a number of simple and effective workload-monitoring techniques implemented across a variety of throwing-dominant sports. The current literature placed an emphasis on the relationship between workload and injury. However, due to differences in chronological and training age, inconsistent injury definitions and time frames used for monitoring, injury thresholds remain unclear in throwing-dominant sports. Furthermore, although research has examined total workload, the intensity of workload is often neglected. Additional research on the reliability of self-reported workload data is also required to validate existing relationships between workload and injury. Considering the existing disparity within the literature, it is likely that throwing-dominant sports would benefit from the development of an automated monitoring tool to objectively assess throwing-related workloads in conjunction with well-established internal measures of load in athletes. [ABSTRACT FROM AUTHOR]

Background: Australian football is a popular sport in Australia, at both the community and elite levels. It is a high-speed contact sport with a higher incidence of medically treated injuries when compared with most other organized sports. Hamstring injuries, ligament injuries to the knee or ankle, hip/groin injuries and tendinopathies are particularly common and often result in considerable time lost from sport. Consequently, the prevention of lower limb injuries is a priority for both community and elite Australian football organizations. There is considerable literature available on exercise programmes aimed at reducing lower limb injuries in Australian football and other running-related sports. The quality and outcomes of these studies have varied considerably, but indicate that exercise protocols may be an effective means of preventing lower limb injuries. Despite this, there has been limited high-quality and systematic evaluation of these data. Objective: The aim of this literature review is to systematically evaluate the evidence about the benefits of lower limb injury prevention exercise protocols aimed at reducing the most common severe lower limb injuries in Australian football. Methods: The Cochrane Central Register of Controlled Trials, the Cochrane Bone Joint and Muscle Trauma Group Specialized Register, MEDLINE and other electronic databases were searched, from January 1990 to December 2010. Papers reporting the results of randomized controlled trials (RCTs), quasi-RCTs, cohort and case-control studies were extracted. Primary outcomes were injury reduction or risk factor identification and/or modification. Secondary outcomes were adherence to any trialled interventions, injury severity and adverse effects such as secondary injuries and muscle soreness. The methodological quality of extracted manuscripts was assessed and results were collated. Results: Forty-seven papers were identified and reviewed of which 18 related to hamstring injury, eight related to knee or ankle ligament injury, five related to tendon injury and four were hip or groin injury related. Another 12 papers targeted general lower limb injuries. Most ( n = 27 [57 %]) were observational studies, investigating injury risk factors. Twenty reported the results of intervention trials. Of these, 15 were efficacy trials reporting the effects of an intervention in reducing injury rates, four were biomechanical interventions in which the impact of the intervention on a known injury risk factor was assessed and one reported changes in injury risk factors as well as injury rates. The strength of the evidence base for exercise programmes for lower limb injury prevention was found to be limited, primarily due to the research methods employed, low adherence to interventions by the study participants and a lack of statistical power. Limited evidence obtained from a small number of RCTs suggests that balance and control exercises might be efficacious in preventing ankle ligament injuries and a programme involving a combination of balance and control exercises, eccentric hamstring, plyometrics and strength exercises could be efficacious in preventing all lower limb injuries. Conclusions: Overall, the evidence for exercise programmes as an efficacious lower limb injury prevention strategy is predominantly restricted to studies addressing injury aetiology and mechanisms. The findings of this review highlight the need to develop and test interventions in well designed population-based trials with an emphasis on promoting intervention uptake and adherence and, hence, intervention effectiveness. The results of this review can inform the development of the components of a future lower limb injury prevention exercise protocol for community-level Australian football. [ABSTRACT FROM AUTHOR]

Background: Hamstrings neuromuscular function is a crucial component of functional movement, and changes after anterior cruciate ligament (ACL) injury contribute to risk factors for secondary injury and long-term sequelae. To effectively treat muscular impairments, an accurate understanding of hamstrings neuromuscular function in patients with ACL reconstruction (ACLR) is needed. Objective: A systematic review and meta-analysis were undertaken to describe and quantify hamstrings neuromuscular function in individuals with ACLR compared to controls. Methods: We searched PubMed, Web of Science, SPORTDiscus, CINAHL, and EBSCOhost databases in October of 2020 for studies evaluating the difference between hamstrings electromyography (EMG) between individuals with ACLR and controls. Two independent reviewers assessed each paper for inclusion and quality. Means and standard deviations were extracted from each included study to allow random-effect size (ES) meta-analysis calculations for comparison of results. Results: Thirty-four studies were included for final review. From these, 5 categories of neuromuscular outcomes were identified, and studies were grouped accordingly: (1) muscle activation levels (EMG amplitude), (2) co-activation, (3) onset timing, (4) electromechanical delay, and (5) time-to-peak activity. Moderate to strong evidence indicates that individuals with ACLR demonstrate higher hamstrings EMG amplitude (normalized to % maximum voluntary isometric contraction) and hamstrings-to-quadriceps co-activation during gait and stair ambulation compared to controls. In addition, there was moderate evidence of longer electromechanical delay during knee flexion and greater hamstrings-to-quadriceps co-activation during knee extension compared to controls. Conclusions: Greater hamstrings EMG amplitude and co-activation during gait and ambulation tasks and longer electromechanical delay of the hamstrings in individuals with ACLR align with clinical impairments following ACLR and have implications for re-injury risk and long-term joint health, thus warranting attention in rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Hamstrings muscle morphology is determinant of muscle function (i.e. strength). Among individuals with ACL reconstruction (ACLR), less cross-sectional area (CSA) and volume in the ACLR-limb are associated with muscle weakness, and may contribute to lower rates of return to preinjury activity level and an increased risk for long-term sequelae. Objectives: To effectively treat muscular impairments, an accurate understanding of differences in hamstrings morphology following ACLR is needed. A systematic review and meta-analysis were undertaken to describe the morphology of the hamstring muscle complex after ACLR. Methods: We searched five databases for studies evaluating the difference between hamstrings size and architecture in individuals with ACLR. Two independent reviewers assessed each paper for inclusion and quality. Means and standard deviations were extracted from each included study to allow fixed-effect size meta-analysis calculations for comparison of results. Results: Twenty-four studies were included for final review. Eight categories of morphological outcomes were identified, and studies were grouped accordingly: (1) volume, (2) cross-sectional area (CSA), (3) muscle length, (4) muscle thickness, (5) fascicle length, (6) pennation angle, (7) fiber area, and (8) fiber type. Meta-analysis demonstrated lower hamstrings volume in the ACLR-limb in both contralateral and control group comparisons, and lower CSA, length, and thickness in the ACLR-limb in contralateral comparisons. The semitendinosus and gracilis were most profoundly impacted. Limited moderate evidence demonstrated greater biceps femoris pennation angle in the ACLR-limb. Conclusions: Individuals with ACLR demonstrated large deficits in semitendinosus and gracilis muscle CSA and volume in the ACLR-limb compared contralaterally, with no differences observed in the biceps femoris or semimembranosus. Clinical implications regarding assessment and treatment of individuals with ACLR are discussed. [ABSTRACT FROM AUTHOR]

Background: Microtechnology has allowed sport scientists to understand the locomotor demands of various sports. While wearable global positioning technology has been used to quantify the locomotor demands of sporting activities, microsensors (i.e. accelerometers, gyroscopes and magnetometers) embedded within the units also have the capability to detect sport-specific movements. Objective: The objective of this study was to determine the extent to which microsensors (also referred to as inertial measurement units and microelectromechanical sensors) have been utilised in quantifying sport-specific movements. Methods: A systematic review of the use of microsensors and associated terms to evaluate sport-specific movements was conducted; permutations of the terms used included alternate names of the various technologies used, their applications and different applied environments. Studies for this review were published between 2008 and 2014 and were identified through a systematic search of six electronic databases: Academic Search Complete, CINAHL, PsycINFO, PubMed, SPORTDiscus, and Web of Science. Articles were required to have used athlete-mounted sensors to detect sport-specific movements (e.g. rugby union tackle) rather than sensors mounted to equipment and monitoring generic movement patterns. Results: A total of 2395 studies were initially retrieved from the six databases and 737 results were removed as they were duplicates, review articles or conference abstracts. After screening titles and abstracts of the remaining papers, the full text of 47 papers was reviewed, resulting in the inclusion of 28 articles that met the set criteria around the application of microsensors for detecting sport-specific movements. Eight articles addressed the use of microsensors within individual sports, team sports provided seven results, water sports provided eight articles, and five articles addressed the use of microsensors in snow sports. All articles provided evidence of the ability of microsensors to detect sport-specific movements. Results demonstrated varying purposes for the use of microsensors, encompassing the detection of movement and movement frequency, the identification of movement errors and the assessment of forces during collisions. Conclusion: This systematic review has highlighted the use of microsensors to detect sport-specific movements across a wide range of individual and team sports. The ability of microsensors to capture sport-specific movements emphasises the capability of this technology to provide further detail on athlete demands and performance. However, there was mixed evidence on the ability of microsensors to quantify some movements (e.g. tackling within rugby union, rugby league and Australian rules football). Given these contrasting results, further research is required to validate the ability of wearable microsensors containing accelerometers, gyroscopes and magnetometers to detect tackles in collision sports, as well as other contact events such as the ruck, maul and scrum in rugby union. [ABSTRACT FROM AUTHOR]

An athlete’s pacing strategy is widely recognised as an essential determinant for performance during individual events. Previous research focussed on the importance of internal bodily state feedback, revealed optimal pacing strategies in time-trial exercise, and explored concepts such as teleoanticipation and template formation. Recently, human-environment interactions have additionally been emphasized as a crucial determinant for pacing, yet how they affect pacing is not well understood. Therefore, this literature review focussed on exploring one of the most important human-environment interactions in sport competitions: the interaction among competitors. The existing literature regarding the regulation of exercise intensity and the effect of competition on pacing and performance is critically reviewed in this paper. The PubMed, CINAHL and Web of Science electronic databases were searched for studies about pacing in sports and (interpersonal) competition between January 2000 to October 2017, using the following combination of terms: (1) Sports AND (2) Pacing, resulting in 75 included papers. The behaviour of opponents was shown to be an essential determinant in the regulation of exercise intensity, based on both observational (N = 59) and experimental (N = 16) studies. However, adjustment in the pacing response related to other competitors appears to depend on the competitive situation and the current internal state of the athlete. The findings of this review emphasize the importance of what is happening around the athlete for the outcome of the decision-making process involved in pacing, and highlight the necessity to incorporate human-environment interactions into models that attempt to explain the regulation of exercise intensity in sports and exercise. [ABSTRACT FROM AUTHOR]

Background: In recent years, there has been a large expansion in literature pertaining to the game of Australian football (AF). Furthermore, there have been a number of rule changes that are likely to have changed the demands of the game. Based on these advances and changes, it seemed important to conduct a review assessing the scientific literature surrounding the sport.Objective: The review evaluates the match demands of AF, the qualities required for success, and the impact training and competition have on adaptation, injury and fatigue.Methods: A systematic search of PubMed, CINAHL, SPORTDiscus, Web of Science and Scopus for AF literature was conducted; studies investigating match demands, physical qualities, training practices and injury were included. Weighted means and standard deviations were calculated for match demands and physical and anthropometric profiles across playing standards.Results: A total of 1830 articles were retrieved in the initial search, with 888 removed as duplicates, 626 removed for being non-relevant and a further 152 removed for being AF papers but not relevant to the review. As such, 164 AF papers were included in the review. Due to the intermittent high-intensity nature of match-play, players need a wide range of physical and technical qualities to excel, with speed, aerobic fitness, reactive agility and well-developed lean mass being central to success. Training for AF at the elite level is associated with high workloads, with players engaging in numerous training modalities; even altitude and heat training camps have been utilised by Australian Football League (AFL) teams to further augment fitness improvements. While high chronic workloads can be tolerated and are needed for improving physical qualities, careful planning and monitoring of internal and external workloads is required to minimise sharp spikes in load that are associated with injury.Conclusions: There is a complex interaction between numerous contextual factors that influence the match demands that are discussed in this review. Whilst players must have the physical capacities to cope with the intense physical demands of AF matches, the successful execution of technical skills during match-play is central to success. To develop these skills and attributes, specific and carefully planned and monitored training must be performed over a number of years. [ABSTRACT FROM AUTHOR]

Background: Team ball sports such as soccer, basketball and volleyball have high participation levels worldwide. Musculoskeletal injuries are common in team ball sports and are associated with significant treatment costs, participation loss and long-term negative side effects. The results of recent randomized controlled trials provide support for the protective effect of injury-prevention exercise programmes (IPEPs) in team ball sports, but also highlight that achieving adequate compliance can be challenging. A key process in enhancing the ultimate impact of team ball sport IPEPs is identifying the specific implementation components that influence the adoption, execution and maintenance of these interventions. Despite this, no systematic review focussing on the specific implementation components of team ball sport IPEPs has been conducted. Objectives: Our objective was to assess the reporting of specific implementation components in the published literature on team ball sport IPEPs using the Reach Efficacy Adoption Implementation Maintenance (RE-AIM) framework. Methods: Six electronic databases were systematically searched from inception to December 2012 for papers reporting team ball sport IPEP trials. All eligible papers were independently evaluated by two raters before reaching consensus on the reporting of individual RE-AIM items, using the RE-AIM Model Dimension Items Checklist (RE-AIM MDIC). Results: A total of 60 papers, reporting 52 unique intervention trials, met eligibility criteria. Before consensus, the level of agreement across all trials between reviewers using the RE-AIM MDIC ranged from 81 to 91 %. The RE-AIM MDIC dimension of 'efficacy' had the highest level of reporting, with the five individual items in this dimension reported in 19-100 % of eligible trials (mean 58 %). The RE-AIM MDIC dimension 'maintenance-setting level' had the lowest level of reporting, with none of the four individual items in this dimension reported. For other dimensions, the mean level of reporting and range across items were 'reach' 34 % (12-60 %); 'adoption-setting level' 1 % (0-2 %); 'adoption-delivery agent level' 7 % (4-10 %); 'implementation' 36 % (13-63 %) and 'maintenance individual level' 1 % (0-4 %). Conclusion: Information on the specific implementation components of team ball sport IPEPs in published studies is scarce. In particular, major reporting gaps exist regarding the adoption and maintenance of these programmes. The RE-AIM MDIC can be successfully applied to reviewing literature in this context. [ABSTRACT FROM AUTHOR]

Background: Self-reported outcome measures of athlete health, wellbeing and performance add information to that obtained from clinical measures. However valid, universally accepted outcome measures are required. Objective: To determine which athlete-reported outcome measures of performance have been used to measure the impact of injury and illness on performance in sport and assess evidence to support their validity. Methods: The authors searched Ovid MEDLINE, Ovid EMBASE, CINAHL Plus, SPORTDiscus with Full Text and Cochrane library to January 2016. Predefined inclusion and exclusion criteria were applied and papers included if an outcome measure of performance, assessed in relation to illness, injury or a related intervention, was reported by an elite, adult, able-bodied athlete. A checklist was used to assess eligible outcome measures for aspects of validity. Reporting of this study was guided by PRISMA guidelines for systematic reviews. Results: Twenty athlete-reported outcome measures in 21 papers were identified. Of these 20, only four cited validation. Of these four, three reported evidence to support validity in elite athlete groups as defined by the predetermined checklist. Fifteen patient-reported outcome measures were identified, of which four demonstrated validity in young athletic populations. Conclusions: Most athlete-reported outcome measures of performance have been designed for individual studies with no reported assessment of validity. Despite some limitations, the Oslo Sports Trauma Centre overuse injury questionnaire demonstrates validity and potential utility to investigate the self-reported impact of pre-defined conditions on athletic performance across different sports. [ABSTRACT FROM AUTHOR]

Background: The ActivityStat hypothesis suggests that when physical activity is increased or decreased in one domain, there will be a compensatory change in another domain, in order to maintain an overall stable level of physical activity or energy expenditure over time. The ActivityStat debate is gaining momentum in the literature and most of the research to date is based on observational studies. Objective: The objective of this paper is to conceptually clarify the ActivityStat hypothesis and to examine the experimental research aiming to demonstrate or refute compensation using a systematic review process. Methods: A systematic review was conducted using electronic database searches with the aim of detecting studies experimentally investigating the ActivityStat hypothesis or compensation in physical activity or energy expenditure. Included studies were critically appraised using a specifically designed tool to address the conceptual considerations of the ActivityStat hypothesis. Results: Searches identified 28 studies that met the inclusion criteria. Publications spanned 26 years and had multiple methodological approaches, including randomized and non-randomized controlled trials, crossover designs, cluster randomized controlled trials and pre-post trials. Populations of the included studies ranged from children, to adults and the elderly, across a range of weight statuses and used both aerobic, resistance and mixed-exercise interventions. The timeframe of interventions ranged from 1 day to 4 years and outcomes were measured using doubly labelled water, accelerometry, heart rate monitoring, resting metabolic rate, indirect calorimetry, pedometry, subjective recall questionnaire and the activity-related time index. Fifteen of 28 included studies provided evidence of compensation, while 13 did not. Subgroup analyses by population, type and duration of intervention, weight status and study quality also showed mixed findings. Conclusion: There is a substantial body of experimental literature investigating compensation that has largely been overlooked in the ActivityStat debate. However, this evidence is currently inconclusive and lacks a cohesive approach to the question of an ActivityStat. Recommendations for the design of future experimental research investigating the ActivityStat hypothesis are presented. [ABSTRACT FROM AUTHOR]

Anterior knee pain is a chronic condition that presents frequently to sport medicine clinics, and can have a long-term impact on participation in physica activity. Conceivably, effective early management may prevent chronicit and facilitate physical activity. Although a variety of nonsurgical interven' tions have been advocated, previous systematic reviews have consistenty been unable to reach conclusions to support their use. Considering a decade has lapsed since publication of the most recent data in these reviews, it is timely to provide an updated synthesis of the literature to assist sports medicine practitioners in making informed, evidence-based decisions. A systematic review and meta-analysis was conducted to evaluate the evidence for non- surgical interventions for anterior knee pain. A comprehensive search strategy was used to search MEDLINE, EM- BASE, CINAHL® and Pre-CINAHL®, PEDro, PubMed, SportDiscus®, Web of Science®, BIOSIS Previews®, and the full Cochrane Library, while reference lists of included papers and previous systematic reviews were hand searched. Studies were eligible for inclusion if they were randomized clinical trials that used a measure of pain to evaluate at least one nonsurgical inter- vention over at least 2 weeks in participants with anterior knee pain. A modified version of the PEDro scale was used to rate methodological quality and risk of bias. Effect size calculation and meta-analyses were based on random effects models. Of 48 suitable studies, 27 studies with low-to-moderate risk of bias were included. There was minimal opportunity for meta-analysis because of heterogeneity of interventions, comparators and follow-up times. Meta- analysis of high-quality clinical trials supports the use of a 6-week multimodal physiotherapy programme (standardized mean difference [SMD] 1.08, 95% CI 0.73, 1.43), but does not support the addition of electromyography bio- feedback to an exercise programme in the short-term (4 weeks: SMD -0.21, 95% CI -0.64,0.21; 8-12 weeks: SMD -0.22,95% CI -0.65, 0.20). Individual study data showed beneficial effects for foot orthoses with and without multimodal physiotherapy (vs flat inserts), exercise (vs control), closed chain exercises (vs open chain exercises), patella taping in conjunction with exercise (vs exercise alone) and acupuncture (vs control). Findings suggest that, in implementing evidence-based practice for the nonsurgical management of anterior knee pain, sports medicine practitioners should prescribe local, proximal and distal components of multimodal physiotherapy in the first instance for suitable patients, and then consider foot orthoses or acupuncture as required. [ABSTRACT FROM AUTHOR]

Football codes (rugby union, soccer, American football) train and play matches on natural and artificial turfs. A review of injuries on different turfs was needed to inform practitioners and sporting bodies on turf-related injury mechanisms and risk factors. Therefore, the aim of this review was to compare the incidence, nature and mechanisms of injuries sustained on newer generation artificial turfs and natural turfs. Electronic databases were searched using the keywords 'artificial turf', 'natural turf', 'grass' and 'inj*'. Delimitation of 120 articles sourced to those addressing injuries in football codes and those using third and fourth generation artificial turfs or natural turfs resulted in 11 experimental papers. These 11 papers provided 20 cohorts that could be assessed using magnitude-based inferences for injury incidence rate ratio calculations pertaining to differences between surfaces. Analysis showed that 16 of the 20 cohorts showed trivial effects for overall incidence rate ratios between surfaces. There was increased risk of ankle injury playing on artificial turf in eight cohorts, with incidence rate ratios from 0.7 to 5.2. Evidence concerning risk of knee injuries on the two surfaces was inconsistent, with incidence rate ratios from 0.4 to 2.8. Two cohorts showed beneficial inferences over the 90% likelihood value for effects of artificial surface on muscle injuries for soccer players; however, there were also two harmful, four unclear and five trivial inferences across the three football codes. Inferences relating to injury severity were inconsistent, with the exception that artificial turf was very likely to have harmful effects for minor injuries in rugby union training and severe injuries in young female soccer players. No clear differences between surfaces were evident in relation to training versus match injuries. Potential mechanisms for differing injury patterns on artificial turf compared with natural turf include increased peak torque and rotational stiffness properties of shoe-surface interfaces, decreased impact attenuation properties of surfaces, differing foot loading patterns and detrimental physiological responses. Changing between surfaces may be a precursor for injury in soccer. In conclusion, studies have provided strong evidence for comparable rates of injury between new generation artificial turfs and natural turfs. An exception is the likely increased risk of ankle injury on third and fourth generation artificial turfs. Therefore, ankle injury prevention strategies must be a priority for athletes who play on artificial turf regularly. Clarification of effects of artificial surfaces on muscle and knee injuries are required given inconsistencies in incidence rate ratios depending on the football code, athlete, gender or match versus training. [ABSTRACT FROM AUTHOR]

Background: The high prevalence of injury amongst cricket fast bowlers exposes a great need for research into the risk factors associated with injury. Both extrinsic (environment-related) and intrinsic (person-related) risk factors are likely to be implicated within the high prevalence of non-contact injury amongst fast bowlers in cricket. Identifying and defining the relative importance of these risk factors is necessary in order to optimize injury prevention efforts. Objective: The objective of this review was to assess and summarize the scientific literature related to the extrinsic and intrinsic factors associated with non-contact injury inherent to adult cricket fast bowlers. Method: A systematic review was performed in compliance with the PRISMA guidelines. This review considered both experimental and epidemiological study designs. Studies that included male cricket fast bowlers aged 18 years or above, from all levels of play, evaluating the association between extrinsic/intrinsic factors and injury in fast bowlers were considered for inclusion. The three-step search strategy aimed at finding both published and unpublished studies from all languages. The searched databases included MEDLINE via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Controlled Trials Register in the Cochrane Library, Physiotherapy Evidence Database (PEDro), ProQuest 5000 International, ProQuest Health and Medical Complete, EBSCO MegaFile Premier, Science Direct, SPORTDiscus with Full Text and SCOPUS (prior to 28 April 2015). Initial keywords used were 'cricket', 'pace', 'fast', 'bowler', and 'injury'. Papers which fitted the inclusion criteria were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Results: A total of 16 studies were determined to be suitable for inclusion in this systematic review. The mean critical appraisal score of the papers included in this study was 6.88 (SD 1.15) out of a maximum of 9. The following factors were found to be associated with injury: bowling shoulder internal rotation strength deficit, compromised dynamic balance and lumbar proprioception (joint position sense), the appearance of lumbar posterior element bone stress, degeneration of the lumbar disc on magnetic resonance imaging (MRI), and previous injury. Conflicting results were found for the association of quadratus lumborum (QL) muscle asymmetry with injury. Technique-related factors associated with injury included shoulder-pelvis flexion-extension angle, shoulder counter-rotation, knee angle, and the proportion of side-flexion during bowling. Bowling workload was the only extrinsic factor associated with injury in adult cricket fast bowlers. A high bowling workload (particularly if it represented a sudden upgrade from a lower workload) increased the subsequent risk to sustaining an injury 1, 3 or 4 weeks later. Conclusion: Identifying the factors associated with injury is a crucial step which should precede the development of, and research into, the effectiveness of injury prevention programs. Once identified, risk factors may be included in pre-participation screening tools and injury prevention programs, and may also be incorporated in future research projects. Overall, the current review highlights the clear lack of research on factors associated with non-contact injury, specifically in adult cricket fast bowlers. Systematic review registration number Johanna Briggs Institute Database of Systematic Reviews and Implementation Reports 1387 (Olivier et al., JBI Database Syst Rev Implement Rep 13(1):3-13. doi:, ). [ABSTRACT FROM AUTHOR]

Background: A return to running after anterior cruciate ligament reconstruction (ACL-R) is critical to the clinical success of any cutting and pivoting athlete who wishes to return to sport. Knowledge of specific alterations during running after ACL-R is required to optimise rehabilitation for improving outcomes and long-term disability. Objective: The objective of this systematic review was to summarise kinematic, kinetic and muscle activation data during running after ACL-R and the intrinsic factors (e.g. surgical technique and strength asymmetries) affecting running biomechanics. Methods: MEDLINE, EMBASE, SPORTDiscus and CINAHL databases were searched from inception to 10 December, 2018. The search identified studies comparing kinematic, kinetic or muscle activation data during running between the involved limb and contralateral or control limbs. Studies analysing the effect of intrinsic factors in the ACL-R group were also included. Risk of bias was assessed, qualitative and quantitative analyses performed, and levels of evidence determined. Results: A total of 1993 papers were identified and 25 were included for analysis. Pooled analyses reported a deficit of knee flexion motion and internal knee extension moment, compared with both contralateral or control limbs, during the stance phase of running from 3 months to 5 years after ACL-R (strong evidence). Inconsistent results were found for both peak vertical ground reaction force and impact forces after ACL-R. Patellofemoral and tibiofemoral joint contact forces differed from both contralateral or control limbs up until at least 2.5 years after ACL-R and moderate evidence indicated no difference for muscle activations during moderate speed running. Quadriceps and hamstring strength asymmetries, and knee function, but not surgical techniques, were likely to be associated with both knee kinematics and kinetics during running after ACL-R. Conclusion: After ACL-R, knee flexion motion and internal knee extension moment are the most affected variables and are consistently smaller in the injured limb during running when pooling evidence. Clinicians should be aware that these deficits do not appear to resolve with time and, thus, specific clinical interventions may be needed to reduce long-term disability. Systematic review registration: Registered in PROSPERO 2017, CRD42017077130. [ABSTRACT FROM AUTHOR]

Background: Soccer is the most popular sport worldwide, with a long history and currently more than 500 million active participants, of whom 300 million are registered football club members. On the basis of scientific findings showing positive fitness and health effects of recreational soccer, FIFA (Fédération Internationale de Football Association) introduced the slogan 'Playing football for 45 min twice a week-best prevention of non-communicable diseases' in 2010. Objective: The objective of this paper was to perform a systematic review and meta-analysis of the literature to determine the effects of recreational soccer on maximal oxygen uptake ( $$ \dot{V}{\text{O}}_{2\;\hbox{max} } $$ ). Methods: Six electronic databases (MEDLINE, PubMed, SPORTDiscus, Web of Science, CINAHL and Google Scholar) were searched for original research articles. A manual search was performed to cover the areas of recreational soccer, recreational physical activity, recreational small-sided games and $$ \dot{V}{\text{O}}_{2\;\hbox{max} } $$ using the following key terms, either singly or in combination: recreational small-sided games, recreational football, recreational soccer, street football, street soccer, effect, maximal oxygen uptake, peak oxygen uptake, cardiorespiratory fitness, $$ \dot{V}{\text{O}}_{2\;\hbox{max} } $$ . The inclusion criteria were divided into four sections: type of study, type of participants, type of interventions and type of outcome measures. Probabilistic magnitude-based inferences for meta-analysed effects were based on standardised thresholds for small, moderate and large changes (0.2, 0.6 and 1.2, respectively) derived from between-subject standard deviations for baseline fitness. Results: Seventeen studies met the inclusion criteria and were included in the systematic review and meta-analysis. Mean differences showed that $$ \dot{V}{\text{O}}_{2\;\hbox{max} } $$ increased by 3.51 mL/kg/min (95 % CI 3.07-4.15) over a recreational soccer training programme in comparison with other training models. The meta-analysed effects of recreational soccer on $$ \dot{V}{\text{O}}_{2\;\hbox{max} } $$ compared with the controls of no exercise, continuous running and strength training were most likely largely beneficial [effect size (ES) = 1.46; 95 % confidence interval (CI) 0.91, 2.01; I = 88.35 %], most likely moderately beneficial (ES = 0.68; 95 % CI 0.06, 1.29; I = 69.13 %) and most likely moderately beneficial (ES = 1.08; 95 % CI −0.25, 2.42; I = 71.06 %), respectively. In men and women, the meta-analysed effect was most likely largely beneficial for men (ES = 1.22) and most likely moderately beneficial for women (ES = 0.96) compared with the controls. After 12 weeks of recreational soccer with an intensity of 78-84 % maximal heart rate (HR), healthy untrained men improved their $$ \dot{V}{\text{O}}_{2\;\hbox{max} } $$ by 8-13 %, while untrained elderly participants improved their $$ \dot{V}{\text{O}}_{2\;\hbox{max} } $$ by 15-18 %. Soccer training for 12-70 weeks in healthy women resulted in an improvement in $$ \dot{V}{\text{O}}_{2\;\hbox{max} } $$ of 5-16 %. Significant improvements in $$ \dot{V}{\text{O}}_{2\;\hbox{max} } $$ have been observed in patients with diabetes mellitus, hypertension and prostate cancer. Conclusion: Recreational soccer produces large improvements in $$ \dot{V}{\text{O}}_{2\;\hbox{max} } $$ compared to strength training and no exercise, regardless of the age, sex and health status of the participants. Furthermore, recreational soccer is better than continuous endurance running, albeit the additional effect is moderate. This kind of physical activity has great potential for enhancing aerobic fitness, and for preventing and treating non-communicable diseases, and is ideal for addressing lack of motivation, a key component in physical (in)activity. [ABSTRACT FROM AUTHOR]

Background: Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist. Objective: Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity. Methods: We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields. Results: One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with high-quality studies (0.54 vs 11.55 per 1,000 exposures). Ankle sprain prevalence period estimates were similar across sub-groups. Lateral ankle sprain was the most commonly observed type of ankle sprain. Conclusions: Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity. Studies at a greater risk of bias were more likely to underestimate the risk of ankle sprain. Participants were at a significantly higher risk of sustaining a lateral ankle sprain compared with syndesmotic and medial ankle sprains. [ABSTRACT FROM AUTHOR]

Behavioural and social science theories and models (BSSTM) can enhance efforts to increase health and safety behaviours, such as the uptake and maintenance of injury prevention measures. However, the extent to which they have been used in sports injury research to date is currently unknown. A systematic review of 24 electronic databases was undertaken to identify the extent to which BSSTM have been incorporated into published sports injury prevention research studies and to identify which theories were adopted and how they were used. After assessment against specific inclusion and exclusion criteria, the full text of 100 potentially relevant papers was reviewed in detail. These papers were classified as follows: (i) explicit — the use of BSSTM was a stated key aspect in the design or conduct of the study; or (ii) atheoretical — there was no clear evidence for the use of BSSTM. The studies that explicitly mentioned BSSTM were assessed for how BSSTM were specifically used. Amongst the 100 identified papers, only eleven (11% of the total) explicitly mentioned BSSTM. Of these, BSSTM were most commonly used to guide programme design/implementation (n = 8) and/or to measure a theory/ construct (n = 7). In conclusion, very few studies relating to sport safety behaviours have explicitly used any BSSTM. It is likely that future sports injury prevention efforts will only be enhanced, and achieve successful outcomes, if increased attention is given to fully understanding the behavioural determinants of safety actions. Appropriate use of BSSTM is critical to provide the theoretical basis to guide these efforts. [ABSTRACT FROM AUTHOR]

Background: More than half of the recurrent hamstring injuries occur within the first month after return-to-play (RTP). Although there are numerous studies on RTP, comparisons are hampered by the numerous definitions of RTP used. Moreover, there is no consensus on the criteria used to determine when a person can start playing again. These criteria need to be critically evaluated, in an attempt to reduce recurrence rates and optimize RTP. Objective: To carry out a systematic review of the literature on (1) definitions of RTP used in hamstring research and (2) criteria for RTP after hamstring injuries. Study Design: Systematic review. Methods: Seven databases (PubMed, EMBASE/MEDLINE, CINAHL, PEDro, Cochrane, SPORTDiscus, Scopus) were searched for articles that provided a definition of, or criteria for, RTP after hamstring injury. There were no limitations on the methodological design or quality of articles. Content analysis was used to record and analyze definitions and criteria for RTP after hamstring injury. Results: Twenty-five papers fulfilled inclusion criteria, of which 13 provided a definition of RTP and 23 described criteria to support the RTP decision. 'Reaching the athlete's pre-injury level' and 'being able to perform full sport activities' were the primary content categories used to define RTP. 'Absence of pain', 'similar strength', 'similar flexibility', 'medical staff clearance', and 'functional performance' were core themes to describe criteria to support the RTP decision after hamstring injury. Conclusion: Only half of the included studies provided some definition of RTP after hamstring injury, of which reaching the athlete's pre-injury level and being able to perform full sport activities were the most important. A wide variety of criteria are used to support the RTP decision, none of which have been validated. More research is needed to reach a consensus on the definition of RTP and to provide validated RTP criteria to facilitate hamstring injury management and reduce hamstring injury recurrence. PROSPERO systematic review registration number: CRD42015016510. [ABSTRACT FROM AUTHOR]

Background: The adolescent 'growth spurt' results in rapid growth of the skeletal system. It has been theorised that absence of a concomitant increase in muscular adaptations in female athletes may predispose them to an increased risk of anterior cruciate ligament injuries. Objectives: To determine if sex differences exist in landing biomechanics and postural stability of adolescent athletes; with a further objective of determining if such differences are propagated during adolescence. Data sources: The following databases were searched: MEDLINE, EMBASE, CINAHL, PEDro, PubMed, SPORTDiscus and Web of Science. Research papers were identified by including search terms for neuromuscular control, lower limb and pubertal development. Inclusion Criteria: Studies were required to be written in English; report on biomechanical analyses; include landing or postural control tasks; be cross-sectional or longitudinal; and include healthy adolescent/pubertal subjects. Study Appraisal and Synthesis Methods: A modified version of the Strengthening the Reporting of Observational studies in Epidemiology checklist was used to rate methodological quality. Meta-analyses were performed when more than one study reported on an outcome measure. Results: Sixteen articles were included. The overall methodological quality of evaluated studies was low (mean score = 5.75/10 points). Adolescent females exhibited increased knee valgus with increasing maturity. There was no consensus on sex differences in postural stability. Conclusions: With increasing maturation, females are characterized by increased knee valgus during landing tasks. To date, no research has longitudinally investigated postural stability development during adolescence in females, despite the importance of postural control training in injury prevention programmes. Therefore, further research on this topic is warranted. [ABSTRACT FROM AUTHOR]

Background: Patellofemoral pain (PFP) is highly prevalent within both sporting and recreationally active populations. Multiple treatment approaches have been advocated for the management of PFP, attempting to address both intrinsic and extrinsic factors thought to contribute to the development and persistence of pain. A number of predictors of treatment success have been proposed, and evaluated, for directing intervention choice. Objective: Our aim was to systematically review the literature that identifies outcome predictors of specific conservative interventions in the management of PFP, including quality of the current evidence, to guide clinical practice and future studies investigating outcome predictors within this population. Data Sources: The AMED, CINAHL, EMBASE, MEDLINE and Web of Science databases were searched from inception to April 2013. Study Selection: Randomized controlled trials (RCTs) and cohort studies. Study Appraisal and Synthesis Methods: Following initial searching, all potential papers were assessed by two independent reviewers for inclusion using a checklist developed from the inclusion criteria. Cited, and citing, references were also searched in Google Scholar, but unpublished work was not sought. Methodological quality was assessed using a previously designed quality assessment scale. Definitions for levels of evidence were guided by recommendations made by van Tulder et al. Results: Fifteen low-quality (LQ) cohort studies were included. No RCTs were found. This systematic review identified the evaluation of 205 conservative management outcome predictor variables. Of this large number of variables that have been assessed, 19 (9 %) were found to significantly predict a successful outcome. Where two or more outcome predictors and success determinants were consistent between studies, data were pooled. Within these studies, the low number of participants per output variable, and absence of controls, is likely to compromise the validity of the predictor's accuracy. Very limited evidence identified higher functional index questionnaire scores (mean 0.82, 95 % confidence interval [CI] 0.18-1.46), greater forefoot valgus (mean 0.67, 95 % CI 0.05-1.28) and greater rearfoot eversion magnitude peak (mean −0.93, 95 % CI −1.84 to −0.01) to significantly predict improved outcomes with orthoses interventions. Shorter symptom duration ( p = 0.019), lower frequency of pain ( p = 0.012), younger age, faster vastus medialis oblique reflex response time ( p = 0.026), negative patella apprehension, absence of chondromalacia patella, tibial tubercle deviation of <14.6 mm and greater total quadriceps cross-sectional area on magnetic resonance imaging ( p = 0.01), and reduced eccentric average quadriceps peak torque ( p = 0.015) significantly predicted exercise intervention success following multivariate statistical analysis. Limited evidence identified increased Q-angle (mean 0.38, 95 % CI 0.05-0.72) and very limited evidence identified greater usual pain (mean 0.43, 95 % CI 0.01-0.85) to predict taping intervention success. Conclusions: This systematic review provides a comprehensive summary of current derivation level studies identifying indicators of prediction for conservative PFP management. The overall strength of evidence was low. With appropriate caution, clinicians should consider taping for those with greater usual pain, orthoses for older individuals and exercise for younger individuals, and orthoses intervention for patients with greater forefoot valgus and rearfoot eversion magnitude peak. RCTs with evaluation of outcome prediction as a primary aim are clearly warranted to provide clinicians with robust evidence and facilitate evidence-informed, tailored intervention to this heterogeneous patient population. [ABSTRACT FROM AUTHOR]

Background: According to the principle of specific adaptations to imposed demands, training induces specific adaptations that predominantly transfer towards performance tasks of similar physiological and/or biomechanical characteristics. Functional performance improvements secondary to resistance and plyometric training have been hypothesized to be force-vector specific; however, the literature pertaining to this matter appears somewhat equivocal. Objective: The objective of the present systematic review with meta-analysis was to synthesize the available body of literature regarding the performance implications of vertically and horizontally oriented resistance- and plyometric training. Data sources: The review drew from the following sources: PubMed, Web of Science, Scopus, Physiotherapy Evidence Database (PEDro), Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), SPORTDiscus and Google Scholar. Study Eligibility Criteria: To qualify for inclusion, studies had to compare the efficacy of vertically and horizontally oriented resistance and/or plyometric training, with one or multiple outcome measures related to vertical/horizontal jumping, sprinting and/or change of direction speed (CODS). Study Appraisal and Synthesis: For each outcome measure, an inverse-variance random effects model was applied, with between-treatment effects quantified by the standardized mean difference (SMD) and associated 95% confidence- and prediction intervals. Results: Between-treatment effects were of trivial magnitude for vertical jumping (SMD = − 0.04, P = 0.69) and long-distance (≥ 20 m) sprinting (0.03, P = 0.83), whereas small to moderate effects in favor of horizontal training were observed for horizontal jumping (0.25, P = 0.07), short-distance (≤ 10 m) sprinting (0.72, P = 0.01) and CODS (0.31, P = 0.06), although only the short-distance sprint outcome reached statistical significance. Conclusions: In conclusion, our meta-analysis reveals a potential superiority of horizontally oriented training for horizontal jumping, short-distance sprinting and CODS, whereas vertically oriented training is equally efficacious for vertical jumping and long-distance sprinting. From an applied perspective, the present analysis provides an advanced basis for weighting of vertical and horizontal force-vector exercises as an integrated component for optimizing sport-specific performances. The present systematic review with meta-analysis was not a priori registered. [ABSTRACT FROM AUTHOR]

Background: Motor competence is an integral component of the health and performance of youth. Numerous studies support the hypothesis that motor competence interacts with perceived motor competence and physical fitness during childhood to induce positive (e.g. healthy weight status) or negative (e.g. reduced physical activity engagement) trajectories. Yet, while adolescence is a key period of rapid growth and maturation, no systematic reviews and meta-analyses have examined the association between motor competence and physical activity, physical fitness and psychosocial characteristics solely within adolescents. Objectives: This study aimed to (1) analyse the scientific literature evaluating associations between motor competence and physical activity, physical fitness and/or psychosocial characteristics amongst adolescents; (2) evaluate the associations between motor competence and physical activity, physical fitness characteristics and/or psychosocial characteristics amongst adolescents; and (3) investigate the impact of moderator variables (i.e., age, sex, type of motor competence assessment) on the associations. Methods: A systematic search of electronic databases was conducted, followed by a qualitative synthesis of study methods. Random-effects meta-analyses were performed to establish the magnitude and orientation of pooled correlation coefficients between motor competence and physical activity, physical fitness and psychosocial characteristics of adolescents, whilst considering potential moderators (i.e., age, sex, type of motor competence assessment). Results: Sixty-one studies were included, totalling 22,256 adolescents. Twenty-seven different assessments of motor competence were used, with 31 studies utilising product-orientated (i.e. outcome) motor competence assessments. Meta-analyses of 43 studies showed that motor competence was positively associated with physical activity (r = 0.20 to 0.26), some physical fitness characteristics (e.g. muscular strength, cardiovascular endurance; r = 0.03 to 0.60) and psychosocial characteristics (r = 0.07 to 0.34), and inversely associated with weight status (r = − 0.36 to − 0.10), speed (r = − 0.31) and agility (r = − 0.37 to 0.41). Associations with flexibility were unclear. Conclusions: The results of this systematic review and meta-analysis support the hypothesised interactions of motor competence with physical activity (positive), physical fitness (positive except for weight status, speed and agility) and psychosocial characteristics (positive) in adolescence. However, methodological approaches vary considerably (e.g. variety of motor competence assessments utilised), with limitations of the current literature including an inadequate assessment of motor competence, a lack of longitudinal observations and a failure to account for biological maturation. Future research assessing associations between motor competence and physical activity, physical fitness and psychosocial characteristics of adolescents should include longitudinal observations of a combined motor competence assessment (i.e. process and product) and account for biological maturation. Improved evaluation using these recommendations could provide more accurate data, leading to more targeted interventions to improve adolescents' physical and psychosocial outcomes. Clinical Trial Registration: CRD42021233441 (PROSPERO ID). [ABSTRACT FROM AUTHOR]

Background: Clinicians manage midportion Achilles tendinopathy (AT) using complex clinical reasoning underpinned by a rapidly developing evidence base. Objectives: The objectives of the study were to develop an inclusive, accessible review of the literature in combination with an account of expert therapists' related clinical reasoning to guide clinical practice and future research. Methods: Searches of the electronic databases, PubMed, ISI Web of Science, PEDro, CINAHL, EMBASE, and Google Scholar were conducted for all papers published from inception to November 2011. Reference lists and citing articles were searched for further relevant articles. Inclusion required studies to evaluate the effectiveness of any conservative intervention for midportion AT. Exclusion criteria included in vitro, animal and cadaver studies and tendinopathies in other locations (e.g. patella, supraspinatus). From a total of 3497 identified in the initial search, 47 studies fulfilled the inclusion criteria. Studies were scored according to the PEDro scale, with a score of ≥8/10 considered of excellent quality, 5-7/10 good, and ≤4/ 10 poor. The strength of evidence supporting each treatment modality was then rated as `strong', `moderate', `limited', `conflicting' or `no evidence' according to the number and quality of articles supporting that modality. Additionally, semi-structured interviews were conducted with physiotherapists to explore clinical reasoning related to the use of various interventions with and without an evidence base, and their perceptions of available evidence. Results: Evidence was strong for eccentric loading exercises and extra- corporeal shockwave therapy; moderate for splinting/bracing, active rest, low-level laser therapy and concentric exercises (i.e. inferior to eccentric exercise). In-shoe foot orthoses and therapeutic ultrasound had limited evidence. There was conflicting evidence for topical glycerin trinitrate. Taping techniques and soft-tissue mobilization were not yet examined but featured in case studies and in the interview data. Framework analysis of interview transcripts yielded multiple themes relating to physiotherapists' clinical reasoning and perceptions of the evidence, including the difficulty in causing pain while treating the condition and the need to vary research protocols for specific client groups - such as those with the metabolic syndrome as a likely etiological factor. Physiotherapists were commonly applying the modality with the strongest evidence base, eccentric loading exercises. Barriers to research being translated into practice identified included the lack of consistency of outcome measures, excessive stringency of some authoritative reviews and difficulty in accessing primary research reports. The broad inclusion criteria meant some lower quality studies were included in this review. However, this was deliberate to ensure that all available research evidence for the management of midportion AT, and all studies were evaluated using the PEDro scale to compensate for the lack of stringent inclusion criteria. Conclusion: Graded evidence combined with qualitative analysis of clinical reasoning produced a novel and clinically applicable guide to conservative management of midportion AT. This guide wilt be useful to novice clinicians learning how to manage this treatment-resistant condition and to expert clinicians reviewing their evidence-based practice and developing their clinical reasoning. Important areas requiring future research were identified including the effectiveness of orthoses, the effectiveness of manual therapy, etiological factors, optimal application of loading related to stage of presentation and how to optimize protocols for different types of patients such as the older patient with the metabolic syndrome as opposed to the athletically active. [ABSTRACT FROM AUTHOR]

Acromioclavicular joint (ACJ) separation injuries are common injuries among sporting populations. ACJ separations are graded according to severity from grade I being a mild sprain to grade VI, which is severe dislocation with displacement. There is consensus in the literature that grade I-III ACJ separations are managed conservatively and grades IV-VI are managed surgically. Despite conservative care being recommended for lesser grades of injury, there is very little evidence in the literature as to what constitutes conservative care. Therefore, the purpose of this paper was, first, to review the relevant anatomy and kinematics of the ACJ and, second, to review the literature relating to current evidence of conservative management of ACJ injury. Using this data, a best practice guideline for conservative rehabilitation in grade I-III ACJ separations was developed. For the conservative management, a literature search was undertaken using the following databases in the Auckland University of Technology's electronic library resources; MEDLINE, CINAHL, SPORTDiscus~" and the Cochrane Library. The following keywords or phrases were used: 'acromioclavicular joint separa- tions', 'injury', 'dislocations', 'rehabilitation', 'conservative care', 'physio- therapy' and 'exercise'. A total of 24 articles was identified. There were no randomized con- trolled trials (RCTs) that investigated conservative treatment for grade I-III ACJ sprains. Therefore, a narrative review was formulated covering the anatomy and biomechanics of the ACJ, injury mechanisms and relevant literature reviewed covering rehabilitation principles. Conservative manage- ment of grade I-III ACJ separations is still the main recommendation following this review. A best practice guideline for managing grade I-III ACJ separations is presented to help guide clinicians until well constructed RCTs are carried out to improve the conservative management of ACJ injuries. [ABSTRACT FROM AUTHOR]

Background: Well programmed strength and conditioning training is an indispensable part of the long-term training process for athletes in individual and team sports to improve performance and prevent injuries. Yet, there is a limited number of studies available that examine the effects of resistance training (RT) on muscular fitness and physiological adaptations in elite female athletes. Objectives: This systematic review aimed to summarize recent evidence on the long-term effects of RT or combinations of RT with other strength-dominated exercise types on muscular fitness, muscle morphology, and body composition in female elite athletes. Materials and Methods: A systematic literature search was conducted in nine electronic databases (Academic Search Elite, CINAHL, ERIC, Open Access Theses and Dissertations, Open Dissertations, PsycINFO, PubMed/MEDLINE, Scopus, and SPORTDiscus) from inception until March 2022. Key search terms from the MeSH database such as RT and strength training were included and combined using the operators "AND," "OR," and "NOT". The search syntax initially identified 181 records. After screening for titles, abstracts, and full texts, 33 studies remained that examined the long-term effects of RT or combinations of RT with other strength-dominated exercise types on muscular fitness, muscle morphology, and body composition in female elite athletes. Results: Twenty-four studies used single-mode RT or plyometric training and nine studies investigated the effects of combined training programs such as resistance with plyometric or agility training, resistance and speed training, and resistance and power training. The training duration lasted at least 4 weeks, but most studies used ~ 12 weeks. Studies were generally classified as 'high-quality' with a mean PEDro score of 6.8 (median 7). Irrespective of the type or combination of RT with other strength-dominated exercise regimens (type of exercise, exercise duration, or intensity), 24 out of 33 studies reported increases in muscle power (e.g., maximal and mean power; effect size [ES]: 0.23 < Cohen's d < 1.83, small to large), strength (e.g., one-repetition-maximum [1RM]; ES: 0.15 < d < 6.80, small to very large), speed (e.g., sprint times; ES: 0.01 < d < 1.26, small to large), and jump performance (e.g., countermovement/squat jump; ES: 0.02 < d < 1.04, small to large). The nine studies that examined the effects of combined training showed significant increases on maximal strength (ES: 0.08 < d < 2.41, small to very large), muscle power (ES: 0.08 < d < 2.41, small to very large), jump and sprint performance (ES: 0.08 < d < 2.41, small to very large). Four out of six studies observed no changes in body mass or percentage of body fat after resistance or plyometric training or combined training (ES: 0.026 < d < 0.492, small to medium). Five out of six studies observed significant changes in muscle morphology (e.g., muscle thickness, muscle fiber cross-sectional area; ES: 0.23 < d < 3.21, small to very large). However, one study did not find any changes in muscle morphology (i.e., muscle thickness, pennation angle; ES: 0.1 < d < 0.19, small). Conclusion: Findings from this systematic review suggest that RT or combined RT with other strength-dominated exercise types leads to significant increases in measures of muscle power, strength, speed, and jump performance in elite female athletes. However, the optimal dosage of programming parameters such as training intensity and duration necessary to induce large effects in measures of muscular fitness and their physiological adaptations remain to be resolved in female elite athletes. [ABSTRACT FROM AUTHOR]

Background: Rugby Union is a collision team sport played globally. Despite this, significant concerns have been raised regarding the sport's safety, particularly in youth players. Given this, a review of injury rates, risk factors and prevention strategies is required across different youth age groups as well as in males and females. Objective: The objective of this systematic review (SR) and meta-analysis was to investigate injury and concussion rates, risk factors and primary prevention strategies in youth rugby. Methods: To be included, studies were required to report either rates, risk factors or prevention strategies in youth rugby and to have a randomised controlled trial, quasi-experimental, cohort, case control, or ecological study design. Exclusion criteria included non-peer-reviewed grey literature, conference abstracts, case studies, previous systematic reviews and studies not written in English. Nine databases were searched. The full search strategy and list of sources are available and pre-registered on PROSPERO (Ref: CRD42020208343). Each study was assessed for risk of bias using the Downs and Black quality assessment tool. Meta-analyses were conducted using a DerSimonian Laird random effect model for each age group and sex. Results: Sixty-nine studies were included in this SR. The match injury rates (using a 24-h time-loss definition) were 40.2/1000 match hours (95% CI 13.9–66.5) in males and 69.0/1000 match hours (95% CI 46.8–91.2) in females. Concussion rates were 6.2/1000 player-hours (95% CI 5.0–7.4) for males and 33.9/1000 player-hours (95% CI: 24.1–43.7) for females. The most common injury site was lower extremity (males) and the head/neck (females). The most common injury type was ligament sprain (males) and concussion (females). The tackle was the most common event associated with injury in matches (55% male, 71% females). Median time loss was 21 days for males and 17 days for females. Twenty-three risk factors were reported. The risk factors with the strongest evidence were higher levels of play and increasing age. Primary injury prevention strategies were the focus of only eight studies and included law changes (n = 2), equipment (n = 4), education (n = 1) and training (n = 1). The prevention strategy with the most promising evidence was neuromuscular training. The primary limitations included a broad range of injury definitions (n = 9) and rate denominators (n = 11) used, as well as a limited number of studies which could be included in the meta-analysis for females (n = 2). Conclusion: A focus on high-quality risk factor and primary prevention evaluation should be considered in future studies. Targeting primary prevention and stakeholder education remain key strategies in the prevention, recognition and management of injuries and concussions in youth rugby. [ABSTRACT FROM AUTHOR]

Background: Dysfunction of the endothelium is a key precursor of cardiovascular disease. Endothelial function, as assessed via the flow-mediated dilation test, is attenuated with chronic disease (e.g., type 2 diabetes mellitus, hypertension). Exercise training may mitigate this dysfunction and promote better vascular health. Objective: The main objective of this umbrella review was to determine the impact of exercise training on flow-mediated dilation in healthy adults and those with chronic disease. Methods: Studies were included if they conducted a systematic review and/or meta-analysis on flow-mediated dilation responses to exercise interventions in adults. Sources were searched in January 2022 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier. National Institutes of Health quality assessment tools were used. The results were presented narratively. Results: Twenty-seven systematic reviews, including 19 meta-analyses, (total: 5464 unique participants, 2181 reported unique female individuals) met the inclusion criteria. The average overall quality of included reviews was 8.8/11. The quality of studies within each included review varied from low to moderate using a variety of quality assessment scales. Reviews were conducted in healthy adults (n = 9, meta-analyses = 6), as well as those with type 2 diabetes (n = 5, meta-analyses = 4), cardiovascular conditions [i.e., conditions that impact the cardiovascular system, but excluding samples of only type 2 diabetes] (n = 11, meta-analyses = 7), and other chronic conditions (n = 2, meta-analyses = 2). Overall, the included reviews provided evidence that the type of training to optimally improve FMD may vary based on disease condition. Specifically, the evidence suggests that healthy adults benefitted most from higher intensity aerobic training and/or more frequent low-to-moderate resistance training. In addition, adults with type 2 diabetes benefitted most from low-intensity resistance or aerobic exercise training, whereas those with cardiovascular conditions should consider engaging in high-intensity aerobic training to improve endothelial function. Conclusions: This information may help guide the design of specific exercise programs or recommendations for adults with chronic conditions. [ABSTRACT FROM AUTHOR]

Background: Nutrition during exercise is vital in sustaining prolonged activity and enhancing athletic performance; however, exercise-induced gastrointestinal syndrome (EIGS) and exercise-associated gastrointestinal symptoms (Ex-GIS) are common issues among endurance athletes. Despite this, there has been no systematic assessment of existing trials that examine the impact of repetitive exposure of the gastrointestinal tract to nutrients before and/or during exercise on gastrointestinal integrity, function, and/or symptoms. Objective: This systematic literature review aimed to identify and synthesize research that has investigated the impact of 'gut-training' or 'feeding-challenge' before and/or during exercise on markers of gastrointestinal integrity, function, and symptoms. Methods: Five databases (Ovid MEDLINE, EMBASE, CINAHL Plus, Web of Science Core Collection, and SPORTDiscus) were searched for literature that focused on gut-training or feeding-challenge before and/or during exercise that included EIGS and Ex-GIS variables. Quality assessment was conducted in duplicate and independently using the Cochrane Collaboration's risk-of-bias (RoB 2) tool. Results: Overall, 304 studies were identified, and eight studies were included after screening. Gut-training or feeding-challenge interventions included provision of carbohydrates only (n = 7) in various forms (e.g., gels or liquid solutions) during cycling or running, or carbohydrate with protein (n = 1) during intermittent exercise, over a varied duration (4–28 days). Gut discomfort decreased by an average of 47% and 26% with a 2-week repetitive carbohydrate feeding protocol (n = 2) and through repeated fluid ingestion over five trials (n = 1), respectively. Repetitive carbohydrate feeding during exercise for 2 weeks resulted in the reduction of carbohydrate malabsorption by 45–54% (n = 2), but also led to no significant change (n = 1). The effect of gut-training and feeding-challenges on the incidence and severity of Ex-GIS were assessed using different tools (n = 6). Significant improvements in total, upper, and lower gastrointestinal symptoms were observed (n = 2), as well as unclear results (n = 4). No significant changes in gastric emptying rate (n = 2), or markers of intestinal injury and permeability were found (n = 3). Inconclusive results were found in studies that investigated plasma inflammatory cytokine concentration in response to exercise with increased carbohydrate feeding (n = 2). Conclusions: Overall, gut-training or feeding-challenge around exercise may provide advantages in reducing gut discomfort, and potentially improve carbohydrate malabsorption and Ex-GIS, which may have exercise performance implications. [ABSTRACT FROM AUTHOR]

Background: Some health benefits from high-intensity interval training (HIIT) are facilitated by peripheral blood lactate levels. However, the lactate response from HIIT is variable and dependent on protocol parameters. Objectives: We aimed to determine the HIIT protocol parameters that elicited peak lactate levels, and how these levels are associated with post-HIIT cognitive performance. Study Design: We conducted a systematic review with meta-regression. Methods: MEDLINE, Embase, CENTRAL, SPORTDiscus, and CINAHL + were searched from database inception to 8 April, 2022. Peer-reviewed primary research in healthy adults that determined lactate (mmol/L) and cognitive performance after one HIIT session was included. Mixed-effects meta-regressions determined the protocol parameters that elicited peak lactate levels, and linear regressions modelled the relationship between lactate levels and cognitive performance. Results: Study entries (n = 226) involving 2560 participants (mean age 24.1 ± 4.7 years) were included in the meta-regression. A low total work-interval volume (~ 5 min), recovery intervals that are about five times longer than work intervals, and a medium session volume (~ 15 min), elicited peak lactate levels, even when controlling for intensity, fitness (peak oxygen consumption) and blood measurement methods. Lactate levels immediately post-HIIT explained 14–17% of variance in Stroop interference condition at 30 min post-HIIT. Conclusions: A HIIT protocol that uses the above parameters (e.g., 8 × 30-s maximal intensity with 90-s recovery) can elicit peak lactate, a molecule that is known to benefit the central nervous system and be involved in exercise training adaptations. This review reports the state of the science in regard to the lactate response following HIIT, which is relevant to those in the sports medicine field designing HIIT training programs. Trial Registry: Clinical Trial Registration: PROSPERO (CRD42020204400). [ABSTRACT FROM AUTHOR]

Background: Tennis is a multidirectional high-intensity intermittent sport for male and female individuals played across multiple surfaces. Although several studies have attempted to characterise the physical demands of tennis, a meta-analysis is still lacking. Objective: We aimed to describe and synthesise the physical demands of tennis across the different court surfaces, performance levels and sexes. Methods: PubMed, Embase, CINAHL and SPORTDiscus were searched from inception to 19 April, 2022. A backward citation search was conducted for included articles using Scopus. The PECOS framework was used to formulate eligibility criteria. Population: tennis players of regional, national or international playing levels (juniors and adults). Exposure: singles match play. Comparison: sex (male/female), court surface (hard, clay, grass). Outcome: duration of play, on-court movement and stroke performance. Study design: cross-sectional, longitudinal. Pooled means or mean differences with 95% confidence intervals were calculated. A random-effects meta-analysis with robust variance estimation was performed. The measures of heterogeneity were Cochrane Q and 95% prediction intervals. Subgroup analysis was used for different court surfaces. Results: The literature search generated 7736 references; 64 articles were included for qualitative and 42 for quantitative review. Mean [95% confidence interval] rally duration, strokes per rally and effective playing time on all surfaces were 5.5 s [4.9, 6.3], 4.1 [3.4, 5.0] and 18.6% [15.8, 21.7] for international male players and 6.4 s [5.4, 7.6], 3.9 [2.4, 6.2] and 20% [17.3, 23.3] for international female players. Mean running distances per point, set and match were 9.6 m [7.6, 12.2], 607 m [443, 832] and 2292 m [1767, 2973] (best-of-5) for international male players and 8.2 m [4.4, 15.2], 574 m [373, 883] and 1249 m [767, 2035] for international female players. Mean first- and second-serve speeds were 182 km·h−1 [178, 187] and 149 km·h−1 [135, 164] for international male players and 156 km·h−1 95% confidence interval [151, 161] and 134 km·h−1 [107, 168] for international female players. Conclusions: The findings from this study provide a comprehensive summary of the physical demands of tennis. These results may guide tennis-specific training programmes. We recommend more consistent measuring and reporting of data to enable future meta-analysts to pool meaningful data. Clinical Trial Registration: The protocol for this systematic review was registered a priori at the Open Science Framework (Registration DOI https://doi.org/10.17605/OSF.IO/MDWFY). [ABSTRACT FROM AUTHOR]

Background: Patellofemoral pain (PFP) is a prevalent knee condition with many proposed biomechanically orientated etiological factors and treatments. Objective: We aimed to systematically review and synthesize the evidence for biomechanical variables (spatiotemporal, kinematic, kinetic) during walking and running in people with PFP compared with pain-free controls, and determine if biomechanical variables contribute to the development of PFP. Design: Systematic review and meta-analysis. Data sources: We searched Medline, CINAHL, SPORTDiscus, Embase, and Web of Science from inception to October 2021. Eligibility criteria for selecting studies: All study designs (prospective, case–control [± interventional component, provided pre-intervention data were reported for both groups], cross-sectional) comparing spatiotemporal, kinematic, and/or kinetic variables during walking and/or running between people with and without PFP. Results: We identified 55 studies involving 1300 people with PFP and 1393 pain-free controls. Overall pooled analysis identified that people with PFP had slower gait velocity [moderate evidence, standardized mean difference (SMD) − 0.50, 95% confidence interval (CI) − 0.72, − 0.27], lower cadence (limited evidence, SMD − 0.43, 95% CI − 0.74, − 0.12), and shorter stride length (limited evidence, SMD − 0.46, 95% CI − 0.80, − 0.12). People with PFP also had greater peak contralateral pelvic drop (moderate evidence, SMD − 0.46, 95% CI − 0.90, − 0.03), smaller peak knee flexion angles (moderate evidence, SMD − 0.30, 95% CI − 0.52, − 0.08), and smaller peak knee extension moments (limited evidence, SMD − 0.41, 95% CI − 0.75, − 0.07) compared with controls. Females with PFP had greater peak hip flexion (moderate evidence, SMD 0.83, 95% CI 0.30, 1.36) and rearfoot eversion (limited evidence, SMD 0.59, 95% CI 0.03, 1.14) angles compared to pain-free females. No significant between-group differences were identified for all other biomechanical variables. Data pooling was not possible for prospective studies. Conclusion: A limited number of biomechanical differences exist when comparing people with and without PFP, mostly characterized by small-to-moderate effect sizes. People with PFP ambulate slower, with lower cadence and a shortened stride length, greater contralateral pelvic drop, and lower knee flexion angles and knee extension moments. It is unclear whether these features are present prior to PFP onset or occur as pain-compensatory movement strategies given the lack of prospective data. Trial Registration: PROSPERO # CRD42019080241. [ABSTRACT FROM AUTHOR]

Background: Velocity loss (VL) experienced in a set during resistance training is often monitored to control training volume and quantify acute fatigue responses. Accordingly, various VL thresholds are used to prescribe resistance training and target different training adaptations. However, there are inconsistencies in the current body of evidence regarding the magnitude of the acute and chronic responses to the amount of VL experienced during resistance training. Objective: The aim of this systematic review was to (1) evaluate the acute training volume, neuromuscular, metabolic, and perceptual responses to the amount of VL experienced during resistance training; (2) synthesize the available evidence on the chronic effects of different VL thresholds on training adaptations; and (3) provide an overview of the factors that might differentially influence the magnitude of specific acute and chronic responses to VL during resistance training. Methods: This review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases were searched, and studies were included if they were written in English, prescribed resistance training using VL, and evaluated at least one (1) acute training volume, neuromuscular, metabolic, or perceptual response or (2) training adaptation. Risk of bias was assessed using a modified Cochrane Collaboration's tool for assessing the risk of bias in randomized trials. Multilevel and multivariate meta-regressions were performed where possible. Results: Eighteen acute and 19 longitudinal studies met the inclusion criteria, of which only one had more than one risk of bias item assessed as high risk. Based on the included acute studies, it seems that the number of repetitions per set, blood lactate concentration, and rating of perceived exertion generally increase, while countermovement jump height, running sprint times, and velocity against fixed loads generally decrease as VL increases. However, the magnitude of these effects seems to be influenced, among other factors, by the exercise and load used. Regarding training adaptations, VL experienced during resistance training did not influence muscle strength and endurance gains. Increases in VL were associated with increases in hypertrophy (b = 0.006; 95% confidence interval [CI] 0.001, 0.012), but negatively affected countermovement jump (b = − 0.040; 95% CI − 0.079, − 0.001), sprint (b = 0.001; 95% CI 0.001, 0.002), and velocity against submaximal load performance (b = − 0.018; 95% CI − 0.029, − 0.006). Conclusions: A graded relationship exists between VL experienced during a set and acute training volume, neuromuscular, metabolic, and perceptual responses to resistance training. However, choice of exercise, load, and individual trainee characteristics (e.g., training history) seem to modulate these relationships. The choice of VL threshold does not seem to affect strength and muscle endurance gains whereas higher VL thresholds are superior for enhancing hypertrophy, and lower VL thresholds are superior for jumping, sprinting, and velocity against submaximal loads performance. Clinical Trial Registration: The original protocol was prospectively registered (https://osf.io/q4acs/) with the Open Science Framework. [ABSTRACT FROM AUTHOR]

Background: The holistic concept of physical literacy assumes that individuals require adequate cognitive (knowledge and understanding), affective (motivation and confidence), and physical (physical competence) qualities to engage in lifelong physical activity behavior. In recent years, the research field has undergone rapid development and has also yielded an increasing number of interventions that aim to translate the theoretical-philosophical ideas into practical endeavors. Objective: The goal of the present pre-registered systematic review was to (a) provide a general overview of evaluation studies on physical literacy interventions and (b) to quantitatively examine the effectiveness of physical literacy interventions. Methods: Drawing on the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched a total of 18 databases for physical literacy interventions. Inclusion criteria were English language, publication by November 2021, and interventions using physical literacy as a theoretical underpinning or evaluation outcome. Articles that met these criteria were analyzed with respect to their basic delivery characteristics, study quality, evaluation approach, and main findings. We additionally ran meta-analyses with all non-randomized and randomized controlled trials to examine and compare the effect of these interventions on five outcome categories: (i) physical competence, (ii) motivation and confidence, (iii) knowledge and understanding, (iv) physical activity behavior, and (v) total physical literacy. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to assess the effects on the different categories. Results: The screening process with two independent raters yielded 48 eligible interventions reported in 51 eligible articles. Quantitative evaluations most frequently addressed physical competence (72.2%), followed by motivation and confidence (47.2%), physical activity behavior (41.7%), and knowledge and understanding (33.3%). The controlled intervention studies (n = 24) exerted significant effects on all five physical literacy categories. Despite meaningful heterogeneity across the subgroups, the strongest effects were found for physical competence (SMD 0.90; 95% CI 0.55–1.25), followed by physical literacy aggregate scores (SMD 0.61; 95% CI 0.20–1.01), knowledge and understanding (SMD 0.54; 95% CI 0.30–0.79), physical activity behavior (SMD 0.39; 95% CI 0.23–0.55), and motivation and confidence (SMD 0.30; 95% CI 0.17–0.44). Conclusions: The present study empirically demonstrated the effectiveness of physical literacy interventions on several outcomes relevant for promoting physical activity and health. To better inform current practices, future studies are advised to identify those program characteristics that significantly influence the effectiveness of physical literacy interventions. Clinical Trial Registration: PROSPERO CRD42020188926. [ABSTRACT FROM AUTHOR]

Background: To improve the understanding of the psychological impacts of anterior cruciate ligament (ACL) injury, a systematic review synthesizing the evidence on knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury is needed. Objective: The aim of this systematic review was to investigate knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury, and compare these outcomes following management with rehabilitation alone, early and delayed ACL reconstruction (ACLR). Methods: Seven databases were searched from inception to April 14, 2022. Articles were included if they assessed Tampa Scale of Kinesiophobia (TSK), Knee Self-Efficacy Scale (KSES), or Fear Avoidance Beliefs Questionnaire (FABQ). Risk of bias (RoB) was assessed using domain-based RoB tools (ROBINS-1, RoB 2, RoBANS), and GRADE-assessed certainty of evidence. Random-effects meta-analyses pooled outcomes, stratified by time post-injury (pre-operative, 3–6 months, 7–12 months, > 1–2 years, > 2–5 years, > 5 years). Results: Seventy-three studies (70% high RoB) were included (study outcomes: TSK: 55; KSES: 22; FABQ: 5). Meta-analysis demonstrated worse kinesiophobia and self-efficacy pre-operatively (pooled mean [95% CI], TSK-11: 23.8 [22.2–25.3]; KSES: 5.0 [4.4–5.5]) compared with 3–6 months following ACLR (TSK-11: 19.6 [18.7–20.6]; KSES: 19.6 [18.6–20.6]). Meta-analysis suggests similar kinesiophobia > 3–6 months following early ACLR (19.8 [4.9]) versus delayed ACLR (17.2 [5.0]). Only one study assessed outcomes comparing ACLR with rehabilitation only. Conclusions: Knee self-efficacy and kinesiophobia improved from pre-ACLR to 3–6 months following ACLR, with similar outcomes after 6 months. Since the overall evidence was weak, there is a need for high-quality observational and intervention studies focusing on psychological outcomes following ACL injury. [ABSTRACT FROM AUTHOR]

Background: No previous systematic review has examined the physical health benefits of playing golf or caddying. Objective: To establish the influence of golf participation and physical health in golfers and caddies. More specifically, the review intended to explore the domains of cardiovascular, metabolic and musculoskeletal health, in addition to body composition. Design: Systematic review. Data Sources: Electronic literature searches were conducted using PubMed, SPORTDiscus and CINAHL databases in July 2021. Eligibility Criteria: Experimental (randomised controlled trials, quasi-experiment, pre-post) and non-experimental (case–control, cross-sectional, cohort) articles relating to health and golf, written in English and published in peer-reviewed journals. Results: Of the 572 articles initially identified, 109 full-text articles were assessed for eligibility with 23 meeting the inclusion criteria. Sixteen articles were rated 'good 'and seven 'fair'. The influence of golf on physical health was mixed, although various articles displayed improvements in balance, systolic blood pressure (SBP) and diastolic blood pressure (DBP), high density lipoprotein-cholesterol (HDL-C) and the ratio of HDL to total cholesterol within golfers. Caddies observed improvements in bone mineral density (BMD), stiffness index and strength. Most of the findings indicate that playing golf or caddying does not influence body mass index (BMI); however, playing golf can positively change other body composition markers such as lean and fat mass. Conclusion: This review demonstrated that golf participation may be an effective method for improving musculoskeletal and cardiovascular health, although mixed findings were observed. Moreover, limited longitudinal evidence suggests that playing golf can positively impact metabolic health and the influence on body composition may be parameter dependent. Additionally, the initial evidence suggests that caddying may improve musculoskeletal health. However, the studies included were limited by their methodological inconsistencies such as: study design, participant demographics and intervention prescription. PROSPERO Registration: CRD42021267664. [ABSTRACT FROM AUTHOR]

Contact sports athletes are regularly facing acute physical pain in part of their sport; however, the literature investigating pain perception in these athletes remains scarce. This scoping review aimed to explore the literature surrounding pain perception in contact sport athletes and to compile and understand how it is studied. The search strategy consisted of using index terms and keywords in the MEDLINE, EMBASE, SPORTDiscus, Web of Science, PsycINFO, CINAHL and ProQuest Dissertations & Theses Global search engines. Results from 11 studies revealed that a mix of team contact sports and combat sports are studied and are included under the umbrella of contact sports. These athletes are being compared with non-athletes as well as athletes from non-contact sports. The cold pressor test and the pain pressure test are the two predominant methods used to investigate physical pain. This review highlights the need to clearly define sports based on contact levels expected in play to better define the types of pain athletes are facing in their practice. Athletes' level of play as well as years of experience should also be more rigorously reported. While contact sport athletes seem to have a higher level of pain tolerance than both active controls and non-contact athletes, the methods of pain testing are not always justified and appropriate in relation to the pain induced during contact sports. Future experimental studies should use pain testing methods relevant to the pain experienced during contact sports and to better justify the rationale for the choice of these methods. [ABSTRACT FROM AUTHOR]

Background: Researchers are capitalising on the strong connections that sport fans have with their teams for health promotion programmes, yet no existing systematic reviews have evaluated the effectiveness of interventions delivered through professional sport. Objective: The aim of this study was to systematically collate, evaluate, and synthesise the evidence on health promotion interventions implemented in professional sport settings. Methods: Randomised controlled trials reporting on adult health promotion initiatives delivered in professional sport settings were identified through electronic database searches in CINAHL, MEDLINE, SPORTDiscus, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. Data on health-related outcomes (e.g., weight, physical activity, dietary intake) were extracted and synthesised, and random effects meta-analyses were conducted to examine effects for weight and waist circumference. Risk of bias was examined using the Cochrane risk-of-bias tool for randomised controlled trials (RoB 2). Results: Six studies reporting on five unique interventions met the inclusion criteria, and all included studies were gender-sensitised and exclusively targeted men. Intervention effects were observed for several health outcomes, including physical activity, dietary intake, and psychosocial health. All studies aimed to reduce weight, and for most studies (n = 4), weight was a primary outcome, either of the included study or to inform a future definitive trial. Findings from the meta-analysis revealed an overall significant difference in change in weight of − 3.2 kg (95% confidence interval [CI] − 4.6 to − 1.8) and waist circumference of − 3.9 cm (95% CI − 4.9 to − 2.8), both in favour of the intervention group at 12 weeks. Intervention effects were also reported for several other health outcomes (e.g., physical activity, dietary intake, psychosocial health); however, they were not consistently measured across the studies and thus were not meta-analysed. Conclusion: Health promotion interventions delivered through professional sporting organisations can significantly improve weight- and lifestyle-related health outcomes. Representation across the socioeconomic spectrum and across culturally and linguistically diverse groups was limited. As only a limited number of studies met the inclusion criteria for this review, a need exists for rigorously designed interventions, standardised intervention approaches, with long-term follow-up, and the potential for scalability. PROSPERO Registration Number: CRD42019123295. [ABSTRACT FROM AUTHOR]

Background: Having a family history of anterior cruciate ligament (ACL) injury has been investigated in the literature but few studies have focused on this factor specifically or reported their outcomes by sex. Objective: We aimed to systematically review family history as a risk factor for sustaining a primary ACL injury and the impact it has on ACL graft rupture or contralateral ACL injury in male and female individuals. Methods: A literature search was completed in seven databases from inception until March 2021 to investigate primary and subsequent ACL injuries in those with a family history of ACL injury. Articles were screened by prespecified inclusion criteria, and the methodological quality of each study was determined. Study results were combined using an odds ratio (OR) meta-analysis. Subgroup analysis was also completed by sex for primary ACL injury, as well as by graft rupture and contralateral ACL injury for subsequent ACL injuries. Results: Twelve studies were acquired for systematic review and meta-analysis. Four studies that investigated primary ACL injury, seven that investigated ACL graft and/or contralateral ACL ruptures and one study that investigated both primary and subsequent ACL injury. Having a family history of ACL injury increased the odds of injury across all outcomes. Those with a family history had a 2.5 times greater odds for sustaining a primary ACL injury (OR 2.53 [95% confidence interval [CI] 1.96–3.28, p < 0.001)]. There was no significant difference of injury odds for primary ACL injury when analysed by sex. Family history of ACL injury was found to increase the odds of subsequent ACL injury by 2.38 (95% CI 1.64–3.46, p < 0.001) and was significant for both graft ruptures (OR 1.80 [95% CI 1.20–2.71, p = 0.005]) and contralateral ACL injuries (OR 2.28 [95% CI 1.28–4.04, p = 0.005]). When compared directly, the odds of sustaining a graft rupture versus a contralateral ACL injury were similar for those with a family history. Outcomes were not frequently reported by sex for subsequent ACL injuries. Conclusions: Having a family history of ACL injury more than doubles the odds of sustaining a primary or subsequent ACL injury. However, if a family history of ACL injury is present, the sex of the athlete does not increase the risk for primary injury nor is there a difference in the risk for a subsequent graft rupture compared to a contralateral ACL injury. Clinical Trial Registration: PROSPERO: CRD42020186472. [ABSTRACT FROM AUTHOR]

Introduction: Changing running technique or equipment can alter tibial loads. The efficacy of interventions to modify tibial loads during running is yet to be synthesised and evaluated. This article reviewed the effect of running technique and footwear interventions on tibial loading during running. Methods: Electronic databases were searched using terms relevant to tibial load and running. Interventions were categorised according to their approach (i.e., footwear; barefoot running; speed; surface; overground versus treadmill; orthotics, insoles and taping; and technique); if necessary, further subgrouping was applied to these categories. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) for changes in tibial loading were calculated and meta-analyses performed where possible. Results: Database searches yielded 1617 articles, with 36 meeting the inclusion criteria. Tibial loading increased with (1) barefoot running (SMD 1.16; 95% CI 0.50, 1.82); (2) minimalist shoe use by non-habitual users (SMD 0.89; 95% CI 0.40, 1.39); (3) motion control shoe use (SMD 0.46; 95% CI 0.07, 0.84); (4) increased stride length (SMD 0.86; 95% CI 0.18, 1.55); and (5) increased running speed (SMD 1.03; 95% CI 0.74, 1.32). Tibial loading decreased when (1) individuals ran on a treadmill versus overground (SMD − 0.83; 95% CI − 1.53, − 0.12); and (2) targeted biofeedback was used (SMD − 0.93; 95% CI − 1.46, − 0.41). Conclusions: Running barefoot, in motion control shoes or in unfamiliar minimalist shoes, and with an increased stride length increases tibial loads and may increase the risk of a tibial stress injury during periods of high training load. Adopting interventions such as running on a treadmill versus overground, and using targeted biofeedback during periods of high loads could reduce tibial stress injury. [ABSTRACT FROM AUTHOR]

Background: Heat is associated with physiological strain and endurance performance (EP) impairments. Studies have investigated the impact of caffeine intake upon EP and core temperature (CT) in the heat, but results are conflicting. There is a need to systematically determine the impact of pre-exercise caffeine intake in the heat. Objective: To use a meta-analytical approach to determine the effect of pre-exercise caffeine intake on EP and CT in the heat. Design: Systematic review with meta-analysis. Data Sources: Four databases and cross-referencing. Data Analysis: Weighted mean effect summaries using robust variance random-effects models for EP and CT, as well as robust variance meta-regressions to explore confounders. Study Selection: Placebo-controlled, randomized studies in adults (≥ 18 years old) with caffeine intake at least 30 min before endurance exercise ≥ 30 min, performed in ambient conditions ≥ 27 °C. Results: Respectively six and 12 studies examined caffeine's impact on EP and CT, representing 52 and 205 endurance-trained individuals. On average, 6 mg/kg body mass of caffeine were taken 1 h before exercises of ~ 70 min conducted at 34 °C and 47% relative humidity. Caffeine supplementation non-significantly improved EP by 2.1 ± 0.8% (95% CI − 0.7 to 4.8) and significantly increased the rate of change in CT by 0.10 ± 0.03 °C/h (95% CI 0.02 to 0.19), compared with the ingestion of a placebo. Conclusion: Caffeine ingestion of 6 mg/kg body mass ~ 1 h before exercise in the heat may provide a worthwhile improvement in EP, is unlikely to be deleterious to EP, and trivially increases the rate of change in CT. [ABSTRACT FROM AUTHOR]