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This paper investigated facilitators and barriers to implementing the European Football Fans in Training program (EuroFIT) in professional sports clubs in England, the Netherlands, Norway, and Portugal. We analyzed qualitative data collected at clubs that delivered EuroFIT, based on semi-structured interviews with coordinating staff (n = 15), coaches (n = 16), and focus group interviews with participants (n = 108), as well as data from clubs that considered delivering EuroFIT in the future, based on interviews with staff (n = 7) and stakeholders (n = 8). Facilitators for implementation related to the content and structure of the program, its evidence-base, and the context for delivery in the football stadia. Financial and human resources were both facilitators and barriers. Further barriers were mostly practical, relating to human resources and infrastructure. Major differences between countries related to experience and commitment to running community projects, and differences in infrastructure, financing, and human resources. Professional football clubs’ ability to support health promotion efforts depended on their ethos and the financial and human resources available to them. Overall, the EuroFIT program was well received by clubs, coaches, participants, and stakeholders, which was reflected by the many facilitators supporting sustained implementation. For sustainable implementation, it is crucial that clubs and their stakeholders engage fully with the EuroFIT program and understand that for an adequate program delivery their views (ethos) and ways of working influence the implementation and thereby the effectiveness of EuroFIT. An important prerequisite for future roll out of EuroFIT would be a strong EuroFIT delivery partner organization to ensure financial and human resources while overseeing and guiding the quality of delivery in clubs. Factors influencing the implementation of the EuroFIT lifestyle change program in professional football clubs in Europe: a qualitative study in four European countries

To investigate the effectiveness of a 3-year worksite lifestyle intervention on cardiovascular metrics and to study whether outcomes are influenced by baseline subclinical atherosclerosis (SA) by non-invasive imaging. A randomized controlled trial was performed to compare a lifestyle intervention with standard of care in asymptomatic middle-aged subjects, stratified by SA. The intervention consisted of nine motivational interviews during the first year, followed by three further sessions between Years 1 and 3. The primary outcome was the change in a pre-specified adaptation of the Fuster-BEWAT score (Blood pressure, Exercise, Weight, Alimentation, and Tobacco) between baseline and follow-up Years 1-3. A total of 1020 participants (mean age 50 ± 4 years) were enrolled, of whom 510 were randomly assigned to the intervention and 510 to the control group. The baseline adapted Fuster-BEWAT score was 16.2 ± 3.7 points in the intervention group and 16.5 ± 3.5 points in the control group. At Year 1, the score improved significantly in intervention participants compared with controls [estimate 0.83 (95% CI 0.52-1.15) points]. However, intervention effectiveness decreased to non-significant levels at Year 3 [0.24 (95% CI -0.10 to 0.59) points]. Over the 3-year period, the intervention was effective in participants having low baseline SA [0.61 (95% CI 0.30-0.93) points] but not in those with high baseline SA [0.19 (95% CI -0.26 to 0.64) points]. In middle-aged asymptomatic adults, a lifestyle intervention was associated with a significant improvement in cardiovascular health and behavioural metrics. The effect attenuated after 1 year as the intensity of the intervention was reduced. ClinicalTrials.gov (NCT02561065). TANSNIP-PESA is funded by Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III through an Investigator-initiated Study grant to Icahn School of Medicine from AstraZeneca. The PESA study is cofunded by the CNIC and Banco Santander. The study also received funding from the Instituto de Salud Carlos III (PI15/02019) and the European Regional Development Fund (ERDF) ‘A way to make Europe’. The CNIC is supported by the Instituto de Salud Carlos III (ISCIII), the Ministerio de Ciencia e Innovación (MCIN), and the Pro CNIC Foundation and is a Severo Ochoa Center of Excellence (grant CEX2020-001041-S funded by MICIN/AEI/10.13039/501100011033. The study funders were not involved in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the paper for publication. Sí

Objective: To develop a trail running injury screening instrument (TRISI) for utilisation as clinical decision aid in determining if a trail runner is at an increased risk for injury. Design: Multiple methods approach. Methods: The study utilised five phases 1) identification of injury risk factors 2) determining the relevance of each identified risk factor in a trail running context, 3) creating the content of the Likert scale points from 0 to 4, 4) rescaling the Likert scale points to determine numerical values for the content of each Likert scale point, and 5) determining a weighted score for each injury risk factor that contributes to the overall combined composite score. Results: Of the 77 identified injury risk factors, 26 were deemed relevant in trail running. The weighted score for each injury risk factor ranged from 2.21 to 5.53 with the highest calculated score being 5.53. The final TRISI includes risk categories of training, running equipment, demographics, previous injury, behavioural, psychological, nutrition, chronic disease, physiological, and biomechanical factors. Conclusion: The developed TRISI aims to assist the clinician during pre-race injury screening or during a training season to identify meaningful areas to target in designing injury risk management strategies and/or continuous health education.

Para athletes play sports with a risk of sustaining head injuries and concussions,1 2 with concussion assessment of para athletes presenting additional challenges due to their impairments.3 Consequently, injury surveillance studies may not accurately reflect para concussion prevalence. Guidelines for para concussion clinical assessment and management have only recently been published.3 Our qualitative study explored English blind 5-a-side footballers’ perceptions of concussion, concussion risks and concussion prevention to improve para concussion care.4 Nine semistructured interviews were conducted with male English blind footballers underpinned by a pragmatic paradigm. Data were analysed using thematic analysis.

Objectives Emerging evidence suggests contrasting health effects for leisure-time and occupational physical activity. In this systematic review, we synthesized and described the epidemiological evidence regarding the association between occupational physical activity and cardiovascular disease (CVD) mortality. Methods A literature search was performed in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews, from database inception to 17 April 2020. Articles were included if they described original observational prospective research, assessing the association between occupational physical activity and CVD mortality among adult workers. Reviews were included if they controlled for age and gender and at least one other relevant variable. We performed meta-analyses on the associations between occupational physical activity and CVD mortality. Results We screened 3345 unique articles, and 31 articles (from 23 studies) were described in this review. In the meta-analysis, occupational physical activity showed no significant association with overall CVD mortality for both males [hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.87–1.15] and females (HR 0.95, 95% CI 0.82–1.09). Additional analysis showed that higher levels of occupational physical activity were non-significantly associated with a 15% increase in studies reporting on the outcome ischemic heart disease mortality (HR 1.15, 95% CI 0.88–1.49). Conclusions While the beneficial association between leisure-time physical activity and CVD mortality has been widely documented, occupational physical activity was not found to have a beneficial association with CVD mortality. This observation may have implications for our appreciation of the association between physical activity and health for workers in physically demanding jobs, as occupational physical activity may not be health enhancing.

Background. Injury risk is high in Physical Education Teacher Education (PETE) students. Insights into specific injury locations per sex, setting, sports, and curriculum year are needed to develop preventive measures. Purpose. To compare injury distributions by body locations in PETE students and how these distributions differ by sex, type, onset, curriculum year, settings, or sports. Methods. In a historical cohort study over 14 years, data from 2899 students (male 76.2%, n = 1947) enlisted in the first three years of a PETE curriculum were analysed. Injuries reported at the institution’s medical facility were categorised per sex, body location, onset, type, setting, sports, and curriculum year. Results. Forty-three percent (n = 1247) of all students (female 54.9%, n = 523, male 37.2%, and n = 429) reported a total of 2129 injuries (freshmen 56.4%; 2nd year 28.2%; 3rd year 15.5%). The most prevalent sudden onset injury locations (63.4% of all injuries) were the ankle (32.5%) and knee (16.6). The most prevalent gradual onset injuries were the lower leg (27.8%) and knee (25.2%). Joint/ligament injuries (45.8%) and muscle/tendon injuries (23.4%) were the most prevalent injury types. Proportions for injury locations and injury types differed significantly between curriculum years. Injury prevalence per setting and sport differed significantly between the sexes. Injury locations differed significantly between sports and between the sexes per sport. Conclusion. A differential approach per injury location, onset, type, sex, setting, sports, and curriculum year is needed to develop adequate preventive measures in PETE studies. The engagement of precurricular, intracurricular, and extracurricular stakeholders is needed in the development of these measures.

ObjectivesAthletes with impairments play sports with a risk of sustaining head injuries and concussions. However, the scientific knowledge needed to improve care is lacking. This qualitative study explores English blind 5-a-side footballers’ perceptions of concussion, concussion risks and prevention to improve para concussion care.MethodsNine semi-structured interviews were conducted with male English blind footballers (six current and three retired). Data were analysed by thematic analysis using a six-stage approach.ResultsBlind footballers were not sure about the number of concussions they had sustained. They lacked an understanding of what to experience when concussed, and they perceived the diagnosis and experience of a concussion to be different for a person without vision. Perceived concussion severity and previous concussion experiences were key concepts affecting their concussion reporting behaviours. Participants mentioned spatial orientation and sleep are important to function in daily life and were affected by concussions. However, these factors are not adequately included in current assessment tools or clinical guidance for sports-related concussions.ConclusionBlind footballers suggested the quality and accuracy of reported concussions were impacted by lack of concussion experience, knowledge and concomitant impairment. A better understanding of concussion symptoms and injury mechanisms will improve concussion reporting for athletes with visual impairments. These athlete insights should guide future studies and para sports governing body initiatives to improve concussion reporting, diagnosis and management in para athletes.

OBJECTIVE: To investigate the association between the acute:chronic workload ratio (ACWR) and running-related injuries (RRI).METHODS: This is a secondary analysis using a database composed of data from three studies conducted with the same RRI surveillance system. Longitudinal data comprising running exposure (workload) and RRI were collected biweekly during the respective cohorts' follow-up (18-65 weeks). ACWR was calculated as the most recent (i.e., acute) external workload (last 2 weeks) divided by the average external (i.e., chronic) workload of the last 4, 6, 8, 10 and 12 weeks. Three methods were used to calculate the ACWR: uncoupled, coupled and exponentially weighted moving averages (EWMA). Bayesian logistic mixed models were used to analyse the data.RESULTS: The sample was composed of 435 runners. Runners whose ACWR was under 0.70 had about 10% predicted probability of sustaining RRI (9.6%; 95% credible interval [CrI] 7.5-12.4), while those whose ACWR was higher than 1.38 had about 1% predicted probability of sustaining RRI (1.3%; 95% CrI 0.7-1.7). The association between the ACWR and RRI was significant, varying from a small to a moderate association (1-10%). The higher the ACWR, the lower the RRI risk.CONCLUSIONS: The ACWR showed an inversely proportional association with RRI risk that can be represented by a smooth L-shaped, second-order, polynomial decay curve. The ACWR using hours or kilometres yielded similar results. The coupled and uncoupled methods revealed similar associations with RRIs. The uncoupled method presented the best discrimination for ACWR strata. The EWMA method yielded sparse and non-significant results.

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

ObjectivesTo explore how sports injury prevention takes place in elite sport practice and to describe the perspectives of athletes, coaches and physiotherapists regarding the most critical factors that help prevent injury in the elite sports context.MethodsQualitative study. Semistructured interviews with 19 international level athletes, coaches and physiotherapists, from different Olympic sports. Interviews were transcribed verbatim and analysed using comparative data analysis based on Grounded Theory.ResultsThe participants perceived injury risk as an inherent part of elite sports, because athletes try to enhance performance by pushing their limits. Participants described injury prevention as a learning process that changed over time, based on their sports experience and the injuries that they had sustained along their career. Communication among the athletes, coaches and physiotherapists was described as a key component of the injury prevention process. Study participants emphasised the relevance of teamwork and shared responsibility. Performance was presented as the core of the athlete’s daily practice, indicating that injury prevention can be a means to that end but is not a goal in itself for this community.ConclusionParticipants perceive injury prevention as part of elite sports and thus embrace the need for injury prevention. Injury prevention strategies in elite sports were described as a learning process, following the dynamic nature of training for maximal performance. Performance is the participants’ main goal.

Purpose This study aimed to investigate the relationship between the moderating role of lifestyle, age, and years working in shifts and, shift work and being overweight. Methods Cross-sectional data were used of 2569 shift and 4848 non-shift production workers who participated between 2013 and 2018 in an occupational health check. Overweight (BMI ≥ 25 kg/m2) was calculated using measured weight and height; lifestyle was assessed by questionnaires. Multiple-adjusted logistic regression with interaction terms between shift work and potential moderators assessed multiplicative interaction; the relative excess risk due to interaction assessed additive interaction (synergism). Results Shift work was significantly related to being overweight (OR 1.53, 95% CI 1.33 1.76). The strength of this association did not differ by level of sleep quality, fruit and vegetable intake, and physical activity (p ≥ 0.05). Additive and multiplicative interaction by smoking status was present (p p Conclusion Shift work was to a similar extent related to being overweight among those with a healthy and unhealthy lifestyle. This does, however, not imply that shift workers can behave unhealthy without any harm. Based on the evident health benefits of a healthy lifestyle, it is still recommended to get sufficient quality of sleep and to meet the recommended level of daily physical activity and, fruit and vegetable intake.

ObjectivesDespite the many proven advantages of a physically active lifestyle in patient populations, prescription of exercise is currently not widely implemented in routine clinical practice. The aims of this study were twofold: (1) to assess perceptions of clinicians on the current practice of exercise is medicine (E=M) prescription in two Dutch university medical centres and (2) to determine their perceived barriers and facilitators for the implementation of E=M in routine clinical care in Dutch university medical centres.DesignA mixed methodologies study, using both online questionnaires and semi-structured interviews.SettingDutch university medical centres.ParticipantsClinicians working within the departments of medical oncology, orthopaedics and rehabilitation medicine of two university medical centres.ResultsForty-five clinicians (response rate of 51%) completed the questionnaire, and 19 clinicians were interviewed. The results showed that even though clinicians had a positive attitude towards prescribing E=M, only a few reported to regularly prescribe E=M to their patients. The 52 identified facilitators and barriers for implementation of E=M were categorised into four main themes: (1) beliefs toward the implementation of E=M (eg, clinicians knowledge and skills, and social support), (2) factors related to the patient perspective (eg, patient priorities or motivation), (3) factors related to the referral options (eg, knowledge of and trust in local referral options) and (4) practical considerations when implementing E=M (eg, time constraints).ConclusionsOur study showed that even though many clinicians have a positive attitude toward an active lifestyle, many are not prescribing E=M on a regular basis. In order for clinicians to effectively implement E=M, strategies should focus on increasing clinicians E=M referral skills, improving clinicians knowledge of E=M referral options and develop a support system to ensure that E=M is high on the priority list of clinicians.

Objective: To investigate the construct validity of the Steep Ramp Test (SRT) by longitudinally comparing the correlation between maximum short exercise capacity of the SRT and direct measurements of peak oxygen consumption (VO 2peak) during or shortly after treatment in patients with breast cancer and the potential effect of chemotherapy-induced symptom burden. Design: Cross-sectional. Setting: Multicenter. Participants: We used data from 2 studies that included women with breast cancer treated with chemotherapy, resulting in 274 observations. A total of 161 patients (N=161) performed the cardiopulmonary exercise test and the SRT in 2 test sessions on different time points around chemotherapy treatment. Interventions: Not applicable. Main Outcome Measures: Fatigue was assessed with the Multidimensional Fatigue Inventory, and nausea and vomiting and pain by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. The longitudinal correlation between the maximum short exercise capacity and VO 2peak was investigated using a linear mixed model. Interaction terms were added to the model to investigate whether the correlation varied by symptom burden. Results: We found a statistically significant moderate correlation between VO 2peak and maximum short exercise capacity (0.61; 95% confidence interval, 0.51-0.70; P2peak with the maximum short exercise capacity with increasing symptom burden. Pain and fatigue did not significantly modify the correlation. Conclusions: The SRT can only be used as a proxy for changes in aerobic capacity with great caution and with attention for the level of nausea and vomiting.

On 17 March 2021, an erratum was published online [1] in the International Journal of Sports Medicine that showed corrected values for the incidences of injury and illness presented in the Vernillo et al. study [1]. The Vernillo et al. study was included in our systematic review[2] and therefore the following updates should be applied: Abstract The sentence describing incidence range previously read: “The overall incidence range was 1.6-4285.0 injuries per 1000 h of running and 65.0-6676.6 illnesses per 1000 h of running.” Updated to read: The overall incidence range was 1.6-61.2 injuries per 1000 h of running and 65.0-95.4 illnesses per 1000 h of running. Table 2: Below the “Incidence/Prevalence” column of the Vernillo et al. (2016) row, the injury rate per 1000 h previously read: “Injury rates per 1000 h (90% CI): MSK a: 4285.0 (3899.3- 5313.4) Skin: 2192.3 (1994.9-2718.4)” Updated to read: Injury rates per 1000 h (90% CI): MSK a: 61.2 (48.0-78.1) Skin: 31.3 (22.2-44.2). Table 3: Below the “Incidence/Prevalence” column of the Vernillo et al. (2016) row, the illness rate per 1000 h previously read: “Illness rates per 1000 h (90% CI): Medical: 6676.6 (6075.7-8278.9)” Updated to read: Illness rates per 1000 h (90% CI): Medical: 95.4 (78.8-115.5) Conclusion: The concluding sentence previously read: “Our review showed that, injury and illness are common among trail runners with an overall incidence range of 1.6- 4285.0 injuries per 1000 h of running and 65.0-6676.6 illnesses per 1000 h of running.” Updated to read: Our review showed that, injury and illness are common among trail runners with an overall incidence range of 1.6- 61.2 injuries per 1000 h of running and 65.0-95.4 illnesses per 1000 h of running.

Trail running involves running on varying natural terrains, often including large elevation gains/losses. Trail running has a high risk of injury, and runners often participate in remote regions where medical support is challenging. The aim of this study was to determine the epidemiology, clinical characteristic, and associated injury risk factors among trail runners. A modified Oslo Sports Trauma Research Center Questionnaire for Health Problems (OSTRC-H) was used biweekly to collect running-related injury (RRI) and training history data prospectively, among 152 participants (males n = 120, females n = 32) over 30 weeks. We report an overall injury rate of 19.6 RRIs per 1000 h and an RRI mean prevalence of 12.3%. The leading anatomical site of RRIs was the lower limb (82.9%), affecting the knee (29.8%), shin/lower leg (18.0%), and the foot/toes (13.7%). A history of previous RRI in the past 12 months (p = 0.0032) and having a chronic disease (p = 0.0188) are independent risk factors for RRIs among trail runners. Two in three trail runners sustain an RRI mainly affecting the knee, shin/lower leg, and foot/toes. A history of previous RRI in the past 12 months and a having chronic disease is independently associated with RRI among trail runners. These results could be used to develop future RRI prevention strategies, combined with clinical knowledge and experience.

To identify primary target groups for injury prevention in physical education teacher education (PETE) students, risk differences between subgroups by sex and curriculum years were compared in a retrospective cohort study (2000-2014). Injuries recorded by healthcare professionals at the medical facility of a Dutch PETE college were used to calculate overall, intra- and extracurricular injury prevalence per sex, curriculum years, and semesters and to compare these by logistic regression analyses. Of 1083 PETE students, 599 (55.3%) reported at least one injury during their curriculum (60.0% intracurricular). Female students had a higher risk for overall (OR 2.29, 95%CI 1.77-2.96) and for intracurricular injuries (OR 3.12, 95%CI 2.41-4.03), but not for extracurricular injuries. Compared to the freshman year, injury risk dropped during the consecutive years (OR 0.56, 95%CI 0.46-0.67; OR 0.33, 95%CI 0.27-0.41; OR 0.04, 95%CI 0.03-0.07, respectively). The first semesters of the freshman and second year showed higher injury prevalence compared to two out of three consecutive semesters (P < .006). Primary target groups for injury preventive measures are freshman and female PETE students. Factors contributing to the predominantly higher intracurricular injury risks, most notably in female students, need to be investigated in prospective cohort studies, regardless of sex.

Several studies have suggested that a ‘physical activity (PA) paradox’ may exist—that is, the well documented beneficial health effects of leisure-time physical activity (LTPA) are not found for occupational physical activity (OPA). A BJSM editorial has outlined potential explanations for such a paradox.1 A recent systematic review has provided some empirical evidence that men, but not women, engaging in high (compared with low) level OPA have an 18% (95% CI 5% to 34%) increased risk of all-cause mortality.2 Nonetheless, the existence of this paradox has been questioned in a discussion paper by Professor Roy Shephard.3 Below we expand on three limitations this discussion paper raised and suggest a research agenda for generating more conclusive evidence regarding this paradox. The current evidence originated from certain regions including Scandinavia, Spain, Iran and Israel. It was suggested that this restricted geographical representation weakens the evidence. However, relatively good working conditions in western European and Scandinavian countries could attenuate the negative health effects of OPA. Studies from countries with higher work demands and/or higher environmental temperatures are likely to provide evidence for even larger negative health effects. Apart from physical work demands, other factors (eg, LTPA or socioeconomical gradients) may also vary between countries and may have an impact on the association between OPA and health. The restricted origin of evidence also raises the possibility …

BackgroundThough rare, rugby union carries a risk for serious injuries such as acute spinal cord injuries (ASCI), which may result in permanent disability. Various studies have investigated injury mechanisms, prevention programmes and immediate medical management of these injuries. However, relatively scant attention has been placed on the player’s experience of such an injury and the importance of context.AimThe aim of this study was to explore the injury experience and its related context, as perceived by the catastrophically injured player.MethodsA qualitative approach was followed to explore the immediate, postevent injury experience. Semi-structured interviews were conducted with 48 (n=48) players who had sustained a rugby-related ASCI.ResultsFour themes were derived from the data. Participants described the context around the injury incident, which may be valuable to help understand the mechanism of injury and potentially minimise risk. Participants also described certain contributing factors to their injury, which included descriptions of foul play and aggression, unaccustomed playing positions, pressure to perform and unpreparedness. The physical experience included signs and symptoms of ASCI that is important to recognise by first aiders, fellow teammates, coaches and referees. Lastly, participants described the emotional experience which has implications for all ASCI first responders.SignificanceAll rugby stakeholders, including players, first responders, coaches and referees, may gain valuable information from the experiences of players who have sustained these injuries. This information is also relevant for rugby safety initiatives in shaping education and awareness interventions.

Background: Behavioral and social science theories/models have been gaining attention in sports injury prevention.Objective: To investigate the potential of the Theory of Planned Behavior in explaining running-related injury preventive behavior.Methods: Six-month prospective cohort study based on data gathered from a randomized controlled trial. From a total of 1512 invited trail runners, 232 were included in this study. Preventive behaviors and their determinants were assessed at baseline and two and six months after baseline. Five-point Likert scales were used to assess the determinants of preventive behavior. A Bayesian path analysis was conducted applying mixed models and mediation analysis.Results: A 1-point increase in intention, attitude, subjective norm, and perceived behavioral control predicted an increase of 54% (95% Bayesian credible interval [BCI]: 38, 71) in the rate of performing running-related injury preventive behavior, explaining 49% (R-2 0.49; 95% BCI: 0.41, 0.56) of the variance around preventive behavior. Intention and perceived behavioral control predicted running-related injury preventive behavior directly, while 40% (95% BCI: 21, 61) and 44% (95% BCI: 20, 69) of the total effect of attitude was mediated by intention and perceived behavioral control, respectively. Attitude, subjective norm, and perceived behavioral control predicted intention.Conclusions: The Theory of Planned Behavior may have the potential to explain half of the variance around running-related injury preventive behavior and intention. Therefore, such theory may be considered a relevant and useful tool in developing, investigating, and/or implementing programs aimed at preventing running-related injuries. (C) 2021 Associacao Brasileira de Pesquisa e Pos-Graduacao em Fisioterapia. Published by Elsevier Espana, S.L.U. All rights reserved.

This study explored the perspectives of dancers and staff of the Dutch National Ballet, regarding injury definition, injury risk factors, and preventive measures. We conducted two focus groups: one with the medical/artistic staff and another with dancers. Data were analyzed inductively by two independent coders, through the constant comparative method, based on Grounded Theory. Participants defined an injury based mainly on dance performance limitations, while pain and time loss reflected injury severity. Dance injury was described as a spectrum of injury levels that depend on the ability to perform to the best of their ability, pain levels, and potential modification on dance participation. The imbalance between workload and the dancers' capacity to deal with load was perceived as the main cause related to injuries. Workload was presented as a complex equation, combining consistency, repertoire demands, daily schedule, traveling plan, and their interrelations. Injury prevention was described as a dynamic balance between being prepared to deal with load and managing load. The critical factors that modulate the injury prevention process were as follows: teamwork, communication, experience, and planning. Our findings show injury is not defined by a clear cutoff, with multiple injury risk factors interacting and evolving, making injury prevention a constant challenge.

Background: Trail running is characterised by large elevation gains/losses and uneven varying running surfaces. Limited information is available on injury and illness among trail runners to help guide injury and illness prevention strategies. Objective: The primary aim of this review was to describe the epidemiology of injury and illness among trail runners. Methods: Eight electronic databases were systematically searched (MEDLINE Ovid, PubMed, Scopus, SportsDiscus, CINAHL, Health Source: Nursing/Academic, Health Source: Consumer Ed., and Cochrane) from inception to November 2020. The search was conducted according to the PRISMA statement and the study was registered on PROSPERO international prospective register of systematic reviews (CRD42019135933). Full-text English and French studies that investigated injury and/or illness among trail runners participating in training/racing were included. The main outcome measurements included: trail running injury (incidence, prevalence, anatomical site, tissue type, pathology-type/specific diagnosis, severity), and illness (incidence, prevalence, symptoms, specific diagnosis, organ system, severity). The methodological quality of the included studies was assessed using an adapted Downs and Black assessment tool. Results: Sixteen studies with 8644 participants were included. Thirteen studies investigated race-related injury and/or illness and three studies included training-related injuries. The overall incidence range was 1.6–4285.0 injuries per 1000 h of running and 65.0–6676.6 illnesses per 1000 h of running. The foot was the most common anatomical site of trail running injury followed by the knee, lower leg, thigh, and ankle. Skin lacerations/abrasions were the most common injury diagnoses followed by skin blisters, muscle strains, muscle cramping, and ligament sprains. The most common trail running illnesses reported related to the gastro-intestinal tract (GIT), followed by the metabolic, and cardiovascular systems. Symptoms of nausea and vomiting related to GIT distress and dehydration were commonly reported. Conclusion: Current trail running literature consists mainly of injury and illness outcomes specifically in relation to single-day race participation events. Limited evidence is available on training-related injury and illness in trail running. Our review showed that injury and illness are common among trail runners, but certain studies included in this review only focused on dermatological injuries (e.g. large number of feet blisters) and GIT symptoms. Specific areas for future research were identified that could improve the management of trail running injury and illness.

BACKGROUND: Rugby carries a risk for serious injuries, including acute spinal cord injuries. The lifetime health consequences of these injuries may be far-reaching. PURPOSE: In this study, we aimed to describe barriers and facilitators to healthcare and rehabilitation, in individuals with rugby-related spinal cord injuries in South Africa. METHODS: This study adopted a pragmatic qualitative approach. Stratified purposive sampling was used to select interviews from players from a variety of socio-economic status and geographical areas for inclusion in this study. The final sample consisted of thirty-one (n = 31) participants. Thematic analysis was used to analyze the data. RESULTS: Participants described long-term, accessible, affordable, quality healthcare and rehabilitation as important contributors to their quality of life. Even though public healthcare is accessible from a cost point of view, quality of care, availability of rehabilitation services and factors such as affordability and availability of adequate transport remain a barrier for lower socio-economic groups. CONCLUSION: This population was unique, as the support from a dedicated organization enabled participants to overcome some barriers, highlighting the challenges of the healthcare system in maintaining the health of people with spinal cord injuries. Every effort should be made to create equitable access to healthcare and rehabilitation for persons with spinal cord injuries in South Africa.

This cross-sectional study aimed to compare the association between self-reported sleep duration and cardiometabolic risk among men and women corporate executives and investigate potential lifestyle, work- and stress-related mediators thereof.Self-reported sleep duration and lifestyle, occupational, psychological and measured anthropometrical, blood pressure (BP) and blood marker variables were obtained from health risk assessment data of 3583 corporate executives. Sex-stratified regression analyses investigated the relationships between occupational and psychological variables with self-reported sleep duration, and sleep duration with individual cardiometabolic risk factors. Mediation analyses investigated the effects of work, psychological and lifestyle factors on the relationships between self-reported sleep duration and cardiometabolic risk factors, as well as a continuous cardiometabolic risk score calculated from the sum of sex-stratified z-standardized scores of negative fasting serum HDL, and positive plasma Glu, serum TG, body mass index (BMI), waist circumference, systolic and diastolic BP.Longer work hours and work commute time, depression, anxiety and stress were associated with shorter sleep duration in both men and women (all p 0.05). Shorter sleep duration was associated with higher BMI, larger waist circumference and greater cardiometabolic risk scores in both men and women (all p 0.05), higher diastolic BP in men (p 0.05) and lower HDL cholesterol in women (p 0.05). Physical activity, working hours and stress significantly mediated the relationships between self-reported sleep duration and BMI, waist circumference, diastolic BP and cardiometabolic risk score in men only.In these corporate executives, shorter self-reported sleep duration is associated with poorer psychological, occupational and cardiometabolic risk outcomes in both men and women. Given that physical activity, working hours and stress mediate this association among the men, the case for sleep health interventions in workplace health programmes is warranted.

Objective This study aimed to investigate the association between shift work, and burnout and distress, and differences by degree of satisfaction with shift schedule and its impact on private life. Methods Population 4275 non-shift factory workers and 3523 rotating 5-shift workers. Workers participated between 2009 and 2016 one to three times in the companies’ periodical occupational health checks. Burnout was measured using the distance, exhaustion and competence subscales of the Dutch Maslach Burnout Inventory and distress by the subscale of the Four-Dimensional Symptom Questionnaire (scale: 0–100). Multiple-adjusted linear mixed models were used to assess between- and within-subject associations between shift work and outcomes, and differences by age, years of shift work, and satisfaction with and impact of shift schedule. Results Shift work was significantly associated with lower scores on burnout distance (B − 1.0, 95% − 1.8 to 0.3), and among those aged P ≥ 0.05). No clear pattern by years of shift work was observed. Conclusions Shift work was associated with burnout and distress in those who were dissatisfied with or who had perceived high impact on the private life of their shift schedule.

Background/aimBokSmart is a nationwide injury prevention programme that aims to reduce players’ injury risk mainly through education of coaches and referees in mandatory biennial education courses. These courses are held throughout each rugby season. The objective of this cross-sectional study was to assess whether these courses were associated with improvements in attendees’ behavioural determinants.MethodsCoaches and referees completed a questionnaire based on the theory of planned behaviour, immediately before and after their 2012 BokSmart courses. Twelve behavioural determinants were assessed on a five-point Likert scale and open-ended questions. A meaningful change was defined as an improvement of ≥1 unit score supported by null hypothesis testing. Odds of improving by ≥1 unit score (compared with not improving) were assessed in attendees using multivariate logistic regression.ResultsIn total, 390 coaches and 74 referees completed both questionnaires. ‘Before’ scores were high for most outcomes, except for knowledge. Although there was a significant (pConclusionAlthough the only meaningful improvement in 2012 BokSmart course attendees was in one outcome, it should be noted that before-course scores were already high, reducing the questionnaire’s ability to assess change because of a ceiling effect. Nonetheless, the knowledge acquisition of these courses was low and not related to previous course attendance or more years of rugby experience. These results justify the biennial nature of this safety course but also indicate that knowledge acquisition is generally low.

BACKGROUND The prescription of physical activity (PA) in clinical care has been advocated worldwide. This “exercise is medicine” (E=M) concept can be used to prevent, manage, and cure various lifestyle-related chronic diseases. Due to several challenges, E=M is not yet routinely implemented in clinical care. OBJECTIVE This paper describes the rationale and design of the Physicians Implement Exercise = Medicine (PIE=M) study, which aims to facilitate the implementation of E=M in hospital care. METHODS PIE=M consists of 3 interrelated work packages. First, levels and determinants of PA in different patient and healthy populations will be investigated using existing cohort data. The current implementation status, facilitators, and barriers of E=M will also be investigated using a mixed-methods approach among clinicians of participating departments from 2 diverse university medical centers (both located in a city, but one serving an urban population and one serving a more rural population). Implementation strategies will be connected to these barriers and facilitators using a systematic implementation mapping approach. Second, a generic E=M tool will be developed that will provide tailored PA prescription and referral. Requirements for this tool will be investigated among clinicians and department managers. The tool will be developed using an iterative design process in which all stakeholders reflect on the design of the E=M tool. Third, we will pilot-implement the set of implementation strategies, including the E=M tool, to test its feasibility in routine care of clinicians in these 2 university medical centers. An extensive learning process evaluation will be performed among clinicians, department managers, lifestyle coaches, and patients using a mixed-methods design based on the RE-AIM framework. RESULTS This project was approved and funded by the Dutch grant provider ZonMW in April 2018. The project started in September 2018 and continues until December 2020 (depending on the course of the COVID-19 crisis). All data from the first work package have been collected and analyzed and are expected to be published in 2021. Results of the second work package are described. The manuscript is expected to be published in 2021. The third work package is currently being conducted in clinical practice in 4 departments of 2 university medical hospitals among clinicians, lifestyle coaches, hospital managers, and patients. Results are expected to be published in 2021. CONCLUSIONS The PIE=M project addresses the potential of providing patients with PA advice to prevent and manage chronic disease, improve recovery, and enable healthy ageing by developing E=M implementation strategies, including an E=M tool, in routine clinical care. The PIE=M project will result in a blueprint of implementation strategies, including an E=M screening and referral tool, which aims to improve E=M referral by clinicians to improve patients’ health, while minimizing the burden on clinicians.

Purpose Shift work has been related to obesity and diabetes, but the potential mediating role of lifestyle is yet unknown. Our aim was to investigate this mediating role of physical activity, diet, smoking, and sleep quality in the relationships between shift work, and obesity and diabetes. Methods In this cross-sectional study, 3188 shift workers and 6395 non-shift workers participated between 2013 and 2018 in periodical occupational health checks. Weight and height were objectively measured to calculate obesity (BMI ≥ 30 kg/m2). Diabetes status, physical activity, diet, smoking, and sleep quality were assessed using standardized questionnaires. Structural equation models adjusted for relevant confounders were used to analyze the mediating role of lifestyle in the relationships between shift work, and obesity and diabetes. Results Shift workers were more often obese (OR: 1.37, 95% CI 1.16–1.61) and reported more often to have diabetes (OR:1.35, 95% CI 1.003–1.11) than non-shift workers. Shift workers had lower physical activity levels, ate fruit and vegetables less often, smoked more often, and had poorer sleep quality (p p ≥ 0.05). Conclusion These results imply that interventions targeting diet, physical activity and in particular sleep problems specifically developed for shift workers could potentially reduce the adverse health effects of shift work.