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Epidemiological studies of injury in elite and recreational golfers have lacked consistency in methods and definitions employed and this limits comparison of results across studies. In their sports-generic statement, the Consensus Group recruited by the IOC (2020) called for sport-specific consensus statements. On invitation by International Golf Federation, a group of international experts in sport and exercise medicine, golf research and sports injury/illness epidemiology was selected to prepare a golf-specific consensus statement. Methodological stages included literature review and initial drafting, online feedback from the consensus group, revision and second draft, virtual consensus meetings and completion of final version. This consensus statement provides golf-specific recommendations for data collection and research reporting including: (i) injury and illness definitions, and characteristics with golf-specific examples, (ii) definitions of golf-specific exposure measurements and recommendations for the calculation of prevalence and incidence, (iii) injury, illness and exposure report forms for medical staff and for golfers, and (iv) a baseline questionnaire. Implementation of the consensus methodology will enable comparison among golf studies and with other sports. It facilitates analysis of causative factors for injuries and illness in golf, and can also be used to evaluate the effects of prevention programmes to support the health of golfers.

ObjectivesThe primary aim was to describe the characteristics and prevalence of musculoskeletal complaints of a large group of non-professional golfers. Secondary aims were to compare golfers different in (A) skill-level, (B) presence of low back pain (LBP) and (C) performance of prevention exercises.MethodsA sample of 1170 male golfers (mean age 54.98, SD=13.3) were surveyed online on personal and golf-specific characteristics, medical history and complaints in the preceding 7 days. Subgroups (A) with different golfing handicap (0 to 5, >5 to 10, >10), (B) with and without LBP and (C) who performed versus did not perform injury prevention exercises were compared using analysis of variance and χ2test.ResultsThe prevalence and severity of musculoskeletal complaints was similar in everyday life and when playing golf. More than one-third of the golfers (n=436; 37.3%) reported LBP in the preceding 7 days, while other frequently affected body parts were the shoulder and knee. Golfers with different skill level differed in age and most golf-related characteristics but not in prevalence and severity of musculoskeletal complaints. Golfers with and without LBP were similar in almost all variables. Golfers who performed prevention exercises (n=371; 27.1%) were older and had a higher prevalence of complaints.ConclusionThe prevalence and severity of musculoskeletal complaints in golfers were similar to the wider population. It seems that injury prevention exercises were implemented after injury, rather than as primary prevention. Prospective studies looking at the epidemiology of injury, risk factors and interventions are required.

ObjectiveThe distribution of injuries affecting professional golfers is yet to be fully understood. We performed a systematic review of the clinical literature to establish the epidemiology of musculoskeletal injuries affecting professional golfers.DesignSystematic review.Data sourcesSearched databases in July 2018 were PubMed, SPORTDiscus and Embase.Eligibility criteriaPublished observational research articles relating to the incidence or prevalence of musculoskeletal injuries in professional golfers, which were written in the English language and not restricted by age or gender.ResultsOf the 1863 studies identified on the initial search, 5 studies were found to satisfy the inclusion criteria for analysis. The mean age of the golfers in these studies was 34.8 (±3.6) years. The gender of patients in included studies compromised 72% males and 28% females. Four studies reported that lumbar spine injuries were the most common (range 22%–34%). Excluding injuries to the spine (lumbar, thoracic and cervical), the hand/wrist was the next most common region of injury (range 6%–37%). The quality of the studies was relatively poor with no study satisfying >50% of the quality assessment tool questions and only one study giving a clear definition of how they defined injury.ConclusionThere is a paucity of well-designed epidemiological studies evaluating musculoskeletal injuries affecting professional golfers. Injuries to the spine are the most frequently affected region, followed by the hand/wrist. This study has identified targeted areas of future research that aims to improve the management of injuries among professional golfers.

New knowledge from research findings rarely produces rapid efficient changes in practice.1 Barton and Merolli2 proposed a model which may help improve knowledge translation via the addition of two novel contemporary steps: multimedia creation and subsequent dissemination (see figure 1). Figure 1 Visual representation of a process to improve knowledge translation based on Barton and Merolli’s model.2 Following this model, we recently produced digital/multimedia resources to help communicate and disseminate the International Consensus on Golf and Health.3 A systematic literature review and modified Delphi process underpinned the International Consensus on Golf and Health and this was published in the British Journal of Sports Medicine in 2018.3 The Consensus is intended to support (1) golfers and potential golfers; (2) golf facilities and the golf industry; and (3) policy makers to make evidence-informed decisions that can maximise the health benefits of golf and minimise the health risks associated with this sport. Articles containing visual information are …

Our scoping review was the first ‘big picture’ review to identify the relationships between rugby union, and health and well-being. Data suggest that all forms of rugby union (contact, non-contact and wheelchair) can provide moderate to vigorous physical activity, and can contribute to non-sedentary time, both of which have a raft of associated health and well-being benefits.1 National population surveys also consider rugby union as an activity that can provide muscle-strengthening/balance improvement when accrued for period of over 10 minutes,2 and ‘ball sports’ are generally considered to improve muscle function, bone health and balance.3 ‘Non-contact’ and …

ObjectivesThere is no published data on the incidence or risk of SARS-CoV-2 transmission when playing golf, a sport played outdoors where social distancing is possible. The purpose of this prospective study was to report incidence and transmission regarding SARS-CoV-2, of professional golfers competing on the PGA European Tour across 23 events in 11 countries.MethodsDaily symptom and temperature checks and weekly reverse transcriptase PCR (RT-PCR) screening were performed to determine potential carriage of SARS-CoV-2. Onset and type of symptomology were analysed. Gene expression and cycle thresholds (Cts) were reviewed for all positive cases. Repeat PCR testing was performed on all positive players. RT-PCR analysis included human housekeeping genes and various RNA genes specific for SARS-CoV-2.ResultsDuring the study period, there were 2900 RT-PCR tests performed on 195 professional golfers competing on the European Tour. Four players tested positive on-site during the study period (0.14% of tests; positive results were declared with Ct ConclusionGolf is an outdoor sport where social distancing is possible, meaning risks can be low if guidance is followed by participants. Risk of transmission of SARS-CoV-2 can be mitigated by highly accurate RT-PCR testing of participants and by setting up a safe bubble that includes testing players and support staff, as well as all persons coming into contact with them during the course of the tournament, for example, drivers and hotel staff. This report can also provide reassurance for participants and policy makers regarding community golf, which can be encouraged for the health benefits it provides, in a relatively low-risk environment, with minimal risk of transmission by observing sensible viral hygiene protocols.

Increasing greenhouse gas emissions, and physical inactivity are major global challenges of the 21st century.1 Tackling climate change and increasing physical activity are key priorities at local, national and international level. We need to act now to prevent or limit the impacts on our children and future generations (figure 1). Figure 1 Best Investments for Physical Activity, includes active travel and suggests “working together to make it happen”. The Scottish Government has committed to doubling spend on the active travel budget from £40 million per year to £80 million per year from 2018 to 2019 (figure …

Number of citations, number of views, Altmetric. To be a relevant and respected researcher, and to succeed in the current ‘publish or perish’ climate, it is important to publish, and to communicate and disseminate research widely to increase its likelihood of influencing clinical and research practice. With over two million scientific articles being produced each year1 (and rising), how can you ensure your contribution is impactful? The number of citations in other published articles and ‘number of views’ has long been used as a guide to assess the impact of a paper.2 This may not be an effective ‘real-time’ measure as some impactful papers take years to generate citations. A journal’s impact factor (IF) has also been viewed as a measure of respectability and an indirect proxy of an article’s impact. However, questions arise regarding such ‘journal-level’ metrics when it comes …

Background Education of health professionals is a key element of the wider strategy to increase society9s physical activity levels. To date, no study has directly assessed UK medical students’ knowledge of physical activity guidelines or their ability/willingness to prescribe exercise. Methods A questionnaire survey of final year medical students in Scottish Universities was conducted prior to a presentation on the current UK guidelines. Results Completed questionnaires (n=177) represented 37% of the final year cohorts. Physical inactivity was incorrectly perceived to be the least important risk factor to global mortality. 40% stated they were aware of current guidelines, but in a forced choice, 68% were able to correctly identify them for adults. In comparison, 97% correctly identified the UK9s alcohol guidelines. 52% stated they felt adequately trained to give physical activity advice to the general public. Conclusions The medical students in this study underestimated the risk of physical inactivity, and did not know the physical activity guidelines as well as other health promotion guidelines. A large proportion remained unconfident about giving physical activity advice. Improved education of this group is required.

Visual data are all around us. A clear purpose of information graphics (infographics) is to communicate key messages in an engaging fashion.1 They are increasingly being used to complement and add value to scientific papers. Some infographics are completely ignored or not given a second glance, while others draw people in and efficiently convey a message to the engaged reader.2 While people are able to form an opinion of infographic content in a split second, the process of successful infographic design can be much more time-consuming. Knowledge, good ingredients and an oven are helpful in making a delicious cake to suit consumer taste. There is an increasing appetite for infographics. We describe some theory and key ingredients, and discuss infographic computer programs that can help you produce outstanding infographics, and consider how to help effectively share infographics (figure 1). Sufficient knowledge of the topic area is as important as artistic skill. Thus, as health professionals and scientists we can be encouraged …

Physical inactivity may well be THE fundamental public health challenge of our age. Despite compelling evidence on the health benefits of physical activity (PA),1 the combination of increasing mechanisation, digitisation, motorisation and urbanisation continues to inexorably squeeze essential PA out of our daily lives. There is a new global target for all countries to reduce inactivity by 10% …

Golf is a hugely popular sport played across the world by people of all ages and abilities and offers a large number of physical and mental health benefits and social opportunities. The elite amateur and professional game has seen a huge rise in recent …

Infographics is an abbreviated term for an information graphic. Information is presented in a logical manner, similar to storytelling, using data visualisations, text and pictures.1 Statistically, the most successful infographics, in terms of number of ‘shares’ on social media, contain an average of 396 words2 and a combination of data visualisations (bar graphs, line graphs and pie charts) and illustrations. Although 396 words may seem like an inadequate amount of text for researchers to convey their findings comprehensively, when considering this in the infographics context, the saying, ‘a picture tells a thousand words’, comes to mind. Three days after learning new information, we are likely to remember up to 6.5 times more through learning from an infographic than by reading text alone.1 Many industries, such as the business, food, …

2016 Sees the reintroduction of golf as an Olympic sport with 60 men and 60 women competing for gold. Although few of the 55 million people1 who play golf in over 200 countries on around 32 000 courses worldwide will ever hit these heights, they are subject to many of the relationships and effects that this sport has on longevity, physical health and mental health. A major new project supported by the World Golf Foundation will assess some of the issues that may be associated with playing, for example, musculoskeletal injuries and skin cancers, and the public health benefits of golf for those playing at any level. In particular, cardiovascular, respiratory, metabolic, musculoskeletal, accident-related, mental health and wellness effects as well as more accurately characterising golf's role as a physical activity, and the effects of utilising golf buggies versus walking the course, are priorities for study. Early information indicates that golf …

In Scotland we aim to increase life expectancy by 5 years in the next 10 years and decrease health inequalities. These ambitions are bold. If life expectancy trends continue, Scotland will fall further behind the rest of Western Europe. Although premature mortality continues to fall, the trajectory of our improvement is currently more modest than that being achieved by other countries. And despite all efforts, health inequalities continue to grow. The gap between the rich and the poor is widening, with the richest 20% now living 10 years longer than the poorest 20% in Scotland. Albert Einstein defined insanity as ‘doing the same thing over and over again and expecting a different result.’ The excess mortality in Scotland requires something new to be done. It may partly stem from the social breakdown and loss of jobs when heavy industry (dominated by shipbuilding, coal mining and steel) declined, particularly in West Central Scotland in the latter half of the 20th century. Those affected were given housing and benefit, and remained predominantly in the region. Although the collapse of heavy industry happened in other countries in Europe, for example, Katowice in Poland, alternative suitable work was found and the sense of control, and community that goes with purpose and employment was preserved. The net result is that Scotland's excess mortality when compared with the rest of Europe can be partly attributed to causes such as violence, drug misuse, alcohol excess and suicide. Interestingly, similar patterns of excess mortality have been noticed in other population groups …

The technological, economical and labour trends that practically eliminated the need for daily physical activity in much of the developed and increasingly in the developing world occurred far too rapidly for human physiology to efficiently adapt. The result is the escalating epidemic of chronic diseases that are contributed to or amplified by physical inactivity. Re-engineering the world to help us prioritise physical activity presents many challenges. There is no single solution or ‘silver bullet’. Understanding a complex problem like physical inactivity requires interdisciplinary thinking and appreciation of both the local and global context. What is clear is that tackling physical inactivity requires a multisectoral response that goes well beyond the traditional healthcare settings and involves, for example, government entities, non-governmental organisations, and private industry. Launched in 2012, the Investments that Work for Physical Activity initiative,1 builds on the 2010 Toronto Charter for Physical Activity …

Background The Genghis Khan Ice Marathon took place in January 2016 in the mountains of the Terelj National Park, Mongolia in a temperature of minus 35 0C. Objective To assess the experience, preparation, race strategy and effect of exercise in a group of ultrarunners undertaking a marathon in extreme cold. Design Prospective observational study. Setting Extreme environment. Participants Multinational group of experienced ultrarunners (n=9, male 5, female 4, age range 25–53 years). Interventions Pre and post race questionnaires. Post-race email surveillance. Main Outcome Measurements Experience, preparation, clothing, equipment, nutritional strategies for race. Adverse effects encountered when competing in the marathon. Perceived effort of race on the Borg Scale. Two weeks post race illness or injury surveillance. Results All nine ultrarunners completed the questionnaires and follow up. Concerns about safety in a remote environment were universal. Consensus was present regarding clothing, equipment, hydration and nutrition. The race was completed in 3:05–5:50. No significant difficulties were encountered. The cold air caused freezing around the nostrils and irritated the airways. No-one experienced cold induced bronchospasm. Clothing froze due to sweat and expired air. There were no cases of hypothermia. There were two cases of frostbite; earlobe (moderate) and nose (mild). Borg scale of perceived exertion values ranged from 13–17 (mean 15). Two week follow up; two cases of viral URTI9s reported. No athlete reported DOMS in the post race period. Conclusions All athletes were experienced in ultrarunning. They shared concerns regarding competing in a remote, extreme cold environment. All were adequately prepared pre race in terms of clothing, equipment and race nutrition strategy. This level of experience contributed to the lack of complications during the race and in the post race period. No athletes experienced DOMS presumably related to lack of peripheral muscular perfusion during exercise in extreme cold.

In little more than a decade, concussion has become one of the biggest issues taxing modern sport. Incidents of apparently concussed athletes in football's World Cup and in recent Six Nations’ rugby matches have generated unparalleled column inches in the press, comment on social media and challenging review articles;1 the clear suggestion is that something is wrong in sport, and young brains are at risk. With the Rugby World Cup under way, yet more scrutiny of further high profile incidents is inevitable. In the USA, heightened anxiety over sports concussion has caused participation levels to fall. Similar reactions are likely to follow in other countries. Is this reaction justified? What is the risk of losing the proven benefits of participation in sport compared with the risks of sports concussion? Concussions are common in contact sports. Data in rugby union suggest approximately one player per match at community level will sustain a head injury requiring medical attention,2 with around one concussion in every 2.5 matches at the elite level.3 Symptoms vary, and may include headache, visual disturbance …

A series of letters have argued for alternatives to acute:chronic workloads or the methods by which the ratio is calculated when predicting injury risks. Based on the hypothetical data presented by Menaspa,1 Williams et al ,2 argue that an exponentially weighted moving average (EMWA) to emphasise the importance of workloads towards the end of the calculation cycle may be more appropriate. A case is presented in one example (athlete 3) where EWMA calculates a greater injury risk than rolling averages …

Background The Genghis Khan Ice Marathon took place in January 2016 in the mountains of the Terelj National Park, Mongolia at an altitude of 1800 metre. The route was a 26 mile marathon following the route of the frozen Tul Goll River. Conditions on race day were dry, sunny, light wind, with an air temperature of minus 35°C. Aim To assess the effect of competing in a marathon in an extreme cold environment in a group of experienced ultrarunners. Method A multinational group of experienced ultrarunners (n = 9, male 5, female 4, age range 25-53 years) completed a post race questionnaire detailing any adverse effects encountered when competing in the marathon. All athletes also rated the perceived effort of the race on the Borg Scale. Two weeks after the event all runners were contacted via email to determine if any illness or injury had occurred in the post race period. Results The race was completed in 3:05 – 5:50. One person did not finish the race due to a navigational error. All athletes completed the post race questionnaire and the two week follow up email survey. No significant difficulties were encountered during the race. The cold air caused freezing around the nostrils and irritated the airways but no one experienced any cold induced bronchopasm. Clothing froze due to sweat and expired air but there were no cases of hypothermia. There were two cases of frostbite; earlobe (moderate) and nose (mild). Borg scale of perceived exertion values ranged from 13 – 17 (mean 15). On two week follow up all athletes had been well with only two cases of viral URTI’s reported. No athlete reported any DOMS in the immediate post race period. Conclusion All the athletes were very experienced in ultrarunning having competed in mountain, desert or cold environments. This experience level possibly contributed to the lack of complications during the race and in the post race period. No athletes experienced any DOMS in the post race period which is unusual for this distance and presumably related to lack of peripheral muscular perfusion during exercise in extreme cold.

Background The Genghis Khan Ice Marathon took place in January 2016 in the mountains of the Terelj National Park, Mongolia at an altitude of 1800 metre. The route was a 26 mile marathon following the route of the frozen Tul Goll River. Conditions on race day were dry, sunny, light wind, with an air temperature of minus 35°C. Aim To assess the experience, preparation and race strategy of a group of ultra-runners undertaking a marathon in extreme cold. Method A multinational group of experienced ultra-runners (n = 9, male 5, female 4, age range 25–53 years) completed a pre-race questionnaire detailing experience, preparation, clothing, equipment and nutritional strategies. They were also given the opportunity to raise any fears or concerns about competing in an extreme cold environment. Results All nine ultra-runners completed the questionnaire. The group was very experienced in running/ultra-running with most have completed other arduous events in mountain or desert environments. Three had competed previously at the North or South Pole. All athletes were concerned about safety in a remote environment, the physical effects of prolonged cold exposure and the ability to maintain adequate hydration and nutrition. With some individual variation in styles, consensus was present regarding several layers of clothing (upper and lower), full face cover, double gloving for hands and trainers a size to big (to allow for extra socks) with spikes or overlying chain links attached. Water would be provided by aid stations that would not be frozen to allow for adequate hydration. Most athletes opted for energy gels for nutrition stored inside their insulated gloves to prevent freezing. Conclusion Despite a high level of experience all ultra-runners shared similar concerns regarding competing in a remote, extreme cold environment. With slight individual variations this experience level led to all the ultra-runners being adequately prepared pre-race in terms of clothing, equipment and race nutrition strategy.

Physical activity (PA) promotes good health, and the challenge of physical inactivity is a major global issue.1 PA levels in the UK remain low, with many not achieving the Chief Medical Officer's recommendation of at least 150 min per week of moderate-intensity PA.2 With limited funds and increasing rates of non-communicable disease, the NHS is prioritising more cost-effective preventive approaches.3 PA is preventive and cost-effective. Doctors have an important role in PA promotion as they provide a point of contact for individuals who are healthy, at risk or have diagnosed chronic illnesses. Doctors are also trusted sources of health information.4 ,5 Therefore, training of medical professionals is key to strategies for increasing PA levels.5 ,6 Tomorrow's doctors should be adequately trained to discuss, advise and engage in the topic of PA. PA promotion and prescription should be a fundamental element for all medical school curricula. Despite this, in 2015, many medical schools including the University of Edinburgh (UoE) Medical School had no PA content on the …

MacAuley and colleagues rightly state that it’s “extraordinary how long mainstream medicine is taking to accept the importance of physical activity.”1 If we are serious about providing the best care for every patient every time, something that is proved to increase happiness, prevent and treat more than 40 chronic diseases, and significantly increase life expectancy should be a key weapon.2 Collaboration …

Introduction Hyponatraemia is common in end stage heart failure (ESHF). It is associated with poorer outcomes and limits the use of increasing doses of loop diuretics to alleviate congestive symptoms. Inability to reduce symptoms from hospitalised patients with ESHF can be the difference between patients dying in hospital or being discharged into the community. Tolvaptan is a vasopressin antagonist with diuretic effect with minimal effect on sodium levels. We present our current clinical experience with tolvaptan in palliative care patients with ESHF, hyponatraemia and congestive symptoms. Method Hyponatraemic patients with ESHF and intractable symptoms (either unresponsive to or conventionally unsuitable for further escalation of loop diuretic therapy) were considered for tolvaptan by their managing cardiologist. Seven patients were selected, 1 died on the day tolvaptan was started, notes were unavailable in 1 case. Results We report on 5 patients – 4 had tolvaptan started in hospital. Demographics: 4 male, mean age 71.8 years, mean number of co-morbidities was 5.6. Mean duration of treatment was 9.6 days. There were no adverse events or side effects. Loop diuretic doses were continued unchanged in 4 and increased in 1. Sodium Creatinine Weight in mmol/l in μmol/l in kg Before tolvaptan mean (SD) 122(4) 108(57) 81.1 (13.6) After tolvaptan mean (SD) 128 (4) 103 (48) 77.6 (12.4) All hospitalised patients were subsequently discharged. One patient died 3 months after treatment. The total cost of tolvaptan was £4300.80. This appears marginal compared to the total cost of hospitalisation (cumulative in patient stay of 169 days). Conclusion Tolvaptan is safe, well tolerated and reduces congestion without significantly worsening either hyponatraemia or (in our patients) renal function. It can aid discharge from hospital to facilitate patient9s palliative care choices. Tolvaptan adds to strategies for symptom relief in ESHF by palliative care specialists and cardiologists alike.

ObjectivesThe aim of this study was to assess whether a risk assessment and managed risk approach to contact tracing was practical and feasible at the Gran Canaria Lopesan Open 2021 and could inform further pilot work regarding disease transmission during elite sporting events.MethodsThis prospective cohort study included all international attendees. All participants required a minimum of one negative reverse transcriptase PCR (RT-PCR) test prior to travelling to each tournament. High-risk contacts were isolated for 10 days. Moderate-risk contacts received education regarding enhanced medical surveillance, had daily rapid antigen testing for 5 days, with RT-PCR day 5, mandated mask use and access to outside space for work purposes only. Low-risk contacts received rapid antigen testing every 48 hours and PCR testing on day 5.ResultsA total of 550 persons were accredited and were required to undergo RT-PCR testing before the event. Two of these tests were positive (0.36%). Of these, case 1 had 1 high, 23 moderate and 48 low-risk contacts. Case 2 did not have any significant travel history within 2 days of positive test and had one high-risk contact. There were no further positive tests on site in the wider cohort of attendees, from a total of 872 RT-PCR and 198 rapid antigen tests.ConclusionsThis pilot study showed it is practical, feasible and well accepted to provide enhanced (daily) virus testing and risk-mitigating measures at a professional golf event. Further study is required to assess the efficacy of these interventions; however, no transmission was found in this pilot study.