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Enabling athletes to achieve peak performances while also maintaining high levels of health is contextually complex. We aim to describe what a health system is and apply the essential functions of stewardship, financing, provision of services and resource generation to an Australian high-performance sport context. We introduce a fifth function that health systems should not detract from athletes ability to achieve their sports goals. We describe how these functions aim to achieve four overall outcomes of safeguarding the health of the athletes, responding to expectations, providing financial and social protection against the costs of ill health, and efficient use of resources. Lastly, we conclude with key challenges and potential solutions for developing an integrated health system within the overall performance system in high-performance sport.

In applied program settings, such as in natural environment control and education, performance evaluation is usually conducted by evaluators considering both self-comparison and comparison with peers. We have developed the performance outcome scoring template (POS-T) for assessments with high face-validity in these settings. POS-T puts achievements of individuals or groups in context, i.e. the resulting performance outcome score (POS) reflects a meaningful measure of performance magnitude with regards to internal and external comparisons. Development of a POS is performed in four steps supported by a statistical framework. Software is supplied for creation of scoring applications in different performance evaluation settings. We demonstrate the POS-T by evaluation of CO2 emissions reduction amongst 36 OECD member countries., Funding Agencies|Linkoping University

BACKGROUND: Injuries are common in rugby sevens, but studies to date have been limited to short, noncontinuous periods and reporting of match injuries only. PURPOSE: To report the injury incidence rate (IIR), severity, and burden of injuries sustained by men and women in the Australian rugby sevens program and to provide the first longitudinal investigation of subsequent injury occurrence in rugby sevens looking beyond tournament injuries only. STUDY DESIGN: Descriptive epidemiology study. METHODS: Ninety international rugby sevens players (55 men and 35 women) were prospectively followed over 2 consecutive seasons (2015-2016 and 2016-2017). All medical attention injuries were reported irrespective of time loss. Individual exposure in terms of minutes, distance, and high-speed distance was captured for each player for matches and on-field training, with the use of global positioning system devices. The IIR and injury burden (IIR × days lost to injury) were calculated per 1000 player-hours, and descriptive analyses were performed. RESULTS: Seventy-three players (81.1%) sustained 365 injuries at an IIR of 43.2 per 1000 player-hours (95% CI, 43.0-43.3). As compared with male players, female players experienced a lower IIR (incidence rate ratio, 0.91; 95% CI, 0.90-0.91). Female players also sustained a higher proportion of injuries to the trunk region (relative risk, 1.75; 95% CI, 1.28-2.40) but a lower number to the head/neck region (relative risk, 0.58; 95% CI, 0.37-0.93; P = .011). The majority (80.7%) of subsequent injuries were of a different site and nature than previous injuries. A trend toward a reduced number of days, participation time, distance, and high-speed distance completed before the next injury was observed after successive injury occurrence. CONCLUSION: Female players have a lower IIR than male players, with variation of injury profiles observed between sexes. With a surveillance period of 2 years, subsequent injuries account for the majority of injur

Objectives Illness can disrupt training and competition performance of athletes. Few studies have quantified the relative contribution of the known medical, behavioural and lifestyle risk factors. Design Cross-sectional. Methods Olympic athletes from 11 sports (n = 221) were invited to complete questionnaires administered nine months before the Rio 2016 Olympic Games. These included the Depression, Anxiety and Stress Questionnaire (DASS-21), Perceived Stress Scale (PSS), Dispositional Resilience Scale (DRS), Recovery-Stress Questionnaire (REST-Q-52 item), Low Energy in Females Questionnaire (LEAF-Q), a modified Personal and Household Hygiene questionnaire, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and custom-made questionnaires on probiotic usage and travel. An illness (case) was defined as an event which limited training or competition for greater hours in the prior month. Odds ratios and attributable fractions in the population (AFP) were utilised for categorical variables with independent t-tests or Wilcoxon rank-sum for continuous variables. Results Eighty-one athletes responded (male, n = 26; female, n = 55). There were 16 illness cases and 65 controls. Female athletes were at higher odds of illness (OR = 9.4, 95%CI 1.3–410, p = 0.01, AFP = 0.84). Low energy availability (LEAF-Q score ≥8: OR = 7.4, 95%CI 0.78–352, p = 0.04, AFP = 0.76), depression symptoms (DASS-21: depression score >4, OR = 8.4, 95%CI 1.1–59, p < 0.01; AFP = 0.39) and higher perceived stress (PSS: 10-item, p = 0.04) were significantly associated with illness. Conclusions Female sex, low energy availability, and mental health are associated with sports incapacity (time loss) due to illness. Low energy availability had high attributable fractions in the population and stands out as a primary association with illness.

Horgan, B. G., Drew, M. K., Halson, S. L., Piromalli, L. E., Drinkwater, E. J., Chapman, D. W., & Haff, G. G. (2021). Impaired recovery is associated with increased injury and illness: A retrospective study of 536 female netball athletes. Scandinavian Journal of Medicine & Science in Sports, 31(3), 691-701. https://doi.org/10.1111/sms.13866

Toohey, L. A., Drew, M. K., Fortington, L. V., Menaspa, M. J., Finch, C. F., & Cook, J. L. (2019). Comparison of subsequent injury categorisation (SIC) models and their application in a sporting population. Injury Epidemiology, 6(1), Article 9. Available here

This is an Author's Accepted Manuscript of: Toohey, L. A., Drew, M. K., Finch, C. F., Cook, J. L., & Fortington, L. V. (2019). A 2-year prospective study of injury epidemiology in elite Australian rugby sevens: Exploration of incidence rates, severity, injury type, and subsequent injury in men and women. The American Journal of Sports Medicine, 47(6), 1302-1311. Available here

Toohey, L. A., Drew, M. K., Bullock, N., Caling, B., Fortington, L. V., Finch, C. F., & Cook, J. L. (2019). Epidemiology of elite sprint kayak injuries: A 3-year prospective study. Journal of Science and Medicine in Sport. Available here