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JA Humphrey,1 PP Humphrey,2 AS Greenwood,3 JL Anderson,4 HS Markus,5 A Ajuied61Orthopaedic Department, Milton Keynes University Hospital, Milton Keynes, MK65LD, UK; 2School of Pharmacy, University College London, London, WC1N 1AX, UK; 3Department of Sport and Exercise Sciences, St Mary’s University, Twickenham, TW1 4SX, UK; 4Medical Education Department, University of Brighton, Brighton, BN1 9PH, UK; 5Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 2PY, UK; 6Orthopaedic Department, Guys’ and St Thomas’ NHS Trust, London SE1 9RT, UKIntroduction: Real tennis is a growing, unique, and well-established sport. To date, there has been no epidemiological data on real tennis injuries. The primary aim of this retrospective study is to record the incidence and document any trends in real tennis musculoskeletal injuries, so as to improve injury awareness of common and possibly preventable injuries.Methods: A surveillance questionnaire e-mailed to 2,036 Tennis & Rackets Association members to retrospectively capture injuries sustained by amateur and professional real tennis players over their playing careers.Results: A total of 485 (438 males and 47 females) questionnaires were fully completed over 4 weeks. A total of 662 musculoskeletal injuries were recorded with a mean of 1.4 injuries per player (range 0–7). The incidence of sustaining an acute real tennis musculoskeletal injury is 0.4/1000 hrs. The three main anatomical locations reported injured were elbow 15.6% (103/662), knee 11.6% (77/662), and face 10.0% (66/662). The most common structures reported injured were muscle 24% (161/661), tendon 23.4% (155/661), ligament 7.0% (46/661), soft tissue bruising 6.5% (43/661), and eye 6.2% (41/661). The majority of the upper limb injuries were gradual onset (64.7%, 143/221), and the lower limb injuries were sudden onset (72.0%, 188/261).Conclusion: This study uniquely provides valuable preliminary data o

Oscar García-García, Alba Cuba-Dorado, Tania Álvarez-Yates, Javier Carballo-López, Mario Iglesias-CaamañoLaboratory of Sports Performance, Physical Condition and Wellness, Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, SpainAbstract: An exhaustive review has been made to filter the studies that have analyzed muscle function though tensiomyography (TMG) with elite or well-trained athletes. The results of this review indicate that the several protocols used in athletes to find the displacement-time curve with greater maximum radial muscle displacement showed a good-excellent reliability. TMG has been used to characterize athletes’ muscles contractile properties from specific sports disciplines, although there are very few sports that have been deeply analyzed. TMG seems to be useful to determine changes in muscles contractile properties after stimuli of competition, training or recovery. These changes have been strongly related with the fatigue produced after an effort. In addition, TMG parameters could be used to control training effects during a specific period or throughout the season being also a very useful tool to individualize athletes training loads. In this sense, it also seems to provide sports performance information in cyclic sports by relating some TMG parameters with performance indicators. On the other hand, the TMG-BCM algorithm has been used as a lateral and functional symmetry measure and as a monitoring tool for injury prevention and recovery. However, it seems to be no clear criterion that determines asymmetry degree, nor established contractile properties values as a reference to prevent or recover sports injuries. Despite the utility shown in these fields, there are still very few sports analyzed and it is really necessary to continue advancing in the knowledge of the contractile properties behavior, such as the effects of athletes’ training, comp

Rafael A Buerba, Nickolas F Fretes, Sai K Devana, Jennifer J BeckDepartment of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USAAbstract: Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations. Lower-extremity CECS is most often observed in running athletes and marching military members. Upper-extremity CECS is most commonly seen in rowers and professional motorcyclists. Although early outcome research on CECS has been based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females. Evaluation of CECS must include a thorough history and physical exam to rule out other causes of exertional leg pain, but differential diagnosis must remain high on the list. Needle manometry can be used to confirm diagnosis of CECS by measuring intracompartmental pressure. Operative treatment of CECS with fasciotomy has been shown to be effective in resolution of CECS, and new surgical techniques are being developed. In the pediatric population, endoscopy-assisted compartment release has provided high success rates with low complication rates. Nonoperative management of CECS is more commonly described in the literature, and consists of cessation of activities, altering foot-strike pattern, physical therapy, taping, and injections of botulinum toxin A. Nonetheless, larger samples and a more diverse population are needed to better understand the outcomes of nonoperative management. There have been fewer studies on upper-extremity CECS, given its rarity. Success has been found in the treatment of upper-extremity CECS with open fasciotomy, but more studies are needed to understand the efficacy of minimally invasive techniques in the upper extremity. Further research also needs to be done to understand why a large portion (approximately 20%) of the patient population

Chandu Sadasivan, Andrew Cave Department of Family Medicine, University of Alberta, Edmonton, AB, Canada Purpose: Asthma is the most common chronic disease among children. Exercise-induced bronchoconstriction which is common in asthmatic patients also occurs in individuals with no prior asthma diagnosis. Despite this and the fact that soccer is a high ventilation sport, there are no validated asthma management protocols in place for soccer coaches. This study aims to address 1) soccer coaches’ current knowledge on asthma, 2) whether there is a need for asthma-related training, and 3) any barriers to administration of such training.Patients and methods: A total of 2,300 volunteer youth soccer coaches from the Edmonton Minor Soccer Association (EMSA) were invited to participate in completing a 22-question online survey. The survey was open for 1 month from June 8, 2018, to July 8, 2018.Results: There was a response rate of 22% (513 of 2,300). Respondents were on average, inexperienced coaches, coached younger age groups, and approximately one-third of respondents had personal experience with asthma (either themselves or their child had asthma). 93% of respondents had not received any asthma-related training at any coaching level, whether it be from EMSA or the Alberta Soccer Association. Coaches had strong knowledge on how to treat asthma attacks, but mixed levels of knowledge on asthma attack prevention. Experienced coaches were better at identifying the number of players with asthma on their team and the number of asthma-related incidents they had encountered as coaches. Coaches demonstrated a receptive attitude toward receiving asthma-related training, with 91% of respondents saying training would be beneficial and 69% of respondents saying training should be mandatory.Conclusion: The results of this study indicate that soccer coaches have limited knowledge regarding asthma management, acknowledge a need for asthma-related training, and are willi

Amanda L Hannan,1 Wayne Hing,1 Mike Climstein,2 Jeff S Coombes,3 James Furness,1 Rohan Jayasinghe,4–6 Joshua Byrnes7 1Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia; 2Exercise Health and Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia; 3School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia; 4Cardiology Department, Gold Coast University Hospital, Gold Coast, QLD, Australia; 5Griffith University, Gold Coast, QLD, Australia; 6Macquarie University, Sydney, NSW, Australia; 7Centre for Applied Health Economics, School of Medicine, Griffith University, Logan, QLD, Australia Purpose: This study explored current demographics, characteristics, costs, evaluation methods, and outcome measures used in Australian cardiac rehabilitation (CR) programs. It also determined the actual usage and perceptions of high-intensity interval training (HIIT).Methods: A cross-sectional observational web-based survey was distributed to 328 Australian CR programs nationally.Results: A total of 261 programs completed the survey (79.6% response rate). Most Australian CR programs were located in a hospital setting (76%), offered exercise sessions once a week (52%) for 6–8 weeks (49%) at moderate intensity (54%) for 46–60 min (62%), and serviced 101–500 clients per annum (38%). HIIT was reported in only 1% of programs, and 27% of respondents believed that it was safe while 42% of respondents were unsure. Lack of staff (25%), monitoring resources (20%), and staff knowledge (18%) were the most commonly reported barriers to the implementation of HIIT. Overall, Australian CR coordinators are unsure of the cost of exercise sessions.Conclusion: There is variability in CR delivery across Australia. Only half of programs reassess outcome measures postintervention, and cost of exercise sessions is

Alberto Migliore,1 Silvana Giannini,2 Emanuele Bizzi,1 Umberto Massafra,1 Maurizio Cassol,3 Martin Jose Michael Abilius,1 Giovanni Boni4 1Operative Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, Rome 00189, Italy; 2Department of Radiology, Villa Stuart Sport Clinic, Rome 00136, Italy; 3Department of Internal Medicine, San Pietro Fatebenefratelli Hospital, Rome 00189, Italy; 4ANTIAGE Sportive Medicine Ambulatory Department (Ambulatorio di Medicina dello Sport Antiage), Foligno, Italy Objective: The aim of this study is to investigate the effect of intra-articular hyaluronic acid administration in active football players complaining of knee pain after sports activity. Efficacy and safety profiles of intra-articular hyaluronic acid and time needed for football players to recover and restart sports activity were examined.Methods: Clinical data of active football players reporting knee pain after sports activity were included in this retrospective study. All patients who received an intra-articular injection at time 0 and after 2 weeks were included in the study. Patients underwent laboratory examination, knee X-ray, ultrasound, and clinical examination before receiving the intra-articular injection. Effusions or cysts were drained before injections. Lequesne index score, pain visual analog scale (VAS) score, and patient’s global assessment score were recorded at time 0 (day of the first injection), 1 and 2 days after the first injection, at 2 weeks (day of the second injection), and at follow-up visits. Only data from patients completing the follow-up were analyzed.Results: Data from 17 patients were analyzed: 16 males and one female, of which three were professional players (two males and one female) and 14 were nonprofessional players. The mean age of patients was 39.8±11.8 years. Two patients (one male and one female) showed joint effusion. Two patients reported relevant joint pain after injection that regressed without any medicatio

Fuminori Takayama,1,2 Atsushi Aoyagi,3 Keigo Takahashi,2,3 Yoshiharu Nabekura1 1Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba-shi, Ibaraki, Japan; 2Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan; 3Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba-shi, Ibaraki, Japan Purpose: Individual variations in response of C-reactive protein (CRP) to acute strenuous exercise are less well known. The purpose of this study was to investigate the relationship between running economy and systemic inflammation following a marathon. Materials and methods: Sixteen college recreational runners participated in this study. To measure maximal oxygen uptake and running economy, the treadmill running test was performed 1–2 weeks before the marathon race. Running economy was defined as oxygen cost (mL/kg/km) at submaximal running. CRP and muscle damage markers (creatine kinase and lactate dehydrogenase) were measured before and 1, 2, and 3 days after the race. Results: All subjects completed the race in 4 hours 7 minutes 43 seconds±44 minute 29 seconds [mean±SD]. The marathon running significantly increased CRP and muscle damage markers. The levels of inflammation and muscle damage peaked after 1 day and remained high throughout the 3-day recovery period compared to that before the race. Spearman correlation analysis showed that the change in CRP level was significantly positively correlated with oxygen cost (r=0.619, P=0.011) but not maximal oxygen uptake. There was no significant relationship in responses between muscle damage markers and CRP. Conclusion: These findings suggest that running economy is related to postmarathon race CRP response. Further study to clarify the cause of the relationship and clinical significance of transient increase in CRP is necessary. Keywords: inflammation, oxygen consumption, C-reactive protein, muscle damage

Kathryn Helmig, Gehron Treme, Dustin Richter Department of Orthopaedic Surgery, University of New Mexico, Albuquerque, NM, USA Abstract: Snowboarding has seen a continuous increase in popularity, leading to an increase in the number of snowboarding injuries seen in orthopedic practice. Upper-extremity injuries are more common than lower-extremity, spine, and pelvis injuries. In this review, we focus on the most common snowboarding injuries of the extremities, spine, and pelvis and provide an overview of their respective rehabilitation and return-to-sport protocols. Despite many of the injuries seen in snowboarding also occurring in other sports, objective data about rehabilitation and return to sport are lacking for many injuries. This provides an opportunity for research in the area with regard to many sports and many different injuries. Keywords: snow sports, return to sport, physical therapy, rehab, wrist injuries, lower extremity, spine, pelvis

Wilson C Lai,1 Brandon J Erickson,2 Ryan A Mlynarek,3 Dean Wang4 1David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 2Rothman Institute, New York, NY, USA; 3IHA Orthopaedic Specialists, Ann Arbor, MI, USA; 4Department of Orthopaedic Surgery, UC Irvine Health, Orange, CA, USA Abstract: Lateral epicondylitis (LE) is a significant source of pain and dysfunction resulting from repetitive gripping or wrist extension, radial deviation, and/or forearm supination. Although most cases are self-limiting over several years, controversy exists regarding the best treatment strategy for chronic LE. Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), shockwave therapy, and injections with corticosteroids or biologics are all conservative treatment options for LE. For refractory cases, surgical options include open, arthroscopic, and percutaneous techniques. In this review, the current evidence behind these treatment strategies is presented. The data demonstrate that NSAIDs, PT, bracing, and shockwave therapy provide limited benefit for treating LE. Biologics such as platelet-rich plasma and autologous whole-blood injections may be superior to steroid injections in the long-term management of LE. Although the initial results are promising, larger comparative studies on stem cell injections are needed. For refractory LE, open, arthroscopic, and percutaneous techniques are all highly effective, with no method seemingly superior over another. Arthroscopic and percutaneous approaches may result in faster recovery and earlier return to work. Keywords: lateral epicondylitis, tennis elbow, shockwave, injection, biologics, platelet-rich plasma, stem cells, surgery

Ian K Lo,1 Matthew R Denkers,2 Kristie D More,1 Atiba A Nelson,1 Gail M Thornton,1 Richard S Boorman1 1Department of Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; 2Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada Purpose: The purpose of this study was to determine the clinical success rate of nonoperative treatment of partial-thickness rotator cuff tears (PT-RCTs), to determine baseline clinical factors predictive of outcome of nonoperative treatment of PT-RCTs, and to determine the imaging outcome of nonoperative treatment of PT-RCTs. Patients and methods: All patients with a primary diagnosis of a PT-RCT were eligible for inclusion. Seventy-six patients (48 males, 28 females) with an average age of 52±10 years were included in the study. Patients were evaluated using a standardized format including clinical, imaging, and shoulder specific quality-of-life outcomes. Patients were assessed and treated either successfully nonoperatively or consented to undergo surgical intervention of their PT-RCT. Patients treated nonoperatively underwent follow-up by MRI arthrogram. Results: Thirty-seven patients (49%) underwent nonoperative treatment. Logistic regression analysis indicated that the baseline variables of side (dominant or nondominant side involved), onset (traumatic or atraumatic), and thickness of tendon tear (<50% or >50%) were significant predictors of outcome. At a mean 46±7 months of follow-up, nonoperatively treated patients demonstrated a mean American Shoulder and Elbow Surgeons score of 85.1±16.0, and a Simple Shoulder Test score of 10.0±2.5. Overall, 76% of tears treated nonoperatively did not show a tear progression on anatomic imaging. Nine patients (24%) demonstrated tear progression, of which three patients (8%) demonstrated full-thickness tearing. Conclusion: Nonoperative treatment was utilized in ~50% of the patients

Guy W Nicolette, Jocelyn R Gravlee University of Florida, Gainesville, FL, USA Introduction: Elbow ulnar collateral ligament (UCL) injuries in gymnastics have not been well documented in the literature, in comparison to UCL injuries in baseball. Few studies have examined the mechanism and nonoperative management of this injury, and no studies to date have been published on incidence of injury and return to play recommendations in gymnastics. Patient case review: A literature search was performed using PubMed to review articles from 1980 to 2016 that addressed the biomechanics of UCL injury in baseball and gymnastics, the anatomy of the elbow, injury rates, surgical vs non-surgical management, rehabilitation, and return to play recommendations for the sport of gymnastics. Five female collegiate gymnasts sustained UCL injury over a 3-year period. Electronic medical records for each case were thoroughly reviewed including imaging, surgical and non-surgical management, rehabilitation, and the progressive return to gymnastics. Discussion: Four UCL injuries were confirmed by MRI to be avulsions at the distal insertion of the UCL and one was an avulsion at the proximal origin. While less than half of baseball players can return to competition with conservative management of these types of injuries, four out of five gymnasts were able to return to competition with nonoperative management. One gymnast opted to have reconstruction after a successful competition season. Time to return to play varied seemingly dependent on the severity of UCL injury and event. Conclusion: In our case series, collegiate female gymnasts were able to return to participation with nonoperative treatment of the UCL. Their success in returning to competitive gymnastics may also depend on the event(s) in which they are trying to participate. Strength of Recommendation Taxonomy: C. Keywords: elbow ulnar collateral ligament, gymnastics, gymnast

Lianne Bissell,1,2 Peter Lorentzos1,2 1School of Medicine, University of Dundee, Dundee, UK; 2Department of Orthopaedics, Westmead Hospital, Sydney, NSW, Australia Purpose: The aim of this study was to investigate the prevalence of overuse injuries in non-elite netballers and whether these increase over a typical competitive season and to establish if player age, experience, training, and use of bracing are related to overuse injuries.Patients and methods: A prospective study was conducted over a 12-week period, using a recently developed questionnaire. Data were collected on overuse injuries in the knee, ankle, and shoulder areas every week.Results: Thirty-seven players responded to the questionnaire, with an average response rate of 65%. The total prevalence of overuse injuries identified was 52.7%, with ankle problems accounting for 26% (75 cases), knee problems accounting for 21.2% (61 cases), and shoulder problems accounting for 5.5% (16 cases). Ankle injuries increased over the study period, while knee and shoulder problems decreased. Injuries were more common in players over 36 years old or those with less than 5 years of playing experience. Players who used a brace were more likely to have an overuse complaint. Training volume was not associated with increased risk.Conclusion: Overuse injuries are common in netballers, particularly of the knee and ankle. Shoulder overuse complaints are higher than previously reported. Risk factors for injury include older age and less playing experience, and these should be considered when planning injury prevention programs for this sport. Keywords: sports, injury, risk, prevention&nbsp

Ehab Abdelbaki Hussin,1 Asim Aldaheri,1 Hatem Alharbi,1 Hazem A Farouk2 1Orthopedics Department, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia; 2Orthopedics Department, Faculty of Medicine, Cairo University, Cairo, Egypt Purpose: This study compared the accessory anteromedial portal (AAMP) and the modified transtibial technique (MTTT)” for single-bundle anterior cruciate ligament (ACL) reconstruction. Patients and methods: Sixty active adult patients with ACL tear were randomly assigned into two equal groups who were treated surgically. One group was operated on using AAMP and the other group through MTTT. Both the groups had the same postoperative course and were followed for 1 year after surgery. The follow-up included Lysholm and International Knee Documentation Committee (IKDC) subjective knee evaluation forms, IKDC objective knee examination form, and radiological evaluation. Results were evaluated and compared with each other. Results: There was no significant difference in subjective effects or clinical examination between the two groups. Regarding radiological angles, the AAMP had more oblique graft orientation in the coronal plane than the MTTT, but both were found to be more slanted than native ACL. Also, the MTTT had succeeded to place the graft and tunnel more obliquity than the traditional non-anatomic TTT and better than the anatomic ranges despite having the graft inclination of the AAMP higher than the MTTT. The complaints from the patients and subjective scoring were found to be positively related to graft stability. Patients with healthier preoperative subjective state had a smoother postoperative period and better outcome. Conclusion: This study offers simple modifications to the transtibial technique to allow near anatomic ACL reconstruction with similar results comparable to the AAMP and with fewer complications. Keywords: anterior cruciate ligament, MTTT, AAMP, arthroscopy, orthopedics, ACL, Modified transtibial, anatomic, Art

Vani J Sabesan,1 Beau Prey,2 Ryan Smith,3 Daniel J Lombardo,3 Wilfredo J Borroto,4 James D Whaley5 1Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA; 2Western Michigan University School of Medicine, Kalamazoo, MI, USA; 3Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, MI, USA; 4Ponce School of Medicine and Health Sciences, Ponce, PR, USA; 5Beaumont Health System, Detroit, MI, USA Background: Major League Baseball (MLB) players are throwing the ball faster and hitting harder than ever before. Although some safety measures have been implemented, by decreasing the 15 days on the disabled list (DL) to the 7 days on the DL, concussion rates remain high across positions and may impact player performance. Our hypothesis was, there would be an increase in concussion incidence following implementation of the 7 day DL, but this would not have a negative impact on player’s postconcussion performance.Study design: This is a descriptive epidemiology study.Methods: The concussed players from 2005 to 2016 were identified from the MLB DL and verified using established new sources. Position-specific performance metrics from before and after injuries were gathered and compared to assess effects of the injury. Postconcussion performance metrics were compared before and after the 7-day DL rule implementation.Results: A total of 112 concussed players were placed on the DL. For all position players, the batting average (BA) and on-base percentage (OBP) showed a nonsignificant decline after injury (P=0.756). Although performance statistics for pitchers declined on average, the trend was not statistically significant. Postinjury BA and OBP did not significantly change before (0.355) and after (0.313) the 7-day DL rule change in 2011 (P=0.162).Conclusion: The incidence of reported concussion has increased with the 7-day DL rule change. Concussion incidence was highest in catchers and pitch

Axel Öhlin,1 Olufemi R Ayeni,2 Leif Swärd,1 Jón Karlsson,1 Mikael Sansone1 1Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden; 2Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada Purpose: The purpose of this case report is to present the successful management of symptomatic bilateral femoroacetabular impingement (FAI) syndrome in a patient who underwent surgical treatment on one side and non-surgical treatment on the other side. Methods: We evaluated the treatment outcome of a young female presenting with bilateral FAI syndrome of cam morphology. A follow-up was performed at 5 years following surgical treatment on the right hip and 2 years following non-surgical treatment on the left hip. The evaluation included a clinical examination, patient-reported outcome measurements (PROM), plain radiographs, and magnetic resonance imaging (MRI). Results: The patient experienced subjective improvements bilaterally. The clinical examination revealed differences in range of motion between the surgically treated and the non-surgically treated sides, with internal rotation differing the most (20° vs almost 0°). Flexion was, however, the same on both sides (125°). The PROM results were satisfactory on both sides, with slightly better results for the surgically treated side (the short version of the International Hip Outcome Tool [iHOT-12]: 96.9 vs 90, the Copenhagen Hip and Groin Outcome Score [HAGOS]: 90–100 vs 65–100). On the surgically treated side, the alpha angle decreased by 19° postoperatively. An MRI did not reveal any injury to the cartilage or labrum on either side. Conclusion: This patient with bilateral FAI syndrome treated with arthroscopic surgery on one side and physiotherapy together with reduced physical activity on the other side, presented with good results bilaterally at follow-up. Keywords: arthroscopy, physioth

Meghan Warren,1 Monica R Lininger,1 Nicole J Chimera,2 Craig A Smith1,3 1Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, USA; 2Department of Athletic Training, Daemen College, Amherst, NY, USA; 3Smith Performance Center, Tuscon, AZ, USA Abstract: The Functional Movement Screen (FMS) is a popular movement screen used by rehabilitation, as well as strength and conditioning, professionals. The FMS, like other movement screens, identifies movement dysfunction in those at risk of, but not currently experiencing, signs or symptoms of a musculoskeletal injury. Seven movement patterns comprise the FMS, which was designed to screen fundamental movement requiring a balance between stability and mobility. The 7 movement patterns are summed to a composite FMS score. For an instrument to have wide applicability and acceptability, there must be high levels of reliability, validity, and accuracy. The FMS is certainly a reliable tool, and can be consistently scored within and between raters. Although the FMS has high face and content validity, the criterion validity (discriminant and convergent) is low. Additionally, the FMS does not appear to be studying a single construct, challenging the use of the summed composite FMS score. The accuracy of the FMS in screening for injury is also suspect, with low sensitivity in almost all studies, although specificity is higher. Finally, within the FMS literature, the concepts of prediction and association are conflated, combined with flawed cohort studies, leading to questions about the efficacy of the FMS to screen for injury. Future research on the use of the FMS, either the composite score or the individual movement patterns, to screen for injury or injury risk in adequately powered, well-designed studies are required to determine if the FMS is appropriate for use as a movement screen. Keywords: movement screen, prediction, sensitivity, athletes

Jan H Rosenvinge,1 Jorunn Sundgot-Borgen,2 Gunn Pettersen,3 Marianne Martinsen,4 Annett Victoria Stornæs,2 Anne Marte Pensgaard5 1Department of Psychology, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway; 2Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway; 3Department of Health and Caring Sciences, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; 4Department of Mathematics, Natural Sciences, and Physical Education, Inland Norway University of Applied Sciences, Hamar, Norway; 5Department of Coaching and Psychology, Norwegian School of Sports Science, Oslo, Norway Introduction: Psychological distress is increasing among adolescents and clusters with other mental health problems such as eating problems. The aim of this study was to investigate the prevalence of psychological distress among young elite athletes and age-matched controls and whether prevalence figures may be attributed to perfectionism and eating problems. Methods: First-year athletes from all Norwegian elite sport high schools (n=711) and 500 ­students from randomly selected ordinary high schools were eligible for this cross-sectional study. In total, 611 athletes and 355 student controls provided self-report data about psychological distress, perfectionism, and eating problems (ie, body dissatisfaction and a drive for thinness), as well as their physical training/activity. Results: A significantly higher proportion of controls scored above the cutoff point for marked psychological distress. Physical activity above the recommended levels for this age group predicted psychological distress among the controls, while the opposite was found in the student elite athlete sample. In both samples, perfectionistic concerns, ie, concern over mistakes, predicted overall psychological distress. However, among elite athletes, perfectionistic concerns were particularly associate

Adam L Owen,1,2 Marco A Cossio-Bolaños,3,4 Gordon Dunlop,1 Mehdi Rouissi,5 Moktar Chtara,5 Nicola Luigi Bragazzi,6 Karim Chamari7 1Servette Centre for Football Research (SCFR), Servette Football Club, Geneva, Switzerland; 2Centre de Recherche et d’Innovation sur le Sport, Université Claude Bernard Lyon.1, Lyon,  France; 3Faculty of Physical Education, State University of Campinas, Sao Paulo, Brazil; 4Department of Physical Activity Sciences, Catholic University of Maule, Talca, Chile; 5Tunisian Research Laboratory, National Centre of Medicine and Science in Sport, Tunis, Tunisia; 6Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy; 7Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopedic and Sports Medicine Hospital, Doha, Qatar Introduction: The stability of hematological status indices is a key determinant of optimal sport performance. The capacity to monitor hematological behaviors of elite soccer players may better explain the stresses placed upon physiological systems and the potential decrements in performance and physical capacity. The primary aim of this investigation was to examine the post-seasonal hematological status of professional top-level soccer players in response to seasonal match-play and training demands, in terms of the training practices, intensity, and loadings that they experience before, during, and after each season. Methods: Seventeen male elite European soccer players participated in the study (mean±SD: age 26.8±4.6 years, weight 78.1±5.7 kg, height 182.4±4.8 cm, body fat 9.8%±2.9%, and maximal aerobic capacity 56.5±4.2 mL kg−1 min−1). The season culminated in 74 competitive matches including domestic, Champions League, and UEFA Cup matches. Blood samples were collected between 9:00 and 10:30 am after an overnight fast (~10 hours)

Caio Victor Sousa,1 Marcelo Magalhães Sales,2 Pantelis Theodoros Nikolaidis,3 Thomas Rosemann,4 Beat Knechtle4,5 1Graduate Program in Physical Education, Universidade Católica de Brasília, Brasília, Brazil; 2Physical Education Department, Universidade Estadual de Goiás, Quirinópolis, Goiás, Brazil; 3Exercise Physiology Laboratory, Nikaia, Greece; 4Institute of Primary Care, University of Zurich, Zurich, Switzerland; 5Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland Abstract: The sub-2-hour marathon is a new barrier in endurance running performance, and it has been widely debated in the scientific community. In this review we present a mathematical model to estimate the possible year when a male could break through the sub-2-hour barrier, and also an estimation of when a female could break Paula Radcliffe’s marathon running record. Further, we present several aspects (ie, physiology, nationality, age, biomechanics, pacing, and drafting) that are associated with marathon running performance in elite runners and, finally, the possible characteristics of the male to break the sub-2-hour barrier. In summary, with the results of the developed equations, it is possible that a male athlete can break through the sub-2-hour barrier in the next decade (with Nike® Breaking2 performance 1920–2018 [NBP]: y =0.0417x2–14.18x +3,128; year of 2026; without NBP 1920–2018: y =0.045x2–15.12x +3,194; year of 2027). This marathoner will possibly have a maximal oxygen uptake >85 mL∙kg–1∙min–1 and should perform the race at a pacing higher than 85% of maximal oxygen uptake. In addition, this runner should pay more attention to strength training, endurance strength, speed training, and focus on running training at an intensity above the anaerobic threshold. Most likely, this runner originates from East Africa

Terje Dalen,1 Ørjan Øverås,1 Roland van den Tillaar,1 Boye Welde,2 Erna Dianne von Heimburg1 1Department of Physical Education and Sport Science, Nord University, Levanger, Norway; 2UiT The Arctic University of Norway, School of Sport Sciences, Alta, Norway Background: The aim of this study was to compare the effect of different soccer-specific maximal actions (Continuous run, Sprint, Sprint with change of direction [Sprint COD], Jump and Shot) upon physiological (oxygen uptake and heart rate) and perceptual (rating of perceived exertion [RPE]) responses and accelerometer load. Materials and methods: Ten moderately to well-trained male soccer players volunteered to serve as subjects in this study. A repeated within-subject design was used in which each subject was tested on five occasions on different days, one test each day, during a period of 2 weeks. Each of the five tests had a distance of 900 m and lasted 5 minutes, thus the mean speed for all five tests was 3 m/s. During the test, oxygen uptake, heart rate and accelerometer load were measured. Immediately after each test, RPE was recorded, and after the test, oxygen uptake was measured for 5 minutes while the subject sat in an upright position on a chair. Results: In the comparison of different soccer-specific maximal actions upon physiological and perceptual responses and accelerometer load, this study found that the total accelerometer load was lowest in Sprint and Sprint COD conditions, although the physiological (oxygen uptake and heart rate) and perceptual (RPE) responses were highest in the respective conditions. The Jump condition experienced lower RPE than Sprint and Sprint COD but achieved the highest accelerometer load. Conclusion: Accelerometer load is not a valid measurement for energy costs or RPE but may function as a complementary tool to investigate the player loads during matches and training. Keywords: soccer, oxygen uptake, rate of perceived exhaustion, repeat

Pantelis T Nikolaidis,1,2 Elias Villiger,3 Luca P Ardigò,4 Zbigniew WaÅ›kiewicz,5 Thomas Rosemann,3 Beat Knechtle3,6 1Exercise Physiology Laboratory, Nikaia, Greece; 2Exercise Testing Laboratory, Hellenic Air Force Academy, Acharnes, Greece; 3Institute of Primary Care, University of Zurich, Zurich, Switzerland; 4Department of Neurosciences, Biomedicine and Movement Sciences, School of Exercise and Sport Science, University of Verona, Verona, Italy; 5Department of Team Sports, Academy of Physical Education, Katowice, Poland; 6Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland Purpose: The age of peak performance (APP) has been studied extensively in various endurance and ultra-endurance sports; however, less information exists in regard to duathlon (ie, Run1, Bike, and Run2). The aim of the present study was to assess the APP of duathletes competing either in a short (ie, 10 km Run1, 50 km Bike, and 5 km Run2) or a long distance (ie, 10 km Run1, 150 km Bike, and 30 km Run2) race. Participants and methods: We analyzed 6,671 participants (women, n=1,037, age 36.6±9.1 years; men, n=5,634, 40.0±10.0 years) in “Powerman Zofingen” from 2003 to 2017. Results: Considering the finishers in 5-year age groups, in the short distance, a small main effect of sex on race time was observed (p<0.001, η2 =0.052) with men (171.7±20.9 min) being faster than women (186.0±21.5 min) by –7.7%. A small main effect of age group on race was shown (p<0.001, η2 =0.049) with 20–24 years being the fastest and 70–74 years the slowest. No sex × age group interaction was found (p=0.314, η2 =0.003). In the long distance, a small main effect of sex on race time was observed (p<0.001, η2 =0.021) with men (502.8±56.8 min) being faster than women (544.3±62.8 min) by –7.6%. A large main effect of age g

Pedro Manuel Serrano, Tiago Amorim-Barbosa, Marta Santos Silva, Ricardo Sousa Centro Hospitalar do Porto Orthopedic Department, Centro Hospitalar do Porto, Porto, Portugal Abstract: Treatment of symptomatic meniscal tears continues to evolve as we improve our understanding of the biomechanical role of the meniscus and its long-term importance to the health of the knee joint. Suture repair of meniscal tears is challenging and continues to rise as we aim to preserve meniscal tissue. Outside–in meniscal suture techniques may involve using expensive equipment that is not readily available for immediate use in most operating rooms. Aware of the different techniques available, the authors describe a fast and reproducible technique that does not require the use of specific material or equipment. Keywords: meniscal suture, arthroscopy, sports trauma, surgical technique

Ralph Smith,1 Julian O M Ormerod,2 Nikant Sabharwal,2 Courtney Kipps3 1Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK; 2Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK; 3Institute of Sport, Exercise and Health, Division of Surgery and Interventional Sciences, UCL, London, UK Abstract: With the growing popularity of water-based sports, cases of swimming-induced pulmonary edema (SIPE) are becoming increasingly recognized. SIPE, a potentially life-threatening condition, is an acute cause of breathlessness in athletes. It has been described frequently in scuba divers, swimmers, and triathletes and is characterized by symptoms and signs of pulmonary edema following water immersion. It is important to recognize that athletes’ symptoms can present with a spectrum of severity from mild breathlessness to severe dyspnea, hemoptysis, and hypoxia. In most cases, there is rapid resolution of symptoms within 48 hours of exiting the water. Recent advances in the understanding of the pathophysiology of SIPE, particularly regarding exaggerated pulmonary vascular pressures, have begun to explain this elusive condition more clearly and to distinguish its predisposing factors. It is essential that event organizers and athletes are aware of SIPE. Prompt recognition is required not only to prevent drowning, but also to implement appropriate medical management and subsequent advice regarding return to swimming and the risk of recurrence. This manuscript provides a current perspective on SIPE regarding the incidence rate, the current understanding of the pathophysiology, clinical presentation, medical management, recurrence rates, and advice on return to sport. Keywords: triathletes, open water swimming, diving, immersion, breathing difficulties

Anna Swärd Aminoff,1 Cecilia Agnvall,2,3 Carl Todd,1 Páll Jónasson,4 Mikael Sansone,1 Olof Thoreson,1 Leif Swärd,1 Jon Karlsson,1 Adad Baranto1 1Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden; 2Sports Medicine Åre, Åre, Sweden; 3Åre Ski Academy, Åre, Sweden; 4Orkuhúsið Orthopedic Clinic, Reykjavik, Iceland Background: Current knowledge of the effect of changes in posture and the way cam morphology of the hip joint may affect hip range of motion (ROM) is limited. Purpose: To determine the effect of changes in pelvic tilt (PT) on hip ROM and with/without the presence of cam. Study design: This was a cross-sectional study. Materials and methods: The hip ROM of 87 subjects (n=61 young elite skiers, n=26 nonathletes) was examined using a goniometer, in three different seated postures (flexed, neutral, and extended). The hips of the subjects were further subgrouped into cam and no-cam morphology, based on the magnetic resonance imaging findings in the hips. Results: There was a significant correlation between the hip ROM and the seated posture in both extended and flexed postures compared with the neutral posture. There was a significant decrease in internal hip rotation when the subjects sat with an extended posture with maximum anterior PT (p<0.0001). There was a significant increase in internal hip rotation when the subjects sat with a flexed posture with maximum posterior PT (p<0.001). External rotation was significantly decreased in an extended posture with maximum anterior PT (p<0.0001), but there was no difference in flexed posture with maximum posterior PT. The hips with cam morphology had reduced internal hip rotation in all three positions, but they responded to the changes in position in a similar manner to hips without cam mor

Michael B Rose, Thomas Noonan Steadman Hawkins Clinic, University of Colorado School of Medicine, Denver, CO, USA Abstract: Glenohumeral internal rotation deficit (GIRD) is an adaptive process in which the throwing shoulder experiences a loss of internal rotation (IR). GIRD has most commonly been defined by a loss of >20° of IR compared to the contralateral shoulder. Total rotational motion of the shoulder is the sum of internal and external rotation and may be more important than the absolute value of IR loss. Pathologic GIRD has been defined as a loss of IR combined with a loss of total rotational motion. The leading pathologic process in GIRD is posterior capsular and rotator-cuff tightness, due to the repetitive cocking that occurs with the overhead throwing motion. GIRD has been associated with numerous pathologic conditions, including posterior superior labral tears, partial articular-sided rotator-cuff tears, and superior labral anterior-to-posterior tears. The mainstay of treatment for patients with GIRD is posterior capsular stretching and strengthening to improve scapular mechanics. In patients who fail nonoperative therapy, shoulder arthroscopy can be performed. Arthroscopic surgery in the high-level throwing athlete should be to restore them to their functional baseline with the minimum amount of intervention possible. Keywords: GIRD, throwing athlete, internal impingement, shoulder

Ryan M Weatherwax,1,2 Nigel K Harris,1 Andrew E Kilding,3 Lance C Dalleck2 1Auckland University of Technology, Human Potential Center, Auckland, New Zealand; 2Western State Colorado University, Recreation and Exercise & Sport Science, Gunnison, CO, USA; 3Auckland University of Technology, Sports Performance Research Institute New Zealand, Auckland, New Zealand Background: Even though cardiorespiratory fitness (CRF) training elicits numerous health benefits, not all individuals have positive training responses following a structured CRF intervention. It has been suggested that the technical error (TE), a combination of biological variability and measurement error, should be used to establish specific training responsiveness criteria to gain further insight on the effectiveness of the training program. To date, most training interventions use an absolute change or a TE from previous findings, which do not take into consideration the training site and equipment used to establish training outcomes or the specific cohort being evaluated. The purpose of this investigation was to retrospectively analyze training responsive­ness of two CRF training interventions using two common criteria and a site-specific TE.Methods: Sixteen men and women completed two maximal graded exercise tests and verification bouts to identify maximal oxygen consumption (VO2max) and establish a site-specific TE. The TE was then used to retrospectively analyze training responsiveness in comparison to commonly used criteria: percent change of >0% and >+5.6% in VO2max.Results: The TE was found to be 7.7% for relative VO2max. χ2 testing showed significant differences in all training criteria for each intervention and pooled data from both interventions, except between %Δ >0 and %Δ >+7.7% in one of the investigations. Training nonresponsiveness ranged from 11.5% to 34.6%.Conclusion: Findings from the present study support the utility

Metin Polat,1 Selcen Korkmaz Eryılmaz,2 Sami AydoÄŸan3 1School of Physical Education and Sports, Erciyes University, Kayseri, Turkey; 2School of Physical Education and Sports, Cukurova University, Adana, Turkey; 3Department of Physiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey Introduction: In order to ensure that athletes achieve their highest performance levels during competitive seasons, monitoring their long-term performance data is crucial for understanding the impact of ongoing training programs and evaluating training strategies. The present study was thus designed to investigate the variations in body composition, maximal oxygen uptake (VO2max), and gas exchange threshold values of cross-country skiers across training phases throughout a season. Materials and methods: In total, 15 athletes who participate in international cross-country ski competitions voluntarily took part in this study. The athletes underwent incremental treadmill running tests at 3 different time points over a period of 1 year. The first measurements were obtained in July, during the first preparation period; the second measurements were obtained in October, during the second preparation period; and the third measurements were obtained in February, during the competition period. Body weight, body mass index (BMI), body fat (%), as well as VO2max values and gas exchange threshold, measured using V-slope method during the incremental running tests, were assessed at all 3 time points. The collected data were analyzed using SPSS 20 package software. Significant differences between the measurements were assessed using Friedman’s twoway variance analysis with a post hoc option. Results: The athletes’ body weights and BMI measurements at the third point were significantly lower compared with the results of the second measurement (p<0.001). Moreover, the incremental running test time was significantly higher at the third measurement, compared with bot

Pantelis Theodoros Nikolaidis,1,2 Beat Knechtle3,4 1Exercise Physiology Laboratory, Nikaia, Greece; 2Laboratory of Exercise Testing, Hellenic Air Force Academy, Dekelia, Greece; 3Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland; 4Institute of Primary Care, University of Zurich, Zurich, Switzerland Purpose: Despite the increasing popularity of 50-km ultramarathons during the last few years, only limited information is available regarding the trends in its performance and participation. The aim of the present study was to examine the age of peak running performance in female and male 50-km ultramarathoners using second-order nonlinear regression analyses.Methods: Data from 494,414 runners (124,045 women and 370,369 men) who finished a 50-km ultramarathon between 1975 to 2016 were analyzed. Results: When the top ten finishers in 1-year age-groups were analyzed, the age of peak running speed was 41 years in both women and men. When the fastest finishers in 1-year age-group intervals were analyzed, the age of peak running speed was 40 years in women and 39 years in men.Conclusion: In summary, the age of peak running speed in 50-km ultramarathoners is older than what has been reported by previous studies for marathons. Women seem to achieve the best race time in a 50-km ultramarathon later in life compared with men. These findings are of great practical value for coaches and fitness trainers when setting performance goals for 50-km ultramarathon runners. Keywords: master athlete, running, sex difference, ultra-endurance, aerobic capacity, aging, cardiorespiratory fitness

Gustavo J Almeida, Samannaaz S Khoja, Sara R Piva Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, USA Background: Total joint arthroplasty (TJA) is a common procedure to treat individuals with hip and knee osteoarthritis. While TJAs are successful in decreasing pain and improving quality of life, it is unclear whether individuals who undergo TJA become more physically active after surgery. It is possible that TJA, by itself, is not sufficient to affect the behavior of patients toward physical activity (PA) participation. To increase PA participation, individuals with TJA may need to be exposed to exercise/behavioral interventions specifically aimed to promote PA (ie, in addition to the surgery).Objectives: This narrative review aimed to assess the evidence on 1) whether TJAs change PA participation from pre- to postsurgery and 2) whether exercise/behavioral interventions delivered before or after TJA help to promote PA in these patients. Results: For aim 1, the studies that assessed PA from pre- to post-TJA reported that PA does not change in the first 3 months postsurgery. The results of follow-ups longer than 3 months but shorter than 12 months are contradictory, and the results of follow-ups longer than 12 months provide weak evidence of increased PA. Assessment of changes in PA due to TJA is challenged by the wide variability in demographics, methods used to assess PA, and different pathways of care used across studies. The results for aim 2 were limited by a scarcity of studies that used exercise/behavioral interventions to promote PA. Conclusion: TJA relieves joint pain and offers a unique opportunity for patients to become more physically active. However, the current evidence is limited and unable to offer definitive results of whether TJA is effective to change PA from pre- to postsurgery. Future large studies in representative samples of patients with TJA are needed to adequately answer

Rodrigo Rico Bini, Alice Flores Bini La Trobe Rural Health School, La Trobe University, Flora Hill Campus, Bendigo, VIC, Australia Abstract: The potential factors associated with overuse injuries and pain in cyclists that are supported by evidence remain unclear. Our study aimed at assessing, using a systematic search of the most updated evidence, the main factors related to overuse knee-related pain and/or injuries in cyclists. The search assessed any potential mechanism related to knee pain or injury that could be used in the clinical practice. Databases were searched (i.e., PubMed, Scopus, Web of Science, and EBSCO). Studies were included if they presented results from original studies. They had to include, preferably but not limited to, recreational and/or competitive cyclists with or without knee pain. Quality of articles was assessed. Eleven articles were deemed eligible for full text appraisal. Studies involved generally the assessment of biomechanical outcomes associated with knee pain in cyclists. Overall, studies showed that cyclists with knee pain present larger knee adduction and larger ankle dorsiflexion and differences in activation for hamstrings and quadriceps muscles. Unclear results were observed for knee moments and no differences were observed for knee flexion angle, tibiofemoral and patellofemoral forces. It is important to state that varied types of knee pain were mixed in most studies, with 2 focused on anterior-related pain. Cyclists with overuse-related pain or injuries on their knees presented an increased medial projection of their knees and an altered activation of the Vastus Medialis and Vastus Lateralis muscles. However, this limited evidence is based on retrospective studies comparing cyclists with and without pain, which limits the conclusion on how cyclists develop knee pain and what are the main options for treatment of knee pain. Keywords: injury, cycling, overuse, biomechanics

Beat Knechtle,1,2 Pantelis T Nikolaidis3 1Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland; 2Institute of Primary Care, University of Zurich, Zurich, Switzerland; 3Exercise Physiology Laboratory, Nikaia, Greece Abstract: It is well known that elderly people up to 90 years of age are able to finish a marathon. We have no knowledge, however, how runners at the age of 90 years or older pace during a long run. In this case report, we describe the pacing of a 94-year-old man competing in a 6-hour run in order to prepare for a marathon at the age of 95 years in category M95. In the “6-Stunden-Lauf” held in Brugg, Switzerland, participants have to run as many laps of 0.934 km as possible on a completely flat circuit within 6 hours to achieve as many kilometers as possible. Before and after the competition we measured body weight, percentage of body fat, fat-free mass and percentage of body water using a bioelectrical impedance scale. On the day before the start, 24 hours after the finish and then every 24 hours for the following 4 days, capillary blood samples at a fingertip were drawn to determine hemoglobin, hematocrit, leukocytes, platelets, C-reactive protein, creatine kinase, creatinine and potassium and sodium. The runner achieved 26 laps during the 6 hours, equal to 24.304 km. Lap times increased continuously and running speed decreased nearly linearly. A large main effect of time point (hours) of the race on running speed was observed (p=0.015, h2=0.48) with running speed being slower in the last hour than that in the first hour (3.5±1.4 km/h versus 5.3±0.4 km/h). Body mass decreased by 0.6%, percent body fat by 1.4% and fat-free mass by 0.7%. During recovery, hemoglobin, hematocrit and the number of thrombocytes increased, whereas the number of leukocytes remained unchanged. C-reactive protein was highest on day 1 after the race and decreased by day 4 nearly to zero. Creatine kinase was slightly elevated pre-race

Amanda L Hannan,1 Wayne Hing,1 Vini Simas,1 Mike Climstein,2,3 Jeff S Coombes,4 Rohan Jayasinghe,5–7 Joshua Byrnes,8 James Furness1 1Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia; 2Exercise Health and Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia; 3Water Based Research Unit, Bond University, Gold Coast, QLD, Australia; 4School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia; 5Cardiology Department, Gold Coast University Hospital, Gold Coast, QLD, Australia; 6Griffith University, Gold Coast, QLD, Australia; 7Macquarie University, Sydney, NSW, Australia; 8Centre for Applied Health Economics, School of Medicine, Griffith University, Logan, QLD, Australia Background: Aerobic capacity has been shown to be inversely proportionate to cardiovascular mortality and morbidity and there is growing evidence that high-intensity interval training (HIIT) appears to be more effective than moderate-intensity continuous training (MICT) in improving cardiorespiratory fitness within the cardiac population. Previously published systematic reviews in cardiovascular disease have neither investigated the effect that the number of weeks of intervention has on cardiorespiratory fitness changes, nor have adverse events been collated. Objective: We aimed to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) within the cardiac population that investigated cardiorespiratory fitness changes resulting from HIIT versus MICT and to collate adverse events. Methods: A critical narrative synthesis and meta-analysis was conducted after systematically searching relevant databases up to July 2017. We searched for RCTs that compared cardiorespiratory fitness changes resulting from HIIT versus MICT interventions within the cardiac population. Results: Seventeen studies, involving 953 participants (465 for

Pantelis Theodoros Nikolaidis,1 Caio Victor Sousa,2 Beat Knechtle3,4 1Exercise Physiology Laboratory, Nikaia, Greece; 2Graduate Program in Physical Education, Catholic University of Brasília, Brasília, Brazil; 3Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland; 4Institute of Primary Care, University of Zurich, Zurich, Switzerland Aim: The aim of the present study was to investigate the relationship of wearing a wetsuit with sex, age group, nationality, calendar year, and performance in crossing the “Strait of Gibraltar”(14.3 km). Materials and methods: A sample of 1,130 open-water (females, n=180, age 35.9±11.9 years; males, n=950, age 40.0±10.2 years) ultra-distance swimmers crossing the “Strait of Gibraltar” since 1950 was analyzed. Results: Male, older, and Spanish swimmers used wetsuits more often than female, younger, and athletes of other nationalities, respectively, and the use of the wetsuit has increased during the past three decades. Swimmers with wetsuits were faster than those without. Male athletes aged 30–34 years were faster than athletes >60 years. Female athletes were younger than male athletes, and swimmers with wetsuits were older than those without. The Spanish were faster than the American swimmers and athletes from other nationalities, and the American swimmers were the oldest. Conclusion: In summary, swimmers were faster when using a wetsuit, and local Spanish swimmers were the fastest and also used wetsuits most frequently. Male and older swimmers used wetsuits more often than other swimmers, and the use of wetsuits has increased in the last three decades. Keywords: aging, master athlete, endurance, water sport, physiology, gender&nbsp