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Copyright of SSEM-Journal is the property of Schwiez Zschr Sportmed Sporttraumatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of SSEM-Journal is the property of Schwiez Zschr Sportmed Sporttraumatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Non-communicable diseases (NCDs), including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers, are on the rise worldwide and are often associated with a lack of physical activity (PA). Globally, the levels of PA among individuals are below WHO recommendations. A lack of PA can increase morbidity and mortality, worsen the quality of life and increase the economic burden on individuals and society. In response to this trend, numerous organisations came together under one umbrella in Hamburg, Germany, in April 2021 and signed the 'Hamburg Declaration'. This represented an international commitment to take all necessary actions to increase PA and improve the health of individuals to entire communities. Individuals and organisations are working together as the 'Global Alliance for the Promotion of Physical Activity' to drive long-term individual and population-wide behaviour change by collaborating with all stakeholders in the community: active hospitals, physical activity specialists, community services and healthcare providers, all achieving sustainable health goals for their patients/clients. The 'Hamburg Declaration' calls on national and international policymakers to take concrete action to promote daily PA and exercise at a population level and in healthcare settings., Competing Interests: Competing interests: EV is Editor in Chief of BMJ Open Sports & Exercise Medicine., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The SARS-CoV-2 pandemic raised concerns about potential cardiac damage when infected athletes returned to sport. Swiss sports medicine and cardiology quickly published guidelines to manage this risk, proposing appropriate investigations and a gradual return to sport protocol. Although these guidelines have been adapted as new knowledge emerged in 2021 and 2022, they were introduced at a time of overestimation of the rate of cardiac complications in pauci-/asymptomatic elite athletes. Updated guidelines should be issued shortly, in accordance with the current state of research. In the meantime, the investigations and process suggested by Sport & Exercise Medicine Switzerland and Swiss Olympic remain valid and should be applied., Competing Interests: Le Dr Gojanovic fait partie des auteurs des différentes itérations des recommandations de la SEMS et Swiss Olympic, et il est président de la SEMS. Le Dr Chiari n’a déclaré aucun conflit d’intérêts en relation avec cet article.

Shoulder injuries are common in athlete population. They can be due to trauma or overuse. Traumatic lesions are roughly the same in the non-athlete population. On the other hand, overuse lesions are specific to the sport, depending on the movements performed by the athlete. The majority of the early literature studied baseball pitchers. Pathophysiological theories have been applied to other overhead sport. In this article, we discuss briefly the main specificities and conditions of the painful athlete's shoulder., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Optimizing treatments requires the prevention of diagnostic errors. The use of shortcuts, cognitive biases, may lead to errors of judgement that can impair clinical reasoning and distort decision-making. Objective, quantifiable and comparable assessment is a safeguard against this, and for instance force quantification is used for this purpose. We will present here the use of hand-held dynamometers with recommendations for best practice as well as simple but essential tools for interpreting the results. Indeed, the use of these easy-to-use dynamometers requires rigour to ensure the quality of measurements and data analysis by/for the clinician. The use of this equipment should be widely promoted and democratized in informed clinical practice., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Context: Mounting evidence suggests neuromuscular electrical stimulation (NMES) as a promising modality for enhancing lower limb muscle strength, yet the functional effects of a single electrical stimulation session for improving the function of the intrinsic foot muscles (IFM) has not been evaluated., Objective: To investigate the immediate effects of an NMES session compared with a sham stimulation session on foot force production, foot dome stability, and dynamic postural control in participants with static foot pronation., Design: Randomized controlled clinical trial., Setting: Laboratory., Patients or Other Participants: A total of 46 participants (23 males, 23 females) with static foot pronation according to their Foot Posture Index (score ≥ 6) were randomly assigned to an NMES (n = 23) or control (n = 23) group., Intervention(s): The NMES group received a single 15-minute NMES session on the dominant foot across the IFM. The control group received a 15-minute sham electrical stimulation session., Main Outcome Measure(s): All outcome measurements were assessed before and after the intervention and consisted of foot force production on a pressure platform, foot dome stability, and dynamic postural control. Statistical analysis was based on the responsiveness of the outcome measures and responder analysis using the minimum detectable change scores for each outcome measure., Results: In the NMES group, 78% of participants were classified as responders for at least 2 of the 3 outcomes, compared with only 22% in the control group. The relative risk of being a responder in the NMES group compared with the control group was 3.6 (95% CI = 1.6, 8.1]. Interestingly, we found that all participants who concomitantly responded to foot strength and navicular drop (n = 8) were also responders in dynamic postural control., Conclusions: Compared with a sham stimulation session, a single NMES session was effective in immediately improving foot function and dynamic postural control in participants with static foot pronation. These findings support the role of NMES for improving IFM function in this population., (© by the National Athletic Trainers' Association, Inc.)

Objectives: (1) To assess the period prevalence of SARS-CoV-2 infections and willingness to vaccinate in Swiss elite athletes and (2) to evaluate whether sociodemographic and sport-related characteristics were associated with infection of SARS-CoV-2 in athletes., Methods: A total of 1037 elite athletes (M age =27.09) were surveyed in this cross-sectional study. They were asked whether they had been infected with SARS-CoV-2 and whether they would like to be vaccinated. Characteristics of a possible COVID-19 illness were also recorded., Results: During the first year of the pandemic, 14.6% of all Swiss elite athletes were found to be infected with SARS-CoV-2, and 5.4% suspected that they had been infected. Male athletes, young athletes and team sports athletes had an increased likelihood of being infected with SARS-CoV-2. There was considerable heterogeneity in the duration and severity of a COVID-19 illness in athletes. Overall, 68% of respondents indicated a willingness to be vaccinated if they were offered an opportunity to do so., Conclusion: In the first year of the pandemic, Swiss elite athletes were tested more often positive for SARS-CoV-2 than the general Swiss population. Because COVID-19 illness can impair health for a relatively long time, sports federations are advised to motivate athletes to be vaccinated., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

In sports medicine and rehabilitation of musculoskeletal conditions, training, knowledge and expertise of clinicians are the guarantors of good clinical practice. But are they really? Since the 1970s, a growing body of sociological and behavioral science has developed the concepts of cognitive biases and thinking errors. In a nutshell, it tries to explain how we approach decision-making using shortcuts, or heuristics. Our brains will alternatively use 2 systems to think and decide: system 1 is fast, intuitive and emotional, whereas system 2 is slow, logical and conscious. We may think clinicians use the latter systematically, but they actually use system 1 in many situations. Whether due to intrinsic thinking errors or external forces that cloud our judgment, we are under unconscious influences and so are all the stakeholders in the rehabilitation setting, including the patient/athlete. We present some of the most prevalent biases that pervade clinical decision-making and attempt to give a bit of background context starting from the typical tension between academic authority and personal experience. The field of sports performance is also riddled with beliefs, egocentrism and a general tendency to search for magic bullets that will bring the marginal gains and edge over the competition. This plays into the rehabilitation of patient-athletes in different ways. Finally, there are ways to mitigate the effect of cognitive biases to improve decision-making. This must include better communication, shared decisions and ultimately the understanding that we should drive our profession to deliver high-value care tailored to the patients, in line with the best evidence at the best possible cost. Hopefully, we can shed some light without too many of our own biases on the complexities of thinking in sports medicine and rehabilitation., Competing Interests: Conflict of Interest None declared., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: To present training load (TL) and heart-rate variability (HRV) in an elite sprinter monitored before, during, and after a COVID-19 infection until successful return to performance., Methods: TL, subjective morning fatigue (MF), and supine HRV were monitored during a 12-week period., Results: During a high-TL period (training camp), MF and heart rate increased and vagally mediated HRV variables decreased. MF increased and stayed high 3 days after the camp despite decrease in TL. In contrast, 4 days after the camp, heart rate decreased and vagally mediated HRV variables increased, reflecting parasympathetic hyperactivity. Elevated MF and suboptimal training performance led to a PCR test decision, which returned positive. After a 10-day training suspension, TL was progressively increased with low MF and high vagal tone. The athlete was able to return to competition 17 days after medical clearance for return to participation and 1 week later beat his indoor 60-m personal best., Conclusions: In this athlete, COVID-19 infection induced parasympathetic hyperactivity with subjective fatigue. This case report presents how performance capacity was only negatively influenced by a COVID-19 infection in the short term, with a quick and successful return to performance, thanks to state-of-the-art medical management. This highlights the importance of TL and HRV monitoring in return-to-participation and return-to-competition decisions.

Physical inactivity (PI) is a leading risk factor for global mortality worldwide, a major preventable cause of non-communicable diseases (NCDs) and a socioeconomic burden for healthcare systems. Fortunately, evidence shows that exercise interventions delivered by qualified exercise science graduates is an effective way to reduce PI, prevent and treat NCDs. This study compares the integration of exercise science graduates, defined as university graduates with degrees in sport and exercise science, in the healthcare systems of Australia, a commonly cited model in this regard, and Switzerland, a country considered to have an effective but costly healthcare system. For both countries, three domains were reviewed: healthcare system, exercise science graduates' education, and roles played by exercise science graduates in healthcare system. Australia formally recognizes specifically trained exercise science graduates (referred to as Accredited Exercise Physiologists) as healthcare professionals. The exercise interventions they deliver, which were shown to be cost-effective and lead to positive health outcomes, are covered by Medicare, the Australian universal health insurance. However, Medicare covers only a maximum of 5 yearly sessions of all allied-health services taken together. Conversely, Switzerland, despite offering university master's degrees that focus on physical activity delivery to clinical populations, does not recognize the respective graduates as healthcare providers. As a result, their services are not covered by the Swiss health insurances. The latter do, however, cover a generous number of services (not formally limited) delivered by other allied-health professionals. In conclusion, Australia makes a better use of exercise science graduates than Switzerland does. Switzerland would benefit from establishing a clinical profession for exercise science graduates, defining competencies that they should acquire and setting their scope of practice. The very restricted number of therapy sessions covered by Medicare might limit the positive impact exercise science graduates have on the Australian healthcare system. Overall, mutual learning between countries can promote development and global recognition of clinical positions for exercise science graduates., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Carrard, Gut, Croci, McMahon, Gojanovic, Hinrichs and Schmidt-Trucksäss.)

High-level sports competition is popular among Swiss youth. Even though preparticipation evaluation for competitive athletes is widespread, screening strategies for diseases responsible for sudden death during sport are highly variable. Hence, we sought to develop age-specific preparticipation cardiovascular evaluation (PPCE) proposals for Swiss paediatric and adolescent athletes (under 18 years of age). We recommend that all athletes practising in a squad with a training load of at least 6 hours per week should undergo PPCE based on medical history and physical examination from the age of 12 years on. Prior to 12 years, individual judgement of athletic performance is required. We suggest the inclusion of a standard 12-lead electrocardiogram (ECG) evaluation for all post-pubertal athletes (or older than 15 years) with analysis in accordance with the International Criteria for ECG Interpretation in Athletes. Echocardiography should not be a first-line screening tool but rather serve for the investigation of abnormalities detected by the above strategies. We recommend regular follow-up examinations, even for those having normal history, physical examination and ECG findings. Athletes with an abnormal history (including family history), physical examination and/or ECG should be further investigated and pathological findings discussed with a paediatric cardiologist. Importantly, the recommendations provided in this document are not intended for use among patients with congenital heart disease who require individualised care according to current guidelines.

There have been repeated calls to re-evaluate how clinicians provide care for people presenting with persistent non-traumatic musculoskeletal conditions. One suggestion is to move away from the 'we can fix and cure you' model to adopting an approach that is more consistent with approaches used when managing other persistent non-communicable diseases; education, advice, a major focus on self-management including lifestyle behavioural change, physical activity and medications as required. Currently the global delivery of musculoskeletal care has many of the elements of a 'super wicked problem', namely conflict of interest from stake-holders due to the consequences of change, prevailing expectation of a structural diagnosis and concomitant fix for musculoskeletal pain, persistent funding of high risk, more expensive care when low risk more economic viable options that don't impact on the quality of outcome exist, and an unquestionable need to find a solution now with the failure resulting in a growing social and economic burden for future generations. To address these issues, 100 participants included clinicians, educators and researchers from low-, middle- and high-income countries, eight presenters representing the physiotherapy, sport medicine and the orthopaedic professions and the insurance industry, together with three people who shared their lived experiences of persistent musculoskeletal pain, discussed the benefits and barriers of implementing change to address this problem. This paper presents the results from the stakeholders' contextual analysis and forms the basis for the proposed next steps from an action and advocacy perspective., (Copyright © 2021. Published by Elsevier Ltd.)

Training in the medical specialty of sport and exercise medicine (SEM) is available in many, but not all countries. In 2015, an independent Delphi group, the International Syllabus in Sport and Exercise Medicine Group (ISSEMG), was formed to create a basic syllabus for this medical specialty. The group provided the first part of this syllabus, by identifying 11 domains and a total of 80 general learning areas for the specialty, in December 2017. The next step in this process, and the aim of this paper was to determine the specific learning areas for each of the 80 general learning areas. A group of 26 physicians with a range of primary medical specialty qualifications including, Sport and Exercise Medicine, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. SEM, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. The hierarchical syllabus developed by the ISSEMG provides a useful resource in the planning, development and delivery of specialist training programmes in the medical specialty of SEM., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Purpose: The present study aimed to determine whether whole-body fat oxidation and muscle deoxygenation kinetics parameters during exercise were related in individuals with different aerobic fitness levels., Methods: Eleven cyclists [peak oxygen uptake ( V . O 2 ⁢ p ⁢ e ⁢ a ⁢ k ): 64.9 ± 3.9 mL⋅kg -1 ⋅min -1 ] and 11 active individuals ( V . O 2 ⁢ p ⁢ e ⁢ a ⁢ k : 49.1 ± 7.4 mL⋅kg -1 ⋅min -1 ) performed a maximal incremental cycling test to determine V . O 2 ⁢ p ⁢ e ⁢ a ⁢ k and a submaximal incremental cycling test to assess whole-body fat oxidation using indirect calorimetry and muscle deoxygenation kinetics of the vastus lateralis (VL) using near-infrared spectroscopy (NIRS). A sinusoidal (SIN) model was used to characterize fat oxidation kinetics and to determine the intensity (Fat max ) eliciting maximal fat oxidation (MFO). The muscle deoxygenation response was fitted with a double linear model. The slope of the first parts of the kinetics ( a 1 ) and the breakpoint ([HHb] BP ) were determined., Results: MFO ( p = 0.01) and absolute fat oxidation rates between 20 and 65% V . O 2 ⁢ p ⁢ e ⁢ a ⁢ k were higher in cyclists than in active participants ( p < 0.05), while Fat max occurred at a higher absolute exercise intensity ( p = 0.01). a 1 was lower in cyclists ( p = 0.02) and [HHb] BP occurred at a higher absolute intensity ( p < 0.001) than in active individuals. V . O 2 ⁢ p ⁢ e ⁢ a ⁢ k was strongly correlated with MFO, Fat max , and [HHb] BP ( r = 0.65-0.88, p ≤ 0.001). MFO and Fat max were both correlated with [HHb] BP ( r = 0.66, p = 0.01 and r = 0.68, p < 0.001, respectively) and tended to be negatively correlated with a 1 ( r = -0.41, p = 0.06 for both)., Conclusion: This study showed that whole-body fat oxidation and muscle deoxygenation kinetics were both related to aerobic fitness and that a relationship between the two kinetics exists. Individuals with greater aerobic fitness may have a delayed reliance on glycolytic metabolism at higher exercise intensities because of a longer maintained balance between O 2 delivery and consumption supporting higher fat oxidation rates., (Copyright © 2020 Zurbuchen, Lanzi, Voirol, Trindade, Gojanovic, Kayser, Bourdillon, Chenevière and Malatesta.)

Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clinical practice and research on standardised measurement methods of physical capacity in young and middle-aged active adults with hip-related pain. Four areas of importance were identified: (1) clinical measures (range of motion, muscle strength, functional impairments), (2) laboratory-based measures (biomechanics and muscle function (muscle activity, size and adiposity)), (3) physical activity, and (4) return to sport/performance. The literature was reviewed, and a summary circulated to the working group to inform discussion at the consensus meeting. The working group developed clinical and research recommendations from the literature review, which were further discussed and modified within the working group at the consensus meeting. These recommendations were then presented to all 38 International Hip-related Pain Research Network (IHiPRN) participants for further discussion, refinement and consensus voting. Therefore, the recommendations voted on were based on a combination of current evidence and expert opinion. The consensus meeting voted on 13 recommendations, six of which were clinically orientated, and seven more research specific. We recommended that clinicians working with young and middle-aged active adults with hip-related pain assess strength using objective methods of measurement, and clinically assess performance of functional tasks, including walking and running. Physical activity should be quantified using both self-reported and objective measures, and patient expectations of recovery should be quantified prior to treatment. It was recommended that return to physical activity (including sport and occupation) be quantified, and sport-specific activities should be assessed prior to return to sport. The IHiPRN participants were uncertain regarding recommendations for range of motion assessment. Research recommendations were that the measurement properties of range of motion, strength and functional performance tests be investigated, reported and improved in both clinical and research settings. Reporting of movement-related parameters (biomechanics and muscle function) should be standardised and the relationship among movement-related parameters, symptoms, function, quality of life, and intra-articular and imaging findings should be investigated. Quantification of return to physical activity (including sport and occupational demands) is required in future research, and the return to sport continuum should be used. Future research is required to determine the best criteria for rehabilitation progression and return to physical activity following hip-related pain management., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

It is well demonstrated that physical activity can improve the control of diseases such as diabetes, or dyslipidemia. Introduction of regular and frequent physical activity is also part of the useful measures in the management of excess weight. It is therefore surprising that the prescription of physical activity for the treatment of these diseases is still not part of the curriculum of medical studies, and that reimbursement remains very scarce. This article summarizes the state of scientific knowledge in the field and outlines their clinical application., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Neuropathic arthropathy is a pathology involving both upper and lower limbs. Different neurological diseases can cause this arthropathy. For instance, shoulder Charcot arthropathies are mostly associated to syringomyelia. The initial diagnosis of this arthropathy is difficult and often delayed in the presence of usually non specific symptoms. Since articular destruction is present in this disease, early diagnosis and primary management of the neurological condition is important, as it slows down the destruction of the joint., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

This study aims to model training adaptation using Artificial Neural Network (ANN) geometric optimisation. Over 26 weeks, 38 swimmers recorded their training and recovery data on a web platform. Based on these data, ANN geometric optimisation was used to model and graphically separate adaptation from maladaptation (to training). Geometric Activity Performance Index (GAPI), defined as the ratio of the adaptation to the maladaptation area, was introduced. The techniques of jittering and ensemble modelling were used to reduce overfitting of the model. Correlation (Spearman rank) and independence (Blomqvist β) tests were run between GAPI and performance measures to check the relevance of the collected parameters. Thirteen out of 38 swimmers met the prerequisites for the analysis and were included in the modelling. The GAPI based on external load (distance) and internal load (session-Rating of Perceived Exertion) showed the strongest correlation with performance measures. ANN geometric optimisation seems to be a promising technique to model training adaptation and GAPI could be an interesting numerical surrogate to track during a season.

In faculties of health sciences, almost 30% of nursing students exercise less than once a week. This mixed-method case report presents the 38-month evolution of the physiological and psychological health parameters of a sedentary and physically inactive nursing student. During this period, she first took part in a one-semester institutional physical activity (PA) program that was offered by her university before being selected for participation in the Race Across America (RAAM) with a university relay team. In the four months leading up to the RAAM, she followed a cycling training program. After the RAAM, she was followed-up for the next 28 months. The results showed that each phase of the study had an important impact on the subject and showed that sedentary and physical inactive behaviours are reversible. Institutional PA programs, including training education in addition to concurrent strength and endurance training, can lead to physiological and psychological health improvements. For some individuals, participating in an athletic challenge can improve motivation and long-term adherence to PA participation. An individualised approach should be considered in future interventions that aim to promote PA participation. In the specific context of a university of health sciences, this kind of initiative could positively influence the general population's health by empowering students to become role models towards PA promotion.