Umeå University's logo

The aims of the study were to evaluate the relative and absolute variability of upper (T11-L2) and lower (L2-S2) lumbar spinal alignment in power- and weightlifters during the deadlift and back squat exercises, and to compare this alignment between the two lifting groups. Twenty-four competitive powerlifters (n = 14) and weightlifters (n = 10) performed three repetitions of the deadlift and the back squat exercises using a load equivalent to 70% of their respective one-repetition maximum. The main outcome measures were the three-dimensional lumbar spinal alignment for start position, minimum and maximum angle of their spinal alignment, and range of motion measured using inertial measurement units. Relative intra-trial reliability was calculated using the two-way random model intraclass correlation coefficient (ICC) and absolute reliability with minimal detectable change (MDC). The ICC ranged between 0.69 and 0.99 and the MDC between 1 degrees-8 degrees for the deadlift. Corresponding figures for the squat were 0.78-0.99 and 1 degrees-6 degrees. In all participants during both exercises, spinal adjustments were made in both thoracolumbar and lumbopelvic areas in all three dimensions. In conclusion, when performing three repetitions of the deadlift and the squat, lumbar spinal alignment of the lifters did not change much between repetitions and did not differ significantly between power- and weightlifters.

Proximal patellar Tendinopathy, commonly denominated as Jumper´s Knee, is widely considered to be a challenge to treat (Abat et al. in J Exp Orthop. 3:34, 2016). The treatment of patellar tendinopathy focuses on reducing if not eliminating the pain and improving function. At present, there are a several distinct treatments oriented to that end, and a “gold-standard” treatment might be in sight. (Abat F, Alfredson H, Cucchiarini M, Madry H, Marmotti A, Mouton C, Oliveira JM, Pereira H, Peretti GM, Spang C, Stephen J, van Bergen CJA, de Girolamo L. Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part II: treatment options. J Exp Orthop. 2018 Sep 24;5(1):38. https://doi.org/10.1186/s40634-018-0145-5.)

Purpose: The present study aims to analyze the accuracy of injections aimed to hit the proximal and depth part of the patellar tendon "target point" in patellar tendinopathy, comparing ultrasound-guided or non-ultrasound-guided (blind) injections.

Methods: A cadaver randomized study was carried out. Injections were performed under ultrasound control, as well as blinded. There were 26 knees from fresh cadavers and injections were placed by 26 practitioners with experience in the use of musculoskeletal ultrasound and injection treatment. Each participant performed 6 ultrasound-guided and 6 blind punctures in different cadaveric specimens. This provided 312 injections that were analyzed in 2 different anatomical cuts, thus providing a database of 624 measurements for statistical analysis.

Results: Statistically significant differences were observed (p < 0.0001) in the distance from the target point between the ultrasound-guided and the non-guided infiltrations. The "unguided" injections were considered to have been performed on average 10 mm away from the target point compared to the "ultrasound-guided" injections. The ultrasound-guided injections obtained an accuracy of 74.36% while the "non-ultrasound-guided" injections obtained an accuracy of 11.54% (p < 0.0001).

Conclusion: The use of ultrasound to guide the positioning of injections on the dorsal side of the proximal patellar tendon had a significantly higher accuracy compared to blind injections. The finding provides knowledge of importance for injection treatment.

Chronic painful tendinopathy is common in elite and recreational athletes and in sedentary subjects; all may have to stop or decrease their level of physical activity [1, 2]. Midportion Achilles tendinopathy and for the younger and heavy loading population also patellar tendinopathy are problematic injuries. However, recent research on innervation patterns histopathology and pain mechanisms in Achilles and patellar tendons has led to an increased knowledge about the chronic painful tendon [3–6].

Soccer is a high intensity sport with intermittent work that puts high demands on aerobic ability. To develop the aerobic ability for soccer players it’s common to use small sided games (SSG). The training method resembles a real match but is played on a smaller area with fewer players. In a sports context, previous research shows a connection between internal motivation and greater perceived happiness to the activity, as well as perseverance in performing activities at hand. This may affect the athlete's development and performance. This study compared the external load (Total distance (TD), sprints (SL), high speed running (HHL), accelerations (ACC) and decelerations (DEC) in SSG between different pitch sizes and number of players. Furthermore it was studied whether there was a difference between the motivation and sizes and whether there was a correlation between motivation and external load. Seventeen soccer players (18 ± 1 years) from a soccerc academy participated in the study. Global Positioning System data were collected from the Polar Team Pro application, allocated from the football club. SSG pitch sizes were 7vs7; 50m x 35-45m, 4vs4; 32m x 20m. TD were longer in SSG 7vs7 than in SSG 4vs4 (p <0.05), players made more accelerations (p <0.05) and decelerations (p <0.05) in SSG 7vs7. A survey based on the Situational Motivation Scale (SIMS) was used to measure the players' form of motivation; Internal motivation, identified regulation, external regulation and amotivation. The results showed no significant differences between SSG 7vs7 and SSG 4vs4 for the motivation forms. The results showed a significant negative correlation between amtoviation and TD in SSG 7vs7, and in identified regulation and SL in SSG 7vs7. This study shows that different layouts of SSG affect the external load of young soccer players in different ways and that the players’ motivation can affect the outcome of training and development. More research is needed on young soccer players to ensure reliable results. 

Objective: To assess the impact of coronavirus on the physical activity levels before and during self-quarantine, and the effect of self-isolation on the total mood status of Iranian citizens during the covid-19 pandemic. 

Material and Methods: A national sample of 2359 middle-aged (M age=42.8±5.3 years, n=1183,50.1%, male; n=1148, 48.7% female) Iranian completed an online questionnaire that assessed changes in daily physical activity behavior and mood status from March 20th to April 20th, 2020. The questionnaire implemented to collect the total duration, intensity, and frequency of physical activity and their psychological mood condition via the BRUMS Mood Scale.

Results: There were significant differences between physical activity frequency, duration, and intensity before and during the coronavirus pandemic. There was no significant difference between the total mood conditions between the sex categories. The main key finding of the current study is that the total physical activity participation behavior of our middle-aged populations has decreased meaningfully.

Conclusion: The present study has provided important approaches that should be implemented to promote the engagement of middle-aged adults in physical activity. Therefore, based on scientific evidence, maintaining a regular physical activity routine regarding world health organization guidelines is a key strategy for physical health.

Background and purpose: Patients with focal cartilage lesions experience functional impairment. Results for biological treatments in the middle-aged patient is poor. Previous studies with focal prosthetic inlay resurfacing have shown a higher risk of conversion to total knee replacement at mid-term follow-up. A novel customized implant (Episealer, Episurf, Stockholm, Sweden) has been proposed to improve implant positioning and survival. The primary objective was to assess subjective-, objective function and implant survival at a minimum of five years after surgery.

Materials and methods: The inclusion criteria were patients aged 30–65 years with symptomatic focal chondral defects in the medial femoral condyle, International Cartilage Research Society grade 3 or 4 and failed conservative or surgical treatment. Minimum follow-up of 5 years. Clinical and radiologic assessments were made. Patient-reported outcome measurements at the latest follow-up were compared with the baseline data for the Knee injury and Osteoarthritis Outcome Score (KOOS), the EuroQoL (EQ-5D), the Tegner Activity Scale and a Visual Analog Scale of pain (VAS 0–10).

Results: Ten patients with the mean follow-up period of 75 months (60–86 months, SD 10) were included. Signs of osteoarthritis were seen in one patient (Ahlbäck 1). No cases with revision to knee replacement. VAS for pain and KOOS showed improvements that reached significance for VAS (p ≤ 0.001) and the KOOS subscores Pain (p = 0.01), ADL (p = 0.003), Sport and Recreation (p = 0.024) and Quality of Life (p = 0.003).

Conclusion: A good subjective outcome, a low risk of progression to degenerative changes and the need for subsequent surgery were seen at the mid-term follow-up with this customized focal knee-resurfacing implant.

Level of evidence: Prospective case series, level 4.

Purpose: Chronic painful quadriceps tendinopathy is a relatively rare condition known to be difficult to manage. Conservative management is first-line treatment and if that fails open intra-tendinous revision surgery followed by a long rehabilitation period is used. There is sparse research on etiology and new treatment methods. This observational study aimed to evaluate the intra-articular findings in patients with chronic painful quadriceps tendinopathy resistant to conservative management.

Patients and Methods: Seven male athletes (mean age 33 years, range 22–40) suffering from chronic painful quadriceps tendinopathy in altogether 10 tendons, not responding to conservative management including heavy strength training, were included. Clinical examination and ultrasound scanning were used for diagnosis. Arthroscopy was used for evaluation of the inside of the knee.

Results: In all 10 knees, there were obliterating major plica formations in the suprapatellar pouch.

Conclusion: Obliterating plica formations in the suprapatellar pouch may be involved in the aetiology and pathology in quadriceps tendinopathy.

Background: Plantaris tendinopathy and plantaris-associated Achilles tendinopathy can be responsible for chronic pain in the Achilles tendon midportion, often accompanied by medial tenderness. As conservative treatments are less successful for this patient group, proper diagnosis is important for decision making. This report presents a case with plantaris tendinopathy in a rare (superficial) location.

Case presentation: This article describes a pain history and treatment timeline of a professional Swedish female soccer player (32 years old, Northern European ethnicity, white) who suffered from sharp pain in the Achilles tendon midportion and tenderness on the medial and superficial side for about 2 years. Conservative treatments, including eccentric exercises, were not successful and, to some extent, even caused additional irritation in that region. Ultrasound showed a wide and thick plantaris tendon located on the superficial side of the Achilles tendon midportion. The patient was surgically treated with local removal of the plantaris tendon. After surgery there was a relatively quick (4–6 weeks) rehabilitation, with immediate weight bearing, gradual increased loading, and return to running activities after 4 weeks. At follow-up at 8 weeks, the patient was running and had not experienced any further episodes of sharp pain during change of direction or sprinting.

Conclusions: The plantaris tendon should be considered as a possible source of Achilles tendon pain. This case study demonstrates that the plantaris tendon can be found in unexpected (superficial) positions and needs to be carefully visualized during clinical and imaging examinations.

Objectives: Chronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.

Methods: Ninety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24-64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.

Results: In 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.

Conclusion: Plantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.

Level of evidence: IV case series.

Background and Objectives: Patellar tendinopathy is difficult to treat, and when combined with partial rupture, there are additional challenges. The aim of this study was to evaluate the subjective outcome and return-to-sport status after ultrasound (US)- and colour doppler (CD)-guided wide awake local anaesthetic no tourniquet (WALANT) arthroscopic shaving in elite athletes.

Material and Methods: Thirty Swedish and international elite athletes (27 males) with a long duration (>1 year) of persistent painful patellar tendinopathy in 35 patellar tendons, not responding to non-surgical treatment, were included. All patients were treated with the same protocol of arthroscopic shaving, including bone removal and debridement of partial rupture, followed by at least 3 months of structured rehabilitation. The VISA-P score and a study-specific questionnaire evaluating physical activity level and subjective satisfaction with the treatment were used for evaluation.

Results: At the 2-year follow-up (mean 23, range 8–38 months), 25/30 patients (29/35 tendons) were satisfied with the treatment result and had returned to their pre-injury sport. The mean VISA-P score increased from 37 (range 7–69) before surgery to 80 (range 44–100) after surgery (p < 0.05). There was one drop-out (one tendon). There were no complications.

Conclusions: US- and CD-guided WALANT arthroscopic shaving for persistent painful patellar tendinopathy, including bone removal and debridement of partial rupture, followed by structured rehabilitation showed good clinical results in the majority of the elite-level athletes.

Background Insertional Achilles tendinopathy is well known to be difficult to treat, especially when there is intra-tendinous bone pathology. This study is a case series on patients with chronic insertional Achilles tendon pain and major intra-tendinous bony pathology together with bursa and tendon pathology, treated with excision of the subcutaneous bursa alone. Methods Eleven patients (eight men and three women) with a mean age of 44 years (range 24-62) and a chronic (>6 months) painful condition from altogether 15 Achilles tendon insertions were included. In all patients, ultrasound examination showed intra-tendinous bone pathology together with pathology in the tendon and subcutaneous bursa, and all were surgically treated with an open excision of the whole subcutaneous bursa alone. This was followed by full weight-bearing walking in a shoe with open heel for 6 weeks. Results At follow-up 21 (median, range 12-108) months after surgery, 9/11 patients (12/15 tendons) were satisfied with the result of the operation and 10/11 (13/15 tendons) were back in their previous sport and recreational activities. The median VISA-A score had improved from 41 (range 0-52) to 91 (range 33-100) (p<0.01). Conclusion In patients with chronic painful insertional Achilles tendinopathy with intra-tendinous bone pathology, tendon and bursa pathology, open removal of the subcutaneous bursa alone can relieve the pain and allow for Achilles tendon loading activities. The results in this case series highlight the need for more studies on the pain mechanisms in insertional Achilles tendinopathy and the need for randomised studies to strengthen the conclusions.

Objectives: Jumper's knee, or proximal patellar tendinopathy, is commonly seen among athletes in leg explosive sports, and for a subgroup surgical treatment is needed. The aim of this study was to identify what type of sports were most frequent among athletes treated surgically for Jumper's knee at an international tendon clinic during a consecutive 13-year period.

Methods: The study included 344 consecutive patients (306 males, mean age 27 years, range 17-58; 38 females, mean age 24 years, range 18-44) from 21 different countries seeking help for therapy-resistant jumper's knee. There were 274 elite athletes, 168 being full-time professionals. All were diagnosed to have tendinopathy in the proximal patellar tendon and were operated on with ultrasound- and Doppler-guided arthroscopic shaving surgery.

Results: The single most common sport was football (n = 95, 28%), followed by rugby (n = 37, 11%) and handball (n = 32, 9%), with 117 (34%) playing at a professional level. The rest of the athletes participated in 17 other different elite sports and nine recreational sports (running/jogging, padel, squash, biking, gym training, bowling, cheerleading, dancing, and ultimate frisbee).

Conclusions: Football was the most common sport among patients requiring surgical treatment for jumper's knee, constituting 28% of all patients, and together with rugby and handball they constituted almost half of all patients. There was a wide sport distribution with 29 different team and individual sports represented.

Background and Objectives: Chronic painful midportion Achilles combined with plantaris tendinopathy can be a troublesome condition to treat. The objective was to prospectively follow patients subjected to ultrasound (US)- and color doppler (CD)-guided wide awake, local anesthetic, no-tourniquet (WALANT) surgery in a private setting.

Material and Methods: Twenty-six Swedish patients (17 men and 9 women, mean age 50 years (range 29-62)) and eight international male patients (mean age of 38 years (range 25-71)) with combined midportion Achilles and plantaris tendinopathy in 45 tendons altogether were included. All patients had had >6 months of pain and had tried non-surgical treatment with eccentric training, without effect. US + CD-guided surgical scraping of the ventral Achilles tendon and plantaris removal under local anesthesia was performed on all patients. A 4-6-week rehabilitation protocol with an immediate full-weight-bearing tendon loading regime was used. The VISA-A score and a study-specific questionnaire evaluating physical activity level and subjective satisfaction with the treatment were used for evaluation.

Results: At the 1-year follow-up, 32/34 patients (43 tendons) were satisfied with the treatment result and had returned to their pre-injury Achilles tendon loading activity. There were two dropouts (two tendons). For the Swedish patients, the mean VISA-A score increased from 34 (0-64) before surgery to 93 (61-100) after surgery (p < 0.001). There were two complications, one wound rupture and one superficial skin infection.

Conclusions: For patients suffering from painful midportion Achilles tendinopathy and plantaris tendinopathy, US + CD-guided surgical Achilles tendon scraping and plantaris tendon removal showed a high satisfaction rate and good functional results 1 year after surgery.

Purpose: Midportion Achilles tendinopathy is a relatively common condition. This study aimed to investigate the presence of a normal Achilles tendon, but a tendinopathic plantaris tendon, in a large and consecutive prospective sample of patients referred to a specialised tendon clinic for midportion Achilles tendon pain not responding to non-surgical treatment.

Patients and Methods: A total of 105 consecutive tendons were operated on in 81 patients (62 males) suffering from painful midportion Achilles tendon pain. Clinical examination, ultrasound (US) and colour Doppler (CD) examination, and wide awake local anaesthetic no tourniquet (WALANT) surgery were performed in all patients.

Results: For 19/105 (18%) tendons from 14 patients, clinical examination suspected plantaris tendinopathy alone as there was a distinct tenderness on the medial side, but no thickening of the Achilles tendon. US examination followed by surgery confirmed the diagnosis.

Conclusion: Midportion Achilles tendon pain is not always related to Achilles tendinopathy since pain related to the plantaris tendon alone was found in almost every fifth patient. Consequently, there is an obvious need for proper examination to identify the pain source and establish a correct diagnosis before treatment.

The purpose of this review was to compare radial versus focused shock wave therapy and to review shock wave therapies usage to reduce pain and increase physical function for the Achilles tendinopathy.The review has followed PRISMA’s checklist while using PubMed, SPORTDiscus, CINAHL, Scopus and Web of Science databases. Data has been analyzed narratively and the evidence of the outcomes has been assessed.A significant difference in pain reduction was seen within two studies for both interventions. Where radial shock wave therapy was administered the intervention groups had a higher pain reduction than the control group. Where focused shock wave therapy was administered the control group had a higher pain reduction than the intervention group. A significant difference in the restoration of physical function was seen within three studies for radial shock wave therapy and two studies for focused shock wave therapy. Where radial shock wave therapy was administered the intervention groups had a greater increased physical function than the control groups and where focused shock wave treatment was administered the control groups had a greater increased physical function than the intervention groups.Radial shock wave therapy seems to be effective to reduce pain and increase physical function in the Achilles tendinopathy. The evidence of the results for focused shock wave therapy is too low to draw any conclusion, or allow us to compare the two methods. Had the studies allowed for a direct comparison between the two methods, this could have led to a guide for healthcare professionals. 

A common issue after injuries with or without surgery is muscular atrophy. Every year approximately 8000 individuals injure their ACL only in Sweden and 4000 undergo surgery. Rehabilitation usually consists of strength training and 70 % of 1RM is a preferred weightwhen trying to build strength and muscle. This systematic review and meta-analysis were investigating the effect of occlusion training after ACL injury compared to traditional rehabilitation, measured with knee function, muscle strength, pain and muscle mass. In this review PubMed, Cinahl, Sportsmedicine & Education index, Cochrane Library, SportDiscus and Web of Science were used for the database search. Two independent authors performed the selection process, GRADE and risk of bias assessment. A total of nine studies were included for the synthesis where four could be included in the meta-analysis. No significant difference were found in the meta-analysis looking at muscle mass. No meta-analysis could be performed on knee function, muscle strength or knee pain. There was a significant difference in the intervention group performing occlusion training compared to the control group when looking at knee pain and knee function, but could not be verified bymeta-analysis. In conclusion occlusion training compared with traditional rehabilitation occlusion training seem to reduce experienced pain during training, increase knee function, preserve more muscle mass and give similar results in strength after 16 days to 16 weeks post ACLR.

Background: Women exercises more now than before, and many of them become pregnant. Exercise during pregnancy has many health benefits. Most advice about exercise during pregnancy is about exercise at a moderate intensity and prevention of pregnancy complications. Some women exercise more than these recommendations. There are advice and recommendations for elite athletes and research on high intensity exercise during pregnancy. Although it is unclear if these advice reaches pregnant women who exercises at a high intensity level.

Objective: To examine if the amount of exercise changed during pregnancy for healthy women who exercised at a high intensity level, how they had perceived the information about exercise during pregnancy they had received and where they got the information from.

Participants: Eighteen women (23–37 years) participated in the study. Criteria for inclusion were first time pregnancy, pregnant in the third trimester up until four weeks postpartum, pregnancy without complications and exercise at a high intensity at least three times a week during at least one year before and up until the pregnancy, either cardio, strength or both.

Method: The participants answered an online survey with 23 questions. The questions were about amount of exercise during pregnancy and the information about exercise the women had received during pregnancy.

Results: Most of the women decreased their amount of exercise during pregnancy and many of the women lacked adequate information to be able to exercise at desired level. Information about exercise came mainly from midwifes.

Conclusion: The amount of exercise in healthy exercising pregnant women have decreased during pregnancy at the same time as the women lacked adequate information about exercise. The women received information about exercise mainly from midwifes. It cannot be said if the lack of information has affected the amount of exercise but that would be interesting to investigate further in future studies. Continued research about high intensity exercise during pregnancy is needed to be able to give adequate information to pregnant women who exercises at a high intensity.

Low energy availability (LEA) can generate performance and health consequences. The cause of LEA seems to be multi factorial and the sports environment can make demands on different body types. This study investigates LEA in female adolescent athletes in endurance- and intermittent sports, using Low Energy Availability in Females Questionnaire (LEAF-Q). Further, LEAF-Q is compared to weight-related behaviors and perceived pressure to attain a body ideal in the specific sport. Body ideal, weight-related behaviors and the view of body composition in this population is also described. Twenty-six (n = 26) endurance athletes and twenty-five (n = 25) intermittent athletes were recruited from national/regional sports high schools in Sweden. A survey-study consisting of LEAF-Q and body ideals questions, was conducted.

No significant difference was found between athletes in risk of LEA from LEAF-Q score (p<.21). In comparison to athletes at risk of LEA and not at risk, no significant difference was found in perceived pressure to attain the body ideal within the sport (p <.823) but in perceived sports body ideal pressure from coaches/teammates (p <.04). In comparison between athletes at risk of LEA, endurance athletes seemed to strive for weight loss (p <.01). Additionally, they had the perception of a thinner body ideal and the idea that a lower weight or different body composition would lead to a performance improvement (38%) in a greater extent than intermittent athletes (16%).

Conclusively, prevalence of LEA did not significantly differ between athletes. Athletes in risk of LEA experience body ideal pressure from coaches/team mates in greater extent than athletes with no risk. In athletes at risk of LEA, only endurance athletes seemed to strive for weight loss. A leaner body ideal and the perception of improved performance from a certain body composition/weight, was greater in endurance athletes than in intermittent athletes. 

Iron is an essential micronutrient for oxygen transport and mitochondrial metabolism and is critical for physical performance. Compromised iron stores are more commonly found among athletes, and females are especially at risk. Iron deficiency is generally treated using oral iron supplements. However, only a small proportion of ingested iron is absorbed, necessitating higher intakes, which may result in adverse side effects, reduced compliance, and inefficient repletion of iron stores. The probiotic strainLactobacillus plantarum299v (Lp299v) significantly increases intestinal iron absorption in meal studies. The present study was conducted to explore the effects of 20 mg of iron with or without Lp299v on iron status, mood state, and physical performance. Fifty-three healthy non-anemic female athletes with low iron stores (ferritin < 30 mu g/L) were randomized, and 39 completed the study. Intake of Lp299v with iron for four weeks increased ferritin levels more than iron alone (13.6 vs. 8.2 mu g/L), but the difference between the groups was not significant (p= 0.056). The mean reticulocyte hemoglobin content increased after intake of Lp299v compared to control (1.5 vs. 0.82 pg) after 12 weeks, but the difference between the group was not significant (p= 0.083). The Profile of Mood States (POMS) questionnaire showed increased vigor with Lp299v vs. iron alone after 12 weeks (3.5 vs. 0.1,p= 0.015). No conclusive effects on physical performance were observed. In conclusion, Lp299v, together with 20 mg of iron, could result in a more substantial and rapid improvement in iron status and improved vigor compared to 20 mg of iron alone. A larger clinical trial is needed to further explore these findings as well as the impact of Lp299v on physical performance.

Our study aimed to investigate the effects of exercise on HDL composition and functional properties in overweight/obese subjects. Eighteen overweight/obese subjects (nine F and nine M, BMI = 30.3 ± 3 kg/m2) attended supervised training for 7 weeks. The protocol included combined resistance and conditioning training four to five times each week. The activity of the antioxidant enzyme paraoxonase-1 (PON1) associated with HDL was evaluated in all subjects before and after the training intervention. Moreover, myeloperoxidase (MPO) levels and oxidative stress markers (ox-LDLs and total antioxidant capacity) were studied in the serums of the subjects. At the end of the intervention, the activity of PON1 was increased (p < 0.0001), and MPO levels and the MPO/PON1 ratio were decreased (p < 0.0001). In addition, a significant improvement in muscle strength and maximal oxygen uptake (VO2max) (p < 0.0001) and a significant reduction in total and visceral adipose tissue mass (p < 0.001) and waist circumference (p < 0.008), without any significant decrease in body weight, were observed. A significant correlation was established between serum MPO/PON ratios, HDL redox activity and ox-LDLs. In conclusion, our results demonstrate that exercise training, without modifications of dietary habits, improved HDL functionality in overweight/obese adults, without any significant reduction in BMI or modifications of glucose and lipid biochemical parameters.

Introduction: Acute injuries are generally classified as more severe than overuse injuries due to the fact that they often lead to longer time away from sport. This type of classification of severity in research is not deemed appropriate since it often excludes people suffering from overuse injuries. People with overuse injuries usually stay in their sport but participates with pain, reduced function and performance.

Purpose: The purpose of this study was to examine significant differences between adherence to rehabilitation, cognitive appraisal and perceived pain depending on if a sport injury has occurred acute or due to overuse.  

Participants: 51 participants answered the questionnaire and 39 (14 women and 25 men) of these were included in the study. The participants were between 16 and 35 years old, suffered from a sport injury and had a rehabilitation program to treat their injury. Based on the diagnosis and description of the injury the participants were separated into two groups, either acute injury or overuse injury.

Method: A questionnaire including two validated questionnaires, the Rehabilitation Adherence Questionnaire and Cognitive Appraisal Health Scale and an estimation of highest experienced pain were distributed among different sport teams and social media. To investigate if there were any significant differences between the two groups on the examined variables several t-tests and one ANOVA was completed.

Results: No significant differences were found between the two groups on any of the examined variables. The category threat on the Cognitive Appraisal Health Scale were close to significance (p=0,071) and suggests that people who suffer from an acute injury found their injury to be more threatful.

Conclusion: If a sport injury has occurred acute or because of overuse doesn't seem to be a singular determinant factor that affects adherence to rehabilitation, cognitive appraisal or perceived pain

Objectives: We aimed to systematically review the potential benefits of digital exercise interventions for improving measures of central obesity including visceral adipose tissue (VAT) and anthropometric surrogates for VAT in overweight or centrally obese adults aged 18 or over.

Methods: A systematic literature search was conducted in three databases up until March 2020 (PROSPERO registration nr CRD42019126764).

Results: N = 5 studies including 438 participants (age 48–80) with body mass index ≥ 25 kg/m² met the eligibility criteria and were included. The duration of the interventions ranged from 8 to 24 weeks. No study measured the primary outcome VAT, although in N = 4 studies, waist circumference (WC) decreased by between 1.3 and 5.6 cm in the intervention groups.

Conclusions: This systematic review shows that there is no evidence for the effects of digital exercise on VAT, although digital exercise may decrease WC. These findings highlight the need for additional randomized controlled trials to confirm the findings with respect to WC, and to further investigate the effects of digital exercise on VAT. Together, this may have important implications for reducing the burden of physical inactivity and obesity.

BACKGROUND: Visceral adipose tissue (VAT) is a strong risk factor for cardiovascular disease and increases with age. While supervised exercise (SE) may be an effective approach, web-based exercise (WE) have other advantages such as being more readily accessible. Therefore, we evaluated the effects of WE on VAT, body composition and cardiometabolic risk markers in centrally obese older adults and compared the effects of WE to SE. We also explored the feasibility of WE.

METHODS: In a randomized controlled trial conducted in Umeå, Sweden during January 2018 - November 2018, N = 77, 70-year-old men and women with central obesity (> 1 kg VAT for women, > 2 kg for men) were randomized to an intervention group (n = 38) and a wait-list control group (n = 39). The intervention group received 10 weeks of SE while the wait-list control group lived as usual. Following a 10-week wash-out-period, the wait-list control group received 10 weeks of WE. The primary outcome was changes in VAT. Secondary outcomes included changes in fat mass (FM), lean body mass (LBM), blood lipids, fasting blood glucose. Additionally, we explored the feasibility of WE defined as adherence and participant experiences.

RESULTS: WE had no significant effect on VAT (P = 0.5), although it decreased FM by 450 g (95% confidence interval [CI], 37 to 836, P < 0.05). The adherence to WE was 85% and 87-97% of the participants rated aspects of the WE intervention > 4 on a scale of 1-5. Comparing SE to WE, there was no significant difference in decrease of VAT (Cohen's δ effect size [ES], 0.5, 95% CI, - 24 to 223, P = 0.11), although SE decreased FM by 619 g (ES, 0.5, 95% CI, 22 to 1215, P < 0.05) compared to WE.

CONCLUSIONS: Ten weeks of vigorous WE is insufficient to decrease VAT in centrally obese older adults, but sufficient to decrease FM while preserving LBM. The high adherence and positive experiences of the WE intervention implies that it could serve as an alternative exercise strategy for older adults with central obesity, with increased availability for a larger population.

TRIAL REGISTRATION: ClinicalTrials.gov (NCT03450655), retrospectively registered February 28, 2018.

Introduction: The rationale for the use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions is still under debate. The evidence supporting best practise guidelines is based on studies with low-level evidence. A consensus group of experts was convened to collaboratively advance towards consensus opinions regarding the best available evidence. The purpose of this article is to report the resulting consensus statements.

Methods: Twenty-five experts participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted via an online survey of two rounds, for initial agreement and comments on the proposed statements. An in-person meeting between the panellists was organised during the 2022 ESSKA congress to further discuss and debate each of the statements. A final agreement was made via a final online survey a few days later. The strength of consensus was characterised as: consensus, 51–74% agreement; strong consensus, 75–99% agreement; unanimous, 100% agreement.

Results: Statements were developed in the fields of patient assessment and indications, surgical considerations and postoperative care. Between the 25 statements that were discussed by this working group, 18 achieved unanimous, whilst 7 strong consensus.

Conclusion: The consensus statements, derived from experts in the field, represent guidelines to assist clinicians in decision-making for the appropriate use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions. Level of evidence: Level V.

In elite football, physical performance during matches is evaluated using global positioning systems (GPSs). At lower levels, tests of physical capacity, such as the Yo-Yo Intermittent Recovery Test Level 2 (YYIR2), are used to predict physical match performance. It is however unclear whether YYIR2 performance is associated with physical match performance. This study investigated potential correlations between YYIR2 performance and physical match parameters towards the end of football matches.Nine male football players (mean ± SD: age = 24.2 ± 3.8 years; height = 184 ± 5.4 cm; weight = 78.9 ± 4.6 kg) of an elite Swedish football team participated. Data from five physical parameters were collected from 28 matches during the 2020 season with the STATSport Apex 10 Hz GPS system. YYIR2 was performed by all players during pre-season. Correlations between YYIR2 performance and each physical match parameter were analysed using Spearman's rho.A significant negative correlation was observed between YYIR2 and the proportion of accelerations (r = -0.812, p = 0.008). No significant correlations were observed between YYIR2 and total distance (r = 0.059, p = 0.881), high-speed runs (r = -0.437, p = 0.240), sprints (r = -0.268, p = 0.486) or decelerations (r = -0.360, p = 0.342).Results indicate that the YYIR2 is a poor predictor of physical performance towards the end of football matches. The results should however be interpreted with caution due to low statistical power. Future research should investigate the influence of playing position on such correlations.

Previous studies on elite orienteers have been focusing on injury occurrence and location of injuries. Studies on risk factors and psychological relationship to injuries are limited. The purpose of this study where to evaluate if there are correlation between demographic, psychological or physical factors and severity score of injuries in elite orienteers. The study used already collected data from an RCT-study. The study involved 62 participants, of whom 32 were men and 30 women. Base measurements were collected from demographic data, stress questionaries and physical tests. The questionnaires that were used were Hassles and Uplifts Scale and Perceived Stress Scale. The physical tests consisted of heel- rise test and square jump test. To evaluate injuries the Oslo Sport Trauma Research Center Overuse Injury Questionnaire were performed every second week for 14 weeks. The analysis was performed with linear regression, but the residuals were not normally distributed and therefore non-parametric statistics were also performed and was compared with the linear regressions. In the multiple linear regression, a relationship was identified between the severity score of injuries and two variables, but which could not be confirmed by the non-parametric statistics. Therefore, no risk factor for injuries in elite orienteers could be established. This result is not corresponding with previous studies on similar sports, who have established that previous injury and stress are risk factors. Before conclusions can be drawn more studies with larger numbers of participants and longer follow-up period are needed before risk factors for injuries in elite orienteers can be identified.

Tests to evaluate runners' aerobic capacity aiming to design training programs are often performed on a treadmill, while the training mainly takes place on over-ground surfaces. Studies have shown that different degrees of inclination on treadmills can compensate for the differences in heart rate (HR) response between running on treadmills and over-ground surfaces. The purpose of the study was to test whether the blood lactate concentration (BLC) differs between over-ground running and treadmill running at matched HR, and if so; can inclination of the treadmill be adjusted to generate equal BLC at matched HR? Eight male elite runners performed three incremental running tests where HR and BLC were measured; on a flat treadmill at six running velocities, on a running track at six velocities equal to the HR at test one, and on a treadmill at a fixed HR on different inclines (0°, 0.3°, 0.6°, 0.9°, 1.1° and 1.5°). The results revealed a non-significant trend indicating that over-ground running yields higher BLC at matched HR than treadmill running, and that 0.3° incline on treadmill correlated best with over- ground running. This study demonstrates a clear tendency of higher BLC at a given HR when running on an over-ground surface in comparison to running on a treadmill. Furthermore, a 0.3° incline on a treadmill is suggested to compensate for the difference in BLC at matched HR, between running on a treadmill and on an over-ground surface. However, more research with a larger sample size is needed to conclude and generalize the results.

Introduction: Sleep is widely recognized as an important factor for athletic performance. The interest and possibility of measuring it has increased dramatically following the number of available wearable devices today. These wearables provide an opportunity to continuously collect data in a home environment, but because of the rapid increase of commercial availability, there remains a constant need for more validation of the most recent models.  

Purpose: The purpose of this review was to examine the capability of different wearables to monitor sleep in comparison to polysomnography (PSG), level I in healthy individuals. 

Method: A structured literature review was performed in the databases SPORTDiscus and PubMed under the period 2023-03-15 until 2023-04-06 with the aim of identifying relevant articles that compared commercially available wearables to PSG level I in healthy individuals. We assessed the quality and risk of bias of the included studies with a modified questionnaire from Downs & Black (1998). 

Results: After screening 213 articles, 11 of them were included, which in total amounted to 368 participants. The result showed that wearables struggle to correctly estimate the time spent in each sleep-stage in comparison with PSG. The capability to assess Total Sleep Time (TST) and Wake After Sleep Onset (WASO) varied between the different models. There were few statistically significant results of the ability to measure Sleep Onset Latency (SOL), Heart Rate (HR) and Heart Rate Variability (HRV). 

Conclusion: Wearables have, at present time, a difficult time correctly estimating time spent in each sleep-stage and show varied results in monitoring TST and WASO. Too few studies analyzed SOL, HR and HRV to draw conclusions regarding these variables. Individuals should be cautious when implementing the data from these devices, and aware of the potential risks when it is used with athletes. 

Background: Low back pain (LBP) is a common problem in the general population as well as in athletes. Among numerous different causes, one of the more serious is a herniated disc. LBP is frequent in many different sports with some typical risk factors being heavy lifts in combination with flexion and rotation of the spine. Depending on the severity of the LBP or herniated disc, it is usually treated with either physical therapy or surgery. Cognitive behavioral therapy (CBT) in combination with physical therapy have been shown to reduce kinesiophobia in patients with LBP, as well as in patients with herniated discs. However, less is known about its effects in athletes. Purpose: The purpose of this study was to present an overview of the current literature which have evaluated the effects of CBT on perceived kinesiophobia in athletes which have rehabilitated LBP or a herniated lumbar disc. Method: A literature search was performed in Pubmed using the primary search terms; low back pain, disc herniation, athletes, cognitive behavior therapy and kinesiophobia. Results: N=1971 articles were identified and judged for relevance by title and abstract. The results showed that no study have evaluated the effects of CBT combined with physical therapy on kinesiophobia in athletes suffering from LBP or a herniated lumbar disc. Searches for studies on individual sports gave no results either. Conclusion: The authors of this study could not find any studies where CBT was applied to athletes with LBP or a herniated lumbar disc. The literature points to CBT being an effective method in combination with physical therapy, this has however not been shown in the same extent on athletes. This indicates that more research in the field is required. Key words: well trained, back pain, ruptured disc, CBT, fear of movement.

Background: One of the primary functions of the human body is to be physically active and this is essential throughout life. Adults over 18 years of age are recommended to achieve at least 150 minutes of physical activity per week with moderate intensity spread throughout the week. Physical activity reduces the risk of premature death and cardiovascular diseases. Health-inspiring apps can improve lifestyle habits such as diet and physical activity and thus prevent diseases. Social media is a collective name for communication platforms. A connection between the use of social media and a deteriorated self-image and body image has been found.  

Purpose: The purpose of the study was to give an insight into how physical activity in adult women in the age group 18-60 years is influenced by the use of social media and health-inspired apps, and how social media affects self-image and body image in younger and older women.

Participants: The participants were 165 women in the ages 18 to 60 years. The younger age group (18-30 years) included 114 participants. There were 19 participants in the age group 31-40 years and 32 participants in the age group 41-60 years.

Method: A digitized questionnaire was designed to answer questions about background information, use of social media, physical activity, body image and self-image.

Result: The study's results show that 95% of the women were physically active and 33% of these were active 4-6 hours per week. The study has shown little awareness regarding how social media can be applied to physical activity in women 18-60 years. Younger women use social media to a greater extent and experienced poorer body image and self-image compared to older women

Conclusion: The study has answered the purpose that the use of social media and apps promote physical activity in women and that there is a difference in the use of social media, comparison and self-image between the age group 18-30 and 31-60.