A Scoping Review of the Epidemiology, Management, and Outcomes of Golf-Related Fractures

ABSTRACT

Golf is a popular sport; however, there is a paucity of data in relation to golf-associated fractures, and the rate and timing of returning to golf. The aim of this review is to describe golf-associated fractures, including epidemiology, management, and timing of returning to golf following treatment. A literature search was performed using MEDLINE/PubMed, Embase, and Web of Science. Data were extracted and summarized in a narrative synthesis. A total of 436 articles were identified with an initial search of which 58 met the inclusion criteria. Twelve anatomical sites of golf swing-related fractures were identified, of which 10 sites were specific for stress fractures. The most common sites of golf swing-related stress fractures were the ribs followed by the hook of hamate. There was a common theme of delay to diagnosis, being initially assigned to a soft tissue injury. Most golfers with swing-related stress fractures were able to return to golf with the exception of osteoporotic associated vertebral stress fractures. Timing of returning to golf was between 4 and 12 months for most of the golfers with stress fractures following conservative management. Operative intervention was an option of hook of hamate nonunion, following a stress fracture, and tibial shaft stress fractures. Golf equipment-related fractures were not rare and were associated with major trauma and in some cases associated with significant persistent morbidity. Golf-related stress fractures commonly involve the ribs and hook of hamate; knowledge of this may aid in early diagnosis and appropriate treatment when symptomatic golfers are encountered. Although golf is a noncontact sport, fractures associated with golf equipment can be life changing, and safety training guidelines should be established.

Validity and Reliability of the FlightScope Mevo+ Launch Monitor for Assessing Golf Performance

ABSTRACT

Brennan, A, Murray, A, Coughlan, D, Mountjoy, M, Wells, J, Ehlert, A, Xu, J, Broadie, M, Turner, A, and Bishop, C. Validity and reliability of the FlightScope Mevo+ launch monitor for assessing golf performance. J Strength Cond Res 38(4): e174-e181, 2024-The purpose of this study was to (a) assess the validity of the FlightScope Mevo+ against the TrackMan 4 and (b) determine the within-session reliability of both launch monitor systems when using a driver and a 6-iron. Twenty-nine youth golfers, with a minimum of 3 years of playing experience, volunteered for this study. All golfers completed 10 shots with a 6-iron and a driver, with 8 metrics concurrently monitored from both launch monitor systems in an indoor biomechanics laboratory. For both clubs, Pearson's r values ranged from small to near perfect ( r range = 0.254-0.985), with the strongest relationships evident for clubhead speed (CHS) and ball speed ( r ≥ 0.92). Bland-Altman plots showed almost perfect levels of agreement between devices for smash factor (mean bias ≤-0.016; 95% CI: -0.112, 0.079), whereas the poorest levels of agreement was for spin rate (mean bias ≤1,238; 95% CI: -2,628, 5,103). From a reliability standpoint, the TrackMan showed intraclass correlation coefficients (ICCs) ranging from moderate to excellent (ICC = 0.60-0.99) and coefficient of variation (CV) values ranged from good to poor (CV = 1.31-230.22%). For the Mevo+ device, ICC data ranged from poor to excellent (ICC = -0.22 to 0.99) and CV values ranged from good to poor (CV = 1.46-72.70%). Importantly, both devices showed similar trends, with the strongest reliability consistently evident for CHS, ball speed, carry distance, and smash factor. Finally, statistically significant differences ( p < 0.05) were evident between devices for spin rate (driver: d = 1.27; 6-iron: d = 0.90), launch angle (driver: d = 0.54), and attack angle (driver: d = -0.51). Collectively, these findings suggest that the FlightScope Mevo+ launch monitor is both valid and reliable when monitoring CHS, ball speed, carry distance, and smash factor. However, additional variables such as spin rate, launch angle, attack angle, and spin axis exhibit substantially greater variation compared with the TrackMan 4, suggesting that practitioners may wish to be cautious when providing golfers with feedback relating to these metrics.

Inequities in the Training Environment and Health of Female Golfers Participating in the 2022 International Golf Federation World Amateur Team Championships

OBJECTIVE

To assess health problems and training environment of female golfers participating in the 2022 World Amateur Team Championships (WATC) and to compare golfers (a) with and without health problems prior the WATC and (b) living and training in countries ranking in the upper versus lower 50% of the team results at the 2022 WATC.

DESIGN

Cross-sectional cohort study using an anonymous questionnaire.

SETTING

International Golf Federation WATC.

PARTICIPANTS

One hundred sixty-two female golfers from 56 countries.

INTERVENTIONS

N/A.

MAIN OUTCOME MEASURES

Golfers' answers on the presence and characteristics of health problems, their training environment, and to the Oslo Sport Trauma Research Centre Questionnaire.

RESULTS

Almost all golfers (n = 162; 96%) answered the questionnaire. In the 4 weeks before the WATC, 101 golfers (63.1%) experienced 186 musculoskeletal complaints, mainly at the lumbar spine/lower back, wrist, or shoulder. Just half of the golfers (50.6%) performed injury prevention exercises always or often. More than a third (37.4%) of the golfers reported illness complaints and 32.5% mental health problems in the 4 weeks preceding the WATC. General anxiety, performance anxiety, and low mood/depression were the most frequent mental health problems. Golfers with injury complaints rated their daily training environment poorer. Golfers ranking in the lower 50% at the WATC had significantly less support staff, rated their training environment poorer, and had a higher prevalence of illness complaints and mental health problems.

CONCLUSIONS

Effective illness and injury prevention programs should be implemented and better access to education and health support in the daily training environment provided.

Associations Between Physical Characteristics and Golf Clubhead Speed: A Systematic Review with Meta-Analysis

BACKGROUND

Historically, golf does not have a strong tradition of fitness testing and physical training. However, in recent years, both players and practitioners have started to recognise the value of a fitter and healthier body, owing to its potential positive impacts on performance, namely clubhead speed (CHS).

OBJECTIVE

The aim of this meta-analysis was to examine the associations between CHS (as measured using a driver) and a variety of physical characteristics.

METHODS

A systematic literature search with meta-analysis was conducted using Medline, SPORTDiscus, CINAHL and PubMed databases. Inclusion criteria required studies to have (1) determined the association between physical characteristics assessed in at least one physical test and CHS, (2) included golfers of any skill level but they had to be free from injury and (3) been peer-reviewed and published in the English language. Methodological quality was assessed using a modified version of the Downs and Black Quality Index tool and heterogeneity assessed via the Q statistic and I2. To provide summary effects for each of the physical characteristics and their associations with CHS, a random effects model was used where z-transformed r values (i.e. zr) were computed to enable effect size pooling within the meta-analysis.

RESULTS

Of the 3039 studies initially identified, 20 were included in the final analysis. CHS was significantly associated with lower body strength (zr = 0.47 [95% confidence intervals {CI} 0.24-0.69]), upper body strength (zr = 0.48 [95% CI 0.28-0.68]), jump displacement (zr = 0.53 [95% CI 0.28-0.78]), jump impulse (zr = 0.82 [95% CI 0.63-1.02]), jumping peak power (zr = 0.66 [95% CI 0.53-0.79]), upper body explosive strength (zr = 0.67 [95% CI 0.53-0.80]), anthropometry (zr = 0.43 [95% CI 0.29-0.58]) and muscle capacity (zr = 0.17 [95% CI 0.04-0.31]), but not flexibility (zr = - 0.04 [95% CI - 0.33 to 0.26]) or balance (zr =  - 0.06 [95% CI - 0.46 to 0.34]).

CONCLUSIONS

The findings from this meta-analysis highlight a range of physical characteristics are associated with CHS. Whilst significant associations ranged from trivial to large, noteworthy information is that jump impulse produced the strongest association, upper body explosive strength showed noticeably larger associations than upper body strength, and flexibility was not significant. These findings can be used to ensure practitioners prioritise appropriate fitness testing protocols for golfers.

Effects of Physical Training and Associations Between Physical Performance Characteristics and Golf Performance in Female Players: A Systematic Review With Meta-Analysis

ABSTRACT

Robinson, L, Murray, A, Ehlert, A, Wells, J, Jarvis, P, Turner, A, Glover, D, Coughlan, D, Hembrough, R, and Bishop, C. Effects of physical training and associations between physical performance characteristics and golf performance in female players: A systematic review with meta-analysis. J Strength Cond Res 37(12): e646-e655, 2023-The aims of this systematic review were to assess the association between physical performance and measures of golf performance, and the effects of physical training on measures of golf performance, in female golfers. A systematic literature search was conducted in PubMed, SPORTDiscus, Medline, and CINAHL. Inclusion criteria required studies to (a) have conducted a physical training intervention of any duration in female players and determine the effects on measures of golf performance, (b) determine the association between physical performance in at least one test and golf performance in female players, and (c) be peer-reviewed and published in English language. Methodological quality was assessed using a modified version of the Downs and Black Quality Index tool, and heterogeneity was examined through the Q statistic and I2 . Pooled effect sizes were calculated using standardized mean differences (SMDs) (with 95% confidence interval [CI]s) within a random-effects model, with Egger's regression test used to assess small study bias (inclusive of publication bias). Of the 2,378 articles screened, only 9 were included in the final review, with 3 of these being associative by design and 6 being training interventions. From an associative standpoint, clubhead speed (CHS) was reported in all 3 studies and was associated with measures of strength ( r = 0.54), lower-body power ( r = 0.60), upper-body power ( r = 0.56-0.57), and flexibility ( r = 0.52-0.71). When assessing the effects of physical training interventions, CHS was again the most commonly reported golf outcome measure ( n = 5). The random-effect model indicated that CHS significantly improves within each training group following training interventions (SMD = 0.73 [95% CIs: 0.32-1.14], Z = 3.50, p < 0.001), with trivial heterogeneity ( I2 = 0.00%, Q = 0.18; p = 0.9963) and no prevalence of small study bias depicted through the Egger's regression test ( z = -0.28, p = 0.78). From the available research, it seems that CHS can be positively affected from strength, power, and flexibility training interventions. From an associative standpoint, only 3 studies have been conducted solely in female players, with one showcasing questionable methodology. Future research should aim to carefully select test measures which better represent the physical capacities needed for the sport when determining the effects of and relationships with golf performance.

Improved Physical Health in Middle-Older Aged Golf Caddies Following 24 Weeks of High-Volume Physical Activity

BACKGROUND

The physical demands of golf caddying, including walking while carrying a golf bag, may potentially affect body composition, and markers of metabolic, cardiovascular, and musculoskeletal health. Therefore, this study examined the impact of 24 weeks of caddying on physical health in middle-older aged males.

METHODS

Eleven full-time experienced male caddies (age: 59 [8] y; caddying experience: 14 [12] y) were recruited from a local golf course. The following were assessed at preseason and after 24 weeks of caddying (March-September 2022): body composition, heart rate, blood pressure, blood lipids, and performance tests (static and dynamic balance, strength, and submaximal fitness). Physical activity (PA) levels were assessed at preseason and at the mid-point of the caddying season. Across the caddying season, participants completed a monthly average of 24.0 (3.8) rounds.

RESULTS

Following the caddying season, improvements in static balance (Δ = 13.5 s), dynamic balance (Δ = -1.8 s), and lower back absolute strength (Δ = 112.8 N), and muscle quality (Δ = 2.0 N·kg-1) were observed (all P < .05). Additionally, blood lipids, including total cholesterol (Δ = -0.6 mmol·L-1), high-density lipoprotein cholesterol (Δ = 0.1 mmol·L-1), low-density lipoprotein cholesterol (Δ = -0.6 mmol·L-1) (all P < .05), and body composition, including body mass (Δ = -2.7 kg), fat mass (Δ = -1.9 kg), fat percentage (Δ = -1.4%), fat-to-muscle ratio (Δ = -0.03), and body mass index (Δ = -0.9 kg·m-2) (all P < .05) improved. Caddying did not offer beneficial changes to cardiovascular variables or cardiorespiratory fitness (P > .05), while coronary heart disease risk score decreased (Δ = -3.3%) (P < .05). In relation to PA, light- (Δ = 145 min) and moderate-intensity (Δ = 71 min) PA, moderate to vigorous PA (Δ = 73 min), and total PA (Δ = 218 min) between preseason and the mid-point of the caddying season increased, while sedentary time (Δ = -172 min) decreased (all P < .05).

CONCLUSION

Golf caddying can provide several physical health benefits such as improvements in various markers of cardiometabolic health, lower back absolute strength, and static and dynamic balance. The physical health improvements that caddying offers is likely contributed to by increased PA volume and intensity through walking on the golf course. Therefore, caddying may represent a feasible model for increasing PA volume and intensity and achieve physical health-related benefits.

Practices and perceptions of strength and conditioning training in female golf: A cross-sectional survey study of high-level amateur players

This study aims to ascertain an in-depth understanding of current practices and perceptions of S&C training in high-level amateur female golfers. A cross-sectional, explorative survey study was constructed which asked questions relating to four key areas: i) general participant information, ii) current strength and conditioning (S&C) practices, iii) the perceived influence of S&C training on golf performance, and iv) knowledge and awareness of S&C. Results showed that the majority of female players had participated in some form of S&C training in the past, with the majority believing that clubhead speed and carry distance were the primary golfing metrics which could be positively impacted. More specifically, 91-97% of the players "Strongly agreed" or "Agreed" that the key physical characteristics for golf were strength and power for the lower and upper body, and flexibility. Interestingly, 58% of the players believed that S&C training should mimic the movement of the golf swing, which based off current evidence, is not how drive metrics and ultimately shots gained, can be maximised. This survey study provides useful information relating to the practices and perceptions of S&C training in high-level female amateur players and areas where education may be able to further advance player understanding of physical preparation.

Transforaminal lumbar interbody fusion with placement of steerable banana cage: A single-center retrospective analysis of radiographic parameters of success

INTRODUCTION

The transforaminal lumbar interbody fusion (TLIF) is among the most utilized methods for the surgical treatment of lumbar degenerative disc disease. The TLIF has advanced significantly with several iterative changes since its inception in the early 1980s, with the advent of several generations of interbody types, shapes, and materials. Steerable curvilinear interbodies are among the most recent innovations in this space and may offer biomechanical advantages, namely in preservation of lumbar and segmental lordosis. While radiographic parameters have been investigated for other cage shapes and lumbar interbody fusion techniques, no study has investigated postoperative radiographic outcomes specific to TLIFs done with curvilinear interbodies.

METHODS

This study is a retrospective review of TLIFs performed with curvilinear interbodies between 2019 and 2022 at a single institution. Upright radiographs were obtained preoperatively and at several timepoints postoperatively. Radiographic variables including interspace height and segmental lordosis were collected.

RESULTS

26 surgeries with 32 curvilinear interbodies were performed across 3 years. There was significant increase in segmental lordosis at the L4-L5 (p = 0.0183) and L5-S1 levels (p = 0.004) as well as interspace height postoperatively at levels L3-L4 (p = 0.011) and L4-L5 (p = 0.002). Pain as measured with the numeric rating scale significantly improved in the overall cohort postoperatively (p<0.001).

CONCLUSIONS

TLIF with curvilinear interbody placement increases segmental lordosis and interspace height at the L4-L5 and L5-S1 levels, and increased interspace height at the L3-L4 and L4-L5 levels. Further investigation into additional radiographic parameters is warranted and expanded cohort size would benefit deeper analysis of other spinal levels.

IMPLICATIONS FOR PRACTICE

As an increasing number of cage designs and materials are brought to market, studies such as this allow for better understanding of cage specific outcomes allowing for better informed device selection.

Trackman 4: Within and between-session reliability and inter-relationships of launch monitor metrics during indoor testing in high-level golfers

The aims of the present study were to: 1) investigate the within and between-session reliability of the Trackman 4 launch monitor system, and 2) determine the inter-relationships of some of these commonly used metrics. Golfers attended two test sessions at an indoor golf academy and performed 10 shots using their own driver. Results showed excellent within and between-session reliability for CHS (ICC = 0.99; SEM = 1.64-1.67 mph), ball speed (ICC = 0.97-0.99; SEM = 2.46-4.42 mph) and carry distance (ICC = 0.91-0.97; SEM = 7.80-14.21 mph). In contrast, spin rate showed the worst reliability (ICC = 0.02-0.60; SEM = 240.93-454.62 º/s) and also exhibited significant differences between test sessions (g = -0.41; p < 0.05), as did smash factor (g = 0.47; p < 0.05) and dynamic loft (g = -0.21; p < 0.05). Near perfect associations were evident in both test sessions between CHS and ball speed (r = 0.98-0.99), CHS and carry distance (r = 0.94-0.95), ball speed and carry distance (r = 0.97-0.98), and launch angle and dynamic loft (r = 0.98-0.99). Collectively, CHS, ball speed and carry distance serve as the most consistently reliable metrics making them excellent choices for practitioners working with golfers.

Cognitive and biomarker responses in healthy older adults to a 18-hole golf round and different walking types: a randomised cross-over study

Introduction

The global burden of age-related cognitive decline is increasing, with the number of people aged 60 and over expected to double by 2050. This study compares the acute effects of age-appropriate cognitively demanding aerobic exercises involving walking, on cognitive functions and exerkine responses such as brain-derived neurotrophic factor (BDNF) and cathepsin B (CTSB) in older, healthy adults.

Methods/design

Healthy older golfers (n=25, 16 male and 9 female, 69±4 years) were enrolled in a 5-day randomised cross-over study and completed three different exercise trials (18-hole golf round, 6 km Nordic walking, 6 km walking) in a real-life environment, in random order and at a self-selected pace. Differences in cognition (the Trail-Making Test (TMT) AB) and exerkines (BDNF and CTSB) were analysed within groups using the Wilcoxon signed-rank test and between groups using the Kruskal-Wallis test.

Results

All exercise types resulted in a significant decrease in the TMT A-test (p<0.05; golf: -4.43±1.5 s, Nordic walking: -4.63±1.6 s, walking: -6.75±2.26 s), where Nordic walking and walking demonstrated a decrease in the TMT B-test (p<0.05; Nordic walking: -9.62±7.2 s, walking: -7.55±3.2 s). In addition, all exercise types produced significant decreases in the TMT AB test scores (p<0.05), and Nordic walking (p=0.035) showed decreases in the TMTB-TMTA-test. There were no immediate postexercise changes in the levels of BDNF or CTSB.

Conclusion

Acute bouts of golf, Nordic walking and walking improved cognitive functions irrespective of exerkines in healthy older adults. In addition, Nordic walking and walking in general enhanced executive functions. No significant effects were seen on the levels of BDNF and CTSB.

Trial registration number

ISRCTN10007294.

Radiation Treatment Preparation Safety Risk Prediction

PURPOSE/OBJECTIVE(S)

To determine the effect of delays in radiation treatment preparation task timeliness on reported safety events.

MATERIALS/METHODS

For 2022, all patients treated at four community-based radiation oncology clinics were included for analysis. Safety reports which occurred during treatment preparation tasks (i.e., between CT simulation and the first treatment) were included for this analysis. Patients with a reported safety event were the report cohort and those without were the control cohort. Treatment preparation tasks are completed sequentially and included contouring, treatment planning, Radiation Oncologist review, Medical Physicist review, Therapist quality check. At baseline, each task was scheduled a standard interval for completion based on treatment technique. The time taken to complete each task was captured using ARIA v16.0 Care Path module (Varian Medical Systems, Palo Alto, CA) and extracted through database query. For each task, two metrics were quantified: Task (1) Completion Timeliness: the time (hours) to complete each task, relative to the time allocated to each task. A negative value indicated more time taken than scheduled. (2) Overall Timeliness: specific task timeliness (hours) relative to overall timeliness for the whole Care Path. A negative value indicated the tasks were behind schedule. A student's t-test with an alpha of 0.05 was used to indicate significance.

RESULTS

Over the study period, 66 courses had a reported treatment preparation safety event (report) and 2690 did not (control). Techniques include 54% and 56% 3DCRT, 35% and 35% IMRT, 3% and 3% SRS, and 6% and 8% SBRT, for the report and control groups, respectively. Disease sites include breast, GU, GI, head and neck, CNS, thoracic, skin, secondary, gynecological, sarcoma, and heme. Table 1 displays the timeliness for each of the five tasks. Of the courses with safety events, overall timeliness was significantly behind the control group from the in contouring, treatment planning, Radiation Oncologist review, and Medical Physicist review. Courses with safety events took significantly more time than scheduled early in treatment preparation with a significant increase at treatment planning and significantly less time towards the end with the therapist quality check.

CONCLUSION

Patient courses with reported safety events had significantly longer treatment planning times, and as a result inadequate time to perform each downstream pre-treatment activity. The implication of this analysis is that a flag could be created to indicate risk of a safety event early in the treatment preparation process.

Cost-Effective Modular Biosensor for SARS-CoV-2 and Influenza A Detection

A modular, multi-purpose, and cost-effective electrochemical biosensor based on a five-stranded four-way junction (5S-4WJ) system was developed for SARS-CoV-2 (genes S and N) and Influenza A virus (gene M) detection. The 5S-4WJ structure consists of an electrode-immobilized universal stem-loop (USL) strand, two auxiliary DNA strands, and a universal methylene blue redox strand (UMeB). This design allows for the detection of specific nucleic acid sequences using square wave voltammetry (SWV). The sequence-specific auxiliary DNA strands (m and f) ensure selectivity of the biosensor for target recognition utilizing the same USL and UMeB components. An important feature of this biosensor is the ability to reuse the USL-modified electrodes to detect the same or alternative targets in new samples. This is accomplished by a simple procedure involving rinsing the electrodes with water to disrupt the 5S-4WJ structure and subsequent re-hybridization of the USL strand with the appropriate set of strands for a new analysis. The biosensor exhibited minimal loss in signal after rehybridization, demonstrating its potential as a viable multiplex assay for both current and future pathogens, with a low limit of quantification (LOQ) of as low as 17 pM.

What differences exist between the lead and trail wrist in extensor carpi ulnaris activity and golf swing joint kinematics in sub-elite golfers?

This study assessed the lead and trail arm peak and average extensor carpi ulnaris (ECU) muscle activity in association with tri-planar angular velocities of the lead and trail wrists during the golf swing. Fifteen sub-elite, male right-handed golfers (Mage = 34.7 years ±13.3, Mhandicap = 1.5 ± 2.2) were recruited to execute five shots each with their pitching wedge, 7-iron and driver clubs in an indoor golf simulator. Surface electromyography (EMG) sensors were placed over the ECU muscle belly and inertial measurement unit sensors were placed bi-laterally on the distal forearm and dorsum of the hand. There was a statistically greater recruitment of the trail ECU muscle during the downswing (p < 0.001) for all clubs. The lead ECU muscle was recruited more during the backswing (p < 0.001) and follow through (p < 0.024) phases. There were statistically different tri-planar movement patterns between the lead and trail wrist throughout all three phases of the golf swing. No significant relationships were found between downswing EMG data and clubhead kinematics at impact. In conclusion, differing wrist kinematics and associated muscle activity may contribute to the asymmetrical injury pattern seen clinically.

Barriers and facilitators to goals of care conversations with Veteran residents of community nursing homes

BACKGROUND

Despite evidence that structured goals of care conversations (GoCCs) and documentation of life-sustaining treatment (LST) preferences improve the delivery of goal-concordant care for seriously ill patients, rates of completion remain low among nursing home residents. The Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED) program aims to improve the consistent documentation of LST preferences among Veterans receiving care in veterans affairs (VA)-paid community nursing homes (CNH); however, the barriers and facilitators of completing and documenting GoCCs in this unique context of care have not been described.

METHODS

We conducted semi-structured, qualitative interviews with key stakeholders of the VA CNH programs located at six VA Medical Centers between July 2021 and July 2022. With a rapid approach to analysis, interview transcripts were reduced into memo templates using the Tailored Implementation for Chronic Disease Checklist and coded and analyzed using qualitative data analysis software.

RESULTS

The 40 participants consisted of nurses (n = 13), social workers (n = 25), and VA physicians (n = 2). Most participants felt confident about conducting GoCC; however, several barriers were identified. At the staff level, our results indicated inconsistent completion of GoCC and documentation due to a lack of training, confusion about roles and responsibilities, and challenging communication within the VA as well as with CNH. At the organizational level, there was a lack of standardization across sites for how LST preferences were documented. At the patient level, we found key barriers related to patient and family readiness and issues finding surrogate decision makers. While COVID-19 brought end-of-life issues to the forefront, lockdowns hindered communication about the goals of care.

CONCLUSION

Findings from this pre-implementation evaluation revealed multi-level barriers in conducting and documenting GoCCs with Veterans receiving VA-paid CNH care, as well as several facilitators that can be used to inform strategies for improvement.

The seasonal variation of physical activity and quality of life during the first wave of the COVID-19 pandemic in Finnish older golfers: A cross-sectional study

Background and Aims

The COVID-19 pandemic was associated with reduced physical activity and increased sedentary behavior. Golf is a health-enhancing outdoor exercise and is associated with low risk of viral transmission. The purpose of this study was to describe the seasonal differences in physical activity and quality of life during the first wave of COVID-19 pandemic in 2020 in Finnish older golfers.

Methods

Older golfers (n = 325) from eight golf clubs retrospectively responded to a questionnaire in summer 2020 on their physical activity and golf activity in winter 2019/20 (pre-COVID-19 winter season) and summer season 2020. In addition, they reported their quality of life after the first wave of pandemic in summer 2020. To evaluate the seasonal differences in physical activity, life quality and its association with golf activity, the data were analyzed using the Mann-Whitney U test, Wilcoxon signed-rank test, Spearman's correlation test, and linear regression analysis.

Results

Despite COVID-19 restrictions, golfers' physical activity increased by 24% (p < 0.001) during the COVID-19 restrictions in the summer of 2020. Moderate physical activity increased by 37% (p < 0.001), walking activity increased by 26% (p < 0.001), and sitting decreased by 21% (p < 0.001) compared with the pre-COVID-19 winter season. The full 18-hole golf round activity was positively associated with moderate physical activity both in the summer and winter season, and with walking in the summer season. Over 90% of golfers reported good quality of life during the 2020 summer restrictions.

Conclusion

In contrast to physical activity levels generally decreasing during the first wave of pandemic, physical activity levels in Finnish golfers increased, and these golfers reported a good quality of life. Golf can provide health enhancing physical activity and older golfers seems to be physically active throughout the year.

Objective Measures of Strain and Subjective Muscle Soreness Differ Between Positional Groups and Season Phases in American College Football

PURPOSE

To assess objective strain and subjective muscle soreness in "Bigs" (offensive and defensive line), "Combos" (tight ends, quarterbacks, line backers, and running backs), and "Skills" (wide receivers and defensive backs) in American college football players during off-season, fall camp, and in-season phases.

METHODS

Twenty-three male players were assessed once weekly (3-wk off-season, 4-wk fall camp, and 3-wk in-season) for hydroperoxides (free oxygen radical test [FORT]), antioxidant capacity (free oxygen radical defense test [FORD]), oxidative stress index (OSI), countermovement-jump flight time, Reactive Strength Index (RSI) modified, and subjective soreness. Linear mixed models analyzed the effect of a 2-within-subject-SD change between predictor and dependent variables.

RESULTS

Compared to fall camp and in-season phases, off-season FORT (P ≤ .001 and <.001), FORD (P ≤ .001 and <.001), OSI (P ≤ .001 and <.001), flight time (P ≤ .001 and <.001), RSI modified (P ≤ .001 and <.001), and soreness (P ≤ .001 and <.001) were higher for "Bigs," whereas FORT (P ≤ .001 and <.001) and OSI (P = .02 and <.001) were lower for "Combos." FORT was higher for "Bigs" compared to "Combos" in all phases (P ≤ .001, .02, and .01). FORD was higher for "Skills" compared with "Bigs" in off-season (P = .02) and "Combos" in-season (P = .01). OSI was higher for "Bigs" compared with "Combos" (P ≤ .001) and "Skills" (P = .01) during off-season and to "Combos" in-season (P ≤ .001). Flight time was higher for "Skills" in fall camp compared with "Bigs" (P = .04) and to "Combos" in-season (P = .01). RSI modified was higher for "Skills" during off-season compared with "Bigs" (P = .02) and "Combos" during fall camp (P = .03), and in-season (P = .03).

CONCLUSION

Off-season American college football training resulted in higher objective strain and subjective muscle soreness in "Bigs" compared with fall camp and during in-season compared with "Combos" and "Skills" players.

Physical Demands of Tennis Across the Different Court Surfaces, Performance Levels and Sexes: A Systematic Review with Meta-analysis

BACKGROUND

Tennis is a multidirectional high-intensity intermittent sport for male and female individuals played across multiple surfaces. Although several studies have attempted to characterise the physical demands of tennis, a meta-analysis is still lacking.

OBJECTIVE

We aimed to describe and synthesise the physical demands of tennis across the different court surfaces, performance levels and sexes.

METHODS

PubMed, Embase, CINAHL and SPORTDiscus were searched from inception to 19 April, 2022. A backward citation search was conducted for included articles using Scopus. The PECOS framework was used to formulate eligibility criteria.

POPULATION

tennis players of regional, national or international playing levels (juniors and adults).

EXPOSURE

singles match play. Comparison: sex (male/female), court surface (hard, clay, grass).

OUTCOME

duration of play, on-court movement and stroke performance.

STUDY DESIGN

cross-sectional, longitudinal. Pooled means or mean differences with 95% confidence intervals were calculated. A random-effects meta-analysis with robust variance estimation was performed. The measures of heterogeneity were Cochrane Q and 95% prediction intervals. Subgroup analysis was used for different court surfaces.

RESULTS

The literature search generated 7736 references; 64 articles were included for qualitative and 42 for quantitative review. Mean [95% confidence interval] rally duration, strokes per rally and effective playing time on all surfaces were 5.5 s [4.9, 6.3], 4.1 [3.4, 5.0] and 18.6% [15.8, 21.7] for international male players and 6.4 s [5.4, 7.6], 3.9 [2.4, 6.2] and 20% [17.3, 23.3] for international female players. Mean running distances per point, set and match were 9.6 m [7.6, 12.2], 607 m [443, 832] and 2292 m [1767, 2973] (best-of-5) for international male players and 8.2 m [4.4, 15.2], 574 m [373, 883] and 1249 m [767, 2035] for international female players. Mean first- and second-serve speeds were 182 km·h^-1 [178, 187] and 149 km·h^-1 [135, 164] for international male players and 156 km·h^-1 95% confidence interval [151, 161] and 134 km·h^-1 [107, 168] for international female players.

CONCLUSIONS

The findings from this study provide a comprehensive summary of the physical demands of tennis. These results may guide tennis-specific training programmes. We recommend more consistent measuring and reporting of data to enable future meta-analysts to pool meaningful data.

CLINICAL TRIAL REGISTRATION

The protocol for this systematic review was registered a priori at the Open Science Framework (Registration DOI https://doi.org/10.17605/OSF.IO/MDWFY ).

Cross-sectional study of characteristics and prevalence of musculoskeletal complaints in 1170 male golfers

Objectives

The primary aim was to describe the characteristics and prevalence of musculoskeletal complaints of a large group of non-professional golfers. Secondary aims were to compare golfers different in (A) skill-level, (B) presence of low back pain (LBP) and (C) performance of prevention exercises.

Methods

A sample of 1170 male golfers (mean age 54.98, SD=13.3) were surveyed online on personal and golf-specific characteristics, medical history and complaints in the preceding 7 days. Subgroups (A) with different golfing handicap (0 to 5, >5 to 10, >10), (B) with and without LBP and (C) who performed versus did not perform injury prevention exercises were compared using analysis of variance and χ2test.

Results

The prevalence and severity of musculoskeletal complaints was similar in everyday life and when playing golf. More than one-third of the golfers (n=436; 37.3%) reported LBP in the preceding 7 days, while other frequently affected body parts were the shoulder and knee. Golfers with different skill level differed in age and most golf-related characteristics but not in prevalence and severity of musculoskeletal complaints. Golfers with and without LBP were similar in almost all variables. Golfers who performed prevention exercises (n=371; 27.1%) were older and had a higher prevalence of complaints.

Conclusion

The prevalence and severity of musculoskeletal complaints in golfers were similar to the wider population. It seems that injury prevention exercises were implemented after injury, rather than as primary prevention. Prospective studies looking at the epidemiology of injury, risk factors and interventions are required.

Smar2C2: A Simple and Efficient Protocol for the Identification of Transcription Start Sites

Promoters and the noncoding sequences that drive their function are fundamental aspects of genes that are critical to their regulation. The transcription preinitiation complex binds and assembles on promoters where it facilitates transcription. The transcription start site (TSS) is located downstream of the promoter sequence and is defined as the location in the genome where polymerase begins transcribing DNA into RNA. Knowing the location of TSSs is useful for annotation of genes, identification of non-coding sequences important to gene regulation, detection of alternative TSSs, and understanding of 5' UTR content. Several existing techniques make it possible to accurately identify TSSs, but are often difficult to perform experimentally, require large amounts of input RNA, or are unable to identify a large number of TSSs from a single sample. Many of these protocols take advantage of template switching reverse transcriptases (TSRTs), which reliably place an adaptor at the 5' end of a first strand synthesis of cDNA. Here, we introduce a protocol that exploits TSRT activity combined with rolling circle amplification to identify TSSs with several unique advantages over existing methods. Sequence adaptors are placed on the 5' and 3' end of the full-length cDNA copy of a transcript. A splint compatible with those adaptors is then used to circularize the full-length cDNA. Linear DNA containing concatemers of the cDNA are generated using rolling circle amplification, and a sequencing library is formed by fragmenting the concatemers. This protocol is straightforward to execute, requiring limited bench time with relatively stable reagents. Using extremely low amounts of RNA input, this protocol produces large numbers of accurate, deduplicated TSSs genome wide. © 2023 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Splint generation Basic Protocol 2: RNA extraction Basic Protocol 3: cDNA synthesis Basic Protocol 4: cDNA circularization and amplification Basic Protocol 5: Library generation.

Assessment of activity energy expenditure during competitive golf: The effects of bag carrying, electric or manual trolleys

Golf is a sport played around the globe, with an estimated 42.6 million people playing within the United Kingdom and United States of America alone. To date, there is limited data on the energy expenditure of golf. The present study assessed the activity energy expenditure (AEE) of 16 high-standard (handicap under 5) golfers who completed three rounds of competitive golf either carrying the golf bag (BC), using a manual push trolley (MT) or an electric trolley (ET) (Stewart Golf, Gloucester, UK). Prior to each round, participants were fitted with an Actiheart® accelerometer (Camntech, Fenstanton, UK) to estimate AEE, whilst ratings of perceived exertion (RPE) and enjoyment were collected following each round. Data were analysed using a one-way repeated measures ANOVA, with Hedges g effect sizes (ES) calculated. Mean (SD) AEE was 688 ± 213 kcal for BC, 756 ± 210 kcal for MT and 663 ± 218 kcal for ET (p = .05) although these differences were deemed small or less. The ET condition resulted in the lowest mean heart rate, moderate or very large from BC or MT, respectively. There were no significant differences in enjoyment although perceived exertion was lowest in the ET condition. In summary, we report meaningful differences in AEE between the three conditions (p = .05), with perceived exertion and maximum HR being lowest when using the electric trolley. Golf may be considered as an effective intervention to increase step count and improve physical activity levels across the general population regardless of transportation methods of clubs.

A Scoping Review of Transgender Policies in the 15 Most Commonly Played UK Professional Sports

INTRODUCTION

There has been much debate recently on the participation of transgender and gender-diverse (TGD) athletes in sport, particularly in relation to fairness, safety and inclusion. The 2021 IOC Framework on Fairness, Inclusion and Non-discrimination acknowledges the central role that eligibility criteria play in ensuring fairness, particularly in the female category, and states that athletes should not be excluded solely on the basis of their TGD identity.

AIMS

To identify policies that address TGD athlete participation in the 15 major United Kingdom (UK) sporting organisations and to summarise the evidence for each of these policies.

METHODS

A scoping review of TGD policies from the 15 major UK sporting organisations.

RESULTS

Eleven of the governing bodies had publicly available TGD policies. Most of the sporting associations drew guidance from the official 2015 IOC Consensus Meeting on Sex Reassignment and Hyperandrogenism, particularly with regard to physiological testosterone levels. Many organisations referenced their policies as a guide for decision making but stated that they ultimately made case-by-case decisions on an athlete's eligibility. Relevant considerations not addressed in most policies included pre- versus post-pubertal athletes, justification for testosterone thresholds, the length of time out of competitive action (if any) for transitioning athletes, the irreversible advantage from male puberty (if any), the responsibility for and frequency of follow up for hormonal testing and the consequences for athletes outside set testosterone limits.

CONCLUSIONS

There is a lack of consensus among the top 15 UK sporting organizations relating to elite sport participation for TGD athletes. It would be useful for sport organizations to work together to develop greater standardization/consensus for TGD athlete policies, taking into consideration fairness, safety and inclusion in each sport.

Mapping quality improvement education initiatives to Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines

AIMS AND OBJECTIVES

To explore the rigour of nurse-led quality improvement projects involving education, training or continuing professional development, and examine evaluation frameworks contained within.

BACKGROUND

Healthcare organisations invest significantly in quality improvement in the pursuit of cost-effective, safe, evidence-based and person-centred care. Consequently, efforts to examine the success of investment in quality improvement activities are prominent, against a backdrop of rising healthcare expenditure, reforms, consumer expectations and feedback.

DESIGN

A qualitative document analysis of quality improvement projects located in a local health district repository was undertaken.

METHODS

N = 3004 projects were screened against inclusion criteria, with n = 160 projects remaining for analysis. Projects were mapped to an adapted version of the Standards for QUality Improvement Reporting Excellence (SQUIRE), specifically the education extension (SQUIRE-EDU). Additionally, project evaluation frameworks were positioned within Kirkpatrick's four levels of training evaluation model. The SQUIRE checklist was also applied in line with EQUATOR guidelines.

RESULTS

Of n = 60 completed projects assessed against four broad SQUIRE-EDU categories and relevant criteria, n = 36 were assessed not to have met any categories, n = 14 projects met one category, n = 8 projects met two categories, and n = 2 projects met three categories. None of the completed projects met all four SQUIRE-EDU categories. There was insufficient documentation relating to evaluation frameworks in n = 133 projects to position within Kirkpatrick's four levels of training evaluation.

CONCLUSIONS

Scientific rigour should underpin all quality improvement efforts. We recommend that SQUIRE international consensus guidelines (full or abridged) should guide both the design and reporting of all local quality improvement efforts.

RELEVANCE TO CLINICAL PRACTICE

To be of value to the expansion of evidence-based practice, quality improvement platforms should be designed to reflect the structural logic, rigour and reporting recommendations being advocated in consensus reporting guidelines. This may require investment in training and development programs, and identification of governance and support systems. No Patient or Public Contribution, as the study was retrospective in nature and involved a health service repository of quality improvement projects accessible to health service staff only.