Position statement of the Royal Spanish Football Federation for the resumption of football activities after the COVID-19 pandemic (June 2020)

Are Football Players More Prone to Muscle Injury after COVID-19 Infection? The "Italian Injury Study" during the Serie a Championship

INTRODUCTION

Football was the first sport to resume competitions after the coronavirus disease 2019 (COVID-19) lockdown and promptly the hypothesis was raised of a potential relationship between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and musculoskeletal injuries in athletes. This study aimed to confirm the association between SARS-CoV-2 infection and muscle strain injury in a large population of elite football players and to investigate if the COVID-19 severity level could affect the risk of injury.

METHODS

A retrospective cohort study involving 15 Italian professional male football teams was performed during the Italian Serie A 2020-2021 season. Injuries and SARS-CoV-2 positivity data were collected by team doctors through an online database.

RESULTS

Of the 433 included players, we observed 173 SARS-CoV-2 infections and 332 indirect muscle strains. COVID-19 episodes mostly belonged to severity level I and II. The injury risk significantly increased after a COVID-19 event, by 36% (HR = 1.36, CI_95% 1.05; 1.77, p-value = 0.02). The injury burden demonstrated an 86% increase (ratio = 1.86, CI_95% 1.21; 2.86, p-value = 0.005) in the COVID-19 severity level II/III versus players without a previous SARS-CoV-2 infection, while level I (asymptomatic) patients showed a similar average burden (ratio = 0.92, CI_95% 0.54; 1.58, p-value = 0.77). A significantly higher proportion of muscle-tendon junction injuries (40.6% vs. 27.1%, difference = 13.5%, CI_95% 0.002%; 26.9%, p-value = 0.047) was found when comparing level II/III versus Non-COVID-19.

CONCLUSIONS

This study confirms the correlation between SARS-CoV-2 infection and indirect muscle injuries and highlights how the severity of the infection would represent an additional risk factor.

Impact of the COVID-19 Pandemic on Injury Incidence in Japanese Male Professional Soccer Players

Background

The outbreak of the 2019 novel coronavirus disease (COVID-19) led to an enforced quarantine period and limited training and match activities for athletes.

Purpose

To report the influence of the COVID-19 pandemic on the occurrence of injury in Japanese male professional soccer players.

Study Design

Descriptive epidemiology study.

Methods

In total, 21 clubs in the 2019 season and 28 clubs in the 2020 season from the Japan Professional Football League were prospectively followed, and 16 clubs in 2019 and 24 clubs in 2020 were analyzed in this study. Individual training, match exposure, and time-loss injuries were recorded using an electronic data capture system. The influence of COVID-19-related suspension during the 2020 season was retrospectively investigated via comparisons with the 2019 season.

Results

Total activity time included 114,001 hours in training and 16,339 hours in matches in 2019 and 170,798 hours in training and 25,411 hours in matches in 2020. The mean training interruption period caused by COVID-19 in 2020 was 39.9 days (range, 3-65 days), and the mean game-interruption period was 70.1 days (range, 58-79 days). The total number of injuries was 1495 in 2019 and 1701 in 2020. The overall injury incidence per 1000 hours of exposure was 5.7 in 2019 and 5.8 in 2020. The overall injury burden per 1000 hours of exposure was 155.5 days in 2019 and 130.2 days in 2020. The muscle injury incidence was highest in May 2020, immediately after the suspension period.

Conclusion

The overall injury incidence did not differ between 2019 and 2020. However, muscle injury incidence notably increased in the 2 months after the COVID-19 pandemic suspension period.

The Five-substitution Option Enhances Teams' Running Performance at High Speed in Football

The aim of this investigation was to describe how the introduction of the five-substitution option affected football teams' running performance. A comparative analysis was performed in 17 professional football teams for the 2019-2020 (up to three substitutions) vs 2020-2021 (five substitutions option) seasons in LaLiga. The five-substitution option increased the number of substitutions (from 2.9±0.1 to 4.2±1.0 substitutions/match, respectively; p<0.01, Effect Size (ES)=2.11) but it did not change the time selected for the first substitution (from 57.5±13.0 to 56.2±13.7 min; p=0.06, ES=0.1). Total running distance was similar between seasons but running distance at 21.0-23.9 km/h (from 3.0±0.4 to 3.2±0.4 km; p=0.01, ES=0.6) and at≥24.0 km/h (from 3.0±0.6 to 3.2±0.5 km; p=0.01, ES=0.3) were higher with the five-substitution option. These increases were associated with a higher distance covered by starting players (p<0.05) rather than an effect of substitute players.: With the five-substitution option, team coaches increased the number of substitutions per match which enhanced the possibilities of the team's staff to manage players' physical load. The five-substitution option allowed also increased running performance at≥21.0 km/h during the matches.

Bio-secure bubble during the COVID-19 pandemic to host the Asian Football Confederation (AFC) Champions League: A retrospective observational study

Background and Aims

To describe the COVID-19 positivity rate among football players, team staff, and local organizing committee members participated in the Asian Football Confederation (AFC) Champions League (West) tournament organized with the Bio-secure bubble protocol in place.

Methods

A retrospective observational study was carried out to include a total of 2184 participants during the AFC-West tournament in Qatar, which was a 3-week event (September 14-October 3, 2020). This event was undertaken under the Bio-secure bubble protocol, which was developed and implemented for sports events in Qatar during the pandemic. Within 72 h of departure and upon arrival in Qatar, all participants underwent reverse-transcriptase polymerase chain reaction testing (RT-PCR) to diagnose COVID-19. The test was considered positive based on the cycle threshold (cT) value which was <30, whereas, reactive if cT value was ≥30 and <40, and negative (cT > 40).

Results

Of the 2184 participants (528 players, 388 team staff, and 1268 local staff), 916 international participants were tested for COVID-19 PCR upon arrival at the Hamad International Airport, whereas the local staff (n = 1268) were tested 2 days before entering the bubble. The mean age of the players was 27.5 ± 9.8. Fifteen teams participated and as many as 60 matches were played over 3 weeks. Most participants tested negative (95.3%) and 3.9% tests were inconclusive. During the entire tournament, the positivity rate was 2.7% among all participants. Of the total positive cases, 0.8% were positive before entering the bubble system. The remaining (1.9%) tested positive during the tournament phase (19 players, 16 team officials, and 8 organizing committee staff).

Conclusion

Bio-secure bubble protocol operated in a controlled environment presents a minimal risk of COVID-19 infection for hosting international football events. This framework could be benchmarked to resume professional football competitions under unprecedented pandemic situations.

Biochemical and Physical Performance Responses to a Soccer Match after a 72-Hour Recovery Period

The physiological and neuromuscular responses at 72 h post-match are not widely researched, despite evidence showing substantial changes in recovery markers at 72 h post-match. Consequently, the aim of this study was to determine the biochemical and physical performance responses to a soccer match after a 72-h recovery period. Male soccer players of a semiprofessional team participated in this study. Before playing a friendly match, blood values of testosterone, cortisol, the testosterone-to-cortisol ratio and urea were collected and the squat jump and the Bangsbo Repeated Sprint Ability test were performed. These measurements were considered as baseline (pre match) and were obtained again after a 72-h recovery period. Results indicate that physical performance at 72 h post-match was similar to baseline (squat jump: p = 0.974; total Repeated Sprint Ability time: p = 0.381; Repeated Sprint Ability fatigue index: p = 0.864). However, perturbations in the biochemical milieu derived from the soccer match metabolic and physiological stress were still evident at this time point. While no significant differences compared to pre match were obtained in testosterone and urea concentrations after the recovery period, cortisol and testosterone-to-cortisol ratio values were significantly higher (14.74 ± 3.68 µg/dL vs. 17.83 ± 2.65 µg/dL; p = 0.045; ES 0.92 [0.00; 1.84], very likely) and lower (39.08 ± 13.26 vs. 28.29 ± 7.45; p = 0.038; ES −0.96 [−1.89; −0.04], very likely), respectively. In conclusion, soccer players have similar physical performance to the pre match after a 72-h recovery period, even with signs of biochemical and physiological stress.

Injury Incidence Increases after COVID-19 Infection: A Case Study with a Male Professional Football Team

Background: The SARS-CoV-2 virus disease has caused numerous changes in sports routines in the last two years, showing the influence on an increase in sports injuries. The aim of this study was to prospectively analyze the incidence and characteristics of injuries in male professional football players diagnosed with COVID-19 when they return to play after recovering from this illness. Methods: Injury characteristics of professional male football players were recorded for the 2020−2021 season following the international consensus statement from the International Olympic Committee (IOC). SARS-CoV-2 infection in the football players was certified by PCR analysis. Injury epidemiology was compared in players infected by the SARS-CoV-2 virus before and after being diagnosed with COVID-19. Results: 14 players (53.8%) were diagnosed with COVID-19 during 2020−2021 season and 12 (46.2%) were not infected (controls). Only three (21.4%) had suffered an injury before being diagnosed with COVID-19. Eleven players (78.6%) had injuries after being diagnosed with COVID-19 (p < 0.001). Among the players diagnosed with COVID-19, injury incidence increased on their return to play after the infection (3.8 to 12.4 injuries/1000 h of exposure, p < 0.001). Additionally, injury incidence during training (10.6 vs. 5.1 injuries/1000 h of exposure, p < 0.001) and matches (56.3 vs. 17.6 injuries/1000 h of exposure, p < 0.001) was ~two-fold higher on return to play after COVID-19 compared to controls (33.4 vs. 17.6 injuries/1000 h of exposure, respectively, p < 0.001). Conclusions: Injury incidence in professional football players who had been infected by the SARS-CoV-2 virus significantly increased compared to the injury rates that these same players had prior to the illness. Additionally, the injury incidence was higher when compared to players who were not infected by the SARS-CoV-2 virus during the season, especially during matches.

Clinical Characteristics of COVID-19 Disease; a Report of Iranian Professional Football

Background: All sporting events were halted due to the COVID-19 pandemic, and many athletes suffered from the infection. Objectives: This study aimed to evaluate the clinical characteristics and training days lost to COVID-19 in professional football. Methods: This questionnaire-based report on COVID-19 symptoms was conducted during the 2019-20 Iranian men's premier league and second division football. Team members with positive PCR tests were enrolled in the study and were told to fill in the questionnaire after the resolution of the symptoms. The questionnaire was designed to measure the frequency, severity, and duration of COVID-19-related symptoms. Results: Out of 133 males, including 86 players and 47 team officials with a mean age of 30.81 ± 10.7 years, 63.2% reported experiencing no symptoms. The most frequent symptom was the loss of smell, while the least frequently reported symptom was gastrointestinal unrest. It was also revealed that our population missed an average of 12.89 days to return to the team training. Conclusions: Since most of the infected individuals in our population were asymptomatic proper case identification using regular PCR testing could stop the transmission of the disease more effectively. Also, more attention is required to be paid to less severe symptoms such as the loss of smell and taste. Moreover, the days lost due to COVID-19 are almost comparable to the days lost by other injuries for the players, which highlights the importance of taking proper preventive measures.

Influence of the COVID-19 Lockdown and Restart on the Injury Incidence and Injury Burden in Men's Professional Football Leagues in 2020: The UEFA Elite Club Injury Study

BACKGROUND

Studies on football and the coronavirus disease 2019 (COVID-19) have mainly focused on the lockdown consequences for player fitness, the resumption of football training, and how to safely restart the league play, but injury data are scarce.

OBJECTIVE

To describe the injury incidence and injury burden in men's professional football teams during the pandemic year of 2020.

METHODS

Nineteen teams in 12 countries prospectively registered data on player-exposure and time-loss injuries throughout 2020. All major football leagues were paused as a direct response to the pandemic in March 2020 and were thereafter completely cancelled or restarted after a lockdown interval of at least two months. Historical data from 43 teams in the same cohort during the five preceding years (2015-2019) were used as reference. Between-season and within-season comparisons were made for injury incidence (number of injuries per 1000 h) and injury burden (number of absence days per 1000 h) with 95% confidence intervals and interquartile ranges.

RESULTS

There was no increased match injury incidence or injury burden following the restart in 2020 compared with other time periods of 2020 and the corresponding periods 2015-2019. There was an increased training injury incidence and injury burden immediately during the lockdown in 2020, and they remained elevated also following the restart, being higher in 2020 compared with 2015-2019, respectively. The injury characteristics during the first months of the new 2020/21 season (August/September-December) were similar between the five teams that cancelled their 2019/20 season in March 2020 and the 14 teams that restarted their season in May/June 2020.

CONCLUSIONS

There was no increased match injury incidence or injury burden following the COVID-19 lockdown and restart of the football season in 2020, but training injury incidence and injury burden were elevated and higher than in 2015-2019.

LaLiga Lockdown: Conditioning Strategy and Adaptation to In-Game Regulations during COVID-19 Pandemic Prevented an Increase in Injury Incidence

The first division of Spanish professional football (LaLiga) was suspended for 12 weeks as part of the policies enforced by health authorities during the first wave of COVID-19. During this period, players were confined to home for 8 weeks, followed by a club-based retraining period of 4 weeks. Afterwards, LaLiga’s teams completed 11 matches, with approximately 3 days of recovery between matches, to finish the competition. The aim of this investigation was to determine whether there is a difference in mean injury incidence in LaLiga players between the pre-lockdown period and post-lockdown period. A total of 277 players belonging to 11 teams competing in LaLiga were monitored during the 2019–2020 season. Injury incidence in the 27 matchdays completed before the lockdown was compared to the last 11 matchdays completed after the resumption of the competition. In comparison to the period before the suspension, the resumption of the championship did not significantly affect the injury incidence (4.2 vs. 5.4 injuries per 1000 h of exposure, p = 0.338). Injury incidence before suspension and after resumption of the competition was similar for muscle (2.6 vs. 3.4 injuries per 1000 h of exposure, p = 0.152) and ligament injuries (0.8 vs. 0.4 injuries per 1000 h of exposure, p = 0.062). The resumption of the competition also did not modify the distribution of injury according to body location (p = 0.948), injury type (p = 0.766), mode of onset (p = 0.614), severity (p = 0.065), or player position (p = 0.295). In summary, mean injury incidence in LaLiga players was similar before and after the lockdown. It is probable that the conditioning strategy adopted by clubs before the resumption of LaLiga and the adaptation of some in-game regulations helped to avoid an increased injury rate after the lockdown.

Findings From Cardiovascular Evaluation of National Collegiate Athletic Association Division I Collegiate Student-Athletes After Asymptomatic or Mildly Symptomatic SARS-CoV-2 Infection

OBJECTIVE

The risk of myocardial damage after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been controversial. The purpose of this study is to report the incidence of abnormal cardiovascular findings in National Collegiate Athletic Association (NCAA) Division I student-athletes with a history of SARS-CoV-2 infection.

DESIGN

This is a case series of student-athletes with SARS-CoV-2 infection and their subsequent cardiac work-up, including troponin level, electrocardiogram, and echocardiogram. Additional testing was ordered as clinically indicated.

SETTING

This study was conducted at a single NCAA Division I institution.

PARTICIPANTS

Student-athletes were included if they tested positive for SARS-CoV-2 by PCR or antibody testing [immunoglobulin G (IgG)] from April 15, 2020 to October 31, 2020.

INTERVENTION

Cardiac testing was conducted as part of postinfection screening.

MAIN OUTCOME MEASURES

This study was designed to quantify abnormal cardiovascular screening results and cardiac diagnoses after SARS-CoV-2 infection in Division I collegiate athletes.

RESULTS

Fifty-five student-athletes tested positive for SARS-CoV-2. Of these, 14 (26%) had a positive IgG and 41 (74%) had a positive PCR test. Eight abnormal cardiovascular screening evaluations necessitated further testing including cardiac magnetic resonance imaging (cMRI). Two athletes received new cardiac diagnoses, one probable early cardiomyopathy and one pericarditis, whereas the remaining 6 had normal cMRIs.

CONCLUSIONS

These data support recent publications which recommend the de-escalation of cardiovascular testing such as cardiac MRI or echocardiogram for athletes who have recovered from asymptomatic or mildly symptomatic SARS-CoV-2 infection. Continued follow-up of these athletes for sequelae of SARS-CoV-2 is critical.

Exploring sports nutritionists' and players' perspectives of nutrition practice within English professional football during the COVID-19 pandemic

The outbreak of the COVID-19 pandemic, and the subsequent suspension of all football-related activity, caused significant disruption to the daily habits of professional football players and support staff. Even when the most severe restrictions were lifted, strict control measures remained in place which likely continued to impact upon nutrition support and intake of players. Thus, this study aimed to understand how restrictions impacted upon nutrition support within professional football, as well as identify how these experiences could inform future practice. Interviews were conducted with twelve sports nutritionists and twelve male professional football players to explore their perspectives of nutrition provision during the COVID-19 pandemic. Thematic analysis indicated three common outcomes: (a) Sub-optimal Nutrition Provision; (b) Reduction in Time with or Access to Players, and; (c) Adaption of Nutrition Practice and/or Dietary Habits. In sum, football clubs should consider the immediate and short-term impact of COVID-19 restrictive measures as players' transition back to normality. Specifically, clubs should provide sports nutritionists with greater capacity to control the nutrition provision, including portion size and food quality. Looking ahead, sports nutritionists are encouraged to reflect upon the novel opportunities that have emerged and consider how these may enhance long-term practice.

Decision-Making in Sport During a Pandemic

OBJECTIVE

The COVID-19 pandemic has affected all elements of global society, and sport is not exempt. Many sporting events have been either postponed or canceled, and national sporting organizations have had to make highly complex decisions in the face of scientific uncertainty and risk. This article applies these lessons to the world of sport with the goal of assisting sporting organizations to make sound and reasoned decisions during a pandemic.

DATA SOURCES

A narrative approach using both academic literature sources and live examples from the authors' experience. We use Daniels and Sabin's accountability for reasonableness framework to facilitate decision-making in the face of such uncertainty.

MAIN RESULTS

Decision-making in the context of uncertainty has the potential to create conflict and disengagement from key stakeholders. Evidence from recent pandemics has illustrated that an ethical approach to decision-making results in reasoned decision-making and confers a legitimacy to decisions that ultimately supports engagement and satisfaction from stakeholders.

CONCLUSIONS

The incorporation of ethical considerations into risk assessment and management when making complex decisions, which incorporate high levels of uncertainty, will assist sporting organizations have positive outcomes.

Let Us Let the Spectators Back in!

: COVID-19 has stricken the world since the beginning of 2020. The pandemic is not controlled yet, and also the new variants of the virus are rapidly spreading. To reduce the virus's person-to-person transmission rate, health authorities and the government applied limitations to all activities (including sports activities). As a result, all football matches and team training worldwide were suspended for a limited period until a reduced infection risk was recognized. Even though training and competitions were gradually resuming worldwide, no spectators were allowed to attend any matches. After the successful experience of resuming football matches and tournaments following tight restrictions in keeping the players, staff, and organizers safe, it is time to let the spectators back in the stadiums and establish the needed guidelines. This commentary will highlight the most important aspects and issues that need to be addressed if the football federation and associations decide to let the spectators back into the stadiums, as football will lose its enthusiasm and financial turnover.

Resumption of professional football during the COVID-19 pandemic. Study findings from Iran

Due to concerns of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) transmission, professional football (soccer) was terminated almost everywhere in the world in early 2020. These are the results from a prospective cohort study conducted in Iran to analyze the resumption of professional football during the coronavirus disease 2019 (COVID-19) pandemic under assigned protocols and regulations. Sixteen teams consisting of 805 individuals formally agreed to follow the rules assigned by the ministry of health and CORONA headquarters in sport, and were subject to study monitoring. The resumption process was implemented over a 5-month period, beginning with a training phase followed by 14 match weeks of professional football. A self-declaration form was provided for the subjects to report any suspicious symptoms immediately and serial PCR testing was performed every 10 days using nasal swab samples. Those with positive tests were to be isolated until the symptoms were resolved or a negative test was returned. Of the 805 individuals included, 17.89% subjects were infected by the SARS-CoV‑2 virus (85 players and 59 staff members and officials). Only two matches were canceled in accordance with the regulations, and no severe cases were found. Case-tracing suggested that most transmissions occurred off the pitch. In conclusion, applying strict hygiene protocols and early case identification by performing repetitive PCR testing could benefit the resumption of professional football competitions.

The Influence of COVID-19 Pandemic Lockdown on the Physical Performance of Professional Soccer Players: An Example of German and Polish Leagues

The purpose of this study was to investigate whether the in-season pandemic lockdown influenced physical match performance in professional soccer players who participated in the competition of German Bundesliga and Polish Ekstraklasa. The data from 306 games for German Bundesliga and 296 games for Polish Ekstraklasa were divided into before- and after-lockdown periods. The physical performance of German Bundesliga teams after the 63-day COVID-19 lockdown did not differ significantly from that in the first part of the season. In contrast, Polish Ekstraklasa teams, after the 81-day lockdown, displayed significantly shorter total distances (p < 0.001), shorter high-intensity running distances (p = 0.03), and fewer high-intensity actions (p = 0.02). Moreover, when the effective playing time was considered, teams covered significantly less relative total distance (p < 0.001) and relative high-intensity running distance (p = 0.02). The results of the current study suggest that physical performance during the matches of the German Bundesliga was not influenced by the COVID-19 lockdown, contrary to those of the Polish Ekstraklasa. This difference could have been caused by different break lengths and different restrictions implemented in these countries during the pandemic lockdown.

Mental Health Status, Life Satisfaction, and Mood State of Elite Athletes During the COVID-19 Pandemic: A Follow-Up Study in the Phases of Home Confinement, Reopening, and Semi-Lockdown Condition

Scientific reports notified that the pandemic caused by the Coronavirus disease 2019 (COVID-19) has raised an unprecedented mental health emergency worldwide. Abrupt changes in daily routine, environmental constraints, adopted home confinement measures, and uncertainty about a date for returning to usual activities can potentially affect mental health and sports activities in athletes. Hence, we designed a cross-sectional study with a within-subjects design to investigate the impact of the pandemic on mental health, mood states, and life satisfaction of elite athletes. During the three phases of home confinement (April 14-24, n = 525), reopening (May 9-19, n = 464), and current semi-lockdown (July 20-31, n = 428), elite athletes voluntarily responded to an online survey. The self-report questionnaire was prepared to collect demographic and epidemiological variables of interest and the COVID-19-related information. All participants also completed the Profile of Mood State (POMS), General Health Questionnaire-28 (GHQ-28), and Satisfaction with Life Scale (SWLS). The main result is that the training rate, mental health, life satisfaction, and positive mood have decreased during the home confinement period as compared with the reopening and semi-lockdown phases. However, the need for psychosocial services has increased during the pandemic period. The present study provides the first preliminary evidence that home confinement conditions during the COVID-19 pandemic might have negatively influenced elite athlete's mood state, mental health, and life satisfaction, as well as training rates. Monitoring the psychological parameters of elite athletes and developing strategies to improve their mental health during the COVID-19 pandemic should be on the agenda. Next studies, therefore, seem reasonable to focus on active interventions for athletes during the ongoing COVID-19 pandemic.

Physical exercise and COVID-19 pandemic in PubMed: Two months of dynamics and one year of original scientific production

Our aim was to conduct a narrative review about physical exercise and Corona Virus Disease 2019 (COVID-19). A literature search was completed crossing the keywords “COVID-19” and “physical exercise”, for a narrative review, and physical activity (PA), physical exercise, physical training, sport, physical fitness, for a systematic review; search strategy (Randomized Controlled Trial, in the last 1 year, English). The first search date was closed on 04/26/2020 and 06/26/2020. This strategy was chosen to assess the dynamics of scientific information production for the pandemic. In two months, an increase of 76%, from 12 (19.4%) to 50 (80.64%) COVID-19 articles (n = 62, 100%) was found. The main types of articles published were editorial articles (16.13%, n = 10 of 62 articles) and commentary (9.68%, n = 6 of 62 articles). The most frequent country of origin of the scientific production was the United States (12.90%, n = 8 of 62 articles), the United Kingdom (12.90%, n = 8 of 62 articles), and Brazil (11.29%, n = 7 of 62 articles). However, in 2020, there were only 2 relevant randomized controlled trials on the COVID-19 topic in the context of physical exercise. Scientific information production shows the concern of the PA science community to bring a solution to the increase in physical inactivity generated by the COVID-19 pandemic. Our findings show the dynamics of scientific production on the COVID-19, in a situation so unique such as a pandemic, denotes that the practice of PA is essential to improve and/or maintain physical and mental health.

Running Patterns in LaLiga Before and After Suspension of the Competition Due to COVID-19

In the first wave of the COVID-19 outbreak (spring 2020), the first division of professional soccer in Spain (LaLiga) was suspended for 12 weeks as part of the lockdown imposed by the Spanish health authorities. Professional soccer players were confined to home for 8 weeks and then a retraining period of 4 weeks was set before the first competitive match. When competition was resumed, professional soccer teams competed in a congested calendar (11 matchdays in 39 days) while some in-game regulations were altered (up to 5 substitutions, refreshment pauses). The current research presents an analysis of running patterns before suspension and after resumption of LaLiga to determine how the lockdown affected players’ physical performance. To aid in this purpose, a pairwise comparison was performed of running patterns of the 2019–2020 vs. 2018–2019 season (i.e., control season). Using a two-way ANOVA (season x matchday), it was found that there was no main effect of the season on total running distance per match (P = 0.288) nor in the distances covered < 14.0 km/h (P = 0.294), at 21.0–23.9 km/h (P = 0.266), and at ≥ 24.0 km/h (P = 0.112). Only the distance at 14.0–20.9 km/h was affected by the season (P = 0.019) with a lower running distance on matchday 34 in the 2019–2020 vs. 2018–2019 season. The number of substitutions (from 2.9 to 4.5 substitutions per game; P < 0.001) and match duration (96 vs. 100 min; P < 0.001) significantly increased after resumption respect to the previous season. These data suggest that high-intensity running performance of professional soccer teams was maintained after the resumption of the competition while the alterations likely aided in the in-game regulations facilitated the maintenance of soccer physical performance.

Training in Rhythmic Gymnastics During the Pandemic

The pandemic caused by the COVID 19 Virus creates an unprecedented situation of global confinement altering the development of competition and sports training at all levels of participation and in all sports, including rhythmic gymnastics (RG). To avoid possible effects of physical, technical and psychological detraining, coaches looked for home training alternatives. The objectives of the study were to know how rhythmic gymnastics training developed during the lockdown period (the conditions, type of training, performance monitoring means, and determinants of gymnasts’ participation) and to provide recommendations for a possible future lockdown. Three hundred and two RG coaches from twenty-six different countries throughout the five continents and four professional levels took part in the study: national team (28), international (26), national (172) and regional (75). The data collection tool was a questionnaire consisting of 39 closed questions structured in three dimensions: identification data of the coaches, training data during confinement and gymnast participation data. The independent variable was the gymnasts’ performance levels and the dependent variables organized in four categories: the technical media used to conduct and monitor the training sessions, the type of training done, the mechanisms for monitoring training performance and the aspects that determined participation. Most coaches kept their gymnasts training during confinement, although 76.5% confirm abandonment of any of their gymnasts. The main means used were real-time video conferencing, although at the lower practice levels the media stand out in deferred time. The contents of the training were mainly body technique, physical preparation and body difficulties. For performance monitoring, challenges, physical, and technical tests were predominant. The determinants for the development of training in the confinement vary depending on the level of the gymnasts, connectivity and electronic resources at the highest level, and the availability of spaces and social distancing at lower levels. For future lockdowns, it is necessary to review the content of the trainings, as well as the performance evaluation and the means necessary for it.

[The Person Who Plays Handball Needs the Ball, the Contact and the Community - Changes in Sport Club Activities Due to the COVID-19 Pandemic and its Significance for Sports Clubs]

Ziel der Studie Sportvereine spielen eine wichtige Rolle für die Bewegungs- und damit auch die Gesundheitsförderung in Deutschland. Die vorliegende Studie befasst sich vor dem Hintergrund der Corona-bedingten Einschränkungen mit den Veränderungen in der Angebotsstruktur und deren Bedeutung für die Sportvereine.

Methode Es wurden 15 Experteninterviews mit Vertretern und Vertreterinnen bayerischer Sportvereine geführt. Die Daten wurden transkribiert und mittels thematischer Analyse induktiv ausgewertet.

Ergebnisse Von den Vereinen wurden umfangreiche Aktivitäten entwickelt, um den Mitgliedern auch unter den Rahmenbedingungen der COVID-19-Pandemie Möglichkeiten für sportliche Aktivitäten zu bieten. Die Vereinsmitglieder hätten dabei mit viel Verständnis auf die Veränderungen und Einschränkungen im Angebot reagiert. Die Nutzung der neu geschaffenen digitalen Angebote durch die Mitglieder scheint sich von der Nutzung der realen Kurse zu unterscheiden. Das längerfristige Potenzial der digitalen Angebote wird jedoch weitgehend skeptisch betrachtet. Insbesondere der im Sport normalerweise immanente Gemeinschaftsaspekt würde den Teilnehmenden an digitalen Formaten fehlen.

Schlussfolgerungen Die Anstrengungen der Sportvereine, ein geregeltes Bewegungsprogramm auch unter den Rahmenbedingungen einer Pandemie bereit zu stellen, betont deren Bedeutung für Prävention und Gesundheitsförderung. Aus Public-Health-Sicht bieten die Veränderungen in der Angebotsstruktur darüber hinaus das Potenzial, auch unter normalisierten Rahmenbedingungen beibehalten zu werden. Hierzu sind aber weiterführende Forschungsarbeiten notwendig.

Playing Non-Professional Football in COVID-19 Time: A Narrative Review of Recommendations, Considerations, and Best Practices

The coronavirus disease (COVID-19) pandemic in 2020 resulted in widespread interruption of team sports training and competitions. Our aim was to review the recommendations and best practices in return to play in non-professional football after activity lockdown. The authors searched two electronic databases (PubMed, Web of Science) to extract studies published before September 15 2020. Twenty studies explained recommendations, considerations, or best practices in return to play in football, and all of them were clustered into three groups: (1) training load management (n = 10), (2) medical recommendations (n = 9), and (3) recovery related issues (n = 5). The way to establish a progression in training process should be based on training load management and managing the number of stimuli per time. Following the studies, this training process should be divided into three phases: phase 1-physical distancing should be maintained; phases 2 and 3-group training should start. Medical considerations were clustered into different groups: general, pre- and post- training, during training, education, planning to return to competition, and suggestions for post confinement weeks. In particular, social issues, strict hygiene questions, and continuous PCR testing should be considered in return to play over football season. Finally, since a correlation has been found between high-intensive training loads and immunoglobulin A, nutritional and lifestyle recovery strategies should be performed. Moreover, since immunosuppression has been related to congested schedules (<72 h between matches), football federations should avoid this situation.

The Benefits of Vitamin D Supplementation for Athletes: Better Performance and Reduced Risk of COVID-19

The COVID-19 pandemic is having major economic and personal consequences for collegiate and professional sports. Sporting events have been canceled or postponed, and even when baseball and basketball seasons resumed in the United States recently, no fans were in attendance. As play resumed, several players developed COVID-19, disrupting some of the schedules. A hypothesis now under scientific consideration is that taking vitamin supplements to raise serum 25-hydroxyvitamin D [25(OH)D] concentrations could quickly reduce the risk and/or severity of COVID-19. Several mechanisms have been identified through which vitamin D could reduce the risks of infection and severity, death, and long-haul effects of COVID-19: (1) inducing production of cathelicidin and defensins to reduce the survival and replication of the SARS-CoV-2 virus; (2) reducing inflammation and the production of proinflammatory cytokines and risk of the "cytokine storm" that damages the epithelial layer of the lungs, heart, vascular system, and other organs; and (3) increasing production of angiotensin-converting enzyme 2, thus limiting the amount of angiotensin II available to the virus to cause damage. Clinical trials have confirmed that vitamin D supplementation reduces risk of acute respiratory tract infections, and approximately 30 observational studies have shown that incidence, severity, and death from COVID-19 are inversely correlated with serum 25(OH)D concentrations. Vitamin D supplementation is already familiar to many athletes and sports teams because it improves athletic performance and increases playing longevity. Thus, athletes should consider vitamin D supplementation to serve as an additional means by which to reduce risk of COVID-19 and its consequences.

Players' physical performance in LaLiga across the season: insights for competition continuation after COVID-19

Due to the COVID-19 outbreak, professional football players competing in LaLiga were confined at home for ~8 weeks and then they were allowed to train to prepare the first competitive match for 4 weeks. As the duration of summer break in the prior four seasons of LaLiga (from 2015-2016 to 2018-2019) was of similar length to the suspension of the championship due to COVID-19 (~12 weeks), we have analysed the running performance of teams competing in LaLiga in these four seasons to anticipate players’ physical performance after the resumption of the competition. The analysis includes the average running distance per game for each of the 38 matchdays that compose LaLiga. One-way ANOVA revealed that there was a main effect of the matchday on total running distance per match (p = 0.001), and in the distance covered between 14.0 and 20.9 km/h (p < 0.001), between 21.0 and 23.9 km/h (p < 0.001) and at above 24.0 km/h (p < 0.001). Overall, the post-hoc analysis revealed that the running patterns progressively increased during the first 8-10 matchdays and then reached a plateau which was significantly different to matchday-1 (p < 0.05). This analysis reveals that, in the prior four competitive seasons of LaLiga, players’ physical performance was lower at the beginning of the season and the teams needed approximately 8-10 matchdays to reach a steady state running performance. These data suggest that football players will progressively increase their performance across the 11 matchdays remaining to complete LaLiga.

Conducting orthopaedic practical examination during the Covid-19 pandemic

BACKGROUND

As the coronavirus disease (COVID-19) pandemic is expected to stay for a longer time, educational activities including residency training have gradually resumed with the aid of virtual tools. In addition to continuing the residency education during COVID-19, it is also important to conduct their examination so that the graduations of final year residents are not delayed. The conventional exam pattern involved clinical case presentations and required resident interaction with a number of patients. However, in view of the COVID-19 pandemic we conducted a "zero-patient contact virtual practical exit examination" for orthopaedic residents.

METHODS

In order to replicate the conventional exam case-scenarios, clinical cases were prepared in a digital presentation format. The candidate used N-95 facemasks and gloves, and adequate social distancing was maintained in the examination area. We also designed a 10- item questionnaire aimed at assessing the quality and satisfaction with the exam pattern.

RESULTS

The mean score for overall satisfaction with the virtual pattern was 4.5 (out of 5) in examiner group while it was 4.1 in examinee group. Higher scores were also reported for questions related to safety of the exam, relevance and quality of the virtual cases, etc. The mean total feedback score for the examiner and examinee group was 48 and 43.4 respectively (out of 50).

CONCLUSION

Orthopaedic residency end-of-training examinations can be successfully conducted during the COVID pandemic, and we hope our experience will be helpful to other residency programs.