Strength and Conditioning Habits of Competitive Distance Runners

Do Exercise-Based Prevention Programs Reduce Injury in Endurance Runners? A Systematic Review and Meta-Analysis

BACKGROUND

Endurance running is a popular sport and recreational activity yet is associated with a high prevalence of injury. Running related injuries (RRIs) are a leading cause of drop-out and represent a substantial financial burden to runners and healthcare services. There is clear evidence for the use of exercise-based injury prevention programs in games-based and youth sport settings, yet the research investigating the use of exercise to reduce injury risk in endurance runners has not been adequately reviewed recently.

OBJECTIVES

The aim of this review and meta-analysis was to systematically summarize the current research that has investigated the effect of exercise-based prevention programs and their state of supervision on the risk of RRIs in endurance runners.

METHODS

Three databases were searched for relevant studies. Selection and review were completed by two independent reviewers using the following inclusion criteria: (1) study population used endurance running training for health, occupational, or performance outcome(s); (2) participants performed running as their main form of exercise (> 50% of their total training time); (3) study was a randomized controlled trial; (4) a non-running-based exercise intervention was used; (5) a running-only or placebo exercise control group was included; (6) injury rate or incidence was reported; (7) injuries were recorded prospectively alongside the exercise training. Two meta-analyses were conducted using random-effects models, one based on log risk ratio and one based on log incidence rate ratio. The Cochrane Risk of Bias Assessment Tool 2 was used to evaluate the quality of studies and the Grading of Recommendations Assessment, Development and Evaluations approach was employed to grade the certainty of evidence.

RESULTS

A total of nine articles containing 1904 participants were included in analysis. Overall pooled results showed no significant differences between intervention and control groups in injury risk (z = - 1.60; p = 0.110) and injury rate (z = - 0.98; p = 0.329), while a post hoc analysis evaluating supervised interventions only showed that injury risk was significantly lower in the intervention group compared to the control group (z = - 3.75, p < 0.001). Risk of bias assessment revealed that seven studies included in the analysis were of low quality.

CONCLUSIONS

Exercise-based interventions do not appear to reduce the risk and rate of running-related injuries. Supervision may be essential for exercise-based intervention programs to reduce risk of RRIs, possibly due to increased compliance. Studies with more robust designs that include supervised exercise interventions should be prioritized in the future.

TRIAL REGISTRY

Clinical Trial Registration: PROSPERO CRD42021211274.

Do you even exercise, ref? Exploring habits of Spanish basketball referees during practice and matches

Background

Basketball referees are a vital part of the organised competition system, although they remain an "outgroup" in sport. While physical development and fitness programming are deemed necessary for basketball officiating excellence, there is a paucity of literature exploring strategies for physical fitness management in this population.

Methods

This research was a nationwide cross-sectional, self-administered online survey conducted in 2021. A sample of 628 (531 males, 97 females) referees from 18 regional referee organisations in Spain provided individual responses to gather information on demographic details, level of participation in refereeing, physical fitness practices, and match-day exercise-based regimens. The data were described using summary statistics, and the associations of the assessed variables were subsequently calculated using contingency tables.

Results

Our findings reveal that a large fraction of the Spanish basketball referee population focuses on aerobic (83%) and strength (73.6%) activities, while less attention is paid to speed (36.9%) and flexibility (23.2%), and agility, coordination, and balance tasks are somewhat overlooked. No significant differences were observed among the referee categories regarding weekly training days or session duration, with most training for 15-60 min per session. Elite referees were more likely to hire personal trainers and engage in strength and flexibility exercises. Sub-elite referees showed a higher tendency to perform stretching and joint mobility activities post-match, while regional referees did so less frequently. Approximately 30.7% of referees across all competitive levels engaged in re-warm-up (RW-U) activities, with stretching and joint mobility being the most prevalent.

Conclusions

Spanish basketball referees participate in routine physical exercise and fitness practices, irrespective of their competition level. While warm-up activities are prevalent, some sub-elite and regional referees do not consistently perform them, and re-warm-up routines are not extensively embraced.

Injury and performance related biomechanical differences between recreational and collegiate runners

Introduction

Running related injuries (RRI) are common, but factors contributing to running performance and RRIs are not commonly compared between different types of runners.

Methods

We compared running biomechanics previously linked to RRIs and performance between 27 recreational and 35 collegiate runners. Participants completed 5 overground running trials with their dominant limb striking a force plate, while outfitted with standardised footwear and 3-dimensional motion capture markers.

Results

Post hoc comparisons revealed recreational runners had a larger vertical loading rate (194.5 vs. 111.5 BW/s, p < 0.001) and shank angle (6.80 vs. 2.09, p < 0.001) compared with the collegiate runners who demonstrated greater vertical impulse (0.349 vs. 0.233 BWs, p < 0.001), negative impulse (-0.022 vs. -0.013 BWs, p < 0.001), positive impulse (0.024 vs. 0.014 BWs, p < 0.001), and propulsive force (0.390 vs. 0.333 BW, p = 0.002). Adjusted for speed, collegiate runners demonstrated greater total support moment (TSM), plantar flexor moment, knee extensor moment, hip extensor moment, and had greater proportional plantar flexor moment contribution and less knee extensor moment contribution to the TSM compared with recreational runners. Unadjusted for speed, collegiate runners compared with recreational had greater TSM and plantar flexor moment but similar joint contributions to the TSM.

Discussion

Greater ankle joint contribution may be more efficient and allow for greater capacity to increase speed. Improving plantarflexor function during running provides a strategy to improve running speed among recreational runners. Moreover, differences in joint kinetics and ground reaction force characteristics suggests that recreational and collegiate runners may experience different types of RRI.

Running-Related Overuse Injuries and Their Relationship with Run and Resistance Training Characteristics in Adult Recreational Runners: A Cross-Sectional Study

This study aimed to characterize running-related injuries (RRIs), explore their relationship with run and resistance training (RT) parameters, and identify perceived prevention measures among adult recreational runners. An anonymous online survey was designed and distributed via social media and email. Data were analyzed with chi-square, t-test, or analysis of variance (ANOVA), with significance accepted at p ≤ 0.05. Data from 616 participants (76.8% female, age: 42.3 ± 10.5 y) were analyzed. Most runners (84.4%) had an injury history, with 44.6% experiencing one in the past year. The most common RRI sites included the foot/ankle (30.9%) and knee (22.2%). RRI prevalence was higher in those running >19 miles weekly (48.4%, p = 0.05), but there were no differences based on RT participation status. Among those using RT, relatively more RRIs were observed in runners who trained the hip musculature (50.3%, p = 0.005) and did not include the upper body (61.6%, p < 0.001). A disproportionately high RRI prevalence was found for several of the other risk-reduction strategies. RRIs remain a substantial problem, particularly around the ankle/foot and knee. Higher run volume and performance motives were positively associated with RRIs. Most runners incorporated RRI risk-reduction techniques, with over half using RT. The current study did not determine whether preventative strategies were implemented before or after injury; therefore, prospective studies controlling for previous injuries are required to evaluate the effectiveness of RT in preventing future RRIs.

Effect of Running-Induced Fatigue on Tibial Acceleration and the Role of Lower Limb Muscle Strength, Power, and Endurance

BACKGROUND

High-impact loads have been linked with running injuries. Fatigue has been proposed to increase impact loads, but this relationship has not been rigorously examined, including the associated role of muscle strength, power, and endurance.

PURPOSE

This study aimed to investigate the effect of fatigue on impact loading in runners and the role of muscle function in mediating changes in impact loading with fatigue.

METHODS

Twenty-eight trained endurance runners performed a fixed-intensity time to exhaustion test at 85% of V̇O 2max . Tibial accelerations were measured using leg-mounted inertial measurement units and sampled every minute until volitional exhaustion. Tests of lower limb muscle strength, power, and endurance included maximal isometric strength (soleus, knee extensors, and knee flexors), single leg hop for distance, and the one leg rise test. Changes in peak tibial acceleration (PTA, g ) were compared between time points throughout the run (0%, 25%, 50%, 75%, and 100%). Associations between the change in PTA and lower limb muscle function tests were assessed (Spearman's rho [ rs ]).

RESULTS

PTA increased over the duration of the fatiguing run. Compared with baseline (0%) (mean ± SD, 9.1 g ± 1.6 g ), there was a significant increase at 75% (9.9 g ± 1.7 g , P = 0.001) and 100% (10.1 g ± 1.8 g , P < 0.001), with no change at 25% (9.6 g ± 1.6 g , P = 0.142) or 50% (9.7 g ± 1.7 g , P = 0.053). Relationships between change in PTA and muscle function tests were weak and not statistically significant ( rs = -0.153 to 0.142, all P > 0.05).

CONCLUSIONS

Peak axial tibial acceleration increased throughout a fixed-intensity run to exhaustion. The change in PTA was not related to performance in lower limb muscle function tests.

Training Habits and Injury Rate in Masters Female Runners

Background

The number of masters females that choose long-distance running as a form of exercise is growing exponentially. As clinicians working with these athletes, it is important to understand their training habits and how these habits relate to running related injuries (RRI).

Purpose

The primary aim of this study was to identify the training behaviors and cross training engagement in masters female runners. A secondary aim was to determine RRI rates and their relationship to training behaviors.

Methods

A 31-question online survey was completed by 68 masters females aged 45 and older. Answers from 18 of the 31 questions were used to address the specific aims of the study. Descriptive variables and Chi Square analyses were used to synthesize the data.

Results

The majority of the cohort ran less than 30 miles week distributed over three days/week. Most participated in cross-training activity that included strength training, cycling, and swimming. Injury was prevalent in this group of runners with many experiencing more than one RRI over their running history. The area of the hip and gluteal region was the most common site of injury.

Conclusion

This cohort of runners trained in a relatively smart manner, with a moderate volume of running mileage, and utilization of cross-training. Many had experienced some form of injury that halted their running for a period of time.

Level of Evidence

Level 3 - Case Controlled, retrospective survey.

Methodological Proposal for Strength and Power Training in Older Athletes: A Narrative Review

INTRODUCTION

Within the adult population, it is not uncommon to meet older athletes who challenge the negative stereotypes associated with aging. Although their physical performance is superior to their sedentary counterparts, they are not immune to impaired neuromuscular function, leading to a decreased physical capacity and an increased risk of injuries. Despite the abundant information about the benefits of strength/power training in advanced ages, there are no methodological proposals that guide physical activity professionals to program this type of training.

OBJECTIVE

This study aimed to review the factors related to the decrease in sports performance within older athletes and the benefits of a strength/power program in order to provide a methodological proposal to organize training in this population.

METHODS

This is a review article. First, databases from PubMed, Science Direct, and SPORTSDiscus and search engines, namely Google Scholar and Scielo, were reviewed, using standard keywords such as strength and power training, evaluation of physical performance, neuromuscular function, and risk of injury in the elderly athlete. All related articles published during the period 1963 to 2020 were considered. A total of 1837 documents were found. By removing 1715 unrelated documents, 122 articles were included in the study after revision control.

RESULTS

Strength/power training is key to alleviating the loss of performance in older athletes and the benefits in neuromuscular function, which helps reduce the rate of serious injuries, maintaining sports practice for a longer period of time. In order to design an appropriate program, a prior evaluation of the individual's physical-technical level must be carried out, respecting the biologicalpedagogical principles and safety regulations.

CONCLUSION

The methodological proposal delivered in this review can serve as a technical guide for physical activity professionals, which will be able to structure the strength/power training and thus preserve the sports practice in older athletes for a longer time.

A comparison of plantarflexor musculotendon unit output between plyometric exercises and running

OBJECTIVES

Plyometric exercises are used to prevent and rehabilitate plantarflexor running injuries. To facilitate exercise programming, this study compared plantarflexor musculotendon output during running to plyometric exercises.

DESIGN

Experimental study with cross-over.

METHODS

Fourteen trained distance runners performed running, ankle bouncing, A-skips, bounding, and hurdle jumps. Three-dimensional motion capture and force plate data were collected and computational simulations used to calculate gastrocnemius lateralis and soleus musculotendon peak forces, strain, power generation and absorption, and total positive and negative work. Percentage difference and standardised mean differences were used to compare variables between plyometrics and running. Musculotendon units were classified as energy generators or absorbers according to their net mechanical work.

RESULTS

Both plantarflexors behaved as net energy generators during running. Plantarflexor peak force and power generation and absorption were lower in the A-skip and ankle bounce compared to running. Soleus behaved as a net energy absorber during hurdle jumps, with greater total negative work (16.5%; standardised mean difference 0.92) and higher peak strain (0.3%; standardised mean difference 0.28) during hurdle jumps than running. Gastrocnemius lateralis behaved as a net energy absorber during bounding, with greater total negative work (63.8%; standardised mean difference 0.81) and peak strain (0.4%; standardised mean difference 0.77) during bounding than running.

CONCLUSIONS

The ankle bounce and A-skip may be appropriate exercises when runners desire lower plantarflexor loads than running. Hurdle jumps elicited high soleus loads but low gastrocnemius lateralis loads, highlighting the disparate function of the plantarflexors. Bounding demanded high plantarflexor musculotendon output and may be suitable when eccentric overload is desired.

Bone mineral density in high-level endurance runners: part A-site-specific characteristics

PURPOSE

Physical activity, particularly mechanical loading that results in high-peak force and is multi-directional in nature, increases bone mineral density (BMD). In athletes such as endurance runners, this association is more complex due to other factors such as low energy availability and menstrual dysfunction. Moreover, many studies of athletes have used small sample sizes and/or athletes of varying abilities, making it difficult to compare BMD phenotypes between studies.

METHOD

The primary aim of this study was to compare dual-energy X-ray absorptiometry (DXA) derived bone phenotypes of high-level endurance runners (58 women and 45 men) to non-athletes (60 women and 52 men). Our secondary aim was to examine the influence of menstrual irregularities and sporting activity completed during childhood on these bone phenotypes.

RESULTS

Female runners had higher leg (4%) but not total body or lumbar spine BMD than female non-athletes. Male runners had lower lumbar spine (9%) but similar total and leg BMD compared to male non-athletes, suggesting that high levels of site-specific mechanical loading was advantageous for BMD in females only and a potential presence of reduced energy availability in males. Menstrual status in females and the number of sports completed in childhood in males and females had no influence on bone phenotypes within the runners.

CONCLUSION

Given the large variability in BMD in runners and non-athletes, other factors such as variation in genetic make-up alongside mechanical loading probably influence BMD across the adult lifespan.

Comprehensive Return to Competitive Distance Running: A Clinical Commentary

Running injuries are very common, and there are well-established protocols for clinicians to manage specific musculoskeletal conditions in runners. However, competitive and elite runners may experience different injuries than the average recreational runner, due to differences in training load, biomechanics, and running experience. Additionally, injury-specific rehabilitation protocols do not consider the broader goal of return to competitive running, including the unique psychosocial and cardiorespiratory fitness needs of elite athletes. This review aims to suggest a guideline for running-specific progression as part of a comprehensive rehabilitation program for injured competitive runners. Tools to evaluate an athlete's psychosocial preparedness to return to competition are presented. Recommendations are also provided for monitoring cardiorespiratory fitness of injured runners, including the nuances of interpreting these data. Finally, a six-phase training paradigm is proposed to guide clinicians as they help competitive runners transition from the early stages of injury through a full return to competition.

Incidence of bone stress injury is greater in competitive female distance runners with menstrual disturbances independent of participation in plyometric training

Bone stress injury (BSI) is prevalent in female distance runners. Menstrual disturbances are associated with impaired bone health in endurance athletes. This study aimed to investigate the association between menstrual function and BSI and explore whether plyometric training may protect against BSI in individuals with menstrual disturbances. Competitive female distance runners (n = 183) aged 18-40 years were surveyed for training habits, menstrual function, and BSI, during the previous 12 months. Oligo/amenorrhoea during the previous 12 months (<9 menses) was deemed to indicate menstrual disturbance; hormonal contraceptive users and those previously diagnosed with a pathology that impacted menstrual function were excluded. BSI incidence rate was 2.25 (p = 0.02, 95% CI: 1.14-4.41) times greater in oligo/amenorrhoeic than eumenorrhoeic runners. BSI incidence rate was similar in oligo/amenorrhoeic and eumenorrhoeic runners that did plyometric training, but 3.78 (p = 0.001, 95% CI: 1.68-8.5) times greater in oligo/amenorrhoeic versus eumenorrhoeic runners that did not. However, the effect of plyometrics was non-significant (menstrual function × plyometric training interaction, p = 0.06; main effect, p = 0.89). Conventional plyometric training may not reduce BSI incidence in female distance runners, but menstrual disturbances and prolonged periods of low energy availability should be avoided.

Effects of Plyometric Jump Training on Physical Fitness in Amateur and Professional Volleyball: A Meta-Analysis

We aimed to examine the effects of plyometric jump training (PJT) on measures of physical fitness in amateur and professional volleyball players. A systematic electronic literature search was carried out in the databases PubMed, MEDLINE, Web of Science, and SCOPUS. Controlled studies including pre-to-post intervention tests of physical fitness and involving healthy volleyball players regardless of age and sex were considered. A random-effects model was used to calculate effect sizes (ES) between intervention and control groups. Moderator analyses considered programme duration, training frequency, total number of training sessions and jumps, participants' sex, age, and expertise level. The Physiotherapy Evidence Database scale was used to assess the methodological quality of the included studies. Eighteen moderate-to-high quality (median of 5 PEDro points) studies were eligible, comprising a total of 746 athletes. None of the included studies reported injuries related to the PJT intervention. The main findings showed small-to-moderate effects (p < 0.05) of PJT on linear sprint speed (ES = 0.70), squat jump (ES = 0.56), countermovement jump (CMJ) (ES = 0.80), CMJ with arm swing (ES = 0.63), drop jump (ES = 0.81), and spike jump height (ES = 0.84). Sub-analyses of moderator factors included 48 data sets. Only age had a significant effect on CMJ performance. Participants aged ≥16 years achieved greater improvements in CMJ performance compared to <16 years old (ES = 1.28 and 0.38, respectively; p = 0.022). No significant differences (p = 0.422) were identified between amateur (ES = 0.62) and professional volleyball players (ES = 1.01). In conclusion, PJT seems safe and is effective in improving measures of physical fitness in amateur and professional volleyball players, considering studies performed in both male and female.

Association Between Knee- and Hip-Extensor Strength and Running-Related Injury Biomechanics in Collegiate Distance Runners

CONTEXT

Running-related injuries are common in distance runners. Strength training is used for performance enhancement and injury prevention. However, the association between maximal strength and distance-running biomechanics is unclear.

OBJECTIVE

To determine the relationship between maximal knee- and hip-extensor strength and running biomechanics previously associated with injury risk.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 36 collegiate distance runners (26 men, 10 women; age = 20.0 ± 1.5 years, height = 1.74 ± 0.09 m, mass = 61.97 ± 8.26 kg).

MAIN OUTCOME MEASURE(S)

Strength was assessed using the 1-repetition maximum (1RM) back squat and maximal voluntary isometric contractions of the knee extensors and hip extensors. Three-dimensional running biomechanics were assessed overground at a self-selected speed. Running variables were the peak instantaneous vertical loading rate; peak forward trunk-lean angle; knee-flexion, internal-rotation, and -abduction angles and internal moments; and hip-extension, internal-rotation, and -adduction angles and internal moments. Separate stepwise linear regression models were used to examine the associations between strength and biomechanical outcomes (ΔR2) after accounting for sex, running speed, and foot-strike index.

RESULTS

Greater 1RM back-squat strength was associated with a larger peak knee-flexion angle (ΔR2 = 0.110, ΔP = .045) and smaller peak knee internal-rotation angle (ΔR2 = 0.127, ΔP = .03) and internal-rotation moment (ΔR2 = 0.129, ΔP = .03) after accounting for sex, speed, and foot-strike index. No associations were found between 1RM back-squat strength and vertical loading rate, trunk lean, or hip kinematics and kinetics. Hip- and knee-extensor maximal voluntary isometric contractions were also not associated with any biomechanical variables.

CONCLUSIONS

Greater 1RM back-squat strength was weakly associated with a larger peak knee-flexion angle and smaller knee internal-rotation angle and moment in collegiate distance runners. Runners who are weaker in the back-squat exercise may exhibit running biomechanics associated with the development of knee-related injuries.

Strength Training Habits in Amateur Endurance Runners in Spain: Influence of Athletic Level

This study determined the strength training (ST) habits of amateur endurance runners in Spain regarding athletic level. A sixteen-item online questionnaire comprised of (i) demographic information, (ii) performance, and (iii) training contents was completed by 1179 athletes. Five group levels were determined according to the personal best times of the athletes in a 10-km trial (LG1: level group 1, 50–55 min; LG2: level group 2, 45–50 min; LG3: level group 3, 40–45 min; LG4: level group 4, 35–40 min; LG5: level group 5, 30–35 min). Most athletes (n = 735, 62.3%) perceived ST as being a key component in their training program. Resistance training (RT) was reported as a ST type used by 63.4% of the athletes, 66.9% reported using bodyweight exercises, 46.8% reported using plyometric training, 65.6% reported using uphill runs, and 17.8% reported using resisted runs. The prevalence of runners who excluded ST from their training programs decreased as the athletic performance level increased (18.2% in lower-level athletes vs. 3.0% in higher-level), while the inclusion of RT, bodyweight exercises, plyometric training, and uphill and resisted runs was more frequent within higher-level groups. Most athletes included ST using low-to-moderate loads and high a number of repetitions/sets comprised of RT, plyometric training, resisted runs, and core, respiratory, and foot muscles training.

Aging and Physiological Lessons from Master Athletes

Sedentary aging is often characterized by physical dysfunction and chronic degenerative diseases. In contrast, masters athletes demonstrate markedly greater physiological function and more favorable levels of risk factors for cardiovascular disease, osteoporosis, frailty, and cognitive dysfunction than their sedentary counterparts. In many cases, age-related deteriorations of physiological functions as well as elevations in risk factors that are typically observed in sedentary adults are substantially attenuated or even absent in masters athletes. Older masters athletes possess greater functional capacity at any given age than their sedentary peers. Impressive profiles of older athletes provide insight into what is possible in human aging and place aging back into the domain of "physiology" rather than under the jurisdiction of "clinical medicine." In addition, these exceptional aging athletes can serve as a role model for the promotion of physical activity at all ages. The study of masters athletes has provided useful insight into the positive example of successful aging. To further establish and propagate masters athletics as a role model for our aging society, future research and action are needed. © 2020 American Physiological Society. Compr Physiol 10:261-296, 2020.