Perceived coaches' health promotion activity, maintenance of participation in sports, and lifestyle habits among emerging adults: a four-year follow-up study

OBJECTIVES

This study focused on how adolescents' perceptions of coaches' health promotion activity predict maintained participation and dropout in organized sports in emerging adulthood. In addition, differences in lifestyle habits between maintainers, dropouts, and nonparticipants in organized sports were explored.

MATERIALS AND METHODS

Overall, 616 adolescents reported organized sports participation in the Finnish Health Promoting Sports Club (FHPSC) study at ages 15 and 19. Of these, 323 reported coach's health promotion activity on health topics at the age of 15. An index of a coach's general health promotion activity was formed. At age 19, all study participants reported their lifestyle habits.

RESULTS

Among males, those who had perceived coaches' general health promotion activity as frequent were more likely to be maintainers than dropouts (48.6% vs. 20.0%) (p = .002). Among females, there was no significant difference (32.0% vs. 28.4%). Logistic regression analysis adjusted for gender showed that perceiving coach's general health promotion activity as frequent increased the odds of being a maintainer rather than a dropout. Moreover, maintainers had higher odds of having healthy lifestyle habits when compared to nonparticipants (related to physical activity; sleep; fruit and vegetable consumption; and cigarette use) or dropouts (related to physical activity; and cigarette use). In addition, dropouts had higher odds of having healthy lifestyle habits than nonparticipants (related to sleep; and cigarette use).

CONCLUSIONS

Perceiving coaches' health promotion activity as frequent was related to maintained participation in organized sports among males. Maintainers were more likely to have more healthy lifestyle habits than nonparticipants and dropouts. There is a need to invest in coaches' health promotion activity when it is infrequent. A more detailed understanding is needed of coaches' health promotion activity that supports both maintained participation in sports, especially among females, and healthy lifestyle habits in emerging adulthood.

Physical activity, physical fitness and self-rated health: cross-sectional and longitudinal associations in adolescents

Objectives

To evaluate the independent associations of physical activity and physical fitness with self-rated health in adolescents.

Methods

Data from a 2-year observational study (2013-2015) were used (n=256, 58% girls, 13.7±0.3 years at baseline). Self-rated health was assessed with a questionnaire, physical activity by an accelerometer and a questionnaire, and physical fitness via the measurements included in the Finnish national Move! monitoring system for physical functional capacity and their z-score average (fitness index).

Results

Self-reported physical activity had cross-sectional associations with self-rated health (girls β 0.213, p=0.006, β 0.221 boys p=0.021) while accelerometer-based moderate-to-vigorous physical activity did not. Higher self-reported physical activity at baseline was associated with higher self-rated health at follow-up in boys (β 0.289, p<0.001), but not in girls (β -0.056, p=0.430). Accelerometer-based moderate-to-vigorous physical activity had positive longitudinal associations with future self-rated health in boys, but some of these similar associations were negative in girls. Fitness index had a positive cross-sectional association with self-rated health in boys (β 0.282 or β 0.283, p=0.002), but not in girls (β 0.162 or β 0.161, p=0.051). Physical fitness was not longitudinally associated with self-rated health.

Conclusions

Self-reported physical activity showed potential to explain current and future self-rated health better than accelerometer-based physical activity or physical fitness. We recommended to consider self-reported physical activity as an adequate metric of adolescent health in the population-level surveillance systems.

Sports-related factors predicting maintained participation and dropout in organized sports in emerging adulthood: A four-year follow-up study

This study explored sports-related factors predicting organized sports participation in emerging adulthood. In the Finnish Health Promoting Sports Club (FHPSC) study, 354 sports club participants aged 15 at baseline reported their main sport, onset age, training volume, current competitive level, and future competitive orientation and participated in the follow-up study at age 19. There were differences in the proportions of maintainers and dropouts in a few sports: football (maintainers 58.6%), and among females, skating (maintainers 60.7%), and swimming (dropouts 80.0%). A binary logistic regression analysis showed that those who had started their main sport by school age (females OR 3.05/95% CI 1.34, 6.98; males OR 3.97/95% CI 1.48, 10.64) and had competed at national top level plus had aimed at success at the adult level competitions in future (females OR 3.42/95% CI 1.16, 10.09; males OR 3.58/95% CI 1.12, 11.41; among females, also had competed at national top level plus had aimed at success at junior level competitions [OR 3.42/95% CI 1.20, 9.78]) were more likely maintainers than dropouts. Early onset in the main sport and competitiveness were related to maintained sports participation while the opposites were related to dropouts in the current organized sports system.

Is health promotion in sports clubs associated with adolescent participants' fruit and vegetable consumption?

BACKGROUND

Although sports clubs' potential for health promotion is acknowledged, research on whether they promote healthy eating is limited. We aimed to evaluate Finnish youth sports clubs' health promotion orientation, as well as associations between sports clubs' health promotion orientation, coaches' nutritional discussions and sports club participants' (SPs') fruit and/or vegetable consumption.

METHODS

The cross-sectional study included 554 SPs aged 14-16 years, 275 club officials and 311 coaches. Participants replied to questionnaires about sports clubs' health promotion and their own health behaviours, including dietary habits. Health promotion orientation was estimated using a Health Promoting Sports Club (HPSC) index (range 0-22) and nutritional discussions and fruit and/or vegetable consumption as frequencies. A mixed-effects multivariable logistic regression was used to analyse the associations.

RESULTS

Most sports clubs (69%) had a high health promotion orientation, but the variation between the clubs was wide (HPSC index range 5-21). SPs' daily fruit and/or vegetable consumption was associated with female gender [odds ratio (OR) 3.48, 95% confidence interval (CI) 2.23-5.42, P < 0.001], better self-rated health (OR 3.26, 95% CI 1.13-9.41, P = 0.03), higher average school grades (OR 1.67, 95% CI 1.04-2.67, P = 0.03), and SPs' responses that their coach had often discussed nutrition (OR 2.11, 95% CI 1.41-3.14, P < 0.001).

CONCLUSION

Although sports clubs' orientation towards health promotion was mostly high, it seems not to be enough to promote healthy eating among adolescent participants. Instead, coaches' nutritional discussions were associated with adolescents' fruit and/or vegetable consumption.

Acute respiratory infections hamper training and competition in cross-country skiers, especially in those with asthma

Acute respiratory infections (ARinf) are one of the leading causes that prevent athletes from training and competing. The aim of this study was to investigate the burden of ARinfs during one season among cross-country skiers. All Finnish cross-country skiers enrolled in the largest national competitions in winter 2019 (n = 1282) were sent a postal questionnaire. A higher proportion of skiers with than without asthma had to refrain from competitions because of ARinf (76.9% vs. 62.2%, p = 0.011) but there was no significant difference in refraining from training (91.2% vs. 83.8%, p = 0.084). In skiers with asthma, the median duration of a single ARinf episode was longer (5.0 days, IQR 3.8-6.8 vs. 4.0 days, IQR 3.0-6.7, p  = 0.017), and they had more days of absence because of ARinf throughout the season (median 15 days (IQR 8-28) vs. 10 days (IQR 6-18), p  = 0.006) in comparison to non-asthmatics. However, many of the skiers either trained (54.4%) or competed (22.5%) during an ARinf.

Magnetoencephalography reveals impaired sensory gating and change detection in older adults in the somatosensory system

Brain electrophysiological responses can provide information about age-related decline in sensory-cognitive functions with high temporal accuracy. Studies have revealed impairments in early sensory gating and pre-attentive change detection mechanisms in older adults, but no magnetoencephalographic (MEG) studies have been undertaken into both non-attentive and attentive somatosensory functions and their relationship to ageing. Magnetoencephalography was utilized to record cortical somatosensory brain responses in young (20-28 yrs), middle-aged (46-56 yrs), and older adults (64-78 yrs) under active and passive somatosensory oddball conditions. A repeated standard stimulus was occasionally replaced by a deviant stimulus (p = .1), which was an electrical pulse on a different finger. We examined the amplitudes of M50 and M100 responses reflecting sensory gating, and later components reflecting change detection and attention shifting (M190 and M250 for the passive condition, and M200 and M350 for the active condition, respectively). Spatiotemporal cluster-based permutation tests revealed that older adults had significantly larger M100 component amplitudes than young adults for task-irrelevant stimuli in both passive and active condition. Older adults also showed a reduced M250 component and an altered M350 in response to deviant stimuli. The responses of middle-aged adults did not differ from those of younger adults, but this study should be repeated with a larger sample size. By demonstrating changes in both somatosensory gating and attentional shifting mechanisms, our findings extend previous research on the effects of ageing on pre-attentive and attentive brain functions.

Psychosocial and health behavioural characteristics of longitudinal physical activity patterns: a cohort study from adolescence to young adulthood

BACKGROUND

The decline in physical activity (PA) during adolescence is well-established. However, while some subgroups of adolescents follow the general pattern of decreased activity, others increase or maintain high or low activity. The correlates and determinants of different PA patterns may vary, offering valuable information for targeted health promotion. This study aimed to examine how psychosocial factors, health behaviours, and PA domains are associated with longitudinal PA patterns from adolescence to young adulthood.

METHODS

This prospective study encompassed 254 participants measured at mean ages 15 and 19. Device-measured moderate-to-vigorous PA was grouped into five patterns (activity maintainers, inactivity maintainers, decreasers from moderate to low PA, decreasers from high to moderate PA, increasers) via a data-driven method, K-Means for longitudinal data. Multinomial logistic regression was used to analyse the associations between health behaviours, psychosocial factors, PA domains, and different PA patterns.

RESULTS

A lack of sports club participation characterised inactivity maintainers throughout adolescence. Difficulties in communicating with one's father at age 15 were associated with higher odds of belonging to inactivity maintainers and to decreasers from moderate to low PA. Lower fruit and vegetable consumption at age 19 was also related to increased odds of belonging to the groups of inactivity maintainers and decreasers from moderate to low PA. Smoking at age 19 was associated with being a decreaser from moderate to low PA.

CONCLUSIONS

Diverse factors characterise longitudinal PA patterns over the transition to young adulthood. Sports club participation contributes to maintained PA. Moreover, a father-adolescent relationship that supports open communication may be one determinant for sustained PA during adolescence. A healthier diet and non-smoking as a young adult are associated with more favourable PA development.

Neuromuscular exercise and counseling for treating recurrent low back pain in female healthcare workers-Findings from a 24-month follow-up study of a randomized controlled trial

BACKGROUND

Female healthcare workers have a high prevalence of low back pain (LBP)-related sickness absence. Here, we report findings of a 24-month follow-up of a previously published 6-month randomized controlled trial (RCT).

METHODS

By adopting an RCT with 6 months of intervention and follow-up at 6, 12, and 24 months, we assessed the maintenance of changes in the effectiveness (LBP and fear of pain) of the interventions (neuromuscular exercise [NME], back-care counseling, both combined) using a generalized linear mixed model adjusted for baseline covariates. The incremental cost-effectiveness ratio was calculated in terms of quality-adjusted life years (QALY). A bootstrap technique was used to estimate the uncertainty around a cost-effectiveness acceptability curve.

RESULTS

Of the 219 females, 71% had data at 24 months. Between 6 and 24 months, LBP intensity (primary outcome) remained low in all intervention arms (-20% to -48%) compared to the control (-10% to -16%). Pain interfering with work remained low in the combined and exercise arms for up to 24 months. At 24 months, the total costs were lowest in the combined arm (€484 vs. €613-948, p < 0.001), as were the number of back-related sickness absence days (0.16 vs. 1.14-3.26, p = 0.003). The analysis indicated a 95% probability of the combined arm to be cost-effective per QALY gained at €1120.

CONCLUSIONS

Six months of weekly NME combined with four counseling sessions was cost-effective for treating LBP and the effect was maintained over 24 months.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01465698, 7/11/2011, prospective.

Longitudinal physical activity patterns and the development of cardiometabolic risk factors during adolescence

PURPOSE

To examine the associations between longitudinal physical activity (PA) patterns and the development of cardiometabolic risk factors from adolescence to young adulthood.

METHODS

This cohort study encompassed 250 participants recruited from sports clubs and schools, and examined at mean age 15 and 19. Device-measured moderate-to-vigorous PA was grouped into five patterns (via a data-driven method, using inactivity maintainers as a reference). The outcomes were: glucose, insulin, homeostasis model assessment for insulin resistance (HOMA-IR), total cholesterol, HDL and LDL cholesterol, triglycerides, blood pressure, and body mass index (BMI). Linear growth curve models were applied with adjustment for sex, age, fruit/vegetable consumption, cigarette/snuff use, and change in the device wear-time.

RESULTS

Insulin and BMI increased among decreasers from moderate to low PA (β for insulin 0.23, 95% CI 0.03-0.46; β for BMI 0.90; CI 0.02-1.78). The concentration of HDL cholesterol decreased (β -0.18, CI -0.31 to -0.05) and that of glucose increased (β 0.18, CI 0.02-0.35) among decreasers from high to moderate PA. By contrast, among increasers, blood pressure declined (systolic β -6.43, CI -12.16 to -0.70; diastolic β -6.72, CI -11.03 to -2.41).

CONCLUSIONS

Already during the transition to young adulthood, changes in PA are associated with changes in cardiometabolic risk factors. Favorable blood pressure changes were found among PA increasers. Unfavorable changes in BMI, insulin, glucose, and HDL cholesterol were found in groups with decreasing PA. The changes were dependent on the baseline PA and the magnitude of the PA decline.

Cross-country skiers often experience respiratory symptoms during and after exercise but have a low prevalence of prolonged cough

Background

Cross-country skiers train and compete during the winter for long periods of time in subfreezing conditions, which strains the airways and provokes respiratory symptoms. This study aimed to compare the prevalence of exercise-related symptoms and prolonged cough in competitive cross-country skiers versus the general population and to investigate the association between these symptoms and asthma.

Methods

A questionnaire was sent to Finnish cross-country skiers (n=1282) and a random sample of the general population (n=1754), with response rates of 26.9% and 19.0%, respectively.

Results

Both groups were mostly asymptomatic at rest, but symptoms were increased in both groups during and after exercise. Cough was more prevalent after exercise in skiers and phlegm production was more common during and after exercise in skiers. Asthma did not provoke specific symptoms, but symptom prevalence was higher in asthmatic individuals. Skiers had a higher prevalence of cough after exercise (60.6% vs 22.8%, p<0.001) compared with controls, but controls had a higher prevalence of prolonged cough (4.1% vs 9.6%, p=0.004). In participants without asthma, cold air triggered symptoms more often in skiers than controls, while strong odours triggered symptoms more often in asthmatic controls than skiers. Chronic cough lasting more than 8 weeks was rare, reported by 4.8% of controls and 2.0% of skiers.

Conclusion

Cross-country skiers, especially those with asthma, experience a higher burden of exercise-related respiratory symptoms compared with controls. However, repeated exposure to cold air does not appear to result in long-term hypersensitivity of the cough reflex arc.

Intrarater Reliability and Analysis of Learning Effects in the Y Balance Test

While the general reliability of the Y balance test has been previously found to be excellent, earlier reviews highlighted a need for a more consistent methodology between studies. The purpose of this test-retest intrarater reliability study was to assess the intrarater reliability of the YBT using different methodologies regarding normalisation for leg length, number of repetitions, and score calculation. Sixteen healthy adult novice recreational runners aged 18-55 years, both women and men, were reviewed in a laboratory environment. Mean calculated scores, intraclass correlation coefficient, standard error of measurement, and minimal detectable change were calculated and analysed between different leg length normalisation and score calculation methods. The number of repetitions needed to reach a plateauing of results was analysed from the mean proportion of maximal reach per successful repetition. The intrarater reliability of the YBT was found to be good to excellent, and it was not affected by the method of score calculation or leg length measurement. The test results plateaued after the sixth successful repetition. Based on this study, it is suggested to use anterior superior iliac spine-medial malleolus length for leg length normalisation because this method was proposed in the original YBT protocol. At least seven successful repetitions should be performed to reach a result plateau. The average of the best three repetitions should be used to mitigate possible outliers and account for the learning effects seen in this study.

Role of the interaction between lumbar kinematics and accelerometer-measured physical activity in bodily pain, physical functioning and work ability among health care workers with low back pain

The aim of this study was to examine the associations of spinal kinematics and physical activity (PA) with bodily pain, physical functioning, and work ability among health care workers with low back pain (LBP). Spinal kinematics and PA were measured with a wireless Inertial Measurement Unit system (ValedoMotion®) and a waist-worn tri-axial accelerometer (Hookie AM20), respectively. Their association was assessed in relation to Work Ability Index (WAI), bodily pain and physical functioning (RAND-36) in 210 health care workers with recurrent LBP. Greater lumbar movement variability/less deterministic lumbar movement (in angular velocity) during a "Pick Up a Box" functional task was correlated with higher amounts of step counts (r = -0.29, p = 0.01) and moderate PA (r = -0.24, p = 0.03). A higher amount of PA (p = 0.03) as well as less movement control impairment (p = 0.04) and movement variability (p = 0.03) were associated with greater work ability, whilst greater vigorous PA was the only parameter to explain higher physical functioning (p = 0.02). PA and movement variability were relative to each other to explain bodily pain (p = 0.01). These findings show the importance of considering the interaction between lumbar kinematics and physical activity while planning strategies to improve bodily pain, physical functioning and work ability among health care workers with LBP.

Test-Retest Reliability of Isokinetic Ankle, Knee and Hip Strength in Physically Active Adults Using Biodex System 4 Pro

BACKGROUND

The isokinetic dynamometry is considered a gold standard in muscle strength testing. The reliability of lower limb isokinetic strength measurements has not been thoroughly evaluated.

OBJECTIVE

To examine the test-retest reliability of isokinetic ankle plantar and dorsiflexion, ankle inversion and eversion, knee extension and flexion and hip abduction and adduction strength in physically active adults using Biodex System 4 Pro.

METHODS

Peak torques (PTs) and average peak torques (APTs) of the dominant and nondominant lower limbs were tested twice in 19 physically active adults 7 to 14 days apart.

RESULTS

The intraclass correlation coefficients (ICC) values varied from excellent to moderate and coefficient of variation of typical error (CV_TE) values were 6.6-19.5%. Change in the mean expressed as a percent varied from -3.1% to 9.6%. There was no difference in the reliability between PT and APT values. Dominant lower limb was more reliable in every case if there was difference between limbs.

CONCLUSION

Test-retest reliability of isokinetic ankle, knee and hip strength in physically active adults using Biodex System 4 is mostly good or excellent. However, the observed range of the random variation has to be noted when using it in scientific follow-up studies or evaluation of patient progress in clinical settings.

Eating behaviours, menstrual history and the athletic career: a retrospective survey from adolescence to adulthood in female endurance athletes

Aim

To evaluate differences in menstrual and pubertal history and trends in eating behaviours among women with and without a competitive sports background. Additionally, we investigated if menstrual history and eating behaviours are associated with sports career-related factors.

Methods

This retrospective study was conducted on 100 women with a competitive endurance sports background and their age-matched, gender-matched and municipality-matched controls (n=98). Data were collected using a questionnaire using previously validated instruments. Generalised estimating equations were used to calculate associations of menstrual history and eating behaviours with outcome variables (career length, participation level, injury-related harms and career termination due to injury).

Results

Athletes reported higher rates of delayed puberty and menstrual dysfunction than controls. No differences between the groups were observed in the Eating Disorder Examination Questionnaire short form (EDE-QS) scores at any age. Previous disordered eating (DE) was associated with current DE in both groups. Among athletes, higher EDE-QS scores during the sports career were associated with a shorter career (B=-0.15, 95% CI -0.26 to -0.05). Secondary amenorrhoea was associated with lower participation level (OR 0.51, 95% CI 0.27 to 0.95), injury-related harms during the career (OR 4.00, 95% CI 1.88 to 8.48) and career termination due to injury (OR 1.89, 95% CI 1.02 to 3.51).

Conclusion

The findings indicate that DE behaviours and menstrual dysfunction, specifically secondary amenorrhoea, have a disadvantageous relationship with a sports career in women competing in endurance sports. DE during the sports career is associated with DE after the career.

Factors associated with body size perception among adolescent goal-oriented sports participants and non-participants: a cross-sectional Finnish study

BACKGROUND

Regardless of competitive athletes' body image pressures, only few studies have focused on adolescent sport participants' body image and the findings are inconclusive. Furthermore, the role of competitive goals in sports on adolescents' body size perception has not been studied. We examined the factors associated with adolescents' competitive goals in sports and body size perception, and the associations between adolescents' competitive goals in sports and body size perception.

METHODS

The cross-sectional study consisted of 475 goal-oriented sports club participants and 936 reference youths (aged 14-16 years). The study questionnaire included multiple choice items on health behaviours, motives to exercise, competitive goals in sports and body size perception. The multinomial logistic regression analysis was used to investigate the associations.

RESULTS

Adolescents with competitive goals in sports perceived their body size as about the right size more frequently than reference youths (68% vs 47%, p < 0.001 in girls; 74% vs 61%, p < 0.001 in boys). More than one-fourth of girls with competitive goals in sports perceived themselves as overweight, although only 7% of them were overweight. Adolescents with appearance/weight motives to exercise and poor perceived physical fitness had higher odds of perceived fatness. Additionally, BMI was positively associated with perceived fatness and negatively with perceived thinness. Having competitive goals in sports was not independently associated with perceived fatness or perceived thinness.

CONCLUSIONS

Adolescents' BMI, appearance/weight motives to exercise, and perceived physical fitness were more strongly associated with body size perception than their competitive goals in sports. However, perceived fatness among girls with competitive goals in sports should be considered in organized sports.

Depressive Symptoms Are Associated With Decreased Quality of Life and Work Ability in Currently Working Health Care Workers With Recurrent Low Back Pain

OBJECTIVE

This study investigates the association between depressive symptoms and multisite pain and health-related quality of life and work ability in currently employed health care workers with recurrent low back pain (LBP).

METHODS

Multisite pain, depressive symptoms, quality of life, and work ability were assessed by validated questionnaires. A generalized linear model was used for statistical analysis.

RESULTS

Notably, 28% of female health care workers with LBP had at least moderate levels of depressive symptoms. Depressive symptoms were significantly associated with decreased health-related quality of life and work ability. Multisite pain was not significantly associated with work ability.

CONCLUSIONS

Depressive symptoms are relatively common in female health care workers with LBP, and treatment of these symptoms may be crucial to improve their work ability.

O9-1 Physical activity change and stability patterns from adolescence to early adulthood: how activity domains and sedentary behaviour are associated with maintaining, increasing and decreasing activity?

Background

Longitudinal studies demonstrate that physical activity (PA) declines on average from adolescence to early adulthood. However, some subgroups of adolescents increase activity while others decrease or maintain high or low activity. Determinants of change or maintenance of (in)activity may differ between subgroups and are valuable information for targeted health promotion. The purpose of this study was to identify PA patterns from adolescence to early adulthood, and also to explore how different activity domains and Sedentary Behaviour (SB) are associated with PA patterns.

Methods

The data of this observational cohort study (collected in 2013/2014 and 2017/2018) consisted of 254 Finns at age 15 and 19 participating the Health Promoting Sports Club study. K-means cluster analysis for longitudinal data was performed to identify participant clusters (patterns) based on their accelerometry-measured moderate-to-vigorous PA (MVPA). Associations of sports club participation (SC), active commuting (AC), and SB with PA patterns were examined by logistic regression analysis.

Results (preliminary)

Five MVPA patterns were identified: inactivity maintainers (n = 71), activity maintainers (n = 70), decreasers from moderate (to low) PA (n = 61), decreasers from high (to moderate) PA (n = 32), and increasers (n = 20). At age 15, SC participation (41-97%) and AC (47-75%) were common in all the patterns. By age 19, clear dropout from these activities was prevalent (SC participation mean 32%, AC 31-63%). Maintained SC participation was associated with a higher likelihood of belonging to the decreasers from high PA (OR = 11.2, CI = 1.4-90.0) and to the combined group of increasers and activity maintainers (OR = 3.6, CI = 1.8-7.4); also with a lower likelihood of being an inactivity maintainer (OR = 0.1, CI = 0.02-0.2). Dropout from SC was related to a higher likelihood of being a decreaser from high PA (OR = 10.9, CI = 1.3-90.7). Maintenance/adoption of AC was associated with a lower likelihood of being an inactivity maintainer (OR = 0.3, CI = 0.1-0.7). Decreased SB was related to a higher likelihood of belonging to the activity maintainers and increasers (OR = 0.96, CI = 0.93-0.98).

Conclusions

PA patterns diverge greatly over the transition to adulthood. Changes in SC participation, AC, and SB show different associations with diverging PA patterns. Hence, tailored PA promotion is recommended.

Physical activity measured by accelerometry among adolescents participating in sports clubs and non-participating peers

AbstractThe purpose of this descriptive cross-sectional study is to describe the amount and intensity of physical activity (PA) measured by accelerometry among adolescents participating in organized sports (SCP) and age-matched non-participating peers (NP). SCPs (332) and NPs (139) wore an accelerometer on the hip for 7 days. PA was reported using the 1 min exponential moving average. The current moderate-to-vigorous physical activity (MVPA) recommendation of at least an average of 60 minutes of MVPA daily was reached by 85% of SCPs and 45% of NPs (p < 0.001). During training days, the MVPA times among SCPs ranged from 153 ± 39 min in males and 109 ± 35 min in females participating in basketball to 113 ± 33 min in males participating in floorball and 83 ± 32 min in females participating in gymnastics. -Sports participation contributes rather strongly to the accumulation of the recommended amount of MVPA. During training days SCPs, except for females participating in gymnastics, accumulated more MVPA than NPs. During non-training days only males participating in cross country skiing and females participating in track and field accumulated more MVPA than NPs.

High training volume is associated with increased prevalence of non-allergic asthma in competitive cross-country skiers

Background

Cross-country skiers have a high prevalence of asthma, but its phenotypes and association with success in competitions are not known.

Objective

To investigate, by means of a postal survey, the relative proportions of allergic and non-allergic asthma in competitive cross-country skiers compared with the general population, to study how performance level and training volume are related to asthma and its type and to assess the possible risk factors for allergic and non-allergic asthma in competitive skiers.

Methods

All Finnish cross-country skiers enrolled in the largest national competitions in winter 2019 (n=1282), and a random sample (n=1754) of the general population of the same age were sent a postal questionnaire. The response rate was 27.4% (n=351) for skiers and 19.5% (n=338) for the controls. International Ski Federation (FIS) ranking points measured the level of success in skiers. Asthma was defined as self-reported, physician-diagnosed asthma. Asthma was considered allergic if associated with doctor-diagnosed allergy, and exposure to allergens provoked asthma symptoms.

Results

The prevalence of asthma was higher in skiers than in the controls (25.9% vs 9.2%, p<0.001), and it was the highest (56.1%) in the most successful quartile of skiers. Asthma was more often non-allergic in skiers than in the controls (60.1% vs 38.7%, p=0.036). Being a skier came with a higher risk for non-allergic (OR 5.05, 95% CI 2.65 to 9.61) than allergic asthma (OR 1.92, 1.08–3.42). Using multivariable regression analysis, training volume was associated with non-allergic asthma, while age, family history of asthma and allergic rhinitis were associated with allergic asthma.

Conclusion

The prevalence of asthma is the highest in the most successful cross-country skiers. The asthma in skiers is mostly non-allergic compared with the general population of the same age. The most important risk factor for non-allergic asthma in skiers is high training volume.

Players with high physical fitness are at greater risk of injury in youth football

The aim of this study was to investigate physical fitness, football-specific skills, and their association with injury risk in youth football. Altogether 447 male and female players aged 9-14 years (median 12 years) participated in performance tests and prospective follow-up. The physical fitness tests included five-jump test for distance, 30-m sprint, football-specific figure of eight agility, countermovement jump, and Yo-Yo intermittent endurance test level 1. The football-specific skill tests included dribbling and passing tests. Injuries and exposure were registered during the 20-week follow-up. Our candidate risk factors were low/high level of physical fitness measured with a composite score of physical fitness tests and low/high level of football-specific skills measured with a composite score of dribbling and passing tests. Secondarily, we investigated performance in individual tests and their association with injury risk. During the follow-up, players reported 565 injuries (264 acute and 301 overuse injuries). High level of physical fitness was associated with increased rate of all injuries (age-, sex-, and mean team exposure-adjusted IRR: 1.28, 95% CI: 1.04-1.58). The level of football-specific skills had no influence on the overall injury rate. Burden of overuse injuries, but not acute injuries was significantly higher in most fit players compared with the players in the reference group (IRR: 2.09, 95% CI: 1.04-4.24). In conclusion, most fit players were at greater risk of sustaining injuries in youth competitive football.

Injury incidence and prevalence in Finnish top-level football - one-season prospective cohort study

OJECTIVE

To investigate the injury characteristics in Finnish male football players.

DESIGN

One-season prospective epidemiological study. Data were collected via injury reports from the medical staff and directly from the players using the Olso Sports Trauma Research Center Health Questionnaire.

PARTICIPANTS

The first team squads of Finnish football league (n = 12 teams, 236 players).

MAIN OUTCOME MEASUREMENT

Injury incidence.

RESULTS

A total of 541 injuries occurred during the exposure of 62 878 hours. Injury incidence per 1000 exposure hours was 8.6 (30.6 in matches and 3.4 in training). A player sustained on average 2.3 (median 2, range 0-13) injuries during the study. Thigh and ankle were the most commonly injured body parts for acute injuries and hip/groin were the most commonly injured body part for overuse injuries. The median absence time for all injuries was 12 (range 0-107) days, 12 (range 0-107) for acute, and 8 (range 0-61) for overuse injuries. Thigh injuries caused the greatest consequences in terms of absence from full participation (median 5 days, range 0-88).

CONCLUSION

Lower limb muscle injuries were the most prevalent injuries in the study. Collecting data directly from the players enabled to report more injuries compared to what was reported only by the medical staff.

Resting Electrocardiogram and Blood Pressure in Young Athletes and Non-Athletes: A 4-year follow-up

A follow-up data on electrocardiogram (ECG) and blood pressure (BP) changes in adolescent athletes are scarce. We compared ECG and BP between adolescent athletes and non-athletes in a 4-year follow-up. A total of 154 youth sports clubs (SC) in Finland and 100 secondary schools for comparison data participated in this observational follow-up study. Those who maintained or adopted SC participation are referred to as "Always athletes" (n=137), those who never participated in SC as "Never athletes" (n=108) and those who dropped out of SC during the follow-up as "Changers" (n=116). The mean age of the participants was 15.5 (0.6) years in all study groups at baseline. Resting ECG including heart rate, PR interval, QRS duration, QRS axis, QRS amplitude, T axis and QT interval and BP were measured from all participants at baseline and after follow-up. "Always athletes" had lower resting heart rate, more negative T-wave axis and higher QRS amplitude than "Never athletes" at baseline and at 4-years (P < 0.05). "Changers" had lower resting heart rate, more negative T-wave axis and higher QRS amplitude, systolic BP and pulse pressure than "Never athletes" at baseline (P < 0.05). None of the observed differences at baseline, were visible at 4-years (P > 0.05) except the difference in T-wave axis (P = 0.028). The significant group x time interaction between "Changers" and "Never athletes" was found for QRS amplitude (P = 0.017). Adolescent athletes have several training-induced cardiovascular adaptations, which return towards the levels of non-athletes after cessation of regular training. This article is protected by copyright. All rights reserved.

Injury History and Perceived Knee Function as Risk Factors for Knee Injury in Youth Team-Sports Athletes

BACKGROUND

The identification of risk factors for sports injuries is essential before injury prevention strategies can be planned.

HYPOTHESIS

Previous acute knee injury and lower perceived knee function measured by Knee injury and Osteoarthritis Outcome Score (KOOS) will increase the risk of acute knee injury in youth team-sports athletes.

STUDY DESIGN

Prospective cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

At baseline, youth (≤21 years old) male and female basketball and floorball athletes completed a questionnaire on previous acute knee injuries and perceived knee function (KOOS). A total of 211 male and 183 female athletes were followed for an acute knee injury up to 3 years. Unadjusted and adjusted Cox regression models were used in risk factor analyses.

RESULTS

In male athletes, previous acute knee injury and lower KOOS Pain, Activities of Daily Living, Sport and Recreation, and knee-related Quality of Life subscale scores increased the risk of acute knee injury in the unadjusted analyses. Adjusted analyses for male injuries were not performed because of low number of acute knee injuries (n = 18). In female athletes, previous acute knee injury increased the risk of acute knee injury when adjusted for athletes' age and body mass index (hazard ratio, 2.6 [95% CI, 1.3-5.2]). In female athletes, none of the KOOS subscale scores were associated with the increased risk of acute knee injury in the adjusted analyses.

CONCLUSION

Previous acute knee injury was associated with the risk of new acute knee injury in youth male and female athletes. In youth male athletes, additionally, lower perceived knee function in 4 out of 5 KOOS subscale scores were associated with the increased risk of new acute knee injury.

CLINICAL RELEVANCE

The treatment and rehabilitation of the present acute knee injury and secondary prevention of reinjury should be emphasized in youth team-sports athletes.

Higher prevalence but later age at onset of asthma in cross-country skiers compared with general population

Cross-country skiing causes strain in the airways because skiers train and compete in cold air. The aim of this survey was to investigate the prevalence and age at onset of asthma, asthma control, and use of asthma medication in Finnish competitive cross-country skiers. All cross-country skiers who were enrolled in the largest national competitions in winter 2019 (n = 1282) were invited to the study via the Finnish Ski Association. A control group (n = 1733) was matched for the responding skiers by age, gender, and region. The response rate was 27.4% (n = 351) for skiers and 19.5% (n = 338) for the controls. The prevalence of asthma was 25.9% in skiers and 9.2% in the controls (p < 0.001). Median (IQR) age at first asthma-related symptoms was higher in skiers than in the controls (13.0 (8.25-16.0) vs. 8.0 (2.25-11.75) years, p < 0.001), and the difference in asthma prevalence was evident only after the start of skiing career. Median (IQR) Asthma Control Test (ACT) score in skiers and controls with asthma was 22.0 (21-24) vs. 22.0 (19-24) (p = 0.611), and 89.0% of skiers and 77.4% of controls had well-controlled asthma (ACT score ≥20). In skiers with asthma, 82.4% used regular inhaled corticosteroids (ICS), and 80.2% used bronchodilators. A fixed combination of ICS +long-acting β2-agonist was regularly used by 47.3% of the skiers and 22.6% of the controls with asthma (p = 0.016). In conclusion, asthma prevalence is about 2.5 times higher, and age at onset of asthma is later in skiers compared with the controls. Asthma in cross-country skiers is mostly well controlled and on regular maintenance treatment.

Change of Direction Biomechanics in a 180-Degree Pivot Turn and the Risk for Noncontact Knee Injuries in Youth Basketball and Floorball Players

BACKGROUND

Studies investigating biomechanical risk factors for knee injuries in sport-specific tasks are needed.

PURPOSE

To investigate the association between change of direction (COD) biomechanics in a 180-degree pivot turn and knee injury risk among youth team sport players.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A total of 258 female and male basketball and floorball players (age range, 12-21 years) participated in the baseline COD test and follow-up. Complete data were obtained from 489 player-legs. Injuries, practice, and game exposure were registered for 12 months. The COD test consisted of a quick ball pass before and after a high-speed 180-degree pivot turn on the force plates. The following variables were analyzed: peak vertical ground-reaction force (N/kg); peak trunk lateral flexion angle (degree); peak knee flexion angle (degree); peak knee valgus angle (degree); peak knee flexion moment (N·m/kg); peak knee abduction moment (N·m/kg); and peak knee internal and external rotation moments (N·m/kg). Legs were analyzed separately and the mean of 3 trials was used in the analysis. Main outcome measure was a new acute noncontact knee injury.

RESULTS

A total of 18 new noncontact knee injuries were registered (0.3 injuries/1000 hours of exposure). Female players sustained 14 knee injuries and male players 4. A higher rate of knee injuries was observed in female players compared with male players (incidence rate ratio, 6.2; 95% CI, 2.1-21.7). Of all knee injuries, 8 were anterior cruciate ligament (ACL) injuries, all in female players. Female players displayed significantly larger peak knee valgus angles compared with male players (mean for female and male players, respectively: 13.9°± 9.4° and 2.0°± 8.5°). No significant associations between biomechanical variables and knee injury risk were found.

CONCLUSION

Female players were at increased risk of knee and ACL injury compared with male players. Female players performed the 180-degree pivot turn with significantly larger knee valgus compared with male players. However, none of the investigated variables was associated with knee injury risk in youth basketball and floorball players.

Physical activity from adolescence to young adulthood: patterns of change, and their associations with activity domains and sedentary time

BACKGROUND

Longitudinal studies demonstrate an average decline in physical activity (PA) from adolescence to young adulthood. However, while some subgroups of adolescents decrease activity, others increase or maintain high or low activity. Activity domains may differ between subgroups (exhibiting different PA patterns), and they offer valuable information for targeted health promotion. Hence, the aim of this study was to identify PA patterns from adolescence to young adulthood; also to explore the associations of (i) changes in PA domains and in sedentary time, (ii) sociodemographic factors, and (iii) self-rated health with diverging PA patterns.

METHODS

The observational cohort study data encompassed 254 adolescents at age 15 and age 19. K-means cluster analysis for longitudinal data was performed to identify participant clusters (patterns) based on their accelerometry-measured moderate-to-vigorous PA (MVPA). Logistic regressions were applied in further analysis.

RESULTS

Five PA patterns were identified: inactivity maintainers (n = 71), activity maintainers (n = 70), decreasers from moderate (to low) PA (n = 61), decreasers from high (to moderate) PA (n = 32), and increasers (n = 20). At age 15, participation in sports clubs (SC, 41-97%) and active commuting (AC, 47-75%) was common in all the patterns. By age 19, clear dropout from these activities was prevalent (SC participation mean 32%, AC 31-63%). Inactivity maintainers reported the lowest amount of weekly school physical education. Dropout from SC - in contrast to non-participation in SC - was associated with higher odds of being a decreaser from high PA, and with lower odds of being an inactivity maintainer. Maintained SC participation was associated with higher odds of belonging to the decreasers from high PA, and to the combined group of activity maintainers and increasers; also with lower odds of being an inactivity maintainer. Maintenance/adoption of AC was associated with decreased odds of being an inactivity maintainer. Self-reported health at age 19 was associated with the patterns of maintained activity and inactivity.

CONCLUSIONS

PA patterns diverge over the transition to adulthood. Changes in SC participation and AC show different associations with diverging PA patterns. Hence, tailored PA promotion is recommended.

Resting Electrocardiogram and Blood Pressure in Young Endurance and Nonendurance Athletes and Nonathletes

CONTEXT

Much information is available on electrocardiogram (ECG) and blood pressure (BP) changes in senior athletes. However, corresponding data on adolescent athletes are scarce.

OBJECTIVE

To study the differences in resting ECG and BP values among adolescent endurance athletes, nonendurance athletes, and nonathletes.

DESIGN

Cross-sectional study.

SETTING

A total of 154 youth sports clubs in Finland and 100 secondary schools for comparison data.

PATIENTS OR OTHER PARTICIPANTS

We recruited young athletes (n = 410) aged 14 to 16 years in 10 popular sport disciplines, including winter and summer as well as team and individual sports, and categorized them as endurance or nonendurance sports. Comparison data for age-matched, non-sports club participants (n = 164) were collected via secondary schools.

MAIN OUTCOME MEASURE(S)

Resting ECG, including heart rate, PR interval, QRS duration, QRS axis, QRS amplitude, T axis, and QT interval as well as systolic and diastolic BPs.

RESULTS

No differences in any ECG variable of interest were found between the endurance and nonendurance athletes. The PR interval was longer in endurance athletes than in nonathletes (P = .05). The QRS amplitude (P = .03) was higher among nonendurance athletes than among nonathletes. Diastolic BP was lower among endurance (P = .002) and nonendurance (P = .02) athletes than among nonathletes. Endurance athletes (odds ratio [OR] = 2.85; 95% CI = 1.81, 4.50) and nonendurance athletes (OR = 2.19; 95% CI = 1.43, 3.35) were more likely to have sinus bradycardia than were nonathletes. Nonendurance athletes were more likely to have elevated systolic BP than were endurance athletes (OR = 1.70; 95% CI = 1.07, 2.72) and nonathletes (OR = 1.73; 95% CI = 1.04, 2.87).

CONCLUSIONS

Young athletes had similar ECG and BP findings independent of their sports. Physiological adaptations including sinus bradycardia, higher QRS amplitude, and lower diastolic BP, which are commonly seen in adult athletes, were also present in adolescent athletes.

On-Ice and Off-Ice Fitness Profiles of Elite and U20 Male Ice Hockey Players of Two Different National Standards

Vigh-Larsen, JF, Haverinen, MT, Panduro, J, Ermidis, G, Andersen, TB, Overgaard, K, Krustrup, P, Parkkari, J, Avela, J, Kyröläinen, H, and Mohr, M. On-ice and off-ice fitness profiles of elite and U20 male ice hockey players of two different national standards. J Strength Cond Res 34(12): 3369-3376, 2020-Differences in body composition and performance were investigated between elite and U20 male ice hockey players of 2 different national standards. One hundred seventy-nine players were recruited from the highest Finnish (n = 82) and Danish (n = 61) national level, as well as from 1 U20 team from Finland (n = 19) and Denmark (n = 17). Body composition and countermovement jump performance (CMJ) were measured off-ice in addition to on-ice assessments of agility, 10- and 30-m sprint performance, and endurance capacity (the maximal Yo-Yo Intermittent Recovery Level 1 Ice Hockey Test, Yo-Yo IR1-IHmax). Large differences in on-ice performances were demonstrated between Finnish and Danish elite players for agility, 10- and 30-m sprint performance (2-3%, P ≤ 0.05), and Yo-Yo IR1-IHmax performance (15%, P ≤ 0.05). By contrast, no differences (P > 0.05) were present between elite players for CMJ ability or body composition. However, elite players possessed more body and muscle mass than U20 players. Finally, the Finnish U20 cohort had a similar performance level as the Danish elite players and superior 10-m sprint performance, whereas the Danish U20 level was inferior to the other groups in every performance assessment (P ≤ 0.05). In conclusion, on-ice speed and endurance differ markedly between elite players of 2 different national standards with no distinction in body composition or CMJ ability. Moreover, the most consistent difference between U20 and senior elite players was related to body and muscle mass. These results highlight the usefulness of on-ice assessments and suggest the importance of on-ice high-intensity training in elite players in addition to training targeted the development of lean body mass in youth prospects.

Neuromuscular Training Warm-up Prevents Acute Noncontact Lower Extremity Injuries in Children's Soccer: A Cluster Randomized Controlled Trial

Background:

Prevention of sports injuries is essential in youth, as injuries are associated with less future physical activity and thus greater all-cause morbidity.

Purpose:

To investigate whether a neuromuscular training warm-up operated by team coaches is effective in preventing acute lower extremity (LE) injuries in competitive U11-U14 soccer players.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

Twenty top-level U11 to U14 soccer clubs in Finland were randomized into intervention and control groups and assessed for 20 weeks. Participants included 1403 players (280 female, 1123 male; age range, 9-14 years): 673 players (44 teams) in the intervention group and 730 players (48 teams) in the control group. The intervention group team coaches were introduced to a neuromuscular training warm-up to replace the standard warm-up 2 to 3 times per week. The control teams were asked to perform their standard warm-up. Injury data collection was done via weekly text messages. The primary outcome measure was a soccer-related acute LE injury, and the secondary outcome measure was an acute noncontact LE injury.

Results:

A total of 656 acute LE injuries occurred: 310 in the intervention group and 346 in the control group. The overall acute LE injury incidence was 4.4 per 1000 hours of exposure in the intervention group and 5.5 per 1000 hours of exposure in the control group, with no significant difference between groups (incidence rate ratio [IRR], 0.82 [95% CI, 0.64-1.04]). There were 302 acute noncontact LE injuries: 129 in the intervention group (incidence, 1.8 per 1000 hours) and 173 in the control group (2.7 per 1000 hours). A significant reduction in acute noncontact LE injuries of 32% (IRR, 0.68 [95% CI, 0.51-0.93]) was observed in the intervention group compared with the control group. Furthermore, significant reductions in injury incidence in favor of the intervention group were seen in the subanalyses of acute noncontact LE injuries, leading to ≤7 days of time loss and fewer ankle and joint/ligament injuries.

Conclusion:

A neuromuscular training warm-up operated by team coaches was found to be effective in preventing acute noncontact LE injuries in children’s soccer, but this was not seen in all acute LE injuries.

Clinical Relevance:

We encourage children’s soccer coaches and health care professionals to implement neuromuscular training warm-up in youth sports.

Registration:

ISRCTN14046021 (ISRCTN registry).

The standing knee lift test is not a useful screening tool for time loss from low back pain in youth basketball and floorball players

OBJECTIVES

The aim of this study was to investigate the association between pelvic kinematics during the standing knee lift (SKL) test and low back pain (LBP) in youth floorball and basketball players.

DESIGN

A prospective cohort study.

SETTING

Finnish elite youth floorball and basketball players.

PARTICIPANTS

Finnish elite youth female and male floorball and basketball players (n = 258, mean age 15.7 ± 1.8).

MAIN OUTCOME MEASURES

LBP resulting in time loss from practice and games was recorded over a 12-month period and verified by a study physician. Associations between LBP and sagittal plane pelvic tilt and frontal plane pelvic obliquity during the SKL test as measured at baseline were investigated. Individual training and game hours were recorded, and Cox's proportional hazard models with mixed effects were used for the analysis.

RESULTS

Cox analyses revealed that sagittal plane pelvic tilt and frontal plane pelvic obliquity were not associated with LBP in floorball and basketball players during the follow-up. The hazard ratios for pelvic tilt and pelvic obliquity ranged between 0.93 and 1.08 (95% CIs between 0.91 and 1.07 and 0.83 and 1.29), respectively.

CONCLUSIONS

Pelvic movement during the SKL test is not associated with future LBP in youth floorball and basketball players.

A 3D motion capture analysis of a giving-way ankle episode during a 180-degree pivot turn: A case report

Lateral ankle sprains are highly prevalent during sporting activities, as it accounts for approximately 60% of all athletic injuries. There is currently a paucity of research which provides kinetic and kinematic assessments of sprains and giving-way episodes of the ankle joint. The aim of this case study was to examine the kinetics and kinematics of the ankle and knee during a giving-way episode in a female ice hockey player during a 180-degree pivot turn, which was conducted in a 3D motion capture laboratory. Three trials were conducted on this participant (one accident trial, two control trials). Kinetic and kinematic analysis was conducted on the outside leg during a left 180-degree pivot turn (right leg). The plantarflexion angle of the giving-way trial was larger than the control trials from the point of initial contact until the end of the trial. Inversion was also 27-degrees greater 150 ms after initial contact in the giving-way trial and 26-degrees greater compared to control trials 1 and 2. Substantially greater plantarflexion, inversion and internal rotation angles of the ankle were observed during the giving-way trial compared to control trials. The maximum vertical and horizontal ground reaction forces, as well as ankle inversion and internal rotation moments, were lower for the giving-way trial in comparison to the control trials. Further research is needed to understand the influence of plantarflexion angle with a giving-way episode of the ankle. This study provides valuable kinetic and kinematic information regarding a giving-way episode of the ankle.

Reliability and construct validity of the modified Finnish version of the 9-item patient health questionnaire and its associations within the biopsychosocial framework among female health-care workers with sub-acute or recurrent low back pain

Background

Health-care workers have an increased risk for chronic low back pain (LBP) leading to reduced workability. Depression, a highly prevalent, costly and disabling condition, is commonly seen in patients with sub-acute LBP. This study investigated the psychometric properties and construct-validity of a modified 9-item Patient Health Questionnaire (PHQ-9-mFIN) in female health-care workers with sub-acute LBP.

Methods

Reliability (internal consistency, test-retest repeatability) was assessed using standard methods. Construct validity of the PHQ-9-mFIN was assessed as level of depressive symptoms (PHQ-9-mFIN: 0–4 none, 5–9 mild, ≥10 at least moderate) against the RAND 36 Health Survey, a valid measure of health-related quality of life (HRQoL). Additionally, the strength of the association between the levels of PHQ-9-mFIN and selected biopsychosocial factors was determined.

Results

The internal consistency of the PHQ-9-mFIN was high (Cronbach’s α = 0.82) and the test-retest repeatability scores (n = 64) were moderate: Pearson’s correlation was 0.73 and Intraclass Correlation Coefficient (ICC) 0.73 (95% CI: 0.58 to 0.82). Construct validity (Spearman correlation) against the Physical and Mental component items and their summary scales of the RAND 36 were much higher for the Mental (range, − 0.40 to − 0.67 and − 0.64) than for the Physical (range, − 0.08 to − 0.43 and − 0.22). There was a clear stepwise association (p < 0.001) between the levels of depressive symptoms and General health (physical component, range, 59.1 to 78.8). The associations with all items of the Mental components were strong and graded (p < 0.001). All participants had low scores for Bodily pain, regardless of the level of depressive symptoms. There was a strong association (p ≤ 0.003) between the levels of PHQ-9-mFIN and multisite pain, lumbar exertion and recovery after workdays, neuromuscular fitness in modified push-ups, workability, and fear of pain related to work.

Conclusions

The PHQ-9-mFIN showed adequate reliability and excellent construct validity among female health-care workers with recurrent LBP and physically strenuous work.

Trial registration

NCT01465698.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-020-03832-y.

Asthma in Competitive Cross-Country Skiers: A Systematic Review and Meta-analysis

INTRODUCTION

In cross-country skiing, the repetitive ventilation of large amounts of cold and dry air strains the airways. The aim of this systematic review was to establish an overview of the current literature on asthma in cross-country skiers, biathletes and ski-orienteers.

METHODS

Six databases were searched on August 29, 2019. The search yielded 2161 articles. Thirty articles fulfilled the search criteria and were pooled together for a qualitative synthesis. Eight articles were included in the meta-analysis on the prevalence of asthma and the use of asthma medication.

RESULTS

According to the meta-analysis, the prevalence of self-reported physician-diagnosed asthma in skiers was 21% (95% CI 14-28%). The onset age of asthma was higher in skiers than in non-skiers with asthma. The prevalence of asthma medication use was on average 23% (CI 95% 19-26%). Several studies reported that asthma was underdiagnosed in skiers, as previously healthy skiers without a prior asthma diagnosis or medication use were frequently found to fulfill diagnostic criteria for asthma according to lung function tests. Studies using bronchial biopsy demonstrated that eosinophilic asthma is not detected in skiers with asthma as often as it is in non-skiers with asthma and that there are signs of airway inflammation even in non-asthmatic skiers.

CONCLUSION

Our findings suggest that the accuracy and coverage of diagnosing asthma in skiers has improved over the recent decades. However, the optimal treatment and natural course of asthma in this population remain unclear. Future research should investigate how the intensity of training, airway infections and their treatment affect the development of asthma among skiers.

PRD REGISTRATION NUMBER

CRD42017070940.

Menstrual dysfunction and body weight dissatisfaction among Finnish young athletes and non-athletes

To determine the prevalence of menstrual dysfunction (MD; ie, oligomenorrhea or amenorrhea) and attitudes toward body weight among athletes and non-athletes, we studied a cohort of athletes and non-athletes, in adolescence (14-16 years) and subsequently in young adulthood (18-20 years). We further studied the differences between athletes reporting MD and eumenorrheic athletes at both time periods and identified physical and behavioral characteristics that might predict MD in young adulthood. Data were collected using questionnaires, accelerometers, and a pre-participation screening. In adolescence, the athletes reported current primary amenorrhea more often than the non-athletes (4.7% vs 0%, P = .03). In young adulthood, athletes reported MD more frequently than non-athletes (38.7% vs 5.6%, P < .001). Athletes had less desire than non-athletes to lose weight at both time points, and in adolescence, athletes were more satisfied with their weight. However, about one fifth of the athletes and about 40% of the non-athletes experienced body weight dissatisfaction at both time points. In adolescence, athletes reporting MD had lower BMI than eumenorrheic athletes. In young adulthood, athletes with MD were more physically active than eumenorrheic athletes. The only longitudinal predictor of MD in young adulthood was MD in adolescence. Our findings indicate that MD is relatively frequent among young Finnish athletes. However, athletes appear to have a smaller tendency to experience body weight dissatisfaction than their non-athletic peers. MD seems to track from adolescence to adulthood, suggesting that there is a need to focus on possible causes at the earliest feasible phase of an athlete's career.

Sharp Rise in Fall-Induced Cervical Spine Injuries Among Older Adults Between 1970 and 2017

BACKGROUND

Fall-induced injuries in older adults are a major public health challenge.

METHODS

We determined the current trends in the number and age-adjusted incidence of fall-induced severe cervical spine injuries among older adults in Finland by taking into account all persons 50 years of age or older who were admitted to Finnish hospitals for primary treatment of these injuries between 1970 and 2017. Similar patients aged 20-49 years served as a reference group.

RESULTS

The annual number of fall-induced severe cervical spine injuries among older Finnish adults rose steeply during the follow-up, from 59 in 1970 to 502 in 2017. The age-adjusted incidence of injury (per 100,000 persons) was higher in men than women throughout this period and showed a clear increase from 1970 to 2017: from 8.4 to 25.0 in men, and from 2.8 to 13.9 in women. In both sexes, the increase was most prominent in the oldest age group, persons aged 80 years or older. In the reference group, the injury incidence declined by time.

CONCLUSIONS

The number and incidence of fall-induced severe cervical spine injuries among older Finns showed a sharp rise between 1970 and 2017. An increase in the average risk of serious falls may partly explain the phenomenon. Effective fall and injury prevention measures are urgently needed since further aging of the population is likely to aggravate the problem in the near future.

New Machine Learning Approach for Detection of Injury Risk Factors in Young Team Sport Athletes

The purpose of this article is to present how predictive machine learning methods can be utilized for detecting sport injury risk factors in a data-driven manner. The approach can be used for finding new hypotheses for risk factors and confirming the predictive power of previously recognized ones. We used three-dimensional motion analysis and physical data from 314 young basketball and floorball players (48.4% males, 15.72±1.79 yr, 173.34±9.14 cm, 64.65±10.4 kg). Both linear (L1-regularized logistic regression) and non-linear methods (random forest) were used to predict moderate and severe knee and ankle injuries (N=57) during three-year follow-up. Results were confirmed with permutation tests and predictive risk factors detected with Wilcoxon signed-rank-test (p<0.01). Random forest suggested twelve consistent injury predictors and logistic regression twenty. Ten of these were suggested in both models; sex, body mass index, hamstring flexibility, knee joint laxity, medial knee displacement, height, ankle plantar flexion at initial contact, leg press one-repetition max, and knee valgus at initial contact. Cross-validated areas under receiver operating characteristic curve were 0.65 (logistic regression) and 0.63 (random forest). The results highlight the difficulty of predicting future injuries, but also show that even with models having relatively low predictive power, certain predictive injury risk factors can be consistently detected.

Haemoglobin, iron status and lung function of adolescents participating in organised sports in the Finnish Health Promoting Sports Club Study

Objectives

To compare laboratory test results and lung function of adolescent organised sports participants (SP) with non-participants (NP).

Methods

In this cross-sectional study, laboratory tests (haemoglobin, iron status), and flow-volume spirometry were performed on SP youths (199 boys, 203 girls) and their NP peers (62 boys, 114 girls) aged 14–17.

Results

Haemoglobin concentration <120/130 g/L was found in 5.8% of SP and 5.1% NP (OR 1.20, 95% CI 0.54 to 2.68). Ferritin concentration below 15 µg/L was found in 22.7% of both SP and NP girls. Among boys ferritin <30 µg/L was found in 26.5% of SP and 30.2% of NP (OR 0.76, 95% CI 0.40 to 1.47). Among SP iron supplement use was reported by 3.5% of girls and 1.5% of boys. In flow-volume spirometry with bronchodilation test, 7.0% of SP and 6.4% of NP had asthma-like findings (OR 1.17, 95% CI 0.54 to 2.54); those using asthma medication, that is, 9.8% of SP and 5.2% of NP were excluded from the analysis.

Conclusions

Screening for iron deficiency is recommended for symptomatic persons and persons engaging in sports. Lung function testing is recommended for symptomatic persons and persons participating in sports in which asthma is more prevalent.

Reliability of the Sport Concussion Assessment Tool 5 baseline testing: A 2-week test-retest study

OBJECTIVES

To examine short-term test-retest reliability of the Sport Concussion Assessment Tool 5 (SCAT5).

DESIGN

Longitudinal study.

METHODS

Sixty-two professional male ice hockey players (mean age=22.5, SD=3.2) completed a preseason baseline test twice over a two-week interval. Half of the players were tested by the same assessor on both testing sessions. Spearman's correlations (rs) were used to determine linear agreements, and Wilcoxon signed rank tests (sig r) were used to determine mean differences, between testing sessions.

RESULTS

Symptoms had high test-retest reliability (Score: rs=0.85, p<0.001, sig r p<0.001; Severity: rs=0.84, p<0.001, sig r p<0.001). The reliability coefficients for the SAC (rs=0.58, p<0.001, sig r: p=0.412), and mBESS (rs=0.40, p=0.001, sig r: p=0.607) were considerably lower than symptoms. More than half (52%) of the athletes reported at least one baseline symptom (Md=1, M=2.2, SD=3.3). The most commonly reported symptoms were fatigue or low energy and neck pain. The broad ranges of SAC total scores (range=28-45, Md=35, M=35.4, SD=4.2) and SAC test-retest change scores (range -7 to +11) were mostly due to variability on the memory performance, tested using 10-item word lists. The number of mBESS single leg stance errors (Md=1, Md 3.2, SD=4.0) was greater than Tandem stance errors (Md=0, Md=2.0, SD=3.6).

CONCLUSIONS

The two-week test-retest reliability of the SCAT5 baseline scores varied from moderate to high. However, there was considerable individual variability on the SAC and mBESS scores and most players have notable short-term fluctuation on performance even if uninjured. Recommendations for interpreting change on the SCAT5 are provided.

Females Sustain more Ankle Injuries than Males in Youth Football

This prospective study evaluated the incidence and pattern of acute injuries in youth (9- to 14-year- old) football players. Ten football clubs [n=730 players (567 males, 163 females)] participated in the 20-week follow-up study (January-June 2015). Data was collected by sending a standardized weekly SMS to players' parents/guardians with follow-up interviews for injured players. During the study period, 278 players (38%) sustained 410 acute injuries. The overall injury incidence for males and females was 6.47 (95% CI, 5.84-7.09) injuries per 1000 h of football exposure. Most injuries (40%) caused minimal absence from sports. Eighty-four percent of the injuries affected the lower extremities, with the ankle (30%), knee (17%), and thigh (16%) being the most commonly injured body sites. Females had significantly higher ankle injury rate (IRR) 1.85 (95% CI, 1.18-2.91, p=0.007) and non-contact ankle injury rate IRR 2.78 (95% CI, 1.91-4.02, p<0.001) than males. In conclusion, our results showed that the acute injury incidence among youth football is moderately high, and females are at higher risk for ankle injuries. Injury prevention programs aimed at preventing ankle injuries should be considered in the future.

Performance in dynamic movement tasks and occurrence of low back pain in youth floorball and basketball players

BACKGROUND

Prospective studies investigating risk factors for low back pain (LBP) in youth athletes are limited. The aim of this prospective study was to investigate the association between hip-pelvic kinematics and vertical ground reaction force (vGRF) during landing tasks and LBP in youth floorball and basketball players.

METHODS

Three-hundred-and-eighty-three Finnish youth female and male floorball and basketball players (mean age 15.7 ± 1.8) participated and were followed up on for 3 years. At the beginning of every study year the players were tested with a single-leg vertical drop jump (SLVDJ) and a vertical drop jump (VDJ). Hip-pelvic kinematics, measured as femur-pelvic angle (FPA) during SLVDJ landing, and peak vGRF and side-to-side asymmetry of vGRF during VDJ landing were the investigated risk factors. Individual exposure time and LBP resulting in time-loss were recorded during the follow-up. Cox's proportional hazard models with mixed effects and time-varying risk factors were used for analysis.

RESULTS

We found an increase in the risk for LBP in players with decreased FPA during SLVDJ landing. There was a small increase in risk for LBP with a one-degree decrease in right leg FPA during SLVDJ landing (HR 1.09, 95% CI 1.02 to 1.17, per one-degree decrease of FPA). Our results showed no significant relationship between risk for LBP and left leg FPA (HR 1.04, 95% CI 0.97 to 1.11, per one-degree decrease of FPA), vGRF (HR 1.83, 95% CI 0.95 to 3.51) or vGRF side-to-side difference (HR 1.22, 95% CI 0.65 to 2.27) during landing tasks.

CONCLUSIONS

Our results suggest that there is an association between hip-pelvic kinematics and future LBP. However, we did not find an association between LBP and vGRF. In the future, the association between hip-pelvic kinematics and LBP occurrence should be investigated further with cohort and intervention studies to verify the results from this investigation.

LEVEL OF EVIDENCE

Prognosis, level 1b.

Fear-avoidance beliefs are associated with exercise adherence: secondary analysis of a randomised controlled trial (RCT) among female healthcare workers with recurrent low back pain

Background

Exercise is recommended for the treatment and management of low back pain (LBP) and the prevention of chronicity. Exercise adherence has been only modest in intervention studies among people with musculoskeletal pain. Fear-avoidance beliefs (FABs) are known to affect exercise adherence.

The purpose was twofold: to examine which bio-psycho-social factors contributed to exercise adherence during a 6-month neuromuscular exercise intervention among female healthcare workers with recurrent LBP, and to investigate how exercising affects FABs at 6 and 12 months’ follow-up.

Methods

Some 219 healthcare workers aged 30–55 years with mild-to-moderate re-current non-specific LBP were originally allocated into: 1) exercise, 2) counselling, 3) combined exercise and counselling, and 4) control groups. In the present secondary analysis, groups 1 and 3 (exercise only and exercise+counselling) were merged to be exercisers and groups 2 and 4 were merged to be non-exercisers. Baseline variables of the exercise compliers (≥24 times over 24 weeks; n = 58) were compared to those of the non-compliers (< 1 time/week, 0–23 times; n = 52). The effects of the exercise programme on FABs were analysed by a generalised linear mixed model according to the intention-to-treat principle (exercisers; n = 110 vs non-exercisers; n = 109) at three measurement points (baseline, 6, and 12 months). A per-protocol analysis compared the more exercised to the less exercised and non-exercisers.

Results

A low education level (p = 0.026), shift work (p = 0.023), low aerobic (p = 0.048) and musculoskeletal (p = 0.043) fitness, and high baseline physical activity-related FABs (p = 0.019) were related to low exercise adherence. The exercise programme reduced levels of both physical activity- and work-related FABs, and there was a dose response: FABs reduced more in persons who exercised ≥24 times compared to those who exercised 0–23 times.

Conclusion

Healthcare workers who had lower education and fitness levels, worked shifts, and had high physical activity-related FABs had a lower adherence to the 6-month neuromuscular exercise programme. Exercising with good adherence reduced levels of FABs, which have been shown to be linked with prolonged LBP. Motivational strategies should be targeted at persons with low education and fitness levels and high FABs in order to achieve better exercise adherence.

Fatal childhood injuries in Finland between 1971 and 2017

BACKGROUND

The injury mortality rates around the globe show considerable country-to-country differences and the rates have decreased at very different speeds. In Finland, the proportion of total mortality attributed to injuries has been one of the highest in the European Union. The purpose of the present study was to examine the 47-year nationwide trend and the male to female ratio in the number and incidence of fatal injuries among 0 to 14-year-old children in Finland.

METHODS

The data were obtained from the Official Cause-of-Death Statistics of Finland during 1971-2017. The main categories for unintentional injury deaths were road traffic injuries, water traffic injuries, falls, drownings, and poisonings. For intentional injury deaths, the main categories were suicides and homicides.

RESULTS

In 1971, there were 109 fatal injuries in girls and 207 in boys, while in 2017, these numbers had reduced to 9 and 12. The corresponding incidences (per 100,000 children per year) were 20.1 and 2.1 for girls, and 36.7 and 2.6 for boys, respectively. During the study period overall male to female injury incidence ratio decreased from 1.8 to 1.2. The greatest decline occurred in the number of fatal motor vehicle injuries. In 1971, the incidence of intentional deaths (suicides and homicides) was 2.6 in girls and 2.7 in boys, while in 2017 these numbers were 0.9 and 0.4, respectively.

CONCLUSIONS

This nationwide study confirms that the number and incidence rates of childhood injury deaths have reduced till current days and are already below the average in Europe.

Neuromuscular exercise reduces low back pain intensity and improves physical functioning in nursing duties among female healthcare workers; secondary analysis of a randomised controlled trial

Background

Low back pain (LBP) is common among healthcare workers, whose work is physically strenuous and thus demands certain levels of physical fitness and spinal control. Exercise is the most frequently recommended treatment for LBP. However, exercise interventions targeted at sub-acute or recurrent patients are scarce compared to those targeted at chronic LBP patients. Our objective was to examine the effects of 6 months of neuromuscular exercise on pain, lumbar movement control, fitness, and work-related factors at 6- and 12-months’ follow-up among female healthcare personnel with sub-acute or recurrent low back pain (LBP) and physically demanding work.

Methods

A total of 219 healthcare workers aged 30–55 years with non-specific LBP were originally allocated to four groups (exercise, counselling, combined exercise and counselling, control). The present study is a secondary analysis comparing exercisers (n = 110) vs non-exercisers (n = 109). Exercise was performed twice a week (60 min) in three progressive stages focusing on controlling the neutral spine posture. The primary outcome was intensity of LBP. Secondary outcomes included pain interfering with work, lumbar movement control, fitness components, and work-related measurements. Between-group differences were analysed with a generalised linear mixed model according to the intention-to-treat principle. Per-protocol analysis compared the more exercised to the less exercised and non-exercisers.

Results

The mean exercise attendance was 26.3 (SD 12.2) of targeted 48 sessions over 24 weeks, 53% exercising 1–2 times a week, with 80% (n = 176) and 72% (n = 157) participating in 6- and in 12-month follow-up measurements, respectively. The exercise intervention reduced pain (p = 0.047), and pain interfering with work (p = 0.046); improved lumbar movement control (p = 0.042), abdominal strength (p = 0.033) and physical functioning in heavy nursing duties (p = 0.007); but had no effect on other fitness and work-related measurements when compared to not exercising. High exercise compliance resulted in less pain and better lumbar movement control and walking test results.

Conclusion

Neuromuscular exercise was effective in reducing pain and improving lumbar movement control, abdominal strength, and physical functioning in nursing duties compared to not exercising.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2678-x) contains supplementary material, which is available to authorized users.

Unintentional injury deaths in adult Finnish population: nationwide statistics between 1971 and 2016

This study determined the nationwide trends in unintentional injury deaths of adult Finns. For this purpose, we obtained from the Finnish Official Cause-of-Death Statistics the data for persons 15 years of age or older whose deaths occurred between 1971 and 2016 due to an unintentional injury. During the study period, a steep decline occurred in road traffic crashes. The death rate (per 100,000 persons) of women's road traffic crashes was 16 in 1971 but only 2 in 2016. Traffic caused much more deaths in men than women, but the declining trend in men's death rates was also clear, from 46 in 1971 to 7 in 2016. Concurrently, falls became the leading category of unintentional injury death in both genders. In women, the rate of fall-induced deaths increased from 16 in 1971 to 23 in 2016. In men, this rate rose from 14 in 1971 to 29 in 2016. Unintentional injury deaths in road traffic crashes declined drastically among adult Finnish population in 1971-2016. In contrast, the increase in their fall-induced deaths was of concern. Effective preventive actions should be started to control this development.