Sports Medicine - Open最新文献

{"title":"Effectiveness of Blood Flow Restriction Training in Neurological Rehabilitation: A Systematic Review and Meta-analysis.","authors":"Hewei Wang, Yefan Cao, Jie Zhang, Liyi Chen, Dan Liang, Liyu Fang, Yao Qian, Guilan Huang, Lianxin Song, Jie Jia","doi":"10.1186/s40798-026-01022-z","DOIUrl":"10.1186/s40798-026-01022-z","url":null,"abstract":"<p><strong>Introduction: </strong>Muscle weakness is a common impairment following neurological disorders, yet traditional high-load training aimed at addressing this is often impractical or unsafe for these patients. Blood flow restriction (BFR) training has emerged as a viable method, capable of eliciting physiological adaptations comparable to high-load training while using significantly lower mechanical loads.</p><p><strong>Objective: </strong>This study aimed to summarize the clinical applications of BFR training for neurological disorders and assess its effectiveness and safety in improving muscle strength and functional outcomes.</p><p><strong>Methods: </strong>The systematic review and meta-analysis followed PRISMA guidelines. PubMed, Embase, PEDro, Cochrane, CINAHL, CNKI were searched for intervention studies comparing BFR with diverse control interventions. The primary outcomes were muscle strength and functional outcomes. Sensitivity analyses, subgroup analysis and meta-regression were also performed.</p><p><strong>Results: </strong>Thirty-seven studies involving 963 participants were included, with individuals having stroke (n = 639), Parkinson's disease (n = 18), multiple sclerosis (n = 128), spinal cord injury (n = 170), cerebral palsy (n = 1), peripheral nerve injury (n = 2), and transverse myelitis (n = 1). Our results revealed that the addition of BFR significantly increased muscle strength, with effect sizes of 0.752 (95% CI 0.49-1.02). Significant improvements were also observed in balance, Fugl-Meyer Lower Extremity assessment, and Modified Barthel Index. Subgroup analyses revealed that onset time was a crucial factor for the effectiveness of BFR on clinical outcomes. Furthermore, BFR training demonstrated overall safety in neurological rehabilitation.</p><p><strong>Conclusion: </strong>These findings support the effectiveness of BFR training in improving muscle strength and functional outcomes in neurological rehabilitation, without any significant adverse events. However, further high-quality research is needed to validate the efficacy of BFR and refine its training protocols for individuals with neurological disorders.</p>","PeriodicalId":21788,"journal":{"name":"Sports Medicine - Open","volume":"12 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial Tendon Retraction is Associated with Muscle Degeneration After Nonoperatively Treated Proximal Hamstring Avulsions.","authors":"Sofia Laszlo, Anne-Mari Rosenlund, Elsa Pihl, Målfrid Holen Kristoffersen, Olof Sköldenberg, Jörg Schilcher, Martin Eklund, Frede Frihagen, Mikael Skorpil, Kenneth B Jonsson","doi":"10.1186/s40798-026-01024-x","DOIUrl":"10.1186/s40798-026-01024-x","url":null,"abstract":"<p><strong>Background and purpose: </strong>Magnetic resonance imaging (MRI) is essential in assessing proximal hamstring avulsions (PHA), where tendon retraction is a key pathological consequence. Beyond its diagnostic role, MRI may also provide prognostic information on subsequent muscle degeneration. This study aimed to determine whether pre-treatment MRI findings, particularly tendon retraction, predict later muscle degeneration and clinical outcomes in nonoperatively treated PHA patients.</p><p><strong>Methods: </strong>This study is a post hoc analysis of nonoperatively treated patients (n = 95) with complete proximal hamstring avulsions from the Proximal Hamstring Avulsion Clinical Trial (PHACT). Diagnostic MRIs were reassessed for tendon retraction, Wood classification, number of tendons avulsed, and hematoma size. The primary outcome was muscle degeneration, defined by the loss of lean muscle volume (LMV) and an increase in muscle fat fraction (MFF) quantified by DIXON MRI at 24 months. The secondary outcome was maximum hamstring muscle isometric force at 24 months. Outcome data was expressed as the limb symmetry index (LSI), which was the measurement of the injured hamstring expressed as a percentage of measurement of the uninjured hamstring. Linear regression was used to analyze the association between diagnostic MRI measurements, patient factors, and LSIs for LMV, MFF, and maximum isometric force.</p><p><strong>Results: </strong>The median (IQR) LSIs of the LMV, MFF and maximum strength were 78% (67.2, 87.1), 139% (124.5, 166.8), and 84% (75.4, 94.0), respectively, at 24-month follow-up. A multivariate linear regression model including tendon retraction, age, sex, hematoma size and whether the dominant limb was injured explained 48%, 48% and 23% of the variance in the LSIs of LMV, MFF and maximum force, respectively. Tendon retraction was the strongest explanatory factor for the variance of muscle degeneration observed in patients with nonoperatively treated PHA.</p><p><strong>Interpretation: </strong>Greater initial tendon retraction is associated with increased muscle atrophy and fat infiltration in the hamstring muscles in patients with nonoperatively treated PHA.</p><p><strong>Trial registration: </strong>NCT03311997.</p>","PeriodicalId":21788,"journal":{"name":"Sports Medicine - Open","volume":"12 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Shoe Sole Thickness on Running Biomechanics and Economy: A Systematic Review.","authors":"Cagla Kettner, Felix Krapp, Thorsten Stein","doi":"10.1186/s40798-026-01020-1","DOIUrl":"10.1186/s40798-026-01020-1","url":null,"abstract":"<p><strong>Background: </strong>Advanced footwear technologies (AFT) are popular for their potential performance benefits, though concerns about injury risks persist. Among various AFT features, sole thickness is particularly debated, especially after World Athletics imposed a 40 mm limit to prevent unfair competitive advantages. However, the effects of sole thickness on running biomechanics and economy are not well understood, particularly because sole thickness often co-varies with other shoe characteristics in shoe designs.</p><p><strong>Objective: </strong>This review examines the effects of sole thickness on spatiotemporal variables, kinematics, kinetics, and running economy. The review focuses on studies in which sole thickness was the primary variable of interest.</p><p><strong>Methods: </strong>A systematic literature search was conducted following PRISMA guidelines. Eligible studies included original research on running with participants of all expertise levels, analyzing spatiotemporal variables, kinematics, kinetics, or running economy.</p><p><strong>Results: </strong>Fourteen studies met the criteria, mostly focusing on male recreational or experienced runners. Thicker soles were linked to increased stance time, while other spatiotemporal parameters remained unchanged. Significant effects were seen in ankle kinematics, with more dorsiflexion at initial contact with thicker soles, though knee and hip movements were less affected. Thicker soles increased peak eversion in the frontal plane. No consistent trends emerged for joint kinetics, stiffness, or center of mass movement. Vertical ground reaction force (GRF) peaks remained largely unchanged, but loading rates generally decreased with thicker soles. Only one study assessed running economy, with no significant effects. Overall, the certainty of evidence across outcomes was low to very low due to methodological heterogeneity and limited study numbers.</p><p><strong>Conclusions: </strong>Thicker soles were largely linked to longer stance times and lower GRF loading rates. Future research should comprehensively report shoe characteristics, include more diverse populations (e.g., female runners, forefoot strikers), and expand investigations to underexplored aspects such as muscle activity and movement coordination.</p>","PeriodicalId":21788,"journal":{"name":"Sports Medicine - Open","volume":"12 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiopulmonary Exercise Testing Reveals Functional Limitations and Work Disability in Severe Post-COVID-19 and ME/CFS Patients.","authors":"Aleksandar Tomaskovic, Vincent Weber, David T Ochmann, Barlo Hillen, Elmo W I Neuberger, Alexandra Brahmer, Ella Lachtermann, Klaus Lieb, Perikles Simon","doi":"10.1186/s40798-026-00995-1","DOIUrl":"https://doi.org/10.1186/s40798-026-00995-1","url":null,"abstract":"<p><strong>Background: </strong>Patients severely affected by post-COVID-19 condition (PCC) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) often experience long-term work incapacity, contributing to a growing economic burden. Organ-centered clinical diagnostics frequently fail to explain their work disability.</p><p><strong>Objectives: </strong>We aimed to objectively assess physical work ability using cardiopulmonary exercise testing (CPET) in a cohort of long-standing and severely affected PCC patients. We hypothesized: (1) patients with ME/CFS exhibit lower peak oxygen uptake (VO₂_peak [mL/min/kg]) and peak power output (PPO [W/kg]) than those without; (2) most patients demonstrate objective work disability, closely aligned with subjective perception of disability; (3) oxygen pulse (O₂ pulse [mL/bpm]) is reduced in ME/CFS, independent of comorbidity.</p><p><strong>Methods: </strong>The study was conducted in the Department of Sports Medicine, Prevention and Rehabilitation at Johannes Gutenberg-University Mainz (Mainz, Germany). Between July 31, 2023, and March 31, 2025, a total of 92 PCC patients with suspected occupational disease underwent symptom-limited CPET and completed the Canadian Consensus Criteria, Bell Disability Scale (Bell-Score), and DePaul Symptom Questionnaire (Post-Exertional Malaise) Short Form (DSQ-PEM).</p><p><strong>Results: </strong>Nearly half of the patients (49%) met ME/CFS criteria and 79% screened positive on the DSQ-PEM. ME/CFS patients showed significantly lower VO₂_peak (13.0 ± 3.1 vs. 15.4 ± 4.9, p = 0.012), PPO (0.9 ± 0.3 vs. 1.1 ± 0.5, p = 0.014), and O₂ pulse (7.7 ± 2.0 vs. 8.5 ± 1.9, p = 0.047) compared to those without ME/CFS. Overall, 66% of patients met objective thresholds for work disability (VO₂_peak < 15 mL/min/kg or PPO < 1 W/kg). Forty-five patients (51%) had a Bell-Score ≤ 30 and 82% from those had VO₂_peak < 15 and/or PPO < 1. VO₂_peak and PPO significantly correlated with Bell-Score (r = 0.3, p = 0.005 and r = 0.3, p = 0.003) and were the lowest among patients on medical sick leave (13.3 ± 3.3 and 0.9 ± 0.3), compared to those in occupational reintegration (16.0 ± 3.9, p = 0.04 and 1.2 ± 0.5, p = 0.024) or currently working (18.0 ± 7.1, p = 0.036 and 1.2 ± 0.5, p = 0.015).</p><p><strong>Conclusions: </strong>Severely affected PCC patients exhibit objective work disability, particularly those with ME/CFS. VO₂_peak and PPO are associated with subjective disability and occupational status. Therefore, early integration of CPET into clinical and occupational evaluations can inform individualized therapy planning and return-to-work decisions. Trial registration DRKS, DRKS00032394. Registered 28 July 2023, https://drks.de/search/de/trial/DRKS00032394.</p>","PeriodicalId":21788,"journal":{"name":"Sports Medicine - Open","volume":"12 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Latent Reaction Speed in Athletes: The Role of Performance Level and Stress Tolerance at Different Competitive Levels.","authors":"Katrina Volgemute, Gundega Ulme, Zermena Vazne","doi":"10.1186/s40798-026-01023-y","DOIUrl":"https://doi.org/10.1186/s40798-026-01023-y","url":null,"abstract":"<p><strong>Background: </strong>Reaction speed represents a fundamental cognitive-motor capacity in sport, yet empirical findings regarding its psychological predictors remain inconsistent, particularly across stages of athletic expertise. This study aimed to investigate the associations of performance level and stress tolerance with latent reaction speed in athletes and to determine whether these associations differ across competitive levels.</p><p><strong>Results: </strong>A cross-sectional sample of 304 competitive athletes (amateur, pre-elite, and elite) completed standardized computerized psychophysiological assessments. Latent reaction speed was modeled as a unified cognitive-motor construct indicated by simple and choice reaction speed and motor execution measures. Performance level and stress tolerance were assessed as task-based indices of performance efficiency and cognitive load tolerance under standardized conditions. Structural equation modeling was used to examine predictors of latent reaction speed, followed by multi-group analyses across athlete competitive levels. Both performance level (β = 0.19, p = 0.004) and stress tolerance (β = 0.17, p = 0.010) showed small but statistically significant positive associations with latent reaction speed, together explaining 14.2% of its variance. Age was negatively associated with latent reaction speed, while gender effects were small. Multi-group analyses revealed that performance level (β = 0.28, p < 0.001) and stress tolerance (β = 0.17, p = 0.028) significantly predicted latent reaction speed only among pre-elite athletes, whereas no significant associations were observed in amateur or elite groups.</p><p><strong>Conclusions: </strong>These findings suggest that the contribution of performance-related psychological factors to reaction speed is stage-specific, with relevance during the pre-elite phase of athletic development. The findings indicate statistically significant but modest associations between performance-related psychological factors and latent reaction speed across stages of athletic development.</p>","PeriodicalId":21788,"journal":{"name":"Sports Medicine - Open","volume":"12 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13109472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Implications of the Enhanced Games: Performance Enhancing Drugs in Competition and Recreation.","authors":"Marco Vecchiato, Stefano Palermi, Mark Zamodics, Mate Babity, Mani Eftekhari, Rohith Ryali, Justin Luk, Atta Taseh, Soheil Ashkani-Esfahani, Gergo Merkely, Vencel Juhasz","doi":"10.1186/s40798-026-01026-9","DOIUrl":"https://doi.org/10.1186/s40798-026-01026-9","url":null,"abstract":"<p><strong>Background: </strong>The Enhanced Games (TEG) initiative-an event that permits the off-label use of FDA-approved drugs for performance enhancement under medical supervision-represents a revolutionary yet highly controversial disruption in modern sport. Although the excessive use of certain performance-enhancing drug (PED) classes is associated with clear health risks, current evidence on PED-related cardiovascular (CV) risk is primarily derived from retrospective reports, small cohorts, or illicit use, leaving major gaps in mechanistic understanding and dose-response relationships in performance enhancement, well-being, and rehabilitation purposes. MAIN: This review synthesizes existing data on the ergogenic mechanisms and CV toxicity of key PED classes relevant to TEG athletes, including anabolic-androgenic steroids (AAS), growth hormone and IGF-1, erythropoiesis-stimulating agents (ESAs), stimulants, β₂-agonists, diuretics, metabolic modulators, and emerging incretin-based weight management therapies. Across these agents, ergogenic effects are inconsistently demonstrated, whereas CV harm is not rare, and may be cumulative and irreversible. AAS and ESAs exhibit the strongest ergogenic signals but are also associated with myocardial remodeling, arrhythmia, and thrombotic events. Other agents provide limited or unclear performance benefits yet may disrupt autonomic balance, metabolism, or myocardial integrity. With the emergence of availability through compounding pharmacies and a rapid increase in PED use among the general population, there is an urgent need for high-quality, prospective data to inform about health risks. Since the recreational and well-being use of PEDs is on the rise among the general population, PEDs' dose-dependent detrimental effects must be carefully evaluated. By applying rigorous pre-participation screening and long-term follow-up, TEG may provide high-quality, longitudinal data not previously available with PEDs.</p><p><strong>Conclusion: </strong>TEG's potential to provide valuable scientific insights should not be interpreted as a proof-of-concept for safe, extreme-level performance enhancement, but rather as a high-risk observational setting that demands exceptional ethical scrutiny, transparency, and long-term accountability. While ethical and regulatory debates dominate public discourse, TEG also presents a research opportunity to systematically evaluate the CV effects of PED use under controlled conditions. A dedicated, risk-adapted pre-participation screening and longitudinal monitoring framework will be essential for characterizing PED-associated CV effects and informing harm-reduction strategies.</p>","PeriodicalId":21788,"journal":{"name":"Sports Medicine - Open","volume":"12 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13109459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return-to-Sport Outcomes and Psychological Readiness to Return to Sport After Revision Compared to the Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis.","authors":"Marko Manojlovic, Vukadin Milankov, Roberto Roklicer, Tatjana Trivic, Aleksander Veraksa, Antonino Bianco, Patrik Drid","doi":"10.1186/s40798-026-01006-z","DOIUrl":"10.1186/s40798-026-01006-z","url":null,"abstract":"<p><strong>Background: </strong>The existing body of evidence referring to the return-to-sport (RTS) outcomes and psychological readiness to return to sport after revision compared to the primary anterior cruciate ligament (ACL) reconstruction has not yet been comprehensively synthesized.</p><p><strong>Objective: </strong>To examine RTS outcomes and psychological readiness to return to sport after revision compared to the primary ACL reconstruction.</p><p><strong>Methods: </strong>A comprehensive search of Web of Science, EMBASE, and PubMed was carried out up to November 15, 2024. Observational studies that compared revision and primary ACL reconstruction regarding RTS outcomes and psychological readiness to return to sport were considered adequate for inclusion. The Methodological Index for Non-Randomized Studies and Grading of Recommendations Assessment, Development, and Evaluation were used to assess methodological quality as well as the overall strength and quality of evidence of involved studies, respectively.</p><p><strong>Results: </strong>A total of 19 studies fulfilled the eligibility criteria and were included in the quantitative analysis. There were 3209 athletes with a history of revision and primary ACL reconstruction (mean age: 26.0 ± 6.5 years; 78% males). The main findings indicated that individuals who were subjected to revision ACL reconstruction had slightly lower odds of RTS (-6%; odds ratio (OR) = 0.66 [95% confidence interval (CI) 0.49 to 0.89]), slightly lower odds of RTS at the preinjury level of competition (-5%; OR = 0.52 [95% CI 0.36 to 0.76]), slightly prolonged RTS time (1.2 months; standardized mean differences (SMD) = 0.38 [95% CI 0.12 to -0.63]), and moderately lower psychological readiness to return to sport (-14.2 points; SMD = -0.75 [95% CI -1.14 to -0.36]) relative to their counterparts who were subjected to the primary ACL surgery.</p><p><strong>Conclusions: </strong>Athletes who underwent the revision ACL surgery had a 6% reduced rate of RTS, 5% lower rates of RTS at the preinjury level of competition, 1.2 months extended RTS time, and 14.2 points decreased psychological readiness to return to sport relative to the respondents with a history of the primary ACL reconstruction. PROSPERO registration number CRD42024600347.</p>","PeriodicalId":21788,"journal":{"name":"Sports Medicine - Open","volume":"12 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Knee Muscle Strength Symmetry and Lower Limb Landing Mechanics Following ACL Reconstruction.","authors":"Kexin Yang, Boshi Xue, Xiaoyuan Ma, Xia Wang, Yuting Zhao, Chen Yang, Zhipeng Zhou, Liangliang Zheng","doi":"10.1186/s40798-026-01018-9","DOIUrl":"10.1186/s40798-026-01018-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Restoring muscle strength in the injured knee is a primary rehabilitation goal following anterior cruciate ligament reconstruction (ACLR). However, even when standard rehabilitation criteria, such as muscle strength and hop distance, are achieved, many patients still exhibit landing mechanical asymmetries, suggesting that the conventional limb symmetry index (LSI), although reflective of strength recovery in the involved limb, fails to capture neuromuscular control deficits during functional tasks. Currently, the relationship between knee muscle strength symmetry and landing mechanics symmetry remains unclear. The purpose of this study is to evaluate lower limb mechanic asymmetry during single-leg drop-landing, and to determine the relationship between symmetry in isokinetic knee strength and landing mechanic asymmetry upon return to sport (RTS) following ACLR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The cross-sectional study entailed a total of 40 participants at the time of RTS following ACLR (Graft type: hamstring tendon; time since surgery: 9.7 ± 3.4 months) and 20 control participants. Isokinetic concentric contractions of the knee flexors and extensors were performed at an angular velocity of 60°/s on each leg. The LSI [LSI = (involved/uninvolved)[Formula: see text]100%] was calculated for isokinetic quadriceps and hamstring strength, which was then used to divide the ACLR participants into high-symmetry (ACLR-HS, LSI ≥ 85% for both the quadriceps and hamstring) and lower-symmetry (ACLR-LS, LSI &lt; 85% for either the quadriceps or hamstring) subgroups. Three-dimensional kinematic data and ground reaction force (GRF) data were collected for the bilateral lower limbs of all participants during the single-leg drop-landing task. Group differences were compared by use of one-way ANOVA, and Pearson correlations were performed to examine the associations between muscle strength symmetry and landing mechanic asymmetry of the measured variables in three groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both the ACLR-HS [peak knee extension moments: p = 0.007; peak vertical ground reaction force (PVGRF): p &lt; 0.001)] and ACLR-LS (peak knee extension moments: p = 0.001; PVGRF: p &lt; 0.001) groups demonstrated lower peak knee extension moments and PVGRF in the involved limb during landing compared with the control group's dominant limb. Compared with the control group, the ACLR-LS group also demonstrated greater asymmetry during landing in knee extension moment (p = 0.001) and knee valgus moment (p = 0.007). No significant correlations were found between quadriceps and hamstring strength symmetry and landing mechanics asymmetry across all variables at RTS among three groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Restoring strength symmetry alone does not guarantee comprehensive functional recovery. To optimize outcomes, clinical decision-making should systematically integrate multidimensional indicators to promote comprehensive functional recover","PeriodicalId":21788,"journal":{"name":"Sports Medicine - Open","volume":"12 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep Behaviour and Subjective Sleep Quality in Esports Athletes: A Multilevel Analysis of Night-to-Night Variability.","authors":"Andrew Kidcaff, Mitchell Nicholson, Tristan J Coulter, Craig McNulty, Remco Polman","doi":"10.1186/s40798-026-01021-0","DOIUrl":"10.1186/s40798-026-01021-0","url":null,"abstract":"<p><strong>Background: </strong>Esports training is typically self-directed and frequently scheduled late in the day, which may disrupt habitual sleep-wake patterns and contribute to poor sleep outcomes. Although previous esports research has identified delayed sleep timing and reduced sleep duration at the group level, less is known about how night-to-night fluctuations in sleep behaviour and stable individual characteristics jointly influence perceived sleep quality. Examining both intra-individual and inter-individual determinants may provide a more nuanced understanding of sleep health in esports athletes.</p><p><strong>Methods: </strong>Twenty-four esports athletes (male: n = 16, age M = 20.13 ± 2.42 years; female: n = 8, age M = 25.13 ± 4.02 years; range 18-33) from Brisbane, Australia, completed the study between October 2023 and March 2024. The protocol comprised baseline questionnaires assessing sleep hygiene, habitual sleep quality, chronotype, and daytime sleepiness, followed by approximately seven consecutive nights of wrist-worn actigraphy and daily sleep diaries (187 valid nights). Subjective sleep quality was rated each morning on a 5-point scale. Multilevel modelling was used to examine within-person associations between nightly deviations in sleep duration and bed/wake times, as well as the timing of esports gameplay relative to bedtime (no gameplay, < 1 h, 1-2 h, > 2 h). Between-person predictors included sleep hygiene, habitual sleep timing and duration, and age.</p><p><strong>Results: </strong>Participants averaged approximately 6 h 42 min (± 51 min) of sleep per night and reported moderate subjective sleep quality. The intraclass correlation coefficient indicated that 20% of the variance in sleep quality was attributable to between-person differences, with the remaining 80% reflecting within-person variability. At the nightly level, longer-than-average sleep duration was associated with higher perceived sleep quality, whereas nightly bed and wake times were not significant predictors. Nights in which gameplay ended 1-2 h before bedtime were associated with poorer sleep quality compared with nights without gameplay. At the between-person level, poorer sleep hygiene was associated with lower sleep quality, whereas later habitual bedtimes were associated with higher sleep quality ratings across the monitoring period.</p><p><strong>Conclusions: </strong>Subjective sleep quality in esports athletes is shaped by both nightly variability in sleep duration and stable behavioural characteristics. These findings highlight the importance of sleep regularity, behavioural routines, and training schedules in esports, and support the use of multilevel approaches to capture dynamic sleep processes in performance-based gaming contexts.</p>","PeriodicalId":21788,"journal":{"name":"Sports Medicine - Open","volume":"12 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13083558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Flexibility and Exercise Performance in Adults with Gilbert's Syndrome-Associated Hyperbilirubinemia.","authors":"Tamara Christina Stelzer, Anna Maria Kripp, Agnes Draxler, Lina Maqboul, Katharina Tatjana Pfeiffer, Andrew Cameron Bulmer, Daniel König, Karl-Heinz Wagner","doi":"10.1186/s40798-026-01011-2","DOIUrl":"10.1186/s40798-026-01011-2","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests that moderately elevated bilirubin plasma concentrations possess protective effects against non-communicable diseases. One possible explanation for this might be that Gilbert's Syndrome (GS), a mildly hyperbilirubinaemic condition, leads to an enhanced lipid metabolism. Furthermore, there are first hints that individuals with GS may have a greater performance capacity. We hypothesize that GS participants have a greater maximal fat oxidation and performance capacity.</p><p><strong>Methods: </strong>To test this, we conducted an age- and gender-matched human case-control study. We included 40 people with GS and 40 controls, aged 18-65 years, who were all moderately physically active. 50% of the participants were over the age of 35. Participants performed a FatMax test on a bicycle ergometer. The study was performed from March 2023 to December 2023 at the University of Vienna.</p><p><strong>Results: </strong>The group of GS participants over the age of 35 had a significantly higher FatMax (GS: median = 1.03 [maximum = 0.44; minimum = 2.42] W/kg body weight; C: median = 0.48 [minimum = 0.33; maximum = 1.61] W/kg body weight, p = 0.002) and a significantly greater oxygen consumption (GS: mean = 30.2 ± standard diviation (sd) = 8.09 ml/min/ kg body weight; C: mean = 23.4 ± sd = 5.91 ml/min/kg body weight, p = 0.005) at the respiratory compensation point.</p><p><strong>Conclusion: </strong>This is the first study to demonstrate that older GS individuals can generate more power whilst harnessing fatty acid metabolism and this may enhance their performance over prolonged periods of sub-maximal exercise.</p>","PeriodicalId":21788,"journal":{"name":"Sports Medicine - Open","volume":"12 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13083743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}