BMJ Open Sport & Exercise Medicine最新文献

{"title":"Cardiovascular responses during blood flow-restricted resistance exercise: a systematic review with meta-analysis.","authors":"Yashveer Singh, Leslie A Avila, Marty Spranger","doi":"10.1136/bmjsem-2025-002989","DOIUrl":"10.1136/bmjsem-2025-002989","url":null,"abstract":"<p><strong>Context: </strong>Blood flow-restricted resistance exercise (BFR-RE) is used to elicit hypertrophy and strength adaptations with low external loads, making it attractive for clinical and rehabilitative populations. However, concerns regarding exaggerated cardiovascular responses highlight the need to clarify haemodynamic effects before broader clinical adoption.</p><p><strong>Objectives: </strong>To compare acute cardiovascular responses-systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR)-during low-intensity BFR-RE (LI-BFR), low-intensity resistance exercise (LI-RE) and high-intensity resistance exercise (HI-RE).</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, ResearchGate, Web of Science and Cochrane Library were searched through February 2025. Randomised controlled trials comparing SBP, DBP and HR during LI-BFR versus LI-RE and/or HI-RE in healthy adults were included.</p><p><strong>Data synthesis: </strong>Four trials for LI-BFR versus LI-RE (n=86) and three for LI-BFR versus HI-RE (n=46) were identified, with six reports eligible for random-effects meta-analyses adjusted for muscle and age. SBP (MD=14.06 mm Hg; 95% CI (0.24 to 27.90) and DBP (MD=11.18 mm Hg; 95% CI (2.8 to 19.57)) were significantly increased during LI-BFR versus LI-RE, while HR was not significant (MD=6.00 bpm; 95% CI (-5.47 to 17.5)). HI-RE and LI-BFR did not differ in effects on SBP (MD=0.53 mm Hg; 95% CI (-15.21 to 16.28)), DBP (MD=2.54 mm Hg; 95% CI(-5.59 to 10.67)) or HR (MD=-5.90 bpm; 95% CI (-12.55 to 0.74)). However, risk of bias and certainty of evidence analyses presented some concerns of bias and low to moderate certainty.</p><p><strong>Conclusion: </strong>Arterial blood pressure is exaggerated during LI-BFR when compared with LI-RE. Data on real-time cardiovascular responses during BFR-RE are limited; therefore, future studies should be designed to measure haemodynamic parameters during exercise accurately.</p><p><strong>Prospero registration number: </strong>CRD42025633694.</p>","PeriodicalId":47417,"journal":{"name":"BMJ Open Sport & Exercise Medicine","volume":"12 1","pages":"e002989"},"PeriodicalIF":3.2,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12983930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of medical doctors in promoting and supporting sports participation by people with disabilities: an exploratory study of medical doctors' knowledge, practices and perceptions.","authors":"Samitha Samanmalee Gowinnage, Jessica Hill, Iain Dutia, Emma Beckman, Gaj Panagoda, Sean Tweedy","doi":"10.1136/bmjsem-2025-002847","DOIUrl":"10.1136/bmjsem-2025-002847","url":null,"abstract":"<p><strong>Objectives: </strong>Despite the well-documented benefits of sports for individuals with disabilities, participation remains low, and disability-related medical complications are a major barrier. Medical doctors, as trusted sources of health information on physical activity with sustained patient contact, are well-positioned to manage these issues and promote safe participation in sports. However, limited evidence exists regarding their role. This study explored medical doctors' knowledge, practices and perceptions in promoting and supporting sports participation among people with disabilities.</p><p><strong>Methods: </strong>An online survey collected quantitative and qualitative data from registered medical doctors internationally who provided direct general or specialised medical care to people with disabilities.</p><p><strong>Results: </strong>A total of 168 medical doctors from 16 countries participated. Most (91.1%) recognised the benefits of sports participation for people with disabilities and acknowledged their role in supporting participation (76.8%), while 69.7% identified medical complications as a barrier to participation. However, many reported low confidence in key areas: awareness of local disability sport organisations (53.6%); guiding patients (49.4%) and identifying relevant medical complications. Only 15.5% (of 58) had experience with pre-participation assessments. Limited awareness of disability sports, identified as a major barrier, and increasing awareness was the most frequently suggested strategy to enhance doctors' involvement.</p><p><strong>Conclusion: </strong>Although medical doctors recognised the benefits of sports for people with disabilities and their role in promoting and supporting participation, many reported low confidence in their knowledge of disability sports and in identifying potential medical complications that may hinder sport participation. Development of methods and materials is required to provide doctors with the knowledge and confidence to effectively promote sport participation among people with disabilities.</p>","PeriodicalId":47417,"journal":{"name":"BMJ Open Sport & Exercise Medicine","volume":"12 1","pages":"e002847"},"PeriodicalIF":3.2,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12983821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"I feel like I'm marinating in the boat…and it just makes me feel gross\": a sociocultural exploration of female rowers' experiences of the menstrual cycle.","authors":"Ciara Everard, Clíodhna McHugh, Kathryn Ackerman, Pauline Cullen, Jane Thornton, Kellie Wilkie, Gráinne M Donnelly, Lari Trease, Geraldine Foley, Sarah J Mcdonnell, Kirsty Elliott-Sale, Fiona Wilson","doi":"10.1136/bmjsem-2025-003004","DOIUrl":"10.1136/bmjsem-2025-003004","url":null,"abstract":"<p><p>The aim of this study was to explore how socio-cultural norms and values influence female rowers' experiences and perceptions of the menstrual cycle in sport. Individual semistructured interviews were conducted with 18 menstruating female rowers (29.2±11 years) from Ireland and the USA. Data were audio-recorded, transcribed verbatim, and analysed using a reflexive thematic analysis.Five themes were identified: (1) normalisation of abnormal periods: the majority of athletes described experiencing menstrual cycle irregularities. These irregularities were viewed as 'normal' or even valorised within rowing subcultures, precluding athletes from seeking help; (2) 'Is she faking it?' The delegitimisation of menstrual cycle pain and symptoms: pain was viewed as part and parcel of rowing culture, leading to athletes silencing or suppressing their pain as well as seeking medical interventions to 'manage away' their symptoms; (3) stigma and fear of leakages: athletes expressed a profound fear of leakages, which was amplified by patriarchal ideals and stigmatising notions surrounding bleeding bodies; (4) gendered norms and issues of non-disclosure: the interpersonal dynamics surrounding gendered norms create and perpetuate cultures of non-disclosure; (5) period power: emergence of alternative sociocultural norms that challenge dominant ideals and expand perceptions of how the menstrual cycle is experienced and managed within sport settings. Heeding calls for more research on the menstrual cycle within sports medicine, this study extends the literature by highlighting how sociocultural influences can perpetuate harmful discourses and practices that have implications for athletes' menstrual health and well-being. Moreover, the findings illustrate how these sociocultural norms create contexts of concealment and taboo, ultimately limiting progression towards best practice management for female rowers.</p>","PeriodicalId":47417,"journal":{"name":"BMJ Open Sport & Exercise Medicine","volume":"12 1","pages":"e003004"},"PeriodicalIF":3.2,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12983884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exertional rhabdomyolysis: clinical features, management, complications and prediction of acute kidney injury.","authors":"Marie Vangstad, Jon Arne Kro Birkeland, Anne Kristine Gulsvik, Ragnhild Louise Ervik, Ingrid Oftebro, Fredrik Barth Brekke, Omar Ahmed Akkouh, Dag Jacobsen, Mari Asphjell Bjornaas","doi":"10.1136/bmjsem-2026-003214","DOIUrl":"10.1136/bmjsem-2026-003214","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the clinical course and complications of exertional rhabdomyolysis, compare inpatient and outpatient management, and evaluate admission markers of acute kidney injury (AKI).</p><p><strong>Methods: </strong>Prospective, multicentre study with consecutive inclusion of patients with rhabdomyolysis (creatine kinase (CK) ≥5000 U/L and/or myoglobin ≥1000 ng/mL) with exercise as the precipitating factor, presenting to the emergency departments of four hospitals in Oslo and Akershus, Norway (2019-2022). Management followed usual care. Primary outcome was AKI, defined by Kidney Disease: Improving Global Outcomes criteria.</p><p><strong>Results: </strong>We included 136 patients with exertional rhabdomyolysis (median age 28 years, 55% male), mainly after strength training (106, 78%); 62 (46%) were managed as inpatients and 74 (54%) as outpatients. Management was similar in both groups, consisting of fluids, serial blood tests, with a median follow-up of 3 days. Complications were rare and no outpatients required escalation to inpatient care. Five (4%) patients developed AKI (median peak creatinine 217 µmol/L, 132-410). Other major complications (severe electrolyte disturbances and compartment syndrome) occurred only in those with AKI.All patients who developed AKI had serum creatinine above the normal reference range at admission, though a few patients with elevated creatinine did not develop AKI (95% specificity). The myoglobin-to-CK ratio (≥0.48) performed best among muscle injury biomarkers and might serve as a supportive high-risk marker (99% specificity).</p><p><strong>Conclusion: </strong>No patient with a normal admission creatinine developed AKI in this cohort, supporting outpatient management as a safe option for otherwise healthy individuals when admission creatinine is within the reference range, provided follow-up is ensured.</p><p><strong>Trial registration number: </strong>NCT04118608.</p>","PeriodicalId":47417,"journal":{"name":"BMJ Open Sport & Exercise Medicine","volume":"12 1","pages":"e003214"},"PeriodicalIF":3.2,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interrupting sedentary behaviour in the workplace through active breaks: a protocol study.","authors":"Maria Scoppolini Massini, Giulio Senesi, Erika Pinelli, Raffaele Zinno, Salvatore Pinelli, Cristian Balducci, Laura Bragonzoni","doi":"10.1136/bmjsem-2026-003226","DOIUrl":"10.1136/bmjsem-2026-003226","url":null,"abstract":"<p><p>Sedentary behaviour (SB) is linked to a higher risk of metabolic disorders, cardiovascular disease, all-cause mortality and musculoskeletal decline. Office workers (OW) are particularly vulnerable to prolonged SB due to the nature of their work. Incorporating active breaks (ABs), brief periods of physical activity (PA) during the workday may offer a promising strategy to interrupt SB in this setting. This protocol outlines the design of a non-randomised controlled study aimed at interrupting SB among OW by implementing ABs during working hours. The potential impact of ABs on changes in SB patterns and on physical and psychosocial outcomes will also be assessed. Participants in the study will self-select into an intervention group (IG) or a control group (CG). Both groups will be assessed at baseline (T0) and after 4 months (T1) using accelerometers, ad hoc questionnaires and validated tools. The IG will take part in a 4-month ABs programme, beginning with a counselling session with a kinesiologist. To monitor adherence, compliance, engagement and satisfaction, participants in the IG will complete daily surveys during the first and last 2 weeks of the intervention, keep a daily adherence diary throughout the study and complete a final ad hoc questionnaire to assess satisfaction with the ABs programme. Approval for this study was obtained from the Bioethical Committee of the University of Bologna. The findings could provide an important contribution to the scientific evidence supporting ABs interventions, highlighting their psychosocial and physical benefits in workplace settings.</p>","PeriodicalId":47417,"journal":{"name":"BMJ Open Sport & Exercise Medicine","volume":"12 1","pages":"e003226"},"PeriodicalIF":3.2,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12993756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Ski and Snowboard Federation (FIS) consensus statement on return-to-performance in competitive alpine and freestyle skiers and snowboarders.","authors":"Jörg Spörri, Philippe O Müller, Oriol Bonell Monsonís, Roald Bahr, Lisa Beck, Peter U Brucker, Lars Engbretsen, Christian Fink, Hubert Hörterer, Matthew J Jordan, Gerald Mitterbauer, Håvard Moksens, Abi Okell, Jaron Santelli, Johannes Scherr, Wolfgang Schobersberger, Annika Stolz, Jim Taylor, Maarit Valtonen, Tina Weirather, Vincent Gouttebarge, Caroline Bolling, Evert Verhagen","doi":"10.1136/bmjsem-2025-002908","DOIUrl":"10.1136/bmjsem-2025-002908","url":null,"abstract":"<p><p>Returning to a high level of performance after injury is a significant challenge for athletes. However, current best practices for return-to-performance in competitive snow sports are not well understood due to a lack of research evidence and international harmonisation. The International Ski and Snowboard Federation commissioned this consensus statement to provide recommendations for the safe and successful return of competitive alpine and freestyle skiers and snowboarders to competitive performance. An international consensus panel was formed to contribute their knowledge and perspectives on return-to-performance. The panel included experts with extensive experience in return-to-performance. The panel consisted of 23 experts (7 women and 16 men) from various skiing and snowboarding disciplines and levels of competition. It included 16 researchers, 6 snow sports or International Olympic Committee officials, 9 physicians, 6 physical therapists, 2 sports psychologists, 2 coaches and 2 former athletes, some of whom had two backgrounds/functions. However, it was disproportionately European (78%) and North American (13%), with minimal representation from South America (4%) and Africa (4%) and no representation from Asia or Australasia. The RAND-UCLA Appropriateness Method was adopted for the underlying consensus process. First, the panel discussed which topics and questions should be included in the consensus statement before developing an overall structure. The consensus process then involved providing key content based on the literature or statements from experts/panel members. These were voted on three times by all the panel members, resulting in a list of 196 statements. The jointly developed overall structure and the final statement list then formed the basis for preparing the manuscript. This consensus statement aims to assist athletes, coaches and medical staff of international and national federations in planning and implementing safe and successful return-to-performance strategies for competitive alpine and freestyle skiers and snowboarders.</p>","PeriodicalId":47417,"journal":{"name":"BMJ Open Sport & Exercise Medicine","volume":"12 1","pages":"e002908"},"PeriodicalIF":3.2,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"eArly phySical therApy Program for PatelloFemoral Pain (ASAP-PFP trial): protocol for a triple-blinded, superiority, parallel-group, multicentre trial.","authors":"Marina Cabral Waiteman, Beatriz Sanches Ferreira, Neal R Glaviano, David M Bazett-Jones, Joachim Van Cant, Miguel Farraj, Ronaldo Briani, Fabio Micolis De Azevedo","doi":"10.1136/bmjsem-2025-003061","DOIUrl":"10.1136/bmjsem-2025-003061","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral pain (PFP) is a chronic knee pain disorder that has high recurrence rates after treatment. While longer pain duration (>4 months) is one of the primary mediators for poor PFP prognosis, there are no clinical studies testing patients' response to early physiotherapy. This study aims to determine the effectiveness of an early physiotherapy programme compared with a delayed-delivery programme for people with PFP at short-term, medium-term and long-term follow-up.</p><p><strong>Methods: </strong>Young adults (18-35 years old) with PFP will be recruited in Brazil, the USA and Belgium. 152 eligible participants will be assessed at baseline and allocated to early (treatment initiated between 4 and 12 weeks after pain onset) or delayed (treatment initiated after ≥6 months after pain onset) intervention groups. The programme (education plus exercise therapy) will be similar for both groups and consists of a 12-week online programme with individual supervised and unsupervised sessions performed three times a week. Primary (self-reported pain, function, recovery and treatment response) and secondary (psychosocial features) outcomes will be reassessed immediately and at 3, 6 and 12 months after treatment completion. Regression models with generalised estimating equations or χ² tests will determine group*time interactions (intention-to-treat analyses).</p><p><strong>Impact: </strong>The timing of physiotherapy may have a significant effect on patient outcomes with PFP. This study can provide relevant clinical messages about early management of PFP.</p>","PeriodicalId":47417,"journal":{"name":"BMJ Open Sport & Exercise Medicine","volume":"12 1","pages":"e003061"},"PeriodicalIF":3.2,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to climbing after musculoskeletal injury: a scoping review protocol of rehabilitation content, outcome measures and return to sport criteria in climbers.","authors":"Uzo Ehiogu, Georgia Wells, Gareth Jones, Matthew Buckthorpe, Stephen Patterson","doi":"10.1136/bmjsem-2025-003156","DOIUrl":"10.1136/bmjsem-2025-003156","url":null,"abstract":"<p><p>Climbing is an Olympic sport featuring three disciplines: lead climbing, speed climbing and bouldering. The injury burden associated with climbing has been well documented. However, the content of rehabilitation programmes, the outcome measures and the return-to-sport (RTS) criteria after injury are sparse. This review will map the content of rehabilitation programmes, examine outcome measures to inform rehabilitation and RTS using a COSMIN-aligned approach, and identify objective and subjective criteria used for return to climbing after musculoskeletal injury (MSKI). The methodological framework of Arksey and O'Malley will be applied for this scoping review. A systematic review of four online databases and a manual search of reference lists of identified articles will be used to identify relevant papers. Given the limited empirical literature on this topic, both peer-reviewed and non-peer-reviewed sources written in English will be used. Sources reporting rehabilitation, recovery, outcome measures in injured and uninjured climbers and RTS/return to climbing criteria after MSKI will be included. All climbers (elite, professional and/or recreational) of any age and sex will be included. Statistical analysis of agreement between reviewers at each stage of the review will be undertaken. This review will inform future research on the rehabilitation content after MSKI. It will also aid in designing sports-specific testing batteries and in return-to-climbing decision-making criteria. The result of this review will be relevant to clinicians, performance staff and researchers and will be disseminated through publications and presentations.</p>","PeriodicalId":47417,"journal":{"name":"BMJ Open Sport & Exercise Medicine","volume":"12 1","pages":"e003156"},"PeriodicalIF":3.2,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reporting of exercise interventions in spondyloarthritis research: a systematic review of randomised controlled trials.","authors":"Kristine Røren Nordén, Hanne Dagfinrud, Geir Smedslund","doi":"10.1136/bmjsem-2025-002877","DOIUrl":"10.1136/bmjsem-2025-002877","url":null,"abstract":"<p><strong>Objective: </strong>Assess the reporting of interventions in exercise trials for patients with spondyloarthritis, evaluate whether reporting has improved and explore whether reporting practices influence the effect on disease activity.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, CINAHL, Cochrane Library and PEDro. Completeness of reporting was assessed with the Consensus on Exercise Reporting Template (CERT). Temporal trends in percentage completeness were assessed via linear regression on publication year. Meta-regression assessed whether completeness of CERT moderated the effect of exercise interventions on disease activity, measured as standardised mean difference (SMD).</p><p><strong>Eligibility criteria for selecting studies: </strong>Randomised controlled trials (RCTs) of cardiorespiratory, resistance, flexibility and/or neuromotor exercise interventions in adults with spondyloarthritis, published between January 2003 and November 2025.</p><p><strong>Results: </strong>Overall completeness of exercise reporting was moderate, with a mean CERT score of 9.9 (SD 3.4) (52%) across 42 RCTs. Exercise reporting showed modest improvement over the past two decades, 1.09 percentage points per year (95% CI 0.27 to 1.90). Pooled data indicated a moderate effect of exercise interventions on disease activity (SMD=-0.46, 95% CI -0.62 to -0.30), with no evidence that completeness of reporting moderated the effect size (β=-0.19, 95% CI -1.11 to 0.73).</p><p><strong>Conclusion: </strong>About half the relevant information is provided for exercise interventions in spondyloarthritis, with only very slight improvements in recent decades. Key aspects such as exercise specifics, adherence and adverse events were often missing. Clarity of reporting did not appear to be related to how well exercise worked, but this relationship was highly variable.</p><p><strong>Prospero registration number: </strong>CRD42023438199.</p>","PeriodicalId":47417,"journal":{"name":"BMJ Open Sport & Exercise Medicine","volume":"12 1","pages":"e002877"},"PeriodicalIF":3.2,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the factors influencing participant engagement and adherence in exercise referral in the City of Manchester.","authors":"Matthew Sharp, Craig Jones, Zoë A Marshall, Stefan Birkett, Nigel Timothy Cable, Amy E Harwood","doi":"10.1136/bmjsem-2025-003157","DOIUrl":"10.1136/bmjsem-2025-003157","url":null,"abstract":"<p><strong>Objectives: </strong>To identify demographic, clinical, socioeconomic and referral-pathway determinants of engagement, early dropout and non-participation in a large metropolitan exercise referral scheme (ERS), and to assess whether machine learning (ML) methods provide additional explanatory value beyond conventional regression.</p><p><strong>Methods: </strong>This retrospective cohort study analysed data from 11 909 adults (≥18 years) referred for ERS in Manchester, UK, between 27 January 2022 and 28 February 2025. Outcomes were programme adherence (completion of ≥12 exercise sessions), early dropout and non-participation. Multinomial logistic regression was used to examine predictors of outcomes. ML methods, including Random Forest models and k-means clustering, were applied to assess predictive performance, rank feature importance and identify participant subgroups.</p><p><strong>Results: </strong>Of 11 909 referrals, 34.6% completed the programme, 34.2% declined to participate and 8.0% left early. Younger age, higher neighbourhood deprivation and psychosocial referral reasons (eg, loneliness, long covid) were associated with lower completion. Participants referred through outreach/social prescribing pathways were substantially more likely to remain in an 'intends to participate' state rather than complete, compared with those referred through clinical pathways. Random Forest models demonstrated good predictive accuracy, with early engagement indicators and deprivation emerging as the strongest predictors. Clustering identified a high-risk subgroup characterised by younger age, higher deprivation and low early attendance.</p><p><strong>Conclusions: </strong>Engagement and adherence in ERS were strongly shaped by early engagement, deprivation, age and referral pathways. ML methods identified high-risk subgroups and reinforced the importance of early attendance. Targeted early support and ML-informed risk indicators may improve retention, particularly among younger and more deprived participants.</p>","PeriodicalId":47417,"journal":{"name":"BMJ Open Sport & Exercise Medicine","volume":"12 1","pages":"e003157"},"PeriodicalIF":3.2,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}